Efficacy and speed of conversion of recent onset atrial fibrillation using oral propafenone versus parenteral amiodarone: A randomized controlled comparative study

Background: Atrial fibrillation is the most commonly encountered arrhythmia. Several antiarrhythmic agents are effective in restoring and maintaining sinus rhythm. Aim of the work: To compare the efficacy and rapidity of conversion of recent onset atrial fibrillation using oral propafenone versus intravenous infusion of amiodarone. Methods: The study included 200 patients with recent onset atrial fibrillation. Patients were equally divided into 2 groups; group A where intravenous infusion amiodarone was given and group B where oral propafenone was administrated. The effectiveness and the time needed for conversion of atrial fibrillation to sinus rhythm were compared in both groups. Results: The success of conversion of atrial fibrillation to sinus rhythm was 83% in group A and 85% in group B, p-value ¼ 0.699. The time elapsed from drug administration till conversion of atrial fibrillation was 9.07 ± 5.04 hours in group A versus 3.9 ± 1.54 hours in group B, p-value ¼ 0.001. In both groups, patients who showed failed conversion had a significantly larger left atrial diameter and a significantly higher high sensitivity C-reactive protein (hsCRP) level. Conclusion: Oral propafenone was faster than parenteral amiodarone in the conversion of recent onset atrial fibrillation to sinus rhythm. Patients with failed conversion had a bigger left atrial diameter and a higher hsCRP when compared to patients with successful conversion

Mesenteric cystic lymphangioma complicated by intestinal volvulus: a case report

Intestinal volvulus is an abdominal pathology which can affect the pediatric age group and may lead to catastrophic intestinal loss. The most common cause is malrotation but other etiologies are also reported. We report a case of intestinal volvulus in which the initial cause was mesenteric cystic lymphangioma

Post- infantile presentation of intestinal malrotation

To study intestinal malrotation presenting after the age of one year, analyze the spectrum of presentations and to predict risk of volvulus. Retrospective study. Zagazig University Hospitals [Egypt] and King Fahd Hospital, Saudi Arabia. All cases [54] of malrotation during April 2006 to April 2010. Analysis of clinical, radiological and operative data. Presentation, significant associations and risk of volvulus. The mean age was 4.8 +/- 2.13 years. Presentations included acute volvulus [n = 27, 50%], chronic volvulus [4, 7.5%], mesocolic hernia [4, 7.5%], intussusception [5, 9%], exomphalos [5, 9%] and non-specific presentation [9, 17%]. Associated anomalies were found in 19 cases [35%] with significant association of chronic volvulus and exomphalos. Typical anatomical malrotation was seen in 21 [39%] cases with significant risk of volvulus [odds ratio 9.2]. Nausea and vomiting, abdominal colic, and malnutrition were dominant in acute and chronic volvulus, mesocolic hernia and intussusception [p < 0.05]. Malnutrition and gastroesophageal reflux disease [GERD] were significantly associated with chronic volvulus [p < 0.05]. Duodenal obstruction was significantly evident in acute volvulus while high cecum was dominant in intussusception. Prolonged ileus and persistent symptoms were significant in chronic volvulus and mesocolic hernia [p < 0.05], while wound infection and short bowel syndrome were significant in acute volvulus. Malrotation in the post-infantile period has a wide spectrum and non-specific presentation. Risk of midgut volvulus is present, especially in typical cases, and trials must be done to predict the risk and avoid unnecessary surgery

Value of abdominal pressure measurement in neonatal abdominal surgical emergencies

