Adding autogenic drainage to chest physiotherapy after upper abdominal surgery: effect on blood gases and pulmonary complications prevention. Randomized controlled trial

ABSTRACT BACKGROUND: Hypoxemia and pulmonary complications are common after upper abdominal surgery (UAS). OBJECTIVE: To examine whether inclusion of autogenic drainage (AD) in chest physiotherapy after UAS confers additional benefits in improving blood gases and reducing postoperative pulmonary complications (PPCs). DESIGN AND SETTING: Randomized controlled study conducted at Kasr Al-Ainy teaching hospital, Egypt. METHODS: A randomized controlled trial was conducted on 48 subjects undergoing elective UAS with high risk of developing PPCs. The study group received AD plus routine chest physiotherapy (deep diaphragmatic breathing, localized breathing and splinted coughing) and the control group received routine chest physiotherapy only. The outcomes included arterial blood gases measured at the first and seventh postoperative days, incidence of PPCs within the first seven days and length of hospital stay. RESULTS: Baseline characteristics were similar between groups. In the AD group, SaO2, PaO2, PaCO2 and HCO3 significantly improved (P < 0.05) while in the physiotherapy group, only SaO2 and PaO2 significantly improved (P < 0.05). Nonetheless, significant differences in post-treatment SaO2 and PaO2 between the groups were observed. The overall incidence of PPCs was 16.66% (12.5% in the AD group and 20.8% in the physiotherapy group) (absolute risk reduction -8.3%; 95% confidence interval, CI, -13.5 to 29.6%), with no significant difference between the groups. The AD group had a significantly shorter hospital stay (P = 0.0001). CONCLUSION: Adding AD to routine chest physiotherapy after UAS provided a favorable blood gas outcome and reduced the length of hospital stay. It tended to reduce the incidence of PPCs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04446520.

Loofah immobilized with Cladosporium cladosporioides CEL14 is a potential bioremediating agent for hexavalent chromium in tannery wastewater

Aims@#Chromium salt possesses unique characteristics that render it useful in numerous applications in several industrial processes, especially tanning of animal hides which act as a major source of hexavalent chromium toxicity in environment. This study aimed to evaluate the efficiency of loofah immobilized Cladosporium cladosporioides CEL14 in remediate tannery wastewater which contains hexavalent chromium. @*Methodology and results@#A total of 18 fungal species were isolated from three different sites of tannery wastewater in Egypt, of which C. cladosporioides CEL14 was the most capable species of chromate remediation with 81% after 7 days of incubation as free cells. The experiments were conducted in minimum salt medium supplemented with 200 ppm chromate in the form of potassium dichromate. Different process parameters studies demonstrated that chromate was completely removed at 30 °C, pH 6, 0.1% malt extract and 0.2% glucose after 7 days of incubation with 20% inoculum size. After that, C. cladosporioides was immobilized on a natural support material (loofah). The removal ability of chromate was enhanced through permanent viable immobilization on loofah pieces, which showing complete removal of chromate within 3 days. The toxicity assessment of treated tannery effluents revealed that 74% of Brassica napus seeds were germinated upon exposure to the treated effluent.@*Conclusion, significance and impact of study@#This study revealed that C. cladosporioides CEL14 isolate has high potential as bioremediating agent against toxic hexavalent chromium. The removal ability of toxic chromate was enhanced through permanent viable immobilization on loofah pieces. This technology is simple, cost effective, efficient and environmentally friendly. The loofah immobilized with C. cladosporioides CEL14 has potential to be applied in wastewater treatment of small-scale tanneries after onsite trials.

