Analgesic properties of a dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea

Dexmedetomidine is an alpha2-adrenergic agonist with sedative and analgesic properties. This study aimed to investigate if the use of a continuous dexmedetomidine infusion with i.v. morphine patient-controlled analgesia [PCA] could improve postoperative analgesia while reducing opioid consumption and opioid-related side effects. In this prospective randomized, double-blinded, controlled study, 39 patients with obstructive sleep apnea syndrome undergoing uvulopalatopharyngoplasty were assigned to two groups. Group D [dexmedetomidine group] received a loading dose of dexmedetomidine 1 microg.kg[-1] i.v., 30 minutes before the anticipated end of surgery, followed by infusion at 0.6 microg.kg[-1] h[-1] for 24 hours. Group P [placebo group] received a bolus and infusion of placebo. In both groups, postoperative pain was initially controlled by i.v. morphine titration and then PCA with morphine. Cumulative PCA morphine consumption, pain intensities, sedation scores, cardiovascular and respiratory variables and opioid-related adverse effects were recorded for 48 hours after operation. Compared with placebo group, patients in the dexmedetomidine group required 52.7% less PCA morphine during the first 24 hours postoperatively, with significantly better visual analogue scale scores, less incidence of respiratory obstruction [5 vs. 12 patients, respectively; P = .037] and longer time to first analgesic request [21 [11] vs. 9 [4] minutes; P = .002]. Fewer patients in group D experienced nausea and vomiting than those in group P [7 vs. 24 patients, respectively; P < .05]. Continuous dexmedetomidine infusion may be a useful analgesic adjuvant for patients susceptible to opioid-induced respiratory depression

Cardiac risk factors in rheumatoid arthritis patients and its relation to disease activity

The aim of this study was to assess cardiac risk factor "Serum profile total cholesterol [TC], Triglycerides Rehabilitation [T.G], high density lipoprotein [HDL], low density lipoprotein [LDL] lipoprotein a [LP [a]] in RA patients and its relation to disease activity. Cardiac Risk Factors Profile serum total cholesterol [TC], Triglycerides [TG], high density lipoprotein [HDL]. low density lipoprotein [LDL] and Lipoprotein a [LP [a]] were assessed for 48 [RA] patients and 20 healthy age and sex matched controls. Comparison of lipid panels revealed that serum [TC]. [HDL] and [LDL] levels were insignificantly lower in [RA] patients compared to controls while [TG] levels was insignificantly higher in [RA] patients compared to controls and [LP[a]] level was found to be significantly higher in [RA] patients. Correlating serum lipids levels to different parameters of disease activity in [RA] patients showed that patients with moderate disease activity have significantly lower [TC] [LDL] and insignificantly lower [TG] than those with mild disease. [LP[a]] was found to be significantly higher in patients with moderate disease activity and correlated positively with ESR. Male sex, older patients [>40 years] and old age at disease onset [>35 years] were found to be predictors of risk for ischaemic heart disease [IHD]. We conclude that [RA] patients are at higher cardiovascular risk due to dyslipidemia and the effects of chronic inflammation on vascular biology

analgesic and sedative properties of dexmedetomidine infusion after uvulopalatopharyngoplasty

