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Background Several researches have examined the impact of inhalation anesthetics, intravenous anesthetics, and muscle relaxants on spectral entropy, but many did not evaluate the extent of neuromuscular block. Besides, they did not inspect the impact of distinct degrees of neuromuscular blockade on spectral entropy under dissimilar saturations of isoflurane inhalation. Hence, this study has evaluated variant degrees of minimum alveolar concentration (MAC) to estimate the isoflurane concentration, along with various levels of neuromuscular blockade. This study aims to evaluate the effect of muscle relaxants (atracurium and rocuronium) on entropy readings (state, response entropy, and response-state difference) during isoflurane anesthesia. This is a prospective randomized study, as forty patients have been included and divided into two study groups: patients in group A received atracurium, while patients in group R received rocuronium. Under 50% and 100% neuromuscular blockage, state and response entropy were observed at MACs of 0.8% and 1%, respectively. Results There was a positive correlation between state (SE) and response entropy (RE) at baseline, different MACs, and different trains of four (TOF) for both atracurium and rocuronium. State and response entropy decreased with increasing MAC of isoflurane (P < 0.001), while atracurium and rocuronium at TOF 50% and 100% showed no effect on SE, RE, or RE-SE (P > 0.05). Conclusions State and response entropy can be used effectively to evaluate the depth of anesthesia at different isoflurane MAC and atracurium or rocuronium doses. Registration number ClinicalTrials.gov identifier: NCT 05097508, Registered October 5, 2021 (prospectively registered), http://www.ClinicalTrial.gov

Introduction: Assessment plays a major role in improving the learning and teaching process. The practical examination has a key role in the assessment of students' competences. In conventional method, the judgment of students' performances is mainly subjective because the same performance of students is graded differently by different examiners. Successful implementation of OSPE deals with this major deficit of the conventional methods Assessing the assessment is very important because the implementation of OSPEs are very complex and resource intensive, as it needs large numbers of examiners, candidates and physical resources and equipment as well as time. Assurance of sufficient quality of OSPEs by a range of metrics that gives us critical view about the assessment process as a whole, rather than focusing on candidate outcomes only. Objectives of the study: The objectives of this study were To evaluate OSPEs conducted by Medical laboratory sciences department in Fakeeh College for Medical Sciences(FCMS) with regards to their quality metrics as an assessment tool. Results: A cross-sectional analytic study was conducted in Medical Laboratory Sciences Department Practical Examinations at FCMS Before OSPE conduction, the different stations were revised for criteria of content coverage, skills assessed, clarity of language, dominant domain assessed, and time allocated for each station. Post examinations quality metrics results showed that the reliability of the different examination in Medical Laboratory Sciences department ranged from 0.75 to 0.93 that mean good to excellent reliability. One OSPE showed that one or two stations didn't contribute to the overall all reliability of the whole exam. All OSPEs showed that there are good positive correlation between the theoretical and practical part of the course, and this come with the concurrent evidence of validity.

Background: Implanted port is an implanted device giving access to veins for patients with difficult veins or who need regular long-term administration of drugs often need to be delivered into a large central vein. Aim: The aim of this study was conducted to assess nurses' performance (knowledge, practice& attitude) for caring of patients with implanted port undergoing chemotherapy. Research design: An exploratory descriptive design was utilized to achieve the aim of the study. Setting: The study was conducted at the oncology department in the El-Demerdash Hospital affiliated to Ain Shams University. Study subject: A convenience sample of (50) nurses working in the previously mentioned unit within 6 months. Tools: three tools were used including: - I- Self-administered questionnaire: it used to assess nurses’ knowledge, factors affecting on their performance and demographic characteristics of the study nurses. II-Nurses’ performance observational checklist: it used to assess nurses’ practice in caring of patients with implanted port. III-Likert scale: it used to assess nurses’ attitude in caring of patients with implanted port. Results & Conclusion: more than three quarter of nurses had inadequate practice, and more than two third of them had inadequate knowledge while more than half of them had a positive attitude regarding caring of patients with implanted port. Recommendations: Further research are recommended periodically to study new approaches in the area of management of patients with implanted port and evaluate its reflection on patient’s outcomes.

