Glucose level in the bronchial aspirate as a marker of ventilator associated pneumonia in mechanically ventilated patients

Ventilator-associated pneumonia [VAP] is the leading cause of death amongst hospital-acquired infections. Despite this, the diagnosis of VAP remains challenging and there is a lack of diagnostic standardization. In humans, glucose concentrations are normally low in nasal and bronchial fluid, but are elevated by inflammation or hyperglycaemia. Exhaled breath condensate glucose was reported to be a potential marker of both infection and outcome in patients with acute respiratory distress syndrome [ARDS]. To study the signifcance of detecting glucose in bronchial aspirate in mechaniclly ventilated patients under tight glycemic control and using it as a follow up parameter in patients with VAP versus patients with community acquired pneumonia [CAP]. Also the present work aimed to describe the pattern of changes of C - reactive protein [CRP] in patients with VAP versus those with CAP. Forty patients were enrolled into the present study and were divided into 3 groups: Group I: Thirty critically ill patients requiring intubation and mechanical ventilation were followed up from admission and daily till they fulfilled criteria suggesting development of VAP. Group II: Ten patients with community acquired pneumonia [CAP]. Group III: Ten healthy volunteers constituting the control group. Patients were assessed using the following scoring systems: 1] Assessing the disease severity using the Acute Physiological And Chronic Health Evaluation scoring system [APACHE II] on the day of admission, 2] Daily assessment of disease severity using the Sequential Organ Failure Assessment [SOFA] score, and 3] the Clinical pulmonary infection score [CPIS]. All patients with CAP were evaluated by Pneumonia severity index [PSI] on admission. CRP was assessed on admission, on day 2 and on day 7. All patients were under tight glycemic control to abolish the effect of hyperglycemia on the bronchial aspirate glucose levels. Glucose measurements were performed simultaneously in the blood and bronchial aspirates. Bronchial aspirates were analyzed for glucose on the day of admission and daily. The present study demonstrated a correlation between the presence of glucose in the bronchial aspirates from mechanically ventilated patients and development of VAP. Glucose in the bronchial aspirates preceded the development of VAP in the first 48 hours of mechanical ventilation and steadily increased thereafter. This was later associated with infiltrates on the chest radiographs, increased levels of CRP, with significant CPIS score. In contrast the glucose level in the sputum from patients with CAP was high on admission then steadily decreased till discharge. There was no correlation between patient's blood glucose and the glucose level in the bronchial aspirate. In the present study CRP values in patients with CAP steadily decreased from admission till the patients were discharged. The mean CRP value in the mechanically ventilated patients at day one was statistically significant less than that in patients with CAP. While at the 7[th] day, the mean CRP value in patients with VAP was higher than that in patients with CAP. The mean CRP level in patients with VAP was higher in nonsurvivors than survivors. In critically ill patients kept under tight glycemic control, early detection of glucose in bronchial aspirates may improve the ability of clinicians to early recognize the onset of VAP. This technique is simple, rapid, and inexpensive and following it daily may serve as a marker for infection or clinical resolution. CRP levels in patients with CAP steadily decrease from time of admission till discharge, whereas in patients with VAP, CRP steadily increases from time of VAP development thereafter thus suggesting a role in following such patients as a prognostic marker

Evaluation of different methods for identification of seminal stains

Identification of seminal stains is critical in the evaluation of sexual assault victims, as it is the most important evidence in sexual crimes. The aim of the present study was to evaluate zinc [Zn], acid phosphatase [AP] and seminal vesicle specific antigen [SVSA] as marker in identification of seminal stains. The study was carried out on 60 seminal stains samples taken from normo and azoospermic men. Zn and AP were detected by spot tests and SVSA was tested by ELISA technique. The tests were repeated on the stains at different storage periods up to 2 years at room temperature. Postcoital vaginal swabs and stains at different body fluids [urine, serum, saliva] were also included in the study. The study revealed that Zn and SVSA were more specific semen markers than AP, yet Zn was more stable in the stains as it detected seminal stain samples stored up to 2 years and semen in vaginal swabs up to 5 days postcoital. All the studied semen markers were able to detect normo and azoospermic semen with no significant difference

