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Reliable HPLC determination of nitrate and nitrite in Egyptian dairy products

Magda Abd El Aziz¹ and Ahmed Salem Sebaei^2*

¹Dairy Chem. Department, Animal Production Research Institute, Agriculture Research Centre, Giza, Egypt.

²Central Laboratory of Residue Analysis of Pesticides and Heavy Metals in Food, Agricultural Research Center, Ministry of Agriculture, Giza, 12311, Egypt.

abdelazizmagda61@yahoo.com, Ahsebaei@gmail.com,

Abstract: Presence of excessive nitrate and nitrite in foodstuff has toxic and carcinogenic effects on human. The present study was to develop HPLC method to determine the two salts in different dairy products in the local Egyptian markets. The optimal conditions of HPLC method were applied by using methanol: water (1:4), N-O ctayl amine at pH 3-4 for the mobile phase at flow rate 0.8 ml/min. Recoveries of nitrate and nitrite were between95-104% and 96-105%, respectively, indicating that the method is quite accurate. So, this method was applied for determination the salts levels in 44 collected samples including UHT milk, fermented milk and cheese from the Egyptian market. The results revealed that the nitrate contents in the samples varied in the range 0.00 - 6.30 mg/kg. High levels of nitrate were observed in the fortified dairy products with fruits or vegetables and processed cheese. However, the nitrite was not detected in all samples. The proposed method is a reliable and applicable method for the determination of nitrate and nitrite levels in dairy products. The mean values for nitrate in investigated samples were lower than ADI levels of WHO. This means that the dairy products which were investigated are safe for consumption.

[Magda Abd El Aziz and Ahmed Salem Sebaei. Reliable HPLC determination of nitrate and nitrite in Egyptian dairy products. Nat Sci 2019;17(6):1-8]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 1. doi:10.7537/marsnsj170619.01.

Key words: Nitrate, Nitrite, HPLC, UHT milk, N-octyl amine, fermented milk, cheese, Egypt.

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Fentanyl or Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block: A Comparative Study

Prof. Dr. Mohsen Abd Elghany Basiony, Dr. Sanaa Mohammed Elfawal, Dr. Marwa Ahmed Khairy, Ahmed Nageh Mohammed

Anaesthesiology, Intensive Care and Pain Management Deparment, Faculty of Medicine, Ain Shams University, Cairo, Egypt

ahmednageh1991@gmail.com

Abstract: Peripheral nerve block as an anesthetic technique plays an important role in modern regional anesthesia. Upper limb surgeries are mostly performed under peripheral blocks such as the brachial plexus block. Peripheral nerve blocks not only provide intra-operative anesthesia, but also extend analgesia in the post-operative period without major systemic side-effects by minimizing stress response and using minimal anesthetic drugs. Ultrasound guidance has many advantages, as it can potentially improve the success rate up to 99%, fastens the onset time and reduce the risk of complications. In our study we compared between fentanyl and dexmedetomidine as adjuvants to bupivacaine in supraclavicular brachial plexus block as regards the onset and duration of the sensory and motor block as well as side effects. Fifty patients were included in this prospective, randomized, controlled, double blind study. Patients were randomly divided into two groups. Patients of group I (BD group) received 30 ml of bupivacaine 0.25% with dexmedetomidine 1 µg/kg while patients of group II (BF group) received 30 ml of bupivacaine 0.25% with fentanyl 1 µg /kg into the supraclavicular brachial plexus block. The two groups were compared regarding their demographic data (age, sex and body weight), the duration of surgery, onset and duration of sensory block and onset and duration of motor block. The duration of analgesia of the brachial plexus block was recorded. Hemodynamics were monitored through the operation. Observation of any side effects was done. Data were collected for each patient and statistical analysis was done. The present study showed that addition of dexmedetomidine to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of both sensory and motor blocks and significantly prolonged their duration compared to fentanyl. Also dexmedetomidine prolonged the analgesia of brachial plexus block as well as postoperative analgesia with subsequent consumption of fewer amounts of analgesics. The use of ultrasonography in performing the supraclavicular nerve block abolished nearly the incidence of complication such as pneumothorax or intravascular injection. To conclude, we would like to state that dexmedetomidine prolongs the duration of sensory and motor block as compared with fentanyl when used as an adjuvant to bupivacaine in peripheral nerve block. Dexmedetomidine also increase time to first analgesic use, and decreases total analgesic use with no side-effects.

[Mohsen Abd Elghany Basiony, Sanaa Mohammed Elfawal, Marwa Ahmed Khairy, Ahmed Nageh Mohammed. Fentanyl or Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block: A Comparative Study. Nat Sci 2019;17(6):9-14]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 2. doi:10.7537/marsnsj170619.02.

