Influence of Short Term Exercise on the Quality of Life of Patients with Chronic Heart Failure: Case Series from Saudi Arabia

Cardiac rehabilitation (CR) is a comprehensive disease management program for heart failure patients. Most of the heart failure (HF) guidelines are classifying the cardiac rehabilitation for heart failure patients as class 1A which mean highly recommended. However, Arab countries and Middle East are lacking specific CR programs and guidelines. In this study, five cases of chronic heart failure patients were exposed to short term regular exercise for maximum 8 weeks. With a mean of 5.6 exercise visits there are 19. 2% improvement in functional capacity, 35% improvement of exercise distance, 32.5% improvement in quality of life, 25% improvement in quality of sleep and decrease the emergency room visits by 37.5%.The significant improvement was in quality of life, exercise capacity and a decrease in ER visit for all patients.

Real-time PCR versus phenotypic diagnostic methods in detection of methicillin and vancomycin resistant staphylococci

Staphylococci are the most frequently isolated bacteria from blood. The prevalence of antibiotic resistance has dramatically increased. Real-time PCR offers rapid, accurate, and sensitive method to detect the presence of antimicrobial resistance. This study is mainly aimed to detect uethicillin [oxacillin] and vancomycin resistant staphylococci isolated from blood of patients with significant bacteremia in Assiut University Hospital using both real-time PCR and phenotypic agnostic methods. Sixty Staphylococcal isolates were included. These isolates were collected from positive blood culture bottles [BACTEC 9050 System] of patients with significant bacteremia in Assiut University Hospital. Identification of staphylococcal species was performed by subculture on Mannitol Salt Agar [MSA] and by Microscan system, while antibiotic sensitivity testing was performed by Microscan system, Epsilometer test [E- test], Disc diffusion [DD] method, Oxacillin Resistance Screening Agar Base [ORSAB] and by real-time PCR for mec A and van A genes. Seven S. aureus isolates and fifty three Coagulase-negative staphylococci [CoNS] were detected by both MSA and Microscan system. The most effective antibiotics for staphylococcal isolates were in order. Vancomycin, Linezolid, Synercid, Rifampicin, Chloramphenicol, Gentamycin, Tetracycline, Trimethoprim/Sulphamethoxazole, Clindamycin, Ofloxacin, Ciprofloxacin, Azithromycin and Erythromycin. Concerning methicillin resistance, Real-time PCR which is the gold standard method detected mecA gene in 57 isolates. Accordingly, sensitivity and specificity of E-test were 964% and 100% respectively, DD method showed 87.7% sensitivity and 100% specificity, ORSAB media showed 92.9% sensitivity and 100% specificity while Microscan showed 100.0% sensitivity and 100.0% specificity. Concerning vancomycin resistance, E-test which is the gold standard method detected vancomycin resistance in 6 staphylococcal isolates. Therefore, the DD method showed 66.7% sensitivity and 100.0% specificity while Microscan showed 83.3% sensitivity and 100.0% specificity. Real-time PCR detected van A gene in only one staphylococcal isolate. CoNS organisms are more implicating than S. aureus in bloodstream infections [BSIs]. About 95% of staphylococcal isolates were resistant to methicillin and 10% were resistant to vancomycin. Real-time PCR was more accurate and rapid method for detection of methicillin resistance than phenotypic methods and it could be considered a confirmatory method for detection of vancomycin resistance in staphylococcal isolates suspected to have the van A gene

Clinical and biochemical characteristics of early onset type 2 diabetes in Kuwaiti youth

