Background: General anesthesia is the typical anesthetic technique for laparoscopic intervention, however, the use of regional anesthesia in the laparoscopic field started to gain familiarity. Shoulder tip pain is a major intraoperative concern that may hinder the feasibility of laparoscopic interventions under spinal anesthesia.

Aim of the study: To evaluate the effect of the intrathecal addition of dexamethasone versus fentanyl on the severity of intraoperative shoulder tip pain during gynecologic laparoscopic surgeries.

 Methods: This RCT included 120 patients, randomized into three equal groups (Group D: received 15 mg bupivacaine and 8 mg dexamethasone intrathecally, Group F: received 15 mg bupivacaine and 25 µg fentanyle intrathecally and Group C: received 15 mg bupivacaine and normal saline intrathecally.

 Results: Significantly fewer patients experienced intraoperative shoulder tip pain in Groups F (n=17) and D (n=19) compared with Group C (n=30), P < 0.005, with no statistical difference detected between Groups D and C. Only two patients in both Groups D and F experienced moderate pain intensity versus eight patients in Group C, P = 0.011. The incidence of postspinal shivering was lower in Groups D and F in comparison to Group C; P = 0.002.

Conclusion:

The use of dexamethasone or fentanyle intrathecally may reduce the incidence and severity of shoulder tip pain during laparoscopic ovarian cystectomy under spinal anesthesia.

Keywords: Dexamethasone, Laparoscopy, Fentanyl, Shoulder Tip Pain, Spinal Anesthesia.

A prevalent increase in antimicrobial resistance represents a universal obstacle for the treatment of Staphylococcus aureus (S. aureus) infection, especially in critically ill patients. Silver nanoparticles are defined as  broad spectrum bactericidal agents, which might be effective against vancomycin resistant S. aureus (VRSA). In this study, we  examined the bactericidal efficacy of silver nanoparticles on VRSA  in 150 blood and sputum samples isolated from intensive care patients. Methicillin resistant  S. aureus (MRSA) isolates were identified in 83 samples, with an incidence of 55.3%.  Meanwhile, VRSA isolates were found in 11 and 8 isolates (a total of 19 isolates out of 150) from sputum and blood samples, with an incidence of 14.67% and 10.67% respectively, with a total incidence of 12.67%. Vancomycin intermediate S. aureus (VISA) isolates had an inhibitory zone ranging from 9 to 13 mm, which was found in 13 out of 19 isolates, whereas VRSA isolates had an inhibitory zone ranging from 0 to 6 mm, which was detected  in 6 out of 19 isolates.  The findings of this study confirm that silver nanoparticles are effective treatment against VRSA.

Keywords: nanoparticles; vancomycin resistance; S. aureus.

Background: A bilateral superficial cervical plexus block provides good analgesia for neck surgery, including thyroidectomy. However, the duration of a single shot nerve block is usually short. Therefore, adjuvants are used in peripheral nerve blocks, especially with ambulatory surgery, where the analgesia duration is very important.

Methods: Sixty patients scheduled for thyroidectomy were randomly assigned to one of two groups. Group C received general anesthesia and a bilateral intermediate cervical plexus block with isobaric 10 ml bupivacaine 2% + 2ml NS deposited on each side. Group D received general anesthesia and bilateral intermediate cervical plexus block with 10 ml isobaric bupivacaine 2% + 4mg (2ml) dexamethasone deposited on each side. Primary outcome was postoperative analgesia evaluated by the VAS score. Secondary outcomes were perioperative IL6, blood glucose level, and postoperative nausea and vomiting.

Results: Postoperative pain VAS scores were significantly lower in the dexamethasone group than control group; mean VAS score at 6h postoperatively was 0.4 in Group D vs. 1.8 in Group C; P <0.001, at 8h it was 0.4 vs. 2.6; P <0.001 in Group D and C, respectively, and in 24h it was 3.5 in Group D vs. 5 in Group C; P 0.003.  Analgesia duration was significantly longer in the dexamethasone group: 12h versus 6 h in the control group; P<0.001. Postoperative IL-6 at 8 and 24 hours postoperatively were significantly lower in the dexamethasone group than the control group (36.8 vs 21; P <0.001) and (18.9 vs 13; P<0.001), respectively. Non-significant changes could be detected between both groups in intraoperative bleeding and postoperative glycemic control.

