Effects of low dose propofol on inflammatory responses to lipopolysaccharide-induced shock in conscious rats

Acute kidney injury [AKI] is a major culprit of mortality in endotoxemia. Propofol has been commonly used in critically ill patients for sedation. This experiment attempted to elucidate the effects and possible mechanisms of propofol on AKI induced by endotoxin shock. Expermentations were carried out wing anesthetized, ventilated rats and isolated perfused kidneys. Endotoxemia was induced by intraperetoneal [i.p] injection of lipopolysaccharide [LPS, 15 mg kg-1]. Subhypnotic dosage of propofol [40 mg/kg] was injected by i.p. route to study its action on LPS induced-endotoxemia in rats. The rats were randomly assigned into five groups of 8 rats each [FIG: 1]. Kidney pathology was evaluated to quantify the kidney injury score. Plasma tumor necrosis factor alpha, [TNF alpha] and interleukin-10[IL-10] were examined. Post treatment of propofol at low or high dose attenuated or prevented the extent of Am. It also reduced the plasma level of TNF alpha, and IL-10. Our results suggest that propofol exerts protective effect on the endotoxin-induced AKI. In addition, propofol abrogates the microvascular leakage of water and protein in the kidneys. The results imply that the use of propofol in critically ill is not only for sedation, but also useful for the prevention of inflammatory progression and organ damage

Behavioral impact of sickle cell disease in young children with repeated hospitalization

Sickle cell disease [SCD] in children with a history of repeated hospitalization is distressing for children as well as their parents leading to anxiety and has negative effects on the psychological state of children and their families. The aim of the study was to determine the overall effect of SCD on the behavior of young children age 1½ to 5 years old who had repeated history of hospitalization, compared to a control group of healthy children attended a vaccination clinic. Thirty-five children of age 1½ to 5 years who have SCD and repeated history of hospitalization were recruited from pediatric clinic as the study group and matched with same number of healthy children who attended vaccination clinic, as a control group. Both groups were administered the child behavior checklist [CBCL] 1½ to 5 years and diagnostic and statistical [DSM]-oriented scale. Behavior data were collected through a semi-structured questionnaire. Children who have SCD had statistically significant behavioral changes on CBCL compared to the control group: Anxiety/depression [65.2 vs. 55.1; P < 0.001], somatic complaint [66.7 vs. 54.4; P < 0.001] withdrawn [63.4 vs. 53.2; P < 0.001], aggressive behavior [60.4 vs. 56; P=0.04], and internalizing symptoms [64.7 vs. 51.5; P< 0.001], respectively. The DSM scale showed that children with SCD scored significantly higher in pervasive developmental disorder compared to the control group [60.9 vs. 53.9; P < 0.001] respectively. Children with SCD who had history of repeated hospitalization are at an increased risk of developing behavioral problems. Psychological counseling, social support, and proper pain management could minimize these behavioral consequences

Clinical experience with severe 2009 H1N1 influenza in the intensive care unit at King Saud Medical City, Saudi Arabia

The objective of this study was to describe the epidemiological characteristics, clinical features, treatment, and outcome of 2009 H1N1-infected patients who were admitted to the intensive care unit [ICU] at King Saud Medical City [KSMC] in Riyadh, Kingdom of Saudi Arabia.: Retrospectively, we collected demographic data as well as data on the clinical presentation and risk factors for 86 patients who were admitted to the ICU with H1N1 influenza A. The APACHE IV System was used to assess the severity of the illness. The overall hospital mortality was calculated and correlated with the use of steroids and the time of oseltamivir administration. The mean age of the patients was 40.8 years. Mortality increased steadily with increasing APACHE IV score. Patients who received steroids had a mortality rate of 47% compared with 23% for patients who were not treated with steroids; this difference was significant, with a P value of <0.01. The late administration of oseltamivir was associated with a mortality rate of 82% compared with 28% in the context of early oseltamivir administration; this difference was significant, with a P value of <0.01. Patients who were admitted to the ICU with severe 2009 H1N1 infection were young and had a relatively high severity-of-illness score. The late administration of oseltamivir was associated with a 12-fold increase in mortality. Steroid use was associated with a 3-fold increase in mortality. 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved

Graves opthalmopathy and psychoendocrinopathies

To assess the psychiatric and endocrinological changes in patients with Graves ophthalmopathy [GO]. A prospective, controlled, University Hospital based study. The current study comprised 60 patients diagnosed with GO at Mansoura Ophthalmic Center. Thirty five patients of them with moderate to severe GO formed the study group and twenty five patients with negligible to very mild GO formed the control group in the euthyroid state. The study group was further subdivided based on their predominant clinical signs into a proptosis subgroup and a muscle restriction subgroup. Psychiatric changes were assessed with the Middlesex Hospital Questionnaire [MHQ]. Biochemical analyses included serum-free thyroxine and thyroid-stimulating hormone [TSH] concentrations, TSH receptor antibody [TRAb] activity and antrthyroglobulin particle agglutination [TGPA] and antithyroid microsomal particle agglutination [MCPA]. The proptosis group reported significantly higher scores on anxiety, depression, and phobia than the muscle restriction group [P<0.0001]. The proptosis and muscle restriction subgroups reported significantly higher scores on all subscales compared to the control group [P<0.05]. The scale scores of depression and phobia showed a positive correlation with scores of anxiety [P<0.0001]. The serum TRAb activity showed a significant correlation with anxiety, phobia and hysteria [P<0.0001]. The psychiatric aspect of GO should be evaluated during routine follow-up and should be considered when making management decisions. Thyroid specific antibodies may be useful in confirming the diagnosis of GO

