ORIGINAL_ARTICLE
IMPACT OF SPONTANEOUS BREATHING TRIAL USING T-TUBE COMPARED TO PRESSURE SUPPORT VENTILATION ON RESPIRATORY FUNCTIONAL PARAMETERS IN CRITICALLY ILL PATIENTS
Introduction: Spontaneous breathing with a conventional T-tube (TT) connected to the endotracheal tube has been frequently used in weaning from mechanical ventilation (MV), when compared with pressure support ventilation (PSV). However, the acute effects of spontaneous breathing using TT versus PSV on respiratory functional parameters (PaCO2 and SaO2) have not been fully demonstrated.
Objective: The purpose of this study was to examine the effects of weaning using spontaneous breathing in TT compared to PSV on respiratory functional parameters in critically ill patients.
Method: Twenty-six patients who had received MV for more than 48h and met the inclusion criteria for weaning were assessed. The patients were randomized into 2 groups. first group weaned using TT and second weaned using PSV. Respiratory functional parameters included pressure of carbon diaxoide (PaCO2), peripheral oxygen saturation (SpO2) were measured.
Results: PSV mode had statistically significantly lower PaCO2 than TT mode during weaning (P<0.001). Also, PSV mode had statistically significantly higher SaO2 than TT mode during weaning (P=0.007).
Conclusion: PSV improves oxygenation and ventilation of patients during weaning from mechanical ventilation.
https://zumj.journals.ekb.eg/article_13248_d17e0e46b398f56dca8dba8a715a99dd.pdf
2018-09-01
359
364
10.21608/zumj.2018.13248
ediatric intensive care unit – mechanical ventilation
Amal
Abdel-Latif
1
AUTHOR
Dalia
Abdel-Rahman
2
AUTHOR
Mohamed
Elanani
3
AUTHOR
ORIGINAL_ARTICLE
GROWTH IN CHILDREN WITH CONGENITAL HEART DISEASES.
Background:Children with congenital heart disease (CHD) commonly experience delayed growth. Because growth and development are closely related, both should be considered when a child’s progress is examined.A longitudinal study was made of height and weight growth in children with cyanotic and acyanotic congenital heart disease. Values were compared to agroup of children without heart disease. Retardation in height and weight was noted in all children with cardiac disease but was more pronounced in those with cyanosis.
Aim: To compare growth in children with congenital heart disease and normal children. Materials and Method :case-control study ,the study took place in out_patient clinic and cardiology unit of pediatric department of faculty of medicine in Zagazig Univesity of Zagazig University Hospitals This study was conducted on 30 infants & children ( 16 males & 14 females )with congenital heart diseases attending the pediatric cardiology unit in zagazig University hospital, over a period of 6 months from february 2017 till July 2017, their age ranged from 2 months to 2 years old. Thirty healthy children of sex & age matched to patients were taken as control group.Results :Asignificant difference was found in both body height (P<0.05) and weight (P<0.05) between the two groups. More children with congenital heart disease were below the 50th percentile in height (P<0.05) and weight(P<0.001). Conclusion:Children with CHD were retarded in growth than normal children. Learning about the growth and developmental differences between children with CHD and normal children may help parents of the former to detect problems associated with delayed growth and development earlier. \
https://zumj.journals.ekb.eg/article_13254_112c61c048cefdd68c38d1762c05ae7d.pdf
2018-09-01
365
370
10.21608/zumj.2018.13254
Growth
Development
Nursing
Congenital heart disease
children
Eman
elmoghazy
1
AUTHOR
Alshayma
Ali
2
AUTHOR
Naglaa
khalifa
3
AUTHOR
Ahmed
Salah
4
AUTHOR
ORIGINAL_ARTICLE
THE EFFECT OF MODERATE EXERCISE ON MONOCYTE CHEMO-ATTRACTANT PROTEIN-1 IN ATHEROGENIC OVARIECTOMIZED RATS
