Ventilation practices in the neonatal intensive care units in Saudi Arabia, survey of the utilization of volume-targeted ventilation among practicing neonatologists.

OBJECTIVE: To assess the current practice in using volume-targeted ventilation among neonatologists working at the Neonatal Intensive Care Units (NICU) of Saudi Arabia. METHODS: The questionnaire was provided electronically to 153 practicing Neonatologists working in 39 NICUs. The survey's results were received and statistically analyzed. RESULTS: One hundred nineteen (119) responses were received with, a 78% response rate. Volume Targeted Ventilation (VTV) was used routinely by 67.2%, whereas 21.8% still use only pressure control (PC)/pressure limited (PL) mode. During the acute phase of ventilation support, Assist Control was the most popular synchronized mode, whereas Synchronized Intermittent Mandatory Ventilation (SIMV) with pressure support (PS) or PSV were the two most common modes during the weaning phase, 31.8%, and 31% respectively. The majority of the neonatologists used a tidal volume of 4 ml/kg as the lowest and 6 ml/kg as the highest. The major reasons for not implementing VTV were the limited availability of ventilator devices that have an option of VTV, followed by lack of experience. CONCLUSION: VTV is the predominant ventilation practice approach among neonatologists working in the KSA. Limited availability and lack of experience in using are the main challenges. Efforts to equip NICUs with the most advanced ventilation technology, enhance practitioners' experience and sufficient training in its use are warranted.

The Relation between Asthma Control and Quality of Life in Children.

BACKGROUND: Asthma is a common chronic illness worldwide. Asthmatic children are forced to alter their way of living to avoid its complications or exacerbations, which negatively affects their psychological and social well-being. High prevalence of behavioral and emotional difficulties was noticed among children with asthma. METHODS: Cross-sectional study that was conducted over 8 months involving asthmatic children within the ages of 7-17 years presenting to two governmental hospitals in Jeddah, Saudi Arabia. Three questionnaires were used: asthma control test, the strengths and difficulties questionnaire, and the pediatrics asthma quality of life questionnaire. Using SPSS, Pearson's chi-square and independent sample t-tests were used to find associations. RESULTS: Among the 106 respondents, 84% of the sample had poor asthma control. Significantly poorer quality of life was observed in children with uncontrolled asthma (p = <0.001). Children with controlled and uncontrolled asthma were equally affected psychosocially with no relation between asthma control and their psychosocial well-being (p = 0.58). CONCLUSION: The majority of asthmatic children were uncontrolled with poor quality of life. This study recommends that the psychosocial well-being should be assessed during clinic visits for a better holistic approach and effective improvement of outcome. Further researches are needed to study the psychological effect of asthma.

Removal of fouling species from brackish water reverse osmosis reject stream.

Brine disposal from reverse osmosis (RO) systems remains a major challenge for the desalination industry especially in inland areas where discharge options are very limited. Solutions will entail the introduction of economic treatment processes that will alleviate the brine's negative impact on the environment and reduce its discharge volume. Such processes could act as an intermediary treatment process for the recycling of the brine through an additional RO stage which, for brackish water (BW) desalination, could lead to saving valuable water while reducing the amount of brine discharge. In this context, the study at hand attempts to evaluate the effectiveness of a one-step chemical process for the treatment of BWRO brine. This study seeks to determine optimal operating conditions relative to type, ratio, and dosage of alkalizing chemicals, pH and temperature, for substantially reducing the concentrations of scaling parameters such as calcium, magnesium, silica, and strontium. The results indicate that precipitation softening at pH = 11.5 using combined chemical dosages of NaOH and Na2CO3 in a ratio of 2:1 leads to substantial removal of calcium and magnesium (>95%) and moderately high removal of strontium and silica (>71%).

Hollow fiber vs. flat sheet MBR for the treatment of high strength stabilized landfill leachate.

