Antibiotic use and resistance in single orthopedic department, Egypt

Antimicrobial use and subsequently antimicrobial resistance among bacterial pathogens is a global problem, but in Egypt data are sparse. Orthopedic departments reflect this problem because in them surgery constitutes the main manipulation and septic diseases constitute common complications, both need guided antimicrobial therapy otherwise antimicrobial resistance will emerge. To highlight these issues, we define the pattern and appropriateness of antibiotic use and identify the infecting microorganisms and their resistance patterns in a prospective study carried out in Orthopedic Department, Tanta University Hospital, Egypt, within 9 months. High antimicrobial prescription rates [98.1%] with low rates of appropriateness [11.3%] were detected. Eighty-one percent of prescribed antimicrobial agents belong to cephalosporins and penicillins classes and 54.2% of all antimicrobial use consisted of cefotaxime [42.1%] and amoxicillin-flucloxacillin [12.1%]. High rates of resistance were found in most of the bacteria studied. 53.3% of Staphylococcus aureus [S. aureus] and 66.7% of coagulase negative staphylococcus [CNS] isolates were oxacillin resistant. Multi-resistant [MR] strains represented 48.6% of the isolated gram negative bacilli of which 29.2% were ESBL [Klebsiella 62.5% and E.coli 33.3%] while 19.4% were MR Pseudomonas and Acinetobacter isolates. Antibiotic treatment in our Orthopedic Department appears to be substantial. Increasing and justifying efforts are needed to improve appropriateness of antimicrobial therapy and minimize the development of antimicrobial resistance. We call for a nationwide surveillance programme to monitor microbial trends and antimicrobial resistance patterns in Egypt

Early effects of esophageal injection sclerotherapy and band ligation on coagulation and bleeding profile

The present study was performed with the aim of comparing the systemic coagulopathy and bleeding profile following endoscopic variceal sclerotherapy with 5% ethanolamine oleate versus that following band ligation, where they were estimated just before then one hour and 2 hours after the procedure. Twenty patients were randomly allocated into two groups, the ligation group [10 patients],with a mean age of [48.5 +/- 10.9 years] and the sclerotherapy group [10 patients],with a mean age of 44 +/- 8.5 years. In the ligation group, no statistically significant differences were obtained on comparing coagulation and bleeding parameters through out the study time.As regards the sclerotherapy group, on comparing these parameters one hour after the procedure to those just before it, there were significant decrease in platelet count, factor VIII concentration, prothrombin concentration and significant prolongation of prothrombin time, partial thromboplastin time. Non significant results were obtained on comparing the tested parameters 2 hours after the procedure with those one hour after it. While on comparing parameters 2 hours after sclerotherapy to those just before it, there were significant changes of the same parameters changed before, denoting that these changes occuring one hour after sclerotherapy are maintained till the second hour. On comparing both groups of patients with each other, regarding parameters one hour after the procedure to those just before it and also 2 hours after the procedure to those just before it, there were significant prolongation of prothrombin time, partial thromboplastin time and highly significant decrease in prothrombin concentration in the sclerotherapy group. In conclusion, only the group of patients undergoing elective intravariceal sclerotherapy using 5% ethanolamine oleate, showed mild changes in the coagulation and bleeding profile. These changes were found one hour after the procedure and were maintained up to the second hour. Thus, endoscopic variceal ligation appears to be a technique of less negative impact on coagulation and bleeding profiles when compared with sclerotherapy and may be considered as the procedure of choice for treatment of bleeding esophageal varices especially in patients with marked thrombocytopenia and coagulation abnormalities, because in such patients scierotherapy might worsen the preexisting coagulation abnormalities and precipitated haemorrhagic complication

study of esophageal motility in patients with chronic renal failure

Esophageal motility studies were conducted on 30 individuals; 20 patients with chronic renal failure [CRF], compared to 10 healthy volunteers. Patients with CRF were divided into 2 groups, [Group I] representing patients on regular haemodialysis [10 patients] and [group II] representing patients on conservative therapy [10 patients].The three groups were age and sex matched.Each group was further subdivided into symptomatic and asymptomatic subgroups according to the presence of symptoms suggestive of esophageal motility dysfunction. Esophageal manometry by Sandhil manometry set was done to all subjects. The results revealed that the lower esophageal sphincter pressure [LESP] was significantly lower in group I [p<0.05] and group II [P<0.001], when compared to the control group III. Group II showed significantly lower level [p<0.05] when compared to group I. The LESP was significantly lower in the symptomatic [p<0.05] than the asymptomatic subgroup of patients in both groups I and II. Regarding the lower esophageal sphincter relaxation [LESR%], there was highly significant difference between both groups of patients I and II [p<0.001] when compared with that of the control group III. At the same time, group I patients showed more significantly lower level [p<0.001] than group II. The amplitude of esophageal body contractions was significantly lower [p<0.05] in group I when compared with that of group II and control group III. While in group II, it showed insignificant change in comparison with that of the control group III [p>0.05]. As regards the velocity of esophageal body contractions in the symptomatic subgroup of group [I], there was a significant increase when [p<0.05] compared with that of the asymptomatic subgroup. Insignificant changes were observed on comparing both groups of patients with the control group and in both subgroups of group II [p>0.05]. The previously mentioned esophageal motor disorders were significantly correlated with decreased serum calcium and increased serum parathormone levels in both groups I and II. So, we could conclude that significant motility disorders were found in patients with CRF, wheather on regular hemodialysis or on conservative measures. However these motility disorders were more, evident in the conservative treatment's group regarding the decrease in the LESP. On the other hand the decrease of the esophageal body pressure was more evident in hemodialysis patients