prevalence of biofilm formation, antimicrobial resistance and adhesive pap gene (pyelonephritis associated pili) among Escherichia coli strains isolated from outpatients and inpatients with urinary tract infection

Background: E.coli is the most common cause of urinary tract infection [UTI] both in the community and hospital settings. UropathogenicE.coli [UPEC] possesses a number of virulence factors that allow it to colonize and persist in the urinary tract. Of particular interest are the P pili and biofilm formation. The emergence of drug resistant E.coli is a global threat to the public health

Objectives: To determine the biofilm producing ability, antimicrobial susceptibility pattern, ESBL production and the presence of the adhesive pap gene [pyelonephritis associated pili] in E-coli strains isolated from Outpatients and Inpatients diagnosed with UTI

Methodology:The study was conducted on 40 Inpatients and 40 Outpatients diagnosed with UTI attending Ain Shams University Hospitals. E. coli Isolates were tested for antimicrobial susceptibility using disk diffusion method, ESBL production by ESBL detection discs, in vitro formation of biofilm on Congo red media, and detection of Pap gene using conventional PCR technique

Results: The prevalence of antibiotic resistance was significantly higher in E.coli isolates from inpatients group than those from the outpatients group. The prevalence of ESBL production, biofilm formation and pap gene among E. coli isolates was 55%, 82.5% and 40% respectively. ESBL production and biofilm formation were significantly higher in the inpatients with upper UTI than in patients with lower UTI [90-38.5%] and [100-61.5%] respectively. There was no statistically significant difference between the 2 groups as regards the prevalence of pap gene

Conclusion: The prevalence of biofilm producing, ESBL producing and antibiotic resistant E.coli strains is more in the inpatients population particularly those with upper UTI. Special concern should be addressed to the spread of ESBL producing E.coli in the community. Pap gene is expressed equally in the outpatients and inpatients groups which highlights its importance in the establishment of UTI

Role of vitamin D supplementation in immunomodulation and improvement of symptoms of patients with chronic spontaneous urticaria

Background: Chronic Spontaneous Urticaria [CSU] is an allergic auto-immune disease with more than 6 weeks of continuous symptoms, it is known to trigger allergic wheal formations and angioedema. Vitamin D at optimal levels plays an important role in adjusting innate immunity thus People who has deficient or insufficient levels of serum vitamin D suffer from disturbance in immune system. Accordingly, studies have been established to explore the effect of vitamin D on CSU. Aim of the Study: To determine the effect of 12 weeks daily oral vitamin D supplementation [ high [4,000 IU/d] versus low [600 IU/d] dose of orally administered vitamin D3] on Urticaria activity score [UAS-7], quality of life [QOL] and medication burden in patients with chronic spontaneous urticaria, and to assess the relationship between vitamin D levels and CRP in these patients

Patients and methods: This single blind randomized prospective study conducted to 50 patients with CSU, admitted to Ain shams hospital, 50 patients were divided into 2 groups according to the dose of vitamin D orally administrated to these subjects, the first was group A , patients have received vitamin D orally in High dose 4000 IU/Day compared to group B , which included 25 cases received oral vitamin D in a low dose concentration 600 IU/d , Patients has been followed up in 3 times at baseline [0 week] , 6 weeks and 12 weeks intervals

Results: Serum vitamin D levels in Group were higher than Group B [44.48 12.86 vs 34.45 5.43]. Medication consumption was higher in group A compared to group B, thus favors orally low dose administration of vitamin D at first 6 weeks in the beginning of treatment course. UAS7 score in group A was better than Group B from baseline]to 6 weeks [P=0.009 vs 0.239] and from 6 weeks to 12 weeks. [P= 0.011 vs<0.0011]. There was no significant difference in serum CRP between group A and group B as regards to CRP,furthermore there was no statistically correlation between 3 times intervals in group A and group B separately [12.71 1.47 vs 13.11 1.45]

Conclusion: Improvement of both quality of life, and UAS7 score after receiving of High dose 4000 IU/d vitamin D orally in Group A, could benefit patients with CSU and decrease the complication of this disease. It was also found Serum Vitamin D level has no significant relation with C Reactive protein level, thus we couldn't relay on evaluation the chronicity of urticarial by measuring its value in serum blood with patients suffering from chronic spontaneous idiopathic urticaria

