Rebonding strengths of lithium disilicate and feldspathic veneers debonded by Er, Cr: YSGG laser / Resistência de recolagem de facetas de dissilicato de lítio e feldspáticas descoladas por laser Er, Cr: YSGG

Objective: The aim of this study is to identify the shear bond strength of rebonded CAD/CAM laminates made of lithium disilicate or feldspathic ceramics after debonding using Er,Cr:YSGG lasers. Material and Methods:Eighty bovine teeth (N=80) were used as a bonding substrate, which were divided into four main groups (20 each) according to the ceramic material and cement-curing mode used as follows: Group AL: lithium disilicate (IPS E.max) with light-cured resin cement, Group AD: lithium disilicate (IPS E.max) with dual-cured resin cement, Group BL: feldspathic porcelain (VITA MARK II) with light-cured resin cement, and Group BD: feldspathic porcelain (VITA MARK II) with dual-cured resin cement. Half the number of each subgroup (n=10/subdivisions) were tested for their shear bond strength without debonding, while the other half of the specimens were tested after Er,Cr:YSGG laser debonding and rebonding. A three-way ANOVA test was used to study the effect of ceramic and curing on shear bond strength. Bonferroni's post-hoc test was used for pairwise comparisons when the ANOVA test was significant. Results: After rebonding and using the light-cure mode, there was no statistically significant difference between the mean shear bond strength of the two ceramics (P-value = 0.065). However, after rebonding and using the dual-cured mode, E.max showed significantly lower shear bond strength than VITA (P-value < 0.001). Conclusion: Ceramic type, the cement's curing mode, and rebonding after laser irradiation all had a significant effect on the mean shear bond strength (AU)

Objetivo: Identificar a resistência de cisalhamento de laminados CAD/CAM recolados, feitos de cerâmica de disilicato de lítio ou feldspática, após descolamento utilizando lasers Er,Cr:YSGG. Material e Métodos: Oitenta dentes bovinos (N=80) foram utilizados como substrato de colagem, divididos em quatro grupos principais (20 cada) de acordo com o material cerâmico e o modo de cura do cimento utilizado da seguinte forma: Grupo AL: disilicato de lítio (IPS E.max) com cimento resinoso fotopolimerizável, Grupo AD: disilicato de lítio (IPS E.max) com cimento resinoso de dupla cura, Grupo BL: porcelana feldspática (VITA MARK II) com cimento resinoso fotopolimerizável, e Grupo BD: porcelana feldspática (VITA MARK II) com cimento resinoso de dupla cura. Metade do número de cada subgrupo (n=10/subdivisões) foi testada quanto à resistência de cisalhamento sem descolamento, enquanto a outra metade dos espécimes foi testada após descolamento e recolagem a laser Er,Cr:YSGG. Um teste ANOVA de três vias foi usado para estudar o efeito da cerâmica e da cura na resistência de cisalhamento. O teste post-hoc de Bonferroni foi usado para comparações pareadas quando o teste ANOVA foi significativo. Resultados: Após a recolagem e usando o modo de fotopolimerização, não houve diferença estatisticamente significativa entre a resistência de cisalhamento média das duas cerâmicas (valor de P = 0,065). No entanto, após a recolagem e usando o modo de dupla cura, o E.max apresentou resistência de cisalhamento significativamente menor que o VITA (valor de P < 0,001). Conclusão: O tipo de cerâmica, o modo de cura do cimento e a recolagem após irradiação a laser tiveram efeito significativo na resistência de cisalhamento média (AU)

Gastric endoscopic mucosal resection and polypectomy among patients with liver cirrhosis and esophageal varices in the setting of acute upper gastrointestinal bleeding

