Evaluation of the role of bedside lung ultrasound versus chest x-ray in critically ill patients

Background: Although chest X-ray is the main imaging approach in many settings, many limitations for it exist. Ultrasound has quite similar performances to CT with many advantages. Methods: From January 2017 till May 2018, a prospective cohort study conducted in emergency ICU at Zagazig university hospitals including 124 critically ill patients older than 18 years with respiratory distress, cough, fever, or hypoxemia. We excluded from the study pregnant females, patients with massive chest wall emphysema or hematoma, morbidly obese and finally patients with risk of transportation. All patients underwent thorough physical examination, history, laboratory investigations & Chest radiology (X-rays, chest ultrasound & CT). We measured the sensitivity and specificity of chest ultrasound and chest X-rays in comparison with CT with measurement of the learning curve of chest US. Results: 124 patients were assessed for eligibility. 24 patients were excluded for different causes and 100 patients (69 males & 31 females) completed the study with mean age of 49.22±11.52 years. Regarding all study population, whatever diagnosis, sensitivity and specificity of chest ultrasound and chest X-rays were 91.4%, 98.3% and 61.7%, 96.2% respectively. Concordance of the results of ultrasound with results of X-rays and clinical diagnosis increased sensitivity, specificity and overall accuracy to highly comparable results with chest computed tomography. Sensitivity, specificity and accuracy of chest ultrasound increased with time and with number of patients. Conclusions: Chest ultrasound is reliable, quick, bedside, low-cost, non-invasive, non-ionizing, more accurate, and easily educated for early detection of chest diseases and their follow up

Multidrug-resistant bacteria among patients with ventilator-associated pneumonia in an emergency intensive care unit, Egypt

Ventilator-associated pneumonia [VAP] is the most common hospital-acquired infection among mechanically ventilated patients. Our objectives were to determine the incidence of VAP, isolate multidrug-resistant bacteria, identify the most prevalent resistant strains and identify their antibiotic susceptibility pattern. The VAP rate was calculated. The isolated microbes were identified and tested for antibiotic susceptibilities. The minimum inhibitory concentrations were determined of imipenem, meropenem and ertapenem for Klebsiella isolates. Klebsiella isolates resistant to carbapenems were tested for the presence of the blaKPC gene. The VAP incidence density rate was 48.8 incidences/1 000 ventilator days. The most common Gram-positive organism was Staphylococcus aureus, of which 86.6% of isolates were resistant to cefoxitin, but 100% were sensitive to teicoplanin, linezolid and tigecycline. The most common Gram-negative bacillus was Klebsiella, of which 94.6% of isolates were resistant to cefotaxime, 70.2% to imipenem, and 64.9% to ertapenem, but 100% were sensitive to colistin and 94.6% were sensitive to tigecycline. Of the carbapenem-resistant Klebsiella strains, 23.1% had the blaKPC gene. The high rates of VAP and the high rates of resistance among isolated organisms point to improper implementation of infection control programmes

Combined intralesional dissection and steroid therapy for keloids

The development of keloid is an unavoidable problem, so there is a need for a simple, safe and efficient procedure which serves as a reliable and standard method for treatment of keloid scars. eighteen patients with 20 lesions without or with recurrence, after trials of steroid or surgical therapy alone, underwent a combined regimen of intralesional dissection and steroid injections therapy. All cases were closed primarily except 6 who needed full thickness skin grafting. immediate postoperative complication were managed satisfactorily by conservative treatment. Follow-up preiod for 22 months showed good prognosis in all cases except in one lesion which recurred [5% per lesion and 5.6% per patient] and is still under subsequent steroid therapy up to date. We can consider the simple, safe and efficient combination of surgical and steroid therapy as the reliable, routine and standard method for treatment of keloids and their recurrence with very low rates of associated side effects

simple technique for the treatment of fistual in ANO preliminary results

The preliminary results of a simple technique used in the treatment of fistula in ano are presented. It involved the insertion of a multi-strand stainless steel wire in the fistulous track and its weekly repeated tightening, and has been used in 37 patients with low anal and 15 patients with high anal fistulae. After completion of the procedure, 49 cases [94.2%] were completely healed while, in 3 cases [two high anal and one low anal fistulae] the discharge persisted. Re-wiring was performed in the 3 cases with successful outcome in two of them while one case of high anal fistula failed to benefit from the procedure. During the follow-up period [average, 18.4 months], 4 patients [7.8%] developed recurrence of their fistulae within 6 months after the completion of the procedure. Three of patients with low anal fistulae were successfully treated by re-wiring while the fourth patient with high anal fistula failed to respond. The overall success rate of Wiring technique in curing all types of anal fistulae was 96.2%. None of the patients complained of temporary or permanent incontinence for flatus or faeces while, the wire was in situ or throughout the whole follow-up period. So, we conclude that wiring of the fistulous track is a safe technique and with highly satisfactory results in the treatment of various types of fistulae in ano. As the procedure does not require special skills or prolonged hospitalization and as it does not entail excision of any tissue, we recommend it as a primary treatment for all types of anal fistula. However, we advise longer follow-up for the proper evaluation of the procedure