Séquelles Grave De Brûlure Des Deux Pieds : Un Cas Pédiatrique De Déformation Extrême Des Orteils.

Les brides rétractiles post-brûlure au niveau du pied sont considérées comme graves en raison de leurs retentissement fonctionnel et esthétique potentiellement importants. Nous rapportons un cas pédiatrique âgé de 13 ans présentant des brides rétractiles au niveau des deux pieds, négligées depuis 10 ans et responsables d'une déformation très importante, avec désaxation marquée des orteils. Le patient souffrait d'une importante limitation des activités et d'une impossibilité de chaussage. La libération chirurgicale des brides par plusieurs plasties en Z associées à la réaxation des orteils luxés a permis d'obtenir un bon résultat avec un retour à une fonction quasi normale. La prévention des brides rétractiles et leur prise en charge précoce restent le meilleur moyen d'éviter des déformations grave et leurs conséquences chez un patient en croissance.

Post-burn retractile contractures of the foot are considered serious given their potentially significant functional and aesthetic repercussions. We report a 13-year-old paediatric case with retractile contractures in both feet neglected for 10 years and responsible for a very significant deformity with marked misalignment of the toes. The patient suffered from a severe limitation of activities and an inability to put on shoes. The surgical release of the contractures by several Z-plasties associated with the realignment of the dislocated toes allowed a good result to be obtained with a return to almost normal function. The prevention of retractable contractures and their early management remains the best way to avoid serious deformities and their consequences in a growing patient.

PCR-based detection of Helicobacter pylori and non-Helicobacter pylori species among humans and animals with potential for zoonotic infections.

Helicobacter species have been reported in animals, some of which are of zoonotic importance. This study aimed to detect Helicobacter species among human and animal samples using conventional PCR assays and to identify their zoonotic potentials. Helicobacter species was identified in human and animal samples by genus-specific PCR assays and phylogenetic analysis of partial sequencing of the 16S ribosomal RNA gene. The results revealed that Helicobacter species DNA was detected in 13 of 29 (44.83%) of the human samples. H. pylori was identified in 2 (15.38%), and H. bovis was detected in 4 (30.77%), whereas 7 (53.85%) were unidentified. H. bovis and H. heilmannii were prevalent among the animal samples. Phylogenetic analysis revealed bootstrapping of sequences with H. cinaedi in camel, H. rappini in sheep and humans, and Wollinella succinogenes in humans. In conclusion, the occurrence of non-H. pylori infections among human and animal samples suggested zoonotic potentials.

Mesenchymal stem cells combined with albendazole as a novel therapeutic approach for experimental neurotoxocariasis.

Neurotoxocariasis (NT) is a serious condition that has been linked to reduced cognitive function, behavioural alterations and neurodegenerative diseases. Unfortunately, the available drugs to treat toxocariasis are limited with unsatisfactory results, because of the initiation of treatment at late chronic stages after the occurrence of tissue damage and scars. Therefore, searching for a new therapy for this important disease is an urgent necessity. In this context, cytotherapy is a novel therapeutic approach for the treatment of many diseases and tissue damages through the introduction of new cells into the damaged sites. They exert therapeutic effects by their capability of renewal, differentiation into specialized cells, and being powerful immunomodulators. The most popular cell type utilized in cytotherapy is the mesenchymal stem cells (MSCs) type. In the current study, the efficacy of MSCs alone or combined with albendazole was evaluated against chronic brain insults induced by Toxocara canis infection in an experimental mouse model. Interestingly, MSCs combined with albendazole demonstrated a healing effect on brain inflammation, gliosis, apoptosis and significantly reduced brain damage biomarkers (S100B and GFAP) and T. canis DNA. Thus, MSCs would be protective against the development of subsequent neurodegenerative diseases with chronic NT.

Schistosomicidal, antifibrotic and antioxidant effects of Cucurbita pepo L. seed oil and praziquantel combined treatment for Schistosoma mansoni infection in a mouse model.

