bluuebunny/crossref_metadata_2025 huggingface dataset:
Atherosclerosis is a major human killer and non-resolving inflammation is a prime suspect
Authors: Fredman Gabrielle , MacNamara Katherine C
Published: October 2021

The resolution of inflammation (or inflammation-resolution) is an active and highly coordinated process. Inflammation-resolution is governed by several endogenous factors, and specialized pro-resolving mediators (SPMs) are one such class of molecules that have robust biological function. Non-resolving inflammation is associated with a variety of human diseases, including atherosclerosis. Moreover, non-resolving inflammation is a hallmark of ageing, an inevitable process associated with increased risk for cardiovascular disease. Uncovering mechanisms as to why inflammation-resolution is impaired in ageing and in disease and identifying useful biomarkers for non-resolving inflammation are unmet needs. Recent work has pointed to a critical role for balanced ratios of SPMs and pro-inflammatory lipids (i.e. leucotrienes and/or specific prostaglandins) as a key determinant of timely inflammation resolution. This review will focus on the accumulating findings that support the role of non-resolving inflammation and imbalanced pro-resolving and pro-inflammatory mediators in atherosclerosis. We aim to provide insight as to why these imbalances occur, the importance of ageing in disease progression, and how haematopoietic function impacts inflammation-resolution and atherosclerosis. We highlight open questions regarding therapeutic strategies and mechanisms of disease to provide a framework for future studies that aim to tackle this important human disease.
Combination of kaempferol and azithromycin attenuatesStaphylococcus aureus-induced osteomyelitis via anti-biofilm effects and by inhibiting the phosphorylation of ERK1/2 and SAPK
Authors: Gao Lei , Tang Zhipeng , Li Tianbo , Wang Jiangning
Published: October 2021

Osteomyelitis is bacterial infection of bone, commonly caused by Staphylococcus aureus. This work aims to study the potential of azithromycin and kaempferol against chronic osteomyelitis induced by azithromycin-resistant Staphylococcus aureus (ARSA). It was noticed that rats tolerated the treatments with no diarrhoea or weight loss; also, no deaths were observed in rats. The treatment by azithromycin alone failed to inhibit bacterial growth and also had no effect on the infection condition of bone, although the treatment decreased the levels of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α), but did not improve the oxidative stress levels. Kaempferol monotherapy slightly inhibited bacterial growth and bone infection; the treatment also inhibited the levels of IL-6 and (TNF-α). The treatment also improved the antioxidant status. However, the combined treatment of azithromycin and kaempferol significantly suppressed bacterial growth and bone infection and modulated oxidative stress. In vitro, the combined treatment inhibited the levels of IL-6 and TNF-α, and also suppressed the phosphorylation of ERK1/2 and stress-activated protein kinase (SAPK). The combined treatment also showed anti-biofilm activity in ARSA. The combination attenuates ARSA-induced osteomyelitis in rats compared with their treatments alone by reducing oxidative stress, inhibiting the phosphorylation of ERK1/2 and SAPK and inhibiting biofilm formation.
Delayed cardiac tamponade caused by a staple line after wedge resection of the lung
Authors: Yamashita Takashi , Asai Katsuyuki
Published: October 2021

An 80-year-old woman was diagnosed with an adenocarcinoma of the left lower lobe, clinical stage IA3. Taking the patient’s age and medical history into consideration, a wedge resection was performed. After the resumption of rivaroxaban on postoperative Day 3, the patient suddenly developed cardiac tamponade on postoperative Day 5. A drainage tube was placed by pericardiocentesis, and the haemodynamics recovered immediately. No recurrence of cardiac tamponade was observed. The confluence of staple lines is a risk factor for tissue damage. Some covering is recommended, especially when the stapling line contacts the pericardium on the left side.
Mistaken Identity: The Role of Autoantibodies in Endocrine Disease
Authors: Nelson Heather A , Joshi Hemant R , Straseski Joely A
Published: October 2021

Background

Autoimmune endocrine diseases can be thought of as a case of mistaken identity. The immune system mistakenly attacks one’s own cells, as if they were foreign, which typically results in endocrine gland hypofunction and inadequate hormone production. Type 1 diabetes mellitus and autoimmune thyroid disorders (Hashimoto and Graves diseases) are the most common autoimmune endocrine disorders, while conditions such as Addison disease are encountered less frequently. Autoantibody production can precede clinical presentation, and their measurement may aid verification of an autoimmune process and guide appropriate treatment modalities.

Content

In this review, we discuss type 1 diabetes mellitus, autoimmune thyroid disorders, and Addison disease, emphasizing their associated autoantibodies and methods for clinical detection. We will also discuss efforts to standardize measurement of autoantibodies.

