Shift in parasitic infections during the Corona pandemic: a hospital-based retrospective study

@#The Corona pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) calls on the Saudi government to take action to control the infection. The government closed borders, prohibited travel, limited outdoor movements, and told primary and secondary care facilities to reduce all regular non-urgent health services. It is not known whether these measures have impacted the prevalence of parasitic intestinal infections. This study has therefore been carried out to investigate this issue. Dataset of 217 stool samples submitted to the King Faisal Medical Complex (KFMC) Microbiology Laboratory in Taif, Saudi Arabia for parasitological examination during the pandemic (January-June 2020) and 649 samples submitted during the corresponding months of the previous year (January-June 2019) were extracted and analyzed. Overall, 24.1% (209/866) of samples were parasitespositives; 26.6% (173/649) before and 16.5% (36/217) during the pandemic, with 79% reduction. There was a significant difference in gender-parasitism between the two periods where the majority of parasitism were for males (p<0.001). Infections were frequent in patients aged 5- 14 years both before (84/649; 12.9%) and during (12/217; 5.5%) the pandemic, with significant difference observed between the two cohorts (p<0.002). Moreover, the majority of infected patients were non-Saudi (67.9%; 142/209), with a significant difference in nationality reported, (p=0.024). Protozoa were identified in 21.8% (189) of all samples investigated, of which, Blastocystis hominis, Entamoeba coli, Giardia lamblia, Entamoeba histolytica/dispar and Cryptosporidium species were identified in 6.1% (53), 5.4% (47), 5.0% (44), 2.8% (25), and 2.3% (20), respectively. Helminths were diagnosed in 2.3% (20/866) of samples. Eggs of hookworm, Ascaris, Taenia spp, and Hymenolepis nana were detected in 0.9% (8), 0.5% (5), 0.3% (3) and 0.4% (4), respectively. In parallel with our research hypothesis, a substantial decrease in the burden of intestinal parasitic infections was recorded with the lock-down measures taken during the Corona pandemic.

Frequency of central nervous system tumors in delta region, Egypt.

Introduction and Aim of Work: Central nervous system (CNS) tumors represent a major public health problem, and their epidemiological data in Egypt have been rather incomplete except for some regional reports. There are no available frequency-based data on CNS tumors in our locality. The objective of this study was to estimate the frequency of CNS tumors in east delta region, Egypt. Materials and Methods: The data were collected during the 8-year period from January 1999 to December 2007 from Pathology Department, Mansoura University, and other referred pathology labs. Examination of HandE stained sections from retrieved paraffin blocks were done in all cases for histopathologic categorization of C.N.S. tumors. Immunohistochemical studies were applied to confirm final histopathologic diagnosis in problematic cases. Results: Intracranial tumors represented 86.7% of cases in comparison to only 13.3% for spinal tumors. Gliomas were the CNS tumors of the highest frequency (35.2%), followed by meningioma (25.6%), pituitary adenoma (11.6%) and nerve sheath tumors (6.6%). 10.25% of tumors were of children <15 years. Conclusion: This study provides the largest series of the relative frequency of CNS tumors in Delta region in Egypt till now and may help to give insight into the epidemiology of CNS tumors in our locality.

C-Reactive protein, Tumor Ncrosis Factor-alpha, interleukin-6 and cortisol in type 2 diabetes mellitus

Recently an abundance of evidence has emerged demonstrating a close link between immunity, inflammation, obesity, insulin resistance and type 2 diabetes mellitus. Activation of innate immunity with production of inflammatory markers was suggested to provide a new model for the pathogenesis of type 2 diabetes and the metabolic syndrome. This may result in new approaches for predicting and managing of type 2 diabetes and its complications. We evaluated the state of obesity and diabetes mellitus of thirty nine male type 2 diabetic patients and nineteen age-matched male healthy subjects as control. This evaluation was performed via assessment of the body mas index [BMI], fasting and postprandial [PP] blood glucose and insulin, insulin resistance and fasting C-peptide. Then we assessed the plasma levels of the most important inflammatory markers; C-reactive protein [C-RP], tumor necrosis factor alpha [TNF-alpha], interleukin-6 [IL-6] and the total leucocytic count as well as the stress hormone cortisol. Our results showed BMI above 30 for both patients and controls which indicated obesity of the two groups. Both fasting and PP glucose were 167.9 +/- 10.3 and 289.8 +/- 16 mg/dl respectively for patients and 96.4 +/- 1.96 and 108.47 +/- 4.6 rng/dl respectively for the control whish confirmed the diagnosis of diabetes mellitus. The C-RP was significantly higher in diabetics. Although the difference did not reach statistical significance fasting and PP-insulin, insulin resistance levels were higher in the diabetic patients compared to the control. Regarding the results of the acute phase reactants and the biornarkers for inflammation, we found a significant increase in C-RP, TNF-alpha, IL-6 and cortisol in the diabetic patients compared to the control. But no change could be detected in the total leucocytic count. This association between hyperglycemia and increased inflammatory markers may indicate a relationship between them. But the question which of them preceded and led to the other is still uncertain. Further studies with different approaches may be needed to solve this puzzle

