Tertiary Trauma Survey: Nurses Performance and Polytrauma Patients’ Outcomes

Context: Tertiary Trauma Survey is an important tool for detecting missed injury, and some trauma units have created their protocol for tertiary trauma surveys to decrease the incidence of missed injuries in trauma patients.Aim: This study aims to assess nurses' performance regarding tertiary Survey and Poly-trauma patients' outcomes.Methods: Descriptive exploratory design was utilized to achieve the aim of the study. A convenient sample of all available nurses (50 nurses) working in the intensive care unit at the emergency hospital affiliated to Ain Shams University Hospitals. A purposeful sample composed of (50) adult patients diagnosed as polytrauma patients was recruited from the same units. Data was obtained through three main tools; Self-administered questionnaire for nurses, nurses practice observational checklist and clinical outcome record for patients. Results: Nurses had an unsatisfactory level of knowledge and practice regarding the tertiary trauma survey (44%&32%, respectively). There was a highly statistically significant positive correlation between the total level of knowledge and practice. There was a difference between injury severity score and laboratory, hemodynamic status, physical assessment, and radiological findings of poly-trauma patients on admission and after 24 hours. Conclusion: Less than half and less than one-third of the nurses under study had an unsatisfactory level of knowledge and practice, respectively, regarding the tertiary trauma survey. There was a highly statistically significant positive correlation between the total level of knowledge and total level practice. Polytrauma patients' outcomes revealed a statistically significant difference between injury severity score, hemodynamic status, physical assessment, and radiological findings in polytrauma patients on admission and after 24 hours. Recommendations: Further research is needed to follow the patients' outcomes and missed injuries. Replication of the current study on a larger probability sample is recommended to achieve generalization of the result. Tailored Training courses are needed for nurses to improve unsatisfactory knowledge and practices regarding tertiary trauma survey- integrated studies with the emergency medical team to communicate patients' outcome research findings

Purification and characterization of phenoloxidase from immunized haemolymph of Schistocerca gregaria

Phenoloxidase (PO) is a key factor in insect immunity. On invasion of microorganisms and pathogens, prophenoloxidase (PPO) changes to its active form, PO. The present study has been conducted to purify and characterize the PO from the haemolymph of desert locust, Schistocerca gregaria (Forskal) following activation of immune system by invasion of bacteria, Bacillus thuringiensis kurstaki (Bt). PO is purified by a combination of ammonium sulfate precipitation, blue sepharose CL-6B and phenyl sepharose CL-4B chromatography yielded a 209.97-fold purity and 54.75% recovery of activity. Sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis (PAGE) reveals that the molecular weight of the purified PO is 70.154 kDa. The purified PO is characterized in terms of its biochemical and enzymatic properties by using L-DOPA as a specific substrate. Ca2+ and Cu2+ significantly stimulated PO activity when compared with other metals. The PO reaction was strongly inhibited by phenylthiourea and thiourea, moderately inhibited by ethylene diamine tetractic acid (EDTA) and poorly inhibited by ethylene glycol tetraacetic acid (EGTA) and diethyl dithiocarbamate (DTC). Inhibition of PO showed excellent recovery ability by addition of Ca2+ on EGTA-inhibited enzyme. Therefore, PO is most probably a kind of tyrosinase-type Ca2+-containing metalloenzyme. The content of Ca2+ is higher than other trace metal elements. The reactive intermediates yielded by PO with its specific substrate L-DOPA had a broad-spectrum bactericidal activity against Gram +ve bacteria (Bacillus cereus and Staphylococcus aureus) with a greater degree more than Gram-ve bacteria (Escherichia coli and Pseudomonas aeruginosa). From the present study, PO from S. gregaria is most probably a tyrosinasetype calcium-containing mono-phenoloxidase, which functions not only as a catalytic enzyme in melanin production in locusts, but perhaps also as a humoral factor in host defense via melaninization as in other insects.Key words: Schistocerca gregaria, phenoloxidase, purification

Determination of dimenhydrinate and cinnarizine in combined dosage form in presence of cinnarizine impurity

Three accurate, sensitive and time saving spectrophotometric methods have been developed and validated for determination of mixture of dimenhydrinate (DMH) and cinnarizine (CIN) in presence of cinnarizine impurity (1-(diphenylmethyl)piperazine) (IMP). In method A; dimenhydrinate was determined by measuring 1D amplitudes at 292.0 nm while cinnarizine and its impurity were determined by 1DD method at 256.2 and 219.6 nm, respectively, using standard spectrum of 20 µg/mL of dimenhydrinate as a divisor. Method B depends on dividing spectrum of ternary mixture by standard spectrum of 20 µg/mL of dimenhydrinate and then cinnarizine and its impurity were determined in the obtained ratio spectrum by ratio difference method using the difference between 219.0 and 237.2 nm and between 230.0 and 264.0 nm, respectively. On the other hand dimenhydrinate could be determined by dividing spectrum of ternary mixture by standard spectrum of 20 µg/mL of cinnarizine and then it were determined at the obtained ratio spectrum by ratio difference method using the difference between 216.8 and 232.8 nm. Method C is the mean cantering of ratio spectra method (MCR) where the amplitudes at 234.8, 240.0 and 233.6 nm in the second mean centering ratio spectra were used for determination of dimenhydrinate, cinnarizine and its impurity, respectively. The developed methods were validated according to ICH guidelines regarding good accuracy and precision, and they were successfully applied to pharmaceutical formulation and laboratory prepared mixtures. The results were statistically compared with those obtained by reported method and no significant difference was found