Despite the seriousness of schistosomiasis, its treatment depends only on praziquantel (PZQ), which has begun to lose its efficacy against the emergent Schistosoma mansoni-resistant strains. Therefore, the discovery of a novel schistosomicidal drug is an urgent priority. This study was designed to evaluate treatment with Cucurbita pepo L. (pumpkin) seed oil (PSO) alone and combined with PZQ against S. mansoni in experimentally infected mice. The study involved five groups: GI was the normal control; GII was the infected control; GIII was treated with an oral dose of PZQ of 500 mg/kg/day for two successive days, starting in the sixth week post infection; GIV was treated with an oral dose of PSO of 50 mg/kg/day for four weeks, starting in the fourth week post infection; and GV was treated with combined PSO-PZQ. Worm burden, tissue egg load and oogram pattern were estimated, and the ultrastructure alterations were examined. Histopathological examination of granuloma diameters, collagen deposition (Picro Sirius red stain), and angiogenesis (immunohistochemical expression of CD34+) was conducted and serum liver enzymes were measured to assess the liver condition. Moreover, the oxidative stress was evaluated by determining the amounts of malondialdehyde and superoxide dismutase in liver homogenates. The results revealed significant changes in all the assessed parameters with PSO administration. However, PZQ was significantly more effective as an antiparasitic agent, whereas PSO was better in terms of fibrosis and oxidative stress. The most significant results were obtained in group V, which may be attributed to a synergy between PZQ and PSO, with antiparasitic, antioxidant and antifibrotic properties.

Sustained outcomes following mild traumatic brain injury: results of a five-emergency department longitudinal study.

OBJECTIVE: To report on the occurrence of sustained outcomes including post-concussion symptoms, health services used and indicators of social disruption following a mild traumatic brain injury (MTBI). RESEARCH DESIGN: A dual cohort comparing MTBI Emergency Department (ED) patients and a comparison group of non-head injured ED patients. METHODS AND PROCEDURES: The outcomes measures employed were the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and indicators of health services used and social disruption all recorded at the ED and at 3 and 6 months post-ED discharge. 'Sustained' meant a positive response to these measures at 3 and 6 months. MAIN OUTCOMES AND RESULTS: Reasonable follow-up success was achieved at 3 and 6 months and the cohorts were alike on all demographic descriptors. RPQ average score and symptom occurrence were far more frequent among MTBI patients than for the comparison cohort from 3 to 6 months. The use of health services and indicators of social disruption were also more frequent among MTBI post-discharge patients. CONCLUSIONS: These findings argue that some with an MTBI suffer real complaints and they are sustained from 3 to at least 6 months. More effort should be given toward specificity of these symptoms from those reported by members of the comparison group.

[Bile duct dilatation associated with pancreatic heterotopia: a case report]. / Hétérotopie pancréatique associée a une dilatation kystique du cholédoque. À propos d'un cas.

Pancreatic heterotopia or aberrant pancreas is a rare congenital anomaly, usually asymptomatic. Its diagnosis is difficult. We report an original observation in an 8-month-old infant, operated in the neonatal period for esophageal atresia type III in the context of VACTERL syndrome, cystic dilatation of the bile duct, and pancreatic heterotopia.

Development of practice guidelines for hemodialysis in Egypt.

Although hemodialysis is the main modaility of treatment of end-stage renal disease, no practice guidelines are available in Egypt. Applying international guidelines for hemodialysis would not be suitable or feasible, because of different health system and lack of resources. The aim of this project was the development of evidence- and consensus-based clinical practice guidelines for hemodialysis in Egypt. The Egyptian guidelines were adopted from the standards developed by The College of Physicians and Surgeons of Alberta (Canada), The National Kidney Foundation (USA), The Clinical Standards Board for Scotland (Scotland), and The College of Physicians and Surgeons of Ontario (Canada). In addition, the guidelines published in Oxford Handbook of Dialysis were reviewed. Thereafter, a panel of Egyptian experts in the field of nephrology and hemodialysis was selected and invited to participate in this project. The Delphi technique was applied to build up the consensus among the experts on the formulated guidelines. The final version of the Egyptian Hemodialysis Practice Guidelines included five main sections; personnel, patient care practices, infection prevention and control, facility, and documentation/records. A consensus on practice guidelines for hemodialysis has been successfully produced and is supported by levels of evidence. The 12 Egyptian experts who participated in the Delphi technique and the reviewers assured the completeness and acceptability of the developed practice guidelines. Also, including experts from the university hospitals together with the Directorates of Cairo and Giza Health Affairs of the Egyptian Ministry of Health (MOH) avoided conflicts between clinical recommendations and feasible application in the MOH hemodialysis facilities.

