Assessment of Functional Mitral Regurgitation Severity by Proximal Isovelocity Surface Area via 3D Transthoracic Echocardiography

Background: Accurate quantitative evaluation of MR severity remains challenging because limited scan plane orientation of 2D echocardiography does not provide direct measurement of the regurgitant lesion. Three-dimensional echocardiography, which has become a clinically established technique, has been shown to provide useful information for flow quantification and so has the potential to address the major drawbacks of 2D-based approaches. Objectives: To assess the reliability of PISA measurement using real-time 3D color trans-thoracic echocardiographic imaging in clinical practice and to compare its derived EROA, regurgitant volume (Rvol) and regurgitant fraction with that obtained by 2D trans thoracic PISA. Patients and Methods: This cross-sectional study, included 30 patients with at least moderate functional MR came for evaluation on clinical basis indications at Al-Hussein and Bab El-Shaareya University Hospitals during the period from November 2020 to July 2021. Two- and three-dimensional echocardiography was done to asses MR and calculate vena contract width, 2D PISA and derived EORA and regurgitant volume. Also, calculation of 3D EROA using PISA method by 3D probe. Results: There was a significant positive correlation between 2D EPISA and 3D EROA using PISA method and EROA, p value was 0.0001. With higher values for 3D EROA using PISA method when compared with 2D PISA in different degrees of MR as summarized in “the mean value of EROA by 2D PISA in moderate MR was 0.25 ±0.042 cm2, while it was 0.32±0.059 cm2 by 3D EROA using PISA method. While the mean value of EROA by 2D PISA in severe MR was 0.58 ±0.14 cm2, and it was 0.47 ±0.049 cm2 by 3D EROA”. Also showed significant difference in different direction of MR jets especially in eccentric jet as shown by the mean value of EROA by 2D PISA in central MR was 0.41±0.19 cm2, while it was 0.41±0.87 cm2 by 3D method. While the mean value of EROA by 2D PISA in eccentric MR was 0.53 ±0.21 cm2, and it was 0.44 ±0.096 cm2 by 3D EROA using PISA method. Conclusion: The use of 3D EROA using PISA method and simple calculation of a mean systolic regurgitation orifice area proved to be superior to 2D measures (VC, 2D-PISA) for distinguishing moderate from severe MR, evaluation, classification and grading of MR in a routine clinical cardiology setting. 3D EROA reduces assumptions and seemingly improves diagnostic value as compared with 2D-PISA

The effect of a newly established urban diarrhea treatment facility in Bangladesh: Changing patient characteristics and etiologies

Background: Mirpur treatment centre (MTC), Dhaka of the International Centre for Diarrhoeal Disease Research, Bangladesh, was established as a consequence of an outbreak of diarrheal disease during the summer month of April 2007 in Mirpur area. Objective: The present study aimed to evaluate the impact of this new facility on patient load, common etiology, and other characteristics of patient population who sought treatment at Dhaka Hospital. Methods: As part of the Diarrheal Disease Surveillance System (DDSS), 10% patients (every 10th) seeking care irrespective of age, sex, sociodemographic background, and severity of disease were enrolled at MTC as opposed to 2% (every 50th) at Dhaka Hospital following identical methodology from 2010 to 2013. Moreover, enrolled DDSS patients from 2005 to 2009 at Dhaka Hospital were also included in analysis to further examine the impact of MTC on Dhaka Hospital. Results: Patient load from Mirpur area attending the Dhaka Hospital reduced from 13% during epidemic in 2010 to 6% in 2013 (53% reduction), whereas attendance in MTC increased substantially by 33%. This changing trend was also observed among children <5 years old. A significant reduction of patients presenting with moderately severe disease from Mirpur area at Dhaka Hospital was observed (69% reduction); however, attendance at MTC increased by 26% during same period. Conclusion: The number of patients from Mirpur area in Dhaka Hospital reduced but increased at MTC explaining the need for establishment of a set up for early treatment and control of diarrheal disease when consistent increase in annual number of cases or at the time of upsurge of cases is observed.

Thrombolytic, Cytotoxic and Antidiabetic Effects of Paederia foetida L. Leaf Extract.