Keywords: Fentanyl, Dexmedetomidine, Bupivacaine

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Role of Troponin-T at Admission and Serial Troponin-T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Prof. Dr. Azza Mohamed Shafeek Abdel Mageed, Dr. Walid Hamed Nofal, Dr. Eman Abu bakr El Seddik Ahmed and Akram Ibrahim Younis

Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University, Egypt

dr_akram193@yahoo.com

Abstract: Serum troponin concentrations have been associated with increased mortality in almost every clinical setting they have been examined, including sepsis. Sepsis is the physiological response to severe infection. It is defined as the presence (probable or documented) of infection together with systemic features of inflammation. Severe sepsis is sepsis-induced tissue hypoperfusion or organ dysfunction, and septic shock refers to sepsis-induced hypotension, persisting despite adequate fluid resuscitation, which may be defined as infusion of 30 ml/kg of crystalloids. Elevated troponin levels are observed in 43% across all intensive care patient groups. The estimated prevalence of positive troponin in the context of sepsis is 61%. The mechanism of myocyte insult in severe sepsis and septic shock, in the absence of thrombotic acute coronary syndrome, leading to elevated serum troponin, is not yet fully understood. Myocardial depressive factors (inflammatory mediators, endotoxins), microvascular dysfunction and increased myocardial cell membrane permeability in conjunction with myocardial oxygen demand–supply mismatch, are potential explanations for sepsis induced troponin elevation. In this setting, troponin elevation occurs in the absence of myocytenecrosis and this hypothesis is supported by clinical observations that myocardial depression in the context of sepsis is a reversible process in most surviving patients. The aim of this study is to evaluate the prognostic value of troponin T level at admission and serial troponin T testing in patients with severe sepsis and septic shock. This work was carried on 70 patients with severe sepsis and septic shock from those attending the intensive care units in Ain shams university hospitals in the time period between February 2018 and July 2018. These patients were subdivided into 2 groups each consisted of 35 patients, the first group with elevated troponin T at admission and the other group with negative troponin T at admission.

[Azza Mohamed Shafeek Abdel Mageed, Walid Hamed Nofal, Eman Abu bakr El Seddik Ahmed and Akram Ibrahim Younis. Role of Troponin-T at Admission and Serial Troponin-T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock. Nat Sci 2019;17(6):15-24]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 3. doi:10.7537/marsnsj170619.03.

Keywords: Role; Troponin-T; Admission; Serial Troponin-T; Testing; Predicting Outcome; Severe Sepsis; Septic Shock

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Increased Body Mass Index and Adjusted Mortality in Intensive Care Unit Patients with Sepsis or Septic Shock.

Prof. Dr. Sherif Wadie Nashed, Prof. Dr. Shereen Mostafa Elgengeehy, Anas Abdelatty Mostafa Abdelatty

Anesthesia, Critical Care and Pain Management Department, Faculty of Medicine, Ain Shams University, Egypt

dr.anasabdelatty@gmail.com

Abstract: Sepsis is life‐threatening organ dysfunction caused by a dysregulated host response to infection and is characterized by the presence of suspected or proven infection accompanied by an increase in sequential (sepsis‐related) organ failure assessment (SOFA) score of two points or more from baseline. Sepsis is one of the most common causes of death among hospitalized patients in the intensive care unit (ICU). It is particularly difficult to diagnose in this setting because of the multiple comorbidities and underlying diseases that these patients present. Over the past few decades, a growing body of evidence has investigated the values of different predictors of sepsis-related mortality. Previously, it was reported that old age, tachycardia, hypotension, elevated C-reactive protein (CRP) and lactate, thrombocytopenia, need of mechanical ventilation, high Acute Physiology, and Chronic Health Evaluation (APACHE) II, and high SOFA scores were variables associated with high mortality. Recently, a growing number of published studies have reported that obesity can be significantly correlate with mortality in the ICU setting. Body mass index (BMI) is one of the common clinical demographic characteristics and can be calculated from the ratio of body weight to squared height (kg/m²). Nevertheless, data are limited regarding the role of BMI in predicting short-term mortality among patients with sepsis. Therefore, we conducted the present prospective study in order to evaluate the effect of increased BMI on mortality in ICU patients with sepsis or septic shock. The present study included 45 adult patients (≥16 years old) who were admitted to the ICU and treated for sepsis, severe sepsis, or septic shock. The patients were divided into three groups based on their BMI. In the present study, the average age of the included patients ranged from 55-70 years old; while the majority of patients were males. Moreover, we found that patients with a BMI < 25kg/m2 were older than other groups of patients. On the other hand, patients with BMI > 30kg/m2 were more likely to have diabetes mellitus. Regarding the cause of admission, our analysis showed that patients with low BMI (< 25 kg/m2) were more likely to have chest infection; while patients with high BMI (>30 kg/m2) were more likely to have bed sores. In terms of vital signs of the included patients during the first day of admission, the present study shows that obese patients had significantly lower body temperature, heart rate, and respiratory rates; while they had significantly higher mean arterial blood pressure than patients in other BMI groups. Our analysis showed that the mortality rate was significantly lower in obese patients than other BMI groups (p =0.049). On the other hand, there were no significant associations between BMI and ICU length of stay, APACHE II Score, SOFA score, or rate of readmission. In concusion, Obesity is a potential predictive characteristics for mortality among septic patients admitted to ICU.

