A Study Of Psychophysical Factor (Heart Rate) For Driver Fatigue Using Regression Model

@#Driving activity has become more important as this medium being practical, it is also cheaper and faster in connecting human from one to another place. However, in some occurrence, it can cause accidents as they become fatigued while driving. Driver fatigue is one of the top contributors to the road accidents and can be dangerous as other road safety issues such as drink driving. Worst is, there are no laws regulating driver fatigue. Therefore, the main purpose of this study is to develop the regression model of apsychophysical factor for drivers’ fatigue which can predict the relationship between the process input parameters and output responses. The study was participated by ten subjects. The heart rate was taken and recorded using heart rate monitor. Design Expert 8.0.6 software was used for the regression analysis. The modeling validation runs werewithin the 90% prediction intervals of the developed model and the residual errors were less than 10%. The R 2 value is 0.9400 whichmeans that the linear regression line passed exactly through all points. The significant parameters that influenced the heart rate were also identified.The parameters are time exposure, type of road, and gender.

Correlation between Anthropometric Measures, Lipid Profile and Serum Adiponectin and Steatosis in Nondiabetic Nonalcoholic Fatty Liver Disease.

Aims: To assess the relation between the grade of steatosis and anthropometric measures, lipid profile and serum adiponectin in non-diabetic patients with nonalcoholic fatty liver. Study Design: Cross sectional study. Place and Duration of Study: Department of Tropical Medicine and Gastroenterology, Qena faculty of medicine, South Valley University. Methodology: Fifty patients with US evidence suggestive of fatty liver disease and normal fasting and post-prandial serum glucose were included. No past or current history of alcohol consumption. Blood samples were taken to detect liver function tests, fasting lipogram, complete blood count and serum adiponectin. Body mass index (BMI) and waist circumferences (WC) were measured for all patients. Liver biopsy was done to detect the presence and the degree of steatosis. Results: The mean age of patients was 40+/-12 years. Patients with steatosis showed significantly higher value for BMI and WC than those without (P value =0.000). Cholesterol, triglyceride and Low density lipoprotein-cholesterol (LDL-C) also were significantly higher in patients with steatosis (P value =0.00). High density lipoprotein-cholesterol (HDL-C) and serum adiponectin were significantly lower in patients with steatosis (P value =0.00). Patients with severe steatosis showed significantly higher values for BMI and WC, cholesterol, triglyceride, LDL-C and lower values for HDL-C and adiponectin (P value = 0.05) than those with mild or moderate steatosis. Positive correlations were detected between the age, BMI and WC, cholesterol, triglyceride, LDL-C and the grade of steatosis and negative correlations with HDL-C and adiponectin. Conclusion: Anthropometric measures, lipogram and serum adiponectin are associated with progression of steatosis in nondiabetic patients with NAFLD. So their detection is important for evaluation and management.

Quantifying the impact of using coronary artery calcium score for risk categorization instead of Framingham score or European heart SCORE in lipid lowering algorithms in a middle eastern population

The use of the Coronary Artery Calcium Score [CACS] for risk categorization instead of the Framingham Risk Score [FRS] or European Heart SCORE [EHS] to improve classification of individuals is well documented. However, the impact of reclassifying individuals using CACS on initiating lipid lowering therapy is not well understood. We aimed to determine the percentage of individuals not requiring lipid lowering therapy as per the FRS and EHS models but are found to require it using CACS and vice versa; and to determine the level of agreement between CACS, FRS and EHS based models. Data was collected for 500 consecutive patients who had already undergone CACS. However, only 242 patients met the inclusion criteria and were included in the analysis. Risk stratification comparisons were conducted according to CACS, FRS, and EHS, and the agreement [Kappa] between them was calculated. In accordance with the models, 79.7% to 81.5% of high-risk individuals were down-classified by CACS, while 6.8% to 7.6% of individuals at intermediate risk were up-classified to high risk by CACS, with slight to moderate agreement. Moreover, CACS recommended treatment to 5.7% and 5.8% of subjects untreated according to European and Canadian guidelines, respectively; whereas 75.2% to 81.2% of those treated in line with the guidelines would not be treated based on CACS. In this simulation, using CACS for risk categorization warrants lipid lowering treatment for 5-6% and spares 70-80% from treatment in accordance with the guidelines. Current strong evidence from double randomized clinical trials is in support of guideline recommendations. Our results call for a prospective trial to explore the benefits/risks of a CACS-based approach before any recommendations can be made

