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Background: Dexmedetomidine is used as an adjuvant to local anesthetic agents in spinal anesthesia and is believed to increase quality of sensory and motor blocks. Our aim was to assess the effects of dexmedetomidine as an adjunct on block quality of spinal anesthesia in orthopedic procedures. Methodology: A systematic review of randomized control trials was conducted to assess the effect of intrathecal dexmedetomidine added to local anesthetic agents on the block quality of spinal anesthesia in orthopedic surgeries. PubMed, Google scholar, and Medline databases were searched for randomized controlled clinical trials. Studies met our inclusion criteria, if they used intrathecal 5 µg dexmedetomidine as an additive to 2.5−3 ml (12.5−15 mg) bupivacaine or ropivacaine, and these were included in our meta-analysis. Results: Eight trials comprising 510 patients matched our inclusion criteria. Time to one sensory segment block regression (mean difference 139.72 min; 95% confidence interval (CI) 35.18−244.26; P = 0.009), two sensory segments block regression (mean difference 54.8 min; 95% CI [31.36−78.24]; P < 0.001), and Bromage score of zero (mean difference 93.66 min; 95%CI [30.20−157.12]; P = 0.004 ) were significantly prolonged in dexmedetomidine group. There were no significant differences between dexmedetomidine group and control group in duration of surgery (P = 0.33) or time till block reaches T10 dermatomal level (P = 0.30). Finally, time to reach Bromage score of III following injection was significantly shorter in dexmedetomidine group (mean difference 2.62 min; 95%CI [−5.12−−0.13]; P = 0.04). Conclusion: Dexmedetomidine was found to achieve extended motor and sensory block when needed, bearing in mind higher cost and potential side effects. Key words: Dexmedetomidine, Spinal Anesthesia, Orthopedic surgery, Meta-analysis. Citation: Alhajahjeh AA, Suleiman A, Almustafa HM, Mesmar TM, Hamdan A, Almustafa MM. Neuraxial block quality of dexmedetomidine-containing regimens in orthopedic surgeries: a meta-analysis. Anaesth. pain intensive care 2022;27(1):43−52. DOI: 10.35975/apic.v27i1.1876 Received: May 22, 2022; Reviewed: August 14, 2022; Accepted: December 28, 2022

Heat generation from the biosynthesized Fe3O4 NPs using Salix babylonica L. aqueous leaf extract in water under sunlight.

Metal Nanoparticles (NPs) are recognized as the most attractive materials due to their distinct physical and chemical characteristics. Several physical and chemical synthesis methods have already been tested to obtain NPs of appropriate size and shape. Although the chemical-based solution methods provide NPs within a proper size and shape and can be reasonably controlled, they require a large amount of raw material including solvents, capping agents, etc., which usually lead to toxic output and waste. In this study, the author tested an easy and environmentally friendly solid-state synthesis pathway for synthesizing silver (Ag) NPs within a suitable size and shape, using a novel reducing agent. Silver carbonate (Ag2CO3) was allowed to react with Violuric acid (C4H3N3O4) as a reducing agent through a solid-state grinding method for one hour. The results confirmed that Violuric Acid can be considered a promising reducing agent that results in the formation of well-shaped spherical Ag NPs within an average particle size of about 60 nm.

This study aimed to analyse the proximate and anti-nutritional components of Cwande in Zuru Local Government, Kebbi State. Five (5) samples in four (4) collection areas were collected and transported to Botany Laboratory Kebbi State University of Science and Technology, Aliero for analysis. The proximate and antinutrient parameters were analysed using the recommended AOAC (Association of Official Analytical Chemists) techniques. The results of the study showed that Cwande had high protein content (37.29±0.50%), followed by moisture (32.07±0.58%), fibre (14.80+3.06%), carbohydrate (7.62+0.81%), lipid (5.18+0.52%) and ash (3.02+1.76%). While the results of anti-nutritional composition showed that Cwande had high phytate composition (5.76 + 0.72) followed by saponins (5.51 + 0.61), cyanide (4.76 + 0.28) and oxalate (4.03 + 0.20). From these findings, it was discovered that Cwande condiments locally produced by Zuru people have good nutritional profile levels. However, the level of anti-nutrient contents in Cwande condiments is reduced. Further studies should be carry out to know the incidence of microbial flora of Cwande and also the toxins substances known to cause harmful effects to humans and animals.

