scholarly journals Zinc supplementation in preterm neonates with jaundice: is it beneficial?

Author(s):  
Mohamed Shawky Elfarargy ◽  
Ghada M Al-Ashmawy ◽  
Sally Abu-Risha

Background: Neonatal jaundice is a common neonatal disease which had adverse effect in the neonates especially preterm neonates when the level of indirect bilirubin is high enough to pass the blood brain barrier causing bilirubin encephalopathy or kernicterus. Aim: The aim of this study is to investigate the value of zinc (Zn) supplementation in preterm neonates with jaundice and if it will be beneficial or not. Patients and methods: A prospective randomized clinical trial (RCT) study, identification number is TCTR20200504007, which was done at Tanta University Hospital (TUH) from July 2016 to March 2018 on 200 preterm neonates suffering from neonatal jaundice. The studied neonates were divided into 2 groups: group 1, which received Zn and phototherapy, and group 2, which received phototherapy only and did not take Zn. In the group 1, 100 preterm neonates with jaundice received Zn as 0.6 ml(cm3 ) of zinc origin/kg/day orally through oro/nasogastric tube divided into 2 doses (/12 hours) which is equal 1.2 mg elemental zinc/kg/day orally for 10 day. Results: There was no significant difference in serum bilirubin between the 2 groups in the 2nd, 4th and 6th day of admission while the serum bilirubin was significantly decreased in neonates who were treated by Zn and phototherapy in group 1, compared with neonates of group 2 who were treated with phototherapy only in the 8th , 9th and 10th day of admission where the p value was 0.045* ,0.027* and 0.004* respectively. Conclusion: Zn administration in jaundiced preterm neonates is beneficial in decreasing serum bilirubin. Recommendation: Zn supplementation for jaundiced preterm neonates.

2020 ◽  
Author(s):  
Mohamed Shawky Elfarargy ◽  
Ghada Al Ashmawy ◽  
Sally Abu-Risha ◽  
Haidy Khattab

Abstract Background: Neonatal jaundice is a common neonatal disease which had adverse effect in the neonates especially preterm neonates when the level of indirect bilirubin is high enough to pass the blood brain barrier causing bilirubin encephalopathy or kernicterus. Aim: The aim of this study is to investigate the value of zinc (Zn) supplementation in preterm neonates with jaundice and if it will be beneficial or not. Patients and methods: A prospective randomized clinical trial (RCT) study, identification number is TCTR20200504007, which was done at Tanta University Hospital (TUH) from July 2016 to March 2018 on 200 preterm neonates suffering from neonatal jaundice. The studied neonates were divided into 2 groups: group 1, which received Zn and phototherapy, and group 2, which received phototherapy only and did not take Zn. In the group 1, 100 preterm neonates with jaundice received Zn as 0.6 ml(cm3) of zinc origin/kg/day orally through oro/nasogastric tube divided into 2 doses (/12 hours) which is equal 1.2 mg elemental zinc/kg/day orally for 10 day. Results: There was no significant difference in serum bilirubin between the 2 groups in the 2nd, 4th and 6th day of admission while the serum bilirubin was significantly decreased in neonates who were treated by Zn and phototherapy in group 1, compared with neonates of group 2 who were treated with phototherapy only in the 8th , 9th and 10th day of admission where the p value was 0.045* ,0.027* and 0.004* respectively. Conclusion: Zn administration in jaundiced preterm neonates is beneficial in decreasing serum bilirubin. Recommendation: Zn supplementation for jaundiced preterm neonates.


Author(s):  
Mohamed Shawky Elfarargy ◽  
Ghada M Al-Ashmawy ◽  
Sally Abu-Risha ◽  
Haidy Khattab

