bluuebunny/crossref_metadata_2025 huggingface dataset:
Connecting the metallicity dependence and redshift evolution of high-mass X-ray binaries
Authors: Fornasini Francesca M , Civano Francesca , Suh Hyewon
Published: May 2020

The integrated X-ray luminosity (LX) of high-mass X-ray binaries (HMXBs) in a galaxy is correlated with its star formation rate (SFR), and the normalization of this correlation increases with redshift. Population synthesis models suggest that the redshift evolution of LX/SFR is driven by the metallicity (Z) dependence of HMXBs, and the first direct evidence of this connection was recently presented using galaxies at z ∼ 2. To confirm this result with more robust measurements and better constrain the LX–SFR–Z relation, we have studied the Z dependence of LX/SFR at lower redshifts. Using samples of star-forming galaxies at z = 0.1–0.9 with optical spectra from the hCOSMOS and zCOSMOS surveys, we stacked Chandra data from the COSMOS Legacy survey to measure the average LX/SFR as a function of Z in three redshift ranges: z = 0.1–0.25, 0.25–0.4, and 0.5–0.9. We find no significant variation of the LX–SFR–Z relation with redshift. Our results provide further evidence that the Z dependence of HMXBs is responsible for the redshift evolution of LX/SFR. Combining all available z > 0 measurements together, we derive a best-fitting LX–SFR–Z relation and assess how different population synthesis models describe the data. These results provide the strongest constraints to date on the LX–SFR–Z relation in the range of 8.0 < 12 + log(O/H) < 9.0.
Prp5−Spt8/Spt3 interaction mediates a reciprocal coupling between splicing and transcription
Authors: Shao Wei , Ding Zhan , Zheng Zeng-Zhang , Shen Ji-Jia , Shen Yu-Xian , Pu Jia , Fan Yu-Jie , Query Charles C , Xu Yong-Zhen
Published: May 2020

Transcription and pre-mRNA splicing are coupled to promote gene expression and regulation. However, mechanisms by which transcription and splicing influence each other are still under investigation. The ATPase Prp5p is required for pre-spliceosome assembly and splicing proofreading at the branch-point region. From an open UV mutagenesis screen for genetic suppressors of prp5 defects and subsequent targeted testing, we identify components of the TBP-binding module of the Spt–Ada–Gcn5 Acetyltransferase (SAGA) complex, Spt8p and Spt3p. Spt8Δ and spt3Δ rescue the cold-sensitivity of prp5-GAR allele, and prp5 mutants restore growth of spt8Δ and spt3Δ strains on 6-azauracil. By chromatin immunoprecipitation (ChIP), we find that prp5 alleles decrease recruitment of RNA polymerase II (Pol II) to an intron-containing gene, which is rescued by spt8Δ. Further ChIP-seq reveals that global effects on Pol II-binding are mutually rescued by prp5-GAR and spt8Δ. Inhibited splicing caused by prp5-GAR is also restored by spt8Δ. In vitro assays indicate that Prp5p directly interacts with Spt8p, but not Spt3p. We demonstrate that Prp5p's splicing proofreading is modulated by Spt8p and Spt3p. Therefore, this study reveals that interactions between the TBP-binding module of SAGA and the spliceosomal ATPase Prp5p mediate a balance between transcription initiation/elongation and pre-spliceosome assembly.
Continuous Spinal Anesthesia versus Combined Spinal Epidural Anesthesia for Major Orthopedic Hip Surgeries
Authors: Abdelaziz M S , Elshaar A N , Elagamy A E , Ibrahim M A , Saleh M A
Published: May 2020

Background

hip replacement surgery is common among elderly patients. These patients have increased risk for perioperative mortality and morbidity due to additional comorbidities, such as cardiac, endocrine, renal, cerebral and respiratory diseases.

Aim of the Work

to compare between continuous spinal anesthesia and combined spinal epidural anesthesia in patients scheduled for elective major hip surgeries as regards their effectiveness and possible complications during operation.

Patients and Methods

after obtaining the approval of the ethical committee of faculty of medicine, Ain-Shams University, and patients’ written informed consents, this prospective randomized clinical trial study was conducted at Ain Shams University Hospitals at the orthopedics operating theatre. Seventy two patients aged older than 30 years, of both sexes and American Society of Anesthesiologists (ASA) class I, II, scheduled for elective major hip surgeries like total hip replacement or hemi arthroplasty were included in the study. All Patients were assigned randomly by using a computer generated program with closed envelops to one of the two equal groups:CSAgroup(36)patient and CSEgroup(36)patient.

