Adding autogenic drainage to chest physiotherapy after upper abdominal surgery: effect on blood gases and pulmonary complications prevention. Randomized controlled trial

ABSTRACT BACKGROUND: Hypoxemia and pulmonary complications are common after upper abdominal surgery (UAS). OBJECTIVE: To examine whether inclusion of autogenic drainage (AD) in chest physiotherapy after UAS confers additional benefits in improving blood gases and reducing postoperative pulmonary complications (PPCs). DESIGN AND SETTING: Randomized controlled study conducted at Kasr Al-Ainy teaching hospital, Egypt. METHODS: A randomized controlled trial was conducted on 48 subjects undergoing elective UAS with high risk of developing PPCs. The study group received AD plus routine chest physiotherapy (deep diaphragmatic breathing, localized breathing and splinted coughing) and the control group received routine chest physiotherapy only. The outcomes included arterial blood gases measured at the first and seventh postoperative days, incidence of PPCs within the first seven days and length of hospital stay. RESULTS: Baseline characteristics were similar between groups. In the AD group, SaO2, PaO2, PaCO2 and HCO3 significantly improved (P < 0.05) while in the physiotherapy group, only SaO2 and PaO2 significantly improved (P < 0.05). Nonetheless, significant differences in post-treatment SaO2 and PaO2 between the groups were observed. The overall incidence of PPCs was 16.66% (12.5% in the AD group and 20.8% in the physiotherapy group) (absolute risk reduction -8.3%; 95% confidence interval, CI, -13.5 to 29.6%), with no significant difference between the groups. The AD group had a significantly shorter hospital stay (P = 0.0001). CONCLUSION: Adding AD to routine chest physiotherapy after UAS provided a favorable blood gas outcome and reduced the length of hospital stay. It tended to reduce the incidence of PPCs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04446520.

Influence of some methylated hepatocarcinogenesis-related genes on the response to antiviral therapy and development of fibrosis in chronic hepatitis C patients

Epigenetics involved in multiple normal cellular processes. Previous research have revealed the role of hepatitis C virus infection in accelerating methylation process and affecting response to treatment in chronic hepatitis patients. This work aimed to elucidate the role of promoter methylation (PM) in response to antiviral therapy, and its contribution to the development of fibrosis through hepatocarcinogenesis-related genes. A total of 159 chronic hepatitis Egyptian patients versus 100 healthy control group were included. The methylation profile of a panel 9 genes (SFRP1, p14, p73, APC, DAPK, RASSF1A, LINE1, O6MGMT, and p16) was detected in patients’ plasma using methylation-specific polymerase chain reaction (MSP). Clinical and laboratory findings were gathered for patients with combined pegylated interferon and ribavirin antiviral therapy. Regarding the patients’ response to antiviral therapy, the percentage of non-responders for APC, O6MGMT, RASSF1A, SFRP1, and p16 methylated genes were significantly higher versus responders (P<0.05). Of the 159 included patients, the most frequent methylated genes were SFRP1 (102/159), followed by p16 (100/159), RASSF1A (98/159), then LINE1 (81/159), P73 (81/159), APC (78/159), DAPK (66/159), O6MGMT (66/159), and p14 (54/159). A total of 67/98 (68.4%) cases of RASSF1A methylated gene (P=0.0.024), and 62/100 (62%) cases of P16 methylated gene (P=0.03) were associated with mild-degree fibrosis. To recapitulate, the PM of SFRP1, APC, RASSF1A, O6MGMT, and p16 genes increases in chronic hepatitis C patients, and can affect patients’ response to antiviral therapy. The RASSF1A and P16 genes might have a role in the distinction between mild and marked fibrosis.

