Alpha-1-antitrypsin level as a predictor of acute exacerbations in chronic obstructive pulmonary disease: a prospective observational study

Background: This prospective study investigated if alpha-1-antitrypsin (AAT) levels could predict chronic obstructive pulmonary disease (COPD) exacerbations needing hospitalization. Methods: 106 COPD subjects hospitalized for acute exacerbations were enrolled. Past 2-years� records were evaluated for prior exacerbation hospitalizations. AAT levels and post-stabilization FEV1 were assessed during current hospitalization. Exacerbation frequency correlated to current AAT levels and lung function. Results: Significant inverse association found between AAT levels and hospitalized exacerbations, indicating utility as a predictive biomarker for COPD patients prone to recurrent severe flares requiring admission. Patients with lower AAT levels also exhibited poorer lung function per lower FEV1 values. Conclusions: Monitoring AAT levels may promote timely interventions in high risk individuals susceptible to relapsing catastrophic exacerbations needing inpatient care. Further research warranted to validate findings and explore if supplementing deficient AAT reduces exacerbation frequency, thereby improving prognosis in this debilitating disease.

A systematic review of clinical characteristics, co-morbidities and outcomes of COVID-19 in children and adolescents

Background: COVID-19 is a major global health challenge that has affected all age groups and gender, with over 5 million deaths reported worldwide to date. The objective of this study is to assess available information on COVID-19 in children and adolescents with respect to clinical characteristics, co-morbidities, and outcomes, and identify gaps in the literatures for appropriate actions. Methodology: Electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for observational studies such as case series, cross-sectional and cohort studies published from December 2019 to September 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide. Data extracted included (i) patient demography (age and gender), (ii) clinical characteristics including vaccination status and presence of co-morbidities, (iii) clinical management including the use of sequential organ failure assessment (SOFA) scores, oxygen requirement, use of mechanical ventilation, and (iv) disease outcomes including length of hospital and intensive care unit (ICU) admission, recovery, complications with sequelae, or death. Data were analyzed using descriptive statistics. Results: A total of 11 eligible studies were included with a total of 266 children and adolescents; 137 (51.5%) females and 129 (48.5%) males. The mean age of the children was 9.8 years (range of 0 ­ 19 years), and children ≥ 6 years were more affected (40.7%) than age groups 1 ­ 5 years (31.9%) and < 1 year (27.4%). The major co-morbidities were respiratory diseases including pre-existing asthma (3.4%), neurologic conditions (3.4%) and cardiac pathology (2.3%). Majority (74.8%, 199/266) of the patients were discharged without sequelae, 0.8% (2/266) were discharged with sequalae from one study, and mortality of 1.9% (5/266) was reported, also from one study. SOFA scores of patients at admission were not stated in any of the study, while only one study reported patient vaccination status. Conclusion: It is recommended that safe vaccines for children < 1 year of age should be developed in addition to other preventive measures currently in place. SOFA scores should be used to assess risk of COVID-19 severity and monitor prognosis of the disease, and vaccination status of children should be documented as this may impact the management and prognosis of the disease.

Assessment of interleukin 17 and transforming growth factor-beta 1 in hepatitis C patients with disease progression

@#Hepatitis C virus (HCV) infection in Egypt is the most serious health problem. Identifying HCV-positive persons at high risk of early complications can help prioritize treatment decisions. Recently, attention has been directed to non-invasive, accurate alternatives using serum biochemical markers. The transforming growth factor β 1/interleukins pathway plays an important role in the process of cell injury and inflammation. Thus, TGF-β1 and IL-17 were assessed in serum of chronic HCV patients with correlation to hepatic inflammatory and fibrotic status. The quantitative serum levels of TGF-β1 and IL-17 were analyzed among chronic hepatitis C (CHC) patients (n=75) and normal control (NC) subjects (n=15). Disease severity in patients was assessed using the Child-Pugh scores and METAVIR. Serum levels of TGF-β1 and IL-17 were significantly increased in HCV patients compared to control group. Furthermore, the levels of TGF-β1 and Il-17 were positively correlated to serum transaminases and alpha-fetoprotein and they were negatively correlated with serum albumin and platelets. Additionally, the serum levels of TGF-β1 and Il-17 were associated with inflammation grades and stages of liver fibrosis. TGF-β1 and IL-17 may be hopeful serum biomarkers concerned in the progression of liver inflammation and fibrosis accompanying chronic HCV infection. Therefore, they could be used in the future as targets for anti-fibrotic therapy of chronic HCV to ameliorate the disease progress.