Background Gastric polyps are not infrequently reported among cirrhotic patients. Endoscopic resection of gastric polyps among patients with liver cirrhosis and esophageal varices carries the risk of post-polypectomy bleeding. This may explain why endoscopists are reluctant to its excision. The aim is to evaluate the incidence of immediate (intraoperative) and delayed (within 30 days) post-polypectomy bleeding among cirrhotic patients with esophageal varices and portal hypertension and determine its risk factors. Methods This study comprised 39 cirrhotic patients with portal hypertension and varices who presented with gastrointestinal bleeding, and they had gastric polyps detected during th endoscopic intervention to control the acute bleeding or during follow-up. All patients were exposed to the entire history, clinical examination, and basic laboratory workup. Esophagogastroduodenoscopy was done to combine bleeding control and polypectomy simultaneously. Results Immediate (intraoperative) post-polypectomy bleeding occurred in 38.8% of patients, and no delayed bleeding was reported. Most of the reported bleeding was mild and clinically non-significant, and it stopped spontaneously or endoscopically. Furthermore, no mortality was reported. The risk of immediate (intraoperative) bleeding significantly increased with advanced age, advanced liver disease, increased portal hypertension with large varices, and decreased platelet count; meanwhile, the sex of patients, size, location, and method of polypectomy did not significantly increase the risk of gastric post-polypectomy bleeding among cirrhotic patients with portal hypertension and esophageal varices. Conclusions. Among patients with cirrhosis and portal hypertension, gastric polypectomy simultaneously done during endoscopic intervention for esophageal varices is considered a safe maneuver.

High prevalence of serological weak D phenotype and preponderance of weak D type 4.0.1. genetic variant in a Nigerian population: implications for transfusion practice in a resource-limited setting

ABSTRACT Introduction: Prevalence of RhD negative phenotype in Nigeria is low; this leads to scarcity of RhD negative red cells for transfusion. Serological and molecular genotyping of RhD negative individuals for weak D types could reduce this scarcity. The aim of this study was to determine the serological prevalence and molecular types of weak D phenotypes among blood donors and pregnant women in Kano, Nigeria. Methods: A total of 4482 blood donors and pregnant women from three hospitals in Kano were recruited. An indirect antiglobulin test was used to determine weak D phenotypes. Molecular genotyping was performed on genomic DNA from whole blood amplified by polymerase chain reaction sequence-specific primers (PCR-SSP) with agarose gel electrophoresis. Results: The mean age of the participants was 26.50 ±5.79 years. The prevalence of the RhD negative phenotype was 4.2% (189/4482). Of the 189 RhD negative phenotypes, 20 (10.6%) were weak D positive. Molecular genotyping of the 20 Weak D positive phenotypes revealed 15 (75%) weak D type 4, of which 11 were due to the RHD*09.03 and RHD*DAR3 (T201R, F223V) polymorphisms and 4, due to RHD* 08.01 and RHD* DFV polymorphisms; 2 (10%) were due to the 602 C>G polymorphism, while the remaining 3 (15%) constituted partial D or other rare weak D types. Conclusion: The prevalence of weak D positive phenotypes is high in this study; weak D type 4 is the most common RhD genetic variant. Routine serologic weak D testing of RhD negative blood and molecular genotyping should be encouraged in resource-limited settings.

Postnatal Care Utilization and Associated Factors among Mothers who gave Birth in the Aysaeta District, Northeast Ethiopia: A Community Based Cross-sectional Study

BACKGROUND: Postnatal care is given to mothers and newborn babies within 42 days of delivery. It is a period of high maternal and newborn mortality and is also the most neglected in terms of maternal health services in many parts of the world. This study aimed to assess postnatal care and associated factors among mothers who gave birth in the year preceding the survey of the Ayssaeta district. METHODS: A community-based cross-sectional study was conducted among 406 mothers who gave birth in the year preceding the survey from August 02­30, 2020. Bivariable and multivariable logistic regression analyses were done to identify factors associated with postnatal care utilization. RESULTS: Slightly greater than four out of ten mothers have visited postnatal care units at least once. Living in urban areas, giving birth in a health facility, having complications during labor and after, and getting advice during antenatal care visits were associated with higher odds of postnatal care utilization. CONCLUSION: Less than half of the mothers received postnatal care following the delivery of their last child. Living in an urban, place of delivery, experiencing labor and postpartum complications, and receiving postnatal care advice during antenatal care have affected the utilization of postnatal care. Promoting skilled delivery and antenatal care with a focus on rural areas can help mothers learn about postnatal care and increase the number of mothers who use it

