bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency surgery in an elective setting: a case report detailing incidental diagnosis of a de Garengeot hernia
Authors: Brosnan Conor , Keogh Shane , Bolger Jarlath C , Farrell Kevin , Hannan Enda , Mulholland Doug , Butt Abeeda , Hill Arnold D K
Published: May 2020

We present a case of acute appendicitis within an incarcerated femoral hernia. This is a rare complication of the phenomenon eponymously known as a ‘De Garengeot Hernia’, which describes a vermiform appendix in an incarcerated femoral hernia sac. Our case is somewhat unique in the manner by which the affected patient had presented. Attending hospital for an unrelated elective surgery, an incarcerated hernia was diagnosed at time of admission. Thorough assessment in advance of the procedure and decisive action led to a satisfactory outcome. This may be the first case in literature reporting a ‘De Garengeot Hernia’ presenting in such a fashion.
Troubling the Tragic Paradigm: Genre and Epigraph in Thomas Hardy’s Tess of the d’Urbervilles
Authors: Rimmer Mary
Published: May 2020

The rarely discussed epigraph to Thomas Hardy’s Tess of the d’Urbervilles – ‘Poor wounded name! My bosom as a bed | Shall lodge thee’ – at first seems an odd choice. Tess is usually read as a tragedy; the epigraph’s source, Shakespeare’s The Two Gentlemen of Verona, is a comedy. The speaker of these lines in the play is a woman, the ‘wounded name’ a man’s, and the immediate context one of erotic playfulness as Julia tears up Proteus’s love letter and then tenderly gathers up the fragments. Yet the apparent mismatch works, because it gestures towards both the generic instability of Two Gentlemen, and the novel’s own unstable genre. Hardy recurrently raises the question of how Tess Durbeyfield’s story should be read. Tess’s ‘fall’ is at different times and for different people a fatal blot on her prospects, a venial error, and material for an amusing or satirical story. Novel and heroine hover between genres; generic interpretations are complicated by gender and class. Early reviewers who refused to read Tess as a tragedy may seem wrong-headed and puritanical in hindsight, but they were in some ways more alive to the novel’s generic slippages than many later readers. Hardy at once invokes and unsettles generic models, in his choice of epigraph and throughout the book.
Ribosome profiling in plants: what is not lost in translation?
Authors: Kage Udaykumar , Powell Jonathan J , Gardiner Donald M , Kazan Kemal
Published: May 2020

Translation is a highly dynamic cellular process whereby genetic information residing in an mRNA molecule is converted into a protein that in turn executes specific functions. However, pre-synthesized mRNA levels do not always correlate with corresponding protein levels, suggesting that translational control plays an essential role in gene regulation. A better understanding of how gene expression is regulated during translation will enable the discovery of new genes and mechanisms that control important traits in plants. Therefore, in recent years, several methods have been developed to analyse the translatome; that is, all mRNAs being actively translated at a given time, tissue, and/or developmental stage. Ribosome profiling or ribo-seq is one such technology revolutionizing our ability to analyse the translatome and in turn understand translational control of gene expression. Ribo-seq involves isolating mRNA–ribosome complexes, treating them with a RNase, and then identifying ribosome-protected mRNA regions by deep sequencing. Here, we briefly review recent ribosome profiling studies that revealed new insights into plant biology. Manipulation of novel genes identified using ribosome profiling could prove useful for increasing yield through improved biotic and abiotic stress tolerance.
Variability in the chloroplast area lining the intercellular airspace and cell walls drives mesophyll conductance in gymnosperms
Authors: Veromann-Jürgenson Linda-Liisa , Brodribb Timothy J , Niinemets Ülo , Tosens Tiina
Published: May 2020

The photosynthetic efficiency of plants in different environments is controlled by stomata, hydraulics, biochemistry, and mesophyll conductance (gm). Recently, gm was demonstrated to be the key limitation of photosynthesis in gymnosperms. Values of gm across gymnosperms varied over 20-fold, but this variation was poorly explained by robust structure-bound integrated traits such as leaf dry mass per area. Understanding how the component structural traits control gm is central for identifying the determinants of variability in gm across plant functional and phylogenetic groups. Here, we investigated the structural traits responsible for gm in 65 diverse gymnosperms. Although the integrated morphological traits, shape, and anatomical characteristics varied widely across species, the distinguishing features of all gymnosperms were thick mesophyll cell walls and low chloroplast area exposed to intercellular airspace (Sc/S) compared with angiosperms. Sc/S and cell wall thickness were the fundamental traits driving variations in gm across gymnosperm species. Chloroplast thickness was the strongest limitation of gm among liquid-phase components. The variation in leaf dry mass per area was not correlated with the key ultrastructural traits determining gm. Thus, given the absence of correlating integrated easy-to-measure traits, detailed knowledge of underlying component traits controlling gm across plant taxa is necessary to understand the photosynthetic limitations across ecosystems.
Objects of Choice
Authors: Schwarz Wolfgang
Published: May 2020

