bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Weaning Failure from Mechanical Ventilation in Post Cardiac Surgery Patients
Authors: Elkhalek Mohamed Ali Mohamed Abd , Kamar Mohamed ELsharnouby Noha Mohamed , Elgendy Hanaa Mohamed , Shalaby Mohamed Diaa Eldin , Sayed AbdelRasol Hatem Mahmoud
Published: November 2024

Background

Cardiac surgery disrupts homeostasis, putting the patient in danger. Weaning from a ventilator requires clinical judgement and multiple signs. Patients recovering from anaesthesia can restart spontaneous ventilation. Cardiopulmonary bypass recovers during breathing. Weaning patients from mechanical ventilation after heart surgery involves vital capacity, tidal volume, respiratory rate, and minute ventilation. Others have related advanced age, comorbidities, protracted extracorporeal circulation, cardiac dysfunction, and low cardiac output to unsuccessful weaning of cardiac patients from mechanical ventilation and postoperative hemodynamics and neurological alterations to long-term ventilation.

Aim

To determine predictors of unsuccessful weaning from mechanical ventilation after cardiac surgery, and therefore avoid the potentially hazardous long stay in ICU.

Subjects and Methods

This study was conducted at Ain Shams University Hospital, post cardiac surgery ICU including 80 patients undergo cardiac surgery and receiving mechanical ventilation after operation.

Results

Most of our included patients were successfully extubated. Most of our included patients developed intraoperative complications; the commonest complications were pacemaker wire followed by VF. Most of our included patients have CABG followed by MVR. Most of our included patients have mild tracheal secretion followed by moderate secretion. Charlson Comorbidity Index, COPD and CVS were statistically significant higher in failed extubation than weaned group while MBP and PO2/FIO2were statistically significant lower in failed than weaned patients.

Conclusion

From findings of this study we can conclude that SOFA (≥ 6), Comorbidity index (>3), sever tracheal Secretion, RR/TV (≥57), MV (≥ 13.5) are independent predictors of failed weaning from mechanical ventilation.
Effect of Intravenous versus Intrathecal Dexmedetomidine on Potentiation of Spinal Anesthesia in Lower Abdominal Surgeries in Pediatric Patients
Authors: El Kersh Kareem Mohammad , El Kady Galal Adel , Khairy Elbeialy Marwa Ahmad , Amer Akram Mohamed
Published: November 2024

Background

regional anesthesia in children was first studied by August Bier in 1899. Since then, spinal anesthesia was practiced for years, and several cases were published in 1909- 1910. After some years, it fell into disuse owing to the introduction of various muscle relaxants and inhalational agents.

Aim of the Work

to compare the effectiveness and feasibility of dexmedetomidine intravenously and intra-thecally in potentiation and prolongation of spinal anesthesia in pediatric population undergoing lower abdominal surgeries.

Patients and Methods

this study is a prospective randomized single-blind Clinical trial. study setting pediatric surgery operating theatre, Ain Shams University Hospitals, Cairo, Egypt. Study Period 6 months. This study was carried out on children aging from 1year till 7 years of age who were undergo elective lower abdominal surgeries.

Results

the major obstacle for routine use of spinal anesthesia in pediatric patients is the short block duration provided with the plain SAB hence the use of adjuvants to overcome this defect were considered. The current clinical trial attempts to synthesize the evidence regarding the safety and efficacy of dexmedetomidine as an adjuvant with the most common spinal anesthetic, bupivacaine. The intrathecal route appear more effective in prolongation of duration of motor block and maintaining an adequate sensory level with slower two segment regression course which can be explained by the previously speculated anti-nociceptive effects of the intrathecal route of dexmedetomidine and its action at the level of spinal cord. Intravenous route seems to provide deeper level of sedation when compared to intrathecal route which can be explained by its higher level and bioavailability in the blood which provides a more satisfactory centrally inhibiting action.

Conclusion

dexmedetomidine as an adjunct to spinal anesthesia in pediatric lower abdominal surgeries either intravenous or intrathecal can potentiate the motor and sensory block and provide good postoperative analgesia without exerting hemodynamic compromise or significant adverse events. While intrathecal route provide better prolongation of the motor and sensory blockade and also provide longer postoperative analgesia than intravenous route.
Ultrasound Guided Transversus Abdominis Nerve Block versus Bilateral Ultrasound Guided Ilioinguinal-Iliohhypogastric Nerve Block in Elective Cesarean Section in El-Demerdash Hospital. A Randomized Controlled Trial
Authors: Kamal Hakim Kareem Youssef , Youssef Osama Ramzy , Mohamed Shimaa Ahmed , Soliman Kholoud Usama
Published: November 2024

Background

Pain after CS is a primary concern of women and the provision of effective analgesics is an essential duty for the obstetric anaesthetist. After the application of ultrasound in anesthetic practice, we can now choose between a landmark- or ultrasound-guided TAP block, Ilio- inguinal nerve block (alone or in combination with an Iliohypogastric nerve block) among others.

