ABSTRACT
Purpose:@#Sepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.@*Methods:@#The study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38℃ or lower than 36℃, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores.@*Results:@#Among the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788-0.963) as compared with 0.75 (0.634-0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%.@*Conclusion:@#SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.
ABSTRACT
Objective: To evaluate the in vitro cytotoxic activity of the fractionated extract as well as isolated compounds of Arum palaestinum Boiss. ( A. palaestinum) (black calla lily), and to identify the volatile components which may be responsible for the potential antitumor activity. Methods: A. palaestinum was collected from its natural habitats and subjected to phytochemical analysis for separation of pure compounds. In vitro cytotoxic activity was investigated against four human carcinoma cell lines Hep2, HeLa, HepG2 and MCF7 for the fractionated extract and isolated compounds. While, the diethyl ether fraction was subjected to GC-MS analysis as it exhibited the most potent cytotoxic effect to evaluate the active constituents responsible for the cytotoxic activities. Results: Four flavonoid compounds were isolated (luteolin, chrysoeriol, isoorientin, isovitexin) from the diethyl ether and ethyl acetate. The extracts and the pure isolated compounds showed a significant high antiproliferative activity against all investigated cell lines. The GC-MS analysis revealed the separation and identification of 15 compounds representing 95.01% of the extract and belonging to different groups of chemical compounds. Conclusions: The present study is considered to be the first report on the cytotoxic activities carried out on different selected fractions and pure compounds of A. palaestinum to provide evidences for its strong antitumor activities. In addition, chrysoeriol and isovitexin compounds were isolated for the first time from the studied taxa.
ABSTRACT
Neurological complications in HCV-infected patients occur predominantly in the peripheral nervous system. Vasculitic neuropathy is the most firmly linked neurologic illness associated with HCV infection. This type of neuropathy occurs frequently in the presence of cryoglobulinemia. HCV-related cranial neuropathies have been also reported. This study was conducted to investigate the various peripheral neurological complications of chronic hepatitis C infection and their possible pathogenetic mechanisms. This study was conducted on 160 patients with chronic hepatitis C infection comprised two subgroups: group I, composed of 80 chronic hepatitis C patients with clinically apparent neurological complication[s], and group II, composed of 80 chronic hepatitis C patients neurologically asymptomatic. Patients were subjected to clinical evaluation, estimation of hepatitis markers, cryoglobulins, anticardiolipin antibodies, antinuclear antibodies and nerve conduction studies. Peripheral neuropathies represented the most commonly encountered neurological disorders, occurring in 25 patients [31.25%]. The sensory peripheral neuropathy was the most common type, representing 32% of neuropathic patients [8/25]. A statistically significant difference was found between groups I and II regarding the presence of cryoglobulin and anticardiolipin antibody, being more common in group I. Antinuclear antibody was more common in group I than in group II. Results of nerve conduction studies showed nerves were more affected in group I and in cryoglobulin and ANA positive patients. Peripheral neuropathies represent the most common HCV-related peripheral neurological disorders especially when associated with cryoglobulins and ANA antibodies
Subject(s)
Humans , Male , Female , Hepacivirus , Hepatitis C/complications , Peripheral Nervous System Diseases , Peripheral Nervous System , Cryoglobulinemia , Antibodies, Anticardiolipin , Antibodies, AntinuclearABSTRACT
Bioethics is intrinsic part of medical practice and health research involving human subjects. Many countries in the world have established a well defined national system to govern the ethical aspects in the field of health research involving human subjects. Sudan, with its long history in the field of health research is still lacking national ethical policy for research involving human subjects. Nevertheless, there is some ethical review process, but is still premature. Bioethics as a system may help policy-makers and researchers at the same time to recognize and deal with the ethical dilemmas in health research. To be acquainted with the means and tools needed for protection of human subjects involved in health research. This article suggests establishing a national framework for ethics in health research that involves human subjects. It suggests four components to be included in this framework