Low Back Pain, Disability and Quality of Life among Health Care Workers

Health workers usually have the highest incidence of work-related back injuries which influence their work.Low back pain patients suffer not only from physical discomfort but also from functional disabilities that maycause impairment and interfere with their quality of life. This study is aimed at evaluating low back pain,disability and quality of life among health care workers. This is a descriptive study which was conducted at fourprimary health care centres in Tabuk. Non-probability purposive sampling method was used to select 120health workers. For data collection, the three tools used were a pre-established questionnaire, Oswestry LowBack Pain Disability Questionnaire for evaluating pain and disability, and the 36-item Short-Form HealthSurvey (SF-36) for evaluating the quality of life. Disability was found in 70.8% of the studied sample. Totalquality of life score was low in 77.5% of the studied sample and there was a highly significant negativecorrelation between total quality of life score and total back pain of the studied sample. Low back paincontinues to be a common occupational disease for health workers. This health issue would also have animportant impact on their job and the quality of healthcare as well. In order to decrease Low back pain, healthcare workers should be included in specific education program. A consistent methodological strategy foroptimizing the qualiy of life problem among health care workers should be developed by health care managers.

Knowledge, Attitude, and Practice of Type 2 Diabetes Mellitus Saudi Patients Regarding Diabetic Retinopathy: A Multi-Center Cross Sectional Survey

Objective: This study is aimed at investigating the knowledge, practice and attitude of the patients with type-2diabetes mellitus regarding diabetic retinopathy in Saudi Arabia. Introduction: Diabetes self-management isdefined as a crucial factor in patients’ care. Many studies show that the lack of sufficient knowledge, goodpractice, and positive attitude among the patients concerning their disease and its complications is due toilliteracy. Therefore, presenting knowledge, practices, and attitudes towards the management of diabetes shouldbe done before considering any possible intervention. The materials and methods section explains the datacollection and analysis along with their limitations. In the results part, the data collected from each section areexplained and summarized in tables. In the discussion section, the results are explained and then related to theprevious studies. Then the conclusion sums up all the results found and subsequently recommends the best wayfor the future researchers to improve the results of the research.

Diabetic Retinopathy Knowledge, Awareness and Practices of Physicians in Primary Health Care Centers

Purpose: Diabetes retinopathy (DR) is one of the fatal causes of permanent and irreversible blindnessinfection that is prevalent making individuals suffer from diabetic conditions; however, annual medicalexamination is a critical interventional approach that not only limits the extent of infection but aids in timelyformulation of relevant mitigation strategies and control of DR. Common to other healthcare systems inadvance economies, the primary care physicians (PCP) are the immediate providers of primary care fordiabetes across the kingdom of Saudi Arabia (KSA). The aim of the present research paper is to assess thecurrent awareness, practices, and knowledge of PCP on DR. Method: The present research adopted a crosssectional design that covered three cities in Saudi Arabia. A self-administered questionnaire with threedifferent parts was submitted to physicians in the healthcare facilities across the three cities. In addition, theresearch adopted a convenience sampling method during which the designated regions were selected due toconvenience in proximity as well as accessibility. Results: The research paper considered a sample size of710 participants. An in-depth and compressive analysis of the results elucidated underlying defects as well asshortfalls on the physicians’ awareness, knowledge, and practices on DR. The results demonstrated defects inscreening methods as well as referral procedures among physicians. Conclusion: Overall, the extent ofknowledge, practices, and awareness among the PCP in the three cities were satisfactory. Hence, it is highlyrecommended that future awareness campaigns should focus on timely and detailed screening approaches inorder to manage diabetic conditions among patients.

