Pattern of candida urinary tract infections among cancer patients in south Egypt cancer institute

The last decade has seen the sustained medical importance of opportunistic infections due to different Candida species mainly because of the worldwide increasing in the number of immunocompromised patients, who are highly susceptible to opportunistic infections. Urine samples were collected from 106 cancer patients in South Egypt Cancer Institute [SECI] that were cultured on Sabouraud dextrose agar media for isolation of Candida species. After Gram staining subculture was done on Hicrome Candida Differential Agar media. Results of the previous media were compared with those obtained with API 20C AUX yeast identification kits. The study revealed an overall isolation rate of Candida species among urinary tract infections was 20.8% [22/106]. Single type of Candida species was isolated from cancer patients with candiduria 16/22 [72.7%] while six patients had mixed species. Candida albicans was the most frequent species isolated responsible for fungal urinary tract infections 27.3% [6/22]. Non-Candida albicans species including Candida tropicalis [13.6%], Candida glabrata [13.6%], Candida stellatoides [9.1%], Candida krusei [4.5%] and Candida guilliermondii [4.5%] were also isolated. Candida albicans, Candida stellatoides and Candida guilliermondii could not be identified on chrom agar as all the isolates gave similar green colonies. Also Candida glabrata and Candida krusei could not be identified on chrom agar as they gave similar white colonies. Chrom agar identifies all Candida tropicalis as the isolates gave the typical pattern of purple to blue colonies. Candida albicans identified on Czapek Dox Agar media as they produced chlamydospores. The results of API 20C AUX were in 100% agreement with the results of Chrom agar in identification of Candida tropicalis. E-test on [SDA] was found to be an accurate method for antifungal susceptibility as it was compared with the reference broth microdilution method recommended by National Committee for Clinical Laboratory Standards [NCCLs]. For fluconazole the E-test demonstrated 94.1% agreement for all candida species

Relationship between coxsackie B-4 virus infection and type-1 diabetes in children

Type-1 diabetes mellitus is believed to result from the selective autoimmune destruction of pancreatic islet cells, occurring in genetically predisposed subjects, and possibly triggered or accelerated by environmental agents. One of the environmental risk factors identified by several independent studies is represented by enteroviral infection. The virus was isolated from infected islets of patients, sequenced, and identified as a Coxsackie B4, In addition, isolated virus was able to in vitro infect cells from non-diabetic multi-organ donors, causing cell dysfunction characterized by impaired glucose stimulated insulin release. We tried to detect the incidence of virally caused type one Diabetes Mellitus with the Coxsackie B4 among cases in Pediatric Department in Assiut University Hospitals. Fifty three cases with recent onset diabetes and 25 matched controls were recruited for the study. We used different techniques to find our targets, including Tissue Culture and PCR. The search yields positively for CVB4 in 54.7% of cases and 4% of controls. Coxsackie B4 may be one of the most common causes of type I Diabetes Mellitus and should be considered in treating of these patients

Screening of nosocomial methicillin-resistant staphylococcus aureus [MRSA] in the intensive care units of Assiut university hospital

