Production of recombinant streptokinase from Streptococcus pyogenes isolate and its potential for thrombolytic therapy

To produce an effective recombinant streptokinase [rSK] from pathogenic Streptococcus pyogenes isolate in yeast, and evaluate its potential for thrombolytic therapy. This study was conducted from November 2012 to December 2013 at King Khalid University, Abha, Kingdom of Saudi Arabia [KSA]. Throat swabs collected from 45 pharyngitis patients in Asser Central Hospital, Abha, KSA were used to isolate Streptococcus pyogenes. The bacterial DNA was used for amplification of the streptokinase gene [1200 bp]. The gene was cloned and in vitro transcribed in an eukaryotic expression vector that was transformed into yeast Pichia pastoris SMD1168, and the rSK protein was purified and tested for its thrombolytic activity. The Streptococcus pyogenes strain was isolated and its DNA nucleotide sequence revealed similarity to other Streptococcus pyogenes in the Gene bank. Sequencing of the amplified gene based on DNA nucleotide sequence revealed a SK gene closely related to other SK genes in the Gene bank. However, based on deduced amino acids sequence, the gene formed a separate cluster different from clusters formed by other examined genes, suggesting a new bacterial isolate and accordingly a new gene. The purified protein showed 82% clot lysis compared to a commercial SK [81%] at an enzyme concentration of 2000 U/ml. The present yeast rSK showed similar thrombolytic activity in vitro as that of a commercial SK, suggesting its potential for thrombolytic therapy and large scale production.

Management of symptomatic ureteral calculi during pregnancy: experience of 23 cases

To present our experience in the management of symptomatic ureteral calculi during pregnancy. Twenty-three pregnant women, aged between 19 and 28 years presented to the obstetric and urology departments with renal colic [17 cases, 73.9%] and fever and renal pain [6 cases, 26.1%]; suggesting ureteric stones. The diagnosis was established by ultrasonography [abdominal and transvaginal]. Outpatient follow-up consisted of clinical assessment and abdominal ultrasonography. Follow-up by X-ray of the kidneys, ureter, and bladder [KUB], or intravenous urography [IVU] was done in the postpartum period. Double J [DJ] stent was inserted in six women [26%] with persistent fever followed by extracorporeal shock wave lithotripsy [ESWL] one month post-partum. Ureteroscopic procedure and pneumatic lithotripsy were performed for 17 women [distal ureteric stone in 10, middle ureter in 5, and upper ureteric stone in 2]. Stone-free rate was 100%. No urologic, anesthetic, or obstetric complications were encountered. Ureteroscopy, pneumatic lithotripsy, and DJ insertion could be a definitive and safe option for the treatment of obstructive ureteric stones during pregnancy

Histological changes in adult rat pancreas upon chronic administration of aspartame

Aspartame is the most popular artificial sweetener consumed by many individuals worldwide. Yet, there is still a debate on its consumption as an alternative to sugar. Further studies are warranted to assess the effects of aspartame on pancreas morphodynamics. The present study aimed to evaluate the effects of chronic aspartame administration on the histological structure of rat pancreas. Twenty male albino rats aged 3 months were divided into two equal groups: a control group [group I] and an experimental group [group II], which included rats that received 250 mg/kg/day aspartame once daily for 6 months. The pancreatic tails were processed for light and electron microscopy. The pancreatic islets were evaluated by immunohistochemical stain for the identification of insulin-secreting beta cells. In group II, binucleated acinar cells, prominent nucleoli, and a relative decrease in secretory granules were observed. Some islet cells showed an acidophilic granular cytoplasm and deeply stained nuclei. A strong positive immunoreaction for insulin was observed in beta cells. Ultrastructurally, acinar cells showed euchromatic nuclei with multiple nucleoli. The proliferation and dilatation of rough endoplasmic reticulum had occurred with disturbed cell polarity. Secretory granules were deficient in most acinar cells. beta Cells showed an apparent increase in the amount of secretory granules, especially immature ones, and a variable degree of vacuolation. Chronic administration of aspartame to adult rats could exert a hyperstimulatory effect on pancreatic acinar and beta cells, leading to the risk of development of pancreatitis and/or diabetes

