Adrenocortical status in infants and children with sepsis and septic shock

AbstractBackgroundThe benefit from corticosteroids remains controversial in sepsis and septic shock and the presence of adrenal insufficiency (AI) has been proposed to justify steroid use.AimTo determine adrenal state and its relation with outcome in critical children admitted with sepsis to PICU of Cairo University, Children Hospital.MethodsThirty cases with sepsis and septic shock were studied. Cortisol levels (CL) were estimated at baseline and after high-dose short ACTH stimulation in those patients and in 30 matched controls. Absolute AI was defined as basal CL<7μg/dl and peak CL<18μg/dl. Relative AI was diagnosed if cortisol increment after stimulation is <9μg/dl.ResultsOverall mortality of cases was 50%. The mean CL at baseline in cases was higher than that of controls (51.39μg/dl vs. 12.83μg/dl, p=0.000). The mean CL 60min after ACTH stimulation was higher than that of controls (73.38μg/dl vs. 32.80μg/dl, p=0.000). The median of %rise in cases was lower than that of controls (45.3% vs. 151.7%). There was a positive correlation between basal and post-stimulation cortisol with number of system failure, inotropic support duration, mechanical ventilation days, and CO2 level in blood. There was a negative correlation between basal and post stimulation cortisol with blood pH and HCO3.ConclusionRAI is common with severe sepsis/septic shock. It is associated with more inotropic support and has higher mortality. Studies are warranted to determine whether corticosteroid therapy has a survival benefit in children with RAI and catecholamine resistant septic shock

Sinteza i biološko djelovanje novih 1-benzil i 1-benzoil 3-heterocikličkih derivata indola

Starting from 1-benzyl- (2a) and 1-benzoyl-3-bromoacetyl indoles (2b) new heterocyclic, 2-thioxoimidazolidine (4a,b), imidazolidine-2,4-dione (5a,b), pyrano(2,3-d)imidazole (8a,b and 9a,b), 2-substituted quinoxaline (11a,b–17a,b) and triazolo(4,3-a)quinoxaline derivatives (18a,b and 19a,b) were synthesized and evaluated for their antimicrobial and anticancer activities. Antimicrobial activity screening performed with concentrations of 0.88, 0.44 and 0.22 g mm2 showed that 3-(1-substituted indol-3-yl)quinoxalin-2(1H)ones (11a,b) and 2-(4-methyl piperazin-1-yl)-3-(1-substituted indol-3-yl) quinoxalines (15a,b) were the most active of all the tested compounds towards P. aeruginosa, B. cereus and S. aureus compared to the reference drugs cefotaxime and piperacillin, while 2-chloro-3-(1-substituted indol-3-yl)quinoxalines (12a,b) were the most active against C. albicans compared to the reference drug nystatin. On the other hand, 2-chloro-3-(1-benzyl indol-3-yl) quinoxaline (12a) display potent efficacy against ovarian cancer xenografts in nude mice with tumor growth suppression of 100 0.3 %.U radu je opisana sinteza, antimikrobno i antitumorsko djelovanje heterocikličkih derivata indola. Polazeći iz 1-benzil- i 1-benzoil-3-bromacetil indola (2a i 2b) sintetizirani su novi heterociklički spojevi 2-tioksoimidazolidini (4a,b), imidazolidin-2,4-dioni (5a,b), pirano(2,3-d)imidazoli (8a,b i 9a,b), 2-supstituirani kinoksalini (11a,b–17a,b) i triazolo(4,3-a)kinoksalini (18a,b i 19a,b). Sintetizirani spojevi testirani su na antimikrobno i antitumorsko djelovanje. Ispitivanje antimikrobnog djelovanja provedeno je s koncentracijama otopina 0,88, 0,44 i 0,22 g mm2 i uspoređeno s referentnim lijekovima cefotaksimom i piperacilinom. Rezultati pokazuju da su 3-(1-supstituirani indol-3-il)kinoksalin-2(1H)oni (11a,b) i 2-(4-metil piperazin-1-il)-3-(1-supstituirani indol-3-il) kinoksalini (15a,b) najaktivniji spojevi na sojeve P. aeruginosa, B. cereus i S. aureus, dok su 2-klor-3-(1-supstituirani indol-3-il)kinoksalini (12a,b) najaktivniji na C. albicans (usporedba s nistatinom). Osim toga, 2-klor-3-(1-benzil indol-3-il) kinoksalin (12a) pokazuje veliku učinkovitost na tumore ovarija miševa (supresija rasta tumora 100 0,3 %)

