A randomized comparative study between selective walking spinal anesthesia and general anesthesia for anorectal surgeries in outpatient settings

AbstractBackgroundSpinal anesthesia is gradually increasing in ambulatory setting. The limiting factor to the more widespread use of spinal anesthesia in the outpatient setting refers to the effect of residual block. Selective spinal anesthesia (SSA) with low dose lidocaine was compared with modern general anesthesia (GA) technique in day care anorectal surgeries.ObjectiveOur objectives in this study was to compare SSA with propofol and fentanyl based modern GA as regard to 1 – operating conditions 2 – patients’ and surgeon’s satisfaction, 3 – intraoperative, postoperative adverse events and 4 – recovery profiles in ambulatory anorectal surgeries.MethodsProspective randomized clinical study was conducted on 60 patients undergoing elective day case anorectal surgery. The patients were randomly allocated into one of two groups (GA and SSA groups) of 30 patients each. In GA group anesthesia was induced with intravenous fentanyl (2μg/kg) and propofol (2–3mg/kg). Airway was secured with I-gel supraglottic airway. Anesthesia was maintained by sevoflurane 1.5–2%, nitrous oxide 60% in oxygen mixture. SSA group patients received spinal anesthesia with lidocaine 20mg and fentanyl 25μg to a total volume of 3ml with sterile water for injection. Intraoperative, postoperative and home adverse events, time to ambulate, time to home discharge, patients’ and surgeon’s satisfactions were statistically compared between both groups.ResultsBoth anesthetic techniques showed acceptable operating conditions and high rate of patients’ satisfaction. Low pain intensity, shorter time to ambulate and home discharge in SSA compared to GA with a p value<0.001. Intraoperative hemodynamic stability was reported in both groups. No major postoperative or home adverse events in both groups.ConclusionsSSA with low dose lidocaine may be suitable alternative and competitive for modern GA in ambulatory anorectal surgery

Usefulness of the Global Echo-Doppler Score (GEDS) in selection of patients with mitral stenosis for percutaneous balloon mitral valvuloplasty

Background: We aimed to create a novel modified score by combining anatomic and hemodynamic Doppler-echocardiographic measures for selection of suitable patients with mitral stenosis for percutaneous balloon mitral valvuloplasty (PBMV) and its impact in prediction of outcome. Methods: 262 consecutive patients candidate for PBMV were enrolled. Wilkins score and a global score based on anatomical parameters (Wilkins score, posterior to anterior mitral leaflet ratio [PMVL/AMVL ratio]; left atrial diameter [LAD]) and hemodynamic parameters (mitral regurgitation [MR]; atrioventricular compliance [CN]; systolic pulmonary artery pressure [SPAP]) were assessed. Patients were classified into two groups according to their outcomes. Results: Global Echo-Doppler Score (GEDS) for patients with favorable vs. those with unfavorable outcomes was (5.0 ± 0.9 vs. 8.9 ± 1.3; p &lt; 0.001). Sensitivity, specificity, and accuracy of a GEDS ≥ 7 for prediction of cardiac events were 97.5%, 88%, and 97.5%, respectively. The area under the receiver operating characteristic curve was 0.95 (p &lt; 0.001). The correlation coefficient was 0.852 (p &lt; 0.0001) for GEDS 0.531 (p &lt; 0.002), for Wilkins score 0.315 (p &lt; 0.02), for PMVL/AMVL 0.460 (p &lt; 0.01), for LAD; MR: Pre-PBMV (r = 0.348, p &lt; 0.03); CN [mL/mm Hg] (r = 0.579, p &lt; 0.01) and SPAP [mm Hg] (r = 0.499, p &lt; 0.01). In the regression analysis, GEDS, Wilkins score, and LAD were entered into the model. The regression coefficient (r = 0.695) of GEDS was much higher than those of the other 2 factors. Conclusions: GEDS is an independent predictor of PBMV success and clinical outcome and may be formulated in a scoring system that would help to identify the proper timing and best candidates for PBMV

