Ascitic Fluid Calprotectin and Serum Procalcitonin as Accurate Diagnostic Markers for Spontaneous Bacterial Peritonitis

BACKGROUND/AIMS: The diagnosis of spontaneous bacterial peritonitis (SBP) is based on a polymorphonuclear leukocytes (PMNs) exceeding 250/μL in ascitic fluid. The aim of the study was to evaluate serum procalcitonin and ascitic fluid calprotectin as accurate diagnostic markers for detecting SBP. METHODS: Seventy-nine patients with cirrhotic ascites were included. They were divided into a SBP group, including 52 patients, and a non-SBP group of 27 patients. Serum procalcitonin, ascitic calprotectin, and serum and ascitic levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) were measured using an enzyme-linked immunosorbent assay. RESULTS: Serum procalcitonin and ascitic calprotectin were significantly higher in SBP patients than in non-SBP patients. Significant increases in both serum and ascitic levels of TNF-α and IL-6 were observed in SBP patients versus non-SBP patients. At a cutoff value of 0.94 ng/mL, serum procalcitonin had 94.3% sensitivity and 91.8% specificity for detecting SBP. In addition, at a cutoff value of 445 ng/mL, ascitic calprotectin had 95.4% sensitivity and 85.2% specificity for detecting SBP. Both were positively correlated with ascitic fluid proteins, PMN count, TNF-α, and IL-6. CONCLUSIONS: According to our findings, determination of serum procalcitonin levels and ascitic calprotectin appears to provide satisfactory diagnostic markers for the diagnosis of SBP.

Role of magnetic resonance venography in evaluation of cerebral veins and sinuses occlusion

Cerebral venous occlusion [CVO] means intraluminal obstruction by cerebral venous thrombosis [CVT] or external compression. The differential diagnosis is broad including stroke, brain capillary telangiectasia, contusion, hypertensive hemorrhage, metastases and venous vascular malformations. MRI in conjunction with MRV is considered the modality of choice in diagnosis of CVO. To assess the role of magnetic resonance venography in the evaluation of cerebral veins and sinuses occlusion. The study was conducted on 15 patients with cerebral venous occlusion and subjected to MRI and MRV. The study included 13 patients with cerebral venous occlusion due to thrombosis and two patients with occlusion by tumors [meningioma]. MRI in conjunction with MRV is considered an accurate, safe, non-invasive, nonionizing diagnostic modality in assessing CVO. It can assess parenchymal lesions and detect intraluminal small thrombi and its extension

Urinary tract infection and adverse outcome of pregnancy

Urinary tract infections [UTIs] during pregnancy are among the commonest health problems world wide, specially in developing countries, including Egypt. It has several adverse outcomes not only on the mother but also on the fetus as well.. The aim of this study is to determine the incidence of UTIs during pregnancy, study the main risk factors associated with such infections and find the impact of these infections on some pregnancy outcomes namely the gestational age and birth weight. A follow-up study on 249 pregnant women attending the ante natal care clinic at Zagazig university hospital. They were recruited over a period from 1st of September to 30th of or November, 2005. The outcome could be recorded for 201 of them. Data were collected through a pretested questionnaire, repeated urine analyses and recording of outcome of pregnancy. The study revealed that the incidence of UTIs during pregnancy was 31.3%. The commonest organisms were Klebsiella and E-coli. Several socio-demographic characteristics were found significantly associated with UTIs, age being 30 years and more, illiterates and low educational level, low socio-economic level and those with unsatisfactory personal hygiene and those using underwear clothes other than cotton. Significant associations with UTIs were also found in multigravidae 4th and more, those having more than one child and those who previously suffered UTIs. The only predicting variable with UTIs was low socio-economic level. The study revealed that the probability of delivering premature infants and low birth weights was significantly higher among those who experienced UTIs during pregnancy. Multivariate analysis revealed that UTI was one of the main contributors to pre-mature deliveries. Conclusion and Recommendations: Urinary tract infections with pregnancy still constitute a big problem with high incidence. It has a great impact on pregnancy outcome mainly pre-mature labor. So, the study recommends health education about personal hygiene, repeated urine cultures early in pregnancy and during the third trimesters, specially for low socio-economic pregnant women. Specific antibiotics should be prescribed to avoid adverse pregnancy outcome

