SummaryThis randomised, controlled, double-blind study investigated the effects of intra-operative magnesium sulphate administration on the incidence of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia. Seventy children were randomly allocated to receive a 30 mg.kg À1 bolus of intravenous magnesium sulphate after induction of anaesthesia followed by a continuous infusion of 10 mg.kg À1 .h À1 or an equal volume of saline 0.9%. All children received titrated sevoflurane anaesthesia adjusted to maintain haemodynamic stability. The Pediatric Anesthesia Emergence Delirium scale and the Children's Hospital of Eastern Ontario Score were used for the assessment of postoperative emergence agitation and pain, respectively. Emergence agitation was more common in the control group than in the magnesium group (23 (72%) and 12 (36%), respectively (p = 0.004)), with a relative risk of 0.51 (95% CI 0.31-0.84), an absolute risk reduction of 0.35 (95% CI 0.10-0.54), and number needed to treat of 3 (95% CI 2-9). Postoperative pain scores were comparable in the two groups. Magnesium sulphate reduces the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia and is not associated with increased postoperative side-effects or delayed recovery.

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FGM is a traumatic experience that may leave a lasting psychological mark and a negative impact on the psychological status of affected girls.

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Background Early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia. Methods Forty patients, aged from 18 to 50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded. Results Duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 h versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 h postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively. Conclusions Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia. Trial registration ClinicalTrials.gov identifier: NCT03526731- on 16 May 2018.

Introduction: Thalassemia is hereditary anemia which requires lifelong transfusion as treatment, and hepatitis viral infection is one of the risks of repeated transfusions. Hepatitis B outbreaks in health-care settings are still a serious public health concern worldwide. Blood samples negative for HBsAg but positive for HBV-DNA, with or without the presence of HBV antibodies, are classified as "occult" HBV infection (OBI). This study investigated the prevalence of occult HBV infection in Egyptian thalassemic children. Methodology: Eighty patients admitted to the Faculty of Medicine, Cairo University Hospital, were involved in this prospective study. Strict inclusion criteria were set to nullify the effect of confounding variables and further minimize selection bias. The following laboratory investigations were performed: complete blood count (CBC); serum AST and ALT; albumin; bilirubin; HBsAg; HBeAg; HBcAb; HCV-RNA; and HBV-DNA. Results: All our patients had no clinical manifestation suggestive of hepatitis. Molecular biology studies revealed positivity for HCV and HBV at 25% and 32.5% respectively. Conclusion: The estimated risk of acquiring hepatitis B and C infection in children receiving multiple blood transfusions is surprisingly high. Moreover, occult hepatitis B infection is a considerably risk.

Objective: This study examined the T helper (Th) 1/Th17-related cytokines, interferon (IFN)-γ and interleukin (IL)-17 in the serum of biopsy-proven chronic hepatitis C patients before and after IFN and ribavirin therapy to address whether or not viral clearance is related to Th1/Th17 cytokines. Subjects and Methods: The serum levels of IFN-γ and IL-17 were assayed by ELISA on 26 patients with chronic hepatitic C virus (HCV) infection before the start and 3 months after treatment with pegylated IFN-α plus ribavarin and compared with sera from 15 normal control subjects. Results: IFN-γ and IL-17 levels are higher in the serum of patients with chronic hepatitis than in normal controls and these elevated levels were not directly correlated (r = –0.01, p = 0.96 for IFN-γ and r = –0.08, p = 0.66 for IL-17) to the viremic state of the HCV infection. In contrast to IL-17, IFN-γ showed significant reduction after 12 weeks of treatment with pegylated IFN plus ribavirin. However, IFN-γ and IL-17 serum levels were not significantly (p = 0.19 and = 0.70, respectively) different among responders and nonresponders for pegylated IFN plus ribavirin therapy. Conclusion: Our findings suggest that the combined treatment with pegylated IFN-α and ribavirin downmodulates the secretion of key cytokine IFN-γ as early as 12 weeks after treatment in infected patients. These findings could encourage new exciting possibilities for immune-based interventions with the aim of restoring functional antiviral T cell responses combined with improved viral clearance.