bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative study between Bilateral U/S guided Transversus Abdominis Plane Block versus local wound infiltration for post-operative pain management in lower abdominal surgeries
Authors: Nafie M M H , Mahmoud D S , Kamal M M , Mohie A G M
Published: May 2020

Background

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

Objective

to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared local wound infiltration after lower abdominal surgery regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received.

Patients and Methods

All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). The study was conducted on 100 randomly chosen patients aged 25 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for lower abdominal surgery in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each:

Results

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

Conclusion

Bilateral TAP block was effective in reducing postoperative pain scores at rest and movement for 8-12hours and lower total 24-h postoperative opioid and analgesic consumption after lower abdominal surgeries under general anesthesia, compared to local wound infiltration..
Prolonged QT Interval and Troponin Level as Predictors of Clinical Outcome in Spontaneous Intra-cerebral Hemorrhage
Authors: Kamel A M , Abdelfatah A M , Ammar M A A , Khadraway O A
Published: May 2020

Background

Spontaneous intracerebral hemorrhage (ICH) accounts for approximately 20% of all strokes among the Western population. Although huge progress has been made in the management of ischemia, ICH remains a major cause of morbidity and mortality worldwide. The case fatality rate of ICH at 1 month is around 10% to 50%, and less than one survivor out of two is independent at 1 year.

Aim of this Study to detect the prognostic value of prolonged QTc interval and Troponin level in clinical outcome of patients with spontaneous intracranial hemorrhage.

Patients and Methods

This prospective randomized observational study was conducted on fifty adult patients, admitted to ICU of Al Arish general hospital, North Sini, Egypt, presented with acute intracranial hemorrhage diagnosed by non-contrast CT brain. Measurement of serum Troponin level was done at admission then after 24 hours. A 12-lead resting ECG examination was done within 30 min of emergency department admission and then after 24 hours. The QT interval was measured manually by a single person, from the onset of the QRS complex to the point at which the T wave ends. It was measured for 3 to 5 consecutive beats and averaged. Lead II was chosen for this purpose as most normal reference ranges are based upon measurements from this limb lead. Full assessment for all patients at discharge from intensive care unit according to modified RANKIN scale (MRS).

Results

our study showed 43 cases (86%) were diagnosed as intracranial hemorrhage and 7 cases (14%) were diagnosed as subarachnoid hemorrhage and the mean of age was [61.38±6.87]. Hypertension was diagnosed in 40 patients (80%) and diabetes was diagnosed in 20 patients (40%).

In this study, long QT syndrome was present in only 21 cases (42%) and troponin elevated in 6 cases only (12%).

Conclusion

Prolonged QT interval has a poor predictive value of intracranial hemorrhage prognosis. On the other side Troponin has a very significant predictive value of poor prognosis.
The Effect of Pectoralis Major Block type 1 (PECS 1) on intraoperative general anesthetic requirements and postoperative analgesic requirements for breast cancer patients Undergoing Mastectomy
Authors: Kamel A M A , Abosleimah A A A , Elgharabawy W , Elemary Y I
Published: May 2020

Background

In describing how patients feel after surgery, Armitage stated that “slapping the patient on the face and telling him or her that it’s all over is a complete inversion of the truth” because as far as the patient is concerned, “it is often just the beginning.” Although the current armamentarium of analgesic drugs and techniques is impressive, effective management of postoperative pain still poses some unique challenges in the ambulatory setting.The increasing number and complexity of operations being performed on an outpatient basis has presented anesthesia practitioners with new challenges with respect to acute pain management.Outpatients undergoing day-care procedures require a perioperative analgesic technique that is effective, has minimal side effects, is intrinsically safe.The pectoral nerves (Pecs) block types I and II are novel techniques to block the pectoral, intercostobrachial, third to sixth intercostals, and the long thoracic nerves. They may provide good analgesia during and after breast surgery.

Objective

In a selected category of patients undergoing mastectomy for breast cancer, we compare the intraoperative anesthetic requirements and postoperative analgesic requirements in patients receiving PECS block type I besides general mode of anesthesia, to patients undergoing general mode of anesthesia alone, hence assessing the anesthetic and analgesic role of PECS block type I in mastectomy.

Patients and Methods

Type of Study: Randomized Controlled double blind Clinical Trial study. Study Setting: After obtaining approval from the medical ethical committee in Ain Shams University, this study will be conducted in Ain Shams University hospitals operating rooms. Study Period: From October 2018 to March 2019.

