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   Table of Contents - Current issue
Coverpage
April-June 2017
Volume 45 | Issue 2
Page Nos. 57-113

Online since Friday, October 13, 2017

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ORIGINAL ARTICLES  

Different low doses of levobupivacaine 0.5% with nalbuphine in spinal anesthesia for transurethral resection of prostate surgery p. 57
Osama M Rehab, Salah I Al Shreif, Yasser M Amr, Rehab S El Kalla
DOI:10.4103/tmj.tmj_9_17  
Background Subarachnoid block is a widely used technique for transurethral resection of the prostate (TURP) surgery in elderly, especially in those with respiratory and cardiac problems. Aim The aim of this study was to evaluate the efficacy of different low doses of levobupivacaine 0.5% when they are combined with nalbuphine in spinal anesthesia for TURP surgery, their efficiency for postoperative analgesia, and its side effects. Patients and methods A total of 90 patients older than 60 years of age and American Society of Anesthesiologists physical status I–III who underwent TURP under spinal anesthesia were enrolled. Patients were randomly divided into two groups: group I received intrathecal injection of 5 mg levobupivacaine 0.5% and 1 mg nalbuphine in 1 ml normal saline as total volume of 3 ml and group II received intrathecal injection of 7.5 mg levobupivacaine 0.5% and 1 mg nalbuphine in 0.5 ml normal saline as total volume of 3 ml. Patients were assessed for sensory and motor block characteristics, postoperative visual analog pain scale, and side effects. Results Patients in group II had earlier onset of sensory block at T10, longer duration of sensory and motor block and two-segment regression times, higher level of maximum sensory block, higher Bromage score at the end of surgery, and lower visual analog pain scale in the early postoperative period. Conclusion Levobupivacaine 0.5% of 5 and 7.5 mg with the addition of 1 mg nalbuphine are considered to be convenient for clinical use in TURP surgery with spinal anesthesia. Levobupivacaine of 7.5 mg had a better sensory block quality and prolonged early postoperative analgesia with similar hemodynamic stability without increasing complications.
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Upper gastrointestinal endoscopic findings in chronic kidney disease p. 64
Omnia S Shabka, Ghada M Al Ghazaly, Mahmoud F Selim, Khalid M Zaghloul
DOI:10.4103/tmj.tmj_7_17  
Background The most common, nonrenal, chronic disorders in patients with end-stage renal disease are gastrointestinal disorders, necessitating the need to understand the accompanying gastrointestinal disorders. End-stage renal disease includes such as those receiving renal replacement therapy. Some gastrointestinal conditions are due to uremia or due to the effects of renal replacement therapy or underlying disease or medications. Aim This study aimed to detect upper endoscopic findings in patients with chronic kidney disease. Patients and methods Thirty patients with end-stage renal disease complaining of gastrointestinal manifestation were recruited from the Internal Medicine Department of Tanta University Hospital in the period from October 2014 to March 2015. All patients in this study were subjected to upper gastrointestinal endoscopy after routine laboratory and radiological evaluation. Results Most patients had upper gastrointestinal bleeding [24 (80%) patients]. Reflux esophagitis was detected in five (16.7%) patients, esophageal erosion in two (6.7%) patients, esophageal ulcer in three (10%) patients, pyloric ulcer in five (16.7%) patients, antral gastritis in 11 (36.7%) patients, gastric ulcer in seven (23.3%) patients, duodenitis in 13 (43.3%) patients, duodenal ulcer in 11 (36.7%) patients. The duodenum was the most common site of lesion with duodenal lesion detected in 24 (80%) patients. Conclusion Gastrointestinal affection is common in patients with chronic kidney disease, with upper gastrointestinal bleeding detected as the most common presenting symptom, duodenum as the most commonly affected site, and duodenitis was the most commonly detected lesion.
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Epidemiology of infection as a precipitating factor for diabetic ketoacidosis at Tanta University Hospital p. 68
Zeinab Shafeek Shafeek Hamed, Amr Mohamed Gawaly, Khalil Mohamed Abbas, Loai Mohamed El Ahwal
DOI:10.4103/tmj.tmj_10_17  
Introduction Diabetic ketoacidosis (DKA) is one of the life-threatening sequels in diabetes mellitus. Nonadherence to treatment, infections, psychological troubles, and comorbid diseases were the main precipitating factors that trigger DKA. Aim Evaluate infection as a precipitating factor of DKA and its correction may contribute to improve outcome and decrease recurrence. Patients and methods This descriptive, cross-sectional study was conducted on 200 patients with DKA admitted to the Internal Medicine Department, Tanta University Hospital. All patients were subjected to history taking, clinical examination, routine investigations, glycosylated hemoglobin, and albumin–creatinine ratio. Results Our study included 86 men and 114 women. Of these, 113 patients were of type 2 diabetes, 83 patients were of type 1 diabetes, two patients were of secondary diabetes, and two patients were having gestational diabetes. Infection was the main precipitating factor of DKA (46.5%). The most common source of infections was urinary tract infections and respiratory tract infections (31.2, 26.8%, respectively). Infection was the precipitating cause in 38.5% of type 1 diabetes and 53.9% of type 2 diabetes with P value was 0.033. DKA was the first presentation of diabetes in 18.5% of patients. Stress, dietary errors, pregnancy, and nonidentified causes were 19%. Conclusion Infection is the main precipitating factor of DKA in patients of Tanta University Hospital.
