Cardiopulmonary effects of prolonged surgical abdominal retractors application during general anesthesia: a prospective observational comparative study

Abstract Introduction: Increasing abdominal pressures could affect pulmonary compliance and cardiac performance, a fact based on which the aim of the present study to detect the cardiopulmonary burden of multiple retractors application during supine versus lateral abdominal surgeries. We hypothesized that surgical ring multiple retractors application would affect the pulmonary and cardiac functions during both lateral and supine abdominal surgeries. Methods: Prospective observational comparative study on forty surgical patients subdivided into two groups twenty each, comparing pulmonary compliance and cardiac performance before, during and after retractors application, group (S) supine position cystectomy surgery, and group (L) lateral position nephrectomy surgery under general anesthesia, Composite 1ry outcome; dynamic compliance C-dyn and cardiac index CI and Other outcome variables ICON cardio-meter were also recorded. Results: C-dyn and C-stat were significantly decreased late during retractor application in lateral compared to supine surgery with significant decrease compared to basal values all over the surgical time. CI was significantly increased after retractor removal in both of the study groups compared to basal values. PAW P was significantly increased in -lateral compared to supine surgery -with significant increase compared to basal value all over the surgical time in both of the study groups. significant increase in DO2I compared to basal value during both supine and lateral positions. Conclusion: Surgical retraction results in a short-lived significant decreases in lung compliance and cardiac output particularly during the lateral-kidney position than the supine position compliance.

Comparison between the use of a genexpert device and conventional diagnostic methods in the detection of mycobacterial tuberculosis and its resistance to drugs

Background: Mycobacterium tuberculosis [MTB] is the causative agent of tuberculosis [TB], which remains the leading cause of morbidity and mortality worldwide. The emergence of drug-resistant strains of MTB has put status of TB to threatening levels

Aim of the Work: was to detect MTB along with rifampicin [RIF] resistance using Genexpert [MTB/RIF]. Its diagnostic, sensitivity and specificity were evaluated by comparing with conventional technique

Patients, Materials and Methods: This prospective study was conducted on two hundred and seven Egyptian patients at Abbasia Chest Diseases Hospital, from November 2016 to December 2017, and comprised clinically and radiologically diagnosed TB suspected cases. This study was approved by the Ethical Committee of faculty of medicine, Alazhar University and the Ethical Committee of Ministry of Health and after Verbal consents from the patients or their parents were taken. Pulmonary specimens [sputum and bronchial lavage] and pleural effusion as an extra-pulmonary specimen were included. All samples collected were sent to TB laboratory of Abbasia Chest Diseases Hospital for further analysis

Result: Out of the 26 Genexpert [MTB/RIF] positive samples for MTBC, 3 [11.54%] showed RIF resistance and diagnosed as MDR-TB. Using LJ and MGIT cultures for drug sensitivity test [DST] on 31 and 34 positive TB samples; respectively, the same three specimens showed resistance to rifampicin [RIF]. Four positive specimens were also resistant to streptomycin [STR] using the previously mentioned cultures. Moreover, resistant to INH was reported in five positive TB samples using the same cultures. Finally, it was found that all positive specimens were sensitive to Ethambutol [ETH]

Conclusion: Although the conventional methods remain the gold standard for diagnosing pulmonary TB, delayed diagnostic times demand for more rapid and sensitive nucleic acid amplification techniques. Genexpert [MTB/RIF] assay is simple, rapid and accurate method for detecting mycobacterial tuberculosis

[Predictive factors of response to peginterferon and ribavirin in Tunisians patients with chronic hepatitis C: about 141 cases]

The current treatment recommendation for chronic hepatitis c is the combination of peginterferon and ribavirin. To report our experience in the treatment of chronic hepatitis c and determine the predictive factors of sustained virologic response. Analysis of consecutive patients treated with peginterferon and ribavirine from 1st January 2000 and 31st December 2009. 141 patients with an average age of 50 years were included. 75% of the patients were infected by a VHc of genotype 1. 22.6% of the patients were cirrhotics. 7% of the patients [n=10] had to stop the treatment because of severe side-effects. A reduction of the dose was indicated for 16% of the patients [n=23]. Among the 117 patients with the end of treatment virologic response, 24 patients [20.5%] relapse during the 6 months after the end of therapy. The sustained virologic response in intention to treat was 66% [57.9% in case of genotype 1-4 and 91% in case of genotype 2-3]. In multivariate analysis, 4 independent factors of sustained virologic response were identified: the male gender, a viral genotype not 1, a pre-therapeutic viral load

[Outcomes of endoscopic gluing with cyanoacrylate glue of bleeding gastric varices]

Gastric variceal bleeding is associated with significant morbidity and mortality. Its optimal treatment is not yet standardized and glue injection is the most often proposed treatment. The longterm results of this technique are still controversial. To assess the safety and efficacy of gastric variceal glue injection. Consecutive patients that underwent glue injection for gastric variceal bleeding in our endoscopy unit, from January 2000 to August 2011, were assessed. Sixteen patients [9 men, 7 women] underwent cyanoacrylate glue injections for gastric variceal bleeding. The median follow-up period of 13 patients was 33 months [three were lost to follow-up]. The average age was 60 years [3 - 80 years]. All patients had stigmata of recent bleeding at endoscopy. Patients underwent an average of 2 gluing sessions [1-3 sessions]. N-butyl-2-cyanoacrylate [Histoacryl [registered sign]] was the most often product used. No significant complications from cyanoacrylate injection were observed. No patient had a recurrent variceal bleeding. During the median follow-up period, two patients died. Our data suggest that cyanoacrylate injection therapy is safe and effective for the prevention of short- and long-term bleeding from gastric varices