Prevalence of and factors associated with increased suicide risk among chronic non-cancer pain patients in zagazig university hospitals

Background: chronic non-cancer pain (CNCP) patients are more likely to experience suicidal ideation and behaviors compared to the general population. To our knowledge, this is the first study in Egypt discussing the prevalence and risk factors of suicide among CNCP patients.Objectives of this study aimed to identify the most important general and pain-related risk factors of suicide in patients with chronic non-cancer pain at Zagagzig University Hospitals. Methods: a total of 179 patients with chronic non-cancer pain were recruited from Outpatient clinics, Zagazig University hospitals, Sharkia. A simple questionnaire was structured for all participants to collect data onsocio-demographic data and pain-related (intensity, duration, interference, sleep problems). Psychometric assessment was done which included; the Visual Analogue Scale (VAS), Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) and Columbia Scale for the Rating of Suicide Severity(C-SSRS).Results: approximately half of the patients (48.6%) reported lifetime suicidal ideation and only 1.1% reported life time suicide attempts, Suicidal ideation occurred after onset of pain in 26.3% of the participants. Several risk factors for SI in chronic pain were identified, including younger age, previous substance abuse, past history of psychiatric illness and sleep-onset insomnia.Conclusion: results of this study are consistent with the prevailing literature on pain andsuicide demonstrating a high prevalence of suicidal ideation in the chronic pain population. Novel predictive variables were also identified that will provide the basis for developing a risk stratification model that can be further tested prospectively in chronic pain patients

Challenge of diabetes control in patients with rheumatic diseases

Patients who are suffering of rheumatic diseases are at great risk for the development of diabetes mellitus; also diabetic patients who develop rheumatic disorders are liable to have fluctuating blood glucose. New onset diabetes, new onset hyperglycemia, uncontrolled pre-existing diabetes, difficulties in life style modifications, and acute complications of diabetes such as diabetic ketoacidosis and hypoglycemia; all of these present a major challenge in the management of patients with rheumatic diseases. There are multiple risk factors which contribute to this challenge. Some of the risk factors are related to the rheumatic disease itself, such as inflammatory cytokines, disease associated renal impairment, physical disability and gastroparesis. Drugs utilized for the treatment of rheumatic diseases [e.g., steroids, calcineurin inhibitors and hydroxychloroquine] impose a great risk in relation to diabetes. The role of non-pharmacological and pharmacological approach in the control of diabetes is essential and can deal well with the challenge

Effects of tranexamic acid during endoscopic sinus surgery in children

This study was conducted to evaluate the effect of tranexamic acid [TA] on the intra-operative bleeding during the functional endoscopic sinus surgery [FESS] in children. A total of 100 children recruited to undergo FESS were randomized into two groups. Group I: Was given just after induction, intra-venous 25 mg/kg TA diluted in 10 ml of normal saline. Group II: Was given 10 ml of normal saline. Non-invasive blood pressure, heart rate, and quality of the surgical field were estimated every 15 min. Volume of bleeding and duration of the surgical procedure were recorded. Surgical field quality after 15 min revealed that seven patients in group I had minimal bleeding versus no one in group II, P=0.006. Meanwhile, 35 patients in group I had mild bleeding versus 26 patients in group II, P=0.064. Higher number of patients in group II than in group I had moderate bleeding, P=0006. Also, at 30 min, revealed that 10 patients in group I had minimal bleeding versus one patient in group II, P=0.004. Meanwhile, 37 patients in group I had mild bleeding versus 28 patients in group II, P=0.059. Higher number of patients in group II than in group I had moderate bleeding, P<0001. Duration of the surgeries and volume of bleeding were significantly less in tranexamic group than the placebo group, P<0.0001. Single intra-venous bolus dose of tranexamic in children during the FESS improves quality of surgical field, reduces intra-operative bleeding, and duration of surgery

Effects of preoperative beta-blocker on blood loss and blood transfusion during spinal surgeries with sodium nitroprusside-controlled hypotension

The present study sought to determine whether premedication with oral beta-blocker before hypotensive anesthesia with sodium nitroprusside could improve the quality of surgical field, decrease the blood loss, and decrease the need for homologous blood transfusion and duration of surgery. Eighty patients scheduled for spinal fixation surgery were included in a prospective, randomized, double-blinded study. Patients were classified into two groups: Group I received oral atenolol 50 mg twice one day before surgery; and Group II received placebo tablets identical in appearance to atenolol tablets for the same period and interval. All patients in both the groups received intraoperative sodium nitroprusside [SNP] as a hypotensive agent. Hemodynamic variables, amount of sodium nitroprusside used, quality of surgical field, and the amount of homologous blood transfusion and blood loss were compared between groups. Heart rate and amount of SNP used were significantly less [P < 0.0001] in the atenolol group, but no significant difference was found in intraoperative mean arterial blood pressure [MABP] between the two groups. The time of surgeries was significantly shorter in Group I than in Group II [185 +/- 15.21 vs 225 +/- 12.61 min], P < 0.0001. The quality of surgical field was better in Group I than in Group II in all times of measurements, P < 0.0001. The amount of blood loss and the amount of packed red blood cells transfused were significantly less in Group I than in Group II, P < 0.0001. No clinically significant complications were observed in either group. Premedication with oral atenolol 50 mg twice/day for one day before hypotensive anesthesia with SNP during spinal surgeries seems to be clinically safe and effective to reduce heart rate, amount of SNP used, amount of blood loss, and amount of blood transfused with better quality of surgical field

