Atorvastatin: In-Vivo Synergy with Metronidazole as Anti-Blastocystis Therapy

Blastocystis is an enteric Straminopile in tropical, subtropical and developing countries. Metronidazole has been a chemotheraputic for blastocystosis. Failures in its regimens were reported and necessitate new studies searching for alternative therapeutic agents. Aim of current study is to investigate potential effects of Atorvastatin (AVA) compared to the conventional chemotherapeutic MTZ in experimentally Blastocystis-infected mice. Anti-Blastocystis efficacy of AVA was evaluated parasitologically, histopathologically and by transmission electron microscopy using MTZ (10 mg/kg) as a control. Therapeutic efficacy of AVA was apparently dose-dependent. Regimens of AVA (20 and 40 mg/kg) proved effective against Blastocystis infections with high reduction in Blastocystis shedding (93.4–97.9%) compared to MTZ (79.3%). The highest reductions (98.1% and 99.4%) were recorded in groups of combination treatments AVA 20–40 mg/kg and MTZ 10 mg/kg. Blastocystis was nearly eradicated by the 20th day post infection. Genotype analysis revealed that genotype I was most susceptible, genotype III was less. Histopathologic and ultrastructural studies revealed apoptotic changes in Blastocystis and significant improvement of intestinal histopathological changes more remarkable in combinational therapy groups. Thus, the present study offers AVA as a potential candidate for Blastocystis therapy combined with MTZ.

Effect of renal sympathetic denervation used in the treatment of resistant arterial hypertension on left ventricular hypertrophy and diastolic function

Background: Hypertension [HTN] results in structural and functional cardiac changes which increase cardiovascular morbidity and mortality. The effect of renal denervation [RD] on left ventricular hypertrophy [LVH] and left ventricular [LV] diastolic function is still unclear

Objective: This study investigated the effect of catheter-based renal sympathetic denervation on LVH and diastolic function in patients with resistant hypertension

Methods: We evaluated systolic and diastolic blood pressure [SBP and DBP, LV size, mass and diastolic function before and 6 months after RD in 68 patients with resistant hypertension by transthoracic echocardiography and Doppler

Results: SBP and DBP reduced 6 months after RD [-22 +/- 3 mmHg and -10 +/- 12mmHg; P<0.0001 respectively] LV mass index decreased similarly independent on BP response [-19.37 +/- 2.6 gm/m[2]: P<0.0001]. Diastolic parameters E/A ratio, E-wave deceleration time and intra-ventricular relaxation time improved similarly in all patients after 6 months [0.89 +/- 0.04; P=0.001, -24.85 +/- 8.93 ms; P=0.007 and -6.97 +/- 2.57 ms; P=0.012 respectively]

Conclusion: In patients with resistant hypertension and beside blood pressure lowering effect, renal denervation improves left ventricular hypertrophy and diastolic function. The relation of BP reduction effect and the improvement of cardiac hypertrophy and systolic function suggests a direct effect of sympathetic activity on LV remodeling and function which needs to be confirmed in larger prospective cohorts

Application of dried blood spot testing for hepatitis C virus RNA amplification

Background/Aim: Hepatitis C Virus [HCV] infection represent a major public health problem because of the ability of HCV to cause a chronic carrier state. Even though chronic carriers remain largely asymptomatic, a large number of these individuals subsequently develop cirrhosis and primary hepatocellular carcinomas. Dried Blood Spot [DBS] samples are a simple and inexpensive sampling method, especially useful for blood collection in resource poor settings with limited access to diagnostic facilities. The main advantage of DBS samples over routine blood samples is that only a small quantity of blood is required, easy to obtain, stable and can be transported to a reference laboratory at minimal cost

The Aim of the work was to evaluate the feasibility of DBS samples as an alternative sample type to serum for the detection of HCV RNA. Results obtained from DBS samples were compared with results of serum using the same technique

Methods: This study was carried out on 50 anti-HCV-positive serum samples, from patients whom attending Arar Central Hospital and Prince Hospital, Arar, kingdom of Saudi Arabia., during November 2011 to February 2012

