One month outcome of ocular related emergencies in a tertiary hospital in Central Saudi Arabia

To investigate the number and characteristics of patients attending the Accident/Emergency [A/E] Department of a tertiary care hospital in Riyadh, and to determine their route of referral, and pattern of ocular emergency cases. A retrospective study was carried out using the records and history of all patients attending the A/E at King Abdulaziz University Hospital [KAUH] in Riyadh, Kingdom of Saudi Arabia in July 2010. Data collected included time of arrival, age, gender, source of referral, principal diagnosis, attending doctor, action taken, and discharge plan. A total of 1,412 patients were recruited in our study with an average daily attendance of 47 patients. A total of 863 [61%] patients were male, and their mean age was 28.2 years. The most frequent diagnosis in patients was trauma [382, 27%], followed by conjunctivitis [211, 14.9%], lids and lacrimal system [133, 9.4%], retina problems [51, 3.6%], glaucoma [30, 2.1%], neuro-ophthalmology [22, 1.6%], keratitis [20, 1.4%], uveitis [10, 0.7%], and episcleritis [5, 0.35%]. Most cases [77.5%] seen were self-referrals. Additionally, 712 [50.4%] of cases were considered as non-emergency, which are visiting the A/E for dry eye, chalazion, blepharitis, and allergy. Most cases seen at our ophthalmic A/E had non-urgent conditions that could be managed satisfactorily by trained ophthalmic assistants under supervision of an ophthalmologist

Sleep apnea and its effect on ascitic patients

Obstructive sleep apnea syndrome has been recently described as a complication of ascites. This occurs due to elevated mechanical loads on the upper airway and defects in compensatory neuromuscular responses. Sleep disturbances, daytime hypersomnolence and neurocognitive dysfunction are common complications of cirrhosis and sleep apnea syndrome. The severity of these complications increases with the presence of both pathologies and improve markedly with the improvement of apnea after tapping of ascites. The aim of this study was to determine the type of apnea associated with ascites. The effect of apnea on the condition and the level of improvement in sleep disturbances and neurocognitive complications after tapping of ascites. The study was conducted on 40 patients with chronic liver disease, divided into 3 groups according to the extent of ascites. Group I with tense ascites [n=20], Group II with mild to moderate ascites [n=10], Group III without ascites [n=10]. Assessment was done through clinical examination, minimental state examination [MMSE], laboratory investigations, abdominal ultrasound and polysomnography. Sleep efficiency and neurocognitive functions as measured by MMSE were significantly affected with the increased degree of ascites. Apnea was found to be of the obstructive type. Apnea hypopnea index [AHI] was clearly higher in group I than groups II and III. MMSE and sleep efficiency showed a statistically significant correlation with the presence of significant apnea. AHI, sleep efficiency and MMSE improved markedly after tapping of ascites. Obstructive sleep apnea syndrome [OSAS] can be a complication of tense ascites. OSAS causes more deterioration of sleep efficiency and neurocognitive functions and these findings improved after tapping of ascites

population based study on mishaps during laparoscopic cholecystectomy in qatar: 10 years experience

In order to determine the national incidence of adverse events following laparoscopic cholecystectomy [LC] the records were reviewed retrospectively of 4861 patients who underwent LC over a period of ten years [1993-2003]. The most serious non-biliary complication was trocar injury of major vessels in three cases. Other non-biliary complications included duodenal perforation during dissection of the Calot's triangle, small bowel injury while inserting the umbilical port and trocar site hernia. Adverse biliary events included common bile duct injury, common hepatic duct injury, bile leakage from the cystic duct and one instance of the migration of an endoloop into the common bile duct. Conversion to open cholecystectomy was required in 109 cases. Although LC may be associated with various adverse sequelae, these are rare and should not deter surgeons and patients

Detection of some heavy metal residues in some camel's meat products

Lead, cadmium and copper residues were determined in each of 15 samples of camel's luncheon and frozen sausage, collected from different supermarkets in Cairo, Giza and Zagazig Cities. The residues of these heavy metals were detected by using Atomic Absorption Spectrophotometer. The obtained results revealed that the mean values +/- S.E. of lead, cadmium and copper [p.p.m] in camel's luncheon were 0.138 +/- 0.008, 0.055 +/- 0.004 and 3.662 +/- 0.221, respectively, while in; frozen sausage, such residues were 0.133 +/- 0.008, 0058 +/- 0.004 and 3.789 +/- 0.189 p p m, respectively. The present results were compared to the permissible limits of FAO/WHO [1972], WHO [1972] and Egyptian Organization for Standardization and Quality Control "E.O.S.Q.C." [1993]. Public health importance and the hazardous toxic effects of these heavy metals as well as the suggestive recommendations to minimize the pollution with heavy metals were discussed