Comparative study between intravitreal ranibizumab and triamcinolone treatment of diabetic macular edema as regard to optical coherence tomography changes and visual acuity / Estudo comparativo entre o tratamento intravítreo com ranibizumabe e triancinolona do edema macular diabético quanto às alterações na tomografia de coerência óptica e na acuidade visual

Abstract Objectives: To compare the effect of intravitreal Ranibizumab (0.3mg) and Triamicinolone (4mg) on different parameters in spectral domain OCT and their relation to visual acuity of patients with diabetic macular edema. Methods: This study is designed as a prospective randomized study. Patients were randomly divided into 2 groups receiving either Pro re nata intravitreal Ranibizumab (0.3mg) or Triamicinolone acetonide (4mg), to whom Spectral Domain OCT was done as well as best corrected Log MAR visual acuity. Results: 40 patients were included in this study. Comparison and correlation of mean BCVA and mean CMT among and within treatment groups of our study revealed strong and significant relationship between both parameters and showing equal effect of both treatment types regarding them with the consideration that Triamicinolone acetonide treated group (Group B) showed statistically significant lower CMT compared to Ranibizumab treated group (Group A) at three and six months. Also both showed equal effectivity regarding improvement of the photoreceptors integrity and in turn the improvement of the BCVA. Meanwhile the association of CMT and IS/OS integrity was found to be significant only at six months in both groups (p =0.009 in Group A; p =0.031 in Group B). The fading initial effect of a single ranibizumab injection on macular edema can be augmented by following that one injection with two injections of the loading dose. Triamicinolone effect after single injection began to fade at 3 months. Conclusion: Both treatment types had good effect on reduction of CMT and improvement of BCVA and the IS/OS junction with difference in sustainability of their effects due to difference in their pharmacokinetics and need for repeated injections.

Resumo Objetivos: Comparar o efeito do ranibizumabe intravítreo (0,3mg) e triacmicinolona (4mg) em diferentes parâmetros do domínio espectral da OCT e sua relação com a acuidade visual de pacientes com edema macular diabético. Métodos: Este estudo foi concebido como um estudo prospectivo randomizado. Os pacientes foram divididos aleatoriamente em 2 grupos que receberam Ranibizumab Pro rata intravitreal (0,3mg) ou acetonido de Triamicinolona (4mg), a quem foi realizada a Spectral Domain OCT, bem como a melhor acuidade visual de Log MAR corrigida. Resultados: Quarenta pacientes foram incluídos neste estudo. A comparação e a correlação da acuidade visual média e CMT média entre e dentro de grupos de tratamento do nosso estudo revelaram uma relação forte e significativa entre ambos os parâmetros e mostrando um efeito igual de ambos os tipos de tratamento, considerando que o grupo tratado com acetonido Triamicinolona (Grupo B) apresentou significância estatística. menor CMT comparado ao grupo tratado com Ranibizumab (Grupo A) aos três e seis meses. Também ambos mostraram igual efetividade em relação à melhoria da integridade dos fotorreceptores e, por sua vez, a melhora do BCVA. Enquanto isso, a associação de CMT e IS / OS integridade foi significativa apenas aos seis meses em ambos os grupos (p = 0,009 no Grupo A; p = 0,031 no Grupo B). O efeito inicial enfraquecido de uma única injeção de ranibizumabe no edema macular pode ser aumentado seguindo-se aquela injeção com duas injeções da dose de ataque. O efeito triamicinolona após injeção única começou a diminuir aos 3 meses. Conclusão: Ambos os tipos de tratamento tiveram bom efeito na redução da CMT e melhora do BCVA e da junção IS / OS com a diferença na sustentabilidade de seus efeitos devido à diferença em sua farmacocinética e necessidade de injeções repetidas.

