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

Effect of aluminum chloride on the hippocampus of adult rats and the possible protective role of Nigella sativa: a histological and immunohistochemical study

Aluminum is among the most abundant elements on earth and it is associated with the etiology of Alzheimer's disease. The hippocampus plays an important role in short-term memory and decision making. The Nigella sativa was reported to have anti-inflammatory and antioxidant properties. To investigate the histopathological effects of aluminum chloride on the hippocampus of adult male albino rat and the possible protective role of N. sativa. Twenty-five adult male albino rats were used in this study. They were divided into five groups [each group included five rats]: group I [control] received no treatment and group II [N. sativatreated] received N. sativa oil daily at a dose of 1 ml/kg orally for 8 weeks. Group III [aluminum chloride treated] received aluminum chloride daily at a dose of 320 mg/kg/l added to the drinking water for 8 weeks. Group IV [aluminum chloride + N. sativa] received N. sativaoil with aluminum for 8 weeks at the same dose as the two previous groups. Group V [withdrawal] received aluminum only without N. sativa oil at the same previous dose for 8 weeks and then the animals were left without treatment for another 4 weeks. Specimens from the hippocampus were processed for light and electron microscopical examination. Also, the immunohistochemical technique was used with glial fibrillary acidic protein [GFAP]. Group III showed apoptotic changes in many pyramidal cells. Moreover, there was a significant decrease in the number of pyramidal cells. These changes were accompanied by a significant increase in GFAP-positive astrocytes. In group IV, minimal apoptotic changes were detected in pyramidal cells, with a significant increase in their number. This was accompanied by a significant decrease in GFAP-positive astrocytes. In group V, many pyramidal cells still showed degenerative changes, with a significant decrease in their number. GFAP-positive cells showed a significant increase. Gliosis was marked in the pyramidal cell layer. One-month withdrawal of aluminum chloride was not sufficient to gain a normal histological appearance of the hippocampus. N. sativa could be used to protect the hippocampus against aluminum chloride-induced damage

Effects of nutritional and socio-economic status on oral hygiene in children

Oral hygiene and personal hygiene are the efficient form of preventive health measures. M Poor oral hygiene, measles and malnutrition are implicated as predisposing factors to Acute Necrotizing Ulcerative Gingivitis [ANUG] and cancrum oris. Malnutrition predominantly affects third world countries where there is a limited supply of nutrient rich foods. Some third world nations also lack particular nutrients such as vitamin C, B and calcium resulting in poor oral health. This study aimed to investigate the effects of nutritional and socio-economic status on oral hygiene among Egyptian children. 800 children aged 5 to 8 years were examined. They were interviewed using a pre-tested questionnaire to record past oral and dental health history, dietary and socio-economic data of children and their parents, as well as, measles immunization status of children. The nutritional status of children was determined using anthropometric measurements. Oral Hygiene was assessed using Oral Hygiene Index Simplified [OHI-S]. Children aged 5-<6 years comprised the highest percent in the malnourished group [41%]. However, in normal nourished children the highest percentage of children were among the age group [7-8 years] comprising [42%]. Higher incidence of malnourished children [34%] was among the low socio-economic level households compared to [16.8%] in middle socio-economic level households, the difference was statistically significant. Results revealed significant statistical association between mother's educational level and nutritional status of their children. The highest percentage of gingivitis was in children who do not brush at all followed by those who brush their teeth daily then children who do not frequently use the brush respectively. There was a significant difference between the frequencies of drinking fizzy drinks in the overweight subgroup on oral hygiene compared with sweets and crunches. There was a significant statistical association between affected gingival level and nutritional status. This study could be concluded that a reciprocal interrelationship between the level of malnutrition and oral hygiene status among children. The presented findings of this study could throw the light on the urgent need for nutritional assessment protocols via a recall schedule as well as intervention programs, such as regular systematic oral examination and treatment for children at different ages