bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Neutrophil Lymphocyte Stress Factor in Diagnosis of Sepsis and Prediction of Mortality in Septic Patients Admitted to the ICU
Authors: El-said Kamel Amr M , Abd El-malek Fady A , Shorbagy Mohamed S , El-sayed Mahmoud A
Published: August 2023

Background

Sepsis is a major public health concern. It is among the most common reasons for admission to intensive care units (ICUs) throughout the world. Severe sepsis and septic shock are associated with 30-60% mortality rate which is very high compared to other common diseases, such as myocardial infarction or breast cancer. Sepsis is now defined as a “life-threatening organ dysfunction due to a dysregulated host response to infection”.

Aim of the Work

to evaluate the efficacy of neutrophil lymphocyte stress factor (NLSF) in the diagnosis of sepsis and prediction of mortality in septic patients admitted to the ICU.

Patients and Methods

We conducted this prospective observational study on 60 patients after informed consents were taken from patients or their next of kin. We enrolled adult patients admitted to the ICU with the diagnosis of septic shock. We excluded patients younger than 18 years, pregnant females, patients with terminal malignancy, patients with liver cirrhosis child-pugh C, patients with shock of mixed origin and patients with aplasia, immunosuppressive disease or receiving immunosuppressive therapy. Then we classified patients into 2 main groups according to presence of sepsis into; Septic group (30 patients), and Non-Septic group (30 patients).

Results

from our study concluded that NLSF can be used in diagnosis of sepsis, although it’s the least accurate diagnostic marker among PCT, CRP and NLSF, it provides the cheapest tool for diagnosis of sepsis. It was also found that NLSF can be used in prediction of mortality in septic patient during the period of our study and that it’s the most accurate prognostic marker of mortality among PCT, CRP and NLSF.

Conclusion

NLSF in combination with other parameters can be used as a cheap easy tool for the early detection of sepsis in intensive care units. NLSF can be used as a prognostic marker in sepsis for prediction of mortality in ICU. Further studies are required to clarify these results on a larger group of patients and for longer periods of time.
Assessment of Brain Midline Shift Using Sonography in Traumatic Brain Injury (TBI) in Critically Ill Patients: A Comparative Study with CT
Authors: Elkabarity Reem H , Hakim Kareem Y , Hafez Mahmoud M
Published: August 2023

Introduction

Brain midline shift (MLS) is a life-threatening condition that requires urgent diagnosis and treatment.

Aim of the Work

The aim of this study was to assess brain midline shift using transcranial sonography in comparison to plain CT.

Methods

The study was carried out on 45 neurocritical patients of both sex admitted to the critical care department in Ain shams University Hospital. The ultrasound MLS was assessed through the temporal bone window by measuring the distance from skull to the third ventricle on both sides prior to plain CT. CT MLS was determined either by the distance from the external bone table to the center of the third ventricle bilaterally (method 1) or the distance between the ideal midline and the septum pellucidum (method 2).

Results

60% of patients were males, the mean GCS on admission was 7.12±1.66.All the patients were mechanically ventilated.

Measurement of MLS by transcranial sonography was possible in all 45 patients. MLS of 4.29 ± 2.17 mm. A MLS >6 mm was observed in 24% (11/45) of the patients. CT MLS was 5.18 ± 2.49 mm (using method 1) and 5.35 ± 2.64 mm (using method 2). A MLS >8 mm with CT was observed in 29% (13/45) of the patients. The sensitivity and the specificity of US to detect a significant MLS (that is, MLS >5 mm) was 100, 91.3% respectively when using CT method (2) to measure MLS. The sensitivity and the specificity of US to detect a significant MLS (that is, MLS >5 mm) was 95.2, 95.8% respectively when using CT method (1) to measure MLS. The correlation coefficient between (the difference between US MLS and CTMLS) and CTMLS was 0.619 (p < 0.001).The smaller the MLS the narrower the difference between the measurement of USMLS and CTMLS. The narrowest difference between US MLS and CT MLS 0.5 (0.5 -0.7) was at MLS <2 mm. At this reading was the most accurate point of comparison between US MLS and CTMLS. The relation between US MLS and GCS was statistically significant, the greater the US MLS the lower the GCS. The relation between US MLS and length of ICU stay and ventilation days was tested and it was statistically significant. The greater the US MLS the longer the length of ICU stay and ventilation days. There was significant relation between US MLS and mortality, 100 % of the cases survived with US MLS less than 4 mm. 100 % of the cases with US MLS greater than 6 mm died. The greater the US MLS the higher the mortality.

Conclusion

This study suggests that TCS can be used as an easy bedside tool to detect MLS in neurocritical patients.
Ultrasound-Guided Rectus Sheath Block versus Transversus Abdominus Plane Block for Post-Operative Analgesia in Elective Cesarean Section
Authors: Maghawry Khaled Mohamed , Ahmed Eman Aboubaker ElSiddik , Almeligy Hany Attia , Abdou Marina Adel George
Published: August 2023

Background

Nerve root or myofascial irritation at the abdominal wall is a common cause of pain following surgeries such as cesarean section, cholecystectomy, prostatectomy, hysterectomy and transplant surgery.