Staphylococcus aureus is a major cause of nosocomial infections that uses numerous virulence factors, such as extracellular toxins and enzymes. Epidemic Methicillin-resistant S. aureus [MRSA] strains were described as multi-resistant strains with special capacity to colonize patients and staff and cause widespread outbreaks of infections. Rapid identification of MRSA from clinical specimens and screening of high risk patients for MRSA colonization have been found to be cost effective measures for limiting the spread of the organism in hospitals. The aim of this study was screening of MRSA infection in patients admitted to the Internal Medicine Department in Assiut University Hospital, using oxacillin resistance agar screen base [ORSAB] and MRSA screen test and to compare the antibiotic susceptibility pattern of MRSA infected patients with those of house-hold contacts and paramedical staff to evaluate their role in transmission of MRSA. The present study included 455 patients with nosocomial infections admitted to the ICU of Neurology and Chest Departments and the Diabetic Foot Care Unit. 154 nurses and workers in these units as well as 110 healthy volunteers who were household contacts of the patients with S. aureus infections were also included. Swabs were collected from the anterior nares of all studied groups and from the bed sores of patients who developed nosocomial beds sores. Sputum samples and endotracheal aspirates were also collected from patients who developed nosocomial pneumonia. Pus samples were collected from post-operative infected wounds of diabetic foot patients. All samples were cultured on mannitol salts agar. Colonies were identified by growth characteristics, Gram staining, biochemical reactions and confirmed by coagulase tube test. Coagulase positive mannitol-fermenting colonies were subcultured on ORSAB medium then subjected to MRSA screen test to detect PBP2a. Sensitivity patterns of the isolated strains were detected by Kirby and Bauer technique. It was found that 24% of the patients [110/455] were infected nosocomially with S. aureus. 60 patients were infected with MRSA [55% of S. aureus infected patients and 13% of the whole patients]. MRSA nasal colonization was reported in 17.5% of the patients [80/455], 5.2% of paramedical staff [8/154] and 18% of the household contacts [20/110]. The results of antibiogram showed that MRSA strains remained sensitive to ciprofloxacin, rifampin, gentamycin and vancomycin with the highest sensitivity obtained by ciprofloxacin. MRSA strains of patients and paramedical staff had the same antibiogram type while slightly different from those of their household contacts denoting that the paramedical staff had a major role in transmission of MRSA. Regular screening of patients gives an early warning of the presence of MRSA and assess the efficiency of barrier and application of basic infection control measures [standard precautions]. Prevention is better than treatment, but for those who are already affected, control is the most likely achievable goal rather than eradication to prevent cross transmission. We recommend the use of molecular methods for accurate and rapid typing of MRSA

Evaluation of multiple transrectal ultrasound guided biopsies of the prostate for the detection of prostate cancer

To evaluate different regimens used in transrectal [TRUS] guided biopsy and to identify the optimal [TRUS] biopsy regimen, a prospective study included 80 consequent men undergoing biopsy either because of an elevated PSA> 4 ng/ml and/or abnormal digital rectal examination. Biopsies yielded 34 patients with prostate cancer giving a positive biopsy rate of 42.5%. Traditional sextant biopsy diagnosed 30 patients [88.2%]out of 34 patients with prostate cancer, while laterally directed biopsies detected 32patients [94%]. Positive transitional biopsy was positive in only two patients. No single case of prostate cancer was diagnosed only by transitional zone biopsies. The highest detection rate among traditional sextant biopsy sites were at the apex [88%] while the lowest were at the base [67.4%]. None of patients developed major complications. A sextant biopsy, far laterally oriented, regimen is the optimum transrectal biopsy regimen for detection of prostate cancer

Clinical and therapeutic aspects of typhoid fever in Upper Egypt

This study included 160 patients [97 males and 63 females, their ages ranged from 3 to 45 years with a mean of 14.66 +/- 7.62 SD] suspected clinically to be typhoid or paratyphoid fevers. They were classified into two groups: Group I, included 93 patients who were blood culture-positive for salmonella and group II, included 67 patients who were culture-negative for salmonella. The criteria of inclusion included patients presenting with fever five days or more with apparent toxemia, headache, coated tongue and with or without splenomegaly. The patients were subjected to full clinical history, general examination, abdominal examination, routine investigations [abdominal ultrasonography, chest X-ray, ECG, urinalysis and stool analysis, complete blood picture, liver function tests and kidney function tests] as well as investigations for the diagnosis of enteric fever, Widal and modified Widal tests to all patients. Serum chloramphenicol level was estimated in 43 patients in group I and in 29 patients in group II and no statistical significant difference was found in the mean level between the two groups. Concerning therapy in the two groups, the response to chloramphenicol was significantly higher in group II in comparison with group I. On the other hand, the resistance to chloramphenicol was significantly higher in group I compared with group II. The responses to antibiotics other than chloramphenicol were similar in the two groups

Relevance of argyrophilic nucleolar organizer regions[AgNORs] in improvement of the accuracy of routine urine cytology in bladder cancer

The argyrophilic nucleolar organizer regions [AgNORs] were studied in urine specimens of 28 cases of bladder cancer and 29 non-malignant controls. Routine cytological examination and silver nitrate stain were used and the AgNORs were counted in 100 nuclei selected randomly in each specimen. While the routine cytology picked up 13 cases [46%], the AgNORs picked up 19 cases [66%]. The AgNORs count was 4.64 in positive cases, while it showed count below 2.1 in control. The AgNORs count was higher in cases than in control [in those negative specimens by routine cytology]. In conclusion, AgNORs which is a simple subjective method can improve the accuracy of routine cytology

