Special Issue

BACKGROUND: Melasma is a common disorder of facial hyperpigmentation that is often resistant to treatment. OBJECTIVE: To evaluate the efficacy of trichloroacetic acid (TCA) peeling in comparison with double frequency Q-switched neodymium-doped:yttrium aluminum garnet (QS-Nd:YAG) laser in the treatment of melasma. PATIENTS AND METHODS: Sixty-five adult Egyptian female patients with melasma were enrolled in this study. Wood light was used for determination of the histological type of melasma. The patients were divided into 4 groups according to treatment modalities: peeling with different concentrations of TCA and double frequency QS-Nd:YAG laser. Trichloroacetic acid peeling was performed every 2 weeks up to 8 sessions, whereas laser treatment was performed every month up to 6 sessions. Melasma area and severity index (MASI) score was used before and after treatment for evaluation. RESULTS: Improvement percentage of MASI score was significantly higher among patients treated with TCA 25% (p .001). Epidermal type of melasma was significantly improved compared with the dermal type (p = .0029). Q-switched neodymium-doped:yttrium aluminum garnet laser showed the highest incidence of postinflammatory hyperpigmentation (53.3%). CONCLUSION: Trichloroacetic acid peeling is effective in the treatment of melasma, TCA 25% was the most effective concentration. Q-switched neodymium-doped:yttrium aluminum garnet laser is not recommended in the treatment of melasma because it was associated with the highest incidence of complications.

Background: This study aims to compare and evaluate the effect of adding ketamine as an adjunct to lidocaine for intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, the onset and recovery times of sensory and motor block, and tourniquet pain. Methods: Forty patients undergoing surgery of the hand or forearm under IVRA were randomly assigned to receive lidocaine 3 mg/kg (group 1) or lidocaine 3 mg/kg plus ketamine 50 mg (group 2) diluted to 40 mL with normal saline. Assessment parameters included the onset and recovery times of sensory and motor block, tourniquet pain, intraoperative hemodynamics, surgeon and patient satisfaction, postoperative pain, time of first analgesic request, total analgesic consumption, and adverse effects in the first 24 hours postoperatively. Results: Groups 1 and 2 were comparable in demographic and surgical parameters. There were no differences between groups in intraoperative hemodynamics, onset and recovery times of sensory and motor block, or surgeon satisfaction index. Compared with group 1, group 2 patients showed less tourniquet pain, prolonged time to first request for postoperative rescue analgesia (5.5 ± 1.3 vs 20.4 ± 3.7 hours, P 0.001), lower postoperative diclofenac consumption (120.00 ± 45.23 vs 55.1 ± 0.00 mg, P 0.001), lower scores for postoperative pain as measured by the Verbal Rating Scale, higher patient satisfaction index, and a nonsignificant difference in the incidence of postoperative adverse effects between groups. Conclusions: The addition of ketamine to lidocaine in patients receiving IVRA significantly reduced intraoperative and postoperative analgesic requirements and improved patient satisfaction without causing significant adverse effects. (Reg Anesth Pain Med 2014;39: 418–422)

Background: This study aims to compare and evaluate the effect of adding ketamine as an adjunct to lidocaine for intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, the onset and recovery times of sensory and motor block, and tourniquet pain. Methods: Forty patients undergoing surgery of the hand or forearm under IVRA were randomly assigned to receive lidocaine 3 mg/kg (group 1) or lidocaine 3 mg/kg plus ketamine 50 mg (group 2) diluted to 40 mL with normal saline. Assessment parameters included the onset and recovery times of sensory and motor block, tourniquet pain, intraoperative hemodynamics, surgeon and patient satisfaction, postoperative pain, time of first analgesic request, total analgesic consumption, and adverse effects in the first 24 hours postoperatively. Results: Groups 1 and 2 were comparable in demographic and surgical parameters. There were no differences between groups in intraoperative hemodynamics, onset and recovery times of sensory and motor block, or surgeon satisfaction index. Compared with group 1, group 2 patients showed less tourniquet pain, prolonged time to first request for postoperative rescue analgesia (5.5 ± 1.3 vs 20.4 ± 3.7 hours, P 0.001), lower postoperative diclofenac consumption (120.00 ± 45.23 vs 55.1 ± 0.00 mg, P 0.001), lower scores for postoperative pain as measured by the Verbal Rating Scale, higher patient satisfaction index, and a nonsignificant difference in the incidence of postoperative adverse effects between groups. Conclusions: The addition of ketamine to lidocaine in patients receiving IVRA significantly reduced intraoperative and postoperative analgesic requirements and improved patient satisfaction without causing significant adverse effects. (Reg Anesth Pain Med 2014;39: 418–422)

