Recent predictive parameters for successful weaning from mechanical ventilation in critically Ill patients

Background: Removal of patients from mechanical ventilation (MV) has been termed liberation, discontinuation, withdrawal and most commonly weaning. Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Although weaning from MV is successful in most cases, the first attempt fails in 20% of patients. In addition, weaning accounts for over 40% of the total MV time, the proportion varying in function of the etiology of respiratory failure. Objective: The aim of this study was to evaluate the recent protocols of successful weaning from mechanical ventilation of critically ill patients, depending on central venous oxygen saturation, ultrasonographic assessment of diaphragmatic movement, and serial arterial blood gases to assess failure rate 48 hours after weaning. Patients and methods: This prospective randomized study included a total of 90 mechanically ventilated Egyptian patients of both sexes, ASA (I-II) attending at least for 48 hours at intensive care unit, AlAzhar University Hospitals. The included subjects were divided into three groups depending on method of monitoring; group A: serial arterial blood gases, group B: Central venous oxygen saturation and group C: Ultrasonographic assessment of diaphragmatic movement pre and post spontaneous breathing trial. All patients were subjected to daily monitoring of the following weaning parameters: static and dynamic compliances and inspiratory resistance, intrinsic positive end expiratory pressure (Auto PEEP) and Maximum inspiratory pressure (MIP). Results: There is highly statistically significant difference between patients as regard weaning outcome. As the group depended on normal ultrasonographic assessment of diaphragmatic movement, had the largest number of patients with successful weaning. Conclusion: Normal ultrasonographic assessment of diaphragmatic movement proved to be the most important criteria for successful weaning from mechanical ventilation

Higher Expression of Toll-like Receptors 3, 7, 8, and 9 in Pityriasis Rosea

BACKGROUND: Pityriasis rosea (PR) is a common papulosquamous skin disease in which an infective agent may be implicated. Toll-like receptors (TLRs) play an important role in immune responses and in the pathophysiology of inflammatory skin diseases. Our aim was to determine the possible roles of TLRs 3, 7, 8, and 9 in the pathogenesis of PR. METHODS: Twenty-four PR patients and 24 healthy individuals (as controls) were included in this case control study. All recruits were subjected to routine laboratory investigations. Biopsies were obtained from one active PR lesion and from healthy skin of controls for the detection of TLR 3, 7, 8, and 9 gene expression using real-time polymerase chain reaction. RESULTS: This study included 24 patients (8 females and 16 males) with active PR lesions, with a mean age of 28.62 years. Twenty four healthy age- and sex-matched individuals were included as controls (8 females and 16 males, with a mean age of 30.83 years). The results of the routine laboratory tests revealed no significant differences between both groups. Significantly elevated expression of all studied TLRs were detected in PR patients relative to healthy controls (p < .001). CONCLUSIONS: TLRs 3, 7, 8, and 9 might be involved in the pathogenesis of PR.

Induction of heme oxygenase-1 attenuates chemotherapy-induced pulmonary toxicity in rats: a possible link between heme oxygenase-1 and NF-kappaB

A critical restriction in the use of bleomycin [BLM] is development of pulmonary fibrosis via oxidative and inflammatory mechanisms. Drugs that induce heme oxygenase-1 [HO-1] like hemin [HEM], have anti-inflammatory, antioxidant, and immunomodulatory effects. Accordingly, it is worth to test HEM against BLM-induced lung Injury. Four groups of rats were used: control group; HEM group [50mg/kg, i.p.]; BLM group [5mg/kg, intratracheal single injection] and HEM+BLM group [HEM administered 1 day before BLM injection and continued for 14 days]. At the end of experiment, lactate dehydrogenase [LDH] and NO levels were estimated in bronchoalveolar lavage fluid [BALF]. Hydroxyproline [HP], myeloperoxidase [MPO], IL-6, GSH, MDA levels and SOD activity were determined in lung tissues. In addition, expression of HO-1 and NF-kappaB protein in lung tissues was determined using both western blot and immunohistochemical techniques. Also lung tissues were investigated histopathologically. BLM produced lung damage as indicated from the elevation in LDH and NO, perturbation in lung oxidative stress indicators, increased HP, MPO, IL- 6 contents and NF-kappaB expression. On the other side, HEM, reduced BLM harmful effects as noticed from amelioration of biochemical markers and histopathological lesions, which is concomitant with over-expression of HO-1. Therefore, induction of HO-1 in lung by HEM may alleviate the lung damaging effects of BLM

Effect of crowding stress on lung and heart of the adult albino rats and the possible protective role of sulpiride

