bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association of Antibiotic Duration With Successful Treatment of Community-Acquired Pneumonia in Children
Authors: Same Rebecca G , Amoah Joe , Hsu Alice J , Hersh Adam L , Sklansky Daniel J , Cosgrove Sara E , Tamma Pranita D
Published: May 2020

Background

National guidelines recommend 10 days of antibiotics for children with community-acquired pneumonia (CAP), acknowledging that the outcomes of children hospitalized with CAP who receive shorter durations of therapy have not been evaluated.

Methods

We conducted a comparative effectiveness study of children aged ≥6 months hospitalized at The Johns Hopkins Hospital who received short-course (5–7 days) vs prolonged-course (8–14 days) antibiotic therapy for uncomplicated CAP between 2012 and 2018 using an inverse probability of treatment weighted propensity score analysis. Inclusion was limited to children with clinical and radiographic criteria consistent with CAP, as adjudicated by 2 infectious diseases physicians. Children with tracheostomies; healthcare-associated, hospital-acquired, or ventilator-associated pneumonia; loculated or moderate to large pleural effusion or pulmonary abscess; intensive care unit stay >48 hours; cystic fibrosis/bronchiectasis; severe immunosuppression; or unusual pathogens were excluded. The primary outcome was treatment failure, a composite of unanticipated emergency department visits, outpatient visits, hospital readmissions, or death (all determined to be likely attributable to bacterial pneumonia) within 30 days after completing antibiotic therapy.

Results

Four hundred and thirty-nine patients met eligibility criteria; 168 (38%) patients received short-course therapy (median, 6 days) and 271 (62%) received prolonged-course therapy (median, 10 days). Four percent of children experienced treatment failure, with no differences observed between patients who received short-course vs prolonged-course antibiotic therapy (odds ratio, 0.48; 95% confidence interval, .18–1.30).

Conclusions

A short course of antibiotic therapy (approximately 5 days) does not increase the odds of 30-day treatment failure compared with longer courses for hospitalized children with uncomplicated CAP.
In Vitro Activity of Imipenem/Relebactam Against Gram-Negative Bacilli from Pediatric Patients—Study for Monitoring Antimicrobial Resistance Trends (SMART) global surveillance program 2015–2017
Authors: Karlowsky James A , Lob Sibylle H , Young Katherine , Motyl Mary R , Sahm Daniel F
Published: May 2020

Background

Studies describing the activity of imipenem/relebactam against gram-negative bacilli (GNB) isolated from pediatric patients are lacking in the peer-reviewed literature. We address this deficiency by reporting on GNB tested against imipenem/relebactam as part of the Study for Monitoring Antimicrobial Resistance Trends global surveillance program.

Methods

In 2015–2017, 221 laboratories in 59 countries collected 9149 consecutive, aerobic or facultative GNB from pediatric patients (age <18 years) and 100 785 from adult patients with intraabdominal, respiratory, and urinary tract infections. Susceptibility was determined using Clinical and Laboratory Standards Institute (CLSI) broth microdilution methodology and CLSI breakpoints (and US Food and Drug Administration breakpoints for imipenem/relebactam).

Results

The 4 most common species of GNB isolated from pediatric patients were Escherichia coli (40.4%), Pseudomonas aeruginosa (17.1%), Klebsiella pneumoniae (13.9%), and Enterobacter cloacae (4.7%); non-Morganellaceae Enterobacterales (NME) accounted for 70.1% of isolates. Imipenem/relebactam inhibited 97.8% of NME from pediatric patients; susceptibility to imipenem was 1.9% lower, and susceptibility to β-lactam comparators (cefepime, ceftazidime, ceftriaxone, piperacillin/tazobactam) was 9.2-25.2% lower. Imipenem/relebactam inhibited 94.2% of P. aeruginosa from pediatric patients; susceptibility to imipenem was 16.2% lower, and susceptibility to β-lactam comparators was 10.2-15.6% lower. Susceptibility was generally slightly higher for isolates from pediatric than adult patients. All K. pneumoniae carbapenemase (KPC)–positive isolates, 93.3% of multidrug-resistant (MDR) NME isolates, and 70.5% of MDR P. aeruginosa isolates from pediatric patients were susceptible to imipenem/relebactam.

Conclusions

Imipenem/relebactam provides a new treatment option for infections caused by resistant gram-negative bacilli, including KPC-positive NME, MDR NME, and MDR P. aeruginosa.
Limit on the LMC mass from a census of its satellites
Authors: Erkal Denis , Belokurov Vasily A
Published: May 2020