Results

Going through the process and results of our study it’s been noticed that performing the PECS block besides general anesthesia as an anesthetic and analgesic technique in patients suffering from breast cancer and undergoing mastectomy, has effectively resulted in: Decreased intraoperative general anesthetic requirements, hence avoiding all probable complications of general anesthesia, and enriching the role of regional targeted anesthesia or to be more precise combining multiple modes of anesthesia to obtain optimum results. Intraoperative vital stability due to adequate analgesia hence decreased need for intraoperative opioids administration and as a result decreased complications as delayed recovery and postoperative nausea and vomiting. Good postoperative pain control accompanied with adequate levels of satisfaction, hence decreased levels of postoperative rescue analgesic requirements (Nalbuphine).

Conclusion

Pecs block offers significant advantages in terms of decreased intraoperative anesthetic requirements, post-operative pain relief, post-operative rescue drug consumption, PONV and overall patient satisfaction.
Echocardiography for left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index as a predictor to fluid responsiveness in severe sepsis
Authors: Nasr D A M , Moharam A A , Abdallah M M K , Karam A A S M
Published: May 2020

Background

Severe sepsis is the most common cause of death for patients admitted to the critical care units. Sepsis is a multifaceted host response to an infecting pathogen that may be significantly amplified by endogenous factors. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. This emphasizes the primacy of the non-homeostatic host-response to infection, the potential lethality that is considerably in excess of a straightforward infection, and the need for urgent recognition.

Aims

The aim of this work is to compare Left ventricular Outflow Tract (LVOT) velocity time Integral (VTI) and inferior Vena Cava (IVC) collapsibility index as a predictor to fluid responsiveness in patients with severe sepsis and septic shock.

Methodology

This study was conducted on 40 patients of both sex who were admitted to the intensive care unit were diagnosed as severe sepsis and /or septic shock. Patients were divided in two groups: Responders (R): 22 patients with LVOT ΔVTI 500 ≥ 15%. Non-responders (NR): 18 patients with LVOT ΔVTI 500 < 15%.

Results

Our results showed that IVCCI 100 and 500 were a less reliable predictor to fluid responsiveness in patients with severe sepsis and septic shock than ΔVTI 500. However when using IVCCI after 100 or 500 cc of fluid resuscitation, patients with IVCCI 100 above 38% or IVCCI 500 above 30% are more likely to respond to fluid challenge. More precisely, an IVCCI 100 below 38% and IVCCI 500 value below 30% cannot exclude fluid responsiveness.

Conclusions

IVC collapsibility Index is less reliable predictor than VTI (LVOT) in predicting fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and/ or septic shock

Recommendations

IVCCI should be used more cautiously as a predictor to fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and /or septic shock.
The Effect of Anesthesia and Analgesia on Control of Breathing after Bariatric Surgery: A Systematic Review and Meta-Analysis of Randomized Control Trials
Authors: Ibrahim A I , Farag H M , Labib M M
Published: May 2020

Background

general anesthesia and mechanical ventilation impair pulmonary function, even in normal individuals, and results in decreased oxygenation in the post anesthesia period. They also cause a reduction in functional residual capacity of up to 50% of the pre anesthesia value. It has been shown that pulmonary atelectasis is a common finding in anesthetized individuals because it occurs in 85% to 90% of healthy adults.

Aim of the Work: Study of the effect of anesthesia and analgesia on control of breathing after bariatric surgery.

Patients and Methods

study design: Systemic Review and Meta-analysis study. Published studies and abstracts concerning prevention and management of complications associated with patient positioning during surgeries were identified through a comprehensive search of electronic databases that will include PubMed (www.ncbi.nlm.nih.gov./entrez/query.fcgi), ScienceDirect (www.sciencedirect.com), Scirus (www.scirus.com/srsapp), ISI Web of Knowledge (http://www.isiwebofknowledge.com), Google Scholar (http://scholar.google. com) and CENTRAL (Cochrane Central Register of Controlled Trials (http://www. mrw.interscience.wiley.com/cochrane/cochrane_clcentral_articles_fs.htm), using a combination of the following key words: “Anesthesia”, “analgesia”, “respiratory outcome” and “morbid obese”.

Results

our initial search yielded 98 citations. Based on the screening criteria for titles and abstracts, 47 citations were excluded. After reviewing the full text of the remaining 52 reports, only 17 eligible RCTs fit our inclusion criteria and were selected for the study. All studies were published in English during 2000 to 2017, and the sample sizes ranged from 28 to 90 patients. Among these studies 50 obese patients were elevated and reported distinct outcome measurements. In all trials, the recruited patients were American Society of Anesthesiologists (ASA) status I–III who underwent general anesthesia with endotracheal intubation. In addition, in all trials the patients underwent elective bariatric operations. The mean BMI of the patients ranged from 37.7 to 54.0 kg/m2.

