Analgesic efficacy and outcome of lumber epidural analgesia versus ultrasound guided trasversus abdominis plane block in laparoscopic sleeve gastrectomy

Background: The transversus abdominis plane [TAP] block provide effective postoperative analgesia in lower abdominal surgery. Subcostal TAP block as a new technique to provide analgesia for the supraumbilical abdomen. Traditionally, pain relief for these patients is provided by epidural analgesia or IV opioid analgesia. Although epidural analgesia is currently the "gold standard" for postoperative pain treatment, associated complications and contraindications may limit its use. IV opioid analgesia may cause opioid-related side effects and be associated with inadequate analgesia

Aim of the Work: This study aimed at clinically evaluating and statistically comparing between lumber epidural versus transversus abdominus plane block as postoperative Analgesia for laparoscopic sleeve gastrectomy. Also, our goal was to figure out the most possible effective technique for this kind of procedure with most benefits and least side effects

Patients and Methods: This single blinded randomized clinical trial was carried out at Ain Shams University hospitals on 60 adult Bariatric patients undergoing elective Laparoscopic sleeve Gastrectomy, aged 20 to 50 years, ASA III, BMI equal or less than 45 Kg/m[2]

Results: Patients in the Lumber Epidural group had significantly less pain score when compared to the other TAP group [p-value < 0.001]. And, they had longer time to first request rescue analgesia [nalbuphin] [P = 0.0013]. Also, total dose of nalbuphin consumption was less in Lumber Epidural group than TAP group [P < 0.001]

Conclusion: This study concluded that TAP block was effective in pain relief after Laparoscopic sleeve gastrectomy, however, Lumber Epidural was superior in pain relief, less narcotic consumption and overall more patient satisfaction

Insulin resistance in chronic hepatitis C virus patients receiving direct acting antiviral drugs

Association between chronic hepatitis C [CHC] infection and insulin resistance [IR] is still challenging. The study assessed the impact of using direct acting antivirals [DAAs] on IR and the effect of IR on the treatment response. A total of 101 Egyptian patients with CHC who were eligible to Sofosbuvir based treatment were prospectively involved. All the patients were subjected to baseline liver function test, fasting and post prandial blood glucose, fasting insulin, quantitative HCV PCR and abdominal ultrasound. All the patients received sofosbuvir and daclatasvir with or without ribavirin for 12 weeks. HOMA-IR evaluated IR, both at baseline and at the end of treatment. The results showed that patients' mean age was 48.59+/-10.56 years; with female dominance [58.4%]. An overall sustained response [SVR] was successfully achieved in 96 patients [95.04%]. Baseline IR [defined as HOMA-IR >2] was identified in 64 patients [63.4%] with a median value of 3.07. Patients with positive sustained virologic response [SVR] had lower median values of HOMA-IR than those with negative SVR; both at baseline and the end of treatment [p=0.004, p=0.04; respectively]. By the end of treatment, ALT, AST, and FBG showed a significant decrease [p=0.0001]. Fasting insulin and HOMA-IR showed a slight improvement [p>0.05]

Cortical lesions in a sample of egyptian multiple sclerosis patients

Background: multiple sclerosis is an inflammatory demyelinating disease with a neurodegenerative component mainly characterized by progressive accumulation of focal white matter [WM] lesions. The degree of cortical damage at baseline was associated with the progression of disability. Cognitive deficits could be better explained by cortical lesions [CLs] than by WM lesions. Fatigue in MS could be due to damage to the cortico striato thalamo cortical circuit

Aim of the Work: to detect [CLs] in MS patients and correlate these lesions with physical disability, cognitive dysfunction and fatigue

Subjects and Methods: a case-control study on 64 subjects including 44 known multiple sclerosis patients diagnosed according to revised McDonald's criteria 2017

Results: we observed a statistically significant difference between MS patients and healthy controls as regard number of [CLs], Symbol Digit Modality Test [SDMT], Fatigue Severity Scale [FSS] and P300 wave latencies and amplitudes. Secondary progressive [SPMS] subgroup was affected more than relapsing remitting [RRMS] subgroup. [CLs] were located mainly in temporal lobes

Conclusion: This study suggested that cortical affection is directly associated with physical and cognitive disability progression