We study the orbits of dwarf galaxies in the combined presence of the Milky Way and Large Magellanic Cloud (LMC) and find six dwarfs that were likely accreted with the LMC (Car 2, Car 3, Hor 1, Hyi 1, Phe 2, and Ret 2), in addition to the Small Magellanic Cloud (SMC), representing strong evidence of dwarf galaxy group infall. This procedure depends on the gravitational pull of the LMC, allowing us to place a lower bound on the Cloud’s mass of $M_{\rm LMC} \gt 1.24\times 10^{11} \, \mathrm{M}_\odot$ if we assume that these are LMC satellites. This mass estimate is validated by applying the technique to a cosmological zoom-in simulation of a Milky Way-like galaxy with an LMC analogue where we find that while this lower bound may be overestimated, it will improve in the future with smaller observational errors. We apply this technique to dwarf galaxies lacking radial velocities and find that Eri 3 has a broad range of radial velocities for which it has a significant chance (>0.4) of having been bound to the Cloud. We study the non-Magellanic classical satellites and find that Fornax has an appreciable probability of being an LMC satellite if the LMC is sufficiently massive ($\text{$\sim$} 2.5\times 10^{11} \, \mathrm{M}_\odot$). In addition, we explore how the orbits of Milky Way satellites change in the presence of the LMC and find a significant change for several objects. Finally, we find that the dwarf galaxies likely to be LMC satellites are slightly smaller than Milky Way satellites at a fixed luminosity, possibly due to the different tidal environments they have experienced.
Two Wolf–Rayet stars at the heart of colliding-wind binary Apep
Authors: Callingham J R , Crowther P A , Williams P M , Tuthill P G , Han Y , Pope B J S , Marcote B
Published: May 2020

Infrared imaging of the colliding-wind binary Apep has revealed a spectacular dust plume with complicated internal dynamics that challenges standard colliding-wind binary physics. Such challenges can be potentially resolved if a rapidly rotating Wolf–Rayet star is located at the heart of the system, implicating Apep as a Galactic progenitor system to long-duration gamma-ray bursts. One of the difficulties in interpreting the dynamics of Apep is that the spectral composition of the stars in the system was unclear. Here, we present visual to near-infrared spectra that demonstrate that the central component of Apep is composed of two classical Wolf–Rayet stars of carbon- (WC8) and nitrogen-sequence (WN4-6b) subtypes. We argue that such an assignment represents the strongest case of a classical Wolf–Rayet+Wolf–Rayet binary system in the Milky Way. The terminal line-of-sight wind velocities of the WC8 and WN4-6b stars are measured to be 2100 ± 200 and 3500 ± 100 km s−1, respectively. If the mass-loss rate of the two stars are typical for their spectral class, the momentum ratio of the colliding winds is expected to be ≈0.4. Since the expansion velocity of the dust plume is significantly smaller than either of the measured terminal velocities, we explore the suggestion that one of the Wolf–Rayet winds is anisotropic. We can recover a shock-compressed wind velocity consistent with the observed dust expansion velocity if the WC8 star produces a significantly slow equatorial wind with a velocity of ≈530 km s−1. Such slow wind speeds can be driven by near-critical rotation of a Wolf–Rayet star.
Cool-core cycles and Phoenix
Authors: Prasad Deovrat , Sharma Prateek , Babul Arif , Voit Gerard M , O’Shea Brian W
Published: May 2020

Recent observations show that the star formation rate (SFR) in the Phoenix cluster’s central galaxy is ∼500 M⊙ yr−1. Even though Phoenix is a massive cluster (M200 ≈ 2.0 × 1015 M⊙; z ≈ 0.6) such a high central SFR is not expected in a scenario in which feedback from an active galactic nucleus (AGN) maintains the intracluster medium in a state of rough thermal balance. It has been argued that either AGN feedback saturates in very massive clusters or the central supermassive black hole is too small to produce enough kinetic feedback and hence is unable to quench the catastrophic cooling. In this work, we present an alternate scenario wherein intense short-lived cooling and star formation phases followed by strong AGN outbursts are part of the AGN feedback loop. Using results from a 3D hydrodynamic simulation of a standard cool-core cluster (M200 ∼ 7 × 1014 M⊙; z = 0), scaled to account for differences in mass and redshift, we argue that Phoenix is at the end of a cooling phase in which an AGN outburst has begun but has not yet arrested core cooling. This state of high cooling rate and star formation is expected to last for ≲100 Myr in Phoenix.
A binning-free method reveals a continuous relationship between galaxies’ AGN power and offset from main sequence
Authors: Grimmett L P , Mullaney J R , Bernhard E P , Harrison C M , Alexander D M , Stanley F , Masoura V A , Walters K
Published: May 2020

Studies investigating the relationship between active galactic nucleus (AGN) power and the star formation rates (SFRs) of their host galaxies often rely on averaging techniques – such as stacking – to incorporate information from non-detections. However, averages, and especially means, can be strongly affected by outliers and can therefore give a misleading indication of the ‘typical’ case. Recently, a number of studies have taken a step further by binning their sample in terms of AGN power (approximated by the 2–10 keV luminosity of the AGN), and investigating how the SFR distribution differs between these bins. These bin thresholds are often weakly motivated, and binning implicitly assumes that sources within the same bin have similar (or even identical) properties. In this paper, we investigate whether the distribution of host SFRs – relative to the locus of the star-forming main sequence (i.e. RMS) – changes continuously as a function of AGN power. We achieve this by using a hierarchical Bayesian model that completely removes the need to bin in AGN power. In doing so, we find strong evidence that the RMS distribution changes with 2–10 keV X-ray luminosity. The results suggest that higher X-ray luminosity AGNs have a tighter physical connection to the star-forming process than lower X-ray luminosity AGNs, at least within the 0.8 < z < 1.2 redshift range considered here.
An obscured AGN population hidden in the VIPERS galaxies: identification through spectral energy distribution decomposition
Authors: Pouliasis E , Mountrichas G , Georgantopoulos I , Ruiz A , Yang M , Bonanos A Z
Published: May 2020

