Detection of extended spectrum beta-lactamase producing Escherichia coli among community-acquired and hospital-acquired urinary tract infections in Tanta University Hospital

Background: Urinary tract infection [UTI] is one of the most common hospital acquired and community acquired infections. Escherichia coli[E. coli] are the most prevalent bacteria causing UTI. As a result of the extensive use of beta-lactam antibiotics in the clinical practice, extended spectrum beta-lactamases [ESBLs] have emerged.E. coli is among the most prevalent ESBL producing bacteria

Objectives are to detect antibiotic sensitivity and ESBL production of E. coli isolates in hospital acquired and community acquired UTIs in Tanta University Hospital and to evaluate different methods for phenotypic confirmation of ESBL production

Methodology: E. coli isolates were identified by Conventional biochemical reactions. The isolates were tested for antibiotic sensitivity by the disc diffusionmethod. Different methods for phenotypic confirmation of ESBL production were evaluated

Results: E.coli was the causative organism in 58% of cases of community acquired UTI and 30% of cases of hospital acquired UTI. It was found that 37 of E.coli isolates were ESBL producers. Among the phenotypic confirmatory methods which were evaluated in our study, it was found that double disk synergy detected the least number of ESBL producing E.coliisolates

Conclusions: incidence of ESBL production among E. coli isolates is high. Periodical detection and monitoring of antimicrobial susceptibility of ESBL isolates, and rotating the use of effective antimicrobial drugs are recommended to decrease the risk of high antibiotic resistance rate

Spring flyways of migrating soaring birds in Akkar/Northern Lebanon

Beale and Ramadan-Jaradi initiated in 2001 the first large scale survey in Lebanon to trace the main routes of migrating raptors and other soaring birds, aiming at contributing to the conservation of flyways and stopover sites through the identification of areas where protection is most needed. Nowadays, the study of the flyways and stopover sites at micro level becomes necessary following the development of the national wind atlas map that will assist among others in locating potential wind farms which on their turn may influence the migratory birds' flyways, especially that the wind farms use winds for their function and the soaring birds use wind for their transportation. The present work starts from where the work of Beale and Ramadan-Jaradi ended but in an attempt to provide policy makers, scientists and experts with a conceptual framework, as well as methodological and operational tools for dealing with wind farms impacts and to prevent collisions of birds with blades of wind turbines. The study is meant to be conducted during spring and autumn passage of birds. This paper concerns the spring migration as at the time of writing it the autumn migration didn't start yet. The present spring season study revealed among others that the migratory soaring birds that may use the wind ridge lifts for their soaring travel in windy areas are more influenced by two other main factors: 1] presence of depressions perpendicular to mountain's ridges and 2] abundance of the thermals in these depressions, a matter that naturally reduces the impact of wind turbines by attracting the birds away from their blades

Helicobacter pylori infection in children with growth failure

To examine if helicobacter pylon infection has a role in growth failure in children. 26 children patients with growth failure and 14 normally growing children of the same age group. socioeconomic level and sex ratio as controls were included in the study. All were subjected to full history taking, clinical examination, anthropometry, laboratory investigations and upper endoscopy with gastric biopsy taking for diagnosis M helicobacter pylon infection by histopathology. Positive cases for helicobacter pylon infection were treated by eradication therapy; the group of children with growth failure were followed for 6 months and reevaluated. Helicobacter pylon infection was diagnosed in 77% of children with growth failure, while it was diagnosed in 43% of normal children [p<0.05]. After 6 months of eradication therapy, there was significant increase in height, weight and hemoglobin [p<0.001 for each]. Helicobacter pylon infection is a causative factor in growth failure in children

