The impact of magnesium sulfate as adjuvant to intrathecal bupivacaine on intra-operative surgeon satisfaction and postoperative analgesia during laparoscopic gynecological surgery: randomized clinical study

BACKGROUND: Surgeon satisfaction and patient analgesia during the procedure of laparoscopic surgery are important issues. The aim of this work was to study if an intrathecal (IT) Bupivacaine combined with Magnesium sulfate may or may not provide good surgeon satisfaction in addition to improvement of intraoperative and postoperative analgesia. METHODS: Sixty female patients were enrolled in this prospective, randomized, double-blind controlled clinical trial study. All patients were operated for gynecological laparoscopic surgery under spinal anesthesia. Patients were divided into two groups (Bupivacaine and Magnesium). Group Bupivacaine (30 patients) received intrathecal Bupivacaine 0.5% only (15 mg), while 30 patients in group Magnesium received intrathecal Bupivacaine (15 mg) in addition to intrathecal Magnesium sulfate (50 mg). The sensory block level, the intensity of motor block, the surgeon satisfaction, the intraoperative visual analog scale (VAS) for pain assessment, the postoperative VAS, and side effects were recorded during the intraoperative period and within the first 24 hours after surgery in the post-anesthesia care unit. RESULTS: Surgeon satisfaction, intraoperative shoulder pain, postoperative pain after 2 h, and perioperative analgesic consumption (ketorolac) were significant better in group Magnesium than in group Bupivacaine. (P < 0.05). The onset of motor and sensory blocks was significant longer in group Magnesium than the other one. The incidence of PONV, pruritus and urinary retention was insignificant statistically between both groups. CONCLUSIONS: Magnesium sulfate if used intrathecally as an adjuvant to Bupivacaine would provide a better surgeon satisfaction and would improve the analgesic effect of spinal anesthesia used for gynecological laparoscopic surgery.

Coagulation and renal effects of voluven versus haes-steril in major orthopedic surgery

Hydroxyelhyl starch [HES] solutions are effective plasma volume expanders. Impairment of coagulation and renal junction occur with large HES volumes infused perioperatively. Therefore, a lower substituted novel HES [Voluven] was developed to minimize hemostatic interactions. The aim of the study is to evaluate the benefit of voluven to reduce hemostatic interactions and preserve renal junction while preserving its efficacy in restoring plasma volume in comparison to HAES-steril [pentastarch]. After approval of our local institutional university ethical committee, and a written consent was obtained from each one. Fifty consecutive adult patients, ASA I and II, scheduled for elective major orthopedic surgery at Assiut University Hospital were included in the study. The patients were allocated into two equal groups [each of 25 patients] according to the type of the study solution used as plasma volume replacement. Group-A: received [Voluven]. Group-B: received HAES-steril. Hemodynamic parameters: central venous pressure [CVP], mean arterial blood pressure [MABP], and heart rate [HR] were recorded before anesthesia induction [baseline], one hour after induction of anesthesia, at the end of surgery, 5 h after surgery and 24 h after surgery. Coagulation profile: Screening tests: prothrombin time [PT], prothrombin concentration [PC], International Normalized Ratio [INR]], partial thromboplastin time [aPTT] and serum fibrinogen level. Specific tests of haemostasis: factor VIII concentration and von Willebrand factor [vWF], Renal function tests: blood urea nitrogen and serum creatinine. Measurements time: sample were collected one day before surgery ['baseline], at 5 h and 24h after surgery. Amount of given colloids [ml], blood loss [ml] and packed RBCs [ml,] were recorded in all patients in two groups. All patients in the two groups were subjected to the some anesthetic management. Data was statistically analyzed using SPSS program version 16, a p value < 0.05 was considered statistically significant. There were significant differences with time as regard PT, PC, and INR in both groups and there was significant difference between the two groups, more increase in PT, INR and more decrease in PC in Haesteril group than in Voluven group. Voluven produced less inhibitory effect on coagulation factor VIII and Von Willibrand factor concentration and consequently, aPTT in comparison with HA ES-steril. Blood loss and transfusion requirements were less with Voluven group than with HAES-steril group. BUN and serum creatinine significantly changed over time in both groups but still within normal range in Voluven groups, but in Haesteril group there were significantly changed over time, mildly elevated above normal range and there was significant difference between the two groups with more increase in Haestril group. Compared with HAES-steril, Voluven are more likely to produce less coagulation abnormalities and less renal impairment in patients undergoing major orthopedic surgery manifested by less blood loss and less erythrocytes transfusion

Thymus and activation-regulated chemokine in children with systemic lupus erythematosus

