Comparative study between intravitreal ranibizumab and triamcinolone treatment of diabetic macular edema as regard to optical coherence tomography changes and visual acuity / Estudo comparativo entre o tratamento intravítreo com ranibizumabe e triancinolona do edema macular diabético quanto às alterações na tomografia de coerência óptica e na acuidade visual

Abstract Objectives: To compare the effect of intravitreal Ranibizumab (0.3mg) and Triamicinolone (4mg) on different parameters in spectral domain OCT and their relation to visual acuity of patients with diabetic macular edema. Methods: This study is designed as a prospective randomized study. Patients were randomly divided into 2 groups receiving either Pro re nata intravitreal Ranibizumab (0.3mg) or Triamicinolone acetonide (4mg), to whom Spectral Domain OCT was done as well as best corrected Log MAR visual acuity. Results: 40 patients were included in this study. Comparison and correlation of mean BCVA and mean CMT among and within treatment groups of our study revealed strong and significant relationship between both parameters and showing equal effect of both treatment types regarding them with the consideration that Triamicinolone acetonide treated group (Group B) showed statistically significant lower CMT compared to Ranibizumab treated group (Group A) at three and six months. Also both showed equal effectivity regarding improvement of the photoreceptors integrity and in turn the improvement of the BCVA. Meanwhile the association of CMT and IS/OS integrity was found to be significant only at six months in both groups (p =0.009 in Group A; p =0.031 in Group B). The fading initial effect of a single ranibizumab injection on macular edema can be augmented by following that one injection with two injections of the loading dose. Triamicinolone effect after single injection began to fade at 3 months. Conclusion: Both treatment types had good effect on reduction of CMT and improvement of BCVA and the IS/OS junction with difference in sustainability of their effects due to difference in their pharmacokinetics and need for repeated injections.

Resumo Objetivos: Comparar o efeito do ranibizumabe intravítreo (0,3mg) e triacmicinolona (4mg) em diferentes parâmetros do domínio espectral da OCT e sua relação com a acuidade visual de pacientes com edema macular diabético. Métodos: Este estudo foi concebido como um estudo prospectivo randomizado. Os pacientes foram divididos aleatoriamente em 2 grupos que receberam Ranibizumab Pro rata intravitreal (0,3mg) ou acetonido de Triamicinolona (4mg), a quem foi realizada a Spectral Domain OCT, bem como a melhor acuidade visual de Log MAR corrigida. Resultados: Quarenta pacientes foram incluídos neste estudo. A comparação e a correlação da acuidade visual média e CMT média entre e dentro de grupos de tratamento do nosso estudo revelaram uma relação forte e significativa entre ambos os parâmetros e mostrando um efeito igual de ambos os tipos de tratamento, considerando que o grupo tratado com acetonido Triamicinolona (Grupo B) apresentou significância estatística. menor CMT comparado ao grupo tratado com Ranibizumab (Grupo A) aos três e seis meses. Também ambos mostraram igual efetividade em relação à melhoria da integridade dos fotorreceptores e, por sua vez, a melhora do BCVA. Enquanto isso, a associação de CMT e IS / OS integridade foi significativa apenas aos seis meses em ambos os grupos (p = 0,009 no Grupo A; p = 0,031 no Grupo B). O efeito inicial enfraquecido de uma única injeção de ranibizumabe no edema macular pode ser aumentado seguindo-se aquela injeção com duas injeções da dose de ataque. O efeito triamicinolona após injeção única começou a diminuir aos 3 meses. Conclusão: Ambos os tipos de tratamento tiveram bom efeito na redução da CMT e melhora do BCVA e da junção IS / OS com a diferença na sustentabilidade de seus efeitos devido à diferença em sua farmacocinética e necessidade de injeções repetidas.

