Coagulation profile tests as a predictor for adult trauma patients’ mortality

Background: Coagulopathy is commonly observed in poly-traumatized patients and is a known contributor to trauma mortality. Although, the incidence of coagulopathy is strongly associated with the severity of the injury, coagulopathy itself exerts an independent factor on mortality.Methods: This is a prospective, observational study on 100 trauma patients. All patients were evaluated using the modified shock index (MSI). Coagulation profile tests including platelet count, prothrombin time (PT), partial thromboplastin time (PTT), D-dimer and fibrinogen/fibrin degradation products (FDPs) were performed for all patients on admission and at 12 hours intervals. Statistically, a logistic regression analysis was performed of coagulation profile tests to determine the incidence of trauma induced coagulopathy (TIC) and its impact on 24 hours mortality. Correlation between clinical and laboratory status was done.Results: There was a statistically significant difference between the dead and the survived patients in the coagulation profile tests and MSI. The best cut-off point of each parameter of coagulation profile tests (PLT count, PT, PTT, d-dimer, FDPs) and MSI was calculated using receiver operating characteristic curve and were <173 × 109/l, >18.7 s, >31 s, >5 mg/l, > 321.5 mg/l and 1.6 respectively. Trauma induced coagulopathy in our study was defined by more than 2 of the following: PLT <173 × 109/l, PT >18.7 s, activated partial thromboplastin time (APTT) >31 s, D-dimer >5 mg/l and FDPs>321.5 mg/l with a p value 0.001 and associated with increased mortality.Conclusions: The incidence of trauma induced coagulopathy early after trauma is high and its severity is related to the injury itself. It is independent predictor of mortality. TIC was developed with presence of more than 2 of the coagulopathy parameters.

Accuracy of phenotypic methods in detection of methicillin resistant staphylococci species compared to PCR assay for mecA gene

Considering the increasing incidence of infection due to methicillin resistant [MR] staphylococci; reliable, accurate and rapid testing for MR is essential for both antibiotic therapy and infection control regimens. Our mmain objective was to evaluate the accuracy of cefoxitin and moxalactam disk diffusion [DD] tests and that of Mannitol Salt agar [MSA] screening test using cefoxitin and oxacillin for detection of MR among S.aureus and coagulase negative staphylococci [CoNS] using PCR for mecA gene as "gold standard" comparison assay. Commercial MRSA-screen latex agglutination test [LAT] was performed to detect mecA gene product [PBP2a]. The following susceptibility tests were studied: E test for oxacillin minimal inhibitory concentration [MIC], DD test using oxacillin [1[micro]g], cefoxitin [30[micro]g] and moxalactam [30[micro]g] disks on Muller Hinton agar plates and agar screening test using MSA containing oxacillin [MSA-Ox] [1[micro]g, 4[micro]g and 6[micro]g/ml] and MSA containing cefoxitin [MSA-Cefox] [4[micro]g/ml]. Methicillin resistance was detected in 74% of 77 staphylococcal clinical isolates [68.8% in 48 S.aureus and 82.7% in 29 CoNS]. Compared to PCR assay, LAT showed 100% sensitivity and specificity for both S.aureus and CoNS isolates. Among S.aureus isolates, diagnosis of MR was best achieved by E-test, moxalactam DD and MSA-Cefox [all had sensitivity and specificity of 100% and 86.7% respectively] while among CoNS isolates, diagnosis of MR was better performed by E-test and MSA-Cefox [both had 100% sensitivity and specificity]. We conclude that E-test could be an accurate method in detection of MR. In laboratories that depend mainly on disk diffusion test, a combination of cefoxitin and moxalactam disks should be used to increase the accuracy of the test. MSA-Cefox [4[micro]g/ml] is a promising screening medium with high accuracy. Identification of MR by applying the MRSA screen LAT is a reliable alternative for clinical laboratories where molecular biology techniques are not readily available

Inducible nitric oxide synthase expression in helicobacter pylori CagA+ strains infections

