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The aim of this study was to predict the blood/plasma drug concentration profiles for five brand of nifedipine present on the Saudi Arabia market by using the numerical convolution method and to estimate the pharmacokinetic parameters (Cmax, Tmax, Ka, K and Vd) by the application of the residual method to the predicted plasma drug concentration profiles. Results showed that the higher Cmax was 118.95ng/ml for brand A2 and the lower Cmax was 72.29ng/ml for brand A3. The Tmax was ranged from 2.3 hr to 4.9 hr for brands A2 and A3 respectively. The total area under plasma drug concentration curve (AUCinf.) was in lower value equal to 585.59 ng x hr/ml for brand A2 and the higher value was for brand A5 equal to 743.52ng x hr/ml. The volume of distribution was also increased from 52.5 L for free nifidipine to 72 L for brand A1. The predicted first order elimination rate constant was decreased from 0.34 hr-1 for free nifedipine to 0.17 hr-1 for brand A3. The half-life of nifedapine was increased from 2 hours for free drug to 3.93 hours for brand A3. From this study it can be concluded that brands present in the market that shows similarity in accordance to the Dissimilarity factor f1 are not always guaranty that they will be bioequivalent in vivo and vice versa. Also, this study indicates that the method of convolution is a useful tool for prediction of bioequivalence of different brands present on the market.

Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

Background: Cancer colon is one of the most common malignancies. After colon cancer surgery patients may experience severe pain. Several studies have reported that a significant decrease in postoperative pain with propofol while other studies have showed this effect was not significant. Aim: Our goal was to assess the effect of combined epidural anaesthesia either with propofol or sevoflurane on intraoperative fentanyl consumption and postoperative pain in patients undergoing open surgical resection of colon cancer. Patients and Methods: 48 adult patients suffering from cancer colon scheduled for open surgical resection randomly allocated either to receive epidural-propofol by total intra venous anaesthesia (TIVA) (n = 24) or epidural-sevoflurane anaesthesia (n = 24), intraoperative heart rate and fentanyl consumption and postoperative pain score (verbal analogue scale, 0 - 10) were recorded. Results: In our study we found that the intensity of postoperative pain was low in all patients and the propofol based anaesthesia had relatively lower pain scores up to 24 hrs postoperatively in comparison to sevoflurane based anaesthesia, intraoperative fentanyl consumption was lower with sevoflurane and heart rate lower with propofol group. Conclusions: we recommend that use of multimodal analgesia decrease postoperative pain in all cancer colon patients undergoing open surgery who anaesthetized with either propofol or sevoflurane. Also use of propofol showed better analgesic outcomes postoperatively.

Background: To determine the incidence of preterm labour and also to determine the incidence and various cause of Morbidity and Mortality in the perinatal period. Materials and Methods: A prospective study of patients in preterm labour (delivered > 28 weeks and prior to 37 completed weeks) admitted to the obstetrics department of JSS Hospital Mysore Karnataka. Which is tertiary teaching hospital. The study was conducted between February 2012 to January 2014. Total number of deliveries during the period were 3209 out of which the number of preterm deliveries were 241 which fulfilled our study criteria. Immediately. Following delivery, the following features of baby noted like Sex, weight, APGAR score at 1 and 5-minute, immediate complications, congenital Anomaly, birth injury, gestational age, as assessed by the paediatrician based on modified Ballard scoring. Babies and mother followed up for a period of 7 days. Baby examined for the detection of any complication which were managed accordingly. During the study the various risk facters associated with preterm labour were also determined in detail and the correlation of the risk factors to antenatal care, maternal age, parity, presentation and lie, mode of delivery, indication of caesarean sections was studied in detail. So, this study we studied the behavioural pattern of the mother and baby towards preterm labour in detail. The data collected as mentioned above were analysed using appropriate statistical methods. Results: The total number of preterm deliveries were 241 out of the total number of 3269 deliveries in the period of 2 years of the study. Therefore, the incidence of preterm labour was 7.4%. Out of which the total number of preterm spontaneous labour cases were180 (74.7%) and total number of elective preterm delivery were 61 (25.3%). The total number of mortalities during the perinatal period was 82 which accounts of perinatal mortality of 30%. Out of which the total number of stillbirths were 28 (34%) an

