Surgical outcomes for perforated peptic ulcer: a prospective case series at an academic hospital in Monrovia, Liberia

Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant; and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes.Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia; Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality.Results Median age was 33 years and 85 were males. A majority of the patients (70) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5 days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35. Median length of stay among survivors was 16 days; and death occurred at median 1 day after admission. Long symptom duration and age 30 years of age were significantly associated with in-hospital mortality on univariate (? = 2.60 [0.18-5.03]; p = 0.035) and multivariate testing (? = 2.95 [0.02-5.88]; p =0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series; surgical treatment for perforated peptic ulcer disease carried a high mortality; and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries

frequency of extended spectrum beta lactamase and CTX M-I of Escherichia coli isolated from the urine tract infection of patients by phenotypic and PCR methods in the city of Khoy in Iran

The production of Extended Spectrum Beta Lactamases [ESBLs] by Escherichia coli is the main cause of resistance to Cephalosporins. In the past decade, CTX-M enzymes have become the most prevalent ESBLs in Europe, Canada, and Asia. In this study, the frequency of ESBL- producing E.coli and molecular detection of the CTX-M-I group was investigated. A total of 400 urine samples were collected from both hospitalized and out-patients in Khoy's hospitals between November 2009 and April 2010. Out of these samples, 188 were identified as E.coli by standard biochemical tests. The antibiotic Susceptibility tests to 10 antibiotics were performed by the-disk-agar diffusion [DAD] method. ESBL production was screened by phenotypic test that including disk diffusion agar and combined disk as recommended by the Clinical and Laboratory Standards Institute [CLSI] Screened isolates were investigated by PCR assay for detection of CTX-M-I group genes. The results show that out of 188 E.coli isolates identified, 56 [29.8%] were producing ESBls by phenotypic test. All isolates were sensitive to imipenem. Overall, 49 [87.5%] isolates were confirmed as CTX-M-I producer by PCR. The results of this study showed that about 30% of the identified E.coli were producing ESBL Therefore, we recommend to use molecular methods in such researches

Evaluation of PCR method for diagnosis of Group B Streptococcus carriage in pregnant women

Group B Streptococcus [GBS] [Streptococcus agalactiae] is the leading cause of morbidity and mortality of newborn infants and accounted as a leading factor causing septicemia after birth in mothers. Infections in infants are usually acquired by contact with the genital tract of the mothers during labor and delivery. In two last decades, significant progress toward detection, prevention and treatment of pregnant women carrying GBS has been achieved. A rapid screening test for GBS that could accurately identify pregnant women carrying the bacteria at the time of delivery would obviate the need for prenatal screening. The standard method for the diagnosis of GBS colonization consists of culturing vaginal and anal secretions in a selective broth medium which inhibits the growth of other microorganisms. Today, it is accepted that PCR has a high sensitivity and specifically in diagnosis. The goal of this study was to screen pregnant woman carrying GBS by PCR. Samples were taken from anal and vaginal mucus of 125 pregnant women who were at 28-38 weeks of ingestion by swab. Samples were tested by standard culture using Todd Hewitt Broth and Blood Agar and also by PCR using primers specific for cfb gene. Culture identified 10 [8%] women as carriage of GBS out of 125 women tested. On the other hand, the PCR assay could identify 12 [9/6%] women positive for GBS. In comparison to culture results, sensitivity, NPV, specificity, and PPV of PCR were 100%, 100%, 98%, and 83%, respectively. The time required for PCR assay and culture were 2h and 36h, respectively. We found that GBS can be detected rapidly and reliably by a PCR assay using combined vaginal and anal secretions from pregnant women at the time of delivery. Also this study shows that the rate of incidence of GBS is high in Iranian pregnant women. We, therefore, recommend screening of pregnant women for detecting of GBS emphatically

Frequency of medical symptoms in Iranian Skiers

Some skiers suffer from medical symptoms during or after skiing, especially downhill skiing. However, there has been no investigation on medical problems in skiers. In this study, our main objective was to evaluate the frequency of medical symptoms during or after ski among Iranian skiers. This cross sectional descriptive study was performed in winter of the year 2005, at Dizin piste [Iran]. We evaluated demographic data and medical history of skiers, as well as the frequency of medical symptoms during ski using a questionnaire. The relations between sex, medical and drug history, smoking habits, and symptoms were assessed by chi-squared and fisher's exact test. The relation between age, duration of skiing, history of previous skiing [in years] and symptoms was analyzed by means of independent t- test. P <0.05 was considered significant. Out of 1448 skiers, 74% were male and the mean age of subjects was 25.2 [ +/- 8.4] years. A total of 1208 skiers wore medical glasses or lenses during skiing, and visual disorders were found in 15.2% of skiers. Among all subjects, one medical symptom was found in 20.1% and two medical symptoms or more in 3.6%. The most common clinical profile was headache, nystagmus and true vertigo. Occurrence of symptoms had significant association with wearing glasses or lenses during routine life, habit of smoking and previous ski injury. Alcohol consumption was seen in 31.2% skiers, and it had a borderline relation with incidence of symptoms. There was not any association between incidence of symptoms and sex, age, duration of skiing, wearing glasses or lenses during skiing, and history of motion sickness. There were at least two symptoms in 3.6% of skiers. This finding shows ski sickness is different from other altitude sicknesses

Overexpression of recombinant human granulocyte colony - stimulating factor in E. coli

Bakground: Granulocyte colony-stimulating factor [G-CSF] is a cytokine that stimulates hematopoiesis and induces proliferation and differentiation of granulocyte progenitor cells as well as production of bone marrow neutrophilic granulocyte colonies. Nowadays, human recombinant G-CSF[hr G-CSF] is used for the treatment of chemotherapy- and radiotherapy-induced neutropenia, and also in patients with bone marrow transplantation. A cDNA of human G-CSF [hG-CSF] was synthesized by PCR from recombinant cloning vector, with two altered nucleotides for increasing mRNA stability and overexpression, then inserted into a pET expression vector under the control of T7 promoter and cloned in E. coli strain BL21 [DE3]. After culture and induction of recombinant E. coli with IPTG, we achieved a high level expression of the hG-CSF, where it represented approximately 35% of the total protein as determined by SDS-PAGE and confirmed by western blotting with polyclonal and monoclonal hG-CSF antibodies. rhG-CSF was produced in a significantly high quantity with a yield of 35% of total protein as determined by SDS-PAGE. Since it is easily obtained by simple purification steps, it may be cost-effective, even on an industrial scale