Results: .HCV RNA was detected in 49/50 [98%] of the DBS samples, with Sensitivity 98% and Specificity 100 %, in comparisons to serum samples. Also there was no statistical significant difference in hepatitis C viral load between the two different samples among the patients. We demonstrated that there is no statistical significant different between the two samples when viral load is both less than and also more than 100000 IU. Concluded that the use of DBS for extraction and amplification of HCV RNA was reliable, specific, sensitive, cheap and appropriate method to monitor the HCV infected patients

Study of non-organ specific antibodies in children with genotype 4 chronic hepatitis C

Adult studies established a relationship between hepatitis C virus [HCV] infection and the presence of non-organ specific antibodies [NOSAs]. Most studies were carried out on genotypes 1 and 2. Only a few studies addressed that issue in pediatrics. No studies have been carried out on autoimmunity and genotype 4 in children. We aim to investigate NOSAs in 80 Egyptian children with chronic HCV infection along with studying the underlying genotype of HCV, and correlating autoimmunity with the epidemiological, clinical, biochemical, and virological features. HCV RNA was assayed by the polymerase chain reaction and viral genotypes were determined. NOSAs were measured and liver biopsies were taken for histopathological examination. Genotype 4 was the only detected genotype in the included 80 patients. Anti-smooth muscle antibodies [ASMA] were the only detected antibodies in 32 [40%] patients, always with V specificity [vessels only] at titers ranging from 1:20 and 1:160. Anti nuclear antibodies [ANA] and liver-kidney microsomal antibodies 1 [LKMA 1] were not detected in any of our patients. Epidemiologic and clinical features did not significantly differ between autoantibody positive and negative patients. Among biochemical features, significantly high levels of total bilirubin, albumin, immunoglobulins, alkaline phosphatase, and gamma glutamyl transpeptidase were found in the antibody positive group. Genotype 4 HCV is the prevailing genotype in Egyptian children with chronic HCV infection. A consistent proportion of these children with chronic HCV infection circulate non-organ specific autoantibodies. The prevalence of ASMA and the absence of ANA and LKMA 1 might be related to the unique situation in Egypt with unique prevalence of genotype 4. More studies are warranted on larger pediatric population to validate these findings.

pathogenic role of different blastocystis hominis genotypes isolated from patients with irritable bowel syndrome

The pathogenic role of Blastocystis hominis is still regarded by some as controversial. Studies have been in progress for years to evaluate the role of blastocystosis in irritable bowel syndrome [IBS] and demonstrated that faecal carriage of B. hominis was frequent in these patients. This study attempted to distinguish different genotypes of B. hominis isolates obtained from patients with IBS and to evaluate their pathogenic potentials. One hundred subjects [51 patients with IBS and 49 asymptomatic infected subjects] harbouring B. hominis were investigated by a direct smear examination and in vitro culture of stool samples followed by genotyping of B. hominis by PCR using STS primers. Sigmoidoscopy was done in all subjects and biopsies were taken and subjected to histopathologic examination. Genotyping proved that only four genotypes of B. hominis were identified. In patients with IBS, genotypes III, I, and IV were detected [28, 15 and 14 isolates, respectively]. On the other hand, genotypes III, IV, and II were identified in asymptomatic infected individuals [21, 19 and 13 isolates, respectively]. The degrees of chronic inflammatory changes in sigmoidoscopic biopsies caused by B. hominis genotypes among IBS patients revealed that severe inflammation was present mainly in patients harboring genotype I isolates [4/15] [26.66%], while genotype III caused severe inflammation only in 9.09%. Genotype II isolates were not detected in IBS cases. Asymptomatic infected individuals harboring genotypes II, III and IV exhibited mild to moderate inflammatory changes. Genotype I isolates were not detected in asymptomatic infected group. The correlation between different B. hominis genotypes and degree of inflammation was statistically insignificant. Genotype I was the most pathogenic genotype of B. hominis isolates in patients with IBS while genotype II was not detected among those patients. Also, our results suggest the presence of pathogenic and non-pathogenic strains among genotypes III and IV