Peripheral arterial disease and risk of cardiac death in type 2-diabetes

The purpose of this study was to determine the natural history of peripheral arterial disease [PAD] complicating type2-diabetics, in particular the influence of PAD on the risk of cardiac death and the adequacy of PAD risk factor management. The study was a prospective study of diabetic patients. The study was performed at Al-Azhar University Hospitals on 15o patients with type 2-diabetes between March 2004 and May 2005, with follow-up period at least 2-years. All patients had a valid data at baseline and three or more subsequent consecutive annual reviews. Assessment consisted of a range of clinical and biochemical variables including the ankle/brachial index [ABI]. PAD was defined as an ABI

Endoscopic trans-septal choanoplasty for congenital choanal atresia

To describe endoscopic trans-septal approach for treatment of choanal atresia. Prospective case series in a tertiary care center. Seventeen patients [7 with bilateral and 10 with unilateral choanal atresia] underwent trans-septal endoscopic choanoplasty. Removal of the vomer and shaving of the medial pterygoid plate were achieved by a small chisel with the use of a 4-mm 0 degree telescope. Nasal stents were not used following creation of the neochoanae. All cases were examined with the endoscopes 4 weeks postoperatively and any granulations or polyps at the site of the neochoanae were removed at that time. One year postoperatively, 16 [out of 17] patients had patent neochoanae. Granulation tissues were encountered in three cases and successfully managed on routine endoscopic examination. Endoscopic trans-septal approach is a direct, wide and safe one day surgery for repair of choanal atresia

Diagnostic role of multi-slice computerized tomography in laryngeal lesions

Diagnostic evaluation of the larynx and hypopharynx is primarily done with endoscopy as almost all malignancies of the larynx arise from the mucosal surface and thus are accessible to direct visualization and biopsy. The radiologist is seldom the first to diagnose malignancy and indeed cannot completely exclude laryngeal malignancy. However, the radiologist evaluates areas that the clinician cannot see: Areas deep to the mucosa or blocked from direct visualization by the bulk of the tumour. CT, the standard imaging modality for larynx assessment for more than a decade, has recently become further enhanced by the introduction of multislice computerized tomography which enables much faster image acquisition and multiplanar or three-dimensional image reconstruction, and virtual endoscopic study. Virtual endoscopy is a computer-generated simulation of endoscopic perspective obtained by processing digital data sets. The simulation can be obtained by dedicated software that reconstructs in three dimensions data obtained from computed tomography. The main advantage of virtual endoscopy is the unrestricted positioning of virtual endoscope within the air spaces of the larynx. The aim of this study was to evaluate the role of multislice CT in the diagnosis of laryngeal lesions. This study involved 37 patients [24 males, 13 females], with age range of 18-80 years [mean age 45.5 years]. They were all referred from the ENT department in Kasr Al-Aini hospitals presenting with a known or suspected laryngeal lesion. Multislice CT was done to all patients with reconstruction of the images in different planes, and performing 3-D reconstruction and virtual laryngoscopic study. The lesion exact site, size, extent and effects were detected in all cases

Predictor factors for success or failure of advancement anocutaneous flap closure of high fistula in ano

The fistula in ano is an ancient and common problem. Different methods of treatment evolved, but the ideal method up till now is not recognized because of the problems of recurrence and incontinence, specially in case of high fistula in ano. The aim of current study is to predict factors of success or failure of advancement ano cutaneous flap closure of high fistula in ano. or in other words to predict the patients who are suitable for treatment by this procedure. 30 cases with high fistula in ano were available for the study. 7 patients were shifted to another line of treatment because of inability to complete the procedure by the present procedure [2 cases with recurrent supra sphincteric fistulas, 2 cases with recurrent high anal fistulas, and case of suprasphincteric, ulcerative colitis fistula and two cases of suprasphincteric, crohn's disease fistulas], and the procedure was completed in the remaining 23 cases with neither recurrence, nor incontinence during the follow up period. In The procedure of ano cutaneous advancement flap closure of high fistula in ano is technically simple, comfortable to the patient, with neither recurrence nor incontinence, but unfortunately is suitable only for selected cases.

