Exhaled breath condensate nitric oxide end products and pH in controlled asthma

AbstractObjectivesAsthma imposes a growing burden on the society in terms of morbidity, quality of life, and healthcare costs. It has the highest morbidity amongst inflammatory lung diseases and its prevalence continues to increase over the world. Inquiry into recent day or nighttime symptoms alone underestimates the burden of asthma and may lead to inadequate treatment of asthma. The aim of the present work is to evaluate the role of nitric oxide (NO) and hydrogen ion concentration (pH) levels in exhaled breath condensate (EBC) in cases of controlled bronchial asthma.Patients and methodsThe present study was conducted on 49 controlled asthmatic patients and 12 control subjects. All patients were subjected to thorough history taking, complete clinical examination and plain postero-anterior chest X-ray. All asthmatics and control subjects were subjected to routine laboratory investigations, spirometric study, EBC collection, processing and analysis for its content of both nitric oxide end products: nitrite and nitrate (NOx) and pH.ResultsAll asthmatics represented Group IT which was further divided into Group Ia: 34 patients on regular inhaled corticosteroid (ICS) therapy and Group Ib: 15 patients on no regular therapy. The control subjects represented Group II. The forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR) and forced expiratory flow during the middle portion of a forced expiration (FEF 25–75%) were significantly lower in asthmatics than control subjects. The EBC-NOx mean±SD in μmol/L in Group IT (5.99±1.63), in Group Ia (5.27±1.26) and in Group Ib (7.63±1.15) were significantly higher than in Group II (3.66±0.67) with, respectively (p=0.000), (p=0.000) and (p=0.000); and was significantly higher in Group Ib than Group Ia (p=0.000). The EBC-pH mean±SD in Group IT (7.32±0.27), in Group Ia (7.35±0.25) and in Group Ib (7.27±0.3) were significantly lower than in Group II (7.82±0.09) with, respectively (p=0.000), (p=0.000) and (p=0.000); with no significant difference between Group Ia and Group Ib. The EBC-NOx was significantly directly correlated to eosinophils count (p=0.017) and neutrophils count (p=0.002); and inversely correlated to FEV1 (p=0.016), FEV1/FVC (p=0.001), PEFR (p=0.030) and EBC-pH (p=0.003). The EBC-pH was significantly inversely correlated to eosinophils count (p=0.017) and neutrophils count (p=0.036); and directly correlated to FVC (p=0.004), FEV1 (p=0.004) and PEFR (p=0.000).ConclusionEBC-NOx is significantly higher and EBC-pH is significantly lower in asthmatic patients than in control subjects. Asthmatics receiving ICS have a lower EBC-NOx level than those not. EBC-NOx and EBC-pH were significantly correlated and both of them showed significant correlations with spirometric parameters of airway obstruction

Comparative study between intracytoplasmic morphologically selected sperm injection versus intracytoplasmic sperm injection in patients with severe male factor infertility and repeated intra cytoplasmic sperm injection failure

Background: The aim and objective of the study was to compare the results of IMSI and ICSI among infertile couples with severe male factor and repeated ICSI failure.Methods: A comparative prospective randomized controlled study was carried out in Agial IVF/ICSI center, Alexandria with sample of one hundred and forty infertile couples with severe male factor and repeated ICSI failure using ICSI or IMSI with controlled ovarian hyper-stimulation. The main outcome measures were the chemical and clinical pregnancy rates.Results: The couples were randomly subdivided equally into two groups: A, B, 70 underwent intra cytoplasmic morphologically selected sperm injection (IMSI) (group A) and 70 underwent intra cytoplasmic sperm injection (ICSI) (group B) treatment. In the IMSI group there were 19 (27.14%) women got pregnant and 51 (72.86%) did not got pregnant, while in the ICSI group, there were 14 (20.0%) got pregnant and 56 (80.0%) did not got pregnant. Using Pearson Chi-Square test there was no significant difference regarding chemical or clinical pregnancy between the two studied groups.Conclusions: The use of IMSI was proved to be of no evident role in improvement of outcome of pregnancy rate in infertile couples with severe male factor and repeated ICSI failure, as analyzed data didn't show any significant difference

