Ketamine versus in total intravenous anesthetic management of children undergoing strabismus surgery: a prospective randomized controlled study Mohammed El-Saied Hamada, Thanaa M El-Nomani, Ghada F El-Baradey, Hesham El-Sayed El-Ashry Tanta Medical Journal 2019 47(1):1-6 Background Strabismus is a malalignment of the visual axes. Manipulation of the globe and traction on the extraocular muscle can elicit oculocardiac reflex (OCR). Propofol anesthesia is associated with rapid induction and recovery with minimal postoperative confusion, while ketamine anesthesia is associated with less hemodynamic changes. Thus both are preferred for anesthesia of strabismus surgery in pediatric patients. Aim The aim of this work was to compare total intravenous anesthesia (TIVA) with ketamine versus propofol in the anesthetic management of children undergoing strabismus surgery. Patients and methods This study had been carried out on 50 children with ASA I scheduled for strabismus surgery. Patients were randomized into two equal groups (25 patients in each group). Group K: received TIVA with ketamine; group P: TIVA with propofol. Heart rate and mean arterial pressure, incidence of OCR, number of patients who needed intravenous atropine, recovery time, postoperative nausea and vomiting (PONV), evaluation of postoperative pain and finally the satisfaction score of the surgeon were recorded. Results Heart rate and the incidence of PONV showed a significant decrease in group P in comparison with group K. Incidence of OCR, the need for usage of atropine and the severity of postoperative pain in group P was higher in comparison with group K. There were no significant differences between the two groups regarding satisfaction score of the surgeon Conclusion TIVA with ketamine showed significant decrease in postoperative pain and incidence of OCR owing to its hemodynamic stability in comparison with propofol, which showed more rapid onset of action with rapid recovery and decreased incidence of PONV.

Clinical and neurophysiology study in hepatitis C virus patients Abdelrahman A Elghorab, Ahmed M Elshamy, Raafat A Salah, Mohamed O Rabie Tanta Medical Journal 2019 47(1):7-13 Background Hepatitis C virus is associated with extrahepatic organ involvement including the nervous system especially peripheral nervous system, which is frequently affected due to the presence of hyper cryoglobulinemia (CG). Sensory and axonal neuropathy is the most frequent presentation in association with hyper CG. Peripheral neuropathy (PN) may also be observed in the absence of hyper CG. Aim The aim of this work was to study peripheral neurological complications related to chronic hepatitis C infection and the possible pathogenic mechanisms of these complications. Patients and methods This study was conducted on 60 patients with chronic hepatitis C infection who were subdivided into two subgroups: group I is composed of 30 chronic hepatitis C patients with clinically apparent neurological complications and group II is composed of 30 chronic hepatitis C patients, who were neurologically asymptomatic. The patients were subjected to clinical evaluation, estimation of hepatitis markers, cryoglobulins, and nerve conduction studies. Results Overt peripheral neuropathies occurred in 42 (70%) patients, detected subclinically in 12 (40%) patients. The chronic sensory peripheral neuropathy was the most common type, representing 60% of neuropathic patients. A statistically significant difference was found between groups I (80%) and II (33.3%), regarding the presence of cryoglobulin, being more common in group I. Results of nerve conduction studies have shown that nerves were more affected in group I and in cryoglobulin positive patients especially in the lower limb. Conclusion Peripheral neuropathies represent the most common hepatitis C virus-related peripheral neurological disorders especially when associated with cryoglobulins

