OXA-10 and GES-1 extended-spectrum beta-lactamases play a major role in causing antibiotic resistance of Pseudomonas aeruginosa isolated from nosocomial infections in Ismailia, Egypt

Background: Pseudomonas aeruginosa causes large percentages of nosocomial infections with high rates of treatment failure due to antibiotic resistance. The production of extended spectrum beta lactamases [ESBLs] is a principal mechanism of antibiotic resistance of this bacterium. Such infections represent a great challenge in our hospitals

Objectives: Application of phenotypic methods and PCR for detection of bla[OXA-10] and bla[GES-1] extended-spectrum beta-lactamases in Pseudomonas aeruginosa isolated from cases of nosocomial infections in Ismailia city, Egypt

Methodology: Forty five isolates of P. aeruginosa isolated from cases of surgical site infection were submitted for antibiotic susceptibility testing, followed by phenotypic screening for both OXA-10 and GES-1 beta lactamases using disc combination method of ceftazidime-clavulanic acid and cefotaxime- clavulanic acid disks. PCR targeting genes of these ESBLs was applied for more accurate detection

Results: The resistance rates were 100% for ampicillin, cefoxitin, cefuroxime, and cefazolin while for cefotaxime, ceftriaxone, ceftazidime and cefepime, the resistance reached 84.5%, 68.9%, 57.8% and 37.8%, respectively. Imipenem, ciprofloxacin and gentamicin were the most effective antibiotics as they had sensitivity rates of 77.8%, 68.9%, and 73.4%, respectively. Disc combination tests were positive in more than two thirds of isolates. PCR detected blaOXA-10 and blaGES-1 in fifteen and twelve isolates, respectively

Conclusion: ESBLs are still playing major role in marked antibiotic resistance P. aeruginosa against the extended beta lactam antibiotics in Ismailia, Egypt as OXA-10 and GES-1 beta lactamases were isolated at rates of 33.3% and 26.7%, respectively. The current study provides a new report for detection of GES-1 in Egypt

Quality of life among adults with beta-thalassemia major in western Saudi Arabia

To assess the quality of life in the thalassemia adult patients and clarify how effective the management is of these patients and whether a change in care is warranted. In this cross-sectional study, adult thalassemia patients [>/= 18 years] of both genders, attending the day care unit in King Abdulaziz University Hospital, Jeeddah, Saudi Arabia were surveyed using SF-36 questionnaire. Data were collected between October 2012 and December 2012. The questions highlighted 3 health status scales; physical functioning [PF], emotional functioning [EF], and social functioning [SF]. Scores were analyzed using SPSS. Forty-eight adults were surveyed [mean +/- SD: 26.02 +/- 5.56]. These were made up of 60.4% males and 41.7% were Saudis. The frequency of blood transfusion was every 3 weeks in 81.3% of patients, but 18.8% were having transfusions less frequently. Half of our sampled patients were splenectomized [54.2%]. The PF score for the total sample was 61.4 [SD=22.7], the SF score was 75 [SD=26.4] and the EF score was 69.7 [SD= 21.6]; the SF and EF scores were lower in females and non-Saudis compared to male Saudis. The PF score in our sample was low compared to other regional studies; the SF and EF scores were low in females and non-Saudis

Quality of life among children with beta-thalassemia major treated in Western Saudi Arabia

To assess the quality of life among children and adolescents with thalassemia major. This cross-sectional study used the Pediatric Quality of Life Inventory [PedsQL]. Children and adolescents with beta-thalassemia major who attended the Day Care Unit at King Abdulaziz University Hospital, Jeddah, Saudi Arabia from October 2012 to February 2013 were surveyed. The questions highlighted 4 health status scales, namely physical functioning [PF], emotional functioning [EF], school performance [SC], and social functioning [SF]. Scores were calculated for each patient and data were analyzed using the Statistical Package for Social Sciences. We recruited 46 children [60.9% males]. The median age of the sample was 12 years [range, 2-18 years]. Most patients [84.8%] had 3 weekly blood transfusions. The mean +/- SD physical functioning [PF] score was 57.2 +/- 25.9; the EF score was 74.1 +/- 20.3, SF score was 78.5 +/- 24, and SC score was 54.3 +/- 24.2. The PF score was significantly lower in patients with a family history of thalassemia [p=0.003], and in those whose families had low incomes [p=0.049]. Conversely, the SF score was significantly higher in school-educated patients [p=0.01]. The quality of life of thalassemic children is affected by multiple factors, such as family income and a family history of thalassemia. Education appeared to increase patient functionality. Supportive measures could improve the quality of life in thalassemic patients