Conclusion

our meta-analysis indicated that recovery was significantly faster in the desflurane groups than in the sevoflurane, isoflurane, and propofol groups in obese adult patients who underwent bariatric surgery. Although no clinically relevant difference was observed in the PACU discharge time, or postoperative pain scores, patients who were given desflurane exhibited higher oxygen saturation on entry to or during stays in the PACU. Thus, in morbidly obese patients, we suggest that desflurane should be considered as the inhaled anesthetic because of its more rapid and consistent recovery profile.
Hemodynamic Effects of Intrathecal Magnesium Sulphate as an Adjuvant for Spinal Anesthesia in Pre-Eclamptic Patients
Authors: Elkabarity R H , Ali R M M , Naseef J N , Hanna M M F
Published: May 2020

Background

pre-eclampsia is defined as a disorder that occurs in pregnancy after twenty weeks of gestation which manifests as hypertension and proteinuria with at least one maternal organ dysfunction involvement with an incidence of 5-10% of all pregnancies.

Aim of the Work

our study will examine the hemodynamic effects of adding two different doses of magnesium sulphate to bupivacaine in patients with severe preeclampsia undergoing caesarean section using spinal anesthesia.

Patients and Methods: type of Study

Prospective comparative study; it was done after approval of the Research Ethics Committee of Anesthesia, Intensive Care and Pain Management Department, Ain Shams University.

Study Setting

Ain Shams University Hospitals, Cairo, Egypt.

Study Period

3 months.

Study Population

Pregnant females with severe preeclampsia undergoing caesarian section.

Results

results of this study indicated that the addition of magnesium sulfate at a dose of 100mg compared to the dose of 50 mg to bupivacaine showed that increasing the dose of magnesium sulfate had no significant hemodynamic effect (systolic blood pressure, diastolic blood pressure and heart rate) on severe preeclamptic patients undergoing caesarean section. But the addition of 100 mg magnesium sulfate lead to a significant delay in the onset of both sensory and motor blockade, and prolonged the duration of sensory and motor blockade compared to the addition of 50mg magnesium sulphate. Also there is no significant difference between the addition of 50 &100mg on shivering, nausea and vomiting, sedation, postoperative pain score (at 2,4 and 8 hours) and APGAR score (at 1 and 5 min).

Conclusion

the addition of magnesium sulfate at a dose of 100mg compared to the dose of 50 mg to bupivacaine in our study, showed that increasing the dose of magnesium sulfate had no significant hemodynamic effect (systolic blood pressure, diastolic blood pressure and heart rate) on severe preeclamptic patients undergoing caesarean section.
Comparative study between paracetamol versus paracetamol and pregabalin combination for postoperative analgesia in hip surgeries
Authors: Hassab A R M , Fawzy H M , Elfawal S M , Kamaleldin D M
Published: May 2020

Introduction

Pregabalin has been used for treatment of chronic pain, but recently it has been introduced in treatment of acute postoperative pain.

Aim of Study

This study is conducted to evaluate the postoperative analgesic effect of paracetamol and pregabalin combination versus paracetamol after hip surgeries.

Methods

The study was done on 20 randomly chosen patients after approval of the medical ethical committee of Ain Shams University. Patients were divided randomly into two groups, each group consisted of 10 patients.After preoperative assessment and obtaining baseline vital data all patients received spinal anaesthesia. Group I received paracetamol 1gm intravenous immediately postoperatively and every 6 hours for 24 hours. Group II received the same as group I plus two doses of oral pregabalin 300mg in the recovery room and 12 hours later. The two groups were assessed postoperatively and they were compared regarding demographic data, postoperative pain control, sedation, total pethidine consumption, hemodynamics and side effects.

Results

In pregabalin group (group II), pain scores and total pethidine consumption were significantly lower and sedation scores were higher than group II. Heart rate and arterial blood pressure were lower in group II but without clinical significance.

Conclusions

This study revealed that combination of paracetamol and pregabalin as multimodal analgesia is better than paracetamol alone in postoperative analgesia, and decreasing use of opioids without significant effect on hemodynamics but with increased incidence of side effects such as somnolence, dizziness and blurred vision.
Comparative Study between Magnesium Sulfate and Pethidine for Controlling Shivering after Spinal Anesthesia
Authors: Ali N M , Mahrose R A , Elsayed S M
Published: May 2020

Background

Shivering is an involuntary muscular activity. Increased muscle tone during shivering is due to temperature-induced changes in neuronal activity in the reticular formation. Synchronization of motor neurons during shivering may be mediated by recurrent inhibition through renshaw cells.

Aim of the Work

To verify the efficacy of magnesium sulfate for controlling post spinal shivering, to compare the efficacy of magnesium sulfate and pethidine for controlling post spinal shivering and to detect the side effects of both magnesium sulfate and pethidine after their use for controlling post spinal shivering.

