Serum Troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients

Background: Chronic Obstructive Pulmonary Disease [COPD] is a major cause of chronic morbidity and mortality worldwide. It is the fifth leading cause of death worldwide. The spectrum of cardiovascular complications associated with COPD is clearly broad, right ventricular [RV] dysfunction and pulmonary vascular disease are common in COPD and progress with time. In RV failure, cardiac Troponins [cTn] are suspected to be elevated secondary to RV ischemia or micro infarction

Objective: To evaluate the prognostic value of cardiac Troponin I level in acute exacerbated chronic obstructive pulmonary diseases [AECOPD] and its impact on the hospital outcome in those patients

Patients and methods: This study was performed on 60 patients with AECOPD, admitted at Chest Department and respiratory ICU; Zagazig University hospital. All patients were subjected to: thorough history taking, clinical examination, electrocardiography and echocardiography, arterial blood gas [ABG] analysis, measure forced vital capacity [FVC] and forced expiratory volume in first second [FEV1], serum assay of cTnI level which is considered -ve if <0.01 ng/ml and +ve if >/=0.01 ng/ml

Results: cTnI was positive in 42 AECOPD patients. cTnI positivity was more prominent among patients with very severe exacerbation of COPD and in those with past history of LTOT, MV, ICU admission. Also, cTnI positivity was more in patients admitted to ICU rather than those managed in the ward and among patients who needed MV rather than who did not need it and in patients who failed weaned rather that who succeeded weaned. P-pulmonate, Rt. ventricular strain, high pulmonary artery pressure, hypoxemia and hypercapnia showed a great effect upon cTnI positivity. The duration of hospitalization was longer among cTnI +ve patients than cTnI ?ve ones, Tropinin cutoff value for the prediction of death was >0.055 ng/ml with Sensitivity = 75%, Specificity = 68%

Conclusion: Positive cTnI in AECOPD patients may suggest exacerbation severity and the occurrence of pulmonary hypertension and right ventricular dysfunction. Positive cTnI is considered as good prognostic marker for the possibility of a need for MV and a longer duration of hospitalization. MV may further elevate cTnI in AECOPD patients and with possible weaning failure. Negative cTnI and cTnI

dry eye: evaluation of clinical features, diagnostic tests and management

Purpose The purpose of this study was to evaluate the clinical features, diagnostic tests and management of dry eye. Methods In this prospective study, 515 patients with different eye and systemic diseases thought to be associated with dry eye were divided into 12 clinical groups. After complete systemic and ophthalmologic examination, Schirmer-l test, tear break-up time [BUT], rose bengal staining 1%, determination of lactoferrin levels by ELISA, and lysozyme levels by spectrophotometer in tear samples, were carried out. Determination of serum vitamin A level, ocular ferming test and impression cytology were additionally performed for patients with liver cirrhosis. Sublabial salivary gland biopsy was done for suspected cases of Sj

Retinoblastoma in Upper Egypt [1981-1991]

We conducted a retrospective study on 78 children with retinoblastoma who were admitted, diagnosed and treated at the Ophthalmology Department of Assiut University Hospital [AUH] in the period between October 1981 and November 1991. Forty-seven children were male and 31 female, forming a male/female ratio of 3:2. The tumor was unilateral in 68 [87%] and bilateral in 10 children [13%]. Retinoblastoma was primary in 67 [86%] and recurrent in 11 cases [14%]. The mean age at diagnosis in males with unilateral and bilateral retinoblastoma was 36 months and 17 months respectively, while it was 33 months in females with unilateral tumors. Bilateral retinoblastoma was seen in only two females, aged 3 and 4 years. The first presenting symptoms were leukokoria [44.9%] and proptosis [39.7%]. Echography showed a solid mass, with moderate to high refractile echoes, an orbital shadowing, and normal axial length of the globe. Retinoblastoma was treated by primary enucleation [50.0%], exenteration [16.7%], irradiation [3.8%], and chemotherapy [2.6%]; in 25.6% of cases the parents refused treatment. The late presentation by the patients, and the deficiency in specialized centers for the management of retinoblastoma in our region of the world worsen the prognosis, both for life and for vision

Eyelid [and orbital] malignant fibrous histiocytoma

We report a case of an eyelid malignant fibrous histiocytoma in a 6 year old girl, because the eyelid is an unusual location for a fibrous histiocytoma [whereas it is common in the orbit], and the malignant variety of the tumor is the least frequent. The tumor presented as a painless, rapidly growing mass, causing complete ptosis of the right upper eyelid. Computerized tomography [CT-scan] showed a soft tissue mass in the right upper eyelid, in contact with the globe, and extending, superiorly to the globe, to the adjacent medial orbital wall, and posteriorly to the level of origin of the superior and medial recti muscles. The diagnosis of malignant fibrous histiocytoma was confirmed by histopathological examination. The tumor was treated by wide surgical excision

Lethal midline granuloma

We report a case of lethal midline granuloma in a 12-year-old girl. She presented with epistaxis, nasal obstruction, and bilateral progressive proptosis. The respiratory tract and kidneys were clinically free, as revealed by chest X-ray films and abdominal sonography. Examination of the bone marrow showed hypercellularity, with increased plasma cells and marrow eosinophils. The blood picture was within normal limits. The diagnosis was confirmed by a CT scan of the skull. A biopsy from the nasopharynx revealed lymphocytes, reticulum cells, and atypical cells considered representative of polymorphic reticulosis. The chosen treatment in our case was a combination of radiotherapy and a course of chemotherapy consisting of endoxan, adriamycin, oncovine and prednisone. The short-term result of treatment was favorable