[Sherif Wadie Nashed, Shereen Mostafa Elgengeehy, Anas Abdelatty Mostafa Abdelatty. Increased Body Mass Index and Adjusted Mortality in Intensive Care Unit Patients with Sepsis or Septic Shock. Nat Sci 2019;17(6):25-37]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 4. doi:10.7537/marsnsj170619.04.

Keywords: Body Mass; Index; Adjusted Mortality; Intensive Care Unit; Patients; Sepsis; Septic Shock

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Levetiracetam versus phenytoin for seizure prophylaxis in patient with traumatic brain injury

Prof. Dr. Adel Michael Fahmy Shenouda, Dr. Ayman Ibrahim Sayed Tharwat, Dr. Rania Mahrous Aly Hussein and Ahmed Tharwat Abd-Elftah Ismail

Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Egypt.

anam7tar2000@gmail.com

Abstract: Traumatic brain injury (TBI) is a serious neuro-disorder commonly caused by road traffic accidents (RTAs), sports related events or violence. It is one of the leading causes of disability and death of young adults in industrialized countries presents a major worldwide social, economic, and health problem. TBI are classified according to severity, physical mechanism, pathophysiology and CT findings. Secondary brain injuries are defined as the constellation of cellular and biochemical processes that are set in motion by the primary injury and then evolve over the subsequent hours and days. They include cerebral edema, hematomas, hydrocephalus, intracranial hypertension, vasospasm, metabolic derangement, infection, and seizures. Researches aiming at reducing or preventing the neurological consequences of head trauma are ongoing, but currently the clinical outcome following TBI depends on the circumstances of injury and early clinical management aiming at reducing the occurrence of secondary brain insults. No effective intervention has been found to reverse the pathologic events initiated by the traumatic event. Post-traumatic seizures are seizures that result from traumatic brain injury (TBI and brain damage caused by physical trauma. Post traumatic seizures classified in to immediate post traumatic seizures, early post-traumatic seizures, late post-traumatic seizures and post-traumatic epilepsy. Anticonvulsants may be indicated in the early stages following moderate to severe TBI in order to reduce the incidence of seizures. Seizure medications can be grouped according to their main mechanism of action, although many of them have several actions and others have unknown mechanisms of action. Phenytoin sodium, is a hydantoin-derivative anticonvulsant. The mechanism of action is through limitating of seizure propagation by reduction of post-tetanic potentiation. Side effects including, hypotension if administered too rapidly though the intravenous approach, atrial or ventricular conduction depression, ventricular depression, respiratory depression, toxic hepatitis and liver damage, hematologic effects, local soft-tissue reactions and rash. The objective of our study is to compare the efficacy of Levetiracetam versus phenytoin in the prevention of early post traumatic seizures. The study was conducted on 40 patients with moderate to severe traumatic brain injury admitted to the Critical Care Department of Ain Shams University Hospital. All the forty patients will be divided into two groups A & B: (1) Patients in group (A) will receive PTH within 1st 24 hours after TBI as15mg/kg loading then 7mg/kg/day maintainence for 7 days. (2) Patients in group (B) will receive LEV syrup as 5 cc (500mg) via NGT or OGT / 12 hour. The results of this study show that no significant effect of both treatment of blood picture, electrolytes, kidney function, liver function and vital signs. The value of SGOT & SGPT of studied patients was described. There was no clinical significance in value of SGOT in seven days follow up between two groups. There were no clinical significance in value of SGPT between two groups in first 6 days but there were clinical significance at day seven with (P=0.0.016). The incidence of seizure was 2 patients (10.0%) in LEV group and 1 patient (5.0%) in phenytoin group with no statistically significant difference between the two groups (p=0.925).

[Adel Michael Fahmy Shenouda, Ayman Ibrahim Sayed Tharwat, Rania Mahrous Aly Hussein and Ahmed Tharwat Abd-Elftah Ismail. Levetiracetam versus phenytoin for seizure prophylaxis in patient with traumatic brain injury. Nat Sci 2019;17(6):38-48]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 5. doi:10.7537/marsnsj170619.05.

Keywords: Levetiracetam versus phenytoin, seizure prophylaxis, patient, traumatic brain injury

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Early Versus Late Norepinephrine Therapy in Management of Septic Shock as Prognostic Factor of Mortality

Ahmed Aly Fawaz, Mohammed Abd- El Salam El Gendy, Samar Mohamed Abd- El Tawab and Hussein Hassan Ibrahim

Department of General Intensive Care, Faculty of Medicine, Ain Shams University, Egypt.

