Fungal Infections in Aseer Central Hospital: A Retrospective Laboratory-based Study of 340 Cases during the Years 2011 to 2015.

Objectives: The incidence of fungal infections is increasing due to increasing episodes of risk factors such as immune competence; broader used of antibiotics and longer hospital stays. This study aimed to analyze fungal isolates from patients admitted to Aseer Central Hospital between 2011 and 2015 and to shed light on practical recommendations based on scientific evidence for improving laboratory diagnosis. Methods: Retrospectively, for a period of 4 years (2011-2015), we analyzed 340 specimens submitted to the Microbiology Laboratory, at Aseer Central Hospital, Abha, Saudi Arabia. The study involved the isolation and identification of fungi using standard methods. Cultures were done on Sabouraud dextrose agar (SDA) plates and Brain Heart Infusion Agar + 5% Sheep Blood (BHIA) according to the type of the clinical specimens. Suspected mold and yeast cultures were identified on the basis of colony morphology appeared on SDA and on microscopic features as per standard criteria. Resulted were analyzed using SPSS investigating prevalence among specimens types, sex, age groups and hospital wards. Results: Of the 340 specimens, positive fungal cultures were obtained in 105 (30.88%), no growth was seen in 218 plates (64.12%) and 17 plates (5%) had been contaminated or overgrown by bacteria. Out of the 105 positive fungal cultures, yeast represented 47 cases (44.76%) of which 23 samples (21.9%) belonged to the genus Candida. Dermatophytes were 18 isolates (17.14%) of which Trichophyton tonsurans was the dominant species 9 patients (8.57%). Aspergillus species were 13 cases (12.38%); Zygomycetes 9 (8.57%); Penicillium species, only 1 case (0.95%) and unidentified molds were 17 (16.19%). Gender showed significant differences (p=0.034) but no differences among ages groups (p = 0.187). Specimens derived from skin represented the highest percentage of fungal infections followed by the lower respiratory tract and subcutaneous tissue. Significance differences were recorded among hospital wards (p = 0.001) nonetheless male and female medical and surgical words revealed relatively higher rates of fungal infections. Conclusion: These fungi represent a considerable hazard to patient health. What is needed in the region is to increase detection rate, by improving sample quality and expanding laboratory capacity in order to enhance patient's health.

Laparoscopic varicocelectomy for bilateral varicoceles in infertile males

Varicoceles, present in 15% to 20% of men, are the most common abnormal finding among men presenting with infertility.Despite the very long history of the disease and many records on different surgical and radiological solutions, the ideal method of spermatic vein ligation for varicocele is still a matter of controversy. The perfect technique would be one that preserves testicular function and eliminates the varicocele with a low rate of recurrence, hydrocele formation and any other complications. To assess the efficacy of laparoscopic Varicocelectomy for management of bilateral palpable varicoceles in infertile males. We analysed the result of 25 patients presented with history of infertility and diagnosed to have bilateral palpable varicoceles treated in our department with Bilateral laparoscopic ligation of the spermatic vessels between January 2009 and November 2010. The average operative [Bilateral Laparoscopic Varicocelectomy] time was 34 minutes. There were no intra operative complications in the study group. Hydrocele formation was seen in 3 [6%] patients recurrence was seen in one [2%] patient .The average hospital stay was 18 hours. postoperative analgesics [1-2] doses, daily activities initiation usually started after 48 hrs and physical exercise 72 hrs . non of the patient has developed an atrophic testis as a result of the laparoscopic procedure. eighteen patients [72%]of the patients had improvement of the seminal fluid parameters During follow up period [6 months],with seminal fluid analysis, clinical and ultrasonic examination. Laparoscopic varicocele ligation is a simple and safe technique, causing minimal morbidity and enabling rapid return to normal activity

Laparoscopic management of symptomatic renal cysts

Simple renal cysts are common, with incidence increasing with age. Symptomatic renal cysts have traditionally been initially treated by percutaneous aspiration with or without injection of sclerosant agents; however, this has a high rate of recurrence.Open surgical cyst decortication for pain relief through a flank or chevron incision is associated with considerable morbidity and protracted convalescence. To assess the efficacy of laparoscopic Surgery in the treatment of symptomatic simple renal cysts. Renal cysts are common in the adult population. From April 2007 to July 2009, ll patients [7 males and 4 females] underwent laparoscopic decortications of symptomatic simple renal cysts with renal cyst wall excision and figuration of the epithelial lining. Complex renal cysts were excluded. The Wong-Baker pain scale was used to assess the preoperative and postoperative pain scores. Radiologic success was indicated as no recurrence on the most recent computed tomography scan. Of the 11 procedures were completed laparoscopically, the mean operative time was 100 minutes [range 80 to 120]. Symptomatic and radiographic success was achieved in 90.9% of patients, with a median follow-up of 12 months [range 6 to 18]. Long-term follow-up has confirmed that laparoscopic cyst decortication is an effective and durable treatment option for symptomatic simple renal cysts during long-term follow-up. The greater and durable success rates of this minimally invasive technique may favor this treatment option over other treatment modalities