Antimicrobial, antiquorum sensing, and antiproliferative activities of sesquiterpenes from Costus speciosus rhizomes

The quorum sensing inhibitory [QSI] and antimicrobial potentials of the total methanol extract [TME] and different extractives as well as the sesquiterpenes: dehydrodihydrocostus lactone [1], dehydrocostus lactone [2], arbusculin A [3], santamarine [4], reynosin [5], and specioic acid [6] isolated from Costus speciosus rhizomes were evaluated. The CHCl3:EtOAc [1:1], EtOAc, and TME fractions exhibited potent antibacterial activity toward B. cereus with inhibition zone diameter 13 mm. While the CHCl3 fraction showed strong activity towards S. aureus and B. cereus with inhibition zone diameter 11 and 19 mm, respectively. Moreover, the TME and CHCl3 fractions have strong activity towards C. albicans with inhibition zone diameter 15 and 12 mm, respectively. Compound 5 showed prominent activity towards B. cereus [MIC 385 µg/mL]. However, 6 exhibited significant activity with MIC values of 150, 400, and 550 µg/mL towards S. aureus, E. coli, and B. cereus, respectively. Moreover, it showed potent antifungal effect towards C. albicans [MIC 320 µg/mL]. Most of the tested fractions had QSI activity against C. violaceum. Only compound 6 exhibited moderate QSI effect with disappearance of violet pigment. In addition, compounds 1-6 were evaluated for their in vitro antiproliferative activity towards KB, BT-549, SK-MEL, and SKOV-3 cancer cell lines

Effect of wet mass on dextromethorphan hydrobromide matrix pellets

Dextromethorphan hydrobromide (DM) sustained release matrix pellets containing 10% w/w drug were prepared by an extrusion/spheronization technique. The effect of mixing different concentrations of ethyl cellulose (EC), hydroxypropyl methylcellulpse (HPMC K10), and Carbopol 934 with Avicel PH101 on the rheological properties of pellet wet mass was evaluated using mixer torque rheometry (MTR). The prepared pellets were characterized for size, drug content, and in-vitro DM release rate. The results showed that increasing the concentration of the hydrophobic polymer (EC) with Avicel PH101 decreased wet mass consistency, represented by mass mean line torque. Lower binder ratio was required for optimum wet massing, while mixing with swellable polymers (HPMC and Carbopol) caused a noticeable increase in both mean line torque and binder ratio. Combinations of HPMC and Carbopol at higher concentrations resulted in controlled in vitro release of DM from the prepared pellets. Furthermore, mathematical treatment of the in vitro release data of DM from the prepared pellets showed that all formulations except those containing 5% Carbopol plus 5% HPMC (F10) follow first order release. n values of these formulation were in the range of 0.09-0.40, which support an anomalous non-Fickian release.

Anti-inflammatory terpenoids from Cyperus rotundus rhizomes

Phytochemical investigation of the methanolic extract of Cyperus rotundus L. [Cyperaceae] rhizomes afforded a new norterpenoid with an unprecedented carbon skeleton, namely cyperalin A [1] and sugetriol triacetate [2]. Their structures were identified by using advanced spectroscopic technique such as UV, IR, 1D [[1]H and [13]C], 2D [[1]H-[1]H COSY, HSQC, HMBC, and NOESY]] NMR, and HRESIMS as well as comparison with literature data. The isolated compounds were evaluated for their anti-inflammatory activity. Compound 1 displayed the highest inhibitory activity of PGE2, COX-2, and LOX-5 with IC[50s] 0.22, 1.03, and 1.37 MuM, respectively compared to indomethacin [IC50s 0.15, 0.69, and 0.81 MuM, respectively]. Moreover, 2 demonstrated significant activity with IC[50s] 0.57 [PGE2], 1.74 [COX-2] and 2.03 [LOX-5] MuM

Clinical comparative study between magnesium sulphate versus rocuronium versus dexmedetomidine as adjuvants for local anesthetic in peribulbar block for eye surgeries

Background: Regional anesthesia is a preferred technique for ophthalmic surgery. It is safe, inexpensive and provides efficient ocular anesthesia for ophthalmic surgery. It is associated with less hemodynamic instability, less respiratory depression, better postoperative pain relief, and less nausea and vomiting compared to general anesthesia

