Bilateral clavicular and scapular neck fractures

The aim of this report is to present a very rare case of unstable clavicular and scapular neck fracture of both shoulder girdles. A thirty one years old male sustained a double floating shoulder injury, fracture transverse process third lumbar vertebra and chest wall contusion in a road traffic accident. He was treated by open reduction and internal fixation of both clavicle and scapula on one side and with only clavicular stabilization on the other, with 3.5 reconstruction plates 6 days after injury. Twelve months after injury at the last follow up, the patient was satisfied with result of the treatment. The function of the shoulder at that time was evaluated using the scoring system of Constant and Murely, and it was [95 points] on both sides and a radiographic examination of both shoulders revealed the fractures healed in a satisfactory position. The conservative treatment affords good results in cases with undisplaced fractures. In the case of bilateral unstable fractures treated surgically, and excellent results was achieved

Validity of interleukin-18 plus CRP measurement in the early diagnosis of sepsis neonatorum

Over the last decade a variety of laboratory tests have been developed to enhance the early and accurate diagnosis of sepsis neonatorum. However, non of these tests has been found to be absolutely reliable in detecting all septic neonates. To test the validity of circulating interleukin-18 [cIL-18] plus serum C-reactive protein [CRP] for the diagnosis of sepsis neonatorum, in term infants admitted to the neonatal intensive care unit [NICU] of Zagazig University Hospitals, during year 2005. Twenty - four neonates with positive blood cultures were selected from 60 neonates with clinically suspected sepsis. Their ages ranged from 0.3 to 25 days [X +/- SD: 14.2 +/- 7.1]. In addition, 14 gestational age [GA]-, chronologic age - and sex - matched healthy neonates served as a control group. Results: Forty percent of neonates with clinically suspected sepsis proved to have positive blood cultures, E. coli being the most significant isolate [62.5%]. Rise of serum CRP and cIL-18 is highly significantly associated with culture-proven neonatal sepsis. Meanwhile, other tests were nonsignificant associates. Using ROC curve analysis, cIL-18 displayed a sensitivity and a specificity of 91.7% and 85.7%, and CRP displayed a sensitivity and a specificity of 72% and 100%, respectively. When both tests were used, combined, the reported sensitivity and specificity accounted for 100%, for each. The combined use of cIL-18 and serum CRP is valuable in the early and accurate diagnosis of sepsis neonatorum

con A purified hydatid glycoprotein fraction effectively diagnoses human hydatidosis

Diagnosis and quantification of Echinococcus granulosus in-fection in man and animal hosts are centralized to feasible con-trol this study included 93 serum sample, 25 sure positive hydatid cases confirmed surgically, 7 suspected cases diagnosed by indirect haemagglutination IHA and 41 cases other parasitic infection [15 S. mansoni, 8 fasciola, 7 Ascaris, 5 H. nana and 6 Ancylostoma] diagnosed by microscopic examination and were negative by ELISA and/or IHA for anti-hydatid antibody. Twen-ty negative serum samples served as healthy controls. Six types of hydatid fluid antigens [crude, host-free and Con-A purified] of human and camel origin were subjected to electrophoretic separ-ation [SDS-PAGE] and immunoblotting [EITB]. The anti-hydat-id IgG was detected in sera of the different groups for evalua-tion of sensitivity, specificity and diagnostic efficacy each type of antigens. Detection of circulating hydatid antigen [CAg] was performed using anti rabbit hyperimmune sera raised again-st Con-A purified either human or camel hydatid antigen. SDS-PGE revealed several bands ranging from 55-185- kDa with 10kD band shared by all antigens. The specific bands revealed by EITB for Con-A purified camel and human antigens were at 80, 110, 55, 110 kDa respectively. ELISA highest sensitivity [96.9%] was by using host-free Con-A purified glycoprotein fraction of human hydatied antigen. Highest specificity [98.4%] was reco-rded upon use of either Con-A purified camel or human antigen with 94.5% and 97.7 and diagnostic efficacy respectively. Detection of circulating antigen by polyclonal antibodies against Con-A purified human hydatid antigen revealed 91.8%specificity.

sub-deltoid versus intra-peritoneal implantation of canine macro-capsule allogenic amniotic membrane; assessment of rejection and neo vascularization

