Prevalence of latent tuberculosis in end stage renal disease patients at Baghdad teaching hospital

Background: Tuberculosis [TB] is one of the oldest diseases known to affect humans, it caused by infection with Mycobacterium Tuberculosis [MTB]. MTB is most commonly transmitted from a patient with infectious pulmonary TB to other person by droplet nuclei. End Stage Renal Disease [ESRD] patients are exposed to a variety of infections, including TB. The standard test for detecting Latent TB infection [LTBI] is tuberculin skin test [TST]

Objective: Determination the prevalence of latent tuberculosis among end stage renal disease patients in hemodialysis unit in Baghdad teaching hospital, and assessing its correlations with various conditions

Methods: A stratified random sampling technique was used to select a sample of 71 patients of ESRD in hemodiaylsis unit in Baghdad teaching hospital. The selected patients were interviewed using a structured pretested questionnaire. Two units of PPD [0.1mL] had been injected intradermally to the volar surface of forearm to be seen within 48-72 hours. The test was considered positive if [>=10mm induration] developed

Results: The study showed the rate of tuberculin reactivity among End Stage Renal Disease [ESRD] patients is 28.57%. About 57.14% of patients were male; mean age of patient was 54.34 +/- 15.25 years. The major cause of renal impairment were diabetes mellitus [DM] 52.86%, followed by hypertension 15.71%, duration of dialysis more than 6 months was 46.67%. History of contact with active tuberculosis patient was 62.5%

Conclusion: Significant relationship between history of contact with active TB patients, duration of dialysis, and age of patients with TST positivity

Rate of tuberculin reactivity among health care workers in Ibn Zuhur and Ibn Alkhateeb Hospitals

Background: Tuberculosis is one of the oldest diseases known to affect human, it caused by infection with Mycobacterium Tuberculosis, which is part of a complex organisms including M.bovis [reservior cattle] and M.africanum [reservior human]. Mycobacterium Tuberculosis is most commonly transmitted from a patient with infectious pulmonary TB to other person by droplet nuclei which are aerosolized by coughing, sneezing or speaking. Health care workers are exposed to a variety of infections, including TB. The standard test for detect latent TB infection is tuberculin skin test [Mantox test] using purified protien derivatives if Mycobacterium Tuberculosis

Objective: Is to estimate the rate of TB transmission from patients with active disease to the Health care workers, and also to study the relation of different variables to the transmission risk including [Gender, Vaccinations, and Duration of contact or occupation duration]

Subjects and Methods: Cross sectional descriptive study done in Ibn Zuhur hospital and Ibn alkhateeb hospital between April and May 2013. One hundred and two health care workers were included in this study [50] HCWs from Ibn zuhur hospital and [52] health care workers from Ibn alkhateeb hospital. 5 units of PPD [0.01 ml] had been injected intradermally to the volar surface of forearm to be seen within 48-72 hours. The test was cinsidered positive if [> = 10 mm induration] developed

Results: The study shows the rate of tuberculin reactivity among health care workers 25.5% [26/102] a significant relationship between duration of work in hospital and tuberculin reactivity among HCWs. 50] HCWs from Ibn zuhur hospital their age ranging between 24-48 years mean 36 year, 34[86%] were male and 16[32%] female and 52 HCWs from Ibn Alkhateeb hospital their age ranging between 21-43 years mean 32 year, 42 [81%] were male and 10 [19%] female in Ibn zuhur hospital 32% [16/50] Ward nursing staff 5-10 years work duration shows the higher rate [38.5] followed by laboratory staff 5-10 years [28.57%] and then doctors < 5 year's work [25%] ,service workers 2-5 years' work shows [22.22%]. While in Ibn Alkhateeb hospital 19% [10/52] Ward nursing staff 5-10 years work duration shows the higher rate [27%] followed by laboratory staff [20%] and then service workers 2-5 years' work shows 12.5% while doctors < 5 years work duration shows 8.5%

Conclusion: Health care workers have high rate of latent TB infection. Their positivity correlated with the duration of their job. Health care workers with negative tuberculin skin test should be immunized with BCG vaccine

Chronic idiopathic thrombocytopenic purpura effects of certain variables on the response to treatment

