Clinical outcomes of moderate to severe COVID-19 patients receiving invasive vs. non-invasive ventilation

Objective: To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit (HDU) in relation to invasive vs. non-invasive mode of ventilation. Methods: In this study, the patients required either non-invasive [oxygen ≤10 L/min or >10 L/min through mask or nasal prongs, rebreather masks and bilevel positive airway pressure (BiPAP)] or invasive ventilation. For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen, Kaplan Meier and log rank analyses were used. In the end, independent predictors of survival were determined by Cox regression analysis. Results: Invasive ventilation was required by 15.1% patients while 84.9% patients needed non-invasive ventilation. Patients with evidence of thromboembolism, high inflammatory markers and hypoxemia mainly required invasive ventilation. The 30-day in hospital mortality was 72.7% for the invasive group and 12.9% for the non-invasive group (1.8% oxygen 10 L/min, 3.6% rebreather mask and 4.5% BiPAP). The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group (P<0.05). Age, presence of co-morbidities, number of days requiring oxygen, rebreather, BiPAP and invasive ventilation were independent predictors of outcome. Conclusions: Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury. Thus, protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.

Incidence of Metachronous Inguinal Hernia among Children under One Year of Age in Pediatric Surgery

Background: Pediatric inguinal hernia is one of the frequent causes of childhood morbidity. Therefore, the aim of the present study was to determine the incidence of metachronous contralateral inguinal hernia in pediatric patients aged ≤ 12 months, in Northern Saudi Arabia. Methodology: In the present study, records of a series of 90 pediatric patients (aged ≤ 12 months) were presented with inguinal hernia and have subsequently undergone inguinal hernia repair. Results: About 2/30 (6.6%) with left side hernia were found with subsequent right side metachronous contralateral inguinal hernia (MCIH) occurrence. One out of the two 1/2 (50%) was found at the age of 2 months, the other one 1/2 (50%) was at the age of 6 months. The 3/54 (5.5%) with right inguinal hernia developed a contralateral hernia, of whom 2/3 (66.6%) were found at the age of 12 months, and one 1/3 (33.3%) was at the age of 2 months. Conclusion: The findings of the present study suggest that there is a relatively higher incidence of contralateral inguinal hernia if the initial presentation was on the left side, which necessitates a close follow up for those patients; however, there is not enough evidence to support routine exploration of the contralateral groin surgically.

Enndobronchial Ultrasound-guided trans-Bronchial needle aspiration for the diagnosis of Granulomatous versus non Granulomatous lung diseases

Objective: To evaluate the diagnostic accuracy of Endo-bronchial ultrasound guided transbronchial needle Aspiration in patients with mediastinal lymphadenopathy and mass lesions especially in the context of granulomatous versus non granulomatous lung disorders

Study Design: Open label, unblended prospective observational cohort

Place and Duration of Study: Department of Pulmonology, Pak Emirates Military Hospital Rawalpindi, from July 2015 to Mar 2016

Patients and Methods: All patients presented during study periods with meditational lymphadenopathy or lesions in which the initial bronchoscopy did not reveal any diagnosis were included in the study. Endobronchial ultrasound-guided transbronchial needle aspiration was performed in the bronchoscopy suit under conscious sedation and local anesthesia. Rapid on site evaluation was available for most of the cases. The procedure was performed using an integrated fibreoptic bronchoscopy with 22G TBNA needle by an experienced Bronchoscopist. The data was analyzed by using SPSS version 21

Results: A total of 53 patients with mean age of 44 years underwent endobronchial ultrasound-guided transbronchial needle aspiration for evaluation of meditational or hilar lesions between Jul 2015 to Apr 2016. There were 43 [81.1percent] male and 10 [18.8percent] female patients. A total of 108 Lymph nodes were sampled in 53 patients, rapid on site evaluation was available in 41 [77.3percent] patients. Adequate representative sample could be obtained in 45 of 53 [84.9percent] patients. The overall diagnosis were chronic granulomatous lesion in 27 [50.9percent] patients, squamous cell carcinoma in 10 [18.8percent], lymphoproliferative disorder in 2 [3.7percent], thymoma in 1 [1.3percent] and reactive hyperplasia in 5 [9.4percent] of cases. No major complication of the procedure was observed

Conclusion: End bronchial ultrasound-guided transbronchial needle aspiration was found useful diagnostic modality for lymph nodes sampling in patients with lymphadenopathy and mass like lesions in mediastinum

Effect of some plants' extracts used in Sudanese folkloric medicines on carrageenan-induced inflammation

Investigations for anti-inflammatory potential and categorization of Sudanese medicinal plants according to their potency. Anti-inflammatory effect of plants' extracts of 17 genera were studied using the carrageenan induced inflammation in rats' paws. The plant extracts were obtained using methanol and dichloromethane as solvent and administered intra peritoneally at the concentration of 2g/kg body weight. The results obtained in this experiment strongly support and validate the traditional uses of these Sudanese medicinal plants to treat various inflammatory diseases. 63.9% of plants extracts showed marked inhibition of inflammation induced by carrageenan [78.3% out of this percentage represented by methanolic extract], 27.8% showed no activity and 8.3% enhanced the carrageenan induced inflammation. The anti-inflammatory effect of many of these plants has not been reported previously, yet they have been extensively used in Sudanese folkloric medicine. The result of this study justify the traditional medicinal use of the evaluated plants species in treating inflammatory disorders and helped in categorizing the investigated plants into most useful, moderately useful and least useful category for inflammatory diseases. Out of the 17 investigated plant species 05 belongs to most useful and 06 belongs to moderately useful category. However, toxicity studies are required to prove the safety of these plant materials

