Gastric physiological and microbial changes in chronic renal failure patients under dialysis

Patients with chronic renal failure have been reported to have an increased incidence of gastric disease, 50 patients with renal failure [25 under haemo dialysis and 25 under peritoneal dialysis] and 12 controls, all suffering of gastritis were subjected to this study with the aim to characterise changes in the gastric physiology and microbial ecology, in end stage renal failure. Symptomatic gastritis was found in 45 of 50 uraemic patients as detected by endoscopic study. Gastric juice urea concentration, blood urea and serum creatinine are all significantly high in haemodialysis and peritoneal dialysis cases than controls. Also gastric juice pH is higher in cases than controls [3.7, 2.5, P<0.01 respectively]. In spite of more alkaline pH values, renal failure cases have high serum gastrin level detected by RAST method than controls [215.2, 185.1 compared to 136 pg/ml, P<0.05 respectively]. High gastric juice urea was expected to encourage urease-producing organisms especially H. pylori to colonise the stomach, yet culturing H. pylori from gastric aspirate and biopsy recovered it to nearly the same prevalence values from renal failure cases and controls [44%, 41.7%]. Serum Ig[G] anti H. pylori antibodies were also detected to nearly same incidence level in cases and controls [42 - 41.7%]. In spite of high urea level in all patients yet H. pylori was detected in only 46% of them. Now the prime mechanism in gastritis is not certain species of bacteria but it is the uraemic state that destruct the gastric mucosa and pump out hydrogen ions. This alkalinisation favours growth of many aerobes, anaerobes and candida species

Evaluation of an ELISA test using 38 kDa antigen for diagnosis of tuberculosis

Tuberculosis still is on the list of world major health problems in developing and industrialized countries. Atypical clinical presentation and necessity of early diagnosis requires the development of an easy rapid specific test for diagnosis. In this work indirect ELISA technique using 38 kDa recombinant antigen was used. The antigen is highly concentrated in M. tuherculosissis which makes the test specific. 84 suspected tuberculous cases and 70 smears were subjected to the test. Anti T.B. Ig[G] was detected to a titre >3 [cut off value] in 85.7% of smear culture positive samples, 35.7% of smearlculture negative samples and 85.7% in cases who did not give bacteriological smears. The test appeared to be of good diagnostic value in extrapulmonary tuberculosis [81.2%] and was not seemed to be affected rapidly by treatment. Only 50% of 4 cases miliary tuberculosis were positive by the test. The 38 kDa antigen could be used for serological diagnosis of tuberculosis together with the bacteriological methods used, especially because BCG vaccine do not interefere with the results. None of 10 healthy vaccinated childern <5 years gave a titre above the cut off value

mycological study of seborrheic dermatitis

Seborrhoeic dermatitis is a chronic superficial disease of the skin. The histologic picture is not diagnostic, it is half- way between psoriasis and chronic dermatitis. The cause is unknown. Of 190 patients and 20 controls, it was found that the highest age incidence [12-20y] [41.1%]. Familial tendency, obesity and winter aggravation are the most important predisposing factors. Direct microscopy of the KOH clearing is not a fruitfully diagnostic method. Culture on Dixon's medium or SDCCA without fermentative assay is sufficient to diagnose the presence of P. ovale. The tape - count method showed that the Seborrhoeic lesions were highly colonised by P. ovale and the patients have tendency to be more colonised by the yeast than healthy controls. Eradication of the yeast and dandruff by ketoconazole shampoo improves the lesions and prevents recurrence for 3 months after treatment. The presence of the yeast was associated with late- onset skin reaction and delayed skin reaction against two prepared antigens: of P. ovale, corpuscular and crude coca extract antigens in [18.8%, 8.3%] of patients

Immunological study of autotransplantation and partial splenectomy after traumatic rupture of the spleen

Due to the settled risk of the so called over-whelming post splenectomy Infection reported in both children and adults, which may represent a life-long risk and caused mainly by bacteria, we aimed to establish a spleen-preserving operative procedure which could be easily done when partial splenectomy is not possible, and we aim to focus light on the importance to preserve the spleen as an immnnological valuable organ. The levels of humeral immunity, mainly IgM was found to reduce after total splenectomy while its mean value increased after partial splenectomy or autotransplantation. Changes of IgG were not marked in asplenics in both children and adults [2.086 dropped to 1.700 gm/L and 2.063 to 1.675]. The phagocytic activity also decreased in asplenic subjects very significantly [76.5 to 57.7 for children and 79.2 to 63.2 for adults]. Tuftsin value was reduced in asplenics [2.17 to 2.11 mg/ml]. All these parameters were not affected in eusplenic operated subjects

Periodontal infections

Periodontitis is the commonest bacterial inflammation of the body. This work studied 50 patients with different forms of periodontal infections and 7 normal subjects. Females are affected more than males, the most prevalent predisposing factor is bad oral hygiene. Smoking comes in a second position. Periodontitis is a redistribution in the resident flora. The same bacterial species were isolated from healthy and diseased gingiva, but aerobic cocci and bacilli tend to colonise healthy tissues, while anaerobic bacilli and spirochaetes tend to predominate in diseased - periodontum. Anaerobic Gram + ve and Gram - ve bacilli especially Bacteroid melaninoqenicus appear to be the most important pathogen. The very rich content of bacterial flora and the nutritional interdependence of most species were obstacles against pure isolation of many strains and required very rapid identification, once they appear. Antibiotic sensitivity was performed by microbroth technique. No single drug appears to be ideal. A combination of tetracycline or carbinicillin and metronidezole may be required