Analgesic effect of intra-articular magnesium sulphate compared with bupivacaine after knee arthroscopic menisectomy

AbstractThis work aimed to evaluate the analgesic efficacy of intra-articular injection of magnesium sulphate (4%) compared with equivalent volume of bupivacaine (0.5%) after outpatient knee arthroscopic meniscectomy. Forty patients were randomly assigned to two groups. Group M (n=20) received intra-articular magnesium sulphate 4%, group B (n=20) received bupivacaine (0.5%). Analgesic effect was evaluated by analgesic duration, and by measuring pain intensity at 1, 2, 4, 6, 12, 24h both at rest and on knee movement to 90°. The primary outcome variable was pain intensity on the VAS at 1, 2, 4, 6, 12, 24h post arthroscopy at rest and on movement (flexion of knee to 90°), although the magnesium group had lower time weighted averages (TWAs) at rest and on movement, these TWAs were not statistically significant. The median duration of postoperative analgesia was significantly longer in the patients treated with magnesium sulphate (528min) than in the bupivacaine group (317min) (p<0.0001), with less number of patients needing supplementary analgesia in magnesium group (8/20) than those of the bupivacaine group (16/20) (p<0.022). Also analgesic consumption was significantly lower in the magnesium sulphate group (p<0.002). We concluded that the use of magnesium sulphate is rational and effective in reducing pain, and is more physiological and shortens convalescence after outpatient arthroscopic meniscectomy, however our hypotheses that analgesic efficacy of intra-articular isotonic magnesium sulphate would be superior to intra-articular local anaesthetic cannot be supported with this study

Hemodynamic changes and stress response during BIS-guided TCI anesthesia with propofol-fentanyl in laparoscopic versus open cholecystectomy

AbstractBackgroundLaparoscopic surgery produces measurable effects on cardio-circulatory, respiratory and metabolic systems. Total intravenous anesthesia with propofol using target-controlled infusion technique guided by Bispectral Index monitoring ensures an optimum level of anesthesia. This study was designed to evaluate the hemodynamic changes with the use of BIS-guided TCI with propofol-fentanyl during either laparoscopic or open cholecystectomy.MethodsTwenty-four ASA class I-II patients, scheduled for cholecystectomy under general anesthesia using BIS-guided TIVA with propofol-fentanyl delivered by TCI pump, were divided surgically into laparoscopic surgery group (LS group, n=12) and open surgery group (OS group, n=12). Hemodynamic data as well as stress hormones were measured at various time intervals.ResultsWithin LS, there was rise of both cardiac output after abdominal insufflation (p<0.05) and stroke volume after end of surgery (p<0.05). Blood pressure decreased in the two groups after insufflation in LS and skin incision in OS (p<0.01) as well as after 15min (p<0.05 & p<0.01 respectively). LS showed decrease in SVR starting from insufflation till end of surgery, while OS showed this decrease only with skin incision. Heart rate decreased 15min after surgical incision till end of surgery in OS while LS showed decrease only after end of surgery. Only in OS, norepinephrine & epinephrine levels showed significant rises throughout the period of study (p<0.001). Cortisol level was elevated after 30min in LS while OS showed a rise after the end of surgery (p<0.001). ACTH levels increased in OS (p<0.001). There was positive correlation between CO and epinephrine, norepinephrine and ACTH in OS.ConclusionBIS-guided TCI anesthesia with propofol-fentanyl offers a good and safe anesthesia technique for patients undergoing either laparoscopic or open cholecystectomy. The hemodynamic stability guided by esophageal Doppler monitor makes it a very appealing choice

Defining criteria for disease activity states in systemic juvenile idiopathic arthritis based on the systemic Juvenile Arthritis Disease Activity Score

Objective To develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MiDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis (sJIA), based on subjective disease state assessment by the treating pediatric rheumatologist. Methods The cutoffs definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, 6 methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, Youden index, 90% specificity, maximum agreement, and ROC curve analysis. Sixty percent of the patients were assigned to the definition cohort and 40% to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. Results The sJADAS10 cutoffs that separated ID from MiDA, MiDA from MoDA, and MoDA from HDA were ≤ 2.9, ≤ 10, and > 20.6. The cutoffs discriminated strongly among different levels of pain, between patients with or without morning stiffness, and between patients whose parents judged their disease status as remission or persistent activity/flare or were satisfied or not satisfied with current illness outcome. Conclusion The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts, and are therefore suitable for use in clinical trials and routine practice