Efficacy of extracorporeal shockwave lithotripsy using dornier sii in different levels of ureteral stones

The objective of this study was to evaluate the efficacy and safety of the Dornier lithotripter S II system in the treatment of ureteral calculi. A total of 97 cases which consists of 54 males and 43 females with ureteral stones were treated by extracorporeal shock wave lithotripsy [ESWL]. Mean age was 42.6 years. Inclusion criteria were solitary radiopaque ureteral stones of radiological stone size of

Comparative study between the effect of nitazoxanide and paromomycine in treatment of cryptosporidiosis in hospitalized children

Ninety children infected with Cryptosporidium parvum attending Al Azhar University Teaching Hospital [Assuit] were chosen [60 males and 30 females] with age range from 6 months to ten years. The patients were divided into two groups of 45 patients for each [G1 and G2]. All patients suffered from chronic diarrhea for more than fifteen days. Cross-matched 45 children suffering from chronic diarrhea were used as a control group [G3]. Stool samples were collected and examined for detection of Cryptosporidium oocysts using Sheather's sugar and Modified Ziehl-Nelseen stain techniques. The first group [G1] received Nitazoxanide [100 mg and 200 mg every 12 hours for 3 days for children aged 6 months to 3 years, and children aged 4 to 10 years respectively], G2 received Parornomycin [25mg/kg/day for 2 weeks]. Third group received placebo. Significant improvement and shortening of the duration of diarrhea occur in G1; of 45 patients received Nitazoxanide 39 cases showed complete clinical and laboratory cure [86.6%], 5 cases showed clinical improvement with reduction in the number of oocysts and 1 case showed no cure. In G2 of 45 cases received Paromomycin 31 cases showed complete cure [68.8%], 8 cases showed clinical improvement with reduction of oocysts number and 6 cases were not cured. Nitazoxanide proved highly effective than Paromomycin in cryptosporidiosis

Effective connectivity between superior temporal gyrus and Heschl’s gyrus during white noise listening: linear versus non-linear models

Purpose: This fMRI study is about modelling the effective connectivity between Heschl’s gyrus (HG) and the superior temporal gyrus (STG) in human primary auditory cortices. Materials & methods: Ten healthy male participants were required to listen to white noise stimuli during functional magnetic resonance imaging (fMRI) scans. Statistical parametric mapping (SPM) was used to generate individual and group brain activation maps. For input region determination, two intrinsic connectivity models comprising bilateral HG and STG were constructed using dynamic causal modelling (DCM). The models were estimated and inferred using DCM while Bayesian Model Selection (BMS) for group studies was used for model comparison and selection. Based on the winning model, six linear and six non-linear causal models were derived and were again estimated, inferred, and compared to obtain a model that best represents the effective connectivity between HG and the STG, balancing accuracy and complexity. Results: Group results indicated significant asymmetrical activation (puncorr < 0.001) in bilateral HG and STG. Model comparison results showed strong evidence of STG as the input centre. The winning model is preferred by 6 out of 10 participants. The results were supported by BMS results for group studies with the expected posterior probability,r = 0.7830 and exceedance probability, φ = 0.9823. One-sample t-tests performed on connection values obtained from the winning model indicated that the valid connections for the winning model are the unidirectional parallel connections from STG to bilateral HG (p < 0.05). Subsequent model comparison between linear and non-linear models using BMS prefers non-linear connection (r = 0.9160, φ = 1.000) from which the connectivity between STG and the ipsi- and contralateral HG is gated by the activity in STG itself. Conclusion: We are able to demonstrate that the effective connectivity between HG and STG while listening to white noise for the respective participants can be explained by a non-linear dynamic causal model with the activity in STG influencing the STG-HG connectivity non-linearly.

