Critical Care Commons^™

Tuberculosis Presenting As Polyarthritis, J A. Khan, M Y. Ahmadani

Section of Pulmonary & Critical Care

No abstract provided.

Repair Of The Airway Epithelium: Potential Opportunities For Therapeutic Intervention In Airway Disease, Stephen I. Rennard

Journal Articles: Pulmonary & Critical Care Med

The epithelium of the airway has considerable capacity to undergo repair. These repair processes are responsible for maintaining and restoring function after injury of the airways, which likely occurs often as a result of infectious, toxic or other exposures. However, repair processes need not be fully effective. Inadequate repair can take a number of forms and may result in metaplasia, hyperplasia or fibrotic scarring. It is likely that repair processes that lead to tissue disruption play an important role in the chronic airways diseases, such as asthma and bronchitis. Through delineation of these processes, it may become feasible to target …

Dyslipidemia And Its Relation With Body Mass Index Versus Waist Hip Ratio, A Jabbar, A Irfanullah, J Akhter, Y K. Mirza

Section of Pulmonary & Critical Care

To study the magnitude of dyslipidemia in asymptomatic subjects and its relation to body mass index (BMI) and waist-hip-ratio (WHR), 88 subjects attending the health analysis programme were examined and their age, sex, BMI, WHR, fasting blood glucose and lipids were measured. The distribution of the lipid levels and the frequency of dyslipidemia were noted. Forty-eight percent had a total cholesterol of > 200 mg/dl and 50% had an HDL-cholesterol of < 40 mg/dl. On comparing the means of total cholesterol to BMI and WHR, it was found that total cholesterol level was statistically significant for WHR above and below 0.9 for males and 0.8 for females, whereas not so for BMI above and below 27 kg/m2. The prevalence of dyslipidemia in asymptomatic people in this group emphasizes the need for routine health screening for early institution of preventive measures. The correlation with WHR rather than BMI points towards importance of measuring parameters of central obesity rather than body weight and height only.

Renal Tubular Acidosis With Muscle Paralysis, A M. Nagaria, A Jabbar, J A. Khan

Section of Pulmonary & Critical Care

No abstract provided.

Late Onset Oesophageal Perforation Due To Gunshot Injury Of Chest: Successful Non-Operative Management In A Young Child, Asad Mian, Saima H. Khan, Naeem-Uz-Zafar Khan

Department of Emergency Medicine

Penetrating firearm injuries of the chest have become commonplace in children living in violent urban areas. Esophageal perforation may present as a late manifestation of peadiatric thoracic trauma due to gunshot injury. Opinion varies as to the surgical or nonsurgical management of such a patient. The authors report a case of a 12-year-old girl who presented with a similar dilemma and her successful conservative management, that they opted for; is discussed.

Enteric Absorption Of Ciprofloxacin During Tube Feeding In The Critically Ill, Stephen M. Cohn, Mark D. Sawyer, Gerard A. Burns, Concertina Tolomeo, Kerry A. Milner

Nursing Faculty Publications

To determine the pharmacokinetic properties of ciprofloxacin in the critically ill, we studied seven mechanically ventilated patients with pneumonia during entcral feedings. Subjects received ciprofloxacin 750 mg every 12 h via nasogastric tube and serial serum drug concentrations were measured after the first and fourth dose. After the initial dose, the maximum serum concentration ranged from 1.24–3.06 mg/L, and the area under the time curve from 0–12 h ranged from 3.2–19.65 mg.h/L. Similar levels were noted after dose four. Gastrointestinal absorption of ciprofloxacin in tube fed critically ill patients was decreased, but well above MIC values for many pathogenic bacteria.

Efficient Vasoactive Intestinal Polypeptide Hydrolyzing Autoantibody Light Chains Selected By Phage Display, Sonia Tyutyulkova, Qing-Sheng Gao, Austin Thompson, Stephen I. Rennard, Sudhir Paul

Journal Articles: Pulmonary & Critical Care Med

An immunoglobulin light chain (L chain) library derived from the peripheral blood lymphocytes of a patient with asthma was cloned into a phagemid vector. Phage particles displaying L chains capable of binding vasoactive intestinal polypeptide (VIP) were isolated by affinity chromatography. Two VIP binding L chains were expressed in Escherichia coli in soluble form and purified to electrophoretic homogeneity by metal chelating and protein L affinity chromatography. Both L chains catalyzed the hydrolysis of [tyr10-125I]VIP substrate. The catalytic activity eluted at the molecular mass of the monomer form of the L chain (28 kDa) from a gel filtration column. The …

Endobronchial Tuberculosis--Manifesting By Coughing Up Of Bronchial Cartilage, A M. Memon, A Shafi, H Thawerani

Section of Pulmonary & Critical Care

No abstract provided.