Background: Adenoid hypertrophy is the most common cause of nasopharyngeal airway obstruction in children. The radiographic evaluation of the adenoid hypertrophy using the adenoid-nasopharyngeal ratio is a simple, economical, and reliable method in determination of the position, size, and shape of the adenoids. Aims and Objectives: The study was conducted to determine the correlation between radiographic adenoid-nasopharyngeal ratio and clinical symptoms of adenoid hypertrophy. Materials and Methods: This crosssectional prospective study was carried out in the Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, North West Nigeria. A total of 90 consecutive patients aged between 3 and 12 years with clinical symptoms of adenoid hypertrophy were included in the study. All the patients had plain radiography of the post-nasal space. The adenoid-nasopharyngeal ratio (ANR), which is the ratio of the adenoid thickness measured from the maximum convexity of the adenoid to the margin of the basiocciput and the nasopharyngeal depth measured from the posterior border of the hard palate to the anteroinferior aspect of the sphenobasioccipital synchondrosis (Fujioka method), was calculated and scores obtained for each patient were graded into mild (0.50–0.62), moderate (0.63–0.75), and severe (0.76–0.88). The clinical symptoms assessed included snoring, mouth breathing, sleep apnea, otitis media, and recurrent upper airway infections. Each symptom was scored on a 4-point scale and the sum of the scores was graded into mild (0–5), moderate (6–10), and severe (11–15). The data were collected using a structured questionnaire and analyzed using Statistical Package for the Social Sciences version 22. Results: A total of 90 patients were involved in the study, their age ranged between 3 and 12 years (mean=6.11±2.77); and male-tofemale ratio was 2:1.5. The mean ANR score was 0.71±0.11 and that of the clinical symptoms score was 8.67±3.23. ANR correlated significantly with the clinical symptoms scores (r=0.901; P

In hospital settings, standard precautions prevent the transmission of infections. A healthcare worker's failure to comply with infection control recommendations may increase his or her risk of exposure to infectious disease, particularly during pandemics. This study's objective was to analyze the level of compliance with infection prevention and control methods among healthcare professionals in various healthcare settings, particularly primary care settings. We scoured the most popular databases, Medline and Embase, for any relevant articles published up to the beginning of 2022 that were relevant to our topic. Due to occupational exposure to germs, healthcare personnel may contract an infection while administering nursing care.

An imperative contemporary management dilemma in moments of rapidly evolving regarding the ongoing digital transformation of business and society in general is recognizing and trying to translate these adjustments into digital business model innovation (DBMI). Academia has plenty to show in exchange of assisting with this managerial problem, but studies in the field still seem to be hazy in terms of what DBMI is, the present, future, and vision. Therefore, this article aimed to review the present situation of DBMI, its future, and its vision in the general context. The secondary databases were used to collect the relevant articles, and the outcome of the study found that DBMI has attained prolonged growth in different businesses especially in COVID-19 period. This scenario would not be changed in future because of increasing digital impact on several businesses. Therefore, it is recommended for all types of businesses to adopt digital business model innovation to attain competitive advantage.

Cement quality is an important well integrity consideration to ensure proper hydraulic sealing. Traditionally, wireline cement bond logs have been used extensively in the Jurassic formation of North Kuwait. The case study well presented in this paper had an 80° inclination and 3,000 ft of a 6-in. open hole, which has remained opened for quite some time. Cement evaluation was required inside the 7 5/8-in liner to determine the cement quality behind the liner and integrity of liner shoe. This information is important for achieving a successful of multistage completion for the producing interval in the 6-in open hole. The target interval had a vertical depth greater than 14,000ft from mean-sea level with a well deviation more than 80°. Four operational days were required to run drill pipe conveyance of conventional cement evaluation wireline tools. This operation would have exposed the 2,500ft of open hole to potentially collapsing situation due to the time dependence of the wellbore stability. The capability of logging-while-drilling (LWD) multipole sonic tool for evaluating the cement quality was considered, as there was plan to acquire open hole log data using LWD technology, which included the LWD multipole sonic tool. While running in the hole to the open hole section, the LWD multipole sonic tool can acquire sonic-based cement evaluation data inside of the 7 5/8-in liner. This operating method consumes no rig time while obtaining the well integrity information. This paper presents the case study, along with the LWD multipole sonic tool theory for measuring cement bond quality index, operation preparation, and the results of the data acquisition.

