Nebulized heparin and salbutamol versus salbutamol alone in acute exacerbations of chronic obstructive pulmonary disease requiring mechanical ventilation: a double-blind randomized controlled trial / 대한마취과학회지

Background@#Nebulized heparin has been effectively used in the management of many pulmonary diseases. However, its effect on mechanically ventilated patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) has never been studied. This study aimed to assess the efficacy of nebulized heparin and salbutamol to increase ventilator-free days (VFD) in mechanically ventilated AECOPD patients and the effect of nebulized heparin on respiratory and coagulation functions. @*Methods@#In this double-blind controlled study, 60 mechanically ventilated adult patients with AECOPD were randomly allocated into two groups; heparin and salbutamol (HS) group and salbutamol only (S) group. In the HS group, patients received nebulized heparin (25,000 IU) and salbutamol (5 mg) every 6 hours. Patients in the S group received nebulized salbutamol only (5 mg). The treatment was continued while patients remained ventilated for a maximum of 14 days. The primary outcome was VFDs at day 14. PaCO2, PaO2/FiO2 ratio, number of nebulizations withheld, C-reactive protein (CRP) titer and activated partial thromboplastin time (APTT) were secondary outcomes. @*Results@#Patients in the HS group had significantly more VFDs (4.7 [3.3]) compared with those in the S group (2.4 [2.6]), P = 0.007. PaCO2 levels, PaO2/FiO2, the decrease in the CRP level and the increase in the APTT from the baseline were comparable in both groups. @*Conclusions@#The co-administration of nebulized heparin and salbutamol, compared with salbutamol alone, significantly increased (VFDs) among mechanically ventilated AECOPD patients without increasing bleeding risks.

Nebulized heparin and salbutamol versus salbutamol alone in acute exacerbations of chronic obstructive pulmonary disease requiring mechanical ventilation: a double-blind randomized controlled trial / 대한마취과학회지

Background@#Nebulized heparin has been effectively used in the management of many pulmonary diseases. However, its effect on mechanically ventilated patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) has never been studied. This study aimed to assess the efficacy of nebulized heparin and salbutamol to increase ventilator-free days (VFD) in mechanically ventilated AECOPD patients and the effect of nebulized heparin on respiratory and coagulation functions. @*Methods@#In this double-blind controlled study, 60 mechanically ventilated adult patients with AECOPD were randomly allocated into two groups; heparin and salbutamol (HS) group and salbutamol only (S) group. In the HS group, patients received nebulized heparin (25,000 IU) and salbutamol (5 mg) every 6 hours. Patients in the S group received nebulized salbutamol only (5 mg). The treatment was continued while patients remained ventilated for a maximum of 14 days. The primary outcome was VFDs at day 14. PaCO2, PaO2/FiO2 ratio, number of nebulizations withheld, C-reactive protein (CRP) titer and activated partial thromboplastin time (APTT) were secondary outcomes. @*Results@#Patients in the HS group had significantly more VFDs (4.7 [3.3]) compared with those in the S group (2.4 [2.6]), P = 0.007. PaCO2 levels, PaO2/FiO2, the decrease in the CRP level and the increase in the APTT from the baseline were comparable in both groups. @*Conclusions@#The co-administration of nebulized heparin and salbutamol, compared with salbutamol alone, significantly increased (VFDs) among mechanically ventilated AECOPD patients without increasing bleeding risks.

