Population Dynamics of Intermediate-Host Snails in the White Nile River, Sudan: A Year-Round Observational Descriptive Study

We aimed to explore the population dynamics of snail in 3 sites of the White Nile in Sudan. More specifically, we aimed to investigate the annual patterns of snail populations that act as intermediate hosts of schistosomes and monthly snail infection rates and ecological characteristics presumably related to snail populations. We collected snails for 1 year monthly at 3 different shore sites in the vicinity of El Shajara along the White Nile river in Khartoum State, Sudan. In addition, we measured air and water temperatures, water turbidities, vegetation coverages, and water depths and current speeds. Most of the collected snails were Biomphalaria pfeifferi and Bulinus truncatus. The population densities of snails and their infection rates varied across survey sites. The collected snails liberated S. mansoni and S. haematobium cercariae as well as Amphistome and Echinostome cercariae. Infected snails were found during March-June. The ecological characteristics found to be associated with the absence of snails population were: high turbidity, deep water, low vegetation coverage (near absence of vegetation), high water temperature, and high current speed. To our knowledge, this is the first longitudinal study of the snail population and ecological characteristics in the main basin of the White Nile river.

Population Dynamics of Intermediate-Host Snails in the White Nile River, Sudan: A Year-Round Observational Descriptive Study

We aimed to explore the population dynamics of snail in 3 sites of the White Nile in Sudan. More specifically, we aimed to investigate the annual patterns of snail populations that act as intermediate hosts of schistosomes and monthly snail infection rates and ecological characteristics presumably related to snail populations. We collected snails for 1 year monthly at 3 different shore sites in the vicinity of El Shajara along the White Nile river in Khartoum State, Sudan. In addition, we measured air and water temperatures, water turbidities, vegetation coverages, and water depths and current speeds. Most of the collected snails were Biomphalaria pfeifferi and Bulinus truncatus. The population densities of snails and their infection rates varied across survey sites. The collected snails liberated S. mansoni and S. haematobium cercariae as well as Amphistome and Echinostome cercariae. Infected snails were found during March-June. The ecological characteristics found to be associated with the absence of snails population were: high turbidity, deep water, low vegetation coverage (near absence of vegetation), high water temperature, and high current speed. To our knowledge, this is the first longitudinal study of the snail population and ecological characteristics in the main basin of the White Nile river.

Cancerous Inhibitor of Protein Phosphatase 2A as aMolecular Marker for Aggressiveness and Survival in OralSquamous Cell Carcinoma

Cancerous inhibitor of protein phosphatase 2A (CIP2A) has been identified as one of the most commonly altered proteins in humancancers. It blocks the tumor-suppressive action of protein phosphatase 2A (PP2A) complex and enhances malignancy. Thirty-fivepatients with squamous cell carcinoma of the oral cavity underwent surgical resection of the tumor. CIP2A was assessed by quantitativereal-time PCR in the resected tumor tissues and in their adjacent normal tissues. CIP2A was found to be overexpressed inall oral squamous cell carcinoma (OSCC) specimens in comparison to their surrounding normal tissue. CIP2A overexpression wasstatistically correlated with poor prognostic feature of the tumor. Thus, a high expression level of CIP2A was associated with shortersurvival. In conclusion, CIP2A is upregulated in OSCC, and its overexpression is correlated with aggressiveness of the tumor andpoor outcome and survival. It may serve as a prognostic marker of OSCC.

Dientamoeba fragilis Infection in Patients with Digestive and Non-Digestive Symptoms: A Case-Control Study

In most developing countries, Dientamoeba fragilis infection is an obscure protozoan infection. We aimed to determine a frequency and clinical importance of D. fragilis infection in Taif, Saudi Arabia. A 1-year case control study included patients with gastrointestinal (cases, n=114) or non-gastrointestinal symptoms (controls, n=90). The fecal samples were examined with the classical parasitological methods for intestinal protozoa, and by real time PCR for D. fragilis. The infection by D. fragilis was detected in 5.8% by PCR and in 4.4% patients by microscopy. The infection was identified more in control group (n=9) than in cases (n=3); a sole infection in 11 patients and mixed with Giardia in 1 patient. The other enteric parasites detected were Blastocystis sp. (8.3%), Giardia sp. (5.3%), Cryptosporidium sp. (2.9%), Entamoeba histolytica (1.4%), Entamoeba coli (0.9%) and Hymenolepis nana (0.4%). Our results tend to reinforce the need to increase awareness of D. fragilis infection in Saudi Arabia.

