Cutaneous anthrax in a school teacher.

Cutaneous anthrax is an infection of the skin caused by Bacillus anthracis. This is a report of a case of cutaneous anthrax attending outpatients of Mymensingh Medical College Hospital in October, 2010. The infected person was a retired school teacher with a very good body build. He reported to handle cow flesh about 4-5 days ago, developed few painless papules over shin of right leg, which gradually became large bullae and blackish eschar developed over the lesion. Smears from the lesions were investigated which confirmed the causative agent B. anthracis. The patient was treated with oral Ciprofloxacin (500mg) twice daily for seven days which cured the infection as observed on his subsequent follow up visits on 7 and 14 days later. Oral Ciprofloxacin is found effective as recommended by the World Health Organization.

A novel potentiometric sensor based on ZnO decorated polyaniline/coal nanocomposite for diltiazem determination.

Diltiazem (DTZ) is one of the most effective medications for treating cardiovascular diseases. It has been widely used for the treatment of angina pectoris, hypertension and some types of arrhythmia. The development and application of a modified carbon paste sensor with improved detection limits for the potentiometric determination of diltiazem are the main goals of the current study. Sensitivity, long-term stability, reproducibility and improving the electrochemical performance are among the characteristics that have undergone careful examination. A modified carbon paste sensor based on ß-cyclodextrin (ß-CD) as ionophore, a lipophilic anionic additive (NaTPB) and a ZnO-decorated polyaniline/coal nanocomposite (ZnO@PANI/C) dissolved in dibutyl phthalate plasticizer, exhibited the best performance and Nernstian slope. The ZnO@PANI/C based sensor succeeded in lowering the detection limit to 5.0 × 10-7 through the linear range 1.0 × 10-6 to 1.0 × 10-2 mol L-1 with fast response time ≤ 10.0 s. The prepared nanomaterial was characterized using X-ray diffraction (XRD), Fourier transform infrared (FT-IR) spectroscopy and scanning electron microscopy (SEM). The surface properties of the proposed sensor were characterized by electrochemical impedance spectroscopy (EIS). The selectivity behavior of the investigated sensor was tested against a drug with similar chemical structure and biologically important blood electrolytes (Na+, K+, Mg2+, and Ca2+). The proposed analytical method was applied for DTZ analysis in pure drug, pharmaceutical products and industrial water samples with excellent recovery data.

Evidence of geoelectrical resistivity values on groundwater conditions in Wadi El Natrun and its vicinities, West Delta, Egypt (cases studies).

Recently, Wadi El Natrun and its surroundings have witnessed intensive investments in land reclamation, including the arbitrary drilling of hundreds of groundwater wells. Currently, serious hydrogeological and environmental problems have been addressed, such as groundwater quality degradation and water head drop. Electrical resistivity measurements were performed at six locations across the study area to assess its ability to reveal the heterogeneous subsurface stratigraphic and hydrogeological setting of groundwater aquifer(s). The geoelectrical results successfully reflect the current vulnerable hydrogeological setting of the study sites. The current study highlights the current practice in which farmers rely on isolated 1-dimensional vertical electrical sounding (1D VES), which is not the only exploration tool for such electrically conductive stratigraphic succession. One of the main findings is addressing the advantage of applying 2-dimensional electrical resistivity imaging (2D ERI), where it offers a more robust view of both vertical and lateral variation of the investigated subsurface section (Case 3). On the other hand, the Geographic Information System (GIS) could mirror the present groundwater potentiality status, where both GIS analysis and resistivity results coincide, and where the good potentiality zone is restricted to the west and southwest directions of the study area (area of interest (aoi)), where the resistivity values of water bearing are relatively high and lie on the main drainage (Cases 2, 5, and 6). On the contrary, poor potentiality zones are deemed because of their proximity to tiny attributers, and are characterized by low resistivity values (Cases 1, 3 & 4), Finally, the current research study demonstrates the significance of combining morphometrical analysis with geophysics techniques for such environmental problems, where groundwater is primarily controlled by geomorphological features and geological conditions, including lithology and geological structures.

Effect of Vitamin D supplementation in patients with liver cirrhosis having spontaneous bacterial peritonitis: a randomized controlled study.