Surveillance of surgical site infection in General Surgery Department at Sohag University Hospital

Background: Surgical site infections [SSI] are the most common nosocomial infections in surgical patients and lead to prolonged hospital stay, readmission to the hospital, and increased morbidity and mortality

Objectives: This study aimed to detect the incidence of SSI and the risk factors, the causative organisms and their antimicrobial susceptibility pattern in general surgery department at Sohag university hospital

Methodology: A prospective SSI surveillance at Sohag University hospital from [January 2017 to June 2017] using the criteria of the Centers for Disease Control. Basic demographic, surgical data and data of possible risk factors were collected from all patients. Patients were followed up for 30 days after surgery. Swabs were collected from cases with signs and symptoms of SSI and cultured on basic microbiological culture media. Isolated colonies were identified microscopically and biochemically. Full identification of the causative organisms and their antibiotic sensitivity were done by Vitek 2 compact automated system

Results:The study included 482 patients and the incidence of SSI infections was [11.2%]. Escherichia coli was the most common organism causing SSI and was responsible for [40%] of SSIs followed by Pseudomonas aeruginosa [20%], Staphylococcus aureus [20%], Enterobacter cloacae [10 %] and Klebsiellapneumoniae [10 %]. Most of isolated E. coli and Klebsiella were ESBL producers [73.3%]. Pseudomonas aeruginosa shows emergence of resistance to tigecycline [25%]. All isolated staph. aureus were [MRSA] and [10%] of them were [VRSA].Univariate regression analysis show that older age, urgent operation type, bad patient general condition, contaminated wound type, hypertension, obesity, intake of antibiotic prophylaxis and increased length of hospital stay [days] were risk factors for SSI. The multivariable regression analysis revealed that urgent operations type, bad patient condition, obesity increasing length of hospital stay [days] and intake of antibiotic prophylaxis independent risk factors for the development of a SSI

Conclusion: The study provides a valuable data about SSI in General Surgery Department and highlights risk factors associated with SSI, the causative pathogens and their antibiotic sensitivity in our hospital that can help in updating the antimicrobial prophylaxis policy and reducing the incidence of SSI

Biofilm producing bacteria in cases of urinary tract infection at Sohag University Hospital

Background: Biofilm is an important problem of great medical concern in which microorganisms are present in extracellular matrix protecting them from external environment, host immunity and antibiotic therapy. Multiple phenotypic methods are present to detect biofilm in vitro tube method, congo red and tissue culture plate methods

Objectives: To determine the ability of bacteria that cause urinary tract infection to form biofilm , antibiotic susceptibility pattern in biofilm forming isolates and to detect some of genes responsible for biofilm formation

Methodology: four hundred urine samples were collected 240 samples from catheterized and 160 from non catheterized patients who fulfill the inclusion criteria. Samples were cultured and colony forming unit was counted [colony forming unit > 105 were considered positive UTI. Identification of bacteria and their antibiotic sensitivity was done by automated system VITEK II. Multiple phynotypic biofilm detection methods were done and detection of biofilm genes was done by PCR

Results: Enterobacter spp. Were the most frequent isolated organism of Gram negative, Staph aureus was the most frequent isolated organism of Gram positive bacteria.Multiple Phenotypic methods for detection of biofilm production were done to Gram positive and Gram negative bacteria. Tube method detected 84 [68.9%] cases as positive biofilm producer in catheterised patients while 2 [5%] were positive in non catheterized patients. Congo red method detected 80 cases [65.6%] as positive in catheterized cases , 2 [5%] in non catheterized patients but tissue culture plate detected 88 cases[72%] as positive in catheterized patients. Non catheterized patients 18 [45%] were positive. PCR was done to detect biofilm genes [ IcaA, IcaD in staphylococci], [BssS gene in enterobacteriaceae], IcaA, D were detected in 8 [19%] isolates of staphylococci, BssS was detected in66/104[63.5%] of enterobacteriaceae. Sensitivity of phenotypic methods for biofilm detection in relation to genotypic revealed that tissue culture plate showed more sensitivity in Gram positive and negative bacteria

Conclusion: Multiple phenotypic methods are known for biofilm detection in vitro but tissue culture plate is the most sensitive method; so we can recommend tissue culture plate as a screening method for biofilm detection

Association of virulence genes of enterobacteriaceae and biofilm formation in urinary tract infection at Sohag University Hospital

