Clinical and lab-assessed antibiotic resistance pattern of uropathogens among women with acute uncomplicated cystitis

Background: acute uncomplicated cystitis [AUC] in females is among the most frequent infections in community. Treatment of AUC in Egypt usually based on empirical therapy

Objectives: To determine the most common uropathogens and their pattern of resistance to commonly used antimicrobials aiming at finding a proper antibiotic which can be used as effective empirical therapy in AUC

Patients and Methods: Observational, hospital based, cross sectional study was performed. Three hundred and twelve female patients were recruited for the study with positive urine culture and clinical symptoms correlate with AUC during the period from December 2017 to August 2018

Results: Eight organisms were isolated. E. coli was the most common uropathogen and was isolated from 231 cases [74%]. The next most common was Pseudomonas which was detected in 41 cases [13.1%]. Other organisms include MRSA [6.1%], Klebsiella [2.2%], Enterococcus spp. [1.9%], proteus [1.3%], Acinetobacter and Staph. aureus [0.6%] each. Isolated uropathogens in this study were least resistant to Nitrofurantoin [47.1%]. The highest resistance rate was to TMP/SMZ [87.8%]. Resistance pattern to quinolones were 64.1%, 67% and 60.6% to Ciprofloxacin, Norfloxacinand and Levofloxacin respectively

Conclusion: The most common cause of community acquired AUC was E. coli. Nitrofurantoin can be used as a first line empirical therapy for AUC as it showed the least resistance pattern [47.1%]. Antimicrobial resistance is a crucial issue which evolves continuously and thus more studies must be carried out in different regions and constanttime intervals

Prevalence of internal hernia post laparoscopic surgery

Background: Laparoscopic approach for colorectal resections is now very popular. Internal small bowel herniation [SBH] through a mesenteric defect has been recorded especially if the mesentery is not repaired. Although it's rare, it is a severe complication. Lack of postoperative adhesions is one advantage of minimally invasive surgery but it's also responsible for a higher incidence of internal hernias. These patients often present with intermittent abdominal pain or small bowel obstruction with completely normal contrast radiographs. Laparoscopic surgery is a minimally invasive approach with good treatment outcomes and is currently the standard surgery for colorectal cancer in Saudi Arabia

Objective: the aim of our study was to evaluate the incidence and outcome of internal hernias after laparoscopic procedure in King Abdul-Aziz Hospital and Oncology Center

Patients and methods: a total of 372 patients underwent laparoscopic colon resection surgery for colon cancer during the study period from August 2015 to October 2016 in King Abdul-Aziz Hospital and oncology center. Results: our result found that internal hernia was reported 48 times

Role of magnetic resonance imaging and ultrasonography in diagnosis and follow up rheumatoid arthritis in hand and wrist joints

Aim of the work: to compare the role of ultrasonography and magnetic resonance imaging in the diagnosis of wrist joint affection in patients with rheumatoid arthritis

Patients and methods: this study included 50 patients diagnosed as rheumatoid arthritis [41 females and 9 males] with mean age 43 years; they were subjected to high resolution ultrasound and MRI of the wrist joint for the dominant affected wrist clinically. Comparison and correlation between both modalities was done

Results: our results showed agreement between ultrasound and MRI in the assessment of synovial inflammation, activity and bone erosions in wrist joint in rheumatoid arthrtis patients

Conclusion: we concluded that both modalities were comparable and close to each others as regards the bony erosions and synovial hypertrophy and inflammation in the wrist joints in patient with rheumatoid arthritis and the ultrasound was useful tools in detection of erosions and synovial inflammation so can be used in patients without erosions on conventional x ray and also can be used in follow up and monitoring the patients with established diagnosis of rheumatoid

Effectiveness and impact of rotavirus vaccines in Saudi Arabia: a single hospital-based study

Background and Study Aims: Rotavirus is the most important cause of severe gastroenteritis in children. The primary public health intervention is vaccination. Rota vaccine has been included to the national vaccination schedule in Saudi Arabia since 1 January 2013. Here we aim to evaluate the effectiveness and impact of rotavirus vaccines in Saudi Arabia following the addition of rotavirus vaccine to the national vaccination schedule

