Effect of preoperative fluoroscopic guided single shot Erector Spinae Block for posterior lumbar spine surgery: A surgeon and patient prospective

Background: Posterior spinal surgery is considered one of the most painful surgeries. Erector Spinae Block is likely to produce effective pain management as it causes blockade of the dorsal rami .Objective: This study was conducted to assess the efficacy of ESPB in controlling intraoperative and POP and surgical field during lumbar spine fixation.Patients and methods: A total of 70 cases were enrolled, and they were haphazardly divided into two groups; ESPB group which comprised 35 cases who underwent the blockade technique, and the control group which included the remaining 35 cases that underwent surgery without blockade. The primary outcome was POP, while secondary outcomes involved intraoperative bleeding, and surgeon satisfaction.Results: No significant differences were detected among both groups concerning patient demographic features. Operative bed bleeding was significantly decreased in the ESPB group. Also, ESPB group expressed lower pain scores during the initial 6 hours after surgery with no difference detected between both studied groups on subsequent assessment. Surgeon satisfaction was significantly better in the ESPB group.Conclusion: ESPB appears to be safe and efficacious technique not only in decreasing POP, but also in improving operative bed bleeding, and surgeon satisfaction

Imagining a Future with Intelligent Machines A Middle Eastern and North African Perspective

Narratives about intelligent machines can influence the development, adoption, reception and regulation of artificial intelligence (AI). The Middle East and North Africa (MENA) region is hugely overlooked by the Western mainstream when it comes to discussing the future of artificial intelligence. Recognizing the vital importance of diversity in the global debate on what AI is and should be, this report examines the narratives about technological futures spreading in the Arab world

Comparison of Post-Operative Analgesic Effects of Peritonsillar Infiltration of Dexmedetomidine, Lidocaine or Both in Children Following Tonsillectomy

Background: Peritonsillar infiltration of local anesthetics has efficient pain relief in children undergoing tonsillectomy. We hypothesize that lidocaine plus dexmedetomidine will potentiate the analgesic effect of each other rather than. Objectives: This study aimed to compare the analgesic effect of peritonsillar infiltration of lidocaine, dexmedetomidine, or lidocaine/dexmedetomidine on post-tonsillectomy pain. The primary outcome is the time of analgesia. The secondary outcomes are postoperative pain score, the effect of study medications on postoperative hemodynamic, and complications. Patients and Methods: Ninety patients were randomly allocated to three groups, 30 patients each. L group, patients received 2mg/kg lidocaine. D group, patients received 1 μg/kg of dexmedetomidine. LD group, patients received 1 μg/kg of dexmedetomidine plus 2 mg/kg lidocaine. Results: The time of the first analgesia request (h.) was longer in the LD group (13.70 ± 2.91) when compared with the L and D groups. Postoperative pain score was significantly lower in LD and D groups compared with the L group (P <0.05) On the other hand, there was a significantly lower median VAS score in the LD group when compared with the D group (P1 <0.05) Postoperative paracetamol consumption was significantly lower in LD group (0.55 ± 0.51 gm/24h) when compared with D and L groups (0.65 ± 0.59, 2.25 ± 0.44 gm/24h respectively). Conclusion: the use of lidocaine with dexmedetomidine is better than using each drug alone in decreasing posttonsillectomy pain and increasing the time to first request for analgesia with no significant postoperative side effects

The Impact of Communication in Teaching: A Two-way Communication Approach

Teaching is an exciting adventure in which both the teacher and the students participate. The Teaching Philosophy includes basic communication approaches; (a) Passion and Communication. (b) Fairness: to understand students as individuals and students. (c) Critical thinking: as lecturers should be challenged to try to deliver course materials in different ways and from different perspectives. (d) Humour and fun; Pleasing students by being approachable will make them more determined to excel in their assignments and lecturers will be inspired by their students. Communication in the teaching process help students attach concepts to their own lives, as students will apply what they learn in class to the world around them. The researcher happened to apply some approaches on random sample of Hotel-Department students, at the Faculty of Tourism and Hotels, University of Alexandra. The importance of this study lies in the new trend of developing the education process nowadays, which will require the participation of students for best results

