Blocking Toll-like receptor 9 attenuates bleomycin-induced pulmonary injury

Background@#Acute respiratory distress syndrome (ARDS) is one of the most common complications in coronavirus disease 2019 patients suffering from acute lung injury (ALI). In ARDS, marked distortion of pulmonary architecture has been reported. The pulmonary lesions in ARDS include hemodynamic derangements (such as alveolar edema and hemorrhage), vascular and bronchiolar damage, interstitial inflammatory cellular aggregations, and eventually fibrosis. Bleomycin induces ARDS-representative pulmonary damage in mice and rats; therefore, we used bleomycin model mice in our study. Recently, Toll-like receptor 9 (TLR9) was implicated in the development of ARDS and ALI. @*Methods@#In this study, we evaluated the efficiency of a TLR9 blocker (ODN2088) on bleomycin-induced pulmonary damage. We measured the apoptosis rate, inflammatory reaction, and fibroplasia in bleomycin- and bleomycin + ODN2088-treated mice. @*Results@#Our results showed a significant amelioration in bleomycin-induced damage to pulmonary architecture following ODN2088 treatment. A marked decrease in pulmonary epithelial and endothelial apoptosis rate as measured by cleaved caspase-3 expression, inflammatory reaction as indicated by tumor necrosis factor α expression, and pulmonary fibrosis as demonstrated by Van Gieson staining and α-smooth muscle actin immunohistochemistry were observed following ODN2088 treatment. @*Conclusions@#All these findings indicate that blocking downstream TLR9 signaling could be beneficial in prevention or mitigation of ARDS through hemodynamic derangements, inflammation, apoptosis, and fibrosis.

A multi-component spectrophotometric method for simultaneous determination of total bilirubin, oxyhemoglobin, and methemalbumin in human sera

A new multi-component spectrophotometric method was developed experimentally and theoreticallyto determine the accurate serum concentrations of the total bilirubin (TB), oxyhemoglobin (HbO2), andmethemalbumin (Mha) in healthy human adults and neonates with hemolytic jaundice. With respect to theexperimental technique, the method of preparation of serum solution has been developed, like the use ofdistilled water as a solvent and centrifugation of serum solutions to clear the sample turbidity. The resultsof TB were compared to the diazo-assay. Theoretically, the formulas used for the calculation of the majorcomponents (TB, HbO2, and Mha) in human sera have been derived based on the theory of multi-componentspectrophotometric analysis and the mathematical Gaussian elimination method for matrix calculation. Themethod of multi-component spectrophotometry, suggested in this study for determination of TB, showed% error (3.1%–4.9%), indicating the high accuracy of the method. The small coefficients of variation(CV = 3.65%–5.1%) indicate the high precision of the method. The results showed higher values of serum TB(p < 0.00005), HbO2 (p < 0.001), and Mha concentrations (p < 0.00005) in neonates, when compared to adults.The method is highly sensitive and accurate. It is inexpensive, precise, reproducible, and has the advantages ofsimplicity, speed, and can be computerized.

Low back pain among high school teachers in Kuwait: prevalence, risk factors and level of disability

Objectives: High school teachers in Kuwait are at a risk of developing low back pain [LBP] due to psychosocial and physical factors. The aim of this study was to determine LBP prevalence, and identify its associated factors

Design: A cross sectional study

Setting and Subjects: Three hundred and eighty one high school teachers from 12 randomly selected high schools were included in this study

Intervention: Self administered questionnaire

Main outcome: LBP prevalence and associated risk factors

Results: The life time and one-year prevalence of LBP among high school teachers were found to be 68.5% [95% confidence interval [CI]: 63.3 - 73.1%] and 63.5% [95% CI: 58.4 - 68.3%] respectively. Socio-demographic characteristics such as, gender, marital status, and number of children, were significantly associated with LBP. In addition, obesity, smoking, prolonged standing, carrying heavy weights and mental health score of 4 or more were significantly associated with LBP. The logistic regression analysis showed that marital status [adjusted odds ratio, OR = 3.228, p = 0.022], obesity [OR = 3.207, p = 0.014], being a former smoker [OR = 0.343, p = 0.02], prolonged sitting [OR = 1.981, p= 0.048], and carrying heavy weights [OR = 2.121, p = 0.031] were independently associated with LBP

Conclusion: The prevalence of LBP among high school teachers in Kuwait is higher than other populations. This study managed to identify a number of modifiable associated factors with LBP. Through modifying these factors, the level of disability due to LBP may be improved

