Usefulness of atropine in patients with chronotropic incompetence and poor exercise capacity during treadmill stress testing

AbstractBackgroundAtropine, an anticholinergic agent, has been shown to increase heart rate and enhance the sensitivity of dobutamine stress echocardiography in the detection of CAD in patients with chronotropic incompetence; however, the addition of atropine to exercise stress testing EST, in these types of patients has not been well studied previously.ObjectiveInvestigating the usefulness and accuracy of atropine in decreasing the number of inconclusive results of EST in patients with chronotropic incompetence and poor exercise capacity.MethodsThirty patients (16 males and 14 females with the age range of 40:73years with mean of 55±8) out of 180 patients who preformed EST were chosen as having chronotropic incompetence or poor exercise capacity by Borg scale. Atropine was administered during the exercise phase in doses of 0.5mg per minute until test conclusion or the maximum dose of 2mg was reached. All patients were subjected to stress myocardial perfusion imaging SMPI to confirm accuracy.ResultsConclusive test results were achieved in 29 patients (97%). Heart rate and blood pressure were markedly increased with statically highly significant difference (P value <0.001), patients on b-blocker treatment had lower maximum heart rate compared to other patients with significant difference. Twenty-three (79%) patients had negative test results and six (21%) patients had positive test results, and if compared to SMPT results, EST was considered better positive than negative test, with higher specificity than sensitivity and accuracy.ConclusionsAtropine injection during EST significantly reduced the inconclusive test results in patients with chronotropic incompetence and poor exercise capacity

A Comparative study between Different Treatment Modalities of Floating Knee Jnjury At Aswan University Hospital

Purpose: The study aimed at presenting a comparison between the modalities of treatment different of floating knee injury at Aswan University Hospital.  Materials and Methods:  This study is a prospective study including all of our 20 cases of floating knee injuries who were treated utilizing various treatment modalities at Aswan University Hospital between December 2018 and September 2019 with a follow-up period of 12 months  Results: Based on the data analysis,  nailing is a better modality in floating knee injury (especially with diaphyseal long bone). Moreover, plating is a good choice for distal fractures, the external fixator is considered a choice for limb saving(as in popliteal ischemia, open fractures(OG3), and compartment syndrome).  Conclusion: Management of floating knee injury is critical as floating knee injury is not like other fractures. Floating knee injuries are serious injuries with a high rate of complications. Besides being caused by high-energy trauma with extensive skeletal and soft tissue damage, they are also associated with potentially life-threatening injuries of the head, chest, and abdomen. There are multiple controversies in surgical management starting from choosing suitable fixation for each patient according to variable conditions.  Floating knee injury remains a challenging orthopedic problem in which regaining good knee function outcome is a major concern. Stable osteosynthesis to achieve rigid fixation and early mobilization should always be attempted

Usefulness of atropine in patients with chronotropic incompetence and poor exercise capacity during treadmill stress testing

AbstractBackgroundAtropine, an anticholinergic agent, has been shown to increase heart rate and enhance the sensitivity of dobutamine stress echocardiography in the detection of CAD in patients with chronotropic incompetence; however, the addition of atropine to exercise stress testing EST, in these types of patients has not been well studied previously.ObjectiveInvestigating the usefulness and accuracy of atropine in decreasing the number of inconclusive results of EST in patients with chronotropic incompetence and poor exercise capacity.MethodsThirty patients (16 males and 14 females with the age range of 40:73years with mean of 55±8) out of 180 patients who preformed EST were chosen as having chronotropic incompetence or poor exercise capacity by Borg scale. Atropine was administered during the exercise phase in doses of 0.5mg per minute until test conclusion or the maximum dose of 2mg was reached. All patients were subjected to stress myocardial perfusion imaging SMPI to confirm accuracy.ResultsConclusive test results were achieved in 29 patients (97%). Heart rate and blood pressure were markedly increased with statically highly significant difference (P value <0.001), patients on b-blocker treatment had lower maximum heart rate compared to other patients with significant difference. Twenty-three (79%) patients had negative test results and six (21%) patients had positive test results, and if compared to SMPT results, EST was considered better positive than negative test, with higher specificity than sensitivity and accuracy.ConclusionsAtropine injection during EST significantly reduced the inconclusive test results in patients with chronotropic incompetence and poor exercise capacity

