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Objectives.The primary end-point of the current study was to to provide contemporary estimate about both cytoplasmic and nuclear effects of intramuscular progesterone therapy prior to craniotomy. Secondary end-points were to track post-operative course and short term (3 months) neurological sequele.Measurments.Cellular neuronal microscopic examination by immuno-histochemistry (Progesterone receptor density ) and by H&E. Allred score for nuclear staining for PR receptors . Post-operative course included time to wean from mechanical ventilation (hours), Length of ICU stay (days) and brain neuro-imaging by brain CT). Short term outcome included sensory, motor and autonomic assessment. Patients.Two hundred fifty two (252) adult patients of both sexes aged 18–60 years, American society of anesthesia (ASA class І-ІІ ) candidate for intra-parenchymal intra-axial elective brain tumors resection , Excluded candidates included refusal to sign document for intervention, urgent craniotomy, history of endometrial or ovarian neoplasia, redo craniotomy, stented coronary arteries or history of deep venous thrombosis. Design. This research was a randomized, double-blind, placebo controlled single center study. Intervention. Two groups, the control group and Progesterone (PR) group. PR group received 1mg/ kg intramuscular progesterone five days before and five days after craniotomy, while Control group received intramuscular isotonic saline daily, five days before and five days after surgery.Setting.Fixtures performed in Minia university hospital, Neurosurgery operative theatre, Floor two (non trauma floor). The study was registered in local ethical committee on April 2020. First patient enrollment was on first of June 2020 and the patient allocation in the rank ended on 30 of December 2020. Main resultsProgesterone therapy successfully increased expression of active nuclear PR receptors on oligodendrocytes and astrocytes, provided cytoplasmic and nuclear neuro-quiescence. Progesterone gave better neurological outcome on 3 month follow- up.Conclusions.Neuronal biopsy examination represented a leap in confirming anti-neuro-inflammatory action offered by progesterone.

Background: Massive blood loss occurs frequently and remains a challenge in spinal surgery, significant intra and postoperative hemorrhage negatively affects patient outcomes by increasing coagulopathy, postoperative hematoma and anemia. Many efforts have focused on reducing blood loss, Hydrogen peroxide (H2O2) is an inexpensive and readily available option with hemostatic and antiseptic properties. Objectives: to evaluate topical H2O2 application on wound in patients undergoing laminectomy. Study design: prospective randomized controlled double blinded study. Methods: this study involved 80 patients underwent thoraco-lumbar laminectomy. 40 patients received topical H2O2 3% in 100 ml saline (group H), while 40 patients received 100 ml saline wash (group C) as control group. The outcome was measured by postoperative drains, total blood loss and hemoglobin (Hb), hematocrit (Hct) and platelet (PLT) levels after 24 hours and after 48 hours. Results: there was a significant difference in the postoperative blood loss & transfusion and Hb & PLT levels after 48 hours in H2O2 group when compared to the control group. Conclusion: H2O2 can reduce postoperative blood loss and preserves higher levels of Hb & Hct in a safe and effective manner compared to control group.