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Dhahran, Saudi Arabia

Introduction Transversus abdominis plane (TAP) block is used as a part of multimodal analgesia in decreasing pain of lower abdominal wall incision. Local anesthetic instillation of wounds through subcutaneous or subfascial catheters is used to treat postoperative pain in different types of surgery. The aim of this randomized controlled trial was to study the opioid-sparing effect of these two techniques (if any) compared to placebo in women undergoing gynecologic procedures through transverse lower abdominal incisions. Methods Seventy-eight ASA I-III patients planned to undergo gynecologic procedures through a transverse lower abdominal incision were randomly divided into three equal groups: Control (C) group (n = 26), Continuous Wound Infusion (CWI) group (n = 26), and continuous transversus abdominis plane block (TAP) group (n = 26). After standardized general anesthetic and before extubation, the patients were given the allocated treatment. A morphine patient-controlled analgesia (PCA) was started postoperatively alongside with the local anesthetic (or placebo) infusion. Cumulative dose of morphine PCA in the first postoperative 48 h was the primary outcome. Secondary outcomes included visual analog pain score (VAS) at rest and on movement and complications of morphine PCA. Results The cumulative dose of morphine PCA in the first postoperative 48 h was higher in control group than in groups CWI and TAP (P < 0.001). However, no significant difference was found between groups CWI and TAP. No significant differences were found among the three groups regarding VAS during rest but TAP group showed less pain scores than groups C and CWI on movement. The three groups were similar regarding morphine side effects. Conclusion Continuous bilateral TAP block and CWI can decrease PCA morphine consumption in the first postoperative 48 h when compared to placebo in women undergoing gynecologic surgery through transverse lower abdominal incision. Continuous TAB block might give better analgesia with movement than CWI. © 2013 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists. Source


Omar A.M.,King Fahd Military Medical Complex
Egyptian Journal of Anaesthesia | Year: 2012

Introduction: In spite of introduction of intermediate-acting neuromuscular blocking drugs (NMBDs), incidence of postoperative residual muscle weakness is still high. The aim of this trial is to study the effect of systemic lidocaine infusion on intraoperative consumption of rocuronium and TOF ratios at extubation and on arrival to postanesthesia care unit (PACU). Methods: Forty-six ASA I-III patients aged 16-60 yr were randomly allocated into two groups: lidocaine (L) group (n = 23) and control (C) group (n = 23). After induction of standard endotracheal general anesthesia with fentanyl, propofol and rocuronium, patients of group L were given i.v. lidocaine bolus (1.5 mg kg -1) followed by continuous infusion (1.5 mg kg -1 h -1) till time of endotracheal extubation while patients in group C were given equal volumes of normal saline. Rocuronium was titrated based on clinical signs. On conclusion of surgery, neostigmine was given to reverse the effects of rocuronium if TOF count was two or more. Immediately before extubation, TOF ratio was measured and recorded and considered the primary outcome. Results: There were no significant differences between the two study groups regarding intraoperative fentanyl doses or core temperature at the end of surgery. End-tidal sevoflurane concentrations were significantly lower in group L than in group P (P < 0.01). The dose of rocuronium was significantly less in group L than in group C (P = 0.001). Train-of four ratios were significantly higher in group L than in group C either before extubation (P < 0.001) or on arrival to PACU (P = 0.001). Conclusion: The current study shows that intraoperative use of i.v. lidocaine infusion in generally anesthetized patients can result in higher TOF ratios at time of extubation and on arrival to PACU when rocuronium was given based on clinical signs. © 2012 Egyptian Society of Anesthesiologists. Production and hosting by Elsevier B.V. All rights reserved. Source


Kavarodi A.M.,King Fahd Military Medical Complex | Thomas M.,Hamad Medical Corporation | Kannampilly J.,Dr. Johnnys Dental Clinic
Asian Pacific Journal of Cancer Prevention | Year: 2014

Background: The expatriate population in Qatar largely comprises workers from the Indian subcontinent which has a very high rate of oral malignancy. Social and cultural habits and as well premalignant risk factors in this population remain prevalent even after migration. Materials and Methods: This cross sectional study assessed the prevalence of risk factors and occurrence of oral precancerous lesions in a low income group expatriate community from the Indian subcontinent residing in Qatar. Results: Among the 3,946 participants screened for oral premalignant lesions 24.3% (958) were smokers and 4.3 % (169) were pan chewers while 6.3% (248) were users of both smoked and smokeless forms of tobacco. Significantly higher proportion of industrial laborers (49.9%) followed by drivers (24.1%) were found to be smokers (p=0.001). The prevalence of white lesions was higher in smokers versus non-smokers 3.5% versus 2.3% (p=0.111), however this difference was statistically non-significant. Red and white lesions were highly significant (i.e. 1.2 % and 10.9% respectively) in the subjects with pan chewing and smoking habits (p=0.001). A significant proportion (8.9%) of the subjects with pan chewing habit showed evidence of oral precancerous lesions (p=0.001). Conclusions: Even though smoking and pan chewing were two significant risk factors detected in this population, their prevalence and occurrence of premalignant lesions are low as compared to the studies conducted in their home countries. Source


Al-Hassan D.,King Fahd Military Medical Complex | Leipsic J.,University of British Columbia
Future Cardiology | Year: 2013

Coronary computed tomographic angiography (CCTA) provides anatomic detail of lumen stenosis and information on plaque burden, plaque extent and plaque characteristics. CCTA does not, however, provide insight into the hemodynamic significance of a stenosis, which is essential to allow appropriate revascularization decision-making. This could reduce downstream invasive coronary angiography and nonbeneficial coronary revascularization, particularly with intermediate coronary stenosis. Invasive fractional flow reserve (FFR) is the gold standard for the determination of lesion-specific ischemia and the need for revascularization. Advances in computational technology now permit calculation of FFR using resting CCTA image data, without the need for additional radiation or medication. Early data demonstrate improved accuracy and a discriminatory ability of FFR computed tomography to identify ischemia-producing lesions compared with CCTA alone. This new, combined anatomic-functional assessment has the potential to simplify the noninvasive diagnosis of coronary artery disease with a single study to identify patients with ischemia-causing stenosis who may benefit from revascularization. © 2013 Future Medicine Ltd. Source


Elkholy S.,King Fahd Military Medical Complex | Elkholy S.,Ain Shams University | Lardhi A.A.,University of Dammam
International Journal of Diabetes Mellitus | Year: 2015

Monogenic forms of diabetes are still rare and not well understood. Their prevalence among children and young adults at diagnosis is thought to be between 1% and 2% of cases of diabetes. However, awareness of these conditions may be lacking, and screening for them genetically is not routinely undertaken, even when the clinical picture may point to their probability. The aim of this work is to identify the indicators for suspecting cases of monogenic diabetes beyond the neonatal period in children and young adults in Saudi Arabia, and to provide a draft for baseline investigations for those suspected cases, depending on available resources. The implications of the diagnosis of such conditions would be better management of cases, providing genetic counseling to families and planning health resources. © 2011 International Journal of Diabetes Mellitus. Source

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