bluuebunny/crossref_metadata_2025 huggingface dataset:
Pleural Ultrasonography versus Chest Radiography for the Diagnosis of Pneumothorax
Authors: Salah Amir Ibrahim , El- Serwi Heba Bahaa el-Dien , Ansary Amin Mohammad Al , Houssien Ahmed Badawy Ibrahim
Published: October 2021

Background

Pneumothorax (PTX) is an emergency that requires urgent management to avoid catastrophic consequences. PTX is also an important cause of respiratory failure in the emergency department, and may occur frequently as a complication of central venous catheter insertion.

Aim

The aim of this study is to compare the diagnostic accuracy of bedside lung US with those for anteroposterior (AP) chest X ray (CXR) for the detection of PTX in critically ill patients.

Methods

This study was conducted on fifty adult patients from both sexes, mechanically ventilated at least 48 hours and planned for central line insertion. We excluded overt pneumothorax, patients requiring immediate invasive intervention, pregnancy and lactation. Lung ultrasound was done to all patients after 30 minutes from central line insertion followed by CXR to confirm the diagnosis of pneumothorax. Pneumothorax was confirmed using CT chest.

Results

Results showed that ultrasound is superior to chest X Ray in detection of PTX.Ultrasound showed sensitivity of 94.87%, specificity of 81.82%, positive predictive value of 94.87%, negative predictive value of 21.82% and accuracy of 92.0% in detection of PTX, while Chest X Ray showed sensitivity of 76.92%, specificity of 63.64%, positive predictive value of 88.24%, negative predictive value of 43.75% and accuracy of 74.0% in detection of PTX.

Conclusions

In conclusion, US represent a good approach for the evaluation of PTX, with advantages of timeliness, high accuracy and high reliability.
Soluble MICA versus Troponin as Early snd Specific Predictor for Acute Myocardial Infarction in Patients with Chronic Kidney Disease
Authors: Ali Rania M , Elsaid Amr M , El Shaer Ahmed I , Abd El-Hafiz Rania H
Published: October 2021

Background

Accurate early detection & early management of MI as a life threatening condition in patients with CKD , who are more likely than those without it to have elevated troponin levels still challenging. Recently, MICA could be activated in the normal tissues by a variety of stimuli, such as ischemia/reperfusion-induced tissue injury.

Aim of the Work

To compare sensitivity and specificity of serum sMICA to that of Troponin for early and accurate diagnosis of AMI in patients with CKD.

Patients and Methods

Total 30 patients was enrolled in the study and divided into 2 groups A & B (15 for each one) in NHI , cTnI and sMICA was assayed in both groups; in the group A,cTnI & sMICA was assayed serially according to time from arrival of the patient to ED (0 hour , 3 hours, 6 hours, 12 hours, and 24 hours ) and recording the pattern of rising, peaking & falling of both biomarkers.. ‘

Results

At zero hour both markers were positive serum level in both groups but lower in sMICA then pattern of rising and peaking of sMICA was early than TnI in AMI group which peaks later.

Conclusion

sMICA could be considered as a novel predictor that more sensitive and specific than cTnI.
A comparative study between Levobupivacaine alone and in combination with Dexmedetomidine in caudal analgesia of hernia repair in pediatrics
Authors: Kamar Ahmed K , Awad Hala G , Awad Hanan Mahmoud F , Maarouf Mohammed M
Published: October 2021

Background

Inguinal hernia repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery.

Aim of the Work

to examine the effect of Dexmedetomidine as an adjuvant to Levobupivacaine in caudal anesthesia, mainly its effect in enhancing and prolonging post-operative analgesia.

Patients and Methods

The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group A: Patients in this group received caudal anesthesia with Levobupivacaine 0.25% at a dose of 2 mg·kg−1 (0.8 ml·kg−1) before the beginning of the procedure. Group B: Patients in this group received Levobupivacaine 0.25% at a dose of 2 mg·kg−1 (0.8 ml·kg−1) in addition to Dexmedetomidine 1 μg·kg−1 in 1 ml normal saline before the beginning of the procedure.

Results

The results of the study revealed that there was significant reduction in FLACC score in group B at 4, 8, and 12 hours postoperatively compared to group A, at the twenty-fourth hour there was no significant difference. Regarding the duration of analgesia postoperatively we found statistically significant increase in group B compared to that in group A (p-value <0.001). Regarding the number of doses of analgesia required post operatively (Paracetamol 15ml/kg/dose) there was a statistically significant decrease in patients requirement in group B compared to that in group A (p-value <0.001).

Conclusion

Dexmedetomidine as adjuvant to Levobupivacaine provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal analgesia using Levobupivacaine alone in children undergoing hernia repair.
Efficacy of Atorvastatin in Prevention of Contrast induced Nephropathy in Patients Undergoing Coronary Angiography
Authors: Kamaly Ayman Mokhtar , Samir Ghada Mohamed , Fahim Hany Magdy , Gaber Mahmoud Amira Mohamed
Published: October 2021

Background

The use of radiocontrast media has increased greatly from the past decades for diagnostic radiography and interventional procedures and it is estimated that approximately 60 million people in the world are used radiocontrast media each year.