Comparison of intraperitoneal versus intravenous dexamethasone on postoperative nausea and vomiting after gynecological laparoscopy: a randomized clinical trial / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication following laparascopic surgery. This study compared the effect of intraperitoneal versus intravenous dexamethasone for reducing PONV after gynecological laparoscopic surgeries. METHODS: Eighty adult female patients, American Society of Anesthesiologists physical status I–II, scheduled for gynecological laparoscopic surgery were randomized to receive 8 mg dexamethasone intravenously (IV) (n = 40) or intraperitoneally (IP) (n = 40). The primary outcome was the PONV incidence during the first 24 h after laparoscopy. Secondary outcomes included visual analogue scale (VAS) pain scores, total rescue analgesic consumption during the first 24 h postoperatively, the need for rescue antiemetic drugs, and the incidence of complications that may accompany these medications. RESULTS: Eleven women (27.5%) in the IV group, versus only 3 (7.5%) women in the IP group, experienced nausea during the first 24 h postlaparoscopy (P = 0.037). However, 5 patients (12.5%) in the IV group, versus only 2 patients (5.0%) in the IP group, experienced vomiting (P = 0.424). No statistically significant differences were seen in the severity of nausea or the need for rescue antiemetics. The IV group had a higher rate of side-effects than the IP group (27.5% vs. 7.5%, P = 0.037). Headache and dizziness were common side effects in the IV dexamethasone group. The groups did not differ significantly in terms of mean VAS score for pain and total meperidine consumption during the first 24 h postoperatively. CONCLUSIONS: Intraperitoneal dexamethasone at a dose of 8 mg at the end of gynecological laparoscopy reduces the incidence of postoperative nausea.

Comparison of intraperitoneal versus intravenous dexamethasone on postoperative nausea and vomiting after gynecological laparoscopy: a randomized clinical trial / 대한마취과학회지

BACKGROUND@#Postoperative nausea and vomiting (PONV) is a common complication following laparascopic surgery. This study compared the effect of intraperitoneal versus intravenous dexamethasone for reducing PONV after gynecological laparoscopic surgeries.@*METHODS@#Eighty adult female patients, American Society of Anesthesiologists physical status I–II, scheduled for gynecological laparoscopic surgery were randomized to receive 8 mg dexamethasone intravenously (IV) (n = 40) or intraperitoneally (IP) (n = 40). The primary outcome was the PONV incidence during the first 24 h after laparoscopy. Secondary outcomes included visual analogue scale (VAS) pain scores, total rescue analgesic consumption during the first 24 h postoperatively, the need for rescue antiemetic drugs, and the incidence of complications that may accompany these medications.@*RESULTS@#Eleven women (27.5%) in the IV group, versus only 3 (7.5%) women in the IP group, experienced nausea during the first 24 h postlaparoscopy (P = 0.037). However, 5 patients (12.5%) in the IV group, versus only 2 patients (5.0%) in the IP group, experienced vomiting (P = 0.424). No statistically significant differences were seen in the severity of nausea or the need for rescue antiemetics. The IV group had a higher rate of side-effects than the IP group (27.5% vs. 7.5%, P = 0.037). Headache and dizziness were common side effects in the IV dexamethasone group. The groups did not differ significantly in terms of mean VAS score for pain and total meperidine consumption during the first 24 h postoperatively.@*CONCLUSIONS@#Intraperitoneal dexamethasone at a dose of 8 mg at the end of gynecological laparoscopy reduces the incidence of postoperative nausea.

