bluuebunny/crossref_metadata_2025 huggingface dataset:
P-174 Are new machine learning (ML) models worth it: Equivalence of iDA, KIDscore, and Gardner Scoring in Predicting IVF Pregnancy
Authors: Varghese A , Savage S , Li W , Peek J , Davydova D , Knowlton N
Published: July 2024

Study question

Is there a significant difference in predicting pregnancy outcomes among iDAScore 1.0, KIDScoreD5, and Gardner Score in elective blastocyst transfers?

Summary answer

Contrary to previous studies, iDAScore v1.0 does not demonstrate a significant Receiver Operating Characteristic (ROC) curve advantage over the traditional Scores in predicting pregnancy outcomes.

What is known already

iDAScore 1.0, a deep neural network integrated into the EmbryoScope system, and KIDscoreD5 have shown potential in ML-driven embryo assessment, potentially easing the workload of embryologists. While recent studies have highlighted their superior performance in predicting pregnancy outcomes, our study offers a contrasting perspective.

Study design, size, duration

This retrospective analysis encompassed 1762 embryos from 1112 cycles with 1424 fresh and 338 frozen single embryo transfer cycles conducted from November 2018 to September 2023 across three IVF clinics in New Zealand. No PGT cases were included. All embryos that fulfilled the defined study criteria and transferred were included in this analysis. An extended Gardner Scoring was used at our clinics: A, B, C and X, where X being poorest grades, get discarded.

Participants/materials, setting, methods

Retrospectively computed KID and iDAScores were analyzed alongside the pregnancy prediction accuracy of conventional grading. Gardner scores were converted to a ranked ordinal value with ‘AA’ (5), ‘AB’ and ‘BA’ at 4, ‘BB’ at 3, and both ‘AC’, ‘BC’ as 2 and ‘CC’ as 1 among the age groups; <35, 35-37, 38-40, 41-42, >42. Differences in overall predictive capacity were compared via AUC curves within age groups via paired Delong tests. P-values reported are nominal.

Main results and the role of chance

The study found no statistically significant differences in AUC between any of the 3 tests examined even before adjusting for multiple comparisons. Notably, in 35-37 years olds (n = 495), AUCs were 0.63 for iDAScore, 0.62 for KIDScore, and 0.61 for Gardner criteria, showing a robust ability to predict pregnancy across all methods. Similar patterns were observed in all other age groups, with no significant disparities in pregnancy prediction models (P-value > 0.05).

Limitations, reasons for caution

Given its retrospective nature, this study has inherent limitations. A prospective, controlled study would provide more definitive insights.

Wider implications of the findings

ML-based models are innovative, but they do not significantly exceed the predictive ability of traditional embryo assessment across a range of patient ages. Such models are not a panacea yet, but a data tool to increase reproducibility that might have over-promised and under delivered on clinical impact.

Trial registration number

not applicable
P-279 Significant increased isolation of escherichia coli in Iranian women with endometriosis: a case control – study
Authors: Askary E
Published: July 2024

Study question

Considering the role of bacterial infection in causing endometriosis, we decided to compare the cultures of endometriosis-affected women a in this study

Summary answer

Considering the possible role of E. coli in the progression and/or recurrence of endometriosis and also infertility

What is known already

(5). Due to the finding of endotoxin of E. coli species in the peritoneal cavity and menstrual fluid of endometriosis patients, infection with this bacterium has recently been proposed as an effective factor in the occurrence and growth of endometriosis lesions.

Study design, size, duration

This prospective case-control study was carried out in the Women’s Department of Shiraz University of Medical Sciences in collaboration with the Bacteriology and Virology Department between 60 participants.

Participants/materials, setting, methods

30 women with endometriosis in stages 3 and 4 of the disease, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared in terms of the presence of Enterobacter spp., Klebsiella spp., and E. coli species.

Main results and the role of chance

Based on the comparison between the two groups, only E. coli species had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. Parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P < 0.001).

Limitations, reasons for caution

Lack of sample trail for repeat testing and antibiotic susceptibility testing, low taxonomical resolution, and costly laboratory setup and maintenance are other limitations of this technology

Wider implications of the findings

we suggest that in women who have endometriosis and recurrent IVF failure and also in cases of endometriosis recurrence after surgical treatment, treatment of couples with appropriate antibiotics and repeated culture along with subsequent antibiotic susceptibility testing until their culture becomes negative could be beneficial.

Trial registration number

IR.SUMS.MED.REC.1400.097
P-317 Risk of endometrial polyps and hyperplasia after tamoxifen treatment in women with breast cancer: a population-based study in Taiwan
Authors: Hsu C , Eing-Mei T , Hui-min H
Published: July 2024

Study question

This study aimed to examine the association between tamoxifen treatment and incident risks of uterine disease among breast cancer patients in Taiwan.

Summary answer

We found tamoxifen treatment group may have greater risk of endometrial polyps and hyperplasia than unexposured group after adjusting for age and body mass index.

