Lanthanide complexes of spiropyran photoswitch and sensor: spectroscopic investigations and computational modelling.

A number of novel lanthanide (Gd3+, Sm3+, and Tb3+) complexes of the 1',3'-dihydro-8-methoxy-1',3',3'-trimethyl-6-nitrospiro[2H-1-benzopyran-2,2'-(2H)-indole] (spiropyran; SP), a widely studied molecular photoswitch, were investigated. Comparative spectroscopic (absorption and fluorescence) and kinetic investigations of the stimulated photochromic and solvatochromic behavior were carried out in different media. SP embedded in a rigid thin film of poly(methylmethacrylate) might be exploited profitably as an optical sensor for the identification of a solvent's nature. Furthermore, thermodynamic parameters, in particular, Gibbs' free energy change (ΔG°), were derived using density functional theory quantum chemical calculations with the SP and merocyanine coloured form. The model used was the B3LYP/6-31G(d,p)/SCRF = (SMD, solvent) and its time-dependent extension procedure was used to quantitatively explain the structural isomerization in response to a variety of stimuli, such as light, solvent nature, lanthanide(iii) ions, and macromolecular support. These findings might be useful for the design of photoswitchable and energy transfer materials and their related fields.

Baseline evaluation for natural radioactivity level and radiological hazardous parameters associated with processing of high grade monazite.

Egyptian monazite is a promising resource and investment attractive for production of valuable metals of industrial or nuclear interest such as rare earth elements (REEs), thorium (Th) and uranium (U). The study was focused to establish a baseline framework in viewpoint of radiation protection for the workers in production of REEs from high-grade monazite treated by sodium hydroxide (NaOH) solutions. Radiological hazard indices (cancer, gonadal and other risks) were evaluated, due to emissions (α-, ß- and γ-radiations) of radium-isotopes (228Ra, 226Ra, 223Ra) and lead (210Pb). The values of the estimated radiological hazard indices were higher than the permissible safe limits, worldwide average and varied with those reported in other countries. It was found that more than 70% of radioactivity and radiological hazardous indices resulted from emissions of 228Ra, while the rest was attributed to 226Ra, 223Ra and 210Pb. Therefore, processing of the Egyptian monazite can cause a significant radiological impact on workers through external exposure from γ-radiations and/or internal exposure through inhalation or ingestion airborne contaminated by the radionuclides. Thus, the results recommended that protection rules could be considered to prevent the radiation hazards associated with the production of the REEs from the high grade monazite attacked by caustic method.

High prevalence of the PER-1 gene among carbapenem-resistant Acinetobacter baumannii in Riyadh, Saudi Arabia.

The prevalence of carbapenem-resistant Acinetobacter baumannii in Saudi Arabia and their resistance genetic mechanisms are yet to be identified. We studied the prevalence and genetic diversity of extended-spectrum beta-lactamase genes, particularly the PER-1 gene, among carbapenem-resistant A. baumannii strains from patients at a tertiary care hospital in Riyadh, Saudi Arabia between 2006 and 2014. Fresh subcultured samples were tested for antimicrobial susceptibility minimum inhibitory concentration (MIC). Total genomic DNA was extracted from each isolate and further used for polymerase chain reaction (PCR) genotyping, sequence-based typing (SBT) of PER-1 and OXA-51-like gene, and multilocus sequence typing (MLST) of positive isolates. Randomly selected clinical isolates (n = 100) were subjected to MLST. A total of 503 isolates were characterized as multidrug-resistant (MDR) using the MIC. Isolates were further PCR tested for bla -TEM and bla -PER-1 resistance genes (n = 503). The genotyping results showed that 68/503 (14 %) isolates were positive to bla TEM. The genotyping results of PER-1-like genes showed that 384/503 (76.3 %) were positive among MDR Acinetobacter isolates. Based on SBT, the majority of these isolates were clustered into three main groups including isolates harboring PER-1: AB11 (bla -PER-1), isolate AB16 (bla -PER-1), and, finally, the plasmid pAB154 (bla -PER-7). Remarkably, many isolates were concealing the PER-1 gene and harboring the TEM resistance genes as well. MLST results for selected isolates (n = 100) identified four main sequence types (STs: 2, 19, 20, and 25) and four novel isolates (ST 486-489). We report 76.3 % prevalence of the PER-1 resistance gene among Acinetobacter clinical isolates from Riyadh, Saudi Arabia. Further work is needed to explore the clinical risks and patient outcome with such resistance related to healthcare-associated infections and investigate the genetic and molecular mechanisms that confer the MDR phenotype.

