Acute dacryocystitis retention: a case report and literature review / Dacriocistite aguda de retenção: relato de caso e revisão da literatura

ABSTRACT Acute dacryocystitis retention (ADR) is an unusual entity that contributes to an incorrect diagnosis and treatment. We describe a case of acute dacryocystitis retention occurring in a 61-year-old diabetic male who presented with severe pain, swelling, and inflammatory signs above the left medial canthal ligament tendon. He had no previous history of epiphora. Computed tomography scan indicated acute dacryocystitis. Clinical treatment resulted in complete resolution of the condition. Syringing one month after the acute episode indicated a patent lacrimal excretory system. The temporary obstruction that evolved to an acute dacryocystitis retention was probably secondary to nasal alteration or supposed dacryoliths. Timely, conservative clinical treatment can lead to complete resolution of acute dacryocystitis retention with no further treatments.

RESUMO A dacriocistite aguda de retenção é uma entidade incomum, o que contribui para que o diagnóstico e o tratamento não sejam corretos. Estamos descrevendo um caso de dacriocistite aguda de retenção ocorrendo em um homem diabético de 61 anos que apresentou dor intensa, edema e sinais inflamatórios acima do tendão cantal medial esquerdo. Ele não tinha histórico anterior de epífora. A tomografia computadorizada indicou dacriocistite aguda. O tratamento clínico resultou na resolução completa da condição. A irrigação, um mês após o episódio agudo, indicou sistema excretor lacrimal pérvio. A obstrução temporária que evoluiu para uma dacriocistite aguda de retenção foi provavelmente secundária a alteração nasal ou supostos dacriolitos. O tratamento clínico conservador pode levar à resolução completa da dacriocistite aguda de retenção, sem necessidade de outros tratamentos.

Regeneration of Neural Networks in Immature Teeth with Non-Vital Pulp Following a Novel Regenerative Procedure

BACKGROUND AND OBJECTIVES: Recombinant amelogenin protein (RAP) was reported to induce soft-tissue regeneration in canine infected endodontically treated permanent teeth with open apices. To characterize identities of the cells found in the RAP regenerated tissues compared to authentic pulp by identifying: 1) stem cells by their expression of Sox2; 2) nerve fibers by distribution of the axonal marker peripherin; 3) axons by their expression of calcitonin gene–related peptide (CGRP); 4) the presence of astrocytes expressing glial fibrillary acidic proteins (GFAP).METHODS: A total of 240 open-apex root canals in dogs were used. After establishment of oral contamination to the pulp, the canals were cleaned, irrigated, and 120 canals filled with RAP, and the other 120 with calcium hydroxide.RESULTS: After 1, 3, and 6 months, teeth were recovered for immune-detection of protein markers associated with native pulp tissues. Regenerated pulp and apical papilla of RAP group revealed an abundance of stem cells showing intense immunoreactivity to Sox2 antibody, immunoreactivity of peripherin mainly in the A-fibers of the odontoblast layer and immunoreactivity to CGRP fibers in the central pulp region indicative of C-fibres. GFAP immunoreactivity was observed near the odontoblastic, cell-rich regions and throughout the regenerated pulp.CONCLUSIONS: RAP induces pulp regeneration following regenerative endodontic procedures with cells identity by gene expression demonstrating a distribution pattern similar to the authentic pulp innervation. A- and C-fibers, as well as GFAP specific to astrocytic differentiation, are recognized. The origin of the regenerated neural networks may be derived from the Sox2 identified stem cells within the apical papilla.

