Clostridium difficile infections in HIV-positive patients with diarrhoea.

Background. Patients with HIV/AIDS are at a high risk of being infected with toxin-producing strains of Clostridium difficile (C. difficile) because of frequent hospitalization, exposure to antibiotics and antibiotic prophylaxis for opportunistic infections. There are little data from India on the prevalence of C. difficile infection in such patients. Methods. We assessed the occurrence of C. difficile infections in HIV-positive patients with diarrhoea by looking for the presence of its toxin as well as by culturing. Enzyme immunoassay (EIA, Premier toxins A and B; Meridian Diagnostic Inc.) was used to detect toxin from 237 fresh stool samples collected from HIV-positive patients with diarrhoea. Culture was done on cycloserine–cefoxitin–fructose agar and brain– heart infusion agar. Results. C. difficile was found in 12 of 237 (5.1%, 95% CI 2.64%–8.68%) HIV-positive patients with diarrhoea (9 patients were positive by EIA and 3 by culture). The presence of C. difficile in patients who had received antiretroviral therapy (7/66 [10.6%]) was significantly higher (p<0.016) compared with those who had not (5/171 [3%]). Of the 12 patients positive for C. difficile, 7 were on antiretroviral therapy for a mean (SD) of 34.4 months with mean CD4+ count of 186 (98.81) cells/cmm and 5 patients were anti-retroviral-naïve with mean CD4+ count of 181 (68.7) cells/cmm. All the 12 patients were on antibiotics for previous 2 months and 4 of 12 had been hospitalized in the previous 30 days. Conclusion. C. difficile infections occurred more frequently in patients who had received antiretroviral therapy. Our study population had a lower frequency of C. difficile infections compared to previous studies.

Overexpression of Her-2/neu oncogene in 51 cases of endometrial carcinoma

Endometrial cancer is a common malignancy of the female genital tract. Her-2 overexpression is strongly correlated with tumor grade, type, and stage and this association complicate the issue of response of Her-2 positive endometrial carcinoma to chemotherapy. The aims of the current study are; to estimate the overexpression of Her-2 in endometrial carcinoma in our patients, to correlate the results with other known clinicopathologic markers and to compare our results with others. This is a cross-sectional retrospective study of 51 cases of endometrial carcinoma collected with their clinical data from Al-Batool Teaching Hospital and Al-Khansa'a Maternity Teaching Hospital in Mosul-Iraq from January 2007 to January 2010. All cases were revised histologically. Forty-three cases were total abdominal hysterectomy and 8 were curetting material. Tumors were classified into two main types, endometroid and non-endometroid carcinomas. Immunoperoxidase stains for Her-2/neu were performed on representative formalin-fixed paraffin embedded blocks. Majority of the endometrial carcinoma were in the 6th decade [50.9%] with a mean of 56.5 year. Her-2/ neu overexpression was observed in 58.8% of cases. The most frequent association was with non-endometroid carcinoma [100%]. Expression of Her-2/neu increased with increasing grade reaching 89.47% in grade III tumors. The highest expression was detected in tumors invading deep into the myometrium [77.77%]. HER-2/neu appears to play an important role in the biologic behavior of endometrial cancers. It was overexpressed in non-endometroid carcinoma, especially papillary-serous type, high grade tumors, and among the higher stages. Therefore, targeted therapies directed against HER-2, could be effective in some patients with endometrial cancer

Giant pedunculated esophageal liposarcoma associated with Hurthle cell thyroid neoplasia. Case report

Giant pedunculated liposarcoma of the esophagus is considered rare entity. They impose difficulties in its management, especially the surgical approach. We report a case of giant pedunculated liposarcoma of the esophagus in a 62-year-old male who underwent cervical excision of this large tumor, and made a full recovery. Hurthle cell thyroid cancer was found during the work-up, which was managed accordingly

[ harmful effect of quinolone [pefloxacine] on immature cartilage in juvenile rat]

The aim of our study was definition of the exact mechanism by which quinolone harm the immature cartilage causing arthropathy, and upon these results we can determine the suitable treatment for this damage. This effect was studied in four groups of juvenile wistar rats as following:1- normal group.2- the group of pefloxacine with a dose 15 mg/kg per day for one month. 3- the group of pefloxacine 15mg/kg per day for one month with addition of the magnesium ions with compensate amount 84mg/kg per art. 4- the group of pefloxacine 15mg/kg per day for one month with addition of vitamin E with compensate amount75mg/kg per rat. The drugs were administered by incubation tube for one months, and at the end of the experiment blood samples were took from animals hearts preparing for measuring malondialdehide, then animals were scarified and the maximum extension angle of the knee joints was measured, then we put the joints in the formol for the histological study. Pefloxacine increased the values of maximum extension angle significantly in compare to the normal group and the control group, with significant improvement in the group of magnesium ions and the group of vitamin E but non of each group could return the cartilage to the normal condition. The results of malondiadehyde assay inssure the effect of free radicals in this arthropathy. Histological study: pefloxacine damage significantly the cartilage and the damage was decreased in the addition of magnesium or vitamin E. There is a lot of factors participate in causing the arthropathy which induced by taking quinolone and this pathology don't confine on the participate of magnesium ions or oxidative stress.