Fixed gonadotropin-releasing hormone antagonist protocol versus gonadotropin-releasing hormone agonist long protocol in patients with polycystic ovary syndrome treated for intracytoplasmic sperm injection cycles

Background: Women with polycystic ovary syndrome (PCOS) are at risk of developing ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation. Use of GnRH antagonist in the general sub fertile population is associated with lower incidence of (OHSS) than agonists and similar probability of live birth but it is unclear. Our Objective was to compare the fixed GnRH antagonist and GnRH agonist long protocols in patients with PCOS undergoing IVF.Methods: In this randomized controlled trial (RCT), 200 patients with PCOS were randomly allocated in two groups: long GnRH (n = 100) and fixed GnRH antagonist protocol (n = 100).           Results: There is significant difference was observed in chemical pregnancy rate (46.0% versus 31.0%), and clinical pregnancy rate (43.0% versus 29.0%) in agonist and antagonist protocols, respectively. Duration of stimulation was significantly higher in agonist group (13.58 versus 12.381 days), respectively.  Total number of ampoules of gonadotrophin is comparable in both groups (t=1.914, p=0.057).Conclusions: The use of GnRH antagonists is more advantageous than GnRH agonists in relation to shorter duration of stimulation thus allowing a reduction in the treatment time that makes COS less costly and better patient compliance. In this study GnRH agonist shows higher pregnancy rate than antagonist, so larger studies needed to clarify their roles

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Selection of non-apoptotic, DNA intact spermatozoa: an approach to improve sperm fertilization potential

The impact of seminal reactive oxygen species (ROS), sperm DNA damage and apoptosis on male infertility remains to be fully elucidated. There appears to be a need to develop new sperm preparation techniques that consider these molecular pathways and subsequently may improve outcomes of assisted reproductive techniques (ART). The specific aims of our research were to: 1) examine the role of some sperm morphological attributes in the occurrence of ROS-mediated DNA damage; 2) test the hypothesis of using the magnetic activated cell sorting (MACS) as a sperm preparation method that excludes apoptotic sperm; 3) examine the extent of improvement in sperm parameters following MACS; and 4) identify the MACS protocol limitations and which ART procedures would benefit the most from its application. Based on our findings, we conclude that: 1) a rise in sperm DNA damage should be expected in conjunction with immature spermatozoa due to NADPH-mediated increase in ROS; 2) MACS could be considered as a feasible sorting system for the separation of non-apoptotic spermatozoa; 3) the implementation of MACS yields a sperm population characterized by higher motility, viability, more normal morphology and reduced DNA fragmentation; and 4) separated non-apoptotic spermatozoa display higher tolerance to cryopreservation and potentially better fertilization capacity as documented by higher hamster oocyte penetration. Thus, the use of MACS may significantly enhance the outcome of intrauterine insemination or in vitro fertilization where the sperm DNA integrity is expected to play a significant role in determining success rates.

Study of sleep – Related breathing disorders in patients admitted to respiratory intensive care unit

AbstractObjectivesThe purpose of this study was to assess the prevalence of SRBDs in acutely ill patients admitted to respiratory ICU.Patients and methodsThe study enrolled 72 patients admitted to respiratory ICU. All patients were subjected to full clinical examination, Epworth Sleepiness score, arterial blood gases analysis and clinical apnea score calculation. According to this latter, patients were divided into group I: without clinically suspected SRBDs and group II: with clinically suspected SRBDs. Patients in group II were subjected to polysomnography.ResultsGroup I included 21 patients while group II included 51 patients. The BMI, neck circumference and waist/hip ratio were significantly higher in group II. Hypertension was the commonest comorbidity in group II. Type II respiratory failure was the commonest cause of ICU admission in both groups of patients. The mortality rate was higher within the 28days that followed ICU admission in group I compared to group II. This latter group had a higher mortality rate later on. All patients subjected to polysomnography suffered from OSAHS, 82% of them showed associated sleep hypoventilation (SHV) with significantly elevated bicarbonate level. More than half the patients with SHV fulfilled the criteria of obesity hypoventilation syndrome. The AHI showed a significant direct correlation with neck circumference, systolic blood pressure, snoring index and T85%; and a significant inverse correlation with PaO2, minimal saturation as well as average saturation.ConclusionIn ICU patients, SRBDs are common coexistent findings and every physician should systematically search for them. Type II respiratory failure is the main cause of ICU admission in patients with SRBDs. Quality of sleep in ICU is very disturbed. Most ICU patients with SRBDs have concomitant SHVS mostly due to OHS. Important comorbidities coexist in patients with SRBDs; both influence each other and should be identified and managed properly for the wellbeing of the patient. BiPAP therapy is the cardinal mode of ventilation used in patients with respiratory failure and SRBDs

