Ventilator associated pneumonia: incidence and risk factors in a university hospital

Ventilator associated pneumonia [VAP] is a type of nosocomial pneumonia associated with increased morbidity and mortality. Awareness about the risk factors can be used to implement simple and effective preventive measures.To determine the factors associated with development of VAP and its mierobial profile among patients admitted to ICUs. A nested case-cohort study was conducted at Al-Hussein university hospital in Cairo city, Egypt for a period of 6 months from the 1[st] of March 2013 to the end of August 2013. Patients who were on mechanical ventilation [MV] for more than 48 hours were monitored at frequent intervals fordevelopment of VAP. Samples obtained by endotracheal aspiration were ccultured on Blood agar -Chocolate agar - MacConkey agar, plates of which were incubated at 37c for 24 hours. The isolated organism was identified by morphological and biochemical identification. Of the 73 samples which were taken from endotracheal tubes of the patients, 42 cases were diagnosed as VAP with an incidence rate of 57.5%. Early onset VAP occurred in 36 [85.7%], while late onset VAP was observed in the remaining 6 patients [14.3%]. Escherichia coli [40.5%] followedby Klebsiella pneumonia [23.8%] were the most commonly isolated pathogens. Univariate analysis showed that the duration of MV and ICU stay, re-intubation, supine head position, impaired consciousness, steroids use and H[2] blocker use were the risk factors associated with VAP [p < 0.05], Logistic regression revealed duration of MV as an independent risk factor for VAP. The incidence of ventilator pneumonia is high in our study. VAP was significantly related to duration of MV and ICU stay, re-intubation, supine head position, impaired consciousness, steroids use and H[2] blocker use

Detection of occult cor-Pulmonale using dobutamine stress echocardiography in patients with schistosomal hepatic fibrosis

The presence of early diastolic dip of the ventricular septum has been reported to be able accurately diagnose occult cor-pulmonale during cycle ergo meter exercise test in patients with chronic obstructive pulmonary disease [COPD]. This study was conducted to test the ability of dobutamine stress echocardiognaphy [DSE] to detect cases of occult corpulmonale among patients with hepatosplenic schistosomiasis. The study included 25 patients aged 35.6+/=l2.7 years with hepatosplenic schistosomiasis [group 1, 15 males and 10 females] compared to 25 age- and sex-matched patients with COPD [group II]. M-mode echocardiognaphic ventricular septal motion, left ventricular shape [determined by short-axis 2-dimensional echocandiography], and pulmonary artery [PA] acceleration time [determined by pulsed Doppler echocardiognaphy] were measured at rest and during DSE. The ventricular septal motion and PA acceleration time were normal at rest in all patients. In gnoup 1, 22 patients [88%] reported marked downward ventricular septal motion in early diastole during DSE, indicating distortion of left ventricular shape. In group II, only 11 patients [44%] showed the same change during DSE. There is significant decrease in PA acceleration time in patients who showed septal dip in both groups from rest to DSE. It could be concluded that occult cor pulmonale can be diagnosed by the appearance of an early diastolic dip of the ventricular septum and distorted left ventricular shape during DSE in patients with hepatosplenic schistosomiasis. This method may be useful in selecting cases for medical treatment for early cor-pulmonale

Craniofacial war injuries

In this paper, recent concepts in the management of war wounds of the maxillofacial region are described. A brief differentiation is also given between general practice medicine and military medicine

Production of new chocolate milk drinks

Chocolate milk was prepared, using fresh skim milk [FSM] and high fructose corn syrup [HFCS] as a sweetening agent, two types of low fat and lactose chocolate milks were prepared. The first type considered as high protein chocolate milk, which was prepared from a mixture of 90.25% FSM, 9.0% HFCS, 0.45% cacao powder, 0.1% chocolate essence and 0.2% carboxy methyl cellulose [CMC] as control, other treatments were prepared by replacing 25% and 50% of FSM with each of soy protein, sodium casein and whey protein suspensions [1: 9]. The sensory evaluation of the obtained products revealed that replacing 25% of FSM by protein suspensions led to obtain an acceptable product, which gain the highest total scores especially the product fortified with whey protein than that prepared from whole FSM

in vitro study of the wear of composite inlays, inlays and inlays with bevel with their enamel antagonists at the occlusal contact areas

The wear of composite class II MOD onlays, inlays and inlays with occlusal bevel at the occlusal contact areas and their antagonistic enamel cusps was measured in vitro. For each group, 12 inlays or onlays were directly made and cemented in extracted human molars. After repeated cyclic loading, corresponding to 6 months and one year of clinical service, the wear values were measured as the means of the occluso-cervical depths of 4 different points on the occlusal surface. Final wear measurements of composite inlay [mean +/- S.D.] ranged from 61.5000 +/- 1.408 Um, for the onlays, to 28.8083 +/- 0.824 for the inlays, to 36.6750 +/- 0.553 for the inlays with bevel. The mean wear of the enamel antagonists ranged from 35.2500 +/- 0.337 for the onlays, to 15.9250 +/- 0.302 for the inlays to 31.9500 +/- 0.444 for the inlays with bevel. A significant difference in wear was found between the 3 groups of composite inlay restorations and also between their controls. It can be concluded that, in this investigation the inlays were more wear resistant than the onlays and inlays with occlusal bevel

In Viro study of the effect of three dentinal bonding agents on microleakage in class V composite restorations

Some clinicians now advocate dentinal bonding agent to eliminate microleakage around composite margins. Controversy exists as to whether the smear layer should be left in place or completely removed with composite resin. Recently, marketed dentinal bonding agents modify but not remove the smear layer. The present study compare the leakage around class V composite restoration using three commercially dentin adhesives, Prisma Universal bond 2, Scotch bond 2 that alter the smear layer and Tenure which completely removes it. The results indicated that Tenure was the most effective system and the amount of leakage around composite restorations was minimal. Alteration of the smear layer differ from one system to another. No statistical significance was observed between Scotch bond 2 and Tenure, while Prisma Universal bond 2 showed the greatest amount of leakage

in vitro study of the diametrical tensile strength of composite inlay system repaired using a posterior composite bonding agent

Esthetics are highly recommended in posterior regions as well as in anteriors. The use of composite resins for restoring posterior teeth increased. To overcome problems associated with polymerization shrinkage and low wear resistance composite inlays are becoming available as an alternative to posterior composites. The wide use of composite inlays in dentistry has necessitated repair of fractured discolored or worn out restorations. A number of studies have demonstrated that clinically acceptable repairs can be obtained for anterior composites. The aim of this in vitro study was to evaluate the diametral tensile strength of composite inlays repaired with a posterior composite [occlusion with or without the use of bonding agent]. It was found that the underpaired specimens [group 1] had a breaking force higher than those of the repaired specimens [groups 2, 3]. Also, there was a significant difference between repaired groups [groups 2, 3]. Better results were found when the repaired specimens were repaired using a bonding agent followed by posterior composite [in group 2]. Therefore, the use of a bonding agent for repair of composite is recommended. However, both repaired groups showed a diametral tensile strength which is highly acceptable clinically

role of cercarial glycoproteins in immunization against mansoniasis infection of experimental animals

Immunization of CDI mice with the cercarial glycoproteins showed a marked reduction in the worm burden and a significant reduction in the intestinal egg load and egg extrusion in the immunized mice infected with S. mansoni as compared with non-immunized infected control group. This effect seemed to be more marked in mice heavily infected with 100 cercariae each than in lightly infected animals with 30 cercariae each