Conclusions

Autoimmune endocrine disease progression may take months to years and detection of associated autoantibodies may precede clinical onset of disease. Although detection of autoantibodies is not necessary for diagnosis, they may be useful to verify an autoimmune process.
How Representation Reduces Minority Criminal Victimization: Evidence from Scheduled Castes in India
Authors: Aneja Abhay , Ritadhi S K
Published: October 2021

In this paper, we consider whether the representation of historically disenfranchised minorities in government can reduce violence suffered by these groups. To answer this question, we examine the impact of political parties that represent India’s marginalized Scheduled Castes (SCs). We address the endogenous selection of minority-favoring parties using state-level variation in aggregations of close election outcomes. We find that a 10 percentage-point increase in representation reduces the minority murder rate by 3 percentage points. An analysis of channels suggests that politicians respond to minority constituents by increasing police effort in responding to the victimization of SCs, which may have the effect of deterring future offenders. Moreover, improvements in self-reported attitudes toward government institutions suggest that our results are not the product of negative reporting bias in government crime statistics (JEL: J15, D72, K14).
Intravenous cyclophosphamide treatment for systemic lupus erythematosus with severe autonomic disorders confirmed by head-up tilt table test: A case series
Authors: Umeda Masataka , Kawano Hiroaki , Endo Yushiro , Takatani Ayuko , Koga Tomohiro , Ichinose Kunihiro , Nakamura Hideki , Mukaino Akihiro , Higuchi Osamu , Nakane Shunya , Maeda Takahiro , Kawakami Atsushi
Published: October 2021

Autonomic disorders are common in patients with systemic lupus erythematosus (SLE), but the therapeutic strategy and methods for evaluating the effects of therapy have not been established. We describe the three cases of SLE patients who developed severe autonomic disorders as demonstrated by the head-up tilt table test (HUT). All three patients were treated by intensive immunosuppressive treatments including intravenous cyclophosphamide (IVCY); their HUT results all became negative. Our cases suggest that IVCY treatment can be a good therapeutic option for severe autonomic disorders in SLE patients. The HUT is a useful objective method for the diagnosis of and the evaluation of longitudinal therapeutic effects on autonomic disorders in SLE patients with orthostatic intolerance.
Post Stroke Hyperglycemia as a marker of Stroke Severity and Prognosis: A cohort study
Authors: Alsayes Ayman Mahmoud Mahmoud , Maarouf Mohammed Mahmoud , Sayed Ayman Ibrahim Tharwat , Ahmed Azza Atef Abdelaleim
Published: October 2021

Background

Stroke is the third most leading cause of death worldwide after coronary heart disease and cancer especially ischemic infarcts. Hyperglycaemia is common in patients with acute stroke, occurring in up to 60% of patients overall and approximately 12–53% of acute stroke patients without a prior diagnosis of diabetes,

Aim of the Work

The aim of this work is study of the glycemic status after acute stroke and assess the role of glycemic status in influencing stroke outcome.

Patients and Methods

This was a prospective cohort study conducted in the Critical Care Department of Ain-Shams University Hospitals and Damanhour Medical National Institute for six months from January 2018 to June 2018.

Conclusion

From our study we can conclude that diabetes mellitus as a risk factor in cases of stroke leads to increase complications and worsens the outcome in cases of stroke whether hemorrhagic or ischemic.

Recommendations

From our study we recommended strict control of diabetes mellitus when present in cases of stroke to avoid bad outcome and to prevent complications in these cases.
Comparative Study Between Dexmedetomidine and Fentanyl as Sedatives in Awake Fiberoptic Intubation in Cervical Spine Surgeries
Authors: El Mageed Waleed Mohamed Abd , Ali Ahmad Kamal Mohamed , Bayoumi Eeman Aboubakr ElSiddik Ahmed , Omar Haitham Sabry Mahmoud
Published: October 2021

Background

Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them have various side effects.

Aim

The aim of this study was to compare the effects of dexmedetomedine and fentanyl as regards sedative effects, hemodynamic stability, intubation time and intubation attempts success during awake fiberoptic intubation.

Material and Methods

A randomized double-blind prospective study was conducted on a total of 40 patients scheduled for elective cervical spine surgeries who were randomly allocated into two equal groups (n 20): (group A) patients received a bolus dose of dexmedetomidine of 1 mcg/kg over 10 min followed by a continuous infusion of dexmedetomidine at 0.5 mcg/kg/h. and fentanyl group (group B) received dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/hr. Sedation score (Ramsy sedation score), hemodynamic variables, oxygen saturation, intubation time and intubation attempts were noted and compared between the two groups.

Results

Ramsy Sedation Score was significantly favorable (P < 0.001) in group A in comparison to group B, moreover better hemodynamic stability during intubation (P < 0.05) and less intubation attempts were observed in group A in comparison to group B.