Objectives: The aim of the study was to compare the safety and efficacy of the use of Magnesium sulfate versus that of Rocuronium versus Dexmedetomidine as an adjuvant to the local anesthetic in peribulbar anesthesia. It is characterized by generating optimal operating conditions for eye surgery in terms of akinesia, analgesia, incidence of complications, as well as induction of patient and surgeon satisfaction

Patients and Methods: The present study included100 patients of the American Society of Anesthesiology [ASA], physical status I, II, III or IV of both sex, [20-80] years old and undergoing to anterior and posterior segment surgeries. Informed written consent from all patients was taken after approval of Al-Azhar University Ethical Committee

Results: Evaluation of the globe akinesia was done at [2.5],[5],[7.5],and[10] min. after injection. The onset of motor block showed a statistically significant difference between the four groups, the rocrounium group showed more rapid onset of motor block then dexmedtomedine group then magnisum sulphate group then lastly the control group

Conclusion: The present study concluded that using Rocuronium as an additive to local anathestic drugs in peribublar block it makes onset of block more rapid and dense but it has less effect on analgesic aspect. On the other hand, when Dexmedetomidine or Magnesium sulfate were used as additive they increased analgesic effect of local anathestic and decreased the need for early postoperative rescue analgesia, as well as fastening the onset of block but to a lesser extent less than Rocuronium as an additive to local anathestic

Formulation and evaluation of orally disintegrating clopidogrel tablets

ABSTRACT Recent advances in drug delivery systems have aimed to achieve better patient compliance. One of these advances is the formulation of orally disintegrating tablets (ODTs) that dissolve instantaneously, releasing drugs within a few seconds without the need of water. The main objective of this paper was to prepare and develop ODTs of clopidogrel. The ODTs were prepared by direct compression. The effect of three superdisintegrants, namely crospovidone, croscarmellose sodium, and sodium starch glycolate, using three different disintegration times on the dissolution rate was investigated. The prepared tablets were evaluated for hardness, friability, disintegration time and in vitro drug release. Furthermore, the interaction of clopidogrel with the formulation excipients was studied using differential scanning calorimetry (DSC). DSC studies revealed that there were no interactions between the drug and the excipients used. All tablets had hardness values in the range 4.0-5.2 kp and friability lower than 1%. The weight and drug content uniformity of all formulations was within official limits according to BP. In vitro drug release studies of the ODTs showed that more than 90% of the drug was released within ten minutes. A palatability test in human volunteers showed acceptable taste and mouth feel. Thus, the obtained results conclusively demonstrated successful rapid disintegration of the formulated tablets and acceptable palatability.

RESUMO Recentes avanC'os em sistemas de liberaC'C#o de fC!rmacos novos visam C obtenC'C#o de melhor adesC#o do paciente. Um destes avanC'os C) a formulaC'C#o de comprimidos de desintegraC'C#o oral (ODTs), que se dissolvem instantaneamente, liberando o fC!rmaco, em alguns segundos, sem a necessidade de C!gua. O principal objetivo deste trabalho foi preparar e desenvolver ODTs de clopidogrel. Os ODTs foram preparados pelo mC)todo de compressC#o direta. Estudou-se o efeito de vC!rias concentraC'C5es de diferentes agentes de desintegraC'C#o, tais como super-crospovidona, croscarmelose de sC3dio, glicolato de amido de sC3dio no tempo de desintegraC'C#o e velocidade de dissoluC'C#o. Os comprimidos preparados foram avaliados quanto C dureza, C friabilidade, ao tempo de desintegraC'C#o e C liberaC'C#o do fC!rmaco in vitro. AlC)m disso, estudou-se a interaC'C#o de clopidogrel com os excipientes de formulaC'C#o, utilizando calorimetria de varredura diferencial (DSC). Estudos de DSC revelaram nC#o haver interaC'C#o entre o fC!rmaco e os excipientes utilizados. Todos os comprimidos possuC-am dureza na faixa de 4,0-5,2 kp e a friabilidade inferior a 1%. A variaC'C#o de peso e o teor de fC!rmaco de todas as formulaC'C5es mostraram-se dentro do limite oficial, de acordo com a BP. O estudo de liberaC'C#o do fC!rmaco in vitro de comprimidos ODTs mostrou que mais de 90% do fC!rmaco foram liberados em10 minutos. O teste de palatabilidade em voluntC!rios humanos mostrou sabor e sensaC'C#o na boca aceitC!veis. Assim, os resultados obtidos demonstraram, conclusivamente, a rC!pida e bem-sucedida desintegraC'C#o dos comprimidos formulados e a palatabilidade aceitC!vel.