Exposure to crowding stress is associated with increased respiratory system morbidity, However, the underlying mechanisms are unclear. Thus, there is a need for more study of this harmful effect. Sulpiride had been shown to have a protective role against crowding stress on other systems but this role was not studied well on the respiratory and cardiovascular systems. Investigating the possible harmful effects of crowding on adult albino rats' lung and heart and the possible protective role of combined sulpiride treatment. The present study was carried out on 24 adult albino rats of local strain weighing 120 +/- 3 g which were randomly divided equally into Group 1[C, untreated negative control], Group 2 [Cr, crowding exposed or positive control] where rats were exposed to crowding in a cage [20x20x20 cm- 6 rats /cage] for 1 month, Group 3[D, sulpiride-treated] where the rats were exposed to sulpiride "0.028 mg/B.W./day" and Group 4 [Cr+D, crowding + sulpiride-treated]. Paraffin sections were prepared for histological, histochemical and morphometric studies. The data were statistically analysed. The rats exposed to crowding only or sulpiride only showed highly significant damaging changes on lung such as thickening in the interalveolar septa and obliteration of the alveoli, inflammatory cells infiltration within the pulmonary interstitium, peribronchiolar infiltration and fibrosis, thickening of the pulmonary blood vessels walls, interstitial collagen fibres deposition and apoptotic cellular changes. On the level of heart, significant decrease in the diameters of the myocardial muscle fibres with focal areas of necrosis, apoptotic changes and increased collagen fibres deposition was marked in sulpiride group. When crowding and sulpiride treatments were combined, the damaging effects were maximized on the lung and heart. These results provided evidence that crowding stress causes obvious lung and heart tissue damages. No protective role for sulpiride was proofed. This is because using sulpiride alone or in combination with crowding showed marked damaging effects on the lung and heart tissues

Spectrophotometric Determination of Rabeprazole Sodium Using Two Charge Transfer Complexation Reactions.

This work presents two simple and direct spectrophotometric methods for determination of rabeprazole sodium (RB) through charge transfer complexation reactions. The first method is based on the reaction of the drug with p-chloranilic acid (p-CA) in acetonitrile to give a red colored product with maximum absorbance at 518 nm. The second method is based upon the interaction of RB and 7,7,8,8‐tetracyanoquinodimethane (TCNQ) in acetone resulting in the formation of a bluish-green complex measured at 845 nm. Factors affecting the color development were studied and optimized. The proposed colorimetric procedures were effectively validated with respect to linearity, ranges, precision, accuracy, robustness, detection and quantification limits. Regression analysis for the calibration curves of the formed color products with p-CA and TCNQ showed good linear relationships over the concentration ranges of 20–200 and 2–16 μg/mL respectively. The method was successfully applied to the assay of rabeprazole enteric coated tablets with good accuracy and precision. Assay results were statistically compared to a reference HPLC method where no significant differences were observed between the proposed methods and reference method.

Evaluation of circumcision in male babies during neonatal period

Circumcision is one of the oldest surgical procedure performed today. The present study was performed to find a suitable age for adequate and satisfactory circumcision in male babies. It includes 100 male babies; fifty were circumcised early in the neonatal period and the other fifty at around 5 months of life. Tight frenula band was present in 60% of the early circumcised group and in [16%] of the late circumcised group. Easy retraction of the prepuce was done more frequently in the late group. Wound crust formation, infection and perimeatal inflammation occurred in 40%, 28%, 12% of the early group, while in the late group it was 6%, 10%, 4% respectively. In conclusion, Circumcision in male babies performed later around 5 months of age is more easier and results in fewer complications than circumcision done in the early neonatal period

Alterations in the ultrastructure of the liver in chronic lead intoxication in the adult albino rats

In the present work, the effect of chronic lead intoxication in two doses [5 mg/kg body weight, as therapeutic dose and 10 mg/kg body weight as sublethal dose] on the ultrastructure of the rat liver was studied. The rats were classified into three groups: one control group [10 rats], experimental group A [20 rats] who received a therapeutic dose of lead acetate orally for six months, and experimental group B [20 rats] who received a sublethal dose of lead acetate orally for six months. Ten rats of both groups A and B were sacrificed one month after the last given dose [recovery rats]. Small slices of the liver of the rats of all groups were processed for electron microscopic examination. The livers of group A rats showed a few pathological changes in the form of proliferation of both rough and smooth endoplasmic reticulum, multiple areas of glycogen depletion with a few lysosomes and fat droplets. The liver of group B rats showed marked pathological changes in both hepatocytes and Van Kuppfer's cells. The cytoplasm of the hepatocytes showed intracytoplasmic vacuoles and a few degenerative granules. The Von Kuppfer's cells showed pale degenerated cytoplasm, intra-cytoplasmic and degenerated electro-dense granules. The recovery animals of group A showed good recovery, while those of group B showed only partial recovery

Early postoperative outcome in diffusely diseased left anterior descending artery comparative study between endarterectomy and mammary arterial patch reconstruction