Aim of the Work

The aim of this study is to test the efficacy of ultrasound guided TAP block versus ultrasound guided rectus sheath block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used.

Patients and Methods

In the current study eighty patients who received spinal anesthesia were included. Patients were divided randomly into two groups, each group consisted of 40 patients. Group A: Patients in this group received bilateral US guided TAP block at the end of surgery. Group B: Patients in this group received bilateral US guided rectus sheath block at the end of surgery.

Results

These result met with another study, Ayman Saleh et al which shows the time for first analgesic request (minutes) was significantly increased in TAP when compared to RS block groups (332.50±42.93 vs 220.10±21.51 minutes, respectively). Also, the total analgesic consumption (mg) was significantly reduced in TAP when compared to RS block groups respectively (90.40±27.02 vs 157.00±37.80 mg, respectively).

Conclusion

Ultrasound-guided TAP block was more effective than ultrasound-guided RS block in patients undergoing cesarean delivery with prolonged postoperative analgesia, less analgesics consumption and less postoperative nausea and vomiting.
Post-Operative Analgesic Effect of Intra-Articular Local Anesthetic Infiltration versus Adductor Canal Block after Knee Arthroscopic Surgeries
Authors: Hefni Amira F , Rahman Waleed A Abd El , Moris Kerolos E , Nabieh Mena M
Published: August 2023

Background

Knee arthroscopic surgery is one of the most common orthopaedic procedures. Postoperative pain after Knee arthroscopy is caused by irritation of free nerve endings of synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection.

Aim of the Work

To compare between intra-articular local anaesthetic infiltration and ultrasound guided adductor canal block to achieve effective and safe postoperative analgesia after knee arthroscopic surgeries as regarding duration of postoperative analgesia, need for analgesic supplements postoperatively, patient satisfaction, time of ambulation, and presence of any associated complications or side effects.

Patients and Methods

A prospective randomized comparative study was conducted in Ain Shams University hospitals, on patients aged from 20 to 60 years, ASA class I-II-III assigned for knee arthroscopic surgeries. For six to eight months started after approval from ethical committee of Ain Shams University. A written informed consent had been obtained from all patients. Every patient received an explanation for the purpose of the study and research results only used for scientific purposes.

Results

The study showed that adductor canal group had lower Pain perception (VAS-10) at rest, but the differences were statistically significant beginning from hour-8. Also, adductor canal group had lower Pain perception (VAS-10) during movement, but the differences were statistically significant beginning from hour-8. Rescue analgesia was significantly less frequent in adductor canal group. High satisfaction (Good/excellent) grades were significantly more frequent in adductor canal group.

Conclusion

The findings of our study revealed that ACB Provides better postoperative analgesia after knee arthroscopic surgeries than intra-articular local anaesthetic infiltration at rest and movement. Furthermore it facilitated earlier mobility than local anaesthetic infiltration. However, in clinical practice intra-articular local anaesthetic infiltration is easier to perform than ACB which requires experienced anaesthesiologist.
Effect of Glycemic Control on Sepsis in Critically Ill Diabetic Patients: A Prospective Cohort Study
Authors: Hamid Hatem Said Abdel , Rabie Amal Hamed , Danial Samuel Habachi , Anwar Michael Mamdouh
Published: August 2023

Background

Hyperglycemia is common and often multifactorial in critically ill patients. Severe hyperglycemia can result in endothelial dysfunction, cytokine release, platelet activation, mitochondrial dysfunction and electrolyte and acid base disturbances and has been associated with an adverse outcome in a variety of settings in patients without a history of diabetes; this association has not been demonstrated in diabetes patients.

Aim of the Work

Aim is to evaluate the outcome of glycemic control in critically ill diabetic patients.

Patients and Methods

This Prospective Cohort study was performed at Ain Shams University Hospitals - El – Zaitoun Specialized Hospital. 60 patients that are known diabetic and admitted to ICU suffering from sepsis aging over 18 years. Patients have been divided equally into two groups: 1st group RBG measurements less than or equal 150 mg/dl while the 2nd group RBG measurements above 150 mg/dl. So there was highly statistically significant difference between the two studied groups and glucose level on admission.

Results

There was statistically insignificant difference between the two studied groups and Sex or Age. Also there is no significant difference in special habits (smoking) between the two groups. Considering ICU stay, in our study, there was statistically significant higher mean of ICU stay in 2nd group, in comparison to 1st group. The calculated Acute Physiology and Chronic Health Evaluation (APACHEII) in our study showed no significant difference between two groups Considering complications, our study reported insignificant increase in complicated cases the 2nd group in comparison to 1st group. This may be due to the small number of patients in our study. Further observational and randomized control studies are suggested to further evaluate the variability of complications.

