Relationship between FEV1 and PEF in patients with obstructive airway diseases

Spirometry is the recommended investigation for diagnosis and categorization of the severity of the air flow limitation, however Spirometer is not widely available, while Peak-flow meter is cheap, portable, and easy to operate and maintain, so the PEF is frequently proposed as alternative to FEV1 for this purpose, and widely used in general practice as a surrogate for FEV1 in assessment of airway obstruction diseases. To determine effect of FEV1 and PEF in obstructive airway diseases. This study was took place between 1[st] December 2006 and 1[st] July 2007 in Baghdad teaching hospital. A total of 100 patients with history suggestive of obstructive airway diseases [symptoms of cough, wheezes, shortness of breath, and chest tightness], and their pulmonary function test show obstructive pattern [FEV1/FVC <70%] were included. They were [60%] male and [40%] female, and their age ranged from 16 to 82 years. In screening for obstructive airway diseases, there was a significant relationship [P value 0.05] between FEV1% and PEF%, [94%] of patients with obstructive airway disease as assessed by FEV1% [FEV1%< 80%] had PEF%< 80%.In severity categorization, the PEF% and FEV1% were concordant in only [60%] of patients, with better concordance as severity of obstruction [based on FEV1%] became more. In patients with mild to moderate airway obstruction [FEV1%>40%], PEF% tended to underestimate FEV1%; while in patients with more severe obstruction [FEV1%< =40%], PEF% tended to overestimate FEV1%. For the entire study population, PEF% underestimated FEV1% by mean of only 0.35%. However, limits of agreement were wide and exceeded-/+ 14.5. In our study 70% of patients had discordance more than 5% apart between PEF% and FEV1%, [which could be considered clinically important error for estimation of severity of airway obstruction], and this discordance more marked in women, short patients, and in patients with mild airway obstruction. The PEF% can reliably exclude airway obstruction, when normal value is present. Assumption of parity between PEF% and FEV1% must be avoided especially in categorization of severity of air way obstruction

Severe invasive community-associated methicillin-resistant staphylococcal sepsis in paediatric intensive care unit patients

Objective: an increase 1n community-associated methicillin-resistant Staphylococcus aureus [CA-MRSA] infections has been reported in the literature. Most severe, life-threatening infections were previously thought to be associated with chronically ill patients. Our pediatric intensive care unit [PICU] in Zagazig University hospital and National Liver institute, Al- Minufiya University, Egypt has reported a recent dramatic increase in primary, severe invasive CA-MRSA infections in healthy children

Design: we have prospectively identified patients admitted to the 2 PICUs with a diagnosis of culture-proven severe sepsis during the period from June 2007 till March 2008. Patient records were reviewed, and MRSA isolates were obtained for susceptibility testing and DNA extraction. Isolates were tested for the presence of virulence gene Panton-Valentine leucocidin [PVL]

Results: eight previously healthy patients were admitted to our PJCUs with severe primary, invasive CA-MRSA during the study period. MRSA positive cultures represented 20% of the total positive blood cultures in this period [24/120].Thirty three percent [8/24] were proved to be CA-MRSA and 66% [16/24] were HA-MRSA. The mortality rate of the CA-MRSA was 25% compared with an overall PJCU mortality rate during the study period of 10% and 12% in both PICUs. The mean PJCU length of stay of these patients was 9 days compared with an Average PJCU length of stay of 5.5 days. Six patients had pulmonary involvement in the form of bilateral necrotizing pneumonia requiring prolonged mechanical ventilation. Despite initiation of treatment with vancomycin at admission to the PICU in the eight patients, patients took a mean of 5.6 days to convert to negative blood cultures. Six patients had bacteremia longer than 5 days

Conclusions: severe CA-MRSA infections in healthy children are increasing at an alarming rate in our institutions. This acute rise in incidence, coupled with an alarmingly high associated mortality rate, raises important questions about the initial empirical antibiotic therapy we use in caring for patients presenting with suspected life threatening CA-MRSA disease. Vancomycin monotherapy may not be adequate treatment for severe CAMRSA infections