Conclusion

The results of our study showed that dexmedetomidine provides optimum sedation without compromising airway or hemodynamic stability and with favorable intubation time and less intubation attempts during AFOI in comparison to fentanyl.
Comparing General Anesthesia with Preemptive IV Atropine vs General Anesthesia with Single Injection Peribulbar Block with Levobupivacaine 0.5% or Lidocaine 2% for Prevention of Oculocardiac Reflex in Children Undergoing Strabismus Surgery: Randomized Control Study
Authors: Ezzat Hani Ali , ElKady Galal Adel , Zekry Melad Ragaey , Ibrahim Dalia Ahmed , Salem Abeer Sameer
Published: October 2021

Background

Strabismus is one of the common health problems among the children. The incidence of the oculocardiac reflex decreases with age and tends to be more pronounced in young, healthy patients, which is clinically significant for pediatric as it is observed with greatest incidence in young healthy neonates and infants undergoing strabismus surgery.

Objective

to prevent and attenuate the oculocardiac reflex in children age group from (2yrs to 14 yrs) undergoing surgical correction for strabismus.

Patients and Methods

Three groups were allocated Group C received general anaesthesia combined with pre emptive atropine, Group L received general anaesthesia combined with Peribulbar block with Lidocaine 2 % and Group LB which received general anaesthesia combined with peribulbar block with Levobupivacaine 0.5%.

Results

In Our study we found that group L which received peribulbar lidocaine 2 % was the most successful group regarding blocking the occurrence of the OCR and with acceptable post operative pain control results.

Conclusion

In Our study the use of peribulbar block with lidocaine 2 % in combinations with General anaesthesia is very effective against the incidence of OCR in children undergoing strabismus surgery and superior to the Iv pre emptive Atropine with higher surgeon satisfaction while the use of peribulbar levobupivacaine 0.5% combined with general anaesthesia has a great role in post operative pain control with superior patient satisfaction, on the other hand the atropine is a very important emergency drug but our study found that it has a very minor role in both preventing the OCR and post operative pain control in addition to subjecting the patients to the tachycardia and other complications like dryness of the mouth and blushing so its not recommended by our study.
A Clinical Trial of Adding Morphine to Levobupivacaine in TAP Block for Open Appendectomy
Authors: Ibrahim Sherif Farouk , Hakim Kareem Youssef Kamal , Elgharabawy Wael Sayed Ahmed Abdelghaffar , Muhammad Hebatullah Ramadan
Published: October 2021

Background

Postoperative pain management is becoming an integral part of anaesthesia care. Various techniques of pain relief have been designed among which the most commonly practiced are peripheral nerve blocks. We have designed the study to assess analgesic efficacy, duration of postoperative analgesia, hemodynamic stability, and total need of analgesics and opioids after adding morphine to levobupivacaine in TAP block for open appendectomy. A substantial component of the pain experienced by patients after major abdominal surgery is derived from the abdominal wall incision. The abdominal wall consists of three muscle layers, the external oblique, the internal oblique and the transversus abdominis, and their associated fascial sheaths. This muscular wall is innervated by nerve afferents that course through the transversus abdominis neuro-fascial plane. Different adjuvants have been studied to improve the quality and increase the duration of local anaesthetics during various nerve block techniques.

Aim of the work

The aim of this study is to assess the analgesic effect of peripherally administered morphine with levobupivacaine for ipsilateral TAP block in patients undergoing appendectomy under general anaesthesia.

Patient and Methods

Type of Study

prospective, randomized and double blind controlled clinical trial.

Study Setting

Ain Shams University Hospitals.

Study Period

6 months.

Sampling Method

randomized double blind clinical trial.

suction evacuation for molar pregnancy, all cases were included in the study were agreed on a consent for inclusion in the current study after explanation for the details of the study.

Conclusion

TAP block was effective in reducing postoperative pain scores, lowering total 24-h postoperative analgesic consumption. Morphine as an adjunct to levobupivacaine in ipsilateral ultrasound guided transversus abdominis plane block as more effective postoperative analgesia with reduced analgesic requirement in patients undergoing appendectomy.
Critical illness myopathy in intensive care setting
Authors: Fouad Mostafa K , Hazem Ashraf M , Elnaghy Kareem M
Published: October 2021

Aim of the Work

to provide cumulative data about the efficacy and safety of neuro-muscular electrical stimulation (NMES) combined with usual care (UC) versus usual care alone in ICU patients with Critical Illness Myopathy (CIM).

Methodology

The current systematic review was done on studies published between 2009 and 2019. The total number of patients in all the included studies was 1259 patients; 652 in NMES group, and 607 in UC group. Our data were divided into two groups: NMES (652 patients), and UC (607 patients). Metaanalysis study was done on 11 studies which described and compared the 2 different techniques for treatment of CIM; with overall number of patients (N = 1259).