To assess clinical features and investigation results in early onset type 2 Kuwaiti diabetics. Descriptive study. Mubarak Alkabeer Hospital, Kuwait. Ninteen early onset type 2 diabetics. Clinical features and investigation results. All patients were overweight [n = 6, 16%] to obese [n = 13, 84%] at diagnosis with a mean BMI of 31.43 +/- 2.09 kg/ m2 and a mean waist circumference of 94 +/- 1.7 cm in females and 103.43 +/- 1.24 cm in males. Hypertension was reported in three cases with mean systolic blood pressure of 134.32 +/- 8.45 and mean diastolic blood pressure [DBP] of 87.05 +/- 10.34. Family history of type 2 diabetes was reported in 68.4% and maternal history of gestational diabetes in 52.6%. Ten patients [52.6%] had acanthosis nigricans. Six female patients [out of 12] had clinical features of polycystic ovary syndrome. Homeostasis model assessment was found to have strong positive correlation with BMI, waist circumference in females, triglycerides [TG] and DBP; and negative correlation with high-density lipoprotein cholesterol [HDL-C] and apolipoprotein A1. Similarly, high-sensitive C-reactive protein showed positive correlation with BMI, waist circumference in female and male patients, TG and DBP; and negative correlation with HDL-C. Early onset type 2 DM is increasingly recognized in Kuwait. This phenomenon is strongly associated with obesity; in particular central adiposity and chronic inflammatory states which appear early in these youngsters. Type 2 DM is frequently asymptomatic and should be considered in obese adolescents with positive family history

Improvement of steatosis after interferon therapy in HCV genotype 4 is related to weight loss.

Introduction Hepatic steatosis is common in patients with chronic hepatitis C virus (HCV) infection, and its occurrence may be related to both host and viral factors. Relationship between improvement in steatosis and response to anti-viral treatment remains unclear. This study assessed the factors associated with steatosis in patients infected with genotype 4 HCV, and to correlate degree of changes in steatosis with host factors and response to treatment. Methods Records of 175 patients with chronic genotype 4 HCV infection, who had received interferon and ribavirin combination therapy, were reviewed retrospectively to extract data on body mass index (BMI), presence of diabetes mellitus, and liver histology findings. Paired BMI data and liver biopsies (pre- and 24-weeks post-treatment) were available in 86 patients. Baseline steatosis and its changes (before and after treatment) were the dependent variables in a univariate and multivariate analyses. Results Steatosis was found in 88/175 (50.3%) of baseline biopsies. Its presence was related to baseline BMI (r=0.33, P<0.01), but not with viral load, or grade of liver inflammation or fibrosis. On follow up, improvement in steatosis was significantly associated with degree of weight loss but not with response to anti-viral treatment. Conclusion Steatosis is common in genotype 4 HCV infection, and its presence appears to be related to high BMI, but not to viral load or degree of liver injury.

Caries experience and selected caries-risk factors among a group of adult diabetics

To investigate the prevalence of dental caries and selected caries-risk factors among a group of adult diabetics and to determine the impact of sociodemographic, medical history, caries risk factors and oral health behaviors on caries experience. A case-control study was conducted on 150 adult diabetics [Type 1= 49, Type 2= 101] and 50 healthy, sex and age-group matched controls. The data were gathered by questionnaire, clinical examination and laboratory investigations. The diabetics' coronal caries experience based on the DMFT scores was not statistically different from that of non-diabetics. However, by excluding the contribution of missing teeth from the coronal DMF index, the result showed lower diabetics' caries experience due to a lower number of filled teeth [P < .001]. The prevalence of diabetics' current root caries [DT scores] was statistically significantly higher than that of non-diabetics, although there were no statistical significant differences in the root DMFT values between the groups. The diabetics showed significantly higher buffer capacity and lactobacilli counts but similar salivary flow rates and mutans streptococci counts in comparison to controls. The overall results indicated no significant statistical differences in the prevalence of dental caries or caries-risk factors between Type 1 and Type 2 diabetics. Factors contributing to higher caries experiences among the groups were plausible with current information on caries risk, e.g., high mutans streptococci counts, lower buffer capacity and less brushing frequency. The presence of dental caries is not significantly elevated in most diabetics but a certain subpopulation may be at risk, especially for root caries

Occurrence of Fungal Species and Mycotoxins from Decayed Sugarcane (Saccharrum officinarum) in Egypt