Clinical presentation, genotype and microbiological data among cystic fibrosis children at King Hussein medical center

To describe the clinical presentations, genotype, microbiological data among children with cystic fibrosis treated at King Hussein Medical Center. A retrospective review of all the medical records of children [80] already diagnosed with Cystic fibrosis was conducted during the period 2002-2008 at King Hussein Medical Center. Clinical data collected included: age at presentation and diagnosis, clinical manifestation, delay in diagnosis, and family history. Laboratory tests that were done included: complete blood count, kidney and liver function tests, sweat chloride and genetic testing. PCR testing was performed for 36 mutations of cystic fibrosis. Those with borderline sweat chloride reading or atypical presentation were excluded. The study group consisted of 46 [57%] males and 34 [43%] females with classic cystic fibrosis. Age ranged from one month to 16 years of age with a median of eight months. Most of the patients presented between one and six months of age [35%] with the majority being in neonatal period [24%]. Only 13% presented after the age of two years. Most common presentation was recurrent wheezy chest [28%], while the least common was direct hyperbilirubinemia [2%]. A delay in diagnosis more than six months was seen in 18 patients [26%]. Twenty-one children [26%] had positive family history of Cystic Fibrosis, while 12 [15%] gave a history of male infertility in the family. Sputum cultures were positive in 24 patients; Pseudomonas Aureginosa was the most commonly found [24%]. Cystic Fibrosis mutations were found in 25 patients [31%]; Delta F508 mutation was the commonest 4%. Three patients died [4%]; one with respiratory failure and severe pulmonary hypertension, two with severe fatal sepsis. There are diverse clinical presentations and genotypic features among our study group. A complete analysis of the DNA mutation would be helpful in knowing the most prevalent mutations in our population

[Evaluating sea water quality in the coastal zone of North Lebanon using Telemac-2D[TM]]

The coastal zones of the Mediterranean are undergoing rapid development with growing and conflicting demands on the natural resources. Coastal zones are often subjected to irreversible land degradation and environmental deterioration. Lebanon is located in the eastern part of the Mediterranean basin and the integrated management of the environment in the Lebanese coastal zone must be given concern. Most of the successful decisions addressing the environment protection or the elaboration of preventive measures in the coastal zone. These decisions depend on the availability of efficient simulation tools. The existence of these tools can help protecting the environment and establishing the ground for sustainable natural resources in the coastal zones. In this paper, a simulation tool called Telemac-2D[TM] software was used to simulate the business as usual, pessimistic, and optimistic status of the sea water quality in the coastal zone of Tripoli [North Lebanon]. The coastal zone is affected by the effluents of solid and liquid wastes from Abou-Ali river. The different quality states of the coastal zone represent the normal, high, and low flow of the effluents [plume pollutants] from Abou-Ali river. In addition, it represents the variation of different factors such as wind and sea currents speed and direction. This simulation will help the decision makers to implement pre-cautious measures before a disaster takes place by assessing the quality of the sea water near the coastal zones

Effect of smoking on leptin concentration in normal subjects and during acute myocardial infarction

The purpose of this study was to measure leptin concentrations in the blood of smokers and non smokers during ST elevation acute myocardial infarction, and to compare them with values obtained from normal smoker and non smoker subjects. Leptin serum concentrations were measured in 58 patients [34-75 years of age] with acute myocardial infarction and 38 normal subjects [36-69 years of age]. Leptin serum concentrations were measured using two-site immunoradiometric assay [IRMA] principle. In normal smokers [N=20] leptin concentration was 5.8 +/- 2.5 ng/ml [mean +/- SD], while in non smokers [N=18] this value was 5.9 +/- 4.1 ng/ml [mean +/- SD]. Data showed no significant difference in both groups [p > 0.05]. While leptin concentration was 7.8 +/- 2.9 ng/ml in smoker patients [N=32] which was significantly higher than in normal smoker subjects [p=0.02]. Also leptin value was 9.2 +/- 3.7 ng/ml in non smoker patients [N=28] which was also significantly higher than in normal non smoker subjects [p=0.001]. Our results demonstrated that smoking has no effect on leptin concentrations in normal subjects and in patients with acute myocardial infarction, but leptin concentration increases significantly during ST elevation acute myocardial infarction in smoker and non smoker patients

