Bacteriological study of diabetic foot infection in Egypt

Foot infections are one of the major complications of diabetes mellitus and are a significant risk factor for lower extremity amputation. Providing effective antimicrobial therapy is an important component in treating these infections. This study assesses the microbial isolates of patients with diabetic foot infections and their antibiotic susceptibility pattern. A prospective study of 75 patients with diabetic foot infections admitted to Al-Azhar university hospitals was undertaken. Bacteriological specimens were obtained and processed using standard hospital procedure for microbiological culture and sensitivity testing. Overall, 40 [54%] patients had subcutaneous infections, 22 [29%] had infected superficial ulcers, seven [9%] had infected deep ulcers involving muscle tissue, and six [8%] patients had osteomyelitis. A total of 99 pathogens were isolated. Forty percent of patients had polymicrobial infection, 39 [52%] had single organism infections, and six [8%] had no growth. Gram-negative bacteria [67%] were more commonly isolated compared with Gram-positive bacteria [30%]. The three most frequently found Grampositive organisms were Staphylococcus aureus [10.2%], Streptococcus pyogenes [7.1%] and methicillin-resistant S. aureus [7.1%], and the most common Gram-negative organisms were Pseudomonas aeruginosa [19.4%], Klebsiella pneumoniae [15.3%], and Acinetobacter spp. [10.2%]. Vancomycin was found to be the most effective against Gram-positive bacteria, whereas imipenem and amikacin were most effective against Gram-negative bacteria on antibiotic testing. Forty percent of diabetic foot infections were polymicrobial. S. aureus and P. aeruginosa were the most common Gram-positive and Gram-negative organisms, respectively. This study helps us to choose empirical antibiotics for patients with diabetic foot infections

Comparative study between modified Koyanagi and Snodgrass techniques in management of proximal types of hypospadias

The aim of this study is to compare between the modified Koyanagi and Snodgrass techniques in the management of proximal types of hypospadias as regards operative time, hospital stay, success rate, postoperative complications and cosmetic results. Fifty male patients with different types of proximal hypospadias [the urethral meatus is proximal penile, penoscrotal or scrotal] were enrolled in the present study; these patients underwent surgical repair using the tubularized incised plate urethroplastyand Modified Koyanagi repair. They were studied during the period between 2010 and 2012 at Pediatric Surgical Units, Al-Azhar University Hospitals [Cairo and Damietta]. All patients were subjected to: detailed history taking, full clinical examination, both general and local. Fifty patients were randomized into two groups; A; [n = 30] patients underwent TIPU; B; [n = 20] patients underwent MK technique. The range of follow up period is 4 to 8 months with a mean of 6 months. Operative time was significantly decreased in group A in comparison to group B [83.30 +/- 6.51 vs. 158.25 +/- 22.78 min respectively]. Duration of hospital stay was significantly shortened in group A in comparison to group B [9.56 +/- 1.73 vs. 17.80 +/- 2.26 days respectively]. The success rate in group A was 70.0% compared to 60.0% in group B. The fistula was more in group A than B and meatal stenosis was more in group A than B, while disruption was equal in both groups. TIP and Modified Koyanagi repair techniques could be considered as acceptable and as effective as each other for hypospadias repair, provided that a good selection of cases for each type of repair was achieved. The tubularized incised plate [TIP] urethroplasty is a reliable one stage procedure in dealing with proximal hypospadias either without or with a mild degree of chordee if the urethral plate is supple and wide enough for tubularization, while MK is a reliable one stage procedure in severe degree of chordee, small sized penis or with narrow urethral plate

[Interaction between nicotine and dopaminergic D1 receptor of dorsal hippocampus in the hole-board test of anxiety]

Background: Nicotinic and dopaminergic systems influence anxiety behavior. Furthermore, the interaction between nicotine and dopamine D1 receptors has been demonstrated in modulation of some behaviors

Objective: To investigate the involvement of dorsal hippocampus dopaminergic D1 receptor in the nicotine effects on anxiety behavior

