Comparative Study between Adductor Canal Block, Femoral Nerve Block and Epidural Analgesia for Management of Post-Operative Pain in Total Knee Replacement

Background: Total knee arthroplasty (TKA) is a common surgery that is associated with moderate to severe pain. Early ambulation and physical therapy are essential for functional recovery and long-term functional outcome after TKA as well as for reducing the immobility related complications. Hence, optimal pain relief while maintaining the motor function remains the mainstay in postoperative pain management after TKA. ‎Patients and Methods: This prospective randomized controlled open-labelled study was carried out at Tanta University Hospital, Orthopedic Surgery Department from January 2020 to February 2021. Results: Heart rate was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and there was insignificant change between group I and group II. Mean arterial blood pressure was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II.NRS was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II. Patient satisfaction was significantly higher in group III compared to group I and group II on the second postoperative day. Conclusion: Adductor canal nerve block provide better postoperative pain relieve with lower NRS after TKA than femoral and epidural blocks. It provides more stability of hemodynamic parameter and longer time for the 1st time of analgesic request. Also, total consumption of morphine in 1st postoperative day is lower than femoral and epidural blocks.

Surface lipids of Kalanhoe as a material for nanoparticles preparation

The purpose of the investigation was to elaborate the methods of extraction of surface lipids from Kalanchoe Degremona plants and preparation of solid lipid nanoparticles containing a dirhenium(III) cluster compound. The procedure of growing plants and increasing the quantity of surface lipids by means of adaptation biochemistry to toxicants was used in this work. Data on the quantities of extracts, IR-spectra, and GC-MS-data of hydrocarbons and oxocompounds of surface lipids obtained were presented. An increase in the total number of surface lipids and an insignificant change in heterogeneity under the influence of monochlorobenzene exposition were shown. The absence of differences in the ratio of the intensity of the characteristic bands in the FTIR spectra allowed concluding that the toxicant did not affect the qualitative composition of the surface lipids. The nanoparticles (with a size of 14540 nm) with high encapsulation efficiency were prepared, these nanoparticles containing the dirhenium(III) cluster compound that previously showed a cytostatic action in experiments in vivo.

Analysis of woven fabric behavior under punching force

In several applications, the industrial and protective fabrics might be subjected to punching by the rigid sharp spikes. Fabric resistance to the penetration of the puncher at a constant rate was studied. The analysis of the factors influencing the resistance of the fabric and an explanation of the puncture mechanism were generated. Punching force-displacement curves were obtained and four noticeable fabric failure modes were observed. A special setup was designed so that the fabric sample can be subjected to the biaxial stresses during the puncture tests. This paper studies the puncture behaviors of the plain, twill 1/3, and twill 2/2 woven fabric designs. It was found that the increase in the number of fabric layers from one to three and the number of picks/cm from 17.6 to 27.2 would elevate the punching resistance and the punching energy by 354% and 333%, respectively, with the insignificant change in the values of specific punching force and energy. Plain weave design proved to have higher values than twill design. A high correlation was observed between fabric tensile strength, fabric Young’s modulus, fabric failure energy and its punching force and punching energy.

Orthodoxy Marches West

On New Year’s Day 1837, what might appear to be an insignificant change in bureaucratic procedure actually signified a major step in effecting one of history’s most striking examples of confessional engineering and in terminating the existence of an entire church within the Russian empire. Formally proclaimed in 1839, the union of the Greek Catholic (Uniate) Church with Orthodoxy pushed the boundary between Western and Eastern Christianity substantially westward, and played a key role both in consolidating a single Orthodox Russian nation and in binding territories previously acquired from Poland to Russia’s central provinces. The audacious project had begun a decade or so earlier, but 1837 represented a decisive moment in this process.

The Scope of Regulation of Access to Activities in the Field of Organizing Tourist Events and Facilitating the Purchase of Related Tourist Services in Polish Law. Selected Issues

The considerations carried out in this article focus on the scope of regulation of undertaking (access to) activities in the field of organizing tourist events and facilitating the purchase of related tourist services in the part relating to the features of the activity covered by it. Entities operating in this area are subject to specific legal obligations, including requirement for obtaining an entry in the register. Business in question is no longer a regulated activity but the provisions regarding this activity apply to it. This study also deals with the consequences of this seemingly insignificant change in the nomenclature. These issues are presented against the background of EU regulations and selected EU Member States.