A study of serum uric acid and lactate level in patients with obstructive sleep apnea syndrome Mona A.E. Taha Elgazzar, Adel S Bediwy, Ghada A Attia, Sahar M Eldin Hazzaa, Wafaa S El-Shimy Tanta Medical Journal 2019 47(1):14-20 Background Tissue hypoxia due to repeated sleep apneas leads to evolution of reactive oxygen stress and serum levels of uric acid (UA) and lactate in patients with obstructive sleep apnea syndrome (OSAS). Objective The objective of this study was to determine whether there is an association between OSAS and both serum UA and lactate levels as potential markers of tissue hypoxia and their relation with OSAS severity. Participants and methods Thirty participants were classified into two groups. Group I included 10 control persons matched to obstructive sleep apnea (OSA) patients by sex, age, and BMI. Group II included 20 patients with OSA as diagnosed by polysomnography [apnea–hypopnea index (AHI)≥5]. The following were conducted: full history, clinical examination, complete overnight polysomnography to detect AHI, oxygen saturation parameters, and snoring index. Finally serum lactate and UA levels were assessed through two samples of peripheral arterial blood: one before sleep and the second at the end of polysomnography. Results In OSA patients, the mean levels of serum UA and lactate both before and after sleep were significantly higher compared with controls with significant overnight increase after sleep and high percent of change of serum UA and lactate levels. These higher levels were independent of age, sex, and BMI. Moreover, UA and lactate levels after sleep in OSA patients were significantly correlated with OSA severity (AHI) and degree of nocturnal hypoxia through positive correlation with (%TST<90%, %TST<80%, and oxygen desaturation index) and negative correlation with average SpO2% and lowest SpO2%. This correlation was not affected by age or obesity as confirmed by regression models. Conclusion Both serum UA and lactate may be considered as potential markers of tissue hypoxia and related to OSAS severity. Their levels were significantly elevated after sleep with significant overnight rise and significant positive correlation with AHI, %TST<80%, %TST<90%, oxygen desaturation index, and negative correlation with average and lowest SpO2%. This correlation was not affected by age or obesity.

Role of magnetic resonance spectroscopy in evaluation of breast masses Aya E Elkafas, Rania E Ali, Salah El-Dein A El-Gohary, Usama E Ghieda Tanta Medical Journal 2019 47(1):21-26 Background Early detection followed by appropriate treatment is currently the most effective strategy to reduce breast cancer mortality. New techniques must provide more precise evaluation of the indeterminate lesions. Magnetic resonance spectroscopy (MRS) is one of the available new techniques on MRI. It represents a noninvasive and nonionizing method of characterizing a user-selected volume of tissue based on the metabolic (chemical) content. Aim The aim was to assess the role of in-vivo proton MRS in diagnosis, characterization, and differentiation between benign and malignant breast masses. Patients and methods In this study, 40 female patients were examined by MRI using the multiphase dynamic sequence and proton MRS using magnets of intensity field 1.5 Tesla systems. Single-voxel technique after adequate shimming was used. Results Thirty (62.5%) cases were malignant (based on the presence of high choline peak in the spectrum) and 18 (37.5%) cases were benign (no choline peak). MRS has increased the specificity of dynamic MRI for diagnosis of probable lesion from 76.5 to 94.1%. False-positive results were found in one case, and false-negative results were found in two cases. Conclusion In-vivo proton MRS is a powerful method for characterizing indeterminate breast lesions based on the presence of a high choline peak in the spectrum.

Efficacy of pharmacoinvasive percutaneous coronary intervention versus primary percutaneous coronary intervention in ST elevation myocardial infarction Ashmawy M., Sharaf El-din S., Deraz E., Mosaad A. Tanta Medical Journal 2019 47(1):27-32 Background ST-segment elevation myocardial infarction (STEMI) is mainly caused by complete occlusion of a coronary artery by a thrombus. Primary percutaneous coronary intervention requires transfer to an interventional cardiology center and this delays initiation of reperfusion therapy. A pharmacoinvasive strategy may alleviate the barriers in timely reperfusion of STEMI, especially in a developing country like Egypt. Aim The aim of the study was to assess the safety and efficacy of pharmacoinvasive strategy versus PPCI in STEMI patients at 3 months. Patients and methods A total of 200 patients were presenting with STEMI who were divided into two groups: group 1 included patients who underwent PPCI (n=160) and group 2 included patients who underwent pharmacoinvasive strategy as patients received thrombolytic therapy followed by scheduled coronary angiography and PCI within 24 h from the symptom onset (n=40). Primary end points were death, cardiogenic shock, reinfarction, repeated revascularization of the culprit artery, and congestive heart failure at the time of discharge or at follow-up till 3 months. Results In group 1, we found that about 28.1% of patients had infarct-related artery open and 71.9% were closed, while in group 2 there were 70.0% patients who had infarct-related artery open and 30.0% who had failed thrombolysis. There were 4.4% patients in group 1 and 75.0% patients in group 2 who were with bleeding complication especially at the access site. Complication was less frequent in group 1. Conclusion A pharmacoinvasive strategy resulted in outcomes that were comparable with PPCI at 3 months, suggesting it might be a viable option in Egypt. Larger studies are required to confirm these findings.

