Fecal indicators and bacterial pathogens in bottled water from Dhaka, Bangladesh

Forty-six bottled water samples representing 16 brands from Dhaka, Bangladesh were tested for the numbers of total coliforms, fecal indicator bacteria (i.e., thermotolerant Escherichia coli and Enterococcus spp.) and potential bacterial pathogens (i.e., Aeromonas hydrophil, Pseudomonas aeruginos, Salmonella spp., and Shigella spp.). Among the 16 brands tested, 14 (86%), ten (63%) and seven (44%) were positive for total coliforms, E. coil and Enterococcus spp., respectively. Additionally, a further nine (56%), eight (50%), six (37%), and four (25%) brands were PCR positive for A. hydrophila lip, P. aeruginosa ETA, Salmonella spp. invA, and Shigella spp. ipaH genes, respectively. The numbers of bacterial pathogens in bottled water samples ranged from 28 ± 12 to 600 ± 45 (A. hydrophila lip gene), 180 ± 40 to 900 ± 200 (Salmonella spp. invA gene), 180 ± 40 to 1,300 ± 400 (P. aeruginosa ETA gene) genomic units per L of water. Shigella spp. ipaH gene was not quantifiable. Discrepancies were observed in terms of the occurrence of fecal indicators and bacterial pathogens. No correlations were observed between fecal indicators numbers and presence/absence of A. hydrophila lip (p = 0.245), Salmonella spp. invA (p = 0.433), Shigella spp. ipaH gene (p = 0.078), and P. aeruginosa ETA (p = 0.059) genes. Our results suggest that microbiological quality of bottled waters sold in Dhaka, Bangladesh is highly variable. To protect public health, stringent quality control is recommended for the bottled water industry in Bangladesh.

Surgical procedures for abdominal hydatid cyst: a mini-review

Hydatid disease [HD] may occur in any intra-abdominal organ and the liver is the most frequently involved. Surgery is the treatment choice for this disease. A retrospective study of 95 patients [64 female and 31 male, aged 5 to 82 years] with intra-abdominal HD. Eighty eight patients were symptomatic and the remaining seven asymptomatic. HD diagnosis was accomplished with laboratory tests, imaging techniques and serological tests. All of our material underwent surgical treatment, 61 patients by endocystectomy with drainage of the remaining cavity [by external tube or marscipulization], 23 by endocystectomy with obliteration of the remaining cavity [by omentoplasty or capitonnage] and 11 patients by cystectomy or organectomy [splenectomy, nephroectomy, cholecystectomy or cyst excision]. The morbidity rates were higher in drainage techniques compared with obliteration techniques or cystectomy [24.21%, 5.4% and 1.1 respectively]. Infections of the remaining cavity was the most common complications in 11 [11.6%] patients, followed by prolonged externqal drainage 7 [7.4%], biliary discharge 4 [4.2%] and recurrence 2 [2.1%] [table2]. Over all mortality rate 3.6%, represented by 3 patients died in our study, 2 of them due to septicaemia and one patient due to pulmonary embolism. Cysectomy and obliterating of the remaninig cavity [omentoplast and capitonnage] techniques could be advised for uncomplicated hydatid disease

brief discussion complications of thyroid surgery at El-Thoura teaching hospital

As every operation, thyroid surgery carries risk to complications, which may transient or permanent Objective of this study was to explore our expereince in thyroidectomy performed for seventy nine patients in General Surgical Departmen of El-Thoura Central Teaching Hospital El-beida, Libya, for a peroid of two years [from May 2003 to April 2005]. Twenty eight [35.4%] patients of them operated by lobo-isthmoectomy, 39 149.4%] sub-total thyroidectomy, 6 [7.6%] near total thyroidectomy, 4 15.1%] total thyroidectomy and the remaining 2 [2. 5%] patients by enculation of simple cyst Post-operatively; reccurent laryngeal nerve [RLN] injury and hypoparathyroidism were transient for a few months and were not common [3.6% and 2.5% respectively]. Wound infection occurred in two [2.5%] cases and hypothyrodism in one [1.3%] case. Severe primary heamorrhage was not developed in our material. Complications of thyroid surgery are fear to patient and surgeon; can be prevented or minimized when the surgery performed under optimal condition by an experienced hand surgeon with meticulous surgical techniques

Post-streptococcal reactive arthritis [PSRA]: is it a distinct disease entity?

