Conventional mechanical ventilation Vs. noninvasive positive pressure ventilation in COPD patients

In patients with COPD and mild to moderate hypercapnic ARF, the addition of NPPV to medical treatment has been proven to be effective in relieving dyspnea, improving vital signs and gas exchange, preventing endotracheal intubation and improving hospital survival. For this reason we compared the response to conventional ventilation delivered via ETI vs. NPPV delivered via face mask in COPD patients with ARF failing to sustain the initial improvement with conventional medical therapy in the emergency ward and meeting predetermined criteria for mechanical ventilation. We evaluated 72 consecutive patients. 18 were already intubated and 14 improved with standard medical therapy. The condition of 40 patients initially improved with medical therapy, and they stayed in the medical ward, but their improvement was not maintained over time and<24h. They met predetermined criteria for ventilatory support and were admitted to receive mechanical ventilation. 18 patients were randomized to NPPV and 22 patients to [ETMV] conventional ventilation. There were no differences between the two group before institution of mechanical ventilation, except in SAPS II, Albumin and GCS were significantly different [0.006, 0.05, 0.003] respectively. Patients randomized to NPPV, had a trend toward a lower rate of ventilator associated pneumonia [2vs.7] severe sepsis [lvs.7] and septic shock [lvs.3]. NPPV had decreased duration of ventilation, ICU stay, and post ICU hospital stay. [12.5vs.7.8 and 13.2 vs. 8.83 and 7.27vs.4.5] respectively [SD]. The ETMV group had a trend toward requiring permanent oxygen supplementation and open tracheastomy in comparison with NPPV group [8vs.0 and 5vs.2] respectively [%]. After failure of medical treatment in acute exacerbation of COPD patients NPPV is comparable to invasive mechanical ventilation. The reasons for improved outcome are not clear, but it is possible that a reduction in duration of ventilation, ICU stay, mortality rate and serious complications may play an important role, Improvement in PH and a decrease in PCO[2] after 2h of use benefited from NPPV. There are no clear clinical predictors to identify which patients with COPD RF would benefit from NPPV. A score based on SAPS II and serum albumin level is predictive of outcome in COPD patients. A high percentage of patients with the primary diagnosis of COPD successfully treated with NPPV

[A survey of detecting Chlamydia pneumoniae DNA with the aid of PCR in human coronary arteries and ascending aorta at postmortem and in alive patients]

Atherosclerosis is an important agent of mortality and morbidily among humans. Knowledge of the causative and precipitating factors of atherosclerosis is therefore highly important. Among the factors, infections have been cited among which Chlamydia pneumoniae. Accordingly we performed a systemic dissection of the 3 coronary arteries and ascending aorta in 49 postmortem subjects who underwent operation and 5 atherosclerotic plaques in alive subjects and studied the relationship in individual persons between the presence of Chlamydia pneumoniae DNA and the number of major risk factors. Other major risk factors comprising age, sex, blood pressure, diabetes mellitus, smoking, hypercholestrolemia and history of deaths due to heart ailment in families were also studied. From each vessels, two sections were obtained, one determining pathological grading of atherosclerosis [study classification], and other determining the prevalence of Chlamydia pneumonia DNA by polymerase chain Reaction [PCR] method. PCR was performed in Pasteur Institute. C.Pneumoniae was detected by PCR in 14 [25.9%] out of 54 subjects. 19 segments of vessels were positive for C. Pneumoniae out of which 16 segments [84.2%] had atherosclerosis and an equal or more than 3 in pathologic gradings. In the C. Pneumoniae positive patients, in comparison of the two groups comprising of patients with one or more risk factors, no statistically significant difference was seen [P>0.05]. This study opens up the path for management strategies in eradicating C. Pneumoniae, and decreasing morbidity, mortality secondary to atherosclerosis

Indoor/outdoor concentration of potentially toxic elements in urban areas in greater Cairo, Egypt

Potentaillay toxic elements [PTE] like lead, chromium and nickel in suspended paniculate matter [SPM] were evaluated indoor and outdoor at four sites. Two of the sites were offices and the others were homes. The aim of this work was to study the seasonal and annual indoor and outdoor PTE concentrations. The relationship between indoor and outdoor values was studied as well. The results showed seasonal variations. The maximum indoor and outdoor SPM, Pb, Cr and Ni concentrations were recorded during winter season. It was interesting to observe that the annual mean concentration of SPM in both indoor and outdoor [242 and 290 micro g/m[3] respectively] were more than 3.2 times [indoor] and 3.9 times [outdoor] the EPA yearly air quality standard for SPM [75 micro g/m[3]]. In the same way, mean values were more than 2.6 times [indoor] and 3.2 times [outdoor] the Egyptian ambient air quality standardal of 90 micro g/m[3]as annual mean. Also the results showed that the outdoor atmosphere was highly contaminated not only with lead [2.6-0.9 micro g/m[3]] but also with Cr [0.9-0.18 micro g/m[3]] and Ni [2.2-0.37 micro g/m[3]]. Abnormally high metal levels were measured indoor also. In addition, the study showed that the soluble matter of SPM [ammonium, sulphate and chloride] highly exceeded the concentrations found in the atmosphere of other countries. Regarding to indoor/ outdoor [I/O] ratios, the median values of the measured pollutants were observed to be smaller than I. It could be concluded that the above mentioned contaminant concentrations create an appreciable threat lo human health