Objective The ‘PROspective Study of dose adjustment of multiple anti-diabetic therapy for Type-2 diabetic patients FASTing the Month of Ramadan aimed to assess the biophysical and metabolic effects of fasting during Ramadan, including HbA1c, weight, blood pressure and lipid profile. Study design methods We performed a prospective study of people with Type-2 diabetes who were on ≥3 drugs for lowering glucose before and after Ramadan of H1438 (May-June 2017) in Hamad Medical Corporation, Qatar. We enrolled 228 participants, of whom 181 completed the study and were included in the analysis. Results There were 115 (63.5%) men and 66 (36.5%) women, mean age 53.6 ± 9.7 years and mean diabetes duration of 10 ± 6 years. Both HBA1c [7.8% (62 mmol/mol) vs. 7.6% (60 mmol/mol); p = 0.004]; and diastolic BP (75.7 ± 8.55 vs. 68.8 ± 23.1 mmHg, P = 0.001) improved significantly after Ramadan while there was an increase in total cholesterol (3.94 ± 0.89 mmol/l vs 4.11 ± 1.02 mmol/l; p = 0.008) and triglycerides (1.55 ± 0.72 mmol/l vs 1.71 ± 0.9 mmol/l; p = 0.012). Subgroup analysis showed that patients on sulphonylurea, South Asians and males had a significant reduction in both HBA1c and weight. Conclusion Patients with Type 2 diabetes who fast during Ramadan show an improvement in glycaemic control and diastolic blood pressure, but a worsening of total cholesterol and triglycerides, particularly those of South Asian origin and men.

This paper studies the Spillover effect of US unconventional monetary policy (UMP) on Egypt as a case study of an emerging market and a small open economy The authors adopts structural vector autoregressive (SVAR) model with variable lag structure. The Wu and Xia (2016)’s shadow interest rate is used as a measure of U.S. unconventional monetary policy. In case of Egypt, we use Short Interest rate (r) as a measure of monetary policy rate; our empirical results reveal that US unconventional monetary policies significantly affect the monetary policy of Egypt but this effect is less on other macroeconomic variables. The main recommendation of the paper is that monetary authority in Egypt should take into consideration the conflict effect of US monetary policy on Egyptian economic indicators, and at the same time it should implement suitable policies coincide with it to achieve the economic stability and targeting inflation.

Heat stress caused adverse effects which induce oxidative stress and membrane disturbances in brain. Thus, we evaluated the brain oxidative stress induced by heat stress in rabbits with consequent changes in brain neurotransmitters (adrenaline, nor adrenaline and serotonin) and examined the potential protective role of capsaicin against the changes induced by heat stress. Forty eight growing APRI rabbits were used in this study and they were divided into four groups. Rabbits were received oral doses of capsaicin dissolved in 1ml of corn oil orally three times a week for 7 weeks by using stomach tube, doses were 0 (control), 10, 30 and 50 mg/kg body weight for the four groups respectively. The results indicated that heat stress induce oxidative stress in the brain leading to alterations in the neurochemistry of the brain tissue. On the other hand, heat stress significantly increased the content of lipid peroxidation and decreased the level of non-enzymatic antioxidants and activities of antioxidant enzymes; glutathione peroxidase, superoxide dismutase and catalase and capsaicin treatment significantly decreased the contents of lipid peroxidation and significantly increased glutathione and activities of antioxidant enzymes. Also brain neurotransmitters contents were decreased in control group while capsaicin increased these values in treated group. Conclusively, capsaicin administration can improve the antioxidant defense systems and brain function during summer season.

