Tracheostomy in the Intensive Care Unit: a University Hospital in a Developing Country Study

Abstract Introduction Tracheostomy is the commonest surgical procedure in intensive care units (ICUs). It not only provides stable airway and facilitates pulmonary toilet and ventilator weaning, but also decreases the direct laryngeal injury of endotracheal intubation, and improves patient comfort and daily living activity. Objective The objective of this study is to assess the incidence, indications, timing, complications (early and late), and the outcome of tracheostomy on patients in the intensive care units (ICU) at a university hospital in a developing country. Methods This study is an observational prospective study. It was performed at the otolaryngology department and ICU new surgery hospital on 124 ICU admitted patients. We collected patients' demographic records, cause of admission, indications of tracheostomy, mechanical ventilation, and duration of ICU stay. We also gathered patientś tracheostomy records including the incidence, timing, technique, type, early and late complications, and outcome. All tracheostomized patients received follow-up for 12 months. Results The indication for tracheostomy in ICU patients was mostly prolonged intubation (80.5%), followed by diaphragmatic paralysis (19.5%). All tracheostomies were done by the open approach technique. Tracheostomy for prolonged intubation was done within 17 to 26 days after intubation with a mean of 19.4 ± 2.07 days. Complications after tracheostomy were 13.9% tracheal stenosis and 25% subglottic stenosis. Conclusion Prolonged endotracheal intubation is theman indication of tracheostomy, performed after two weeks of intubation. Although there were no major early complications, laryngotracheal stenosis is still a challenging sequel for tracheostomy that needs to be investigated to be prevented.

The Efficacy of Nasal Steroids in Treatment of Otitis Media with Effusion: A Comparative Study

Introduction Otitis media with effusion (OME) continues to be an important pediatric clinical problem, and more studies are needed to decide the proper treatment for it. Objective To assess the efficacy of nasal steroids in the management of OME by comparing its results with that of oral steroid and that of nasal saline spray as placebo. Methods This study was carried on 60 patients with OME who were divided into three groups: in group 1, 20 patients received mometasone furoate spray, one puff in each nostril daily, for 3 months; in group 2, 20 patients received oral prednisolone, 5 mg three times per day for the first 3 weeks; in group 3, 20 patients received nasal saline spray, one puff in each nostril daily for 3 months. Results A highly significant difference between systemic or topical (nasal spray) steroid therapy and saline nasal spray was detected (p < 0.001), and the difference between systemic and topical steroid was nonsignificant (p > 0.05). Conclusion Nasal steroid spray can be used as an effective treatment for OME, giving a significant result similar to systemic steroid. Further studies are needed to investigate its use for longer duration and in recurrent cases.(AU)

Epidemiological, clinical and bacteriological studies on bacterial lamb enteritis at behera province, Egypt

Lamb enteritis is economically important problem because several agents may be involved in the etiology of it. This study was conducted to throw light on bacterial enteritis in some sheep flocks in Behera province. From 1200 examined lambs, 650 showed enteritis [54.16%]. Enteritis rate were higher in closed system [83.70%0 than in open system [46.80%]. Mortality rate was [4.16%] and case fatality was [7.69%]. Bacteriological examination of fecal samples revealed that 190 lambs [29%] were positive for pathogenic bacterial culture and 460 lambs [71%] were negative. The isolated bacteria were E. coli pathogenic form from 65 cases [34.20%] which was the most predominant bacterial isolate. Other bacteria isolated were salmonella from 10 cases [5.26%], clostridia isolated from 15 cases [7.89%], proteus species isolated from 25 cases [13.10%], shigella isolated from 20 cases [10.52%], klel'siclla isolated from 15 cases [7.89%] and mixed infection was reported in 40 cases [21%]. Serotyping of E coli revealed that O55/K50 [35] [2 isolates], while O78/K80 [B-], O125.K70 [B15], O101/K99 and O22/K11 [L] and each of them [l isolates], while the untypable isolates was [4 isolates]. Salmonella typing revealed that S. typhimurium serotype B [2 isolates], S. enteritidis serotype Dl [1 isolate] and the un typable salmonella isolates [2 isolates]. The antimicrobials susceptibility of isolated bacteria was done to determine its susceptibility