Bacteriological and immunological study in diabetic foot

Background: Diabetes mellitus is increasing rapidly through the world, so the diabetic foot syndrome become more and more important as a major diabetic complication

Objectives: The aim of study was to determine the association between the up-regulation of circulating level ofIL-6 in diabetic patients with foot ulcer compared with diabetic patients without foot ulcer

Subjects and methods: The study included 60 subjects, they were divided into three groups; group I included 20 diabetic patients without foot ulcer syndrome, group II included 20 diabetic patients with diabetic foot ulcer syndrome [DFUS] and group HI included 20 apparently healthy subjects as a control. All subjects were subjected to clinical assessment, routine laboratory investigations and specific investigations including assay of glycosylated haemoglobin, serum IL-6 and bacteriological culture and sensitivity for ulcer

Results: There is no significant difference among the three studied groups regarding the gender, age, duration of the disease and type of treatment. There was significant difference between group I and other groups regarding hypertension [p<0.02]. There was no significant difference between the three studied groups regarding WBC. There was a significant difference between the three studied groups as regards neutrophils and platelets counts f [p=0.009] nd [p=0.03] respectively. There was a highly significant difference between the three studied groups as regards Hb concentration [p<0.001]. There was a highly significant difference [p<0.00l] between group II and both group I and group III as regards ESR [43 +/- 77.2, 13+/-3.9, 11+/-3], random blood sugar [RBS] [319.7+/-47, 238+/-47.8, 92.5+/-10.8], glycosylated haemoglobin [HbAlc] [9.93+/-1.35, 8.83+/-1.4, 4.6+/-0.6], Urea [49.9+/-37, 52.5+/-41, 20.6+/-2.4] and IL-6 [18.9+/-5.6, 4.9+/-2.7, 2,77+/-I].There was positive significant correlations [p<0.001] between IL-6 and levels of RBS [r=0.72], and HbAlc [r=0.62], respectively. Also, a positive significant correlation between IL-6 and neutrophils% [r=0.35, p<0.005] was found The most common isolated microorganisms from foot culture were mixed gram + ve cocci and gram -ve bacilli representing 60% and lonely gram + ve cocci and gram -ve bacilli were 20% respectively. Also, it was found that the most gram +ve organism was Staphylococcus aureus and the most gram -ve organism was E. coll and the most effective antibiotic was Ampicillin-Sulbactam 70% followed by Imipenem 30%

Conclusion: Diabetic patients with foot ulcer were found to have higher IL-6 level than diabetic patients without foot ulcer and they were prone to complications or mortality. This assay could facilitate early and accurate diagnosis and greatly aid timely institution of appropriate treatment

Hepatocellular carcinoma in Yemeni patients: a single centre experience over an 8-year period

We carried out a retrospective study of all patients admitted to Al-Thawra Teaching Hospital in Sana'a with hepatocellular carcinoma to study the disease profile in Yemeni patients and identify possible risk factors. During the 8-year study period, January 2001-December 2008, 251 patients were admitted with confirmed hepatocellular carcinoma. From hospital records we collected data on demographic characteristics, clinical manifestations, histological characters, viral markers, treatment and outcome. Around 75% of the patients were males. Age range was 26-75 years, mean 53.5 [SD 13.9] years. Most patients were farmers [73.7%] and had a history of chemical contact. Chronic hepatitis B virus infection [48.2%] and hepatitis C virus infection [38.2%] were the most frequently identified risk factors. Qat chewing and smoking were not statistically significant risk factors. Right lobe involvement was seen in 109 [43.4%] patients and 154 [61.4%] presented with multiple lesions. We found 187 [74.0%] patients had cirrhotic liver associated with hepatocellular carcinoma. Overall mortality rate within 6 months of admission to hospital was 24.3%