Seventy-three fungal species belonging to forty-three genera were isolated from 40 samples of Saccharrum officinarum (collected from Naage-Hamadi canal in Qena Governorate, Egypt). Aspergillus, Trichoderma, Mucor and Pythium were the most common genera on the two isolation media. The dominant species of Aspergillus were A. niger, A. flavus, A. ustus, A. terreus and A. wentii. Some species were dominant on 40 g/l sucrose such as Aspergillus niger, A. flavus, Emericella nidulans, Trichoderma viride, Torula herbarum and Mamaria echinoeotryoides, while the dominant species on 10 g/l glucose were Mucor circinelloides, Aspergillus niger, Torula herbarum and Trichoderma viride. Mycotoxins including aflatoxins B1, B2, G1 and G2, zearalenone and diacetoxyscirpenol were detected in the examined samples of Saccharrum officinarum. The mycelial growth of A. flavus, A. niger, Fusarium moniliforme and Torula herbarum decreased with the increase in Dimethoate concentrations, although 25 ppm was less effective than the higher levels of the insecticide (75~200 ppm). Dimethoate stimulated the activity of Go-T in A. niger, F. moniliforme and T. harbarum, while the Go-T activity was inhibited in A. flavus with the Dimethoate treatments.

Improved procoagulant activity and dyslipidemia in obese patients post bariatric surgery

Obesity is an increasing health problem worldwide. Obesity has characteristics of a prothrombotic state along with other endocrine and metabolic disturbances. We focused on the pathophysiological substrate of hypercoagulability and the potential consequences of weight loss post bariatric surgery on biochemical markers of procoagulant activity and dyslipidemia. A total 24 morbidly obese patients [18 women, 6 men] of mean age 32.96 +/- 5.9 and mean BMI 44.25 +/- 2.8 kg/m2 underwent restrictive gastric surgery [vertical banded gastroplasty,VBG]. Body mass index, blood pressure, lipid profile, plasma fibrinogen and plasminogen activator inhibitor-1 were monitored at baseline, 6 and 12 months post surgery. A significant weight loss was observed in all patients during the one year follow-up period. Mean body mass index was 44.25 +/- 2.8 kg/m2 before surgery, and significantly decreased to 37.79 +/- 2.60 kg/m2 at 6 month [p<0.001] and to 35.62 +/- 2.69 kg/m2 at 12 [P<0.001] months post bariatric surgery. After the dramatic weight reduction, a significant reduction in TC [p<0.01], LDL-C [p<0.01] and TG [p<0.001], plasma fibrinogen [p<0.001] and PAI - l [p<0.001] levels were observed throughout 12-month follow-up, with a significant rise in HDL-C[p<0.001]. Bariatric surgery could optimize cardiovascular risk profile and exert beneficial effects on thrombosis and the hemostasis axis in obesity. Weight loss resulted in improved metabolic parameters, suggesting a lowered atherogenic risk

role of reduced nicotinamide adenine dinucleotide dehydrogenase activity, nitric oxide, malondialdehyde and vitamin E in Parkinson's disease

The aim of the present work was to study the role of NADH dehydrogenase enzyme [complex I] activity, nitric oxide [NO], malondialdehyde [MDA] and vitamin E [vit. E] in the etiogenesis of Parkinson's disease [PD]. This study included 20 PD patients [group I] and 20 healthy subjects [group II]. Mitochondria from platelets were isolated to detect complex I activity. Plasma nitrite and nitrate together with their platelets homogenate levels were estimated. Plasma and platelets homogenate MDA, and plasma vit. E levels were also measured. The results of the present work showed: -Significant decrease of complex I activity [n mol/min/mg protein] as compared to healthy control subjects [t=4.03, p<0.001]. -Non-significant difference between the 2 studied groups as regard plasma nitrite and nitrate and their platelets homogenate levels [micro mol/L] [P>0.05]. -Non-significant difference between the 2 groups as regard the level of MDA in both plasma [n mol/L] and platelets homogenate [n mol/mg protein] [p>0.05]. -Significant increase of plasma vit. E level [ng/ml] in group I as compared to group II [t=3.6, p<0.001]. Age, age at onset and sex of PD patients showed non-significant correlation with complex I activity, plasma nitrate, plasma and platelets MDA and plasma vit. E [p>0.05]. However, plasma nitrite levels showed significant correlation with age [r=0.467, p<0.05]. These results suggest that complex I defect is a contributing factor in the pathogenesis of PD, To be considered as a biochemical marker, it should be measured repeatedly to detect progressive decrease in activity. Nitrite, nitrate, MDA and vit. E are apparently not related to the risk for PD