Aims: This research investigated the thrombolytic, cytotoxic and antidiabetic effects of Paederia foetida leaf methanol extract. Place and Duration of Study: Department of Genetic Engineering and Biotechnology and Department of Biochemistry and Molecular Biology, University of Chittagong, Bangladesh, between April to December, 2012. Methodology: An in-vitro thrombolytic model was used to check the thrombolytic effect of Paederia foetida extract using streptokinase as a positive control. Cytotoxic effect was measured by Brine shrimp lethality bioassay. Antidiabetic effect of the extract was conducted in alloxan induced diabetic model of Swiss albino mice. Data were analyzed by one way ANOVA using statistical package for social science (SPSS) software. Results: In in-vitro thrombolysis, Paederia foetida extract (100μl) lysed 21.40 ± 1.39 %, Streptokinase (positive control) 81.42 ± 0.88 % and water (negative control) 4.63 ± 0.31% of the blood clots. These clot lysis values were statistically different (p<0.05) from each other. In Brine shrimp bioassay, lethal concentration (LC50) of Paederia foetida extract was found 65.31 μg/mL which was statistically significant compared to Vincristine sulfate (positive control, LC50=0.76 μg/mL). The extract showed a significant and dosedependent decrease in blood glucose level in alloxan induced diabetic mice. The effect of the extract was comparable to the reference antidiabetic drug metformin (150 mg/kg BW). Conclusion: The results demonstrated a moderate thrombolytic, cytotoxic and antidiabetic effect of Paederia foetida leaf extract to be analyzed further for prospective pharmaceutical preparation.

Determinants of Undernutrition in Children Under 2 years of Age From Rural Bangladesh.

This study aimed to assess the determinants of under nutrition among under-two year old children of rural Bangladesh. The data of the National Nutrition Program baseline survey conducted in 2004 was analyzed, which included 8,885 under-two children and their mothers. Among the children studied, 41%, 35% and 18% were stunted, underweight, and wasted; and 16%, 11.5% and 3% were severely-stunted, -underweight, and –wasted, respectively. Multivariate analysis revealed that undernourished children were less likely to be female and having received measles vaccination, more likely to have suffered from diarrhea in the previous two weeks, and more likely to have older- (>30 years), shorter- (<145 cm), undernourished- (BMI ≤18.5 kg/m2) and illiterate/less educated mother. Children with moderate stunting and underweight were more likely to reside in households with un-hygienic toilet. Children with all forms of under nutrition were more often from families with lowest quintile of asset index. The identified associated/risk factors can be used for designing and targeting preventive programs for undernutrition.

Nutrition of Children and Women in Bangladesh: Trends and Directions for the Future.

Although child and maternal malnutrition has been reduced in Bangladesh, the prevalence of underweight (weight-for-age z-score <-2) among children aged less than five years is still high (41%). Nearly one-third of women are undernourished with body mass index of <18.5 kg/m2. The prevalence of anaemia among young infants, adolescent girls, and pregnant women is still at unacceptable levels. Despite the successes in specific programmes, such as the Expanded Programme on Immunization and vitamin A supplementation, programmes for nutrition interventions are yet to be implemented at scale for reaching the entire population. Given the low annual rate of reduction in child undernutrition of 1.27 percentage points per year, it is unlikely that Bangladesh would be able to achieve the United Nations’ Millennium Development Goal to address undernutrition. This warrants that the policy-makers and programme managers think urgently about the ways to accelerate the progress. The Government, development partners, non-government organizations, and the academia have to work in concert to improve the coverage of basic and effective nutrition interventions, including exclusive breastfeeding, appropriate complementary feeding, supplementation of micronutrients to children, adolescent girls, pregnant and lactating women, management of severe acute malnutrition and deworming, and hygiene interventions, coupled with those that address more structural causes and indirectly improve nutrition. The entire health system needs to be revitalized to overcome the constraints that exist at the levels of policy, governance, and service-delivery, and also for the creation of demand for the services at the household level. In addition, management of nutrition in the aftermath of natural disasters and stabilization of prices of foods should also be prioritized.

