The spread of carbapenem resistance among Enterobacteriaceae have become a problem for healthcare facilities worldwide. Community and hospital-acquired infections caused by these bacteria have been associated with significant morbidity and mortality with limited treatment options. Rapid detection of carbapenem resistant Enterobacteriaceae (CRE) is important for infection control. Objectives: To detect the prevalence of carbapenem resistant Enterobacteriaceae (CRE) species and determine their antimicrobial susceptibility profile using the Vitek 2 system and the presence of carbapenemases genes using Multiplex PCR. Methodology: Various clinical samples were collected from 469 patients from Sohag University Hospitals in the period between August 2016 and April 2018, CRE isolates were identified by conventional methods and antimicrobial susceptibility testing using disc diffusion method and also performed by Vitek 2 automated system, Multiplex PCR was used for detection of carbapenemases genes as blaKPC, blaVIM, blaIMP, blaNDM-1 and blaOXA-48. Results: The prevalence of carbapenem resistant Enterobacteriaceae (CRE) species was 19.9%, Klebsiella pneumoniae was the most common species (51.4%), Escherichia coli (28.6%), Enterobacter aerogenes(8.6%) and Acinetobacter baumannii (5.7%). Vitek 2 system identified CRE isolates with 82.7% sensitivity, 98.6 % specificity and 90.6% diagnostic accuracy 25.7% of CRE strains were isolated from the internal ICU and 20 % from Chest Department, and mostly isolated from urine(40%) and from endotracheal tubes swabs(28.6 %) 77.1 % of CRE isolates contained carbapenemases genes, 62.1 % were blaKPC positive, 20.7 % were blaVIM-positive, 3.4 % were blaNDM-positive, 13.8 % were blaOXA-48-positive and none was blaIMP-positive. Conclusion: Conventional methods supported by Vitek 2 system is a valuable method for identification of CRE species, the detected carbapenemases genes in this study indicate that carbapenem resistance is spreading in Egypt and support the use of molecular methods for the rapid detection of CRE for successful implementation of infection control measures. We recommend routine testing to determine carbapenem resistance in Enterobacteriaceae in health facilities in Egypt.

Background the aim of this study is to compare between ketamine and dexamethasone when added to bupivacaine in ultrasound guided infraclavicular brachial plexus block for upper limb surgeries. Methods: The patients were randomly allocated to two groups, 25 patients each: Group K (ketamine group) Patient received 30 ml of 0.375% bupivacaine plus 0.5 mg/kg ketamine in 2 ml saline Group D (dexamethasone group) Patient received 30 ml of 0.375 bupivacaine plus 8 mg dexamethasone in 2 ml. Results: Onset time of sensory and motor blocks was significantly decreased in dexamethasone group in comparison with the ketamine group. The visual analogue scale was significantly lower in patients who received dexamethasone versus patients who received local anesthetics and ketamine. The duration of analgesia and resolution of motor block were significantly prolonged in dexamethasone group as compared to ketamine group. Postoperative analgesic consumption was reduced significantly in dexamethasone group as compared with ketamine group. Conclusion: The addition of dexamethasone to bupivacaine resulted in significant reduction in onset time of sensory and motor blocks, prolonged duration of post-operative analgesia, lower analgesic consumption and lower incidence of complications.

Aim:The aim of the study is to evaluate the efficacy of 0.5%lidocaine when given intrathecally in perianal surgery in comparison to lidocaine 2% concentration, and to study the effect of change in patient position on sensory anesthesia.Patient and Methods: forty patients aged between 18-70 years with ASA I-II who were scheduled for perianal fistula surgeries under spinal anesthesia were enrolled in our study after written informed consent and approval of ethical committee; This Study was conducted in Sohag University Hospitals from August 2016 to March 2017. Patients Were divided into 2 equal groups:-(Group I) 20 received 8ml (0.5%) lidocaine (prepared by adding 2ml(40 mg) 2% lidocain to 6ml sterile distilled water ). Subarachnoid block will performed in jack-knife.-(Group II)20 patients received 2ml lidocaine 2% (40mg) with the same technique, After injection patient will turned to lithotomy Position with table in horizontal Level. Under complete aseptic conditions, spinal anesthesia was carried out in the sitting position, at level (L3-4 or L4-5). After a free flow of cerebrospinal fluid was confirmed, each patient received one of the coded spinal solutions (GI or GII).Immediately after administration; the patients were turned into the supine or jackknife position. Patients were monitored for: Heart rate; NIBP and Oxygen Saturation. Patients were observed for onset, duration of sensory block and motor block,hemo dynamic stability; In the post-anesthesia care unit (PACU). Complications also were observed . Results The onset of sensory is faster in hypobaric lidocain but duration and time needed to reach highest sensory level longer in isobaric, onset of motor block is faster in hypobaric but duration of motor block longer in iso baric lidocain hemo dynamic stability more in iso baric . Conclusion The use of hypo baric lidocain reveal early onset for sensory and motor block with early recovery than isobaric and hemo dynamic stability slight more in iso baric lidocain in short stay surgeries as perianal surgeries.

Aim: This study was designed to evaluate analgesic efficacy, duration of sensory and motor block, hemodynamic stability and adverse effects of intrathecal morphine and intrathecal dexmedetomidine as an adjuvant to bupivacaine in spinal anesthesia in patients undergoing lower abdominal surgeries. Methods: This was a prospective, randomized, double-blind study involving 30 patients in each group. Group A received 15 mg of 0.5% hyperbaric bupivacaine with 250 μg of morphine while Group B received 15 mg of 0.5% hyperbaric bupivacaine with 5 μg of dexmedetomidine. Sensory and motor characteristics of spinal block, time for first rescue analgesia, the total dose of rescue analgesia required and side effects were noted perioperatively. Results: The duration of sensory and motor blockade was significantly longer in dexmedetomidine group than in morphine group. Time for first rescue analgesia and total analgesic dose were similar in both groups. The itching was noticed only in morphine group, nausea and vomiting occurred in both groups and there was no respiratory depression occurred in the two groups. Conclusion: Intrathecal dexmedetomidine produces prolongation of sensory and motor blockade with less undesirable side effects than morphine

the aim of this study is to compare two anesthetic modalities commonly used for shunt creation surgery in the patients of end-stage renal disease, two common anesthetic modalities are compared in this study as regard suitability and enhancement of outcomes on short and long time ,the two methods were sonographic guided supraclavicular nerve block using bupivacaine local anesthetic, or local infiltration of bupivacaine at the surgical site, follow-up of 20 patients from each group revealed that nerve block not only was more comfortable for both patient and surgeon but also it enhanced the blood flow across the shunt detected by duplex scan performed 4 hours post-operative (p-value 0.002), also improves success rate of shunt detected by 4 months follow up, this may be explained by venous vasodilatation produced by sympathectomy that enhances blood flow at early hours and helps canalization of the shunt at the early hours of the shunt creation. Keywords: supraclavicular nerve block, shunt success, patient satisfaction SOHAG MEDICAL JOURNAL Nerve block enhances the success rate in arterio-venous shunt operation in patients