Evaluation of management of paediatric gastrointestinal bleeding in emergency department at Alexandria university children's hospital

Objective: Gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The objective of this study is to evaluate the management of pediatric gastrointestinal tract bleeding in the emergency department [ED] at .Alexandria University Children's Hospital

Methods: A retrospective survey was conducted. All medical records of patients attending the ED complaining from gastrointestinal tract [GIT] bleeding and admitted to the hospital in the period from January 2010 to December 2013 were included in the study

Results: The medical records collected during the period of the current study [2010-2013] were 200 medical files. The valid files from which the data could be collected were 119 files. The patients were from urban and rural areas and were of different age groups [neonates, infants, preschool, and school age and adolescents] with male to female ratio of 1: 0.7. The management of GIT bleeding in ED did not follow the guide lines accurately. The most cases were diagnosed as UGIT bleeding. The diagnosis of LGIT bleeding was limited. The data of the patients were not fully and accurately recorded in the medical files

Conclusion: The management of GIT bleeding in ED should follow the guide lines. Full and accurate data should be recorded in the medical file

Chemical and toxicological studies on some phenothiazines

Phenothiazines are widely used in the treatment of certain psychiatric disorders. Overdoses of these drugs are common and are potentially lives threatening of patients. This work aims to study the chromatographic and spectrophotometric behavior of some of commonly used phenothiazines [chlorpromazine hydrochloride and fluphenazine decanoate]. And estimation of the drugs to determine their distribution among different tissues, hair and body fluids of albino rats by using quick, sensitive and reliable method of analysis. The present study was conducted on ninety albino rats. The study divided into two parts [A and B] each involved 45 rats; A: The chemical and toxicological studies on chlorpromazine hydrochloride in toxic, lethal and chronic toxic doses. B: The chemical and toxicological studies on fluphenazine decanoate in toxic, lethal and chronic toxic doses. After extraction of chlorpromazine and fluphenazine from brain, liver, kidney, muscle, hair and plasma with ammonium sulphate, identification of the drugs was done using color tests and thin layer chromatography. UV spectrophotomeric and HPLC analysis of the samples was done. The results revealed that thin-layer chromatography gave positive results with tissue extracts of all organs and in all doses. It was obvious from the obtained results that the method used for spectrophotometric analysis offers the advantages of simplicity, specificity without the need of further extraction or heating, besides having higher sensitivity range than most of the existing spectrophotometric methods. The highest concentration of chlorpromazine was found in the kidney in all doses, followed by serum in toxic dose and liver in both lethal and chronic toxicity. Then the distribution varies in the other organs according to the different doses. The mean concentration of chlorpromazine was higher with HPLC than that with spectrophotometric method with significant difference in all organs. The order of distribution of fluphenazine in various organs of animals receiving the toxic dose by both HPLC and spectrophotometric methods was; [kidney, muscles, serum, liver, lung, hair, brain and heart] While the order of distributions of fluphenazine in various organs of animals received the lethal dose by the two methods was; [kidney, liver, serum, muscle, brain, hair, heart and lung] and that for animals receiving the chronic toxic dose was,[kidney, liver, serum, muscle, hair, brain, lung and heart]. It was clear that the order of distributions of chlorpromazine and fluphenazine in various organs in all doses was the same either by spectrophotometric or by HPLC methods, but the concentration of the drug was higher by HPLC than that by spectrophotometer and this difference was significant in all organs

Induction chemotherapy followed by chemo-radiotherapy versus concurrent chemo-radiotherapy in advanced head and neck carcinomas

The aim of this study was to compare the result of application of induction chemotherapy followed by chemo-irradiation for treating locally advanced head and neck carcinoma in comparison with the former standard of concurrent chemo-irradiation. Between 2003 and 2006 we treated 74 patients with unrespectable [stage III and IV head and neck] cancer by two different protocols. The sequential protocol [Arm I], started with two courses of neoadjuvant chemotherapy [cisplatin + continuous infusions 5- fluorouracil [5-FU]], followed by a course of chemo-irradiation using conventional fractionation up to 70 Gy. The concomitant protocol [Arm II], Patients were given Cisplatin 100 mg/m[2] [D1, D22, D43]; concomitantly with a course of radiotherapy up to 70 Gy in conventional fractionation; Results from the two groups were compared. Patient and tumor characteristics were balanced [arm I=33, arm II =31 pts.]. Mean radiation dose achieved [66.3 Gy Vs. 69.6 Gy, p=0.001], response rates were [85% Vs. 88% for primary, p=0.4 and 79% Vs. 85% for lymph nodes, p=0.1]. Local control [LC; 33.5% Vs. 53.5%, p=0.04], was significantly lower in the sequential group, and overall survival [23% Vs. 38%, p=0.3] after 3 years. Acute toxicities grades III and IV predominate in the sequential group while late toxicity was similar in both groups. Concomitant chemo-irradiations is more effective in treating head and neck tumors than induction chemotherapy followed by chemo-irradiation, resulting in better local control and a trend towards improved survival