Intensive care unit [ICU] admission and discharge criteria in acute poisoned cases admitted to Menoufiya university hospital over one year [2008] [A prospective study]

Poisoning emergency is a common occurrence which constitutes a significant source of aggregate morbidity, mortality, and health care expenditure. The aim of the present study was to clinically evaluate the ICU admitted poisoned cases as regard criteria of ICU admission, approach to treatment and discharge criteria during the period from 1-1-2008 to 31-12-2008. Data were collected from self designed admission clinical sheet which included all needed data. The present study revealed that the total poisoned cases that were admitted to Menoufiya poison control center [MPCC] were, 423 cases from 35550 total menoufiya hospitals admission during the year of the study i.e [1.18%] of which 86 cases have been admitted to ICU i.e. [20.33%] and they represented about [2.79%] of total hospital ICU admission [3073 cases]. Most of admitted poisoned cases throughout the year of the study were due to anticholinesterase poisoning 126 cases [29.78%] from those 34 cases were admitted to ICU i.e. [26.98%] from total ICU admitted poisoned cases. Regarding the admission criteria the present work represents that the patients who were admitted due to both hemodynamic instability and altered mental status were the commonest ones [61.63%], followed by altered mental status [16.3%], hemodynamic instability [13.9%] while those presenting with the three admission criteria were [8.1%]. There is a statistically significant relationship between type of poison and admission criteria where all digitalis poisoned cases were admitted with hemodynamic instability [100%] while a high proportion of anticholinesterase poisoned cases were admitted for both hemodynamic instability and altered mental status were [67.6%]. As regards the poisoning characteristics, the present work shows that suicidal cases who were admitted due to hemodynamic instability were [66.7%], ingestion of solution form of poison, represented in both homodynamic instability and altered mental status were [62.3%] and high percentage of patients that were transported by ambulance were admitted due to both haemodynamic instability and altered mental status [85.7%]. Regarding the discharge criteria from ICU, the present study revealed that the patients who were discharged due to death represented [19.76%] of cases. Discharge of patients as hemodynamic instable [in the form of no need for mechanical ventilation, normal ABG] were [26%], controlled arrhythmia [7.2%], shocked patients discharged with no need for inotropic drugs [5.8%]. The patient who were admitted to ICU due to altered mental status and didn't receive mechanical ventilation were discharge as fully conscious [alert and aware] and represented [76.8%] of ICU discharged cases. This study revealed that an ideal ICU must be available in each PCC [poison control center] and ICU admission and discharge criteria are an important part of clinical evaluation for acutely poisoned patients in emergency room

Utility of imidazole derivative in the synthesis of biologically active nitrogen heterocyclic systems

Reaction of 2-[4-[4-Chlorobenzylidene]-5-oxo-4,5 dihydroxazol2-ylmethyl]- isoindole-l,3-dione [1] with p-aminoacetophenone followed by reaction with p-chi- orobenzaldehyde afforded chalcone 3, which used was as a precursor for the synthesis of a variety of pyrazole, oxazole, pyrimidine, pyridine and oxarine compounds.On the other hand, the reaction of 1 with glycine afforded imidazolylglycine [14] which reacted with thionyl chloride followed by addition of ammonium thiocyanate to give the isothiocyanate derivative 15 which reacts with different nitrogen and carbon nucleophiles to afford new derivatives of biologically active heterocycles. The antimicrobial activities of some synthesized derivatives were examined against some selected bacteria and fungi