Background: Enterobacteriaceae are group of multiple organisms that causing different human infections including urinary tract infections. They harbor multiple virulence factors e.g. fimbria and pili that play an important role in attachment of the organism to uroepitheliumwhich is the first step to infection. Attachment also forms the early steps in biofilm formation that covers the organisms with a shield protecting them from host immune system and from chemotherapeutic agents

Objectives: Determine some virulence factors of enterobacteriaceae, biofilm production ability and antibiotic resistance pattern of these bacteria

Methodology: Two hundreds urine samples were collected from different departments at sohag university hospital from patients complaining of UTI symptoms, cultured on MacConkey agar. Bacterial count was done and count = 105/ml was considered significant bacteruiria. Identification, antibiotic susptability were done using VITEK II automated identification system. Phenotypic detection of biofilm was done by tissue culture plate method, molecular detection of biofilm and virulence genes by polymerase chain reaction

Results: Out of the 200 urine samples; 104 samples were positive for enterobacteriaceae, 50% of the isolates were enterobacterspeceies, 30.8% were e.coli, 17.3% were k.peumonia and 1.9% were citrobacter.100% of the isolates were resistant to ampicillin, 94.2% were resistance to ampicillin sulbactam, 82.7% were resistance to trimethoprime/sulfamethoxazole. Tissue culture plate detected 10/104[9.6%] as high biofilm producers, 42/104[40.4%] as moderate, 10/104[9.6%] as weak and 42/104[40.4%] as non biofilmproducers.pcr detected fimH gene in 34/104[32.7%], papC gene in18/104[17.3%] and BssS gene in 66/104[63.5%]

Conclusion: Enterobacteriaceae group is an important cause of serious infections and has a great ability to form biofilm that enables them to cause recurrent, persistent and resistant infections. Infection control measure should be applied sharply to prevent spread of these virulent organisms

Species identification and antifungal susceptibility profile of candida isolates from ICU patients in Sohag University hospital, Upper Egypt

Background: Candida species are among the most common fungal pathogens in ICU patients. Candida albicans was the predominant species, but a shift toward non-albicans Candida species has been recently observed

Objectives: To detect the prevalence of different Candida species and determine their antifungal susceptibility profile in ICU patients using phenotypic methods, the Vitek 2 system compared with CHROMagar Candida agar and a genotypic method; PCR-RFLP

Methodology: Various clinical samples were collected from 248 ICU patients in Sohag University Hospital from the period between September 2014 and May 2015. Samples were cultured on CHROMagar Candida agar. Results were compared with those of Vitek 2 system and confirmed by PCR- RFLP method and antifungal susceptibility profiles were analyzed by disc diffusion and Vitek 2 antifungal susceptibility tests

Results: The study revealed an overall isolation rate of Candida species among ICU patients was 29% by PCR-RFLP. Candida albicans was the most frequent species isolated [40.3%]. Non- albicans Candida species including Candida tropicalis [22.2%], Candida glabrata [18%], Candida krusei [12.5%], C. parapsilosis [4.2%], C. dubliniensis [1.4%] and Candida guilliermondii [1.4%] were also isolated. The sensitivity of vitek 2 with regard to correct identification of Candida species was 96%; the specificity was 100%, also CHROMagar Candida agar enable the correct identification with sensitivity 89%, specificity 100%. Vitek 2 antifungal susceptibility tests results were found to be an accurate method as it was compared with the disc diffusion method for fluconazole, voriconazole and amphotracin B

Conclusion: CHROMagar Candida agar supported by Vitek 2 system is a valuable method for identification of common Candida species, these methods are easy to interpret and give rapid results in comparison with the expensive PCR-RFLP method. Although amphotericin B and fluconazole are widely used in clinical practice, there was no evidence of enhanced resistance. Moreover, voriconazole could be used in treatment of fluconazole-resistant Candida species

