bluuebunny/crossref_metadata_2025 huggingface dataset:
O-002 CRISPR-Cas, from a bacterial defense system to a novel genetic tool in humans
Authors: Staals R
Published: July 2024

In a span of merely a decade, the CRISPR-Cas technology has revolutionized the scientific, industrial, and medical sectors. Its ability to serve as a highly precise genome editing tool has gained a lot of attention over these years, leading to its recognition with the Nobel Prize in Chemistry in 2020. Amidst these achievements, it is easy to overlook the natural role of the CRISPR-Cas system, which functions as an adaptive immune system against viruses in bacteria. The ongoing exploration and characterization of various variants of these systems continue to pave the way for the development of innovative genetic tools and the enhancement of existing ones. In this presentation, I will start with an explanation of the natural role of CRISPR-Cas in bacteria. This will be followed by a brief overview of how these systems were repurposed into the aforementioned genome editing tools. Subsequently, I will delve into some of the latest advancements (and their bottlenecks) in the field, including a few unconventional applications, and discuss their potential short-term and long-term impacts on human reproduction.
O-039 Con - the faster the better
Authors: Kovacic B
Published: July 2024

Late o’clock: Are slow growing embryos clinically usable?

Con - the faster the better

Reproductive medicine and, within it, embryology, have experienced milestones in the understanding of pre-implantation embryonic development over the last quarter of a century. The development of blastocyst culture media for embryo culture even after embryonic genome activation and the possibility of continuous monitoring of embryonic morphokinetics throughout the pre-implantation period have been major contributors. The development of molecular genetic techniques has also played an important role. The introduction of new cryopreservation techniques has also improved the success rate of the clinical use of surplus embryos, including slow-growing embryos not otherwise selected for fresh cycle transfer. Two questions are most frequently encountered in clinical embryology today: which embryo in a cohort has the best chance of resulting in a live-born child, and how slow and morphologically suboptimal can an embryo be to still be considered clinically useful?

In particular, the latter question does not have an easy answer, as embryos demonstrate varying pace of development. A further problem arises if there are no optimal embryos available in the cohort and this answer has to be given on day 2, 3 or 5, as this is when the embryo transfer is scheduled to take place. Some studies suggest that longer timing of any stage of embryonic development from pronuclear fading onwards means that the embryo is late in development due to certain abnormalities and is likely to be energetically depleted by the activation of its repair mechanisms. Such embryos not only have a lower implantation potential compared to fast embryos, but also diverge in time from the optimal receptivity of the endometrium. Additional testing and/or storage of slow-growing embryos brings the question of their clinical usability to the time of frozen embryo replacement cycles and quiets the couple's expectation of a “successful” completion of the stimulated cycle. Whether embryos are to be selected for fresh ET or FER, the “the faster - the better” principle is likely to be applied. In daily clinical practice, decisions on the use of slow-growing and/or morphologically sub-optimal embryos and the timing of embryo transfer are made on an individual basis, taking into account various medical as well as non-medical (e.g. economic, logistical) factors. These may also include portraying a positive image of the centre's performance. However, patients expect infertility specialists to make realistic assessments not only of the viability of slow growing embryos, but also of the outcome of the transfer of them. The assessment must be based not only on medical and ethical but also on rational grounds.
O-172 Live imaging reveals key events in preimplantation embryo development
Authors: Skory R
Published: July 2024

Preimplantation development encompasses the zygote to blastocyst stages, occurring in vivo within the Fallopian tube and in vitro within embryology labs worldwide. During these first five days of life, several key morphologic changes take place facilitating cell fate specification and resulting in blastocyst assembly containing ICM and trophectoderm lineages. These include cell polarization, embryo compaction and inner-outer segregation, which transform the collection of blastomeres into a morula. Subsequently, the blastocoel cavity forms and expands followed by hatching from the zona pellucida prior to implantation. This ability to self-organize has enabled live imaging of these events within intact embryos. Moreover, this has revealed the dynamics of early mitoses, nuclear morphology and cytoskeletal changes driving early development. Although a great deal has been learned in the mouse, events in the human embryo remain relatively unknown. Recent achievements in stem cell-based embryoid models and non-invasive live imaging now poise researchers to make significant advancements unveiling human embryo development. Furthermore, a comprehensive understanding of human embryogenesis is essential to improving IVF efficiency and outcomes. Preimplantation development in mouse and human will be reviewed with a focus on recent discoveries made possible by live imaging.
O-175 Ethical practices and policies for ART carbon reduction
Authors: Richie C
Published: July 2024

Background

The carbon emissions of global health care activities make up 4-5% of total world emissions, placing the health care industry on par with the food sector. Health care contributes to climate change and climate change health hazards. Safe amounts of carbon in the atmosphere have been exceeded—in part because of medical lifestyles in the industrialized world.

A significant proportion of health care carbon comes from pharmaceuticals and clinical services in the developed world, including reproductive technologies. Since 1978, approximately 12 million babies have been born through IVF alone.

Problem statement

Reproductive technologies have an exceptional impact on the environment as they 1. expend carbon in the medical process, 2. increase population growth in mostly high-carbon countries, 3. impact earth’s carrying capacity, and 4. create a carbon legacy. This would not necessarily be ethically problematic, but in a climate crisis carbon emissions must be reduced in all areas of life.

