Effect of combining epidural with general anesthesia on recovery after spine surgery: randomized controlled study

Background: Fast track techniques have been applied to reduce surgical stress response and to provide effective perioperative analgesia, thereby improving patient''''''''s recovery and reducing postoperative morbidity. The present study was undertaken to assess the effect of using combined general/epidural anesthesia (CGEA) on early recovery after lumbar spine surgeries. Subjects and Methods: The current prospective randomized clinical study had included a total of 40 patients who underwent elective one or two level laminectomy/discectomy. Patients were randomized and divided into two groups; general anesthesia (GA) group (group I) and combined general/epidural anesthesia group (CGEA) (group II). Patient characteristics, anesthesia time, surgical time, heart rate, mean arterial pressure (MAP), anesthetic / analgesic requirements, the occurrence of intraoperative bradycardia and/or hypotension, time to extubation, time to post anesthesia care unit (PACU) discharge and duration of PACU stay were recorded and considered for analysis. Results: It was observed that CGEA was significantly associated with reduction of intraoperative anesthetics / analgesic requirements, shorter time to extubation, time for PACU discharge and duration of PACU stay but on the expense of higher incidence of intraoperative hypotension. Conclusion: This study proved that CGEA seems to be an effective fast track anesthetic protocol in patients undergoing elective lumbar spine surgeries

Spondylodiscitis desease evaluation in patients with seronegativespondyloarthropathies

Spondylodiscitis [SD] is a destructive discovertebral lesion which is uncommon, but well recognised as a complication of Ankylosing Spondylitis [AS], and also called the Andersson lesion. This prospective study described 24 cases of AS, 12 of them with SD with variable clinical presentation and radiological appearance [SD]. Two had multiple lesions, in one patient spondylodiscitis was the presenting symptom of AS. None had a history of even a minor trauma and radiological appearance of Andersson lesion in AS. In a prospective analysis of 24 patients with ankylosing spondylitis [AS] with multiple nationalities, 12 individuals [50%] had spondylodiscitis, affecting the spine at various levels, we described the demoaphic data, full medical history, clinical examination and radiological findings including thoracolumbar spinal magnetic resonance imaging [MRI] in all patients diagnosed as SD with AS admitted to our department. All patients were fulfilling the modified New York criteria and ASAS criteria for AS. The results showed that the mean age of patients was 43 +/- 10.8 yrs, 16 [66.667%] were males. Half of the 12 patients had multiple lesions [between two and six levels]. Mean disease duration were 11+/-8.7. The most common Site of lesion was the thoracic spine. The prognosis was good with conservative treatment including NSAID's, rest, and physiotherapy. The literature was reviewed regarding the mechanisms that may contribute to these lesions: mainly inflammatory like increasing enthesopathy or mainly mechanical like pseudoarthrosis about a fracture site. It might be that both mechanisms could result in similar destructive intervertebral disc lesions

B-natriuretic peptide, C- reactive protein and microalbuminuria in association with diastolic dysfunction, ankle brachial index and carotid duplex in type 2 diabetic female patients

Background: Cardiovascular diseases [CVD] is the leading cause of death in patients with type 2 diabetes accounting for 50-70% of all deaths [Berryet al., 2007] and it is believed that in 2020 CVD over-run infectious diseases and cancer to become the leading cause of death and disability, so the evidence is accumulating in favor of a wider use of several novel biomarkers in CVD [Dotsenko et al., 2007]

Aim of the work: 1- Evaluation of plasma BNP, hs-CRP and microalbuminuria as a risk biomarkers in detection of left ventricular diastolic dysfunction [LVDD], low ABI and increase in carotid intima- media thickness [CIMT] in asymptomatic type 2 diabetic female patients. 2- Detection of LVDD, peripheral arterial disease and carotid lesion in asymptomatic type 2 diabetic female patients in comparison to controls and their relation to cardiovascular risk biomarkers

Patients and methods: The study included 50 type 2 diabetic female patients [patient group] with duration of diabetes from 5-7 years and another age matched 40 female subjects were chosen as [control group]. Patients and controls were subjected to the following: history taking, body mass index [BMI], waist circumference, electrocardiography, echocardiography, ankle brachial index [ABI] and carotid duplex and laboratory investigations including; blood glucose, lipogram, serum creatinine, hemoglobin A1c [HbA1c,], BNP, hs -CRP and microalbuminuria