Objective

The aim of this study was to evaluate the efficacy of atorvastatin (ATN) 80 mg in the prevention of CIN in patients undergoing angiography.

Patients and Methods

This study was a prospective, two‑arm, parallel group, controlled, clinical trial. This study has been performed on 100 Egyptian patients. Patients of either sex and aged between 21 and 65 years admitted for coronary angiography from January 2019 to June 2019, the patients had serum cretinine between 1 and 1.5 mg/dl or estimated glomerular filtration rate (eGFR > 60 ml/min/1.73m2) and suffering from controlled DM or HTN.

Results

As regard to prevalence of contrast nephropathy, in our study we found that the total prevalence was 13%. We have concluded a great effect of diabetes on development of contrast nephropathy. We have concluded a great effect of hypertension on development of contrast nephropathy. There was a great effect of number of vessels affected on development of contrast nephropathy. As regard FBS there was no significant difference between the two groups. Also, there was a highly significant positive correlation between and study markers of acute kidney injury (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR) and FBS. As regard Contrast media dose there was no significant difference between the two groups. Also, there was a highly significant positive correlation between and study markers of acute kidney injury (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR) and contrast media dose. In our study there was a highly significant difference between the two groups as regard study markers of evidence of contrast nephropathy (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR).Also, there was a great effect of on development of contrast nephropathy. In our study there was a highly significant difference between the two groups as regard study markers of evidence of contrast nephropathy (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR).Also, there was a great effect of on development of contrast nephropathy.

Conclusion

There was a beneficial significant effect of statin on prevention of contrast nephropathy, also we concluded that age, hypertension, DM, dyslipidaemia, FBS, hemoglobin level, serum uric acid and dose of contrast media are major risk factors for developing contrast nephropathy.
A comparative study between the effect of Aminophylline, Neostigmine and Gabapentin on prevention of post dural puncture headache after cesarean section
Authors: Saafan Asmaa Abd Elfattah , Mahmoud Zaki Mohammed Sidky , Ghaly Safaa Ishak , Ahmed Youssef Ahmed Moneir
Published: October 2021

Objectives

Post dural puncture headache (PDPH), since it is first described by August Bier in 1898, remains a common complication in spinal anesthesia (SA). Many pharmacological agents are suggested for PDPH management as acetaminophen, caffeine, non-steroidal antiinflammatory drugs, corticosteroids, and sumatriptan.

Aim

The aim of this study is to compare between the prophylactic effect of each of; aminophylline, gabapentin, and neostigmine added to atropine on the occurrence of PDPH after caesarean section (CS) under SA.

Subjects and Methods

This prospective randomized controlled clinical study was carried out 75 pregnant female patients 20-40 y, 60-100 kg. ASA physical status II undergoing elective CS. Patients were randomly divided into 3 groups (25 patients in each); group A: received 250 mg aminophylline IV immediately after delivery of the infant, group B: received IV neostigmine 20 µg/kg added to atropine 10 µg/kg immediately after delivery of the infant and group C: received 3 capsules gabapentin 300 mg; the 1st before SA by 2 h with sip of water, the 2nd after CS by 6 h and the 3rd after 14 h from CS.

Results

The incidence of PDPH was lower in group A (8% vs 40% in group B and 24% in group C. The onset of PDPH was significantly delayed in group C than group A and in group C than B, but insignificant between group A and B. The duration of PDPH and total dose of analgesic requirement was significantly lower in group A than group B and C and in group B than C. Heart rate (HR) showed significant increase in group A (post aminophylline than pre) only. HR in the other groups and mean arterial blood pressure showed insignificant difference among the three groups (between pre and post administration of drugs). As regards VAS, there was no significant difference in the three groups at 3 h. There was significant difference among the three groups at 6, 12, 24, 36, 48 and 72 h. (between group A & B from 24h up to 72h, between group A & C from 6 up to 72h and between group B & C at 6 h only (delayed onset with neostigmine)). Side effects were minimal and tolerable.

Conclusion

Aminophylline reduced the incidence and duration of PDPH after CS under SA more than gabapentin and neostigmine with less analgesic requirement and minimal side effects. Also, neostigmine was superior than gabapentin in delaying the onset and decreasing the duration of PDPH.
A Comparative study between Dexmedetomidine versus Propofol for sedation in upper GI endoscopy procedure considering effect on intraoperative vital data, patient amnesia and onset of recovery after the procedure
Authors: Elsamahi Eslam Ahmed Mohamed , Ghobrail Bassem P , Samir Ghada Mohamed , Zaki Hany Victor
Published: October 2021

Background

In the modern medicine, upper gastrointestinal endoscopy has become a definitive tool for diagnosis and management of many diseases. It is usually preformed in separate unit as day-case procedure and for outpatient clinic. The search of a safe and effective sedation for these patients is still an open topic.

Objective

The aim of the study is to compare the use of propofol and dexmedetomedine in upper GI endoscopy regarding the hemodynamics, sedative effect and the patient satisfaction.