Objectives

This presentation by an ethicist (PhD) will:

1. Highlight aspects of environmental ethics for reproductive technologies

2. Offer practices and policies to make reproductive technologies more sustainable.

Takeaways

• Prevention of infertility fits within basic health care.

• Carbon emissions from reproductive technologies can be reduced by life cycle assessments (LCA) of the procedures and components.

• Clinical evidence can inform ethical policies to reduce the number and kind of reproductive technologies, thereby lowering fertility industry carbon emissions.

• New scientific and technological developments in reproduction must consider sustainability proactively, not reactively, thus putting ethics in the pipeline of reproductive medicine.

Further Reading

Bhopal A, and Norheim O. Priority setting and net zero healthcare: how much health can a tonne of carbon buy?. BMJ 2021; 375:e067199.

Pichler, P.-P. et al., “International Comparison of Health Care Carbon Footprints,” Environmental Research Letters 14, no. 6 (2019): 064004.

Richie, Cristina. Environmental Ethics and Medical Reproduction (Oxford University Press, 2024.
O-177 Emotional experiences of staff caring for parents suffering a pregnancy loss
Authors: Judith J
Published: July 2024

Experiencing pregnancy loss can have devastating emotional impacts on expectant parents, leading them to experience depression, anxiety and post-traumatic stress. There is now a well-established literature into the experiences of expectant parents, with dozens of studies conducted since the 1990s. However, over this period there has been notably less research conducted into the experiences of the professionals who care for these women. Addressing this is crucial; healthcare professionals are the greatest asset that healthcare systems have. Providing better support for them is the best route to improving care for expectant parents. The studies which have been conducted suggest the emotional toll on professionals can be significant. Emotions described can reflect those of expectant parents, including sadness, grief, and anger. One study suggested that delivering this care can be like ‘working in darkness’; another found that delivering news of losses to expectant parents on a regular basis can cause an emotional ‘repetitive strain injury’ for some.

This talk will tackle this topic, providing updates and insights from recent studies which have investigated the experiences of healthcare professionals who undertake the emotional work of caring for expectant parents who are experiencing loss. It will take an interactive approach, using audience feedback to understand and learn from the experiences shared by those in the room. The importance and value of professionals who work in this area will be highlighted; coping strategies and self-care activities will be considered.
P-196 Early blastocyst formation on day 4 is associated with improved clinical outcome and advocates for embryo quailty assessment on day 4
Authors: Lammers J , Loubersac S , Reignier A , Freour T
Published: July 2024

Study question

Is early cavitation on day 4 associated with improved clinical outcome?

Summary answer

Early blastulation on day 4 is a positive predictor of implantation after single blastocyst transfer on day 5.

What is known already

In order to select the blastocyst with the highest implantation potential for transfer or freezing, several morphological and/or morphokinetic parameters have been proposed. For instance, early compaction on day 3 (D3) or blastocyst expansion on day 5 (D5) have been reported to be relevant when selecting embryos for transfer. However, day 4 has often been overlooked and very few studies focused on early blastulation on day 4 (D4). Indeed, data on early blastulation on day 4 is scarce. It was however recently demonstrated that embryos transferred on day 4 could provide acceptable pregnancy rates.

Study design, size, duration

This monocentric retrospective cohort study was conducted in all consecutive couples undergoing IVF cycles in 2017-2022 with single blastocyst transfer and observation on day 4.

Participants/materials, setting, methods

Morphological and morphokinetic assessment was performed by 2 operators at 93±2h, 116±2h (and 140±2h) post insemination, on day 4, 5 (and 6) respectively. A total of 26 507 D4 embryos were included in this study and grouped according to the observation of early cavitation or not : 23 244 were in the D4 control group (absence of early cavitation on D4) and 3263 were in the D4 blastocyst group (observation of early cavitation on D4).

Main results and the role of chance

The proportion of embryos used clinically for either transfer or freezing on day 5 or 6 was significantly higher in the D4 blastocyst group than in D4 control group (86.7% vs 50.1% respectively, p < 0.05).

Concerning pregnancy rate, cinical pregnancy rate was significantly higher in the D4 blastocyst group than in D4 control group (p < 0.05). In the D4 control group, 5051 embryos were transferred and clinical pregnancy rate is 28.7%. In the D4 blastocyst group, 1286 embryos were transferred (fresh or frozen) and clinical pregnancy rate is 40.2%.

Limitations, reasons for caution

The retrospective and monocentric design calls for caution when considering the generalizability of our findings.

Wider implications of the findings

We postulate that D4 embryo quality assessment should be widely implemented in any blastocyst program in order to improve embryo quality assessment and subsequently clinical outcome.

Trial registration number

not applicable
P-236 Simulated cohort ranking analysis estimates the number of IVF cycles needed to reach fetal heartbeat with and without artificial intelligence (AI) embryo triage
Authors: Shapiro M , Amar Y , Tauber Y , Seidman D , Gilboa D
Published: July 2024

Study question

What is the impact of AI-based embryo triage on the number of IVF cycles needed to reach fetal heartbeat (FH)?

Summary answer

Simulated cohort ranking via the AIVF Day-5 AI model demonstrates a 27.5% reduction in the number of IVF cycles needed to achieve FH.

