Introduction: Concomitant cranial and facial injuries carry the significant potential for mortality and neurological morbidity mainly in young adults. Object: evaluation of the early versus delayed management of these combined craniofacial fractures Methods: Fifty-five patients ranging in age from 5 to 62 years with combined craniofacial fractures were included. Data regarding age, gender, aetiology, pattern of injuries, anatomic site and pattern of facial fractures, associated cranial injuries and systemic injuries, treatment details and complications were analyzed. Conservative treatment was indicated in 7 patients while the remaining 48 patients underwent surgical intervention and classified into two groups: group 1:35 patients received early (less than two weeks) one-step surgical treatment of their fractures and group II: 13 patients received late surgery (more than 2 weeks after the trauma). Results Majority of patients had mild head injury and managed conservatively. Regarding the intracranial procedures: elevation of depressed fractures with dural repair was needed in 39 patients; primary dural closure was done in 31 patients, while 8 patients needed pericranial graft. Evacuation of intracranial hematomas was performed in 8 patients. Maxillofacial procedures consisted of exenteration of the sinus in 33 patients, cranialization of the sinuses in 5 patients. The nasofrontal duct was identified and packed with muscle grafts in 36 patients. In 9 patients there was a large bone defect which repaired by bone grafts. In 39 patients bone fragments and/or bone grafts were fixed by miniplates only or by miniplates and wires. Conclusion: early single-stage repair of complex craniofacial injuries can be performed with an acceptable rate of morbidity and mortality. Many advantages are reported for the early surgical repair such as prevention of infection, better cosmetic and functional results and reduce hospital stay.

Objective: This study was designed to evaluate the effect of positive end-expiratory pressure (PEEP) and Alveolar recruitment maneuver (ARM) used to improve gas exchange during anesthesia in laparoscopic bariatric surgery on cardiac output parameters using non-invasive thoracic electrical bioimpedance. Study Design: A randomized controlled study was con-ducted on 30 morbidly obese patients (ASA I and II), with BMI >40kg.m2, scheduled for laparoscopic bariatric surgery were included the study. Setting: International Medical Center (IMC) Hospital, OR department, Bariatric surgery unit, Jeddah, K.S.A. Interventions: Patients were classified into two groups after induction of anesthesia (15 in each): Group I: PEEP was maintained at 10cm H20 prior to peritoneum insufflation with CO2 until the end of the surgery. Group II: The first set of Lung recruitment was achieved prior to insufflation of peri-toneum with CO2, by sequential increases in PEEP in three steps from 0 to 20 cm H20. The maneuver was repeated ten minutes after insufflation of peritoneum and lastly the maneu-ver was done after abdominal deflation. Measurement: Stroke volume index (SVI), cardiac index (CI), and ejection fraction (EF), using non-invasive thoracic electrical bioimpedance, together with heart rate (HR) and mean arterial blood pressure (MAP) were measured in both groups, at three points: To: Prior to, applying PEEP in group I and before starting the first set of Lung recruitment in group II. Ti: 10 minutes after applying PEEP in group I and after starting the first set of Lung recruitment in group II. T2: 10 minutes after abdominal deflation in group I and group II. Results: The patients were comparable regarding their age and BMI. HR was significantly increase in group I and group II at Ti when compared toTo (p=0.01). MBP showed significant decrease at T1 inside group I (p=0.04) and group II (p=0.01) when compared to To. At T2 there were insignif- icant changes in HR and MBP values in both groups (p>0.05). Correspondence to: Dr. Abdelrady S. Ibrahim, The Department of Anesthesia, Faculty of Medicine, Assiut University SVI and CI showed significant decrease in group I, at Ti and T2 when compared to To, (p0.05). In group II, SVI and CI values were decreased significantly at Ti (p0.05) and de-creased insignificantly at T2 (p>0.05) when compared to To. EF was statistically insignificant when compared Ti and T2 to To inside each group (p>0.05). In comparison between group I and group II the mean values of HR, MBP, SVI, CI and EF showed insignificant differences at To, Ti and T2. Conclusions: The use of PEEP or alveolar recruitment maneuver to improve arterial oxygenation during laparoscopic bariatric surgery in morbidly obese patients was associated with intraoperative negative hemodynamic changes.

SUMMARY Background: The aim of this study was to compare the analgesic efficacy and side effects of preservative free ketamine either alone or in combination with bupivacaine for caudal blockade in pediatric surgery. Methods: After the induction of standardized general anesthesia without premedication sixty children, were allocated randomly into 3 groups to receive single shot caudal blockade by bupivacaine 0.125% 1 ml/kg (group B, n= 20), S- ketamine (preservative free) 1 mg/kg (group K, n= 20), or a mixture of bupivacaine 0.125% ...

Abstract: Obesity is one of the greatest public health challenges of the 21st century (WHO, 2010a). University students constitute a specific community (Krzyszycha et al., 2008) and leaving home is a time when changes in dietary intake are likely (Edwards and Meiselman, 2003). Aim of this study: The aim of this study was to determine the prevalence of obesity and overweight and its determents among those students. Methodology: The present study was cross sectional conducted among 567 undergraduate girl students chosen randomly of Assiut University dormitory in Upper Egypt. Data were collected with self-administrated questionnaires and weight & height were assessed. Results: The obesity and overweight prevalence were 13.1% and 30.3% respectively in contrast to a negligible underweight percentage, Obesity and overweight were significantly associated with some variables like age, dormitories residence duration, balanced diet concept, number of meals eaten per day, some of eating habits in different situations, maternal obesity, sleeping hours per night and physical exercise. Conclusion: dormitories female students are special important group of university students and their residence durations and circumstances they live have effect on their weight status. Recommendations: we recommend provision of nutritional consultant to dormitories female students, more clarification of students' knowledge about balanced diet concept& correcting the false concept of missing meals to lose extra weight, provision of more psychosocial support to those students by the dormitory supervisors, and encouragement of physical activity in the dormitory.