Background: Measurement of diaphragmatic motion by ultrasound is being utilized in different aspects of clinical practice. Defining reference values of the diaphragmatic excursion is important to identify those with diaphragmatic motion abnormalities. This study aimed to define the normal range of diaphragmatic motion (reference values) by M-mode ultrasound for the normal population.Methods: Healthy volunteers were included in this study. Those with comorbidities, skeletal deformity, acute or chronic respiratory illness were excluded. Diaphragmatic ultrasound in the supine position was performed using a low frequency probe. The B-mode was applied for diaphragmatic identification, and the M-mode was employed for the recording of the amplitude of diaphragm contraction during quiet breathing, deep breathing and sniffing.Results: The study included 757 healthy subjects [478 men (63.14%) and 279 women (36.86%)] with normal spirometry and negative history of previous or current respiratory illness. Their mean age and BMI were 45.17 ±14.84 years and 29.36±19.68 (kg/m2). The mean right hemidiaphragmatic excursion was 2.32±0.54, 5.54±1.26 and 2.90±0.63 for quiet breathing, deep breathing and sniffing respectively, while the left hemidiaphragmatic excursion was 2.35±0.54, 5.30±1.21 and 2.97±0.56 cm for quiet breathing, deep breathing and sniffing respectively. There was a statistically significant difference between right and left diaphragmatic excursion among all studied subjects. The ratio of right to left diaphragmatic excursion during quiet breathing was (1.009±0.19); maximum 181% and minimum 28%. Only 19 cases showed a right to left ratio of less than 50% (5 men and 14 women). The diaphragmatic excursion was higher in males than females. There was a significant difference in diaphragmatic excursion among age groups. Age, sex and BMI significantly affected the diaphragmatic motion.Conclusions: Diaphragmatic excursion values presented in this study can be used as reference values to detect diaphragmatic dysfunction in clinical practice. Diaphragmatic motion is affected by several factors including age, sex and body mass index.

All samples were subjected to microscopy, antigen detection, culture and PCR. Twenty six of the isolates obtained by culture were further subjected to MLST genotyping method on ABI 3130 Genetic analyzer.Results: Of the 150 suspected patients 47 were positive by culture. 43.43% of the isolates were from HIV + ve patents. Comparing the Latex agglutination and PCR techniques using culture as the gold standard, they gave a sensitivity of 91.49% and 100% respectively and a specificity of 92.92% and 87.38%. Latex agglutination and PCR detected an additional seven patients 13 patients respectively which were not detected by culture. The predominant molecular type was VNI (96.15%). Only one isolate was of VNII. The phylogenetic analysis showed three major clusters.Conclusion: Cryptococcal meningitis a critical illness in patients on antiretroviral therapy. There could be a role of developing vaccines directed against VNI genotype of C. neoformans for the management of patents with HIV infection. http://dx.Background: Pediatric patients after hematopoietic stem cell transplantation (HSCT) have a high risk of invasive fungal infection. Due to the excellent results from prospective studies in adults, we have been using posaconazole for antifungal prophylaxis in pediatric patients for several years now. In addition to posaconazole oral suspension, posaconazole has recently been formulated as a tablet. In this analysis safety, feasibility, initial data on efficacy and posaconazole serum concentrations of posaconazole suspension were compared to posaconazole tablet in pediatric patients after HSCT.Methods & Materials: 52 pediatric patients with hematooncological malignancies with a median age of 11 years (range 6 months -21 years) that received posaconazole as antifungal pro-phylaxis after allogeneic HSCT were analyzed. Of the 52 patients, 31 received posaconazole suspension and 21 received posaconazole tablet up to a maximum of 200 days after HSCT. Posaconazole trough levels were analyzed on days 2, 3, 5, 7, 10, 14 and four weeks after start with posaconazole.Results: No possible, probable or proven invasive fungal infection occurred in both groups. On every analyzed time point after start of antifungal prophylaxis the trough levels were significantly higher in the tablet group compared to the suspension group. For example: day 3 suspension group (median 133 ng/ml, mean 156 ± 81 ng/ml, range 45-312 ng/ml) vs. tablet group (median 516 ng/ml, mean 656 ± 385 ng/ml, range 224 -1383 ng/ml) P<0.0001; day 7 suspension group (median 252 ng/ml, mean 390 ± 459 ng/ml, range 54 -2441 ng/ml) vs. tablet group (median 710 ng/ml, mean 910 ± 528 ng/ml, range 329-2227 ng/ml) P < 0.0001; day 14 suspension group (median 529 ng/ml, mean 643 ± 493 ng/ml, range 115-2081 ng/ml) vs. tablet group (median 834 ng/ml, mean 1076 ± 628 ng/ml, range 404-3060 ng/ml) P = 0.0031; 4 weeks suspension group (median 634 ng/ml, mean 732 ± 408 ng/ml, range 290-1664 ng/ml) vs. tablet group (median 1367 ng/ml, mean 1720 ± 973 ng/ml, range 582-4066 ng/ml) P = 0.0001.Co...

Background Cardiovascular disease (CVD) is the most common cause of death in patients with renal diseases. Cardiac arrhythmia and sudden cardiac death are particularly important, and the burden is higher in patients on hemodialysis. The aim of this study is to compare specific ECG changes as markers of arrhythmias in patients with CKD and patients with end-stage renal disease (ESRD); all without clinically manifest heart disease, with normal control subjects. Results Seventy-five ESRD patients on regular hemodialysis, 75 patients with stage 3–5 CKD and 40 healthy control subjects were included. All candidates were subjected to thorough clinical evaluation and laboratory tests including serum creatinine, glomerular filtration rate calculation, serum potassium, magnesium, calcium, phosphorus, iron, parathyroid hormone, and total iron binding capacity (TIBC). Resting twelve-lead ECG was done to calculate P wave dispersion (P-WD), corrected QT interval, QTc dispersion, Tpeak-Tend interval (Tp-e), and Tp-e/QT. Patients with ESRD had a significantly higher QTc dispersion (p < 0.001) and P-WD (p = 0.001) when compared to the other 2 groups. In the ESRD group, males had a significantly higher P-WD (p = 0.045), insignificantly higher QTc dispersion (p = 0.445), and insignificantly lower Tp-e/QT ratio (p = 0.252) as compared to females. Multivariate linear regression analysis for ESRD patients showed that serum creatinine (β = 0.279, p = 0.012) and transferrin saturation (β =  − 0.333, p = 0.003) were independent predictors of increased QTc dispersion while ejection fraction (β = 0.320, p = 0.002), hypertension (β =  − 0.319, p = 0.002), hemoglobin level (β =  − 0.345, p = 0.001), male gender (β =  − 0.274, p = 0.009) and TIBC (β =  − 0.220, p = 0.030) were independent predictors of increased P wave dispersion. In the CKD group, TIBC (β =  − 0.285, p = 0.013) was an independent predictor of QTc dispersion while serum calcium (β = 0.320, p = 0.002) and male gender (β =  − 0.274, p = 0.009) were independent predictors of Tp-e/QT ratio. Conclusions Patients with stage 3–5 CKD and those with ESRD on regular hemodialysis exhibit significant ECG changes that are considered substrates for ventricular as well as supraventricular arrhythmias. Those changes were more evident in patients on hemodialysis.