Diagnostic utility and complications of flexible fiberoptic bronchoscopy in Assiut University Hospital: a 7-year experience

Few studies with small number of patients reported their experience with flexible fiberoptic bronchoscopy [FFB]. We aimed to report our 7-year experience with the diagnostic yield and complications of FFB at Assiut University Hospital. A retrospective review of bronchoscopy reports and corresponding patients' charts over 7 years from January 2006 to December 2012 performed at the Department of Chest Diseases, Assiut University Hospital, was done. Indication for procedures, suspected diagnosis, final diagnosis, and complications were reported. Of 3980 bronchoscopies, 3660 [92%] were diagnostic. Mean age was 45 +/- 18 years and 68% were males. Malignancy and infection, including tuberculosis [TB], were the 2 main indica-tions for FFB [47% and 23.8%]. The overall diagnostic yield was 67%. A total of 1690 broncho-alveolar lavage [BAL], 1303 brushing, 188 transbronchial biopsies [TBB], and 645 bronchial biopsies [BB] were performed. Malignancy was confirmed in 70% of suspected cases. Tuberculosis was diagnosed in 58.5% of suspected cases, whereas bacterial pneumonia was diagnosed in 48.5%. Bronchoscopy diagnosed 38.4% of patients with interstitial lung disease. The diagnostic yield was 55% for sarcoidosis and 33% for usual interstitial pneumonia. The overall complication rate was 1.61%. Mortality rate was 0.05%. Our results confirm that flexible fiberoptic bronchoscopy is a valuable diagnostic tool, with a low rate of complications, particularly in patients with lung cancer. The diagnostic yield in our locality is almost similar to that reported in other series

Oedematous skin disease in buffaloes [diagnosis and treatment]

Skin lesions in affected buffaloes were either closed [166 cases] or open [81 cases]. Forms of closed lesions [non-suppurative] included regional oedema [96], subcutaneous nodules [60] and granulating overgrowth [10]. According to duration of the disease open lesions [suppurative] were acute [47], sub-acute [19] or chronic [15]. Animals treated with combination of systemic anti-inflammatory, anthelmentic drugs and antibiotics showed the highest response. It was concluded that the use of broad spectrum anthelmentic [like ivermectine or levamisole] in combination with antibiotic and anti-inflammatory drugs can increase the response to treatment by improving unspecific immunity; the effect of the exotoxins of C. pseudotuberculosis indicates that further researches for production of toxoid are essential for controlling the disease

Intrapulmonary insulin reduces blood glucose in type 1 diabetic patients

Administration of biosynthetic insulin is the mainstay of treatment of type 1 diabetes. Because of the inconvenience of multiple daily injections, alternative methods are actively sought. Intrapulmonary insulin delivery is a new and promising method. The aim of the present work has been to assess its efficacy and safety. We conducted our study on 11 patients with type1 diabetes mellitus. The patients received in the fasting state 3 units / kg BW of unmodified insulin by inhalation using an air compression nebulizer. Pulmonary function tests [FEV1, FVC and PEF] were measured to rule out immediate side effects on the airways, and blood glucose and insulin were measured before and after insulin inhalation. No significant changes were observed in pulmonary functions. Blood glucose decreased from 289 +/- 107 mg/dl to 218 +/- 106 mg/dl after 120 minutes [P<0.01]. The percent change [d%] reached a maximum of -26 +/- 14.8% [min. 2.9 and max. 52%]. Meanwhile, serum insulin reached a peak of 144 +/- 162 micro lU/ml 10 minutes after the inhalation. The maximum% change in insulin level was observed at 40 minutes [714%]. However, great variability was observed between patients. One can conclude that insulin is absorbed effectively from the pulmonary bed and this route carries a good potential for insulin delivery. However, the great inter- individual variability will be a problem in dose prescription. Further studies are needed to assess the efficiency of intrapulmonary insulin delivery in controlling mealtime glucose peaks.

Effect of verapamil and diltiazem on basal and acth-induced corticosterone secretion in the rat

It has been proposed that calcium plays an important role in endocrine reactions such as hormone biosynthesis, release, secretion and action on tarhet organs. The aim of this study was to evaluate the effects of the ca++ channel blockers [verapamil and diltiazem] on basal and ACTH induced corticosterone secretion in the rat. ACTH produced an increase in the plama level of both corticosterone and glucose with peak effect occurring one and two hours respectively. In this respect, administration of verapamil [20 mg kg-1; p.o.] and diltiazem 20 mg kg-1;p.o.] to rats for 8 days produced nonisgnificant change in both basal or stimulated corticosterone levels after challenge doses of ACTH [4 units kg-1 s.c.]. similarly the fasting plasma glucose level was not significantly modified by neither verapamil nor diltiazem as compared with the control group. These results suggest that the ca++ channels blocked by verapamil and diltiazem may not be directly involved in steroidogenesis, at least in the rat. Further studies may however be needed to fully characterize the role of the ca++ channels and drugs of different chemical groups which modulate such channels