Patients and Methods: Retrospective analysis of electronic data of children admitted to al Jeddani Hospital, Jeddah, Saudi Arabia, with gastroenteritis between 1 September 2011 and 31 August 2012 [1 year before the implementation of Rota vaccine; group 1] compared to those admitted between 1 September 2015 and 31 August 2016 [3 years after the implementation of the vaccine; group 2]

Results: A total of 730 patients with gastroenteritis had documented rotavirus stool analysis. Their median age was 32 [16-56] months, 54% male and 46% female. The prevalence of rotavirus-positive gastroenteritis significantly decreased from 38.5% in group 1 to 13.2% in group 2, P = 0.0001. The median age of rotavirus infection significantly increased to 44 [21-56] months after the implementation of rotavirus vaccine compared to 16 [12-36] months before routine vaccination, P = 0.003

Conclusion: Rotavirus gastroenteritis has significantly decreased among Saudi children, especially infants below 24 months of age, after the implementation of rotavirus vaccine in the national vaccination programme

Evaluation of gastro-oesophageal reflux disease in wheezy infants using 24-h oesophageal combined impedance and pH monitoring

Background and study aims: Gastro-oesophageal reflux disease [GERD] is incriminated as a cause of non-asthmatic infantile wheeze. To date, no diagnostic test is considered standard for GERD-related airway reflux diagnosis. Oesophageal combined multiple channel intraluminal impedance and pH [MII-pH] monitoring is proposed to be a sensitive tool for evaluation of all GERD including infantile wheeze. We aimed to determine the GERD prevalence amongst wheezy infants in the first year of life using combined MII-pH versus pH monitoring alone and evaluate the sensitivity and specificity of objective MII-pH monitoring parameters in GERD-associated infantile wheeze diagnosis compared to those of lipid-laden macrophage index [LLMI]

Patients and methods: Thirty-eight wheezy infants below 1 year of age were evaluated for GERD using oesophageal combined MII-pH monitoring and LLMI

Results: Totally, 60.5% of cases had abnormal MII-pH; only 7.9% of them had abnormal pH monitoring. LLMI was significantly higher in wheezy infants with abnormal MII-pH than infants with normal MII-pH monitoring [112 +/- 88 versus 70 +/- 48; P = 0.036]. The current definitions of abnormal MII-pH study, reflux index >/= 10% and distal reflux episodes >/= 100, had low sensitivity [23%] but high specificity [100% and 96%, respectively] in GERD-related aspiration diagnosis defined by LLMI >/= 100. Using ROC curves, bolus contact time >/= 2.4% and proximal reflux episodes >/= 46 had 61% and 54% sensitivity and 64% and 76% specificity, respectively, in GERD-related aspiration diagnosis

Conclusion: Combined MII-pH is superior to pH monitoring in reflux-associated infantile wheeze diagnosis. Objective data including proximal reflux episodes and bolus contact time should be combined with the current parameters used in reflux-associated infantile wheeze diagnosis

Airway inflammatory biomarker: could it tailor the right medications for the right asthmatic patient?

Asthma is a heterogeneous disease, in which asthmatic patients present with different clinical phenotypes, variable endotypes, and different response to asthma medicines. Thus, we are faced with an asthma paradox; asthma is diagnosed subjectively by clinical history and treated with biologically active drugs. To solve this paradox, we need objective airway biomarkers to tailor the proper medications to the proper patient. Biomarkers should have one or more of the following characteristics: 1] could differentiate poor symptoms perceivers from over-perceivers, 2] could predict disease activity and hence disease outcome, 3] could clarify asthma phenotype responders from non-responders, and finally 4] could characterize different clinical asthma phenotypes. Therefore, we have conducted a review of literature trying to apply those four parameters to different airway inflammatory biomarkers. We found that FeNO fulfilled the four proposed clinical parameters of airway inflammatory biomarkers whereas; serum periostin was the single best systemic biomarker of airway luminal and tissue eosinophilia in severe uncontrolled TH2 asthma phenotype. Thus, this may be considered a trial towards tailoring the proper medication to the proper patient. However, application of biomarkers in clinical practice requires easier and cheaper techniques together with standardized methods for sample collection and analysis

Polypropylene Mesh for Recurrent Incisional Hernia: Different Operative Techniques.

