Catheter directed thrombolysis in treatment of acute iliofemoral deep venous thrombosis: determinants of outcome

Background: Acute deep vein thrombosis [DVT] of the lower limbs occurs in about 1.0 person per 1000 population per year and is associated with substantial morbidity. Although anticoagulation effectively prevents thrombus extension, pulmonary embolism, death, and recurrence may occur. Moreover, many patients develop venous dysfunction resulting in post-thrombotic syndrome [PTS]. PTS is associated with reduced individual health-related quality of life and a substantially increased economic burden. Hence, additional and more aggressive treatment, including systemic thrombolysis, thrombectomy, and catheter- directed thrombolysis [CDT], has been introduced to accelerate thrombus removal. Numerous studies suggest that additional CDT may provide highly effective clot lysis. There is little doubt that the overall benefit of thrombolysis depends on multiple factors, including predisposing risks, symptom duration, thrombus extension, and technical approaches and interventional success

Aim of the Work: This study aimed to define predictors of immediate and mid-long-term anatomic and clinical failures to guide patient selection and to set a standard for patient and physician expectations

Patients and Methods: This is a prospective observational cohort study that enrolled 20 patients [22 limbs] who presented to the Ain Shams University hospitals in the period from 7/2015 to 7/2017 with acute iliofemoral deep venous thrombosis [IFDVT] and fulfilled the inclusion criteria [mentioned below]. Intrathrombus catheter directed thrombolysis [CDT] was done. Assessments of predictors of immediate periprocedural success was based on degree of clot lysis and resolution of symptoms and signs. Incidence of postthrombotic syndrome [PTS] was calculated at 6 months postoperative using Villalta score [>/=5 vs <5]

Results: During the study duration, 20 patients [22 limbs] were recruited. The mean age was 40.95 +/- 12.35 years old, 11 patients [12 limbs] were women. The indication for CDT was severe progressive pain/swelling [18 limbs], and phlegmasia cerulea dolens [4 limbs]. 5 patients [7 limbs] had IVC thrombosis at the initial venography. 5 limbs had balloon dilatation only while iliac stenting was done in 12 limbs. 15 patients received CDT for 48 hours while 5 patients [7 limbs] received CDT for 24 hours [mean duration of CDT was 1.68 days]. As regards bleeding, only 2 cases of those who had CDT for 24 hours had bleeding, while bleeding occurred in 12 cases of those who had CDT for 48 hours. There were no recurrent DVT, intra or postoperative pulmonary embolism nor death within the study population till the end of the follow up period [6months]. 6 months post intervention, 7 limbs were free of PTS [Villalta score < 5], 15 limbs had mild to moderate PTS, and no patients had severe PTS. The mean Villalta score was 5.14 +/- 1.859

Conclusion: In our study, determinants of outcome following CDT for acute IFDVT were: 1] access site, 2] dose of thrombolytic agent used, 3] duration of thrombolysis, and 4] thrombus score at the end of the procedure. More studies should be done comparing not only the effect of CDT on incidence of PTS but also its effect on its severity [e.g. Villalta score] on short and long term

Comparative randomized controlled blind study of the anti-shivering effect of hydrocortisone, granisetron and meperidine in post-spinal anesthesia in patients undergoing cesarean section

Background: it was observed that a considerable proportion of patients undergoing surgery experience intraoperative and postoperative hypothermia and it was found that misregulation of body temperature due to anesthesia as well as the cold temperature of the operation room were the main cause

Purpose: to compare the anti-shivering effect of meperidine, hydrocortisone and granisetron after spinal anesthesia during elective cesarean section

Patients and Methods: this study presents a placebo-controlled prospective randomized blind study. Included patients were randomly [using computer generated randomization table] allocated into four equal groups each group consists of 28 patients

Results: in our study, age, sex, and ASA grade distribution of patients were nearly identical in the four groups. Furthermore, the duration of surgery and amount of irrigation fluid used in the four different groups were also similar. We did not observe a change in temperature gradient between the four groups. A study with a more prolonged duration of postoperative temperature monitoring is needed to note if core-periphery temperature changes occur with passage of time

Conclusion: the results indicate that IV granisetron 40 micro g/kg was effective as IV meperidine 0.4 mg/kg and both are slightly effective than IV hydrocortisone 2 mg/kg in reducing the incidence and intensity of shivering during spinal anesthesia compared to control group