Risk factors for work-related stress, burnout and coping among nurses of University Hospitals

To investigate the extent of burnout among nurses and risk factors related to burnout; to ascertain which aspects of nursing work were related to burnout and to examine the relative contribution to burnout made by these different variables. This study included a total of 200 nurses working in the Medical and Surgical Wards, Sohag and Zagazig University Hospitals [100 nurses from each hospital]. Study tools included an interview questionnaire, the Staff Stress Inventory Checklist, the Burnout Potential Inventory and the Jalowic Coping Scale. Nurses stresses in Sohag and Zagazig University Hospitals were mainly in the form of physical stresses, mainly due to workloads. Total stress scores were significantly higher among nurses in Sohag University Hospital than those among nurses in Zagazig University Hospital [95.4 +/- 34.7 and 82.1 +/- 29.6, p=0.004]. Affective oriented coping was more than the problem-oriented coping [72.0 +/- 25.9 and 35.2 +/- 12.5, in Sohag vs. 64.4 +/- 22.5 and 3 1.6 +/- 10.9 in Zagazig]. Nurses in Sohag showed significantly higher scores for coping than those in Zagazig [107.2 +/- 38.2 and 96.0 +/- 33.4, respectively, p=0.028]. In both university hospitals, conflict and overload mean scores were high, while the mean scores of values conflict were the lowest score. Nurses in Sohag University Hospital sustained significantly higher conflict, poor teamwork and values conflict while those in Zagazig University Hospital sustained significantly higher punishment. Age, income, and years of experience in nursing had significantly negative correlation with stress scores and burnout and significantly positive correlation with coping scale. There is a positive significant correlation of stress with burnout in both Sohag and Zagazig [r=0.6283 and 0.7094, respectively, p<0.001] and negative significant correlation of coping with burnout [-0.4235 and -0.3760, respectively p<0.001]. Stress scores were significantly higher among nurses having Diploma with specialty than those with Diploma in nursing. Coping scores were higher among nurses having Diploma with specialty than those with Diploma in nursing. Nurses in university hospitals experience occupational stress. With less age, salary and years of experience in nursing, work-related stress becomes more perceived. Affective oriented coping strategies are resorted to more than the problem-oriented coping. Nurses in Sohag cope better than those in Zagazig. The hospital organization should monitor staff conflict and must ensure that workloads correspond to workers capabilities and resources. Training places more emphasis on preparing nurses to deal with the emotional needs of their patients, with detached concern. Stress inoculation training which teaches nurses appropriate coping skills could be implemented. Particularly vulnerable groups of nurses, such as those with Diploma with specialty, should be monitored regularly for signs of burnout. They should be the primary targets for ongoing training and/or preventative interventions such as stress inoculation training

Parent-adolescent conflict in Egypt and United Arab Emirates

This study aimed at exploring the frequency and intensity of parent-adolescent conflict within Egyptian families living in Egypt and those living in a Gulf country [Abu Dhabi, United Arab Emirates]. Two Arab countries were studied [Egypt and United Arab Emirates]. We examined everyday conflicts for the past 4 weeks between 400 Egyptian children in early adolescence [aged 10-15 years] and their parents [200 Egyptian adolescents living with their parents in Egypt and 200 Egyptian adolescents living with their parents in United Arab Emirates]. The frequency and intensity of conflicts were assessed using an Arabic translated version of the Parent Issues Checklist, which consists of a list of 44 items that can possibly lead to disagreements between parents and adolescents. Fighting with sibling ranked as the most frequent adolescent-parent conflict issue both in Egypt and UAE. Adolescent-parent conflict issues of highest intensity were using drugs, telephone calls and watching TV in Egypt compared with telephone calls and who friends should be and watching TV in UAE. Outcome of most adolescent-parent conflicts was mainly concession of adolescent to parents in Egypt [92%] and to a much lesser extent in UAE [56%]. Concession of parents was much more observed as an outcome for adolescent-parent conflicts in UAE [26%] than Egypt [6%]. A significant positive correlation between frequency of adolescent-parent conflict issues and income of family as well as age of the adolescent in both Egypt and UAE. A significant negative correlation is present between duration of attained education by parents and frequency of adolescent-parent conflict issues. It is to be noted that mother's length of education correlated negatively with frequency of conflict more than that of the father [r=-0.328 vs. -0.310 in Egypt and-0.347 vs. -0.305 in UAE]. Pattern of conflict is affected by socioeconomic status, age of parents and growth of the adolescent. Parents' education, especially maternal education is a favorable factor toward minimizing parent-adolescent conflict. Primary prevention efforts should focus on avoiding the identified reasons and patterns of dispute between parents and their adolescent children in addition to spreading an atmosphere of harmony within the family between parents and their children. This can be achieved through carrying out mental health educational programs. Mothers should actively participate in all these mental health educational programs

