Postoperative delirium after cardiac surgery; incidence, management and prevention

Delirium is an acute neurological state branded as confusion, distraction, and varied consciousness. Other symptoms include disorientation, memory impairment, perceptual disturbances, altered psycho-motor activity, and sleep disturbances. Oilman was the first person to report delirium as a complication of cardiac surgery in 1965. Despite peri-operative advancements, including both surgical and anesthetic, delirium is a frequent post cardiac surgery complication. Delirium is a common menace in the cardiac surgical ICU and outcome consequences of greater number of morbidity and mortality. Recent research has identified possible hazards for the occurrence of delirium and strategies to treat it. However, more studies are required to standardize the risk factors, its occurrence and treatment strategies in post cardiac surgical patients

Vitamin D deficiency in patients with systemic lupus erythematosus

Hypovitaminosis D is common in the general population Many studies that have been conducted to show the association between vitamin D deficiency and systemic lupus erythematosus [SLE] reveal that deficiencies in vitamin D are common in this group of patients. Our aim was to study the relationship between 25 [OH] D and disease activity in patients with SLE, Retrospective cohort study of patients with SLE who were followed up at King Abdulaziz University Hospital, Jeddah, from January 2007 to November 2010. Demographic and clinical data were recorded and the 25 [OH] D levels of the patients were measured. Chi square tests. Students t-test, ANOVA and Pearson tests were used for data analysis. ANOVA test was followed by Bonferroni correction. A p-value <0.05 was considered significant. Ninety-five patients with SLE were enrolled in the study. The levels of 25[OH]D were significantly lower in patients with active SLE [n=41; 43%] than in those with inactive disease [n=54; 57%; p=0, 04]. The mean [SD] levels were 22.3 [14] nmol/L for patients with active disease against 25.0 [14] nmol/L for patients with inactive SLE. No correlation was detected between 25 [OH] D levels and disease activity score evaluated by SLEDAI-2K By Pearson correlation, a significant negative correlation existed between 25 [OH] D and anti ds-DNA [r=-038; p<0.001]; a positive correlation existed between 25 [OH] D levels and C4 [r=0.25; p=0.25]. By chi square testing, azathioprine treatment [OR=3.5], low C4 [OR= 2.23], low C3 [OR=1.92], and active disease [OR=1.6] were associated with 25[OH] D deficiency in SLE patients. Vitamin D deficiency is frequent in patients with SLE, Patients with SLE have a higher risk of developing 25[OH] D deficiency in the presence of low serum C3 and C4 levels, and high anti-dsDNA levels

Antimicrobial susceptibility patterns of multidrugresistant Pseudomonas aeruginosa and Acinetobacter baumannii against carbapenems, colistin, and tigecycline

To examine susceptibility of Pseudomonas aeruginosa [P. aeruginosa] and Acinetobacter baumannii [A. baumannii] against carbapenems along with colistin and tigecycline as alternative therapeutic options. A total of 117 strains of multidrug-resistant [MDR] non-fermenting Gram negative bacteria isolated from non-duplicate samples were collected consecutively. We included one sample from each patient [84 isolates of A. baumannii and 33 isolates of P. aeruginosa isolated from patients seen at King Khalid University Hospital, Riyadh, Saudi Arabia, from June to December 2010]. Isolates were identified by the MicroScan WalkAway 96 Plus system. The minimum inhibitory concentrations [MICs] were determined by E-test following the Clinical and Laboratory Standards Institute breakpoint recommendations. Most A. baumannii strains were resistant to imipenem [90.5%], meropenem [90.5%], and doripenem [77.4%]. Whereas, a higher percentage of P. aeruginosa was resistant to imipenem [90.9%], and meropenem [81.8%], only 39.4% were resistant to doripenem. Colistin had excellent activity against both A. baumannii [100%] and P. aeruginosa [93.9%], while 89.3% of A. baumannii strains were susceptible to tigecycline. Among the carbapenems, doripenem was found to be the most potent antimicrobial agent against P. aeruginosa, whereas colistin proved to be an effective alternative antimicrobial agent for treatment of A. baumannii or P. aeruginosa. Tigecycline remains the best therapeutic option for MDR A. baumannii