P0281THE EFFECT OF DIRECT ANTIVIRAL AGENTS ON GLOMERULAR FILTRATION RATE

Background and Aims HCV infects 170 million individuals approximately worldwide. The kidney is a major component of the HCV clinical syndrome. This viral infection imposes itself as a cause of kidney disease, a major risk in hemodialysis units and a significant threat in kidney transplantation. In 2011, direct acting antivirals (DAA) had been developed, which represented a huge boom in the treatment of HCV. Some doubtful data suggest possibility of association between some DAA administration and AKI occurrence, but larger prospective studies are recommended for confirming this suggestion. Method Retrospective cohort study of 118 adult HCV infected patients with normal baseline kidney functions (GFR ≥ 60ml/min) were included. Patients coinfected with HBV and those with impaired kidney functions at beginning of treatment were excluded. Patients were divided into 3 groups according to their DAA-combination treatment regimen. Patients’ eGFR were measured at baseline, at the end of treatment and one year later. Results Our results showed that patients who received Sofosbuvir/Daclatasvir/Ribavirin, their pre-treatment eGFR Mean ± SD. was (86.15±16.37). Post treatment eGFR showed an insignificant change after end of treatment (84.73±17.41) and 1 year after treatment (82.0±18.07) (P-value: 0.998 and 0.220 respectively). Those who received Sofosbuvir/Daclatasvir, their pretreatment eGFR Mean ± SD was (94.60±19.32). Post treatment eGFR showed an insignificant change after end of treatment (89.39±18.39) and 1 year after treatment (89.17±20.27). (P-value: 0.156 and 0.097 respectively). As for patients who received Sofosbuvir/Simeprevir, their pretreatment eGFR Mean ± SD was (92.71±15.11). Post treatment eGFR showed an insignificant change after end of treatment (88.36±16.27) and 1 year after treatment (89.01±15.72). (P-value: 0.620 and 0.676 respectively). Conclusion The new direct antiviral agents (sofosbuvir, daclatasvir and simeprevir) are effective and safe regarding glomerular filtration rate in patients with normal renal function. However, a meticulous monitoring of kidney function is mandatory during the use of these medications to early detect any untoward side effects.

Is the Common Technical Solution Always an Insignificant Change?

The article presents problems related to the implementation of railway investments related to obtaining authorization for placing in service of structural subsystems. The main purpose of the investment is to increase speed on railway lines while keeping or improving the level of safety. All modernized railway lines are subject to the certification process. Any interference in the certified subsystem involves the need to assess the introduced change in accordance with the requirements of the common safety method for risk evaluation and assessment. Such assessment may also generate various interpretation problems, therefore it is necessary to assess the impact of implemented investments on already built-in devices of the control - command and signalling subsystem - trackside equipment.

AB0286 EFFICACY AND SAFETY OF INTRA-ARTICULAR INJECTION OF ETANERCEPT IN RHEUMATOID ARTHRITIS PATIENTS

Background:Refractory mono-oligo-arthritis is still a challenging clinical situation in rheumatoid arthritis. Intra-articular corticosteroids are the first-line therapy; however, their efficacy is rather varying and many patients experience relapses within 6 months after injection.(1)Intra-articular anti-TNF has the potential of being less toxic and cost effective compared to its systemic usage.(2)Recent evidences have shown a reduction in the synthesis of either the T helper 1 cytokines or in the interleukin-6/17 axis cytokines at joint level following intra-articular injection of etanercept.(3)Objectives:Our aim was to evaluate the safety and efficacy of intra-articular injection of etanercept in patients with rheumatoid arthritis.Methods:This study included 23 rheumatoid arthritis patients diagnosed according to the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) 2010 diagnostic criteria for RA(4), who suffered from flare of activity in one joint. Patients were selected from the outpatient clinic and the in-patient section of Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University Hospitals, Egypt. The degree of swelling and tenderness of the affected joint was evaluated on a score (0-3) and the degree of pain was assessed by using visual analog scale (VAS). Musculoskeletal ultrasound (MSUS) examination was done to assess synovitis which was evaluated on two axes, longitudinal and transverse and was semiquantitivaly scored on a (0-3) scale, synovial vascularity was assessed using power Doppler and it was semi-quantitativaly scored on a (0-3) scale,Follow-up:Patients were examined both clinically (degree of swelling, degree of tenderness and VAS), and by MSUS on weeks: 1, 4 and 12 after injection.Results:No serious or life-threatening adverse effects were noticed in any patient during the follow-up periods and up till the end of the study except for temporary local soreness during the injection, there was a significant improvement of VAS, tenderness and swelling scores after 1-weekp<0.002 and 1-monthp<0.003 follow-up periods, but there was insignificant change after 3 monthsp=0.116, by MSUS, there was an insignificant change in synovitisp=0.112, but a significant change was found in power Doppler after 1-weekp= 0.046 and no significant changes were detected further.Conclusion:Intra-articular injection of etanercept is a safe and an encouraging treatment modality in managing refractory mono-arthritis in rheumatoid arthritis patients. Further researches are needed to study the use of repeated injection of etanercept to get more sustained effects.References:[1]Schumacher HR and Chen LX (2005):Injectable corticosteroids in treatment of arthritis of the knee. Am J Med. 118(11):1208-14.[2]Haroon M and O‘Gradaigh D (2010):Efficacy and safety of combining intra-articular methylprednisolone and anti-TNF agent to achieve prolonged remission in patients with recurrent inflammatory monoarthritis. Joint Bone Spine. 77(3):232-4.[3]Fiocco U, Sfriso P, Oliviero F, et al (2013):Blockade of intra-articularTNF in peripheral spondyloarthritis: Its relevance to clinical scores, quantitative imaging and synovial fluid and synovial tissue biomarkers.Joint Bone Spine. 80(2):165-70.[4]Smolen JS, Landewé R, Bijlsma J, et al (2017):EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum dis. 76(6):960-77.Disclosure of Interests:None declared