Study of metacarpals and phalanges for sex identification among Egyptian

The purpose of the present study was to develop a method for the determination of sex from metacarpals and proximal phalanges. The study was carried out on 50 adult hands of known sex. Four measurements were taken on each bone. Regression equations were computed for each bone using combination of these measurements for prediction of sex. The percentage of accuracy of correct sex determination calculated from these equations ranged from 78 to 94%. These equations were then applied to a test sample of another 20 hands, also of known sex, to establish the degree of accuracy in assigning sex, where the percentage of actual correct sex determination ranged from 80 to 95%

Effect of prolonged consumption of cola drinks on parathyroid gland in rats: light and electron microscopic study

This study aimed to evaluate the effect of consumption of cola drinks on blood calcium and phosphorus levels as well as parathyroid glands [PTG] in rats. Rats were divided into three groups: Group I was a control group, Groups II and III received commercial coca cola by gastric intubation at a dose of 60 ml/day divided into three times for one and two months, respectively. Parathyroid glands were examined by light and electron microscopes. The study revealed decreased serum calcium and increased serum phosphorus levels which led to compensatory hyperplasia of chief cells of PTG of rats that consumed cola for one month. These hyperplastic cells showed evidences of hyperactivity as dilated prominent r ER cisternae, cell membrane folding and increasing secretory and prosecretory granules. On the other hand, after a consumption of cola for two months, serum calcium level was higher than the other group but still lower than the normal value and this was reflected on the PTG of rats of this group which exhibited exhaustive degenerative and apoptotic changes of the hyperplastic hyperfunctioning dark chief cells

Is it antemortem or postmortem blood?

Bloodstains examination is required in many fields in medicolegal practice. This study was carried out to discriminate between antemortem [AM] andpostmortem [PM] bloodstains. The method used depended on the determination ofthe level of human myoglobin [by radioimmunoassay] as well as the levels ofadenosine triphosphate [ATP], xanthine and uracil [by HPLC] in thebloodstains. The study revealed a highly statistically significant elevationof myoglobin levels in PM than AM bloodstains. ATP was found in highconcentrations in all AM bloodstain samples and could not be detected in anyof the PM bloodstain ones. On the other hand, xanthine and uracil werepresent in considerable concentrations in all the PM bloodstain samples andwere not detected in any of the AM bloodstain ones. These results wereindependent of the age of the stain, the postmortem interval and the cause ofdeath. It was suggested that the determination of the above-mentionedparameters could help in the discrimination between antemortem and postmortembloodstains in medicolegal practice

Study of skull sutures as a tool for identification

The aim of the present work was to study the possibility of using the patternsof skull vault sutures as a tool for a positive personal identification. Itwas carried out on 100 human Egyptian skulls. They were photographed andexamined to determine the different patterns of skull vault sutures [coronal,sagittal and lambdoid sutures]. A method of describing these patterns on theectocranial surface of the skull was adopted and based on dividing each sutureinto subdivisions and describing the pattern found in each one. Skullradiographs [lateral and posteroanterior views] of 150 adult Egyptianindividuals of both sexes were also included in the study to determine thedifferent patterns of skull vault sutures recorded incidentally in routinediagnostic skull radiographs. The results showed that the suture patterns ofskull vaults were highly individualistic. Thus, no two skulls can ever havean identical suture patterns. This is of an utmost medicolegal importance inidentification, if only the suture patterns were recorded during life throughX-ray radiography for comparison

Protective effect of deferoxamine on cadmium induced testicular toxicity in rats

This study examined the possible protective action of deferoxamine [DF], whichis an iron chelator on cadmium-induced testicular damage in albino rats. Theparameters used to evaluate the testicular damage were the histological andultrastructural status of the testis as well as the level of serumtestosterone. The results of the study revealed that the administration of asingle dose of 50 mg/kg DF did not cause evident protective effect againsttesticular damage caused by a single dose of CdCl2. However, when DF wasgiven in repeated doses [3 doses], it caused an excellent protective action,where the histological and ultrastructural picture of the testis was nearlynormal, except for very few residual damage, and maintained an almost normallevels of serum testosterone. It was suggested that repeated low doses ofdeferoxamine could protect and reduce cadmium- induced testicular damage

study of the genotoxic effects of some drugs of abuse

The study was carried out to investigate the potential mutagenicity of somecommon drugs of abuse [opiates, alcohols, benzodiazepines and cannabis] inaddicts. Forty male addicts were included in the study. The frequency ofSister Chromatid Exchanges [SCEs] and structural chromosomal aberrations wereused as genetic bioassays in this work. The study revealed that the threequarters of the addicts [75.0%] were in age group 20-40 years. Astatistically significant increase in the frequencies of SCEs and structuralchromosomal aberrations were observed in addicts of opiates, alcohols andbenzodiazepines than the controls, while no such significant increase wasobserved in cannabis users. The study proved the mutagenic potentially ofopiates, alcohol and benzodiazepines, while no definite prove was drawn asregard the effect of cannabis

