Handling injectable medications in anaesthesia: Guidelines from the Association of Anaesthetists.

Peri-operative medication safety is complex. Avoidance of medication errors is both system- and practitioner-based, and many departments within the hospital contribute to safe and effective systems. For the individual anaesthetist, drawing up, labelling and then the correct administration of medications are key components in a patient's peri-operative journey. These guidelines aim to provide pragmatic safety steps for the practitioner and other individuals within the operative environment, as well as short- to long-term goals for development of a collaborative approach to reducing errors. The aim is that they will be used as a basis for instilling good practice.

Substance use disorder in the anaesthetist: Guidelines from the Association of Anaesthetists: Guidelines from the Association of Anaesthetists.

Anaesthetists have a higher incidence of substance use disorder when compared with other doctors. This might be due to the ease of access to intravenous opioids, propofol, midazolam, inhalational agents and other anaesthetic drugs. Alcohol use disorder continues to be the most common problem. Unfortunately, the first sign that something is amiss might be the anaesthetist's death from an accidental or deliberate overdose. While there are few accurate data, suicide is presumed to be the cause of death in approximately 6-10% of all anaesthetists. If we are to prevent this, substance use disorder must be recognised early, we should ensure the anaesthetist is supported by their department and hospital management and that the anaesthetist engages fully with treatment. Over 75% of anaesthetists return to full practice if they co-operate fully with the required treatment and supervision.

Recruitment to higher specialty training in anaesthesia in the UK during the COVID-19 pandemic: a national survey.

There were more applications for higher specialty training posts in anaesthesia in the UK starting in August 2021 than in previous years, with approximately two-thirds being unsuccessful. We surveyed applicants to investigate their experience of the recruitment process (response rate 536/1056; 51%). Approximately 61% of respondents were not offered ST3 posts (n = 326). We enquired about their career plans for the next 12-24 months. Most respondents (79%) intended to take up a post equivalent to a third year of core training or a clinical fellow post from August 2021. Other options considered included: pursuing work abroad (17%); embarking on career breaks (16%); taking up higher training posts in intensive care medicine (15%); and permanently leaving medicine (9%). Nine per cent of respondents also expressed plans to pursue training in another medical specialty. Some expressed an intention to pursue further education or research (10%). A large proportion (42%) expressed a lack of confidence in being able to achieve the training requirements to later apply for a higher training post. The majority reported not feeling confident in achieving specialist registration in anaesthesia in the future without a training number (75%), and noted disruption to their wider life plans from the impending time out of training (78%). Sentiment analysis of free-text responses indicated generally negative sentiment about the recruitment process. Themes elicited included: feeling the recruitment process was unfair; burnout and negative impact on well-being; difficulties in making life plans; and feeling undervalued and abandoned. These results suggest that junior anaesthetic doctors in the UK negatively perceived postgraduate training structures and changes to the postgraduate curriculum and experienced difficulties in securing higher training.

Epidemiology and risk factors of brucellosis in Alexandria governorate.

This study aimed to describe the trend and to identify possible risk factors for brucellosis in Alexandria in northern Egypt. We enrolled 72 confirmed cases of brucellosis and 144 age-matched controls in this study. Participants were interviewed at home using a structured questionnaire. Working with animals, breeding goats and eating ice cream bought from street vendors were significantly associated (P < 0.05) with brucellosis by univariate and multivariate analysis. Contact with infected animals and their products was the most important method of transmission.

Epidemiology and risk factors of brucellosis in Alexandria governorate

This study aimed to describe the trend and to identify possible risk factors for brucellosis in Alexandria in northern Egypt. We enrolled 72 confirmed cases of brucellosis and 144 age-matched controls in this study. Participants were interviewed at home using a structured questionnaire. Working with animals, breeding goats and eating ice cream bought from street vendors were significantly associated [P < 0.05] with brucellosis by univariate and multivariate analysis. Contact with infected animals and their products was the most important method of transmission

Treatment of type 1 diabetes with insulin lispro during Ramadan.

