Comparison of the air-Q intubating laryngeal airway and the cobra perilaryngeal airway as conduits for fiber optic-guided intubation in pediatric patients

One of the methods proposed in cases of difficult airway management in children is using a supraglottic airway device as a conduit for tracheal intubation. The aim of this study was to compare the efficacy of the Air-Q Intubating Laryngeal Airway [Air-Q] and the Cobra Perilaryngeal Airway [CobraPLA] to function as a conduit for fiber optic-guided tracheal intubation in pediatric patients. A total of 60 children with ages ranging from 1 to 6 years, undergoing elective surgery, were randomized to have their airway managed with either an Air-Q or CobraPLA. Outcomes recorded were the success rate, time and number of attempts required for fiber optic-guided intubation and the time required for device removal after intubation. We also recorded airway leak pressure [ALP], fiber optic grade of glottic view and occurrence of complications. Both devices were successfully inserted in all patients. The intubation success rate was comparable with the Air-Q and the CobraPLA [96.7% vs. 90%], as was the first attempt success rate [90% vs. 80%]. The intubation time was significantly longer with the CobraPLA [29.5 +/- 10.9 s vs. 23.2 +/- 9.8 s; P < 0.05], but the device removal time was comparable in the two groups. The CobraPLA showed a significantly higher ALP [20.8 +/- 5.2 cmH 2 O vs. 16.3 +/- 4.5 cmH 2 O; P < 0.001], but the fiber optic grade of glottic view was comparable with the two devices. The CobraPLA was associated with a significantly higher incidence of blood staining of the device on removal and post-operative sore throat. Both the Air-Q and CobraPLA can be used effectively as a conduit for fiber optic-guided tracheal intubation in children. However, the Air-Q proved to be superior due to a shorter intubation time and less airway morbidity compared with the CobraPLA

Review of Parasitic Zoonoses in Egypt

This review presents a comprehensive picture of the zoonotic parasitic diseases in Egypt, with particular reference to their relative prevalence among humans, animal reservoirs of infection, and sources of human infection. A review of the available literature indicates that many parasitic zoonoses are endemic in Egypt. Intestinal infections of parasitic zoonoses are widespread and are the leading cause of diarrhea, particularly among children and residents of rural areas. Some parasitic zoonoses are confined to specific geographic areas in Egypt, such as cutaneous leishmaniasis and zoonotic babesiosis in the Sinai. Other areas have a past history of a certain parasitic zoonoses, such as visceral leishmaniasis in the El-Agamy area in Alexandria. As a result of the implementation of control programs, a marked decrease in the prevalence of other zoonoses, such as schistosomiasis and fascioliasis has been observed. Animal reservoirs of parasitic zoonoses have been identified in Egypt, especially in rodents, stray dogs and cats, as well as vectors, typically mosquitoes and ticks, which constitute potential risks for disease transmission. Prevention and control programs against sources and reservoirs of zoonoses should be planned by public health and veterinary officers based on reliable information from systematic surveillance.

Serum Troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients

Background: Chronic Obstructive Pulmonary Disease [COPD] is a major cause of chronic morbidity and mortality worldwide. It is the fifth leading cause of death worldwide. The spectrum of cardiovascular complications associated with COPD is clearly broad, right ventricular [RV] dysfunction and pulmonary vascular disease are common in COPD and progress with time. In RV failure, cardiac Troponins [cTn] are suspected to be elevated secondary to RV ischemia or micro infarction

Objective: To evaluate the prognostic value of cardiac Troponin I level in acute exacerbated chronic obstructive pulmonary diseases [AECOPD] and its impact on the hospital outcome in those patients

Patients and methods: This study was performed on 60 patients with AECOPD, admitted at Chest Department and respiratory ICU; Zagazig University hospital. All patients were subjected to: thorough history taking, clinical examination, electrocardiography and echocardiography, arterial blood gas [ABG] analysis, measure forced vital capacity [FVC] and forced expiratory volume in first second [FEV1], serum assay of cTnI level which is considered -ve if <0.01 ng/ml and +ve if >/=0.01 ng/ml

Results: cTnI was positive in 42 AECOPD patients. cTnI positivity was more prominent among patients with very severe exacerbation of COPD and in those with past history of LTOT, MV, ICU admission. Also, cTnI positivity was more in patients admitted to ICU rather than those managed in the ward and among patients who needed MV rather than who did not need it and in patients who failed weaned rather that who succeeded weaned. P-pulmonate, Rt. ventricular strain, high pulmonary artery pressure, hypoxemia and hypercapnia showed a great effect upon cTnI positivity. The duration of hospitalization was longer among cTnI +ve patients than cTnI ?ve ones, Tropinin cutoff value for the prediction of death was >0.055 ng/ml with Sensitivity = 75%, Specificity = 68%