Blood Pressure and Blood Pressure Deficits as Predictors of Acute Kidney Injury in Vasopressor Dependent Patients Post Cardiovascular Surgery

BACKGROUND: Acute kidney injury (AKI) is a common and serious post-operative complication following cardiovascular surgery. AIM: The aim of the study was to evaluate the value of blood pressure and blood pressure deficits as predictors of AKI in post cardiovascular surgery vasopressors’ dependent patients. METHODS: A prospective observational, single center study, conducted on 100 patients requiring vasopressor support for more than 4 h after cardiovascular surgery. All included patients were subjected to the measurements of three or more systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) readings from the ward charts before surgery and the mean of these measures was calculated, was recorded and pre-operative systolic perfusion pressure (SPP), diastolic perfusion pressure (DPP), and mean perfusion pressure (MPP) were calculated. A vasopressor-associated average values for hemodynamic pressure-related parameters (SAP, DAP, MAP, CVP, SPP, DPP, and MPP) were calculated on the 1st 24 h after admission. The percent deficit in post-operative average parameters in relation to pre-operative parameters was determined as % parameter deficit. RESULTS: The pre-operative SAP, DAP, MAP, SPP, DPP, and MPP were significantly higher in the non-AKI compared to AKI patients while pre-operative central venous pressure (CVP) was significantly higher in AKI patients. The post-operative DAP, MAP, DPP, and MPP were also higher in non-AKI and the post-operative CVP was lower in non-AKI compared to AKI patients. CONCLUSIONS: This study concluded that the relative decrease in the perfusion pressures could be significant predictors of AKI after cardiovascular surgery in vasopressor dependent patients. The higher pre- or post-operative CVP or its relative decrease after cardiac surgery was seen also to be associated with higher incidence of AKI

Arabic gum acacia improves diabetic peripheral neuropathy in rats: a biochemical and histopathological evidence

Background: Diabetic peripheral neuropathy (DPN) is a frequent complication of diabetes mellitus and unfortunately, its present therapeutic alternatives are exceptionally poor. Objectives of this study was to assess the antidiabetic, antioxidant and hypolipidemic action of Gum Arabic (GA) and its role in promoting the functional recovery from diabetic neuropathy developed in in an experimental model of diabetic neuropathy.Methods: Sixty adult male Sprague-Dawley rats were utilized and randomly assigned into six groups (n= 10); control, Arabic gum-treated, untreated diabetic, diabetic received metformin, diabetic received metformin and B12 vitamin and diabetic received metformin, B12 vitamin and AG. Locomotor activity and hyperalgesia were assed at the end of the study. Fasting and two hours post-prandial blood glucose, serum insulin levels, lipid Profile, oxidants/antioxidants parameters were assessed in the blood. Sciatic nerve was assessed histopathologically.Results: The locomotor activity of the untreated diabetic rats was significantly (p<0.001) reduced compared to the control group while it was significantly increased in all treated groups. The lipid profile and Malondialdehyde were significantly improved in all treated groups. Levels of CAT, GSH, SOD, GPx were significantly decreased in untreated diabetic group compared to the control while they were significantly increased in all treated groups compared to the untreated diabetic group. Sciatic nerve fibers of untreated diabetic rats showed degenerated axons with dilated myelin sheaths and degenerated Schwann cells. The nerve had significantly fewer fiber compared to the control. These changes were alleviated in all the treated groups specifically that received metformin, vitamin B12 and GA.Conclusions: It could be concluded that Arabic gum had hypoglycemic, antioxidant and hypolipidemic activity and had a protective effect on diabetic neuropathy. Based on this it is recommended that human clinical trials are necessary to prove this therapeutic effect

