Ethylene glycol intoxication: a case report

Ethylene glycol intoxication is one of the most serious acute poisonings due to the high toxicity that can result in death if not treated rapidly. We report the case of a patient who presented to the intensive care unit with a hypertensive crisis associated to a renal insufficiency. Laboratories investigations which revealed metabolic acidosis and elevated anion gap, highlighted an unexpected ethylene glycol intoxication. Clinical and psychiatric feature lead to suspect a chronic ingestion. Spontaneous recovery occured without specific treatment.     

Effect of training program regarding smoking cessation counseling for primary health care physicians in Port Said City,Egypt

Background

Smoking is a major risk factor for death-related diseases. Not all healthcare professionals are following evidence-based guidelines for smoking cessation counseling in primary care settings. The WHO, Framework Convention on Tobacco Control (FCTC), and United States Public Health Service (USPHS) guidelines recommend that all healthcare professionals, including students in healthcare training programs, receive education in the management of tobacco use and dependence.

Objective

To evaluate the effect of training programs for primary healthcare physicians on the knowledge, attitude, and practice of smoking cessation counseling.

Methods

This was a pre-post intervention study. The study included 74 primary care physicians working in primary healthcare centers affiliated with the Ministry of Health and Suez Canal University Hospitals in Port Said City. The study was conducted between June 2015 and March 2016 using a structured questionnaire and observation checklist to assess counseling of patients willing to quit smoking.

Results

There were highly statistically significant improvements in the physicians’ median scores of knowledge (30%–80%), attitude (65% -100%), and practice (20%–70%) (p?<?0.001) pre-post intervention. The most frequent correct knowledge was consequences of smoking (73%–87.3%) (p?<?0.001) pre-post intervention. The most favorable attitude was the importance of smoking cessation (70.3%–100%) (p?<?0.001) pre-post intervention. The best observed correct practice was asking about smoking (70.3%–100%) (p?<?0.001) pre-post intervention.

Conclusion

Knowledge, attitude, and practice skills regarding smoking cessation counseling among primary healthcare physicians were markedly improved after implementation of the education program.

     

Rheumatoid arthritis patients with interstitial lung disease: Clinical,radiological and laboratory characteristics

BackgroundRheumatoid arthritis associated interstitial lung disease (RA-ILD) has a significant burden of morbidity and mortality.Aim of the workTo analyze clinical, radiological and laboratory characteristics of RA-ILD in an Egyptian cohort.Patients and methodsThe study included 160 RA patients. Detailed medical history, disease activity score (DAS28) and joint damage (Sharp score) were carefully recorded. Chest x-ray, high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) were done and patients were sub-grouped as RA-ILD (HRCT or PFTs abnormalities) and RA without ILD.ResultsPatients were 136 (85%) females and 24 (15%) males with a mean age of 37.8 ± 11.3 years and disease duration of 4.98 ± 5.53 years. 50% of patients had chest manifestations suggestive of ILD. 60% demonstrated abnormalities in PFT and 63.75% in HRCT. The most common HRCT findings were reticulation (66.6%) and ground glass appearance (64.7%), followed by bronchiectasis (50.9%) and honey combing (46%). usual interstitial pneumonia (UIP) was the most common HRCT subtype (49%). RA-ILD patients were significantly older (p < 0.001), had longer disease duration (p < 0.001), more frequent arthritis (p = 0.002), higher DAS28 (p < 0.001) and Sharp score (p < 0.001), significantly positive rheumatoid factor (RF) (p = 0.007) and anti-citrullinated protein antibody (ACPA) (p < 0.001).ConclusionA high frequency of ILD among Egyptian patients is recorded due to careful evaluation of respiratory symptoms and valuable assessment by PFTs and HRCT chest. UIP is the most common radiologic pattern of RA-ILD. RA patients with ILD are significantly older with longer disease duration, delayed age at onset, high disease activity with arthritis and positive RF and ACPA.     