Incidence of acute pyogenic meningitis in infants and children

118 cases of acute pyogenic meningitis were admitted in the department of Paediatrics Liaquat Medical College, Hospitals Jamshoro/ Hyderabad in one year period with prevalence of 1.57% of the total admissions. After selecting the cases on clinical ground were proceeded further to confirm the diagnosis by cerebrospinal fluid cytochemical analysis, gram staining, culture and sensitivity and detection of the antigen of micro-organism by latex agglutination test

Efficacy of the accent method of voice therapy in treatment of vocal fold paralysis

One of the commonly used methods in treatment of unilateral vocal fold paralysis [U.V.F.P.] is the Smith Accent method. Individuals with glottal incompetence due to U.V.F.P. may complain of hreathy voice, decreased loudness and poor pitch control. The efficacy of the Accent method in those patients shows a great debate. This study was conducted on 20 patients with U.V.F.P. They were divided into two groups, group 1 did not receive therapy by the accent method, and group 2 who received therapy by the accent method. All patients were subjected to initial evaluation using the protocol of assessment which was taken as a [pretest data]. Follow-up evaluation was taken as a [post test] data. The values of the two groups were compared together and results were discussed

Hydrocortisone effects on composition of rat bone

Hydrocortisone is sometimes used as a necessary treatment for many diseases. But unfortunately, it usually causes osteoporosis when used for long periods of administration even with normal doses. It produces variations in calcium and phosphate contents in bones. The aim of the present work is to study the effects of long period hydrocortisone treatment on the bone composition of rat hind-leg. Three techniques were used in this study: X-ray imaging to analyze the bone density, molecular spectrophotometer for determining bone composition and histological study to clear the bone structure. The obtained data showed variations in calcium and phosphate contents during the hydrocortisone treatment periods which reached maximum changes after three weeks of treatment. The obtained results by X-ray images indicated changes in the bone density which were supported and found in good agreement with that obtained by both spectrophotometric analysis and structural changes

Successful outcome after evacuation of intracranial hematoma following thrombolysis in acute myocardial infarction

Thrombolytic therapy is the modality of choice for the treatment of life threatening thrombosis in various vascular territories and nowadays, is used extensively in setting of acute myocardial infarction. There is, however, the omnipresent danger of serious bleeding inherently associated with the use of all thrombolytics which if it occurs in the brain, can lead to potentially serious neurological impairment and even death. In our report, we describe the successful surgical management of a streptokinase-induced intracranial hemorrhage. Timely neurosurgical intervention is advocated as the optimal approach for this particular side effect of thrombolytic agents

Functional and destructive effects of microwave radiation on rat brain

Thite rats were in vivo exposed to microwave [MW] radiation in the cellular phone communication frequency range to investigate whether such exposure produces functional or morphological damage in the brain. Three groups were investigated: Mobile phone [MP] handset group, mobile stations tower [MT] group, and microwave source [MS] group. Subgroups of all exposed rats were taken for recovery studies. ECoG activities and histopathological changes were recorded before, during and after microwave exposure. As compared to control animals, EcoG patterns in exposed animals were found to be distinctly altered in each case of exposure. Some fluctuations had been recorded in shape, frequency, and amplitude of EcoG pattern accompanied with structural changes in some brain tissue elements

Gangrenous cutaneous mucormycosis of the anterior chest wall

Mucormycosis is a rare but serious fungal infection. We report a case of pro g ressive gangrenous cutaneous mucormycosis of the anterior chest wall

effect of maternal oxygen administration during the second stage of normal vaginal delivery or during cesarean section under general anaesthesia on umblical cord blood gases and acid- base state

