Efficacy of dexmedetomidine in suppressing cardiovascular and hormonal responses to general anaesthesia for caesarean delivery: a dose-response study.

BACKGROUND: Preoperative dexmedetomidine administration blunts haemodynamic and hormonal responses to tracheal intubation and reduces anaesthetic requirements. We hypothesized that dexmedetomidine would reduce the maternal haemodynamic and hormonal responses to elective caesarean delivery without harmful neonatal effects. METHODS: After ethical approval, 68 parturients scheduled for elective caesarean delivery under general anaesthesia were randomly allocated to receive either placebo, or 0.2, 0.4 or 0.6 µg/kg/h intravenous dexmedetomidine (n=17 per group) 20 min before induction. Anaesthesia was induced using a rapid-sequence technique with propofol and suxamethonium, and was maintained with 0.5-0.75 minimum alveolar concentration sevoflurane. Changes in maternal heart rate, mean blood pressure, minimum alveolar concentration sevoflurane, uterine tone, serum cortisol level, and Apgar scores, Neurologic Adaptive Capacity Scores and acid-base status were recorded. RESULTS: After induction, patients receiving dexmedetomidine had smaller increases in heart rate (P<0.001) than those in the placebo group. Patients who received 0.4 and 0.6 µg/kg/h infusions of dexmedetomidine showed slower heart rates (-21.5% and -36%, respectively; P<0.001), lower mean blood pressures (-17% and -25%, respectively; P<0.001), sevoflurane minimum alveolar concentrations (-40% and -44.5%, respectively; P<0.001) and serum cortisol levels (-27% and -34.6%, respectively; P<0.001) and higher sedation scores for the first 15 min after extubation and greater uterine tone (P<0.002). Apgar scores, NACS and acid-base status were similar in the four groups. CONCLUSION: Preoperative administration of dexmedetomidine 0.4 and 0.6 µg/kg/h is effective in attenuating the maternal haemodynamic and hormonal responses to caesarean delivery under sevoflurane anaesthesia without adverse neonatal effects.

Hairy cell leukemia-variant.

Hairy cell leukaemia variant is a very rare chronic lymphoproliferative disorder and is closely related to hairy cell leukemia. We hereby describe a case of hairy cell leukaemia variant for the first time in Saudi Arabia. An elderly Saudi man presented with pallor, massive splenomegaly, and moderate hepatomegaly. Hemoglobin was 7.7 g/dl, Platelets were 134 x109/l and white blood count was 140x10 9/l with 97% being abnormal lymphoid cells with cytoplasmic projections. The morphology, cytochemistry, and immunophenotype of the lymphoid cells were classical of hairy cell leukaemia variant. The bone marrow was easily aspirated and findings were consistent with hairy cell leukaemia variant.

Seroprevalence of hepatitis A virus markers in Eastern Saudi Arabia.

OBJECTIVE: To record and update the sero-epidemiological status of Hepatitis A virus in Eastern Saudi Arabia. To investigate the main viral etiology of clinical hepatitis in children and discuss the possibility of introducing a Hepatitis A virus vaccine in this Province. METHODS: Examining serum specimens by Enzyme Linkage Immuno-Sorbet Assay technique for these parameters: Immunoglobulin M anti-hepatitis A virus, total immunoglobulin anti-hepatitis A virus, and in selected cases we checked for hepatitis B surface antigen and anti-hepatitis C virus. The study was carried out in the Virology Diagnostic Labs, of Dammam Regional Laboratories & Blood Bank, Dammam. A total of 12,357 serum samples were collected from 5876 healthy children, 5798 healthy adults, and 683 from clinically diagnosed hepatitis in children. The period of study was 12 years from February 1987 to January 1999. RESULTS: Hepatitis A virus prevalence showed 3% for pre-school age, 80% in older children and 93% in adults, while total prevalence was 86%. Breaking down the prevalence among children showed 3% in the <6 years age group, 62% in the 6 - <8 years age group, 71% in the 8 - <10 years age group, 83% in the 10 - <12 years age group and 93% in the 12 - <18 years age group. While the grand total among children was 78%. The prevalence of hepatitis viruses causing clinical hepatitis in children showed: 65% for hepatis A virus, 21% for hepatitis B virus, 7% for hepatitis C virus, 2% for double infection of hepatitis B virus + hepatitis C virus and 5% for non A, non B, non C. CONCLUSION: Hepatitis A virus infection starts dramatically high in school-age children, and then rises gradually with an increase in age. This reflects that our region is of pattern I class. There is no difference in the prevalence due to seasons of year, climate or sex. Hepatitis A virus is the leading cause of clinical hepatitis in children, followed by hepatitis B virus and hepatitis C virus. There is a possibility of starting to introduce hepatitis A virus vaccine among pre-school age children, as well as among hepatitis A virus negative adults that live in a higher socioeconomic environment within the country, which can be considered as islands of pattern II among pattern I areas.

Immunophenotypic pattern of childhood acute lymphoblastic leukemia.

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Prevalence of coxsackieviruses among healthy populations and opthalmic disease patients in the Eastern Province, Saudi Arabia.

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Seroepidemiological prevalence of Rubella IgG antibodies among different populations in Eastern Saudi Arabia.

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The prevalence of indices of hepatitis C and B infection, and elevated aminotransferase enzymes in patients with oral lichen planus (olp) in eastern saudi arabia.

OBJECTIVE: To determine the possibility of any association between HBV, HCV, elevated aminotransferase enzymes and Oral Lichen Planus (OLP)patients in Eastern Saudi Arabia. DESIGN: Sera were collected from OLP patients, to be tested for HbsAg, anti-HCV and ALT/AST levels. SETTINGS: All the patients who were diagnosed clinically in periodontal section, Dammam Central Hospital were from Eastern Saudi Arabia. The histopathological diagnosis was done in Histopathology Section, Dammam Regional Labs, the virological studies in the Virus Diagnosis Lab of Dammam Regional Labs and Blood Bank, and the aminotransferase tests done in the Dammam Central Hospital Labs. SUBJECTS: 34 serum specimens were collected from OLP patients, and 32 other samples from healthy populations of the same age and sex as the controls of the study. RESULTS: Incidence of HBsAg, anti-HCV, HBsAg+HCV, and elevated aminotransferase enzymes among OLP patients were 8.8%, 14.7%, 2.9%, and 47.05% respectively and the results from the control subjects were 6.25%, 3.12%, 0%, and 3.12% respectively. CONCLUSION: There is a significant association between OLP and HCV infection. No clear evidence of this relationship appeared with HBV. All the aminotransferase elevated samples were positive to HCV, giving a clear evidence of the association of chronic HCV infection with the OLP. Aminotransferase elevated results could be used as a clue to clinical signs of asymptomatic hepatopathies, and as a marker to check the OLP cases for the relevant Hepatic Viruses. Despite the limited number of OLP patients in this study, the results could highlight the problem in this geographical area of the world. We recommend a comprehensive study to be carried out using this current study as a preliminary one.