Preoperative Fasting Time and Selected Postoperative Outcomes among Patients Undergoing Abdominal Surgeries: Correlation Study

Background: Prolonged preoperative fasting time had a negative impact on the recovery of the patient in the postoperative period. Aim of the study: was to determine the relationship between the preoperative fasting time and selected postoperative outcomes among patients undergoing abdominal surgeries at one of the University Hospitals Cairo-Egypt. Research question: What is the relationship between the preoperative fasting time and the selected postoperative outcomes (patients' blood glucose levels, blood pressure and vomiting frequency) among patients undergoing abdominal surgeries? Design: Descriptive-correlation design was utilized. Setting: The study was conducted on waiting areas of general surgery operating room at 2nd and 3rd floor in addition to the general surgical wards at one of the University Hospitals. Subjects: A convenience sample of 60 female & male adult patients with the following inclusion criteria: 1- undergoing abdominal surgeries, 2- have no diabetes or hypertension were recruited in the current study Tools: Two tools were utilized to collect data pertinent to the study; I- A semi-structured interview questionnaire, it contained two parts: 1: Demographic data 2: Surgical patient’s clinical data.  II - Postoperative outcomes data sheet: It included measurement of the three selected postoperative outcomes. Results: The current study findings revealed that nearly three quarters of the study sample fasted for longer than required time with a mean+ SD= 11.1 + 2.5 and more than two third of the study sample had waiting time between 3->6 hrs. There was a significance difference between pre-operative & post-operative, post-operative & baseline readings regarding the systolic blood pressure and between the baseline and the pre-operative diastolic blood pressure. There was a positive moderate correlation between the pre-operative fasting time and the post-operative blood glucose results r=0.41. Also, there was a strong correlation between baseline and preoperative blood glucose results r=0.77, while, There was no correlation  between frequency of vomiting post operatively and age, preoperative fasting time, waiting time, blood glucose, and blood pressure.  Conclusion: There was a correlation between preoperative fasting time and blood glucose level followed by blood pressure while no correlation with vomiting frequency postoperatively. Recommendations: Awareness of heath care team regarding updating evidence-based preoperative fasting guidelines, nurse should measure blood glucose level and blood pressure for the non-diabetic as well as the diabetic patients before the surgical procedure and further studies are needed to determine the optimal fasting time and its effect on postoperative outcomes. Keywords: Preoperative fasting time, waiting time, abdominal surgery, blood glucose level, blood pressure, postoperative vomiting

Symptoms-Related Distress among Patients Receiving Adjuvant Therapy: Radical Mastectomy versus Lumpectomy

Background: Breast cancer is the most common cancer in women worldwide. Although adjuvant therapy after breast-conserving surgery or mastectomy reduces the risk of breast cancer coming back but it induces many of physiological and psychological effects. The aim of the current study was to compare the Symptoms-related distress among patients receiving adjuvant therapy: Radical Mastectomy versus Lumpectomy at a University Hospital. Research Questions: Q1: What are the symptoms related distresses among radical mastectomy and lumpectomy patients receiving adjuvant therapy? Q2: Is there a difference in symptoms related distress between radical mastectomy and lumpectomy patients receiving adjuvant therapy? Design: A comparative descriptive -non-experimental design was utilized to achieve the aim of the current study. Tools: I) Socio-demographic and medical data sheet: It included data related to the studied subjects such as age, gender, marital status, types of received chemotherapy,…..etc. Tool II: Rotterdam Symptom Checklist (RSCL); it is useful in measuring the symptoms reported by cancer patients. It aims to enhance the insight into the consequences of the disease and its treatment. Setting: The study was conducted at the Nuclear Medicine Unit at Kasr Al-Aini Educational Hospital; affiliated to Cairo-University-Egypt. Subjects: A convenient sample of 60 adult female patients divided into two equal groups, patients with radical mastectomy (n=30) and patients with lumpectomy (n=30) both groups received chemotherapy after surgery. Results: 80% of mastectomy and lumpectomy cases overall their age was between 40 and less than 60 years old. 33.3% of the study sample can read and write. The study pointed out that 48.3% of the sample had breast cancer between 2 and less than 6 months. While 50% of them between 6 to less than 12 months with Mean+SD= 5.65+2.There was a perfect correlation between total score of RSCL and physical total score =0.826, 0.829 & 0.828 for patients overall cases, mastectomy cases only & lumpectomy cases only respectively. Also there was a strong correlation between the RSCL total score and psychological total score=0.705, 0.747 & 0.668 for the patients overall cases, mastectomy cases only & lumpectomy cases only respectively. Conclusion: The lumpectomy cases scored generally their physical, psychological & activity level impairment status much better than the mastectomy cases. Also lumpectomy cases their general QOl was better than the mastectomy cases. Recommendation of the study: 1-More close physical, psychological support must endorse in nursing care for patients with mastectomy. 2-QOL advanced tool is recommended on survey scale to evaluate patients' condition with mastectomy & lumpectomy. 3-All patients with breast cancer must join a rehabilitation program before & after proceed in either mastectomy or lumpectomy surgical management. Keywords: Adjuvant therapy, Mastectomy, lumpectomy, symptoms related distress

