Role of non-contrast MRI in diagnosis of pulmonary embolism

Background: pulmonary embolism patients with contraindication to radiation exposure and contrast injection

Objective: comparative study between the non -contrast Magnetic Resonance Pulmonary Angiography [MR PA] and the Computed Tomography Angiography [CTA] in diagnosis of pulmonary embolism [PE]

Patients and methods: twenty-one patients were included in our study. All patients were admitted and/or referred to Ain Shams University Hospital Departments, Kasr El Ainy Hospital and private centers confirmed to have pulmonary embolism [PE] by CTA. All patients underwent CTA and non-contrast MR-PA in the same day or within three consecutive days. The radiological examinations were interpreted by two different radiologists. The results were compared and statistically analyzed

Results: the mean age of the selected patients was about 49.43years old. 16 cases showed positive PE in both MR-PA and CTA. The 5 cases showed negative results in both

Conclusion: the non-contrast MR-PA has a reasonable sensitivity and specificity in the diagnosis of PE especially in major branches. So, it can be used as an alternative to the CTA especially when the CTA and the use of gadolinium are contraindicated

Congestive Heart Failure among the Libyan Population (North Africa); A Community Based Survey of Risk Factors and Complication.

Congestive Heart failure (CHF) is a very common medical disorder and a major health problem in Libya. CHF is associated with an increase in the risk of stroke and hospitalization. Objectives: To estimate and describe the main risk factors and complications of CHF among people with a particular interest in Libyan community. Methodology: This project is classified as a community based descriptive cross-sectional study using the CHADS2 questionnaire as well as the local Libyan classification called the Community Stroke Risk Classification (CSRC). Area; North Africa (North of Libya, the capital Tripoli). Time; five years from 2010-2014 Population: Convenient sampling was done from a large cohort of individuals living in the Libyan community. 7497 individuals were screened for risk factors of stroke. CHF was one such factor which was studied in detail among the sample population and was diagnosed by taking detailed histories (including treatment), medical examinations and previous hospital confirmations. Results: The prevalence of CHF among our participants (7497 individuals) was 15.2% (1139 patients) among the sample population as a total with males and females being 51.2% and 48.8% respectively (P=0.87). Among different age groups, females had higher rates than the males except for age interval from 60 to 79 where males had higher rates. The male to female ratio among the total population screened for CHF was 7.8%: 7.4% (583:556 respectively with males being higher). CHF prevalence increased with the progress of age, with higher rates among age groups of over 40 (P <0.0001). 68.3% of CHF patients had hypertension (778 patients), 54.3% had DM (618 patients), 38.7% had transient ischemic attach (TIA) (441 patients), 27.2% had atrial fibrillation (AF) (310 patients), 25.9% had prior stroke (PS) (295 patients), All of these risk factors accompanying CHF increased with age (P<0.0001). 99.92% of CHF patients had risk points of stroke in CHADS2 scores (0.08% had no risk points), from whom 27.1% had intermediate scores (1-2 Risk Points) and 72.9% had high scores (≥3 risk points) (P<0.0001). Results of the CSRC scores showed that 99.91% had risk factors of stroke (0.09% had no risk factors), from whom 29.5% had intermediate scores (1-2 Risk Factors) and 70.5% had high scores (≥3 risk factors) (P<0.0001). Conclusion: CHF is a major risk factor of stroke among the Libyan population in North Africa of whom had very high CHADS2 risk scores. These scores are defined as a combination of six different risk points; 0 points being low risk, 1-2 being intermediate, and a score of 3 or more risk points is defined as being high risk. CHF appeared to dominate the high scores (≥3 risk points). Almost all CHF patients had risk factors of stroke on the CSRC scoring system of whom expressed intermediate and high scores with a significant proportion of high scores (≥3 risk factors of stroke). Hypertension, DM, AF and being aged of over 40 years were very important risk factors contributing to CHF. Both genders of male and female had similar chances of developing CHF in the Libyan community. CHADS2 & CSRC classification scores are very useful and simple tools to be used to classify and describe the risk factors of stroke in populations living within a community.

Role of Hypertension as a Major Risk Factor of Stroke in Africa; Libya: Community Based Survey.