This study belongs to the pattern of semi-experimental studies aimed at measuring the effectiveness of the family therapy program in reducing PTSD for children as a result of parental separation,The study was based on theories of family therapy, theory of behavior and behavioral theory in its theoretical premise. The sample size of the study was single children in late childhood who receive psychological and family counseling services within Al-Iman Family Care Foundation. The study relied on two tools namely family therapy program and a measure to determine the effectiveness A family therapy program for disturbed children after the shock of separation of spouses, and the results of the study found that there are significant differences statistically significant at the level (0.05) between pre and post measurement in the self-confidence index on the scale of the effectiveness of the family treatment program in favor Yas Al-Baadi. There are also significant statistical differences (0.05) between the pre- and post-measurement in the psychological pressure index on the scale of the effectiveness of the family therapy program in favor of telemetry. There are significant differences (0.05) between the pre- and post-measurement in the emotional disorders index. (0.05) between pre and post measurement in the psychosocial compatibility index on the scale of the effectiveness of psychological rehabilitation programs in favor of telemetry.

Background and aim Intraoperative use of a single bolus dose of tranexamic acid may not be sufficient to prevent bleeding in the early postoperative period. The present study was carried out to compare the effect of two dose regimens of tranexamic acid in reducing perioperative blood loss and the amount of allogeneic blood transfusion in transurethral resection of prostate. Design prospective, double-blinded and controlled study. Setting Ain Shams University Hospital, Patients and Methods 50 patients electively posted for transurethral resection of prostate were randomly assigned to receive a single bolus dose of tranexamic acid (10 mg/kg) (Group A), a bolus dose of tranexamic acid (10 mg/kg) followed by infusion (1 mg/kg/h) till 4 h postoperatively (Group B). Measurements Total intraoperative blood loss, amount of allogeneic blood transfusion, postoperative drain collections, and hemoglobin and hematocrit levels were recorded at different time intervals. Data obtained after comparing two groups were analyzed using the statistical package for social sciences. Results There was no statistically significant difference among patients in both groups regarding intraoperative blood loss and postoperative blood loss at 6 hrs and 48 hrs postoperatively. However the post-operative blood loss at 24 hrs was significantly higher among patients in group A than patients in group B (P-value= 0.014) . Conclusion Tranexamic acid causes more effective reduction in post-operative blood loss when used as a bolus followed by an infusion continued in the postoperative period in comparison to its use as a single intravenous bolus in transurethral resection of prostate.

Background: Spinal anesthesia is the commonest technique used in Cesarean Section (CS) and most frequently associated with maternal hypotension, for which a lot of techniques have been described to prevent but an effective method is yet to be found. Objectives; The aim was to study the effect of using a sub-anesthetic dose of ketamine to prevent post-spinal hypotension in CS delivery. Methods: This double-blinded randomized controlled study was conducted on 80 participating parturients who were ASA І, П term pregnant. All the parturients received spinal anesthesia. The parturients were then randomly divided into two equal groups (n= 40 in each); ketamine group received a sub-anesthetic dose of ketamine of 0.5 mg/kg IV bolus in 3 ml saline and control group received the same volume of normal saline IV bolus. Heart Rate (HR) and Mean Arterial blood Pressure (MAP) were recorded at baseline (5 minutes prior to the intrathecal injection), at 5, 10, 15 and 20 minutes after the injection and then every 15 minutes till the end of the operation. Incidences of hypotension and severe hypotension were recorded. The total dose of ephedrine was recorded. Ramsay sedation score was recorded at baseline then 5, 10, 15, 30, 45 minutes after injection and then at the end of the operation. Results: Compared to the control group, sedation score was significantly higher among ketamine group at 5, 10 and 15 minutes. MAP and HR were significantly higher among ketamine group at 5, 10, 15, and 20 minutes. Total ephedrine dose was significantly lower among the ketamine group. Mild hypotension and severe hypotension were significantly less frequent among the ketamine group, as all the patients in the control group had an attack of mild hypotension and 55% of this group had an attack of severe hypotension. No significant difference between both the groups regarding diplopia, nystagmus, hallucination, nausea and vomiting. Conclusion: It is concluded that ketamine in a sub-anesthetic dose is an effective agent that can be used in preventing post-spinal hypotension in parturients undergoing CS delivery.