The extensor tendon splitting approach to the proximal interphalangeal joint: do we need to reinsert the central slip?

Current approaches to the proximal interphalangeal (PIP) joint have potential complications and limitations. We present a dorsal approach that involves splitting the extensor tendon in the midline, detaching the insertion of the central slip and repairing the extensor tendon without reinserting the tendon into the base of the middle phalanx. A retrospective review of 16 digits that had the approach for a PIP joint arthroplasty with a mean follow up of 23 months found a postoperative PIP active ROM of 61 degrees (range 25-90 degrees). Fourteen digits had no extensor lag, while two digits had an extensor lag of 20 degrees and 25 degrees. This modified approach is fast and simple and does not cause an extensor lag.

Is umbilical cord blood total thyroxin measurement effective in newborn screening for hypothyroidism?

OBJECTIVE: To assess the performance of the use of umbilical cord blood for screening of primary congenital hypothyroidism in the Saudi Aramco Medical Services Organization newborn thyroid screening programme. METHODS: Umbilical cord blood total thyroxin (CB-TT4) was measured. In samples with low T4 concentrations, an additional measurement of cord blood thyroid-stimulating hormone was made. RESULTS: A total of 96,015 newborn infants were screened in the period January 1990-December 2007. Twenty-six cases of primary congenital hypothyroidism, six cases of transient hypothyroidism and 13 cases of central hypothyroidism were detected. This method of screening resulted in 100% sensitivity and 98% specificity (95% CI 84-100, and 95% CI 98-98.2, respectively). However, there was a high mean recall rate of 1.9%. CONCLUSION: The use of CB-TT4 is a valid screening strategy for primary congenital hypothyroidism. It meets the metabolic screening demands of early discharge policy and guarantees screening all newborns delivered in the hospital.

Progressive wound necrosis associated with postoperative thrombocytosis in mastectomy and immediate breast reconstruction surgery: report of a case.

A 37-year-old who underwent splenectomy for motor vehicle accident-related injuries was diagnosed with stage IIA carcinoma of left breast 12 years later. She underwent bilateral mastectomy and bilateral immediate unipedicle TRAM flap reconstruction. Her preoperative platelet counts ranged from 332 to 424 K/cmm. Intraoperative fluorescein confirmed mastectomy flap viability. On postoperative day 1, platelet count was 374 K/cmm and all suture lines appeared benign. The patient was discharged 3 days later with healthy appearing tram flaps and slight epidermolysis in the abdominal region. Over the next 2 weeks, both the mastectomy flaps and the abdominal region underwent progressive necrosis as the platelet count increased to 1390 K/cmm. Aspirin therapy was instituted at this time. The TRAM flaps remained completely viable. Eighteen days later, the patient required wound debridement with secondary closure of the breast wounds. Platelet count peaked at 1689 K/cmm 2 days later (postoperative day 38). The wounds deteriorated again and were managed conservatively. Two months after mastectomy, the first area of spontaneous healing was documented (platelet count 758 K/cmm). Ultimately, wounds healed as platelet count reached its preoperative baseline. We hypothesize that an abnormal secondary thrombocytosis at subdermal plexus level caused problematic healing in this patient's mastectomy and abdominal flaps.

An outbreak of Serratia marcescens septicaemia in neonatal intensive care unit in Gaza City, Palestine.

