Background:The inhibitory effect of Tranexamic Acid (TXA) on γ-aminobutyric acid and glycine receptors of spinal dorsal horn neurons which leads to pain arousal, has been highlighted recently in animal studies. Such findings would elicit concerns about adverse effects of TXA as a routine agent used to reduce perioperative blood loss. Objectives:This study aimed to evaluate the effect of different doses of TXA on analgesic requirements in adolescent patients undergoing elective single-stage posterior spine fusion surgery for idiopathic scoliosis. Patients and Methods:This prospective, randomized, double-blinded study comprised 75 patients who were randomly allocated to one of three groups. Each group comprised 25 patients. In group C (Control), patients received normal saline. While in group HD (High Dose), patients received TXA with a loading dose of 50 mg/kg and maintenance dose of 20 mg/kg/h and patients in group LD (Low Dose) received TXA with a loading dose of 10 mg/kg and maintenance dose of 1 mg/kg/h. The total intraoperative fentanyl dose was calculated for each patient which we used as a measure of the patients' nociception level. Results:Group HD patients' required the highest dose of fentanyl compared to those in LD group (mean of 60µg versus 27µg). Patients in group C received no extra intraoperative narcotic doses and experienced the longest duration of surgical procedure. These results showed high statistically significant difference (p < 0.001). Conclusion:Intraoperative administration of TXA increases the analgesic requirement during elective single stage posterior spine fusion surgery which likely reflects an increase in patients' intraoperative nociception.

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This study investigated the diagnostic value of soluble urokinase plasminogen activator receptor (suPAR) and serum lactate in elderly patients with sepsis and evaluated their capacity to predict mortality and their correlation to Sequential Organ Failure Assessment (SOFA) score. The study included 80 participants, divided into two groups: 40 cases (mean age, 68.9 ± 5.9) admitted to the intensive care unit and 40 healthy controls (mean age, 67.1 ± 6.2). Elderly patients with sepsis had significantly higher levels of serum suPAR and lactic acid compared to healthy controls. Receiver operating characteristic (ROC) curve analysis showed that suPAR (cutoff value, ≥4.37 ng/ml) has higher area under the curve (AUC) than lactic acid (cutoff value, ≥1.95 mmol/l) for diagnosing sepsis. Serum lactate has superior prognostic value compared to suPAR with AUC of 0.82 (cutoff value, 2.2 mmol/l) and 0.72 (cutoff value, 6.3 ng/ml), respectively. The diagnostic power of combined usage of suPAR and lactate serum concentrations showed AUC of 0.988 (95% confidence interval 0.934 to 1.0). The combination of both biomarkers either together or with SOFA score may serve as a useful guide to patients who need more intensive resuscitation.

Background: The delivery of aerosolized drugs is a vital component of treatment for many respiratory disorders. We used this mode of medication delivery as a pre-emptive strategy to alleviate a Postoperative Sore Throat (POST) in children receiving general anesthesia. Objectives: The primary aim of the study was to compare the effects of prophylactic ketamine, magnesium sulfate and dexamethasone nebulization, on the intensity of POST. Methods: Through a prospective, randomized, double-blind study, data were collected from children (6-16 years) undergoing surgeries from March 2018 to May 2018. The patients were allocated into 3 equivalent groups (36 patients each). Preoperative nebulization was performed for all patients. Group M received 40 mg/kg magnesium sulphate, group K received 1 mg/kg ketamine, and group D received 0.16 mg dexamethasone. The primary outcome of the study was the incidence and intensity of POST at the 4th postoperative hour. The secondary outcomes included evaluation of adverse effects specifically nausea, vomiting, postoperative cough and postoperative sedation. Results: Patients in the K group had the lowest incidence of POST compared to patients in groups M and D, specifically, at the 4th - postoperative hour (p-value = 0.003). Conclusions: Preoperative nebulization with ketamine was more effective in reducing the intensity of POST in pediatric patients postoperatively without systemic adverse effects.

Methicillin-Resistant Staphylococcus aureus (MRSA) is an important cause of healthcare associated infections globally. New mecA homologue (mecC), was first reported in the UK and Denmark. The mecC mediated MRSA is resistant only to Β-lactams antibiotics and is sensitive to other antibiotics. Detecting the prevalence of mecC MRSA provides more options in treatment of MRSA infections. The aim of this study was to prevalence of mecC gene in clinical isolates of MRSA in Ain-Shams university hospitals & to correlate Minimal Inhibitory concentration (MIC) of Oxacillin with the mecC gene expression in MRSA isolates. Fifty MRSA isolates were collected from different intensive care units (ICUs) of Ain-Shams university hospital from April-December 2018. Methicillin resistance was detected by Cefoxitin disc, and antimicrobial susceptibility testing was done for all isolates and its results were interpreted according to Clinical & Laboratory Standards Institute (CLSI) guidelines 2018. Minimal Inhibitory Concentration of Oxacillin was detected using Oxacillin E-test and the results were interpreted according to the manufacturer’s instructions, then Polymerase Chain Reaction was done to detect mecA and mecC genes among MRSA isolates. Fifty isolates were identified as MRSA by Cefoxitin disc out of 163 samples. Twelve isolates were sensitive to Oxacillin while 38 isolates were resistant to Oxacillin. All isolates were positive to mecA gene while only 3 isolates were positive to both mecA and mecC genes. MecC is a new emerging gene responsible for methicillin resistance in staphylococci and was detected in 6 % of the isolates in this study.