What is known already

Published reports show FH rates per first-time IVF/single euploid embryo transfer ranging from 26-43% (age <38 yrs). Likewise, the average number of autologous retrieval cycles required for FH is 2.25±0.8, depending on oocyte age and demographic. While conventional embryo morphology ranking is used as a proxy indicator for IVF success, its use is associated with observer variability and manual workflow. This leads to a non-efficient cycle number-per-FH ratio, preventing the clinic’s ability to service more patients.

Study design, size, duration

A single center database (N = 10,000 embryos) was used to generate 1,288 simulated cohorts reflecting known maternal age/cohort size distributions. Only cohorts containing ≥1 FH+ embryo(s) were included. The model ranked embryos within each cohort by scalar output (1-9.9). The position of the first FH+ embryo within each AI-ranked cohort was calculated and averaged across cohorts to compute number of cycles required to reach FH.

Participants/materials, setting, methods

Data was stratified into 5 age categories; the prevalence of top/good/fair graded embryos per cohort were included according to their known (%) prevalences per stratified age group. Data was randomized into 1,288 cohorts; positions of the first FH+ embryo in each cohort was calculated (for example, if the 2nd AI-ranked embryo was FH+, a value of 2 was assigned, respectively). Values were averaged and compared to conventional IVF.

Main results and the role of chance

A mean ± SD of 1.63 ±1.06 cycles was needed to reach the first FH+ embryo with AI cohort ranking (pooled mean across all age groups <38 years) with a mean cohort size N = 7.8 embryos. The relative percent reduction in cycles needed to reach FH when compared to conventional IVF without AI ranking (2.25±0.8; age <38 yrs) was 27.5%. Ranking and electronic recording time for ranking per embryo with/without AI implementation was 186.0 versus 30.9 seconds per embryo, respectively. Relative ranking time reduction was 83%.

Limitations, reasons for caution

Results were pooled across age groups and not stratified per age. Prospective validation is ongoing to show the influence of demographics/clinical characteristics on AI utility.

Wider implications of the findings

This study demonstrates the potential of shortening the time to pregnancy by using AI-based quantitative embryo assessment for cohort ranking.

Trial registration number

Not applicable
P-621 Rekovelle® vs Gonal-F®: in vitro characterization of intracellular signals induced by the two FSH preparations
Authors: Lazzaretti C , Baschieri L , Mascolo E , Sperduti S , Perri C , Fusco C , Simoni M , Casarini L
Published: July 2024

Study question

Do Rekovelle® and Gonal-F® modulate preparation-specific signalling?

Summary answer

Gonal-F® and Rekovelle® induce preparation-specific pattern of intracellular signalling.

What is known already

Rekovelle® and Gonal-F® are two commercial preparations of recombinant FSH used in assisted reproduction. These preparations differ in originator cells (PER.C6® cell line of human fetal retinal origin for Rekovlle®; modified Chinese Hamster Ovary cell line for Gonal-F®), likely reflecting glycosylation profiles impacting their mode of action.

Study design, size, duration

3-year in vitro functional comparison of Rekovelle® and Gonal-F®, using the transfected HEK293 cell line expressing FSH receptor (FSHR).

Participants/materials, setting, methods

FSHR-expressing HEK293 cells were treated with increasing concentrations of GonalF® and Rekovelle® (pM-µM) to evaluate receptor-receptor interaction and trafficking, intracellular cyclic adenosine monophosphate (cAMP) and Ca2+ increase by bioimaging techniques, as well as phospho-protein by Western blotting, and genomic effects by CRE-luciferase reporter gene activity.

Main results and the role of chance

Both the preparations induced similar, dose-dependent increase of receptor trafficking through intracellular organelles. These data were obtained by evaluation of the interaction between FSHR and endosomal markers RAB-GTPases (Rab) 5 and 7. Rekovelle® induced more pronounced steroifogenic signals than Gonal-F®, detected as FSHR-FSHR interactions at the cell membrane, cAMP accumulation, cAMP-responsive elements binding protein (CREB) phosphorylation and CRE promoter activity. Interestingly, while cell treatment by Gonal-F® mediated complete dose-response of cAMP, consisting in the continuous increase of the second messenger together with the increase of FSH concentration, Rekovelle® had biphasic action where cAMP increased from 0 to 100 nM although decreased at 1 µM Rekovelle® dose. Moreover, Rekovelle® was 10-times more potent than Gonal-F® in activating intracellular Ca2+ activation. The two preparations induced similar pattern of extracellular signal-regulated kinases 1 and 2 (ERK1/2) phosphorylation. In conclusion, Rekovelle® has higher potency than Gonal-F® in activating cAMP- and Ca2+-dependent intracellular events, potentially resulting in preparation-specific steroidogenic pattern.

Limitations, reasons for caution

Experiments were performed in the transfected HEK293 cell line in vitro and should be confirmed by clinical observations.

Wider implications of the findings

We described different intracellular events mediated by Gonal-F® and Rekovelle® in vitro, likely originated by different glycan profiles and possibly impacting the ovarian response during assisted reproduction.

Trial registration number

Not Applicable
P-651 Neither high nor low serum progesterone levels affect clinical outcomes in Artificially prepared-frozen embryo transfer cycles using intramuscular progesterone
Authors: Sharma G , Roque M , Bhoi N , Chandra V , Murdia K , Murdia N
Published: July 2024

Study question

Does serum progesterone level on the day of frozen-thawed embryo-transfer (FET) correlate with the likelihood of achieving pregnancy in artificial FET cycles utilizing intramuscular progesterone?