Response of C-reactive protein after lumber laminectomy, a prospective study

To assess the level of C-reactive protein [CRP] following lumber laminectomy to evaluate the physiological increase related to the surgical operation from that resulting to post operative infection. CRP was measured for 40 patients who underwent lumber laminectomy. CRP rapidly increased to reach a peak value [average 39] on the second post operative day. In 18 patients it reached it is maximum level in the third post operative day. From day 5 the level started to decline reaching to normal levels [mean 4.8] on day 9. There was no significant correlation between the CRP and Erythrocyte Sedimentation Rate [ESR], body temperature, white blood cell [WBC] count. CRP is effective and highly sensitive for evaluation of patients following lumber laminectomy. The rapid decline CRP will probably be interrupted by a second rise or persisting elevation [more than 5 days] if infection occurs

[Survey the prevalence of dental ankylosis in primary schools children [2006]]

Introduction: Dental ankylosis is one of the local factors that can influence tooth eruption. It always was observed in primary molars. Dental ankylosis might be leads to delay of eruption of successors tooth, ectopic eruption, arch length deficiency and peril the periodontal health of successors and neighboring permanent teeth. Timely diagnosis is imperative in prevention and control of occlusal disturbances

Objective: Investigate the prevalence of dental ankylosis in primary schools children in Rasht

Materials and Methods: This is a descriptive cross sectional study witch was performed on 1023 children in grade two and three. Exist of 1mm infraocclusion in compare to intact marginal ridge of neighboring tooth was consider as diagnostic criteria of ankylosis. In case of difficult diagnosis, occlusion of antagonist teeth and immobility were considered. Data was analyzed according to qui-square test

Results: Prevalence of dental ankylosis was 15%. There was no significant difference between two sexes. Ankylosis was significantly more in mandible [p=0.001]. The most affected teeth were observed first primary molars and the least involved teeth were upper second primary molars. More than 60% of subjects had more than one Ankylosed tooth. 9 aged children had the highest frequency of Ankylosed molars, but not significant between groups. In 2% of subjects, dental ankylosis was in upper larger than normal upper central incisors were observed

Conclusion: According to high prevalence of dental ankylosis in this population during and the importance stage of alveolar growth and clinician's knowledge about the problems is necessary intervention during routine dental examinations to reduce its complications and treatment costs

Features of Egyptian type 1 diabetic toddlers clinico-epidemiological study of Egyptian toddlers and preschool children with type 1 Dm

The incidence of type 1 diabetes mellitus is increasing worldwide especially in toddlers and preschool children in whom the disease appears to run a more accelerated course than the elder age group. To determine the epidemiological and clinico-pathological features of type 1 diabetes in Egyptian toddlers and preschool children. 120 diabetic patients were included divided into two groups: according to age at presentation: group I [N = 60], aged < 5 years at presentation [32 males and 28 females] diagnosed in the period from January 1[st] 2006 till December 31[st] 2006; group II [N = 60], aged > 5 years at presentation [30 males and 30 females]. They were diagnosed in the period from January 1[st] 2000 to December 31[st] 2005. Patients were subjected to thorough history, and examination. Laboratory investigations included; random blood sugar [RBS], glycated hemoglobin [HbA[1c]] every 3 months as well as C-peptide assessed initially and after 6 months. Structured questionnaire was filled by parents for assessment of diabetic risk factors. There was a steady increase in the percentage of diabetic toddlers and preschool children in relation to total number of diabetic patients diagnosed in the 6 years period, increasing from 16% in the year 2000 to 23.3% in year 2005. The median duration of exclusive breast feeding was 2 months in patients with early onset versus 4 months in patients with late onset of diabetes. The median duration of total breast feeding was 9.5 months versus 11.2 months in patients with early onset diabetes mellitus and late onset respectively. Median age of introduction of cow milk was 2.5 months in early onset diabetics [range 1-5.3] compared to 4 months in late onset diabetics [range 2-7]. History of preceding clinical infection [febrile illnesses] occurred in 73.3% and 33.3% in diabetic toddlers and older age group respectively [p<0.0001]. 50% of young diabetics were diagnosed in winter and autumn versus 25% of older group [< 0.05]. More aggressive disease presentation in the toddler group as 75% had diabetic ketoacidosis [DKA] as a presenting symptom compared to 38.3% of the older diabetics [p<0.0001]. Higher initial RBS, higher incidence of hypoglycemia attacks in diabetic toddlers compared to older age group [p<0.0001]. Higher mean insulin dose and mean random blood sugar follow up values were found in young diabetics [p<0.01]. Young diabetics had significantly lower initial C-peptide values [p<0.0001] as well as significantly lower 6 months follow up values [p<0.0001] compared to older age. Initial C-peptide values were negatively correlated with initial RBS [r = -0.335; p<0.05] and mean insulin dose [r = -0.609; p<0.0001] while it positively correlated with age at presentation [r = 0.538; p < 0.0001]. The role of environmental factors in triggering type 1 DM was highlighted especially in toddlers with more aggressive presentation and disease course which was related to lower beta-cell reserve

