Surveillance of acute hepatitis C in Cairo, Egypt

Surveillance of acute hepatitis has been set up in two fever hospitals in Cairo to diagnose acute hepatitis C. Patients were categorized as definite acute hepatitis C with positive hepatitis C virus (HCV) RNA and without anti-HCV antibody, or probable acute hepatitis C with positive HCV RNA, positive anti-HCV antibody, alanine aminotransferase >/=4 times the upper limit of normal (ULN), and high risk parenteral exposure in the 1--3 months prior to the beginning of symptoms. From May to November 2002, 315 patients were recruited in the study. Of these, 115 (36.5%) had acute hepatitis A, 89 (28.3%) had acute hepatitis B, and 111 (35.2%) had non-A non-B acute hepatitis. Of the total with complete data (n=309), 12 (3.9%, 95% CI=2.0%-6.7%) had definite acute hepatitis C, and 11 (3.6%, 95% CI=1.8%-6.3%) had probable acute hepatitis C. In patients with definite acute hepatitis C, dental exposure (n=5) and intravenous drug use (n=2), were the only high risk procedures found in the 6 months prior to diagnosis. Five patients had no identifiable parenteral exposure. In conclusion, results from this study suggest that acute hepatitis C can be diagnosed by surveillance of acute hepatitis in hospital settings in Cairo and that minor community exposures contribute substantially to local HCV transmission.     

Diarrhea associated with Cryptosporidium parvum among young children of the Nile River Delta in Egypt

Over a 2-year period, the prevalence and clinical characteristics of Cryptosporidium-associated diarrhea in the Nile River Delta of Egypt was studied. A stool sample was obtained from children with diarrhea attending one of two study hospitals and of the 1275 children evaluated, 214 (17%) were found to be infected with Cryptosporidium.Younger age was a risk factor for developing Cryptosporidium-associated diarrhea. Children <12 months of age were 2.4 times more likely to be infected with Cryptosporidium (p<0.01) and children 12 to 23 months were 1.9 (p<0.05) times more likely to be infected with the organism as compared to older children. Breastfeeding had a trend towards protection against Cryptosporidium-associated diarrhea (p=0.07). Clinical findings associated with Cryptosporidium diarrhea included vomiting, persistent diarrhea and the need for hospitalization. Our data suggest that Cryptosporidium is common in Egyptian children and may be associated with severe diarrhea.     

Leg ulcers are a diagnostic and therapeutic challenge

Leg ulcers are common. They cause a substantial burden to the patient and society. However, there is no need for therapeutic nihilism. The target of leg ulcer therapy is the individual patient. To be treated in a rational and successful way, exact diagnosis of the underlying cause(s) and associated diseases is necessary. This can be done in the most effective way with an interdisciplinary approach. The collection of cases demonstrates the need for careful clinical investigation substantiated and supported by vascular, histopathologic, and microbiologic techniques whenever needed. It is difficult to heal every ulcer completely, but improvement of the medical situation as well as the quality of life of the patient is possible in most cases.     

Alcohol or traditional methods versus natural drying for newborn's cord care

This is a quasi-experimental study that aimed to compare the use of alcohol and traditional methods for newborn's cord care with a no-treatment approach, natural drying. The study also aimed to identify the factors associated with the occurrence of cord infection and time of cord separation. A convenient sample of 70 women with vaginal delivery, full-term and healthy babies was selected from postpartum departments of two university hospitals in Alexandria and Minia. A specially designed interview schedule was developed and utilized to collect data. Swabs were taken from the newborns' umbilical stumps on zero and 3rd day of birth to detect bacterial colonization. Follow-up was carried-out at home to assess methods used for cord care, babies' hygiene, cord infection and time of cord separation. The study revealed that traditional methods of cord care were used by women with higher mean age (30.8 +/- 7.8 years), from Minia (100%) or rural areas (71.4%), while alcohol and natural drying were used by women with lower mean age (27.7 +/- 4.8 and 24.8 +/- 6.5 years) respectively, from Alexandria (76% and 100%) respectively or urban areas (56% and 64.7%) respectively. Alcohol was used for male babies (76%), while traditional methods and natural drying were used for female babies (71.4% & 64.7%) respectively. Incidence of cord infection was significantly lower among natural drying group (35.3%), and no signs of systemic infection were observed among them. Rate of increase of bacterial colonization (from 0-3rd day of birth) was significantly higher in alcohol group (44%). It was relatively similar with presence or absence of cord infection (33.3 & 32.1) respectively. Mean time of cord separation was longer among alcohol group (6.4 +/- 2.4 days), as compared with natural drying group (4.7 +/- 1.9 days) and traditional methods group (3.4 +/- 0.7 days). Bathing baby while cord was attached was carried-out by all women of alcohol and natural drying groups, compared to only 28.6% of traditional methods group. Breast-feeding was significantly related to less incidence of cord infection (P= 0.008) and shorter time of cord separation (P= 0.002). Incidence of cord infection was significantly related to using cloth diaper (P= 0.015), using dry method for skin care (X(2) 2= 7.2917), giving tub bath (X(1)2 = 4.1788) and delaying the bath to the 7th day of birth (P= 0.050). Time of cord separation was significantly shorter with closed cord dressing (X(2)2= 20.4028), in Minia, during spring, among male babies (X(2)2= 15.0352), and in rural areas (X(2)2 = 9.7608). It was significantly longer with bathing the baby while cord was attached (X(2)2 = 27.9354), giving 2-3 baths/week or delaying the bath to the 7th day of birth (P= 0.049) and with using cloth diaper (P= 0.0467). So, moving from an intervention to a non- intervention, particularly in a healthy population should be applied to the healthy naturalistic approach to care advocated in nursing. Also, only through continuing efforts done to examine our assumptions about historic health care routines, will we be able to demonstrate evidence-based practice and to advance nursing care.     