Methods: This was an experimental study carried out at Tehran Institute of Cognitive Sciences in2009. Initially, 190 mice in 10-member groups were placed in a stereotaxic apparatus and twocannulae placed in the CA1 region of hippocampus. Later, the effects of dopaminergic D1 receptors agonist [SKF38393] and antagonist [SCH23390] on nicotine anxiogenic effects in mice were measured using hole-board test of anxiety. Data were analyzed using one-way analysis of variance followed by Dunnett's test

Findings: Nicotine [0.5 mg/kg] produced anxiogenic effect [P<0.001]. Intra-CA1 injections of ineffective doses of SCH23390 reversed the anxiogenic effects induced by nicotine [P<0.001]. Furthermore, co-administration of ineffective dose of SKF38393 plus ineffective dose of nicotine increased the anxiogenic effect of nicotine [P<0.001]. Locomotion activity was unchanged when no drug was administered

Conclusion: The results indicated that dopamine D1 receptors of the dorsal hippocampus have modulatory role in the anxiogenic response induced by nicotine

[Interaction between cannabinoidergic system and H2 receptors in CA1 region upon anxiety-like behaviors in Hole-Board test]

Cannabinoids produce a wide array of effects on different species and interact with different neurotransmitter systems in the brain. In the present study, the effects of histaminergic and cannabinoidregic systems as well as their interactions on anxiety-related behaviors were examined on mice. In this study, at first mice were anesthetized with intra-peritoneal injection of ketamine hydrochloride and xylazine. They were then placed in a stereotaxic apparatus. Two stainless-steel cannuale were placed one mm above CA1 regions of the dorsal hippocampus. After that, seventeen groups of animals were tested with hole board apparatus for measuring anxiety behavior. For the statistical analysis, One-way analysis of variance [ANOVA] and Dunnett's test were used. Intra-CA1 injection of WIN55, 212-2 [0.1, 0.5 microg/mice] did not modify anxiety-related behaviors in mice. But administration of AM251 [25 and 50ng/mice], histamine or ranitidine [5micro g/mice] induced anxiogenic-like response. Also, co-administration of WIN55, 212-2 with histaminergic agents, decreased the anxiogenic-like response of histamine, but not that of ranitidine. Co-administration of an ineffective dose of AM251 with histaminergic drugs did not alter the response induced by these drugs. In all the experiments, locomotor activity was not significantly changed. These results showed that there may be a partial interaction between the cannabinoidergic and the histaminergic systems of the dorsal hippocampus on anxiety-like behaviors

[Interaction between apomorphine and histaminergic system of mouse dorsal hippocampus in the elevated plus-maze test of anxiety]

Histaminergic and dopaminergic systems influence anxiety-related behavior. Furthermore, interaction between histaminergic and dopaminergic receptors has been demonstrated in the modulation of some behaviors in the hippocampus. In the present study, the interaction between histaminergic and dopaminergic receptors of dorsal hippocampus in the anxiety-related behavior has been evaluated. This experimental study was carried out on 140 male NMRI mice. Mice were anesthetized with intra-peritoneal injection of ketamine hydrochloride plus xylazine and then placed in a stereotaxic apparatus. Two cannuales were placed in the CA1 region of hippocampus. All animals were allowed to recover for one week before the beginning of the behavioral testing. The elevated plus-maze test was used to evaluate anxiety-related behaviors. One-way analysis of variance [ANOVA] followed by LSD test were done for the statistical analysis of the data. All experiments were conducted in accordance with institutional guidelines for animal care and use. Intra-CA1 injection of histamine [10 alpha g/mouse] or apomorphine [0.1 and 0.3 alpha g/mouse] 5 min before testing induced anxiety. Intra-CA1 injection of apomorphine [0.01 and 0.1 alpha g/mouse] 2 min before the effective dose of histamine [10 alpha g/mouse] inhibited the anxiogenic effects of histamine. It seems that both histaminergic and dopaminergic system not only play a role in the modulation of anxiety in the dorsal hippocampus of mice but also demonstrate a complex interaction as well

Histological and histochemical studies of the skin of some fresh-water teleost fishes

