CMV colitis presenting as neoplastic lesions with life-threatening bleeding in an immunocompetent patient

An elderly woman with multiple medical problems developed cytomegalovirus [CMV] colitis following a prolonged hospitalization. She presented life-threatening colonic bleeding mimicking a neoplastic process while the final diagnosis was CMV colitis. This is an uncommon presentation of CMV colitis in an immunocompetent patient needing a high index of suspicion to proceed early with proper diagnosis and therapy

Cognitive functions changes in Egyptian sewage networks workers

Hydrogen sulfide is a toxic gas about which much has been written. It constitutes one of the most serious chemical hazards to which sewage network workers are exposed to. The current work aimed at assessment of cognitive dysfunctions among workers of sewer networks and the relation of these changes, if any, to the level of exposure to the biomarker, urinary thiosulfate. A trial for setting a screening test for cognitive function change. The work was conducted among 34 male workers involved in the maintenance of the sewage network and a matched unexposed control group [n = 21]. The participants were subjected to clinical neurological examination, estimation of urinary thiosulfate as hydrogen sulfide exposure biomarker, and assessment of cognitive functions changes by using neurophysiological [simple reaction time, P300 test] and neuropsychological tests [Wechsler Memory Scale] and frontal executive functions. Clinical neurological history revealed significantly higher neurological symptoms [headache, memory defects, lack of concentration] among exposed workers compared to their controls [P < 0.05]. Marked elevation of urinary thiosulfate was observed among the exposed workers [P < 0.001] although this elevation was not correlated with the duration of exposure. Exposed workers showed poor performance of most of neuropsychological tests compared to control subjects. Significantly prolonged simple reaction time and delayed P300 latency were found among sewer network workers. Most of exposed workers had significantly lower Mini-Mental State Examination [MMSE] scoring than that of the controls [P < 0.001]. MMSE was significantly correlated with other neuropsychological tests. Exposure of sewer network workers is associated with significant cognitive dysfunction which can be screened by applying MMSE annually as a screening test of the exposed workers

Ultrasonographic assessment of intracranial hemodynamics in acute stroke patients

Transcranial ultrasound [TU] is a noninvasive, easy-to-repeat diagnostic technique that is being used widely for the evaluation of cerebral heamodynamic. The aim of the study was to explore and demonstrate the findings that can be afforded by the Transcranial ultrasonography, the non imaging Transcranial Doppler sonography [TCD] and the imaging Transcranial color-coded Doppler sonography [TCCS], with more emphasis on the practical work of the TCCS. During a period of one academic year from October 2005 to October 2006, 50 non consecutive patients, seen at the stroke clinics of two medical institutions, were enrolled in the study. They were divided into two groups. The 1st group comprised of 25 patients recruited from Ain Shams specialized hospital who had TCD. The 2nd group comprised of another 25 patients recruited from Cairo University Hospital who had TCCS. Extra cranial Carotid Duplex had been done for both groups. In the two groups, the effect of the supplying artery on the insonated intracranial arteries was put in consideration whenever TCD or TCCS was done. Out of the 50 patients, 40 [80%] were successfully insonated yet in 10 [20%] patients, insonation through the temporal acoustic window failed; of which 6 [60%] were females and 4 [40%] were males. We found 11 [14%] MCAs which revealed abnormal waveform patterns [10 dampened and 1 blunted], reversal of flow in the ACA was noticed in three cases and a dampened waveform pattern in 12 PCAs. Regarding intracranial arterial stenosis, it was detected in 21 arteries [13 MCAs, 2 ACAs, 6 PCAs], 16 showed < 50% stenosis [9 MCAs, 2 ACAs, 5 PCAs] and 5 showed >/= 50% stenosis [4 MCAs, I PCAs]. We recommend that acute stroke patient, must perform a baseline TCU which, provide a hemodynamic intracranial image to what is present extracranially, Repeated examination can be achieved by TCU to serially monitor the therapeutic or spontaneous recanalization

