Inhibitory Effects of Bacterial Silk-like Biopolymer on Herpes Simplex Virus Type 1, Adenovirus Type 7 and Hepatitis C Virus Infection.

Bacterial polymeric silk is produced by Bacillus sp. strain NE and is composed of two proteins, called fibroin and sericin, with several biomedical and biotechnological applications. In the current study and for the first time, the whole bacterial silk proteins were found capable of exerting antiviral effects against herpes simplex virus type-1 (HSV-1), adenovirus type 7 (AD7), and hepatitis C virus (HCV). The direct interaction between bacterial silk-like proteins and both HSV-1 and AD7 showed potent inhibitory activity against viral entry with IC50 values determined to be 4.1 and 46.4 µg/mL of protein, respectively. The adsorption inhibitory activity of the bacterial silk proteins showed a blocking activity against HSV-1 and AD7 with IC50 values determined to be 12.5 and 222.4 ± 1.0 µg/mL, respectively. However, the bacterial silk proteins exhibited an inhibitory effect on HSV-1 and AD7 replication inside infected cells with IC50 values of 9.8 and 109.3 µg/mL, respectively. All these results were confirmed by the ability of the bacterial silk proteins to inhibit viral polymerases of HSV-1 and AD7 with IC50 values of 164.1 and 11.8 µg/mL, respectively. Similarly, the inhibitory effect on HCV replication in peripheral blood monocytes (PBMCs) was determined to be 66.2% at concentrations of 100 µg/mL of the bacterial silk proteins. This antiviral activity against HCV was confirmed by the ability of the bacterial silk proteins to reduce the ROS generation inside the infected cells to be 50.6% instead of 87.9% inside untreated cells. The unique characteristics of the bacterial silk proteins such as production in large quantities via large-scale biofermenters, low costs of production, and sustainability of bacterial source offer insight into its use as a promising agent in fighting viral infection and combating viral outbreaks.

In vitro assessment of the bioactivities of sericin protein extracted from a bacterial silk-like biopolymer.

Sericin is one of the main components of silk proteins, which has numerous biomedical applications because of its antioxidant, anticancer and antimicrobial properties. We recently isolated and characterized a novel silk-like protein named BNES. It is of non-animal origin and is like a bacterial polymeric silk. Sericin is a very popular protein compound that is effective in treating cancerous tumors. The process of extracting it from natural silk produced by silkworms or spiders is both complex and expensive. From the published scientific literature, it has been shown that sericin has not been previously extracted from a bacterial source. In the present study, sericin was extracted from bacteria capable of producing a biopolymer named BNES whose chemical composition is like that of natural silk and its bio-therapeutic effects were evaluated for the first time. The antioxidant activity of BNES measured by DPPH and ABTS assays showed IC50 values of 0.38 and 0.41 mg mL-1, respectively. BNES displayed satisfactory cytotoxic effect against four cancer cell lines, including Huh-7, Caco-2, MCF-7 and A549 cells, with IC50 values in the ranges of ca. 0.62 ± 0.17, 0.72 ± 0.27, 0.76 ± 0.36 and 0.83 ± 0.31 mg mL-1, respectively, after 24 h of treatment and 0.51 ± 0.22, 0.49 ± 0.19, 0.41 ± 0.25 and 0.55 ± 0.38, respectively, after 48 h of treatment, without affecting normal cells (WI38 cells). The antitumor activity of BNES was established to be an apoptosis-dependent mechanism determined via cellular morphology alterations, cell cycle arrest in the sub-G1 phase and nuclear staining with highly fluorescent fragments. The antimicrobial effects of BNES were examined with yeast and Gram-negative and Gram-positive bacteria. The results confirmed its antimicrobial activity against all tested organisms at concentrations of up to 1.33 mg mL-1. The competitive advantage of the bacterial sericin BNES over sericin extracted from spider or silkworm sources is that it can be produced in very large quantities through large-scale bio-fermenters, which reduces the expected cost of production, in addition to having sustainable bacterial production source.