What is known already

In the worldwide Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) breast cancer treatment trail reported that the women continue tamoxifen up to 10 years, compared with 5 years may reduce breast cancer recurrence and mortality rate. However, tamoxifen use has been reported to be associated with the cumulative risk of subsequently endometrial cancer during 5–14 years was 3.1%. Specifically, several Western studies have showed that the high incidence of endometrial cancer in breast cancer survivors with tamoxifen treatment.

Study design, size, duration

We conducted a retrospective cohort study using population-based data from Taiwan Cancer Registry and the National Health Insurance Research Database (NHIRD), and the National Population Registry Data set from 2011 to 2020.

Participants/materials, setting, methods

A total 138,934 newly diagnosed breast cancer female patients with age greater than 18 years old were included. We further used a 1-to-1 propensity score matching to generate comparable exposure and un-exposure groups. Cox proportional hazard regression models were used to examine the research question. All statistical analysis was performed using SAS version 9.4, and p-values < 0.05 were considered statistically significant

Main results and the role of chance

Incidence rate ratio (IRR) to compare incidence rate of uterine disease between tamoxifen treatment groups and unexposed group, adjusting for age and BMI. Our results showed that IRR were 1.36, 0.33, 3.73, 0.63, endometrial polyps, endometrial carcinoma, endometrial hyperplasia and uterine carcinosarcoma, respectively. This study found possible correlations between tamoxifen exposure with endometrial polyps and hyperplasia among breast cancer. During the 10-year study period, tamoxifen group did not significantly increase the risk of endometrial cancer in breast cancer survivors at aged 40 and over.

Limitations, reasons for caution

Our cohort study with 10-year period is its short study period, Tamoxifen group did not significantly increase the risk of endometrial cancer.

Wider implications of the findings

This cohort study found higher endometrial polyps and hyperplasia incidence rates among women with breast cancer who received tamoxifen women than those not treated with tamoxifen. Results of this study suggest that clinicians should consider the risk of uterine disease among tamoxifen use and counsel patients accordingly.

Trial registration number

KMUHIRB-G(II)20200217
P-591 Per- and Polyfluoroalkyl Substances Serum Concentrations and Polycystic Ovary Syndrome among Women Attending a Fertility Clinic
Authors: Zhang Y , Martin L , Mustieles V , Ghaly M , Archer M , Yang S , Torres N , Coburn-Sanderson A , Souter I , Petrozza J , Yixin W , Messerlian C
Published: July 2024

Study question

What is the association between serum per- and poly-fluoroalkyl substances (PFAS) concentrations and polycystic ovary syndrome (PCOS) risk in populations with low-level PFAS exposure.

Summary answer

Higher serum concentrations of perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) were associated with elevated risk of PCOS among women attending a U.S. fertility clinic.

What is known already

Previous studies reported that exposure to high-levels of PFAS exposure was associated with elevated risk of PCOS. However, studies evaluating PCOS risk in populations with exposure to lower levels of PFAS are limited.

Study design, size, duration

A cohort study of 502 females who sought fertility evaluation for medically assisted reproduction in a U.S. fertility clinic and had similar PFAS exposure level as the general U.S. population.

Participants/materials, setting, methods

Nine PFAS were quantified in non-fasting serum samples collected at study entry. Diagnosis of PCOS was based on the Rotterdam criteria after study entry before treatment. We used logistic regression to examine the odds ratio (OR) of PCOS in relation to PFAS concentrations (continuous and by tertiles). We applied quantile g-computation (QGC) and Bayesian Kernel Machine Regression (BKMR) to examine the joint associations of PFAS mixture with PCOS.

Main results and the role of chance

A total of 38 (7.6%) females were diagnosed with PCOS. Doubling of serum PFOS and PFHxS concentrations were associated with higher odds of PCOS [OR (95%CI): 1.70 (1.06, 2.81) and 1.45 (1.02, 2.08), respectively]. There was a dose-response relationship of PFOS with PCOS risk (p of trend by tertiles = 0.07). Both QGC and BKMR identified PFOS as the most important contributor among the PFAS mixture to PCOS risk. No clear joint effect was found for other examined PFAS nor for PFAS as a total mixture on PCOS risk.

Limitations, reasons for caution

Findings in this subfertile population may not be directly generalizable to reproductive aged women in the general population.

Wider implications of the findings

Our findings are consistent with existing evidence from populations with higher concentrations of some of the evaluated PFAS and supports the potential adverse effects of PFAS on female reproductive function. Larger prospective studies are needed to validate the findings.

