Genotyping of nosocomial methicillin resistant Staphylococcus aureus with tracingthe source of infection: a guideline step in infection control strategy at General Surgery Department of Tanta University Hospital

Background: Methicillin-resistant Staphylococcus aureus [MRSA] represents a serious causal agent in nosocomial infections that are becoming increasingly difficult to cure due to their emerging resistance. Therefore, it becomes essential to understand the epidemiology of MRSA where pulsed field gel electrophoresis [PFGE] is considered to be the gold standard for the this

Objectives: This study aimss to make genotyping for the nosocomial strains of methicillin-resistant Staphylococcus aureus [MRSA] isolated form General Surgery Department of Tanta University Hospitals with tracing the source of infection as a guideline for infection control

Methodology: 159 different samples were collected from patients and 41 from suspected sources of infection. MRSA isolates were screened by Cefoxitin disk diffusion method then confirmed by detection of MecA gene by PCR. Phenotyping of the isolates was done by using the antibiogram while genotyping was done by using pulsed field gel electrophoresis [PFGE]

Results: MRSA isolates were found in 60 patients and 5 health care workers [HCWs]. Genotyping revealed 26 patterns [A - N and[ a - l] where type [A] was the most predominant. Isolates which had identical genotypes had different antiograms .Each ward revealed infection with muliple strains indicating multiple sources of infection while certain strains were found in multiple patients and multiple wards. Genotyping revealed that 2 HCWs were the most probable source of infection in 4 patients

Conclusions: Genotyping using PFGE is highly significant in studying the epidemiology of MRSA. HCWs should be seriousely considered, not only as a source of infection, but also as a major cause for transmitting infection between patients in different wards

Successful management of bilateral refractory chylothorax after double lung transplantation for lymphangioleiomyomatosis

Lymphangioleiomyomatosis [LAM] is a rare disease that leads to airways and lymphatic channels obstruction due to abnormal smooth muscle proliferation. It presents with dyspnea, pneumothorax or chylothorax. Lung transplantation [LT] has emerged as a valuable therapeutic option with limited reports. We report a case of LAM that underwent double LT and complicated by refractory bilateral chylothorax which was managed successfully by povidone-iodine pleurodesis and the addition of sirolimus to the post-transplantation immunosuppressive therapy. The patient has no recurrence with 24 months follow-up.

Incidence of rheumatoid arthritis [2001 to 2011]

The incidence of rheumatoid arthritis[RA] varies from country to another which not depend on genetic bases alone but can explained by environmental exposure and genetic and environmental interaction, area of military conflict, there was stress induced pathway that elevates the risk for rheumatoid arthritis, in Iraq rheumatoid was 1% of population in 1975. To evaluate incidence of RA in Babylon -Iraq from 2001-2011. This study was done to examine the incidence of RA in Babylon between 2001-2011 by Retrospective cohort study in Merjan Teaching Hospital, Rheumatology unit .Data included sex .birth year, residency and latex test, from 2001 to 2011.All patients were diagnosed as Rheumatoid Arthritis according to American College of Rheumatology ACR 1987revised criteria of RA .the numbers of patients of RA who were received DMRADs included methotrxate therapy were recorded each year and incidence of each year was found then the cumulative incidence was calculated. There were1039 patients with rheumatoid arthritis from 53786 patients in rheumatology unit. 50.1% living in urban area while 49.9% in rural area. The incidence in 2001 was 1.60 while in 2011 was 3.02 for the same population and the cumulative incidence in 2011 was 22.74. Latex test was 52% in2001 while in2011 was 58% in rheumatoid patients in the same year. The P value for age mean difference between female and male was [0.009]. The incidence of RA was increasing from 1.60% in 2001 to 3.02% in 2011 and the cumulative risk wasb22.74% in Babylon -Iraq

comparison study of histochemical staining of various tissues after Carnoy's and formalin fixation