Multicenter screening of diabetic patients for detecting new cases of tuberculosis: an approach to intensify the case detection rate of tuberculosis in developing countries with high prevalence of diabetes.

INTRODUCTION: Tuberculosis (TB) is a major public health problem in most of developing countries. Meanwhile, the prevalence of type 2 diabetes mellitus (DM) is also increasing rapidly. OBJECTIVES: To describe the feasibility of implementing screening test for tuberculosis among diabetic patients and identifying factors associated with high detection rate. METHODS: Study Design: Multi-center cross-sectional study. This study was implemented in the governmental healthcare settings. To diagnose TB among diabetics, we used a symptom-based questionnaire that included the symptoms of suspected TB according to the guidelines of National Tuberculosis Program in Egypt. RESULTS: Among 4283 adult diabetics, 14 TB cases were diagnosed; 9 known TB cases and 5 newly detected cases. The number needed to detect one new case of TB was 855. Male diabetics and who those suffered from liver disease experienced a significantly higher prevalence of TB and a higher detection rate of new active cases. CONCLUSIONS: Screening for TB among diabetics in routine governmental healthcare services was successfully implemented. Screening DM patients in countries with a high prevalence of DM will reveal a significant number of active TB cases, which will in turn improve the case detection rate of TB.

Sleep convulsive seizures predict lack of remission in genetic generalized epilepsies: A retrospective study from a single epilepsy center in Egypt.

BACKGROUND: Genetic generalized epilepsies (GGEs) represent 15-20% of all epilepsies. There are no studies on the outcome of GGEs in the Middle East. AIMS: To investigate the long-term prognosis of GGEs and identify prognostic predictors in Egypt. MATERIAL & METHODS: This is a retrospective cohort study of consecutive children and adults with GGEs seen in an epilepsy clinic in Cairo, Egypt, followed for 10+ years. Follow-up visits were scheduled every 3-6 months or earlier. Demographic and clinical prognostic predictors were collected. Presence and number of seizure types were noted along with the number and doses of drugs. The outcome was defined as 5-year remission (5yrR), relapse, or no remission. The probability of 5yrR was calculated using Kaplan-Meier curves. Prognostic predictors were assessed with Cox proportional models. RESULTS: Included were 120 patients (males, 41.7%), mean age at onset 13.6 years, followed for a mean of 12.5 years (range 10-20). Generalized tonic-clonic seizures were present in 93.3% of cases, followed by myoclonic (65%) and absence seizures (37.5%). 85 cases (70.8%) attained 5yrR (18 of them off-medications) and 59.1% had a relapse. The cumulative probability of starting 5yrR was 6.7%, 30.8%, and 50% at onset, 5 and 10 years. Only absence of sleep seizures was an independent predictor of 5yrR (Hazard ratio, 2.08; 95% CI 1.01-4.33). DISCUSSION: Our findings are in keeping with others. The negative effects of sleep seizures are not unexpected because further unrecognized seizures might be expected. CONCLUSIONS: Prolonged remission of GGEs is high and compatible with treatment discontinuation. Sleep seizures are negative prognostic predictors.

Intracranial haemorrhage is linked to late onset vitamin K deficiency in infants aged 2-24 weeks.

AIM: Late vitamin K deficiency bleeding (VKDB) can be serious and manifest as early onset intracranial haemorrhage (ICH). This study aimed to determine the frequency of ICH in relation to vitamin K deficiency and the outcome in infants aged two to 24 weeks. METHOD: A hospital-based study was conducted in two main tertiary hospitals in Cairo, Egypt, from May 2011 to May 2012 with 40 patients with ICH and 50 age-matched controls without ICH. RESULTS: Forty patients with ICH were recruited, 19 were excluded for clinical reasons and the remaining 21 had a significantly low vitamin K level. Exclusive breast feeding (81% of patients), diarrhoea lasting more than 1 week (38.1%) and antibiotic consumption within a week before the development of ICH (57.1%) were more common in the patients than in the control group (p value>0.05, <0.01 and <0.01, respectively). CONCLUSION: A high frequency of ICH due to late VKDB was reported in Egyptian infants aged two to 24 weeks, with poorer outcomes than international studies. A national survey is required to evaluate the timing and protective value of a second booster vitamin K dose to reduce ICH, especially in high-risk patients in this age group.