Screening for negative emotional syndromes among medical students in Upper Egypt

To assess anxiety and depression levels among medical students in Upper Egypt and to identify associated risk factors. The Arabic Version of the Depression Anxiety Stress Scale [DASS] was used to screen for depression and anxiety among the 1200 medical students [300 from Beni Suef Faculty of Medicine and 900 from Sohag Faculty of Medicine]. Anxiety is more prevalent than depression among medical students in Upper Egypt. Depression was absent in almost four-fifths of medical students in Upper Egypt [83% in Beni Suef and 76.9% in Sohag]. Difference between medical students in both governorates was not statistically significant. Anxiety was absent in almost two-thirds of medical students in Upper Egypt [67% in Beni Suef and 63.8% in Sohag]. Difference between medical students in both governorates was not statistically significant. Grades of depression were significantly more prevalent among older medical students [p<0.001], females [p<0.001], students at the clinical stages [p<0.001], parental consanguinity [p=0.020] and medical students with positive family history of psychiatric disorder [p<0.001]. Grades of anxiety were significantly more prevalent among female medical students [p<0.001], parental consanguinity [p=0.017] and medical students with positive family history of psychiatric disorder [p=0.024]. Medical students are vulnerable to depression and anxiety. Older students, female sex, clinical studies, parental consanguinity and positive family history of psychiatric disorders constitute risk factors for depression while female gender, consanguinity and positive family history of psychiatric disorders constitute risk factors for anxiety. Psychological and psychiatric support for medical students is a well-established need that should be met. The process of medical education should be analyzed to recognize sources of stress that should be dealt with accordingly. This study should be replicated on other university students to identify the impact of other types of university education on the mental health of students

Oxidant/antioxidant status and endothelial dysfunction in obese and hypertensive models of insulin resistance

[1] To investigate the oxidant-antioxidant status and nitric oxide [NO] production in essential hypertensive patients and comparing them to obese normotensive and obese hypertensive patients [2] To compare the NO, antioxidant and oxidants in insulin resistant [IR] patients [fasting glucose insulin ratio [F-G/l ratio] <4.5] versus insulin sensitive [IS] ones [F-G/l ratio > 4.5]. Design: A case control study. Patients: Fifty two patients ranging from 30-55 years of age, and classified into: Essential hypertensive, non obese patients [group II]; normotensive obese subjects [group III]; and hypertensive obese patients [group IV]. They were further subdivided according to the F.G/I ratio into IR and IS groups. Sixteen age and sex matched healthy subjects [group I] were chosen as controls. Setting: Internal Medicine and Biochemistry Depts., Cairo Medical Hospital. Serum malondialdehyde [MDA] [as a marker for lipid peroxidation], total plasma nitrites and nitrates [Nox] [as an index for NO production], erythrocytic reduced glutathione [GSH], glutathione peroxidase]. [GSH-PX], superoxide dismutase [SOD], and blood vitamin C were estimated by specific colourimetric assays. Plasma selenium was estimated by atomic absorption spectrophotometry. A significant increase mean levels of MDA and reduction in Nox, GSH, vitamin C and, SOD was detected in all patients' groups. Significant reduction in GSH-PX was detected only in the obese groups III and IV. Significant increase in MDA and decrease in Nox, vitamin C and GSH were detected in IR versus IS patients. Simple correlation [r] showed positive relations between MDA and each of MABP, BMI and WHR. Negative correlation was detected between each of Nox, GSH and vitamin C, and each of mean arterial blood pressure [MABP], body mass index [BMI] and waist hip ratio [WHR]. The correlations were higher with WHR than BMI. The F.G/I ratio was negatively correlated with MDA and positively correlated with Nox, GSH and vitamin C. By multiple regression analysis, the WHR was an independent variable concerning F G-I ratio and MABP Activation of lipid peroxidation processes and depression of some antioxidants [especially vitamin C and GSH] proceed more or less in parallel with declining NO bioavailability, the severity of hypertension, extent of obesity, distribution of body fat and degree of IR. The body fat distribution appears to be a more important associate to hypertension and IR than total body fat