Trial registration number

NA
Sublime music
Authors: Levinson Jerrold
Published: July 2024

The goal of this essay is to identify the species of music that is most justifiably denominated sublime and to characterize it as fully as possible, in part through a suggested taxonomy of the species, illustrated by a wide range of musical examples. After a general discussion of sublimity in its original sphere of application—the natural world—I go on to consider the nature of sublime musical experience. I propose that categorizing music as some species of sublime is at base a matter of what it is most like or most resembles among natural phenomena. This results in a scheme which recognizes five distinguishable kinds of sublime music: negatively transcendent, positively transcendent, mixedly transcendent, energizing, and transcendent-energizing. I distinguish sublime music from other valuable music kinds and finish by pointing to some rewards that come with the experience of sublime music.
Dyslipidemia and hyperglycemia induce overexpression of Syndecan-3 in erythrocytes and modulate erythrocyte adhesion
Authors: Mallanna Smitha Honnalagere , Thimmulappa Rajesh K , Chilkunda Nandini D
Published: July 2024

Erythrocytes are important vascular components that play vital roles in maintaining vascular homeostasis, in addition to carrying oxygen. Previously, we reported that the changes in the internal milieu (e.g. hyperglycemia or hypercholesterolemia) increase erythrocyte adhesion to various extracellular matrix components, potentially through altering glycosaminoglycans (GAGs). In this study, we have investigated the expression of syndecan (Sdc) family members that could be involved in mediating cytoadherence under conditions of dyslipidemia and hyperglycemia. Among the Sdc family members analysed, we found significant overexpression of Sdc-3 in erythrocyte membranes harvested from high-fat-fed control and diabetic animals. Animal studies revealed a positive correlation between Sdc-3 expression, blood sugar levels and erythrocyte adhesion. In the human study, diabetic cohorts with body mass index >24.9 showed significantly increased expression of Sdc-3. Interestingly, blocking the Sdc-3 moiety with an anti-Sdc-3 antibody revealed that the core protein might not be directly involved in erythrocyte adhesion to fibronectin despite the GAGs bringing about adhesion. Lastly, Nano liquid chromatography-mass spectrometry/MS verified the presence of Sdc-3 in erythrocyte membranes. In conclusion, the high-fat diet and diabetes modulated Sdc-3 expression in the erythrocyte membrane, which may alter its adhesive properties and promote vascular complications.
Genetic Enhancement, Human Rights, and Regioglobal Bioethics
Authors: Fan Ruiping
Published: July 2024

This article examines the cross-cultural bioethical concerns stemming from the potential use of CRISPR-Cas9 for genetic enhancement projects. It emphasizes the need to differentiate between basic and non-basic human rights when considering genetic enhancement, as recent international declarations lack this distinction. Basic rights possess a universal nature and are applicable across cultures, while non-basic rights are culturally specific and should be determined within respective regions. To illustrate this, the study explores the acceptance or rejection of non-basic rights related to genetic enhancement in two distinct cultural categories: Type-A and Type-B cultures. Type-A cultures predominantly adhere to a liberal moral framework, while Type-B cultures are rooted in Confucian morality. Additionally, the article argues for two basic rights in genetic enhancement: the right to be free from bodily harm and the right to be free from deception. These rights differ from non-basic rights and should be universally upheld in all cultures. By analyzing a hypothetical case and drawing parallels with the He Jiankui incident, the article investigates the violation of these two basic rights in each scenario, regardless of cultural context. Consequently, both cases should be unequivocally rejected in both Type-A and Type-B cultures.
Optimizing early phase clinical trial washout periods: a report from the Therapeutic Advances in Childhood Leukemia and Lymphoma consortium
Authors: Schafer Eric S , Rushing Teresa , Crews Kristine R , Annesley Colleen , Colace Susan I , Kaiser Nicole , Pommert Lauren , Ramsey Laura B , Sabnis Himalee S , Wong Kenneth , Chang Bill H , Cooper Todd M , Shah Nirali N , Rheingold Susan R , Place Andrew E , Chi Yueh-Yun , Bhojwani Deepa , Wayne Alan S , Bernhardt M Brooke
Published: July 2024

Background

The National Cancer Institute (NCI) issued a 2021 memorandum adopting the American Society of Clinical Oncology (ASCO) and Friends of Cancer Research (Friends) task force recommendations to broaden clinical study eligibility criteria. They recommended that washout periods be eliminated for most prior cancer therapy and when required to utilize evidence- and/or rationale-based criteria. The Therapeutic Advances in Childhood Leukemia and Lymphoma (TACL) consortium responded to this guidance.

Methods

A TACL task force reviewed the consortium’s research portfolio, the relevant literature and guidance documents from ASCO-Friends, NCI, and US Food and Drug Administration to make expert consensus and evidence-based recommendations for modernizing, broadening, and codifying TACL-study washout periods while ensuring consistency with pediatric ethics, and federal regulations. TACL’s screening log was reviewed to estimate the impact that updated washout periods would have on patient inclusivity and recruitment.

Results

Over a 19-year period, 42 (14.6% of all screened ineligible patients [n = 287]) patients were identified as excluded from TACL early phase studies exclusively because of not meeting washout criteria. An additional 6 (2.1%) did not meet washout and at least 1 other exclusion criterion. A new TACL washout guidance document was developed and then adopted for use. Where washout criteria were not eliminated, rationale- and/or evidenced-based criteria were established with citation.