Conclusion

Glycemic control in the ICU continues to be challenging at best. Glucose control in the intensive care unit adds yet another facet to the routine care of a highly complex patient profile. Although observational studies and certain interventional trials have suggested that intensive glucose control can reduce mortality in this setting, recent studies have failed to confirm these findings. Like that is our study, hyperglycemia was associated with increased duration of total days in the intensive care unit. There was insignificant increase in complicated cases in hyperglycemic group in comparison to the other group. This may be due to the small number of patients in our study. So further observational and randomized control studies are suggested to further evaluate the variability of complications.
Prognostic Value of Platelet-To-Lymphocyte Ratios among Critically Ill Patients with Acute Kidney Injury
Authors: Nour-Eldin Basel Mohammed Essam , Abd-Elsalam Ihab Hamed , Nasr Thabet Aziz , Karim Michael Safwat
Published: August 2023

Background

Kidney is one of the most affected organs by sepsis causing acute kidney injury (AKI). Sepsis is a major cause of morbidity and mortality worldwide, and it results from a dysregulation of the systemic inflammatory response to infection. Despite significant advances in the pathophysiology and therapeutic strategies for sepsis, the mortality remains high, at 300 deaths per 100 000 people.

Aim of the Work

It is reasonable to speculate the presence of a potential relationship between PLR and mortality for sepsis. However, no investigation has been conducted. Therefore, in this study, we aimed to investigate the prognostic value of PLR for sepsis.

Patients and Methods

Logistic regression was used to explore the association between PLR and hospital mortality. Subgroup analyses were performed based on acute kidney injury (AKI) and a Sequential Organ Failure Assessment (SOFA) score >10.

Results

In our study, the overall mortality was 43.5% (87 out of 200 patients). There were 78 cases death (78%) of PLR <90, also were 9 cases death (9%) of PLR >90 regarding prognosis with (p-value = <0.001 highly significant).

Conclusion

This study confirmed that the platelet-to-lymphocyte ratio (PLR) has significant prognostic value for sepsis with acute kidney injury. PLR appears to be additive biomarker used in detection high-risk patients and this can add to early diagnosis of such patients with better management strategies.
Dynamic of Glycemic State as a Prognostic Marker in Acute Ischemic Stroke: A Prospective Controlled Cohort Observational Study
Authors: Said Amr Mohamed El , Sayed Hussien Noha , Negm Mohamed Atef
Published: August 2023

Background

Hyperglycemia is encountered in 20% to 40% of acute stroke patients, with or without a pre-morbid diagnosis of diabetes mellitus. Hyperglycemia is a risk factor for infarct expansion and poor outcome through the first 72 hours of hospitalization in both diabetics and nondiabetics. Major and minor studies of stroke patients suggested that ‘Stress Hyperglycemia’ (raised blood glucose levels without a previous diagnosis of diabetes) was associated with a poorer outcome.

Aim of the Work

The aim of the work was to study the glycemic status after acute ischemic stroke and to assess the influence of glycemic status in the stroke outcome.

Patients and Methods

This study was a prospective cohort study conducted in Ain shams University Hospitals during the period from October 2019 to March 2020. The study included a total of 105 patients presented with acute ischemic stroke within 24 hours from onset of symptoms. The study population were predominantly males (60.95%), with a mean age of 61.66 ± 10.38 years (range from 40 to 85 years).

Results

Our study revealed that: Hyperglycemia is a good predictor of mortality outcome after acute ischemic stroke (65.7% vs. 5.7%), stress hyperglycemia had the worst mortality outcome compared with diabetic group and control group (85.7% vs. 45.7% vs. 5.7%; respectively), hyperglycemia is a good marker of stroke severity assessed by NIHSS score (14.60 ± 5.80 vs. 7.60 ± 3.38), hyperglycemia has significant association with longer ICU and hospital stay (12.26 ± 8.92 vs. 2.89 ± 4.07 days), NIHSS score is a significant predictor of mortality outcome after acute stroke (18.20 ± 3.43 vs. 7.30 ± 1.86), hyperglycemia has significant association with posterior circulation strokes (20% vs. 0.0%) and patients with hyperglycemia had higher incidence of intracerebral complications, namely hemorrhagic transformation (17.1%) and brain edema (10%).

Conclusion

This study revealed that there is an association between admission hyperglycemia and poor outcome after acute ischemic stroke. Admission hyperglycemia worsens the outcome and functional disability during the phase of ischemic stroke. Hyperglycemia at stroke onset, without prior history of DM have particularly poor prognosis, than those with hyperglycemia in known diabetes.
Comparison of Adding Magnesium Sulphate to Bupivacaine with Plain Bupivacaine in Ultrasound Guided Pectoral Nerve Block for Postoperative Analgesia in Modified Radical Mastectomy
Authors: Mageed Azza Mohammed Shafik Abd El , Emam Dalia Fahmy , Nasr Thabet Aziz , Mohamed Mohamed Sabry Bayoumi
Published: August 2023

Background

Breast cancer is the most common malignancy in women, and its incidence continues to increase. Modified radical mastectomy (MRM) is one of the standard treatments for multi-centric disease or tumors with extensive coexistent ductal carcinoma in situ.

Aim of the Study

To elaborate the analgesic efficiency and safety of pectoral nerve block by adding magnesium sulphate to bupivacaine as an adjuvant versus bupivacaine as a sole agent in cases of modified radical mastectomy (MRM).

Patients and Methods

This is a Prospective double – blinded randomized controlled study was conducted in the operating theatres of Ain Shams University Hospitals. It included Female patients undergoing Modified Radical Mastectomy. Twenty-four patients were enrolled in the study divided into 12 patients in each group.