The detection of X-ray emission constitutes a reliable and efficient tool for the selection of active galactic nuclei (AGNs), although it may be biased against the most heavily absorbed AGNs. Simple mid-infrared (IR) broad-band selection criteria identify a large number of luminous and absorbed AGNs, yet again host contamination could lead to non-uniform and incomplete samples. Spectral energy distribution (SED) decomposition is able to decouple the emission from the AGN versus that from star-forming regions, revealing weaker AGN components. We aim to identify the obscured AGN population in the VIMOS Public Extragalactic Redshift Survey in the Canada–France–Hawaii Telescope Legacy Survey W1 field through SED modelling. We construct SEDs for 6860 sources and identify 160 AGNs at a high confidence level using a Bayesian approach. Using optical spectroscopy, we confirm the nature of ∼85 per cent of the AGNs. Our AGN sample is highly complete (∼92 per cent) compared to mid-IR colour-selected AGNs, including a significant number of galaxy-dominated systems with lower luminosities. In addition to the lack of X-ray emission (80 per cent), the SED fitting results suggest that the majority of the sources are obscured. We use a number of diagnostic criteria in the optical, IR, and X-ray regimes to verify these results. Interestingly, only 35 per cent of the most luminous mid-IR-selected AGNs have X-ray counterparts suggesting strong absorption. Our work emphasizes the importance of using SED decomposition techniques to select a population of type II AGNs, which may remain undetected by either X-ray or IR colour surveys.
On the settling of small grains in dusty discs: analysis and formulae
Authors: Laibe Guillaume , Bréhier Charles-Edouard , Lombart Maxime
Published: May 2020

Instruments achieve sharper and finer observations of micrometre-in-size dust grains in the top layers of young stellar discs. To provide accurate models, we revisit the theory of dust settling for small grains, when gas stratification, dust inertia, and finite correlation times for the turbulence should be handled simultaneously. We start from a balance of forces and derive distributions at steady state. Asymptotic expansions require caution since limits do not commute. In particular, non-physical bumpy distributions appear when turbulence is purely diffusive. This excludes very short correlation times for real discs, as predicted by numerical simulations.
The Relationship Between Vestibular Sensory Integration and Prosthetic Mobility in Community Ambulators With Unilateral Lower Limb Amputation
Authors: Lučarević Jennifer , Gaunaurd Ignacio , Clemens Sheila , Belsky Paulina , Summerton Lauren , Walkup Melody , Wallace Stephen Paden , Yokomizo Lori , Pasquina Paul , Applegate E Brooks , Schubert Michael C , Gailey Robert S
Published: May 2020

Objective

The modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is used to clinically assess vestibular sensory integration (VSI), the process by which the central nervous system integrates vestibular afference to maintain balance. The rate and effects of impaired VSI (IVSI) on prosthetic mobility in people with lower limb amputation (LLA) is unknown. The objective of this study was to use the mCTSIB to classify VSI in active community ambulators with LLA and to examine the relationship between IVSI and prosthetic mobility, as measured by the Component Timed Up and Go (cTUG) test.

Methods

This was a cross-sectional study with a convenience sample of 130 community ambulators with unilateral LLA. Classification of VSI was determined based on a time-based pass/fail mCTSIB performance. Participants were classified as having normal sensory integration (NSI) if they could balance for 30 seconds in every mCTSIB condition. Participants who failed condition 4 exclusively were classified as IVSI. Prosthetic mobility, as measured by the cTUG, was compared between NSI and IVSI groups.

Results

Of the 130 participants, 29 (22%) were classified as IVSI and 95 (73%) were classified as having NSI. Prosthetic mobility significantly differed between IVSI and NSI groups, with IVSI participants performing all components of the cTUG significantly slower. Medium to large effect sizes were found between groups during cTUG.

Conclusions

These results suggest that 1 in 5 community ambulators with LLA have IVSI, with associated limitations in balance confidence and prosthetic mobility.

Impact

The ability to integrate vestibular information was found to have a strong relationship with prosthetic mobility in active community ambulators with LLA, especially with performing a 180-degree step turn. Physical therapists can use the mCTSIB to classify sensory integration during prosthetic rehabilitation and develop an appropriate balance intervention.

Lay Summary

Active adults with LLA can use information from their senses to maintain their standing balance. Adults with LLA who have difficulty balancing on foam with closed eyes were slower to get in and out of a chair, walk, and perform a 180-degree step turn.
Effect of Low Dose Insulin Therapy on Normoglycemic Critically Ill Patients in Intensive Care Units
Authors: Kamel A M , Hosny M R , Awad M O , Eid A M
Published: May 2020

Background

Insulin has anti-inflammatory effect and vasodilatory effect via endothelial NO release in arteries, veins and capillaries. Insulin inhibits release of inflammatory mediators like IL-6, TNF-α and enhances the immune function of monocytes. Stress-induced hyperglycemia is very common in the ICU, being detected in 50–85% of critically ill patients. It is defined as a blood glucose level >140 mg/dL or glycated hemoglobin (HbA1c) > 6.5 without a past history of pre-existing diabetes.