Idiopathic thrombocytopenic purpura is an acquired chronic autoimmune disease.Treatment when indicated is usually by corticosteroids,then splenectomy if no acceptable response,with variable response rate to both types of treatment. To look for the effects of certain variables on the type of response to steroid therapy in patients with adult idiopathic thrombocytopenic purpura, and to study the outcome of splenectomy in relation to previous steroid therapy. A prospective study on 80 patients, presented with bleeding and a platelet count of

prevalence of weight loss assessed by body mass index in patients with stable chronic obstructive pulmonary disease

The association between chronic obstructive pulmonary disease [COPD] and weight loss has long been recognized and is a common clinical observation and it is one of the systemic manifestations of COPD. A number of studies have identified weight loss and low body mass index [BMI] as independent predictors of mortality and worse prognosis. We have undertaken this study to confirm the association between BMI, weight loss and COPD and the relation to its severity. A cross section study of 100 patients with stable COPD have been identified and classified according to Global initiative for Chronic Obstructive Lung Disease [GOLD] guideline. BMI have been calculated according to the formula: BMI=Body Weight [kg]/Height[2] [kg/m[2]] Subjects; were classified according to the BMI in to three groups using World Health Organization guideline: underweight, normal weight and overweight also classified as current cigarette smokers and ex smokers. It had been shown in this study that the underweight more common in COPD [23%],compared with the control subjects only [7%].low BMI significantly associated with more severe stages of COPD and in current smoker than in Ex-smoker and with increase in age, but there is no significant difference between gender and nutritional status. Weight loss is a prevalent condition in patients with COPD and BMI can be used to assess this relationship there was an interaction between smoking habits and BMI in COPD patients. BMI correlates well with FEV1 and COPD severity and can be used by every clinician because it is a simple, inexpensive, readily available tool

Clinical and angiographic characteristics of left main coronary artery disease, a retrospective study

Left main coronary artery [LMCA] disease represents important and serious portion of coronary artery disease [CAD]. The aim of this study is to estimate the incidence of LMCA disease among patients with CAD undergoing coronary artery angiography and to evaluate clinical characteristics of patients with LMCA disease. The study involved review of clinical notes and coronary angiography of 1020 patients with CAD in Ibin Al Bitar hospital for cardiac surgery between April and September 2004. This review included evaluation of electrocardiogram [ECG], echocardiogram [ECHO], ECG exercise test [EET] and coronary angiography. Among 56 patients proved to have left main coronary artery [LMCA] disease, 40 patients had complete data available which were studied. Mean age of patients with LMCA disease was 60 +/- 8.07 years, 82% of them were males, 62% were smokers, 40% were diabetics and 55% were hypertensive. In this group 62.5% of patients with LMCA disease presented as acute coronary syndrome [ACS] and 37.5% as chronic stable angina [CSA],normal left ventricular [LV] function was found in 75% of patients and 40% hade normal electrocardiogram [ECG]. Patients with LMCA disease who hade distal involvement represented 75%. 15% hade diffusely diseased LMCA, right coronary artery [RCA] was involved in 80% of patients and those with RCA involvement were more commonly presented with ACS [78%], while those without RCA involvement presented more as CSA. Those patients who underwent ECG exercise test had poor functional Capacity, with mean exercise duration of 3.7 +/- 2.3 minutes and mean metabolic equivalents [METs] of 4.5 +/- 2.46. The tests were positive in 76.9% of patients, inconclusive in the rest but no negative tests were recorded. No significant differences were observed between those patients with ACS and those with CSA in regard to patients' characteristics. LMCA disease is not uncommon among those with CAD, it occurs in patients with multiple cardiovascular risk factors. Patients with LMCA disease usually have poor functional capacity and their ETTs are commonly positive and of high risk score. Involvements of right coronary artery [RCA] in addition to LMCA render the patients more unstable

Nurses performance in pain management for burn patient at Baghdad city's general hospitals

A descriptive study was carried out on nurses who were working at Burn Units in Baghdad city hospitals, Al-Kindy, Al-Yarmook, Al-Qadisiya, Al-karkh, and Al-Karama hospital, in the period from 20[th] july 2003 to 20[th] November 2003. The study aimed to identify the nurses performance about pain management for burned patients at burn units and find out the relationship between the demographic characteristics and performance. A purposive [non-probability] sample of [40] nurses, [24] male nurses and [16] female. The data were collected through the use of observational checklist, which comprised [38] items distributed on four parts. The validity and reliability of the instrument were determined through a pilot study and by exposing the data to a panel of experts in the field. The data were analyzed through the application of descriptive statistical analysis that includes frequency count, percentages and means, also used inferential statistical analysis that includes the means of scores, chi-square test. The results of the study showed that there was deficiency in nursing management presented by the nurses at burn units. There was significant difference between the performance and level of education. The results of the study showed that the nurses at burn units needs more training for pain management. The study concluded that those nurses should have institute level or more. The study recommended that it is better to develop and improve the nursing staff by continuous educational and training program cessions

audit of outcome of treatment in patients with acromegaly at mansoura University Hospital