Early versus late excision and grafting in the treatment of second and third degree burns

One hundred seventy eight patients with second or third degree burns who attended the emergency department in Suez Canal University Hospital in whom the total body burned surface area [TBSA] ranged between 10- 50% were included in our study. They were allocated randomly into two equal groups using simple randomization technique. [n= 89 patients]. Patients of the first group were treated by early excision of eschars and auto grafting [EEG], after a mean period of 5.39 +/- 1.47 days while patients of the second group were treated by repeated eschar excision, wound dressing and late grafting [LEG] after a mean period of 39.12 +/- 18.26 days [P<0.0001]. The mean graft take was 95.38% +/- 7.70 in the EEG group while it was 94.37% +/- 6.81 in the EEG group. The difference was statistically insignificant. Hypertrophic scars were common among patients of EEG group [41.57%] compared to [26.96%] in LEG group. It declined to 35% in EEG group compared to 30% in LEG group when burned surface area was equal or below 20% of [TBSA]. Late contracture was less common among patients of EEG group [6.74%] compared to [24.71%] in LEG group [P<0.001]. It declined to 0% in EEG group compared to 25% in LEG group when burned surface area was equal or below 20% of [TBSA]. The overall mortality was 5.06% [9 patients]. All mortalities had a burned surface area of 40-50%, it was due to septicaemia in 6 patients [3.37%], acute renal failure in 2 patients [1.12%] and DIC in one patient [0.56%]. Five of them [5.62%] were in EEG group and 4 [4.49%] were in the LEG group [NS]. The mean hospital stay was shorter in the EEG group [22.75 +/- 22.58 days] compared to [61.43 +/- 22.01 days] in the LEG group [p=0.0002]. We recommend the use of EEG in the management of second and third degree burn

fast track arterial duplex ultrasound performed by vascular surgeon. Is the now?

With the technologic advancement in vascular ultrasound imaging, surgeons are now encouraged to perform their own examinations. The vascular surgeons run the vascular laboratory in Suez Canal University hospital.The aim of this study to determine the efficiency and advantages of the arterial duplex scanning performed by the surgeon. A prospective comparative study between the results of colour duplex [performed by vascular surgeon], arteriogram and operative finding in 105 limbs [96 lower and 9 upper] from 63 patients, with chronic arterial occlusive disease or peripheral arterial emergencies, was performed. The arterial vessels were divided into 13 segments. A total of 858 segments were examined. Duplex scan was able to detect significant disease with sensitivity 83%, specificity 100% positive predictive index 100%, negative predicative index 93%, accuracy 95% and K value of 0.85. Accuracy for final therapeutic decision was 83% in arteriography, 80% in duplex and combination of both was 100%.Surgeon performed duplex is reliable and should be an integral part of vascular surgeon's practice. Our practice recommends performing arteriogram as well in the lower limb to maximize preoperative information. This paper is accepted for presentation in the first congress of the North African and Middle East chapter of the international union of angiology. Cairo, Egypt- October 2001

Radial forearm flap versus anterolateral thigh flap in the treatment of problematic wounds of the leg a clinical prospective study