Aim: pancreatic islets encapsulation is an alternative for using the immuno-suppression to prevent rejection. We used the amniotic membrane as a macro-capsulation. The main objective was to assess the re-vascularization of the allogenic amniotic membrane macro capsule in different sites to ensure the islet viability when using it for encapsulation

Methods: 30 amniotic membranes macro capsules were implanted in 15 dogs in two different sites; in the sub-deltoid shoulder region and in a piggy bag pouch in the recipient peritoneal cavity under general anesthesia. The capsules are removed after day 1, 3, 7, 10, 15, 21, 30 and 60 days. All the capsules are subjected to histo-pathological examination and immuno-histochemistry for neo-vascularization using VEGF, Factor VIII and CD4, CD8 for detection of rejection

Results: all specimens showed inflammation and congested blood vessels with no thrombosis or rejection. VEGF expression and Factor VIII were increased; neo-vascularization associated with vascular invasion but no inflammatory cells of acute rejection. CD4 and CD8 showed mild rejection

Conclusion: the implantation of the amniotic sac macro capsule was fixed nicely within the omental tissue and the sub-deltoid region with minimal or no sign of rejection. Our results should help the clinical application of using this capsule as an immuno-isolator for pancreatic islets transplantation

MRI of sellar and suprasellar regions in hyperprolactinemia

This study included 40 patients [29 women and 12 men aged between 12-75 years] presented with hyperprolactinemia. MR imaging for the sella and brain was made for all patients before and after i.v. injection of Gd-DTPA using 1.5 Tesla magnet [G.E. sign]. Serum prolactin level was measured on Roche Elecsys immunoanalyzer-reference values for man is 86-390 mIu/L and for woman is 72-511 mIu/L. MRI is the optimal imaging technique to evaluate the sellar/suprasellar regions. Hyperprolactinemia secondary a prolactinoma usually presents with a prolactin level, which is more than 3600mIu/L. The key image in the work up of macroadenomas is the coronal plane which demonstrates the degree of suprasellar extension and size of the waist as the tumor passes through the diaphragm sellae. If the waist is too narrow, then the usual transsphenoidal approach is replaced by a more invasive subfrontal craniotomy to remove the tumor. It is also important to look for cavernous sinus invasion as tumor located in the cavernous sinus can not be effectively removed by trans-sphenoid approach. The results from MRI must always be assessed in the light of the patients clinical history and biochemical parameters

Antioxidant status in minimal change nephrotic syndrome

Minimal change nephrotic syndrome [MCNS] accounts for about 75% of causes of NS in children. A still growing body of evidence has accumulated indicating that a disturbance of balance between oxidative stress and antioxidant defence mechanisms plays a major role in the pathomechanism of glomerular diseases. This study was carried out to evaluate the role of oxidant-antioxidant imbalance in the pathogenesis of MCNS. The serum levels of some antioxidants [alpha -tocopherol, superoxide dismutase "SOD", selenium, zinc and copper] were estimated in 50 children, of ages ranging from 2 to 12 years, diagnosed as MCNS, and compared with that of 20 healthy age and sex- matched control children. Oxidant stress was evaluated as well in all subjected by estimating levels of serum and urinary malondialdhyde [MDA]. Levels of antioxidants, but vitamin E were significantly decreased in children suffering MCNS compared to control children. Meanwhile oxidative stress, measured by serum and urinary MDA was significantly increased in patients group. In addition, a significant positive correlation between SOD and both copper and zinc was reported. It was concluded that an oxidative stress, in. the face of defective antioxidant defence, does exist and may play a role in the pathogenesis of idiopathic nephrotic syndrome. So it is recommended that nutritional antioxidants, especially vitamin E, selenium, zinc, and copper should be added in the diet of children and all risky groups

new screening technique for the diagnosis of tuberculous pleural effusion in children

