Types and microbiological spectrum of infections in patients with cirrhosis: a single-centre experience in Upper Egypt

Background and Study Aims: Egypt has a high prevalence of hepatitis C virus [HCV] and high morbidity and mortality related to cirrhosis complications. Patients with cirrhosis have an increased risk of bacterial infections. Approximately 25-35% of cirrhotics had infections at admission or during hospitalisation. Data on infection among cirrhotics in Egypt are limited. This study aimed to determine the frequency and microbiological spectrum of infections in cirrhotics and possible risk factors

Patients and Methods: This study was conducted at a tertiary care hospital. The frequency and microbiological spectrum of infections in cirrhotics were determined. The risk factors for infection were evaluated

Results: Of the 100 patients with liver cirrhosis, 61% had infection. Ascitic fluid infection [AFI] was the most common infection [44.3%], followed by urinary tract infection [UTI] [21.3%], respiratory tract infection [RTI] [19.7%], gastroenteritis [6.6%] and skin infection [4.9%]. The only risk factor for infection among cirrhotics was diabetes mellitus [DM] [p = 0.047]. The mean value of mid-arm muscle circumference was significantly lower in the infected group [p = 0.047]. Among all the cirrhotics, 32.0% had mild to moderate malnutrition and 52.0% had severe malnutrition. The frequency of infection was higher in severe malnutrition [71.2%]

Conclusions: The frequency of infections among cirrhotics was 61%. Many types of infections including AFI, RTI, UTI and skin infections were present in patients with liver cirrhosis, but AFI was the most common. DM was the only risk factor for infection, and independent predictors for infection were elevated WBC count and C-reactive proteinlevels. The frequency of infection was related to the degree of malnutrition

Esophageal stricture causes and pattern of presentation at Ibn Sina Specialized Hospital

The aim of this study is to evaluate the causes and pattern of presentation of esophageal stricture in Ibn Sina Specialized Hospital. This is a retrospective study done at Ibn Sina Specialized Hospital during the period from April 2008 to December 2008. All patients had upper gastrointestinal endoscopy [UGIE], and those who were found to have esophageal stricture were enrolled in the study. The data collected were then processed and analyzed using appropriate statistical tests. Out of 780 patients who had UGIE, 60 were found to have esophageal stricture; 37 [61.6%] were males. The age group ranged between 20 years and 89 years, with a mean [ +/- SD] age of 50.483 [ +/- 17.437] years. Esophageal cancer of the squamous cell carcinoma type [SCC] was the most important cause of stricture in the study. In both genders, the cancer was common in the elder age groups. Dysphagia was the commonest presenting symptom. Malignant and benign strictures were located at different site of the esophagus. In males postsclerotherapy was more common especially in the young, while peptic stricture was common in elderly. In females peptic stricture and esophageal webs were common in young adults [20 - 50 years]. Endoscopic dilatation was performed successfully to 59 patients. Only one male in the age group 60 - 69 years was managed with percutaneous endoscopic gastrostomy [PEG] tube due to failure of dilatation. Esophageal stricture is an alarming sign of malignancy. Post-SCC stricture was detected in a considerable number of patients in our study group, therefore it require careful early diagnosis and distinction from other varieties because of their good outcome. Adenocarcinoma and other malignant tumors which cause esophageal stricture were not detected in our study group. Alcohol consumption was not a significant risk factor contributing to the development of post-SCC stricture in this study. Post-sclerotherapy stricture represented the peak in male farmers residing in the center of Sudan compared to females, other occupations and regions, and to other causes of benign stricture

Genotyping of toxoplasma gondii strains in pregnant women with toxoplasmosis in Gezira state, central Sudan

To perform genotyping of Toxoplasma gondii among pregnant women with toxoplasmosis in Central Sudan. The study group was presented by 94 pregnant women who had abortion between the second and fourth months of gestation, whereas the control group consisted of 64 full term normally delivered women. The study was conducted at Wad Medani Teaching hospital, Gezira State, Central Sudan during the period of March 2002 to May 2004. PCR test on aborted and placental tissue revealed positivity rate of 19.1% and 22.3%, in study and control groups respectively, with no significant difference between them [P=0.55]. This compared to a seroprevalence rate of 35.1% and 39.4% in study and control groups respectively. Genotyping form clinical samples using PCR/RELP revealed Toxoplasma gondii type II in 89% and 95% of the study and control group respectively, whereas, 11% and 5% were infected with type III. The most prevalent strain of T. gondii among the pregnant women was Type II followed by type III but type I was completely absent