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

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.

Objective: To explore the effect of diluting tranexamic acid as 1000 mg versus epinephrine as 1 mg in a
volume of 200 mL of normal saline used for local washing and rinsing of the used gauze at the surgical
bleeding sites during microscopic ear surgeries.
Methods: In a randomised, double-blind trial, sixty patients scheduled for elective microscopic
exploratory tympanotomy consented to participate after meeting the inclusion criteria. Patients
assigned using the balanced block randomisation method into two similar groups; one received
tranexamic acid (TXA), and the other received epinephrine. The outcome of the study focused on blood
pressure, heart rate, quality of surgical field assessed via Boezaart score, the volume of bleeding, and the
incidence of complications.
Results: The more prominent findings were the statistically significant and favourable surgical field
assessment according to the Boezaart score, and lower estimates of bleeding demonstrated in the TXA
group compared to the epinephrine group, along the time of the study P-value was < 0.05. The
haemodynamic monitoring showed promising changes in the TXA group compared with the epinephrine
group in terms of lower mean blood pressure and lower heart rate that reached the level of statistical
significance during the time of the study.
Conclusion: the use of topical tranexamic acid during microscopic ear surgeries is associated with a better
surgical field, less bleeding, and favourable haemodynamic parameters compared to epinephrine.

Background & Objectives: comparing the effect of adding dexamethasone and magnesium sulfate to bupivacaine in ultrasound guided supraclavicular brachial plexus blockade. The primary endpoints were the onset of sensory and motor block and quality of analgesia and the secondery end points were duration of analgesia and motor block.

Materials & Methods: Ninety patients scheduled for elective surgeries on the upper limb under ultrasound guided supraclavicular brachial approach. patients were randomly allocated using a standard randomization code, in a double blinded manner, into three groups; group one (n=30) received 20 ml 0.5% plain bupivacaine, group two (n=30) received 18 ml bupivacaine 0.5% + 2 ml (8mg) dexamethasone, group three (n=30) received 18 ml bupivacaine 0.5% + 200 mg magnesium sulfate.

The following parameters were studied: Onset of sensory block, onset of Motor blockade, haemodynamic and respiratory data, Analgesia time,and Duration of motor and sesory blocks

Results: There was no significant difference in the demographic data and surgical characteristics in the three groups. The sensory block onset time in minutes was earlier in group 2 (dexamethasone) as compared to group 1 and 3; 8.20±2.09 versus 16±3.48 (P< 0.05) and 8.20±2.09 versus 12.70 ± 2.92(P< 0.05) respectively, also the sensory block onset was earlier in group 3 (magnesium) than group 1 (control) 12.70 ± 2.92 versus 16±3.48 (P< 0.05). Also onset of motor blockade in minutes was earlier in group 2 than in group 1 and 3; 1.50 ± 2.09 versus 13.10 ± 3.34 (p< 0.05) and 12.75 ± 3.43 respectively, while the difference in motor block onset was clinically insignificant between group 1 and 3(P> 0.05). As regard duration of analgesia in minutes it was significantly longer in group 2 than group 1 and 3 1104.00 ± 289.16 versus 313.50 ± 103.68 and 558.00 ± 48.08 respectively, also analgesia duration was significantly prolonged in group 3 than group 1(P< 0.05). the motor power was significantly prolonged for group 2 than group 1 and 3; 563.00 ± 69.29 versus 136.50 ± 28.34 and 214.50 ± 36.92 respectively, and also the motor power return was delayed in group 3 than group 1(P< 0.05).

Conclusion: both of them proved to prolong the duration of block and the analgesia time, both of them fasten the sensory block onset time, but dexamethasone is significantly more effective in prolonging the analgesia duration and the block duration. dexamethasone shorten the motor block onset time while magnesium does not enhance the motor block onset time.

Objectives

The aims of the study were to explore the contraceptive practices of married adolescent girls in rural Upper Egypt and identify the determinants of their ever use of modern contraception.

Methods

The study was a household survey of 729 married adolescent girls in 23 villages of two governorates in Upper Egypt. Listing and enumeration of all households in the selected villages were performed prior to data collection, to recruit married adolescent girls below 20 years of age. The girls were interviewed using a structured questionnaire.

Results

Only 6% of married adolescent girls were using a modern contraceptive method; 10.6% had ever used a modern contraceptive method, mostly a short-acting method. Considerable proportions of participants believed that using contraception would reduce a woman’s fertility and that women should not delay their first pregnancy (34% and 54.3%, respectively); only 50.2% believed that contraception could be used for birth spacing. Predictors of the ever use of a modern method of contraception among married adolescent girls were: accepting that contraception could be used for birth spacing (B = 1.82, p < .001), older age (B = 0.42, p < .01), better reproductive health knowledge (B = 0.23, p < .05) and sharing in contraceptive decision making (B = 0.55, p < .05).

