Serum Albumin Level as a Predictor of Outcome in Patients Admitted to Pediatric Intensive Care Units.

OBJECTIVE: The aim of this study was to assess serum albumin level on admission to the pediatric intensive care unit (PICU) as a prognostic indicator. METHODS: A prospective study was conducted in Fayoum University Children's Hospital. The study subjects' demographics and clinical and laboratory data were recorded. Pediatric Risk of Mortality III (PRISM-III) score was calculated. Serum albumin level was assessed within 24 hours from admission. Outcomes included mortality, PICU and hospital stay, need and duration of mechanical ventilation, and inotrope use. RESULTS: The incidence of admission hypoalbuminemia was 26%. The study subjects had a significantly higher mortality rate than subjects with normal albumin levels (42.3% vs 17.6%, respectively, P = 0.011). Each unit of increase in serum albumin decreased the risk of mortality by 28.9% (odds ratio, 0.289; confidence interval, 0.136-0.615, P = 0.001). Serum albumin showed a fair discriminatory power (area under the curve, 0.738). At a cutoff point of ≤3.7 g/dL, albumin had a 79.2% sensitivity, 67.1% specificity, 43.2% positive predictive value, and 91.1% negative predictive value. Incorporation of serum albumin with PRISM-III score was more predictive of mortality than either predictors alone (area under the curve, 0.802). No significant difference was found between the 2 groups regarding either PICU and hospital stay as well as the need and duration of ventilation. CONCLUSIONS: In PICUs, admission hypoalbuminemia is a good predictor of mortality. Further studies to confirm the value of adding serum albumin to PRISM-III score are recommended.

Impaired Pancreatic ß-Cell Function in Critically Ill Children.

Critical illness hyperglycemia (CIH) is common in the pediatric intensive care unit (PICU). Increased glucose production, insulin resistance (IR), and pancreatic ß-cell dysfunction are responsible mechanisms. We aimed to investigate ß-cell function in the PICU and to uncover its relation to clinical and laboratory variables and ICU mortality. We prospectively recruited 91 children. Pancreatic ß-cell function was assessed by using a homeostasis model assessment (HOMA)-ß. Patients with ß-cell function <40.0% had significantly higher Pediatric Risk of Mortality III (PRISM III) scores, higher rates of a positive C-reactive protein (CRP), lower IR, and a longer hospital stay. The patients with 40-80% ß-cell function had the highest IR. Intermediate IR was found when the ß-cell function was >80%. ICU survivors had better ß-cell function than ICU non-survivors. A multivariate logistic regression analysis revealed that higher PRISM III score and HOMA-ß <80.0% were significant predictors of mortality. In conclusion, ß-cell dysfunction is prevalent among PICU patients and influences patient morbidity and mortality.

Correction to "Synthesis and Antimicrobial Activity of Novel Piperidinyl Tetrahydrothieno[2,3-c]isoquinolines and Related Heterocycles".

[This corrects the article DOI: 10.1021/acsomega.9b02604.].

Synthesis and Antimicrobial Activity of Novel Piperidinyl Tetrahydrothieno[2,3-c]isoquinolines and Related Heterocycles.

A novel series of 1-amino-2-substituted-5-piperidinyl-6,7,8,9-tertahydrothieno[2,3-c]isoquinolines (4a-e) was synthesized upon treatment of 4-cyano-1-piperidinyl-5,6,7,8-tetrahydroisoquinline-3(2H)-thione (2) with α-halo carbonyl compounds such as chloroacetone, ethyl chloroacetate, 2-bromoacetophenone, chloroacetamide, and chloroacetanilide. Construction the pyrrolyl ring associated with the thienotetrahydroisoquinoline moiety was achieved by treatment of compounds 4a, b with 2,5-dimethoxytertahydrofuran in acetic acid. 1-Pyrrolyl-2-substituted-thieno[2,3-c]isoquinolines 5a and 5b which in turn were used as multipurpose precursors for synthesis of other new heterocycles. Assignments of the chemical structures of the respectively synthesized thienotetrahydroisoquinolines and their derivatives were established on the bases of elemental and spectral techniques (Fourier transform infrared, 1H NMR, 13C NMR, and mass spectroscopy). Furthermore, certain compounds were screened for their antimicrobial activity which revealed promising activities against various pathogenic strains of bacteria and fungi.

Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit.

Elevated cortisol level is an component of the stress response. However, some patients have low cortisol levels; a condition termed: critical illness-related corticosteroid insufficiency (CIRCI). Basal cortisol levels during PICU admission may be related to outcome. This prospective cohort study aimed to assess basal total serum cortisol levels and their relation to outcome in PICU. The study included 81 children over 6 months. Total serum cortisol was assessed using an early morning sample. The severity of illness was assessed using the PRISM-III score. Outcome measures included mechanical ventilation duration, use of inotropic support, length of stay, mortality. Comparison between patients' subgroups according to total serum cortisol levels revealed significantly higher PRISM-III score in patients with total serum cortisol levels. In addition, those patients had a significantly higher mortality rate when compared with patients with low and normal total serum cortisol levels. Multivariate logistic regression analysis recognized high total serum cortisol level and PRISM-III score as significant predictors of mortality. We concluded that PRISM-III score and elevated total serum cortisol levels are significant predictors of mortality in the PICU. Although CIRCI is prevalent in this population, it wasn't associated with an increased mortality rate.

Chemical design and toxicity evaluation of new pyrimidothienotetrahydroisoquinolines as potential insecticidal agents.

Neonicotinoids are the most widely used from all existing pesticides. So, in purpose to discover new pesticides being more effective against the aphid, twelve heterocyclic compounds neonicotinoid analogs have been prepared in a pure state; pyrimidothienotetrahydroisoquinolines 1-12 and their toxicity as potential insecticidal agents against cowpea Aphid, Aphis craccivora Koch was screened. Their characterizations by using spectroscopic analyses were performed. The toxicity data exhibited that the 8-chloropyrimidine compound 4 is more toxic about 2-fold than a reference insecticide, acetamiprid. The other screened compounds showed weak to strong toxicological activities against cowpea aphid.

A convenient synthesis and biological activity of novel thieno[2,3-c]pyrazole compounds as antimicrobial and anti-inflammatory agents.

A new method for synthesizing 4-amino-3-methyl-1-phenyl-1H-5-substituted thieno[2,3-c]pyrazole was reported. The substituted groups at position 5 include carbonitrile, carboxamide, N-phenyl carboxamide, and benzoyl groups. The newly synthesized compounds and their derivatives were characterized by elemental analysis and spectroscopy (IR, 1H NMR, and mass spectra). Furthermore, some of these synthesized compounds were screened against various pathogenic bacterial and fungal strains. The results demonstrate that most of the synthesized compounds possess a significant antibacterial activity against gram-positive and gram-negative bacteria. In addition, most of these compounds showed a remarkable anti-fungal activity. On the other hand, some of the synthesized compounds possess high anti-inflammatory activity, which was demonstrated using the carrageenan-induced rat paw edema assay.

The biological activity of new thieno[2,3-c]pyrazole compounds as anti-oxidants against toxicity of 4-nonylphenol in Clarias gariepinus.

Synthesis of bi functionally substituted thieno[2,3-c]pyrazole compounds was carried out by a new method. The substituted group at position five is namely (carbonitrile, carboxamide, N-(substitutedphenyl) carboxamide and benzoyl group). Chloroacetylation of the amino thieno[2,3-c]pyrazolecarboxamide compound afforded the chloroacetyl amino derivative. The chemical structure of the newly synthesized compounds was established by elemental and spectral analysis including IR, 1H NMR spectra in addition to 13C NMR and mass spectra for most of them. In the present work, we assessed the role of the new synthesized thieno[2,3-c]pyrazole compounds as antioxidants against the toxicity of the 4-nonylphenol on the red blood cells of the most economically important Nile fishes namely African catfish (Clarias gariepinus). The erythrocytes alterations were used as biological indicators to detect those effects. After exposure to 4-nonylphenol, the erythrocytes malformations (swelled cells, sickle cells, tear drop like cells, acanthocytes, and vacuolated cells) were recorded in highest number in comparison with other groups control and those injected with thieno[2,3-c]pyrazole compounds. So, the new thieno[2,3-c]pyrazole compounds can be used as antioxidants against toxicity of 4-nonylphenol on fishes.