Objective

To compare the effect of bilateral ultrasound guided TAP block versus ultrasound guided Ilioinguinal and Iliohypogastric nerve block on post-operative analgesia in patients undergoing elective Cesarean section under spinal anesthesia.

Patients and Methods

The study was conducted on 64 random patients per each group who were scheduled to undergo elective cesarean section under spinal anesthesia, the two groups were as following;

Results

As for the comparison between effect of TAP block and ilioinguinal-iliohypogastric block as regard post-operative pain in elective cesarean section under spinal anesthesia, it showed that there is significance regarding the numeric version of the VAS score and its intensity. These findings the TAP block more effective than the ilioinguinal-iliohypogastric block. These findings with our primary and secondary outcomes showed that TAP block has more analgesic effect with respect to ilioinguinal-iliohypogastric block regarding pain assessment but with no significant difference regarding the time till first analgesia postoperative and total analgesics consumption over 24-hour period post-operative.

Conclusion

The comparison between effect of TAP block and ilioinguinal-iliohypogastric block as regard post-operative pain in elective cesarean section under spinal anesthesia showed significant difference regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity. These findings with our study primary and secondary outcomes showed that TAP block has more analgesic effect with respect to ilioinguinal-iliohypogastric block regarding pain assessment and the time till first analgesia postoperative and total analgesics consumption over 24-hour period post-operative.
Nebulized Heparin for Prevention of Acute Lung Injury in Adult Patients Suffering Smoke Inhalation Injury: A Randomized Controlled Trial
Authors: Hakim Sameh Michel , Foad Mariam Nady , Ghaly Safaa Eshak , Saad Mohamed Mahmoud , Habib Mariam Kamal
Published: November 2024

Background

Nebulized heparin (NH) has been used for treatment of inhalation injury- induced acute respiratory distress syndrome (ARDS) but its benefit for prevention of severe ARDS in those patients is not known.

Aim of the Work

The aim of this study was to examine the effect of NH on prevention of severe ARDS and on survival in patients suffering inhalation injury.

Methods

Eighty-eight adults suffering inhalation injury were randomized to receive 5,000 IU of heparin in 3 ml normal saline (n = 44) or to normal saline only (n = 44) by nebulization every 4 hours until successful extubation or death, whichever was earlier, to a maximum of 14 days. Primary outcomes were occurrence of severe ARDS (PaO2/FiO2 ratio <100) and survival to ICU discharge. Secondary outcomes were failed weaning from mechanical ventilation (reintubation in 48 hours after extubation) and occurrence of heparin-related side effects.

Results

There was no statistically significant difference between both groups as regards occurrence of severe ARDS (p-value =.233), mortality (p-value = .354), reintubation within 48 hours (p-value = .419) or thrombocytopenia (p-value = .777). None of the patients developed abnormal prolongation of prothrombin time (PTT). Estimated marginal mean PaO2/FiO2 ratio was significantly higher (p-value < .001) and mean platelet count was significantly lower (p-value = .005) in the nebulized heparin group, with no statistically significant difference in mean PTT (p-value = .074).

Conclusions

Nebulized heparin was associated with improved oxygenation but was did not reduce the incidence of severe ARDS, failed weaning from mechanical ventilation or mortality in patients suffering inhalation injury. Nebulized heparin had no effect on prothrombin time but could be associated with clinically unimportant reduction in platelet count.
Fentanyl-Midazolam versus Ketamine-Midazolam in Anesthesia of Patients with Sepsis undergoing Abdominal Surgery
Authors: Zohdy Marwa Mounir , Abo-Elela Sahar K , Hefny Sameh S , Hafez Amr F
Published: November 2024

Background

Induction of anesthesia in hemodynamically compromised patients is a challenge for every anesthetist. Most of the intravenous induction agents have a negative effect on arterial blood pressure and cardiac output. Theoretically, the ideal emergency induction intravenous anesthetic should achieve rapid hypnosis and maintain the hemodynamic stability.

Aim of the Work

to compare the effect of ketamine midazolam versus fentanyl midazolamin anesthesia of septic patients and find which one of them is more effective to maintain hemodynamic stability in patients with sepsis.

Patients and Methods

A randomized controlled double-blinded study was conducted in Ain Shams University hospital after research ethics board approval during the period from June 2020 to June 2022. Written informed consent was obtained from participants or their surrogates before enrollment. Randomization was achieved using a computer-generated sequence. Concealment was achieved using opaque envelopes.

Results

there was no difference between study groups according to serum lactate. intra operative mean arterial blood pressure was higher in ketamine group than fentanyl group and norepinephrine infusion rate was increased in the two groups over the period from the baseline, but the most increase was in the fentanyl compared with ketamine group; as there was a statistically significant difference between them at 2-5 minutes then from 10 to 90 minutes with 10-minutes intervals. There was no statistically significant difference between study groups according to ICU length of stay and mortality rates. In this study we found that ketamine- based induction of anesthesia maintained hemodynamics better than fentanyl-based induction of anesthesia in patient with abdominal sepsis.