Evaluation of air pollution in Egyptian rural areas

The major objective of this study is to point out the air pollution sources in rural areas and to evaluate the role of the emissions on the air quality in the investigated village [El-Danabik] in Northeast Egypt. The main sources of the air pollution in rural areas are brick kiln, using of biomass fuel and livestock excreta. SO[2], NO[2], CO. CO[2] and smoke were measured in the atmosphere surrounding a brick kiln. The data obtained revealed that the atmosphere of the investigated area is highly polluted with these gases. The mean concentration of SO[2] was 23.804 mg/m[3] and NO[2] concentration ranged between 39.01 to 1.41 mg/m[3]. Smoke was also found in a significantly high concentration. The concentrations ranged between 17.70 mg/m[3] and 70.71 mg/m[3]. The wood and agriculture residue combustion [the main fuels used in rural homes] produce many toxic gases besides fine particulate matter [smoke]. High concentration of CO[2] was recorded in the indoor atmosphere, the average concentration was 33673.5 mg/m[3]. Carbon monoxide [CO], is also produced as a product of incomplete combustion of the organic fuels. The CO concentration ranged between 1544.6 mg/m[3] and 2304.5 mg/m[3] in the indoor air in rural houses. The average concentration of SO[2] was 0.98 mg /m[3] while it was 13.79 mg/m[3] for NO[2]. A livestock excreta is a major source of atmospheric ammonia in rural areas. High concentration of ammonia gas was found in the atmosphere near the cattle and chicken farms. The average concentrations were 1.07 +/- 0.93 mg/m[3], 2.5 9 +/- 2.99 mg/m[3] in the atmosphere near the cattle and chicken farms, respectively. It must be stated that adverse effects are possible on the basis of the concentration of air pollutants in indoor and outdoor air in the rural areas

Nasal valve obstruction: reconstruction of the upper lateral cartilage by using septal versus conchal cartilage graft

The nasal valve refers to the cross-sectional area bordered by the junction of the caudal portion of the upper lateral cartilage and the nasal septum. This study was planned to include patients suffering from nasal valve obstruction due to weakened or deformed upper lateral cartilage which may be associated with deviated septum or hypertrophied inferior turbinate. In these cases reconstruction of the upper lateral cartilage was done using various types of cartilage grafts [septal or conchal] through closed approach. This was accompanied by septoplasty or turbinoplasty when indicated. According to the type of cartilage graft used the cases were divided into two groups: The 1[st] group [l5 patients] had been operated using septal cartilage graft and the 2[nd] group [15 patients] by conchal cartilage graft. Patients were subjected to serial clinical examination, nasal endoscopy, photography and rhinomanometry. Results showed the use of septal cartilage graft is superior to conchal one in correction of nasal valve obstruction. This is due to: [1] Use of septal cartilage graft is usually associated with septoplasty so the airway becomes more patent due to correction of septal deviation and reconstruction of upper lateral cartilage, [2] The septal cartilage graft is stronger than the conchal cartilage graft so it gives more support for the upper lateral cartilage, [3] The incidence of complications is less with the use of septal cartilage graft [cartilage resorption, cartilage extrusion and visibility of the edges of cartilage]. We recommend the use of septal cartilage graft for reconstruction of the upper lateral cartilage in cases of nasal valve obstruction

Effect of acute lead intoxication on the ultrastructure of the peripheral blood and bone marrow of male albino rats

Forty adult male albino rats were used in the current study [control rats n =20, 10 rats per each experimental group, group 1 - experimental "after 3 hoursof injection", and group 2 - experimental" after 6 hours of injection" n =10]. The experimental groups were injected intraperitoneally with a singledose of lead acetate, 150 mg/kg body weight dissolved in distilled water. Retro-orbital blood was sampled for the determination of blood lead level,complete blood count, and differential leucocytic count. In addition, bloodand bone marrow samples were obtained for transmission electron microscopicstudies from ten randomly chosen animals. Blood lead levels showed asignificant increase in both group 1 and group 2. Red blood cells countshowed a nonsignificant decrease in both experimental groups, while the totalleucocytic count showed a nonsignificant increase. Hemoglobin concentrationand platelet count decreased in both experimental groups, but this decreasewas significant only in group 2. Hypersegmentation of the neutrophilicnucleus was observed in both experimental groups. The ultrastructuralalterations such as irregular nuclei, occasional nuclear pockets, the presenceof cytoplasmic vacuoles containing inclusions, dilatation of rough endoplasmicreticulum cisternae were most clearly expressed in some neutrophils of group 2. Furthermore, electron dense nuclear inclusions, with a densecenter and outer fibrilly zone, together with dilated nuclear membrane werepresented among the erythroid cell series. Besides, bizarre shaped ordeformed red cells were also seen. Platelets showed hypo-granularity withdilated open canalicular system [OCS] and satellitism

Correlation between environmental and biological levels of lead in printing industry

In the present study the concentration, of lead particles and fumes in the working environment of a printing industry were throughly investigated. The blood lead, urinary lead and ALA of 106 exposed workers and 20 non-exposed workers, as a control group, were measured. Results showed that workers in the departments where lead materials are handled are mainly exposed to lead fumes which represent >80%of total lead exposure moreover, it was found that exposed to >20 micro/g/m[3] [8 hrs] atmospheric lead in both forms of respirable particles and vapour can result in high blood level. ALA was found to be a reliable indicator of lead effect. The present investigation points out that the TLV of 0.20 mg/m[3] is a non-realistic level since the exposure to atmospheric lead in a range between 20-37 micro g/m3 results in a high blood lead and subsquently a higher level of ALA in urine. Consequently, it is suggested to lower the TLV for lead exposure especially where lead fumes exist. Conclusions and special recommendations were given