Role of percutaneous transhepatic cholangiography and drainage [PTC and D] in cases of inaccessible endoscopic retrograde cholangiopancreatography [ERCP]

Endoscopic retrograde Cholangiopancreatography [ERCP] represents an important diagnostic and therapeutic tool in management of obstructive biliary lesions. Yet, the level of obstruction contributes to failure of this technique and represents hindering limitations. The purpose of this study was to evaluate the feasibility and role of percutaneous transhepatic Cholangiography and drainage [PTC and D] in management of inaccessible ERCP. Out of 318 obstructive jaundice patients scheduled for ERCP, 22 [6.9%] failed cases formed the subject of this study. ERCP trial failed due to advanced tumor infiltrating the papilla or the lower end of the common bile duct in 14/22 [63.6%] cases whereas in the remaining 8 cases, the distal end of CBD showed filling with non visualization of the rest of biliary tree. These cases were subjected to PTC and D using ultrasonography guided technique in16/22 [72,7%] cases and the blind technique in 6/22 [27.3%] patients. The obstructive jaundice proved to be due to advanced cancer head of pancreas in 8/22 cases, peri-ampullary carcinoma in 6/22 cases, advanced cholangiocarcinoma in 2/22 patients, hilar stricture in 2/22 cases, iatrogenic ligation of the CBD in 2/22cases and extra-hepatic sclerosing cholangitis in 2/22 cases. Further operative biliary reconstruction or palliative bypass were done in 10/22 cases. Two patients [0.9%] had complications in form of leak around the tube with subcutaneous collection in one case and slipped tube in the other. Two unrelated hospital deaths were reported. There was no biliary peritonitis, peritoneal hemorrhage, subdiaghragmatic collection nor failed case. This study highlights PTC and D as safe and applicable procedure resort to visualize and decompress the biliary tree in inaccessible ERCP cases

Antinutritional and toxic effects in albino rats of rapeseed protein products added to standard diet

Flour and protein concentrate of two rapeseed varieties were prepared and used at a level of 50% of total protein in synthetic diets containing 15.4% protein. The feed consumption [FC] and protein retained by the albino male rats fed the concentrate diets were significantly higher than those of flour diets and insignificantly differed from a casein control diet. The partial composition of rat bodies at 2,4 and 6 weeks of age showed slight differences in dry matter and protein percentage between rats fed casein and concentrate diets. Highest protein efficiency ratio [PER] and biological value [BV] were found for rats fed Brassica campestris diets. Whereas, the highest NPU was found for rats fed casein or Brassica napus diets. Also, there was a positive relationship between PER and BV, and negative with each of PER or BV and NPU. The proteins concentrate diets had no significant effect on relative liver weight, whereas flour diets caused significant enlargement of the liver. The macroscopic examination indicated that the increase of liver weight of rats was paralleled with hemorrhage incidence. The concentration of low density cholesterol and triglycerides, GOT and GPT enzymes activity were significantly decreased in rats blood fed concentrates, while albumin concentration was only slightly affected. Histological examination of liver and heart of rats indicated lower negative effects of rape protein concentrates comparing to the effects of rape flour. The above findings indicated clearly that processing rape flour to rape concentrates reduced the toxic and antinutritional components but did not eliminate them

Effect of extraction treatments for removal of antinutritional substances on chemical and functional properties rapeseed protein products

