Dexmedetomidine as an adjuvant to bupivacaine in ultrasound fascia iliaca compartment block in proximal end femur surgeries

Background: Fracture neck femur is a common cause of hospital admission among the elderly population. Many patients admitted with fracture femur have long-standing cardiac, hepatic or renal problems. This makes a challenge to balance adequate analgesia with side effects of opioids. Fascia iliaca compartment block (FICB) is one of the peripheral nerve block techniques. It became widely used in providing postoperative analgesia for patient with fracture neck femur either in emergency department or in the operating room.Objective: To evaluate the efficacy of addition of dexmedetomidine to bupivacaine on the duration and quality of postoperative analgesia in ultrasound guided fascia iliaca compartment block in proximal end femur surgeries.Patients and methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I - II of both sexes aged from 20-60 years scheduled for proximal end femur surgeries. They were randomly assigned to one of two equal groups (n=30 each), using closed envelope technique: Bupivacaine group (B group), and Bupivacaine + dexmedetomidine (BD group). Result: Our study demonstrated prolongation of postoperative analgesia in bupivacaine-dexmedetomidine group (BD) compared to bupivacaine group (B). It showed statistically significant reduction in cumulative pethidine doses and prolongation in the time till first rescue analgesic is required in the BD group in comparison with the B group in the first 24 hours. Hemodynamic changes and incidence of side effects, were statistically insignificant among the two groups. Conclusion: Addition of dexmedetomidine, as an adjuvant to the local anesthetic bupivacaine, in ultrasound fascia iliaca compartment block provides prolongation of the duration of postoperative analgesia with less opioid consumption without remarkable side effects

Feasibility of adding magnesium to intrathecal fentanyl in pediatric cardiac surgery

AbstractBackgroundMagnesium is (NMDA) receptor antagonist used as an adjuvant for postoperative analgesia. There are several studies comparing the efficacy of the different routes of administration of magnesium. We aimed to study the effects of adding magnesium to IT fentanyl on peri-operative analgesic requirements after elective pediatric cardiac surgery.MethodsThis prospective double controlled randomized study (closed envelop method) included eighty pediatric patients subjected to elective open cardiac surgery. They were randomly allocated into four equal groups (20 patients each): (A) control group (i.v. fentanyl), (B) intrathecal fentanyl group (ITF) (received IT 1μg/kg of fentanyl), (C) intrathecal fentanyl and magnesium (0.5mg/kg) group (received IT 1μg/kg of fentanyl citrate and 0.5mg/kg magnesium sulfate), and (D) intrathecal fentanyl magnesium (1mg) group (received IT 1μg/kg of fentanyl citrate, and 1mg/kg magnesium sulphate). The perioperative anesthetic management was standardized.ResultsThe results of this study demonstrated that the analgesic profile tended to be better with ITF, ITF-Mg 0.5mg/kg and ITF-Mg 1mg/kg groups than the control group. Also, intraoperative fentanyl used in ITF-Mg (1mg) was statistically less as compared with ITF and ITF-Mg (0.5mg) groups. Time to extubation (h) was surprisingly, shorter in ITF-Mg (1mg) as compared with ITF and control groups. Also, postoperative intravenous fentanyl consumption μg/kg/24h was more in control group as compared with other groups.ConclusionIn conclusion, the use of intrathecal fentanyl-magnesium (1mg/kg) in pediatric patients subjected to open cardiac surgery reduced intra and postoperative analgesic consumption, prolonged the time to first analgesic requirement and allowed early tracheal extubation when compared with intravenous fentanyl, intrathecal fentanyl or intrathecal fentanyl-magnesium (0.5mg/kg)

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Attitude of Syrian students toward GAD patients: An online cross-sectional study

Generalized Anxiety Disorder (GAD) is a prevalent condition and a significant cause of mental disability and poor quality of life. People with GAD have chronic worrying, restlessness, and discrimination from the general public; Little is known about the stigmatizing attitudes toward people with GAD among Syrian students. The questionnaires contained demographic data about age, gender, social status, personal stigma toward GAD scale, perceived stigma toward GAD scale, social distance with those with GAD, the participants' usual source of their knowledge about GAD, helpful interventions, and supporting information. A total of 1,370 replies were collected, but only 1,358 were used for analysis as 12 participants declined to complete the survey. About 44.1% of participants agreed that people with GAD could snap out of the problem, most of them being females (32.4% of the total population). Compared to medical students, more non-medical students (7.1% of the total population) believed that anxiety is a sign of personal weakness. This study demonstrated that Syrian college students showed a high level of stigmatizing and socially distancing attitudes toward people with GAD, particularly female and non-medical students