Results: -BNP, CRP and ,microalhuminuria significantly increased [P=0. 000] in diabetic patients versus controls. -There was significant LVDD, low ABJ and significant increase in CIMT in diabetic patients versus controls - Significant increase in BNP, CRP and microalbuminuria in patients having LVDD, low and in patients having increase in CIMT There was a significant positive correlation between diastolic dysfunction and CIMT with BNP, also there was significant negative correlation between ABI and BNP as a cardiovascular predictor at [p<0.05] with [r-square] [0. 778, 0.350 and 0.282] respectively

Conclusions: BNP, CRP and microalbuminuria are significant cardiovascular biomarkers in type 2 diabetic finale patients. BNP is a significant cardiovascular predictor for LVDD, low ABI and increase in CIMT

Value of MRI and inflammatory markers in assessment of erosive osteoarthritis hand

To investigate the role of MRI and inflammatory markers [serum C reactive protein [CRP] as a marker of erosive osteoarthritis [EOA] of the hand. Thirty three patients, 22 with EOA and 11 with non-EOA of the hand, were included in the study and analysed for radiographic score [RS], number of erosions, and joint count [JC] at clinical observation and at MRI CRP was assayed in a serum sample by a highly sensitive immunonephelometric method. The median [interquartile range] CRP level was 5.2[2.7-7.2] mg/l in the EOA and 2.8 [0.7-5.2] mg/I in the non-EOA group [p = 0.001]. In all patients, CRP correlated with RS [p<0.001], and mainly with JC at clinical observation [p<0.001] and MRI [p<0.001]. The correlation of CRP with RS and JC was confirmed at clinical observation and at MRI in the EOA subgroup, but only with JC at clinical observation in the non-EOA subgroup. CRP levels are higher in EOA than in non-EoA patients. These levels probably reflect the disease activity of EOA, as suggested by correlations between CRP and JC at clinical observation and MRI. BMI, body mass index; CRP, C reactive protein; EOA, erosive osteoarthritis; ESR, erythrocyte sedimentation rate; hsCRP, high sensitivity CRP; MRI, Magnetic Resonance Imaging; IL, interleukin; JC, joint count; OA, osteoarthritis; RS, radiographic score

Independent associations of anti-cyclic citrullinated peptide antibodies and rheumatoid factor with radiographic severity of rheumatoid arthritis

Recent studies have established a strong association between anti-cyclic citrullinated peptide antibody [anti-CCP] positive rheumatoid arthritis [RA] and carriage of shared epitope [SE] alleles. Although anti-CCP have also been associated with more severe RA, the issue of whether this is independent of rheumatoid factor [RF] has not been addressed. To indentify associations between RF, anti-CCP, SE status and radiological damage, we studied a large cross-sectional cohort with longstanding RA. Individuals [n=100] enrolled in the study all fulfilled the American College of Rheumatology criteria for RA had a minimum disease duration of 4 years, and at least one definite radiographic erosion was present in hands or feet. Radiographs were scored blind at study entry by a single musculoskeletal radiologist using a modified Larsen's score, Anti-CCP and RF levels were determined using enzyme-linked immunosorbent assay, and DRBI typing was performed using polymerase chain reaction based methodology. Both anti-CCP and RF status, evidence of independent associated with radiographic severity [P<0.0001]. In subgroups stratified for both anti-CCP and RF status, evidence of independent associations of both antibodies with radiographic outcome was found [P<0.0001]. An association of SE alleles playing at most a secondary role. Our study support the view that previously described associations between SE and radiological severity, especially in RF-negative patients, may be indirect and due to an association with anti-CCP

Evaluation of tuberculosis versus pyogenic [infectious] arthritis by using MRI imaging

