Potential impact of fluorescein angiography as a primary imaging modality in the management of diabetic retinopathy

Purpose: To evaluate current practice patterns for Egyptian ophthalmologists in the diagnosis of diabetic retinopathy (DR) and explore potential implications of these approaches on management. Methods: Cross?sectional survey conducted in Egypt amongst practicing ophthalmologists. Results: The study had 203 responses (~6% of all Egyptian ophthalmologists). A majority of respondents were general ophthalmologists (78.2%), practicing for five to ten years (41.9%). In patients with DR and no diabetic macular edema (DME), 33.0% of respondents would use FA in patients with mild DR, 44.3% in patients with moderate DR and 51.2% in patients with severe non?proliferative diabetic retinopathy (NPDR). Color imaging (CI) was used by less than 1% as the sole imaging modality for any level of DR. Approximately 70% of respondents used fluorescein angiography (FA) to grade and base treatment decisions for DR, either alone or in conjunction with dilated eye exams and/or CI. Given the known more severe appearance of DR on FA than on standard color imaging upon which treatment guidelines are based, use of FA as the primary modality over a one?year period could result in PRP that would otherwise not be suggested in approximately 78,820 eyes at an additional cost of $10.1 million US dollars. These numbers are projected to double by 2045. Conclusion: Given that FA detects significantly greater pathology than CI, and that treatment and follow?up recommendations are based on CI, its use as the primary imaging modality in DR grading may result in apparently significantly higher DR severity, with subsequently increased procedures and associated costs

Antibiofilm activity of carvacrol loaded chitosan nanoparticles against Listeria monocytogenes

Aims@#This study was designed to evaluate the effectiveness of the synthesised carvacrol loaded chitosan nanoparticles (CLCNPs) on the growing and pre-formed biofilms of Listeria monocytogenes isolated from slaughterhouses.@*Methodology and results@#The swab samples were collected from knives, hocks and cutting tables representing slaughterhouses meat contact surfaces (MCS), while those samples from walls and floors represent slaughterhouses meat non-contact surfaces (MNCS). The bacteriological analysis revealed the existence of L. monocytogenes with a prevalence rate of 3.3, 10 and 6.7% for knives, hocks and cutting tables, respectively and 2.2 and 6.6% for walls and floors, respectively. The isolates L. monocytogenes were assayed for biofilm production by the crystal violet binding assay method. Among the 10 L. monocytogenes isolates, 10%, 50% and 30% of the isolates were found to be strong, moderate and weak biofilm producers, respectively. The activities of carvacrol, chitosan nanoparticles (NPs) and CLCNPs against the only strong biofilm producer strain of L. monocytogenes were tested by microtiter plate assay. The minimum inhibitory concentrations (MIC) values were 3.75 mg/mL for CAR, 5 mg/mL for chitosan NPs and 0.62 mg/mL for CLCNPs. CLCNPs inhibit the produced biofilm by 35.79, 73.37 and 77.76%, when 0.5 MIC, 1 MIC and 2 MIC were used, respectively. Furthermore, the pre-formed L. monocytogenes biofilms were significantly reduced from 1.01 (control) OD570 to 0.40 and 0.29 OD570 by applying 2 MIC and 4 MIC doses, respectively.@*Conclusion, significance and impact of study@#The data generated is promising to develop bio-green disinfectants to inhibit biofilm formation by L. monocytogenes in the food processing environment and control its adverse effects for consumers.

Does oregano protect against testicular toxicity produced by ethylene glycol in adult male albino rat? / ¿El orégano protege contra la toxicidad testicular producida por etilenglicol en ratas macho albinas adultas?

SUMMARY: Origanum vulgare Linn has traditionally been used as a diuretic and antispasmodic. Therefore, we investigated the active extract of Origanum vulgare for possible andrological effect and preventive effects against testicular damage using ethylene glycol rat model of testicular damage, to rationalize its medicinal use. Male Wistar rats received lithogenic treatment comprising of 0.75 % ethylene glycol injection twice with one day interval, then in drinking water, active extract of Origanum vulgare treatment (20 mg/kg) was given for 3 weeks to prevent toxic damage including loss of body weight gain and appetite, Following oral administration of EGME, a rapid decrease in testis weight associated with testicular cell damage was observed. Origanum vulgare treatment (20 mg/kg) prevented as well as reversed toxic changes including loss of body weight gain.