Adenovirus and respiratory tract infection in young children

This study was conducted on 115 infants and preschool children [65 males and 50 females] complained from different respiratory symptoms. Their ages ranged from 2 months to 5 years old. They were subjected to history taking, clinical and chest examinations. Moreover samples from transnasal endotracheal tube were collected. From all investigated children, 28 cases [24.3%] proved to be infected with different bacterial causes by direct culture on different media. Streptococcus pneumonia, Staph. aureus and Strept. pygoges were the predominant pathogens. Adenovirus [Ad] was detected by enzyme-linked immunosorbent assay [ELISA] in 25.3% and by immune-electron microscope [IEM] in 23% of the cases. Different clinical data were recorded in this study, high temperature [38.5-39.5°C], expectoration and cough were the most significant positive data. Ad-infections occurred among all age groups with higher prevalence in older age [13- 24 months and >24 months]. Infection was predominant among females more than males with a significant statistical difference. Ad-infection was recorded all over seasons of the year but no statistical significant difference was recorded. Regarding the relationship between Ad and different forms of respiratory infections, acute bronchitis and pneumonia were the significant diagnosis. On recoding the validity test of ELISA in comparison to IEM, it shows 81.8% sensitivity and 96.9% specificity, while there were 93.1% agreement between the two tests and only 6.9% disagreement. On conclusion ELISA and IEM are rapid and useful methods for detection of Ad-infections

High frequency of alteration in PTEN expression in Egyptian patients with urinary bladder cancer

PTEN is a tumor suppressor gene which is involved in the pathogenesis of multiple cancers including urinary bladder cancer. Recent experimental evidence suggests that PTEN could be utilized as an effective targeted therapy. The aim of this study was to determine the frequency of PTEN alteration in Egyptian patients with urinary bladder cancer and to investigate potential role of PTEN in the pathogenesis of this tumor. We examined PTEN expression using immunohistochemistry in 19 unselected sporadic primary urinary bladder cancers from Egyptian patients. Of the 19 tumors, 6 [32%] showed no PTEN immunostaining, 9 [47%] showed weak or partial staining and the remaining 4 [21%] showed staining similar to the normal internal controls. The strength of immunostaining correlated with tumor grade with higher grade tumors showing more prominent PTEN loss. This study indicates the high frequency of PTEN alteration in urinary bladder cancer from Egyptian patients. The results of this study also suggest that PTEN is involved in the progression of these tumors. Finally these results may suggest the utility of PTEN as a potential target for therapy of urinary bladder cancers in Egyptian patients

Emergency ureteroscopic management of acute calcular anuria

To study the outcome and complications of emergency ureteroscopy in management of acute calcular anuria. 35 patients with calcular anuria were included in the study. The mean age was 45 +/- 18 years with 30 male and 5 females. The diagnosis was based upon anuria associated with high serum creatinine and hydronephrosis detected by ultrasonography. KUB was done to detect radio-opaque stones and its location and size. Emergency ureteroscopy was done to all cases. Bilateral ureteric calculi were detected in 31 patients and unilateral ureteric calculus in 4 patients in whom the other kidney was surgically removed. The stones were localized in the distal ureter in 50 units and in the proximal ureter in 16 units. 60 stones were radio-opaque and 6 stones were radiolucent. The mean stone size was 9 +/- 3mm. The mean serum creatinine was 7.3 +/- 2.5 mg/100 ml. The stone free rate in the proximal ureteric stones was 50% and for the distal ureteric stones was 90%. The overall stone free rate was 80%. No complications were discovered after ureteroscopy to any case. The urine output increased dramatically immediately after treatment in all cases. The serum creatinine dropped to the normal level in all cases [1.2 +/- 0.4 mg/100 ml] in 6.9 +/- 1.8 days after treatment. The mean hospital stay was 2.8 +/- 1.3 days. Emergency ureteroscopy is a safe and an appropriate therapeutic option in the management of acute calcular anuria. It can save patients from a second procedure