Evolution of highly pathogenic avian influenza H5N1 viruses in Egypt indicating progressive adaptation.

Highly pathogenic avian influenza (HPAI) virus of the H5N1 subtype was first diagnosed in poultry in Egypt in 2006, and since then the disease became enzootic in poultry throughout the country, affecting the poultry industry and village poultry as well as infecting humans. Vaccination has been used as a part of the control strategy to help to control the disease. Epidemiological data with sequence analysis of H5N1 viruses is important to link the mechanism of virus evolution in Egypt. This study describes the evolutionary pattern of Egyptian H5N1 viruses based on molecular characterization for the isolates collected from commercial poultry farms and village poultry from 2006 to 2011. Genetic analysis of the hemagglutinin (HA) gene was done by sequencing of the full-length H5 gene. The epidemiological pattern of disease outbreaks in Egyptian poultry farms seems to be seasonal with no specific geographic distribution across the country. The molecular epidemiological data revealed that there are two major groups of viruses: the classic group of subclade 2.2.1 and a variant group of 2.2.1.1. The classic group is prevailing mainly in village poultry and had fewer mutations compared to the originally introduced virus in 2006. Since 2009, this group has started to be transmitted back to commercial sectors. The variant group emerged by late 2007, was prevalent mainly in vaccinated commercial poultry, mutated continuously at a higher rate until 2010, and started to decline in 2011. Genetic analysis of the neuraminidase (NA) gene and the other six internal genes indicates a grouping of the Egyptian viruses similar to that obtained using the HA gene, with no obvious reassortments. The results of this study indicate that HPAI-H5N1 viruses are progressively evolving and adapting in Egypt and continue to acquire new mutations every season.

Surface modification of thin film composite forward osmosis membrane using graphene nanosheets for water desalination.

In this study, the main motivation of this work is desalination of water for irrigation arid area such as Sidri- Baba basins- south Sinai, Egypt. Also, the novelty of this work is modification of TFC surface membrane by mix of HA, DA and GO to get high performance of FO technique. Interfacial polymerization was employed to modify a thin-film composite (TFC) membrane for forward osmosis (FO) applications; moreover, graphene oxide (GO) nanosheets (GONs), a dopamine solution (DA), and naturally accessible humic acid (HA) were modified on a polyethersulfone (PES) substrate. The effects of the different quantities of GO, HA, and DA on the membrane surfaces, as well as their various cross-sectional morphologies and FO-desalination capabilities, were investigated. The integrated TFC membrane containing appropriate GO, HA, and DA blends outperformed the control membrane, obtaining high water flux, and high salt rejection. Furthermore,.

Microstructure of gamma-ray developed polymeric nanocomposite respecting cesium and cobalt removal from aqueous solutions.