Common MEFV mutations in Egyptian patients with familial Mediterranean fever

Familial Mediterranean fever [FMF] which is an autosomal recessive condition that primarily affect population of the Mediterranean basin. If undiagnosed effectively and treated with coichicine for life it may lead to serious consequences in terms of renal amyloidosis and renal failure. We aim to check for the presence of FMF mutations in clinically suspected Egyptian patients, as an important step for family counseling and case management. The study is a pilot study to check for the presence of FMF mutations among suspected cases [24 cases] from Sharkia Govemorate. The control subjects [24] were selected from healthy volunteers. We examined FMF mutations by PCR technique for MEFV gene analysis in order to establish a diagnosis of FMF by examining two mutations, M694V and E148Q. We found 58.3%[14/24 cases] of cohort were positive for M694V mutation, and all cohort were negative for E148Q mutation. The normal controls were negative for previous two mutations. PCR technique provides a rapid, reliable, cost-effective, noninvasive, and sensitive test for establishing a diagnosis of FMF in symptomatic patients and also provides a rational basis for medical and genetic counseling of FMF patients and their families

MUC5B expression in middle ear effusions: the main gel-forming mucin responsible for viscous properties of middle ear effusions

Several mucin genes are expressed in the middle ear mucosa resulting in the development of middle ear effusion. However, the detailed mucin protein expression in middle ear effusions has not been studied in individual effusions. This study aimed to explore the expression patterns of the 3 main secretory mucins, known to be expressed in the air-ways, in individual middle ear effusions with studying the possible correlation with the effusion viscosity. Middle ear effusions were collected under general anesthesia from 30 children with otitis media with effusion. The viscosity of individual effusions was studied. Mucins were extracted from the individual effusions and their antigenic identity was studied with ELISA. Mucoid effusions have significantly higher viscosity and mucin content than serous effusions. MUCs2, 5AC and 5B were expressed in middle ear effusions within a wide range. MUC5B was the most abundant mucin with significantly strong positive correlation with the viscosity of middle ear effusions. Middle ear epithelium expresses MUC5B as the major secretory mucin which is likely to be the main determinant of the viscosity, and hence physical and biological characteristics, of middle ear effusions. A secondary role is played by MUC5AC and, to a small extent, by MUC2. This could have significant clinical implications. MUCsSB, 5AC and 2 are expressed in middle ear effusions with MUC5B representing the major secretory mucin which is also the main determinant of mucin viscosity. The clinical implications of these findings need further studies

Modified ribbon gauze packing technique versus merocel nasal packing in reducing nasal adhesions following functional endoscopic sinus surgery. A randomized controlled study

Objective: This study compares the efficacy of 2 common techniques of nasal packing [compressed sponge [Merocel] and Vaseline ribbon gauze] in preventing intranasal adhesions following functional endoscopic sinus surgery [FESS] in adult patients

Study design: Prospective, blinded, randomized controlled trial. Setting: Tertiary care referral hospital

Patients: Sixty seven adult patients aged between 19 - 70 years, who had undergone FESS for chronic sinusitis, were included in the study. All patients had diagnostic nasal assessment and preoperative coronal and axial CT scanning of nasal and paranasal sinuses. FESS was performed following Messerklinger technique. Additional surgical procedures were performed as indicated. After completion of surgery, one side of the nasal cavity was packed with compressed sponge [Merocel] and the other side with Vaseline ribbon gauze filling the nasal cavity from above downward

Main outcome measure: Three months post-operatively, all patients were assessed endoscopically for the development of postoperative intranasal adhesions. Anatomical distribution of post-FESS adhesions was noted

Results: One hundred and thirty four sides were operated upon. On 3 months post-operative follow up, nasal adhesions developed in 18 [27%] and 6 [9%] of sides packed with Merocel and ribbon gauze respectively [p = 0.007]. The described modified technique of ribbon gauze nasal packing has reduced the incidence of post operative adhesions mainly between the middle turbinate and lateral nasal wall. No major complications were recorded in association of either packing technique. Two out of six sides [33%] packed with ribbon gauze had symptoms of recurrent sinusitis and showed endoscopic signs of persistent infection at the middle meatus while 4 out of 18 sides [22%] packed with Merocel showed similar signs. All these patients improved with medical treatment and none of them required revision surgery with a mean follow up 5 months

Conclusion: Vaseline ribbon gauze nasal packing is more effective than compressed sponge [Merocel] in reducing postoperative nasal adhesions. This packing technique is safe and could reduce the need for further [revision] endoscopic surgery

Osteocalcin and bone mineral density in children with compensated congestive heart failure on antifailure measures

Background: congestive heart failure [CHF] is a chronic disease whose incidence is growing in children. Some risk factors associated with CIIF such as low mobility and prescription of specific drugs may predispose patients to develop osteopenia