Safety and outcome of treatment of metastatic melanoma using 3-bromopyruvate: a concise literature review and case study / 癌症

3-Bromopyruvate (3BP) is a new, promising anticancer alkylating agent with several notable functions. In addition to inhibiting key glycolysis enzymes including hexokinase II and lactate dehydrogenase (LDH), 3BP also selectively inhibits mitochondrial oxidative phosphorylation, angiogenesis, and energy production in cancer cells. Moreover, 3BP induces hydrogen peroxide generation in cancer cells (oxidative stress effect) and competes with the LDH substrates pyruvate and lactate. There is only one published human clinical study showing that 3BP was effective in treating fibrolamellar hepatocellular carcinoma. LDH is a good measure for tumor evaluation and predicts the outcome of treatment better than the presence of a residual tumor mass. According to the Warburg effect, LDH is responsible for lactate synthesis, which facilitates cancer cell survival, progression, aggressiveness, metastasis, and angiogenesis. Lactate produced through LDH activity fuels aerobic cell populations inside tumors via metabolic symbiosis. In melanoma, the most deadly skin cancer, 3BP induced necrotic cell death in sensitive cells, whereas high glutathione (GSH) content made other melanoma cells resistant to 3BP. Concurrent use of a GSH depletor with 3BP killed resistant melanoma cells. Survival of melanoma patients was inversely associated with high serum LDH levels, which was reported to be highly predictive of melanoma treatment in randomized clinical trials. Here, we report a 28-year-old man presented with stage IV metastatic melanoma affecting the back, left pleura, and lung. The disease caused total destruction of the left lung and a high serum LDH level (4,283 U/L). After ethics committee approval and written patient consent, the patient received 3BP intravenous infusions (1-2.2 mg/kg), but the anticancer effect was minimal as indicated by a high serum LDH level. This may have been due to high tumor GSH content. On combining oral paracetamol, which depletes tumor GSH, with 3BP treatment, serum LDH level dropped maximally. Although a slow intravenous infusion of 3BP appeared to have minimal cytotoxicity, its anticancer efficacy via this delivery method was low. This was possibly due to high tumor GSH content, which was increased after concurrent use of the GSH depletor paracetamol. If the anticancer effectiveness of 3BP is less than expected, the combination with paracetamol may be needed to sensitize cancer cells to 3BP-induced effects.

Synthesis and biological evaluation of some new coumarin derivatives as antimicrobial agents

A series of new 7-[2-[3-alkyl/aryl-4-arylthiazol-2[3H]-ylidene]hydrazono]propoxy]-4-methyl-2H-chromen-2-ones, [6-9a-e], was prepared by the reaction of appropriate N-alkyl/aryl-2-[1-[4-methyl-2-oxo-2H-chromen-7yloxy]propan-2-ylidene]hydrazine carbothioamides [4a-d] and phenacyl bromides [5a-e]. The purity of all new compounds was checked by TLC and elucidation of their structures was confirmed by IR, [1]H NMR, and mass spectrometry along with elemental microanalyses. All the target compounds were evaluated for their possible antimicrobial activity. Most of the tested compounds showed weak to moderate antibacterial activity against most of the bacterial strains used in comparison with gatifloxacin as a reference drug. The most active compounds were 6b, 6c, 7b, 8b, 8c, and 9c against B. cereus, E. coli and S. marcescens. Results of antifungal activity revealed that all compounds showed weak to moderate activity against S. brevicaulis, while ketoconazole as a reference drug was completely inactive. Compounds 6a, 6b, 6c, 6e and 7b were even more active than ketoconazole against F. oxysporum

