Antimicrobial resistance patterns among acinetobacter baumannii isolated from king abdulaziz hospital, Jeddah,Saudi Arabia, four-year surveillance study [2010-2013]

To carry out a retrospective study on Acinetobacter baumannii [A.baumannii] isolates and analyze its epidemiology, antimicrobial resistance patterns, and nosocomial status from various clinical isolates of patients samples admitted in a tertiary care Hospital, King Abdulaziz hospital, Jeddah, Saudi Arabia. The clinical specimens over a period of 4 years from January 2010 to December 2013 were identified and analyzed, by the conventional microbiology methods and/or an automated identification systems [Pheonix and MicroScan] and there covered A. baumannii isolates were segregated for further study to detect the prevalence and tested for antibiotic susceptibility patterns used the automated susceptibility systems, and/or the disk diffusion and E test methods A total 1176 A. baumannii strains out of 13440 isolates were collected from various specimens during study period. The overall proportion of A. baumannii isolates among all clinical isolates has increased throughout the study from 4.2% [N.134] in 2010 to 12.3%[N.443] in 2013. Most of the source of infections was obtained from the intensive care unit [27.3%], followed by male surgical ward [11.4%], female surgical ward [9.7%] male medical ward [7.7%], female medical ward [7.5%], renal unit [6.7%], neonatal intensive care [5.7%], pediatric Intensive care [4.9%] and lastly out patient, private ward, Ob-Gyne ward and cardiac unit were 4.3%, 2.7%, 2.5% and 2.3% respectively.cefoxitin was the most resistant agents with [100%], then ceftriaxone [92.3%], gentamicin [90.3%], cefepime [88.7%], levofloxacin [88.5%], piperacellin/ tazobactam [88.4%], ciprofloxacin [88.4%], meropenem [88.2%], ceftazidime [88.2%], imipenem [86.5%], amikacin [84.6%], trimethoprim/sulphamethoxazole [69.3%], while colistin and tigecycline were with no resistance. The prevalence of MDR and PDR A. baumannii was increased throughout this study from 55% and 20%, respectively in 2010 to 67% and 33% in 2013. Trend of A. baumannii infection incidence is on the increase with increase of MDR and PDR suggests that prevention of healthcare-associated transmission of A. baumannii infection is essential

Non-foveal macular holes after PPV for macular pucker

To describe six patients [six eyes] who developed an eccentric macular hole after surgery for idiopathic epimacular proliferation. Review of records from six patients who developed eccentric macular holes postoperatively following vitrectomy in 107 consecutives cases with peeling of the epimacular proliferation and internal limiting membrane [ILM] from June 2004 to January 2009. Eccentric macular holes were developed from nine days to eight months [mean, 3.1 months] after epimacular proliferation peeling. The ILM was peeled in addition to the epimacular proliferation in five of the six cases. Of the six eccentric macular holes, four were located temporal to the fovea, one was located superior to the fovea, and one was located nasal to the fovea. Final visual acuities after a mean follow-up period of 17.3 months were 20/20 in two eyes, 20/25 in one eye, 20/40 in two eyes, and 5/200 in one eye. The eye with eccentric macular hole nasal to the fovea had the poorest final visual acuity of 5/200. Eccentric macular holes occurring after vitrectomy to remove epimacular proliferation is an uncommon postoperative finding. Various explanations have been suggested for the etiology of these holes, but there is no consensus. We suggested that the ILM tear should be initiated with a diamond dusted knife to reduce the likelihood of injury to the underlying Muller cells that may contribute to the formation of eccentric macular holes