The problem of diffusely diseased LAD represents one of the surgical challenges with very few alternative solutions. Some my leave this diffusely diseased vessel without grafting and keep such patients on lifelong anticoagulation with the acceptance of some residual symptoms, others my do surgical grafting of this vessel using either extensive endarterectoy or creating a newly constructed LAD by the use of a long mammary artery graft patch. In this short prospective study we used both techniques in grafting the diffusely diseased LAD and we evaluated the early outcomes in the immediate post operative period [3 months]. This prospective shortterm study was done at Kasr Eleini teaching hospitals in the period between January 2006 and April 2009, 100 patients with severely and diffusely diseased LAD underwent bypass grafting. We used two techniques of LAD grafting. In group "A" [50 patients] we used the internal mammary artery for grafting after conventional endarterectomy [excision of the entire atheromata] while in the other group "B" [50 patients] we employed long mammary patch grafting of the LAD without coronary endarterectomy. In both groups selection of the technique was the surgeon's preference and there was no significant differences in the preoperative and operative criteria of patients. The preoperative data was not significantly different in both groups. The average length of endarterectomy in group A was 2.4 +/- 0.75 cm while the average length of mammary artery patch in group B was 3.2 +/- 0.8 cm. The duration of aortic cross clamp was 68.2 +/- 6.4 mm in group A and 78 +/- 8.5 mm in group B. there was higher postoperative mortality in group A [22%]. and only [8%] mortality in group B. ICU stay was 8.5 +/- 2.8 days in group A and 6.3 +/- 2.6 days in group B. postoperative myocardial infarction was higher in group A [32%] than that in group B [12%]. Also there was 4 cases in group A who needed additional saphenous vein grafting to the distal LAD, while no one needed additional LAD grafting in group B. postoperative bleeding was 540 +/- 86cm2 in group A and 830 +/- 116 cm2 in group B. long mammary arterial patch grafting of the LAD can be used as a surgical technique for grafting the diffusely diseased LAD. This technique provides better early postoperative outcome than that of LAD grafting after endarterectomy, however this study still needs longer evaluation of the graft patency in both groups. Pathological Q wave and positive cardiac biomarkers are predictors for worse prognosis among patients having myocardial infarction post-CABG

Repair of chronic moderate functional ischemic mitral regurge during coronary bypass surgery versus no repair: experience and early results

An increased attention is nowadays being focused on the surgical management of chronic functional mitral valve regurgitation coexisting with ischemic heart disease [IHD]. The optimum approach as to its management is still under debate as different techniques have been proposed to correct tethering-induced regurgitation caused by derangement in the mitral valve apparatus. This study was carried out to assess the results of surgical repair of isolated chronic moderate functional ischemic mitral regurgitation [IMR] as regards the technique and postoperative left ventricular functions for the first year postoperatively. This comparative prospective-retrospective study was carried out between April 1999 and May 2008 in the Department of Cardiothoracic Surgery of Cairo University as well as the private practice after obtaining the approval of the local ethical committees in these places. The study population included 100 patients who were all diagnosed to have coronary heart disease complicated by moderate degree of ischemic functional mitral regurge. Patients were equally divided to two groups of equal number. Patients of the two groups were chosen to match as close as possible for sex, mean age, and preoperative risk factors. Group A patients contained 50 patients were submitted for mitral valve repair in addition to coronary artery bypass graft [CABG]; whereas group B patients contained another 50 patients were submitted for CABG alone without mitral repair. Perioperative patient evaluation included clinical examination; transthoracic [TTE]; and or transoesophageal [TEE] echocardiography. The surgical times [total operative time, total cardiopulmonary bypass time, and the cross-clamping time] were longer in group A patients [with statistical significance]. The mean number of bypass grafts done in group A was 3.4 +/- 0.4 [range 3-5 grafts]; versus 3.2 +/- 0.6 for group B patients [range 2-5] [p:NS]. Intraoperative IABCP was needed in 5 [10%] of group A patients; versus 14 [28%] of group B patients [p<0.03]. Before going out of the OR, TEE examination revealed trivial or no MR in all of group A patients together with no valve-related complications. The overall mortality was 13 [13%]: 4 [8%] in group A and 9 [18%] in group B [p < 0.05]. Intraoperatively 2 of group A [4%]; versus 2 [4%] of group B died for refractory cardiac muscle failure; while in-hospital mortality occurred in 6 [12%] of group B patients versus 1 [2%] of group A patients within the first 15 days postoperatively, mortality after 6 months was 1 in group A versus 1 in group B. Morbidity occurred in 11 [22%] of group A patients; versus 4 [8%] group B [p <0.04]. In group A, 4 patients [8%] needed prolonged mechanical ventilation with inotropic support; 4 patients [8%] were reoperated for hemostasis; 2 patients [8%] had transient hepato-renal insufficiency and superficial wound infection; while 1 patient [2%] newly-developed transient episode of atrial fibrillation that was medically-controlled. In group B, 3 patients [6%] needed prolonged mechanical ventilation with inotropic support; while another 3 patients [6%] developed prolonged non-fatal low cardiac output symptoms that became controlled on prolonged inotropic support. In both groups, all morbidity were adequately-controlled without fatal consequences. NYHA class has showed a significant improvement in survivors of group A than B with lower percent of patients with NYHA III/IV in group A [7/46] versus [14/41] in group B [p value 0.04]. The group A had a higher LVEF at 6 months 62 +/- 6 than group B 46 +/- 0.9 [p value 0.0001] despite matching of the preoperative LVEF of both groups. Combined CABG and repair of moderate degree of ischemic functional mitral regurge was associated with higher incidence of intraoperative and in-hospital non-fatal morbidity. Performing CABG with no mitral repair was associated with progressive deteroration of the left ventricular dimensions and functions especially in the patient subset with dilated preoperative LV diameters [LA and LVEDD] and compromised functional parameters [LVEF% and FS]. We advocate combining CABG with repair of moderate IMR in specific patient groups for augmenting postoperative LV performance and maximizing surgical results