The effect of maternal oxygen administration during labor on the fetal acid-base status was a subject of controversy for long time. This prospective study aimed to investigate the effect of maternal oxygen administration during the second stage of normal term vaginal delivery or elective Cesarean section on the umbilical cord arterial blood acid-base status. This study was carried out on 61 mothers admitted at term for vaginal delivery [32 cases] or elective Cesarean section under general anaesthesia [31 cases]. Oxygen was given in a rate of 10 L/ min. by tight-fitting face mask to 16 mothers during the second stage of vaginal delivery while the other 16 vaginally delivered mothers received no oxygen. Oxygen was given in a concentration of 30% [14 cases] and 50% [15 cases] to the mothers delivered by Cesarean section in the period between hysterotomy and birth. Umbilical cord arterial blood samples were taken and the following parameters were determinated: pH, P02, PCO2, bicarbonate, and base-excess by blood gas analyzer- No significant effect of maternal oxygen supplementation on the umbilical blood gas values was found. But maternal oxygen administration for short period [less than 15 min.] during the second stage of vaginal delivery may improve the umbilical blood gas values. Oxygen administration is not recommended during the second stage of normal term vaginal delivery. Oxygen in a concentration of 30% during elective Caesarean section is quite satisfactory

value of branched DNA hybridization assay [chiron] in patients with chronic HBV infection in comparison with HBeAg and HBV DNA-PCR

The optimal hepatitis B virus [DNA] quantitative assay for clinical use remains to be determined. Information on the virus load and the replicative activity of I-IBV is of importance in the management of patients with chronic HBV infection. We evaluate the branched-DNA [bDNA] assay [Quantiplex: Chiron Corp.] in-patients with chronic HBV infection in comparison with HBeAg and in-house HBV DNA-PCR. Serum samples from 53 hepatitis B surface antigen [HBsAg]-positive patients and 20 HBsAg-negative controls were assayed. According to presence or absence of HBeAg, the patients were divided into two groups: [1] First group consists of 9 HBsAg-positive and HBeAg-positive patients, [2] Second group consists of 44 HBsAg-positive and HBeAg-negative patients. Our results showed that the in-house HBV DNA-PCR was positive 77.78% [7 patients] and 15.91% [13 patients] in the first and second groups respectively. The branched DNA was positive [above the detection level] 55.56% [5 patients] and 9.1% [4 patients] in the first and second groups respectively. All the positive patients for HBV DNA by bDNA assay were positive also by in-house HBV DNA-PCR [9 patients]. Only 5 patients were positive for HBV DNA by in-house HBV DNA-PCR and at the same were negative by bDNA [below the detection level]. The rest of patients [39 Patients] were negative for HBV DNA by in-house DNA-PCP and bDNA assays. These results showed that PCR is a more sensitive method for detecting HBV DNA in serum than bDNA assay

Effect of chronic helicobacter pylori infection on growth and iron status in school children

Helicobacter pylori is probably the commonest bacterial infection of humans. The infection is likely to be acquired in childhood. Little is known about the effects of this chronic and lifelong infection on growth of infected. The aim of this work was to investigate the true effect of chronic Helicobacter pylori infection on growth and iron status of school children. Also to study the effect of eradication of H pylori on the management of iron deficiency anemia in this age group. This study was carried out on 60 school children, 34 males and 26 females whose ages ranged from 6 to 14 years. They were selected from the outpatient pediatric clinics during the period from August 2000 to November 2001. These children were classified into three groups. Group I: Included 21 children infected with H. pylori and had no evidence of iron deficiency. Group II: Included 16 H pylori infected children with proved iron deficiency anemia. Group III: Included 23 normal healthy control children. The diagnosis of H. pylori infection was based on the detection of serum IgG anti-Helicobacter pylori antibodies by ELISA technique. Each case was subjected to a thorough clinical examination and complete environmental history with emphasis on risk factors for H pylori infection. The following investigations were carried out for all cases: hemoglobin levels, MCV values, reticulocytic counts, serum iron levels, total iron binding capacity, and serum ferritin levels. Our findings confirmed a significant association between low socioeconomic classes, lack of running water, overcrowded unsanitary homes and H pylori infection. We also found that the means of children 's weight and height values were significantly decreased [p value <0.05 and <0.01 respectively] in the group II having both H pylori and iron deficiency anemia compared to the control group. After eradication of H pylori infection, iron therapy resulted in a significant increase in the mean levels of hemoglobin, hematocrit, serum iron and serum ferritin when compared with the mean levels before eradication. In conclusion, chronic H pylori infection is one of the environmental hazards, which may affect the growth and the iron status of school children that are in need for larger amount of iron to meet their rapid growth requirements. H pylori infection should be suspected when IDA is refractory to iron administration in older children. We also propose that treatment for iron deficiency anemia coexistent with H pylori infection should include H pylori eradication

In utero sonographic estimation of fetal liver weight can it be a useful biometric parameter for assessment of fetal growth?

