A comparative study between magnesium sulphate and dexmedetomidine for deliberate hypotension during middle ear surgery

AbstractBackgroundThis study was designed to compare magnesium sulphate with dexmedetomidine, regarding their efficiency in inducing deliberate hypotension and providing a better surgical field exposure during middle ear surgery. It also compared the influence of their use on postoperative pain and recovery time.MethodsEighty-eight adult patients undergoing middle ear surgery were included. Patients were randomly divided into two equal groups. Patients were assigned to receive either magnesium sulphate (M group) or dexmedetomidine (D group). Anaesthesia was induced by propofol 2mg/kg iv and fentanyl 1μg/kg. Patients in the M group received an iv bolus of magnesium sulphate 50mg/kg in a total of 100ml saline over 10min followed by infusion of 15mg/kg/h until the end of surgery. Similarly, patients in the D group received dexmedetomidine 1μg/kg over 10min followed by 0.4–0.8μg/kg/h until the end of operation. The target MAP during operation was between 60 and 70mmHg. The surgeon who was blinded of the selected hypotensive agent was asked to assess the quality of the surgical field. In the postanaesthesia care unit (PACU), postoperative pain was assessed and recovery time was recorded.ResultsBoth study drugs succeeded to reach the target MAP. The quality of the surgical field was not different between the two groups. Postoperative pain was not different between the two group and only eight patients in the M group and seven patients in the D group required analgesics. Recovery time was significantly longer for the patients in group D (p<0.05).ConclusionWe concluded that both magnesium sulphate and dexmedetomidine successfully induced deliberate hypotension in patients undergoing middle ear surgery but magnesium sulphate was associated with shorter recovery time and earlier discharge from the PACU

Preoperative Evaluation and Management of Patients with Liver Disease

Patients with liver disease who undergo surgery have an increased risk of morbidity and mortality. Impairment of the liver functions increases the risks of surgery and anesthesia.The risk depends on the severity of liver disease, nature of the surgery and comorbid conditions. Patients with compensated cirrhosis and normal synthetic function have a low risk. Elective surgery should be postponed in patients with abnormal liver tests. All patients should have thorough preoperative evaluation, and their conditions are to be optimized before elective surgery. Thorough history and physical examination usually provide important informatation. Elective surgery can be rescheduled or cancelled once the severity of underlying liver disease is assessed. When surgery is mandatory, meticulous perioperative management is required, including hemodynamic stability, broad-spectrum antibiotics, correction of coagulopathy, improvement of nutritional status, avoidance of nephrotoxins and sedatives that could precipitate hepatic encephalopathy, and intensive care unit admission if needed

Pattern of tuberculosis in patients of a university hospital during the period (2004–2011)

AbstractAim of the workTo identify the pattern of infection among diagnosed patients with tuberculosis presented to chest diseases clinic and/or admitted to the department of chest diseases in Bab El Shaaria (Al-Azhar) University hospital.Subjects and methodsBy retrospective analysis of available data, all patients who were diagnosed and registered in the period from January 2004 till December 2011 in the follow up records in TB clinic and in the chest diseases department in Bab El Shaaria University hospital were included. Data were collected from the patient files. These data included: full history, chest X-ray, sputum examination results, and all other data related to the patient’s condition.ResultsA total of 384 patients were registered in TB clinic in Bab El Shaaria University hospital with a diagnosis of tuberculosis (pulmonary or extra-pulmonary). Their age ranged from 3 to 80years, with mean age of 37.5+16.0years. As regards gender there were 178 male patients (46.4%), and 206 female patients (53.6%). As regards site affected there were 209 patients (54.4%) with pulmonary TB and 175 patients (45.6%) with extrapulmonary TB. The percentage of TB cases to the total number of chest clinic visitors per year was ranging between 0.08% and 0.8% with an average of 0.48%, while the percentage of pulmonary TB cases to the total number of TB cases per year was ranging between 27% and 65% of total TB cases per year with an average of 51.7%

Aging changes in the retina of male albino rat: a histological, ultrastructural and immunohistochemical study

