Lactoferrinsupplementation for prevention of sepsis in preterm neonate

Background: Sepsis related morbidity and mortality is a concern in neonatal intensive care units [NICUs]specially in preterm and Low birth weight [LBW] infants who are more vulnerable due to immaturity of immune defenses and protective barriers. Lactoferrin is an iron binding glycoprotein presents in mammalian milk and involved in innate immunity. Recent data suggest that bovine lactoferrin[BLF] might prevent late onset sepsis in preterm and LBW neonates

Objective; To evaluate the effectiveness of oral bovine lacoferrin in prevention of neonatal sepsis in Egyptian preterm neonates

Patients of Methods: A randomized clinical trial, double blind, placebo-controlled study was conducted on 135 preterm neonates [born before 37 weeks of gestation] admitted to the NICUs of Ain Shams University and Manshiet El Bakry Hospitals from February 20l3 to January 2015. Infants were randomly sub-divided into two groups: Group 1 consisted of 45 infant received oral lactoferrm supplementation [100 mg/day] within a day of starting feeds for 4 weeks. Group 2 consisted of 90 infants matching group 1 neonates, received placebo in the form distilled water in the same schedule. History and physical examination were carried out laying stress on signs of sepsis, severity [classified according to Tollnerscore], laboratory investigations were done: CBC with blood film [classified according to hematological scoring system], CRP, Blood culture upon admission and on suspicion of sepsis, other cultures and arterial blood gases when clinically indicated. Radiological investigation were done when clinically indicated, Data were analyzed using the Statistical Package for Social Sdences SPSS

Results: Lactoferrin group [45 preterm neonates] with mean gestational age [33.11 +/- 1.81 weeks]. 32 males [71%] and 13 females [29%]. Placebo group [90 preterm neonates] with mean gestational age [33.28 +/- 1.89 weeks], 45 males [50%] and 45 females [50%]. Lactoferrin group showed a significantly lower incidence of late onset sepsis according to Tollner score and Rodwell score and blood cultures [6.7%] compared to placebo group [17.8%]. E coli and Soureuswere the most common organisms found in septic neonates in the current study [28.6% for each]

Conclusion: BLF supplementation would be a suitable preventive tool for late onset neonatal sepsis in preterm neonates

Effect of oromotor exercises on energy and duration of anterior voiceless non-emphatic consonants in spastic dysarthria

Treatment of dysarthric children may rely on speech therapy [direct therapy] or on oro-motor exercises [indirect therapy]. Some authors believe that therapy is more effective when both methods are applied. Others believe that application of oro-motor exercises provide little or no beneficial effect. The aim of this work was to study the effect of oromotor therapy on the energy and duration of anterior non-emphatic voiceless Arabic consonants prior to and after therapy in order to obtain a more objective view about the progress achieved by therapy which would aid in selecting the most appropriate line of therapy for such patients. Subjects and methods: Thirty dysarthric children and fifteen normal children of both gender participated in this study. The dysarthric children were randomly divided using a customized random sample into 2 groups. One group received speech therapy while the other group received speech therapy, in addition to, oromotor exercises. Spectrographic analysis of the anterior voiceless non-emphatic consonants /f/, /thea/, /t/, and /s/ was performed prior to and after therapy. Spectrographic analysis for the normal group was done during the study. The study extended over a period of about 9 months. Spectrographic analysis revealed reduction in the duration of consonants and increase in their energy values for both patients group with more significant improvement when oromotor exercises were applied the application of oromotor exercises in conjunction with speech therapy can aid in improving the production of anterior non-emphatic voiceless consonants in dysarthric patients. 1-Considering oromotor therapy while planning any speech rehabilitation program for dysarthric patients as it can be beneficial in some patients. 2- Thorough objective analysis of other phonemes and follow up for longer duration to detect any subclinical improvement achieved by different lines of therapy which would help in selecting the most effective and rapid ones in improving the speech of dysarthric patients

Vaccine immunotherapy for a deadly disease like malignant melanoma: where do we stand?

The incidence of cancer and its related morbidity and mortality remain on the increase in both developing and developed countries. Cancer remains a huge burden on the health and social welfare sectors worldwide and its prevention and cure remain two golden goals that science strives to achieve. Among the treatment options for cancer that have emerged in the past one hundred years, cancer vaccine immunotherapy seems to present a promising and relatively safer approach as compared to chemotherapy and radiotherapy. The identification of different tumor antigens in the last fifteen years using a variety of techniques, together with the molecular cloning of cytotoxic T lymphocytes [CTLs]-and tumor infiltrating lymphocytes [TILs]-defined tumor antigens allowed more refining of the cancer vaccines that are currently used in different clinical trials. In a proportion of treated patients, some of these vaccines have resulted in partial or complete tumor regression, while they have increased the disease-free survival rate in others. These outcomes a re more evident now in patients suffering fro m melanoma. This review provides an update on melanoma vaccine immunotherapy. Different cancer antigens are reviewed with a detailed description of the melanoma antigens discovered so far. The review also summarizes clinical trials and individual clinical cases in which some of the old and current methods to vaccinate against or treat melanoma were used. These include vaccines made of autologous or allogenic melanoma tumor cells, melanoma peptides, recombinant bacterial or viral vectors, or dendritic cells

Direct coronary stenting and conventional PTCA followed by coronary stenting comparitive study