Competency of nursing care activities of nurses working at neonatal intensive care units together with advancement in medical science and technology increased the survival rate of newborns that need specialized care. To ensure the quality of care and provide the safety of patients, assessing the competency of nursing care activities of nurses working at NICU seems necessary. This study aimed to assess competency of nursing care activities at the neonatal care units. Design: A descriptive design was used. Setting: The study was carried out at the neonatal intensive care units affiliated to Ain Shams University Hospital. Subjects: A purposive sample of 70 nurses working at the previously mentioned setting, regardless their characteristics. Tools of data collection involved an interviewing questionnaire (that was constructed by the researcher after reviewing related literatures to gather data in relation to characteristics of nurses such as age, qualification, years of experience……etc) and observation checklist (to assess competency of nursing care activities at neonatal intensive units). Results: The study findings revealed that nursing care activities at NICU were incompetent by nearly two thirds (64.3%) of them. There was a statistically significant difference between the total mean scores of nursing care activities competencies skills at NICU and their age, qualifications, years of experience and social status. Conclusion: The study concluded that more than half of studied nurses were having incompetent nursing care activities at NICU. Recommendations: The study recommends continuous assessment and upgrading of competency of nursing care activities at NICU.

Background: Emergency physicians are often challenged with a comatose patient; 30% of patients with coma of unknown origin are due to intoxication. Comatose patients are at high risk for morbidity and mortality. Objective: The present study assessed poisoning-induced coma regarding demographic and intoxication data, causative agents, clinical data, management modalities and outcome. In addition to evaluation of the role of creatine phosphokinase (CPK) level on admission and other variables as predictive factors for the outcome in toxic coma. Subjects and Methods: This study was conducted prospectively on one hundred comatose intoxicated patients, admitted to Poison Control Center Ain Shams University Hospitals (PCCASU). Results: The majority of patients (64%) were in the age group 18-40 year, and there was male predominance (56%). Organophosphorus, carbamazepine and tramadol were the most common toxic agents inducing coma. Death rate was 12% and mortality is much higher in patients with older age, elevated admission creatine phosphokinase, longer duration of hospital stay and higher grade of Reed’s classification of coma. Conclusion: Organophosphorus followed by carbamazepine and tramadolwere the most common toxic agents inducing coma. Older age, elevated admission creatine phosphokinase, longer duration of hospitalization and higher grade of Reed’s classification of coma can predict the mortality. In addition, respiratory acidosis and the need of intubation and mechanical ventilation indicated poorer outcome, while administration of antidotes was correlated with better outcome.

Background: Caustic ingestion is still a difficult medical problem, and the outcome is often unexpected. Objectives: This study assessed the usefulness of intoxication data, clinical data and some laboratory parameters in predicting the outcome following caustic ingestion, and test the applicability of DROOL Score (DS) as a prognostic indicator of oesophageal stricture. Methods: Ninety-two patients with caustic ingestion admitted to Poison Control Centre Ain Shams University (PCCASU), during the period from 1st June to November 30, 2015 were prospectively studied. Diagnoses of stricture made via barium study. Results: Sixty-six percentage of cases were children under 5 years. In 48.9% of cases, the caustic agent was alkaline. Symptoms and signs can adequately predict the outcome of corrosive patients. DROOL Score and Total Leucocytic Count (TLC) ≥ 20,000 are useful tools for predicting both stricture formation and mortality, in addition blood pH ˂ 7.2 can also predict mortality. A new value of DS ≤ 5.5 to predict stricture formation and mortality of corrosive patients was proposed. Conclusion: Clinical manifestations can adequately predict the outcome also; DS and TLC ≥ 20,000 have predictive value for outcome prediction of corrosive patients. Moreover, blood pH ˂ 7.2 can predict mortality. A new value of DS ≤ 5.5 was identified as a prognostic indicator of outcome in caustic patients.

This study aimed to evaluate the Health care providers (nurses) performance regarding helping babies breathe during neonatal resuscitation. Research design: descriptive analytical study. Setting: The study was conducted at the delivery room of Obstetric and Gynecological Hospital affiliated to Ain Shams University Hospitals. Subjects: A purposive sample composed of 50 health care providers (nurses, assistance nurses trainee and nursing staff) who, attended and receive the baby for resuscitation at the previously mentioned setting over a 6 months period regardless of their residence, age and gender. Tools: A predesigned questionnaire sheet to assist health care providers (nurses) knowledge regarding helping baby breath and an observation checklist to assess health care providers (nurses) performance regarding helping babies breathe. Results: the study revealed that there was Almost three quarters studied sample had poor score for total knowledge, compared with less than one quarters had average score. Almost less than two thirds of the studied nurse had incompetent performance regarding helping baby breath, There was a positive correlation between total knowledge of the studied nurses and their total performance regarding helping baby breath Conclusion: Based on finding of the present study and answering research question, more than three quarters of the studied health care providers (nurses) had poor score level of knowledge regarding helping babies breathe, more than one fifth of the studied health care providers (nurses) had incompetent performance regarding helping baby breath, and there were positive correlation between total knowledge of the studied nurses and their total performance regarding helping babies breathe. Recommendation: upgrade health care providers' knowledge regarding helping babies breathe through continuous educational program. Enhance health care providers (nurses) practice according to helping babies breathe. Further researches are required involving all health care providers not only nurses about helping babies breathe at different study all over Egypt..