Letrozole versus combined clomiphene citrate plus metformin as a first line treatment in women with polycystic ovarian syndrome: a prospective randomized trial

To compare the effect of letrozole to combined clomiphene citrate plus metformin as a first-line treatment to induce ovulation in women with polycystic ovarian syndrome [PCO]. In the present prospective randomised trial, 200 infertile women with PCOS were equally randomised to receive letrozole 2.5 mg for ,five days [days 3-7 of the cycle] or clomiphene citrate [CC]100 mg for five days [days 3-7 of the cycle] plus metformin 1500 mg daily for three treatment cycles. Human chroinic gonadotropine injection [HCG] was given when at least one follicle 18 mm present. The 3-month rate of ovulation, pregnancy and abortion were evaluated. The groups were similar with regard the baseline clinical characteristics and hormonal profiles. The ovulation rate was higher in the letrozole group [76.5% versus 71.6%] but without significant difference and the endometrial thickness at day of HCG was significantly higher in the letrozole group [8.6 mm versus 7.4 mm]. Letrozole shows higher pregnancy rate [45.7% versus 39.2%] and lower rate of abortion [10.8% versus 18.2%] but with no significance. The rate of multiple pregnancy was significantly higher in the CC metformin group 12.1% versus no case in the letrozole group letrozole is a suitable alternative first-line ovulation inducing drug in PCO

Assessment of antibacterial, thrombolytic and cytotoxic potential of Cassia alata seed oil.

Cassia alata is a pan tropical shrub. It has been reported to have medicinal activities like laxative effect and active against ringworm, skin diseases and ulcer. The leaf extract of this plant has shown antibacterial activity. In this study, seed oil extracted from Cassia alata , was studied for Antibacterial, Thrombolytic and Cytotoxic activity by using in vitro techniques. Chloroform extract of the seed oil was tested for Antibacterial activity using disc diffusion method and that extract showed potent antibacterial activity against both Gram(+) and Gram(-) bacteria. DMSO extract of the seed oil was tested for Brine shrimp lethality bioassay using Brine shrimp nauplii. The LC50 of DMSO extract of Cassia alata seed oil was found to be 250μg/ml, indicates that the oil has moderate pharmacological action. The DMSO extract of the seed oil was also tested for in vitro thrombolytic activity. The extract showed reasonable thrombolytic activity against negative control (water).Further investigation on the plant is required to confirm their pharmacological activity and thereby utilizing them as useful medicinal plant.

Nutritional Status, Dietary Intake, and Relevant Knowledge of Adolescent Girls in Rural Bangladesh.

This study estimated the levels and differentials in nutritional status and dietary intake and relevant knowledge of adolescent girls in rural Bangladesh using data from the Baseline Survey 2004 of the National Nutrition Programme. A stratified two-stage random cluster-sampling was used for selecting 4,993 unmarried adolescent girls aged 13-18 years in 708 rural clusters. Female interviewers visited girls at home to record their education, occupation, dietary knowledge, seven-day food-frequency, intake of iron and folic acid, morbidity, weight, and height. They inquired mothers about age of their daughters and possessions of durable assets to divide households into asset quintiles. Results revealed that 26% of the girls were thin, with body mass index (BMI)-for-age <15th percentile), 0.3% obese (BMI-for-age >95th percentile), and 32% stunted (height-for-age ≤2SD). Risks of being thin and stunted were higher if girls had general morbidity in the last fortnight and foul-smelling vaginal discharge than their peers. Consumptions of non-staple good-quality food items in the last week were less frequent and correlated well positively with the household asset quintile. Girls of the highest asset quintile ate fish/meat 2.1 (55%) days more and egg/milk two (91%) days more than the girls in the lowest asset quintile. The overall dietary knowledge was low. More than half could not name the main food sources of energy and protein, and 36% were not aware of the importance of taking extra nutrients during adolescence for growth spurt. The use of iron supplement was 21% in nutrition-intervention areas compared to 8% in non-intervention areas. Factors associated with the increased use of iron supplements were related to awareness of the girls about extra nutrients and their access to mass media and education. Community-based adolescent-friendly health and nutrition education and services and economic development may improve the overall health and nutritional knowledge and status of adolescents.

