Serum procalcitonin as a good marker for diagnosis and prognosis of ventilator associated pneumonia

The purpose of this study was to investigate the value of serum level of procalcitonin as diagnostic and prognostic marker during ventilator pneumonia. 92 patients with a strong suspicion of VAP were enrolled in this study. The diagnosis of VAP depends on the clinical criteria of pulmonary infection and presence of radiological findings. APACHE II was calculated during the first 24 hours of admission to ICU. Chest X-ray, arterial blood gases, complete blood count, creatinine, total bilirubin, albumin, PCT and CRP were obtained by the time VAP was suspected [D1] and repeated on the third day of treatment [D3] and on the seventh day [D7]. PCT was determined with the commercially available ELISA assay [Uscn Life Science Inc. Wuhan] with an analytical sensitivity of 7 pg/ml and analyzed with BA-88A, MINDRAY. Semi-automated chemistry analyzer. CRP was measured by ELISA assay. Serum PCT above10 pg/ml was considered a highly positive for diagnosis of VAP. The serum procalcitonin in non VAP did not exceed 7.7pg/ml. It was significantly higher at [D1] in VAP group [49.77 +/- 36.22 pg/ml] than non VAP [5.8 +/- 2.28 pg/ml]. Also the PCT was significantly higher in patients with bad outcome than those with good outcome at day 1. The level of PCT decreased significantly from day 1 to day 3 and 7 in response to the medical management; however it was still higher in patients with bad outcome. As regards the microorganisms considered responsible for VAP group the percentage of Pseudomonas aeruginosa infections was higher in patients with bad outcome. The CRP was significantly higher in VAP patients than non VAP and there was a positive correlation with the increase level of PCT [r=0.86]. Serum PCT seems to be a good marker for early diagnosis of VAP before establishment of the microorganism results and the level of PCT may help in determination of the outcome

Evaluation of different anaesthetic techniques for insertion of laryngeal mask airway in cardiac patients undergoing urgent retinal surgery

Forty-five ASA I and II adult patients scheduled for urgent retinal surgery were included in the study after giving a written informed consent. Patients were randomly divided into three equal groups; 15 patients each: Group P [propofol group], group S [sevoflurane group] and group MT [midazoIam-thiopentone group]. Induction of anaesthesia was done by propofol in group P in a dose of 3 mg.kg[-1] while 8% sevoflurane in 50% nitrous oxide in oxygen was used for induction in group S. In-group MT, midazolam was given iv in a dose of 0.1 mg.kg[-1] followed after three minutes with thiopentone in a dose of 5 mg.kg[-1]. The laryngeal mask airway [LMA] was inserted using the standard method described by Brain. The three groups were comparable as regards age, weight, gender and type of surgical procedures. There were significant decrease in heart rate, MABP, and CI compared with baseline values in group P and group MT [P<0.05]. There was insignificant difference between the three groups as regards percentage of patients with excellent to satisfactory quality of LMA insertion being 90%, 85%, and 95% in group P, S, and MT respectively. Time of insertion of LMA was significantly shorter in propofol group compared with the other two groups [P<0.001]. The number of attempts of insertion of LMA was significantly higher in sevoflurane group. The percentage of patients who received additional propofol doses was significantly less in sevoflurane group compared with other two groups [P<0.05]. During trial of insertion of LMA, it was successfully inserted in high percentage of patients in the first minute in both propofol and midazolam-thiopentone groups compared with sevoflurane group [P<0.001]. The incidences of cough, laryngeal spasm and inadequate jaw relaxation were higher while the duration of apnoea was significantly shorter in sevoflurane group compared with the other two groups [P<0.001]. There was insignificant difference between the three groups as regards the incidences of hiccough, head movement, and bronchospasm. It could be concluded that the use of sevoflurane-N[2]O for insertion of LMA in cardiac patients was associated with greater degree of haemodynamic stability. The ease and quality of insertion of LMA was comparable between the three groups. The time for insertion of LMA using sevoflurane -N[2]O was longer but the incidence of respiratory depression was less compared with the other two groups

Myocardial changes during open heart surgery: a clinical, histopathological and ultra structural study

Crystalloid cardioplegia and induced fibrillation reduce myocardial injury and improve metabolic recovery during open heart surgery. However, there is little evidence of a benefit of either technique in clinical practice. Twenty patients ASA physical status II and III from Alexandra Main University Hospital scheduled for open heart surgery with congenital or acquired cardiac lesions using cardiopulmonary bypass were included in the study. They were divided into two groups, group I received cold crystalloid and group II in whom hypothermic fibrillatory arrest was applied using the fibrillator. The time of whole operation, total cardiopulmonary bypass time, aortic cross clamp time and time to resume heart beating in both groups were recorded. The level of CK-MP, createnin kinase and lactic dehydrogenase were determined at 1, 6, and 24 hours after cross clamp. In addition histological studies for assessment of myocardial injury were done. The results of this study revealed a significant shorter cardiopulmonary bypass time and the fibrillation time in group II, also the recovery time was shorter in group II. As regards the enzymatic studies, the CK-MB was statistically high in group II than group I at 1 and 6 hours. The light microscope shows signs of ischemic damage were detected in both groups with a greater intensity in group II as compared to group I patients: however no irreversible changes [myofibril necrosis] were observed in either group. The Electron microscopic examination shows no irreversible changes in the form of necrosis in the studied cases. The mean scores of ischaemic injury in group I patients were significantly lower [p=0.045] and more consistent than those in group II which showed a higher wider range and higher. Normothermic fibrillation and hypothermic crystalloid cardioplegia provide equal protection of the myocardium during open heart surgery and provide an optimum condition for the surgical field

Towards more humane circumcision: the use of local anaesthesia in circumcision

Circumcision is performed under five techniques for operative and postoperative pain controI. The purpose of this study was to compare between five anaesthetic techniques used during circumcision for the achievement minimal postoperative pain. In a twelve-month prospective study, 450 boys of different age were randomized into five groups. In group I, no analgesia was given, in groups II and III, IocaI infiltration was done by xylocaine or xylocaine marcaine mixture, while groups IV and V received general anaesthesia. In group V, local infiltration by xylocaine marcaine mixture was done in addition to generaI anaesthesia. The groups were compared for operating room time. The time of stay in post anaesthesia care unit [PACU] was significantly shorter in group I, II and III and children in the first group were agitated and need sedation. The percentage of children who needed analgesia in the immediate postoperative period was greater in group I and IV than in group II, III and V; also it recorded the Iowest value in the third group. Severe degree of crying was noticed frequently in group I, II and IV. In group III and IV most of the children [more than 70 %] were calm during the procedure Conclusion: Circumcision without local anaesthesia leads to considerable degree of pain with possible Iong-term effects. Xylocaine + marcaine mixture resulted in best pain relief during and after the procedure with rapid discharge. General anaesthesia alone results in severe pain after recovery. Adding sucrose pacifier during the procedure was very useful. Lastly, it is the right of every newborn boy to have painless circumcision