Background: Effective discharge planning is a vital component to maintain care continuity for head traumapediatric patient. Despite this, there is a critical gap in the process and quality of discharge planning in Egypt.Aim of this studywas to assess the effect of discharge plan on parents having children suffering from headtrauma.Design: A quasi- experimental design was used.Settings: This study was conducted in Emergency Department, Pediatric Intensive Care Unit (PICU) andNeurological Department at children Hospital affiliated to Ain Shams University and El-Menshawy Hospitalin Tanta affiliated to Ministry of Health.Subject: A convenient sample consist of 40 parents accompanied their children suffering from head traumawho attended in the previously mentioned settings.Tools: 1)- Pre-designed questionnaire sheet which included two parts: part I: concerned with characteristicsof studied parents and characteristics of the studied children,Part II: knowledge of the parents regardingcaring of their children suffering from head trauma, 2)- Observational check list and 3)- Child MedicalRecord.Results: All of studied parents reported that no one gave them any information about head trauma. There wasa marked improvement in parents’ knowledge and reported practices post implementation of discharge plan.There were strong positive correlations between studied parents’ total knowledge and their total reportedpractices related to care of children after head trauma pre/post discharge plan.There was highly statisticalsignificance difference between parents’ total knowledge regarding care of head trauma in children andtheir level of education post implementation of discharge plan. There was statistical significance differencebetween parents’ total reported practices regarding care of head trauma in children and their level of educationpost implementation of discharge plan.Conclusion: All of research hypothesis were accepted and implementation of discharge plan led to significantimprovements in parents’ knowledge and reported practices regarding care of their children suffering fromhead trauma. Recommendations: Discharge plan for all parents having children suffering from head trauma must beginwith parents at their first day of admission.

BACKGROUND AND OBJECTIVE As liver biopsy had multiple procedure-related complications, the introduction of reliable noninvasive tests for accurate discrimination of NASH and liver fibrosis in patients with NAFLD are mandatory. The aim was to elucidate the diagnostic value of fibrosis-4 index (FIB-4), Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and Cytokeratin-18 fragments (CK18-Fs) in the prediction of NASH and liver fibrosis. MATERIALS AND METHODS One hundred Egyptian patients with NAFLD selected from outpatient's clinics of Mansoura University Hospitals underwent histological examination through liver biopsy after approval and consent. The FIB-4, HOMA-IR, CK18-Fs (measured using a human ELISA Kit) and their combination in FICK-3 score were investigated for predicting NASH and liver fibrosis. Receiver operating characteristic (ROC) curves and multivariate logistic regression were analyzed. RESULTS In patients with NAFLD, the areas under the ROC were significantly high (AUC: 0.765, 0.700, 0.803, 0.835 for FIB-4, HOMA-IR, CK18-Fs, FICK-3 score, respectively, p = 0.05) displaying a highly statistically significant predictive ability for NASH. Significantly higher AUCs for these parameters were demonstrated predicting early-or advanced-stage liver fibrosis (AUC >0.7, p 1.46, HOMA-IR >2.11 and CK18-Fs >307U L-1) had highly significant predictive values for NASH and liver fibrosis and had the best diagnostic accuracy at a cutoff value of 1(AUC >0.8, p

