The application of a new regimen for short term sedation in the ICU (ketofol) – Case series

AbstractObjectiveSedation is an effective component of care in ICU patients. The aim of this study was to evaluate the safety and efficacy of ketamine/propofol combination in short term sedation for the critically ill patients in ICU.DesignProspective case series study.SettingIntensive care unit (ICU) in a tertiary hospital (Kasr Al Aini).MethodsFourteen critically ill patients who were mechanically ventilated and were in need for sedation were included in this case series. An initial bolus dose (500μg/kg) of ketamine/propofol 1:1 (ketamine 8mg/ml and propofol 8mg/ml) was given to all patients followed by a maintenance dose of 10μg/kg/min and the infusion dose adjusted (in 5μg/kg/min increments) to achieve Ramsay Sedation Scale of 4. Recorded parameters included heart rate, systolic blood pressure, Ramsay score, the need for use of noradrenalin and the recovery time from discontinuation of sedation.ResultsThe mean and standard deviation of the age of the patients was 60±14.5y and their APACHEII score ranged from 18 to 35. The median initial bolus dose of ketofol administered was 5ml of aliquot with median infusion rate 6ml/h (range: 4.8–7.5ml/h) only three patients (21.4%) needed the infusion rate to be increased to achieve Ramsay score 4. Only one patient experienced hypotension due to hypovolemia secondary to internal hemorrhage.ConclusionContinuous intravenous infusion of ketofol may provide adequate and safe short term sedation (less than 24h) for critically ill patients in the intensive care units, with rapid recovery and no clinically significant complications. Further studies with larger number of patients are required to evaluate and validate these findings

Effect of vaginal progesterone in combination with cervical cerclage on improved gestational age and perinatal outcome in twin pregnancy: A prospective randomized study

Background: Prematurity is the second leading cause of death in the first month of life. Objective of present study was to evaluate the effectiveness of vaginal progesterone and cervical cerclage each alone and in combination in improving gestational age in twin pregnancy and its subsequent impact on perinatal outcome.Methods: A sample size of seventy-five patients has been calculated out of those recruited from outpatient clinic at menoufia university hospital. All fulfilled eligibility criteria of having a twin pregnancy with a history of spontaneous preterm labour, or with a sonographic short cervical length <25mm in mid trimester. The participants were randomly assigned to three groups. Group 1 (N-25): received vaginal progesterone supplementation of 200 mg from 20 weeks until 34 weeks of gestation. Group2 (N-25): were remedied with cervical cerclage of Mc Donald type at 14-16 weeks of gestation Group 3 (N-25): received both vaginal progesterone as well as cervical cerclage. The primary outcome measure was spontaneous delivery between 34-37 weeks of gestation. Secondary outcomes were delivery prior 34 weeks of gestation as well as some parameters of neonatal morbidity and mortality.Results: There was a statistically significant higher gestational age in combination group when compared to progesterone group or cerclage group (P<0.001). Comparison between progesterone and cerclage groups did not reach statistical significance(P=-0.85). Both progesterone and cerclage groups demonstrated significantly lower birth weights, lower Apgar scores and a higher NICU admission rate than in combination group(P<0.001), while such significant difference did not exist between progesterone and cerclage groups.Conclusions: Combination of vaginal progesterone and cervical cerclage can improve gestational age at delivery as well as some parameters of perinatal morbidity and mortality in twin pregnancy

Giant parathyroid adenoma: A case report and review of the literature

Background: Giant parathyroid adenoma is a rare type of parathyroid adenoma defined as weighing > 3.5 g. They present as primary hyperparathyroidism but with more elevated laboratory findings and more severe clinical presentations due to the larger tissue mass. This is the first reported case of giant parathyroid adenoma from the Middle East. Case presentation: A 52-year-old Indian woman presented with a palpable right-sided neck mass and generalized fatigue. Investigations revealed hypercalcemia with elevated parathyroid hormone and an asymptomatic kidney stone. Ultrasound showed a complex nodule with solid and cystic components, and Sestamibi nuclear scan confirmed a giant parathyroid adenoma. Focused surgical neck exploration was done and a giant parathyroid adenoma weighing 7.7 gm was excised. Conclusions: Giant parathyroid adenoma is a rare cause of primary hyperparathyroidism and usually presents symptomatically with high calcium and parathyroid hormone levels. Giant parathyroid adenoma is diagnosed by imaging and laboratory studies. Management is typically surgical, aiming at complete resection. Patients usually recover with no long-term complications or recurrence. - 2019 The Author(s).Scopu

Predicting the potential current and future distribution of the endangered endemic vascular plant primula boveana decne. ex duby in Egypt