Compliance with haemodialysis practice guidelines in Egypt.

Evidence- and consensus-based clinical practice guidelines for haemodialysis have recently been developed in Egypt. This study aimed to measure compliance with the guidelines in a sample of 16 government hospitals in Cairo and Giza governorates. Each haemodialysis unit was visited to assess the haemodialysis unit and patient care practices for all patients under dialysis at the time of the visit. The mean percentage compliance with haemodialysis guidelines among all study hospitals was 59.3% (SD 11.2%) overall. Within the 5 separate domains, compliance was: 58.8% (SD 12.4%) for personnel, 68.5% (SD 16.0%) for patient care practices, 61.3% (SD 15.4%) for infection prevention and control, 51.5% (SD 18.2%) for the facility and 56.5% (SD 7.1%) for documentation/ records. There were no statistically significant differences between Cairo and Giza governorates except for facility measures which were slightly better in Giza. Overall, compliance with the developed practice guidelines for haemodialysis in Egypt was not satisfactory and was not uniform across facilities.

Compliance with haemodialysis practice guidelines in Egypt

Evidence- and consensus-based clinical practice guidelines for haemodialysis have recently been developed in Egypt. This study aimed to measure compliance with the guidelines in a sample of 16 government hospitals in Cairo and Giza governorates. Each haemodialysis unit was visited to assess the haemodialysis unit and patient care practices for all patients under dialysis at the time of the visit. The mean percentage compliance with haemodialysis guidelines among all study hospitals was 59.3% [SD 11.2%] overall. Within the 5 separate domains, compliance was: 58.8% [SD 12.4%] for personnel, 68.5% [SD 16.0%] for patient care practices, 61.3% [SD 15.4%] for infection prevention and control, 51.5% [SD 18.2%] for the facility and 56.5% [SD 7.1%] for documentation/ records. There were no statistically significant differences between Cairo and Giza governorates except for facility measures which were slightly better in Giza. Overall, compliance with the developed practice guidelines for haemodialysis in Egypt was not satisfactory and was not uniform across facilities

Are patients and healthcare providers satisfied with health sector reform implemented in family health centres?

BACKGROUND: Patients' and healthcare providers' satisfactions are important outcomes for any healthcare programmes. In Egypt, the Health Sector Reform Program (HSRP) has been implemented since 1999 in primary healthcare (PHC) centres adopting the family health approach. OBJECTIVES: To assess the clients' satisfaction towards the overall health services provided by health centres affiliated to HSRP and to evaluate the satisfaction of healthcare providers, physicians, nurses and social workers. METHODOLOGY: Four reformed PHC units were compared with four non-reformed units in the Alexandria governorate regarding patients' and providers' satisfactions. Assessment of the satisfaction was done using survey questionnaire and focus group discussion. The provider survey questionnaire was carried out on all providers working in the selected units. Focus group discussion was done in one reformed health unit and another non-reformed unit. RESULTS: The current study showed that providers in the reformed PHCs were more satisfied than providers in non-reformed PHCs regarding availability of equipments, job satisfaction and income satisfaction. No significant differences were noticed between both groups regarding social relations with either colleagues or directors. The patient satisfaction was higher in accredited family health units compared to non-accredited units in all aspects: cleanness, doctors and nurses, waiting area and waiting time. During the focus group discussion, patients in the accredited PHCs expressed their satisfaction regarding the cleanness, privacy, attitude of doctors and nurses as well the waiting area and waiting time. CONCLUSION: Implemented HSRP in PHC units has had positive implications regarding patients' and providers' satisfactions in most areas studied.