Several treatments were utilized to minimize the antinutritional factors in protein products of two rapeseed varieties [Tobin] [B. campestris] and [Liraspa] [B. napus]. Rapeseed protein concentrates [RPC] were prepared from rapeseed Tobin flour [TF] or Liraspa flour [LF] using water at pH 4 [TPC 1 and LPC1], 50% methanol [LPC2] and 10% ammonia in 95% methanol [LPC3]. Rapeseed protein isolates [RPI] were also prepared from LF using 0.0 and 0.25% SHMP [LPI1 and LPI2]. 0.0 and 18.6% succinylation [LPI3 and LPI4]. The protein contents of RPC were in descending order of LPC1, TPC1, LPC3 and LPC2. RPI prepared by SHMP had a higher protein content than those prepared by succinylation. Glucosinolates, phytic acid, phenolics and tannins were higher in [Liraspa] than [Tobin] variety. Solvent system of 10% ammonia in 95% methanol was the most effective for removal of glucosinolates and tannins. Whereas water at pH 4 was best for extraction of phytic acid and phenolics. Succinylation with 18.6% succinic anhydride reduced markedly phytic acid, phenolics and tannins as compared to 0.25% SHMP. The minimum NSI of rapeseed flours, concentrates and isolates was at pH 4.0-4.5 depending on the method of extraction. NSI was increased below and above these regions reaching its maximum at pH 2.0 and 9.0. It was higher for [Tobin] than [Liraspa] products. The products showed minimum emulsion capacity [EC], emulsion stability [ES], foam capacity [FC] and foam stability [FS] at pH values of their dispersions in water which were acidic in nature. Shifting the pH to 7.0 improved emulsifying and foaming properties due to increasing NSI. LPC prepared by either 50% methanol or 10% ammonia in 95% methanol remarkably increased EC and decreased ES. Whereas, LPI prepared by SHMP had great emulsion properties. Protein products, except LPC 1 prepared by water washing at pH 4, had higher oil absorption index [WOAI] than Liraspa flour. Thus they obtained high water-oil absorption capacity with WOAI ranged from 0.94 to 1.18. Meanwhile, LPC1 had unsuitable balance with WOAI of 3.32. Actually 50% methanol gave the best extraction of antinutrients except tannins and the best functionality, and would be more economic and technically feasible than 10% ammonia in 95% methanol

Prognostic significance of negative exercise imaging in the face of positive electrocardiography

While, the generally favorable prognosis of a normal exercise thallium scintigram is recognized, the impact of negative thallium scintigraphy in the presence of a positive exercise ECG is less well defined. Therefore, the incidence of subsequent cardiac events was evaluated in 235 consecutive patients with negative thallium scintigraphy and positive exercise ECG. Follow up [21 +/- 10 months] was available in 209 patients [89%], of these 79 patients [38%] had past clinical evidence of coronary artery disease. The clinical categorization of the remaining patients was uncertain. During follow up, 23 "hard" and "soft" cardiac events occurred, 1 cardiac death, 2 myocardial infarction, 5 coronary bypass grafting, 6 coronary angioplasty and 9 hospitalizations for cardiac reasons, of these 16 events including the 2 myocardial infarctions occurred in patients with clinical coronary artery [20% prevalence]. In contrast, only 7 events including the cardiac death occurred in the remaining clinically uncategorized patients [5.4% prevalence] P <0.002

Pulmonary myiosis in chronic obstructive pulmonary diseases and effect of some medicinal plants extracts

Pulmonary mycosis is not uncommon finding in patients complaining of chronic obstructive pulmonary diseases. Excess use of corticosteroids enhances the infection. Aspergillus and Candida species were the predominant strains isolated. The isolated fungi were sensitive [in vitro] in different degrees to different medicinal plants extracts

Medical antireflux treatment for asthma associated with gastroesophageal reflux

Thirty patients with non-allergic bronchial asthma associated with gastroesophageal reflux [GER], were studied before and after 9 weeks of antireflux medical therapy [ranitidine HCl]. All patients were subjected to full clinical history and examination, chest roentgenogram, ventilatory function tests, and tests to confirm GER [Bernstein test, Tuttle test, upper gastroesophageal endoscopy including taking biopsy from lower esophageal mucosa for histopathological examination]. Esophageal and pulmonary symptoms scores were recorded weekly. Endoscopic evidence of GER was shown in 63% of cases, while histopathologically esophagitis was proved in 96%. 9-week antireflux medical treatment was associated with rapid and dramatic response of reflux symptoms in 80% of cases and with more delayed and less dramatic improvement in pulmonary symptoms in 87% of case, evidenced subjectively by decline of both esophageal and pulmonary symptoms scores. Objectively esophageal erosions were diagnosed endoscopically in 16 out of 19 patients and healed completely. Ventilatory function tests also significantly improved [P <0.01]. It was concluded that there is a subset of patients in whom bronchoconstriction is triggered by GER. Treatment of the reflux in such patients improved their asthma

Comparative study between the spectrum and drug sensitivity of pathogens causing empyema thoracis in the period of 1974-1977 and 1991-1993 in upper Egypt

