bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Use of Vaginal Misoprostol with Intracervical Foley Catheter Versus Vaginal Misoprostol alone in Induction of Labor at Term Pregnancy
Authors: Swidan Khaled Hassan , El-Shahawy Ahmed Abdel Shafy , Abbass ; Ahmed Mohamed , Mohamed Huda Mohamed Elsayed
Published: October 2021

Background

Induction of labor should be used in the most efficient way possible that will result in a favorable obstetric outcome with minimum fetal morbidity.

Objectives

The aim of this study is to compare the efficacy and safety of intravaginal misoprostol alone versus intra cervical Foley catheter combined with vaginal misoprostol in induction of labor at term pregnancy.

Methods

This study was conducted at Obstetrics & Gynecology Department; Ain Shams University, Maternity Hospital in the period between May 2017 to October 2017. The total number of patients studied was 120 patients, divided into two groups; the first group (A) included 60 patients who received vaginal misoprostol, the second group (B) included 60 patients who received vaginal misoprostol combined with trans cervical Foley catheter.

Results

The current study found that the combined group has a better chance for NVD 88.3% versus 78.3% in misoprostol alone group, a lesser probability to CS 11.7% in combined group versus 21.7% in misoprostol alone group and a shorter induction delivery interval within 12 hours after induction (81.6% in combined group versus 59.5% in misoprostol group). Regarding the effect of both methods on fetal safety, we found that non reassuring FHR was more common in combined group 8.3% than misoprostol alone group 1.7% but it’s statistically non-significant. There was statistically significant increase in tachysystole in combined group 28.3% versus 13.3% in misoprostol alone group. However, dystocia was more common in misoprostol group 15% than combined group 3.3% that is also statistically significant.

Conclusion

Both methods can be used in induction of labor at term pregnancy without forgetting the precautions and close observation to the mother and the fetus. Combined method results in a shorter induction-to delivery time, but misoprostol alone was safer for the mother and the fetus.
Relationship between Transvaginal Ultrasound Endometrial Volume, Body Mass Index and Endometrial Pathology in Women with Postmenopausal Bleeding
Authors: Sokkary Mohammed Salah El , Ghaleb Mahmoud Mohamed , El Helw Rowyna Hany Mohamed
Published: October 2021

Background

Menopause is recognized to have occurred after one year of amenorrhea, for which there is no other obvious pathological or physiological cause. Perimenopause should include the period immediately prior to the menopause (when the endocrinological, biological and clinical features of approaching menopause commence) and the first one year after menopause.

Objectives

The aim of the study is classification of patients into those with benign endometrial pathology and those with endometrial hyperplasia or carcinoma using endometrial volume and BMI.

Patients and Methods

This observational cross sectional study was conducted at the Department of Obstetrics and Gynecology in Ain Shams University Hospital from March 2019 till January 2020. The population of this study was 100 menopausal women with postmenopausal bleeding ≥12 months and endometrial thickness by TVUS ≥5 mm.

Results

According to histopathology of endometrial carcinoma, statistical analysis of our data revealed that age, menopausal duration and BMI were significantly highest. Parity was significantly lowest. Endometrial volume was significantly highest in carcinoma (7.9±2.9 cc). Age, menopausal duration, parity and endometrial volume had significant moderate diagnostic performance in predicting endometrial carcinoma but BMI had significantly low. Age ≥ 62.0, menopausal duration ≥ 11.0 and parity ≤3.0 had low diagnostic characteristics in diagnosis of endometrial carcinoma but endometrial volume ≥ 6.0 had high sensitivity but low other diagnostic characteristics in the diagnosis of endometrial carcinoma. According to histopathology of endometrial hyperplasia, statistical analysis of our data revealed that age, menopausal duration, BMI, parity and endometrial volume had no significant diagnostic performance in the diagnosis of endometrial hyperplasia.

Conclusion

In our study, analysis of data revealed that the using of transvaginal measurement of endometrial volume is the best predictor of endometrial cancer with a positive correlation with BMI.
Evaluation of Serum level of thrombomodulin in cases with preeclampsia
Authors: Taleb Yasser M. Abou , Mohammed Hayam F , El-Khazragy Nashwa N , Ahmed Sohaila K
Published: October 2021

Background

Preeclampsia is a multisystmic disorder of unknown cause. Endothelial cell damage has recently been suggested to underlie the pathologic change in preeclamptic pregnancy. Thrombomodulin an endothelial cell surface glycoprotein act as a co-factor for thrombin catalyzed activation of protein C. activated protein C inhibits coagulation by inactivation the coagulation factor Va and VIIIa.

Aim of the Work

to assess the changes in thrombomodulin level in women with preeclampsia.

Patients and Methods

This prospective case-control study was conducted on 123 women at Ain Shams University Maternity Hospital.

Results

Regarding clinic-pathological features of pre-eclampsia patients and healthy control groups, our study found that there was high significant difference (p ≤ 0.01) between hypertensive and normal patients regarding (hypertension, obesity and history of PET). Our study found that there was high significant difference (p ≤ 0.01) between pre-eclampsia patients and healthy control group regarding serum thrombomodulin protein level and serum thrombomodulin protein increases significantly with mild and severe preeclampsia and HELLP syndrome and considered a good marker for evaluation of hypertensive patients with pregnancy.

