End tidal concentration of sevoflurane and isoflurane for adequate depth of anaesthesia in caesarean section guided by BIS

Inadequate hypnosis in the absence of opioid analgesia may account for the increased incidence of awareness in caesarean section before delivery of the neonate. We investigated the concentration of sevoflurane and isoflurane required to maintain bispectral index [BIS] < 60 unitl delivery occurred. We enrolled 40 ASA physical status I, II parturients in an up-down sequential allocation study [group I [sevoflurane group] 20 patients and group II [isoflurane group] 20 patients]. The median effective end-tidal concentration [EC50] of sevoflurane and isoflurane was defined as that which maintain BIS<60 between skin incision and delivery in 50% of patients. The EC50 for sevoflurane and isoflurane was 1.2% [1.06-1.31] and 0.8% [0.64-0.92] respectively. There was no postoperative awareness in all patients in both groups. There were no differences regard haemodynamic parameters [HR-MAP] between both study groups. We conclude that sevoflurane concentration of at least 1.2-1.3% and isoflurane concentration of at least 0.8-0.9% should be administered during caesarean section to minimize the risk of awareness and recall

Premedication with low-dose oral midazolam reduces the incidence of emergence agitation in paediatric patients after sevoflurane anaesthesia

Sevoflurane is a volatile anaesthetic agent with low pungency, nonirritating odor, and low blood/gas partition coefficient that makes it an attractive alternative to halothane. However, a high incidence of emergence agitation [EA] has been reported in paediatric patients after sevoflurane anaesthesia. The underlying mechanism of sevoflurane-induced EA remains unclear. Rapid recovery of consciousness [emergence] from sevoflurane anaesthesia has been proposed as one possible mechanism. It was, therefore, hypothesized that sedatives such as midazolam may counteract sevoflurane's rapid emergence and thus reduce the incidence and the severity of sevoflurane-induced EA. This prospective, controlled, single-blinded study included 88 ASA class I or II paediatric patients scheduled for elective outpatient surgery. Patients were assigned to receive either oral midazolam [0.2 mg kg-_ as anaesthetic premedication] or saline [oral normal saline as premedication] before the conduct of anaesthesia. Induction and maintenance of anaesthesia were uniform in both groups. Induction of anaesthesia was made possible with 8% sevoflurane and N2O in 50% O2. Intubation was performed straight without the aid of muscle relaxant and the ventilator was set to maintain normocapnia. Anaesthesia was maintained with 3% sevoflurane and N2O in 50% O2 until the surgery was over. All matters of relevant time periods were recorded [induction, surgical procedure, extu bation and transportation]. In the post-anaesthesia care unit [PACU], adverse events, the incidence and the severity of EA, analgesic requirement, duration of PACU stay, and parental as well as PACU nurses' satisfaction were evaluated. A significant lower incidence and less severity of EA were noted in patients premedicated with midazolam. Less postoperative analgesia was required in patients who had received midazolam. Although midazolam premedicated patients remained sedated after sevoflurane anaesthesia, the duration of the PACU stay was not significantly different from that of saline-treated patients. Both parents and PACU nurses were more satisfied with midazolam as premedication. It was concluded that premedication with oral midazolam is safe, convenient and effective in decreasing the occurrence of sevoflurane-induced Emergence agitation [EA]. It does not delay discharge from PACU and is suitable for outpatient surgery

Sub-tenon's block in cataract surgery a comparison of 2% articaine and a mixture of 2% lignocaine and 0.5% bupivacaine

Articaine is a novel amide local anaesthetic with a shorter duration of action than prilocaine. Sub-Tenon's anaesthesia arguably provides a safer method of anesthetic delivery for cataract surgery. In our study we compared 2% articaine with mixture of 2% lignocaine and 0.5% bupivacaine through sub-Tenon's block for cataract surgery. 60 ASA [American Society of Anesthesiologists] I-III patients were selected for comparison and allocated in two equal groups in randomized double-blinded study. We found that sub-Tenon's block using articaine 2% resulted in a more rapid onset of motor block than lidocaine / bupivacaine mixture [mean time to readiness for surgery was 3.3 +/- 2.4 [SD] min. in articaine group vs. 5.1 +/- 3.2 [SD] min. in lidocaine/bupivacaine group [p=0.0077]. Ocular movement scores were significantly lower from 2 min. after injection until the end of surgery p = 0.021 [p