Rational agents are supposed to maximize expected utility. But what are the options from which they choose? I outline some constraints on an adequate representation of an agent’s options. The options should, for example, contain no information of which the agent is unsure. But they should be sufficiently rich to distinguish all available acts from one another. These demands often come into conflict, so that there seems to be no adequate representation of the options at all. After reviewing existing proposals for how to construe decision-theoretic options and finding them all wanting, I suggest that our model of rational agents should include a special domain of ‘virtual’ option propositions to serve as formal objects of deliberation and choice.
Instability of non-Keplerian warped discs
Authors: Doğan S , Nixon C J
Published: May 2020

Many accretion discs are thought to be warped. Recent hydrodynamical simulations show that (i) discs can break into distinct planes when the amplitude of an imposed warp is sufficiently high and the viscosity sufficiently low, and that (ii) discs can tear up into discrete rings when an initially planar disc is subject to a forced precession. Previously, we investigated the local stability of isolated, Keplerian, warped discs in order to understand the physics causing an accretion disc to break into distinct planes, finding that antidiffusion of the warp amplitude is the underlying cause. Here, we explore the behaviour of this instability in disc regions where the rotation profile deviates from Keplerian. We find that at small warp amplitudes non-Keplerian rotation can stabilize the disc by increasing the critical warp amplitude for instability, while at large warp amplitudes non-Keplerian rotation can lead to an increased growth rate for discs that are unstable. Tidal effects on discs in binary systems are typically weak enough such that the disc remains close to Keplerian rotation. However, the inner regions of discs around black holes are strongly affected, with the smallest radius at which the disc can break into discrete planes being a function of the black hole spin. We suggest that interpreting observed frequencies in the power spectra of light curves from accreting compact objects as nodal and apsidal precession of discrete orbits requires an instability that can break the disc into discrete rings such as the one explored here.
The impact of AGN feedback on the 1D power spectra from the Ly α forest using the Horizon-AGN suite of simulations
Authors: Chabanier Solène , Bournaud Frédéric , Dubois Yohan , Palanque-Delabrouille Nathalie , Yèche Christophe , Armengaud Eric , Peirani Sébastien , Beckmann Ricarda
Published: May 2020

The Lyman-α forest is a powerful probe for cosmology, but it is also strongly impacted by galaxy evolution and baryonic processes such as active galactic nucleus (AGN) feedback, which can redistribute mass and energy on large scales. We constrain the signatures of AGN feedback on the 1D power spectrum of the Lyman-α forest using a series of eight hydro-cosmological simulations performed with the adaptive mesh refinement code ramses. This series starts from the Horizon-AGN simulation and varies the subgrid parameters for AGN feeding, feedback, and stochasticity. These simulations cover the whole plausible range of feedback and feeding parameters according to the resulting galaxy properties. AGNs globally suppress the Lyman-α power at all scales. On large scales, the energy injection and ionization dominate over the supply of gas mass from AGN-driven galactic winds, thus suppressing power. On small scales, faster cooling of denser gas mitigates the suppression. This effect increases with decreasing redshift. We provide lower and upper limits of this signature at nine redshifts between z = 4.25 and 2.0, making it possible to account for it at post-processing stage in future work given that running simulations without AGN feedback can save considerable amounts of computing resources. Ignoring AGN feedback in cosmological inference analyses leads to strong biases with 2 per cent shift on σ8 and 1 per cent shift on ns, which represents twice the standards deviation of the current constraints on ns.
Electrostatic charging of permanently shadowed craters on the Moon
Authors: Mishra S K , Bhardwaj Anil
Published: May 2020

An open question of the electrostatic charge development on the lunar surface in the electron-rich region within the permanently shadowed craters (PSCs) is addressed. We propose that the fine dust grains on the crater surface may act as efficient field emission centres generating electrons via quantum field tunnelling. This return current may be sufficient to establish a steady-state dynamical equilibrium for the surface-plasma system. This leads to the crater surface attaining a finite electric potential. Our analysis illustrates that the PSC having ∼100 nm dust, covering 1 per cent of the surface area within the electron-rich region, may acquire a negative potential of few hundred volts in the steady-state condition.
eIF4G has intrinsic G-quadruplex binding activity that is required for tiRNA function
Authors: Lyons Shawn M , Kharel Prakash , Akiyama Yasutoshi , Ojha Sandeep , Dave Dhwani , Tsvetkov Vladimir , Merrick William , Ivanov Pavel , Anderson Paul
Published: May 2020

