Cutaneous metastasis from breast carcinoma: a brief report of a rare variant and proposed morphological classification

Breast carcinoma is the second commonest cancer in women after non-melanoma skin cancers and, excluding melanoma, the most common tumor to metastasize to the skin in women. Cutaneous metastasis from breast cancer has varied presentations but there is no well-established classification which includes them all. We report a 69 year-old lady with advanced primary ductal carcinoma of right breast [Ct[4]cN[1]cM[0]] who presented five months after radical mastectomy with very extensive cutaneous metastases in absence of distant spread. Skin involvement was in the form of nodules and purpuric papulo-vesicles on a background of erythema which clinically mimicked lymphatic malformation. We also propose a morphological classification of the cutaneous metastasis from breast cancer

Prognostic value of plasma pro-adrenomedullin and antithrombin levels in neonatal sepsis

Neonatal sepsis is one of the major causes of morbidity and mortality in neonates. Proper diagnosis and management of neonatal septicemia can markedly affect prognosis of neonatal sepsis. In sepsis serum pro-Adrenomedullin level [pro-ADM] was known to be increased while Anti thrombin is rapidly depleted as a result of decreased synthesis, increased destruction, and enhanced clearance. The aim of this study was to clarify the prognostic value of serum Pro-ADM and Anti thrombin level in neonatal sepsis. 40 full term neonates with sepsis were enrolled in this study including 20 cases with mild sepsis and 20 cases with severe sepsis. They were admitted to the neonatal intensive care unit, they included 26 males and 14 females with a mean birth weight of 3.2 +/- 0.26 kg. Twenty healthy full term neonates of matched age and sex served as a control group. Serum levels of Pro ADM and Antithrombin were measured in all patients and control group. Serum Pro ADM level was significantly higher in neonates with sepsis than control group, was significantly higher in severe than mild sepsis and was significantly higher in the unsurvived cases. Antithrombin concentrations were significantly lower in neonates with sepsis than control group, significantly lower in severe than mild sepsis and significantly lower in neonates with sepsis who died than who survived. In conclusion, higher pro-ADM and lower initial AT levels in neonatal sepsis are associated with severe disease and increased risk of mortality

Fentanyl transdermal therapy system [ITS-patch] for post-traumatic blunt chest injury

Proper post-extubation pain control in traumatic blunt chest injury represents a challenge to provide adequate analgesia for proper lung inflation and to prevent re-intubation. In this case, the average opioid [Remifentanil] infusion drip in a traumatic blunt chest injury patient in the 48 hours prior to extubation was calculated and converted to the equivalent analgesic one of the Fentanyl Transdermal Therapeutic System [Fentanyl TTS Patch]. The analgesic gap before the onset of action for the applied fentanyl patch was covered by frequent injections of tramadol. Evaluation of the Fentanyl TTS effect through the post-extubation period was carried out by measuring the analgesic effect on a visual analogue scale, the alertness status by simple sedation score, while the respiratory performance was followed by the negative inspiratory force. The outcome in this case showed that Fentanyl Patch is a reliable, favorable, safe and non-invasive method that produces a good analgesic effect and positive impaction on the post-extubation course of respiratory performance with a satisfactory outcome and no side effects

Experienced airway management in laryngotracheal injuries: series of cases, survey and review of literature

Definitive airway control of penetrating laryngotracheal injury can be an extremely difficult challenge for the emergency physician. We report three serious cases of penetrating neck trauma with laryngeal injury that were managed successfully using different techniques of airway control in the Emergency Department [ED] of Hamad General Hospital during the three years from January 2006 through December 2008. Individualized assessment, identification of type of injury and familiarity with airway control techniques and the available options assure timely, safe and proper airway control in such injuries. Choice of technique in penetrating Iaryngotracheal injury is multifactorial and depends upon case presentation, physician preference, skill, and clinical constraints. The incidence of neck injury during this period was lower than in other reports; being 0.07% of total trauma cases, while the incidence of penetrating neck injuries represented 17.6% of total neck injuries with no deaths. Familiarity and availability of variant airway management techniques and variant surgical interventions in penetrating laryngotracheal injuries, improve outcome and reduce mortality