Abdominal ultrasonic changes in pediatric patients with acute viral hepatitis

Acute hepatitis causes not only pathological ultrasound changes in the liver, but also affects other abdominal organs. This study was carried out to detect ultrasonic changes in the abdominal organs and hepatic vessels in cases of acute hepatitis in children and determine the chronology of these changes. 143 pediatric patients with clinical picture and laboratory findings of acute hepatitis were prospectively examined by gray scale and Duplex Doppler ultrasound early at the start of the disease and every 6 weeks for 6 months. Eighty seven age and sex matched normal children were also examined as a control group. Enlarged lymph nodes in hepatic hilum was the most common finding, it affected 97.9% of cases in the first examination and did not disappear for 12 weeks; 30% of cases showed its presence at 6 months but with decreasing size. Hepatomegaly was found in 84.6% of cases in the first examination, but returned to normal size by 12 weeks. Increase in liver echogenicity was found in 50.4% of the cases in the first examination, in 39% after 6 weeks and disappeared by 18 weeks. Hypoechoic liver was found in 20.3% at the start of the disease and disappeared by 6 weeks. Splenomegaly was detected in 33% of cases at the start of the disease, in 3.6% at 6 week visit and disappeared by 3 months. Thickened gallbladder wall was present in 25.2%, hepatic veins biphasic waveform in 19.3% and ascites in 2.1% of cases at the start of the disease, all were very transient and not detected by 6 weeks. Lymph node enlargement in porta hepatis was the most prevalent and persistent finding in children with acute viral hepatitis. Other organ affection detected by abdominal ultrasonography [gray scale and duplex Doppler] in those children disappeared by 6 to 24 weeks

Oxidative criteria and somebone turnover markers in beta-thalassemic patients

Bone disease in beta-thalassemic patients has multifactorial etiology; increased iron stores and per-oxidative stress are involved factors. This study aimed to investigate the relationship between some bone turnover markers and some oxidants, antioxidants parameters of beta-thalassemic patients. The study included 50 patients were diagnosed as beta-thalassemia major aged between 3 and 40 years, 30 males and 20 females compared to 34 normal controls of same age and sex ratio. The patients and the controls were divided into 2 groups: group Al 18 years compared to their controls group B2. All were subjected to full clinical examination and laboratory analysis of their blood and urine for bone turnover markers; osteocalcin [OC], bone specific alkaline phosphatase [BAP] and urinary deoxypyridinoline [DPD].Also parathormone [PTH], serum calcium [Ca] and phosphorus [Ph]. Oxidants and antioxidants determined were; plasma malondialdehyde [MDA], nitric oxide [NO], blood reduced glutathione [GSH], erythrocyte Cu- Zn Superoxide dismutase [SOD]. Serum levels of copper [Cu], zinc [Zn], selenium [Se], vitamin E and total antioxidant capacity [TAOC] were also determined. The results showed significant increase in urinary DPD and decrease in serum OC, BAP and PTH in thalassemic groups compared to controls. Also, the results revealed significant elevation in plasma MDA, NO, SOD and serum Cu and TAOC especially in group Al. While there was significant decrease in GSH, serum Zn, Se, and vitamin E. Plasma OC was positively correlated with serum iron and NO and negatively correlated with plasma TAOC in thalassemic patients within age group 3

value of measurement of plasma renin - angiotensin - aldosterone system in hepatorenal syndrome

Renal hemodynamic changes begin early in the course of liver disease. Hepatorenal syndrome [HRS] is defined as functional renal failure in advanced cirrhosis and ascites. The aim of this study was to measure and assess the role of plasma renin activity, circulating plasma angiotensin II and serum aldosterone in the pathogenesis of hepatorenal syndrome. Forty eight chronic liver disease patients were selected. They were divided into three groups, Group I: 15 patients, diagnosed as having HRS according to inclusion criteria. Group II: 20 patients diagnosed as having cirrhosis with ascites and without renal impairment. Group III: 13 patients with cirrhosis without ascites and renal impairment. Twenty apparently healthy subjects matching the age and gender of patients served as a control group. All patients subjected to complete history taking and clinical examination, abdominal ultrasonography, urine analysis, liver and kidney function tests, urine proteins an, Na, serum Na and K, as well as plasma renin activity, plasma angiotensin II and serum aldosterone levels were measured in all patient groups and controls. A highly significant increase [p<0.01] in plasma renin activity, serum aldosterone and plasma angiotensin II levels were detected in HRS syndrome patients [group I] compared to the other patient groups and controls. Also, a statistically significant increase [p<0.01] in the serum creatinine and urea levels were observed in the HRS patients compared to other groups, while creatinine clearance was significantly lower in group I more than other groups. In addition a positive correlation [p<0.05] was found between serum creatinine level and each of plasma renin activity and serum aldosterone level in the group of HRS. In contrast, an inverse correlation [p<0.05] between serum sodium and aldosterone levels was detected in HRS patients. From the above results, we conclude that, the renin-angiotensin-aldosterone system might have a considerable role in the pathogenesis of HRS. Thus, a routine measurement of plasma renin activity, plasma angiotensin II and serum aldosterone levels could be recommended for cirrhotic patients with ascites, to detect early changes in their levels, that might indicate of developing HRS and early controlling of this potentially fatal complication cirrhotic patients