159 cases of post-pneumonic empyema thoracic were included in this study. They were divided into 2 groups. Comparative study between both groups revealed no difference as regard aged and sex predilection. Bacteriologically, positive cultures of pus collected from group I for aerobic bacteria were obtained in 80.6% of cases. Staph. aureus played a major role in causing empyema thoracic [43.5%]. Other isolates were: Pneumoccoci [syn. strept. pneumoniae] [25.8%], Pseudomonas sp. [14.5%], Klebsiella sp. [12.9%], Strept. pyogenes and Proteus [8% for each] and Diptheroid [4%]. Nothing recorded about anaerobic bacteria. In group II, positive cultures of pus for aerobic and anaerobic bacteria were obtained in 43.3 and 42.1%, respectively. Although Staphylococcus aureus headed the aerobic bacterial list yet, its frequency decreased to 23.7%. Other isolates were Klebsiella sp. [11.3%], Strept, pyogenes [7.2%], Strept. pneumoniae [6.2%], E. coli [5.1%], Proteus sp. [4.1%] and Pseudomonas sp. [2.1%]. Contrary to group I, Strept. pneumoniae and Pseudomonas sp. played minor roles. As regard anaerobic bacteria, the commonest was Bacteroids sp. [18.4%], followed by Peptostreptococcus [10.5%], Peptococcus [7.9%] and Fusobacterium was the least common [5.3%]. Results of sensitivity tests showed that the different isolated pathogens were sensitive to different antimicrobial drugs, so, the choice of antibiotic must usually be determined by the results of culture and sensitivity testing

Cell-type diagnosis of advanced central bronchogenic carcinoma without restoring to major thoracotomy

Seventy-three patients [forty-five males and twenty-eight males] who had central bronchogenic carcinoma were diagnosed. The methods utilized in the diagnosis were revised to decide a rapid diagnostic approach without restoring to major thoracotomy. According to the radiologic features, they were classified into total lung atelectasis [six patients], para- cardiac shadow [thirty patients], hilar and para-hilar shadows [sixteen patients], para-tracheal shadow [sixteen patients] and more than of the mentioned features [five patients]. Bronchoscopically, they were classified into those with visualized lesions [22 patients] and non-visualized lesions [51 patients]. Palpable scalene lymph gland was positive in all specimens [100%] regardless of the radiologic or the bronchoscopic classification. This is in contrast to non-palpable node which produced negative diagnosis in all specimens. Bronchoscopic biopsy was positive in all cases with visualized lesions, while blind biopsy was positive in 9% of non-visualized lesions. The patients with non- visualized growth and non-palpable scalene node could be diagnosed safely by anterior mediastinotomy without restoring to major thoracotomy. This procedure has many advantages

Primary lung cancer in patients below the age of 40 years in upper Egypt

Thirty-two patients aged from 18 to 39 years were managed for bronchogenic carcinoma in Menia and Assiut University Hospitals in the period from July 1988 to December 1993. All patients were symptomatic at time of diagnosis. Initial clinical examination, radiologic features and bronchoscopic findings that indicated advanced disease tumor were found in 27 patients. Yielded positive results of exfoliative cytology were low [sputum 13%, bronchial wash 28% and pleural fluid 9%]. Adenocarcinoma was found in 46.8% of the patients, small cell carcinoma in 28.1%, alveolar cell carcinoma in 9.4%, mixed adenosquamous and large cell carcinomas in 6.3% for each and lastly, squamous cell carcinoma in 3.1%. According to TNM definition in new international staging for lung cancer [1986], none had stage II or IIIa, but nine patients had stage IIIb and twenty-two had stage IV, while one patient only had stage I tumor disease. Resectability rate was 3%

Extrapulmonary tuberculosis in Minia governorate in years 1985-1990

A study of incidence of extrapulmonary tuberculosis in six years [1985-1990] was carried out in EL-Menia Chest Hospital. The number of subjects examined was 16925, of which 2353 [14%] were diagnosed as tuberculosis. Out of the 2353 tuberculous cases, 535 [22.7%] had extrapulmonary lesions. Tuberculosis lymphadenitis accounts for 39.1%. There were 188 cases [35.1%] with pleural effusion, 23 cases [43%] with genitourinary tuberculosis, 42 cases [7.9%] with skeletal tuberculosis, [2.6%] with meningeal tuberculosis, 18 cases [3.4%] with peritoneal tuberculosis, and 20 cases [3.7%] with miliary tuberculosis. From 1985 to 1987, the number of tuberculous cases [pulmonary or extra pulmonary] declined slowly [from 340 to 279 and from 93 to 68, respectively] then increased again in the subsequent 3 years. The proportion of extrapulmonary tuberculosis among all patients with tuberculosis by age, was found to be highest in youngs and generally to decrease with increasing age, higher among female than male patients and higher among rural than urban natives. Considerable differences in susceptibility to different sites of extrapulmonary tuberculosis by age, sex, region of origin were found. The reasons of these differences remain largely unexplained

Pulmonary mycosis in chronic obstructive air way diseases and effects of some medicinal plant extracts

Pulmonary mycosis is not uncommon finding in patients complaining of chronic obstructive airway diseases. Excess use of corticosteroids enhances the infection. Candida and Aspergillus species were the predominant strains isolated. The isolated fungi were sensitive [in vitro] in different degrees to different medicinal plant extracts

Why surgery is preferable in management of solitary pulmonary nodules?