newborn requiring selective left bronchial intubation Case report

Pulmonary interstitial emphysema [PIE] is an iatrogenic pulmonary condition of the premature infant with immature lungs. PIE occurs almost exclusively with mechanical ventilation. We report a case of preterm newborn 26 weeks gestation who developed PIE in the right lung while on advanced nasal CPAP ventilation mode and managed by selective left bronchial intubation and mechanical ventilation

Patterns of coping among Egyptian rheumatoid arthritis patients

This study aimed to identify different stressors perceived by rheumatoid arthritis [RA] patients and to describe their strategies for coping. Study tools included a sociodemographic data questionnaire, related stressor checklist and the Jalowiec coping scale. The study concluded that psychiatrists can evaluate stressors and psychological precipitants, which will help patients to cope and adapt. Teaching of coping strategies will increase the patients' ability to handle the pain and enhance the psychological wellbeing

Epidemiology and risk factors of substance use disorders among universty students in Upper Egypt

This study aimed to identify the substances abused by university students in Upper Egypt, recognizing the risk factors for substance use among Upper Egyptian university students and exploring reasons for initiating the substance abuse. The study comprised 1780 students in three nonmedical faculties belonging to South Valley University [Arts, Education and Commerce]. The diagnosis of "substance use disorders" was based on the definition of DSM-IV. The study tools included a study questionnaire and the socioeconomic class assessment sheet. The study concluded that substance abuse is a serious problem affecting university students in Upper Egypt, especially males. Cannabis as well as sedatives/hypnotics/anxiolytics and opioids are the most frequently abused illicit substances. Smoking is a highly significant risk factor for illicit substance abuse. Mass media and friends constitute the main source for information about the psychoactive substances. The improper family integrity is a major factor leading to illicit substance abuse

Site of lesion in stroke and its relation to depression

A total of 174 patients [103 males and 71 females] suffering from acute stroke was recruited for this study. All patients were subjected to complete and thorough neurological history and examination on admission, mini-mental state examination [MMSE], CT scanning of the brain within 72 hours after the onset of stroke and Barthel daily living test to compare the physical disability before stroke with that at the time of neurological examination. Six months after the stroke, the patients underwent complete and thorough psychiatric evaluation according to DSM-IV, Barthel daily living test and Beck Depression Inventory. Sixty-two patients met the DSM-IV criteria for depressive disorder. Three significant correlates for post-stroke depression were identified; namely, female gender, severity of disability and volume of lesion. Left hemisphere lesions were significantly more associated with post-stroke depression than right hemisphere lesions. Within the left hemisphere, anterior lesions were significantly more associated with post-stroke depression than the posterior ones

