Introduction/Objective Massive transfusion is often defined as transfusion of adults with 10 or more of packed red blood cells units in 24 hours period or transfusion of 4 or more units of packed red blood cells (PRBCs) in one hour when on-going need for more transfusion is foreseeable. Massive transfusion protocol in children is defined as transfusion of >40 mL/kg. Massive transfusion protocol (MTP) is a vital element of damage control resuscitation and provides a coordinated clinical response to hemorrhage in patients requiring massive blood transfusions after hospital admission. Hemorrhage is the most common cause of death within the first hour of arrival to the trauma center. Methods/Case Report This study aims to develop and establish the first massive protocol in Egypt to provide a consistent treatment for blood transfusion for trauma patients that will Reduce delay in ordering and administering blood products and Deliver a reasonable ratio of plasma to red blood cells. The protocol will be first implemented in a military hospital in Egypt. Developing the massive transfusion protocol will allow the practitioners to follow algorithm for rapid replacement of blood products using uncrossmatched packed red blood cells, Plasma, platelets and cryoprecipitate if necessary. Adopting the American Association of Blood Banks (AABB) and the American College of Surgeons (ACS) guidelines are the best practice around the world. The Protocol will be developed by multidisciplinary committee engagement, Blood bank, Diagnostic laboratory and Clinical care areas (OR, ER, ICU, OBS). Results (if a Case Study enter NA) The massive transfusion protocol ratio will be 3:2 (RBC: FFP) and one units of platelets for every 6 units of RBC. according to American College of Surgeons (ACS) guidelines the ratio should be 1:1 to 1:2 (RBC: FFP). The committee established defined criteria for MTP activation and termination. The delivery time of the blood products should be between 5-10 minutes. Administration of tranexamic acid to inhibit plasminogen activation and stabilize the clot. Conclusion The Developing and Implementing MTP in Egypt will provide reduction in mortality for trauma and uncontrolled hemorrhage patients. Once implemented, we will regularly evaluate the use and efficacy of the MTP to ensure positive patient outcomes., the MTP will be evaluated to ensure best practice.
Introduction/Objective Fungal infection is usually caused by an overgrowth of yeast typically found in the vaginal flora. The major pathogen C. albicans is the best-characterized member of the Candida clade. Candida species are common inhabitants of the female genital tract, and the use of intrauterine devices (IUDs) has been associated with pelvic inflammatory diseases. This study explored the relationship between insertion (IUDs) and candidiasis. Methods/Case Report 350 female patients using IUDs suffering from vaginitis from The Delta region, Egypt, were enrolled in this study. The median age was 20 to 43 years old. Vaginal swabs and IUDs were collected. Patients were classified according to the period of using IUDs as the following. Group 1: 46 users of IUDs for a period of one month to one year. Group 2: 85 users for one year to 5 years. Group 3: 171 users for five years to 10 years. Group 4: 52 users for 10 years to 20 years. The cultural characters identified the isolated organisms (morphological characters of the purified fungal isolates were carried out according to the organism's colony characters and biochemical tests). Results (if a Case Study enter NA) : 292 patients were positive for Candida albicans. We observed that 38 (5.59 %), 41 (11.2 %), 163 (7.6 %), and 48 (5.93 %) cases have positive Candida albicans for group1, group2, group2, and group4 respectively. There was a statistically significant difference between the occurrence of Candidiasis and IUDs in all studied groups P-value was ≤ 0.05. Conclusion In Egypt, women who use intrauterine devices have a higher chance of developing vaginitis. The findings indicated that women who used IUDs for longer periods of time had a higher risk of developing candidiasis. We advocate for the regulation of IUDs and the education of women on how to recognize the symptoms of candidiasis vaginosis and how to properly treat it.
Introduction/Objective Noninvasive Markers (NIM) of Liver Fibrosis help evaluate the stage of fibrosis in patients with no clear indication for a liver biopsy, such as patients with chronic hepatitis C who need monitoring of the stage of fibrosis during or after treatment. The perfect NIM for hepatic fibrosis should be inexpensive, safe, simple, reliable, and well-validated in different forms of chronic liver disease. Aim of the work Find if there is a correlation between serum collagen III and APRI as noninvasive markers in patients with HCV-induced liver fibrosis. Methods/Case Report 118 patients with HCV induced liver fibrosis (60 males and 58 females) and 50 healthy comparable control subjects (27 males and 23 females) were enrolled in the study. Collagen III was identified in serum samples of HCV-induced liver fibrosis patients at 70 kDa using collagen III polyclonal antibody and western blot analysis techniques. Collagen III was purified using the electroelution technique and then quantified using the ELISA technique. AST, ALT, albumin, and total bilirubin were measured. The APRI was calculated as [AST/ (upper limits of normal)/ platelets count 109/L]×100. The AST-ALT ratio was calculated as [AST/ ALT]. Results (if a Case Study enter NA) There was a statistically significant difference between the diseased and control groups (P<0.0001) regarding collagen III and APRI. Also, significant positive correlation between serum collagen III, APRI, and ALT levels (r=0.3 and p=0.02). However, there were no correlations between serum collagen III levels and AST, Albumin, Total Bilirubin, and AST/ALT ratio (r=0.15, -0.26, 0.22, and -0.027), respectively. Conclusion Collagen III and APRI is a promising diagnostic and prognostic potential in the noninvasive assessment of liver fibrosis as their levels elevate with each other. So, we can powerfully depend on them in liver fibrosis diagnosis in chronic HCV patients.