Celiac disease as uncommon cause of death in type 1 diabetes mellitus: a case study

Celiac disease [CD] is one of the most common immune mediated diseases. This disease is triggered by ingestion of wheat gluten and related other cereal proteins, particularly those in rye and barley. The prevalence of CD in type 1 diabetes in children is 1:6 to 1:103 and in adults 1:16 to 1:76. In-spite of that, there is no current clinical evidence supporting routine screening of adult type 1 diabetic patients for CD. Most patients who have diabetes and CD have nonclassic forms of CD, with various presentations such as short stature, sideropenic anemia, or hypertransaminasemia; in many cases, patients are totally symptom free. CD elevates the mortality risks of a wide array of diseases in CD patients. This case had an atypical presentation of CD, and died unexpectedly because of the disease. We report this case to emphasize on the value of high index of suspicion of CD in type 1 diabetes mellitus

Acute normovolemic hemodilution versus controlled hypotensive anesthesia in major orthopedic surgery

The purpose of this study was to investigate the efficacy and safety of controlled hypotension versus ANH as blood conservation methods during major orthopedic surgery. Forty patients, assigned to receive either ANH [HT= 30%] or controlled hypotension. General anesthesia was induced by fentanyl 2micro gm/kg intravenously, thiopental Na 5mg/kg intravenously and atracurim 0.5mg/kg. After induction of anesthesia but before surgery, the patients were classified into two groups according to the technique of blood conservation used: group I [20 patients] acute normovolemic hemodilution. The volume of blood withdrawn has been replaced simultaneously by infusion of identical volume of hydroxyethyl starch 6% in order to maintain normovolemia. Group II [20patients]: controlled hypotensive anesthesia. A mean of 1000 ml blood was predonated [20% of the total blood volume] in hemodilutio group. Blood loss was, significantly higher in ANH group. The total loss was 1500mL [ANH] vs. 1200 mL [in hypotensive group], [p < 0.05]. The average amount of blood transfusion was 262.5 ml [ANH group] vs. 187.5 ml [hypotensive group]. 50% went through surgery without receiving blood [ANH] vs. 60% [hypotensive group]. No renal, neurological or cardiopulmonary complications were registered. Also there was slight but significant metabolic acidosis. The acidosis was metabolic in origin because PaCO2 was kept constant and [Bic] and [BE] decreased significantly and it was not lactic acidosis as serum lactate remains within normal limit. It is considered as hyperchloermic metabolic acidosis as serum chloride significantly increased. Both ANH and hypotensive anesthesia can be used safely in patients undergo major orthopedic surgery however, Deliberate hypotension was the most effective means of reducing intraoperative bleeding and the time for this procedure was shorter than for normovolaemic haemodilution combined with autotransfusion. Also there was slight but significant metabolic acidosis

Relationship of echographic findings with visual outcomes in post-cataract surgery endophthalmitis

To correlate the initial echographic findings in eyes with infectious endophthalmitis with the visual prognosis. A prospective study of the clinical and echographic findings in eyes with infectious endophthalmitis was performed in Zagazig University Hospitals, ophthalmology department. This study included 17 eyes with post-operative infectious endophthalmitis from January 2005 to December 2005. Ultrasonography of the patients by A and B scan revealed presence of vitreous debris in all patients. Thirteen patients [76.5%] had mild to moderate vitreous debris, while 4 patients had dense vitreous debris. Vitreous membranes were observed in 8 of the 17 eyes [49%]. Partial or complete posterior vitreous detachment was present in 6 eyes [35.3%]; retinochoroidal thickening was seen in 2 eyes [11.76%]. None of the patients evaluated in the present study had retinal or choroidal detachment on ultrasonography. Analysis of the final visual outcome revealed that six [35.29%] of the 17 eyes had a poor final visual outcome [visual acuity of less than 3/60]. Eleven eyes [64.7%] had a good final visual outcome [visual acuity of 6/60 or better]. B and A scan ultrasonography is a useful method in the clinical evaluation and treatment of infectious endophthalmitis, especially in eyes with opaque media