Conclusion

In anesthesia of septic patients ketamine midazolam was more effective than fentanyl midazolam in maintenance of hemodynamic stability.
Effectiveness of U/S Guided Erector Spinea Plane Block for Post-Operative Pain Control in Breast Surgeries
Authors: Din Abdel Wahab Qara'ah Alaa El , Malek Fady Adib Abdel , Fahim Hani Magdy , Abo AlMagd Mohamed Sayed
Published: November 2024

Background

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related mortality among females in more than 100 countries. The traditional therapeutic approaches for breast cancer include surgery, radiation therapy, chemotherapy, Immunotherapy and endocrine therapy, surgical resection is still considered to be the primary and most effective therapy.

Objective

To evaluate the analgesic effect of ultrasound-guided erector spinae plane (ESP) block in breast surgery postoperatively

Methods

This was randomized controlled clinical trial that was held in major operating theaters in el demerdash hospital, Ain Shams University, Cairo, Egypt for 6 months on females undergoing breast surgeries aged between 21 - 45 years.

Results

Our results reported that there was highly statistically significant difference found between Group I and Group II regarding Postoperative pain scores Immediately, Postoperative pain scores After 5min, Postoperative pain scores After 10 min, and there was no highly statistically significant difference found between Group I and Group II regarding Postoperative pain scores After 15min, Postoperative pain scores After 20min, Postoperative pain scores After 25min and Postoperative pain scores After 30min. There was highly statistically significant difference found between Group I and Group II regarding Total morphine consumption (mg) and Number of patients requiring morphine. Also, there was highly statistically significant difference found between Group I and Group II regarding Mean arterial blood pressure (mmHg) Immediately, and there was no highly statistically significant difference found between Group I and Group II regarding Mean arterial blood pressure (mmHg) After 5min, Mean arterial blood pressure (mmHg) After 10 min, Mean arterial blood pressure (mmHg) After 15 min, Mean arterial blood pressure (mmHg) After 20 min, Mean arterial blood pressure (mmHg) After 25 min and Mean arterial blood pressure (mmHg) After 30 min. Regarding Patients satisfaction, there was statistically significant difference found between Group I and Group II

Conclusion

Ultrasound-guided ESP block with general an aesthesia offers superior post-operativeanalgesia compared to general an aesthesia alone in patients undergoing unilateral non-reconstructive breast cancer surgeries and is associated with better patient satisfaction scores at discharge. There was no significant difference in intraoperative morphine consumption. The ultrasound-guided ESP block appears to be an effective block for postoperative analgesia in breast cancer surgery.
Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Post-Operative Pain Management after Laparoscopic Sleeve Gastrectomy
Authors: Elsaid Amr M , Hussien Rania M , Mahrose Ramy A , Abd Elraziq Mohamed Y
Published: November 2024

Background

ultrasound-guided quadratus Lumborum block (QLB) performed as one of the postoperative pain management procedures for patients undergoing abdominal surgeries.

Objective

The aim of this study is to compare the effect of ultrasound guided bilateral QLB versus bilateral ultrasound guided Transversus abdominis plane (TAP) block on postoperative analgesia in patients undergoing laparoscopic sleeve gastrectomy (LSG) under general anesthesia.

Patients and Methods

Setting and design: pilot exploratory study conducted on 45 patients scheduled for elective LSG. All patients received general anesthesia using IV fentanyl (1-2 Mg/kg). QLB Group (15 patients): received ultrasound-guided QLB after induction of general anesthesia using 0.2 mL/kg of 0.25% bupivacaine per side. TAP Group (15 patients): received ultrasound-guided TAP block after induction of general anesthesia using 0.2 mL/kg of 0.25% bupivacaine per side. Control Group (15 patients): received general anesthesia and then 1gm IV paracetamol and 30mg IV ketorolac 1 hour and 8 hour postoperative.

Results

there was statistically significant difference between the three groups as regards the VAS score, total dose of pethidine used postoperatively, number of patients needed rescue analgesia and postoperative hemodynamics; indicating that TAP block was more effective than intravenous drug analgesia, while QLB was more effective than TAP block.

Conclusion

QLB was the most effective technique in providing analgesia after LSG in comparison to TAP block and intravenous analgesic drugs.
The Effect of Quadratus Lumborum Block vs Erector Spinae Block in Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy
Authors: Abd Elhady Abo Elkassem Mostafa Moharram , Abd Elhamid Hadeel Magdy , Khattab Salwa Omar , Farrag Ossama Mohamed
Published: November 2024

Background

However, the postoperative pain following laparoscopic cholecystectomy consists of both somatic and visceral components with pain originating from port entry wounds, gallbladder resection and abdominal insufflation that leads to peritoneal distention and peritoneal damage.

