Aim The aim was to evaluate the efficacy of a combination of intrastromal injections of amphotericin B (AmB) and autologous serum eye drops (ASED) in the treatment of resistant fungal keratitis. Patients and methods This is a prospective nonrandomized study that evaluated 15 eyes of 15 patients with resistant fungal corneal ulcers not responding to conventional medical treatment treated with intrastromal AmB injection (25 µg/ml) combined with the use of ASED. The efficacy, complications, and outcomes were evaluated. Results Patients showed marked improvement in symptoms (e.g. pain, discharge, photophobia, and lacrimation) in 12 cases (80%) by the second week after injection and total disappearance of symptoms in all patients by the second month. By the second week, three eyes (20%) showed complete ulcer healing, at the first month eight eyes (53.3%), at the second month 12 eyes (80%), and at the third month 15 eyes (100%) showed complete ulcer healing. The procedure was performed successfully, and no severe intraoperative or postoperative complications were observed except two patients develop minimal intrastromal bleeding which resolved. All the study cases underwent use of ASED after the intrastromal injection to accelerate ulcer healing, alleviate corneal irritation, and reduce inflammatory reactions and all of them showed rapid improvement of symptoms, for example, pain and good ulcer-healing process. Conclusion Combination of intrastromal injection of AmB and autologous serum eye drops is a promising, safe, and effective technique for the management of resistant fungal corneal ulcers not responding to conventional medical treatment. ASED shows good results in improving epithelial healing, alleviating corneal irritation, and in reducing inflammatory reactions.

Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Objective to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared local wound infiltration after lower abdominal surgery regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). The study was conducted on 100 randomly chosen patients aged 25 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for lower abdominal surgery in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores for 12 h after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received wound infiltration. Conclusion Bilateral TAP block was effective in reducing postoperative pain scores at rest and movement for 8-12hours and lower total 24-h postoperative opioid and analgesic consumption after lower abdominal surgeries under general anesthesia, compared to local wound infiltration..

Background Postoperative pain after spine surgeries is a major concern for the patients, anesthesiologists and surgeons. Nociceptive signals have the capacity to initiate prolonged changes in both the peripheral and central nervous system that will lead to the amplification and prolongation of postoperative pain. Objective This study aims to compare between the effect of MMA and single mode analgesia in lumbar spine surgery on intraoperative and early postoperative analgesia, the consumption of morphine in both types and incidence of side effects. Patients and Methods In our study a number of 70 patients were scheduled to undergo single or double lumber vertebral discectomy or fixation under general anesthesia and were randomly assigned to one of two groups: Group A: (35 patients) The multimodal group that received preoperative analgesia in the form of paracetamol 1 gm I.V, ketorolac 30 mg and morphine 3 mg I.V. 20-30 min before surgery and intraoperative maintenance of analgesia for this group was done by morphine I.V. infusion in a rate of 1 mg/hour. Group B: (35 patients) The single mode group that received preoperative analgesia in the form of morphine 3 mg I.V 20-30 min before surgery only. Intraoperative maintenance of analgesia for this group was done by morphine I.V. infusion in a rate of 1 mg/hour. Results Regarding systolic and diastolic blood pressures and heart rate, there was a significant decrease in intraoperative and early postoperative values in the multimodal group than morphine group. Regarding narcotic consumption there was significant lower consumption in the multimodal group and also significant longer interval time for requesting analgesia. Conclusion We concluded that the use of MMA prolonged the duration of postoperative analgesia and decrease the intensity of pain, with stable hemodynamics and without any respiratory burden, furthermore it decreases the consumption of narcotics by decreasing the frequent requesting of analgesia.

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