Comparison of intrathecal versus intra-articular dexmedetomidine as an adjuvant to bupivacaine on postoperative pain following knee arthroscopy: a randomized clinical trial

( Eman A. Ismail ),( Jehan A. Sayed ),( Mohamed H. Bakri ),( Reda Z. Mahfouz ) 대한통증학회 2017 The Korean Journal of Pain Vol.30 No.2

Background: Postoperative pain is a common, distressing symptom following arthroscopic knee surgery. The aim of this study was to compare the potential analgesic effect of dexmedetomidine after intrathecal versus intra-articular administration following arthroscopic knee surgery.Methods: Ninety patients undergoing unilateral elective arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intrathecal dexmedetomidine group (IT) received an intrathecal block with intrathecal dexmedetomidine, the intra-articular group (IA) received an intrathecal block and intra-articular dexmedetomidine, and the control group received an intrathecal block and intra-articular saline. The primary outcome of our study was postoperative pain as assessed by the visual analogue scale of pain (VAS). Secondary outcomes included the effect of dexmedetomidine on total postoperative analgesic use and time to the first analgesic request, hemodynamics, sedation, postoperative nausea and vomiting, patient satisfaction, and postoperative C-reactive protein (CRP) levels.Results: Dexmedetomidine administration decreased pain scores for 4 h in both the intrathecal and intra-articular groups, compared to only 2 h in the control patient group. Furthermore, there was a significant reduction in pain scores for 6 h in the intra-articular group. The time to the first postoperative analgesia request was longer in the intra-articular group compared to the intrathecal and control groups. The total meperidine requirement was significantly lower in the intra-articular and intrathecal groups than in the control group.Conclusions: Both intrathecal and intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery. Less total meperidine was required with intra-articular administration to extend postoperative analgesia to 6 h with hemodynamic stability. (Korean J Pain 2017; 30: 134-41)

Comparison of intraperitoneal versus intravenous dexamethasone on postoperative nausea and vomiting after gynecological laparoscopy: a randomized clinical trial

Eman A Ismail,Ghada M Abo Elfadl,Mustafa Bahloul 대한마취통증의학회 2019 Korean Journal of Anesthesiology Vol.72 No.1

Background: Postoperative nausea and vomiting (PONV) is a common complication following laparascopic surgery. This study compared the effect of intraperitoneal versus intravenous dexamethasone for reducing PONV after gynecological laparoscopic surgeries. Methods: Eighty adult female patients, American Society of Anesthesiologists physical status I–II, scheduled for gynecological laparoscopic surgery were randomized to receive 8 mg dexamethasone intravenously (IV) (n = 40) or intraperitoneally (IP) (n = 40). The primary outcome was the PONV incidence during the first 24 h after laparoscopy. Secondary outcomes included visual analogue scale (VAS) pain scores, total rescue analgesic consumption during the first 24 h postoperatively, the need for rescue antiemetic drugs, and the incidence of complications that may accompany these medications. Results: Eleven women (27.5%) in the IV group, versus only 3 (7.5%) women in the IP group, experienced nausea during the first 24 h postlaparoscopy (P = 0.037). However, 5 patients (12.5%) in the IV group, versus only 2 patients (5.0%) in the IP group, experienced vomiting (P = 0.424). No statistically significant differences were seen in the severity of nausea or the need for rescue antiemetics. The IV group had a higher rate of side-effects than the IP group (27.5% vs. 7.5%, P = 0.037). Headache and dizziness were common side effects in the IV dexamethasone group. The groups did not differ significantly in terms of mean VAS score for pain and total meperidine consumption during the first 24 h postoperatively. Conclusions: Intraperitoneal dexamethasone at a dose of 8 mg at the end of gynecological laparoscopy reduces the incidence of postoperative nausea.

Dexamethasone alone versus in combination with intra-operative super-hydration for postoperative nausea and vomiting prophylaxis in female patients undergoing laparoscopic cholecystectomy: a randomized clinical trial

Eman A. Ismail,Sayed Kaoud Abd-Elshafy,Mohamed H. Bakri 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.5

Background: Dexamethasone has a prophylactic effect on postoperative nausea and vomiting (PONV) and perioperative hydration is believed to play a role in PONV prophylaxis. This study was performed to examine the combined effects of pre-induction dexamethasone plus super-hydration on PONV and pain following laparoscopic cholecystectomy (LC). Methods: A total of 100 female patients undergoing LC were enrolled and randomized equally into two groups. Group DF received 5 mg dexamethasone (pre-induction) plus 30 ml/kg Ringer’s lactate (intraoperative) and group D received 5 mg dexamethasone (pre-induction) alone. Anesthetic and surgical managements were standardized for all patients. The incidence and severity of PONV, and intra and post-operative analgesic and postoperative antiemetic consumption, were assessed during the first 24 h postoperatively. Post-anesthesia care unit (PACU) stay and aggregated 24 h pain scores were calculated. Results: Group DF had significantly lower PONV than group D (P = 0.03). The number of patients with the lowest PONV score was significantly increased in group DF (P = 0.03). Ondansetron consumption was significantly lower in group DF (P < 0.0001). The mean accumulated 24 h pain scores were significantly lower in group DF compared to group D (P < 0.0001). The time to first analgesic request was significantly longer in group DF than group D (P < 0.0001). In addition, total meperidine consumption during the first postoperative 24 h was significantly lower in group DF than group D (P = 0.002). Conclusions: In female patients undergoing LC, pre-induction with 5 mg dexamethasone plus intraoperative 30 ml/kg Ringer’s lactate solution decreased PONV and pain during the first 24 h postoperatively compared to 5 mg dexamethasone alone.

