outcome of a combination of superfi cial femoral artery angioplasty with infragenicular angioplasty in the treatment of critical lower limb ischemia

As endovascular disease with significant femoropopliteal or infragenicular arterial lesions largely affects the outcome in critical limb ischemia [CLI], the aim of this study is to examine the impact of dealing with distal outfl ow infragenicular arterial lesions on the outcome of CLI in terms of patency and limb salvage rates. A prospective study was carried out of all endovascular interventions performed for patients with CLI encountering femoropopliteal and tibial arterial lesions between February 2012 and January 2014; the patients were randomly divided into two groups. The first group included patients who received a concomitant tibial intervention and the second group included those who received femoropopliteal interventions alone. The duration of follow-up was 12 months, which was within the period of this study. Endovascular procedures were used to treat 54 patients with a runoff score of greater than 10. The first group included 29 patients and the second group included 25 patients with CLI. Primary success reached 89.6% in the first group and 96% in the second group. Primary patency rates at 12 months were 59 and 51% in both groups, respectively, whereas secondary patency rates at 12 months were 70 and 52% in both groups, respectively, with no statistically significant difference. The limb salvage rate over 12 months was better in the first group [83%] than in the second group [76%]. Although simultaneous superfi cial femoral artery with tibial angioplasty did not yield a significant increase in patency rates, the better limb salvage rates make interventional treatment for infragenicular arteries a key part of the vascular specialist armamentarium when treating CLI

Evaluation of the application of DOTS strategy in Gharbia Governorate

Egypt has succeeded in implementing the directly observed treatment, short course [DOTS] strategy nationwide. This strategy involves the direct observation of tuberculous patients during drug intake to ensure that the full treatment course is followed. It has been shown world-wide that patients treated without direct observation have a substanti ally higher risk of adverse outcome than those treated under direct observation. Estimate the risk of Mycobacterium Tuberculosis disease in a trial to reduce its prevalence and evaluating DOTS strategy implementation in Gharbia Governorate to prevent the spread of tuberculosis in the community by early detection of patients with infectious tuberculosis and providing them with effective treatment to ensure a rapid and lasting cure. Diminished development of treatment failure and resistant cases would thus follow as an achievement. This study included 276 tuberculous patients who attented in the last two year 2006, 2007 in Mehalla El Kobra and Tanta chest centers. They were categorized according to their locality arid study year. Their age, sex, site of tuberculosis, the regimen of drug used, were recorded. The treatment outcome of the patient and notification of number of cured, completed treatment, relapsed, treatment failure, transferred and died patients were also thus known. The 276 tuberculous patient, included 101 patients belonging to Mehalla [41 patients in 2006 and 60 patients in 2007] and 175 patients belonging to Tanta [88 patients in 2006 and 87 patients in 2007]. The pulmonary form of the disease represented 77.23% in Mehalla and 76% in Tanta. The remaining were extrapulmonary. In relation to gender there were male predominance 64.36% in Mehalla and 69.71 in Tanta. The difference was statistically insignificant. The percent of treatment success in the form of cured and completed treatment patients were 88.12 in Mehalla and 77.14 in Tanta. The percent of treatment failure were 1.98 in Mehalla and 4.57 in Tanta. The percent of died patient were in 2.97 Mehalla and 5.72 in Tanta. The difference were statistically significant [p<0.05]. cases needs to be improved, so that treatment would be initiated early enough to minimize pre-treatment transmission of infection in the community. The need for interventions aiming at, earlier identification of sources of infection and reducing tuberculosis transmission in the studied communities and in other similar communities, is urgent. However the outcome of successful manangement of the detected cases in the study fulfills the desired international standard in Mehalla and is promising in Tanta, which would satisfy the desired effect of avoiding resistence of the bacillus with its economic, medical and social burden

study on the aetiology of pneumonia in Cairo and Tanta university hospitals: a bacteriologic approach

