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: 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 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 study 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. Group C: received 15 mg bupivacaine and normal saline intrathecally.

 Results: Significantly fewer patients experienced intraoperative shoulder pain in Group F (17) and Group D (19)  than Group C (30); P = 0.006,  with no statistical difference detected between Group D and C. Only two patients in both Groups D and F experienced moderate pain intensity versus 8 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:

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

Keywords:dexamethasone, laparoscopy, fentanyl, shoulder pain, spinal anesthesia.

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.

Background

Intra-arterial chemotherapy has shown promising results and improved the prognosis of retinoblastoma in the developed countries. Here, we aim to report our initial experience, in Egypt, in the treatment of all stages of naïve retinoblastoma with ophthalmic artery chemosurgery (OAC), using melphalan.

Results

The technique was successful in 23 out of 26 eyes. Overall, a total of 63 treatment sessions were performed. Ophthalmic artery catheterization was performed in 59 treatment sessions, whereas middle meningeal artery catheterization was performed in 4 treatment sessions. Adequate tumor control was achieved in 95.6%. Progression has developed in one eye after the third OAC session. The mean follow-up period was 18.5 months. Recurrence of the main tumor as well as vitreous and subretinal seeds was reported in one eye after 19-month duration. A globe salvage rate of 91.3% was attained. No metastasis was recorded, and all patients were alive within the stated follow-up period.

Conclusion

A high globe salvage rate along with metastasis free survival and mild complications were achieved. Therefore, our initial experience with OAC in primary retinoblastoma proved to be safe and effective.

Background

Retinoblastoma is the most common pediatric intraocular neoplasm. It remains a significant health problem, particularly in the developing countries [1]. For both unilateral and bilateral diseases, enucleation used to be the main treatment strategy to cure patients and maintain their survival [2]. Yet, this was at the expense of the globe and vision salvage. In more advanced stages, external beam radiation was the alternative treatment procedure that provided globe salvage [3]. This was, however, associated with a high rate of second cancer which, in most cases, might have been more fatal than the retinoblastoma [4]. Therefore, systemic intravenous chemotherapy was proposed to reduce the harmful effect of radiotherapy [5] and was frequently used in combination with other focal therapies such as laser or cryotherapy. Some major systemic complications, however, were associated with systemic chemotherapy such as acute myeloid leukemia and neutropenia [6]. Intra-arterial chemotherapy through the carotid artery was introduced early to save the globe and to minimize the radiation exposure and the systemic side effects [7]. The regimen has been modified afterward, to include selective ophthalmic artery infusion chemotherapy, which has been developed by the Japanese [8, 9]. Eventually, the super-selective ophthalmic artery chemotherapy, which is also known as ophthalmic artery chemosurgery (OAC), has introduced by Abramson et al. [10].

The use of OAC has been increased, gradually, to be the first choice of retinoblastoma treatment in the developed countries. Consequently, the enucleation rate has been reduced from 95 to about 10% [11] with the estimated survival rate of retinoblastoma exceeds 95% in the developed countries [12]. OAC was implemented, however, in a small percent of low- and middle-income countries [1]. Thus, the enucleation rate, in such regions, remains high and ranges from 50 to 87.6%, with estimated survival rate of retinoblastoma reaches about 60% in Asia and about 30% in Africa [12].

Here, we introduce our OAC experience in Egypt. Namely, we report our 3 years initial experience for the treatment of early and advanced naive retinoblastoma with OAC, in two major referral centers in Egypt.

Background and Aim: Aspergillus fumigatus is a zoonotic fungus that causes several diseases in humans ranging from
allergic reaction to fatal disseminated invasive infection, especially in immunocompromised patients. This study aimed to
investigate the incidence of invasive A. fumigatus in patients admitted to the intensive care unit (ICU) of Assiut University
Hospital, highlight the factors associated with their infection, and determine the antifungal effect of thyme nano-emulsions
(TNE) and carvacrol nano-emulsions (CNE) on isolated A. fumigatus strains.
Materials and Methods: Mycological culture method and scanning electron microscopy (SEM) were used in the
identification of A. fumigatus in 630 blood samples collected from 210 patients. TNE and CNE at five concentrations (1%,
2%, 4%, 6%, and 8%) and average sizes of 90.3 and 75.6 nm, respectively, were characterized by transmission electron
microscopy. Their effect on A. fumigatus isolate growth was evaluated by the well-diffusion method and SEM, which was
used for the detection of the degenerative effect of A. fumigatus ultrastructure.
Results: A. fumigatus was detected in 54 of 210 (25.7%) patients in the ICU. Advanced age and chronic diseases were
considered important risk factors for invasive aspergillosis, especially in patients with more than 1 clinical disease. TNE
and CNE showed an inhibitory effect on A. fumigatus isolates, which significantly increased with high concentrations. The
respective values for TNE at concentrations of 6% and 8% were 6±0.41 mm and 15±0.67 mm. CNE completely inhibited
A. fumigatus growth at concentrations of 4%, 6%, and 8%, while mean inhibition zones of 22±0.68 mm and 30±0.32 mm
appeared at concentrations of 1% and 2%. SEM demonstrated degenerative changes in A. fumiga tus structure.
Conclusion: TNE and CNE can be used in bioactive treatments against A. fumigatus, and additional studies are required to
determine the safe and effective doses and best method for application in human and veterinary medicine.
Keywords: Aspergillus fumigatus, carvacrol nano-emulsion, intensive care unit patients, invasive aspergillosis, scanning
electron microscopy, thyme nano-emulsion

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.