The present work conducted on 28 specimens of adult fresh water fishes collected from the Nile River [at Giza and El Qanater]. Four types of fresh water fishes were used Bayad [Bagrus bayad], Karmout [Clarias lazera], Nile Eel [Anguilla vulgaris] and Bolti [Tilapia nilotica]. The epidermis could be divided into three distinct layers. There were lymph spaces between the germinal cells. Various types of unicellular glands in the epidermis as sacciform glands in Bayad and Karmout; club cells in the epidermis of Nile Eel and mucous cells in the epidermis of all fishes. The mucous cells gave positive reaction to both PAS and AB stains. The sacciform slime secreting gland were unicellular glands surrounded by the epidermal cells themselves. The secretory materials they contained were PAS and AB negative. The club cells were recorded in the epidermis of Nile Eel. They were large in size, wedged between the epidermal cells. The contents of the glands were negatively reacted to both PAS and AB stains. The dermis was formed of spongy layer [stratum spongiosum] and compact layer [stratum compactum]. In the spongy layer the blood vessels occur forming, just under the basement membrane, a dense sub-epithelial net. A layer of pigment cells, supplied with blood capillaries in the loose connective tissue below the basement membrane and a second layer at the deeper part of the dermis were noticed. The epidermis of Bayad, Karmout and Bolti contained taste buds. The taste buds appeared flask-shaped and were embedded in the epidermis

prospective, randomized comparison of intravitreal triamcinolone acetonide versus intravitreal bevacizumab [avastin] in diffuse diabetic macular edema

To compare the functional and anatomical outcomes following intravitreal triamcinolone acetonide vs. intravitreal bevacizumab [Avastin] treatment for diffuse diabetic macular edema. In this prospective, randomized study, subjects were divided into two groups: 24 eyes that received intravitreal injection of 4 mg/0.1mL triamcinolone acetonide [IVTA group] and 24 eyes received intravitreal injection of 1.25 mg/0.05 mL bevacizumab [IVB group]. Changes in best corrected visual acuity [BCVA], intraocular pressure [IOP], baseline fluorescein angiography and optical coherence tomography measurements were evaluated in both groups. Follow-up visits out to three months from baseline are reported. One month after treatment, baseline foveal thickness decreased 452 micro to 299 micro in the IVTA group and from 292 micro to 270 micro in the IVB group. BCVA increased by two or more lines in 58.3% of eyes in the IVTA group and there was no similar improvement in the IVB group. In the IVTA group, a transient increase in IOP [27- 43 mmHg] occurred in four cases [16.7%], which was successfully controlled with topical medications. There were no complications in the IVB group. Short term outcomes indicate that intravitreal injection of bevacizumab was not associated with surgical complications compared to triamcinolone acetonide. Triamcinolone acetonide appears to be more effective treatment for diabetic macular edema than bevacizumab

[ interaction between harmane and nicotinic receptors of dorsalhippocampus in a hole-board test of anxiety in mice]

beta-carboline alkaloids, such as harmane, are found in common plant-derived foodstuffs and plant-derived inhalation components of tobacco. In the present study, the involvement of dorsal hippocampus nicotinic receptor in the harmane effects on anxiety behavior has been evaluated. Mice were anesthetized with an intra-peritoneal injection of ketamine hydrochloride plus xylazine and then placed in a stereotaxic apparatus. Cannual were bilaterally implanted in the CA1 region of hippocampus. All animals were allowed to recover for 1 week before the beginning of the behavioral testing. The hole-board test was used to evaluate the anxiety-like behaviors. One-way analys was of variance so that Dunnett's test was used to analyse data. All experiments were performed in accordance with institutional guidelines for animal care and use. Intraperitoneal injection of harmane decreased the number of head dip and locomotion [P<0.001]. While bilateral intra-dorsal hippocampal injections of nicotine decreased the number of head dip [P<0.01], it had no effect on locomotor activity. Furthermore, intra-dorsal hippocampal injection of mecamylamine [nicotinic receptor antagonist] in the presence and absence of harmane had no effect on anxiety behavior and locomotion [P>0.05]. harmane and nicotine not only display anxiogenic effects but also demonstrate a complex interaction. The findings also indicated that harmane induces anxiety via nonnicotinic receptors