Introduction/Objective Chronic hepatitis C virus (HCV) infection is typically characterized by slowly progressive hepatic fibrosis, with progression from stage 0 (no fibrosis) to stage 4 (cirrhosis). Aspartate aminotransferase-to- platelet ratio (APRI) may be a simple and convenient noninvasive diagnostic test because it is based on the regular laboratory tests and demographic data. However, its overall test performance in various settings remains questionable. Methods/Case Report Objectives: This study aimed to evaluate the diagnostic accuracy of APRI in the prediction of hepatic fibrosis. Subjects and Methods: Serum samples were collected from patients recruited from Internal Medicine Dept., Mansoura University Hospitals, Egypt. The study included 118 liver fibrosis patients associated with chronic HCV infection (60 males and 58 females) and 50 age-matched healthy volunteers (27 males and 23 females). The HCV infection was diagnosed based on biochemical, serologic, and histological criteria. All samples of fibrotic liver patients showed a positive result for anti-HCV Abs using ELISA as a confirmatory test. AST, ALT, albumin, and total bilirubin were measured using standard methodologies. Routine blood pictures, including platelets counting were determined. The AST-ALT ratio was calculated as [AST/ ALT]. The APRI was calculated as [AST/ (upper limits of normal)/ platelets count 109/L]×100. Results (if a Case Study enter NA) There was no statistically significant difference between sex distribution in liver fibrosis patients and healthy volunteers. The mean±SD was (46.1±10.44 and 33.3±11.13) respectively. The medians of the selected laboratory markers in the healthy group and liver fibrotic patients were (41,39), (272.5,167), (36,54), (35.5,51), (0.9,0.98), (0.71,2.5), and (0.34, 0.86) for Albumin, Platelet count, AST, ALT, AST/ALT ratio, Total Bilirubin, APRI respectively. There was a statistically significant difference between the two groups in all laboratory parameters (p<0.001) and for APRI (p<0.0001). Conclusion The evaluation of APRI is uncomplicated, inexpensive, and has a reasonable degree of diagnostic accuracy in determining whether or not patients with chronic HCV have liver fibrosis.
Introduction/Objective Liver biopsy is still the gold typical for assessing hepatic fibrosis. Non-invasive serum parameters measurement leads to essential changes in diagnosis. This procedure is painful, carries a risk of bleeding and infection, and is accompanied by a high sampling error rate. New biomarkers that can accurately predict the stage of fibrosis are urgently needed. Objectives This study aimed to identify, characterize, and detect serum collagen III in patients with HCV-induced liver fibrosis and healthy subjects. Methods/Case Report The study subjects were divided into two groups; group1: included 118 patients with HCV-induced liver fibrosis (60 males and 58 females). Group2: included 50 healthy comparable control subjects (27 males and 23 females). Collagen III was identified in serum samples of group1 at 70 kDa using collagen III polyclonal antibody and western blot analysis techniques. Additionally, it was purified from serum samples using the electroelution technique from preparative slab gels. The purified antigen gives a single sharp band at 70 kDa when resolved by SDS–PAGE (sodium dodecyl sulfate-polyacrylamide gel electrophoresis) and stained with coomassie blue. The 70 kDa purified collagen III showed high reactivity towards the collagen III polyclonal antibody. We used the ELISA method to quantify the collagen III, dose-response curve for purified collagen III as a function of the concentration in serum samples of liver fibrosis patients was done. Results (if a Case Study enter NA) The collagen III was identified in 62% of patients, and 38 % were negative collagen III (false negative) in group one. For group two, 96% of total healthy volunteers were negative for collagen III, and 4% were positive for collagen III (false positive). The mean ± SD of serum collagen III concentration was (8.38±3.56) and (3.2±0.59) for groups 1 and 2, respectively, with (P<0.0001). Conclusion The non-invasive assessment of liver fibrosis by collagen III has shown promising diagnostic and prognostic potential.
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