Prevalence of hepatitis C virus infection and evaluation of a health education program in El-Ghar village in Zagazig, Egypt

Hepatitis C virus [HCV] is an emerging global epidemic, some nations have been more drastically affected than others. Egypt reports the highest incidence in the world, with a prevalence rate of over 20% [global average 3%]. Despite the alarming prevalence of the disease in the country, awareness of the disease is still low. The objectives of this study were: 1-to estimate the prevalence of hepatitis C seropositivity among the study group. 2-to study some risk factors with hepatitis C, 3-to assess the effect of the health education on the knowledge and concepts about hepatitis C. This study is a combined cross sectional and an interventional educational community-based study. It was carried out at El-Ghar village in Zagazig district from November 2006 to January 2007. A multistage systematic sample included 304 households above 12 years of age, using a predesigned questionnaire for assessing some potential risk factors [medical and lifestyle behavior] and another questionnaire to assess the effect of health education on knowledge and attitude toward Hepatitis C problem. In addition, samples were collected to assess the seropositivity of HCV among the studied group. The results showed that the prevalence of seropositivity of HCV among the sample was 10.9%. The seropositivity of HCV was higher among males than females and increased sharply with age from 3.6% in those below 20 years old to 30.9% in older age [40 years or more]. Those who were illiterate and farmers had a significantly higher prevalence. According to the logistic regression model, the significant predictors of HCV infection were previous infection with schistsomiasis, those who have positive medical history, followed by those shaving at the community barber, above 40 years and male sex. A highly significant improvement in knowledge in all aspects of HCV infection and also the attitude toward HCV problem [p < 0.000] was revealed. Conclusion and recommendations: Hepatitis C is a health problem in rural areas in Zagazig district. Health education program successfully improved knowledge and attitude toward this problem. The following is recommended: 1- Introduction of health education programs about HCV infection into the established health services 2-Surviellance activities to monitor the disease trend

Detection of helicobacter pylori infection and upper gastrointestinal disorders among Zagazig university hospitals waste collectors: a comparative cross- sectional study

Hospital work, involving direct patient contact and poor sanitary conditions, constitutes a major risk factor for acquisition of H. pylori infection. 1] determining the prevalence and occupational risk of, pylori infection among hospital waste collectors, 2] identifying some of its associated risk factors, 3] investigating the validity of some non-invasive tests for the diagnosis of H. pylori infection in comparison with the gold-standard invasive test, esophagogastroduodenoscopy with biopsy, 4] comparing the diagnostic performance of salivary H. pylori IgG with that of serum H. pylori IgG, and 5] determining the percentages of upper gastrointestinal [GIT] symptoms and the endoscopic findings among hospital waste collectors and assessing their relation to H. pylori infection. This comparative cross-sectional study was conducted on 78 hospital waste collectors and 78 security and administrative workers from Zagazig University Hospitals as a control group. All participants filled pre-constructed questionnaires and were subjected to H. pylori stool antigen and serum and salivary anti-H. pylori IgG tests; while only 110 workers underwent esophagogastroduodenoscopy with biopsy and rapid urease test. The results revealed absence of significant occupational risk of H. pylori infection acquisition among hospital waste collectors compared to the controls. Moreover, Male sex, smoking habit, low socioeconomic status, poor personal hygiene, and family history of upper GIT complaints were the risk factors significantly associated with active H. pylori infection. Fecal antigen test had the highest sensitivity, specificity, positive, and negative predictive values for the diagnosis of H, pylori infection compared to the other non-invasive tests. Moreover, there was a fair degree of agreement between salivary and serum H. pylori IgG tests regarding their diagnostic performance [0.34]. Also, absence of statistical significant differences between both studied groups regarding the percentages of upper gastrointestinal symptoms and different endoscopic findings was revealed. Finally, current H. pylori infection was found to be significantly associated with different types of gastritis; however, normal mucosa by endoscopy didn't exclude the presence of H, pylori infection. So, improving the overall standard of living in our country, environmental sanitation, introducing effective anti-infective sanitary regulations at work, mass screening through either stool antigen or serum IgG or salivary IgG tests to detect infected persons, and proper treatment of infected persons are mandatory