Aims: To locate the plane of mesh insertion whether it is onlay, inlay, sublay, or underlay. Design: Prospective study Place and Duration: Done at Bani suef hospital between May 2011 till May 2012 with follow till May 2014. Methodology: Twenty two patients, six were males sixteen were females with recurrent incisional hernias were included in the study with a mean age ± SD of 44 years ± 11.87, there were 14 patients presented after the first recurrence (Groups 1, 2), 7 patients after the second recurrence (Groups 3, 4) and only one for the third recurrence. There were no significant difference between patients presented by 1st and 2nd recurrence concerning the age, sex and level of hernia. To all patients a polypropylene mesh was applied, 12 onlay, 2 inlay, 5 sublay and 3 underlay. Results: There were two serosal lesions and only one perforation. There were 4(18%) patients with seroma, 1 (4.5%) with haematoma, 4 (18%) with infection, 3 (13.6%) with DVT, 1 (4.5%) with non fatal PE, and 1 (4.5%) respiratory failure. The highest incidence of complications were in the onlay repair, the lowest in the underlay repair. The patients were followed for two year, there were 6 recurrence (27.2%), most of them were in the onlay repair with the highest incidence in the inlay repair. The incidence of recurrence in the onlay to inlay was statistically non significant (P<0.5), the onlay to the sublay was significant (P<0.05) and the onlay to the underlay was highly significant (P<0.02). Conclusion: It is to be concluded that when a patient with recurrent incisional hernia is in need for repair, it is better to avoid inlay technique, not to do the underlay and the onlay techniques, and recommended to do the sublay approach.

Assessment of some herbal drugs for prophylaxis of peptic ulcer

Aqueous [hydrophilic] and chloroform [Lipophilic] extracts of nine medicinal plants currently used in traditional medicine, in Egypt, to treat some gastrointestinal tract [GIT] disorders were tested for their gastro-protective effect against the incidence of peptic ulcer. Indomethacin-induced ulcer in a rat model was used for this testing. Mentha microphylla, Brassica oleracea Capitata [Cabbage], B. oleracea Botrytis [cauliflower] aqueous fraction, Lagenarea sicerarea polysaccharide fraction, Oreganum marjoranum, Matricaria recutita, Solanum nigrum hydrophilic and lipophilic fractions, in addition to the chloroform fraction of Lagenarea sicerarea and Cicorium intybus afforded high protection against the incidence of gastric ulcer [ 95%]. O. syriacum hydrophilic and lipophilic fractions and gum arabic afforded moderate prophylactic effect. L. sicerarea, C. intybus hydrophilic fractions and M. microphylla lipophilic fraction were inactive. Herbs represent excellent resources for cost-effective and readily available gastro-protective remedies without side effects

Angiogenic potential of human umbilical cord blood ex vivo expanded CD 133* stem cells in chronic hepatic fibrosis of murine schistosomiasis

As a source of hematopoietic stem cells [HSCs], umbilical cord blood [UCB] has the advantages of speed of availability, tolerance of more than one HLA mismatch, and a low incidence of severe graft-versus-host disease [GVHD]. Hence, it represents a promising, alternative non-costly and non-invasive source for prospective stem cell based therapy. In this study we investigated the angiogenic potential of ex vivo expanded human umbilical cord blood CD 133* stem cells transplanted into mice with chronic hepatic fibrosis induced by Schistosomiasis infection. Histopathological, ultrastructural and immunohistochemical analysis of mice liver sections were done to detect specific human angiogenic markers. Umbilical cord blood was obtained from healthy pregnant females after delivery and mononuclear cells were collected by density gradient using Ficoll Hypaque. Enrichment for the CD 133* stem cells was done by positive selection using the Magnetic Activated Cell Sorting system and magnetic microbeads. Cells were cultured in prirnaly ex vivo expansion medium for three weeks. Flowcytomeric analysis of the cultured cells was done in each step to identify the CD 133* cells. Schistosomiasis was induced in Swiss Albino mice by intradermal injection of schistosoma cercariae. Twenty two weeks post schistosoma infection a total of 0.3 x 106 human CD 133* stem cells were injected intrahepatically in mice. Accordingly, mice were divided into three groups: Group 1 [infected, transplanted]; Group 2 [infected controls] and Group 3 [healthy, transplanted]. All mice were sacrificed 3 wks after cell transplantation was done in groups I and 3. Histopathology and Electron microscopy showed an obvious increase in the capillary network and the small blood vessels and a decrease in the fibrosis known for this stage of the disease. By immunohistochemical analysis the cellular constituents of these newly formed blood vessels showed positive expression of the human-specific angiogenic markers CD31, CD34 and von Willebrand Factor [vWF]. Few hepatocyte like polygonal cells showed positive expression of human Vascular Endothelial Growth Factor [VEGF] and inducible Nitric Oxide Synthase [iNOS]. Ex vivo expanded CD 133* human stem cells incorporate into the liver of schistosoma infected mice enhancing local angiogenesis and hepatic neovascularization. These preliminary results obtained suggest a dual benefit of CD 133* cells in cell therapy in hepatic diseases based on its capability of hematopoietic and endothelial differentiation. We suggest that the CD 133* cells contribute to repair in a paracrine manner by creating a permissive environment that enables rapid proliferation and survival of damaged cells rather than through direct differentiation to hepatocytes