Background Various adjuvants have been used to prolong spinal anesthesia, with the additional advantages of delaying the onset of postoperative pain and reducing postoperative analgesic requirements. Pregabalin is an R-aminobutyric acid analog that binds to the α2-δ subunit of presynaptic voltage-gated calcium channels. Objective The aim of this work is to evaluate the efficacy of a single dose of pregabalin in terms of spinal blockade duration and its potential opioid-sparing effect during the first 24 hours postoperatively Patients and Methods There were limitations to the present study. First, since only 1 dosage of pregabalin was evaluated, we could not determine the most effective dosage. Second, clinically meaningful improvements in recovery were not assessed. Adequate postoperative pain control provides early postsurgical mobilization, shortened hospitalization, and increased patient satisfaction. Third, preoperative pain and anxiety scores were not recorded. Pregabalin might affect the preoperative pain, mood, and anxiety scores, and these factors can be related to the postoperative pain score. Results The mechanisms by which pregabalin premedication prolongs motor and sensory blocks using local anesthetics in spinal anesthesia are not fully understood. There may be several reasons for the prolongation of spinal anesthesia. Gabapentinoids are an r-aminobutyric acid analog that binds to α2-δ subunit of presynaptic voltage-gated calcium channels, and this inhibition decreases postsynaptic excitability by reducing potassium-evoked excitatory transmitter release. These medications provide antiepileptic, anxiolytic, and analgesic features by modulating both GABAergic neurotransmission and calcium influx. Gabapentinoid compounds produce a significant and clinically important improvement in preoperative anxiety scores. Since patients may be anxious in the perioperative period, the anxiolytic effects and euphorigenic effects of pregabalin may be beneficial.

Hemophilia is a coagulation disorder arising from a genetic defect of the X chromosome; the defect can either be inherited or result from spontaneous gene mutation. In each type of hemophilia (A, B, C, and willebrands disease), a critical coagulation protein is missing, causing children to bleed for long periods of time before clotting occurs. Aim: this study was a quasi- experimental aimed to evaluate the outcomes of the instructional module on the studied sample. Setting: the study was carried out at hematology departments at children's hospitals affiliated to Ain Shams University Hospital (Al Demerdash) Cairo University Hospital (Abo Elreesh) and Benha children's Hospital affiliated to ministry of health. The Sampling: A convenient sample involved Fifty nurses from the previously mentioned settings. Tools of data collection: involved a structure questionnaire to assess nurses' knowledge and observational checklists to assess performance regarding care of children with hemophilia and instructional module about hemophilia. Results: Slightly less than half (46.0% &48%) of the studied nurses their ages were 30 years and more, had nursing diploma from technical institute of nursing respectively, less than two thirds of the nurses (62%) had experience ≥ 6years, Post implementation of the instructional module most of the studied nurses had satisfactory level of knowledge and competent practice in comparison to pre implementation of the instructional module. Conclusion: The designed instructional module led to significant improvement of knowledge and performance of the studied nurses towards care of hemophilic children. Recommendations: continuous refreshing training should be provided for all of nurses working in hematological departments and caring of children with hemophilia. A manual guided booklet about hemophilia should be available to all nurses working in hematological departments.

LAPAROSCOPIC VERSUS OPEN REPAIR OF PERFORATED PEPTIC ULCER Abutalib B Alluaibi@, Ali Y Al-Wajeeh$ & Mansour Amin Mohammed* @MB,ChB, FIBMS, General Surgeon, Al-Mawanee General Hospital, Basrah. $MB,ChB, CABS, General Surgeon, Al-Mawanee General Hospital, Basrah. *MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine, Basrah, IRAQ. Abstract Peptic ulcer is the most common GIT disorder with a prevalence of 2%, peaking around the age of 70 years. Laparoscopic repair of perforated peptic ulcer began to evolve and replace the ordinary upper laparotomy. We studied 47 patients suffering from perforated duodenal or gastric ulcer in Al-Mawanee General Hospital in Basrah in the period 2014-2017, the patients were categorized into 2 groups: 1st group(24 patients) managed laparoscopically and the 2nd group (23 patients) managed by open approach. Perforation found to occur more with duodenal ulcer (29 pt. 61.70%) and more in male patients (26 pt. 55.33%). The peak perforation seen in age group >60 years and the commonest risk factors was the NSAIDs usage. Operative time was insignificantly longer in laparoscopic approach. However, the laparoscopic approach has less post operative pain and less overall complications (4 pt. 16.6% vs. 8 pt. 34.7%). In conclusion, laparoscopic repair of perforated peptic ulcer is a feasible operation and considered promising with less postoperative pain, less postoperative complications and better cosmetic results.