Sumatriptan and gabapentin for treatment of postdural puncture headache

Postdural puncture headache [PDPH] is one of frequent adverse complication of dural puncture. Although, it is a self limiting and non-fatal condition, its postural nature prevents the patient from performing routine activity and may make them anxious and depressed. In this study we evaluate a combination of sumatriptan and gabapentin for treatment of PDPH and compare it with sumatriptan or gabapentin as sole medication. ASA I and II 45 patients age between 20 and 40 years and non-parturient, who's developed PDPH after spinal or epidural neuraxial block was included in the study. Patients were randomized to receive either gabapentin 300 mg orally every 8 hours for one week group I, in group II patient was received sumatriptan 50 mg orally once daily for 3 successive days. In group III, patients received sumatriptan 50 mg orally every day for 3 days and gabapentin 300 mg every 8 hours for 7 days. PDPH was evaluated by using Visual Analog Scale [VAS], measured 20 min after patients assumed upright postures either sitting or standing. It was recorded before start the treatment as baseline and at 12, 24, 36, 48, 72 and 96 hours after. Satisfaction of patients with treatment was asked, after 4 days. Complications such as somnolence, dizziness, seizures, chest pain, nausea, vomiting and dry mouth were recorded. VAS was significantly low and patient satisfaction was high in group III when compared with the other two groups. Number of patients reported somnolence and dizziness were significantly high in group III compared to group I or II. Combination of sumatriptan and gabapentin could be beneficial for treatment of patients with PDPH, more than sumatriptan or gabapentin alone, as it relief the headache and decrease usage of epidural blood patch which is invasive and not safe procedure

[Evaluation of concentration methylene diphenyl diisocyanate [MDI] in the polyurethane industries of Iran]

MDI [Methylene Diphenyl Diisocyanate] is a high tonnage product, which comprises about 90% of the total diisocyanate in the market. Polyurethanes are produced by reacting diisocyanate with polyols and other chemicals. They are known as respiratory tract and skin sensitizers and are the most common cause of occupational asthma in the world [NIOSH 1994]. On this subject, evaluation of MDI concentration in the polyurethane factories by HPLC, and is worthy to determine its pollution level. All sampling methods have some limitation, therefore, this survey the method of NIOSH 5522 has been used as a standard sampling and analyzing method t then, we utilize SPSS V.13 software, for our data to be analyzed for statistical discussion. Results showed that all of the polyurethane industries under this study have high concentration, rate of more than 80 micro g/m[3]. There was a strong correlation between indoor temperature and high MDI concentration, thus, it implies that various temperatures may be increased, in addition to working time ensuring it has a good correlation with MDI concentration. It also implies that when ever they have more working time comparatively, in turn, they have high exposure rate of MDI pollutant in the workplace. To obtain a better way for determination of MDI concentration in the workplace is using biological monitoring as a standard method to survey the exposure to diisocyanate, by using metabolite determination, it will be easier to collect and analyze more samples as the sampling is not as time-consuming as air monitoring

Intraocular pressure during lumbar disc surgery - a comparative study between prone position and knee-elbow position