CURRENT AND EXPECTED ECONOMIC EFFECTS OF GLOBAL ENERGY AND FOOD ON THE MOST IMPORTANT EGYPTIAN IMPORTS

The study aimed at studying economic effects of global energy and food on the most important Egyptian imports. Descriptive and analytical statistical methods were used to achieve study objectives. Mathematical averages percentages and annual growth rates of variables under study were estimated. Expected values of imported food commodities using double exponential smoothing method was used. The study reached to some important conclusions, namely Global price and production of oil, coal, natural gas, ethanol and biodiesel have risen during the period 1996-2011. There were also a significant relationship between world prices and production of the above products. The price elasticities were about 0.089, 0.32, 0.174, 0.062, and 2.5 for these products respectively. The increase of oil price has an impact on food imports showing an increase of about 3.46% as a result of 10%of oil price increase. The study revealed that world oil price will be about $133.2/ a barrel in the year 2015 compared with$112.9/ barrel in the year 2011. It is therefore expected that value of food imports will increase to about $12.9 billion in the year 2015 compared to$ 10.6 billion in 2011

Relation of some clinical composite indices of disease activity in rheumatoid arthritis to a simplified 12 joint power Doppler ultrasound activity index

Aim of the work: To assess the association of some clinical composite disease activity indices with a simplified 12 joint power Doppler ultrasound (PDUS) activity index in rheumatoid arthritis (RA). Patients and methods: One hundred RA patients who fulfilled the 2010 European league against rheumatism/American college of Rheumatology (EULAR/ACR) classification criteria for RA were recruited from the Rheumatology outpatient clinic, Cairo University Hospitals. Disease activity score (DAS28), the simplified disease activity index (SDAI), clinical disease activity index (CDAI) as well as mean overall index for RA (MOI-RA) were assessed. Grey Scale Ultrasonography (GSUS) and PDUS activity assessment was performed using a simplified 12-joint score. Results: The 100 patients were 80 females and 20 males (F:M 4:1). Their mean age was 44.4 ± 10.8 years with disease duration of 6.3 ± 4.7 years. Rheumatoid factor was positive in 77 %. DAS28 was 4.5 ± 1.3, SDAI 27.7 ± 22.7, CDAI 17.5 ± 13.2 and MOI-RA 86.8 ± 25.1. On US, tenosynovitis was present in 10 %, irregularity in 23 % and erosion in 62 %. The mean 12-point PDUS was 3.53 ± 4.16 and the overall US score 10.34 ± 9.3. A significant correlation was found between the US findings of overall synovitis, degree of PD and US score with DAS28 (r = 0.3, p < 0.0001; r = 0.4, p < 0.0001 and r = 0.3, p < 0.0001) with SDAI (r = 0.3, p < 0.0001; r = 0.4,p < 0.0001; r = 0.4, p < 0.0001) and with MOI-RA score (r = 0.3, p < 0.0001; r = 0.4, p < 0.0001 and r = 0.4, p < 0.0001 respectively) but the highest correlations was with CDAI (r = 0.4, p < 0.0001; r = 0.5, p < 0.0001 and r = 0.4, p < 0.0001 respectively). Conclusion: Simplified 12 -joint PDUS score is well correlated with activity indices in RA patients