Aim of the Work

to compare analgesic efficacy of Quadratus lumborum block versus erector spinae block in postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

Study Design

prospective randomized controlled clinical trial

Methods

This prospective randomized controlled clinical trial was conducted at operative theatres, Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University Hospitals from March until August 2023. During this study, 80 patients electively scheduled for laparoscopic cholecystectomy were enrolled and divided into two equal groups; group A subjected to quadratus lumborum block and group B subjected to erector spinae block. Intraoperative, Post Anaesthesia Care Unit and postoperative haemodynamic, postoperative VAS score, first time of postoperative analgesic request, total amount of postoperative analgesia, time needed for postoperative mobilization and side effects of study procedures were evaluated.

Results

In this study there was no significant difference between the two groups as regards VAS score. In this study there was no significant difference between the two groups according to total amount of analgesia needed post operatively. In this study there was no significant difference between the two groups according to total amount of analgesia needed post operatively. In this study time needed for mobilization was insignificant different between two groups. In this study, no statistically significant disparity was observed between the two groups in terms of side effects. In this study, no significant difference was found between the two groups according to the first time postoperative analgesia.

Conclusion

This study showed comparable effect of both QLB and ESPB in patients undergoing laparoscopic cholecystectomy.
Comparative Study between Ultrasound Guided Pectoral Nerve Block Type-II (PECS II) and Serratus Anterior Plane Block (SAPB) in Postoperative Analgesic Efficacy in Modified Radical Mastectomy
Authors: Nemr Nouran Ehab , Mohsen Abdel Lateef Samia Abdel , Hamawy Tamer Youssef , Abdel Tawab Samar Mohamed
Published: November 2024

Background

Breast cancer has continued to be the most common cancer afflicting women, accounting for 31% of all new cancer cases in the female population. Every year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for early-stage breast cancers.

Aim of the Work

to evaluate the effectiveness of ultrasound guided pectoral nerve block (PECS II) versus serratus anterior plane block (SAPB) for postoperative Analgesia in modified radical mastectomy.

Patients and Methods

After obtaining approval from the medical ethical committee in Ain Shams University and written informed consent. This Double Blind Prospective Randomized Controlled study was conducted in the operating theatres of Ain Shams University Hospitals. It included Sixty Female patients undergoing Modified Radical Mastectomy.

Results

The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed.

Conclusion

SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after Modified Radical Mastectomy under general anesthesia, compared to PECS II block.
Comparative study between Inferior Vena Cava Collapsibility Index (IVCCI) and Serum Lactate Level as Weaning Predictors of Vasopressors in Septic Shock Patients
Authors: Mohammed Ali Osama Mohammed , Elazzazi Hesham Mohammed , Zekrey Milad Ragaie , Ahmed Youssef Ahmed Monier
Published: November 2024

Background

Sepsis is a complex disorder that develops as a dysregulated host response to an infection, and is associated with acute organ dysfunction and a high risk of mortality. This syndrome needs urgent treatment, and thus awareness of the presenting characteristics is of great importance. The incidence of sepsis is high, and the condition remains one of the leading causes of death globally. Thus, sepsis is an important public health issue with considerable economic consequences.

Aim of the Work

to elaborate the effectiveness of IVC collapsibility index versus serum lactate level as predictors for weaning from vasopressors in septic shock patients.

Patients and Methods

 

Results

There were no statistically significant correlations between vasopressor doses, serum lactate or IVCCI at different time- points. To stratify the predictive value of serum lactate and IVCCI in weaning from vasopressors, patients were divided into 2 groups at the end of the 2nd day and at the end of the 3rd day: Weaned group and non- weaned group. Both groups were compared and performance of serum lactate and IVCCI in prediction of weaning from vasopressors at different time- points was assessed using Receiver Operator Characteristics analysis. At different measurements, IVCCI had larger area under curve with better diagnostic performance than serum lactate in prediction weaning from vasopressors.

Conclusion

serum lactate and inferior vena cava collapsibility index decrease significantly with improvement of sepsis and subsequent reduction of vasopressor doses. Changes in serum lactate and inferior vena cava collapsibility could predict changes in vasopressor doses with better performance for inferior vena cava collapsibility index.
Comparative Study of Nebulized Dexmedetomidine and Intramuscular Ketamine for Premedication in Paediatric Patients Undergoing Hernia Repair Surgery
Authors: Shoukry Randa Ali , Naseef John Nader , El Sayed Ahmed El Sherif Ibrahim Mohamed , Hassan Bayoumi Rana Galal
Published: November 2024

Background

Infants and preschool children that require surgery and imaging are often anxious, due to the separation from their parents, fear of doctors, and unfamiliar environments, and it is often difficult to obtain their cooperation.

Aim of the Work

It was to determine the sedative effect of inhaled nebulized dexmedetomidine as a premedication for pediatrics compared to intramuscular ketamine.

Patients and Methods

60 patients, aged 2 to 8 years of both sexes scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (5 mg/kg) before the induction of anesthesia.