Effectiveness of using electronic school broadcasting to meet the needs of secondary school students

Aims: The study aims to identify the extent of measurement the effect of using the electronic school broadcasting for meeting some psychological and social needs of students in the secondary schools, and aims at presenting model of specialized electronic school broadcasting for the secondary school students, in addition to providing tool for welfare of talent students in the fields of school broadcasting out of the school, to train students on the production of electronic school broadcasting that can help them to career orientation in the future in the fields of media

Methods: The researcher used semi-empirical approach

Sample: A sample of 100 subjects in ages between [15-18] of [Male-Female] students in the experimental schools.Tools: The researcher used the scale of psychological and social needs, and used the questionnaire form in the interview to be applied to the experimental group to answer the questions of the study and survey the opinions of the experimental group students the sample of the study in the experiment of designing electronic school broadcasting of their own during the school year [2014]

Results: The key results of the study: there are statistically significant differences between the average scores of the experimental group students on the dimensions [belonging, security, self-esteem, independence and achievement] and the average scores of the control group students on the psychosocial needs scale in the dimensional measurement for the experimental group for the favor of the average scores of the experimental group students. In addition, there are statistically significant differences between the average scores of the experimental group and the control group on the average scale of psychological and social needs in the pre measurement. There are also statistically significant differences between the average scores of the experimental group students on the scale of social and psychological needs in the pre measurement and their average scores in the post measurement on the scale of psychological and social needs for the favor of the post measurement. Moreover, there are no statistically significant differences between the average scores of females in the experimental group and the average scores of males in the same group on the score of psychological and social needs scale

Single incision tans-umbilical laparoscopic cholecystectomy using conventional laparoscopic instruments: initial experience of single institute

Laparoscopic cholecystectomy [LC] had been considered the gold standard treatment for symptomatic gall bladder [GB] stones. Single incision laparoscopic cholecystectomy [SILC] was emerged as a less invasive alternative with better cosmesis and less post operative pain. This study evaluated the feasibility, safety, advantages and complications of SILC using the conventional laparoscopic instruments. A total of 52 patients [47 females and 5 males] with symptomatic GB stones underwent elective SILC using the conventional laparoscopic instruments. The mean operative time was 61.75 min and the mean estimated blood loss was 17.21 ml. Gall bladder perforation occurred in 5 cases [9.6%] in which 3 cases calculi spillage occurred. Troublesome cystic artery bleeding occurred in 2 cases [3.8%] while gall bladder bed bleeding happened in 1 case [1.9%]. An intraoperaive cholangiogram was performed in 3 cases and a drain was inserted in one case. No conversions of the technique occurred. 49 patients discharged in the first post operative day and 3 patients [5.8%] in the 2nd day. Three month post-operative wound length was an average of 1.58 cm while patient satisfaction of the surgery was an average of 9.32

Effects of glycine on haemostatic changes in stressed immobilized rats

Administration of antioxidants aimed at reducing oxidative stress induced haemostatic disorders is recommended in chronic immobilization. This study was conducted to investigate the effects of glycine supplementation on haemostatic changes in chronic immobilization stress in rats. Rats were divided into normal control group, stressed [immobilized] rats, glycine-treated group and glycine-treated +stressed [immobilized] group, Platelets aggregation, Prothrombin Time [PT], Activated Partial Thromboplastin Time [APTT], as well as plasma levels of fibrinogen [fibrinogen], Fibrinogen Degradation Products [FDP] and malondialdehyde [MDA] were assessed. Immobilization stress is associated with significant reduction of PT and APTT with significant increase in platelets aggregation as well as plasma levels of fibrinogen, FDP and MDA. On the other hand glycine supplementation for immobilized rats resulted in significant prolongation of PT and APTT with significant decrease in platelets aggregation as well as plasma levels of fibrinogen, FDP and MDA. In addition, in normal rats glycine administration induced significant reduction in platelets aggregation with prolongation of APTT. PT and plasma levels of fibrinogen and FDP were significantly changed. Chronic immobilization stress s associated with increased platelets aggregation, hypercoagulability and increased free radical production. Glycine counteracted the oxidative insult in immobilization stress and ameliorated these disorders accompanying this condition

