Role of Bedside Ultrasonography in Assessment of Diaphragm Function as a Predictor of Success of Weaning in Mechanically Ventilated Patients / 결핵및호흡기질환

Background@#Weaning failure is common in mechanically ventilated patients, and if ultrasound can predict weaning outcome remains controversial. The purpose of this study was to evaluate the diaphragmatic function (thickness and excursion) measured by ultrasound as a predictor of the extubation outcome. @*Methods@#We included 62 mechanically ventilated patients from the chest intensive care unit in this study. Sixty-two patients who successfully passed the spontaneous breathing trial (SBT) were enrolled. The transthoracic ultrasound of the diaphragm was performed during an SBT to the assess diaphragmatic function (excursion and thickness), and they were classified into the successful extubation group and the failed extubation group. @*Results@#There was a statistically significant increase in the successful extubation group in the diaphragmatic excursion and thickness fraction (p<0.001), a statistically significant negative correlation between the diaphragmatic function and the duration of the mechanical ventilation, and a statistically significant negative correlation between the diaphragmatic excursion and the Acute Physiology and Chronic Health Evaluation II. The diaphragmatic excursion cutoff value predictive of weaning was 1.25 cm, with a specificity of 82.1% and a sensitivity of 97.1% respectively, and the diaphragmatic thickness cut-off value predictive of weaning was 21.5%, with a specificity of 60.7% and a sensitivity of 91.2%, respectively. @*Conclusion@#The diaphragmatic ultrasonography was found to be a promising tool for predicting the extubation outcome for mechanically ventilated patients.

Chemotherapeutic effect of Ulmus pumila leaves methanolic extract against N-methyl-N-nitrosourea-induced mammary carcinoma in female rats: An in vitro and in vivo study

Searching for a chemopreventive agent is an important approach for breast cancer management. The aim of the study was to evaluate the chemopreventive potential of Ulmus pumila (UP) leaves extract on breast tumorigenesis induced in experimental animals by N-methyl-N-nitrosourea. This target was undertaken through preparing several extracts from the fresh leaves of UP using different solvents against the breast adenocarcinoma cell line (MCF-7). Our in vitro results demonstrated that the methanolic extract of UP (UPME) showed the highest cytotoxic activity against the growth of MCF-7 cells. After determination of UPME safe dose (1/10) of a lethal dose, the in vivo results revealed that UPME treatment significantly decreased the activities of liver enzymes, kidney function, cancer antigen 15-3 (CA 15-3) level, urokinase plasminogen activator, heparanase, basic fibroblast growth factor, B-cell leukemia lymphoma 2, and cyclooxygenase-2. By contrast, total antioxidant capacity (TAC) was increased in therapeutic, protective, and prophylactic groups as compared to the tumor group. These improvements were supported with histopathological changes. These results indicated that the chemotherapeutic potential of UPME through stimulation of apoptosis and the suppression of angiogenesis, proliferation, and metastasis.

Synthesis, biological evaluation and docking analysis of some novel quinazolin derivatives as antitumor agents

Different acid chlorides [2a-d] reacted with anthranilic acid to produce 2-substituted-3, 1-benzoxazin-4-one [3a-d] which was used as starting material to synthesize some condensed and non-condensed heterocyclic compounds by reaction with nitrogen nucleophiles e.g., hydrazine hydrate, and formamide. Some of the newly synthesized analogues were chosen to evaluate their cytotoxic activity against human liver carcinoma cell lines [HePG2- MCF7- A549]. The docking and the cytotoxic activity results revealed that nearly all of the compounds containing N-phenyl aniline showed signifcant inhibition for the three cell lines

HCV RNA in peripheral blood mononuclear cells [PBMCs] as a predictor of the response to antiviral therapy in chronic hepatitis C

Hepatitis C virus [HCV] has been found to infect peripheral blood mononuclear cells [PBMCs], using them as a reservoir, which might contribute to the development of resistance to treatment. To study hepatitis virus C [HCV] RNA in peripheral blood mononuclear cells [PBMC5] of patients with chronic HCV infection, and explore the relationship between the HCV RNA in the PBMCs and response to interferon [IFN] therapy. Twenty-five patients with chronic viral hepatitis C were included. The HCV RNA in PBMCs and serum was detected after 12 weeks of initializing interferon treatment, at the end of treatment, and 24 week and 1 year follow up after the end of the treatment. At the end of the treatment course, patients who were found to have positive PCR test for HCV RNA in PBMCs were subdivided into two groups, one group continues to receive IFN therapy while the other group stops. The HCV RNA in PBMCs and serum was detected by RT-PCR using the Amplicor HCV 2.0 assay. All patients had negative serum PCR test for HCV RNA at the end of treatment, nevertheless HCV RNA was detected in PBMCs of approximately 32% of these patients. Patients who tested positively for HCV RNA in PBMCs at the end of treatment had an overall significantly