Prevalence and Antibiotic Susceptibility of Salmonella Species among Food Handlers in Khartoum- State (Sudan)

Aims/Objectives: To screen the prevalence of Salmonella fecal carriage among healthy foodhandlers and to identify the common species of Salmonella among study population and its antibacterial susceptibility in Khartoum state by taking stool samples. Study Design: Cross-sectional study. Place and Duration of Study: Khartoum state, Sudan, from January 2009 to December 2009. Methodology: Stool samples were collected, processed and cultured on suitable bacterial culture media. Presence of colonies resembling (non-lactose fermenting) Salmonella species were further studied to identify the bacterium by using appropriate biochemical tests.Confirmation and serotyping of isolates were done by using Salmonella antisera. Antibacterial susceptibility test for common antibacterial drugs were also studied. Results: A total of 387 stool samples collected from apparently healthy food handlers werestudied. Salmonella fecal carriage among food handlers was 17 (4.4%) and the highest prevalence was noted in Umbada locality (5.1%). Salmonella Paratyphi B was the commonest 14 (3.6%), followed by Salmonella Typhi 2(0.5%) and Salmonella Cholerasuis 1 (0.3%). Our study revealed that 141 (36.4%) of food handlers were illiterate, 29 (7.5%) werepreschool, 134 (34.6%) were elementary school graduates 68 (17.6%) and 15 (3.9%) university graduates. Forty two (10.9%) of the studied cases mentioned that, they sometimes wash their hands by soap after defecation, while, 9 (2.3%) never washed theirhands. The study also, revealed that 3 (17.6%) of positive food handlers have had history ofprevious typhoid or gastroenteritis. The study demonstrated that Salmonella species isolated were sensitive to co-trimoxazole, ciprofloxacin, chloramphenicol, tetracycline, amoxicillin/ clavulanic acid, ceftriaxone and cefuroxime. Conclusion: This study demonstrated the presence of considerable number of Salmonella fecal carriage among food handlers in Khartoum state. Most of them were illiterate and had poor compliance of hand washing after toilet use. Study also revealed that isolated Salmonella species were highly susceptibility to the common first line antibiotics used in Sudan.

Digital Childhood: the Impact of Using Digital Technology on Children’s Health

Background and Objective: Digital media can be considered as an important element of life for today's children and adolescents since theyspend a lot of time using it. This increased use of digital media is associated with poor behavior and health status. Society in general andpractitioners in public health in particular should promote digital media use strategies through health education. This study is aimed atevaluating the impact of using digital technology on children physical, social and behavior health. Methodology: This is a descriptive studywhich was conducted at the primary health care centers of Tabuk. Through purposive sampling, 300 people were included in the study. Aquestionnaire and a checklist were used as the tools for data collection. Results: There was a significant relationship between theattachment to technology and both physical and psychological health of the studied children. There was also a significant differencebetween the awareness of mothers regarding both negative and positive effects of technology and total effects of technology at the pre andpost-intervention stages. Conclusion: Using technology had an impact on both physical and psychological health of children, and there wasan improvement in mothers’ awareness in this regard. This reflects the key role of health education on improving the awareness of mothersabout the effects of using technology on the health of their children.

