Severe pneumonia requiring ICU admission: revisited

To describe the aetiology, outcome and management approach for patients with community acquired pneumonia [CAP] and hospital-acquired pneumonia [HAP] who required ICU admission and to determine the predictors of mortality. A prospective observational study of 119 consecutive patients who were admitted to the ICU with diagnoses of CAP [n = 89] or HAP [n = 30] from May 2011 until December 2012. The overall ICU and hospital mortality rates for CAP and HAP were 24.4% and 30.3%, respectively. There were no significant differences between the patients with CAP and HAP in terms of ICU mortality or the average length of hospital stay. The most commonly isolated pathogens were H1N1 [23%] and Streptococcus pneumonia [17%] in the patients with CAP and Acinetobacter baumannii [37%] in the patients with HAP. Multidrug resistant [MDR] organisms were detected in 32 [38.6%] isolates. The median time for receiving antibiotics was 2 h. Most of the patients [82%] received double antibiotic coverage. Multiple regression analysis identified septic shock [beta = 0.43, p < 0.001], acute respiratory distress syndrome [ARDS] [beta = 0.34, p = 0.003], and the pneumonia severity index [PSI] [beta = -0.36, p < 0.024] as significant predictors of mortality. The outcomes of patients with severe pneumonia who were admitted to the ICU were better than those of previous reports. Early administration of combination antibiotics was practiced with vigilance. MDR organisms and respiratory viruses were the commonly isolated pathogens. The presence of septic shock, ARDS and high PSI were independent predictors of mortality

Natural vegetation at middle and high altitudes region in Lawder and Mukairas, Abyan Governorate, Republic of Yemen

This study aims at identifying the nature of natural vegetation at the middle and high altitudes regions in the area under study .The field study has shown the vegetation affluence of this region, of which 116 plant species, belonging to 86 genera and distributed among 45 families, have been collected .It has also illustrated the prevalence of the communities of herbs, shrubs and dwarf hushes. Moreover, the study has demonstrated that there is a plant variation between Lawder and Mukayras due to the increase in their altitudes. It is worth mentioning that some plant species, such as Anisotes trisulcus, have been extinct [disappeared] in the areas with an altitude of 1500 rns. The region under study is characterized by unique different ecological factors and circumstances: weather and geotopography such as cliffs, slopes and the prevailing rock structures, in addition to the weakness of soil profile with scarce and intermittent rainfall. Besides, it has been noticed that there are some succulents that have been prevailed such as Adenium obesum, Euuphorbia spp. and Caralluma spp

Hormonal levels, semen parameters and presence of antisperm antibodies in patients treated for testicular torsion

In spite of prompt diagnosis and either orchiectomy or preservation of the affected testis, infertility remains a significant sequel of testicular torsion. The objective of this study was to evaluate late endocrine profile, seminal parameters and antisperm antibody levels after testicular torsion and to analyze the impact of orchiectomy or detorsion on the organ's fate. This is a cross-sectional study that involves 17 patients evaluated after testicular torsion 12 patients were treated with orchiectomy [group 1] and 5 were treated with orchiopexy [group 2]. All patients were assessed by semen analysis, endocrine profile [follicle-stimulating hormone [FSH], luteinizing hormone [LH] and testosterone] and seminal antisperm antibody levels. A group of 15 proven fertile men was used as the control group. Results: Median ischemia time in group 1 [48hs] was significantly higher than in group 2 [7hs]. Both groups demonstrated a decrease in sperm count and morphology compared with controls.; Group 1 showed a significantly higher motility than group 2 [p=0.02]. Group 1 also showed a significantly better morphology than group 2, [p=0.002]. All patients presented an endocrine profile within normal ranges and no significant difference in antisperm antibody levels was detected between the groups. However, a trend for higher levels was found in patients treated for testicular torsion, regardless of the fate of the testis. Moreover, no significant correlation was found between antisperm antibody levels and age at torsion, ischemia time, seminal parameters or treatment applied. We found that after torsion, patients maintain hormonal levels within normal ranges. Testicular fate did not have any correlation with the formation of antisperm antibodies. Although sperm quality is preserved in most of the patients with the exception of sperm morphology, patients treated with orchiectomy presented better motility and morphology compared with the detorsion group

Protective effect of Jasonia montana against ethinylestradiol-induced cholestasis in rats

Estrogens, and particularly glucuronides such as ethinylestradiol [EE], have been shown to cause cholestasis in animal studies, by reducing bile acid uptake by hepatocytes. The aim of the present article is to investigate anticholestatic activity of the ethanolic extract of the aerial parts of Jasonia montana against liver cholestasis induced by EE in adult female rats in an attempt to understand its mechanism of action, which may pave the way for possible therapeutic applications. Subcutaneous administration of 100 micro g/kg b.w. ethinylestradiol to rats induced hepatocellular cholestasis with a significant decrease in serum cholesterol, bile acids and bilirubin levels as well as in hepatic superoxide dismutase [SOD], glutathione peroxidase [GPx], glutathione reductase [GR] activities and hepatic total, protein-bound and non-protein sulfhydryl groups. Also, treatment with EE produced significant increase in serum Pi-glutathione-s-transferase [Pi-GST], gamma glutamyl transpeptidase [gamma-GT] and alpha-glutathione-s-transferase [alpha-GST] activities as well as serum nitric oxide [NO] and tumor necrosis factor alpha [TNF-alpha] level and hepatic malondialdehyde [MDA] level as compare to control group. Oral administration of the aerial parts of ethanolic extract at a concentration of 150 mg/kg b.w. daily to rats treated with EE for 15 days showed a significant protection against-induced decrease in serum cholesterol, bile acids and bilirubin levels. The treatment also resulted in a significant increase in hepatic SOD, GPx and GR activities as well as hepatic total, protein-bound and non-protein sulfhydryl groups. In addition, the extract could inhibit serum Pi-GST, gamma-GT and alpha-GST activities as well as reduce serum TNF-alpha, NO and hepatic MDA as compare to ethinylestradiol treated rats. High content of flavonoids and phenolic compounds was found in ethanolic extract, which may be responsible for free radical activity. The results clearly suggest that the aerial parts of J, montana extract may effectively normalize the impaired antioxidant status in ethinylestradiol [EE]-cholestatic model. Thus the extract may have a therapeutic value in drug-induced biliary cholestasis as well as in hormonal therapy

Antidiabetic and antioxidant activity of Jasonia Montana extract in streptozotocin-induced diabetic rats

The aim of the present study is to investigate the antioxidant activities of the ethanolic and aqueous extracts of the aerial parts of J. Montana in streptozotocin- induced diabetic rats. Oral administration of both the aerial parts extracts at a concentration of 150 mg/kg b.w daily for 30 days showed a significant decrease in fasting blood glucose, hepatic and renal thiobarbituric acid reactive substances and hydroperoxides. The treatment also resulted in a significant increase in reduced glutathione, superoxide dismutase, catalase, glutathione peroxidase and glutathione-stransferase in the liver and kidney of diabetic rats. The results clearly suggest that the aerial parts of J. Montana treated group may effectively normalize the impaired antioxidant status in Streptozotocin induced diabetes than the glibenclamide-treated groups. The extract exerted rapid protective effects against lipid peroxidation by scavenging of free radicals by reducing the risk of diabetic complications. The effect was more pronounced in ethanolic extract compared to aqueous extract