Tuberculosis remains a public problem that is considered one of the top causes of morbidity and mortality worldwide. The National Tuberculosis Control Program in Yemen was established in 1970 and ...included in the national health policy under the leadership of the Ministry of Public Health and Population to monitor tuberculosis control. The surveillance system must be evaluated periodically to produce recommendations for improving performance and usefulness.
This study aims to assess the usefulness and the performance of the tuberculosis surveillance system attributes and to identify the strengths and weaknesses of the system.
A quantitative and qualitative evaluation of the national tuberculosis surveillance system was conducted using the Centers for Disease Control and Prevention's updated guidelines. The study was carried out in 10 districts in Sana'a City. A total of 28 public health facilities providing tuberculosis services for the whole population in their assigned catchment areas were purposively selected. All participants were interviewed based on their involvement with key aspects of tuberculosis surveillance activities.
The tuberculosis surveillance system was found to have an average performance in usefulness (57/80, 71%), flexibility (30/40, 75%), acceptability (174/264, 66%), data quality (4/6, 67%), and positive predictive value (78/107, 73%), and poor performance in simplicity (863/1452, 59%) and stability (15%, 3/20). In addition, the system also had a good performance in sensitivity (78/81, 96%).
The tuberculosis surveillance system was found to be useful. The flexibility, positive predictive value, and data quality were average. Stability and simplicity were poor. The sensitivity was good. The main weaknesses in the tuberculosis surveillance system include a lack of governmental financial support, a paper-based system, and a lack of regular staff training. Developing an electronic system, securing governmental finances, and training the staff on tuberculosis surveillance are strongly recommended to improve the system performance.
Objectives: To evaluate the short-term outcome of a 3-in-1 procedure including percutaneous facet radiofrequency, percutaneous spinal fixation and steroid with hyaluronidase enzyme injection versus ...percutaneous spinal fixation alone for cases with failed back surgery syndrome (FBSS).
Patients and methods: The study included 50 patients who had had previous spinal surgery since a mean duration of 39.7 ± 8.5 months and developed recurrent back pain since a mean duration of 10 ± 2.1 months. Patients were randomly allocated into two groups; group A underwent percutaneous spinal fixation only and group B underwent the 3-in-1 procedure. Outcome was evaluated at the end of six months postoperatively (PO) using a pain numeric rating scale (NRS), the Oswestry Disability Index (ODI) and Odom's criteria for evaluation of surgical outcome with evaluation of patients' satisfaction by outcome.
Results: All patients showed progressive decrease of NRS pain and ODI scores compared with preoperative scores. However, patients in group B showed significantly lower postoperative NRS pain scores and ODI with significantly higher frequency of patients having had > 50% reduction of both scores compared with patients in group A. PO analgesic consumption rate in both groups was significantly lower than the preoperative rate with a significant reduction of mean total scoring compared with preoperative scoring. The frequency of patients who found the provided therapeutic procedure satisfactory and its outcome good-to-excellent was significantly higher among patients in group B compared with group A.
Conclusion: Short-term outcomes of the applied 3-in-1 procedure are promising for improvement of symptoms secondary to FBSS and may ultimately prove to be recommended as the therapeutic modality for such a challenging clinical problem.
To compare the analgesic effects of thoracic paravertebral block versus lidocaine infusion for management of post-thoracotomy pain.
60 patients who were scheduled for thoracotomy were randomly ...divided into two equal groups: IV group received 1.5 mg/kg of 1% lidocaine over 10 min then infusion of 1.5 mg/kg/h, and thoracic paravertebral group (PVB) received 10 ml lidocaine 1% over 30 s then infusion of 1.5 mg/kg/h through catheter was inserted under ultrasound guidance. Hemodynamic and respiratory variables, frequency and duration of postoperative mechanical ventilation, duration of ICU stay, time till start of respiratory exercise and till chest tube removal, analgesia was assessed using 100-point visual analogue scale and defined as VAS <30 mm at rest, and in case of inadequate analgesia, IV morphine 2 mg bolus was given. Frequencies of complications and postoperative hospital stay were also recorded.