Post-operative visual loss occurs more commonly in spinal surgery. Increased intra-ocular pressure is often Implicated In the etiology of postoperative visual impairment. We Investigated intraocular pressure in 20 patients undergoing lumber disc surgery. We classified the patients into two groups: Group I: patients were in the knee-elbow position with the head resting on a cushion and turned to one side and group II: patients were in prone position and the head neutral. We classified patients in knee-elbow position into two sub-groups: subgroup A where we measured IOP in nondependant eye and subgroup B where we measured IOP in dependant eye. In both groups we measured lOP during 2 times, the first time in both group when the patients were awake and In supine position and the second time was In group I at the end of surgery when the patients were still anesthetized and in knee elbow position and in group II at the end of surgery when the patients were still anesthetized and in prone position. In group I after mean duration of surgery 120 +/- 18 min. [mean +/- SD], the mean intra-ocular pressure in the non-dependnnt eye was unchanged when compared to awake state 16.3 +/- 2.1 vs. 17.2 +/- 3.2 mmHg [p >/= 0.05]. whereas the intraocular pressure in the dependant eye had significantly increased 17.1 +/- 2.2 vs. 19.2 +/- 1.1 mmHg [p<0.05]. In group II after mean duration of surgery 119 +19 mmHg, mean Intra-ocular pressure had highly significant increase compared to awake state 16.7 +/- 2.2 vs. 21.3 +/- 2.1 mmHg [p<0.01]. We conclude that IOP increased when anesthetized - patients are placed in prone position more than when placed in knee-elbow position

Hemodynamic and catecholamine stress responses to insertion of the combitube as an alternative airway management in general anaesthesia for caesarean section

The introduction of Combitube to the field of airway management brought about a solution of the problem of difficult airway in trauma patients and during cardiopulmonary resuscitation. This trial was designed to assess the efficacy of Combitube in preventing the lethal complications of failed Intubation during caesarean section and compare the haemodynamic and stress response to the device with that resulting from endotracheal intubation. Forty-five healthy parturients scheduled for CS were randomized Into three equal groups. Combitube was inserted blindly in group I and facilitated by laryngoscopy in group II In group III, endotracheal intubation was performed under laryngoscopy. Patients were assessed for the degree of difficulty of insertion of the Combitube, manifestation of regurgitation or trauma to the oropharynx. haemodynamic changes and hormonal response to Combitube Insertion and endotracheal intubation. There was no significant difference in the degree of ease on Introduction of Cornbitube in group I as compared to group II. Combitube proved to be a safeguard against regurgitation as group I and II were compared to group III A high incidence of trauma was noticed in group I during blind insertion of Combitube as compared to laryngoscopy aided insertion in group II or endotracheal Intubation in group III Laryngoscopy aided Insertion of Combitube [group II] or endotracheal intubation [group III] produced a significant increase In heart rate as compared to blind insertion in group I. Comparison between groups II and III showed a significant increase In HR in group III. Systolic blood pressure Increased significantly in group III while the other two groups manifested an insignificant increase. Stress hormones manifested increases in all the groups. Nor- adrenaline level increased insignificantly in group I and II. while it was statistically significant In group III. Adrenaline levels increased insignificantly in all the study groups. Prolactine level increased insignificantly In group I and manifested a significant increase in groups II and III. This Increase was significantly higher in group III as compared to group II. It is concluded that Combitube provides a safe patent airway not only in emergency situations but also in patients scheduled for surgery if they were at risk of aspiration or difficult intubation as those scheduled for caesarean section

Role of serum interleukin-18 in the assessment of activity of tuberculosis

This study is carried out to evaluate the role of interleukin-18 [IL-18] in the immune response against Mycobacterium tuberculosis [M. tuberculosis] and the reliability of its serum level in the assessment of tuberculous disease activity. It included 40 subjects who were classified into three groups, group I [included 20 patients with active pulmonary tuberculosis], group II [included 10 patients with active extrapulmonary tuberculosis], and group III [included 10 healthy subjects served as controls]. All subjects were investigated, before and 3 months after start of antituberculous treatment, by conventional methods to assess tuberculous disease activity [clinical features, ESR, sputum direct smear for acid fast bacilli and chest X-ray] and measurement of serum IL-18 level. In group I, 16 patients showed good response to treatment and became inactive and showed significant reduction in serum IL-18 level, while the remaining 4 patients showed poor response to treatment and still active and their serum IL-18 level did not change significantly. In group II, 9 patients showed good response to treatment and became inactive and their serum IL-18 level was reduced significantly. In conclusion, serum IL-18 plays an important role in the immune response against M. tuberculosis, as it was higher in patients than in the healthy controls. Serum IL-18 level is directly proportionate to the tuberculous disease activity and severity and it caries a prognostic value, where patients with high serum IL-18 level had good response to treatment, while patients with low serum IL-18 level had poor response to treatment

