Effect of Pilates Exercises on Standing, Walking, and Balance in Children With Diplegic Cerebral Palsy

Objective@#To analyze how Pilates exercises affect standing, walking, and balance in children with diplegic cerebral palsy throughout a 10-week program. @*Methods@#We included 40 children aged 7–9 years with diplegic cerebral palsy, and randomly allocated them into two groups of the same size: conventional therapy group (group A) and conventional therapy+Pilates group (group B). We administered the same conventional physical therapy program to both groups for 45 minutes, with group B receiving additional Pilates exercises for 45 minutes. Both groups attended the intervention program three times/week for 10 weeks. We used the Growth Motor Function Measure Scale (GMFM-88) to evaluate standing and walking (Dimensions D and E), and the Pediatric Balance Scale to evaluate balance function before and after treatment. @*Results@#Comparison of the average values of all measured variables before and after therapy showed a statistically significant difference (p<0.05) between the two groups. All measured variables showed a significant difference between groups A and B, in favor of group B (p<0.05). @*Conclusion@#Pilates exercise in addition to conventional therapy is more effective in improving balance and gross motor function in children with diplegic cerebral palsy than the conventional therapy alone.

Comparison between the efficacy of transureteral lithotripsy and extracorporeal shock wave lithotripsy in the treatment of distal ureteral stone

Objective: To compare the efficacy, cost effect and safety of extracorporeal shock wave lithotripsy [ESWL] and ureteroscopy [URS] for distal ureteric calculi by evaluating stone-free rates, retreatment rates, need for auxiliary procedures, associated complications and technical consideration with respect to patient satisfaction

Patient and method: 70 patients with single unilateral radiopaque distal ureteric stone ranges from 0.8 cm to 1.2 cm in diameter and >/=1.5 cm in length were enrolled in a prospective randomized trial. Patients were randomized to undergo URS [35] or ESWL [35]. The electromagnetic Dornier lithotripter S was used for ESWL and a semi-rigid Olympus ureteroscope, 7[degree sign] direction of view, angled ocular,8.6/9.8 Fr. x 43 cm, 6.4 Fr. channel was used for URS. Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group

Results: Patients in the ESWL group achieved a 77.1% overall stone-free rate [SFR] with a 74.3% retreatment rate and no auxiliary procedure was done. Complications occurred in 11.4% of patients treated with ESWL. Patients in the URS group achieved a 97.1% overall SFR with a retreatment rate of 8.6% and an auxiliary procedure rate of 100%. Complications occurred in 31.4% of patients treated with URS. Patient satisfaction was high for both groups, including 94.3% for URS and 77.1% for ESWL. ESWL were already at outpatient clinic so there were no admission or hospital stay. While in URS group patients admitted with mean hospital stay 1.6+/-0.5 day

Conclusions: In the treatment of large distal ureteral calculi >/= 1.5 cm, both URS and ESWL modalities are comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone-free rate and it provides immediate stone clearance with lower retreatment rates and higher patient satisfaction

Value of broncho-alveolar lavage in diagnosis of newly developed lung infiltrates in mechanically ventilated patients

Background and Objectives: in a developing country, cost effectiveness is an important consideration. The aim of this study was to investigate the efficiency and safety of mini broncho-alveolar lavage [mini BAL] samples in the diagnosis of newly developed lung infiltrates in mechanically ventilated patients

Methods: fifty mechanically ventilated patients with newly developed lung infiltrates were assessed by mini-BAL and subsequent microbiological examination. An infant Ryle catheter FG-10 was used as the inner catheter, a Nelaton catheter size 18 FG was used as the outer protective catheter and was blocked by sterile K-Y gel instead of the pre-packaged catheters

Results: eighty six percent of samples collected by Mini-BAL technique from mechanically ventilated patients showed positive growth for culture and sensitivity. Thirty percent of patients had bi microbial infection while fourteen had polymicrobial infection. Fungal infection [Candida] was the most frequent isolated pathogen [32%] followed by Gram-negative bacteria [Klebsiella] [30%]. Legionella was the commonest isolated atypical bacteria