Conclusion

serum thrombomodulin protein level is considered a good marker for evaluation of hypertensive patients with pregnancy.
Antenatal Azithromycin to Prevent Preterm Birth in Pregnant women with Vaginal Cerclage. A Randomized Controlled Trial
Authors: Mostafa Rania Hassan , Ashoush Sherif Ahmed , Bayoumy Hassan Awwad , Gabr Wessam Kamal Lotfy
Published: October 2021

Background

Preterm birth with its complications is one of the leading causes of perinatal morbidity and mortality, as well as maternal morbidity, especially in low and middle-income countries. Cervical cerclage is a well-established preventive tool in women at high risk of preterm birth; however, subclinical maternal infection might still cause failure of this method. Thus, adding prophylactic antibiotics, namely macrolides, could prevent preterm birth.

Patients and methods

This was a randomized controlled clinical trial involving two groups of women who underwent vaginal cerclage at Ain Shams University Maternity Hospital. One group received azithromycin 500mg one tablet orally once daily for 3 days every month from 14th week to 34th week gestation, in addition to routine antenatal care; while the other group received usual antenatal care without antibiotic prophylaxis after cerclage. Follow-up was done and we compared the outcomes in each group: gestational age at delivery, birth weight, mode of delivery, maternal complications, and perinatal complications. ClinicalTrials.gov Identifier NCT04278937.

Results

Gestational age at delivery was significantly higher in the azithromycin group (36.8weeks vs 34.1weeks; P = 0.017), with significant prolongation of gestation in the azithromycin group (23.7weeks vs 21.1weeks; P = 0.005). As regards birth weight, it was significantly higher in the azithromycin group (2932.6gm vs 2401.8gm; P = 0.006); however babies with low birth weight (birth weight <2500gm) were non-significantly less frequent in the azithromycin group (3cases vs 7cases; P = 0.165). There was no significant difference between the two groups as regards other outcomes (miscarriage, stillbirth, neonatal intensive care unit admission, antepartum hemorrhage, postpartum pyrexia, need for blood transfusion).

Conclusion

Adding azithromycin as antenatal prophylaxis in women undergoing vaginal cerclage prolongs pregnancy and reduces risk of PTB, with slight increase in birth weight. However, there was no clear effect on incidence of low birth weight, or perinatal morbidity/mortality.
Relation between Circulating Vitamin k2 level and Osteoporosis in Post-Menopausal Women
Authors: Abdel Aziz Dina M , Saleh Hala A , Taha Neven M , Elbadawy Mohga A
Published: October 2021

Objective

We aimed to measure the serum level of vitamin k2 in postmenopausal osteoporotic patients to determine its role in the disease.

Patients and Methods

Our study was designed as a cross sectional study, with 15 postmenopausal osteoporotic patients (with reduced bone mineral density BMD), aged between 54-58 years old compared to 15 healthy controls (with normal BMD at all of lumbar spine, femoral neck and hip) matched in age with the patients. All participants were subjected to full medical history taking, physical examination and functional assessment of the activity of daily livings (ADL). Biochemical assays of thyroid stimulating hormone, parathyroid hormone, total calcium, phosphorus, alkaline phosphatase (ALP), 25-hydroxyvitamin D (25 (OH) D), erythrocyte sedimentation rate, Kidney and liver function tests and serum levels of vitamin k2 were performed.

Results

The patients showed highly significantly lower vitamin k2 levels (P < 0.05) and non-significant correlations between vitamin k2 and the activity of daily living (ADL) nor the other laboratory assessment parameters (P > 0.05) among the patient’s group.

Conclusion

Vitamin K deficiency is highly prevalent in the majority of our patients and should be considered an associating factor in the etiology of postmenopausal osteoporosis. Vitamin k2 deficiency could result in a decrease in the bone mineral density in postmenopausal women, so vitamin k2 levels should be checked in post-menopausal osteoporosis and any deficiency must be treated and corrected to improve the bone mineral density.
Comparative study between the effect of mesenchymal stem cells and/or platelet-rich plasma on bone parameters in ovariectomized mature rats
Authors: Hamed Gehane M , Nassef Noha A , Eissa Rania S.A , Shawky Mona K.E , Abo Zeid Asmaa A , Hassan Arwa A
Published: October 2021

Background

Osteoporosis is a common bone disease and is associated with considerable morbidity and mortality. Osteoporosis occurs most frequently in postmenopausal women. The inadequacy of current treatments and their side effects have driven a search for improved methods of dealing with osteoporosis.

Design

Experimental study.

Aim of Work

This study was conducted to throw light on the ability of BM-MSCs and/or PRP in improving bone formation and slow down bone loss in ovariectomized rats with osteoporosis.

Materials & Methods

This study was carried out on adult female Wistar rats allocated randomly into five groups: Sham-operated, OVX untreated, OVX-MSCs treated (MSCs administered once intravenously), OVX/PRP treated (PRP administered once subcutaneously), OVX-MSCs/PRP treated groups. Rats were subjected to assessment of serum ALK, CTX-1, MDA and TNF-α. In addition, specimens of tibia were taken and processed for light microscopic studies and morphometric analysis.

Results

OVX untreated group showed significant increases in serum levels of ALK and CTX-1. Significant elevations of serum MDA and TNF-α levels were also noticed in the OVX untreated group. Administration of BM-MSCs and PRP significantly lowered serum levels of ALK, CTX-1, MDA and TNF-α. These results were confirmed by the histopathological findings.

Conclusion

BM-MSCs together with PRP can partially reverse OVX-induced bone loss and halt osteoporosis progression.