As cells encounter adverse environmental conditions, such as hypoxia, oxidative stress or nutrient deprivation, they trigger stress response pathways to protect themselves until transient stresses have passed. Inhibition of translation is a key component of such cellular stress responses and mounting evidence has revealed the importance of a class of tRNA-derived small RNAs called tiRNAs in this process. The most potent of these small RNAs are those with the capability of assembling into tetrameric G-quadruplex (G4) structures. However, the mechanism by which these small RNAs inhibit translation has yet to be elucidated. Here we show that eIF4G, the major scaffolding protein in the translation initiation complex, directly binds G4s and this activity is required for tiRNA-mediated translation repression. Targeting of eIF4G results in an impairment of 40S ribosome scanning on mRNAs leading to the formation of eIF2α-independent stress granules. Our data reveals the mechanism by which tiRNAs inhibit translation and demonstrates novel activity for eIF4G in the regulation of translation.
Characterization of the ZFX family of transcription factors that bind downstream of the start site of CpG island promoters
Authors: Ni Weiya , Perez Andrew A , Schreiner Shannon , Nicolet Charles M , Farnham Peggy J
Published: May 2020

Our study focuses on a family of ubiquitously expressed human C2H2 zinc finger proteins comprised of ZFX, ZFY and ZNF711. Although their protein structure suggests that ZFX, ZFY and ZNF711 are transcriptional regulators, the mechanisms by which they influence transcription have not yet been elucidated. We used CRISPR-mediated deletion to create bi-allelic knockouts of ZFX and/or ZNF711 in female HEK293T cells (which naturally lack ZFY). We found that loss of either ZFX or ZNF711 reduced cell growth and that the double knockout cells have major defects in proliferation. RNA-seq analysis revealed that thousands of genes showed altered expression in the double knockout clones, suggesting that these TFs are critical regulators of the transcriptome. To gain insight into how these TFs regulate transcription, we created mutant ZFX proteins and analyzed them for DNA binding and transactivation capability. We found that zinc fingers 11–13 are necessary and sufficient for DNA binding and, in combination with the N terminal region, constitute a functional transactivator. Our functional analyses of the ZFX family provides important new insights into transcriptional regulation in human cells by members of the large, but under-studied family of C2H2 zinc finger proteins.
Transcriptome Analysis of Low- and High-Sucrose Pear Cultivars Identifies Key Regulators of Sucrose Biosynthesis in Fruits
Authors: Lü Jiahong , Tao Xin , Yao Gaifang , Zhang Shaoling , Zhang Huping
Published: May 2020

Sucrose accumulation is one of the important factors that determine fruit enlargement and quality. Evaluation of the sugar profile of 105 pear cultivars revealed low-sucrose and high-sucrose (HS) types of pear fruits. To better understand the molecular mechanisms governing the sucrose content of pear fruits, this study performed transcriptome analysis during fruit development using low-sucrose ‘Korla’ fragrant pear and HS ‘Hosui’ pear, and a coexpression module uniquely associated with the control of high-sucrose accumulation was identified by weighted gene coexpression network analysis. These results suggested that there are seven candidate genes encoding key enzymes (fructokinase, glucose-6-phosphate isomerase, sucrose phosphate synthase and sucrose synthase) involved in sucrose biosynthesis and several transcription factors (TFs) whose expression patterns correlate with those of genes associated with sucrose biosynthesis. This correlation was confirmed by linear regression analysis between predicted gene expression and sucrose content in different pear cultivars during fruit development. This study provides insight into the molecular mechanism underlying differences in sucrose content across pear cultivars and presents candidate structural genes and TFs that could play important roles in regulating carbohydrate partitioning and sucrose accumulation.
The Relationship Between the Pain Experience and Emotion Regulation in Older Adults
Authors: Ghandehari Omeed , Gallant Natasha L , Hadjistavropoulos Thomas , Williams Jaime , Clark David A
Published: May 2020

Objective

To investigate the relationship of emotion regulation strategies (i.e., emotional suppression and reappraisal) with pain catastrophizing, fear of pain, pain intensity, worry, and depression as function of age in samples of older and younger adults.

Design

Cross-sectional design using validated questionnaires.

Setting

Participants resided in the community. They completed validated measures using online questionnaires.

Subjects

Two-hundred fifty-seven older adults and 254 younger adults with chronic pain participated.