Effect of binary and ternary solid dispersions on the in vitro dissolution and in-situ rabbit intestinal absorption of gliclazide

Solid dispersion technique is widely used to improve the dissolution rate of drugs. Most investigators relied on the in-vitro characterization and considered the enhanced dissolution as an indication of improved bioavailability. The current study investigated the effects of binary and ternary solid dispersions of gliclazide with polyethylene glycol 6000 [PEG 6000] and/or pluronic F68 [PL F68] on the dissolution of gliclazide. The study also investigated the intestinal absorption in presence of solid dispersion components. The latter employed the in-situ rabbit intestinal perfusion technique. Preparation of binary solid dispersion with PEG 6000 or PL F68 significantly enhanced the dissolution rate compared to pure drug. The ternary solid dispersion of gliclazide with both polymers resulted in rapid drug dissolution with most drug being released in the first five minutes. The intestinal perfusion indicated the possibility of complete drug absorption from the small intestine. This, together with slow dissolution of pure drug suggested that the absorption of gliclazide is dissolution rate limited. The presence of PEG 6000 did not alter the intestinal absorption but PL F68 showed a trend of enhanced intestinal absorption of the drug. Ternary solid dispersion can thus provide rapid absorption due to rapid dissolution and potential increase in intestinal permeability

Knowledge, attitude, and behavior among Saudis toward cancer preventive practice

To examine self-reported knowledge, attitude, and preventive practices on cancer among Saudis. Data was collected from Saudis aged 15 years or more, who attended one of the randomly selected 20 Primary Health Centers [PHC] or the four major private hospitals located in the Riyadh region, either as patients or their escorts. The association between the variables was evaluated by the Chi square test. The study population consisted of 618 males and 719 females. Among the female respondents 23.1% reported that they practiced breast self-examination [BSE]; 14.2 and 8.1%, respectively, had clinical breast examination [CBE] and mammography. However, 10.0 and 16.1% of the females, aged 40 years and older, reported having had mammograms and CBE, respectively. The BSE performers were more educated, knew someone with cancer, and had heard of the cancer warning signal. Both educational level and 'heard of cancer warning signal' were significantly related to CBE. Cancer information was received from television / radio by 65.1% and from the physician by 29.4%. Even though 69.4% believed that cancer could be detected early, a vast majority [95.8%] felt early detection of cancer was extremely desirable and 55.1% said their participation was definite in any screening program. A majority of the respondents [92.6%] insisted on the need for physician recommendation to participate and 78.1% expected that any such program should be conducted in the existing hospitals / clinics. Culturally sensitive health education messages should be tailored to fulfill the knowledge gap among all population strata. Saudis will benefit from partnerships between public health educators and media to speed up the dissemination of cancer information

Portal vein parameters in Egyptian patients with spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis [SBP] is a severe complication of cirrhosis and the role of portal hypertension in the development of SBP has been suggested. This study assessed the portal vein [PV] haemodynamic changes in patients with SBP. The study was conducted on 20 ascitic patients with SBP [GI], 20 ascitic patients without SBP [GII], 20 cirrhotic patients without ascites [GIII] and 20 healthy cross-matched controls [GIV]. All groups were subjected to complete clinical assessment and routine laboratory investigations. Portal vein diameter, velocity and congestion index [CI] were assessed by Doppler ultrasound. The results showed no significant difference between SBP patients and ascitic patients without SBP as regard PV diameter, velocity or CI. Portal vein diameter was significantly wider in patients with SBP [14.9 +/- 2.08 mm] and cirrhotic ascites [14.15 +/- 2.3] than normal persons [10.5 +/- 2.24 mm] or cirrhotic compensated patients [13.15 +/- 1.6mm]. The mean velocity of PV was significantly lower in patients with SBP [10.4 +/- 2.11] and ascites [10.7 +/- 2.22] than normal persons [15.35 +/- 2.08] or cirrhotic compensated patients [14 +/- 2.6], with no significant difference between controls and cirrhotic compensated patients. The CI of PV was significantly higher in patients with SBP [0.1825 +/- 0.036] and ascites [0.1743 +/- 0.051] than controls [0.05 +/- 0.050] or cirrhotic compensated patients [0.0955 +/- 0.091]. Cirrhotic compensated patients showed significantly wider PV [13.15 +/- 1.6] and higher congestion index [0.0955 +/- 0.091] than normal persons [10.55 +/- 2.24 and 0.05 +/- 0.050 respectively]