Background: Neonatal hyperbilirubinemia is a serious neonatal problem which had hazardous effect in the neonates when the level of indirect bilirubin is increased to the levels that could cause kernicterus. Aims: The aim of this research is to study the cord blood levels of erythropoietin (EPO), bilirubin and reticulocyte count (RC) as early predictors of neonatal hyperbilirubinemia. Methods: A prospective case control study, which was done at Tanta University Hospital (TUH) from July 2016 to March 2018 on 90 neonates. The studied neonates were divided into 2 groups: Group 1 (45 neonates) who developed pathological hyperbilirubinemia and required treatment and group 2(45 neonates) who did not develop pathological hyperbilirubinemia and did not require treatment. Cord blood levels of EPO, bilirubin and RC were measured in all the studied neonates in both groups. Recommendation: There was significant difference between both groups as regard cord blood bilirubin (CBB), hemoglobin, EPO & RC levels where the P. value is 0.001*,0.027, *0.001*&0.001*respectively. There was significant positive correlation between cord Blood EPO levels and both CBB & cord blood RC with r=0.610 & 0.579 respectively and P. value is 0.001* & 0.001* respectively. As regard to ROC curve ,There was superiority of cord blood EPO levels where the cut off value was 22.5 mIU/ml while the sensitivity & specificity were 96 & 89 respectively then the cord blood RC where the cut off value was 5.7% while the sensitivity & specificity were 93 & 85 respectively and lastly CBB where the cut off value was 1.8 mg/dl while the sensitivity & specificity were 89 & 78 respectively. Conclusion: Cord blood levels of EPO, bilirubin and RC were increased in cases of pathological neonatal hyperbilirubinemia.


Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
May Nwe Lwin ◽  
Christopher Holroyd ◽  
Christopher J Edwards

Abstract Background/Aims  Baricitinib is an oral targeted synthetic disease-modifying anti-rheumatic drug (tsDMARD) recommended by the National Institute for Health and Care Excellence (NICE) in the UK for severe rheumatoid arthritis (RA) either as mono- or combination therapy. We wanted to observe the frequency of discontinuation in a real-world setting, the characteristics of patients who stop taking baricitinib, and the reasons for discontinuation. Objective: To describe the characteristics of patients who discontinue baricitinib treatment and the reasons for discontinuation. Methods  A real-world retrospective observational study of baricitinib use in RA patients at University Hospital Southampton using local advanced therapy database for data collection. We described the characteristics of patients discontinuing baricitinib therapy and divided patients into two groups. Group 1 (those who discontinued therapy within the first 12 months of use) and group 2 (who continued therapy beyond 12 months) Results  From October 2017 to July 2020, a total of 83 patients started baricitinib and were recorded in the database, 55 (66.27%) remain on treatment to date. Among 28 (33.74%) patients who stopped baricitinib, 21 had stopped within 12 months. The reasons for discontinuation were lack of efficacy (64.28%) and AEs (28.57% - 1 tooth infection, 1 urinary tract infection, 1 discitis, 2 chest infection, 1 personality change, 1 deranged liver function and 1 lymphoma). In group 1, the mean (±SD) age was 49.00 (13.65) years, 66.67% were female and 85.71% were previously biologic inadequate responders (IR), 42.86% were receiving monotherapy, with 57.14% being on combination therapy with a csDMARD and 9.52% were using a glucocorticoid. In group 2, 82.26% were female, 61.52 (10.94) years of age and 83.87% were previously biologic IR, 41.94% were on monotherapy and 58.06% on combination therapy with a csDMARD. Patients who discontinued appeared more likely to be younger and male. However, there was no significant difference regarding mono- or combination therapy, disease duration or seropositivity (p-value > 0.05) (Table 1). Conclusion  In a real-world setting, baricitinib appears efficacious and well-tolerated in the first year of use by two-thirds of patients. Characteristics such as older age and female gender were associated with continued use. Disclosure  M. Lwin: None. C. Holroyd: Honoraria; Lily. Member of speakers’ bureau; Lily. C.J. Edwards: Honoraria; Abbvie, Biogen, BMS, Celgene, Fresenius, GSK, Janssen, Lilly, Mundipharma, Pfizer, Roche, Sanofi, UCB. Member of speakers’ bureau; Abbvie, Biogen, BMS, Celgene, Janssen, Lilly, Sanofi, Pfizer, Roche. Grants/research support; Abbvie, Biogen, Pfizer.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Basma Helal Mohamed ◽  
Othman Ali Othman Ziko ◽  
Hisham M Khairy Abd El Dayem ◽  
Nancy Ezzelregal Khamis Ahmed