Results

Regarding 1ry outcome measures, we found 8 studies reported critical Critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and the overlap, critical care setting

 

MRC scale for muscle strength, with total number of patients (N = 968). The random-effects model of the meta-analysis study showed non-significant difference in mean MRC scale in NMES group compared to usual care group (p > 0.05). We also found 11 studies reported ICU stay with total number of patients (N = 1259). The random-effects model of the meta-analysis study showed nonsignificant difference in mean ICU stay in NMES group compared to usual care group (p > 0.05). We also found only 2 studies reported SF-36 scale for quality of life, with total number of patients (N = 270). The fixed-effects model of the metaanalysis study showed highly significant decrease in mean SF-36 scale in NMES group compared to usual care group (p = 0.003). Regarding 2ry outcome measure, we found 3 studies reported CIM incidence with total number of patients (N = 394). The fixed-effects model of the meta-analysis study showed marked decrease in CIM incidence in NMES group compared to usual care group, but not reaching statistical significance (p > 0.05). We also found 9 studies reported mortality rate with total number of patients (N = 1044). The fixed-effects model of the meta-analysis study showed non-significant difference in mortality rate in NMES group compared to usual care. Our systematic review and meta-analysis showed that NMES combined with usual care was not associated with significant differences in global muscle strength, ICU stay, quality of life score, CIM incidence and mortality rate in comparison with usual care alone in critically ill patients.

Conclusion

NMES is not superior to usual care in management of CIM. Usual care remains the mainstay of management of CIM with significant better outcomes, in addition to preventive measures as early aggressive treatment of sepsis and MOF, blood glucose control, optimizing certain drugs use, early enteral nutrition, maintaining water, electrolyte and acidbase balance.
The effect of intravenous infusion of magnesium sulphate during spinal anesthesia on post-operative analgesia in patients undergoing total hip replacement
Authors: Ghonim Maha Fawzy Elkotb , Eltaher Waleed Abd EL Mageed , Hussien Mostafa Mansour , Refaat Sameh Ahmed
Published: October 2021

Introduction

Fundamental of regional anesthesia is pharmacologically interrupting transmission of sensation in the specific nerve fiber. The sensory signals generated by tissue damage triggers a state of increased excitability, leading to prolonged post-operative pain or sensitization to such pain. The optimal pain treatment pre-empts the establishment of pain hypersensitivity during and after surgery by minimizing the patient discomfort while leaving physiologic nociceptive mechanisms intact so as to function as an early warning symptom.

Aim

To measure the effect of intravenous magnesium infusion during spinal anesthesia on post operative analgesia in patients undergoing total hip replacement.

Patients and Methods

Patients were randomly assigned to two groups using closed envelopes chosen by patients before the study. Patients in the magnesium group (Group M, n = 15) received magnesium sulphate 50 mg per Kg over 15 min after spinal anesthesia and then 15 mg per Kg per hr by continuous i.v. infusion until the end of surgery. Patients in the saline group (Group S, n = 15) received the same volume of isotonic saline over the same period. Infusions were prepared in pharmacy and they were administered using the infusion machines. Study data were recorded by an observer unaware of group assignments.

Results

the study showed that intravenous magnesium infusion during spinal anesthesia decreased VAS results in magnesium group specifically in the first 24 hours and hence decreasing need for post operative rescue analgesic consumption .Also post operative nausea,vomiting and shivering were lower in magnesium group.

Conclusion

We concluded that intravenous magnesium infusion during spinal anesthesia improves post operative analgesia and reduces incidence of nausea, vomiting and shivering in patients undergoing total hip replacement.
A Comparative Study of the efficacy of preoperative of oral Pregabalin and placebo on acute Postoperative Pain After Coronary Artery Bypass Graft Surgery
Authors: Ahmed Mahmoud Ahmed Ibrahim , Hamed Hatem Said Abdel , Fahmy Nevein Gerges , Mohamed Wael Abdel Aziz
Published: October 2021

Background

Pain that pursues coronary artery bypass graft (CABG) surgery is usually associated with increased both recovery duration and hospital stay. Patient outcome could be worsened owing to large doses of opioids for pain control through over sedation, and prolonged mechanical ventilation. This study was designed to evaluate the effect of preemptive pregabalin on post CABG surgery pain control.

Objective

To study the effect of pregabalin administration before surgery in the treatment of acute postoperative pain after coronary artery bypass surgery. To study the effect of pregabalin on the consumption of opioids for acute postoperative pain.

Patients and Methods

Type of Study: Prospective double – blinded, randomized controlled Trial. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Study Setting: National Heart Institute, Egypt. Study Period: 6 months. Study Population: adult undergoing coronary artery bypass graft surgeries.