Methods

Double – blinded, randomized controlled trial with allocation ratio 1:1 arranged in two parallel groups. This study was conducted in the endoscopy unit of Ainshams University Hospital, Cairo, Egypt within a period of 6 months started from April 2019. All recruited patients were adults undergoing upper gastrointestinal endoscopy. They were included in the study according to the following criteria: Age 21-60 years; elective procedures under general anesthesia with patients who completed eight hours of fasting; and physical Status: ASA I and II Patients after taking written and informed consent.

Results

Concerning the results of the study, there was no statistically significant difference considering the heart rate in relation to base line readings. The changes of heart rate between the two groups were significantly different with dexmedetomidine associated with lower readings. Respiratory rate and oxygen saturation were insignificantly different in both groups. Time of induction was significantly shorter in propofol than dexmedetomidine (P < 0.001) and time to reach full recovery identified by modified Alderete’s score 10/10 was significantly shorter in dexmedetomidine than propofol (P < 0.014). There was a significant difference between the two dugs concerning the patients and endoscopists satisfaction. The patients were more satisfied with propofol (P 0.047), while the endoscopists were more satisfied with dexmedetomidine (P 0.034).

Conclusion

Dexmedetomidine and propofol are equally effective and safe to provide enough sedation for upper gastrointestinal endoscopy in a day-case manner. Advantages of dexmedetomidine were providing analgesic effect, rapid recovery from sedation and stability of respiratory rate and oxygen saturation. However, there were some disadvantages such as the bradycardia and patient dissatisfaction although the bradycardia can be utilized in cardiac patients as a safety factor against myocardial ischemia. Other point noticed that using dexmedetomidine for sedation was more costly than propofol and requires the usage of a syringe pump for accurate dosing. On the contrary, propofol is cheap and available in all centers with rabid onset of induction but it causes hypotension and respiratory depression which might be risky in cardiac patients.
Red cell Distribution Width as a Prognostic Predictor in Ventilator Associated Pneumonia
Authors: Fawzi Hazem Mohamed Abd El Rahman , Said Sherif George Anis , Saleh Ashraf Nabil , Elnabi Heba Osama Abd
Published: October 2021

Background

Ventilator-associated pneumonia (VAP) is the most frequent life-threatening nosocomial infection in intensive care units. It develops in patients mechanically ventilated for at least 48 hours.

Objective

To evaluate if red cell distribution width has a prognostic value in ventilator associated pneumonia.

Patients and Methods

This retrospective study included adult patients (> 18 years) who were admitted to ICU and mechanically ventilated a total of 50 patients who were divided into 2 groups: Group 1 (includes 25 patients): patients who were mechanically ventilated then developed ventilator associated pneumonia. Group 2 (includes 25 controls): patients who were mechanically ventilated didn't develop pneumonia during course of ventilation.

Results

In the current study RDW (red cell distribution width) is significantly higher in patients with pneumonia at the end of the study, also RDW is significantly higher in poor outcome in all study patients regardless developed pneumonia or not during MV.

Conclusion

RDW is used as an inexpensive index that is routinely reported as a part of the complete blood count, RDW is an important marker for both diagnostic and prognostic purposes in all cause mortality in ICU patients not specifically in mechanically ventilated patients. Larger studies and clinical trials are recommended to determine the clinical outcome of RDW prognostic value in VAP.
Effects of Delayed Supine Positioning after Induction of Subarachnoid Block on Post-spinal Hemodynamic Changes Compared to Traditional Subarachnoid Block: prospective observational randomized controlled dose response clinical study
Authors: Elhalim Moustafa Karim saad Abd , Salama Hala Gomaa , Anis Sherif George , Elrazik Rehab Abd Elfattah Abd
Published: October 2021

Background

This is a prospective observational study to examine if the delayed supine positioning after induction of subarachnoid block will be of value in minimizing hemodynamic derangement following subarachnoidblock for knee Arthroscopein the teaching hospital of Misr University for science and technology

Methods

Fifty healthy patients are undergoing knee Arthroscope under spinal Anesthesia were randomized into 2 groups Group A(immediate supine position after Subarachnoid block) and Group B (delayed supine position after Subarachnoid block by 2.5 minutes) each group includes 25 patients. After the injection of local anaesthetic, Heart rate (HR), non-invasive blood pressure (Systolic Blood pressure (SBP), diastolic Blood pressure (DBP) and mean blood pressure(MBP)) were measured at 3 min intervals for the first 15 min following administration of local anaesthetic, and then every 5 min until completion of the surgical intervention.

