Factors Predicting Early Major Adverse Events in the Intensive Care Unit After Successful Cardiac Surgery for Congenital Heart Disease in Full-Term Neonates

ABSTRACT Objective: In this study, we aimed to evaluate the factors affecting major adverse event (MAE) development after full-term neonatal cardiac surgery. Methods: This study was conducted retrospectively on newborns who underwent congenital heart surgery between June 1, 2020, and June 1, 2022. MAE was defined as the presence of at least one of the following: cardiac arrest, unplanned reoperation, emergency chest opening, admission to the advanced life support system, and death. The role of blood lactate level, vasoactive inotropic score (VIS), and cerebral near-infrared spectroscopy (NIRS) changes in predicting MAE was investigated. Results: A total of 240 patients (50% male) were operated during the study period. The median age of patients was seven days (interquartile range 3-10 days). MAE was detected in 19.5% of the cases. Peak blood lactate levels >7 mmol/liter (area under the curve [AUC] 0.72, 95% confidence interval [CI] [0.62-0.82], P<0.001, sensitivity 76%, specificity 82%, positive predictive value [PPV] 88%) was an independent risk factor for MAE (odds ratio [OR] 2.7 [95% CI 1.3-6]). More than 30% change in NIRS value during the operative period (AUC 0.84, 95% CI [0.80-0.88], P<0.001, sensitivity 65%, specificity 85%, PPV 90%) was a strong predictor of MAE. VIS > 10 was an independent risk factor (AUC 0.75, 95% CI [0.70-0.84], P<0.001, sensitivity 86%, specificity 80%, PPV 84%) and strongly predicted MAE (OR 1.4 [95% CI 0.9-5]). Conclusion: Cerebral NIRS changes > 30%, high blood lactate levels, and VIS score within the 48 hours may help to predict the development of MAE in the postoperative period.

Assessment Of Volatile Organic Compound (Vocs) In Multi-Storey Shopping Mall In Malacca Malaysia

@#This study investigates the mall's Indoor Air Quality (IAQ) to compare changes in levels of Volatile Organic Compounds (VOCs) concentration in the morning and evening. It also explores the sources of emission released that could be related to occupants' health status (dizziness, headaches, flu, running nose, nose stuffy, nose irritation, eye irritation, watery eye, and eye reddening). A questionnaire survey approach was used to collect quantitative data involving 32 workers from malls in Malacca, Malaysia. This study established models to measure changes in VOCs level in two different sessions for a given area. Also, predictors related to the work context (human performance and condition) were found to be significantly related to occupants' symptoms. Two significant values identified the changes in VOCs concentration for morning and evening sessions in the lobby, bakery, eye ware shop, mobile centers, and supermarket. No evidence supports the exposure towards the personal individual in the present findings. This study contributes to the literature on levels of VOCs in the shopping mall as well as the emission sources. It also suggests that more comprehensive monitoring can be achieved, particularly in the context of Malaysia.

Bacteriological study of diabetic foot infection in Egypt

Foot infections are one of the major complications of diabetes mellitus and are a significant risk factor for lower extremity amputation. Providing effective antimicrobial therapy is an important component in treating these infections. This study assesses the microbial isolates of patients with diabetic foot infections and their antibiotic susceptibility pattern. A prospective study of 75 patients with diabetic foot infections admitted to Al-Azhar university hospitals was undertaken. Bacteriological specimens were obtained and processed using standard hospital procedure for microbiological culture and sensitivity testing. Overall, 40 [54%] patients had subcutaneous infections, 22 [29%] had infected superficial ulcers, seven [9%] had infected deep ulcers involving muscle tissue, and six [8%] patients had osteomyelitis. A total of 99 pathogens were isolated. Forty percent of patients had polymicrobial infection, 39 [52%] had single organism infections, and six [8%] had no growth. Gram-negative bacteria [67%] were more commonly isolated compared with Gram-positive bacteria [30%]. The three most frequently found Grampositive organisms were Staphylococcus aureus [10.2%], Streptococcus pyogenes [7.1%] and methicillin-resistant S. aureus [7.1%], and the most common Gram-negative organisms were Pseudomonas aeruginosa [19.4%], Klebsiella pneumoniae [15.3%], and Acinetobacter spp. [10.2%]. Vancomycin was found to be the most effective against Gram-positive bacteria, whereas imipenem and amikacin were most effective against Gram-negative bacteria on antibiotic testing. Forty percent of diabetic foot infections were polymicrobial. S. aureus and P. aeruginosa were the most common Gram-positive and Gram-negative organisms, respectively. This study helps us to choose empirical antibiotics for patients with diabetic foot infections

