Management of infected mesh following ventral hernia repair

Background: abdominal hernia represents a major health care burden. With over 350,000 repairs performed annually in the United States, millions of dollars are consumed with results that are often far from ideal. The use of the prosthesis in the abdominal wall hernia repair [AWHR] has introduced new problems. Although mesh has reduced hernia recurrence rates, it has its own set of complications. So, mesh infection is one of the most devastating complications after the implantation of any mesh

Objective: this work aimed to focus on management of infected mesh after ventral hernia repair

Patients and Methods: this study was conducted in the Department of Surgery, Faculty of Medicine, Al-Azhar University Hospitals from September 2016 until March 2018. The study included 40 patients with surgical mesh infections after the repair of the ventral hernia

Results: cases with laparoscopic hernia repair, minor infections and a patient unfit for surgery were excluded for any medical reason. And after taking the history of the disease and clinical examination and the necessary investigations and the most important is to take a sample of infected fluid over the mesh to determine the type of infection caused by this or doing fistulogram if the fistula connected to the intestine small or large

Conclusion: research of best practices in surgical technique, preoperative care and mesh materials is ongoing, and much remains to be learned on prevention and management of this complex and potentially devastating complication

Bacterial and parasitic profile of acute infectious pediatric diarrhoea and the role of faecal screening tests in prediction of the invasive type of diarrhoea

Diarrhoea is one of the leading causes of morbidity and mortality in children worldwide. Faecal screening methods as detection of faecal leucocytes, faecal lactoferrin and faecal occult blood, have diagnostic and therapeutic implications in the provisional diagnosis of invasive diarrhea before culture results made available. Aim of the work was to outline the bacterial and parasitic profile of acute pediatric diarrhoea and to evaluate faecal screening test in preliminary diagnosis of invasive diarrhoea. Three hundred children under five years of age, suffering from acute diarrhoea [<4 days] and attending the out-patient clinic of El Shatby Children's University Hospital in Alexandria over a period of 1 year, were recruited in the study. Stool samples were collected from the children and were subjected to bacteriological examination, parasitological examination and 3 faecal screening tests to distinguish invasive [inflammatory] from non invasive [non inflammatory] diarrhoea. Forty eight percent of samples were positive for enteric pathogens. Enteric bacterial pathogens were isolated from 25% of samples. Parasites 29% and mixed bacterial and parasitic infections were detected in 6% of samples. Enterotoxigenic E.coli [ETEC] was the most common bacterial isolate detected in 10% of samples, followed by Salmonella [8%], Shigella [6.67%] Campylobacter [5%] and Vibrio parahaemolyticus [1.33%]. Cryptosporidium was the most commonly identified parasite [13%] followed by Giardi lamblia [11%], Entamoeba histolytica [8%] and Cyclospora cayetanensis [3%]. Ascaris lumbricoides and Haeminolipus nana were only identified in 1% of samples, each. The gold standard for evaluation of faecal screening tests was positive culture for invasive bacterial pathogens and/or positive E. histolytica on microscopic examination of stool samples. Leuko test had the highest sensitivity [85.54%], specificity [73.73%], positive predictive value [55.47%], negative predictive value [93.02%] and accuracy [77%]. False positive results of the Leuko-test were significantly higher in the breast-fed children than non breast-fed ones [26.7%, 11.7% respectively, p<0.01]. Better sensitivity, specificity, positive and negative predictive values of the Leuko-test was recorded in the non breast-fed children than in the breast-fed ones. The recorded values in the first group were: 91.11%. 83.64%, 69.5% and 95.83%, respectively compared to 78.95%, 63.55%, 43.48% and 89.47% respectively in the second group. The study concluded that, Leuko test is the best applicable faecal screening test in differentiation of invasive and non invasive diarrhoea but is better avoided in breast-fed infants as many false positive results might be interpreted

comparative study between influence of rosiglitazone; a peroxisome proliferator-activated receptor gamma [PPARS] agonist, and corticosteroids on experimentally induced asthma in guinea pigs