Abbreviations

BM-MSCs: bone marrow derived mesenchymal stem cells, PRP: platelet-rich plasma, OVX: ovariectomized, ALK: alkaline phosphatase, CTX-1: cross linked c telopeptide of type 1 collagen, MDA: malondialdehyde, TNF-α: tumour necrosis factor-alpha.
Workplace violence among nurses and physicians in a tertiary teaching hospital in Egypt
Authors: Abozaid Dena Ali , Momen Mohamed , Ezz Nahla Fawzi Abou El , Ahmed Hanaa Abdelhakiem , Al-Tehewy Mahi Mahmoud , Houssinie Moustafa El
Published: October 2021

Background

Workplace violence (WPV) has been recognized as a major occupational hazard worldwide. Healthcare professions are particularly at a higher risk of WPV. Reported magnitude of WPV represents only the tip of an iceberg. The consequences of WPV in healthcare sector are dramatic; it affects the wellbeing of healthcare professions as well as the quality of the delivered service.

Objective

The study aimed to measure the magnitude of WPV, to identify factors associated with WPV among nurses and physicians working in a tertiary teaching hospital in Egypt.

Methodology

A descriptive cross-sectional study was conducted. A total of 114 physicians and 128 nurses were interviewed about exposure to WPV within the previous 12 months.

Results

The study found a high magnitude of WPV; nearly three fourth of physicians and nurses experienced violence in the workplace within the past 12 months. Female physicians experienced WPV more commonly compared to male physicians. There was a statistically significant association between type of patient nurses commonly cared for and experiencing WPV.

Conclusion and Recommendations

WPV among healthcare professions is an increasing problem that needs to be addressed. Increasing awareness of the problem among healthcare professions as well as the general public is warranted. Violence prevention program with a zero-tolerance policy is warranted.
Work Related Stress and its Effect on Mental Health among employees of Ain Shams University Hospitals
Authors: Ibrahim Noha M , Gadallah Mohsen A , Kandil Sahar K , El-Din Dina A. Gamal
Published: October 2021

Background

Work related stress reduces the overall mental and physical wellbeing of employees. Workers in health industry are more prone to work stress than any other workplace. Many researches were conducted among health-care professionals, but not among hospital employees who are not involved in the direct patient’s care.

Objectives

This study was aiming to measure the prevalence of work related stress among employees of Ain Shams University Hospitals, to determine its risk factors and to measure its effect on the occurrence of depression, anxiety and stress.

Method

A cross-sectional study was conducted upon a sample of employees in Ain Shams University Hospitals, working in the same job for at least one year and not involved in direct patient’s care. Employees were interviewed using the “workplace stress scale”, the “Depression Anxiety Stress Scale DASS-21”, and the “socioeconomic status scale for health research in Egypt” by El-Gilany.

Results

The study included 462 participants, their age ranged from 18 to 59 years (mean ± SD: 43.4 ± 10.9), 171(37%) were males and 291 (63%) were females, and the majority were in the middle and high social class (79.2% and 16.9%) respectively). Most of the employee experienced work-related stress: 40 (87.7%) of them, the moderate, severe, and dangerous levels were 32.3%, 22.5% and 7.6% respectively. Work-related stress was significantly associated with job category with engineers were the least stressed (50%) and workers were the most (94.1%). The majority of participants suffered any of the three mental ill-health and the frequency of depression, anxiety and stress (312 (67.5), 319 (69.0) and 239 (51.7) respectively). Severe/extremely severe levels of depression, anxiety and stress were observed among 20.8%, 34.6% and 17.6% of participants respectively. Work related stress was significantly associated with the three mental ill-health status.

Conclusion

This study revealed a high level of workrelated stress among hospital employee who are not involved in patient’s care with around fifth of them suffered severe levels of mental ill-health. Occupational stress resulted mainly from inadequate control over work duties and unpleasant or unsafe work conditions.
Participation and Satisfaction with the National Campaign on Viral Hepatitis C and Non-Communicable Diseases among Administrative Workers of Ain Shams University, Cairo, Egypt
Authors: Abd-ElSamad Nourhan B , Basyoni Nashwa I , Allam Mohamed F , El-Damaty Samia I
Published: October 2021

Background

On the first of October,2018, the Egyptian Ministry Of Health and Population (MoHP) launched an initiative; named 100 Million Seha, for nationwide screening of hepatitis C virus (HCV) and major non communicable diseases (NCDs) diabetes, hypertension and obesity. Egypt has one of the highest prevalence rate of HCV infection in the world and NCDs are considered the leading cause of mortality in Egypt

Objectives

This study aimed to estimate the prevalence rate of participation of ASU workers in the Egyptian Initiative 100 Million Seha and to assess their level of satisfaction.

Method

A cross sectional study was conducted on 400 Administrative workers of Ain shams university faculties between March and August, 2019 in Cairo, Egypt. A multistage random sample was applied.

Results

Most of the study group (96%) had participated in the campaign.“Reassurance about health” was considered the main reason for participation (92%), followed by “desire to obtain follow up card”, (36%). the main cause of non-participation was fear of needle prick. About 91% of the participants were satisfied with the services provided by the campaign. Mass media was the main source of information (91%).