Efficacy of implementation of a 5 scale pediatric triage and acuity scale in pediatric emergency, Saudi Arabia

To evaluate the effectiveness of implementation of the pediatric Canadian Triage and Acuity Scale [Ped-CTAS] for children visiting the pediatric emergency department [ED]. This cross-sectional study evaluated all children presented to the ED during a 9-day period in March 2010. The Ped-CTAS triage system was used. Triage performance was analyzed on the basis of quality indicators, rate of admissions, rate of referral, observation duration, and relationship between investigations requested and CTAS level. During the study period, 3,337 patients were triaged. Overall, 4 patients [0.1%] were in triage level 1, 356 [[12%] were level 2, 655 [22%] were level 3, 1810 [60%] were level 4, and 189 [6%] were level 5. The left without being seen rate was 6.25%. A triage duration of 5 minutes or less was carried out for 97% of cases. Within the CTAS time objectives, the waiting time to nurse and physician was 100% for cases triaged to level 1. The proportion of cases who needed observation was 100% for level 1, 85% for level 2, 53% for level 3, 33% for level 4, and 26% for level 5. The proportion of patients admitted to the hospital was 100% for level 1. The lower the level [more acute and emergent the condition] the more use of the laboratory and radiological investigations. The pediatric CTAS triage system is a good tool for categorizing pediatric patients attending the ED. Stratified by triage level, triage indicators can be used as indicators of ED performance

Análise eletromiografica do exercício agachamento com utilização do cinto pélvico / Electromyographic analysis of the bending down exercise using the pelvic belt

O objetivo deste estudo foi analisar eletromigraficamente os músculos: reto femoral (RF), bíceps femoral (cabeça longa) (BFCL), eretor da espinha (ES) e glúteo máximo (GM), de ambos os lados nas fases excêntrica e concêntrica durante a execução do exercício agachamento, que podem ser realizadas com ou sem a utilização de um cinto pélvico. Participaram deste estudo dez (10) voluntárias praticantes do agachamento, com idade de 20 a 22 anos, e de antropometria semelhante e sem antecedentes de lesões músculo esqueléticas. Com os resultados obtidos, concluiu-se que: o uso do cinto não apresenta um efeito significativo sobre as ações dos músculos RF, BFCL, ES e GM músculos, este fato ocorrendo apenas para o músculo glúteo máximo direito, que apresentou um maior nível de atividade, sem o uso do cinto. Todos os músculos apresentam maior atividade na fase concêntrica do movimento.

This study examined the electromyographic muscles: rectus femoris (RF), biceps femoris (long head)(BFCL), erectors spinae (ES) and gluteus maximus (GM), on both sides during eccentric and concentric during execution the squat exercise, which can be taken with or without the use of a belt pelvic. Participial this study (10) voluntary practitioner’s squat, aged 20 to 22 years, and similar anthropometry and without a history of skeletal muscle injury. With the results obtained, it was concluded that: the use of the belt does not present a signifi cant effect on the actions of the RF, BFCL, ES and GM muscles, this fact occurring only for the right gluteus maximus muscle which presented a greater level of activity without the use of the belt. Regarding the movement phases, all of the muscles presented greater levels of activity while raising the load.