Cardioprotective effect of calcium channel blocers [verapamil] during ischemia/reperfusion after acute haemorrhage

An in-vitro study was designed to focus on effects of verapamil on the metabolic potential of cardiac slices after reversible ischemia in rats. The study included two main groups: Group A, non ischemia/reperfusion group and group B, ischemia/reperfusion group. Each was subdivided into two subgroups [a and b], each subgroup included ten experiments. Ischemic cardiac slices were obtained from rats subjected to 10 min hemorrhage to induce reversible global ischemia. The results revealed that there was an enhancement in the release of free fatty acids, and lactate and in glucose uptake in group Ba as compared with group Aa. These metabolic alternations produced by ischemic cardiac slices were revealed by verapamil addition but in group Ab, verapamil did not alter the release of FFA and lactate from non- ischemic cardiac slices, whereas it inhibited glucose uptake from these slices. The improvement of the metabolic alternation of ischemic myocardium indicates that verapamil may be of importance in reducing the extent and severity of acute myocardial ischemic injury in acute hemorrhage

Effects of Beta 2 adrenergic agonist [terbutaline], in dogs with acute hyperkalemia

This work was carried out to study the effects of gradually increasing doses of terbutaline [B2 agonist] on canine model of acute hyperkalemia to evaluate the possible use of B2 agonists in the management of acute hyperkalemia. The latter was induced by IV. infusion of Kcl during the whole period of the experiment, 4 hours. Potassium chloride infusion leads to a gradual increase in plasma K+ and no significant change in plasma glucose or arterial Bp. Hyperkalemic ECG changes depend on plasma K+ level ending in marked widening of QRS and large undulated pattern and lastly asystole. Administration of terbutaline IV in gradually increasing doses, and increasing by the same for 5 doses, resulted in dose related decrease of plasma K+ and increase in glucose levels. Also, terbutaline converted ECG changes induced by Kcl loading to sinus rhythm and prevented the ECG changes resulting from continuous Kcl infusion. The effect of terbutaline is mediated through stimulation of B2 receptors, since it is blocked by non selective blockade B1 and B2 [propranolol] and not by selective B1 blockade [atenolol]. So, correction of hyperkalemic ECG changes following terbutaline is a result of a decreased plasma K+ level, which is blocked by propranolol and is not affected by atenolol

Prophylactic and therapeutic effects of prostaglandin E1 on the disease activity in adjuvant arthritic rats

The effect of oral prostagladin E[1] on the disease activity, histolpathological pattern of gastrointestinal tract and on serum cortisol level were:studied in rats rendered arthritic by intradermal inoculation of Freund's adjuvant In the arthritic rats PGE[1] 100ug/kg/day orally was given first day of adjuvant inoculation till full development of arthritis [28 days] i.e as a prophylactic agent or given after establishment of arthritis for 2 weeks i.e. as a therapeutic agent. It was found that the prophylactic or the therapeutic administration of PGE[1] significantly decreased the arthritic disease activity as evidenced by the reduced development of paw oedema, increased pain threshold and correction of biochemical inflammatory markers namely serum C-reactive protein and serum albumin. The histopathological examination revealed marked gastrointestinal trophic action of PGE[1] which was more pronounced in the stomach. Serum cortisol level was significantly raised in the groups treated with PGE[1] The present findings strongly suggest the prophylactic and therapeutic value, of oral PGE[1] and investigate some of the possible underlying mechanism for their action in rheumatic diseases. However, further studies are needed to confirm the efficacy and safety of PGE[1] in management of arthritis

Comparative study of verapamil, isradipine and cimetidine on the gastric changes induced by stress or indomethacin