Reactive arthritis is defined as a sterile inflammatory arthritis occurring in association with primary infection at a distant site. Arthritis following primary throat infection with Group A beta, haemolytic Streptococci [GA beta S] may apply to this definition, Because of the similarity between the diagnostic criteria for acute rheumatic fever [ARF] and post-streptococcal reactive arthritis [PSRA], the diagnosis and treatment of PSRA are not well defined. To clarify whether PSRA is a separate disease entity? and to evaluate the extent of joint affection by using various clinical, laboratory and radiological tools. Twenty-five patients with arthritis secondary to infection with GA beta S who attended the Outpatient Rheumatology Clinics in Assuit University Hospitals were included in this study. Other forms of reactive arthritis [ReA] were excluded. All patients were submitted to complete medical history and clinical examination. Erythrocytic sedimentation rate [ESR], C-reactive protein [CRP], complete blood count, rheumatoid factor [RF], antinuclear antibodies [ANA], throat swab and Antistreptolysin O Titre [ASOT], have been done to all patients. Electrocardiogram [ECG] and Echocardiogram [ECHO] were performed. Plain radiography, ultrasonography [US] and Magnetic Resonance Imaging [MRI] to both knees and ankles were done to all patients. Twenty-five patients with a mean age +/- standard deviation of 22.40 +/- 7.42 years were selected. The arthritis persisted for up to six months with a latent period from 10 days to 2 weeks. ASOT was positive with a range from 200-800 IU. Culture of throat swab was positive for GA beta S in 72% of cases, in addition to other organisms [staphylococci in 24% and pneumococci in 16% of the patients]. All of the patients had non migratory arthritis of lower limbs, Knees and ankles synovitis with minimal effusion was detected in 36% of the patients by using ultrasound and 32% and 40% by using MRI respectively. Synovitis with marked effusion of the knees and ankles was detected in 36% and 44% of patients respectively by ultrasound and 40% by MRI. Post-streptococcal arthritis is a separate disease entity. The extent of joint affection might be evaluated by the use of US and MRI as the findings were concordant in knee joint affection. MRI was preferable in evaluating ankle joint synovitis

Erectile dysfunction: Current diagnosis and risk factors in Upper Egypt

Erectile dysfunction [ED] has taken an increasing importance in andrology and vascular practice. Recognizing the pathological pattern of ED assists in choosing the best method of treatment Normal erectile function needs good arterial inflow for adequate volume expansion of the cavernously sinusoids, sufficient to cause restriction of venous outflow and retention of the penile blood flow. Color flow Doppler analysis after intra-cavernous injection of vaso-active drugs has been reported to be a minimally invasive, accurate method, and considered to be the gold-standard technique for evaluating penile hemodynamics. It becomes one of the useful diagnostic methods for evaluation of ED. to diagnose types of erectile dysfunction and to evaluate the risk factors. From january to August 2006, 280 married patients with ED referred from andrology and vascular surgery clinics to radiology department, of Assiut University Hospital to be included and diagnosed according to International Index of Erectile Function. They aged from 21-63 years and age >40 were considered a risk factor. Full history and clinical examination [including vascular examination of peripheral blood vessels and examination of the external genitalia] was done. Pharmacodynamics color Doppler was done to all patients using Acuson XP/10 machine, and 7 MHz frequencies transducer. Gray scale and color Doppler imaging was performed to the penis to visualize the anatomic details of the corpora cavernosa, cavernosal arteries and surrounding structures. Vaso-dilating agent 20 micro g prostaglandin E1 [PGEI] was injected directly into the corpus cavernosma. Peak systolic velocity [PSV] and end diastolic velocity [EDV] of the cavernosal artery was measured. The resistivity index [Rl] was readily calculated by the machine and given. Description of sildenafil citrate [Viagra] 50 mg orally for six coitus times in all patients was done and they were objectively reevaluated. Patients with peripheral arterial diseases, Leriche syndrome or ischemic heart disease were excluded from the study. Patients mean age was 37.68 +/- 10.85 years and was from 4 months to 15 years and the mean duration of impotence was 3.92 +/- 4.06 years. History of risk factors as smoking was present in 47%, age > 40 years in 35% diabetes in 28%, and drugs induce impotence in 10% of ED patients. Normal Doppler-findings were present in 67.8% of ED patients and were diagnosed non-vasculogenic ED [psychogenic in 32.2 %, idiopathic in 28.5% and neurogenic in 7.1 % of ED patients]. .Abnormal Doppler findings were present in 32.2% of ED patients and were diagnosed as vascurlogenic ED [13.5% of total ED patients were venogenic, 10.5% were arteriogenic and 8.2% were combined ED]. vasculogenic ED patients were venogenic in 41.1%, arteriogenic in 33.3% and combined in 25.6% of them. Doppler study showed a significant decrease ii cavernously artery PSV and RI and a significant increase m EDV values in vasculobogenic group than those of total patients and non-vasculogenic group. Arteriogenic group showed a significantly lower PSV values and venogenic group showed a significantly lower. RI and significantly higher EDV values than those of non-vasculogenic group. No significant difference was present in-between non-vasculogenic groups regarding their Doppler values. Sildenafil citrate [Viagra] response was present in all patients and varies between grade II in 21.6% and grade III and lV in 78.4% of ED patiens. Vasculogenic and psychogenic ED got response in 100% of them. Idiopathic and neuogenic ED response was in 70% and 40% of them respectively. Erectile dysfunction could be vasculogenic or non-vasdogenic as psychogenic, idiopathic, or neurogenic. Pharmacodynamic color Doppler using PGE1 is diagnostic, safe and minimally invasive method to differentiate vasculogenic from nonvasculogenic typs. Risk factors concerned in ED are diabetes, smoking and some drugs. Sildenafil citrate can give good result with vasculogenic and psycogenic and to less extent with idiopathic and neurogenic ED