relation between nutritional factors and multiple sclerosis: an Egyptian study

No single environmental exposure has been consistently identified as a causal factor in MS. It has been suggested that nutrition and food patterns may play a role in the aetiology of MS. To explore the nutritional pattern of MS Egyptian patients in comparison with that of controls. The relation between nutritional factors and MS was studied among 30 MS patients and 30 matched controls in neurology department Cairo University between June 2006 and January 2007. Dietary information was collected by employing 24 hours recall method and food frequency questionnaire. MS patients were underbuilt with lower BMI as compared to controls. Also patients seem to consume less vitamin A, B1, C, carbohydrates, proteins and more fat. A significant negative correlation was found between patient disability as measured by EDSS and iron and B1 intake. We found no statistical significant difference between patients and controls in zinc, iron, calcium, vitamin A, B2, C carbohydrates, fat and protein on one hand and patient disability. The study generally supports a protective role for antioxidants and increased risk of MS with fat consumption

Role of antenatal care in toxemia of pregnancy in Alexandria

Pre-cclampsia and eclampsia remain one of the major obstetrical problems in less developed countries. Proper antenatal care [ANC] with regular measurement of blood pressure remains the mainstay of screening for hypertension in pregnancy. The aim of the current study was to identify frequency and characteristics of women with toxemia of pregnancy, assess both the quantitative and qualitative adequacy of antenatal care among cases with toxemia of pregnancy and to evaluate the effect of antenatal care on maternal and perinatal outcome. A cross-sectional case series study design was utilized. The study population was all cases, with confirmed diagnosis of toxemia of pregnancy who were admitted to El-Shatby University hospital during the period from January to May 2005. A structured interviewing schedule was used to collect data on characteristics of cases, maternal and fetal outcome. Site, adequacy and quality of received antenatal care were assessed. Out of total cases [336], 14.29% were diagnosed as mild pre-eclampsia, 83.31% were found to have severe pre-eclampsia while 2.40% were suffering from eclampsia. The severity of the condition was significantly associated with older maternal age, multiple pregnancy, primigravity, nulliparity, low socioeconomic conditions, husband's smoking and excessive caffeine consumption. Three-quarters of eclampsia cases [75.0%] didn't receive antenatal care and 60.0% of severe pre-eclamptics received inadequate antenatal care. The mean percent score of quality care domains of antenatal care content for mild pre-eclamptics was 75.62 +/- 13.80%. This was significantly higher than that for those of severe [59.96 +/- 27.95%] or for eclampsia cases [48.75 +/- 20.04%] where X2 of Kruskal-Wallis=8.316 [F<0.001]. Adverse maternal and fetal outcome occurred in 79.4% of women and 72.3% of babies for those who received poor quality ANC. In conclusion, the complications of pre-eclampsia and eclampsia could be prevented by wide spread use of adequate antenatal care, education and training of primary medical care personnel, prompt diagnosis of high risk patients and timely referral to higher level health care

role of color doppler sonography in the diagnosis of testicular lesions

Testicular lesions are common clinical problems affecting males of all age groups. Forty patients with scrotal pain and/or scrotal swelling were examined with Grey Scale and Color Doppler Sonography of the scrotum. In acute testicular lesions, including testicular torsion [15%] and acute epididymo-orchitis [47.5%], Color Doppler Sonography was more sensitive than Grey Scale Sonography, reaching up to 100% sensitivity in differentiating the two conditions. In chronic testicular lesions, there was an overlap in the vascular pattern and Doppler indices between chronic inflammatory lesions [20%] and malignant lesions [12.5%], that limit the role of Color Doppler Sonography to differentiate between these lesions. In cases of testicular trauma [5%], Color Doppler Sonography was able to demonstrate uninterrupted blood supply and avascular nature of testicular contusion. Color Doppler Sonography was very accurate in the diagnosis of acute testicular lesions, while its role in chronic testicular swellings still in need of further research on large number of patients

conformity of physicians' performance with the national guidelines of the Egyptian family planning program