Bioactive compounds from Acokanthera oblongifolia

One cardiotonic glycoside, three triterpenes and one steroidal glycoside were isolated from Acokanthera oblongifolia fruits (pericarp) growing in Libya. Their structures were investigated by extensive application of IR, MS, 1DNMR and 2DNMR spectroscopy. The isolated compounds have evidenced in-vitro cytotoxicity on selected human cell lines (A-549, H-1299) when compared to doxorubicin. Keywords: Cardenolide; Acokanthera oblongifolia; antitumor activity; lung carcinoma cell line (A-549, H-1299)

Serum transforming growth factor-beta1 in asthmatic children

Background: Transforming growth factor-beta1 is a multifunctional cytokine which has been linked to the pathogenesis of subepithelial fibrosis and airway wall remodeling in bronchial asthma. Objective: To outline the changes in serum TGF-beta1 in children with bronchial asthma in relation to severity of asthma and different treatment modalities. Methods: Twenty-three children with bronchial asthma recruited from the Pediatric Allergy and Immunology Clinic of Ain Shams University Children’s Hospital were enrolled in the study as well as 29 healthy controls. Asthmatic children were classified according to severity into two groups; the mild asthma group which included 12 children, 4 with mild intermittent and 8 with mild persistent asthma (none received steroid therapy), and the severe persistent asthma group which included 11 children (all were on steroid therapy). All patients were subjected to clinical evaluation and laboratory investigations including absolute eosinophilic count (AEC), total serum IgE% and biologically active serum TGF-beta1 by ELISA technique. All patients were studied during acute asthma exacerbations. Reevaluation during steady state asthma was carried out for 8 patients with mild persistent asthma and 9 with severe persistent asthma. Results: During acute asthma exacerbations, the mean serum TGF-beta1 was significantly elevated in mild asthma (77.04 ± 57.04 ng/ml) compared to controls (21.81 ± 22.09 ng/ml). However for severe persistent asthma , the mean serum TGF-beta1 was significantly lower (4.23 ± 0.85 ng/ml) than in controls. Comparison of paired observations of serum TGF-beta1 revealed a significant drop, during steady state, in patients with mild asthma, whereas in severe asthma, a significant rise was observed. The levels of both asthma groups during steady state were comparable to the control values. A positive correlation, of borderline significance, between serum TGF-beta1 and total serum IgE% was observed among mild asthamtics during acute exacerbations (r = 0.55). Conclusion: The behavior of serum TGF-beta1 in acute asthma exacerbations depends on asthma severity and is perhaps related to steroid inhalation therapy. The tendency towards normality of serum TGF-beta1 in steady state asthma is possibly a good prognostic sign.Keywords: TGF-beta1, bronchial asthma, children, remodelingEgypt J Pediatr Allergy Immunol 2004; 2(1): 46-5