Aim of the Work

to evaluate the effect of low dose insulin therapy on the clinical progression of organ dysfunction and on the level of C-reactive protein (CRP), procalcitonin and lipid profile in patients known to be normoglycemic complaining of systemic inflammatory response syndrome (SIRS) or sepsis in intensive care unit.

Patients and Methods

The study was conducted on 60 patients which were randomized into 2 groups: 30 patients received moderate insulin therapy (group 1) and 30 patients received iv infusion of placebo (normal saline 0.9% NaCl) during the course of the study (group 2).

Results

There was an improvement in blood pressure, heart rate and body temperature in group 1 compared to group 2 and throughout the study period in group 1. CRP and lactate levels were declined in group 1 with better creatinine values. Triglycerides were decreased in group 1 and hypoxic index was higher in group 1 compared to group 2.

Conclusion

Insulin therapy with target blood glucose (120-140 mg/dL) has been found in our study that it reduces the complications of SIRS and organ failure, which was expressed by the gradual improvement in heart rate, means arterial blood pressure, body temperature, serum lactate level and urine output. These results support the hypothesis that insulin has a positive inotropic effect.

Recommendations

Future studies are required to compare between moderate insulin therapy with target blood glucose (120 – 140 mg/dL) and intensive insulin therapy with target blood glucose (80-110 mg/dL) as regard patients' mortality and morbidity.
Efficacy of perineural versus systemic dexamethasone in prolonging analgesia after ultrasound guided femoral and sciatic nerve block for patients undergoing below knee surgeries
Authors: Abdelaziz A A , Elzahaby H M , Elshebeiny A A , Heiba D M
Published: May 2020

Background

Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use.

Objective

to compare the analgesic efficacy of both, intravenous and perineural administration of dexamethasone during femoral and sciatic nerve block using bupivacaine in patients undergoing below knee surgeries.

Patients and Methods

In our study, 50 patients were randomly divided into two equal groups: Group A (Perineural Dexamethasone group) [n = 25]: Those cases received 2ml volume of dexamethasone (8mg) combined with the 20 ml of bupivacaine of 0.5% concentration in each block, followed by injecting 5 ml saline intravenous. Group B (Systemic Dexamethasone group) [n = 25]: Those cases received 2 ml of dexamethasone (8mg) diluted over 3 cm saline in a 5 ml syringe following injection of the perineural 20 ml bupivacaine (0.5%) combined with 2 ml saline to have the same syringe volume for each block.

Results

Our study showed that onset time for sensory block was (25.39 ± 3.79) mins for systemic group and (18.85 ± 4.11) mins in perineural group with a significant statistical difference (P < 0.001) between both groups as the onset of sensory block in perineural group was significantly shorter than the systemic group and the duration of sensory block was (650.00 ± 62.8) mins in systemic group and (718.52 ± 62.06) mins in perineural group. The duration of sensory block was significantly shorter in systemic group than in perineural group with statistically high significant difference between groups (P < 0.001). Onset time for motor block was (30.61 ± 4.89) mins in systemic group and (27.59 ± 3.31) mins in perineural group. Perineural group had shorter time of onset than systemic dexamethasone group with a significant difference between groups (P = 0.013). The duration of analgesia was significantly longer in perineural group than systemic group (P < 0.001)

Conclusion

Dexamethasone was seen to be a potent adjunct to local anesthetic to prolong post operative analgesia with negligible side effects & better outcome to the perineural route.
Dexamethasone with Local Anesthetics Versus Local Anesthetics Alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries
Authors: Elshaer A N , Said S G A , Alawady D S , Reyad A M
Published: May 2020

Background

Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stays and an increased likelihood of chronic pain. Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuroaxial or peripheral nerve blocks were employed. Local anesthetics alone were used, then various adjuvants were added to achieve quick, dense and prolonged block.

Objective

The aim of this study was to study the effect of dexamethasone as an adjuvant to bupivacaine in supraclavicular brachial plexus block. The comparison included the onset and the duration of the sensory and motor blocks, the duration of analgesia of the block as well as their effects on the postoperative analgesic requirements. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done.

Patients and Methods

In our study, 60 patients were randomly divided into 2 equal groups. Control group received bupivacaine only (0.5%) and dexa group in which 8 mg of dexamethasone were added to bupivacaine. All patients received equal volumes of 20 milliliters.

Results

Our study showed that addition of 8 milligrams of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of motor blocks and significantly prolonged motor and sensory block durations. In addition, dexamethasone prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of analgesia. Moreover, in dexa group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of dexamethasone also did not affect the hemodynamics to a significant level. This makes dexamethasone with bupivacaine more superior than the use of bupivacaine alone.