Permanent and transient congenital hypothyroidism in Fayoum, Egypt: a descriptive retrospective study.

BACKGROUND: Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation. One important challenge in understanding the epidemiology of CH is that some newborns will have transient CH, a temporary depression of thyroid hormone concentrations that can last from several days to several months. Studies from other countries have reported that 10 to 15% of children treated for CH ultimately prove not to need treatment past 3 years of age to maintain normal hormone concentrations, and thus have transient hypothyroidism. The purpose of this study was to determine the prevalence of permanent and transient congenital hypothyroidism in Fayoum, Egypt. METHODS: Cases detected by Fayoum neonatal screening program (NSP) between January 2003 and December 2011, and followed up at health insurance center were included. Permanent or transient CH was determined using results of thyroid function tests. RESULTS: Of the 248 patients diagnosed primarily with CH by NSP; 204 (82.3%) patients were diagnosed to have permanent CH (prevalence 1/3587 live birth), and 44 (17.7%) patients were diagnosed to have transient CH (prevalence 1/16667 live birth). Initial TSH levels were higher in permanent CH cases than transient cases (p<0.004). Female to male ratio was 0.8 and 0.7 in permanent and transient CH respectively. 161 (65%) patients had thyroid dysgenesis (107 ectopic thyroid gland, 28 athyreosis and 26 thyroid hypoplasia). 87 (35%) patients had intact gland in thyroid scan and were considered to have dyshormonogenesis. Of these 87 patients 44 proved to have transient CH and 43 had permanent CH. CONCLUSION: The preliminary data from our study revealed that the incidences of CH as well as the permanent form were similar to worldwide reports. Although the high incidence of transient CH in our study could be explained by iodine deficiency further studies are needed to confirm the etiology and plan the treatment strategies.

Synthesis and antimicrobial activity of new heterocyclic compounds containing thieno[3,2-c] coumarin and pyrazolo[4,3-c] coumarin frameworks.

Reaction of 4-chlorocoumarin-3-carbonitrile with ethyl thioglycolate and ethyl glycinate hydrochloride leads to a series of title products. Hydrazinolysis of amino thienocoumarin carboxylate afforded the hydrazine derivative which underwent various reactions to build new heterocyclic rings containing thienocoumarin moiety. Chloro acetylation of aminoester compound afforded the chloro acetyl amino which underwent nucleophilic substitution reactions various amines. The following treatment with formaldehyde under Mannich conditions afforded the corresponding imidazo derivatives. Reaction of Ghloroacetylamino with potassium thiocyanate yielded ethylpyrimidothieno coumarin sulfanylacetate which was used as a versatile precursor for synthesis of other heterocycles. On the other hand, reaction of chloro coumarin carbo nitrile with hydrazine gave the aminopyrazolocoumaine which reacted with bifunctionally compounds to give the substituted pyrimido derivatives. Diazotization and coupling of aminopyrazole with ethylcyanoacetate yielded ethylaminotriazinopyrazolocoumarine carboxylate. Several of the compounds obtained demonstrated considerable antifungal and antibacterial activity in the in vitro test systems.

Masa abdominal gigante. Implicaciones anestésicas / Giant abdominal mass. Anesthetic implications

No disponible

Synthesis and antimicrobial activity of novel benzo[f]coumarin compounds.

The acetyl benzo[f]coumarin condensed with phenyl hydrazine to afford the corresponding phenyl hydrazone which cyclized into the pyrazolyl benzocoumarin under Vilsmeier reaction conditions. The pyrazolylaIdehyde was used as starting material for synthesis of other heterocyclic compounds containing pyrazolylbenzocoumarin moiety. The ethyl benzo[f]coumarin carboxylate were subjected to react with other reagents to synthesize thiazolidinyl and oxadiazolyl derivatives attached to benzocoumarin system. Some of novel synthesized compounds showed highly antibacterial and antifungal activities.

