Diagnosis of major bacterial causes of culture negative meningitis in children

The study included 250 patients admitted to fever hospitals in Egypt with suspected clinical signs and symptoms of bacterial meningitis, their age ranged from six months up to eleven years. Cerebrospinal fluid [CSF] samples isolated from patients were transported to the central health laboratories for confirmation of diagnosis. Physical, cytological, chemical examination for glucose and total protein concentration. Gram stained smear, culture on blood and chocolate agar were done. 62 [24.8%] CSF samples were culture negative and no bacterial organisms could be detected by direct gram stain. All these samples were further examined by latex agglutination and RT-PCR. Samples which found to be culture positive were excluded from this study. 15 samples of them [24.2%] were positive by RT-PCR.7 of them [46.6%] were Heamophilus influenza b [H. influenza b] and 8 samples of them [53.3%] were Streptcoccus pneumoniae [S. pneumoniae]. Out of 15 RT-PCR positive samples 12 of them [80%] were Latex positive, while 3 of them [20%] were Latex negative, one of the three was S. pneumoniae, while the others were H. influenza b by RT-PCR only. Out of 62 culture negative CSF samples 47 [75.8%] had a history of previous antibiotic use. 11samples of them [23.4%] were positive by latex agglutination [5 samples were H. influenza b and 6 samples were S. pneumonia] and 3 samples of them [6.3%] were positive by RT-PCR and negative by latex agglutination. Out of 15 RT-PCR positive samples, 8 of them were clear [53.3%], 3 of them were turbid [20%], and 4 of them were bloody [26.6%]. 10 CSF samples out of the 15 samples [66.6%] had normal cytological profile, 6 samples [40%] had normal CSF glucose levels and 3 samples [20%] had normal total CSF protein concentration

Pelvic exenteration in advanced and recurrent cervical cancer

Pelvic exenteration consists in a radical surgical procedure for patients with advanced and recurrent cervical cancer and it offers the chance for cure. Surgical techniques have been developed for reducing morbidity and mortality. From July 2005 to September 2009, Pelvic Exenteration was performed for 20 patients with primary advanced cancer cervix and 10 patients with recurrent cervical carcinoma. Full data about the surgery [type of exenteration, type of feacal and urinary diversion, lymph node dissection, and operative morbidity] was recorded. No operation-related mortality, the complications rate was 23.3% and the overall mean survival was 34.7 months [95% CI=28.0-41.5]. Multiple factors were analyzed [univariate analysis] to determine their association with long-term survival. Mean survival was 37.2 months [95% CI 29.7-44.7] in the primary group and was 21.6 months [95% CI=12.8-30.4] in the recurrent group [p=0.033 by Cox regression]. An important prognostic factor was the margin status. Mean survival was 39.2 months [95% CI<=33.0-45.4] for patients with tumor-free resection margins and was 6.4 months [95% CI=3.3-9.5] for those with positive margins [p<0.001 by Cox regression]. In patients with primary advanced cervical cancer, exenteration is a valid alternative to primary chemoradiation. In patients with recurrent tumor limited to the pelvis, secondary exenteration should be offered without post operative mortality although the morbidity rate is still high. Univariate analysis showed that margin status is important prognostic factor for survival

Propofol anaesthesia and the immune system

Many studies have called attention to the possible depressive effects of I.V. anaesthetics and hypnotics on the immune system. The productivity, mobilization and functional state of the cells forming the structure of the immune system are suppressed by anaesthetics and hypnotics. The possible effects of Propofol on the immune system are assessed. Forty healthy female patients scheduled for uterine dilatation and curettage [D and C] were categorized into two equal groups [20 patients in each], - control and study groups. Induction was done by thiopentone sodium for the control group while Propofol was used for the study group. One and twelve hours later, venous blood samples were taken for: firstly - total leucocytic count secondly -immunological study : a] Cellular immunity b] Humoral immunity and c] Phagocytic count and intracellular killing effect thirdly - alpha globulin fraction estimation. A significant reduction in total leucocytic count and an insignificant suppression of the other parameters were found in both groups

Uremic toxins, the blood brain barrier and uraemic encephalopathy in experimental uraemic rats