Patients and Methods

This prospective study was conducted at El-Matarya Teaching Hospital from 2018 till 2019. After obtaining approval from the Research Ethical Committee of Ain Shams University, informed patient consent was obtained before the procedure. After giving the spinal anesthesia, only patients who developed post-spinal shivering were followed for the study. 60 patients with post-spinal shivering were included with the following criteria:

Results

Regarding age, weight, height and duration of surgery; there were no statistically significant differences between the two studied groups. Comparison of the two studied groups revealed no statistically significant changes at all times of measurement.

Conclusion

Magnesium sulfate in a dose of 30 mg/kg IV infusion in 100 ml normal saline over 10 min is effective for control of post spinal shivering. Pethidine in a dose of 0.5 mg/kg IV bolus is effective for control of post spinal shivering.
Furoemside versus mannitol as a renal protection after adult cardiac surgery
Authors: Saleh G A , Hussein W R , Shorbagy M S , Abdelkader A M
Published: May 2020

Background

Occurrence of acute oliguric renal failure in the immediate postoperative period carries important morbidity and mortality after a successful cardiac surgical procedure. Adult cardiac and aortic surgical procedures are especially prone to this complication with the incidence varying between 2% to 15% and the mortality rate as high as 40% to 60%.

Aim of the Work

to compare between furosemide versus mannitol as a renal protection after adult cardiac surgery.

Patients and Methods

This prospective comparative trial was conducted at Academy of Cardiothoracic Surgery Ain Shams University on patients undergoing CABG operation consisting of a total of 50 patients with normal renal function, EF of greater than 40%, normal protein and electrolyte levels.

Results

the study revealed no statistically significant difference between groups according to cystatin-C

Conclusion

The difference between patients given mannitol and patients given furosemide regarding urinary microalbumin, urinary creatinine and serum cystatin-c was insignificant. Addition of mannitol to the priming solution of the cardiopulmonary bypass acts as a renal protector against AKI postoperative. Finally, giving furosemide infusion to patients undergoing cardiac surgery at the beginning of the CPB improves renal perfusion.
Prophylactic use of intravenous tramadol vs intravenous nalbuphine for control of postspinal shivering after knee arthroscopy: a randomized double-blind placebo controlled trial
Authors: Fahmy A M , Esmat I M , Shabana T , Etman M S M
Published: May 2020

Background

Post-anesthetic shivering refers to spontaneous, involuntary, rhythmic, oscillating and tremor-like muscle hyperactivity that increases metabolic heat production up to 600% after general or regional anesthesia. Shivering is not only subjectively unpleasant but is physiologically stressful because it elevates blood pressure, heart rate, oxygen consumption, and plasma catecholamine concentrations. Moreover, shivering may aggravate pain and hinder wound closure by simply stretching surgical incisions.

Objective

The aim of this work is to compare the efficacy of intravenous tramadol VS nalbuphine for prevention of post spinal shivering during knee arthroscopy.

Methods

This prospective randomized double blinded study was carried in Ain Shams University hospitals on 90 patients scheduled for knee arthroscopy. Patients were randomized into three groups 30 patients each: Group C: patients received normal saline 0.9%) intravenously. Group T: Patients received Tramadol 0.5 mg/kg intravenously. Group N: Patients received nalbuphine 0.1mg/kg intravenously. All drugs were given immediately after intra thecal injection of the anaesthetic drugs and returning to the supine position.

Results

The study revealed that the incidence of shivering was less in the tramadol (23.3%) and nalbuphine (26.7%) groups compared to the saline group (56.7%) (P < 0.05) with no significant difference between Nalbuphine and Tramadol groups (p > 0.05). The mean grade of shivering was comparable between the three groups (P > 0.05). Shivering onset was significantly earlier in the saline group (24.1±2.9 min) compared to Nalbuphine (32.3±4.9min) and Tramadol (36.4±4.3min) groups (P < 0.05) with no significant difference between Nalbuphine and Tramadol groups (p > 0.05). There were no significant differences among the three groups as regards hemodynamics (Heart rate and mean blood pressure), respiratory rate, oxygen saturations, body temperature, the incidence of nausea or vomiting (P > 0.05). While sedation grade was significantly highest in Nalbuphine group followed by Tramadol group and least in Saline group (P < 0.001).

Conclusion

The current study revealed that both tramadol 0.5mg/kg and balbuphine 0.1mg/kg was effective in prevention of post spinal shivering in patients undergoing knee arthroscopy.
Comparative evaluation of hemodynamic stability and recovery during conscious sedation by dexmedetomidine with fentanyl versus ketamine with fentanyl dilatation and curettage
Authors: Kamel G F , Ali R M , Ismail A E A , Hanna B E A
Published: May 2020

Background

Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, predictable recovery with minimal post-operative sequels. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and cooperative sedation without respiratory depression. it inhibits the release of norepinephrine via actions on the alpha2A (α-2A) adrenoceptors located in the locus ceruleus and the spinal cord, resulting in sedation and analgesia via sympatholysis.