Assessment of fetal growth is important and difficult issue. The aim of this work was to define the usefulness of liver weight estimation by ultrasonography as a biometric parameter for assessing fetal growth in normal pregnancies. A single fetal ultrasonographic examination was obtained between 20[th] and 41[st] week of gestation in 113 normal pregnancies. Fetal body weight was calculated with standard methods. Fetal liver weight was estimated on the basis of longitudinal, antro-posterior, and cephalo-caudal liver dimensions multiplied by a constant [K] of 0.42. Fetal liver weight estimation in our study was highly correlated with both fetal weight and gestational age. Liver weight estimation is a very useful parameter in assessing fetal growth and in calculation of fetal age in normal pregnancies

Evaluation of diagnostic procedures and outcomes in thyroid surgery: the experience of Al-Amiri hospital

To evaluate the ability of different diagnostic procedures in predicting thyroid malignancy, and to highlight outcomes of thyroid surgery Al-Amiri Hospital, 1990-95 Retrospective review of surgical records. 1.4% of all surgical interventions performed during that period [N=210] were thyroid cases. Surgical indications were solitary cold nodule [58%], multinodular goitre [36%] and hyperthyroidism [5%]. Following surgery, only 10% [n = 21] were histopathologically malignant. Based on postoperative findings, malignancy could have been predicted by thyroid isotopic scanning in no more than 11% of cases, and by ultrasounds [U/S] in 9% of solid lesions. Fine needle aspiration [FNA] accurately predicted 87% of cases. Only 26 patients [13%] developed post-operative complications, of which the most common was voice change [n = 8], mostly transient [6/8]. In this series, most patients [77%] stayed in-hospital for 3-5 days. The predictive value of malignancy in thyroid nodule[s] using fine needle aspiration is by far higher than that of ultrasound or thyroid scans. U/S may be preferred to visualise sub-clinical nodules. At this point in time, FNA is always recommended to diagnose malignancy, and the adjunct use of U/S helps in locating all potentially active nodules. In the presence of U/S. thyroid scans may be of lesser value. Thyroid surgery is generally safe, and should become an outpatient procedure. Hospital stays should be determined by the extent of surgery and/or the appearance of complications

Preliminary results on prevalence of hepatitis C viral infection among patients with surgical biliary diseases

To assess the frequency of hepatitis C virus [HCV] seropositivity among biliary surgical patients. Follow-up of 105 patients tested over 6 months at the Al-Amiri Hospital [1997]. Results: 8.6%, of patients were HCV seropositive. There were no age and sex differences between seropositive and seronegative patients. The risk for seropositivity was higher among Egyptian patients compared to other nationalities. A history of blood transfusion was reported by only one seropositive patient. The prevalence of seropositivity among biliary surgery patients was higher than that reported among blood donors in Kuwait [2.6% in 1997], suggesting that HCV may indeed be a risk factor for biliary problems. The relatively higher proportion of seropositivity among Egyptian patients reflects the endemicity of HCV in their country of origin. This study highlights the importance of adhering to standard surgical precautions. Routine testing is not recommended except for Egyptian patients

Penile reconstruction using a sensate radial forearm osteocutaneous flap

One-stage reconstruction of the penis on using a radial forearm innervated osteocutaneous flap was performed on a 20 year-old man who lost his external genitalia due to a rocket explosive injury. The operative details, six month-follow up, as well as the literature review are discussed

Laparoscopic removel of needle embedded in small bowel wall

In this report, we describe a successful laparoscopic removal of foreign body [FB] "Metallic Needle" embedded in the small bowel wall

Umbilical artery doppler velocimetry and high risk pregnancies evaluation and clinical significance

Our prospective controlled study includes a study group of 46 cases with abnormal Doppler umbilical artery velocity wave from flow and compared to 98 high risk matched pregnancy women with normal Doppler test as a control group. Our results showed that the study group had a significant lower gestational age, birth weight and higher incidence of elective delivery [59%]. Caesarean section and neonatal intensive care admissions at birth. There was a significant risk of acidosis and hypoxia in cases with assenter reversed end diastolic flow as indicated by the significant changes of umbilical cord artery ph. PHz 02. PC02. base deficit and bicarbonate compared to other study groups. A significant low 1-and 5-minute apgar score was also reported. The mean cord artery PH was significantly lower if the amniotic fluid was meconium stained. No prenatal death was reported throughout the study. We concluded that Doppler study of umbilical artery flow is an important criteria during assessment of high risk pregnancies. Cases with elevated S D ratio can be closely followed up other commonly used criteria for delivery to avoid iatrogenic prematurely and prolong gestational age with acceptable fetal outcome. Cases with absent or reversed end diastolic flow are much more liable for fetal acidosis and asphyxia. Thus early obstetric interference will improve fetal outcome and decrease perinatal death rat