Plasma levels of TNF in obstructive sleep apnea syndrome [OSA] before and after surgical intervention

Prior studies have shown that biomarkers of inflammation, including TNF-alpha, are raised in patients with sleep apnea. TNF-alpha is one of important risk factors for atherosclerosis, stroke, and cardiovascular disease in OSA patients. To determine whether TNF-alpha blood levels are elevated in OSA syndrome and whether they are reversible after surgical intervention. Among the patients who had visited the ENT clinic for evaluation of sleep problems, 70 subjects were selected. Polysomnography [PSG] and morning venous blood serum for levels of TNF- alpha were performed in all the subjects and 35 patients were diagnosed as having OSAS. All patients with OSA had surgical intervention according to individual cases. Laser assisted uvulopalatoplasty [LAUP], extended LAUP [LAUP and laser assisted tonsillar ablation], or laser assisted uvuloplasty were done using a CO[2] laser. Sleep apnea monitoring, clinical evaluation and TNF-alpha level were then compared before and 3 months after intervention. We compared thirty five patients with OSA [21 males and 14 females], mean age [46.6 +/- 12.4], with 35 control subjects [11males and 24 females], mean age [34.2 +/- 9.6]. The mean [SD] plasma level of TNF-alpha was significantly higher in patients with OSAS than in control group [[5.77 +/- 4.04 pg/ ml vs. 2.24 +/- 1.5 pg/ml respectively, [P = 0.039]], and TNF-alpha level significantly decreased to [[3.22 +/- 3.4 pg/ml] [P = 0.001]] after treatment. In addition, TNF-alpha levels showed a statistically significant positive correlation with the AHI before treatment and with neck circumference after treatment. Our results suggest that TNF may be prognostic factors for comparing patients with OSAS before and after treatment

Assessment the nurses performance in providing care to patients undergoing nasogastric tube in suez canaluniversity hospital

Nasogastric tube feeding is the introduction of liquid, via a tube inserted through the nose and running directly to the stomach. In general, tube feeding is a technique used for those who are unable to eat on their own. The aim of the present study is to assess nurses' performance in providing care to patients undergoing nasogastric tube. The study was a descriptive research design was used to conduct this study; a total number of 50 nurse were selected randomly using systematic sampling technique. Data were collected over a period of four months, using two tools: Tool [1] Questionnaire sheets to assess nurses knowledge about care provided to patients undergoing nasogastric tube. Tool [2]: Observational checklist to assess the nurses practice in providing care to patients undergoing nasogastric tube. The results of the present study revealed that unsatisfactory level of performance in providing care to patients undergoing nasogastric tube among nurses in the sample. Age and experience was correlated with levels of nurse's knowledge. However, there were statistical significant differences between practice and gender, marital status and graduation. The study recommended that they had satisfactory theoretical knowledge and clinical applications nasogastric tube care and feeding parts should be taught together, to facilitate learning continuous evaluation of nurse's knowledge and performance is essential to identify nurse's needs

Assessment the nurses performance in providing care to patients undergoing chest tube in Suez Canal university hospital

Chest tube care is one of the most important nursing procedures because patients who need chest tubes are usually seriously ill and require advanced nursing care. Accordingly, vigilant and expert nursing care can prevent serious complications. The aim of the present study is to assess nurses' performance in providing care to patients undergoing chest tube. The study was a descriptive research design was used to conduct this study; a total number of 70 nurses were selected randomly using systematic sampling technique. Data were collected for a period of four months, using two tools: Tool [1] Questionnaire sheets to assess nurses, knowledge about care provided to patients undergoing chest tube. Tool [2]: Observational checklist to assess the nurses' practice in providing care to patients undergoing chest tube. The results of the present study revealed that unsatisfactory level of performance in providing care to patients undergoing chest tube among nurses in the sample. There was significant relation between nurses, knowledge, practice and degree of qualification. Also there was no correlation between nurses, knowledge and practice .The study recommended that improve nurses, theoretical knowledge and clinical applications of chest tube care and continuous evaluation of nurse's knowledge and performance is essential to identify nurse's needs

Validity of multidimensional body mass index [B], airflow obstruction [O], dyspnea [D] and exercise capacity [E], BODE index as predictor of hospitalization for COPD