Comparison of the safety and efficacy of intravaginal misoprostol [prostaglandin E1] with those of dinoprostone [Prostaglandin E2] for cervical ripening and induction of labor in Bab El-Shaariah hospital

This clinical trial was to evaluate and to compare the effectiveness, safety, and side effects of intravaginal misoprostol [prostaglandin E1] with vaginal dinoprostone for cervical ripening and labor induction in Bab El-Shaariah Hospital. Women with Biopsy score 6 or less admitted for labor induction at term were eligible for this randomized controlled trial. Exclusion criteria were multiple pregnancy, breech, fetal distress, or previous uterine scar. The allocation to the intravaginal micoprostol group [145 patients] [20 micro g given every 2 hours increased to 40 micro g depending on uterine contractions] or to the vaginal dinoprostone group [81 patients] [2mg twice, 6 hours apart] from March 2004 to February 2006. The mean time to delivery was significantly shorter with misoprostol [19.8 +/- 10.4 hours] than with prostaglandin E2 [31.3 +/- 13.0 hours, p<0.001]. Delivery within 24 hours of induction was significantly more frequent with misoprostol [71.9% of subjects vs 31.3%, p<0.001]. There was no difference in the cesarean delivery rate with misoprostol [25.6% Vs 22.2%, p<0.67]. The incidence of uterine hyper-stimulation was higher with prostaglandin E2 [7.4% Vs 0.7%, p<0.007]. There were no uterine ruptures with both groups. There was no difference in neonatal outcome. Compared with prostaglandin E2, misoprostol is more effective in cervical ripening and induction of labor, is as safe for patients who do not have a history of cesarean birth

[Survey DMFT index in twelve year old children]

Introduction: One of the best ways to evaluate the activity and efficiency of a health care system is to assess WHO advised indices. In oral health systems, one of the most important of these indices is DMFT index

Objective: The aim of this research was to assess DMFT index in 12-year-old children in East of Gilan province in 2003

Materials and Methods: 855 students at age 12 were examined in three cities of Langrood, Lahijan and Siahkal, in this descriptive- analytic cross sectional study. Staged clustering randomly chose samples. Method of clinical examination was by Visual- tactile and questionnaire. Data about gender, parental education frequency of tooth brushing and number of children in the family was also recorded

Results: The mean DMFT index was 1.65, 1.49, and 1.60 respectively and about 33.3%, 39.3%, 34.4% of population was caries -free [DMFT=0]. There was a positive correlation between five and more children in the family, and more than 2 times of brushing each day with DMFT. The correlation between filling teeth and education was also significant

Conclusion: The study populations are grouped in low caries group according to WHO criteria in Iran as an Eastern Mediterranean region. More efforts are needed to attain DMFT =0 for 50% of 12 year old population

Pattern of gastrointestinal tract malignancy At Al-Thawra Hospital, Sana'a, Yemen 1998-2001

