[Scutumplasty with glass ionomer cement [GIC] after cholesteatoma surgery]

Objectives: To evaluate the value of glassionomer cement in repair of scutum defect after cholesteatoma surgery

Patients: Prospective study was performed on consecutive patients undergoing combined approach tympanoplasty[CAT] in 34patients with attic cholesteatoma in ENT department of Assuit University Hospital,Assuit, Egypt, from October 2012, to June 2015

Results: In this study, recurrence of cholesteatoma at the last .follow-up was found in6 % and no retraction pocket was seen. Permanent epithelialization of the bone replacement material was achieved in 30 cases[88.2 %]

Conclusion: The GIC aided scutumplasty is simple, safe and effective way of reconstruction of the attic wall in terms of cholesteatoma recurrence and further hearing restoration

impact of cytomegalovirus infection on mechanically ventilated patients in the respiratory and geriatric intensive care units

Reactivation of cytomegalovirus [CMV] has been reported in critically ill patients [especially elderly] lying in the intensive care units. So identifying such patients to treat is important. To detect the frequency of CMV infection in mechanically ventilated patients, and its correlation with patients' risk factors, and outcomes. The present study was carried out on 51 mechanically ventilated patients admitted to the Respiratory [20] and Geriatric ICU [31] of the Ain Shams University hospitals over a 3 month period. Serum CMV load was measured by real-time PCR. The overall rate of active CMV infection by RT-PCR among the studied populations was [68.6%], [77.4%] in patients of geriatric ICU versus [55%] in respiratory ICU patients. Comparison between CMV positive and negative cases showed a significant difference in the duration of mechanical ventilation and mortality rate. A statistically higher CMV load was recorded in respiratory ICU patients admitted due to exacerbation of chronic respiratory disease or stroke and developing ventilator associated pneumonia [VAP] or septic shock. Also there was a significant direct correlation between CMV load and age of the patient, duration of mechanical ventilation and duration of ICU stay CMV infection is frequent in mechanically ventilated critically ill patients especially the elderly. It is associated with poor outcomes, leads to increased mortality and morbidity in terms of increased ICU stay, longer duration of mechanical ventilation, and higher rates of nosocomial infections

Relation between smoking and cognition in egyptian elderly

In spite of numerous studies published in the past few years on the topic, the effectof smoking on Alzheimer's disease and dementia remains uncertain. Case-control studies havelargely suggested that smoking lowers the risk of AD, whereas prospective studies have shownthat smoking increases this risk or has no effect on the probability of developing AD. The aim of this study is to compare the prevalence of Smoking in elderly withcognitive impairment and elderly with non-cognitive impairment. A Case control 88 participants aged 60 years and above. They wereselected from Ain Shams University Hospital from inpatient wards and outpatient clinics. Thestudied sample was divided into 3 groups: Group A [32 elderly patients with Alzheimer's disease],Group B [32 elderly patients with Mild cognitive impairment] and Group C [24 controls withnormal cognitive function].Comprehensive geriatric assessment, including detailed history, physicalexamination, and also cognitive assessment using Montreal Cognitive Assessment [MOCA] andMini mental status examination [MMSE].As regards smoking there was a highly statistical significant difference between the 3groups as non-smokers were more prevalent in Alzheimer's diseaseand Mild cognitiveimpairment groups in comparison to control group with [p-value= 0.001]. There was a highly significant negative association between smoking and cognitiveimpairment

impact of gender on difficulty of classical open cholecystectomy

Cholecystectomy demands attention, and expectation of abnormal anatomy in the veins, arteries or ducts. Prediction of difficult cholecystectomy does not only helpin patient counseling but also helps the surgeon to prepare better for the technical difficulties that may be encountered[1-3]. To find out whether there is impact of gender on the difficulty of surgery during open cholecystectomy. This is a prospective hospital based study. Patients who presented to Ibn Sina Hospital for open cholecystectomy during the period from April 2011 to April 2012 were included in this study. Special emphasis was put on gender, the operative time, difficulty of surgery and complications of open cholecystectomy. A pre-tested questionnaire was filled during interview of patients and operating surgeons. A total 327 operations were included in the study. Of them there were 34[64.2%] males and 99[36.1%] females presented early i.e. after the first diagnosis was made. The mean operative time was 44.6 min for males and 43.57 min for females. Difficult surgery was described in 6[11.3%] of male and 23[8.4%] females. There was no significant statistical difference in the operative time, difficulty of operation and complication rate between males and females