The influence of the calcium channel blockers verapamil and isradipine on gastric ulceration and glandular wall mast cell count in rats was investigated and compared with that of cimetidine [H2 antagonist]. Two different models for induction of experimental gastric ulcer were performed; cold restraint stress ulcer and indomethacin - induced gastric ulcer. Restraint at 4°C for 1 h or single bolus dose of indomethacin 30 mg/kg p.o, produced a marked gastric mucosal ulceration in saline pretreated controls. The pretreatment with single I.P injection. of either cimetidine [100 mg/ kg], verapamil [4 mg/kg] or isradipine [0.5 mg/kg] 30 minutes before cold restraint or indomethacin administration produced a significant reduction in mean gastric ulcer severity score and reduced incidence of ulceration in both macroscopic and microscopic examinations of stomachs of different groups. Both verapamil and isradipine are more or less equally effective in reducing gastric damage produced by either stress or indomethacin, however, cimetidine produced significant greater protective action. Cold restraint produced a marked decrease in mucosal mast cell count. This degranulating action of stress was prevented with verapamil or isradipine but cimetidine did not produce any significant effect. It is possible that decreased amine release [Histamine and 5 HT.] from mast cell may be responsible for the antiulcer effect of Ca channel blockers, since mast cell degranulation seems to play an important role in pathogenesis of stress gastric ulcers. Other suggested anti-ulcer mechanisms of Ca[++] channel blockers are discussed in the light of the available literature, including decreased stomach wall motility, reduced gastric acidity, peripheral and central interference with vagal overactivity, stimulation of gastric PG, synthesis and/or antioxidant action that counteract stimulation of gastric lipid peroxidation produced by stress or indomethacin. This study proved the potential value of Ca" channel blockers in the management of two different models of experimental gastric ulcers, however, a controlled clinical study is needed before any attempt to extrapolate ulcer therapy in rats to ulcer therapy in man

Experimental and clinical evaluation of a mixture of medicinal plants commonly used in folk therapy of diabets mellitus

A mixture of raw dried and grounded medicinal plants [Nigella Sativa, Chamomella, Damsesa, Mahlab and Aloe]and two legumes [Helba and Termis] in a proportion of one volume of each medicinal plant, and five volumes of each legume has been largely used in Folk medicine by many diabetics for better control of blood glucose Ievel. The present study was conducted to examine the effect of this mixture on fasting and 2 hours post prandial serum glucose levels and fasting serum insulin level in alloxan diabetic albino rats and in parents with type II diabetes mellitus. The results revealed that oral administration of the tested mixture to alloxanized rats [0.5 gm/kgm/day] and to diabetic patients [5 gm/day] for two or four weeks produced statistically significant lowering of fasting and 2 hours post prandial serum glucose levels accompained with a significant elevation of serum insulin level. Histopathological examination of pancreas of alloxanized rats demonstrated that this mixture produced a marked increase in the size of islet tissue with significant recovery of the destructed B-cells. This study is a preliminary report of the antidiabetic action of this tested mixture. Further well controlled studies are required to evaluate the efficacy and safety of long term use of this mixture and to investigate the possible underlying mechanism [s] for it's antidiabetic action

Isradipine and indomethacin effects on collagen adjuvant arthritic rats

This work was carried out to study the effect of a relatively new calcium channel blocker "isradipine" on some therapeutic and side effects of indomethacin. Inflammatory collagen polyarthritis model which bears resemblence to rheumatoid arthritis was induced by injection of collagen in complete Freund's adjuvant. Treatment of arthritic rats either by indomethacin or isradipine or combination of both drugs for 15 days resulted in significant analgesic activity as evaluated by the analgesimeter. Meanwhile, indomethacin either alone or in combination with isradipine reduced the rats hind paw thickness. Induction of arthritis was accompanied by significant elevation of serum C-reactive protein and a decrease in albumin, with no significant change in cortisol levels. These parameters were not significantly affected by treatment with any drug i.e. these drugs improved the symptoms and did not affect the progress of the disease. Histopathologic changes of the stomach revealed that, isradipine improved the gastric lesions of nontreated and indomethacin treated arthritic rats. Also, isradipine partially protected the kidney from renal tubular necrosis and interstitial nephritis caused by indomethacin. It could be concluded that administration of calcium channel blockers in association with N.S.A.I.Ds in rheumatologic practice may be used to increase the analgesic effect and decrease the gastric erosion and nephrotoxicity of NSAIDs

Effect of calcium antagonists on rat's testis; serum prolactin and testosterone

The effect of chronic administration of phenylakylamine derivatives [Verapamil] on the gonadal structure and function of adult male rats were investigated and compared with dihydropyridine dervatifves [nifedipine and isradipine] 64 male albino rats were included in this study, they were divided into four equal groups the first group received water and served as control Verapamil 20 mg/kg/day, nifedipine 1 mg/kg/day and israpidine 0.3 mg/kg/day were given orally through a stomach tube without anaesthesia for 6 weeks to group II, III and IV respectively. Serum testosterone and prolactin were estimated by radioimmunoassay method. Furthermore, histopathological study of testis was performed Verapamil included marked alteration in histopathology of testis, which was followed by some recovery after drug withdrwal serum prolactin was significantly increased while serum testosterone was significantly decreased. The histopathologic changes in testis following nifedipine were less marked but irreversible, however, no significant decrease in serum testosterone level were observed. Israpidine, neither, induced histopathologicl changes in testis, nor changes in serum prolactin and testosterone thus, this study shows that the effects of calcium antagonists are variable on fertility, though israpidine is more safe for long term therapy