diagnostic efficiency of ultrasound and mammography in the evaluation of breast masses correlated with histopathology

To evaluate the role of mammosonography and mammography and histopathological correlation in assessment of the breast masses. We had studied a totally forty female patients with breast complaint either breast lump [36 cases] or other breast symptoms [fever, pain and discharges] 14 cases. All patients attended to radio-diagnosis departments of Sayed Galal hospital. Mammography and mammosonography were done in all cases to evaluate the specificity and sensitivity of both technique in correlation to the histopathological results [either fine needle, core biopsy or excision biopsy]. Forty patients with breast lesion were examined, 25 patients were benign [16 cases fibroadenoma 64%, 4 cases abscess 16%, 2 cases simple cyst 8%, 2 cases galactocele 8%, and 1 case duct ectasia 4%] and 15 patients were malignant, 13% cases infiltrating ductal carcinoma represent 86.6%, 1 case infiltrating lobular 6.6% and 1 case medullary type represents 6.6%. Combined use of mammography and sonomammography has a valuable role in diagnosis and management of breast lesion and can differentiate between benign and malignant lesions, however histopathology and its role can significantly reduce the need for surgery in breast lump

Radiological modalities versus histopathological finding in chronic small bowel diseases

The small intestine is one of the most difficult areas to study radiographically in the gastrointestinal tract, yet satisfactory investigations are needed to give the maximum definition of every inch of the intestine. Barium radiology remains the method of choice for diagnosis and evaluation of many small intestinal disorders. The other radiological modalities are helpful in diagnosis of chronic small bowel disorder and also detecting the associated pathology and the complications in the different organs. Aim of the work: To evaluate the accuracy of the different radiological modalities in diagnosis of different chronic small bowel diseases. This study was conducted on 50 patients referred from the inpatients departments and outpatients' clinic of medicine and surgery to the radiology department of Bab El Sharia University hospital. They were 30 males and 20 females, their age ranged between 22 and 50 years. The predominant clinical presentations were diarrhea [40 cases], loss of body weight [34 cases], abdominal colic [42 cases], distension [18 cases], fever [6 cases] and bleeding per rectum [1 case]. The cases were submitted to the following: Full clinical examination, Basic laboratory investigations and radiological studies. 38 patients of our conducted study were pathologically proven [76%]. Two cases [4%] were suspected to have small intestinal loops infiltration by an invasive ovarian carcinoma using another modality, while barium study decline this [our results was confirmed operatively]. On the other hand, there were four cases [8%] of post radiotherapy enteric changes having no definite criteria by barium study, and was diagnosed by previous clinical data of receiving radio-therapeutic treatment. Our study was non specific in two cases [4%]. Our study was negative in one patient suffering from obscure rectal bleeding proved by angiography to have a ceacal vascular malformation. Then we classified our population for more detailed analysis according to the type of abnormality into: Post therapeutic complications [6 case], inflammatory diseases [18 cases], neoplastic disorders [6 cases], obstructive disorders [4 cases] and others [6 cases]. Barium study is a highly sensitive imaging tool for detecting small bowel disorder. However other radiological modalities with correlation with the histopathological finding are helpful in the diagnosis and detection of complications of different chronic small bowel diseases

Evaluation of tuberculosis versus pyogenic [infectious] arthritis by using MRI imaging