In pursuit of higher Gas production targets in Kuwait, a major campaign was initiated to increase reservoir contact in a tight carbonate limestone formation associated with depositional uncertainties. The primary challenge was to overcome lack of sufficient offset data and ambiguous seismic interpretation. To add to the complexity, the well was overlapping a major fault plane, resulting in several anomalies. A combination of deep-reading mapping and accurate imaging tools in real time was a must to properly land and steer the lateral within less than 9 feet thickness at 14,475 feet true vertical depth. Several sub-seismic faults were encountered while drilling and further complications were present with high temperature anomalies while drilling that exceeded tool temperature rating. A pre-well model was completed to predict formation behavior and develop an initial trajectory with expected responses for different scenarios as well as identifying optimum landing point parameters. Bottom-hole assembly (BHA) was optimized according to required setup and outputs. Latest well placement solutions combining ultra-deep resistivity reservoir mapping and spectral gamma ray imaging tools were deployed. Tool output was used to correlate to the model and anticipate anomalies in formation behavior while crossing any sub-seismic faults or react to sudden change in dip angles. During drilling, a steep increase in temperature was observed exceeding tool specifications. This resulted in premature trips, increasing the complexity of the challenge, especially as longer open hole section became exposed. An analysis bases on collecting circulating and non-circulating temperature in different runs, along with correlated mud flow and rotation parameters helped establishing best practices to mitigate the high temperature while drilling within tool operating envelope. The established best practice helped to extend tool life to continue drilling to the required objective, with no compromise to the reservoir data transmitted in real-time for steering purposes. The final outcome was achieving field record in deep drilling group by completing successfully and precisely the longest and deepest lateral in north Kuwait Jurassic asset area while remaining inside the required reservoir unit and providing insight on further units more than 30 ft. away. The final run was the deepest in terms of true vertical depth in which ultra-deep reservoir mapping tool was utilized for steering worldwide. The paper focuses on how the output of latest well placement technologies helped achieve the objectives and the approach to develop and apply drilling best practices in real time to achieve this field record. The knowledge and methodology is considered crucial in Kuwait Oil Company's path to achieve the set gas production targets, especially with the increase in planned number of laterals in Jurassic asset.

Background: In spite of concerted global efforts to reduce childhood mortality, countries in Sub-Saharan Africa are still being plagued with incomparably high mortality rates; thereby contributing majorly to the global burden. These deaths occur from causes which are preventable. Men play a pivotal role in sustained efforts to reduce childhood mortality, however, they are usually overlooked in favour of the mothers. The study aimed to assess the knowledge and attitude of men towards factors influencing childhood mortality in a semi-urban community, North-Western Nigeria.Methods: A descriptive cross-sectional study was conducted using structured interviewer-administered questionnaire. A total of 174 married men were sampled using a multistage sampling technique. Data collected were analysed using the IBM SPSS version 21. Results were presented in tables and bar charts. The level of statistical significance was set at p

Aim: to indicate the importance of adequate selection of all on four-fixed implant supported hybrid mandibular prosthesis material to reduce bone stresses. Materials and methods: one three-dimensional simplified geometric model, for bone and fixed prosthesis, was created by using engineering CAD/CAM software. On the other hand, implant system manufacturer data gave sufficient geometrical data to model it exactly. The modelled part was transferred to ANSYS for assembly, meshing, and analysis. Three overlying materials were tested; Acrylic, Polycarbonate, and Zirconia above the cobalt chromium bar. The lowest area of the cortical bone was set to be fixed in place as boundary condition. While unilaterally load of 250N was applied vertically on central fossa of first and second molars as two loading cases. Results: changing overlying material resulted in, cortical bone and implant complex receiving Von Mises stress in sequence with material rigidity. The more rigid the overlying material the less bone stresses with first molar loading, while, opposite trend (sequence) appeared with second molar loading. On the other hand, bar, coping, screws, mucosa, and spongy bone deformations and stresses decreased with increasing overlying material rigidity. Where, all the model components showed stresses and deformations within the physiological limits. Conclusions: More rigid overlying material is recommended to reduce stresses on bar, coping, screws, mucosa, and spongy bone. Overlying material selection for cortical bone and implant complex is extremely tricky. That it showed same behaviour as other soft tissues with applying load close to the bar (short cantilever arm), then inverted behaviour with shifting the applied load away from first to second molar (increasing cantilever arm).