Background: Cardiovascular disease (CVD) is one of the leading causes of death worldwide and is more prevalent in post-menopausal women. Monocyte chemo-attractant protein-1(MCP-1) is a chemokine that attracts monocytes/macrophages to sites of inflammation and play a role in development of atherosclerosis. Objective: This study aimed to explore the effects of ovariectomy (Ovx) as a model of menopause on the serum level of MCP-1 in high fat diet induced atherogenesis and clarify the modulatory effects of moderate exercises on the serum level of MCP-1 in this model. Animals and methods: 96 female albino rats divided equally into 4 groups, each is subdivided equally into 2subgroups subgroup (Ia): non ovx ,sedentary, fed standard diet for 10 weeks, subgroup (Ib): non ovx ,sedentary, fed high fat diet for 10 weeks. Subgroup (IIa) ovx sedentary, fed standard diet for 10 weeks subgroup (IIb): ovx, sedentary fed high fat diet for 10 weeks. Subgroup (IIIa): non ovx ,exercised and fed standard diet for 10 weeks. subgroup (IIIb) non ovx ,exercised and fed high fat diet for 10 weeks. Subgroup (IVa): ovx ,exercised and fed standard diet for 10 weeks. subgroup (IVb) ovx ,exercised and fed high fat diet for 10 weeks. Results: in ovx obese sedentary rats, there was a significant (p <0.001) increase in MCP-1,Lipid profile, Atherogenic indices, Platelets activation percentage, Total leucocytic counts, Differential monocyte counts, and Interleukin 8 and aortic thickness versus lean subgroup. Swimming exercise showed significant (p <0.001) reductions in the above parameters, associated with significant increase in the serum HDL level in ovx obese exercised subgroup versus ovx obese sedentary subgroup. Conclusions: MCP-1 level increased in obesity and menopause leading to development of atherosclerosis and these changes could be reversed by adaptive moderate exercises.
https://zumj.journals.ekb.eg/article_13256_801f14978b3d4602cfd8aee17d2cf7a9.pdf
2018-09-01
371
385
10.21608/zumj.2018.13256
MCP-1
Ovariectomy
Obesity
Atherosclerosis
Swimming exercise
Mohammed
Abd EL hamed
1
AUTHOR
El sayed
Ahmed
2
AUTHOR
Shereen
Bedair
3
AUTHOR
Heba
El sayed
4
AUTHOR
ORIGINAL_ARTICLE
PREDICTION OF WEANING FAILURE OF MECHANICAL VENTILATION USING CLINICAL PARAMETERS IN PICU
Background:Mechanical ventilation is a life support intervention that is used for a large number of patients in Pediatric intensive care units. The current pediatric literature shows that the science of ventilator weaning and extubation remains undetermined. No optimal weaning method has been described for a more rapid and successful extubation.
Objective:Weaning predictors are used as a decision point in protocols to determine whether a patient may advance to a spontaneous breathing trial. We designed a study to determine the effect of including a weaning predictor (clinical weaning parameters) in a weaning protocol.
Subjects & Methods:
Cross section study was conducted on 53 children who admitted to PICU. All patients should be eligible for weaning from mechanical ventilation. Clinical data and laboratory investigations were obtained on admission. Patients underwent a spontaneous breathing trial (SBT) after reversal of the underlying cause for respiratory failure and when they met all the weaning criteria. Then Rapid shallow breathing index (RSBI) was performed. As RSBI ≤ 8 breath/min/ml/kg, PaO2 > 60 mmHg, Pa CO2 < 50 mmHg, FiO2 < 0.5, PaO2/FiO2 > 200 mg, Tidal volume (VT) > 5 ml/kg, Ve >200 ml/min/kg, PEEP < 5 CmH2O and RR < 45 breath/min.
Weaning failure is defined as the inability to sustain spontaneous breathing without any form of ventilator support, for at least 48 h. The results were tabulated and analyzed with SPSS.
Results:RSBI differed significantly between patients who succeeded weaning from mechanical ventilation and those who failed (3.12±1 vs. 9.5±1.04 breath/min/ml/kg; P < 0.001). A cutoff value ≥3.5 breath/min/ml/kg on were associated with a prediction of failure of weaning from mechanical ventilation with a 100%sensitivity, 75% specificity,0.724 positive predictive value (PPV), 1 negative predictive value (NPV) and 84.91% accuracy.
Conclusion and key messages:Clinical weaning parameter could be considered a sensitive and specific marker for prediction of weaning failure.
https://zumj.journals.ekb.eg/article_13261_8c132dd8ce2d2117542d99f2645d885f.pdf
2018-09-01
386
393
10.21608/zumj.2018.13261
Weaning
Extubation
Mechanical Ventilation
pediatric intensive care unit
weaning criteria
spontaneous breathing
Rabab
El-Beheidy
1
AUTHOR
Dalia
Abdulrahman
2
AUTHOR
Sameh
Bayoumi
3
AUTHOR
Walaa
Hassan
4
AUTHOR
ORIGINAL_ARTICLE
THE DEMOGRAPHIC PROFILE, CLINICAL PRESENTATION & ANGIOGRAPHIC PREVALENCE AND PATTERN OF CORONARY ARTERY DISEASE IN WOMEN UNDERGOING CORONARY ANGIOGRAPHY.