Summary answer

Serum progesterone levels on the day of FET do not correlate with the likelihood of achieving a pregnancy in artificial FET cycles employing intramuscular progesterone.

What is known already

There is scientific evidence suggesting that serum progesterone levels under a specific cutoff level on the day of FET significantly decrease the clinical outcomes in patients under artificial endometrial preparation using micronized vaginal progesterone. However, no substantial evidence exists in patients under artificial endometrial preparation using intramuscular progesterone.

Study design, size, duration

This prospective cohort study was conducted from February to December 2022 and enrolled 353 patients undergoing FET in hormone replacement therapy (HRT) cycles using intramuscular progesterone until the day of embryo transfer.

Participants/materials, setting, methods

The study included women aged 21-40 years old undergoing FET, triple layer endometrium >7mm, and ≥2 high-quality embryos (Gardner’s grade 3/4/5/AA/AB/BA/BB) available. Exclusion criteria included patients with uncontrolled diabetes, hypertension, heart disease, known autoimmune diseases, uterine infertility factor, severe male factor infertility (total sperm count < 5 million/ml), and cases requiring surgically retrieved sperm for ICSI.

Main results and the role of chance

The cohort had an average age of 32.09 ± 4.19 years, BMI of 24.70 ± 3.07 kg/m², and endometrial thickness of 8.87 ± 1.06 mm on the day of embryo transfer. The mean serum progesterone level was 31.36 ± 13.78 ng/ml. Participants were categorized into quartiles based on serum progesterone levels. :Q1 (<21.7 ng/ml), Q2 (21.7-28.1 ng/ml), Q3 (28.2-40.0 ng/ml), and Q4 (≥40.0 ng/ml). No significant difference in Clinical Pregnancy Rate (CPR), Ongoing Pregnancy Rates (OPR), and first-trimester miscarriage rates were observed across quartiles. The OPRs according to serum progesterone quartiles were: Q1: 57.5%; Q2: 62.6%; Q3: 59.6%; Q4:62.8%, with no statistical difference among the groups. Binary logistic regression revealed no statistically significant differences in clinical pregnancy and ongoing odds among the quartiles.

Limitations, reasons for caution

Although a prospective study, its relatively small sample size may affect the results’ robustness and generalizability.

Wider implications of the findings

These findings suggest that when using intramuscular progesterone before embryo transfer in FET under HRT, serum progesterone testing may not be necessary before embryo transfer, as progesterone levels have no impact on clinical outcomes in this group of patients.

Trial registration number

CTRI/2022/11/046995
Breast Cancer Screening With Automated Breast US and Mammography vs Handheld US and Mammography in Women With Dense Breasts in a Real-World Clinical Setting
Authors: Winkelman Andrew J , Tulenko Kassandra , Epstein Samantha H , Nguyen Jonathan V , Ford Clay , Miller Matthew M
Published: June 2024

Objective

We compared the performance of 2 breast cancer screening approaches, automated breast US (ABUS) with same-day mammography (ABUS/MG) and handheld US (HHUS) with same-day mammography (HHUS/MG), in women with dense breasts to better understand the relative usefulness of ABUS and HHUS in a real-world clinical setting.

Methods

In this institutional review board–approved, retrospective observational study, we evaluated all ABUS/MG and HHUS/MG screening examinations performed at our institution from May 2013 to September 2021. BI-RADS categories, biopsy pathology results, and diagnostic test characteristics (eg, sensitivity, specificity) were compared between the 2 screening approaches using Fisher’s exact test.

Results

A total of 1120 women with dense breasts were included in this study, with 852 undergoing ABUS/MG and 268 undergoing HHUS/MG. The sensitivities of ABUS/MG and HHUS/MG were 100% (5/5) and 75.0% (3/4), respectively, which was not a statistically significant difference (P  = .444). The ABUS/MG approach demonstrated a slightly higher specificity (97.4% [825/847] vs 94.3% [249/264]; P = .028), higher accuracy (97.4% [830/852] vs 94.0% [252/268]; P = .011), and lower biopsy recommendation rate (3.2% [27/852] vs 6.7% [18/268]; P = .019) than the HHUS/MG approach in our patient population.

Conclusion

Our findings suggest that ABUS/MG performs comparably with HHUS/MG as a breast cancer screening approach in women with dense breasts in a real-world clinical setting, with the ABUS/MG approach demonstrating a similar sensitivity and slightly higher specificity than the HHUS/MG approach. Additional variables, such as patient experience and physician time, may help determine which imaging approach to employ in specific clinical settings.
Patient characteristics and antimicrobial susceptibility profiles of Escherichia coli and Klebsiella pneumoniae infections in international travellers: a GeoSentinel analysis
Authors: McGuinness Sarah L , Muhi Stephen , Nadimpalli Maya L , Babiker Ahmed , Theunissen Caroline , Stroffolini Giacomo , Motta Leonardo , Gobbi Federico , Huits Ralph , Libman Michael , Leder Karin ,   for the GeoSentinel Network
Published: June 2024

Background

Antimicrobial resistance (AMR) is a global health crisis, with Enterobacterales, including Escherichia coli and Klebsiella pneumoniae, playing significant roles. While international travel to low- and middle-income countries is linked to colonization with AMR Enterobacterales, the clinical implications, particularly the risk of subsequent infection, remain unclear due to limited data. We aimed to characterize E. coli and K. pneumoniae infections in travellers and the antimicrobial susceptibility profiles of their isolates.