Evaluation of some available hcv antibody detection tests [elisa, chemiluminescence, immune assay] and rt-pcr assay in the diagnosis of hepatitis c virus infection

Background: The purpose of diagnosis of viral infection is to allow the infected persons to be identified and treated and to prevent blood-transfusion infection. Majority of primary HCV-infected patients are asymptomatic, thus, symptoms could not be used as specific indicators for HCV infection. HCV viremia could still exist despite a normal serum alanine aminotransferase [ALT] level. Therefore, virological methods rather than ALT levels are used to diagnose HCV infection. The diagnosis of HCV infection is mainly based on the detection of anti-HCV antibodies by the enzyme immunoassay[EIA] or Chemiluminescence immunoassay [CIA] of serum samples. These anti-HCV assays are used as a screening test, while PCR is essential for detection of screening test falsity. The presence of HCV-RNA in the serum is a reliable marker of viremia. Universal standardization for HCV-RNA titer is important for diagnosis and follow up

Objective: This study aimed to evaluate the commercially available antibody tests for diagnosis of hepatitis c virus infection in comparison to RT-PCR in Egyptian blood donors

Materials and Methods: This study Included 456 serum samples from blood donor at Al-Hussien hospital blood bank [Al-Azhar University, Cairo] from June 2016 to June 2018. Serum samples subjected to routine laboratory tests [CBC, liver and renal function] to exclude organs affection. Also they are subjected to HCV antibody detection by ELISA and Chemiluminescence tests and HCV-RNA detection by RT-PCR assay

Results: We considered PCR as a standard test to evaluate ELISA and Chemiluminescence. The detected percentage of infectivity of donors in this study was 9% by ELISA, 13% by Chemiluminescence and 8 % by PCR. The percentage of false negativity of HCV antibody by ELISA and CIA when compared with PCR assay were 0.96% and 1.5% respectively. The false positivity of HCV -Ab by ELISA and CIA as compared PCR was 14-6% [6 out of 41] and 26.6% [16 out of 60]

Conclusion: Generally, ELISA is more sensitive and specific than Chemiluminescence for blood transfusion screening. But, at gray zone results, PCR should be used as confirmatory method. And so it is very important to screen blood donors using RT-PCR to avoid false positive and false negative results

Effect of interictal epileptiform EEG discharges on cognitive functions in epileptic children

Background: Epilepsy is a chronic disorder of the brain that affects people of all ages Neuropsychological impairment is an important comorbidity of chronic epilepsy in the majority of children with epilepsy. interictal epileptiform EEG discharges may present as a complicating factor in spite of being seizure free. In a group of children with interictal EEG discharges there is sudden and unexpected decline of school performance as the first symptom of epilepsy

Consequently, accumulating cognitive impairment, and even a decline in IQ scores, is reported in epileptic children with frequent episodes with epileptiform EEG discharges

Aim of the Work: To evaluate the possible relationship between interictal EEG discharge and cognitive function in a sample of Egyptian epileptic children

Patients and Methods: The ethical approval was obtained from the Hospital Ethical Research Committee. Each patient and/or parents entering the study signed an informed consent. This study was conducted on 140 children selected from Epilepsy Outpatient Clinic of Al-Azhar University Hospitals during a period of two years starting from June 2016 untill June 2018. A specialized pediatric neurology sheet was taken. EEG and cognitive assessment of epileptic patients with and without epileptiform EEG discharges using Stanford-Binet intelligence scale and P300 by ERP were performed to each patient two times 3 months in between

Results: we found that patients with frequent IEDs had high mean P300 latency and low IQ when compared to patients with infrequent and normal EEG examination. In addition, the mean p300 latency significantly reduced with rising in IQ [more improvement in cognitive function] after disappearance of IED in some patients

Conclusion: Interictal epileptiform EEG discharge had an additional effect on cognitive function especially if generalized and of high frequency. This effect might be often underestimated and might accumulate, and have a severe cognitive impact. So, treatment of epileptic patients should put in concern reduction or even treatment of IEDs as controlling of these IED lead to improvement of cognition

Comparison between the effects of insulin versus corticosteroid local injections in diabetic patients with carpal tunnel syndrome

Background: Carpal tunnel syndrome [CTS] is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Carpal tunnel syndrome is the most commonly diagnosed and treated entrapment neuropathy and is a significant cause of morbidity. It is estimated to affect one out of ten people during their lifetime. Diabetic patients have a higher incidence with carpal tunnel syndrome. It has been reported that insulin improves the nerve regeneration and myelination through its role as neurotrophic factor