Results

Hemodynamic readings (SBP, DBP, MBP, HR) showed more stability in Group(B) than Group(A), group(A) showed higher anesthetic sensory level but adequate anesthetic sensory level to perform Knee Arthroscope surgery was achieved in group (B)

Conclusion

Under the conditions of this study delayed supine positioning after induction of SAB for 2.5 minutes is of great value in gaining an adequate level of anesthesia with more hemodynamic stability and less vasopressor need as a management of hypotension compared to the conventional SAB in Knee Arthroscope surgery.
A Comparative Study between Intrathecal Fentanyl and Dexmedetomidine as Adjuvants to Hyperbaric Levobupivacaine 0.5% in Patients Undergoing Infra Umbilical Surgeries
Authors: Mohammed Loay Ashraf Taha , Ibrahim Sherif Farouk , El-Fattah Ghoniem Mohammed Mohammed Abd , El-Sayed Ahmed Ibrahem Mohamed
Published: October 2021

Background

Spinal anesthesia is a common technique for lower abdomen and lower limb surgery, but the use of local anesthetics alone may produce unwanted side effects such as prolonged motor and autonomic block, limited duration of action, besides, excessive local anesthetics can cause cardiac toxicity and central nervous system side effects. For these reasons, local anesthetics combined with other drugs, to utilize their synergistic analgesia and to reduce the dose of local anesthetics, has become a new option for anesthesiologists.

Objectives

This study is designed to assess and compare the effect of intrathecal Fentanyl and Dexmedetomidine as adjuvants to hyperbaric Levobupivacaine 0.5% regarding the onset, duration of sensory and motor block, duration of post operative analgesia and possible side effects in patients undergoing infra umbilical surgeries.

Materials and Methods

The study was performed at Ain Shams university hospitals. After obtaining ethical committee approval and informed consent from the patients. The study protocol was obtaining an informed consent; 75 patients admitted for infraumbilical surgeries in Ain Shams University hospitals operation theatre, were blindly randomized into three groups, using their medical record number (MRN) and subjected to a comparative study. A for Fentanyl group, group B for Dexmedetomidine group and group C for Levobupivacaine control group in the duration of 6 months from March to August 2019.

Results

The study showed that the quality of intraoperative analgesia was significantly better with dexmedetomidine than fentanyl group, and the requirement for opioids was significantly lower with dexmedetomidine than fentanyl group. The degree of motor block and postoperative analgesia was significantly denser with dexmedetomidine than fentanyl group.

Conclusion

From the current study we can conclude that using intrathecal 5 µg dexmedetomidine seems to be a suitable alternative to 25 µg fentanyl as adjuvants to 0.5% hyperbaric levobupivacaine in spinal anaesthesia. Its associated with prolonged motor and sensory block and provides good quality of intraoperative analgesia and extended duration of post operative analgesia as compared to fentanyl.
Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Intraperitoneal and Perioportal Bupivacaine Infiltration in Post Operative Analgesia after Laparoscopic Cholecystectomy
Authors: Eshak Mina Elia Haleem , Allah Sherif Samir Wahba Rezk , Mohamed Hadeel Magdy Abdel Hameed , Esmaeil Mohammed Abdel Mohsen Abdel Naeem
Published: October 2021

Background

Laparoscopic cholecystectomy is one of the commonest elective laparoscopic surgeries done in our setup. We found that post-surgery most of the patients complain of incisional pain at port sites and right shoulder tip pain.

Objectives

The aim of this study has been to test the efficacy of TAP block versus intraperitoneal and periportal infilteration with local anesthetic agent specially to provide postoperative analgesia after laparoscopic cholecystectomy.

Patients and Methods

All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). The study was conducted on 50 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective laparoscopic cholecystectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each: TAP block Group: received general anaesthesia and 20 ml of 0.25% bupivacaine on each side by midaxillary approach under ultrasound guidance. Intraperitoneal and periportal infiltration Group: received general anaesthesia and 20 ml of 0.25% bupivacaine was injected under the direct vision into the hepato-diaphragmatic space, near and above the hepato-duodenal ligament and above the gall bladder before removal of the probes, also 20ml of 0.25% bupivacaine was injected at the port sites at the end of operation.

Results

The Patients receiving TAP block had significantly lower pain scores at rest for 6 hrs and upon coughing for 6 hrs also after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received Intraperitoneal and periportal infiltration.

Conclusion

Bilateral TAP block was effective in reducing postoperative pain scores at rest and upon coughing for 6-12 hours and lower total 24-h postoperative opioid and analgesic consumption after laparoscopic cholecystectomy under general anesthesia, compared to intraperitoneal and periportal infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.
Norepinephrine as an Alternative in Hypotension Prophylaxis During Cesarean Sectionunder Spinal Anesthesia
Authors: Shahin Mohamed I , Kamaly Ayman M , Saleh Mohamed , El-Agamy Ashraf E
Published: October 2021

Background

Spinal anesthesia is the preferred method for elective cesarean sections (C.S.) due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Thus we compare the administration of intermittent I.V. boluses of norepinephrine and ephedrine to guard against the hypotensive effect of spinal anesthesia during cesarean delivery.

Patients and Methods

120 female patients undergoing electiveC.S.were randomly divided into “group-E” for Ephedrine and “group-N” for Norepinephrine.

Results

Compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery.

Conclusion

Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.
Prognostic Value of Lactate / Albumin Ratio combined with APACHE II, SAPS II and SOFA Score for Predicting Mortality in Critically Ill Patients with Septic Shock
Authors: Nofal Walid H , Abo Alela Sahar K , Aldeeb Moustafa M , Elewa Gamal M
Published: October 2021

Background

Despite all worldwide efforts towards sepsis, more than 5.3 million patients die annually. Till now, there is no parameter or score to detect mortality in septic patients precisely.

