Laparoscopic splenectomy alone for sickle cell disease account of 50 paediatric cases

Objectives: In Oman, the most frequent indication for a splenectomy in children is sickle cell disease [SCD], which is one of the most common haematological disorders in the Gulf region. This study aimed to describe paediatric laparoscopic splenectomies alone for SCD at a tertiary hospital in Oman

Methods: This study was conducted between February 2010 and October 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all children aged

Results: A total of 71 children underwent laparoscopic splenectomies during the study period; of these, 50 children [28 male and 22 female] underwent laparoscopic splenectomies alone for SCD. The children's weight ranged between 11-43 kg. The most common indication for a splenectomy was a recurrent splenic sequestration crisis [92%]. Surgically removed spleens weighed between 155-1,200 g and measured between 9-22 cm. Operative times ranged between 66-204 minutes and intraoperative blood loss ranged between 10-800 mL. One patient required conversion to an open splenectomy. Postoperative complications were noted in only four patients. The median hospital stay duration was three days

Conclusion: Among this cohort, the mean operating time was comparable to that reported in the international literature. In addition, rates of conversion and postoperative complications were very low. These findings indicate that a laparoscopic splenectomy alone in paediatric patients with SCD is a feasible option

Factors responsible for the prolonged stay of surgical neonates in intensive care units

The length of hospital stay [HS] for patients is a major concern due to its social, economic and administrative implications; this is particularly important for neonates admitted to intensive care units [ICUs]. This study aimed to determine the factors responsible for prolonged HS in surgical neonates. This retrospective study was conducted at Sultan Qaboos University Hospital, in Muscat, Oman. The medical records of 95 neonates admitted to the neonatal ICU who underwent general surgical procedures between July 2009 and June 2013 were reviewed. Mann-Whitney U and Pearson's Chi-squared tests were used for non-parametric numerical and categorical variables, respectively. A multiple regression analysis was performed to find a relationship between the variables and to detect the most important factor responsible for prolonged HS. A P value of <0.05 was considered statistically significant. Gestational age, birth weight, number of days on a ventilator and postoperative morbidity were associated with prolonged HS. Furthermore, the age of neonates at first full enteral feed was associated with increased HS using both independent and multiple regression analyses. Prolonged HS can occur as a result of many factors. In this study, a number of factors were identified, including low gestational age, low birth weight, increased number of days on a ventilator and postoperative morbidity. Additionally, neonate age at first full enteral feeds also correlated with increased HS. Further research on this topic is suggested to explore this correlation in more detail and to inform future practices

Effectiveness of a computerized monitoring tool for the baby friendly hospital initiative in Egyptian settings

This study is an intervention study aimed at promoting the quality of Services delivered to mothers and babies in birthing facilities, by monitoring the Global Criteria set for the Baby Friendly Hospital Initiative [BFHI]. This study was carried out in Damanhour Teaching Hospital. The obstetric and neonatal intensive care [NICU] practices were periodically assessed by sampling twenty mother-infant pairs at three weeks intervals over 6 monitoring Sessions with a total of 120 mother-infant Pairs over the entire period of study from August to November 2008. Two weeks after the last monitoring session, we sampled a total of 80 mother- infant pairs from maternity services of four neighboring hospitals as a Comparison group with the intervention hospital. The results showed that there was a significant improvement in the practice of the Ten Steps using the monitoring technique. We recommend that future BFHI implementation in Egypt should adopt monitoring as a tool to reinforce training and ensure sustainability

Care for people with diabetes during the moslem pilgrimage [HAJ] an overview

Haj is one of the five cardinal components of Islam commonly known as the five pillars of Islam. Approximately two million Muslims perform it each year. Haj involves travel to the holy sites in and around Mecca and Medina during a specified short period of time in a limited space, not usually inhabited by such a large number of people. This article deals with the effects of this event on diabetes and its management. The importance of this arises from the fact during Haj, the person's life routine changes as he travels to a different place of his own for a period of 4-6 weeks where geography, weather, diet, and habits are different. During Haj most people live what is effectively a very basic life in very crowded places. Therefore, medical conditions, such as diabetes, whose management depends on a stable routine, would predictably be affected significantly. People with diabetes should have enough time to consider a management plan for their diabetes. The objectives are to achieve a good control and avoid any complications that may be particularly associated with the conditions faced during Haj