The nanoparticles of fly ash (FA) were obtained by high energy ball milling of their parent Class C kind for subsequent synthesis of poly(acrylamide-acrylic acid)/fly ash (poly(AM-AA)/FA) nanocomposite. The gamma-radiation induced polymerization was applied to achieve this concern. Different techniques were utilized to characterize such nanocomposite. The sorption abilities of the synthesized nanocomposite toward 60Co2+ and 134Cs + radionuclides were evaluated using batch and fixed-bed column approaches. Batches were designed at constants of solution pH (6.5-7.0 ± 0.02), nanocomposite particle size and dosage (106-250 µm and 0.1 L/g, respectively). The microstructure of such nanocomposite (<100 nm) was mainly amorphous with porous rough surfaces containing homogenous distribution of the incorporated nano-FA. About 56.46 and 47.9 mg/g of Co2+ and Cs+ were sorbed at equilibrium with an ion exchange reaction mechanism. Langmuir, Freundlich and Dubinin-Radushkevich D-R isotherm model parameters were calculated indicating the favorability of all sorption processes. The spontaneous and endothermic natures of sorption were observed by the calculated ΔG° and ΔH° thermodynamic parameters, respectively. Thomas, Yoon-Nelson and Adams Bohart models were fitted to the fixed-bed column data at varied conditions. The predicted sorption capacities of Thomas were very close to those obtained experimentally. Modeling of the fixed-bed column data dominates that the external mass transfer kinetics was predominant in the initial parts of the fixed-beds. Values required for retaining 50% of the initial sorbate concentration were extended from 89.05 to 68.55 to 177.2 and 149.3 min for 60Co2+ and 134Cs + radionuclides, respectively, by increasing bed depth from 1.5 to 3.0 cm. Modification of FA to its nano-scale form with the subsequent synthesis of a nanocomposite material having sorption capabilities made a duplicate beneficial environmental concern.

Pathogenicity of two Egyptian H5N1 highly pathogenic avian influenza viruses in domestic ducks.

Domestic ducks have been implicated in the dissemination and evolution of H5N1 highly pathogenic avian influenza (HPAI) viruses. In this study, two H5N1 HPAI viruses belonging to clade 2.2.1 isolated in Egypt in 2007 and 2008 were analyzed for their pathogenicity in domestic Pekin ducks. Both viruses produced clinical signs and mortality, but the 2008 virus was more virulent, inducing early onset of neurological signs and killing all ducks with a mean death time (MDT) of 4.1 days. The 2007 virus killed 3/8 ducks with a MDT of 7 days. Full-genome sequencing and phylogenetic analysis were used to examine differences in the virus genes that might explain the differences observed in pathogenicity. The genomes differed in 49 amino acids, with most of the differences found in the hemagglutinin protein. This increase in pathogenicity in ducks observed with certain H5N1 HPAI viruses has implications for the control of the disease, since vaccinated ducks infected with highly virulent strains shed viruses for longer periods of time, perpetuating the virus in the environment and increasing the possibility of transmission to susceptible birds.

Increasing 2 -Bio- (H2 and CH4) production from food waste by combining two-stage anaerobic digestion and electrodialysis for continuous volatile fatty acids removal.

A novel approach of using two stage anaerobic digestion coupled with electrodialysis technology has been investigated. This approach was used to improving bio hydrogen and methane yields from food waste while simultaneously producing a green chemical feedstock. The first digester was used for hydrogen production and the second digester was used for methane production. The first digester was combined with continuous separation of volatile fatty acids using electrodialysis. The concentrations of carbohydrates, proteins and fats in the prepared food waste were 22.7%, 5.7% and 5.2% respectively. Continuous removal of volatile fatty acids during fermentation in the hydrogen digester not only increased hydrogen yields but also increased the production rate of volatile fatty acids. As a result of continuous VFA separation, hydrogen yields increased from 17.3 mL H2/g VS fermenter to 33.68 mL H2/g VS fermenter. Methane yields also increased from 28.94 mL CH4/g VS fermenter to 43.94 mL CH4/g VS fermenter. This represents a total increase in bio-energy yields of 77.1%. COD reduced by 73% after using two stage anaerobic digestion, however, this reduction increased to 86.7% after using electrodialysis technology for separation of volatile fatty acids. Electrodialysis technology coupled with anaerobic digestion improved substrate utilization, increased bioenergy yields and looks to be promising for treating complex wastes such as food waste.

