Non-invasive assessment of liver fibrosis in patients with hepatitis C: shear wave elastography and colour Doppler velocity profile technique versus liver biopsy

Background and study aims: Determination of the presence and degree of liver fibrosis is essential for the prognosis and treatment of patients with chronic hepatitis C. Non-invasive methods of assessing fibrosis have been developed to reduce the need for biopsy. We determined the efficacy of shear wave elastography [SWE] and colour Doppler velocity as non-invasive methods for the assessment of liver fibrosis compared to liver biopsy among patients with chronic hepatitis C virus [HCV] infection

Patients and methods: In total, 117 patients with chronic HCV infection and 50 healthy age- and sexmatched control subjects were included. For each patient and control, abdominal ultrasonography, Doppler ultrasonography of the right portal vein [PV], and SWE were performed, whereas liver biopsy was performed for patients

Results: The mean value of the right PV maximum velocity was lower in patients with different stages of fibrosis than in controls [p < 0.001]. The mean value of liver stiffness determined by SWE was significantly higher in patients with different stages of fibrosis than in controls. Cutoff values for liver stiffness determined by SWE for assessing fibrosis stages were F2 >/= 4.815, F3 >/= 6.335, and F4 = 7.540 with a sensitivity of 84.6%, 96.2%, and 100.0%; specificity of 88.5%, 93.8%, and 100.0%; positive predictive value [PPV] of 93.6%, 98.0%, and 100.0%; negative predictive value [NPV] of 74.2%, 88.2%, and 100.0%; and overall accuracy of 85.9%, 95.6%, and 100.0% [area under the ROC curve [AUC]: 0.89, 0.96, and 1.0], respectively. Cutoff values for the right PV maximum velocity for assessing fibrosis stages were F2 < 23.4, F3 < 21, and F4 < 20 with a sensitivity of 65.0%, 57.4%, and 57.1%; specificity of 59.8%, 76.4%, and 75.5%; PPV of 33.8%, 58.3%, and 32.0%; NPV of 84.4%, 75.7%, and 89.7%; and overall accuracy of 61.1%, 69.5%, and 72.5% [AUC: 0.614, 0.696, and 0.625], respectively

Conclusion: SWE is effective for the non-invasive assessment of liver fibrosis in patients with HCV infection. SWE provides a more accurate correlation with liver fibrosis stage than colour Doppler velocity profile for the assessment of liver fibrosis, especially in advanced stages [F3 and F4]

[Study of treatment and prevention activity for plant juice Ecballium elaterium from Cucurbitacinaceae family from hepatotoxicity]

Evaluation Ecballium elaterium fruits juice activity on hepatic cell level using experimental animals in two towards :hepatotoxicity treatment and prevention induced by Carbon tetrachloride [CCL4]. This effect was studied on Wistar rats in groups: [Normal group, group given single dose of CCL4[1ml/kg], treated group given dose of Ecballium elaterium fruit juice [0.5ml] for three days consecutive after the injury inducing, prevention group given dose of Ecballium elaterium fruit juice [0.1ml]for three days consecutive before the injury inducing, group given dose of juice equal to prevention dose[0.1ml/kg] for three days consecutive whithout inducing injury, treated group given dose ofreference drug [1.35 mg/kg]for three days consecutive after the injury inducing, The prevention group given dose of reference drug [1.35 mg/kg]for three days consecutive before the injury inducing. Results showed clear increase in serum values of serum glutamic pyruvic transaminase [SGPT] and serum glutamic oxaloacetic transaminase[SGOT], with high degrees of hepaticsteatosis, necrosis and inflammation in illness group comparative with normal one, also showed clear decrease in values SGPT and SGOT for treatment and prevention plant juice groups comparative with illness one and which make sure by results of histology study in decrease degrees of steatosis, necrosis and inflammation of the liver. The study comfier activity of plant juice in the treatment and prevention from hepatotoxicity induced by CCL4

Feedback performance of peripheral intravenous catheter manipulation in neonatal ICU in medical center in Cairo

The insertion and daily use of vascular access devices are associated with risks and complications that can significantly impact the clinical status and outcome of neonates in neonatal intensive care units [NICU]. The lack of strictness in infection control protocols application particularly hand hygiene is the source of proved nosocomial catheter related to blood stream infections [CRBSI]. This study aimed to assess the quality of the current practice of intravenous catheter insertion and its manipulation in [NICUS], in order to improve quality of care and control nosocomial catheter related infections. This work has been carried out in 2 NICUs in El Zaitoun specialized hospital with a capacity of [7] incubators. Data collection for intravenous catheter insertion, manipulation [IVCIM] and duration was done by a checklist and another one for the resources needed for IVCIM. Data was analyzed using SPSS software [version 12.1]. The global and specific compliance rate for IV catheter insertion and manipulation was calculated. In total, 80 observations for IVCIM were established in the two NICUs [NICU-1 and 2]. Global compliance rate for IVCIM in both units collectively was 19% and selectively 12.5% and 6.5% in NICU 1 and NICU 2 respectively. Guidelines for IV catheter insertion were followed by 9% of healthcare workers [HCWs] in both NICUs but with more compliance in NICU1 [5%] in comparison to [4%] in NICU2. Guidelines for IV catheter manipulation were followed by 10% of HCWs in both NICUs collectively but with 7.5% and 2.5% compliance rate in NICU1 and NICU2 respectively. Improper hand hygiene [H.H] was the predominant cause [67%] of incorrect IVCIM in both NICUs. The most common cause of incorrect H.H whether was short contact-time and improper cleaning of all the hand surfaces. Duration of catheter application was more in NICU 1 than NICU2 and the most common cause for catheter removal was inflammation [43%]. As consequence of the audit it became apparent that a discrepancy existed between practice and trust guidelines. This showed the importance of audit, in which deficiencies are identified, documented and evaluated, forming basis of an action plan to improve performance. Consequently, feedback was provided [both verbally and in writing] and arrangements for future meetings were made in order to develop and implement the action plan