Sphincter saving surgeries for locally advanced low rectal cancer after neoadjuvant chemoradiation

Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The Golden standard treatment of primary rectal cancer is curative surgical resection; however, affine balance remains between disease cure and restoration of gastrointestinal continuity. Combined modality has proven efficacy in many malignant tumors with advantage of organ preservation. Forty nine [49] patients with low rectal carcinoma were included in a prospective study, between Jan 2007 and Jan 2012. Preoperative chemoradiation was administrated to all patients and subjected to different techniques of sphincter saving surgery. Stage I and Stage IV disease at diagnosis were excluded from the study. Forty nine patients were included in the study. 27 [55%] patients were male and 22 [45%] were female the age range from 23 years to 70 years with the median age 46 years. The main presenting symptoms were bleeding per rectum and tenesmus. Stage II 18 patients [36.7%,], stage III 31 patients [63.3%. Complete clinical and pathological response in 3 patients [6%], and complete clinical response with only microscopically residual carcinoma in 20 patients [41%], partial response in 18 patients [36.7%], and no significant response in 8 patients [16%] 7 from 8 were mucoid carcinoma. Low anterior resection [LAR] in 22 patients [44.9%], Hartman 's procedure in 4 patients [8.1%], Coloanal pull-through [COP] was done in 19 patients [38.9%] and perineal colostomy in 4 patients [8.1%]. For patients with cola-anal pull-through technique complete dehiscent and retraction observed in 2 cases, Major leakage in one case, stenosis in 4 cases. There is tendency of colorectal cancers to affect younger groups. Most patients presented in advanced stage. Neadjuvant chemo radiation is an excellent tool in sphincter saving surgery. Coloanal pull- through technique is not wide spread technique for low rectal cancer with good oncological safety and acceptable functional outcome

Homocystiene profile in elderly

Homocysteine [Hcy] is a sulfurated amino acid an elevated homocysteine level is a marker for a pathogenic process as well as a cause of pathology. It is across sectional study conducted on 91 elderly participants 60 years and older selected from geriatric outpatient clinic and geriatric inpatient departmentthey underwent comprehensive geriatric assessment, and homocysteine [Hcy] level in blood by Enzyme Immunoassay [EIA]. homocysteine not significantly related to age, sex and functional status. Also mean Hcy level is 15.4 micromol/liter. Further studies to evaluate Hcy level in elderly with different ages are recommended

Relation between frailty and common geriatric problems in elderly

There is a high prevalence of common geriatric problems [falls, urinary incontinence, visual and hearing impairment] among frail elderly leading to more disability and functional impairment. The aim of this study is to compare the prevalence of common geriatric problems between frail and non-frail elderly. A Case control study. 90 participants aged 60 years and above. They were selected from Ain Shams University Hospital from inpatient wards and outpatient clinics. The studied sample was divided into 2 groups: Group A [30 frail elderly females and 30 frail elderly males] and Group B [30 healthy elderly subjects; 15 males and 15 females]. Comprehensive geriatric assessment, including detailed history of common geriatric problems as mentioned above, physical examination, and also assessment of frailty using modified Fried criteria]. Hearing impairment, incontinence and falls were more prevalent in frail elderly with a highly difference between the two groups, with p values< [0.001,0.009,0.006] consequently, visual impairment was statistically significant in cases more than controls with p value [0.012]. There is a significant positive relationship and high prevalence of common geriatric problems especially falls, urinary incontinence, visual and hearing impairment among frail elderly

crude plant juices of desert plants as appropriate culture media for the cultivation of rhizospheric microorganisms

The exclusive use of plant juices, not as a mere supplement to synthetic culture media, for culturing rhizospheric microorganisms [RMO] is introduced here. Juices were prepared from desert [Mesembryanthemum crystallinum L., Zygophyllum album L., Carpobrotus edulis L.] as well as cultivated [Trifolium alexandrinum L., Beta vulgaris L.] plants. Colonies of RMO [Azospirillum brasilense, Enter obacter agglomerans and Klebsiella pneumoniae] nicely developed on surface-inoculated agar plates prepared from crude and diluted juice of M. crystallinum [ice plant]. Furthermore, hundreds of RMO colonies developed on various standard culture media were replicated [> 90%] on agar plates of different plant juices. RMO cells grew nicely in liquid ice plant juice, with doubling times comparable to those grown in the reference culture medium. RMO populations resident in various host plants were able to develop on culture media prepared from homologous and heterologous juices. The application of a thin semi-solid overlay agar on the surfaces of inoculated agar plates significantly increased the recovery of micro-colonies on agar plates, particularly those prepared from plant juices

relation between the presence of intestinal bacteria in the perianal abscess and the anticipated perianal fistula