Studies on Shiga-toxins [STX1 and STX2] produced by escherichia coli isolated from diarrheal cases in Assiut university children hospital

Shiga toxin producing E. coli. [STEC] are emerging pathogens capable of producing sporadic and epidemic diarrhea that may be complicated by haemorrhagic colitis and life threatening hemolytic uremic syndrome [HUS]. The goals of the present study is testing stool specimens for Shiga toxins [Stx1 and Stx2] and detection of the prevalence of the Shiga toxin producing E. coli [STEC] among the diarrheal cases collected in Assiut University Children Hospital. For these purposes, stool specimens from 150 inpatients and 150 outpatients with diarrhea, watery diarrhea or bloody diarrhea and from 40 infants and children with no gastrointestinal illness as control were collected from Assiut University Children Hospital. Escherichia coli was detected in 30 [20%], 64 [42.67%] and 12 [30%] of the inpatients, outpatients and control group respectively. The detection of the Shiga toxins [verotoxins] was done by phenotypic method [Vero cell cytotoxicity assay], immunological method [EIA using RIDA screen kit] and finally by genotypic method [multiplex PCR]. During our study, multiplex PCR [as gold standerd] showed that 4 [13.33%] and 17[26.56%] of E. coli isolated from the inpatients and outpatients respectively were STEC. Non of the E. coli isolateded from control group were STEC. Seven [33.3%] of STEC isolates carried Shiga toxin 1 [Stx1] genes and 14 [66.7%] of STEC isolates carried Shiga toxin 2 [Stx2] genes

Nurses' perception toward hallmarks of the professional nursing practice environment

Are characteristics of the practice setting that best support professional nursing practice and allow baccalaureate and higher degree nurses to practice to their full potential, and assist nursing students educated at the baccalaureate level and above to make the best decision regarding where to practice following graduation. This study aimed to assess Hallmarks of the Professional Nursing Practice Environment as perceived by Bachelor Undergraduate Nursing students, Nurse Interns and nursing staff working/training at Main University hospital, Alexandria University, and conducted at Alexandria Main University hospital, on 336 nurse students, interns and staff nurses from those meeting the inclusion criteria and were available during data collection period. "Hallmarks of the professional nursing practice envtronment questionnaire developed by American Association of Colleges of Nursing [AACN 2001] was used to collect data. The study main findings were that the subjects' perception for Hallmarks of the professional nursing practice environment was below the acceptable level, however, above the average. Nurse Interns tended to have significantly higher perception for all hallmarks; while staff nurses as well as nurse students tended to have the lowest one. Age and years of experience of the staff nurses were found to be not affecting nurses' perception. Diploma nurses were found to perceive hallmarks more significantly as compared to bachelor nurses, Finally, the overall perception of staff nurses working in special care units was high in comparison to those working in the general wards

Job-related stressors and coping strategies among nurses

Stress sometimes can be constructive but too much pressure creates prolonged stress.It can lead to negative organizational outcomes and also can lead to employees physical and mental ill health. Job-related stress results from interaction of the worker and the conditions of work. These conditions include: organizational external environment; organizational structure and climate; physical work environment; role demands and expectations; relationships at work; and patient care demands. Managing stress effectively can significantly improve the quality of life that is reflected in the performance and conduct. This study was conducted to determine the relationship between job-related stressors and coping strategies among nursing personnel. This study conducted in the Intensive Care Units [ICU] [n=10 units] and in general units [n=40] at Alexandria Main University Hospital. The subject comprised of two categories of nursing personnel. The first category comprised of all available head nurses [n=50], the second category comprised of all available bed side nurses [n=150]. Job-related stress and coping strategies questionnaires was the tool developed by the researcher based on the review of the related literatures. The findings of this study show that there was significant relationship between job-related stress, outcome responses, coping strategies, and job categories. The relationship between nurses' qualifications and coping strategies was not statistically significant. Also, it was found that the mean score of the three groups of the nurses' qualifications was the highest for eliminating stressors as a coping strategy. Moreover, there was negative significant correlation between the outcome responses and eliminating stressors as a coping strategy. There was negative significant statistical correlation between external job-related stressors and coping strategy related to using adaptive behaviors. This study concluded that unpleasant physical conditions, organizational climate, Job demands and relationship at work can directly contribute to stress evokes on the job