Results

There was a statistically significant difference between 2 groups according to post-operative visual analogue scale. It was lower in consumption in group B than in group A. Also a statistically significant difference between group A and group B according to first time of rescue morphine consumption was found, it was longer time to need postoperative morphine consumption in group B than in group A And we found the addition of 300 mg of magnesium sulfate to bupivacaine in an ultrasound-guided Pectoral Nerve Block significantly prolong the duration of the analgesia, and reduce the VAS score without significant side effects after Modified Radical Mastectomy under general anesthesia.

Conclusion

The addition of 300 mg of magnesium sulfate to bupivacaine in an ultrasound-guided Pectoral Nerve Block significantly prolong the duration of the analgesia, and reduce the VAS score without significant side effects after Modified Radical Mastectomy under general anesthesia
Using of Oral Midodrine in Weaning of Intravenous Vasopressors in Patients with Septic Shock Admitted to ICU
Authors: Basiouny Mohsen Abd El-Ghany , Samir Ghada Mohamed , Ibrahim Ahmed Farouk , Mahmoud Mohammed Ali Mohammed
Published: August 2023

Background

Septic shock is the most severe form of sepsis, in which profound underlying abnormalities in circulatory and cellular/metabolic parameters lead to substantially increased mortality. Diagnosis of septic shock is based on presence of certain symtoms, signs & there is also many Biomarkers which are essential for Diagnosis and Prognosis of Sepsis patients like CRP, Prolactin & BNP.

Objective

To assess whether the use of adjunctive oral midodrine in patients with vasopressordependent hypotension reduces the time to cessation of intravenous vasopressor.

Patients and Methods

In order to achieve this aim, we included a total of 140 patients admitted to the ICU unit at Ain Shams University Hospitals who developed septic shock and required IV vasopressors. Patients were divided into 2 groups: Group (A): consists of 70 patients who will receive IV vasopressors only (control group). Group (B): consists of 70 patients who will receive IV vasopressors with adjunctive oral midodrine (midodrine group) or (case group).

Results

In our study there were no significant differences among patient’s demographics, clinical and hemodynamic parameters suggesting so that the observed results were not secondary to baseline group characteristics. Our results indicate that use of oral midodrine during recovery from septic shock has no effect on the duration and weaning of IV vasopressor infusions. Although the previous parameters were lower in the IV vasopressor with midodrine group compared with the IV vasopressor only group, but the differences weren't significant. The IV vasopressor duration in hours was (139.65 ± 46.21 VS 141.30 ± 79.00) and the IV vasopressor weaning duration in hours was (65.37 ± 13.94 VS 73.20 ± 35.78). These insignificant results may be attributed to the absence of special protocol for vasopressor weaning in the unit, in addition to the obligatory and temporary stoppage of vasopressor weaning when hemodynamic instability occurs (MAP ≤65 mmHg or SBP < 90 mmHg, low urine output < 0.5 ml/kg/h). Our results are inconsistent with most of studies that have demonstrated that midodrine use was associated with a rapid and effective wean from IV vasopressors.

Conclusion

Use of midodrine doesn't reduce duration of IV vasopressor infusion and weaning during the recovery phase of septic shock. Use of midodrine has no impact on overall survival, length of ICU stay and ICU mortality. Administration of midodrine improved MAP in midodrine group.
Ultrasound Guided Fascia Iliaca Block versus Femoral Nerve Block for Post Operative Analgesia for Patient Undergoing Total Knee Arthroplasty
Authors: Gadalla Raouf Ramzy , Daniel Reham Fathy Galal Samuel Habachi , Ahmed Nermeen Shawky
Published: August 2023

Background

Total knee arthroplasty (TKA) is commonly performed in patients with end-stage osteoarthritis or rheumatic arthritis of the knee to relieve joint pain, increase mobility, and improve quality of life. Multimodal techniques featuring peripheral nerve blocks have demonstrated a significant advantage in perioperative pain relief for TKA patients. Peripheral nerve blocks have gained more attention because of the discovery of new and more trustworthy anesthesia medications and developments in technology and anesthesia. Peripheral nerve blocks can also be used for anesthesia of the operation area and are commonly used for postoperative analgesia being with general anesthesia.

Aim of the Study

To compare the effect of Fascia iliaca versus femoral nerve block on postoperative anaelgesia in patients undergoing TKA.

Patients and Methods

This is a prospective randomized clinical trial study was conducted in Ain Shams University Hospitals within a period of 6 months. Seventy adult patients scheduled for total hip arthroplasty (THA), under spinal anesthesia were included in this study and randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group I (FICB group) received ultrasound guided Fascia iliaca compartment block (FICB) and Group II (FNB group) received ultrasound guided femoral nerve block.

Results

There was a statistically significant mean in FNB group compared to FIB group according to VAS score after 6 hrs postoperative and shows significant higher mean in FNB group after 12 hrs and 24 hrs postoperative. Also, a statistically significant increase mean/hrs in FIB group compared to FNB group was found according to first time to ask analgesia and also shows statistically significant higher mean in FNB group compared to FIB group according to total pethidine given (mg).