Graphene Oxide Nano Sheets Increase Brain Damage and Alter Dopamine, Norepinephrine and 5-Hydroxytryptamine Levels in Brain of Albino Mice

Background: Hazards of graphene particles, as novel application in biomedicine and industry of electronics, have attracted extensive attention Large number of toxicological studies have evaluated the interactions of graphene nanomaterials with living systems Although many studies have been performed on graphene-induced toxic effects, toxicological data for the effect of graphene materials on the nervous system are lacking Aim: To follow whether graphene oxide nano-sheets (GONs) affect malonaldehyde (MDA), glutathione (GSH) and nitric oxide (NO) contents, also, mice brain neurotransmitters levels upon using different increasing doses at different time intervals Materials and methods: The present study focused on the biological effects of GONs, at 10, 50, 100, 250 and 500 µg/kg bw, on mice brain content of GSH, MDA and NO after 7, 28 and 56 days of injection Moreover, dopamine (DA), norepinephrine (NE) and 5-hydroxytryptamine (5-HT) levels, in mice brain, were also evaluated Results: Data obtained revealed significant decreases in GSH content coupled with significant increases in MDA and NO contents after GONs injection and these changes was dose and time dependent Meanwhile, DA and 5- HT levels s in mice brain revealed fluctuating responses, NE level showed significant elevations at different time intervals

Accidental lacrimal gland removal during resection of the levator palpebrae superioris muscle / Remoção acidental da glândula lacrimal em cirurgia de ressecção do músculo levantador da pálpebra superior

ABSTRACT Accidental removal of the lacrimal gland is a rare complication of ptosis surgery. We report two children who underwent large unilateral levator palpebrae superioris resections (LPSr). After surgery, both patients developed dry eye. Post-operatively, the parents of both patients noticed no tears in the affected eye when their child cried. Computed tomography proved the absence of the lacrimal gland in the operated eye in both patients. Oculoplastic surgeons should pay close attention to the anatomy of the levator muscle and its proximity to surrounding tissues in order to avoid lesions on important orbital structures, including the lacrimal gland, and to avoid the development of long-term dry eye.

RESUMO A remoção acidental da glândula lacrimal é uma complicação rara da cirurgia de ptose. Relatamos duas crianças que foram submetidas à grandes ressecções unilaterais do músculo levantador da pálpebra superior que desenvolveram olho seco após a cirurgia. No pós-operatório, os pais notaram ausência de secreção lacrimal durante o choro no olho operado. Tomografia computadorizada de órbitas comprovou ausência da glândula lacrimal no olho submetido à cirurgia, em ambos os casos. Cirurgiões oculoplásticos devem estar atentos à anatomia do músculo levantador e estruturas relacionadas para evitar lesões em importantes estruturas orbitais como as da glândula lacrimal que podem induzir permanente olho seco.

Non-invasive assessment of liver fibrosis in patients with hepatitis C: shear wave elastography and colour Doppler velocity profile technique versus liver biopsy

Background and study aims: Determination of the presence and degree of liver fibrosis is essential for the prognosis and treatment of patients with chronic hepatitis C. Non-invasive methods of assessing fibrosis have been developed to reduce the need for biopsy. We determined the efficacy of shear wave elastography [SWE] and colour Doppler velocity as non-invasive methods for the assessment of liver fibrosis compared to liver biopsy among patients with chronic hepatitis C virus [HCV] infection

Patients and methods: In total, 117 patients with chronic HCV infection and 50 healthy age- and sexmatched control subjects were included. For each patient and control, abdominal ultrasonography, Doppler ultrasonography of the right portal vein [PV], and SWE were performed, whereas liver biopsy was performed for patients

Results: The mean value of the right PV maximum velocity was lower in patients with different stages of fibrosis than in controls [p < 0.001]. The mean value of liver stiffness determined by SWE was significantly higher in patients with different stages of fibrosis than in controls. Cutoff values for liver stiffness determined by SWE for assessing fibrosis stages were F2 >/= 4.815, F3 >/= 6.335, and F4 = 7.540 with a sensitivity of 84.6%, 96.2%, and 100.0%; specificity of 88.5%, 93.8%, and 100.0%; positive predictive value [PPV] of 93.6%, 98.0%, and 100.0%; negative predictive value [NPV] of 74.2%, 88.2%, and 100.0%; and overall accuracy of 85.9%, 95.6%, and 100.0% [area under the ROC curve [AUC]: 0.89, 0.96, and 1.0], respectively. Cutoff values for the right PV maximum velocity for assessing fibrosis stages were F2 < 23.4, F3 < 21, and F4 < 20 with a sensitivity of 65.0%, 57.4%, and 57.1%; specificity of 59.8%, 76.4%, and 75.5%; PPV of 33.8%, 58.3%, and 32.0%; NPV of 84.4%, 75.7%, and 89.7%; and overall accuracy of 61.1%, 69.5%, and 72.5% [AUC: 0.614, 0.696, and 0.625], respectively