Co-Evolutionary Particle Swarm Optimization Applied to the 7x7 Seega Game

Seega is an ancient Egyptian two-stage board game that, in certain aspects, is more difficult than chess. The two-player game is most commonly played on a 7 × 7 board, but is also sometimes played on a 5 × 5 or 9 × 9 board. In the first and more difficult stage of the game, players take turns placing one disk each on the board until the board contains only one empty cell. In the second stage players take turns moving disks of their color; a disk that becomes surrounded by disks of the opposite color is captured and removed from the board. Building on previous work, on the 5 × 5 version of Seega, we focus, in this paper, on the 7 × 7 board. Our approach employs co-evolutionary particle swarm optimization for the generation of feature evaluation scores. Two separate swarms are used to evolve White players and Black players, respectively; each particle represents feature weights for use in the position evaluation. Experimental results are presented and the performance of the full game engine are discussed

Applying Co-Evolutionary Particle Swam Optimization to the Egyptian Board Game Seega

Seega is an ancient Egyptian two-phase board game that, in certain aspects, is more difficult than chess. The two-player game is played on either a 5 × 5, 7 × 7, or 9 × 9 board. In the first and more difficult phase of the game, players take turns placing one disk each on the board until the board contains only one empty cell. In the second phase players take turns moving disks of their color; a disk that becomes surrounded by disks of the opposite color is captured and removed from the board. We have developed a Seega program that employs co-evolutionary particle swarm optimization in the generation of feature evaluation scores. Two separate swarms are used to evolve White players and Black players, respectively; each particle represents feature weights for use in the position evaluation. Experimental results are presented and the performance of the full game engine is discussed

Cam versus pincer femoroacetabular impingement. Which type is associated with more hip structural damage?:An exploratory cross-sectional study

Background: Femoroacetabular impingement (FAI) occurs as a conflict between the proximal femur and the acetabular rim. The purpose of this study was to evaluate MRI findings and look for correlations with pain intensity and duration in each type of FAI separately in an attempt to identify which type is associated with more structural damage. Methods: Forty-four patients (78 hips) diagnosed with either cam or pincer FAI were consecutively recruited in a prospective cohort study. None of our patients had evidence of osteoarthritis (OA) on the initial plain radiography. All patients had contrast-enhanced MRI and CT scans of the hips. All patients filled in a visual analogue scale (VAS) for pain. Results: The frequency of bone marrow edema (BME) was 37% in cam FAI and 20.8% in pincer FAI. In cam FAI, BME positively correlated with pain severity as measured by VAS (P<0.0001), cartilage degradation (P=0.001), pseudocysts (P<0.0001), hip effusion (P=0.013) and reactive synovitis (P<0.0001). However, in pincer FAI, BME only correlated with pain severity (P=0.004) and duration (P=0.011) and did not correlate with other MRI signs of structural hip damage. Conclusions: In cam FAI, BME of the femoral head and neck on MRI positively correlated with chondral damage and synovitis, but not in pincer FAI. This correlation suggests that cam FAI might be associated with a worse long-term prognosis. This finding might have an impact on clinical practice and decision making as it would encourage surgeons to intervene early in cases of cam FAI, thus preventing the possible development of irreversible, established hip OA

Relation between Lymphopenia and Internal Organ Involvement in Systemic Lupus Erythematosus Patients

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease, characterized by autoantibody production and immunocomplex formation, leading to widespread inflammatory damage involving multi-organ systems. Lymphopenia is a common laboratory involvement seen in patients with SLE and the mechanism of it is still unclear. Objectives: The aim of the current study was to investigate the relation between lymphopenia and clinical manifestations, laboratory findings, and disease activity in systemic lupus erythematosus (SLE) patients. Patients and Methods: It was a cross sectional study; with a total of 60 patients with SLE recruited from the Rheumatology and Rehabilitation outpatient clinic at Sohag University Hospital. Demographic data, personal history, detailed history of general health condition and chronic or current diseases were reported. All the participants were subjected to detection of erythrocyte sedimentation rate, liver function tests, renal function tests, complete blood count (CBC), renal biopsy, protein/creatinine ratio and/or 24hr protein in urine, urine analysis, ANA profile, and Complement 3 and 4. Results: Two thirds of the study population had normal lymphocytic count, and one third had lymphopenia. Lymphopenia group showed significantly more hypochromic anemia with significant lower hemoglobin level and lower MCV. The mean creatinine level was significantly higher among lymphopenic cases. Lymphopenic cases had higher proteinuria. Conclusions: It could be concluded that lymphopenia in patients with SLE may be used as indicator of renal involvement in these patients

