Objective:A comparative study to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery (FESS).Methods:Forty patients ASA I or II scheduled for FESS were equally randomly assigned to receive either dexmedetomidine 1 μg/Kg over 10 min before induction of anesthesia followed by 0.4-0.8 μg/Kg/h infusion during maintenance (DEX group), or esmolol, loading dose 1mg/kg was infused over one min followed by 0.4-0.8 mg/kg/h infusion during maintenance (E group) to maintain mean arterial blood pressure (MAP) between (55-65 mmHg). General anesthesia was maintained with sevoflurane 2%-4%. The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP and HR); arterial blood gas analysis; plasma cortisol level; intraoperative fentanyl consumption; Emergence time and total recovery from anesthesia (Aldrete score ≥9) were recorded. Sedation score was determined at 15, 30, 60 min after tracheal extubation and time to first analgesic request was recorded.Result:Both DEX group and E group reached the desired MAP (55-65 mmHg) with no intergroup differences in MAP or HR. The for the quality of the surgical filed in the range of MAP (55-65 mmHg) were <=2 with no significant differences between group scores during hypotensive period. Mean intraoperative fentanyl consumption was significantly lower in DEX group than E group. Cortisol level showed no significant changes between or within groups. No significant changes were observed in arterial blood gases. Emergence time and time to achieve Aldrete score ≥9 were significantly lower in E group compared with DEX group. The sedation score were significantly lower in E group compared with DEX group at 15 and 30 minutes postoperatively. Time to first analgesic request was significantly longer in DEX group.Conclusion:Both dexmedetomidine or esmolol with sevoflurane are safe agents for controlled hypotension and are effective in providing ideal surgical field during FESS. Compared with esmolol, dexmedetomidine offers the advantage of inherent analgesic, sedative and anesthetic sparing effect.

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Objectives: Medical students, the future doctors, were presumed to be knowledgeable about physical activity and would have future influence on their patients. This study aims to describe the pattern of physical activity, predictors of physical inactivity and perceived barriers to and benefits of physical activity among a sample of Egyptian and Saudi medical students. Methods: A cross-sectional comparative study was carried out on 319 Egyptian and 297 Saudi medical students. The long form of the international physical activity questionnaire (IPAQ) was used to measure physical activity. Data was analyzed according to the guidelines for data processing and analysis of the IPAQ. Perceived barriers to and potential benefits of physical activity were reported. Results: Physical inactivity was significantly higher among Saudi than Egyptian medical students (41.1% versus 15.4%, respectively). Logistic regression analysis revealed that the independent predictors of physical inactivity were non-membership in sports clubs (OR =4.6) and use of private cars for transportation (OR=3.9). The most frequent barriers to physical activity are time limitation due to busy study schedule and lack of accessible and suitable sporting places. More than 70% of students perceived that physical activity promotes and maintains health. Conclusions: Because time and access are key barriers to medical student exercise, we believe that provision of free playgrounds in the college to practice sports during free times will promote physical activity in students. [TAF Prev Med Bull 2011; 10(1.000): 35-44

Background and Aims:The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic, and recovery parameters. The aim of the study was to assess the effects of ketamine-propofol induction with dexmedetomidine preadministration (ketofol-dex group) and without its preadministration (ketofol group) on haemodynamics, depression, seizure duration, recovery characteristics, and agitation following ECT in patients with depression.Methods:40 patients aged 18-60 years were scheduled for ECT for treatment of depression. Dexmedetomidine (0.5 μg/kg) diluted to a volume of 10 ml with 0.9% saline or 10 ml 0.9% saline were infused intravenously over 10 minutes before induction of anaesthesia with ketamine and propofol (ketofol). Statistical analysis was carried out using the Statistical Software for the Social Sciences (SPSS) package.Results:Motor seizure duration in ketofol group was significantly less compared to ketofol-dex group (35.8 ± 6.6s versus 38.9 ± 4.9s). Total ketofol used was significantly less in ketofol-dex group compared to ketofol group (78.5 ± 10.8mg versus 90 ± 13.2mg). The number of patients with agitation score >2 was significantly lower in ketofol-dex group (1.4%) compared to ketofol group (8.6%). There was significant decrease (P = 0.000) in mean arterial pressure (MAP) and heart rate (HR) in ketofol-dex group compared to ketofol group at 20, 30, and 40 minutes for MAP and at 10, 20, 30, and 40 minutes for HR.Conclusions:Ketofol-dex mixture in ECT is associated with longer mean seizure duration, effective anti-depression, less incidence of agitation, more patient satisfaction, and acceptable decreases in blood pressure and HR when compared to ketofol alone.