Conclusion: SWE is effective for the non-invasive assessment of liver fibrosis in patients with HCV infection. SWE provides a more accurate correlation with liver fibrosis stage than colour Doppler velocity profile for the assessment of liver fibrosis, especially in advanced stages [F3 and F4]

Human Umbilical Cord Blood CD34-Positive Cells as Predictors of the Incidence and Short-Term Outcome of Neonatal Hypoxic-Ischemic Encephalopathy: A Pilot Study

BACKGROUND AND PURPOSE: Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of neurological handicap in developing countries. Human umbilical cord blood (hUCB) CD34-positive (CD34⁺) stem cells exhibit the potential for neural repair. We tested the hypothesis that hUCB CD34⁺ stem cells and other cell types [leukocytes and nucleated red blood cells (NRBCs)] that are up-regulated during the acute stage of perinatal asphyxia (PA) could play a role in the early prediction of the occurrence, severity, and mortality of HIE. METHODS: This case-control pilot study investigated consecutive neonates exposed to PA. The hUCB CD34⁺ cell count in mononuclear layers was assayed using a flow cytometer. Twenty full-term neonates with PA and 25 healthy neonates were enrolled in the study. RESULTS: The absolute CD34⁺ cell count (p=0.02) and the relative CD34⁺ cell count (CD34+%) (p<0.001) in hUCB were higher in the HIE patients (n=20) than the healthy controls. The hUCB absolute CD34⁺ cell count (p=0.04), CD34⁺% (p<0.01), and Hobel risk scores (p=0.04) were higher in patients with moderate-to-severe HIE (n=9) than in those with mild HIE (n=11). The absolute CD34⁺ cell count was strongly correlated with CD34⁺% (p<0.001), Hobel risk score (p=0.04), total leukocyte count (TLC) (p<0.001), and NRBC count (p=0.01). CD34+% was correlated with TLC (p=0.02). CONCLUSIONS: hUCB CD34⁺ cells can be used to predict the occurrence, severity, and mortality of neonatal HIE after PA.

Safety and Efficacy of Cerebrolysin in Infants with Communication Defects due to Severe Perinatal Brain Insult: A Randomized Controlled Clinical Trial

BACKGROUND AND PURPOSE: The neuroregenerative drug Cerebrolysin has demonstrated efficacy in improving cognition in adults with stroke and Alzheimer's disease. The aim of this study was to determine the efficacy and safety of Cerebrolysin in the treatment of communication defects in infants with severe perinatal brain insult. METHODS: A randomized placebo-controlled clinical trial was conducted in which 158 infants (age 6-21 months) with communication defects due to severe perinatal brain insult were enrolled; 120 infants completed the study. The Cerebrolysin group (n=60) received twice-weekly Cerebrolysin injections of 0.1 mL/kg body weight for 5 weeks (total of ten injections). The placebo group (n=60) received the same amount and number of normal saline injections. RESULTS: The baseline Communication and Symbolic-Behavior-Scale-Developmental Profile scores were comparable between the two groups. After 3 months, the placebo group exhibited improvements in the social (p<0.01) and speech composite (p=0.02) scores, with 10% and 1.5% increases from baseline, respectively. The scores of the Cerebrolysin group changed from concern to no concern, with increases of 65.44%, 45.54%, 358.06%, and 96.00% from baseline in the social (p<0.001), speech (p<0.001), symbolic (p<0.001), and total (p<0.001) scores. CONCLUSIONS: Cerebrolysin dramatically improved infants' communication especially symbolic behavior which positively affected social interaction. These findings suggest that cerebrolysin may be an effective and feasible way equivalent to stem cell therapy.