Tubeless percutaneous nephrolithotomy in the management of renal calculi

To evaluate the status of tubeless percutaneous nephrolithotomy [PCNL] after managing uncomplicated renal calculi in selected patients. From August 2006 to May 2007, 28 patients with single renal stones were selected for tubeless PCNL. At the end of the procedure, a 6 Fr ureteral catheter was left in place and a nephrostomy tube was avoided. The outcomes measured were the operative time, change in the haematocrit value, urinary leak, blood transfusion requirement, hospital stay and the success rate. The mean age was 48 +/- 11 years. There were 25 male and 3 females. The mean stone size in these patients was 35 +/- 10 mm. The operative time was 56 +/- 20 minutes. 25 [89.3%] patients were stone free and three patients [10.7%] had residual fragments less than 5 mm. Two patients had prolonged urine leakage for more than three days and managed by DJ insertion. No patient required blood transfusion or had postoperative urinoma. The mean hospital stay was 2.6 +/- 1.1 days. Tubeless percutaneous nephrolithotomy is an option in selected patients when there is no bleeding, perforation, or repeat PCNL required

Stability study of drug contains amine group [leflunomide] by chromatographic methods

In this work a stability indicating TLC densitometric method for the determination of leflunomide [LEF] in presence of its induced alkaline degradation product and a stability sudy of LEF in different media by HPLC method are presented. The proposed TLC densitometric method is based on the separation of LEF from its alkaline degradation product by TLC followed by densitometric measurement of the spots of the intact drug at 29 nm. Separation is performed at silica gel F254 [20 x 20 cm] plates using methanol: acetonitrile: distilled water [35:40:25] as a developing system. The method is found applicable for the determination of intact LEF over a concentration range 5-60 microg/spot with mean percentage accuracy 100.52 +/- 1.39. The proposed method is successfully applied for the determination of LEF in pure form, in laboratory prepared mixture and in pharmaceutical formulation. The validity of the method was assessed applying the standard addition technique. The results obtained agreed statistically with those obtained by the reported method. The second part is stability study of LEF in pure form in different media by HPLC method

Effect of hydration on geriatric patient submitted to orthopedic surgery

Background: The aim of this present study was to evaluate the effect of perioperative hydration on morbidity and mortality among geriatric patients submitted to orthopedic operations

Methods: The study was carried out on geriatric patients subjected to orthopedic surgery in Mansoura University Emergency Hospital. It included two groups: a retrospective group and a prospective one. The retrospective group patients were considered as the control group. It included 310 patients who represent geriatric patients subjected to orthopedic surgery at Mansoura University Emergency Hospital during the last three years. Patients data obtained from the file records were collected. The Prospective group included 100 patients representing geriatric surgical orthopedic patients in the last six months. At the time of admission to the orthopedic department, they were clinically examined, laboratory investigations were done and received i.v. fluids till the time of the operation. Postoperatively and for three days, they were subjected to fluid regimen in the form of 500 ml of Ringers lactate every 12 hours and 500 ml of 5% glucose every 12 hours during the first day. During the second day, 500 ml of Ringer s lactate every 12 hours and 500 ml of 5% glucose every 24 hours. In the third day, they received 500 ml of Ringers lactate every 24 hours and 500 ml of 5% glucose every 24 hours. They were followed clinically by heart rate, arterial blood pressure and amount of urine output every 6 hours and laboratory by serum creatinine and arterial blood gases after 72 hours. Morbidity and mortality among this group were record-ed and, together with the data as those of retrospective group patients. compared statistically to the retrospective group

Results: our study showed no statistically significant difference between the two groups as regards hospital stay and morbidity while mortality in prospective group showed zero incidence compared to [5.8%] incidence in retrospective group patients. Prospective group patients postoperative heart rate were, although within normal, significantly decreased when compared to the basal while their mean arterial blood pressure showed no statistically significant change a part from at the sixth and twelfth hours where significant reduction was noticed. Seventy-two hours postoperative serum creatinine in Prospective group patients was significantly reduced compared to the basal value while serum electrolytes showed no statistically significant change. Seventy-two hours postoperative ABG in Prospective group patients showed no statistically significant change in PaCO2, PH and HCO3 levels while PaO2 and SaO2 were significantly increased when compared to the basal value

Conclusion: From our study we concluded that perioperative hydration of geriatric orthopedic patients reduces mortality among those patients

Intrathecal hyperbaric ropivacaine versus hyperbaric bupivacaine in geriatric hypertensive patients

