Gastric endoscopic mucosal resection and polypectomy among patients with liver cirrhosis and esophageal varices in the setting of acute upper gastrointestinal bleeding

Background Gastric polyps are not infrequently reported among cirrhotic patients. Endoscopic resection of gastric polyps among patients with liver cirrhosis and esophageal varices carries the risk of post-polypectomy bleeding. This may explain why endoscopists are reluctant to its excision. The aim is to evaluate the incidence of immediate (intraoperative) and delayed (within 30 days) post-polypectomy bleeding among cirrhotic patients with esophageal varices and portal hypertension and determine its risk factors. Methods This study comprised 39 cirrhotic patients with portal hypertension and varices who presented with gastrointestinal bleeding, and they had gastric polyps detected during th endoscopic intervention to control the acute bleeding or during follow-up. All patients were exposed to the entire history, clinical examination, and basic laboratory workup. Esophagogastroduodenoscopy was done to combine bleeding control and polypectomy simultaneously. Results Immediate (intraoperative) post-polypectomy bleeding occurred in 38.8% of patients, and no delayed bleeding was reported. Most of the reported bleeding was mild and clinically non-significant, and it stopped spontaneously or endoscopically. Furthermore, no mortality was reported. The risk of immediate (intraoperative) bleeding significantly increased with advanced age, advanced liver disease, increased portal hypertension with large varices, and decreased platelet count; meanwhile, the sex of patients, size, location, and method of polypectomy did not significantly increase the risk of gastric post-polypectomy bleeding among cirrhotic patients with portal hypertension and esophageal varices. Conclusions. Among patients with cirrhosis and portal hypertension, gastric polypectomy simultaneously done during endoscopic intervention for esophageal varices is considered a safe maneuver.

Frequency of Toxoplasmosis among Zagazig University Students in 2017

Toxoplasmosis caused by Toxoplasma gondii, is a major health problem in which about 30% of people are born with anti Toxoplasma antibodies worldwide. Toxoplasmosis causes congenital infection, neurological and psychatric disorders. The present study aimed to determine prevalence and factors associated with T. gondii infection in Zagazig university students in 2017-2018.

Influence de la vitamine D3 livrée localement sur la conservation des crêtes alvéolaires après extraction, des dents (évaluation clinique radiographique et histologique)

BUT DE L'ÉTUDE: Le but de cette étude d'essais cliniques contrôlés randomisés était d'évaluer et de comparer la conservation des dimensions de la crête alvéolaire après une extraction dentaire atraumatique à l'aide d'une membrane de collagène et d'une xénogreffe mélangée avec du gel vit D3 actif par rapport à une membrane de collagène et à une xénogreffe uniquement. MATÉRIEL ET MÉTHODES: Dix patients ont été sélectionnés. Tous les patients ont dû extraire deux prémolaires non restaurables (ou dents antérieures) situées dans des quadrants symétriques d'arcs maxillaires ou mandibulaires et ont demandé une restauration d'implant. Deux chirurgies ont été réalisées pour chaque patient; le premier était destiné à l'extraction de la préservation de la crête alvéolaire, tandis que le second était destiné à la biopsie osseuse centrale et à la pose d'implants de façon routinière. Chez le même patient, une prise d'extraction (site de test) a été traitée avec une membrane de collagène et une xénogreffe mélangée avec de la vit active D3 tandis que la deuxième prise d'extraction (site de contrôle) a été traitée avec une membrane de collagène et une xénogreffe uniquement. Des évaluations cliniques, radiographiques et histologiques / histomorphométriques ont été réalisées. RÉSULTATS: Cliniquement et par radiographie tout au long de la période d'étude, il n'y avait pas de différence statistiquement significative entre les variations moyennes en% de la largeur des crêtes BL et de la hauteur des crêtes dans les deux groupes. L'analyse histomorphométrique a montré une différence statistiquement significative entre la fraction de surface moyenne de la nouvelle formation osseuse dans les deux groupes. CONCLUSION: L'application locale de vitamine d3 avec la xénogreffe dans la préservation de la crête alvéolaire accélère la formation de nouveaux os et favorise la maturation osseuse lors de la comparaison avec la xénogreffe uniquement