Posttraumatic Acute Disseminated Encephalomyelitis in a Child Resolved by Steroid Therapy: Case Report

No abstract available.

[Impact of educational intervention on physiological and psychological problems for menopausal women]

Menopause, known as climacteric, is the time in a woman's life when her menstrual period stop and she is no longer able to have children. It is said to have occurred when a woman has not had a period for a year

Objective: This study aimed to identify the physiological and psychological problems; for menopausal women at Al Dawadmi, Riyadh, Saudi Arabia and to evaluate the effect of an educational intervention on the improvement of physiological and psychological health problems

Methods: A quasi-experimental design was utilized for the study [i.e. pre and posttest design]. Setting A convenient sample conduction of 40 women at 2 dispensary "Sharq and Gharb dispensary" Al Dawadmi, Riyadh, Saudi Arabia, was included in the study at the time of research conduction. Where a pre and posttest with no control group was designed and adopted. The study was conducted from [October 2014 to April 2015]. A total of 40 menopausal women were selected in the study, all of them were interviewed, and descriptive analysis was used for demographic data. The investigators assess menopausal woman knowledge and practices regarding the menopause before giving the educational booklet

Results: the study revealed that category of [51-56] years of old age of menopause women were more than third of the sample [40 %]. According marital status about half [52.5%] of the sample were married. It was found that majority of physical symptoms improved post program and there was a highly significant differences pre and post program specifically for hot flushes [0.025*], night sweeting [0.000*], difficult sleeping [0.016*] and dry skin [0.045*]. Also study indicated that knowledge of menopause women improved and became more enough post program than preprogram. In addition, the study revealed that the Majority of psychological symtpoms improved post program.

Conclusions: This study was conducted to assess the physiological and psychological needs for menopausal women at Al Dawadmi, Riyadh, Saudi Arabia. In addition, to evaluate effect of an educational intervention on the improvement of physiological and psychological health problems in menopausal women at Al Dawadmi, Riyadh, Saudi Arabia. The study revealed that the majority of physical and psychological symptoms improved post program and there was a highly signficant differences pre and post program. Also study indicated that knowledge of menopause women improved and became more enough post program than preprogram. The study findings showed that an appropriate training to menopausal women could improve health standards in menopausal women and promote their health

Bone Marrow Mesenchymal Stem Cell Transplantation in a Rabbit Corneal Alkali Burn Model (A Histological and Immune Histo-chemical Study)

BACKGROUND: Alkali-burned corneas can seldom heal properly to restore corneal transparency. Treatment of this severe disorder of the ocular surface remains a challenge. AIM OF THE WORK: was to investigate whether systemically transplanted bone marrow mesenchymal stem cells (BM-MSCs) can promote corneal wound healing after alkali burn. MATERIAL AND METHODS: Thirty five male New Zealand rabbits were used in this study. The animals were divided into three groups. Group I; the control group was sham operated. Group II; corneal alkali burn was created. Group III; underwent corneal alkali burn then treated with BM-MSCs. All corneas were collected after fourteen and twenty eight days. Evaluation using H&E, PAS & alkaline phosphatase reaction was carried out. Immune histo-chemical staining for CD44 and vimentin was performed as well. RESULTS: the corneal epithelium of (Group II) showed marked alterations. Vascularization, cellular infiltration and irregularity of the collagen fibers were also seen in the substantia propria. Increase in the thickness of the Descemet's membrane was noticed as well. On the other hand, at the time of 28 days, Group III rabbits showed best histological results with nearly healed corneas compared to other groups. Meanwhile, vimentin was more strongly expressed in Group III assessing the differentiating ability of BM-MSCs. CONCLUSION: BM-MSCs could effectively promote corneal alkali burn healing.

Role of Magnesium Supplement on Hyperlipidemia and L-CAT Level in Patient on Atorvastatin Therapy.