Clinical and radiographic assessment of implant retained removable partial denture

The use of dental implant-supported restorations has given an expanded ability to provide predictable replacements for missing teeth. New designs will expand the use of this treatment modality further, especially in the areas of poor bone quality. Implant retained prostheses have become a well-established option to treat the partially edentulous patients and often represent an improvement over traditional removable partial dentures. This article describes implant alternatives and prosthesis design for a group of patients with mandibular unilateral -free end edentulous ridge with one modification on the opposite side. Each patient received removable partial denture retained by telescopic crowns on osseointegrated implants inserted in the edentulous spaces. Implants were used as supporting and retentive elements for mandibular distal extension prostheses. In these cases, sufficient retention gained from telescopic crowns on the implant abutments. A clinical and radiographic evaluation is performed for each patient. Results indicated consistent increased satisfaction in all patients, no radiographic evidence of excessive bone loss, and stable peri-implant soft tissues

Comparative evaluation of removable partial overdentures with and without attachments in anterior long span partially edentulous maxilla

Patients attitudes, medical, surgical and financial considerations lead to the use of a removable partial denture [RPD] as the chosen prosthetic restoration even in the [dental implant era]. There is an unlimited RPD design options. Choosing the right one involves considering biochemical factors, aesthetics and patients' comfort. Treatment with a removable partial overdenture [RPOD] is an affordable choice to fulfill the patient's esthetic demands together with providing good prognosis for the prostheses and preservation of the remaining dentition. This article presents a restorative option to optimize the aesthetic by using auxiliary attachments for retention of RPDs. Precision attachment system provides esthetics, vertical resiliency, and easy replacement of worn attachment. The flexi post attachment offers direct retention for the partial overdenture and at the same time providing direct tooth support via the overdenture abutments. Partial overdenture with these attachments has the advantage of being more stable and retentive than partial overdenture without attachments. Ten male patients having long span maxillary anterior edentulous area were selected. The patients were divided into two groups; for group A, removable partial overdentures retained with flexi post attachments were constructed while for group B, removable partial overdentures with conventional bar clasps were used on the abutment teeth. The objective of this work was to study the effect of the two designs on the abutment teeth and supporting structures. Clinical, radiographic and finite element stress analysis examinations were done. The results revealed that both groups showed no significant differences as presented by clinical, radiographic and stress analysis examinations. The patients wearing dentures with flexi-post attachments gained the added advantages of good esthetic and retention

Immunomodulation of pulmonary and hepatic granulomatous response in mice immunized with purified lung-stage schistosomulae antigen

The present objective was to investigate the possible effect of immunization protocol against Schistosoma mansoni infection using purified lung-stage schistosomulae antigen. Two experimental models [lung and liver] were used, each of 3 groups [Gs]: Immunized G. [10 mice] infected control G. [10 mice] and normal control G. [10 mice]. Hundred micro g of purified schistosomulae antigen followed by two booster doses each of 50 micro g antigen and at one week interval were injected intraperitoneally into Swiss albino mice three days prior to intravenous injection of 3000 viable S. mansoni eggs [lung model] or to exposure to 100 cercariae [hepatic model]. Mice were sacrificed 16 days post-injection [lung model] and 8 weeks post-infection [hepatic model]. Various parasitological parameters, histopathological assessments and immunological parameters were studied. The data revealed that immunization with purified lung-stage schistosomulae antigen induces protective effect against S. mansoni infection. The marked reduction in worm burden, egg load, granuloma diameter and collagen content were accompanied by increased percentage of degenerated ova and amelioration of the associated pathological changes in pulmonary and hepatic tissue. Increased levels of specific immunoglobulins particularly IgG and IgM and decreased ratio of T cell subsets [CD4+/CD8+] in granulomas of both models were also noticed

Effect of complete denture on the supporting oral mucosa and alveolar bone in-patients with hypohidrotic ectodermal dysplasia [HED]