Value of echocardiography during hospital phase of acute myocardial infarction to predict left ventricular aneurysm

Left ventricular [LV] morphologic and functional changes were studied in 13 patients with acute myocardial infarction by Doppler echocardiography on admission [ADM], discharge [DIS], and after 6 weeks [6W]. Five patients developed LV aneurysm [group I] and 8 patients had no aneurysm [group II]. The mean wall motion index score [WMI] was 1.8 +/- 03 on ADM and 2.1 +/- 0.3 on DIS in group I versus 1.7 +/- 0.3 and 1.7 +/- 0.3 for group II [P <0.05]. The mean LV end-diastolic volume [LVEDV] was 209 +/- 68 ml on ADM and 229 +/- 66 ml on DIS in group I versus 167 +/- 26 ml and 183 +/- 26 ml for group II [P <0.05]. The mean LV end-systolic volume [LVESV] was 94 +/- 27 ml on ADM and 119 +/- 43 ml on DIS in group I versus 77 +/- 23 ml and 85 +/- 29 ml for group II [P <0.05]. The mean ejection fraction [EF] was 56 +/- 9% on ADM and 50 +/- 8% on DIS in group I versus 54 +/- 10% and 54 +/- 12% for group II. In group I the mean early to total mitral flow velocity ratio [E/Mi] was 7.5 +/- 3.3 on ADM, 4.9 +/- 1.4 on DIS, and 6.3 +/- 1.6 after 6W and the mean isovolumic relaxation time [IVR] was 100 +/- 25, 124 +/- 23, 98 +/- 18 msec, respectively. No significant changes in E/Mi or IVR were noticed in group II. In conclusion, early increase in WMI, LVEDV, LVESV, with EF drop during hospital phase of acute MI carries a higher risk for LV aneurysm formation

Effect of thyroid hormones excess on left ventricular function in thyrotoxic patients: Effects of metoprolol versus carbimazole

To determine the role of beta adrenoreceptors in the pathophysiology of thyroid hormones excess on left ventricular [LV] function, 12 patients with thyrotoxicosis were studied before and after using beta adrenoreceptor blocker metoprolol [M] versus antithyroid drug carbimazole [C]. LV functions were assessed by Doppler echocardiography. M and C were equally effective in slowing the heart rate. Both drugs equally prolonged preejection/ejection time ratio, while C, but not M, significantly slowed the velocity of LV circumferential fiber shortening suggesting direct effect of thyroid hormones on myocardial contractility. However, both drugs showed similar effect on LV diastolic function by prolonging time to peak LV filling and increasing early to peak mitral flow velocity ratio [E/A]. However, the increase in E/A was due to decrease in A velocity with atrial contraction suggesting increased atrial contractility in thyrotoxicosis. In conclusion, thyroid hormones excess increased myocardial contractility by direct effect, and increased heart rate, atrial contraction and LV relaxation by increasing cardiac beta adrenoreceptor activity

Hyperoxaluria and hyperuricosuria in calcium urolithiasis

Twenty four hour urinary oxalate and uric acid were determined in 139 calcium stone-formers and 100 control subjects. Hyperoxaluria [>41 mg/day] was found in 42 out of 139 stone-formers [30.2%]. Hyperuricosuria [>531.8 mg/day] was found in 19 out of 139 calcium stone-formers [13.7%]. It is concluded that hyperoxaluria and hyperuricosuria are common associated metabolic abnormalities in calcium urolithiasis

Idiopathic hypercalciuria in calcium urolithiasis

A study of 139 calcium stone-formers and 100 control subjects in the Suez Canal area revealed the presence of idiopathic hypercalciuria [24-hour urinary calcium >222 mg/24 hours] in 28 of them [20.1%]. Employing oral calcium loading test and nephrogenous CAMP level for the differentiation between absorptive [AHC] and renal [RHC] hypercalciuria, 19 [67.9%] had AHC and 9 [32.1%] had RHC. The relatively high incidence of IHC in this study alerts attention to disturbances in calcium metabolism as important associated abnormality in calcium urolithiasis and also to the value of calcium-loading lest for differentiating AHC from RHC for the sake of choice of selective lines of management