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

Hepatocellular carcinoma in Yemeni patients: a single centre experience over an 8-year period

We carried out a retrospective study of all patients admitted to Al-Thawra Teaching Hospital in Sana'a with hepatocellular carcinoma to study the disease profile in Yemeni patients and identify possible risk factors. During the 8-year study period, January 2001-December 2008, 251 patients were admitted with confirmed hepatocellular carcinoma. From hospital records we collected data on demographic characteristics, clinical manifestations, histological characters, viral markers, treatment and outcome. Around 75% of the patients were males. Age range was 26-75 years, mean 53.5 [SD 13.9] years. Most patients were farmers [73.7%] and had a history of chemical contact. Chronic hepatitis B virus infection [48.2%] and hepatitis C virus infection [38.2%] were the most frequently identified risk factors. Qat chewing and smoking were not statistically significant risk factors. Right lobe involvement was seen in 109 [43.4%] patients and 154 [61.4%] presented with multiple lesions. We found 187 [74.0%] patients had cirrhotic liver associated with hepatocellular carcinoma. Overall mortality rate within 6 months of admission to hospital was 24.3%

Features of Egyptian type 1 diabetic toddlers clinico-epidemiological study of Egyptian toddlers and preschool children with type 1 Dm

The incidence of type 1 diabetes mellitus is increasing worldwide especially in toddlers and preschool children in whom the disease appears to run a more accelerated course than the elder age group. To determine the epidemiological and clinico-pathological features of type 1 diabetes in Egyptian toddlers and preschool children. 120 diabetic patients were included divided into two groups: according to age at presentation: group I [N = 60], aged < 5 years at presentation [32 males and 28 females] diagnosed in the period from January 1[st] 2006 till December 31[st] 2006; group II [N = 60], aged > 5 years at presentation [30 males and 30 females]. They were diagnosed in the period from January 1[st] 2000 to December 31[st] 2005. Patients were subjected to thorough history, and examination. Laboratory investigations included; random blood sugar [RBS], glycated hemoglobin [HbA[1c]] every 3 months as well as C-peptide assessed initially and after 6 months. Structured questionnaire was filled by parents for assessment of diabetic risk factors. There was a steady increase in the percentage of diabetic toddlers and preschool children in relation to total number of diabetic patients diagnosed in the 6 years period, increasing from 16% in the year 2000 to 23.3% in year 2005. The median duration of exclusive breast feeding was 2 months in patients with early onset versus 4 months in patients with late onset of diabetes. The median duration of total breast feeding was 9.5 months versus 11.2 months in patients with early onset diabetes mellitus and late onset respectively. Median age of introduction of cow milk was 2.5 months in early onset diabetics [range 1-5.3] compared to 4 months in late onset diabetics [range 2-7]. History of preceding clinical infection [febrile illnesses] occurred in 73.3% and 33.3% in diabetic toddlers and older age group respectively [p<0.0001]. 50% of young diabetics were diagnosed in winter and autumn versus 25% of older group [< 0.05]. More aggressive disease presentation in the toddler group as 75% had diabetic ketoacidosis [DKA] as a presenting symptom compared to 38.3% of the older diabetics [p<0.0001]. Higher initial RBS, higher incidence of hypoglycemia attacks in diabetic toddlers compared to older age group [p<0.0001]. Higher mean insulin dose and mean random blood sugar follow up values were found in young diabetics [p<0.01]. Young diabetics had significantly lower initial C-peptide values [p<0.0001] as well as significantly lower 6 months follow up values [p<0.0001] compared to older age. Initial C-peptide values were negatively correlated with initial RBS [r = -0.335; p<0.05] and mean insulin dose [r = -0.609; p<0.0001] while it positively correlated with age at presentation [r = 0.538; p < 0.0001]. The role of environmental factors in triggering type 1 DM was highlighted especially in toddlers with more aggressive presentation and disease course which was related to lower beta-cell reserve

Pattern of gastrointestinal tract malignancy At Al-Thawra Hospital, Sana'a, Yemen 1998-2001

This study is based on data collected from 388 patients registered with primary cancer of the gastrointestinal tract and its accessory glands. The diagnosis was confirmed histophathologically in all patients. These patients were seen at Al-Thawra Teaching Hospital in the period 1998-2001. The relative frequency and rank of order were determined for each type of GIT cancer. The male/female ratio was 1.3:1. The age of the patients ranged between 25-65 years with a mean of 45 years. The peak occurrence was in the age group of 46-55 years. Abdominal pain was reported in all patients. 'The other most common presenting symptoms were weight loss, weakness, vomiting and abdominal distension reported in 79.9%, 77.3%, 74.5% and 72.2%, respectively. Hepatocellular carcinoma was the most common GIT cancer, ranked the first and diagnosed in 150[38.7%] patients. Colorectal carcinoma ranked the second, followed by esophagus and small intestine cancers found in 25.8%, 18% and 7.7%, respectively. Stomach and pancreatic cancers were less frequent, recorded in 7.2% and 2.6% in that order. No gallbladder cancer or premalignant conditions were registered. The results of this study were compared with findings mentioned in the literature. Some differences in the pattern of GIT cancers were encountered. GIT cancers were often discovered in late stage, when the treatment offers little chance of cure. The study stresses the importance of prevention, screening and early detection for GIT malignancy. Furthermore, eradication of H. pylori and vaccination against HBV preferably integrated into expanded program of immunization are strongly recommended