Objectives: The aim was to define the demographic profile, clinical presentation and angiographic prevalence and pattern of coronary artery disease (CAD) in women undergoing coronary angiography.
Data Sources: Medline databases (Pub Med, Circulation, American Heart Journal, British Medical journal and Science Direct) and also materials available in the Internet. The search was performed in the electronic databases from 2013 to 2017.
Study Selection: The initial search presented 150 articles of which 25 met the inclusion criteria. The articles studied the demographic Profile, clinical Presentation of CAD in women and also studied angiographic prevalence and pattern of CAD in women.
Data Extraction: If the articles did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.
Data Synthesis: Comparisons were made by structured review with the results tabulated.
Findings: In total 25 potentially relevant publications were included. The articles discussed the characteristics and risk factors attributed to CAD in Women, and also studied angiographic prevalence and pattern of CAD in women.
Conclusion: cardiovascular risk factors are highly prevalent among women and the combination of risk factors is common. Interventions to minimize CAD in our population are needed.
https://zumj.journals.ekb.eg/article_13262_596914135a742277e2bfa0d04569d1fc.pdf
2018-09-01
394
403
10.21608/zumj.2018.13262
Coronary Artery Disease
risk factors
Chest Pain
Coronary angiography
Women
Ahmed
Emara
1
AUTHOR
Morad
Beshay
2
AUTHOR
Mohamed
Gado
3
AUTHOR
ORIGINAL_ARTICLE
ROLE OF INTERLEUKIN-23 AS A MARKER OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS PATIENTS
Background: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease. The pathogenesis of RA is mediated by an interdependent network of cytokines which has been extended to include the cytokine, IL-23. IL-23 production appears to be of great importance in the inflammatory reaction in RA.
Objectives: We aimed in this study to estimate interleukin-23 (IL-23) level in the sera of rheumatoid arthritis (RA) patients and to determine its relation with disease activity.
Subjects and methods: This study was carried out on 40 patients with RA, and 40 healthy control subjects. RA disease activity was measured by 28-joint disease activity score (DAS-28). All patients were subjected to full history taking, thorough clinical examination, radiological and laboratory investigations including c- reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), anti cyclic-citrullinated peptide (anti-CCP) antibodies. Serum IL-23 was measured by enzyme-linked immunosorbent assay (ELISA).
Results: In RA patients serum IL-23 level was significantly elevated in comparison to the healthy controls (p<0.001). There was a significant positive correlations between IL-23 level and DAS 28 score. The highest level was detected in patients with high disease activity (p=0.03). There was statistically significant correlation between IL-23 levels and ESR, CRP, RF, anti-CCP antibodies.
Conclusion: IL-23 could be a useful marker for disease activity in RA.
https://zumj.journals.ekb.eg/article_13265_2de071c7e1f33711245a56b239187095.pdf
2018-09-01
404
408
10.21608/zumj.2018.13265
IL-23
Rheumatoid Arthritis
DAS-28
Mazen
Al Sheikh
1
AUTHOR
Abeer
El-shafey
2
AUTHOR
Heba
Gawish
3
AUTHOR
Enas
El desoky
4
AUTHOR
ORIGINAL_ARTICLE
The RELATION OF SERUM IRISIN LEVEL WITH METABOLIC AND HORMONAL CHANGES IN RAT MODEL OF POLYCYSTIC OVARY
Background: Polycystic ovary syndrome (PCOS) is one of the leading causes of infertility in female. It is usually associated with insulin resistance (IR), obesity, hyperlipidemia, and type II diabetes. Irisin is amyokine which increases energy expenditure and protects against insulin resistance and obesity. There were controversial studies about the levels of irisin and its relation to hormonal and metabolic changes in PCOS. This study was designed to estimate serum level of irisin in letrozole-induced PCOS in both lean and obese female rats, and to study the link between serum irisin level and some metabolic and hormonal parameters in PCOS.
