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B Barakat

Publications and source records attributed to B Barakat.

33 records · Page 2Linked to original sources
PubMed1998

Pancreatic involvement associated with tricyclic overdose.

To our knowledge, only two cases of pancreatic involvement after tricyclic overdose have so far been described in the literature. We report another case of pancreatic involvement after tricyclic antidepressant overdose. Patient. A 30-year-old female was admitted to our Emergency Room after having ingested 800 mg of amitriptyline in a suicide attempt. On the second day of hospitalization, high serum values of amylase 823 IU/l (normal values < 220 IU/l) and lipase 1054 IU/l (normal value < 270 IU/l) were found. The pancreas appeared normal upon ultrasonography. Serum pancreatic enzymes further increased on the third day of hospitalization, peaked on the fourth day and then progressively decreased. Repeated ultrasonography examination did not show any alteration in the pancreatic gland. The patient was discharged eight days after admission. Fifteen days after the overdose episode, the ultrasonographic examination still did not show any alteration of the pancreatic gland, and serum amylase and lipase were 403 IU/l and 239 IU/l, respectively. In our opinion, serum pancreatic enzymes should be determined in patients with tricyclic overdose in order to detect possible pancreatic involvement.

Adult↗
PubMed1998

Silent myocardial ischemia induced by hypoglycemia.

Hypoglycemia is known to produce various EKG changes, including arrhythmias. Although these changes have been rarely documented, their presence may pose diagnostic and therapeutic problems in an emergency situation. We report the case of a 81-year-old man with insulin-dependent diabetes mellitus who showed electrocardiographic features of acute myocardial ischemia during an episode of hypoglycemia; these alterations disappeared after glucose administration.

Aged↗
PubMed1997

Serum pancreatic enzymes in patients with coma due to head injury or acute stroke.

Serum amylase and lipase were measured in 32 patients with cerebral ischemia, 19 with spontaneous cerebral hemorrhage, 15 with head injury and intracranial bleeding, and 22 with head injury without intracranial bleeding; 20 healthy subjects were also studied as controls. Serum pancreatic isoamylase concentrations were assayed in hyperamylasemic sera. The overall incidence of hyperamylasemia was 14% (12 of 88 patients: 4 with cerebral ischemia, 4 with spontaneous cerebral hemorrhage, 1 with head injury and intracranial bleeding, and 3 with head injury without intracranial bleeding). In 4 of the 12 patients the hyperamylasemia was of pancreatic origin: 1 patient with cerebral ischemia, 1 patient with spontaneous cerebral hemorrhage, 1 patient with head injury and intracranial bleeding, and 1 patient with head injury without intracranial bleeding. The incidence of hyperlipasemia was 7% (6 of the 88 patients: 1 patient with cerebral ischemia, 2 with spontaneous cerebral hemorrhage, and 3 with head injury without intracranial bleeding). We conclude that hyperamylasemia is more frequent than hyperlipasemia in patients with an altered state of consciousness due to head injury or stroke and is usually of non-pancreatic origin. This knowledge may save these patients from invasive and costly examinations.

Acute Disease↗
PubMed1997

Serum interleukin-10 in human acute pancreatitis.

Interleukin 10 (IL-10) recently emerged as an antiinflammatory cytokine that inhibits the secretion of proinflammatory cytokines by monocytes and/or macrophages and the release of free oxygen radicals. It has been reported that treatment with IL-10 decreases the severity of experimental pancreatitis, mainly by inhibiting cellular necrosis. The aim of this study was to evaluate the behavior of serum IL-10 in patients with acute pancreatitis and to explore the possibility of a relationship between this cytokine and severity of the disease. Forty-five patients with acute pancreatitis were studied. Acute pancreatitis was of biliary origin in 30 patients, due to alcohol abuse in 10, due to pancreas divisum in 1, and of unknown origin in the remaining 4. According to the Balthazar criteria, 19 patients had scores of A, B, or C and 25 had scores of D or E. Twelve healthy subjects were also studied as controls. Serum IL-10 was determined in all subjects on admission, and in acute pancreatitis patients also daily for the following four days using a commercial kit. Healthy subjects had no detectable serum levels of IL-10. In acute pancreatitis patients, serum IL-10 levels were increased on the first day of the disease and then progressively decrease in the following days. On the first day of the acute pancreatitis, patients with the mild disease had serum levels of IL-10 significantly higher than those with severe disease, whereas in the following days, no statistically significant difference was observed between the two groups. The elevation of IL-10 on the first day of the illness is more marked in patients with mild acute pancreatitis than in those with the severe form of the disease. The finding of low values of serum IL-10 in severe acute pancreatitis suggests that there may be altered down-regulation of the immune system response in these patients.

