Ultra-low-dose naloxone added to fentanyl and lidocaine for peribulbar anesthesia: A randomized controlled trial

AbstractPurposePurpose was to evaluate the quality of the block and the duration of postoperative analgesia when ultra-low-dose of naloxone added to fentanyl and lidocaine for peribulbar anesthesia.MethodsSixty adult patients of both sexes, ASA I and II scheduled for open globe cataract surgery in the Ophthalmology Department Tanta University Hospital were included in this randomized prospective clinical trial.The patients were randomized into 2 groups (30 patients each). Group I: patients received 50μg fentanyl and lidocaine 2% with hyaluronidase 15IU/ml. Group II: patients received 100ηg naloxone, 50μg fentanyl and lidocaine 2% with hyaluronidase 15IU/ml.Total akinesia was scored every 2min till the best akinesia score. Onset, best akinesia score, total injected volume, number of patients needed supplemental injection, time of first request for analgesia and, any complication were recorded. Pain was assessed during and after surgery at 30, 60, 90min, 2, 3, 4, 6 and 8h postoperatively, using Visual Analogue Score; 0=no pain, to 10=maximum pain.ResultsThe time to first rescue analgesic was significantly longer in group II (7.73±0.98) than group I (4.30±0.47). The IOP was increased significantly at 2min post-injection then, it became insignificant at 10min postinjection compared to the preinjection values in both groups. There were few minor complications with no significant difference between groups.ConclusionAddition of ultra-low-dose naloxone to fentanyl and lidocaine for peribulbar anesthesia prolongs the duration of postoperative analgesia without increasing the adverse effects

Reaching women in Egypt: a success story

Women in Egypt are more likely than men to suffer from low vision or blindness from avoidable causes.1–3 This is, in large part, because women are not using eye care services as frequently as men, especially in rural areas.4–5 A 2002 community-based survey of 4,500 people in Al Minya Governorate, Upper Egypt showed that the prevalence of cataract in women was double that in men and that trachomatous trichiasis was four times as prevalent in women as in me

Terrorism and Growth: Evidence from India and Egypt

The impact of terrorism is different in developed and developing countries, according to many economists. But what leads to variation in the consequences of terrorism among two developing countries? This paper takes into account two developing countries from two different continents and quantifies the impact of terrorism on GDP per capita. The data is extracted and arranged from the Global Terrorism Index (Humanity, n.d.) for India and Egypt from the years 1975-2018 and 1977-2018, respectively. A set of statistical analyses using the OLS and Newey-West method is used to examine the relationship between the variables. For India, an act of terrorism has no significant impact whereas, for Egypt, terrorism does have growth restricting character. The main reason is the type of regime each country demonstrates. India is a democratic country with a polity score of 9 and on the other hand, Egypt has an authoritarian regime with a polity score of -3

Diagnostic performance and predictive value of rheumatoid factor, anti-cyclic-citrullinated peptide antibodies and HLA-DRB1 locus genes in rheumatoid arthritis

<p>Abstract</p> <p>Background</p> <p>We evaluated the significance of the genes, defined as <it>DRB1*04 </it>or <it>DRB1*01</it>, in rheumatoid arthritis (RA) patients. We focused on the role of genetic and serologic markers to predict disease activity and destructive process of joints.</p> <p>Methods</p> <p>Sixty patients with RA were examined. Radiographic changes were evaluated by (Larsen score) and disease activity was measured by disease activity score 28 (DAS28). The markers analyzed were: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP2) and HLA-<it>DRB1 </it>alleles typed by PCR.</p> <p>Results</p> <p>In this study, anti-CCP antibodies, CRP, RF and AKA were detected in 83.3%, 56.7%, 71.7% and 52% of patients respectively. HLA-<it>DRB1</it>*01 was found in 45% of patients and 35% of them had one or two HLA-<it>DRB1*04 </it>alleles. According to <it>DRB1*04 </it>subtypes, (<it>DRB1* 0405</it>) was present in of 80% them. For prediction of grade of activity, the independent predictors were anti-CCP (OR 19.6), and <it>DRB1*04 </it>positive allele (OR 5.1). The combination of <it>DRB1*04 </it>+ anti-CCP antibodies gave increase in the specificity and positive predictive value to 92% and 90 respectively. As regards to the prediction of radiological joint damage, the independent predictors were HLA-<it>DRB1*04</it>, HLA-<it>DRB1*01</it>, RF, and CRP > 18 (OR 5.5, 4.5, 2.5, 2.0 respectively).</p> <p>Conclusion</p> <p>Our findings suggest that anti-CCP2 is superior to RF for the detection of RA and provided predictive information on joint destruction and disease activity. The presence of RA associated antibodies (ACCP or RF) and/or the SE genes are indicative for a poorer radiological outcome and higher grade of activity.</p

Neonatal Auditory Screening is a Necessity in The Neonatal Intensive Care Unit: Single Center Study

