comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery

One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action. Hence, different additives have been used. Dexmedetomidine is a potent as well as highly selective alpha2 adrenergic receptor agonist. The aim of this randomized, double-blinded, study was to compare the duration of postoperative analgesia of caudal dexmedetomidine versus morphine in combination with bupivacaine in pediatric patients undergoing lower abdominal or perineal surgery. A total of 50 pediatric patients 1-5 years old The American Society of Anesthesiologists status I, II scheduled for lower abdominal and perineal surgeries were included in the study. The patients were enrolled into 2 equal groups: Group A patients [n = 25] received dexmedetomidine with bupivacaine while Group B patients [n = 25] received morphine with bupivacaine. Patients were placed in a supine position then inhalational general anesthesia was induced, and laryngeal mask airway [LMA] was placed. Patients were then given caudal epidural analgesia. By the end of surgery reversal of muscle relaxation was done and the LMA was removed. Post-operatively, the sedation as well as pain score were observed and recorded. The current study showed that minor complications were recorded in the post-anesthesia care unit; in addition, significantly longer periods of analgesia and sedation were detected in Group A. However, no signifi cant differences in demographic data, as well as in the duration of surgery, and the time of emergence from anesthesia and patient condition during recovery were detected. The present study suggested that use of dexmedetomidine, during single dose injection, as an additive to the local anesthetic bupivacaine in caudal epidural analgesia prolongs the duration of post-operative analgesia following lower abdominal as well as perineal surgery compared with caudal morphine with no side effects on the vital signs. Postoperative side effects were seen with caudal morphine injection rather than with dexmedetomidine.

Histological and histochemical studies of the skin of some fresh-water teleost fishes

The present work conducted on 28 specimens of adult fresh water fishes collected from the Nile River [at Giza and El Qanater]. Four types of fresh water fishes were used Bayad [Bagrus bayad], Karmout [Clarias lazera], Nile Eel [Anguilla vulgaris] and Bolti [Tilapia nilotica]. The epidermis could be divided into three distinct layers. There were lymph spaces between the germinal cells. Various types of unicellular glands in the epidermis as sacciform glands in Bayad and Karmout; club cells in the epidermis of Nile Eel and mucous cells in the epidermis of all fishes. The mucous cells gave positive reaction to both PAS and AB stains. The sacciform slime secreting gland were unicellular glands surrounded by the epidermal cells themselves. The secretory materials they contained were PAS and AB negative. The club cells were recorded in the epidermis of Nile Eel. They were large in size, wedged between the epidermal cells. The contents of the glands were negatively reacted to both PAS and AB stains. The dermis was formed of spongy layer [stratum spongiosum] and compact layer [stratum compactum]. In the spongy layer the blood vessels occur forming, just under the basement membrane, a dense sub-epithelial net. A layer of pigment cells, supplied with blood capillaries in the loose connective tissue below the basement membrane and a second layer at the deeper part of the dermis were noticed. The epidermis of Bayad, Karmout and Bolti contained taste buds. The taste buds appeared flask-shaped and were embedded in the epidermis

T-cell cytokine production and endothelial dysfunction in type 2 diabetic patients with nephropathy

This study assessed changes in serum levels of cytokines IFNgamma and IL-10 [biomarkers of inflammatory changes] and soluble biomarkers sICAM-1 and sE-selectin [biomarkers of endothelial dysfunction] in diabetic patients with and without nephropathy. IFNgamma and IL-10 were significantly elevated in patients with diabetic nephropathy [DN] and end-stage renal disease [ESRD] compared with controls and diabetic patients without DN. IFNgamma and IL-10 levels were significantly increased after haemodialysis. sICAM-1 and sE-selectin were significantly higher in diabetic, DN and ESRD groups compared with controls, and sICAM-1 but not sE-selectin was increased after haemodialysis

Total intravenous anesthesia versus inhalational anesthesia in patients undergoing laparoscopic cholecystectomy. A comparative study of postoperative subclinical hepatic dysfunction