A COMPARATIVE STUDY BETWEEN HARMONIC SCALPEL HEMOSTASIS AND CONVENTIONAL HEMOSTASIS IN TOTAL AND SUBTOTAL THYROIDECTOMY Mohammed Salim Mohammed*, Jasim D Saud#, Mansour Amin Mohammed$ & Mazin H Al-Hawaz@ *MB,ChB, Board Candidate. #MB,ChB, FICMS, CABS, Consultant Surgeon, Basrah General Hospital. $MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine. @ MB,ChB, CABS, DGS, FRCS, Prof. of General Surgery, Basrah Medical College., Basrah, IRAQ. Abstract Thyroid gland is highly vascularized organ, so good hemostasis during total or sub-total thyroidectomy is crucial to decrease the complications and to improve the outcome. This study aimed to evaluate the advantages and disadvantages of using harmonic scalpel device in comparison with conventional hemostasis for total and subtotal thyroidectomy in terms of operative time, nerves injury, post-operative blood loss, hematoma development, hypocalcemia and length of hospital stay. This study included 80 patients who underwent total or subtotal thyroidectomy. They were divided into two groups according to the type of hemostasis: conventional hemostasis group and harmonic hemostasis group. Different diseases were included (multinodular goiter, toxic goiter and malignant diseases). The results showed that time of operation was significantly shorter in the harmonic hemostasis group (79.52±14.98 min) than conventional hemostasis group (100.92 ±10.64 min) with p value 0.0001, also post-operative blood loss was lower in harmonic hemostasis group (52.5±26.23 ml) than conventional hemostasis group (75.13±17.8 ml) with p value 0.0001. Other outcome such as recurrent laryngeal nerve injury, post-operative hematoma, post-operative hypocalcemia and length of hospital stay did not show significant difference between the groups. In conclusion, using harmonic scalpel device in total or subtotal thyroidectomy reduced the operative time and post-operative blood loss, without any change in the incidence of nerve injury, hematoma, hypocalcemia and the length of hospital stay.

BACKGROUND Early detection of post-thyroidectomy vocal cord dysfunction is crucial. This study compared GlideScope® with Macintosh direct laryngoscope (MDL) regarding the accuracy of assessment of post-thyroidectomy vocal cord dysfunction. METHODS One hundred and twenty patients scheduled for elective thyroidectomy, aged 18 - 50 years, of either sex were enrolled in the study. Standard general anesthesia technique was used in all patients. At the end of operation, patients were randomly allocated into one of the following sequences: 1) examined with MDL then GlideScope®, or 2) examined with GlideScope® then MDL. Postoperative tele-laryngoscopic examination was done after 12 hours. The primary outcome of the study was the sensitivity and the specificity of GlideScope® to detect vocal cord dysfunction while the secondary outcomes were the Cormack-Lehane grade of the glottis visualization and the incidence of complications. RESULTS The incidence of vocal cord dysfunction was 15 (12.5%); all cases were unilateral. The GlideScope® was more sensitive (86.7%) and specific (95.2%) with higher diagnostic accuracy (94.2%) for detecting vocal cord dysfunction than MDL. There was a high agreement between the GlideScope® findings and the final diagnosis (kappa 0.754 [95% CI: 0.581-0.928]). Cormack-Lehane score was significantly better by the GlideScope® than by the MDL (P

Purpose To determine whether patients with amyotrophic lateral sclerosis (ALS) show retinal axon pathology. Methods Postmortem eyes from 10 patients with ALS were sectioned and compared with 10 age-matched controls. Retinal sections were evaluated with periodic acid Schiff and phosphorylated (P-NF) and nonphosphorylated (NP-NF) forms of neurofilament with SMI 31 and 32 antibodies. Spheroids identified in the retinal nerve fiber layer were counted and their overall density was calculated in central, peripheral, and peripapillary regions. P-NF intensity was quantified. Morphometric features of ALS cases were compared with age-matched controls using the exact Wilcoxon matched-pairs signed-rank test. Results Distinct periodic acid Schiff-positive round profiles were identified in the retinal nerve fiber layer of patients with ALS and were most commonly observed in the peripapillary and peripheral retina. The density of periodic acid Schiff-positive spheroids was significantly greater in patients with ALS compared with controls (P = 0.027), with increased density in the peripapillary region (P = 0.047). Spheroids positive for P-NF and NP-NF were detected. P-NF-positive spheroid density was significantly increased in patients with ALS (P = 0.004), while the density of NP-NF spheroids did not differ significantly between ALS and control groups (P > 0.05). P-NF immunoreactivity in the retinal nerve fiber layer was significantly greater in patients with ALS than in controls (P = 0.002). Conclusions Retinal spheroids and axon pathology discovered in patients with ALS, similar to hallmark findings in spinal cord motor neurons, point to disrupted axon transport as a shared pathogenesis. Retinal manifestations detected in ALS suggest a novel biomarker detectable by noninvasive retinal imaging to help to diagnose and monitor ALS disease.