Background: Hearing impairment early in life interferes with normal healthy psychosocial, linguistic and educational development. Neonatal morbidities might be complicated by increased hearing impairment. Aim of the Work: To study the frequency of hearing loss among neonates with morbidities necessitating admission to neonatal intensive care units. Materials and Methods: This cross-sectional study involved screening of 250 neonate on day of discharge from Neonatal Intensive Care Unit (NICU), Children Hospital, Cairo University Hospitals, Egypt during 2020 using evoked otoacoustic emission (EOAE). Automated auditory brain stem response (AABR) was used as a confirmatory test for those who failed EOAE. Results: among the 250 neonates, 70 (28%) failed the screening by EOAE, and hearing loss was confirmed by AABR among 35(14%). Morbidity risk factors that contributed to hearing impairment was prematurity (p = 0.001), low birth weight (p = 0.003), low APGAR score at 1 and 5 minutes (p = 0.004), long NICU stay duration (p = 0.001), complications of pregnancy and delivery (p = 0.001 and p = 0.006 respectively), hypoxic ischemic encephalopathy (p = 0.001), intracranial hemorrhage (p = 0.001), meningitis (p = 0.003), mechanical ventilation for more than 5 days (p = 0.005), ototoxic drug use (p = 0.007) and hyperbilirubinemia at level of exchange transfusion (p = 0.001). Conclusion: EOAE and confirmatory AABR non- invasively and objectively detected 14% hearing loss among neonates admitted to NICU. Implementation of screening for hearing impairment among those with morbidity risk factors is a necessity to allow prompt diagnosis and early management of hearing loss

Determination of Best Refractories Suitable for Glass Forming Molds by Manual Blowing

Refractories are characterized by their ability to withstand high temperatures that reach 2800°C, their ability to withstand sudden changes in temperature, resist mechanical shocks, due to the formation of glass at a temperature of 1050-1100°C, it is required that the molds manufactured from refractories withstand that temperature. This is in addition to the ability of the refractory material to show the fine details and the prominent and recessed sculptural surfaces (smooth - rough) in the glass product, and to achieve the uniqueness and excellence of the glass product.This is due to the requirements of refractory mold in its manufacture and assortment with manual blowing in terms of its ability to withstand pressures, non-fragmentation, thermal endurance that reaches (1500 - 1750°C), and a low rate of expansion and contraction that reaches ± 0.05 mm, as well as its flat smoothness, which is considered as a mirror of a model formation.Since the glass material is acidic, it requires that the components of the refractory composition of the mold be acidic or neutral as well. To prevent the adhesion with the glass components thus, some refractories were selected that enter into the work of refractory formulations that can achieve chemical and natural properties suitable in the manufacture of glass forming molds by manual blowing. (16) Refractory compositions were made, and the research reached to find new refractories that meet the requirements. Thus, it is recommended to use refractories for producing the prototype of the glass products which are characterized by aesthetic products

GPC3 gene expression and allelic discrimination of FZD7 gene in Egyptian patients with hepatocellular carcinoma

Background: Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide, and especially in Egypt. Early diagnosis of HCC greatly improves the survival and prognosis of patients. Low sensitivity and specificity of alpha-fetoprotein (AFP) has led to the demand for novel biomarkers of HCC. The aim of the present study was to evaluate the validity of frizzled-7 (FZD7) and glypican-3 (GPC3) gene expression as potential biomarkers for HCC early diagnosis, and to investigate the association between FZD7 rs2280509 polymorphism and HCC risk. Materials and methods: Quantification of FZD7 and GPC3 gene expression by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay, and genotyping FZD 7 (rs2280509 SNP) gene polymorphism using RT-PCR. Results: The current results revealed that FZD7 gene expression had a greater area under the curve (AUC) for identifying HCC than GPC3 gene expression and AFP levels. The combination of the three markers as a panel showed a better diagnostic performance with a greater AUC than any of the single markers alone (p &lt; 0.05). The FZD7 rs2280509 polymorphism (CT) was found to be significantly associated with an increased risk of HCC. The CT genotype and T allele were significantly more prevalent in the HCC group compared to either the cirrhosis (p = 0.03) or control groups (p = 0.0009 and 0.002; respectively). Conclusion: FZD7 and GPC3 gene expressions have a complementary role in early HCC detection, with a greater diagnostic sensitivity and accuracy than AFP. In addition, FZD7 rs2280509 polymorphism is significantly associated with an increased risk of HCC in the Egyptian population

Prevalence of trachoma in four marakez of Elmenia and Bani Suef Governorates, Egypt.

PURPOSE: In 2015, to determine where interventions are needed to eliminate trachoma as a public health problem from Egypt, we initiated population-based prevalence surveys using the Global Trachoma Mapping Project platform in four suspected-endemic marakez (districts; singular: markaz) of the governorates of Elmenia and Bani Suef. METHODS: In each markaz, 30 households were selected in each of 25 villages. Certified graders examined a total of 3682 children aged 1-9 years in 2993 households, noting the presence or absence of trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI) in each eye. A total of 5582 adults aged ≥15 years living in the same households were examined for trachomatous trichiasis (TT). Household-level access to water and sanitation was recorded. RESULTS: Three of four marakez had age-adjusted TF prevalence estimates in 1-9-year olds of >10%; the other markaz had a TF prevalence estimate of 5-9.9%. Estimates of the age- and gender-adjusted prevalence of unmanaged TT in adults ranged from 0.7% to 2.3%. Household-level access to water and sanitation was high. (We did not, however, measure use of water or sanitation facilities.) Conclusions: Each of the four marakez surveyed has trachoma as a public health problem, with a need for implementation of the SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) strategy. Further mapping is also required to determine the need for interventions in other areas of Egypt

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020