Silver nanoparticles: A potential antibacterial and antibiofilm agent against biofilm forming multidrug resistant bacteria

Background: Multi-drug resistant (MDR) bacteria are seriously endangering the antibiotics. Different alternative strategies are needed to reinforce antibiotics, of, these; nanostructured materials may play a fruitful role. This study aimed to investigate the antibacterial and antibiofilm activity of silver nanoparticles (AgNPs) against MDR bacteria. Methods: In a cross-sectional study, a total of 33 methicillin resistant Staphylococcus aureus (MRSA) and 52 MDR Pseudomonas aeruginosa (P. aeruginosa) isolates were recovered from intensive care units' (ICUs) admitted patients over a period of 9 months, from December 2017 to August 2018. The antibacterial activity of AgNPs on the clinical isolates of MRSA and MDR P. aeruginosa was assessed by minimum inhibitory concentrations (MICs) using broth microdilution method. The minimum bactericidal concentrations (MBCs) were determined as the lowest concentrations required to kill 99.9% of the initial inoculum. Tissue culture plate method was used to evaluate the antibiofilm activity. Results: The MIC and MBC values ranged from 1 to 16 µg/ml and 2 to 64 µg/ml, respectively. Silver nanoparticles exerted a significant antibiofilm activity against MRSA and MDR P.aeruginosa at all tested concentrations, recording a maximum inhibition value of (82%) and (91%), respectively. Conclusions: AgNPs exhibited a considerable antibacterial and antibiofilm, effect; it could represent a promising weapon in the fight against biofilm forming MDR organisms

Anti-Helicobacter pylori activity of Egyptian medicinal plants and bacteriophages

Background: Helicobacter pylori (H. pylori) is the most common cause of gastric infections worldwide. Due to antibiotic resistance and adverse effects, phytotherapy and phage therapy have been a research focus as an alternative therapy for H. pylori infection. Objectives: To assess the medicinal plant extracts and bacteriophages as a treatment of H. pylori infection. Methodology: Thirty five gastric biopsies were cultured for H. pylori isolation. Screening of medicinal plants extract efficiency was done by Disc diffusion method. Minimum inhibitory concentrations of extracts were assessed. In vivo effect of Punica granatum peel extract was tested by bacterial density and histopathology in rats. Sewage water samples were screened for H. pylori specific bacteriophages. Single plaque isolation technique was used for phage purification. Results: Ten out of 35 (28.57%) patients had positive gastric biopsy for H. pylori by culture. Four out of 10 (40%) isolates were resistant to all antibiotics. Inhibitory effect of Rosemarinus officinalis, Syzygium aromaticum, Rhus coriaria and Ammi visagna on H. pylori was detected. Punica granatum extract was the most efficient in vitro. In vivo, Punica granatum peel extract caused significant reduction of bacterial density (Pty (P<0.05) and enhanced ulcer healing. Sewage water filtrates contained 3 types ofH. pylorispecific bacteriophages. During phagepurification,phage infectivity waslost.Conclusions:Punicagranatumpeel extract revealed better in vivo activity againstH. pylorithanv standard regimen antimicrobials. Other effective plants can be beneficial inH. Pylori infection management .Loss of bacteriophage infectivity may be an obstacle to phage therapy of H. pylori

Percutaneous microwave ablation versus partial splenic embolization for treatment of hypersplenism in patients with liver cirrhosis