Acute Disease↗
PubMed1997

Serum C-reactive protein in acute biliary pancreatitis. Is it a reliable marker for the early assessment of severity of the disease?

BACKGROUND: The cut-off point of serum C-reactive protein to differentiate the mild from the severe form of acute pancreatitis is still debated; data concerning the C-reactive protein pattern in assessing the severity of acute biliary pancreatitis are lacking. AIM: To define the best cut-off point in differentiating the severe from the mild form of acute biliary pancreatitis. PATIENTS: Fifty patients with acute biliary pancreatitis: 34 patients with mild pancreatitis and 16 with the severe form of the disease were studied. METHODS: Serum C-reactive protein concentrations were assessed in all patients upon admission and for the following 5 days. RESULTS: No significant difference in serum C-reactive protein levels was found in the first 2 days in patients with mild pancreatitis compared to those with the severe form of the disease. Using a cut-off point of 11 mg/dl, the sensitivity of serum C-reactive protein in assessing the severity of acute pancreatitis during the first two days of the study was 9% and 57%, the specificity, 93% and 81%, and the accuracy 71% and 74%, respectively. CONCLUSIONS: Serum determination of C-reactive protein in the first 48 hours of the disease is not a reliable marker of the severity of acute biliary pancreatitis.

Acute Disease↗
PubMed1997

Clinical value of serum pancreatic enzymes in acute alcohol intoxication and acute alcoholic pancreatitis.

BACKGROUND AND AIMS: The aim of this study was to evaluate the incidence in the serum of elevated levels of amylase, pancreatic isoamylase, and lipase in acute alcohol intoxication among occasional drinkers and chronic alcoholics, and to assess the diagnostic ability of the three enzymes for acute alcoholic pancreatitis. PATIENTS AND METHODS: One-hundred and seventeen consecutive subjects with acute alcohol intoxication but no abdominal pain (47 occasional drinkers, 70 chronic alcoholics), and 17 with acute alcoholic pancreatitis were studied. For all subjects serum amylase, pancreatic isoamylase, and lipase were determined using commercially available kits. RESULTS: Among occasional drinkers, serum amylase levels were abnormally high in 6 subjects (13%), whereas serum pancreatic isoamylase and lipase were abnormally high in one, (2%). In chronic alcoholics without abdominal pain serum amylase and lipase were abnormally high in 10 subjects (14%) but serum pancreatic isoamylase in only 7 (10%). In patients with acute alcoholic pancreatitis, serum amylase and pancreatic isoamylase were abnormally high in 16 of the 17 patients (94%), whereas serum lipase was abnormally high in all. CONCLUSIONS: Chronic alcohol abuse, but not occasional alcohol intoxication, may cause pancreatic damage. Amylase, pancreatic isoamylase and lipase determinations in the serum are all equally useful in the diagnosis of acute alcoholic pancreatitis.

Acute Disease↗
PubMed1995

Serum interleukin-6, interleukin-8, and beta 2-microglobulin in early assessment of severity of acute pancreatitis. Comparison with serum C-reactive protein.

The aim of this study was to compare the sensitivity, specificity, and diagnostic accuracy of serum interleukin-6, interleukin-8, beta 2-microglobulin, and C-reactive protein in the assessment of the severity of acute pancreatitis using commercial kits for their respective assays. Thirty-eight patients with acute pancreatitis (25 men, 13 women, mean age 59 years, range 16-97) were studied; the diagnosis was based on prolonged upper abdominal pain associated with a twofold increase of serum lipase, and it was confirmed by imaging techniques. According to the Atlanta criteria, 15 patients had severe illness and 23 had mild disease. The four serum markers were determined in all patients on admission, as well as daily for the following five days. On the first day of the disease, the sensitivity (calculated on patients with severe pancreatitis), specificity (calculated on patients with mild pancreatitis), and the diagnostic accuracy of these serum markers for establishing the severity of acute pancreatitis were 100%, 86%, and 91% for interleukin-6 (cutoff level 2.7 pg/ml); 100%, 81% and 88% for interleukin-8 (cutoff level 30 pg/ml); 58%, 81%, and 73% for beta 2-microglobulin (cutoff level 2.1 mg/liter); and 8%, 95%, and 64% for C-reactive protein (cutoff level 11 mg/dl). The results of our study indicate that, when assayed during the first 24 hr of disease onset, interleukin-6 and interleukin-8 are better markers than beta 2-microglobulin or C-reactive protein for evaluating the severity of acute pancreatitis.

Acute Disease↗
PubMed1995

Conserving fertility with early management of cervical pregnancy. A case report.