Objective

It was to study the effect of dexemdetornidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. The comparison included the vital data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done.

Patients and Methods

In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedtomidine loading dose 1 πg/kg over 10 min and followed by 0.5 πg/kg/hr infusion till completion of surgery and group KF received ketamine 0.5 mg/kg slow intravenous Bolus.

Results

Dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines and propofol.

Conclusion

This study demonstrates that dexrnedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine better preserved MBP and SpO2.
Hypertriglyceridemia with total parenteral nutrition versus enteral nutrition in patients with acute pancreatitis
Authors: Ghobreal B B , Mahmoud S F , Elsamie H S A , Metwally A M
Published: May 2020

Background

Acute pancreatitis (AP) is an inflammatory condition of the pancreas that can cause local injury, systemic inflammatory response syndrome, and organ failure. Worldwide, AP is a common gastrointestinal condition and there is evidence that the incidence has been rising in recent years. AP is associated with substantial suffering, morbidity, and cost to the health care system.

Objective

Our study aims to compare between the effect of enteral (EN) and parenteral nutrition on serum triglycerides in patient with acute pancreatitis in intensive care unit of Ain Shams University (ICU). We found that enteral route is more safe than parenteral nutrition regarding serum triglycerides.

Patients and Methods

An informed written consent was obtained from patients and /or relatives who were included in this study. All patients were adults, more than 18 years old, admitted to ICU of Ain Shams University Hospital, either have acute pancreatitis on admission or acquired acute pancreatitis in ICU due to different causes in period of six months of approval of the protocol. Patients were divided into two groups: 30 patients started total parenteral nutrition TPN ) one day after admission consisting of 70% carbohydrate (in the form of dextrose 25%) and 30% fat (smoflipid 250 ml, 2 gm per ml). The other 30 patients started enteral nutrition rich in carbohydrates with low fat content one day after admission (peptamen) 6 scoops in 200 ml water every 2 hours, stopped from 12 am to 8 am. Serum triglyceride level was measured at first day of admission, then 3 days after admission, then one week after admission.

Results

Our study showed that TPN was associated with more increase of serum triglycerides level from first day of admission to 3 days after admission when compared with enteral nutrition, there is also increase in serum triglycerides from 3days to one week after admission, comparing the three periods together, there is increase in serum triglycerides with TPN group more than in enteral group.

Conclusion

The study showed that TPN was associated with higher mortality rate than EN, also there was an increase in serum triglycerides with TPN more than EN; suggesting that, enteral nutrition is a safer mode of nutrition in patients with acute pancreatitis.
Facilitatory Effects of Perineural Dexmedetomidine on Neuraxial and Peripheral Nerve Block
Authors: Seifelnasr G , Abdelhamid H M , Abdou A M H , Sobhy M M
Published: May 2020

Background

DXM is an anxiety reducing, sedative, and pain medication. It has been used as adjunct to local anesthetics to improve the quality of perioperative analgesia and prolong its duration. Alpha2-adrenergic agonists have expanded the horizons of regional anesthesia. DXM is a highly selective α-2 agonist similar to clonidine but with a greater affinity for the α-2 receptor. It is the pharmacologically active d-isomer of medetomidine, a full agonist of α-2 adrenergic receptors.

Objective

The aim of this study is to evaluate the efficacy of DXM as an adjuvant to local anesthetics for intrathecal and supraclavicular blocks compared to LA alone.

Methods

This is a meta-analysis study. Searches were conducted in PubMed, Ovid/MEDLINE and Embase using free text and controlled vocabulary terms relating to Dexmedetomidine (MeSH). Results will be combined using Boolean operator “AND” with search terms analgesia, anesthesia, adjuvant, local anesthetics, nerve block, perineural, and terms designating route of administration such as neuraxial, intrathecal, supraclavicular, arm, and brachial plexus. Additional non-indexed articles will be retrieved using Google Scholar; and reference sections of retrieved trials will be hand-searched for additional relevant studies. Search will be limited to randomized trials published in English language, conducted on humans over the last 15 years. All protocols were approved by the local ethics committee or institutional review board of their respective institution.

Results

Throughout the studies reviewed, the dose of DXM was either given through a lumbar puncture performed in lateral or sitting position (range 3ug – 10ug) or via the supraclavicular approach in supine position with arm adducted (range 30ug – 100ug). DXM has been shown to prolong sensory and motor block duration in spinal and supraclavicular blocks. However, sensory and motor block onset has varied greatly from one study to another. DXM has also proved to have no significant adverse effects in the short term.