Perianal abscess and fistulas are frequently encountered in our surgical practice; however, very little has been written about them. The clinical effectiveness of pus swabs for microbiological analysis during incision and drainage of perianal abscess is controversial. Its cost implication is often overlooked. To assess whether the culture of pus swab following incision and drainage of perianal abscess has any significant impact on surgical outcome and on early anticipation of development of fistula in-ano in our local population. A non-probability sample, total coverage multicenteric cross-sectional study. All consecutive cases of incision and drainage of perianal abscess between November 2008 and June 2011 were enrolled into our study after acceptance of a pre-given informed consent. Out of 76 patients with perianal abscess included in the study only 62 patients were available for the final assessment [9 F: 53 M; age range: 18-63 years; mean +/- SD: 37.66 +/- 10.67]. Median follow-up was 2 months irrespective to culture result. The mean hospital stay was 1.44 days, and is affected by the presence of associated illness [p=0.02]. Skin flora organisms, heavy mixed growth of both skin flora and intestinal organisms, and no bacterial growth were isolated from 75.8%, 12.9% and 11. 3% respectively. Fistula in-ano developed in 16.7%, 83.3% and 0% respectively. 83.3% of fistula developed in the group of patient who presented >/= 10 days, which is statistically found to be significant p=0.003.Fistula was developed in 7.1% [4/56] of patients who were treated under general anaesthesia, and in 33. 3% [2/6] of patients who were treated under local anaesthesia. The preliminary findings suggest that microbiological results have correlation with presence of fistula in-ano. The result warranted us to submit pus swabs from perianal abscess for assessment as it affect clinical effectiveness of treatment, and that culture of pus in perianal abscess is an essential part of its management

Herbal extracts counteract cisplatin-mediated cell death in rat testis / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the protective effects of ginger (Gin) and roselle (Ros) against testicular damage and oxidative stress in a cisplatin (CIS)-induced rodent model. Their protective effects against CIS-induced apoptosis in testicular and epididymal sperms is also investigated.</p><p><b>METHODS</b>Ethanol extracts of Gin or Ros (1 g/kg.day) were given orally to male albino rats for 26 days. This period began 21 days before a single CIS intraperitoneal injection (10 mg/kg body weight).</p><p><b>RESULTS</b>Gin or Ros given orally significantly restored reproductive function. Both tested extracts notably reduced the CIS-induced reproductive toxicity, as evidenced by restoring the testis normal morphology. In Gin and Ros, the attenuation of CIS-induced damage was associated with less apoptotic cell death both in the testicular tissue and in the sperms. CIS-induced alterations of testicular lipid peroxidation were markedly improved by these plant extracts.</p><p><b>CONCLUSION</b>The present results provide further insights into the mechanisms of protection against CIS-induced reproductive toxicity and confirm the essential anti-oxidant potential of both examined extracts.</p>

Comparative study of a standard Macintosh blade III and a modified Optic Viewmax blade II for endotracheal intubation