Conus medullaris ganglioglioma

Conus medullaris ganglioglioma is rare and an usually benign tumour. Ganglioglioma may occur anywhere in the cranio-spinal axis but is rarely encountered in the spinal cord. It is observed more in the younger age group. Symptoms and signs are usually long and variable. Since this condition is rare it is easily overlooked and mistakenly diagnosed. When removed entirely the outcome is favourable. We report a 5-year-old boy who presented with a 3-year history of unsteady gait and lower limbs deformity, it was initially confused with congenital bone anomalies. His condition worsened over the following 6 months before his imaging scans identified a mass lesion involving the conus medullaris with syringomyelia. He underwent gross total removal of the tumour and the histopathology identified clusters of ganglion and glial cells. He made an excellent neurological recovery

Conocimientos sobre fiebre y conductas de los residentes del Postgrado de pediatría ante un paciente febril / Knowledge of pediatric residents in relation to fever and their approach on a febrile patient

La fiebre es reconocida por médicos y pacientes como de las más comunes e indiscutibles manifestaciones de enfermedad. Constituye la principal razón de un elevado porcentaje de consultas al médico y puede ser identificada como un problema importante, aún ausencia de otros signos y síntomas significativos. Determinar el nivel de conocimiento que tienen sobre fiebre los residentes del último año de postgrado universitario de Pediatría y las conductas que asumen ante un paciente febril. Se realizó un estudio descriptivo y transversal entre los meses de julio y agosto de 2004. Aplicamos un cuestionario a 62 residentes de 7 hospitales ubicados en Caracas, contentivo de 30 preguntas entre cerradas y semiabiertas. Con las 10 primeras se evaluó el nivel de conocimiento y con las preguntas restantes, las conductas que asumen los residentes ante un paciente febril. Sólo el 3% de los encuestados tuvo un nivel de conocimiento bueno sobre fiebre. Con relación a las conductas de los encuestados ante un paciente febril, encontramos que 89% lo despierta para tratarlo, 97% usa crioterapia y 89% combina antipirética y crioterapia. Los residentes encuestados tienen un nivel de conocimiento malo sobre fiebre y las conductas que asumen ante un paciente febril son erróneas, agresivas y desproporcionadas.

Estudo experimental comparativo entre anastomose colocólica com sutura manual e com anel biofragmentável / Comparative experimental study between colocolic anastomosis with manual suture and biofragmentable ring

OBJETIVO. Os autores realizaram um estudo experimental comparando anastomoses colocólicas realizadas através de sutura manual seromuscular, pontos separados de fio sintético absorvível monofilamentar de poligliconato,com anel anastomótico biofragmentável; este dispositivo, constituído por ácido poliglicólico (87,5//) e sulfato de bário (12,5//), determina cicatrizaçäo dos cotos cólicos por aposiçäo sero-serosa, sendo eliminado através da evacuaçäo, em virtude de sua fragmentaçäo por hidrólise, duas a três semanas após sua implantaçäo. MATERIAL E MÉTODOS. Foram operados 14 cäes, estudando-se 28 anastomoses, 14 com a sutura manual clássica e 14 com o anel biofragmentável, ambas no mesmo segmento cólico e em seqüência alternada, distantes entre si 10cm. Foram comparados o tempo de execuçäo, dificuldades técnicas, evoluçäo clínica e a qualidade da cicatrizaçäo. O exame histopatológico foi realizado por meio de metodologia convencional clássica e também utilizando-se programaçäo específica de processamento de imagens por computador, com a finalidade de quantificar as alteraçöes observadas. RESULTADOS. Todos os cäes apresentaram boa evoluçäo clínica. Após período médio de 33 dias os cäes foram reoperados, constatando-se maior incidência de aderências perianastomóticas na sutura manual. Os índices anastomóticos foram semelhantes em ambos os métodos, observando-se, no entanto, infiltrado inflamatório com reaçäo granulomatosa de corpo estranho, fibrose e espessamento da parede intestinal mais acentuados em todas as anastomoses com sutura. A quantificaçäo do líquido de edema na anastomose, mediante recurso da informática, mostrou diferença signficantemente maior na sutura manual do que no anel biofragmentável. CONCLUSAO. Os autores concluem, baseados nos resultados obtidos, que a utilizaçäo do anel anastomótico biofragmentável representa uma alternativa segura, mais uniforme, fácil e mais rápida para a execuçäo de anastomoses colocólicas, determinando cicatrizaçäo com menor reaçäo inflamatória. Näo foram observadas diferenças quanto à incidência de complicaçöes no pós-operatório

