Patterns of drug resistance in case of smear positive pulmonary tuberculosis in Giza and Cairo governorate

Pulmonary tuberculosis is a major cause of morbidity and mortality World Wide, resulting in the greatest number of deaths due to any other single infectious agent. Drug resistance threatens global tuberculosis control efforts. Multi drug resistance means drug resistance to at least rifampicin and isoniazid. One hundred and nineteen sputum and culture positive patients underwent drug susceptibility to the first line drugs [Isoniazid, Rifampicin, Streptomycin and Ethambutol]. 79/119 patients in addition underwent drug susceptibility to Pyrizinamide, Ofloxacin, Amikacin and Levofloxacin. The susceptibility test shows that 35/119 patients [29.4%] were sensitive to all the tested drugs. 84/119 of the included patients [70.6%] showed drug resistance to at least one of the first line drugs by different patterns. 29/119 patients were diagnosed as MDR cases with a percent of 31% [resistant to both INH and Rifampcin]. This study shows increase incidence of resistance to first line drugs as well as increase incidence of MDR

Adrenal cystic masses: report of ten cases and suggested algorithm for therapy

Purpose: To report our experience in diagnosis and treatment of adrenal cysts in 10 cases. Patients and Over 7 years period adrenal cysts have been diagnosed in 10 patients [7 males and 3 females]. Their ages ranged between 25 n 68 years. Eight cases were between 50 and 68 years. Six cysts were detected incidentally during imaging work-up performed for extra-adrenal complaints. Three cases presented by flank pain and only one had severe hypertension. Diagnosis was made by ultrasound [US] in all cases and confirmed by computed tomography [CT] in six cases. The longest diameter of the cysts ranged from 3 to 12 centimeters. The right side was affected in 8 cases and the left side in 2 cases. All cases had unilateral cysts. Biochemical work up included determinations of serum electrolytes, lipids and hormonal study. Adrenal ultrasound-guided FNAB was performed in all cases. Six cases had simple non-functioning adrenal cysts, two had infected adrenal cysts one had cystic pheochromocytoma and one had adrenal carcinoma. Surgical adrenalectomy was performed in three patients [30%]. The indications for operation were pheochromocytoma in one patient, symptomatic adrenal cyst with diameter greater than 5 cm in another one, and adrenal carcinoma in a third patient. Imaging characteristics suggestive of malignancy were found in only one proved to have adrenal carcinoma. Cysts recurred in five cases after FNAB. Small, asymptomatic, non-functional cysts with benign characteristics may be treated conservatively with regular follow-up by US or CT. Symptomatic benign nonfunctioning adrenal cyst may be managed by aspiration alone. If the cyst recurs and is asymptomatic, it may observed. If a symptomatic cyst recurs, it may be reaspirated or excised. Malignant adrenal cysts should be treated by adrenalectomy

Computerized morphometric analysis of muscular structure in pelviureteric junction obstruction [PUJO] based on aetiology and duration of obstruction

The pathophysiology of pelviureteric junction obstruction [PUJO] is unknown. Abnormalities of smooth muscle and/or collagen fibers in PUJ were reported by light and electron microscopes. Computerized image analysis was used to objectively quantify the percentage of smooth muscle fibers in surgical specimens of PUJ obtained from 45 patients [28 male and 17 female], aged 1- 53 years mean age 27.48 +/- 12.27, after surgical repair using dismembered technique of pyeloplasty. Control materials were obtained from 10 patients [aged 40-70 years] in whom nephrectomy was done for other pathology than PUJO. Twenty different fields were examined for each tissue section, which were stained by Masson trichrome stain for smooth muscle fibers. In patients with PUJO the percentage of smooth Muscle fibers [SMFs] ranged between 16 and 44% with a mean 26.08 +/- 5.68 while in control group, the Percentage of SMFs was ranging between 41 and 89%with amean 64.22 +/- 13.13 In 34 patients with intrinsic PUJO the percentage of SMFs ranged from 15 to 49% with a mean 24.71 +/- 4.74 while in 11 patients with extrinsic PUJO it ranged between 15 and 49% with a mean 30.31 +/- 6.47. Out of 34 patients with intrinsic PUJO, in patients below I6 years [n=10] the percentage of SMF ranged between 17 and 44% with a mean 27.83 +/- 4.3 and while in patients above 16 years [n=24] the percentage of SMF ranged between 15 and 49% with a mean 23.41 +/- 4.33. The significant difference between mean percentage of smooth muscle fibers in PUJO group 26.08% and control group 64.22% indicate the role of SMF in pathogenesis of PUJO. The difference between percentage of SMF in intrinsic PUJO 24.71% and those of extrinsic causes 30.3 1%, confirm this finding. The difference in percentage of SMFs in patients with intrinsic PUJO below 16 years 27.83% and those above 16 years 23.41% indicate that the duration of obstruction may affect the muscular structure