الفاصل الأسمنتى للعظم الحمل بالمضاد الحيوى هو الإستخدام الأمثل لحالات الإلتهاب الصديدى لمفصل الحوض سواء كان كامل أو نصفى. فى هذه الدراسة تم تطبيق هذه الفكرة بطريقة جديدة وممتازة فى حالات إلتهاب العظام الطويلة مثل الفخذ والساق. مابين يونيو2012 وسبتمبر 2013 تم تطبيق الفكرة فى (5) حالات إلتهاب صديدية ، (8) حالات للكسور المفتوحة باجمالى 13 حالة. تم تنظيف الجروح بطريقة دقيقة وازالة العظم الملوث ، وسد الفجوة الناتجة عن ذلك بواسطة الفاصل الأسمنتى المحمل بالمضاد بعد تقويته بدبوس شتايمن مع مراعاة طول الفاصل عن طريق سرنجة متدرجة ثم وضع الأسمنت مع الدبوس. تترك هذه الفاصلة الأسمنتية لمدة ستة أسابيع مع إعطاء مضاد حيوى استنادا لنتائج المزرعة الصديدية. يتم عمل سرعة ترسيب والبروتين الحساس "س" بعد إيقاف المضادات الحيوية لمدة أسبوع. فى حالة الشفاء يتم التعامل مع الفجوة حسب طولها ومقدارها.

إضافة الميتفورمين إلى الكلوميد يحسن نتائج الحمل ومعايير مقاومة الأنسولين في مرضى متلازمة تكيسات المبيض المصاحبة لمرضى الشواك الأسود.

إضافة الميتفورمين إلى الكلوميد يحسن نتائج الحمل ومعايير مقاومة الأنسولين في مرضى متلازمة تكيسات المبيض المصاحبة لمرضى الشواك الأسود.

إضافة الميتفورمين إلى الكلوميد يحسن نتائج الحمل ومعايير مقاومة الأنسولين في مرضى متلازمة تكيسات المبيض المصاحبة لمرضى الشواك الأسود.

To assess the risk factors of developing female sexual dysfunction (FSD) among women with diabetes mellitus (DM). Material and methods: This study included 100 sexually active diabetic women and age matched 100 healthy women served as control. All participants underwent full history taking, general and genital examination and glycated hemoglobin (HbA1c) level. Sexual function was evaluated by the Arabic version of the Female Sexual Function Index (FSFI). Results: FSFI score was significantly lower in patients (25.39 ± 3.25) compared to control (28.84 ± 4.26) (P=0.000). There was a significant negative correlation between FSFI score and HA1c (P=0.016, r=-0.239). HA1c level was negatively correlated to arousal (P=0.000, r=-0.383) and lubrication (P=0.05, r=-0.197). As regards the type of DM, FSFI full score was significantly lower in patients with type II DM (25.02 ± 3.21) compared to type I DM (26.51 ±3.19) (P=0.047). Desire domain score in type II DM patients (3.50 ± 0.61) was significantly lower than type I DM patients (3.96 ± 0.57) (P=0.001). Similarly, arousal domain score was significantly lower in type II group (4.01 ± 0.84) compared to type I group (4.48 ± 0.76) (P=0.016). On the contrary, no significant correlation was detected between FSFI score and age (P=0.813, r=-0.024), duration of DM (P=0.808, r=0.025), waist circumference (P=0.292, r=-0.106) and Body Mass Index (P=0.292, r=-0.106). As regards DM complications, patients with nephropathy or retinopathy had lower FSFI score compared to those without (P=0.008, P=0.042 respectively). Moreover, patients with associated hypertension showed lower FSFI compared to those without hypertension (P=0.014). Conclusion: Poor glycemic control in diabetic women is a risk factor for developing FSD. Type II DM seems to have a greater negative impact on female sexual function than type I DM. Patients with diabetic nephropathy or retinopathy are at risk of developing FSD. Hypertension is a risk factor for FSD in diabetic women.