Pre-emptive low-dose ketamine with local anesthesia reduces postoperative morbidity after third molar surgery: a systematic review and meta-analysis / Ketamina en dosis bajas con anestesia local reduce la morbilidad postoperatoria de la cirugía del tercer molar: revisión sistemática y metanálisis

Objective: This review addresses a clinical research question related to lower third molar surgery (L3MS): does the combination of pre-emptive low-dose ketamine with local anesthesia (KLA) reduce postoperative complications compared with local anesthesia (LA) alone? Material and methods: A systematic literature search was performed to identify eligible articles by electronic searches of PubMed, Cochrane Central Register of Controlled Trials, EBSCO Library, Web of Science and grey literature through June 2019 without data or language restrictions. We analyzed all randomized controlled clinical studies (RCTs) comparing use of KLA with use of LA in L3MS regarding pain, swelling, and trismus outcomes. The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Results: Five RCTs encompassing 230 extraction sites (KLA = 115, LA = 115) were included in this study. The standardized mean difference (SMD) with the 95% confidence interval (CI) was used to synthesize the results. The data show that there were significant differences between the two groups in post-operative pain (SMD -1.464, 95% CI -1.683 to -0.949, p= 0.001) and swelling (SMD -0.450, 95% CI -0.758 to -0.142, p= 0.004, all low quality evidence). However, there was no significant difference in the trismus (SMD -0.754, CI -1.487 to -0.022, p = 0.043, very low quality evidence). Conclusion: The combination of pre-emptive low-dose ketamine with LA significantly decreased pain and swelling within the first 24 hours after L3MS compared with the control group.

Objetivo: Esta revisión aborda una pregunta de investigación clínica relacionada con la cirugía del tercer molar inferior (L3MS): ¿la combinación de ketamina preventiva en dosis bajas con anestesia local (KLA) reduce las complicaciones postoperatorias en comparación con la anestesia local (AL) sola? Material y Métodos: Se realizó una búsqueda bibliográfica sistemática para identificar artículos elegibles mediante búsquedas electrónicas en PubMed, Registro Cochrane Central de Ensayos Controlados, Biblioteca EBSCO, Web of Science y literatura gris hasta junio de 2019 sin restricciones de datos ni de idioma. Se analizaron todos los estudios clínicos controlados aleatorios (ECA) que compararon el uso de KLA con el uso de LA en L3MS con respecto a los resultados de dolor, hinchazón y trismo. La calidad de la evidencia se clasificó de acuerdo con la herramienta Cochrane para evaluar el riesgo de sesgo. Resultados: Se incluyeron en este estudio cinco ECA que abarcan 230 sitios de extracción (KLA = 115, LA = 115). La diferencia de medias estandarizada (DME) con el intervalo de confianza (IC) del 95% se utilizó para sintetizar los resultados. Los datos muestran que hubo diferencias significativas entre los dos grupos en el dolor posoperatorio (DME -1,464; IC del 95%: -1,683 a -0,949; p= 0,001) e hinchazón (DME -0,450; IC del 95%: -0,758 a -0,142, p= 0,004, todas las pruebas de baja calidad). Sin embargo, no hubo diferencias significativas en el trismo (DME -0,754; IC: -1,487 a -0,022; p= 0,043, evidencia de muy baja calidad). Conclusión: La combinación de ketamina preventiva en dosis bajas con LA disminuyó significativamente el dolor y la hinchazón dentro de las primeras 24 horas después de la L3MS en comparación con el grupo de control.

Post-Tonsillectomy Bleeding: Assessing the Merit of Some Risk Factors in a Series of Saudi Patients

Background: Post-tonsillectomy bleeding is a commonly encountered problem due to several risk factors. This study aimed to assess the burden of post-tonsillectomy bleeding and its possible hematological risk factors in Saudi Arabia. Methodology: This is a retrospective study involved a series of 311 patients who attended with evidencebased indications of tonsillectomy and subsequently underwent surgical removal of the tonsils, with or without adenoidectomy (adeno/tonsillectomy). All of the patients underwent bipolar diathermy surgical techniques. Results: Out of the 311 patients, 67.5% underwent tonsillectomy and 32.5% underwent adenotonsillectomy. Post-tonsillectomy bleeding was experienced in 5.8% patients, 6.9% were males and 4% were females. The males’ risk (relative risk (RR)) of Post-tonsillectomy bleeding and the 95% confidence interval 95% CI): RR (95% CI)=1.7011 (0.6220 to 4.6521), p=0.3007. Conclusion: The prevalence of post-tonsillectomy bleeding is relatively higher in Saudi Arabia than the reported values in most studies. Factors such as post-operative infection, use of bipolar diathermy technique, and pain might be incriminated in the reported cases of postoperative bleeding in the current study.