Factors associated with fistula secondary failure in patients on hemodialysis

Background: Native arteriovenous [AV] fistulas, which are the most commonly used access line, enable sufficient and repeated hemodialysis [HD] applications and improves the rate of survival and quality of life in patients with end-stage renal disease [ESRD] when performed timely in an appropriate anatomic location using a fine technique

Objectives: We aimed to assess factors responsible for fistula secondary failure in patients on hemodialysis

Patients and Methods: Thirty patients with end stage renal disease [ESRD] on regular HD were included. All patients underwent history taking, clinical examination and ultrasound examination was carried out for all patients to assess AVF and factors associated with its patency and failure

Results: There was no statistically significant differences between group I and group II as regards to age, BMI, HD duration and AVF age [p-value >0.05]. There was statistically high significant difference between patients with well functioning AVF [group I] and patients with malfunctioning [secondary failed] AVF [group II] as regarding SVP and mean arterial blood pressure [P-value < 0.01] and there was statistically significant difference between group I and group II as regarding DVP [p-value < 0.05]. There was statistically high significant difference between group I and group II as regarding venous diameter and FV [P-value < 0.01], while there was no statistically significant difference between group I and group II as regarding arterial diameter [P-value > 0.05]. There was statistically high significant difference between group I and group II as regarding hemoglobin and dialysis adequacy [Kt/V] [P-value < 0.01]

Conclusion: The native AVF is the vascular access of choice for patients who require hemodialysis: it lasts longer and is associated with fewer complications than other types of vascular access; for hemodialysis patients, these benefits translate into better quality of life and longer survival. The result of this study showed a significant positive correlation between access blood flow [Qa] and Kt/V. This confirm the importance of well-functioning non stenotic AVF in delivering adequate dialysis

egyptian study for standardization of myocardial t1 mapping values on a 3 tesla mri machine

Objective: of this study is to set standard values for the native T1 values in both normal and diseased myocardium on a 3 tesla MRI machine

Methodology: this study was carried out in Misr Radiology Center. 31 patients were divided into normal group [control] including 10 patients and diseased group including 21 patients

Result: The native T1 values on the healthy myocardium ranged from 1110 to 1300 msec, with ECV values ranging from 25 to 33 % with variable elevations of the native T1 and ECV values according to the pathology affecting the myocardium. We concluded that the above values are the reference values for the 3 T MRI machine

Comparative study between intravenous and intraperitoneal magnesium sulphate as adjuvant to general anesthesia for pain management in laparoscopic cholecystectomy

Background: numerous researches have proved the benefits of laparoscopic cholecystectomy compared to the open method, mainly because of less metabolic response to stress, maintenance of diaphragm and pulmonary function, less postoperative complications, lower incidence of postoperative ileus, early mobilization, shorter hospital stay, and a more cosmetic. The main presentation of postoperative pain is somatic, whereas visceral pain is less present, and thus the pain is less in the patients operated by laparoscopic method

Aim of the Work: to compare intravenous Magnesium Sulphate with intra peritoneal Magnesium Sulphate as adjuvant to general anesthesia for pain management in laparoscopic cholecystectomy

Patients and Methods: this prospective randomized double blind clinical study using closed envelopes method was carried out on 100 adult patients, Undergoing laparoscopic cholecyctectomy in Bab-Alshaeria University Hospital, faculty of medicine, Al-Azhar University. After approval by the Institutional Ethical Committee, and informed written consent obtained from the patients, we randomly divided the patients into two groups 50 patients each

Results: the pain scores of group II [intra-peritoneal group] were significantly lower than group I [intravenous group], the total opioid consumption postoperatively in group II[intra-peritoneal group] was highly significant lower than group I [intravenous group]. Also there was a significant reduction in opioid-related side effects such as postoperative nausea and vomiting

Conclusion: the intraperitoneal administration of magnesium sulphate is a safe and effective method in the management of acute postoperative pain after laparoscopic cholecystectomy more than intravenous administration of magnesium sulphate

Evaluation of pyloric stenosis management, laparoscopic versus open pyloromyotomy

Background: Hypertrophic pyloric stenosis [HPS] is associated with gastric outlet obstruction that occurs as a result of pylorus muscular layers hypertrophy. HPS is considered as the most common cause of vomiting in infancy that requires surgical intervention. Despite advances in neonatal and surgical care,still there is a debate between the pediatric surgeons about the approach that can provide better outcomes for the patients