Background and study aim: In patients suffering from portal hypertension as result of liver cirrhosis, hypersplenism was ranged from 11 to 55%. The aim of our work was to compare between percutaneous microwave ablation (MWA) and partial splenic artery embolization (PSE) in the management of hypersplenism in patients with liver cirrhosis as regard efficacy and safety. Patients and Methods: Sixty patients with liver cirrhosis complicated with splenomegaly and hypersplenism were divided randomly into three groups; Group (1): Twenty patients were underwent one session of MW ablation of splenic parenchyma with target ablation volume about 20%, Group (2): Twenty patients were underwent two sessions of MW ablation of splenic parenchyma with 1 week interval with target ablation up to 40%, Group (3): Twenty patients were underwent PSE. Results: There was an improvement in the hemoglobin, platelet and leucocyte levels in three groups, which was 9.47± 2.14 gm/dl, 42.75 ± 15.4 x103/ mm3 and 2.6±0.5 x103/mm3 before the procedure respectively and become 9.95 ± 2.29 gm/dl, 313.5±99.6 x103/mm3 and 6.88± 1.89 x103/mm3 after one month as regard PSE group. As regard one session of MWA was 9.73±2.02 gm/dl, 45.57±11.2 x103/mm3 and 2.8±0.85 x103/mm3 and become 11.83±0.74 gm/dl, 152±26.43 x103/mm3 and 5.85±1.01 x103/mm3 after one month. As regard two sessions of MWA group; was 9.2±2.15 gm/dl, 40.6± 11.5 x103/mm3 and 2.4±0.55 x103/mm3 and become 12.74±1.2 gm/dl, 183.4± 26.43 x103/mm3 and 6.29±1.17 x103/mm3 after one month. PSE was significantly more effective in the elevation of platelets and leucocytes than other two groups (p=0.00), and two sessions of MWA more than one session of MWA. The two sessions MWA group was significantly higher than other two groups while one session of MWA group was more than PSE group in the elevation of hemoglobin (p=0.00). No mortality occurred in the three groups, but PSE was associated with more serious complications than the other two groups. Conclusion: MWA and PSE were effective in treatment of hypersplenism in patients with liver cirrhosis, while percutaneous MWA has less serious complications than PSE

Laparoscopy in gastro- intestinal tumors

Background: Cancer is a major public health problem worldwide. Many studies have shown that the completion of adjuvant chemotherapy improves the survival rate. Objectives: The aim of the current study was to discuss the efficacy and role of diagnostic and therapeutic laparoscopy as a new trend in managing gastrointestinal tumors. Patients and Methods: This prospective study included a total of 50 patients, whom had gastro-intestinal tumor diagnosed by tissue biopsy and histopathology attending at General Surgery Department, Sayed Galaal Al-Azhar University Hospital. The hospital statistically significant data for the included 50 patients, pre and post diagnostic laparoscopy and surgical intervention were collected and analyzed. Results: A significant percentage of intra-abdominal cancers prove to be inoperable because of metastatic or locally advanced disease despite a preoperative workup suggesting a potentially resectable disease. Conclusion: It could be concluded that diagnostic laparoscopy is accurate staging tool for gastro intestinal tumors as staging method prior to surgery that can change plan to start neoadjuvant chemotherapy (CTR) instead of surgery. Laparoscopic surgery shows also short post- operative patient stay at hospital and early start of CTR

Correlation between autoimmune thyroid diseases and helicobacter pylori infection

Background: Helicobacter Pylori (H. Pylori) usually acquired in childhood, it colonizes the gastric mucosa of about 50% of the world's population at some time in their life. In eastern countries, H. pylori infection has a prevalence of approximately 70%. Objective: To correlate between H. pylori infection and autoimmune thyroid diseases (AITD). Patients and Methods: This is a cross-sectional study done on 200 patients selected as a convenient sample with upper GI upset. They were selected from gastroenterology outpatient clinics at Al-Hussein and Alexandria Police Hospitals, during the summer months of 2018. They were classified according to the results of stool H. pylori Ag testing into two groups; positive and negative (each group 100 patient). This is cross-sectional study done on 200 patients selected as a convenient sample Results: Our results indicated that patients with H. pylori infection were more susceptible to AITD. There was significant association between H. pylori infection and both Hashimoto's and Graves' disease. H. pylori infection had shown to be associated with elevated liver enzymes, anemia, and IL 17. Conclusion: There is a significant positive relationship between H. pylori infection and Hashimoto's disease (HT). There is a significant positive relationship between H. pylori infection and Graves' disease (GD)