Background: Transition from pre-clinical to clinical training has been identified as a crucial stage of medical education regarding student stress. When entering the clinical environs, students may become more prone to burnout. Aims: This study aimed to determine the prevalence, sources and predictors of high stress levels and burnout among medical students at King Faisal University, Saudi Arabia, during the clinical phase of medical education. Subjects and Methods: A cross-sectional survey of medical students in years four through six at Al-Ahsa Medical College during the academic year 2011-12 was performed. All 324 regular course attendants were invited to participate in the study and 233 participated (response rate of 71.9%). A self-reported questionnaire was used which covered three categories, including 18 sources of stress. Short Perceived Stress Scale and Emotional Exhaustion Subscale of Maslach Burnout Inventory were used to measure stress and burnout. Result: Sixth year students were more likely to cite relationship, hospital, and professional issues as stressors. Top stressors cited by final year students were concern about the future, defective clinical practice skills, fear of harming patients, and high parental expectations. Whereas first year students cited stressors such as transportation problems to hospital, fear of infection, and time limitations for training. The prevalence of emotional exhaustion and high levels of perceived stress was 76.8 and 71.7% respectively. Year of study was the only single independent risk factor for burnout and high levels of stress among students of clinical years. Conclusions: Clinical phase of medical education is a necessary area of intervention in order to provide an improved transition between pre-clinical and clinical periods. In addition, adoption of a new curriculum that integrates pre-clinical and clinical training of students from an early stage of education may reduce the stress.

Background:Few previous studies proved that complications related to sickle cell disease (SCD) were common with regional anesthesia compared with general anesthesia while others reported no differences. This study was carried out to evaluate the role of prophylactic vitamin D on anesthetic outcome among male children with SCD undergoing circumcision.Materials and Methods:A comparative study was carried out on 58 children undergoing circumcision with the regional block under light general anesthesia. The study sample was classified into two groups: one group received daily 400 IU vitamin D for 6 months before surgery while the other group without vitamin D. All patients were followed regarding the post-operative analgesia and the incidence of post-operative SCD related complications (acute chest syndrome, painful crisis and cerebrovascular accident). Data were analyzed with Statistical Package for Social Sciences version 13, produced by IBM SPSS, Inc. in Chicago, Illinois, USA.Results:There was a highly significant difference between the two groups (P < 0.001) regarding first analgesic request and total analgesic consumption per day: there was delayed analgesic request and less total analgesic consumption per day in vitamin D group. Comparison of post-operative sedation scores showed highly significant difference (P < 0.001) between the two groups, Sedation scores was increased significantly in vitamin D group. This study also reported that the administration of vitamin D was associated with less noticeable post-operative SCD complications.Conclusion:The use of prophylactic vitamin D in SCD will result in delayed post-operative analgesic request and less total analgesic requirement. Administration of vitamin D was also associated with less post-operative complications.

Background The sudden transmission of the novel coronavirus along with instant measures taken in response to the Coronavirus Disease 2019 (COVID-19) pandemic caused many new challenges adversely disturbing quality of life (QoL). The objective of this study is to measure quality of life of the public during the COVID-19 pandemic and factors affecting it among adults. Methods This is a community-based cross-sectional household study with analytic component conducted in an agricultural area in Dakahlia governorate, Egypt and included 500 individuals. Data were collected through a structured interview, and the collected data included socio-demographic characteristics as well as some data related to their habits and comorbidities, their experience with COVID-19 and data about QoL using the COV19-Impact on Quality of Life (COV19-QoL) scale Arabic version, after assessing Content validity and reliability. Results The total QoL score (mean ± standard deviation) is 2.3 ± 0.6 and the score for QoL in general and perception of danger on personal safety show the highest mean with 2.6 ± 0.7. The lowest mean score is related to the perception of mental health deterioration (1.9 ± 0.8). Independent predictors of the total QoL scale are sex (regression coefficient (95% CI) = 0.1 (0.02 to 0.2), p value = 0.02), monthly income (regression coefficient (95% CI) = 0.1 (0.004 to 0.2), p value = 0.04), knowing someone infected with COVID-19 (regression coefficient (95% CI) = 0.15 (0.08 to 0.3), p value = 0.001), and data collection time (regression coefficient (95% CI) = 0.1 (0.006 to 0.2), p value = 0.04). Conclusions COVID-19 pandemic has impacted the public quality of life, particularly in terms of general quality of life and personal safety. People with substantial predictors of lower quality of life should be given more attention.

Background:The assessment of the anesthesia course in our university comprises Objective Structured Clinical Examinations (OSCEs), in conjunction with portfolio and multiple-choice questions (MCQ). The objective of this study was to evaluate the outcome of different forms of anesthesia course assessment among 5th year medical students in our university, as well as study the influence of gender on student performance in anesthesia.Methods:We examined the performance of 154, 5th year medical students through OSCE, portfolios, and MCQ.Results:The score ranges in the portfolio, OSCE, and MCQs were 16-24, 4.2-28.9, and 15.5-44.5, respectively. There was highly significant difference in scores in relation to gender in all assessments other than the written one (P=0.000 for Portfolio, OSCE, and Total exam, whereas P=0.164 for written exam). In the generated linear regression model, OSCE alone could predict 86.4% of the total mark if used alone. In addition, if the score of the written examination is added, OSCE will drop to 57.2% and the written exam will be 56.8% of the total mark.Conclusions:This study demonstrates that different clinical methods used to assess medical students during their anesthesia course were consistent and integrated. The performance of female was superior to male in OSCE and portfolio. This information is the basis for improving educational and assessment standards in anesthesiology and for introducing a platform for developing modern learning media in countries with dearth of anesthesia personnel.