Conclusion

In an effort to reduce unnecessary exclusion from clinical trials, TACL created rationale- and/or evidenced-based washout period standards largely following guidance from the NCI and ASCO-Friends recommendations. These new, expanded eligibility criteria are expected to increase access to TACL clinical trials while maintaining safety and scientific excellence.
Understanding the Genetic Basis of Variation in Meiotic Recombination: Past, Present, and Future
Authors: Johnston Susan E
Published: July 2024

Meiotic recombination is a fundamental feature of sexually reproducing species. It is often required for proper chromosome segregation and plays important role in adaptation and the maintenance of genetic diversity. The molecular mechanisms of recombination are remarkably conserved across eukaryotes, yet meiotic genes and proteins show substantial variation in their sequence and function, even between closely related species. Furthermore, the rate and distribution of recombination shows a huge diversity within and between chromosomes, individuals, sexes, populations, and species. This variation has implications for many molecular and evolutionary processes, yet how and why this diversity has evolved is not well understood. A key step in understanding trait evolution is to determine its genetic basis—that is, the number, effect sizes, and distribution of loci underpinning variation. In this perspective, I discuss past and current knowledge on the genetic basis of variation in recombination rate and distribution, explore its evolutionary implications, and present open questions for future research.
Impact of Intrathecal Dexmedetomidine versus Intrathecal Fentanyl as Adjuvants to Bupivacaine on Post Spinal Urinary Retention in Knee Joint Arthroscopic Surgeries
Authors: Bassiouny Mohsen , Samir Ghada Mohamed , Nabil Tamer , Al Sharabasy Toqa Hamdy
Published: July 2024

Background

Patients undergoing orthopedic surgery are prone to developing postoperative urinary retention (POUR). They have an estimated relative risk of 8% to 55% higher than other surgical patients. This inability to void increases patient’s risk of urinary tract infections (UTIs) and bacteremia, and can lead to chronic voiding difficulties due to bladder architecture alterations. A great degree of variability exists among studies describing the prevalence and risk factors of postoperative urinary retention and its management strategies.

Objective

To compare the effects of Dexmedetomidine or Fentanyl added to intrathecal bupivacaine in knee arthroscopic procedures in terms of the occurrence of postoperative urinary retention.

Patients and Methods

This prospective randomized clinical study was conducted at tertiary care hospital at Ain Shams University hospitals from September 2021 till Mars 2022 and performed on a total of 70 patients who assigned for knee joints orthoscopic surgery.

Results

The current study results revealed that the incidence of postoperative urine retention in dexmedetomidine group was 5.7% while was 28.6% in Fentanyl group, the difference was statistically significant. however, the need to postoperative urinary catheterization was statistically non-significantly among the two groups. The current study results revealed that the Time to achieve maximum block was significantly shorter in dexmedetomidine group and the duration of motor block statistically was significantly longer in dexmedetomidine group.

Conclusion

On the basis of current evidence, when compared to fentanyl, our study revealed that intrathecal dexmedetomidine, as adjuvant to local anesthetics for intrathecal injection, can statistically significantly prolong the duration of sensory and motor block, as well as the pain free period, meanwhile significantly reducing the incidence of urinary retention. Intrathecal dexmedetomidine seems to be an attractive alternative as an adjuvant to spinal bupivacaine in surgical procedures, especially those requiring long time. It has excellent quality of postoperative analgesia with minimal side effects.
Opioid-Free Anesthesia with a Mixture of Dexmedetomidine, Ketamine and Lidocaine in Severely Obese Patients Undergoing Laparoscopic Cholecystectomy
Authors: EL-Said Kamel Amr Mohamed , Khalaf Khaled Mostafa , Abdelghaffar Abdelrahman Mabrouk , Mohamed El-ghanam Ahmed Samy
Published: July 2024

Background

Opioids have historically been a first-line therapy for surgical pain control. They were considered optimum and the mainstay for balanced anesthesia but recently the concerns about their side effects were raised. The concept of opioid free anesthesia (OFA) was introduced to provide a safer alternative that would provide benefits to selective group of patients as well as enhance recovery after surgery.

Methods

The current study compares the use of a mixture of dexmedetomidine and ketamine infusion with traditional fentanyl infusion intra-operative on many variables both intra-operative and post- operative in laparoscopic surgeries. Number of patients who will need rescue narcotics after extubation and total nalbuphine consumption, hemodynamic events (bradycardia, hypotension and hypertension), time to extubation, time to reach Alderete score of 9, post-operative hypoxemia, vomiting, pain scores were recorded and compared with the traditional balanced anesthesia (TBA).

Results

Forty patients were enrolled in the study, 20 patients in each group. The 2 groups, TBA and OFA, were comparable in demographic data (age, sex, body mass index (BMI), lean body weight (LBW)) and duration of surgery. There was significant decrease in pain scores, number of patients who will need rescue narcotics after extubation and nalbuphine consumption in the OFA group that extended to 24 h post-operative. TBA group showed statistically significant less time needed for extubation (P-value 0.018) and reaching Aldrete score of 9 (P-value 0.02).