Primary repair of unilateral cleft lip nasal deformity

There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern. This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome. A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008. Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were perfonned primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages. The average follow up periods were 3 years [ranging from 1-5 years]. The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good resu1ts, 16 patients had acceptable results, and 6 patients had poor results. Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Whether it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question

Septorhinoplasty for the crooked nose

The externally deviated nose represents a complex cosmetic and functional problem. Its correction remains one of the challenging problems in rhinoplasty. To evaluate the result of correction of crooked nose by septorhinoplasty with fixation of nasal septum to the anterior nasal spine. 54 patients have undergone primary septorhinoplasty through a closed approach including full mobilization of the septal cartilage, osteotomy to reduce the displaced lateral nasal wall and finally fixing the septal cartilage to the anterior nasal spine. The minimum follow-up period was 6 months. Recurrence rate for nasal deviation 10%. The aesthetic results were considered good to excellent in all patients, as judged by both the surgeons and patients. Complete mobilization of septal cartilage without scoring along with its fixation to the anterior nasal spine is satisfactory for correcting crooked nose

Nutrition: basis for healthy children and mothers in Bangladesh.

Recent data from the World Health Organization showed that about 60% of all deaths, occurring among children aged less than five years (under-five children) in developing countries, could be attributed to malnutrition. It has been estimated that nearly 50.6 million under-five children are malnourished, and almost 90% of these children are from developing countries. Bangladesh is one of the countries with the highest rate of malnutrition. The recent baseline survey by the National Nutrition Programme (NNP) showed high rates of stunting, underweight, and wasting. However, data from the nutrition surveillance at the ICDDR,B hospital showed that the proportion of children with stunting, underweight, and wasting has actually reduced during 1984-2005. Inappropriate infant and young child-feeding practices (breastfeeding and complementary feeding) have been identified as a major cause of malnutrition. In Bangladesh, although the median duration of breastfeeding is about 30 months, the rate of exclusive breastfeeding until the first six months of life is low, and practice of appropriate complementary feeding is not satisfactory. Different surveys done by the Bangladesh Demographic and Health Survey, United Nations Children's Fund (UNICEF), and Bangladesh Breastfeeding Foundation (BBF) showed a rate of exclusive breastfeeding to be around 32-52%, which have actually remained same or declined over time. The NNP baseline survey using a strict definition of exclusive breastfeeding showed a rate of exclusive breastfeeding (12.8%) until six months of age. Another study from the Abhoynagar field site of ICDDR,B reported the prevalence of exclusive breastfeeding to be 15% only. Considerable efforts have been made to improve the rates of exclusive breastfeeding. Nationally, initiation of breastfeeding within one hour of birth, feeding colostrum, and exclusive breastfeeding have been promoted through the Baby-Friendly Hospital Initiative (BFHI) implemented and supported by BBF and UNICEF respectively. Since most (87-91%) deliveries take place in home, the BFHI has a limited impact on the breastfeeding practices. Results of a few studies done at ICDDR,B and elsewhere in developing countries showed that the breastfeeding peer-counselling method could substantially increase the rates of exclusive breastfeeding. Results of a study in urban Dhaka showed that the rate of exclusive breastfeeding was 70% among mothers who were counselled compared to only 6% who were not counselled. Results of another study in rural Bangladesh showed that peer-counselling given either individually or in a group improved the rate of exclusive breastfeeding from 89% to 81% compared to those mothers who received regular health messages only. This implies that scaling up peer-counselling methods and incorporation of breastfeeding counselling in the existing maternal and child heath programme is needed to achieve the Millennium Development Goal of improving child survival. The recent data showed that the prevalence of starting complementary food among infants aged 6-9 months had increased substantially with 76% in the current dataset. However, the adequacy, frequency, and energy density of the complementary food are in question. Remarkable advances have been made in the hospital management of severely-malnourished children. The protocolized management of severe protein-energy malnutrition at the Dhaka hospital of ICDDR,B has reduced the rate of hospital mortality by 50%. A recent study at ICDDR,B has also documented that home-based management of severe protein-energy malnutrition without follow-up was comparable with a hospital-based protocolized management. Although the community nutrition centres of the NNP have been providing food supplementation and performing growth monitoring of children with protein-energy malnutrition, the referral system and management of complicated severely-malnourished children are still not in place.

Closure of A large complicated pharyngocutaneous fistula

Pectoralis major muscle or myocutaneous flap is usually used for closure of big pharyngocutaneous fistula. In case of partial or complete failure, the plastic surgeon should be well prepared to use a second option for closure weather using myocutaneous or fasciocutaneous flaps, alone or with combination. Deepithelialized Deltopectoral flap found to be a reliable option

Expression of cyclooxygenase-2 and 12-lipoxygenase in human breast cancer and their relationship with HER-2/neu and hormonal receptors: impact on prognosis and therapy.