New chelating resin for preconcentration and determination of molybdenum by inductive couple plasma atomic emission spectroscopy

A chelating resin is prepared by condensation polymerization of aniline with formaldehyde and characterized by Fourier transform infrared spectrometer, elemental analysis and thermogravimetric analysis and studied for the preconcentration and determination of trace Molybdate ion from environmental water sample using inductive couple plasma atomic emission spectroscopy. The optimum pH value for sorption of the metal ion was 5. The sorption capacity of functionalized resin is 3.1 mg/g. The chelating sorbent can be reused for 20 cycles of sorption-desorption without any significant change in sorption capacity. The best desorption of the metal ions from resin was obtained by 0.5 mol/L nitric acid as eluting agent. The profile of molybdenum uptake on this sorbent reflects good accessibility of the chelating sites in the aniline- formaldehyde. Scatchard analysis revealed that the homogeneous binding sites were formed in the polymers. The equilibrium adsorption data of Molybdate ion modified resin were analyzed by five isotherm models such as Langmuir, Freundlich and Temkin. Langmuir isotherm parameters obtained from the four Langmuir linear equations by using linear method. Based on the Langmuir isotherm analysis, the monolayer adsorption capacity was determined to be 4.03 mg/g at 20 °C. The method was applied for molybdenum ions determination from river water sample

Ethylmalonic encephalopathy. Another patient from Kuwait

We report a Kuwaiti girl with ethylmalonic encephalopathy. She presented at the age of 4 months with chronic mucoid diarrhea and delayed psychomotor development, and at 6 months she developed myoclonic epilepsy. She was found to have central hypotonia with pyramidal tract signs, acrocyanosis, and petechiae. Plasma lactate level was elevated. Blood spot and urine for organic acids results were consistent with the diagnosis of ethylmalonic encephalopathy. Cerebral MRI showed basal ganglia and white matter changes. Gene mutation study revealed homozygous deletion of exon 4 of the ETHE1 gene. The patient died at 14 months after extensive bronchopneumonia. Our objective is to alert physicians to the existence of such a devastating disease in our community and their role in the early diagnosis in the index patient for proper genetic counseling

Fracture penis with complete urethral disruption during intercourse

We present a rare case of fracture penis with complete urethral disruption in a 38 years old male. This resulted in an erect penis during sexual intercourse. He presented with diffuse and tense swelling of the penis along with acute urinary retention and distended urinary bladder. Emergency exploration revealed complete urethral disruption with tears in both corpus cavernosa. Evacuation of haematoma, repair of corpora and primary urethral repair was performed. Post-operative recovery was smooth and the patient developed satisfactory erectile and voiding function

Dnase I activity and gene polymorphism: role in SLE susceptibility and auto-antibody production

Previous studies have suggested that interrupted clearance of nuclear DNA-protein complexes after cell death might initiate and propagate systemic lupus erythematosus [SLE]. Deoxyribonuclease I [DNase I] may be responsible for the removal of DNA from nuclear antigens at sites of high cell turnover, thus preventing the onset of SLE. To investigate the association of serum DNase I activityand single nucleotide polymorphism [SNP]+2373A>G [Gln244Arg] of DNase I gene with susceptibility.to systemic lupus erythematosus [SLE] and the production of auto-antibodies to double-stranded DNA. A total of 42 SLE patients, all fulyilled the revised criteria of the American College of rheumatology for the diagnosis of SLE, were enrolled in the study and 17 healthy individuals with matching age and sex as a control group, 27 out of the 42 SLE patients had lupus nephritis proved by renal biopsy. DNase I gene+2373A>G SNP was studied by polymerase chain reaction followed by restriction fragment length polymorphism analysis. Serum DNase I activity [measured as percent of activity reduction;%AR] and anti-double-stranded DNA [anti ds-DNA] level were determined by solid phase enzyme immunoassay ELISA]. There was a significant decrease in DNase I enzyme activity [increase%AR] in the sera of SLE patients compared to the healthy individuals [p=O.000]. Anti ds-DNA antibody level was significantly higher in SLE patients compared to control group [p=0, 000]. There was a significant positive correlation between DNase I enzyme [%AR] and the level of anti ds-DNA antibody [r=0.596, p=0, 000]. Comparing the results of lupus patients with and without nephritis revealed an increase in both DNase enzyme%AR and the level of Anti ds-DNA antibody in the nephritis group but the difference is not statistically significant. There was no association of the+2373A>G SNP genotypes or alleles with SLE susceptibility. However SLE patients with GG genotype showed significant increase in both DNase I%AR [p=0.007] and anti ds-DNA body level [p=0.022] than those with AG and AA genotypes. The observed association of+2373A>G SNP of DNase I gene with DNase I activity and production of anti ds-DNA anti antibodies but not with SLE susceptibility calls into question how this SNP could contribute to SLE pathogenesis. A wider scale study with special emphasis on other auto-antibodies and genetic polymorphisms is recommended