Conclusions

Most of the study group participated in the initiative 100 Million Seha and were satisfied with the service provided. Mass media played the most important role in awareness with the campaign.
Two New Bacterial Pathogens of Peanut, Causing Early Seedling Decline Disease, Identified in the Texas Panhandle
Authors: Obasa Ken , Haynes Leonard
Published: October 2021

Peanut (Arachis hypogaea L.) is cultivated in tropical and subtropical regions of the world as an important source of oil and protein. Until now, bacterial wilt, caused by Ralstonia solanacearum, was the only known bacterial disease of peanut. In 2020, widespread incidence of poor stand establishment was observed in multiple production fields planted to the Spanish-type peanut varieties in the Texas Panhandle. The observed symptoms included seed rot, pre- and postemergence damping-off, poor seedling vigor, poorly developed root systems with little or no nodule formation, and death. Subsequent diagnosis of symptomatic seedlings recovered two bacterial species identified by BLAST using 676- and 661-bp 16S rRNA fragments as a Ralstonia sp. and a Pantoea sp., respectively. To investigate a possible causative role of these bacteria in the observed peanut disease, the pathogenicity of the two isolates was evaluated under greenhouse conditions relying on Koch’s postulates. Cell suspensions of the two bacteria, separately and in combination, were used to inoculate seeds of a Valencia-type peanut variety with no history of the disease and found to be pathogenic on the resultant seedling plants. Symptoms that developed on the inoculated plants were similar to the symptoms initially observed in the field, including seed rot, pre- and postemergence damping-off, poor seedling vigor, and root establishment. The two bacteria were also successfully recovered from inoculated and symptomatic plants, thus satisfying Koch’s postulates. Given the early onset of symptom development on affected seeds and seedlings, a seedborne origin of the disease, described here as early-decline bacterial disease of peanut, was investigated in the same batches of peanut seeds that were planted, as well as seeds later harvested in some of the affected fields. Identical bacterial species, on the basis of 16S rRNA identity, were recovered from all of the seeds evaluated indicating that the bacteria are both seedborne and seed-transmissible. Multilocus sequence analysis involving six genes (dnaK, fumC, gyrB, murG, trpB, and tuf) showed that these new strains are most closely related to R. pickettii and Pantoea dispersa, but also phylogenetically distinct. The two bacteria were designated Ralstonia sp. strain B265 and Pantoea sp. strain B270. Losses from the disease in affected fields in 2020 averaged 50% (US$1.12 million) from a total of nine production fields. Findings from this study provide evidence for two new bacterial pathogens of peanuts capable of infecting Spanish and Valencia peanut varieties.
Depression Moderates Physical Functioning Over Time in Survivors of Cancer
Authors: Bamonti Patricia M. , Weiskittle Rachel E. , Naik Aanand D. , Bean Jonathan F. , Moye Jennifer A.
Published: October 2021

Background:

Cancer survivors are at risk for declines in physical functioning (PF). The strongest predictor of PF is prior PF. Clinically significant depression predicts declines in PF; however, the extent to which depression symptoms moderate the association between self-reported and performance-based measures of PF over time is unknown.

Objective/Purpose:

To examine whether level of depression symptoms in cancer survivors moderates the association of repeated self- and performance-based measures of PF at 6 and 18 months after cancer diagnosis.

Methods:

Prospective, observational study with assessment at 6 (T1), 12 (T2), and 18 months after cancer diagnosis (T3).

Setting and Patients:

Community-dwelling US veterans with newly diagnosed head and neck, esophageal, gastric, or colorectal cancers.

Measurements:

Measures included demographics, cancer variables (type, stage, severity, and treatment), depression symptoms (Patient Health Questionnaire-9 [PHQ-9]), Short Physical Performance Battery (SPPB), and self-reported PF (Patient-Reported Outcomes Measurement Information System-29 [PROMIS-29]).

Results:

Using hierarchical regression models, after adjustment for covariates, depression symptoms at T2 moderated the relationship between performance-based PF, SPPB (β = −0.24, P = .001) but not self-reported PF, PROMIS (β = −0.14, P = .05). In moderation analyses, SPPB T1 was only related to SPPB T3 when the PHQ-9 score was less than 9.

Limitations:

Majority White, male participants, did not measure chronicity of depression.

Conclusions:

Depression symptoms moderate the relationship of performance-based PF from baseline to 18 months.
Efficacy and Safety of Pectoral Nerve Block (Pecs) Compared With Control, Paravertebral Block, Erector Spinae Plane Block, and Local Anesthesia in Patients Undergoing Breast Cancer Surgeries
Authors: Elshanbary Alaa Ahmed , Zaazouee Mohamed Sayed , Darwish Youssef Bahaaeldin , Omran Maha Jabir , Elkilany Alaa Yousry , Abdo Mohamed Salah , Saadeldin Ayat M. , Elkady Sherouk , Nourelden Anas Zakarya , Ragab Khaled Mohamed
Published: October 2021

Objective:

We aimed to compare the safety and efficacy of pectoral nerve block (Pecs) I and II with control or other techniques used during breast cancer surgeries such as local anesthesia, paravertebral block, and erector spinae plane block (ESPB).

Methods:

We searched 4 search engines (PubMed, Cochrane Library, Scopus, and Web of Science) for relevant trials, then extracted the data and combined them under random-effect model using Review Manager Software.

Results:

We found 47 studies, 37 of them were included in our meta-analysis. Regarding intraoperative opioid consumption, compared with control, a significant reduction was detected in Pecs II (standardized mean difference [SMD]=−1.75, 95% confidence interval [CI] [−2.66, −0.85], P=0.0001) and Pecs I combined with serratus plane block (SMD=−0.90, 95% CI [−1.37, −0.44], P=0.0002). Postoperative opioid consumption was significantly lowered in Pecs II (SMD=−2.28, 95% CI [−3.10, −1.46], P<0.00001) compared with control and Pecs II compared with ESPB (SMD=−1.75, 95% CI [−2.53, −0.98], P<0.00001). Furthermore, addition of dexmedetomidine to Pecs II significantly reduced postoperative opioid consumption compared with Pecs II alone (SMD=−1.33, 95% CI [−2.28, −0.38], P=0.006).

