Low Dermatitis Potential of a Powder-Free, “Accelerator-Free” Non Natural Rubber Latex Gloves Using Modified Draize Study

Introduction: The escalated demand for protective rubber glove in the healthcare industries has resulted in increased prevalence of glove related skin problem, irritant and allergic contact dermatitis and latex sensitivity. The industry has recently introduced a new nitrile glove product using a novel patented non-sulphur system to effect co-valent bond crosslinking to provide the desired elasticity of the gloves. This glove also has ionic crosslinking provided by the zinc oxide used in the formulation and the carboxylic group of the nitrile latex. The main objective of this study is to prove that residual chemical additives at a level that may induce Type IV allergy in the unsensitized general user population are not present in this rubber glove and to compare it with a powder free latex examination glove. Methods: In collaboration with the Islamic University of Gaza, we conduct modified test on a specially formulated and powder free, accelerator free LOW DERMA™ enhanced nitrile rubber glove that has physical properties and barrier integrity similar to that of NRL gloves. This glove does not contain sulphur or sulphur related compound. Two sets of Powder free, accelerator free LOW DERMA™ Nitrile Patient Examination Gloves*, white and blue colour were tested using the modified draize-95’ test. Filter paper soaked in normal saline and powder free latex examination glove were used as control. Results: A total of 209 subjects, 149 subjects, Caucasian (71.29%), 30 subjects, Afro Caribbean (14.35%) and 30 subjects, Asiatic (14.35%) were recruited. All 209 subjects had a final patch testing scoring of not more than 1.5 during both the induction phase and the challenge phase for both types of Powder Free Nitrile Patient Examination Gloves (white and blue) and to the negative control, normal filter paper and the powder free NRL control glove. Conclusion: The skin sensitization test (‘Modified Draize-95’ Test) of Powder Free Nitrile Patient Examination Gloves (white and blue) and the powder free NRL examination glove were negative. There was no clinical evidence on the presence of residual chemical additives at the level that may induce Type IV allergy in unsensitized general user population for both Powder Free Nitrile Patient Examination Gloves, blue and white colored, non-sterile. Both gloves qualify for “Low dermatitis Claim”.

Advances in the management of infertility in men with spinal cord injury / 亚洲男科学杂志(英文版)

Couples with a spinal cord injured male partner require assisted ejaculation techniques to collect semen that can then be further used in various assisted reproductive technology methods to achieve a pregnancy. The majority of men sustaining a spinal cord injury regardless of the cause or the level of injury cannot ejaculate during sexual intercourse. Only a small minority can ejaculate by masturbation. Penile vibratory stimulation and electroejaculation are the two most common methods used to retrieve sperm. Other techniques such as prostatic massage and the adjunct application of other medications can be used, but the results are inconsistent. Surgical sperm retrieval should be considered as a last resort if all other methods fail. Special attention must be paid to patients with T6 and rostral levels of injury due to the risk of autonomic dysreflexia resulting from stimulation below the level of injury. Bladder preparation should be performed before stimulation if retrograde ejaculation is anticipated. Erectile dysfunction is ubiquitous in the spinal cord injured population but is usually easily managed and does not pose a barrier to semen retrieval in these men. Semen analysis parameters of men with spinal cord injury are unique for this population regardless of the method of retrieval, generally presenting as normal sperm concentration but abnormally low sperm motility and viability. When sperm retrieval is desired in this population, emphasis should be placed on initially trying the simple methods of penile vibratory stimulation or electroejaculation before resorting to more advanced and invasive surgical procedures.

Assessment of risk factors responsible for difficult weaning from mechanical ventilation in adults

The aim of this work is to identify the most important risk factors responsible for difficult weaning from mechanical ventilation in adult patients. A prospective cohort study. Respiratory Intensive care unit of Alexandria main University Hospitals. Thirty one patients requiring mechanical ventilation with difficult weaning according to Brochard's classification. After failure of weaning on PSV mode of mechanical ventilation, the patient is reevaluated to detect the risk factors responsible for difficult weaning. Eighteen patients [58%] were successfully weaned and thirteen [42%] failed weaning trials and finally died. Of the thirty-one studied cases, 16 [52%] were males. Mean age of the studied patients was 57.7 +/- 15 and mean BMI was 30 +/- 7.9. Twenty-one patients [67.7%] required prolonged mechanical ventilation and ten [32%] required less than 14 days. Mean of Rapid Shallow Breathing Index measured during SBT was 56 +/- 9 breaths/min per L among cases who were successfully weaned from MV and 122 +/- 19 breaths/min per L among those who failed weaning trials. Mean CROP index value was 38.7 +/- 11 ml/breath per min among cases who were successfully weaned and of significantly lower value 7.5 +/- 2.6 ml/breath per min among those who failed weaning trials and finally died, [p = 0.00]. In the present work; risk factors that found to be responsible for failure of weaning trials were recent infections [pulmonary and/or extra-pulmonary] that were detected in all the studied cases [100%], disturbances in the trace elements and electrolytes in 26 cases [83.8%], cardiovascular dysfunctions in 18 [58%], psychological problems in 12 [38.7%], endocrinal disturbances in the form of hypothyroidism in 3 [9.6%], nutritional deficiency in 27 [87%], neuromuscular dysfunctions in 14 [45%] and other additional co-morbid problems as hepatic or renal impairment in 15 patients [48%]. In the present work; EMG and nerve conduction study was done to 19 cases with difficult weaning. The results showed 26% with normal picture, 63% with moderate to severe axonal sensory motor peripheral neuropathy and 10.5% with a picture of myopathy. Regarding the effect of neuromuscular dysfunctions on the outcome of MV, in the present study, 33% of the patients with polyneuropathy failed weaning trials and finally died [p = 0.798]. The present study stresses on the importance of neuromuscular assessment in all cases with difficult weaning as this may be an important contributing factor for difficult weaning and prolonged mechanical ventilation. All potential causes of ventilator dependency should be identified when a patient is difficult-to-wean. Then, a plan should be developed that uses a multidisciplinary team approach to correct the reversible causes of weaning failure and facilitates weaning thereafter