Protective role of acacia nilotica extracs and silymarin against mutagenic and hepatic injuries induced by 2-butoxyethanol in male mice

2-Butoxyethanol [2-BE] is a clear colorless liquid that smells like ether. It is used as a solvent in spray lacquers, varnishes, varnish removers, herbicides, liquid soaps, cosmetics, industrial and household cleaners, and dry-cleaning compounds. 2-BE causes cellular damage via formation of reactive oxygen species. Acacia nilotica [A.nilotica] leaf extract exhibited significant antimutagenic and DNA-protective effects against oxidative damage due to the presence of alkaloids, volatile essential oils, phenols and phenolic glycosides; it is considered an excellent free radical scavenging antioxidant owing to the high number of hydroxyl groups. Silymarin [SIL] is a standardized mixture of antioxidant flavonolignans [silybin and silibinin]. Silybum marianum [Milk thistle] family Asteraceae is an ancient medicinal plant from which SIL is extracted. It is a free radical scavenger and a membrane stabilizer that prevents lipid peroxidation. In the present study, we investigated the effects of extracts of A.nilotica leaves and SIL on the toxicity of 2-BE

Materials and Methods: 2-BE was given orally to male albino mice for 28 days at dose [450microl/kg b.wt]. A. nilotica leaf extract [25 mg/kg b.wt] was dissolved in water and was administered orally for 14 days prior to 28 days treatment of 2-BE and during the 28 days. Also SIL [20 mg/kg b.wt] was administered orally for 14 days prior to 28 days treatment of 2BE and during the 28 days

Result: In the present work, genotoxic effects were induced by 2-BE through oral administration, and the protective effect of A. nilotica and SIL are studied. 2-BE induced a significant increase in the structural as well as numerical chromosomal aberrations. The frequency of chromosomal aberrations showed significant decrease when mice treated with A. nilotica extract and SIL. Also, there were significant increases in micronuclei. A. nilotica extract and SIL administration significant decreases micronuclei induced by 2-BE. However 2-BE induced a significant decrease in mitotic index. Administration of both A. nilotica extract and SIL significant increase mitotic index in mice treated with 2-BE. Exposure of mice to 2-BE caused significant changes in the hematological paramters as well as significant increases in the activities of serum enzymes alanine aminotransferases [ALAT], aspartate aminotransferases [ASAT] and alkaline phosphatase [ALP]. Also, 2-BE induced a significant decrease in the content of liver reduced glutathione [GSH], however, induced a significant increase in the level of hepatic lipid peroxidation end product [MDA] of male mice. Coadministration of both A. nilotica extract and SIL to 2-BE-intoxicated mice ameliorated the above-mentioned parameters

Conclusion: 2-BE induced mutagenic and liver injury in male mice. A.nilotica and SIL are found to reduce the percentage of chromosomal aberration and micronuclei cells as they are a powerful antioxidant, they are able to scavenger reactive oxygen species [free radicals] formed by 2-BE in the cells, these free radicals damage DNA and hence cause defects in the chromosomes. A. nilotica extract and SIL could be used as a protective agent against mutagenic and hepatic injuries resulting from 2-BE. The protective action of SIL is more effective than A. nilotica

Abrogation of carbon tetrachloride-induced hepatotoxicity in Sprague-Dawley rats by Ajwa date fruit extract through ameliorating oxidative stress and apoptosis

Ajwa, a variety of date palme Phoenix dactylifera L., has long been used and considered as one of the most popular fruits in the North Africa and Middle East region. For Muslims this fruit is of religious importance and is mentioned several times in Quran. Besides being a part of the Arabian essential diet, dates have been used traditionally for number of complications. This study aimed to evaluate the possible potential of Ajwa date extract to guard against carbon tetrachloride [CCL[4]-induced liver damage in rats. Adult male Sprague-Dawley rats were given Ajwa date extract and silymarin [a standard reference drug] at doses of 300 and 50mg/kg, p.o., respectively for 2 weeks before CCU [2 ml/kg, s. c., twice weekly for 8 consecutive weeks], and concomitantly administered with CC1[4] for 8 consecutive weeks. Like silymarin, Ajwa date extract produced significant decrease in serum levels of alanine transaminase [ALT], aspartate transaminase [AST], alkaline phosphatase [ALP], total cholesterol, triglycerides [TG] and LDL-cholesterol as well as lipid peroxides measured as malondialdehyde [MDA], hydroxyproline and caspase-3 contents of liver tissue with marked increase in serum albumin, HDL-cholesterol and reduced glutathione [GSH] content as well as enzyme activities of super oxide dismutase [SOD], catalase [CAT] and glutathione-S-transferase [GST]. In conclusion, Ajwa date extract afforded significant protection against CCLrinduced hepatocellular injury; an effect that could be attributed to its antioxidant, antiapoptotic and antifibrotic activities