RESUMEN: Origanum vulgare Linn se ha usado tradicionalmente como diurético y antiespasmódico. Por lo tanto, investigamos el extracto activo de Origanum vulgare por su posible efecto andrológico y efectos preventivos contra el daño testicular utilizando el modelo de rata de etilenglicol de daño testicular. El objetivo del estudio fue racionalizar su uso medicinal. Su utilizaron ratas Wistar macho que recibieron un tratamiento litogénico de una inyección de etilenglicol al 0,75 %, dos veces con un intervalo de un día, y luego se administró en agua potable. Se administró el extracto activo del tratamiento con Origanum vulgare (20 mg / kg) durante 3 semanas con el objetivo de prevenir el daño tóxico, la pérdida de peso corporal y el apetito. Tras la administración oral de EGME, se observó una rápida disminución del peso de los testículos asociada al daño de las células testiculares. El tratamiento con Origanum vulgare (20 mg / kg) logró prevenir y revertir las alteraciones tóxicas, incluyendo la pérdida de peso corporal.

Correlation between haemoglobin A1c and umbilical artery Doppler as predictors for perinatal outcome in pregestational diabetic pregnancy and pregestational diabetic pregnancy complicated by preeclampsia in third trimester

Background: Diabetes mellitus is one of the most common metabolic disorders that occur during pregnancy. It has two clinical patterns; either pregestational diabetes mellitus or gestational diabetes mellitus. Pregestational diabetes mellitus is associated with worse maternal and fetal outcomes compared to gestational diabetes mellitus

Objectives: To assess usefulness of using both heamoglobin A1C and umbilical artery Doppler velocity waveform analysis in predicting adverse perinatal outcomes for both pregestational diabetic pregnancies and pregestational diabetic pregnancies complicated by preeclampsia

Methods: This comparative study was conducted on 150 pregnant women with gestational age 34 - 40 weeks who were equally divided into 3 groups; 50 pregnant women with pregesational diabetes melleitus alone and 50 pregestional diabetes melleitus complicated with preeclampsia. These two groups were compared with 50 healthy pregnant women, free from medical disease, as control group

Results: In pregnant women with pregestational DM, HbA1c should be kept below 7% and it is better to be less than 6.5% by proper glycemic control, as higher levels of HbA1c were associated with bad perinatal outcomes in the forms of RDS, neonatal hypoglycemia, macrosomia, IUGR, Apgar score 1 and 5min and NICU24. In addition to, bad maternal outcomes in the forms of polyhyramnios, preterm labor, PROM, prolonged labor, mode of delivery, postpartum hemorrage, puerperal sepsis, pulmonary embolism, preeclampsia and its complications as eclampsia, HELLP syndrome, renal affection, hepatic affection and retinal affection. There was no significant relation between long term maternal glycemic control [HbA1c] and the changes of blood flow velocity in the umbilical artery in pregnancy complicated with diabetes mellitus unless the pregnancy is complicated with fetal growth restriction or preeclampsia

Conclusion: An increased pulsatility index of umbilical Doppler was found in our study to be the important predictor of perinatal outcome in diabetic pregnancies complicated by preeclampsia but not in uncomplicated diabetic pregnancy

Impact of increased maternal body mass index on pregnancy outcomes

Background: in the last decade, the prevalence of obesity has significantly increased in populations worldwide and becomes epidemic. Obesity has been documented by World Health Organization [WHO] as "a pandemic nutritional disorder. Egypt had the highest average Body Mass Index [BMI] and obesity in the world

Aim of the Work: evaluation of the possible effects of increased body mass index on pregnancy and measure its maternal, fetal and neonatal outcomes

Patients and Methods: the present study was approved from alazhar research ethical committee. The present study was carried out in Obstetrics and gynecology out-patient, Nasr city police hospital and El-hussien university hospital. Three hundred [300] pregnant women were included in the study; they were divided into3 groups: Group I 150 pregnant women with normal weight [BMI = 18.5 - 24.9 kg/m2]. Group II: 75 pregnant women who are overweight [BMI = 25 - 29.9 kg/m2]. Group III: 75 pregnant women who are obese [BMI >/= 30 kg/m2]. Groups were subjected to full history taking, clinical examination, obstetric palpation, ultrasound, investigations, antenatal care, post natal care and neonatal assessment

Results: statistical significant relationship between increased BMI and incidence of gestational hypertension, diabetes, postpartum hemorrhage and macrosomia. No Statistical significant relationship was found between increased BMI and incidence of cesarean rate, wound infection and intra uterine fetal retardation [IUGR]

