SUMMARY
Ventilator-associated pneumonia (VAP) remains the second leading type of nosocomial infection according to the national nosocomial infection survey of the centers for disease control and prevention. VAP seems to be associated with high mortality. (as a member of the macrolides family)
Because multiple factors contribute to the high risk of ventilator associated pneumonia, a multi‑strategy approach is required to prevent such infections, one of them is ventilator care-bundle that incorporates several strategies to prevent morbidity associated with the ventilator. Although care-bundle implementation appears to be associated with the successful reduction in VAP rates, we wanted in this study to determine efficacy of the addition of Clarithromycin (as a member of the macrolides family) to Ventilator Associated Pneumonia care bundle to help in prevention of VAP in a critical care unit with a high prevalence of multi-drug resistant organisms
Clarithromycin was administered once daily by a nurse blind to treatment group ,each dose of clarithromycin (1g tablet) was grounded and administrated to the patient through the Ryle over the first three days after intubation
And we found that administration of clarithromycin for 3 days inhibits the productions of pro-inflammatory cytokines with concomitant reduction of development of VAP in mechanically ventilated patients but without affection the incidence of mortality

Transforaminal Epidural Steroid Injection is highly recommended for the treatment and diagnosis of radicular pain resulting from lumbar disc herniation. Two of the techniques suggested for performing TFESI are the antero-posterior approach and the oblique approach.
Abstract
The aim of our study was to compare both techniques regarding time to perform the procedure, pain relief and the incidence of complications and adverse events.
We didn't find any difference between the two techniques regarding pain relief or the incidence of adverse events, the time needed to perform the oblique approach was shorter (9.7±2.1 min) than the antero-posterior approach (11.3±2.2 min), mainly due to the performer being more familiar with it rather than a true difference

carbon paste (CP) electrode modified with gold nanoparticles (GNMCPE) was
introduced. The advantages of the gold nanoparticles enhanced the sensitivity of
the CP-electrode significantly. In a mixture of DA, AA and UA the sensor shows
high selective response towards DA and no response for AA or UA. The effect of
various experimental parameters including time of deposition of gold
nanoparticles on CP-electrode, pH, scan rate, accumulation time and types of
electrolytes were studied to find the highest sensitivity for the determination of
DA. Another promising electrochemical sensor was developed using carbon paste
electrode, gold nanoparticles and Nafion (CP-electrode/Nafion modified with gold
nanoparticles-[electrode (2)]). This sensor is sensitive for the determination of
catecholamine compounds, in the presence of interference molecules.
Simultaneous determinations of DA with 5-TH and ACOP with L-DOPA in binary
mixtures were achieved with good separation. Also a highly sensitive and simple
method was investigated for the determination of acetaminophen and morphine
using both electrodes. Under optimized experimental conditions, their sensitivities
were improved greatly. Moreover, the present method was also applied for their
determination in the presence of common interferents and in binary mixture with
dopamine (DA). Also the effect of various experimental parameters on the
voltammetric response of TR and GSH were investigated using [electrode (2)]. At
the optimum conditions, the concentration of TR and GSH was determined and the
effects of common interferences on the current responses were studied. The results
showed that the method was simple and sensitive enough for their determination in
clinical preparations and in commercial tablet under physiological conditions with
good precision.

Experimental modal analysis (EMA) has grown steadily in popularity since the advent of the digital FFT spectrum analyzer in the early 1970’s. Today, EMA has become widespread as a fast and economical technique for studying the dynamical behavior of real full-scale civil structures in order to find the modes of vibration that are inherent properties of these structures. During the last decade, finite element analysis has been integrated in the design and evaluation processes since it is an easy method in spite of the material properties and boundary conditions that are often not well known.
In this research work, modal testing approach had been utilized to evaluate the FE results in order to complete the modelling update that will lead to have a full-scale simulation between the mathematical model and the actual structure. Four studied cases had been selected and examined by an accelerogragh and the natural frequencies and corresponding mode shapes were extracted. In addition, 3D FE model for each case was created, and its results were compared with the previous extracted data by taking into consideration two affecting factors of the material used in these structures (concrete strength and brick Young's modulus). The process of modelling update was suggested for each case, and a comparison between the actual measured data and the Egyptian code formula results for the fundamental period was established.
Finally, the study presents a number of conclusions and recommendations regarding the EMA. It has been shown that the EMA process can be used to insure the accuracy of the mathematical model generally assumed by the designer in order to use it in any further investigation especially the evaluation of existing buildings.