Emergency percutaneous tracheotomy in failed intubation

AbstractObjectiveCricothyrotomy is the emergency surgical means of gaining access to the airways. However it holds a lot of problems to the patient and is only a temporary measure until a definitive airway is reached. Griggs’ forceps technique for elective bedside percutaneous dilational tracheotomy (PDT) is safe, fast, and carries fewer complications in expert hands. This study aimed at comparing between emergency cricothyrotomy and emergency PDT in patients with failed intubation.DesignA comparative double blind study.SettingEmergency room of Alexandria main university hospitals.Patients169 failed to intubate, failed to ventilate patients.MethodsThey were serially randomized into group I (85 patients): percutaneous cricothyrotomy and group II (84 patients): PDT using Griggs’ forceps technique.ResultsSuccess rate was 95.3% in group I and 97.6% in group II. Procedure duration (in minutes) was 1.85±0.36 in group I versus 1.46±0.31 in group II. Lung atelectasis occurred to 8.2% of patients in group I only. Vocal cord injury occurred to 4.7% of patients in group I versus 1.2% in group II.ConclusionEmergency PDT is feasible and safe in expert hands

Hypoglossal Facial Nerve Anastomosis for Post-Operative and Post-Traumatic Complete Facial Nerve Paralysis

AIM: This study aims to evaluate the outcome of patients with complete facial paralysis following surgery to cerebellopontine angle tumours or following traumatic petrous bone fractures after reanimation by hypoglossal-facial anastomosis as regards clinical improvement of facial asymmetry and facial muscle contractility as well as complications associated with hypoglossal-facial reanimation procedure. METHODS: This thesis included a prospective study to be carried out on 15 patients with unilateral complete lower motor neuron facial paralysis (11 patients after cerebellopontine angle tumour resection and 4 patients after traumatic transverse petrous bone fracture) operated upon by end to end hypoglossal-facial nerve anastomosis in Cairo university hospitals in the period between June 2015 and January 2017. RESULTS: At one year follow up the improvement of facial nerve functions were as follows: Three cases (20%) had improved to House Hrackmann grade II, eleven cases (73.33%) had improved to grade III, and one patient (6.66%) had improved to House Brackmann grade IV. CONCLUSION: Despite the various techniques in facial reanimation following facial nerve paralysis, the end to end hypoglossal-facial nerve anastomosis remains the gold standard procedure with satisfying results in cases of the viable distal facial stump and non-atrophic muscles. Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm

A Community Model to Improve Physical Activity in Children

Introdction: • The prevalence of overweight / obese children aged 2-5 in the United States is 21.2%. The National Center of Health Statistics estimates a 30% increase in the prevalence of obesity between 2001 and 2004. • The Vermont Department of Health estimates that about 30% of low income children between 2 and 5 years of age are overweight or at risk of becoming overweight. • Physical activity programming at child care centers is the most important predictor of physical activity in preschool-aged children, more important than the child’s socioeconomic and demographic characteristics. • Although the National Association for Sports and Physical Education offers some guidelines, there are no clear recommendations for physical activity in childcare settings in Vermont and nationwide.https://scholarworks.uvm.edu/comphp_gallery/1067/thumbnail.jp

Vitamin D Receptor Gene (Fok-I) Polymorphisms in Type 1 Diabetic Children; Case Study in Zagazig University Hospitals

Background: Many meta-analyses studied the association between vitamin D receptor (VDR) gene polymorphism and type 1 diabetes (T1DM) susceptibility. Objective: This study was designed to assess the role of VDR gene (FOK-I) polymorphisms in type 1 diabetic children from Zagazig University Hospitals in Egypt. Patients and Method: In this case-control study, the genotypes of VDR gene (FOK-I) polymorphisms were assessed in 180 type 1 diabetic children and 120 healthy matched age controls by PCR-RFLP analysis. Results: A high statistical difference between patient and control regarding VDR gene (FOK-I) polymorphisms, where 44% of the patient group had heterozygous genotype (AG) compared to 8.3% in the control group. AG genotype has almost a higher risk nine times odds ratio (OR) = 8.8 than AA genotype in diabetic patients. There was a significant increase in the G allele in the patient group. Moreover, a significant association between (FOK-I) polymorphisms and T1DM complications was also observed. Conclusion: (AG) genotype of VDR gene (FOK-I) polymorphisms could be a risk factor for T1DM complications. So, VDR gene (FOK-I) polymorphisms should be performed with other genetic studies for early prediction, detection and prevention of microvascular complications of T1DM that adversely affect health-related quality of life of Egyptian children and burden the primary care units

Frequency and risk factors for Hepatitis C virus seropositivity in blood transfusion-dependent thalassemic patients in Qena hospitals

