Pulmonary tuberculosis among municipal street cleaning workers at Zagazig city; an epidemiological study

The risk for occupational exposure to pulmonary tuberculosis is increasing among municipal workers as they are the poorly paid and poorly educated workers, occupationally exposed to different biohazards, and usually work without adequate protective equipments. The aim of this study is determining the magnitude of pulmonary tuberculosis among municipal street cleaners, identifying some of the associated occupational risk factors, and identifying the DNA fingerprint patterns of mycobacterium tuberculosis isolates among those workers. Three hundred and twenty [320] male municipal street cleaners and 200 male drivers were included in the initial screening procedures of the tuberculosis survey; where they were subjected to a pre-constructed questionnaire, clinical examination, mass miniature radiography [MMR], and tuberculin skin testing. Chest X-ray and CT were done to confirm the diagnosis in subjects with any suspected lesions detected by MMR. Moreover, pulmonary TB suspects underwent sputum examination for acid fast bacilli, sputum culture, and biochemical tests to speciate mycobacterial isolates. Genotyping of Mycobacterium tuberculosis isolates, from the diagnosed cases with active pulmonary TB, was done using polymerase chain reaction amplifying the DNA fragments between insertion sequence IS6110. The study revealed that municipal street cleaners had significantly higher risk for Mycobacterium tuberculosis infection, as detected by tuberculin skin testing and chest radiography, than did the controls [OR=3.88, 95% CI; 2.4-6.19 and OR=3.02, 95 % CI; 1.07-9.22, respectively]. Moreover, higher percent of the street cleaners [3.4%] were classified as pulmonary tuberculosis suspects compared to the controls [1%]; however the difference between both groups of workers was not of statistical significance. Pulmonary tuberculosis disease was confirmed in 7 out of 320 street cleaners [2.2%]. Moreover, long duration of employment and bad street status were found to be associated with pulmonary TB disease in such workers. Finally, genotyping of Mycobacterium tuberculosis isolates from the 7definite cases of pulmonary TB, revealed 2 distinct sets of fingerprint patterns; this may suggest that these workers acquired TB from 2 different sources of infection. The study concluded that: Genotyping of M. tuberculosis isolates is mandatory in the study of TB epidemiology. Municipal street cleaners are at increased risk for occupational acquisition of Mycobacterium tuberculosis infection and contracting pulmonary TB disease

Iatrogenic bile duct injury : evaluationby MR cholangiopancreatography

Iatrogenic bile duct injury is a complex problem for both surgeons andpatients. This study was designed to assess the diagnostic role of MRcholangiopancreatography [MRCP] in the evaluation of bile duct injury

Patients and methods: In this prospective study, MRCP was performedin 11 postoperative patients [7 females and 4 males], mean age 43 [range26 - 65] years, suspected of having bile duct injury as a result of surgery. Presence or absence of biliary dilatation, fluid collection and freefluid were noted using abdominal ultrasonography, spiral CT or MRI. Ex-cision injury was diagnosed if a segment of bile duct was not visible onany of the MRCP sequences. Positive cases were classified according toanatomic location and extent of injury. Results were compared with per-cutaneous transhepatic cholangiography [PTC] in five patients, endoscop-ic retrograde cholangiopancreatography [ERCP] in two surgery in fiveand clinical follow up in three

Results:Three patients had normal findings on MRCP and remained asymptomatic on clinical follow up. Five patients had bile duct excision injury on MRCP that was surgically provenand were treated by hepaticojejunostomy Rouxen Y, one patient had biliary stricture, confirmed by PTC and was treated by balloon dilatation. Of these sex patients, one had Bismuth type I injury, two had Bismuth typeII, one had Bismuth type III and two had type IV. Two patients had findings suggestive of bile duct leak on MRCP, one was treated by endo-scopic sphincterotomy and percutaneous drainage was done for the second patient followed by surgery because the collection was increasing

Conclusion: MRCP is an accurate diagnostic technique in the identification of postoperative biliary strictures and excision injuries. This technique allows exploration above and below the level of obstruction, a resource provided by neither ERCP nor PTC, and can characterize and ana-tomically classify these injuries for planning reparative surgery. It can also suggest the presence of cystic duct leaks in patients who have un-dergone cholecystectomy

Evaluation of facial nerve function in bell's palsy patients with serial GD-DTPA enhanced MRI

To find out the role of Magnetic Resonance Imaging [MRI] in diagnosing and investigating Bell's palsy. Ten patients with mild to moderate acute idiopathic facial palsy, so called Bell's palsy, were serially examined with gadolinium-DTPA-enhanced MRI [Gd-MRI] on mean days 12,35 and 92 after the onset of palsy [second follow-up n=9]. Seven out of the 10 patients demonstrated ipsilateral facial nerve enhancement, exclusively in the internal auditory canal including meatal portion [IAC/Me] at the initial examination. Four patients out of them also exhibited facial nerve enhancement at the second examination. Only one patient showed enhancement at the third examination. The reduction in facial nerve enhancement was found to be correlated with clinical and neurophysiologic improvements in the nerve function during recovery from Bell's palsy. On the other hand, the three patients who did not exhibit facial nerve enhancement had the lowest electroneurography values at the initial examination in spite of the fact that there was no clinical difference between their palsy and that of the patients with positive findings. Those three patients did not exhibit enhancement at serial follow-up examination. These findings showed the presence of enhancement does not necessarily indicate poor prognosis for recovery and that the disappearance of facial nerve enhancement was related to improved facial nerve function during recovery from mild and moderate cases with Bell's palsy

Radiologic and endoscopic assessment of the skull base in children with recurrent meningitis

Meningitis is a potentially fatal disease. Recurrence of the attacks should alert the physician to the possibility of an underlying cause. Six children who had between 2 to 6 episodes of meningitis were investigated by computed tomography, magnetic resonance imaging, fluorescein endoscopy and cisternography in order to find the cause of recurrence. Cerebrospinal fluid rhinorrhea was confirmed in three patients. Cerebrospinal fluid otorrhea was confirmed in one patient. Streptococcus pneumonia was isolated from the CSF of four patients. The following findings were found: [1] bone defect and CSF fistula in the region of the cribriform plate; [2] CSF fistula in the region of the sphenoid sinus; [3] bone defect and encephalocele in the region of the cribriform plate/glabella; [4] bone defect in the roof of the ethmoid sinus; [5] bone defect and CSF fistula in the region of the tegmen antri; [6] one patient did not have any congenital defects in the skull base, but had complement defects and immunoglobulin subclass defects. Duraplasty was done for the patients by using endonasal, transfacial, trans- frontal and transmastoid approaches. In patients with recurrent meningitis, modern diagnosis methods should be used to search for congenital defects of the skull base. The necessary surgical repair should be performed to prevent the further occurrence of potentially fatal attacks of meningitis