Biomarkers of the pathogenesis of metabolic syndrome

To investigate the association between oxidant/anti-oxidant balance [MDA and paraoxonase] with the degree of severity of metabolic syndrome [MS] that was measured by the pro/anti-inflammatory markers [TNF-alpha and adiponectin] and other clinical and biochemical criteria to find biomarkers identifying patients at risk for cardiovascular disease [CVD]. The study included eighty patients [20 obese diabetics, 20 non-obese diabetics. 20 obese non-diabetics and 20 controls]. Serum levels of adiponectin and TNF-allpha, were analyzed by ELIZA. MDA and paraoxonase activity [PON] were determined by colorimetric method in all patients with or without MS. The international Diabetes Federation [IDF] proposal identified a greater percentage of MS. The highest prevalence was found in females. Serum levels of adiponectin and paraoxonase activity were significantly decreased but serum levels of TNF-alpha and MDA were significantly increased in MS subjects. There was an inverse correlation between number of features of metabolic syndrome [BMI, waist circumference, fasting plasma glucose, fasting insulin, insulin resistance, blood pressure, TGs and LDL] and protective markers [serum adiponectin and paraxonase levels]. Positive correlation existed with serum TNF-alpha and MDA levels. Metabolic syndrome patients had a higher accumulate [from 3/25 to 9/25 to 13/25]. Triglycerides and TG/HDL-C ratio were significantly positively correlated with TNF-alpha and negatively correlated with adiponectin. Hypoadiponectemia and decreased paraoxonase are associated with higher degree of metabolic alterations of MS. These could be contributing factors to the increased incidence and severity of CVD. These markers levels were significantly changed before accumulation of metabolic criteria indicating their role in production of metabolic syndrome

Serological evidence of antibodies to certain arboviruses in desert rodent sera in Egypt

Small rodents inhabiting the wadis close to St Katherine in the mountains of the Sinai Peninsula, Egypt, were trapped and antibodies to Sindbis [SIN], West Nile [WN] and Quaranfil [QRF] viruses in their sera were studied. One mouse had Haemagglutination-inhibition [HI] antibodies against SIN antigen in his serum, 3 mice had HI antibodies against WN antigen in their sera. The titers is low to be of any significance. It seems that natural cycle of transmission of SIN and WN viruses involving rodents does not exist. Seven mice had Complement-fixation [CF] antibodies in their sera against Quaranfil antigen. Conclusion, the CF test results suggest the existence of another mammal vector cycle

Right ventricular dysfunction type in idiopathic and Ischemic cardiomyopathy: Assessment by tricuspid annular velocities

Impaired right ventricular [RV] function can occurred in patients with left ventricular [LV] dysfunction. Tissue Doppler derived tricuspid annular velocities [TAV] permits assessment of systolic and diastolic RV function. The current study aimed to identify the cause of LV dysfunction whether idiopathic cardiomyopathy [DCM] or ishemic cardiomyopathy [ICM] on the basis of RV dysfunction type assessed by TAV. Fifty seven patients with LV ejection fraction <45% and dilated both ventricles were subgrouped according to the finding of coronary angiography into 30 patients with normal coronaries [DCM group], 15 patients with left coronary artery disease [CAD] [ICM[L] group] and 12 patients with proximal right CAD in addition [ICM[LR]] group]. Fourteen control subjects were also studied. Beside the routine echocardiographic assessment of LV and RV functions, peak systolic[s[m]] and peak early [E[m]] and late diastolic [A[m]] TAV were recorded. RV systolic dysfunction was defined as TA S[m] <10 cm/sec, while RV diastolic dysfunction was defined as TA E[m]/A[m] <1 Patients of DCM and ICM were matched regarding the global LV dysfunction [p>0.05]. ICM groups showed more frequent electrocardiographic Q wave, regional wall motion abnormalities, abnormal LV filling and RV systolic and diastolic dysfunction [TA S[m] <10cm/sec and TA E[m]/A[m] <1].While DCM group showed RV systolic dysfunction only [TA S[m] <10 cm/sec and TA E[m]/A[m] >1] [p<0.001]. Optimized detection of ICM [sensitivity 100%, specificity 100% and accuracy 100%] was achieved depending on the presence of TA E[m]/A[m]8.2 cm/sec could discriminate ICM[L] from ICM[LR] with sensitivity 100%, specificity 100% and accuracy 100%.In the presence of systolic dysfunction of both ventricles, the salient feature of ICM as compared to DCM is the TA derived RV diastolic dysfunction. In addition the marked RV systolic dysfunction in ICM favour left and right CAD

Solitary pulmonary nodules: value and pathologic correlation of MSCT bronchus sign