Data on adequacy of physicians' performance at family planning clinics in Alexandria is contained in this report. An observational check list was used for monitoring the daily performance of 35 physicians working in the 12 family planning clinics of Alexandria. Clients were intrauterine device users in their initial visits to the clinics. The whole care process was divided into five areas covering interpersonal communication and technical aspects. The percentage score [physicians' performance index] was calculated for total, area and sub-areas of care. The collective performance index combines indices of physicians in both types of facilities together. Fifty percent value of physician performance index was taken as the cut-off point between lower unacceptable performance and higher acceptable one. The collective total performance index was unacceptable [49.37 +/- 8.24] denoting considerable deviation from standards of adequate care. Areas of care related to examination and history taking tasks had the most deficient collective physician performance index [6.72 +/- 6.64 and 25.56 +/- 13.03 respectively]. Negligence of these two areas skips the two basic rationales for right choice of the contraceptive method. The collective performance index for communication was just above the acceptable value [51.20 +/- 13.37]. The two areas with highest performance index were infection control and intrauterine device insertion [63.36 +/- 10.79 and 65.66 +/- 12.08 respectively]. This is an indication of the technical orientation of physicians leaving the total program concepts like informed decision and continuation inadequately implemented. Performance index of physicians in specialized clinics was repeatedly found to be significantly higher than those of integrated clinics in all areas of care. In area of communication, the performance index in specialized clinics was acceptable in contrast to that in integrated ones. However, the performance index in the two types of clinics were found together in either the acceptable or the unacceptable range in all other areas. This may reflect the existence of a dominant atmosphere that enhances or weakens the performance in different areas of care and the priority of importance given to these areas

Quality assessment of medical care in chest dispensaries in Alexandria

Eight million new cases of tuberculosis are merging annually, worldwide, of which an estimated three million are dying. The quality of medical care rendered by chest clinics [dispensaries] to tuberculous patients is crucial. The present study was conducted in order to assess quality of medical care rendered to tuberculous patients in all chest clinics in Alexandria [n=7]. To achieve this aim, three checklists were developed in relation to the three dimensions of medical care, namely, structure, process of care and outcome. They were validated and rated by ten medical experts working in the field of tuberculosis and chest diseases. Accordingly for the process of care, each item was scored using weighted scores for physicians performance. Unit weighted scoring was also used for physicians, nurses, as well as social workers. Direct observation was conducted for assessment of structure and process of care rendered by physicians, nurses and social workers. On the other hand outcome was measured by cure or treatment completion rate, treatment failure rate, defaulter rate, as well as death rate. The results revealed that percentage of recommended structure items ranged between 77.8% and 94.4%. Regarding process of care, it was found that the overall weighted physicians performance index [PPI] expressed in percentage was 36.97 +/- 13.65% while the mean unit weighted PPI was 35.26 +/- 13.5%. For the different areas of care, the mean weighted and unit weighted PPI, respectively, were 27.86 +/- 20.83% and 28.61 +/- 21.7% in history taking, 54.65 +/- 11.92% and 42.83 +/- 13.83% for examination, 31.64 +/- 19.61% and 37.10 +/- 19.40% for educating patients, while it was 36.36 +/- 16.0% and 37.90 +/- 16.20% for measures applied to contacts. Moreover, assessment of nurses and social workers performance revealed that they had carried out 91.86% and 86.60% of their recommended activities, respectively. Outcome indices among the different clinics showed that cure or treatment completion rate ranged from 47.48% to 81.51%, while treatment failure rate ranged between 1.71% and 11.54%. On the other hand, the defaulter rate showed a minimum of 13.70% and a maximum of 44.86%. From the present study it could be recommended that quality of medical care in chest clinics should be emphasized specially as regards process of care given by physicians

Poliomyelitis, measles and neonatal tetanus: a hospital based epidemiological study