Evaluation of the results of management of frozen shoulder using the arthroscopic capsular release

BACKGROUND: The aim of treatment of frozen shoulder is to regain a painless and functional shoulder range of shoulder motion. In this study we evaluated the results of using the arthroscopic technique for the release of the shoulder joint capsule in patients with a diagnosis of frozen shoulder. MATERIAL AND METHODS: The study included 40 patients with frozen shoulder. They were operated upon with the use of electrocautery for the release of the shoulder joint capsule. The group consisted of 29 women and 11 men with a mean age of 48.2 years (range 38-62). RESULTS: Preoperatively, the mean Constant and Murly shoulder score was 36.35 (range 21-51). At the end of the follow up period, the mean score was 85.8 (range 62 to 98). The difference between the means of pre- and postoperative total score was statistically significant (t =10.85 and p=0.0001). 22 patients (55%) had excellent results, 14 patients (35%) had good results, 4 patients (10%) had fair results and none had poor results. The 4 cases with fair results were all female, all had insulin-dependent diabetes mellitus and were > 50 years old. CONCLUSIONS: 1. Arthroscopic capsular release is an effective and safe method for the treatment of refractory frozen shoulder. 2. It achieves dramatic pain and motion improvement post-operatively, allowing very early postoperative rehabilitation

MicroRNA-451 as an Early Predictor of Chronic Kidney Disease in Diabetic Nephropathy

Background. Diabetes mellitus is the leading cause of end-stage renal disease worldwide. Microalbuminuria is the cornerstone for the diagnosis of diabetic nephropathy. However, it is an inadequate marker for early diagnosis. MicroRNAs are not only new and promising markers for early diagnosis but also, but they may also play a role in the prevention of disease progression. Methods. This study included ninety patients with type 2 DM in addition to 30 control subjects. MicroRNA-451 expression in blood and plasma using real-time PCR was evaluated in addition to the classic diabetic nephropathy markers (serum creatinine, urinary albumin, and eGFR). Results. There was a significant difference between the studied groups versus control regarding serum creatinine, eGFR, urinary, and plasma microRNA-451 with p=0.0001. Patients with eGFR 60 ml/min/1.73 m2 showed a significantly higher plasma microRNA-451 (29.6 ± 1.6) and significantly lower urinary microRNA-451 (21 ± 0.9) in comparison to patients with eGFR >60 ml/min/1.73 m2 and p=0.0001. eGFR showed a positive correlation with urinary microRNA-451 and negative correlation with both plasma microRNA-451 and urinary albumin. Both plasma and urinary microRNA-451 are highly sensitive and specific markers for chronicity in diabetic nephropathy patients with sensitivity of 90.9% and 95.5% and specificity of 67.6% and 95.6%, respectively. Conclusion. MicroRNA-451 is a promising early biomarker for chronic kidney disease in diabetic nephropathy with high sensitivity and specificity

In silico modeling of human α2C-adrenoreceptor interaction with filamin-2.

Vascular smooth muscle α2C-adrenoceptors (α2C-ARs) mediate vasoconstriction of small blood vessels, especially arterioles. Studies of endogenous receptors in human arteriolar smooth muscle cells (referred to as microVSM) and transiently transfected receptors in heterologous HEK293 cells show that the α2C-ARs are perinuclear receptors that translocate to the cell surface under cellular stress and elicit a biological response. Recent studies in microVSM unraveled a crucial role of Rap1A-Rho-ROCK-F-actin pathways in receptor translocation, and identified protein-protein interaction of α2C-ARs with the actin binding protein filamin-2 as an essential step in the process. To better understand the molecular nature and specificity of this interaction, in this study, we constructed comparative models of human α2C-AR and human filamin-2 proteins. Finally, we performed in silico protein-protein docking to provide a structural platform for the investigation of human α2C-AR and filamin-2 interactions. We found that electrostatic interactions seem to play a key role in this complex formation which manifests in interactions between the C-terminal arginines of α2C-ARs (particularly R454 and R456) and negatively charged residues from filamin-2 region between residues 1979 and 2206. Phylogenetic and sequence analysis showed that these interactions have evolved in warm-blooded animals