Dexmedetomidine is an alpha[2] - adrenergic agonist with sedative and analgesic properties. This study aimed to investigate if the use of continuous dexmedetomidine infusion with i.v. morphine patient-controlled analgesia [PCA] could improve postoperative analgesia while reducing opioid consumption and opioid-related side effects. In this prospective randomized, double-blinded, controlled study, 24 patients with obstructive sleep apnea syndrome undergoing uvulopalatopharyngoplasty were assigned to two groups. Group D received a loading dose of dexmedetomidine micro kg kg[-1] i.v., 30 min before the anticipated end of surgery, followed by a continuous infusion at a rate of 0.6 pig kg[-1] hr[-1] for 24 hr. Group P received a volume-matched bolus and infusion of placebo. In both groups, postoperative pain was initially controlled by i.v. morphine titration and then PCA with morphine. Cumulative PCA morphine consumption, pain intensities, sedation scores, cardiovascular and respiratory variables and narcotic-related adverse effects were recorded for 48 h after operation. Extubation time was significantly prolonged in dexmedetomidine group [16 +/- 7 vs. 11 +/- 6 ; r; p=0.074] in the placebo group. Visual analogue scale scores were significantly greater during the first 2h after tracheal extubation in the placebo group than in the dexmedetomidine group. The time to first analgesic request was significantly longer in the dexmedetomidine group than in the placebo group [21 +/- 11 vs. 9 +/- 4min; p=0.002]. Compared with group P, patients in group D required 52.7% less morphine by PCA during the first 24h postoperative period, whereas levels of sedation were similar between the 2 groups at each observational time point. Fewer patients in group D experienced nausea and vomiting than those in group P [P< 0.05]. There was no bradycardia, hypotension, or respiratory depression. Continuous dexmedetomidine infusion may be a useful anesthetic adjuvant for patients who are susceptible to narcotic-induced respiratory depression. Continuous infusion of dexmedetomidine for pain relief after uvulopalatopharyngoplasty significantly reduces the amount of PCA morphine used by the patients postoperatively without affecting their ventilatory parameters and was associated with fewer morphine-related side effects. This novel drug could become a useful anesthetic adjuvant for patients with obstructive sleep apnea who are susceptible to narcotic-induced, respiratory depression

Intramuscular ketamine for prevention of postanesthesia shivering in children

To compare the effects of intramuscular ketamine with pethidine and placebo on post operative shivering in children undergoing tonsillectomy. A prospective randomized double-blind study was conducted at King Abdulaziz Naval Base Hospital, Jubail, Kingdom of Saudi Arabia, from November 2006 to October 2007. One hundred and twenty children [American Society of Anesthesiologists Grade 1, aged 5-12 years] were enrolled. Children were randomly allocated to receive ketamine 1 mg/kg [group K, n=40], or pethidine 0.5 mg/kg [group P, n=40], or normal saline [group S, n=40] intramuscularly just after induction of general anesthesia. Hemodynamic parameters, oxygen saturation and tympanic temperature were measured and recorded before induction of anesthesia and at regular intervals thereafter. An investigator blinded to the treatment group, graded postoperative shivering using a 5 point scale. The number of patients shivering on arrival to the recovery room and at 10 and 20 minutes after operation were significantly less in groups K [1,1,1] than in group S [19,12,17]. No patient that received pethidine shivered. The time to first analgesic requirement in group S was shorter than groups K and P [p=0.001]. The study indicates that the use of a prophylactic low dose ketamine was found to be effective in preventing post anesthesia shivering in children undergoing tonsillectomy. Ketamine may have at least theoretical advantages over pethidine as regard respiratory depression, nausea, and vomiting

Short gamma nail versus dynamic Hip screw in the treatment of unstable trochanteric femoral fractures in the elderly. A comparative study

Trochanteric femoral fractures in osteoporotic bone pose a challenge to both the surgeon and the osteosynthesis device. The problem becomes compounded when the fracture is unstable. Thirty consecutive cases of unstable trochanteric fractures were treated surgically using two different methods of internal fixation, 13 cases being treated with the short gamma nail [GN] and 17 cases treated with the dynamic hip screw [DHS]. The average age in the GN group was 67.2 years, while being 66.8 years in the DHS group. Average follow-up was 11.6 months in GN group versus 12 months for the DHS group. Union occurred in all cases of GN [100%] while occurring in 12 of 17 of the DHS [70.6%]. A second procedure was not needed in any of the GN cases, while used in 5 of the DHS cases. Major complication as screw cut out occurred in 5 of the DHS cases with none in the GN cases. Final outcome based on clinical and radiologic data showed superior performance of the short gamma nail compared to the dynamic hip screw in the treatment of unstable trochanteric fractures

Does phototherapy induce an oxidative stress in preterm neonates?