Some Risk Factors in children with cerebral palsy [A meta-analysis on Egyptian studies 2000-2017]

Background: Cerebal palsy [CP] is a group of disorders that characterized by long term disability which affects the developmental process with consequent negative impact on the general status of CP children

Objective: To provide the first meta-analysis of Egyptian studies regarding risk factors [prenatal,natal and postnatal] in children with CP

Methodology: According to PRISMA statment, the researcher reviewed the Egyptian theses, papers, journals, in English language, searching for the eligible studies published from January,2000 to the end of June 2017. Meta-analysis was done using MedCalc software ver.12.7.7.0.the pool of 78 studies involved a total sample of 7338 children with CP and 961 control children [26 articles directly related to to risk factors in relation to CP]

Results: Positive consanguinity in CP children had an Odds Ratio 1.7 [Z= 2.25, P= 0.024]. The prevalent risk factors pooled random effect proportions in CP children are: hypoxic ischemic encephalopathy 54.4%, recurrent chest infectionns 62.3%, epilepsy 47%, 1st birth order 43.2% birith asphyxia 40.3% difficult labor 35%, brain atrophy 34% hospital delivery 32%, prenatal risk factors 22%, postnatal risk factors 20.2%, neonatal jaundice in 18%, positive family history 16% and premature rupture of membranes 15.3%

Conclusion: there is insufficient evidence to implicate any factor in CP etiology. there is a need for large, prospective, population-based studies with the goal of elucidating the modifiable risk factors

Multiple myeloma: a retrospective analysis of the patients treated at ain shams university clinical oncology department with a review of the literature

Background: multiple myeloma [MM] is a malignant neoplasm of plasma cells that accumulate in bone marrow leading to bone destruction and marrow failure. Multiple myeloma accounts for about 1.8% of all cancers and slightly over 17% of all the hematologic malignancies in the United States. It is more common in men and for unknown reasons

Objective: this study aims at analysis the epidemiological data of the patients treated from multiple myeloma at Ain Shams University together with reviewing the different lines of management according to recent recommendations

Patients and Methods: this retrospective analysis of 62 patients with multiple myloma data recorded at their files with follow up and reviews of the recent advances in the management of multiple myeloma

Results: we found that 96.8% of patients showing clinical improvement after treatment on other hand only 3.2% deteriorated, 61.35 of patients were alive, 9.7% died and 29% lost follow up, the mean time to DFS was 22.55 months, mean OS was 63.2 months with 87.8% of patients survived at the end of the study, as regard mean PFS was 54.9 months with PFS at end of study was 74.9% of patients, there was insignificant differences between OS and demographic data, laboratory studies, there was insignificant differences between PFS and demographic data, laboratory studies

Conclusion: Multiple myeloma [MM] is a heterogeneous hematologic malignancy involving the proliferation of plasma cells derived by different genetic events contributing to the development, progression, and prognosis of this disease

Severe hypertension and pulmonary edema associated with systemic absorption of topical phenylephrine in a child during retinal surgery

Topical phenylephrine solutions are widely used in eye procedures to promote pupil dilation without cycloplegia. We report a case of intraoperative severe hypertension and acute pulmonary edema occurring in a child during retinal surgery after possible systemic absorption of topical phenylephrine eyedrops. Our objective is to discuss the proper treatment and preventive strategies for such a complication. A 4-year-old, male patient, 18.4 kg in weight, physical status ASA I was admitted for right retinal detachment surgery. Anesthesia was induced with sevoflurane in oxygen, followed by glycopyrrolate [5.0 microg/kg], propofol 25 mg, fentanyl 50 microg and cisatracurium 0.15 mg/kg given intravenously. Anesthesia was maintained with sevoflurane 2-2.5% in a mixture of nitrous oxide and oxygen [60%:40%]. After incision, two drops of 10% aqueous phenylephrine were administered topically by the surgeon to the right eye for further pupil dilation. Few minutes later, the noninvasive blood pressure rose to 220/120 mmHg and the heart rate increased to 140 beats/min. Oxygen saturation [SpO[2]] dropped from 99% [with an inspired oxygen concentration [FiO[2]] of 0.4] to 82%. Auscultation revealed crepitations throughout the chest and a blood-stained frothy fluid was aspirated from the trachea with possible development of acute pulmonary edema. Hydralazine [5 mg] and furosemide [10 mg] were administered intravenously. Seven minutes later, the blood pressure returned to normal and the SpO[2] increased to 92% on FiO[2] of 1.0, with decreased intratracheal secretions. After approximately 20 minutes, the SpO[2] had improved to 99%, with a FiO[2] of 1.0 and the blood pressure was 109/63 mmHg and heart rate was 121 beats/min. The FiO[2] gradually reduced back to 0.4 over 30 min with no further desaturation. The patient was discharged from the post anesthesia care unit 5 h after surgery with adequate spontaneous breathing, SpO[2] 99% on room air, normal blood pressure and pulmonary auscultation. Anesthesiologists and ophthalmologists should be aware of the possible cardiovascular side-effects of topical phenylephrine, and it should be used cautiously with appropriate intraoperative monitoring of hemodynamic variables. Moreover, preventive strategies to minimize systemic absorption of the drug should be taken