Diagnostic markers of physically abused children in autopsy cases

This study was performed on 15 cadavers of physically abused babies to identitydiagnostic markers, particularly at both radiological and histopathologicallevels. For every case, complete external examination and X-ray imaging weredone. Autopsy was performed and histopathological specimens were taken frombrain, heart, lungs, liver, spleen, kidneys and areas of skin containingrecent or old traumatic or pathological lesions. Samples were processed andexamined by light microscopy. Some new changes were revealed, particularly atthe histopathological level including fibrotic changes in both spleen andliver, recent bleeding on top old scars or keloids and papillomatosis of skin. Other diagnostic features were also found such as the string beaded appearanceof malunited fractured ribs, the calcified hematoma and cortical splitting oflong bones, the rheumatoid-like deformity of interpharyngeal joints and thewide- spread cautery burns. In all cases, multiplicity of traumatic lesions[particularly the old ones] was the predominating factor

qualitative technique for routine human identification by using lateral x-ray images of head

A qualitative identification technique was designed and performed on 200 adultmale cadavers. Lateral X-ray images were taken for the head in each case andthe unrequired spaces of the images were minimized. The X-ray images werethen photographed in group [6-10 cases in each picture]. The pictures werearranges in a file form [10 cases in each row of the page, making it possibleto group 100 cases in one page]. Contact tracing was then performed onfrontal sinus, forehead boundary, jaws and teeth. Zoom pictures were alsotaken for those compartment. The study revealed that the contrast of frontalsinus and its details were high in lateral X-ray film, and there were no twopersons identical in the appearance of this sinus. Examination and contracttracing of forehead boundaries and linear details of jaws, teeth and spacesbetween them showed also great variations in these details among persons. Thetechnique designed in this study is simple, reliable, and economic. It doesnot require high technical or professional procedures. It could be applied asan identification system in routine fields particularly in mass disasters aswell as in criminal identification

Study of the immunogenetic profile in idiopathic pulmonary fibrosis

T-lymphocyte subsets, HLA-antigens, and bronchoalveolar lavage [BAL] cytology were studied in 20 patients with idiopathic pulmonary fibrosis [IPF] and compared to another 20 normal volunteers. T-lymphoctes% was significantly decreased in IPF, but T-helper [T[h]]%, T-suppressor [T[s]]% and T[h]/T[s] ratio were similar in both groups. T[h]% was found to have a significant positive correlation with the dyspnoea grade and X-ray stage. Although there was no single HLA-antigen that has been significantly prevalent among IPF, there were few antigens that were more frequent in IPF without frank significancy; they were HLA-B[7], B[8], B[12], and DR[2]. HLA-B[8] had a significant negative correlation with T[h]%, so it may protect against pulmonary fibrosis as T[h]%, is elevated with progression of the disease. BAL study revealed that there was significant decrease in alveolar macrophage% [AM] and increase in neutrophils, lymphocytes and eosionphils% in IPF. Correlation studies revealed that AM% had negative correlation with X-ray stage and T[s]%, while neurophils% had significant positive correlation with X-ray stage. Meanwhile, eosinophils had a good association with many parameters, i.e., dyspnoea grade, X-ray stage, T[h]% and T[s]%. These results may provide a support for the role of immune mediated pathogenesis in IPF

Some psychological profiles in COPD and acute bronchitis

Thirty patients were included in this study, 10 patients with manifestations of acute bronchitis, 20 patients with COPD. Psychiatric profile was done in both groups and one found that there was a high prevalence of psychiatric changes in the form of depression [55%] and anxiety [45%] among the COPD patients while the prevalence of these changes in acute bronchitis was much less. There was no correlation between arterial blood gases and the psychiatric state

Pulmonary involvement in Behcet's disease

Nine patients with Behecet's disease were studied in this work, it was found that 30% of cases showed radiological abnormalities in the form of bilateral pulmonary micro-nodular infiltrates in the upper and lower lung zones. The pulmonary function study revealed a tendancy towards a restrictive pattern. But no gasometric changes were detected