BACKGROUND: A number of studies have shown over-expression of cox-2 in breast cancer. Also it has been recorded that human breast cancer expresses high level of cox-2 and 12-lipoxygenase which may be beneficial in future therapy plan for those patients. AIMS: The present study aims to examine the level of transcripts of cox-2 and 12-lipoxygenase in Egyptian breast cancer patients and to compare between the expressions of both enzymes and TNM staging, hormone receptors status (including estrogen and progesterone) and HER2/neu expression. MATERIALS AND METHODS: Total cellular RNA was extracted from 64 frozen tissue samples of breast carcinoma and their corresponding normal adjacent tissues. Cox-2 and 12-lipooxygenase expressions were detected using RT-PCR. Hormonal receptors as well as HER2/neu were detected immuno-histochemically for each patient. RESULTS: About 47 and 62.5% of carcinoma samples showed over-expression of cox-2 and 12-lipooxygenase respectively as compared to their corresponding normal tissues. The results revealed that cox-2 significantly associated with TNM staging (P = 0.0047) and hormonal receptors status (P = 0.0201). The relationship between cox-2 and HER2/neu expression was close to a significant value (P = 0.0747). 12-lipooxygenase showed only significant association with TNM staging (P = 0.0076). Neither hormonal receptors nor HER2/neu showed significant association with this enzyme. CONCLUSION: Elevated levels of cox-2 and 12-lipoxygenase expression were detected in human breast cancer. Also, the results revealed that cox-2 and 12-lipooxygenase mRNA expressions are associated with TNM staging in human breast cancer. Furthermore, there is an inverse association between cox-2 expression and hormonal receptor status. This observation may drive us to the possible role of those two enzymes in determining the plan of therapy of breast cancer patients.

Role of some inflammatory markers in recent ischemic stroke

The onset of cerebral ischemia triggers a cascade of pro-inflammatory molecular and cellular events. Clinical studies suggest that the strength of this acute response is important in early and late clinical outcomes, early clinical worsening, and extent of brain damage. The aim of this work was to estimate the. role of some inflammatory markers in recent ischemic stroke, and to correlate these inflammatory markers with the short term outcome. Twenty sex patients presented with recent history of hemiplegia within 24 hours were included. The patient group was planned to contain 13 patients with the age between 20 and <40years and 13 patients with the age between 40 and 60 years. 15 subjects, [age and sex matched to the patients] were included in the study as control Neurological deficits were rated by Scandinavian Stroke Scale. Clinical assessments and serum levels of the inflammatory markers, Neopterin C -Reactive Protein [CRP], Tumor Necrosis Factor-alpha [TNF-alpha], Complement 4 [C-4], Interleukin-8 [IL-8], and Neopterin, were done at the time of admission, day 3, and day 7 from the stroke onset. Serum levels of neopterin started to increase from the 3 rd day and remained high to the end of the first week from the onset of the stroke. The increase was more obvious in the young aged patients. Serum levels of IL-8, raised rapidly in the acute phase of the stroke and then gradually decreased through the first wee and but still higher than the base line of the total patients and control. Serum levels of TNF-alpha and CRP had rapid significant increase from the first day to reach maximum levels in the 3 rd day and still significantly high till the end of the first week Serum CRP levels were higher in the old age group while serum C4 levels decreased from the 1 st day then gradually increased to reach maximum levels in the 7 th day, but still significantly lower than the control group. Also, there were statistically positive correlations between serum levels of neopterin and C-4 in the 3 rd sample with the Scandinavian scale in the 3 rd assessment. Brain ischemia induced an inflammatory cascade by the increase in serum levels of neopterin, IL-8, TNF-alpha, CRP and decrease in C4. This inflammatory response continued through the first week by the increase in the levels of complement -4. The inflammatory response was more obvious in the young aged patients. There were positive correlations between serum levels of neopterin, and C-4 with the short-term outcome of the stroke patients

Intellectual impairment among epileptic children correlation with age of onset and duration of epilepsy

Intellectual impairment among epileptic children has been a subject of study throughout the modern era of epileptology. Early age of onset and long duration of epilepsy have been implicated as possible contributors. To test for this hyposis, 45 epileptic children and 20 normal controls of the same age group [6-16 years] were studied using Wechsler Intelligence Scale for Children Revised [WISC-R]. Correlations between intellectual impairment and age of onset and duration of epilepsy were done. The results showed that epileptic children have significantly lower IQ than controls. Moreover, those with earlier seizure onset and longer seizure duration have significantly lower IQ. In conclusion, the earlier the age of onset and the longer the duration of epilepsy, the more the intellectual impairment