The Antimicrobial Behavior of Polyelectrolyte Chitosan-Styrene Maleic Anhydride Nano Composites

Eman A. Ali,Mohamed Eweis,Said Elkholy,Mohamed N. Ismail,Maher Elsabee 한국고분자학회 2018 Macromolecular Research Vol.26 No.5

A new antimicrobial polyelectrolyte polymer was prepared based on chitosan and alternating styrene maleic anhydride (SMA) copolymer. The SMA was subjected to alkaline hydrolysis, followed by blending with chitosan and chitosan in the nano form which has been prepared by self-assembly technique with particle size 46±0.08 nm. The composition was investigated and characterized by spectral and, thermogravimetric analysis, dynamic light scattering, and transmission electron microscopy. The nano polyelectrolyte complexes and composite were screened for their antimicrobial behavior and showed excellent antifungal as well as antibacterial efficacy against four bacterial and fungal strains. The hydrolyzed styrene maleic anhydride-nano-chitosan exhibited higher antimicrobial activity than the hydrolyzed styrene maleic anhydride-chitosan.

Cancer incidence in the Tobruk area, eastern Libya: first results from Tobruk Medical Centre

Faisal Ismail,Ahmed G,Elsayed,Islam El-Garawani,Eman Abdelsameea 한국역학회 2021 Epidemiology and Health Vol.43 No.-

OBJECTIVES: Cancer is a major cause of morbidity and mortality worldwide, and it is an increasing problem in developing countries. Estimation of the incidence of cancer is important, especially in regions with limited epidemiological data on cancer. Therefore, the aim of this study was to provide an updated report on the incidence of cancers in the Tobruk region in eastern Libya. METHODS: Data on cancer patients from the records of the Department of Histopathology of Tobruk Medical Centre from January 2013 to June 2020 were included. RESULTS: In total, 402 cases were recorded. Men patients accounted for 30.3% (n= 122) of cases, and women patients repre-sented 69.6% (n= 280). The overall mean age at the time of the first diagnosis was 49.0± 17.1 years. The most common malig-nancies were breast and uterine cancer in women (18.4%, n= 74; 15.9%, n= 64, respectively), colorectal cancer (11.6%, n= 47; 26 in women and 21 in men), bladder cancer (8.2%, n= 33; 8 in women and 25 in men), and thyroid cancer (8.0%, n= 32; 23 in women and 9 in men). CONCLUSIONS: Breast and uterine cancers were the most common cancers in women, and bladder and colorectal cancer were the most common cancers in men, followed by colorectal cancer in both genders. These data will help health authorities launch preventive plans for cancer in the region. Further studies to identify aetiological factors and cancer-related risk factors need to be conducted in the region.

Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

Mohamed H. Bakri,Eman A. Ismail,Ahmed Ibrahim 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.3

Background: Postoperative nausea and vomiting (PONV) are common following laparoscopic cholecystectomy (LC). Dexamethasone has been reported to reduce PONV. However, there is insufficient evidence regarding the effect of dexmedetomidine in decreasing PONV. This study was designed to compare the effects of a single dose of dexmedetomidine to dexamethasone for reducing PONV after LC. Methods: Eighty-six adult patients scheduled for LC were randomized to receive either single dose 1 μg/kg of dexmedetomidine (Dexmed group, N = 43) or 8 mg dexamethasone (Dexa group, N = 43) before skin incision. During the first 24 h postoperatively, the incidence and severity of PONV were assessed. Pain and sedation scores were assessed on arrival in the recovery room and early postoperatively. Analgesic and antiemetic consumption during the 24 h after surgery were calculated. Intra-operative and postoperative hemodynamics were recorded. Results: Twenty-one percent of the patients in the Dexmed group developed PONV compared to 28% in the Dexa group (P = 0.6). Severity of PONV was similar between the two groups (P = 0.07). Early postoperatively, pain severity was significantly lower in the Dexmed group, but sedation scores were significantly higher. The first analgesic request was significantly delayed in the Dexmed group (P = 0.02). The total amounts of intraoperative fentanyl and postoperative tramadol administered were significantly lower in the Dexmed group. No difference in ondansetron was noted between the two groups. Mean arterial pressure and heart rate were significantly lower in the Dexmed group after administration of dexmedetomidine. No major side effects were reported. Conclusions: Dexmedetomidine reduces the incidence and severity of PONV, similar to dexamethasone. It is superior to dexamethasone in reducing postoperative pain and total analgesic consumption during the first 24 h after LC.

Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia

Mohamed H. Bakri,Eman A. Ismail,Gamal Ghanem,Mahmoud Shokry 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.5

Background: Sickle cell anemia (SCA) increases the rate of maternal and fetal complications. This pilot study was designed to compare the maternal and fetal outcomes of spinal versus general anesthesia (GA) for parturients with SCA undergoing cesarean delivery. Methods: Forty parturients with known SCA scheduled for elective Cesarean delivery were randomized into spinal anesthesia (n = 20) and GA groups (n = 20). Perioperative hemodynamic parameters were recorded. Postpartum complications were followed up. Opioid consumption was calculated. Blood loss during surgery and the number of patients who received intraoperative or postpartum blood transfusion were recorded. Patient satisfaction with the type of anesthesia was assessed. The Apgar score at 1 and 5 min, neonatal admission to the intensive care unit, and mortality were also recorded. Results: Blood loss was significantly higher in the GA than spinal group (P = 0.01). However, the number of patients who received an intraoperative or postpartum blood transfusion was statistically insignificant. Significantly more patients developed intraoperative hypotension and bradycardia in the spinal than GA group. Opioid use during the first 24 h was significantly higher in the GA than spinal group (P < 0.0001). More patients had vaso-occlusive crisis in the GA than spinal group without statistical significance (P = 0.4). There was one case of acute chest syndrome in the GA group. No significant differences were observed in postoperative nausea and/or vomiting, patient satisfaction, or hospital length of stay. Neonatal Apgar scores were significantly better in the spinal than GA group at 1 and 5 min (P = 0.006 and P = 0.009, respectively). Neonatal intensive care admission was not significantly different between the two groups, and there was no neonatal mortality. Conclusions: Spinal anesthesia may have advantages over GA in parturients with SCA undergoing Cesarean delivery.

Impact of nano silver composite structure on cadmium neurotoxicity in albino rats

El-Sherbiny Emad Mohamed,Abdel-Gawad Eman Ismail,Osman Hala Fawzy 한국응용생명화학회 2022 Applied Biological Chemistry (Appl Biol Chem) Vol.65 No.6

The present study was planned to investigate the possible therapeutic effects of silver/hydroxyapatite nanocomposite (nAg/HAp) on neurotoxicity induced by cadmium chloride ( CdCl2) in albino rats. The nanocomposite has been formulated by a chemical route and characterized by scanning electron microscope (SEM), Transmission Electron Microscopy (TEM), and energy-dispersive X-ray Analysis spectroscopy (EDAX). A population of rats was randomly assorted into three groups; the animals were subjected to intraperitoneal CdCl2 administration every 2 days at a dose level of 1.0 mg/kg b.wt. for 3 months while the treatment with nAg/HAp was performed via intravenous injection at a dose level of 50 mg/kg b,wt. once a week for 4 weeks. Quantitative DNA fragmentation and biochemical analysis including the content of γ-aminobutyric acid (GABA), noradrenaline (NA), dopamine (DA), caspase-3, calmodulin (CaM), calcium adenosine 5′-triphosphatase ( Ca++ATPase), tau protein, glutathione (GSH) and malondialdehyde (MDA) were measured in brain tissue. The results revealed the potent efficacy of nAg/HAp in attenuating DNA fragmentation and partially recovering most of the investigated parameters manifested by a significant elevation in GABA, NA, DA, Ca++ ATPase, and GSH levels and a decrease in tau protein, caspase-3, CaM and MDA tissue content in comparison with Cd—intoxicated groups. Accordingly, the synthesized nAg/HAp at the selected dose can be used as a biosafe intravenous injection in neurodegenerative diseases. The present study was planned to investigate the possible therapeutic effects of silver/hydroxyapatite nanocomposite (nAg/HAp) on neurotoxicity induced by cadmium chloride (CdCl 2 ) in albino rats. The nanocomposite has been formulated by a chemical route and characterized by scanning electron microscope (SEM), Transmission Electron Microscopy (TEM), and energy-dispersive X-ray Analysis spectroscopy (EDAX). A population of rats was randomly assorted into three groups; the animals were subjected to intraperitoneal CdCl 2 administration every 2 days at a dose level of 1.0 mg/kg b.wt. for 3 months while the treatment with nAg/HAp was performed via intravenous injection at a dose level of 50 mg/kg b,wt. once a week for 4 weeks. Quantitative DNA fragmentation and biochemical analysis including the content of γ-aminobutyric acid (GABA), noradrenaline (NA), dopamine (DA), caspase-3, calmodulin (CaM), calcium adenosine 5′-triphosphatase (Ca ++ ATPase), tau protein, glutathione (GSH) and malondialdehyde (MDA) were measured in brain tissue. The results revealed the potent efficacy of nAg/HAp in attenuating DNA fragmentation and partially recovering most of the investigated parameters manifested by a significant elevation in GABA, NA, DA, Ca ++ ATPase, and GSH levels and a decrease in tau protein, caspase-3, CaM and MDA tissue content in comparison with Cd—intoxicated groups. Accordingly, the synthesized nAg/HAp at the selected dose can be used as a biosafe intravenous injection in neurodegenerative diseases.