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.

National Survey of Prevalence of Mental Disorders in Egypt: preliminary survey.

This study is an initial step for the National Survey of Prevalence of Mental Disorders in Egypt. We conducted a door-to-door household survey of 14,640 adults aged 18-64 years in 5 regions in Egypt. Mental disorders were diagnosed using the MINI-Plus diagnostic interview. Overall prevalence was estimated at 16.93% of the studied adult population. The main problems were mood disorders, 6.43%, anxiety disorders, 4.75%, and multiple disorders, 4.72%. Mental disorders were associated with sociodemographic factors (e.g. being female, being unemployed, being divorced) and physical illness (e.g. heart disease, kidney disease, hypertension).

National survey of Prevalence of Mental Disorders in Egypt: preliminary survey

This study is an initial step for the National Survey of Prevalence of Mental Disorders in Egypt. We conducted a door-to-door household survey of 14 640 adults aged 18-64 years in 5 regions in Egypt. Mental disorders were diagnosed using the MINI-Plus diagnostic interview. Overall prevalence was estimated at 16.93% of the studied adult population. The main problems were mood disorders, 6.43%, anxiety disorders, 4.75%, and multiple disorders, 4.72%. Mental disorders were associated with sociodemographic factors [e.g. being female, being unemployed, being divorced] and physical illness [e.g. heart disease, kidney disease, hypertension]

Breast screening in the emerging world: high prevalence of breast cancer in Cairo.

The Cairo Breast Screening Trial (CBST) was designed to evaluate the role of clinical breast examination as a primary screening modality in the context of primary care, as in Egypt breast cancer is usually diagnosed at an advanced stage. A specialised medical centre in Cairo (the Italian Hospital) was selected as the headquarters of the study. The initial target group was women age 35-64 living in a geographically defined area around the Italian Hospital, 4116 being contacted by social workers and invited to attend a Primary Health Centre for clinical breast examination. High rates of breast cancer were observed; 8 per 1000 at the first examination and approximately 2 per thousand among those who attended for re-screening. The initial prevalence suggests that many women in the community with early but palpable breast cancer fail to seek medical attention until their cancer is advanced. The detection rate on re-screening, and after follow-up of those who only received one or no screens, ( approximately 3/1000) is similar to expectation.

Patient satisfaction with primary health care services in two districts in Lower and Upper Egypt.

This study compares patient satisfaction with primary health care services and identifies factors associated with patient satisfaction in two health districts in Egypt where a project for upgrading primary health care services had been running for three years. An exit interview was conducted for 1108 patients using a structured questionnaire. The results revealed that most clients using primary health care services were females. Patient satisfaction was high for accessibility, waiting area conditions and performance of doctors and nurses. The main complaints centred on the availability of prescribed drugs and laboratory investigations. Additionally, level of privacy in the consultation room was described as unsatisfactory by 33% of patients. There was no association between overall patient satisfaction and age, gender, education level or type of service received.

Patient satisfaction with primary health care services in two districts in Lower and Upper Egypt

This study compares patient satisfaction with primary health care services and identifies factors associated with patient satisfaction in two health districts in Egypt where a project for upgrading primary health care services had been running for three years. An exit interview was conducted for 1108 patients using a structured questionnaire. The results revealed that most clients using primary health care services were females. Patient satisfaction was high for accessibility, waiting area conditions and performance of doctors and nurses. The main complaints centred on the availability of prescribed drugs and laboratory investigations. Additionally, level of privacy in the consultation room was described as unsatisfactory by 33% of patients. There was no association between overall patient satisfaction and age, gender, education level or type of service received

Changing the trend: a prospective study on factors contributing to the growth rate of peritoneal dialysis programs.