Stapedectomy: effect of type of anaesthesia on outcome results

The ideal type of anaesthesia which could offer maximum hearing results and least complications still a point of controversy in stapes surgery. This study was conducted on 20 patients suffering from conductive hearing loss [CHL] due to otosclerosis. Patients were classified into 2 groups; group [L] included 10 patients and were operated upon under local anaesthesia and group [G], included 10 patients, operated upon under general anaesthesia. All operations were performed at Otorhinolaryngology department; Benha Teaching Hospital. Our aim was to study the effect of type of anaesthesia, whether local or general on the outcome results of stapes surgery. Our results showed hearing gain in low and mid tone frequencies in both groups with no significant difference of air-bone gap posoperatively, while the high tone frequency in group [G] had a lower bone conduction threshold compared with that in group [L], indicating the more suffering of the cochlea. We concluded that stapes surgery is better to be operated under local anaesthesia than to be operated under general anaesthesia as it gives the surgeon and the patient good chance to protect the inner ear and to test the hearing on the operative table to the satisfactory level for both. However, general anaesthesia should be used with some indviduals especially anxious ones

Effect of primary T-tube insertion in a cartilage-perichondrium graft in tympanoplasty

Cartilage/perichondrium composite graft with concomitant placement of a ventilation tube is a common practice among otologists to repneumatize the middle ear, and to reverse atelectasis in poor Eustachian tube function. We conducted this study to investigate the necessity of a ventilation tube primarily incorporated into the cartilage/perichondrium graft for reconstruction of the tympanic membrane[TM] in tympanoplasty with a potential Eustachian tube dysfunction to improve the rate of graft success. A prospective clinical trial. Benha Teaching Hospital. Twenty patients with chronic suppurate otitis media [CSOM], were included in the study, for tympanoplasty. They were randomly divided into 2 groups. In Group [A], 10 patients underwent reconstruction of the TM with cartilage/perichondrium graft and intra-operative T-tube insertion, and in Group[B], 10 cases were operated upon using the same procedure without ventilation tube insertion. Outcome measures were: graft taking success, improvement of hearing, and postoperative complications. Analysis of the results was performed by Student's paired t test. The level of significance was set at 5%. Significant postoperative improvement of pure tone air-conduction threshold averages and air-bone gap averages were reported in the two groups. The postoperative air-bone gap averages showed statistically significant difference between Group A and B, with a better results in group A. In group A, there were one failed case, postoperative otorrhea in 2 cases which were resolved within 3 weeks follow up by medical treatment, and three plugged tubes were also encountered on the tenth day which managed successfully. In group B, we had two failed cases and another 2 post-operative otorrhea which were resolved medically. Primary insertion of a ventilation T-tube during simultaneously tympanoplasty with cartilage/perichondrium graft in cases of [CSOM] with, potential poor Eustachian tube function may improve the success rate of graft taking and hearing gain

Role of surface coil magnetic resonance imaging in diagnosing vitreo-retinal disorders

This study included a total of 26 patients [16 females and 10 males with ages ranging from 5 months to 65 years]. In nine patients, the lesions were bilateral; thus, the total number of the examined eye globes was 35. All patients were subjected to history taking and MRI examination. Sixteen patients underwent US examination, while CT examination was performed to five patients. In the 26 patients evaluated with MRI, the final diagnosis included unilateral retinoblastoma [n = 3], bilateral retinoblastoma [n = 5], choroidal melanoma [n = 3], ciliary body capillary hemangioma [n = 1], choroidal metastasis [n = 2], choroidal hemangioma [n = 2], retinopathy of prematurity [bilateral] [n = 1], persistent hyperplastic primary vitreous [bilateral] [n = 1], bilateral coloboma [n = 2], endophthalmitis [n = 2], post-traumatic intraocular lesions [n = 1], retinal detachment [n = 2] and vitreous hemorrhage [n = 1]. A histopathologic confirmation was obtained in retinoblastoma [four patients], choroidal melanoma [two patients], ciliary body capillary hemangioma [one patient] and choroidal metastasis [one patient]

value of MR imaging in diagnosis of cranio-spinal leptomeningeal carcinomatosis

Post-contrast MR is considered to be a greatly sensitive noninvasive method for detection of different patterns and subtle findings of leptomeningeal carcinomatosis, with or without parenchymal involvement and due to the inherent advantages of such modality it can cover the full extent of the meningeal lesions in continuity along wide segments of the spinal and/or the cranium. This has its useful impact on the management, where rapid diagnosis and treatment can be established even when no malignant cells are detected in the CS fluid, and in some cases MR can guide the surgical biopsy towards the area involved