Parental smoking and lower chest problems in infants and children

Tobacco is the commonest indoor environmental pollutant to which children-are exposed. Passive smoking, the major source of indoor pollution has been identified as a risk factor for a variety of diseases. Children appear to be particularly vulnerable to passive smoking with increased incidence of wheezing, bronchial hyperreactivity, asthma, atopy, frequent cough, otitis media, persistent ear effusion, snoring and sudden infant death syndrome. The aim of this work was evaluation the relationship of parental smoking and lower chest problems, serum immunoglobulin E and eosinophil count in infants and children in Sharkia Community.This study included 2 main groups. Group I: Consists of 100 children with history of exposure to indoor passive smoking and group II: included 50 children without history of exposure to parental smoking as a control group. Every child in both groups was subjected to general and local chest examination, stool and urine analysis; chest X-ray; urinary cotinine level; absolute eosinophil count and serum IgE. This study showed that passive smoker children had statistically significant increase in urinary cotinine level; serum total IgE; and the frequency of lower respiratory illness than in control group. This increase was more in boys than girls and in children aged less than 2 years than those above 2 years. Also passive smoker children had significant increase in total eosinophil count than controls but there was no difference regarding the sex and age. Lastly there was positive and significant relationship between urinary cotinine level and serum IgE and the frequency of lower respiratory illness. From the above we can conclude that children exposed to environmental tobacco smoke are more vulnerable to health hazards especially lower respiratory illness

Hormone replacement therapy: effects on serum lipoproteins, internal carotid pulsatility index and cognitive functions during 12 months follow up, a prospective study

To determine the preventive effect of postmenopausal hormone replacement therapy on cerebrovascular disease. A randomized prospective study included 46 postmenopausal non hystrectomized women, designed to evaluate the changes produced by oral combined sequential hormone therapy in body mass index, blood pressure, total cholesterol, triglycerides high density lipoprotein cholesterol, low density lipoprotein cholesterol, internal carotid artery pulsatility index and two cognitive function tests. Women were randomly allocated into 2 groups; the 1st received oral oestradiol valerate 2 mg and norgestrel 0.5mg "cyclo-progynova" and the 2nd who refused hormone therapy, as a control group. Women who received hormone therapy showed significant drop in their total cholesterol, low density lipoprotein cholesterol and internal carotid artery pulsatility index associated with significant increase of high density lipoprotein cholesterol and maintained cognitive functions. Those in the 2nd group showed significant increase in their total cholesterol, low density lipoprotein cholesterol and internal carotid artery pulsatility index associated with deterioration in cognitive functions. No significant change in other parameters. Postmenopausal oral combined sequential hormone therapy decreases, internal carotid artery pulsatility index, reflecting low cerebral vascular resistance This may be the mechanism by which postmenopausal hormone replacement therapy maintains cerebral functions

Determination of interleukin - 10 level in rheumatoid arthritis and corralation with disease activity parameters [a controlled study]

lnterleukin-10 [IL-10] has been shown to exert both anti-inflammatory and immunostimulatory affects both in vivo and in vitro. We, therefore, sought to examine the role of this cytokine in rheumatoid arthritis [RA] by assessing serum and synovial fluid IL-10 level and correlating its level with disease activity parameters. Serum and synovial fluid samples were collected from 40 RA patients and 20 OA patients and 20 healthy persons as a control group. IL-10 was assessed by specific enzyme linked immunosorbent assay [EL1SA]. Results showed that both serum and synovial fluid IL-10 level were non-significantly higher than that of the control including OA patients with synovial level non significantly higher than serum level. Results, also, showed that there is an inverse non significant correlation with RA disease activity parameters This study suggested that there is a tendency of increased production of IL-10 in patients with RA. This increased IL-10 production is mainly originating from synovium. IL-10 level is not a reliable marker for RA disease activity