Histological and immunohistochemical study on the protective effect of Ginkgo biloba extract against glutamate-induced neurotoxicity in male albino rat retinal cells

Monosodium glutamate [MSG] has a flavor-enhancing effect; hence, it is added to processed food. It is known for its neurotoxicity. This study was conducted to demonstrate the possible protective effect of the natural antioxidant, Ginkgo biloba extract, against the neurotoxicity of MSG on the retinal cells of male albino rats. Thirty adult male albino rats were used. The animals were divided into the following groups: group I was the control group and group II was subdivided into subgroup IIa, which received MSG injections for 7 days, and subgroup IIb, which received Ginkgo biloba [EGb 761] orally for 7 days and then received MSG injections, in addition to EGb. Retinal sections were stained with H and E stain, toluidine blue stain, and immunohistochemical staining for glial fibrillary acidic protein [GFAP]. Total retinal thickness, thickness of the outer nuclear layer, and the mean area% of GFAP were measured using an image analyzer. MSG caused complete loss of the outer and inner segments of the photoreceptors, a decrease in the thickness of the outer nuclear and plexiform layers, focal cytoplasmic vacuolation in the inner nuclear layer, and complete distortion of the ganglion cell layer. Such abnormalities were, to a large extent, prevented with the use of EGb 761. Statistically significant differences in the total retinal thickness, the thickness of the outer nuclear layer, and mean area% of GAP were found between the groups. MSG exposure was shown to induce deleterious morphological changes on the retina, many of which were prevented with the use of EGb 761. Thus, this natural extract could have further clinical implications in reducing glutamate-induced excitotoxicity in several ophthalmic diseases

Phase II study of thoracic radiation therapy with concurrent cisplatin and etoposide in unresectable non-small cell lung cancer

The primary objectives were to determine the overall response rate [ORR], progression-free survival [PFS], and overall survival [OS]. Secondary objectives were evaluation of possible prognostic factors, and toxicity profile. Induction chemotherapy consisted of Cisplatin 30mg/m2 and etoposide 130 mg/m2 on days 1 through 3 every 28 days for 3 cycles, then concurrent hyper fractionated-split course radiation with 1.5 GY per fraction bid up to 60 GY together with 2 cycles of Cisplatin and etoposide in the 1st week and last week, followed by 1-2 cycles of Cisplatin and etoposide given to patients with locally advanced stage III non small cell lung cancer. Thirty five patients were enrolled, five were excluded, ORR was 76.7%, the mean time to tumor progression was 14.57 months, the estimated one year PFS was 73.9% with CI=95%, the two year OS was 21.7% with CI=95%, grade 3 hematological toxicity developed in 6.7% of patients [n=2], no more than grade 2 non hematological toxicity was developed. Our protocol was feasible and tolerable, but it did not add any advantage over the standard concurrent chemo radiation

Cryptosporidium and giardia in water in Alexandria: detection and evaluation of viability by flow cytometry and different stains

