Search

Abstract Background One of the most often used bedside surgical techniques in critical care units (ICUs) for critically ill individuals who need prolonged mechanical ventilation is percutaneous dilatational tracheostomy (PDT). Numerous difficulties may arise from puncturing the esophagus or making a false passage during surgery. Objectives To compare the use of laryngeal mask airway (LMA) and endotracheal tube (ETT) during PDT guided by ultrasonography (US) or bronchoscopy. Methods Our study was a prospective cohort of 120 patients admitted to the Critical Care Department at Kasr Alainy Hospital and Damanhur Medical National Institute between March 2020 and November 2021. Hemodynamics, arterial blood gasses, complications, and outcomes of the patients were recorded. Results The studied patients were divided into the ETT and LMA groups (60 patients in each group). Then, each group was subdivided into two subgroups (ETT-US, ETT-Bronch, LMA-US, and LMA-Bronch; 30 patients in each subgroup) according to the guiding procedure used for puncturing the trachea: US-guided or bronchoscopy-guided. Regarding HR, there was no statistically significant difference between the two groups or four subgroups before, during, and after the procedure. In addition, there was no statistically significant difference between the two studied groups regarding MAP before the procedure. However, during and after the procedure, MAP was significantly higher in the ETT group. There was no discernible change in oxygen saturation or PaO2 before, during, or after the procedure. However, there was no discernible difference in PaCO2 levels before and after the procedure; it was much greater in the ETT group and ETT-Bronch subgroup during the process. Furthermore, there was no statistically significant variation in the number of punctures between the two groups or the four subgroups. The length of the process varied significantly across the two major groups and the four evaluated subgroups. The LMA group had the shortest procedure duration (5.05 ± 1.28 min), the LMA-Bronch subgroup (4.79 ± 1.42 min), and the LMA-US subgroup (5.31 ± 1.10 min), while the ETT had the longest procedure duration group (5.86 ± 1.11 min), the ETT-Bronch subgroup (6.09 ± 1.23 min), and ETT-US (5.63 ± 0.94 min). Regarding complications, there was no considerable difference between the two groups or four subgroups except aerophagia. Aerophagia was considerably more common in the LMA group (7 candidates) and was not observed in the ETT group. Conclusions Our study concluded that the laryngeal mask airway improves ventilation during percutaneous dilatation tracheostomy, especially when used with ultrasound, and thus can be used for candidates with traumatic brain injury and brain edema.

Background and Purpose: This study aimed to determine the effectiveness of shock wave and dynamic training for intermittent claudication in diabetic patient. Subjects and Methods: This study is a randomized controlled trial. The study was carried out on 60 patients with type 2 diabetic patients of both sexes (37 men, 23 women) who suffered from peripheral arterial disease that caused intermittent claudication since 2 to 4 years, their ages ranged from 40 years -65 years from both sexes. Patients were selected from Kafr El-Dawar general hospital from vascular department. the patients were assigned into 2 equal groups in number, both groups were assessed by treadmill exercise testing (till maximum claudication pain) and ankle brachial pressure index for all patients at base line and after 8 weeks. Group (A) (17 men, 13 women) performed shock wave sessions on calf muscle twice per week for 8 weeks till maximum tolerated pain for each patient. The second group (B) (20 men, 10 women) performed treadmill walking exercise by using electric treadmill 3 sessions/week for 8weeks till maximum claudication pain for 8 weeks. Results: shock wave sessions increased pain free walking distance and maximum walking distance 87,64% and 55,95% respectively while treadmill training increased pain free walking distance and maximum walking distance 65,19% and 48,43% respectively. Also shock wave sessions increased pain free walking time and maximum walking time by 75, 29% and 83, 71% respectively while treadmill training increased pain free walking time and maximum walking time 55, 11% and 71, 09% respectively with no significant differences in ABPI in both groups. Conclusions: Shock wave therapy effective than Dynamic training in dealing with intermittent claudication problems in type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

Background Dermatomycosis affects millions of people worldwide; the availability of data on the prevalence of superficial fungal infections and some associated epidemiological factors in our region is little. Objective To compare conventional and molecular methods to characterize some fungal species causing human mycotic infection. Patients and methods The present cross-sectional study of fungal skin diseases was done on 100 patients. Skin scrapings and nail cuttings were subjected to direct microscopic examination using potassium hydroxide and lactophenol cotton blue, followed by culturing on Sabouraud' dextrose agar. HiCrome agar was used for characterization of Candida species. Molecular diagnosis of some fungal isolates was performed by sequencing the ribosomal DNA internal transcribed spacer region. Results Tinea capitis was the commonest clinical presentation in 48% of cases, followed by tinea corporis 20% and tinea faciei 13%. Fungi were demonstrated in 88% of cases by direct microscopy and/or culture. Direct microscopy was positive in 51% of cases. A higher percentage of positivity 77% was obtained from samples cultured on Sabouraud' dextrose agar. Dermatophytes were isolated from patients who complained of tinea capitis and tinea corporis (75 and 70%, respectively). Comparing molecular with conventional results, it was found that molecular identification was confirmatory to conventional results, except in two isolates: Chrysosporium lobatum was previously diagnosed as Chrysosporium tropicum and Trichophyton interdigitale was previously diagnosed as Trichophyton mentagrophytes by conventional methods. Conclusion Trichophyton violaceum and Microsporum canis were the main etiologic agents of tinea capitis (45.8 and 27%, respectively). Epidermophyton floccosum was only isolated from four cases of tinea corporis and one of the tinea cruris. Candida species were the main causal agents of onychomycosis. Acremonium spinosum and C. lobatum appeared in this study as new etiologic agents of nail infections. Molecular identification is confirmatory to conventional results, but it is expensive and faces some difficulties, in our country, its use is encouraged to identify dermatophytes in atypical isolates. [ABSTRACT FROM AUTHOR]