Rheological properties of blood serum of rats after irradiation with different gamma radiation doses in vivo

The blood serum rheological properties open the door to find suitable radio-protectors and convenient therapy for many cases of radiation exposure. The present study aimed to investigate the rheological properties of rat blood serum at wide range of shear rates after whole body irradiation with different gamma radiation doses in vivo. Healthy male rats were divided into five groups; one control group and 4 irradiated groups. The irradiation process was carried out using Co60 source with dose rate of 0.883cG/sec. Several rheological parameters were measured using Brookfield LVDV-III Programmable rheometer. A significant increase in viscosity and shear stress was observed with 25 and 50Gy corresponding to each shear rate compared with the control; while a significant decrease observed with 75 and 100Gy. The viscosity exhibited a Non-Newtonian behaviour with the shear rate while shear stress values were linearly related with shear rate. The decrease in blood viscosity might be attributed to changes in molecular weight, pH sensitivity and protein structure. The changes in rheological properties of irradiated rats' blood serum might be attributed to destruction changes in the haematological and dimensional properties of rats' blood products

Perceptions, attitudes, and practices towards research among resident physicians in training in Saudi Arabia

Health research training forms an important part of medical education. This cross-sectional study examined the attitudes to research, perceived barriers to research and experience of participation in research projects among resident physicians in Saudi Arabia. A self-administered email questionnaire was completed by 191/207 residents working in different specialties and regions of Riyadh. A majority [97.9%] agreed that research is essential and improves health care and 86.9% that it helps in building a future academic career. Lack of research training [93.2%], lack of time [89.5%], work-related stress [83.2%] and lack of supervisors [73.3%] were perceived barriers to doing research. Only 58 [30.4%] had had any research involvement. Involvement in research was significantly more likely for residents at an advanced level of training than at earlier levels [OR 3.50, 95% Cl: 1.1-11.1] and less likely for those who had 1 or 2 children during residency than those who had none [OR 0.29,95% Cl: 0.1-0.8]

Study the relationship of erythropoietin and chronic obstructive pulomonary disease

It has long been known that COPD causes polycythemia secondary to erythrocytosis caused by hypoxia present in advanced cases of COPD. However, it was shown in several studies that some COPD patients had anemia rather than erythrocytosis. Revealing the changes which occur in erythropoiesis in response to COPD was the aim of the current study. 41 COPD patients of different groups according to the inclusion and exclusion criteria and ten healthy control subjects age and sex matched were enrolled in the study. For all, history taking and full Clinical exam were performed, also ABGs, PFT [spirometry], routine labs [CBC, liver and renal function] and determination of EPO should be performed on human serum by ELISA. Showed that the erythropoietin level was 15.24 +/- 2.6 in stage 1, 22.61 +/- 5.68 in stage 2, 33.59 +/- 4, in stage 3, then 17.9 +/- 3.3 in stage 4. Also the total percentage of anemia in COPD patients was 46.3% [19/41], in comparison to 51.3% [21/41] non anemic and 2.4% [1/41] polycythemic. And that the percentage of anemia was 27.3% in stage 1, followed by 38.0% in stage 2, 100% in stage 3 then dropped to 58.33% in stage 4 with emergence of polycythemia in 8.33% of cases. Although COPD was thought to cause polycythemia, the current study showed that almost half of patients have anemia, and polycythemia occurred only in the advanced stages. It also appeared that response to erythropoietin in COPD is probably blunted especially with increased severity of the condition. This might be considered as a contributing factor in the development of anemia in COPD which is considered as anemia of chronic disease

Are 25[OH]D levels related to the severity of knee osteoarthritis and function?