Colorectal carcinoma from Saudi Arabia Analysis of MLH-1, MSH-2 and p53 genes by immunohistochemistry and tissue microarray analysis

To document the incidence and role of p53 and DNA mismatch repair proteins in colorectal carcinomas, and to evaluate the relative frequency of major molecular pathways in colorectal cancers from Saudi Arabia. We collected the formalin fixed, paraffin embedded tissues from 154 colorectal tumors [83 patients from King Faisal Specialist Hospital and Research Centre and 71 from Saudi Aramco Dhahran Health Centre] between January 1989 and December 2003. We analyzed the p53 and mismatch repair gene expression [hMSH-2, hMLH-1] by immunohistochemistry in tissue microarray format. Expression loss of at least one mismatch repair gene was found in 33.8% of cases and significantly associated with the right-sided tumor location [p=0.0047]. The p53 positivity was observed in 57.5% of tumors, and was inversely linked to expression loss of mismatch repair genes [P=0.0102]. The strong confirmation of the previously established associations between tumor phenotype, and mismatch repair gene alteration provided strong evidence for the validity of our experimental approach. Together with the higher incidence of right sided location in Saudi [46.6%] than in Western colon cancers [34.9%], the observed high prevalence of mismatch gene expression loss in Saudi tumors argues for a higher importance of microsatellite instability in this population. If confirmed, it will be interesting to see whether an increased level of familial or sporadic microsatellite instability cases is causing this variation

Appropriateness of length of hospital stay for patients undergoing one-day urology surgery

One day surgery has developed over the past 3 decades for a number of reasons including advanced managing care and health maintenance organizations, improved surgical instruments, less invasive surgical techniques, availability of a team approach in preparing a person for surgery and home recovery and the desire to reduce health care costs. The present study aimed at assessing the Pre-decided one day surgeries among patients admitted in urology surgery department at the Main University Hospital, determining proportion of inappropriate days of hospitalization, and uncovering reasons associated with inappropriate utilization of hospital stay. Among 1607 reviewed records, 800 [49.78%] cases were decided to be conducted as one-day surgeries. Concerning the total Length of Stay [LOS], findings revealed that only 10.6% of these days were appropriated 89.4% of the reviewed hospital days were inappropriate and can be managed for more efficient and effective care provision. Premature admission, weekends and problems in scheduling surgery were the reasons of inappropriate preoperative stay, while doing diagnostic procedures and/or treatment that can be done on an outpatient basis and lack of family for home care, were found to be reasons for postoperative stay

effects of different storage media on the regeneration of pdl in experimentally avulsed teeth [histological and immuno-histochemical study]

The choice of storage medium for preserving the traumatically avulsed teeth is important for the success of future replantation. The objectives of this study were to evaluate the effectiveness of pre-replantation storage media on periodontal ligament healing. Extracted, fully-developed rat maxillary incisors were stored in milk, saline or tap water for 15 minutes. Teeth that had been stored in either cold milk or saline showed regeneration of typical PDL, while those stored in tap water showed signs of degeneration. The present study has showed that cold milk and saline may thus be rec-'ommended as storage medium for ex-articulated teeth prior to replantation in case when immediate replantation is not possible

Scanning electron microscopic observations of the root surface in both permanent and deciduous teeth

This study describes the histological features of human cementum along different locations of the root in both deciduous and permanent teeth. 20 freshly extracted teeth with minimal periodontal involvement were collected. They include deciduous [anterior and posterior] teeth and permanent [anterior and posterior] teeth. Scanning electron microscopic observations revealed presence of minute resorping lacunae in both deciduous and permanent teeth with great variability in the number and depth. A striking observation revealed the presence of cracks on the root surface of permanent teeth and their absence in deciduous one. The recorded differences may be related to the differences in the fate as well as the function of the roots in both dentitions. Where in deciduous teeth, roots were re-sorped during shedding whereas in permanent teeth, cementum provides media for the attachment of periodontal ligament through out the life span of the tooth