Conclusion:

Pecs block is a safe and effective analgesic procedure during breast cancer surgeries. It shows lower intra and postoperative opioid consumption than ESPB, and reduces pain compared with control, paravertebral block, and local anesthesia, with better effect when combined with dexmedetomidine.
Changes in Brain-derived Neurotrophic Factor From Active and Sham Transcranial Direct Current Stimulation in Older Adults With Knee Osteoarthritis
Authors: Suchting Robert , Teixeira Antonio L. , Ahn Brian , Colpo Gabriela D. , Park Juyoung , Ahn Hyochol
Published: October 2021

Objectives:

Previous work has shown effects of transcranial direct current stimulation (tDCS) on clinical pain measures, qualitative sensory testing measures, and peripheral inflammation. The present report extends this research to investigate the effect of tDCS on brain-derived neurotrophic factor (BDNF) levels.

Materials and Methods:

This secondary analysis examined a sample of 40 older adults (50 to 70 y old) with symptomatic knee osteoarthritis randomly assigned in a 1:1 fashion to active (n=20) or sham (n=20) tDCS for 20 minutes on 5 consecutive days. BDNF was measured before the first session and after the final treatment session. Generalized linear modeling evaluated BDNF plasma levels as a function of tDCS group, adjusted for baseline. Bayesian statistical inference was used to quantify the probability that effects of the treatment exist.

Results:

Generalized linear modeling indicated a 90.4% posterior probability that the sham condition had 49.9% higher BDNF at the end of treatment, controlling for baseline. Follow-up analyses within the active TDCS group supported an association between change in BDNF and change in clinical pain, and exploratory analyses found an effect of tDCS on irisin.

Discussion:

Results indicated that tDCS could be a potential nonpharmacological treatment to decrease BDNF levels, which may in turn decrease pain. This study adds to a growing literature suggesting that tDCS affects cortical excitability, and consequentially, the neural circuits implicated in pain modulation. In addition to a direct connection to analgesia, BDNF changes may reflect tDCS-induced changes in different cortical areas and/or neural circuits.
Ultrasound-guided Multiple Nerve Blocks
Authors: Gu Jue , Wang Eerdun , Dai Shiyun , Dong Rong , Xu Fengying , Shen Zijin , Wang Zhiyuan , He Xingying
Published: October 2021

Objectives:

The aim was to compare the feasibility of ultrasound-guided multiple nerve blocks (fascia iliaca compartment block+sacral plexus block+superior cluneal nerve block) with general anesthesia in geriatric hip fracture patients.

Methods:

Ninety-four patients were randomly divided into 2 groups: group N received ultrasound-guided multiple nerve blocks and group G received general anesthesia. Primary outcome measures included perioperative Pain Threshold Index (PTI) and Numerical Rating Scale. Secondary outcome measures comprised the following: (1) perioperative Delirium Index and Short Portable Mental Status Questionnaire; (2) perioperative Comfort Index; (3) perioperative opioid consumption (within 72 hours postoperatively); and (4) postoperative side effects (within 72 h postoperatively).

Results:

Eighty-seven patients completed the study. Baseline PTI was comparable between the groups. However, intraoperative PTI was significantly lower in group N than in group G. Preoperative and postoperative Comfort Index scores were comparable between the groups. Moderate delirium (24 to 72 h postoperatively) was significantly higher than the baseline in group G. Early moderate delirium (24 h postoperatively) was significantly higher in group G than in group N. Severe delirium was comparable between the groups and within each group. High intraoperative PTI was associated with high opioid consumption. The intravenous sufentanil dose in group G was twice of that in group N. Incidence of nausea and vomiting was similar between the groups.

Discussion:

Ultrasound-guided multiple nerve blockade may be an alternative to the common anesthetic procedures used for geriatric hip fracture patients. It provided satisfactory intraoperative pain management and reduced early postoperative cognitive disorders.
Reducing Blood Culture and Antibiotic Usage in Neonates
Authors: Romano-Clarke Giuseppina , Merrit Kamaris , Ziady Emily , Durham Cathleen , Johnson Jennifer , Morris Sarah , Nelson Brett D.
Published: October 2021

Background:

A maternal diagnosis of chorioamnionitis, based on maternal peripartum fever of 100.4°F alone, is commonly used as an indication for blood work and antibiotic treatment in newborns. New strategies such as the Kaiser Permanente early-onset sepsis (EOS) calculator have proven effective in identifying high-risk newborns and reducing unnecessary antibiotic administration.

Purpose:

Retrospective data from October 2017 to September 2018 from 297 well-appearing newborns ≥35 weeks' gestational age (GA) with maternal chorioamnionitis showed that 93.6% had blood work and 90.2% were treated with antibiotics. This was despite no culture-positive cases of sepsis. Our aim was to reduce by 50% blood work evaluation and antibiotic treatment within a 6-month period.

Methods:

Using plan-do-study-act (PDSA) cycles, we adopted the Kaiser Permanente EOS calculator. We collected longitudinal data to track the outcomes after its implementation.