Results

there was no statistically significant differences between the CSA and CSE groups as regards demographic data; Age, Sex or BMI. Baseline HR was similar in both groups. The heart rate was significantly higher in the CSE group at 5 min and 15 min when compared to CSA group. The mean blood pressure was significantly lower in group CSE at 5min anf 15 min when compared to CSA group.The total dose of bupivacaine 0.5% mg collectively given was much lower in the CSA group than the CSE group. The onset of sensory block (time between the end of injection and the time to reach T10sesnsory level) and degree of motor block between two groups showed no statistically significant difference but the level of sensory block was significantly higher in CSE group than CSA group.there was no significant difference as regard PDPH, Post operative nausea and vomiting, Bradycardia but there was significant difference as regard incidence of hypotension being higher in CSE group than CSA group. The time of first analgesic request showed no significant difference between the two groups

Conclusion

both continuous spinal anesthesia and compined spinal epidural anesthesia are safe anesthetic techniques for lower limb surgeries. CSA offers possibilities of more hemodynamic stability with smaller doses of local anesthetics than CSE with rapid onset of sensory block and good extendede post operative analgesia.
Perioperative Pain Control in Bariatric Surgeries, a Systematic Review
Authors: Abdelsabour Y G , Mohamed G S , Kamal E M , Abdelkawy A S
Published: May 2020

Introduction

Research on adequate postoperative pain management is a current trend in post-anesthetic and surgical areas. Patient satisfaction is a parameter of medical quality. High pain scores increase the incidence of post-operative morbidity and lead to delayed recovery, prolonged hospital stay and increased healthcare costs.1 Bariatric Surgeries are surgeries performed for morbid obese patient to reduce patient’s weight through several methods and because morbid obese patients are at higher risk of complications after surgery2, Pain control during bariatric surgery is a major challenge3. Opioids play an important role in anesthesia practice; however, related complications like; sedation, airway obstruction, and respiratory depression are of concern in morbid obese patients .Therefore, opioids should be used sparingly. And newly safe methods better to be used for better perioperative pain control in bariatric surgeries.

Objective

To cover the gab of knowledge regarding the evidence of the safest and most efficient method to control perioperative pain in bariatric surgeries by reviewing the literature about this evidence through comparative systematic review study.

Methodology

Systematic review study discussed the results of 30 studies found in the literature related to perioperative pain control in bariatric surgeries according to the inclusion and exclusion criteria .

Results and Discussion

30 different studies were discussed about the different methods of anesthesia in bariatric surgeries 6 of them about Transverses abdominis plane. ‘TAP’ block, 5 about Local anesthesia, 4 about Dexmedetomidine, 3 about spinal morphine, 3 about multi modal analgesia, 2 about preoperative medication, 2 about patient controlled analgesia ‘PCA', 1 about continuous infusion catheter, 1 about ibuprofen, 1 about Pulmonary recruitment maneuver, 1 about Sugammadex and 1 about non opioid anesthesia). Results are recorded about the efficacy of each method through the outcome measures.

Conclusion

It's found that the most effective method is multi modal analgesia represented in preoperative ultra sound guided TAP block, intraoperative port- sites and intraperitoneal infiltration with local anesthesia then recovery by sugammadex followed by postoperative IVI acetaminophen and PCA. Using preoperative clonidine, ketamine, pregabalin, epidural analgesia and pulmonary recruitment maneuver at the end of the surgery are also with low complication. Continuous infusion catheter, IV Ibuprofen, combined Dexmedetomidine and Acetaminophene, preoperative port-site infiltration and post operative intraperitoneal local anesthetic have no evidence based efficacy right now and it needs further studies.
Comparative Study between Ketamine and Magnesium Sulfate as Adjuvant to Bupivacaine in Ultrasound Guided Supra-Clavicular Brachial Plexus Block
Authors: Ibrahim A Y , Labib H A , Toulan H F A , Deabes E A
Published: May 2020

Background

In modern anesthesia practice, peripheral nerve block has a significant contributory role. Safety and accepted success rate have made this technique of anesthesia as very popular in ambulatory and inpatient anesthesia.

Aim of the Work

is to compare onset, degree of blockade, duration of blockade, duration of postoperative analgesia, and associated side effects after adding either magnesium sulfate or Ketamine to bupivacaine for performing supraclavicular Brachial Plexus Blocks for upper-limb surgeries.

Patients and Methods

After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. Randomized controlled double blinded study.

Results

Regarding the assessment of sensory block in the study, Onset times (mean ± SD) were (22.15 ± 3.20) mins, (17.35 ± 4.12) and (15.42 ± 3.23) mins in control, Magnesium and ketamin groups respectively. Adding ketamine or Magnesium significantly fastened the onset of sensory block with a highly significant difference (P < 0.001) in comparison to control group. These results also demonstrated that Ketamin fastened the onset time more than Magnesium but there was no statistically significant difference between two groups.

Conclusion

Ultrasound guidance should be used as a routine technique for brachial plexus block and anaesthetists should gain experience in the application of ultrasound in all nerve blocks. Lower volumes and different types and concentrations of local anaesthetics should be tried in order to maintain effectiveness and decrease incidence of complications. Different doses of ketamin and magnesium sulfate should be tried to detect the ideal dose to be used as additive to local anaesthetics.
Hyperglycemia as a Prognostic Factor In Acute Ischemic Stroke Patients
Authors: Abdelhamid A E E , El-Gendy H A , Nosseir M A E , Mohamed M A
Published: May 2020

Background

Hyperglycemia is encountered in 20% to 40% of acute stroke patients, with or without a pre-morbid diagnosis of diabetes mellitus. Hyperglycemia is a risk factor for infarct expansion and poor outcome through the first 72 hours of hospitalization in both diabetics and non-diabetics.