Four young male children [10-13 years] referred from dermatology clinic for prosthetic management .The children were diagnosed as hypohidrotic ectodermal dysplasia with complete an-odontia of their deciduous and permanent dentition. Full upper and lower acrylic dentures were constructed for those children for physiologic and psychosocial reasons .Cytological and radiographical evaluations were carried out before and after denture wearing. Cytological examination before denture insertion showed the presence of large prickly and rounded epithelial cells indicating either incomplete differentiation of the covering surface epithelium, that is normally keratinized. After denture insertion the predominant exfoliated cells were found to be spindleform flattened cells. This may reflect the protective effect of denture wearing on the integrity, of the surface epithelium. Radiographic examinations showing slight increase in the amount of alveolar bone loss after denture insertion

Modified intraoral prosthetic appliance to retract protruded premaxillae and prolabium in babies with bilateral cleft lip and palate [BCLP]

Management of the protruded and rotated premaxilla and prolabium in patients with bilateral cleft lip and palate [BCLP] presents a challenging problem for the reconstructive team. Prosthetic intervention to retract a protruded premaxilla before surgical correction may improve the bony base for tissue molding, avoid excess tension at the surgical site and permitting a one-stage surgical repair. An extraoral and intraoral prosthetic appliance has been used to move the premaxilla and prolabium to a more favorable position. Resilient denture liners were used to cover the part of the elastomeric chain covering the prolabium in intraoral appliances. These liners always need frequent replacement due to lost resiliency, irritation to the skin and their contamination with nasal discharges and sweet. The aim of this study is to improve this design of an intraoral traction appliance to align the protruding premaxilla in infants with bilateral cleft lip and palate. Five babies were selected for this study from pediatric clinic -Tanta University. Their age ranged from 2-10 months. All the babies had bilateral cleft lip and palate. Silicone rubber impressions were made, palatal base plate was constructed using light-cured resin, and two orthodontic buttons were placed in the middle alveolar ridge area of the plate medial to the alveolar crest. A flat rubber tube was cut nearly the same size of the prolabium, the elastomeric chain was passed through this part of the rubber tube. Using a flat rubber tube instead of resilient denture liner is non- irritant to the skin, easy to clean and allows a free movement of the elastomeric chain

Intratympanic gentamicin in unilateral Meniere's Disease: Titration therapy

Twenty five patients disabled by episodic vertigo attacks of unilateral Meniere's disease were treated with administration of gentamicin intratympanically in a titration treatment protocol where one injection every two weeks was given, terminating the therapy when sufficient effect was observed as evidenced by the patient report or audiologically. Vertigo was completely eliminated in 72% with additional 20% of substantial control and only 8% limited control. Hearing was unchanged in 44%, improved in 32% and worse in 24% of patients. Intratympanic gentamicin titration therapy is safe, easily performed as an outpatient procedure with only topical anesthesia

Conchomeatoplosty technique for open casvity mastoidectomy

A Concho-meatoplasty technique is described which has proved successful in creation of a wide meatus when it is used in tympanoplasty with open cavity mastoidectomy. The technique is described in details and the results are mentioned with a discussion of the technique in accordance to the otologic surgery literature

Clinico - pathological study of cervical lymphadenopathy in children with recurrent tonsilitis

50 child patients with the diagnosis of recurrent tonsillitis associated with cervical lymphadenopathy were the subject of the current study. The diagnosis was achieved after full general, ENT and local examination combined with full investigations to exclude other causes of lymphadenopathy. In the first group of 20 children, combined tonsillectomy and excisional lymph node biopsy was performed in one setting. In the second group of 30 children, only tonsillectomy was performed. Histopathological study of the tonsillar and lymph node sections was performed and the findings were discussed in accordance to the relevant literature. After one year follow up of the children in the second group 92% showed marked improvement in their lymph node enlargement

Efeitos protetores da glutamina e dieta elementar na enterocolite actínica aguda: avaliaçäo histológica / Protective effects of glutamine and elemental diet in acute actinic enterocolitis: histological evaluation