Evaluating developmental characteristics of children with attention deficit and hyperactivity disorder and learning disabilities in kindergarten stage

Background: Current study aims at evaluating developmental characteristics for kindergarten children who are enrolled in K.G.2 with developmental learning disabilities and children with attention deficit and hyperactivity disorder with learning disabilities through comparing between them in [attention and audio recognition

Sample: Study sample consists of 60 children of both sexes from K.G.2 enrolled in Sheikh Zaid experimental school, subordinate to Sheikh Zaid educational administration, they are 33 males, 27 females

Tools: Study tools were applied on children with attention deficit and hyperactivity with developmental learning disabilities, Visual recognition-kinetic recognition and memory] hence concluding some educational applications that help in caring about these children, if they achieve this objective, that will help specialists in directing interest in these children since the beginning of problem

Results: The study concluded that there is statistically significant difference between males and females in their developmental characteristics as t value of disabilities and of total degree was [2.87, 2.10, 2.19, 3.88, 5.26, and 3.61] at significance level 0.05, 0.01, We find that males are more than females in learning disabilities in majority of disabilities that are represented in [memory, visual recognition, audio recognition and kinetic recognition] while females were less attentive than males. Data indicate that there is statistically significant difference between males and females as t value of disabilities and total degree was [2.18, 3.61, 3.43, 2.43] at significance level of 0.05, 0.01 in favor of males, we find that males are more impulsive and hyperactive while females are more in attention deficit on scale of attention deficit and hyperactivity disorder

Effectiveness of program to use some of principles of Triz theory for developing skills of reading readiness amongchildren with learning difficulties in kindergarten stage

Objectives: the study aimed to prepare a traming program based on some principles of Triz theory for a sample of children with learning difficulties in the kindergarten stage to develop the skills of readiness

Sample; the study sample consisted of 20 male and female child of preschool children [Kindergarten stage] with developmental learning difficulties

Tools: man drawing test to deter mine the Intelligent coefficient [prepared By Jodariv Harris], sodoeconomic Measurement of the family [prepared By Adel Aziz ashakh], Measurement [List] of developmental learning difficulties [prepared By Adel abddullah], Reading readiness scale [prepared By the researcher], and The study training program [prepared By the researcher]

Statistical Methods: The Correlation Coefficient, Alpha Corn Bach, Spear Man, and T. Test

Findings: The study Findings revealed that oil the study hypotheses

Effectiveness of speech rehabilitation program for developing some language communication skills for a sample ofautistic children aging between [5- 6] years by using some forms of child's literature

Background: Current study aimed at trying to ascertain from program effectiveness for developing some language communication skills for a sample of autistic male children aging between [5-6] years by using some forms of children's literature, it includes skills of [attention and concentration-imitation-recognition and understanding-expression], the researcher concluded that

Results: There are no significant statistical differences between degrees average of control group in pre and post measures on language communication scale for autistic child, There are no significant statistical differences between degrees average of experimental group in pre and post measures on language communication scale for autistic child, There are significant statistical differences between degrees of average of control and experimental group in post measure in favor of experimental group children on language communication scale for autistic child, and There are no significant statistical differences between degrees average of experimental group in post measure and follow-up measure on language communication scale for autistic child

Chromatographic finger print analysis of anti-inflammatory active extract fractions of aerial parts of Tribulus terrestris by HPTLC technique

<p><b>OBJECTIVE</b>To develop HPTLC fingerprint profile of anti-inflammatory active extract fractions of Tribulus terrestris (family Zygophyllaceae).</p><p><b>METHODS</b>The anti-inflammatory activity was tested for the methanol and its fractions (chloroform, ethyl acetate, n-butanol and aqueous) and chloroform extract of Tribulus terrestris (aerial parts) by injecting different groups of rats (6 each) with carrageenan in hind paw and measuring the edema volume before and 1, 2 and 3 h after carrageenan injection. Control group received saline i.p. The extracts treatment was injected i.p. in doses of 200 mg/kg 1 h before carrageenan administration. Indomethacin (30 mg/kg) was used as standard. HPTLC studies were carried out using CAMAG HPTLC system equipped with Linomat IV applicator, TLC scanner 3, Reprostar 3, CAMAG ADC 2 and WIN CATS-4 software for the active fractions of chloroform fraction of methanol extract.</p><p><b>RESULTS</b>The methanol extract showed good antiedematous effect with percentage of inhibition more than 72%, indicating its ability to inhibit the inflammatory mediators. The methanol extract was re-dissolved in 100 mL of distilled water and fractionated with chloroform, ethyl acetate and n-butanol. The four fractions (chloroform, ethyl acetate, n-butanol and aqueous) were subjected to anti-inflammatory activity. Chloroform fraction showed good anti-inflammatory activity at dose of 200 mg/kg. Chloroform fraction was then subjected to normal phase silica gel column chromatography and eluted with petroleum ether-chloroform, chloroform-ethyl acetate mixtures of increasing polarity which produced 15 fractions (F1-F15). Only fractions F1, F2, F4, F5, F7, F9, F11 and F14 were found to be active, hence these were analyzed with HPTLC to develop their finger print profile. These fractions showed different spots with different Rf values.</p><p><b>CONCLUSIONS</b>The different chloroform fractions F1, F2, F4, F5, F7, F9, F11 and F14 revealed 4, 7, 7, 8, 9, 7, 7 and 6 major spots, respectively. The results obtained in this experiment strongly support and validate the traditional uses of this Sudanese medicinal plant.</p>