Compared with countries worldwide, the United States currently has one of the lowest peritoneal dialysis (PD) populations as compared with its hemodialysis (HD) population. Approximately 12% of the total dialysis population in the United State is on PD. This figure correlates with the take-on rate [percentage of end-stage renal disease (ESRD) patients enrolling in PD programs] of about 12%-15% in the United States. Over a two-year period, we prospectively examined the role that developing a comprehensive infrastructure and support system had on expanding our PD program. The changes made included these: nephrologists placing PD catheters using the laparoscopic method; active identification of, and training for, family members and personnel in nursing homes and daycare centers to perform PD; improvements in home conditions through support by social workers; early ESRD patient education; and provision of in-center intermittent PD (IPD) for selected patients. We then compared the results from the two years after commencement of the changes against the two years before the changes were made. Training of personnel in nursing homes increased enrollment from 3 to 11 patients (p = 0.01); training of personnel in daycare centers increased enrollment from 0 to 5 patients (p = 0.05); training family members and providing family support increased enrollment from 4 to 15 patients (p = 0.03); early patient and family education increased enrollment from 4 to 24 patients (p = 0.008); improving home conditions increased enrollment from 1 to 14 patients (p = 0.01); and providing an IPD program for selected patients added 6 patients (p = 0.05). Introducing a program for nephrologists to place PD catheters by the laparoscopic technique decreased catheter mechanical failure (and subsequent transfer to HD), from 22 to 3 patients (p = 0.005). Our PD take-on rate (percentage of ESRD patients choosing PD modality) increased from 19% to 76% (p = 0.002). The total number of patients in the PD program over the two years after initiation of the changes increased from 33 to 93 (p = 0.01), while the number of HD patients decreased from 168 to 142 (p = 0.05). Developing a comprehensive infrastructure and support system for PD programs permits enrollment of patients who otherwise would have been excluded as PD candidates and eliminates loss of PD patients to HD. Implementation of such programs can contribute considerably to enhancing the PD population growth rate.

Relationship between intraperitoneal bleeding, adhesions, and peritoneal dialysis catheter failure: a method of prevention.

Intraperitoneal (i.p.) bleeding causes intense inflammatory reactions and extensive adhesions. The relationship between i.p. bleeding and adhesions is well documented in both animal and human studies. Over an 8-year period, we performed 362 permanent peritoneal dialysis (PD) catheter placements in 317 patients, using the laparoscopic technique. In the first 203 procedures (group I), we observed intra-operative bleeding in 12 patients (intra-operative i.p. bleeding seen laparoscopically, and significant blood-tinged dialysate irrigation). Patients were left dry for 3-5 days before dialysate instillation during the break-in period. During the break-in period, 7 of the 12 patients (58%) developed primary catheter failure requiring catheter removal (p = 0.03). All 7 patients underwent repeat laparoscopy for placement of a new catheter. In all 7 patients, laparoscopy showed significant adhesions. In the subsequent 159 procedures (group II), we observed intra-operative bleeding in 10 patients. We irrigated the peritoneal cavity repeatedly, until clear dialysate was obtained, then instilled 500-1000 mL 1.5% Dianeal solution (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.) and capped the catheter. These patients were then placed on low-volume continuous cycling peritoneal dialysis [(CCPD) 700-1200 mL, based on the patient's size, every 2 hours, until the effluent became clear]. Following this, patients underwent daily irrigation and PD fluid cell count, and were left with 700-1200 mL dialysate to dwell. The process was continued until PD fluid drainage showed no red blood cells or until the patient was started on routine peritoneal dialysis. None of these patients were drained dry. Compared with group I, no patient among the 10 in group II developed catheter failure (p = 0.001), and mean catheter survival was 31 +/- 7 months. Of the 10 patients, 2 developed exist-site leaks, both after clearance of red blood cells from the drained dialysate. None developed peritonitis. We conclude that intra-operative i.p. bleeding associated with significant blood-tinged dialysate irrigation may lead to local adhesions if the peritoneum is drained dry. The result may be loss of the PD catheter in about 60% of cases. Continuous irrigation, combined with a moderate amount of Dianeal solution left to dwell, or early initiation of low-volume PD, or both, prevents this complication.