Serum complements C3 and C4 in chronic HCV infection and their correlation with response to pegylated interferon and ribavirin treatment

To search for an immunological parameter that may correlate with the response to interferon [IFN] treatment is very crucial. The objective of this study was to correlate the levels of C3 and C4 complement components with the response to IFN treatment in patients with chronic hepatitis C virus [HCV] infection. Patients and This study was conducted on 100 patients and control subjects classified into three groups. Group [I] consisted of 50 patients with chronic hepatitis C who were receiving IFN treatment and showed various responses; group [II] included 25 patients with chronic hepatitis C naive to IFN treatment; and group [III] included 25 healthy subjects matched for age and sex who served as controls. Measurement of the level of complement C3 and C4 was done by a quantitative turbidimetric test. Measurement of complement levels in group [I] was done at the end of treatment at the 48th week. Serum levels of C3 and C4 were found to be significantly reduced in all patients with chronic HCV infection in both groups [I and II] compared to the healthy control group [III] [p < 0.05]. Moreover, chronic HCV patients treated with IFN and ribavirin had significantly lower levels of C3 and C4 compared with patients naive to IFN and ribavirin treatment. At the end of treatment, both C3 and C4 had significantly increased in responders to IFN when compared to non-responders [p = 0.025 and 0.05, respectively]. There was a significant negative correlation between C3 and C4 levels and the concentration of serum alanine aminotransferase [ALT] measured simultaneously. Higher C3 and C4 serum concentrations were found to be positively correlated to the end-of-treatment response in patients with chronic HCV infection treated with IFN and ribavirin

Post-streptococcal reactive arthritis versus acute rheumatic fever

A migrating polyarthritis after throat infection with group A beta-hemolytic streptococci is classically attributed to acute rheumatic fever [ARF]. Sterile non-migratory arthritis may occur as a separate entity, the so called post-streptococcal reactive arthritis [PSRA]. To identify clinical and serological differences of reactive arthritis patients after infection with Lancefield group A beta-hemolytic streptococci, as compared with acute rheumatic fever. The study was conducted of 120 patients who were recruited for the study. They were equally divided into two groups according to the diagnosis of ARF or PSRA. They were consecutively seen in the Rheumatology and Rehabilitation and the Pediatric wards. Clinical and laboratory data were assessed through a questionnaire. The diagnosis of rheumatic fever was made based on the revised modified Jones criteria, while the diagnosis of post-streptococcal reactive arthritis was made based on Deighton criteria; these associated with laboratory data, electrocardiography, chest X-rays and bi-dimensional echocardiography. There was no significant difference between both groups as regard age where p>0.05, while there was a significant difference regarding the date of antecedent upper respiratory tract infection [p<0.05]. Clinical assessment showed that the duration of disease and Enthesitis, joint tenderness and joint swelling counts have a highly significant difference [p<0.01]. As regard to the response to aspirin, indomethacin and steroid there were significant differences between both groups [p<0.05]. Also, as regard the laboratory assessment ESR, CRP, ASOT, the differences between both group were highly significant for ESR, ASOT [p<0.01] and significant for CRP [p<0.05]. No significant difference was found between both groups regarding specific laboratory assessment [Anti deoxyribonuclease-B liter or anti-Hyaluronidase] [p>0.05]. Regarding the cardiological changes P-R interval on ECG was prolonged in 19 patients 31.67% and Echo study showed changes in 12 patients, 20% of cases of ARF patients only. Also there were no chest or CNS changes either in ARF or PSRA patients, so, chest X-ray changes showed no significant differencesp>0.01. Post-streptococcal reactive arthritis and acute rheumatic fever are actually having different presentations and managements

Evaluation of the vasodilator capacity in normotensive offsprings of hypertensive parents

Background: blood pressure [BP] levels appear to have strong familial tendencies. An estimated 30-60% of the variation of the BP between individuals, after adjustment of age and sex, is attributed to gene factors. Recent reports suggest occurrence of endothelial dysfunction in development of essential hypertension. The defective nitric oxide production resulting in reduced vasodilator capacity of the peripheral blood vessels, with consequent increase in the peripheral resistance and BP