OBJECTIVE: Spontaneous Bacterial Peritonitis (SBP) is one of the most serious liver cirrhosis with ascites complications. Vitamin D (Vit D) deficiency has been associated with a high risk of infection and mortality in cirrhotic patients. Herein, the assessment of Vit D level as a prognostic marker in SBP patients and the impact of Vit D supplementation on their treatment plan was studied as well. PATIENTS AND METHODS: Ascetic patients with SBP and Vit D deficiency were divided randomly into treatment and control groups. The control group received standard treatment without Vit D and the treatment group received standard treatment plus Vit D. Clinical monitoring of Vit D was done over 6 months. RESULTS: At baseline, all patients in both groups revealed an elevated serum and ascetic TLC, AST, ALT, total and direct bilirubin, in addition to elevation in INR and procalcitonin (PCT) level. Univariate regression analysis confirmed that deficiency of Vit D was an independent predictor of infection and mortality (p < 0.01; Crude Hazard Ratio: 0.951). Over 6 months, the study revealed significant improvement in serum Vit D level in the treatment group (34.6 ± 9.2 and 18.3 ± 10.0 ng/mL; p < 0.001). Moreover, a statistically significant increase in survival rate (64% vs. 42%; p < 0.05) and duration (199.5 days vs. 185.5 days; p < 0.05) were recorded as well. Univariate and multivariate regression analysis confirmed that Vit D supplementation was positively correlated to survival over 6 months (p < 0.001; Adjusted Hazard Ratio: 0.895). CONCLUSIONS: Vit D deficiency is prevalent in SBP cirrhotic patients and is used as an independent predictor of infection and death. Therefore, Vit D supplementation revealed improvement in their response to treatment.

The cost of an intensive care unit: a prospective study.

The cost of intensive care for patients admitted to the ICU were estimated. Patients suffering from severe combined acute respiratory and renal failure who required mechanical ventilation and renal replacement therapy (SCARRF-D) cost per day significantly more than non-renal patients (pounds 938 compared to pounds 653 per patient respectively) and their average length of stay in hospital is nearly 4 times as long (28.8 compared to 7.6 days respectively). Approximately 44% of the total cost was staff related (28% for the provision of nurses and 16% for the rest). Retrieving information related to cost was difficult, time consuming and labour intensive.

Multiple organ failure--a role for plasma exchange?

Two patients with multiple organ failure, septicaemia and a deteriorating clinical course were treated by plasma exchange in addition to standard supportive measures. Dramatic improvements were seen in cardio-respiratory (patient 1), neurological and renal parameters (patient 2) which were attributable to the exchanges. Plasma exchange might be of value as adjunctive therapy where overwhelming septicaemia occurs with multiple organ failure.

Nitrous oxide and internal tamponade during vitrectomy.

We analysed the nitrous oxide composition of the intraocular gas bubble following vitrectomy and fluid-air exchange in 12 patients. Samples were taken under standardised conditions at 20 minutes after completion of the fluid-air exchange. Analysis was conducted by a Medishield MS2 mass spectrometer. The percentage composition of nitrous oxide in the samples varied between 4 and 21% (mean 9%). This influx of nitrous oxide was associated with an increase of intraocular pressure. Pressure rises of greater than 20 mm Hg were not seen owing to venting of gas through the sclerostomies. An inverse relationship was noted between the extent of retinal detachment preoperatively and the amount of nitrous oxide entering the eye. A possible explanation for this relationship is proposed. The importance of nitrous oxide movement is stressed.

Prevention of bacterial infection and sepsis in acute severe pancreatitis.

Between 1984 and 1986 six patients with acute respiratory failure (requiring ventilation for at least 3 days) complicating acute pancreatitis were managed on the intensive care unit (median ventilation period 6 days; range 3-41 days). Between 1987 and 1989 nine similar patients were managed (median ventilation period 35 days, range 4-69 days), and a regimen of enteral tobramycin, polymyxin and amphotericin to selectively decontaminate the digestive tract (SDD) was introduced. Five of six patients treated before 1987 had serious infections (three Gram-negative, one fungal), compared with only one of nine patients treated with SDD (P < 0.05). Clinical signs of sepsis were evident for 62% of the pre-SDD period, compared with 39% of the period during SDD therapy (P < 0.001). Systemic antibiotic prescribing was reduced in the SDD group; however, mortality remained unaffected with only two patients surviving pre-SDD and three during SDD treatment. SDD reduces infection rates and sepsis in patients with acute pancreatitis and may help to improve the prognosis of this life-threatening condition.