The availability of a laryngoscope blade that could improve visualization of glottic structures without requiring excess traction force during tracheal intubation would be helpful in reducing the perioperative complications related to laryngoscopy. The Viewmax laryngoscope blade II [Rusch] is a modified laryngoscope blade which incorporates an unmagnified optic side port to a standard Macintosh [MAC] blade III. This modification allows for an alternative view of the glottis from a position 1 cm behind the left tip of the blade while still allowing the standard direct view provided with MAC-3 blade during tracheal intubation. In this study, we compared the Viewmax to a standard MAC-3 blade using a randomized cross-over study design. Fifty six patients ASA physical status I and II requiring tracheal intubation were enrolled in this study. The preanesthesia airway evaluation included Mallimpoti score, thyromental distance, and maximal mouth opening. Anesthesia was induced with propofol 2 mg/kg and fentanyl 50-100 mg, followed by rocuronium 0.6 mg/kg IV for muscle relaxation. According to a randomization, either the standard MAC-3 blade [Mac Group] or Viewmax II blade [Viewmax Group] was first chosen for laryngoscopy. After viewing the laryngeal structures, the first blade was withdrawn and the second blade [MAC or Viewmax] was used to repeat the laryngoscopy. A strain gauge laryngoscope handle was used with both blades to measure the peak axial force applied at the handle by the anesthesiologist during the laryngoscopy. After viewing the laryngeal structures with the second blade, tracheal intubation was performed in all patients. The views of laryngeal structure during laryngoscopy were classified by the anesthesiologist as: Grade 1= most of the glottis is visible; Grade 2 = only the posterior portion of the glottis is visible; Grade 3 = only the epiglottis is visible; and grade 4 = only the soft palate is visible. Anesthesiologist's satisfaction with the Viewmax laryngoscope was evaluated using a verbal score from 0 to 100. Our results showed that there were no significant differences in the laryngoscopic views between the two blades. However, the use of Viewmax blade was associated with lower percentage of laryngoscopic views grade III and IV compared to MAC blade. The recorded force applied to the laryngoscope handle during laryngoscopy was significantly less in Viewmax group compared to MAC group. The view of the laryngeal structures with Viewmax 11 blade was comparable to the MAC-3 blade. However, the use of Viewmax blade required less axial force applied at-the handle during the laryngoscopy

Prevalence of low back pain among elderly people living in elderly homes in Cairo

Musculoskeletal complaints in the elderly have physical, functional and psychological consequences. The problem of low back pain had been studied from different aspects. This study aimed at obtaining a cross sectional view of chronic low back pain among elderly living in elderly homes in Cairo. First a pilot study was performed in which time tools had been designed in the forum of a questionnaire, which had been applied on a sample of tell individuals and according to their response time structured interview for the definitive study was designed. After that the modified questionnaire was applied to 25 individuals to test time validity and reliability of the questionnaire. Test retest reliability by percent of agreement of items testing the low back pain, ranged from 80 to 100 and the general reliability was 97.6. Construct validity was established by showing the questions to consultants of neurology, orthopedics and physiotherapy to assure that the questions contained in the questionnaire cure suitable and sufficient for the assessment. The definitive study was performed among 60 elderly participants [60 years and over] recruited from different elderly homes in different geographical areas in Cairo. Each participant answered the interview than was subjected to complete clinical examination with special consideration to body mass index, neurological examination and functional assessment. 43.3% of participants reported a history of recurrent attacks of low back. Most of the patients described pain as moderate or severe. Studying the relation between low back pain and body mass index [BMI] revealed that participants suffering from low back pain have higher mean BMI [31.6 +/- 6.2] then others [29 +/- 6.5] but the difference was not statistically significant [P = 0.1]. The mean age of participants suffering from low back pain was lower than others with no statistically significant difference [P = 0.5]. Low hack pain was significantly more common among females [P = 0.01]. 38.5% reported that during the attack they suffered from impairment in one or more items of daily activities. On examination 42.3% had muscle spasm. 50% did not show any neurological abnormality as regards muscle weakness, reflexes and sensory impairment. The prevalence of low back pain among Egyptian elderly living in elderly homes is 43.3%. Females significantly suffer from low back pain more than males. No statistically significant relation between low back pain and age or body mass index could be confirmed. 38.5% reported functional impairment during time attack. The most common sign present on examination was spasm in time back muscles

Molecular epidemiology of antibiotic associated diarrhoea due to clostridium dificile and clostridium perfring ensin Ain Shams University Hospitals

As we are Iiving in the era of antibiotic overuse, antibiotic associated dlarrhea [AAD] is considered now a distinct health problem with a need for more attention was to perform a highly specific detection and definition of pathogenic Clostridium perfringens and Clostridium difficile related AAD in children compared to adults and geriatircs. One hundred and fifty patients diagnosed for AAD were included in this study [50 children, 50 adults and 50 geriatric patients]. All of them were subjected to full medical history including complete therapeutic history of antibiotics and collection of stool sample during the attack for detection of Clostridium perfingenes enterotoxin [CPEnt] and Clostridium difficile cytotoxin by [EIA] kit. PCR detection of Clostridium perfingenes epegene [Coding gene for CPEnt] was perfomed as well. Results showed that prevalence of Clostridium difficile cytotoxin was 24% while Clostridium perfingenes enterotoxin was 12% as detected by EIA in faecal specimens as a whole. Detection of epe gene by PCR was positive in 16% of all cases. Children [OR: 4.2, 95% CI: 1.3-14.8, P