Functional status among patients with spinal cord injuries: a proposed protocol of care

Spinal cord Injuries [SCI] can result in devastating the physical, psychological or social functional status due to prolonged immobility. Spinal cord injury is a catastrophic condition that may cause dramatic changes in the victim's life. The aim of this study was of two folds to 1-assess the functional status among patients with spinal cord injuries; 2-propose a protocol of care. A total of one hundred patients were recruited in the study from 4 orthopedic wards at El Manial University Hospital affiliated to Cairo University. Data were collected utilizing three designed tools; interviewing schedule, the Functional Status Rating System Scale in relation to self care, mobility, communication, psychosocial adjustment and cognitive function; physical complications assessment sheet including the most common physical complications among patients with SCI. The study findings revealed that, there are statistically significant differences between the items of self care, communication, psychosocial adjustment and severity of the disease, while there are no statistically significant difference between the items of cognitive function and the severity of illness. The most common physical complications among those patients are constipation, pressure ulcer, urinary tract infection, urine and stool incontinence, chest infection, and deep venous thrombosis. The study recommended that, the proposed protocol of care should be implemented and evaluated in relation to incidence of complications. Health education of patients and family should be provided to maximize the injured individual's potential for full participation in activities of daily living and prevent secondary complications

effects of hypothermic versus normothermic cardiopulmonary bypass on hepatic blood flow

To explore Trans-esophageal Echo [TEE] as a monitoring device for hepatic blood flow during cardiac1 surgery and to correlate between the hepatic venous blood flow measurements and the liver function tests during normothermic and hypothermic cardiopulmonary bypass. Forty patients scheduled for cardiac surgery were randomly divided into 2 groups: group 1 [Gl] undergoing normothermic cardiopulmonary bypass [CPB] and group 2 [G2] undergoing hypothermic CPB. Serum AST, ALT, billirubin and hyalurinic acid levels were measured before, during and 6 hours after the bypass. During these same phases, TEE was used to measure both cardiac index [Cl] and middle hepatic vein blood flow. During CPB there were no significant differences in demographic data, AST, ALT or billirubin levels between the 2 groups. There was, however, a significant increase [P<0.001], in both groups, in serum hyalurinic acid levels during CBP in relation to the baseline and in Cl 6 hours after bypass in relation to pre and intra bypass phases. The middle hepatic venous blood flow was significantly higher amongst Gl patients six hours following the procedure in relation to the pre and intra bypass phases, whereas G2 patients showed a significant decrease in middle hepatic venous flow during the bypass followed by a significant increase 6 hours after the procedure in relation to the baseline. Hepatic venous blood flow is reduced significantly more during hypothermic bypass than during normothermic bypass. This may cause disturbances in sinusoidal endothelial cell [SEC] function. However, this change may be well tolerated by the healthy liver. Multiplan TEE may be used to monitor hepatic blood flow during CPB

Primary pilonidal sinus repair: the outcome of 5 different techniques. can a modification be near ideal or provide a benefit?