Structural abnormalities of the Y chromosome: Genotype-phenotype correlation

The aim of this study was to correlate the structural abnormalities of the Y chromosome to its presenting clinical features to evaluate the phenotype-genotype correlation. The study was performed on 30 patients who had structural Y chromosome abnormalities. The cytogenetic methods included conventional G-banding, diamidino-2-phenylindole [DAPI] and fluorescent in situ hybridization [FISH] techniques. The structural abnormalities of the Y chromosome were a deletion of the long arm [Yq-] in 13 cases, a partial deletion of the short arm [Yp-] in 6 cases, large heterochromatin of Y [Yq+] in 6 cases, pericentric inversion in 4 cases and one case with ring Y. Their phenotypic presentations varied from complete normal male, ambiguous genitalia to complete female phenotype. The clinical presentations and cause of referral of the patients were variable including male infertility and azoospermia, primary amenorrhea, mental retardation, multiple congenital anomalies and/or dysmorphism, short stature, ambiguous genitalia, routine premarital counseling and repeated abortions

Assessment of genome damage in a population of Egyptian workers occupationally exposed to cotton dusts

Earlier reports described byssinosis syndrome among workers in cotton industry, while recent studies have shown that workers occupationally exposed to cotton dusts have an increased risk of development of many types of cancer. Hence this study was conducted to assess genotoxic effects [as a measure of carcinogenic risk] of chronic cotton dust inhalation in workers with byssinosis and to combine clinical and occupational data with the results of genotoxicity assays in order to reach quantitativness in risk assessment. Clinically, byssinosis was diagnosed mainly in workers employed at early production areas of yarn preparation: opening, blowing and carding [80%] and those working as machine operators [8.5%]. There was significant correlation between the duration of exposure to cotton dusts and the clinical severity of the disease. Study of cytogenetic markers in exposed workers showed significant increase in the percent of total chromosomal breaks and aberrations as well as the mean value of sister chromatid exchanges accompanied with significant decrease in mitotic index value as compared to controls. Assessment of total genomic damage of DNA by visual comparing of the density of released [migrated, damaged] DNA bands and by measuring the optical density of damaged DNA bands using Gel-Pro computer program revealed 20% increase in DNA damage in blood lymphocytes of workers chronically exposed to cotton dusts when compared to non-exposed controls. Also, there was 50% increase in the optical density of the released RNA in blood lymphocytes of exposed workers than controls which might be used as an index of stress of pollution applied on cotton industry workers. Comet assay endpoints revealed more than twice times higher number of migrated DNA spots [damaged, strongly damaged] in blood lymphocytes from cotton industry workers compared to non-exposed subjects. The genotoxicity burden measured as% of total chromosomal breaks, and aberrations, mean values of SCEs/metaphase and DNA damage endpoints [the number of damaged DNA spots and the optical density of damaged DNA] was correlated significantly with the duration of exposure to cotton dusts. Therefore the fact that workers occupationally exposed to cotton dusts have distinctly more chromosomal mutations and DNA damage may be an important indicator in the chronic effect of cotton dust-associated carcinogenesis. Combining the clinical and occupational data with the results of genotoxicity assays showed that the severity of byssinosis syndrome was associated with the degree of genome damage

dose response study of three different concentrations of clonidine with local anesthetic mixture for peribulbar block