Study on evaluation of the persistent elevation of C-reactive protein as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on hemodialysis

The average age of dialysis patients is increasing each year, reflecting the aging of the population in general. Hemodialysis [HD] patients suffer from a chronic inflammation. They are at increased risk of cardiovascular disease. To evaluate the persistent elevation of C reactive protein [CRP] as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on HD. Quantitative determinations of serum high-sensitivity C reactive protein [hs-CRP] by ELISA were done in the 3 studied groups; Group A: included 30 selected end stage renal disease [ESRD] elderly patients maintained on regular HD at the Main Alexandria University Hospitals. Their mean ages were 68.50 +/- 5.20 years [15 males and 15 females]. Group B: included 20 age-matched elderly healthy individuals. Their mean ages were 69.10 +/- 6.42 years [10 males and 10 females]. Group C: included 10 healthy adult individuals. Their mean ages were 34.20 +/- 4.85 years [5 males and 5females]. Doppler Echocardiography was done to all subjects with estimation of ejection fraction [EF%], fractional shortening [FS%], and left ventricular mass index [LVMi] as well as E/A and El/Al ratios. In elderly HD patients, hs-CRP showed statistically significant higher levels than those of groups B and C with significantly higher values in group B than group C [F=19.85, p=0.001]. By using echocardiography, LVMi showed statistically significant higher values in group A than the other 2 groups with no significant difference between them [F=0.854, p=0.01], whereas FS and EF percentages showed no significant differences between the 3 studied groups. Both E/A and El/Al ratios showed statistically significant lower values in group A than groups B and C [x[2]= 13.33 and 12.38, p= 0.00] and 0.02 respectively]. Correlation study showed a significant negative correlation between serum hs-CRP levels and serum albumin, EF% and E/A ratio. On the other hand, serum hs-CRP levels had a significant positive correlation with serum urea, erythrocyte sedimentation rate [ESR] and LVMi. In elderly patients maintained on HD, the persistent elevation of CRP, which reflects chronic inflammation, had a high impact on the occurrence of left ventricular hypertrophy [LVH] and dysfunction. These data lend support to the hypothesis that inflammation plays an important role in the pathogenesis of cardiovascular diseases in these patients

Effectiveness and value of using free pericardial fat pad to control residual alveolar air leaks after pulmonary resection operations

Residual postoperative air leaks are one of the most common problems following pulmonary resection operations. Many clinical studies were carried out in an attempt to offer solutions for this problem. Our study, aims to investigate the effectiveness and value of using free pericardial fat pad to control air leaks in residual raw parenchymal surfaces following lung resection or pleural decortication operations. This prospective comparative study was done in the Departments of Cardiothoracic Surgery and chest internal medicine of Kasr El Aini University French Teaching Hospital as well as private hospitals after approval of the local ethical committee. The study included 50 adult patients who were submitted to lung resection or pleural decortication operations between 2001 and 2006. There were 27 [54%] lobectomies with incomplete fissure; 5 [20%] wedge resections; .4 [8%] cases of segmentectomy; and 14 cases [28%] of pleural decortication. Patients were divided into two adequately-matched groups: group [I] contained 25 patients in whom residual air leaks were intraoperatively controlled by suturing them to pieces of free pericardial fat pad. In group [II], another 25 patients, in whom residual air leaks were solely managed by conventional manual suturing methods. Data was collected prospectively in group [I] patients but retrospectively in group [II] patients. In both groups, preoperative patient characteristics [age, sex, surgical risk factors], as well as the general standard operative techniques, were matchable. The hospital stay time was longer in group II patients [mean 9 days +/- 1.5 SD] vs. 3 days +/- 0.5 SD][p < 0.05]. In group I, there was no mortality, and no patient showed air leaks beyond 3 days postoperatively. All patients had their chest drains removed [day 3 and 5] after the operation. In none did evidence of space problems occur for 4 weeks postoperatively. In group II, there was no mortality, but shortcomings were noticed in 4 patients [16%] as persistent air leak in 3 patients [12%]; and persistent air leak transforming to empyema in one patient [4%], who needed surgical-reexploration 2 monthes later for pleural decortication. Application of a free pericardial fat pad proved to be effective and useful for controlling air leaks from residual raw parenchymal surfaces after pulmonary resections

