Bronchial aspirates glucose level as indicator for methicillin-resistant staphylococcus aureus [MRSA] in intubated mechanically ventilated patients

This study evaluated if the level of glucose in bronchial aspirate serves as indicator for the risk of MRSA infection in intubated mechanically ventilated ICU patients.A total of 50 critically ill patients was enrolled and were under tight glycemic control to abolish the effect of hyperglycemia on bronchial secretion, if they were expected to require mechanical ventilation for more than 48 hours. Bronchial aspirates were detected for glucose and sent twice weekly for microbiological analysis and whenever an MRSA was expected.The results showed that all the patients had glucose tested in bronchial aspirates. Glucose was detected in bronchial aspirates of 28 of the 50 patients. Glucose in bronchial aspirates in these patients ranged between [2.9-5.lmmol/1]. MRSA was detected in 22 patients where 28 were MRSA free of the MRSA patients 19 had positive glucose where glucose was positive in 28 patients of them 19 [86.4%]where MRSA positive to 9 with no MRSA [32.1%].The risk of having MRSA present markedly increased significantly in the presence of glucose: [p value .001]

Catheter- related right atrial thrombosis in haemodialysis patients: a study of internal jugular and subclavian venous approaches

Right atrial thrombosis is an under diagnosed condition that may occur as a complication of central venous cannulation when adopted temporarily in haemodialysis patients. It can have serious potentially life-threatening complications that include systemic sepsis and pulmonary embolism. The diagnosis often is challenging and requires, first and foremost, a high degree of clinical suspicion. The aim of the study is to evaluate the role of transthoracicechocardiography [TTE] in diagnosis of cardiac complications namely: right atrial thrombosis and infection by. In this study, TEE was done for 100 of chronic haemodialysis patients with temporary central venous haemodialysis catheters aiming at detection of cardiac complications mainly, right atrial thrombosis and infection. Incidence of right atrial thrombosis was 1 patient [1.9% with internal jugular [IJV]catheters] and 2 patients 4.1% with subclavian[SCV] catheters one week after catheter placement. 1 patient [1.9%] for group I, 3 patients [6.3%] for group II one month after catheter placement. Also, it was more prevalent with the presence of catheters tips in right atrium and development of catheter infection. TEE is one of the valuable tools in the diagnosis of intravenous catheter complications research should focus on defining the precise incidence of thrombosis with central venous cannulation .Priority should be given to internal jugular vein cannulation

Pulmonary function and pain relief after laparoscopic gastric banding performed under combined general epidural anesthesia in morbidly obese patients

Recovery from general anesthesia might be compromised in morbidly obese patients due to increased the risk of postoperative hypoxaemia and pulmonary complications, particularly after abdominal surgery. This study was carried out to compare the effect of general anesthesia and combined general epidural anesthesia in laparoscopic gastric banding to control postoperative pain, their effect on pulmonary functions and recovery time. Thirty adult patients aged 20-33years, ASA status I-II, undergoing elective laparoscopic gastric banding for treatment of morbid obesity. They were divided randomly into 2 equal groups according to anesthesia received. Group I [n=15] received combined general cervical epidural anesthesia and group II [n=15] received general anesthesia alone. Subjective pain relief was assessed by visual analogue scale. Pulmonary functions were assessed by forced vital capacity, forced expiratory volume in 1st second and peak expiratory flow rate [FVC, FEV1 and PEFR]. Pulmonary function tests were better in group I than group II at first and six hours postoperatively. FVC, FEV1 and PEFR were reduced significantly in group II than in group I [forced vital capacity was reduced by 42% compared with 30%, forced expiratory volume in 1st second was reduced by 43% compared with 31% and peak expiratory flow rate by 12% compared with 8% respectively]. Pain severity during mobilization and on coughing was significantly less in group I than in group II as evidenced by less VAS scores. Also, the narcotic consumption was less in group I. Postoperative recovery time was shorter in group I than in group II. [Times to extubation were 6 +/- 1min, 13 +/- 8 min respectively]. It was concluded that: Combined general epidural anesthesia, in morbidly obese patients had less postoperative pain and more preservation of pulmonary functions after laparoscopic gastric banding

Ventilation tubes versus conservative treatment in management of secretory otitis media in adenoidectomeized children

The study was carried on 79 adenoidectomized patients suffering from secretory otitis media. Forty patients received medical treatment for 3 weeks consisting of decongestant nose drop, septazol suspension, phenadone syrup with one of three different types of mucolytic agents. The cure rate was 53.3%, 40% and 40% according to the mucolytic agent used as a part of the combination therapy. The average cure rate of medical treatment was 45%. In another 39 patients myringotomy and insertion of ventilation tubes were done. Four commonly used ventilation tubes were the Shepard Grommets, Collar Button, T tube and Paparella tube in 34, 8 and 4 ears, respectively, to compare the incidence to complications including otorrhea, obstruction and extrusion. The average follow up was 5 months