Comparative study between cisatracurium, atracurium as an adjuvant agent to local anesthetics on peribulbar anesthesia in adult healthy patients Marwa M Elgohary, Abd El-Azez H El Badawy, Ahmed S Elgebaly, Wesam M. A Nassar Tanta Medical Journal 2019 47(1):33-38 Background Patients with cataracts tend to be older and to have serious comorbidities and there is evidence that local anesthetic causes fewer adverse events than general anesthesia as well as reduces the recovery time of the patient. Many adjuvant drugs have been shown to improve the quality of peribulbar anesthesia. Aim The aim was to compare the effect of using atracurium and cisatracurium as an adjuvant to local anesthetic on peribulbar anesthesia in cataract surgeries. Patients and methods A total of 90 patients of both sexes belonging to the American Society of Anaesthesiology I and II status scheduled for cataract surgery using peribulbar anesthesia were divided into three equal groups as follows. Group I: received only bupivacaine and lidocaine, group II received bupivacaine+lidocaine+atracurium, and group III patients received bupivacaine+lidocaine+cisatracurium. Results There was a significant increase in time to begin surgery in group I when compared with groups II and III (P=0.001). There was a statistically significant difference (P=0.001) in akinesia score at 1, 3, 5, 7, and 10 min between groups. Also, there was a statistically significant difference (P=0.001) in eyelid squeezing score at 1, 3, 5, 7, and 10 min between groups. There was an increased number of patients who required supplementary dose in group I (33.3%) than in groups II (10%) and group III (10%) (P=0.024). Rapid offset of akinesia occurred in group I than in group II and group III (P=0.001). Intraoperative pain using the visual analog scale score was statistically insignificant (P>0.05) between groups. There was no statistical difference between groups I, II, and III regarding complications and adverse effects. Conclusion Addition of muscle relaxant (atracurium or cisatracurium) in peribulbar anesthesia provides better akinesia, rapid onset, and more prolonged time of akinesia; it also decreases the need for supplementary injection.

Assessment of iron deficiency in malnutrition: the value of serum ferritin AishatOluwatoyin Saka, Ayodele I Ojuawo, Mohammed Jimoh Saka, S. Abayomi Biliaminu, Lukman Olatunbosun Tanta Medical Journal 2019 47(1):39-44 Background Iron deficiency is the most common micronutrient deficiency seen in protein energy malnutrition (PEM) and a common cause of morbidity and mortality in this condition. Aim The aim of the study was to assess the value of serum ferritin among PEM patients with iron deficiency. Patients and methods It was a case–control study in which the participants were children diagnosed of PEM and the controls were children with normal nutrition. Ninety participants and controls each participated in the study with informed consent obtained from caregivers. Full blood count and examination of peripheral blood smear and serum ferritin concentration was analyzed by enzyme-linked immunosorbent assay. Statistical analysis Data entry and analysis were carried out with a microcomputer using the SPSS, version 16, software packages. Results The mean age of the children with PEM was 22.7±14.4 months. In the participants, the prevalence of iron deficiency was 24.4%, while that of iron-deficiency anemia was 16.6%. The mean serum ferritin levels were significantly lower in the patients compared with controls (P=0.000). The sensitivity and specificity of serum ferritin was 100.0% (95% confidence interval). The likelihood ratio was 0.00 (95% confidence interval). Conclusion Patients with PEM were found to have high prevalence of iron-deficiency anemia and low serum ferritin levels. The sensitivity and specificity of serum ferritin levels were found to be high among PEM patients with iron-deficiency anemia.