Patterns of breastfeeding in Jordan

A cross sectional study was conducted in Jordan during 1981-1983 on 1052 mother-child pairs selected randomly from nine population strata to represent all governorates and four socioeconomic groups : urban economically advantaged, urban lower income, rural and refugees living in camps. The governorates were : Amman, Irbid, Balqa, Karak and Ma'an. The selected children were between 0 and 36 months of age and were the youngest to their mothers at the time of the interview. It was observed that less than 3% of all children had never been breast-fed. Reasons for not breast-feeding were : failure of lactation, baby's refusal of the breast, illness of mother and painful nursing. The study showed that about 50% of the children were breast-fed at 6 months of age and 24% at 12 months. The most frequent reasons given by mothers for stopping breast-feeding were : new pregnancy and insufficient milk. Feeding on demand and frequent feeding were the most popular practices by mothers who were breast-feeding, irrespective of child age. Maternal views on breast-feeding indicated that the vast majority [not less that 90%] of mothers felt that breast-feeding is superior to bottle feeding. 69% of mothers or more were in favor of prolonged east-feeding for 12 months and beyond, and up to five months without supplements. These opinions did not seem to be consistent with the actual practice of breast-feeding. No apparent differences in the opinions or practices of mothers on breast-feeding were observed among the various regions or socioeconomic groups, the economically advantaged group, however, tended to deviate from the others

nutritional impact of the school feeding program in the Mafraq area, Jordan

The nutritional and educational impact of the school feeding program in the Mafraq area was assessed and compared with that of Madaba, which was not included in the school feeding program and was used as a control. A total of 2,554 male and female students from eight primary and preparatory schools [four urban and four rural] were studied in both areas. Weight and midarm circumference values were significantly and generally higher in Mafraq area, especially among females and younger age groups, the latter being the most sensitive period to nutritional changes. In most age groups, height retardation was significantly more in Mafraq than in Madaba, suggesting a greater presence of past or chronic malnutriton. This difference agrees with the known fact that in general the people of Mafraq are of a lower economic status than those of Madaba. The personality characteristics of the students were more favorable and the attendance record better in Madaba than in Mafraq, suggesting that other factors such as socioeconomic status are more influential on these characteristics than a school lunch. In order to truly test the positive impact of school feeding on the measured characteristics, especially the anthropometric ones, it is advisable to allow a longer period of school feeding before following up with a longitudinal study. In addition, a comparison of the feeding group with a control group would be more revealing if the two groups are more similar except for the presence of school feeding. The World Food Program [WFP] assisted project in Jordan began in March, 1978. Its objective was to raise the standard of education by helping the school children of the poorest districts through the provision of supplementary diet to [a] improve the level of nutrition and consequently their health, and [b] encourage their school attendance and improve their learning capacity. The WFP assisted project was implemented by the Nutrition and School Health Section of the Ministry of Education. The total number of beneficiaries in the 1979-1980 school year averaged almost 47,000 students. Almost 90% of beneficiaries were children enrolled in primary and preparatory schools and only about 10% in secondary schools. The WFP daily ration per child [provided over 210 days during the school year] consisted of 120 g wheat flour, 20 g dried skim milk, 25 g canned beef meat, 25 g canned cheese, and 10 g sugar. This ration provided approximately 690 calories, 31 g protein and 10 g fat. Since there was a problem with the acceptability of the milk, 10 g sugar were added to the original daily ration to sweeten the milk. The daily snack is normally served around 10 a.m. Children brought homemade bread [WFP donated flour] and received a cup of milk [sweetened] and alternatively each day, a slice of meat or cheese weighing 50 g or two days' ration [i.e. 25 g h 25 g] Nutrition education in the schools is taught as part of the science subjects and is also part of the newly "life-oriented curriculum" of the compulsory cycle. The School Health Section undertakes periodical medical check-up of all students enrolled in the first year primary and first year preparatory schools. In addition, all students receive the necessary vaccinations. After the program had been in operation for less than one year, we were asked by the project authorities to evaluate the impact of the school feeding program on the nutritional status of school children during the months of March, April, and May, 1978