Cardioprotective effects of adenosine during surgical correction of congenital heart diseases

Objective: To evaluate cardioprotective effects of adenosine on myocardial recovery during repair of CHD using CPB and included 40 pediatric patients ASA II and III

Patients and Methods: Patients were allocated into 2 equal groups [n=20]: Control group [group C] and Adenosine group [group A]. In group A, 3 minutes after starting the CPB, adenosine 150 micro g/kg/minute was infused for 6 minute and was added to the cardioplegia in a concentration of 200 micro mol/L. In group C, 3 minutes after starting CPB, equal volume of saline infused for the same period of time. Ischemic time, duration of CPB, total duration of mechanical ventilation and PICU stay were recorded. Cardiac indices were obtained using trans-esophageal Doppler probe. Hemodynamic parameters were recorded at different times. Blood levels of CK-MB isoenzyme and neutrophil count were measured before and after CPB

Results: Adenosine administrations improved the cardiac indices and significantly induced elevation of SVI, CI and PVI at 15-min and 1-hr after CPB and till 6-hrs after admission to PICU in comparison to group C. The sum of epinephrine doses was significantly higher in group C than in group A from 6-hrs till 36-hrs, and also its duration of infusion was significantly higher in group C than in group A at 24,36, and 48-hrs. The total duration of mechanical ventilation, and ICU stay were higher in group C than in group A nevertheless this difference did not reach a statistical significance. There was a non-significant difference between both groups as regards changes of HR, SBP, DBP and CVP. There was a non-significant difference between both groups as regards the mean ischemia time and CPB duration. Mean of estimated levels of CK-MB were significantly elevated at 24, 48hrs after admission to PICU in both groups compared to their baseline levels and significantly decreased at 48-hrs compared to levels estimated at 24-hrs hours after admission to PICU with a non-significant difference between both groups. Neutrophil count was non-significantly elevated in group C but decreased in group A compared to their baseline levels, with a significantly higher count in group C compared to group A

Conclusion: Use of Adenosine resulted in improvement of postoperative cardiac performance in terms of CI, PVI and SVI in patients undergoing surgical correction of CHD. It also decreased the sum of epinephrine doses, the total duration of epinephrine use and the number of patients needed inotropic support

Abbreviation: SV: Stroke volume; Cardiac index; SVI: Stroke volume index; SVRI: Systemic vascular resistance index; FTc: Time of systolic flow corrected for heart rate determines the preload; PVI: Peak velocity index to determine myocardial contractility [It is the maximum velocity of blood measured during systole normalized for body surface area]; CK-MB: creatinine kinase isoenzyme; HR: Heart rate; SBP: Systolic BP; DBP: Diastolic BP, CVP:Central venous pressure; CPB: Cardiopulmonary bypass; PICU: Pediatric ICU; CHD: Congenital heart disease; BIS: Bispectral index; ACT: Activated clotting time; CO=SV*HR [L/min]; SVI = SV/BSA [ml/m2]; CI=CO/BSA [L/min/m2]; SVR=[MAP-CVP]/CO*79.7 [dyne.sec.cm-5]; SVRI =SVR/BSA [dyne.sec.cm-5.m2]; PVI=PV/BSA [dyne/sec/m2]

Isoflurane provides better myocardial protection than midazolam in pediatric patients during open heart surgeries

Objectives: This study was designed to evaluate the applicability of anesthetic myocardial protection [pre-conditioning and minimization of reperfusion injury] using two anesthetic regimens on plasma levels of cardiac troponin T [cTnT], as a marker of myocardial ischemia, in pediatric patients assigned for surgical correction of congenital heart diseases using cardiopulmonary bypass [CPB]

Patients and Methods: The study included 60 patients [36 males and 24 females]. Patients were randomly allocated in 2 equal groups: Midazolam group received a continuous infusion of midazolam [0.2 mg/kg/hour] and Isoflurane group maintained by an end-tidal concentration of isoflurane of 1-1.5% throughout the operation. Six blood samples were taken for estimation of plasma cTnT levels immediately after induction of anesthesia [S1], 8- hours [S2], 16-hours [S3], 24-hours [S4], 36-hours [S5] and 48-hours [S6] after aortic cross-clamping