One hundred and sixty cases of "pneumonia" with proved clinical and radiological evidence from the Chest Departments in Cairo and Tanta University Hospitals during the year 2007, were the subjects of a conventional bacteriologic study having in mind the empirical approach in the antibiotic therapy. They represented 4.06% of the yearly admissions. The major age incidence was 16 year with more sex predilection. 92.5% belonged to CAP [community acquired pneumonia] and only 7.5% to HAP [hospital acquired pneumonia], VAP [ventilator associated pneumonia] being excluded. 80.6% were primary; with no antedating pathology in the patients, while 19.4% were secondary with co-morbidity in such patients; out which malignancy and COPD were the main associations in older age groups and foreign body in younger ages. The causative organisms were bacteriologically identified only in 53.7% of cases. The main organism in the causation of CAP was Streptococcus pneumoniae in 51.7% of the cases, followed by Hemophilus influenzae in 15.5%, while in HAP, 2 major organisms were responsible for the disease; namely Streptococcus pneumoniae and Klebsiella pneumoniae; 33.3% for each, followed by Hemophilus influenzae and Streptococcus pyogenes; 11.1% for each, but the number of cases in HAP is too small to draw valid conclusions. The organism detected, in primary pneumonia was also essentially Streptococcus pneumoniae 57.6%, while in secondary pneumonia the same organism was encountered in only 33.3% of the cases. Concerning the lobar and lobular distribution of the disease the S. pneumoniae was overwhelming in the lobar type: 84.2%, while in the lobular bronchopneumonic type the main organisms, besides S. pneumoniae which was responsible for 22.2% of the cases were S. pyogenes was responsible for one quarter of the cases and H. influenzae which was encountered in 22.2%. Figures for other organisms are detailed in the text with their relation to other parameters of the study

study on the aetiology of pneumonia in Cairo and Tanta university hospitals, a bacteriologic approach

One hundred and sixty [160] cases of "pneumonia" with proved clinical and radiologic evidence from the Chest Departments in Cairo and Tanta University Hospitals during the year 2007, were the subjects of a conventional bacteriologic study having in mind the empirical approach in the antibiotic therapy. They represented 4.06% of the yearly admissions. The major age incidence was 16 year with more male sex predilection. 92.5% belonged to CAP [community acquired pneumonia] and only 7.5% to HAP [hospital acquired pneumonia], VAP [ventilator associated pneumonia] being excluded. 80.6% were primary; with no antedating pathology in the patients, while 19.4% were secondary with comorbidity in such patients; out which malignancy and COPD were the main associations in older age groups and foreign body in younger ages. The causative organisms were bacteriologically identified only in 53.7% of cases. The main organism in the causation of CAP was Streptococcus pneumoniae in 51.7% of the cases, followed by Hemophylus influenzae in 15.5%, while in HAP, 2 major organisms were responsible for the disease; namely Streptococcus pneumoniae and Klebsiella pneumonia; 33.3% for each, followed by Hemophylus influenza and Streptococcus pyogenes; 11.1% for each, but the number of cases in HAP is too small to draw valid conclusions. The organism detected, in primary pneumonia was also essentially Streptococcus pneumoniae 57.6%, while in secondary pneumonia the same organism was encountered in only 33.3% of the cases. Concerning the lobar and lobular distribution of the disease the S. pneumoniae was overwhelming in the lobar type: 84.2%, while in the lobular Bronchopneumonic type the main organisms, besides S. pneumoniae which was responsible for 22.2% of the cases, were Streptococcus pyogenes was responsible for one quarter of the cases and H. influenza which was encountered in 22.2%. Figures for other organisms are detailed in the text with their relation to other parameters of the study

