Sero-prevalence of avian influenza in animals and human in Egypt

In opposite to most countries, avian influenza virus H5N1 became endemic in Egypt. Since, its first emerge in 2006 in Egypt, the virus could infect different species of birds and animals and even human. Beside the great economic losses to the local poultry industry in Egypt, the virus infected 166 confirmed human cases, 59 cases ended fatally. In the present study, the persistence of the avian influenza in the Egyptian environment was studied. For this purpose, serum samples were collected from human, cattle, buffaloes, sheep, goat, horses, donkeys, swine, sewage rats, stray dogs and stray cats. The sera were collected from Cairo and the surrounding governorates to be examined for the presence of anti-H5N1 antibodies by Haemagglutination Inhibition Test (HI) and ELISA test. Clear differences in the seroprevalence were noticed among different species and also between the results obtained by both techniques indicating the difference in test accuracy. The present data indicate wide spread of the H5N1 virus in the Egyptian environment.

A national house-staff audit of medical prophylaxis in medical patients for the PREVENTion of Venous ThromboEmbolism (PREVENT-VTE)

We established a national audit to assess the thromboprophylaxis rate for venous thromoembolism (VTE) in at risk medical patients in acute hospitals in the Republic of Ireland and to determine whether the use of stickers to alert physicians regarding thromboprophylaxis would double the rate prophylaxis in a follow-up audit. 651 acute medical admission patients in the first audit and 524 in the second re-audit were recruited. The mean age was 66.5 yrs with similar numbers of male and female patients and 265 (22.6%) patients were active smokers. The first and second audits identified 549 (84%) and 487 (93%) of patients at-risk for VTE respectively. Of the at-risk patients, 163 (29.7%) and 132 (27.1%) received LMWH in the first and second audit respectively. Mechanical thromboprophylaxis was instigated in 75 (13.6%) patients in the first and 86 (17.7%) patients in the second audit. The placement of stickers in patient charts didn't produce a significant increase in the number of at risk patients treated in the second audit. There is unacceptably low adherence to the ACCP guidelines in Ireland and more complex intervention than chart reminders are required to improve compliance.

Prevalence and risk factor of renal dysfunction induced by bacterial infection other than spontaneous bacterial peritonitis in patients with cirrhosis

BACKGROUND

Deterioration of renal function in cirrhotic patients with spontaneous bacterial peritonitis (SBP) is a predictor for inhospital mortality. However, the clinical significance of renal dysfunction during bacterial infection other than SBP is unknown.

AIM

To investigate the prevalence and clinical significance of renal dysfunction due to bacterial infections other than SBP in patients with liver cirrhosis.

METHODS

Retrospective data from in-patients with bacterial infections other than SBP were analyzed.

RESULTS

Eighty-two patients were recruited for the analysis. Infection was located in urinary tract (41.5%), pneumonia (34.1%), biliary tract (3.7%), cellulitis (6.1%), gastrointestinal tract (4.9%) and bacteremia of unknown origin (9.7%). Renal dysfunction developed in 40 patients (48.8%), of which 13 patients had irreversible renal dysfunction. In the univariate and multivariate analysis, the initial MELD score, neutrophil count, bilirubin, and blood pressure were significant risk factors for renal dysfunction.

CONCLUSION

The prevalence of renal dysfunction during bacterial infection other than SBP in patients with liver cirrhosis was 48.8%, and its development was related to the severity of the liver disease. Occurrence of irreversible renal dysfunction seemed to affect the prognosis of these patients.

Effect of cryopreserved amniotic membrane on the development of adhesions and fibrosis after extraocular muscle surgery in rabbits

PURPOSE

To histopathologically evaluate the effect of cryopreserved human amniotic membrane (AM) transplant on preventing the development of postoperative adhesions after extraocular muscle surgery.

METHODS

Ten albino rabbits were used. The superior rectus muscles were bilaterally resected. In right eyes, the muscle was wrapped with cryopreserved human AM (group AM). In left eyes, the muscle was not wrapped with AM and served as a control group (group C). The rabbits were killed, and the eyes were enucleated 6 weeks after surgery to perform histopathological examination.

RESULTS

On histopathological examination, the AM was present in eight eyes, surrounded by periamniotic inflammation, with no adhesions detected between rectus muscle and sclera, conjunctiva and Tenon's capsule in the segment where the AM was present, but detected elsewhere. Adhesions were detected in the other two eyes of group AM, in which the AM was absent, and in all group C eyes. When comparing eye pairs of each rabbit, AM eyes showed significantly less adhesions between the muscle and sclera (p = 0.009) and between the muscle and Tenon's capsule and conjunctiva (p = 0.008), in the region of AM application, and significantly more foreign body inflammation (p = 0.031), than C eyes. The differences between AM and C eye pairs, in terms of conjunctival inflammation and vascularity and muscle fibrosis, were insignificant (p > 0.05).

CONCLUSIONS

Cryopreserved AM is effective in reducing postoperative extraocular muscle adhesions. Its application is, therefore, recommended during strabismus reoperations.

[Burn contractures of the extremities]

Burn contractures are common after deep burns of the limbs. When rehabilitation fails to restore joint function and normal range of motion, surgical contracture release should be performed. Different plastic surgery techniques can be used, from Z-plasty to skin grafts, artificial dermis and flaps. Surgery can also be used in case of esthetic concerns. Available surgical techniques and indications are presented.