Phylogenetic analysis of hemagglutinin and neuraminidase genes of highly pathogenic avian influenza H5N1 Egyptian strains isolated from 2006 to 2008 indicates heterogeneity with multiple distinct sublineages.

The Eurasian-lineage H5N1 highly pathogenic avian influenza (HPAI) virus caused widespread outbreaks in Egypt in 2006 and eventually become enzootic in poultry. Although outbreaks have a seasonal pattern, with most occurring during the cooler winter months, it remains unclear whether this seasonality reflects virus maintenance within Egypt or yearly introductions of the virus into the country. To evaluate the epidemiology of H5N1 HPAI in Egypt, sequence analysis of the hemagglutinin (HA) and neuraminidase (NA) genes of selected Egyptian isolates from early 2006 to 2008 was conducted. The data from this study identifies distinct genetic markers in both HA and NA genes and suggests grouping Egyptian isolates into two major HA isolate sublineages from 2006 to 2008 and into three smaller, emergent subgroups. The NA phylogenetic and sequence analysis showed a similar pattern, except that two of the emergent groups from the HA phylogenetic tree clustered together, evidence of likely reassortment. The different subgroups did not appear to segregate by relation to the date of isolation, to the species of origin, nor to the geographic location of the viruses. The conclusion is that H5N1 is continuing to mutate with multiple heterogenic strains persisting in Egypt.

Isolation of a low pathogenic avian influenza virus (H7N7) from a black kite (Milvus migrans) in Egypt in 2005.

Avian influenza is endemic in some species of wild birds and is generally believed to cause only an asymptomatic infection. These viruses are routinely transmitted from this wild bird reservoir to poultry in many areas all over the world. Low pathogenic avian influenza (LPAI) was previously reported in Egypt from different types of wild birds. This report describes the isolation and genetic characterization of H7N7 LPAI virus from a black kite (Milvus migrans), the first reported from this species, during surveillance done on wild birds in 2005. The black kite is a migratory bird that has breeding habitat in Europe and migrates in the winter to North Africa and the Middle East. Eight samples were collected in South Sinai, Egypt, and tested by virus isolation in embryonating chicken eggs. One sample had positive hemagglutination activity after the second passage in specific-pathogen-free embryos. Virus identification and characterization were done and the isolate was confirmed as H7N7 LPAI. The sequence data showed that this isolate was most closely related to European H7 strains isolated from domestic and wild birds.

Genetic characterization of variant strains of highly pathogenic avian influenza H5N1 that escaped detection by real-time reverse transcriptase-PCR diagnostic tests.

The highly pathogenic avian influenza virus of subtype H5N1 that caused serious outbreaks in Egypt in 2006 was efficiently detected using a commercially available real-time reverse transcriptase-PCR (RRT-PCR) for the type A specific matrix (M) gene in field samples of cloacal and tracheal swabs. RRT-PCR was also used for subtyping and confirmation of H5 subtype. During late 2007 the National Laboratory for Veterinary Quality Control on Poultry Production detected five field cases that were positive for avian influenza virus (AIV) based on the M gene RRT-PCR. Three different commercial H5 RRT-PCRs were used for identification of the H5 subtype, as well as a published World Organization for Animal Health (OIE) H5 RRT-PCR that had been previously carefully validated. The five cases had positive results for the H5 gene using the published OIE H5 RRT-PCR, but the three commercial H5 RRT-PCRs tests only returned two to four positive results out of the five positive cases. The hemagglutinin gene (HA) sequencing analysis of these five isolates showed multiple nucleotide substitution mutations, suggesting genetic variation that could affect the H5 primer and/or probe binding sequences. These data highlight the importance of continued monitoring of RRT-PCR primers and probes to ensure that sensitivity and specificity are maintained. The use of conventional methods in national and reference AIV laboratories, including virus isolation, serologic subtyping, and alternative RRT-PCR primers, is necessary to detect the newly emerging variant H5N1 strains that affect diagnostic performance.