O emprego da radioterapia abdominal pode ocasionar a enterite actínica aguda. A utilizaçäo de formulaçöes nutricionais especiais tem sido proposta a fim de proteger o intestino durante e após a irradiaçäo. OBJETIVO. Avaliar histologicamente o efeito protetor de dietas polimétricas e elementares enriquecidas com glutamina na prevençäo da enterite actínica aguda. MÉTODOS. Foram estudados 65 ratos machos, adultos, da raça Wistar, monitorizados diariamente quanto à ingestäo e às variaçöes de peso corpóreo. Os animais foram randomizados em três grupos e alimentados com dietas isocalóricas e isonitrogenadas: 1) CRt - dieta polimérica com caseína enriquecida com glutamina a 2 por cento; e 3) ERt - dieta elementar enriquecida com glutamina a 2 por cento. O experimento constou de períodos de adaptaçäo (7 dias), de irradiaçäo (5 dias) e de recuperaçäo (3 dias). Após a adapataçäo alimentar, todos os ratos receberam irradiaçäo abdominal fracionada em 5 doses diárias de 300cGy.quatro dias após o término da irradiaçäo, os ratos foram operados para ressecar o intestino delgado e o cólon para estudo histopatológico. RESULTADOS. Os grupos ERt e GRt apresentaram número significativamente maior de ratos com aumento da celularidade, do número de mitoses e médias superiores de altura das vilosidades em comparaçäo à CRt no intestino delgado. O grupo ERt apresentou, ainda maior número de ratos com relaçäo das alturas vilosidade-cripta normal do que os grupos CRt ou GRt, que näo apresentaram diferença estatística entre si. No intestino grosso, as médias de altura das criptas dos grupos ERt e GRt foram iguais e superiores às de CRt; os três grupos näo apresentaram, porém, diferença significante em relaçäo à celularidade epitelial e ao número de mitoses nas criptas do cólon. CONCLUSAO. Nas condiçöes do presente trabalho, a suplementaçäo alimentar com glutamina antes, durante e após a irradiaçäo abdominal em ratos, em dieta polimérica ou elementar, determinou efeitos protetores sobre o intestino irradiado, preservando sua arquitetura morfológica e a capacidade de recuperaçäo, sobretudo no intestino delgado

Histoplasmose disseminada em transplantado renal. / Disseminated histoplasmosis in renal transplant patients

Os Autores registram caso de histoplasmose generalizada em paciente transplantado com rim de doador nao aparentado. Alem da infeccao fungica diagnosticada sorologicamente e pela histopatologia, a autopsia revelou cirrose hepatica macro e micronodular, de provavel etiologia viral (virus B), hepatocarcinoma, deplecao linfoide do baco e glomerulopatia de transplante. Revendo a literatura sobre o assunto, chegam a conclusao de que, provavelmente, com a imunodepressao medicamentosa, as lesoes pulmonares por reinfeccao endogena foram as primeiras a aparecer sob a forma de uma histoplasmose pulmonar cronica

Carcinoma do saco lacrimal: apresentacao de 2 casos e revisao da literatura. / Carcinoma of the lacrimal sac: report of 2 cases and review of the literature

Os autores apresentam 2 casos de carcinoma do saco lacrimal, com evolucao respectivamente de 5 anos e 8 anos, este considerado atipico. Uma revisao da literatura internacional demonstrou a existencia de 81 casos publicados de carcinoma do saco lacrimal, inexistindo trabalhos nacionais sobre o assunto. Os carcinomas do saco lacrimal podem simular dacriocistites. Tal ocorreu com o caso numero 1 apresentado no presente trabalho.O exame histopatologico de toda dacriocistectomia devera ser obrigatorio em decorrencia do exposto acima. Os carcinomas do saco lacrimal podem originar-se de papilomas da mucosa daquela estrutura. Tem carater polifocal podendo manifestar-se clinicamente como tumores isolados das palpebras, como ocorreu no caso numero 2 do presente trabalho, com recidivas frequentes apesar dos tratamentos cirurgicos e radioterapicos efetuados. Os carcinomas palpebrais recidivantes exigem uma pesquisa das vias excretoras lacrimais que poderao ser a sede primaria oculta do tumor, causador das recidivas