Conclusion

The study results indicate that the use of dexmedetomidine as a local anesthetic adjuvant prolongs sensory and motor block duration when administered intrathecally as part of spinal anesthesia or peripherally as part of a supraclavicular block.
Comparative study between: Epidural bupivacaine versus Patient Controlled Analgesia for postoperative pain control in total knee arthroplasty
Authors: Elkhouly A T A , Bassiony M A , Elshafey M M N , Khalaf K M , Alansary A M
Published: May 2020

Introduction

Effective postoperative pain control in total knee arthroplasty is important, especially with starting physiotherapy and early ambulation, which enhances recovery and reduces hospital length of stay. The risk of postoperative complications, such as deep venous thrombosis and nosocomial infections, has also been shown to decrease with early mobilization.

Aim

The aim of this study is to assess the analgesic efficacy of epidural bupivacaine compared with intravenous patient controlled analgesia (opioid and NSAIDs) during postoperative period in total knee arthroplasty.

Patients

Forty patients, ranging in age from 20 to 70 yr, scheduled to receive total knee replacements with spinal anesthesia were randomly assigned to this study.

Methods

patients received epidural bupivacaine 0.125% alone in (group epa) or iv nalbuphine 50mg, ketorolac 60mg via pca device. The quality of postoperative analgesia was assessed by the anesthesiologist according to Visual Analogue Score (VAS), Cortisol level 24 hours preoperative and 2 hours postoperative for stress response.

Results

The efficacy of both epidural Bupivacaine and i.v nalbuphine & ketorolac via PCA device in controlling pain after total Knee arthroplasty however PCA was slightly less efficient especialy during the 12 hr after surgery. We found that one of the main draw backs of epidural analgesia using bupivacaine were arterial hypotension and urinary retention which required catheterization of many patients for voiding of urine. Results were comparable between the 2 groups and were against group EPA, Serum cortisol levels were elevated 2h post-surgery in all patients. This elevation is in accordance with the well-established stress response to surgery. Furthermore, cortisol levels were significantly less elevated in the group EPA, compared with group PCA.

Conclusion

The results of the study revealed both Epidural bupivacaine and systemic opioids combined with NASID via PCA device are effective of pain control post TKA.
Non-invasive Hemodynamic Monitoring in Prediction of the Outcome and Prognosis in Sepsis
Authors: Zaki M S M , Kassem A A A , Mohamed R H A , Guirguis N N M
Published: May 2020

Background

Complex disease syndromes such as sepsis require multimodal diagnostic and therapeutic approaches. Besides the diagnosis of septic shock and early causal therapy, one major challenge in its treatment remains the resuscitation and management of cardiocirculatory and respiratory dysfunction. As Pulmonary artery catheterization poses significant risks and requires specialized training. Technological advances allow for more readily available, noninvasive clinical measurements of hemodynamics. Impedance cardiography (ICG) offers the potential for safe, noninvasive hemodynamic monitoring that can be easily applied.

Objective

To evaluate the effect of cardiac index, mean arterial blood pressure, heart rate, and oxygen delivery as measured noninvasively by impedance cardiography (ICG) in prediction of the outcome and prognosis in sepsis.

Patients and Methods

This is a prospective, observational convenience trial of patients presenting to the ED or the ICU with severe sepsis or septic shock. The patients were part of a cohort that was followed at day 1, day 3 and day7, or until hospital discharge or in-hospital death. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Oral informed consent is obtained from the patient or designated surrogate before data collection begins.

Results

Twenty-three were enrolled; three were excluded due to an inability to complete data acquisition. The mean cardiac index in nonsurvivors (2.3 L / minÆm2, 95% CI = 2.1 to 2.6) was less than that for survivors (3.3, 95% CI = 2.9 to 3.5). Oxygen delivery as well as lactate were less in non-survivors group. A cardiac index of < 2.5 L / minÆm2 had a sensitivity of 43% (95% CI = 18% to 71%), specificity of 93% (95% CI = 80% to 95%), for predicting in-hospital mortality.

Conclusions

Early, noninvasive measurement of the cardiac index in critically ill severe sepsis and septic shock patients can be performed in the ED for those who meet criteria for EGDT. There appears to be an association between an initial lower cardiac index as measured noninvasively and in-hospital mortality.
Effect of Aging on the Cornea of Male Albino Rat and Possible Therapeutic Role of Royal Jelly
Authors: Elareny H R , Ahmed A I , Alneklawy A F , Tawfik M K
Published: May 2020

Introduction

Nowadays interest in aging has greatly increased, Aging is a complex natural process involving every molecule, cell, and organ in the body that is associated with tissue dysfunction in many organs. Aging of the cornea causes major eye effects and leads to substantial cost in medical and social terms. These effects include the highly prevalent dry eye disease (DED) that affects both visual function and quality of life in elderly. Symptoms of (DED) include, ocular pain, visual disturbances, and increase lacrimation. Functional foods such as Royal jelly (RJ) have a growing attention because of consumers increasing concerns about their health. Its importance not only for its nutritional properties but also for its functional and biological properties such as antioxidant, anti-inflammatory, antibacterial, antiviral, and anti-ulcerous activities. It is used as a cheap natural source in daily life and medicine. (RJ) is a complex substance composed of proteins, sugars, lipids, amino acids, vitamins, and minerals.

