Background: To date, central line-associated bloodstream infections (CLABSIs) are the most common healthcare-associated infections in high-risk neonates and children. These infections are associated with significantly longer hospital stays, increased health care cost, and mortality in the health care systems. Application of evidence-based preventive interventions has proven to decrease CLABSI rate. The purpose of this study is to reduce the undesired relative high CLABSI rate through the adoption of standardized quality improvement interventions. Methods: and Methods: The study employed a pre-post-intervention design. Phase one is a retrospective calculation of 12 months of surveillance period as a baseline. Phase 2 establishes a multidisciplinary quality improvement intervention, which includes the formation of a dedicated central line insertion team, provision of central line kit at the bedside, training and educating the team, and selecting bundle checklist. In the third phase, we performed auditing and calculating the checklist compliance and monthly feedback for 12 consecutive postintervention months. During phase 1 and 3, we calculated the following measures; CLABSI per 1000 catheter-days, duration of central line use, and device utilization ratio. Results: During the post-intervention phase the CLABSI rate significantly reduced by 59.5% from 7.5 to 3.0 per 1000 central line day, and the duration of use of the central line decreased from 21.3 AE 9.9 to 11.0 AE 3.2 days (P < 0.05).

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BackgroundLaparoscopic surgeries are associated with less postoperative pain and adverse events compared to open procedures. But, it still reduces the quality of life in children. Transversus abdominis plane (TAP) block is used to reduce pain. We hypothesized that dexmedetomidine or clonidine could improve the analgesic profile of levobupivacaine to the same extent during TAP block in children.MethodsNinety children were randomly allocated in a randomized double‐blind trial to receive bilateral TAP block with levobupivacaine plus normal saline (group B, n = 30), or dexmedetomidine (group D, n = 30) or clonidine (group C, n = 30). Primary outcome was the modified Children's Hospital of Eastern Ontario Pain Scale score. Secondary outcomes included time to initial analgesic request, number of analgesic claims, total analgesic consumption, parents' satisfaction, sedation score and complications.ResultsChildren of group D showed reduced pain scores compared to other groups. They represented the longest period of analgesia (565.00 ± 71.5 min) with p < 0.001, and fewer patients required two doses of analgesia during the first postoperative day. The cumulative amount of backup analgesia was significantly different between these groups (p = 0.026). Higher parents’ satisfaction scores were recorded in groups D and C compared to group B. Sedation among the study groups revealed significant differences (p = 0.035), but no severe complications were recorded.ConclusionsAdding dexmedetomidine to levobupivacaine can extend the time of analgesia and reduce the use of postoperative backup analgesics with minimal sedation effects when used in TAP block in paediatrics undergoing laparoscopic orchiopexy. Clonidine can be used as an alternative adjuvant to local anaesthetics with good postoperative analgesic profiles.SignificanceClonidine can alternate dexmedetomidine during TAP block with local anesthetics for pediatrics laparoscopies. Both can lead to better postoperative analgesic profiles. Clonidine may be preferred, especially in our developing regions, because of its easy availability and lower cost than that of dexmedetomidine.

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Background and Study Aim : Hepatocellular carcinoma (HCC) is the fifth most common form of cancer worldwide and the third most common cause of cancerrelated deaths. This study was designed to investigate the therapeutic efficacy of percutaneous Radiofrequency ablation versus Microwave ablation for small HCC measuring ≤3 cm in diameter. Patients and methods : This study was carried out in Al-Mahalla Hepatology Teaching Hospital on 30 patients with cirrhosis and small HCC. All the patients were evaluated by thorough history, clinical examination, laboratory investigations, abdominal ultrasound and spiral triphasic CT. Results: The mean age was 56.2±5.8, 70% (21) were males and 30% (9) were females. There was highly statistical significant increase in liver function in MW ablation as regard AST, ALT and bilirubin, and decrease in  FP level of both groups after treatment. There was no significant difference between two groups in the response to treatment as regarding Triphasic CT and complications. Conclusion: Microwave (MW) and Radiofrequency (RF) ablation are similar in pathologic appearance and imaging characteristics, but RFA has many limitations and many complications. MW ablation offers many of the advantages of RF ablation while overcoming some of its limitations and the heat-sink effect.

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