Conventional Vs non invasive ventilation in acute respiratory failure

Treatment of patients with acute respiratory failure [ARF] often involves mechanical ventilation via endotracheal intubation. Non-invasive positive pressure ventilation [NIV] using Bi-level positive airway pressure [BiPAP] can be a safe and effective means of improving gas exchange. 1] Assess non-invasive positive pressure ventilation [BiPAP] as an alternative way for ventilation in ARF, and to 2] Determine factors that can predict the successful use of BiPAP. Thirty patients with acute respiratory failure [both type I and II] were enrolled in the study and divided into two groups. Group I included 10 patients who were subjected to invasive mechanical ventilation. Group II included 20 patients were subjected to NIV using BiPAP. Both groups were compared regarding the following parameters: Arterial blood gases [ABG] on admission, 30 minutes after beginning of mechanical ventilation, 1[1/2] hour then once daily. Complications namely ventilator associated pneumonia [VAP], skin necrosis and CO[2] narcosis; static compliance and resistance were measured at day one and day two. Compared to group I, group II patients were associated with similar improvement in ABGs data at 30 minutes and at discontinuation of ventilation [Table A]. Group II patients showed significantly lower incidence in VAP [20% Vs 80%], shorter duration of mechanical ventilation [3 +/- 3 Vs 6 +/- 5 days, p=0.006], with shorter length of hospital stay [5.8 +/- 3.6 Vs 8.9 +/- 2.7 days, p=0.011] when compared to group I. Skin necrosis [50%] and CO[2] narcosis [20%] occurred in group II only. Group II patients showed significant difference change in compliance and change in resistance from day I to day II when compared to group I Table [B]. On univariate basis, parameters were analyzed to choose those who were associated with outcome in concern [successful NIV]. The following parameters were identified: Level of consciousness, pH [7.3 +/- 0.03 Vs 7.26 +/- 0.1, p=0.009] PCO[2] [69.16 +/- 13.14Vs 100.97 +/- 12.04] on admission, 1[1/2] hour after NIV, pH [7.37 +/- 0.03 Vs 7.31 +/- 0.17, p=0.005], PCO[2] [53.98 +/- 8.95 Vs 77.47 +/- 5.22, p=0.0001] in whom NIV succeeded and failed respectively. Then multivariate analysis utilizing two different techniques namely [multivariate logistic regression and discriminate analysis] was used. The variable identified was PCO[2] after 1[1/2] hour in the two models with specificity 100%. In patients with acute respiratory failure, non-invasive ventilation was as effective as conventional ventilation in improving gas exchange, associated with fewer serious complications and shorter stay in intensive care. One and half hour trial with NIV can predict success with BiPAP, as shown by an improvement in pH and PCO[2] and overall clinical picture. PCO[2] after 1[1/2] hour could be the sole predictor of successful NIV with 100% specificity

Endotracheal-endobronchial metastases: report of 14 cases

Endotracheal-Endobronchial Metastases [EEM] secondary to extrapulmonary neoplasm are rare. Since 1989 we have encountered 14 patients with EEM. EEM were defined as documented extra pulmonary neoplasm metastatic to subsegmental or more proximal central bronchi in a bronchoscopically visible range. The developmental modes were described on the basis of classifying categories of Kiryu. The primary tumors included breast cancer [4 cases including 3 women, 1 man], colorectal carcinoma 1, renal cell carcinoma 1, embryonal cell carcinoma of testis1, uterine cervix carcinoma 2, melanoma 1, osteogenic sarcoma 2, papillary thyroid carcinoma 1 and prostatic sarcoma 1. The chest roentgenographic findings were: collapse 5, parenchyma mass 5, multiple nodule 2 and hilar enlargement 2. Median interval from diagnosis of primary tumor was 39.5 months. Endobronchial lesions were detected by bronchoscopy and their metastatic nature was confirmed histopathologically in all patients. Six patients were treated with external radiotherapy, while 6 patients had chemotherapy and 2 patients underwent surgical resection of metastasis. The cases we have reported are similar to those found in the literature, regarding their clinical and roentgenographic presentation. Local treatment is effective for palliating symptoms. All patients with extra pulmonary malignant tumor who are suspected to have pulmonary metastasis should undergo bronchoscopy to diagnose end bronchial metastasis and to differentiate it from primary lung cancer