Background: Degenerative changes caused by aging may affect the eye, especially the retina. Such changes occur as a part of normal physiological process and may be irreversible. The aim of the study was to demonstrate the influence of aging on the morphology of the retina to provide a basis to explain the pathogenesis of age-associated decline in visual acuity, scotopic and photopic sensitivity.  Materials and methods: Forty male albino rats were used and divided into four age groups (group I: age of cortical maturity, group II: middle-aged, group III: aged group and group IV: senile group). The rats were sacrificed, the eye balls were enucleated. Intra-vitreal injections of formalin for haematoxylin and eosin and immunohistochemical sections, glutaraldehyde for toluidine blue semithin and E/M ultra-thin sections were performed. Measurements and quantitative histomorphometric estimation of the layers of the retina were done.  Results: Light microscopic examination revealed age-dependent attenuation of photoreceptor striations. Aged and senile groups presented pyknotic, widely- -spaced nuclei of the outer nuclear layer. The inner nuclear layer was thinned out to 2 or 3 cellular rows. Retinal capillaries showed progressive dilatation and congestion. Statistical analysis proved significant thinning of the retina with variable degrees of thinning of the constituting layers. Decreased arborisation with age was confirmed with quantification of synaptophysin-immunostained sections. Glial fibrillary acidic protein immunostaining revealed the picture of reactive gliosis. On the ultrastructural level, the retinal pigment epithelium exhibited major alterations with aging. Numerous phagosomes, lipofuscin and melanolipofusin granules appeared within the cells, together with exaggerated basal infoldings. The pho- toreceptor nuclei became degenerated and the perinuclear space was widened. Conclusions: Rat retinae clearly undergo age-related morphological changes. Such changes provide a cellular base for explanation of decreased vision in humans with aging other than reflection errors. Effect of aging was not only qualitative, but also quantitative

Morphological and radiometrical study of the human intervertebral foramina of the cervical spine

Background: Degenerative changes of the cervical spine are an inevitable response to certain occupational status and aging processes. Compression of cervical nerve roots may result from disc degeneration, disc herniation or intervertebral foraminal stenosis. The precise and detailed anatomical knowledge of the intervertebral foramen of the cervical spine is essential for the diagnosis and management of cervical radiculopathy. The significance of the observations and findings of the present study was to elucidate the correlation between the morphology and disorders of the cervical intervertebral foramina in normal and pathological conditions especially at the level of C3-C4 to C6-C7 on both sides and in both sexes. Moreover, it will help greatly in the planning of both surgical and conservative strategies. Materials and Methods: In the present study, 5 formalin-fixed adult cadavers and radiological specimens of the cervical region of the vertebral column of 28 normal and 209 subjects suffering from cervical disorder from both sexes and different age groups. They subjected for morphological and radiometrical analysis. Results: All measurements of the present study of the cervical disorders in females were found to be 6% less than in males in all age groups, which is statistically significant (p &lt; 0.01) as compared with the control group (2%). The mean intervertebral foraminal areas in the control group of C5-C6 and C6-C7 are significantly greater than those of C3-C4 and C4-C5. Conclusions: The mean intervertebral foraminal area was greater in the lower cervical region than the upper in normal adult individuals. In pathological condition the affection of C3-C4 and C4-C5 intervertebral foramina was more due to narrower surface area. The pathology of cervical spine affecting the intervertebral foramina of female which complaint earlier than male due to narrower foramina

Long-term protection of hepatitis B vaccination among Egyptian children

Background: Hepatitis B Vaccination is the most effective way to prevent transmission of hepatitis B virus (HBV). Objective: to detect the long-term immunogenicity of the vaccine in Egyptian children after five and ten years of vaccination. Methods: Two hundreds healthy children were recruited. They were divided into two groups according to their age. Group A included 100 child, around 6 years old, vaccinated 5 years ago. Group `B` included 100 child, around 11 years old, vaccinated 10 years ago. Hepatitis B surface antibody (HBsAb) titre was tested, booster dose of the vaccine was given to children whose HBsAb was &lt; 10 mIU/ml, then one and half month later, they were retested for HBsAb to evaluate the response. Results: Both groups had a wide range of HBsAb (2-1000 mlU/ml), and there was a significant difference in the level of the two groups. Our data proves the decline of antibody titre with time. In group A, 19 children needed a booster dose, 14 of them were vaccinated, and 10 were retested after one and half month. The results showed that 9 (90%) responded by increased level of HBsAb, with six (66.6%) showing an adequate response. In group B, 52 children had antibody titre &lt; 10, 48 of them were vaccinated and 34 were retested one and half months later. Two out of the 34 did not respond and 32 (94.2%) responded by an increase in the antibody titre. Of those who responded, 19 had adequate response (HBsAb ≥ 100) and 13 had hypo-response (HBsAb = 10 -100). Eighty percent (80%) of boys versus 51.7% of girls responded adequately. Conclusion: Hepatitis B vaccine is an effective and successful way for preventing HBV infection. No need for booster dose at least for 5 years after vaccination .Keywords: HBV- HB vaccine- long term immunityEgypt J Pediatr Allergy Immunol 2011;9(1):35-4