Conclusions

OFA has a better profile than TBA as regard to post-operative pain score and opioid consumption post-operative but they have relative increase in time to extubation and time to reach Aldrete score of 9, and they were equally safe regarding post operative hypoxia and hemodynamics.
I Pack Block versus Adductor Canal Block for Post-Operative Pain Management in Total Knee Arthroplasty
Authors: Abd El Latif Hassan Samia Abd El-Mohsen , Abd El Fattah Sayed Amr Mohamed , Abdel Hafiez Mohamed Rania Hassan , Mohamed Elbukhari Mohamed Mahmoud Serry
Published: July 2024

Background

Total knee arthroplasty (TKA) is a highly distressful major surgery, with a significant potential for complications, not only because of the surgical and anesthetic impact of the procedure, but also because of the demographic and clinical characteristics of the target population. Careful pain management is necessary post-operative to achieve early post-operative mobilization while ensuring patient comfort throughout and preventing post-operative complications.

Objective

we aim to compare postoperative pain management and post- operative analgesic consumption between IPACK block and Adductor canal block in total knee arthroplasty cases.

Methods

After obtaining approval from the medical ethical committee in Ain Shams University, this Prospective randomized controlled double-blind clinical trial study was conducted in the operating theatres of Ain shams University Hospitals. Study period March 2022 to August 2022. Physical status: ASA 1 or 2 and candidates for spinal anaesthesia undergoing total knee arthroplasty. Age group: 40-65 years. Sample sizes of 30 patients in total; 15 in group I (group I) and 15 in group II (group A).

Results

As for the comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty, it showed that there is significance regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block.

Conclusion

The comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty showed significant difference regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block. These findings with our study primary and secondary outcomes showed that Adductor canal block has more analgesic effect with respect to IPACK block regarding pain assessment but with no significant difference regarding the by the time till first analgesia postoperative and Total analgesics consumption (in mg.) over 24-hour period post-operative.
Comparative Study between Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Epidural as Postoperative Pain Management in Modified Radical Mastectomy
Authors: Nashed Sherif W , El Shebiny Ahmed A , Sayed Amr G , Farag Michael G
Published: July 2024

Background

Surgery is one of the mainstays of treatment of breast cancer, and modified radical mastectomy (MRM) is one of the standard treatments for multi-centric disease or tumors with extensive coexistent ductal carcinoma in situ, where achieving a clear surgical margin becomes difficult with a segmental mastectomy.

Aim of the Work

to compare between Serratus Anterior plane block and thoracic epidural as efficacy of postoperative analgesia in Modified Radical Mastectomy.

Patients and Methods

This study was prospective controlled single blinded randomized clinical study, carried out in Ain Shams University hospitals, Cairo, Egypt over a period of 6 months. The study included adult female patients undergoing modified radical mastectomy was randomly assigned into two equal groups by computer generated: Group A: Included 15 patients received general anaesthesia preceded by Thoracic Epidural 9 ml of 0.25% Bupivacaine at T4-T5 level. Group B: Included 15patients received general anaesthesia followed by SAP block using only bupivacaine 0.25% (safety dose 3 mg /kg).

Results

The haemodynamic data including heart rate and mean arterial blood pressure show a significant decrease in SAP group less than the TE group. The pain scale (VAS) showed a significant decrease in SAP group less than the TE group. The total opioids consumption was significantly less in SAP than TE group. The first rescue morphine analgesia (min.) was significantly higher in SAP group more than TE group.

Conclusion

The SAP was effective and safe technique which provides better pain relief compared with the TE and reduced post-operative opioid consumption. Also, SAP was effective analgesic technique showing greater hemodynamics stability and less stress response to surgery compared with TE.
The Role of Procalcitonin and Red Cell Distribution Width as Diagnostic and Prognostic Biomarkers in Patients with Sepsis and Septic Shock at Intensive Care Unit
Authors: Shokeir Mohamed Hossam , Gad Ehab Ahmed , Farrag Ossama Mohamed , Mostafa Abdullah Mostafa
Published: July 2024

Background

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be identified as an acute change in total sequential organ failure assessment (SOFA). Septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality. Biomarkers can be used in suspected sepsis for identifying or ruling out sepsis, evaluating the severity and assessing the prognosis and evaluating patients’ response to proper treatment. This study is on procalcitonin (PCT) and red cell distribution width (RDW) as diagnostic and prognostic biomarkers in patients with sepsis and septic shock.

Objective

This study aims to assess the feasibility of PCT and RDW as early diagnostic and prognostic biomarkers in patients with sepsis and septic shock.

Methods

This is a prospective observational study, in which 100 blood samples of clinically suspected sepsis and septic shock patients’ were included following a convenience sampling technique. PCT and RDW were recorded in day 0, 3, 6, 9 and 12.

Results

A rise in RDW and PCT levels could serve as early indicators of outcome including mortality. We found that baseline RDW cut-off point > 15.6 with sensitivity of 80.0%, specificity of 85.71% while in day 12 cut-off point > 17.3 with sensitivity of 60.0%, specificity of 100.0%. Accordingly PCT cut-off point > 4.1 with sensitivity of 80.0% and specificity of 94.29% in baseline values. While cut-off point in day 12 was > 0.7 with sensitivity of 80.0%, specificity of 97.0%.