Toxic effect of cisplatin on cerebellar cortex and spinal cord of adult male albino rat and the possible role of vitamin E: light and electron microscopic study

The nervous system is frequently the site of symptomatic toxicity of antineoplastic agents, cisplatin is a widely used potent chemotherapeutic agent that is highly neurotoxic. It has been proven that it is able to generate reactive oxygen species and inhibit the activity of antioxidant enzymes. This study was carried out to demonstrate the neurotoxic effects of cisplatin on the structure of adult rat cerebellum and spinal cord, and the role of vitamin E which has been shown to ameliorate hephro, oto and neurotoxicities induced by cisplatin. Thirty adult male albino rats weighing 200-250 gm were divided into three groups: Group one: kept as a control. Group two: animals treated with cisplatin at a dose of 4mg/kg twice weekly by intraperitoneal injection, for one month. Group three: animals treated with vitamin E at a dose of 100mg/kg by intramuscular injection in concomitant with cisplatin twice weekly for one month. Animals were sacrificed and their cerebella and spinal cords were processed for light and electron microscopy. Morphometrical and statistical study was done for the mean number, as well as the mean surface area of Purkinje cells and mean surface area of their nuclei. The histological approach revealed marked degenerative changes in the Purkinje cells and motor ceurons of cisplatin treated animals [Group II]. Some of these cells appeared irregular with deeply stained cytoplasm and pykontic nuclei. Ultrastructural examination showed Purkinje cells with cellular shrinkage, damaged organelles and irregular nuclei with electron dense karyoplasms. Significant degenerative changes in the motor neurons and blood capillaries of the anterior horn of the spinal cord in the same group were frequently observed. Morphometric evaluations demonstrated significant decrease in the mean number and the mean surface area of nuclei and cell bodies of Purkinje cells. These structural and morphometrical alterations were much less observed in concomitant use of vitamin E with cisplatin [Group III]. Cerebellum and spinal cord are considered the target areas of cisplatin neurotoxicity, while vitamin E, when used in combination with cisplatin displays a protective action against neurotoxicity

Effect of cisplatin on the cerebellar cortex and spinal cord of adult male albino rat and the possible role of vitamin e: light and electron microscopic study

The nervous system is frequently the site of symptomatic toxicity of antineoplastic agents. Cisplatin is a widely used potent chemotherapeutic agent that is highly neurotoxic. It has been proven that it is able to generate reactive oxygen species and inhibit the activity of antioxidant enzymes. This study was carried out to demonstrate the neurotoxic effects of cisplatin on the structure of adult rat cerebellar cortex and motor neurons of the anterior horn of the spinal cord and to evaluate the role of vitamin E which has been shown to ameliorate nephro, oto and neurotoxicities induced by cisplatin. Thirty adult male albino rats weighing 200-250 gm were divided into three groups: Group [I]: Kept as a control. Group [II]: Animals treated with cisplatin at a dose of 4 mg/kg twice weekly by intraperitoneal injection, for one month. Group [III]: Animals treated with vitamin E at a dose of 100 mg/kg by intramuscular injection in concomitant with cisplatin twice weekly for one month. Animals were sacrificed and their cerebellar cortex and spinal cords were processed for light and electron microscopy. Morphometrical and statistical study was done for the mean number, as well as the mean surface area of Purkinje cells and mean surface area of their nuclei. The histological approach revealed marked degenerative changes in the Purkinje cells and motor neurons of cisplatin treated animals [GII]. Some of these cells appeared irregular with deeply stained cytoplasm and pykontic nuclei. Ultrastructural examination showed Purkinje cells with cellular distortion, damaged organelles and irregular nuclei with electron dense karyoplasms. Degenerative changes in the motor neurons and blood capillaries of the anterior horn of spinal cord of the same group were frequently observed. Morphometric evaluations demonstrated significant decrease in the mean number and the mean surface area of nuclei and cell bodies of Purkinje cells. These structural and morphometrical alterations were much less observed in concomitant use of vitamin E with cisplatin [GIII]. Cerebellar cortex and spinal cord motor neurons are considered target areas of cisplatin neurotoxicity, while vitamin E, when used in combination with cisplatin displays a protective action against neurotoxicity