Results

Analysis of VAS in the first 24 hours after extubation showed significant difference between Groups 1 and 2. Analysis of systolic blood pressure and heart rate in the first 24 hours showed no significant difference between Groups 1 and 2. It is important to note that because the observed “average” differences in systolic blood pressure and heart rate between groups were small, the clinical significance of such differences can be questioned. Furthermore, it would not be realistic to expect a big, dramatic benefit from a single intervention in a complex, multifactorial care process, such as in cardiac surgery. Given the complexity of these cases, we believe that even a small reduction in pain intensity is a meaningful improvement as we all try to improve care for these patients.

Conclusion

Pregabalin can be effective for reduction of post CABG pain and have better patient satisfaction if given preemptively with single dose preoperatively.
Effect of perineural dexamethasone as an adjuvant to levobupivacaine in saphenous nerve block for knee arthroplasty
Authors: Nemr Marina M , Abd El Fattah Amr M , Shorbagy Mohammed S , Mohsen Mohamed M
Published: October 2021

Background

Total knee arthroplasty (TKA) is a major surgery where postoperative pain management not only aims for patients comfort but also is crucial to achieve post-operative ambulation leading to better outcome and preventing post-operative complications. Femoral nerve block is commonly used following Total knee arthroplasty for post-operative pain control but affects the quadriceps muscle strength increasing the risk of falls. Meanwhile, Adductor canal block has only sensory effect while preserving the motor power allowing for functional recovery within the first 24 hours post‑total knee arthroplasty. However, single injection nerve block is limited by its short duration. Adding adjuvants to the local anesthetic has shown prominent results in prolongation of the duration of the nerve block with dexamethasone being the most effective one.

Aim of the Work

to assess the efficacy of perineural dexamethasone as an adjuvant on duration of sensory blockage of Saphenous nerve block - performed by levobupivacaine -after knee arthroplasty surgery.

Patients and Methods

This randomized clinical trial study was carried at Ain Shams university hospitals, starting from March 2019 to August 2019. It included forty adult patients undergoing unilateral total knee arthroplasty who were randomly divided into 2 groups. A group received spinal anaesthesia followed by adductor canal block (ACB) with 19ml levobupivacaine plus 1ml normal saline and the other received spinal anesthesia followed by ACB with 19ml levobupivacaine injection plus 1ml (4mg) dexamethasone. The two groups were adequately monitored and assessed post-operatively for 24 hours and they were compared regarding analgesic outcome by recording time for first for analgesic need, total consumption of opioid and pain score during walking and climbing stairs. Side effects were also monitored and compared.

Results

prolongation of ACB when adding dexamethasone perineurally as an adjuvant to levobupivacaine, evident by prolongation of time for first analgesic requirement, decrease in total consumption of opioid in first 24 hours and lower pain score during walking and climbing stairs.

Conclusion

Adding dexamethasone as an adjuvant to ACB showed that it prolonged its duration with decrease in the post-operative pain scores and total morphine consumption.
The Diagnostic Role of Lung Ultrasound in Critically Ill Patients In Comparison With Chest X-Ray
Authors: Hanna Mina Fayez , Latef Fahmy Saad , El-Hennawy Ahmed Mohamed El-Sayed , Selima Wessam Zaher
Published: October 2021

Purpose

To compare between lung ultrasound and chest X-ray in diagnosis of different lung pathologies in critically ill patients using lung CT as a gold standard.

Methods

Comparative prospective randomized single group observational study was conducted in the Critical Care unit (medical and surgical ICU). The study was conducted upon fifty patients (28 females &22 males) with a mean age of 58 years (SD ± 15.55; (19 - 82) presented to Kom Hamadah Hospital during a period of one year starting from July 2018 to July 2019, with acute dyspnea as the primary complaint or developed acute dyspnea and or tachypnea during their ICU stay were evaluated for the presence of pleural effusion, pneumothorax, alveolar-Interstitial Pathology and consolidation by LUS and CXR for detecting the sensitivity and specificity of each modality with CT chest done as a reference in cases of doubt.

Results

The comparison between Sensitivity and Specificity of US finding was (86.8% for parenchymal disease, 100.0% for pleural diseases) and (100.0% for parenchymal diseases, 94.7% for pleural diseases) respectively while CXR finding was (65.8% for parenchymal diseases, 75.0% for pleural diseases) and (58.3% for parenchymal diseases), (92.1% for pleural diseases) respectively among studied patients.

Conclusion

Transthoracic ultrasound is valuable for the evaluation of a wide variety of chest diseases, particularly mechanically ventilated patient.

The advantages of low cost, bedside availability and no radiation exposure have made ultrasound an indispensable diagnostic tool in ICU.