correlation of cyclin A with dtug resistance in adult acute non lymphoblastic leukemia

Acute Non Lymphoblastic Leukemia is one of the most common malignant tumors of haematology. With the recent progress in chemotherapy and supportive therapy, the remission and survival rate have been markedly improved. In this study, cyclin A2 and multidrug resistance expression was measured by flow cytometry and RT-PCR in 52 de novo AML patients with acute myeloid leukemia. Their expression was correlated with other prognostic criteria, response to treatment and to overall survival. The rate of CR and PR was significantly higher in the group of positive expression of cyclin A2, compared to that with negative expression. However a statistically significant difference was only reached by PCR [p=0.02]. By flow cytometry, the overall Survival [OS] in the group with positive cyclin A2 expression is significantly higher than that in the group of negative cyclin A2 expression, p=0.03. Regarding MDRI, it was expressed in 39% of our patients and the level of expression was slightly higher by RT-PCR. The rate of CR and PR in the group of negative MDR expression was significantly higher as compared to the group of positive MDR expression, by both flow cytometry and RTPCR [p= 0.005, 0.004, respectively]. The OS in the group with negative MDR1 expression was significantly higher than that in the group of positive MDR1 expression, p=O.04. There was a significant inverse relationship between Cyclin A2 and MDR expression in our AML cases by RTPCR technique [p= 0.005], while it showed no significance by Flow cytometry [p=0.12]. There was no agreement [Kappa=0.25] between Flow cytometry and RT-PCR in detection of cyclin A2. On the contrary, there was an agreement between Flow cytometry and RT-PCR in detection of MDR. In conclusion, the low expression of cyclin A2 and high expression of MDR1 are indicators for unfavorable prognosis for individuals with AML. The detection of cyclin A2 level would predict drug resistance. However, it is one of many other factors

Seroprevalance of helicobacter pylori among Egyptian pastients with hepatic encephalopathy

Hepatic encephalopathy is a serious complication of end stage liver disease [ESLD], several theories for etiopathogenesis have been suggested, recently Helicobacter pylon [H. pylon] have been hypothesized to be correlated with the severity of hepatic encephaloptahy. Is to assess for the prevalence of H. pylon in patients with hepatic encephalopathy and to study its correlation with severity of illness. 75 patients with ESLD were evaluated; 50 patients with hepatic encephalopathy and 25 patients without encephalopathy. In addition to 25 healthy subjects served as a control. Demographic data of studied patients were collected and staging of encephalopathy was done according to West Haven classification system. Seropevalence of H. pylon was evaluated by ELISA. Seroprevalence of H. pylon infection was 74% in encephalopathy group while it was 64% and 44% in patients without encephalopthy and healthy subjects respectively. Prevalence and titre of H. pylon were found significantly increasing with the severity of hepatic encephalopathy. There is a significant association between FT. pylon and patients of liver disease with hepatic encephalopathy. There may be a role of anti-H. Pylon therapy in patients of hepatic encephalopathy and should be investigated further

Management of primary post partum hemorrhage by balloon tamponade

To assess the use of balloon tamponade in management of primary post partum hemorrhage. A retrospective review of postpartum records of women with massive postpartum hemorrhage between January 2003 and 2006. Primary postpartum hemorrhage were identified in 62 patients in which there was a blood loss of over 1000mls the records of 40 cases were reviewed. Two of 40 cases needed a hysterectomy seven women had been identified as being managed by insertion of inlrauterine balloon catheter of these six of seven were successfully managed one women needed a hysterectomy. We advocate the increase used of intrauterine balloon tamponade for the management of massive obstetric hemorrhage before resorting to invasive procedure