OBJECTIVE: To assess the incidence of hypoglycemia in people with type-2 diabetes mellitus (T2DM) on three or more anti-diabetic medications during Ramadan. STUDY DESIGN METHODS: We have studied people with T2DM on three or more glucose-lowering drugs during Ramadan of H1438 (May–June 2017). The dose of each drug was adjusted according to a pre-specified protocol. The incidence of symptomatic or blood glucose confirmed hypoglycemia was recorded during the study. RESULTS: We enrolled 228 people with T2DM; 181 completed the study, and data on hypoglycaemia was available in 172 subjects. There were 115 males and 66 females, (mean age ± SD) 53.6 ± 9.7 years, diabetes duration 10 ± 6 yrs. The incidence of hypoglycaemia was 16.3% (28/172). Univariable logistic regression analysis showed that the risk of hypoglycaemia was increased in Arab subjects compared to Qatari; in those with longer duration of diabetes; and in those on four or more anti-diabetic medications compared to those on three anti-diabetic medications. CONCLUSION: Despite the tailored advice, there is a high incidence of hypoglycemia in people with T2DM taking multiple glucose lowering therapies whilst fasting during Ramadan. Guidelines should address the increased complexity in anti-diabetic medications in patients who fast during Ramadan. Healthcare providers should individualize the modifications in anti-diabetic medications during Ramadan. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40200-018-0374-2) contains supplementary material, which is available to authorized users.

Background: Laparoscopicmini-gastric bypass (MGBP) is gaining popularity among the bariatric procedures today and laparoscopic sleeve gastrectomy (SG) as a single-stage procedure fort he treatment of morbid obesity is becoming increasingly popular. Patients and Method : Between October 2014 and July 2018, 100 obese patients were randomized, operated upon, and followed up for 24 months in Al Minia University Hospital. A total of 50 patients underwent SG, and 50 patients underwent MGBP. The mean BMI of all patients was 47.8±5.5kg/m 2 , their mean age was 30±8.3 years and 80% of them were female. Patients were followed up at 1, 3, 6, 9, 12,15,18,21 and 24 months. Results : Age, sex, BMI, and comorbidities were equal. The mean operative time for SG was 86.9 ± 51.6 min and that for MGBP was 108.4 ± 41.8 min; the percentage of 1-year excess weight loss was similar (76.2±4.49% for SG and 80.3±8.3% for MGBP). The comorbidities were significantly improved after both procedures, except for type 2 diabetes mellitus, which showed a higher resolution rate after MGBP. Conclusion : Laparoscopic SG regarding excess weight loss is comparable to laparoscopic MGBP in short-term follow-up (2 year) with less metabolic effect. Further long-term studies are needed.

Introduction Dengue virus (DENV) affects over half the world’s population in 112 countries, and dengue fever (DF) is the second largest arthropod borne infectious global hazard after malaria with complications like Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), accounting for significant morbidity and mortality world-over. Pakistan is significantly affected with DENV infection and to-date no study identifying risk factors associated with development of severe complications of DF has been done. Methods 997 confirmed cases of DF were collected from a tertiary care hospital in Lahore, Pakistan and their clinical and biochemical data were collected. Univariate, multivariate and logistics regression analysis was performed to identify risk factors associated with development of DHF and DSS. Results Bleeding OR 70.7 (CI 38.4–129.9), deranged liver function test OR 1.9 (CI 0.97–0.99), presence of urinary red blood cells OR 1.4 (95%CI 0.179–0.900) and presence of urinary protein OR 1.1 (95%CI 0.191–0.974) were related to development of DHF and DSS. Discussion Severe Dengue, like DHF and DSS can be predicted by the presence of clinical and biochemical factors like signs of bleeding, deranged liver function test, presence of urinary red blood cells and urinary protein; so that the patients at high risk for complication be identified early and started on treatment timely. Conclusion Predictors of severe dengue are identified in this study but further large scale multi-centered studies are needed for better interpretation.