Abstract Purpose to compare between recurrence incidence after primary pterygium excision when using preoperative subconjunctival injection of Bevacizumab (Avastin) and using it as a postoperative eye drops. Methods thirty two eyes of thirty patients (two patients had bilateral pterygium) with primary pterygia were clinically examined, classified into 3 groups and operated by simple excision with bare sclera technique. Group 1 included 10 patients received Bevacizumab (Avastin) in the form of eye drops (10 mg/ml) 3 times daily for 6 days postoperative. Group 2 included 10 patients received preoperative Bevacizumab in the form of subconjunctival injection (1.25 mg/0.05ml) single dose 1 week preoperative. Group 3 included 10 patients (12 eyes) 2 patients with bilateral Pterygium didn’t receive any form of Bevacizumab. Postoperative follow up was done clinically and by serial photography at 1 week, 1 month, 3 months and 6 months searching for signs of recurrence and/or complications. Results The results showed different grades of recurrence in 18 eyes of 32.True recurrence was seen in 7 patients of 18 (1 patient in group 1, 2 in group 2 and 4 in group3).Recurrence grades in group 1and 2 who used the Bevacizumab (20%grade II, 50% grade III, and 30% grade IV). Recurrence could be predicted by 100% depending on fibrovascular tissue appearing in the surgical bed at 3 months postoperative (P value 0.038).Preoperative fleshy pterygium has high statistical significance in realation to recurrence(P value = 0.006).Patient’s sex, residence and occupation had no statistically significant value in the process of recurrence (P value > 0.05). Patients with recurrent Pterygia (in group 1&2) had statistically significant changes in the corneal K- readings at 3 months and 6 months.No significant difference in the limbal or central corneal thickness in the operated eye and the other eye (Pvalue > 0.05). Conclusion Bevacizumab (Avastin) is a well tolerated drug with multiple drug delivery methods.The eye drops give better results than the subconjunctival injection.Appearance of fibrovascular tissue in the surgical bed at 3 months predict the recurrence by 100%. Preoperative fleshy pterygia will mostly recur again whatever Bevacizumab form was used .The corneal thickness by anterior segment OCT has no role in prediction or detection of early pterygium recurrence.


2020 ◽  
Vol 8 (1) ◽  
pp. 24
Author(s):  
Ali G. Mohammed Redha ◽  
Adil A. Jaber ◽  
Aqeel M. Nasser

Background: Different methods are found for mesh fixation in inguinal hernioplasty both open and laparoscopic. In open technique, sutures have been the method of choice for their reduced costs and surgeons’ habits. Whether absorbable instead of non-absorbable sutures can be used still a matter of debate in view of hernia recurrence and post-operative complications.Methods: This is a prospective done on 158 male patients with uncomplicated unilateral inguinal hernias. Two groups of 69 patients were evaluated after periods up to 1 year after open hernioplasty by using delayed absorbable sutures in one group (group 1) and non-absorbable sutures in the other group (group 2) for fixation of mesh.Results: In spite of a noticeable reduction in complication in the group 1 in term of number and percentage when compared with group 2 mainly chronic pain, there is no significant difference (p value>0.05). However, these results are associated with zero recurrence in both groups during a period of one year follow up.Conclusions: Delayed absorbable sutures are good alternative of non-absorbable sutures in open mesh hernia repair associated with less complications and almost no increase in chance of recurrence.  


2014 ◽  
Vol 21 (03) ◽  
Author(s):  
Asghar Khan ◽  
Amin Fahim ◽  
Aneela Qureshi ◽  
Ghulam Shah Nizamani ◽  
Mohammad Ahmed Azmi