Conclusion: Positive cTnI in AECOPD patients may suggest exacerbation severity and the occurrence of pulmonary hypertension and right ventricular dysfunction. Positive cTnI is considered as good prognostic marker for the possibility of a need for MV and a longer duration of hospitalization. MV may further elevate cTnI in AECOPD patients and with possible weaning failure. Negative cTnI and cTnI

Evaluation of specific biochemical indicators of Helicobactepylori-associated gastric cancer in Egypt

The aim of the study was to assess the accuracy of some specific biochemical indicators in discriminating between Helicobacter pylori-associated gastritis and H. pylori-associated stomach cancer [serum gastrin level, serum soluble E-cadherin and tissue COX-2 activity, as well as serodiagnostic markers for H. pylori infection] in order to find a simple diagnostic test that can reasonably predict the development of gastric cancer. The study participants comprised 20 patients with gastric carcinoma, 20 patients with positive H. pylori-associated gastritis and 20 individuals as the control group. Standard procedures and quality control measures were followed. Using cut-off values and ROC analysis to assess the diagnostic abilities of the biochemical indicators, E-cadherin showed the highest sensitivity [100%]. We suggest that close follow-up together with periodic endoscopic examination for all patients with persistent H. pylori infection and serum soluble E-cadherin level above 5 microg/mL is essential

Cardiac autonomic status among pediatric patients intoxicated with digoxin

The current study is a prospective study aiming at evaluating cardiac autonomic function and dysrhythmias among pediatric patients intoxicated with digoxin. The study was conducted on fifty pediatric patients who were presented to Pediatric Cardiology Department and Poison Control Center of Ain shams University Hospitals during the period from January 2010 to June 2010. The patients were divided into three groups as follows: Group I included fifty healthy volunteer children age and sex matched served as control group. Group II included thirty patients with cardiac diseases on digoxin for therapeutic purpose and Group III included twenty patients with normal heart who took digoxin for non therapeutic purpose. An informed written consent was taken from the volunteers and patients' legal guardians. The studied parameters were personal data, clinical manifestations, investigations, ECG recording of the heart rate and rhythm, followed by twenty four hours Holter monitoring. The present study revealed that most of the pediatric patients intoxicated with digoxin were belonging to early infancy age category and most of them were females. Most of intoxicated with digoxin were belonging to early infancy age category and most of them were females. Most of intoxicated patients received digoxin for therapeutic reasons for underlying cardiac conditions followed by accidental exposure and lastly due to suicidal attempts. The main clinical manifestations among pediatric patients intoxicated with digoxin were mainly in form of gastroeintestinal [GIT] and cardiovascular [CVS] manifestations followed by neurological manifestations. There was a significant correlation between serum electrolyte levels sodium, potassium and calcium when compared with the serum digoxin level. The main ECG changes in group II versus [vs.] group III were as follows; sinus bradycardia [20% vs. 45%], first degree heart block [16.6% vs. 10%], Sagging of ST segment [100% vs. 85%], Ventricular Bigeminy [VPC] or pulsus bigeminy [10% vs. 15%], premature ventricular contractions PVCs [3.3 vs. 15%] and torsades de pointes [0% vs. 5%]. There was significant decrease in heart rate variability indices SDNN, PNN50 and RMSSD during 24 hours Holter monitoring in studied groups when compared with control group denoting presence of cardiac autonomic dysfunction associated with digoxin toxicity. In conclusion pediatric patients presenting with digoxin toxicity were found to have cardiac autonomic dysfunction predisposing them to dysrhythmias. This autonomic dysfunction was found in all patients with digoxin toxicity even those not presenting with cardiac manifestations and was found to be more severe in patients with underlying cardiac diseases which mandates 24 hours Holter monitoring for those patients

Evaluation of the antimicrobial effect of gaseous ozone, ozonated water and ozonated sodium hypochlorite on the enterococcus faecalis of human root canals