Objective: In our paper, we aimed to review the recent randomized clinical trials and reviews that compared between laparoscopic and open pyloromyotomy to assess their outcomes, merits and pitfall of each

Methods: PubMed database was used for articles selection, and the following keys used in the mesh [[Hypertrophic Pyloric Stenosis /management][Mesh] OR [\\ Hypertrophic Pyloric Stenosis /outcomes][Mesh]] AND [[Mortality/Morbidity][Mesh]]. A total of 12 studies were enrolled into our review according to our inclusion and exclusion criteria

Conclusion: We found that overall Laparoscopic pyloromyotomy procedures were as safe and effective as Open pyloromyotomy procedures for infants with hypertrophic pyloric stenosis. However, there was a trend in the LP group towards shorter time, especially with regard to the full time to feeds, length of stay after surgery, operating time. We think that our findings justify the continued use of laparoscopic pyloromyotomy for the management of infantile hypertrophic pyloric stenosis, and recommend its use in centers with appropriate laparoscopic experience

Therapeutic effect of Aloe vera and silver nanoparticles on acid-induced oral ulcer in gamma-irradiated mice

Abstract Radiation combined injury, a life-threatening condition, has higher mortality than simple radiation injury. The aim of the present study was to analyze the efficiency of Aloe vera and silver nanoparticles in improving the healing of ulcerated oral mucosa after irradiation. Thirty male Albino mice were divided into five groups: control, radiation, Aloe vera (AV), silver nanoparticles (NS), and AV+NS. The mice were exposed to whole body 6Gy gamma-radiation. After one hour, 20% acetic acid was injected into the submucosal layer of the lower lip for ulcer induction. The animals received topical treatment with the assigned substances for 5 days. Lip specimens were subjected to hematoxylin and eosin and anti alpha-smooth muscle actin immunohistochemical staining. Results demonstrated occurance of ulcer three days post irradiation in all groups except in the AV+NS group where only epithelial detachment was developed. After seven days, data revealed persistent ulcer in radiation group, and almost normal epithelium in the AV+NS group. A significant reduction of epithelial thickness was detected in all groups at the third day as compared to control. At the seventh day, only the AV+NS group restored the epithelial thickness. Area percent of alpha-smooth muscle actin expression was significantly decreased in radiation group at the third day followed by significant increase at the seventh day. However, all treatment groups showed significant increase in alpha-smooth muscle actin at the third day, which decreased to normal level at the seventh day. Our study demonstrated the efficiency of Aloe vera and silver nanoparticles in enhancing ulcer healing after irradiation.

Relation between serum levels of vitamin D and echocardiographic determinants of systolic and diastolic functions in patients with and without cardiorenal syndrome

Background: vitamin D is a fat-soluble vitamin; it has skeletal and non-skeletal functions. The effect of Vitamin D on CV disease had several mechanisms including elevated PTH and Calcium-phosphate metabolism. It decreases the pro- remodeling of Angiotensin II on the cardiomyocytes

The Objectives: To study relation between serum levels of vitamin D and echocardiographic determinants of systolic and diastolic functions in patients with and without cardio-renal syndrome

Patients and Methods: Prospective study was conducted on 90 patients of all age groups and both sexes, admitted to Ain-Shams University hospital. The study included 3 groups of patients: Group 1: systolic dysfunction and renal insufficiency [30 patients], Group 2: systolic dysfunction only [30 patients]. Group 3: renal insufficiency only [30 patients], in addition 10 healthy controls were taken as controls. Patients were subjected to full comprehensive echocardiography and KFT with estimation of creatinine clearance, and Vitamin D level that was statistically studied against echocardiographic parameters of cardiac systolic and diastolic function

Results: Our study found that, compared to patients with normal vitamin D level, patients with vitamin D deficiency [defined as having vitamin D level <20 ng/ml] had significantly higher ventricular thickness [IVS, PW and mean wall thickness] [P value < 0.001], and higher LV mass which seems to be linked eventually to worse outcomes with no significant impact on worsening Diastolic dysfunction. A ROC curve was done revealing a sensitivity of 80% for the mean wall thickness [>/= 10 mm] to identify patients with vitamin D deficiency

