Early extubation failure in very low birth weight infants: Clinical outcomes and predictive factors.

OBJECTIVE: To identify the clinical outcomes and the potential predictive factors of early extubation failure (EEF) in very low birth weight (VLBW) infants. METHODS: A retrospective study of VLBW infants admitted to the neonatal intensive care unit (NICU) over fifteen years. Neonates were intubated and mechanically ventilated on the first day of life, and early extubated within the first 3 days. EEF was defined as the need for re-intubation within 3 days of the first extubation. A composite outcome of mortality or any major morbidity (grade 3-4 intraventricular hemorrhage or periventricular leukomalacia; stage 3-4 retinopathy of prematurity, moderate-severe bronchopulmonary dysplasia or stage 2-3 necrotizing enterocolitis) was assessed. RESULTS: In total, 394 infants were extubated early. Of those, 347 (88%) had early extubation success (EES), whereas 47 (12%) had EEF. Incidence of the composite outcome was significantly higher in the EEF group than the EES group, even after adjusting for confounding factors. Logistic regression indicated that birth weight < 1000 g (p < 0.01), administration of≥2 doses of surfactant (p < 0.01) and administration of≥2 inotropic agents (p < 0.01) were all significantly associated with EEF. The area under the curve (AUC) for the combination of these three factors (AUC = 0.77) indicated significantly higher predictive value (p < 0.01) for EEF in VLBW infants, compared with individual factors (AUC = 0.59 for≥2 inotropic agents, AUC = 0.64 for birth weight≤1000 g and AUC = 0.66 for≥2 doses of surfactant). CONCLUSION: EEF is associated with poor clinical outcomes in VLBW infants. The combination of birth weight and the requirement for surfactants and inotropic agents can predict EEF.

Urinary schistosomiasis: urographic features and significance of drooping kidney appearance.

The purpose of the study was to analyse the urographic features of schistosomiasis and to see the theurapeutic implications of "drooping kidney" appearance for the urologists. Over a period of one year, 1636 patients undergoing intravenous urography (IVU) were analysed to look for urographic features of schistosomiasis. A total of 136 patients revealed the classical urographic feature such as ureteric strictures, vesical and ureteric calcification and calculi etc. 131 of these patients were of Egyptian origin. In addition to above mentioned classical features, 8 patients (6%) with urinary schistosomiasis revealed "drooping kidney" appearance. In the remaining patients with no evidence of clinical or urographic features of urinary schistosomiasis, only one patient (0.07%) showed similar bilateral appearance. Renogram in 6 to 8 patients with "drooping kidney" revealed poorer renal function on the affected side. Ureteroscopy (URS) revealed more florid ureteritis cystica on the side with "drooping kidney" in 6 out of 8 patients compared with the normal side. URS also confirmed the presence of a kink and more difficulty with insertion of J stents. "Drooping kidney" a new urographic feature of urinary schistosomiasis may have theurapeutic implications for the urologists and should be looked for on the I.V.U. of patients with urinary schistosomiasis.

Otological manifestations of primary ciliary dyskinesia.

Primary ciliary dyskinesia is a hereditary defect in the ultrastructure of cilia, leading to poor ciliary motility. The sinonasal and the bronchial manifestations of the disease are well documented; whereas its otological aspects have received less attention. In this report, we describe the clinical profile of 16 patients with primary ciliary dyskinesia laying particular emphasis on the otological manifestations. All children (11 patients) had bilateral otitis media with effusion. Of the five adults, three had tympanosclerosis; one had bilateral cholesteatoma; and one patient had bilateral keratosis obturans in combination with tympanosclerosis. Hearing improvement and a dry ear was achieved in all the children treated by tympanostomy tube insertion. The study suggests that otitis media is a prominent feature of this disorder. Most subjects suffer from protracted bilateral otitis media with effusion throughout childhood.

Hearing results in tympanoplasty in Riyadh.

In patients with chronic otitis media, the aims of surgery are to eradicate middle ear disease, prevent recurrent infections, and improve hearing. In most published papers about tympanoplasty, the surgical approaches receive more attention as compared to hearing results. A total of 2015 ears with CSOM but without cholesteatoma, operated upon in a period of 9 years at King Abdul Aziz University Hospital, were studied and analyzed. The results showed 78% perforations closure rate, 19% reperforation rate, and 74% objective audiometry air-bone closure. The results of graft taking and closure of air-bone gap to within 10 dB were better using temporalis fascia compared to dura grafts. Post operative SNHL at 4000 KHz was more in cases using dura graft 6% compared with temporalis fascia 1.9%. Skill, experience, and development of medical facilities in distant areas in developing countries may prove helpful in improving the final results.