Nondepolarizing muscle relaxant improves direct laryngoscopy view with no effect on face mask ventilation / Relaxantes musculares não despolarizantes melhoram a visibilidade em laringoscopia direta sem efeito sobre a ventilação via máscara facial

Abstract Background: Difficult or impossible face mask ventilation complicated with difficult tracheal intubation during anesthesia induction occurs in 0.4% of adult anesthesia cases, possibly leading to life-threatening complications. Because of such catastrophes, muscle relaxants have been recommended to be administered after confirming adequate face mask ventilation without a solid scientific validation of this principal. Methods: In this observational study, the ease of ventilation and the scores of direct laryngoscopy views before and after administration of cisatracurium were assessed in ninety young healthy adults, without anesthetic risks and without foreseen difficult intubation and who were scheduled for general elective surgeries. Results: Before muscle relaxation, 43 patients (48%) were Cormack Grade I, while the remaining 47 patients (52%) were either Cormack Grade II (28 patients, 31%) or Cormack Grade II (19 patients, 21%). Following muscle relaxation with cisatracurium, the number of patients with Cormack Grade I significantly increased from 43 patients (48%) to 65 patients (72%) (p = 0.0013). Only 1 patient out of 19 patients (5%) improved his Cormack grade from Grade III to Grade I while 16 out 19 patients (84%) improved their Cormack grade from Grade III to Grade II after the use of cisatracurium. The quality of face mask ventilation did not differ with and without muscle relaxants in all patients. Conclusion: The use of cisatracurium in healthy young adults undergoing general elective surgeries with no anticipated difficult endotracheal intubation had no effect on the quality of face mask ventilation despite resulting in a quantifiable improvement in the laryngeal view.

Resumo Justificativa: A ventilação difícil ou impossível via máscara facial complicada pela intubação traqueal difícil durante a indução da anestesia ocorre em 0,4% dos casos de anestesia em adultos, possivelmente leva a complicações fatais. Devido a tais catástrofes, recomendou-se que a administração de relaxantes musculares seja feita após a confirmação de ventilação adequada via máscara facial, sem uma validação científica sólida dessa conduta. Métodos: Neste estudo observacional, a facilidade de ventilação e os escores de visibilidade em laringoscopia direta antes e após a administração de cisatracúrio foram avaliados em 90 adultos jovens e saudáveis, sem riscos anestésicos e sem intubação difícil prevista, agendados para cirurgias eletivas gerais. Resultados: Antes do relaxamento muscular, 43 pacientes (48%) eram Cormack Grau I, enquanto os 47 (52%) restantes eram ou Cormack Grau II (28, 31%) ou Cormack Grade III (19, 21%). Após o relaxamento muscular com cisatracúrio, o número de pacientes com Cormack Grau I aumentou significativamente de 43 (48%) para 65 (72%) (p = 0,0013). Apenas um paciente (5%) dos 19 melhorou sua classificação de Cormack do Grau III para o Grau I, enquanto 16 dos 19 (84%) melhoraram suas classificações de Cormack do Grau III para o grau II após o uso de cisatracúrio. A qualidade da ventilação via máscara facial não diferiu com ou sem relaxantes musculares em todos os pacientes. Conclusão: O uso de cisatracúrio em adultos jovens saudáveis submetidos a cirurgias eletivas gerais sem intubação traqueal difícil prevista não teve efeito sobre a qualidade da ventilação via máscara facial, mesmo resultando em melhora quantificável da visibilidade da laringe.

Pulmonary tuberculosis in patients with chronic renal failure at Zagazig University Hospitals

The incidence of active TB and attendant mortality is increased in patients with impaired cellular immunity, such as HIV infected patients, solid organ and stem cell transplant recipients and patients with end-stage renal failure. The relative risk for TB varies with the type of immunodeficiency and mortality rates may be as high as 75%. End-stage renal disease [ESRD] and particularly uraemia is a known contributor to immunosuppression. The aim of this work was to evaluate the increasing risk of pulmonary tuberculosis among patients with chronic renal failure and the impact of hemodialysis. This study was carried at both Nephrology Unit and Chest Department, Zagazig University Hospitals during the period from April 2012 to Jan 2013. The study included a total number of 140 patients with chronic renal failure [92 males and 48 females], with mean age of 49 +/- 6.4 years. Patients were classified to three groups: Group 1: Included 40 Patients with chronic renal failure and not on dialysis. Group 2: Included 50 Patients with chronic renal failure and on regular hemodialysis three sittings per week for less than 1 year. Group 3: Included 50 Patients with chronic renal failure and on regular hemodialysis three sittings per week for more than 1 year. All patients were subjected to: history taking and medical evaluation including general and local examinations, routine laboratory investigations, Plain chest X-ray; Posteroanterior and lateral views for all patients, Sputum Ziehl-Neelsen staining and Sputum induction in patients who had chest X-ray suspecting pulmonary TB without expectoration and Tuberculin skin testing. Selected cases were subjected to fiberoptic bronchoscopy to obtain BAL for ZN staining 16 patients [11.4%] proved to have pulmonary tuberculosis by + ve ZN stain for acid fast bacilli in either sputum or BAL, 28 patients [20%] were suspected to have pulmonary tuberculosis by radiological suspension and -ve sputum ZN for acid fast bacilli, 6 patients [4.3%] proved to have extra-pulmonary TB while 90 patients [64.3%] were free from tuberculosis. There were no significant differences among different groups as regards infection by TB. Patients with chronic renal failure are at increased risk for pulmonary and extra pulmonary tuberculosis and should be screened routinely and carefully for early detection of TB infection