The pathophysiology of uremic encephalopathy and the various cerebral disorders associated with uremia are poorly understood. The aim of the present work was to study the role played by the major uremic toxins [non protein nitrogen, urea, uric acid, creatinine and phenols] in this regard. This was achieved by determining their concentrations in the plasma, the cerebrum, cerebellum, brain stem and skeletal muscles of rats with experimental uremia induced by bilateral ligation of both ureters for 48 hours. Results revealed that uremic rats showed an apparent alteration in alertness and appeared drowsy compared with their pre-fed controls suggesting an early stage of metabolic encephalopathy. It was evident from the study that the blood brain barrier was broken in uremia as there was high concentration of the studied uremic metabolites in the brain parts of uremic animals compared with controls. However, this barrier was not totally ruptured because the concentration of any given metabolite was higher in the skeletal muscle than the brain parts. The affinity of the different brain parts to the same metabolite was also different. So, it was justified to postulate that the composite picture of the uremic patients may be due to the variability in the concentrations of these studied toxins and/or others in the different parts of the brain resulting in disturbance of their normal function. The effect of the metabolites studied on the nervous system was also reviewed

Studies on some central neurotransmitters in experimental uremia

Changes in some brain neurotransmitters and peptides in the thalamo- hypothalamic region of the brain of uremic rats were studied. Experimental uremia was induced in rats by bilateral ureteral ligation. Samples of blood were taken for the determination of non- protein nitrogen [NPN]. The activity of acetylcholinesterase as well as the concentrations of serotonin, insulin and adrenocorticotrophic hormones were determined in homogenates of the thalamo- hypothalamic regions of the brains of control and uremic rats. The mean level of plasma NPN was highly increased in uremic rats than in controls, denoting the occurrence of uremia. A significant decrease in acetylcholinesterase activity, whereas a dramatic decrease in the concentration of serotonin were found in homogenates of the thalamo- hypothalamic regions of brain of uremic rats compared with those of controls. Attempts were made to measure the concentration of the thalamo-hypothalamic insulin, but it was below the detectable level of the method used. A marked decrease in the concentrations of adrenocorticotrophic hormone [ACTH] was observed in the brains of uremic rats compared with those of controls. The present study suggested that many of the neurobehavioral changes in uremia might be due to metabolic disorders of some neurotransmitters and brain peptides

Factors affecting the informative needs of cardiac, cancerous and abdomen surgical patients

Health care professionals proved that for total medical care to be effective patients must have better understanding of health information. Two hundred patients were interviewed to investigate the effect of some independent variables [age, sex, educational level, occupation, diagnosis and need for information] on the dependent variable the informative needs of the patient. The results of the study showed that, different variables affected significantly the different studied informative needs. Multiple regression indicated that the variables included in the study [age, sex, education,... etc.] explain a small proportion of the variability in the dependent scores. It also appears that diagnosis as a variable affects significantly the majority of the categories as [nutrition, surgical operation intervention and rest and activities]. It can be said that patients and staffs agree on the fact that patients should be involved in the planning of care and treatment

possible cause for anemia in chronic uremic patients on hemodialysis

Eight dialysing solutions with varying ionic and glucose concentrations were tested in vitro for their effect on the integrity of normal red blood corpuscles [RBCs] membrane. All solutions were found to have a haemolytic action ranging from 1.03-4.5% after 6 hours of incubation which makes a calculated hidden loss of 50-225 ml of RBC's per dialysis. The molal concentrations of Na[+], K[+], Ca[2+] and Mg[2++] and glucose are important determining factors. The mechanism of haemolysis was suggested to be through Na[+], K[+] adenosine triphosphatase [Na+ pump] of the cells. The construction of an ideal solution to minimize this route of blood loss is under investigation

Plasma and tissue CAMP in experimental acute uremia in rats

Uraemia was induced in rats by bilateral ureteral ligation. 3',5'-cyclic adenosine monophosphate [CAMP] concentration was estimated in the plasma and tissues [brain, liver, kidney and adrenals] of control and uraemic rats. Cyclic AMP in the plasma, brain, kidney and adrenals was markedly increased in uraemic rats whereas, liver CAMP did not change significantly. The increased plasma CAMP was suggested to originate from these tissues. The mechanisms and pathophysiological significance of the increased CAMP in tissues were discussed