Aim of the Work: was to compare the short-term effects of insulin and corticosteroid local injections in the treatment of diabetic patients with carpal tunnel syndrome

Patients and Methods: Fifty diabetic patients with clinical and electrophysiological evidence of mild to moderate carpal tunnel syndrome were included in this study. All Patients had been sub-classified into two equal groups:- Group [1]: Twenty five patients have received local insulin injection of 10 IU Neutral Protamine Hagedorn [NPH] \{Insulinagypt N\} into the affected carpal tunnel at the first visit and the same dose of insulin after 2 weeks. Group [2]: twenty five patients have received a single dose of 40 mg triamcinolone acetonide \{Epirelefan\} local injection into the affected carpal tunnel. Nerve conduction study [NCS], Boston Carpal Tunnel Questionnaire [BCTQ] and clinical evaluation were carried out for both groups at baseline and four weeks after second dose of insulin injection and one month after steroid injection

Results: In steroid group, significant improvement in nerve conduction study as regard distal sensory latency and sensory conduction velocity without significant improvement in distal motor latency and motor conduction velocity and significant improvement in [BCTQ]. In insulin group, a more significant improvement in all parameters of nerve conduction study and also in [BCTQ] was observed with insulin injection than steroid done. Also, there were significant differences between results of both groups for insulin injection group

Conclusion: Local insulin injection is an effective treatment for restoring median nerve function in diabetic patients with mild to moderate carpal tunnel syndrome and produce significant improvement in NCS and BCTQ

Congenital insensitivity to pain with talar avascular necrosis and neuropathic arthropathy of the ankle joint

Congenital insensitivity to pain with anhydrosis [CIPA], is a very rare genetic disorder characterized by recurrent episodes of unexplained fever, inability to feel pain and temperature, generalized anhydrosis, self-mutilating injuries and mental retardation. We present a case of a 8-year-old boy with these criteria who presented with gross right ankle swelling, collapse and avascular necrosis of the talus that was treated conservatively with non-weight-bearing cast

Association between the polymorphisms of angiotensin converting enzyme [Peptidyl-Dipeptidase A] INDEL mutation [I/D] and Angiotensin II type I receptor [A1166C] and breast cancer among post menopausal Egyptian females

Renin-angiotensin system [RAS] is involved in the regulation of cardioascular homeostasis. Angiotesin [Ang II] is converted from angiotensin converting enzyme [ACE]. Ang II exerts it effects by binding to two types of receptors; AT[1]R and AT[2]R. Ang II effect on AT[1]R promotes proliferation angiogenesis and metastasis in breast tissues. ACE [I/D] polymorphism is an insertion/deletion of a 287 bp DNA fragment within intron 16 of ACE gene. A1166C is a single nucleotide polymorphism [SNP] in the 3-UTR of AT[1]R gene. Both [D] and [C] alleles were found to be related to RAS overactivation. One hundred and twenty postmenopausal Egyptian females were included in the present study and were divided into control group [fifty apparently healthy women] and patients group [seventy breast cancer patients]. Detailed history taking was done with stress on age, family history, menstrual, obstetric, medical and drug history. Physical examination including body mass index calculation was done. Histopathological examination was done for tumor grading and staging. Detection of ACE gene [I/D] polymorphism by PCR and AT[1]R AT[1]66C SNP using PCR/RFLP were done

Effect of electrical muscle stimulation on prevention of ICU acquired muscle weakness and facilitating weaning from mechanical ventilation

ICU acquired muscle weakness [ICUAMW] is an acquired neuromuscular disorder associated with increased duration of mechanical ventilation and weaning suggesting a possible relation between the limb and respiratory neuromuscular involvement. There is no preventive tool and no specific treatment has been proposed for ICU acquired muscle weakness. Aim of this study was to assess the effect of electrical muscle stimulation on prevention of ICUAMW and in facilitating the weaning from mechanical ventilation in critically ill patients. A prospective, randomized, placebo-controlled trial. Critical care department, main Alexandria university hospital. 80 Critically ill patients on mechanical ventilation for more than 24 h. They were randomly categorized into two groups: 40 patients received conventional lines of treatment only [control group] and 40 patients received in addition one daily session of Electrical Muscle Stimulation [EMS] [EMS group]. Assessment of occurrence of ICUAMW was done through the MEDICAL RESEARCH COUNCIL SCALE [MRCS] which is a method for clinical assessment of muscle strength. MRCS did not show any significant difference between the two groups in the first 3 days post mechanical ventilation while on day 4, MRCS mean value was 46.86 +/- 10.88 in the EMS group versus 43.70 +/- 9.32 in the control group [p= 0.041]. On day 21, MRCS mean value was 29.67 +/- 8.87 in the EMS group versus 19.60 +/- 4.34 in the control group [p=0.037]. Significant difference was also noted in the duration of mechanical ventilation as the mean value in the EMS group was 9.01 +/- 8.01 days versus 11.97 +/- 8.07 in the control group [p= 0.048]. Although the EMS could not prevent the occurrence of ICUAMW in critically ill mechanically ventilated patients it still has a role in minimizing the degree of muscular weakness and could be helpful in facilitating weaning from mechanical ventilation