Phytochemical and biological study of petrea volubilis L. [verbenaceae]

Petrea volubilis L. was studied for its secondary metabolites and biological activities. The phytochemical screening of dried aerial parts revealed the presence of different constituents such as unsaturated sterols, triter pens, and flavonoids. The biological activities of the total extract and different fractions were evaluated in a series of bioassays [antioxidant, antiinflammatory, analgesic, antipyretic and antibacterial], the majority of them showed significant activities in the applied test systems. Extensive purification of the ethyl acetate extract led to isolation of apigenin [1], quercetin [2], 4, 6-dimethylscutellarien [3], hypogallic acid [3,4-dihydroxybenzoic acid] [4], trans-caffeic acid [5] vanillic acid [6] and acteoside [7]. The structure elucidation of 1-7, was carried out by [1]H-NMR, UV and MS analyses

Assessment of regional wall motion abnormalities using parametric imaging of real time 3D echocardiography compared to 2D echocardiography: validation by coronary angiography

Identification and quantification of left ventricular regional wall motion abnormalities [RWMA] on echocardiograms is of paramount clinical importance but is still performed by a subjective visual method. we tried a new tool for assessment of RWMA using parametric [PI] of real time 3D Echocardiography [RT3DE] compared to traditional visual assessment of 2D echo [2DE] and validated by coronary angiography. We studied 100 patients scheduled for coronary angiography based on previous history of myocardial infarction [MI] [STMI or NSTMI]. RWMA was assessed by both conventional 2DE and PI of RT3DE according to the 17 segment left ventricular model of the American Society of Echocardiography [ASE].Coronary angiography was performed for all patients. Coronary artery stenosis was considered significant when luminal narrowing of 70% or more was present. The angiographic data of all patients was used as the gold standard to compare the diagnostic ability of both methods for detection of RWMA. There was a good agreement between PI of RT3DE and 2DE in assessment of RWMA of most [5 of 7] segments supplied by LAD, and all 5 segments supplied by LCX and 3 of 5 segments supplied by RCA. PI of RT3DE showed higher sensitivity than 2DE [60.71% VS 47.32%, p 0.001] for detection of RWMA in significant LAD lesion, while there was no significant difference regarding sensitivity of both methods in detection of RWMA in significant LCX or RCA lesions. [66.33%vs 54.00% p=0.074] and [62.77%vs 53.88%, p=0.140] respectively. There was no significant difference between PI of RT3DE and 2DE specificity for LAD, LCX and RCA lesions. [89.68% vs 90.07% p=0.0865], [87.42% vs 89.14%p=0.063] and [79.06% vs 80.62%, p=0.568] respectively. RT3DE showed higher sensitivity, specificity, positive predictive value and negative predictive than 2DE for detection of RWMA in patients with NSTMI in prescense of significant angiographic lesions. [77.8% vs 44.4, p=0.031], [95% vs 83.% p=0.04],[95% vs 88.8%],[60% vs 33.3%] Respectively. We have shown that PI of RT3DE can be used for assessment of RWMA with good agreement to visual assessment by conventional 2DE with better sensitivity to detect RWMA in segments supplied with LAD .PI also has better sensitivity, specificity, positive predictive value [PPV] and negative predictive value[NPV] than 2DE in patients with NSTMI

Relationship between cognitive function, self-esteem, self-care capabilities, and activities of daily living of institutionalized older adults