To evaluate the relationship between solitary pulmonary nodules [SPN] and bronchi and its value in predicting the pathologic nature of the SPN. We performed preoperative volumetric targeted ultra-thin sections using multi-slice computed tomography [MSCT], and by reconstructing multiplanar reconstructions [MPR], curved multiplanar reconstructions [CMPR] and surface-shaded display [SSD] images of its adjacent bronchus in fifty two patients with SPN [35 malignant and 17 benign] and correlated the findings with those of macroscopic and microscopic specimens. With this CT protocol, the third to seventh-order bronchi were shown continuously and very clearly in all patients. CT findings were consistent with those of specimens. CT demonstrated the relationship between the SPN and bronchi in 31 [88.6%] malignant and 13 [76.5%] benign nodules. Ultra-thin section with MSCT can improve the demonstration of the patterns of tumor-bronchus relationships, which can reflect the pathological changes of the nodules to some extent and can help to differentiate malignant from benign tumors

Oral prednisolone or dexamethasone, which one to be prefered for preventing relapse of acute asthma exacerbations in childhood?

In this prospective, randomized, clinical trial, 68 asthmatic patients, between 6 and 12 years were followed-up for 2 weeks after their acute exacerbation had been stabilized by the standard acute asthma treatment protocol. They were assigned to receive either 2 mg / kg / day of prednisolone divided on 3 doses for 5 days [PRED group], or 0.5 mg / kg / day of dexamethasone as a single morning dose for 3 days [DEX group]. The primary outcome measure was the rate of relapse within the follow-up period assessed by a Peak Expiratory Flow Rate [PEFR] < 70% of the predicted value, and a clinical asthma severity score more than 3. The secondary outcome measures included persistence of symptoms, quality of life, medication use, and adverse effects. There was no significant difference in relapse rates between the two groups [13.3% For PRED group and 15.2% for DEX group, P= 0.87].Compliance to medication was significantly higher in DEX group compared with PRED group[P= 0.04], and more children vomited their medication in the PRED group than in DEX group, but the difference was non-significant [P=0.32]. There was no significant difference between the two groups in the prevalence of persistent symptoms, quality of life, or adverse effects other than vomiting at the time of follow - up [P< 0.05]. We concluded that dexamethasone was as effective as prednisolone, with better compliance and less adverse effects, for preventing relapse of acute asthma exacerbations in childhood

Necrotizing enterocolitis in the full term newborn

In a two-year period, 12 cases of full term neonates that developed necrotizing enterocolitis [NEC] were diagnosed. The history was positive for enteral feeding in nine of the twelve patients. An underlying risk factor was determined in all cases with hypoxic ischemia and respiratory distress being the most common. Postoperative NEC was found in two of the patients. All cases were diagnosed by radiological exploration and laboratory investigations with delay in the diagnosis in the postoperative group only. In those, tumor necrosis factor [TNF] seemed to be an early reliable indicator of the occurrence of the disease in front of misleading clinical and laboratory evidences. Nine of the patients required surgical interference with six survivors. Out of the three patients that were not operated upon, two expired from severe sepsis

Identification of semen by using prostate specific antigen [PSA] as a marker

A modified has been used for the determination of PSA by enzyme- linkedimmunosorbent assay [ELISA], in which commercial kits are used, that is nowavailable in the market instead of preparing the reagents. Normal, oligo andazoospermic seminal samples were collected with other body fluids [blood,urine, milk, saliva, vaginal secretions and 12 hours post-coital vaginalswabs]. The results revealed that PSA is a useful semen market, even in casesof azoospermia, and can be also detected in the vaginal swabs that have beentaken 12 hours after coitus. No true cross reactions were found between theanti-PSA and other body fluids, including vaginal secretions. This method isvery sensitive and can detect semen in very small amount [0.5 mu l]. The fourdifferent studied semen markets could be measured easily, even after two months. The higher concentrations of these markets were obtained in stains that were kept refrigerated in comparison with other strong temperature, this was observed at all storage periods. Statistically significant differences have been recorded between fertile and infertile groups only for GGt and LDH but neither for PSA nor PSA not PAP. The best conserved activities after 2 months were those of GGT followed, then LDH and lastly PAP

Magnetic resonance imaging versus arthroscopy in the evaluation of knee joint traumatic and degenerative lesions