Aim of the Work

to study the glycemic status after acute ischemic stroke and assess its role in influencing stroke out-come as regards the duration of hospital stay, motor deficit outcome and mortality.

Patients and Methods

This retrospective study was conducted in Elzaiton specialized hospital and Ain Shams University from June 2016 to June 2017 on 80 patients after approval of local medical ethical committee. Patients with acute ischemic stroke without other major comorbidities within 24 hours of onset of symptoms were evaluated.

Results

The study revealed that hospital stay mean was 12.04 ± 9.61 (in control group) and 21.36 ± 12.49 (in uncontrolled group), with p-value < 0.022 S. A highly statistically significant difference between controlled and uncontrolled according to increase motor power at ICU admission in controlled a highly statistically significant difference between controlled and uncontrolled according to increase motor power discharge in controlled group. A highly statistically significant difference was found between both groups as regards outcome (mortality).

Conclusion

Hyperglycemia is common among acute stroke patients and is associate with less favorable outcome as regards mortality, hospital stay and functional outcome and euglycemic control is recommended in these patients.
Magnesium sulfate with Local Anesthetics versus Local Anesthetics Alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries
Authors: Bassiony M A , Ghaly S I , Selima W Z , Mostafa F A
Published: May 2020

Background

Brachial plexus is a network of nerves that arises from the neck passing through the axilla to supply the whole upper limb with motor and sensory supply. Our target in upper limb surgeries is to block this plexus using local anesthetics. Different adjuvants have been mixed with local anesthetics (LAs) for peripheral nerve blocks (PNBs). These drugs usually affect may delay the onset of action and prolong the duration of analgesia.

Objective

The aim of the present study was to compare the effect of Magnesium with bupivacine vesus bupivacine alone in supraclavicular nerve block ultrasound guided in upper limb surgeries

Patients and Methods

In our study 82 patients are randomly divide into two equal groups, control group received only bupivacine 0.5 % and magnesium group received 250 mg in addition to bupivacine 0.5%

Results

Our study showed that addition of 150 mg of magnesium to bupivacine in ultra sound guided supraclavicular block prolong the onset time of both sensory and motor block (p value >0.05) non significant. But it significantly prolonged their duration, p value <0.05 for sensory block and <0.001 for motor block which was highly significant

Conclusion

Addition of magnesium also did not affect the hemodynamics as regard systolic, diastolic blood pressure and o2 saturation. The previous findings proved that adding magnesium to bupivacine is more superior than the use of bupivacine alone.
Role of Insulin Glargine in Early Phase of Treatment of Diabetic Ketoacidosis
Authors: Wahba S S , Elsersi M , Alansary A M , Elzahaby M H
Published: May 2020

Background

Diabetic ketoacidosis (DKA) is a common cause of intensive care unit (ICU) admission, with high morbidity and mortality rates. A growing body of evidence has suggested that adding insulin Glargine to the standard regimen may facilitate the transition from an intravenous infusion of insulin to subcutaneous injection in the recovery of patients with DKA.

Aim of the Work

to investigate the effect of adding Insulin Glargine to the standard regimen of treatment of DKA on the recovery process of patients regarding the amount of intravenous insulin infusion and the duration of the patients’ stay in the ICU.

Patient and Methods

This randomized controlled study was conducted on 50 Egyptian individuals, in National Institute of Diabetes and Endocrinology & Ain Shams University Hospitals. 50 Patients with Diabetic Ketoacidosis diagnosed according to The American Diabetes Association criteria. All patients were divided into 2 groups according the protocol used for treatment: The first group including 25 patients treated only with the standard regimen of intravenous regular insulin infusion (0.1 unit/kg/hour). The second group including 25 patients treated with intravenous regular insulin (0.1 unit/kg/hour) + Iv infusion of normal saline.

Results

Added insulin Glargine resulted in a significantly shorter length of hospital stay, compared to SOC alone. The present study showed that insulin Glargine led to statistically significant less amount of insulin infused until resolution of DKA than the SOC alone.

Conclusion

subcutaneous insulin Glargine coadministration with regular insulin results in a shorter length of hospital stay and less amount of infused insulin in DKA patients admitted to ICU. Larger multi-centric trials are still needed to confirm our findings.
Predictors of Success of Immediate Tracheal Extubation in Living Donor Liver Transplantation Recipients
Authors: Ibrahim D G M , Zaki G F , Aboseif E M K , Elfawy D M A , Abdou A M H
Published: May 2020

Background

Early tracheal extubation of recipients following liver transplantation (LT) has been promoted and gradually replacing standard postoperative prolonged mechanical ventilation, possibly contributing to better graft and patient survival and reduced costs. There are no universally accepted predictors of success of immediate extubation in LT recipients. We hypothesized a number of factors as predictors of successful immediate tracheal extubation in living donor liver transplantation (LDLT) recipients.

Aim

The aim of this study was to evaluate the validity of the following hypothesized factors: Model for end stage liver disease (MELD) score, duration of surgery, number of intraoperatively transfused packed red blood cells (RBCs) units and end of surgery (EOS) serum lactate, as predictors of success of immediate tracheal extubation in living donor liver transplantation (LDLT) recipients.