BACKGROUND: Cervical pregnancy can be a life-threatening entity, with the diagnosis often made on the hysterectomy specimen. A case of distal ectopic pregnancy involved the endocervical canal, and prompt diagnosis and treatment allowed the preservation of fertility. CASE: The patient presented at six weeks' gestation with vaginal bleeding. Serial ultrasound examinations revealed a viable pregnancy and ultimately suggested placental implantation within the endocervical canal. Curettage was performed using cervical stay sutures at the three and nine o'clock positions, with minimal bleeding and no postoperative morbidity. One year after the procedure the patient had a spontaneous delivery of a full-term male following an unremarkable prenatal course. CONCLUSION: Improvements in sonography and serum testing have allowed earlier diagnosis and hence greater success with conservative management of cervical pregnancy.

Adult↗
PubMed1994

Human pancreatic secretory trypsin inhibitor in the assessment of the severity of acute pancreatitis. A comparison with C-reactive protein.

We assessed the ability of serum human pancreatic secretory trypsin inhibitor (hPSTI) to establish the severity of acute pancreatitis and compared it in this respect to that of serum C-reactive protein (CRP). Of 26 patients studied with acute pancreatitis, 16 had mild pancreatitis, and 10, severe disease. Initial studies were performed at onset of the disease in 20 patients, on the second day of illness in two, and on the third day of illness in the remaining four. In all, serum hPSTI and CRP concentrations were determined on admission and daily for the following 5 days using commercial kits; Ranson's score was evaluated within the first 48 h of admission. Sixty-three healthy subjects and 31 patients with nonpancreatic acute abdomen were also studied. Values of 70 ng/ml for serum hPSTI and 10 mg/dl for serum CRP were taken as limits to distinguish severe from mild-to-moderate acute pancreatitis. When assessed within the first 24 h of pain, serum hPSTI correctly classified 71% of the patients with severe acute pancreatitis, whereas serum CRP did so for 29%. In subsequent days, the two markers showed a similar sensitivity in predicting severe acute pancreatitis. Serum hPSTI and CRP were alike in excluding a diagnosis of severe acute pancreatitis. Ranson's score correctly identified 50% of patients with severe illness and 63% of patients with mild pancreatitis. This study indicates that, when assessed within 24 h of pain onset, serum hPSTI is a better predictor of the severity of acute pancreatitis than serum CRP or Ranson's criteria.

Abdomen, Acute↗
PubMed1992

[Rhabdomyolysis during acute poisoning with drugs and narcotics. Experience with 7 clinical cases].

Numerous and extremely varied conditions (intense muscular activity, ischemia, metabolic and genetic disorders, infections, immunological diseases and toxic causes) may play a role in the genesis of non-traumatic rhabdomyolysis. Over the past years there has been an increased number of reports of forms due to drug or narcotic intoxication. Seven cases of rhabdomyolysis are reported in patients admitted to emergency wards in a state of coma due to heroin overdose (4 cases), cocaine overdose (1 case), carbamazepin (1 case), and tricyclic anti-depressives (1 case). In all cases it was possible to hypothesise a multifactorial pathogenesis of the disease in which other factors, such as acidosis, hypoxia, hypothermia and compression of the muscle mass during coma, were associated with the direct toxic damage caused by the drug. The most frequent complication was acute renal failure. One case of myocardial involvement with non-Q infarction characteristics was also observed.

Adult↗
PubMedDate not supplied

Psychosocial stressors and low birthweight in an urban population.

INTRODUCTION: Low birthweight is a major determinant of infant mortality, as well as a contributor to infant and childhood morbidity. A key issue is how to reduce the incidence of low birthweight in the United States. One emerging factor is exposure to psychosocial stressors. In this research, we evaluated the association between exposure to psychosocial stressors and low birthweight in a population of urban, low-income pregnant women. METHODS: Over 2,000 pregnant women 18 years of age and older were enrolled in this prospective study and recruited at their first prenatal care visit. We obtained information on maternal exposure to stressors. After the pregnancy, we abstracted clinical records of each woman enrolled in the study. Logistic regression was used to estimate the adjusted odds ratio for the association between stressor group membership and low birthweight, controlling for the effects of confounding factors. RESULTS: In logistic regression analyses stratified by race, for African-American women, the following variables were significantly associated with low birthweight: smoking, hypertension, low prepregnancy weight, hospitalization during pregnancy, previous preterm birth, and exposure to stressors. For Caucasian women, significant predictors were: smoking, drug use, hospitalization during pregnancy, hypertension, and previous preterm birth. Exposure to stressors was also significantly associated with many clinical and behavioral risks for low birthweight. CONCLUSION: Our results suggest two potential mechanisms for an association between stressors and low birthweight. Exposure to stressors may be indirectly associated with low birthweight through a relationship with clinical and behavioral risks for low birthweight. Exposure to psychosocial stressors may also be directly associated with risk of low birthweight among African-American women.

Adolescent↗