The Impact of Physical Activity on Health Care Student Academic Performance in Riyadh, Saudi Arabia

Background: It is assumed that the students of health care colleges have a greater knowledge about healthy lifestyle and dietary habits when compared to other students. The main goal of this study was to determine the prevalence and effect of exercise on the academic performance of the health care students. Materials and methods: This cross-sectional study was conducted on 376 male healthcare students at King Saud University in Riyadh from Colleges of Medicine, Dentistry and Pharmacy in the period from December 2014 until March 2015. The study population was selected by multistage random sampling. A self-administered questionnaire was used for data collection. A pilot study was conducted to test its feasibility. A statistical package for the social sciences (SPSS) version 21.0 was used for data analysis. Results: 56.6% of the subjects were found to be physically active. Those who did not perform exercise, lack of time (55.8%) and lack of interest (36.2%) appeared to be the two most common Muath Ibrahim Alsabih, Hussein Saad Amin, Ali Saeed Alrawdhan, Fahad Yousef Alturki, Abdulrahman Mansour Alakeel, Yasser Abdulaziz Alrumih, Ahmed Saleh Allohidan, Ammar Abdullah Naji, Naif Abdulrahman Alarjani. The Impact of Physical Activity on Health Care Student Academic Performance in Riyadh, Saudi Arabia. IAIM, 2018; 5(2): 30-37. Page 31 causes for not exercising. The effect of physical activity on academic performance was found to be statistically significant in only two domains which were being less likely to be being late to the classes (P.026) and relatively better concentration during lectures (P.001). Conclusion: The study included that a significant positive effect of exercise was found on two domains of academic performance, namely better concentration in classes and punctuality in attending lectures, but with no significant effect on GPA of students.

Assessment of knowledge, attitude and practice of parents towards immunization of children in Saudi Arabia, 2018

Background: Immunization has shown a major preventive aspects of infectious diseases, disability and death

Objectives: Assessing the Knowledge, attitude and practice [KAP] of Saudi parents in Saudi Arabia the immunization programs for children, Saudi Arabia [KSA], 2018

Methods: It is a cross sectional survey study that was carried among 600 different Saudi parents form different Cities of Saudi Arabia for 3 months from Nov 2017 to Jan 2018. The parents completed a questionnaire that contains 4 different parts about the demographics, knowledge, attitude and practice of parents toward immunization

Results: The included parents have shown a high level of awareness about vaccination regarding the preventive measures and importance of vaccination which resulted in positive attitudes and practice pattern among most of them. The overall KAP was good among most of the parents [87.2%]. The higher KAP level was significantly associated with female gender, higher educational degree and having higher number of children

Conclusion: Most of Saudi parents had good KAP toward immunization which was associated with female gender and higher educational degrees. However, educational programs are still needed to increase the parents' knowledge and practice especially among illiterate and less educated parents living in rural areas

Screening of toxoplasma gondii infection among childbear- ing age females and assessment of nurses'role in prevention and control of toxoplasmosis