Circulation of avian influenza H5N1 in live bird markets in Egypt.

The poultry meat trade in Egypt depends mainly on live bird markets (LBMs) because of insufficient slaughterhouses, lack of marketing infrastructure, and cultural preference for consumption of freshly slaughtered poultry. There are two types of LBMs in Egypt: retail shops and traditional LBMs where minimal, if any, food safety standards or veterinary inspection are implemented. Before January 2009, LBMs were considered to be a missing link in the epidemiology of avian influenza in Egypt. This incited us to initiate this surveillance to better understand the perpetuation of H5N1 and the risk of infection in poultry markets. Seventy-one out of 573 (12.4%) examined LBMs were positive for the H5N1 subtype by real-time--quantitative polymerase chain reaction (RT-qPCR) from January to April 2009. Where a 70.4% detection rate from LBMs had waterfowl only as a solitary sold species, a 26.8% detection rate from LBMs had waterfowl mixed with chicken and/or turkey, and 2.8% from LBMs had only turkey. Higher incidence, 40.8%, of positive LBMs was recorded during the cold month of February and concentrated mainly in the highly populated Nile Delta. These findings revealed wide circulation of H5N1 avian influenza virus in LBMs in Egypt, which poses a threat to public health and the poultry industry. Long-term control measures are required, and routine surveillance of bird markets should be conducted year-round.

Isolation of highly pathogenic avian influenza H5N1 from table eggs after vaccinal break in commercial layer flock.

In May 2009, during routine monitoring of a commercial layer flock of about 87,000 birds kept in cages in 4 different houses that had been vaccinated 3 times with an inactivated H5N1 vaccine at weeks 1, 7, and 16, highly pathogenic avian influenza (HPAI) virus of subtype H5N1 was isolated and detected by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in tracheal and cloacal swabs collected from houses 3 and 4; 7 days after onset of clinical signs, there was an increase in mortality accompanied by a decrease in egg production and egg quality. In addition, using RT-PCR, the viral RNA could be detected from albumin and eggshell as well. Seven days after the onset of the clinical signs, the hemagglutination inhibition (HI) titers in the affected houses were 3.2 and 1.9 log2. In the other two houses, there were no clinical signs, and all tested samples were negative using virus isolation and real-time RT-PCR. The HI titers were 6.6 and 7.0 log2 in nonaffected houses. The isolated virus from egg albumin showed high nucleotides and amino-acid identities and clustered with viruses from recently H5N1-confirmed human infections and poultry from different places in Egypt. Moreover, several amino-acid substitutions of viral H5 protein were observed. The vaccinal break seems to be associated with immune escape mutants and/or improper vaccination. The role of contaminated eggs as a source of infection and as a vehicle for spread of the virus should be considered in area with avian influenza outbreaks.

Avian influenza H5N1 virus infections in vaccinated commercial and backyard poultry in Egypt.

In this paper, we describe results from a high-pathogenic H5N1 avian influenza virus (AIV) surveillance program in previously H5-vaccinated commercial and family-backyard poultry flocks that was conducted from 2007 to 2008 by the Egyptian National Laboratory for Veterinary Quality Control on Poultry Production. The real-time reverse transcription PCR assay was used to detect the influenza A virus matrix gene and detection of the H5 and N1 subtypes was accomplished using a commercially available kit real-time reverse transcription PCR assay. The virus was detected in 35/3,610 (0.97%) and 27/8,682 (0.31%) of examined commercial poultry farms and 246/816 (30%) and 89/1,723 (5.2%) of backyard flocks in 2007 and 2008, respectively. Positive flocks were identified throughout the year, with the highest frequencies occurring during the winter months. Anti-H5 serum antibody titers in selected commercial poultry ranged from <2 (negative) to 9.6 log(2) when determined in the hemagglutination inhibition test using a H5 AIV antigen. In conclusion, despite the nationwide vaccination strategy of poultry in Egypt to combat H5N1 AIV, continuous circulation of the virus in vaccinated commercial and backyard poultry was reported and the efficacy of the vaccination using a challenge model with the current circulating field virus should be revised.