Background: Prolonged postoperative mechanical ventilation after intracranial surgery is associated with significant morbidity and mortality. Many traditional tools could help in prediction of weaning success as blood gas analysis (ABG), chest radiography, ventilator parameters and rapid shallow breathing index (RSBI). These tools have a significantly higher failure rate. The aim of this study was to describe the role of transthoracic lung ultrasound (LUS) as a clinical tool in predicting weaning of postoperative mechanically ventilated patients after intracranial surgery. Patients and method:130 patients who were scheduled for weaning from mechanical ventilation (MV), were prospectively enrolled in the study, age 20-70 years, of either sex. They were randomly allocated into two groups- group C (n=65) were examined by traditional methods chest X- ray, ABG, ventilator parameters and RSBI, and group US (n=65) were examined by traditional methods plus LUS. Diaphragm thickness (DT) and fraction (DTF), lung aeration and extravascular lung water (EVLW) were assessed by LUS. A failure of weaning was considered when reintubation was needed within 48 hours. Results: The success rate in group US (LUS+ traditional methods) was 84.6% compared to 66.2% in group C (traditional methods only). The value of diaphragm thickness and fraction were significantly more in the weaning success group than in failure group. B-lines detected by LUS in success and failure groups were ≤2, 3 respectively with no significant difference. Conclusion: Lung ultrasound as an added tool could decrease failure rate of weaning in postoperative mechanically ventilated patients after intracranial surgery.

MED12, a subunit of mediator complex genes is known to harbor genetic mutations, (mostly in exon 2), causal to the genesis of uterine leiomyomas among Caucasian, African American, and Asian women. However, the precise relationship between genetic mutations vs. protein or disease phenotype is not well-explained. Therefore, we sought to replicate the MED12 mutation frequency in leiomyomas of Saudi Arabian women, who represents ethnically and culturally distinct population. We performed molecular screening of MED12 gene (in 308 chromosomes belonging to 154 uterine biopsies), analyzed the genotype-disease phenotype correlations and determined the biophysical characteristics of mutated protein through diverse computational approaches. We discovered that >44% (34/77) leiomyomas of Arab women carry a spectrum of MED12 mutations (30 missense, 1 splice site, and 3 indels). In addition to known codon 44, we observed novel somatic mutations in codons 36, 38, and 55. Most genetically mutated tumors (27/30; 90%) demonstrated only one type of genetic change, highlighting that even single allele change in MED12 can have profound impact in transforming the normal uterine myometrium to leiomyomas. An interesting inverse correlation between tumor size and LH is observed when tumor is positive to MED12 mutation (p < 0.05). Our computational investigations suggest that amino acid substitution mutations in exon-2 region of MED12 might contribute to potential alterations in phenotype as well as the stability of MED12 protein. Our study, being the first one from Arab world, confirms the previous findings that somatic MED12 mutations are critical to development and progression of uterine leiomyomas irrespective of the ethnic background. We recommend that mutation screening, particularly codon 44 of MED12 can assist in molecular diagnostics of uterine leiomyomas in majority of the patients.

Background: Hepatocellular carcinoma (HCC) is an aggressive deadly cancer with few therapeutic options mostly limited for early-stage HCC. Unfortunately, alphafetoprotein (AFP) has a limited performance, especially in early-stage HCC. Objectives: to investigate plasma levels of Cyclaseassociated protein-2 (CAP2) as a new biomarker and evaluate its role in detecting early-stage and AFP-negative HCC Egyptian patients. Methods: Plasma CAP2 and AFP levels in 150 HCC, 150 cirrhotic patients, 150 healthy controls. Correlation with tumor behavior, the area under the curve (AUC), sensitivity, specificity, and diagnostic accuracy were analyzed. Results: Plasma CAP2 and AFP levels were significantly elevated in HCC patients than liver cirrhosis and controls. Only plasma CAP2 levels significantly correlated with clinico-pathological characteristics of HCC (BCLC, histological and clinical stages) but not correlated with patient's age, gender, viral infection status or AFP levels. Compared to AFP, CAP2 had significantly higher AUC: 0.86 (0.79-0.93) vs. 0.75 (0.65-0.85), Sensitivity: 81.5% vs. 62% in all HCCs and significantly higher AUC: 0.80 (0.72-0.89) vs. 0.68 (0.58-0.79, Sensitivity: 80.5% vs. 43.1% in earlystage HCC. Moreover, the combined diagnostic value of both CAP2+AFP was statistically significantly better than either CAP2 or AFP alone. Also, CAP2 could predict 82.4% of AFP-negative HCCs [AUC: 0.85 (0.77-0.92)] and 73.5% of AFP-negative early-stage HCCs [AUC: 0.80 (0.72-0.88)]. Conclusion: Compared with AFP, CAP2 was significantly elevated in HCC patients with higher sensitivity and AUC especially for early-stage HCC. Moreover, CAP2 was significantly correlated with the clinico-pathological features of HCC. CAP2 could be a novel biomarker predicting early-stage, AFP-negative, and AFP-negative early-stage HCC patients.