Role of Ghizae Dawai [Nutraceuticals] during pregnancy

Promotion of Maternal and Child Health is most important component of the reproductive and child health programme. Women's health is important during all phases of their lives, from childhood to adulthood. Some of the initiatives have been taken up such as increasing accessibility of service providers by an accreditation of private institutions as training center, improve quality of antenatal and post natal care and Integrated Nutrition and Health Project etc. Essential nutrition plays an important role during pregnancy, which helps the baby as well as mother growth. Nutraceutical, a portmanteau of nutrition and pharmaceutical, refers to extracts of foods claimed to have a medicinal effect on human health. The nutraceutical is usually a contained nutrition as well as medicinal portion essential to prevent problems like anaemia, nausea, vomiting, low blood pressure, hemorrhage, dizziness, and fatigue and also ensures that baby is getting essential nutrients growing inside the womb. Iron, protein, calcium as supplements and cereals, dairy foods, fruits, vegetables and nuts as nutrition have been recommended in various Unani Classics as single such as Zanjbeel, Isapghol and Soya or compound formulations such as Arq-e-Gaozaban, Arq-e-Mako and Jawarish Anarain help in various conditions throughout pregnancy

Comparison of incidence of post-obturation flare-ups following single and multiple visit root canal treatment

Post-operative pain and discomfort after endodontic treatment is an unwanted occasion for both the patient and the dentist. A flare up is a true complication characterized by the development of pain and swelling and requires emergency treatment. Certain factors such as pre-operative pain, numbers of appointments, use of intra-canal medication and tooth location, predispose to the development of post-operative pain and flare-ups. The purpose of this study is to analyze the incidence of post-obturation flare-ups in teeth following single visit and multiple visits Root Canal Treatment in Operative dentistry Department, Baqai Dental College, 2010 to 2011. To observe effect of: [1] skill and experience, [2] Single and multiple visits [3] Gender. Total 60 patients requiring endodontic treatment in single rooted teeth were identified and included in this study. The patients were randomly assigned and treated in the department of Operative dentistry, Baqai Dental College into two groups. The teeth of patients in group 1 were with vital inflamed pulp treated in single visit. Group 2 were with vital inflamed pulp treated in multiple visits. They were asked whether they had experienced any postoperative pain within 1 hr, within 24 hrs, within 48 hrs. Dental practitioners included in this study were fresh graduates [C1], graduates with 5 years [C2] and 10+years [C3] clinical experience. Data was analyzed statistically using the chi-square test, SPSS version 19. P-value was set at 0.001. 3 males and 5 females patients complained of pain within 24 hrs of obturation that was sharp in nature and spontaneous; no complaint of pain was reported after 24 hrs without medication. The flare-up incidence came out to be 13.3%. All patients in this study suffered irrereversible pulpitis in which 25 were obturated in single visit, 30 in multiple visits in which 5:3complained of pain after obturation within 24 hrs. Fresh graduates performed root canal therapy on 20 patients, 20 with 5+years and 20 with 10+years clinical experience and the flare-up ratio regarding clinical experience was found to be 4:3:1 respectively. It was concluded that the incidence of flare-up or post obturation pain is related to the number of visits, clinical experience of the dentist and gender of the patient

Ethics of eating and drinking in the light of Qur'an and Unani system of medicine

Dietetics or regimen of health define a controlled way of eating in order to preserve one's health, as opposed to impulsive eating which does not care about consequences. Diet was regarded as being essential for health and the prevention of disease since Medieval times. Dietary guidelines were written for different age groups, different body types and different seasons of the year. The amount of food to be ingested, the number of meals recommended and the order in which the food should be consumed were all issues that were discussed. A variety of foods were thought to have medicinal properties, some of which are known today. The present paper discusses in detail the principle of dietetics mentioned in the Holy Quran and by Unani physicians

Daa-us-sadaf [Psoriasis] and role of herbal drugs

Hippocrates, Dioscorides and other Unani Physicians also described this disease. Psoriasis is a non-contagious idiopathic skin disorder which also include the joints. It commonly causes red scaly patches appearing on the skin. Herbal or aromatherapeutic agents could be useful in this context. Here authors review the herbal drugs which have antipsoriasis property and benefited the patients of this disease. It is a review of plants drug published in MAPA [Medicinal Aromatic Plant Abstracts] and PubMed and on Wikepedia