[Paraspinous Sagittal Shift (PSSS): a novel approach for transmuscular quadratus lumborum block for hip surgery analgesia - four case reports]. / Paraespinhoso Sagital (PES): nova técnica no bloqueio transmuscular do quadrado lombar para analgesia em cirurgia de quadril ­ relato de quatro casos.

BACKGROUND: Effective pain management is essential for successful rehabilitation and enhanced recovery after joint arthroplasty. The Quadratus Lumborum Block (QLB) has mostly been described for abdominal surgery, but has also recently been applied to hip surgery patients. METHODS: In the following cases series, we suggest a modification of the TQL block described as Paraspinous Sagittal Shift QL block. We hypothesize that this approach may allow better LA spread to the lumbar nerve roots. Such technique involves a craniocaudal approach of LA injection between the QL and PM muscles behind the Anterior Thoracolumbar Fascia (ATLF) at the level of L4. Cases were provided with combined GA and PSSS modification of QL block via a single shot or catheter technique. RESULTS: Sensory distribution of the block in the four patients studied was found to cover the area between the T11-12 and L4-5 dermatomes. Spread of the injectate was confirmed via an A-P fluoroscopy imaging of the lumbosacral spine after injection of a mixture of LA and a contrast in the plane between the QL and PM muscles in two cases. CONCLUSIONS: The PSSS technique for TQL block may be beneficial as a part of multimodal analgesia for hip surgeries. This technique may be a safe alternative to psoas compartment block; however, future comparative studies are recommended. The PSSS technique for TQL block also may provide an easy access for catheter insertion.

Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists.

BACKGROUND AND AIMS: Regional analgesia may play a role in pain management during breast surgery. Ultrasound approach to paravertebral block may be challenging. This study compared success rates of ultrasound-guided erector spinae plane block (ESPB) versus parasagittal in-plane thoracic paravertebral block among senior anaesthesia residents in modified radical mastectomy. METHODS: One hundred and two female patients undergoing modified radical mastectomy were randomly categorized into PARA group receiving sagittal in-plane paravertebral block and ESPB group receiving erector spinae plane block. The block in the 1st six cases in each group was done by an experienced consultant as a demonstration for three anaesthesia residents not experienced in either block. Primary endpoint was assessing success rate of the blocks. Secondary endpoint was the haemodynamic response to skin incision and postoperative analgesia. RESULTS: All patients were females undergoing modified radical mastectomy. Success rate among residents was 100% in ESPB versus 77.8% in PARA group (P = 0.002). Duration to perform the block was less in ESPB group (4.39 ± 1.2 min) than PARA group (8.18 ± 2.42 min) (P < 0.0001). Guidance frequency by consultants was significantly higher in PARA than ESPB group. Time to 1st analgesic requirement and morphine consumption postoperatively were insignificant between the groups. There was no significant difference regarding haemodynamics. CONCLUSION: ESPB may be a simple and safe alternative to parasagittal in-plane paravertebral block to provide postoperative analgesia in modified radical mastectomy especially in novice practitioners. It provides equivalent profile of postoperative analgesia with less time to perform the block.

Mycoplasma gallisepticum: an emerging challenge to the poultry industry in Egypt.