With advancing age, there is an increased susceptibility to various functional limitations, cognitive declines, and self-care disabilities, which often results in compromised physical and psychological well-being. The study was conducted to identify the relationship between cognitive function, self-esteem, self-care capabilities, and activities of daily living of institutionalized older adults. 100 elders.of both sexes aged 60 years andabove were included in the study. Mini-Mental State Examination [MMSE]. The Katz Activities of Daily Living [ADL] Scale, The Exercise of Self-Care Agency [ESCA] Scale and The Rosenberg Self-Esteem Scale [RSES] were used. Results: Findings revealed the presence of significant relationships between cognitive function and both self-care capabilities and activities of daily living, whereas no significant relationships were found between self-esteem of the studied elders, and their cognitive function, self-care capabilities, and activities of daily living. The findings suggest that, specific emphasis should be placed on the ongoing assessment of cognitive function which is important to predict the self-care of older adults, and to institute the appropriate intervention, and further researches are needed to examine and evaluate the effectiveness of rehabilitation programs to improve elders' cognitive function and self-care capabilities

Corrected QT dispersion improves diagnostic performance of exercise testing in diagnosing coronary artery disease

To determine the best combination of parameters that would improve the diagnostic performance of exercise testing, coronary angiography plus exercise testing were done on 112 patients with angina pectoris and normal electrocardiogram. The univariate predictors of coronary artery disease included: age >/= 40 years, male sex, hypertension, smoking, development of exertional chest pain, decrease in systolic blood pressure [BP] >/= 10 mmHg or systolic BP 3 min post-exercise > 90% of peak, heart rate drop < 12 beats/min 1 min post-exercise, exercise-induced ST-segment depression >/= 1mm. Multivariate logistic regression analysis showed that using either ST depression >/= 1mm or peak exercise QTDc > 70 ms significantly improved sensitivity and negative predictive value of the test without a significant decrease in specificity

Effect of cardiopulmonary bypass on the pharmacokinetics of intravenous paracetamol

Recently, intravenous paracetamol [propacetamol] is commonly in use as analgesic and antipyretic after surgery. The pharmacokinetics of intravenous paracetamol in patients undergoing cardiac surgery with cardiopulmonary bypass [CPB] were not previously described. This study was designed to investigate the effect of CPB on the pharmacokinetics of single intravenous dose of paracetamol in adult patients. Experimentally, nine patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass using mild hypothermia were selected. Intravenous propacetamol [2 g] was infused over 10 min and arterial samples were taken starting from 20 min after infusion and afterwards over 8 hours from infusion. Plasma paracetamol concentrations were measured by high-pressure liquid chromatography. ANOVA was used to compare between the pharmacokinetic parameters before and after CPB. The results revealed a C of 10.19 +/- 0.9545 mg. litre[-1] which was appeared after 20 min of infusion [experimentally]. Mean clearance [CL] was significantly reduced by about 40% in post CPB [prebypass 0.589 +/- 0.1069 L.h[-1]. Kg[-1] vs. 0.357 +/- 0.0394 L.h[-1]. Kg[-1] after CPB, P < 0.05]. The elimination rate constant [Ke] was significantly reduced by about 55% after CPB compared to prebypass values. However, the elimination half-life [t1/2] was significantly increased from 1.380 h before bypass to 2.431 h in post bypass period. It appears from this study that hypothermic cardiopulmonary bypass can affect the kinetic profile of IV paracetamol in patients undergoing coronary artery bypass graft surgery by altering its elimination. However, the change in the pharmacokinetic parameters and blood level of paracetamol is not serious and its use in such situations as analgesic and antipyretic is safe

Evaluation of recently validated non- invasive formula using basic lung functions as new screening tool for pulmonary hypertension in idiopathic pulmonary fibrosis patients

