Prevalence of extended spectrum beta-lactamases production among resistant gram negative bacteria in samples of intensive care unit patients

The rapid emergence and dissemination of antimicrobial resistant microorganisms in hospitals worldwide is a problem of crisis dimensions. Although infections caused by drug resistant bacteria can strike anyone, they are especially grave for immune-compromised patients whose such as the hospitalized in Intensive Care Units [ICUs]. Extended Spectrum beta Lactamases [ESBLs] is a neglected health care crisis that is intended to provoke a debate. This study aimed to determine the prevalence of extended spectrum beta-lactamases multidrug resistant isolates of Enterobacteriacea in all samples [urine, respiratory, surgical and body fluid, blood] collected in ICU patients at El Damardash Hospital. Also, to study the antibiogram profiles of the ESBLs organisms isolated. A total of 1065 different samples collected from patients admitted to the surgical long term care nad ICUs were cultured. The antibiogram carried out for the possible ESBLs gram negative isolatles by screening preliminary method, thereafter confirmed for Klebsiella pneumonia [K.pneumoniae], Escherichia coli [E. coli] and Proteus mirabilis [P.mirabilis]. Out of the 1065 samples the total positive urine, respiratory, surgical and blood cultures were 434, 202, 352, and 77, respectively, where 670 gram negative organisms were isolated from the urine, respiratory, surgical and body fluid and the blood specimens were 299, 164, 187 and 20, respectively. The isolated Gram negative bacteria were 273 E. coli, 114 K. pneumoniae and 20 Proteus mirabilis isolates. The Gram negative organisms isolated from the urine culture was 68.9% [299/434], 64% [190/299] of the gram negative organisms were E. coli, 13.2% [25/190] were ESBL producers, 14% [41/299] the gram negative organism isolated from urine were K. penumoniae, 9.8% [4/41] were ESBL producers. About 4% [11/299] of the gram negative organisms were P. mirabilis and they were all non ESBLs producers. As regards, the gram negative organisms isolated from the respiratory specimens were 81.2% [164/202], 12% [20/164] of the gram negative organisms were E.coli, 15% [3/20] were ESBL producers, 19.5% [32/164] of gram negative organisms were K. penumoniae, 3% [1/32] of them were ESBL producers and 1.8% [3/164] of gram negative respiratory cultures were Proteus mirabilis, 33% [1/3] were ESBL producers. ESBLs is a neglected healthcare crisis in Egypt that needs strategies to treat, prevent and control the rising rate. In addition, clinical laboratories need to have adequate funding, equipment and expertise to provide a rapid and clinically relevant antibiotic testing service. Besides, the controlled use of 3[rd] generation cephalosporin along with implementation of infection control measures are the most effective means of controlling and decreasing the spread of ESBL isolates

Dilemma of bilateral versus unilateral neck exploration in management of primary hyperparathyroidism

There is still a considerable discussion about whether focal unilateral or bilateral neck exploration should be used in patients with primary sporadic hyperparathyroidism because of improved preoperative localization tests and intraoperative parathyroid hormone assay. Making sense of applying these new technologies is difficult and poses the question. Is limited parathyroid surgery better surgery?. Most clinicians deduce that limited surgery is better only if the success rate is equivalent to bilateral exploration. The aim of this study was to find out if there is an advantage in unilateral neck exploration over the standard bilateral neck exploration for parathyroid surgery. This is a prospective non-randomized clinical study which had been conducted in the period between October 1996 and January 2004 on 29 patients with a diagnosis of primary hyperparathyroidism divide into two groups. Group I: Fourteen patients [4M and 10F] that had bilateral neck exploration. Group II: Fifteen patients [5M and 10F] that underwent unilateral neck exploration. All patients had preoperative clinical and biochemical assessment, ultrasound, CT of the neck and sestamibi scanning [for those patients considered candidates for unilateral neck exploration]. All patients were seen on follow-up visits after 1 week, 1 month, 3 months, 6 months and then yearly. There was no statistically significant difference in preoperative serum calcium level or serum parathyroid hormone level between the two groups [p>0.5]. Median operative time was 105 minutes [range 95-180 minutes] in group I compared to 90 minutes [range 80-155 minutes] in group II [p value<0.5; significant]. Only one patient [7.2%] had postoperative hypocalcaemia in group 1. One patient [7.2%] had recurrence in group! compared with two patients [13%] in group II [p value>0.5, non-significant]. No patient had recurrent laryngeal nerve paralysis or permanent hypocalcaemia in either group. There was no statistically significant difference between group I and II patients in postoperative histopathological findings. In group II three patients [20%] required conversion to bilateral neck exploration; one patient had [7%] multiple adenomas and two patients bad hyperplasia [13%]. Bilateral neck exploration for surgery for primary hyperparathyroidism is as safe as unilateral neck exploration and has higher cure rates. It also avoids the costs of preoperative and intra-operative localization scans and techniques. In hospitals where intra-operative localization methods are not available; the conventional neck exploration for primary hyperparathyroidism should be considered the method of choice

Sentinel node mapping in colorectal cancer: is it worth the effort?