Aim: This study aimed to evaluate the effect of magnesium supplement to atorvastatin on hyperlipidemic patients and to elucidate the possible ability of oral magnesium supplement to counteract or delay statins induced myalgia. Study Design: Forty hyperlipidemic male and female patients were randomly divided into two groups: group one consisted of twenty patients, who received atorvastatin 10 mg once daily for 6 weeks then 20 mg once daily for another 6 weeks; group two consisted of twenty patients, who received the same dose of atorvastatin plus once daily oral low dose magnesium sulfate trihydrate 419.5 mg equivalent to 50 mg of magnesium. Place and Duration of Study: The Laboratory of Pharmaceutical Research Center of Faculty of Pharmacy, Tanta University, Egypt, between July to December 2013. Methodology: Two samples of venous blood (2 ml + 8 ml =10 ml total), were collected from all individuals, and were drawn from the antecubital vein before, 1.5 and 3 months after treatment. Sera and plasma were separated immediately for biochemical analyses of lecithin cholesterol acyltransferase (L-CAT) (ELISA), creatine kinase (CK), serum Ca+, Mg++, Na+, K+, lipid profile and aspartate transaminase (AST) (colorimetrically), and serum creatinine (S.Cr) spectrophotometrically. Results: The statistical analysis revealed that, 3 months after treatment, both groups showed significant amelioration in lipid profiles and significant elevation in L-CAT level regarding to baseline data obtained before initiation of treatment. In addition, the patients received atorvastatin plus magnesium supplement showed significantly higher levels of serum magnesium, plasma L-CAT and HDL-cholesterol concentrations and significantly lower total cholesterol, LDL-cholesterol and triglycerides concentrations with non significant lower CK level as compared to the patients group received atorvastatin solely. Conclusion: Mg++ supplement to atorvastatin improve all lipid profile and provide better control on dyslipidemia than atorvastatin alone. However, Mg++ supplement to atorvastatin doesn’t prevent elevation in CK; it may delay and provide some protection against statin induced myopathy that in turn may increase patient compliance.

Role of percutaneous microwave ablation in treatment of hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is one of the most common malignancies worldwide with an annual occurrence of one million new cases. An etiologic association between HBV infection and the development of HCC has been established. Hepatitis C virus is also proving an important predisposing factor for this malignancy, the use of minimally invasive Percutaneous ablative technique [e.g. Radiofrequency [RF] and Microwave ablation [MW] has gained great momentum and because of the drawbacks of RF ablation, several groups have successfully proved the efficacious nature of Microwave ablation in the treatment of hepatocellular carcinoma. The aim of this work is to highlight the role, the principles and the applications of percutaneous Microwave Ablation in Hepatocellular carcinoma. The studied group included 30 patients [25 men and 5 women] with hepatocellular carcinoma. All patients underwent microwave ablation for the hepatocellular carcinoma. The results of the procedures will be assessed as regarding sizeand enhancement of the lesion [s] on triphasic CT abdomen before the procedure and at the follow up at one month as well as the Alpha fetoprotein levels. MWA technique represents a safe, fast and efficacious way to perform hepatic ablation in patients with HCC. Initial results are encouraging; however, longer follow-up is needed for further classification of our results

Three dimensional MRI study: Safety of short versus long needle peribulbar anesthesia

