Thyroid storm: Is there a role for thyroid function test?

@#Introduction: Thyroid storm (TS) is an endocrine emergency. Early diagnosis for prompt treatment is essential as it has a high mortality rate. Case Report: A 31-year-old lady with underlying hyperthyroidism, dilated cardiomyopathy with severe mitral regurgitation presented with shortness of breath. She was intubated and admitted due to decreasing Glasgow Coma Score. Her blood investigations revealed increased white cell count, raised free thyroxine with suppressed thyroid stimulating hormone, deranged liver, renal and coagulation profiles. As her condition did not improve with initial treatment, plasmapheresis was commenced on day 4. Biochemically, her thyroid function test (TFT) showed improvement; however, she succumbed due to multi-organ failure. Discussion: Plasmapheresis is considered in TS if there is no clinical improvement within 24-48 hours of initial treatment. The improvement in patient’s TFT post plasmapheresis signifies its role in treating TS. Unfortunately, there was a delay in commencing plasmapheresis due to haemodynamic instability in this patient.

Hypertension control at a nephrology clinic at Jordan university hospital

To determine the degree of control of hypertension in hypertensive patients attending the nephrology clinic. A cross sectional study carried out by examining the records of patients with hypertension attending the nephrology clinic. There were 335 subjects included with mean age of 58.8 +/- 13.4 years and 189 [56.4%] were women. The mean systolic BP was131 +/- 13 and mean diastolic BP was 79 +/- 7. Two hundred seventy three subjects [81.5%] had BP

Effect of cadmium as feed additive on broilers growth performance

A total of 120 one day-old Cobb broiler chicks to were evenly distributed to four equal groups of 30 chicks for each, fed on four experimental rations for six weeks of the experimental period. The first group was fed on a basal diet [control group [G1]], and the other groups were fed 2.5 [G2, 5 [G3] or 7 [G4] mg cadmium /kg diet. The average body weight development G2 and G3 showed highly significant [p<0.01] and significant [p<0.05] improvement respectively. Feed intake was more in treated groups but was progressively reduced with increasing cadmium levels, also feed conversion ratio was increased and significant decrease of edible parts and giblets weight percentages was also observed. The breast muscle weight percent significantly decreased in G4. Feed economical efficiency was decreased as cadmium levels increased. Concentration of cadmium in the examined tissue increased progressively with increased dietary cadmium additive but still within the permissible limits of cadmium in poultry meat and offal. In conclusion the present study showed that cadmium additive at level of 2.5 ppm in broiler diets has improved growth performance and the economic efficiency

Behavioral effects of essential oil from salvia Aegyptiaca in rats

The genus Salvia, a member of the Lamiaceae family, includes over 900 species distributed through out the world. The hydro-distilled essential oil of wild growing S. aegyptiaca was analyzed by GCIMS. Twenty-one constituents were identified. The oil was characterized by high content of oxygenated compounds. The major constituents were virdiflorol [18.4%] CLs-nerone [18.1%] and carvenone [11.2%]. In the present study, the main behavioral effects along with the adverse effects of S. aegyptiaca essential oil [EO] in rats were investigated. The EO was used in three dose levels [125, 250, 750 mg/kg, I.P.] and examined in a series or check-list of tests with gradual increase in stress level for careful evaluation of a broad spectrum of behavioral effects. The used tests were swimming test [non-stressful], open-field test [mild stressful] and conditioned fear test [high stressful]. The study exhibits a marked dose-related behavioral changes regarding all stress levels or models. These changes are manifested as inhibition of attention and vigilance, muscular strength and neuromuscular co-ordination [in swimming test] as well as emotionality, locomoter and exploratory activity [in open-field test]. They also include enhancing of learning and memory as well as inhibition of avoidance and escape [in conditioned fear test], in addition to the high dose related hallucinogenic effects. It is concluded that EO of S. aegyptiaca has a wide dose-related behavioral effects ranged from anxiotytic, sedative, muscle relaxant, as well as cognitive and memory enhancing ability to hallucinogenic effects. It is also suggested to be efficacious in different anxiety-related conditions and can help in inhibiting the withdrawal syndrome in cases of addiction

Major liver resection for giant hepatic tumors in adults and children

With the evolution in surgical technique, anaesthetic care and postoperative management, major hepatic resections for giant liver tumors are now considered reasonably safe procedures with a low surgical death rate. The aim of this study is to evaluate the results of major hepatic resection for giant hepatic tumors in the National Liver Institute during the period between September 1991 and September 2001 and to compare these results with reports from other centers. From September 1991 to September 2001 twenty-six giant liver tumors undenvent major hepatic resection out of a total number of one hundred and thirty seven liver tumors that were resected in the National Liver Institute. The tumor diameter was ranging from 8 cm to 27 cm. There were 6 children: their ages ranged from 8 months to 13 years. Four of them had hepatoblastoma, one malignant mesenchymoma [undifferentiated embryonal sarcoma] and one case of liver cell adenoma. The adult group included 20 cases with a mean age of 52.5 years [range 26-65 years]. There were six cases of hepatocellular carcinoma [HCC]; two of them were done as an emergency due to bleeding after tumor rupture. The remaining 14 cases were: 2 cases of HCC fibrolammellar type, one gallbladder carcinoma, 2 cases of colorectal liver metastasis, 5 cases of haemangioma, one case of haemangioendothelioma, one case of secondary leomyosarcoma from the stomach, one case of cholngiocarcinoma and one case adenocarcinoma. Right or extended right hepatectomy was done in 14 patients and left or extended left hepatectomy was done in 12 cases. Ultrasonic dissector and bipolar coagulation was used in 21 cases. Hospital mortality was three cases; two of them were emergency cases on top of chronic liver disease. Postoperative complications included: temporary ascites, chest infection, minor biliary leak and wound infection. major liver resection is a reasonably safe procedure especially, when performed on normal liver under elective conditions