Comparison of corneal measurements in normal and keratoconus eyes using Anterior Segment Optical Coherence Tomography (AS-OCT) and Pentacam HR topographer

Abstract Background Keratoconus (KC) is easily recognized by its unique topographic pattern, but it can be difficult to distinguish subclinical form of the disease from the normal cornea. Optovue anterior segment optical coherence tomography (AS-OCT) helps diagnose KC. Aim of the work To assess and the level of agreement of Keratometry-readings (K), Central Corneal Thickness (CCT) and Thinnest Corneal Thickness (TCT) measurements obtained by Optovue AS-OCT and Wavelight Oculyzer Pentacam HR in two groups: KC eyes and normal eyes. Patients and methods This is a prospective clinical observational study. The study included 110 eyes divided into two groups. The study group included 62 eyes with topographic evidence of KC. The control group included 48 eyes of normal subjects with no topographic evidence of KC. All of the participants underwent full cycloplegic refraction, spectacle best-corrected distance visual acuity, comprehensive slit-lamp biomicroscopy and fundoscopy. All participants underwent corneal topography by Pentacam HR and AS-OCT. Results There were highly significant differences between the studied groups as regarding BCVA, intraocular pressure and CCT measurements which were found to be lower among KC group compared to the control one. There were highly significant differences between the studied groups regarding TCT measurement detected by Pentacam HR and AS-OCT which was found to be lower among the keratoconus group compared to the control one (470.9, 455.7 versus 541.9 and 518.7 respectively). Conclusion Both Scheimpflug-based imaging and AS-OCT provide comparable readings with a good agreement regarding corneal pachymetry in keratoconus group with accurate identification of KC eyes and healthy ones. However, there was a significant difference in K readings between both devices in Keratoconus and control group

Early CT and MRI signs of invasive fungal sinusitis complicating COVID-19 infection: case report

Abstract Background Corticosteroids are usually prescribed for severe cases with SARS-CoV-2 (COVID-19). Despite their importance to decrease patients’ mortality, they can cause serious side effects like fulminant fungal infection that can damage lungs or invade the sinuses then rapidly spread to the orbit and even intra-cranially. Unless early diagnosed and properly managed, patients can lose their vision or die from cavernous sinus thrombosis or other intracranial complications. Case presentation A 71-year-old diabetic male patient presented with dry cough, fever, and dyspnea for 6 days. PCR test for COVID-19 was ordered and declared positive. The oxygen saturation on day 7 started to decline to reach 90%. Eight ampules of intra-muscular dexamethasone were prescribed. The patient’s dyspnea improved, and the oxygen saturation reached 94% by day 13. Oral prednisone was prescribed in a withdrawal protocol. Unfortunately, on day 15, the patient complained of mild left-sided cheek swelling and noticeably dropped left angle of mouth. Neurological consultation suspected facial palsy and asked for brain MRI examination. Limited lower cuts of the MRI study that covered the left maxillary antrum revealed mild fullness of the pre-maxillary fat planes with mucosal thickening. Complimentary dedicated MRI and CT cuts over the left maxillary sinus showed localized signs of invasive fungal sinusitis without orbital or intracranial complications. The patient received antifungal therapy even before evident endoscopic findings appeared. He underwent endoscopic debridement few days after and he had an excellent outcome without any progression or significant morbidities. Conclusion Early CT/MRI radiological signs of invasive fungal sinusitis that complicated COVID-19 infection aid in the diagnosis and proper timely management of this fatal disease