Cryptosporidium oocysts and Giardia cysts have become ubiquitous in surface waters worldwide. The number and extent of outbreaks of waterborne diseases indicate a significant risk for their possible transmission by drinking-water. Since many Egyptian cities depend on surface water as their main source of drinking water, knowledge of the prevalence of waterborne protozoa in water resources is important. The present study was designed to use flow cytometry to detect Cryptosporidium oocysts and Giardia cysts in water samples in Alexandria city in comparison with the standard staining techniques. Testing the viability of the encountered parasites was also carried out comparing flow cytometry and trypan blue vital stain. Thirty water samples were collected from water tanks from different districts of Alexandria city. Samples were subjected to staining techniques and flow cytometry. Stains used were modified Zeihl-Neelsen [MZN], safranin methylene blue [SMeB], modified trichrome, fluorescent stains [phenol auramine and acridine orange]. Viability was evaluated comparing trypan blue stain and flow cytometry using 4'-6-Diamidino-2-phenylindole immunostain [DAPI]. Flow cytometry proved to be much more sensitive than staining techniques with a sensitivity of 100% for both Cryptosporidium oocysts [30 samples] and Giardia cysts [11 samples]. Following flow cytometry, the fluorescent phenol auramine stain had the greatest sensitivity of 94.74% and 80% [18 and 4 samples, respectively]. The percent of live parasites present in each sample was always significantly higher by DAPI than trypan blue stain. The results of the present study clearly demonstrate that incorporation of flow cytometry can improve sensitivity of detection of Giardia cysts and Cryptosporidium oocysts in water samples. Although it is more expensive than the other staining methods, it is rapid, simple and accurate in estimating the quantity and viability of the parasites in each sample. Thus, flow cytometry can be recommended for detection of protozoa in water

Physicians' therapeutic practice and compliance of diabetic patients attending rural primary health care units in Alexandria

The objectives of the study were to investigate physician's therapeutic practice and the compliance of diabetic patients attending rural primary health units in Alexandria. A cross-sectional study was conducted and a multistage stratified random sample method was used for the selection of 600 diabetic patients. Data were collected by means of an interviewing questionnaire, an observation checklist, review of prescriptions and laboratory investigations. A scoring system was made for a diabetic patient's knowledge and skills, patient's compliance, doctor-patient relationship, and glycemic control. About 57% always took their medication as prescribed by doctor and on time, only 2.2% always complied with dietary regimen while no one reported regular compliance with exercise regimen. Complications of the regimen was the commonest cause [63.3%] of noncompliance. A highly statistically significant difference was found between compliance with all regimens and patient's knowledge of diabetes. The scores for doctor-patient relationship were all unsatisfactory. Results of glycosylated hemoglobin [HbAlc] revealed that metabolic control of four-fifth of the patients was satisfactory, 12% had fair and 8% had poor metabolic control. Patient's compliance with most of the diabetes regimen was low. Doctor-patient relationship and patient's compliance should be improved by conducting educational and training programs

epidemiological study on survival of oropharyngeal cancer cases in Alexandria, Egypt

A retrospective cohort study was conducted to determine the 5-year survival and prognostic factors for survival for 407 oropharyngeal cancer cases registered in the 3 main hospitals in Alexandria, Egypt, from 1996-2000. Survival analysis was conducted using Kaplan-Meier curves, and multivariate Cox regression analysis. The overall 5-year survival rate was 30.8%. Multivariate analysis showed that significant prognostic factors for survival were tumour stage [hazard ratio = 2.39; 95% CI: 1.41-11.72], tumour site and patient's age. Secondary prevention of oral cancers can be conducted through examination of the oral cavity to find precancerous and early cancerous lesions and hence improve survival

Surveillance of childhood vaccinepreventable diseases at health facilities in Jeddah, Saudi Arabia

A cross-sectional study was conducted at 33 randomly selected health facilities in Jeddah, Saudi Arabia, to assess health facilities' performance and health workers' knowledge of surveillance activities for childhood vaccine-preventable diseases. The WHO surveillance assessment questionnaire and a specially designed knowledge questionnaire were used. There were deficiencies in some surveillance items. The percentages of health facilities that had the surveillance manual and correctly filled clinical registers were 57.6% and 60.6% respectively. In the 6 months preceding the study, 36.4% of facilities lacked the appropriate surveillance forms while only 18.2% had received supervision reviews. Only one-quarter of health workers had a satisfactory knowledge score