Toxoplasmosis, caused by Toxoplasma gondii is an obligate intracellular zoonotic protozoan parasite, with a worldwide distribution particularly in Arab countries including Egypt. The study evaluated toxoplasmosis infection among childbearing age Egyptian females and assessed the military nursing staff knowledge, attitude and compliance to toxoplasmosis prevention and control measures. The study was conducted in a general military hospital. Research design: cross-section descriptive research design was used to conduct this study. The subjects consisted of 14 young females [11 were in-patients undergoing gynecological treatment in a military hospital and 3 were staff nurses. On the other hand, 44 staff nurses were available for assessment who met the inclusion criteriaTools: 4 tools were used for data collection: first consisted of self-administered questionnaires to assess nurses' socio-demographic data and knowledge, second rating scale to assess nurses' attitude towards toxoplasmosis infection and its prevention, third performance check list to measure nurses' compliance to infection control measures, and fourth measured the anti-Toxoplasma antibodies by commercial indirect hemagglutination test [IHAT].The results showed that almost half of the nurses had satisfactory levels of knowledge, attitude, and compliance to toxoplasmosis infection control measures. 22.2% of the pregnant women and 20% of non-pregnant ones showed antibodies against T. gondii.Thus health education about toxoplasmosis should be tailored to women whether married or single to help in avoiding the risk of infection. Frequent periodic MAT should be done for people who continuously contact with cats. Adherence to strict infection prevention measures is a must to eliminate exposure to toxoplasmosis infection. Training intervention should be implemented to achieve successful improvement in knowledge, attitude, and compliance of toxoplasmosis control measures

Thyroid hemiagenesis: case report and review of literature

Thyroid hemiagenesis is a rare embryological condition in which the left lobe is usually absent. The remaining thyroid lobe may present as benign adenoma, multinodular goiter, hyperthyroidism, chronic thyroiditis, hypothyroidism and rarely carcinoma. The most common pathology involved in thyroid hemiagenesis is hyperthyroidism. This report probably represents the first ever reported case of thyroid hemiagenesis from Kuwait. This 56-year-old Kuwaiti male presented with a left thyroid swelling, a history of progressive fatigue, constipation and weight gain, and exercise intolerance. The patient's preoperative workup included an ultrasound scan, thyroid scan, computed tomography [CT] scan and thyroid profile. His T4 was 3 pmol/ 1 and TSH was 200 uUI/ml. All investigations revealed a multinodular goiter in the left lobe with an absent right lobe. A fine-needle aspiration biopsy was suspicious for malignancy. The patient underwent left thyroid lobectomy. The operative findings confirmed hemiagenesis of the right lobe and histopathology showed benign multinodular goiter in the left lobe. The parathyroids on the left side were in the normal position. This case report presents a rare case of hypothyroidism and absent right thyroid lobe. It may help increase awareness of this rare anomaly of the thyroid gland and thus make preoperative diagnosis possible

Assessment of cardiac involvement of hepatitis C virus; tissue Doppler imaging and NTproBNP study

Hepatitis C disease burden is substantially increasing in Egyptian community, it is estimated that prevalence of Hepatitis C virus [HCV] in Egyptian community reach 22% of total population. Recently there is a global alert of HCV cardiovascular complications. To evaluate LV diastolic functions of HCV patients using tissue Doppler Imaging and NTPBNP. 30 HCV patients of 30 years, sex and BMI matched controls were evaluated by PCR, ECG, Echocardiography "conventional Doppler, pulsed wave tissue Doppler [PW-TD], strain rate imaging" and NTPBNP to assess LV diastolic functions. Mean age was 32.8 years +/- 5.1 in HCV group, 29.8 years +/- 6.6 in control group. Cardiovascular anomalies and predisposing factors were excluded. HCV group has shown significant increase in QTc interval, significant statistical increase in A wave, deceleration time; [p < 0.05], highly significant decrease in tissue Doppler E[a] [p < 0.001], highly significant decrease in A[a] [p < 0.001], highly significant increased E/E[a] ratio [p value < 0.001], significant decrease in E[a]/A[a] ratio and significant increase in SR[a] [p < 0.05]. NTPBNP levels showed highly significant increase with mean value 222 pg/ml +/- 283 in HCV group and 32.7 pg/ml +/- 21.2 in control group [p value < 0.001]. The best cut-off value of NTPBNP to detect diastolic dysfunction in HCV group was 213 pg/ml. No statistical differences in SRe/SRa and E/SRe ratios were observed, however they had significant correlation with NTPBNP level and tissue Doppler parameters. The best cut-off value of E/SRe ratio to detect diastolic dysfunction in HCV group was 0.91, with 75% sensitivity and 100% specificity. This data show the first direct evidence that HCV infection causes diastolic dysfunction without any other predisposing factors, probably due to chronic inflammatory reaction with mild fibrosis in the heart. Previous studies did not follow strict inclusion and exclusion criteria that confirm the independent role of HCV to cause diastolic dysfunction. Tissue Doppler was more sensitive to diagnose diastolic dysfunction than conventional Doppler