Comparison between endo-tracheal tube, laryngeal mask airway, combitube and streamlined liner pharynx airway

In a prospective, randomized trial 80 patients scheduled for gynacological, urological and lower abdominal procedures in supine position were randomly allocated to one of four groups to evaluate time of insertion, insertion with resistance, number of attempt of insertion, hemodynamic changes, catecholamine level, fibro-optic score, maximum inspiratory peak airway pressure, trauma and post-operative complications after insertion of ET, LMA, CT, SLIPA. All four devices could be inserted easy and rapidly with shorter time of insertion in LMA than SLIPA, and all providing adequate ventilation and oxygenation with higher peak inspiratory airway pressure in CT than the other three groups. Also insertion of CT was associated with significant increase in MAP compared with ET, LMA or SLIPA respectively. While the catecholamine level were significantly higher after insertion of CT than the ET, LMA or SLIPA. Finally, sore throat, hematoma, mucosal laceration and dysphagia occurred more often in CT group than the other groups. While in LMA or SLIPA there is no suffering from sore throat or dysphagia. We conclude that the four devices providing adequate ventilation and oxygenation, but the SLIPA is useful alternative to the other three groups with easy of insertion, less hemodynamic, less catecholamine release response and less complications, so it useful in elective patient specially with cardiovascular disease

The Acquisition, Analyses and Interpretation of fMRI Data: A Study on Functional Specialisation in Primary Auditory Cortices

In this study, functional magnetic resonance imaging (fMRI) is used to investigate func-tional specialisation in human auditory cortices during listening. A silent fMRI paradigm was used to reduce the scanner sound artefacts on functional images. The subject was instructed to pay attention to the white noise stimulus binaurally given at an inten-sity level of 70 dB higher than the hearing level for normal people. Functional speciali-sation was studied using the Matlab-based Statistical Parametric Mapping (SPM5) software by means of fixed effects (FFX), random effects (RFX) and conjunction analyses. Individual analyses on all subjects indicated asymmetrical bilateral activation of the left and right hemispheres in Brodmann areas (BA) 22, 41 and 42, involving the primary and secondary auditory cortices. The percentage of signal change is larger in the BA22, 41 and 42 on the right as compared to the ones on the left (p>0.05). The average number of activated voxels in all the respective Brodmann areas are higher in the right hemisphere than in the left (p>0.05). FFX results showed that the point of maximum intensity was in the right BA41 whereby 599±1 activated voxels were ob-served in the right temporal lobe as compared to 485±1 in the left temporal lobe. The RFX results were consistent with that of FFX. The analysis of conjunction which fol-lowed, showed that the right BA41 and left BA22 as the common activated areas in all subjects. The results confirmed the specialisation of the right auditory cortices in pro-cessing non verbal stimuli.

Blood levels of iron, copper, zinc, nitric oxide, and APOE [epsilon]4 allele frequency in patients with Alzheimer's disease