Child maltreatment: behaviors of mothers in Jeddah, Saudi Arabia

Cross-cultural research has shown that children throughout the world experience various forms of violence. Important to tackling child maltreatment problem is an understanding of the mechanisms contributing to abusive parenting. The present study aims to investigate child disciplinary and maltreatment practices, and to determine the predictors of mothers' severe physical maltreatment practices against their children aged < 18 years. Twenty-five female primary schools in Jeddah were selected during the educational year 2007/2008, with invitation of students' mothers to participate in the study. A total of 537 mothers fulfilled confidentially, anonymous, self administered questionnaire. The Standardized Arabic Version of Child Abuse Screening Tool for Parents was used to inquire about the disciplinary and maltreatment practices, during the 12 months preceded the study. Results revealed that discussing / explaining [96.8%] was the commonest non-abusive mothers' disciplinary behavior. On the other hand, high proportions of mothers practiced child maltreatment; 96.3%, 89% and 56.8% employed at least one kind of emotional, moderate and severe physical maltreatment, respectively. While, 10.1% of mothers reported that their children were exposed to negligence. Shouting / yelling [91.4%], pinching [60.7%] and hitting the child, not on buttock, with objects [42.3%] were the most prevalent mothers' emotional, moderate and severe physical maltreatment, respectively. Results of regression analysis indicated that children aggressive behavior [aOR = 2.32; 95% Cl: 1.55-3.46], mothers' age < 30 years, and non-university graduated mothers were the independent predictors of mothers' severe physical maltreatment practice. In conclusion, mothers practiced high percentages of child maltreatment Establishing parenting classes, institution of family education intervention for teens, and construction of television and web-based educational programs on sound parenting skills are recommended

Traumatic hyphema: a study of 40 cases

Hyphema is a relatively common problem in our society with complications and risk sequels. No study has been conducted on this problem in Kurdistan region. To detect common causes of ocular trauma in Dohuk governorate and to detect the most vulnerable age group involved with the visual acuity outcome after treatment. The study was conducted in Azadi General Teaching Hospital and the Emergency Hospital / Dohuk / Kurdistan region, from June 2006 to June 2007. A follow-up clinical study of patients presenting with traumatized eyes with hyphema was conducted. The study included 40 patients of traumatic hyphema out of 137 cases of ocular trauma. Ocular examinations [visual acuity, intra ocular pressure, fundoscopy and others] were done for all patients at presentation and subsequently during the follow-up. The annual prevalence rate of traumatic hyphema in Dohuk govemorate was about 5 per 100.000 individuals. The study showed a male predominance. A total of 35% of cases were encountered among children aged [6 - 10] years. Blunt trauma was observed in [60%] of patients while the other [40%] had penetrating traumas. A total of [90%] of females suffered from penetrating trauma while males were injured by blunt trauma more frequently. The left eye was relatively more frequently involved [55%] than the right. A total of 37 eyes regained acceptable final visual acuity, while two eyes progressed to no light perception, and one eye had just light perception. Tranexamic acid was found to reduce re-bleeding in our cases. Increased intraocular pressure is one of the most frequent complications of traumatic hyphema that may ultimately result in impaired vision. Complete eye examination is essential to assess concomitant injuries which reflect the severity of initial trauma

Epidemiological pattern of diseases and risk behaviors of pilgrims attending Mina hospitals, Hajj 1427 H [2007 G]

