A Randomized Control Trial Comparing Transparent Film Dressings and Conventional Occlusive Dressings for Elective Surgical Procedures

BACKGROUND: Surgical site infection is one of the major health-care-associated problems causing substantial morbidity and mortality and constituting a financial burden on hospitals as well. The wound management is one of the crucial evidence-based strategies in the reduction of surgical site infection rates AIM: To study the impact of standardisation of transparent semipermeable dressing procedure on the rate of surgical site infection in comparison with conventional dressing in clean and clean-contaminated surgeries. METHODS: The study included 100 patients who were admitted to surgical wards in Cairo university hospitals, for clean and clean-contaminated operations, in the period from February 2017 to August 2017. Immunocompromised and uncontrolled diabetic patients were excluded. Patients were randomly allocated into two groups; in the first group, patients wounds were covered using transparent semipermeable dressing, while the second group patients’ wounds were covered using conventional occlusive gauze dressing. Patients were followed up for criteria of infection every other day during the first week then at two weeks, three weeks and four weeks. RESULTS: In clean and clean-contaminated operations, the transparent dressing group showed a significantly lesser rate of surgical site infection at (2%), compared with the conventional occlusive gauze dressing group with a surgical site infection rate of (14%) (p-value of 0.02). CONCLUSION: The transparent semipermeable dressing is effective in reducing surgical site infection rate in clean and clean-contaminated operations

Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients

Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.National Research Foundation of South Africa; Libyan GovernmentWeb of Scienc

Strategies for Improving Fertility in Buffalo Bulls under Summer Condition in Upper Egypt

          The purpose of this study was to determine the effect of i.m administration of (250 mg) GnRH on predicted testicular volume (PTV), scrotal circumference (SC), sperm assessment, and eventual fertility after ten weeks (period of the experiment), particularly in the summer (heat stress). Fifteen buffalo bulls (10 treatment and five control) with comparable age (1.5-2 years old) and body weight (300-400 kg) were used in this study. These animals must be housed in the Farm of Animals Production Department, Faculty of Agriculture, Al-Azhar University, Assiut, Egypt, under identical conditions (administration, diet, etc.). PTV, SC, and blood samples were collected soon before GnRH administration. Blood samples were taken from all animals after GnRH injection (treated groups) and normal saline in the control groups. PTV and SC were assessed every 15 days for the first 75 days. All blood samples were centrifuged after being stored at 4°C for 6 hours. Serum was isolated and kept at - 20°C until the hormone meagered. The ejaculate volume, individual motility, living sperm percent, and sperm concentration were all measured in the collected semen from these animals. Five females in estrus were bred by each animal from the treatment and control groups. At 60-75 days after mating, the pregnancy was detected by rectal palpation technique. Testosterone concentrations, PTV, and SC values rose considerably (P0.01) in treated bulls compared to controls after GnRH therapy. Serum testosterone levels climbed from 5.38 0.75 ng/ml to 14.86 1.51 ng/ml. Individual motility, the overall number of sperm/ejaculates, and the number of living sperm were significantly affected by GnRH administration. Furthermore, after receiving GnRH injections, the rate of pregnancy increased in females inseminated by treated bulls. It was 84.56.8% for treated buffalo bulls and 76.57.89% for control buffalo bulls. GnRH injection considerably enhanced PTV and SC levels, according to the findings. Furthermore, semen quality and fertility improved dramatically in treated bulls compared to controls, which may be affected by summer heat stress. GnRH also improves the reproductive performance of buffalo bulls in the summer

Association of circulating endothelial cells with flow mediated vasodilation and disease activity in patients with systemic lupus erythematosus

The aim of this study was to determine the correlation between CEC count and endothelial function, disease activity, and organ involvement in patients with SLE. Background: Premature atherosclerosis in patients with systemic lupus erythematosus (SLE) is not explained by traditional risk factors. Circulating endothelial cells (CEC) have been identified as a surrogate marker of endothelial dysfunction Methods: The present study included 30 premenopausal women with SLE and 20 age and sex matched healthy controls (HC). Endothelial function was studied by flow mediated vasodilation (FMD%) in the brachial artery. Serum levels of VCAM-1, ICAM-1 were measured. Results: FMD% was lower in patients with SLE than HC (3.5 ± 0.4 vs 9.7 ± 3.2, p < 0.001). CEC count was significantly elevated in patients with SLE compared to HC (38 ± 18 vs 7 ± 3, p < 0.001). CEC count correlated positively with systemic lupus activity score (r = 0.97), and negatively with FMD% (r = −0.94). Serum levels of VCAM-1 and ICAM-1 were significantly elevated in patients with SLE compared to HC (p < 0.001). There was a significant correlation between CEC count and vasculitic skin lesions (p < 0.01), renal involvement (p < 0.01), and VCAM-1 levels (p < 0.001). Conclusion: CEC is associated with endothelial dysfunction, disease activity and increased VCAM-1 levels in patients with SLE. These findings suggest a potential role of CEC in the pathophysiology of cardiovascular disease in these patients

Diagnosis of human brucellosis in Egypt by PCR

Background: Brucellosis is a significant health problem in Egypt.Methodology: To establish a PCR technique for diagnosis of active brucellosis in our institutions, DNA extraction was done using a commercial kit, and a laboratory extraction procedure. PCR amplification was done using 2 sets of primers: B4/B5 and JPF/JPR. Extraction of Brucella DNA using the commercial kit failed; therefore, this technique was discontinued. The laboratory extraction method was successful and more economic.Results: The technique showed high sensitivity, specificity, and accuracy. The PCR positivity increased significantly (P=0.001) with increasing the positive standard tube agglutination titer and showed 100% positivity in patients with positive blood culture.Conclusions: An accurate and sensitive PCR technique was established. Based on the results, the PCR method is recommended as an alternative to culture for the diagnosis of brucellosis. A large-scale study to evaluate this PCR technique to screen for brucellosis in Egypt is needed

Accuracy of the Traditional COVID-19 Phone Triaging System and Phone Triage-Driven Deep Learning Model

Objectives: During the COVID-19 pandemic, a quick and reliable phone-triage system is critical for early care and efficient distribution of hospital resources. The study aimed to assess the accuracy of the traditional phone-triage system and phone triage-driven deep learning model in the prediction of positive COVID-19 patients. Setting: This is a retrospective study conducted at the family medicine department, Cairo University. Methods: The study included a dataset of 943 suspected COVID-19 patients from the phone triage during the first wave of the pandemic. The accuracy of the phone triaging system was assessed. PCR-dependent and phone triage-driven deep learning model for automated classifications of natural human responses was conducted. Results: Based on the RT-PCR results, we found that myalgia, fever, and contact with a case with respiratory symptoms had the highest sensitivity among the symptoms/ risk factors that were asked during the phone calls (86.3%, 77.5%, and 75.1%, respectively). While immunodeficiency, smoking, and loss of smell or taste had the highest specificity (96.9%, 83.6%, and 74.0%, respectively). The positive predictive value (PPV) of phone triage was 48.4%. The classification accuracy achieved by the deep learning model was 66%, while the PPV was 70.5%. Conclusion: Phone triage and deep learning models are feasible and convenient tools for screening COVID-19 patients. Using the deep learning models for symptoms screening will help to provide the proper medical care as early as possible for those at a higher risk of developing severe illness paving the way for a more efficient allocation of the scanty health resources