Nonopioid versus opioid based general anesthesia technique for bariatric surgery: a randomized double-blind study

The objective of this study was to evaluate the efficacy and safety of giving general anesthesia without the use of any opioids either systemic or intraperitoneal in bariatric surgery. Prospective randomized controlled trial. Obese patients [body mass index >50 Kg/m[2]] undergoing laparoscopic sleeve gastrectomies were recruited and provided an informed signed consent. Patients were randomized using a computer generated randomization table to receive either opioid or non-opioid based anesthesia. The patient and the investigator scoring patient outcome after surgery were blinded to the anesthetic protocol. Primary outcomes were hemodynamics in the form of "heart rate, systolic, diastolic, and mean arterial blood pressure" on induction and 1/2 hourly thereafter. Pain monitoring through visual analog scale [VAS] 30 min after recovery, hourly for 2 h and every 4 h for 24 h was also recorded. Pain monitoring through VAS and post-operative nausea and vomiting 30 min after recovery were also recorded and finally patient satisfaction and acute pain nurse satisfaction. There was no difference in background characteristics in both groups. There were no statistically significant differences in different outcomes as heart rate, mean blood pressure, O[2] saturation in different timings between groups at any of the determined eight time points but pain score and nurse satisfaction showed a trend to better performance with non-opioid treatment. Nonopioid based general anesthesia for Bariatric surgery is as effective as opioid one. There is no need to use opioids for such surgery especially that there was a trend to less pain in non-opioid anesthesia

many faces of Ewing sarcoma: difficult to diagnose pediatric cases

Ewing sarcoma [ES] is the second most frequent primary malignant bone cancer, following osteosarcoma. ES is a small round-cell tumor typically arising in the bones, rarely in soft tissues, of children and adolescents. We describe four children aged 3, 3.5, 9, and 9.5 years, who presented with two femur masses simultaneously [patient 1], a huge mediastinal mass [patient 2], an abdomino-mediastinal mass with dysphagia [patient 3], and a huge abdomino-pelvic mass [patient 4]. Our patients were of younger age and had abnormal presentations that made initial diagnosis difficult, but also are representative of the different problems encountered in pediatric practice. Biopsy initially revealed round cell tumor and by immunohistochemistry, CD99 was positive, which confirmed the diagnosis of ES. Our patients were difficult to diagnosis. The patients were misdiagnosed initially, so there was a delay in diagnosis. Definitive diagnosis required use of various radiological imaging methods and immunohistochemistry

Femoral nerve block versus spinal anesthesia for lower limb peripheral vascular surgery

Perioperative cardiac complications occur in 4% to 6% of patients undergoing infrainguinal revascularization under general, spinal, or epidural anesthesia. The risk may be even greater in patients whose cardiac disease cannot be fully evaluated or treated before urgent limb salvage operations. Prompted by these considerations, we investigated the feasibility and results of using femoral nerve block with infiltration of the genito4femoral nerve branches in these high-risk patients. Forty peripheral vascular reconstruction of lower limbs were performed under either spinal anesthesia [20 patients] or femoral nerve block with infiltration of genito-femoral nerve branches supplemented with local infiltration at the site of dissection as needed [20 patients]. All patients had arterial lines. Arterial blood pressure and electrocardiographic monitoring was continued during surgery, in PACU and in the intensive care units. Operations included femoral-femoral, femoral-popliteal bypass grafting and thrombectomy. The intra-operative events showed that the mean time needed to perform the block and dose of analgesics and sedatives needed during surgery was greater in group I [FNB,] compared to group II [P=0.01*, P0.029*, P0.039*], however, the time needed to start surgery was shorter in group I than in group II [P=0. 039]. There were no block failures in either group, but local infiltration in the area of the dissection with 2 ml [range 1-5 ml] of 1% lidocaine was required in 4 [20%] patients in FNB group vs none in the spinal group. The recovery times showed that the nerve block resolution and time to micturition was longer [P0. 0001 [p=0.0001*, p=0.00032*] in the Spinal group [group II] as compared with patients receiving femoral nerve blockade [group I]. Moreover, the incidence of pain requiring analgesics in PACU and postoperative complications was higher in group II than in group I [P0.021*, p0.0028*]. lower limb vascular reconstruction can be done under local anesthesia [femoral nerve block with infiltration of genitor-femoral nerve branches] with acceptable complication rates specially in patients with high-risk diseases