Conclusion

Addition of dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset motor blocks. Addition of dexamethasone to bupivacaine significantly prolongs of both sensory and motor block durations.
Comparison between Bupivacaine with Neostigmine and Bupivacaine alone in Caudal Block for Pediatrics undergoing Lower Abdominal Surgery
Authors: Hassan B E E , Abdelhamid H S , Elderh M S , Sharaf A I A
Published: May 2020

Background

Peripheral nerve blocks provide prolonged analgesia restricted to the site of surgery e.g. penile block for circumcision or sciatic nerve block for pediatric surgery. The drawback is not all anesthesiologists are familiar with the necessary spectrum of peripheral nerve blocks in children. That is why Caudal block is preferred as all types of surgery below the umbilicus can be covered by it: ‘one technique fits all’. The main goal of caudal block is to provide postoperative pain relief, in addition it can be effective intraoperative and it is accepted that the block is performed in anesthetized children.

Objectives

The aim of this work is to compare Bupivacaine with Neostigmine and Bupivacaine alone as regard intraoperative hemodynamics and postoperative pain control for lower abdominal surgery in pediatrics.

Patients and Methods

Prospective randomized controlled clinical Trial.

Conclusion

In conclusion, caudal bupivacaine plus 2μg/kg neostigmine provided excellent analgesia lasting up to 24 hours post-operative, without serious side effects and minimal additional analgesics thus providing a safe, simple and effective postoperative analgesia for children undergoing lower abdominal surgery.
A Comparative Study Between Magnesium Sulfate Versus Morphine Added to Bupivacaine in Ultra-Sound Guided Transversus Abdominis Plane Block for Post-Operative Analgesia after Inguinal Herniorraphy
Authors: Kamaly A M , Khamies A M , Hassan R M , Tawfik H A H
Published: May 2020

Background

Inguinal hernia considered the third common disease in surgeries for adult after acute appendicitis and proctologic disorders. About 20 millions of inguinal hernia repairs are performed globally. Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. A significant proportion of pain experienced by patients undergoing abdominal surgeries is related to somatic pain signals derived from the abdominal wall.

Aim of the Work

The aim of this study is to assess the postoperative analgesic efficacy of Magnesium sulfate added to Bupivacine verus Morphine to Bupivacaine in ultrasound guided transversus abdominis plane (TAP) block after inguinal herniorraphy regarding the pain relief and the amount of rescue analgesia used postoperative.

Patients and Methods

The study was conducted on 45 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in three groups of 15 patients each: Group - I (B): received TAP block with Bupivacaine only as a “Control Group”. Group - II (B-MO): received TAP Block with Bupivacaine plus Morphine. Group - III (B-Mg): received TAP block with Bupivacaine plus Magnesium Sulfate. The three groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total consumption of it in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed.

Results

The results of the study revealed that Magnesium added to bupivacaine better than Morphine added to Bupivacaine in transversus abdominis plane block regarding the postoperative analgesia after inguinal Herniorraphy.

Conclusion

In Conclusion the addition of MgSo4 as an adjuvant to bupivacaine in TAP block has shown superiority over either mono-therapy with bupivacaine or bupivacaine-Morphine combination in many aspects such as postoperative analgesic outcome assessed by VAS score, 1st time of rescue analgesia and without the pronounced side effects of the conventional postoperative opioids and less side effect than Morphine.
Comparison between Intrathecal Nalbuphine and Bupivacaine versus Fentanyl and Bupivacaine For Postoperative Analgesia After Lower Abdominal Surgeries
Authors: Ibrahim S F , Ataallah R Y , Abdelmalek F A , Hamisa M M
Published: May 2020

The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Several investigations have shown that intrathecal or epidural administration of opioids produces a dose dependent modulation of spinal nociceptive processing in animals and humans and is not associated with sedation.

Aim of Study

The purpose of this study was to assess the spinally mediated analgesic effects postoperativally of intrathecal Nalbuphine plus bupivacaine after lower abdominal surgeries in comparison to intrathecal bupivacaine plus fentanyl

Patients & Methods : 60 patients came to Ain-shams Hospital for lower abdominal surgeries, They were randomly allocated into two equal groups (30 patients each) group F and group N. Group F :

Bupivacaine-Fentanyl

Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (25 µg) fentanyl. Group N: Bupivacaine-Nalbuphin Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (0.5 mg) Nalbuphine. All patients were assessed and monitored for: Hemodynamics: ECG for heart rate, and non-invasive arterial pressure, respiratory rate and arterial oxygen saturation, onset of sensory block, onset of motor block, duration of analgesia & 1st rescue analgesia, duration of motor block, adverse effects as: hypotension, bradycardia, respiratory depression, pruritus, shivering, nausea and vomiting were recorded.

Results & Conclusion

Addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia moderately prolonged the time of postoperative analgesia the duration of postoperative analgesia is nearly the same in nalbuphine group & the fentanyl group. There is more rapid onset of motor block in fentanyl group than in nalbuphine group but with no difference in sensory or motor block regression. No respiratory depression or degree of sedation occurs in both groups. Hemodynamic stability & side effects incidence are the same in both groups
Procalcitonin versus C-reactive protein as indicator of acute rejection during orthotropic liver transplanation
Authors: Marzouk M M , Shoukery R A , Mohammed M H , Khalil G M , Mohamed M A
Published: May 2020

Background

Procalcitonin is the precursor for the hormone calcitonin (CT), which is found in the thyroid C cells and the pulmonary endocrine cells, it has a metabolic role in calcium homeostasis. In normal subjects, PCT is found in the blood at a very low concentration but during bacterial infection, there is more than 1,000 fold increase in its blood concentration as it is released by many other tissues as Liver, Spleen and Lungs.