To investigate the effect of 25-hydroxyvitamin D [25[OH]D] in Kuwaiti patients with primary knee osteoarthritis [OA] and to assess its relation with radiological grading and functional status. In this cross-sectional study, 25[OH]D was measured using radioimmunoassay in 99 patients [90 women and 9 men; mean age 56.5 +/- 9.1 years [range: 36-80]] with clinical and radiological findings of primary knee OA. X-ray grading using the Kellgren-Lawrence grading scale and the Osteoarthritis Research Society International [OARSI] Atlas grading scale and functional assessments using Lequesne's indices were evaluated in relation to the 25[OH]D level. Other variables studied were age at onset of symptoms, body mass index and duration of disease. The age of the patients at the onset and the duration of disease were 51.58 +/- 7.14 and 3.88 +/- 2.51 years, respectively. Mean scoring for functional assessment was 10.31 +/- 4.35 and mean Kellgren-Lawrence radiological grading was 2.43 +/- 0.85. Radiological finding according to the OARSI Atlas revealed joint space narrowing of grades 2-3 in 87 [87.9%] patients and the presence of osteophytes in 55 [55.6%] patients. The mean value of 25[OH]D level was 11.4 +/- 6.07 ng/ml. Of the 99 patients, 92 [92.9%] were vitamin D deficient. Comparison of 25[OH]D levels to radiological findings and different functional classes showed no significant association. Most of our patients had vitamin D deficiency, but the level of 25[OH]D was not related to the severity of the knee X-ray grading or to the functional assessment in our patients with primary knee OA

Knowledge and practices of, and attitudes towards, the use of hair dyes among females visiting a teaching hospital in Riyadh, Saudi Arabia

Use of hair dye is extremely common worldwide. However, our literature search failed to find studies concerning the knowledge and attitudes of the public with regard to hair dyes. We sought to explore the knowledge and practices of, and attitudes towards, the use of hair dye among females. A cross-sectional survey conducted on females who attended various outpatient clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, a tertiary referral hospital open to the general public. A self-administered questionnaire about the use of hair dyes was distributed randomly among females attending the outpatient clinics at a university hospital in 2008. The response rate was 87.2%, with completion of 567 of the 650 distributed questionnaires. The mean [SD] age of respondents was 32.0 [10.2] years. Among respondents, 82.6% [464/562] had at some point dyed their hair. Furthermore, 69.3% [334/482] had dyed their hair in the past 12 months. The mean [SD] age of the participants when they first dyed their hair was 22.2 [7.1] years [range, 7-50]. Of the participants, 76.8% [354/461] used permanent dyes, and about the same percentage of participants believed such dyes were the safest hair dye type. However, 52.4% [278/531] of the participants believed that hair dyes are harmful, and 36% [191/531] believed that hair dyes could cause cancer. Younger females tend to dye their hair less frequently [P<001l], whereas those with less education tend to dye their hair more frequently [P=.013]. Use of hair dye is very common among females. Because the practice starts at a very young age, we conclude that hair dyes are overused and misused. The public should be informed about the risks associated with excessive hair dye use

Dexamethasone with either granisetron or ondansetron for postoperative nausea and vomiting in laparoscopic surgery

In a prospective randomized double-blind study, we compared the effectiveness of dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery. Hundred ASA I and II patients scheduled for laparoscopic surgery were enrolled in the study and 84 patients completed it. Following induction of anesthesia, group I [n = 42] received granisetron 1 mg and dexamethasone 8 mg, group II [n = 42] received ondansetron 4 mg and dexamethasone 8 mg. Nausea and vomiting episodes, pain scores as well as side effects were recorded during the first hour and subsequently during the first 6 and 24 hours postoperatively. Satisfaction scores were obtained at discharge. There was no statistically significant difference between the 2 groups during the 1[st] 24 hours following surgery in regards to pain scores, satisfaction and side effects manifestations. At 0-1 hour interval, 100% of patients in group I and 97.6% in group II had no vomiting. Total response [no moderate or severe nausea and no rescue antiemetics] was 83.3% in group I and 80.95% in group II, and metoclopramide was used in 7.1% of patients in both groups. At 1-6 hours interval, 97.6% of patients in group I and 100% in group II had no vomiting. Total response was 92.8% in group I and 90.9% in group II, and metoclopramide was used in 4.76% of patients in group I and 2.38% in group II. At 6-24 hours no vomiting occurred in 97.6% of patients in group I and 100% in group II. Total response was 95.2% in both groups, and metoclopramide was used in 2.38% of patients in both groups. In conclusion, the combination of dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg following induction of anesthesia in patients undergoing laparoscopic surgery showed no statistically significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction

Prevalence of type 2 diabetes mellitus among Kuwaiti children and adolescents

To determine the prevalence of type 2 diabetes among 6- to 18-year-old Kuwaiti children. Children with type 2 diabetes were identified at 182 schools [50 primary, 63 intermediate, and 69 secondary] randomly selected using the 2000/2001 educational districts' registers as a sampling frame. Prevalence rates were adjusted to the 2002 Kuwaiti population. Diagnosis of type 2 diabetes was based on the World Health Organization and the American Diabetes Association criteria. Type 2 diabetes was identified in 45 of the 128,918 children surveyed, thereby giving an overall prevalence of 34.9 per 100,000 [95% confidence interval [CI] 24.7-45.1]. There was a significant difference in prevalence between males [47.3, 95% CI 28.7-65.8] and females [26.3, 95% CI 14.8-37.8] at p = 0.05 and a significant trend for an increase in prevalence of type 2 diabetes with age [p = 0.026]. The overall age-adjusted prevalence rate in the 2002 Kuwaiti population was 33.2 [95% CI 26.6-39.9], 41.6 [95% CI 31.2-52.0] in male and 24.6 [95% CI 16.4-32.7] in female children; the difference was significant at p = 0.013. There was no significant difference in prevalence between regions. Children with type 2 diabetes had a significantly higher frequency [51.1%] of a positive family history of diabetes than children of a similar age without type 2 diabetes [22.2%] [p = 0.004]. The prevalence of type 2 diabetes in adult Kuwaitis is spreading to children and adolescents, making it an emergency public health problem. Efforts need to be initiated to address prevention strategies of type 2 diabetes in youth

Opioid saving strategy: bilateral single-site thoracic paravertebral block in right lobe donor hepatectomy

Postoperative analgesia after hepatectomy remains a challenge, mainly because of limited therapeutic index of the conventional opioids. The aim of this study is to evaluate the efficacy of bilateral single-site thoracic paravertebral block for the management of postoperative pain following right lobe donor hepatectomy [RLDH] using a prospective, randomized and controlled study design. Twenty four adult patients, aged 18-50 years, ASA-I-II, of both sexes scheduled for right lobe donor hepatic resection, were enrolled in this study. Patients were randomly allocated into 2 equal groups of 12 patients each. Before induction of general anesthesia, all patients received bilateral single-site thoracic paravertebral injection at the level of T7-8 in the sitting position. Patients of Group B were injected with 25 mL of bupivacaine 0.25% with epinephrine 1:200.000 on each side. Patients of Group P were injected with 25 mL of 0.9% NaCl [placebo]. General anesthesia was standardized in all patients. Postoperative pain score, analgesic requirements and the incidence of postoperative nausea and vomiting Bilateral single-site thoracic paravertebral block significantly decrease the pain visual analogue score parameters. Total morphine consumption in the first 24 hours postoperatively was decreased by more than 50% in Group B [21.76 +/- 6.8 mg compared to 44.12 +/- 9.2 mg in Group P].There was significant prolongation in time to rescue analgesia [104.08 +/- 2.04 mm in Group B, and 31.5 +/- 6.14 mm in Group P]. Postoperative nausea and vomiting was significantly less in the active Group B when compared to the controlled Group P. Bilateral single-site thoracic paravertebral block is easy, safe and efficient technique for postoperative pain management in patients undergoing right lobe donor hepatectomy

Quality of life in systemic lupus erythematosus

To study quality of life in Systemic Lupus Erythematosus patients. And to assess the impact of the psychological state on quality of life in a group from these patients. The study included 50 patients with systemic lupus, Including 40 subjects divided into 20 normal control and 20 subjects with depressive disorders from the same age group. Who were subjected to Hamilton depression rating scale [HDRS], Minnesota Multiphase Personality Inventory [MMPI], Rating scales for psychopathological health status and Quality of life Scale. [PCASEE] questionnaire. There are statistically significant differences between SLE patients with psychiatric manifestations and those without psychiatric manifestations as regards the [HDRS] and [MMPI] scales regarding depression, hysteria, hypochondrasis, paranoia, psychoathenia, schizophrenia, social introversion, psychopathic, hypomania. Also, there is statistically significant difference between the patients group and control group regarding the total score of the physical item [somatic items] regarding quality of life scale. Also, there are statistically significant differences between both groups as regards economic problems, at affective problems and cognitive problems according to [PCASEE]. Quality of life in SLE patients with psychiatric manifestations was more impaired than the SLE patients without psychiatric manifestations in the following items: economic problems, cognitive functions and affective problems. That may help in explain that the psychiatric manifestation increase the degree of impairment and disability in patients of SLE. Also, SLE patients are more impaired in quality of life than the group of depression as regards the economic problems