Dugs used currently to treat asthma have limitations partly due to their undesired effects. PPARgamma agonists including rosiglitazone may offer additional therapeutic advantages to current treatment. The aim of the present study was to assess the anti-inflammatory potential of a PPARi agonist, rosiglitazone, locally delivered by means of nebulization in a guinea pig model of asthma, in comparison with that of the corticosteroid budesonide. Five groups of guinea pigs were used, five animals each. The first group was Sham -sensitized guinea pigs; the other four groups were sensitized by ovalbumin [OVA] by allergen solution containing 100 micrograms OVA and 100 mg Al [OH]3 per ml saline. 0.5 ml was injected intraperitoneally, while another 0.5 ml of the solution was divided over seven intracutaneous injection sites. The second group was OVA-sensitized and exposed to inhalation of saline. The third, fourth and fifth group were OVA albumin-sensetized. The third group was treated with vehicle inhalation, The fourth group was treated with rosiglitazone and the fifth group was treated with budesonide. Animals in the last 3 groups were exposed to allergen provocation procedure [Ag challenge] from weeks 4 to 5 after OVA sensitization. Assessment of asthma was done by studying the effect of rosiglitazone and budesonide on airway hyper responsiveness [AHR] to acetylcholine [Ach], inflammatory cellular changes in bronchoalveolar lavage and histopathological changes. The effect of rosiglitazone and budesonide pretreatment on histamine induced contraction of isolated OVA sensitized guinea pig tracheal spiral strips was also investigated. In addition, the direct effect of rosiglitazone and budesonide incubation on histamine induced contraction of isolated guinea pig tracheal spiral strips was examined. The results revealed that one week pre-treatment with rosiglitazone [20 minutes inhalation in a dose of 300 microg/ Kg/ day] and budesonide [20 minutes inhalation in a dose of 2mg/ Kg/ day] resulted in significant reduction in airway hyperreactivity to inhaled Ach, inflammatory cellular content in bronchoalveolar lavage fluid [BALF] and improvement in histopathological changes of asthmatic lung. There was no significant difference between both drugs as regard improvement of AHR, reduction in thickness of the interalveolar septum, decrease in total leucocytic count [TLC], count of lymphocytes and macrophages. However, budesonide caused significant reduction in eosinophils and macrophages count in comparison to rosiglitazone. In addition, rosiglitazone had a direct relaxant effect on airway smooth muscle. The results provided evidence for the therapeutic potential of inhaled PPARi agonist, rosiglitazone, in the treatment of airway asthmatic inflammation. In addition PPARgamma agonists had a direct relaxant effect on the isolated tracheal smooth muscle

use of gabapentin in the control of endometriotic pain

Endometriotic pain is a combined nociceptive and neuropathic pain. Nociceptive endometriotic pain is caused by infiltrating endometrtotic lesions as well as fibrotic traction on different pelvic contents. Neuropathic endomnetriotic pain is due to nerve infiltration by endometriotic lesions, fibrotic traction on the nerve, and nerve irritation by inflammator mediators and cytokines in peritoneal fluids. The study was conducted on 33 patients with pain as the only or main symptom. All patients received hormonal and NSAIDs [ +/- Tramadol] treatment for at least 6 months and pain failed to be controlled. All patients received gabapentin for 3 months. Pain was evaluated using SF McGill mean overall pain score and NRS to evaluate the intensity of deep dyspareunia and dysmenorrhea. Serum IL-6 and CA-125 were evaluated. There is a significant improvement of SF McGill mean overall pain score. deep dyspareunia and dysmenorrhea 2 weeks, 4 weeks and 3 months after treatment. SF McGill mean overall pain score showed significant improvement with the rates of 46.54%, 56.18% and 59.31% at 2 weeks. 4 weeks and 3 months respectively. Also, deep dyspareunia showed significant improvement in the rates of 30. 76%, 52.14% and 58.12% at 2 weeks, 4 weeks and 3 months respectively. Dysmenorrhea showed improvement with the rates of 18.87%. 2 7.52% and 35.85% at 2 weeks. 4 weeks and 3 months respectively [All shows P value < 0.01]. This was associated with different degrees of clinical improvement in 72.73% of patients. Serum levels of IL6 showed significant decrease after 3 months with the treatment [P-value < 0.05] while CA-125 showed insignificant decrease of serum levels with treatment [P-value> 0.05]. This study proved an effective role of GABAPENTIN, not only in controlling the mean overall endometriotic pain, but also in deep dyspareunia and dysmenorrhea. This pain control is associated with significant decrease in the level of IL-6, but not CA-125