Utility of bad [aegle marmelos linn.] in unani medicine

Bael [Aegle marmelos] is an important medicinal plant used in Unani System of medicine, which is cultivated throughout India. It is popularized for having antidiarrhoeal and antidysenteric activity. The present paper is an attempt to summarize the pharmacological actions and medicinal uses of the BaeI plant mentioned in Unani medical literature as well as in currently reported studies

Inhibition of growth of Leishmania donovani promastigotes by newly synthesized 1,3,4-thiadiazole analogs

Leishmania donovani, the causative agent of visceral leishmaniasis, is transmitted by sand flies and replicates intracellularly in their mammalian host cells. The emergence of drug-resistant strains has hampered efforts to control the spread of the disease worldwide. Forty-four 1, 3, 4-thiadiazole derivatives and related compounds were tested in vitro for possible anti-leishmanial activity against the promastigotes of L. donovani. Micromolar concentrations of these agents were used to study the inhibition of multiplication of L. donovani promastigotes. Seven compounds were identified with potential antigrowth agents of the parasite. Compound 4a was the most active at 50 micro M followed by compound 3a. These compounds could prove useful as a future alternative for the control of visceral leishmaniasis

Separate submission of standard lymphadenectomy in 6 packets versus en bloc lymphadenectomy in bladder cancer

Our aim was to evaluate detection of nodal metastasis during radical cystectomy with standard pelvic lymph node dissection versus en bloc lymphadenectomy for the treatment of bladder cancer. Hospital records of a total of 77 patients with radical cystectomy and either standard pelvic lymph node dissection or en bloc lymphadenectomy were reviewed. Nodal dissection specimens during standard lymphadenectomy were sent for pathology examination in 6 separate containers marked as external iliac, internal iliac, and obturator groups from both sides. En bloc dissection specimens were sent in 2 containers marked as the right and the left pelvic nodes. Clinical and pathological findings of these two groups were compared in terms of the number of dissected lymph nodes, number of nodes with metastasis, lymph node density, and clinical outcomes. There were 34 patients with standard lymph node dissection and 43 with en bloc lymphadenectomy [anterior pelvic exenteration]. Age, sex, duration of the disease, number of transurethral resections prior to cystectomy, pathological grade at cystectomy, and stage of the primary tumor were comparable in the two groups of patients. The median numbers of nodes removed per patient were 15.5 [range, 4 to 48] and 7.0 [range, 1 to 24] in those with standard and en bloc lymphadenectomy, respectively [P<.001]. Nodal involvement was detected in 10 [29.4%] and 9 [20.9%] patients, respectively [P=.43]. Although nodal involvement was not significantly different between the two groups, standard lymphadenectomy submitted in 6 different containers significantly improved the nodal yield over en bloc resection. Obturator nodes were the most commonly involved nodes in our study

Surgical ligation of scrotal varicocele for male factor infertility is a valid option of treatment

To evaluate the role of surgical ligation of scrotal varicocele for treatment of male factor infertility. We studied 60 patients who presented with infertility and were also found to have scrotal varicocele. Patients with other probable causes contributing to infertility were excluded. Diagnosis was made by clinical examination and scrotal ultrasonography. All the patients underwent either laparoscopic varicocelectomy or open retroperitoneal high ligation of the testicular veins. Operative time and hospital stay was recorded. All patients were evaluated for postoperative improvement of semen parameters and development of any postoperative complication. The results were analyzed by commercially available software. During the study period 5 patients were lost to follow up and were excluded. The rest of patients [n=55] were young, with age ranging from 20 - 35 years [Mean age 27.8 years, SD + 4.38]. All patients had unilateral left sided varicocele; two patients [3.6%] had grade I varicocele, 21 patients [38.2%] had grade II varicocele and 32 patients [58.2%] had grade III varicocele. Statistically significant improvement in sperm density [p value < 0.05], sperm activity [p value < 0.05] and sperm morphology [p value < 0.05] was observed after the surgical ligation. The mean operative time was 54.88 minutes [SD + 13]. The mean hospital stay in laparoscopic procedure was 33.4 [SD + 15.3]. Minor complications were noted in 13 patients and included superficial wound infection in 3 patients, 6 patients exhibited testicular pain and persistence of varicocele in 4 patients. Surgical ligation of scrotal varicocele is a safe and effective mode of treatment of male factor infertility in selected population