Career counseling activities and choice of specialties among medical interns

To identify the specialties chosen by medical interns and factors influencing their choices during academic year of 2009. King Abdulaziz University Hospital. Questionnaire study. A questionnaire adopted from the American Graduate Council was distributed to 250 medical interns. Data were analyzed using SPSS software version 16 [2005]. One hundred and fifty-one questionnaires were completed with a response rate of 60%. Hundred and thirteen [75%] of students are planning to become certified in one of the different subspecialties, see figure 1. Seventeen [11.3%] favored internal medicine followed by anesthesia, 11 [7.3%]. Pathology, cardiac surgery, dermatology, general surgery and occupational medicine ranked third, 10 [6.7%], see figure 2. Plastic and orthopedic surgeries were not among their interest.Eighteen [12%] had been engaged in in-house electives, 14 [9.3%] had accessed the websites; the two had been found the most useful tools in helping students in their specialty choices. Career planning programs, careers availability on medicine websites, group presentations, career planning workshops and courses were not considered by students while choosing their career mainly due to unavailability, see table 1. Personal interest was the most important factor which had strongly influenced students' specialty choices, 109 [73%], see table 2. Family expectations and the length of residency training programs had minor influence. The lack of physicians in some specialties where should be addressed. Establishing a career advising committee at KAU is advised. This committee should focus on medical students during their final clinical years and during internship rotations putting in perspective the national health problems in the Kingdom of Saudi Arabia

Jaundice with hepatic dysfunction in P.faldparum malaria

To evaluate the frequency and severity of jaundice with hepatic dysfunction in Plasmodium [P.] falciparum malaria in adult patients admitted in the hospital. Descriptive study. The Infectious Diseases Unit and Medical Wards at Rashid Hospital, Dubai, United Arab Emirates, from January 2005 to December 2007. This study included 105 adult patients who fulfilled the inclusion criteria. The diagnosis of P.falciparum malaria was confirmed by examination of thin and thick film stained with Leishman's stain. Other laboratory investigations included full blood count, liver function tests, blood urea, electrolytes, serum creatinine, reticulocyte count, blood sugar, viral hepatitis serology and coagulation profile. Patient with significant clinical/biochemical hepatic dysfunction were also subjected to ultrasonic examination of abdomen. On clinical examination, 23% patients were found to be jaundiced. Serum alanine amino transferase [ALT] level was above the reference range in 67.6%, but in only 11.4%, ALT was more than 3 times of normal level. Serum bilirubin was found to be higher than normal level in 81%, however, only in 23% of the patients, Serum bilirubin was >3mg/dl. Predominantly conjugated hyperbilirubinemia was observed in patients with high ALT. There was no significant change in serum albumin and prothrombin time. In comparison to normal bilirubin level, the patient with bilirubin >3mg/dl had high frequency of raised ALT 87.5% vs. 45% [p <.0001], thrombocytopenia 91.6% vs. 65% [p <.01], anemia 70.8% vs. 25% [p <.05] and renal impairment 50% vs. 20% [p >.05]. Overall, 5 [4.7%] patients died and mortality rate was high among the patients with bilirubin level >3mg/dl than with normal bilirubin level 4 [16.6%] vs 1 [5%]. Hepatic dysfunction in acute P.falciparum malaria ranged from mild elevation of liver enzymes to acute hepatitis [ALT >/= 10 times of normal level]. It indicates severe illness with high frequency of complication and mortality rates

Study of gastroesophageal reflux in cirrhotic patients with esophageal varices without endoscopic treatment