Alzheimer's disease [AD] is the most common form of dementia, characterized by slow, progressive memory loss. As the disease progresses other symptoms such as visuospatial disorientation, language impairment, and executive dysfunction or frontal lobe signs develop. The current study was performed to investigate the role of iron, copper, zinc, nitric oxide [NO] in relation to ApoE epsilon 4 allele frequencies in patients with AD. This study was carried out on sixty elderly subjects aged >/= 60 years. The subjects were classified into two groups matched for age and gender: Group I: included 30 elderly patients [74.3 +/- 7.2 years] diagnosed as probable Alzheimer's disease according to the DSM-IV-TR and the NINCDS-ADRDA. Group II: included 30 cognitively normal elderly subjects [71.7 +/- 3.6 years] with no evidence of any neurological or psychiatric diseases, or any medical illness that affects cognition. Laboratory investigations were done for patients. The following plasma parameters were measured: iron, copper, zinc and nitric oxide together with ApoE genotyping by PCR - RFLP. The current study revealed that plasma copper, zinc and nitric oxide levels were higher in AD group than control group. But, no statistically significant difference could be found between the two groups in plasma iron level. The frequency of ApoE 4 allele was higher among AD patients than control subjects. In comparison between ApoE4 +ve and ApoE4 -ve patients, no statistical significant difference in the neuropsychological assessment and biochemical assays was observed. Plasma copper level had statistically significant negative correlation with constructional praxis, ward list recognition, recall of constructional praxis, and stage of AD. While, iron, zinc, and NO plasma levels were not significantly correlated with any of the tested neuropsychological tests. We have demonstrated that, NO level had the highest sensitivity and specificity for predicting AD, followed by copper level. It can be concluded that, the ApoE4 gene is a strong risk factor for the AD but it is neither necessary, nor enough for the disease occurrence. Trace metals and NO abnormalities would influence ApoE, leading to development AD. Also, Copper blood levels are related to the abnormal cognition in AD patients

Levosimendan versus milrinone in heart failure: a study of hemodynamic changes

Levosimendan is a drug with a considerable cardiotonic properties; it improve myocardial contractility without causing an increase in myocardial oxygen consumption. The aim of this randomized double blinded study was to compare the effect of levosimendan and milrinon on heamodynamic performance in patients with severe cardiac dysfunction due to acute heart failure. A total of 375 patients admitted to general I.C.U with acute heart failure with the need for hemodynamic monitoring and further hemodynamic support were allocated to this study. After exclusion of 215 patients, 160 patients were randomized to receive levosimendan [Group L, no.=81], or milrinon [Group M no.=79]. Group L patients [no.=81] received an initial loading dose of 12 micro g/kg i.v over 10 minutes, followed by a continuous infusion of 0.1 micro g/kg/min in a maximum of 0.4 micro g/min [according to hemodynamic tolerance]. Group M patients [no.=79] received a loading dose of 25 micro g/kg up to 75 micro g/kg followed by 0.375 micro g/kg/min that was escalated to 0.75 micro g/kg/min to reach satisfactory hemodynamic response. The favored target was to increase cardiac output to more than 30% of the baseline and decrease after load especially that of the right side [pulmonary artery pressure PAP] to more than -25% of the initial reading. Those hemodynamic results were expected to occur within 24 hours from starting the infusion. Hemodynamic parameters monitored were: Repeated baseline measurement of cardiac output [CO], pulmonary capillary wedge pressure [PCWP], mean right atrial pressure [CVP], mean pulmonary artery pressure [PAP] by means of pulmonary artery catheter. Cardiac index [CI], systemic vascular resistance [SVR], pulmonary vascular resistance [PVR] was calculated through hemodynamic measurements. Readings were taken 10 minutes after beginning of loading dose infusion, 1 hour, 4 hours, 8 hours, 12 hours, 18 hours and 24 hours, whilst systolic and diastolic blood pressure was continuously monitored by arterial cannula and heart rate and rhythm through ECG monitoring. The study target was achieved in 49 patients in the levosimendan group and 33 patients of the milrinone group. After tracing the study patients for 180 days, 7 patients of the levosimendan group had died, compared with 9 patients of the milrinone group. Levosimendane showed an improvement in hemodynamic performance than milrinone in case of acute heart failure and showed a lower mortality incidence than the latter drug as well