Photometric and Spectroscopic Analysis of the SX Phe Star BL Cam

In the present paper, we report the photometric and spectroscopic observations obtained by the 1.88 m telescope at the Kottamia astronomical observatory of the pulsating star BL Cam. Fourier analysis of the light curves reveals that the fundamental mode has two harmonics. The O-C method is used to establish the period changes. So far, the analysis has been very successful in mapping the pulsation amplitude of the star across the instability strip. By using the formalism of Eddington and Plakidis (1929), we found significant results and strong indications of the evolutionary period change. A total of 55 new maximum light timings are reported. New values of (1/P) dP/dt are estimated using the O-C diagram based on all newly obtained times of maximum light combined with those taken from the literature, assuming the periods are decreasing and changing smoothly. To compute the effective temperature and surface gravity of the star, we performed model atmosphere analysis on its spectra. The physical parameters of the star are calculated and compared with the evolutionary models

Characterization of a biosurfactant producing electroactive Bacillus sp. for enhanced Microbial Fuel Cell dye decolourisation

A biosurfactant producing Gram positive bacterium isolated from anodic biofilm of textile wastewater fed MFC was identified as Bacillus sp. MFC (Accession number: MT322244). Scanning Electron Microscopy of the bacterium showed appendages, the bacterium forms biofilm on Congo red agar medium. The obtained results showed that the addition of 5 mg/l endogenous biosurfactant to the bacterial cells resulted in 19-fold increase in bacterial surface-bound exopolysaccharides (EPS) and 1.94-fold increase in biofilm. However, when the biosurfactant concentration increased to 20 and 40 mg/l, EPS and biofilm decreased and the cells lost their colony forming ability. The dielectric properties of the bacterial cells showed increase in conductivity and relative permittivity with increasing biosurfactant concentrations. The shape of the voltammogram currents peak, their location and Electrochemical impedance spectroscopy (EIS) suggest the involvement of biofilm as direct electron transfer pathway. The average voltage obtained was 0.65 V as compared to 0.45 V for the control MFC. Decolourization was tested for Congo red in a double chamber Microbial Fuel Cell (MFC), the results showed 2-fold increase in decolourization when biosurfactant is added post biofilm formation. The results confirm that Bacillus sp. MFC possess electrogenic properties and that adding low concentrations of endogenous biosurfactant to 24 h biofilm accelerates electron transfer by inducing perforations in the cell wall and increasing EPS as an electron transfer transient medium. Therefore, MFC performance can be enhanced

Modification of bacterial cell membrane to accelerate decolorization of textile wastewater effluent using microbial fuel cells: role of gamma radiation, salinity and endogenous biosurfactant induction

A combined approach was investigated to accelerate Microbial Fuel Cell (MFC) performance and textile wastewater decolorization through modifying bacterial membrane. The aim was to increase both bacterial adhesion on anode and electron mediator release. Ten Gram-positive exoelectrogenic bacteria were isolated from the anodic biofilm after decolorization of real textile waste water in mediator-less MFC. The isolates were identified and characterized, to understand the nature of the bacteria involved. According to the battery of tests performed, three factors gamma radiation, salinity and induction of endogenous biosurfactant were involved membrane modification. Dielectric measurement, a non-invasive technique, was used to measure the cell membrane permeability and cell surface charge. Plackett-Burman experimental design was carried out to determine the key contributor among the three studied factors. Exposing the cells to 1 KGy gamma radiation led to 7.84- and 1.71- fold increase in total surface-charge and cell-permeability, respectively. Scanning Electron Microscope (SEM) images and surface-bound protein concentrations for the samples indicated that biofilm formation increased under the same conditions. These results have been reflected on the power density profiles and decolorization of textile wastewater. Modification of bacterial membrane prior to MFC operation can be considered highly effective as a pre-treatment tool that accelerates MFC performance

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