The aim of this work is to study prevalence of abnormal gastroesophageal reflux [GER] by pH recording in cirrhotic patients with esophageal varices without previous endoscopic treatment and its possible predicting factors. Sixty five patients [38 men, 27 women] with liver cirrhosis, were selected from those admitted at the Internal Medicine Department of Benha University Hospitals. Their ages ranged from 38 to 59 years [with a mean age of 54.4 +/- 10.5 years]. Diagnosis of liver cirrhosis was based on clinical, laboratory, abdominal ultrasonographic image and histological findings. All patients had esophageal varices confirmed by endoscopy and were submitted to a questionnaire about typical gastroesophageal reflux disease symptoms [heartburn and or acid regurgitation]. pH recording was performed with the probe placed 5 cm above the superior lower esophageal sphincter limit, as determined by manometry. Abnormal pH reflux [pHR] is defined as percentage total time with pH < 4 greater than 4.5%.The pH recording demonstrated abnormal pHR in 25 patients [38.5%]: 6 [24%] just in upright position, 9 [36%] in supine position and 10 [40%] in both positions. Regarding the caliber of the esophageal varices [EV], 15 patients out of 34 [44.1%] with small size varices, 6 patients out of 19 [31.6%] with medium size varices and 4 patients out of 12 [33.3%] with large size varices, had abnormal pHR. There was no statistically significant difference in the prevalence of abnormal reflux between patients with small variceal size and those with medium and large variceal sizes [P> 0.05 respectively]. As for patients with congestive gastropathy, 10 of them out of 29[34.5%] had abnormal pHR; 15 patients without congestive gastropathy out of 36[41.7%] had abnormal pHR. There was no statistical significant difference between patients with congestive gastropathy and abnormal reflux and those without [P >0.05]. Regarding the severity of the disease as assessed by Child Pugh classification, 13 patients out of 37[35.1%] with Child's A, 5 patients out of 12[41.7%] with Child's B and 7 patients out of 16[43.8%] with Child's C had abnormal pHR. There was no statistical significant difference between patients with Child's A and those with Child's B and Child's C [P>0.05 respectively] as regards presence of abnormal reflux. As for ascites, 12 of them out of 28[42.9%] patients presented with an abnormal pHR and 13 patients out of 37 [35.1%] without ascites had abnormal pHR. Abnormal reflux was not statistically significantly different between patients with ascites and those without ascites [P>0.05]. Also, no statistical significant difference was found between patients with severe ascites and those with mild and moderate degrees of ascites [P>0.05 Respectively]. Thirty five patients [53.8%] had typical reflux symptoms, 19 of them [54.3%] presented with abnormal pHR and 6 out of 30 [20%] patients without typical reflux symptoms, had abnormal pHR. There was a statistically significant difference between patients with typical reflux symptoms and abnormal reflux and those without typical reflux symptoms [P< 0.05]. Regarding the lower esophageal sphincter [LES] pressure, there was no statistical significant difference in the mean levels of the LES pressure between neither the various degres of severity of the disease[as assessed by Child's A, B and C], the degree of ascites, the grades of EV nor the presence of normal and abnormal reflux [P>0.05 Respectively]. The prevalence of abnormal gastroesophageal reflux was high [38.5%] in patients with hepatic cirrhosis and esophageal varices. Only typical gastroesophageal reflux disease symptoms predicted these findings

Engaging universities and ministry of health in evaluation of reformed community medicine training program

Reform of the community medicine training program [CMTP] for the undergraduate medical students is crucial for successful medical education and community development. To evaluate the practical component of the reformed CMTP by: 1] reviewing the students' performance, 2] exploring the perspectives of the public health department [PHD] staff at Cairo and Ain-Shams Universities towards the program 3] exploring the views of the managers of the Ministry of Health [MOH] Primary Health Care [PHC] centers where medical students receive their PHC training towards the program. Quantitative data were obtained by focus groups discussions with PHD staff and MOH PHC managers. It was found that the total students' mean score was 94.2%. About 91% of students scored >85% of the total marks. PHD staff from both universities expressed appreciation to the introduction of generic skills in the CMTP. They referred the success in management of CMTP to small-group teaching. The community-oriented and service-learning approaches also added more points to the CMTP. The MOH PHC managers acknowledged the CMTP which would contribute to preparing future physicians to have vital role in the dynamic health system

Study of gastroesophageal reflux in cirrhotic patients with esophageal varices and without endoscopic treatment