To assess magnetic resonance [MR] imaging features in differentiating tuberculous arthritis from pyogenic arthritis. Findings in 29 patients with tuberculous arthritis were compared with those of 13 patients with pyogenic arthritis. Bone erosion, marrow signal intensity, synovial lesion signal intensity, boundaries [smooth or irregular] for extraarticular extension of infection, and abscess rim enhancement [thin and smooth or thick and irregular] were analyzed. Revealed that bone erosion was more common in patients with tuberculous arthritis [24 [83%] of 29] than in those with pyogenic arthritis [six [46%] of 13] [P = 0.026], while subchondral marrow signal intensity abnormality was seen more frequently in patients with pyogenic arthritis [12 [92%] of 13] than in those with tuberculous arthritis [17 [59%] of 29] [P = 0.036]. On T2-weighted images, there was no significant difference between the synovial lesion signal intensities of tuberculous arthritis and pyogenic arthritis. Lesions in 16 [70%] of 23 patients with tuberculous arthritis and two [17%] of 12 patients with pyogenic arthritis had smooth extraarticular boundaries, while those in seven [30%] of 23 patients with tuberculous arthritis and 10 [83%] of 12 patients with pyogenic arthritis had irregular boundaries [P = .005]. Tuberculous abscesses [16 [100%] of 16] had thin and smooth rim enhancement, while most pyogenic abscesses [five [7 1%] of seven] had thick and irregular rims[P .001].MR imaging of bone abnormalities Tnalities, extraarticular lesions, and associated abscesses provides useful information in the differentiation of tuberculous arthritis and pyogenic arthritis

Tuberculuous spondylitis and vertebral pyogenic infection: how far can MRI differentiate?

evaluation of the vertebral osteomyelitis and tuberculous spondylitis need an accurate and specific imaging modality to guide invasive procedures for a definitive microbiological diagnosis and to spare patients with other disorders that might mimic these entities a percutaneous or open biopsy. the aim of this study is to assess the validity of Magnetic Resonance Imaging [MRI] in diagnosis and characterization of the spinal infection, either pyogenie or graulomatous, and specifically the tuberculous spondylitis. twenty patients who were clinically and radiographically suspected of having vertebral osteomyelitis, or Tuberculous spondylitis They were evaluated with MRI after performing conventional x-ray of the involved spinal region, with analysis of the imaging findings by two experienced radiologists to set the imaging diagnosis. MRI findings showed good correlation with the clinical signs and symptoms in 19 patients out of the 20 included in this study, also these imaging findings revealed high predictive ratio for the spinal infection category in 19 out of 20 patients, with excellent accuracy and specificity ratios, ten patients were proved either radiologically or micobiologically to have spinal osteomyelitis, and the other ten to have Tuberculous spondylitis. MRI is an accurate and sensitive modality in diagnosis of spinal infection, and have a high specificity rate in characterization of the type of infection, it is also capable to give excellent anatomical details regarding the extra-vertebral extension of the encountered pathological process