Psychoimmunological aspect of systemic lupus erythematosus

To detect the most common psychiatric manifestations associated with systemic lupus Erythematosus. Also, to correlate between psychiatric manifestations and immunity. The study included 50 patients with systemic lupus, Including 40 subjects divided into 20 normal control and 20 subjects with depressive disorders who were subjected to Hamilton depression rating scale [HDRS], Minnesota MuItiphase Personality Inventory [MMPI], Immunological tests to detect immunogloblins IgG, IgM and antiribosomal P protein antibodies. The total frequency of antiribosomal antibodies in the group of SLE patients was [38%] compared to the group of control depression only one patient is strong positive while the group of normal control no persons are positive. All depressed patients had high serum level of IgG and 93.3% of the control normal had a higher level of IgG while 88% of the SLE patients had high lgG serum levels 28% of the SLE patients had high IgM serum levels compared to both groups of depression and control normal with no statistically significant. Also, there are non significant negative correlations between antiribosomal antibodies and paranoia, schizophrenia and non significant positive correlations between the antiribosomal antibodies and depression detected by NI MMPI. There are highly significant positive correlations between depression and the lgG. While there are significant negative correlations between the IgM and depression. There are statistically significant differences between SLE with psychiatric manifestations and SLE without psychiatric manifestations regarding HDRS and MMPI. There is high frequency of psychiatric manifestations in SLE patients and depression considered the most frequent psychiatric disorders in SLE patients. There are strong relation between disturbance in the immune system and psychiatric disorders proved by high level of immunogloblins in patients with depression. Also, there are high frequency of antiribosomal antibodies in patients of SLE but their relations with the development of psychiatric symptoms are still contradictory

Effect of preoperative hydration on postoperative nausea and vomiting

Postoperative nausea and vomiting [PONV] remains one of the most common postoperative complications, causing discomfort, patient dissatisfaction, delayed discharge and increased costs. Our aim: Was to determine whether preoperative IV rehydration with a balanced salt solution would decrease the incidence of PONV in patients at increased risk for these symptoms. Sixty female patients [physical status ASA class I and II] presenting for laparoscopic cholecystectomy were included in the study and were instructed to fast from the previous midnight. Patients were randomly assigned to either a control group [group 1] or a high infusion group [group 2] according to the volume of fluid infused preoperatively. Patients of control group [group 1] didn't receive pre-operative fluid bolus, whereas patients of the high infusion group [group 2] received pre-operative fluid bolus of Ringer's solution in a volume of 1.5 mL kg[-1] h[-1] of fasting time. This volume was completely administered in group 2 before induction of anesthesia, over approximately 30 min, in the preoperative holding area. The incidence of PONV, was assessed by a blinded investigator during the stay in post anesthesia care unite [PACU], and at 6, 12 and after 24 hrs postoperatively. Post-operative adverse effects [thirst, pain and drowsiness], and the need for supplemental antiemetic and analgesic therapy were also recorded during stay in PACU and for 24 hrs. The incidence of PONV and the need for anti-emetics were significantly reduced in the high volume infusion group at all time intervals. The high volume infusion group also had decreased postoperative thirst, drowsiness, and pain scores and required less supplemental analgesia. Preoperative hydration effectively reduces the incidence of PONV, antiemetic and analgesic requirements in patients with increased risk of PONV

Pattern of postgraduate specialization of Kuwaiti medical graduates throughout the last 30 years