This study included 108 patients who had solitary pulmonary nodules. 65 had malignant lesions [Group I] and 43 had nonmalignant nodules [Group II]. Bronchogenic carcinoma headed the list of malignant lesions [91%], while granulomas either specific or nonspecific headed the list of nonmalignant nodules [60%]. After thoracotomy, it was proved that the clinical, radiological, laboratory and bronchoscopic studies achieved the following In group I [GI] correct preoperative diagnosis in 3%, false negative diagnosis in 12% and the remaining 85% their lesions were suggestive of malignancy but without definite proof. In group II [GII] correct preoperative diagnosis was achieved in 20 nodules [granuloma [18], hamartoma [one] and pulmonary arteriovenous fistula [one]]. The preoperative diagnosis was different from post operative diagnosis in 6 cases. False diagnosis as bronchogenic carcinoma was reported in one case. The remaining lesions [16], their benign nature was established after thoracotomy. Surgery is the line of choice in dealing with such cases to explore, identify and resect the lesion whenever possible

Neisseria meningitidis carriage among household contacts to children with bacterial meningitis

A convenient sample of 70 children with signs and symptoms of meningitis admitted to Abbassia Fever Hospital [AFH] are included in the study. Their ages ranged from one month to 16 years with a mean age of 10.5 years. A diagnostic lumbar puncture was performed upon admission and the cerebrospinal fluid [CSF] was collected and examined bacteriologically, cytologically, chemically and for serogrouping of microorganism. Pharyngeal swab for culture and serogrouping was also done for patients, 104 of their household contacts and 200 apparently healthy persons from general population served as controls. The results of this study showed that, Neisseria meningitidis [N. meningitidis] was predominant in the CSF of children less than 6 years [preschool age] and the positive meningococcal pharyngeal swab culture was predominant in school age children. Serogrouping of microorganism showed that meningococci group B was the predominant group in the patients CSF and in pharyngeal swab of both the patients and their contacts. N. meningitidis carriers was higher among household contacts [7.7%] than in general population [4%] with the predominance of meningococci group B in both the contacts and in the general population. These findings showed that N. meningitidis group B carriage was predominant in school age children and proved that host immunity and over crowding specially in schools plays an important role

Value of lysozyme [muramidase] in pleural effusion and serum of children

The study included 55 patients with pleural effusion [18 transudate, 27 bacterial empyema and 10 tuberculous exudate] their ages ranged from 1-10 years. Also 20 apparently healthy children of matched age and sex were taken as control. No significant difference was found in the levels of serum lysozyme between disease and control groups. There was a significant increase in pleural fluid lysozyme levels in bacterial empyema than in transudate or tuberculous exudates [P = 0.000, P = 0.001] respectively. There was also a significant increase in pleural fluid lysozyme in cases of tuberculous effusion when compared with transudate group [P = 0.002]. Pleural fluid-to-serum lysozyme [PL/SL] ratio was 0.81 +/- 0.11 mg/dL in cases of transudate, 11.69 +/- 2.48 mg/dL in bacterial empyema and 1.98 +/- 0.75 mg/dL in tuberculous effusion groups. The existence of a raised PL/SL ratio in cases of tuberculous and bacterial empyema groups suggested important local synthesis of lysozyme. Comparing patients of tuberculous effusion with patients of transudate a PL/SL ratio higher than 1.4 showed a sensitivity of 90%, specificity of 100%, positive predictive value of 100%, negative predictive value of 94.7% and accuracy of 96.4% for discrimination of tuberculous effusion. All of these suggest that the determination of pleural fluid lysozyme and PL/SL ratio is a simple, fast method for obtaining corroborative information in the differential diagnosis of tuberculous pleurisy from transudate

Histological study of skin biopsies from patients with otosclerosis

Otosclerosis is a collagen disorder of otic capsule, the cause of which is still unknown. In the present work histological studies of Skin biopsies from patients with otosclerosis were carried out Twenty five patients with otosclerosis and five age and sex matched control were included. Two skin biopsies were taken from two different regions. Sections were prepared and stained with haematoxylin and eosin and with verhoeff and Van Gieson's stains. Histological examination of the skin patients, compared with the control showed thinner epidermis in 40% decreased thickness and density of the collagen fibers and bundles as well as decreased or absent elastic fibers the collagen was seen in fine either diffusely arranged or loosely textured or in thin bundles loosely textured. These results may suggest otosclerosis is caused by a generalized connective tissue disorder