P1413EFFECT OF PULSE ORAL VERSUS INTRAMUSCULAR VITAMIN D REPLACEMENT IN HEMODIALYSIS PATIENTS WITH VITAMIN D DEFECIENCY

Background and Aims Low 25-hydroxyvitamin D (25(OH)D) level is common in patients with chronic kidney disease and hemodialysis (HD) patients . It has been associated with high bone turnover, secondary hyperparathyroidism (SHPT), and decreased bone mineral density (BMD). We aimed to investigate the efficacy of equivalent doses of pulse oral cholecalciferol (25,000 IU weekly for 12 weeks) versus single intramuscular cholecalciferol (300,000 IU) in correcting serum 25 (OH) D levels in HD patients. Method Prospective randomized open label Clinical trial. 40 prevalent HD patients with vitamin D deficiency were enrolled. Serum 25 hydroxy-vitamin D (25 (OH) D) level &lt; 20 ng/m and Serum parathyroid hormone level ( iPTH) &gt;100 pg/ml. Exclusion Criteria were serum calcium &gt; 10 .5mg/dl, Calcium phosphorus product ≥ 55, tertiary hyperparathyroidism and Parathyroidectomy among others. Patients were randomized equally into two groups. 36 patients were compliant and completed the study. Group I :17 HD patients received oral cholecalciferol 25000 IU weekly of (Vidrop® 2800 IU/ml ) for 12 weeks. Group II: 19 HD patients received a single intramuscular injection (IM) of cholecalciferol 300,000 IU (Devarol® 200000 IU/ ampoule). Vitamin D supplements were stopped if serum calcium &gt;10.5mg/dl or 25(OH) D level &gt; 100 ng /ml (toxic level) during study. Serum calcium (albumin-adjusted), phosphorus, 25(OH) D by ELISA, Alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) were monitored at baseline, 6 and 12 weeks of intervention. Both groups were maintained on their regular medications used to control mineral bone disorder as: alfacalcidol, sevelamer or a calcium-based chelator. Results Significant increase in serum 25(OH) D level in group II patients who received single dose IM Cholecalciferol after 12 w. Means of 25 (OH)D levels basal and 12 w of study were (10.54±5.14 and 13.45 ±5.72) ng/ml respectively. There was a significant increase in the mean of serum calcium basal and at 12 w (8.19±0.69 and 8.42 ±0.54) mg/dl respectively. No significant reduction in the iPTH level or any significant change in the serum phosphorus level was noticed. compared to group I with oral vitamin D, there was an insignificant change in the mean of serum 25(OH) D basal and at 12 w were (11.91±6.13 and 9.30±5.29) ng/ml respectively, associated with insignificant increase in serum calcium and an insignificant change in either the level of phosphorus or iPTH level. Conclusion Cholecalciferol 300,000 IU IM single dose showed better response on serum 25 (OH) D and calcium levels as a treatment of hemodialysis patients with Vitamin D deficiency compared to weekly oral dose for 3 months.

Ostracodes from the Devonian-Carboniferous boundary deposits on the reference section Yjid-Kamenka river (Pechora Uplift)

This article presents new data on ostracodes and their stratigraphic distribution in the boundary deposits of the Devonian and Carboniferous (D3-C1) in the reference section Kamenka River (Pechora Uplift). The positions of the Kamenka River section and stratotypic sections of the southern Urals relative to the transgressive-regressive sequence are considered. The ostracode assemblage of the Ps. venulosa — Cor. alba — Cr. primaris zone, which occurs in the section on the Kamenka River and appears in sections of the southern Urals from the base of this zone, is represented by the following taxa: Pseudoleperditia venulosa (Kummerov), Coryellina alba Kotschetkova, Bairdia zaninae Posner, Blessites feluyensis Tschigova, Shishaella alekseevae Tschigova, Knoxiella complanata (Kummerov), Cavellina subeichwaldi Buschmina. The taxonomic characteristics of the upper part of the Pseudoleperditia venulosa — Coryellina alba — Cribroconcha primaris ostracode zone (Gumerovian Regional Substage (Horizon)) are supplemented Acratia subordinaria Buschmina, Healdianella ex gr. alba Lethiers, Phlyctiscapha ? pusilla Gurevitsсh, Pustulobairdia ex gr. confragosa (S. et Sm.), Acanthoscapha pechorica Sobolev, Acratina romboiformis Sobolev, and Rectobairdia eleganta Sobolev first appear at this level A gradual and insignificant change in the ostracode association is observed during the transition from the Gumerovian Horizon to the Malevkian Horizon, which precludes drawing the boundary between them. It is suggested that it would have been more appropriate to draw the boundary at the base of the global Hangenberg transgressive event near the base of the Ps. venulosa — Cor. alba — Cr. primaris ostracode zone (South Urals), which coincides with the initial phase of this transgression.