Study of psychological aspects in asthma an Egyptian experience

The problem of psychologic trouble in asthma is frequently overlooked, and needs to be assessed. For this purpose 40 asthmatic patients were investigated. A psychological trouble was found to be present in 55% of them; mostly in the form of anxiety/neurosis [84.6%]. Its proper conventional management, when added to the traditional phamacotherapy, stepped up the outcome of treatment in the particular case: The success, interpreted as relief and control parameters; combined together in the treatment which means controlled or partially controlled, reached 81.8% in these patients. The incidence of "difficult to treat" or uncontrolled cases dropped from 36.4% to 18.2%, when such cases received added psychotherapy. Even the comparison of the overall relief and control of patients revealed significant better outcome, when the proper treatment was applied to either patients with or without psychological trouble; figures being 81.8% and 77.7%, respectively. As a pilot study, this presentation calls for more elaborate study on the subject, with special attention to whether the relationship is a cause and effect one and/or a mere association

Serum interleukin levels in asthmatic patients with eosinophilia

The incidence, morbidity and mortality of bronchial asthma have increased over the last two decades. Immune and inflammatory responses mediated by cytokines are essential in the pathophysiology of bronchial asthma. Substantial evidence has implicated Th2 cytokines, IL-4 and IL-5, in the pathology of allergic asthma and demonstrated protective effects of Th1 cells. This work was conducted to study the serum levels of IL-4, IL-5, IL-12 and IL-18, in patients with allergic asthma associated with eosinophilia. Interleukins levels were correlated with IgE level and the degree of eosinophilia in these patients. The study included 25 asthmatic patients with acute attack of bronchial asthma, associated with history of allergy and eosinophilia; and 25 normal healthy controls. All patients and controls were subjected to full medical history, clinical examination, and laboratory investigations for assessment of the eosinophil count and measurement of serum levels of IgE and interleukins [IL-4, IL-5, IL-12 and IL-18]. The correlation between interleukin [IL] levels, and degree of eosinophilia and IgE levels were also examined in these patients. Measurement of serum levels of interleukins showed significant elevation of IL-4, IL-5 and IL-18 levels in asthmatic patients as compared with the control group [p<0.0001], whereas IL-12 levels did not show any significant change [p>0.05]. Marked elevation in the IgE level and eosinophil count were also detected in asthmatic patients as compared with the control group [p<0.0001]. Significant positive correlations were observed between serum levels of IL-4, IL-5 and IL-18 and the degree of eosinophilia in asthmatic patients. A significant positive correlation was also detected between level of IL-18 and the IgE level in asthmatic patients. Patients with allergic bronchial asthma have elevated levels of IL-4, IL-5 as well as IL-18; and these levels correlated significantly with degree of eosinophilia in these patients. Further studies are needed to clarify the signaling cascade involved in allergic responses mediated by these ILs. This may help in developing new therapeutic modalities, as blockade of IL receptors, for these conditions

Tuberculosis and HIV infection: an egyptian experience

The interval change, in the association of Tuberclosis and H.I.V. infect ion, was studied; clinically, and by radiologic, pathologic, and microbiologic parameters. An immunologic study, for HIV. serology, was also carried out in two stages: The first was a screening phase; by the HIV 1 and 2 ultra-rapid test device [Serum/Plasma] and the second was confirmatory by the Immunocomb II HIV 1 and 2 Bispot. The immunologic study was done for 22 of 121 proved total tuberculous cases. These 22 cases had a high risk for HIV infection. The risk factors included, as examples, behavioral aberrations, encountered in 18.2% and blood transfusion in 59.1% of such high risk cases. Also sexual aberrations, though not reported in the present study, in spite of meticulous inquiry, received proper attention. No HIV. Seropositivity was met with in the present study. Hence the problem is not sizeable, but multicenter studies, in Egypt, are recommended, in order to have a global view of the problem. Also periodic assessment of the problem, is needed in order not to be suddenly faced by its hazards

Trends of ambulatory management of pulmonary tuberculosis: experience in Mehalla El Kobra chest center, Egypt