Methods

Participants completed validated questionnaires of emotion regulation strategies, pain-related functioning and mental health.

Results

Emotion regulation varied as a function of age and gender. Among our chronic pain sample, older adult males reported lower use of reappraisal and suppression than younger adult males, while older adult females reported higher use of reappraisal than younger adult females. Emotional suppression was positively related to pain catastrophizing, pain intensity, worry, and depression. Reappraisal was negatively related to depression and worry. Interestingly, age showed a positive relationship with fear of pain, pain catastrophizing, worry, depression, and pain intensity, while gender was related to fear of pain and worry. Finally, emotional reappraisal partially mediated the relationship between the affective dimensions of pain intensity and pain catastrophizing among older adults.

Conclusions

Our results indicate that reappraisal strategies are important for older and younger adults with chronic pain, pointing to the necessity of considering these strategies when working clinically with such populations. However, given our findings as well as those in the literature, gender should also be considered.
Who Governs Immigrant Labor? Status, Residency, and Rights in Federal and State Law
Authors: Newton Lina
Published: May 2020

This article examines a collection of 244 state bills selected from the National Conference of State Legislatures (NCSL) Immigrant Policy Project between 2006 and 2018 covering three areas of immigrant work and worksite regulations. Even though employment regulation is an area where states claim statutory and court-backed authority and therefore where states might have been expected to act independently of the federal government, state employment, and workplace laws are in many cases aligned with federal policy. The significant degree of alignment of state and federal law in this area reveals how states face downward pressures from federal efforts to regulate and crack down on immigration broadly, and unauthorized immigrants specifically. This, in turn, suggests that immigration federalism scholarship, which has generally highlighted state–federal conflict in the area of policing and enforcement, needs to account for different types of intergovernmental relationships that accompany distinctive immigrant policy areas, and researchers should consider the different spheres where enforcement occurs.
Relation between fluid balance and incidence of morbidity and mortality rates in critically ill patients prospective observational study
Authors: Gerges M G A , Elazzazi H M M , Elsersi M H S A , Mustafa S A R , Saeed M A
Published: May 2020

Background

While administration of fluid can be lifesaving, it has been suggested that the fluid accumulation after initial resuscitation and hemodynamic stabilization can contribute to potentially avoidable adverse effects and less favorable outcomes.

Objective

The aim of this study is to assess whether positive fluid balance in comparison with negative or even fluid balance is associated with increased morbidity and mortality rates in critically ill patients.

Patients and Methods

This prospective observational study was performed on 145 Patients older than 18 years admitted to intensive care units at Helwan university hospitals and Ain shams university hospitals during the period from November 2017 till May 2018.

Results

A total of 145 patients with an ICU mortality rate of 14.5% were enrolled. The median cumulative fluid balance of the 124 patients who survive was -110 ml (IQR -2.1-2.2 L) after the fourth day following randomization while the median cumulative fluid balance of the 21 patients who not survive was 3800 ml (IQR 1.7-5.2 L) after the fourth day in ICU. In our study critically ill patients with fluid balance more than 1.2 litres per day had higher ICU complications: increased risk of AKI, longer ICU and hospital stays, and mechanical ventilation, and fluid balance was independently associated with mortality.

Conclusion

In the view of this study, we concluded that:Zero fluid balance and negative fluid balance independently associated with decrease mortality and morbidity rates in critically ill patients after 4 days from admission in ICU.There was higher cumulative fluid balance in non survivors compared to survivors. Cumulative fluid balance after 4 days from admission was independently predictive of mortality in a heterogeneous group of critically ill patients.96 hour negative fluid balance in critically ill patients was associated with less length of stay at ICU and less mechanical ventilation duration.Positive fluid balance, mechanical ventilation, vasopressors, and high admission SAPS II, SOFA, APACHE II and KIDGO were significantly associated with high mortality.
Ultrasound Guided Transversus Abdominis Plane (TAP) Block versus Caudal Block in Pediatrics Undergoing Inguinal Hernia Repair
Authors: Fahmy N M A , Hazem A M , Tolba M A A , Mostafa S A
Published: May 2020

Background

Inguinal hernia repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics are caudal block and TAP block.

Objective

This study was to compare the effectiveness and safety of US guided TAP block versus caudal block as a part of multimodal analgesia in pediatric patients undergoing inguinal hernia repair.

Patients and Methods

The study was conducted on 90 randomly chosen patients in Ain Shams University Hospitals after approval of the Medical Ethical Committee. Patients were divided randomly into two groups, each group consisted of 45 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia.