We performed a case-control study of Serratia marcescens incidence in the neonatal intensive care unit of a governmental Gaza Strip hospital from January to December 2005. S. marcescens was detected in the blood of 159 confirmed nosocomial cases of septicaemia, 70 (44%) neonates died due to S. marcescens infection and 89 recovered. The main clinical symptoms were hypothermia 38%; jaundice 42%; Apgar score 4 at 1 min in 29% of neonates; and Apgar score 5 at 5 min in 5%. Risk factors significantly associated with S. marcescens infection were birthweight <1,500 g (OR: 1.7; P=0.026); <37 weeks gestational age (OR: 2.0; P=0.002); and use of mechanical ventilation (OR: 2.3; P=0.001). Agar diffusion susceptibility testing indicated that S. marcescens was generally susceptible to imipenem, followed by ciprofloxacin and ofloxacin. We identified potential risk factors associated with development of neonatal sepsis and highlight the importance of appropriate infection control measures to prevent serious infection.

Sentinel lymph node biopsy (SLNB) in management of N0 stage T1-T2 lip cancer as a "same day" procedure.

Current management of N0 stage lip Squamous Cell Carcinoma (SCC) are prophylactic neck dissection, radiotherapy, or "watch and see" policy. The aim is the evaluation of the role of sentinel lymph node biopsy (SLNB) in their management based upon actual and not hypothetical presence of cervical lymph node (CLN) micrometastases as a same day procedure. Fourteen patients between November 2003 and August 2005 were included, nine men and five women, median age:57 years, (range 34-65 years). SLNB using preoperative lymphoscintigraphy and intra-operative localisation with patent blue and radioactive Tc(99m) Human Serum Albumin was performed. The median follow-up period was 26 months. Successful patent blue localisation in 13/14 whilst successful radio-localisation in all patients. Micrometastases were detected in 1/14 whom underwent therapeutic neck dissection. No local recurrence or regional lymph node involvement were detected. SLNB is a technically feasible and accurate approach for detection of CLN micrometastases in N0 stage lip SCC using the triple diagnostic localisation technique as a same day procedure.

Trichobezoar with small bowel obstruction in children: two cases report.

A trichobezoar is a mass of cumulated hair within the gastrointestinal tract. Stomach is the common site of occurrence. Intestinal obstruction due to trichobezoar is extremely rare. The authors report two cases of a trichobezoar obstructing the terminal ileum in one and the jejunum in another.

An evaluation of the Motion Picture Association of America's treatment of violence in PG-, PG-13-, and R-rated films.

OBJECTIVE: The purpose of this study was to determine whether the Motion Picture Association of America's ratings system distinguishes among the 3 primary rating categories (PG, PG-13, and R) with respect to violence based on a study of the 100 top-grossing films of 1994. METHODS: The Motion Picture Association of America assigns age-based ratings for every film that is released in the United States accompanied by the reasons for the rating. A data abstraction instrument was designed to code each act of violence within the sample of 100 films. A series of Poisson regression models were used to examine the association among rating, seriousness of violence, and primary reason for the rating assignment. RESULTS: The total average number of violent acts within each film by rating category increased from PG (14) to PG-13 (20) to R (32). However, using results from the Poisson models, it is clear that the rating does not predict the frequency of violence in films. For all 3 rating categories, the predicted number of violent acts is almost identical for films with violence as a primary descriptor and films with the highest level of seriousness (R = 62.4 acts, PG-13 = 55.2 acts, and PG = 56.1 acts). The regression analysis shows that the rating does not predict the frequency of violence that occurs in films. CONCLUSIONS: Frequency of violence alone is not the most important criterion for the assignment of rating. The content descriptors and average seriousness of films are better measures of the violence than rating assignment.

Physical complaints, medical service use, and social and employment changes following mild traumatic brain injury: a 6-month longitudinal study.

Using a prospective, dual-cohort study design in which selected preinjury factors were controlled, we present outcomes of 235 patients in a case cohort and 235 patients in a comparison cohort following emergency-department-diagnosed mild traumatic brain injury (MTBI). Symptoms, medical services use, and social and employment concerns were evaluated 6 months after the injury. After adjusting for preinjury characteristics, headaches, dizziness, vision difficulties, memory or learning problems, and alcohol intolerance were found to occur significantly more often in the MTBI cohort than in the comparison cohort. Problems sleeping, use of prescribed medications, and changes in employment were less likely in the MTBI cohort. Although MTBI is not life threatening, our findings suggest that 6 months after injury persons still have related health problems that require routine medical management.