 dr.husseinhassan22@gmail.com

Abstract: Background: Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is a critical reduction in tissue perfusion; acute failure of multiple organs, including the lungs, kidneys, and liver. Common causes include many different species of gram-positive and gram-negative bacteria. Immunocompromised patients may have uncommon bacterial or fungal species as a cause. Signs include fever, hypotension, oliguria, and confusion. Diagnosis is primarily clinical combined with culture results. Early recognition and treatment is critical. Treatment is aggressive fluid resuscitation, antibiotics, surgical excision of infected or necrotic tissue and drainage of pus, and supportive care. Objective: Demonstration of the relationship between delay in initiation of vasopressor therapy (norepiniphrine) in the management of septic shock patients and the mortality rate. Determine effects of early Norepinphrine adminstration on septic shock patients and their ICU length of stay. Methodology: This study was conducted on 50 diagnosed patients with septic shock at general intensive care unit Ain Shams University Hospitals. Patients are divided into two groups according to time (Hours) to initial norepinephrine administration: group A (Early-NE group which received norepinephrine <3 hours after the onset of septic shock) and group B (Late-NE group which received norepinephrine ≥3 hours after the onset of septic shock). Results: The mean arterial pressure improvement is better in the Early-NE group than in the Late-NE group during the first 12 hours of resuscitation and the subsequent serum lactate levels were significantly lower in the Early-NE group than in the Late-NE group during the first 24 hours of resuscitation. There was no significant difference between the two groups in the ICU Length of Stay. 28 Day Mortality was significantly lower in group A than in group B. The overall 28-day mortality was 40 %. Every one hour delay in norepinephrine initiation within the first six hours after the onset of septic shock is associated with increase in mortality rate by 10,66%. The 28-day mortality was 24% in the Early-NE group A and 56% in the Late-NE group B. Conclusion: This study indicates that early administration of norepinephrine for septic shock is associated with improved survival. Mortality increases when initial norepinephrine administration is delayed.

[Ahmed Aly Fawaz, Mohammed Abd- El Salam El Gendy, Samar Mohamed Abd- El Tawab and Hussein Hassan Ibrahim. Early Versus Late Norepinephrine Therapy in Management of Septic Shock as Prognostic Factor of Mortality. Nat Sci 2019;17(6):49-54]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 6. doi:10.7537/marsnsj170619.06.

Keywords: Norepinephrine, Septic Shock

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Comparison between Preload with Colloid versus Preload with Crystalloid before Spinal Anesthesia

Prof. Dr. Mohammed Saeed Abd El-Aziz¹, Ass. Prof. Dina Salaah El-Deen¹, Dr. Alaa Abd El-Aziz niazy² and Moustafa Tarek Nabieh Ghazal²

¹Anesthesiology, Intensive Care & Pain Management Department, Faculty of Medicine, Ain Shams University, Egypt.

²Anesthesiology, Intensive Care & Pain Management Department, Faculty of Medicine, Misr University for Science and Technology, Egypt.

 moustafaghazal69@gmail.com

Abstract: Background: Hypotension following spinal anaesthesia is mainly occurs due to sympathetic blockade leading to peripheral vasodilatation and venous pooling of blood. As a result, there is decreased venous return and cardiac output leading to hypotension. Objectives: To aid in making appropriate therapeutic decisions in the prophylaxis and management of post spinal hypotension and decreasing hazards of hypotension and the use of vasopressor. Patients and Methods: Type of study: Prospective randomized controlled Study. The study was performed in the teaching hospitals of Misr university of Science and Technology. Study period: 5 months from March to July 2018. Study population: 20-50 years old patients undergoing elective surgery with spinal anesthesia. Results: To aid in making appropriate therapeutic decisions in the prophylaxis and management of post spinal hypotension and decreasing hazards of hypotension and the use of vasopressor. Conclusion: In conclusion, colloid appears to be more effective than crystalloid in maintaining the blood pressure after spinal anesthesia. Nevertheless, further large-scale trials are still needed to confirm our findings.

[Mohammed Saeed Abd El-Aziz, Ass. Dina Salaah El-Deen, Alaa Abd El-Aziz niazy and Moustafa Tarek Nabieh Ghazal. Comparison between Preload with Colloid versus Preload with Crystalloid before Spinal Anesthesia. Nat Sci 2019;17(6):55-60]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 7. doi:10.7537/marsnsj170619.07.

Keywords: Colloid, Crystalloids, Spinal Anesthesia

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Outcome of Z-plasty Technique for Reconstruction of Defects after Sacrococcygeal Pilonidal Sinus Excision. Systematic Review

Emad El-dein F. Ibrahim, Shaaban M. Abdulmaged, Hossam S. Aly, Amira H. Sabry and Ahmed M. Hussein

Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Ahmedm.hady@yahoo.com

Abstract: Background: Sacrococcygeal pilonidal sinus disease is defined as a hair-filled cavity in the subcutaneous fat of the natal cleft (postsacral intergluteal region). Aim of the Work: to investigate the complications of z-plasty technique for reconstruction of defects after sacrococcygeal pilonidal sinus excision as regards the incidence of seroma, wound infection, flap necrosis, wound dehiscence and recurrence of sacrococcygeaal pilonidal sinus. Patients and Methods: The current review was restricted to clinical studies that discuss z-plasty technique for reconstruction of defects after sacrococcygeal pilonidal sinus excision. Adolescents and adult patients from age 15 to 50 years who underwent excision of sacrococcygeal pilonidal sinus and reconstruction of the defect by z-plasty. All studies incuded depended on excision of sacrococcygeal pilonidal sinus and coverage by z-plasty. Results and Conclusion: our study advocates that z-plasty technique provides a reasonable method of treatment of sacrococcygeal pilonidal sinus that flattens the natal cleft with low overall incidence of complications and a low recurrence rate and the advantage of less frequent dressings, short hospital stay and rapid return to work. Surgical management of sacrococcygeal pilonidal sinus is a big challenge and there is no single approach recommended between surgeons.