The potential problems related to the use of formalin in histopathology, such as health hazards, deterioration of nuclei acids are well-known. The aim of this study was to evaluate the utilization of a Carnoy's solution fixation in comparison with formalin on subsequent tissue sectioning and histochemical staining. Corresponding sections of 25 tissue biopsies of rabbit's different organs were fixed in Carnoy's solution and in 10% neutral buffered formalin. Samples were processed using the conventional method and then stained applying five histochemical methods. The degree of the quality of the staining was assessed for each method by scoring system [1-10] depending on comparison of the stained tissue sections with illustrated photomicrographs. For the quality of cutting, the best quality was obtained by Formalin [mean = 4.76] then Carnoy's fixative [mean =3.84]. The best quality of Haematoxylin and Eosin staining was obtained by formalin [mean =5.28] then Carnoy's [mean = 4.00]. For Alcian blue and Perl's Prussian blue, the best staining qualities were obtained by Formalin [mean = 4.76 and 5.64 respectively] followed by Carnoy's [mean = 2.88 and 3.92 respectively]. For periodic Acid Schiff's the best staining quality was obtained following Carnoy's fixation [mean = 4.52] then, the formalin [mean = 3.76]. Although, Carnoy's fluid is a safe fixative and can rapidly penetrate the tissues, but it can't be a substitute for formalin

Recurrent bacterial meningitis in children role of imaging

Recurrent bacterial meningitis may be the consequence of immune deficiency or result from anatomic abnormalities which provide portals of entry of infection into the central nervous system. Bacterial migration along congenital or acquired pathways from the skull or spinal dural defects gain entrance into the CNS and should be taken into consideration when children face recurrent bacterial meningitis. Assess the role of imaging in children with recurrent bacterial meningitis 10 children with Recurrent bacterial meningitis were included in this study. They were 8 males and 2 females. Their age ranged from 2-16 years. All patients were subjected to CT scan for brain and skull base. CT metrizamide was done in 7 cases, cranial MRI in 3 cases and spinal MRI in one case. Cranial dural defects were found in 9 cases. These defects were traumatic [3 cases], congenital [4], chronic increased intracranial pressure [1] and in 1 case we were not able to identify the exact nature either congenital or acquired. One child has spinal dural defect due to congenital dermal sinus of the lumbar spine. Among the helical CT scanners used in this study [single, 4 and 64 slices], the 64-slice scanner was very sensitive to small cranial dural defects while CF metrizamide was sensitive and specific for defect localization. Recurrent bacterial meningitis should prompt a search for an underlying cranial or spinal anatomic detects especially in the absence of immunodeficiency conditions

Rotavirus infection among hospitalized children with acute watery diarrhea in Basrah - Iraq

To estimate the frequency and describe the clinical profile of rotavirus infection in children under five years admitted with acute watery diarrhea. A prospective study done on 268 patients. All were investigated for the detection of rotavirus antigen in their stool by ELISA test. The report focuses on 116 [43.3%] patients in whom rotavirus was detected. The percentage of rotavirus infection among children with acute watery diarrhea was 43.3%. The percentage was higher in the first year of life and males were more affected than females. Malnourished children were at higher risk of having prolonged diarrhea and prolonged shedding of the virus from the intestine. Rotavirus infection should be suspected in any patient with acute watery diarrhea, as there is no specific clinical pattern. Malnourished children are at a higher risk of developing prolonged diarrhea after rotavirus infection that may aggravate their nutritional status

parathyroid glands identification during neck surgery: a microsurgical perspective

Parathyroid gland identification using the operative microscope was attempted in twenty patients operated upon for thyroidectomy and other neck surgeries. Histopathological examination of an incisional biopsy confirmed the identification in twenty four out of twenty five identified glands [i. e accuracy rate of 92%]. The point of intersection of the recurrent laryngeal nerve with the inferior thyroid artery. The cricothyroid joint and the paratracheal pad of fat were all found to be valuable landmarks for parathyroid gland identification