Systemic Lupus Erythematosus [SLE] is an autoimmune rheumatic disease and glomerulonephritis is a challenging complication of SLE which is more frequent in children. Thymus and activation - regulated chemokine [TARC] is a hemostatic chemokine and TARC production is induced rapidly thus providing an important link between early innate immune responses and adaptive immunity. The aim of the present work was to measure serum TARC in SLE patients and correlate it with disease activity in patients with clinically evident lupus nephritis versus patients without lupus nephritis. This study was conducted on thirty patients [26 females and 4 males] with SLE, regularly attending the Pediatric Allergy and lmmunology Clinic Children's Hospital, Ain Shams University. Their ages ranged between 9-16 years [mean +/- SD = 13.6 +/- 2.68 years]. Lupus patients were categorized into two groups according to lupus nephritis [LN]: Group I a [with LN] and Group I b [without LN]. Results of the previous two groups were compared to a control group comprised of 40 [27 females and 13 males] age and sex matched apparently healthy subjects whose ages ranged between 10 and 16 years [mean + SD= 12.95 +/- 2.68 years]. All participants were subjected to full history taking, thorough clinical examination, urine analysis, assessment of ESR, creatinine, C3, ANA Abs, anti-dsDNA Abs and serum TARC. All SLE patients were seropositive for ANA. Serum TARC levels were statistically highly significantly [p=<0.001] elevated in all lupus patients, in Group Ia, in Group lb all respectively compared to controls and also in Group Ia versus Group lb. As regards indicators of LN, serum TARC showed statistically highly significant [p<0.001] elevated levels in patients with hematuria, edema, hypertension and anti-dsDNA positivity than in those with negative indicators of LN. Serum TARC showed statistically significant [p<0.05] positive correlation with ESR and SLEDAT score in all lupus patients, statistically highly significant [p=<0.001] positive correlation with ESR [in group I a], 24 hrs urinary proteins [in all lupus patients and group I b] and serum creatinine [in all lupus patients, group I a and group I b]. In conclusion, serum TARC levels were statistically significantly higher in all lupus patients versus healthy controls being statistically significantly higher in LN patients with versus lupus patients without nephritis. Also, serum TARC had significant positive correlation to SLEDAI score and ESR indicating its correlation with disease activity

Efficacy of viscocanalostomy technique to manage glaucoma secondary to uveitis

To evaluate the effectiveness and safety of viscocanalostomy technique in managing uncontrolled glaucoma secondary to uveitis. The study included ten eyes in ten patients with uncontrolled glaucoma secondary to uveitis in spite of maximum tolerated medical therapy. All of them were assigned to viscocanalostomy according to Stegmann's technique. A complete ophthalmologic examination was performed the day before surgery and postoperatively. The mean follow up period was 12 months. After the mean follow up of 12 months, viscocanalostomy significantly reduced IOP. The number of antiglaucoma medications had reduced postoperatively. Complications were few including hyphema and transient rise of IOP. Viscocanalostomy is a useful surgical modality for treatment of glaucoma secondary to uveitis

Urinary S-100B protein as an early biochemical indicator of hypoxic-ischemic encephalopathy after birth asphyxia in term newborn infants

Measurements of serum and cerebrospinal fluid concentrations of S-100B protein has been used to detect brain distress, and in the perinatal period are correlated with brain maturation and are used to assess cerebral damage after perinatal asphyxia. As S-100B protein is eliminated by the kidneys, and because collecting urine is a simpler procedure than collecting cerebrospinal fluid or blood, especially in high-risk infants in whom anemia attributable to repeated blood sampling is common, we aimed to investigate the relation of urinary S-100B protein to the severity of hypoxic-ischemic encephalopathy [HIE] and to the neurological outcome in full-term newborns with HIE. Routine laboratory variables neurologic patterns, ultrasound imaging, and urine concentrations of S-100B protein were determined at first urination and at 24 hours after birth in 34 infants with perinatal asphyxia and in 25 control subjects. The concentrations of S-100B protein in urine were measured using an immunoluminometric assay. Neurological examination and Denver Developmental Screening Test [DDST] were performed at 12 months in the survivors. The results were correlated with the degree of HIE, and the presence or absence of neurologic abnormalities at age 12 months. Urinary levels of S-100 protein [micro g/L] were significantly higher in asphyxiated infants with favorable outcome [group I] [0.93 +/- 0.31 at 2 hours, and 1.05 +/- 0.30 at 24 hours] and in asphyxiated infants with adverse outcome [group II] [2.62 +/- 0.92 at 2 hours and 4.78 +/- 2.11 at 24 hours] compared to controls [0.18 +/- 0.04 at 2 hours and 0.24 +/- 0.08 at 24 hours, P=0.001 for all]. Also, these levels were significantly higher in asphyxiated infants with severe HIE than infants with moderate HIE, and those with no or mild HIE, with P <0.001 [at 2 hr] and P <0.003 [at 24 hr]. S-100 levels were negatively correlated with perinatal pH in the infants and associated with abnormal CTG at admission to the labor ward. For prediction of neonatal outcome measured as severe HIE, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92.3%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97.4%. For prediction, of adverse outcome at 12 months, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97%. The use of S-100B as a pathologic marker in urine offers a tool to identify which asphyxiated infants are at risk of hypoxic-ischemic encephalopathy and its possible neurologic sequelae, and provide a new perspective for improving the monitoring and care of newborns