Role of different imaging modalities in diagnosis of salivary gland diseases

A variety of neoplastic and non-neoplastic diseases affects the salivary glands, and requires differential diagnosis and management. Imaging plays an important role in evaluation of salivary gland diseases. The most common conditions affecting the salivary glands are calculi, inflammation and tumors. The aim of the study was to determine the diagnostic value of different imaging modalities for the evaluation of different lesions in the parotid and submandibular salivary glands, and if there is any particular advantage of one method in detecting and characterizing salivary gland lesions. Sixty-eight patients diagnosed clinically to have salivary gland disease were investigated as follow: Plain X-ray was performed in 55 cases, Sialography was performed in 55 patients following plain radiography, US was done in all patients, US-guided fine needle aspiration biopsy [FNAB] was done in 19 cases to verify diagnosis. CT oAas done in 18 patients and MRI was done in 13 patients. The final diagnosis in each patient in the study was based on consensus of clinical, imaging and biopsy or surgery results. Thirteen patients had submandibular calcular sialadenitis radio-opaque stones were seen in 11 of them [84.6%] as detected by X ray. Both sialography and US could accurately detect submandibular calcular sialadenitis in all the 13 patients [100%]. Sialography was highly accurate in diagnosis of cases with non-calcular submandibular sialadenitis [96%]. On the other hand, sialography was also able to detect duct system abnormalities in 10 out of the 15 examined parotid cases [66.6%]. The pattern of duct system abnormalities was typical in the 2 cases with Sjogren's syndrome. US was useful in diagnosis of parotid abscesses, cysts and masses. US-Guided FNAB was able to yield the diagnosis in 90% of cases with neoplastic salivary gland disease. CT was highly accurate [90.9%] in determining the benign from malignant nature of salivary gland masses, while the accuracy of MRI was 100% in this respect. Plain radiography has an important role in detection of salivary calculi and calcifications. Sialography is so far the imaging modality of choice with indispensable value for evaluation of salivary duct system abnormalities. US is a sensitive non-invasive tool for salivary glands imaging. Its diagnostic value is augmented by its use for guidance of FNAB which is easy to perform and of high diagnostic yield. Both CT and MRI are considered to be the mainstay for diagnosis in suspected salivary gland neoplastic disease. The two modalities have high accuracy in detection of mass lesions and evaluation of their extent; however, the inherent high tissue discrimination capabilities of MRI give privilege to this technique in evaluation of the nature of such lesions

role of interleukin 16 in the immunopathogenesis of rheumatoid arthritis

Rheumatoid Arthritis [RA] is a chronic inflammatory disease characterized by hyperplasia of the synovium and excessive cellular infiltration, which leads to progressive joint destruction. We analyzed, interleukin 16 [IL16], in relation to disease activity to characterize its biologic function in RA. Secreted IL-16 was measured by enzyme immunoassay in sera from 30 RA patients and 30 healthy controls [HC], and also in synovial fluid [SF] from 16 RA patients and 15 patients with non-RA synovitis as controls. IL-16 expression in peripheral blood mononuclear cells [PBMC] was characterized by flow cytometric analysis after intracellular cytokine staining for IL-16. In synovial tissue specimens, both were done: Immunohistochemistry for localization of IL-16, and histopathology, in which the tissue scored semiquantitatively for synovial hyperplasia and cellular infiltration. IL-16 was detected at significantly higher levels in sera and SF of RA patients in comparison to HC and non-RA synovitis [p<0.001 and p<0.0001 respectively]. Also, IL-16 was detected significantly higher in SF in comparison to sera in RA patients [p<0.001]. Flow cytometry of PBMC showed that a great proportion of both CD4+ and CD8+ cells expressed IL-16 protein. Also, immunohistochemistry revealed more CD4+ and less frequency of CD8+ cells in synovial infiltration. A significant correlation between IL-16 expression and local inflammatory activity could not be established [p>0.21] by microscopic analysis of the synovial cells infiltrate. In addition, no significant association was observed between serum, SF, and synovial tissue expression of IL-16 and clinical disease activity in RA [p>0.61, p>0.5 and p>0.42 respectively]. This indicated that, IL-16 played a regulatory rather than a proin-flammatory role in the immunopathogenesis of RA