The study examines postgraduate specialty training of Kuwaiti medical graduates during the period 1968 to 1999, identifies their attained professional qualifications in order to reveal scarcity in some specialties. A survey was carried out involving review of the records maintained at the Kuwait Institute for Medical Specialization [KIMS] and Ministry of Health for all the trainees who were enrolled in higher training programs for specialization during the study. Information obtained from the records were ascertained through matching with the doctors' career destinations and employment in the recruitment departments of the health sector. Ascertained data included gender, year and awarding country, level of attained qualifications [medium: Diploma and M.Sc.; higher clinical: fellowship/membership: MRCP, FRCS, MRCOG, Boards of Kuwait, Canada, USA, Germany; and higher academic qualification: Ph.D.]. A total of 679 [363 males, 316 females] Kuwaiti medical graduates attained their higher postgraduate qualifications until year 1999. There was an excess of female postgraduates since 1993, and a drop in 1991 due to the Gulf War. Specialty differed according to gender males mostly opted for medicine and surgery, while females mainly chose obstetrics and gynecology, pediatrics and family medicine. The nature of postgraduate qualifications differed according to gender, fewer females undertook academic qualifications. Also, the awarding country differed according to gender: females obtained their qualifications mostly from Kuwait or UK, while males were mainly awarded by Canadian, American or German universities. Scarcity in some clinical specialities was apparent: subspecialities in surgery [vascular, pediatric, h and, chest, laparoscopic, neurosurgery and oncology]; pediatric [nephrology, respiratory, cardiology, and neonatology]; psychiatry, occupational medicine, and immunology. The number of Kuwaiti medical graduates with higher professional qualifications significantly increased after 1985 due to the establishment of KIMS and Kuwait Faculty of Medicine. Excess of female postgraduates since 1993 was due to the social and cultural transitions witnessed by Kuwait resulting in rapid urbanization, changing the structure and content of education, increasing the numbers of females employed, professional redistribution in social dimensions, and modification in life style. Gender significantly affected the nature of postgraduate studies, the awarding countries and the choice of specialty. The pattern of preference of Kuwaiti graduates to specialties was consistent with other parts of the world; males opted mainly to internal medicine and surgery, while females preferred obstetrics and gynecology, pediatrics and family medicine. Scarcity in some specialties has been revealed and needs to be adjusted

role of national medical education in Kuwait

This study highlights the role of national medical education in the promotion of medical manpower. This was emphasized through tracking the development in the size and professional structure of the main category of the Kuwait national health care delivery system, the physicians, throughout the years 1996 to 2001. Data were ascertained from three sources: Department of Vital and Health Statistics and Department of Manpower, Ministry of Health for data on physicians, and Department of Statistics and Information Sector, Ministry of Planning, Kuwait for data on population. The study revealed increasing trends toward employment of Kuwaiti female physicians, employment of Kuwaiti physicians to upper and lower ranks, and rarity of Kuwaiti physicians in some specialties, such as anesthesia. The study emphasized the role of national medical education in increasing the number of Kuwaiti graduates. Moreover, the study highlighted the apparent influence of KIMS in enhancement of higher medical specialization training programs as witnessed by the predominance of Kuwaiti physicians in the leading job categories. Besides, the study generated essential information required for planning the qualitative and quantitative pattern of the higher specialization programs

Rating errors in the assessment of clinical competence of newly graduated doctors

Clinicians and academicians attached to health care institutions who share the responsibility for training medical graduates, need to guard against common errors of measurement when assessing trainees' competencies. This study aims to identify the rating errors that may occur during the assessment of the clinical competence of interns. Trainers assigned responsibility for the internship program assessed the competencies of 45 internship trainees in the March 2002 cohort in six domains [case presentation, clinical skills, diagnosis, therapy, [h and ling of emergencies and professional behavior] using a structured format provided. Competencies related to different clinical problems were rated under 1 = Unsatisfactory, 2 = Below expected st and ard, 3 = At expected st and ard, 4 = Above expected st and ard or 5 = Excellent. 4868 assessments were made of the performances of 45 interns who completed rotations in Surgery, Medicine, Obstetrics and Gynecology, and Pediatrics. 66% of all ratings fell in Excellent category [mean = 4, mode = 5]. The rotations in Surgery and Pediatrics elicited more Excellent ratings [37.6% and 31.8% respectively] than other specialties. Of all trainers, Registrars allocated the highest proportion [46%] of Excellent ratings. When considering the number of trainers in each category Excellent ratings had been assigned to a high extent by Assistant Registrars [72%], and Registrars [70%] A high proportion of the ratings given by the trainers fell at the upper end of the Rating Scale. This could be a result of the assessments being affected by errors of leniency, compromizing their usefulness. It is desirable that the heads of the respective Clinical Departments take steps to organize appropriate training programs so that the trainers improve their knowledge in the concepts underlying the assessment of clinical competencies and skills and methods of the use of the instruments

Prevention of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery- granisetron alone vs granisetron combined with dexamethasone / droperidol