Bipolar sealing devices versus endoscopic vascular staplers during laparoscopic splenectomy in children with benign hematological diseases

Background: Splenectomy, whether open or laparoscopic, is considered a step of management in many children with benign hematological diseases such as immune thrombocytopenia, thalassemia, autoimmune hemolytic anemia, and spherocytosis. The major challenge during laparoscopic splenectomy (LS) is the rich blood supply of the spleen. Many techniques were considered to control the vascular supply of the spleen. Staplers, clips, either titanium or hemoclips, a bipolar sealing device (BSD), or ultrasonic shears were all used to complete LS. We aimed to compare the results of using BSD versus endoscopic staplers for vascular control of the pedicle during LS.Patients and methods: The study was carried out on 30 children with benign hematological diseases who presented to the Pediatric Surgical Unit. They were grouped randomly into two groups: group A and group B. Group A included 15 patients who were subjected to LS in which BSD was used for vascular control, whereas group B included 15 patients subjected to LS in which endoscopic staplers were used for vascular control of the pedicle.Results: The mean age of the children in group A was 9.60 years, whereas the mean age of the children in group B was 10.40 years. In group A, the mean estimated amount of blood loss was 72.27 ml. However, this was 80.67ml in group B. In group A, the mean operative time required was 39.00 min, whereas it was 56.27 min in group B. The indications for splenectomy were thalassemia in 15 cases (seven for group A and eight for group B), idiopathic thrombocytopenic purpura in 13 cases (seven for group A and six for group B), and spherocytosis in two cases (one for each group). The mean splenic size in group A was 10.43 cm, whereas it was 11.73 cm in group B.Conclusion: LS has evolved over the last decade because of the advancements of BSDs and endoscopic staplers. According to our data the use of LigaSure reduces the overall operative time, operative blood loss, and associated complications compared with the use of staplers.Keywords: children, laparoscopic, splenectom

Spatiotemporal analysis of Highly Pathogenic Avian Influenza (H5N1) outbreaks in poultry in Egypt (2006 to 2017)

BACKGROUND: In Egypt, the highly pathogenic avian influenza (HPAI) subtype H5N1 is endemic and possesses a severe impact on the poultry. To provide a better understanding of the distributional characteristics of HPAI H5N1 outbreaks in Egypt, this study aimed to explore the spatiotemporal pattern and identify clusters of HPAI H5N1 outbreaks in Egypt from 2006 to 2017. RESULTS: The Epidemic curve (EC) was constructed through time series analysis; in which six epidemic waves (EWs) were revealed. Outbreaks mainly started in winter peaked in March and ended in summer. However, newly emerged thermostable clades (2.2.1.1 and 2.2.1.2) during the 4th EW enabled the virus to survive and cause infection in warmer months with a clear alteration in the seasonality of the epidemic cycle in the 5th EW. The endemic situation became more complicated by the emergence of new serotypes. As a result, the EC ended up without any specific pattern since the 6th EW to now. The spatial analysis showed that the highest outbreak density was recorded in the Nile Delta considering it as the ‘Hot spot’ region. By the 6th EW, the outbreak extended to include the Nile valley. From spatiotemporal cluster epidemics, clustering in the Delta was a common feature in all EWs with primary clusters consistently detected in the hot-spot region, but the location and size varied with each EW. The highest Relative Risk (RR) regions in an EW were noticed to contain the primary clusters of the next EW and were found to include stopover sites for migratory wild birds. They were in Fayoum, Dakahlia, Qalyobiya, Sharkia, Kafr_Elsheikh, Giza, Behera, Menia, and BeniSuef governorates. Transmission of HPAI H5N1 occurred from one location to another directly resulted in a series of outbreaks forming neighboring secondary clusters. The absence of geographical borders between the governorates in addition to non-restricted movements of poultry and low vaccination and surveillance coverage contributed to the wider spread of infection all over Egypt and to look like one epidemiological unit. CONCLUSION: Our findings can help in better understanding of the characteristics of HPAI H5N1 outbreaks and the distribution of outbreak risk, which can be used for effective disease control strategies. GRAPHICAL ABSTRACT: [Image: see text

ASSESSMENT EFFECT OF ALOE VERA, AZADIRACHTA INDICA AND MORINGA OLEIFERA AQUEOUS EXTRACTS ON CARBON TETRACHLORIDE-INDUCED HEPATOTOXICITY IN RATS

