Ultrasound-guided post-pyloric feeding tube insertion in peri-operative cardiac infants.

Delivery of enteral nutrition in critical infants post-paediatric cardiac surgery is sometimes hampered, necessitating direct feeding into the small intestine. This study is highlighting the role of ultrasound-guided post-pyloric feeding tube insertion performed by the paediatric cardiac ICU intensivist in critically ill infants. METHODS: We carried out a prospective pilot observational experimental study in peri-operative cardiac infants with feeding intolerance between 2019 and 2021. Feeding tube insertion depends on a combination of ultrasound and gastric insufflation with air-saline mixture. Insertion was confirmed by bedside abdominal X-ray. RESULTS: Out of 500 peri-operative cardiac infants, 15 needed post-pyloric feeding tube insertion in median 15 postoperative day. All were under 6 months of age with average weight of 3 ± 0.2 kg. Median Risk Adjustment for Congenital Heart Surgery Categories was 4. Median insertion time was 15 minutes. No complications have been reported. First pass success rate was 87%, while a second successful insertion attempt was needed in 2 cases (13%). Target daily calorie intake was achieved within average of 3.5 ± 0.4 days. Mean post-pyloric feeding tube stay was 20 ± 3 days. Out of 15 infants, 3 patients died, 1 patient needed gastrostomy tube, and 11 patients were discharged home on oral feeds. CONCLUSIONS: Ultrasound-guided post-pyloric feeding tube insertion using gastric insufflation with air-saline mixture in peri-operative cardiac infants with feeding intolerance is a useful and practical bedside tool, and it can be performed by a trained paediatric cardiac ICU intensivist. It may have potential positive effects on morbidity and outcome.

Carvacrol hinders the progression of hepatic fibrosis via targeting autotaxin and thioredoxin in thioacetamide-induced liver fibrosis in rat.

Fibrosis is a common outcome of nearly all chronic diseases of liver that results in changes of its functions which requires medical attention. The current research aims to investigate the potential anti-fibrotic efficacy of Carvacrol against thioacetamide (TAA)-induced liver fibrosis in male rats using Ursodeoxycholic acid (UDCA) as a reference anti-fibrotic product. Carvacrol (25 and 50 mg/kg) markedly declined TAA-increased serum liver enzymes; alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) as well as total bilirubin (TB) and direct bilirubin (DB) levels as well as increased levels of total protein (TP) and albumin. Carvacrol significantly reduced glutathione depletion (GSH), Nitric oxide (NOX) and malondialdehyde (MDA) accumulation in liver tissue. Additionally, its anti-oxidant effect brightened up via affecting markers of stress found in the cell as nuclear factor erythroid 2-related factor 2 (Nrf-2) where it still had high content and decreased Thioredoxin (Trx) level. The anti-inflammatory effect of Carvacrol was confirmed by decreasing nuclear factor kappa B (NF-κB), interleukin-1beta (IL-1ß) and inducible nitric oxide synthase (iNOS) contents. Carvacrol showed anti-fibrotic effect clarified by turning down fibrosis-related markers; TGF-ß1, matrix metalloproteinase-3 and 9 (MMP-3 and 9) and Autotaxin (ATX) contents. Furthermore, it decreased alpha smooth muscle actin (α-SMA) and caspase-3 immune-expression. The overall outcome of aforementioned markers results showed that Carvacrol suppresses the progression of liver fibrosis via its anti-oxidant, anti-inflammatory, anti-apoptotic effect and its ability in lowering Thioredoxin and Autotaxin; hence it can be categorized as a hepatoprotective natural substance.

Molecular characterization of Cryptosporidium isolates from humans by nested polymerase chain reaction - restriction fragment length polymorphism (nPCR-RFLP) analysis in Egypt.

ryptosporidium species is a group of protozoan parasites recognized as a cause of diarrhea with significant morbidity and mortality in industrialized and developing countries. Cryptosporidium hominis and Cryptosporidium parvum seem to be the most common causes of human cryptosporiodosis, however, other species are also found. Hence, the present study aimed to determine Cryptosporidium spp. infecting humans by nested PCR-RFLP targeting 18 sRNA gene in Minia Governorate, Egypt. A total of 300 diarrheic stool samples have been collected from inpatient and outpatient clinics of University Hospitals and Tropical Hospital, Minia Governorate, Egypt. One hundred twelve positive samples for Cryptosporidium infection (37.3%) were detected by nPCR while, 60 positive samples (20%) were detected by routine microscopy (p-value <= 0.0004). The one hundred twelve positive samples detected by nested PCR were processed to RFLP. The RFLP yielded a typical restriction patterns for C. hominis in 73 (65.2%) cases, C. parvum in 25 (22.3%) cases, and C. meleagridis in 14 (12.5%) cases. C. hominis was more prevalent among cases of urban areas with negative history of animal contact in comparison to cases of rural areas (95.5% vs. 21.7%; p-value <= 0.001). Moreover, there was a statistically significant association between C. hominis infection and drinking tap water. C. parvum was more prevalent among cases of rural areas than among those of urban areas (47.8% vs. 4.5%; p-value <= 0.001) While C. meleagridis was only present among cases live in rural areas (30.4%; p-value <= 0.001).

Molecular characterization of Cryptosporidium isolates from humans by nested polymerase chain reaction – restriction fragment length polymorphism (nPCR-RFLP) analysis in Egypt

@#Cryptosporidium species is a group of protozoan parasites recognized as a cause of diarrhea with significant morbidity and mortality in industrialized and developing countries. Cryptosporidium hominis and Cryptosporidium parvum seem to be the most common causes of human cryptosporiodosis, however, other species are also found. Hence, the present study aimed to determine Cryptosporidium spp. infecting humans by nested PCR-RFLP targeting 18 sRNA gene in Minia Governorate, Egypt. A total of 300 diarrheic stool samples have been collected from inpatient and outpatient clinics of University Hospitals and Tropical Hospital, Minia Governorate, Egypt. One hundred twelve positive samples for Cryptosporidium infection (37.3%) were detected by nPCR while, 60 positive samples (20%) were detected by routine microscopy (p-value < 0.0004). The one hundred twelve positive samples detected by nested PCR were processed to RFLP. The RFLP yielded a typical restriction patterns for C. hominis in 73 (65.2%) cases, C. parvum in 25 (22.3%) cases, and C. meleagridis in 14 (12.5%) cases. C. hominis was more prevalent among cases of urban areas with negative history of animal contact in comparison to cases of rural areas (95.5% vs. 21.7%; p-value < 0.001). Moreover, there was a statistically significant association between C. hominis infection and drinking tap water. C. parvum was more prevalent among cases of rural areas than among those of urban areas (47.8% vs. 4.5%; p-value < 0.001) While C. meleagridis was only present among cases live in rural areas (30.4%; p-value < 0.001).