Results

Sedation scale (RSS) was significantly lower in Dexmedetomidine group than in Ketamine group at minutes-5, 10 and 15. Acceptable sedation was significantly less frequent in Dexmedetomidine group than in Ketamine group at minutes-5, 10 and 15. Dexmedetomidine group significantly had more frequent excellent parental separation anxiety and less frequent fair parental separation anxiety than Ketamine group had. Acceptable parental separation was significantly more frequent in Dexmedetomidine group than in Ketamine group. Dexmedetomidine group significantly had more frequent excellent mask acceptance and less frequent fair mask acceptance than Ketamine group had. Satisfactory mask acceptance was significantly more frequent in Dexmedetomidine group than in Ketamine group. Recovery time was significantly shorter in Dexmedetomidine group than in Ketamine group. Watcha score was higher in Dexmedetomidine group than in Ketamine group beginning from minute-0 until minute-30, but the differences were statistically significant only at minutes-25 and 30. Emergence agitation (Watcha-3/4) started to appear in Dexmedetomidine group at minute-20 and its frequency increased until minute-30, while in Ketamine group Emergence agitation (Watcha-3/4) appeared at minute-30. Emergence agitation (Watcha-3/4) was more frequent in Dexmedetomidine group than in Ketamine group in minutes-20, 25 and 30, but the differences were statistically significant only at minutes-25 and 30. Bradycardia and hypotension were more frequent in Dexmedetomidine group, but the differences were statistically significant only in case of bradycardia.

Conclusion

Dexmedetomidine nebulization had better smooth separation from parents and had satisfactory acceptance of face mask for induction of general anesthesia compared to intramuscular ketamine. Sedation was the same between the two groups. Emergence agitation was higher in Dexmedetomidine group.
Intranasal Dexmedetomidine (Precedex) versus Intranasal Midazolam (Dormicum) as a Premedication in Pediatrics Undergoing Upper GI Endoscopy
Authors: Shoukry Randa Ali , Hanafy Amira Fathy , Salem Reem Refaat Muhammed Refaat Marwa Mostafa
Published: November 2024

Background

Upper GI endoscopy is one of the most common surgical procedures performed in pediatric patients. Relieving pre- and post- operative anxiety is an important concern for the pediatric anesthesiologist. Anxiety can produce aggressive reactions, increase distress, and may make the control of postoperative pain difficult. Pre-anesthetic medication in children should aim at relieving this anxiety and psychological trauma and also to facilitate the induction of anesthesia without prolonging the recovery.

Aim of the Work

The aim of this work is to compare the effectiveness of intranasal dexmedetomidine and midazolam as a premedication in sedation of preschool children in GI endoscopy.

Patients and Methods

A prospective, randomized and double blind clinical trial was done after approval of institutional ethics committee in Ain Shams University Hospitals for 6 months and obtaining an informed written consent from parents. It was designed to include 70 pediatric patients, aged 2 to 6 years old of both genders, with physical status ASA I – II.

Results

In the present study, the children were satisfactorily separated from parents in dexmedetomidine group when compared to the midazolam group; p value <0.001 as also documented by Ayushi that Parental separation was successful in 73.3% of patients in Group SD compared with 46.7% of patients in Group SM (P = 0.035). Furthermore, children in dexmedetomidine group achieved significant lower agitation and delirium postoperative after drug in comparison to midazolam group; regarding delirium: p value <0.001, and regarding agitation: p value <0.001.

Conclusion

Premedication with intranasal dexmedetomidine 1 μg/kg attained significant and satisfactory sedation with better parent separation and lower agitation and delirium in the postoperative period as compared to intranasal midazolam 0.2 mg/kg in children undergoing upper GI endoscopy although dexmedetomidine had a delayed onset of action when compared to that of midazolam.
A Comparative Study of Subinguinal Microscopic versus Open Surgical Varicocelectomy in Treatment of Primary Varicocele
Authors: Abdallah Hany Mostafa , El-Sayed Tarek Osman , Radwan Ahmed Ibrahim , Abdel Aziz Aly Abbas Khalaf
Published: November 2024

Purpose

To compare the outcome between microscopic and conventional subinguinal varicocelectomy regarding improvement in semen quality and pain resolution in patients who complain of varicocele-related infertility, pain, or both.

Patients and Methods

A prospective interventional non randomized controlled trial was carried out on 64 patients who met the criteria and allocated to two groups, group A (n = 34) underwent microscopic sub inguinal varicocelectomy, and group B (n = 30) underwent conventional sub inguinal varicocelectomy. A 3-month postoperative semen analysis was compared to the preoperative one, and pain was assessed preoperatively, 1 month and 3 months postoperatively.

Results

Both study groups showed significant improvement in the semen quality. Moreover, improvement in semen parameters was significantly higher in group A when compared to group B. Improvement in sperm concentration was 89.2 % and 41.7%, and in progressive motility was 100% and 50% for group A and B, respectively (P < 0.01). At 1 month and 3 months postoperatively, pain score was significantly lower in group A (Median = 0 & 0, respectively) in contrast to group B (Median = 2 & 0, respectively) (P < 0.01).