Association of obesity and hyperandrogenemia in peripubertal girls: obesity as a risk factor for postpubertal hyperandrogenism

The objective of the present work was to assess the degree of hyperandrogenemia across puberty in obese girls. A cross-sectional analysis of data obtained at Out Patients Clinics. Fasting blood samples were extracted from 56 obese [body mass index [BMI] for age >/= 95%] and 55 normal-weight [BMI for age,<85%] peripubertal girls to assess [testosterone T, sex hormone binding globulin SHBG, free testosterone FT. insulin, blood glucose, LH, FSH and dehydroepiandrosterone sulfate DHEAS]. BMI and BMI percentile for age were calculated and correlated with these hormones in each stage of puberty. BMI was found to be correlated with total testosterone [T] [rs 0.81], SHBG [rs=-0.93], and free T [rs=0.74]; free T was 3.9 times as great in obese girls compared with normal-weight girls [p<0.001 for all]. BMI correlated with insulin [rs=-0.93]; both insulin and LH correlated with free T [rs=0.71 and 0.70, respectively; p<0.0001 for all]. When analyzing early pubertal girls [pubertal stages 1-3; n=41] alone, BMI correlated with total T [rs=0.97], SHBG [rs=-0.89], and free T [rs=0.96]; free T was 5.2 times as great in obese early-pubertal girls [p<0.001]. BMI correlated with insulin [rs 0.87], and insulin correlated with free T [rs=0.87, p<0.0001 for both]. BMI correlated with free T [rs=0.96, p<0.0001]. In conclusion, peripubertal obesity is associated with marked hyperandrogenemia, which is especially pronounced in early puberty

Clinical evaluation and follow up of autoimmune thyroiditis in children and adolescents [a retrospective study]

The objective of the present study was to assess the clinical manifestations of autoimmune thyroiditis [AlT] in children and adolescents, in addition to disease course and long-term outcome. A retrospective analysis of data obtained at pediatric endocrinology outpatients clinic, Saudi German Hospital, Jeddah, Saudi Arabia. Fifty three children, 11 boys and 42 girls, with diagnosis of autoimmune thyroiditis and with the age of 12.33 +/- 1.58 years at presentation were included in the study and followed-up in pediatric endocrinology clinic for two years. Clinical characteristics at presentation, reasons for referral, treatment and outcome; by thyroid and pubertal status were recorded. Noticeable goitre was found in 37.75%at time of presentation. Other reasons for referral were clinical symptoms of hypothyroidism [28.3%] and findings on work-up for an unrelated problem [20.7%] or for high-risk groups [13.2%]. Thirteen patients [24.5%] were euthyroid, 18 [34%] had sub-clinical hypothyroidism, and 22 [41.5%] had overt hypothyroidism. The concordance of anti-thyroid peroxidase [anti-TPO] high titers was found in 83%of subjects, while 75.4%of the cases had anti thyroglobulin [ATg] positive titer and both titers were positive in 71.6%. Treatment was initiated shortly after diagnosis in all 22 hypothyroid patients and in 12/18 compensated hypothyroid patients, and within 12 months in two euthyroid patients. Indications for treatment of euthyroid patients were further thyroid enlargement during follow-up, significant increase in TSH concentration, or development of one or more symptoms compatible with hypothyroidism. Ht-SDS at last follow-up was significantly lower than at diagnosis for the entire study group [-0.02 +/- 0.38 vs-0.14 +/- 0.30], p<0.01] but both were within normal Puberty was normal in the studied patients. Forty two [79.2%] had reached their final height by the last follow-up visit [mean Ht-SDS-0.13[0.31] and their final height was within the normal range. There was no significant difference in body mass index SDS at referral by thyroid status. In conclusion, although goitre is the main symptom leading to diagnosis of AlT, it is still often overlooked, underscoring the need for thorough thyroid evaluation on routine physical examination. Acquired hypothyroidism is not often associated with obesity, and ultrasound usually has no added diagnostic value. Adequate treatment in this age group leads to normal growth, puberty and final height

efficacy of bilateral arm training with rhythmic auditory cueing in stroke rehabilitation: clinical and electrophysiological study