Anti-Inflammatory Activity of Salvadora persica L. against Carrageenan Induced Paw Oedema in Rat Relevant to Inflammatory Cytokines

<span style="font-family: Times New Roman; font-size: small;"> </span><p style="margin: 0in 0in 0pt; text-align: justify;" class="MsoNormal"><span lang="EN-US" style="color: #221e1f; font-size: 10pt; mso-bidi-font-family: &quot;Garamond Premr Pro Subh&quot;;"><span style="font-family: Times New Roman;">In this study, the anti-inflammatory effect of aqueous alcoholic crude extract and ethyl acetate extract of miswak sticks (<span style="mso-bidi-font-style: italic;">Salvadora persica </span></span></span><span lang="EN-US" style="color: #221e1f; font-family: &quot;Garamond Premr Pro&quot;,&quot;serif&quot;; font-size: 10pt; mso-bidi-font-family: &quot;Garamond Premr Pro&quot;; mso-bidi-font-style: italic;">L.</span><span style="font-family: Times New Roman;"><span lang="EN-US" style="color: #221e1f; font-size: 10pt; mso-bidi-font-family: &quot;Garamond Premr Pro Subh&quot;;">) was investigated in carrageenan induced rat paw oedema in respect to immunological parameters. Adult male sapargue dawely rats were classified into four groups, group I received the vehicle (0.25% gum acacia solution), group II received crude aqueous alcoholic extract orally at 100 mg/kg, group III received ethyl acetate extract (100 mg/kg) orally and group IV received indomethacin (20 mg/kg) orally, and served as standard reference. The oedema was quantified by measuring the hind paw thickness immediately before subplantar injection, and at 1, 2, 3 and 4 h. Blood samples were withdrawn after the 4</span><span class="A9"><span lang="EN-US" style="font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; font-size: 5.5pt; mso-bidi-font-family: &quot;Garamond Premr Pro Subh&quot;;"><span style="color: #221e1f;">th </span></span></span><span lang="EN-US" style="color: #221e1f; font-size: 10pt; mso-bidi-font-family: &quot;Garamond Premr Pro Subh&quot;;">hour of carrageenan induction, centrifuged and sera were used for analysis of pro-inflammatory cytokines. Administration of aqueous alcoholic extract and ethyl acetate extract (100 mg/ml) significantly reduced the oedema thickness in a time dependent manner, the inhibition percentage of inflammation was 17% for crude extract and 27% for ethyl acetate extract. Also the two extracts reduced secretion of inflammatory mediators, interleukin-1β (IL-1β), IL-6, tumor nercrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1) in serum. The ethyl acetate extract shows potent activity to be nearly the same of indomethacin activity on all determined parameters at the last hour of following up. These results may be due to the presence of flavonoids in ethyl acetate extract. Three major flavonoids were isolated from ethyl acetate extract and identified as apigenin rhamnoglucoside, luteolin glucoside and rutin. The experimental study revealed that <span style="mso-bidi-font-style: italic;">Salvadora persica </span>extracts display remarkable anti-inflammatory activity.</span><span lang="EN-US"></span></span></p><span style="font-family: Times New Roman; font-size: small;"> </span

Prevalence of Shoulder pathologies in Cairo and Qalubiya, Egypt: Hospital based cross sectional study

Background: Pathological conditions of the Shoulder joint are very common as the shoulder is the most freely movable joint in the body (and hence the most unstable). These conditions can lead to pain and disability that affect individuals socially and economically. Purpose: This study was conducted to identify the prevalence and characteristics of shoulder pathologies in two main hospitals in two Egyptian governorates as up to researchers’ knowledge, no previous epidemiological studies of shoulder conditions attending orthopedic physical therapy outpatient clinics have been carried out in Egypt, so the current study&nbsp; provides valuable information about diseases’ burden for researchers and healthcare policy makers, thus assisting in disease prevention , identifying health economic models and establishing guidelines. Methodology: A hospital- based record study was made for 1633 patients, 101 patients of them were suffering from shoulder pathologies, data were collected from patients’ referral records to orthopedic physical therapy outpatient clinics in two hospitals (Kasr Aini educational hospital) (KA) in Cairo and (Benha educational hospital) in Qalubiya – Egypt, that are reviewed from the first of January 2019 to 31 December 2019. Demographic characteristics including (gender, affected side) and different types of pathologies were described.&nbsp