Conclusion: Vitamin D deficiency was associated with ventricular hypertrophy with worsening outcomes with no impact on diastolic function

impact of transradial versus transfemoral approach for percutaneous coronary intervention on the outcome of patients presenting with acute coronary syndrome

Background: The transfemoral approach [TFA] has been until presently the main-stay for arterial access PCI in the setting of acute STEMI, while the transradial approach [TRA] is gaining ground in elective as well as primary procedures

Objectives: to assess the impact of transradial versus transfemoral approach for PCI on the outcome of patients presenting with acute coronary syndrome

Patients and Methods: prospective study was conducted on 100 patients presenting to Ain Shams University Hospitals Coronary Care Unit [CCU] with recent onset acute coronary syndrome [whether unstable angina [UA]/non-ST-segment-elevation MI [NSTEMI] or ST-segment-elevation MI [STEMI]] undergoing revascularization via percutaneous coronary intervention [PCI]. Patients were randomized into 2 equal groups, for the first group PCI was performed via TFA while for the second group via TRA

Results: Our study found that, with TRA we get less bleeding, less local vascular complications [8 [16%] vs 2 [4%], p=0.045] and less amount of dye used [169.60 +/- 21.28 versus 187.00 +/- 37.65 ml, p=0.006] without significant increase in fluoroscopy time [10.86 +/-4.88 versus 9.76 +/-4.74 mins, p=0.256] or radiation exposure. Although there was no significant difference in mortality and morbidity, TRA offers the patient a more simple procedure with less hospital stay [3.4 +/-0.948 versus 3.86 +/-0.808 days, p<0.01]

Conclusion: Radial artery access is a safe and effective approach for management of ACS. If performed by experienced operators, TRA should be the standard access in managing ACS specifically in STEMI

Routine early coronary angioplasty versus ischaemia-guided coronary angioplasty after successful thrombolysis in patients with acute anterior STEMI

Background: the potential benefits of routine early intervention after thrombolysis include prevention of re-infarction, recurrent ischemia, and reduction of the infarct size and mortality

Aim of the work: the purpose of this study is to compare routine early coronary angioplasty in patients with acute anterior STEMI after successful thrombolysis versus ischaemia-guided coronary angioplastyas regards the occurrence of MACCE

Study design: a total number of 100 patients with acute anterior STEMI received thrombolytic therapy and then were randomly assigned to either routine invasive strategy or ischemia based strategy based on risk stratification by stress myocardial perfusion scan done within 30 days of the onset of AMI with subsequent CA after demonstration of residual myocardial ischemia and or good viability

Results: the cumulative incidence of MACCE including recurrent ischemia, stroke, MI, HF or mortality was significantly lower in theroutine early invasive strategy

Conclusion: STEMI patients who cannot undergo timely primary PCI should receive prompt fibrinolysis followed by early routine invasive strategy

Behavioral and emotional effects of repeated general anesthesia in young children