Aim of work: is to address the genetic familial factor in hypertension through the evaluation of vasodilator capacity in normotensive offsprings of hypertensive patients

Patients and methods: 53 Subjects age from 15 to 35 years old were included: Group I: 20 subjects with normal BP but one or both of their parents is hypertensive, 12 subjects having only one of their parents is hypertensive [Group 1A], while 8 subjects of this group [40%] having both parents are hypertensives [Group 1B]. Group 2: 20 subjects with normal BP and their parents are of normal BP too, as a control group and 13 subjects were excluded as they were discovered to be hypertensives [By APBM]. Subjects were divided into two groups according to family history of hypertension: Both groups were subjected to: History taking, Clinical Examination, FBS and PPBS, lipogram, Ambulatory blood pressure monitoring, Coloiured duplex ultrasound to test the vasodilator capacity before and after reactive hyperaemia and GTN

Results: there is significant difference between both groups for mean post FMD [p=0.014], mean FMD% [p<0.001] and mean Dil.ratio [p<0.001]. While there is no statistical significance between both groups as regard mean pre FMD, mean pre and post GTN-MD and GTN-MD%. There is significant difference between group 1A and group 1B for mean post FMD [p=0.033], mean FMD% [p<0.001] and Dil.ratio [p=0.001].While there is no statistical significance between both groups as regard mean pre FMD, mean pre and post GTN-MD, and GTN-MD%

Conclusion: there is an obvious endothelial dysfunction in offsprings of hypertensive parents, preceding their development of hypertension. Those traits are inherited to them from their hypertensive parents, and being more if they are inherited from both parents. This endothelial dysfunction may be due to a genetic defect in nitric oxide [NO] synthesis pathway either in production of NO synthase enzyme [NOS] isoforms, co-factors for NOS induction and inhibition andlor L-arginine which is the. NO substrate or its analogues. Also the autonomic disturbance is due to a genetic defect, which makes them more susceptible to environmental stresses resulting in a high sympathetic tone in those subjects. Finally, the inherited impaired baroreceptors sensitivity and autonomic dysfunction together with the endothelial dysfunction and defective nitric oxide may represent mechanisms through which subjects with familial predisposition for hypertension may develop hypertension later on in their life

Surgical management of bronchiectasis: indications, experience and early results

Background: in the developing and the underdeveloped countries pulmonary bronchiectasis is commonly-faced forming a significant cause of morbidity and mortality. Although antibiotics postural drainage is widely applied in the medical management of the disease, resection of the involved segment[s] remains the only treatment modality that can offer a potential cure. In this prospective study, we evaluated our medico-surgical management protocol for pulmonary bronchiectasis [uni or bilateral] stressing on methodology of preoperative evaluation of the extent of the tissue damage caused by bronchiectatic pathology [morphologic and hemodynarnic classification] prior to recommending surgical solution in an attempt to reduce perioperative morbidity and mortality complications to its least

Patients and Methods: this prospective study was carried out in the departments of Cardiothoracic Surgery, and chest internal medicine Kasr El Ainy Faculty of Medicine, Cairo University, as well as the Islamic Charity Hospital of El Agousa from January 2002 till January 2006. The study encompassed 20 patients: 15 men [75%]; and 5 women [25%]. The mean age was 39.5 +/- 4.5 years [range 23-51 years]. Bronchiectasis was unilateral in 14 patients [70%]; and bilateral in 6 patients [30%]. The main presenting symptom was unresolving pneumonia [uncontrollable productive cough] in 10 patients [50%]; progressive dyspnoea and shortness of breath [SOB] in 8 patients [40%]; and troublesome haemoptysis was present in 2 [10%]. The organism cultured in sputum samples was Streptococcus pneumoniae in 7 [35%]; Haemophilus influenzae in 5 [25%]; Staphylococcus aureus in 4 [20%]; Pseudomonas aeruginosa in 2 [10%]; and Klebsiella pneumoniae in 2 [10%]. Preoperative patient management started by complete physical examination; vigorous chest pb ysiotherapy and medical treatment by specific broad-spectrum antibiotic courses, mucolytics, expectorants, bronchodilators.. etc.], for a mean period of 22.5 + 4.5 months [range 3 months84 years]. Preoperative lab investigations consisted of full blood picture, renal-and-hepatic function tests, and coagulation profile. Special investigations included: plain chest radiography, bronchoscopy [rigid or fiberoptic]; high-resolution chest scanning [HRCT]; pulmonary function tests [spirometry and arterial blood gas analysis], and perfusion lung scanning [VQNT matching]. Surgery was planned targeting to remove destroyed non-perfuse lung tissues "Unresolving Pneumonia"; when pathology of lung destruction was progressive [cytic or advanced cylindric forms by HRCT or hemodynamic features]; and when the patient feared death or morbidity complic;itions