COVID-19 is the deadly respiratory disease of the century caused by new type unknown origin Coronavirus. The recent effort of the word researchers is toward finding the origin of the virus. The current study investigated the extent of molecular similarity and divergence between SARS-CoV2 and other related Coronavirus. An attempt has been made to investigate the epidemiological study of this new contagious virus using molecular biology techniques. The phylogenetic trees for all human coronaviruses with the novel Coronavirus have been built using a several complete amino acid sequences of the four known structural proteins, S (spike), E (envelope), M (membrane), and N (nucleocapsid). The result of the study revealed that the SARS-CoV2 is related to human SARS-CoV isolated from different countries very cloely, especially those strains recovered from China in recent times, 2020. The evolutionary changes observed in the inserted 23 amino acids in the RNA binding domain (RBD) of the coronvirus spike glycoprotein which cannot be detected in any other human coronavirus. Moreover, the 2019-nCoV is not closely related to other alpha, beta and gamma human Coronavirus, including MERS-CoV. The current study concluded that 2019-nCoV is more likely believed to originated from SARS-CoV. The probability is more vital to be originated from the strain isolated in China in 2020, which is coincident with the spraed of COVID-19 in the same country. The phyloepidemiologic analyses suggested that the coronaviruses are circulating in human hosts evolving gradually by times in response to the different environment stimuli facing the virus inside the host in different geographical areas. Furthermore, the analysis showed the flow of transmission, and evolutionary changes of SARS-CoV2 which may be directed from the transmission of SARS-CoV from human to Bat and Pangolin then jumped to human again in the crowded market Wuhan city in China.

Primary spontaneous pneumothorax (PSP) is a common medical emergency. Its treatment includes simple observation, needle thoracentesis, pleural catheter, video-assisted thoracoscopy (VATS), and open surgery. We aimed to establish the demographic, clinical characteristics, and 12-month recurrence rate of patients with PSP in four hospitals of the Hamad Medical Corporation, Qatar.We conducted a retrospective analysis of patients14 years old who were admitted with PSP from January 1, 2017 to December 31, 2019. The patients were followed up for 12 months for the recurrence of PSP.Out of 246 patients enrolled in this study, 223 (90.7%) were males and 23 (9.3%) were females. Their mean age was 29.1 ± 9.59 years and their mean body mass index (BMI) was 21.7 ± 4.22 kg/mPSP is more common in males than in females, with a tendency for younger age onset. The recurrence rate of PSP in our study was 2.66%. Furthermore, the recurrence rate in our patients who underwent VATS was 1.85%. Prospective studies are warranted to compare the success rates of different treatment interventions.

Background and objectives Tuberculosis (TB) is a global public health issue. The emergence of multidrug-resistant (MDR) TB has further complicated the situation in the form of poor treatment outcomes and costs to individuals and health-care systems. We therefore aimed to measure the prevalence and associated risk factors of MDR TB among TB patients in Makkah city. Patients and methods This was a cross-sectional study conducted at Al-Noor Specialist Hospital, a public-sector hospital in Makkah. We included records of 158 confirmed TB patients from the list of all patients admitted in the hospital from January 2009 to January 2019 by systematic random sampling. Data were collected on socio-demographics, clinical profile and drug resistance patterns. Analysis was done in SPSS version 21.0. Results The mean age of the participants was 43.4 ± 18.7 years, and two-thirds (66.5%) were male. About 40% of the patients had chronic disease while lung disease other than TB was present in 5% patients. About 13% of cases were extrapulmonary infections. Prevalence of drug resistance was found to be 17.1% among TB patients. Among the resistant cases, streptomycin (25.9%) and isoniazid (11.1%) were the drugs most commonly affected by resistance. Prevalence of MDR TB was 5% among TB patients. Age, smoking, lung disease and previous TB were significant factors associated with MDR TB. Conclusion Prevalence of MDR TB, although comparable to current national estimates, is higher compared to previous reports. There is a need to reduce this burden through strengthening TB control programs to prevent further emergence of a public health threat of MDR TB. History of previous TB was the strongest risk factor in this study. This calls physicians, program managers and policy makers to focus on counselling and support of TB patients for compliance with the regimen to complete treatment without interruption.