A definitive diagnosis of tuberculosis [TB] requires the recovery of Mycobacterium tuberculosis [MTB] from a patient's secretions, body fluids or tissues. However, the detection rate of MTB, by various methods [Z-N smear, culture and/or PCR], is not high in TB pleural effusions. Several studies, on adult patients, demonstrated that an activity of adenosine deaminase [ADA] level in pleural effusion above 40 lU/L is strongly associated with TB. The objective of this trial was to test the validity of ADA level in the diagnosis of TB pleural effusion, in children. Forty five patients with confirmed TB pleural effusion were studied versus 25 control children with non-tuberculous effusion.The mean age of onset of TB pleural effusion was 9.54 +/- 3.6 years. Males are affected more than females, with an M/F ratio of 3 : 1; 89% of patients had received BCG-vaccination, which finding may indicate doubtful efficacy of the currently used BCG-vaccine against the development of TB pleurisy; Anorexia and weight loss, fever and night sweats, chest wheezes and local signs of pulmonary involvement represent the most common manifestations of TB pleural disease; A low total peripheral blood WBCs counts [with relative lymphocytosis], an increased ESR, a frequently positive tuberculin test are characteristics of TB pleural effusions; Pleural fluid is frequently associated with characteristics of exudate; The average level of ADA activity in pleural fluid of TB children accounted for 116.4 +/- 36 U/L which is statistically higher than that of nontuberculous children, 93% of patients had levels above 60 U/L vz 4% for nontuberculous children; A statistically higher average mean proportion of lymphocytes, in pleural fluid of TB patients, more than nontuberculous ones; The most sensitive tests in the diagnosis of TB pleural effusion in children were ADA [93.3%], lymphocyte proportion [> 50%] in pleural fluid [91.1%], and positive tuberculin skin testing [75.6%]. We conclude that the analysis of ADA levels in pleural effusions constitutes a useful marker for the diagnosis of tuberculous pleural effusion, which in addition, can be made quickly and cheaply

Effect of relactation on the nutritional and immuno-microbiological status in persistent diarrhea: a multi-stage study

Lactation failure is known as one of the most important risk factors associated with the development of persistent diarrhea [PD]. The subjects of this study included 41 infants, of 41 respondent mothers, who are suffering PD. They were 21 females and 20 males with ages ranging from 2 to 12 months [X +/- SD, 6.7 +/- 2.5 mo]. Nutritional and immunomicrobiological assessement was tried at initial diagnosis of PD, and one month after established relactation. A statistically significant improvement of all nutritional parameters, except pallor, hypotonia and length/age, was observed. Abnormal findings detected in stool examination and culture, before relactation, in the form of visible blood, pus cells, RBCs, reducing substances, acidity and pathogenic organisms disappeared significantly, one month after established relactation. A statistically significant rise of serum IgG and absolute lymphocyte count was observed after relactation. Meanwhile, IgM levels and CD[+4] / CD[+8] showed non-significant change. On other hand, IgA levels dropped significantly after relactation. It is concluded that; relactation is possible among the majority of mothers of infants suffering PD and so it is worthtrial in every episode of PD; and relactation should be included in the management strategies of PD, as it is benificial for the nutritional and immunomicrobiological outcome of these infants

Visceral Leishmaniasis in children

Visceral leishmaniasis is a common tropical disease. This study was carried out on 85 patients during the period between October 1994 and December 1995 in Al-Salam Hospital at Sana'a, Republic of Yemen. Visceral leishmaniasis was diagnosed in 82 cases on history, physical findings and laboratory tests with positive leishmania donovani bodies on microscopy of splenic aspirations and was suspected in three cases on clinical, hematological and biochemical grounds only. The commonest presenting clinical findings were fever [100%], splenomegaly [100%], anemia [100%], hepatomegaly [67.1%], abdominal distension [70.7%], anorexia [63.4%], respiratory [16%] and gastrointestinal symptoms [21.9%]. The consistent laboratory findings were anemia [mean Hb level 6.3 g/dl], neutropenia [mean level 2.1 g/dl] and low serum iron [mean level 26.4 mug/ml]. Bone marrow aspiration was positive for leishmania donovani bodies in 48.8% of cases, liver biopsy was positive in 47.3%, while splenic aspiration was positive in all cases [100%]. Both groups of patients [the confirmed 82 patients and the suspected 3 patients] were given sodium stibogluconate 20 mg/kg body weight IM for 30 days. After this regimen of treatment, all patients were reevaluated where the first group showed good clinical and laboratory response with negative splenic aspiration for leishmania donovani bodies, while the second group showed no response and further investigation proved illnesses [two cases were Schistosoma mansoni and one was tuberculosis]