Lung ultrasound is more sensitive than chest x-ray in diagnosis and follow up chest diseases) PNX, alveolar-interstitial syndromes, parenchymal consolidations, and pleural effusion (LUS is an interesting medical method that is complementary to bedside CXR and reduces the need to use a CT scan.
Comparison between Nalbuphine and Ketamine as an adjuvant to Heavy Bupivacaine on Post Dural Puncture Headache
Authors: El Gendy Mohammad A , Elewa Gamal M , Wadea Mina Z , Hazem Ashraf M
Published: October 2021

Background

Incidence of post dural puncture headache (PDPH) is relatively high, and many methods have been tried to prevent or treat it, but results are not satisfactory. Both Nalbuphine and Ketamine have analgesic effects, and have been used intrathecally with local anesthetics, but their effects on PDPH were not studied.

Objective

To study the incidence and severity of PDPH when nalbuphine or ketamine was added as an adjuvant to hyperbaric bupivacaine in spinal anesthesia (primary outcome). Secondary outcomes were the effects of adding nalbuphine or ketamine as an adjuvant to hyperbaric bupivacaine on motor and sensory effects, duration of analgesia, hemodynamics and side effects of both of them.

Patients and Methods

This prospective double-blind, randomized controlled study was conducted on 320 patients, aged 21–60 years of both sexes, ASA physical status I and II, and allocated for lower abdominal, pelvic, or lower limb surgeries under spinal anesthesia, after approval from ethical committee (Assurance No. FWA 000017585) of Faculty of Medicine, Ain, Shams University, Cairo, Egypt. Contact with 17 patients was lost. So, 303 patients completed the study. Patients were divided into 3 equal groups (101 each) according to drugs injected intrayhecally.

Group (N): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 mg nalbuphine hydrochloride diluted in 0.5 ml normal saline. Group (K): 3 ml of 0.5% hyperbaric bupivacaine with 25 mg ketamine hydrochloride diluted in 0.5 ml normal saline. Group (C): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline.

Results

Incidence of PDPH was statistically significantly less in group N in comparison to Groups K and C, in the first day. But, no statistically significant difference was found between the three groups at 2nd and 3rd days. There was no statistically significant difference between groups according to severity of PDPH by visual analog score (VAS). Group N has the most rapid onset and long duration of sensory block in comparison with groups K and C. There was no statistically significant difference between groups according to onset and duration of motor block and hemodynamic changes.

Conclusion

Adding nalbuphine, and not ketamine, with hyperbaric bupivacaine in spinal anesthesia decreased incidence of post dural puncture headache, and prolonged the duration of sensory block. Both groups provided adequate anesthesia and analgesia with good hemodynamic stability.
Predictors of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting: A Prospective Cohort Study
Authors: Elewa Gamal Eldin M , Elgendy Hanaa A , Ali Amr H , Dabsha Mohamed H
Published: October 2021

Background

Postoperative atrial fibrillation (POAF) is common both after cardiothoracic and non cardiothoracic surgery.In patients undergoing cardiothoracic surgery, the incidence of 16–46% has been reported. Even though POAF can be selflimiting, it may be associated with hemodynamic instability, postoperative stroke, myocardial infarction, ventricular arrhythmias and heart failure.

Objective

To determine the effect of certain predictors on the incidence of postoperative atrial fibrillation during the ICU stay after coronary artery bypass graft surgery.

Patients and Methods

This prospective cohort study was done after approval of the Institutional Review Board and written informed consent from patients or first kin. Patients undergoing isolated CABG or CABG with valve replacement were included and monitored for POAF during their postoperative ICU stay and the potential predictors of POAF as age, sex, smoking and left atrial diameter, serum Potassium and Magnesium levels, CHA2DS2-VASc score, valve replacement and inotropic support were recorded.

Results

123 patients were included in the study, 76.4% were males with a mean age of 57.4 ±8.7 years and mean left atrial diameter 4.1 ±0.52 cm. The incidence of POAF following CABG surgery was almost 33.3%. There was no statistically significant association between POAF and smoking (P = 0.123). However there were statistically significant associations between POAF and CHA2DS2-VASc score, valve replacement (P < 0.001) and inotropic support (P = 0.005). The logistic regression analysis showed that left atrial diameter, CHA2DS2-VASc score and female sex were independent predictors of POAF. In contrary, there were no statistically significant associations between POAF and serum K+ and Mg ++ levels (p > 0.05).

Conclusion

There are a wide range of significant epidemiological, clinical, and operative predictors for the development of post-CABG AF including older age, female gender, large LA diameter, higher CHA2DS2-VASc score, valve replacement and postoperative inotropic support. Nevertheless, further large-scale studies are still needed to confirm our findings.
New Onset of Atrial Fibrillation" as an Outcome Predictor in Critically Ill Patients with Sepsis: A Systemic Review
Authors: Mohamed Mohamed W , Riyad Mostafa K , Khamis Ahmed M , Toulan Heba F
Published: October 2021

Background

Evidence of various cardiac arrhythmias in septic patients has been demonstrated by multiple clinical reports and observations .Most cardiac arrhythmias in sepsis are new-onset and may be related to sepsis-induced myocardial dysfunction, autonomic dysfunction and, most likely also, by impairment and involvement of the cardiac conduction system.