Methods

In this prospective clinical trial, perioperative data of adult LDLT recipients were recorded. “Immediate extubation” was defined as tracheal extubation immediately and up to 1 hour postransplant in the operating room. Patients were divided into; extubated group who were successfully extubated with no need for reintubation, and non-extubated group who failed to meet criteria of extubation or were re-intubated within 4 hours of extubation.

Results

Of 64 patients, 50 (76.9%) were extubated early after LDLT while 14 (23.07%) were transported to the intensive care unit (ICU) intubated. After data analysis, it was found that EOS serum lactate, duration of surgery and number of packed RBCs units transfused intraoperatively, were good predictors of success of immediate extubation, while MELD scores had no statistically significant impact on the results. In addition, other factors such as EOS urine output and pH were shown to have significantly affected the results.

Conclusions

EOS serum lactate, duration of surgery and number of packed RBCs units transfused were predictors of post-transplant early extubation.
Efficacy of Noninvasive Positive Pressure Ventilation in Limiting Re-Intubation of COPD Patients After Extubation
Authors: Elkady G A A , Rabie A H , Hamza A H , Mohamed M N
Published: May 2020

Background

Mechanical ventilation is the most widely used supportive therapy in intensive care units (ICU). Several forms of external support for respiration have been described to assist the failing ventilator pump and had constituted a major advance in the management of patients with respiratory distress. More recently, new noninvasive positive pressure ventilation (NIPPV) techniques, using patient/ ventilator interfaces in the form of facial masks, have been designed. Noninvasive ventilation (NIV) is one of the most important developments in respiratory medicine over the past 15 years and is increasingly used in many countries, but with a highly variable frequency of use.

Objective

The aim of this study is to clarify the role of non-invasive ventilation in preventing re-intubation if was used immediately following planned extubation in patients suffered respiratory failure in COPD patients and requiring invasive mechanical ventilation for 5 to 7 days.

Methodology

Forty consecutive patients, who are invasively mechanically ventilated and classified as difficult to wean from the ventilator in the intensive care units of Ain Shams main university hospital between the 1st April and 1st of September 2018, were included. The mean age in the present study for oxygen group was 56.20±5.56 years, while in NIV group was 57.75±5.17 years, 70% of patients in this present study were males.

Results

APACHE II score, PaO2 and mean arterial blood pressure which might have a role in respiratory failure showed no statistically significant differences between both study groups. Meanwhile, respiratory rate, pulse rate and arterial blood gases showed high significance between both study groups

Conclusion

The use of NIV is associated with a marked reduction in the need for endotracheal intubation after planned extubation.
Effect of Granisetron Plus Dexamethasone versus Granisetron Alone on Postoperative Shivering in patients undergoing Gynecological surgery under general anesthesia
Authors: Abdelfatah I , Abdelmohsen S , Fathy A
Published: May 2020

Background and rational

Shivering, a very common complication of surgery owing to postoperative pain and post anesthesia hypothermia, is distressing for both patients and clinicians. It can be defined as involuntary and oscillatory muscular activities that increase the metabolic rate by two to three folds to maintain the core temperature. Both neuraxial (epidural and spinal anesthesia) and general anesthesia are associated with a significant incidence of shivering. The incidence is 40%-60% in regional anesthetic patients and up to 60% in general anesthetic ones.

Patients and Methods

This study was conducted at Ain Shams University Hospitals between September 2018 and February 2019, after obtaining approval of research ethical committee and patients’ informed consents, 150 patients were included in the study and underwent elective gynecological, and received general anesthesia.

Results

this study show incidence of post anesthetic shivering is significantly reduced after combination of granisetron and dexamethasone compared to control group

Conclusion

Combination of granisetron and dexamethasone significantly reduced Post anesthetic shivering (PAS) compared to granisetron alone. It is difficult to establish which drug can be considered the gold standard in prevention of PAS after general anesthesia. Because many research centers have reported that the effects of different anti-shivering drugs are similar, it is wise to administer the cheapest and safest drugs.
Comparison between subcutaneous ketamine with intramuscular pethidine versus intramuscular pethidine for post-operative analgesia after cesarean section
Authors: Noureldin B M E , Kamal M M , Bedewy A A A , Sultan H M M
Published: May 2020

Background

Cesarean section is one of the most common operations. Women undergoing cesarean delivery should achieve adequate postoperative pain relief because of different factors related to the operation complications as well as maternal and neonatal well-being. Immobility due to inadequate pain control could result in thrombo-embolic events, inappropriate neonatal care and delay in discharge which consequently increase the cost of this common procedure both for patients and health care system.

Objective

to investigate the efficacy of adding subcutaneous ketamine for postoperative analgesia in cesarean section and comparing it to using intramuscular pethidine only regarding opioid requirements and pain level.

Patients and Methods

The present study was carried out on two groups of women (each group consists of 25) after undergoing cesarean section under spinal anesthesia in Ain Shams University Hospitals and Helwan University Hospitals.

Group A

patients were given three doses of subcutaneous ketamine (0.9 mg/kg) at post-operative care unit (PACU), 12 and 24 hours after the operation with intramuscular pethidine (50mg) given when patients’ numerical pain score exceeded 5.