To study the efficacy of repetitive bilateral arm training with rhythmic auditory cueing [BATRAC] on motor recovery in stroke patients clinically and electrophysiologically. Forty patients with chronic hemiplegia were included in the study. All patients participated in BATRAC [3 sessions/week] for six weeks. The upper extremity functional performance was evaluated by the Fugl-Meyer Upper Extremity Motor Performance [FMUEMP] and grip strength. Transcranial magnetic stimulation [TMS] was used to elicit MEP to the abductor digiti minimi. Functional performance and MEP were recorded before and after BATRAC. Following BATRAC there were improvement in functional performance [FMUEMP and grip strength], decrease in TMS threshold, decrease in the central motor conduction time and increase in MEP amplitude. These changes were significant [p<0.01]. Besides, there was a significant positive correlation between pre-rehabilitation MEP amplitudes and the improvement in FMUEMP. BATRAC for 6 consecutive weeks has been proven effective in improving both functional performance [of the paretic upper extremity] and MEP parameters in chronic stroke patients suggesting that functional improvement might has been secondary to central motor excitability changes

Is parvovirus B19 infection incriminated in chronic fatigue syndrome?

Background: parvovirus B19 is a small DNA virus that belongs to the genus Erythrovirus. It is the cause of erythema infectiosum in children and incriminated in the pathogenesis of chronic fatigue syndrome [CFS], which is a heterogeneous disorder of unknown pathogenesis and etiology

Objective: we aimed to determine the possible role of parvovirus B19 in the etiology of CFS

Methods: 50 patients with CFS and 45 people with no symptoms comparable with CFS as a control were investigated for specific anti B19 IgG and IgM, also B19 DNA in their sera

Results: no specific anti B19 IgM was detected in both CFS patients and control, anti B19 IgG was detected in 26 of 50 CFS patients [52%] and in 23 of 45 control [51.1%]. Also B19 DNA was found in 4 of 50 CFS cases [8%], and in 3 of 45 controls [6.7%]. There was no statistical difference between patients with CFS and control for the presence of parvovirus B19

Conclusion: B19 infection bears no apparent relationship to CFS

Giant cell tumors of long bones analysis of 21 cases

This is a prospective study of giant cell tumors of long bones performed in El-Meno-fyia university hospital in the period from 1997-2002. Twenty one cases were included. There was 13 females and 8 males the mean age of the patients was 34.7 years. The tumor was primary in 15 cases and recurrent in 6 cases. All the patients had been treated with intra-lesional curettage. In 10 patient's curettage and bone graft or bone cement was done. In 11 patients curettage was augmented with high speed burr and or phenol 80%. The overall recurrence rate was 28%. The group of Patients treated with curettage alone had a local recurrence rate of 50%. While those treated with curettage and adjuvant treatment had a local recurrence rate of 9%. There was no difference between cases treated with bone cement or bone graft as regard local recurrence rate. Recurrent tumors treated with curettage had a local recurrence rate of 40%

[Involvement of D1/D2 receptors on 1-methyl-B-carboline [harmane] induced-amnesia in the step-down passive avoidance test]

Background and Objective: a number of beta-carboline alkaloids such as harmane are naturally present in the human food chain. In the present study the involvement of dopaminergic system on harmane induced amnesia was investigated

Materials and Methods: one-trial step-down paradigm was used for the assessment of memory retention in adult male NMRI mice

Results: intraperitoneal [i.p.] administration of harmane [5 and 10 mg/kg] immediately after training, dose dependently decreased memory formation. Administration of D1/D2 receptors agonist, Apo morphine [0.5 and 1 mg/kg, i.p.] before testing by itself could not alter memory retrieval. On the other hand, in the animals in which memory formation was impaired due to harmane post-training administration, pre-test administration of Apo morphine [0.5 and 1 mg/kg, i.p.] 24 hrs. After training in days test restored memory Furthermore, administration of SCH23390 [0.025, 0.05 and 0.1 mg/kg, i.p.] or sulpiride [12.5, 25 and 50 mg/kg, i.p.] before testing by itself could not alter memory retrieval, respectively. On the other hand in the animals in which memory formation was impaired due to harmane post-training injection, pre-test administration of SCH23390 [0.05 and 0.1 mg/kg] or sulpiride [25, 50 mg/kg, i.p.] 24 hrs. after training in days test decreased harmane-induced amnesia