Although various surgical treatment procedures for pilonidal sinus disease have been evaluated, no clear agreement has been reached as to which one is optimal for the lower incidence of wound infection, wound dehiscence and recurrence rate, almost certainly because there is none. This study was intended to investigate the outcome among five different selected primary closure techniques and to investigate the possibility of decreasing the operation costs by omitting the subcutaneous suture usage in some primary techniques. Prospective study considering morbidity and recurrence as the main outcome measures. This study included 94 patients: 84 male and 10 females with chronic pilonidal sinus disease who were operated on. All underwent excision and primary closure under spinal [64- 61 males, 3 females] or general anaesthesia [30 patients 23 males, 7 females] between May 2004 and February 2007. Patients were prescribed IV prophylactic antibiotic. 5 different techniques were done. They were simple closure technique in the midline, full-thickness z-plasty flap, semi-open, semi-closed closure techniques, musculofascial flap, and the modified musculofascial flap. Early wound complications with delayed wound healing had occurred in seven patients. Two patients had wound dehiscence [one due to haematoma in the modified group and the 2nd due to wound deep infection in the group of musculofascial flap]. A case of seroma occurred in the modified group. Four cases [4.25%] had minor wound breakdown due to superficial wound infections. They were one case in the simple closure method, one in the musculofascial flap, the third in the full thickness z-plasty and the fourth in the modified musculofascial flap procedure. Late postoperative complications: One patient suffered from late wound dehiscence in of the modified group due to infected haematoma. Two cases of recurrence had occurred. One of the superficial wound infections in the simple closure technique. The 2[nd] case was that of the deep wound infection in the musculofascial flap no recurrence has occurred in either the full-thickness z-plasty flap, the semi-open, semi-closed closure, or in the modified group.No significant difference in operation time, time of wound healing, time to return work, patient's or surgeon's satisfaction and cost effectiveness. Best treatment is still unclear. A perfect operation for pilonidal sinus disease should be simple with short hospital stay and low recurrence and complication rate associated with minimal pain, cost effective and have short off work time. Judging the results of the different procedures is difficult because there are no enough significant differences to prefer one to other procedures. Further investigations into the whole medical, financial and social aspects of these procedures for the treatment and management of pilonidal disease are still required

Endothelial and platelet activation markers in early and convalescent phases of ischemic stroke: correlation with clinical and functional disability

The soluble form of selectins in the blood may play an important role in the pathophysiology of atherosclerotic ischemic stroke. To determine whether blood concentrations of the soluble form of selectins are elevated among patients with atherosclerotic ischemic stroke, whether their concentrations in blood correlate with clinical and functional disability and to estimate differences in their levels between lacunar and territorial strokes. We measured the serum levels of soluble E-selectin [sE-selectin] and soluble P-selectin [sP-selectin] during the early and convalescent phases of 37 patients with ischemic stroke compared to controls. We, also did correlation analysis between their levels at baseline and after 3 months with clinical and functional disability scores [National Institutes of Health Stroke Scale-NIHSS-and Barthel Index-BI-respectively]. Levels of sE-selectin and sP-selectin in stroke patients were significantly elevated compared with controls during the early phase, with significant fall in their levels below baseline measurements and below those in controls after three months. sE-selectin levels after 3 months correlated with a better functional status as measured by BI, while sP-selectin levels didn't show any correlation with clinical or functional scores. No significant differences were found in the course of sE-selectin, sP-selectin levels between lacunar and territorial strokes. The evaluation of endothelial and platelet markers would represent the pathophysiological status of stroke. This may offer the possibility of researching the application of antagonists and/ or activity modulators of some of them in ischemic brain disease therapy

Scrub typhus associated with systemic lupus erythematosus: a case report

The etiology of systemic lupus erythematosus [SLE] is largely unknown and there is a probable contribution of genetic, hormonal, immunological and environmental factors for its manifestation. The widespread immunological destruction of many organs in SLE and the associated decreased immunity increase the risk of infections. Steroids and other immunosuppressant are important in the treatment of SLE, but they further increase the risk of infections, and sometimes with rare organisms. We present a case of an adolescent girl with prolonged fever, joint pains and without skin rashes. The initial diagnosis was SLE. She was treated with steroids with improvement in her general condition and relief of joint pains. However the fever persisted and subsequent investigations revealed an associated scrub typhus. The fever subsided after treatment with oral tetracycline. There were no complications of scrub typhus. Since scrub typhus infection is not common in the Arabian Peninsula the disease was not initially thought of. In the investigation of prolonged fever in SLE, viral, bacterial, protozoal as well as rickettsial diseases should be borne in mind