Relationship between Chlamydophila Pneumoniae and Atherosclerosis

The present work to evaluate whether there is a significant relationship between atherosclerosis and Chlamydophila Pneumoniae [C. pneumoniae] infection by using the Enzyme Linked Immunosorbent Assay [ELISA] techniques to detect the antibodies, and polymerase chain reaction [PCR] to detect the microbial DNA. Case-control study was carried out on atheromatous plaque and serum samples obtained from 74 patients with peripheral arterial disease caused by atherosclerosis and another 14 patients with varicose veins as a control group in the Vascular Surgery Department, Sohag University Hospital over a period between October 2013 and June 2014. Chlamydophila pneumoniae DNA was extracted, amplified and detected using PCR assay, and anti – C. pneumoniae IgG antibodies were detected by ELISA assay. Both ELISAandPCR techniques were done for the studied cases and the control group. ELISA technique was positive for Chlamydophila pneumoniae IgG antibody in 40 patients [54.05%] among the studied cases while in the control group, it was positive only in 4 cases [28.57%] with p-value 0.08. PCR technique was positive in 28 patients [37.84%] in the cases for Chlamydia pneumoniae 16sRNA gene, while for the control group, all cases were negative with p- value 0.005. Conclusions: Chlamydophila pneumoniae infection can be considered as a strong risk factor for atherosclerosis

Anti-cyclic citrullinated peptide [ACCP] Antibody versus Rheumatoid factor [RF] for diagnosis of rheumatoid arthritis

Introduction: Rheumatoid arthritis [RA] is an inflammatory autoimmune disease characterized by chronic joint inflammation and extra-articular manifestations culminating in permanent disability without early therapeutic interventions. Early accurate diagnosis and therefore treatment of rheumatoid arthritis [RA] has become increasingly important

Aim of the Work: To compare the diagnostic power of anti-cyclic citrullinated peptide [ACCP] antibody to rheumatoid factor (RF) in RA adult patients

Material and Methods: A total of 180 patients were enrolled in this study. ACCP antibody and rheumatoid factor [RF] were determined by ELISA technique in 31 RA patients and 149 patients with rheumatic diseases other than RA

Results: The sensitivities for ACCP antibodies and RF were 64.5% and 61.3%, respectively, with P-value > 0.05, while their specificities were 97.3% and 90%, respectively with P < 0.05]. The positive predictive value [PPV] was 83.3% for ACCP and 55.88% for RF [P < 0.05], whereas the negative predictive value [NPV] was 92.95% for ACCP antibodies and 91.78% for RF [P > 0.05]. The positive likelihood ratio [LR] was 23.89 for ACCP and 6 for RF. Placing the results of both tests together, increases the diagnostic utility of both tests. The ACCP antibodies test has statistically significant higher specificity, PPV and LR for RA than the RF test

Conclusion: If new criteria are to be devised to help diagnose early RA, ACCP should be included because it has a greater diagnostic power than RF

Abbreviations: ACCP, anti cyclic citrullinated peptide; ACR, American College of Rheumatology; NPV, negative predictive value; LR, negative likelihood ratio; PPV, positive predictive value; + LR, positive likelihood ratio; RA, rheumatoid arthritis; RF, rheumatoid factor?

Late onset neonatal sepsis at the neonatal intensive care unit of sohag university hospital

Background: The prevalence of healthcare-associated neonatal bloodstream infections is increasing and results in significant morbidity, mortality, and economic cost. The continuous emerging of bacterial resistance to antibiotics worsens the situation and complicates the challenges. The epidemiology of these infections is well studied in developed countries, but the picture is not that clear in developing countries

Objectives: The research aimed to study the epidemiology of late onset neonatal septicemia at the neonatal intensive care unit of Sohag university hospital, the potential predisposing factors for acquiring septicemia, the potential pathogenic bacteria existed in the environment of the unit, and the antibiotic resistance patterns of the isolated bacteria to recommend policy for empirical treatment

Material and Methods: A total of 330 newborns having one or more signs of sepsis, aged from 5 to 28 days, were enrolled in this study. Blood samples were taken from the newborns, cultured, and then antibacterial susceptibility tests were performed for the isolates