A major chest center, in Mehalla El Kobra, Egypt, was chosen to carry out the present study. A total of 812558 individuals attended the dispensary during the 25 years covered in the study; starting from 1971 and ending in 2001, inclusive: our of these, 5179 cases were diagnosed as being turberculous: The pulmonary cases were 4831 and the extra-pulmonary were 348. The trend in the incdenee of pulmonary cases was declining, being 99.2%, of all T.B. cases, at the starting year, 1971, while it dropped to 77.1% in the last year, 2001. The analogous figures for extrapulmonary cases are rising i.e. 0.8% and 22.8%, respectively. The positive yield on sputum smear, rose from 12.1% of the pulmonary cases in the year 1977 to 70.4% in the year 2001, Hence there is prompt and active case finding at the center, by sputum microscopy, among the pulmonary T.B. patients. Before the year 1992 short-term therapy was used only in hospitalized and not in ambulatory chest center patients. It was instituted, for some cases together with other cases who received only the old standard treatment in the center, for ambulatory cases in the year, 1992. It was thus decided to further analyze the data of the trends of tuberculosis treatment, in the chest center, starting from this year; 1992 and for the following 10 year; up to 2001; inclusive. The initial number of pulmonary T.B. cases during this period was 946. Their contacts; presenting for examination in the dispensary, were 3942, viz 4.1 contacts for every index case. The overall rate of detection of T.B. among the contacts, was 4.7%. Out of the 946 original pulmonary T.B. cases during the 10 studied years, the outcome of management could be traced in 634 patients; at the time of the study during 2002, i.e. 67%: 40.6% of the traced cases received the older traditional standard therapy, before the nation-wide application of the recent short-term therapy. Thus short-term therapy was prescribed to 59.6% of the whole traced cases. The favourable outcome; namely cured and completed treatment cases, was achieved in 70.6% of those on short-term therapy, while the analogous figure for cases on standard therapy, was 60.6% [p < 0.05]. The analogous figures for unfavourable outcome were 20.3% and 34.1% for short-term and standard therapy cases, respectively [p < 0.05]. Cases referred on their own request, to other centers, for further management were not included. The application of DOTS therapy definitely improved the outcome. The defaulting rate, thanks to DOTS, dropped to 7.6% as whole, when compared to 21.5% in the era before DOTS application [p <0.005]. The same beneficial trend could not be demonstrated, as far as treatment failure is concerned, possibly due to such cases being resistant, which may need DOTS PLUS; as a policy. Such policy is not yet applicable, at the surveyed area. The over-all look is promising and hence perfect combat, on the way of irradication, may be expected and even foreseen, in our local circumstances

role of parenteral iron therapy in treating the chronic hemodialysis associated anemia, a comparative study between iron saccharate and gluconate

Anemia in hemodialysis patients is a complex syndrome and many factors other than absolute or relative erythropoietin [EPO] deficiency may contribute to it. The most important factor is the presence of iron depletion. The impetus of this study was to assess the safety and efficacy of iron saccharate complex [ISC] and sodium ferric gluconate complex [SFGC] as relatively new parenteral iron preparations in treating anemia in hemodialysis patients. Forty-eight adult anemic patients of both genders [33 males and 15 females] who had an adequate level of both hemodialysis and nutrition status and received neither EPO nor parenteral iron therapy during the preceding 6 months were randomized into two groups. The first group, comprised 22 patients who were treated with parenteral ISC, 100 mg twice weekly for two months and once weekly thereafter. The second group included 26 patients who received SFGC, 62.5 mg twice weekly for two months and once weekly thereafter. The patients were followed up for 6 months. Our results showed that iron stores had been adequately repleted by the use of both parenteral iron formulas. Repletion of iron stores was associated with a significant rise of both hemoglobin and hematocrit% in both groups at the end of follow up period in comparison to their initial values at the start of the study [P < 0.001]. Both parenteral iron therapy preparations were tolerated and comparable with no statistical difference between both groups. Parenteral iron saccharate and gluconate are effective and sale treatment of anemia associated with chronic hemodialysis patients provided that they had an adequate level of both dialysis and nutrition

