The role of dexmedetomidine as an adjuvant for high-thoracic erector spinae plane block for analgesia in shoulder arthroscopy; a randomized controlled study.

BACKGROUND: Management of postoperative pain after shoulder arthroscopy is an important issue. Dexmedetomidine, as an adjuvant, improves nerve block efficacy and decreases postoperative consumption of opioids. As a result, we designed this study to determine if adding dexmedetomidine to an erector spinae plane block (ESPB) that is guided by ultrasound (US) is beneficial for treating immediate postoperative pain following shoulder arthroscopy. METHODS: This randomized controlled double-blind trial recruited 60 cases 18-65 years old of both sexes, American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective shoulder arthroscopy. Random allocation of 60 cases was done equally into two groups according to the solution injected in US-guided ESPB at T2 before general anesthetic induction. Group (ESPB): 20 ml 0.25% bupivacaine. Group (ESPB + DEX): 19 ml bupivacaine 0.25% + 1 mL dexmedetomidine 0.5 µg/kg. The primary outcome was The total rescue morphine consumption in the first 24 postoperative hours. RESULTS: The mean intraoperative fentanyl consumption was significantly lower in the group (ESPB + DEX) compared to the group (ESPB) (82.86 ± 13.57 versus 100.74 ± 35.07, respectively, P = 0.015). The median (IQR) time of the 1st rescue analgesic request was significantly delayed in the group (ESPB + DEX) compared to group (ESPB) [18.5 (18.25-18.75) versus 12 (12-15.75), P = 0.044]. The number of cases that required morphine was significantly lower in the group (ESPB + DEX) than in the group (ESPB) (P = 0.012). The median (IQR) of total postoperative morphine consumption in 1st 24 h was significantly lower in the group (ESPB + DEX) compared to the group (ESPB) [0 (0-0) versus 0 (0-3), P = 0.021]. CONCLUSION: The dexmedetomidine as an adjuvant to bupivacaine in ESPB produced adequate analgesia by reducing the intraoperative and postoperative opioid requirements in shoulder arthroscopy. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov (NCT05165836; principal investigator: Mohammad Fouad Algyar; registration date: 21/12/ 2021).

Challenges During Review of COVID-19 Research Proposals: Experience of Faculty of Medicine, Ain Shams University Research Ethics Committee, Egypt.

The COVID-19 pandemic resulted in an overwhelming increase in research studies submitted to research ethics committees (RECs) presenting many ethical challenges. This article aims to report the challenges encountered during review of COVID-19 research and the experience of the Faculty of Medicine, Ain Shams University Research Ethics Committee (FMASU REC). From April 10, 2020, until October 13, 2020, the FMASU REC reviewed 98 COVID-19 research protocols. This article addressed the question of how to face an overwhelming amount of research submitted to the REC while applying the required ethical principles. Ethical challenges included a new accelerated mode of review, online meetings, balance of risks vs. benefits, measures to mitigate risks, co-enrolment in different studies, protection of a vulnerable COVID-19 population, accelerated decisions, online research, how to handle informed consent during the pandemic, and justification of placebo arm.

Chemical composition, in vitro antioxidant and antibacterial activities of Centaurea resupinata subsp. dufourii (dostál) greuter.

The current study focuses on the chemical composition, and evaluation of antioxidant and antibacterial activity of the aerial parts of Centaurea resupinata subsp. dufourii. Using different chromatographic methods nine compounds 1-9 were isolated. The structural identification of isolated compounds was achieved using several spectroscopic methods NMR techniques (1H NMR, 13C NMR, COSY, HSQC, HMBC) and mass spectroscopy (ESI-MS) and by comparison with literature data. The structures of these compounds were identified as nicotiflorin (1), apigetrin (2), chrysoeriol (3), apigenin (4), chrysin (5), daucosterol (6), ß-sitosterol (7), taraxastrerol (8) and lupeol (9). The antibacterial and antioxidant activities of ethyl acetate and n-butanol extracts have been evaluated. The antioxidant activity was assessed in vitro using DPPH radical scavenging method, which showed that ethyl acetate extract possessed an interesting antioxidant potential (IC50 = 36.263 ± 0.005 µg/mL).