Laparoscopic bariatric surgeries are associated with an appreciably high rate of postoperative nausea and vomiting. This study was designed to compare the effectiveness of granisetron either alone or in combination with droperidol or dexamethasone, for the prevention of post operative nausea and vomiting [PONV] in patients undergoing laparoscopic bariatric surgeries. In a randomized, double-blind, placebo-controlled trial, 120 patients received either Granisetron 1 mg, Granisetron 1 mg plus Droperidol 1.25 mg, Granisetron 1 mg plus Dexamethasone 8 mg or Placebo [saline], intravenously immediately before induction of anesthesia. Perioperative anesthetic care was standardized in all patients. Patients were then observed for 24 hours after administration of the study drugs. The incidence of PONV was 30% with granisetron alone, 30% with granisetron plus droperidol, 20%, with granisetron plus dexamethanone, and 67% with placebo [P < 0.05; overall Fisher's exactprobability test]. The incidence of adverse events was not different among the 4 groups. Graniserton is effective and safe drug for reducing the incidence of PONV in patients undergoing bariatric surgeries, and becomes highly effective when combined with dexamethasone

Bilateral superficial cervical plexus block alone or combined with bilateral deep cervical plexus block for pain management after thyroid surgery

Patients undergoing thyroid surgery need postoperative pain management. Bilateral superficial cervical plexus block [BSCBs] has been shown to improve postoperative analgesia. The objective of this study was to assess its analgesic efficacy in the first 24 hours after thyroid surgery alone and when combined with bilateral deep cervical plexus block [BDCBs]. We performed a prospective randomized and controlled study that compared 3 equal parallel groups, 12 patients each: Group A, received [BSCBs] before surgery and under general anaesthesia with 10 ml of bupivacaine 0.5% and epinephrine 1:200.000 in each side. Group B received [BSCBs] as in group A with [BDCBs] with 5 ml bupivacaine 0.5% and epinephrine 1:200,000 at the level of C3. Group C: received general anaesthesia without any block. Postoperative pain was assessed by the use of a 0-10 numeric rating scale. All patients received paracetamol every 6 hours. Morphine was administered following a standardized protocol if the numeric rating scales was 4 or higher. The main outcome variables were the proportion of patients given morphine during the 24 hours postoperatively, pain intensity scores, and total morphine consumption. There was no significant difference among the 3 groups as regards their demographic data. Both groups A and B were significantly superior to the controlled group C as regards percentage of patient required morphine, pain scores and postoperative morphine consumption. In comparison between groups A and B, there was no significant difference between the 2 groups as regards the main outcome variables. [P < 0.05]. Bilateral deep cervical plexus block does not add significant analgesic efficacy or has a narcotic saving strategy when combined with bilateral superficial cervical plexus block for pain control after thyroid surgery

Health vision 2020. Workforce needs of health professionals in Kuwait. Part III-Pharmacists

Pharmacists contribute to reducing the cost of health care while at the same time improving patients' use of medications and health outcomes. Pharmacists play an important role in counseling patients, and reducing medication errors. The aims of the study were to: 1. describe the size of the workforce of pharmacists during the years 2000 to 2005; 2. project the future demand of pharmacists, with special reference to the supply of Kuwaiti pharmacists during the years 2006 to 2020. Local and international data on demand and supply of pharmacists were retrieved. Data on actual population and supply of pharmacists during the years 2000 to 2005 were used to project the future demand of pharmacists during the period 2006 to 2020. Population projections were derived using an exponential average annual population growth rate. The future need for pharmacists was projected using the average pharmacists: population ratio during 2000 to 2005, of one pharmacist to 1,613 population [equivalent to 0.6231 pharmacist: 1000 population]. The projected number of Kuwaiti pharmacists at a given year was calculated by incrementing the number of Kuwaiti pharmacists of the previous year by 9.44%, the average annual growth rate of Kuwaiti pharmacists during 2000 to 2005. Projections for the demand of pharmacists were also computed based on the UK ratio of 0.5891 pharmacist: 1000 population [equivalent to one pharmacist to 1698 population. The average annual growth rate of 9.44% for Kuwaiti pharmacists indicates that the number of Kuwaiti pharmacists is increasing. However, there is a gap between the numbers of Kuwaiti and non-Kuwaiti pharmacists. Of the total demand of pharmacists in year 2005, Kuwaiti pharmacists constituted 18.4%, mostly employed by the Ministry of Health. Disparity between the number of Kuwaiti pharmacists available and total demand for pharmacists is expected to become wider if the health authorities were to improve the pharmacist: population ratio to the values that exist in industrialized countries such as UK. It is unlikely that the supply of Kuwaiti pharmacists will meet the projected demand until the year 2020. To minimize the gap between the total demand and the supply of Kuwaiti pharmacists, it is desirable that the Faculty of Pharmacy, Kuwait University consider increasing the annual intake of students, and the Ministry of Higher Education increase the number of scholarships offered for pharmacy education