Aim of the study: to investigate for the effect of long term use of furosemide and/or captopril on bone biochemical markers [osteocalcin and alkaline phosphates], S.Ca, S.P and bone mineral density [BMI]] in children with compensated congestive heart failure, and to evaluate the osteocalcin as diagnostic marker of osteopenia

Subjects and methods: the study was conducted on 30 children [mean age of 7.11 +/- 4.95y, 15 males and 15 females] with compensated CHF [NYHA class 1-11] recruited from the pediatric cardiology clinic, pediatric hospital, Ain Shams University, On ant failure measures for more than six months [14 on captopril and furosemide, 7 on furosemide, and 9 on captopril]. Ten healthy age [7.2 +/- 4.96y] and sex matched children studied as controls. All subjects underwent full history taking, thorough clinical examination, and measurement of S.Ca, S.P. S. alkaline phosphatase [alk phos.], and S. osteocalcin [Enzyme Amplified Sensitivity Immunoassay]. Twenty six of the patients were subjected to BMD measurement

Results: patients on furosemide showed significantly lower S. Ca, S. P , alk phos and S. osteocalcin as compared to those on captopril either alone or with furosemide [P<0.001, P<0.001, P<0.05, P<0.001 respectively]. Z score of BMD in this group [-3.70 +/- O.43] denoted the presence of established osteopenia. Serum osteocalcin was higher in patients on captopril [50.0+/ 16.39ng/ml] and in patients on captopril and furosemide [36.00 +/- 14.29ng/ml] as compared to the control group [8.90 +/- 6.47ngIml] [P<0.001 respectively]. Both groups showed normal S.Ca, S.P and z score of BMD. S. osteocalcin correlated directly with Ca [P<0.05], Ph [P<0.05], alk phos [P<0.0l], captopril index [P<0.001] and z score of BMD [P<0.001] and inversely correlated with furosemide index [Pe0.05]. At a cut off level of 25.5nglml osteocalcin can be used as a diagnostic marker of osteopenia in patients with CHF with 100% sensitivity and 99.37% specificity

Conclusion: long term use of furosemide lowers S.Ca, S.P and induces osteopenia, while use of captopril either alone or with furosemide can preserve S.Ca, S.P and BMD through enhancement of osteobalstic activity. Osteocalcin can diagnose osteopenia in CHF at a cut off level of 25.5nglml in reference to the bone mineral content measured by DXA

Non-ligation of the hernial sac during repair of indirect inguinal hernia

The present study was designed to study the effect of. non-ligation of the hernial sac of indirect inguinal hernia during repair. As ligation of the hernial sac has been considered mandatory for a successful repair and essential for preventing recurrence, the recent studies found that non-ligation of the hernial sac has no effect on recurrence rate and may decrease post operative pain, so we can recommend that it is not necessary to ligate the hernial sac during inguinal hernia repair, as ligation of the hernial sac is a hallowed and time consuming concept and result in increase post operative pain, however, this concept has been contested in recent studies. We conducted a prospective study on sixty patients of indirect inguinal hernia repair. In thirty cases the sac was ligated at the neck and excised [control group] in the other thirty cases the sac was not ligated at all, and either inverted or excised without ligation [test group]. The chosen type of repair was Lichtenstein's repair. Post-operative pain was significantly less in those cases where hernial sac was not ligated as it is recorded by pain score. Also there were no recurrence in either groups at one year follow up. Ligation of the hernial sac during inguinal hernia surgery is not only unnecessary and time consuming but also may increase post-operative pain. And has no effect on recurrence rate

High resolution computed tomography assessment of airway wall thickness in patients with bronchial asthma