Management of Infantile diarrhoea through Unani oral rehydration fluids

Children are the indicators of development of our future, and diarrhoeal diseases among children is still a major health problem in developing countries. In India alone about 1.5 million children die of dehydration due to diarrhoea every year and are indicative of tragic symbol of inefficiency of our health care system. Greater tragedy behind this fact is that most of these deaths arc preventable not by sophisticated or expensive means but by simple and cheap Unani home remedies. Oral re-hydration therapy is considered as the best medical revolution and oral rehydration fluids prepared from homely available Unani drugs can play valuable role not only to control dehydration but also to check diarrhoeal episode, and help decrease needless diarrhoeal deaths. The topic is discussed in the paper at length

Clinical effects of lactuca scariola linn, coriandrum sativum linn. rauwolfia serpentina linn., nymphaea alba linn. in the management of essential hypertension [zaghtuddam qawi]

Hypertension is a major public health problem in every society throughout the world. It develops dreadful complications such as Cerebrovascular accidents, Angina pectoris, Myocaidial infarction and renal failure leading to cardiovascular mortality and morbidity. If we trace back the historical genesis of hypertension, we come to know that the basic concept of this disease is an ancient one. The ancient Unani physicians like Ibn-e-Sina, Ibn-e-Rushd, Ali Ibn-e- Abbas Majoosi, Abu Bakar Mohammad Bin Zakaria Razi and Ismail Jurjani have described Imtela [Congestion] in their treatises. They have mentioned the types, etiological factors, symptoms and complications of Imtela

Temperament [Mizaj] and blood groups of donors and recipients and their importance in blood transfusion

Blood groups are checked before transfusion to avoid agglutination caused due to the interaction of agglutinogen present in the red cells [khilt-e-dam] of donor and agglutinin present in the plasma of recipient or vice versa. On the basis of agglutinogens present in the red cells, human beings are divided into groups, A, B, AB and O. Unani medical science is based on the concept of four Akhlat [Humours] which remain intermixed in the blood as their name suggests. Each dominating humour in the blood constitutes a particular temperament and accordingly all individuals are divided into four humoural temperaments, sanguine, phlegmatic, choleric and melancholic. Concluded, blood of all persons are not similar but differ according to temperaments. Observations revealed that in several recipients even after transfusion of compatible blood, jaundice occurred due to haemolysis. This is indicative of incompatibility of temperament of recipient and donor. In this paper it is emphasised that besides blood groups, temperaments of donors and recipients must also be checked before transfusion and be similar, to avoid ill-effects

Assessment of mizaj [temperament] in Unani system of medicine and its relevance to modern theory of blood grouping

Mizaj [temperament] forms the bases of diagnosis and treatment in the Unani System of Medicine. Evaluation and classification of various temperaments are based on the intermixture of four akhlat [humours] in the blood in different proportions and this blood plays and important role in the constitution of Mizaj. Domination of humours e.g., blood, phlegm, bile and black bile in the blood categorises persons in sanguine, phlegmatic, choleric and melancholic temperaments respectively. Similarly, on the other hand, presence or absence of A and B antigens in the blood classifies persons into four groups, A, B, AB, and O. The study was undertaken to find out the relationship between temperaments and blood groups of 120 healthy temperaments and blood groups of 120 healthy individuals

Predictors of surgery outcome for colorectal carcinoma in the United Arab Emirates

In this retrospective study, 72 patients with colorectal cancer were followed up for a mean period of 28.2 months. Predictors of recurrence and survival were determined using standard analyses. Univariate analyses identified a group of patients with a shorter time to recurrence. The mean overall survival time was 63.2 +/- 7.7 months and survival time was shorter for younger patients with palliative resection, lymph node metastasis and peritoneal nodules. In multivariate Cox proportional hazards analysis, the hazard ratio for positive lymph nodes was 2.54 [95% CI: 1.36-4.79] compared to negative nodes, and for Dukes' stages A and B compared to stage C it was 0.45 [95% CI: 0.25-0.81]