To assess the predictive and prognostic value of abdominal pressure measurement in neonatal abdominal surgical emergencies. Case series. Zagazig University Hospitals [Egypt] and King Fahd Hospital, Hofuf [KSA]. Seventy nine neonatal abdominal surgical emergencies admitted and managed over a four-year period [Jan 2005 to Jan 2009] Measurement of abdominal pressure through management period. Abdominal pressure was classified into pressure at presentation [T1], preoperative [T2], and postoperative pressure [T3]. The levels of pressure were classified into [pA] below 12 mmHg, [pB] 12-20 mmHg, and [pC] more than 20 mmHg. Seventy-nine neonates were included. There was significant high abdominal pressure in jejunoileal atresia, necrotizing enterocolitis [NEC], and duodenal obstruction. In pyloric stenosis, there was no significant abdominal hypertension all over the management period. Temporary elevations occurred preoperatively [T1] in meconium ileus, cecal perforation, and jejunal stenosis. Significant association was found between [T1] and mortality, postoperative blood transfusion, need for mechanical ventilation, and sepsis. No correlation was found with blood need or sepsis. Postoperative complications had significant association with elevated postoperative abdominal pressure [T3]. Intra-abdominal pressure [IAP] can be of importance in monitoring changes which accompany neonatal surgical emergencies. It can be of predictive and prognostic value in neonatal surgical emergencies. However, more controlled studies are needed to confirm this conclusion

Plasma ghrelin concentrtions in: lean and obese individuals: effects of food intake, dieting and partial gastrectomy

Ghrelin is a recently discovered hormone synthesized predominantly by the stomach. It has been reported to have adipogenic and orexigenie actions and induces weight gain in addition to its Gil-releasing properties. This work aimed at studying the Ghrelin levels in both lean and obese individuals, effect of feeding, dieting, gastric resection on plasma Ghrelin levels. 30 individuals were the subjects of this study, using radio immunoassay method for measurement of plasma Ghrelin levels. There were high significant plasma Ghrelin level in lean group compared to both obese and partial gastrectomy groups[p<0.01, p<0.05 respectively]. Plasma [Ghrelin level decreased significantly after feeding [p<0.01], and increased significantly post-dieting loss of weight [p<0.05]. In conclusion, Ghrelin is a hormone produced mainely by the stomach, has a role in the long-term regulation of body weight, promote feeding. prevent further weight and energy loss

Incidence of extrapulmonary congenital anomalies with neonatal respiratory distress at Sharkia governorate

Congenital anomalies are one of the leading causes of death in infancy. Not all the disorders producing neonatal respiratory distress are primarily diseases of the lung. So the aim of this work is to find out the spot incidence of extrapulmonary congenital anomalies among neonates with respiratory distress at Sharkia Governorate. For this purpose, all neonates who presented with respiratory distress during a period of one year [from January to December, 1998] were admitted to Neonatal Intensive Care Unit, Pediatric Department, Zagazig University Hospital and were the candidate of this study. Their number was 520 newborn infants, all of them were subjected to full clinical history, thorough clinical examination and the following investigations: complete blood count, blood glucose level, serum calcium level, serum electrolyte, arterial blood gases, chest X-ray and the following investigations were done when indicated, upper gastrointestinal tract [GIT] series with contrast, ultrasonography, CT and Echo- cardiography.The results of this study show that, thirty three out of the 520 neonates with respiratory distress [6.3%] had extrapulmonary congenital anomalies [group I] while the remaining 487 neonates [93.7%] had respiratory distress due to other causes [group II]. In group I, the GIT anomalies were the most common extrapulmonary congenital anomalies with respiratory distress 16/33 [48.50%], while in group II, septicemia with or without bronchopneumonia was the most common cause of neonatal respiratory distress 236/481 [48.5%]. As regards some clinical parameters, we have found that, group I was significantly more common with vaginal deliveries, full term neonates, good moro reflexes, low birth weight neonates, and consanguineous marriages. Whereas group II was significantly more common with caesarian section, premature neonates, poor moro reflexes, normal birth weight neonates and history of maternal drug intake extrapulmonary congenital anomalies are not uncommon causes of neonatal respiratory distress. The diagnosis of these anomalies depends primarily on a high index of suspicion, careful clinical evaluation and if required, investigations according to the suspected anomalies