Methods

We analysed data on E. coli and K. pneumoniae infections in travellers collected at GeoSentinel sites between 2015 and 2022, focusing on epidemiological, clinical and microbiological characteristics. We defined multi-drug resistance (MDR) as non-susceptibility to agents from at least three drug classes.

Results

Over the 8-year period, we included 655 patients (median age 41 years; 74% female) from 57 sites in 27 countries, with 584 E. coli and 72 K. pneumoniae infections. Common travel regions included sub-Saharan Africa, Southeast Asia and South-Central Asia. Urinary tract infections predominated. Almost half (45%) were hospitalized. Among infections with antimicrobial susceptibility data across three or more drug classes, 203/544 (37%) E. coli and 19/67 (28%) K. pneumoniae demonstrated MDR. Over one-third of E. coli and K. pneumoniae isolates were non-susceptible to third-generation cephalosporins and cotrimoxazole, with 38% and 28% non-susceptible to fluoroquinolones, respectively. Travellers to South-Central Asia most frequently had isolates non-susceptible to third-generation cephalosporins, fluoroquinolones and carbapenems. We observed increasing frequencies of phenotypic extended spectrum beta-lactamase and carbapenem resistance over time.

Conclusions

E. coli and K. pneumoniae infections in travellers, particularly those to Asia, may be challenging to empirically treat. Our analysis highlights the significant health risks these infections pose to travellers and emphasizes the escalating global threat of AMR. Enhanced, systematic AMR surveillance in travellers is needed, along with prospective data on infection risk post travel-related AMR organism acquisition.
Night shift work and myocardial infarction in the UK Biobank
Authors: Yang M J , Jia Z W , Wang E , Li J C , Tang A M , Song Z B , Zhang Z
Published: June 2024

Background

Shift work has become popular along with adverse effects such as disrupted biological rhythms, metabolic changes, sleep disorders and myocardial infarction. Studies have shown a link between myocardial infarction and shift work, but evidence is still lacking.

Aims

We aim to explore the association between present and past shift work and risk of myocardial infarction in a large population of European workers.

Methods

We analysed data from the UK Biobank with >500 000 participants and an average 12-year follow-up duration. Cox proportional hazard models were employed to analyse the relationship between present shift work (n = 265 064), lifetime duration or frequency of shift work (n = 71 428) and the risk of myocardial infarction, as well as the association between rest day during shift work and myocardial infarction incidents in night shift workers (n = 14 588).

Results

Night shift workers had a higher risk of myocardial infarction compared to day workers, including ‘shift but never/rarely night shifts’ (hazard ratio [HR] = 1.09, 95% confidence interval [CI] 1.00–1.20), ‘some night shifts’ (HR = 1.13, 95% CI 1.01–1.27) and ‘usual/permanent night shifts’ (HR = 1.21, 95% CI 1.07–1.37), respectively. Similarly, higher frequency and longer duration of night shift work were associated with the increased risk of myocardial infarction (<10 years: HR = 1.20, 95% CI 1.01–1.42; ≥10 years: HR = 1.51, 95% CI 1.28–1.77; or an average of more than eight nights per month: HR = 1.45, 95% CI 1.23–1.71). However, longer rest days couldn’t decrease myocardial infarction risk compared to those who rest 1 day.

Conclusions

Present and lifetime exposure to night shifts were associated with a risk of myocardial infarction and did not benefit from longer rest days.
Costs of Community-Based Viral Hepatitis Screening in Cameroon Using Point-of-Care Technologies
Authors: Tazinkeng Nkengeh N , Mohareb Amir M , Asombang Akwi W , Hyle Emily P
Published: July 2024

This cost analysis of a community-based viral hepatitis screening program in Cameroon found an investment of $3.52 per person screened, $50.63 per new diagnosis of hepatitis B, $159.45 per new diagnosis of hepatitis C, and $47.97 per new diagnosis of either hepatitis B or C.
Comparison of Analgesic Efficacy between Bupivacaine with Dexamethasone versus Bupivacaine in Caudal Block for Pediatric Patients Undergoing Lower Abdominal Surgeries
Authors: GadAlla Raouf Ramzy , Hussien Noha Sayed , Armanious Simon Halim , Fawaz Mariam Momtaz , Younan Younan Sayed
Published: July 2024

Background

Caudal analgesia is one of the most popular regional blocks in paediatric patients undergoing lower abdominal surgeries but with the drawback of short duration of action after single shot local anaesthetic injection. We evaluated whether caudal dexamethasone as an adjuvant to the Bupivacaine improves analgesic efficacy after paediatric lower abdominal surgeries.

Aim of the Study

The current study is conducted to evaluate the analgesic effect of dexamethasone when given caudally as an adjuvant to bupivacaine for children undergoing lower abdominal surgeries eg: open inguinal hernia repair, hypospidius, orchidopexy and circumcision surgeries.

