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Article informationBackground: Chronic kidney disease (CKD) patients need efficient vascular access once they progress to end-stage renal disease (ESRD) and require hemodialysis (HD). The most common forms of vascular access used in clinical practice are arterio-venous fistula (AVF), arterio-venous graft (AVG), and central venous catheters (CVC). AV Fistula is preferred over AVG and CVC because it provides better patient and Access survival owing to fewer accessrelated complications.

Article informationBackground and Objective: The target of our study compares the effect of dexamethasone versus dexmedetomidine when used as adjuvant to bupivacaine for improving the analgesic effect of spinal anesthesia after lower abdominal surgeries. Patients and methods:The patients were divided into 3 groups: Control group [I], in which patients were administered 3 ml bupivacaine [0.5%] plus 1 ml of saline, Dexmedetomidine group [II], in which patients were administered 3 ml bupivacaine [0.5%] plus 10 μg dexmedetomidine in1 ml saline, and Dexamethasone group [III], in which patients were administered 3 ml bupivacaine [0.5%] plus 4 mg dexamethasone in 1 ml saline. Results: As regarding duration of sensory blockade was significantly longer in Dexmedetomidine group [II ] and Dexamethasone group [III] when compared to the Control group [I] [p-value=0.02] and also as regards to the duration of motor blockade was significantly longer in Dexmedetomidine group [II ] and Dexamethasone group [III] when compared with Control group [I] [p-value=0.02]. Conclusion:Our study perceived that intrathecal dexmedetomidine or dexamethasone as adjuvant to bupivacaine in spinal anesthesia prolong the duration of sensory, motor block and improved postoperative analgesia but dexmedetomidine is superior to dexamethasone.

Article informationBackground: Peripheral neuropathy is a common sequel of diabetes mellitus type 2, and may occur as an initial manifestation of diabetes. The role of uric acid in diabetic neuropathy as a microvascular complication of diabetes type 2 has been reported in numerous studies. Aim of the Work:The objective of the study is to assess the relationship between serum uric acid levels and diabetic neuropathy in cases with diabetes mellitus type 2. Patients and Methods:A case-controlled study included 168 cases with type 2 diabetes mellitus, conducted at internal medicine and neurology departments. Two groups of diabetic patients [type 2 DM] each one was 84 in number; 1st one diabetic with peripheral neuropathy and 2nd group was diabetics without peripheral neuropathy. All patients submitted to history taking, general and neurological examination, biochemical study, and electrophysiological examination. Results:The serum uric acid mean level was a statistically significant higher in the 1st group in comparison with the 2nd group [4.71 ± 0.97 vs. 4.35 ± 0.9]. The severity of polyneuropathy in the 1st group showed that 38 patients had mild diabetic peripheral neuropathy [DPN], while 22 patients had moderate DPN and 24 patients had severe DPN. Uric acid levels in these three subgroups were respectively as follows: [4.6 ± 0.8] mg/dl, [4.9 ± 0.5] mg/dl and [5.3 ± 0.6] mg/dl. Regarding the relation of severity of peripheral polyneuropathy to serum uric acid level, there was a statistically significant relation between mild and moderate polyneuropathy and a statistically significant relation between Mild to severe polyneuropathy. The logistic regression model revealed that an increase in uric acid level is an important indicator for a more severe degree of peripheral neuropathy. Conclusion:The severity of diabetic polyneuropathy is increased with the increase of uric acid serum level.