[Hepatitis B and C infection as a part of hospital acquired infection at the Renal Dialysis Unit in Assiut University Hospital]

Background: Hospital-acquired hepatitis B [HBV] and C virus [HCV] infections continue to occur despite increased awareness of this problem among the medical community. Infection with hepatitis viruses continues to be a major concern for hemodialysis patients, who are recognized as a high-risk group

Objectives: To measure the HBV and HCV seroconversion in hospitalized patients at the hemodialysis unit in Assiut University hospital and to assess the potential risk factors for infection with these viruses in this unit

Methods: This study was performed in Assiut University Hospital at the renal dialysis unit. A total of 63 patients on regular hemodialysis who should be negative for anti HCV, HBsAg and IgG anti HBc with normal liver enzymes and abdominal ultrasound were included in this study between June 2011 and August 2014. An identification questionnaire for possible risk factors for HBV and HCV was done at the start of study. Then follow up after 3 months with another questionnaire for the risk factors and screening by anti HCV, HBsAg and IgM anti HBc were done. Then another follow up after 6 months with other questionnaire for the risk factors and screening by anti HCV and HBsAg. Qualitative PCR test for HCV was used for patients whose results were positive for anti HCV either at 3 months or 6 months follow up. The study also include 12 health care workers and they were screened for anti HCV and HBsAg. Their history of vaccination for HBV was also assessed. Assessment of adherence to infection control measures was also done

Results: Twenty one patients were anti HCV positive, seven of them were positive after 3 months follow up and 14 were positive after 6 months follow up with seroconversion rate of 33.3%. No patient was positive for HBV throughout the study period. All these positive for anti HCV were negative for qualitative PCR for HCV All the included health care workers were negative for HBV and HCV markers. Furthermore all of them had complete vaccination for HBV. The potential risk factors for HCV seroconversion were duration and frequency of dialysis, blood transfusions, dialysis with patients positive for HCV in the same room, lack of strict adherence to infection control measures by the health care workers

Conclusion: Regular screening of all patients and health care workers in hemodialysis units for HBV and HCV with improvements in infection control practices should be done. Therefor health education of the health care workers and their vaccination against HBV infection should be considered

Medical education

Introducing a new 4S model for clinical skills learning is simulated setting utilizing a standardized patient of midline neck mass experienced at clinical skills centre, School of Medical Sciences. University Science Malaysia

Haematologic parameters in acute promyelocytic leukemia patients treated with ALL trans- retinoic acid

Acute Promyelocytic Leukemia [APL] is commonly associated with disseminated intravascular coagulation [DIC] and early correction of coagulopathy is of vital importance. All Trans-Retinoic Acid [ATRA] is considered to be the drug of choice in the treatment of APL. The work was conducted to: 1- Identify patients with APL who show laboratory evidence of DIC. 2- Study the serial changes in haemostatic parameters in APL patients treated with ATRA and to compare their results with those treated with conventional chemotherapy without ATRA. In this prospective study [from October 2003 to October 2005], 44 newly diagnosed, untreated APL patients were included. ATRA plus chemotherapy - treated patients were 24 while 17 patients were treated with chemotherapy other than ATRA. For each patient, a full clinical evaluation was done and hematological investigations were accomplished at time of diagnosis and repeated on day 3 and 7 of therapy. Diagnosis of DIC was based on finding a positive D- dimer test with hypofibrinogenaemia with or without pathologically prolonged [PT and/or APTT]. In 44 newly diagnosed, untreated APL patients studied, the age ranged between 6-81 years with a median of 27 years. Male to female ratio was 1.3:1. Before treatment all patients had anemia, thrombocytopenia, and elevated level of D - dimer. DIC was present in all patients at time of diagnosis. All parameters that showed abnormal level at time of diagnosis had returned to normality within one week in ATRA treated group, indicating that DIC has essentially resolved. By contrast, those parameters remained abnormal even on day 7 in the chemotherapy treated group, indicating that DIC was ongoing. ATRA therapy in APL patients is associated with rapid improvement of coagulopathy therefore, it is justified to be used from day one of the treatment

Respiratory symptoms and pulmonary functions in patients with chronic hepatitis C infection