Diagnosis, Treatment and Clinical Features of Cutaneous Leishmaniasis in Saudi Arabia

Cutaneous leishmaniasis (CL) has been one of the most common parasitic diseases in Saudi Arabia. This study exhibits the clinical features, diagnosis, cytokine profile and treatment of CL patients in Al-Taif province. Ninety CL suspects at a tertiary care general hospital were enrolled in one-year study. Patients were interviewed, clinically-examined, and subjected to laboratory tests: skin scraping smear microscopy, OligoC-TesT commercial PCR (Coris BioConcept) and kinetoplast DNA (kDNA) PCR for Leishmania diagnosis. Interferon-gamma (RayBio; Human IFN-γ) and nitric oxide (NO) levels in patients' sera were evaluated before treatment with sodium stibogluconate (pentostam) with 20-day intramuscular drug regimen. Positive rates of microscopy, commercial PCR and kDNA PCR were 74.4%, 95.5% and 100%, respectively. Patients came to hospital mostly in winter (45.0%). CL was frequently exhibited in Saudi patients (78.8%), male gender (70.7%), age < 20 years (50.0%), rural-dwellers (75.5%) and patients with travel history (86.6%). Lesion was mostly single ulcer (93.3%), occurred in the face (67.7%). Upon pentostam treatment, 85.1% of ulcers showed rapid healing signs. Levels of IFN-γ and NO were significantly higher in the healing than the non-healing cases (P < 0.001). The kDNA PCR proved more sensitive than microscopy and OligoC-TesT commercial PCR. Our results open perspectives for IFN-γ use as a biomarker predicting treatment response.

Dosimetric audit of diagnostic and therapeutic Angiographic procedures at Aminu Kano Teaching Hospital, Kano Nigeria

@#Angiography is the gold standard for the diagnosis and treatment of vascular and related diseases. However, the challenges and peculiarities of the procedure may result in increased fluoroscopy time and number of acquired images, which increased personnel and patients‟ radiation exposure. This study determines the dose area product readings following diagnostic and interventional angiographic procedures in an attempt to establish reference values for patient radiation dose optimization. This retrospective study reviewed the cases of 25 patients that were managed at the teaching hospital. Types of angiographic procedure, exposure parameters as well as radiation dose parameters were documented. Fluoroscopy time, number of frames acquired for each examination, fluoroscopy and frame radiation doses were equally recorded. Of the 25 patients, 6 were for 4-vessel cerebral Digital Subtraction Angiography (DSA), 3 for both lower limbs DSA, 4 for both lower limbs DSA and angioplasty, 3 for Inferior Vena Cava (IVC) filter placement, 2 for pulmonary arteriography, 2 for renal artery embolisation, and 5 for unilateral lower limb DSA and angioplasty. Renal artery embolization had the highest fluoroscopy and frame radiation doses (73764 cGy.cm2 and 4090 mGy) compared to others. Measured Dose Area Product (DAP) doses were above the Diagnostic Reference levels (DRLs) available in the literature thereby necessitating the need for radiation dose optimization through, continuous dose management.

High Frequency of Enteric Protozoan, Viral, and Bacterial Potential Pathogens in Community-Acquired Acute Diarrheal Episodes: Evidence Based on Results of Luminex Gastrointestinal Pathogen Panel Assay

Infectious diarrhea is endemic in most developing countries. We aimed to investigate the protozoan, viral, and bacterial causes of acute diarrhea in Taif, Saudi Arabia. A cross-sectional prospective 1-year study was conducted on 163 diarrheal patients of various ages. Stool samples were collected, 1 per patient, and tested for 3 protozoa, 3 viruses, and 9 bacteria with the Luminex Gastrointestinal Pathogen Panel. Overall, 53.4% (87/163) of samples were positives (20.8% protozoa, 19.6% viruses, 2.8% bacteria, and 9.8% mixed). Rotavirus (19.6%), Giardia duodenalis (16.5%), and Cryptosporidium spp. (8.5%) were the mostly detected pathogens. Adenovirus 40/41 (4.2%), Salmonella (3%), Shiga toxin-producing Escherichia coli (3%), and Entamoeba histolytica (2.4%) were also detected. Norovirus GI/II, Vibrio cholerae, Yersinia enterocolitica, and Clostridium difficile toxin A/B were not detected in any patients. All pathogens were involved in coinfections except E. histolytica. Giardia (5.5%) and rotavirus (3%) were the most commonly detected in co-infections. Enterotoxigenic E. coli (2.4%), Campylobacter spp. (2.4%), E. coli 0157 (1.8%), and Shigella spp. (1.2%) were detected in patients only as co-infections. Infections were more in children 0–4 years, less in adults 40 years, with statistically significant differences in risk across age groups observed with rotavirus (P < 0.001), Giardia (P=0.006), and Cryptosporidium (P=0.036) infections. Lastly, infections were not significantly more in the spring. This report demonstrates the high burden of various enteropathogens in the setting. Further studies are needed to define the impact of these findings on the clinical course of the disease.