Serum transferrin in newborns, healthy children and with iron deficiency anemia

Serum transferrin receptor [STfR] is a reliable tool for assessing functional iron status and erythropoietic activity in adults, but little is known about its role in children. The aim of this study was to evaluate STfR concentrations in healthy newborns, infants, and children and to show age and sex-related variations. A further aim was to investigate the value of STfR in children with iron deficiency anemia [IDA], and its response to oral iron therapy. We studied 3 groups. Group I included 26 healthy newborns, they were 70 preterm and 16 term babies. Group II included 22 healthy infants and children. Group III included 27 children with IDA. Complete blood count, serum iron, total iron binding capacity [TIBC], serum ferritin [SF], and STfR levels were measured. STfR/log ferritin index [STfR-F index] was calculated. Cord blood samples were obtained from the studied newborns just after delivery. Children with IDA were treated for 3 months with oral iron to evaluate its effects on parameters reflecting iron status. The results showed that: in group I, serum iron, SF, and TIBC were highest at term, whereas reticulocytes were highest in the preterm babies. STfR levels were not influenced by gestation. STfR in healthy newborns correlated negatively with hemoglobin [r = -0.779; P 0.005], with iron[r -0.25; P = 0.03] and with SF [r = -0.273; P= 0.071, and positively with reticulocytes [r = 0.838; P = 0.007]. In-group II, a negative correlation was found between STfR and age among healthy infants and children [r = -0.595; P = 0.001]. There was no significant difference in STfR between male and female subjects in-group I and II [P = 0.113, and P = 0.456]. STfR concentration was significantly higher in children with IDA compared to healthy children [P = 0.001]. After oral iron therapy, STfR level was significantly decreased compared to that before iron therapy [P 0.006]. STfR-F index was significantly decreased in children with IDA after oral iron therapy compared to that before iron therapy [P = 0.0001]. In children with IDA before treatment, STfR correlated negatively with hemoglobin [r = -0.798; P 0.001], with serum iron [r = -0.485; P =0.02], and with SF [r = -0.447; P = 0.03], and positively with TIBC [r = 0.503; P=0.02]

Conclusions: STfR levels in cord blood are not directly influenced by gestation. STfR concentrations show age-,but not sex-related changes. STfR is a reliable indicator for identifying IDA, and STfR and STfR-F index are useful parameters for assessing the effect of iron therapy in these children

Prognostic value of interleukin-1 beta [IL-1 beta] and tumor necrosis factor-a [TNF-alpha] in full-term newborns with hypoxic-ischemic encephalopathy

A correlation between elevation of pro-inflammatory cytokines and white matter injury or abnormal neurological outcome has been established in the preterm infant. In the full-term neonate, few studies exist linking elevation of cytokines with encephalopathy and poor neurodevelopmental outcome. The aim of this study was to examine the relation of plasma and cerebrospinal fluid [CSF] interleukin-1 beta [IL-1beta] and tumor necrosis factor-alpha [TNF-alpha] to the severity of hypoxic-ischemic encephalopathy [HIE] and to the neurological outcome in full-term newborns with HIE. Thirty full-term neonates with HIE were included in the study. HIE was classified according to the criteria of Sarnat and Sarnat. Blood and CSF were obtained within the first 24 hours of life for determination of IL-1beta and TNF-alpha by ELISA. Five neonates died soon after the hypoxic insult. Neurological examination and Denver Developmental Screening Test [DDST] were performed at 12 months in the survivors. The results showed that, at the age of 12 months, neurological examination and DDST showed that 13 infants were normal; 12 had abnormal neurological findings and/or an abnormal DDST result. Thirteen normal infants were classified as group1 and 17 infants [12 with abnormal neurological findings and/or an abnormal DDST and five who died] as group 2. CSF IL-1beta and TNF-alpha levels in-group 2 were significantly higher than those in-group1 [P = 0.0005 for IL-1beta, and P = 0.003 for TNF-alpha]. Plasma IL-1beta and TNF-alpha levels were not significantly different between the two groups [P = 0.098 for IL-1 beta, and P= 0.275 for TNF-alpha. CSF IL-1 beta but not TNF-alpha levels, in-group 2 were even higher than those in-group1, although non-survivors were excluded from group 2 [P = 0.001 for IL-1beta, and P = 0.257 for TNF-alpha]. When the patients were evaluated according to the stages of Sarnat, the differences in the three groups were significant [P = 0.002 for IL-1beta, and P = 0.03 for TNF-alpha]. Patients whose CSF samples were taken within 6 hours of the hypoxic insult had higher IL-1 beta and TNF-alpha levels than the patients whose samples were taken after 6 hours [P = 0.0001 for IL-1 beta and P = 0.015 for TNF-alpha

Conclusion: IL-1 beta and TNF-alpha probably contribute to the damage sustained by the central nervous system after hypoxic insult, and this support a recommendation for future studies with brain blockers of the actions of these cytokines for neuroprotective strategies