Conclusion

A significant concurrence was seen between elevated serum PCT and RDW levels with severity and prognosis of sepsis. They were found to be a good predictor of sepsis and low levels rule out an infection.
A Comparative Study between Continuous Epidural Analgesia versus Ultrasound Guided Continuous Femoral Nerve Block (CFNB) versus Ultrasound Guided Continuous Adductor Canal Block (ACB) for Post-Operative Pain Management after Total Knee Replacement (TKR)
Authors: Nassif Kalad Remon Nadhy , Mahmoud Ali Hoda Omar , Hussein Thabet Wael Reda , Sayed Sharaf Amr Gaber , Abdelghaffar Elsotouhy Abdelrahman Mabrouk
Published: July 2024

Background

Total knee replacement (TKR) is considered a prevailing cause of severe postoperative pain and discomfort among orthopedic surgeries, limiting postoperative ambulation that is important for regaining joint function. Despite being the gold standard, epidural analgesia can be accompanied by diverse complications delaying postoperative ambulation and discharge from hospital. Continuous femoral nerve block (CFNB) and continuous adductor canal block (ACB) are reliable and efficacious regional anaesthesia techniques allowing better control of postoperative pain. This study purposed to compare epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative analgesia & incidence of postoperative complications. The aim of this study is to estimate the efficacy of epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative pain control following total knee replacement and the rate of incidence of associated postoperative complications. This is a prospective randomized controlled study where sixty patients were randomized into three equal groups, patients in group A received epidural analgesia, patients in group B received continuous femoral nerve block while patients in group C received continuous adductor canal block with postoperative continuous infusion of 0.125% bupivacaine with fentanyl 2μg/ml in the three groups at a rate of 5 ml/hr. VAS score was assessed for 48 hours post-operatively and complications were recorded.

Results

Epidural analgesia was superior to CFNB and ACB regarding postoperative pain control using visual analogue scale and postoperative pain control. CFNB and ACB are superior to epidural analgesia regarding postoperative ambulation and postoperative complications.

Conclusions

Continuous epidural analgesia provides superior analgesia following total knee replacement than femoral nerve block and adductor canal block, with relatively more adverse effects like pruritus, post operative nausea, and vomiting (PONV). Both CFNB and ADB are good alternatives with fewer systemic side effects.
Plethysmography Variation Index versus Pulse Pressure Variation as an Indicator of Fluid Responsiveness in Colorectal Surgeries during Immediate Postoperative Period
Authors: Alamir Maye M , El Seidy Mohamed I , Taha Sahar M , Al Gharabawy Wael S , Galal Mohammed A
Published: July 2024

Objective

Goal directed fluid therapy during major abdominal surgery may reduce postoperative morbidity. The Plethysmography Variability Index (PVI), derived from the pulse oximeter waveform, has been shown to be able to predict fluid responsiveness in a number of surgical circumstances. In this study, we will compare the effectiveness and re liability of Plethysmography variation index (PPV) and Pulse pressure variation (PPV) in prediction of fluid responsiveness in all sedated intubated mechanically ventilated patients admitted for postoperative resuscitation in our surgical ICU.

Method

100 patients were placed in two different groups equally where heart rate, PPV, CI, and PVI were recorded on admission. Immediately after volume expansion is performed by infusing saline 500 ml over 30 mins and at the end of volume expansion PPV, CI, PVI will be recorded every 2 hours for the first 24 hours.

Results

Hundred patients aged from 18 to 64 years who were scheduled for colorectal surgery and were to be transferred to the intensive care unit for postoperative care for the f irst 24 hours post operatively who didn’t have any of the exclusion criteria were included in this prospective randomized comparative single blinded research. 100 patients were divided in to “responders” and “non responders”. Both groups received a volume 500 ml saline over 30 minutes immedietly postoperatively. Fluid responsiveness was tested in both groups using PVI (Plethysmography variability index) and PPV ( pulse pressure variation) using cardiac index as a reference parameter. PVI showed accurate fluid responsiveness in comparison with PPV in responders with mean ranging from ( (-6.66 ± 0.90) and (-5.89 ± 1.93) respectively, with a P-value<0.01

Conclusion

This study revealed that after giving a fluid challenge of 500 ml of saline over 30 minutes, a rise in PVI and PPV was demonstrated using cardiac index as a reference for reliability for comparing the effectiveness and accuracy between PVI and PPV.comparing the effectiveness and accuracy between PVI and PPV.PVI and PVI and PPV PPV can be used can be used in assessment of fluid responsiveness of the intubated ventilated sedated patients in assessment of fluid responsiveness of the intubated ventilated sedated patients with sinus rhythm in ICU, and both methods can be performed at the bedside, but with sinus rhythm in ICU, and both methods can be performed at the bedside, but PVI has advantage of being continuousPVI has advantage of being continuous, operator independent, and more reliable, operator independent, and more reliable thanthan PPVPPV.
Effect of Sacubitril / Valsartan Combination on Abnormal ECG Findings in Patients with Heart Failure with Reduced Ejection Fraction
Authors: Aly Ahmed , Shehata Hassan , Allam Lamyaa , Eldamanhoury Hayam
Published: July 2024

Background

The mortality rate of patients suffering from choronic heart failure is still high despite advantages in diagnosis and treatment. A new therapeutic class of agents acting on the renin angiotensin aldosterone system (RAAS) and neutral endopeptidase system has been developed, known as angiotensin receptor neprilysin inhibitors (ARNI). Recently, promising data from its administration have demonstrated a decrease in the mortality rate as compared to angiotensin receptor blocker alone.