The aim of this work is to study prevalence of abnormal gastroesophageal reflux [GER] by pH recording in cirrhotic patients with esophageal varices and without previous endoscopic treatment and its possible predicting factors. Sixty five patients [38 men, 27 women] with liver cirrhosis, were selected from those admitted at the Internal Medicine Department of Benha University Hospitals. Their ages ranged from 38 to 59 years [with a mean age of 54.4 +/- 10.5 years]. Diagnosis of liver cirrhosis was based on clinical laboratory, abdominal ultrasonographic image and histological findings. All patients had esophageal varices confirmed by endoscopy and were submitted to a questionnaire about typical gastroesophageal reflux disease symptoms [heartburn and or acid regurgitation]. pH recording was performed with the probe placed 5 cm above the superior lower esophageal sphincter limit as determined by manometry. Abnormal pH reflux [pHR] was defined as percentage total time with pH < 4 was greater than 4.5%. The pH recording demonstrated abnormal pHR in 25 patients [38.5%]: 6 [24%] just in upright position, 9 [36%] in supine position and 10 [40%] in both positions. Regarding the caliber of the esophageal varices [EV], 15 patients [44.1%] out of 34 with small size varices, 6 patients [31.6%] out of 19 patients with medium size varices and 4 patients [33.3%] out of 12 patients with large size varices, had abnormal pHR. There was no statistical significant difference between patients with small variceal size and abnormal reflux and those with medium and large variceal sizes [P> 0.05 respectively]. As for patients with congestive gastropathyt 10 of them [34.5%] out of 29 had abnormal pHR and 15 patients [41.7%] without congestive gastropathy out of 36 had abnormal pHR. There was no statistical significant difference between patients with congestive gastropathy and abnormal reflux and those without [P >0.05]. Regarding the severity of the disease as assessed by Child Pug classification, 13 patients [35.1%] out of 37 patients with Child's A, 5 patients [41.7%] out of 12 with Child's B and 7 patients [43.8%] out of 16 with Child's C had abnormal pHR. There was no statistical significant difference between patients with Child's A and abnormal reflux and those with Child's B and Child's C [P>0.05 respectively]. As for ascites, 12 of them [42.9%] out of 28 patients presented with an abnormal pHR and 13 patients [35.1%] oat of 37 patients without ascites had abnormal pHR. There was no statistical significant difference between patients with ascites and abnormal reflux and those without ascites [P>0.05]. Also, no statistical significant difference was found between patients with severe ascites and abnormal reflux and those with mild and moderate degree of ascites [P>0.05 respectively].Thirty five patients [53.8%] had typical reflux symptoms, 19 of them [54.3%] presented with abnormal pHR and 6 [20%] out of 30 patients without typical reflux symptoms, had abnormal pHR. There was a statistical significant difference between patients with typical reflux symptoms and abnormal reflux and those without typical reflux symptoms [P< 0.05]. Regarding the lower esophageal sphincter [LES] pressure, there was no statistical significant difference in the mean levels of the LES pressure between neither the severity of the disease [as assessed by Child's A, B and C], degree of ascites, grades of EV nor the normal and abnormal reflux disease [P>0.05 respectively]. The prevalence of abnormal gastroesophageal reflux was high [38.5%] in patients with hepatic cirrhosis and esophageal varices. Only typical gastroesophageal reflux disease symptoms predicted these findings. Long-term ambulatory follow-up of this group of patients is important since, if the "erosive" theory holds true, patients with abnormal reflux could present a higher incidence of variceal bleeding. This, however, needs to be demonstrated

Malaria and hematological changes

The hematological changes associated with acute malaria are well recognized. This study was conducted to assess and compare the incidence and severity of hematological changes in various types of malaria in adult population. This observational study included 133 acute malaria patients admitted in the Infectious Diseases Unit of Rashid Hospital Dubai [JCI accredited] UAE, during January 2005 to December 2007. The diagnosis of malaria was confirmed by thick and thin film stained with Leishman,s staining for malarial parasite. Slides were reviewed by hematologist and FBC were performed using an automated Beckman Coulter machine. Overall 83% of the patient had thrombocytopenia, 64% anemia, 24% lymphopenia and 10% monocytosis. The incidence of thrombocytopenia was slightly more in P. Falciparum [87%] than P. Vivax [81%] cases, p value > 0.05, where as there was no significant difference in the incidence of anemia in two groups [67% vs 63%]-p value > 0.05. However, lymphopenia was observed in 36% in P. Vivax as compared to 15% in P.Falciparum cases, p value < 0.04. Eosinophil and basophil count was normal in both groups. P.Falciparum as well as P.Vivax can cause significant hematological changes with high frequency of thromboctopenia, anemia lymphopenia and monocytosis