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Human Health Risks: Impact of Pesticide ApplicationHuman Health Risks: Impact of Pesticide Application

This article reviews the application of pesticides in Gaza Strip, Palestine and discusses its associated  health risks. This study is based on data collection and analysis. Data showed that large quantities of pesticides are used in Gaza Strip and the quantities are increased annually. Analyzing the data indicates that large numbers of pesticides are used for controlling different types of pests. Some pesticides are restricted by law but are available in the local market. Classification of pesticides according to its biological activity indicates that insecticides are the largest uses among other pesticides. Reviewing the acute poisonous cases in health records indicates that the reported acute toxic cases were among local farmers in Gaza and the number of acute toxic cases increased annually indicating direct health risks associated with pesticide use. In addition, the increased number of congenital malformation among the newborns indicates indirect health risks. Moreover, the number of cancer cases in Khan Younis governorate indicates a positive association with pesticide use. Classification of pesticides according to WHO standards identified extreme toxic pesticides (e.g parathion), highly toxic (dichlorvos), moderately toxic (malathion) and less toxic ones. These Pesticides have a wide range of octanol-water partitioning coefficient (Kow, log P) values (-0.8 - 6.6), which results in a variety of storage and transport patterns in human bodies. They may move from the storage sites (e.g fat bodies) via partitioning to other parts of the human body. A pesticide with high Kow log P value (hydrophobic) such as Fenvalerate can be stored in fat containing particles and be released in milk secretion exposing fetus, mother, and infants to health risks. A satisfactory solution to these problems is the implementation of restriction measures and the performance of frequent pesticide residue analysis of food samples. Key words: Contamination, health risk, toxicology, log Kow value

Chat / Audio / video Android application

It’s a good i dea to devel op a customized tool between peopl e usi ng the common and wi del y used technology of smart phones.Communication between people is very important, so social media came to life. Social media applications like Facebook, WhatsApp, Facetime...etc., facilitate the communication between people in which they can call each other through video/audio call freely without being restricted by mobile networks, and share their moments with each other. The proposed system is Chat/Audio/Video Application that allows people to call each other freely and share images and location. Using advanced protocols like XMPP, SIP and specific newly developed server applications like Openfire and Asterisk we could develop our app in our own way. And in our future work we aim to make the system more secured, to add more features to facilitate the communication between people and provide more luxury

Recent Microextraction Techniques for Determination and Chemical Speciation of Selenium

Research designed to improve extraction has led to the development of microextraction techniques (ME), which involve simple, low cost, and effective preconcentrationof analytes in various matrices. This review is concerned with the principles and theoretical background of ME, as well as the development of applications for selenium analysis during the period from 2008 to 2016. Among all ME, dispersive liquid-liquid microextraction was found to be most favorable for selenium. On the other hand, atomic absorption spectrometry was the most frequently used instrumentation. Selenium ME have rarely been coupled to spectrophotometry and X-ray spectrophotometry methods, and there is no published application of ME with electrochemical techniques. We strongly support the idea of using a double preconcentration process, which consists of microextraction prior to preconcentration, followed by selenium determination using cathodic stripping voltammetry (ME-CSV). More attention should focus on the development of accurate, precise, and green methods for selenium analysis

Long standing biliary colic masking chylous ascites in laparoscopic roux-en-Y gastric bypass; a case report

Abstract Background Chylous ascites is considered to be an intra-abdominal collection of creamy colored fluid with triglyceride content of > 110 mg/dL. Chylous ascites is an uncommon but serious complication of numerous surgical interventions. However, it is a rare complication of LRYGB. An internal hernia limb defect is thought to be the underlying etiology, where the hernia will cause lymphatic vessel engorgement and lymphatic extravasation. Case presentation We report a case of a 29 years old male with a 9 year history of laparoscopic Roux en y gastric bypass (LRGYB), presenting with recurrent abdominal pain for 2 months radiating to the right shoulder. Ultrasound examination revealed gallstones and the patient was subsequently admitted for laparoscopic cholecystectomy. Intraoperatively, whitish colored fluid, high in triglycerides content was aspirated. During exploration, an internal hernia limb defect was found and corrected. Conclusion Post LRGYB patients with symptoms of recurrent abdominal pain should be suspected for chylous ascites reflecting an internal hernia