Non invasive predictors for decision making in acute exacerbation of chronic obstructive pulmonary disease [AECOPD]

Accurate prediction for prognosis is important for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease [AECOPD] requiring mechanical ventilation [MV] and for proper assessment of decision making regarding plane of management and ongoing hospital morbidity and mortality. The present study was designed to determine the predictability of non invasive parameters including APACHE II score, arterial blood gases [ABGs] and bedside Echocardiography in management of critically ill patients with COPD exacerbation either invasively or conservatively. The study was conducted on 60 adult patients [50 male and 10 female] with AECOPD, with mean age 60.1 +/- 6.2 were admitted to intensive care unite [ICU]. All patients were subjected to arterial blood gases [ABGs], APACHE II score and bedside Echocardiography study. Patients were divided into two groups according to ventilatory requirement invasive or non invasive into group I [34 patients] with need of MV and group II [26 patients] with success of conservative treatment. We found that APACHE II score, had a high predictive value for MV necessity, it was 19.17 +/- 3.4 in the group I Vs 11.46 +/- 4.4 in the group II also Doppler evidence of pulmonary hypertension had high predictive value for MV necessity. The mean value of PASP was 48.95 +/- 12.44mmHg in group I, Vs 30.71 +/- 6.5mmHg in group II with significant p value. The mean value of PAPm was 42.08 +/- 6.89mmHg in group I Vs 31.50 +/- 7.71 mmHg in group II with significant p value. Increases in the APACHE II score, the mean pulmonary artery pressure [PAPm] and pulmonary artery systolic pressure [PASP] were significantly more in patients who died in comparison to survivors in the group I. APACHE II score, bedside Echocardiography and routine arterial blood gases could be used as a marker to identify patients at the time of admission who are likely to have a poor prognosis, so that such patients can be managed aggressively, either medical conservative treatment or mechanical ventilation [NIPPV or Invasive MV]

Antileukotriens: new adjunctive therapeutic option in allergic rhinitis and nasal polyposis

Allergic rhinitis is one of the most prevalent medical conditions. Almost 40% of the allergic rhinitis patients have lower airways involvement, whereas more than 80% of the allergic asthma patients have concomitant rhinitis symptoms. Therapeutic options include allergen avoidance, antihistamines and intranasal corticosteroids and recently, antileukotrienes. The objective of this study was to determine the efficacy of leukoriene receptor antagonist in the medical management of allergic rhinitis and nasal polyposis as an adjuctive therapy to antihistamines and corticosteroids. The 50 patients recruited for this study were divided into three groups; group I included 23 allergic rhinitis patients without nasal polyposis where antileukotrien [montelukast 10 mg once per day] was given in combination with the antihistaminic [loratadine] 10 mg for 6 months. Group II; included 11 patients with nasal polyposis who were undergoing daily intranasal steroid sprays fluticasone, 200 micro g and antileukotriene was given as an adjunctive therapy. Group III; included 16 nasal polyposis patients who underwent endoscopic ethmoidectomy and bilateral maxillary antrostomy. Treatment administered after surgery was 10 mg of montelukast once daily for 6 months in 9 patients and in a control group of 7 subjects; fluticasone 200 micro g nasal spray and loratadine tablets 10 mg once per day. Six months follow-up for the three groups included rhinoendoscopy, anterior rhinomanometry and computerized tomography [CT]. Group I. revealed clinical subjective improvement in 19 patients [82.6%]. Nasal symptoms; itching, postnasal discharge, headache sneezing and rhinorrhea were improved .There was also a significant improvement in objective assessment. Clinical subjective improvement in group II was experienced only by 3 patients [27%]. Patients in Group III showed in both subgroups total absence of any local recurrence and good nasal patency. Leukotriene synthesis inhibitors appear to be a novel treatment modality for patients with allergic rhinitis when used as adjunctive or alternative therapy. They might play a role in controlling polyposis and their symptoms, and might be an alternative to longterm steroid therapy and repeated surgical therapy

Flavonoids of Gomphocarpus sinaicus

The aerial parts of Gomphocarputs sinaicus Boiss. yielded four flavonoids that were identified as isorhamnetin 3-O-rhamnoglucoside [1], luteolin-7-O-glucoside-3'-O-rhamnoside [2], rutin [3] and rutin-7-O-rhamnoside [4]. All of the isolated flavonoids were identified by spectroscopic methods [UV, FAB-MS, [1]H-NMR and [13]C-NMR] and in comparison with the literature data. The isolated flavonoids [1], [2] and [4] are reported here for the first time from Gomphocarpus sinaicus Boiss

Critical analysis of recurrences after trans-oral endoscopic laser resection of laryngeal cancer

This study included 41 patients with recurrent squamous cell carcinoma of the larynx 3-14 months after failed transoral endoscopic laser resection [TLS]. They were subjected to diagnostic and staging work up. The initial diagnostic data before performing TLS were analyzed. The patients were treated surgically according to the presenting stage, either by conservative laryngeal surgery [CLS] or by total laryngectomy [TL] with or without neck dissection. Deep X-ray therapy [DXT] was given to patients who were presented with T3 and T4 lesions if a full dose of DXT was not given after initial TLS. The patients were followed up for at least two years. Initially, 13 patients were presented with T1 disease, 9 with T2, 17 with T3 and 2 with T4. Three to 14 months after failed TLS, 22 patients developed a recurrent disease but of the same initial stage, while 19 developed a more advanced stage