Background: The aim of this study was to compare the effects of hyperbaric ropivacaine versus hyperbaric bupivacaine in geriatric hypertensive patients subjected to orthopedic surgery

Methods: This study was carried out on 60 patients aged above 60 years undergoing orthopedic lower limb surgery. The studied patients were randomely classified into 2 groups. Bupivacaine group [BG] [n-30]: 3 ml of hyperbaric bupivacaine 0.5% [15 mg] was injected. Ropivacaine group [ RG] [n=30]: 2 ml of isobaric ropivacaine 0.75% [15 mg] added to 1 ml glucose 5% [to give 3 ml solution containing 5 mg ropivacaine + 17 my glucose/ml]. The patients in both groups were observed for: Sensory block duration, level and recovery], degree of motor block [according to Bromage score], the hemodynamic parameters [including MAP, HR, CVP and SpO2], analgesia [assessed by VAS] and side effects

Results: we found that there was a significant decrease in MAP in BG at 5, 15 and 30 minutes compared with the basal value but in RG there was insignificant differences in MAP compared with the basal value. There was insignificant difference as regards time of onset of sensory block or peak sensory level reached in both BG and RG. There was no difference in potency of motor block or adequacy of sensory block between both groups. There was a significant difference in the duration of sensory and motor block as there was faster recovery from motor and sensory block in RG. Also, there was a significant difference in duration of analgesia between RG and BG. The duration of analgesia in BG was longer than in RG

Conclusion: Intrathecal administration of either 15 mg hyperbaric ropivacaine or 15 mg hyperbaric bupivacaine was well tolerated and provided similar effective anaesthesia for lower limb orthopedic surgery. Ropivacaine showed more hemodynamic stability than bupivacaine especially during the first 30 minutes after intrathecal injection. Both ropivacaine and bupivacaine produced the same potency of motor and sensory block with more rapid recovery with ropivacaine. So for these results ropivacaine may prove useful when surgical anaesthesia is desired especially in geriatric hypertensive patients whom are more liable for hemodynamic instability

Acute renal obstruction: evaluation with intrarenal duplex doppler ultrasound

To assess the value of duplex Doppler ultrasound [DU] in diagnosis of acute renal obstruction, 50 patients with symptoms suggestive of renal colic were studied. Intravenous urography was done as a standard technique for diagnosis of renal colic. DU was done during the attack, with determination of the intrarenal resistive index [RI], and the difference between the resistive index of the affected kidney and the asymptomatic kidney [dRI] was calculated. 12 to 24 hours after treatment with non steroidal anti-inflammatory drugs [NSAIDs], DU was repeated determining the RI and the dRI. An RI >/- 0.70 and or dRI >/- 0.06 considered reliable cut-off values to diagnose acute renal obstruction. The results of DU were compared with the IVU findings. 13 patients were shown to be normal by IVU and 37 proved by IVU to have a unilateral renal obstruction with a normal opposite kidney. The mean RI in the affected kidneys during the attack of renal colic [0.72 +/- 0.06] was significantly higher than that in normal kidneys [0.60 +/- 0.05] [P < 0.001]. The mean dRI in patients with unilateral renal obstruction [0.08 +/- 0.03] was significantly higher than that in patients without obstruction [0.02 +/- 0.02] [P < 0.001]. 12 to 24 hours after treatment with NSAIDs, the mean RI of normal kidneys remains constant, while, the mean RI of the obstructed kidneys decreased to 0.65 +/- 0.04 and it remained significantly higher than that of normal kidneys [P < 0.001]. The mean dRI in patients with acute renal obstruction decreased to 0.06 ' 0.03 and again it was significantly higher than the mean dRI in normal patients. The sensitivity of the RI was 76% and the specificity was 79% with +ve predictive value of 68% and -ve predictive value of 85% during the attack of renal colic.The sensitivity of dRI was 81% and the specificity was 92% with +ve predictive value of 97% and -ve predictive value of 63%. 12 to 24 after the relive of pain, the sensitivity of the RI and of dRI decreased to 49% and 70% respectively while the specificity remained stable at 79% and 92% respectively. The +ve predictive value of RI was 58% and the -ve predictive value was 72%. The +ve predictive value of dRI was 96% and the -ve predictive value was 52%