Background: Lymphatic mapping [LM] with sentinel node [SN] biopsy is an interesting recent development in surgical oncology. This approach has the potential of accurately identifying the first lymph node [or nodes] that drain primary tumors. These nodes are the most likely to harbor metastatic or micrometastatic disease. Sentinel node mapping and the pathologic search for micrometastasis may therefore increase the accuracy of the pathologic staging, which may alter the further management and the prognosis

Aim of the Study: To evaluate the usefulness of intra-operative in-vivo and ex-vivo sentinel node mapping in colorectal cancer [CRC] resections, and its effect combined with selected pathologic focus node examination on upstaging of CRC and consequent therapeutic strategies

Patients and Methods: Twenty- nine [after exclusion of six] patients with CRC were enrolled in a study of lymph mapping [LM] with peritumoral and submucosal injection of isosulfan blue dye. In-vivo LM was undertaken intraoperatively during colon resection in 23 patients. Ex-vivo LM was done after specimen removal in 6 patients [1 rectosigmoid and 5 extraperitoneal low rectal carcinoma]. All nodes wereexamined with hematoxylin and eosin [H and E] staining; in addition, negative sentinel lymph nodes [SNs] for metastasis with H and E were multi-sectioned and examined by immunohistochemical staining with cytokeratin[CK-lHC]

Results: SNs were successfully identified in 27/29 patients [93%][at least one SN was identified]. SNs were not identified in 2 cases; one case of very low rectal cancer and the other one was a locally advanced rectosigmoid colonic cancer. LM .demonstrated primary lymphatic drainage to SNs outside the margins of conventionally surgical planned resections in 2 cases [7%] and guided multiple sections and histochemical staining that identified occult micrometastases in 3 of the SN negative patients [11%]. Upstaging was thus achieved in 5 cases [18%] using mapping and focus nodal examination. Overall, the specificity and the negative predictive value in this series were 100% and 67%, respectively, whereas the sensitivity and positive predictive value were 89% and 78% respectively. There was a significant positive correlation between the tumor T stage and lymph node metastases [P< 0.001]

Conclusion: Sentinel node mapping is easy to do intraoperatively during colorectal resections. Ex-vivo LM can be applied when in- vivo techniques are unsuccessful and could beuseful for rectal carcinoma. LM techniques appear to improve staging accuracy in CRC through detection of more node metastases as well as guiding the use of sophisticated histopathologic studies to search for occult nodal micrornetastases. It may demonstrate an unexpected pattern of lymphatic drainage requiring modification of the conventional resection

Preliminary trials for the improvement of the locally produced inactivated RVF vaccine

After the last outbreak of RVF in Egypt during 1993, research works were directed towards the development of a much higher immunogenic and more potent inactivated RVF vaccine. The present work reports on the production of a much safer, more economic and potent inactivated vaccine as well as increasing its shelf live validity. The vaccine was safe when tested in suckling mice and potent when tested in adult mice and sheep. It had an ED[50] of 0.0005/ml. Yet, this vaccine has to be tried on a large scale to judge upon its validity for field use and/or replacing the present classical inactivated one

Role of atrial natriuretic peptide in preeclampsia

To compare plasma levels of atrial natriuretic, peptide [ANP] in normal and preeclamptic patients during labor and 24 hours later. The study involved 50 primigravidae in labor, twenty cases were normal control group [Gl], twenty cases had mild preeclampsia [GIl], and ten cases had .severe preeclampsia [GIII]. Two venous blood samples were collected: one during labor and the 2nd. 24 hours later for measurement of ANP, Na, K and Ca. The mean [ +/- D.] levels of ANP were significantly increased in GIl and GIll than, GI [69.5 +/- 10.6 and 98.7 +/- 16.6 vs 33.3 +/- 17.3 pg./ml, respectively, p < 0.001]. ANP levels were significantly correlated with the severity of preeclampsia [r =.87, p < 0.01]. Postpartum levels of ANP dropped significantly in GIl and GIII [36.5 +/- 6.6 and 48 +/- 6.4 respectively, p < 0.001] compared to intrapartum values. However, ANP levels increased significantly after delivery in Gl [65.7 +/- 22.2, p < 0.001]. Na and Ca plasma levels were significantly decreased in GIl and GIII compared to Gl. Plasma ANP levels are increased in preeclamptic patients and correlate positively with the degree of hypertension. ANP seems to have a protector role; stabilizing blood pressure, and maintaining water and electrolyte balance. It may be responsible for the hemoconcentration of preeclampsia, mediated by increased diuresis and shift of fluid to the interstitium