Cardiac operations in patients with chronic liver diseases

Thirty-six patients with chronic liver diseases [group I], and 32 patients with no liver disease [group II] in need of elective cardiac surgery were studied. After careful clinical, radiological and laboratory investigations, group I was subdivided into group IA well compensated liver patients, asymptomatic, with no or minimal laboratory changes [N =19] and group IB with mild cirrhotic liver[N =17]. Moderately and severely cirrhotic patients were excluded from the study. The numerical values in the postoperative course of group IA and IB were compared with those of group II. Differences between the group were considered significant if the p value was less than 0.05 [ANOVA]. The results revealed a significant increase in the postoperative chest tube drainage, total ventilation time, total intensive care duration and total hospital stay in hepatic patients, especially group IB. The incidence of postoperative morbidity and mortality was significantly higher in group IB compared with IA and group II and in group IA compared with group II

impact of education on Fertility according to region and contraceptive use

This study showed that there is a highly significant association between the educational level and the number of children ever born for women who do not want more children. This may indicate that the couple build their decision about their family size on the basis of living children rather than children ever born. It may also be due to the limitations from which children ever born data suffer. The percentage of women with no education reaches 0.72 in rural areas, while it reaches 0.34 in urban areas. For this group of women, the global odds ratios are generally higher in urban than rural areas. These results mean that urban women with no education have lower fertility than rural women with no education. The linear trend was tested when it applied and proved to be insignificant in many situations, which means that the global odds ratios are increasing linearly with number of children ever born. It ought to be known that the sample sizes in rural are quite larger than their counterparts in urban areas. This fact has led to better results for a complete table in rural than those in urban areas. In general, the global odds ratios in rural are larger than their counterparts in urban areas. This finding may be due to serious omission error in rural areas. The sample sizes for contraceptives users are quite higher than their counterparts for nonusers, which led to the results for users being more reliable than those for nonusers

Life events stress in Saudi peptic ulcer patients of the eastern province

The frequency of stress, as measured by the occurrence of 34 life events in the year preceding evaluation, was compared between 51 Saudis with peptic ulcers, diagnosed endoscopically, and 52 Saudis without peptic ulcer. All subjects were examined at King Fahd Hospital, Al-Khobar, Eastern Saudi Arabia, and were seen between March 1985 and July 1987. The mean number of events, their frequency distribution, and their categorization into areas of activity such as bereavement and other problems relating to health, marital, financial, and undesirable circumstances were similar for both groups. With regard to individual events, the only significant differences between ulcer patients and controls were that more patients had had serious arguments with in-laws or relatives and more controls had had minor personal illness or moderate financial problems. Excessive stress, as measured by life events, does not appear to be evident in Saudi peptic ulcer patients of the Eastern Province. Anxiety and/or depression was significantly more frequent in the group of patients with ulcers

Deliberate self-harm in the migrant population in the Eastern Province of Saudi Arabia

This is a preliminary retrospective investigation of non-fatal deliberate self-harm in 32 non-Saudi migrants who were admitted over 7 years [1982-1988] to a University Hospital in eastern Saudi Arabia. The female to male ratio was 1.9:1. The group comprised 1 5 Arabs [47%], and 1 7 non- Arabs including 16 Asians [50%] and one European [3%]. The majority were below the age of 25 years. The predominant precipitants of the episodes were interpersonal conflicts [56%] which were noted significantly in females, and psychiatric disorders [34%] noted significantly in males. Drug overdose was involved in 50% of cases. About one-third of the group [34%] and especially males significantly resorted to dangerous self-injuring. The commonest psychiatric diagnosis in the series was depression [72%]. Two non-Arab males committed suicide in the hospital

Deliberate self-harm in the Eastern Region of Saudi Arabia: a hospital-based study

This study comprises all Saudi cases of deliberate self-harm who were admitted to university teaching hospital in the Eastern Province of the Kingdome of Saudi Arabia between 1 January 1982 and 31 December 1986. A total of 40 cases were identified, of whom two were admitted to the surgical departments and the rest to the medical wards. Deliberate self-harm accounted for 0.4% of all Saudi medical admissions during the study period. This low frequency could be attributed to the influence of Islamic teachings. The majority of subjects were single, below the age of 30 years [95%] with most below the age of 20 [52.5%]; female to male ratio was 4:1. Interpersonal conflicts leading to quarrels precipitated the act in over two thirds [72.5%] of the episodes. Drug overdosage was involved in 80% of the cases. Psychotropic, analgesic, and miscellaneous drugs were used almost equally. Reactive depression was the commonest diagnosis [60%]. Limited sales of analgesics, discard of unused medications, and discrete prescription of psychotropic, particularly to young females, are among the recommended preventive measures