Relation between clinical severity of haemophilia and the factor inhibitor

Alloantibodies occuring in haemophilia as a side effect of repeated treatment represents a severe complication. The antibody binds to a specific epitope within the factor molecule in a time dependent manner. If the alloantibody is present in excess, factor coagulant activity will be inactivated. Our study was conducted on 34 haemophilic patient and 10 control healthy children. All cases and control were subjected to the following: full history taking; complete clinical examination, laboratory investigation of Hb%, RBCs, WBCs, platelets counts, bleeding, coagulation, prothrombin and partial thromboplastin time. And assay of levels of FVIII and FIX, FVIII inhibitor level and FIX inhibitor.71% of haemophilia A were mild and 29% were moderate, 90% of haemophilia B were mild and 10% moderate. An inhibitor was detected in 16 cases [66.6%] out of 24 cases of hemophilia A, and 9 cases [90%] out of 10 cases of haemophilia B. These inhibitors were detected 2-11 years after the diagnosis. There was non significant correlation between inhibitor level in heamophiliaA to age, Hb% and FVIII% but there was negative correlation V.H.S [R< 0.001] to residual FVIII%. Also there was no correlation between inhibitor level in haemophilia B to age, Hb% and FVIII% but there was negative correlation V.H.S [R< 0.001] to residual FIX%. So we can conclude that development of inhibitor to FVIII and FIX although predominantly develop in severe heamophiliacs, they do occasionally appear in mild and moderate disease. Many of them are of low-level and perhaps transient. So we recommend to screen these patients at intervals for the inhibitor. The development of the inhibitor depends on the immunogenecity of the replacement therapy and also on a genetic predisposition

Intereukin-1 beta in rheumatoid arthritis; corrlation with disease activity

Serum level of interleukin-[l] beta was estimated in 22 patients with rheumatoid arthritis, who fulfilled the American Collage of Rheumatology criteria. Another 15 persons, matched for age and sex, were chosen as a control group. Quantitative assay by an immunoenzymatic method showed significant increase [P < 0.05] of interleukin-1 beta in sera of rheumatoid arthritis patients than sera of the control group. When level of serum interleukin-[1] beta was correlated to parameters of disease there was significant correlation with joint tenderness using Ritchie articular index. Results confirm the role of interleukin-[1] beta in the pathogenesis of rheumatoid arthritis and suggest. its serial estimation for follow-up purpose or monitoring response to therapy

Verotoxigenic escherichia coli 0157 among chronic renal failure patients

Escherichia coli 0157 has become an enteric pathogen of increasing importance. In this initial survey, which is confined to uraemic patients, the frequency of isolation of verotoxin [shiga-like toxin] producing E. coli 0157 from stools of 160 uraemic patients was 3.1%. The frequency of isolation rises to 4. 5% among uraemic patients with a prodroma of diarrheal illness and rises to 50% [P < 0.05] when uraemic patients were accompanied by a prodrome of diarrhea and bleeding tendencies in a syndrome known as haemolytic uraemic syndrome [HUS]. E. coli 0157 was isolated from stools of 4 out of 8 [50%] cases of HUS, thus it is considered the most important cause of diarrhea associated HUS. E. coli 0157 was found to be an infrequent enteric pathogen among other pathogenic bacterial organisms causing diarrheal prodroma in uraemic patients lout of 22 [4.5%]. Campylobacter spp., on the other hand was the commonest pathogen isolated 7 out of 22 [31.8%]. Rapid screening for E. coli 0157 was done by culturing on selective sorbitol MacConkey agar and non sorbitol fermenting colonies were tested by latex agglutination with E. coli 0157 antiserum. Shiga-like toxin production of E. coli 0157 was then assayed by verocytotoxicity because it is the better marker of the pathogenic potential of a strain than serotyping. Variations among strains of E. coli 0157 as regards shiga-like toxin production yield were noticed, with the highest titre obtained from strains isolated from HUS patients. Old age, female predominance, fever, ingestion of anti motility and antimicrobial drugs especially trimethoprim-sulfamethoxazole were the commonest risk factors observed for patients who developed HUS after a prodroma of E. coli 0157 diarrhea. We concluded that, it is the responsibility of microbiologists to make physicians and pediatricians aware about the importance of this newly discovered enteric pathogen and its greatest complication HUS