Methods

Totally 60 patients of 1–3 years age group, American Society of Anaesthesiologists physical status I and II undergoing elective lower abdominal surgeries were randomly allocated to two groups in double-blind manner. Group B (the control group) received 1 ml/kg of 0.25% bupivacaine caudally for lower abdominal surgeries and 0.5 ml/kg for anal and penile surgeries and Group BD received 1 ml/kg of 0.25% bupivacaine for lower abdominal surgeries and 0.5 ml/kg for anal and penile surgeries, in which 0.1 mg/kg dexamethasone was added for caudal analgesia. Post operative pain by FLACC scale (faces, legs, activity, cry and consolability tool score), rescue analgesic requirement and adverse effects were noted for 24 h.

Results

Results were statistically analysed using KRUSKAL-WALLIS TEST. Pain scores measured at 4,8 and 12h post-operative, were lower in Group BD as compared to Group B Mean duration of analgesia in Group BD 1026±139,8 min and in Group B was 465,6± 79,2 min with P = 0.001. Rescue analgesic requirement was more in Group B as compared to Group BD. Adverse effects after surgery were comparable between the two groups.

Conclusion

Caudal dexamethasone added to bupivacaine is a good alternative to prolong post-operative analgesia with less pain score compared to caudal bupivacaine alone.
Comparative Study between Modified Pectoral Nerve Block versus Serratus Block for Analgesia For Modified Radical Mastectomy
Authors: Eldin Abdelhamid Amr Essam , Eldin El Serwi Heba Bahaa , Abdelaziz Noha Mohamed , Mohamed Abdelrahman Gamal
Published: July 2024

Background

One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal.

Objective

To assess the analgesic efficiency and safety of both Modified Pectoral Nerve Block versus Serratus Block in cases of modified radical mastectomy (MRM). The duration of analgesia and effect on hemodynamic parameters were evaluated. Moreover, undesirable side effects were studied.

Patients and Methods

The purpose of this study was to evaluate the effect of both PECS II block versus and Serratus anterior block in patients undergoing modified radical mastectomy surgery. The duration of analgesia and effect on hemodynamics parameters were evaluated. Moreover, undesirable side effects were studied. forty patients were randomly allocated into two equal groups (20 patients): group (A) and group (B). Group (A): received a PECSII block with 30 mL of bupivacaine 0.25%. Group(B): received a serratus anterior plane block (SAPB) using the same volume of 30 ml bupivacaine 0.25%.

Results

This study demonstrated that PECSII and serratus blocks have comparable analgesic properties in patients undergoing modified radical mastectomy. Both blocks were associated with reduced postoperative pain intensity and morphine consumption, intraoperative fentanyl requirement, and prolonged analgesia. The two blocks were associated with hemodynamic stability and absence of major complications characterizes both blocks.

Conclusion

This study confirms that PECSII and serratus blocks provide similarly adequate analgesia following modified radical mastectomy.
A Comparative Study between Fascia Iliaca Block and Femoral Nerve Block for Postoperative Analgesia after Intertrochanteric Fracture Surgery
Authors: El Deen Mohammed Ahmed Emad , El Kabarity Reem Hamdy , Khamis Ahmed Mohammed , Sedky Kareem Ahmed
Published: July 2024

Background

Intertrochanteric fracture surgery is a common orthopedic procedure worldwide, pain may be severe, and the patients generally require a significant amount of opioid-based analgesics after such procedures. Peripheral nerve blocks offer effective analgesia and decrease the need for opioids, thereby reducing the complications associated with the use of this class of drug. Pain management regimens following Intertrochanteric fracture surgery include oral analgesics, periarticular injection, peripheral nerve blocks (PNBs), and intravenous patient- controlled analgesia (PCA).

Objective

To compare the analgesic efficacy and functional recovery of Fascia iliaca block and FNB in patients who have undergone Hip surgery.

Methods

This prospective randomized clinical trial study was conducted in Ain Shams University hospital after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent Intertrochanteric fracture surgery under spinal anaesthesia regarding postoperative pain and early ambulation were included in the study their ages range between 40 to 75 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30).

Results

The two groups were compared as regard pain control post operatively. Numerical rating scale (NRS) was used to assess pain post operatively and used at regular interval (PACU, After 15min., After 30min., After 45min., After 1 hr., After 1.5 hrs., After 2 hrs., After 4 hrs., After 6 hrs., After 8 hrs., After 10 hrs., After 12 hrs., After 14 hrs., After 16 hrs., After 18 hrs., After 20 hrs., After 22 hrs. and After 24 hrs.). And there is no significant difference between two groups, with p- value (p > 0.05 NS). As regard to total dose of narcotics used in each group, there is no difference in postoperative nalbuphine consumption. The two groups are compared as regard to quadriceps weakness, onset of ambulation and there was a significant difference between two groups.

Conclusion

Fascia iliaca block is more effective than Femoral Nerve Block in in patient satisfaction for post-operative analgesia and equally effective with femoral nerve block in post-operative ambulation after Intertrochanteric fracture surgery.
Ticagrelor versus Clopidogrel in Prevention of No Reflow after 1ry PCI in Diabetic Patients with STEMI
Authors: Khalil Elshawa Mohamed Gamal AbdElzaher , AbdElmonaem Moustafa Mohamed , Hassan Mohamed Atef Hamza , Hamid Galal Wagdy Abdel
Published: July 2024

Background

Adequacy of coronary flow can be judged upon using several methods like TIMI Grade and myocardial blush grade. No-reflow phenomenon, defined as incomplete reperfusion at the microvascular level despite adequate patency of the occluded artery, remains an important limitation of primary percutaneous intervention in STEMI patients nowadays. We aim in this study to investigate the relationship between the antiplatelet loading dose whether to be Ticagrelor or Clopidogrel and post intervention coronary flow, bleeding risk in these patients.