The Impact of Communication in Teaching: A Two-way Communication Approach

Teaching is an exciting adventure in which both the teacher and the students participate. The Teaching Philosophy includes basic communication approaches; (a) Passion and Communication. (b) Fairness: to understand students as individuals and students. (c) Critical thinking: as lecturers should be challenged to try to deliver course materials in different ways and from different perspectives. (d) Humour and fun; Pleasing students by being approachable will make them more determined to excel in their assignments and lecturers will be inspired by their students. Communication in the teaching process help students attach concepts to their own lives, as students will apply what they learn in class to the world around them. The researcher happened to apply some approaches on random sample of Hotel-Department students, at the Faculty of Tourism and Hotels, University of Alexandra. The importance of this study lies in the new trend of developing the education process nowadays, which will require the participation of students for best results

Analgesic Effect of Intra-Articular Dexamethasone versus Fentanyl added as an adjuvant to Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery

Background: Knee arthroscopy is usually associated with a variable degree of pain ranging from moderate-to-severe pain in about 70% of patients. Objective: This trial was designed to assess the efficacy of intra-articular administration of dexamethasone versus fentanyl as adjuncts to bupivacaine in patients undergoing arthroscopic knee surgery. Patients and methods: Eighty-nine patients of either sex were enrolled in this study. The patients were randomly divided into three equal groups. Group F that received intra-articular (IA) injection of 1 μg/kg fentanyl (In 2 ml saline) added to 18 ml of 0.25% bupivacaine, group D, which received IA injection of 8 mg (2 ml) dexamethasone added to 18mL of 0.25% bupivacaine and group S that received IA injection of 2 ml normal saline added to 18 mL of 0.25% bupivacaine. Results: The time required for the first request of analgesia in group F, group D, and group S was 5.7 ± 0.7 vs 4.5 ± 0.5 vs 3.3 ± 0.5 hours respectively. There were significant differences between both treatment groups and the control group (p < 0.001) and in between both treatment groups (p < 0.001) in favor of group F. There was a significantly lower median visual analogue score in group F when compared to group D and S at 6 hours (p = 0.006 & 0.01, respectively), 12 hours (p < 0.001 & < 0.001, respectively), and 18 hours (p = 0.003 & 0.007, respectively) postoperatively. Conclusion: The addition of fentanyl or dexamethasone to IA bupivacaine in knee arthroscopic surgery provided a better quality of analgesia with less consumption of systemic analgesics without significant adverse effects

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

A Revised Model For The Cost Of Quality

Traditionally, process improvement is considered a defect prevention effort. Current cost models consider the coupled effect of both prevention and appraisal costs on the cost of failure. This paper proposes a new model for the cost of quality, which captures the value of continuous process improvement in achieving economic operation. The model is developed to incorporate two cost functions. The first accounts for quality related costs incurred while maintaining a stable level of operation, while the second accounts for the cost of process improvement. Using incremental economics, the two cost functions are assembled and an economic criterion for evaluating improvement alternatives is developed. Numerical examples are used to illustrate potential applications and performance of the model. © Emerald Group Publishing Limited

The Economic Design Of X̄ Charts: A Proactive Approach

It has long been recognized that poor quality can only result in higher costs. Yet, the idea of reducing cost through better quality is not fully realized. Current models for the economic design of control charts provide strategies to maintain existing quality levels. In this research, a comprehensive cost model is developed to incorporate two cost functions. A reactive function, which accounts for all quality related costs incurred while maintaining a stable level of the process, and a proactive function, which accounts for the cost of process improvement. Using incremental economics, the two cost functions are assembled to allow an evaluation of process improvement alternatives based on their economic worth. Procedures for obtaining economically optimum designs for controlling the process mean are developed and designed experiments are utilized to investigate model performance over a wide range of input parameters. The results indicate that the model is sensitive to changes in 13 parameters, especially when the magnitude of the process shift is small. Copyright © 2004 John Wiley & Sons, Ltd