Results: Plasma cTnT levels estimated after aortic cross-clamping [S2-S6] showed a significant [P1<0.001] elevation in both groups compared to levels estimated in S1 sample. Moreover, plasma cTnT levels showed a progressive increase in all patients irrespective of anesthetic regimen used reaching a peak levels in S4 sample and started to decline thereafter but still significantly higher compared to levels estimated in S1 sample. Plasma cTnT levels estimated in S2 sample showed a non-significant increase in midazolam group compared to levels estimated in isoflurane group. On contrary, plasma cTnT levels estimated in midazolam group at 16, 24, 36 and 48 hours after aortic cross-clamping were significantly higher [P[6]=0.034, 0.01, <0.001 and =0.031, respectively] compared to levels estimated in isoflurane group. In midazolam group, there was a positive significant correlation between mechanical ventilation time and plasma cTnT levels estimated at 24-hours [r=0.413, p=0.023], respectively. However, such correlations were non-significant despite being positive in isoflurane group, [r=0.265, p>0.05]

Conclusion: It could be concluded that the hypothesis of anesthetic myocardial protection [preconditioning and minimization of reperfusion injury] is applicable for pediatric patients with congenital heart disease who are assigned for cardiac surgery. Isoflurane-based anesthesia minimized myocardial ischemic and reperfusion injury and provided efficient cardioprotection irrespective of the type of cardiac lesion

Changes of amino acid neurotransmitter concentrations in striatum and thalamus induced by exposure of young and adult rats to electromagnetic radiation

The rapid rise in the use of mobile communications has raised the questions about the health issues. The head and the brain are usually the most exposed targets in mobile phone users. Over the last decade, exposure to high frequency electromagnetic radiation [EMR] has been found to induce deficits in rodents in spatial memory tasks. In addition, radiofrequency radiation has measurable effects on human cognitive performance. The aim of the present study was to investigate the effects of 900MHz EMR on some amino acid neurotransmitters [glutamic acid, glutamine, GABA, glycine and taurine] to measure their significant variations in the thalamus and striatum of adult and young rats

In the present study, both adult and young rats were exposed to EMR at a frequency of 900MHz, a power density of 0.02mW/Cm[2] and an average specific absorption rate of 1.165 W/Kg for one hour daily. Both the exposed and control rats were decapitated after 1h, 1,2 and 4 months of daily exposure to EMR and another group was decapitated after 1 months of stopping the exposure that extended daily for 4 months. Most of the excitatory and inhibitory amino acid meurotransmitters in the thalamus and straitum of the two ages showed significant increase after 1h of a single exposure. This increase persisted in the two areas of the adult animals only throughout the three time intervals [1, 2 and 4 months of daily exposure]. However, in the young rats this increase was normalized after 1 and 2 months and reappeared after 4 months. The most prominent effect recorded after stopping exposure was a significant increase in the striatal excitatory amino acid neurotransmitters of adult rats and a decrease in striatal GABA in young animals. The present reported data cannot exclude the possibility of the microwave-induced biological effects on the brain at a power level and frequency related to mobile communication. It may be concluded that the alteration in the amino acid neurotransmitters may provide one of the mechanisms underlying the memory and cognitive disorders induced by mobile phone radiation

Randomized clinical trial of herbal [EN free] syrup for treatment of medically resistant otitis media with effusion compared to surgical intervention

Otitis media with effusion refers to fluid in the middle ear space without symptoms of acute infection; it is the most common cause of hearing loss in children Otitis media with effusion is very common in children, especially between the ages of one and three years with a prevalence of 10% to 30% and a cumulative incidence of 80% at the age of four years Research has shown that medication is not so effective in treating Otitis Media with effusion, many are initially treated by simply watching an d waiting. A combination of antibiotic with steroids, anti-inflammatory drugs, decongestant, antihistamines and prostaglandin all failed to produce a sustained and significant therapeutic effect Surgery may resolve OME and improve hearing in the short term, but there is less certainty about long-term outcomes. There is large variation in effect between children The operation of myringotomy and ventilation tubes has many complications, damage to the ossiculr chain, dehiscent facial nerve, the tub e may lost in the middle ear, tympano-sclerosis, persistent ear discharge, perforation of the tympanic membrane, obstruction of the tube Supherb's EN Free is a natural preparation for immediate relief and prevention of recurrent middle ear infections, therefore the use of herbs with anti-inflammatory properties, which act to strengthen the immune system [Echinacea, Plantago], have a smoothing and analgesic effect [chamomile] treat secretion, phlegm and congestion in nasal and ear passages and tearing eyes [eyebright]

Modified bronchoalveolar lavage for pulmonary alveolar proteinosis in pediatrics and adults