Diabetic nephropathy as a cause of end-stage renal disease in Egypt: a six-year study.

The prevalence of diabetic nephropathy as a cause of end-stage renal disease (ESRD) in Egypt has been examined in small cross-sectional studies, with conflicting results. The need for a large-scale study prompted us to perform this 6-year multiple cross-sectional study. A sample of ESRD patients enrolled in the Egyptian renal data system was evaluated during the period 1996-2001 for the prevalence of diabetic nephropathy. Prevalence gradually increased from 8.9% in 1996, to 14.5% in 2001. The mean age of patients with diabetic nephropathy was significantly higher than that of patients with ESRD from other causes. Mortality was also significantly higher in diabetic patients with ESRD.

Diabetic nephropathy as a cause of end-stage renal disease in Egypt: a six-year study

The prevalence of diabetic nephropathy as a cause of end-stage renal disease [ESRD] in Egypt has been examined in small cross-sectional studies, with conflicting results. The need for a large-scale study prompted us to perform this 6-year multiple cross-sectional study. A sample of ESRD patients enrolled in the Egyptian renal data system was evaluated during the period 1996-2001 for the prevalence of diabetic nephropathy. Prevalence gradually increased from 8.9% in 1996, to 14.5% in 2001. The mean age of patients with diabetic nephropathy was significantly higher than that of patients with ESRD from other causes. Mortality was also significantly higher in diabetic patients with ESRD

Mutation and biochemical analysis in carnitine palmitoyltransferase type II (CPT II) deficiency.

Carnitine palmitoyltransferase type II (CPT II) deficiency has three basic phenotypes, late-onset muscular (mild), infantile/juvenile hepatic (intermediate) and severe neonatal. We have measured fatty acid oxidation and CPT II activity and performed mutation studies in 24 symptomatic patients representing the full clinical spectrum of disease. Severe and intermediate phenotypes show a clear correlation with biochemical indices and genetic analysis revealed causative mutations in most patients. Studies of mild phenotypes suggest a more complex interaction, with higher residual fatty acid oxidation, a wider range of CPT II activity (10-60%) but little evidence of genotype-phenotype correlation. Residual CPT II mutant protein from myopathic patients shows thermal instability at 41 degrees C. The common 'polymorphisms' V3681 and M647V are strikingly overrepresented in the myopathic patients, the implication being that they may significantly influence the manifestation of clinical disease and could therefore potentially be considered as a susceptibility variants. Among myopathic individuals, males comprised 88% of patients, suggesting increased susceptibility to clinical disease. A small number of symptomatic patients appear to have significant residual CPT II activity (42-60%) The synergistic interaction of partial deficiencies of CPT II, muscle adenosine monophosphate deaminase and possibly other enzymes of muscle energy metabolism in the aetiology of episodic myopathy deserves wider consideration.

Effect of gamma irradiation on elimination of aflatoxins produced by apple mycoflora in apple fruits.

The influence of ionizing radiation on the growth of apple mycoflora and the aflatoxins production was investigated. Four strains of fungal isolates, Aspergillus flavus, A. fumigatuis, A. niger, Penicillium expansum, were used. Four doses of gamma radiation were applied (0.5, 1.0, 1.5 and 2.0 KGy). The elimination of aflatoxins under selected conditions was detected by using HPLC techniques. Doses of 0.5 KGy stimulated the production of aflatoxins by all fungi tested while 1.0-2.0 KGy reduced the aflatoxins production. The studies were also carried out to investigate the effect of pre- and post-inoculation of both irradiated and non-irradiated fungal spores on irradiated and non-irradiated apples. The results showed the necessity of irradiation of fresh apple fruits followed by good preservation conditions. The results showed also that the effect of radiation is influences on the apple mycoflora producing aflatoxins and not the apple itself.