Extra-hepatic manifestations of hepatitis C virus [HCV] infection are common. The interaction between chronic hepatitis C virus [HCV] infection and chest diseases is of considerable interest. Chronic hepatitis C viral infection has been incriminated as an aetiological agent that increases the risk for development of COPD and idiopathic pulmonary fibrosis. This prospective study was designed to determine chest symptoms and the effects of chronic hepatitis C virus [HCV] infection non lung functions in two groups of patients. Design: Prospective observational study. Setting: Assiut University Hospital. Patients: Fifty-two patients with chronic hepatitis C vieral infection [group 1, 35 HCV-positive patients with liver cirrhosis; group 2, 17 HCV-positive patients without liver cirrhosis]. The most common reported chest symptom among either group was dysnea [52.29%] for group 1, and [29.41%] for group 2. Arterial blood gases [ABGs] results were pH of 7.39 +/- 0.4 for group 1 and 7.38 +/- 0.3 for group 2, partial arterial tension of carbon dioxide [PaCO[2]] of 37.9 +/- 7.19 mm Hg for group 1 and 43.07 +/- 5.39 for group 2, partial arterial tension of oxygen [PaO[2]] of 87.0 +/- 9.58 mm Hg for group 1 and 89.12 +/- 8.5 for group 2, arterial O[2] Sat of 96.1 +/- 2.2 for group 1 and 96.85 +/- 1.39 for group 2, and alveolar-arterial gradient of 22 +/- 11 mm Hg for group 1 and 13 +/- 1.2 for group 2. Despite higher impairment of ABGs levels among group 1, this was statistically not significant for all parameters [P > 0.05]. Eight patients [15.4%], 5 in group 1 and 3 in group 2 had pulmonary function tests parameters that were within normal range, 9.6% had obstructive airway disease, 51.9% had restrictive lung impairment, 15.4% had combined obstructive and restrictive dysfunction and 7.7% had small airway obstruction. Restrictive lung impairment was significantly the commonest type of pulmonary dysfunction [P <0.05]. Various pulmonary function test abnormalities did not lead to significant differences in arterial blood gases. Our findings suggest that pulmonary changes were frequent in patients with chronic hepatitis C virus infection. The commonest form of pulmonary dysfunction is restrictive pattern. Despite the lack of much pulmonary symptoms; however, dyspnoea was the most commonly reported one

Vestibuloplasty using submucosal mucosal graft and fenestrated mucosal flap techniques, three years clinical follow-up

The aim of this work was to evaluate a 3-year follow up of three different techniques of sulcus deepening: The mucosal grafting vestibuloplasty, the submucosal vestibuloplasty and the fenestrated mucosal flap vestibuloplasty

study of 1684 impacted third molars in Makkah

A study of 1684 impacted third molars between the ages of 15-40 years wasaccomplished during 1990 and 1992. Particular emphasis was given to the age,sex angulations and complications which associated with third molar impactions. The results revealed that third molar impactions occur with greater frequencyin the mandible than in the maxilla. A higher prevalence of impacted wisdomteeth was observed affecting the age group 20-24 years. No significantdifference existed between sex and impacted third molars in the mandible andmaxilla. There was a statistically significant difference betweenhorizontal and distoangular angulations and impacted third molars in mandibleand maxilla. Pericoronitis and caries are the most encountered pathologicconditions associated with third molars impactions

Association of hook worm infestation with post cricoid carcinoma

During the period of August 1986 to April 1989 we had seen 50 cases of postcricoid carcinoma. Out of that, 10 cases had sideropenic dysphagia. Six patients [4 females and 2 males] of postcricoid carcinoma had hookworm infestation while rest of the four patients had other causes of iron deficiency anaemia. By timely diagnosis and treatment of infestation, pre-malignant changes can be reverted and malignancy avoided. The number of patients studied is however small which may be open to criticism but this definitely shows a trend. However, further large studies are needed

Long term effect of tricyclic antidepressant drugs of the periodontium of albino rats

Tricyclic antidepressants, are used for treatment of depression, nocturnal enuresis, trigeminal neuralgia, headache and parkinsonism. The complications associated with the use of the drug include restlessness, malaise, delerium, agranulocytosis, fever, sore throat, dry mouth, constipation, hypotension, tacchycardia and mydriasis with blurred vision. Since the drug may be used for a long period in a high or low doses according to the severity of the condition, so the aim of the present investigation was to study the long term effect of high and low doses of tricyclic antidepressant drugs [Amitriptyline hydrochloride] on the periodontium of albino rats. The study was performed on 36 male albino rats divided into two experimental groups, 15 rats for each, and one control group consisted of 6 rats received intra-muscular injection of saline. The first experimental group [low dose group] received intramuscular injection of 1.35 mg/day of Amitriptyline hydrochloride, while the second experimental group received intra-muscular injection of 2.7 mg/day of the same drug. Two rats of the control group as well as five rats of each experimental group were sacrified at the end of the first, second and third months respectively from the begining of the experiment. Maxillary and mandibular specimens were dissected, fixed, sectioned and stained with H. and E. and Examined microscopically. Slight increase was shown in collagen fibres without any consistent pattern with no changes in thickness of the periodontal ligament at the end of the third month in the group received low dose of the drug. On the other hand, for the high dose group an increase in the periodontal ligament thickness was noted with marked proliferation of collagen bundles and some fragmented areas of the alveolar bone. It was concluded that the drug has a stimulating action on fibrous tissue synthesis of the gingival fibres and periodontal ligament. Fragmentation of the alveolar bone may be related to excessive pressure induced by the proliferating collagen fibres and/or the impairement of the blood supply to the alveolar bone. There was no evidence of chronic inflammatory cell infiltration in the connective tissue or gingival epithelial degeneration which proved that the changes were not dependent on local irritating factor. The proliferation of the junctional epithelium appeared to be hindered by the firm attachment of the dense collagen fibres to the root surface giving no chance for periodontal pocket formation