Conclusion: this study highlighted the mini-BAL technique as a simple, safe, cheap, available and non-invasive bedside procedure for acquiring uncontaminated lower respiratory secretions in patients with newly developed pulmonary infiltrates

Correlation between clinical and urodynamic improvement in patients with overactive bladder syndrome on anticholinergic drugs

Background: the International Continence Society [ICS] defined overactive bladder syndrome [OAB] as urinary urgency with or without urge incontinence, often accompanied by frequency and nocturia in absence of infection. Urinary urgency is the complaint of a sudden compelling desire to void which is difficult to defer with patients often suffering from anxiety due to fear of leakage. Urge urinary incontinence is defined as involuntary leakage of urine, accompanied or immediately preceded by urgency. Overactive bladder syndrome is a symptomatic diagnosis. On the other hand, detrusor overactivity [DO] is an urodynamic finding, characterized by involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked. These terms aren't interchangeable, as overactive bladder syndrome patients may not have detrusor activity on urodynamic testing

Aim of the Work: to determine the relation between clinical improvement and urodynamic based improvement in patients with overactive bladder syndrome receiving anticholinergic drugs

Patients and Methods: this study included thirty eight patients, who presented to the Outpatient Urology Clinic at Ahmed Maher Teaching Hospital with symptoms of OAB syndrome. This study design was prospective. Patients clinical histories were taken, they were examined thoroughly, and completed an IPSS questionnaire. This was followed by a urinalysis, free uroflowmetry and a pelvi-abdominal ultrasound

Results: this study included thirty eight patients who were divided into two groups. Group A included twenty one patients, fifteen females and six males with mean age of 48.2 years old [21-60], who did not have detrusor overactivity in the first urodynamic study. On the other hand, group B included seventeen patients, ten females and seven males with mean age of 43.7 years old [18-58], who had detrusor overactivity in the initial urodynamic study. Patients in both groups received Solifenacin 10 mg once daily for twelve weeks before completing another IPSS questionnaire and undergoing a follow up urodynamic study

Conclusion: in this study, we concluded that there was strong correlation between urodynamic and clinical improvement in OAB patients after Solifenacin treatment as patients who were improved urodynamicaly reported improvement of their symptoms while those with poor urodynamic response reported that their symptoms were either the same as before treatment or worse. We also concluded that Solifenacin 10 mg once daily led to significant improvement in IPSS results of OAB patients with significant increase in volume to first desire and maximum cystometric capacity

Pre-operative prediction of difficulties in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy [LC] is one of the most common laparoscopic procedures being performed by general surgeons all over the world. Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. The purpose of our prospective study was to analyze various risk factors and to predict difficulty and degree of difficulty preoperatively by the use of a scoring system

Objective: The objective of this study is to evaluate a Scoring system to predict difficult laparoscopic Cholecystectomy

Patients and Methods: Laparoscopic cholecystectomy was done in the department of surgery, EL Hussin University Hospital. The parameters considered in the preoperative scoring method were old age, male sex, history of hospitalization, obesity, previous abdominal surgery scar, and palpable gall bladder, wall thickness of gall bladder, pericholecystic collection and impacted stone. A total of 50 patients were included in the study

Results: We found that history of hospitalization; palpable gall bladder, impacted stone and gall bladder wall thickness were statistically significant factors for prediction of difficult laparoscopic cholecystectomy. Conversion rate from laparoscopic to open cholecystectomy was found to be 4%

Conclusion: High risk patient may be informed beforehand regarding the probability of conversion and hence they may have a chance to make arrangements. Surgeons can also be aware about the possible complications that may arise in high risk patients

Role of platelet-rich plasma injection during modified radical mastectomy

Background: platelet-rich plasma [PRP] is a human plasma product enriched by platelets, growth factors, and fibrinogen with high hemostatic and healing properties