Assessment of quality of life among children with atopic dermatitis

Patients with skin diseases experience a wide range of symptoms, which affect their lives, ranging from trivial problems to major handicaps. Sometimes, these symptoms are caused by objective changes that impair daily life directly and measurably, while at other times the impairment is subtle and occurs mainly on psychological level. The aim of this work is to study the impact of atopic dermatitis on the quality of life [QOL] among affected children. The aim of this work is to study the impact of atopic dermatitis [AD] on the quality of life [QOL] among affected children. One hundred child aged 7-13 years were the cases of the study. They were selected from the patients attending the dermatology outpatient clinic at El-Hussin University Hospital. Also, one hundred child were selected as a control with age and sex matching. Quality of life was assessed for patients and controls through a specific questionnaire. The QOL was good among 24% of cases in comparison to 88% of controls. It was observed that 91.3% with severe AD had poor QOL, while, 37.5% with mild severity had good QOL with statistical significance difference. The QOL of patients with atopic dermatitis is clearly impaired with comparison to control group. QOL showed strong negative effect with increase the severity of the disease

Urinary excretion of glycosaminoglycans and ultrasound urinary bladder wall thickness in children with refractory primary nocturnal enuresis

This study was undertaken to determine variations in the amount of glycosaminoglycans [GAGs] excreted by patients with refractory primary nocturnal enuresis [RPNE], and assessment of associated bladder dysfunction with the use of a special ultrasound [US] protocol, as prediction of pathophysiology of refractory primary nocturnal enuresis and associated bladder dysfunction. The study included 30 children with [RPNE] with mean age 7.33 +/- 2.23 and 30 healthy age matched control children with mean age 8.9 +/- 1.68 years. All patients more than 5 years old were treated for primary nocturnal enuresis [PNE] with behavioral therapy and desmopressin for at least 6 months with no response. The studied groups were subjected to the following complete medical history, physical examination, urine analysis and their urinary GAGs excretion was assessed over 24 h using the sodium tetraboratecarbazole method. Plain KUB, and abdominal ultrasound using special protocol was designed for the evaluation of bladder parameters using bladder volume and wall thickness index [BVWI%], and expected percentage bladder volume index for kidney volume. Patients with refractory primary nocturnal enuresis had higher mean values of urinary GAGs excretion than age-matched controls. Also they had low bladder capacity and thick bladder wall more than age-matched. The mean urinary GAGs contents were 38.9, and 27.5 mg/g creatinine in patients with RPNE and controls respectively; [P<0.001]. Comparing the BVWI in normal and enuretic children in correlation with functional bladder capacities we found that patients with low capacity thick bladder wall also have high GAGs excretion. Measuring urinary GAGs excretion and Ultrasound bladder wall thickness can be used as predictive pathophysiological clues, for underlying bladder dysfunction, which has an important role in the pathophysiology of enuresis especially in refractory cases. Also they can minimizing the need for invasive urodynamic study in children with RPNE for assessing bladder wall dysfunction

effect of miswak and toothbrush on saliva total bacterial count and cariogenic bacteria