MR examinations using Fonar non superconducting magnet 0.3 Tesla were performed for all 70 cases. Diagnostic arthroscopy of the knee for 42 patients was done under general anesthesia to document the location of the lesion. The anterior and posterior cruciate ligaments were easily demonstrated by sagittal images through the intercondylar notch, while the tibial and fibular collateral ligaments were evaluated on coronal images. The lesions of the medial and lateral menisci can be evaluated properly on either coronal or sagittal images. Tears of the anterior cruciate ligament were detected in 24 cases [57.1%], while posterior cruciate ligament tear was detected in one case [2.4%]. Medial meniscal tears were detected in 25 cases [59.5%], while lateral meniscal tears were detected in 19 cases [45.5%]. Grade 1 meniscal degenerations were found in 5 medial menisci and 6 lateral menisci, while grade 2 generation involved 33 medial menisci and 18 lateral menisci. Popliteal cyst was detected in one case, but meniscal cysts were demonstrated in 3 cases. Chondromalacia patella were detected in 7 cases in this work

Microleakage at the interface between composite veneering material and precious alloy surface constructed either by new metallurgical sintering technique or the conventional casting technique

The new metallurgical sintering technique in construction of precious metallic structure of the resin veneered restorations was introduced recently in the prosthetic dental work. This study compared the microleakage at the interface between photocured composite veneering material and gold platinum alloy surface constructed either by the new sintering technique or the conventional casting technique. Two chemically adhesive systems were used, a] silicoater and b] Lee metal primer, in order to retain the veneering material. The samples were subjected to thermal cycling and the procedures used in determination microleakage were the radioactive isotope and the autoradiograph methods. Two time intervals were compared 1 - one month and 3 - three months. It was concluded that the two different techniques used in construction of the metallic part showed no statistical significant difference in microleakage at their interface with the veneering material retained either by silicoater or Lee metal primer systems

Influence of linear expansion of two different non metallic core materials upon cervical marginal accuracy of full veneer crowns

The effect of water sorption and linear expansion of two different non metallic core materials: 1] Composite and 2] Reinforced glass ionomer on the cervical marginal seating of cast metal crowns was investigated in this study. Thirty freshly extracted sound mandibular molar teeth were used in this study. The teeth were machined cut to simulate average dimensions of a prepared lower second premolar tooth with chamfer finish line. The teeth were decoronated 2 mm above the finish line then specially prepared to receive equal volumes of either pin retained composite or pin retained reinforced glass ionomer. The teeth after that were restored with full coverage metal crowns. Ten of each type of core samples were immersed in 37 degree normal saline while the remaining samples were maintained dry [control]. The vertical cervical marginal accuracy of the crowns were microscopically measured with 1 micron accuracy before immersion and after 6, 12 hours and every day of the following ten days of saline immersion. The statistical analysis of the results revealed that composite core immersed in saline solution at 37 degree possessed dimensional instability with the maximum linear change between the first and the second day. Also the reinforced glass ionomer core showed no effect upon the certical marginal seating of the overlying full coverage cast metal crown

Inhibition of herpesvirus ribonucleotide reductase by new synthetic peptides

The prospect of total chemical synthesis of large biologically active peptides up to the protein size has always represented a powerful tool in bioorganic chemistry. The advances made in the chemical synthesis of peptides would not have been possible without the availability of solid phase peptide synthesis [SPPS] introduced by Merrifield[1]. Since the conception of [SPPS], the chemistry developed for its application has remained fairly standardized. Like all ingenious ideas, [SPPS] also has its short-comings, for example the repetitive acidolysis required for the deprotection of [Boc] group, which may affect the acid sensitive peptide bonds and also catalyze some undesirable side reactions result in failure sequences. This initiated the development of different N-alpha-aminoblocking groups. However, the most successful one was the base labile 9-fluorenyl methoxycarbonyl Fmoc group, which is considered one of the best choices for protecting the alpha-amino-group not only because of its cleavage in weak alkaline medium [e.g. piperidine in DMF] and can therefore be used in conjunction with acid labile linker, acid sensitive amino acids and side chain protecting groups, but also because it enables- as UV active group- continuous spectroscopic monitoring during all steps of synthesis cycle[2]

Indications and results of the MAGPI Technique in minor forms of hypospadias

This study included 22 infants and children with a minor form of hypospadias. After clinical examination and appropriate preoperative investigations a MAGPI procedure was used to correct the malformation. The cosmetic and functional results were favorable in 86.3% of the cases with 3 complications. The comparison of the results to the original position of the meatus and anatomical state of the penis allows to redefine the indications of the MAGPI

Impact of electron microscopy on timing of excision of congenital chordae

30 male patients with clinically evident chordee were included in this study. Orthoplasty of the penis was performed under general anesthesia and controlled by artificial erection tests. In 60% of cases, skin degloving was sufficient, while in 40% fibrous tissue had to be excised to achieve penile straightening. It is evident that when fibrous chordee exist, they are an active process in the young patients and their excision should be complete to avoid recurrences