Objective: To assess the early detection of thrombocytopenia in womenpresenting with varying degree of pregnancy induced hypertension (PIH). Study Design: A casecontrol study. Place of Study: Hematology laboratory Isra University Hospital Hyderabad.Duration of Study: From July 2009 to December 2010. Materials and Methods: Total 130pregnant women were included in this study. The subjects were divided into three groups asGroup 1 with pre-eclampsia, Group 2 with eclampsia and Group 3 with normotensive pregnantwomen as control group. The Group 1 was further divided into two sub groups such as Subgroup1a with mild preeclampsia and Sub-group 2b with severe pre-eclampsia. Results:Anticoagulated whole blood samples (5cc) from all subjects were analyzed for the detection ofthrombocytopenia for the possible involvement of pregnancy induced hypertension. It was notedthat out of total subjects, 33(25.39%) had mild pre-eclampsia, 17(13.07%) had severe preeclampsia,15(11.54%) had eclampsia and 65 (50.0%) were normotensive pregnant women.Based on the comparative findings, the results showed significant differences between group 3and group 1a (p-value 0.001), group 3 and group 1b (p-value 0.001), group 2 and group 3 alsoshowed same results (p-value 0.001) but the subjects of group 1a and 1b when compared,showed non-significant findings (p value 0.955). Conclusion: The results suggested that earlydetection of platelet count provide significant role for the assessment of severity of disease inwomen with pregnancy induced hypertension when compared with normotensive pregnantwomen.


Author(s):  
I Putu Agus Budi Sudarsana ◽  
J. Alex Pangkahila ◽  
Bagus Komang Satriyasa ◽  
Wayan Weta ◽  
I Nengah Sandi ◽  
...  

ABSTRACTThis study was conducted to determine the increase in limb muscle explosive power. The training was conducted with 5 reps of 3 sets over six weeks in the field of Tegallalang 1 Public High School starting at 17.00 WITA until completion. In this study using 2 groups, namely the 1st group given jump training up and down the stands, the 2nd group was given jump training up and down the bench. The sample for each group is 8 people who have met the requirements of the male volleyball extra-curricular participants of Tegallalang 1 Public High School. Data from leg muscle explosive results obtained from 3 jumps taken before and after training. The results obtained before and after the Group-1 training were 57.5 cm to 70.875 cm and Group-2 were 57.375 cm to 65.75 cm. Hypothesis testing uses an independent t-test at a significance limit of 0.05 (p <0.05). Based on the differences in the results of the intergroup test analysis using independent t-test obtained group-1 and group-2 for p = 0.935 which showed no significant difference before being given treatment with a p value greater than 0.05. Whereas after treatment the group-1 and group-2 were obtained at p = 0.007 which showed a significant difference between groups 1 and 2 groups with a p value smaller than 0.05. It can be concluded that jumping up and down the stands is more effective than jump training up and down the bench in increasing the explosive power of the leg muscles. For this reason, it is expected that sports coaches to apply jumping up and down the stands as an alternative in increasing athletes' explosive power.Keywords: Training jumping up and down the stands, training jumping up and down the bench, explosive muscle power.


Author(s):  
Sneha S. ◽  
Sreelatha S. ◽  
Renuka Ramaiah

Background: The current study follows grannum grading of placenta. It is well known that there is accelerated placental maturation in PIH patients and the ultrasonic appearance of grade 3 placenta before 37 weeks may signify placental dysfunction and is associated with development of low birth weight babies, IUGR meconium stained liquor, low APGAR score. Hence this study was conducted to emphasize on placental grading at different periods of gestation to predict and prevent increased obstetric and fetal compromise and to compare the outcomes.Methods: Obstetric scans were performed in all PIH patients attending antenatal OPD and inpatients at ESIC and PGIMSR medical college, Bangalore to know the placental grading and biophysical profile. These women were followed till their delivery for obstetric and fetal outcomes.Results: Grade 3 placenta is seen in 17 patients in group 1(50%) and 39 patients (59%) in group 2. For statistical analysis grade 1 and 2 were combined and compared with  grade 3. P-value 0.198 which was not statistically significant. There was no statistically significant difference in age and gravidity between two groups. The medical disorders were more in group 2 i.e., between 37 - 40 weeks. The complications of PIH were also more in group 2. There were more number of LSCS (n=19 versus 14) in 34-36 weeks group which was not statistically significant. Fetal outcomes like IUGR and IUD were more in group 2 which was not statistically significant. The mean birth weight in group 1 was 2 kg as compared to 2.7 kg in group 2. All associated medical disorders were more in group 2.Conclusions: In hypertensive women there is accelerated placental maturation leading to maternal and fetal complications. Hence women with accelerated placental maturity in ultrasound should be closely monitored and appropriately managed. However, we recommend larger randomized studies are necessary.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2528-2528
Author(s):  
Ariane Steindl ◽  
Maximilian Mair ◽  
Angelika Martina Starzer ◽  
Karin Dieckmann ◽  
Georg Widhalm ◽  
...  