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Comparative study between midazolam versus nalbuphine on prevention of emergence agitation after sevoflurane anesthesia in pediatric patients undergoing tonsillectomy with or without adenoidectomy p. 73
Khaled Sayed Ahmed Mohammed, Kamal El Den Haikal Ali, Hoda Ezz Alsaid Ahmed, Hesham Altatawy Ibrahem
DOI:10.4103/tmj.tmj_18_17  
Background Emergence agitation (EA) in children is increased after sevoflurane anesthesia. Nalbuphine and midazolam have been used for prophylactic treatment with controversial results. Aim The aim of the present study was to compare the effect of nalbuphine or midazolam before termination of sevoflurane-based anesthesia on the incidence and severity of EA in children. Patients and methods Totally, 90 children between 4 and 8 years of age and of American Society of Anesthesiologists I-II undergoing adenotonsillectomy under sevoflurane-based anesthesia were enrolled in the study. Children were randomly allocated to one of the two groups: group I received nalbuphine 0.1 mg/kg and group II received midazolam 0.03 mg/kg. The study drugs were administered 5 min before the end of surgery. In the postanesthesia care unit, the incidence of EA was assessed with Aonos four-point scale. Severity of EA was assessed with the pediatric anesthesia emergence delirium scale upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), and 30 min (T30). Results The incidence and severity of EA were lower in group I as compared with group II at T0, T5, and T10. Conclusion Nalbuphine 0.1 mg/kg was more effective compared with midazolam 0.03 mg/kg in decreasing the incidence and severity of EA, when administered 5 min before the end of surgery in children undergoing adenotonsillectomy under sevoflurane anesthesia.
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Histological and immunohistochemical study on the effect of gibberellic acid on the seminiferous tubules of testis of adult albino rat and the possible protective role of grape seeds proanthocyanidin extract p. 79
Eman M El-Beltagi, Walaa M Elwan, Nadia Abdel Mohsen El-Bakry, Ehsan F Salah
DOI:10.4103/tmj.tmj_38_16  
Background Gibberellic acid (GA) is widely used in Egypt and other countries to increase the growth of many fruits and vegetables. GA can induce disturbances in the testicular enzymes and hormones. Recent studies have revealed that grape seed proanthocyanidin extract (GSPE) has a potential protective effect in male reproductive disorders. Aim This work aimed to study the effect of GA on the seminiferous tubules of testis of adult albino rat and to evaluate the possible protective role of GSPE. Materials and methods Forty adult male albino rats were divided into four groups: control group, group II treated with GSPE (100 mg/kg once daily for 4 weeks), group III treated with GA (20 mg/kg once daily for 4 weeks), and group IV concomitantly treated with GSPE and GA with the same dose and duration of previous groups. Specimens from the testes were processed for light and electron microscopy. Immunohistochemical study was carried out using antibodies against Bcl-2. Results Specimens from GA-treated animals showed disturbance in the normal architecture with obvious structural changes. Some spermatogenic cells appeared disorganized with wide intercellular spaces, and others were exfoliated into the lumen of the tubules. Many spermatogonia showed vacuolated cytoplasm and deeply stained nuclei. Ultrastructurally, the cytoplasm of Sertoli cells showed markedly dilated smooth endoplasmic reticulum. Some primary spermatocytes appeared with vacuolated cytoplasm and dilated perinuclear cisternae. The early spermatids appeared with electron-dense bodies, concentric lamellar formations, and irregular outlined nuclei. Abnormally shaped spermatozoal heads were detected. The immunohistochemical study showed a highly significant decrease in Bcl-2 immunoreaction. In contrast, minimal changes were observed in rats treated concomitantly with both GSPE and GA, with a nonsignificant change in the immunoreaction. Conclusion GA induced structural changes of the seminiferous tubules of the rat testis that could be minimized by the coadministration of GSPE.