Conclusion

In patients who suffer from varicocele-related infertility or pain, microsurgical technique in sub inguinal varicocelectomy gives better results in improvement of semen quality and pain resolution when compared to the conventional technique.
The Effect of General Anesthesia on Liver Function Tests in Patients with Portal Hypertension
Authors: Lotfy Atallah Youstina Magdy , Muselhy ElAnsary Adel Mohamed , Wahba Gobran Ramy Mounir , Zakhary Lydia Edward Aziz
Published: November 2024

Background

Patients with liver disease and portal hypertension usually as a result of advanced fibrosis or cirrhosis, are at increased risk of complications when undergoing surgery.

Aim of the Work

The aim of the study is to assess the changes in liver functions postoperatively in patients with portal hypertension undergoing abdominal or pelvic surgeries, to assess intra operative complications in patients with portal hypertension undergoing general anesthesia, for abdominal or pelvic surgeries.

Patients and Methods

The type of this study is prospective Observational Study, conducted at Ain Shams University Specialized Hospital on 40 patients in 6 months duration.

Results

In this study, we compared changes in liver functions postoperative in patients with portal hypertension undergoing pelvic surgery or abdominal surgery and there were highly significant difference between pre operative and post operative labs as postoperative Hb, Plts level decreased while INR, liver enzymes, bilirubin level increased than preoperative. There was significant difference between pelvic surgery and abdominal surgery of the studied patients regarding intra-operative blood loss as amount of blood loss intraoperative increased in abdominal surgery more than pelvic surgery. In this study, we compared between pelvic surgery and abdominal surgery regarding laboratory data post operative, and there were highly significant difference in labs postoperative between them as liver enzymes increased, Hb, Plts levels decreased in abdominal surgery more than pelvic surgery. In our study we compared between child B, child C classification patients there was highly significant difference between them regarding total time of surgery as time of surgery increased in child C patients more than child B patients, there were highly significant difference between them postoperative regarding hepatic encephalopathy, Bilirubin as they affected more in child C patients and there were highly significant difference between them regarding blood products transfusion as child C patients received more amounts of PRBCS, FFP, Plts transfusion than child B patients.

Conclusion

Patients with underlying liver disease have an increased surgical risk. Prediction of surgical risk is based on the degree of liver dysfunction, the type of surgery, and the preoperative clinical status of the patient as previously mentioned.
Study of Effects of Amino Acids Infusion on Perioperative Hypothermia and Postoperative Shivering in School-Age Children Scheduled for Abdominal Surgeries
Authors: Mohamed Hegazy Yumna Ahmed , Ali Sultan Sherif Sayed , Shabanna Tarek Samir , Hafez Helmy Amr Fouad
Published: November 2024

Background

Hypothermia is one of the reported side effects of general anesthesia. Deviations from normothermia are associated with numerous complications and adverse outcomes, with infants and small children at the highest risk.

Aim of the Work

to assess the role of perioperative amino acid infusion in the prevention of perioperative hypothermia and postoperative shivering in school-age children.

Patients and Methods: Study

Randomized Controlled Double Blind Study. Study Setting: Ain Shams University Hospitals, Cairo, Egypt. Study Period: 6 months. Study Population: School age children undergoing abdominal surgery.

Results

The present study involved fifty-two patients divided into two groups. Group A consists of twenty-six patients who received IV amino acid infusion, and Group B (control) consists of patients who received an equivalent volume of Ringer’s solution. In addition, the current study analyzed temperature fluctuations between the two distinct groups. Initially, no statistically significant difference was found in temperatures at baseline, during induction, and minute-15 intraoperatively between the Amino Acid and Control groups. This initial parity in the temperature profiles indicates a well-matched starting point for temperature measurements. In addition, the current study revealed a significant difference in the frequency of perioperative hypothermia between the two groups. Importantly, all cases of hypothermia observed in this study were classified as mild. In the Amino Acid group, perioperative hypothermia occurred less frequently when compared to the Control group. This statistically significant difference suggests that the infusion of amino acids may have a protective effect against the development of hypothermia in school-age children undergoing abdominal surgeries.

Conclusion

We conclude that intraoperative hypothermia is relatively frequent complication that can have adverse physiological effects. Maintenance of normothermia during anesthesia and surgery decreases the overall morbidty. Intraoperative hypothermia could be prevented or at least decreased by using one or more of different methods for this purpose.
Comparative Study between One Year Patency of Brachio- Basilic Arteriovenous Fistula versus Brachial to Basilic Forearm Loop Graft in End Stage Renal Disease Patients
Authors: Mohammed Islam Badry , Khattb Mahmoud Sobhy , Whba Ramez Mounir , Emam Fakhr Mohammed
Published: November 2024

Background

Autogenous arteriovenous fistula (AVF) is considered the first choice for vascular access. Transposed arteriovenous fistulas include transposed brachial-basilic arteriovenous fistulas and transposed brachial-brachial arteriovenous fistulas, both basilic vein and brachial vein are too deep to cannulate, so requires transposition to be accessible.