17 patients of both groups were maintained on MV for mean duration of 1.5 ± 0.5 days. PVB group was successfully weaned from MV and extubated after significantly shorter duration. Mean duration of ICU stay, time till start of respiratory exercise, and till removal of chest tube were significantly shorter in PVB group. All patients requested analgesia, but the frequency of consumption and mean number of requests were significantly higher in IV group. VAS scores determined at 1, 2, 12, 36 and cumulative 48 hours were significantly lower in PVB group compared to IV group.
Ultrasound guidance allowed safe paravertebral space catheterization. PVB using continuous lidocaine infusion provided adequate analgesia for post-thoracotomy pain with significant reduction of rescue analgesia, shorter time till respiratory exercises start, minimal complications and shorter hospital stay.
Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome ...its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations.
64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase.
Patients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile.
Our data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase.
Clinical Trial registry on ClinicalTrials.gov , NCT 03411330 , 25-1-2018.
Sinai Peninsula is considered as a unique region in the world due to its geographical location, tectonic and thermal activities. It is located geographically at the crossroads of Europe, Asia, and ...Africa constituting a triple junction point between the three continents. It is also characterized by thermal manifestations represented by several hot springs with varied temperatures (30–70
°C). Most of these hot springs are located along the shoreline of the Gulf of Suez.
In this study, we aim to map the Curie depth isotherm surface for Sinai Peninsula based on the analysis of ground magnetic data. Spectral analysis technique will be used to estimate the boundaries (top and bottom) of the magnetized crust. The depths obtained for the bottom of magnetized crust are assumed to correspond to Curie point depths where the magnetic layer loss its magnetization.
Results of this study indicate that the shallow Curie depths (~
15–18
km) are located at the southern part of Sinai Peninsula and along the shoreline of the Gulf of Suez and depths increase (22–25
km) towards the central and north western portions of Sinai Peninsula. The whole average Curie depth point of Sinai Peninsula is about 20
km. Generally, the shallow depths to Curie isotherm indicate that Sinai Peninsula is a promising area for further geothermal exploration particularly near the eastern side of the Gulf of Suez.
► This article addresses a very important issue related with geothermal exploration. ► The Curie depth surface is estimated from the analysis of magnetic data in Sinai Peninsula, Egypt. ► The most important result is that, once you have an area with high frequent earthquakes, the Curie depth will be shallow.
Abstract Background The management of epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC) has dramatically changed following the introduction of target therapy in the ...last 15 years. Comprehensive reflex biomarker testing, including EGFR, is recommended for all patients with a diagnosis of non-squamous NSCLCs, regardless of disease stage and should be initiated by the pathologist at the time of initial diagnosis. Objective To compare the response to Geftinib between EGFR mutation exon 19 and EGFR mutation exon 21 in non- small cell lung cancer in Egyptian patients. Methods Our retrospective analysis examined 60 patients with advanced NSCLC who had received gefitinib therapy and the specimen were available at Shefa Alorman Oncology Hospital from June 2017 to May 2020. Results Our study showed no statistically difference as regard response to first line treatment between exon 19 deletion and exon 21 mutation with P Value = 0.1273. Our study showed no statistically significance as regard progression free survival after first line treatment Gefitinib between exon 19 deletion and exon21 mutation with median PFS 12 months for patient with exon 19 deletion compared to 10 months for patients with exon 21 mutation (Hazard ratio of progression or death 1.57; 95 % confidence interval 0.87 – 2.82; P- Value= 0.1269).Median PFS of study population was 12 months. The median survival was 27 months for exon 21 group while median survival not reached for exon 19 group (Hazard ratio for death 2.95; 95 % confidence interval 0.78 – 11.20). Median survival of whole study population was 33 months. Conclusion The EGFR mutation subtype should be considered when making treatment decisions for designing new clinical trials for chemotherapy-naïve, EGFR mutation- positive patients with advanced NSCLC.