Conclusion

Married adolescent girls' current use and ever use of modern contraception were very low in rural Upper Egypt. Changing the social norms to create the desire to delay first childbirth, improving adolescent girls' reproductive health knowledge, correcting myths about contraception and building girls' agency to use contraception may increase their contraceptive use.

Introduction
Bipolar disorder (BD) is a serious and chronic mental illness that may result in disability. We evaluated effect of the duration of untreated of bipolar (DUB) (manic episodes) on clinical outcomes, including episode severity, residual symptoms, duration of hospitalization, and suicide attempts, and on socioeconomic status of patients.

Methods
A total of 216 participants who had bipolar I disorder (manic state) recruited from November 2017–December 2019 from an inpatient psychiatric unit. Patients divided into 2 groups based on DUB: Group A, with DUB < 4 months; and Group B, with DUB ≥4 months. All participants had evaluation for demographic and clinical features, Socioeconomic scale, Young mania rating scale (YMRS) at admission and discharge.

Results
Group A participants were more often male, urban residents, married, literate and educated, professionally employed. Group A had a younger age of onset, less duration of illness, less frequency of episode, less suicide attempts, less duration in hospital, high mean of socioeconomic, lower mean of YMRS at admission and discharge in compared to Group B.

Conclusion
A longer DUB (manic episodes)was associated with negative clinical outcomes (more frequent episode, more symptoms severity, longer hospital admission, more suicide severity, more residual symptoms) and low socioeconomic state of patients with BDI (manic episodes).

Objective
Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder caused by structural and functional brain abnormalities as well as genetic and environmental factors. ADHD symptoms are commonly observed in individuals with epilepsy. A few studies have reported a pattern of behavioral problems in children with combined epilepsy and ADHD. We aimed to evaluate comorbid behavioral problems and mental health concerns among children with epilepsy with ADHD and without ADHD including autism spectrum disorder, anxiety, depression, somatic problems, oppositional defiant disorder, and conduct disorder.

Methods
A total of 100 children aged between 6 and 11 years were recruited and categorized into 1 of 5 groups (20 child/group): (1) epilepsy, (2) epilepsy with ADHD, (3) ADHD with electroencephalogram (EEG) changes, (4) ADHD without EEG changes, and (5) healthy control. The scales used in our study included the Childhood Autism Spectrum Test (CAST) to screen autism spectrum conditions and related social and communication conditions, Conners’ Parent Rating Scale (CPRS) to assess ADHD and other comorbid behavioral and social-emotional difficulties, and Children Behavior Checklist (CBCL) to evaluate behavior problems.

Results
The CAST scale score showed no significant difference among the studied groups. Regarding the Conners-3 scale, the combined type of ADHD was predominant in the ADHD with EEG changes group and the ADHD with epilepsy group, while hyperactive ADHD was predominant in the ADHD without EEG changes group. The ADHD with EEG changes group and the ADHD with epilepsy group had equally high clinical rating scores for CBCL in internalizing and externalizing problems. There was a significant difference in the profile of all Diagnostic and Statistical Manual of Mental Disorders (DSM-5) scales of CBCL among the studied groups.

Conclusion
This is the first study to use EEG in patients with ADHD in comparison with epilepsy. ADHD with epilepsy is closely related to ADHD with EEG changes regarding psychiatric comorbidity in terms of anxiety, depression, somatic problems, oppositional defiance problems, and conduct problems.

COVID-19 is a severe respiratory disease caused by the newly identified human coronavirus (HCoV) Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The virus was discovered in December 2019, and in March 2020, the disease was declared a global pandemic by the World Health Organization (WHO) due to a high number of cases. Although SARS-CoV-2 primarily affects the respiratory system, several studies have reported neurological complications in COVID-19 patients. Headache, dizziness, loss of taste and smell, encephalitis, encephalopathy, and cerebrovascular diseases are the most common neurological complications that are associated with COVID-19. In addition, seizures, neuromuscular junctions’ disorders, and Guillain–Barré syndrome were reported as complications of COVID-19, as well as neurodegenerative and demyelinating disorders. However, the management of these conditions remains a challenge. In this review, we discuss the prevalence, pathogenesis, and mechanisms of these neurological sequelae that are secondary to SARS-CoV2 infection. We aim to update neurologists and healthcare workers on the possible neurological complications associated with COVID-19 and the management of these disease conditions

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries (P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.