Of this study was to investigate whether phototherapy leads to oxidative stress in preterm newborns. Lipid peroxidation products as indicated by the thiobarbituric acid reacting substances [TBARS] in blood and urinary 8-Hydroxydeoxyguanosine [8-OHdG] as a protein peroxidation product in urine were assessed before and after exposure to phototherapy. Meanwhile, antioxidant activity in terms of plasma vitamin E and erythrocyte-glutathione peroxidase [GSH-PX] was assessed. The study group enrolled 24 preterm infants with physiological hyperbilirubinemia categorized according to the used modality of phototherapy into single and double phototherapy groups. Their mean gestational age was 31.22 +/- 2.63 weeks, and birth weight was 2.175 +/- 0.86 kg. Blood samples were collected immediately before and after 72 hours of phototherapy. Samples were analyzed for total serum bilirubin [TSB], serum albumin, blood TBARS, plasma vitamin E and erythrocyte-GSH-PX. Urine samples were collected before and after phototherapy for analysis of 8-OHdG. Levels of blood TBARS, Urine 8-OHdG were significantly elevated after phototherapy while plasma vitamin E and erythrocyte GSH-PX did not significantly change. Blood TBARS showed a negative correlation to TSB before phototherapy. The percent increase in serum TBARS or Urine 8-OHdG after phototherapy did not significantly correlate to gestational age or birth weight. Phototherapy induces oxidative stress in preterm neonates with unconjugated hyperbilirubinemia, regardless of their birth weight or gestational age. In face of this stress, antioxidant defense may be inadequate, requiring vitamin E supplementation. No significant photo-oxidant hazard is added in proceeding with double phototherapy in neonates under single phototherapy

Prenatal diagnosis of beta-thalassemia in the West Bank and Gaza

This study focuses on the genetic aspect of beta-thalassemia among 88 at risk couples from the West Bank and Gaza, and the attitude of these couples toward prenatal diagnosis and its outcome as a preventive method. We tested 130 prenatal samples for beta-thalassemia during the period from January 1999 to July 2005. We performed prenatal diagnosis in these cases using the amplification refractory mutation system, as well as beta-globin gene sequencing as a conformational method. We drew a chorionic villus sample [CVS] for 1st trimester pregnant women and amniotic fluid [AF] for those in the 2nd trimester depending on the stage the pregnant woman contacted our lab. The DNA analysis of 130 prenatal samples revealed 25 [19.2%] cases of beta-thalassemia major and 67 [51.5%] cases of beta-thalassemia carriers, while the remaining 38 [29.2%] were normal. The 25 affected fetuses were aborted according to the wishes of the parents. In the tested 88 couples, 14 mutations of beta-thalassemia were identified. These mutations and their frequencies were: IVSI-110 [22.2%], IVSI-6 [13.6%], Cd37 [12%], IVSI-I [9.7%], IVSII-1 [6.2%], Cd39 [9%], Cd6 [sickle cell mutation] [8.5%], Cd5 [8%], Cd8/9 [2.8%], Cd106/107 [2.8%], -30 promoter [1.1%], -88 promoter [1.1%], IVSI [-1] [2.3%] and IVSI-5 [0.6%]. We found that in 77.3% of the couples, both the mother and the father carry the same type of mutation while 22.7% of them carry different mutations. We found 77.9% consanguinity among the couples. We found very good acceptability for prenatal diagnosis in beta-thalassemia afflicted families. All couples with affected fetuses opted for abortion. The spectrum of mutations in the tested couples revealed several similarities to neighboring countries with -88 promoter mutation reported for the first time in our region

ND YAG laser-assisted periodontal practice

Periodontal treatment modalities have advanced steps with implementation of LASER therapy. When the LASER used clinically in treating periodontal diseases it offers the clinician many advantages. This paper discussed the features of Nd: YAT wave length using 800 ND YAG pulsed LASER in treating different periodontal cases with the advantages of an optic fiber delivery system

relationship of IL-6 and TNF alpha in serum and gingival cervicular fluid of Egyptian pregnant women with periodontitis to preterm labor