Hypertension is a very common medical disorder and a major health problem in North Africa. Hypertension is associated with an increase in the risk of stroke and hospitalization. Objectives: To estimate the importance of hypertension (HT) as a stroke predisposing risk factor among people living in Libyan community using both CHADS2 and Community Stroke Risk Classification (CSRC). Methodology: Area; North Africa (North of Libya, the capital Tripoli). Time; Five years from 2010-2014. The study was a community based descriptive cross-section, which screened 7497 individuals living in local communities, looking for risk factors of stroke. Hypertension was one of the factors which was studied in details by community physicians, among this population whom have HT were diagnosed by their past histories, medical reports, hospital discharge letters, whether they were taking any treatment or on a diet for hypertension and also medical examinations were conducted to confirm diagnosis by measuring blood pressures. Results: The prevalence of HT among study participants (7497 individuals) was 38% (2850 patients), among males and females was 50.2% and 49.8% respectively (P =0.041). Among different age groups, males had higher rates than females except for age intervals of 50-59 and ≥80 where females had higher rates. The male to female ratio among the total population screened was almost similar (19%: 18.9%). HT prevalence rose with the increase of age, with higher rates among age groups of over 40 (P <0.0001). 53% of hypertensive patients had: Diabetes Mellitus (DM) (1538 patients), 27.3% had Congestive Heart Failure (CHF) (778 patients), 15.6% had Atrial Fibrillation (AF) (446 patients), 26.7% had Transient Ischemic attack (TIA) (761 patients), and 14.8% had prior stroke (PS) (423 patients), All these risk factors accompanying hypertension rose with increase of age (P<0.0001). 99.9% of hypertensive patients had risk points of stroke on the CHADS2 scoring system (0.1% had no risk points), from that 53% had intermediate scores (1-2 Risk Points) and 47% had high scores (≥3 risk points). Results of CSRC score showed that 99.9% of hypertensive patients had risk factors of stroke (0.1% had no risk factors), from whom 56% had intermediate scores (1-2 Risk Factors) and 54% had high scores (≥3 risk factors). Conclusion: Hypertension is a major risk factor of stroke among the North African Libyan population and many, of whom have HT, had very high risk scores in CHADS2 which mainly concentrates on 1-6 risk points (P<0.0001). Almost all hypertensive patients had risk factors of stroke on CSRC scores which was generally contributed to intermediate and high scores. CHADS2 & CSRC classification scores are very useful tools to be used to classify and describe the risk factors of stroke in a population of a community regardless of having hypertension or not.

Diabetes Mellitus and Cerebrovascular Accident among North African Population (Libya) Community Based Survey.

Diabetes mellitus (DM) is a very common medical disorder and a major health problem in North Africa including Libya. DM is associated with an increase in the risk of stroke and hospitalization. Objectives: To estimate the importance of DM as a stroke risk factor among people living in Libyan community. Methodology: The study was community based descriptive cross-sectional study used CHADS2 Questionnaire, as well a local Libyan classification of stroke risk factors called Community Stroke Risk Classification (CSRC). Area: North Africa (North of Libya, the capital Tripoli). Time: Five years from 2010-2014. Population: Sampling was done from a large cohort of individuals living in the community, 7497 individuals were screened looking for risk factors of stroke. Results: The prevalence of DM among our participants (7497 individuals) was 39% (2908 patients), among males and females was 54.1% and 45.9% respectively (P =0.0001). Among different age groups, males have higher rates compared to females except in very young (10-19) and very old (>80) where females dominated. The male to female ratio among total population screened was 21%: 17.8% (1573:1335 respectively). DM prevalence increased with age, with higher rates among age over 40 (P <0.0001). 53% of DM patients had hypertension (1538 patients), 21.3% had Congestive Heart Failure (CHF) (618 patients), 13% had Atrial Fibrillation (AF) (382 patients), 22% had Transient Ischemic Attach (TIA) (643 patients), 12.3% had Prior Stroke (PS) (359 patients), All those risk factors accompanying DM increased with age increase (P<0.0001). 100% of DM patients had risk of stroke on CHADS2 and CSRC scores, which mainly concentrated in intermediate and high scores. Conclusion: DM is a major risk factor of stroke among Libyan population and had very high risk scores in CHADS2 and CSRC.

Impact of physical and chemical characteristics of breeding sites on mosquito larval abundance at Ismailia governorate, Egypt

The distribution and monthly abundance of mosquito larvae in released water, drainage canals and sewage water tanks in Ismailia governorate were investigated. The results obtained indicated the presence of five culicine [Culex. pipiens, Cx. pusillus, Cx. perexiguus, Cx. theleri and Ochlerotatus. caspius] and two anopheline [Anopheles. multicolor and An. pharoensis] mosquito species. Significantly higher larval density was recorded in sewage water [n= 5534; 46.08%] as compared with released water [n= 2903; 24.17%] and drainage water [n= 3573; 29.75%]. Culex pipiens was the most dominant mosquito species in the three habitats. The effects of environmental parameters including pH, biological and chemical oxygen demands, day time water temperature, plant growth, salinity, total organic matter and concentrations of heavy metals on larval population density were investigated. The positive correlations observed between heavy metals concentrations in the three habitats suggested relative uniformity of the sources of metal pollutants. Culex pipiens larvae demonstrated high tolerance to elevated levels of heavy metals in sewage water and compensatory effects of high nutrient levels generally associated with sewage or domestic waste. High densities of culicine larvae were accompanied by low density of anopheline larvae. This was attributed to water chemistry and competitive interactions