Dexamethasone alone versus in combination with intra-operative super-hydration for postoperative nausea and vomiting prophylaxis in female patients undergoing laparoscopic cholecystectomy: a randomized clinical trial / 대한마취과학회지

BACKGROUND: Dexamethasone has a prophylactic effect on postoperative nausea and vomiting (PONV) and perioperative hydration is believed to play a role in PONV prophylaxis. This study was performed to examine the combined effects of pre-induction dexamethasone plus super-hydration on PONV and pain following laparoscopic cholecystectomy (LC). METHODS: A total of 100 female patients undergoing LC were enrolled and randomized equally into two groups. Group DF received 5 mg dexamethasone (pre-induction) plus 30 ml/kg Ringer's lactate (intraoperative) and group D received 5 mg dexamethasone (pre-induction) alone. Anesthetic and surgical managements were standardized for all patients. The incidence and severity of PONV, and intra and post-operative analgesic and postoperative antiemetic consumption, were assessed during the first 24 h postoperatively. Post-anesthesia care unit (PACU) stay and aggregated 24 h pain scores were calculated. RESULTS: Group DF had significantly lower PONV than group D (P = 0.03). The number of patients with the lowest PONV score was significantly increased in group DF (P = 0.03). Ondansetron consumption was significantly lower in group DF (P < 0.0001). The mean accumulated 24 h pain scores were significantly lower in group DF compared to group D (P < 0.0001). The time to first analgesic request was significantly longer in group DF than group D (P < 0.0001). In addition, total meperidine consumption during the first postoperative 24 h was significantly lower in group DF than group D (P = 0.002). CONCLUSIONS: In female patients undergoing LC, pre-induction with 5 mg dexamethasone plus intraoperative 30 ml/kg Ringer's lactate solution decreased PONV and pain during the first 24 h postoperatively compared to 5 mg dexamethasone alone.

Comparison of intrathecal versus intra-articular dexmedetomidine as an adjuvant to bupivacaine on postoperative pain following knee arthroscopy: a randomized clinical trial

BACKGROUND: Postoperative pain is a common, distressing symptom following arthroscopic knee surgery. The aim of this study was to compare the potential analgesic effect of dexmedetomidine after intrathecal versus intra-articular administration following arthroscopic knee surgery. METHODS: Ninety patients undergoing unilateral elective arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intrathecal dexmedetomidine group (IT) received an intrathecal block with intrathecal dexmedetomidine, the intra-articular group (IA) received an intrathecal block and intra-articular dexmedetomidine, and the control group received an intrathecal block and intra-articular saline. The primary outcome of our study was postoperative pain as assessed by the visual analogue scale of pain (VAS). Secondary outcomes included the effect of dexmedetomidine on total postoperative analgesic use and time to the first analgesic request, hemodynamics, sedation, postoperative nausea and vomiting, patient satisfaction, and postoperative C-reactive protein (CRP) levels. RESULTS: Dexmedetomidine administration decreased pain scores for 4 h in both the intrathecal and intra-articular groups, compared to only 2 h in the control patient group. Furthermore, there was a significant reduction in pain scores for 6 h in the intra-articular group. The time to the first postoperative analgesia request was longer in the intra-articular group compared to the intrathecal and control groups. The total meperidine requirement was significantly lower in the intra-articular and intrathecal groups than in the control group. CONCLUSIONS: Both intrathecal and intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery. Less total meperidine was required with intra-articular administration to extend postoperative analgesia to 6 h with hemodynamic stability.