Objectives: The aim of this study was to evaluate the effect of autologous PRP on wound healing in women undergoing modified radical mastectomy [MRM]

Patients and Methods: In this randomized and controlled trial, 100 females were admitted to El Sayed Galal hospital, Egypt from October of 2017 to August of 2018 for MRM. The patients were randomly assigned into two groups. The intervention group received PRP after surgery, whereas the control group received the usual care. All patients were evaluated at baseline, five days, and 2 weeks after surgery. The primary endpoint used the REEDA scale for assessing the changes in wound healing. The secondary outcome measures used were the Vancouver scar scale [VSS]. All scale scores were analyzed using a repeated measures test for variance

Results: At the end of study, the PRP group showed a greater reduction in the edema ecchymosed discharge approximation [REEDA] score compared to the control group [85.5% reduction in the PRP group; 72% in the control group] [P < 0.001]. Furthermore, patients treated with PRP experienced a 93% reduction in the VAS score at the end of follow-up, but the control group only observed a 79% reduction [P < 0.001]

Conclusions: It seems that applying PRP is an effective therapeutic approach for wound healing, and faster wound healing is expected due to the presence of more platelets and growth factors

Post-pandemic seroprevalence of human influenza viruses in domestic cats

The continuous exposure of cats to diverse influenza viruses raises the concern of a potential role of cats in the epidemiology of these viruses. Our previous seroprevalence study of domestic cat sera collected during the 2009 H1N1 pandemic wave (September 2009–September 2010) revealed a high prevalence of pandemic H1N1, as well as seasonal H1N1 and H3N2 human flu virus infection (22.5%, 33.0%, and 43.5%, respectively). In this study, we extended the serosurvey of influenza viruses in cat sera collected post-pandemic (June 2011–August 2012). A total of 432 cat sera were tested using the hemagglutination inhibition assay. The results showed an increase in pandemic H1N1 prevalence (33.6%) and a significant reduction in both seasonal H1N1 and H3N2 prevalence (10.9% and 17.6%, respectively) compared to our previous survey conducted during the pandemic wave. The pandemic H1N1 prevalence in cats showed an irregular seasonality pattern in the post-pandemic phase. Pandemic H1N1 reactivity was more frequent among female cats than male cats. In contrast to our earlier finding, no significant association between clinical respiratory disease and influenza virus infection was observed. Our study highlights a high susceptibility among cats to human influenza virus infection that is correlated with influenza prevalence in the human population.

effect of endometrial injury on first cycle IVF/ICSI outcome: a randomized controlled trial

Background: Implantation remains a limiting step in IVF/ICSI. Endometrial injury isa promising procedure aiming at improving the implantation and pregnancy rates after IVF/ICSI

Objective: The aim of this study was to evaluate the effect of endometrial injury induced in precedingcycle on IVF/ICSI outcome

Materials and Methods: Four hundred patients undergoing their first IVF/ICSI cycle in two IVF units in Minia, Egypt were randomly selected to undergo either endometrial injury in luteal phase of preceding cycle [intervention group] or no treatment [control group]. Primary outcome wasthe implantation and live birth ratesWhile the secondary outcome was clinical pregnancy, miscarriage, multiple pregnancy rates, pain and bleeding during and after procedure

Results: Implantation and live birth rates were significantly higher in intervention compared with control group [22.4% vs. 18.7%, p=0.02 and 67% vs. 28%, p=0.03], respectively. There was also a significant reduction in miscarriage rate in intervention group [4.8% vs. 19.7%, respectively, p<0.001]

Conclusion: Endometrial injury in preceding cycle improves the implantation rate and live birth rate and reduces the miscarriage rate per clinical pregnancy in patients undergoing their first IVF/ICSI cycle

Language affects length of stay in emergency departments in Queensland public hospitals / 世界急诊医学杂志（英文）