Zoonoses from pets horses, donkeys and mules: with special references to Egypt.

A zoonosis is an animal disease that is transmissible to humans. Humans are usually an accidental host that acquires disease through close contact with an infected animal, who may or may not be symptomatic. Children are at highest risk for infection because they are more likely to have close contact with pets. Pets are responsible for transmission of an extensive array of bacterial, fungal, and parasitic zoonotic pathogens. The route of transmission can be through the saliva (e.g., bites or contaminated scratches), feces, respiratory secretions, direct contact, or by the animal acting as a vehicle and source of tick or flea exposure. Although pets have been implicated in transmission of zoonoses to their owners, risk of transmission from contact with pets is low and may be further reduced by simple precautions.

Spinal anaesthesia for caesarean section. Management of a parturient with severe cardiovascular disease.

A parturient with severe mitral valve disease and pulmonary oedema was admitted to the labour ward. Fetal distress was also present. An emergency Caesarean section was undertaken under spinal blockade. The reasons for the choice of this technique are discussed.

Variation in subglottic size in children.

The incidence of variation in the subglottic size was investigated in 3304 infants and children. A mild degree of congenital subglottic stenosis was found in 0.91% and a moderate degree of stenosis in 0.06% of the patients. A mild degree of congenital subglottic enlargement was noted in 0.7% and moderate enlargement in 0.06% of the patients.

Adverse effects of buffered glutaraldehyde on the Heidbrink expiratory valve.

The effect of chemical disinfection of the Heidbrink expiratory valve in buffered glutaraldehyde (Cidex solution) was investigated. Cidex caused stickiness and increased the opening pressure and resistance of the valve to different gas flow rates. An electrolytic type of corrosion may also have occurred. However, autoclaving of the Heidbrink valve did not appear to cause corrosion or significant alteration of its opening pressure or resistance.

Hydrodynamic evaluation of a new anaesthetic gas scavenging system.

A new anaesthetic gas scavenging system is described. The resistance of the system appears to be low. When input gas flow rate in the system was zero or 150 litre min-1, misuse of the system produced pressure changes at its collecting points of 26 Pa subatmospheric and 630 Pa above atmospheric pressure, respectively. Suggestions to develop the system and increase its safety are presented.

Expiratory valves and anaesthetic reservoir bags. The implications of scavenging.

The pressure-volume characteristics of 24 new and old '2-litre' anaesthetic reservoir bags of three different makes were measured. When inflated with gas to a pressure of 50 Pa all the new bags and six used ones contained 1.6 litres and when filled with 2 litres of gas, the pressure within them exceeded 700 Pa. The opening pressures and pressure drops to 30 litres/minute gas flow of scavenging adjustable pressure limiting valves were also investigated. Tests were carried out on 44 valves of four different types, all with their adjusting screws in the fully open position. All the valves had low opening pressures and pressure drops which were both further decreased when the orientation of the valves was changed to the inverted position. A substantial proportion of them remained permanently open. After one year's use both opening pressure and pressure drop tended to rise, the proportion of permanently open valves increased and the discs of some valves were damaged.

Comparison of atropine and glycopyrronium in patients with pre-existing cardiac disease.

The effects of atropine and glycopyrronium, when given intravenously with neostigmine during the reversal of neuromuscular blockade in patients with cardiovascular disease, were compared in a double blind trial. Atropine was associated with a significantly greater elevation of heart rate and rate-pressure product than glycopyrronium. This elevation was also more sustained with atropine. The entire atropine population also showed a significantly greater incidence of ST-segment depression on the electrocardiogram than that observed in those who had received glycopyrronium. Furthermore, patients with ischaemic heart disease and previous myocardial infarction who received atropine showed a significantly greater incidence of dysrhythmias than those given glycopyrronium. It is suggested that at the time of reversal of neuromuscular blockade in patients with cardiovascular disease, glycopyrronium is a more suitable agent than atropine.

Randomized prospective double-blind placebo-controlled trial of effect of intravenous ondansetron on intraocular pressure during ophthalmic surgery.

The effect of i.v. ondansetron, before induction of anaesthesia, on intraocular pressure (IOP) in patients undergoing cataract surgery was investigated. Forty patients (two groups of 20) received either ondansetron 4 mg (treatment group) or 0.9% saline (placebo group) in a double-blind controlled manner. There were no significant differences in IOP between the groups. Ondansetron had no significant effect on IOP during the study period.