The standard technique of Peribulbar block is to use 25 g 25 mm needle at the junction between the lateral one third and medial two third of the lower orbital rim in the infero-temporal quadrant of the orbit. Theoretically, insertion of longer needles increases the potential of injury to important structure; however, safety of the shorter needle had never been demonstrated. This study describes the anatomy of the orbital structures with magnetic resonance imaging [MRI] using the three-dimensional constructive interference in steady state [3D CISS] sequence to present a morphological basis for needle entry at 12.5 and 25 mm lengths. Statistical comparisons were performed at the 12.5 versus 25mm depths. Statistical significance was indicated by P<0.05. Fifty patients free of orbital pathology with normal axial length were selected for MRI with the 3D CISS sequence. Original axial and multiplanar image reconstruction [MPR] images were selected for image interpretation. Orbital structures were identified at 12.5 and 25 mm depths from the orbital rim to compare significant differences in anatomy between the two imaging planes at the expected needle depth and to assess the size of the globe and the orbit. The cross sectional area of the extraocular muscles were statistically significantly smaller at the 12.5 mm plane [P = 0.001]. The area of inferotemporal fat was statistically significantly larger at the 12.5 mm plane [P = 0.033]. There was no statistical difference in the inferonasal and superonasal fat areas at different depths [P = 0.34, P = 0.35 respectively]. The size of the orbit and globe was significantly larger at 12.5 mm [P = 0.001]. There was no difference between depths in the presence or absence of neu-rovascular bundles and supporting structures including the intramuscular septae. There is a larger structure-free space at a depth of 12.5 mm than at 25 mm. Therefore, the inference is that a needle inserted in the infero-temporal zone to a depth of 12.5 mm is less likely to injure the eyeball or extra-ocular muscles than one advanced to 25 mm

Possible causes of treatment failure of asthmatic children attending the asthma clinic of Alexandria University Children's Hospital

Objectives: The present study was conducted to identify possible causes of treatment failure among asthmatic children attending asthma clinic of Alexandria University Children's Hospital [AUCH]

Study Design: This study was carried out on a convenient sample of 100 asthmatic children attending the Asthma Clinic at Alexandria University Children's Hospital [AUCH]. Face to face interview with caregiver using an interviewing questionnaire include data about socio-demographic characteristics of both parents and child clinical data, environmental exposures and treatment behavior

Results: The mean age of studied children was 6.26 +/- 3.11 years and male children constituted two thirds [68%] of the study sample. Out of 100 asthmatic children only 42 children were controlled comparing to 43 children were partially controlled and 15 children were uncontrolled. Several variables were significantly associated with treatment failure include rural residency, school or daycare center attendance, in-appropriateness of asthma treatment, inadequate doses of drugs, poor compliance with the prescribed treatment and incorrect technique of inhaler intake. Continuous exposure to triggers [as smoking, URTI], associated co-morbid diseases and family history of asthma or other allergic conditions were not significant factors in this study; they are important factors that affect asthma control

Conclusion: The current study shows that asthma control remains unsatisfactory, with less than half of children having an acceptable level of control. Several variables were found to be associated with poor asthma control

Quality of life among of menopausal women in Saudi Arabia

Objective: to assess the menopause related symptoms and their impact on the women's quality of life

Methods: A descriptive design was carried out in Obstetrics and Gynecological department at maternity and children hospital in Makkah Al Mukkarrmah. Convenient sample composed of 90 women at range of from 40-60 years were recruited in the study. Interviewing sheet that was designed by the investigators and Menopause Specific Quality of Life Questionnaire were used to collect the data

Results: The present study showed that the most severe symptoms in vasomotor, psychosocial, physical and sexual domains were, hot flushes [29%], experiencing poor memory [48.3%], being dissatisfied with their personal life [44.8%], Low backache [41.9%], and change in your sexual desire [36.8%].The overall scores of menopausal quality of life for each domain are indicated that the highest mean score in sexual domain [3.19 +/- 1.99], following by psychosocial [2.94 +/- 1.45] then vasomotor [2.55 +/- 1.53] and finally physical symptoms [2.28 +/- .749]

Conclusions: The present study concluded that most severe symptoms in vasomotor, psychosocial, physical and sexual domains were, hot flushes, experiencing poor memory, being dissatisfied with their personal life, low backache, and change in your sexual desire. The mean scores of physical and vasomotor domain were significantly more in postmenopausal [PM] group then menopausal transition MT group. While the mean scores of each domain suggest that menopausal symptoms were associated with decrease in women quality of life

Epithelial lacrimal gland tumors: a comprehensive clinicopathologic review of 26 lesions with radiologic correlation

