Neonatal screening program in Dakahlia: hypothyroidism in clinically suspected cases

In the line with the priorities of the national health services towards preventive medicine early diagnosis and treatment of CH is emphasized. The aim was to assess thyroid status in clinically suspected cases. Subjects and The present study included two groups, the first is a set of neonates [800] attending the general health units in some villages in Dakahlia complaining of prolonged jaundice, constipation, abdominal distention, chocking and/or umbilical hernia. Neonatal TSH levels in filter paper spots taken from heels were assessed for this group. The second group included 114 infants suspected clinically as congenital hypothyroidism by pediatricians. Serum TSH and T4 were estimated for this second group. In the first group 690 neonates [86.25%] had TSH less than 20 micro IU/ml, 88 neonates [11%] had TSH of between 20 and less than 40 micro IU/ml and 22 [2.75%] has TSH more than 40 micro IU/ml. All neonates [110] with TSH more than 20 micro IU/ml [13.75%] had to be recalled after two weeks for reevaluation by serum TSH and T4 levels estimation. Transient hypothyroidism were detected in 70 cases [8.8%] and their serum T4 and TSH levels two weeks after, were normal. Forty neonates [36.4%] were missed and did not respond to our call. Effect of storage on neonatal TSH levels were evaluated in blood spots collected on preserved filter papers. The results revealed that there were gradual increases in the missed cases as zero when estimated with prolonged period of preservation. The results of the second group: Ninety cases [79%] were euthyroid with normal serum TSH and serum T4,17 cases [15%] were with mild elevated serum TSH [7-20 micro IU/ml] and normal serum T4. 7 cases [6.0%] were with elevated serum TSH [more than 20 micro IU/ml] and low serum T4 [less than 96 nmol/L]. second samples, two weeks after the first revealed normalized serum TSH and T4 in 23/24 case. One case presented with prolonged jaundice was diagnosed as overt congenital hypothyroidism. Prolonged jaundice is the presenting complain among 53/114 infants referred by pediatricians as suspected CH [46.49%]. One case Out of 114 studied infants was detected as true CH, while no case of true CH was detected among the neonatal cases. Serum confirmation tests [TSH and T4 levels] should be done in any infant who is suspected to have congenital hypothyroidism. The study assures the importance of public education and awareness in contributing to the cost effectiveness of screening program using filter paper blood spotting and supports the necessity of the rapid assay of filter paper spots within few days in large common collecting center for screening

Serum testosterone and aggression in schizophrenics and substance abusing subjects

This study had been carried out in psychiatric department of Zagazig University Hospital and Al Azazy Mental Hospital with the aim of studying the association between serum testosterone levels and aggression in some psychiatric disorders. 24 schizophrenics and Substance abusing who presented to the outpatient clinic with aggressire behaviour were subjected to the following; DSMII, R and clinical diagnosis, Brown aggressive scale and also measurement of free and total testosterone and sexhormone binding globulin [SHBG] by radioimmuno- assay and Enzyme immuno- assay teahniques. The results showed that substance abusing males had significautly higher serum levels of total and free testosterone than schizophrenics and controls. Also among schizophrenics the serum level of this hormone decreased significantly more with age compared to the other two groups, and correlated negatively with the duration of neuropleptic drug usage. The results also showed that the aggressive behavior of the schizophrenics were significantly lower than that of the drug abusing subjects, however there was no significant correlations between serum testosterone levels and the intenesity of aggression in either the schizophrenics or the substance abusing subjects

Evaluationof psychomoter performance and quality of recovery during propofol auto. co.sedation as an alterenative to fentanyl, midazolam and ketamine co-sedation during monitored anaesthesia care

Supplemental analgesics and anxiolytics are commonly used to improve patients comfort during procedures performed under local anesthesia and sedation. Eighty female out patients ASA I or II undergoing breast biopsy procedures under local anaesthesia were participated in this study. Patients divided into four groups [n = 20 each]. They recieved either 20 mg propofol in first group, 50 micro g fentanyl, in second group, 2 mg midazolam in the third group or 30 mg ketamine in the fourth group. Two minute later propofol infused at a rate 50 micro g/kg/min. Increasing rate of propofol infusion were used as needed to treat patients response [if any] to local infiltration or surgical stimulation with maintaing respiratory and haemodynamic function. Psychomotor tests and anxiety level were performed before operation and at 30, 60, 120, 240 min post operatively. There were asignificant reduction in psychomotor tests in all groups from baseline after 30 minute postoperative but in propofol-propofol [P.P] group and fentanyl-propofol group [EP] group were associated with the most rapid recovey and least impairment compared with preoperative baseline. Ketamine-propofol [K.P] group associatel with delayed recovey in psychomotor test at 60 min post operatively, [K.P.] group showed the least level of haemodynamic instability but P.P. and F.P. groups showed the highest level of reduction of MAP and HR from baseline [P < 0.001]. Patients satisfaction were high and equal among groups