Effect of fluoride on rat cerebellar cortex: light and electron microscopic studies

Fluoride accumulation in the brain of experimental animals was particularly observed in the hippocampus. It caused altered neuronal and cerebrovascular integrity, abnormal behavioral patterns and metabolic brain lesions. Fluoride affected indeed the cerebellar development in mice but its effect on adult rat cerebellar cortex is something awaits further investigation. Is to define the effects of fluorosis on the histological structure of adult rat cerebellar cortex. A total number of 40 adult female albino rats were used. They were divided into two groups [20 animals each]. Group I: Was kept as control group, received distilled water orally daily by gastric tube for 2 months. Group II: Received sodium fluoride orally [dissolved in distilled water] at a dose of 12 mg/Kg body weight for two months. Samples from cerebella were taken and processed for light and electron microscopic investigation. After fluoride treatment, features of neurodegeneration were observed. The Purkinje cells appeared shrunken, deeply stained, with multilayer disposition, which was confirmed by morphometric evaluation of the Purkinje cell layer thickness. Ultrastructurally, increased infolding of nuclear envelope, mitochondrial alterations, dilated Rough endoplamic reticulum cisternae and clusters of vesicles near the Golgi bodies were observed. Apoptotic granule cells accumulated in a clumping manner, Bergmann astrocytes with features of increased activity, dilated and congested blood capillaries were noticed. GFAP positive cells were more abundant and appeared larger in the three cortical layers of treated animals associated with positive reaction for inducible nitric oxide synthase [iNOS] compared to negative reaction in control animals. The cerebellar cortex was particularly susceptible to sodium fluoride- induced oxidative stress and could contribute to the development of neurodegenerative diseases

Biological importance of marine algae

Marine organisms are potentially prolific sources of highly bioactive secondary metabolites that might represent useful leads in the development of new pharmaceutical agents. Algae can be classified into two main groups; first one is the microalgae, which includes blue green algae, dinoflagellates, bacillariophyta [diatoms]. etc., and second one is macroalgae [seaweeds] which includes green, brown and red algae. The microalgae phyla have been recognized to provide chemical and pharmacological novelty and diversity. Moreover, microalgae are considered as the actual producers of some highly bioactive compounds found in marine resources. Red algae are considered as the most important source of many biologically active metabolites in comparison to other algal classes. Seaweeds are used for great number of application by man. The principal use of seaweeds as a source of human food and as a source of gums [phycocollides]. Phycocolloides like agar agar, alginic acid and carrageenan are primarily constituents of brown and red algal cell walls and are widely used in industry

Evaluation of the role of garlic on the structure of liver and gastric mucosa in aged male albino rat: a histological and histochemical study

Age related changes in the hepatic and gastric tissues have been discovered and are considered to be implicated in the pathogenesis of some diseases. To evaluate the effect of garlic as a prophylactic or a therapeutic tool against age related changes in the liver and stomach. 80 male albino rats were used. Classified into four groups: group 1: 15 rats served as control adult, group 2: 15 rats served as control aged, group 3: 25 adult rat treated with Tomax in a dose of 100 mg/kg orally daily till aging and group 4: 25 aged rats treated with Tomax in the same previous dose for 4 months. Animals were sacrificed and specimens from the liver and stomach were prepared for light and electron microscopy. Light and electron microscopic examination of liver and stomach of group 1 revealed the normal structure. Age related changes were detected in group 2 in the form of vacuolation of cells lining the gastric glands and disturbed hepatic architecture. Ultrastructurally, degenerative changes in parietal and chief cells were observed. Hepatocytes showed variable sized nuclei with marginated hetero chromatin clumps, areas of rarified cytoplasm, fragmented endoplasmic reticulum and interrupted cell membrane. Tomax treatment in group 3 greatly improved the aging changes in liver and gastric mucosa. Decreased vacuolation of gastric epithelial cells and restored hepatic architecture were observed. Ultrastructural degenerative changes were less pronounced in both tissues. In group 4 there was no obvious improvement but they were more or less similar to group 2. It could be concluded that garlic could be used as a prophylactic measure against age induced structural changes in the liver and stomach rather than being used as a therapeutic one