OBJECTIVE: To compare insulin lispro with regular human insulin with respect to blood glucose control and frequency of hypoglycaemia in patients with type 1 diabetes who wished to fast during the month of Ramadan. RESEARCH DESIGN AND METHODS: Insulin lispro or regular human insulin was given together with NPH insulin, twice daily before the morning and evening meals, for two weeks each in an open-label, randomised, cross-over design, and 64 patients completed the protocol. Blood glucose was self-monitored at fasting morning and evening, and 1-h and 2-h after the post-sunset meal on three consecutive days at the end of each treatment period. RESULTS: The 2-h blood glucose excursion after the post-sunset meal was significantly (p=0.026) lower with insulin lispro (2.50 +/- 0.46 mmol/l) than with regular human insulin (3.47 +/- 0.49 mmol/l). Daily insulin doses did not differ between treatments but compliance with recommended time of injection was better with insulin lispro. Hypoglycaemia incidence (insulin lispro, 15 (23.4%) patients; regular human insulin 31 (48.4%) patients; p=0.004) and frequency (insulin lispro, 0.70 +/- 0.19; regular human insulin 2.25 +/- 0.36 episodes/patient/30 days; p<0.001) were lower with insulin lispro. Five (22.7%) of the episodes during insulin lispro occurred during the nocturnal period compared with 27 (36.5%) of the episodes while on regular human insulin. CONCLUSIONS: Glycaemic control, measured by postprandial glycemic excursions, was improved and hypoglycaemia was significantly reduced with insulin lispro compared with regular human insulin. Patients with type 1 diabetes who insist on fasting during Ramadan may be better managed with insulin lispro.

Magnesium deficiency and other risk factors for diabetic retinopathy.

A case control study was carried out to detect the relation between magnesium deficiency and diabetic retinopathy and to study other risk factors for diabetic retinopathy. The study involved 30 cases with diabetic retinopathy, 30 diabetics and 30 non-diabetics with normal retina as controls. Serum magnesium was significantly lower in the diabetic control group than both other groups. Significant association between diabetic retinopathy and hypertension, poor control of blood sugar, irregularity in drug treatment, lack of routine fundus examination, high gravidity and low socioeconomic status were found. Multiple regression analysis was used to adjust for all variables mentioned. Magnesium deficiency was found to be statistically significantly associated with diabetic retinopathy after considering the effects of other variables.

A four years old girl with phthiriasis pubis infestation.

A four years old girl had Phthirus pubis infestation in the scalp, eyelids, eyelashes, neck and shoulders. She had fever, severe itching, allergic reaction and anxiety. The girl was successfully treated with 2.5% permethrin cream. The risk of lice infestation as a community health problem was discussed.

Laboratory study on the molluscicidal effect of Earth Tec: an environmentally responsible copper sulfate product.

Studies were carried out, under laboratory conditions to evaluate the molluscicidal activity of Earth Tec on Biomphalaria alexandrina snails, the intermediate host of Schistosoma mansoni. Earth Tec is an environmentally responsible copper sulfate product manufactured and marketed as an algicide/bactericide with an active ingredient form of copper ion (Cu++). A single application, of 1 ppm of copper equivalent, for 24 hours caused 100% mortality rate of the snails. Exposure for 48 hours to 1 ppm and 2 weeks to 0.25 ppm caused mortality rates of 84% and 100% respectively. It was concluded that this chemical compound is a promising molluscicide. Field studies are ongoing and will be published in due time.

The functional deformation of maxillary complete dentures in patients with flabby alveolar ridges. Part I: Before surgery.