Histological changes in the human gallbladder epithelium associated with gallstones

Pathological changes related to gallstone formation are still the focus of intensive research. The hypothesis most widely accepted is the stasis of bile caused by gallbladder dyskinesia, while dyskinesia may be the result of pathologic changes in the gallbladder wall. The aim of this study is to investigate the relation between gallstones and light as well as electron microscopic changes in the gallbladder epithelium. Gallbladder specimens were collected from patients who underwent cholectstectomy. Paraffin section were stained with haemaroxylin and eosin to demonstrate the general histology. Periodic acid-Schiff and alcian blue were utilized to evaluate the intraepithelial mucin content. Minute specimens were also fixed and processed to evaluate the fine structures of the gall bladder epithelium. PAS positive materials were increased in the basement membrane. Additionally, an increase in the intensity of alcian blue reaction was observed. At the ultrastructural level, abraded and altered microvilli accompanied by mitochondrial damages, angulated lysosomes, heterogeneous liposomes and damaged organelles were also found. Complete collapse of intercellular spaces in the region above the tight junction up to the bases of the marginal microvilli was revealed by thin-section electron microscopy. Secondary lysosomes were seen forming complex substructural formations called lipo-mucosomes and collagen fibrils in some cholecystic gallbladders. Gallstones are accompanied by major changes in the gallbladder epithelium, as shown by both light and electron microscopy. The relation between the observed changes and gallstone formation needs further studies

Surgical management of post endoscopic retrograde cholangiopancreatography [ERCP] duodenal perforation

Traditionally post ERCP duodenal perforations have been managed surgically; however, in the last decade, management has shifted toward a more selective approach. Those who favor a selective approach have not elaborated distinct management guidelines. To evaluate the authors experiences in management of post ERCP duodenal perforations to define the criteria for operative management and a systematic management approach. A retrospective review of consecutive cases of ERCP related perforation [from May 2000 to May 2004] was carried out. Seventy-four out of 3050 ERCP performed [2.4%] were complicated by duodenal perforations and were included in the study. Forty-two perforations [56.8%] were discovered at ERCP while 32 cases [43.2%] required additional radiological assistance. Twenty-nine patients [39.2%] were operated early within 6 hours whereas 45 patients [60.8%] were initially treated conservatively. Fifteen patients had surgery after failure of medical treatment. Four cases [8.9%] died under conservative treatment and 14 cases [31.8%] died after surgical intervention. Pyloric exclusion procedure [PE] was done for 33 patients [75%]. Early diagnosis is important but difficult especially for retroperitoneal perforations. Clinical and radiographic features of ERCP - related duodenal perforations can be used to stratify patients into surgical or non-surgical cohorts. A selective management scheme is proposed based on the features of each type. Pyloric exclusion procedure is the operation of choice when the diagnosis is delayed and when the perforation is not detected or can't be repaired

young girl with acute lobar nephronia

We report a young girl with acute lobar nephronia. She presented with signs and symptoms suggestive of a febrile urinary tract infection. Sonography, radioisotope study and enhanced computed tomography scan confirmed the diagnosis of acute lobar nephronia. She was treated with intravenous antibiotics for two weeks followed by long-term prophylaxis antibacterial therapy. Despite clinical recovery, follow-up computed tomography scams and isotope studies showed residual renal scarring of the affected kidney

Study of the endometrium in post menopausal uterine bleeding by histopathology and transvaginal ultrasound