Objectives

The aim of this study was to evaluate the prognostic performance of the lactate/albumin (L/A) ratio when combined with APACHE II score, SOFA score and SAPS II for predicting 28-day mortality in critically ill patients with septic shock.

Patients and Methods

After approval of the Medical Ethics Committee of Ain Shams Faculty of Medicine, an informed consent was taken from the patient or next of kin to include his/her data in this study. All patients who were admitted to the intensive care units (ICUs) with septic shock from 1st of September, 2019 to 30th of March, 2020 were assessed for enrollment in this study.

Results

In this prospective observational study, 100 adult patients of both sexes with septic shock were enrolled. They were categorized into two groups according to the primary endpoint (outcome) “28-days mortality”. Sixty-one patients (61%) died (non-survivors’ group) and thirtynine patients (39%) survived (survivors group). The most significant factors which affecting the mortality were LAR, SOFA score on admission, APACHE II, and SAPS II score. Prediction performance of the four variables for estimating 28 days mortality. When combined LAR + SOFA, LAR + APACHE, LAR + SAPS II, Overall score the ROC (AUROC, 0.867,0.847,0.849,,0.899 respectively) was the highest, compared to the other single models and lower cutoff (>0.48, >0.53, >0.42, >0.47 respectively)in comparison to single scores. Moreover, the overall score (including the 4 parameters together) gave the best predictive value for 28 day mortality

Conclusion

Lactate/Albumin ratio combined with APACHI II, SOFA and SAPS scores gave the best predictive value for 28 day mortality in septic shock patients, when compared with each separate score

Recommendations

combined LAR + SOFA, LAR + APACHE, LAR + SAPS II, Overall score recommended to use to predictho spital mortality, Further research on large sample sizeto study the risk stratification and implementing new scores using the lactate/albumin ratio (LAR) is needed. Simple, available and cheap markers should be used in developing new prediction scores.
Acomparative Study between Epidural Analgesia of Levobupivacaine with Fentanyl versus Dexmedetomidine for knee replacement surgeries
Authors: Ali Naglaa Mohammed , El Mohsen Ehab Hamed Abd , Hussien Rania Maher , Massoud Omar Abd El Gawad Kamel
Published: October 2021

Background

The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. Epidural analgesia offers superior postoperative pain relief compared with systemic opioids. In addition to improved patient outcome.

Objective

To compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural levobupivacaine in knee replacement surgeries regarding duration of action and the analgesic potency of both drugs.

Patients and Methods

This prospective double blinded randomized clinical trial study was conducted in Maadi Military and Ain Shams University Hospitals after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent knee replacement surgeries were included in the study their ages range between 21 and 60 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30).

Results

As regards sedation score intraoperative and postoperative, in the present study, we found that Ramsay sedation score was significantly higher in group ‘BD’ when compared to group ‘BF’ intraoperative and postoperative. This finding may be attributed to the sedative properties of dexmedetomidine that is far superior to fentanyl acting by dose-dependent decrease in activity of noradrenergic neurons in the brain stem via post-synaptic receptor-mediated inhibition. This increases gamma-aminobutyric acid (GABA) neurone activity, which mediates central sedative effects.

Conclusion

Epidural levobupivacaine with dexmedetomidine provided better sedation, adequate surgical anesthesia with prolonged postoperative analgesia for lower limb surgeries. Both adjuvants reduced the epidural dose of levobupivacaine and potentiated its efficacy.
Perineural versus Systemic Dexamethasone to Prolong Analgesia after ultrasound guided Inter-Scalene Brachial Plexsus Block in Arthroscopic Shoulder Surgeries
Authors: AbdelHalem Sarah Amr Abbas , Fahmy Adel Mekhail , El Fawy Dalia Mahmoud , ElFar Marwa Mamdouh Mohamed
Published: October 2021

Background

Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuraxial block is used for postoperative pain management and decrease analgesic use.

Objective

To compare the analgesic duration of intravenous and perineural administration of Dexamethasone in interscalene block during arthroscopic shoulder surgery.

Patients and Methods

Interventional randomized Double-Blind Study. This study was conducted in Ain Shams University Hospitals’ operating rooms throughout six months. In our study, 60 patients were randomly divided into two equal groups:

Group A (30 patients)

Block with 20 ml Bupivacaine 0.5% (+ 2 ml Dexamethasone ‘8 mg’) & 5 ml normal saline was injected IV.

Group B (30 patients)

Block with 20 ml Bupivacaine 0.5% (+ 2 ml normal saline) & 5 ml Dexamethasone ‘8 mg’ was injected IV.

Results

Our study showed that addition of 8 mg dexamethasone to bupivacaine in interscalene brachial plexus nerve block prolongs post-operative analgesia & reduced numbers of rescue analgesia doses more than injecting dexamethasone intravenously.