Factors modulating cytosolic calcium. Role in lipid metabolism and cardiovascular morbidity and mortality in peritoneal dialysis patients.

Studies in the uremic rat indicate that insulin resistance and glucose intolerance leading to dyslipidemia are associated with a hyperparathyroid-induced increase in cytosolic calcium ([Ca++i]). These alterations are reversed with verapamil, but recur after discontinuation of the drug, suggesting that increased [Ca++i] is responsible for the metabolic derangement. To our knowledge, no similar studies have been conducted in humans. We retrospectively examined, over 12-year period, the effects of factors that lower [Ca++i] on total serum cholesterol and triglycerides in 176 peritoneal dialysis (PD) patients. Because the study was retrospective, detailed lipid profiles were not available. We therefore relied on the morbidity and mortality outcome related to atherosclerotic vascular disease. Diabetic patients were excluded from the study, because their dyslipidemia and vascular disease are mediated via a different mechanism. The patients were classified into four groups. Group I [high parathyroid hormone (PTH) in the absence of calcium channel blockers (CCBs), n = 56] represented the highest [Ca++i]. Group II (high PTH in the presence of CCBs, n = 43) and group III (lower PTH in the absence of CCBs, n = 37) represented intermediate [Ca++i]. Group IV (lower PTH in the presence of CCBs, n = 40) represented the lowest [Ca++i]. High PTH was defined as > or = 3.0 times normal; lower PTH, as < 3.0 times normal. Lower [Ca++i] was achieved through the use of CCBs, or through lower PTH, or both. Lower PTH was achieved by parathyroidectomy or calcitriol administration. The four groups showed no differences in age, sex, race, weight, dialysis duration, or primary disease. Group I showed a mean serum cholesterol of 358 +/- 27 mg/dL and serum triglycerides of 469 +/- 41 mg/dL. Group II showed mean serum cholesterol of 198 +/- 21 mg/dL and serum triglycerides of 147 +/- 17 mg/dL. Group III showed a mean serum cholesterol of 205 +/- 20 mg/dL and serum triglycerides of 174 +/- 16 mg/dL. Group IV showed mean serum cholesterol of 184 +/- 10 mg/dL (p = 0.008) and serum triglycerides of 103 +/- 8 mg/dL (p = 0.005). The cardiovascular morbidity and mortality incidences were: group I, 64%; group II, 27%; group III, 31%; and group IV, 20% (p = 0.002). We conclude that, in non diabetic PD patients, dyslipidemia is related to a hyperparathyroid-induced increase in cytosolic calcium [Ca++i]. Lowering [Ca++i] by decreasing the parathormone level (via parathyroidectomy or calcitriol administration), or by blocking calcium entry into cells (via CCBs), or both, is associated with less dyslipidemia and improved long-term morbidity and mortality related to atherosclerotic vascular disease.

Hepatitis c and cirrhotic liver disease in the Nile delta of Egypt: a community-based study.