Group B

patients were given three doses of placebo at same intervals as group A and were given intramuscular pethidine (50mg) when NRS score exceeded 5.

Results

There was significant decrease in pain scores between two groups PACU, 12 and 24 hours postoperative with no significant change in the rest of the study. There was highly significant increase in the time to first pethidine demand in group A than B. There was highly significant decrease in total dose of pethidine given (in group A than in B.

Conclusion

Subcutaneous ketamine with a dose of (0.9mg/kg) can be used in reducing pain in postoperative period after CS with minimal side effects. The addition of SC ketamine to the pethidine appear to cause more pain control and decrease the total dose of pethidine given in post-operative period.
Comparative Study between Fractional Excretion of Sodium and Fractional Excretion of Urea in Differentiating Prerenal From Renal Acute Kidney Injury in ICU Patients with Circulatory Shock
Authors: Sargious S W N , Hassan M H M , Mostafa S A R , Saad G S R
Published: May 2020

Background

The incidence of acute renal injury (AKI) in ICU is 5%. The mortality rate increases up to 50% if AKI is a part of multiple organ dysfunction syndrome.

Aim of the Work

Comparison between FENa and FEurea in differentiating renal from prerenal acute kidney injury in circulatory shock, and the effect of diuretics on their handling.

Patients and Methods

This retrospective study was conducted on 45 Egyptian patients with AKI complicating circulatory shock admitted to the ICUs of AIN SHAMS University Hospital, from August 2018 to February 2019. Consents were taken from all of them according to the local ethics committee approval.

Results

The cutoff points of both FENa and FEurea as a predictor of mortality were not statistically justified. This is explained as all our patients had circulatory shock, and so patients with mild renal impairment may die from their severe shock state, and patients with severe renal affection may survive if their shock could be rapidly corrected. This cutoff point calculation is recommended only in patients with AKI without other organ affections or shock that may affect the mortality.

Conclusion

Although both fractional excretion of urea (FEurea) and fractional excretion of sodium (FENa) are feasible, reproducible, and inexpensive markers used in differentiating renal from prerenal azotemia, in our study FEurea showed higher sensitivity and specificity than FENa, not only in differentiating renal from prerenal azotemia in critically ill patients complicating circulatory shock, but also its values were not affected by the use of diuretics like FENa in the same group of patients.
Ringer Lactate Versus Voluven In Sepsis In Intensive Care Unit Patients
Authors: Abd-aziz M S , Abdallah M M K , Ali R E
Published: May 2020

Background

Sepsis, a syndrome of physiologic, pathologic, and biochemical abnormalities induced by infection, is a major public health concern. Sepsis should be defined as life-threatening organ dysfunction caused by a dys-regulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%.

Objective

To compare between ringer lactate and voluven in resuscitation of patient with sever sepsis in intensive care unit.

Patients and Methods

It is a prospective analytical study to compare ringer lactate versus voluven in resuscitation in sever sepsis. The required sample size has been estimated to be 30 patients for each group. A total number of 60 patients were treated for severe sepsis in our ICU during the study period. 30 patients assigned to ringer lactate and 30 patients assigned to HES 130/0.42, there was 40% of patients known to have HTN and 66.7% know to have DM.

Results

In comparison between the studied groups regarding the ABG data in first day, we found a PH improvement in Voluven group more than Ringer lactate group by P-value 0.020. Pao2 was worsened in Voluven group than Ringer lactate group by p-value 0.022. The laboratory data showed no specific significance between the two groups and C-Reactive protein results were not in the two study groups.

Conclusion

There’s no significant difference in Patients with severe sepsis assigned to fluid resuscitation with Voluven compared to those receiving Ringer’s lactate in SOFA score results as well as mortality index.
Comparison between the Effects of Thiopental Sodium and Propofol on Maternal Hemodynamics during Cesarean Section Under General Anesthesia and Apgar score of the newborns
Authors: Elshaer E , Omar H , Elshaer A , Youssif T , Abdelmoneim W
Published: May 2020

Background

Cesarean delivery is one of the most current surgeries in women and one of the most significant challenges of anesthesiologists in this kind of surgery is the fetuses' exposure to anesthetic drugs. Regional anesthesia is generally preferred during cesarean section, but general anesthesia may be the only option under certain circumstances such as patient preference, back deformities. The most common drugs which are used in cesarean section to induce general anesthesia are thiopental sodium and propofol.

Aim

compare the effect of sodium thiopental induction versus propofol induction on hemodynamics of mothers undergoing elective cesarean section under general anesthesia and their effect on Apgar score of their newborns.

Materials and Methods

A total 260 healthy patients were included in an open randomized study, among whom 130 patients received Thiopentone and 130 received Propofol. These patients were premedicated with granisetron and ranitidine, after induction dose the maintenance was similar for both groups. APGAR scoring and umbilical cord venous gas analysis were among the parameters used for determining the general well-being of newborns. There were no significant difference between the two groups regarding Apgar scoring in 1st, 2nd and 5th minutes. Umbilical cord blood gas values were similar . There was no metabolic acidosis in newborns of mothers receiving thiopental or propofol as anesthetic agents during cesarean section.