Increased expression of inducible nitric oxide synthase [iNOS] has been observed in patients with chronic inflammatory diseases of the gastrointestinal tract leading to sustained production of nitric oxide [NO] which may induce DNA damage. Since Helicobacter pylori [H. pylori] infection produces a state of chronic immunostimmulation in the gastric epithelium and a causal relationship between H. pylori CagA+ strains infection and gastric cancer has been suggested, therefore, our aim was to evaluate the significance of iNOS expression in gastric lesions induced by H. pylori CagA+ strains with correlation to the encountered endoscopic and pathological diagnoses. Eighty four dyspeptic patients underwent endoscopic examination. Four antral gastric biopsies were obtained for detection of H. pylori by histopathological assessment [Giemsa staining], urease test and gene expression of H. pylori using PCR assay. Immunohistochemical staining for iNOS expression and quantitative detection of anti-CagA antibodies were performed. It was found that H. pylori infection was detected in 64.3%, CagA seropositivity in 54.8% and iNOS expression in 61.9%. Anti-CagA antibodies seropositivity and iNOS immunoexpression were significantly related to H. pylori infection. The positive rates of iNOS immunostaining increased with the lesion progression from chronic superficial gastritis to chronic atrophic gastritis to intestinal metaplasia [45.2%, 87.5% and 92.8% respectively]. Positive immunostaining rates of iNOS correlated significantly with H.pylori Cag A seropositivity with respect to both endoscopic and pathologic diagnoses. In conclusion, CagA+ H. pylori strains are associated with enhanced immunoexpression of iNOS in H. pylori-related gastric diseases, therefore they might contribute as risk cofactors that conduces to gastric carcinogenesis. Given the high prevalence of H. pylori gastric diseases and frequent performance level of endoscopic gastric examinations among Egyptian patients, prompt identification of gastric infections caused by H. pylori harboring Cag A virulence factor is necessary for the early eradication of infection before the development of pre-neoplastic lesions

SEN virus infection in Egyptian chronic hepatitis C and haemodialysis patients

SEN virus [SENV] has been tentatively linked to transfusion-associated non A-E hepatitis. The aim of the present study was to determine the prevalence of SENV among Egyptian patients with HCV-related chronic liver disease [CLD] and haemodialysis [HD] patients and to assess the clinical effect of SENV infection on coexistent hepatitis C either in the severity or the probability of developing hepatocellular carcinoma [HCC]. Polymerase chain reaction [PCR] was used to detect SENV-D and SENV-H DNA in serum samples of 74 HCV-related CLD patients, 45 uraemic patients on maintenance HD and 28 healthy controls. SENV DNA was detected in 13.5%, 11.1%, and 7.1% of CLD, HD patients and healthy controls respectively with no significant differences between patients and control group. No statistically significant differences were demonstrated between SENV infected and non infected CLD or haemodialysis patients regarding the clinical and biochemical parameters. SENV infection was significantly higher in CLD patients with HCC [33.3%] than without [8.5%] [p<0.05]. In conclusion, SENV does not seem to be a common infection in Egyptian patients. It has no apparent influence on the severity of co-existent HCV related CLD but it could be a risk factor for developing HCC in these patients. Further studies are needed to define the aetiopathogenic role of SENV infection in HCC development

Subclinical neuropathy in children with IDDM: peripheral and central nerve functions: part I

Peripheral neuropathy is one of the major complications of diabetes mellitus. However the early natural history of this complication has not been well defined. Studying nerve functions in IDDM at an early stage was the aim of this work in order to evaluate the prevalence of neuropathy. The study included 20 insulin dependent diabetic patients, in addition to 10 healthy subjects of matching age and sex as a control group. Patients were subjected to full clinical evaluation which included detailed survey for neuropathic symptoms and signs, urine testing for microalbuminuria and repeated fasting blood glucose, with measurement of serum glycated hemoglobin [HbA[1c]]. Electrophysiological study included motor conduction studies of the median and deep peroneal nerves and sensory conduction studies of the sural and median nerves in addition to visual evoked potentials [VEPs]. Neuropathic symptoms were present in only 2 patients [10%] but nerve conduction studies revealed the presence of abnormalities in motor and sensory nerve functions which were more common in lower than upper extremities and more in motor nerve functions than sensory nerve functions. The duration of diabetes was a major determinant of the presence of peripheral nerve dysfunction also older age and more height were positively correlated with nerve dysfunction. Central nerve functions testing by visual evoked potentials [VEPs] demonstrated that although eyes of diabetic children showed no abnormalities in fundus examination, the implicit time of the P100 of the VEP, was significantly prolonged in eyes of IDDM cases with duration <5 years while the P100 amplitude was significantly reduced only in IDDM patients with duration of diabetes >10 years. These findings emphasize the importance of follow up and testing for subclinical peripheral and central neuropathy by repeated electrophysiological testing of children with IDDM

Subclinical neuropathy in children with IDDM: autonomic nerve functions: part II

Studying autonomic nerve functions by testing for cardiovascular reflexes in addition to pupillary diameter and adaptation in IDDM at an early stage was the aim of this work in order to evaluate the prevalence of autonomic neuropathy. The study included 20 insulin dependent diabetic patients. In addition to 10 healthy subjects with matching age and sex as a control group. Patients were subjected to full clinical evaluation which included detailed survey for neuropathic symptoms and signs, urine testing for microalbuminuria and repeated fasting blood glucose, with measurement of serum glycated hemoglobin [HbA[1c]]. Autonomic function tests included cardiovascular reflex test, pupil size and measurement of pupillary dark adaptation. There was evidence for autonomic dysfunction demonstrated by abnormal cardiovascular reflexes which was most common in heart rate response to standing which was abnormal in 90% of cases, and also smaller pupil diameter. These findings emphasize the importance of follow up and testing for subclinical autonomic neuropathy in children with IDDM