Defects in asthma management: a factual clinical Egyptian experience

A factual clinical approach concerning the management of bronchial asthma patients in an Egyptian experience is the main objective of this study in order to disclose any defects and try to amend them. A total of 870 patients were included in this study. Only 750 were analyzed as 120 of them were considered not to be genuine asthmatics and were thus excluded. 41.3% of asthmatic cases were managed by general practitioners [GPs], while 37.6% were managed by chest specialists. Other specialties including pediatricians, general medical physicians and allergy specialists managed 21.1%. In 89.5% of the patients, ventilatory functions were not done. The classification management according to GINA and Egyptian guidelines were not possible in 91.4% and 93.1%, respectively. The main bulk in this defect was among general practitioners [90%], the least was among chest specialists [49.2%]. Other specialists shared in this defect by 87.3%. Non-compliance in the management was essentially in inhalation therapy [40.2%], followed by corticoid therapy [34.89%]. Cost of drugs was prohibiting in 19.2% of cases as an outcome 35.3% of patients could be relieved in their acute episodes, while only 15.5% could achieve control of their disease. All these parameters were also analyzed according to the managing speciality

Serum intercellular adhesion molecule 1 [sICAM-1] and vascular cell adhesion molecule 1 [sVCAM-1] in asymptomatic smokers

Adhesion molecules particularly ICAM-1 and VCAM-1 are known inflammatory markers in chronic inflammation. Hence it was thought feasible to study their level in smokers before symptoms appear possibly as an early predictor in this respect. Twenty-five male asymptomatic subjects were studied, of whom 32 were smokers and 20 were matching non-smokers. The smokers were subdivided into 22 cigarette consumers and 10 "goza" or "shisha" smokers. Serum ICAM-1 and VCAM-1 levels were estimated in all subjects. The results refer to a highly significant rise in sICAM-1 level and a significant rise in sVCAM level in smokers than non-smokers, mean figures being 318.5, 208, 655.9 and 576.8 mug/ml, respectively. The difference was also statistically highly significant when mild cigarette smokers and "goza" or "shisha" consumers were compared, figures being 230.8, 336.4, 520.8 and 749.5 mug/ml, respectively. It can be concluded that both studied adhesion molecules levels are raised in smokers, even before symptoms appear. This rise may be an early predictor for future occurrence of asthma and/or COPD even in a preclinical stage. BAL level of such products is suggested to be a future study to establish a local issue in this respect

Smoking attitude in sports: an Egyptian experience

This study aimed to investigate the attitude towards smoking in "Ahli Sporting Club" as a leading club in sports in Egypt. A total of 480 subjects was approached by a preset and a pretested questionnaire prepared for the objective with an adequate response rate of 93%. The mean age of the players was statistically significantly less than that of their responsible technical and administrative staff, being 23.7, 43.5 and 51.6 years, respectively. Males constituted 77.7% of the total subjects. Football showed the highest figure in the activity, 38.3% of the whole group and 41.0% of the players. The current smokers in the whole group constituted 12.3% of the total subjects, which was much lower than the figure in the Egyptian community as a whole and also in many other professions. The study concluded that the attitude towards smoking in sports needs a proper attention, especially among the responsible staff. Although it is less encountered than among other jobs, it is an important sector in the population, especially among the youth

Tracing of pulmonary tuberculosis cases among "goza" smokers using mycobacterial phage typing