Assessment of lung cancer risk due to exposure to radon from coastal sediments

We conducted a lung cancer risk assessment for internal exposure to naturally occurring [222]Rn gas both indoor and outdoor. A series of equations were used to estimate Rn concentrations indoor and outdoor and the associated lung cancer risk in some coastal regions in Egypt. The mean [222]Rn concentrations were 42.98 [SD 33.12] Bq/m[3] and 8.63 [SD 6.16] Bq/m[3] indoor and outdoor respectively. The mean risk of radon-induced cancer [deaths per million population] was 83.4 [SD 64.67] indoors and 25.1 [SD19.52] outdoors. Levels were higher for western regions of the country compared to eastern ones but the highest levels were in Rashid [Nile delta]. Smoking was shown to increase the risk considerably

Shock wave lithotripsy treatment of radiolucent renal stones: a simple alternative

Objective: To evaluate a simple procedure for dealing with radiolucent renal pelvic stones larger than 2cm using combined ureteric catheter [for stone localization] and double-J stent [for prophylaxis of stein-strasse] prior to shock wave lithotripsy [SWL]

Methods: Thirty-five patients [21 males and 4 females] with single radiolucent stone in the renal pelvis were entered in this study in the period from Feb. 2003 to March 2007. The average stone size was 25mm [range from 20 to 30 mm]. Patients underwent initial ureteric catheter insertion followed by double-J stent and referred to SWL unit. The stone localized by contrast medium injected in the catheter throughout the lithotripsy session then the catheter was removed leaving the stent. Patients were followed up 10 days post lithotripsy by ultrasonography and I.V.P or non contrast spiral C.T scanning to detect the residual stones

Results: The success rate was 91% [32 patients] 10 days after lithotripsy. Three patients [9%] showed significant residual fragments. Those patients required oral chemolysis for stone dissolution. There was no adverse reactions of contrast medium and there was no significant complications intra or post-operatively

Conclusion: Shock wave lithotripsy for radiolucent renal pelvic stones with help of contrast medium injected through a ureteric catheter is a minimally invasive technique with a high success rate. It can be considered as a simple alternative to traditional treatment modalities for radiolucent stones

Moyamoya syndrome as a risk factor for stroke in Saudi children. Novel and usual associations

To report on moyamoya syndrome [MMS] as a risk factor for stroke in a prospective and retrospective cohort of Saudi children. The usual and novel associations of MMS in this cohort will also be described. Children with stroke were evaluated at the Division of Pediatric Neurology at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the periods July 1992 to February 2001 [retrospective study] and February 2001 to March 2003 [prospective study]. Investigations for suspected cases included hemostatic assays, biochemical, and serological tests. Neuroimaging included CT, MRI, magnetic resonance angiography [MRA], single photon computerized tomography [SPECT] brain scan and conventional cerebral angiography. Moyamoya syndrome was the underlying risk factor for stroke in 6 [5.8%] of the 104 children [aged one month to 12 years]. They were 4 females and 2 males. Their first cerebral ischemic event occurred at a mean age of 45 months [median = 44 months, range 17-66 months]. In all 6 cases, MMS was associated with an underlying hematologic abnormality or other diseases. Protein C deficiency was identified in one girl and protein S deficiency in another. Two patients had respectively, sickle cell disease [SCD] and sickle cell-B-thalassemia [S beta-thalassemia], which had been associated in the latter with membranous ventricular septal defect. Adams-Oliver syndrome [AOS, OMIM 100300] was associated with MMS in an 18-month-old girl. A 4-year-old boy had wrinkly skin syndrome [WSS, OMIM 278250] phenotype. The association of MMS and protein C deficiency was first reported in this cohort of patients, whereas the association of the syndrome with WWS and AOS has not, hitherto, been described. The 3 patients who had MMS associated with protein C deficiency, SCD, and AOS underwent successful revascularization surgery in the form of encephaloduroarteriosynangiosis. Moyamoya syndrome constitutes an important risk factor of stroke in Saudi children. Comprehensive clinical evaluation and investigations, including screening for thrombophilia and neuroimaging studies, are required for the primary diagnosis of the disease and for unraveling other diseases associated with MMS. This will help in managing these patients and in guiding genetic counseling for their families.