Application of the platelet count/spleen diameter ratio to predict the presence of esophageal varices in cirrhotic patients

Screening for oesophageal varices represents an important part of the diagnostic work - up of cirrhotic patients. The non invasive assessment of the presencelabsence of oesophageal varices [OV] was done by studying the platelet count /spleen diameter and their ratio in patients with liver cirrhosis with and without OV. This study was performed on 140 patients diagnosed as having liver cirrhosis by history, clinical examination, laboratory and radiological findings. Seventy of them had no oesphageal varices NOV [group I] and 70 cases had OV [group II] were diagnosed by upper endoscopy. All patients were also classified according to modified child Turcotte-Pugh's Criteria into: Classes A,B and C [50, 60 and 30 patients respectevily]. Also, 10 normal, age and sex matched subjects were included as a control group. ultrasonographic findings revealed a high significant increased [P<0.01] of the mean bipolar spleen diameter in group 11 [166.79 +/- 25.78 mm] in comparison to group I [137.89 +/- 22.06 mm]. The mean portal vein diameter was increased in group 11 [13.54 +/- 2.39 mm] as compared to group I [11.83 +/- 1.95 mm] with a highly significant difference [P<0.01]. Color Doppler sonography demonstrated, portal vein flow direction was normal [hepato -petal] in all cases [100%] of group I. While in group II, it was reversed [hepato -fugal] in 31 patients [44.29%] , with a highly significant difference between groups 1 and 11 [p < 0.01]. According to Modified Child Turcotte Pugh classification, there was a highly significant increase [P<0.01] in the score in group II than group I. There was a highly significant decrease in platelets count [P<0.01] in group II [113.13 +/- 66.04 mm3] in comparison to group I [167.39 +/- 95.66 mm3]. The mean of platelet count /spleen diameter ratio was highly significant decrease [P<0.01] in group II [71 1.44 +/- 346.0] in comparison to group I [1488.74 +/- 1613.731]. As regards the correlation between that ratio and some parameters, we found that in group I, there was highly significant correlation between the studied ratio and platelet count, spleen diameter and modified child score. Also In group II, there was highly significant statistical correlation between the ratio and the platelet count and spleen diameter but no correlation with modified child score. The diagnostic accuracy of platelets count ,maximum bipolar spleen diameter and the portal vein diameter, as a non-invasive parameters in the detection of the presence of OV was [68%] [66%] and [65%] respectively. Concerning the studied ratio, the cut-off value was <739, with sensitivity [67.14%], specificity [62.86%], positive predictive value [64.38%] and negative predictive value [65.67%], while the diagnostic accuracy was [72.5%] as a non-invasive method in the detection of the presence of OV. In conclusion, the cut off -value of the platelet count/spleen diameter ratio 5739 is the only parameter which carries the best diagnostic accuracy and is independently associated with the presence of OV in patients with liver cirrhosis

Clinical and laboratory profile of mental disability among chidren attending a governmental teaching hospital in Cairo