Conclusion

Addition of perineural dexamethasone to bupivacaine in interscalene brachial nerve block prolongs post-operative analgesia & reduced numbers of rescue analgesia doses more than injecting dexamethasone intravenously. Dexamethasone was seen to be a potent adjunct to local anaesthetic to prolong post-operative analgesia with negligible side effects.
Outcome of surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis
Authors: El-Galb Hani Abd El-Maabood Metwlly , Amar Ayman Mahmoud Amin , Abd El-Gawad Mohamed Nabil Mohamed , El-Kholey Mohamed Ibrahim Reiad
Published: October 2021

Background

The results of surgical treatment of type A aortic dissection (AAD) in the elderly are controversial and aggravated by a higher operative mortality rate. The studies published in this subset of patients are mainly retrospective analyses or small samples from international registries. We sought to investigate this topic by conducting a contemporary meta-analysis of the most recent observational studies.

Methods

A systematic literature search was conducted for any study published from the inception till August 2019 on aortic dissection treated surgically in patients 70 years and older. A pooled risk-ratio meta-analysis has been conducted three main post-operative outcomes: short-term mortality, stroke and acute kidney injury.

Results

A total of 23 retrospective observational studies have been included in the metaanalysis. Pooled meta-analysis showed an increased risk of short-term mortality for the elderly population [relative risk (RR) =1.39; 95% CI, 0.64–3.5; I2=92%; P < 0.001], and this has been confirmed in a sub-analysis of patients 80 years and older. The risk of having stroke (RR = 1.47; 95% CI, 0.66–3.29; I2=91%; P = 0.35) and acute kidney injury (RR = 1.12; 95% CI, 0.32–3.9, I2=90%, P = 0.85) after surgery were comparable to the conservative treatment of patients.

Conclusion

Although affected by an increased risk of short-term mortality in the elderly, surgical repair remains the treatment of choice for AAD. The main post-operative outcomes are comparable to younger patients and the mid-term survival rates are acceptable.
The Added Value of ST-Elevation in Lead aVR to Clinical TIMI Score in Predicting the Angiographic Severity of Coronary Artery Disease in Patients with Non ST-Elevation Myocardial Infarction
Authors: Elfahham Abobakr Fawzy , El Etriby Shehab Adel , Abdelsalam Ahmed Mohamed , Awad Omar
Published: October 2021

Background

Atherosclerosis is the ongoing process of plaque formation involving primarily the intima of large and medium-sized arteries. The condition progresses relentlessly throughout a person’s lifetime, before finally manifesting itself as an acute ischemic event. TIMI score is a tool of 7 points for patients with NSTE-ACS to detect the risk according to the score. The term acute coronary syndrome (ACS) includes unstable angina (UA), non STsegment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).

Aim

To investigate the added value of the presence of ST-segment elevation in lead avR on admission electrocardiogram to the (TIMI) clinical scoring system in predicting the angiographic severity of coronary artery disease in patients admitted with NSTE-ACS.

Patients and Methods

150 patients with Non ST-segment elevation acute coronary syndrome was included from Cardiology Department, Ain Shams University Hospital, Cairo, Egypt.

Results

From those patients, 137 patients (91.3%) diagnosed by coronary angiography to have significant CAD and 93 patients (62%) had ST-Elevation in lead aVR . These 137 patients were divided into 3 groups according to TIMI risk score to 16 patients (10.6%) had low risk score, 63 patients (42.0%) had intermediate risk & lastly 58 patients (38.7%) had high risk score. . Although being useful in prediction of multi-vessel & LM involvement among high risk group, TIMI score failed to predict the same in intermediate & low risk groups where multi-vessel involvement was found in 46 patients (30.6%) & 7 patients (4.6%) of intermediate & low risk groups respectively. Also LM involvement was found in 15 patients (10%) & 2 patients (1.3%) of intermediate & low risk groups respectively.

Conclusion

ST-segment elevation (STE) in lead avR had an adding predicting value in NSTEACS patients especially those with low to intermediate TIMI score. Adding the value of STE in lead aVR to TIMI risk score may improve the early stratification & management of those patients at high risk coronary artery disease, with subsequent impact on morbidity & mortality.
Echocardiography calcium score as predictive tools of severity of coronary artery disease
Authors: Ismail Asmaa , Abdeltawab Adham , Roshdy Alaa
Published: October 2021

Background

Coronary artery disease (CAD) represents a leading cause of death worldwide. Coronary angiography represents the gold standard for diagnosis and selection of the best treatment for the patients with coronary artery disease; however some efforts have been made to predict CAD severity and complexity using non-invasive methods in order to identify the patients at high risk for cardiovascular events with less risk to the patients and before doing coronary angiography. Characterization of coronaryartery calcification by computed tomography known as Coronary artery calcium score (CACS) is equivalent to the total coronary atherosclerosis load and is proven to be related to angiographically significant lesions. Echocardiographic calcium score is now validated against non-coronary calcium by computed tomography with lower cost and no irradiation safety issues for reclassification of cardiac risk.

Aim and Objectives

to determine the correlation of echocardiography calcium score to severity of coronary artery disease.