The result of this study revealed that transvaginal ultrasonography can be considered as a fairly simple non-invasive technique in the diagnosis of endometrial abnormalities in cases of postmenopausal bleeding with the use of high frequency transvaginal ultrasonography [6.5] M.H. the endometerium can be easily visualized and its thickness could be easily measured. Five mm. endometrial thickness is recommended as a cut off value below which endometrial abnormalities could be excluded and above it could be expected with the need of other diagnostic complementary technique as histopathologic evaluation to establish the diagnosis

Children discharged against medical advice

This study was conducted to discern the magnitude of the problem of parents discharging their children against medical advice [DAMA], to identify the causes behind this phenomenon and to recommend means of solving this problem. Over a six-month period, all parents discharging their children against medical advice were interviewed on discharge to get demographic data and to evaluate the reason[s] for the premature discharge. For comparison, a similar number of randomly selected parents of hospitalized children were interviewed at the time of their discharge. During the study period a total of 105 [6.8%] children were DAMA. The most common reasons given by the parents were; the problem of caring for other children at home, false parental judgment of improvement and lack of trust for the medical establishment. To reduce this problem we recommend improvement of the physician-parent relationship. education of the public and legislation controlling the rights of parents over their children when their well-being is endangered

Proteinuria selectivity in childhood nephrotic syndrome

To assess the value of proteinuria selectivity index [PSI] in predicting the response of children with nephrotic syndrome to corticosteroid therapy and its correlation with renal biopsy findings. Setting: Paediatric Department, Our Lady's Hospital for Sick Children, Dublin, Ireland. Design: Retrospective analysis of the records of 39 children admitted to the above hospital with nephrotic syndrome. PSI was performed for all children prior to therapy. All received corticosteroid therapy according to the protocol of International Study of Kidney disease in Children for initial attacks and relapses. Patients were divided into 3 groups according to their response to steroid; steroid responsive infrequent relapsers [n.15], steroid responsive frequent relapsers [10] and steroid resistant [8]. PSI of < 0.01 was statistically significant in differentiation between the steroid responsive and resistant nephrotic syndrome. All children in the latter group had non-minimal change lesions on biopsy. Protein selectivity index should continue to be one of the valuable initial tests in childhood nephrotic syndrome due to its useful additional predictive value on the response to steroid in those patients

Febrile urinary tract infection in children: role of 99m TC-dimercaptosuccinic acid [DMSA] scan and other imaging techniques

Fifty children [37 females and 13 males] with first febrile urinary tract infections were studied to assess the value of 99M Tc-dimercaptosuccinic acid [DMSA] scan in detecting inflammatory changes of acute pyelonephritis [APN]. These findings were compared with renal ultrasonography [US]. We also evaluated the reliability of clinical and laboratory observations in diagnosing acute pyelonephritis [APN]. All children had micturating cystourethrography [MCUG]. DMSA-documented acute pyelonephritis was present in 29 [58%] patients. Only four children [8%] demonstrated changes suggestive of APN on renal ultrasonography. Vesicoureteric reflux [VUR] was documented in 17 [47%] of the total group and in 13 [45%] of those with abnormal DMSA scan. Follow-up DMSA scan in 15 children with initial abnormal findings showed complete recovery in seven [47%]. Our data have shown that DMSA renal scan is the most useful investigational procedure in children with febrile UTI. The diagnosis of APN, depending on clinical and laboratory data, is unreliable. Renal US alone can miss serious renal defects. MCUG remains the most sensitive procedure to detect VUR and it should be performed in all children with UTI and abnormal DMSA scan. Early detection of acute pyelonephritis allows the prompt introduction of antimicrobial agents in those children and can prevent or decrease renal damage and its complications

Bronchogenic cyst: a cause of recurrent wheezing in an infant

Mediastinal bronchogenic cysts are uncommon but potentially life-threatening. In this case study, an infant with recurrent wheezing and severe respiratory distress is described. The clinical course of his illness was initially suggestive of bronchial asthma. His poor response to bronchodilators during his last hospital stay prompted a search for a possible alternative diagnosis. Radiological imaging of the chest revealed a mediastinal mass pressing on the trachea. The mass was surgically excised and histopathological examination confirmed the diagnosis of bronchogenic cyst. The child continues to be asymptomatic 18 months after surgery

treatment of rheumatic chorea with sodium valproate

Three patients with rheumatic chorea were treated with sodium valproate for their involuntary movements. A few days after the start of the treatment, chorea disappeared completely. One patient had a relapse after discontinuation of the drug, but responded quickly to the same drug after reusage. It appears that sodium valproate is a promising drug in the treatment of rheumatic chorea