To study the prevalence, clinicopathological and radiological correlations of epithelial lacrimal gland tumors and compare these with similar published literature. The study was also designed to look at the natural history of benign mixed tumors [BMT] in regard to recurrence and malignant degeneration. This was a retrospective study of all suspected epithelial tumors of the lacrimal gland surgically excised at King Khaled Eye Specialist Hospital [KKESH] for the period: 1983-2008. Exclusion criteria included structural lesions [dacryops] and inflammatory lesions. We included 26 cases of epithelial lacrimal gland tumors [from 24 patients]. The histopathologic slides and the radiologic findings were reviewed. The corresponding demographic and clinical data were obtained by chart review using a data sheet. BMT accounted for 12/26 of the lesions while malignant lesions including adenoid cystic carcinoma [ACC] were more common [14/26]. The mean age was 44.27 years [range 12-75]. Commonest clinical presentation was proptosis. Median duration of symptoms in the BMT cases was 30 months and 7 months in the ACC group. The 12 BMT cases were primary in 9 and recurrent in 3 patients. The 11 ACC cases showed mostly cribriform pattern and low histopathologic grade. We had 2 cases of malignant mixed tumor [MMT] one of which arising in a recurrent tumor. One case of primary mucoepidermoid carcinoma with histopathologic grade 2 was noted. Radiologically, a well-defined appearance with bone remodeling was observed in BMT in contrast to invasive appearance with destruction in malignant lesions. Our series information indicated a different distribution of benign and malignant epithelial lesions with a slightly higher rate of malignancy. BMT was the commonest benign tumor where recurrence was a squeal of incomplete surgical excision. ACC was the commonest malignant tumor with shorter duration of symptoms and radiologic evidence of invasiveness that correlated with the histopathologic features

Comparative study between computed tomography guided superior hypogastric plexus block and the classic posterior approach: a prospective randomized study

The classic posterior approach to superior hypogastric plexus block [SHPB] is sometimes hindered by the iliac crest or a prominent transverse process of L5. The computed tomography [CT] - guided anterior approach might overcome these difficulties. This prospective, comparative, randomized study was aimed to compare the CT guided anterior approach versus the classic posterior approach. Controlled randomized study. A total of 30 patients with chronic pelvic cancer pain were randomized into either classic or CT groups where classic posterior approach or CT guided anterior approach were done, respectively. Visual analog score, daily analgesic morphine consumed and patient satisfaction were assessed just before the procedure, then, after 24 h, 1 week and monthly for 2 months after the procedure. Duration of the procedure was also recorded. Adverse effects associated with the procedure were closely observed and recorded. Student's t-test was used for comparison between groups. Visual analog scale and morphine consumption decreased significantly in both groups at the measured times after the block compared with the baseline in the same group with no significant difference between both groups. The procedure was carried out insignificantly shorter duration in the CT group than that in the classic group. The mean patient satisfaction scale increased significantly in both groups at the measured times after the block compared with the baseline in the same group. The patients in the CT groups were significantly more satisfied than those in classic group from day one after the procedure until the end of the study. The CT guided approach for SHPB is easier, faster, safer and more effective, with less side-effects than the classic approach

Risk factors and outcome in ICU patients with end-stage liver disease

Acute or chronic liver failure is associated with numerous complications that may occur in combination, and patients may require ICU treatment. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. The present study aims to estimate the frequency of mortality and evaluate morbidity from cirrhosis in patients with end-stage liver disease [ESLD] admitted to the ICU and evaluate the relationship between the demographic, clinical, and laboratory data [potential risk factors] of those patients and mortality. A total of 120 patients with ESLD were enrolled [102 [85%] male and 18 [15%] female patients]. History taking, clinical examination, and other laboratory investigations were carried out, and patients were classifi ed according to the Child-Turcotte-Pugh [CTP] and the model for endstage liver disease [MELD] scores. Regarding the clinical presentation, hepatic encephalopathy [HE] was found in 87.5% of patients, jaundice in 60%, hematemesis in 41.7%, hepatorenal syndrome [HRS] in 35.8%, and spontaneous bacterial peritonitis in 20.8% of patients. The mortality rate was 57.5%; the main causes of death were HRS [40.8%], HE [21.7%], aspiration pneumonia [10%], septic shock [2.5%], and irreversible shock [1.7%]. There was a significant relationship between mortality and old age, CTP and MELD scores, and a longer stay at the ICU. Increased white blood cell count, increased hemoglobin and decreased prothrombin concentration, and elevated creatinine were independent risk factors of mortality in ESLD patients in the ICU. Mortality rates were higher in patients with 5-6 risk factors [86.2%] than in those with 1-2 risk factors [21.7%]. Mortality rate in ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP, MELD score, HE, HRS, and jaundice were significant predictors of mortality in ESLD patients. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin, and prothrombin concentration were independent risk factors of mortality in ESLD patients