Synthesis and biological activity of pyrazolothienotetrahydroisoquinoline and [1,2,4]triazolo[3,4-a]thienotetrahydroisoquinoline derivatives.

1-hydrazino-3-thioxo-5,6,7,8-tetrahydroisoquinoline-4-carbonitrile (3) was subjected to react with bifunctional compounds namely: acetylacetone, ethyl cyanoacetate, ethyl benzoylactate, diethylmalonate and ethyl acetoacetate to produce pyrazololthienotetrahydroisoquinoline derivatives 6-11. Also, heating of compound (3) with formic acid afforded triazolothienotetrahydroisoquinoline compound 5 which reacted with α-halogenated compounds to afford compounds 13a-e. Compound 13c when heated with triethylorthoformate afforded triazolo derivative 14. Also, compound 6 was used for synthesizing compounds 18-20. Representative compounds of the synthesized triazolo and pyrazolothienotetrahydroisoquinoline products were tested and evaluated as antimicrobial agents.

Immunophenotyping of tumor-infiltrating mononuclear cells in ovarian carcinoma.

Infiltrating mononuclear cells play an important role in many types of cancer. The aim of this work was to determine the immunologic characteristics of mononuclear cellular infiltrate in ovarian cancer as compared to benign ovarian tumors. Paraffin-embedded tissues obtained from 52 ovarian carcinomas and 21 benign ovarian neoplasms were examined immunohistochemically to demonstrate suppressor/cytotoxic T cells and macrophages by using CD8 and CD68 monoclonal antibodies, respectively. The mean percentage of CD8+ cells was much higher in the malignant than in the benign group (P=0.00009). Similarly, the mean level of CD68+ cells was significantly higher in carcinomas than in benign cases (P=0.006). There was a significant negative correlation between the percentage of CD8+ cells and CD68+ cells in the malignant group (P=0.000002). Conversely, no correlation could be obtained between the values of these two cell types in the benign lesions. In the malignant group, although the percentages of CD8+ cells and CD68+ cells were not related to tumor differentiation, they were significantly related to tumor type. CD8+ cells were significantly higher in the serous (P=0.02), and CD68+ cells were higher in the mucinous carcinomas (P=0.0005). CD8+ T cells and macrophages constitute a major component of the infiltrating mononuclear cells in ovarian carcinoma. Their frequency seems to be related to the tumor type rather than the degree of tumor differentiation.

[Values of ultrasound attenuation of the calcaneus in premenopausal and postmenopausal women]. / Valores de atenuación de ultrasonidos en el calcáneo en mujeres premenopáusicas y posmenopáusicas.

OBJECTIVE: To find the value of the bone mass measured by ultrasonics in pre- and postmenopausal women. DESIGN: A descriptive study of a crossover type. SETTING: Primary Care, Tórtola Health Centre, Valladolid. PATIENTS: Women over 35 assigned to Tórtola HC selected at random with age stratification. Sample of 266 women. MEASUREMENTS AND MAIN RESULTS: Determination of the bone mass through BUA ultrasonics technique: UBA 575 Walker Sonix. BUA Value in the sample: 70.77 +/- 15.57 dB/MHz. Proportion of values below that expected from the reference values: 9.02% +/- 0.02. Statistically significant differences were found among the different age groups, with BUA values lower in older patients. The accumulated percentage of fall in the BUA value in the 35 to 86 age range was 24.26%. The BUA value in pre-menopausal women was 76.61 +/- 13.23 dB/MHz and 65.10 +/- 15.57 dB/MHz in post-menopausal women, with a statistically significant difference (p < 0.01), which remained significant even when the variables (age, no childbirth, size and ICM) were considered. The percentage of fall of the BUA value in the first ten years after the menopause was 15.04%. CONCLUSIONS: The structural bone values measured in our sample, using an easily-managed portable ultrasonic bone analyser, presented falls linked to age and to the menopause, independently of any other variables studied.