Knowledge about population attributes, current geographic distribution, and changes over predicted climate change for many threatened endemic vascular plants is particularly limited in arid mountain environments. Primula boveana is one of the rarest and threatened plants worldwide, surviving exclusively in Saint Catherine Protectorate in the Sinaic biogeographic subsector of Egypt. This study aimed to define the current state of P. boveana populations, predict its current potential distribution, and use the best-model outputs to guide in field sampling and to forecast its future distribution under two climate change scenarios. The MaxEnt algorithm was used by relating 10 occurrence-points with different environmental predictors (27 bioclimatic, 3 topographic, and 8 edaphic factors). At the current knowledge level, the population size of P. boveana consists of 796 individuals, including 137 matures, distributed in only 250 m2. The Canonical Correlation Analysis (CCorA) displayed that population attributes (density, cover, size index, and plant vigor) were positively correlated with elevation, precipitation, and pH. Based on the best-fitting model, most predicted suitable central sites (69 km2) of P. boveana were located in the cool shaded high-elevated middle northern part of St. Catherine. Elevation, precipitation, temperature, and soil pH were the key contributors to P. boveana distribution in Egypt. After field trips in suitable predicted sites, we confirmed five extinct localities where P. boveana has been previously recorded and no new population was found. The projected map showed an upward range shift through the contraction of sites between 1800 and 2000 m and expansion towards high elevation (above 2000 m) at the southern parts of the St. Catherine area. To conserve P. boveana, it is recommended to initiate in situ conservation through reinforcement and reintroduction actions

Selected studies on foreign body impaction in goats with special reference to ultrasonography

Background and Aim: Diagnosis of foreign body impaction in ruminant is still of interest in most clinical studies. The main purpose of this study was to evaluate this condition using B-mode ultrasonography in addition to evaluation of clinical, hemato-biochemical and ruminal parameters in healthy and affected goats. Materials and Methods: Fifteen clinically normal goats and 15 goats with foreign body impaction were recruited in Menia El-Kamh abattoir. All animals were selected only when revealed negative for internal and external parasite. Thorough clinical, ultrasonographic examination and blood analysis were applied before slaughtering. Meanwhile, ruminal fluid and necropsy findings were assessed after slaughtering. Results: The prominent clinical signs in diseased group were inappetence, dullness, emaciation, weakness, scanty hard feces and tympany. Ultrasonographic examination of diseased goats revealed the presence of foreign body at left 11th-12th ICS. Foreign body in rumen appeared as hyperechoic band with acoustic shadowing. Significant reduction in ruminal wall thickness and biphasic reticular motility along with significant increase in monophasic reticular contraction and relaxation period were recorded in diseased goats when compared with control one. The erythrocytes count, hemoglobin content, hematocrit percent and albumin were significantly decreased in diseased goats when compared with healthy one. Moreover, ruminal fluid analysis of affected goats revealed significant decrease in ruminal pH and prolonged Methylene blue reduction time. Conclusions: Findings indicated that B-mode ultrasonography is a relatively simple and objective method for diagnosis of foreign body impaction in goats

Impact of Augmented Reality on Pattern Designing Using Origami-Style among Clothing and Textile Students

The study aimed to examine the effects of augmented reality technology on the development of origami-style pattern designing skills among female students in the clothing and textile field, as well as to explore their attitudes towards this technology. The quasi-experimental approach was employed to achieve the research objectives, with a sample of 24 female students from the Fourth Grade of the Department of Clothing and Textile, Faculty of Home Economics at Al-Azhar University. The participants were divided into two groups: a control group of 12 students who studied in the traditional way, and an experimental group of 12 students who used augmented reality technology to learn. The study was conducted in the second semester of the academic year 2020/2021. The results showed that there was a statistically significant difference (at a significance level of 0.01) between the average scores of the control group and the experimental group in both cognitive achievement and skill performance, with the experimental group performing better. Additionally, the retention of learned information was higher among the experimental group, and they had a more positive attitude towards using augmented reality technology in learning

The Reality of Applying the Balanced Scorecard in the Egyptian Ceramic Companies

The study aimed to identify the level of organizational performance in ceramic companies in the Tenth of Ramadan City, where the researchers used the descriptive analytical method, through a questionnaire distributed. The study reached a set of results, the most important of which are: the presence of a clear consensus of the study sample from the members of the senior management that all dimensions of the balanced scorecard variable are largely present in the ceramic companies under study, and the results showed the approval of the study sample of workers in an average way on the application of the financial dimension and that it is applied Well, the approval of the study sample of the employees in an average way that tends to decline on the degree of application of the customer dimension and that it is applied by the senior management in an inappropriate way, the approval of the study sample of the employees in a large way on the degree of application of the internal operations dimension and that it is applied by the senior management in a large and appropriate way, approval The study sample of workers applying the learning and growth dimension is moderately low and it is applied inappropriately by the senior management. The study presented a set of recommendations, the most important of which are: working on clarifying and translating the vision and strategy of the institution, working on clarifying the strategy and linking it to the goals, planning and setting goals and arranging strategic initiatives, promoting strategic feedback