Oncological emergencies clinico pathologic study and treatment results

This retrospective study included 98 patients who developed oncologic emergencies and presented to Radiation Oncology Department of Assiut University Hospital between the period of January 1999 and May 2000. The incidence of oncologic emergencies was 7% of all patients. The most common type of oncologic emergency encountered was neurologic emergency [spinal cord compression and increased intra cranial tension], it represented 56.12% of the patients, followed by metabolic emergency, superior vena cava syndrome, surgical emergency, urologic emergency and tumor lysis syndrome in 13.2%, 10.25%, 9.18% and 2%, respectively. Various treatment modalities were used including radiotherapy in 63% of the patients, supportive measures in 20%, surgery in 8%, combined modalities in 8% and chemotherapy in only 1%. Fifty-nine patients have been saved by urgent management and could survive with good control, while nineteen patients showed no response and the death rate was 20.4%

Congenital syringobulbia a radiological study with clinical correlation, study of its incidence and probable aetiopathogenic factors

In the present study 25 patient with the clinical diagnosis of congenital syringomyelia are included. All cases were examined MRI. The brain, craniocervical junction, the cervical and upper dorsal spine were scaned in every patient. Special focus of attention was given to the brain stem for evidence of syringobulbia. 9 patients were also examined by CT myelography with early and late study [done 6 Hr later]. The brain stem, craniocervical junction and the cervical spine were scanned. Four, cases [16%] were found to have brain stem cavitations in conjunction with syringomyelia. Cases with syringomyelia and syringobulbia are compared with syringomyelia cases without syringobulbia hoping to find out aetiopatho genie factors or risk factors that are responsible for extension of syringomyelic cavitation to the brain stem, as early correction of these factors might help preventing extension of syringomyelic cavitations to the medulla. Full description of the pathoanatomical types of syringobulbia will also be made

idiopathic parkinson disease. A magnetic resonance imaging study correlation with the clinical picture and the pattern of levodopa responsiveness

In the present study 20 patients with the clinical diagnosis of idiopathic parkinson disease are included. All patients were subjected to [1] full clinical examination and MRI study of the brain with a special focus on the mid-brain and the basal ganglia. Based on the duration of the parkinsonian symptomatology and the clinical response to levodopa treatment, patients were classified into two main groups. Group [A] is characterized by short duration of the parkinsonian symptomatology and a good sustained response to levodopa treatment, while group [B] was characterized by a longer duration of the parkinsonian symptomatology and a fluctuant response to levodopa treatment. MRI demonstrated important structural changes at the level of the substantia nigra and the red nucleus in both groups, while structural changes at the level of the basal ganglia [putaminal hypointensity on the T2 weighted images] were demonstrated only in group [B] patients. The significance of the MRI findings, their probable aetiology and pathogenesis, their value in explaining the pattern of clinical levodopa responsiveness and their implications in the management of parkinson disease will be discussed

acyclovir responsive herpes simplex encephalitis definition of its radiological features; correlation with the clinical picture and CSF analysis

In the present study 13 patient with the clinico- radiological diagnosis of herpes simplex encephalitis [HSE] are included. All patients were subjected to [1] full clinical examination [2] CSF analysis that included CSF chemistry [protein, glucose and chloride], cells, latex test for bacterial antigens, CSF culture of pyogenic bacteria and TB and PCR [polymerase chain reaction] for detection of both type I and type II herpes simplex virus [HSV] DNA [3] Both MRI and CT scan of the brain with and without contrast were done to all patients. CSF analysis showed moderate rise of proteins [average 860 mg/dl, normal values up to 450 mg/dl] with normal sugar and glucose and with a predominately lymphocytic pleocytosis in all patients. Latex test was negative for all patients. Both CSF bacterial and TB cultures were eventually negative. HSV type I DNA was detected in the CSF by the PCR test in all patients, type II HSV DNA was not detected in the CSF of any of the patients examined. Involvement of the temporal lobes unilaterally or bilaterally were the cardinal radiological feature demonstrated in all patients. Other areas of the brain, such as the orbital frontal region, the paraventricular region, the basal ganglia or the brain stem, are involved but less frequently. The significance of these findings for the early diagnosis of herpes encephalitis are discussed. Also the clinical course of the patients and their response to treatment will be presented and discussed

Possible antigenic cross reactivity between hepatitis c virus and schistosoma soluble worm antigens

The possible cross-reactivity between antibodies [Abs] to hepatitis-C virus [HCV] and Schistosoma mansoni was investigated. Ninety-one serum samples were collected from Egyptian adult healthy male blood donor volunteers. Sera were assayed for HCV antibody using a third generation ELISA technique, and divided into two groups. Group I [n = 61] included the anti - HCV positive sera, and group II [n = 30] anti HCV negative sera. For the two groups of sera, the seropositivity for anti - S.mansoni adult microsomal antigen [MAMA] was determined by Falcon assay screening test - ELISA [FAST-ELISA] and found to be higher in group I [78.7%] than group II [33.3%]. In contrast, screening for anti - Escherchia coli Abs by passive haemagglutination test demonstrate positive results in 44 [72.1%] of group I, and 28 [93.3%] of group II. Elimination of schistosoma Abs from HCV +ve sera did not affect detection of Hcv Abs when re-tested. It is concluded that Abs to immunogenic epitopes of Hcv and schistosoma adult worm antigens are not cross-reactive