Conclusion: The addition of 8 mg dexamethasone to ultrasound-guided intermediate cervical plexus block can enhance analgesia duration and reduce postoperative opioid consumption and postoperative IL-6 levels with no significant effect on postoperative glycemic control in non-diabetic patients undergoing thyroidectomy under general anesthesia.

Keywords: ultrasound-guided cervical plexus block, perineural dexamethasone, thyroidectomy.

Background: shoulder pain secondary to laparoscopic interventions may cause more discomfort to the patient than the incision site pain, with a reported incidence varies from 35% to 80%.

Aim of the study: - Evaluate the effect of intrathecal dexmedetomidine on incidence and severity of  laparoscopy-triggered shoulder tip pain.

 Methods: Sixty patients, 1st patient recruited on the 1st of July 2017, undergoing elective laparoscopic ovarian cystectomy under spinal anesthesia were randomly allocated into one of two groups. Group C: received intrathecal hyperbaric Bupivacaine 3.5 ml plus 0.5 ml normal saline. Group D: received intrathecal hyperbaric Bupivacaine 3.5 ml plus 10 μg dexmedetomidine (0.5 ml). Measurements: Data on the severity of intraoperative shoulder pain was collected using visual analogue scale.

 Results: Twenty-four patients in Group C, the complaint of intraoperative shoulder tip pain, 16 patients (53.3%) required fentanyl which was given in 25 μg increments and total fentanyl consumption for 16 patients was 875 μg. Two patients were converted into general anaesthesia as pain was intolerable (≥ 4). In Group D, five patients (16.7%) experienced shoulder pain intraoperative with a mean VAS score 0.37± 0.9.

Conclusion: intrathecal dexmedetomidine can effectively decrease the incidence and severity of shoulder tip pain during laparoscopic ovarian cystectomy under spinal anesthesia.

Keywords: Dexmedetomidine, Laparoscopy, Spinal anesthesia, shoulder tip pain.

A 35 years old man present with a skin lesion on his glans complaining of mild irritation. The condition began 3 years ago, he took wrong medication as he was diagnosed as psoriasis, mostly because the disease in it the beginning is very similar and could trick the dermatologist. He was diagnosed by the biopsy taken,Pseudo-epitheliomatous hyperkeratotic and micaceous balanitis. 5-Flouracil was given in combination with oral Acitretin, Dramatic improvement occurred in both the skin lesion and the symptoms associated.

Background: Amantadine sulfate is both a dopamine agonist and N-methyle-D-Aspartate (NMDA) antagonist which can augment the levels of dopamine in the striate body by triggering dopamine release and inhibiting dopamine reuptake. This study evaluated the effects of amantadine sulfate as a dopamine agonist on intraoperative wake up test duration and as a NMDA antagonist on cumulative opioid consumption 48h after surgery.

Methods: A randomized controlled double blind study, where 60 ASA class I and/or II patients of both sexes, planned for spine deformity corrective surgery were enrolled and divided into two groups (30 patients each):  Group A received intravenous (IV) amantadine sulfate infusion (200 mg), and Group B received Ringer’s lactate IV infusion.

Results: Forty-eight hours after surgery, morphine consumption in group A was significantly lower than that in Group B (21.24 ±1.1 vs. 30.41±2.12 P <0.001). Dynamic visual analog scale score was lower group A than that in group B (0.8±0.71 vs. 2.7±0.84 P <0.001). Moreover, anesthetic consumption in group A was lower than that in group B; however, no statistical difference in wake-up test duration or recovery time from anesthesia was found between both groups.

Conclusions: Preoperative administration of amantadine sulfate decreases postoperative morphine consumption and dynamic VAS score in patients undergoing corrective spine surgery. However, despite being a dopamine agonist, amantadine has no effect on wake- up test duration.