[Emad El-dein F. Ibrahim, Shaaban M. Abdulmaged, Hossam S. Aly, Amira H. Sabry and Ahmed M. Hussein. Outcome of Z-plasty Technique for Reconstruction of Defects after Sacrococcygeal Pilonidal Sinus Excision. Systematic Review. Nat Sci 2019;17(6):61-66]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 8. doi:10.7537/marsnsj170619.08.

Key words: pilonidal sinus, sacrococcygeal pilonidal sinus, treatment of sacrococcygeal pilonidal sinus, z-plasty after sacrococcygeal pilonidal sinus excision, z-plasty

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The Impact of Quercetin on Sirtuin1, High Mobility Group Box 1 and Selected Oxidative Stress Indices in Ulcerative Colitis Induced by Oxazolone in Rats

Aya Fathi Mohamed, Heba Bassiony Ghanem, Samia Abd El Hamid El-Dardiry, Yahya Ahmed Al-Mashad

Department of Medical Biochemistry and Molecular Biology Faculty of Medicine, Tanta University, Tanta, Egypt.

ayafathi405@yahoo.com, Al-Mashad@gmail.com

Abstract: Background: Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease (IBD) characterized by superficial mucosal ulceration, rectal bleeding, diarrhea, and abdominal pain. UC is restricted to the colon. The cause of UC is still unknown, but several factors have been documented. These include environmental factors, genetic factors, microbial pathogens, altered levels of inflammatory mediators, oxidative stress. Recently, antioxidant supplementation has been the major focus of attention across the world among the health professionals to explore it as a strategy to protect against the injurious effects of oxidative stress. The aim of this study is to investigate the beneficial effects of quercetin in a rat model of oxazolone induced ulcerative colitis. Material and method: The study was conducted on 60 male albino rats divided into four groups; group І(control group), group II (oxazolone induced colitis group) and group IIІ ( co-treated group) which was subjected to intra-rectal injection of a single dose of 1.1ml / rat of oxazolone solution which was dissolved in 40% (v/v) aqueous ethanol to a final concentration of 7.5 mg/mL at the day of induction were given Quercetin orally in a dose of 5mg/kg / day for 14 days. Group IV (prophylaxis & treated group): which was given quercetin orally in a dose of 5 mg /kg / day for 7 days before induction of ulcerative colitis then quercetin was given orally in a dose of 5 mg /kg / day for 14 days after induction of ulcerative colitis. All groups were subjected to estimation of Peroxinitrite level, Sirtuin 1 (SIRT1) Level, High mobility group box 1 (HMGB1) level and FRAP (ferric reducing antioxidant power) assay respectively. Results: This study showed that quercetin significantly decreased HMGB1 and peroxinitrite level. Also it increase SIRT1 and FRAP level. Conclusion: On basis of these results it could be concluded that quercetin exhibits anti-inflammatory, antioxidant effects in experimentally induced UC in rats.

[Aya Fathi Mohamed, Heba Bassiony Ghanem, Samia Abd El Hamid El-Dardiry, Yahya Ahmed Al-Mashad. The Impact of Quercetin on Sirtuin1, High Mobility Group Box 1 and Selected Oxidative Stress Indices in Ulcerative Colitis Induced by Oxazolone in Rats. Nat Sci 2019;17(6):67-76]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 9. doi:10.7537/marsnsj170619.09.

Keywords: Ulcerative colitis, quercetin, oxazolone, SIRT1, High mobility group box 1.

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Update in Anesthesia of Joint Arthroplasty

Prof. Dr. Basel Mohammed Essam Nor El-Din, Prof. Dr. Ibraheem Mostafa Al-Ganzouri, Dr. Mohammed Mohammed Abdel Fattah, Mohammed Mohei El Deen Shawki

Anesthesiology and Intensive Care Department, Faculty of Medicine - Ain Shams University, Egypt

mohammedmoheieldeen@gmail.com

Abstract: Ultrasound Guided has had a profound effect on regional anesthesiology and acute pain medicine. Despite the heterogeneity in the design of multiple RCTs, USG has consistently provided improved outcomes regarding block procedure time, block onset time, and (depending on the varying definitions) increased block success for single-injection and CPNBs. More recent data support a role for preprocedural USG in patients with predictors of technically difficult spinal anesthesia. Although the evidence for decreasing the risk of peripheral injury is currently lacking, accumulating evidence confirms that USG decreases but (just as important) does not eliminate the risk of LAST. Finally, the focus of research has appropriately changed to investigating the optimal USG techniques for specific nerve blocks and emerging data should further expand the applications and benefits of regional anesthesia.

[Basel Mohammed Essam Nor El-Din, Ibraheem Mostafa Al-Ganzouri, Mohammed Mohammed Abdel Fattah, Mohammed Mohei El Deen Shawki. Update in Anesthesia of Joint Arthroplasty. Nat Sci 2019;17(6):77-85]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 10. doi:10.7537/marsnsj170619.10.