Aim of the Work

to compare between procalcitonin and CRP as a markers of infection versus rejection in orthotropic liver transplantation; this comparison with their plasma level and the clinical difference during postoperative period.

Patients and Methods

This study was conducted on 25 patients aged 2-60 years old of both sexes scheduled for elective liver transplantation from living donors; after ethical committee approval and informed consent from patients and/or their first degree relatives, Ain Shams Specialized Hospitals.

Results

The study revealed that the normal course after liver transplantation for postoperative 28 days was (48%), rejection (16%), sepsis (24%) and rejection and sepsis (12%).

Conclusion

Procalcitonin is a good early diagnostic marker and is superior to CRP and WBCs in early detection of postoperative sepsis after orthotropic liver transplantation.
Hyperglycemia Is A Predictive Of Poor Outcome In Stroke Patients: A Prospective Randomized Trial
Authors: Elazzazi H M , Esmat I M , Aly R M , Senosy A M M
Published: May 2020

Stroke is the third most common cause of disability and second most common cause of death worldwide. Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Hyperglycemia is common during acute ischemic stroke. Several studies have shown admission blood glucose is elevated in > 40% of patients with acute ischemic stroke, most commonly among patients with a history of diabetes mellitus. The question is whether it is possible to determine a patient’s prognosis based on the data available during an initial hospitalization for stroke.

Aim of the Work

To evaluate the prognostic significance of stress hyperglycemia in acute ischemic stroke.

Our study confirmed the association between hyperglycemia and poor clinical outcome among patients with acute stroke. Our data indicates that hyperglycemia is an independent risk factor for worse clinical short-term outcome after acute ischemic stroke. A more severe degree of NIHSS score was observed in patients with hyperglycemia both at presentation and 48 hours later.
The Influence of Body Mass Index on Sensorimotor Block and Vasopressor Requirement during Spinal Anesthesia for Elective Cesarean Delivery
Authors: Elsayed N M A , Rizkallah S S W , Maamoon R M H , Ahmed S H A
Published: May 2020

Background

Physiological changes associated with pregnancy are significant enough to have serious anesthetic implications. When these are compounded by obesity, the anesthesiologists may have to deal with a patient with seriously limited physiological reserve. Obese patients often had co-morbidities and pathological changes in different organ systems.

Aim

The objective of this study is to determine if obesity have a clinical important effect on the vasopressor requirements or the block height following a standard fixed dose of spinal anesthesia during elective cesarean delivery.

Methodology

In this prospective randomized comparative clinical study, two groups of 33 patients were recruited with widely differing body mass indices to examine the influence of body mass index (BMI) on the responses to a specific dose of spinal bupivacaine. One group includes women with BMI < 32 kg/m2 (group N) and the other group has a BMI of > 40 kg/m2 (group O).

Results

This study showed that Body Mass Index doesn’t have much influence on sensorimotor block level and vasopressor requirement during spinal anesthesia for elective cesarean delivery &so the dose of spinal bupivacaine should not be reduced in morbidly obese parturients.

Conclusion

The result of the present study showed that Body Mass Index up to 50 doesn’t have much influence on sensorimotor block level or vasopressor requirement during spinal anesthesia for elective cesarean delivery &so the dose of spinal bupivacaine should not be reduced in morbidly obese parturients.
Conscious Sedation with Local Anesthesia versus General Anesthesia for Patients Undergoing Transcatheter Aortic Valve Implantation
Authors: Abdelhafez O S M , Abdou A M H , Ismail A E A , Aboseif E M K , Kamaly A M
Published: May 2020

Background

Transcatheter Aortic Valve Implantation (TAVI) procedure is being performed under general anesthesia (GA), conscious sedation associated with local anesthesia (CSLA) and local anesthesia alone. There have been limited studies to determine which plan of anesthesia is associated with better results.

Aim

We aimed in this study to assess the role of CSLA in outcome, complications, mortality and to assess quality of life in immediate post-procedural period (ICU and hospital stay).

Methodology

After approval of ethical committee, seventy cases of moderate to severe aortic stenosis planned for TAVI were randomized into two groups. Group-GA: received general anesthesia and Group-CSLA: received conscious sedation combined with local anesthesia. We measured intraoperative hemodynamic changes, pH, PaO2, PaCO2, need for inotropic support and need for blood products. Post-operative variables were need for inotropic support, prolonged respiratory support, need for renal dialysis, and incidence of stroke, heart block, aortic regurge as well as mortality.

Results

The CSLA group showed more incidence of respiratory acidosis with increase in PaCO2 (p=0.024), less decrease in mean arterial blood pressure (p=0.028), less need for inotropic support both intraoperative (p=0.001) and post-operative (p=0.005). The CSLA patients showed less hospital length of stay (LOS) (p=0.006) and less prolonged respiratory support more than 24h (p=0.001) compared to the GA group patients. However, there was no significant difference between the two groups as regards need for blood products (p=0.587) and incidence of complications in the form of renal failure (p=0.113), heart block (p=0.756), aortic regurge (paravalvular leak) (p=0.168) and mortality (p=0.238). There was no incidence of stroke in either group.