@#BACKGROUND: A long length of stay (LOS) in the emergency department (ED) associated with overcrowding has been found to adversely affect the quality of ED care. The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home.METHODS: A secondary data analysis of a Queensland state-wide hospital EDs dataset (Emergency Department Information System) was conducted for the period, 1 January 2008 to 31 December 2010.RESULTS: The interpreter requirement was the highest among Vietnamese speakers (23.1%) followed by Chinese (19.8%) and Arabic speakers (18.7%). There were significant differences in the distributions of the departure statuses among the language groups (Chi-squared=3236.88,P<0.001). Compared with English speakers, the Beta coeffi cient for the LOS in the EDs measured in minutes was among Vietnamese, 26.3 (95%CI: 22.1-30.5); Arabic, 10.3 (95%CI: 7.3-13.2); Spanish, 9.4 (95%CI: 7.1-11.7); Chinese, 8.6 (95%CI: 2.6-14.6); Hindi, 4.0 (95%CI: 2.2-5.7); Italian, 3.5 (95%CI: 1.6-5.4); and German, 2.7 (95%CI: 1.0-4.4). The fi nal regression model explained 17% of the variability in LOS.CONCLUSION: There is a close relationship between the language spoken at home and the LOS at EDs, indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.

Immigrants and the utilization of hospital emergency departments / 世界急诊医学杂志（英文）

@#BACKGROUND: Immigrants with language barriers are at high risk of having poor access to health care services. However, several studies have indicated that immigrants tend to use emergency departments (EDs) as their primary source of care at the expense of primary care. This may place an additional burden on already overcrowded EDs and lead to a low level of patient satisfaction with ED care. The study was to review if immigrants utilize ED care differently from host populations and to assess immigrants' satisfaction with ED care. DATA SOURCES: Studies about immigrants' utilization of EDs in Australia and worldwide were reviewed. RESULTS: There are conflicting results in the literature about the pattern of ED care use among immigrants. Some studies have shown higher utilization by immigrants compared to host populations and others have shown lower utilization. Overall, immigrants use ED care heavily, make inappropriate visits to EDs, have a longer length of stay in EDs, and are less satisfied with ED care as compared to host populations. CONCLUSIONS: Immigrants might use ED care differently from host populations due to language and cultural barriers. There is sparse Australian literature regarding immigrants' access to health care including ED care. To ensure equity, further research is needed to inform policy when planning health care provision to immigrants.

Glucose level in the bronchial aspirate as a marker of ventilator associated pneumonia in mechanically ventilated patients