A prediction formula for mean pulmonary artery pressure [MPAP] using standard lung function measurement has been recently validated to screen for pulmonary hypertension [PH] in idiopathic pulmonary fibrosis [IPF] patients. To test the usefulness of this formula as a new non invasive screening tool for PH in IPF patients. Also, to study its correlation with patients' clinical data, pulmonary function tests, arterial blood gases [ABGs] and other commonly used screening methods for PH including electrocardiogram [EGG], chest X ray [CXR], trans-thoracic echocardiography [TTE] and computerized tomography pulmonary angiography [CTPA]. Cross-sectional study of 37 IPF patients from tertiary hospital. The accuracy of MPAP estimation was assessed by examining the correlation between the predicted MPAP using the formula and PH diagnosed by other screening tools and patients' clinical signs of PH. There was no statistically significant difference in the prediction of PH using cut off point of 21 or 25 mm Hg [P= 0.24]. The formula-predicted MPAP greater than 25mm Hg strongly correlated in the expected direction with O[2] saturation [r = -0.95, P < 0.000], partial arterial O[2] tension [r = -0.71, P < 0.000], right ventricular systolic pressure measured by TTE [r = 0.6, P < 0.000] and hilar width on CXR [r = 0.31, P = 0.03]. Chest symptoms, EGG and CTPA signs of PH poorly correlated with the same formula [P > 0.05]. The prediction formula for MPAP using standard lung function measurements is a simple non invasive tool that can be used as TTE to screen for PH in IPF patients and select those who need right heart catheterization

Chemical and biological studies of the methanolic extarct of primula elatior L. seeds

Fractionation and purification of the methanolic extract of the seeds of Primula elatior L [Primulaceae] cultivated in Egypt yielded six compounds named as beta-sitosterol-S-O-beta-D-glucoside [1], 4-ethyl gallic acid methyl ester [2], kaempferol [3], [+] catechin [4] together with the two polygalloylglucose derivatives, 1, 2, 3, 4, 6-penta-O-galloyl- beta-D-glucopyranose [5] and 1, 2, 3, 6-tetra-O-galloyl-beta-D-glucopyranose [6]. The structures of the isolated compounds were determined on the basis of extensive 1D [[1]H and [13]C] and 2D [COSY, HMQC, and HMBC] NMR studies, and mass spectral measurements. The anti-hypercholesterolemic effect of the total methanolic extract of Primula elatior L seeds has been studied and discussed

Effect of different quarantine periods on performance, behaviour and physiology of laboratory guinea pigs

A total of 60 adult guinea pigs of homogenous weight [250-350g] were used for evaluation of the appropriate quarantine period [1-5, 6-10 and 11-15 days post arrival] of laboratory guinea pigs before using the animal for experimental work. On arrival, the animals were allotted into 6 cages [10 animals of the same sex / cage]. Feed intake, body weight and weight gain, growth rate, feeding behavior, and cortisol level were recorded for the animals during the different periods. Guinea pigs were also tested as experimental animal for evaluation of X-product toxicity; as indicated by two indicies [weight gain and mortality] during one week post injection, The highest stressful effect of transportation appears mainly during the first few days post arrival [1-5d], where guinea pigs recorded significantly the worst performance and behavior, and the highest cortisol level. However, during the second period [6-10d], the animals tended to modulate themselves and acclimate successfully to the Surrounding environment through increased feed intake, attaining more weight, with lower morbidity and cortisol level. Meanwhile, by increasing the quarantine period to more than 10 days, the performance of the animal tended to redecrease again to values lower than that of the second period [6-10d] but still better than those of the first one [1-5d]. Safety test results indicated that, the best performance was met in animals injected 10 days post arrival, while the lowest was obtained when the animals injected after 15 days post arrival. It can be Concluded that, the stress of transportation and receipt of animals into new environment extended for at least 5 days post arrival, The period from 6-10 days is the best suitable period of acclimatization and stabilization of the animal behaviourally and physiologically. Increasing the quarantine period for more than 10 days is not preferable as the animal may be exposed to adverse management conditions that reduce its performance again. Therefore, a quarantine period not less than 5 days or more than 10 days with average 7 days post arrival is recommended for successful acclimatization of the laboratory guinea pig before its use in experimental purposes

Fluconazole-loaded liposomes for ocular delivery: characterization and antifungal activity