Effect of uremic toxins on platelet aggregation and plasma fibrinolysis

The uremic syndrome is characterized by the controversy of bleeding tendency and clotting complications. The effect of some uremic toxins on platelet aggregation and plasma fibrinolytic activity, the key stones of coagulation and fibrinolysis was investigated. Urea, creatinine, uric acid, phenol, ammonia, indole and 5-OH tryptamine were found to inhibit platelet aggregation. Urea, creatinine, uric acid and phenol decreased the fibrinolytic activity, whereas aliphatic amines has no effect on either platelet aggregation or fibrinolysis [and also guanidinosuccinic acid]. The possible mechanisms and clinical implications were discussed

Effect of experimental nephrotic syndrome on some trace elements in the liver, skin and bone of rats

A renal disease simulating the nephrotic syndrome as seen in infants was induced in rats using anti-rat kidney serum prepared from rabbits. The heavy proteinuria [12.0 +/- 0.26 g/l] produced in nephrotic rats would result in the loss of metallo-proteins in urine. Trace elements Zn++, Mn++, Mo++, Ni++, Cr3+ and Fe3+ concentrations in the liver, skin and bone of both nephrotic and control rats were determined. The nephrotic rats showed depletion of Ni++ and Fe3+ in all tissues studied, whereas Zn++ and Mn++ concentrations were significantly decreased in the liver and skin, but not in the bone. In case of Cr3+, there was a significant increase in all the tissues studied. Mo++ showed a significant increase in the skin only. The mechanisms of these changes were discussed. Most of the manifestation of the nephrotic syndrome can be explained by the changes recorded for the trace elements in this study

Mechanism [s] of some abnormal carbohydrate metabolism in uraemia: an experimental study

Uraemia was induced in albino rats by bilateral ureteral ligation. Carbohydrate intolerance manifested a hyperglycemia was found. The mechanism[s] which may be suggested from this study are enhanced liver glycogenolysis, inhibition of glycolytic chain in uraemic liver and muscle cells leading to a decrease of glucose breakdown and hence its diminished peripheral utilization. The factors behind this result were suggested to be through the inhibition of cell enzymes concerned with carbohydrate metabolism by the accumulated uraemic toxins. Among these enzymes are aldolase, glutamic oxaloacetic and glutamic pyruvic transaminases [GOT and GPT]. Oxidative phosphorylation was found to be affected as shown by the diminished oxygen consumption of rat diaphragm. The results of the study suggest also a depressed exchange between keto acid and amino acid pools resulting in the activation of the pathways leading to enhanced glluconeogenesis from the amino acid pool and the accumulation of amines in the blood, a factor considered to be important in uraemia

Effect of uraemia and uraemic toxins on oxygen and glucose uptake of rat diaphragm

Uraemia and uraemic toxins [urea, uric acid. creatinine, phenol, dimethylamine, trimethylamine, ethanolamine, serotonin, ammonia, 5-hydroxyindol acetic acid and guanidinosuccinic acid] in concentrations comparable to those found in clinical uraemia were found to have an effect on glucose and oxygen uptake of rat diaphragm. This may explain the diminished peripheral utilization of glucose recorded in uraemic patients. The mechanisms of this effect of toxins were discussed

Water and electrolyte changes in patients with schistosomal hepatic fibrosis subjected to major surgery

Ten patients with schistosomal hepatic fibrosis and other ten non-bilharzial patients [controls] subjected to major surgical operations were studied as regards urine flow rate [U[v]], osmolal clearance [C[osm]], free water clearance [C[H[2]O]], creatinine clearance [C[cr]], tubular reabsorption rate for Na[+] and Cl[-], urinary excretion rate for K[+]; preoperatively, 24 hours and 5 days after operation. Schistosomal patients differed from controls in having more water, Na[+] and Cl[-] absorption and less K[+] excretion by the kidney. The significance of such renal functional changes in schistosomal patients is discussed and its application in postoperative fluid and electrolyte therapy is mentioned