Detection of anticardiolipin and antinuclear antibodies in juvenile idiopathic arthritis and their relation to disease activity

Juvenile Idiopathic Arthritis [JIA] is an autoimmune disorder. The American College of Rheumatology defined juvenile arthritis as a chronic condition that causes inflammation in one or more joints and begins before the age of sixteen. Juvenile arthritis may be difficult to diagnose because children often compensate well for loss of function and may not complain of pain. Observations of limping, stiffness when awakening, reluctance to use a limb or reduced activity level may be clues. Anticardiolipin antibodies [aCL] have been demonstrated in a large spectrum of autoimmune diseases. However, its occurrence in childhood, in particular in JIA, is not well established. The present study addressed the frequency and clinical significance of aCL and to find an association of aCL and antinuclear antibodies [ANA] with JIA and their correlation to clinical picture, functional capacity and disease activity. Thirty five children were included in this study. The patients group consisted of 20 children [6 boys and 14 girls] with JIA according to the American College of Rheumatology [ACR] 1987 criteria and fulfilling the criteria for diagnosis of JIA [Cassidy and Pretty, 1990]. Their mean age was 12.0 years [yr] +/- 2.6 SD, ranged from 8.3 to 16 yr, with a mean of disease duration 3.4 yr +/- 1.1SD, ranged from 1.4 to 5.0 yr. The control group consisted of 15 healthy children [6 boys and 9 girls] with a mean age of 11.9 [yr] +/- 2.2 SD, their ages ranged from 7.3 to 15.3 yr. The JIA patients group was further classified into two subgroups according to the onset of the disease into systemic onset [no.= 7] and polyarticular-pauciarticular [P-P] [no.= 13]. All groups were subjected to complete history taking and physical assessment of local articular and systemic manifestations. Assessment of the degree of disease activity for JIA patients was performed according to Mallya and Mace scale [1981]. The functional capacity in all subjects was assessed according to Juvenile Arthritis Function Assessment Scale [JAFAS]; this scale ranged from 0 to 20. Blood samples were collected and subjected to the following tests: Complete blood count [CBC], ESR, C- reactive protein, Latex agglutination slide test for RF, and assessment of aCL [IgG and IgM] antibodies and ANA using ELISA method. There was increased incidence of disease in females rather than males [nearly double] and the P-P in patients represented 65%. There was a significant increase of ESR and serum levels of ANAs, aCL [IgG and IgM] autoantibodies and JAFAS [p<0.05] in the JIA patient groups as compared to the control group. There was a significant increase of ESR, AI and activity grade in systemic onset group as compared to P-P patients group [p<0.05]. The correlation study in P-P patients group determined a significant negative correlation between aCL- IgG with patient's age of onset and morning stiffness [p<0.05]. A significant positive correlation was found between disease duration with age [p=0.03] and no. of swollen joints [p=0.009]. In the systemic onset patients group, there was a non-significant correlation of aCL-IgG with any clinical or laboratory data [p>0.05], while significant negative correlations was found between aCL-IgM with age, age of onset, JAFAS and ANAs [p<0.05]. There was a positive significant correlation between ANAs and no. of swollen joint [r=0.79, p=0.04] and JAFAS [r=0.78, p=0.04]. We encountered two JIA female patients having positive aCL and ANA antibodies who manifested as P-P onset of the disease. They should have clinical follow up and regular ophthalmologic examination as they are highly susceptible for uveitis. The presence of aCL was not associated with ANA. The relation of aCL with the clinical parameters, could not be established. Age of disease onset, sex, disease activity, and JAFAS could be a prognostic indicator rather than immunological profile tests