Sleep-related breathing disorders in patients with Schistosomal cor-pulmonale

Schistosmiasis has long been an endemic disease in Egypt and an important cause of pulmonary hypertension. We aimed to investigate the clinical and polysomnographic features of sleep-related breathing disorders [SRBD] in patients with schistosomal cor-pulmonale and to evaluate their effects on pulmonary hemodynamics. We studied 10 stable patients diagnosed with schistosomal pulmonary hypertension [7 males and 3 females their mean age was 43.7 +/- 8.04] and 10 healthy volunteers matched for age, sex and BMI. Patients' exclusion criteria were: smoking, morbid obesity, other secondary causes of pulmonary hypertension, systemic hypertension, ischemic or rheumatic heart disease or left heart failure. All patients underwent overnight polysomnography or ambulatory cardiorespiratory sleep studies, spirometry, ECG and echocardiography. Daytime sleepiness was also assessed using the Epworth sleepiness scale [ESS]. The mean AHI in patients group was 20.0 +/- 11.34/h while in the control group it was 2.3 +/- 1.16/h. 80% of the patients were found to have an AHI > 10/h and 60% had moderate to severe sleep apnea [AHI >/= 15/h]. In addition, the majority of the patients [80%] spent > 30% of the night with an arterial oxygen saturation <90%. SRBD were not correlated with anthropometric measures, spirometry nor with the typical symptoms of SA such as excessive sleepiness as assessed by ESS. More importantly, SRBD were significantly associated with measures of pulmonary hypertension severity, and patients with moderate to severe SA had more impaired cardiovascular function as indicated by more severe right ventricular dilatation [p = 0.036] than patients with mild sleep apnea. SRBD are highly prevalent in patients with schistosomal pulmonary hypertension [PH]. Also, the SA severity was correlated with more advanced PH and more severe cardiovascular impairment. Therefore in the evaluation of patients with schistosomal PH, polysomnography or an ambulatory cardiorespiratory sleep study seems justified to identify potentially treatable SRBD that may additionally challenge the already compromised cardiovascular system in these patients

role of the biomarker and the genetic polymorphism of endothelin-1 in pulmonary arterial hypertension among Egyptians

This study analyses for the first time endothelin-1 [ET-1] level, and gene polymorphisms for endothelin-1 [EDN1 gene] in patients with pulmonary arterial hypertension [PAH] in Egypt. Cross-sectional study. Large, tertiary care, Alexandria university teaching hospital, Chest Department. Thirty subjects with PAH with 30 control subjects. Subjects were divided into two groups of matched age and sex were allocated. The first group consisted of thirty subjects, >/=18 years one group with no apparent evidence of disease free from pulmonary hypertension after full medical history, examination, and selected investigations [control group]. The second group consisted of thirty subjects, >/=18 years, suffering from pulmonary hypertension. All subjects who had a documented pulmonary hypertension with routine Echodoppler study were screened for endothelin-1[ET-1] and Gene polymorphism. Measurements and results: This study analyzed the frequency and the potential role of endothelin- 1 and gene polymorphisms, the +134 del/insA, located in the gene encoding for endothelin-1 [EDN1] in PAH. Thirty patients with pulmonary hypertension [12 [40%] men] were included in the study [Table 1]. The mean age of the patients was 53.5 +/- 12.8 years range from 34 to 72 years. The two groups of patients and control subjects were matched as regard the age and gender. The endothelin-1 mean was 1.8 +/- 1.3 fmol/ml with range from 0.3 to 3.8 fmol/ml in the patients group. The endothelin-1 mean was 0.7 +/- 0.05 fmol/ml with range from 0.6 to 0.75 fmol/ml in the patients group. There was a significantly higher level of endothelin-1 in the group of pulmonary hypertension [p < 0.001]. For the groups of polymorphisms studied, there was three genotypes [GT, TT, and GG], no substantial differences in genotype and allele distributions for +134 del/insA located in EDN1 gene, between PAH patients and control population, were observed [DF = 1; C.I. = 95.0; and p= 0.226]. The genotype GG show the highest level of endothelin while the TT type show the lowest value of endothelin-1. Also, we found a significant relation between the higher endothelin-1 level and the lower oxygen saturation [p= 0.049], and the higher meanPAP [p =0.004]. In conclusion, our findings suggest a potential link between endothelin-1 level and specific genotypes in the EDN1 gene and susceptibility for PAH with a worse haemodynamic profile. Further investigations are warranted to understand the molecular basis and to confirm the potential clinical importance of these findings on larger cohorts of patients with PAH. This will impact on the management of PAH of Egyptian patients in the near future

Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: randomized clinical trial

This randomized controlled study was designed to compare the effectiveness of local injection of autologous platelet rich plasma [PRP] and local steroid in reducing pain and improving function in a cohort of patients with tennis elbow [TE] and plantar fasciitis [PF]. The study population comprised two groups; Group 1 patients with TE [n = 30] and Group 2 patients with PF [n = 30]. In each group patients were allocated randomly to receive either a steroid or PRP injections. All patients filled in visual analog scale [VAS], disability of arm, shoulder and hand [DASH] score for TE and foot health status questionnaire [FHSQ] for PF at base line and after 6 weeks. Relative to TE group of patients significant differences were observed between VAS and DASH scores at base line and 6 weeks after treatment in both groups [p < 0.001]. While no significant differences were observed relative to VAS and DASH score changes between both groups [p > 0.05]. In PF patients comparison of VAS and FHSQ at base line and 6 weeks after treatment between control group and PRP group showed significant differences for VAS [p = 0.005 and p < 0.001, respectively], and for FHSQ [p = 0.03 and p < 0.001, respectively]. While highly significant difference were observed between both groups regarding VAS and FHSQ changes [p = 0.001]. Local injection of autologous PRP proved to be a promising form of therapy for TE and PF. It is both safe and effective in relieving pain and improving function and superior to local steroids in PF

use of thoracoscopy in a rare cause of massive pericardial effusion

In multiple myeloma the involvement of the pericardium is very rare and usually caused by amyloidosis, infections, bleeding abnormalities or plasma cell infiltration, usually at a late or terminal stage of the disease. Constructive pericarditis and massive pericardial effusion is a rare presentation in this disease. The clinical picture includes slowly progressing pericardial effusion as well as emergency pericardial temponade. Treatment typically consists of surgical management of the effusion by means of pericardial fenestration. Medical thoracoscopy is a non-invasive, simple procedure that gained popularity among interventional pulmologists and which has not been reported before in the management of multiple myeloma pericardial effusion. We present a male patient that was diagnosed with non-specific chronic pericarditis associated with massive pericardial effusion. This is the report of management of pericardial tamponade by means of thoracoscopic pericardial fenestration

Myasthenia gravis: towards a safe anaesthesia technique, five years clinical experience in Hamad medical corporation, Qatar and review of literature

Myasthenia gravis [MG] is a disease with many implications for the safe administration of anesthesia and involves considerable morbidity and mortality. Myasthenia gravis is caused by autoantibodies to postsynaptic nicotinic acetylcholine receptors at the neuromuscular junction, causing weakness of skeletal muscles. Patients with thymoma-associated MG produce autoantibodies to a variety of neuromuscular antigens, including antibodies to the skeletal muscles calcium release channel and antibodies to cytoplasmic filamentous proteins. Thymectomy is a common surgical procedure in patients with myasthenia gravis.. Our aim is to review and document retrospectively our initial experience of providing a safe general anaesthesia technique involving continuation of preoperative anticholinesterase doses, use of non-paralyzing technique, and use of ultra-short acting anesthetics and cautious reintroduction of anticholinesterase after surgery. Eight patients underwent thymectomy from January 2002 to March 2006 under general anaesthesia technique involving continuation of preoperative anticholinesterase doses, avoidance of muscle relaxants, and use of ultra-short acting anesthetics and cautious reintroduction of anticholinesterase after surgery. Demographic and clinical data, preoperative symptomatology, treatment history, intraoperative and post-operative data, and distribution of patients according to intubating grade were recorded and analysed. All our patients who underwent trans-sternal thymectomy using the above technique were extubated on operating table following administration of intravenous anticholinesterase and anticholinergic drugs. There was no postoperative morbidity or mortality. None of our patients needed ventilatory assistance in the postoperative period. Patients can be extubated on table safely after thymectomy if we avoid muscle relaxants and use ultrashort acting anesthetics intraoperatively. Surgical exposure and technique was adequate in all our patients. This technique was safe and effective in all of our 8 patients who underwent trans-sternal thymectomy