Aim of the Work

to compare the outcomes of patients treated with a Brachio-basilic arteriovenous fistula with those of patients treated with the polytetrafluorethylene (PTFE) brachial to basalic loop graft.

Methods

This prospective cohort observational study included 50 patients with end stage renal disease (ESRD) on regular hemodialysis who were divided into two equal groups; group A: included patients who underwent the Basilica forarm polyteterafloruracil arteriovenous graft (BBAVG) and group B: included patients who underwent Basilic vein transposition or basilic vein superficialization (BBAVF).

Results

There was no statistically significant difference between the two studied groups regarding age, gender, clinical characteristics, primary, assisted primary or secondary patency rates, functional maturity at 1, 3, and 6 months, early postoperative bleeding (p = 0.312), late postoperative bleeding (p = 1), early postoperative mortality (p = 1), thrombosis (p = 0.018), late postoperative thrombosis (p = 0.157), early postoperative mild Infection (p = 0.123), early postoperative sever infection (p = 1), late postoperative mild infection (p = 0.074) and late postoperative sever infection (p = 0.297).

Conclusions

Both BBAVF and PTFE brachial to basilic loop graft can be considered as viable options for vascular access in this patient population. The choice of procedure may depend on individual patient factors, as well as the risk of thrombosis, which should be carefully evaluated.
Effect of Mesenchymal Stem Cells in Androgenic Induced Alopecia in Adult Male Albino Rats versus Conventional Minoxidil Treatment
Authors: Hussein Ali Heba Mohammed , Hamdy Khaled Naiem , Ebrahim El- Nefiawy Nagwa , Kamar Sherif A , Moneim Abo El Fetouh Marwa Abd El
Published: November 2024

Background

Androgenic alopecia (AGA) could be the most common form of hair loss in man. AGA could be associated with reduced quality of life. Might cause several psychological comorbidities such as depression, anxiety. There are two FDA approved medications for treatment of hair loss; minoxidil (antihypertensive & vasodilator) in addition to finasteride (a selective inhibitor of type II & III isoforms of 5α-reductase enzyme).

Aim of Work

The current study was performed to investigate the potential role of human umbilical cord blood-derived mesenchymal stem cells (hUCB)-MSCs in aiding hair growth in AGA compared to conventional minoxidil treatment in adult male albino rats.

Material and Methods

Forty-eight adult male albino rats were used in the study. Rats were assigned into the following groups; control group that either received no treatment or daily subcutaneous injection of sesame oil (0.1 ml), AGA group in which rats received daily subcutaneous injection of testosterone in a dose of 2 mg/rat /day, AGA plus Minoxidil treatment group in which rats received testosterone injection as in group II in addition to 2% Minoxidil spray treatment, AGA plus hUCB-MSCs treatment group in which rats received testosterone injection in addition to dermal injection of 1 x105 cells /cm2 of stem cells. At the end of the experiment after 2 weeks, rats were sacrificed for paraffin blocks and stained with H & E and Masson’s Trichrome.

Results

Decrease in both total number of hair follicles and number of anagen hair follicles was noticed. There was an increase in mean number of the telogen hair follicles. There were increase in the catagen hair follicles with numerous fibrous streamers observed, with increased vellus hair number. Meanwhile, terminal hair number had been decreased in comparison to control group. There were cavitations in hairs and their sheaths, inter follicular cavitation, wavey collagen fiber deposition, perifollicular mononuclear cell infiltrate, and thinning of arrector pili muscle.

Conclusion

Stem cell therapy had superior efficacy over minoxidil in the treatment of AGA.
Comparative Study between the Accuracy of Transcerebellar Diameter versus Femur Length and Biparietal Diameter Measurements in Estimation of Gestational Age during Third Trimester
Authors: Solaiman Nourhan Galal , Desouky Ahmed Mohamed , ElHodiby Mohamed E , El Moez Ahmed Walaa Adel Abd
Published: November 2024

Background

Knowledge of accurate gestational age is of great importance in obstetric practice. Pregnancy complications as low birth weight, preterm labor are very common in pregnancies with unknown and inaccurate estimated gestational age, gestational age estimation is essential for proper prenatal care and determining whether the fetal size is appropriate-for- gestational age. Moreover, it is essential for many prenatal interventions, such as fetal lung maturation, use of magnesium for neuroprophylaxis in preterm infants, induction of delivery and neonatal resuscitation. Optimal assessment requires good judgment by the obstetrician caring for the patient.

Objective

To compare the accuracy of transcerebellar diameter versus the current fetal biometrics including (femur length and biparietal diameter) in estimation of the gestational age during the third trimester according to last menstrual period.

Patients and Methods

The study was conducted in clinic of Obstetrics and Gynaecology Department- MUST University Hospital. This study included 120 pregnant females. They were divided equally into three equal groups each contained 40 patients; Group I: Biparietal diameter measured group, Group II: Femur Length measured group, and Group III: Transcerebellar measured group.

