optimal succinylcholine dose for intubating emergency patients: retrospective comparative study

Succinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose [ED95] of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED95. To compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading. This retrospective comparative study was carried into three groups of ASA III and IV [American Society of Anesthesiologist's Physical Status III and IV] non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board [IRB] approval was obtained. This study was limited to 88 patients who received fentanyl 1 micro g/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg. Increasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly [P<.001]. Tracheal intubation was 100% successful in the three groups of patients. Succinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III and IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes

Clinical evaluation of coronary vasculitis, rheumatoid disease and interleukine-2 interrelationship

Systemic vasculitis complicating rheumatoid disease has a reported mortality rate up to 30%. It has been demonstrated at necropasy studies that vasculitis in rheumatoid disease can also, affect coronary arteries mostly of the smaller muscular type. Twenty patients with rheumatoid disease [RD] below the age of 35 years presented with typical or atypical anginal pain. Other coronary risk factors were excluded such as: hypertension, obesity smoking, diabetes mellitus, hyperlipidemia, and hyperuricemia. Twenty healthy controls of matched age and sex were included, both patients and controls were subjected to resting ECG, Echo-Doppler, dobutamine-thallium moyocardial perfusion SPECT studies and serum interleukin-2 [IL-2] assay, to determine the proper evaluation of coronary artery affection and to search for another new risk factors. Resting ECG was normal except sinus tachycardia in 20% of cases. Echo-Doppler study revealed normal findings except mitral incompetence grade I in 20% and diastolic dysfunction in 15% of cases. Dobutamine stress ECG test was normal in 18 rheumatoid patients [90%] and positive ischemic changes in two patients [10%]. Myocardial perfusion study with thallium 201 [SPECT] was positive in nine cases [45%] and negative in eleven cases [55%]. All patients with chest pain, positive pharmacological stress test and/or positive thallium-201 myocardial perfusion, showed cutaneous vascular affection, high level of Rose Waaler titres for rheumatoid factor as well as a high level of serum IL-2. Also, there was a positive correlation between positive thallium study and rheumatoid activity. The study of thallium perfusion in rheumatoid patients had revealed a high incidence of coronary affection due to coronary vasculitis. High Rose Waaler titer for rheumatoid factor as well as high IL-2 in the present study appear to be a new risk factor for coronary vasculitis in rheumatoid patients

Hospital based epidemiological study of cerebrovascular stroke

Epidemiological studies are essential in order to assess the extent of cerebrovascular disease, its natural cause, major differences between countries, etiological and prognostic factors, and for planning therapeutic trials [Beech et al., 1996]. The present study aimed at evaluating some epidemiological aspects of recent cerebrovascular stroke, evaluating the benefits obtained from different neuroimaging tools such as magnetic resonance imaging [MRI], computerized tomography [CT] and transcranial Doppler ultrasonography [TCD] and evaluating some risk factors of stroke such as age, sex and other demographic characteristics, smoking, hypertension, diabetes, hyperlipidaemia and some hematological, cardiac, and blood chemistry variables. The present study included 235 patients with cerebrovascular stroke admitted to stroke unit in Ain Shams University Specialized Hospital, 173[73.6 percent] patients with cerebral infarction, 26 [11.1 percent] patients with cerebral hemorrhage, 13 [5.5 percent] patients with hemorrhagic infarction, and 23 [9.8 percent] patients with lacunar infarction. The mean age of the total sample of the patients included in our study was [61.75 +/- 11.59], it ranged from 25 to 90 years. We found that there is difference in sex distribution as males [n=161] represent 68.5 percent of patients while females [n=74] represent 31.5 percent, among our male patients III [68.9 percent] were smokers while 50 [32.1 percent] non-smokers and all of our female patients were non-smokers, at the same time, 181 of the patients [77 percent] were hypertensive while 54 of them [23 percent] were non-hypertensive, also, 116 patients [49.4 percent] were diabetic while 119 [50.6 percent] were non-diabetic, and the mean of non-fasting glucose level in cerebral infarction [l92 +/- I07.9mg/dl] was higher than in patients with cerebral hemorrhage [186 +/- 120.5]. Regarding other laboratory parameters we found that mean of total cholesterol in patients with cerebral infarction [207.3mg/dl] was approaching significantly higher [p=0.056] than in patients with cerebral hemorrhage [185.7mg/dl], also, triglyceride level was significantly higher [p=0.03] in patients with cerebral infarction [I48.6mg/dl] than in patients with cerebral hemorrhage [113mg/dl], at the same time, the mean of total leukocytic count was non-significantly higher [p=0.90] in patients with hemorrhagic cerebral infarction [12. l +/- 4.65x10[3]cell/cmm] than in patients with lacunar infarction [10.0565xl0 [3]cell/cmm] than patients with cerebral hemorrhage 9.9565x10[3]cell/cmm], although, the mean of ESR in the total stroke patients was [36.41 +/- 23.48], it was higher in patients with all subtypes of cerebral infarction. Our study confirmed the significance of heart disease as a risk factor for stroke, particularly for ischemic stroke, and hemodynamically significant carotid artery stenosis [>70 percent] was detected in 15 [6.4 percent] patients, of them 14 patients with cerebral infarction while only one patient with cerebral hemorrhage. In our study TCD was done to 133 patients 10 with cerebral hemorrhage and 123 with cerebral infarction, intracranial stenosis was detected in 76 [61.7 percent] patients from those with cerebral infarction, and 3 [30 percent] patients from those with cerebral hemorrhage, and there is statistically significant difference [p=0.013] between ischemic stroke subtypes as intracerebral stenosis was detected in 67 percent of patients with cerebral infarction while only in 30 percent of patients with lacunar infarction The present study included 235 patients with cerebrovascular stroke. The mean age [ +/- SD] of the total sample of the patients included in our study was [61.75 +/- 11.59], it ranged from 25 to 90 years, it included 161 [68.5 percent] males, and 74 [31.5 percent] females. The most common risk factors detected in our stroke patients were, increasing age, smoking, hypertension, diabetes, hyperlipidemia, cardiac diseases, carotid artery stenosis, as well as intracranial arterial stenosis