Metabolic effects of melatonin supplementation in stressed immobilized rats

Therapeutic interventions aimed at reducing metabolic perturbances are recommended in chronic immobilization stress via administration of melatonin. This study was conducted to evaluate the effects of melatonin supplementation on carbohydrate and lipoproteins metabolism in chronic stressed immobilized rats. A total of 32 male albino rats [150-250 grams, each] were divided into 4 equal groups; control group, stressed immobilized group, melatonin-supplemented group and melatonin supplemented + stressed immobilized group. Fasting blood glucose level and rate of glucose uptake by skeletal muscle [diaphragm] were investigated. Also plasma levels of triglyceride [TG], total cholesterol [TC], low density lipoprotein-cholesterol [LDL-C], high density lipoprotein-cholesterol [HDL-C] and malondialdehyde [MDA] were measured. Stressed immobilized group showed significant hyperglycemia associated with decreased glucose uptake by diaphragm. In addition, plasma levels of TG, TC, LDL-C and MDA were significantly increased. But the level of HDL-C in plasma was decreased significantly. Melatonin supplementation for stressed immobilized rats resulted in significant increase of glucose uptake by diaphragm, as well as HDL-C. On the other hand blood, glucose level, TG, TC, LDL-C and MDA were significantly decreased. In addition melatonin supplementation for normally fed rats produced significant increase of glucose uptake by diaphragm with significant reduction of plasma levels of TG, TC and LDL-C. Melatonin supplementation could ameliorate the metabolic disturbances in carbohydrate and lipoproteins metabolism in chronic immobilization stress in rats

Plasty transposition flaps a new technique in closure of skin defects after lumbosacral meningomylocele resection in pediatrics

Different closure techniques are available after lumbosacral meningomylocele [MMC] resection for large defects reconstruction, but wound healing and tension-free closure in the midline remain major considerations. In this study we use Z plasty technique in closure of MMC defects>5 cm. Twenty newborns with large lumbosacral MMC were enrolled in this study. The mean age was 57.45 +/- 59.8 days. Complete healing of the skin occurred within two weeks in 14 patients [70%]. Superficial wound infection was seen in four patients [20%]. Necroses of the edges of the flap were showed in two patients [10%]. No mortality or complete wound dehiscence were observed in this study. Almost skin wounds healed without any major complications

Effects of exercise training and vitamin E on cardiac performance in aged rats

Aging is characterized by impaired contractile function in the heart. Meanwhile, during senescence the heart faces a high risk of free radical injury which may be a reason for development of myocardial dysfunction in the aged heart. To investigate this, we compared the effects of swim exercise training versus vitamin E treatment on age associated changes in intrinsic cardiac function in response to beta- adrenergic stimulation, induced ischemia and reperfusion. Rats were divided into a] control group b] exercise-trained group c] vitamin E treated group. Isolated hearts were studied in a Langendorff preparation for their intrinsic properties, and their responses to beta- adrenergic stimulation. After recovery the isolated hearts were subjected to global ischemia followed by reperfusion. The results showed that the exercise program adopted resulted in enhancement of time to peak tension response of aged hearts to beta- adrenergic stimulation. Following ischemia/reperfusion [I/R], such program enhanced half relaxation time. Treatment of the aged hearts with vitamin E maintained coronary blood flow and improved the inotropic cardiac reserves. Vitamin E proved to be cardioprotective against the toxic doses of catecholamines as well as the injury of post I/R on the heart. Coronary effluent from hearts of vitamin E _ treated rats had the significant highest level of nitrate compared to the other two groups when measured at 3.46 micro g dose of isoproterenol and at 30 min of reperfusion. Vitamin E enhanced cardiac responsiveness to beta- adrenergic stimulation, and protected the aged heart against I/R injury. Preservation of NO from being transformed to peroxynitrite by antioxidant action of vitamin E may have played a significant role. Swim- training program did not show promising cardio-protective effects against cardiac changes associated with the aging process

In vitro evaluation of the light speed and profile rotary systems in the preparation of curved root canals