Simple effective regional technique for eye surgery

The study included 50 elderly cooperative unpremedicated patients undergoing peribulbar block for elective cataract extraction and intraocular lens implantation [ASA physical status I, II or 111]. The patients were assigned to one of the two groups according to the technique of peribulbar block used [n=25 per group] by random selection. Group I received local anesthetic mixture through a single transconjunctival infrotemporal approach. Group II received the block through a single transconjunctival medial approach. The injected anesthetic mixture was composed of equal volumes [5 ml each] of plain lignocaine 2% and plain bupivacaine 0.75% supplemented by 15 U/m1 hyaluronidase and 0.05 ml of 8.4% sodium bicarbonate that makes pH of the mixture around 6.5. Up to 10 ml of this solution was injected initially. This study assessed the injective volume [initial, supplementary and total volume used]. Motor block scoring system was done after initial and supplementary injections. Eye tension was reported after initial and supplementary injections and the overall quality assessment of the block by the surgeon, as well as patient satisfaction, together with any complication were reported. On conclusion, the ideal local anesthetic mixture for peribulbar block is that made from equal volumes of lignocaine and bupivacaine supplemented with 15 U/ml hyaluronidase and 0 05 ml of 8.4% sodium bicarbonate. The medial transconjunctival approach is easy to be performing by non-ophthalmologist, more comfortable to the patient and with minor complications

Rocuronium versus succinylcholine for rapid sequence induction of anesthesia in elective cesarean section

This study was conducted on forty parturient women undergoing elective cesarean section under general anesthesia to evaluate the onset and tracheal intubation condition together with the fetal and maternal impacts of rocuronium and succinylcholine for rapid sequence induction. The parturient women were randomly allocated into two groups [20 women each] according to the neuromuscular blocker used, group A [0.6mg/kg rocuronium] and group B [Img/kg succinylcholine]. After pre-oxygenation, rapid sequence induction was performed with thiopental sodium 4-6mg/kg followed by either rocuronium or succinylcholine according to the group. Neuromuscular transmittion was assessed using electromyographic response to train of four stimulation of the ulnar nerve at the wrist every 10 seconds. The time to the beginning of depression of Tl amplitude [lag time] and the time to maximum depression of Tl [onset time] were compared in the two groups. They were [25.2 +/- 2.7], [71.7 +/- 2.7] seconds for group [A] and [22.4+2.2], [50.6 +/- 8.2] seconds for group [B] respectively. There were statistically significant difference between the two groups as regard lag time and onset time [P<0.05, P<0.01 respectively]: As regard, the. intubation conditions, there was no statistically significant difference between the two groups. There is statistically significant difference as regard maternal heart rate or mean blood pressure between the two groups [P<0.01, P<0.05 respectively]. As regard Apgar score, there was no statistically significant difference between the groups. It can be concluded that rocuronium provide good intubating conditions comparable to those of succinylcholine and is suitable for rapid sequence intubation when succinylcholine is contraindicated. It is also safe for both the mother and the foetus. List of abbreviations: NMB: Neuromuscular blocker EMG: Electromyography MMG: Mechanomyography

effect of premedication with H2 receptor antaconists on thermoregulation of body temperature during general anesthesia

This study was conducted on 60 patients undergoing open abdominal surgery under general anesthesia to evaluate the effect of premedication with H2 antagonists on thermoregulation. The patients were randomly allocated into three groups, each group consisted of 20 patients according to the premedication given. The first group was given a placebo [control group], the second group was given famotidine 40 mg tablet and the third group was given ranitidine 150 mg tablet at 1 hour before anesthesia. Induction of anesthesia was done by 1-2 ug/kg fentanyl, 5-7 mg/kg thiopental and endotracheal intubation was facilitated by vecuronium bromide 0.1 mg/kg. Anesthesia was maintained by nitrous oxide 66% in oxygen and isoflurane 0.6% to 0.8%. Nasopharyngeal temperature [core temp], forearm temperature and index finger temperature, hemodynamic parameters [heart rate and mean arterial blood pressure] were measured before induction [baseline], then every 15 minutes till the end of surgery. The results demonstrated that famotidine has central thermoregulatory inhibitory effect that augments core hypothermia and decrease vasoconstriction threshold

Performance of white Peking ducklings fed on diets supplemented with fat and bile

To study the effect of dietary bile and vegetable oil supplementation on the performance of white Pekin ducklings, an experiment was carried out on 120 white Pekin ducklings 2-week old. They were divided into 8 groups, each of 15 birds. Ox bile was added at the rate of 0, 4, 8, and 12 ml/kg diet either alone or with 5% vegetable oil. The experiment lasted for 6 weeks. Body weight development, feed intake, feed conversion, dressing values of total protein, glucose, cholesterol and total lipids were estimated. It was found that the addition of ox bile to the diet at the level of 12 ml/kg improved the body weight development, feed conversion and dressing values without any harmful effect on the health condition of the ducks. In contrast, the addition of fat either alone or with bile had insignificant adverse effect on body weight development, feed conversion and dressing values of the used ducks