Renal functional disorders in children with liver cirrhosis: role of renal prostaglandins

Renal prostaglandins have been implicated in the pathogenesis of the renal dysfunction of cirrhosis, but the information is fragmentary and often contradictory. To assess the role of renal prostaglandins in renal hemodynamics and sodium handling in cirrhosis, the urinary levels of PGE2 and TXB2 were measured and correlated with the severity of cirrhosis [grade A to C according to Pugh-Child's score] in 40 children, 4 - 14 years of age. From the results obtained it was concluded that, both PGE2 and TXB2 excretion are increased in children with severe cirrhosis [grade B and C]. A larger increase in vasoconstrictor TXB2 than in vasodilator PGE2 is associated with a decrease in GFR. The low FENa in patients with severe cirrhosis in the presence of high PGE2 may be viewed as an sufficient attempt at natriuresis

Attenuation of cardiovascular responses to electroconvulsive therapy by topical nitroglycerine

The effect of topical transdermal nitroglycerine on the cardiovascular response to electroconvulsive therapy [ECT] was studied in 20 severely depressed patients of both sexes with median age 30 +/- 7.90 [range 20 - 54] years and median weight 69.56 +/- 13.77 [range 45 - 100] kg belonging to ASA [American Society of Anesthesiologist] I, II during 40 electroconvulsive sessions under general anesthesia. Each patient received two sessions of monitored ECT separated by two days. One session was preceded by application of 30 mg nitroglycerine ointment 20 minutes before beginning of the ECT. Thus, each patient served as his or her own control. Pulse frequency, pulse width and stimulus duration were selected by the attending psychiatrist and remained similar in both sessions. Hemodynamic variables were measured during and for four minutes after ECT. Statistical analysis of data within and between patient groups proved the ability of nitroglycerine application to prevent significant rises in systolic, diastolic, mean blood pressure and rate-pressure-product during and after ECT. On the other hand, the means of heart rate showed significant increase during and after ECT compared to the basal means whether nitroglycerine was applied or not. Thus, it can be concluded that the cardiovascular dynamic responses to ECT can be attenuated effectively by application of nitroglycerine ointment. This procedure has a beneficial clinical utility particularly in patients who are at high risk of myocardial ischemia and/or stroke subjected to ECT

Flumazenil [anexate] versus non-specific benzodiazepines antagonist for recovery of patients using subjective and psychomotor assessments

80 patients were scheduled for minor surgical procedures [herniorrhaphy, cystolithotomy, excision of bladder ulcer or diagnostic cystoscope], their age ranged from 18-60 years of both sexes, they received benzodiazepines supplementation for regional anaesthesia. At the end of surgery sedation is reversed by flumazenil [Anexate], naloxone, aminophylline and placebo. The recovery was evaluated by recovery assessment of level of sedation, comprehension and co-peration, temporo-spatial orientation, cognitive and psychomotor tests and anterograde amnesia. The parameters are measured 5, 15, 30, 60, 120, 240 minutes after injection of the trial drug. Recovery score, comprehension and co-operation, orientation and psychomotor assessment showed marked and significant improvement after flumazenil in comparison with placebo, as regard the anterograde amnesia significant changes were noted between flumazenil and placebo; resedation was more with diazepam subgroups. There was no role for naloxone which was similar to placebo while aminophylline hasten the recovery from benzodiazepine sedation but more late if compared with flumazenil [30 minutes post-aminophylline versus 5 minutes post-flumazenil injection]

Koro, is it a culture bound syndrome?

Koro syndrome has been recognized by many as culture bound [Yap, 1965; and Rin, 1965]. The syndrome has been described as early as 1834 by Pao, a Chinese author. More recently, many reports in the literature casted doubt about the geographical distribution of the syndrome and its culture bound nature. The author reviewed the literature and discuss the cases diagnosed in subjects of non-Chinese origin including a case who is pure Saudi citizen with no connections with Southeast Asia whatsoever. All cases described in the non-Chinese subjects shaved an incomplete picture of the syndrome, the one noticeable difference was the abscence of the fear of death which usually accompany the main presenting symptom of shrinking penis

Maternity blues in Sharkia

To determine the prevalence of maternity blues in sample of Egyptian women we took 71 ladies whom delivered a living full-term baby in Zagazig University Hospital, we found 26 ladies [36.6%] who manifest maternity blues particularly those patients with significant items affect maternity blues like that crying baby, capability for carrying her infant, any lactation problems, desired sex, women with somatic symptoms, acceptance of pregnancy, fears to lose her atractivity to her husband, women who forced to marry her husband, motivation for marriage, husband age; and effect of problems with her husbands family before conception or with her own's family before or during conception. The patients experienced tearfulness, depression, anxiety, elation, emotional lability, irritability, insomnia and confusion. It is emphasized that the reaction in this period and needs of these patients deserved recognition, attention and follow-up