Immune receptors on liver macrophages in patients with hepatic schistosomiasis: relationship to plasma fibronectin and circulating immunne complexes

Liver macrophages carry receptor sites for immunoglobulin [Fc], complement [C] and fibronectin receptors, which can mediate the immnune-phagocytic function.As the function of hepatic macrophages could be impaired in many liver diseases, this work aimed at studying Fc and C receptors on isolated liver macrophages in cases of hepatic schistosomiasis and to correlate these with plasma fibronectin [FN] and circulating immune compIexes [CIC]. The study included 55 schistosaomal patients divided into 4 groups, group1: 15 patients with early hepatic schistosomiasis, group2: 15 patients with late hepatic schistosomiasis, group3: 15 schistosomal patients with HCV infection and group4: 10 schistosomal patients with HBV infection. In addition, 10 normal controls were included, liver biopsies were taken from all patients either during an elective surgery or by Tru-cut needle to isolate liver macrophages by Dabes method. Total nucleated cells and liver macrophages were counted for each patient. Fc and C receptors were studied by using sheep erythrocytes coated with immunoglobulin and complement respectively. Moreover, plasma FN and CIC were estimated in all patients and controls. Our results concluded that liver biopsies obtained from cases with early hepatic schistosomiasis yielded higher macrophage numbers and more Fc and C receptors than those obtained from late hepatic affection. When schistosomiasis was associated with viral hepatitis C or B, the cell counts and their receptors decreased further. There was a significant positive correlation between immune receptors and PFN level,while a significant negative correlation was found between these receptors and CIC. Thus, immune receptors could be an indirect index for the immunophagocytic function of liver macrophages

Effects of the major parameters affecting the clot formation

The effects of the major parameters affecting the clot formation such as time, temperature, and flowrate are investigated using a constant-low machine of a closed loop-circuit type. Furthermore, the effects of adding different concentrations of [heparin] as anticoagulant; capramol and [trasylol] are also investigation both stationary tanks and agitated tanks in addition to the closed loop-circuit of constant flow. The following relations were deduced from the results of this study: I] W[c] = 35.995 W[0.01 z]/ j[0.052] T [1.23] L[0.Iz6] where w[e] is the weight ratio of the clot. J is the time, t is the temperature, w is the angular velocity. L is the flowrate. Although the injection of heparin at low concentrations [below 5000 units / body] has no effect, yet at high concentrations [in the range of 15000, 20000 and 25000 units/adult body] heparin acts as fibrinolytic drug. Also it is shown that both [capramol] and trasylol reveal fibrinolytic activity, which is attributed to their known inhibitory action to plasmin