Results

Group (T) received general anesthesia with thiopental at a dose of ( 4-6 mg/kg) while patients in group (P) received general anesthesia with propofol at a dose of (2mg/kg). As regards hemodynamic changes, there were no significant difference in maternal heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure during their measurement throughout the procedure-preoperatively, after delivery of the baby,15 minutes after delivery, after extubation and in recovery room- but after intubation, there were significantly lower in propofol group which suppressed hemodynamic response to intubation .

Conclusion

Thiopental and propofol can be safely used in cesarean sections, but the use of propofol is more advantageous than thiopental because it provides adequate anesthetic suppression of pressor response of intubation without any depressive effect on newborns.
Comparison Between Volume Controlled Ventilation And Pressure Controlled Ventilation In Morbidly Obese Patients Undergoing Laparoscopic Gastric sleeve Surgery
Authors: Elshafie M A , Elfawy D M A , Abdelhak A A , Abdelalim Y N
Published: May 2020

Background

Although numerous studies conducted in the past years, there is no superior guideline that indicates the best ventilation mode during laparoscopic anesthesia inobese patients. There are numerous studies with dissimilar controversial points. The management of oxygenation in a morbid obese patient undergoing laparoscopic procedures presents many challenging aspects to the anesthetist.

Objective

The aim of this study was to equate the effect of pressure controlled ventilation (PCV) vs. volume controlled ventilation (VCV) on respiratory, oxygenation parameters and post operative complications.

Patients and Methods

This study was conducted on 80 patients who underwent laparoscopic gastric sleeve surgery in Ain Shams University Hospitals. Post induction of Anesthesia, Patients were divided into two groups. The first group mechanical ventilation setting was volume controlled ventilation and the second group mechanical ventilation setting was pressure controlled ventilation.

Results

The results of our study shows that despite some valuable effects regarding plateau and mean airway pressure with PCV, there is no momentous clinical difference between volume controlled ventilation (VCV) and pressure controlled ventilation (PCV) in obese patients undergoing laparoscopic gastric sleeve surgery. However, pressure controlled ventilation shows slightly more favorable results regarding post extubation oxygen saturation and the decrease of post operative basal atelectasis. It appears that using dual modes would be an epitome approach with lower complications and similar outcomes.
Comparitive Study Between Ultrasound Guided Rectus Sheath Block versus Local Wound Infiltration for Post-Operative Analgesia in Patients Undergoing Midline Exploratory Surgeries
Authors: Mahmoud H O , Elhennawy A M , Ali M M M M , Abdelhalim A A A
Published: May 2020

Background

Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress. respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs.

Objective

To assess the postoperative analgesic efficacy of Rectus Sheath Block (RSB) compared local wound infiltration after midline incision regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received.

Patients and Methods

All patients were informed with the procedure US guided RSB block and were trained to use the visual analogue scale (VAS). The study was conducted on 50 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective midline exploratory surgery. In Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each: RSB block Group: received general anaesthesia and 20 ml of 0.25% bupivacaine on each side under ultrasound guidance. Local wound infiltration: received general anaesthesia and with 0.25% bupivacaine 20 ml at surgical site.

Results

The results of the study revealed that there is Patients receiving RSB block had significantly lower pain scores at rest for 12 h and on mobilization for 6 h after operation and decrease total need of analgesic in first 24 h post-operative compared with patients who received wound infiltration of local aneasthetic.

Conclusion

U/S-guided rectus sheath block is as effective analgesic technique as local infiltration of the surgical wound, with longer duration of action and pethidine -sparing effect during the postoperative period after midline exploratory surgeries.
Effect of Sleep Deprivation on the Hippocampus of Adult and Senile Male Albino Rat: A Histological and Histochemical Study
Authors: Elkilany S S I , Zakaria M M A , Tash R F , Mostafa A Y , Abdelmalik S W , Nadim H S
Published: May 2020

Background

The importance of sleep and the impact of its deprivation on development of brain pathology became a recent subject of interest in medicine. The restorative effect of sleep on the brain and the harmful effects of insomnia have been recently revealed through the discovery of the glymphatic system and its association with sleep.

Aim of work

Specific objectives are: To detect histological and apoptotic changes in the neurons and dendrites of the cornu Amonis and the dentate gyrus in sleep deprived rats in comparison to rats with undisturbed sleep pattern (control). To detect deposition of neurotoxic metabolites in comu Amonis and dentate gyrus in sleep deprived rats in comparison to controls.

Methods

Twenty four adult male Albino rats were used in the present experiment. randomly categorized into four equal groups; Group A1 served as the control group, Group .A2 one day sleep deprivation, Group A3 three days sleep deprivation and Group A4 seven days sleep deprivation. They were deprived of sleep using grid over water method where the animals placed over a grid suspended above tank filled with water with free access to food (rat chew) and water. Hippocampai specimens were collected, processed for paraffin blocks and examined by light microscopy.

Results

there were neurodegenerative signs appeared from day one sleep deprivation, increased by day three and prevailed by day seven. It was confirmed by apoptotic changes detected by caspase 3 immunohistochemical staining. Furthermore, deposition of beta amyloid appeared in rats deprived of sleep and confirmed by congo red stain.