Aim of the Work

To compare between the effects of preoperative loading dose of Ticagrelor and clopidogrel in Diabetic STEMI patients undergoing primary percutaneous coronary intervention regarding prevention of no reflow, Instent thrombosis and short term bleeding risk. Myocardial reperfusion was judged upon using TIMI Grade and myocardial blush grade.

Patients and Methods

a single center prospective randomized controlled trial based at the coronary care units in Ain shams university hospitals. The study included Three hundred Diabetic patients presenting to Ain shams university hospitals diagnosed with STEMI in the ER fulfilling the inclusion criteria were randomized to receive Ticagrelor (150 patients) or receiving clopidogrel (150 patients)

Results

As regard TIMI flow there was statistically highly significant highly significant difference between two studied groups with P value 0.000 where in group A 64 % of patients developed TIMI III flow, 22.7 % with TIMI II flow, 12.7% with TIMI I and 0.7% with TIMI 0 While in group B 86% of patients developed TIMI III flow, 9.3% of them developed TIMI II, 3.3 % developed TIMI I flow and 1.3 % developed TIMI 0. As regard MBG there was statistically highly significant difference between two groups with P value 0.00 where in group A where percentage of patients with MBG grades 0,1,2 and 3 were 4%, 16 %,18 % and 62 % respectively while in group B percentage of patients with MBG grades 0,1,2 and 3 were 1.3 %, 3.3 %, 9.3 % and 86 % respectively. As regard echo EF, there was statistically significant difference between two groups with P value 0.036 where mean EF in patients with group A was 40.50 ± 7.93 while the mean EF in patients with group B was 42.55 ± 8.88 .

Conclusion

Ticagrelor loading before primary PCI resulted in improved post-procedural TIMI flow. It also increased the post-procedural MBG. This resulted in a significant increase in the number of patients having more post-procedural Ejection fraction as measured by modified Simpson’s method. However, it did not decrease incidence of in-hospital MACE. Also there was no significant increase in risk of major nor minor bleeding in both young and elderly patients.
Meta-Analysis of Surgical Treatment versus Sclerotherapy for Management Of Branchial Arch Lesions
Authors: EL Samny Talaat Aly , Sobhy Tamer Shoukry , Mohammed Marawan khairi Mahmoud , Abd Elaty Ahmed Mohamed Kamel
Published: July 2024

Background

Branchial arch lesions (BALS) are uncommon congenital malformations presenting mainly in first 2 decades with neck cysts, sinuses, fistulas, recurrent infections and have low potential to turn malignant. Surgical management of these lesions can be associated with significant risk of complications and recurrence. Sclerotherapy has been described as effective and less invasive alternative option.

Aim of the Study

is to summarize current available evidence regarding effectiveness and safety of surgery and sclerotherapy as two modalities of treatment for BALS.

Methods

A systematic review for all interventional studies on management of (BALS) was conducted in multiple medical databases from its inception till March 2021 with inclusion of all studies reporting on either surgical management or sclerotherapy for BALS in humans and reported effectiveness or safety outcomes. Diagnostic and review articles, single case reports and non-human studies were excluded. Proportional meta-analyses were utilized where there is only uncontrolled studies available reporting on outcomes. Assessment of quality was done with use of validated tool relevant to design of primary studies included and risk of bias of studies was assessed statistically. PRISMA Guidelines were followed in reporting of the study.

Results

A total of 525 studies were retrieved of which only 25 were eligible for inclusion. All included studies were uncontrolled case series; 18 reported on surgery and 7 reported on sclerotherapy The overall quality of included studies were fair to good according to NIH validated tool. Meta-analyses of surgical studies for BALS showed success rate of complete excision of 90%,96%,96% and 98% for first, second, third and fourth branchial arch lesions respectively with complications rates of 19.7%,5%,24% for first, second and third arch lesions. The rates of recurrence were 11.2%,2%,5%,1% for first to fourth arch lesions in order. The corresponding success rates of completed resolution for sclerotherapy were 86% with complications rates of 8% all of which were minor complications. There were no recurrences but recognized incomplete resolution.

Conclusion

Both surgery and sclerotherapy have satisfactory success in terms of complete excision/resolution of BALS. The risks of complications howeverseem to be more significant with surgical management however no controlled studies were available to allow for definitive conclusions. Further studies with standardized diagnostic criteria and treatment techniquesare needed to allow for prioritizing treatment lines based on conclusive evidence.
Brain-Derived Neurotrophic Factor as a Potential Diagnostic Marker in Minimal Hepatic Encephalopathy
Authors: Bayoumi Essam Mohamed , Sabry Mohamed Manal , Saad Mohamed Ahmed , Abdelnaeem Amin Lobna Wafik
Published: July 2024

Background

Based on the etiology, liver cirrhosis is sub-classified into viral hepatitis (hepatitis B, C, and D), due to toxins (alcohol and drugs), autoimmune hepatitis, Cholestatic (primary biliary cholangitis, and primary sclerosing cholangitis), vascular (Budd-Chiari syndrome, sinusoidal obstruction syndrome, and cardiac cirrhosis), and metabolic causes (hemochromatosis, NASH, Wilson disease, alpha-1 antitrypsin deficiency, cryptogenic cirrhosis).