Management of occipital encephalocele

The clinical records, hematological and radiological investigation and operative notes of five patients [four females and one male] operated on were done. All cases were full-term newborns with a weight ranging from 2.270 to 3.552 g. The patients' mothers mean ages were 24.4 years [19-32 years]. A surgical intervention was done for all cases, an elliptic skin incision surrounding the occipital encephalocele was made along a vertical axis. The ellipse was performed narrow enough to allow skin closure at the end of the procedure, but broad enough to resect the total of the encephalocele. Ventriculo-peritoneal shunt operation was done for three cases that had hydrocephalus, but the other two cases had no hydrocephalus and did not develop after the operation. All cases discharged without any neurological deficit

Comparison of H-reflex latency with conventional motor nerve conduction study in diagnosis of diabetic neuropathy

Distal polyneuropathy is the most common neurologic complication of diabetes mellitus. Prolongation of H-reflex latency could be demonstrated at time when convential motor nerve conduction study may not show an abnormality. The aim of this work was to compare motor conduction study with H-reflex latency in diagnosis of diabetic neuropathy. This study was carried out on 44 patients with diabetes mellitus of both type 1 and type 2, they were 26 males with mean age 47.5 years and 18 females with mean age 43.4 years. A control group of 10 healthy subjects were chosen, six were males and 4 were females, the two groups were matched together as regard the age and sex. The patients and control groups were subjected to thorough clinical evaluation and electrophysiological testing for distal latency of the median and lateral popliteal nerves and their motor nerve conduction velocity as well as the H-reflex latency. Correlations between H-reflex and other variables including motor conduction velocity and type of diabetes were done. The results were: 30 cases showed peripheral sensory affection while 14 patients showed no symptoms of sensory affection, 27 patients showed motor manifestations, 6 patients showed cranial nerve affection and 5 patients showed manifestations of autonomic dysfunctions. The electrophysiological tests showed highly significant difference between control and patients groups regarding median nerve distal latency, median and lateral popliteal nerves motor conduction velocity and very highly significant difference between control and patients groups in H-reflex latency. Comparing H-reflex latency with motor nerve conduction velocity revealed significant superiority of H-reflex latency on motor conduction velocity in both clinical and subclinical cases of diabetic neuropathy. We concluded that H-reflex latency is of great diagnostic value in diabetic neuropathy. Furthermore, it is more sensitive than conventional motor nerve conduction study

Poor prognostics in patients with spontaneous lobar haemorrhages

The study included 30 consecutive patients presented with acute spontaneous lobar hemorrhages. Neurological deterioration was defined as a decrease in GCS sum score by two points, new neurological deficit and/or clinical signs of brain herniation. CT brain was done initially and thereafter whenever indicated. A univariate logistic regression analysis was performed. The results showed that 33.3% patients with lobar hemorrhages deteriorated after admission. In univariate analysis, only a Glasgow coma score <14 predicted deterioration [70% of deteriorates vs. 20% who did not deteriorate]. Initial CT characteristics predictive of deterioration included hemorrhage volume >60 ml [63% vs. 16%.]. Patients presented and deteriorated within 12 hours of ictus because of enlargement of hemorrhage. Those who deteriorated more than 12 hours after initial neurological symptoms showed increased mass effect secondary to edema

Is it worthy to do CT to diagnose acute appendicitis

20 patients have been evaluated by CT, if they have appendicitis either proximal or distal. the changed occurred in CT has been documented by many radiologist. Our purpose is to find, is it worthy to do CT to diagnose appendicitis in Egypt. Appendicitis historically has been diagnosed clinically, with only occastional use of diagnostic imaging. Reported rates of negative findings at diagnostic laparotomy in patients diagnosed clinically range between 6.5% and 45% [average, 20%] [1-3]. Reported clinical false - negative ranges between 7% and 33% [average, 20%] [4.5] when clinical impression alone was relied on for diagnosis, a normal appendix was removed in approximately every fifth patient who underwent appendecetomy and the diagnosis was over looked in every fifth patient who actually has appendicitis but was clinically evaluated and sent home