At PACU arrival there is no difference between two groups as two groups were recovering from anesthesia then fascia illiaca block group showed the best response as regard as pain control post operatively for 12 hours postoperative then there is no statistical difference between two groups. There was statistically significant difference between groups as regard as visual analog score. As regard to total dose of morphine used in each group, facia illiaca block scientifically used less amount of morphine than control group (P < 0.001).

Conclusion

The fascia iliaca block and femoral nerve block provide the same analgesic effect during early post operative period; however after 6 hrs, fascia iliaca block provides a more efficient pain control and less morphine consumption.
Ultrasound Guided Oblique Subcostal Tranversus Abdominis Plane Block (TAP) versus both Subcostal and Posterior TAP Block as Postoperative Analgesia in Hepatectomy
Authors: Lateef Fahmy Saad , Hosny Mona Refaat , Ezzat Ahmed Wagih , Abdelhalim Rana Ayman Mohamed
Published: August 2023

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.

Aim of the Work

The aim of this study is to determine the postoperative analgesic effect of ultrasound guided TAP block via oblique subcostal and posterior approaches in hepatectomy.

Patients and Methods

The study was conducted on 40 randomly chosen patients aged 40 to 60 years old, American Society of Anesthesiologists (ASA) class II and III scheduled for hepatectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 20 patients each: Subcostal TAP block Group: received general anesthesia and 30 ml (10 ml bupivacaine 0.25%, 10 ml lidocaine, 1 gm magnesium and 4 mg dexamethasone) by oblique subcostal approach under ultrasound guidance. Subcostal- posterior TAP block Group: received general anesthesia and with injection of same solution as in the first group in both approaches divided equally between them “ without exceeding the toxic dose “ with total volume 60 ml.

Results

The results of the study revealed that the Patients who received only subcostal TAP block had significantly lower pain scores for 24 h after operation and decreased total need of analgesic in first 24 h post operative compared with patients who received combination of subcostal and posterior TAP.

Conclusion

Combination of Oblique Subcostal TAP block with posterior TAP block was more effective in reducing postoperative pain and analgesic consumption after hepatectomy under general anesthesia, compared to subcostal TAP block only.
A Comparative Study between Non-Invasive Continuous Positive Airway Pressure Ventilation and High Flow Nasal Cannula Oxygenation among COVID-19 Patients with Acute Hypoxemic Respiratory Failure
Authors: Shehab-eldin Sara Osama Tawfik , Zaki Mohamed Sidky Mahmoud , Mahmoud Noura Mohamed Youssri Ahmed , Mohamed Ahmed Moustafa Mohamed
Published: August 2023

Background

Both non-invasive continuous positive airway pressure ventilation (NIV CPAP) and high flow nasal cannula oxygenation (HFNC) are beneficial in patients with acute hypoxemic respiratory failure. COVID-19 is a pandemic infectious disease caused by the coronavirus with a variable clinical picture. This study compares NIV CPAP and HFNC oxygenation in maintaining adequate ventilation, oxygenation and prevention or delaying endotracheal intubation and invasive mechanical ventilation in COVID-19 patients with acute hypoxemic respiratory failure.

Objective

To study the effect of NIV CPAP versus HFNC oxygenation among COVID-19 patients with acute hypoxemic respiratory failure in maintaining adequate ventilation, oxygenation and prevention or delaying endotracheal intubation when conventional oxygen therapy (COT) fails to maintain adequate oxygenation.

Patients and Methods

Our study compares the effect of NIV CPAP versus HFNC oxygenation among COVID-19 patients with acute hypoxemic respiratory failure in maintaining adequate ventilation, oxygenation and prevention or delaying endotracheal intubation when conventional oxygen therapy (COT) fails to maintain adequate oxygenation.

Results

Results showed a significant improvement in most of patients whether using NIV or HFNC and delaying intubation, with superiority of NIV over HFNC specially as regard oxygenation in terms of PaO2/FiO2. As regard invasive ventilation free days NIV-CPAP use yielded a mean invasive ventilation free days of statistically significant longer duration than HFNC group. While comparison between both groups showed that there was no significant difference as regard ICU stay days or mortality rate.

Conclusion

We concluded that both NI-CPAP and HFNC therapy are effective measures in respiratory support and management of acute hypoxemic respiratory failure caused by COVID-19. This is proved by improvement in oxygenation and ventilation after treatment with both NI-CPAP and HFNC which is evident by increase in both peripheral oxygen saturation (SpaO2) and PaO2/FiO2 ratio with lower both respiratory rates and PaCO2. This makes them as an excellent alternative to prevent or postpone invasive mechanical ventilation as a standalone therapy and as a bridge for respiratory recovery. This is especially important in limited resources in face of worldwide outbreak.
Efficacy of Dexamethasone in Attenuation of Postinduction Hypotension in Geriatric Patients Undergoing General Anesthesia: A Randomized Controlled Trial
Authors: Fawaz Ahmed Ali , Esmat Ibrahim Mamdouh , Hasseb Ahmad Mahmoud , Ashoor Tarek Mohamed , Labib Shenouda Nabih
Published: August 2023

Background

Postinduction hypotension is a common problem that faces anesthesiologists on a daily basis, with incidence ranging from 25% to 67.5% when propofol is used as an induction agent. Post-induction Hypotension is even more common in the elder population because increase in age is an independent predictor of intraoperative hypotension as a result of the diminished cardiovascular reserves.