Keywords: Update in Anesthesia of Joint Arthroplasty

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Microbial, Proximate and Heavy Metals Composition of Smoked Frog (Rana esculenta) From Selected Markets in Ilorin, Nigeria

Awe, Sunday and Oshomah, Omonegbo Christiana

Department of Biosciences and Biotechnology, Kwara State University, Malate, Ilorin Nigeria

Sunday.awe@kwasu.edu.ng; asflor5@yahoo.com

Abstract: The high cost of dietary protein from conventional sources such as cattle, fish and poultry has necessitated the demand for smoked frog as an alternative sources of protein by the common man. Microbial quality, proximate and heavy metal compositions of smoked frog samples from Ilorin markets (Ganmo, Idiape, Oja-Oba, Pata and Mandate) in Nigeria were studied using standard laboratory methods. The bacteria isolates were Staphylococcus aureus, Escherichia coli and Salmonella typhi. The fungi isolates were Fusarium oxysporum, Aspergillus flavus, Rhizopus sp, Aspergillus niger, Penicillium sp and Saccharomyces cerevisiae. The total heterotrophic count of the samples ranged from 1.1±0.152x10⁴ cfu/g – 4.8±0.057x10⁴ cfu/g. The coliforms levels were generally high, ranging from 1.0±0.321x10³ cfu/g - 7.0±0.577x10³ cfu/g in Idiape [E] and Pata [B] respectively. The Salmonella counts ranged from 1.0±0.577x10² cfu/g - 4.0±0.500x10² cfu/g in Idiape [E] and Pata [B] respectively. The total Staphylococci count ranged from 2.0±0.259x10²cfu/g - 4.0±0.500x102 cfu/g in Mandete [D] and Ganmo [C] respectively. The fungi count ranged from 1.0±0.152x10³ cfu/g - 8.0±1.040x10³ cfu/g. The total Escherichia coli ranged from 2.0±0.500 - 6.0±0.288x10²cfu/g. The total microbial counts obtained from this work were found to be lesser than the specified limits [1x10⁵ cfu/g] for bacteria but higher for fungi and for coliforms [1x10² cfu/g]. The crude protein content of the samples ranged from 8.2±0.378% -14.5±0.264% in Idiape [E] and Gamon [C] respectively. The crude fat, ash, carbohydrate and moisture content ranged from 50.50±0.520%-62.15±0.057%, 11.1±0.202% - 15.2±0.152%, 7.4±0.152% - 13.60±0.404% and 8.1±0.264% - 15.3±0.152%, respectively. The concentrations of Zn, Fe and Cu in the samples were 0.17±0.035mg/l - 0.22±0.115mg/L, 2.1±0.453mg/L - 2.3±0.230mg/L, 0.01±0.005mg/L - 0.03±0.002mg/L respectively while Pb and Cd were not detected. These heavy metals concentrations were found to be within the standard limits prescribed by WHO/SON. Smoked frog from Ilorin markets was found to be nutritionally rich but harbor pathogenic microorganism which can pose serious health hazard to consumers. Hence, they are not totally safe for human consumption.

[Awe, Sunday and Oshomah, Omonegbo Christiana. Microbial, Proximate and Heavy Metals Composition of Smoked Frog (Rana esculenta) From Selected Markets in Ilorin, Nigeria. Nat Sci 2019;17(6):86-90]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 11. doi:10.7537/marsnsj170619.11.

Keywords: Smoked frog, microbiological, proximate, heavy metals concentration

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Evaluation of Risk Factors for Malignancy in A Solitary Thyroid Nodule

Dr. Fawzi Salah Fawzi and Rami Kamal Atiya Morcos

General Surgery Department, Faculty of Medicine - Ain Shams University, Cairo, Egypt