Lymphocyte apoptosis and proliferation related gene products in childhood acute lymphoblastic leukemia

The aim of the study is to characterize markers of apoptosis in children with ALL in relation to treatment outcome of the disease. The study was performed on 34 children with ALL and 60 healthy children as a control group. Apoptosis was assessed by cell morphology; DNA fragmentation; ELISA and RT-PCR for CD95, CD95L, BcL2 and NF-KB; and flowcytometry for CD95, CD40, CD49d, and CD11a. Apoptosis was significantly lower in cases than controls. Apoptosis detected by CD95 ligand was significantly lower in cases with no remission after treatment than those with remission. Antiapoptotic factors: CD40, BcL2, and NF-KB were all found to be higher in cases than controls and in cases with no remission than those with remission, CD49d was significantly lower in cases than controls, and significantly lower in cases with no remission. CD11a levels were not different among various groups. Delayed apoptosis of ALL cells is genetically controlled either directly or indirectly by a network of oncogenes and tumor suppressor genes. CD40 appeared to stimulate both T and lineage and is considered the most potent influencer and predictor to resistance to therapy. Inhibitors for the activity of CD40, 8c/2 and NF-kB as well as stimulants to CD95 could have a potential therapeutic benefit

Epidural ropivacaine alone versus ropivacaine and sufentanil for postoperative analgesia after major orthopaedic surgery

In this randomized, double-blinded study, we evaluated the efficacy of patient controlled epidural postoperative analgesia after major orthopaedic surgery using ropivacaine alone versus ropivacaine and sufentanil in different doses. Sixty patients' ASA physical status I-III, scheduled for elective major knee or total hip replacement surgery were enrolled into the study. Patients were block randomized on admission to the hospital for their surgery to receive one of three patient controlled epidural postoperative infusion solutions: ropivacaine 2 mg.ml[-1] [Group R], ropivacaine 2 mg.ml[-1] and sufentanil 1 micro g.ml[-1] [Group RS]. or ropivacaine 1 mg.ml[-1] and sufentanil 0.75 micro g.ml[-1] [Group RSL]. The three groups were comparable as regards age, weight, height, gender and type of surgery. There were insignificant changes between the three groups as regards heart rate and MABP at any time of measurements. There was significant decrease in the total volume of analgesic solution infused in-group RS compared with other two groups and the total volume infused in-group R was also significantly less compared with group RSL. The number of PCEA demands and the number of PCEA demands delivered and the total dose of ketorolac given as a rescue analgesia were significantly less in-group RS compared with the other two groups. The incidences of respiratory depression, nausea and pruritus were significantly higher in-group RS compared with the other two groups. Although there was less sensation of pain whether during rest or passive mobilization as determined by VAS in-group RS compared with the other two groups but this was not statistically significant. The quality of analgesia was significantly better in-group RSL with most of the patients [90%] were comfortable compared with group R [75%] and group RS [65%]. It could be concluded that the use of patient controlled epidural analgesia with low concentrations of ropivacaine [1 mg.mr[-1]] and sufentanil [0.75 micro g.ml[-1]] was an effective method for postoperative analgesia after major orthopaedic surgery with less side effects and this may be closer to provide the best analgesia postoperatively

value of intraperitoneal meperidine for amalgesia after laparoscopic cholecystectomy