The present study included 564 patients with chest symptoms belonging to 3 groups: 175 cigarette smokers, 160 "Goza" smokers [Hubble-bubble or water pipe] and 229 non-smokers. The objective was defining any relation between "Goza" smoking and pulmonary tuberculosis, with special utilization of the technique of Mycobaeteriophage typing in this respect. Results refer to a definite statistically significant increased incidence of pulmonary tuberculosis among "Goza" smokers [19.3%], versus cigarette smokers [5.7%] and non-smokers [4.8%]. There was also statistically significant difference in the clinical and radiological aspects between the 3 groups, namely: art increased incidence of haemoptysis [51.6%] and dyspnea [64.5%] in Goza smokers and more far-advanced extent of the disease among them [70.9%]. The resistance pattern of Mycobacteria isolated from tuberculosis "Goza smokers belonging to the same "Goza-smoking session', was the same, in each of 9 "sessions" from which the cases were collected. The same trend was obtained when the phage typing of the bacilli was correlated with the "Goza-smoking session'. The same phage type, was shown, among the patients collected from the particular session e.g. sessions I .2,3 and 4 showed only phage type A in all their tuberculous patients while session 6 showed phage type B. Phage type Ax was isolated only from session 7 and phage type C only from session 9 and phage type I from session 8. It can he concluded that the mass use of one 'Goza" in the concerned "Goza-smoking session', usually in an unwholesome atmosphere among consumers with low apprehension of symptom like cough and expectoration, is a definite risk factor for cross-infection with pulmonary tuberculosis discovered in an advanced stage. So, "Goza" smokers are a high vulnerable group, in this respect, that needs special epidemiological attention as a public health problem

Videcoscopic versus mini-incisional ligation of incompetent perforating veins of the legs in the treatment of chronic venous insufficiency with leg ulceration

Comparative study of the results of videoscopic versus mini-incisional ligation of perforating veins of the legs in the treatment of chronic venous insufficiency as regards to ulcer healing and recurrence rates and compared them with preoperative and postoperative duplex findings. Patients with venous ulceration on the medial side of the lower leg were randomly allocated to endoscopic exploration or mini-incisional ligation of perforators. All patients were put in a follow up schedule for 24 months. Ulcer healing and recurrence rates were documented and the results were compared. Fifty patients were randomly allocated to exploration, 24 patients to subfascial endoscopic division of incompetent perforating veins [Group I] and 26 patients to mini-incisional perforator ligation [Group II]. During the follow-up period, two patients in the SEPS group and four patients in the mini-incisional group were lost from follow up. In a mean follow-up period of 24 months, the venous ulceration of all 44 patients in both groups who were available for follow-up initially healed. The recurrence rate in Group I was 18% [4 patients]. In Group II, the recurrence rate was 22.7% [5 patients]. The follow-up results of the endoscopic division of perforating veins are comparable with those of the mini-incisional ligation of perforating veins. There is insignificant difference in recurrence rate. The mini-incisional technique is simpler with low incidence of postoperative wound complications. The ligation of incompetent perforating veins of the legs has high recurrence rate and should be restricted to patients with persistent ulcerations despite goodúconservative treatment. The comparative results of both research techniques make us to restrict SEPS technique to those legs with severe lipodermatosclerosis at the perforator site

Evalation of deep venous thrombosis in the lower limbs and pelvis. mr venography versus duplex doppler sonography

This study was designed to show the comparable diagnostic value of MR venography and color Doppler Sonography in the assessment of deep venous thrombosis [DVT]. Twenty five patients with clinically suspected DVT of the lower limb and pelvis were included in this study. Two Dimensional Time of Flight MR venography and color Doppler sonography were performed to all cases twelve hours before conventional venography. The data were collected prospectively and analyzed in blinded manner. In evaluating DVT in the pelvic region, MR venography was superior to color Doppler sonography, reported 91% sensitivity and 99.4% specificity versus 78% sensitivity and 98% specificity for Doppler sonography. MR venography and color Doppler sonography were 100% sensitive and 100% specific in evaluating DVT in the thigh region. While, MR venography surpassed both techniques in evaluating DVT in the calf veins, with sensitivity and specificity of 87.5% and 99% respectively versus 67% sensitivity and 97% specificity for color Doppler sonography. MR showed more ability to assess the extent of thrombus. MR venography showed 47 collateral vessels, where as only 40 were dedected by contrast enhanced venography. The combined readings of axial and maximum intensity projection MR images was significantly modified the levels of sensitivity and specificity of MR venography. MR venography was more sensitive than color Doppler sonography in evaluating pelvic and calf DVT. Where as both techniques were equivalent in evaluating femoro popliteal DVT. MR venography showed better demonestration of thrombus extension and collaterals