Stevens-Johnson syndrome in patients on phenytoin and cranial radiotherapy

The use of phenytoin as a prophylactic anticonvulsant after brain surgery, particularly for brain tumors, is a common practice, regardless of whether the patient has a previous history of convulsions. This treatment policy assumes that the benefits exceed the risks. Four cases are described of adverse reactions to phenytoin during the concomitant use of cranial radiotherapy. In one patient this proved fatal. There is increasing anecdotal support in the literature for a synergistic effect between phenytoin therapy and cranial radiotherapy that can result in the life-threatening Stevens-Johnson syndrome. While the association is uncommon, four cases within 24 months in one department suggest that the routine use of postoperative phenytoin as a prophylactic anticonvulsant in the absence of a history of seizures may not be warranted, particularly if the patient is to receive cranial radiotherapy.     

Susceptibility of ABO blood group to COVID-19 infections: clinico-hematological,radiological, and complications analysis

In the wake of the COVID-19 pandemic, research indicates that the COVID-19 disease susceptibility varies among individuals depending on their ABO blood groups. Researchers globally commenced investigating potential methods to stratify cases according to prognosis depending on several clinical parameters. Since there is evidence of a link between ABO blood groups and disease susceptibility, it could be argued that there is a link between blood groups and disease manifestation and progression. The current study investigates whether clinical manifestation, laboratory, and imaging findings vary among ABO blood groups of hospitalized confirmed COVID-19 patients.This retrospective cohort study was conducted between March 1, 2020 and March 31, 2021 in King Faisal Specialist Hospital and Research Centre Riyadh and Jeddah, Saudi Arabia. Demographic information, clinical information, laboratory findings, and imaging investigations were extracted from the data warehouse for all confirmed COVID-19 patients.A total of 285 admitted patients were included in the study. Of these, 81 (28.4%) were blood group A, 43 (15.1%) were blood group B, 11 (3.9%) were blood group AB, and 150 (52.6%) were blood group O. This was almost consistent with the distribution of blood groups among the Saudi Arabia community. The majority of the study participants (79.6% [n = 227]) were asymptomatic. The upper respiratory tract infection (P = .014) and shortness of breath showed statistically significant differences between the ABO blood group (P = .009). Moreover, the incidence of the symptoms was highly observed in blood group O followed by A then B except for pharyngeal exudate observed in blood group A. The one-way ANOVA test indicated that among the studied hematological parameters, glucose (P = .004), absolute lymphocyte count (P = .001), and IgA (P = .036) showed statistically significant differences between the means of the ABO blood group. The differences in both X-ray and computed tomography scan findings were statistically nonsignificant among the ABO age group. Only 86 (30.3%) patients were admitted to an intensive care unit, and the majority of them were blood groups O 28.7% (n = 43) and A 37.0% (n = 30). However, the differences in complications’ outcomes were statistically nonsignificant among the ABO age group.ABO blood groups among hospitalized COVID-19 patients are not associated with clinical, hematological, radiological, and complications abnormality.     

Application of endovascular pure electrocoagulation in the management of coronary artery perforation during percutaneous coronary intervention

Coronary artery perforation(CAP)during percutaneous coronary intervention(PCI)is a serious complication associ- ated with significant morbidity and mortality.It...     

A possible route for the introduction of Rift Valley fever virus into Egypt during 1977

Rift Valley fever (RVF), which was enzootic in Sudan in 1976 and epidemic in Egypt in 1977-78, may have been introduced into Egypt from Sudan via sheep transported along Lake Nasser. A hypothesis is presented which describes sheep transport from holding areas in north-central Sudan, where RVF was epizootic, to live animal markets in southern Egypt. Travel time from north-central Sudan to the Aswan area was less than 5 days, approximating the incubation period of RVF virus in sheep. Reintroduction of RVF or other diseases from Sudan into Egypt will be facilitated by the construction of new roads linking the two countries.     

The Effect of Vitamin A Supplementation on FoxP3 and TGF-β Gene Expression in Avonex-Treated Multiple Sclerosis Patients

Journal of Molecular Neuroscience - Multiple sclerosis (MS) is an autoinflammatory condition of the central nervous system with impaired T helper (Th)17 and regulatory T cell (Treg) balance that is...     

Does implementing a regime of dexamethasone before planned cesarean section at term reduce admission with respiratory morbidity to neonatal intensive care unit? A randomized controlled trial

Aim: To assess the effectiveness of dexamethasone before planned cesarean section (CS) at term in reducing admission with respiratory morbidity to neonatal intensive care units (NICU).

Methods: A prospective randomized controlled trial which was conducted at an Egyptian teaching hospital. Participants at ≥38 weeks gestation who were planned to have planned CS were recruited. They were randomized into a treatment group (636 women) who received three intramuscular (IM) doses of dexamethasone 8?mg, 8?h apart, and control group (636 women) who have not received dexamethasone, before having planned CS. The primary outcome was admission to NICU with respiratory morbidity, which was analyzed by intention to treat.

Results: A total of 1272 planned CS’s were carried out in this trial. They were associated with less admission to NICU with respiratory morbidity in women treated with dexamethasone than in women not treated (13 (2.0%) versus 21 (3.3%), respectively). However, the difference between the two groups failed to show a statistical significance (p?=?.88).

Conclusion: Dexamethasone administration before planned CS at term, as compared to routine management without antenatal steroids, was not associated with a statistically significant reduction in the incidence of admission to NICU with respiratory morbidity.     

Do nondiabetic patients undergoing coronary artery bypass grafting surgery require intraoperative management of hyperglycemia?

ObjectiveTo study the effect of blood glucose (BG) control with insulin in preventing hyperglycemia during and after coronary artery bypass grafting (CABG) surgery in nondiabetic patients.MethodsIn a randomized clinical trial, 120 nondiabetic patients who underwent elective CABG surgery were enrolled for study of whether the control of hyperglycemia was a need in such a surgery in a teaching heart hospital. The patients were randomly divided into study (n = 60) and control (n = 60) groups. In the study group, insulin was infused to maintain BG level between 110 mg/dL and 126 mg/dL (a modified insulin therapy protocol, and in the control group, the patients were excepted). Insulin therapy was limited to intraoperative period. BG levels during surgery and up to 48 hours after surgery and early postoperative complications were compared between the study and control groups.ResultsOne hundred seventeen patients completed the study (59 patients in study group and 58 in control group). Peak intraoperative BG level in the study group was 126.4 ± 17.9 mg/dL and in the control group was 137.3 ± 17.6 mg/dL (p = 0.024). The frequencies of severe hyperglycemia (BG ≥ 180 mg/dL) were 6 of 59 (10.1%) in the study group and 19 of 58 (32.7%) in the control group during operation (p = 0.002). Peak postoperative BG level in the study group was 194.8 ± 41.2 mg/dL and was 199.8 ± 43.2 mg/dL in the control group (p = 0.571). There was no hypoglycemic event in either group. The frequencies of early postoperative complications were 10 of 59 (16.9%) in the study group and 19 of 58 (32.7%) in the control group (p = 0.047).ConclusionsHyperglycemia (BG ≥ 126 mg/dL) is common in nondiabetic patients undergoing CABG surgery. A modified insulin therapy to maintain BG level between 110 mg/dL and 126 mg/dL may be acceptable for avoiding hypoglycemia and keeping intraoperative BG levels in acceptable range in nondiabetics.