Objective: This experiment aims to investigate the hepatotherapeutic effect of Aloe vera (AV), Azadirachta indica (N), and Moringa oleifera (MO).Methods: Eighty albino rats have been divided into ten groups. The first group was fed on a basal diet while the second group was administered paraffin (10 ml/kg body weight) through gavage for four days. The third to the tenth groups received (5 ml/kg body weight) CCl4: liquid paraffin (2:1) for three days followed by (10 ml/kg body weight) CCl4: liquid paraffin (2:1) for one day through gavage. Group three kept without any treatment, other groups then received (AV) (60 mg/kg body weight), (MO) (200 mg/kg body weight), (N) (200 mg/kg body weight), bi-extract of (AV+N), bi-extracts of (AV+MO), bi-extract of (MO+N), and tri-extracts of (AV+N+MO) respectively for 36 d. The liver and blood were studied for hepatotoxicity and antioxidant indices.Results: Biochemical and histopathological analysis revealed that CCl4 elevated plasma liver enzymes (aspartate transaminase, alanine aminotransferase, and gamma glutamyl transferase). Carbon tetrachloride also caused an elevation in erythrocyte content of glutathione with a concomitant increase in the plasma malondialdehyde content, along with marked atrophy of hepatocytes. However, these effects were ameliorated by the treatment of rats with the different extracts.Conclusion: Results showed that administration of the aquatic extracts of Aloe vera, Neem, and Moringa (separately/mixedly) played a therapeutic role against CCl4-induced liver damage by improving liver enzyme activities, antioxidant blood parameters, and a liver histopathological picture of intoxicated rats.Keywords: Aloe vera, Azadirachta indica, Moringa oleifera, CCl4 hepatotoxicity, Antioxidant, Rat hepatocyte

Central Venous Oxygen Saturation as a Predictor of the Outcome of Weaning From Mechanical Ventilation

Weaning from mechanical ventilation represents a corner stone of management of critically ill patients. Successful weaning represents a great achievement in patient's critical course in the ICU. This makes the process of weaning one of the most difficult steps in ICU care, for those reason, such a study was done to create a new thinking about the predictors that facilitate patient weaning from mechanical ventilator. The aim of this study is to evaluate the central venous saturation as a predictor of the outcome of weaning from mechanical ventilation. Cohort, unicentric, clinical study research design was utilized in the current study. Sample consists of one hundred and twenty patients over a one year period, all patients passed the first SBT (spontaneous breathing trial) and weaned successfully from mechanical ventilation were extubated after undergoing a two-step weaning protocol (measurements of predictors followed by a T-tube trial). Extubation failure was defined as the need of re-intubation within 48 hrs. The weaning protocol evaluated hemodynamic, ventilation parameters, arterial and venous gases during mechanical ventilation (Immediately before T-tube trial), and at the 30th min of spontaneous breathing trial. Findings of this study show that re-intubation rate was 30%. Analysis by logistic regression revealed that central venous saturation was the only variable able to discriminate outcome of extubation. Reduction of central venous saturation by >5% was an independent predictor of re-intubation, with odds ratio of 52.6 (95% confidence interval =16.34–169.42), a sensitivity of 87%, and a specificity of 90%. Reduction of central venous saturation during spontaneous breathing trial was associated with extubation failure and could reflect the increase of respiratory muscles oxygen consumption. Results of the present study indicated that central venous saturation was an early and independent predictor of extubation failure and may be a valuable accurate parameter to be included in weaning protocols. Keywords: Central Venous Saturation - Mechanical Ventilation - Extubation

Day case laparoscopic cholecystectomy in Sudan

Background: Laparoscopic surgery faces lots of constraints in the less developing countries. The aim: To audit day-case laparoscopic cholecystectomy in our set up in Sudan. Method: Prospective collection of data for 602 consecutive laparoscopic cholecystectomies. 136 patients were discharged 10 hours after surgery. They were selected according to clinical and social criteria. Pain, nausea and vomiting, operative time, period of hospitalization and patient satisfaction were studied. Results: 136 patients operated as day case have mean (±SD) age 46.92(± 14.95) years and ASA score I (n = 122), II (n = 14) and their mean operative time (±SD) was 61.62 (±24.17) (range 25-150) min. There was no conversion or common bile duct injury. 122 patients were pleased with the day case procedure, 12 were satisfied and two thought that overnightstay could have been better. Conclusion: Success of day case laparoscopic cholecystectomy is reflected by the annual steadily increasing number of patients from 25 in 1998 to 50 in 2002. Good planning, patient selection, and encouragement of early mobilization make postoperative hospitalization unnecessary in the majority of cases. Keywords: ambulatory cholecystectomy, laparoscopic cholecystectomy Sudan Journal of Medical Sciences Vol. 1(1) 2006: 48-5