simple method to avoid recurrence in Licthenstein free hernioplasty in huge, longstanding inguinoscrotal hernia

Inguinal hernia [I.H] repair is one of the commonest surgical procedures and is an important training operation for youngs as it combines a low mortality risk and appropriate technical challenge. The optimum method for I.H. repair has not yet been determined. The recurrence rates for non mesh sture repair of I.H. vary between 0.2-33%, but licthenstein free hernioplasty [L.F.H.] has a world wide reported recurrence rate of 1%. The present study tried to compare the results of L.F. mesh onlay hernioplasty alone and the above method plus narrowing of U shaped internal inguinal ring to admit the tip of the little finger only by plication of the fascia transversalis as a separate step in huge, long standing inguinoscrotal hernia. There was no recurrence by adding this step compared by 3 cases of recurrences [16.6%] in control group. Adding U/S examination to the groin led to discovery of recurrence in two cases with groin pain but without bulge on straining

Will treatment of pilonidal sinus by elliptical rotation flap in selected cases prevent its recurrence?

Pilonidal sinus disease is a common, chronic intermittent disorder, with different theories regarding its etiology. There are different methods and procedures for the treatment. In current study, from January 2002 to January 2005, 32 patients were selected for the study. 2 cases were excluded. The surgical procedure is a vertical elliptical excision of the sinus and the diseased tissue and closure of the defect by rotational elliptical transverse flap without drain. There was neither recurrence rate nor other major complications. Mean follow up period was 14 months and hospital stay ranged from 12-24 hours. Elliptical rotation flap is recommended in selected cases for closure of the defect in case of pilonidal sinus disease with no recurrence rate and shorter hospital stay

Single staged surgery [SSS] for left sided colonic obstruction [LSCO]

There are controversial opinions for management of left sided colonic obstruction. The orthodox surgeons prefer to do twice or triple sittings for the treatment of this situation. Because of the safety and avoid time consuming and cost-effectiveness, single staged colonic surgery is a safe and definitive procedure. From a period of four years duration between March 2000 to March 2004, 37 cases [22 men and 15 women] were under went to this single-typed technique for left sided colonic obstructive patients. We performed resection anastomosis [one layer] without fecal [bowel] diversion. The results were good and encouraging the surgeon to continue and perform this single-staged procedure for selected patients presented with left-sided colonic obstruction. This decreases the hospital stay, cost-effectiveness and reduce surgical intervention

Laparoscopic cholecystectomy conversion in relation to previous laparotomy

Laparoscopic cholecystectomy [L.C] has replaced open cholecystectomy for the treatment of gall bladder disease. However, certain cases still require conversion to open procedure. Several studies have predicted the operative condition and conversion rate of L.C from clinical manifestations, laboratory findings, ultrasonic findings, surgeon skill, etc. Previous laparotomy was considered as contraindication for L.C while in its beginning. The current study tried to predict the patients with previous laparotomies who are liable to conversion to open cholecystectomy. 22 patients with previous laparotomies were selected for the study and a similar number were chosen as a control group. Modified method of L.C was performed for the first group and classic L.C for control group. two cases from the first group needed conversion to open cholecystectomy [9%], while no one needed conversion from the control group [0%]. No major complications for all, but minor complications in both group [4 cases-18%] had occurred. Except for patients with previous laparotomy for peritonitis, L.C is a safe procedure

Studies on SLE: Correlation between immunological and electroencephalographic changes

Systemic Lupus Erythematosus [SLE] is :m autoimmune disease characterized by n ihisystem involvement. Nervous system ivemen,t in SLE can present with diverse airologic or psychiatric symptomatology. study was done on fifty patients with vi.. They were divided into 2 groups:Group included twenty five patient with active / K Group II included twenty five patients i non active SLE. the following were for each patient: Complete history, full .ail examination , complete blood count ' HH! urea, creatnine, ANA, anti DNA, anti :[1 JSSA], anti LA [SSB] , anti SM, anti All, LAC, and conventional EEG. i EG findingsamongbothgroups :d that the EEG was normal in 12 % of .ills and abnormal in 88 % of patients long group I. The generalized epileptic

Study of the relationship between h. pylori and gastro-esophageal reflux disease in Egypt

Gerd is relatively uncommon in developing countries but H. pylori known to be the most common important cause of gastritis and associated with duodenal and gastric ulcers. The aim of our study was to find the relationship of H . pylori infection and GERD in Egyptian patients. The patients were selected and divided into two groups. Group I included 40 patients suffering from GERD [19 males and 21 females] and their ages ranged from [24 to 70] years; Group II, included 20 non GERD patients, with ulcerative or non ulcerative dyspepsia with H . pylori positive [12 males 8 females] and their ages ranged from [20] to [55] years. All patients were subjected to full history taking; clinical examination, laboratory investigation, endoscopic examination and three biopsies were taken from antrum of stomach to recognize H . pylori by R.U.T. and histopathological examination