Residents of Egypt's Nile river delta have among the world's highest seroprevalence of hepatitis C virus (HCV) infection. To assess the impact of HCV on chronic liver disease, we studied the association between HCV, other hepatitis viruses, and cirrhotic liver disease in a cross-sectional, community-based survey of 801 persons aged > or = 10 years living in a semi-urban, Nile delta village. Residents were systematically sampled using questionnaires, physical examination, abdominal ultrasonography and serologically for antibodies to HCV (confirmed by a third-generation immunoblot assay) and to hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis E virus (HEV). The seroprevalence of HCV increased with age from 19% in persons 10-19 years old to about 60% in persons 30 years and older. Although no practices that might facilitate HCV transmission were discovered, the seroprevalence of HCV was significantly associated with remote (> 1 year) histories of schistosomiasis. Sonographic evidence of cirrhosis was present in 3% (95% CI: 1%, 4%) of the population (0.7% of persons under 30 years of age and in 5% of older persons), and was significantly associated with HCV seroreactivity. Our findings are consistent with the hypothesis that past mass parenteral chemotherapy campaigns for schistosomiasis facilitated HCV transmission, and that HCV may be a major cause of the high prevalence of liver cirrhosis in this Nile village.

The role of peritoneal dialysis catheter configuration in preventing catheter tip migration.

Migration of the peritoneal dialysis (PD) catheter from the pelvis to the upper abdomen frequently results in peritoneal dialysis failure and removal of the catheter. Previous studies compared PD catheter survival in various catheter configurations. These studies included single-cuff and double-cuff, straight-end and curled-end catheters, and showed an incidence of catheter migration ranging from 5%-35% depending on the catheter type. Recent studies demonstrated that the double-cuff, Swan-neck, curled-end configuration is associated with a considerably lower incidence of migration. Most of these studies, however, had a small patient sample or no control group, or they compared nonequivalent catheters (for example, Swan-neck, curled-end versus straight, non-curled-end). Over a six-year period, we examined two similar double-cuff, curled-end catheters: Group I catheters had a straight segment between the two cuffs, and Group II catheters had a 60 degrees Swan-neck bend between the two cuffs (Quinton Instrument Co., Bothell, WA, U.S.A.). The two catheters were identical, except for the presence or absence of the Swan-neck bend. All catheters were placed by the closed laparoscopic technique. In the two groups of patients in whom the catheters were implanted, no statistically significant difference was observed in primary disease, age, sex, race, weight, prior abdominal surgery, or duration of dialysis before catheter migration. In group I, 33 of the 219 patients developed catheter migration (15%); in group II, 2 patients of 243 patients developed catheter migration (less than 1%, p = 0.002). In conclusion, the Swan-neck configuration presents an independent factor in preventing PD catheter migration. Review of previous studies and the data from our study, show that double-cuff, curled-end, Swan-neck PD catheters are superior to other catheters in regard to prevention of catheter migration and should be the catheter of choice in PD patients.

Preoperative vancomycin prophylaxis for newly placed peritoneal dialysis catheters prevents postoperative peritonitis.

The role of vancomycin and other antibiotics in treatment of acute peritonitis in peritoneal dialysis patients is well established. However, the role of preoperative vancomycin or cephalosporins in preventing early infection in newly placed peritoneal dialysis catheters remains controversial. We performed a prospective randomized study to examine the role of vancomycin or cefazolin prophylaxis in decreasing the incidence of postoperative peritonitis. Over 8-year period, 265 patients undergoing 305 permanent peritoneal catheter placement procedures were randomized into three groups. Group I (103 procedures) received a single intravenous (i.v.) dose of 1000 mg vancomycin 12 hours before the peritoneal catheter placement procedure. Group II (102 procedures) received a single i.v. dose of 1000 mg of Ancef (cefazolin) 3 hours before the procedure. Group III (100 procedures) received no antibiotics preoperatively for a least one week before the procedure. Patients were monitored for peritonitis during the following 14 days. Peritonitis developed in 1 patient (1%) in Group I (vancomycin group) compared to 12 patients (12%) in Group III (control group), p = 0.002, and in 9 patients (9%) in Group II (cefazolin group) compared to Group III, p = 0.68. We conclude that the use of preoperative single-dose i.v. vancomycin prophylaxis for permanent peritoneal dialysis catheter placement reduces the risk of postoperative peritonitis. Cefazolin did not achieve a statistically significant difference from the control group and may not provide adequate prophylaxis.