Serum S100B and neuron-specific enolase as predictors of the neurologic disability status after traumatic brain injury

This study was designed to evaluate the correlation between serum levels of protein S100B and neuron-specific enolase [NSE] and the severity and outcome of traumatic brain injury [TBI] so as to be used as prognostic markers for cases admitted to Intensive care unit [ICU] after TBI. The study comprised 40 patients with head injury of varied severity and 10 volunteers [control group]. Inclusion criteria were head injury and presentation to the emergency department within 6 hours of injury. Initial injury severity was assessed using the Glasgow coma score [GCS] and all patients had cranial CT scans and lesions were evaluated with respect to lesion topography and territories of vascular supply. A venous blood sample was collected at admission for estimation of serum protein S100B and NSE levels. All patients received measures to decrease intracranial pressure [ICP] and phyntoin for posttraumatic seizures and underwent the appropriate neurosurgical procedure according to type of post-traumatic lesion. Follow-up was conducted monthly and the final outcome at six months was assessed using the Expanded Disability Status Scale [EDSS]. The mean initial GCS score was 11.1 +/- 3; 14 patients [35%] had mild, 17'patients [42.5%] had moderate and 9 patients [22.5%] had severe trauma. Normal CT was reported in 14 patients [35%]; however, CT scanning detected extradural hemorrhage in 5 patients [12.5%] fissure skull fracture in 5 patients [12.5%], fissure basal skull fracture in 3 patients [7.5%] and depressed skull fracture in 2 patients [5%]; while 3 patients [7.5%] had intracerebral hemorrhage and the other 8 patients had subdural hemorrhage, subdural hemorrhage with contusion, subdural hematoma and subarachnoid hemorrhage. Throughout follow-up, 18 patients [45%] had favorable outcome [EDSS<5]; while 22 patients had unfavorable outcome with EDSS >/= 5. Serum levels of S100B and NSE were significantly [P[1]<0.05] increased in patients compared to control levels, moreover, mean serum level of S100B was significantly [P[2]<0.05] and of NSE was non-significantly [P[2]>0.05] higher in patients with unfavorable outcome [EDSS >/=] compared to those with favorable outcome [EDSS<5] with a positive significant correlation between serum levels of S100B and NSE, [r = 0.485, p = 0.002]. Moreover, serum levels of both parameters showed a negative significant correlation with the initial GCS while showed a positive significant correlation with EDSS. However, there was a negative correlation between both parameters and the final outcome as favorable or unfavorable; such correlation was significant with S100B and non-significant with NSE. Using Logestic regression analysis serum S100B was the most significant predictor of the final outcome, [beta =-0.371, p = 0.018]. Receiver operator characteristics [ROC] curve analysis for serum levels of both S100B and NSE for prediction of favorable outcome found serum levels of S100B more specific with an area under curve [AUC] =0.379 than serum levels of NSE that found to be more sensitive with an AUC = 0.294. It could be concluded that estimation of serum S100B and NSE immediately after traumatic brain injury could define patients who will develop unfavorable outcome and posttraumatic disability with high sensitivity with NSE and specificity with S100 and must be used for the initial evaluation of TBI irrespective of the extent of severity of inflicted trauma

Correltion between magnetic resonance imaging and arthroscopic findings in patients with anterior cruciate injuries

The stabilizing anterior cruciate ligament prevents anterior translation and abnormal internal rotation of the tibia during standing and walking. Its disruption lead to loss of stability and potential significant dysfunction. This work was performed to evaluate the role of MRI in diagnosis of ACL injuries. This study was carried out on 50 patients with anterior cruciate ligaments injuries. They were classified into acute and chronic tears according to the time interval between injury and time of examination. All were examined by Magnetic Resonance Imaging [MRI] and by knee arthroscopy. A variety of MR signs were encountered and were classified into primary and secondary signs. Correlation of MR findings with arthroscopic findings was done revealing sensitivity, specificity, and accuracy of MR to be 88.8%, 50%, 81.8%. Accordingly, MRI is a non invasive reliable and versatile method of ACL tears assessment with a good sensitivity