Magnetic resonance imaging evaluation of normal variations of corpus callosum according to sex and age

To evaluate changes in the size and morphology of the corpus callosum as regard sex and age. Two hundred persons with ages ranged between 20 and 80 years and had no psychiatric disorders or lesion involving the corpus callosum or adjacent structures including 100 males and 100 females were studied by MRI for brain. The study revealed increase in total callosal area in females than in males. The maximum changes in size were found in isthmus and splenium and least variations occurred in the trunk. There was no specific sex variation in genu and rostrum. There was definite decrease in the total callosal area in old age group in both sexes. In males the decrease was evident above age of 60 years and in females above the age of 70 years. The maximal decline in size was found in the genu. No specific morphological patterns could be described for corpus callosum in different sex or age groups. MRI is the most valuable imaging modality in evaluation of the corpus callosum. The females have larger corpus callosum evidently seen at posterior part. There is decline in size of corpus callosum in old age evidently seen in the anterior part

Computed tomography [CT] versus magnetic resonance imaging [MRI] in differentiation between neoplastic orbital lesions

To compare between the role of CT and MRI in diagnosis of neoplastic orbital lesions. The study included 126 patients proved to have orbital neoplasm and were subjected to CT and MRI. The study included. 59 males and 67 females with age ranged from 12 days to 91 years. The orbital lesions were bilateral in 16 patients. The lesions were distributed according to their location in one or more of the five orbital compartments including optic nerve, globe, conal intraconal, extra-conal and preseptal space. The most frequent encountered lesion was lymphoma followed by following order: uveal melanoma, optic nerve glioma, juxtaorbital meningioma, retinoblastoma, optic nerve meningioma, rhabdomyosarcoma, metastases, pleomorphic carcinoma, leukemia, aneurysmal bone cyst, schwannoma, neurofibroma, capillary hemangioma, basal cell fibroma, lacrimal gland carcinoma, malignant fibrous histiocytoma, malignant teratoma, osteoma, assifying fibroma and esthesioneuroblastoma. CT assessed the attenuation values of the lesion, presence of enhancement, bony changes and calc/lcations. MRJ assessed signal changes on T1 and T2WI and enhancement. CT and MRI are complimentary studies for imaging of orbital neoplasm

Left ventricular diastolic function in heart failure

This study included 25 patients with heart failure in three groups: Group A 3/25 [12%] have pure syslolic dysfunction, according to the M-Mode and Doppler echocardiographlic assessment with fractional shortening [FS] less than 25%, left ventricular enddiastolic dimension [LVEDD] exceeding 5.7 cm and the A/E ratio less than 1. Group B 8/25 [32%] have pure diastolic dysfunction where FS was exceeding 25%, LVEDD less than, 5.7 cm and A/E ratio was greater than or equal 1. Group C 14/25 [56%] have both diastolic and systolic dysfunction according to the combined criteria mentioned formerly. From the results obtained in this work, it is evident that combined systolic and diastolic dysfunction is the most common pathophysiologic category in heart failure whatever the aetiology is and pure diastolic dysfunction complicated by heart failure represents about 1/3 of cases, with hypertension being the most likely underlying cause

preliminary study of community air pollution in Riyadh, Saudi Arabia, 1990

This preliminary study was performed to assess the pollution in Riyadh city. Four major pollutants were measured in the atmosphere; namely, total suspended particles, hydrocarbons [BSOM], carbon monoxide and lead. These measurements were done in both summer and winter time in 4 selected areas in the city which represented the industrial, commercial, city center in addition to a control area. All 4 pollutants showed high concentration which in most of the cases exceeded the allowable international levels. There was a statistically significant difference between the measured levels in the 3 areas and the control one in most of the comparisons

Cutaneous vesicostomy in infants and young children

Cutaneous vesicostomy was done as a temporary form of diversion in eight cases with chronic urinary retention and renal insufficiency in the past 2 years at the pediatric Urology Unit, Children's Hospital, Cairo University. Six cases had posterior urethral valves and two cases with neurogenic vesical dysfunction. Seven cases were males and only one was female. The excellent results achieved suggested that this technique is ideally suited for certain conditions. Few points were added to Duckett's modifications of Blocksom operation