Vitamin B12 status among pregnant women and Its association with obesity and gestational diabetes

Background: pregnant women in resource-poor areas are at risk of multiple micronutrient deficiencies, and diets that are low in animal products place women at increased risk of vitamin B12 deficiency. Aim of the Work: to investigate the vitamin B12 status of pregnant women in Egypt and its relationship with obesity and gestational diabetes mellitus (GDM). Patients and Methods: this clinical observational prospective study has been conducted at Bab Al-Shaaria University Hospital Obstetrics and Gynecological Department from April 2018 to January 2019. To assess vitamin B12 status among pregnant woman and its association with obesity and gestational diabetes. 80 pregnant women attended to out-patient clinic were included in the study. The evaluation included data collection through: history taking, examination, anthropometric measurement, maternal blood vitamin B12 level estimation at second and third trimester and blood glucose level. Results: vitamin B12 deficiency in pregnancy is common particularly in obese women and those with GDM. Conclusion: vitamin B12 deficiency is silent and common in general population. Causes of vitamin B12 deficiencies are multifactorial and associated with many health problems. Also, obesity is common and its prevalence is increasing in the world. Therefore, both health problems have gained importance in family medicine practice in the last decades

Strain-strain rate imaging of impaired left atrial function in patients with metabolic syndrome

Background: Metabolic syndrome (MS) predisposes to left ventricular dysfunction and heart failure, however, alterations in left atrial (LA) function in MS are unknown. Objectives: We aimed to use strain/strain rate (SR) imaging to investigate the effect of MS on LA function. Subjects and Methods: This prospective case control study included a total of 100 subjects divided in to 75 metabolic syndrome (MS) patients referred to Al-Azhar university hospital outpatient clinic for evaluation and treatment of hypertension and/or diabetes mellitus and 25 age and sex matched apparently healthy volunteers as a control group. All subjects underwent conventional echocardiographic examination and assessment of LA function by speckle tracking. Partial correlation and multiple stepwise regression analyses were used to determine the risk factors for impaired LA function. Results: Compared with the controls, the MS patients showed significantly lower levels of mean strain, mean peak systolic SR and mean peak early diastolic SR (P<0.05 for all), with no difference in the mean peak late diastolic SR. Central obesity, hypertension, dyslipidemia and uncontrolled diabetes were independent risk factors for impaired LA function. Conclusion: SR imaging is reliable in assessing LA function in MS patients

Assessment of retinal nerve fiber layer thickness using optical coherence tomography in patients with type 2 diabetes mellitus

Background: Diabetic retinopathy (DR) is the most common ocular complication of diabetes mellitus (DM) and considered one of the leading causes of blindness in developed countries. Diabetic retinopathy is predominantly amicroangiopathy in which high glucose levels can make small blood vessels particularly, vulnerable to damage. Objective: The aim of this work was to assess the thickness of peripapillary retinal nerve fiber layer (RNFL) measured by Swept Source optical coherence tomography (SS-OCT) in patients with Type 2 Diabetes Mellitus (DM). Patients and Methods: The study was an observational cross-sectional study. The study was conducted on 40 eyes of diabetic patients from the outpatient clinic in ophthalmology department of Al-Azhar University Hospitals. All patients were subjected to a complete ophthalmic examination including OCT. Results: The current study showed a negative correlation between parameters related to DM (duration of DM, and state of glycemic control measured by HbA1C) and all the parameters related to RNFL, and RGCL thickness but this correlation was statistically insignificant, and there was statistically significant decrease in superior RNFL thickness in patients with mild DR than patients with no DR, however, this difference was statistically insignificant in all parameters related to RGCL thickness in the two groups. Conclusion: Optical coherence tomography (OCT) provides non-invasive, quantitative and objective measurement of RNFL thickness, optic nerve head, and RGCL thickness with high resolution and accuracy. This could be the method of choice for monitoring the neurodegenerative changes in DR