Pulmonary Alveolar Proteinosis [PAP] is a rare disease of uncertain etiology and variable natural course. This study aimed to evaluate the clinical features and natural history following our management protocol for PAP which consisted of multiple sessions of modified bronchoalveolar lavage under general anaesthesia. This prospective study was carried in Kasr El Aini's University Hospital and new Kasr El Aini hospital From October 2003 till May 2006. Nine patients received 24 sessions of whole bronchoalveolar lavage for management of pulmonary alveolar proteinosis [PAP]. Patients age ranged from 7 and 42 years [mean of 23 years] and were categorized into two groups: [A] the pediatric group [included 3 patients aged 7,8 and 11 years] and [B] the adult group which included 6 patients. Whole lung lavage [one lung at a time] was carried out under general anesthesia with selective one lung ventilation using a double-lumen endotracheal tube in adult patients. In the pediatric group as a double-lumen endotracheal tubes suitable for their size were not available, a small-for-weight endotracheal tube was introduced through the vocal cords to ventilate one lung while a rigid bronchoscope was passed beside it to lavage the other lung. In each adult patient around 20 liters of warm normal saline [to which 1 ampoule of heparin was added to each 500 mls] were instilled in increments of 5 ml/kg inside the main bronchus of a single lung followed by a few minutes of postural changes while multiple gentle chest percussions were applied. The process was stopped when the lavage fluid suctioned from the endo-bronchial tree became clear. None of our patients died in the follow up period. No morbidity occurred in our patients apart from an episode of mild retention of saline inside the alveolar tree which was manifested by marked increase in the CVP, low arterial oxygen saturation and low [PaO[2]] in the ABG which was managed promptly using combination of Oxygen inhalation by mask, bronchodilators and intravenous diuretics. All patients stated a remarkable improvement in their tolerance to physical exertion. All 9 patients [100%] expressed total disappearance of SOB during the follow-up period. One patient [11.1%] complained of intermittent cough for 4 days before being ameliorated. A single patient [11.1%] complained of transient low-grade fever. Few scattered rales were present in 6 patients [66.6%] due to residual retention of the lavage fluid inside the alveoli from which they were treated by diuretics until it totally disappeared within the first 24 hours. Plain chest radiographs and CT chest showed fainting and near-total disappearance of the ground glass and the reticulation patterns. Spirometry and lung volumes [percentage predicted] revealed a marked improvement with FVC and mean total lung capacity values. The mean value of Forced Expiratory Volume [FEV1] during the first second became 94.9 +/- 13.6, the total lung capacity [TLC] became 83.1 +/- 15.7 and the ratio of FEV1 to the Forced vital capacity became 101 +/- 8.4. Arterial blood gases measurements, showed that the mean arterial oxygen tension [PaO[2]] was 79.5 +/- 6.2 mmHg, while the mean PCO[2] tension was 36.3 +/- 3.5 mmHg. The mean pH value of the blood was 7.43 +/- 0.02. The mean arterial oxygen saturation became 84 +/- 8.8%, [mean of 79-96%]. In our experience whole lung PAL was simple, safe and could be applied in patients with pulmonary alveolar proteinosis with a sound degree of safety with no grave complications. Careful attention to all preoperative and intraoperative patient parameters is mandatory in order to perform whole-lung lavage under general anesthesia in adults or pediatrics

effect of low dose magnesium sulphate combined with esmolol on hemodynamic responses and recovery profile

To study the effects of low dose Magnesium sulphate combined with Esmolol on hemodynamic responses and recovery profile. During laparoscopic surgery transient acute hemodynamic responses typically occur at laryngoscopy and tracheal intubation, during insertion of the veress needle and trocars and during creation of pneumoperitoneum. MgSO[4] has been shown to inhibit catecholamine release during tracheal intubation. Patients given peri-operative MgSO[4] infusion have lower intra-and post-operative analgesic requirements. Esmolol is an ultra-short acting beta-Blocker reduces the anesthetic requirements and blunts the sympathetically mediated cardiovascular changes during surgery. 60 female patients were scheduled for diagnostic laparoscopy for gynecological causes of infertility were randomly assigned into two groups. Group I to receive low dose MgSO[4] + esmolol and Group II to receive saline. In both groups, the anesthesia was induced with fentanyl, thio-pental and atracurium, maintained with sevoflurane in O[2]. Mean HR, SBP and DBP were monitored. Recovery times and postoperative analgesic requirements were also recorded. Results showed that such co-administration can attenuate the hemodynamic responses to intubation and surgical stimulation without any side effects. Low dose MgSO[4] and esmolol can be used as an adjuvant to anesthesia for providing hemodynamic stability, shortened recovery time and decrease postoperative analgesic requirements

Effect of exposure to electromagnetic radiation from the mobile phone on acetylcholinesterase activity in the hippocampus and striatum of young and adult male rats