Aim of the Work

The aim of the current study is to detect Minimal Hepatic Encephalopathy (MHE) among cirrhotic patients of Child C with no or clinically manifest encephalopathy using Brain-Derived Neurotrophic Factor (BDNF) and study the diagnostic value of BDNF serum marker versus Psychometric Hepatic Encephalopathy Score (PHES) in detecting MHE.

Patients and Methods

90 patients were enrolled into a clinical cross-sectional study. All patients gave informed written consent. Patients are divided equally into 3 groups, 30 patients each. Patients are either in-patient or out-patients in Ain shams University Hospitals. Group 1 The Examined Group (EG): includes 30 patients diagnosed as hepatitis C, cirrhotic, Child class C with no overt or clinically manifest encephalopathy. Group 2 The Hepatic Encephalopathy Group (HEG): includes 30 patients diagnosed as hepatitis C, cirrhotic, Child class C with overt or clinically manifest encephalopathy. Group 3 The Control Group (CG): includes 30 healthy individuals (volunteers).

Results

In the present study among the whole sample (n = 90), there was a significant positive correlation between PHES score & BDNF serum level with Hb, platelet count and albumin. While, there was a significant negative correlation between PHES score and BDNF serum level with AST, ALT, total bilirubin, direct bilirubin, INR and Child’s Score. On the other hand, Stawicka et al. 2021, reported that BDNF had a negative correlation with bilirubin (R = –0.35, p = 0.005) and international normalized ratio (INR) (R = –0.37, p = 0.003), and positive with platelets (R = 0.36, p = 0.004), while no associations with age, sex, body mass index (BMI), waist-hip ratio (WHR), creatinine and ammonia.

Conclusion

MHE constitutes a significant medical problem in a common patient population. Unfortunately, it is often underdiagnosed, likely related to the notion that testing is time consuming requiring highly specialized personnel. Additionally, the term ‘MHE’ may create the impression that this condition has limited impact on patient’s wellbeing; however, it has been shown that MHE has clinical implications on the patient as well as public safety concerns. Diagnosing and treating MHE is difficult owing to the subclinical nature of the disease. The use of Psychometric Hepatic Encephalopathy Score (PHES) and Brain-Derived Neurotrophic Factor could be of great help in early detection of the condition and to give suitable preventive treatment.
Diagnostic Role of Non-Invasive Risk Scores in Prediction of Simple Steatosis versus Non-Alcoholic Steatohepatitis
Authors: Awad Emad Ahmed , Ali-Eldin Zainab Ahmed , Allam Ahmed Samir , Mahmoud Maher Ibrahem
Published: July 2024

Background

Non-alcoholic fatty liver disease (NAFLD) is currently considered one of the most common liver diseases in the Western world. NAFLD includes a spectrum of diseases from simple fatty liver disease, to non-alcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma (HCC). NASH, the critical stage in NAFLD progression, is the only bridge between NAFLD and liver cirrhosis, and its persistent existence has become one of the leading causes of liver cirrhosis and even HCC.

Aim of the Work

To assess the value of non-invasive risk scores in differentiation between simple steatosis and NASH

Patients and Methods

This was prospective cohort study, conducted Internal Medicine and Gastroenterology outpatient clinics and ward in Ain Shams University Hospitals, on 60 patients with NAFLD divided into 2 groups: (Group I): Patients with normal liver enzymes, (Group II): Patients with persistant elevation of liver enzymes, during a period of 6 months.

Results

There was statistically insignificant difference between the two studied groups and sex and age. There were 12 (40%) of the group I were males and 18 (60.0%) were females. There were 16(53.3%) of the group II were males and 14(46.7%) were females. The mean age of group I was 40.63 ± 10.53 SD with range (25.0 – 59.0). The mean age of group II was 40.83 ± 9.06SD with range (27.0 – 54.0). There was statistically significant difference between the two studied groups and weight, BMI and waist circumference. There was statistically insignificant difference between the two studied groups and height, DM and HTN. There was statistically significant difference between the two studied groups and ALT, AST, GGT, ALP, ALB and Platelets. There was statistically significant difference between the two studied groups and TC, HDL, LDL, TG and AST/ALT ratio. There was statistically insignificant difference between the two studied groups and FBG. There was statistically significant difference between the two studied groups and FLI, NFS, BARD, APRI, FIB-4 and Fibrosis score. There was statistically significant difference between the two studied groups and Ultrasound (Size, Findings and Fibrosis score). The mean size in group I was 10.03 ± 1.56 SD with range (8.0 – 12.0). The mean size in group II was 13.63 ± 1.22SD with range (12.0 – 16.0).

Conclusion

A combination of Fibroscan, Fib-4, NFS, BARD and APRI provides a valuable non- invasive method in diagnosis of NASH patients, and this can eliminate the need for liver biopsy in patients without clear indication, BMI, platelet count, HDL cholesterol level, ALT level, and the AST/ALT ratio were independent predictors of NAFLD.