Thyroid dysfunction and anti-thyroid antibodies in systemic sclerosis patients

Aim of the work: To assess the frequency of thyroid dysfunction and thyroid auto-antibodies in systemic sclerosis (SSc) patients. Patients and methods: This study included thirty-three SSc patients and 30 matching controls. Thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), anti thyroglobulin (ATG) and anti thyroid peroxidase autoantibodies (ATPO) were measured in the sera of patients and controls. Results: The mean age of the patients was 45.9 ± 13.05 years; 28 females and 5 males (F: M 5.6:1) and a disease duration of 4.58 ± 3.84 years. The FT3, FT4, TSH tended to be higher in patients (T3: 2.8 ± 0.66 pg/ml; T4: 1.5 ± 0.65 ng/ml; TSH: 1.9 ± 2.1 ul/ml) than in controls (p = 0.07, p = 0.21 and p = 0.24 respectively) while the ATG level in patients was 40 ± 21.3 IU/ml and ATPO 36.7 ± 88.2 IU/ml. Four patients had hypothyroidism (12 %); 3 (9 %) subclinical hypothyroidism (SCHT) and 1 (3 %) clinical hypothyroidism (CHT). ATG was positive in one patient and in 2 controls while ATPO was positive in two patients compared to one control. Both antibodies were positive in one patient. ATPO was associated with SCHT in one (3 %) and with overt hypothyroidism in another (3 %). The thyroid profile, ATG and ATPO were comparable between females and males (p = 0.34, p = 0.23, p = 0.96, p = 0.77 and p = 0.35 respectively) and all were similar between lcSSc and dcSSc except TSH (lower in dcSSc; p = 0.03). Muscle weakness was significantly higher among ATPO positive patients (p = 0.005) while thyroid dysfunction was significantly associated with arthralgia (p = 0.007). Conclusion: Thyroid dysfunction mainly hypothyroidism is more frequent among SSc patients

Fatal acute myocarditis and fulminant hepatic failure in an infant with pandemic human influenza A, H1N1 (2009) virus infection

We report the clinical presentation of a 10 month-old infant who succumbed with acute myocarditis and fulminant hepatic failure associated with a virologically confirmed human influenza A, H1N1 (2009) virus infection. To date, this is the first pediatric patient presenting with this fatal combination of complications during the current H1N1 pandemic. Therefore, we recommend meticulous assessment and follow up of the cardiac status, liver enzymes and coagulation profile in all pediatric patients with severe H1N1 influenza infection

Incidence and risk factors of retinopathy in Egyptian patients with chronic hepatitis C virus treated with pegylated interferon plus ribavirin

SummaryBackgroundData are scarce on ocular complications in Egyptian patients with chronic hepatitis C treated with pegylated interferon and ribavirin therapy. The aim of this study was to investigate the development of retinal lesions induced by interferon therapy for chronic hepatitis C.MethodsWe prospectively analyzed 84 patients with chronic hepatitis C (total 168 eyes), who underwent combination pegylated interferon and ribavirin therapy for 48 weeks. Visual acuity, color vision, and visual field were measured, and a fundus assessment was made at baseline, at 12, 24, and 48 weeks post the commencement of treatment, and at follow-up, 1 month after treatment. Past medical and ocular histories, visual symptoms, and the results of a full ophthalmologic assessment were recorded for each patient.ResultsTwenty-two patients (26%) developed retinopathy. Retinal hemorrhage was observed in eight patients. Four patients complained of visual disturbance. Retinopathy disappeared in 16 patients (73%) despite the continuation of combination therapy. However, retinopathy persisted in six patients with retinal hemorrhage and three of them stopped treatment. A comparison of the clinical backgrounds between the patients with and without retinopathy showed no significant differences with regard to gender, HCV RNA level, white blood cell count, platelet count, hemoglobin level, or fibrosis score. However patients with retinopathy were of older age, had a higher prevalence of hypertension and diabetes mellitus, and more often did not respond to therapy. Multiple logistic regression analysis revealed that hypertension and diabetes were factors predicting retinopathy.ConclusionRetinopathy associated with interferon α-2a and ribavirin combination therapy tends to develop in patients of older age with hypertension and diabetes