Successful root canal treatment depends on removal of pulp tissue, bacteria and necrotic debris from the root canal system, with adequate canal shaping that facilitates obturation. Recently a variety of engine drive rotatory systems have been introduced to the market in an attempt to simplify canal preparation especially the curved canals and reduce operator fatigue. The aim of this work was to evaluate the Profile and the light speed rotary systems together with their recommended obturation techniques which are the Thermafil and the Simplfill respectively, versus the conventional hand instrumentation with Ni-Ti K-files using step-back technique and lateral condensation obturation technique, regarding three parameters, cleanness of instrumented canals, canal deviation and leakage of obturated canals. 90 Freshly extracted human mandibular molars were used in this study. Teeth were divided into three main groups according to the method of canal preparation. Each group was evaluated by histological examination, digital radiography assessment and apical dye Leakage. The Profile and the lightspeed rotary systems, and also the hand instrumentation by the Nitiflex files were able to remove the major contents of the instrumented canals at #35 apical preparations. But none of them totally debrided the entire root canal system. The Lightspeed rotary instruments were superior to the hand instrumentation with the Nitiflex files in maintaining the original canal curvature

Mycoplasma hominis and ureaplasma urealyticum vaginosis in pregnant women

The main feature of bacterial vaginosis is a change in vaginal flora from predominant Lactobacilli to overgrowth of other microorganisms like; Mycoplasma hominis [M. hominis] and Ureaplasma urealyticum [U. urealyticum]. M. hominis and U. urealyticum vaginosis has been associated with abortion, intraamniotic infection, premature rupture of membranes [PROM] and intrapartum fever in pregnant women. This study was carried out on 100 pregnant women complaining of abnormal vaginal discharge in addition, 50 normal healthy pregnant women were included as a control. Vaginal specimens were collected from all studied women. The incidence of BV among pregnant women was [39%] whereas none of the controls has BV There was positive correlation between the number of pregnancy but not its duration. M. hominis was detected in BV cases [38.5%] and U. urealyticum in [46.2%]. As regarding the susceptibility, M. hominis was more sensitive to norfioxacin and tetracycline [100% for each] and also, U. urealyticum isolates were more sensitive to norfloxacin and tetracycline [94.4, 88.9%] respectively, but they were resistant to Amoxicillin and Amoxacillin/Culvunate

Biochemical markers of fibrogenesis in pediatric chronic liver diseases

Non-invasive diagnosis of hepatic fibrosis has become the focus, especially in the surveillance of treatment and in screening hepatic fibrosis. To investigate the clinical usefulness of fibrogenesis markers in evaluating liver fibrosis, we determined serum levels of TGF-beta 1, collagen N, and laminin, their relationship with frequently used liver function tests, and findings of liver ultrasonography and biopsy were investigated. 50 patients with chronic liver disease were enrolled from the National Liver Institute, Menoufiya University. Serum markers of fibrosis, liver function indices [for the patients and 30 controls], and ultrasonography for all patients were performed and compared with histologic fibrotic changes. showed that Serum levels of TGF beta 1, collagen IV, and laminin were significantly higher in patients than those in control [P<0.000]. The levels of serum fibrosis markers were not correlated with fibrotic scores [P>0.05], but laminin was positively correlated to histologic activity index. There were no significant changes in the level of serum fibrosis markers related to ultrasongraphic findings. Their levels were also not correlated to ALT or AST. The cut-off values, specificity and sensitivity were determined for all markers, among which collagen N was the marker with the highest sensitivity and specificity. our that Serum level of TGF- beta 1, collagen N, and laminin can be used as indices for the diagnosis of hepatic fibrosis. Among them, Collagen N is more sensitive. Biochemical markers of fibrogenesis might be useful in regular monitoring of disease development and treatment effectiveness and should be inseparable part of progression assessment in all chronic hepatopathies

Screening for human papillomavirus [HPV] in Egyptian females by the second-generation hybrid capture [HC II] test