ramikamal1@live.com

Abstact: The incidence of malignancy in STNs is quite significant and it is not very low as was thought before. Thyroid cancer may be less frequent in MNG compared to STNs. No significant increase in the rate of carcinoma was observed in patients with STNs. Multinodularity does not increase the risk of thyroid malignancy. However, patients with MNG who develop PTC are at an increased risk of cancer multifocality. STNs with suspicious US criteria can be evaluated by elastography that seems to be a useful addition for the assessment of such indeterminate nodules. Taking individual risk factors in isolation is not always reliable. Using a predictive model, one can anticipate a patient’s risk of malignancy when the diagnosis is unclear. Nodule size does not appear to be a reliable parameter to improve the clinical management of a nodular goiter because of a high variability between size of nodular area and tumor diameter. Clinical examination is not useful in assessing malignancy risk, as corroborated by previous studies. FNA is sensitive in clinical suspicion of PTC, according to our results it should be complemented with extemporaneous biopsy due to its higher Specificity. STNs should be investigated thoroughly with a high index of suspicion because there is a high probability of malignancy, more than 30%. US-detected thyroid calcifications are strongly associated with malignancy, especially in certain groups, such as young patients or patients with a STN. With age, the prevalence of clinically relevant STNs increases, whereas the risk that such nodules are malignant decreases. TSH alone is not as useful as US features in deciding whether or not to perform FNA in patients with STNs. FNAC is a simple, easy-to-perform, cost-effective, and easily-repeated procedure for the diagnosis of thyroid cancer. The overall prevalence of thyroid carcinoma in this study population with STNs was 12%. US characteristics are extremely important in evaluating STNs. Radiological evaluation of lesions for the differentiation of benign versus malignant nature is important because unnecessary surgical procedures may lead to complications. FNAC should be performed on ALL STNs classified as positive, regardless of palpability. It is concluded from the study that a remarkable proportion of STNs (12%) was malignant. Clinical, Laboratory, and Ultrasound features of STNs can be used as predictors of malignancy in children. Although none has diagnostic accuracy as high as that of FNA. While malignancy is associated with positive family history of thyroid cancer and hypoechoic lesions, palpable lymphadenopathy had the greatest risk. There are significant predictors of malignancy in STNs such as: Male gender, Solitary nodules, Size between 2-4 cm, Microcalcifications, Hypoechogenic pattern, Solid pattern, Ill-defined edges and Increased intranodular vascularity. This study concluded female predominance was observed, peak incidence was in the age group 31-50 years. Most common presenting complaint was painless neck swelling. The management of a STN remains a clinical challenge despite guidelines. Clinically, STNs should be investigated thoroughly with a high index of suspicion because there is at least a 10–20% probability of malignancy.

[Fawzi Salah Fawzi and Rami Kamal Atiya Morcos. Evaluation of Risk Factors for Malignancy in A Solitary Thyroid Nodule. Nat Sci 2019;17(6):91-99]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 12. doi:10.7537/marsnsj170619.12.

Keywords：Evaluation；Risk; Factor; Malignancy; solitary Tudate Thyroid; Nodule

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Incidence of Post-Operative Hypocalcaemia Post Total Thyroidectomy in the Early Learning Curve of Junior Surgeons

Ayman Abdullah Abdraboh ¹, Hesham Omran ², Hossam Sobhy Rady ³, Khaled Nabil Mahmoud Saad ⁴

¹ Professor and Head of the Endocrine Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.

² Assistant Professor of General Surgery, Faculty of Medicine, Ain Shams University, Egypt.

³ Lecturer of General Surgery, Faculty of Medicine, Ain Shams University, Egypt.

⁴ General Surgery, Faculty of Medicine, Ain Shams University, Egypt.M.B.B.Ch

khalednabilsaad@gmail.com

Abstract: Background: Goiter is one of the most common disorders within the thyroid gland. Some patients are presented with symptoms while other are presented without symptoms and discovered accidentally during a routine U/S of the neck. Goiter is defined as an enlargement of the thyroid gland. Aim of the Work: The purpose of this study is to detect the hypocalcaemia rate after total thyroidectomy done by junior surgeons in their early learning curve. Materials and Methods: This is a prospective study of new consecutive patients underwent total thyroidectomy and preoperative and postoperative time-serial analysis of total calcium, and PTH levels to study the incidence of hypocalcemia post total thyroidectomy done by junior surgeons in their early learning curve from July 2018 to December 2018 in Ain shams university hospital. Total patients in the study are 20 patients undergoing total thyroidectomy operated by the same surgical team under the supervision of the same university professors. Results: Conclusion: By applying this study the junior staff could have a chance to increase their learning curve and dependability in the surgical ward as they are supervised by the professors. Given the statistical analysis the results are nearly the same regarding this study and previous studies.

[Ayman Abdullah Abdraboh, Hesham Omran, Hossam Sobhy Rady, Khaled Nabil Mahmoud Saad. Incidence of Post-Operative Hypocalcaemia Post Total Thyroidectomy in the Early Learning Curve of Junior Surgeons. Nat Sci 2019;17(6):100-105]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 13. doi:10.7537/marsnsj170619.13.

Keywords: Hypocalcaemia, Thyroidectomy

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The Effect of Addition of Atracurium to Local Anesthetic in Peribulbar Block in Patients Undergoing Cataract Surgery

Prof. Dr. Raouf Ramzy Gadalla, Ass. Prof. Dr. Salwa Omar El Khattab, Dr. Mohamed Moien Mohamed, Mohamed Ahmed Abdalla Abdelkader