Aim of the Work

to describe the incidence of NOAF and to determine the risk factors associated with its development, as well as its clinical course and its effect on the outcome of patients with sepsis admitted to the ICU.

Patients and Methods

A systematic search was conducted to retrieve articles that investigated the association of NOAF in patients diagnosed with sepsis. We identified potential Englishlanguage sources from the PubMed, Medline, and EMBASE databases. Keywords used were “atrial fibrillation” and (“sepsis” or “septic shock”). In addition, reference lists of any studies meeting inclusion criteria were reviewed manually to identify additional relevant publications.

Results

In our meta-analysis, we found that NOAF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease. Also, we found that NOAF in sepsis patients is significantly associated with increased risk of ICU. In hospital, and After hospital discharge mortality, as well as, increased risk of developing ischemic stroke.

Conclusion

NOAF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease. Our Meta-analysis suggests that it is independently associated with poor outcome. In view of these findings there is a need for better quality observational studies, because reliable identification of patients with sepsis who are prone for the development of AF may allow for early pharmacological interventions to prevent this complication.
Effect of intrathecal Dexmedetomidine on preventing shivering after spinal anesthesia in caesarian section
Authors: Abdelhamid Mostafa Mohammed Mohyeldin , AbdelAleem Azza Atef , Hussien Rania Maher , Khalifa Ahmed Abdelghany
Published: October 2021

Background

Shivering is among the common troublesome complications of spinal anesthesia (SA), and causes discomfort and discontentment in parturients undergoing cesarean section (CS).

Objective

to investigate the effects of intrathecal dexmedetomidine (DEX) as an adjuvant to heavy bupivacaine in the prevention of shivering in those who underwent CS under SA.

Methods

A prospective double-blind conducted at Ain Shams University hospitals on 100 parturients who are undergoing CS under Spinal anesthesia over a period of six months starting from December 2018 to May 2019 at Ain shams university hospitals. Patients were randomly subdivided into 2 groups of 50 patients each, Group BD: 5 micrograms DEX was added to 12.5 mg 0.5% heavy bupivacaine. Group BN: 0.5 mL 0.9% normal saline was added to the 12.5mg 0.5% of heavy bupivacaine.

Results

The incidence of shivering was significantly higher in the BN group (56%) than the BD group (24%). Likewise, the intensity of shivering was significantly higher in the BN group than the BD group.

Conclusion

Intrathecal DEX in conjugation with heavy bupivacaine reduced the incidence and intensity of shivering in patients undergoing cesarean section after spinal anesthesia and did not increase the incidence of hypotension or bradycardia.
Neutrophil-to-lymphocyte count ratio in predicting prognosis of septic shock patients
Authors: Mahmoud Hoda Omar , Fahmy Niven Gerges , Ammar Mona Ahmed Mohamed Abdelmotaleb , ELryany Mostafa Mansour Mohamed Elsaid
Published: October 2021

Background

Septic shock is one of the most common causes of admission to the intensive care unit in the world and one of the most common causes of death among intensive care patients. Since the definition of sepsis and septic shock and many studies have been designed to understand everything about sepsis regarding mechanism, pathophysiology, complications, diagnosis, management and all other aspects.

Objective

To find the association between neutrophil to lymphocyte count ratio and the mortality from septic shock patients. The work aims also to determine if this ratio can be used as a prognostic marker of septic shock patients and to compare this ratio with other sepsis markers as C-reactive protein (CRP) and procalcitonin.

Patients and Methods

This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 125 patients between January 2018 to January 2019. The ethics committee of our institution approved the study protocol, and written informed consent was obtained from each patient’s family.

Results

In our study, the neutrophils count was significantly increased in survived patients compared with early and late mortality patients in day 1 while lymphocytes count was lower in survived patient than early and late mortality patients and the NLCR in our study was higher in survived patients than early and late mortality patients. In day 4, our results revealed significant increase in neutrophils count in patients of late mortality compared with its count in survived patients, while lymphocytes didn't show any significant difference compared with its count in survived patients with significant increase in NLCR in patients of late mortality compared with those of survived patients in day 4. Both CRP and procalcitonin are increased in patients of early and late mortality groups compared with its value in survived patients in day 1 and 4.