Semen parameters in smokers and non-smokers fertile men

Introduction: World Health organization stated that, approximately one third of the world' population older than 15 years are smokers. Cigarette smoking affects reproductive health in both men and women with poorly understandable mechanisms. Some of the studies focused on the relation between cigarette smoking and the principal semen analysis' variables such as concentration, Morphology and Motility. In this study, we compared the semen parameters between smokers and non-smokers fertile men with time to pregnancy less than one year

Materials and Methods: this case control study was done on proved fertile men in Assiut university hospital between March 2013 and September 2015. The subjects of the study were classified into 2 groups; smokers and non-smokers and their semen parameters were compared

Results: 93 fertile men were included in the present study. 50 non-smokers and 43 smokers the mean age of subjects was not significantly different between the two groups. There were no significant differences among groups according to semen volume, sperm concentration, total sperm count, motility and vitality. However, normal forms were statistically higher in nonsmokers than in smokers

Conclusion: according to our results, semen parameters [semen volume, sperm concentration, total sperm count, motility and vitality] were lower in smokers but without significant differences between groups. Normal forms were higher significantly in nonsmokers than in smoker's fertile men

Semen parameters in fertile men in Assiut governorate

Introduction: the WHO periodically releases manuals for the laboratory examination and processing of human semen. The WHO [2010] semen analysis criteria are likely to have a significant effect on the management of male infertility as the adoption of the new WHO reference values will likely lead to more men being classified as fertile

Aim of the work: to study and analyze the different semen parameters of fertile men in Assiut and comparing this with both WHO manuals 1999 and 20 10 parameters

Materials and Methods: this case control study was done on proved fertile men with time to pregnancy less than 1 year in assiut university hospital between March 20 13 and September 20 15

Results: 93 fertile men were included in the present study. The lower fifth centile for semen parameters were as follow, semen volume: 1.7, sperm concentration: 20 mill/ml, total sperm count: 45 mill/ejaculate, progressive motility: 42%, vitality: 70%, normal forms: 5%

Conclusion: according to our results, semen parameters in Assiut governorate is close to WH0, 2010 parameters and our results may also serve as reference values for future studies of fertile men from the general population in Egypt

Dumbbells and ankle-wrist weight training leads to changes in body composition and anthropometric parameters with potential cardiovascular disease risk reduction

Objectives: Promoting physical activity is a global strategy to reduce the burden of cardiovascular disease. This study aimed to determine and compare the effect of light resistance training using either dumbbells or ankle-wrist weights on the anthropometric parameters and body composition of adults in Kelantan

Malaysia. Methods: This randomized community trial was conducted in Kelantan, Malaysia, from March through August 2012. Adults with a body mass index [BMI] of more than 23 kg/m2 were randomized into dumbbell [N ¼ 69] and ankle-wrist [N ¼ 69] weight groups. Participants in the dumbbell group performed structured group exercises three times per week using a pair of onekilogram dumbbells. Participants in the ankle-wrist weight group were given one pair of 500 gm ankle weights and one pair of 500 gm wrist weights to be worn during the activities of daily living three days per week for at least 20 min. BMI, waist circumference [WC], waist-tohip ratio [WHR], body fat percentage [BF%] and skeletal muscle percentage [SM%] were measured at baseline, week 6, month 3 and month 6

Results: Eighty-nine participants completed this study. There were significant reductions in BMI only at week six for the dumbbell group. No significant BMI changes were observed for the ankle-wrist weight group. Significant improvements of WC, WHR, BF%, and SM% were observed in both intervention groups from baseline at week 6, month 3, and month 6

Conclusion: Resistance exercise using either dumbbells or ankle-wrist weights produced significant improvements in certain components of body composition and anthropometric parameters

Impact of a Baby-Friendly hospital on breastfeeding indicators in Shaqlawa district in Erbil governorate, Kurdistan region of Iraq

This study aimed to assess the impact of the Baby-Friendly Hospital Initiative on WHO-defined breastfeeding indicators in Shaqlawa district in Kurdistan region of Iraq. A household survey was carried out on a purposive non-probability sample of 200 mothers with a child aged < 30 months. Mothers were interviewed using a structured form to determine demographic data and feeding practices of the most recent child. The rate of early initiation of breastfeeding was 38.1%, exclusive breastfeeding was 15.4% and continued breastfeeding was 61.0% and 39.5% at 1 and 2 years of age respectively. A significant relationship was found between delivery at the Baby- Friendly accredited hospital and early initiation of breastfeeding but not with exclusive or continued breastfeeding. While continued breastfeeding at 1 year and 2 year was good, early initiation and exclusive breastfeeding indicators were not at an acceptable level, which indicates an ineffective role for the Baby-Friendly Hospital Initiative

Behavioral and emotional effects of repeated general anesthesia in young children