Study of the effect of repetitive transcranial magnetic stimulation on a sample of children with autism spectrum disorder

Background: Autism Spectrum Disorder (ASD) is a behaviorally defined complex neurodevelopmental syndrome. ASD is one of the most common child psychiatric disorders. Despite the long history of research on ASD, no much is known yet about the exact biological causes and how the disorder can be effectively treated. Objective: To study clinical effect of repetitive Transcranial Magnetic Stimulation (rTMS) on a sample of children with autism spectrum disorder. Patients and Methods: the sample consisted of 30 children. Their ages ranged from 4 to 10 years old. After being diagnosed clinically according to DSM-5 through a designed semi-structured interview and through application of childhood autistic rating scale CARS and assessment of the degree of clinical severity of autism spectrum disorders according to DSM-5. Results: The results of the study after the completion of 12 sessions of rTMS, there was a significant difference and improvement in the severity of the clinical symptoms for ASD except for the level of activity and listening response and use of the body by comparing the severity of symptoms before and after rTMS. Comparing results before and after rTMS by the level of clinical severity of autism according to DSM-5; at the level of severity in social communication, the improvement was statistically significant (p-value 0.001). At the level of severity in restricted and repetitive behaviors the improvement was statistically highly significant (p-value <0.001). Conclusion: this study concluded that rTMS over left dorso-lateral prefrontal cortex may be safe and effective way of providing a relief of ASD symptoms

Assessment of musculoskeletal ultrasound guided injection of the new regenerative medicine techniques (neural prolotherapy and platelet rich plasma) impact versus well established techniques (steroid injection) in cases of carpal tunnel syndrome secondary to rheumatoid arthritis

Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming poly-arthritis with extra-articular manifestations in 10­20% of patients, especially those with high titers of rheumatoid factor. Extra articular pathology includes bursitis, tendonitis and neuritis, which results from entrapment, nerve ischemia due to vasculitis or drugs used to treat this condition. Carpal tunnel syndrome is the most common compression neuropathy associated with rheumatoid arthritis. Aim of the Work: To evaluate the efficacy of Neural Prolotherapy and Platelet Rich Plasma in treatment of carpal tunnel syndrome secondary to rheumatoid arthritis. Patients and Methods: Ninety patients with Rheumatoid Arthritis (RA) that were all fulfilling the 2016 ACR/EULAR classification criteria for RA. All were over the age of sixteen years at time of diagnosis, complaining of burning pain or paresthesia in the median nerve distribution of the hand. They were recruited from Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from December 2018 to July 2019. Results: Neural Prolotherapy and Platelet Rich Plasma (PRP) have improved all measured parameters like visual analogue scale (VAS), nerve conduction studies and neuromuscular ultrasonography parameters in carpal tunnel syndrome secondary to rheumatoid arthritis. Conclusion: Neural Prolotherapy and Platelet Rich Plasma proved to be effective treatments of carpal tunnel syndrome secondary to rheumatoid arthritis

Effect of steroid loaded middle meatal gelfoam sheet on endoscopic sinus surgery outcome

Background: Endoscopic sinus surgery (ESS) represents the overall accepted type of surgical treatment for chronic rhinosinusitis with nasal polyposis (CRSwNP) refractory to medical treatment. Presence of postoperative Middle meatal adhesions are a potential cause of surgical failure. Triamcinolone is recently proposed as a solution for these adhesions. Objective: This study was designed to evaluate the effect of steroid loaded middle meatal gelfoam sheet on endoscopic sinus surgery outcome regarding middle meatal adhesions and synechiae formation in patients with CRSwNP refractory to medical treatment. Patients and Methods: This prospective, randomized, single-blinded, placebo-controlled study was conducted on 62 nasal cavities of 31 patients with bilateral CRSwNP. At the end of ESS, randomly gelfoam sheet loaded with triamcinolone was placed in one middle meatus and another gelfoam sheet loaded with saline in the contralateral middle meatus for 1 week. Results: Our results as regards topical application of steroids to the middle meatus showed a statistically significant difference between the steroid side and the saline (control) side in reduction of synechia formation after ESS. Therefore, topical application of steroids is effective in minimizing synechiae formation after ESS. It is also safe and no local or systemic complications were noted during the study. Conclusion: Results of our study demonstrated that the steroid loaded middle meatal gelfoam sheet has a role in minimizing middle meatal adhesions and synechiae formation after endoscopic sinus surgery for patients with CRSwNP