Dexamethasone with either granisetron or ondansetron for postoperative nausea and vomiting in laparoscopic surgery

In a prospective randomized double-blind study, we compared the effectiveness of dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery. Hundred ASA I and II patients scheduled for laparoscopic surgery were enrolled in the study and 84 patients completed it. Following induction of anesthesia, group I [n = 42] received granisetron 1 mg and dexamethasone 8 mg, group II [n = 42] received ondansetron 4 mg and dexamethasone 8 mg. Nausea and vomiting episodes, pain scores as well as side effects were recorded during the first hour and subsequently during the first 6 and 24 hours postoperatively. Satisfaction scores were obtained at discharge. There was no statistically significant difference between the 2 groups during the 1[st] 24 hours following surgery in regards to pain scores, satisfaction and side effects manifestations. At 0-1 hour interval, 100% of patients in group I and 97.6% in group II had no vomiting. Total response [no moderate or severe nausea and no rescue antiemetics] was 83.3% in group I and 80.95% in group II, and metoclopramide was used in 7.1% of patients in both groups. At 1-6 hours interval, 97.6% of patients in group I and 100% in group II had no vomiting. Total response was 92.8% in group I and 90.9% in group II, and metoclopramide was used in 4.76% of patients in group I and 2.38% in group II. At 6-24 hours no vomiting occurred in 97.6% of patients in group I and 100% in group II. Total response was 95.2% in both groups, and metoclopramide was used in 2.38% of patients in both groups. In conclusion, the combination of dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg following induction of anesthesia in patients undergoing laparoscopic surgery showed no statistically significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction

Letrozole as an appropriate therapeutic modality for infertile women with endometrial hyperplasia

To evaluate the impact of oral letrozole therapy for 3-months on infertile patients with pathologically confirmed endometrial hyperplasia [EH]. The study comprised 17 infertile patients with EH. All patients underwent full clinical examination, transvaginal ultrasonography [TVU] to determine endometrial thickness [ET] and estimation of serum E2 levels. All patients were prescribed letrozole 2.5 mg tablets once daily for 3 months and underwent endometrial biopsy at end of treatment. The study outcome was defined as regression of EH to histologically normal endometrium at end of treatment. At the end of the 3-months treatment period, all patients showed significant reduction of preliminary endometrial thickness and decrease of serum E2 levels. All cases with simple EH without atypia [n=10] showed good response with a mean regression rate of ET of 70.2%, while was 59.3% in cases of complex EH without atypia [n=5] and 53% in cases of complex EH with atypia [n=2]. The overall pathological success rate was 88.2%; 100% in simple EH without atypia, 80% in complex EH without atypia and 50% in EH with atypia. For EH without Atypia in infertile patients oral letrozole therapy for 3-months resulted in high regression rate of endometrium and high pathological success rate. However, further large scale studies with dosage modification are needed to determine its true efficacy in EH with atypia in infertile patients

Parasitiosis in handicapped children in an Egyptian blind asylum

Examination of visually handicapped children and their serving staff revealed in a descending order Enterobius vermicularis, Giardia lamblia, Entamoeba histolytica, Hymenolepis nana, Ascaris lumbricoides, Cryptospodium parvum, Tricocephalus trichura and Strongyloides stercoralis. Head lice were encountered. But, neither blood parasites nor protozoan infective agent in water for human consumption

Serum level of cytokeratin 19 as a serum marker in preeclampsia

The cytokeratin family is expressed by all epithelial cells and it appears therefore to be a general specific and useful marker of epithelial differentiation. Cytokeratin 19 is over pressed in strongly proliferating tissues. Excessive proliferation of immature trophoblasts within the placenta might contribute to an increase in the serum cytokeratins in women with preeclampsia. To evaluate cytokeratin 19 as a serum marker of preeclampsia. This prospective study included sixty nine primigravida who attended the outpatient clinic of Obstetrics and Gynecology Minoufiya University hospital in the period from October 2006 to June 2007. Their ages were between [20-31] years, and their gestational ages were between [30-38] weeks, The patients were divided into two groups, group [A] 45 women with preeclampsia and group [B] 24controls. Serum cytokeratin 19 levels were measured in all patients using enzyme - linked immunosorbent assay [ELISA]. Cytokeratin 19 levels were identified with no statistical difference in the study groups regarding maternal age and mode of delivary [p > 0.05], while there was significant statistical difference regarding blood pressure and birth weight. The mean of serum cytokeratin 19 level in preeclampsia was significantly higher in women with preeclampsia than control group [p<0.001]. Significant positive correlation between blood pressure and serum level of cytokerati 19 in preeclamptic patients. Birth weight < 2000 gm was associated with higher level of cytokeratin 19. Cytokeratin 19 can be used as a marker for preeclampsia and disease severity

descriptive study of 45 patients with atypical brain metastases

Forty five patients who had symptoms and signs of intracranial mass lesions were examined by Computed Tomography. Neither of them had definite history of primary neoplastic disease nor conclusive radiological evidence suggestive of metastases. The possibility of primary neoplastic mass lesion, or abscesses were considered most likely in the majority of those patients. All the patients were submitted to surgery, with the preoperative diagnosis of neoplastic primary tumour or abscess. The pathological results turned out to be metastases. Retrograde full evaluation has been achieved as regards the patients clinical condition, the radiological tumour characteristics and the pathological types. A comparative study was done and discussed with a final conclusion that brain metastases may mimick primary masses or abscesses. In most of our patients the differentiation was impossible