Fluid-fluid level in Langerhans cell histiocytosis of the skull

We present a case of solitary eosinophilic granuloma in the skull of a 6-year-old Saudi boy. This osteolytic lesion has fluid-fluid level on CT and MRI. We are presenting a rare radiological finding of eosinophilic granuloma

Food composition and feeding habits of some fresh water fishes in various water systems at Abbassa, Egypt, with special reference to snails transmitting diseases

Study of feeding habits of freshwater fishes collected from ponds at World Fish Center [ICLARM] showed that the African catfish, Clarias gariepinus and Forskal catfish, Bagras bayad had the highest proportion of full stomachs [31-58% and 44-45% respectively]. In cichlid fishes, the rate of full stomachs was much lower, being 0.0-12.5% and showed higher incidence of empty stomachs that varied from 37.5% for Oreochromis niloticus to 78.3% for Sarotherodon galilaeus. Food items were analyzed by the percentage of point assessment [P%], abundance [N%] and frequency of occurrence [F%]. Results of the three methods of analyses [Index of relative importance. I.R.I] emphasized the importance of plants [1214.7] as a major food resource in the stomach of Nile tilapia, O. niloticus followed by shell fragments [628.5], whereas, snail soft bodies were the main food category in the diet of hybrid tilapia O. niloticus x O. aureus [2539.3]. Shell fragments [652] and snail soft bodies [296.9] were the 1st in relative importance as foods of O. aurea. In case of S. galillae, shell fragments [338] came 2nd in I.R.I. after plants [559]. Present investigation shows that shell fragments were represented by 11.1% and 15.1% in the diet of African catfish, C. gariepinus by [N%] and [P%] methods, however, they came as the second food item in its diet by I.R.I [1237.3]. According to F% method, both shell fragments and Crustacea were present in the diet of C. gariepinus in considerable proportions each of 47.4%. Shell fragments were represented by low proportions in the diet of B. bayad 3.9, 2.1 and 22.2 by N%, P% and F% respectively

Tubularization of the incised urethral plate [Snodgrass procedure] for distal and midpenile hypospadias repair

To evaluate tubularized incised plate urethroplasty [TIPU] in management of distal and midpenile hypospadias. Thirty-two boys [mean age 5.4 years] underwent tubularized incised plate urethroplasty.Twenty-five boys had distal and seven had mid-penile hypospadias. The operation -involved incision of the urethral plate, which was, then tubularized [Snodgrass procedu re]. The neourethra was then covered with a deepithelialized pedicled dartos flap from the inner prepuce before glans and skin closure. With a mean follow-up of 10 months [range 3-14], there were seven complications. Four patients developed a fistula, spontaneous closure occurred in two cases by regular dilatation while the remaining two cases required surgical closure. Two patients had meatal stenosis and responded to meatal dilatation and one patient had complete breakdown of the neourethra. The cosmetic appearance in the other patients is that of a normal slit-like terminal meatus. Tubularized incised plate urethroplasty is considered to be a successful technique for correction of distal and midpenile hypospadias with few complications and superior cosmetic results

Comparison of tubularized incised plate urethroplasty [Snodgrass] and perimeatal based flap [Mathieu] in primary distal hypospadias

To determine whether the tubularized incised plate urethroplasty [Snodgrass] or the perimeatal-based flap [Mathieu] is the more appropriate treatment of distal hypospadias in terms of complication rate, operative time duration and cosmesis of the meatus. Between January 1999 and May 2000, 60 children having primary distal hypospadias were randomized in two equal groups. Thirty patients underwent tubularized incised plate urethroplasty [Snodgrass] and thirty underwent a penmeatal-based flap [Mathieu]. The operative time duration, cosmesis of the meatus as well as the complication rate of both techniques are determined. The mean duration of surgery was significantly lower for Snodgrass procedure than for Mathieu repair [90 vs. 130min, P < 0.05]. Four children undergoing Mathieu repair had complications [13%] compared with only one in the Snodgrass Group [3.3%]. The resultant meatus was slit-like in patients undergoing Snodgrass whereas those with Mathieu had a rounded or horizontal meatus. The overall complication rate was lower and the surgery was significantly quicker with the Snodgrass, which also had a better cosmetic outcome. The Snodgrass procedure could be recommended as a primary treatment for distal hypospadias

