Abstract:

Context:

 Patients in the intensive care unit (ICU) are at risk not only from their critical illness but also from secondary processes such as nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients.   Indeed, diagnosis of ventilator associated pneumonia (VAP) requires a high clinical suspicion combined with bedside examination, radiographic examination, microbiologic analysis of respiratory secretions, and blood test.

Aims: This study aimed to evaluate the effectiveness and accuracy of lung ultrasound for VAP diagnosis and follow-up.

Settings and Design: A prospective cohort study was done on 74 patients, with total number of 54 with high likelihood of VAP and 20 with low likelihood of VAP

Methods and Material:Mechanically ventilated patients for 48 hours or more were included. We calculated Clinical pulmonary infection score and Lung Ultrasound was performed within 24 hours.

Statistical analysis used:Data were collected and analyzed by using SPSS (Statistical Package for the Social Science, version 20, IBM, and Armonk, New York). Quantitative data were expressed as mean ± standard deviation (SD) and compared with Student t test. Nominal data were given as number (n) and percentage (%). Chi₂ test was implemented on such data.

Results:

Based on Clinical pulmonary infection score (CPIS) with cutoff point (≥ 6), the sensitivity of transthoracic ultrasound was 81.5%, the specificity was 82% and the accuracy was 81.6%. Regarding sonographic signs, the highest sensitivity was for sub-pleural dots of consolidation 82%, then B-lines 56%, followed by pleural effusion and air bronchogram both 19%. Highest specificity was for air bronchogram 100%, then B-lines and pleural effusion both 90%, followed by sub-pleural dots of consolidation 80%. Positive predictive value for transthoracic ultrasound was 92%, Area under the receiver operation characteristics (ROC) curve (AUC) for total ultrasound score was 0.82.

Conclusions: Transthoracic ultrasound is an easy bedside tool for diagnosis and follow up of ventilator associated pneumonia.

Key-words: Ventilator associated pneumonia, Clinical pulmonary infection score, Lung Ultrasounds, intensive care unit

Key Messages: 

Transthoracic ultrasound is a useful and convenient bed-side tool for diagnosis and follow up of ventilator associated pneumonia. It should be established as a reasonable tool in early diagnosis due to its availability, being easy to use and low cost. This helps in starting early treatment with antimicrobial therapy.

Background: Diffuse large B-cell lymphoma (DLBCL) is considered the most common lymphoid malignancy that represented about 35% of adult non-Hodgkin lymphomas (NHL). Although most patients can be cured with the Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone (R-CHOP) regimen, many patients die due to relapsed disease. In this study, we aim to assess the clinicopathological characteristics of relapsed DLBCL, not otherwise specified (NOS).

Methods: This is a retrospective study conducted on 16 cases of relapsed DLBCL (relapsed group). Meanwhile, 27 cases with DLBCL who capable of attaining complete remission (CR) for 36 months were used as control (CR group).

Results: clinically, most patients in the relapsed group were male (62.5%). The relapsed group had a significant difference in comparison to the CR group as regard bone marrow involvement (P= 0.003), serum lactate dehydrogenase (LDH) level (P= 0.005), B symptoms (P= 0.007), performance status (PS)(P= 0.008), international prognostic index (IPI)(P= 0.000) and age-adjusted IPI (P= 0.017). Pathologically, relapsed DLBCL was associated with negative CD10 expression (P= 0.001), negative BCL6 expression (P= 0.047), and nongerminal center B-cell (non-GCB) phenotype (P= 0.018). Conclusions: patients with bone marrow involvement, abnormal serum LDH level, B symptoms, poor PS, intermediate to high IPI & AA-IPI, non-GCB phenotype, lower CD10, and BCL6 expression are more likely to relapse.

Cisplatin (CDDP) is an effective chemotherapeutic drug that has been used successfully in treating various tumors. Although its higher antineoplastic agent activity, CDDP exhibited severe side effects that limit its use. CDDP-induced toxicity is attributed to oxidative stress and inflammation. Apocynin (APO) is a bioactive phytochemical with potent antioxidant and anti-inflammatory properties. However, pharmaceutical experts face significant hurdles due to the limited bioavailability and quick elimination of APO. Therefore, we synthesized a chitosan (CTS)-based nano delivery system using the ionic gelation method to enhance APO bioactivity. CTS-APO-NPs were characterized using different physical and chemical approaches, including FTIR, XRD, TGA, Zeta-sizer, SEM, and TEM. In addition, the protective effect of CTS-APO-NPs against CDDP-induced nephrotoxicity, hepatotoxicity, and cardiotoxicity in rats was evaluated. CTS-APO-NPs restored serum biomarkers and antioxidants to their normal levels. Also, histopathological examination was used to assess the recovery of heart, kidney, and liver tissues. CTS-APO-NPs attenuated the oxidative stress mediated by Nrf2 activation while it dampened inflammation mediated by NF-κB suppression. CTS-APO-NPs is a potentially attractive target for more therapeutic trials.