Postoperative pain has been an important limiting factor for ambulatory laparoscopic chlecystectomy. The intraperitoneal [IP] administration of drugs is controversial but has proven effective in some studies for the relief of postoperative pain following laparoscopic surgery. However, some investigators have not been able to confirm the analgesic efficacy of IP local anaesthetics. The administration of IP opioids for the relief of postoperative pain has received little attention. Forty patients, ASA physical status I and II were scheduled for laparoscopic cholecystectomy. At the end of anaesthesia, the patients were randomized into one of two groups: Patients of group A received 20 ml of IP ropivacaine 0.75% [150mg] and 50 mg of IM meperidine. Patients of group B received 20 ml of IP ropivacaine 0.75% [150mg] and 50 mg of IP meperidine. Postoperative pain scores were measured at rest and with movement at certain time periods for the first 24 hours. Pain scores were significantly lower in the group receiving the IP meperidine both at rest and with movement especially during the early post- operative hours. It was concluded that the combination of IP ropivacaine and IP meperidine was better than the combination of IP ropivacaine and IM meperidine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy

Study of emergence time and recovery of psycho-motor function after propofol-alfentanil anaesthesia

We have investigated the emergence time and the postoperative recovery of psychomotor function after minimally invasive procedures carried out under total intravenous anaesthesia using propofol and alfantanil. The study was carried out on 60 patients categorized into two equal groups: group I [elderly patients>65 years] and group II [younger patients < 40 years]. The emergence time was assessed by detecting the awaking time [eye opening on verbal commands], time to orientation, and Aldrete Recovery score. The recovery of psychomotor function was assessed using the speed of information processing [simple visual reaction time and simple auditory reaction time] and memory function test. These tests were performed before surgery and, 30 min, 1h, 2h, and one day after it. The results showed that the emergence time was similar in both groups, however, the psychomotor function recovered completely 2h after surgery in the elderly group compared to 1h in the younger group. These findings emphasize that the emergence time after minimally invasive surgery under propofol-alfentanil anaesthesia was comparable in both groups and the delay in recovery of psychomotor function in the elderly patients compared to younger patients was short lasting and improved within 2h after surgery

Effect of preoperative hydration on postoperative nausea and vomiting

This study was carried out on 80 patients scheduled for laparoscopic gynaecological or surgical operations. Our aim was to assess the effect of preoperative hydration on the incidence of postoperative nausea and vomiting after laparoscopic surgery. Our patients were scheduled into two groups [40 patients each] according to the volume of preoperative fluid infused. In the control group, patients received 2ml/kg Lactated Ringer solution, where in the high infusion group, patients received 20ml/kg Lactated Ringer solution 30 min before induction of anaesthesia in the preoperative area. In the postoperative period, the episodes of nausea and vomiting were recorded during stay in the recovery room, 2h later, and after 24h. Also the number of patients who required anti-emetics or the occurrence of any adverse effects [thirst and drowsiness] was recorded. Our results showed a less incidence of postoperative nausea, vomiting and adverse effects in the high infusion group compared to the control group. We concluded that supplemental preoperative fluid load reduce the incidence of postoperative adverse clinical outcome such as nausea, vomiting, thirst, and drowsiness

Does oocyte granularity affect ICSI prognosis?