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

Serum Islet Cell Autoantibodies During Interferon α Treatment in Patients With HCV-Genotype 4 Chronic Hepatitis

Chronic hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease worldwide and HCV genotype 4 (HCV4) is predominant in African and Middle Eastern countries. It is well established that interferon-α (IFNa) treatment for HCV may trigger serum autoantibodies against pancreatic islet cells (ICA) in a subgroup of patients. Available data on the incidence of ICA during IFNa therapy for chronic HCV4 infection are not conclusive. We investigated the appearance of ICA in 40 naïve Egyptian patients (38 males, 32 ± 6 years) with histologically defined chronic HCV4 infection undergoing IFNa treatment at a dose of 9-million U/week for 24 weeks. Serum samples were collected at baseline and following IFNa therapy and ICA were detected using indirect immunofluorescence. Baseline evaluation indicated that 2/40 (5%) patients had detectable serum ICA. After the completion of the treatment scheme, 12/38 (32%) previously ICA negative patients became ICA positive; however, no patient developed impaired glucose tolerance (IGT) or diabetes during follow-up. In conclusion, we submit that IFNa treatment for chronic hepatitis C (CHC) may induce serum ICA in one-third of Egyptian patients with HCV4. These autoantibodies, however, do not lead to alterations in glucose metabolism

Pro-inflammatory profile of preeclamptic placental mesenchymal stromal cells: new insights into the etiopathogenesis of preeclampsia.

The objective of the present study was to evaluate whether placental mesenchymal stromal cells (PDMSCs) derived from normal and preeclamptic (PE) chorionic villous tissue presented differences in their cytokines expression profiles. Moreover, we investigated the effects of conditioned media from normal and PE-PDMSCs on the expression of pro-inflammatory Macrophage migration Inhibitory Factor (MIF), Vascular Endothelial Growth Factor (VEGF), soluble FMS-like tyrosine kinase-1 (sFlt-1) and free β-human Chorionic Gonadotropin (βhCG) by normal term villous explants. This information will help to understand whether anomalies in PE-PDMSCs could cause or contribute to the anomalies typical of preeclampsia. METHODS: Chorionic villous PDMSCs were isolated from severe preeclamptic (n = 12) and physiological control term (n = 12) placentae. Control and PE-PDMSCs’s cytokines expression profiles were determined by Cytokine Array. Control and PE-PDMSCs were plated for 72 h and conditioned media (CM) was collected. Physiological villous explants (n = 48) were treated with control or PE-PDMSCs CM for 72 h and processed for mRNA and protein isolation. MIF, VEGF and sFlt-1 mRNA and protein expression were analyzed by Real Time PCR and Western Blot respectively. Free βhCG was assessed by immunofluorescent. RESULTS: Cytokine array showed increased release of pro-inflammatory cytokines by PE relative to control PDMSCs. Physiological explants treated with PE-PDMSCs CM showed significantly increased MIF and sFlt-1 expression relative to untreated and control PDMSCs CM explants. Interestingly, both control and PE-PDMSCs media induced VEGF mRNA increase while only normal PDMSCs media promoted VEGF protein accumulation. PE-PDMSCs CM explants released significantly increased amounts of free βhCG relative to normal PDMSCs CM ones. CONCLUSIONS: Herein, we reported elevated production of pro-inflammatory cytokines by PE-PDMSCs. Importantly, PE PDMSCs induced a PE-like phenotype in physiological villous explants. Our data clearly depict chorionic mesenchymal stromal cells as central players in placental physiopathology, thus opening to new intriguing perspectives for the treatment of human placental-related disorders as preeclampsia

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223