Patients with COPD have systemic manifestations that are not reflected by the FEV[1]. These systemic manifestations often correlate with increased risk of mortality and may be considered surrogates of disease severity. We hypothesized that the BODE [body mass index, airflow obstruction, dyspnea, and exercise capacity] index would better predict hospitalization for COPD than FEV1 alone. The purpose of this study was to test in a cohort of patients with COPD, how well a multidimensional grading system that assessed the respiratory and systemic expressions of COPD would better categorize and predict outcome in these patients. A total of 150 patients with COPD [ages 45-83 yr; 89% male] recruited from the outpatient clinic of Suez Canal University Hospital were enrolled in 30 months, prospective study and followed-up for a mean period of 12 months from January 2004-June 2006. The BODE index was calculated for each patient using variables obtained within 4 weeks of enrollment. The main outcome measure was the number of hospital admissions for COPD during follow-up. The following variables were assessed for each patient: Age, sex, pack years of smoking, FVC%, FEV[1]%, the best of two 6 minute walk tests done 30 minutes apart, degree of dyspnea, body mass index [BMI]. We evaluated the relationship between FEV[1]%, the level of dyspnea, BMI, the best of two 6 minute walk tests done 30 minutes apart and BODE scores with the number of hospital admissions. After 30 months, 126 patients were available for the follow-up examination [follow-up rate, 84%]. During the follow-up period, 85 [67%] of patients required at least one hospital admission and 6 [4.8%] died. In multivariate analysis a significant effect of BODE score on the number of hospital admissions was found [95% confidence interval [CI], 0.36 to 0.61; p<0.000]. In comparison, there was a significant but smaller effect of the pack years of smoking, BMI and BMI score on the number of hospital admissions [[95% confidence interval [CI], 0. 03 to 0.05; p<0.000], [95% CI, -0.32 to -0.09; p<0.01] and [95% CI, -1.6 to -0.12; p<0.05] respectively]. FEV[1]%, the level of dyspnea, and 6 minute walk test were significant predictors of hospitalization in univariate analysis [p<0.000] but were excluded in multivariate analysis. The BODE staging system, which includes in addition to FEV[1] other physiologic and clinical variables, is a better predictor of hospital admissions than FEV[1] in COPD

Electrodiagnostic study of phrenic nerve function in patients with systemic lupus erythematosus

Systemic lupus erythematosus [SLE] may affect respiratory muscles. Diaphragmatic weakness in patients with SLE is a controversial issue and is claimed to have a neuropathic, myopathic or unknown pathogenesis. To determine whether the diaphragmatic weakness could be explained on the basis of a phrenic neuropathy in patients with SLE. A total of 21 patients [18 female and 3 male] with systemic lupus erythematosus [SLE] [age range, 16-36yr] were included and studied by physical chest examination, chest radiography, spirometry, as well as serological examinations and bilateral transcutaneous phrenic nerve conduction studies. 14 [66.6%] patients complained of dyspnea, only one patient showed paradoxical abdominal movement. Pulmonary function tests showed proportional reduction of the forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV[1]] in 17 [81%] patients, suggesting a restrictive process which was severe in 5 [23%] patients. Phrenic nerve evaluation using transcutaneous stimulation studies showed delayed latencies of the right, left and both phrenic nerve in 17 [81%], 19 [90%] and 17 [81%] patients respectively, confirm-ingademyelinating neuropathy. Also Phrenic nerve stimulation evoked a low-amplitude response from right, left and both phrenic nerve in 17 [81%], 15 [71%] and 14 [66.6%] of patients respectively, confirming axonal neuropathy. There were no significant differences in serum immune markers between individuals with and those without abnormal electrical phrenic nerve stimulation. All patients presented with dyspnea showed abnormal phrenic nerve conduction studies. There was tendency for small but clear lung fields in CXR of individuals with abnormal electrical phrenic nerve stimulation. Overall FVC% predicted was decreased in individuals with abnormal electrical phrenic nerve stimulation compared to those without. Diaphragmatic weakness in patients with SLE is both common and is very likely to be caused by a phrenic neuropathy with evidence of bilateral involvement in patients with SLE