This study is based on data collected from 388 patients registered with primary cancer of the gastrointestinal tract and its accessory glands. The diagnosis was confirmed histophathologically in all patients. These patients were seen at Al-Thawra Teaching Hospital in the period 1998-2001. The relative frequency and rank of order were determined for each type of GIT cancer. The male/female ratio was 1.3:1. The age of the patients ranged between 25-65 years with a mean of 45 years. The peak occurrence was in the age group of 46-55 years. Abdominal pain was reported in all patients. 'The other most common presenting symptoms were weight loss, weakness, vomiting and abdominal distension reported in 79.9%, 77.3%, 74.5% and 72.2%, respectively. Hepatocellular carcinoma was the most common GIT cancer, ranked the first and diagnosed in 150[38.7%] patients. Colorectal carcinoma ranked the second, followed by esophagus and small intestine cancers found in 25.8%, 18% and 7.7%, respectively. Stomach and pancreatic cancers were less frequent, recorded in 7.2% and 2.6% in that order. No gallbladder cancer or premalignant conditions were registered. The results of this study were compared with findings mentioned in the literature. Some differences in the pattern of GIT cancers were encountered. GIT cancers were often discovered in late stage, when the treatment offers little chance of cure. The study stresses the importance of prevention, screening and early detection for GIT malignancy. Furthermore, eradication of H. pylori and vaccination against HBV preferably integrated into expanded program of immunization are strongly recommended

Age Distribution of breast cancer in Lebanon: increased percentages and age adjusted incidence rates of younger-aged groups at presentation

Background: Breast cancer is the most common cancer in Lebanese women. Lebanon has no national cancer registry and the American University of Beirut Medical Center [AUBMC] is one of the largest hospitals in Lebanon and has a fully operational cancer registry. Earlier studies showed that it sees about one third of all cancer cases in Lebanon. Methods: All female breast cancer patients recorded at AUBMC between 1983 and 2000 were evaluated. We used the sex-specific age distribution of 1995 Lebanese Population and Housing Survey to estimate the age-specific incidence of breast cancer in Lebanon. The results were calculated as number and proportion of cases, 10-year age-specific incidence rates, crude rates and age standardized rates [ASR] per 100,000 population. The ASR per 100,000 population was estimated by the direct method with the use of the World Standard Population. Results Between 1983 and 2000, there were a total of 16421 cancers of which 8007 were in women. There were 2673 female breast cancers, averaging 148 cases per year [Range 94-202]. Almost half of cases [9.1%] were in women below the age of fifty. The mean age was 49.8 years +/- 13.9 years. Ten-year age groups distribution showed that 4.7% were below 30 years of age, 16.1% were 30-39 years, 28.3% were 40-49 years, 26.3% were 50-59 years, 16.9% were 60-69 years, 6.1% were 70-79 years and 1.6% were 80 years of age or older. Twenty-two patients [0.9%] had their age missing in the records. Overall ASR was 30.6, for a crude rate of 27.7. Age adjusted incidence rate-had its peak in women aged 50-59, followed by women 40-49 then 60-69 with values of 96.3, 79.9 and 77.4 per 100,000 respectively. We also noted 19 male breast cancer cases corresponding to 0.7% of the 2692 combined total. Conclusions: The percentage of women with breast cancer in Lebanon seen at AUBMC in pre-menopausal and younger-aged groups is higher than those reported from western countries. Our results emphasize the need to search for possible environmental, lifestyle and/or genetic risk factors in Lebanon.Our study also shows the importance of implementing early detection and screening programs which, along with high quality mammography and medical care, can have a positive impact on survival, especially in younger-aged women

Hepatitis B and C in hospital staff in Althawra Hospital Sana'a Yemen

To study the prevalence of HCV Ab. HBs Ag, HBc Ab in health workers in a general hospital in Sanaa, Yemen