This study was designed' to evaluate the relationship between oocyte granularity and fertilization rate, further embryonic development and the outcome of ICSI. The study included 986 oocytes retrieved from 92 patients undergoing ICSI treatment that was assessed for oocyte cytoplasm morphology as either normal oocytes with clear cytoplasm and homogeneous fine granularity, granular oocytes that showed dark cytoplasm with granularity either homogeneous affecting the whole cytoplasm [Generalized] or concentrated as a dark mass in the central portion of the oocyte with a clear peripheral ring [Localized] or having cytoplasmic inclusions: then, the embryo quality was graded after 16-18, 48 and 60 hours; into grade I [embryos without fragmentation], grade II [embryos with <20% of the volume of the embryo fragmented] and grade III [embryos with enucleate fragments present in 20-50% of the volume of the embryo]. There were 348 [35.3%] oocytes with normal cytoplasm [Group A], 308 [31.2%] oocyte had generalized granularity [Group B], 21 4 [21.7%] with localized dense central granularity, [Group C] and 116 [11.8%] with cytoplasmic inclusions [Group D]. Fertilization rate, determined after 16-1 8 hours, was 69% [n=240] in group A, 64% [n=197] in group B, 60% [n=128] in group C and 65 [56%] in group D. Cleavage rate determined at 48 hours after ICSI was 60%, 52%, 43% and 32% in the four groups, respectively. Cytoplasmic fragmentation, evaluated 60 hours after ICSI, was reported in 0-10% of group -4, 10-20% of group B, 15-25% in-group C and >25% in group D. Good quality embryo was detected in 40% in-group A oocytes, 25% in group 8, 10% in group C and <10% in group D oocytes. There was a significant difference in cleavage rate of fertilized oocytes categorized according to cytoplasmic granularity, [F=4.34, p=0.0375] with a significant increase of percentage of cytoplasmic fragmentation in oocytes with dense granularity, compared to oocytes with $ne granularity, [F=100.96, p=0.0000] and a significant difference in percentage of good quality embryos between fertilized oocytes categorized according to cytoplasmic granularity, [F=7.469, p=0.0275]. It could be concluded that although oocyte granularity does not significantly affect fertilize ability in ICSI procedure; it affects embryo cleavage rate and embryo fragmentation significantly and hence the predictability of the outcome of ICSI procedure reflected as the percentage of good quality embryo

Comparison of three differnt techniques for management of difficult intubation

This study was carried out in Alexandria Main University Hospital to evaluate 3 different techniques for management of difficult air way Thirty adult patients with expected difficult airway were categorized into 3 groups [10 patients each]. Patients of group 1 were managed with blind nasotracheal intubation technique, patients of group II were managed with Mc Coy laryngescope, and patients of group III were managed with the intubating laryngeal mask airway [lLMA-Fastrach]. All patients received general anaesthesia before management of the airway with the chosen technique. The parameters recorded included number of intubation trials, incidence of failure and time to achieve satisfactory ventilation Also, haemadynamic and ventilatory parameters were recorded. Our results showed that group III [Fastrach] had the highest success rate for intubation together with the least changes in ventilatory parameters during the procedure. However, group I had the highest failure rate for intubation [30%] followed by McCoy laryngescope [20%]. Also blind nasotracheal intubation technique was accompanied by the highest incidence of changes in ventiiatory parameters and complications during the technique. In conclusion, the study showed that ILMA is a potential aid for management of difficult airway as it has the advantages of high incidence of success and the unique ability to maintain ventilation during trails of tracheal intubation. Also, blind nasal intubation and McCoy laryngoscope still have a considerable role for management of difficult airway

Ribozymes: structure, function and medical correlations

Certain RNA molecules can mediate their own splicing, cleavage or act as enzymes to promote reactions on substrate RNA molecules. Thus, RNA is not restricted as being a passive carrier of genetic information but can have an active role in directing cellular biochemistry. Ribozymes are catalytic metallo-RNA molecules in which metal ions are essential for sufficient chemical catalysis and are often required for stabilization of ribozyme structure. Ribozymes can be used as sequence- specific RNA cleavage agents in vitro, providing useful tools for biochemical studies of RNA. These non protein biocatalysts have significant promise as therapeutic agents for diseases such as AIDS, cancer and viral hepatitis because they can be targeted against the RNA of the invading organisms responsible for these diseases and thus prevent their replication within the host cells

Tumor necrosis factor [TNF] in children with chronic liver diseases

TNF-alpha is a cytokine produced from monocytes and macrophages and has multiple biological activities. Serum TNF levels were determined by radioimmunoassay in 11 children with chronic liver diseases. TNF level was significantly increased in children with chronic liver diseases when compared with reference group [10 healthy children]. There was a significant positive correlation between TNF and liver enzymes [AST and ALT] and a significant negative one between TNF and Hb% and red cell count. TNF production may be related to hepatitis activity or viral replication. Elevations of TNF may contribute in a degree to bone marrow depression in those patients