Aim

The present study aimed to investigate the histological effect of aging on the cornea of male albino rat and possible therapeutic role of (RJ) on senile group.

Materials and Methods

Twenty-four male albino rats were used in this study divided into Group I: consisted of 6 adult male rats aged 3- 6 months. Group II: consisted of 18 senile male rats aged 18-24 months, were further subdivided into three subgroups as follows: Group II A: (n = 6) negative control senile rats, not subjected to any procedure for 4 weeks. Group II B: (n = 6) control senile rats and were given distilled water by oral gavage once daily for 4 weeks. Group II C: (n = 6) senile rats were given (RJ) by oral gavage dissolved in distilled water once daily for 4 weeks. At the end of the experiment, rats were sacrificed after being deeply anesthetized with ether according to the protocol of the Committee of Animal Research Ethics (CARE). The cornea of each animal was carefully dissected out after death and immediately fixed in 10% formalin for preparation of paraffin blocks 5 micrometer thickness. Sections were stained with hematoxylin and eosin (I-I&E), Masson's trichrome and periodic acid-Schiff (PAS). Statistical analysis and quantitative morphometric study were done.

Results

Light microscopic examination of corneas of senile rats revealed different pathological changes included irregularity in the surface epithelium as well as surface erosions and cytoplasmic vacuolations. The stroma showed widely separated collagen fibers with decreased keratocyte density. It was concluded that (RJ) supplementation to senile rats obviously unproved all layers of the cornea histologically.
Minimally Invasive versus Conventional Approach for Mitral Valve Surgery
Authors: ElKerdany A B , Elghanam M A , Gamal M A , Abdelmoneim T M E
Published: May 2020

Introduction

Full median sternotomy has been well established as a standard approach for all types of open heart surgery for many years. Although well established, the full sternotomy incision has been frequently criticized for its length, post operative pain and possible complications. Minimally invasive mitral valve surgery can be an appealing feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. We here made meta-analysis to compare perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease.

Methods A systematic review of studies comparing perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease, from 2012 up to 2017. Review Manager 5.2 (Cochrane Collaboration) was employed to analyze the results. The outcomes of interest are mortality, cerebrovascular accidents, wound infection, reexploration due to bleeding, and LVEF assessment post-surgery.

Results 12 studies involving 10279 patients were included in the meta-analysis. The 30-day mortality was significantly decreased with MIMVS; 1.6% in the MIMVS group and 2.9% in the group treated through a conventional sternotomy. Cerebrovascular events were significantly decreased with MIMVS; the stroke rate was 0.9% in MIMVS patients and 3% in patients treated via a conventional sternotomy. Wound infections, reexploration due to bleeding, and LVEF did not differ significantly between both groups.

Conclusion The perioperative outcome is more or less similar for minimally invasive mitral valve surgery and conventional mitral valve surgery performed via median sternotomy. Given balance in outcomes, MIMVS is at least as safe as the standard approach and can be considered a routine and standard approach for mitral valve surgery.
Correlation between Atherogenic index and the severity of coronary artery disease in diabetic patients undergoing elective coronary angiography using Gensini score
Authors: Elyamani A S , Elnozahi M A , Abdelmoteleb A M
Published: May 2020

Background

Dyslipidemia is one of the most important factors for CAD. Atherogenic index of plasma (AIP) is a new indicator involved in dyslipidemia. However, its relation with CAD severity in diabetic patients is not well established yet.

Aim of the Study

To study the relationship between atherogenic index of plasma and severity of coronary artery disease (CAD) in the diabetic patients.

Methods

Our study was conducted on 150 diabetic patient with stable CAD undergoing elective coronary angiography in Al-Agoza Hospital from april 2016 to august 2018. Atherogenic index was calculated from the logarithmically transformed ratio of concentrations of TGs to HDL-C obtained from the patient’s lipid profile. correlation of the AIP and the severity of CAD according to Gensini scoring system was done.

Results

AIP had a statistically significant positive relation with IDDM (p = 0.033), NIDDM (p = 0.033), HTN (p = 0.024), dyslipedemia (p = 0.042). And a highly significant positive correlation with FBS (p < 0.001, r = 0.479) and HbA1c (p < 0.001, r = 0.538), proximal LAD lesions (p = 0.002), LCX (p < 0.001), and the number of vessls affected (p = 0.005). AIP Also had a highly significant positive correlation with severity of CAD in terms of Gensini score (p < 0.001, r = 0.692).