Human Papillomavirus [HPV] infection is the main cause of cervical cancers and cervical intraepithelial neoplasias [CIN] worldwide. Consequently, it would be useful to evaluate HPV testing to screen for cervical cancer. Recently developed, the second-generation Hybrid Capture [HC II] test is a non-radioactive, relatively rapid, liquid hybridization assay designed to detect 18 HPV types, divided into high and low-risk groups. This test has an additional advantage, as it is also designed to provide quantitative estimates of the viral load .The aim of the present work, is to detect the rate of HPV infection and its various genotypes among the attendants of Kasr El Aini out patient gynecology clinic, using a non-invasive approach and to provide quantitative estimates of viral load. We evaluated 166 Egyptian females for HPV infection with the HC II test. The mean age of the participants was 37.28 +/- 9.16 years. According to cytology, the females were classified into normal cytology, chronic nonspecific cervicitis and squamous intraepithelial lesions [SILs]. The overall prevalence of HPV DNA in the studied groups was 15.06% [25/166], ranging from 6.6% [7/106] in normal cytology to 18% [9/50] in chronic nonspecific cervicitis to 90% [9/10] in squamous intraepithelial lesions. Among the 25 HPV- positive women, 16 [64%] were infected with high-risk HPV types, 4[16%] were infected with low risk HPV types, while 5[20%] had both types. Twenty-one [84%] of the infected woman harbored at least one high risk HPV type while 9[36%] harbored at least one low risk HPV type. Values of HPV viral load for low risk HPV infecton showed no significant difference for normal and chronic nonspecific cervicitis. But when HPV viral load of high risk HPV infecton was compared in normal, chronic nonspecific cervicitis and SIL a significant difference was found between normal and chronic nonspecific cervicitis, and between chronic nonspecific cervicitis and SIL and between normal and SIL, suggesting an association between viral load and risk of SIL and accordingly risk of cancer. Mixed HPV infection gave high viral load values even in normal smears. The viral load was apparently higher in SIL. From this study we may conclude that HPV testing using HC II assay is a useful tool when combined with cytology in diagnosing high-risk HPV viral types in apparently normal tissues. This may decrease greatly the increasing referral rate for colposcopy. This will reduce the cost services and could contribute to cancer prevention. Thus, this test may facilitate the detection of silent carriers of HPV by a sensitive noninvasive technique; leading to the identification of Egyptian women at risk of cervical neoplasia

Neonatal intestinal perforation; laparotomy versus drainage

This study included 25 cases of intestinal perforation with and without necrotizing enterocolitis [NEC]. Infants were divided into two groups: Group 1 consisted of 8 infants who had intestinal perforation without evidence of NEC and group 2 consisted of 17 infants who had intestinal perforation with evidences of NEC. A total of 25 infants underwent initial peritoneal damage [PD] for intestinal perforation. In addition, a cohort of 10 infants was obtained by a chart review of premature infants with intestinal perforation treated with primary laparotomy. Outcome of the cohort group was compared with those of the infants treated with primary PD. All infants showed initial improvements after PD. In group 1, all infants survived. Five infants never required laparotomy and drain was removed after 10 +/- 7 days. One infant underwent laparotomy after 48 hours due to failure of improvement, an isolated perforation was found, a diverting stoma was placed, and the infant recovered. Two infants required laparotomy 15 and 17 days after PD. In group 2, all infants improved systemically immediately after PD. Seven infants survived required no additional surgical intervention and all were discharged with intact gastrointestinal function. Four infants developed clinical deterioration and underwent salvage LAP, three underwent bowel resection and placement of diverting stoma and recovered and one had total intestinal necrosis and died. The remaining six infants died without exploration

Pre-operative port sites infiltration and intraperitoneal administration of bupivacaine: Does it effectively reduce pain after laparoscopic cholecystectomy?

To examine the efficacy of preoperative port sites infiltration and /or intraperitoneal administration of bupivacaine in alleviating pain after laparoscopic cholecystectomy [LC], 80 patients scheduled for elective laparoscopic cholecystectomy were recruited. They were blindly r and omized to 4 groups, 20 patients each. Group A received bupivacaine infiltration in port sites before skin incision as well as intraperitoneal instillation, group B received bupivacaine in port sites only, group C received bupivacaine intraperitoneally only and group D served as a control group and had no treatment. Postoperative pain [viscer al and somatic] and nausea were studied at 1, 2, 3, 6, 9, 12, 24, 36 and 48 hours after operation. The study showed that the combination of preoperative port sites infiltration and intraperitoneal administration of bupivacaine significantly reduces postoperative nausea, port sites pain and shoulder tip pain, but does not affect headache or other types of pains after laparoscopic cholecystectomy