Keywords:  amantadine sulfate, dopaminergic pathway, dopamine induced arousal, opioid consumption, wake up test. 

Background: Nicotine, the main ingredient in tobacco smoke, has always been linked to degenerative
changes to the nervous system and several areas in the brain were reported to be injured due to nicotine.
The effect of nicotine on the auditory system is only being recognized recently with few studies assessed the
morphology. The effect of nicotine on the primary auditory cortex of young adolescent animals was
addressed in this study. Materials & Methods: Twenty young male guinea pigs of two months old were
divided into two groups of 10 animals each. Group I, the control group, received daily subcutaneous
injections of normal saline for one month. Group II, the nicotine-treated group, received 3 mg/Kg body
weight of nicotine subcutaneously daily. After animal sacrifice, brains were removed and processed for light
and electron microscopic evaluations. Morphometry was also done to light microscopic histological sections.
Results: In the nicotine-treated group, there were degenerative changes affecting the neurons, glia as well
as blood capillaries. There was a darkening of neurons and disruption of their dendrites and organelles. The
glial cells revealed reactivity, swelling, and cytoplasmic disruption. Blood capillaries showed collapse and
thickening of their basement membrane. Morphometry revealed a decrease in the thickness of auditory
cortex as well as an increase in the number of dark neurons in the treated group versus the control.
Conclusion: Nicotine administration to adolescent male guinea pigs resulted in degenerative changes
affecting the auditory cortex of the brain, which emphasizes the hazardous effects of cigarette smoking,
especially at a young age.

Introduction: Visual and hearing impairment compromise the basic modes of communication leading to social isolation and impaired cognitive and general functions. Inconsistent results regarding the co-existence of eye and ear pathologies have been found .
Objectives: The aim of this study is to assess audio-vestibular functions in patients with open angle glaucoma (OAG( .
Patients and Methods: Fifty patients with OAG and 20 age and sex-matched healthy controls were included. Pure tone audiometry, immitencemetry, distortion product otoacoustic emission (DPOAEs), auditory brainstem response (ABR), and electronystagmography (ENG) were done and compared between the two groups.
Results: Compared to the control group, patients with OAG had significantly elevated pure tone audiometric thresholds at all audiometric frequencies (P between 0.003 to 0.001), sensory neural hearing loss (SNHL) in 86% of the patients, lower amplitude of the DPOAEs at all tested frequencies, prolonged waves I, III and V in ABR and abnormal caloric test in 22% of the patients.
Conclusions: The present study confirmed the association between SNHL and OAG. The results of PTA, DPOAEs and caloric tests suggesting that the cochlea is most probably the main site of pathology in patients with OAG.
Key words: Open angle glaucoma, Sensory neural hearing loss.

Background: Epilepsy is a chronic medical disease and is associated
with comorbid adverse somatic conditions due to
epilepsy itself or its long-term treatment. Objectives: This
study evaluated cochlear function in patients with idiopathic
epilepsy and treated with carbamazepine (CBZ). Patients
and Methods: Included were 47 patients (mean age = 34.56
± 7.11 years and duration of illness = 17.84 ± 7.21 years) and
40 healthy subjects. They underwent pure-tone audiometry
and transient evoked otoacoustic emission (TEOAE) analyses.
Results: Hearing loss (mainly bilateral mild) was reported
in one third of patients. Compared to controls, patients
had lower TEOAE amplitudes at 1.0–4.0 kHz particularly at
high frequencies (3 and 4 kHz). Significant correlations were
identified between TEOAE amplitudes with CBZ dose (at
3 kHz: r = –0.554, p = 0.008; at 4 kHz: r = –0.347, p = 0.01), its
serum level (at 4 kHz: r = –0.280, p = 0.045) and duration of
treatment (at 3 kHz: r = –0.392, p = 0.008; at 4 kHz: r = –0.542,
p = 0.001). Conclusions: Long-term CBZ treatment may result
in cochlear dysfunction and auditory deficits.