Recognition of a subregion of human proinsulin by class I-restricted T cells in type 1 diabetic patients

Proinsulin is a key autoantigen in type 1 diabetes. Evidence in the mouse has underscored the importance of the insulin B chain region in autoimmunity to pancreatic beta cells. In man, a majority of proteasome cleavage sites are predicted by proteasome cleavage algorithms within this region. To study CD8+ T cell responses to the insulin B chain and adjacent C peptide, we selected 8- to 11-mer peptides according to proteasome cleavage patterns obtained by digestion of two peptides covering proinsulin residues 28 to 64. We studied their binding to purified HLA class I molecules and their recognition by T cells from diabetic patients. Peripheral blood mononuclear cells from 17 of 19 recent-onset and 12 of 13 long-standing type 1 diabetic patients produced IFN-gamma in response to proinsulin peptides as shown by using an ELISPOT assay. In most patients, the response was against several class I-restricted peptides. Nine peptides were recognized within the proinsulin region covering residues 34 to 61. Four yielded a high frequency of recognition in HLA-A1 and -B8 patients. Three peptides located in the proinsulin region 41-51 were shown to bind several HLA molecules and to be recognized in a high percentage of diabetic patients.     

Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess

Introduction

Radiology-based classifications of pelvic ring injuries and their relevance for the prognosis of morbidity and mortality are disputed in the literature. The purpose of this study was to evaluate potential differences between the pelvic ring injury classification systems by Tile and by Young and Burgess with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries.

Patients and methods

Two-hundred-and-eighty-five consecutive patients with pelvic ring fractures were analyzed for mortality within 30 days after admission, number of blood units and total volume of fluid infused during the first 24 h after trauma, the Abbreviated Injury Severity (AIS) scores for head, chest, spine, abdomen and extremities as a function of the Tile and the Young–Burgess classifications.

Results

There was no significant relationship between occurrence of death and fracture pattern but a significant relationship between fracture pattern and need for blood units/total fluid volume for Tile (p < .001/p < .001) and Young–Burgess (p < .001/p < .001). In both classifications, open book fractures were associated with more fluid requirement and more severe injuries of the abdomen, spine and extremities (p < .05). When divided into the larger subgroups “partially stable” and “unstable”, unstable fractures were associated with a higher mortality rate in the Young–Burgess system (p = .036). In both classifications, patients with unstable fractures required significantly more blood transfusions (p < .001) and total fluid infusion (p < .001) and higher AIS scores.

Conclusions

In this first direct comparison of both classifications, we found no clinical relevant differences with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries.     

Metal-free functionalized carbonized cotton for efficient solar steam generation and wastewater treatment

Water desalination via solar steam generation is one of the most important technologies to address the increasingly pressing global water scarcity. Materials for solar photothermal energy conversion are highly sought after for their cost savings, environmental friendliness and broad utility in many applications including domestic water heating and solar-driven desalination. Herein, we report the successful development of metal-free, low weight and cost effective functionalized carbonized cotton (CC) fibers for efficient solar water desalination and wastewater treatment. The CC fibers with nearly full solar spectrum absorption, efficient photo-thermal conversion and low-cost could provide excellent alternatives to the high-cost plasmonic-based materials for solar water desalination. We also report on a novel and simple device to mitigate the issues associated with conductive heat loss by utilizing the economically viable carbonized cotton materials as an irradiation surface placed on a low-density polyethylene foam that floats on the surface of seawater. The CC solar steam generation device exhibits average water evaporation rates of 0.9, 6.4 and 10.9 kg m⁻² h⁻¹ with impressive solar-to-vapor efficiencies of 59.2, 88.7 and 94.9% under 1, 5 and 8 sun illumination, respectively. Moreover, the device displays excellent durability showing stable evaporation rates over 10 steam generation cycles under 5 sun of solar intensity. Furthermore, the applicability of the CC device for the removal of organic dyes from contaminated water through solar steam generation is also demonstrated. The low-cost, simple design, high solar thermal evaporation efficiency, excellent stability and long-term durability make this CC device a perfect candidate for applications in seawater desalination and wastewater treatment by solar steam generation.

Water desalination via solar steam generation is one of the most important technologies to address the increasingly pressing global water scarcity.     

Outcome of transcatheter aortic valve implantation in high risk patients with severe aortic stenosis

Aim

To assess outcome of TAVI in high risk patients with severe symptomatic aortic stenosis.