Vaccine-preventable diseases constitute a major health problem contributing to the morbidity and mortality in many developing countries including Egypt. WHO adopted resolutions to eradicate poliomyelitis by the year 2000, eliminate neonatal tetanus by the year 1995, and reduce measles mortality by 95% and morbidity by 90%, compared to the pre-immunization levels by 1995. Evaluation of preventive programs for these diseases necessitates availability of up to date information on their occurrence. The present study was undertaken to determine the current epidemiological features of poliomyelitis, neonatal tetanus and measles, to identify the trends of these diseases as well as to determine their outcomes and hospital loads. Data about the admitted cases of poliomyelitis, neonatal tetanus and measles were collected from the hospital register of Alexandria fever hospital for five successive years [1992-96]. Available information on age, sex, residence, diagnosis, outcome of treatment, dates of admission and discharge were collected. The total number of cases of the three diseases admitted to the hospital during the period 1992-96 were 1406, measles represented 85.4%, neonatal tetanus 13.9% and poliomyelitis 0.7%. The results revealed that in the year 1994 only one case of poliomyelitis was admitted and since then no other cases were reported. The number of measles cases increased gradually in the latter years and about 78% of them were older than five years of age. A significant increase in the age of measles occurrence was observed. A gradual decline in the number of neonatal tetanus cases was observed. These cases were more apt to occur among early neonates but still clustered in certain geographical areas. The results of the study pinpoint the long term impact of the well run program aiming at eradicating poliomyelitis in Alexandria. However, for elimination of neonatal tetanus and controlling measles morbidity, further activities are required including strengthening the surveillance activities for detection of the high risk geographical areas and the high risk factors

normal pediatric kidney: some observations on the sonographic appearance

Over a period of 2 years, 288 normal pediatric subjects ranging in age from several hours to 12 years were subjected to renal ultrasonography. They all had no clinical and/or laboratory evidence of liver or kidney disease. Scans of the right kidney were included only in the analysis of this study. The scans were evaluated with emphasis on renal cortical echogenicity, prominence and hypoechoic nature of the renal medulla, distinction of the corticomedullary boundary and brightness of he central sinus echoes. Analysis of the data showed that all neonates and almost all infants 2 weeks to 2 months of age demonstrated the typical neonatal renal pattern "increased cortical echogenicity with enhanced corticomedullary differentiation". In infants more than2 months to 4 months of age 70 to 77% exhibited also the same pattern. However, in infants more than 4 months to 6 months of age 27-40 demonstrated the neonatal pattern. Between the age of 6 months and one year 8% only continued to exhibit the neonatal pattern. After the age of one year, all children demonstrated the adult renal pattern "decreased cortical echogenicity with poor corticomedullary differentiation" Possible explanations for the sonographic appearance of the neonatal kidney are given based on the known anatomic and physiologic characteristics of the kidney in adults and neonates

Gangrenous cholecystitis: Is it a possible diagnosis by ultrasonography?

The sonographic findings in 12 patients proved surgically to have gangrenous cholecystitis were analyzed. In all patients a correct preoperative sonographic diagnosis of acute cholecystitis was made. Five patients had a combination of sonographic findings that would not allow differentiation from typical uncomplicated acute cholecystitis. However, in the remaining 7 patients, additional unusual sonographic findings were demonstrated. These included intraluminal membranes, marked irregularities of gall bladder mucosa and /or diffuse intraluminal inhomogeneous non-layering echoes. These sonographic findings were highly suggestive of gangrenous cholecystitis and should prompt early surgical intervention to reduce the associated significant morbidity of this clinically important complication

Evaluation of lymphangiographic patterns in subdiaphragmatic lymphoma with special emphasis on lymphangiographic-histologic correlation

This study included 15 patients with Hodgkin's disease and 25 patients with non-Hodgkin's lymphoma. The radiological criteria of a positive lymphangiogram occurred in different frequency in all types of lymphoma. Our data showed that precise lymphographic histologic correlation is usually unreliable. Lymphography, however, has the advantage of showing a composite picture of all visualized lymph nodes which may be characteristic for some lymphoma subtypes