Aim of the Work

This study assessed the efficacy of dexamethasone to alleviate the drop in blood pressure after induction of anesthesia. All patients were informed of their participation in the study and written consents were taken. They were assessed preoperatively by careful history taking, full physical examination, and laboratory evaluation.

Patients and Methods

A Prospective randomized clinical study in Ain-Shams University hospitals, Cairo, Egypt form June 15, 2021 to October 15, 2021 on 100 randomly chosen patients aged ≥ 60 years, American Society of Anesthesiologists (ASA) class I or II who were scheduled for elective 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 the Patients who received preoperative dexamethasone had a significantly less incidence of hypotension, nausea, vomiting and shivering. Accordingly, ephedrine and IV fluid boluses were less frequently needed.

Conclusion

A single 8 mg IV dexamethasone given two hours preoperatively was able to decrease the incidence of postinduction hypotension in geriatric patients undergoing general anesthesia, leading to decreased use of ephedrine and IV fluid boluses. In addition, a significantly fewer percentage of patients developed nausea, vomiting and shivering after surgery than those who didn’t receive the drug.
Preoperative Ultrasound Assessment of Residual Gastric Volume in Patients with Delayed Gastric Emptying Undergoing Elective Surgeries
Authors: Bekheet Verina F Z , A Elewa Gamal M , Abdelaal Wail A M , Abdel Hamid Faisal S
Published: August 2023

Background

One of the main problems facing anesthesiologists during anesthesia is delayed gastric emptying which may contribute to pulmonary aspiration. Perioperative aspiration of gastric contents is a rare but serious complication of anesthesia. Pulmonary aspiration is involved in up to 9% of all anesthesia-related deaths. One of the main risk factors for aspiration is the presence of residual gastric fluid at the time of anesthetic induction. It was demonstrated that bedside utrasonography can provide reliable qualitative and quantitative information about the nature (fluid or solid) and volume of gastric content.

Aim of the Work

To provide a qualitative description of the sonographic appearance of the gastric antrum in fasted patients with delayed gastric emptying undergoing elective surgery by proposing a grading system of the gastric antrum based exclusively on qualitative findings and correlation with the quantitative predicted gastric volume by the known formula prescribed for persons without delayed gastric emptying.

Patients and Method

This cross-sectional study was conducted at Ain Shams University Hospitals. Using ultrasonography, gastric contents was evaluated in 85 patients, with delayed gastric emptying, scheduled for elective surgeries before induction of anesthesia.

Results

Our study involved 85 patients, with age ranging from 25-66 years old, 49 of them were females and 36 were males, with BMI ranging from 28-35 Kg/m2.The most common surgeries involved were general surgeries especially laparoscopic cholecystectomy, with associated comorbidities such as diabetes, hypertension, smoking, hypothyroid, chronic kidney disease, rheumatoid arthritis. Ultrasonography showed that 46 of patients were Grade 0 with stomach empty in both supine and right lateral decubitus (RLD) and 36 were Grade 1 with stomach empty in supine but contains fluid in RLD and 3 patients in Grade 2 were stomach contains fluid in both supine and RLD or contains solid content.

Conclusion

Bedside ultrasound is of a good value in estimating the gastric volume and content in patients with delayed gastric emptying.
The Possible Protective Effect of Resveratrol on Naphthalene Induced Nephrotoxicity in Adult Male Albino Rat
Authors: Eltanany Mohammed Nabil , Hamid Hemmat Abdel Kader Abdel , Rofael Mervat Thabet , Sonbol Mohamed Mostafa
Published: August 2023

Background

Resveratrol, a natural polyphenolic compound that is extensively stemmed from grapes, berries, red wine, and peanut skins, is reported with its pharmacological activities against numerous cardiovascular and renal diseases, inflammation, anti-oxidation and cancers. Naphthalene (NA) is a common environmental hazardous contaminant and is abundant in tobacco smoking, in addition to various exposures.

Aim of Work

the aim of the present work was to study the possible protective effect of Resveratrol on Naphthalene induced nephrotoxicity in adult male albino rat.

Materials and Methods

36 Adult male albino rats were assigned randomly into three groups; control group, it was further subdivided into four subgroups (IA received no treatment, IB received Resveratrol 10 mg/kg/day, IC received corn oil 5 mg/kg/day and ID received Propylene glycol), NA group (rats received 200 mg/kg of NA dissolved in 5 ml/kg corn oil daily for four weeks, orally), and Resveratrol protected group (rats received Resveratrol dissolved in propylene glycol at a dose 10 mg/kg followed after 60 min with Naphthalene at a dose 200 mg/kg dissolved in 5 ml/kg corn oil daily for four weeks). At the end of experiment (30 days), rats were euthanized, and kidney specimens were processed into paraffin blocks for light microscopic examination. Morphometric study and statistical analysis were done.

