Fungemia in immunocompromised patients [hematological malignant and hematopoietic stem cell transplant patients during febrile neutropenia]

Background: Fungal infections are a major cause of morbidity and mortality among febrile neutropenic patients. The choice of empiric antifungal regimen is based on susceptibility pattern of locally prevalent pathogens

Objectives: to determine fungemia, identify fungal spectrum and their antifungal susceptibility pattern

Methods: From 150 hematological malignant and hematopoietic stem cell transplant patients during febrile neutropenia, blood cultures [B.C] were processed

Results: Eight fungal isolates [5.3%] were recovered which found to be represented by candida spp. Five of them were non albicans Candida [62.5%] and three of them were Candida albicans [37.5%]. C. parapsilosis resulted in the most frequent Candida non albicans [CnA] species [37.5%]. All C. parapsilosis strains were isolated from patients with vascular catheters. C. krusei fungemia generally occur in patients with previous exposure to fluconazoles. All species of Candida were sensitive to amphoterecin B, echinocandins and voriconazole. Persistent fever for prolonged duration and prolonged broad spectrum antibiotic use were statistically significant risk factors for developing fungemia. Also extent of neutropenia, duration of chemotherapy, immunosuppressive therapy, altered mucosal barriers and presence of central venous lines were considered major risk factors for development of fungemia

Conclusion: The current study was limited by method of diagnosis and low sample size in a single center experience. Furthermore review of the epidemiology of fungemia which was represented by candidemia at our institution revealed the percentage of candidemia was 5.3% and non albicans Candida species were the predominant isolates

Recommendations: The choice of therapy in neutropenic patients should be formulated based on local antimicrobial susceptibility of these organisms. Close monitoring of fungal infection in patients receiving broad-spectrum antibiotics is mandatory

Toxic effects of some tricyclic antidepressant drugs on the heart: clinical and experimental study

This study was done due to increased potential risks of cardiotoxicity of acute tricyclic antidepressants intoxication in human. So this work was carried out to investigate the changes in SGOT, SGPT, CPK.MB, and electrocardiograms in human due to use of both imipramine hydrochloride and dothiepin hydrochloride in therapeutic and toxic doses. Also biochemical and histopathological changes that occur in rats receiving the same drugs in therapeutic and toxic doses. The human part was carried out on "100" persons [50 males and 50 females], the age ranges from 20-40 years. Biochemical analyses revealed that in comparing subjects received therapeutic doses of imipramine hydrochloride to the acutely intoxicated persons by the same drug, there was highly significant difference in SGOT, SGPT, CPK-MB levels. On the other hand, there was slight difference in the levels of SGOT, SGPT, CPK-MB in patient treated with dothiepin therapeutic doses and those received toxic doses of dothiepin hydrochloride where there was slight increase of enzyme levels in toxic doses more than therapeutic dose, but both still in normal range. On examination of electrocardiogram of persons that were treated with imipramine hydrochloride at therapeutic doses there were [30%] suffering from sinus tachycardia, [15%] presented with atrial extrasystole, and [5%] complains of atrial fibrillation. In those that were intoxicated with toxic doses of irnipramine hydrochloride, there were [80%] presented with sinus tachycardia, [40%] presented with atrial extrasystole, [15% ]suffering from atrial fibrillation, and there, were [10%] complained from ventricular tachycardia. Also there were [10%] with ventricular extrasystole and [5%] presented with ventricular fibrillation. Persons that were treated with dothiepin in therapeutic doses, only [20%] presented, with sinus tachycardia, and [10%] were presented with atrial extrasystole. While [50%] of subjects that were intoxicated with this drug presented with sinus tachycardia, [30%] presented with atrial extrasystole, [10%] suffering from atrial fibrillation, [5%] complained of ventricular tachycardia and [5%] presented with ventricular extrasystole. In comparison of animals that were injected with therapeutic doses of imipramine hydrochloride and that injected with toxic dose of imipramine hydrochloride group, there was a highly significant difference in SOOT, SGPT and CPK-MB levels. On the other hand the difference in the levels of SGOT, SGPT, CPK-MB in animals injected with dothiepin therapeutic doses and those injected with toxic doses of dothiepin hydrochloride was slight but both still in normal range. Histopathological examination of the heart of rats treated with therapeutic dose of imipramine revealed small areas of infarction. Histopathological examination of heart of rats treated with toxic dose of imipramine revealed massive infarction and the interstitial connective tissue was markedly infiltrated with lymphocytes, polymorphs, and histocytes. There are no histopathological changes in rats that treated with therapeutic doses of dothiepin hydrochloride while rats that treated with toxic doses of dothiepin hydrochloride showed moderate histopathological changes

Temporary defunctioning stomas: a randomized clinical trial comparing loop ileostomy with loop transverse colostomy following low anterior resection with total mesorectal excision

Patients undergoing low anterior resection with total mesorectal excision who required a defunctioning stoma were randomly allocated to receive either a loop ileostomy [n=13] [group A] or a loop transverse colostomy [n=14] [group B]. Postoperative morbidity following closure were compared. From May 1999 to May 2002, 13 patients had a loop ileostomy and 14 had a loop colostomy following low anterior resection. There were no significant differences in the difficulty of formation or closure, or in the postoperative recovery between the groups. However, the ileostomy was associated with significantly less appliance changes. Wound infection was also significantly more common after closure of colostomy compared with the ileostomy. Furthermore, four complications directly related to the stoma in the loop transverse colostomy group have been seen [prolapse [two] and incisional hernia during follow-up [two]]. None of these complications occurred in the loop ileostomy group