Conclusion: maternal obesity carries significant risks for the mother and fetus, including maternal outcomes as increased incidence of hypertension, gestational diabetes, cesarean rates, and postpartum hemorrhage. Fetal outcomes as macrosomia

Manual placental removal versus cord traction for placental delivery at caesarean section in correlation to blood loss

Background: Delivery by cesarean section is one of the most commonly performed obstetrical operations all over the world, but it exposes women to the inherent risks of major abdominal surgery, e.g., injury to the pelvic structures, infection, and the need for blood transfusion etc. Antepartum physiological adaptation in preparation for blood loss at delivery includes a 42% increase in plasma volume and a 24% increase in red blood cell volume by the third trimester

Objective: The aim of this work was to compare the manual removal of placenta and spontaneous placental delivery combined with cord traction at caesarean section. Patients and Methods: We compare between both groups using computer programs to evaluate the safety and efficacy of each method

Results: There was a significantly higher estimated intraoperative blood loss in women who had their placentae manually separated when compared to women who had spontaneous placental separation

Conclusion: There was a statistically significant drop of hematocrit level in both groups with no statistically significant drop of hemoglobin. In addition, there was increased incidence of endometritis

Tranexamic acid for prevention of postpartum hemorrhage after vaginal delivery

Objective: To assess the efficacy of tranexamic acid in reduction of blood loss and pervention of postpartum hemorrhage after vaginal delivary

Methods: This is a multicentric prospective randomized double blind placebo controlled trial. 200 pregnant women were randomized to receive either 60 mg/kg of tranexamic acid [TA] [n=100] or placebo [n=100] intravenously in the second stage of labour. Postpartum blood loss was collected and measured accurately from placental delivery to 2 hours postpartum and adverse effects of were observed

Results: The mean estimated postpartum blood loss was significantly lower in women treated with tranexamic acid compared to women in the placebo group [442.50 +/- 128.55 versus 555.75 +/- 191.88, respectively; p < 0.001], and the proportion of women in the tranexamic acid group who had an estimated blood loss >/= 500 mL was significantly lower than in the placebo group[3 [3 %] versus 9 [9%],relative risk [RR]=0.30; 97% confidence interval [CI] 0.11 to 0.78;P<0.05]. Maternal and neonatal outcomes did not differ significantly between both groups

Conclusion: The addition of tranexamic acid to the active management of third stage of labor after normal vaginal delivery is effective as a prophylaxis against post-partum hemorrhage. It can significantly reduce blood loss during and after delivery

Incidence of placenta accreta and its complications in cases of previous cesearean sections with placenta previa anterior at al hussein university hospital

Objective: Incidence of placenta accreta and its complications in cases of previous cesarean sections with placenta previa anterior at Al Hussein University Hospital

Materials and Methods: Ultrasound is the recommended first step in the diagnosis of placenta previa accreta. Color Doppler ultrasound has been suggested to aid in the diagnosis of placenta previa accreta. Magnetic Resonance Imaging also was used

Results: Cesarean Hysterectomy performed in all cases of accretion, bladder injury in 19 [47.5%] cases, bowel injury in 1 [2.5%] case, all cases received intraoperative blood transfusion, postoperative blood transfusion in 38 [95%] cases and ICU admission in 25 [62.5%] cases

Conclusion: The incidences of placenta accreta in cases of previous cesarean section with placenta previa anterior were 63%. Incidence, risk factors and Feto-maternal outcome of management of Patients with placenta accreta at Al Hussein University Maternity Hospital are comparable with those presented in several literatures

Uterine and subendometrial arteries doppler in patients with recurrent first trimestric abortion

Background: Unexplained Recurrent miscarriage remains a frustrating problem for the clinician and a distressing condition for the affected couple. Recurrent pregnancy loss is defined as three or more successive spontaneous abortion. The incidence of recurrent pregnancy loss is 1-2% in the fertile population

Aim of the Work: This study aimed to find out any difference in uterine artery pulsitility index [PI] between women with history of recurrent unexplained first trimestric abortion and women without this history

Patients and Methods: One hundred cases from Al-Azhar University Hospitals [Al-Hussein and Sayed Galal] were included in the study and classified into two groups: Recurrent pregnancy loss [RPL] group: 50 cases with history of recurrent unexplained abortion. Control group: 50 cases with no history of abortion and one full term child at least. Uterine artery Doppler [Pulsatility Index [PI]] assessment was done to all patients in the study during the luteal phase of spontaneous menstrual cycle