Auditory dysfunction among printing workers

The aim of this study is to explore the combined effect of occupational exposure to noise and lead on the hearing process of the exposed workers. Twenty-four exposed workers [48 ears] from two printing facilities at Cairo University and twenty controls [40 ears], not occupationally exposed to noise or lead, were included in this study. All studied personnel were subjected to medical and occupational history, clinical and ENT examination, blood lead level determination and audiological assessment including: pure tone hearing thresholds, otoacoustic emissions [OAE] and auditory brain-stem response [ABR]. The work environments were tested for noise levels which were found to be 88 and 92 dB A, respectively. Statistically significant differences were detected between the exposed group and the controls as regards the hearing thresholds at frequencies 4 and 8 KHz and the OAE, The ABR revealed significant prolongation of the absolute latencies of waves 1 and 3 with increased [1 -3] interpeak latency in the exposed group. The 5/ 1 amplitude ratio was also smaller in the exposed compared to the controls. The blood lead level was significantly higher in the exposed in comparison to the controls [p < 0.001]

comparative study of abdominal and endoscopically guided vaginal procedures in the treatment of female stress urinary incontinence

The purpose of this study was to compare the results of abdominal and endoscopically guided vaginal procedures used for treatment of stress urinary incontinence[SUI] and evaluation of long term results of each procedure. In a prospective study, a total of 57 patients with type I and II SUI were treated with bladder neck suspension. They were classified into 2 groups. Group I: [20 Patients]: Were subjected to abdominal bladder neck suspension [Burch and Marshal Marchetti procedures]. Group II: [37 patients]: Were subjected to endoscopically guided vaginal bladder neck suspension procedures [Raz and Gitte's]. Associated pelvic relaxation [cystocoele, rectocoele] were treated as well. All patients were subjected to full history, physical examination and investigations to evaluate and classify the types of SUI and associated conditions. After a mean of 27 months, the success rate was 85% [17 of 20 patients] of group I, and 84% [31 of 37 patients] of group II. In addition, 57% of patients in group I and 64% of patients in group II had resolution of urgency symptoms. Concerning pelvic relaxation in group II, cystocoele was cured in 82%, cystocoele and rectocoele were cured in 100% of patients. There is no statistically significant difference between abdominal and endoscopically guided vaginal procedures used in bladder neck suspension in cases of SUI, but vaginal approach gives a chance for concomitant repair of pelvic relaxation

Fracture of the penile shaft: results of early surgical repair

In this article, we review a total of 12 patients with penile fracture who presented over a period of 36 months. Associated urethral injuries were found in 3 out of the 12 patients [25%]. All patients were treated by early surgical repair within 48 hours from the time of injury. They were discharged in good condition and were followed up, both clinically and pharmacocavernosographically in the outpatient department with excellent results. We advocate early surgical exploration and repair of these injuries because of the excellent results, shorter hospitalization, less morbidity and earlier return to full sexual activity

Effect of dietary protein on lipid metabolism in experimental diabetes

Results revealed that total lipid levels significantly decreased by feeding the rats with meat, lupine termis and soybean diets after 3 and 6 weeks while, casein diet showed significant decrease in total lipid levels after 3 weeks only. However, all protein diets showed significant decrease in total cholesterol, high density lipoprotein- cholesterol [HDL-cholesterol] and phospholipid levels after 3 and 6 weeks. On the other h and, plasma triglycerides were significantly decreased by meat and kareesh cheese diets after 6 weeks while, soybean diet significantly reduced triglyceride levels after 3 and 6 weeks. However, lupine termis diet recorded noticeable increase in plasma triglyceride after 3 weeks only, whereas, casein diet caused noticeable increase in triglyceride levels after 3 and 6 weeks. The data obtained revealed that both animal and plant protein diets had nonsignificant effects on plasma low density lipoprotein-cholesterol [LDL-cholesterol] levels

Spermatic cord block: a safe technique for intrascrotal surgery

In this study, 48 patients underwent operative procedures on the testes, epididymis or the spermatic cord using the technique of spermatic cord block anesthesia. There were no complications attributable to the technique. The procedures were tolerated well and most of the patients were treated on a day case basis

Rheumatoid arthritis [RA]: a study of psychological symptoms in relation to various disease parameters

The sample consisted of 100 patients, including 60 rheumatoid arthritis [RA] patients and 40 patients with osteoarthritis [OA] of the knees as a comparative group, and represented newly diagnosed as well as chronic patients in different classes and stages of the disease. Thorough history taking, examination and investigations were done. The Arabic version of Symptom Check List-90-Revised [SCL-90-R] was used as a part of the psychological and psychiatric assessment of the patients. The findings showed that disability was the RA disease parameter that correlated mostly with depression, followed by the ESR, disease severity, duration, seropositivity and pain were not significantly correlated with any psychological factor. These findings were discussed in the light of the recent literature

In vitro transmission of Wuchereria bancrofti L3-stage larvae by experimentally infected culex pipiens L [Diptera: culicidae]

Females of Culex pipiens L. experimentally infected with Wuchereria bancrofti were tested for in vitro transmission of infective stage L[3] larvae using a capillary tube technique. Of the females harbouring L[3] larvae, 60.7% [34/56] transmitted a geometric mean of 2.84 L[3] larvae [range 1- 35]. Transmitting Cx. pipiens contained significantly more L[3] larvae than non-transmitters. Both the probability of transmission and the number of L[3] larvae transmitted were related to the total number of L[3] larvae/mosquito. Almost all females with L[3] loads >/= 10 transmitted larvae in vitro. The possibility is discussed that the detection of L[3] larvae in field collected mosquitoes by dissection may overestimate the proportion capable of parasite transmission and the proportion of L[3] larvae deposited on host skin by Ca. 40%