Value of fetal echocardiographic screening for cardiac malformations

With advancing technology in ultrasound machines, examination of the fetal heart became available even at 14 weeks gestation. There are many reasons for referral for complete fetal echocardiographic assessment; the most common one is family history of congenital heart disease, while the most productive one is abnormal four chamber view. This study describes the value and accuracy of fetal echocardiographic screening for cardiac malformations in high-risk pregnancies. We studied 270 pregnant ladies who were referred for fetal echocardiography for several reasons e. g. family history of CHD, diabetes mellitus, inadequate or abnormal view of the heart [four chamber or great vessels], the presence of fetal abnormality on obstetric scanning and increased nuchal translucency thickness particularly in the first trimester. Antenatal fetal echocardiographic scanning of the heart was performed and compared with the postnatal one or compared with the histopathological finding of the specimen if termination of pregnancy took place. In cases where chromosomal abnormalities were detected, a chromosomal study was carried out. Our results showed a spectrum, of multiple cardiac abnormalities, both major and minor such as atrioventricular septal defect, hypoplastic left heart, aortic coarctation, large VSD, transposition of great vessels, cardiomyopathy and cardiac tumours. The most productive group of patients were those referred due to abnormal or inadequate four chamber view, the percentage of CHD in this group was 66.6% extended examination of the fetal heart [four chamber view and great vessel view] could detect about 75% of CHD. The percentage of chromosomal abnormalities in case with CHD was 20%. The accuracy of fetal echo is affected by the time during gestation when scanning is performed especially for valvular stenosis, coarctation of the aorta. Scanning in the first trimester is confined to the high risk patient

Microbiological cultures of removed intrauterine devices

Intrauterine devices [lUDs] are highly effective, long-term methods of contraception. Although evidence of a direct association between IUD use and pelvic inflammatory disease [PID] is scarce, concerns about PID related to IUDs use has limited their use throughout the world. In this study, 200 participants were chose from among women who requested an IUD as a means of contraception. The IUDs were removed 36 months Iater or in case of PID. No PID cases were recorded during the follow-up period. Prior to IUD insertion, 121 women [60.5%] had symptoms and/or signs of lower genital tract infection, whereas during the follow-up period 179 women [89.5%] had symptoms and/or signs of lower genital tract infection. Vaginal and endocervical specimens prior insertion of IUD and during follow-up period were collected from all participants and also specimens from removed IUD. The Papanicolaou smears were negative for Actionmyces throughout the study period. Following IUD removal, 189 IUD cultures [94.5%] were positive. The bacterial flora of the removed IUDs consisted of common aerobic and anaerobic microorganisms that do not account for PID. The most common microorganisms identified were Staphylococcus coagulase negative 67/200 [33.5%]. Eschericia coli 57/200 [28.5%] and Enterococcus faecalis 47/200 [23.5%]. IUDs are a very effective and safe method of contraception if potential recipients are selected carefully. Culture of the removed IUDs and therapeutic management of women with positive cultures are not recommended when women are asymptomatic for PID

Scroto-peritoneal port for complete laparoscopic orchidopexy

The use of laparoscopy in the management of the clinically impalpable testes has been accepted as the standard procedure of choice. However, many techniques have been described to bring the mobilized testes to the scrotum. In this study a new approach to deliver the mobilized testis to the scrotum is described. The aim of this study is to evaluate the use of a fourth scrota-peritoneal port for the delivery of the mobilized testes without inguinal incision. 43 non palpable intra-abdominal undescended testes are the material of this work. We have used a trans-scrotal port for extraction of the mobilized testes, without inguinotomy. In this study we have delivered the mobilized testes to the scrotum through a scrota-peritoneal port no 10 in 28 cases and thrqugh the radially expanding trocar system [Step port] in 15 cases. The results of this study showed that the scrota-peritoneal port allowed meticulous extraction of the dissected testis, undervision, without any trauma to the testis and without the need for inguinotomy. In conclusion, the use of a fourth scrotoperitoneal port, makes complete laparoscopic orchidopexy possible and in addition, is safe and easy to perform