Methicillin resistant staphylococcus aureus as a nosocomial pathogen in burn wound infection

Methicillin resistant staphylococcus aureus [MRSA] is important as a nosocomial pathogen and MRSA colonization in the burn unit may lead to increased transmission of MRSA to non burn patients in other wards. Was to determine the prevalence of MRSA among patients with burn wound infection in the Burn Unit in Ain Shams University Hospitals. The study involved fifty patients with infected burn wounds divided into two groups as twenty five outpatients and twenty five inpatients in the Burn Unit of Ain Shams University Hospital. Swabs were taken aseptically from infected wounds for bacteriological examination. The most common bacterial isolate among outpatients group was S. aureus [44%], followed by Ps. aeurginosa [40%], coagulase negative Staphylococci [12%], Proteus mirabilis [4%] and Citrobacter freundii [8%]. While in the inpatients group, Ps. Aeruginosa topped the list infecting 36% of patients, followed by S. aureus [24%], coagulase negative Staphylococci [16%], Klebsiella pneurnoniae [12%], E.coli [12%], Proteus mirabilis [8%] and S. pyogenes [4%]. Concerning MRSA, it was isolated from 20% of the inpatients, accounting for 83% of all isolated S.aureus and emerged as a significant nosocomial pathogen as it was not recovered from any outpatient. MRSA is a significant nosocomial pathogen in the Burn unit of Ain Shams University Hospital. Continuous surveillance of burn wound infection and developing strategies for antimicrobial resistance control is recommended

Serum neopterin level in patients with coronary artery ectasia with or without stenosis

Coronary artery ectasia [CAE] is an uncommon angiographic finding, the prevalence in most series ranges from 1.2% to 5.3%. CAE was defined as arterial segment with a diameter of at least 1.5 times the diameter of adjacent normal coronary artery segment. Atherosclerosis is the most common cause of CAE and there is a high association of CAE with stenotic coronary artery disease. CAE is not an innocent condition even in the patients with pure ectasia without stenosis. It may present by chronic stable angina pectoris, unstable angina, myocardial infarction and heart failure. Immune cells appear to be critical in development of atherosclerosis. High levels of neopterin were found in patients with chronic stable angina pectoris and acute coronary syndromes. Correlation of serum neopterin levels to the presence of CAE in patients with stable coronary artery disease. Forty patients referred to cardiac catheterization unit for evaluation of typical stable angina pectoris, were divided into three groups: Group A [15 patients] of pure ectasia, Group B [15 patients] of CAE associated with stenosis and Group C [10 patients] of stenotic lesions only. Each patient in the three groups was subjected to coronary angiography, and measurement of serum neopterin level by ELISA technique. Neopterin levels were elevated in the three studied groups but were significantly higher in patients with two and three vessels lesions than in patients with one vessel lesion. Also neopterin levels were significantly higher in ectasia with slow flow than in ectasia without slow flow. Inflammation seems to play a major role in the etiology of CAE as well as coronary artery stenosis. Neopterin level is related to the severity of the disease. Also it seems that there is more activation of the immune system in ectasia with slow flow than in ectasia without slow flow as neopterin level was higher in ectasia with slow flow than ectasia without slow flow

Diagnostic value of bronchoalveolar lavage in peripheral lung cancer

The purpose of this study was to assess the value of the addition of bronchoalveolar lavage [BAL] to the routine bmnchoscopic exploration with bronchial washing [BW] and postbronchoscopy sputum [PBS] procedures in the diagnosis of peripheral primary lung cancer not visible through bronchoscope when fluoroscopic guidance is not available. BAL, BW, and PBS were performed in 40 patients with suspected primary lung cancer by peripheral lung lesion on chest radiograph and CT [24 nodules and 16 infiltrates]. Transthoracic percutaneous CT guided needle biopsy was performed in cases with negative bronchoscopic results Thirty two patients were found to have malignant disease [14 adenocarcnoma 12 squamous cell carcinoma, 4 small cell carcinoma and two bronchoalveolar cell caminoma]. BAL was positive in 11 of the 32 [34%] carcinomas and it gave the only positive results in four cases [12%].BW was also positive in 11 of the 32 [34%], but it gave positive results in only 2 [6%].PBS was positive in 11 of the 32 [34%] and gave the only positive results in one [3%]. The combination of cytologic study of the three samples produced a significantly greater number of diagnosis [15 of 32, 57%] than each procedure alone [P <0.02]. The diagnostic sensitivity was higher for infiltrates [8 of 12, 66%] than for nodular lesion [10 of 20, 50%]without regard to histologic cell type [P=0.035] of 8 patients with non malignant diseases [four pulmonary tuberculosis and four other benign diseases]. BAL was diagnostic in three of four patients with pulmonary tuberculosis and it gave the only positive results in two. In short, in the diagnosis of lung cancer presenting as a peripheral nodule or infiltrate, when fluoroscopic guidance is not available, at least a 50% yield can be obtained from cytologic examination BAL, aspiration of all bronchoscopic secretions before and after BAL and 3 days collection of early morning sputum after bronchoscopy. Additional advantages are its low morbidity and the high diagnostic value in other diseases such as pulmonary tuberculosis

Diagnostic value of bronchoalveolar lavage in peripheral lung cancer

The purpose of this study was to assess the value of the addition of bronchoalveolar lavage [BAL] to the routine bronchoscopic exploration with bronchial washing [BW] and postbronchoscopy sputum [PBS] procedures in the diagnosis of peripheral primary lung cancer not visible through bronchoscope when fluoroscopic guidance is not available. BAL, BW, and PBS were performed in 40 patients with suspected primary lung cancer by peripheral lung lesion on chest radiograph and CT [24 nodules and 16 infiltrates]. Transthoracic percutaneous CT guided needle biopsy was performed in cases with negative bronchoscopic results Thirty two patients were found to have malignant disease [14 adenocarcinoma, 12 squamous cell carcinoma, 4 small cell carcinoma and two bronchoalveolar cell carcinoma]. BAL was positive in 11 of the 32 [34%] carcinomas and it gave the only positive results in four cases [12%].BW was also positive in 11 of the 32 [34%], but it gave positive results in only 2 [6%].PBS was positive in 11 of the 32 [34%] and gave the only positive results in one [3%]. The combination of cytologic study of the three samples produced a significantly greater number of diagnosis [18 of 32, 57%] than each procedure alone [P<0.02]. The diagnostic sensitivity was higher for infiltrates [8 of 12, 66%] than for nodular lesion [10 of 20, 50%] without regard to histologic cell type [P=0.035] of 8 patients with non malignant diseases [four pulmonary tuberculosis and four other benign diseases]. BAL was diagnostic in three of four patients with pulmonary tuberculosis and it gave the only positive results in two .In short, in the diagnosis of lung cancer presenting as a peripheral nodule or infiltrate, when fluoroscopic guidance is not available, at least a 50% yield can be obtained from cytologic examination BAL, aspiration of all bronchoscopic secretions before and after BAL and 3 days collection of early morning sputum after bronchoscopy. Additional advantages are its Low morbidity and the high diagnostic value in other diseases such as pulmonary tuberculosis