Allergic Bronchopulmonary Aspergillosis: An Unusual Complication Of Bronchial Asthma, S F. Hussain, J A. Khan, M A. Khan

Section of Pulmonary & Critical Care

Asthma is a common medical problem in Pakistan. Allergic Bronchopulmonary Aspergillosis (ABPA), an immune mediated disease, is an unusual complication of bronchial asthma which can result in bronchiectasis, pulmonary fibrosis, respiratory failure and death. Early diagnosis is important so that with proper therapy permanent lung damage can be prevented. First described in 19521 , ABPA was thought to be a rare disorder, but with increased awareness amongst the physicians and better diagnostic techniques, äases are being recognized more frequently. The clinical features of ABPA (cough, fever, hemoptysis and lung infiltrates) are usually mistaken for pulmonary tuberculosis (TB). We present three …

An Audit On Hospital Management Of Bronchial Asthma, J A. Khan, S Saghir, G Tabassum, S F. Husain

Section of Pulmonary & Critical Care

Medical audit is a new concept in developing countries like Pakistan. We carried out this retrospective study on bronchial asthma. The purpose was to see if care given to patient with asthma meets the accepted international standard or not. During this audit several deficiencies were found. Documentation in notes about signs indicating severity of asthma was very poor. Peak flow recording in the notes was also very deficient. There was no documentation in notes whether inhalers technique of the patients has been checked or not. This audit shows that care given to asthma patients is far from satisfactory and we …

Diagnostic Evaluation Of Pleural Effusion And The Role Of Needle Pleural Biopsy, S F. Hussain, S Mujahid, J A. Khan

Section of Pulmonary & Critical Care

No abstract provided.

An Assessment Of Personal Characteristics, Job Satisfaction And Semantic Descriptors Of Virginia Acute And Tertiary Care Hospitals' Chief Executive Officers, Justin C. Matus

Health Services Research Dissertations

The purpose of the study was to identify the determinants of job satisfaction of Virginia Hospital CEO's and to identify those descriptors that best characterize the role of the hospital CEO as defined by the CEO's themselves. The study sample consisted of all hospital CEO's in Virginia as listed by the Virginia Hospital Association. The study employed a four part survey instrument that investigated four major areas: (1) personal and hospital demographics; (2) self rated performance; (3) a semantic scale measuring the concept of Hospital CEO; and (4) The Minnesota Satisfaction Questionnaire. A survey was mailed to 119 CEO's. The …

An Assessment Of Management Practices Among Virginia Acute Care Hospitals, Ogbonnia Godfrey Ochonma

Health Services Research Dissertations

The 1990's will see dramatic changes for the health care industry. At no previous time have both public and private health care institutions faced a more turbulent, confusing and threatening environment. Changes in health care arena will come from Federal, State and local governments; international as well as domestic economic and market forces; demographic shifts and life style changes; and structural evolution of the health care industry including mergers, integrations and competition.

The health care industry faces increasing financial pressures due to fundamentally new forces that affect the very viability of many health care organizations. Such pressures include prospective payment, …

Cryptic Disseminated Tuberculosis: An Often Missed Diagnosis, A Jabbar

Section of Pulmonary & Critical Care

No abstract provided.

Endobronchial Tuberculosis Simulating Bronchial Asthma, J A. Khan, N Islam, J Akhter, S F. Hussain

Section of Pulmonary & Critical Care

No abstract provided.

Sweet's Syndrome, A Jabbar

Section of Pulmonary & Critical Care

No abstract provided.

Testotoxicosis: Gonadotrophin-Independent Male Sexual Precocity, A A. Aziz, S M. Jafri, N U. Haque

Section of Pulmonary & Critical Care

In this era of rapidly developing investigational tools and pharmacology, the pathophysiology of precocious puberty is becoming well defined. What was previously thought to be a form of gonadotrophin releasing hormone (GNRH)-dependent central precocious puberty is now classified as GNRH-independent familial testotoxicosis. We present two such cases and review the clinical features, pathophysiology and treatment of testotoxicosis.

The Effects Of Alpha Adrenergic Blockade On Arachidonic Acid Metabolism And Shock Sequelae During Septic Shock In The Rat, Jeffrey Armstrong

MUSC Theses and Dissertations

Increased activity of the alpha adrenergic nervous system may be a significant factor promoting tissue ischemia in endotoxic shock. The suggestion that increased sympathetic activity affects prostaglandin synthesis prompted investigation of the potential interaction between the adrenergic nervous system and arachidonic acid metabolites during endotoxemia and septicemia. In addition, the possibility that the underlying patterns of arachidonic acid metabolites seen in two different shock models may provide a rationale for therapeutic intervention designed to block either or both the synthesis of arachidonic acid metabolites or the activity of the adrenergic nervous system was examined. Studies were undertaken to determine the …

Role Of The Arachidonic Acid Metabolites, Thromboxane A2 And Prostacyclin, In Shock Induced By Intraabdominal Sepsis, Robert Raymond Butler