Results:

In 423 newborns with maternal chorioamnionitis triaged with the EOS calculator from October 2018 to July 2020, the rates of blood culture and antibiotic treatment decreased from 93.6% to 26.7% and 90.2% to 12.3% (P < .0001). In the larger population of 6426 newborns ≥35 weeks' GA, the rate of blood culture and antibiotic treatment decreased from 12.8% to 5.8% and 9.9% to 2.5% (P < .0001).

Implications for Practice:

The EOS calculator substantially and safely decreases blood work and antibiotic administration in asymptomatic newborns with maternal chorioamnionitis.

Implications for Research:

Our findings provide further evidence for the effectiveness and safety of the EOS calculator.

Video abstract available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
Use of Airway Pressure Release Ventilation in Patients With Acute Respiratory Failure Due to COVID-19: Results of a Single-Center Randomized Controlled Trial*
Authors: Ibarra-Estrada Miguel Á. , García-Salas Yessica , Mireles-Cabodevila Eduardo , López-Pulgarín José A. , Chávez-Peña Quetzalcóatl , García-Salcido Roxana , Mijangos-Méndez Julio C. , Aguirre-Avalos Guadalupe
Published: October 2021

OBJECTIVES:

Airway pressure release ventilation is a ventilatory mode characterized by a mandatory inverse inspiratory:expiratory ratio with a very short expiratory phase, aimed to avoid derecruitment and allow spontaneous breathing. Recent basic and clinical evidence suggests that this mode could be associated with improved outcomes in patients with acute respiratory distress syndrome. The aim of this study was to compare the outcomes between airway pressure release ventilation and traditional ventilation targeting low tidal volume, in patients with severe coronavirus disease 2019.

DESIGN:

Single-center randomized controlled trial.

SETTING:

ICU of a Mexican referral center dedicated to care of patients with confirmed diagnosis of coronavirus disease 2019.

PATIENTS:

Ninety adult intubated patients with acute respiratory distress syndrome associated with severe coronavirus disease 2019.

INTERVENTIONS:

Within 48 hours after intubation, patients were randomized to either receive ventilatory management with airway pressure release ventilation or continue low tidal volume ventilation.

MEASUREMENTS AND MAIN RESULTS:

Forty-five patients in airway pressure release ventilation group and 45 in the low tidal volume group were included. Ventilator-free days were 3.7 (0–15) and 5.2 (0–19) in the airway pressure release ventilation and low tidal volume groups, respectively (p = 0.28). During the first 7 days, patients in airway pressure release ventilation had a higher Pao
2/Fio
2 (mean difference, 26 [95%CI, 13–38]; p < 0.001) and static compliance (mean difference, 3.7 mL/cm H2O [95% CI, 0.2–7.2]; p = 0.03), higher mean airway pressure (mean difference, 3.1 cm H2O [95% CI, 2.1–4.1]; p < 0.001), and higher tidal volume (mean difference, 0.76 mL/kg/predicted body weight [95% CI, 0.5–1.0]; p < 0.001). More patients in airway pressure release ventilation had transient severe hypercapnia, defined as an elevation of Pco
2 at greater than or equal to 55 along with a pH less than 7.15 (42% vs 15%; p = 0.009); other outcomes were similar. Overall mortality was 69%, with no difference between the groups (78% in airway pressure release ventilation vs 60% in low tidal volume; p = 0.07).

CONCLUSIONS:

In conclusion, when compared with low tidal volume, airway pressure release ventilation was not associated with more ventilator-free days or improvement in other relevant outcomes in patients with severe coronavirus disease 2019.
Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: a focus on its controversies and screening of patients most likely to benefit
Authors: Wei Zhan-Qi , Zhang Yue-Wei
Published: October 2021

Surgical resection (SR) is recommended as a radical procedure in the treatment of hepatocellular carcinoma (HCC). However, postoperative recurrence negatively affects the long-term efficacy of SR, and preoperative adjuvant therapy has therefore become a research hotspot. Some clinicians adopt transcatheter arterial chemoembolization (TACE) as a preoperative adjuvant therapy in patients undergoing SR to increase the resection rate, reduce tumor recurrence, and improve the prognosis. However, the findings of the most relevant studies remain controversial. Some studies have confirmed that preoperative TACE cannot improve the long-term survival rate of patients with HCC and might even negatively affect the resection rate. Which factors influence the efficacy of preoperative TACE combined with SR is a topic worthy of investigation. In this review, existing clinical studies were analyzed with a particular focus on several topics: screening of the subgroups of patients most likely to benefit from preoperative TACE, exploration of the optimal treatment regimen of preoperative TACE, and determination of the extent of tumor necrosis as the deciding prognostic factor.
Highly Crosslinked Polyethylene Liners Have Negligible Wear at 10 Years: A Radiostereometric Analysis Study
Authors: Campbell David G. , Callary Stuart A.
Published: October 2021

Background

The introduction of crosslinked ultra-high molecular weight polyethylene (XLPE) acetabular liners has been very successful, with decreased wear and reduction in the rates of revision hip arthroplasties. XLPE is the preferred articulation for most surgeons; however, there are concerns about the long-term performance of XLPE liners created with different manufacturing processes, which may lead to time-dependent failure, including accelerated wear, after several years.

Questions/purposes

(1) What is the amount and rate of wear during the first 10 years using radiostereometric analysis (RSA) measurements of patients who had THAs that included a second-generation XLPE bearing? (2) Does the rate of wear change after 5 years in situ?