Early detection of macro vascular diseases of carotid and femoral arteries in patients with Rheumatoid arthritis

Rheumatoid arthritis [RA] is a multi-system disorder with inflammatory process associated with increased cardiovascular risk. The duplex scanning is a noninvasive technique to detect early atherosclerotic plaques and arterial wall changes either in symptomatic or asymptomatic patients. Early detection of asymptomatic vascular disorders allows early intervention and possibly retards the development of symptomatic cardiovascular diseases. A higher risk of cardiovascular morbidity and mortality persists among patients with an abnormal ankle brachial index [ABI] and it is useful to identify asymptomatic patients with established disease. To detect the early manifestations of atherosclerotic changes of carotid and femoral arteries in patients with rheumatoid arthritis. Twenty-four patients with chronic rheumatoid arthritis [six males and eighteen females] aged 26-65 years [45.7 +/- 14.7 years] with mean disease duration 11.12 +/- 6.4 years [2-18 year] were included in the study. All patients were on methotrexate, corticosteroids and nonsteroidal anti-inflammatory lines of treatment. Twenty apparently normal subjects were included in the study as controls. Patients with other types of collagen diseases or patients with ischemic peripheral manifestations, ischemic heart disease, diabetics or smokers were excluded from the study. Full history and thorough clinical examination, including full joints and vascular examination for all peripheral arteries and calculation of ankle brachial index [ABI] was done using pocket Doppler and sphygmomanometer. Patients and controls were subjected for Hb, WBC, platelet count, rheumatoid factor, blood sugar, ESR, levels of plasma cholesterol, triglyciride, HDL and LDL. Duplex study was performed on carotid and femoral arteries. The mean ABI in patients was 1.21 +/- 0.3, non-significantly lower than controls but still within the range of normal. There was a significant increase in the levels of cholesterol, triglyciride, LDL and HDL than controls and still within the range of normal. Duplex changes of carotid and femoral arteries were present in 18/24 [75%] of patients including hemodynamic changes, intimal thickness, plaques, stenotic segment. Duplex of carotid arteries detected hemodynamic changes in 12.5%, intimal thickness, plaques and stenotic segment in 25% of patients for each and detected intimal thickness of femoral arteries in 25% of patients. There was a significant negative correlation between the ABI and duration of disease [r = - 0.506, p<0.01] and a significant positive correlation between the intimal thickness and duration of disease [r =-0.807, p<0.001]. There was no relation between drug intake or type of drug and ABI or intima thikness and there was no relation between cholesterol, triglyciride, LDL or HDL levels and ABI or intimal thickness. There is increased risk of vascular disease in RA patients involving carotid and femoral arteries in the form of hemodynamic changes, intimal thickness, plaques and stenotic segment. Low ABI together with Duplex study are helpful for detection of subclinical ischemic changes in such high-risk patients. Normal levels of plasma cholesterol, triglyciride, HDL and LDL do not exclude underlying vascular changes. So we recommend ABI and Duplex examination for all RA patients and further studies are needed to elucidate non-traditional risk factors such as endothelial dysfunction, immune activation and impaired fibrinolysis in addition to oxidative stress

Effect of various water supplies on the stability of ampicillin trihydrate mixtures

The stability of aqueous solutions of ampicillin trihydrate, BPC in relation to the quality of water used for their preparation and the possible contamination with penicillinase producing microorganisms was studied. Ampicillin trihydrate suspension [50 mg/m1] and dilute solution [2mg/m1] were prepared with non-sterile distilled water and with tap water. Control preparations made with sterile distilled water and/or a preservative were also prepared for comparison. The solutions and suspension were kept in a constant temperature water bath at 37degree C for 7 days [a condition similar to room temperature in summer in many areas in Saudi Arabia]. Samples were taken at various time intervals and assayed spectrophotometrically for ampicillin. The solutions were also tested for microbial contamination by a pour-plate technique. When a growth of microorganisms was observed the organisms were isolated and tested for penicillinase producing activity. Sterile solutions as well as suspensions were found to have adequate stability. Solutions prepared with non-sterile water were much less stable. Penicillinase producing microorganisms in the water used for the preparation of ampicillin trihydrate solutions were implicated in the degradation of these solutions. Solutions containing a preservative [methy1 paraben] offered an alternative of higher stability. Suspensions of relatively high ampicillin trihydrate concentration were less likely to be affected by bacterial contamination. It seems necessary to add a preservative or to use sterile distilled water for the preparation of dilute ampicillin solutions intended for use over a relatively long time