Aim: In the last decade, there has been much change concerning treatment of patients with acromegaly. Although stringent criteria for cure or remission in acromegaly are advocated by many authors, there is still much controversy about cure rates using different endocrinologic criteria and factors behind the different outcomes in different centers. Because patients with acromegaly are cared for by many specialties including the endocrinologist, the neurosurgeon, and the radiotherapist, pooled data about the outcome of different modalities of treatment are lacking in our hospital. The aim of the present study was to review our patients with acromegaly, therapeutic modalities used, and to evaluate the outcome in lights of the international reports. Subjects and A series of 26 cases with acromegaly due to pituitary adenoma attending the Mansoura Endocrinology and Neurosurgery outpatient clinics and inpatient departments, were assessed retrospectively. Clinical, full endocrinologic and biochemical assessment including serum GH, prolactin, TSH and ACTH were made. Neuroimaging data including MRI and/or CT of the pituitary were examined. Ophthalmologic examination including fundus and field of vision, both pre- and postoperatively were analyzed. Remission was considered at GH level of less than 5 ng/ml. Twenty four patients have undergone transsphenoidal pituitary adenomectomy, combined with external conventional radiotherapy and bromocriptin therapy at a dose of 10 mg/day in divided doses. Two patients accepted only medical treatment. Follow up period ranged from 1 to 6 years with an average of 3 years with serial endocrinal, biochemical and neuroimaging assessment. Patients analyzed included 6 females and 20 males with an age ranging from 27 to 62 years. All females were postmenopausal and were significantly older than males. Clinical features of acromegaly, as abnormal facial features, hyper-hidrosis, hypertension, diabetes, and musculoskeletal abnormalities were not different from those reported in the literature. Pituitary microadenoma was found only in one patient, while macroadenoma confined to the sella was found in 12 cases [46%], and macroadenoma with extrasellar extensions was found in 13 cases [50%]. Serum GH in both types of macradenoma was not significantly different [56 +/- 8ng/ml versus 59 +/- 8 ng/ml, respectively]. Serum prolactin level was high in 10 cases [38%] with a mean of 104 +/- 29 ng/ml. Preoperative defect in the field of vision was found in 10 cases. No case of central diabetes insipidus [CDI] was found at diagnosis in all patients. The outcome of surgery, in terms of postoperative GH less than 5 ng/ml, was zero%. After institution of external radiotherapy and bromocriptin therapy, 3 cases fulfilled the remission criteria after a 3 years' period. Those patients also, developed panhypopituitarism including TSH, ACTH and were given replacement thyroxine and cortisol treatment. Diabetes insipidus was found in the postoperative period in 14 cases [58%], but it vanished within one month in 12 cases and persisted in two patients. The number of patients with CDI rose to 4 [15%] with long term follow up. Pathology studies revealed eosinophil adenoma in 16 cases and chromophobe adenoma in 8 cases. Field of vision improved in 8 cases out of 10 patients with preoperative field defects. Serum postoperative prolactin level showed a significant decrease compared to the preoperative level in the 10 cases with high prolactin serum level, but only 3 cases reached the normal range. Conclusions: The poor outcome in acromegalic patients of the present series, inspite of the combined use of surgery, radiotherapy and medical treatment, is explained by the late diagnosis of the condition with higher prevalence of macroadenoma with extrasellar extensions, dispersion of operated patients among different neurosurgeons with different skills and experience, and lack of more effective drugs. Also, the relatively short period of follow up in relation to the delayed effects of radiotherapy adds to the poor results

Seio uracal em adulto / Urachal sinus in adult

Os autores apresentam um caso de seio uracal em adulto, patologia rara nesta faixa etária, e revisam os aspectos embriológicos e anatômicos do úraco, evidenciando sua apresentaçao clínica, evoluçao e terapêutica.