Patients and Methods

Patients coming to Ain Shams University Hospitals for elective coronary angiography were subjected to histoty taking, examination, blood samples and echocardiographic examination. The echocardiographic calcium score was correlated with syntax score of their coronary angiography films. Also syntax score was divided into three groups; low risk ≤ 18, intermediate risk 18-27 and high risk groups >27.

Results

The study included 45 patients; 21 of which were males representing 46.6% of the participants. The mean age of the whole group was 52.7 ± 8.18. The mean final calcium score of the whole study group was 4.95±1.29. The mean syntax score of the whole study group was 22.88±12.3. There was significant difference between the three subgroups of the syntax score regarding total calcium score (p value 0.013) and highly significant difference between the numerical values of syntax score and final calcium score.

Conclusion

Echocardiographic calcium score is correlated to syntax score and the severity of coronary artery disease. The low cost, availability and the radiation free nature of echocardiography make it an attractive candidate for the on-going research regarding the non-invasive tools for prediction of CAD.
Single Centre Experience in Pediatric Pacing
Authors: Arafa Hosny , Ali Ahmed N , Ahmed Rania S , Wafa Samir S
Published: October 2021

Corresponding author

hosnihosni5627@gmail.com ( Hosny Hosny Elsayed Arafa)

Background

Permanent Pacemakers have a growing use in the pediatric population due to congenital and surgically acquired rhythm disturbances but they present unique problems and implications. Their implantation, follow up, the diversity and complexity of pediatric patients and congenital heart disease make device management a highly individualized art in pediatric pacing. Certain challenges are posed in adult-like somatic growth and active lifestyle susceptibility to infection and generally anticipated long survival.

Objective

The current study aims to present our institute's experience in pediatric and adolescent pacemaker implantation and long term outcome.

Patients and Methods

The study included 100 patients who have cardiac devices (permanent pacemaker)that were implanted in AinShams University and visit our patient clinic for regular programming during the period from July 2018 to December 2019. All patients were subjected to history taking, clinical examination, ECG recording then Echocardiography and device programming.

Results

The study included 100 patients,49 females and 51 males with a mean age of 13.12 ± 5.04. Patients weighted from 8 to 85 kg, measured from 40 to 185 cm in height. According to the mode of pacing, 67 were in the VVIR group while 33 in the DDDR group. According to the indication of pacing, two cases were due to sinus node dysfunction,52 due to congenital complete heart block and 46 due to postoperative CHB. 59 patients underwent cardiac surgery. 53 were admitted to CCU by syncope or presyncope. As Regards the complications,2 cases had superficial infection after 2 weeks relived by antibiotic, 2 patients suffered from pocket hematoma after 2 weeks, 10 cases of lead fracture from 1 to 8 years after implantation due to external trauma, 3 cases of lead dislodgment from 1 to 6 months postprocedure,1 case developed LV dysfunction and upgraded to CRT,1 case had psychological trauma and 3 cases had insulation breaks. The device with the longest longevity duration is Medtronic and Tendril leads had the most common complications.

Conclusion

Implantation of a pacemaker in children is generally safe. It could be justified to implant the pacemaker to improve the hemodynamic situation in individual patients or to consider biventricular pacing in LV dysfunctiont
Hybrid Technique for Acute on chronic Lower Limb Ischemia, A single centre study
Authors: Mohammed Islam Badry , Kamel Amr Nabil , Zaki Mohammed Mahmoud
Published: October 2021

Background

Several methods have been postulated for the treatment of acute on chronic lower limb ischemia; among them, the hybrid procedure (combined open thrombectomy and angioplasty) is gaining popularity .It is aimed at clearing the vessel and treating the underlying vessel lesion in one step.

Patients and Methods

A total of 23 patients admitted to the vascular department were eligible for inclusion in this study. They were subjected to thromboembolectomy, followed by endovascular balloon dilatation with or without stenting. Data regarding the risk factors, procedure success, and complications were recorded.

Results

Hybrid procedures showed 91.6% immediate technical success and 82.6% primary limb salvage rate up to 6 months with accepted minor complications. and no major complications

Conclusion

The hybrid procedure provides an accepted outcome in treating immediately limb- threatening acute on chronic lower limb ischemia.
Assessment of the Oxidative Stress Status in Androgenetic Alopecia in Egyptian Men
Authors: Diab Heba Mahmoud , Soltan Marwa Yassin , El-Khazragy Nashwa , Atef Raafat Aliaa Mohamed
Published: October 2021

Background

Androgenetic alopecia (AGA) is the most common type of hair loss in men. It is commonly known as a male pattern baldness. It is characterized by a stepwise miniaturization of the hair follicle, resulting from alteration in the hair cycle dynamics, leading to vellus transformation of terminal hair follicle. In AGA, the duration of anagen phase gradually decreases and that of telogen phase increases, the maximum length of the new anagen hair becomes shorter than that of its predecessor, leading to miniaturization and eventually a bald appearance.

Aim of the Work

To assess the expression of NRF2 in the scalp of men with androgenetic alopecia.