Methods

This is a brief follow-up of a previous RSA study. In that study, we prospectively enrolled 21 patients with osteoarthritis who underwent primary cementless THA with an XLPE acetabular liner (three cycles of 3Mrad annealed) and 32-mm articulation. That group represented 44% of the 48 THAs performed by the surgeon at the hospital where RSA was available; 16 had cemented hips, leaving 32 who were invited to participate in this study. Of those, 11 lived rurally and declined to participate, leaving 21 patients who were included in the initial study. Since then, three patients died, one developed dementia and could not participate, and one had revision THA for reasons other than wear, leaving 16 patients available for analysis at 10 years. Tantalum markers were inserted during surgery, and all patients had RSA radiographs taken at 1 week, 6 months, and 1, 2, 5, and 10 years postoperatively. Femoral head penetration into the acetabular component was measured with RSA, including bedding-in during the first year and annual wear thereafter.

Results

The median medial, proximal, anterior, two-dimensional (2D), and three-dimensional (3D) wear rates between 1 and 10 years were -0.001, 0.004, -0.012, 0.000, and 0.002 mm/year, respectively. No patient in this cohort had a proximal or 2D wear rate greater than 0.025 mm/year. The median proximal wear rate between 5 and 10 years (0.002 mm/year) was not greater than wear at 1 to 5 years (0.004 mm/year).

Conclusion

Femoral head penetration in this second-generation XLPE liner remained very low at 10 years and accelerated wear after 5 years in situ did not occur. Concerns about late-onset wear from oxidation of irradiated-annealed XLPE were not observed. The low level of wear remains encouraging for the future clinical performance of this material.

Level of Evidence

Level II, therapeutic study.
Changes in Children's Behavioral Health and Family Well-Being During the COVID-19 Pandemic
Authors: Hanno Emily C. , Cuartas Jorge , Miratrix Luke W. , Jones Stephanie M. , Lesaux Nonie K.
Published: October 2021

Objective:

The coronavirus disease 2019 pandemic and associated public health measures have influenced all aspects of life for children and families. In this study, we examine changes in children's behavioral health and families' well-being at the start of the pandemic.

Method:

We used longitudinal data on 2880 children from 1 US state collected over 3 waves to compare family and child well-being before and after a state-wide stay-at-home advisory set in March 2020. We descriptively examined levels and changes in 4 child behavioral health outcomes (externalizing, internalizing, adaptive, and dysregulated behaviors) and 4 family well-being outcomes (parental mental health, parental stress, parent-child relationship conflict, and household chaos) across the preshutdown and postshutdown periods. Fixed effects regression models were used to predict within-child and within-family differences in preshutdown and postshutdown outcomes.

Results:

Fixed effects analyses showed children's externalizing (0.09 points; 95% confidence interval [CI] 0.05–0.13), internalizing (0.04 points; 95% CI, 0.01–0.08), and dysregulated (0.11 points; 95% CI, 0.06–0.16) behaviors increased after the shutdown, whereas children's adaptive behaviors declined (−0.10 points; 95% CI, −0.15 to −0.05). Parental mental health issues (0.22 points; 95% CI, 0.17–0.27), parental stress (0.08 points; 95% CI, 0.03–0.12), parent-child relationship conflict (0.10 points; 95% CI, 0.04–0.16), and household chaos (0.10 points; 95% CI, 0.05–0.14) all increased relative to preshutdown levels.

Conclusion:

Many children experienced declines in behavioral health and many families experienced declines in well-being in the early months of the public health crisis, suggesting the need for family-focused and child-focused policies to mitigate these changes.
Implementation and Routinization of the ABCDE Bundle
Authors: Collinsworth Ashley W. , Brown Rachel , Cole Louann , Jungeblut Candice , Kouznetsova Maria , Qiu Taoran , Richter Kathleen M. , Smith Susan , Masica Andrew L.
Published: October 2021

Background

The ABCDE (Awakening and Breathing Coordination, Delirium monitoring and management, and Early exercise/mobility) bundle has been associated with reductions in delirium incidence and improved patient outcomes but has not been widely adopted.

Objective

The objective of this study was to determine how to facilitate ABCDE bundle adoption by examining the impact of different implementation strategies on bundle adherence rates and assessing clinicians' perceptions of the bundle and implementation efforts.

Methods

This study examined the effect of 2 bundle implementation strategies on patient care in 8 adult intensive care units. The basic strategy included electronic health record (EHR) modification, whereas the enhanced strategy included EHR modification plus additional bundle training, clinical champions, and staff engagement. A total of 84 nurses, physicians, and therapists participated in interviews and a survey to assess bundle implementation.

Results

Respondents indicated bundle use resulted in “best care” through care standardization and coordination and improved patient outcomes. Intensive care units in both intervention groups had significant improvements in bundle adherence after implementation efforts, but intensive care units in the basic intervention group outperformed other sites after initiating their own implementation strategies. Successful implementation tactics included incorporating the bundle into multidisciplinary rounds and providing ongoing support, training, and routine auditing and feedback.

Discussion

The ABCDE bundle can improve quality of care and outcomes, and implementation can be accelerated through EHR tools, trainings, and performance feedback.
Development, Implementation, and Impact of a Proning Team During the COVID-19 Intensive Care Unit Surge
Authors: O'Donoghue Sharon C. , Church Meghan , Russell Kristin , Gamboa Kelly A. , Hardman Jacqueline , Sarge Jennifer , Moskowitz Ari , Hayes Margaret M. , Cocchi Michael N. , DeSanto-Madeya Susan
Published: October 2021

Background

Prone positioning has been used as an intervention to improve oxygenation in critically ill patients with acute respiratory distress syndrome. During the COVID-19 pandemic, resources were even more limited given a surge in acute respiratory distress syndrome patients, which outstripped intensive care unit (ICU) capacity at many institutions.