Conclusion

This study demonstrates a real relationship between the NLCR and the risk of death in septic shock patients. Septic shock patients at risk of early death presented a low NLCR at admission, although late death was associated with an increased NLCR during the first 5 days. Early and late death should be distinguished because they may involve different underlying mechanisms, and the NLCR might be considered as a discriminant indicator of early or late death. In addition, our findings provide more insight into biology. The circulating neutrophil and lymphocyte trends observed in this study offer an interesting mechanistic viewpoint. We observed that circulating lymphocytes and the NLCR behave in opposite ways in early- and late death patients, supporting the hypothesis that divergent mechanisms could be involved in these two groups.
Weaning Outcomes of using Post-Extubation High Flow Nasal Oxygen versus Continuous Positive Airway Pressure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients
Authors: Khaled M.M , Alfred M.S , Mohamed Abd El Salam M.E , Mustafa Kamel A.F
Published: October 2021

Background

Mechanical ventilation is a daily event in any ICU, using HFNO as a weaning facilitating strategy for mechanically ventilated patients after passing Spontaneous Breathing Trial (SBT) recently considered to reduce complications associated with invasive ventilation.

Objectives

To compare high-flow conditioned oxygen therapy versus non -invasive ventilation using continuous positive airway pressure (CPAP) for preventing post-extubation respiratory failure and reintubation in acute exacerbation of chronic obstructive pulmonary disease patients after weaning from mechanical ventilation and to follow patients for ICU and hospital lengh of stay ICU and hospital mortality.

Patients and Methods

This prospective randomized controlled study, including 60 patients admitted to the intensive care unit at Al- Mataria teaching hospital. Approval of the ethical committee of Al-Mataria teaching hospital was obtained before the start of patient’s recruitment. Patients who successfully extubated were equally randomized (sequential) to enter either group I or group II. Study group (I): included 30 patients subjected to high flow nasal oxygen after extubation for 24 hrs. Control group (II): included another 30 patients on non-invasive CPAP after extubation for 24 hrs.

Results

Our results showed lower rate of reintubation in HFNO group (n = 6) 20%, compared to NIV group(n = 7) 23. 3 %, higher PaO2 in HFNO group immediate, 2 hrs post extubation. No significant differences found regarding mortality rate between both study groups (8/30) 26. 6 % in HFNO group, while (9/30) 30 % in NIV group, p (Ns). Arterial PH was significantly lower in NIV group immediately after extubation.

Conclusion

HFNO compared to NIV alone showed lower rate of reintubation when used immediately after planned extubation. Patients weaned using HFNO showed higher PaO2 2hrs postextubation. HFNO compared to NIV alone didn’t affect hospital stay.
Effectiveness of Intrathecal Administration of Bupivacaine with Fentanyl versus Nalbuphine for Elective Cesarean Section
Authors: Rahman Nada Mohamed Bahaa Eldin Mostafa Abdel , Maghawry Khaled Mohammed , Mostafa Raham Hasan , Ezzat Ahmed Wagih
Published: October 2021

Background

Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia.

Objectives

The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives.

Methods and material

After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg)

Results

The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups.

Conclusions

We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine.
Comparative Study Between Neostigmine Versus Sugammadex in Obese Patients Undergoing Laparoscopic Surgery
Authors: Zaghlol Mohammed A , Boctor Alfred M , Abd-Elhamed Hadyl M , Abd-Elhak Ahmed A , Bakheat Ramadan R
Published: October 2021

Background

Complete and rapid reversal of the effects of neuromuscular blocker drugs is a primary element of safety in anaesthesia. Neuromuscular conduction that is not completely improved leads to post-operative residual curarisation and the development of complications that are related to respiration.

Aim of the Work

to compare between the effect of neostigmine and sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization and respiratory complications in the obese patients undergoing laparscopic surgery.

Patients and Methods

We carried out this randomized clinical study on sixty four patients operated upon at General Surgery Department at Armed Forces Hospitals. Patients and Methods: In this study, 64 patients of either sex with average age ranging from 18-65 years, ASA (I,II), submitted for bariatric gastric sleeve operation were included in this study. Patients were randomly classified into 2 equal groups; Group S (sugammadex, n = 32) and group N (neostigmine, n = 32). Results: no significant differences between both groups regarding age, gender, BMI and ASA. But, we showed statistically a high significant difference between both groups regarding TOF0.9 and significant differences between both groups regarding PACU and operative room time.

Conclusion

This study verified the efficiency of sugammadex over neostigmine for full and timely reversal of neuromuscular blockade induced by a rocuronium, in morbidly obese patients undergoing laparoscopic bariatric surgery.
Comparative Evaluation of Hemodynamic Stability and Recovery during Conscious Sedation by Dexmedetomidine-Fentanyl Versus Ketamine- Fentanyl in procedures outside the operating room
Authors: Abd-El Razek Sarah A , El-shafei Mohamed N , Mostafa Ashraf N , Ahmed Ibrahim M
Published: October 2021

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, Email: predictable recovery with minimal post-operative sequels.

Aim of the Work

to study the effect of dexemdetomidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure.

Patients and Methods

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

Results

Our study showed that 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

dexmedetomidine in combination with fentanyl is useful to provide conscious sedation for non operating room procedures in adults and it may be a valuable alternative to ketamine.