Inhalational anesthetics are reported to cause mild liver dysfunction in some cases. This dysfunction reflected as asymptomatic transient elevation in liver enzyme. On the other hand no reports have indicated that total intravenous anesthetics [TIVA] cause liver or other organ dysfunction. In addition the use of TIVA become popular due to the availability of new drugs which have short acting effects and TIVA technique produce less air pollution. 40 patients undergoing laparoscopic cholecystectomy were randomized into two equal groups. The first group received inhalational anesthesia. Anesthesia induced with fentanyl 2 microg/kg, atracurium 0.5 mg/kg, propofol 2.5mg/kg and was maintained using sevoflurane 2-3%, nitrous oxide 66% in oxygen with atracurium infusion at rate of 0.5 mg/kg/hr. The second group received TIVA. Anesthesia was induced with fentanyl 2 microg /kg and atracurium 0.5 mg/kg and propofol 2.5 mg/kg. and anesthesia was maintained using propofol infusion using a syringe pump at a rate of 10 mg/kg/hr for 10 mm then 8 mg/kg for the next 10 mm and finally maintained at 6mg/kg/hr with nitrous oxide 66% in oxygen and muscle relaxation was maintained with infusion of atracurium in rate of 0.5 mg/kg/h. Liver enzymes were measured preoperative, at the end of operation, 3h, 6h, and 24 hours postoperative and compared to the preoperative values. There were transient significant increase in the values of AD, GST, and AST in inhalational group and ALT significantly increased in both groups. There were insignificant changes in hemodynamic parameters. TIVA technique is superior to inhalational technique during laparoscopic cholecystectomy as regards its effect on the liver enzymes

Biocompatible dialysis membranes and oxidative stress in patients with end-stage renal disease on maintenance haemodialysis

Oxidative stress has been shown in [ESRD] patients specially those receiving regular haemodialysis [HD] in relation with an increased production of toxic free radicals due to membrane-induced complement leukocyte activation. An imbalance between oxidants and antioxidants has been suggested in uremic patients on HD. The respective influence of uremia and dialysis procedure has not been evaluated. Studies that have probed into the mechanism of oxygen radical production have implicated the bio-incompatibility of dialysis membranes. The effect of different dialysis membranes on lipid, lipoproteins, lipid peroxidation and total antioxidant capacity in ESRD patients on regular HD was studied. One hundred subjects were selected; 20 healthy controls, 20 chronic renal failure [CRF] patients on conservative drug management and 60 CRF patients on maintenance HD [20 dialyzed by polysulfone, 20 by hemophan and 20 by cuprophane membranes]. All patients were matched for age, sex, gender and etiology of ESRD and HD patients for duration of dialysis. In addition to routine tests [Hb% and creatinine clearance in healthy control group and CRF patients on conservative management], total cholesterol, triglycerides, high density lipoprotein [HDL-C] and low density lipoprotein [LDL-C], apolipoprotein A [Apo A], apolipoprotein B [Apo B], serum malondialdehyde [MDA] and plasma total antioxidant status [TAS] were estimated. MDA was significantly higher and TAS was lower in uremic patients treated conservatively or by HD than in controls. MDA was significantly higher in HD than CRF patients on conservative management with least significant difference in HD patients treated by polysulfone followed by hemophan and then cuprophane membrane, while only cuprophane group showed lower levels of TAS compared to CRF patients on conservative management. HDL-C and Apo A was higher in polysulfone and hemophan than cuprophane group while triglyderide was lower. Polysulfone group showed lower levels of LDL-C than both cuprophane and hemophane groups thus providing less atherogeflic lipid profile. There was a positive correlation between Hb% and TAS and a significant negative correlation between MDA and Hb%. There was a significant negative correlation between TAS and duration of dialysis in HD patients. In CRF patients on conservative management we obtained a significant positive correlation with TAS and a significant negative correlation with MDA