This study included 104 Egyptian infants and children with mental disability and 24 normal children of the same age and sex as a control group. All patients were subjected to full history taking, thorough clinical examination, intelligent quotient [IQ] evaluation and full investigations. The results revealed that 56 of the cases were due to genetic and chromosomal causes [group I], 7 cases were due to prenatal and postnatal insults [group II] and 41 cases were without an exact cause for mental disability [group III]. Complete blood count [CBC], serum iron, iron binding capacity and blood lead levels were compared between group III and the control group. There was no statistically significant difference in serum iron nor blood lead levels between the two groups, while the difference between their serum iron binding capacity was statistically significant. Blood lead levels were significantly positively correlated with ages in group III and the control group and were significantly negatively correlated with the IQ of group III

Evaluation of the haemodynamic changes in the portal and splenic veins by color doppler sonography in patients with chronic liver diseases

This study was designed to evaluate the role of color Doppler sonography in the assessment of portal hypertension in patients with chronic liver diseases by estimating the various hemodynamic parameters in portal and splenic veins including portal vein [PV] and splenic vein [SV] diameter, cross sectional area, flow velocity, congestion index [CI], volume flow and flow direction. These parameters were performed on 20 patients with chronic liver diseases [group I], 10 of them with esophageal varices [group IA] and 10 cases without esophageal varices [group IB]; also, 10 normal age and sex matched persons were included as a control group [group II]. The study concluded that color Doppler sonography is a good tool in evaluating the hemodynamic changes in patients with chronic liver disease as dilated portal vein and splenic vein diameter, reduced PV velocity and increased PV [CI] can be used for the detection and assessment of portal hypertension

Relationship between prothrombin fragment 1+2 and helicobacter pylori associated chronic gastritis

Helicohacter pylori [H. pylori] have been suggested to be an independent risk factor for cardiovascular and cerebral stroke; through the activation of clotting system following chronic inflammation. Among proinflammatory cytokines, tumour necrosis factor-alpha [TNF-alpha] and interleukin-8 [TL-8] which have been previously demonstrated to activate the clotting system in human. This study aimed to investigate: [i] if there is a difference between the circulating levels of prothromhin fragment 1+2 [F1+2]; a sensitive marker of thrombin generation in patients with chronic gastritis according to N. pylori status, [ii] the relationship between circulating and mucosal levels of TNF-alpha, IL-8 and Fl+2 and [iii] If H. pylori eradication modifies the level of these cytokins and clotting system activation. Forty-two patients with chronic gastritis were diagnosed with upper endoscopy, and enrolled in this study, divided into 2 groups on the basis of histopathological examination of gastric antral biopsies and culture. Group I: included 28 H. pylori positive patients, and group H: 14 H. pyIori negative patients chronic gastnitis. A triple eradication therapy for H. pylori [omeprazole, amoxacillin and tinidazole] was given for the 28 H. pylori positive patients [Group I] and H. pylori eradication was evaluated after 2 months. Gastric mucosal levels of TNF-alpha and IL-8 as well as plasma levels of TNF-alpha, IL-8 and F1+2 were measured in group II and before and 2 months after H. pylori eradication in group I. Our results showed that: patients with H pylori positive gastritis had a significant increase in the mean value of plasma F1+2 mucosal and plasma levels of TNF-alpha and IL-8 compared with group II [P<0.001]. There was a significant positive correlation between plasma level of F1+2 and plasma levels of TNF-alpha and IL-8 [r=0.89, p<0.00, r=0.88, p<0.000] respectively and between the plasma levels of F1+2 and gastric mucosal levels of TNF-alpha and IL-S [r=0.89, P<0.000; r=0.86 P<0.001] respectively. There was a significant reduction in the mean value of plasma levels of TNF-alpha. IL-8 and F1+2 as well as fibrinogen 2 months later after H. pylori eradication. While in-group II [H pylori negative chronic gastrius] there was no significant correlation between the studied parameters. In conclusion, the present study showed a close relationship between plasma levels of prothrombin F1+2, and both plasma and gastric mucosal values of TNF-alpha and IL-8 in cases with H. pylori associated chronic gastritis. These findings suggest that H. pylori may represent a trigger factor for clotting system activation through persistent inflammatory stimulation, cytokines production and consequently H. pylori eradication may reduce the risk of hyper-coagulability state or thrombotic events which may be associated in these patients