Screening for minimal hepatic encephalopathy in asymptomatic drivers with liver cirrhosis

Minimal hepatic encephalopathy [MHE] represents a part of the spectrum of hepatic encephalopathy [HE]. It can have a far-reaching impact on quality and ability to function in daily life and may progress to overt HE. This study was designed to screen for MHE in drivers with liver cirrhosis in Mansoura, a city in the Nile delta in Egypt. A total of 174 consecutive drivers with positive serology for viral markers and cirrhosis were screened for MHE. Questionnaires and standard psychometric tests and well-informed consent were performed at the same setting. The diagnosis of MHE was made when one or both symbol digit test [SDT] and number connection test [NCT] appeared abnormal. Beck's inventory and Mini Mental State Examination questionnaires were performed for those diagnosed as MHE. After overnight fasting, venous blood samples were taken for haematologic tests and routine liver function tests by conventional methods. Arterial ammonia was also measured. A total of 66 patients showed evidence for MHE out of 139 patients who fulfilled the inclusion criteria. No significant differences were present, apart from a significantly elevated arterial ammonia level [p-value <0.001] and a bad self-reported driving history [p < 0.05] in the MHE-positive group when compared with the MHE-negative group. Multivariate logistic regression revealed that advanced Child-Pugh grade [p < 0.001], hepatitis B virus [HBV]-related a etiology [p < 0.001] and smoking are significant risk factors for MHE. MHE is significantly commoner among Child-Pugh C patients [p < 0.05] when compared with the other Child-Pugh grades. Our data revealed a high prevalence of MHE [47%] among Egyptian drivers with liver cirrhosis. It is hence recommended to include the driving history as well as regular pencil-paper standard psychometric testing in evaluating those at risk, especially in the outpatient setting, for early detection and proper management

Characterization of methicillin resistant staphylococcal aureus [MRSA] isolates from mansoura university hospitals

Hospital-acquired infections due to MRSA are associated with considerable morbidity, mortality, and excess costs. Our work aimed to study the prevalence, risk factors and genotypic characteristics of MRSA isolates from patients admitted at Mansoura University Hospitals [muhs]. A total 184 of Staphylococcal aureus [SA] clinical specimens were collected from our in-patients between June 2009 to June 2010. Isolated colonies were identified in a systematic manner for selection of MRSA. Oxacillin and cefoxitin resistance tests identified MRSA that were subjected to antibiogram and resistogram. MRSA amplified genes, visualized by agarose gel electrophoresis, were analyzed by Sanger sequencing. Only 49 isolates out of the isolated strains of SA were identified as MRSA strains by cefoxitin disc diffusion test. All strains are resistant to cefoxitin, ceftriaxon, cloxacillin and ampicillin while most strains were susceptible to vancomycin. Sanger sequencing of meca gene showed 3 monographs. MRSA isolates were more from blood samples [F< 0.001] of patients above 60 years [P< 0.001], of low socioeconomic status [P< 0.001], and of >2wks duration hospital stay [P< 0.05], in icus [P< 0.001], with a previous history of hospital admission within the past year [P< 0.001] and a positive history of antibiotic use in the last 6 months [P< 0.001]. Positive family history of chronic disease [P< 0.001] or hospitalization within the last year [P< 0.05] and the presence of family member working in a clinic or a hospital [P< 0.05] were noted in MRSA-positive patients. Our data revealed an increased prevalence of multi-drug resistant MRSA isolates where PCR was of the best choice for their rapid and accurate detection. An effective infection control program should be implemented for appropriate MRSA management