Deep electrical and thermal burns and crushing injuries often result in exposure and devascularization of underlying structures. This study was done to evaluate the results of free flaps in reconstruction of these problematic wounds. Our study included 30 patients who were treated by free flap reconstruction. Twenty-three patients were males [76.67%] and 7 patients were females [23.33%]. Their mean age was 36.5 +/- 12.31 years. Problematic wounds were post-traumatic in 22 cases and post burn in 8 cases. The free flaps used were radial forearm flap [n=15] and anterolateral thigh flap [n=15]. Reconstruction was done using microsurgical technique by one team of surgeons. The total success rate was [90%]. The radial forearm flap succeeded in 14 cases [93.33%] and failed in 1 case [6.67%]. The anterolateral thigh flap succeeded in 13 cases [86.67%] and failed in 2 cases [13.33%]. Post-traumatic wounds were found to have a lower success rate compared to post-bum cases. We think that free flaps should be strongly considered in the management of problematic wounds for their advantages as better preservation of tissues, less number of operations and short hospitalization than other traditional techniques

value of splenic vicryl mesh repair in cases of rupture spleen

Twenty-three patients [15 males and 8 females] with rupture spleen; grade II in 3 cases [13.04%], grade IIl in 12 cases [52.17%] and grade IV in 8 cases [34.78%] had been managed with splenic preservation and vicryl mesh application. Splenic salvage with mesh was done in 20 cases [86.96%] while in the remaining 3 cases [13.04%] partial splenectomy was done followed by mesh application. The vicryl mesh was successful in controlling splenic bleeding in all cases [100%]. However, re-exploration was performed in two cases for causes other than bleeding. The first case was explored due to peritonitis from disrupted gastric tear and splenectomy was performed. The second case was explored due to small bowel gangrene and resection anastomosis was done with preservation of the mesh and the patient was discharged after 10 days. One patient died in the first post-operative day suffering from cerebral laceration. One week after the operation duplex scanning demonstrated normal flow in the splenic vessels in the surviving 22 cases and IgG, IgA and IgM were found to be within normal limits. The application of splenic mesh for preservation of injured spleen is a safe and reliable method for splenic salvage and maintenance of splenic function

Permanent neonatal diabetes mellitus: epidemiology, mode of presentation, pathogenesis and growth.

Permanent neonatal diabetes mellitus (PNIDDM) is a rare form of IDDM with unclear etiology and pathogenesis. We determined the incidence and prevalence rates and studied the clinical and biochemical features of PNIDDM in the Sultanate of Oman. The mean incidence rate during the study period from January 1989 to December 1994 was 1.788 +/- 0.82 per 100,000 live births per year. At the end of December 1994 the prevalence rate was 2.4 per 100,000 children below the age of 5 years. They constituted 41.6% of all cases of IDDM in this age group. Diarrhoea, fever, lethargy, poor feeding and failure to thrive were the most common presenting symptoms. Dehydration and tachypnoea were the most common signs. All patients who developed IDDM during the neonatal period had intrauterine growth retardation and 4.5 presented with diabetic ketoacidosis (plasma glucose 37 +/- 9 mmol/L, pH 7.12 +/- 0.1). Hypertriglyceridemia was a constant feature (19.4 +/- 4.8 mmol/L). They were products of consanguineous marriage with significantly high prevalence of IDDM and NIDDM in their family members. None of the infants had clinical or immunological evidence of congenital viral infection. Three of the five children had HLA-DR2, the diabetes resistance alleles. C-peptide secretion was absent during and after metabolic control of hyperglycemia in all the studied infants and none had circulating islet cell antibody at presentation or during the first year after diagnosis. Despite marked growth retardation at birth, there was a significant improvement of growth after initiating insulin therapy. Four of the 5 patients had normal developmental milestones, one had mild developmental delay following a severe and prolonged attack of hypoglycemia. None of the patients had exocrine pancreatic deficiency. In summary, the very high rate of parental consanguinity, occurrence in both sexes and in two siblings in the same family, absence of islet cell antibodies and the presence of HLA-DR2 loci in 3/5 of patients suggest that PNIDDM is a different disease process to standard IDDM in childhood and an autosomal recessive mode of transmission.

Defective growth hormone (GH) secretion and short-term treatment in Noonan syndrome.