Deterioration Factors that Affect the Mural Paintings at Memi\u27s Burial Chamber in Saqqara, Egypt

Saqqara was the main necropolis of Memphis that was the capital of ancient Egypt during the time of the Old Kingdom, and it has a lot of tombs dating back along the ancient Egyptian history from the time of the first and second dynasties to the Greco-Roman period. Some of the ancient Egyptian tombs from the fifth and sixth dynasties have decorated burial chambers. One of them is the tomb of Memi that might date back to the late fifth dynasty and the beginning of the sixth dynasty. Although his burial chamber has three beautiful decorated walls, the most of the decorated plaster fell down off the bed rock walls. There are some deterioration factors that have affected the mural paintings at Memi\u27s burial chamber, some internal and the other external, and they led to the deterioration of the mural paintings. High humidity is one of the most dangerous factors that carries salts out of the inside structure of the bed rock to the surface and under the plaster, when humidity decreases. It leaves salt under the plaster, that pushes the plaster and causes it to fall down. The internal structure of the bed rock has clay minerals that are affected by the presence of high humidity that leads those minerals to swell and push the plaster off the bedrock walls. Gypsum plaster was used at Memi\u27s burial chamber, whose main components of the plaster are gypsum, sand, calcite and clay minerals. Those components are inhomogeneous and they led to different effect by weathering factors. The thickness of the plaster at Memi\u27s burial chamber varies according to the regularity of the bedrock. However, in general, the thickness of the plaster is thin and the thinness makes it easy to be cracked and broken when it falls off the walls. As a result of high humidity, there is a clear growth of microorganisms on the bedrock walls and the plaster. Salts such as gypsum and halite are the worst problem in the burial chamber because they crystalized to form pins that pushed the plaster to separate and fill off the bed rock walls.This work was supported by JSPS, KAKENHI (21H04366)

Knee Enthesitis and Synovitis on Magnetic Resonance Imaging in Patients with Psoriasis without Arthritic Symptoms

Objective. This case-control study was designed to evaluate magnetic resonance imaging (MRI) findings of knee joints in patients with psoriasis without clinical peripheral or axial joint involvement, and to correlate MRI findings with disease and demographic variables. \ud \ud \ud Methods. In total 48 patients with psoriasis and no clinical evidence of synovitis or enthesitis in any peripheral or axial joints were enrolled. A random sample of 20 healthy subjects without knee or other joint complaints and matched for age and sex served as controls. All patients and controls underwent enhanced MRI studies of both knee joints, and MRI findings were compared. \ud \ud \ud Results. Among 48 patients (96 knees), a total of 90 entheseal lesions were detected, with no enthesitis in 2 cases (6.3%). Signs of continuing inflammation bilaterally were frequently found: soft tissue edema (STE; n = 52), bone marrow edema (BME; n = 20), perientheseal BME (n = 3), cartilaginous erosions (n = 42), and bone erosions (n = 27). In controls, 2 (10%) subjects had BME and another 5 (25%) showed cartilaginous erosions. None showed evidence of enthesitis. Significant correlations were observed between the number of entheseal lesions of both knees vs STE (present vs absent; r = 0.314, p = 0.030) and STE (number of lesions; r = 0.351, p = 0.014). Enthesitis (unilateral vs bilateral) was significantly and positively correlated with STE (r = 0.304, p = 0.036), cartilaginous erosions (r = 0.304, p = 0.036), and villous projections (r = 0.347, p = 0.016). \ud \ud \ud Conclusion. Subclinical synovitis and enthesitis are frequently found in the knee joint of patients with psoriasis. These may be an early sign of psoriatic arthritis\u