Material and Methods: This study was conducted on 48 young virgin female of local strain albino rats. They were randomly divided into 2 equal groups: Group I: lean group were fed on normal laboratory chow diet and Group II: A high fat diet induced obesity group and each group was subdivided into group A (control) and group B (letrozole induced PCOS). Fasting serum irisin, Lutenizig hormone (LH), Folliclular stimulating hormone (FSH), testosterone, estradiol, progesterone, insulin, glucose, triglycerides, cholesterol, LDL and HDL levels were estimated. In addition, body mass index (BMI) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were calculated in all groups at the end of the experiment.
Results: Serum irisin level was elevated in both lean and obese PCOS groups when compared to both lean and obese control groups. In addition, obese PCOS group had significant higher level of irisin when compared to lean PCOS group.
Conclusion: Serum irisin level was positively correlated with BMI, HDL and testosterone levels and negatively correlated with HOMA- IR, insulin, cholesterol, triglycerides and LDL levels. Irisin may have a role in the development of polycystic ovary syndrome.
https://zumj.journals.ekb.eg/article_13266_148045215097788e2a722c9d31af6185.pdf
2018-09-01
409
419
10.21608/zumj.2018.13266
Irisin – PCOS- lean – obese
Mohamed
Ibrahim
1
AUTHOR
Soad
Ahmed
2
AUTHOR
Doaa
Abdel Moety
3
AUTHOR
Sherein
Elsayed
4
AUTHOR
ORIGINAL_ARTICLE
EFFECT OF INFECTION CONTROL PROGRAM ON CATHETER ASSOCIATED URINARY TRACT INFECTION IN INTENSIVE CARE UNITS AT ZAGAZIG UNIVERSITY HOSPITAL
Background: Catheter-associated urinary tract infection produces substantial morbidity in hospitalized patients including discomfort, fever, malaise and unnecessary antibiotic use, which may become an important source of antibiotic resistant organisms. Further, the catheterized urinary tract acts as a reservoir for the dissemination of these drug resistant organisms to other patients.
Aim of the study: was to improve the safety of intensive care unit (ICU) patients with urinary catheter via decreasing the incidence of catheter-associated urinary tract infection (CAUTI) at Zagazig University Hospital through assessment of knowledge and practice of ICU staff about catheter associated infection and assessment of the incidence of CAUTI among ICU patients in Zagazig University Hospital and implementation of Infection Control Program in the selected ICUs.
Subjects and methods: An interventional study (one-group pre-test post-test design) was conducted during the period from 2016 to 2018 at Zagazig university Hospital in two ICUs; surgical and emergency intensive care units. The study was carried out through two phases; the first included the followings: active electronic surveillance for (CAUTI); assessment of health care providers' knowledge about CAUTI before and after intervention through constructed questionnaire and assessment of health care providers' practice before and after intervention by using performance observation checklist. The second phase, included implementation of infection control program based on the conceptual model of Comprehensive Unit-based Safety Program (CUSP).
Results: There was a high statistical significant increase in knowledge of resident physicians and nurses about guidelines for prevention of catheter associated urinary tract infection in the studied intensive care units after intervention (P ˂0.01). There was high statistical significant improvement in urinary catheterization practice in the studied intensive care units after intervention (P ˂0.01). Regarding incidence of CAUTI, before intervention, CAUTI incidence was 10.6 per 1000 urinary catheter days. After intervention, CAUTI incidence significantly dropped to 5.4 per 1000 urinary catheter days. Risk of CAUTI before intervention was approximately twice that after intervention. The intervention reduced risk of CAUTI by 49.1%. Regarding isolated pathogens associated with reported CAUTI, the most frequent isolated pathogens were Klebsiella spp. (31.4%), followed by Candida albicans (21.4%), Pseudomonas spp. (14.3%) and E. coli (12.9%)
Conclusion: At Zagazig university hospitals’ ICUs, implementation of infection control program on CAUTI was noticed to be associated with improvement in healthcare providers’ knowledge and practice and decrease in CAUTI incidence. Sustainability is required to maintain such improvement. So. It is recommended to keep continuous training of ICU staff and upgrade ICU protocols according to recent guidelines.
https://zumj.journals.ekb.eg/article_13268_f726639619621dcbada080163a28f227.pdf
2018-09-01
420
436
10.21608/zumj.2018.13268
Infection control
Catheter Associated Urinary Tract Infection
Intensive Care Units
Seham
Selim
1
AUTHOR
Amany
Abo El-Seoud
2
AUTHOR
Abd Allah
Mohamed
3
AUTHOR
Salah
Ibrahim
4
AUTHOR
ORIGINAL_ARTICLE
ORAL METFORMIN VERSUS INSULIN IN TREATMENT OF GESTATIONAL DIABETES MELLITUS
Objective: The aim of this study is to compare the efficacy of metformin with that of insulin in treatment of gestational diabetes mellitus (GDM).