This paper presents the effect of filling ratio on thermal performance;of a loop thermosyphon. The experimental setup consists of an evaporator, a condenser, a riser and a downcomer. The dimensions of the loop thermosyphon under consideration were chosen so that they are mostly suitable for use in the cooling of electronic components. Distilled water was used as a working fluid. Experiments were carried out to estimate the performance of the loop thermosyphon for a range of input power from 10 to 100 W. Four fill ratios were considered in the present work, namely; 15%, 25%, 50% and 85%. Results showed that the maximum value of wall temperature in evaporator was 95°C, at 100 W input power and 15% fill ratio. The fill ratio of 50% gave the minimum evaporator wall temperature which was 80°C. Increasing fill ratio tends to decrease the evaporator wall temperature for evaporator.

This current review was aimed to evaluate the screening techniques as well as therapy strategies for migraine frustration assaults, also to go over the danger aspects connected with this severe neurological disorder. Targeted thorough search was performed through data sources; PubMed/Midline, as well as Embase, for these articles disusing the migraine headache from different elements as well as mostly analysis procedures and treatment options, with human subjects released up to mid of 2019, We restricted this search to just English language released posts. To be able to approach the precise therapy selection a thorough medical diagnosis has to be performed amongst people believed with migraine headache. This evaluation stresses the practical treatment of migraine frustration in addition to the advancement that has really been made in specifying migraine pathophysiology as well as in developing new specific treatments. There is overlapping reaction to therapy: non-steroidal, triptans, dihydroergotamine, as well as the anti-emetic dopamine-antagonists may play a restorative role for every of these acute headaches.

Bioethanol production from lignocellulosic biomass as an alternative fuel source has received considerable attention from researchers worldwide. Bioethanol was produced from watermelon peels by fermentation in the current work, using Aspergillus niger and Saccharomyces cerevisiae co-cultures isolated from soil and local beverage (kunun zaki), respectively. The isolates were characterised both macroscopically and microscopically. While starch hydrolysis test was carried out for the mould isolates, thermotolerance, glucose and ethanol tolerance tests were used to identify the yeast isolates. According to standard procedures described by the Association of Official Analytical Chemists (AOAC), Proximate analyses were carried out on the watermelon peels. The ethanol yield was determined using the specific gravity method. Isolate BGD of the moulds had the highest (40 mm) zone of clearance on starch agar. The identified yeasts showed the best growth at a maximum of 35 °C while tolerating up to 50% wt/v and 18% v/v of glucose and ethanol, respectively. The yeasts also fermented all the different sugars tested but lactose. The proximate composition of the substrate revealed low protein (3.5%) and ash contents (7.38%) but a remarkably high carbohydrate content of 79.22%. At optimal fermentation conditions (30 °C, pH 6.0, 4% g/L substrate, 200rpm and five (5) days fermentation period), the maximum ethanol yield produced by the co-culture of Aspergillus niger and Saccharomyces cerevisiae was 57 g/L. However, only 13.5 g/L and eight g/L were produced by individual cultures of A. niger and S. cerevisae, respectively. The bioethanol produced has a specific gravity of 0.994, miscible in water with a pleasant smell. This colourless liquid boils at a temperature of 78 °C with a pH of 3.02 and ignites at room temperature. It was concluded that watermelon peels are a suitable substrate for bioethanol production and was used successfully to produce an ethanol yield of 57 g/L by co-culture of A. niger and S. cerevisiae.

To determine the safety and efficacy of same-day urethral catheter removal after laser vaporization of the prostate and to identify factors contributing to a successful trial of void (TOV).We conducted a retrospective analysis of 98 patients who underwent laser vaporization of the prostate using GreenLight or Holmium Xpeeda laser fibers from April 2018 to March 2021. All patients included in the study were offered a same-day TOV and had their catheters removed 3 hours postoperatively. Patient demographics, intraoperative parameters, and postoperative outcomes were collected and analyzed. Patients who were medically unfit or those on antiplatelet or anticoagulant medications were excluded. Multivariate logistic regression analyses were used to determine potential predictors of a failed TOV.The median age of included patients was 69 years (56-86) with a prostate size of 54 grams (40-78.4). The median operative time was 50 minute (20-93). 72 patients (73.5%) had a successful TOV without the need for urethral catheter reinsertion. The median hospital stay for patients was 5 hours. Preoperative post-void residual (PVR) urine was the only predictor of a successful TOV on both univariate and multivariate logistic regression analyses.Same-day catheter removal following laser vaporization of the prostate is a feasible option with a 73.5% success rate.