The aim of this study was to evaluate the antimicrobial effect of gaseous ozone, ozonated water and ozonated sodium hypochlorite on the Enterococcus faecalis of human root canals. It was divided into two parts; in vitro and in vivo study. 60 extracted human anterior maxillary teeth were included in the in vitro part, where they were prepared, incubated with E. faecalis for 48 h and then divided into 3 groups; the first was treated with application of the ozone gas for 120 sec while the second was treated with irrigation using 4mg/L ozonated water for 10 mins and the third was treated by 5.25% sodium hypochlorite irrigation for 2 mins. Then samples were collected from each tooth for the calculation of bacterial count after the application of the treatment. The in vivo part included 32 patients with apical radiolucencies related to upper anterior teeth, pre-chemomechanical samples were collected before the preparation then the teeth were divided into four groups; the first was treated by saline irrigation between each instrument and the other during the cleaning and shaping procedure followed by the application of gas ozone for 120 sec, the second group was treated with 4 mg/L ozonated water irrigation between each instrument and the other during the preparation, the third group was treated using 0.5% NaOCl solution for irrigation between each instrument and the other while the fourth group was treated by 0.5% NaOCl irrigation between each instrument and the other followed by 10 sec ozone gas application after finishing the procedure of cleaning and shaping. The results of the in vitro study showed that 85.25% NaOCl achieved the highest percentage of bacterial count reduction with a statistically significant difference than the other groups followed by the Ozone gas group then the Ozonated water group and there was no statistically significant difference between the last two groups. While the in vivo study concluded the significant antibacterial effect of the ozonated sodium hypochlorite solution that showed the highest percentage of bacterial count reduction followed by the ozone gas and the ozonated water groups with no statistically significant difference between them, while the 0.5% NaOCl gave the lowest antibacterial effect against E. faecalis

Role of rehabilitation of chronic obstructive pulmonary disease patients in intensive care unit

The COPD are the most common chronic lung disease and the major impetus for the development of pulmonary rehabilitation program. Poor endurance, dyspnea, and deconditioning are the hallmarks of the presenting symptoms. The key components of pulmonary rehabilitation are education, exercise training, psychosocial/behavioral intervention and outcome assessment. The present study was designed to study the effects of pulmonary rehabilitation on patient of COPD and compare between comprehensive rehabilitation program and progressive ambulation as regard some physiologic variables. This study included eighty COPD patients recovering from an episode of acute respiratory failure and admitted to RICU of Zagazig University Hospital. All of them fulfilled the American Thoracic Society criteria of COPD 1995, with the age ranging from 51 to 80 years. Evaluating measures were done as early as possible at admission, discharge and after 3 months and they include: arterial blood gases [ABG], pulmonary ventilatory tests [PVT], maximal inspiratory pressure [MIP], visual analog scale [VAS] and 6 min walking distance [6 m WD]. Rehabilitation program were usually begun as early as possible for clinically stable patients, it consists of daily session 30-45 min for each and of four different steps of increasing difficulty. Our results showed that pulmonary rehabilitation is of great beneficial effects for critically ill COPD patients admitted to RICU and early intervention give better results. Also comprehensive program was superior to ambulation program

Comparative study on the effects of steviosides and aspartame on glucose, urea and creatinine levels of normal and type 2 diabetic rats

Comparing the effects of the natural nonnutritive sweetener [steviosides] and the artificial sweetener [aspartame] on the plasma glucose, urea, and creatinie levels of normal and type 2 diabetic rats revealed that treating normal and diabetic rats with different doses of both sweeteners reduced the plasma glucose levels except in normal rats treated with low dose of aspartame and high dose of steviosides that increased glucose levels by 17.3% and in normal rats treated with the high aspartame dose [38%] but fortunately they were still within the normal glucose range. All doses of both sweeteners increased urea levels in normal rats by percentages ranging from 5.2% to 41.7% though they were within the normal urea range except the low aspartame dose and high steviosides dose, moreover medium aspartame dose reduced urea level by 11.1%. All doses of both sweeteners reduced the urea levels in diabetic rats with the highest reduction percentage in those treated with the high steviosides dose [63.8%] while the lowest [40.9%] was in those treated with the medium dose of aspartame but unfortunately, no dose succeeded to lower urea levels to their normal ranges. Treating normal rats with different doses of both sweeteners increased the plasma creatinine by percentages ranging from 33.3% in the medium steviosides dose to 33.3% in the low spartame dose although they were kept within the normal creatinine range. Treating diabetic rats with different doses of both sweeteners succeeded to lower creatinine levels to their normal ranges with reduction percentages ranging from 25.8% to 38.1%. The creatinine levels were more or less similar in diabetic rats treated with different doses of both sweeteners with no significant differences between the two sweeteners in any dose

Telomerase activity, cytokeratin 20 and cytokeratin 19 in urine cells of bladder cancer patients