Results: PI in the RPL group was found to be elevated compared to the control group

Conclusion: Assessment of uterine perfusion through measurement of uterine artery Doppler [PI] could be of value in cases with recurrent unexplained first trimestric abortion

The Combination of Sonography and Physical Examination Improves the Patency and Suitability of Hemodialysis Arteriovenous Fistula in Vascular Access

Purpose: We compared the patency and the suitability of arteriovenous fistula (AVF) created for vascular access by two approaches: (a) physical examination with preoperative vascular mapping and (b) physical examination alone. Methods: We compared the patency and the suitability of AVF created in patients for dialysis. There were two cohorts of patients of 79 patients each: (a) patients with AVF created based on the combination of physical examination and preoperative vascular mapping (PE+VM) and (b) patients with AVF created based on physical examination (PE) alone. Fistula patency is defined as clinical detection of thrill (or auscultation) of murmur over the fistula and coded as having thrills (patent) versus not having thrills (not patent). Suitability of fistula is defined as functioning AVF (AVF can be adequately used via 2-needle cannulation for dialysis) and coded as suitable versus not suitable. Results: AVF created after the preoperative vascular mapping (PE+VM) has 5.70 (at six weeks) and 3.76 (at three months) times higher chance for patency, and 3.08 times higher chance for suitable AVF for dialysis than AVF created after the physical examination (PE) alone. Conclusion: Physical examination with preoperative ultrasound mapping (PE+VM) significantly improves the short term patency and the suitability of AVF for dialysis.

A Morphometric Study of the Sella Turcica: Gender Effect.

Background and objective: Precise anatomical knowledge of the sella turcica is important for neurologists and surgeons operating in the region of cavernous sinus or the surrounding structures. The current study was undertaken to record normal morphometric parameters for future reference and to determine if there is any significance difference in the sella turcica morphometry regarding the gender. Methodology: A Morphometric analysis of the Sella Turcica and structures in vicinity were done in thirty six adults’ formalin fixed cadaver’s skulls (22 male and 14 female). Results: The pituitary stalk positions weremiddle inmajority ofmale cases (72.7%), the remaining 27.3% were posterior. Among female; 57.1%weremiddle and the remaining 42.9%were posterior, no anterior position was detected among both genders with no different between male and female (p = 0.494) Normal Optic chiasma position was detected in all female cases and in 63.6% of male cases with no significant differences regarding gender (p= 0.070). No significant different in diaphragma sella shape and opening regarding gender (p.value = 0.170 and 0.914 respectively) No significant difference betweenmales and females concerning linear dimensions of sella turcica (length, depth and Anteroposterior diameters). Concerning diaphragma sella opening; no significant different regarding gender in transverse diameter (p.value= 0.316) while significant different was detected in anteroposterior diameter (p.value= 0.046) For interclinoid (anterior, posterior) diameters, which represented statistically significant different regarding gender in both right and left sides (p.value = 0.004 and 0.001 respectively). Conclusion: Present studywill providing the normalmorphometric data for future reference and further studies.

Quadriceps Tendon and Patellar Ligament; a morphometric study

Background: Anterior cruciate ligament [ACL] is commonly injured especially in sportsmen. Autografts using tissue from various sources including the quadriceps tendon and patellar ligament are popular but still controversial due to varying degree of success. The morphological characteristics of the quadriceps tendon and the patellar ligament are of prime importance for this purpose

Objectives: This cadaveric study was undertaken to evaluate the morphometric characteristics of the quadriceps tendon and patellar ligament as an autograft for ACL reconstructive surgery

Study design: Qualitative cadaveric study

Material and Methods: The morphometric observations of the quadriceps tendon and patellar ligament on 36 [18 male and 18 female] adult formalin fixed cadavers were recorded by dissection. The observations included the length, breadth and thickness of the quadriceps tendon and the patellar ligament and were recorded on both sides separately in the male and female subjects. The data were tabulated, compared and statistically analyzed

Results: There was no significant difference in measurements on the right and left sides both in the male and in the female specimens. However the length and width of the quadriceps tendon was more in the males as compared to the females. The patellar ligament was significantly longer in the male specimens as was its width. Thickness of the patellar ligament, however, was not significantly different in the two genders

Conclusion: Both the quadriceps tendon and the patellar ligament are safe and convenient sources of autograft tissue for reconstruction of the ACL