clinical comparison of prolonged sevoflurance versus isoflurane anesthesia

This study aimed to determine whether prolonged anesthesia with either sevoflurane [S] or isoflurane [I] can produce clinically significant effect on the renal, hepatic and hematologic condition of patients undergoing prolonged orthopedic reconstructive surgeries lasting approximately ten hours. After ethical approval and an informed consent from each patient were obtained before surgery. The patients were classified into two groups according to the anesthetic agent[s], either S group [n = 15] or I group [n = 20]. It was concluded that sevoflurane is at least has comparable effects to isoflurane, and both can be used safely without major hepatorenal or hematological side effects in such type of prolonged surgery

Herpes simplex 1,2 viruses as a risk factor in benign and malignant laryngeal tumors

The aim of this work was to study HSV1,2 as a risk factor in laryngeal tumors through the detection of the virus DNA using polymerase chain reaction [PCR]. The study group consisted of 40 patients presented by laryngeal masses. Biopsy was taken by direct laryngoscopy and each specimen was divided into two portions; one for histopathological study and according to its results the patients were divided into two groups: Group A, 20 patients, with mean age 58.7 years, having malignant laryngeal tumors and group B, 20 patients with mean age 34.4 years, having benign laryngeal tumors. The other portion of the specimen was examined using PCR for detection of herpes simplex 1,2 viruses DNA. The study showed that 55% of patients in group A [11 out of 20 patients with malignant laryngeal tumors] were positive for HSV1,2 DNA by PCR, while in group B [patients with benign laryngeal masses], all patients were negative for HSV1,2 DNA by PCR. The histopathological study showed that all malignant tumors in group A were invasive squamous cell carcinoma [SCC] with the highest percentage in grade I [40%]

Purification and characterization of alkaline phosphatase from pseudomonas aeruginosa 50071

Alkaline phosphatase was purified to homogeneity from Pseudomonas aeruginosa 50071 starting with heat treatment at 60°C in the presence of Co[2]+ and ammonium sulphate fractionation, followed by separation on DEAE-Sephadex A50 and G-100 Sephadex gel filtration. The enzyme was purified 468 fold and showed a final specific activity of 51.5 unit/mg protein with a yield 42%. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis [SDS-PAGE] of the purified enzyme revealed a single protein band of molecular weight 82 KDa. The molecular weight of the native enzyme was calculated to be 158 KDa, as determined by gel filtration, which approximated to two subunits together [164 KDa] suggesting a homogeneous dimeric structure of the enzyme. The enzyme showed a maximum activity at pH 9.5 when incubated at 37°C. A Lineweaver-Burk analysis gave a K[m] of 2.1 mM and V[max] of 8.0 U/ml. The enzyme activity was enhanced by addition of CoCl[2] and ZnCl[2] together. The amino acid composition of the purified enzyme was also determined

Corralation between snails and fish in fish ponds of world fish center [ICLARM] with spicial refernce to snail vectors of schistosomiasis and fascioliasis