Conclusion

Adequate sleep is essential for integrity of the newly discovered glymphatic system responsible for clearance of the brain from waste products including the area most involved in learning and memory function; the hippocampus. Correction of SD could be a viable therapeutic strategy to prevent the onset or slow the progression of AD.

Recommendations

Further characterization of the glymphatic system in humans are required, it may lead to new therapies and methods of prevention of neurodegenerative diseases. Correction of SD could be a viable therapeutic strategy to prevent the onset or slow the progression of AD.
Correlation between QRS duration and cardiac output measured by left ventricular outflow tract velocity in patient with cardiac resynchronization therapy
Authors: Elshikh A S A E , Khalifa M M , Shehata H , Murtada A
Published: May 2020

Background

Cardiac resynchronization therapy (CRT) is proved as an effective treatment for moderate to severe heart failure. It reduces all-cause mortality in patients with advanced heart failure. There is strong evidence that CRT reduces mortality and hospitalization, improves cardiac function and structure in symptomatic chronic heart failure patients with optimal medical treatment, severely depressed LVEF (i.e. <35%) and complete LBBB. However 30% of patients may show negative response to CRT therapy. Therefore, optimization of CRT therapy in patients with heart failure seems to be a main subject for study in our researches. Methods of optimization includes optimization of medical therapy, control of risk factors and comorbidities, and optimization of device implantation and programming. Overall, studying the correlation between QRS duration and cardiac output will improve CRT programming optimization techniques.

Aim

To study the correlation between QRS duration and cardiac output measured by left ventricular outflow tract (LVOT) VTI in patients with CRT implantation.

Methods

Study included 100 CRT already implanted patients, they are requested to do a simple electrocardiographic and echocardiographic study. The relation between post implant QRS and cardiac output are studied among the patients.

Results

There was negative significant correlation between QRS duration and LVOT VTI and SVi. The optimal cut off values for optimal response to CRT using ROC curves were 130msec for post implant QRS duration and 17.1 cm for LVOT VTI.

Conclusion

CRT response is more in female patients with lower BSA, and without previous history of IHD or smoking. There is a significant negative correlation between QRS duration and LVOT VTI. Post implantation cut off value of QRS duration (<130) predict higher LVOT VTI and also the post implantation benefit for the patient with CRT implanted.
Predictors of No-Reflow Phenomenon in ST-Elevation Myocardial Infarction in Patients undergoing Primary Percutaneous Coronary Intervention
Authors: Abdelaziz H S , Zahran M E , Othman K S , Wafa S S
Published: May 2020

Background

Functional single ventricle (FSV) is a spectrum of severe congenital heart disease, with multiple anatomic variations but similar surgical treatment strategies. FSV patients are living longer into adulthood compared to two or three decades ago, and they are more frequently undergoing imaging to assist in clinical and surgical management.

Objective

To assess the relation between admission eGFR, HDL, Monocytes, CRP & albumin levels in patients presenting with acute STEMI and angiographic no-reflow after primary PCI.

Material and Methods

From October 2018 to February 2019, 60 patients with STEMI who underwent primary PCI in Ain-Shams University hospitals. All patients subjected to history, clinical examination, ECG pre and post pPCI, pre-pPCI eGFR, monocytes, HDL, CRP and albumin, echocardiography. Patients were divided into two groups based on post-pPCI Thrombolysis in Myocardial Infarction (TIMI) flow grade. No reflow was defined as TIMI flow grades ≤ 2, and normal reflow was defined as TIMI 3 flow grade. All the laboratory parameters were measured on admission before pPCI.

Results

The study population was divided into 2 groups: reflow (n = 31) and no-reflow (NR) (n = 29) groups. CRP over albumin ration “CAR” (7.9 [4.41-16.18] vs 1.74 [1.54-2.35] (P <.001) were significantly higher in the NR group than in the reflow group, and these factors were found to be independent predictors of NR development. However, eGFR and Monocytes over HDL ratio “MHR” didn’t show any statistical differences between the two groups.

Conclusion

No-reflow can be predicted by systemic inflammation markers including monocytes, CRP, albumin and HDL. CAR has the highest positive predictive value for no-reflow.
Predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization due to stable angina or acute coronary syndromes
Authors: Ayman R , Shehata H , AL-Fikki E , Gomaa Y
Published: May 2020

Background

Introduction of coronary stents in the field of interventional cardiology has significantly improved short- and long-term results of the percutaneous coronary interventions but in the same time they became responsible for development of a new entity called neo-intimal hyperplasia (NIH). If overexpressed, NIH can lead to so-called in-stent restenosis (ISR).

Objective

To assess the predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization in Proximal Left Anterior Descending(LAD) Artery using Drug Eluting Stents (DES) due to stable angina and acute coronary syndrome.

Material and Methods

This study was conducted over 113 pateints to assess the predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization in Proximal Left Anterior Descending (LAD) Artery using Drug Eluting Stents (DES).