HRCT scanning increasingly used in bronchial asthma. This work was planned to assess the thickness of airway wall in chronic bronchial asthma by using HRCT scanning and its relation to pulmonary function and asthma severity. The study was carried out on 25 chronic asthmatic patients 14 females and 11 males and 10 normal healthy subjects as a control group they were matching as regard age, gender, and height All cases were subjected to the following: complete history taking complete clinical examination, plain chest radiography, pulmonary function tests and HRCT chest scanning at 5 levels; top of aortic arch, at the main carina, 1 cm below main carina, at the level of pulmonary veins, and 2 cm above right hemidiaphragm. Asthmatic patients were classified into severe asthma II cases, moderate asthma 10 cases, and 4 cases as mild asthma, the following data were found: There were no statistically significant difference between cases and control groups -in age, sex or height. There were highly significant increases in FVC, FEV[1], and FEF25-75% and low significance increase in FEV[1]/FVC among cases after use of bronchodilator than before it There was no significant difference in pulmonary function before and after BD among control group There were significant difference between cases and control groups in all pulmonary function results. There were high significant difference between cases and control groups in FEV[1], FVC, FEF 25-75% after use of bronchodilator. There were statistically significant negative association between wall thickness and FEV[1]/FVC and FEF25 75%. There were statistically negative significant correlation between wall area and FEF25-75%, and FEV[1]/FVC- There were significant negative correlation between [thickness/diameter] T/D ratio and FEF 25-75% and FEV[1]/FVC. There were significant correlation between airway wall area and severity of bronchial asthma. No significant correlation between airway wall thickness and FEV[1] but there is negative association between wall thickness and FEF25-75% and FEV[1]/FVC ratio. This study showed strong positive correlation between wall thickness, wall area and asthma severity and duration of asthma There were significant correlation between asthma severity, duration, and thickness of the airway wall and wall area%. Many changes as bronchiectasis, mucoid impaction, emphysema and bronchial dilatation were found in chronic asthmatics

Rhomboid flap versus fasciocutaneous V-Y advancement flap in treatment of pilonidal sinus

Pilonidal sinus of the natal cleft is one of the common surgical problems and represents a challenge to many surgeons, because the high incidence of recurrence and long postoperative morbidity course. Although many methods of surgical and non surgical approaches have been proposed to overcome these problems, an optimal treatment modality has not been achieved yet. Evaluation of two different types of surgical procedures for surgical treatment of Sacrococcygeal pilonidal sinus; Rhomboid flap technique and V-Y advancement flap technique, comparing the results of each one separately. 30 patients with chronic pilonidal sinus disease were admitted to surgical department in Ain Shams University hospital during the period from December 2002 to August 2003. The patients were divided into two groups. Group [A]. 15 patients, 13 of them were classic cases while 2 cases were recurrent cases. This group was treated by excision of the sinus and closure the wound by Rhomboid flap technique. Group [B] 15 patients, 12 of them were classic cases while 3 cases were recurrent cases. This group was treated by excision of the sinus, and closure the wound by V-Y advancement flap technique. In group [A], mean hospital stay was 5 days, mean healing time was 15 days, and only 2 cases developed wound infection, while in group [B], mean hospital stay was 7 days, mean healing time was 17 days, and only one case of wound infection. No recurrence detected in both groups during the whole period of follow up [12 months]. Treatment of chronic pilonidal sinus of the natal cleft can be efficient using one of the both techniques mentioned above, as both techniques having the same principles [flattening of the natal cleft and keeping the scar away from the midline]. We advise the use of one of both techniques for the treatment of chronic pilonidal sinus disease, specially the V-Y flap advancement for treatment of recurrent complex cases allowing removal of all pathological tissues, and rhomboid flap for simple classic cases

Management of senile entropion by retractor tightening and horizontal shortening

To determine the efficacy of two operations aimed at curing the principal causes of senile entropion. The lower lid retractors were tightened transcutaneously in 8 lids, while an additional horizontal lid shortening was performed in another 13 lids. Surgery was uneventful in all cases. The patients were reexamined from 7- 15 month after surgery. In the group with only lower lid retractor tightening, recurrence was found in three cases, however, there was only one case of recurrence in group with combined procedure. Lower eyelid retractor tightening combined with simultaneous horizontal shortening of the lid is recommended to correct senile entropion with a lasting result

Cervicular fluid asparatate aminotransferase AST levels innon-insulin dependent diabetes mellitus