Miswak, a chewing stick prepared from the roots, twigs or stems of Salvadora persica. The beneficial effects of miswak in respect of oral hygiene and dental health are partly due to its mechanical action and partly due to its pharmacological actions. The aim of this study was to evaluate the effects of miswak sticks, miswak extract and toothbrush/toothpaste as antimicrobial agents on total bacterial count in the saliva, and to study the effect of miswak stick, toothbrush/toothpaste and saline on salivary Streptococcus mutans [S. mutans] and lactobacilli in vivo. The study clarified that there was a marked reduction in the total bacterial count among all groups. The reduction was 100%, 100%, 97.5% and 67.5% among users of miswak stick, miswak extract, toothbrush/toothpaste and saline [control], respectively. The results of the current study also showed marked reduction of S. mutans in 66.7% of the individuals using miswak and among individuals using toothbrush/toothpaste, whereas the reduction was only 29.2% among saline users. The reduction of lactobacilli was 62.5%, 58.3% and 54.2% by using miswak stick, toothbrush/toothpaste and saline, respectively. The difference was not statistically significant. It can be concluded that miswak has an antimicrobial effect comparable to the use of fluorinated toothpaste. It was clear from the current study that the Caries Risk Test [CRT] kit is a rapid and a simple, semi-quantitative method for counting lactobacilli and S. mutans, which can be used in dental clinics without the need for trained technicians. It is recommended that further studies can be performed on larger sample size of patients, at high risk of developing dental caries

Job description for head nursing in surgical units at Mansoura University Hospital

A new perspective developed at Mansoura University Hospital is to provide quality patient care. The responsibility of ensuring quality patient care units falls directly on the shoulders of the head nurses. So, Job description is needed more than ever to have a written statement of: organizational relationships, duties, responsibilities as well as qualifications of the head nurses. Thus, this study aims to develop and validate job description of the head nurses in the surgical units at Mansoura University Hospital. The sample consists of all head nurses [10 head nurses] in the surgical units and 12 nurse supervisors at Mansoura University Hospital. There is also a jury group includes 15 different levels of nurse managers working at Mansoura University Hospital and 15 academic staff from Faculty of Nursing at Mansoura, Ain shams, and Cairo Universities. Three tools were used for data collection, namely: an observation sheet [activity analysis], a job description questionnaire, and opinionnaire sheet. The study findings indicated that the proposed job description is valid to be used in the general surgical inpatient units at Mansoura University Hospital. It is recommended to be applied and to be up dated periodically

Neonatal bacteremia: risk factors and diagnosis using bactec system

Neonatal bacteremia is a low incidence, high-risk disease with many sepsis work-ups performed to detect a single case. Seventy-two hours of antibiotic therapy have been traditionally recommended pending negative culture results. Improved culture media and new technology integrated into blood culture systems could shorten incubation time required to detect positive culture results. This would then change the length of antibiotic therapy in the management of the newborn infant with suspected sepsis. Blood samples from 150 newborn infants with suspected sepsis were tested to evaluate the time of incubation to detect positive blood culture using BACTEC 9050 [Becton Dickinson, Sparks, Md.]. The vast majority [64%] of infections were caused by Gram-positive Staph. "CONS" were the most common late-onset pathogens. The risk of infection increased in patients with increasing duration of ventilator support. So; successful interventions should improve survival, shorten mechanical ventilation and hospital stay, decrease antibiotic usage, and reduce the high cost of caring for very low birth weight [VLBW] infants

Program for improving psychosocial state of patients with end stage renal disease

Recently, number of patients with chronic renal failure in Egypt has considerably increased. As a life-threatening and potentially disabling disease, End Stage Renal Disease and its treatment cause stress as well as other psychosocial problems for patients and their families. The researchers used the following measurements: Scale for Emotional status, Scale for psycho-social adaptation; and to measure the cognitive status the researcher used Primary Mental Abilities Test and Memory Processes Scale. The above mentioned measurements were applied to a sample consists of 80 units, including 40 patients with chronic renal failure, 40 healthy persons as a control sample, this experimental study was carried out in Fayoum governorate, a verbal consent had been taken before doing the study to uncover the effect of chronic renal failure on the emotional status, social and psychological adaptation, and the cognitive status of patients. The results of the study showed that there are statistically significant differences between patients and controls concerning their response using the scales of emotional/cognitive status and the psycho-social adaptation in favor of healthy sample. The results of the study also revealed that there are statistically significant differences concerning the response using the scales of emotional/cognitive status and the psycho-social adaptation before and after the application of the program for improving psycho-social state of the patients. This study supports the effectiveness of an intervention program to decrease cognitive and mental impairment of patients receiving dialysis