Conclusion: these findings indicate the involvement of D1/D2 receptors in harmane induced-amnesia through different mechanism[s]

Endoprothetic reconstruction for primary bone sarcoma of the knee region

This study was performed to assess the preliminary results, operative technique, complications and performance of the prosthetic reconstruction after the excision of bone sarcoma in the knee region. Nineteen patients with primary bone sarcoma of the distal end femur or proximal tibia had en-block resection of their tumor. The bone defect was reconstructed with a modular constrained tumor prosthesis. Fourteen cases had high grade lesions and five had low grade lesions. The median follow up period was 32 months. The 3-year overall disease free survival was 84%. The overall prosthetic survival rate was 79%. Satisfactory functional results were achieved in 73% of the patients. Distant metastasis was developed in five patients. Two patients had local recurrence and required amputation. Fourteen endoprosthetic related complications were developed. Infection, local recurrence and aseptic loosening were the most difficult complications which resulted in a failure of the procedure

Role of transesophageal echocardiography in the management of non-valvular atrial fibrillation

Elective cardioversion of atrial fibrillation may be complicated by systemic thromboembolic events presumably caused by embolization of pre-existing left atrial thrombi. Transe sophageal echocardiography [TEE] has proven to be a very sensitive tool of detecting left atrial thrombi and may therefore provide a mean of screening patients before cardioversion. Over a 10-months period, 41 patients underwent transesophageal echocardiography to exclude the presence of an LA thrombus before elective cardioversion for atrial fibrillation [n-38] or atrial flutter [n = 3] of nonvalvular origin. All patients were believed to have atrial fibrillation/flutter for a minimum of 2 days. The mean age of the patients was 59.8 +/- 13.22 years and 58% were men and 13 patients had history of embolization. All patients underwent transthoracic and transesophageal echocardiography. Transthoracic echocardiography detected thrombus in one patient only while TEE detected left atrial or left atrial appendage thrombus in 9 patients [21.9%] 3 of these were in the left atrial cavity and 6 were in the left atrial appendage. All of the patients with left atrial thrombi were in atrial fibrillation rather than in atrial flutter. Thirty three patients [80.5%] received heparin. Cardioversion was cancelled and anticoagulant therapy was begun in the 9 patients with left atrial thrombi. Cardioversion was successful in 25 out of 32 patients [15 spontaneous, 7 pharmacological and 3 electrical]. Four patients died during the period of follow-up due to other medical causes not related to complications of cardioversion. No one revealed evidence of thromboembolic event either immediately after cardioversion or at one month follow-up. Recurrence of atrial fibrillation occurred in 2 patients. There was transient atrial mechanical disjunction in 3 patients [7.3%] who received long-term anticoagulants for 4 weeks. The results of the present study are similar to preliminary information from other studies that have addressed this issue. In conclusion, our study revealed that if results are negative for thrombus, utilization of transesophageal echocardiography, lowers the embolic risk, provides some level of reassurance in patients with contraindication to anticoagulant therapy, and may obviate the need for anticoagulant therapy before cardioversion thus allowing cardioversion to be performed earlier

Peroxide and non-peroxide antibacterial activity in some Iranian honeys

A range of some Iranian monofloral honeys were assayed for antibacterial activity with and without hydrogen peroxide which is inactivated by the addition of catalase. It was found that the high amount of antibacterial activity in honeys was due to a factor other than hydrogen peroxide. The test microorganism Staphylococcus aureus, was not inhibited by the acidity or the osmolarity of the honey. The association of high antibacterial activity with particular florae sources suggest that the non-peroxide antibacterial activity is of floral origin. The activity of some Iranian honeys were tested and found to be heat stable