Recent advances in the pathophysiology of meningitis in children

Over the past decade, much has changed on the landscape of meningitis. The purpose of this study was to investigate the involvement of nitric oxide [NO] and tumor necrosis factor alpha [TNF-alpha] in the pathogenesis of childhood meningitis. We measured the concentration of NO[-][2] [a stable metabolite of NO] and TNF-alpha in serial samples of cerebrospinal fluid [CSF] from 21 children with septic and 18 with aseptic meningitis and 20 control patients without meningitis. Significantly higher CSF NO[2] concentrations were detected in those with bacterial meningitis than those with aseptic meningitis [27.6 +/- 26.8 versus 12.2 +/- 12.3 micro mol/L; P<0.001] or among non-meningitis subjects [13.2 +/- 24.2 micro mol/L; P<0.0001]. Clinical and laboratory improvement following administration of antibiotics and dexamethasone was associated with a fall in CSF [NO[-][2] to normal levels in these patients. The mean [ +/- SD] of concentration in septic meningitis was 148.74 +/- 338.77 pg/ml. There was significantly more TNF-alpha than aseptic meningitis [6.85 +/- 17.93 pg/ml; [P<0.,001] or non-meningitis [7.67 +/- 16.07 pg/ml; P<0.001]. We did not find a correlation between CSF nitrate/nitrite levels and TNF-alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha production are enhanced in the CSF compartment of children with septic meningitis and support the hypothesis that both markers are involved in the pathophysiology of septic meningitis

Relationship between negative versus positive symptoms of schizophrenia and caregiver stress in Egypt

In this study, the prevalence of stress among Egyptian mothers caring for an offspring with schizophrenia was examined. The relationship of negative versus positive symptoms of the patients and the level of perceived stress among the caregivers were also explored. A total of 41 mothers of schizophrenic patients was surveyed. The schizophrenic patients were assessed using the scale for the assessment of positive symptoms and the scale for the assessment of negative symptoms. Caregivers stress was assessed using the perceived stress scale and depression/anxiety level was examined using the hospital anxiety and depression scale. The mean level of anxiety and depression reported by caregivers was 12.1 and 11.7, respectively. A significant positive correlation was found between the perceived stress experienced by the mothers and patients' positive symptoms. On the other hand, the correlation between mothers perceived stress and the patients' negative symptoms did not reach a statistical significance

Laterality in somatization in a group of arab muslim patients

The lateralized pattern of somatic symptoms is controversial and most Western and Far East studies detected more symptoms on the left side of the body, especially pain. Additional studies are needed to determine left or right predominance of psychogenic somatic symptoms. Seventy-six right handed Arab Muslim patients with depressive disorders, anxiety disorder and somatization disorder were examined for the lateralized distribution of somatic symptoms in their body and its relationship to diagnosis. Somatic symptoms were presented more on the left side than the right side. There was no significant difference between right sided and left sided group in sociodemographic variables, such as age, gender, marital status and education. Chest and upper limb pain were significantly more on the left side, while neurological symptoms [weakness and numbness] were more significant on the right side. The results revealed that somatization is not a simply lateralized, but reflects a complex interaction of many factors and culture plays a major role in determining the lateralized pattern

Pharmacological treatment versus cognitive behavioral therapy in social phobia: a comparative study between moclobemide, paroxetine and cognitive behavioral therapy

Sixty-four patients with generalized social phobia were randomly assigned to Moclobemide, Paroxetine and cognitive behavior therapy groups for twelve weeks. The pattern of response was assessed. Response rate was 47.8, 50 and 23.4% for Moclobemide, Paroxetine and cognitive behavior therapy groups, respectively. Moclobemide was superior in reducing the somatic symptoms and interpersonal sensitivity. Paroxetine was superior in reducing global anxiety symptoms and obsessive compulsive symptoms. Both groups were superior to cognitive behavior therapy in reducing avoidance behavior. Cognitive behavior therapy was superior to Paroxetine in reducing interpersonal sensitivity