Sesame seed sensitization in a group of atopic Egyptian children

Background: There are no published data on the prevalence of sesame allergy/sensitization in Egypt

Objective: In this pilot study, we thought to estimate the frequency of sesame seed sensitization in a group of atopic Egyptian infants and children

Methods: We consecutively enrolled 90 patients with physician diagnosed allergic disease. The study measurements included clinical evaluation for the site and duration of allergy, history suggestive of sesame seed allergy, and family history of allergy, as well as skin prick testing [SPT] using a commercial sesame extract, and serum sesame specific IgE [SpIgE] estimation

Results: None of the studied patients reported symptoms suggestive of sesame seed allergy. Nevertheless, two children [2.2%] showed positive SPT response to sesame [wheal diameter >/= 3 mm above the negative control]. Only one of them had a wheal diameter which exceeded that of the histamine control. The serum sesame SpIgE exceeded 0.35 IU/ml in all subjects [range = 0.35 - 3.0 IU/ml; median [IQR] = 0.9 [0.6] IU/ml]. Serum sesame SpIgE was significantly increased in patients with history of recurrent urticaria [p=0.03]

Conclusion: Sesame seed sensitization is not uncommon in atopic Egyptian children. It can be associated with any clinical form of allergy and the causal relationship needs meticulous evaluation. Wider scale population-based studies are needed to assess the prevalence of sesame allergy and its clinical correlates in our country

Comparison between two regimens of prophylactic tranexamic acid administration in re-operative coronary revascularization patients

Repeated cardiac operations are increasing in number and represent a group particularly at risk for bleeding. Bleeding during cardiac surgery is due in part to the activation of the fibrinolytic system and the systemic inflammatory response. Although tranexamic acid [TA] is used to reduce bleeding after cardiac surgery, there is large variation in the recommended dose. The dose of prophylactic tranexamic acid administered in CABG using CPB and in particular in redo cases has not been adequately studied. This prospective randomized double-blinded study aims to compare the efficacy of two regimens of prophylactic TA administration to reduce bleeding and blood transfusion in redo CABG. 120 adult patients undergoing redo coronary revascularization using CPB were randomly divided into two equal groups. Patients in group A received a loading dose infusion of TA 10 mg.kg[-1] over 20 minutes before sternotomy, followed by 1 mg.kg[-1] hr[-1] infusion over the following 6 hours. While patients in group B received a loading dose of TA of 25 mg.kg[-1] infused intravenously over 20 minutes before sternotomy, followed by placebo infusion over the following 6 hours. The anesthetic and surgical techniques and the anticoagulation protocol were standardized for all patients. There was no statistically significant difference between the two groups regarding the demographics, preoperative and operative characteristics. The postoperative platelet counts and prothrombin times show no statistically significant change between both groups, while the postoperative PIT [51.7 +/- 1.94 seconds versus 50.9 +/- 1.99 seconds] and hematocrit [23.2 +/- 0.95% versus 22.8 +/- 0.92%] show statistically significant higher level in Group A [p value <0.001]. The blood loss shows highly significant decrease in group A [1114.9 +/- 50.22 versus 1350.74 +/- 22.5 ml] [p value <0.001]. The use of red blood cell transfusion shows highly significant statistical decrease in group A [p value <0.001]. While the platelet and fresh frozen plasma transfusion show statistically significant decrease in group A [p value <0.05]. The percentage of patients not receiving any blood product transfusion during or after operation shows statistically significant decrease in group A [p value <0.05]. The data regarding risk of complications potentially caused by hypercoagulability shows no statistically significant change between both groups. Administration of tranexamic acid loading dose infusion of 10 mg.kg[-1] over 20 minutes before sternotomy, followed by 1 mg.kg[-1] hr[-1] infusion over the following 6 hours, offers a better antifibrinolytic effect than a loading dose of 25 mg.kg[-1] infused intravenously over 20 minutes before sternotomy, reducing blood loss and requirement for transfusion in patients undergoing redo coronary revascularization without increasing the risk of hypercoagulability

Thermoregulatory effects of perioperative intravenous amino acid infusion in patients undergoing TURP under spinal anesthesia

Hypothermia during anesthesia is associated with many postoperative complications. Therefore, many ways to avoid intraoperative hypothermia have been developed, usually by minimizing heat loss. Anesthetic agents suppress oxidative metabolism. Amino acids enhance thermogenesis by stimulating this metabolism. Forty-five adult patients were randomized into 3 groups each included 15 patients. Group A received intravenous amino acid infusion for 1 hour before spinal anesthesia and continuing throughout the first hour intraoperatively, Group B received intravenous amino acid infusion for 1 hour after the onset of spinal anesthesia and Group C received volumes of nutrient-free saline solution infused for 1 hour before and during first hour of anesthesia. Tympanic membrane core temperature and mean skin temperature were measured every 15 minutes during the 1[st] hour then after 120 minutes from the onset of spinal anesthesia. Plasma osmolality and serum lactate were measured in the 3 groups. Shivering, TUR Syndrome and total hospital stay were also assessed. Mean final core temperature, 120 minutes after induction of spinal anesthesia was 37.1 +/- 0.29°C in group A, 36.7 +/- 0.31°C in group B and 35.5 +/- 0.34°C in group C [P<0.05]. The increased level of oxygen consumption in the amino acid groups compared with the saline group was preserved even after the onset of anesthesia. The thermal vasoconstriction threshold, the tympanic membrane temperature that triggered a rapid increase a skin temperature gradient, was increased in group A [36.55 +/- 0.48°C] in comparison to group B [36.34 +/- 0.47°C] and group C [35.02 +/- 0.45°C]. Plasma osmolality was higher in groups A and B in comparison to group C [P<0.05]. Serum lactate was higher in group C in comparison to both A and B [P<0.05]. The incidence of shivering and the total hospital stay were higher in group C than in groups A and B [P<0.05]. Amino acid infusion in the preopferative period for anesthesia for TURP, prevents spinal anesthesia-induced hypothermia by increasing the metabolic rate and core temperature for peripheral thermal vasoconstriction