Anterior ethmoidal artery, a surgical and radiological study

Anterior ethmoidal artery [AEA] has a great clinical and surgical importance. It is a particularly important landmark for the fovea ethmoidalis and the base of the anterior cranial fossa. It is a possible sight of traumatic or intraoperative bleeding. Accurate localization of the anterior ethmoidal canal [AEC] and anterior ethmoidal artery [AEA] both radiologically and surgically and their relation to nasal lamellas and skull base in order to avoid the serious complications that might happen after violation of the canal or the artery. 50 patients diagnosed to have chronic rhinosinusitis [CRS] with or without sinonasal polyposis were selected. All the cases were subjected to: a] preoperative computerized tomography. b] operative intervension in the form of endoscopic sinus surgery [ESS], with dissection of the roof of the ethmoid sinuses for indentification of the anterior ethmoidal canal [AEC]. Radiological evaluation was done by axial, helical thin cuts and reconstructed saggital views, while assessment during surgery was encountered after direct endoscopic visualisation, using palpation with a probe and simple ruler measurements. Twelve patients had ESS performed on one side and 38 patients ESS on both sides. Thereby, a total of 88 AEC identifications were performed. In all dissections the AEC and AEA were successfully identified surgically and radiologically. On comparing surgical and radiological localization of the AEC in relation to the lamellas, it was found that the location of the AEC was the same in 86 dissections, while not in 2 dissections. AEC was positioned inside the skull base without bony defects in 82 dissections, and in 6 dissections, 2mm below the skull base, connected to it by a mesentry. Endoscopic localization of the AEC during surgery and the results of CT imaging were comparable. It was found that the AEA, the anterior turbinate axilla and the superomedial edge of the nostril were in a straight line. This finding was extremely helpful in the endoscopic search for the AEA

Assessment of autonomic nervous system in non-pregnant, pregnant and pre-eclampsia patients

During pregnancy, there are remarkable changes in the circulation. Blood pressure and vascular resistance are increased in woman with pre-eclampsia, the blood volume is smaller, and blood pressure and heart rate responses to various provocations are changed compared with those of normotensive pregnant women. Autonomic nervous system [ANS] functions were investigated in women subdivided into three groups [non-pregnant, pregnant, pre-eclampsia]. Cardiovagal arch functions was assisted by spontaneous heart rate and blood pressure variabilities, deep breathing test and valsalva maneuver. Evaluation of adrenergic vasomotor response to posture and Cold stress test [CST] and evaluation of Heart Rate Variability was done. All the tests were done at 30-38 weeks of gestation. There was high significant difference between normal pregnancy group and pre-eclampsia groups in heart rate [HR], systolic blood pressure [SBP] and diastolic blood pressure [DBP]. There was no significant difference between groups in oxygen [O[2]] saturation. As for skin temperature, there was significant decrease in pre-eclampsia reading than the pregnant group. As regard baroreflex function, there was an increase in heart rate with deep inspiration and decrease in heart rate with expiration with no statistical difference between groups as regard the mean heart rate for three groups [p>0.05]. However, the% of change of maximal heart rate response to deep breathing was diminished [17.93%] than non pregnant [48.7%] and the maximal heart rate response to deep breathing was diminished in cases of pre-eclampsia [3.65%] than normal group. The difference between groups was highly significant in lowest heart rate and blood pressure with valsalva maneuver. There was decrease in valsalva ratio in pregnant groups than in non pregnant group but the valsalva ratio was decreased in pre-eclampsia group more than normal pregnant group. The decrease in blood pressure during strain was more marked in normal groups than PIH group. There was increase in heart rate and systolic and diastolic blood pressure during cold stress test and decrease in O[2] saturation and skin temperature in all groups with significant difference between groups in HR, SBP, DBP and skin temp 20 minutes after CST [there was delayed recovery pre-eclampsia group]. As regard HR variability; increase in HR in pre-eclampsia than normal groups in pregnant and non-pregnant. There was increase in HR in the two pregnant groups with significant difference in pregnant than in non pregnant women [p<0.01]. There was reduced HR variability [NN, SD and rMSSD] during pregnancy than in non-pregnant women [p<0.01]. During pregnancy changes in the ANS occur. Normal pregnancy is associated with significant decrease in baroreflex gain as compared with non pregnant state and this decrease in baroreflex gain is even more pronounced in subjects with hypertensive disorders with pregnancy. ANS evaluation can predict abnormal changes in the circulatory system and therefore, early detection can be important to reduce or prevent hemodynamic instability during regional or general anesthesia. Impairment of autonomic nervous system functions may be the cause of pre-eclampsia