Results

The present work demonstrated that NA induced several histopathological changes of the kidneys in terms of cortex and medulla. Distorted renal capsule, thickened glomerular basement membrane, scattered small-sized and hypercellular glomeruli with apoptotic cells and narrow Bowman’s spaces. Proximal tubules and the distal tubules showed markedly apoptotic epithelial lining with pyknotic nuclei, partial loss of brush borders, vacuolations and intra-tubular hyaline casts. Congested interstitial blood vessels, peri-vascular edema, massive inflammatory infiltrate and dense collagen distribution. Renal medulla showed collecting tubules with apoptotic epithelial lining with pyknotic nuclei and intratubular hyaline casts. Findings were demonstrated by histomorphometry. Resveratrol protected group showed histopathological findings significantly reduced compared with NA group. Reduced number of scattered small-sized glomeruli with less thickened glomerular basement membrane. The proximal tubules and distal tubules appeared with less apoptotic epithelial lining, fewer pyknotic nuclei and preserved brush borders and interstitium with fair collagen deposition. The medullary regions showed collecting tubules with mostly normal epithelial lining and reduced inflammatory infiltrate.

Conclusion

The present study demonstrated the deleterious effects of NA on the structure of the kidney. It also suggested the protective role of Resveratrol against the nephrotoxicity.
The Relationship between Visceral Adiposity Form of Non-Alcoholic Fatty Liver Disease and Increased Epicardial Adipose Tissue Mass with Coronary Artery Disease
Authors: Hamed Ahmed S , Attia Sameh , Samir Hany , Zeidan Hanan H , Demerdash Salah E L
Published: August 2023

Background

Cardiovascular disease is the largest cause of death in the world, and coronary artery disease (CAD) makes up the greatest proportion of those deaths that may enable more sensitive measures for risk stratification, or offer novel therapeutic targets for the prevention and treatment of coronary vascular disease.

Aim of the Work

to determine the association between visceral adiposity form of non-alcoholic fatty liver and increased Epicardial adipose tissue mass with coronary artery disease severity.

Patients and Methods

This study was conducted on fifty patients presented with signs and symptoms of coronary artery disease who were coming for elective coronary angiography at cardiovascular outpatient clinic in the internal medicine hospital, Ain Shams University from March 2018 to October 2018.

Results

In two patients with severe steatosis (Grade 3) the average thickness of long and short axes was detected 9.600 ± 0.141 mm. Average of 12 patients with no steatosis, Epicardial fat thickness was 6.323 ± 0.754 mm. In our study, Non critical coronary artery disease (below the 50% stenosis) was detected in eight patients (16 %). While critical coronary artery disease (Above the 50% stenosis) was detected in forty two patients (84%). According to the severity of coronary artery disease, in patients who do not have significant stenosis, EAT mean thickness was found 5.600± 0.400 mm measured. In patients with severe stenosis coronary artery disease, this value was measured as 7.857 ± 0.707 mm. In our study, Hypertension, diabetes mellitus and dyslipidemia (represented by LDL-c) were found to have statistically significant relations and correlation with EAT, but it was found that there was no statistically significant relationship between NAFLD fibrosis scoring system and FIB-4 with CAD. In this study, it was found a statistically significant relationship between the severity of NAFLD and CAD and a similar relationship between EAT and CAD.

Conclusion

Epicardial fat deposition is part of the same metabolic disorders associated with the development of fatty liver in individuals with insulin resistance and metabolic syndrome. High EAT may represent a marker of the severity of visceral adiposity as well as an independent predictor of cardiovascular and coronaries diseases risk.
Effect of Cardiac Rehabilitation on Post Exercise Systolic Blood Pressure Recovery in Patients with Impaired Left Ventricular Ejection Fraction after Recent Myocardial Infarction
Authors: Mohamad Almoatasem , Karem Khalid , Khorshid Hazem
Published: August 2023

Background

Ischemic Heart diseases (IHD) are significant causes of morbidity and mortality worldwide with an estimated 9 million deaths each year. Exercise-based Cardiac Rehabilitation (CR) is one of the most important and cost-effective aspects of secondary prevention in patients with IHD. Post-exercise Systolic Blood Pressure Recovery (SBPR) represents an important hemodynamic parameter that is associated with the risk and severity of ischemic artery disease and future cardiovascular events.

Aim of the Work

The aim of this study is to assess the effect of CR on post-exercise SBPR in patients with Left Ventricular Ejection fraction less than 45% following a recent Myocardial Infarction.

Patients and Methods

this study included patients with Left Ventricular Ejection fraction less than 45% following a recent Myocardial Infarction, presenting to Cardiac Rehabilitation Units. the study included two groups of patients. Study group included Patients on optimal medical treatment who are attending CR sessions, and control group included patients on optimal medical treatment who refused or failed to attend more than 50% of cardiac rehabilitation sessions. SBPR was assessed in each patient before and after the CR program.

Results

When compared to baseline findings, both groups had statistically significant improvement in LVEF, resting SBP, recovery SBP value and HRR. However, CR group had better improvement in LVEF, lower Resting SBP, lower Peak SBP, Better SBP recovery ratio and better HRR outcomes when compared to the changes in the control group.

Conclusions

Cardiac Rehabilitation after recent Ischemic coronary artery event can provide significant improvement in Systolic blood pressure recovery and heart rate recovery which are important haemodynamic parameters that are associated with the significance and severity of future cardiovascular events.