Fluconazole loaded liposomes were prepared using reverse phase evaporation technique for ocular delivery of the drug. Characterization of fluconazole liposomes including; particle size and physical morphology were studied. The effects of different variables [cholesterol weight ratio and charge type] on the loading efficiency of liposomes as well as particle size were determined. Inclusion of cholesterol in liposomal formulations improved the encapsulation of fluconazole into liposomes at certain Phosphatidylcholine: Cholesterol [PC: Ch] weight ratios further increase in cholesterol content resulted in a decrease in the encapsulation percent of the drug. A significant increase in the encapsulation at ratio 7:3 was noticed. At ratio 7:6, the encapsulation significantly decreased. Incorporation of stearylamine [SA] into liposomes decreased the loading efficiency of fluconazole at ratio [PC: Ch: SA] 5: 5: 0.25 followed by insignificant increase in the entrapment of the drug into liposomes at ratio 5: 5: 0.5. On the other hand, addition of dicetyl phosphate [DP] into liposomes resulted in a significant increase in fluconazole encapsulation into liposomes at all tested [PC: Ch: DP] ratios. The loading efficiency of the neutral liposomes was found to be in between those of positively and negatively charged liposomes. The particle size studies showed that, increasing cholesterol amount, led to an increase in the particle size. While increasing stearylamine and dicetyl phosphate led to decrease in the particle size of liposomes. An in-vitro study was done to know the effect of fluconazole loaded liposomes on different fungi isolated from eye

Liposomes as an ocular delivery system for fluconazole: in-vivo study

The purpose of this study was to formulate topically effective controlled release ophthalmic fluconazole liposomal formulations using the reverse-phase evaporation technique. Soya bean phosphatidylcholine [PC] and cholesterol [Ch] in specific weight ratios were used. Selected formulations were tested for their in-vivo ocular antifungal effect. These included the neutral, the positively [using stearyl amine] and the negatively [using dicetyl phosphate] charged liposomes. A reproducible model of Candida keratitis in rabbits was performed and the effects of the prepared liposomes were better than a solution of fluconazole. The order of fluconazole liposomal formulations according to the time to achieve complete healing is arranged in a descending order: negatively charged liposomes > positively charged liposomes > neutral liposomes [7:4] > neutral liposomes [5:5] > fluconazole solution. The frequency of instillation was decreased; also, the time of ulcer healing was decreased. It was concluded that the use of liposomes as a drug delivery system could contribute to the enhancement of the effect of fluconazole in the eye

Liposomes as an ocular delivery system of fluconazole: in-vitro studies

The purpose of this study was to formulate topically effective controlled release ophthalmic fluconazole liposomal formulations. Reverse-phase evaporation technique was used for the preparation of fluconazole liposomes consisting of phosphatidylcholine [PC] from soyabean and cholesterol [Ch] in weight ratios of [9:1], [7:2], [7:3], [7:4], [6:4], [7:6] and [5:5] with or without stearylamine [SA] or dicetyl phosphate [DP] as positive and negative charge inducers, respectively. The prepared liposomes were evaluated for their in-vitro release. The release mechanism was found to follow Higuchi and first order kinetics. Increasing cholesterol weight ratio in the prepared liposomal formulations progressively decreased the release of fluconazole from the vesicles. The positively charged liposomes showed slower rate of drug release compared to neutral ones. Negatively charged liposomes showed slight increase in the release rate and extent of fluconazole from the liposomal formulations 5:5:0.25 and 5:5:0.5; in comparison with neutral ones. Further increase in the amount of dicetyl phosphate 5:5:1 resulted in a significant decrease in the release rate. Four fluconazole liposome eye drops were prepared. Physical stability study including, visual appearance, particle size and amount of drug leakage from liposome eye drops were studied. Approximately 82.82%, 76.55%, and 70.90% of fluconazole was retained in negative, positive and neutral liposomal ocular formulations up to a period of 24 weeks at 5°C

