HCV Infection in Egyptian Patients with Acute Hepatitis

The diagnostics of community-acquired acute HCVhepatitis in an endemic area was studied in 110 Egyptianpatients with acute jaundice. In the first week of thejaundiced period 30 of 110 patients (27.3%) had anti-HCVantibodies. The majority already showed high levels ofanti-HCV IgG (25/30), associated with anti-HCV IgM innine of them. Five patients showed only an HCV IgMreactivity. Seven had also anti-HEV and/or anti-HBV: their jaundice couldthen be related to an acute infection caused by thoseviruses. All patients were infected with genotype 4a, inthree associated with the 3a. During the follow-up five patients seroconverted for IgG, whiletheir anti-HCV IgM did not show a uniform pattern ofreactivity. Patients with positive serology suspected ofan acute HCV infection were older than the patients with other acute hepatitis and showed a lowerpeak of ALT level. Seroconversion during acute hepatitisstrongly indicated HCV as the etiologic agent. However,the detection of anti-HCV IgG antibodies in the jaundiced period showed that the majorityof patients had already seroconverted to anti-HCVantibodies; in most of them it is possible tohypothesize a reactivation of a chronic HCVinfection.     

Detection of abnormal proliferation in histologically 'normal' colonic biopsies using FTIR-microspectroscopy

BACKGROUND: Abnormal crypt proliferation and development in the colon has been associated with premalignant stages of colon cancer. Conventionally, molecular markers are used to detect abnormal crypt proliferation. METHODS: In the present work, feasibility studies of FTIR-MSP to distinguish between normal and abnormal crypts from colon biopsies that show normal histopathological features have been undertaken. RESULTS: The results indicate that abnormal crypts show deviations in the pattern of absorbance in the Mid IR region along the crypt height when compared with the normal crypts. The crypts could be empirically classified into three groups such as crypts having a normal absorbance pattern for all biochemical components, crypts with abnormal absorbance pattern for some biochemical components and crypts with completely abnormal absorbance pattern along the height for all or most biochemical components studied by FTIR. The utilization of FTIR-MSP is proposed for diagnosis of abnormal metabolism at the molecular level of histologically completely normal-looking crypts, especially from those biopsies that are taken from sites far away from cancer. CONCLUSIONS: This method could give rise to a reduction in false-negative results during examination of biopsies using the conventional histopathological methods. The present method may be complementary to existing methods for precise demarcation of the zone of colostomy prior to colon cancer surgery.     

The significance of elevated troponin T in patients with nondialysis-dependent renal insufficiency: a validation with coronary angiography

BACKGROUND: Patients with elevated troponin are at high risk of adverse outcomes, future cardiac events, and are more likely to have hemodynamically significant coronary artery stenoses. Elevated troponin T (cTnT) in patients with poor renal function portends a poor prognosis; however, findings of significant coronary artery disease (CAD) by coronary angiography have not been demonstrated in patients with poor renal function and elevated cTnT. HYPOTHESIS: The purpose of this study was to correlate the angiographic findings of patients with elevated cTnT with respect to renal function in patients with nondialysis-dependent renal insufficiency. METHODS: We retrospectively identified 342 patients with elevated cTnT who underwent coronary angiography in the setting of acute coronary syndrome. Patients were divided into poor (< 40 ml/min) and normal (> 40 ml/min) renal function by measuring their glomerular filtration rate. Our primary outcome was CAD stenosis, defined as epicardial stenosis > or = 70%. Secondary outcomes were rates of contrast nephropathy, initiation of hemodialysis, revascularization, length of stay (LOS), and in-hospital mortality. RESULTS: There was no significant difference in the prevalence of CAD between patients who had positive cTnT with poor renal function versus patients with positive cTnT and normal renal function (87.1 vs. 89.7%, p = 0.54). This finding persisted after stratifying by age. Patients with impaired renal function had a higher mortality, longer LOS, and a higher rate contrast nephropathy requiring hemodialysis. CONCLUSION: The association between elevated cTnT and significant CAD stenosis does not vary with renal function.     