Outcome of double burr-hole craniotomy in patients with chronic subdural haematoma

Chronic subdural haematoma [CSDH] is a common condition in late stages of life. Most of the patients are subjected to minor trivial trauma which will end up with a collection of altered blood in the subdural space. This necessitates immediate surgical drainage, with the aim to reduce the mass effect on the brain to alleviate the symptoms and to reverse the condition. To report the experience and outcome of double burr-holes craniotomy in treatment of chronic subdudal haematoma. This study was conducted on 70 patients with CSDHs managed at Omdurman Teaching Hospital Sudan, during the period from November 2004 to November 2006. All patients after clinical assessment and CT scan of the brain proved to have CSDH. The haematoma was removed surgically by double burr-holes craniotomy, irrigation and close system drainage. The study included 70 patients, 50 males and 20 females. The mean age was 69 years. Computed tomography scan, showed unilateral collection in 60% of patients and bilateral in 40%, only 1.8% showed conning of the brain. Unilateral double burr-hole craniotomy was performed in 60% of the patients, while bilateral was done in 35.7%. In the postoperative follow up 87.1% of the patients showed uneventful recovery. Seven patients developed complications in the form of pneumocephallus or postoperative recurrence. The mortality rate was 2.9%. Burr holes craniotomy, irrigation and close system drainage, is effective and favor rapid regression of residual subdural collection and associated with fewer recurrences

Surgical management of endobronchial tumors: analysis of 24 patients

To evaluate the variable surgical options performed in the management of endobronchial tumors and the factors determining selection of the appropriate surgical technique. Retrospective study of a series of 24 patients with endobronchial tumors who were diagnosed and underwent surgery in the cardiothoracic surgery department, Mansoura university hospital from January 1985 to March 2006. Full history taking and complete clinical examination, routine laboratory investigations, chest x-ray, and computerized tomography, and bronchoscope were done for all cases. Surgery was the line of treatment for all patients. Close sex distribution with age ranges from 20-64 years. Cough with expectoration was the main presentation. Zonal opacity was the most common radiological finding. CT chest showed sensitivity of 79.2% for detection of endobronchial lesions. Bronchoscopic examination revealed endobronchial lesions in all patients. Benign tumors were detected in 5 patients and malignant lesions in 19 patients, 14 patients were neuroendocrine tumors and 5 patients were other malignant varieties. Surgical interference included bilobectomy [7 patients], lobectomy [5 patients] pneumonectomy [7 patients], and one patient underwent surgical exploration for open biopsy while 4 bronchoplastic procedure were performed. Endobronchial tumors occur over a wide range of age without significant sex differentiation. Endobronchial tumor should be suspected in case of prolonged chest complaint inspite of maximal medical treatment. Bronchoscope is the main diagnostic tool and is important for detection of the provisional plane for surgery. Early diagnosis and screening should be established for early detection of endobronchial tumors and more conservative resectional and bronchoplastic techniques

Effects of Roselle and Ginger on cisplatin-induced reproductive toxicity in rats / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the protective effects of Hibiscus sabdariffa (Roselle) and Zingiber officinale (Ginger) against cisplatin-induced reproductive toxicity in rats and to study the mechanisms underlying these effects.</p><p><b>METHODS</b>Ethanol extracts of H.sabdariffa or Z.officinale (1g/kg x day) were given p.o. to male albino rats for 26 days, which began 21 days before a single cisplatin i.p. injection (10 mg/kg body weight).</p><p><b>RESULTS</b>Extracts of H.sabdariffa and Z.officinale reduced the extent of cisplatin-induced sperm abnormality and enhanced sperm motility. Both extracts restored the control level of malondialdehyde (MDA) (lipid peroxidation marker) in the cisplatin-treated testis. The cisplatin injection induced decline in the levels of superoxide dismutase (SOD), reduced glutathione (GSH) and catalase (CAT) were significantly reversed to control levels in groups where cisplatin was preceded by the administration of either H.sabdariffa or Z.officinale.</p><p><b>CONCLUSION</b>Both H.sabdariffa and Z.officinale treatment increased the activities of testicular antioxidant enzymes and restored sperm motility of cisplatin-treated rats. The protective effects of tested plants are, therefore, suggested to be mediated by their potent antioxidant activities.</p>

Some differences between dyspnea of cardiac origin and dyspnea of pulmonary origin in the elderly