This study was carried out on 30 subjects their age ranged from 35-45 years. They were divided into three groups Group I: consisted of 10 non insulin dependent diabetes mellitus patients [NIDDM] with periodontitis, selected from the Outpatient Clinic of Diabetes, the duration of the disease not less than 5 years. Group II: consisted of 10 having adult periodontitis according to Page et al., [1983] 118 selected from the Oral Medicine and Periodontology Dept., faculty of Dentistry, Alexandria University. Group III: consisted of 10 matched age and sex healthy subjects, with clinically normal gingiva, GI < 1 [Loe and Silness, 1963][19], served as controls. All three groups were screened clinically and biophysically exclude other systemic diseases Clinical dental examination was performed to all subjects enrolled in the study including: Gingival index [GI] [Loe and Sliness, 1963][9]. Plaque index [PI] [Silness and Loe 1964][20]. Probing pocket depth using William's probe. Probing attachment level [Ramfjord 1974][21] Determination of Aspartate Aminotransferase [AST] Level in the Gingi- Val Crevicular Fluid: The site to be sampled was dried supragingival calculs was removed. After isolation a filter paper strip was inserted into the crevice and left for one minute. The filter strip was then placed in a vial containing 100 ul-Tris-Hcl pH 8.0 and AST assessment was performed according to the standardized method of Bergmeyer, et al., [1978][22]. The results of the present study revealed a relationship between diabetes and the severe periodontal disease. The mechanisms by which increased susceptibility to periodontitis in diabetes is not entirely clear. However, this is in partly due to the susceptibility of NIDDM patients to periodontal disease breakdown, due to increased salivary glucose that may arise besides abnormal PMN function including depressed chemotaxis phagocytosis and PMN-bacterial interaction. The biochemical analysis in this study showed significant statistical increased GCF AST level in both NIDDM patients and adult periodontitis as compared to controls Additionally, a significant increase was detected on comparing group I and group II. This shows that AST enzyme activity is associated with the extent of gingival inflammation and tissue destruction. The high levels of AST in GCF of diabetic patients in the present study possibly arise from local tissue destruction, this supports the concept that elevated GCF levels indicate concurrent or impending disease activity. Commonly used clinical parameters as plaque and gingival indices are correlated to each to other but are poor diagnostic indicators of periodontal deterioration. Furthermore plaque and gingival indices pocket depth and attachment measurements do not reveal concurrent or further disease activity Clinical enzymology is used nowadays to aid in the diagnosis of inflammatory destruction, so it could be concluded that AST activity may be more useful for the assessment of inflammatory periodontal disease Therefore, paired with clinical data crevicular fluid AST activity could provide valuable data about the periodontyal condition and likelihood disease activity. A significant relationship between AST level and the clinical parameters recorded has been demonstrated It could be concluded that AST enzyme level is one of the promising markers of tissue destruction. Biochemical enzyme analysis without clinical examination cannot be useful for the assessment of inflammatory disease Finally, GCF AST level can be used as a diagnostic adjunct for periodontal condition, to verify clinical methods to evaluate the combination of information gathered for initiation of periodontal therapy

Diagnostic characteristics of C reactive proteins in rapidly progressive periodontitis activity

This study was carried out on 20 patients suffering from rapidly progressive periodontitis [RPP] according to Page et al, [1983][3], selected from the Periodontology Department -Faculty of Dentistry Alexandria university. Their ages ranged from 23-34 years. They were divided into two groups Group I: included 10 RPP patients on active phase according to the criteria of Page et al., [1983][3]. The gingiva is extremely red and there is increased bleeding in the marginal gingival. Group II: included 10 RPP patients on inactive phase Page et al, [1983][3]. The gingival tissue appeared free from any signs of inflammation. Group III: included 10 normal healthy subjects of matched age and sex served as controls. Clinical Dental examination: To avoid errors duplicate initial recordings of clinical parameters were performed for all groups. Gingival index [Loe and Silness, 1963][22]. Probing pocket depth [Glavind and Loe1967][23]. Probing attachment level [Glavind and Loe 1967][23]. Laboratory Investigations including Rheumatoid factor to exclude rheumatoid arthritis Antinuclear factor to exclude lupus erythematosus C-reactive protein [CAP] test is periormed for all subjects enrolles in the study by Latex method [pepys, 1981][24]. Both clinical and C-reactive protein test is repeated after one month period to predict and confirm disease activity in RPP The results of the present study revealed that two out of 10 clinically active APP patients were negative for CAP initially and one month later these two cases proved to be clinically active and were still negative for CAP This indicates that they were going into inactive phase as early detected and confirmed by CRP In addition out of the 10 inactive APP patients, three were found to be positive for CAP initially, one month later only two of the three proved to be clinically active and still positive for CAP This indicates that they were going into active phase Whereas the third patient showed positive CAP initially and one month later, yet remained clinically in the inactive status From there results RPP is highly episodic and is in consistent with the concept of burst activity Also CAP is considered as a sensitive marker of APP activity as it preceded the clinical status in the previous results Therefore conclusively CRP could be used as a diagnostic test as it is a reliable indicator for RPP activity This is important to determine therapy the outcome of treatment decision and the relation between the treatment rendered and the underlying disease activity So in future it would be able to accurately predict future breakdown than rather correlate with current inadequate measures as traditional clinical parameters are not valid to predict PDA. CRP could be used in combination with clinical parameters to improve their predictive value as it is an available test safe practical and acceptable to the patient