Background: Nasotracheal intubation is associated with many complications such as epistaxis and nasal cavity injury. Stenting the endotracheal tube with appropriate sized nelaton catheter may decrease these complications. In this study we compared stenting the endotracheal tube by nelaton catheter with ordinary intubation technique. Methods: Eighty paediatric patients who were scheduled for elective dental surgery (restoration surgery) were randomly divided into two groups according to the nasotracheal intubation technique. In the first group endotracheal tube was stented with appropriate size nelaton catheter which was removed immediately after tube passage to the oropharynx. In the second group nasotracheal intubation was done by the ordinary technique without tube stenting. Evaluation of the resistance during nasal intubation, incidence and severity of epistaxis and nasal cavity injury were done. Results: Nasotracheal intubation was smooth in 80% of patients with stented tube compared to 40% in the non-stented tube. Epistaxis was found in 22.5% of patients with stented tubes compared to 85% of patients with non-stented tubes. Histopathology of tube contents after extubation showed blood cells in 32.5% in stented tubes and 92% in the non-stented ones. Adenoid tissue was found in5% of patients with stented tubes and 37.5% of patients with non-stented tubes. Conclusion: Stenting the endotracheal tube with nelaton catheter facilitates nasotracheal intubation and decreases the incidence and severity of epistaxis and nasal cavity injury.

Background: The literature on drugs used for combined general anesthesia and epidural analgesia (CGE) in lumbar operations is scarce. The purpose of the study was to compare the addition of either dexmedetomidine or fentanyl to bupivacaine for epidural analgesia in combination with general anesthesia with regard to efficacy and adverse events in such operations. Materials and Methods: This prospective, randomized, double-blinded study was conducted on 80 patients who were scheduled for an elective lumbar disc operation, age 20–65 years, of either sex and American Society of Anesthesiologists physical status I or II. They were randomly allocated into one of the two groups – group bupivacaine-dexmedetomidine (BD) (n = 40): patients who received CGE with 15 mL of bupivacaine 0.20% plus 50 μg of dexmedetomidine and group bupivacaine-fentanyl (BF) (n = 40): patients who received CGE with 15 mL of bupivacaine 0.20% plus 50 μg fentanyl. The primary outcome was time to first analgesic requirement, whereas the secondary outcomes were the total opioid consumption and pain scores during the first 24 h. The incidence of adverse postoperative (PO) effects related to the study drugs, such as sedation, nausea and vomiting, pruritus, shivering, and respiratory depression, was also documented. Results: Patients in the BD group experienced a significantly prolonged pain-free period, lower total opioid consumption, and lower pain scores than patients in the BF group (P < 0.001). Patients in the BD group showed a significantly lower intraoperative heart rate and mean blood pressure (P < 0.001). Regarding adverse events, there were greater PO sedation scores (P < 0.001) and less frequent episodes of PO nausea and vomiting in the BD group. In addition, patients in the BD group showed less pruritis and shivering. There were no reported cases of respiratory depression in either group. Conclusion: CGE with bupivacaine plus dexmedetomidine provided better PO pain control than bupivacaine plus fentanyl, with fewer adverse events overall.

Nubian goats were the animals tested for the toxicity of both alum and polydadmac blend of 1% alum and 1% polydadmac at 1:2 Clinical signs of tested goats showed interrupted salivation, vomiting, watery diarrhea, dullness, inappetance ,inability to move accompanied by hind limb paralysis and finally recumbency. On postmortem, and histopathological assessment, most vital organs were clearly affected. Serum concentrations of tested enzymes showed marked (P0