Acute dyspnea is a common problem among elderly patients. Few studies have examined acute dyspnea in the elderly. The most common causes of dyspnea in the elderly are either of cardiac origin include heart failure, or of pulmonary origin as chronic obstructive pulmonary disease and asthma. Other causes include parenchymal lung disease, pulmonary vascular diseases, upper airway obstruction and pneumonia. In clinical practice, it is often difficult to distinguish between cardiac and pulmonary causes of dyspnea. To detect some differences between cases of cardiac dyspnea and those suffering from pulmonary dyspnea in elderly patients admitted to the departement of Geriatrics in Ain Shams University hospital. All patients admitted to the department of Geriatrics in Ain Shams University hospital with acute dyspnea as a main complaint for a period of 6 months [56 patients] were evaluated by both clinical assessment and some investigations as arterial blood gases, chest X ray, ECG, echocardiography. Accordingly determination of the cause of dyspnea was made. Comparison between the three groups i.e. cardiac, pulmonary and mixed were made regarding number, mean age, mean PO2, delirium and ICU admission. The total number of patients presented to the geriatric department during the period of the study were 361 patients, so those 56 patients represented 15% from the total admission. 37.5% of cases were suffering from dyspnea of pulmonary origin. The rest were suffering from cardiac dyspnea [26.8%], mixed type [26.8%] and [8.9%] only were suffering from dyspnea due to other causes. The highest mean age was among the mixed group. There was no statistically significant difference between the three groups regarding sex, delirium and ICU admission. The lowest mean PaO[2] was among those with mixed cardiac and pulmonary dyspnea and the highest was among the cardiac group. In the elderly it is difficult to set out points of differentiation between dyspnea of cardiac origin and that of pulmonary origin. The number of mixed cases is relatively high. It was found also that there are other confounding factors which are important in predicting mortality and morbidity should be considered when we are assessing cases of acute dyspnea in the elderly

Coxsackie B Viruses as the main etiologic agent of myocarditis: Characterization of capsid proteins

Enteroviruses especially Coxsackie B viruses [CBVs] are responsible for approximately 50% of viral myocarditis cases. Coxsackie B viruses were inoculated in BGM cells for three successive passages. Viral capsid proteins were screened by SDS-PAGE, followed by Western blot. Electrophoretically separated proteins of CB2, CB4 in comparison to CA9, Echo9, and PV1 Sabin, showed common peptides particularly at the low molecular weight [ranging between 40 to 10 kDa]. The results of immunoblotting analysis using polyclonal antibodies raised against the whole Coxsackieviruses B viral particles did not reflect that all those bands are immunogenic, nevertheless those peptides could be used to raise specific antibodies which in turn could be useful in detecting viral circulating antigens

Cross - sectional study of heart failure therapy with angiotensin converting enzyme inhibitors and digoxin

The aim of the present study is to show a better short-term [2 weeks] clinical improvement in patients with heart failure [HF] who are receiving angiotensin converting enzyme inhibitors [ACEIs] [with or without digoxin] when compared to the standard therapy excluding ACEIs. The study was conducted in Al-Gamhuria Teaching Hospital, Aden, Yemen, from January to July 2003. In this study, 78 patients with HF were enrolled into 3 therapeutic groups [ACEIs alone, ACEI and digoxin and digoxin alone] and their responses within 2 weeks were recorded. Exclusion criteria were as follows: thyroid disorders, gastrointestinal disturbances [diarrhea, malabsorption], electrolyte unbalanced [unless corrected] and insufficient data. Serum creatinine was measured at the beginning and after 10 days. In addition, the patients' body weight and age were recorded. Criteria for a complete improvement within 2 weeks were the occurrence of the following: 1] The relief of pulmonary congestion, 2] Decrement in heart rate to less than 74 +/- 5, 3] Disappearance of the lower limb edema, and 5] Recorded positive electroencephalogram change. Partial amelioration was recognized if only 2 or 3 of the preceding criteria were observed. Nine patients received digoxin alone, while 40 patients were treated with ACEIs and digoxin. Treatment with ACEIs without digoxin was observed in 29 patients. The discrepancy between the number of patients was necessitated by the need of patients with HF. This last category of treatment regimen produced better clinical improvement [complete with 10.1%, partial with 24.3%] compared to the digoxin group without ACEI [complete 2.5% or partial 5.1%]. Nevertheless, the addition of digoxin to an ACEI increased this ratio [17.8% for complete and 28.2% for partial improvement]. A 49.3% increase in serum creatinine was observed after 10 days in 25 HF patients, who were randomly selected and followed up [the baseline concentration was 99.75 +/- 9.9 umol/L, while the level after 10 days was 148.97 +/- 19.8 umol/L, p=0.005]. We confirmed that short-term use of ACEI regimens has a superior effect on the therapy of HF [34.4% complete and partial response] as compared to the therapy of not using ACEI [7.6% had a complete and partial response]. The combination of ACEI and digoxin has resulted in the best outcome [46% had a complete and partial response]. However, we also noticed a significant rise in serum creatinine by 49% concomitant with the use of ACEI [the baseline concentration was 99.75 +/- 9.9 um/L, while the level after 10 days was 148.97 +/- 19.8 umol/L, p=0.005]