Magnetic resonance imaging in differentiation between usual and unusual cerebellopontine angle lesions

To assess the role*of MRI in differentiation between usual and unusual cerebellopontine angle [CPA] lesions.The study was conducted on 40 patients with signs and symptoms pointing to CPA lesions and subjectedto MRI examination.MRI showed usual lesions such as Schwannoma in 14 patients and meningioma in eight patients. Lessfrequent lesions include glomus tumour in five patients and chordoma in five patients. Unusual lesions such asepidermoid cyst, arachnoid cyst, ependymoma, medulloblastoma, expophytic glioma, papillary adenocarcinoma ofendolymphatic sac, metastatic adenocarcinoma and atherosclerotic basilar artery in one patient for each entity.MRI could differentiate between usual and unusual lesions by proper identification of the site, extentand signal characteristic of each lesion

effects of single dose of dexmedetomidine on haemodynamics, core body temperature and shivering during spinal anaesthesia in elderly patients

Thirty elderly males [over 60 years], ASA physical status I and II patients scheduled for elective inguinal hernia repair were randomly assigned [n=15per group] to receive premedication with either saline 3 ml [Group I], or dexmedetomidine Hcl 0.5micro/kg diluted in 3 ml saline [Group II] given intramuscular, 45 minutes before induction of spinal anaesthesia. During spinal anaesthesia, heart rate [HR] significantly decreased in the dexmedetomdine group compared to the control group. Although systolic arterial blood pressure [SABP] decreased significantly in both groups. no significant difference was recorded between dexmedetomidine and control groups. Core body temperature showed significant decrease in both groups without statistical significant differences between them. During and after spinal anaesthesia shivering incidences were significantly less in the dexmedetomidine group in comparison to the control group. In conclusion, when compared to control elderly patients under spinal anaesthesia, single dose [0.5micro/kg] of intramuscular dexmedetomidine premedication provided minimal changes in patient's haemodynamics. This small dose did not attenuate nor exaggerate redistribution of core hypothermia. While core temperature decreased in both groups, there was a lower incidence of shivering in the dexmedetomidine group

Evaluation of some haemostatic markers in normal pregnancies and pregnancies complicated by preeclampsia or eclampsia

To establish the plasma evolution of P-selectin, plateletfactor4 [Pf4], prothrombin fragments 1+2 [F1+2], thrombin antithrombin complex [TAT], von Willebrand factor [vWF] and blood platelet count during normal pregnancy, preeclampsia and eclampsia and to determine which are the most relevant and accurate to perform in clinical practice for estimating the severity of preeclampsia. Twenty patients with mild preeclampsia, twenty patients with severe preeclampsia, ten eclamptic cases and ten normotensive pregnant women were included in the study. All cases and controls were with gestational age ranging between 28 and 38 weeks. All five markers increased and platelet count decreased in the severe preeclampsia and eclampsia groups. A highly significant negative correlation was found between platelet count and both P-selectin and Pf4 in the three studied hypertensive groups. Moving from mild to severe preeclampsia to eclampsia, vWF and Pf4 showed an increasingly abnormal results. Pf4 was the only haemostatic marker elevated in the mild preeclampsia group as compared with the normal pregnant group [P=0.000]. [1] Platelet activation may play an important role in the pathogenesis of preeclampsia; [2] Plasma levels of vWF and Pf4 could reflect the severity of this disease, [3] Pf4 appears to be an interesting marker for detecting early alterations in the haemostatic system in pregnancies complicated by preeclampsia. It seems that measurements of haemostatic markers in patients with preeclampsia may have prognostic value in determining the outcome of pregnancy in this pregnancy disorder. They offer possibilities of early assessment of therapeutic approaches aimed at limiting vascular endothelial damage and platelet activation