Treatment of hypertension in acute ischemic stroke

There has been substantial controversy regarding treatment of blood pressure in the management of acute ischemic stroke. Non-Uniformity of study design and reporting makes it difficult to draw conclusions from previous data. When to treat hypertension in the acute setting is one of the unsettled questions yet. To study stroke outcome in relation to treatment of hypertension in the management of acute ischemic stroke and its impact on the cardiovascular system. This was a prospective study in which all admitted patients for acute ischemic stroke within 24 hours throughout the year 2006 were included. The severity of the stroke was based on the National Institutes of Health Stroke Scale [NIHSS]. The 2005 AHA/ASA guidelines in the management of acute ischemic stroke were followed. We also followed the same guidelines in the treatment of hypertension in adults with acute ischemic stroke in the first 24 hours. However, patients who continued to have hypertension grade II and III after the first 24 hours were also treated. A total of 356 patients were initially included and managed in the acute phase. Only 241 completed the study and attended the clinics for their follow up assessment at 3 months. The majority were males [76%], preexisting hypertension was found in 68.9% and most of the patients had hypertension on admission [87.5%]. In 223 patients [92.53%] no antihypertensive medication was given in the 1[st] 24 hours. In 134 patients [55.6%] the blood pressure continued to be on the hypertensive side after the first 24 hours and they received antihypertensive medications. The 223 patients [92.53%] who did not receive antihypertensive treatment achieved 57.1%, 78.09% and 73.87% of the total reduction in SBP, DBP and MBP respectively at the end of the 1[st] 24 hours. All cardiac complications [ten patients, 4.15%] were reported in the first 24 hours only. The mean NIHSS score on admission was 22.98 +/- 10.38, while the mean score at the 3[rd] month was 9.4 +/- 6.5. The differences were highly significant [p<0.0001]. When the stepwise regression analysis was used, only the increase in stroke severity at the onset [p<0.0001], followed by the decrease in SBP at the 3[rd] day [p<0.001] and lastly the increase in SBP on admission [p<0.05] were predictive for poor stroke outcome. Introducing antihypertensive medications after the first 24 hours of acute ischemic stroke in patients who continued to have hypertension grade II and III has no negative impact on stroke outcome and limits the cardiovascular complications

Glucose level in the bronchial aspirate as a marker of ventilator associated pneumonia in mechanically ventilated patients

Ventilator-associated pneumonia [VAP] is the leading cause of death amongst hospital-acquired infections. Despite this, the diagnosis of VAP remains challenging and there is a lack of diagnostic standardization. In humans, glucose concentrations are normally low in nasal and bronchial fluid, but are elevated by inflammation or hyperglycaemia. Exhaled breath condensate glucose was reported to be a potential marker of both infection and outcome in patients with acute respiratory distress syndrome [ARDS]. To study the signifcance of detecting glucose in bronchial aspirate in mechaniclly ventilated patients under tight glycemic control and using it as a follow up parameter in patients with VAP versus patients with community acquired pneumonia [CAP]. Also the present work aimed to describe the pattern of changes of C - reactive protein [CRP] in patients with VAP versus those with CAP. Forty patients were enrolled into the present study and were divided into 3 groups: Group I: Thirty critically ill patients requiring intubation and mechanical ventilation were followed up from admission and daily till they fulfilled criteria suggesting development of VAP. Group II: Ten patients with community acquired pneumonia [CAP]. Group III: Ten healthy volunteers constituting the control group. Patients were assessed using the following scoring systems: 1] Assessing the disease severity using the Acute Physiological And Chronic Health Evaluation scoring system [APACHE II] on the day of admission, 2] Daily assessment of disease severity using the Sequential Organ Failure Assessment [SOFA] score, and 3] the Clinical pulmonary infection score [CPIS]. All patients with CAP were evaluated by Pneumonia severity index [PSI] on admission. CRP was assessed on admission, on day 2 and on day 7. All patients were under tight glycemic control to abolish the effect of hyperglycemia on the bronchial aspirate glucose levels. Glucose measurements were performed simultaneously in the blood and bronchial aspirates. Bronchial aspirates were analyzed for glucose on the day of admission and daily. The present study demonstrated a correlation between the presence of glucose in the bronchial aspirates from mechanically ventilated patients and development of VAP. Glucose in the bronchial aspirates preceded the development of VAP in the first 48 hours of mechanical ventilation and steadily increased thereafter. This was later associated with infiltrates on the chest radiographs, increased levels of CRP, with significant CPIS score. In contrast the glucose level in the sputum from patients with CAP was high on admission then steadily decreased till discharge. There was no correlation between patient's blood glucose and the glucose level in the bronchial aspirate. In the present study CRP values in patients with CAP steadily decreased from admission till the patients were discharged. The mean CRP value in the mechanically ventilated patients at day one was statistically significant less than that in patients with CAP. While at the 7[th] day, the mean CRP value in patients with VAP was higher than that in patients with CAP. The mean CRP level in patients with VAP was higher in nonsurvivors than survivors. In critically ill patients kept under tight glycemic control, early detection of glucose in bronchial aspirates may improve the ability of clinicians to early recognize the onset of VAP. This technique is simple, rapid, and inexpensive and following it daily may serve as a marker for infection or clinical resolution. CRP levels in patients with CAP steadily decrease from time of admission till discharge, whereas in patients with VAP, CRP steadily increases from time of VAP development thereafter thus suggesting a role in following such patients as a prognostic marker