Results

The comparison in 1 week proved that the TCD gave correct assessment of gestational age in 107 patients (89.17%), the BPD gave correct assessment of gestational age in 73 patients (60.83%) and the FL gave correct assessment of gestational age in 97 patients (80.83%).

Conclusion

Transcerebellar diameter is the most accurate and reliable method for assessment of gestational age in third trimester followed by FL and the least accurate is the BPD.
Impact of Coronary Revascularization on Left Ventricular Global Longitudinal Strain in Chronic Total Occlusion
Authors: Ali Khaled Mohammed , Abdulhamid Mohammed Amin , Abdulrahman Mohammed Ahmed , Hatata Ahmed Ibrahim
Published: November 2024

Background

Ischemia is the cause of decreased ventricular relaxation and diastolic dysfunction, which is followed by reduced systolic function. This sequence of events is the outcome of a chain reaction that starts with metabolic and biochemical changes. A temporary impairment in ventricular relaxation is brought on by ischaemia. Even in cases when there are coronary collaterals present, the majority of patients who have a CTO still have some degree of LV dysfunction. PCI to CTO lesions is a technically complex treatment that is performed in the hope of a functional recovery, which has been found to enhance the possibility of survival.

Objective

To investigate the impact of CTO revascularization on LV function using LV GLS.

Methods

This study is a prospective observational study that was conducted at Ain Shams university hospitals, in the time interval from October 2022 till October 2023. The study included 30 consecutive patients with CTO lesions who underwent successful PCI. All the patient underwent assessment of GLS of LV before PCI and two months after.

Results

There was a significant improvement in GLS in the follow up study; P value was <0.001, and significant improvement in the EF; p value was <0.023. There were no associations of gender and age with the percentage of improvement; there were insignificant P values 0.361 and 0.640 among gender and age respectively. We found no associations of risk factors with the percentage of improvement in EF and GLS in hypertensive patients (P value was 0.426), in smokers (0.426), in diabetic patients (0.666), and in dyslipidemic patients (0.580) which were all insignificant. Regarding the relationship between the improvement in LV GLS and angiographic characteristics post PCI, all the P values were insignificant since all the CTO PCI sessions resulted in TIMI III flow

Conclusion

Our study showed significant improvement in LV systolic function after successful CTO PCI during follownup period of two months (The LV GLS and LVEF). Also, we found no impact of predictors on GLS Improvement.
Role of Statin Therapy in Prevention of Anthracycline-Induced Cardiotoxicity
Authors: Mohamed Ahmed L , El-Abd Ali A , Mohamed Haitham G , Noufal Ahmed M , Kamal Bassam S
Published: November 2024

Background

Recent advances in the treatment of breast cancer have resulted in improved overall cancer survival; however, cancer therapy-related cardiac dysfunction is considered a major adverse effect of several chemotherapeutic agents, particularly anthracyclines. Hence, there is a need to develop proper cardioprotective strategies to limit myocardial injury following chemotherapy.

Objective

To evaluate the effect of statin therapy on the prevention of anthracycline-induced cardiotoxicity in female patients with breast cancer.

Patients and Methods

The current study is a prospective, randomized, single-blind, placebo- controlled trial that included a total of 100 female patients with newly diagnosed breast cancer who received anthracycline-based chemotherapy. Patients were randomly assigned in a 1:1 ratio into two groups, the study group in which patients received 40 mg of oral atorvastatin and the control group in which patients received a placebo. A comprehensive echocardiographic examination was performed to all patients before receiving the chemotherapy and at 6 months after, assessment of LV ejection fraction was done by 3D-echocardiography.

Results

The mean age of patients assigned to the control group was 49.8±10.51 years, while patients assigned to the intervention group had a mean age of 47.84± 9.16 years, both the control group and the intervention group were similar in demographic data and baseline clinical characteristics. There was a highly significant difference between the two groups regarding both the absolute LVEF assessed by 3D-echocardiography at 6 months and the percentage of change compared to baseline values, patients assigned to the control group had mean LVEF of 52.92% at 6 months with a percentage of change reaching -7.06%, while those assigned to the intervention group had mean LVEF reaching 56.22% at 6 months with a percentage of change reaching -3.64% (P-value: 0.008 and 0.004 for the absolute value and percentage of change respectively). There was a significant difference between the two groups regarding the incidence of development of cancer therapy-related cardiac dysfunction (defined as a drop in LVEF of more than 10% and to a value below 53% assessed by 3D echocardiography), among the control group 15 patients (30%) developed CTRCD after 6 months from starting Anthracyclines based chemotherapy, while, among the intervention group only 6 patients (12%) developed CTRCD. (P-value= 0.027)

Conclusion

Prophylactic use of atorvastatin may prevent the development of cancer therapy- related cardiac dysfunction in breast cancer patients receiving anthracycline- based chemotherapy.