Subjects & Methods: The study included 94 pregnant women who have been diagnosed as gestational diabetics at 25-33 weeks gestation with singleton pregnancy. They had fasting blood glucose (FBG) level ranging from 95-120 mg/dl or 2-hour postprandial blood glucose (PPBG) level ranging from 120-190 mg/dl. The exclusion criteria include pregnant women with preexisting DM and underlying diseases known to affect fetal growth or drug clearance. All patients were randomized to receive metformin (n=47) or insulin (n=47).
Results: There were no significant differences between the two groups regarding maternal age, gravidity, parity, GA at time of diagnosis, GA at beginning of treatment, and BMI at time of diagnosis. Additionally, it was noticed that women in the metformin treated group reached sooner to the glucose targets and maternal weight gain was less in the metformin treated group. It was found that women who required supplemental insulin had higher BMI, earlier gestational age at the start of treatment and higher levels of FBG and 2 hours glucose level at time of diagnosis.
Conclusion: Analysis of the results revealed that metformin was an effective medication for control of blood glucose in women with GDM who failed to achieve euglycemic with diet only.
https://zumj.journals.ekb.eg/article_13270_d049935a7c6a93f29f2a60284cba8e69.pdf
2018-09-01
437
448
10.21608/zumj.2018.13270
Ali
Ali
1
AUTHOR
Mohamed
Mohamed
2
AUTHOR
Mostafa
Ahmed
3
AUTHOR
ORIGINAL_ARTICLE
EFFECT OF NON-SELECTIVE BETA BLOCKERS ON ESOPHAGEAL VARICES AND PORTAL VEIN DIAMETER IN CIRRHOTIC HCV PATIENTS
Background: Esophageal varices is one of the major complications of portal hypertension and one of the main causes of death in cirrhotic patients, so prophylaxis from esophageal varices bleeding can decrease the number of deaths in those patients.
Aim of the work: To assess the effect of non-selective beta blockers on portal vein diameter and grades of esophageal varices.
Subjects and methods: Our study was carried out at Gastroenterology and Hepatology unit, Internal Medicine department, Zagazig University hospital. Forty patients with HCV positive liver cirrhosis were enclosed in the study. All were Child Pugh grade A and B, diagnosed by clinical examination, laboratory investigations (hepatitis C virus antibody, hepatitis C virus RNA by polymerase chain reaction, hepatitis B virus surface antigen, liver and kidney functions, complete blood count, INR and alpha feto-protein) and pelvi-abdominal ultrasound findings. Upper gastro-intestinal (GI) endoscopy was done at the beginning of the study for detection and grading of esophageal varices (EVs) and those without EVs were excluded, also portal vein diameter (PVD) was recorded by ultrasound. The maximum tolerated dose of Propranolol (decrease pulse rate by 25% but not below 60 beats per minute) was given to all patients for three months. EVs grading, by upper GI endoscopy, and PVD were reassessed at the end of the study.
Results: Propranolol showed a significant reduction in heart rate and PVD for the pre and post-treatment results after three months of treatment (P<0.001 for both). The dose of Propranolol didn't show significant effect on reduction of small size EVs (P=0.07) while the percent of reduction of PVD correlated significantly with percent of reduction in EVs grade for the pre and post-treatment (P<0.05). A cut off point for detection of significant EVs (GII and III) was 12.5 mm with sensitivity 82.4%, specificity 47.8%, positive predictive value (PPV) 53.8% and negative predictive value (NPV) 78.6%.
Conclusion: Non-selective beta blocker (Propranolol) caused significant reduction in portal vein diameter and the percentage of reduction of portal vein diameter significantly correlated with change in esophageal varices grades.
https://zumj.journals.ekb.eg/article_13279_28e99a8262298c190fb4ba2598f7e284.pdf
2018-09-01
449
456
10.21608/zumj.2018.13279
Portal Hypertension
HCV
Esophageal varices
Portal vein diameter
liver cirrhosis and Non-selective beta blockers
Ahmed
Amin
1
AUTHOR
Sahar
Zaghloul
2
AUTHOR
Khaled
Lakouz
3
AUTHOR
Essam
Abdel Wahab
4
AUTHOR
Waseem
Seleem
5
AUTHOR