Results: we performed 13 lobotomies [65%]; 2 bi-lobotomies [10%]; 3 completion pneumonectomies [15%]; and 2 pneumonectomies [10%] via thoracotomy [15 anterolateral, and 5 posterolateral] 14 done on the right and 6 on the left side. One patient died postoperatively [5%] due to fulminant pneumonia, while 4 [20%] had morbidity events as: surgical wound gaping needing 2ry. stitches to heal [2ry. Intention] in 2 diabetic patients [10%] localized pocket without stump disruption treated by prolonged tube drainage in diabetic patient [5%]; and exploration for stump revision to control prolonged air leak in 1 patient [5%] with previous pseudomonas infection. In 19 survivors, follow-up for 1st. year [January 2005- January 2006] following surgery revealed that 12 patients [60%]; were cured; 5 patients [25%] had disappearance of the majority of their symptoms; while 2 [10%] showed mild symptomatic improvement without serious complications. Previous TB infection; Diabetes mellitus; Cystic pathology, and Pseudomonas infection were factors associated with poor prognosis

Conclusion: surgical resection for bronchiectasis in properly prepared and chosen patients is the final solution after failure of other management modalities. Preoperative morphologic and hemodynamic classification provided an accurate functional classification as to the extent of the histopathology damages and hence allowed proper determination of the patient who is truly in need of surgical resection and guided well the extent of surgical resection which was done with acceptable morbidity

Surgical management of pulmonary tuberculosis; indications and benefits

Background: mycobacterium tuberculosis is caused by a virulent organism rapidly destroys normal lung tissue leading to an acute illness with systemic side effects with serious morbidity an even mortality. We herewith assess our experience and early results with surgical intervention for thoracic TB and its sequelae according to its past and current indications

Patients and Methods: this retrospective study was carried out in the departments of cardiothoracic surgery, and chest internal, El Agousa Faculty of Medicine, Cairo University; and private practice be- Charity Hospital between 1999 and 2006. It enrolled 30 patients who underwent thoracic surgery for treatment of mycobacterium TB, or its sequelae. There were 20 men [66.6%]; and 10 women [33.3%]. Mean age was 32.5 +/- 1.5 years [range 25-54 years]. Preoperative symptoms lasted for a median of 8 +/- 0.5 years [range 4-15 years]. Twenty-five patients [83.3%] were operated upon primarily for parenchymal MTB, 4 patients [13.3%] had thickened pleurae; 1 [3.3%] for destruction of vertebral body D9 and 3 patients [9.9%] had hemoptysis. 10 patients [33.3%] had multi-drug resistance [MDR-TB]; while 20 patient [66.6%] were drug-sensitive in all patients. Pre- operative chemotherapy was by mean of 4 drugs [range 3-6]; for mean time of 4 +/- 0.5 months [range 3-7 months], based on in- vitro susceptibility. The regimen used included combination[s] of first line and second. Line drugs, while a fluoroquinolone was added in 14 patients [46.6%]

Results: we had one mortality [3.3%] due to uncontrollable ventricular arrhythmias. 18 lobectomies [60%] were performed : 11 right [36.6%], and 7 left [23.3%]; 3 right cavernoplasties [9.9%]; 1 right pneumonectomy [3.3%], 3 left [9.9%] with one of them being a completion pneumonectomy and comprised our single mortality case; pleural decortication as : 2 right [6.6%], 2 left [6.6%], while vertebral body in one patient [3.3%] needed debridement level of D9. At the time of surgery, 26 of our patients [68.6%] were sputum positive, while 4 [13.3%] were sputum negative. Postoperatively, and excluding one mortality case, 24/25 patients [96%], showed conversion to negative sputum over a mean duration of 2 +/- 1.7 months [range 2-4 months], and became culture-negative over mean duration of 3 +/- 2.5 months [range 3-6 months]. One patient relapsed [3.3%] and remained positive. Morbidity occurred to 11 [36.6%] of patients as prolonged air leak in 4 patients [13.3%]; empyema in 3 [9.9%];post-pneumonectomy lung congestion in 1 patient [3.3%]; re- exploration to remove early clotted haemothorax in 1 patient [3.3%]; atelectasis in 1 patient [3.3%]; and chylothorax in 1 patient [3.3%]