Value of renal biopsy in the diagnosis of acute renal failure in children

This work aims to evaluate the role of renal biopsy in the diagnosis of patients presented with acute renal failure [ARE] with correlation between the clinical and pathological diagnosis and their impaction on the prognosis. The study was preformed on fifty patients presenting with the manifestation of ARE received in Pediatric Hospital Mansoura Eaculty of Medicine. Paraffin blocks were cut for hematoxyline and eosin and special stains as well. Analysis of pathological findings with clinical parameters related to outcome of patients. This study delineated that the childhood cause of ARF are acute glomerulonephritis [48%] followed by acute tubular necrosis [18%] then thrombotic microangiopathy [12%], then malignant lymphomatous infiltration [6%], then acute pyelonephritis [4%] lastly renal cortical necrosis [2%] and interstitial hemorrhage [2%]. The renal biopsy confirmed the clinical diagnosis in 58% of cases and altered .the clinical diagnosis in 12% of cases. Moreover in cases with uncertain clinical diagnosis the renal biopsy clarified the accurate diagnosis. More over the biopsy guided the treatment in some cases. The results of this study demonstrate that renal biopsy is essential in many cases of pediatric ARF not only to confirm the diagnosis but also to diagnose cases of unknown causes and changes the clinicat diagnosis in many cases as well

A survey on lower urinary tract symptoms (LUTS) among patients with Benign Prostatic Hyperplasia (BPH) in Hospital Universiti Sains Malaysia (HUSM)

Patients with Benign Prostatic Hyperplasia (BPH) commonly presents with lower urinary tract symptoms (LUTS), which can be of obstructive symptoms such as hesitancy, incomplete voiding, post void dribbling or of irritative symptoms such as urgency, frequency and nocturia. Various recent studies indicate that nocturia is a very important and bothersome lower urinary tract symptom especially among patients with Benign Prostatic Hyperplasia (BPH). The aim of the study was to determine the frequency of common urinary symptoms among patients with BPH in HUSM as well as to evaluate the extent of bothersomeness of each and every symptom to these patients. This study too was aimed at evaluating the success of TURP in resolving pre operative LUTS. This was a questionnaire-based survey using a validated ICSBPH model whereby patients with BPH were selected and quizzed personally by an investigator. A subset of patients who had undergone TURP was further questioned regarding their satisfaction with the procedure. When nocturia is defined as waking up at night once or more to pass urine, the prevalence of nocturia was about 90%, but only 1 in 6 patients considered this is a very serious symptom. Even if the definition was changed to waking up twice or more, the prevalence is still quite high at over 80%. Urgency was noted in half of the patients, but only a quarter of them consider it a serious problem. 1 in 5 patients experienced significant leak and almost all consider it serious. About one third of the studied population had to be catheterized due to urinary obstruction and interestingly only about half of them considered it as a very serious event. Overall, a great majority of these patients considered suffering from these urinary symptoms for the rest of their life as very devastating. This study concludes that although the prevalence of nocturia was high among BPH patients, but it was not considered serious by majority of them. In fact, LUTS in our BPH patients did not differ much from BPH patients elsewhere. On the whole, TURP resolved most of the LUTS effectively.

Effect of ozone on some blood coagulation patterns in male albino rats

In this study forty adult male albino rats were used to investigate the effect of ozone on some coagulation patterns. Rats were divided into four equal groups, i.e. control group, immobilization stress group, immobilization plus small dose ozone group and immobilization plus large dose ozone group. In each group prothrombin time [PT], partial prothrombin time [PPT], platelet count, malonyldialdehyde, and catalase enzymes were measured. The results showed that immobilization stress led to significant increase in prothrombin time, partial prothrombin time and malonyldialdehyde with significant decrease in platelet count and catalase enzyme as compared to control group. Ozone in small dose led to significant decrease in prothrombin time, partial prothrombin time and malonyldialdehyde with significant increase in platelet count and catalase enzyme as compared to immobilization stress group. Ozone in large dose led to significant decrease in prothrombin time, partial prothrombin time and malonyldialdehyde with significant increase in platelet count and catalase enzyme as compared to immobilization stress group. The results of this study showed that immobilization stress had hypocoagulability effects and that ozone in large and small doses had improved these immobilization-induced hypocoagulability changes