Malaria and maternal mortality in Gezira-Sudan

The objectives of this study include: [1] to identify the magnitude of malaria as a cause of maternal mortality [MM] [2] to study the demographic characteristics of MM cases caused by malaria and [3] to identify the actual cause of MM due to malaria. This is a six years hospital based retrospective review of hospital records of ladies died due to malaria in Wad Medani Teaching Hospital for Obstetrics and Gynaecology [WMTHOG], form 1 January 1998 to 31 December 2003. Malaria caused 10% to 40% of MM per year. The mean age was 27.57 years, most of them were primigravidae and from rural areas. 37.8% of the deaths occurred between 28 and 36 week of gestation. The median duration of stay in hospital was two days. However 32.4% of deaths stayed for less than 24 hours that indicated severe and serious clinical presentations. The main causes of death due to malaria or its complication were: anaemia [24.3], cerebral malaria [21.6%], circulatory failure [12.51] and renal failure [8.1%]. Others were pulmonary oedema, hyperpyrexia, puerperal psychosis, abortion, severe epistaxis, cardiac arrest, black water fever, electrolyte imbalance, and hepatic failure. The study recommended effective prevention of malaria and an intensive care approach in its management

Mixed ligand complexes of some transition metal ions with new Schiff base salicylidine-1-amino -2- cyanodiphenyl -5- yl-glyoxalic acid phenyl hydrazone as primary ligand and 2-aminopyrimidine as secondary ligand

The interaction of Schiff base salicylidine-1-amino -2- cyanodiphenyl -5- yl-glyoxalic acid phenyl hydrazone [L1] [structure I] as a primary ligand and 2-aminopyrimidine [ap] [L2] [structure II] as a secondary ligand with [Cr[III], Mn[II], Fe[III], Co[II], Ni[II], Cu[II], and Zn[II]] were examined pH-metrically. The results indicated the stepwise formation of 1:1:1 mixed complexes. The formation constants of the resulting binary and mixed ligand complexes at 25. 35, and 40°C and an ionic strength 1M NaC1 obeyed Irving-Williams order [1] in terms of metal ions

Transcranial colour dupplex sonography in pre and post shunt assessment of hydrocephalus

The submitted study was concerned with the role of transcranial Doppler [TCD] in diagnosis and postoperative follow up of hydrocephalus. TCD was performed in 40 hydrocephalic infants [mean age = 6.95 month], as well as 40 control subjects [mean age = 4.4 month]. Patients clinically suspected of being hydrocephalic were examined transcranially in B-mode to estimate ventricular size, configuration and cerebral parenchyma, while the coloured Doppler examination focused on the velocity rates and resistive index [RI]. Patients with hydrocephalus proved to have larger ventricular systems and higher RI in comparison to their normal counterparts. The hydrocephalic patients were shunted and post-shunt TCD was performed [after an average interval of 28 days], reassessing the pre-shunt parameters and locating the position of the placed shunt. The patients with well-functioning shunts show significant decrease in the RI almost back to normal. As regards ventricular size, a less significant change was doccumented. In infected infants the RI remained high or even increased and the CSF echopattern was turbid, with echogenic ventricular lining. From the above data, we conclude that the TCD has a reliable role in the diagnosis and post shunt assessment of hydrocephalus

Defective monocyte phagocytic function as a possible genetic marker for heumatic susceptibility

The activity of the monocyte phagocytic system in children with rheumatic heart disease [RHD], their parents, their normal siblings and in nonrheumatic families was investigated. Phagocytic activity of isolated monocytes was assessed using luminol-dependent chemiluminescence. The count per minute of emitted light was measured before and after stimulation with zymosan solution. The results indicate that one-third of the siblings of children with RHD were genetically free while two-thirds, as well as the parents, were heterozygous, and that children with RHD were homozygous for [a] mutant gene[s] responsible for the defective function of the monocyte phagocytic system. The findings are strongly suggestive of autosomal recessive inheritance

Detection of enterotoxigenic escherichia coli by DNA colony hybridization method

500 diarrheal stool specimens were obtained from infants and children suffering from acute gastroenteritis. Isolates of E. coli were identified by conventional methods and they were further subjected to phadebact ETEC-LT coagglutination test, suckling infant mouse assay and hybridization with synthetic enzyme labelled oligonucleotide probe for the detection of heat labile enterotoxigenic E.coli and heat stable enterotoxigenic E.coli. ETEC was detected in 20.8% of specimens. The rate of detection of LT enterotoxin by enzyme labelled LT probe was significantly higher than the phadebact ETEC-LT [McNemnar's X[2] =27.0089]. No significant difference for detection of ST by probe and suckling mouse was found [X[2]=0.05]. The DNA probe hybridization, is recommended for ETEC detection, as an easy rapid technique in minimally equipped laboratories