Prevalence and clinical features of recurrent herpetic keratitis in upper Egypt

The prevalence and clinical features of herpes simplex keratitis in Upper Egypt were studied. Of 8447 patients presenting to the Eye Clinic in Assiut University Hospital, 456 [5.4%] patients had herpetic keratitis. The highest prevalence of herpetic keratitis was found in the age group of 30 - 39 years of both males and females [116 out of 456 patients]. The disease was unilateral among 427 [93.6%] and presented in the seasons of winter in 195 [42.8%] patients. Herpetic keratitis was detected during the first recurrence in 274 [60.1%] patients, and 182 [39.9%] patients had more than one recurrence [average 1 recurrence per year]. The commonst symptom was irritation, 233 [51.1%]. Herpetic lesions were ulcerative keratitis in all patients with one recurrence and keratouveitis in 47 [25.8%] out of 182 patients with more than one recurrence. Herpetic keratitis should be considered as one of the leading causes of corneal blindness in Upper Egypt. The factors affecting the course and seriousness of the disease are discussed

Ocular injuries in children

This is a study of 170 children admitted to the Ophthalmology Department of Assiut University Hospital [Egypt] for ocular trauma between January 1987 and December 1990. Results of this study showed that ocular injuries among children were a relatively common occurrence in this locality forming 2.5% of all admitted ophthalmic patients and 46.7% of all admitted ocular injuries. Boys were affected more than girls. The age group 5-12 years included the largest number of such cases. The most common objects involved were of botanic origin i. e. sticks, twigs, stems, etc

Bilateral primary localized amyloidosis of eyelids

Amyloid tumours localized to the conjunctiva and eyelids are not a common finding. This is a case of primary localized amyloidosis of both the upper eyelids of a middle-aged female patient. The diagnosis was confirmed by histo - pathological examination and Congo-red staining

orbital osteoma presenting as epiphora

A 14-year-old boy presented with a four-months history of epiphora in his left eye. Clinical examination revealed a hard palpable mass in the upper-inner quadrant of the left orbit, laterally displacing the medial palpebral ligament. Orbital radiography, computed tomographic scan, and dacryocystography confirmed the presence of an osteoma of the anterior ethmoidal cells causing impaired drainage of left lacrimal passages. Surgical excision of the osteoma restored the patency of the impaired lacrimal passages, as confirmed by postoperative dacryocystography

Prevalence and clinical features of recurrent herpetic keratitis in upper Egypt

The prevalence and clinical features of recurrent herpes simplex keratitis [RHSK] in Upper Egypt were studied. Of 8447 patients presenting with different eye diseases to Assiut University Hospital, 456 [3.4%] of patients had active recurrent herpetic lesions. The highest incidence of herpetic affection was found in the age group of 30-39 years of both males, 70[26.5%] and females, 46[24.0%] patients. The majority of cases were unilateral, 427[93.6%] patients and presented in the season of winter, 195 [42.8%] patients. RHSK was detected during the first recurrence in 274[60.1%] of patients, and 182.[*39.9%][of cases had more than one recurrence [average3 recurrences in 3 years]. The commonest symptom was pain in 233[51.1]%] - patients and the commonest herpetic lesions were ulcerative keratitis in 319[70%] patients with one recurrence and kerato-uveitis in 47[25.8%] patients with more than one recurrence. RHSK should be considered as one of the serious diseases affecting the cornea in Upper Egypt. The factors affecting the course and seriousness of the disease were discussed

Surgical management of rodent ulcer of the eyelids

A clinical study of 34 cases of rodent ulcer of the eyelids and adjacent skin was carried-our over a period of 4 years in the ophthalmic department of Assiut University Hospital. For the treatment of these cases, variable surgical techniques were performed and their results were compared with those of others

safe retrobulbar block; How?

In a retrospective study; the incidence and severity off retrobular haemorrhage [RBH] were estimated in 1378 patients subjected to various ocular operations under local anaesthesia. The retrobulbar block [RBB] was done by disposable needles of 38.9 mm and 20 gauge. RBH had occurred in 33 [2.4%] patients [4 mild, 5 moderate and 24 severe]. In a prospective study, the safety and efficacy off the trocars of two i.v. cannulae in doing the RBB were evaluated in two groups of patients, each formed off 100 patients. A mild RBH occurred in one patient off the group off "Angiocath" trocars, and no RBH had occurred in the group of "Supercath" trocars. Both trocars were proved to be cheap, safe and effective needles for doing the RBB for various ocular operations done under local anaesthesia

randomised double-controlled clinical study of trifluridine and adenine arabinoside in herpetic keratitis

This study included 213 patients with different herpetic lesions. They were randomly divided into two treatment-groups. Group 1 included 144 patients [88 men and 56 women] received 3% Ara-A [Vidarabine] ointment 5 times daily. Thereapy was continued for a period of 7-15 days. The results of therapy in different herpetic lesions by the two drugs were compared and discussed

Evaluation of conjunctival flaps in the treatment of resistant corneal ulcers

This work presents the management of 85 cases or resistant corneal ulcers. The diagnosis was made on pure clinical grounds, due to the inavailability of laboratory tools. Different types of conjunctival flaps were done for 39 cases of corneal ulcers resistant to various lines of medical treatment. The advantages and disadvantages of conjunctival flaps were discussed

Incidence and management of lid entropion

One hundred and twenty cases of different types of entropion were studied. The aim of this work is to know the different types of entropion, its incidence, its complications and management. This was compared with the work of other authors in other parts of the world