Value of TC-99M DMSA scintigraphy in urinary tract infection: comparative study with other imaging modalities

Urinary tract infection [UTI] is a common medical problem. It causes considerable morbidity specially if complicated, can cause severe renal damage. The aim of this study is to evaluate value of Tc-99m DMSA in UTI comparing with ultrasound and CT scan. We analyzed a random sample of 63 patients approved to have urinary tract infection. Abdominal ultrasound, CT, and [99m] Tc-DMSA scintigraphy of the kidneys were performed in all patients. Tc-99m DMSA scan showed scintigraphic changes consistent with pyelonephritis in all patients. The involvement was either unilateral in 53 patients [84%] or bilateral in 10 patients [16%]. The number of diseased kidneys were 73/126 [58%], 16/73 kidneys had abnormal unifocal defects [22%], 27/73 kidneys had multifocal defects [37%], while 30/73 kidneys had diffuse hypoactivity [41%]. The sensitivity of CT scan in detecting pyelonephritis was 82.8% while the sensitivity of ultrasound was poor [23.8%] and there was a statistically significant difference between the sensitivity of ultrasound and that of Tc-99m DMSA. Tc-99m DMSA is reliable diagnostic, cost-effective, simple, safe and noninvasive modality and may be taken as a routine procedure for the patients with clinical suspicion of upper UTI whenever the facilities are available

Believes and attitudes of critical care nurses toward family presence during cardiopulmonary resuscitation [CPR] in selected hospitals at Assiut

The concern over family witnessed cardiopulmonary resuscitation [CPR] has been a frequent topic of debate in many countries. The Emergency Nurses Association [ENA] has formally resolved that family presence [FP] during resuscitation is the right of the patient and is beneficial for both patients and family members. This descriptive study was designed to identify believes and attitude of nurses working in critical care units toward family presence during resuscitation and to examine factors influencing them believes and attitudes. To achieve the research objectives two research questions were addressed. First: What are the critical care nurses' believes and attitude toward FP during resuscitation? Second: What are the factors that influence critical care nurses' believes and attitudes toward FP during CPR? The studied sample included 208 nurses working in critical care units in three hospitals at Assiut .A self-administered questionnaire have been administered to those nurses. All participants hold either Diplomas or Bachelor's degree [Bsc] in nursing with working experience less than five years. The most of participants believes that family should not be allowed to he present during CPR. Two thirds of the nurses disagreement that family presence is a patient right. As regard nurses attitudes toward family presence during CPR 64% of them stated that family presence increases the Stress level for CPR team members, more than half of nurses mentioned that family presence interferes with resuscitation effort and lead to increased malpractice Suits. Study findings concluded that the majority of nurses working in critical care units under study do not support family presence during resuscitation attempt; logistic regression analysis indicated that those nurses who support family presence correlated strongly with years of experience and type of institution but was not predicted by age, gender, level of education. Further studies are recommended to investigate attitudes on a more representative sample and in a wider geographical area; efforts to change their attitudes should aim at setting up a mechanism that facilitates the practice and at relieving their concerns on legal liability. Experimental and qualitative methods are especially recommended to investigate the effect of family presence during resuscitation on patients, families, nurses and physicians, and other multidisciplinary staff member

study of DNA damage and antioxidant defense in the peripheral leucocytes of diabetic mothers and their newborn infants

Oxidative stress plays a key direct and indirect role in the pathogenesis of several diabetes and pregnancy related complications in both diabetic mothers and their infants. Forty women and their newborn infants divided into two groups were studied. Group I included 20 diabetic women and their newborn infants. Group II consisted of 20 clinically healthy women and their twenty newborns as controls. All involved mothers and newborns were subjected to detailed history, thorough clinical examination, routine laboratory investigations, imaging studies, and specific laboratory investigations including assessment of glycosylated hemoglobin [HbA1C] for diabetic mothers, and erythrocyte antioxidant enzymes [superoxide dismutase, catalase and glutathione peroxidase] and DNA fragmentation assay for mothers and neonates of both groups. It was found that 25% of the diabetic women had diabetic complications. About 1/3 of the newborn infants of diabetic mothers were large for gestational age, 10% of them had major congenital anomalies [cyanotic heart disease and meningomyelocele] and 15% of them died. Levels of erythrocytes glutathione peroxidase and catalase were significantly lower in diabetic mothers and their infants than those in nondiabetic mothers and their infants. DNA damage, mainly in the form of apoptosis was present in diabetic mothers and their infants [60% and 50% respectively]. There was a significant difference between the values of maximal optical density at 200bp and 600bp between both groups. Comparison between diabetic mothers with and without diabetic complications as regards HbA1C, antioxidants and DNA damage showed that erythrocytes catalase was significantly lower in those with complications [means 366 +/- 54 units/g Hb, 426.3 +/- 45.7 units/g Hb respectively] as a possible explanation for complications in this group. There was a significant negative correlation between HbA1C of diabetic mothers [i.e. diabetic control] and glutathione peroxidase level [i.e. antioxidant defense] in their infants. A significant negative correlation was found between DNA damage and erythrocytes antioxidant [Superoxide dismutase in diabetic mothers, and glutathione peroxidase in their infants]. It can be concluded that hyperglycemia causes a significant reduction of antioxidant capacity [reduced catalase and glutathione peroxidase] in the diabetic mothers and their infants compared with controls and this may be the cause of increased DNA damage observed in these individuals which may lead to the development of diabetic complications in the pregnant mothers and congenital anomalies in their infants. It is recommended to maintain a good control of diabetes and combat oxidative stress to lessen diabetic complications in pregnancy and to avoid congenital anomalies

Evaluation of the efficacy of concurrent cisplatin and radiotherapy in locally advanced head and neck cancer

Thirty-six patients with locally advanced unresectable head and neck squamous cell carcinoma were included in this study. All patients received radiotherapy by cobalt60 machine. They received 70 Gy to the tumor area in 35 fractions for 7 weeks and 50 Gy to the uninvolved cervical and supraclavicular LN in 25 fractions for 5 weeks duration [cisplatin]. Concurrent cisplatin [CDDP] was infused in 3 hours and 1/2 hour before radiotherapy. The dose of CDDP was 20 mg/m2 from day 1 to 5, day 22 to 26 and day 43 to 47. The patients were evaluated for response at three weeks after the completion of irradiation and every month for six months, then every three months. The assessment of the response to treatment showed that the overall response was 75% [61% complete remission [CR] and 14% partial remission [PR]]. Six patients showed a stationary course and three patients showed disease progression. Acute toxicity was tolerable and no treatment interruption occurred. The most frequent toxicity was vomiting GI in 21 patients, stomatitis GII in 17 patients and dryness of the mouth GII in 23 patients. Finally, the results of concurrent radio- and chemotherapy were encouraging and a large number of patients and a long time follow up are needed to assess the improvement in survival