Psoriasis vulgaris (PsV) is an immune-mediated inflammatory disorder with devastating psychosocial consequences. Expression of immunoregulator molecules on leukocytes in PsV remains unclear. Leukocyte-associated Ig-like receptor-1 (LAIR-1) and complement receptor-1 (CR-1) are immunoregulator receptors reported to bind complement component 1q involved in phagocytosis. We aimed to explore if altered leukocyte expression of LAIR-1 and CR-1 is associated with PsV. This case–control study included 36 PsV patients and 36 healthy controls. Neutrophils, monocytes and B and T cells were examined by flow cytometry for LAIR-1 and CR-1 mean fluorescence intensity (MFI) and positive cell percentage. Comparison between both groups revealed a significant decrease in LAIR-1 MFI on neutrophils and T cells (P < 0.001 and P = 0.003, respectively). CR-1 MFI on neutrophils, monocytes and T cells also showed a significant decrease in patients (P = 0.033, P = 0.001 and P = 0.040, respectively). There was a significant positive correlation of LAIR-1 MFI on neutrophils with CR-1 MFI on neutrophils (r = 0.503; P = 0.002) and LAIR-1 MFI on monocytes with CR-1 MFI on monocytes (r = 0.371; P = 0.026). Receiver operating characteristic curves revealed that CR-1 MFI on monocytes had the highest discrimination power to differentiate patients from controls, with 86.1% specificity and 75% sensitivity (P = 0.001). In conclusion, altered leukocytes expression of LAIR-1 and CR-1 is associated with PsV. Down-regulated CR-1 MFI on monocytes is a promising diagnostic biomarker for PsV. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to assess the level of myeloid-derived suppressor cells (MDSCs) and the expression of costimulatory molecules CD80 and CD86 on monocytes and their ligands (CD28) on T-lymphocytes in children with allergic rhinitis (AR). Methods: The study included 60 children with AR and 50 controls. Flow cytometry was performed to analyze MDSCs and the expression of costimulatory molecules CD80 and CD86 on monocytes and their ligands (CD28) on T-lymphocytes. Results: The percentages of total and monocytic MDSCs and the expression of costimulatory molecule CD86 on monocytes were significantly higher in children with AR than in healthy controls. In addition, the expressions of CD28 on CD4+ and CD8+ were significantly elevated in AR patients. Conclusion: The present study demonstrated that the percentages of MDSCs were significantly elevated in AR children. Moreover, the expressions of CD28 on CD4+ and CD8+ were significantly higher in children with AR. [ABSTRACT FROM AUTHOR]

Hematopoietic stem cells (HSCs) and hematopoietic progenitor cells (HPCs) play a crucial role in the context of viral infections and their associated diseases. The link between HSCs and HPCs and disease status in COVID -19 patients is largely unknown. This study aimed to monitor the kinetics and contributions of HSCs and HPCs in severe and non-severe COVID -19 patients and to evaluate their diagnostic performance in differentiating between healthy and COVID-19 patients as well as severe and non-severe cases. Peripheral blood (PB) samples were collected from 48 COVID-19 patients, 16 recovered, and 27 healthy controls and subjected to deep flow cytometric analysis to determine HSCs and progenitor cells. Their diagnostic value and correlation with C-reactive protein (CRP), D-dimer, and ferritin levels were determined. The percentages of HSCs and common myeloid progenitors (CMPs) declined significantly, while the percentage of multipotent progenitors (MPPs) increased significantly in COVID-19 patients. There were no significant differences in the percentages of megakaryocyte-erythroid progenitors (MEPs) and granulocyte-macrophage progenitors (GMPs) between all groups. Severe COVID-19 patients had a significantly low percentage of HSCs, CMPs, and GMPs compared to non-severe cases. Contrarily, the levels of CRP, D-dimer, and ferritin increased significantly in severe COVID-19 patients. MPPs and CMPs showed excellent diagnostic performance in distinguishing COVID-19 patients from healthy controls and severe from non-severe COVID-19 patients, respectively. Collectively, our study indicated that hematopoietic stem and progenitor cells are significantly altered by COVID-19 and could be used as therapeutic targets and diagnostic biomarkers for severe COVID-19. [ABSTRACT FROM AUTHOR]