Prognostic Value of Urine Albumen/Creatinin Ratio in Sepsis in Critical Care Patients

Several scoring systems were developed for prognosis and outcome prediction in sepsis.This study aims to evaluate the urinary albumin/creatinine ratio(ACR)as a prognosticp redictorinsepsis.The study included 50 adult septic patient sinapros pectiveobser vational study. Study excluded patients with preexisting chronic kidney disease or diabetes mellitus. After clinical evaluation, urine spot samples were collected on admission and 24h later for ACR1 and ACR2.Admission APACHEIVscoreandthehighestrecordedSOFAscoreoftheirdailyestimationwereconsidered.Thisstudyalsoevaluatedtheneedformechanicalventilation,inotropicorvasoactivesupport,renalreplacementtherapy(RRT),andin-hospitalmortality.InapopulationwithMean±SD51.4±16.3(19-82)yearoldwith34(68%)males,wefoundthattheACR2iscorrelatedwithbothAPACHEIVandSOFAscores(P<0.001).ACR2washigherinpatientswhoneededmechanicalventilationandinotropicorvasoactivesupport[121(21-235)and166.5(89-235)mg/grespectively]comparedto[49(22-120)and56.5(21-211)mg/g],P<0.001inboth.ΔACR,ACR2,increasing AC Rand APACHEIVwerepredictorsofmortality.TheAUCformortalitypredictionwaslargestforΔACR(1),increasingACR(0.985),ACR2(0.963)thenAPACHEIV(0.90).∆ACRandACR2of91.5mg/gand-22was88.2%&100%sensitiveand90.9%&100%specificrespectivelytopredictmortality.WeconcludedthattheurinaryACRmightbeusedasasimpletestforprognosisandmortalitypredictioninsepsis

Percutaneous microwave ablation versus partial splenic embolization for treatment of hypersplenism in patients with liver cirrhosis

Background and study aim: In patients suffering from portal hypertension as result of liver cirrhosis, hypersplenism was ranged from 11 to 55%. The aim of our work was to compare between percutaneous microwave ablation (MWA) and partial splenic artery embolization (PSE) in the management of hypersplenism in patients with liver cirrhosis as regard efficacy and safety. Patients and Methods: Sixty patients with liver cirrhosis complicated with splenomegaly and hypersplenism were divided randomly into three groups; Group (1): Twenty patients were underwent one session of MW ablation of splenic parenchyma with target ablation volume about 20%, Group (2): Twenty patients were underwent two sessions of MW ablation of splenic parenchyma with 1 week interval with target ablation up to 40%, Group (3): Twenty patients were underwent PSE. Results: There was an improvement in the hemoglobin, platelet and leucocyte levels in three groups, which was 9.47± 2.14 gm/dl, 42.75 ± 15.4 x103/ mm3 and 2.6±0.5 x103/mm3 before the procedure respectively and become 9.95 ± 2.29 gm/dl, 313.5±99.6 x103/mm3 and 6.88± 1.89 x103/mm3 after one month as regard PSE group. As regard one session of MWA was 9.73±2.02 gm/dl, 45.57±11.2 x103/mm3 and 2.8±0.85 x103/mm3 and become 11.83±0.74 gm/dl, 152±26.43 x103/mm3 and 5.85±1.01 x103/mm3 after one month. As regard two sessions of MWA group; was 9.2±2.15 gm/dl, 40.6± 11.5 x103/mm3 and 2.4±0.55 x103/mm3 and become 12.74±1.2 gm/dl, 183.4± 26.43 x103/mm3 and 6.29±1.17 x103/mm3 after one month. PSE was significantly more effective in the elevation of platelets and leucocytes than other two groups (p=0.00), and two sessions of MWA more than one session of MWA. The two sessions MWA group was significantly higher than other two groups while one session of MWA group was more than PSE group in the elevation of hemoglobin (p=0.00). No mortality occurred in the three groups, but PSE was associated with more serious complications than the other two groups. Conclusion: MWA and PSE were effective in treatment of hypersplenism in patients with liver cirrhosis, while percutaneous MWA has less serious complications than PSE

Monocyte chemotactic protein and response to pegylated interferon-alpha-2A treatment in patients with chronic hepatitis C [CHC] genotype 4

The prevalence of hepatitis C virus [HCV] infection varies across the world, with the highest number of infections reported in Egypt. Monocyte chemotactic protein-1 [MCP-1] is a potent chemokine, and its hepatic expression is up-regulated during chronic HCV infection. Fifty naive patients with chronic hepatitis C in National Hepatology and Tropical Medicine Research Institute and 20 healthy volunteers as controls were enrolled in a prospective study designed with strict inclusion criteria to nullify the effect of confounding variables and further minimize selection bias. Fifty naïve patients were treated with PEG-IFN-a2b, at a dose of 180lg/kg subcutaneously every week plus ribavirin at a dose of 1000- 1200 mg/day, according to the patient's body weight, for 48 weeks. Quantification of HCV-RNA by real-time PCR and MCP-1 by ELISA were performed for every patient and controls. There was a statistically significant difference between patients and control group as regards the quantity of MCP-1 [P <0.05] [Mann-Whitney test] [P =0.004]. There was a significant difference between responders and nonresponses regarding MCP-1 [P < 0.05], responders showed a higher percentage of cases with initial MCP-1< 306 [P < 0.05]. We conclude the importance of the detection of MCP-1 expression at the start of therapy as a factor for assessing the likelihood of HCV genotype 4 patients to achieving a sustained virological response to treatment with IFN-a2 in combination with ribavirin