Prevalence of extended spectrum beta-lactamases production among resistant gram negative bacteria in samples of intensive care unit patients

The rapid emergence and dissemination of antimicrobial resistant microorganisms in hospitals worldwide is a problem of crisis dimensions. Although infections caused by drug resistant bacteria can strike anyone, they are especially grave for immune-compromised patients whose such as the hospitalized in Intensive Care Units [ICUs]. Extended Spectrum beta Lactamases [ESBLs] is a neglected health care crisis that is intended to provoke a debate. This study aimed to determine the prevalence of extended spectrum beta-lactamases multidrug resistant isolates of Enterobacteriacea in all samples [urine, respiratory, surgical and body fluid, blood] collected in ICU patients at El Damardash Hospital. Also, to study the antibiogram profiles of the ESBLs organisms isolated. A total of 1065 different samples collected from patients admitted to the surgical long term care nad ICUs were cultured. The antibiogram carried out for the possible ESBLs gram negative isolatles by screening preliminary method, thereafter confirmed for Klebsiella pneumonia [K.pneumoniae], Escherichia coli [E. coli] and Proteus mirabilis [P.mirabilis]. Out of the 1065 samples the total positive urine, respiratory, surgical and blood cultures were 434, 202, 352, and 77, respectively, where 670 gram negative organisms were isolated from the urine, respiratory, surgical and body fluid and the blood specimens were 299, 164, 187 and 20, respectively. The isolated Gram negative bacteria were 273 E. coli, 114 K. pneumoniae and 20 Proteus mirabilis isolates. The Gram negative organisms isolated from the urine culture was 68.9% [299/434], 64% [190/299] of the gram negative organisms were E. coli, 13.2% [25/190] were ESBL producers, 14% [41/299] the gram negative organism isolated from urine were K. penumoniae, 9.8% [4/41] were ESBL producers. About 4% [11/299] of the gram negative organisms were P. mirabilis and they were all non ESBLs producers. As regards, the gram negative organisms isolated from the respiratory specimens were 81.2% [164/202], 12% [20/164] of the gram negative organisms were E.coli, 15% [3/20] were ESBL producers, 19.5% [32/164] of gram negative organisms were K. penumoniae, 3% [1/32] of them were ESBL producers and 1.8% [3/164] of gram negative respiratory cultures were Proteus mirabilis, 33% [1/3] were ESBL producers. ESBLs is a neglected healthcare crisis in Egypt that needs strategies to treat, prevent and control the rising rate. In addition, clinical laboratories need to have adequate funding, equipment and expertise to provide a rapid and clinically relevant antibiotic testing service. Besides, the controlled use of 3[rd] generation cephalosporin along with implementation of infection control measures are the most effective means of controlling and decreasing the spread of ESBL isolates

rapid and accurate method for prevention and control of methicillin-resistant staphylococcus aureus in the ICU

Methicillin-resistant S. aureus [MRSA] oxacillin - resistant S. aureus [ORSA] is frequently encountered in health-care settings. Early screening for MRSA nasal colonization can identify patients requiring isolation and can be part of an effective infection control program. This study aimed to provide same-day results to facilitate rapid diagnosis and therapy MRSA to avoid hospital-acquired infections. A total of 80 patients from the medical intensive care units [ICUs] of El-Demerdash Hospital, Cairo Egypt, were screened for MRSA colonization. Two nasal swabs were collected from each patient, the first vortexed in the Liquid Stuart medium and two aliquots of 200 micro l were collected from the medium and tested. For direct culture, the 200 micro l aliquot was inoculated directly onto MRSA screening medium agar plate and incubated at 35[degree sign]C for 24-48h. The other 200 micro l aliquot was first cultured in a pre-enrichment broth medium for 24 hours at 35[degree sign]C, thereafter cultured onto MRSA screening medium agar for another 24-48 hr at 35[degree sign]C. The second swab was used to screen MRSA by a qualitative real-time PCR. Sixty six swabs [82.5%] were negative by culture and real time PCR for MRSA. Fourteen swab samples [17.5%] were positive by both methods. None was positive by culture only [0%], while the PCR assay detected additional four MRSA positive specimens [i.e 5%]. The sensitivity, specificity, positive-predictive value and negative-predictive value for PCR were 100%, 93.9%, 77.8% and 100%, respectively. Real-time PCR testing of nasal specimens can be used as a rapid and reliable technique for MRSA surveillance programs in the ICUs