Slow versus fast shock wave lithotripsy rate for urolithiasis: a prospective randomized study

PURPOSE: We determined the effect of shock wave lithotripsy (SWL) rate on treatment outcome in patients with renal and ureteral stones. MATERIALS AND METHODS: A total of 156 patients were prospectively randomized to receive SWL using a slow (60 pulses per minute) or fast wave rate (120 pulses per minute). Inclusion criteria were patients with a single radiopaque renal or ureteral stone not exceeding 30 mm in maximum diameter. Patient characteristics, stone and therapy features were reviewed, and the relation to success rate and total number of shock waves required was assessed using the chi-square, Fisher exact and Mann-Whitney tests. Factors proven to be significant in univariate analysis were entered in a multivariate logistic regression analysis. RESULTS: The study included 114 male (73.1%) and 42 female (26.9%) patients with a mean age +/- SD of 42.1 +/- 13.3 years. Stone length measured in maximum diameter was 13.2 +/- 5.9 mm (range 5 to 30). Renal stones were encountered in 94 (60.3%) patients and ureteral stones in 62 (39.7%). The slow SWL rate was used in 76 (48.7%) patients and the fast rate in 80 (51.3%). Baseline variables were comparable in both groups. However, the total number of shock waves required was statistically significantly lower in the slow rate group (p = 0.004) and the treatment time was significantly longer (p = 0.000). The rate of success, defined as being completely stone-free or having clinically insignificant gravel less than 2 mm, was significantly higher with the slow rate (p = 0.034), an increased number of sessions (p = 0.001), decreased stone length (p = 0.000) and greater total number of shock waves (p = 0.011). However, only the slow SWL rate and stone length maintained a statistically significant impact in multivariate analysis. CONCLUSIONS: The slow SWL rate is associated with a significantly higher success rate at a lower number of total shock waves compared to the fast SWL rate.     

Multicenter, randomized study of the effectiveness of basiliximab in avoiding addition of steroids to cyclosporine a monotherapy in renal transplant recipients

BACKGROUND: Steroid therapy is associated with an increased risk of cardiovascular events and well-documented adverse effects, but two thirds of patients initiated on monotherapy with cyclosporine A (CsA) microemulsion require addition of steroids. METHODS: In this 12-month randomized, double-blind, multicenter study, 108 renal transplant recipients were randomized and received basiliximab (n=52) or placebo (n=56) to assess whether basiliximab reduces the need for addition of steroids or other adjunctive immunosuppressive drugs to CsA monotherapy. RESULTS: The primary endpoint of the study (requirement for additional immunosuppression at 12 months posttransplant) occurred significantly less frequently with basiliximab (54%) than placebo (73%) (P=0.046). By the end of the study, 25% of basiliximab-treated patients were receiving maintenance steroids versus 61% of placebo-treated patients (P=0.0006). During the trial, 33% of basiliximab-treated patients received oral steroids at some time compared with 61% of placebo-treated patients (P=0.004). The proportion of patients experiencing biopsy-proven rejection was not significantly different between the basiliximab (29%) and placebo (43%) groups (P=0.16). Median serum creatinine at 12 months was 141 mumol/L with basiliximab and 164 mumol/L with placebo (not significant). One-year graft and patient survivals were 88% and 98% for basiliximab and 88% and 96% for placebo (not significant), respectively. Adverse events were similar in the basiliximab and placebo treatment groups. CONCLUSIONS: These findings demonstrate that the addition of basiliximab significantly reduces the need to modify the initial treatment regimen in patients scheduled to receive steroid-free CsA therapy, suggesting that basiliximab induction may be useful as a strategy in other steroid-avoidance regimens.     

Malignant bone tumors in Kuwait

Between 1995 and 2004, 142 malignant bone tumours comprising 76 primary and 66 secondary tumours were identified in the Pathology Department of Al-Sabah Hospital, Kuwait. Pathological fracture was the presenting sign in 35% of the cases. The mean incidence of primary tumours/year was 3.3 cases/million inhabitants. The primary tumours showed a male predilection and 42% occurred below the age of 20 years. The most frequent in the descending order of frequency were Ewing's sarcoma, multiple myeloma, osteosarcoma, chondrosarcoma and non-Hodgkin's lymphoma. The femur was the most common site for secondary tumours; more than half of the tumours with metastases at this site originated in the breast. The high frequency of Ewing's sarcoma is noteworthy and requires further investigation.