Conclusion

AIP is considered a good predictor of CAD severity and multivessel affection in diabetic patients.
The Effect of Cardiac Rehabilitation Program on Depression in Patients After Acute Coronary Events
Authors: Alsioufy S A , Elfiky E , Shabana A M , Raymond R
Published: May 2020

Background

Cardiac Rehabilitation (CR) is a multidisciplinary approach for secondary prevention of coronary heart diseases as well as its comorbid psychological disorders such as depression. Its importance is not well established like other secondary prevention measures although it is one of the most cost-effective methods.

Objectives

The aim of this study is to examine the effect of the cardiac rehabilitation on depression symptoms in patients after acute coronary events and potential improvement in patient prognosis and reduction of overall morbidity and mortality.

Methods

This analysis is a double armed intervention study that was conducted in the period between March 2018 and August 2018 on 60 patients who were referred to the CR clinic after surviving acute coronary events. Patient selection was done so that a study group of 30 patients who completed the CR program and a control group of 30 patients who dropped out early from the CR program were included. It included mainly Egyptian patients who were referred the Ain Shams University Hospital CR clinic. The patients were studied as regard their full history and examination, and their psychological status was assessed using the Patient Health Questionnaire 9 (PHQ-9) before and after the rehabilitation program. Verbal consent was taken from each patient, confidentiality was ensured, patients were informed about findings in their results and they had the right to refuse inclusion

Results

The study included a majority of male patients: 51 male patients (85%) and 9 female patients (16.5%). The mean age was 52 years. 15% of the patients were diabetic and 40% hypertensive, 46.7% were smokers and 48.3% were dyslipidemic. There was no statistically significant correlation between age, gender and risk factors and whether or not the patients completed the cardiac rehabilitation program or dropped out. Most patients were presenting after anterior STEMI (63.3%) followed by inferior STEMI (21.7%) with a minority of NSTE-ACS patients (15%). There was a statistically significant effect of the CR on the CCS class but not on the NYHA class. The median PHQ-9 score before joining the program in the control group of 15.5, while that of the study group ranged from 8 to 20 with a median of 13, which was a significantly different score (P 0.03). Right after finishing the program the study groups PHQ-9 score median was 6.5. Three months after the beginning of the CR program the median PHQ-9 score was 23.5 and 0 for the control group. The change of the PHQ-9 over the course of 3 month from the beginning of the CR program was significantly improved for the study group with (P 0.00) and the median PHQ-9 score decreased from 13 to 0, while the control groups PHQ-9 score significantly deteriorated with a median score changing from 15.5 to 23.5.

Conclusion

CR is a highly effective method in reduction of the comorbid depression in coronary disease patient and should be recommended as a routine management after acute coronary events.
Impact of Admission Glycated Hemoglobin on Angiographic Characteristics and Short Term Clinical Outcomes of Non-diabetic patients with Acute ST Elevation Myocardial Infarction
Authors: Elabd A A I , Helmi H G M , Alfiky E M A , Bassily R A Y
Published: May 2020

Background

Coronary artery disease is the most important cause of death in industrialized countries. Diabetes mellitus is one of the most important modifiable risk factors of coronary artery disease. It increases the risk of coronary artery disease by 2 to 4-fold. Interestingly, this increased risk is not confined to patients with DM, but non-diabetic patients with impaired glucose tolerance (IGT) also may have an increased incidence of cardiovascular complications. Moreover, increased admission glucose levels may be related to a higher mortality rates in patients with acute myocardial infarction (AMI), regardless of diabetic status.

Objective

To assess the prognostic impact of admission HbA1c in patients without known diabetes mellitus who were admitted with acute ST elevation myocardial infarction, on outcome of 1ry PCI and short-term outcome of adverse cardiac events.

Material and Methods

This is an observational, this study was conducted at Coronary care unit & coronary catheterization lab unit of cardiology department in Ain Shams University & specialized hospitals. The study period was 6 months (From 1-9-2018 till 1-3-2019).

Results

100 patients without prior diagnosis of DM were included in our study population Three categories of patients were created according to HbA1c level: Group 1 (< 5.7%): 46 patients (46%); Group 2 (5.5 to 6.4%): 38patients (38%); Group 3 (>6.5%): 16 patients (16%).

Baseline characteristics of the study population are shown in Table 1.

The mean age of our sample was 55.06 ± 11.73 years and 96% were males.

There was highly statistically significant difference found between DM groups regarding SYNTAX score with P-value (0.002) & another highly significant difference in EF between the 3 groups.

Conclusion

The present study showed that admission higher HbA1c level in non-diabetic patients presented by acute STEMI is associated with more severe CAD, lower rate of complete revascularization TIMI 3, and higher incidence of adverse cardiac events and mortality. Introducing measurement of HbA1c in the CCU seems to be a simple method to obtain important information on mortality risk.