Using strain-guaged duplicate maxillary dentures, the deformation patterns and magnitude of functional strain were studied on five complete denture wearing subjects who had varying amounts of soft mobile tissue over their maxillary edentulous alveolar ridge so called flabby ridges. The thickness of mobile tissue--expressed as depth--was measured by a sharpened periodontal probe with aid of a plastic base plate as a locator. The functional test included maximum biting, and the chewing of three test food samples. The results did not point on any direct relationship between the thickness of the soft tissue and the midline deformation pattern and/or magnitude of functional strain. It seems, however, as if the main influence of mobile tissue is on the strain behaviour in the lateral part of the denture.

The functional deformation of maxillary complete dentures in patients with flabby alveolar ridges. Part II: After surgery.

Using strain-gauged maxillary complete dentures, the effects of the surgical removal of soft mobile tissue over the maxillary edentulous alveolar ridges--flabby ridges--on the deformation pattern and magnitude of functional strain were studied in five subjects. The results showed that a 20-90% reduction in denture deformation had taken place after surgery. Furthermore, a pre-operative shear-straining pattern of the buccal flanges and the lateral palatal slopes was not evident post-operatively. The results of this study point on the beneficial value of early surgical removal of flabby maxillary alveolar ridges.

Significant increase of chromosomal damage in protein energy malnutrition.

The present study attempts to investigate the impact of protein energy malnutrition (PEM) on chromosomes. Twenty infants suffering from marasmus and kwashiorkor were chosen from the in-patient paediatric hospital of Ain Shams University. They were matched by age and sex and socioeconomic status to ten healthy infants (controls). Whole blood lymphocytic cultures were set up for every infant and harvested after 48 h incubation. The frequency of chromosomal aberrations was found to be nearly nine times greater among infants with PEM compared to controls (6.7% versus 0.7% respectively); the difference was statistically highly significant, P less than 0.001. The recorded aberrations were mainly chromatid gaps and isogaps. In addition, chromatid breaks, dicentrics and acentric fragments were observed. Moreover, the younger the age of the infant the greater the frequency of chromosomal aberrations. The results direct our attention to the genetic risk effect of PEM.

On the clinical deformation of maxillary complete dentures. Influence of denture-base design and shape of denture-bearing tissue.

This paper aimed to study the influence of denture base design and the shape of the denture-supporting area on the functional deformation of maxillary complete dentures. Six strain-gauged duplicate maxillary dentures were made for the study of two test subjects with different shapes of the palatal vault. Each subject was supplied with two polymethyl methacrylate dentures, one with a 1-mm-thick palatal base and the other 2 mm thick. A third denture was constructed with a cobalt-chromium base. The functional loading tests included maximum biting and the chewing of the food test samples. An analysis based on chewing time and total number of chewing cycles per test piece was also made. The results showed that surface straining is highly complex at the anterior part of the maxillary dentures constructed from polymethyl methacrylate and that increasing the denture thickness per se might not be accompanied by a reduction of strain. The results also suggest that high thrust to the supporting tissue is produced with high palatal vault dentures made in polymethyl methacrylate. The study proposes that cobalt-chromium bases may be used in maxillary dentures to reduce functional deformation and thrust to the supporting tissues at the anterior part of the maxilla.

On the clinical deformation of maxillary complete dentures. Influence of the processing techniques of acrylate-based polymers.

This paper aims to study the functional deformation patterns of complete maxillary dentures constructed in three different types of denture base materials and with two techniques of processing of dentures. The patients' evaluation of the fit of the dentures was also recorded. Thirty strain-gauged duplicate dentures were made for this study of five test subjects. The functional loading tests included maximum biting and the chewing of three food test samples. The results showed that there was no correlation between the patients' evaluation and acceptance of the fit of the dentures and the actual straining magnitudes and deformation of their dentures. The results also suggest that dentures manufactured from toughened or co-polymerized poly(methyl methacrylate) and processed by the injection molding technique deform to a lesser extent than when processed by by the compression molding technique. Standard poly(methyl methacrylate) seems to be less sensitive to the processing technique.