Preclinical and clinical data suggest the possibility of neurotoxicity following exposure of young children to general anesthetics with subsequent behavioral disturbances. The aim of the study was to determine the overall effect of repeated general anesthesia on behavior and emotions of young children aged 1½-5 years old, compared to healthy children. Thirty-five children underwent repeated anesthesia and surgery were matched with the same number of healthy children who attended vaccination clinic, as a control group. Both groups were administered the child behavior checklist [CBCL] 1½-5 years and Diagnostic and Statistical Manual of Mental Disorders [DSM] oriented scale. Behavior data were collected through a semi-structured questionnaire. The CBCL score revealed that children with repeated anesthesia were at risk to become anxious or depressed [relative risk [RR]; 95% confidence interval [CI] = 11 [1.5-80.7]], to have sleep [RR; 95% CI = 4.5 [1.1-19.4]], and attention problems [RR; 95% CI = 8 [1.1-60.6]]. There was no difference in the risk between the two groups regarding emotionally reactive, somatic complaints, withdrawn problems, aggressive behavior, internalizing or externalizing problems. On DSM scale, children with repeated anesthesia were at risk to develop anxiety problems [RR; 95% CI = 3.7 [1.1-12.0]], and attention deficit/hyperactivity problems [RR; 95% CI = 3 [1.1-8.4]]. There was no difference in the risk between the two groups regarding affective, pervasive developmental and oppositional defiant problems. Young children who undergone repeated surgical procedures under general anesthesia were at risk for subsequent behavioral and emotional disturbances. Proper perioperative pain management, social support, and avoidance of unpleasant surgical experiences could minimize these untoward consequences

Effect of platelet-rich plasma intra articular injection on patients with primary knee osteoarthritis

Background: Osteoarthritis [OA] is the most common type of arthritis. It is a degenerative joint disease. OA is usually defined according to radiographic changes. Conventional radiographs [CR] were considered the most relevant outcome measure to assess the progression of OA in clinical trials and epidemiological studies. Many modalities are used in treatment of knee OA. There is a distinct need for new procedures that are cost effective by reducing the need for pharmaceutical and surgical management, while targeting the biochemical process of OA. Platelet-rich plasma [PRP] is one of these new procedures. PRP was found to increase hyaluronic acid [HA] concentration, stabilizing angiogenesis in patients with osteoarthritic knees

Aim of the study: Was to assess the value of intra articular injection of autologous platelet rich plasma in management of knee osteoarthritis

Patients and methods: This study was conducted on 40 patients with primary knee osteoarthritis, divided into 2 groups; study group treated with 3 injections of PRP, and control group treated with single dosed high-molecular weight HA. Clinical assessment and visual analogue scale [VAS] scoring were done pretreatment and 3 months post treatment

Results: Clinical improvement and reduction of VAS in both groups which is significant at the study group

Conclusion: PRP injection could be considered as a simple, safe, effective and non-palliative treatment that may promote cartilage healing in knee osteoarthritis as it improve the clinical condition and the function of the joint. Hence, it may represent a useful addition to the available therapeutic options for knee osteoarthritis

Comparison of dexmedetomidine or ondansetron with haloperidol for treatment of postoperative delirium in trauma patients admitted to intensive care unit: randomized controlled trial

This study was designed to compare the effect of dexmedetomidine or ondansetron with haloperidol, as a control, for the treatment of postoperative delirium in trauma patients. A total of 96 adult trauma patients diagnosed with postoperative delirium were randomized into three equal groups. Patients were given either 1 microg/kg dexmedetomidine [Dexmed group] or 4 mg ondansetron [Ondan group] or 5 mg haloperidol [Halo group], administered twice daily for 3 consecutive days. Number of delirious patients, patients who needed [rescue haloperidol] and the total amount of [rescue haloperidol] during study period was calculated. At the end of the study, the number of remaining delirious patients was 3, 6, and 2 in Dexmed,Ondan, and Halo groups, respectively, without statistical significance. During the study period, there was no significant difference in the number of patients who needed [rescue haloperidol] between Dexmed and Halo groups [5 vs. 3; p = 0.7]. However, the difference was significantly higher in Ondan group compared to Halo group [11 vs. 3; p = 0.03]. The mean total [rescue haloperidol] dose was significantly higher in Ondan group compared to Halo group [p < 0.001], but there was no difference between Dexmed and Halo groups [p = 0.07]. At the same time of delirium assessment, mean arterial blood pressure and mean score on Visual Analog Scale were not statistically different between Dexmed or Ondan group versus Halo group. No serious adverse events were reported. Dexmedetomidine is a potential alternative treatment for postoperative delirium in trauma patients admitted to ICU