Background:Mechanical ventilation is a life support intervention that is used for a large number of patients in Pediatric intensive care units. The current pediatric literature shows that the science of ventilator weaning and extubation remains undetermined. No optimal weaning method has been described for a more rapid and successful extubation. Objective:Weaning predictors are used as a decision point in protocols to determine whether a patient may advance to a spontaneous breathing trial. We designed a study to determine the effect of including a weaning predictor (clinical weaning parameters) in a weaning protocol. Subjects & Methods:  Cross section study was conducted on 53 children who admitted to PICU. All patients should be eligible for weaning from mechanical ventilation. Clinical data and laboratory investigations were obtained on admission. Patients underwent a spontaneous breathing trial (SBT) after reversal of the underlying cause for respiratory failure and when they met all the weaning criteria. Then Rapid shallow breathing index (RSBI) was performed. As RSBI ≤ 8 breath/min/ml/kg, PaO 2 > 60 mmHg, Pa CO 2 < 50 mmHg, FiO 2 < 0.5, PaO 2 /FiO 2 > 200 mg, Tidal volume (V T) > 5 ml/kg, V e >200 ml/min/kg, PEEP < 5 CmH 2 O and RR < 45 breath/min.  Weaning failure is defined as the inability to sustain spontaneous breathing without any form of ventilator support, for at least 48 h. The results were tabulated and analyzed with SPSS. Results:RSBI differed significantly between patients who succeeded weaning from mechanical ventilation and those who failed (3.12±1 vs. 9.5±1.04 breath/min/ml/kg; P < 0.001). A cutoff value ≥3.5 breath/min/ml/kg on were associated with a prediction of failure of weaning from mechanical ventilation with a 100%sensitivity, 75% specificity,0.724 positive predictive value (PPV), 1 negative predictive value (NPV) and 84.91% accuracy. Conclusion and key messages:Clinical weaning parameter could be considered a sensitive and specific marker for prediction of weaning failure.

Mathematical modeling has been a vital tool in the field of environmental engineering. Various models have been developed to simulate the level of aeration efficiency (AE) provided by different aerating structures to raise levels of dissolved oxygen (DO) in streams; one of which is the stepped cascade structure. Three models developed by Gameson et al. WRL, and Nakasone, in addition to Qual2k, a computer program for stream modeling, have been used in this research; values of AEs obtained have been compared to those computed using DO measured from a built model at a WWTP. A stepped cascade structure was installed with different heights to aerate five flowrates with different levels of COD. An adjustment has been made to the Nakasone model to test the effect of pollutant load on the amount of aeration that could be reached. Values of AEs computed using the Gameson model were 30%, 39.5%, and 40% for cascade heights (H(d)) 45, 60, and 75 cm respectively for the five flowrates (q) that ranged from 21-66 m³/hr. Values of AEs from WRL model were 32.8%, 42%, and 43% consequently. Values of AEs from Nakasone model ranged from 4.6-7.5%, 6-10%, and 7.6-12% respectively. For the adjusted Nakasone model, values of AEs ranged from 3.2-4.9%, 3.3-5.3%, and 4.1-6.7% respectively. Finally, the AEs computed using the values of downstream DO generated by Qual2k ranged from 4-18%, 2-15%, and 2.5-5.1% correspondingly. Around 80% of the downstream DO values computed using the Nakasone and adjusted Nakasone model were closer to those measured in the field, thus more reliable in cascade design.

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Aim of work: To determine the role of Multi-detector Computed Tomography in the evaluation of various pancreatic lesions. Background:MDCT with its thin collimation allows three-dimensional reformatting and multiplanar reconstruction of pancreatic anatomy which permits good depictions of many pancreatic lesions. Patients and Methods:30 patients with pancreatic lesions suspected on the basis of clinical symptoms, laboratory investigations and USS findings were enrolled in this study. Majority of patients (2 patients were fellow-up patients) were subjected to full clinical history, general and abdominal examination, Laboratory investigations, Ultrasonography examinations with (Siemens, Acuson.X300), and CT examinations; Triphasic contrastenhanced and monophasic MDCT (with delay of 40-50s) performed on (Philips, Ingenuity core128-multislice CT) in the Zagazig university hospital. Results:This study included 30 patients with suspected pancreatic lesions. They were 19 males (63.4%) and 11 females (34.6%). The most studied patients were above 50 years. 11 patients were diagnosed with acute pancreatitis, one patient with acute on chronic pancreatitis, and 18 patients with pancreatic neoplasms. Hence, pancreatic neoplasms were found to be the most common pancreatic lesions in our study. Conclusion:MDCT with contrast proved to be the imaging modality of choice in identification of various pancreatic lesions. The faster scanning time (with single breath hold) and thin slice thickness, allowed for better resolution and superior scan quality. The ability of MDCT to scan in both arterial and venous phases with its post processing techniques (MIP, MinP, CRP, and VR) allowed for excellent visualization of the pancreas, biliary anatomy and peripancreatic vasculature.

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