Ventilator-associated pneumonia [VAP] is the leading cause of death amongst hospital-acquired infections. Despite this, the diagnosis of VAP remains challenging and there is a lack of diagnostic standardization. In humans, glucose concentrations are normally low in nasal and bronchial fluid, but are elevated by inflammation or hyperglycaemia. Exhaled breath condensate glucose was reported to be a potential marker of both infection and outcome in patients with acute respiratory distress syndrome [ARDS]. To study the signifcance of detecting glucose in bronchial aspirate in mechaniclly ventilated patients under tight glycemic control and using it as a follow up parameter in patients with VAP versus patients with community acquired pneumonia [CAP]. Also the present work aimed to describe the pattern of changes of C - reactive protein [CRP] in patients with VAP versus those with CAP. Forty patients were enrolled into the present study and were divided into 3 groups: Group I: Thirty critically ill patients requiring intubation and mechanical ventilation were followed up from admission and daily till they fulfilled criteria suggesting development of VAP. Group II: Ten patients with community acquired pneumonia [CAP]. Group III: Ten healthy volunteers constituting the control group. Patients were assessed using the following scoring systems: 1] Assessing the disease severity using the Acute Physiological And Chronic Health Evaluation scoring system [APACHE II] on the day of admission, 2] Daily assessment of disease severity using the Sequential Organ Failure Assessment [SOFA] score, and 3] the Clinical pulmonary infection score [CPIS]. All patients with CAP were evaluated by Pneumonia severity index [PSI] on admission. CRP was assessed on admission, on day 2 and on day 7. All patients were under tight glycemic control to abolish the effect of hyperglycemia on the bronchial aspirate glucose levels. Glucose measurements were performed simultaneously in the blood and bronchial aspirates. Bronchial aspirates were analyzed for glucose on the day of admission and daily. The present study demonstrated a correlation between the presence of glucose in the bronchial aspirates from mechanically ventilated patients and development of VAP. Glucose in the bronchial aspirates preceded the development of VAP in the first 48 hours of mechanical ventilation and steadily increased thereafter. This was later associated with infiltrates on the chest radiographs, increased levels of CRP, with significant CPIS score. In contrast the glucose level in the sputum from patients with CAP was high on admission then steadily decreased till discharge. There was no correlation between patient's blood glucose and the glucose level in the bronchial aspirate. In the present study CRP values in patients with CAP steadily decreased from admission till the patients were discharged. The mean CRP value in the mechanically ventilated patients at day one was statistically significant less than that in patients with CAP. While at the 7[th] day, the mean CRP value in patients with VAP was higher than that in patients with CAP. The mean CRP level in patients with VAP was higher in nonsurvivors than survivors. In critically ill patients kept under tight glycemic control, early detection of glucose in bronchial aspirates may improve the ability of clinicians to early recognize the onset of VAP. This technique is simple, rapid, and inexpensive and following it daily may serve as a marker for infection or clinical resolution. CRP levels in patients with CAP steadily decrease from time of admission till discharge, whereas in patients with VAP, CRP steadily increases from time of VAP development thereafter thus suggesting a role in following such patients as a prognostic marker

Feeding camel milk and Nigella sativa oil [NS] and their effect on the immunity of children with viral hepatitis

Camel milk is known for its antimicrobial properties, and used for treatment of diabetes and liver diseases in folk medicine. So, this study aimed to find out the health benefits of camel milk alone or mixed with Nigella sativa [NS] oil on outcome of viral hepatitis among children. 35 [14 girl and 21 boy] children infected with viral hepatitis with mean age 8.1 +/- 3.6 years were selected from outpatients of Minufiya University and Monshaat Sultan hospitals, Minufiya Governorate, Egypt. The selected children were divided into 4 groups; control group [CG] [n=5] they didn't receive any dietary intervention; milk group [MG] [n=10] they receive 100ml/day of camel milk; oil group [OG] [n=10] they receive 2ml/day of NS oil; and milk oil group [MOG] [n=10] they receive 100 ml of camel milk in addition to 2 ml of NS oil daily. The children were free living and receive their standard medical treatment and normal diet without any modification. The dietary intervention continued for 35 consecutive days. Blood samples were collected from subjects at baseline and after dietary intervention period for determination of ALT, AST, IgG, IgM, alkaline phosphatase, bilirubin, hemoglobin, and HCT. The results showed that feeding camel milk alone decreased IgM by 34.5% and increased IgG by 84.3%, while mixing it with NS oil resulted in decrement of IgM by 47.1% and increment of IgG by 91.7%, and surprisingly NS oil decreased IgM by 64.8% and increased IgG by 72.7%. Whereas, the concentration of elevated liver enzymes decreased significantly by the dietary intervention, especially among group fed camel milk alone or combined with NS oil. In conclusion, feeding camel milk alone or mixed with NS oil had a favorable affect on health status of children with viral hepatitis

Interleukin-5 production by peripheral blood monocytes from asthmatic patients: effect of alveolar macrophages