The abundance of snail species in earthen fish ponds, irrigation and drainage canals at World Fish Center [ICLARM] in a descending order was Bellamya unicolor [50.89%] > Physa acuta [18.94%] > Cleopatra bulimoides [7.6%] > Lanistes carinatus [6.73%] > Bulinus truncatus [5.19%] > Melanoides tuberculata [4.83%] > Lymnaea natalensis [3.14%] > Gabbiella senaarensis [0.9%] > Biomphalaria alexandrina [0.55%] > Lymnaea truncatula [0.4%] > Planorbis planorbis and Succinea cleopatra [0.33%] > Ferrissia isseli [0.18%]. The dead snails constituted about 5.19% of all the collected specimens. There was a dramatic decrease in the total number of pulmonates in fish ponds, which contained only Tilapia sp., and a very small number of cat fish, whereas the numbers of Prosobranchia snails were much higher in these ponds. In fish Ponds, which accommodated a variety of fish species, the most dominant snail was B. unicolor, followed by L. carinatus. However, pulmonate snails were absent in these ponds. B. Truncatus was the only snail species found in concrete tank, which contained only young tilapias with a very small size [5-8 cm in standard length]. In irrigation canals, the number of snails and diversity was much higher than those in fish ponds. Out of 191 snails collected from inlet irrigation canal, 71 were dead, but in the outside irrigation canals, 7 out of 564 snails were dead. P. acuta was absent in all examined fish ponds, but it was alive and occurred in a high number [497 snails] in the outside irrigation canals. The number of snails collected from Bahnasawy drain was remarkably low [128 snails]; however, the diversity of snails was much higher compared with those in fish ponds and irrigation canals. Snail populations were stable with constant recruitment of young to adult snails for all the studied species

Efficacy of preemptive, continuous, thoracic paravertebral nerves block with ropivacaine 0.5% in relieving post-thoracotomy pain

The purpose of our study was to evaluate the efficacy of preemptive, continuous paravertebral block to relief post-thoracotomy pain after open heart surgery. to help weaning from mechanical ventilation. Also, to study its effect on pulmonary function tests postoperatively, and any complication that occurs. Patients were classified into two groups, 20 patients each In the paravertebral group, 20 patients with paravertebral catheter inserted at the 4th thoracic space before induction of anesthesia. Postoperative pain relief was achieved by preemptive injection of 20 ml of 0.5% ropivacaine through the paravertebral catheter, followed by continuous infusion at a rate of 0.1 ml /kg/ hr of ropivacaine 0.5% during the perioperative period and 5 days postoperatively. In the control group, 20 patients were the postoperative analgesia was achieved by IM injection of 5 mg morphine 6 hrs starting at the end of the surgery and for 5 days postoperatively. In both groups, 20 mg pethidine was injected IV. if pain scoring was 3. postoperative data collected: time to extuhatlon when criteria for extubation were fulfilled. pain score [VAS] at rest, on coughing, respiratory rate. FVC. PEFR/6 hrs for 48 hours postoperatively, total dose of pethidine used and any untoward effects. Both groups were comparable as regard age, duration of CPB and duration of surgery, but the time from admission to ICU till extubation was significantly shorter in the paravertebral group than in the control group [4.8 +/- 3.3 hours vs 6.3 +/- 4.5 hours]. The visual analogue pain scores were significantly lower in both groups at all time of measurements compared to full recovery score both at rest and on coughing. The paravertebral group has significant lower VAS pain score when compared to the control group at all time of measurements. The pethidine consumption was significantly less in the paruvertehrul group throughout all the study period. The respiratory rate decrease insignificantly in paravertebral group compared to preoperative value. In contrast, the decrease in respiratory rate was significant in the control group. There was significant difference between groups with lower rate in the control group at 12 hours till 36 hours postoperatively. The FVC and PEFR decreased significantly at recovery when compared with the preoperative value in both groups and then gradually increased during the 48 hours postoperatively. After recovery which was comparble in both groups, both had significantly lower values in the control group compared to the paravertebral group. Oxmietre recordings were significantly better in the paravertebral group throughout the 5 days study period compared with the control group. After full recovery, no patient in either group had a sedation score >2 throughout the study time, although patients in the control group were significantly more sedated till the 4th day postoperatively than in the paravertebral group. Nausea and vomiting occurred more frequently in the control group [8/5 vs 2/2] [P< 0.05]. Hypotension, after weaning from inotropes occurred only in 2 patients in the control group [P> 0.05]. Urinary retention after removal of urinary catheter occurred more frequently in the control group [11 vs 2] [P<0.001].There was no difference between group in the duration of ICU stay [3.9 vs 3.1 days]. We concluded that continuous paravertebral block, beginning before operation was highly effective for post-thoracotomy pain. In this study, we found that paravertebral analgesia was superior in terms of analgesia, pulmonary function and side effects then IM morphine