Evaluation of the repeated exposure of hexaflumuron on liver and spleen tissues and its mutagenicity ability in male albino rat

Background: Hexaflumuron (HFM) is an insect growth regulator (IGR); it is highly effective against a wide range of pests. Aim of the work: Due to the lack of toxicological assessments of this insecticide especially the formulation type, the objective of the present study was aimed to investigate the toxicological effects of repeated exposure of HFM formulation on adult albino rats. Materials and methods: Three groups were administered daily by gavage for (28 days) at dose of 11, 4, and 2.5 mg/kg b.wt respectively. In addition to control group. Results: The results of acute toxicity indicated HFM exhibited moderate to some extent high toxicity toward the treated rats. Slight tremors and bleeding from nose were observed. The repeated exposure results revealed the high and middle doses exhibited methemoglobinemia. Also, the HFM treatment led to increase in AST and ALT levels. The urea and creatinine levels were not significantly increased except the level of creatinine in high dose. According to the histopathological findings the middle and low doses of HFM revealed greater injurious in liver and spleen tissues than induced by high dose. HFM induced a statistically significant increase in the micronucleus (MN) frequency in a dose-dependent manner compared with a negative control group. Conclusion: So, it is obvious the middle and low doses induced damage in the liver and spleen organs while the high dose induced damage in blood, bone marrow, and kidney organs

Estimation of the prophylactic effect of the egyptian propolis extract against aluminum silicate toxicity on some organs of albino rats growth performance and histochemical studies

Background: the liver is a critical organ because it contains most of the accumulated metals where toxic effects can expected. Also, the lung is directly affected by receiving aluminum as aluminum silicate. Exposure of aluminum leads to production of free radicals that damage living organs and tissues. Aim of the work: this study aimed to evaluate the nucleic acid content in liver, lung and cerebellum tissues intoxicated by aluminum silicate (AlS) and the possible ameliorative effect of propolis extract (PP). Material and methods: Forty male albino rats (weighting 100-120 grams) were categorized randomly into four groups, ten rats on each group (n=10). The 1st group considered as the healthy control group. The 2nd group received 200 ml PP/kg b.wt., day after day by stomach gavage. The 3rd group was injected intraperitoneally by 20 mg AlS/kg b.wt., twice weekly. The 4th group was treated with AlS in addition to PP as the same doses as in the 2nd and 3rd groups. After two months for each group. Liver, lung and cerebellum organs were harvested. Results: decreased body weight gain of rats was realized with weakly stained nucleic acids contents in liver, lung and cerebellum tissues that intoxicated by AlS. While, using the supplemented treatment (PP) at the same time with the induction of AlS compound showed an ameliorative effect on the nucleic acid contents. Conclusion: propolis has anti-oxidant by inhibiting AlS toxicity on nucleic acids in the different experimental organs of rats

Study of the relationship between severity of liver cirrhosis and Pulmonary function tests

Background: Cirrhosis is a condition in which the liver does not function properly due to long-term damage. This damage is characterized by the replacement of normal liver tissue by scar tissue. Objective: The aim of this work is to study the relationship between severity of liver cirrhosis according to the Child-Pugh score and pulmonary function tests (namely spirometry and arterial blood gas). Patients and Methods: The study is a cross sectional one, which was carried out on 50 patients admitted in the inpatient wards, or in regular follow-up in the out-patient's clinics of the Gastroenterology Departments, in Al-Azhar University Hospitals between November 2018 and May 2019.They were divided into 3 groups according to Child Pugh Classification (A, B and C). Result: The prevalence of hypoxia was (30%) in all studied groups (50 patients), the hypoxia was present in patients with Child C and Child B (62%) and (29.4%) respectively but none of Child A had hypoxia. It was noted that all pulmonary functions were worst in patients Child class C when compared to other groups. However, patients Child B had also significantly worse pulmonary functions when compared to patients class A. We also showed that pulmonary functions are significantly correlated with synthetic liver function, Child and MELD score. The deterioration of liver functions and rise of patients score is accompanied by worsening of all pulmonary functions. Conclusion: Patients suffering from severe liver cirrhosis and ascites, have significant reduction in (PaO2) and (SaO2) in association with restrictive pulmonary function pattern (up to 100% of patients with massive ascites)