Tretinon peeling versus glycolic acid peeling in the treatment of melasma

The present study was designed to evaluate the result of applying chemical peel by l% tretinoin versus glycolic acid 70%in the treatment of melasma. The study included 30 patients presented with epidermal melasma, tretinoin 1%solution was applied on the left side of the face while glycolic acid 70% was applied on the right side at weekly interval for 12 weeks. Assessment of patients was done at the end of the study for the improvement of melasma and the presence of associated complications. 30 caces [22 F: 8 M] were collected, the mean age of females was 37.09 +/- 8.8, and the mean age of males was 33 +/- 113. All patients are of skin type II, III and IV. After 12 weeks of treatment by glycolic acid 70% [right side] ,most of the patients showed good response. After 12 weeks of treatment by tretinoin 1% [left side] most of the patients showed good response. Tretinoin 1% solution is as effective as glycolic acid 70%peel in the treatment of melasma and it is less irritant and more tolerable than glycolic acid as a peeling agent

Workplace violence against nurses and its effect on their job satisfaction

Workplace violence is a serious phenomenon involving the health care settings, and presents challenges to management. Literatures indicate that the majority of nurses experience some form of violence during their working lives. Managing workplace violence presents a problem stem from lack of consistency among those perceiving and defining it. The consequences can be devastating, since it affects nurses' morale, decreases job satisfaction and altered job performance. The present multidisciplinary study aims at investigating the phenomenon of workplace violence among nurses and its association to their job satisfaction. The main results are that about three quarters of the involved subjects experienced violence in the workplace. Verbal abuse and psychological/emotional stressing act are highly perceived by the subjects to define violence, and that the last one is the most frequent type experienced by nurses. Clients and their relatives, as well as the administrative staff are the most significant perpetrators, and that the most precipitating factors are violating privacy, inadequacy of available nurses, equipment supplies, and treatments, as well as visits from outside the hospital. Nurses who experienced workplace violence reported their dissatisfaction, about half of them not preferring their work, and have tendency to leave due to violence, and as a result, more than quarter are searching for a career rather than nursing

Violence on hospital nurses and job satisfaction

Workplace violence is a serious phenomenon involving the health care settings, and presents challenges to management. Literature indicates that the majority of nurses experience some form of violence during their work. Managing workplace violence presents a problem which stems from lack of consistency among those perceiving and defining it. The consequences can be devastating, since they affect nurse morale, decrease job satisfaction and alter job performance. The present multidisciplinary study aims at investigating the phenomenon of workplace violence among nurses and its association to their job satisfaction. The main results are that about three quarters of the subjects experienced violence in the workplace. Verbal abuse and psychological/ emotional stressing acts were highly reported by the subjects to define violence, and that the latter one is the most frequent type experienced by nurses. Clients and their relatives, as well as the administrative staff are the most significant perpetrators. The most precipitating factors are violating privacy, inadequacy of available nurses, equipment supplies, and treatments, as well as visits from outside the hospital. Nurses who experienced workplace violence reported their dissatisfaction. About half of them did not like their work, and had the tendency to leave due to violence. Presently, more than a quarter of the sample is searching for a career other than nursing

Dietary fat and breast cancer in Saudi Arabia: a case-control study

A case-control study investigated the association between dietary fat and breast cancer in Saudi Arabian women attending a specialist hospital in Riyadh. Women with breast carcinoma [n= 499] newly diagnosed between 1996-2002, and control women [n = 498] randomly selected from patients' attendants and relatives, completed a food frequency questionnaire. Serum levels of triglycerides and total cholesterol were measured. A significant positive association was found between risk of breast cancer and intake of fats, protein and calories. Adjusted odds ratios for the highest quartile of intake versus the lowest were 2.43 for saturated fat, 2.25 for animal protein, 2.12 for polyunsaturated fat, 1.88 for cholesterol and 2.69 for total energy from dietary intake. For serum triglycerides the adjusted odds ratio was 2.16 for the highest quartile