Aim of the Work

The aim of this study is to asses effect of Sacubitril/Valsartan combination on abnormal ECG and ECHO parameters in patients with heart failure with reduced ejection fraction as a marker of reverse cardiac remodeling.

Patients and Methods

Our study was conducted at Ain Shams university hospitals and our target population was heart failure patients with reduced ejection fraction planned to initiate Sacubitril \ Valsartan combination therapy. 100 patients were collected from February 2022 to August 2022. It was an interventional study to follow up the effects of the drug on ECG parameters besides ECHO parameters 6 months after drug initiation.

Results

We found that in Sacubitril/Valsartan combination therapy there was significant decrease in HR, QRS width and QTc values which reflects the role of this combination to reduce ventricular arrhythmias and preventing SCD. There was significant increase in the EF which was correlated to the significant decrease in QRS width. There was significant improvement in diastolic dysfunction. There was significant decrease in the LA and LV dimensions giving an explanation of the role of the drug in reverse cardiac remodeling. There was significant improvement in NYHA class reflecting the role of the drug in improving quality of life.

Conclusion

HR, QRS width and QTc were significantly decreased with Sacubitril/Valsartan combination therapy through the follow up period reflecting the effect of the drug on ECG. EF, LA dimension and LVID were improving with Sacubitril/Valsartan combination therapy through the follow up period which give an explanation of the combination therapy for its role in reverse cardiac remodeling. NYHA class of our patients was improving through follow up period which means this drug improves quality of life and reduces hospitalization.
The Value of 24 Hour Ambulatory Blood Pressure Measurement vs Home/in-office BP measurement in predicting left ventricular Mass Index in Egyptian Hypertensive Patients on Medical Treatment
Authors: Abdelkarim Hanan , Rayan Mona , Keaddes Viola , Hennawy Bassam
Published: July 2024

Background

An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. An estimated 46% of adults with hypertension are unaware that they have the condition. Less than half of adults (42%) with hypertension are diagnosed and treated.

Aim of the work

To determine the value of 24hour ambulatory blood pressure monitoring vs in office /home BP measurement in predicting left ventricular mass index in Egyptian hypertensive adults receiving anti hypertensives medications.

Patients and Methods

The present study included 100 known hypertensive patients. All were on either one or two anti-hypertensive drugs, and were coming in for follow up in the period between January 2021 and July 2022. The study setting was Ain Shams University hospitals and national heart institute.

Results: Conclusion

Ambulatory blood pressure monitoring was superior to office and home blood pressure measurement in assessing left ventricular mass index in hypertensive Egyptian medicated patients. There was a discordance between ambulatory blood pressure monitoring and home / office-BP measurement in detecting controlled hypertension status of patients.
Evaluation of the GeneXpert MTB/RIF Assay for Rapid Diagnosis of Tuberculosis and Detection of Rifampin Resistance in Tuberculous Patients Admitted to Abbassia Chest Hospital
Authors: Ahmed Mona Mansour , Al Adawy Eman Ramzy Ali , Mohammed Rehab M , Galal Hamed Amal Hamed
Published: July 2024

Background

Tuberculosis is considered one of the major infectious diseases especially in the developing countries and a significant diagnostic and therapeutic challenge worldwide. Gene Xpert MTB/RIF assay is a diagnostic test which depends on a real-time polymerase chain reaction for rapid diagnosis of Mycobacterium Tuberculosis and rifampicin resistance in a single test.

Aim

To evaluate the diagnostic utility of Gene Xpert MTB/RIF assay for rapid diagnosis of pulmonary and extrapulmonary tuberculosis as well as the detection of rifampin resistance in specimens obtained from suspected tuberculous patients in Abbassia Chest Hospital.

Patients and Methods

Pulmonary and extrapulmonary samples from 77 cases with suspected TB were collected. All retrieved samples were examined with: direct smear microscopy for AFB, culture for Mycobacterium tuberculosis (L.J. media) along with Drug susceptibility testing (D.S.T.) for positive cultures. As well as the gene Xpert MTB/RIF assay and their results were compared to those of both culture and D.S.T. (as gold standard reference methods).