This work aims to search for markers suitable for the screening of bladder cancer, which should be specific, sensitive, reproducible, non-invasive and at acceptable cost. The study included 50 patients diagnosed as bladder cancer [35 TCC, 15 SCC] of different stages and grades, 30 patients with various urothelial diseases, besides 20 apparently healthy subjects of matched age and sex to the malignant group. A random midstream urine sample was collected in a sterile container for the determination of telomerase by RT-PCR, keratin 19 by ELSA CYFRA 21-i IRMA kit, keratin 20 by RT-PCR and immunohistochemical staining, and urine cytology. For all parameters [telomerase, Ki9, K20 and cytology] the malignant group was significantly different from both the benign and the control groups. None of the four studied parameters was correlated to the stage of the disease, and when it comes to grade, only Ki9 showed a significant positive correlation with grade both in TCC and SCC. When ROC curves for all parameters were compared, Ki9 had the largest area under the curve, and then comes K20. K 19 may be used as a biological marker for the diagnosis of bladder cancer Ki9 could not be used for differential diagnosis of different types of bladder cancer, meanwhile it could be a marker for differentiation that decreases in less differentiated tumors. As a tumor marker, K20 reflects inability to differentiate tumor type or grade in TCC, while in SCC of the bladder it is correlated with the grade. As a method, RT-PCR is superior to immunostaining for the detection of bladder cancer, meanwhile K20 immunohistochemistry [IHC] results were much better than urine cytology as a bladder cancer screening test. Haematuria and inflammation reduced the specificity of telomerase assay, which reduced its validity as a tumor marker of bladder cancer. Ki9 and K20 are the best candidates as screening tests for the diagnosis of bladder cancer, representing the highest sensitivity and specificity, beside the radiological and histopathology. Meanwhile, telomerase, although it was a sensitive enough marker, it reflected a high false positive rate

Pancreatitis in enterica among Egyptian children

Fifty children [30 males and 20 females] diagnosed as typhoid fever were randomly chosen among those admitted to Abbassia fever hospital. Their ages ranged between 3-12 years [8.35 +/- 2.62 years]. History-taking, clinical examination and laboratory investigations including CBC, ESR, Widal test, blood culture, serum [SYMBOL 97 /F Symbol] amylase and serum lipase were assessed twice; at admission and 10 days later. A cohort of 20 healthy children served as the control group. The study showed that serum amylase and serum lipase [210.12 +/- 45.34 U/L and 180.35 +/- 20.45 U/L respectively] were significantly higher than those levels among the control group [86.34 +/- 30.45 U/L and 95.44 +/- 23.76 U/L respectively]. The levels decreased significantly 10 days after the start of specific therapy; near to normal levels [90.12140.65 U/L and 99.56 +/- 34.45 U/L respectively]. Considering a cut off value of 145 U/L for serum amylase and 140 U/L for serum lipase, it was clear that pancreatic involvement was evident among 37 [74%] cases or 33 [66%] cases according to their serum levels of amylase and lipase respectively. Addingly, symptomatic cases with vomiting, epigastric tenderness and hypotension are associated with significantly higher levels of serum amylase [290.78 +/- 25.67 U/L, 310.23 =/- 7.60 U/L and 295.46 +/- 22.50 U/L respectively] and serum lipase [220.56 +/- 27.89 U/L, 230.56 +/- 10.54 and 219.34 +/- 13.24 U/L respectively] than cases without these findings. We can conclude that pancreatic invovement is a common finding among children with typhoid fever. This involvement can be expected in the presence of vomiting, epigastric tenderness and/or hypotension and predicted with a higher accuracy by serum pancreatic amylase and/or lipase assessment

Effect of pirprofen on the lung of albino rats: a histopathological and histochemical study

The relationship between the use of non-steroidal anti- inflammatory drugs and pulmonary diseases is recognized with greater frequency. The present work aimed to study the histological and histochemical effects of pirprofen administration on the lung of albino rats and the changes that occur after its withdrawal as compared to placebo. Bronchopneumonia, bronchiectasis, non caseating tuberculous lesions and emphysematous changes were seen in the animals killed one hour after the last dose of drug administration. Gradual resolution was observed in the withdrawal groups. The histopathological changes were associated with decreased cytochrome oxidase which retained its normal level at three weeks after withdrawal. On the other h and, acid and alkaline phosphatases showed increased activity with progressive decrease to normal levels after three weeks withdrawal. The above mentioned changes were probably caused by a reversible hypersensitivity reaction to the non- steroidal anti- inflammatory drug, pirprofen. Clinicians should be aware of the possibility of such a complication in patients receiving this drug