Clinical, laboratory and radiological follow-up of tuberculous infants and children

The aim of this study was to investigate the pattern of clinical, laboratory and radiological improvement of the newly diagnosed tuberculous children, who were treated for nine months. The study was done in the Tuberculous Paediatric Outpatient Clinic of Bab-El Shaareya Hospital and El-Galaa Teaching Hospital during 1999-2000. History, clinical examination, ESR, WBCs, HB and chest X-ray were done every three months for a period of nine months. The total number of tuberculous children was 50 [22 were males and 28 were and females]. The maximum number of cases was in the age group 10-15 year. Pulmonary TB cases were 29, lymphadenitis 14, urinary 4, miliary 2 and skin 1]. The temperature, ESR, WBC and HB showed a gradual improvement throughout the nine months; while the X-rays showed rapid clearance within the first three months. Treatment for nine months with INH, RIF and PZA was effective

Traumatic diaphragmatic injuries

Traumatic diaphragmatic injury is a potentially serious complication, which can be overlooked at the time of presentation. 1 present 15 cases of blunt [14] and penetrating [one] injuries of the diaphragm encountered during surgical practice in 4 years time. Most of the injuries were on the left side [12 cases], 2 on the right side and only one case with bilateral injury. Rupture was correctly diagnosed or suspected in 12 cases. High suspicion index is required to diagnose such cases. 1 failed to diagnose 3 cases. The diaphragmatic injuries are almost always associated with other injuries and prognosis depends upon presence of such associated injuries. Chest X-rays proved to be of great value in diagnosing diaphragmatic injuries and other diagnostic aids are occasionally needed. All cases treated surgically using polypropylene mesh and very good results obtained except for little morbidities unrelated to the diaphragmatic injury itself and one recorded mortality due to severe head injury

Ultrasonographic demonstration of fetal cardiac activity in threatened abortion and its prognostic significance

To evaluate the prognostic value of detecting fetal heart activity in cases of threatened abortion occurring early in the first trimester, and consequently to demonstrate the importance of ultrasonography in the routine management of vaginal bleeding in early pregnancy. Two hundred and sixteen patients were enrolled in this study. They were all seen in the first attack of vaginal bleeding, occurring in the first trimester. Fetal cardiac activity was demonstrated by the use of abdominal ultrasound on the first visit. They all had singleton pregnancy. There was neither history of recurrent abortion, nor intake of anticoagulant drugs. The patients were then seen weekly or whenever bleeding recurred. No drugs were given. Out of the 216 cases, 193 [89.4%] continued to full-term delivery. Twenty three cases [10.6%] aborted during the first or second trimester. Premature delivery, congenital abnormalities and cesarean section rates were not significantly different from the expected averages of the general population. Eighteen of these 23 cases of fetal loss started bleeding in the late weeks of the first trimester [10th - 12th week]. At the first attack of vaginal bleeding occurring in the first trimester, if the cervix is closed and a living fetus could be demonstrated, the pregnancy should be considered viable and the outlook for fetal survival is favorable. Sonographic demonstration of fetal cardiac activity is assuring, indicating a low risk of subsequent abortion and a favorable prognosis

Prevalence, clinical forms, and outcome of triple therapy of childhood tuberculosis

The aim of this work was to study the prevalence, clinical forms and efficacy of triple therapy of childhood tuberculosis to form a strategy for intervention. A total number of 260685 children was included in the study, there were 163 tuberculous children and the prevalence rate of TB was 0.06% with a range of 0.05-0.09%. The maximally affected age group was 0-5 years old and the lowest was 5-10 years. Pulmonary TB was the most common form [99], followed by extrapulmonary TB [64]. Drug susceptible mild and moderate pulmonary and lymph node TB were effectively treated by a triple therapy for six months, while cases with extensive pulmonary and extrapulmonary TB needed a nine-month duration therapy

Anaemia in children with tuberculosis prevalence, type and efficacy of therapy

The aim of this work was to study the prevalence, type and outcome of therapy of anemia in children with tuberculosis to form a strategy for intervention. Children from birth to 15 years old were enrolled in the study. There were 152 TB cases, 72 males and 80 females. Before treatment, there were 65 non-anemia cases, 87 total anemia cases, 58 normocytic-normochromic anemia cases and RDW was 10-15% in 66 cases. After treatment, there were 111 non-anemic cases, 41 anemic cases and 27 normocytic-normochromic cases and RDW was 10-15% in 36 cases. Anemia was very common among TB children and was of the normocytic- normochromic type. CBC and RDW must be done for TB cases to detect concomitant iron deficiency anemia. Anti-TB drugs with iron were effective in its corrections

Clinical, laboratory and radiological follow-up of tuberculous infants and children

The aim of this work was to study the pattern of clinical, laboratory and radiological improvement of the newly diagnosed tuberculous children, who were treated for nine months. This study included 50 tuberculous children, 29 pulmonary TB cases, 14 lymphadenitis cases, four urinary cases, two miliary cases and one skin case. The means + SD of the weight, length, temperature, ESR, WBC and HB showed a gradual improvement throughout the nine months; while, X-rays showed a rapid clearance within the first three months. The number of cases of stunted, wasted, low temperature, high ESR, leucocytosis and anemia showed a gradual improvement during the nine months of anti-TB therapy; while, X-ray positive cases were improved within the first three months of treatment. Nutritional advice and ferrous sulfate were given during anti-TB therapy. Treatment for nine months with INH, RIF and PZA was 100% effective