Bone mineral density and trabecular bone score in patients with non-radiographic axial spondyloarthropathy

Background: spondyloarthropathies (SpA) are a group of chronic inflammatory rheumatic conditions that share multiple clinical features including axial and/or peripheral arthritis, enthesitis, absence of serum rheumatoid factor and presence of common extra articular manifestations. Objective: the aim of this work is to study bone mineral density and trabecular bone score at patients with non-radiographic axial spondyloarthropathy. Patients and Methods: this study is a cross sectional study in which 200 patients having chronic back pain selected from those attending the outpatient clinic and inpatient of Al-Azhar University Hospitals, Damietta and were divided into two groups: 1- (Group A, study group): (160) patients had inflammatory low back pain fulfilling Calin criteria for inflammatory low back pain. 2- (Group B, control group): (40) patients had mechanical low back pain not fulfilling criteria of inflammatory back pain. Results: regarding results of clinical examination, there was significant increase of arthritis, dactylitis, enthesitis and psoriasis in Group A when compared to Group B (43.3%, 16.7%, 30.0%, 20.0% vs 3.3%, 0.0%, 3.3% and 3.3% respectively). In addition, there was significant increase of arthritis plus dactylitis and arthritis plus enthesitis in Group A when compared to Group B (16.7%, 30.0% vs 3.3% and 0.0% respectively). Conclusion: results of the present study proved that, both bone mineral density and trabecular bone scores showed early changes in patients with non-radiographic axial spondylo-arthropathy. In addition, both correlated with each other and with results of axial magnetic resonance imaging. Thus, they are advocated in diagnosis of nr. SPA

Comparison of the effect of nitroglycerin, magnesium sulphate and dexmedetomidine as hypotensive agents in lumbar spine surgery

Background: in orthopedic procedures more blood is lost from raw bone and muscle surface than from identifiable blood vessels. Moderate hypotensive anesthesia was found to significantly decrease the average blood loss by nearly 40%, reduce the need for transfusion by 45% and shorten the average operating time by nearly 10%. Objective: The aim of the current study was to compare magnesium sulphate and dexmedetomidine with nitroglycerin as regard hypotensive effect as primary outcome, volume of blood loss, blood substitution and pattern of recovery as secondary outcome during lumbar spine surgery. Patients and Methods: This prospective, controlled, comperative, randomized, double blind study included a total of ninty patients aged 21-50 years of both sex, ASA I-II scheduled for elective lumber spine surgery, attending at Department of Orthopedic, AL-Azher university Hospital in Assuit as single center study. Patients have received either dexmedetomidine, magnesium sulfate or nitroglycerine. Results: There were highly significant difference (P <0.000) with duration of surgery between different study groups with duration of surgery shortest in dexmedetomidine group followed by magnesium sulfate group and then nitroglycerine group. There were highly significant differences between different study groups with fluid maintenance with higher volume in nitroglycerine group then magnesium sulfate group and then dexmedetomidine group. There were highly significant differences (P <0.000) with systolic blood pressure between study groups at A1 and hypotensive agent discontinuation with lowest systolic blood pressure in dexmedetomidine group followed by magnesium sulfate group and then nitroglycerine group. Conclusion: nitroglycerine, magnesium sulfate and dexmedetomidine could induce hypotension, but dexmedetomidine showed more favorable hemodynamic profile as regard blood pressure and heart rate