Prevalence and risk factors of erectile dysfunction among patients attending primary health care centres in Qatar

Erectile dysfunction is a common health problem affecting the quality of life of men of all ages. The aim of this study was to find the prevalence of and significant risk factors for erectile dysfunction among men of all nationalities attending primary health care centres in Qatar for any reason. Respondents aged > 30 years (n = 1139) completed the sexual health inventory for men plus a questionnaire about their demographic characteristics, lifestyle habits and presence of chronic diseases. The total prevalence of erectile dysfunction was 56.9% (32.7% mild and 2.3% severe cases). All studied sociodemographic variables showed a significant association with erectile dysfunction. A lower prevalence of erectile dysfunction was found in smokers and those who exercised. More than 1 sexual partner, obesity and having a chronic disease (hypertension, coronary heart disease, hypercholesterolaemia or diabetes mellitus) were significantly positively associated with erectile dysfunction.

Contrast enhanced CT (CE-CT) changes and nephrometry down-scoring of unresectable primary renal cell carcinoma (RCC) tumors in patients (Pts) treated with neoadjuvant sunitinib

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Background: The impact of neoadjuvant sunitinib on CE-CT parameters and nephrometry score of primary RCC tumors remains unknown.

Methods: Retrospective review of baseline and prenephrectomy CE-CT from a prospective phase II trial of neoadjuvant sunitinib (50 mg sunitinib continuous dosing) in unresectable primary RCC tumors with or without metastatic disease. CE-CT parameters and R.E.N.A.L. nephrometry score for each lesion were determined in pts who underwent subsequent surgery. RECIST and MASS criteria were used to assess primary tumor radiographic response. CT changes were analyzed using the sign test and Wilcoxon signed rank test.

Results: Twenty nine pts were enrolled, of which 13 pts (85%M; median age 63y) underwent post-sunitinib resection of 16 primary tumors (3 pts had multifocal RCC). Post-therapy, 88% of tumors had decreased long diameter (median 32% decrease, p<0.001 vs. baseline), 88% decreased attenuation (median 30 HU reduction, p=0.006) and 69% increased necrosis (p=0.001). 56% of tumors had a decrease in nephrometry score (median 1 point decrease; 10 to 9, p=004). At baseline, 81% of tumors were highly complex by nephrometry score; following therapy 46% of the highly complex tumors became moderately complex. At baseline 13 tumors abutted renal hilar vital structures, whereas following treatment 4 tumors demonstrated abutment. Adenopathy decreased (range, 23%-83%) in 4/4 patients with enlarged baseline lymph nodes, with complete resolution in 1 patient. RECIST objective response was seen in 38% and SD in 56% of primary tumors; 1 tumor had PD based on size despite > 95% necrosis. MASS criteria response was favorable 38%, intermediate 62%. Two of four pts had reduction in extent of venous thrombus (1 pt from level 0 to resolved and 1 pt from level IV to II).

Conclusions: Neoadjuvant sunitinib resulted in decreased size/attenuation, increased necrosis of the primary tumor and reduction in lymphadenopathy and venous thrombus in pts who underwent subsequent surgery. Sunitinib reduced the RENAL nephrometry score and facilitated nephrectomy, notably due to impact on tumor proximity to vital structures in the renal hilum.

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Study of coronary artery calcification risk in Egyptian adolescents with type-1 diabetes

The objective of the study is to assess coronary artery calcification (CAC) among adolescents with type-1 diabetes and to determine its relation with high-sensitivity C-reactive protein (hs-CRP), dyslipidaemia, glycaemic control and microvascular complications. The study included sixty patients with type-1 diabetes. Their ages ranged from 12 to 18 years and their diabetes duration ranged between 10 and 15 years. Patients were compared with 60 healthy subjects who served as controls. Clinical examination and laboratory investigations were done for evaluation of glycaemic control and presence of microvascular complications. Lipid profile, hs-CRP and multislice spiral computed tomography were done. Hs-CRP, total cholesterol, triglycerides and low-density lipoproteins levels were significantly higher in patients with diabetes compared to controls (P < 0.001). Twelve patients with diabetes (20%) had positive CAC. The mean calcium score was significantly higher in patients with diabetes compared to controls (P < 0.05). Smoking significantly affects CAC as 50% of smokers with diabetes had evidence of CAC compared to 9.1% of non-smokers with diabetes (P < 0.001). Fifty percent of patients with diabetes on angiotensin-converting enzyme inhibitor (ACEI) had evidence of CAC compared to 0% of patients without history of ACEI therapy (P < 0.001). Diabetics with CAC had significantly elder age, longer disease duration and higher mean glycosylated hemoglobin compared to diabetics without CAC (P < 0.05). Blood pressure percentiles, albumin creatinine ratio and serum lipids were significantly higher in patients with CAC compared to those without CAC (P < 0.001). All diabetics with severe retinopathy had positive CAC compared to 0% with normal Fundus (P < 0.001). All diabetics with overt nephropathy had positive CAC compared to 13.3% and 0% in micro- and normo-albuminuric patients (P < 0.001). Young patients with diabetes have evidence of CAC. Smoking, microvascular complications and dyslipidaemia might contribute to this risk.