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Hepatoprotective activity of quercetin against paracetamol-induced liver toxicity in rats p. 92
Afaf A El Faras, Amel L Elsawaf
DOI:10.4103/tmj.tmj_43_16  
Background Paracetamol (PCM) overdose induces hepatotoxicity in both humans and experimental animals. The pathogenesis and progression of PCM hepatic toxicity are associated with free radical injury and oxidative stress, which could be partially attenuated by antioxidants and free radical scavengers. Aim The present study was undertaken to examine the effects of quercetin on PCM-induced hepatic toxicity in rats. Material and methods In this experimental study, forty adult male rats were divided into four groups: control, quercetin, PCM groups, and the protective group that was pretreated with quercetin orally [50 mg/kg body weight (b.w.)] daily for 16 days and thereafter received both quercetin (same dose) and PCM (500 mg/kg b.w.) for another 5 days. Twenty-four hours after the administration of PCM, the rats were killed to measure serum hepatotoxic markers, levels of tumor necrosis factor-α, and oxidative stress biomarkers. Results Oral administration of PCM (500 mg/kg b.w.) for 5 days resulted in a significant elevation of liver enzymes in serum such as aspartate transaminase, alanine transaminase, alkaline phosphatase, and total bilirubin, and in levels of tumor necrosis factor-α as well as reducing hepatic total protein and albumin concentrations when compared with the results in the control group. As regards oxidative stress biomarkers, there were increased tissue levels of malondialdehyde and decreases in the activity of liver enzymes [superoxide dismutase, catalase, glutathione, glutathione peroxidase, and glutathione-s-transferase] in the group treated with PCM. All of these results were ameliorated by coadministration of quercetin. Conclusion These results suggest that the protective role of quercetin in the prevention of PCM-induced hepatic toxicity in rats was associated with a decrease of oxidative stress in hepatic tissues. However, clinical studies are warranted to investigate such an effect in humans.
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Evaluation of midazolam as an adjuvant to bupivacaine in supraclavicular brachial plexus block p. 99
Saad A Moharam, Ahmed S Basuoni, Ahmed A Abd-elhafez, Ahmed S Ibrahim
DOI:10.4103/tmj.tmj_17_17  
Background The duration of the supraclavicular brachial plexus block is limited by the duration of action of local anesthetic used for the block. Many adjuvants are used to prolong the duration of the block. Few studies were carried on evaluate the effects of using midazolam as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Aim The aim of the study was to evaluate the anesthetic characteristics of adding midazolam to bupivacaine during ultrasound-guided supraclavicular brachial plexus block. Patients and methods The study was carried out on 96 patients scheduled for upper limb surgeries. They were divided into three equal groups to receive ultrasound-guided supraclavicular brachial plexus block using 30 ml bupivacaine 0.5% in group I, 30 ml bupivacaine 0.5% and 30 µg/kg midazolam in group II, and 30 ml bupivacaine 0.5% in addition to 30 µg/kg intravenous midazolam in group III. Results The onset of sensory and motor block were significantly faster, and the durations were significantly longer in group II compared with groups I and III; furthermore, postoperative analgesia was significantly prolonged in group II (P<0.05). Patients of group II had prolonged mild sedation compared with group III. Conclusion Midazolam is a valuable adjuvant to bupivacaine during ultrasound-guided supraclavicular brachial plexus block, which requires further evaluation.
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Effect of monosodium glutamate on body weight and the histological structure of the zona fasciculata of the adrenal cortex in young male albino rats p. 104
Nehal F El-Helbawy, Doaa A Radwan, Maysa F Salem, Manal E El-Sawaf
DOI:10.4103/tmj.tmj_11_17  
Introduction Monosodium glutamate (MSG) is commonly used as a flavor enhancer in both home and restaurant cooking. Aim The aim of this work was to clarify the possible effect of MSG administration on the body weight and the histological structure of the zona fasciculata (ZF) of the adrenal cortex in young male albino rats and to assess whether or not this effect was reversible. Materials and methods A total of 40 male albino rats aged 4 weeks were weighed at the onset of the study and then divided into two equal groups. The control rats (group I) were held without medication either for 2 weeks (group Ia) or for 4 weeks (group Ib) and then killed. The experimental rats (group II) received a daily oral dose of MSG (4 mg/g body weight) dissolved in 3 ml of distilled water for 2 weeks and then 10 of them were killed 2 h after the last dose (group IIa); the other 10 rats were held without medication for another 2 weeks and then killed (group IIb). All rats were weighed before scarification. Sections of the adrenal glands were examined with light and electron microscopes. Thickness of the ZF was measured in all subgroups. Data of the final body weight and ZF thickness were analyzed as mean±SD and P values were calculated. Results Statistically, the final body weight of rats increased in both groups IIa and IIb and also the thickness of the ZF increased in group IIa as compared with their controls. Histologically, group IIa showed loss of the cord-like architecture of ZF cells. They appeared distended with highly vacuolated cytoplasm that was ultrastructurally full of lipid droplets. Group IIb revealed partial improvement and retained normal thickness and structure of the ZF. Conclusion MSG causes histopathological changes in the ZF of the adrenal cortex, increasing its thickness and its secretion, and this could explain the increased final body weight. These changes are reversible but may need a long time to regain their normal values.
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