Video-assisted thoracoscopic versus transsternal thymectomy for myasthenia gravis: our early experience

Thymectomy is an accepted surgical modality of therapy for patients with myasthenia gravis. This study aimed at examining the thoracoscopic and transsternal approaches and to compare their surgical outcomes. A prospective cohort study of twenty patients with myasthenia gravis who underwent thymectomy between November 2003 and October 2004. Ten patients [50%] had thoracoscopic surgery while the other ten patients underwent resection by the transsternal route. The patients were followed up for twelve months. Statistical significance was determined by the Student t test or the Fisher's Exact Test. The thoracoscopic group had a mean operating time of 65.5 minutes compared to 76.3 minutes in the transsternal group [P=0.004]. The mean postoperative tube drainage was 54.5 mIs in the thoracoscopic group while it was 118.3 mls in the transsternal group [P=0.0001]. Surgical site infection was the most common complication in the transsternal group occurring in 30% of patients compared to 0% in the thoracoscopic group [P=0.05]. While four patients in the thoracoscopic group [40%] were in remission at 12 months, there were three [30%] in the transsternal group though this was not significant [P=0.23]. Thymectomy through the thoracoscopic approach is a safe and prefecred option for non-thymomatous myasthenia gravis as well as for very small encapsulated thymomas due to the shorter operating time, low complication rates and shorter hospital stay. However, both thoracoscopic and the transsternal routes achieved similar response rates in the short-term

Efficacy of single intramuscular dose of methotrexate in haemodynamically stable patients with unruptured ectopic pregnancy

The objective of this study was to evaluate the influence of pretreatment serum human chorionic gonadotropin [hCG] concentrations and the adnexal mass size on the success rate after intramuscular [IM] single-dose methotrexate [MTX] treatment on patients with unruptured ectopic pregnancy [EP]. A retrospective chart review was conducted for 51 haemodynamically stable patients with an unruptured EP, who were treated with an IM single-dose of MTX at King Fahad National Guard Hospital. The patients were divided into two groups according to pretreatment serum hCG concentrations. Group I patients with serum hCG < 5,000 IU/L [n = 41], and group II patients with serum hCG > 5,000 IU/L [n = 10]. The 51 patients were divided again into two groups according to adnexal mass size - Group III mass size 3.5 cm [n = 10]. Overall 48/51 patients [94.1%] were successfully treated with MTX and 3/51 patients [5.9%] failed treatment and were subjected to surgical interventions. Thirty-eight patients [74.5%] received a single dose of MTX, and 10/51 patients [19.6%] received a second dose of MTX. There were no significant differences in total successful treatment rates between groups I-IV; 92.7%, 100%, 92.7% and 100% respectively. No significant correlation was found between pretreatment serum hCG concentrations and adnexal mass size [P = 0.2]. The median pretreatment serum hCG concentration was 1345 IU/L [range 79.3 to 44282.0 IU/L] and mean time to complete resolution of serum hCG was 2.3 +/- 0.7 weeks Single-dose MTX treatment is effective and safe in patients with higher serum hCG > 5,000 IU/L and larger adnexal mass size -> 3.5 cm without foetal cardiac activity. However, patients with serum hCG > 5,000 IU/L were more likely to receive repeated doses of MTX

Guided wire localization of non-palpable breast lesions

The wide use of screening mammography had resulted in the discovery of an increasing number of suspicious non-palpable breast lesions for which surgical excision after guided wire localization is the diagnostic gold standard. This study had included 32 patients with non-palpable breast lesions, wire localization was done guided by U.S in 22 patients and by mammography in the remaining ten. This was followed by operative excision of the lesion around the guide wire tip. Specimen radiography was done for 25 of excised specimens. Complete excision was achieved in 22 patients [88%]. Histopathological examination yielded the final pathological diagnosis, malignant lesions were found in 7 occasions [21.87%]. U.S proved to be a simple technique allowing guidance in different sites of the breast through the shortest possible route thus obviating excessive breast dissection