To assess magnetic resonance [MR] imaging features in differentiating tuberculous arthritis from pyogenic arthritis. Findings in 29 patients with tuberculous arthritis were compared with those of 13 patients with pyogenic arthritis. Bone erosion, marrow signal intensity, synovial lesion signal intensity, boundaries [smooth or irregular] for extraarticular extension of infection, and abscess rim enhancement [thin and smooth or thick and irregular] were analyzed. Revealed that bone erosion was more common in patients with tuberculous arthritis [24 [83%] of 29] than in those with pyogenic arthritis [six [46%] of 13] [P = 0.026], while subchondral marrow signal intensity abnormality was seen more frequently in patients with pyogenic arthritis [12 [92%] of 13] than in those with tuberculous arthritis [17 [59%] of 29] [P = 0.036]. On T2-weighted images, there was no significant difference between the synovial lesion signal intensities of tuberculous arthritis and pyogenic arthritis. Lesions in 16 [70%] of 23 patients with tuberculous arthritis and two [17%] of 12 patients with pyogenic arthritis had smooth extraarticular boundaries, while those in seven [30%] of 23 patients with tuberculous arthritis and 10 [83%] of 12 patients with pyogenic arthritis had irregular boundaries [P = .005]. Tuberculous abscesses [16 [100%] of 16] had thin and smooth rim enhancement, while most pyogenic abscesses [five [7 1%] of seven] had thick and irregular rims[P .001].MR imaging of bone abnormalities Tnalities, extraarticular lesions, and associated abscesses provides useful information in the differentiation of tuberculous arthritis and pyogenic arthritis

protective role of anti-oxidant beta-carotene on schistosoma mansoni infected murine mice

Schistosomiasis is the second most prevalent tropical disease in the world after malaria and is caused by the Schistosoma, genus of fluke. The pathophysiology of schistosomiasis is due to the immune response against the schistosome eggs. The clinical manifestations depend on the species of parasite, intensity of worm burden, and immunity of the person to the parasite. Many trials were done for production of vaccine against infection of shistosomiasis and many efforts were spent to prevent infection, but the rate of new cases is still high. On the other hand, we need a methed to prevent or at least decrease the inflammatory reaction caused by schistosomiasis. This study aimed to the evaluation of possible protective effect of anti-oxidant beta-carotene on S.mansoni infected mice or decrease the inflammatory reaction caused by schistosomiasis. Sixty mice were included in this study and they were divided into 4 groups, every group is 15 mice: Group [1]: [treated infected group]; Group [2]: [treated noninfected group]; Group [3]: [infected group] and Group [4]: [normal control]. The results: b-carotene reduced worm burden to about 20%. Beta-carotene significantly reduced hepatic and intestinal tissue egg load with a reduction percentage of 26% and 18% respectively. Beta-carotene normalized the serum enzyme AST that were elevated by schistosomal infection. Beta-carotene did not significantly change serum proteins both in infected and non infected animals. Beta-carotene exerted immunomodulatory effects on inflammatory reaction of hepatic schistosoma reflected as significant reduction in mean cellular infiltration diameter, more circumscription and less inflammatory cellular content, as well as more inflammatory reaction changes in schistosomal ova. We recommended further studies to judge the protective efficacy of beta-carotene through histological study of animal skin and to judge its therapeutic efficacy if administered adjuvant with antibilharzial therapy

Some psychiatric aspects of children with diabetes in first two years after diagnosis

This study was implemented to determine the Psychological Aspects of children with Diabetes within the first two year. After diagnosis, it was a case control study carried out in endocrinology pediateric out patient clinic Zagazig University Hospitals. A sample of 100 patients of type I diabetes with a mean age y 10-6 +/- 2.0 years and their healthy peers children their mean age of 12-7 +/- 1-9 years, the range of both group 6-14 years of age at diagnosis. .Their parents had completed similar years of education family social status scor Based on education's levels and occupation of both parents. Family income was also similar between group.Nearly all of the children [93.72] with diabetes were taking two injections of insulin per day, approximatly divided between regular and NPH insulin glycosylated haemoglobin values were similar across the treatment sites over all time. Comparison of psychological status using repeated measures analysing of variance between children with diabetes and healthy control are done. We found that the children with diabetes scored higher on the CDI [children's depression inventory] than the children without diabetes was statistically highly significant [P = 0.00076] children with diabetes scored higher STAT [Stait - Trait - Anxiety - Inventory] than children without diabetes was statistically significant [P=0.003811]. So we concluded that children with diabetes are depressed and anxious than children without diabetes social status we found some children suffer from parentral loss, other from divorce of mother and some children complain from family disharmony