Evaluation of infections related to the different types of dialysis accesses in patients with end stage renal disease

Introduction: Infection is considered a common life threating complication of vascular access and causing morbidity, access failure, and it is the second leading cause of death after cardiovascular event. It accounts approximately 15% to 36% of morbidity and mortality [Jacob, 2011]. Peritonitis, subcutaneous tunnel and exit site infection are the most common complication in Continuous Ambulatory Peritoneal Dialysis [CAPD] patients and accounts for 18% of mortality [Johnson DW, 2009]

Aim of the work:1. To identify the most common pathogenic microorganisms in different types of dialysis accesses in suspected patients in hemodialysis and patients screened for Tenckhoff catheter infection in CA PD. 2. Common risk factors responsible for infection, 3. Most common sensitive antibiotic, and,.4. Strategy for management and prevention of infection in the dialysis units of Assiut governorate, Egypt

Material and methods: A total 88 patients with End Stage Renal Disease on regular dialysis. Divided into two main groups: Group [A]: 63 patients on hemodialysis with suspected infected vascular accesses. They were sub-divided into: 27 patients with Permanent accesses including [15 patients with AV fistula and 12 patients with tunneled catheters], and 36 patients with suspected infected temporary catheters including 12 patients for each of jugular, subclavian and femoral catheters in the dialysis unit in Assiut university hospital. Group [B]: 25 patients on Continuous Ambulatory Peritoneal Dialysis [CA PD] screened for Tenckhoff catheter infection in dialysis unit of Alexandria Students Hospital

Results: the positive cultures form colonized permanent accesses were 100% in AV fistula and 58.3% :n tunneled, regarding to CVCs, positive cultures were 75% in suhclavian, 83.3% in jugular and 100% in femoral so femoral vein catheters were the highest frequency of colonization, while in CAPD patients, the frequency of colonization were 12%.the most frequent organisms in the colonized permanent accesses and temporary non tunneled catheters were mixed infections [53.3% in AV fistuIa,.57.1% in tunneled, 60% in jugular and 75% in femoral, while the most common organism in subclavian was non- pathogenic staphylococci by 55.6%, and in CAPD patients, 100% of positive cultures were staphylococcus aureus. Our results demonstrate that, Vancomycin was the most sensitive antibiotic by 93.3% in arterio-venous fistula, 100% in tunneled, 75% in subclavian, 93.8% in Jugular and 87.5% in femoral catheter infections

Conclusion: Mixed infection with non- pathogenic staphylococci and candida were the most frequent pathogens in our centers, most sensitive antibiotics were Vancomcin, Amikacin, Niturofurantoin, and this should be combined with systemic antifungal

OUTCOMES OF APLASTIC ANEMIA PATIENTS IN ASSUIT UNIVERSITY HOSPITAL, ONE YEAR STUDY

Aplastic anemia is a disorder in which the bone marrow fails to make enough blood cells. to identify the various aetiological factors that stands behind aplastic anemia as a common hematological problem and the various outcomes of those patients along one year. The study included 80 patients with aplastic anemia who were admitted to the Clinical Hematology Unit of Assuit University Hospital from November 2011 to October 2012. All patients were recruited for careful history and meticulous investigations to detect predisposing factors. Results: 42.5% of all studied aplastic anemia patients had any definite etological or predesposing factor, so considered as idiopathic group while, 57.5% were secondry to chmicels and/or insecticides [22.5%], hepatitis C[15%], systemic lupus erythematosis[SLE] [12.5%] and rheumatoid arthritis[7.5%]. The observed outcomes showed that complete recovery in 39%t of the secondry aplastic anemia patients [P<0.001], chronicity in 22% while 39% died. However, none of the idiopathic aplastic anemia' patients reached recovry, 59% become chronic [P<0.001] and 41% died [P<0.05]. Secondary aplastic anemia patients have a chance for recovery by correcting the primary etiology that is not an option in idiopathic patients. The hope for not recovered aplastic anemia patients is dependency on transfusional support and immunosupressive therapy waiting for a chance in allogeneic stem cell transplantation. The expected outcome of most of unrecovered patients is death unless find early chance for transplantation.So, there is a very potential need for stem cell transplantation center in Assuit University as an important referral center in Upper Egypt

Predictors of outcome in patients with diabetic foot ulcer at Assiut university hospital

Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline, In this study data were collected prospectively in 107 patients with diabetic foot ulcer examined and followed between March 2009 and March 2012 in the Diabetic clinic at Assiut university hospital and were used to evaluate potential predictors of ulcer non-healing, after a follow-up period for a maximum one year. After 1 year of follow-up, 29.9% of the patients showed non-healed ulcers. Baseline predictors of ulcer non-healing in the whole study population were duration of diabetes > 10 years [P<0.0001], negative neuropathic symptoms [ie: loss of sensation in the foot] [P<0.0001], colour changes in the foot [P<0.0001], duration of ulcer [>3 months] [P<0.0001], HbA1c [> 12%] and Texas classification class D Older age [P<0.004], presence of hypertension [P< 0. 02] nephropathy [P< 0.005] ,smoking, presence of PAD as ABI < 0.9 [P< 0.02] and absent pedal pulses [P<0.0001] ,ulcer size [> 5 cm[2]]., ulcer depth grade 3, increase total white blood cell count, ,decreased serum albumin and decreased hemoglobin levels were also associated with increased risk of unhealing. Duration of diabetes > 10 years [P<0.0001], negative neuropathic symptoms [ie: loss of sensation in the foot] [P<0.01], colour changes in the foot due to presence of PAD [P<0.01], duration of ulcer > 3 months [P<0.04], HbA1c > 12% [P<0.001] and Texas classification stage D [P<0.01] were considered a major independent predictors of unhealing of diabetic foot ulceration

Predictors of outcome in hyperglycemic crises in Assiut university hospital [prospective study for one year]

Ketoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes even if managed properly [Glaser and Kupperman et al., 1997]. The mortality rate in patients with DKA is < 5% in experienced centers. Also the prognosis of it is substantially worsened at extremes of age and in presence of coma and hypotension [Argent AC 2004]. DKA occurs in 5% of patients with type1 diabetes annually, it is seen less frequently in type2 diabetes [Dunger et al., 2004]. The aim of our study was to: Detect the hyperglycemic crises in patients admitted in Intermediate Care Unit in Internal Medicine Department in Assiut University Hospital from May 2005 to May 2006. Determine the survival rate [primary end point] and functional outcome [secondary end point] of patients with hyperglycemic crises. Determine the prognostic factors associated with a fatal outcome of those patients. And To assess the possibility of improvement in the management of the potentially fatal acute hyperglycemic complications of diabetes [DKA and HHS]

Evaluation of biliary dyskinesia in diabetic patients with and without autonomic neuropathy and factors affecting it

Diabetes mellitus is known as one of the factors causing the cholesterol gallstone. Though the pathophysiologic mechanisms of this phenomenon are unclear, hypotheses such as reduced gallbladder motility were presented to explain the higher incidence of gallstones in diabetes. The aim of our study was to study gall bladder motor function in diabetic patients with and without autonomic neuropathy to reach the pathogenesis of gallbladder dysfunction in diabetic patients and to correlate GB dyskinesia with demographic features [Age, sex, BMI Body Mass index and waist to hip ratio], duration of illness, fasting and two hours post-prandial blood glucose levels, lipogram and type of antihyperglycemic drugs. Our study included fifty persons, 30 type 2 diabetic patients divided into two groups, group [A] included 15 patients with autonomic neuropathy and group [B] included 15 patients without autonomic neuropathy, and 20 age matched healthy persons. All studied groups were subjected to the following: Careful history and clinical examination, measurement of body weight, height, and BMI. Measurement of waist circumference and hip circumference, calculation of waist/hip ratio and assessment of Cardiovascular autonomic function by the bedside tests of Ewing et al. [1985], which are: Heart rate response to standing, heart rate response to Valsalva maneuver, heart rate response to deep breathing, systolic blood pressure response to standing, diastolic blood pressure response to sustained hand grip. Fasting and two hours post-prandial blood glucose levels with follow up for 3 months, liver function tests, lipogram, blood urea and serum creatinine. Abdominal ultrasonograhy and Tc99m hepato-immuno-diacetate hepatobiliary scintigraphy after 6 hours fasting and 30 minutes after fatty meals for 30 minutes to measure the gallbladder ejection fraction. The results of our study revealed that GBEF was lower in type 2 diabetic patients in comparison with the control group. It was also found that GREF was lower in diabetic patients with autonomic neuropathy than in those without. In our study we discovered that GBEF was lower in type 2 diabetic patients with autonomic neuropathy than in those without and there is inverse correlation between GBEF and fasting and after two hours blood glucose levels. We did not find any correlation between the duration of diabetes mellitus and GBEF probably because of the small sample of patients with long duration and no correlation was found between GBEF and demographic features or lipogram. Furthermore, we did not find a significant correlation between GBEF and the type of antihyperglycemic drugs