Abbreviations

IHD: Ischemic Heart Disease; CR: Cardiac Rehabilitation; LVEF: Left Ventricular Ejection fraction; SBP: Systolic Blood Pressure
The Relationship between Loading of a High Dose Atorvastatin and No Reflow in STEMI Patients Undergoing Primary PCI
Authors: Mohammed Amr Magdi , Kamal Bassam Sobhy , Fouad Khaled Ahmed
Published: August 2023

Background

Worldwide, ischemic heart disease is the single most common cause of death and its frequency is increasing. STEMI is a significant cause of morbidity and mortality in patients with coronary heart disease.

Aim of the Work

The aim of our study was to assess the impact of high dose atorvastatin loading before primary PCI in patients presenting with acute STEMI on No-reflow and MACE at 1 month follow up.

Patients and Methods

This is a randomized control clinical trial based at the coronary care units & coronary catheterization lab unit of the cardiology department in Ain Shams University Hospitals. Patients who presented, between April 2021 to October 2021, with STEMI and undergoing primary percutaneous coronary intervention were allocated to the study and divided into 2 groups: Study group: received high intensity statin (80 mg of Atorvastatin) besides guideline recommended therapy before primary PCI, Control group: received guideline recommended therapy before primary PCI.

Results

Results for age, gender, hypertension, Diabetes and smoking did not show any statistical significance between the control and study groups. There was a statistically significant improvement in study group compared to control group in No-reflow (28% vs 47%) with a P-value of 0.006; primarily derived by improvement in MBG (0-1: 28% vs 43%, 2-3: 72% vs 57%) with a P-value 0.027, and improvement in EF at 24 h after PCI (Mean±SD 48.35 ± 8.78 vs 45.20 ± 7.89) with a P-value of 0.008 and at 1 month follow up (43% vs 20%) with a P-value of 0.039, but it did not have a significant impact on MACE at 1 month follow up.

Conclusion

Our study concluded that high dose atorvastatin loading before primary PCI resulted in improved post-procedural MBG, no-reflow and Ejection fraction as measured by bi-plane Simpson's method but did not decrease in MACE at 1 month follow up. Based on the results of this study, we highly recommend the routine use of high dose atorvastatin before primary PCI in patients presenting with STEMI.

Abbreviations

ACS: Acute coronary syndrome; BP: Blood pressure; ECG:. Electrocardiography; ESC: European society of cardiology; EF: Ejection fraction; MACE: Major adverse cardiac events; MBG: Myocardial blush grade; MRI: Magnetic resonance imaging; PCI: Percutaneous coronary intervention; SPSS: Statistical Package for Social Science; STEMI: ST segment elevation myocardial infarction; STR: ST segment resolution; TIMI: Thrombolysis in myocardial infarction
Detection of Early Cardiac Affection in Post-COVID Syndrome Using Heart Rate Variability and 2D Global Longitudinal Strain Echocardiographic Assessment of the Left Ventricle
Authors: Fouad Mirna Bassem , Fahmy Zainab Abdel Salam , Noureldin Amira Ahmed
Published: August 2023

Aim and objectives

The aim of our study is to estimate the Heart Rate Variability (HRV) & two-dimensional global longitudinal strain (GLS) by speckle tracking echocardiography (2D STE) in post-COVID-19 patients after mild to moderate acute SARS COV-2 infection.

Patients and Methods

This study included fifty consecutive subjects between 17 & 82 years of age who were symptomatic after three weeks up to 3 months of experiencing mild to moderate COVID19 illness according to the CDC criteria of severity. Patients enrolled were coming for follow-up clinic visits at Ain Shams University Hospitals between June 2021- Jan2022. All patients had normal LVEF upon enrollment as assessed by M-mode and Modified Simpson's method. 2D Left Ventricular Global Longitudinal Strain (GLS) and 24-hours Holter monitoring were performed for all patients.

Results

The LVGLS and HRV were significantly impaired in the symptomatic post-COVID-19. LVGLS was below -16 in 20% of the patients while 22% were in the grey zone; between -18 and -16. SDNN was decreased (< 100 msec) in 24% of the patients. RMSSD values favored a mean below 40 msec with prevalence of 58% among the study population. LF/HF ratio was above 2 in 42% of the patients. Our research suggested a highly significant association between LVGLS and HRV; as 66.7% of patients with decreased SDNN had impaired LVGLS, as opposed to 33% who had normal LVGLS (p-value 0.000)

Conclusion

LVGLS measured by Speckle Tracking Echocardiography (STE) is an important bedside tool, alternative to CMR which is the gold standard, in assessing LV systolic functions post COVID-19. HRV can explain a lot of post- COVID symptoms attributed to dysautonomia. In our study, we targeted the patients having prolonged symptoms after COVID-19 illness, GLS and HRV were assessed trying to explain the cardiac involvement and if it is the cause of the so called" long COVID". We found high incidence of GLS impairment using STE as well as significant prevalence of diminished HRV. HRV (especially SDNN) and GLS were significantly correlated as 80% of the patients with impaired GLS had decreased SDNN (p-value 0.00).