Value of TC-99M DMSA scintigraphy in urinary tract infection: comparative study with other imaging modalities

Urinary tract infection [UTI] is a common medical problem. It causes considerable morbidity specially if complicated, can cause severe renal damage. The aim of this study is to evaluate value of Tc-99m DMSA in UTI comparing with ultrasound and CT scan. We analyzed a random sample of 63 patients approved to have urinary tract infection. Abdominal ultrasound, CT, and [99m] Tc-DMSA scintigraphy of the kidneys were performed in all patients. Tc-99m DMSA scan showed scintigraphic changes consistent with pyelonephritis in all patients. The involvement was either unilateral in 53 patients [84%] or bilateral in 10 patients [16%]. The number of diseased kidneys were 73/126 [58%], 16/73 kidneys had abnormal unifocal defects [22%], 27/73 kidneys had multifocal defects [37%], while 30/73 kidneys had diffuse hypoactivity [41%]. The sensitivity of CT scan in detecting pyelonephritis was 82.8% while the sensitivity of ultrasound was poor [23.8%] and there was a statistically significant difference between the sensitivity of ultrasound and that of Tc-99m DMSA. Tc-99m DMSA is reliable diagnostic, cost-effective, simple, safe and noninvasive modality and may be taken as a routine procedure for the patients with clinical suspicion of upper UTI whenever the facilities are available

Quantitative postural sway assessment by computerized dynamic posturography in athletes with chronic ankle sprain and normal subjects in Kuwait

To identify quantitative postural sway assessed by unilateral stance test using computerized dynamic posturography in athletes with chronic ankle sprain and normal subjects in Kuwait. Retrospective case control study. Sports and balance clinics, Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait. Twenty six male athletes suffering from chronic ankle sprain and twenty two healthy individuals as a control group well-matched for age and sex were included in this study. Clinical assessment and computerized dynamic posturography. Mean centre of gravity [COG] sway velocity which displays COG stability with eyes open and eyes closed was computerized and assessed. A significant increase of mean [ +/- SD] COG sway velocity on left or right leg standing with eyes open and eyes closed of athletes with chronic ankle sprain as compared to control group was found [p< 0.05]. In addition, the mean [ +/- SD] percentage difference scores with eyes open and eyes closed in athletes with chronic ankle sprain was higher compared to control group [p<0.001]. Patients with chronic ankle sprain have a higher COG sway velocity and impaired postural sway compared to normal subjects. The unilateral stance test may be used to identify quantitative postural sway and balance in chronic ankle sprain. The ligamentous damage, ankle muscle strength deficits and proprioception deficits at the ankle joint may explain poor balance in ankle sprain

Effects of visual feedback balance training by using computerised dynamic posturography in patients with multiple sclerosis

To study the effects of the visual feedback balance training on the Berg Balance Scale [BBS] under static and dynamic conditions, the somatosensory, visual and vestibular systems by dynamic posturography before and after training program in patients with multiple sclerosis [MS]. Retrospective case training study. Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait. A total of 23 patients with MS were recruited. All patients were evaluated using both the BBS and the sensory organization test [SOT] using computerized dynamic posturography [CDP] before and three months after the training program. The SOT consists of six conditions and composite equilibrium score [CES]. CES [%] and SOT were calculated. Before training, all patients had a reduction of BBSS and parameters of the SOT. After training, a significantincrease of BBS [p < 0.05], all parameters of the SOT [p < 0.05] and CES [p < 0.001] were observed. Improvement in all parameters of the SOT after training program could be explained by change in the somatosensory system of the posture control system. Also, there is impairment of the somatosensory system, rather than a specific lesion of vestibular and/or visual systems

Analysis of cervical smears in a Muslim population

Screening for cancer of the cervix remains a neglected health care issue in Pakistan. To provide baseline data for future efforts to improve screening, we conducted a retrospective analysis of cervical smears taken in the obstetrics and gynaecological clinics of the Aga Khan University Hospital, Karachi, Pakistan. Method: We collected data on cervical smear cytology for cervical smears taken from January 1, 1990 to December 31,1996. We assessed risk factors for dysplasia, including age, age at first marriage, and number of pregnancies. The overall prevalence of abnormal smears in our study was 0.5%. Of 20,995 cervical smears, 12,451 [59.3%] smears showed non-specific inflammation, 7302 [34.8%] were reported as normal, 809 [3.85%] showed monillial infection, 148 [0.71%] showed atypia, 105 [0.5%] had dysplastic cytology, and 52 [0.25%] samples were inadequate. The highest incidence of dysplastic smears was seen in the age group 35 to 44 years. Of 105 patients with dysplasia, 12 were pregnant, and all were asymptomatic, while in 93 non-pregnant women, 33 were symptomatic. The low prevalence of abnormal smears, compared with data from Western populations, could be due to the inherent bias of health awareness in the women who attended our hospital. The results of this study may serve as a baseline for future comparisons. A larger community-based study may establish the exact prevalence of malignant and premalignant lesions so as to plan for future screening