Results: 111 [36%] cases yielded positive cultures. Significant positive culture results were found among the group of males [66.67%], preterm [74.36%], with low birth weight [75%], delivered by normal vaginal delivery [67%]. Gram negative bacteria constituted [56%] of the total isolates, of which Klebsiella pneumoniae was the predominant pathogen [23%], followed by Coagulase Negative Sta[hylococci [CoNS][18%]

The mortality rate was 41%. Most bacterial isolates were sensitive to imipenem, and some isolates were sensitive to fourth-generation cephalosporins, but most isolates were highly resistant to the majority of other antibiotics tested. Pseudomonas aeruginosa has shown the highest rate of antibiotic resistance, while Streptococcus pyogenes has shown the least resistance

Conclusion: Potential intrinsic risk factors for septicemia are: preterm, low birth weight and gender [male]. Gram negative organisms were the most frequent causative agents of bacterial sepsis, which is a significant cause of mortality and morbidity in the newborn, and particularly in those of low birth weight. It can also be concluded that imipenem, meropenem and fourth-generation cephalosporins can be used as empirical treatment of bacterial sepsis

Recommendations: Adherence ofhealthcare workers to hand hygiene and personal protective procedures beside appropriate disinfection of the environment are key factors to reduce the acquisition of neonatal septicemia and other infections. This may be achieved by promotion, role modeling and continuous monitoring. Besides that, the availability and accessibility of alcoholic hand-rub solutions will make the difference?

Gastritis; helicobacter pylori or giardia lamblia infection or both?

Introduction: infection with Helicobacter pylori is accepted as a main cause of gastritis and gastritis associated diseases. Giardia lamblia parasite is considered the most common protozoal infection in human. Concomitant H. pylori and Giardia infection is common for their similar mode of transmission and strong correlation to socioeconomic levels, but only few reports had described gastric giardiasis. In this work, H. pylori and Giardia lamblia were detected by PCR in gastric antral mucosal biopsies from a random sample of patients complaining from dyspepsia, in Sohag University Hospital, Egypt. Results were compared with a control group of patients undergoing EGD for other reasons rather than dyspepsia. The impact of H. pylori and Giardia lamblia infection whether singularly or concert, on clinical, endoscopic or histopathogical changes was studied

Patients and methods: 48 patients [26 males and 22 females] with dyspepsia and 28 control [26 males and 2 females], were subjected to esophagogastroduodenoscopy [EGD]. Endoscopic data were reported and gastric biopsy specimens were obtained for subsequent PCR assay for H. pylori and Giardia lamblia, histopathological and electron microscopic examination

Results: endoscopic antral gastritis and duodenal lesions were found in both patients and controls. Both lesions occurred significantly more frequently in patients group [p= 0.002 and 0.0005 respectively]. Esophageal lesions, nodular antral gastritis, gastric ulcers and superficial carpal gastritis were found only in patients group. PCR detected H. pylori infection in 28 out of the 48 patients [about 58%] and in 18 out of 28 [64%] control subjects while Giardia lamblia infection was present in 32 out of 48 patients [67%] compared to 12 out of 28 controls [64%]. In the latter, the results were statistically significant [P=0.0003, Odd ratio=2.6]. Co-infection with H. pylori and Giardia was present in 33% of patients compared to 36% of controls. Abnormal histologic findings were found in both patients and control groups, however, gastric atrophy occurred significantly more frequently in symptomatizing patients [P=0.027] with an odd ratio = 2.6. Intestinal metaplasia was found only in the patients group. Electron microscopic study; cellular abnormalities in the form of cytoplasmic vacuoles, mitochondrial destruction or nuclear abnormalities were found in infected subjects [H.pylori, Giardia or both]

Conclusion: H. pylori is not the only gastric pathogen in our community, gastric giardiasis is quite common. Its contribution to symptoms or pathological changes couldn't be confirmed in our study but it might be a factor in persistent epigastric pain after H. pylori eradication