Background: Beta-thalassemia major (BTM) is still mostly treated with routine blood transfusions. One of the most prevalent transfusion-transmitted infections (TTI) of clinical significance is the hepatitis C virus (HCV). Objectives: To estimate the prevalence of HCV infection among thalassemic patients in Qena hospitals, and to identify the possible risk factors associated with HCV infection. Patients and methods: a cross-sectional study involving 400 thalassemic patients with an age ranging from 1.5 to 29 years, a mean age of 12.8 ±7.3 years, 176 (44%) were male and 224 (56%) were female, and 75.5% were from rural areas. All are reviewed by a structured questionnaire. Results: The study revealed that the prevalence of HCV infection in the studied thalassemic patients was 9.5%. The most important risk factors were the duration of blood transfusion for more than 15 years, previous surgery, dental procedure, and splenectomy (P<0.001), followed by patient age of more than 18 years (P = 0.001), urban population, and a positive family history of thalassemia (P = 0.001), and frequency of blood transfusion (P = 0.054). Conclusion:The most important risk factors were the duration of blood transfusion for more than 15 years, previous surgery, dental procedure, and splenectomy. Thalassemic patients with older age were at higher risk for HCV infection. The risk increased with patients aged more than 18 years old. A family history of thalassemia was a risk factor for HCV infection

Rutin ameliorates carbon tetrachloride (CCl4)-induced hepatorenal toxicity and hypogonadism in male rats

Rutin, a food derived-polyphenolic bioflavonoid, has been acknowledged for several health benefits. This study aims to explore the ameliorative effects of rutin against carbon tetrachloride (CCl4) toxicity in male rats. Adult male rats were given either CCl4 (30% in olive oil, 3 ml/kg b.w. intraperitoneally) alone or in combination with rutin (70 mg/kg intragastrically) twice a week for 4 weeks. Our data showed that rutin mitigated CCl4 hepatorenal damage, as indicated by diagnostic markers (i.e., transaminases, alkaline phosphatase, total bilirubin, total protein, albumin, urea, uric acid and creatinine), and histopathological findings. In addition, CCl4 induced profound elevation of free radical generation and oxidative stress, as evidenced by increasing lipid peroxidation and reducing catalase, superoxide dismutase and glutathione peroxidase activities in liver, kidney and testicular tissues; these effects were suppressed by coexposure with rutin. Moreover, the increase in the levels of serum triglycerides, cholesterol, low-density lipoprotein cholesterol, and very-low-density lipoprotein cholesterol induced by CCl4 was effectively counteracted by rutin. The decrease in the level of high-density lipoprotein cholesterol in the CCl4 group was also counteracted by rutin treatment. Interestingly, the decreased levels of hormonal mediators associated with sperm production, including serum testosterone, luteinizing hormone and follicle-stimulating hormone, and the impaired sperm quality induced by CCl4 were reversed by rutin. Data from the current study clearly demonstrated that rutin supplementation could at least partly overcome CCl4-induced hepatotoxicity, nephrotoxicity and reproductive toxicity by antioxidant and antidyslipidemic effects

Self-Nanoemulsifying Drug Delivery System Loaded with Psiadia punctulata Major Metabolites for Hypertensive Emergencies: Effect on Hemodynamics and Cardiac Conductance

Vasodilators are an important class of antihypertensive agents. However, they have limited clinical use due to the reflex tachycardia associated with their use which masks most of its antihypertensive effect and raises cardiac risk. Chemical investigation of Psiadia punctulata afforded five major methoxylated flavonoids (1–5) three of which (1, 4, and 5) showed vasodilator activity. Linoleic acid-based self-nanoemulsifying drug delivery system (SNEDDS) was utilized to develop intravenous (IV) formulations that contain compounds 1, 4, or 5. The antihypertensive effect of the prepared SNEDDS formulations, loaded with each of the vasodilator compounds, was tested in the angiotensin-induced rat model of hypertension. Rats were subjected to real-time recording of blood hemodynamics and surface Electrocardiogram (ECG) while the pharmaceutical formulations were individually slowly injected in cumulative doses. Among the tested formulations, only that contains umuhengerin (1) and 5,3′-dihydroxy-6,7,4′,5′-tetramethoxyflavone (5) showed potent antihypertensive effects. Low IV doses, from the prepared SNEDDS, containing either compound 1 or 5 showed a marked reduction in the elevated systolic blood pressure by 10 mmHg at 12 μg/kg and by more than 20 mmHg at 36 μg/kg. The developed SNEDDS formulation containing either compound 1 or 5 significantly reduced the elevated diastolic, pulse pressure, dicrotic notch pressure, and the systolic–dicrotic notch pressure difference. Moreover, both formulations decreased the ejection duration and increased the non-ejection duration while they did not affect the time to peak. Both formulations did not affect the AV conduction as appear from the lack of effect on p duration and PR intervals. Similarly, they did not affect the ventricular repolarization as no effect on QTc or JT interval. Both formulations decreased the R wave amplitude but increased the T wave amplitude. In conclusion, the careful selection of linoleic acid for the development of SNEDDS formulation rescues the vasodilating effect of P. punctulata compounds from being masked by the reflex tachycardia that is commonly associated with the decrease in peripheral resistance by most vasodilators. The prepared SNEDDS formulation could be suggested as an effective medication in the treatment of hypertensive emergencies, after clinical evaluation

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London