Multicenter randomized trials have demonstrated that restenosis and repeat revascularization are reduced and event-free survival at 6 months is increased when elective stent implantation is performed' in carefully selected patients and coronary lesions. Therefore, in the majority of centers intracoronary stent placement is now used in more than 80% of the percutaneous coronary interventional procedures. The standard stent implantation technique includes pre- dilatation of the lesion with a balloon cather followed by stent implantation. The new generation of stents is reliably pre-mounted on high pressure compatible balloons with a very low profile stent delivery system that allows direct stent implantation without pre- dilatation in high proportion of patients who are candidates for. PCI

Aim of the Work: In this work we compare short and long-term [6 months] outcome of direct coronary stenting, with standard PTCA followed by coronary stenting

Subjects and Method: This study included 80 patients with IHD whom were proper candidates for PCI in the form of coronary artery stenting with or without pre- dilatation, patients were divided into two groups: Group [1] Included 40 patients treated by direct coronary stenting technique and Group [2] included 40 patients treated by standard balloon angioplasty and stent implantation. All patients subjected to complete history taking and thorough clinical examination, 12-lead surface ECG, Coronary angiography followed by PCI procedure and stenting with and without predilatation and follow-up repeated clinical evaluation and coronary angiography was done for all patients 6 month's after PCI for detection of restenosis of the dilated vessel

Results: we found no statistically significant difference between the two groups regarding age, sex, prevalence of smoking, hypertension, diabetes mellitus, the family history, history of previous coronary artery disease and cholesterol level. There was no statistically significant difference between both groups regarding lesion morphology before dilatation and after dilatation. And there were no significant difference in maximal inflating pressure. But there was highly. significant difference between both groups regarding mean flouro-time used in both procedure [less flouro-time in group [1]] highly significant difference in total procedural time and amount of dye used in the procedure [less total procedural time and less amount of dye used in the group [1]]. There were no significant difference between two groups regarding procedural complications and follow up complications. Also, there was no significant difference between both groups regarding restenosis rate in the follow up coronary angiography, [restenosis occurred in 11 patients in group [1] 27.5%, and in 13 patients in the group [2] 32.5%]

Conclusion: From this study we concluded that: Direct stenting in selected lesions seems to be safe and feasible procedure. The procedural, in-hospital and long-term clinical and angiographic outcomes are equivalent comparing group [1] with group [2], The demonstrated benefits of direct stenting approach were the reduction of the amount of dye, reduction of fluoro-time, reduction of the total procedure time, saving the balloons of pre-dilatations, so, reduction of the total procedure cost and reduction of radiation exposure risk on intervention team. So, we recommend the use of direct stenting whenever indicated

Effect of recombinant erythropoietin therapy on some nutritional markers in patients on regular haemodialysis

Several factors in changes renal disease [esrd] enhance protein catabolism and increase protein requirements. The relative important of nutritional markers in relation to haemodialysis process in patients with chronic renal failure [crf] is still under investigation. This study was designed to evaluate the effect of recombinant human erythropoietin [r-huepo] therapy on hemoglobin [Hb] level and some nutritional markers [serum albumin, insulin like growth factor-1 [IGF-1] and serum leptin] in patientys on regular haemodialysis. Patients were subdivided into 2 group, the first group receiving r-huepo and the second group not receiving r-huepo. All parameters were studied at the start of study after 3 months. Recombinant human erythropoietin therapy combined with haemodialysis caused significant increase in h[b], albumin and igf-1 level after 3 months, while regular haemodialysis caused significant increase in h[b] and albumin only. The increases were more marked in the group receiving r-huepo. A significant positive correlation was found between both body mass index [bmi] and triceps skin fold [tsf] and lepton. In conclusion, r-huepo therapy can accelerate improvements in nutritional status and the h[b] level in patients on regular haemodiaysis

Prediction of servere angiographic coronary artery disease through multivariable probability scoring system based on clinical and exercise test data

This study included 120 patients [98 males and 22 females, their ages ranged from 24-70 years] with suspected coronary artery disease. All candidates were subjected to complete history taking and thorough clinical examination including blood cholesterol level, resting 12-lead surface ECG, exercise stress test and coronary angiography. The patients were randomly divided into a training set and a testing set. The training set included 95 patients [80 males and 15 females], which were divided into 2 groups according to the coronary angiographic result. Group I included patients with significant coronary artery disease defined as >70% narrowing in LAD, circumflex artery, right coronary artery or their major branches or 50% narrowing in the left main coronary artery. The test set included 25 patients [18 males and 7 females with an age ranged from 35-61 years, with a mean age of 48.2 +/- 8 years]. Group I and II were compared as regards the different clinical, exercise and hemodynamic variables and introduced those variables into a step-wise logistic regression analysis for the development of the pretest and post test equations for predicting the presence of CAD in the test set of patients. The study showed that the equation can discriminate the accuracy for the detection of patients with severe coronary artery disease in a given group. It can be used for detecting patients with high probability of coronary artery disease with accepted accuracy, sensitivity, specificity and predictive value compared with other equations. It may be helpful for the detection of patients with coronary artery disease and referring them to the appropriate level of investigation and treatment with superior sensitivity than that of the standard criteria of exercise stress test. So, it will be of a great help in referring the patient to the appropriate level of evaluation and treatment, which will result in selective resource use [only the high-risk patient to be referred to expensive and invasive procedures] and cost saving