Results of the present study showed that no significant positive association between H. pylori and pathogenesis of GERD where H. pylori positive with GERD occur in five patients [12.5%] especially in grade I reflux eosophagitis and H. pylori negative with GERD occur in [28] patients [70%]. There were seven patients [17.5%] with incompetent cardia and hiatus hernia hadpositive H. pylori without reflux eosophagitis. We conclude neither symptoms of GERD nor endoscopic grading of reflux eosophagitis has no relation with H. pylori infection

Results of repair of spontaneously ruptured umbilical hernia in cirrhotic patients with ascites

The aim of this work was to revise the results of the repair of spontaneously ruptured umbilical hernia in cirrhotic patients using prolene mesh only on urgent bases and to compare it to the results of other works dealing with the same complication in umbilical hernia using the same or other techniques. The study included 21 patients, 17 males and four females with ages ranging between 35 and 67 years [average 52 years] complaining of longstanding history of chronic liver disease with ascites. All the patients were rapidly prepared and operated upon immediately by hernioplasty using prolene mesh. There were two deaths of liver cell failure, one patient passed into hepatic encephalopathy from which he recovered after intensive medical therapy and three patients had wound infection which were managed by repeated culture and sensitivity with giving the proper antibiotic and frequent dressings. Follow up period from one month to 1.5 years revealed no recurrences. The use of hernioplasty as an emergency procedure in ruptured umbilical hernia in cirrhotic patients with ascites gives the same results as regard the mortality and the morbidity

One stage resection of acute sigmoid volvulus

In a descriptive prospective study, 20 patients with sigmoid volvulus and two with ileosigmoid knotting had primary resection of the redundant sigmoid colon with an immediate anastomosis after intraoperative antegrade colonic irrigation. Tube caecostomy was established in the two patients who required resection of both small bowel and sigmoid colon and in a further five patients in whom the integrity of the colorectal anastomosis was suspected. There was no clinical anastomosis leak and no mortality in any of the patients. Superficial wound infection occurred in three patients. The duration of hospital stay ranged from 10 to 14 days. The result showed that the procedure was associated with an acceptable morbidity and a short hospital stay. Also, it suggested that the resection of acute sigmoid volvulus and primary anastomosis after antegrade intraoperative colonic lavage safely provided that the patient is reasonably fit

Well tolerated videotelelaryngography in the office

Living direct sight is the best method of documentation, both for the patient and physician. Our study aims to get a precise and well tolerated system for routine diagnostic living documentation of the larynx in the office. This was achieved by using the wide angled 70 degrees telescope sinoscope and attaching it to an endovision telecam, videorecorder and monitor. The slimline telescope, 4 mm diameter and 18 cm long, shows a precise image and is easily tolerated by most patients without topical anaesthesia. The magnified image by telecam is viewed on monitor and recorded by videorecorder as a permanent documentation. This system is applied on our patients from 4 months old. It could be tolerated in up to 100% of patients and resulted in minimizing the failure rate of visualizing the larynx to a very low extent [3%]

Silastic sheets in tympanoplasty: hearing outcome

Chronic inflammation of the middle ear is one of the most common diseases affecting population in our locality. Surgical managements of this disease sometimes result in the development of middle ear adhesions and hearing deterioration and communication disorders. This study included 106 selected subjects suffering from chronic otitis media [suppurative and non suppurative]. Selection depended on intraoperative findings which included the presence of adhesions and intact ossicles. Cases with ossicular necrosis, cholesteatoma, granulation tissues and tympanosclerosis were excluded. The studied subjects were classified into 2 groups. The first group [74 patients] underwent single stage tympanoplasty with insertion of silastic sheets [0.127 mm thick: on the medial wall. lateral to incus long process and between the incus and malleus]. In cases of opening the mastoid cavity a tube like silastic sheet was inserted in the aditus to avoid adhesions and to allow good ventilation. The second group [32 patients] underwent single stage tympanoplasty without silastic sheets insertion. Subjects of the two groups were audiologically evaluated preoperatively and 1 month, 6 months and one year postoperatively. The first group showed better air conduction and bone conduction averages one year postoperatively when compared to those of the second group. The difference was statistically significant. One can conclude that silastic sheets are inert and can prevent the recurrence or formation of adhesions in the middle ear cavity, as reflected by stably improved hearing. Therefore, it would be recommended to use silastic sheets in tympanoplasty for restoration and maintenance of hearing