High prevalence of Klebsiella pneumoniae carbapenemase-mediated resistance in K. pneumoniae isolates from Egypt

The emergence and rapid spread of antibiotic-resistant Klebsiella pneumoniae isolates harbouring the bla[KPC] gene that encodes for carbapenemase production have complicated the management of patient infections. This study in a tertiary care hospital in Egypt used real-time PCR assay to test ertapenem-nonsusceptible isolates of K. pneumoniae for the presence of the bla[KPC] gene and compared the results with modified Hodge test. Antibiotic sensitivity was performed by standard methods, and interpreted following both the old CLSI breakpoints [M100-S19] for carbapenems and the revised breakpoints [M100-S22]. From the 45 non-duplicate isolates of K. pneumoniae recovered from different clinical specimens, a high prevalence of ertapenem-nonsusceptible isolates [44.4%] was reported using the new lower CLSI breakpoints. The bla[KPC] gene was confirmed in 14/20 [70.0%] of these isolates. The high prevalence of ertapenem nonsusceptibility at a tertiary care hospital in Egypt was predominantly attributed to K. pneumoniae carbapenemase-mediated resistance mechanisms in K. pneumoniae isolates

Expert System Shells for Rapid Clinical Decision Support Module Development: An ESTA Demonstration of a Simple Rule-Based System for the Diagnosis of Vaginal Discharge / 대한의료정보학회지

OBJECTIVES: This study demonstrates the feasibility of using expert system shells for rapid clinical decision support module development. METHODS: A readily available expert system shell was used to build a simple rule-based system for the crude diagnosis of vaginal discharge. Pictures and 'canned text explanations' are extensively used throughout the program to enhance its intuitiveness and educational dimension. All the steps involved in developing the system are documented. RESULTS: The system runs under Microsoft Windows and is available as a free download at http://healthcybermap.org/vagdisch.zip (the distribution archive includes both the program's executable and the commented knowledge base source as a text document). The limitations of the demonstration system, such as the lack of provisions for assessing uncertainty or various degrees of severity of a sign or symptom, are discussed in detail. Ways of improving the system, such as porting it to the Web and packaging it as an app for smartphones and tablets, are also presented. CONCLUSIONS: An easy-to-use expert system shell enables clinicians to rapidly become their own 'knowledge engineers' and develop concise evidence-based decision support modules of simple to moderate complexity, targeting clinical practitioners, medical and nursing students, as well as patients, their lay carers and the general public (where appropriate). In the spirit of the social Web, it is hoped that an online repository can be created to peer review, share and re-use knowledge base modules covering various clinical problems and algorithms, as a service to the clinical community.

Effect of renal transplantation on serum hepatocyte growth factor levels in hemodialysis patients with HCV infection

Hepatocyte growth factor [HGF] acts as an activator of mitogenesis, motogenesis, and morphogenesis, and as a potent survival factor. It is one of the cytokines that has proven to be involved in the regeneration of renal tubule cells following injury. The purpose of this study was to evaluate the effect of renal transplantation on serum hepatocyte growth factor levels in hemodialysis patients with HCV infection.74 subjects with HCV infection were enrolled in the study, they were further subdivided into three groups: Control group [n=10]; hemodialysis group [HD] [n= 30] and renal transplant recipient group [n=34]. Serum hepatocyte growth factor [HGF] determination was performed using quantitative sandwich enzyme immunoassay. Our study revealed that serum levels of HGF, in HD patients showed a significant increase as compared to control [p<0.001] and renal transplant groups [p<0.001]. In HD patients serum HGF levels showed a positive correlation with both serum creatinine levels [r =0.874, p< 0.001] and urea levels [T= 0.559, p< 0.001] but did not correlate with ALT levels or duration of HD. Serum HGF values in renal transplant recipients showed no statistically significant changes as compared to controls and did not correlate with either creatinine, urea, ALT and cyclosporine blood levels. We concluded that serum HGF was elevated in HD patients, which may be attributed to the increased production of HGF in response to the chronic renal injury, the effect of heparin, or reduced removal of serum HGF in CRF patients. Serum levels of HGF in renal transplant recipients showed no statistically significant changes as compared to controls and no correlation with cyclosporine blood levels as patients had good allograft function and cyclosporine blood levels were properly monitored. Although serum HGF values in HD patients are elevated, levels return back to normal in renal transplant recipients with good allograft function

Fixed drug eruption clinical and histopathological study

Sixty cases [50 males and 10 females] affected with fixed drug eruption attending the out patient clinic of dermatology and venereology department of the faculty of Medicine, Alexandria University were examined.Their ages ranged from 21 years to 58 years. Sulphonomides were found to be the commonest drug causing fixed drug eruption [33.33%]. Antibiotics including Tetracycline and ampicillin were next in frequency [23.33%]. Different histopathological changes were encountered. Hydropic degeneration resulting in pigmentary incontinence was the commonest finding [83.33%]. Other findings were in the form of epidermal cell necrosis, oedema of epidermis and upper dermis, dermal cellular infiltration and picture stimulating vasculitis

comparison of trimethoprim sulphamethoxazol with oxytetracycline and placebo in acne vulgaris

This comparative study included 30 patients to detect the effect of trimethoprim-sulfamethoxazole as compared with oxytetracycline or placebo for treatment of Acne vulgaris. Analysis of the results revealed that both drugs had a beneficial effect on Acne vulgaris and if compared with oxytetracycline, patients on trimethoprim-sulfamethoxazole showed antiseborrheic effect. during therapy

Pathological changes in nodular scabies

Twelve patients with persistent nodular scabies are described. The histology bore a striking resemblance to that of malignant lymphoid neoplasm in ten cases. The possibility of pseudo-lymphomas such as actinic reticuloid and lymphomatoid papulosis must be considered. The reaction could be due to the resorption of toxic material through the epidermis via the intercellular spaces into the dermis