Recent studies have suggested that periodontal disease is a risk factor for preterm labor [PL]. Our objective was to determine if maternal periodontitis could be a risk factor for PL through assessing and correlating the levels of IL-6 and TNF alpha in both serum and gingival crevicular fluid [GCF] from pregnant women in between [20-31] weeks of gestation with and without periodontitis and also to determine if periodontal treatment may have an effect on the level of IL-6 and TNF in GCF and serum to reduce the risk of PL.200 pregnant women with periodontal disease aged 25-35 were enrolled while receiving prenatal care in Antenatal Clinic of Maternal and Child Care of Tanta Hospitals. Women were assigned to control group [n= 40] which are free from any periodontal disease. Study grqup [n= 160] with attachment >6mm, this group included group A [treated group] [n=80] which received periodontal treatment [phase I therapy]. Group B [untreated group] [n=80] which did not receive any periodontal treatment. The level of IL-6 and TNF alpha in both local [GCF] and systemic [serum] was determined by ELISA. Of the 200 women enrolled, 134 were excluded from the analysis for different reasons. The incidence of PL in the treated group was 30% [6/15] but in the untreated group was 80% [18/23], and in the control group was 0%. Multivariate analysis showed that the effect of time changes was strong for plaque index [PI] by IL-6 and lastly GI [1, 0.759, and 0.604] respectively. Periodontal disease appears to be an independent risk factor for PL. Periodontal therapy significantly reduces the level of IL-6, TNF alpha in both GCF and serum which in turn reduce the rate of PL in this population of women with periodontal disease

Serological diagnosis of Neospora caninum infection in some domestic animals from Egypt

This study investigated the presence of antibodies to N. caninum in cattle, sheep, goats and dogs from Egypt. Sera from the tested animals were examined using a direct agglutination test incorporating mercaptoethanol and formalin-preserved whole N. caninum tachyzoites as antigen. Anti-N. caninum antibodies were found in 18 out of 111 aborted cattle. Abortion occurred during the third to ninth month of the gestation period. Three out of the 26 non-aborted cattle were seropositive. The statistical analysis indicated that anti-N. caninum antibodies occurred more in the aborted than in the non-aborted group [slightly significant]. Seventy-three of 202 sheep and 31 of 88 goats recorded antibodies for N. caninum. Eight out of 29 stray dogs had antibodies against N. caninum

Effect of heavy smoking on the mucosa of the upper respiratory tract

This study was conducted on 30 individuals; their ages ranged between 20 and 60 years. The patients were divided into two groups: Group A composed of 15 individuals who were heavy smokers, i.e. they used to smoke at least 20 cigarettes per day for at least 10 years duration, and group B [control]composed of 15 individuals who were non-smokers. 73% of smokers had postnasal discharge, hyperemia of mucosa of nasopharynx and lymphoid tissue aggregation on the posterior pharyngeal wall in contrast to 13.3%, 13.3% and 20% in non-smokers, respectively. In the present work, the histopathological examination of nasal biopsies showed a high percentage of pathological abnormalities among the smokers group including squamous metaplasia of respiration epithelium [73.3%], thickening of basement membrane [53.3%], edema of submucosa [40%], patchy fibrosis of submucosa [60%], congested blood vessels [66.7%], seromucinous gland hyperplasia [60%], lymphocyte [66.7%], plasma cells [66.7%] and mast cellinfiltration [36.7%]. These findings were less among non-smokers, i.e. 0%, 26.7%, 0%, 2%, 26.7% 6.7%, 26.7% 13.3% and 26.7%, respectively. Smokers had a statistically significant higher percentage of all abnormalities, except thickening of basement membrane where the difference was not statistically significant

Paravertebral and epidural blocks for post thoracotomy pain

Thoracic anesthesia offers particular challenge. Thoracic patients frequently have a painful wound after surgery. So analgesia after thoracic surgery is of particular significance. In the present study we assessed the efficacy of thoracic paravertebral and epidural blockade on post thoracotomy pain and pulmonary function. Thirty adult ASA I-III patients undergoing elective thoracic surgery were enrolled in this study. they were randomly divided into two groups: paravertebral and epidural group [15 patients each]. Both percutaneous paravertebral and epidural catheters were placed preoperatively. Before chest closure each patient received a bolus dose of bupivacaine [0.25 %] according to its height. This was followed by postoperative bupivacaine infusion [0.25 %] 0.1 ml kg-1h -1 in both groups. Also patients were encouraged to take supplementary doses of morphine from a patient controlled analgesia [PCA]. Subjective pain relief was assessed on a linear visual analogue scale and pulmonary function was measured by spirometry. Stress responses to noxious stimuli was assessed by plasma levels of cortisol and glucose. Respiratory variables were recorded throughout the study period. Also sensory level of analgesia and performance status were assessed in the two groups. Although we found significantly lower visual analogue pain scores at rest and on maximal coughing in the paravertebral compared to the epidural group, no significant difference in patient controlled morphine requirements was noted between the two groups. Pulmonary function [FVC, FEV1 and PEFR] was significantly better in the paravertebral group. Meanwhile no significant difference in respiratory variables was recorded between the two groups. Paravertebral block produced significantly diminished stress responses to noxious stimuli as manifested by less increase in plasma cortisol level than in epidural block. Sensory levels of analgesia and performance status was similar in both groups. Side effects as hypotension, urine retention, nausea and difficulty in breathing were troublesome in the epidural group. While nausea and difficulty in breathing were less in paravertebral group. Like epidural analgesia, paravertebral block deserves to be considered for post thoracotomy pain relief