Psychometric properties of the arabic version of the semi structured clinical interview for children and adolescents [SCICA]

The aim of this study was to examine the reliability and validity of the Arabic version of the SCICA. The Arabic version of SCICA was administered to 42 children aged 6-11 years attending the psychiatry outpatient clinic; Mansoura University Hospital, Egypt. Test-retest correlation after two months and Cronbach's alpha of the internal consistency of the eight sub-scales and the two global scales were adequate. The concurrent validity, assessed by a correlation with the child behavior checklist [CBCL] was also found to be moderate. In conclusion the present study showed that the Arabic version of the SCICA is a good instrument for clinical and research use

Intrathecal neostigmine versus intrathecal morphine, their combination for postoperative analgesia in patients undergoing herniorrhaphy

We designed this study to evaluate the postoperative analgesic efficacy and safety of intrathecal [IT] neostigmine, intrathecal [IT] morphine, and their combination in patients undergoing herniorrhaphy under spinal anesthesia. Eighty adult patients were randomly divided into four groups to receive isotonic sodium chloride solution 0.5 ml, neostigmine 100ug, morphine 0.3 mg or the combination of IT neostigmine 50 ug and morphine 0.15 mg with IT 0.5 0/0 hyperbaric bupivacaine 15 mg. There were no significant differences among the four groups with regard to spinal anesthesia, age, heart rate, or mean arterial blood pressure. Postoperative analegisa was provided by IM diclofenac. Compared with the saline group, the time to first use of analgesic was significantly longer in neostigmine group [p= 0.02], with lower 24 h analgesic consumption [p=0.001]. Nausea and vomiting were the most common side effects of IT neostigmine 60 0/0. Analgesic effectiveness was similar between the neostigmine and morphine groups. Compared with the neostigmine group, the combination group had significantly longer analgesic effects [P=0.02] with less incidence of nausea and vomiting [p=0.04]. Compared with the morphine group, the combination group tended to have prolonged times to first use of analgesic [p=0.02] with lower incidence of pruritus [p=0.03]. the combination of IT neostigmine 50 ug and IT morphine 0.15 mg produce longer postoperative analgesia with fewer side effects than IT neostigmine 100ug or IT morphine 0.3 mg alone. Intrathecal [IT] neostigmine 100ug produced postoperative analgesia for herniorraphy similar to [IT] morphine 0.3mg, but with high incidence of nausea and vomiting, morphine group had high incidence of pruritus. Thus, combination of both has higher analgesic effects with lower side effects than single drug alone

Mycoplasma pneumoniae infection in non-asthmatic children with prolonged cough

Mycoplasma pneumoniae is a common cause of community-acquired respiratory tract infections. It causes interstitial pneumonia and more often a long-standing tracheobronchitis in children and adults. Clinical diagnosis of Mycoplasma pneumoniae infection is frequently hindered by the lack of specific symptoms and signs as well as by difficulties in the isolation of the pathogen from clinical specimens. The aim of this work was to study the prevalence of specific antibodies to Mycoplasma pneumoniae in children with acute respiratory infections. The study was conducted on 48 children aged from 5 to 15 years complaining of cough for more than one week, children with frank lobar pneumonia and those with past or family history of bronchial asthma were excluded. All patients were subjected to full clinical examination, plain X-ray chest, complete blood picture, C-reactive protein detection and assessment of serum Mycoplasma pneumoniae IgM and IgG antibodies by ELISA. Results revealed that positive IgM antibodies were detected in 75% of cases. Among the studied patients, there was no significant difference in the prevalence of clinical signs and symptoms between Mycoplasma positive and negative cases. Also, the studied laboratory parameters; C-reactive protein, complete blood picture and chest X-ray findings did not help in identification of Mycoplasma infected patients. Therefore, we recommend that one should suspect Mycoplasma pneumoniae infection in children, especially those over the age of 5 years, with no or past history of asthma who present with cough for more than one week and in whom clinical findings are not typical for pneumonia, and that empiric therapy with a macrolide antibiotic, rather than lactam agents should be considered in such group of patients

Synthesis and antimicrobial activity of some new Chiral Bridged macrocyclic pyridines

The utilization of 2,6-pyridinedicarboxylic acid [dipicolinic acid] in the synthesis of some chiral pridged bicyclic pyridine tripeptides is described. The antimicrobial activity of these natural cyclic peptides was tested

Study of some trace elements in children suffering from intestinal amebiasis before and after treatment with ornidazole

The aim of the present work was to study the serum levels of iron, copper and zinc in Egyptian children suffering from intestinal amebiasis before and after treatment with ornidazole. The study was conducted on 20 children [13 females and 7 males] suffering from acute amebic dysentery admitted to Alexandria University Children's Hospital. Their ages ranged from 3 to 6 years with a mean of 4.4 years. Ten apparently healthy children of matched age and sex were taken as controls. Beside detailed history and clinical examination, laboratory investigations were done to prove amebic infection and to estimate the levels of serum iron, copper and zinc in controls and in patients with acute amebic dysentery on admission and 3 weeks after the end of treatment with ornidazole in a dose of 20 mg/kg/day for 5 days. The results showed that serum iron, copper and zinc were low during amebic infection, this could be one of the protective mechanisms of the human body against the E-histolytica. These levels returned back the human body against the E-histolytica. These levels returned back to normal after treatment except copper which may need a longer time to return to its normal level