Unsafe injection practices in Hodeidah governorate, Yemen

Unsafe injection practices are a major public health problem and can lead to the transmission of blood borne pathogens, including hepatitis B virus [HBV], hepatitis C virus [HCV] and human immunodeficiency virus [HIV]. The present study was conducted to determine the nature and magnitude of unsafe injection practices in healthcare facilities in Hodeidah governorate, Yemen. The study was conducted in two hospitals and a representative sample of the governorate's health centers. A total of 1600 injections were observed in these facilities. This study revealed several unsafe practices, particularly the recapping of needles after use, which occurred in 61.1% and 36.8% of the observations in the hospitals and the health centers, respectively. This study showed that most healthcare workers [HCWs] followed the proper injection protocols but performed some procedures that exposed themselves and the community to the risk of needlestick injuries [NSIs] and blood borne infections

Association of hyperplastic polyposis syndrome, colorectal cancer and meningioma

Recent research has provided compelling evidence that a subset of hyperplastic polyps may be associated with a risk of colorectal cancer. Colorectal cancer with extracolonic manifestation is usually seen in a hereditary syndrome setting, but some association with meningioma has been reported. The associattion of colorectal cancer with hyperplastic polyposis and meningioma is extremely rare. This report in a 57-year-old female with no family history of colon cancer or polyps, could be the first case of hyperplastic polyposis syndrome, colorectal cancer and meningioma. Hyperplastic polyposis syndrome was diagnosed as per WHO criteria at the time of colon cancer diagnosis. Within 4 months of colon cancer diagnosis she developed seizures. Imaging of the brain revealed meningioma of the left cerebellopontine angle. The patient underwent surgery followed by chemotherapy

role of capsule endoscopy in obscure gastrointestinal bleeding

Obscure gastrointestinal bleeding is mostly recurrent and originates in the small bowel, which can be only partially examined by conventional endoscopy. Capsule endoscopy has revolutionized the evaluation of obscure gastrointestinal bleeding [OGIB]. The diagnostic yield of capsule endoscopy in OGIB was a main concern of many studies. The aim of this study is to assess the diagnostic yield of capsule endoscopy in cases of OGIB. Capsule-related complications and degree of inter-observer variation will be recorded as well. 54 consecutive patients suffering from OGIB, whether occult or overt, were subjected to capsule examination and data analysis. The majority [74.1%] presented with obscure overt bleeding. Examination was complete in 68.4%. The commonest lesions were angiodysplasias [17.5%]. Examinations were negative for lesions in 35.1% and hampered by limitations in 19.3%. The capsule diagnostic yield was 56.1%, while capsule retention occurred in 3.5%. The inter-observer agreement for the cause of bleeding was 91.2%. Capsule endoscopy proved helpful in solving the mystery of OGIB. It succeeded in diagnosing the cause of bleeding and directing further management with good compliance, high proportion of inter-observer agreement and low incidence of complications

Matrix metalloproteinase- 2 [MMP-2] expression in psoriasis

The role of MMP-2 in psoriasis was investigated immunohistochemically in 21 specimens of psoriatic lesions as well as samples of normally looking skin from the same patients in addition to 10 control specimens. The histopathological examination of psoriatic lesions classified the cases into three grades; early or eruptive [42.85%], evolving [23.82%] and fully developed lesions [33.33%]. Munro microabscesses were mainly found in early lesions, while papillomatosis was more prominent in well-developed lesions. Also, dermal inflammation was commonly seen in early lesions. MMP-2 was demonstrated in both lesional [85.7%] and non-lesional [81%] specimens in basal and suprabasal keratinocytes and the difference was highly significant as regards the extension and intensity. The over- expression of MMP-2 in noninvolved and involved psoriatic epidermis supported the concept that the primary alteration may reside in the keratinocytes and suggested its role in the remodeling of psoriatic skin by inducing papillomatosis. MMP-2 has a key role in the inflammatory process associated with psoriasis. A new therapeutic approach by antidrug application of MMP-2 inhibitor was recommended

Serum vitamin [A] levels in respiratory syncytial virus infection

The objective of this study was to estimate the serum level of vitamin A in infants with acute bronchiolitis and its relation to respiratory syncytial virus [RSV] infection. Thirty-five infants suffering from acute bronchiolitis were studied compared with a control group of ten apparently healthy infants [their ages ranged 4-10 months]. Serum levels of vitamin A were estimated using high pressure liquid chromatography [HPLC] technique and RSV diagnosis was based on clinical findings and detection of serum IgM antibodies by ELISA. Post-illness serum levels of vitamin A for +ve RSV assay were reestimated. It was found that 65.7% of bronchiolitis cases were caused by RSV. Serum vitamin A levels were lower in RSV +ve infants in comparison with both RSV -ve and control subjects. Post-illness levels of serum vitamin A were higher than the levels during illness but still lower than the control. The lower values were associated with the more severe and longer duration of illness. In conclusion, respiratory syncytial virus infection led to the depression of serum levels of vitamin A during illness which raised post-illness