Study of nosocomial respiratory infections and nurses' performance related to infection control measures in artificially ventilated patients

This study was conducted on 30 ventilated patients and the 30 nurses who were responsible for their care. An observation checklist was used to assess nurses' practices regarding daily care activities, ventilator decontamination, use of universal infection control measures and the maintenance of the patients' care environment. A second sheet was developed to estimate the incidence of nosocomial respiratory infection and to identify the causative microorganisms. A third sheet was designed to help in the daily assessment of the patient's health condition. The study revealed a high incidence of nosocomial respiratory infections. Also, it was revealed that pseudomonas was the causative agents in more than one- fourth of the cases. Moreover, nurses' infection control practices were inadequate

Comparison of nicardipine and sodium nitroprusside induced hypotension for spinal surgery

The aim of this study was to compare the hypotensive effect of nicardipine versus Na nitroprusside on 40 adult patients undergoing lumbar fusion. An anesthetic technique was used in all patients. A significant difference was noted between the two groups in the amount of blood loss and restoration of mean arterial blood pressure after the discontinuation of infusion. A prolonged hypotension was recorded in the nicardipine group versus nitroprusside group. A statistical significant decrease in arterial oxygenation was observed in the nitroprusside patients. Meanwhile, there was no significant difference in both groups regarding the surgical outcome

Experience in using ND: yagt laser for mandibular labial frenectomy

The surgical ND: YAG Sunrise 800 laser has the ability to vaporize soft tissue of frenum with high attachment with little bleeding, pain, swelling. The laser surgeries were evaluated in three reported cases of Saudi subjects with different ages. Surgeries were performed with no bleeding or infection. Vestibular width was also increased after 3 weeks of healing period. ND: YAG laser appears to have a promising future in periodontics. Precise long controlled studies were indicated

Control of heparin anticoagulation during cardiopulmonary bypass experience with a small initial dose

Forty adult patients of both sex undergoing cardiac surgical procedures requiring cardiopulmonary bypass were included in the present study. Patients were classified into two equal groups [each of 20 patients], group I were given the usual initial dose of heparin 400 IU/Kg while group II were given an initial dose of heparin 200 IU/Kg. Additional doses of heparin 50 IU/Kg added to attain ACT just above 400 sec in both groups to study this small initial dose for safe anticoagulation during CPB. It is found that the total heaparin dose before cannulation, the mean ACT values, the total heparin during surgery and the protamine dose for reversal were significantly lower in group II than in group I. So, starting with an initial heparin dose of 200 IU/Kg, adding small incremental doses to attain ACT just above 400 sec and proper ACT monitoring is a safe technique for heparin anticoagulation during CPB avoiding heparin overdosager

prevalence of localized juvenile periodontitis in a selected Saudi population: sex ratio in association with recovery of actinobacillus actinomycetemcomitans

The rationale of this study was to determine the prevalence and sex ratio oflocalized juvenile periodontitis cases in selected Saudi population and tocompare these values with different societies and to correlate the sex ratiowith the presence of Actinomyces actinomycetemcomitans in the afflicted sites. 23 subjects of LJP were diagnosed from a group of 5480 subjects havingdifferent forms of periodontal diseases in a three year retrospective study. The overall prevalence was 0.42% female to male ratio 1.88 to 1. Nostatistically significant difference was noticed in the sex ratio associationregarding the sites afflicted by Actinomyces actinomycetemcomitans