Bacteriological and immunological study in diabetic foot

Background: Diabetes mellitus is increasing rapidly through the world, so the diabetic foot syndrome become more and more important as a major diabetic complication

Objectives: The aim of study was to determine the association between the up-regulation of circulating level ofIL-6 in diabetic patients with foot ulcer compared with diabetic patients without foot ulcer

Subjects and methods: The study included 60 subjects, they were divided into three groups; group I included 20 diabetic patients without foot ulcer syndrome, group II included 20 diabetic patients with diabetic foot ulcer syndrome [DFUS] and group HI included 20 apparently healthy subjects as a control. All subjects were subjected to clinical assessment, routine laboratory investigations and specific investigations including assay of glycosylated haemoglobin, serum IL-6 and bacteriological culture and sensitivity for ulcer

Results: There is no significant difference among the three studied groups regarding the gender, age, duration of the disease and type of treatment. There was significant difference between group I and other groups regarding hypertension [p<0.02]. There was no significant difference between the three studied groups regarding WBC. There was a significant difference between the three studied groups as regards neutrophils and platelets counts f [p=0.009] nd [p=0.03] respectively. There was a highly significant difference between the three studied groups as regards Hb concentration [p<0.001]. There was a highly significant difference [p<0.00l] between group II and both group I and group III as regards ESR [43 +/- 77.2, 13+/-3.9, 11+/-3], random blood sugar [RBS] [319.7+/-47, 238+/-47.8, 92.5+/-10.8], glycosylated haemoglobin [HbAlc] [9.93+/-1.35, 8.83+/-1.4, 4.6+/-0.6], Urea [49.9+/-37, 52.5+/-41, 20.6+/-2.4] and IL-6 [18.9+/-5.6, 4.9+/-2.7, 2,77+/-I].There was positive significant correlations [p<0.001] between IL-6 and levels of RBS [r=0.72], and HbAlc [r=0.62], respectively. Also, a positive significant correlation between IL-6 and neutrophils% [r=0.35, p<0.005] was found The most common isolated microorganisms from foot culture were mixed gram + ve cocci and gram -ve bacilli representing 60% and lonely gram + ve cocci and gram -ve bacilli were 20% respectively. Also, it was found that the most gram +ve organism was Staphylococcus aureus and the most gram -ve organism was E. coll and the most effective antibiotic was Ampicillin-Sulbactam 70% followed by Imipenem 30%

Conclusion: Diabetic patients with foot ulcer were found to have higher IL-6 level than diabetic patients without foot ulcer and they were prone to complications or mortality. This assay could facilitate early and accurate diagnosis and greatly aid timely institution of appropriate treatment

Knowledge, perceptions and practices towards medical ethics among physician residents of University of Alexandria hospitals, Egypt

This cross-sectional study was conducted to assess the knowledge, perceptions and practices towards medical ethics of physician residents at university hospitals in Alexandria, Egypt. A self-administered structured questionnaire was used for knowledge and perceptions and a checklist for observations of doctor -patient interactions in the outpatient setting. Only 18.0% of the 128 participating residents had obtained their knowledge from their medical education and 29.9% were dissatisfied with the roles played by the ethics committee. Most of the residents had satisfactory knowledge and 60.2% had satisfactory perceptions regarding ethical issues. The lowest perception score was in the domain of disclosing medical errors. Only 48.0% of the residents were compliant with the principles of medical ethics in practice and 52.0% of patients were dissatisfied with their treating physicians. The study identified areas of unsatisfactory knowledge and practices towards ethical issues so as to devise means to sensitize residents to these issues and train them appropriately

Problems and perceived needs for medical ethics education of resident physicians in Alexandria teaching hospitals, Egypt

There is a call for greater preparation for the ethical challenges encountered by physicians in their future professional duties. This study in Egypt aimed to reveal problems and perceived needs for medical ethics education of resident physicians working at University of Alexandria hospitals. In a descriptive, cross-sectional survey, 128 residents answered a self-administered questionnaire. More than half were of the opinion that their medical ethics course was ineffective; 56.3% mentioned poor curricular planning. The majority complained that the subject was not tailored to specialties, the course was too short, there was a shortage of resources to facilitate the educational process and that assessment was done for knowledge but not for skills. Problems related to staffing were low staff:student ratios and staff lack of experience. Trainees, regardless of clinical discipline, felt that there was a great need for improvement to their medical ethics education

Ultrasonographic imaging of the urinary tract pre and post experimental urethral obstruction in bucks

The purpose of this study is to throw a light on the validity of ultrasonographic examination of urinary tract pre and post urethral obstruction in Egyptian mixed breed non castrated bucks [male goats].Nine bucks were subjected to direct penile ligation at the distal bend of the sigmoid flexure after surgical exposure of the penis to induce urethral obstruction and subsequent urine retention. Clinical and ultrasonographic examinations were carried out immediately pre experimental urethral obstruction and continued periodically every 12 hrs, throughout 48 hrs. post experimental urethral obstruction. The Ultrasonographic appearance and measurements of urinary tract compartments were assessed and compared at different examination positions using linear array endorectal probe [7.5-2.6 MHZ] and convex array general purpose probe [6-2.6 MHZ]. Both kidneys were visualized ultrasonographically through transabdominal approach and the bladder was visualized through transabdominal and transrectal approaches in all bucks. Both of them revealed normal architexture, echogenicity and dimensions before ligation. The course of the urethra in the pelvis and in the penis was not imaged in any of the bucks before ligation. There were significant increase in kidneys and bladder dimensions after urethral obstruction. The proximal portion of the pelvic urethra was visualized clearly in all bucks 24 hrs. post urethral ligation. The course of the ureters was not visualized ultrasonographically by means of the transrectal or transbdominal approaches pre-and post experimental urethral obstruction. It could be concluded that using of ultrasonography is considered a good clinical diagnostic tool for examination of the urinary tract in bucks affected with urine retention