Predicting factors for distant failure in head and neck cancer-impact of grade

This retrospective study was performed on 157 patients treated by radiotherapy between 1993-1998 years. The frequency of distant metastases and the influence of different variables as tumor stage, nodal stage, tumor grade and anatomic site in addition to p53 on the appearance of distant metastases were evaluated. The study showed that patients with high grade squamous cell carcinoma of head and neck presented with advanced tumor stage combined with advanced nodal stage, arising mainly from nasopharynx, are at a high risk of developing distant failure and should be candidates for extensive evaluation by recent imaging studies as well as pathological markers. This subset of patients should be considered for combined modality treatment

Pseudotumour cerebri. medical and surgical management

A cross sectional study was done for 20 patients with pseudotumour cerebri who were treated at the neurosurgical unit in Mosul Teaching Hospital. All underwent the classical medical treatment by diuretics, corticosteriods, carbonic anhydrase inhibitors and repeated lumbar punctures. Eleven patients underwent surgical treatment by inserting a lumbo-peritoneal shunt in order to stop the progressive deterioration of vision. The aim of this study is to evaluate such methods of treatment and their prognostic value

Selective expolratory protocol, a possibility in penetrating neck trauma

A four year [1993-96] prospective study of penetrating neck trauma was carried out at a surgical unit of a major teaching hospital. The study comprises of 48 patients. Age ranged from 16-72 years with a male to female ratio of 9:1. Thirty two [66.6%] merited early exploration while 16 [33.3%] were initially treated conservatively. Two of the later group underwent delayed exploration for infected hematoma. Firearm was the commonest mode of injury [43.7%] and cervical vasculature was the most commonly injured[25.4%]. Exsanguination and respiratory paralysis following cord damage were responsible for the mortality in 5 cases

Craniofacial surgery: the team approach

The aim of this article is to give a view on the field of this surgery through illustrated cases treated in our units and to support the role of a team approach, the first author had adopted since 1989, in the early diagnosis and proper management of these difficult conditions hopping that our contribution will improve the performance of this specially in our country. Also we wish to introduce these problems to other surgical and medical specialties and to the general practitioners in order to recognize the importance of early diagnosis and treatment for early referral to avoid any medical, technical, and psychological problems since many patients are still behind the ideal care and treatment

Time constant of lung emptying

The force vital capacity [FVC] - time curves from 20 healthy volunteers and 20 patients with COPD were analysed semilogarithmically [log volume remaining in lungs against time by reading the curves at 0.1s intervals]. Important observations from this study are: [i] Volume-time curve for a forced expiration is biexponential in healthy subjects and in patients with moderate obstruction. [ii] A single exponential FVC-time curve is a typical finding in patients with severe obstruction. [iii] The intersection of the two exponentials occurs at a remaining volume that may correspond to the point of dynamic airway compression and it shifts towards lower lung volume in obstruction determining the degree of air trapping. [iv] Both regions of the bronchial tree corresponding to FEF25 and FEF25-75% have a single time constant of 0.46s in healthy volunteers. There are two time constants [0.96 and 1.66 seconds] of peripheral regions of the bronchial tree corresponding to FEF25-75in patients with moderate obstruction. [v] The plot of time constant against the FEV1/FVC ratio shows a hyperbolic curve for the fast component [tau1] and a non-hyperbolic for the slow component [tau2]. [vi] the time constant [tau1] of The fast component seems to be independent from the lung volume, age, height and sex in contrast to tau2. Mean transit-time [MTT] seems to correspond more to the second time constant

ASO titer in tuberculosis patients

Sera of 100 tuberculous patients, 73 males and 27 females, were investigated for ASO titer. ESR for each patient was also determined. This study indicates that tuberculous patients have higher mean titer 364.40 Todd units/ml than normal individuals 218.40 Todd units/mI. No significant difference in the mean ASO titer was observed in males and females, also no correlation between ASO titers and ESR was noticed

Drug dependence in Mekran Panjgur revisited

Through epidemiological method, prevalence of drug dependence in the four villages of Panjgur is estimated to be 3.37% of the population. Cannabis was found to be abused by 1.13% opium 0.5% and heroin 0.64%. The difference between the estimates of heroin abuse made earlier through information from patients and the current survey is more than five times. It is suggested that currently used estimates may be reviewed critically