Patients and Methods

This case control study included 28 male patients whose age ranged from 18 to 45 years old. They were diagnosed as having AGA according to Norwood-Hamilton scale. Further, 28 age and sex matched healthy male controls were recruited. All patients and controls were recruited from the dermatology outpatient clinic of Ain-Shams University Hospitals, during the period of September 2018 to April 2019.

Results

A group of Twenty-eight male patients with AGA were recruited to the study. The of patients ranged from 18 to 45 years (mean = 33.46 years ± 9.9 SD). Twenty-eight age matched male healthy volunteers without AGA were e recruited. The majority of AGA patients had positive family history of AGA in their first degree relatives. None of our patients had a medical history of systemic diseases like diabetes mellitus or hypertension.

Conclusion

The current study showed that alteration of Nrf2 levels may play an important role in the pathogenesis of AGA.
Assessment of Calprotectin in blood and tissue of Acne Vulgaris patients of different clinical severities
Authors: Mohamed Ghada Fathy , fattah Afify Ahmed Abdel , hady Ahmed Waleed Abdel , Elsayed Eid Basant Alaa Eldin Elsayed Mohamed
Published: October 2021

Background

Acne vulgaris is a multifactorial inflammatory skin disease of the pilosebaceous unit with complex pathogenesis. Calprotectin is a heterodimer of two calcium-binding proteins S100A8 and S100A9, which are members of the S100 protein family, and which play a role in various inflammatory processes, it is mainly present in the cytoplasm of neutrophils and expressed on the membrane of monocytes.

Objective

to assess the level of Calprotectin in blood and in tissue of AV patients and compare it with healthy controls. Beside correlate it with the degrees of severity of acne in order to further understand the role of Calprotectin in the pathogenesis of AV.

Subjects and Methods

This case-control study included 28 subjects who have AV, divided into four groups according to Global Acne Grading System: the first group included 7 patients with mild acne, the second group included 7 patients with moderate acne, the third group included 7 patients with severe acne, and the fourth group included 7 patients with very severe AV. In addition to a control group which included 28 apparently healthy individuals of matched age, sex and with no previous history of acne or active acne. All the patients were recruited from the outpatient clinic of Al Haud Al Marsoud hospital from September 2019 till January 2020. After taking the approval of research ethics committee (FMASU M S 22/2019) all subjects gave an informed consent to participate in this work.

Results

Our study showed that the increase in AV severity was not affected by the difference in gender, type of acne, nor disease duration. However, there was a significant correlation between plasma calprotectin level and AV severity. In addition to, There was a significant statistical correlation between the increase in the age of patients and the decrease in the severity of acne, which indicates that AV is more severe in younger patients than older ones. The correlation between the Plasma Calprotectin level in patients group and Tissue Calprotectin level in inflammatory lesions (papules) was non-significant. However, the correlation between the Plasma Calprotectin level in patients’ group and Tissue Calprotectin level in non-inflammatory lesions (comedones) was highly significant.

Conclusion

Plasma Calprotectin level showed significant relation with AV severity and presence of scar. The correlation between plasma Calprotectin level and tissue Calprotectin level in noninflammatory lesions (comedones) was highly significant.
A Split Scalp Study of Single versus Double Spin Platelet-rich plasma Injections in Treatment of Female Pattern Hair Loss: Clinical Effect and Relation to Vascular Endothelial Growth Factor in PRP
Authors: Salem Samar A , Elhusseiny Rania M , Saleh Haitham M
Published: October 2021

Background

Female pattern hair loss (FPHL) is the most common hair loss disorder in women. Platelet-rich plasma (PRP) provides an option for patients recalcitrant to the currently approved therapies. As there are many methods for the preparation of PRP, the most suitable for AGA therapy is not yet clear.

Aims

To compare the efficacy between single and double spin PRP injections in treatment of FPHL and to assess the relationship between the concentrations of vascular endothelial growth factor (VEGF) in the PRP preparation and the treatment results obtained.

Patients and Methods

15 female patients with FPHL were enrolled. Each patient was subjected to intradermal injection of PRP (prepared by double-spin method) into the right half of the scalp, in addition to intradermal injection of PRP (prepared by singlespin method) into the left half of the scalp in the form of three treatment sessions three weeks apart. Evaluation of treatment response was done through comparing patients' global photographs, assessment of patients' satisfaction and folliscopic assessment before and after treatment.

Results

Our results showed clinically significant improvement by comparing patients' photographs in most of the treated patients. In addition, folliscopy revealed significant change of the terminal hair density in the right half of the scalp following treatment sessions.VEGF concentration didn't differ significantly between double-spin and single-spin prepared PRP, also it didn't differ significantly upon calcium activation.

Conclusions

PRP is an effective treatment modality for FPHL. Double-spin prepared PRP could yield better results in the treatment of FPHL than the single-spin method. However, adding Calcium gluconate prior to PRP injection is of no benefit as it didn't significantly increase the release of VEGF. Yet, further studies discussing different PRP preparation protocols and involving a larger number of cases are needed to minimize statistical errors and to detect the most accurate PRP preparation method with the greatest yield of growth factors.