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

Role of balloon angioplasty in the management of critical lower limb ischemia

Untreated critical lower limb ischemia most commonly leads to amputation. Successful revascularization will reduce the amputation rate in patients presenting with CLI. Two general techniques of revascularization exist: open surgical procedures and endovascular intervention. Endovascular revascularization is less invasive, less costly, needs no anesthesia [General or spinal] and has a low incidence of complications. This study was aimed to evaluate the safety and efficacy of balloon angioplasty as an option for revascularization of CLI patients. 30 Patients with critical limb ischemia treated with P.T.A. of the infra-inguinal vessels in vascular surgery unit in El-Hussein university hospital over one year according to clinical and angiographic findings. Clinical findings include rest pain, ulceration and /or gangrene while angiographic findings confirm stenosis or occlusion in the infra-inguinal arteries. Ankle brachial pressure index is recorded. Technical success was achieved in 93.33% patients while clinical success in the form of improvement of rest pain and increase in healing of ulcers was achieved in 21 Patients [70%]. The complications in the procedure were low and only 2 Patients had done above knee amputation. According to our results,CLI patients with lesions categorized as TASC A and B, irrespective of their co-morbid conditions, should be considered for percutaneous treatment as afirst line treatment. PTA as the first choice revascularization procedure for CLI is feasible, safe and effective for limb salvage, with low complications rate

Conservative surgical treatment for benign aggressive intrabony lesions

This study was performed to document that not all the aggressive lesions require extensive surgical intervention. Accurate assessment, as regard to clinical examination and histopathological investigation, should be done to determine the most suitable treatment. The study was conducted on 12 patients: 7 patients were suffering from large odontogenic keratocyst, 5 patients were suffering from central giant cell lesions. All lesions were confined to the mandible and treated by surgical enucleation and aggressive curettage [peripheral ostectomy]. Long term follow-up was done [up to 18 months] which revealed that fair bone regeneration with no evidence of recurrence

effects of single dose of dexmedetomidine on haemodynamics, core body temperature and shivering during spinal anaesthesia in elderly patients

Thirty elderly males [over 60 years], ASA physical status I and II patients scheduled for elective inguinal hernia repair were randomly assigned [n=15per group] to receive premedication with either saline 3 ml [Group I], or dexmedetomidine Hcl 0.5micro/kg diluted in 3 ml saline [Group II] given intramuscular, 45 minutes before induction of spinal anaesthesia. During spinal anaesthesia, heart rate [HR] significantly decreased in the dexmedetomdine group compared to the control group. Although systolic arterial blood pressure [SABP] decreased significantly in both groups. no significant difference was recorded between dexmedetomidine and control groups. Core body temperature showed significant decrease in both groups without statistical significant differences between them. During and after spinal anaesthesia shivering incidences were significantly less in the dexmedetomidine group in comparison to the control group. In conclusion, when compared to control elderly patients under spinal anaesthesia, single dose [0.5micro/kg] of intramuscular dexmedetomidine premedication provided minimal changes in patient's haemodynamics. This small dose did not attenuate nor exaggerate redistribution of core hypothermia. While core temperature decreased in both groups, there was a lower incidence of shivering in the dexmedetomidine group

Cytogenetic evaluation of epilepsy

The aim of this study was to detect the chromosomal abnormalities in patients suffering from epilepsy through chromosomal study, and to evaluate the correlation between these results with physical and intellectual disabilities. The present study was conducted on 50 epileptic pediatric patients [29 males and 21 females], their age ranged between 6 months and 11 years. Patients were selected from Pediatric Neurology out-patient clinic in EI-Minia University Hospital, from December 2002 to August 2003. All patients were diagnosed as having epilepsy based on the detailed clinical symptomatology of seizures. The patients were subjected to careful history taking, complete general and neurological examination. Electroencephalography [EEG], computerized tomography of brain [C.T.] and chromosomal study by studying G-bands to facilitate the identification of structural abnormalities were done. The studied patients were divided into 2 groups: Group 1 included 20 epileptic patients with normal physical and intellectual developments and group 2 included 30 epileptic patients with intellectual disabilities and/or physical abnormalities. The results proved that 4 cases [8%] showed chromosomal abnormalities among the group 2 of patients. One patient had distal deletion of the long arm of chromosome 1, one patient had ring chromosome 20 and the remaining two patients had distal deletion of the long arm of chromosome 6

Conclusion : We concluded that epileptic patients not in need for chromosomal study, karyotype analysis should be performed in a child or adult complained from seizures with dysmorphic features and/ or intellectuaidisability