Anesthesiology, Intensive Care & Pain Management Department, Faculty of Medicine, Ain Shams University, Egypt

mecho_201090@yahoo.com

Abstract: This study was carried out in Ain Shams University Hospital and included 62 patients of both sexes undergoing cataract surgery using peribulbar block. The aim of the study was to evaluate the effects of adding Atracurium (5mg) to local anesthetic mixture on akinesia of globe and eyelid regarding onset and duration in cataract surgery. Patients were randomly allocated into two equal groups, (32 patients in each group) according to the medications they had received (with a total volume of 8 ml): Group I (study group): Local anesthetic 4 ml 2% Lidocaine +3.5ml 0.5% plain Bupivacaine + hyalurinidase in a dose of 15 IU/ml of local anesthetic + 0.5ml Atracurium (5mg). Group II (control group): Local anesthetic 4 ml of 2% Lidocaine +3.5 ml 0.5% plain Bupivacaine + hyalurinidase in a dose of 15IU/ml of local anesthetic + 0.5ml saline 0.9%. Both groups were assessed for onset and degree of eyelid and globe akinesia using the OASS at 5, 7 and 10 minutes after injection, duration and degree of globe akinesia postoperatively and presence of complications or side effects during or after the block. The main finding in this study was that Atracurium group (group I) demonstrated significantly rapid onset of lid and globe akinesia compared to the control group (group II). Regarding complete lid akinesia (demonstrated by complete loss of levator and orbicularis oculi muscles function) a high statistical difference between the Atracurium and control groups was detected at 5 and 7 minutes postinjection. As 26 patients (81.3%) in group I showed complete lid akinesia versus 6 patients (18.8%) in group II at 5 minutes, while at 7 minutes 29 patients (90.6%) in group I compared to the 15 patients (46.9%) in group II. Also, The Atracurium group showed better complete globe akinesia scores overall. Globe akinesia scores were significantly better at 5 minutes post injection. The effect of the globe block in the Atracurium group was longer than the control group, but there was no statistical significant difference. One patient from the atracurium group and two patients from the control group showed subconjunctival hemorrhage. There were noother significant complications or adverse effects observed in both groups.

[Raouf Ramzy Gadalla, Salwa Omar El Khattab, Mohamed Moien Mohamed, Mohamed Ahmed Abdalla Abdelkader. The Effect of Addition of Atracurium to Local Anesthetic in Peribulbar Block in Patients Undergoing Cataract Surgery. Nat Sci 2019;17(6):106-114]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 14. doi:10.7537/marsnsj170619.14.

Keywords: Effect; Addition; Atracurium; Local Anesthetic; Peribulbar Block; Patient; Surgery

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Non-invasive ventilation at the pulmonary infection control window versus spontaneous breathing trials as weaning strategies in acute exacerbation of chronic obstructive pulmonary disease.

Sherif Wadie Nashed Sargious, Noha Sayed Hussein Ahmed, Dalia Fahmy Imam Aly and Michael T. G. Tawfik

Anaesthesia, Intensive Care & Pain Management Faculty of Medicine, Ain Shams University, Cairo, Egypt.

michael1tawfik@gmail.com

Abstract: Introduction: Applying non-invasive positive pressure ventilation (NPPV) has been used for years in clinical practice during weaning of mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), in order to avoid complications of invasive ventilation. Nevertheless, the choice of the optimal timing to apply NPPV in exacerbations caused by pulmonary infections, and whether its use would provide benefit over conventional weaning strategies, remain an issue requiring further investigations. Aim of the work: To examine the efficacy of implementing Pulmonary Infection Control (PIC) window as the optimum switching point to wean invasive mechanical ventilation (IMV) in intubated patients for AECOPD with pulmonary infection, compared to conventional weaning strategies implementing the use of Spontaneous Breathing Trials (SBT). Methods: In our prospective randomized controlled study, we enrolled the included patients to two groups, where Group A patients were extubated at the PIC window and immediately received NPPV, while Group B patients were weaned according to the conventional criteria for weaning and were granted an SBT then were extubated and received venturi oxygen therapy. All patients were monitored for forty eight hours post-extubation through assessment and documentation of certain parameters at specific checkpoints, and accordingly the success and failure rates of both weaning strategies were decided, along with the predetermined secondary outcomes of the study. Results: 65 patients who were enrolled in the study. Of the 31 patients (47.7 %) who represent Group A, 27 patients (87%) were successfully weaned, and 4 patients (13%) developed respiratory distress within the 48 hourspost-extubation and were re-intubated. Two of these patients were diagnosed with ventilator-associated pneumonia (VAP). Of the other 34 patients (52.3%) representing Group B, 15 patients (44 %) experienced successful weaning, while the other 19 patients (56 %) developed respiratory distress and received NPPV. 8 patients were diagnosed with VAP and 7 of them failed to respond to NPPV within the 48 hours post-extubation, and were re-intubated. Conclusion: Based on the higher rate of successful weaning, shorter duration of invasive ventilation, shorter ICU length of stay and lower incidence of VAP, implementation of the PIC window as an optimal switching point for application of NPPV during weaning of IMV, has proven to be a more promising weaning modality than conventional weaning strategies.

[Sherif Wadie Nashed Sargious, Noha Sayed Hussein Ahmed, Dalia Fahmy Imam Aly and Michael T. G. Tawfik. Non-invasive ventilation at the pulmonary infection control window versus spontaneous breathing trials as weaning strategies in acute exacerbation of chronic obstructive pulmonary disease. Nat Sci 2019;17(6):115-124]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 15. doi:10.7537/marsnsj170619.15.

Keywords: Chronic obstructive pulmonary disease, Acute exacerbations, Acute respiratory failure, Invasive mechanical ventilation, Non invasive positive pressure ventilation, Pulmonary infection

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