Acute spinal epidural abscess: clinical presentations and surgical management

Spinal epidural abscess is a serious condition affecting males more than females causing spinal cord compression. Risk factors include imunocomprimise, septic lumbar puncture, or haematogenous spread of remote infections. The aim of this study was to highlight the common risk factors for epidural abscess and its management based on eliminating these factors. All patients in the present study underwent plain x-ray, CT scan of affected spine, MRI of the affected area of the spine, and bone scanning when needed. Once neurological symptoms appeared urgent decompression and evacuation of the pus with subsequent culture and sensitivity was done. Liver diseases and Diabetes Mellitus. Were the most risk factors among our patients. The lumbar spine was commonly affected than other areas of the vertebral column. Posterior laminectomy and decompression were done for 24 cases. Fluid puss collection was found in 21 patients whereas 3 patients had a fibrous granulation tissue. Discectomy and partial corpectomy were done when affection of the anterior column was found. Staph. Aurues was found in about 60% of the culture obtained from the abscess. Epidural abscess is best treated by urgent decompression and giving the appropriate antibiotic

Functional evaluation after laparoscopic Heller-Dor surgery for esophageal achalasia

Evidence of long-term outcome of laparoscopic Heller-Dor surgery is limited. The aim of this study was to assess the long-term outcome of achalasia patients after surgery, particularly in relation to the preoperative stage of the disease. Sixty eight patient with esophageal achalasia, undergoing laparoscopic Heller-Dor surgery were assessed clinically and by esophageal radiology, manometry and 24-hour ambulatory pH monitoring before and at 3 months, 1 year, 1 to 3 years, 3 to 5 years and more than 5 years after surgery. The study included 68 patients, 36 were males [52.9%] and 32 were female [47.1%] with median age of 41 years [range 19-79y]. At 1 year after surgery the symptom score was significantly lower than the preoperative score [p<0.001], and a satisfactory clinical outcome was seen in more than 90% of the patients with stage I, II and III disease at the preoperative radiologic assessment Only 50% of stage IV patients reported satisfactory results. An adequate opening of the lower esophageal sphincter [LES] and LES resting pressure of less than 8mm Hg was achieved in all patients and esophageal emptying was accelerated significantly [p<0.001]. At the consecutive follow-up evaluation [1-5y], the satisfactory outcome was maintained in all stage I, II and III responders. Those with initially unsatisfactory results [stage IV patients] reported a worsening of symptoms [p<0.02]. LES opening and resting pressure remained at the level of the 1-y follow-up evaluation. Esophageal emptying remained satisfactory in stage I, II and III responders, but deteriorated in stage IV non-responders. A satisfactory outcome has been achieved after laparoscopic Heller-Dor procedure in stage I, II and III achalasic patients and seems to last. Stage IV nonresporders tend to deteriorate over time