Results

Gene Xpert MTB/RIF assay showed the highest sensitivity, negative predictive value (NPV) and diagnostic accuracy in detection of pulmonary TB (96.4, 96.4 and 93.1% respectively), with 90%specificity. Xpert MTB/RIF assay showed the lowest sensitivity in diagnosing TB pleural effusion (66.6%) but with the highest specificity and positive predictive value (PPV) (100% for both). As regards diagnosing TB lymphadenitis, gene Xpert MTB/RIF assay showed 75% sensitivity and the lowest specificity (33.3%). Considering rifampin resistance, gene Xpert MTB/RIF assay showed 100% specificity in detection of RIF- Resistance with variable sensitivity according to the type of TB, being the highest in pulmonary TB (90.9% sensitivity).

Conclusion

Gene Xpert MTB/RIF assay could be used as the first line diagnostic tool for diagnosis of pulmonary TB because of its high diagnostic yield. Yet, it’s not recommended to replace the culture for diagnosing extrapulmonary TB especially in diagnosing tuberculous pleural effusion (pauci-bacillary specimens) which has limited diagnostic utility. Also, the assay showed 100% specificity in diagnosing rifampicin resistance guiding physicians to justifiably starting second line anti-TB treatment.
Immunophenotypic Evaluation of Circulating Monocyte Subsets in Beta Thalassemia Major Patients
Authors: Mahmoud Abdelghaffar Marwa Abdelmoniem , Wahba Mona Ahmed , Pessar Shaimaa Abdelmalik
Published: July 2024

Background

β-thalassemia is a major public health problem in Egypt with particularly high incidence due to strong cultural preference for consanguineous marriages, and the high carrier rate. Iron overload, which is caused by increased gut iron absorption secondary to ineffective erythropoiesis, and regular blood transfusion is linked to accumulation within different organs with subsequent organ dysfunction. Monocytes are important lineages of innate immunity which activate the adaptive immune response and play a pivotal role in the host response to pathogens. Human blood monocyte subsets classification is based on the expression of CD14 and CD16 cell surface receptors.

Aim of the Work

To evaluate the circulating monocyte subsets in β-thalassemia major (β-TM) patients and its potential role in prediction of iron overload and chronic inflammation in β- thalassemia major patients.

Patients and Methods

A Case-Control study conducted on 40 previously diagnosed beta thalassemia major patients attending the outpatient clinic of Ain Shams University Pediatric Hospital, and 20 age and sex matched healthy control subjects. CBC, iron profile, CRP and immunophenotyping for monocyte subsets classification were done.

Results

Non classical monocytes were found statistically significantly higher in thalassemic patients especially in those with serum ferritin level < 1000 ng/ml (P value < 0.01). In addition, classical monocytes were found to be statistically significantly lower among the patients’ group (P value < 0.01). A negative correlation was found between intermediate monocytes and Transferrin saturation percent (TS%) suggesting its protective role in iron overload thalassemia patients. By using ROC curve, non- classical monocytes predicted ferritin < 1000 ng/ml at a cutoff point of 17.8 % and 0.05 x 10∧9/L for relative and absolute counts respectively.

Conclusion

All monocyte subsets proposed to have role in predicting iron overload and chronic inflammation β-TM patients. We recommend further studies on β-TM patients with the engagement of activity assays of monocyte subsets to clarify the co-regulatory role in iron hemostasis and chronic inflammation.
Penile Length and Circumference among Adult Egyptians
Authors: Aldaeji Ahmad Hasan , Sallam Mohamed Abdelnaeem , El-Fattah Afifi Ahmed Abd
Published: July 2024

Background

accurate measurement of penile length is important for both clinical and academic purposes. For this reason, a standard practice for measurement has been defined to maintain consistency. Rather than measuring a flaccid penis, which offers limited clinical significance, stretched penile length (SPL) measurement is considered best practice for adult men as it most closely replicates normal erect penile length.

Aim of the Work

to assess the stretched penile length and penile circumference in a sample of physically normal Egyptian men and to determine the penile anthropometry-somatometric parameters relationship.

Patients and Methods

The current study demonstrated that the mean stretched penile length of this sample of Egyptian men was 13.0 ±1.9 cm and the flaccid penile circumference was 9.3±1.1; which are consistent with the results of previous studies done in Egypt and with studies done within the same geographical region. There were significant positive correlations between penile measures and height, weight, and BMI with no significant correlations between penile measures and age. Our study results revealed as well that there was no significant difference between age grades regarding penis length and penis circumference. The previous correlations agree with most of the studies except for BMI which remains controversial whether it has positive or negative correlation with the penile anthropometry.

Results

revealed that alcohol use and smoking were significant factors that decrease penis length and circumference. This could be attributed to the associated erectile dysfunctions revealed in previous studies to be found in smokers and alcohol drinkers, in addition to the findings that postulate that erectile dysfunction could shorten the penile measurements. Nonetheless, further studies are needed to clarify these associations.

Conclusion

Concern over penile size is not uncommon. The results of this study help to establish a reference range for male genital size among adult Egyptian men, which should be helpful for andrologists in counselling patients. As evident from the current study, the mean stretched penile length of Egyptian men was 13.0 ±1.9 cm and the flaccid penile circumference was 9.3±1.1 with significant positive correlations between penile measures and height, weight, and BMI. Moreover, penile anthropometry was significantly lower in smokers and alcohol users.