Renal ultrastucture changes with experimentally induced microliths in rats

This work aimed to study the ultrastructure changes that occur in rat kidney with microlith formation and detecting the feature of formation and mechanism of retention and development of renal tubular crystal deposits. Calcium oxalate stone formation was induced in rats by oral application of stone forming diet containing ammonium oxalate [5.3%] and ammonium chloride [2%] mixed with semisynthetic diet for 6 weeks. Periorbital blood samples were taken for determination of blood urea, serum creatinine, cholesterol and total serum triglycerides at the start of experiment and just before scarification. Plain X-ray was done for three rats at the end of six weeks feeding to detect any abnormal calcification. The rats were anaesthetized and perfusion of kidneys with saline, followed by Karnovsky's fixative. The kidneys were excised and processed for diagnosis by light and electron microscopic [E/M] studies. Microliths were present in kidneys of all rats in this study. Light microscopic study revealed protrusion of apical cells in proximal and distal tubules and presence of cellular debris and crystal ghosts in lumen of proximal and distal convoluted tubules. Transmission E/M study revealed swollen cytoplasm and mitochondria of renal tubular cells. Cellular debris and crystal ghosts were present in lumen of both proximal and distal convoluted tubules. Scanning E/M study revealed that renal tubules appeared swollen and lost their brush borders. Tubules were crowded with red blood corpuscles, cellular debris and crystal nucleations

Dermatitis of the napkin area

Dermatitis of the diaper area is best viewed as a family of disorders due to a variety of etiological factors. Our study showed irritant dermatitis to be the most common, followed by c and idiasis, seborrhoeic dermatitis and atopic dermatitis. the influence of clothing was studied according to the type of diaper used in comparison with the control subjects. Staphylococcus aureus was the most common isolated bacteria from cases, while C and ida albicans was the most common fungus isolated

Isolation of keratinophilic fungi from Alexandria beaches using hair baiting technique

This work studied the survival of keratinophilic fungi in the sand of Alexandria beaches. Thirty-three samples were taken from the sand at 11 different places along the beach. By the use of hair baiting technique, Trichophyton mentagraphytes was isolated from three places, Trichophyton rubrum from one place and moulds from three places. The controlling environmental factors for the survival of these organisms has been discussed. The effect of these fungi as a potential source for infection has been clarified

Renal functions in erythema multiforma

Fifteen cases with minor EM [Erythema multiforms] and another 15 cases with major EM, of whom two were of SJS [Stevens Johnson syndrome] were studied. All the cases were subjected to full history taking, clinical examination, complete urine analysis and some renal function tests. Evident renal affection was detected in two cases of SJS as evidenced by the presence of proteinuria, hematuria and defective creatinine clearance along with mild elevation of blood urea and serum creatinine in one of them. These patients did not pass into a nephrotic phase. Further investigation in the surviving case showed an elevated antistreptolysin 0 titer, which might indicate that the renal lesion could be secondary to streptococcal infection. The other cases of EM showed normal findings, except for microscopic hematuria in 20% of cases of minor EM and 38% of cases of major EM. This indicated that mild renal involvement could occur in EM, especially the major type