Results

From the study population collected(n = 113), 18.4% of which were females (n = 21), statistically significant relation was found between DES-ISR and CHADSVasc score (p value =0.033). A significant relationship existed between ISR and CHADVasc score 3 or more, and each of: Age(p value= 0.022), DM(p value=0.029), SBP during the procedure(p value = 0.036), time since the PCI was done(p value =0.001), stent length(p value=0.028), pattern of the lesion and management of the lesions as individual variables (p value less than0.001). However, non-significant relationship could be concluded between ISR and each of gender(p value= 0.987), CHF(p value=0.163), HTN(p value=0.446), vascular diseases (p value=0.662), CAD type (SCAD or ACS)(p value=0.616), DBP during the procedure(p value=0.167), creatinine clearance (p value=0.69), HBA1c(p value=0.091), use of DAPT(p value=0.198), the duration of DAPT use(p value=0.873), type of P2Y12 inhibitor used(p value=0.083), use of statins(p value=0.402), beta blockers or nitrates (p values= 1 & 0.836, respectively) and stent diameter used (p value=0.615)

Conclusion

This study was able to show a significant relationship between ISR and each of CHADVasc score, Age, DM, SBP during the procedure, time since the PCI was done, stent length used, pattern of the lesion and management of the lesions
Big endothelin-1 level as a predictive marker for the presence of isolated coronary artery ectasia in patients presented with chest pain
Authors: Bishay B , Elhammady W , Elkashlan Y , Zarif J
Published: May 2020

Background

Coronary artery ectasia (CAE) is a common finding of coronary angiography, therefore, to find a biomarker to discriminate isolated coronary artery ectasia ICAE from obstructive coronary artery disease CAD may be important for clinical implication.

Objectives

The aim is to study the relationship between big ET-1 level and isolated CAE in patients presented with chest pain, undergoing coronary angiogram.

Methods

This study was conducted on 55 patients. They were presented by cardiac symptoms (chest pain, dyspnea, unstable and stable angina). They were subjected to coronary angiography. According to its findings, patients were classified into four different groups (ICAE; n = 15), (CAE & CAD; n = 15), (CAD; n = 15), and (Normal; n = 10). The level of big ET-1 was found to be significantly higher in the patients with ICAE compared with the other three groups (ICAE; 261±176 ng/ml, CAD + CAE; 132±29 ng/ml, CAD; 107±16 ng/ml and Normal; 109±17 ng/ml, p < 0.001, respectively). Also we found that the percentage of hypertension was significantly higher in patients with CAD group compared with ICAE group and normal coronary angiography group.

Conclusion

In conclusion, in our study, our data suggested that the big ET-1 level was higher in isolated CAE patients and was an independent predictor for isolated CAE. Recognizing big ET-1 as an independent predictor of isolated CAE requires multivariate analysis which was not done in our study.
Safety and outcome of cryoballoon ablation versus radiofrequency catheter ablation of the pulmonary veins in patients with paroxysmal atrial fibrillation
Authors: Riad O H M A , Wong T , Ali A N , Ibrahim M T , Abdelhamid M A , Nabih M A
Published: May 2020

Background

Pulmonary vein isolation (PVI) has become the mainstay of catheter ablation of atrial fibrillation (AF). There are two commonly used methods to isolate the pulmonary veins, either point-by-point delivery of circumferential lesion sets around ipsilateral pulmonary veins using radiofrequency energy, or the application of the cryoballoon to the pulmonary vein antrum with occlusion of the vein ostium. The cryoballoon has proven to be a reliable alternative to radiofrequency ablation in acute and long-term freedom from AF. We describe our results using both modalities.

Aim and Objectives

to compare the safety and efficacy of cryoballoon (CB) ablation and radiofrequency (RF) ablation in treatment of paroxysmal atrial fibrillation.

Patients and Methods

Forty-four consecutive patients having paroxysmal AF underwent PVI using the second generation cryoballoon were compared to a retrospective cohort of 69 patients who had radiofrequency induced PVI, either by conventional RF catheter (n = 32), or a contact-force sensing-catheter (n = 37). The study took place at Ain Shams university hospitals and Royal Brompton & Harefield NHS trust. Patient data, procedural data and follow up data- at 3, 6 and 12 months- were collected and analysed. Recurrence was defined as documented AF or atrial arrhythmias with duration exceeding 30 seconds, either by 12 lead ECG or an ambulatory monitoring device.

Results

A total of 113 patients were studied. The mean age was 53.84 ± 15.01 for the CB group and 55.78 ± 14.84 for the RF group and females representing 40.9% vs 34.8% respectively. The mean procedural times in minutes were significantly less in the CB group (94.37 ± 39.32 vs 184.57 ± 88.19, p < 0.0001), while the median fluoroscopy times were similar [30 (11.04 - 40) vs 37.25 (14.2 - 70), p = 0.172]. Procedural complications were comparable between the two groups (p = 0.06) with 1 patient (2.3%) having long term phrenic nerve paresis. At 1 year follow up, after an initial 90-day blanking period, recurrence rate of CB was similar to RF (27.3% vs 30.4% respectively, p = 0.719), the Kaplan Meier estimates of AF- free survival for a period of 1 year were comparable between both groups (log rank test, p = 0.606).

Conclusion

Cryoballoon is a feasible method for pulmonary vein isolation with similar success rates to radiofrequency ablation. Cryoballoon ablation is safe with shorter duration of the procedure.