Effects of interaction between gliclazide and some calcium channel blockers on serum glucose, insulin and cortisol levels in non-diabetic and diabetic albino rats

The present work was conducted to study the effects of some calcium channel blockers[nifedipine and verapamil] on fasting serum glucose, insulin and in alloxan diabetic rats. Also the interactions between these calcium channel blockers and the oral hypoglycaemic sulfonylurea [gliclazide] were studied following the same parameters. It was found that oral administration of verapamil 20 mgm/kgm/day or nifedipine 1 mg/kgm/day for 15 succes sive days produced a significant elevation of serum glucose level accompanied by a significant reduction of serum insulin level in non diabetic rats, meanwhile in diabetic rats although they had significant reduced serum insulin level they did not elevate serum glucose level. This is probably due to some potential hypoglycaemic effects of calcium channel blockers that are only working in diabetic rats e.g. reduction of intestinal glucose absorption in diabetic rats and/ or blockade of the effects of hyperglucagonaemia that often prevails in type ll diabetes mellitus. Gliclazide 18 mg/kgm/day for 15 successive days produced a highly significant reduction of serum glucose level, accompanied by significant elevation of serum insulin in both non diabetic and diabetic rats. Coadministration of either calcium channel blockers with gliclazide significantly reduced it's hyperinsulinaemic effect in both groups of rats, whereas the gliclazide hypoglycaemic effect was abolished in non diabetic rats but in diabetic rats it was not signigicantly affected. As regards serum cortisol level neither verapamil nor nifedipine could produce any significant changes. Gliclazide elevated serum cortisol in nondiabetic rats only, such an effect that was abolished by coadministration of verapamil of nifedipine. Therefore, until a further detailed clinical study is available, it may be justifiable to follow up blood glucose level in patients under calcium channel blockers therapy and care should be exercised in using these drugs in potentially diabetic individuals. As regards the use of calcium channel blockers in diabetic patients under treatment with oral sulfonylurea, although they did not seem to adversely affect the control of diabetic state inspite of their hypoinsulinaemic effect as the present animal study proved, yet further evaluation of such interaction in human is still needed

How accurate are household spoons in drug administration?

The type of household spoons or measuring devices used by 630 mothers in Kuwait when administering drugs to children was determined. Only a very small percentage of mothers used calibrated measuring devices. The rest used household spoons: 99% in the case of those measuring out teaspoonfuls and 92.5% of those measuring out tablespoonfuls. The capacity of the household spoons used was found to range from 2.5 to 5.0 ml for teaspoons and 7.0 to 15.0 ml for tablespoons. Of the mothers using household spoons, 93.5% used a teaspoon with a capacity of

Reactions of 1-phenyl-5-arylazo-4-thiohydantoin derivatives with grignard reagents, acrylonitrile and chloroacetic acid

Addition of organomagnesium compounds to the conjugation created by the attachment of an exocyclic double bond to a heterocyclic nitrogen ring, having a carbonyl function, has been reported in the case of 5-arylidene-2-thiohydantoin [la], and 5-arylidene-4-thiohydantoin [Ib] yielding the corresponding saturated derivatives [2]

Synthesis of some new thiazolo [4,3-b] quinazolone and thiazolo [2,3-b] quinazolone derivatives

5H-thiazolo [4, 3-b] quinazoline-3,5[lH]-dione [III] was, synthesized via reaction of anthranilic acid with 2-thiazoli-dinone-4-thione [Ib]. 1-Arylidene and 1-arylazo derivatives of III [IVa-c] and [Va-c] were prepared by the action of anthranilic acid on 5-arylidene-4-methylmercapto-3-thiazolin-2-one [Vla-c] and 5-arylazo-2-thiazolidinone-4-thione [VIIa-c] respectively. Similarly 2-arylidene-and 2-arylazo-5H-thiazolo [2,3-b quinazoline-3,5 [2H]-diones [IXa-c] and [XIa-c] were obtained by the action of anthranilic acid on 5-arylidene-2-ethylmercapto-2-thiazolin-4-one [Vllla-c] and 5-arylazo-2-methylmercapto-2-thiazolin-4-one [Xa-c] respectively

Intestinal lymphomas; a clinico-pathological study

Forty two cases of intestinal lymphoma were considered in this study. In 26 cases, the lymphoma was confined within the wall of the gut [9 small intestine, 14 ileoceacal and 3 colon]. In the remaining 16 cases the lymphoma was confined to the mesentric and retroperitoneal lymph nodes. Abdominal pain and/or mass was the main clinical presentation. Intestinal obstruction or perforation come next. Using Rappaport's classification, the diffuse poorly differentiated lymphocytic was the most frequent histologic type [40%] and DHL was the second commonest [22%]. Staging at the time of presentation was available in 20 cases [50% were stage IIE]