Liver disease during and after hematopoietic stem cell transplantation in adults: a single-center Egyptian experience.

BACKGROUND: Hepatic complications are a well-known cause of both early and late mortality and morbidity in hematopoietic stem cell transplant (HSCT) recipients. Early diagnosis and management of hepatic complications is important in order to commence appropriate therapy. Conditioning regimens, acute and chronic graft versus host disease, sinusoidal obstruction syndrome, and infections among others represent major hepatic complications for the transplant recipient. We assessed liver function tests, viral markers, polymerase chain reaction, abdominal ultrasound, portal, and hepatic venous duplex in 88 patients underwent autologous and 102 patients underwent allogeneic transplant as well as liver biopsy in selected patients in this retrospective study and evaluated early and late hepatic complications and their impact on transplant outcome. RESULTS: The major cause of hepatic injury in allogeneic patients is the conditioning regimen (38.8%) followed by acute GVHD (14.7%), after day +100 chronic hepatic GVHD is the primary cause of liver injury which occurred in about 40% of allogeneic patients. In autologous patients, the first cause of hepatotoxicity is also conditioning regimen involving 27.9% of patients followed by flare of viral hepatitis in 7.9% and sepsis in 6.3% of cases. The prevalence of HCV, HBV, and CMV is 19%, 16%, and 8%, respectively. CONCLUSION: In our study, conditioning regimens, acute and chronic hepatic GVHD are frequent causes of hepatic injury following allogeneic HSCT while conditioning regimens, flare of viral hepatitis, and sepsis represent the most common causes of hepatic injury following autologous HSCT.

In situ synthesis of Fe3O4@ cyanoethyl cellulose composite as antimicrobial and semiconducting film.

Cyanoethyl cellulose (CEC)/ magnetite (Fe3O4) flexible composite film with enhanced dielectric and magnetic properties was successfully prepared. CEC has been synthesized from micro crystalline cellulose (MCC). The effects of magnetite mass fraction on the morphology, microstructure, thermal stability, and antimicrobial activity of the as-prepared composite films were investigated. The Vibrating sample magnetometer (VSM) and broadband dielectric spectrometer was also employed to study the magnetic and dielectric properties, respectively. In addition to study the computational calculation of MCC, and CEC by DFT/ B3LYP/6-31G (d) basis sets. The results showed that, the sample that is magnetite free has a diamagnetic response to the applied magnetic field, however the other samples that is loaded with magnetite show super-paramagnetic behavior indicating that the particles' sizes of the magnetite mostly below 20 nm. Also, antimicrobial activities of composite films against (G + ve), (G-ve), were investigated.

Acetabular dysplasia in adult hips of a Saudi population. A possible relation to coxarthrosis.

OBJECTIVE: To evaluate acetabular morphology and the prevalence of dysplasia in a Saudi population, and compare it with others in different geographical areas. METHODS: The study took place at King Fahd University Hospital, Al-Khobar, Kingdom of Saudi Arabia from May 2005 to April 2006. We recruited radiographs of 104 patients of 40-88 years of age. We digitally measured the center edge angle (CEA) of both hips. RESULTS: Of the 208 hips examined, 3 hips (1.44%) had mild-to-moderate acetabular dysplasia but there was no case with severe dysplasia (CEA

Can double gloves improve surgeon-patient barrier efficiency?

The aim of this study was to compare double gloves (DGs) with single gloves (SGs) during orthopedic and trauma surgery in prevention of blood contact between patients and surgeons. DGs and SGs were collected after orthopedic operations, tested for size, site, and number of perforations. Medical records were reviewed for age, sex, type of operation, duration, and postoperative wound infection. Data were compared using t-test with level of statistical significance at P < 0.05. Five hundred seven operations yielded 1204 DGs and 830 pairs SGs. In DGs, perforations were detected in 220 outer glove and 39 inner glove (10.7%). In SGs, 226 perforations were detected (13.3%). The incidence of perforations in inner gloves of the double indicator glove was 1.6% (P < 0.001). During surgery, perforations were recognized in DGs in 67% compared with 12% in SGs (P < 0.005). This study confirms that DGs form an efficient barrier between patients and surgeons.