Protective effect of zinc against cadmium toxicity on pregnant rats and their fetuses at morphological, physiological and molecular level

Cadmium is a potent teratogen in laboratory animals, causing exencephaly when administered at early stages of development. Due to its heterogenicity with respect to molecular targets, the mechanisms behind cadmium toxicity are not well understood. In the present study, 40 pregnant rats (Sprague-Dawley) were divided into four groups (10 each); first group served as the control (G1), the second group (G2) received 61.3 mg/kg cadmium chloride daily from 7th to 16th day of gestation (organogenesis period) by oral tube. Group 3 (G3) was administrated a solution of 25 mg/kg zinc chloride orally from the 1st day to 20th day of pregnancy. Group 4 were administrated a solution of cadmium chloride (61.3 mg/kg) and zinc chloride (25 mg /kg) daily from the 7th to16th day of gestation. Maternal body weights were measured on gestational day 0, 6, 9, 12, 15 and 20. At the 20th day of gestation, blood samples were collected from the eye, using orbital sinus technique. Serum aspartate transaminase (AST) and alanine transaminase (ALT) were determined calorimetrically and serum, urea and creatinine were determined. All of the pregnant rats were sacrificed by ether anaesthesia at the 20th day of gestation and foetuses were removed from the uterus. The implantation sites, corpora lutea, living, dead and reabsorbed foetuses were counted and recorded. Liver of pregnant rats and their fetuses were used to isolate a total RNA for quantification of Msx1, Cx43, Bcl2 and Bax genes. The results show the toxic effect of Cd on the pregnant rats and their fetuses, at morphological, physiological and molecular level but, zinc has a very effective protection against cadmium-induced developmental toxicity.Keywords: Cadmium, zinc, rat, organogenesis, gene expressionAfrican Journal of Biotechnology Vol. 12(16), pp. 2110-211

Hepatitis B virus (HBV) genotypes in Egyptian pediatric cancer patients with acute and chronic active HBV infection

<p>Abstract</p> <p>Background</p> <p>There are eight genotypes of hepatitis B virus (A-H) and subgenotypes are recognized. Genotyping can be accomplished based on a partial sequence of HBV genome such as the pre-S or S gene. Several methods have been developed and used for HBV genotyping. This study was undertaken to determine the HBV genotypes in Egyptian pediatric cancer patients with acute and chronic liver disease.</p> <p>Methods</p> <p>HBV genotypes were determined in 22 patients who had acute forms of liver disease (AH) and in 48 patients with chronic active hepatitis (CAH). A type-specific primer based the nested-PCR method was employed in the HBV genotyping.</p> <p>Results</p> <p>This study showed that HBV infections in pediatric cancer patients are attributed predominantly to viral genotypes D and B that constituted 37.1% and 25.7%, respectively of the total infections. In addition, there was a relatively high prevalence of mixed infections of 15.7% among the studied group especially mixed A/D genotype infections. Genotype D was found significantly more often in patients with CAH than in patients with AH [23/48(47.9%) <it>v </it>3/22 (13.6%)].</p> <p>Conclusion</p> <p>These findings show the distribution of HBV A-D genotypes in pediatric cancer Egyptian patients. Furthermore, our results indicate a markedly high prevalence of mixed A/D genotype infections in subjects with CAH and a possible association of mixed infections with the severity of liver diseases.</p

A Rare Association Between Leukocyte Adhesion Deficiency Type I and Psoriasis in Humans

