Predictors and Outcome of in-Hospital Cardiac Arrest Patients in Emergency Department Suez Canal University Hospitals

Background: In-hospital cardiac arrest (IHCA) is defined as cessation of cardiac activity, confirmed by the absence of signs of circulation, in a hospitalized patient who had a pulse at the time of admission. The purpose of the present study was to record the definitive predictors of IHCA, focusing on the relation between cause and outcome as well as the influence of location on survival. Subjects and Methods: This prospective observational study (cross sectional) was carried out in Emergency Department at Suez Canal University Hospital and included 223 patients experiencing IHCA at the Emergency Department (ED). Results: Our study showed return of spontanous circulation (ROSC) rate of 27.4%, which is lower than those reported in other studies from the region. In our study, we found that the overall mean duration for comprehensive cardiopulmonary resuscitation (CPR) was 21 min (SD ± 10).We found that Pulse, RR, BP, Witnessed and advanced life support (ALS) interventions at time of event were significant positive predictors to ROSC with patients while age, modified early warning score (MEWS), Interval between collapse to start CPR and CPR duration were negative predictors to cognitive impairment with diabetic patients. Conclusions: IHCA can be predicted using different variable related to patients vital data, laboratories, radiological investigations and patient demographic data which helps in predicting and modifying the outcome in limited situations.

Correlation between the RhD genotyping and RhD serotyping in isoimmunized pregnancies

Alloimmunisation was one of the most important causes of perinatal mortality and morbidity by the middle of the last century. The objective of the present study was to investigate the presence of the RHD gene in fetal cells [amniocytes] obtained from amniotic fluid by genotyping to compare it with the RhD serotyping. Also to correlate the presence of RhD gene with the neonatal outcome. This work was carried out at Maternity hospital and Medical Genetics center, while PCR testing was done at the Medical Research center, Faculty of Medicine, Ain Shams University in the period from 2008 to 2010. The present study included recruiting of 20 RhD negative [sensitized to the RhD antigen] pregnant mothers. The entire study group was subjected to complete general, obstetric and a detailed obstetric ultrasonographic examination. Rh typing and indirect Coomb's test were also done. Amniocentesis was performed with a 20-gauge needle under continuous ultrasound guidance. RhD serotyping of the fetuses showed that, 14 fetuses [70%] were positive and six fetuses [30%] were negative. While using RhD gentyping 13 cases [65%] were positive and seven cases [35%] were negative [P value = 0.002]. Among fetuses positive for RhD genotyping six fetuses [46%] had received postnatal treatment, while among fetuses negative for RhD genotyping, neither of them had received postnatal treatment [P value = 0.032], which is statistically significant. From the present study we can conclude that, the identification of an antigen-negative fetus on the basis of the blood group genotype provides significant advantages in managing the pregnancy at risk for HDFN

Changes in vaginal microflora and bone resorbing cytokines level in postmenopausal period

This study was designed to evaluate the role of postmenopausal estrogen deficiency on vaginal microflora, detect its relation with level of bone resorbing cytokines and to evaluate their role in postmenopausal osteoporosis. One hundred and twenty females were investigated. They were divided into two groups, Group I included 60 women in postmenopausal period, Group II [control group] included 60 women in premenopausal period. All of them were subjected to bacteriological examination: vaginal swabs were used for making direct Gram-stained smears but only 100 specimens [50 from each group] were cultured on suitable culture media to isolate different vaginal microorganisms and compare the isolates of the two tested groups. Eighty females [40 from each group] were subjected to serological studies including estimation of serum level of interleukin-6, interleukin- 1 beta, and tumor necrosis factor-alpha] using enzyme immunoassay [EIA] technique, estradiol and osteocalcin levels were measured by radioimmunoassay [RIA] technique. The study revealed that vaginal flora in postmenopausal females, according to Nugent Scoring System, showed normal pattern [82%] Intermediate [15%] and bacterial vaginosis [3%] compared with 72%, 23% and 5% respectively in premenopausal females with no statistically significant difference between the two groups [P>0.05]. There was a lower isolation rate of facultative Lactobacilli, Gardnerella vaginalis, C and ida albicans and Mobiluncus in postmenopausal females than in premenopausal females. Catalase +ve Lactobacilli was found to be predominant over catalase -ve in both post- and premenopausal females although their rate of isolation was lower in premenopausal females. In most of the cases, which showed bacterial vaginosis, G. vaginalis were isolated in high percentage associated with catalase-ve Lactobacilli. There was higher level of estradiol in sera of premenopausal than in postmenopausal females with statistically significant difference between them [P<0.001]. Serum level of osteocalcin was elevated in post- than in premenopausal females with no statistically significant difference between them [P>0.05]. There was also no statistically significant correlation between osteocalcin and age, parity, body mass index and estradiol level. A higher serum level of IL-6 and TNF-alpha was found in post- than in premenopausal females with statistically significant difference between them [P 0.05]. These factors showed no statistically significant correlation with serum level of both estradiol and osteocalcin [P>0.05]. Estrogen replacement therapy is recommended for postmenopausal females with more attention must be paid to personal hygienic measures for protection against colonization of vagina with potentially pathogenic microorganisms. Moreover, detection of bone resorbing cytokines level in bone microenvironment together with their estimation in serum are more important tool to evaluate the role of postmenopausal estrogen deficiency on bone resorption

Serum lactate dehydrogenase enzyme concentration in women with pre-eclampsia

Lactate dehydrogenase enzyme [LDH] is a glycolytic enzyme involved in the reversible conversion of pyruvate to lactate when absolute or relative anoxemia is present. Several authors have found that LDH concentration was increased in pre-eclampsia, but the reason for this elevation was not yet clear. In this study we measured serum LDH enzyme concentration in normal pregnancy and in pregnancy induced hypertension and its relation to fetal weight. Blood was collected from 60 women Presenting with pre-eclampsia from 60 healthy pregnant controls and from 20 non pregnant women of child bearing age. Serum LDH, liver function tests, kidney function tests and blood film for evidence of haemolysis were performed for each women. Serum LDH was measured using kinetic determination of LDH as recommended by the German Clinical Chemistry Society [DSKC]. LDH concentration was significantly higher in women with pre-eclampsia compared with healthy pregnant controls. Furthermore, LDH concentration was significantly higher in women with severe pre-eclampsia compared with women with mild pre-eclampsia. A positive significant correlation was also found between diastolic blood pressure and LDH concentration in women with pre-eclampsia. An increase in LDH level was associated with some liver cell damage, as elevated aspartate amino transferase [AST] and alanine amino transferase [ALT] concentrations were observed in pre-eclamptic women with LDH activity. There was a significant negative correlation LDH and fetal weight in women with pre-eclampsia. Elevated LDH concentration in women with pre-eclampsia may act as a predictor for small for gestational age infants. The underlying mechanism for elevated LDH in pre-eclampsia might be some abnormality in liver function