This study aimed to assess the role of ALM in the pathogenesis of bronchial asthma by studying the effect of ALM derived from bronchoalveolar lavage [BAL] on IL-5 production by peripheral blood monocytes PBMC [including T lymphocytes] in cocultures in patients with bronchial asthma as compared to that in non asthmatic individuals. Nineteen patients with bronchial asthma were enrolled in this study. Ten normal non-smoker subjects were considered as controls. Patients were subjected to broncoalveolar lavage [BAL]. The lavage fluid was cultured in 3 wells; one with peripheral blood monocytes [PBMC], another with PBMC with mitogen stimulation and the third with PBMC with BAL cells and stimulation. Cultures were incubated and the supernatants were assayed for IL-5 by EL1SA. The mean [SD] age for the asthmatic patients was 37.67[9.66] years with a mean [SD] body mass index of 28.3[6.12]. Male constituted 53% [11/19] of the studied asthmatic patients. The levels of 1L-5 in the supernatant of resting PBMN cultures were significantly higher in patients with asthma in all three states [basal state, after PHA stimulation, in cocultures with ALM [mean [SD] = 219.45[68.34] ng/ml, range [100-320 ng/ml], 484.85[115048.01], range [170-670 ng/ml], 1118 [336.59], range [530-1800 ng/ml], respectively. The respective levels in the nonatopic normal subjects was [mean [SD]: 21.20[8.97], 26.8[10.10], 29.30[7.87]]. The differences between the three states in the asthmatic patients were highly significant. The changes between the three states in the non-asthmatic patients were insignificant. IL5 production by PBMN is markedly increased in asthmatic patients versus non-asthmatic subjects, furthermore, IL-5 production was markedly amplified by co-culturing PBMN with autologous ALM derived from BAL in the asthmatics patients. This is in contrast to the finidings in non-asthmatic subjects where IL5 production was not augmented by autologous ALM. The fact that ALM from non-asthmatic subjects functioned poorly as APC may represent a local inhibitory protective mechanism in the airways

Intercellular adhesion molecule [ICAM-1] in bronchial asthma and chronic obstructive pulmonary disease

In recent years, great progress has been made towards elucidating the cellular and molecular mechanisms responsible for the development of inflammation. Sixteen patients with obstructive lung disease were included in the present study. Eight patients were diagnosed as having bronchial asthma [Group I], and eight patients with chronic obstructive pulmonary disease [COPD, Group II]. Asthmatic patients were all in status necessitating their admission to the hospital. COPD patients were subdivided into two equal groups: group IIA; included four patients with COPD admitted to the ward with acute exacerbations of their disease and group IIB; included four other patients with acute exacerbations necessitating their admission to the respiratory intensive care unit [RICU] in acute respiratory failure. Seven healthy adult subjects were selected as a control group [Group III]. Soluble serum ICAM-1 was analyzed. Moreover respiratory function data [flow volume, spirometric variables] including; forced vital capacity [FVC], forced expiratory volume in one second [FEV[1]], forced expiratory flow rate at 25% to 75% of the vital capacity [FEF[25-75%]] and peak expiratory flow rate [PEFR] were measured in all patients [n=16]. The mean value of soluble ICAM-1 in the control group was 205.7 +/- 51.3 ng/ml and it was 3I2.5 +/- 175.8 ng/ml in the patients with obstructive lung disease enrolled in the present study [Group I and II]. In patients with broncheal asthma [Group I] the mean value of ICAM-1 was 282.5 +/- 226.6 ng/ml, while it was 342.5 +/- 113.2 ng/ml in patients with COPD [Group II]. In group IIA the mean value was 355 +/- 81.9 ng/ml, and group IIB it was 292 +/- 156 ng/ml. The results of the present study revealed a significant difference between the mean values of serum ICAM-1 in patients with COPD and the control group. There was no significant difference between all patients [asthmatics and COPD patients] and the control group and also there was insignificant difference between group IIA and IIB. It was concluded from the present study that ICAM-1 was higher in patients with COPD in acute exacerbations than in patients with status asthmaticus. Spirometric variables measured in group I and II showed insignificant difference and the results of the present study revealed no significant correlation between serum ICAM-1 and the spirometeric variables in group I and II