Conclusion

CSLA for TAVI patients in the current study showed better intraoperative hemodynamic stability, less need for inotropic support whether intaoperative or postoperative and less hospital LOS despite the presence of mild acceptable respiratory acidosis. So we can recommend to consider CSLA in such patients.
The Role of laryngeal ultrasound in comparison with cuff leak test in prediction of post extubation stridor
Authors: Nashed S W , Elsharnouby N M , Abdulnaiem M A , Eltaher S M
Published: May 2020

Background

Endotracheal intubation is commonly used in (ICU) for different causes. However, intubation/extubation may lead to the development of complications such as post-extubation stridor (PES), one of the most frequent causes of reintubation, prolonged mechanical ventilation, and increased morbidity in the ICU patients. PES and upper-airway obstruction are multifactorial in etiology and can occur as a result of laryngotracheal edema, intubation trauma, excessive cuff pressure with mucosal ulceration, and prolonged intubation with secondary inflammation and granuloma formation.

Objective: The aim of this study was to evaluate the value of laryngeal ultrasonography versus cuff leak test in predicting post-extubation stridor.

Patients and Methods

Our study included fifty patients admitted to the critical care department, Misr University for Science and Technology Hospitals from the period of November 2017 to July 2018 intubated for different causes for a minimum of 24 h. excluded patients primarily intubated for the upper airway obstruction, patients with laryngeal carcinoma, Previous tracheostomy, neck radiotherapy. All patients will undergo for laryngeal ultrasonography versus cuff leak test to predict post-extubation stridor.

Results

In our study CLT identified PES patients with a sensitivity of 75%. But with low PPV of 50% for leakage volume of (132.5 mm ) . Laryngeal ultrasound showed a sensitivity of 50% for those patients with air column width before deflation less than 10.955 mm and ACWD 0.905 mm with PPV of 11.8% and 14.3% for air column width and ACWD respectively

Conclusion

Both CLT (Cuff leak test) and laryngeal US (ultrasound) might have sensitivity in predicting PES and should be used with caution in this regard.
Minimally Invasive versus Conventional Mitral Valve Surgery Comparison of Early Outcomes
Authors: Mohamed M A , Elsayegh T M , Elbawab H Y , Elnahas Y M , Omar A H
Published: May 2020

The mitral valve has been traditionally approached through a median sternotomy. However, mitral valve surgery could be performed using smaller incisions including the right minithoracotomy. This study was a case-control non randomized conducted on 60 patients. All patients had isolated mitral valve disease for mitral valve surgery, 30 of them were operated through right anterolateral minithoracotomy and the others through full median sternotomy to study the effects of minimally invasive mitral valve surgery through right anterolateral minithoracotomy on morbidity and mortality compared with conventional mitral surgery. Medico legal concent was taken from all the patients in this study. All the patients completed the study and there was no mortality among the patients. There was no statistically significant difference as regards the demograohic data, NYHA score and the preoperative echocardiographic findings. Regarding intraoperative comparison, there was statistically significant difference in the cross-clamp time, total bypass time & total operation time. This difference may be due to the new experiences in this MIMVS and the lack of instrumentation that narrow the field of MIMVS. The length of the incision was highly significantly lesser in the minimally invasive group than the full sternotomy group. There was significant difference in the intensive care parameters. The blood loss and the blood transfusion required were lesser in the minimally invasive group. But the ventilation hours and ICU stay was nearly the same in both groups. There was highly significantly less postoperative pain in the minimally invasive group than in the stenotomy group. Total hospital stay was nearly the same in both groups. Minimally invasive mitral valve surgery is a safe alternative to a conventional approach and is associated with less morbidity especially with expert surgeon in simple mitral valve surgery.
Comparative Study between the Use of Self-Fixating Mesh and Non Self-Fixating Mesh in Laprascopic Inguinal Hernia Repair Transabdominal Preperitoneal (TAPP) Technique
Authors: Ebied E F , Khalil A A , Soliman A I I
Published: May 2020

Background

Hernia is a common problem of the modern world with an incidence ranging from 5%-7%. Of all groin hernias, around 75% are inguinal hernias. Recently with advancement in laparoscopy, endoscopic repairs seem to offer better quality of life, decreasing hospital stay and early return to work.

Aim of the Work

To compare between self fixating mesh and non self fixating mesh in laproscopic inguinal hernia repair transabdominal preperitoneal (TAPP) approach as regards intraoperative time, complications, postoperative pain, return to normal activity and incidence of recurrence.

Patients and Methods

This study was conducted on 30 adult patients presenting with inguinal hernias. They were divided into 2 equal groups of 15 patients each. The first group (A): includes fifteen patients and was operated upon by a Laparoscopic transabdominal pre-peritoneal inguinal hernioplasty technique using self -gripping (SGM group) (Parietex ProGrip] Laparoscopic (PPL) meshes), while the second group (B): includes fifteen patients and were operated upon by a Laparoscopic transabdominal pre-peritoneal inguinal hernioplasty technique with non-self fixating mesh.