Effect of high salt loading on the retina of adult male rats with special reference to aquaporin 1: a histological and immunohistochemical study

In the retina, glial cells control ionic concentrations by mediation of transmembrane water fluxes through aquaporin [AQP] water channels. The risk factor of a high-salt diet on renal and cardiovascular systems is pretty well known. However, it is not yet known whether a high-salt diet alone can affect the retina. The aim of this study was to determine whether a high-salt diet alone can induce changes in the retina and whether it may be accompanied by changes in the expression and immunolocalization of water channel aquaporin1 [AQP1]. Forty-two adult male albino rats were used. They were divided into three equal groups. Group I served as the control group. Rats in group II were administered 2 ml of a high-salt solution [8% NaCl concentration] once daily by means of a gastric tube. Group III was the recovery group. Retinal tissues were collected and examined by means of light and electron microscopy. Immunohistochemical analysis using AQP1 and glial fibrillary acidic protein [GFAP] antibodies was performed and the results were statistically analyzed. The retina of rats given a high-salt diet [group II] displayed obvious disorganization of the outer segment of photoreceptors, together with cytoplasmic vacuolations in the cells of the inner nuclear and ganglionic layers. Furthermore, significant increase in AQP1 and GFAP immunoexpression was detected. In the recovery group [group III] the retinae of some rats regained their normal histological appearance, whereas others failed to do so. High salt loading might alter glial cell-mediated water transport through AQP1 channels in the retina

Atrial Function and Glutathione in Children with Iron Deficiency Anemia- Tanta-Egypt-2012.

Aims: is to correlate the atrial function with the level of oxidative stress marker (Glutathione) in children with Iron deficiency anemia (IDA). Materials and Methods: Thirty children with IDA and 20 healthy children had serum Ferritin, total blood Glutathione level and studied with conventional trans-thoracic 2-D echocardiography, Tissue Doppler (TDI) and Speckle Tracking Strain (STI) analysis. Study Design: A case–controlled study Place and Duration of Study: Pediatric Outpatient Clinic; Pediatric Hematology Unit; Pediatric Cardiology Unit; Pediatric Department; Faculty of Medicine; Tanta University Hospital; Egypt. The study was conducted between January; 2012 to December; 2012. Results: Children with IDA had significantly low Glutathione [4.63 ±3.4 ng/ml] (P =.013) and Ferritin [11.88 ±5.3 ng/ml] (P < .0001) levels than that observed in the control group. There was no significant increase in LA dimension and volume (minimum) [31± 27 ml] (P = .433), by M-mode but there was significant decrease in e/a ratio assessed by tissue Doppler in IDA patients [1.29 ±0.5] than in controls [1.6±0.7] (P = .038). There were significant decrease in LA velocity (P = .02) and increase in RA velocity (P = .04) compared to left atrial and atrial septal velocity and insignificant increase in left atrial velocity compared to atrial septal velocity. There was no significant correlation between Glutathione level and echo-Doppler parameters of atrial function (P >.05), but there was significant negative correlation between Hemoglobin% and atrial septal velocity (P < .05). Conclusion: IDA is associated with diastolic dysfunction. Tissue Doppler and STI were more sensitive than conventional echocardiography in detection of subclinical structural and functional changes due to hemodynamic abnormality in children with IDA.