Hajj is a unique Islamic ritual where around 2.5 million Muslims gather annually in the Kingdom of Saudi Arabia. The objective of this work was to determine epidemiological pattern of diseases and risk behaviors of pilgrim patients during Hajj 1427 H. A cross sectional study was conducted at two randomly chosen Mina hospitals and a total of 248 patients were selected using systematic random sample method. Results show that about two-fifths [39.1%] of patients had chronic diseases and only 34.4% received health education before Hajj. The commonest patients' complaints were cough, dyspnea and fever [28.2%, 27.4% and 25% respectively]. Acute respiratory infections and gastrointestinal illnesses were the commonest diagnosed diseases. Analgesics and antibiotics were the most commonly prescribed drugs. Regarding risky behaviors, 24.6% of pilgrims were unvaccinated against meningococcal meningitis, 87.9% didn't wear protective masks and 43.1% had their hair shaved or cut by re-used razors or scissors. Pilgrims who followed organized camps and who received health education before hajj conducted significantly lower risky behaviors compared to others. Intensified health education campaigns should be conducted for all pilgrims in their mother countries and KSA. Surveillance of behavioral risk factors, formulating intervention strategies and proposing new policies and regulations are urgently needed

Prevalence, risk factors and outcome of childhood abuse reported by female university students in Jeddah

Child abuse constitutes all forms of physical and /or emotional ill treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power. The objective of the study was to determine the prevalence, types, main predictors and outcome of child abuse, retrospectively reported by female university students in Jeddah. A cross sectional study was conducted and the Standardized Arabic Version of Child Abuse Screening Tool for Young Adult [18-24 years old] was used. Ethical standards of confidentiality and freedom to participate were followed. Multistage stratified random sample was used with selection of 1, 897 females. About two-thirds [68.3%] of students reported exposure to some form of child abuse. Physical and emotional forms were recalled by 45.1% and 50.6% of students, respectively, while, 2.9% reported exposure to forced contact sexual assault. Parents and siblings were the commonest perpetrators of both physical and emotional abuse, while other relatives and extra-familial persons were the main offenders of sexual violence. The predictors of exposure to three forms of abuse together were: existence of parent who hit the other [aOR= 2.54; 95% CI: 1.88-3.42], non-university graduated mother [aOR =1.83; p

Long term formalin preserved stool specimens for detection of intestinal parasites from school aged children in Tripoli, Libya

A total of 949 single stool samples were collected from school aged children [5-14 years old] in the city of Tripoli. The samples were preserved in 10% formalin and examined by routine microscopy using normal saline and Lugols iodine preparations as well as the formol ethyl concentration method after a storage period of twelve months at room temperature. Of 949 samples examined 4.5% were positive. Giardia lamblia and Entamoeba coli were the only protozoan parasites identified with an infection rate of 3.2% and 1.3% respectively. No helminthes were detected in any of the samples. About 14% of the children had intestinal yeast infection Candida albicans in their stool of which 0.63% was infected with intestinal parasites. No distortion or alteration of morphology was observed particularly in G. lamblia. Preservation in 10% formalin is a very productive means for the accurate identification of protozoan parasites

Congenital trichinellosis in experimentally infected mice

The present study aimed at allocating the time during pregnancy at which transpiacental transmission of Trichinella spiralis [T. spiralis] larvae took place. Swiss albino mice were infected at different durations of pregnancy; five days before mating, on gestation day zero and five days after mating. Furthermore, to study the effect of immunosuppression on transplacental transmission, half of the experimental mice were immunosuppressed using cyclophosphamide drug [Endoxan]. The percentage of infected uteri, embryos and placentas and the mean larval count were calculated on day 8 post infection [PT]. Moreover, the percentage of infected offspring and the mean larval count in their muscles were estimated on day 30 P1. The results of the present study revealed that, transpiacental transmission of T. spiralis could occur in offspring of mice when their mothers are infected before or after pregnancy. This was documented by the presence of larvae in the muscles of offspring. However, the rate of this transmission increased when the mothers are infected at late pregnancy whether they were immunosuppressed or not. The administration of the immunosuppressive drug whether before or after pregnancy increased the rate of infection and the mean larval count in both uteri of mothers and muscles of their offspring. A higher percentage of abortion was demonstrated in females infected before mating in different studied groups

comparative efficacy study of praziquantel and albendazole treatment in experimental schistosomiasis