Acetylcholine is an established neurotransmitter in the transmission of signals in many of brain neurons. A decrease in the activity of cholinergic systems has been implicated to underlie the memory disturbances resulting from electromagnetic radiation [EMR]. The present study shows clearly that EMR from mobile phone [at a frequency of 900MHz, a power density of 0.02mW/cm[2] and an average specific absorption rate of 1.165W/kg] had an adverse effect on acetylcholinesterase [AchE] activity, the enzyme specific for the functioning of acetylcholine. The exposure of young male rats to the previous EMR for one hour caused a significant increase in AchE activity in the hippocampus, but not in the striatum, whereas the prolonged exposure for one month and four months [1 h daily] induced a significant increase in the enzyme activity in both areas. Both acute [I h] and prolonged [1 and 4 months, 1h daily] exposure to EMR produced significant increases in AchE activity in both hippocampus and striatum of adult male rats. The increase in the enzyme activity continued also after stopping EMR exposure for one month. The implication of these changes to the brain functions of the cholinergic system in both areas is discussed

Comparative study between pedicular screws, interbody fusion cages and combined procedures in management of spondylolisthesis

Background and Objective: to evaluate surgical management of spondylolisthesis through posterior approach using different instrumentation including fixation by pedicular screws/rods with posterolateral arthrodesis, posterior interbody titanium threaded [stand alone] cages as PLIF or pedicular system and posterior different types of cages [titanium or carbon] to bold the bony interbody fusion

Patients and Methods: sixty patients with lumbar spondylolisthesis were classified into three groups: Group A [n=20] was fixed by pedicular-screws/rods fixation with posterolateral arthrodesis; group B [n=20] had posterior interbody titanium threaded [stand alone] cages as PLIF; and group C [n=20] was fixed by pedicular system and posterior different types of cages [titanium or carbon]. All patients underwent serial clinical evaluations at regular 3-month intervals between the 3rd and the 12th postoperative months. At the second year they were examined at 6-month intervals. Functional disability was measured by the Oswestry low back pain disability questionnaire. Radiological evaluation was done with 6 months interval for 2 years to evaluate: fusion status; hardware status [correct placement or failure]; anatomical correction [horizontal displacement, angular displacement; disc height]; and instability and degenerative . changes on adjacent levels. All surgical problems were recorded including intraopertaive, early and late postoperative ones

Results: excellent postoperative Brodsky scores of pain were reported by 50%, 55% and 60% in group A, B and C respectively, showing a significant difference to preoperative scores in each group. The success rates were 80%, 85% and 90% in group A, B and C respectively. Correction Rate [CR] of preoperative symptoms was 90% in group C, 85% in group B and 75% in group A. Obvious fusion was detected in 18 cases [90%] of group C, 16 cases [80%] of group B and 14 cases [70%] of group A, i.e. the fusion rate after circumferential fusion is higher and reliable than that in stand-alone procedure. Immediately after surgery, there was a significant reduction in horizontal displacement [HD], and angular displacement [AD], and a significant increase in disc height [DH] in all groups, which still significant after 2 years in group B and group C only. There was non significant difference in the rate of complications except the significant increase in-operative time > 4 hours in group C

Conclusion: in cases of spondylolithesis grade I. and II, fixation by pedicular system and posterior different types of cages [titanium or carbon] provide a more solid mechanical construct -when compared with the pedicle screws used alone or stand alone cages. All surgical procedures are effective, although combined procedure showed better clinical outcomes if quality of life, pain improvement, and functional recovery are considered

Utility of certain pi-acceptors for the spectrophotometric determination of some skeletal muscle relaxants and antihistamine drugs

Three pi-acceptors, p-chloranilic acid [PCA], 2,3-dichloro-5,6-dicyano-p-benzoquinone [DDQ] and tetracyanoquinodimethane [TCNQ], have been used for the assay of some drugs of pharmaceutical interest. The studied drugs were orphenadrine citrate [1], baclofen [2], acrivastine [3] and tizanidine hydrochloride [4]. The assay is based on the fact that, the drugs under test are electron donors and react with p-CA, DDQ and TCNQ forming charge transfer complexes having intense absorption bands in the visible region of the spectrum. The colored products had absorption maxima at 530, 457 and 842nm for p-CA, DDQ and TCNQ respectively. The different experimental parameters were studied and incorporated in the procedure. For p-CA, Beer's law was obeyed in the concentration ranges [40-280], [20-140], [20-200] and [40-600] microg/ml for 1, 2, 3 and 4 respectively. For DDQ, Beer's law was obeyed from [20-140], [30-90] and [10-200] microg/ml for 1, 2 and 4 respectively. For TCNQ, Beer's law was obeyed in the concentration ranges [5-50], [1-15], [1.25-11.25] and [5-17.5] microg/ml for 1, 2 ,3 and 4 respectively. The procedure was favorably applied for determination of certain pharmaceutical dosage forms containing the studied drugs. The obtained results from tablets assays were found of good accuracy [t-test] and reproducibility [F-test]. The obtained results were also compared to the official and reported ones. There no significant differences were found between the proposed and the official or reported methods