MUSC Theses and Dissertations

A rat fecal peritonitis model of acute intraabdominal sepsis was investigated in order to evaluate the potential role of arachidonic acid metabolites in septic shock. Immunoreactive (i) Thromboxane (Tx) B2, the stable metabolite of TXA2' and i6-keto-PGF1α, the stable metabolite of prostacyclin, were measured by radioimmuonassay. plasma levels of iTXB2 rapidly increased from non-detectable (ND< 200 pg/ml) to 1,066 -/+ 194 pg/ml (N=14) 1 hour after feces injection. iTxB2 then increased to 1,695 -/+ 218 pg/ml (N=16) at 4 hours and remained unchanged through 6 hours. Plasma i6-keto-PGF1α increased from ND to 3,777 -/+ 414 pg/ml (N=16) at 1 hour. Four hours after feces, i6-keto-PGF1α levels rose to 6,945 -/+ 732 pg/ml (N=16) then continued to rise to 9,465 -/+ 792 pg/ml (N=7) at 6 hours. Either essential fatty acid deficiency (arachidonic acid depletion) or indomethacin pretreatment (cyclooxygenase inhibition) significantly decreased (P< 0.01) the elevations of plasma iTxB2 and i6-keto-PGF1α associated with fecal peritonitis. Thrombocytopenia occurred within 6 hours after injection of feces and was significantly improved (P< 0.05) by indomethacin. Elevated fibrin degradation products at 6 hours (18 -/+ 3 µg/ml) were significantly reduced in essential fatty acid deficient (7 -/+ 2 µg/ml; P< 0.05) and indomethacin treated (4 -/+ 0.7 µg/ml; P< 0.01) rats. Survival time (8.6 -/+ 0.2 hours) was significantly enhanced by essential fatty acid deficiency (10.2 -/+ 0.4 hrs; P< 0.01) or indomethacin pretreatment (13.3 -/+ 0.6 hrs; P< 0.01). These studies show that fecal peritonitis is associated with increased synthesis of thromboxane A2 and prostacyclin and suggest that these arachidonic acid metabolites may play a role in the pathophysiology of septic shock. To evaluate the pathogenic role of thromboxane (Tx) and prostacyclin (PGI2) in septic shock, the protective efficacy of the Tx synthetase inhibitor, 7(l-imidazolyl) heptanoic acid (7-IHA) and the cyclooxygenase inhibitor, ibuprofen, were assessed during fecal peritonitis in the rat. 7-IHA (60 mg/kg) administered ip 30 minutes prior to feces significantly reduced the plasma level of iTxB2 to ND (P< 0.01) at 1 hour and to 508 -/+ 56 pg/ml (P< 0.01) at 4 hours after injection of feces. In contrast, the levels of i6-keto-PGF1α, the stable metabolite of PGI2 were significantly elevated by 7-IHA pretreatment from septic control levels to 5,185 -/+ 467 pg/ml (P< 0.05) at 1 hour. Plasma i6-keto-PGF1α at 4 hours in 7-IHA treated rats (5,503 -/+ 665 pg/ml) was not different from untreated controls. Ibuprofen (5 mg/kg) administered ip 30 minutes prior to feces significantly decreased both iTxB2 and i6-keto-PGF1α plasma levels to 729 -/+ 99 pg/ml and 1,327 -/+ 251 pg/ml, respectively (P< 0.05) at 4 hours. Survival associated with fecal peritonitis was not altered by 7-IGA pretreatment, but was significantly improved (P< 0.05) in ibuprofen treated rates. Fibrin degradation products were also significantly decreased (P< 0.05) by 7-IHA pretreatment. These results suggest that TxA2 may contribute to the coagulopathies seen in septic shock and that PGI2 may be associated with terminal pathophysiologic events. The final phase of this project investigated the possible synergistic benefit between an antibiotic, gentamicin (GENT), and reduction of arachidonic acid metabolism by pre-administration of indomethacin (INDO) or essential fatty acid (EFA) deficiency. GENT significantly increased mean survival time to 23.8 -/+ 2.6 hours (N=16; P< 0.01). GENT + INDO or GENT + EFA deficiency further improved mean survival time and produced long term survivals (>48 hrs) of 35% (N=17) and 30% (N=7) respectively (P< 0.01 compared to GENT). GENT pretreatment did not significantly alter plasma iTxB2 levels, however, it selectively decreased i6-keto-PGF1α. For example, i6-keto-PGF1α decreased from 9,465 -/+ 792 pg/ml (N=7) to 2,096 -/+ 1174 pg/ml (N=5; P< 0.01) at 6 hours after induction of fecal peritonitis. GENT + INDO pretreatment significantly decreased both iTxB2 and i6-keto-PGF1α to ND (P< 0.01). Pretreatment with GENT alone did not reduce fibrin degradation products. These findings are consistent with the concept that TxA2 may play a role in consumptive coagulopathies and PGI2 may be associated with the terminal hypotension seen during septic shock. The effect of GENT on TxA2 and PGI2 production was investigated further. GENT had no observable effect on in vitro endotoxin stimulated production of these arachidonic acid metabolites by cultured rat peritoneal macrophages. GENT significantly reduced the plasma levels of iTxB2 and i6-keto-PGF1α during endotoxin induced shock in rats. These observations support a complex interaction of bacteria, endotoxin, host tissues, and gentamicin with the possible involvement of undescribed mediated factors.