Use of autologous fibrin glue in splenic salvage after its traumatic injuries

To avoid the well known risks of splenectomy and preserve the splenic function after its traumatic injuries, splenic salvage by using autologous fibrin glue [AFG] is particulary promising because of its unique characteristics. In this study we evaluated the efficacy and compatibility of AFG by its application to fourteen partially splenectomized New Zealand White rabbits. There was complete haemostasis in all animals, and the histopathological examination after re-exploration of the experimental animals within 24 hours, and 2 weeks revealed no body reaction and good healing. As the reparation time of AFG was suitable [30-44mins] and due to its good results on animals, we applied this material on six patients with different splenic injuries [fissures and evulsion of one pole]. Through the follow up period of two weeks by using haematocrite value, U.S., C.T, there was no recurrent bleeding from splenic sites. For that we concluded that AFG is an effective haemostatic agent with good systemic and local compatibility and can be used in splenic salvage, which therapy avoids the use of non-autologous products with their risks of diseases transmission and anaphylactic reaction

Avoidance of external laryngeal nerve injury during thyroidectomy

100 patients suffering from simple multinodular goitre [78 females and 22 males] with mean age of [32.8Y] were classified into two equal groups 50 patients each. In the first group the superior thyroid vessels were ligated as mass ligation with in the upper pole. In the second group, the superior thyroid vessels were ligated individually with identification of external laryngeal nerve whenever possible. The voice function was tested pre -and 3 months postoperatively in both groups. There was preservation of the voice function in the second group with some aspects of deterioration of voice function in the first group. So, individual ligation of superior thyroid vessels and identification of external laryngeal nerve if possible, is a good method for preservation of voice functions after thyroidectomy operations

impact of heavy metals on the energy reserves of lepidotriglae lastovisa from the South-Eastern Mediterranean, Alexandria, Egypt

Lepidotriglae lastovisa were collected monthly over one annual reproductive cycle, from January to December 1994. Total lipid, protein, Pb and Cd content were determined in muscles, liver and gonads of mature [>13 cm length] and immature [8-13 cm length] fishes of both sexes. Mercury content was determined in fish muscles of both sexes at different lengths during one month. Lipids were primarily transported to ovaries prior to fertilization. Energetic lipids were maximal in liver and muscles before spawning and declined to the minimum after spawning, during early winter. L lastovisa spawns two times a year, from February to April, and from August to October. Fish that spawned early still had plenty of fat left in muscles it probably takes its energy from liver fat, while late spawners had low fat reserves [declined by about 70%]. The total energy required for gonad development were significantly parallel in both sexes, and were mostly consumed from lipid mobilization rather than protein. The body lipid content increased significantly during the period of heavy phytoplankton blooms [July and September] and declined in winter. Muscle protein was found to be related to that in the ambient water. Mercury content showed similar distribution patterns in both sexes, being accumulated with growth. The general levels of Pb and Cd were remarkably high in different tissues, which may be traced to the elevated levels in surrounding water, sediments and biota. Bioaccumulation of such metals occurred in almost the same proportion as the total discharge to the area. Such elevations in metals seem to reduce the body energy reserve, where significant inverse correlations between total energy [in the form of lipid and protein] with Cd and Pb was computed and assessed

Signal averaged electrocardiogram SAECG in patients with normal hearts

This work aimed to detect the quantitative parameters of signal averaged electrogram in patients without heart disease. 50 patients, admitted in Al-Husain University Hospital for non-cardiac problem, who had normal cardiovascular examination and resting electrogram were included in this study in the period between October and December 1995. Signal averaged electrogram [SAECG] was detected in time domain using PPG Hellige [model EK 56]. The band pass filter was set at 40 HZ, correlation coefficient 98%, 200 cycles and 1.O uV noise end point. Late potential analysis was performed on the orthogonal leads X, Y and Z. C1 was put on the back opposite the site of C2, potential different between C1 and C2 results in z. C3 site is below the clavicle in a parasternal position, potential difference between C3 and C4 results in Y. C5 site is in the fifth intercostal space at right mid axillary line, potential difference between C5 and C6 results in X. Careful skin preparation and adhesive electrodes were attached just before recording the SAECG