Auxological and endocrine data from 12 prepubertal children (3 males, 9 females) with Noonan syndrome (NS) were compared with those of 15 children with constitutional short stature (CSS), 20 children with partial GH deficiency (GHD), and 6 children with Turner syndrome (TS). Four children with NS were treated with human growth hormone (hGH) (n = 4) (25 units/m2 week, divided on daily s.c. doses). In children with NS, the peak serum GH response to clonidine (5.4 +/- 2.7 ug/L) and glucagon (7.4 +/- 3.4 ug/L) were significantly lower than those for children with CSS (14.8 +/- 3.4 and 12.8 +/- 2.8 ug/L respectively). Nine out of the 12 (75%) children with NS did not mount normal GH peak (10 ug/L or more) after provocation. The 12-h integrated GH secretion in the 3 children with NS who had normal GH response to provocation (2.7 +/- 0.7 ug/L) was markedly lower compared to that for children with CSS (6.7 +/- 1.2 ug/L). The serum insulin-like growth factor-1 (IGF-I) concentrations were lower in children with NS (67 +/- 32 ng/ml) vs CSS (165 +/- 35 ng/ml), but not different from those for GHD children (59 +/- 33 ng/ml). In 4 children with NS, hGH therapy for a year increased height growth velocity from 4.1 +/- 0.3 cm/yr to 7.4 +/- 0.6 cm/yr and height standard deviation score (Ht SDS) from -2.2 +/- 0.6 to -1.45 +/- 0.3. This growth acceleration was accompanied by an increase in IGF-I concentration (from 52 +/- 21 ng/ml to 89 +/- 25 ng/ml). In summary, these results prove a defect of the GH secretion in children with NS and suggest that GH therapy has an important role in the management of their short stature.

Chronic Endopath thelitis after extract Sular cataract extraction caused by Aspergillus niger

Chronic postoperative endophthalmitis is a distinct clinical entity that describes eridophthalmitis that presents one or more months after cataract surgery and which is associated with micro organisms of low-grade virulence. This study concerns the case of a 65-year-old man in whom chronic endophthalmitis developed three months after extracapsular cataract extraction with implantation of a posterior chamber intraocular lens. Aspergillus niger was isolated and identified from the infiltrate which was recovered from the anterior chamber of the left eye. The infection responded to combined medical and surgical treatment

Defective growth hormone secretion and hypogonadism in the new syndrome of congenital hypoparathyroidism, growth failure and dysmorphic features.

A child with extreme growth failure, dysmorphic features, hypoparathyroidism, and abnormal skeletal survey was studied. He was a product of first degree consaguineous marriage who had intrauterine growth retardation and presented at 14 days of age with hypocalcemic tetany with normal cardiovascular system and immune function. Endocrine evaluation after infancy revealed defective growth hormone (GH) secretion in 2 provocation tests and lack of clinical and testosterone response to human chorionic gonadotrophin (HCG) therapy.

study of burn injuries among children under 15 years old

This is a prospective clinical study, conducted as ismailia general hospital over a period of one year. In this study, 222 burned children were included. Their mean age was 4.8 years and males to females ratio was 1.2:1. The majority of children [55%] came from rural areas. Most of them [91.9%] sustained burns at home during tea or food preparation. So, scalds occurred in 74.3% of cases, flame burns in 22.9% and both electrical and chemical burns in 2% 2.8% of cases. Based on the extent and depth, 117 patients [52.7%] had minor burns, 54 patients [24.4%] had moderate and 15 patents [22.9%] had major burns. Sixty nine patients [31.1%] with moderate or major burns were hospitalized. The mean time of hospital stay was 22.8 days. Fluid therapy based on the total body surface area [tbsa] was found to be more efficient for resuscitation than that based on the body weight [parkland formula]. Surgical intervention was restricted to escharotomy for 7 patients [3.7%] and skin grafting for 54 patients [29%]. Out of 69 hospitalized patients, wound sepsis by staph aureus and pseudomonas aerogenosa occurred in 40 patients [54%]. The total mortality rate was 6.8%; septicemia and ciruatory collapse were the main causes of death