In this study, the authors examined the technical performance of culture methodology using specific media: Mycoplasma isolation media of pleuropneumonia-like organisms (PPLO) broth and PPLO agar. Digitonin sensitivity, growth inhibition, the serum plate agglutination test, a commercially available enzyme-linked immunosorbent assay (ELISA) and a commercially available simplex polymerase chain reaction (PCR) test were used to detect Mycoplasma gallisepticum infections in samples collected from the lungs, trachea and tracheal swabs of poultry. These samples were collected from broiler-breeder flocks, broiler flocks and layer flocks. In addition, genomic bacterial deoxyribonucleic acid (DNA) was extracted and amplified, using a simplex PCR. The seroprevalence of M. gallisepticum antibodies in chickens and chicks was also investigated. The prevalence of M. gallisepticum was found to be highest in the layer flocks, at 33.3% (17/51), when the tracheal swab procedure was adopted. In young birds, the serum plate agglutination test and ELISA assay detected antibodies against M. gallisepticum in 69.9% (320/458) and 58.3% (267/458) of the chicken samples, respectively, and 48.7% (146/300) and 60% (180/300) of the samples from the chicks.

Epidemiological findings of outbreaks of disease caused by highly pathogenic H5N1 avian influenza virus in poultry in Egypt during 2006.

This paper describes the first threats of H5N1 avian influenza outbreaks in Egypt recorded from February to December 2006 in commercial and domestic poultry from different species and summarizes the major characteristics of the outbreak. There were 1024 cases from different poultry species (rural and commercial chickens of different breeding types, turkeys, ducks, geese, and quail) either in commercial breeding or in backyards from different locations in Egypt. All tested positive for the H5N1 subtype. From these cases only 12 avian influenza A viruses were isolated and characterized from samples collected during outbreaks. All isolates were characterized, and the data confirmed that the isolated viruses belong to highly pathogenic avian influenza of subtype H5N1. Full hemagglutinin (HA) gene (segment 4) sequencing was also done, and the sequences of these isolates were compared with other strains from Russia, Africa, and the Middle East. The data revealed that all Egyptian strains were very closely related and belonging to subclade 2.2 of the H5N1 virus of Eurasian origin, the same one circulating in the Middle East region and introduced into Africa at the beginning of 2006. This study showed evidence of the wide spread of H5N1 virus infection in domestic poultry in Egypt within a short time. The most obvious features of these outbreaks were severe clinical signs and high mortalities as well as very rapid and widespread occurrence within the country in a very short time. The possible causes of its rapid spread and prospects of disease control are discussed.

The Shikani Optical Stylet as an Alternative to Awake Fiberoptic Intubation in Patients at Risk of Secondary Cervical Spine Injury: A Randomized Controlled Trial.

BACKGROUND: Conventional intubation of the trachea and consequent prone positioning of anesthetized patients with cervical spine instability may result in secondary neurological injury. Historically, flexible fiberoptics used to be the chief choice for patients presenting with cervical spine instability surgery with difficult airway. Recently, the rigid optical stylets have shown promise in assisting difficult intubations. PURPOSE: The aim of the present study was to compare the efficacy of Shikani optical stylet (SOS) with the flexible fiberscope for awake intubation in patients with cervical spine instability. PATIENTS AND METHODS: In total, 60 adult patients diagnosed with cervical instability or at risk of secondary cervical injury, who were planned for awake intubation and/or self-positioning prone, were registered in this study and were randomly categorized into 2 equal groups (30 patients each), a fiberoptic group and an SOS group, followed by assessment of coughing and gagging during intubation, time to successful intubation, number of attempts for successful intubation, and hemodynamic parameters. RESULTS: As regards time to successful intubation, statistically significant differences were detected between the 2 studied groups, with the fiberoptic group having significantly longer intubation time than the Shikani group, whereas no statistically significant differences were recorded between the 2 groups with regard to the first-attempt success, the mean heart rate value, the mean arterial blood pressure, coughing, and occurrence of complications. CONCLUSION: This study validates the efficacy of both SOS and flexible fiberoptic bronchoscope for awake oral intubation in patients with cervical spine instability. SOS has been found to be more effective in reducing time to intubation.