Clonidine, the alpha[2] agonist prolong anesthesia and analgesia when added to local anesthetics, in epidural anesthesia, subarachnoid anesthesia, plexus anesthesia and retrobulbar block. We evaluate the dose-response relationship of different concentrations of clonidine added to lidocaine in peribulbar block. Sixty patients undergoing cataract surgery were given peribulbar block with 7-10 ml of 2% lidocaine and hyaluronidase with either saline [control] or clonidine 0.5 ug/kg [0.5 clon] 1.0 ug/ kg [1.0 clon] or 1.5 ug/kg [1.5 clon] doses. The onset of globe anesthesia, akinesia and analgesia, the duration of anesthesia and analgesia, the postoperative analgesia requirement and the adverse effects [Hypotension, bradycardia, hypoxia, sedation and dizziness] were recorded. The onset of block was comparable in all groups. The duration of globe anesthesia, analgesia and akinesia was significantly [p<0.01] prolonged in patients receiving 1.0 and 1.5 ug/kg clonidine as compared with the control group. Perioperative pain scores and analgesic requirements were significantly less in these groups. 0.5 ug/kg clonidine did not significantly increase the duration of anesthesia and analgesia. The side effects were observed more with 1.5 ug/kg clonidine as compared with other groups. We conclude that 1.0 ug/kg clonidine significantly prolong the anesthesia and analgesia when mixed with local anesthetic with minimal side effects

Monitoring of diesel exhaust exposed workers at risk by clinical and cytogenetic studies

Clinical assessment revealed that exposure to diesel exhaust [DE] inducedallergic manifestation with significant increase in the number of exposedworkers with clinical asthma, allergic conjunctivitis and eczema. Additionally, there was a significant increase in the percent of exposedworkers with auditory troubles and hypertension. Cytogenetic study revealedsignificant increase in the frequencies of chromosome aberrations [CA] andsister chromatid exchanges [SCEs] among exposed workers. Whereas, the mitoticindex insignificantly decreased. The increased duration of exposure to DEsignificantly affected the frequency of SCEs but not that of CA. Moreover,treatment of the cultures with N-acetylcysteine significantly decreased thefrequencies of CA and improvement of the mitotic index as compared withnon-treated cultures, whereas, no significant decrease was observed in thefrequencies of SCEs

Malignant body cavity effusion: cytologic criteria with special reference to Ag-nors

This study was conducted on 563 cases of body cavity effusions to establish the following points: 1. Determination of the underlying malignant causes 2. A search for the morphological feature of malignant cells for determination of their nature and site of origin 3. Differentiation between mesothelioma, cells and metastatic adenocarcinoma. Also, differentiation between non - Hosgkin's lymphoma and non- neoplastic lymphoid reaction.Qualitative cytoplasmic feature of prepared smears were studied by May- Grueniwald Giemsa [MGG] and nuclear feature in slides stained by Papanicolaou's stain [PAP]PAS stain and AB stain were used when needed 100 cells were assessed. Malignant effusions constituted 17.23% of all studied cases metaststic carcinoma was found to be the most common cause of pleural and peritoneal effusions.Adenocarcinomas formed the majority and the different primarysite of origin were breast, lung GIT and ovaries. Lymphoma/leukemia constituted the second frequent cause of body cavity effusions. It has been shown that MGG stain is highly valuable in differentiation of small cell lymphoma from lymphoid reaction. In small cell lymphoma all cells show monotonous nuclear staining, while in lymphoid reaction it is variable Methothelioma was the last frequent cause of malignant effusions. The most discriminating feature from reactive and highly reactive effusions are morula formation, cytoplasmic vacuolation, nuclear shape [irregular and oval] chromatin pattern [irregular and hyperchromatic], and prominent nucleoli. Metholelioma cells are PAS positive and negative after diastase digestion

Effect of aging on the rat's body and brain weights

The rat's body, total brain, forebrain and cerebellar weights were recorded in 2, 5, 12 and 24 months old animals. The ratios between brain and body weights as well as cerebellar to forebrain weights were examined. The statistical tests showed a significant increase in the body, total brain and cerebellar weights from 2 to 24 months of age. The forebrain weight showed an increase between 2 and 5 as well as 5 and 12 months and a insignificant difference between 12 and 24 months of age. The brain to body weight ratio showed a significant decrease with age in all age groups indicating a slower increase in the brain weight as compared with the body weight with age. Cerebellar to forebrain weight ratio showed a significant increase between 12 and 24 months of age reflecting the stoppage of any increase in the forebrain weight during this period of life, while the cerebellar weight was still increasing. This was attributed to the post-natal origin of the cerebellar granule cells, which were suggested to survive when the death of other neurons occurred