Susceptibility patterns of TB isolates from HIV-infected and non-HIV- infected tuberculous patients at king Abdulaziz university hospital, Jeddah, Kingdom Of Saudi Arabia

Tuberculosis [TB] is the most common opportunistic infection and leading cause of death in persons infected with human immunodeficiency virus [HIV] worldwide. HIV pandemic is one of the greatest challenges facing TB control program. Immune suppression by HIV- infection increases the risk of reactivation of latent TB infection and rapid progression of either recent or latent TB infection to active TB disease. Multidrug resistant- TB [MDR -TB] has been associated with inadequate and poor adherence to treatment regimens, poorly managed TB- control programs, as well as HIV- infection. Comparing the anti- tuberculous drug resistance patterns of Mycobacterium tuberculosis complex [MBTC] isolates from HIV-seropositive and HIV- seronegative TB patients attending King Abdulaziz University Hospital [KAAU], Jeddah, KSA, from January 2011 till January 2013. A total of [132] TB patients were included, they were divided into 31[23.48%] patients with HIV- infection [51.60% males and 48.40% females]and 101[76.52%] patients without HIV- infection [40.60% males and 59.40% females]

All resistance detected in our study was primary resistance except one case with secondary resistance. Our results showed that, the percentage of any resistance to rifampicin was higher in TB patients with HIV- infection than those without HIV- infection [19.4% vs 3%] with high significant difference. While the percentage of any resistance to streptomycin was higher in TB patients with HIV- infection than those without HIV-infection [9.7% vs 0.0%] with significant difference. The percentage of monoresistance to rifampicin was higher in TB patients with HIV- infection than those without HIV- infection [9.7% vs 2%] with significant difference. The percentage of one drug resistance was higher in TB patients with HIV-infection than those without HIV- infection [19.4% vs 3%] with high significant difference. Moreover, the percentage of MDR -TB [resistance to rifampcin and isoniazid] was higher in TB patients with HIV- infection than those without HIV- infection [9.7% vs 2%] with significant difference. Also, there was one patient [3.2%] had 4 drug resistance and also one patient [3.2%] had 5 drug resistance in TB patients with HIV-infection

Conclusion: Our study showed significant associations between any resistance to rifampicin and streptomycin, monoresistance to rifampcin and MDR strains with HIV- seropositive than HIV-seronegative TB patients

Recommendations: HIV testing of TB patients and susceptibility testing ofM. tuberculosis isolates from HIV- infected patients should be routinely done for early detection of resistant strains

Midazolam versus metoclopramide in prevention of nausea and vomiting after cardiac surgery

To compare the effect of metoclopramide versus midazolam on the incidence of nausea and vomiting after cardiac surgery. Prospective, randomized double blind study. 45 patients aged from 18-60 years old, ASA physical state fl or HI underwent elective cardiac surgery using cardio-pulmonary bypass [CPB] were assigned to one of three groups [15 patients each] according to the antiemetic drug received, group [I], received intravenous saline 0.9% 10 ml/kg [control group], group [fl], received metoclopramide O.lmg/kg IV bolus at time of initiation of CPB, then O.lmg/kg IV after weaning off CPB and every 6 hrs for 24 h postoperative and group [LLJ], received a 1 mg IV bolus of midazolam at time of initiation of CPB, then a continuous infusion of midazolam 0.02 mg/kg/h from the time of successfully weaning off CPB until 24 h after surgery. The following parameters were assessed: visual analogue score [VAS], postoperative nausea and vomiting, dose of rescue antiemetic, Ramsay sedation score, fentanyl consumption during 24 hours and side effects. As regard sedation score, most of the patients were cooperative, oriented and sedated during the 1st postoperative day but sedation was observed more in the midazolam group. The mean nausea score and the incidence of postoperative vomiting were less in group II and group III than the control group and this decrease was significant in the midazolam group when compared to the control group at most of the recorded times. The incidence of postoperative vomiting and dry retching was 53.3%, 20%, 13.3% in the three groups respectively by the end of the 1[st] postoperative day. As regard the need for rescue antiemetic, a significant decrease in the need for rescue antiemetic was observed more in group III compared to the other two groups. As regard complications and side effects, no patient in the study groups had any drug related complications or developed any electrocardiograph

distribution of human leukocyte antigens class-I alleles in ulcerative colitis patients in Egypt

Advances in Inflammatory Bowel diseases [IBD] genetics hold the potential to provide knowledge about the disease pathogenesis at the molecular level, with ensuring benefits for clinical practice. The association between ulcerative colitis and human leukocyte antigens [HLA] typing varies from race to race. In an attempt to clarify the association between HLA typing and ulcerative colitis in Egypt this study was performed on 30 patients with ulcerative colitis, 50 healthy volunteers were taken as controls, all patients subjected to full clinical examination and investigated with, sigmoidoscopy, rectal biopsy, barium enema and examination of faeces, determination of HLA type was done for patients and controls. The study revealed that patients with ulcerative colitis have significant frequencies of HLA-A25-26 and HLA-B13 as compared to controls [50%, 50%and 55%vs7.3, 7.3 and 10.6 respectively, p<0.05]. Their relative risks are significantly high [12.69,12.69 and 10.3 respectively,p<0.05]. We conclude that HLA typing provides a useful non-invasive diagnostic modality for ulcerative colitis in Egypt. However, this needs to be verified on a large scale

Role of interleukin-18 in allergic rhinitis

The role of IL-18 has not been well studied in allergic rhinitis. Few studies demonstrated up- regulation of IL-18 in nasal discharge of allergic rhinitis patients. The persistence of elevated IL-18 concentrations until after the season suggests a role for this cytokine in persistent allergic inflammation. In this study, we tried to through light on this role in patients with allergic rhinitis by investigating whether polymorphism is present in the coding regions of the IL-18 gene and, if so, to further analyze the association between polymorphism and allergic rhinitis in a case-control study. Blood samples were collected from 32 patients and 8 healthy controls matched by age and sex. Every patient was subjected to skin prick test [SPT] to confirm the clinical diagnosis and to detect the causative allergen[s]. Sera from the patients and controls were analyzed by using PCR single-nucleotide polymorphisms [SNPs]. There was a significant difference of IL-18 gene polymorphism at position -137 among allergic rhinitis patients and controls. The frequency of the -137C allele was significantly higher among allergic rhinitis patients as compared to the controls. We concluded that IL-18 gene polymorphism may represent an important susceptibility biomarker for the increased susceptibility to allergic rhinitis. This study reinforced the need for in-depth analysis of immune dysregulation of patients with allergic rhinitis arid point to the potential usefulness of cytokine-based therapy