Local Problem

The purpose of this article is to describe the development and implementation of a proning team during the surge in ICU patients with COVID-19 and to measure the impact of the program through surveys of staff involved.

Methods/Interventions

A proning protocol and educational plan was developed. A proning team of redeployed staff was created. A survey of ICU registered nurses and proning team members was used to evaluate the benefits and challenges of the proning team.

Results

The proning team was successful in safely performing more than 300 proning and supinating maneuvers for critically ill patients. There is overwhelming support within the institution for a proning team for future COVID-19 surges.

Discussion

The development and implementation of the proning team happened quickly to assist with the surge of patients and off-load work from ICU registered nurses. Despite the success of the proning team, more clearly defined roles and expectations, as well as additional education, are needed to further enhance teamwork and workflow.

Conclusions

Creation of the proning team was a creative use of resources that helped manage the large and medically complex patient population. This work may serve as a guide to other health care institutions.
Full-Thickness Laparoendoscopic Excision for Management of Complex Colon Polyps
Authors: Mirza Kasim L. , Wickham Carey J. , Noren Erik R. , Shin Joongho , Cologne Kyle G. , Lee Sang W.
Published: October 2021

BACKGROUND:

Benign colon polyps are increasingly being detected because of improved colonoscopic screening and early detection of masses on the adenoma-to-carcinoma pathway. Full-thickness laparoendoscopic excision is a colon-preserving technique for endoscopically unresectable polyps consisting of endoscopically guided nonanatomic wedge colectomy.

OBJECTIVE:

This study aimed to evaluate the safety and success of full-thickness laparoendoscopic excision compared to segmental colectomy for complex polyps not amenable to endoscopic resection.

DESIGN:

This is a retrospective case-control study.

SETTINGS:

This study was conducted at a tertiary academic center.

PATIENTS:

A prospectively maintained institutional database identified 22 patients with benign complex polyps managed with full-thickness laparoendoscopic excision from 2015 to 2020. These patients were compared with 22 propensity score-matched controls from the same database that underwent laparoscopic segmental colectomy.

MAIN OUTCOME MEASURES:

Primary outcome was inpatient length of stay. Secondary outcomes included operative details and postoperative morbidities.

RESULTS:

Full-thickness laparoendoscopic excision was successful in all patients. Patients had a median age of 64 years (41–85), and 82% were men. Final pathology revealed complete excision of benign lesions in 20 of 22 patients and adenocarcinoma in 2 of 22. For the adenocarcinomas, 1 patient underwent subsequent elective colectomy without complications, and 1 patient declined surgery. Propensity score matching was successful for age, sex, BMI, ASA score, colon location, and prior abdominal surgery. Compared with controls, cases had significantly shorter operative time (89.5 minutes (46–290) vs 122 minutes (85–200), p = 0.009), length of stay (1 day (0–17) vs 3 days (1–8), p < 0.001), and reduced blood loss (5 mL (2–15) vs 25 mL (10–150), p < 0.001). Thirty-day morbidity (9.1% vs 27.3%, p = 0.240) was not significantly different. An unplanned 30-day reoperation was performed in 1 patient for suspected small-bowel obstruction. There was 1 mortality due to decompensated cirrhosis in the treatment group.

LIMITATIONS:

This study was limited by its single-institution retrospective design.

CONCLUSIONS:

Full-thickness laparoendoscopic excision is safe and successful compared with corresponding segmental colectomy for complex polyps. Favorable postoperative outcomes, including decreased operative time, length of stay, and blood loss, make it a useful approach for managing complex polyps throughout the colon.
Two-Team Lateral Pelvic Lymph Node Dissection Assisted By the Transanal Approach
Authors: Matsuda Takeru , Yamashita Kimihiro , Hasegawa Hiroshi , Urakawa Naoki , Kanaji Shingo , Oshikiri Taro , Nakamura Tetsu , Kakeji Yoshihiro
Published: October 2021

INTRODUCTION:

Although lateral pelvic lymph node dissection is considered as a treatment option for advanced rectal cancer, it is technically demanding. Recently, the transanal approach for total mesorectal excision has become increasingly used. In this Technical Note, we describe lateral pelvic lymph node dissection using a 2-team method that was assisted by the transanal approach.

TECHNIQUE:

First, the lateral pelvic area was entered from the anal side by dissection between the S4 sacral splanchnic nerve and levator ani muscle. Then, the fatty tissues including the obturator compartment and the distal part of the internal iliac compartment were separated from the inferior and superior vesical vessels and the bladder wall. Next, the fatty tissues were separated from the lateral pelvic wall. The obturator nerve was isolated and preserved, whereas the obturator vessels were resected at their peripheral end. Then, the fatty tissues were dissected from the bottom plane. Finally, the fatty tissues were dissected from the ventral bladder wall and were completely isolated from the obturator nerve in cooperation with the transabdominal team.

RESULTS:

The 2-team method shortened the operative time dramatically and decreased mental and physical burden on the operators during lateral dissection. Assistance with the transanal approach helped with a secure and effective dissection, especially of the most distal parts, such as around the internal pudendal and inferior vesical arteries, because substantial skill is required for the transabdominal approach alone.

CONCLUSIONS:

This procedure is useful for the safe and effective performance of lateral pelvic lymph node dissection for patients with rectal cancer.