Approaches to minimize the risk of epidural fibrosis after lumbar disc surgery: [clinical - and MRI-based outcome evaluation]

Epidural fibrosis [EF] after lumbar disc surgery is a consequence of normal wound healing. Previous clinical studies have demonstrated a significant association between the presence of extensive post-lumbar discectomy EF formation and the recurrence of low-back and radicular pain with poor surgical outcomes in 5% up to 60%; in the nearly absent curable surgical solutions. Moreover, the presence of fibrosis may lead to nerve root tethering and renders reoperations risky. Theoretical approaches to minimizing the risk of developing EF include decreasing the chance of its development by decreasing the amount of postoperative hematoma by suction drainage [SD] and hence its invasion of by dense fibrous tissue; providing a barrier like autogenous fat between the exposed dura and the healing connective tissues; or applying a drug locally which is supposed to decrease scar tissue formation as steroids. In the present study, we aimed to evaluate the results of these theoretical approaches in the clinical and imaging outcomes of patients after lumbar disc surgery. The present study is a prospective, pragmatic, cohort study conducted and designed to evaluate the clinical outcome and efficacy of SD alone and combined with local application of fat grafts and/or steroids in prevention of post-lumbar discectomy EF. These outcomes were compared with outcomes in patients in whom neither the drain nor the barrier or steroids was implanted. A total of 58 patients [25 women, 33 men] indicated for surgery for a symptomatic, unilateral or bilateral, single-level lumbar disc herniation was included in this study. All patients underwent randomization and surgery. Patients were divided into 2 major groups with 33 patients in Group I [intervention group] and 25 patients in Group II [control group]. Group II served as the control, with decompressive surgery of their symptomatic nerve root alone without SD, local fat or steroid application. Group I was subdivided into 4 subgroups [Ia, Ib. Ic, and Id] according to the procedure done, whether decompressive surgery followed by SD alone or SD combined with local fat and/or steroid application. The barrier tested was autogenous fat graft. Thirty one patients underwent surgery at L4-5, and twenty-seven at L5-S1. Clinical outcome was assessed pre-and postoperatively by evaluating pain intensity, and patients' functional outcome. Pain intensity was evaluated in our study by numeric verbal rating [NVR] scale; and the patients' functional clinical outcome was measured by the range of motion and straight leg raising [SLR] tests. Imaging outcome was assessed on the basis of follow-up magnetic resonance imaging [MRI] findings. We proposed an MRI-based grading system for the extent of EF. No operative or early post operative complications were reported, and no new neurological deficits occurred. A significant proportion of patients in group I showed pain relief compared to the control group, as well as compared to the baseline findings. Analysis of functional outcome showed significant improvements in the intervention group compared to the baseline, as well as the control group at intervals of 3 months, 6 months, and 12 months. The results of pain relief and recovery of the functional status at the end of the study [12m] was best in group Id [SD + fat graft + steroids], followed by group Ib [SD + fat graft], group Ic [SD + steroids], and group Ia [SD alone] respectively. The worst results were obtained in the control group II. Based on the definition that less than 6 months of relief is considered short-term and longer than 6 months of relief is considered long-term, a significant number of patients obtained long-term relief with improvement in pain and functional status. At 1-year follow-up MRI examination, there was a trend toward better outcome in the intervention group. Both suction drainage and fatlsteroid combinations consistently reduced the frequency and the extent of epidural fibrosis on MRI. We conclude that, in patients operated on for unilateral, single-level lumbar disc herniations, implantation of suction drainage into the operation site results in less formation of EF radiologically and yields better clinical outcome. Fat grafts further reduced epidural fibrosis and did not impair normal healing. Local steroid is an effective adjuvant in a significant number of patients without adverse effects. Thus, the use of SD with addition of peridural fat barrier and steroids may improve outcome in these patients