Empirical treatment with cefotaxime is effective in 81% of cases; meropenem is effective in cefotaxime-resistant cases.

Conclusion:This study showed a high prevalence of parasitic infections among the children in the rural areas of Egypt and IDA is associated with intestinal parasitic infection.

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Introduction: Available data on the possible association between Helicobacter pylori (H. pylori) infection and diabetes mellitus (DM) are contradictory. The prevalence of cytotoxin associated gene product A (cagA) positive H. pylori is high in Egypt. This study aims to examine its association with type 2 DM, and its effect on glycemic control and the occurrence of microalbuminuria. Methods:The study involved 98 dyspeptic type 2 diabetic patients and 102 dyspeptic non-diabetic subjects who underwent upper gastrointestinal tract endoscopy in Zagazig university hospital. H. pylori infection was diagnosed by histopathology and/or culture. The presence of cagA positive strains was confirmed by polymerase chain reaction (PCR) and gel electrophoresis. Fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c) and urinary albumin excretion ratio (UAER) were compared between infected and non-infected diabetic patients.Results: Diabetic patients had similar age and gender distribution but significantly higher body mass index (BMI) compared to controls. The prevalence of H. pylori infection (54.1% versus 56.9%, P = 0.3) and the prevalence of cagA positive H. pylori strains (40.8% versus 36.3%, P =0.1) were not significantly different between the two groups. Diabetic patients infected with cagA positive H. pylori strains had higher mean FBS (199±22 versus 163±20, P=0.00), higher mean HbA1c (8.6±0.8 versus 6.3±0.8, P=0.00) and higher rate of microalbuminuria (67.5% versus 10.3%, P=0.00) than non infected diabetic patients. Conclusion:H. pylori infection with cagA positive strains was similarly common in dyspeptic diabetic patients and controls. It was associated with poorer glycemic control and higher rates of microalbuminuria in diabetic subjects.

Aim of the study: Liver cirrhosis is an irreversible destructive liver disease that is associated with a wide range of complications. Among the recognized comorbidities of liver cirrhosis are sleep-disordered breathing (SDB), which is being more and more often described among cirrhotics. This study aimed to detect the prevalence of SDB among Egyptian post-viral cirrhotic adults. Material and methods: This study enrolled 48 post-viral cirrhotic patients and 16 apparently healthy control subjects. All patients and controls were evaluated by thorough history taking, full clinical examination, laboratory investigations, the Epworth Sleepiness Scale questionnaire, the Berlin Questionnaire and polysomnography. Results: Patients and controls were comparable as regards baseline demographics. Patients with liver cirrhosis had higher frequency of SDB compared to controls (56.2% vs. 12.5%, p = 0.002). The most frequently encountered SBD patterns among cirrhotics were obstructive sleep apnea and apnea hypopnea index. Moreover, SDB was more severe among cirrhotics (25% were mild, 16.6% were moderate and 14.6% were severe obstructive sleep apnea-OSA) compared to the healthy controls (all were mild). Conclusions: It seems that post-viral cirrhotic patients had a wide range of SDB with variable degrees of severity compared to the healthy controls.

Background and aim: Endoscopic variceal ligation (EVL) is one of the best modalities for treatment of esophageal varices. One of the most serious complications after EVL is post-banding ulcer bleeding. In this study, frequency and risk factors of EVL-induced ulcer bleeding were assessed. Methods: One hundred and twenty six patients with liver cirrhosis subjected to EVL, whether done as prophylactic or therapeutic, were followed up for two weeks for detection of occurrence of postbanding ulcer bleeding. A prospective cohort study was performed comparing the patients that bleed after EVL due to post-banding ulcer (bleeder group, n= 10) with those without this complication (non-bleeder group, n= 116). All patients received full medical history taking; complete physical examination; routine laboratory tests; Pelvi-abdominal ultrasonography; Esophago-gastroduodenoscopy (EGD) and EVL; treatment with blood transfusion and pharmacologic agents; re-endoscopy if rebleeding occur after EVL. Results: Frequency of post-banding ulcer bleeding after EVL in patients who have liver cirrhosis was 7.9%, and its mortality within 14 days follow up was 10%. Reflux esophagitis was found to be a risk factor of post-banding ulcer bleeding (P= 0.016, OR= 8). Proton pump inhibitor (PPI) may be a protective factor against occurrence of post-banding ulcer bleeding (P= 0.054). Conclusion: Post-banding ulcer bleeding is an infrequent complication after EVL. Reflux esophagitis is considered an independent risk factor for this complication.

Objectives: Salmonella typhi forms biofilm on the surface of gallstones promoting colonization and carrier state. The aims are to detect its frequency in chronic calcular cholecystitis patients, to find out their antibiotic resistance pattern, and also to examine biofilm on the surface of gallstones and detect its correlation to antibiotic susceptibility pattern. Materials and methods: The study group included 257 patients with chronic calcular cholecystitis. S. typhi was isolated from gall bladder specimens. Antibiotics susceptibility tests of the isolates were done. Biofilm on surface of gallstones were visualized using scanning electron microscopy. Virulence (Vi) antibodies against S. typhi were studied in sera of 257 healthy controls. Results: 10.9% of patients were chronic typhoid carriers compared to only 3.5% of the controls (OR= 3.37, p=0.002). Multidrug resistance was detected in 35.7% of isolates. S. typhi biofilms on the surface of the 21/28 (75%) gallstones were detected. Ninety percent of the strains that produced maximum amount of biofilm were multidrug-resistant. Conclusion: Chronic calcular cholecystitis patients are more prone to typhoid carriage due to biofilm formation of S. typhi on the surface of gallstones.

Background and study aim: Schistosomiasis was endemic in Egypt since the ancient times. It was traditionally the most important public health problem. This study aimed to evaluate the current status of schistosomiasis in Sharkia governorate, Egypt. Patients and methods: Over 5 years (2005-2010), schistosome eggs were sought by sedimentation techniques in stool and urine samples of 30,000 outpatient persons attending the Tenth of Ramadan Charity Hospital, Tenth of Ramadan City, Sharqia Governorate, Egypt and in histologically processed rectal biopsy samples from patients with negative coproscopy. These samples were obtained by lower endoscopy from 250 patients out of them. Results: Eggs of Schistosoma haematobium were encountered in urine samples of 6 persons (0.02%) of the 30,000 outpatients.Eggs of Schistosoma mansoni were encountered in stool samples of 99 persons (0.33%) of the 30,000 outpatients. Eggs were also found in 12 persons (4.8%) (2 with living Schistosoma mansoni eggs, 1with dead Schistosoma haematobium eggs and 9 with dead Schistosoma mansoni eggs) out of the 250 patients contributing to rectal biopsy samples. Conclusion: The present findings revealed a decrease in the prevalence of schistosomiasis that may be explained by the current policy of schistosomiasis control in Egypt.