The β2 integrins are expressed exclusively on leukocytes and participate in many immune and inflammatory processes. This subfamily comprises four heterodimeric glycoproteins with a common β-subunit, designated β2 (CD18). Spontaneous mutations of the CD18 gene result in leukocyte adhesion deficiency type I (LAD-I). Low level of CD18 expression has also been implicated in the pathogenesis of psoriasis. We here describe a child with recurrent skin infections without pus formation, persistent gingivitis and periodontitis. His blood counts showed persistent leukocytosis (neutrophilia). CD11b expression was defective on neutrophils, while that of CD18 was normal. So, our patient represents a mild variant of LAD-I with possible dysfunctional CD18. Moreover, he developed psoriasis with reduced CD18 expression on CD4+ T-cells. Psoriasiform dermatitis has been described before in association with LAD-I, however, clinically and histologically confirmed psoriasis in association with LAD-I has been described only in CD18 hypomorphic mice. Therefore, our patient represents the first clinically and histopathologically documented association between LAD-I and psoriasis in humans. It lends support to the role of β2 integrins in the etiopathogenesis of psoriasis

Antidepressant-Like Effect of Selected Egyptian Cultivars of Flaxseed Oil on a Rodent Model of Postpartum Depression

Flaxseed (Linum usitatissimum L.) is a multipurpose crop with health promoting potential. This study was undertaken to investigate the fatty acid profile and yield of fixed oil of six Egyptian flaxseed cultivars. The selected cultivars with the highest content of polyunsaturated fatty acids (PUFAs) (G9 and G10) were assessed for their antidepressant-like effect in rat model of postpartum depression (PPD) induced by hormone-simulated pregnancy followed by hormone withdrawal and compared to fluoxetine. As compared to control group, administration of G9 and G10 (270 mg/kg/day, p.o) for two weeks during the postpartum period can alleviate anxiety and depressive-like behaviors and biochemical changes in PPD-induced rats. This was confirmed by evaluation of anxiety-like behaviors (elevated plus maze, open field test, and forced swim test tests), in addition to biochemical analysis (brain monoamine oxidase-A, corticosterone level, proinflammatory cytokines, and hippocampal redox state). In conclusion, flaxseed oil of Egyptian cultivars G9 and G10 exhibited significant antidepressant-like effect in rat model of PPD without affecting locomotor activity. At the treatment doses, the antidepressant-like activity of Giza 9 oil is comparable to fluoxetine

Update on Immunodeficiency-Associated Vaccine-Derived Polioviruses - Worldwide, July 2018-December 2019.

Since establishment of the Global Polio Eradication Initiative* in 1988, polio cases have declined >99.9% worldwide; extensive use of live, attenuated oral poliovirus vaccine (OPV) in routine childhood immunization programs and mass campaigns has led to eradication of two of the three wild poliovirus (WPV) serotypes (types 2 and 3) (1). Despite its safety record, OPV can lead to rare emergence of vaccine-derived polioviruses (VDPVs) when there is prolonged circulation or replication of the vaccine virus. In areas with inadequate OPV coverage, circulating VDPVs (cVDPVs) that have reverted to neurovirulence can cause outbreaks of paralytic polio (2). Immunodeficiency-associated VDPVs (iVDPVs) are isolated from persons with primary immunodeficiency (PID). Infection with iVDPV can progress to paralysis or death of patients with PID, and excretion risks seeding cVDPV outbreaks; both risks might be reduced through antiviral treatment, which is currently under development. This report updates previous reports and includes details of iVDPV cases detected during July 2018-December 2019 (3). During this time, 16 new iVDPV cases were reported from five countries (Argentina, Egypt, Iran, Philippines, and Tunisia). Alongside acute flaccid paralysis (AFP) surveillance (4), surveillance for poliovirus infections among patients with PID has identified an increased number of persons excreting iVDPVs (5). Expansion of PID surveillance will facilitate early detection and follow-up of iVDPV excretion among patients with PID to mitigate the risk for iVDPV spread. This will be critical to help identify all poliovirus excretors and thus achieve and maintain eradication of all polioviruses

Recommendations for asthma monitoring in children : A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO

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