2528 Background: Radiotherapy was postulated to impact the inflammatory microenvironment composition in patients with lung cancer brain metastases (BM). Methods: Formalin fixed and paraffin embedded BM specimens from treatment naïve patients (group 1) and from patients treated with radiation therapy including whole brain radiotherapy and/or stereotactic radiosurgery (group 2) or prophylactic cranial irradiation (group 3) before BM resection were identified from the Vienna Brain Metastasis Registry. T cell subsets (CD3+,CD8+,CD45RO+,FOXP3+,PD-L1+) were investigated using the Ventana Benchmark Ultra system Definiens software. Results: Specimens from 41 patients (28/41;68.3% NSCLC, 13/41;31.7% SCLC) were included in the study. A significant difference in CD3+TIL density between group 1 (median: 964.5cells/mm2) and group 2 (median: 283.4cells/mm2; p-value=0.021; Mann-Whitney-U test), as well as group 3 (median: 168.8 cells/mm2; p-value= 0.028; Mann-Whitney-U test) were observed. Furthermore, CD8+ and FOXP3+TIL densities of group 2 (CD8+ median: 172.1cells/mm2; FOXP3+ median: 210.7cells/mm2) were numerically lower compared to group 1 (CD8+ median: 190.1 cells/mm2; FOXP3+ median: 221.2 cells/mm2). Of 10/41 (24.4%) patients further resected BM tissue specimens after initial resection were available. Here, the inflammatory microenvironment of BM treated with radiation therapy between the resections was significantly associated with lower densities of CD3+ (median: 105.1 cells/mm2) and CD8+ (median: 20.3cells/mm2) compared to radiation-naïve patients (CD3+ median: 825.4cells/mm2; CD8+median: 105.5cells/mm2; p=0.037; Mann-Whitney U-test). Conclusions: Radiation treatment was associated with lower densities of TIL subsets in our BM cohort. Although results have to be interpreted with caution due to the limited sample size, further studies investigating the sequencing of radiotherapy and immune modulating therapies might be of interest. [Table: see text]


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ghada Fathy Mohammed ◽  
Ahmed Abd-Elfattah Afify ◽  
Wessam Moustafa Abo Elmagd Abdel Latif

Abstract Background Warts (verrucas) are an extremely common, benign, and usually self-limited skin disease. Their size ranges from a few millimetres to several centimetres. The normal skin lines are interrupted by skin coloured to brownish-grey proliferations, the diagnosis is established clinically; no supplementary histologic or virologic investigations are needed. Objective The aim of this two armed double blinded randomized clinical trial was to evaluate the clinical efficacy of intralesional combined digoxin and furosemide in the treatment of multiple planter warts. Methods This study included 40 patients with plantar warts, they were divided into 2 groups, 20 patients per group, the first group received intralesional normal saline, one injection session every week for maximum 5 injection sessions. The second group received intralesional combined digoxin and furosemide, one injection session every week for maximum 5 injection sessions. All the patients were recruited from the Dermatology outpatient clinic at Ain-Shams University Hospital and Shobra General Hospital during the period From July 2018 to July 2019. Results There was no statistically significant difference between the 2 studied groups as regard size of wart before treatment. While there was statistically significant difference between the 2 studied groups as regard size of wart after the 5th session. Also there was a steady increase in the response to treatment in group 2 showing an earlier response to treatment and most of patients with excellent and very good response to treatment after the 5th session. There was no statistically significant difference between the 2 studied groups as regard the number of warts before treatment. While there was statistically significant difference between the 2 studied groups as regard the number of warts after the 5th session. There was no statistically significant correlation between age, sex, disease duration and response to treatment (as regard reduction in number of warts) after the 5th session in group 2. While in group 1 there was no reduction in number of warts after the 5th session. There was a statistically significant difference between the number of warts before and after receiving the active treatment in group 1, in group 2 and for both groups together (all patients). Conclusion We concluded from this study that intralesional injection of combined digoxin and furosemide offers effective alternative form of treatment for plantar warts in adults. It is inexpensive and safe to treat plantar warts.


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