Event related potential P300 as a measure of auditory evoked potential In type 2 diabetic patients: correlation with micro vascular complications and the different parameters of metabolic control particularly previous hypoglycemic episodes

Impaired cognitive functions are one of the major CNS complications of diabetes. Chronic hyperglycemia, chronic hyperinsulinaemia, chronic hypertension, dyslipidaemia, cardiovascular diseases and drugs, are among the contributing factors for the occurrence of CNS complications of diabetes. Tight metabolic control definitely reduces the risk of diabetic complications but is associated with increased risk of hypoglycaemia. Severe hypoglycaemia by itself can cause severe and irreversible brain damage, however, the impact of hypoglycaemia on CNS complications is not definite. Event-related potential [ERP] P300 auditory evoked potential measure reflects the speed of neural events related to attention and short term memory; both are important and essential cognitive functions. Increased ERP P300 latency has been associated with early abnormalities in psychometric tests in diabetic patients. We studied the ERP P300 latency -as an indirect index of cognitive functions- and its relation to the different microvascular complications and the different parameters of control of Type 2 diabetes to try to find predictive factors for early intervention in such patients before sever cognitive impairment occurs. Also, we tried to correlate it with the number and severity of hypoglycaemic episodes to evaluate the effect of hypoglycaemia on cognitive functions. The study was carried out on 50 type 2 diabetic patients with no clinical evidence of cerebral dysfunctions or cognitive impairment and 20 controls. All the patients and controls were subjected to full clinical examination including neurological examination. Those with abnormality suggestive of peripheral neuritis were subjected to sural nerve sensory conduction velocity [SNSCV]. Blood samples were taken to measure fasting blood glucose and HbA 1c. Urine was tested by micral test for immunochemical semi quantitative determination of microalbuminurea. Diabetic retinopathy was detected by ophthalmologic examination after dilatation of the pupil Cognitive functions were examined and a Minimental State Examination [MMSE]. Questions were put in clear Arabic language. Hypoglycaemia was evaluated through history interrogation. ERPs were obtained by the conventional technique with an acoustic ball paradigm. Diabetic subjects had significantly higher incidence of retinopathy, neuropathy, microalbuminurea, fasting blood glucose level and Hb A[1c] than the control subjects. Diabetic patients had higher ERP P300 than the control subjects. ERP 300 was correlated to age and the presence of both peripheral neuritis and microalbuminurea, and not to the duration of diabetes, glucose levels, HbA1c, TG, cholesterol or the presence of retinopathy. There was no difference in ERP 300 latency when we compared the diabetic patients according to the number or severity of previous hypoglycaemic episodes. Patients with no history of previous hypoglycaemic episodes showed a tendency towards a lower ERP 300 latency but this was not statistically significant. There was a collinear relationship between the prolongation of ERP P300 and both the age of the patients and the degree of shortening of the SNSCV. There was no collinear relationship between ERP P300 and the degree of microalbuminurea [quantitatively]. ERP P300 is an easy test to apply in diabetic patients as a test of early changes in brain functions. It is not influenced by the number or severity of previous Hypoglycaemic attacks. Previous attacks of hypoglycemia although of a potential lethal effects could be less dangerous in type 2 diabetic patients than was previously expected and the brain functions of type 2 diabetes patients may be less vulnerable to the effect of hypoglycaemia. Aging, the presence of microalbuminurea and the degree of peripheral neuritis are associated with deterioration of ERP P300. There is a linear relationship between age and the degree of peripheral neuritis on one hand and the deterioration of ERP P300 on the other hand