Preclinical and clinical data suggest the possibility of neurotoxicity following exposure of young children to general anesthetics with subsequent behavioral disturbances. The aim of the study was to determine the overall effect of repeated general anesthesia on behavior and emotions of young children aged 1½-5 years old, compared to healthy children. Thirty-five children underwent repeated anesthesia and surgery were matched with the same number of healthy children who attended vaccination clinic, as a control group. Both groups were administered the child behavior checklist [CBCL] 1½-5 years and Diagnostic and Statistical Manual of Mental Disorders [DSM] oriented scale. Behavior data were collected through a semi-structured questionnaire. The CBCL score revealed that children with repeated anesthesia were at risk to become anxious or depressed [relative risk [RR]; 95% confidence interval [CI] = 11 [1.5-80.7]], to have sleep [RR; 95% CI = 4.5 [1.1-19.4]], and attention problems [RR; 95% CI = 8 [1.1-60.6]]. There was no difference in the risk between the two groups regarding emotionally reactive, somatic complaints, withdrawn problems, aggressive behavior, internalizing or externalizing problems. On DSM scale, children with repeated anesthesia were at risk to develop anxiety problems [RR; 95% CI = 3.7 [1.1-12.0]], and attention deficit/hyperactivity problems [RR; 95% CI = 3 [1.1-8.4]]. There was no difference in the risk between the two groups regarding affective, pervasive developmental and oppositional defiant problems. Young children who undergone repeated surgical procedures under general anesthesia were at risk for subsequent behavioral and emotional disturbances. Proper perioperative pain management, social support, and avoidance of unpleasant surgical experiences could minimize these untoward consequences

Comparison of dexmedetomidine or ondansetron with haloperidol for treatment of postoperative delirium in trauma patients admitted to intensive care unit: randomized controlled trial

This study was designed to compare the effect of dexmedetomidine or ondansetron with haloperidol, as a control, for the treatment of postoperative delirium in trauma patients. A total of 96 adult trauma patients diagnosed with postoperative delirium were randomized into three equal groups. Patients were given either 1 microg/kg dexmedetomidine [Dexmed group] or 4 mg ondansetron [Ondan group] or 5 mg haloperidol [Halo group], administered twice daily for 3 consecutive days. Number of delirious patients, patients who needed [rescue haloperidol] and the total amount of [rescue haloperidol] during study period was calculated. At the end of the study, the number of remaining delirious patients was 3, 6, and 2 in Dexmed,Ondan, and Halo groups, respectively, without statistical significance. During the study period, there was no significant difference in the number of patients who needed [rescue haloperidol] between Dexmed and Halo groups [5 vs. 3; p = 0.7]. However, the difference was significantly higher in Ondan group compared to Halo group [11 vs. 3; p = 0.03]. The mean total [rescue haloperidol] dose was significantly higher in Ondan group compared to Halo group [p < 0.001], but there was no difference between Dexmed and Halo groups [p = 0.07]. At the same time of delirium assessment, mean arterial blood pressure and mean score on Visual Analog Scale were not statistically different between Dexmed or Ondan group versus Halo group. No serious adverse events were reported. Dexmedetomidine is a potential alternative treatment for postoperative delirium in trauma patients admitted to ICU

Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia / 대한마취과학회지

BACKGROUND: Sickle cell anemia (SCA) increases the rate of maternal and fetal complications. This pilot study was designed to compare the maternal and fetal outcomes of spinal versus general anesthesia (GA) for parturients with SCA undergoing cesarean delivery. METHODS: Forty parturients with known SCA scheduled for elective Cesarean delivery were randomized into spinal anesthesia (n = 20) and GA groups (n = 20). Perioperative hemodynamic parameters were recorded. Postpartum complications were followed up. Opioid consumption was calculated. Blood loss during surgery and the number of patients who received intraoperative or postpartum blood transfusion were recorded. Patient satisfaction with the type of anesthesia was assessed. The Apgar score at 1 and 5 min, neonatal admission to the intensive care unit, and mortality were also recorded. RESULTS: Blood loss was significantly higher in the GA than spinal group (P = 0.01). However, the number of patients who received an intraoperative or postpartum blood transfusion was statistically insignificant. Significantly more patients developed intraoperative hypotension and bradycardia in the spinal than GA group. Opioid use during the first 24 h was significantly higher in the GA than spinal group (P < 0.0001). More patients had vaso-occlusive crisis in the GA than spinal group without statistical significance (P = 0.4). There was one case of acute chest syndrome in the GA group. No significant differences were observed in postoperative nausea and/or vomiting, patient satisfaction, or hospital length of stay. Neonatal Apgar scores were significantly better in the spinal than GA group at 1 and 5 min (P = 0.006 and P = 0.009, respectively). Neonatal intensive care admission was not significantly different between the two groups, and there was no neonatal mortality. CONCLUSIONS: Spinal anesthesia may have advantages over GA in parturients with SCA undergoing Cesarean delivery.

Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common following laparoscopic cholecystectomy (LC). Dexamethasone has been reported to reduce PONV. However, there is insufficient evidence regarding the effect of dexmedetomidine in decreasing PONV. This study was designed to compare the effects of a single dose of dexmedetomidine to dexamethasone for reducing PONV after LC. METHODS: Eighty-six adult patients scheduled for LC were randomized to receive either single dose 1 microg/kg of dexmedetomidine (Dexmed group, N = 43) or 8 mg dexamethasone (Dexa group, N = 43) before skin incision. During the first 24 h postoperatively, the incidence and severity of PONV were assessed. Pain and sedation scores were assessed on arrival in the recovery room and early postoperatively. Analgesic and antiemetic consumption during the 24 h after surgery were calculated. Intra-operative and postoperative hemodynamics were recorded. RESULTS: Twenty-one percent of the patients in the Dexmed group developed PONV compared to 28% in the Dexa group (P = 0.6). Severity of PONV was similar between the two groups (P = 0.07). Early postoperatively, pain severity was significantly lower in the Dexmed group, but sedation scores were significantly higher. The first analgesic request was significantly delayed in the Dexmed group (P = 0.02). The total amounts of intraoperative fentanyl and postoperative tramadol administered were significantly lower in the Dexmed group. No difference in ondansetron was noted between the two groups. Mean arterial pressure and heart rate were significantly lower in the Dexmed group after administration of dexmedetomidine. No major side effects were reported. CONCLUSIONS: Dexmedetomidine reduces the incidence and severity of PONV, similar to dexamethasone. It is superior to dexamethasone in reducing postoperative pain and total analgesic consumption during the first 24 h after LC.

potential protective and therapeutic effects of aloe vera juice on malathion induced hepatotoxicity in rabbits

the potential protective and therapeutic effects of Aloe vera juice against malathion induced hepatotoxicity were evaluated in this study. one hundred twelve young male rabbits were used ; they were allocated into two sets of experiments included rabbits treated for short [7 days] and long [21 days] periods. Animals of the first set [short period of treatment] were divided into eight groups; each consisted of four treated groups and four control groups [each treated group had its own control]. The animals of the first group were orally dosed with Aloe vera juice [0.84 ml/kg b. wt]. Rabbits of the second group were orally dosed with malathion [5 mg/kg b. wt.]. The third group animals were dosed orally with malathion concomitant with Aloe vera juice [this group served as the protective group]. Animals of the fourth group were dosed orally with malathion; for 7 days followed by Aloe vera juice for the same period [this group served as the therapeutic group]. The design of the second set [long period of treatment] was exactly similar to that of the short period experiments [divided into eight groups; four treated and four control groups] except the duration of treatment which extended to 21 days. Animals of the control groups of Aloe vera treated rabbits were dosed with distilled water, and those of malathion treated animals were dosed with the solvent of the insecticide. All the animals were sacrificed, blood samples were collected and the serum was used to determine the levels of hepatic enzyme markers: lactate dehydrogenase [LDH], aspartate aminotransferase [ASAT], alanine aminotransferase [ALAT] and alkaline phosphatase [ALP] as well as the total bilirubin. the results revealed that treatment of rabbits with malathion caused marked increase in the serum activity of LDH, ASAT, ALAT and ALP in treated rabbits. Administration of Aloe vera juice [in the protective and therapeutic groups] was found to be effective in lowering the elevated activities of these enzymes to approximate near normal levels for both the short and long periods of treatment, especially in the activity of LDH, ASAT and ALP. The present results suggested that Aloe vera juice has ameliorative effects against hepatotoxicity produced by malathion in the treated rabbits