Parotid elastography: a potential alternative to replace labial biopsy in classification of patients with primary Sjögren’s syndrome?

Clinical Rheumatology - There has been a substantial improvement in classifying patients with primary Sjögren’s syndrome (pSS), with the new 2016 ACR/EULAR classification criteria. It...     

Management of fistula of ileal conduit in open abdomen by intra-condoit negative pressure system

INTRODUCTION

We aimed to present the management of a patient with fistula of ileal conduit in open abdomen by intra-condoid negative pressure in conjunction with VAC Therapy and dynamic wound closure system (ABRA).

PRESENTATION OF CASE

65-Year old man with bladder cancer underwent radical cystectomy and ileal conduit operation. Fistula from uretero-ileostomy anastomosis and ileus occurred. The APACHE II score was 23, Mannheim peritoneal index score was 38 and Björck score was 3. The patient was referred to our clinic with ileus, open abdomen and fistula of ileal conduit. Patient was treated with intra-conduid negative pressure, abdominal VAC therapy and ABRA.

DISCUSSION

Management of urine fistula like EAF in the OA may be extremely challenging. Especially three different treatment modalities of EAF are established in recent literature. They are isolation of the enteric effluent from OA, sealing of EAF with fibrin glue or skin flep and resection of intestine including EAF and re-anastomosis. None of these systems were convenient to our case, since urinary fistula was deeply situated in this patient with generalized peritonitis and ileus.

CONCLUSION

Application of intra-conduid negative pressure in conjunction with VAC therapy and ABRA is life saving strategies to manage open abdomen with fistula of ileal conduit.     

Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: A case report

INTRODUCTION

To present the management of open abdomen with colorectal fistula by application of intrarectal negative pressure system (NPS) in addition to abdominal NPS.

PRESENTATION OF CASE

Twenty-year old man had a history of injuries by a close-range gunshot to the abdomen eight days ago and he had been treated by bowel repairs, resections, jejunal anastomosis and Hartman''s procedure. He was referred to our center after deterioration, evisceration with open abdomen and enteric fistula in septic shock. There were edematous, fibrinous bowels and large multiple fistulas from the edematous rectal stump. APACHE II, Mannheim Peritoneal Index and Björck scores were 18, 33 and 3, respectively (expected mortality 100%). After intensive care for 5 days, he was treated by abdominal and intrarectal NPS. NPS repeated for 5 times and the fistula was recovered on day 18 completely. Fascial closure was facilitated with a dynamic abdominal closure system (ABRA) and he was discharged on day 33 uneventfully. There was no herniation and any other problem after 12 months follow-up.

DISCUSSION

Management of fistula in OA can be extremely challenging. Floating stoma, fistula VAC, nipple VAC, ring and silo VAC, fistula intubation systems are used for isolation of the enteric effluent from OA. Several biologic dressings such as acellular dermal matrix, pedicled flaps have been used to seal the fistula opening with various success. Resection of the involved enteric loop and a new anastomosis of the intestine is very hard and rarely possible. In all of these reports, usually patients are left to heal with a giant hernia. In contrast to this, there is no hernia in our case during one year follow up period.

CONCLUSION

Combination of intra and extra luminal negative pressure systems and ABRA is a safe and successful method to manage open abdomen with colorectal fistula.     

Assessment of muscle stiffness using a continuously scanning laser‐Doppler vibrometer

Introduction: A stand‐alone and low‐cost elastography technique has been developed using a single continuously scanning laser Doppler vibrometer. Methods: This elastography technique is used to measure the propagation velocity of surface vibrations over superficial skeletal muscles to assess muscle stiffness. Results: Systematic variations in propagation velocity depending on the contraction level and joint position of the biceps brachii were demonstrated in 10 subjects. Conclusions: This technique may assist clinicians in characterizing muscle stiffness (or tone) changes due to neuromuscular disorders. Muscle Nerve 50 : 133–135, 2014