Results

The postoperative pain assessment at 24 hours and 4 weeks shows that the mean VAS score for GROUP A was (3.70 ± 1.72) and for GROUP B (3.90 ± 1.25) while after 1 month duration follow up, the mean VAS score was (1.25 ± 0.79) for Group A and (1.20 ± 0.77) for Group B with no difference between the two groups confirming the atraumatic nature of the self gripping mesh.

Conclusion

After this comparative study, both mesh fixation with absorpable tacks and fixation using SGM approaches are similarly effective in terms of operative time, the incidence of recurrence, complications and chronic pain coinciding with all the available literature.
Three minutes walking test in correlation to six minutes walking test in COPD patients
Authors: Koraa E E A , Ali E R , Elshaer T K
Published: May 2020

Background

Chronic Obstructive Pulmonary Disease (COPD) is a common preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particels or gases.

Aim of the Work

The present objective is to analyze whether the distance covered over a short time period, 3 min, can be considered a reproducible test, determine whether there is a learning effect, and correlate the results with those obtained from the standard 6 min test.

Patients and Methods

This prospective study was performed on 40 COPD patients recruited from the Emergency room or outpatient clinic at Chest Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt) who will fulfill the inclusion criteria, Spirometry is required to make the diagnosis; the presence of post-bronchodilator FEVI/FVC < 0.70 confirms the presence of persistent air flow limitation). Without resting hypoxemia with FEVI/FVC <70%, Oxygen saturation of hemoglobin by pulse oximetry (SpO2) at room air>88%y. All eligible patients were asked to perform 3 minutes and 6 minutes walking test

Results

learning effect exists with the 3 and 6 min distances repeated over short periods of time. A good correlation was observed between the distance walked at 3 and 6 min.

Conclusion

Our results suggest that the 3 min walking test is sub-maximal strength test that is simple and easy to carry out both in the hospital as well as outpatients environment, with a low cost, facilitating the evaluation of the functional capacity of patients with COPD, not very severe patients. Potential use includes evaluation of results after therapeutic treatment: bronchodilator drugs therapy, lung volume surgery, lung transplant and respiratory rehabilitation programs.
Impact of Diabetes Mellitus on Pulmonary functions in COPD patients
Authors: Ahmed M M , Abdelfattah N M M , Elsherbeny A A , Afifi S A
Published: May 2020

Introduction

COPD is known to be a multisystemic inflammatory disease that goes beyond lung involvement. The association of decreased lung functions and diabetes mellitus has been studied for many years suggesting that the lung could be a target organ in diabetes mellitus.

Objective

assessment of pulmonary functions in COPD patients with normoglycemia and with diabetes mellitus, and patients with diabetes mellitus.

Patients and Methods

The study was conducted in Ain shams university hospitals After the inclusion criteria was met, patients were divided into 3 groups, each group was 20 patients,(group 1): diabetes mellitus patients,(group 2): COPD patients, and (group 3): COPD with diabetes mellitus patients. spirometry was performed and results were analyzed.

Results

In COPD with diabetes mellitus patients (group 3), the lung functions were the least. Diabetes mellitus was also an independent risk factor for reduced lung functions as was seen in nonsmoking diabetic patients (group 1).

Conclusion

Pulmonary functions are reduced in DM independent of smoking.
Interventional Nutrition Education Program for Sixth Grade Students in a Governmental Primary School in Giza Governorate
Authors: Farah S K , Abouseif H A , Gamaleldin D A , Fahim H I
Published: May 2020

Background

Nutrition is a critical part of health and development. Better nutrition is related to improvement of child health, stronger immune systems, and lower risk of non-communicable diseases.

Objectives

the study aimed to describe knowledge, attitude and practice of sixth grade, primary school students about healthy eating habits and healthy diet and to implement and assess a nutrition education program for healthy eating habits and healthy diet.

Participants and Tools

An interventional study was conducted in one governmental primary school in Giza governorate and included 120 sixth grade students. The health education program was divided into three stages: Pre-intervention stage in which the knowledge, attitude and practice (KAP) of students about healthy and unhealthy dietary habits was assessed. Then educational program was implemented and (KAP) of students was re-assessed again twice after the education session immediately and then two months later.

Results

Most of the children (69.6%) had fair nutrition knowledge, (23.2%) had good knowledge, while (7.2%) had poor knowledge. After the intervention, there was an improvement in nutrition knowledge score of participated students (p < 0.05) and this change was maintained after 2 months of the intervention. The total mean score percentage was (68% ± 9.8%) before intervention and had improved after 2 months of the intervention than before. The attitude of participated students had improved after intervention in relation to the concept that eating a lot of fat can make one become obese and eating a lot of sugar and sweets is harmful for health (p < 0.001) The practice had improved among the study participants after 2 months of the intervention than before intervention (80.1% ± 5.1 vs. 68.5 ± 9.8%).

Conclusion

School nutrition intervention programs can have a great impact on knowledge and behavior of primary school students especially if various methods of teaching and learning were applied.