Conclusion : the results of our study confirms the good results obtained by lung resection for tuberculosis due to either drug-sensitive [evolving under treatment] or drug-resistant mycobacterial infection, Proper perioperative collaboration must be present between the chest internist and the surgeon for proper timing of surgery and to avoid induction of unneeded complications. Encouraged by the relatively-low rate of morbidity-and-mortality that follows the different types of surgical interventions, and given the increasing global epidemic of TB complications and resistant strains, it seems more likely than ever for surgery to take a more definitive role in treatment of such disease in the near future

Aortic elasticity in young pregnant women

Background: cardiovascular changes that occur during pregnancy include not only increase heart rate, blood volume, changes in left ventricular dimensions and functions but also changes of aortic elastic properties

Objectives: our aim was to study the aortic elasticity of young pregnant women by comparing them with those of age-matched healthy females

Patients and methods: the study population consisted of 25 pregnant women and 23 healthy women served as controls. Both groups were subjected to Doppler echocardiographic examination and measurement of serum estradiol [E2] levels. The blood samples were obtained from the control group in the first week after menstrual bleeding. Left ventricular dimensions, functions, systolic and diastolic aortic diameters [AOS and AOD, 3 cm proximal to the aortic valves] were measured. Aortic elastic properties [strain, dispensability, diameter changes and stiffness index were then calculated

Result: all women in the study group were in the second trimester of their first pregnancy there were no significant differences between both groups as regards age and body mass index. The height and weight were 157 +/- 4 vs 160 +/- 3 cm and 70 +/- 8 vs 65 +/- 4 kg in the study vs control groups, [p=0.08, and p<0.009] respectively. There · were no significant differences between pregnant and non-pregnant women as regards. systolic, diastolic, mean blood pressure, pulse pressure, LVEDD, LVESD, FS%, and C-~EF% while the heart rate was higher in pregnant women than in controls, however, it :did not reach a statistically significant level. LVEDV, LVPWTH, LV mass, LV mass index, were significantly higher in pregnant than control group. The AOD was 27 +/- 3 vs 26 +/- 4 mm and AOS 30 +/- 4 vs 29 +/- 4 mm Pulse pressure was 42 +/- 3 vs 44 +/- 4 mmHg in the study vs control groups, respectively [P> 0.05]. The serum E2 level was significantly higher in pregnant women [21600 +/- 3050 pg/ml] than non-pregnant ones [219 +/- 51 pg/ml] [p<0.0001]. Aortic elastic properties in pregnant women were also increased significantly [P<0.0001]. The E2 serum level was significantly conflated for both groups with the aortic elastic properties. Correlation coefficients between E2 and aortic strain, aortic distention, aortic diameter change, and aortic stiffness index were 0.65, 0.86, 0.88, and 0.62 in the pregnant and 0.77, 0.75, 0.92, and 0.77 in the non-pregnant group, respectively

Conclusion: the aortic elastic properties increased while aortic stiffness decreased in young pregnant women

Evaluation of the safety limits and potential toxicity of chlorinated drinking water in rats; immunobiochemical and ultrastructural study

Recently, studies have been attempted to evaluate the risks associated with a lifetime exposure to chlorinated drinking water, where it has been reported to impair some immune functions. The present study amis to investigate the safety limits and the potential toxic effects of different concentrations of chlorinated drinking water on the cell mediated immunity. In this study, 56 adult male albino rats were used. Animals were divided into seven equal groups [n= 8], one control and three group were treated with sodium hypochlorite at different concentrations 2, 15, 30 parts per million, and the remaining three groups were also treated with monochloramine at concentrations 2, 15, 30 parts per million respectively. The study Lasted for three months. For each animal, body weight, spleen weight per body weight ratio, phagocytic function of peritoneal macrophages, electron microscopic study of splenic macrophages, lymphocyte blastogenesis and interleukin-2 were investigated for evaluation of immune activity at the different concentrations of both agents. Results showed that the whole body weight was not significantly affected. While the spleen weight/body weight ratio was significantly decreased. Also, phagocytic function of peritoneal macrophages, lymphocyte blastogenesis and interleukin-2 were significantly decreased. Electron microscopic examination of the splenic macrophages showed high activation at the lowest concentration 2 parts per million, while higher concentrations 15 and 30 parts per million showed different degrees of suppression, reaching it's maximal effect at the highest concentration [30 parts per million]. These changes could be attributed to the toxic effects of the chlorine byproducts on the immune system