The Membrane Bioreactor (MBR) technology is increasingly becoming a prominent process in the treatment of high-strength wastewater such as leachate resulting from the decomposition of waste in landfills. This study presents a performance comparative assessment of flat sheet and hollow fiber membranes in bioreactors for the treatment of relatively stable landfill leachate with the objective of defining guidelines for pilot/full scale plants. For this purpose, a laboratory scale MBR system was constructed and operated to treat a leachate with Chemical Oxygen Demand (COD) (3900-7800mg/L), Biochemical Oxygen Demand (BOD5) (∼440-1537mg/L), Total Phosphorus (TP) (∼10-59mg/L), Phosphate (PO4(3)(-)) (5-58mg/L), Total Nitrogen (TN) (1500-5200mg/L), and ammonium (NH4(+)) (1770-4410mg/L). Both membranes achieved comparable BOD (92.2% vs. 93.2%) and TP (79.4% vs. 78.5%) removals. Higher PO4(3)(-) removal efficiency or percentage (87.3% vs. 81.3%) and slightly higher, but not statistically significant, COD removal efficiency were obtained with the hollow fiber membrane (71.4% vs. 68.5%). On the other hand, the flat sheet membrane achieved significantly higher TN and NH4(+) removal efficiencies (61.2% vs. 49.4% and 63.4% vs. 47.8%, respectively), which may be attributed to the less frequent addition of NaOCl compared to the hollow fiber system.

Melanoma differentiation associated gene-7 (mda-7): a novel anti-tumor gene for cancer gene therapy.

BACKGROUND: The mda-7 gene (melanoma differentiation associated gene-7) is a novel tumor suppressor gene. The anti-proliferative activity of MDA-7 has been previously reported. In this report, we analyze the anti-tumor efficacy of Ad-mda7 in a broad spectrum of cancer lines. MATERIALS AND METHODS: Ad-mda7-transduced cancer or normal cell lines were assayed for cell proliferation (tritiated thymidine incorporation assay, Alamar blue assay, and trypan-blue exclusion assay), apoptosis (TUNEL, and Annexin V staining visualized by fluorescent microscopy or FACs analysis), and cell cycle regulation (Propidium Iodide staining and FACs analysis). RESULTS: Ad-mda7 treatment of tumor cells resulted in growth inhibition and apoptosis in a temporal and dose-dependent manner. The anti-tumor effects were independent of the genomic status of p53, RB, p16, ras, bax, and caspase 3 in these cells. In addition, normal cell lines did not show inhibition of proliferation or apoptotic response to Ad-mda7. Moreover, Ad-mda7-transduced cancer cells secreted a soluble form of MDA-7 protein. Thus, Ad-mda7 may represent a novel gene-therapeutic agent for the treatment of a variety of cancers. CONCLUSIONS: The potent and selective killing activity of Ad-mda7 in cancer cells but not in normal cells makes this vector a potential candidate for cancer gene therapy.

Genomic rearrangements of the APC tumor-suppressor gene in familial adenomatous polyposis.

Germline mutations of the adenomatous polyposis coli (APC) tumor-suppressor gene result in the hereditary colorectal cancer syndrome familial adenomatous polyposis (FAP). Almost all APC mutations that have been identified are single-nucleotide alterations, small insertions, or small deletions that would truncate the protein product of the gene. No well-characterized intragenic rearrangement of APC has been described, and the prevalence of this type of mutation in FAP patients is not clear. We screened 49 potential FAP families and identified 26 different germline APC mutations in 30 families. Four of these mutations were genomic rearrangements resulting from homologous and nonhomologous recombinations mediated by Alu elements. Two of these four rearrangements were complex, involving deletion and insertion of nucleotides. Of these four rearrangements, one resulted in the deletion of exons 11 and 12 and two others resulted in either complete or partial deletion of exon 14. The fourth rearrangement grossly altered the sequence within intron 14. Although this rearrangement did not affect any coding sequence of APC at the genomic DNA level, it caused inappropriate splicing of exon 14. These rearrangements were initially revealed by analyzing cDNAs and could not have been identified by using mutation detection methods that screened each exon individually. The identification of a rearrangement that did not alter any coding exons yet affected the splicing further underscores the importance of using cDNA for mutation analysis. The identification of four genomic rearrangements among 30 mutations suggests that genomic rearrangements are frequent germline APC mutations.

Technology evaluation: StealthVector (HIV) Enzo.

