Clinical spectrum of fever of unknown origin among adult Egyptian patients admitted to Ain Shams university hospitals: a hospital based study

This prospective study was designed to analyze the clinical spectrum of fever of unknown origin [FUO] among adult Egyptian patients admitted to Ain Shams University Hospitals during the period from May 2009 till the end of December 2010. All Egyptian patients fulfilling the criteria of FUO admitted during this period were followed up till reaching the diagnosis. 93 patients were included in the study. They were 48 [51.6%] females and 45 [48.4%] males, their ages ranged from 15 to 65 years [34.39 +/- 13.6]. Infections were the commonest cause of FUO[41.94%] followed by malignancies[30.11%]. While autoimmune diseases represented 15.05% and in 12.9% of patients the diagnosis was not established. Brucellosis and infective endocarditis were the commonest infections, while hematological malignancies were the commonest oncological diseases. Systemic lupus erythematosus [SLE] was the commonest auto-immune disease. Brucellosis, infective endocarditis, hematological malignancies and SLE must be considered in the differential diagnosis of adult FUO in Egypt

value of fibroscan as a non-invasive predictor of large esophageal varices in cirrhotic patients

Periodic endoscopic screening for esophageal varices [EV] is recommended in patients with cirrhosis, but might be limited to a subgroup of patients if a simple non-invasive test was available to select those at risk of bleeding. To assess the value of Fibroscan as a simple non-invasive test for selecting patients with cirrhosis at risk of bearing large EV. In 50 patients with cirrhosis, we studied the relation between the presence and grading of esophageal varices as assessed by endoscopy and liver stiffness measurement by Fibroscan, a non-invasive parameter related to liver fibrosis. Receiver operator characteristic curve was used to identify the best cut-off point for liver stiffness measurement. The identified best cut-off point for liver stiffness measurement [LSM] was 20.90 with sensitivity 71.4% and specificity 66.6% for prediction of the presence of esophageal varices while for prediction of the presence of large varices, the best cut off value was 26.00 with sensitivity 80% and specificity 60%. LSM is of higher diagnostic value in predicting the presence of large esophageal varices in patients with cirrhosis. and may help to select patients for endoscopic screening

Antimicrobial resistant bacteria among health care workers in intensive care units at Ain Shams university hospitals

Fifty HCWs in ICUs of Internal medicine, Chest, Neonatology and Burn were included in prospective cohort study. Collection of nasal, hand and rectal swabs, proper biochemical identification, culture media and antibiotic sensitivity tests were used to detect Methicillin-resistant Staphylococcus aureus [MRSA]; vancomycin-resistant Enterococci [VRE] and extended spectrum beta-lactamase producing gram -ve bacilli [ESBLs]. S. aureus was isolated from 34% of HCWs; 28% were nasal carriers, 4% were hand carriers and 2% had S. aureus at both sites. Nasal and hand carriage rates of MRSA were 20% and 4% respectively, with an overall rate of 22%. Gram -ve bacilli were isolated from 8% of HCWs hand swabs and showed Citrobacter koseri, Escherichia coli, Kiebsiella pneumoniae and Pseudomonas aeruginosa. Hand carriage rate of ESBLs was 2%. Hand contamination with gram -ve bacilli and S. aureus was in 14% of HCWs. VRE carriage rate was 9.5%. ESBLs carriage rate in rectal swabs was 21.43%. K. pneumoniae was the most common ESBLs producing isolate [33.3%], followed by E. coli [18.75%]. In combined disc method, aztreonam was the most sensitive [90%] in detecting ESBLs. Burn ICU had highest% of MRSA and ESBLs carriage. Neonatal ICU showed highest% of VRE carriage. An insignificant association was between infection control training or antimicrobial intake and carriage of antimicrobial resistant bacteria

Shigella gastroenteritis in children with a cute diarrhea in children welfare teaching hospital

Shigellosis is the most common cause of epidemic dysentery and affecting all age groups especially in the first [2] years of life, It is a major cause of childhood mortality and morbidity in developing countries. To study the extent of shigella gastroenteritis among children presented with acute diarrhea. Three hundred sixteen patient were included in the study [186 males and 130 females],admitted to the children welfare teaching hospital, medical city complex, Baghdad, suffering from diarrhea and their ages ranged from 2 months-10 years, over a 4 months period [from the first of December 2007 till the end of March 2008], History and physical examination were carried out, general stool examination and stool culture were done by taking fresh stool samples collected from these children and submitted to serial investigations. The study showed that out of 316patients suffering from diarrhea, 22[6.9%] patients with shigella positive, 16[6.2%]had watery diarrhea, 6[10.7%] had bloody diarrhea, 262[82.9%] were less than 2 years. Out of 22patients with shigella positive 12[54.5%] of them were less than 2 years. Most of the patients presented with diarrhea consume unboiled tap water 192 [60.8%], with 8 [36.4%] of them are Shigella species positive. The use of filtration and chlorination of water at home shows no shigella species diarrhea and only 2 [0.7%] Shigella species negative diarrhea. Diarrhea is the presenting symptom followed by fever 20[90.9%], vomiting 14[63.64%], Then abdominal pain 4[18.18%]. Shigellosis was found to be the third most common cause of infectious bacterial diarrhea following Escherichia coli and campylobacter jejuni and also the third most common cause of bloody diarrhea following entamoeba histolytica and Campylobacter jejuni, and the relationship between water supply and its sterilization with shigella infection is significantly different between people who consume purified and sterilized water than those who did not