background: There is a rise in the importance of evaluating the negative impact of illnesses on quality of life from the patient’s perspective. The burdens of refractive error (RE) on perceived visual functions have not been yet explored among Egyptian youth. The study aimed to determine the prevalence of self-reported RE and its association with perceived vision-related quality of life among Egyptian university students.
Methods: A cross-sectional study was conducted on 821 students at Assiut University, Upper Egypt. Data was collected using a questionnaire filled by students. It composed of personal criteria, a self-report of RE and its type, the used visual aids for RE, and the visual function questionnaire (VFQ -25). Ishihara’s test was used for the assessment of color vision.
Results: About 25% reported having a refractive error, and the most reported RE type was myopia. Among students with RE, nearly 76% used visual aids, and eyeglasses were used by most of students for their visual aid (90.6%). Adjusted by age and gender, RE significantly predicts low scores of perceived general health, ocular pain, mental health, dependency, role difficulties, both near and distant activities, and peripheral vision. No significant association was detected between RE and social functioning, driving ability or colored vision.
Conclusions:
Refractive error is a prevalent illness especially myopia among Egyptian university students. RE negatively affects vision-related quality of life. Accurate correction of RE and provision of subsidized visual aids may help to mitigate the adverse effect of RE on the perceived visual functions.

Background

Inadequate acute postoperative pain control after modified radical mastectomy (MRM) can compromise pulmonary function. This work aimed to assess the postoperative pulmonary effects of a single-shot thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in female patients undergoing MRM.

Methods

This prospective, randomized comparative trial was conducted on 40 female American Society of Anesthesiologists (ASA) II-III, aged 18 to 50 years undergoing MRM under general anesthesia (GA). Patients were divided into two equal groups (20 in each group): Group I received ESPB and Group II received TPVB. Each group received a single shot with 20 ml volume of 0.5% bupivacaine.

Results

Respiratory function tests showed a comparable decrease in forced vital capacity (FVC) and forced expiratory volume (FEV1) from the baseline in the two groups. Group I had a lower FEV1 …

This study compared the clinical outcomes of the two main neurophysiological types of Guillain-Barré Syndrome (GBS). Sixty-two GBS patients were examined clinically at onset using Medical Research Council (MRC), Hughes disability scales (HDS), and nerve conduction studies were evaluated in four limbs. The Modified Erasmus GBS outcome score (MEGOS) was assessed 2 weeks after onset. Outcomes were measured after 3 months using MRC and HDS scores. According to electrophysiological data two main groups identified acute inflammatory demyelinating polyneuropathy (AIDP = 31 cases) or acute axonal GBS including inexcitable forms (26 cases). The number of days between onset of weakness and admission was significantly shorter, and gastrointestinal symptoms were significantly higher among the axonal type than AIDP. MRC sum scores at onset and at nadir were significantly worse in the …

N-acetyl cysteine can blunt metabolic and cardiovascular effects via down-regulation of cardiotrophin-1 in rat model of fructose-induced metabolic syndrome

CD10 is widely expressed in various tumor types and their surrounding cancer associated fibroblasts; and correlate withpoor prognosis. In present study CD10 immunohistochemical expression in stromal fibroblasts surrounding urothelialcarcinoma and its relationship with clinicopathological parameters were investigated.

Patients and Methods

Formalin-fixed paraffin embedded tissue sections from 106 urothelial cancer specimens werestained with CD10 antibody using immunohistochemistry technique. Expression of CD10 in the stromal cells was thenanalysed to evaluate its association with different clinicopathological variables.

Results

Stromal CD10 expression was significantly associated with each of high grade (P<0.001), invasive tumor,advanced stage (P<0.001), squamous differentiation of tumor cells (P=0.02) and papillary architecture (P<0.001). Therewas no significant association between stromal CD10 expression and, and patient age, sex and tumor size.

Conclusion

Increased expression of CD10 in cancer associated fibroblasts was strongly correlated with tumorprogression and invasion

Background:

CD44 is an epithelial-mesenchymal transition (EMT) surface receptor that regulates the interactivity between the cells and the extracellular matrix, thereby promoting cell migration. The epidermal growth factor receptor (EGFR) family is a trans-membrane kinase-related protein. It regulates cell adhesion proteins, which may promote cell proliferation and invasiveness. Mesenchymal epithelial transition (MET) is another EMT receptor that stimulates cell proliferation, invasion, survival, and angiogenesis. This study aimed to evaluate the prognostic impact of CD44, EGFR expressions, and MET gene amplification in epithelial ovarian cancer (EOC).

Methods:

This is a retrospective cohort study, including 85 cases of EOC. CD44 and EGFR expressions were evaluated in both epithelial and stromal cells by immunohistochemistry. Tumor cells also underwent a cytogenetic analysis using fluorescent in situ hybridization (FISH) to detect MET gene amplification.

Results:

High CD44 expression in tumors was significantly associated with serous subtypes (P=0.001), peritoneal deposits (P=0.002), and advanced stage (P=0.002). EGFR high tumor expression demonstrated a significant association with lymph node metastasis (P=0.038) and the advanced stage of EOC (P=0.016). Increased copy number of the MET gene was significantly associated with partial therapy response (P=0.030). CD44 and EGFR tumor high expression was associated with poor overall survival (OS). In addition, MET gene gain in tumors was associated with a shorter OS (P=0.000).

Conclusion:

EMT biomarkers (CD44 and MET) and EGFR expression in EOC are independent prognostic factors for OS. MET gene increase copy number was detected in cases of serous neoplasm and associated with poor survival and minimal therapy response.