Efficient inhibition of human immunodeficiency virus-1 (HIV-1) replication with intracellularly expressed antiviral genes would be an important step toward clinical gene therapy for HIV-1 disease. Enzo Biochem is investigating and developing antisense genes as a potential gene therapy approach against a variety of conditions including acquired immunodeficiency syndrome (AIDS), cancer and hepatitis. The subsidiary of Enzo Biochem, Enzo Therapeutics, utilized its StealthVector technology and initiated phase I trials in July 1998 [291511,307156]. StealthVector, which is comprised of independent antisense sequences directed against two functional HIV-1 regions, is involved in regulation of gene expression soon after HIV infection, transactivation response (TAR) and tat/rev. StealthVector localizes primarily in the cell nucleus, where it could be most effective in inhibiting viral growth.

Systemic plus local metronidazole and cephazolin in complicated appendicitis: a prospective controlled trial.

Appendicectomy was performed on 100 patients with complicated appendicitis through a grid-iron incision. All patients received systemic metronidazole and cephazolin sodium which started preoperatively and continued postoperatively for 5 days. At operation, patients were allocated randomly to receive either local instillation of metronidazole and cephazolin intraperitoneally and interparietally (group A) or no local antibiotic therapy (group B). All wounds were closed primarily without drainage. Postoperative wound sepsis occurred in four (8%) of the 50 patients in group A and in 17 (34%) of the 50 patients in group B. One patient in group B developed pelvic abscess in addition to wound sepsis. The mean duration of postoperative hospital stay was 6.6 days (s.d. 2.98) in group A and 8.7 days (s.d. 5.55) in group B. These differences were statistically significant. No adverse reaction was noted. The conclusion of this study is that a single peroperative instillation of metronidazole and cephazolin into the peritoneum and wound layers is a safe and valuable adjunct to the perioperative systemic administration of these drugs in significantly reducing postoperative sepsis and duration of hospital stay in complicated appendicitis.

The place of antibiotics in the prevention of post-appendicectomy sepsis: a prospective study of 400 cases.

Post-appendicectomy sepsis still causes considerable morbidity and prolongs hospital stay. A large amount of recent work has gone into attempts to reduce such problems using various topical and systemic agents in differing regimes, with wide variation in their results. The aim of our study was to examine further the effectiveness of those different lines of prophylaxis against placebo in reducing post-appendicectomy sepsis. It is a comparative study of 400 cases of uncomplicated appendicitis operated upon by three senior Surgeons. The cases were allocated randomly in equal number to four groups according to the prophylactic antibiotic regime used: (a) Placebo; (b) Metronidazole alone; (c) Metronidazole and cefazolin; (d) Metronidazole and tobramycin. Antibiotics were given preoperatively with premedication and continued postoperatively for three days. The patients were checked for signs of sepsis during hospital stay and weekly up to a minimum of four weeks after discharge. They were also compared as far as their hospital stay is concerned. The conclusion of this study is that a combination of an antibiotic aimed at aerobes (cefazolin or tobramycin) with another aiming at anaerobes (metronidazole) is the best prophylactic regime against post-appendicectomy sepsis.

Clearance of intravitreal 3H-fluorouracil.

The clearance of intravitreally administered 5-fluorouracil (5-FU) was studied under five experimental conditions. The same nontoxic dose resulted in similar initial intravitreal concentrations and cleared rapidly from all eyes (approximately 90% clearance within eight hours). Half-life values ranged from 46 to 168 minutes. The longest half-life occurred in aphakic-vitrectomized eyes in which hyaluronic acid (Healon) was substituted for vitreous (168 minutes). A similar half-life was found in normal eyes (150 minutes). The shortest half-life occurred in aphakic-vitrectomized eyes postoperatively (46 minutes). Intermediate half-life values occurred in vitrectomized but phakic eyes postoperatively (67 minutes) and in aphakic-vitrectomized "quiet" eyes (at least two weeks postoperatively) (82 minutes).

Ab interno retinochoroidectomy in primates.

Primates underwent the ab interno removal of up to a 6 X 7-disc diameter area of the retina and choroid adjacent to the optic disc. The area of resection was treated three weeks before surgery with an encircling row of xenon arc photocoagulation. Surgery involved photocoagulation of the entire resected area and removal of the retina and choroid using a wide-angle cutter vitrophage. Vitreous fluid was replaced in 50% of the eyes with sodium hyaluronate (Healon). The majority of eyes in which the vitrectomy fluid was replaced with saline solution became phthisical. All but one eye containing sodium hyaluronate recovered preoperative intraocular pressures and maintained the integrity of the remaining intraocular structures.