The currently used drug for chemotherapeutic control of schistosomiasis is praziquantel [PZQ]. Albendazole is a broad spectrum antiparasitic drug that showed trematocidal activity. The present study aimed at testing the effect of albendazole on experimental schistosomiasis mansoni infection using PZQ as therapeutic control. Swiss strain albino mice were infected with Schistosoma mansoni [S. mansoni] cercariae. Drugs were given orally on the 45[th] day post infection [PI] for 2 successive days. Mice were sacrificed on the 47[th] day PI and subjected to parasitological and scanning electron microscopic [SEM] studies. Albendazole caused a significant reduction in worm load and those recovered were shorter as measured by the camera lucida. By SEM, perfused S. mansoni albendazole treated worms showed surface tegumental changes. Albendazole is a promising drug for treatment of schistosomiasis

Effect of topical agents on cercariae of schistosoma mansoni

The present work was planed to evaluate the effect of free N, N- diethyl-m- toluamide [DEET], controlled release DEET and white precipitate ointment on the viability of cercariae of S. mansoni in vitro. They were also topically applied to mice to study their efficiency in preventing cercarial skin penetration. Free DEET and controlled release DEET formula caused immobilization and death of cercariae within 20 and 5 min, respectively. The number of adults detected after the application of free DEET and white precipitate ointment to mice skin prior to infection were significantly lower than the control group. When controlled release DEET was applied, no adults could be detected, indicating the failure of cercariae to enter through the skin. This was confirmed by histopathological study of the liver which was free of granuloma. Scanning electron microscopy revealed tegumental changes in cercariae exposed to both free DEET and controlled released DEET. So, topical application of any of the three chemicals was found to be effective in controlling S. mansoni infection. The best was with controlled release DEET

Experimental conversion of virulent RH Toxoplasma gondii tachyzoites in vitro

We aimed to induce conversion of RH-stain tachyzoites to bradyzoites by changing the pH of the culture medium. Alkalization of the medium to pH 8 induced morphological changes in the cultured tachyzoites. The majority of the organism increased in size and changed from a regular crescent shape to a rounded or ovoid shape. Cyst-like structures were formed. Using a computerized image analyser, significant differences in the size of the whole organisms and in their nuclei were observed compared to the control group. The converted organisms also showed significant differences from the control group by quantitative DNA analysis, and did not infect mice

Detection of Cryptosporidium parvum antigen by co-agglutination test and ELISA

Confirmation of the presence of Cryptosporidium in environmental samples is laborious, costly and often difficult. We report here a simple and economic slide agglutination test [co-agglutination test] for detecting cryptosporidial antigen in stool, serum and water. The results show that as a screening method co-agglutination is clearly superior to enzyme-linked immunosorbent assay [ELISA] and modified Ziehl-Neelsen staining, although ELISA is more accurate. The co-agglutination test is recommended for application as a new tool for detecting cryptosporidial antigen in large-scale epidemiological surveys

Coccidial infection in immunosuppressed mice: prophylaxis and treatment with dehydroepiandrosterone

Cryptosporidiosis and toxoplasmosis are diseases caused by opportunistic coccidial parasites that can lead to life-threatening infection in immunocompromised patients. We evaluated dehydroepiandrosterone as prophylaxis and therapy in immunosuppressed mice infected with Cryptosporidium parvum and avirulent Toxoplasma gondii. Mice were infected with either Cryptosporidium oocysts or Toxoplasma cysts. Assessment was by mortality rates, parasitic counts and electron microscopic studies. Mortality rates were significantly reduced in all treated groups. A significant reduction in the cryptosporidial oocyst count in stool and intestinal villi and in Toxoplasma cysts in the brains of infected mice was observed in all the groups. The effect of the drug was greater when given prior to infection