ABSTRACT
Objective:To investigate the efficacy of the placement of two towels around uterus before delivery of fetes upon the incidence of intraoperative shoulder tip pain (STP) during cesarean section.Methods:Two hundred and sixty parturient were scheduled to undergo elective cesarean section under spinal anesthesia were randomized to do packing around the uterus before uterine incision or placebo (control group). The primary outcome was the incidence of intraoperative shoulder pain. Secondary outcomes were operative time, amount of intraoperative blood loss, incidence of hypotension, and the Need of post-opertive morphine.Results:Shoulder tip pain was recorded only in 7 cases (5.4%) in towel placement group compared to 25 cases (19.2%) in placebo group (P value, 0.001). The need of post-operative morphine was statistically significant lower in Towel placement group (33.8%) compared to (47.7%) in control group (P value, 0.023).Conclusion:Packing around the uterus just before uterine incision decreases the incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section
ABSTRACT
Bacterial sepsis is a life-threatening event. Some cytokines and recently, nitric oxide [NO] have been incriminated in the pathogenesis of sepsis, especially in the mechanisms by which sepsis progresses to septic shock. The aim of the present work is to determine whether NO level is increased in neonates with bacterial sepsis and if it is related to the levels of the inflammatory mediators namely interleukin-6 [/L-6] and tumor necrosis factor-alpha [TNF-alpha]. The study was conducted on twenty neonates with bacterial sepsis proved by history, clinical examination and laboratory investigations. Ten healthy age and sex matched-neonates were taken as a control. All cases were subjected to blood, cerebrospinal fluid and urine cultures and estimation of serum tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6] and serum NO [nitrite+nitrate] [the stable and catabolic products of NO]. Neonates with bacterial sepsis had a significantly higher serum TNF-alpha serum /L-6 and serum NO [nitrite + nitrate] than controls. There were significant positive correlations between serum levels of TNF-alpha [ng/ml], 12-6 [pg/ml], NO [nitrite +nitrate] [[micro mol/L] and I/T leukocytic ratios, Complete cure had occurred in 14 cases [70%], while 6 cases had succumbed [30%]. All succumbed cases had low systolic pressure <50 mmHg and oliguria, a picture denoting septic shock. In conclusion, levels of serum IL-6, TNF-alpha and plasma nitric oxide are elevated in neonatal septicemia. However, these mediators may be prognostic for survival rather than diagnostic, since, immature/total leukocytic ratio is still a rapid and easy method for suspicion of the case, together with the clinical picture