There are many factors affecting knee osteoarthritis (OA) as genetic and metabolic factors, obesity, mechanical trauma, osteoporosis, inflammatory joint disorders, previous joint infection, and ...laxity of ligaments.
The aim of this study was to detect the influence of intra-articular injection (IAI) of both hyaluronic acid (HA) with platelet-rich plasma (PRP) and radiofrequency (RF) of genicular nerve and to compare their effects in the treatment of knee OA pain.
After approval of local research committee of anesthesia, Tanta University (committee protocol code 32049/01/18) and written informed consent, this prospective randomized study was done at Tanta University Hospital on 100 patients complaining of knees OA with mild-to-moderate degrees. IAI was performed in a pain clinic and RF was performed in an operating room during the period from April 2018 to January 2019.
In intra-articular knee injection group, results show decreased visual analog scale (VAS) score from (3-10) at 1-week follow-up session to (0-8) in 6-month follow-up session. It also shows reduction of analgesia requirements (etoricoxib 60 and 90 mg) from (60-270) to (0-180) mg/day. In RF group patients, results show decreased VAS score from (0-9) at 1-week follow-up session to (0-5) in 6-month follow-up session. It also shows reduction of analgesia requirements (etoricoxib 60 and 90 mg) from (0-270) to (0-90) mg/day.
Both IAI of PRP with HA and RF of genicular nerves reduced pain of knee OA and reduced analgesic requirements with rapid onset in RF group.
The Gebel El-Zeit area is located on the western coast of the Gulf of Suez, Egypt. The areas in/and around the Gulf of Suez are generally important due to their hydrocarbon resources. In this study, ...we have applied gradient interpretation techniques (Euler deconvolution and analytic signal) to the aeromagnetic data of the Gebel El-Zeit area. The main objective of this study is to identify and delineate the possible subsurface structure of the area that may assist in locating new hydrocarbon prospects. Results of Euler method suggested that, on the eastern and western parts of the area, the basement could be observed on the ground (-50 m over the ground) and became more deeper on the central part to reach depth of 5 km (from the ground level). Results from the analytic signal method indicated that, the depth to the basement has an average value of 156 m on the eastern side and 758 m on the western side. Generally, the area is characterized by a graben structure bounded by major faults striking in the NW-SE direction.
Auxiliary drugs augment the effect of local anesthetic in intravenous regional anesthesia (IVRA). The aim of our study was to estimate the median effective dose (ED50) of Dexmedetomidine in elective ...upper limb Lidocaine 0.5% IVRA.
A prospective, double-blind, sequential study using modified Dixon's up and down method. Thirty patients scheduled for minor upper limb surgeries were recruited in the Study, however, we ended up analyzing data of 26 patients due to protocol violation. The first patient in this sequential trial was randomly selected and received a mixed solution of 0.5% lidocaine and 0.4 µg/kg of dexmedetomidine, with 0.1 µg/kg dose interval. If IVRA outcome was satisfactory, the dose went down for the next patient by 0.1 µg/kg. Vice versa, if the outcome was unsatisfactory, the dexmedetomidine dose was stepped up by 0.1 µg/kg. Sensory and motor block onset, recovery times, hemodynamic variables, surgical and tourniquet VAS scores and time to first analgesic request were recorded.
The series of patient responses to IVRA was satisfactory in 11 patients (42.3%) and unsatisfactory in 15 patients (57.6%) due to either surgical pain in 6 patients or tourniquet pain in the remaining 9 patients. In patients with satisfactory response to IVRA, intraoperative and postoperative mean arterial pressure and heart rate, compared with baseline (just prior to inflating the proximal cuff) measurement, showed no statistically significant differences (P = 0.754 and 0.324, respectively). Intergroup comparison of Patients with unsatisfactory response to IVRA time to first analgesic request showed no statistical difference (P > 0.05).
the ED 50 of Dexmedetomidine (95% confidence interval, CI) as adjuvant for satisfactory 0.5% lidocaine IVRA was 0.7 µg/kg (0.6-0.8).
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