Results

The results of the study revealed that US guided TAP block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal block in pediatric patients undergoing inguinal hernia. Both analgesic techniques are safe.

Conclusion

The current study revealed that US guided TAP block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal block in pediatric patients undergoing inguinal hernia. Both analgesic techniques are safe.
Preoperative Pregabalin Prolongs Duration of Spinal Anesthesia and Reduces Early Postoperative Pain
Authors: Elkady G A A , Ghaly S I , Elansary A M , Ismail A M
Published: May 2020

Background

Various adjuvants have been used to prolong spinal anesthesia, with the additional advantages of delaying the onset of postoperative pain and reducing postoperative analgesic requirements. Pregabalin is an R-aminobutyric acid analog that binds to the α2-δ subunit of presynaptic voltage-gated calcium channels.

Objective

The aim of this work is to evaluate the efficacy of a single dose of pregabalin in terms of spinal blockade duration and its potential opioid-sparing effect during the first 24 hours postoperatively

Patients and Methods

There were limitations to the present study. First, since only 1 dosage of pregabalin was evaluated, we could not determine the most effective dosage. Second, clinically meaningful improvements in recovery were not assessed. Adequate postoperative pain control provides early postsurgical mobilization, shortened hospitalization, and increased patient satisfaction. Third, preoperative pain and anxiety scores were not recorded. Pregabalin might affect the preoperative pain, mood, and anxiety scores, and these factors can be related to the postoperative pain score.

Results

The mechanisms by which pregabalin premedication prolongs motor and sensory blocks using local anesthetics in spinal anesthesia are not fully understood. There may be several reasons for the prolongation of spinal anesthesia. Gabapentinoids are an r-aminobutyric acid analog that binds to α2-δ subunit of presynaptic voltage-gated calcium channels, and this inhibition decreases postsynaptic excitability by reducing potassium-evoked excitatory transmitter release. These medications provide antiepileptic, anxiolytic, and analgesic features by modulating both GABAergic neurotransmission and calcium influx. Gabapentinoid compounds produce a significant and clinically important improvement in preoperative anxiety scores. Since patients may be anxious in the perioperative period, the anxiolytic effects and euphorigenic effects of pregabalin may be beneficial.
Comparison between Intravenous and Perineural Dexamethasone in Prolonging the Analgesic Effect of Supraclavicular Plexus Nerve Block
Authors: Elzahaby H M M , Kamal K Y , Emam D F , Saad M Y
Published: May 2020

Background

poor controlled acute pain post-surgery is accompanied with several unwanted postoperative consequences, including patient agony, distress, myocardial ischemia, increased hospital stays and an increased possibility of post-operative chronic pain.

Aim of the Work

to study the effect of dexamethasone as a supplementary to bupivacaine in supraclavicular brachial plexus block. The comparison included the onset and the duration of the motor and sensory blocks, the duration of analgesia of the block and their effect on the postoperative analgesic needs. The effect of the drugs on hemodynamics and monitoring for the occurrence of any complication.

Patients and Methods

in our study, 50 patients were randomly divided into 2 equal groups. Perineural group received bupivacaine (0.5%) assosciated with 8 mg dexamethasone and Systemic group in which 8 mg of dexamethasone was injected systemically. All patients received equal volumes of 20 milliliters.

Results

our study revealed that adding 8 milligram of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block decreased the onset times of motor and sensory blocks and significantly increased their durations. In addition, dexamethasone prolonged the time of analgesia of the plexus block markedly, as shown by the time of request of first analgesia. Moreover, in perineural dexamethasone group, postoperative analgesic needs were much lesser than that of bupivacaine groups. Addition of dexamethasone perineural also did not affect the hemodynamics to a significant level. This makes perineural dexamethasone with bupivacaine more superior than the use of bupivacaine with addition of intravenous dexamethasone.

Conclusion

addition of Dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset times of both sensory and motor blocks than injecting dexamethasone intravenously. Addition of Dexamethasone to bupivacaine significantly prolongs both sensory and motor block durations than injecting dexamethasone intravenously.
Effect of Oral Gabapentin Premedication on Post-Operative Pain in Pediatric Patient Undergoing Adenotonsillectomy
Authors: Bassiony M A , Elserwi H B , Abdelnaiem M A , Elrazzaz M H S M
Published: May 2020

Background

Tonsillectomy is one of the most common surgical procedures performed in otorhinolaryngology. Postoperative pain following tonsillectomy, which is especially aggravated by swallowing, can lead to various complications, such as impairment of food intake, possible dehydration, sleep disturbance and increased risk of secondary hemorrhage.

Objectives

The current study aims to evaluate the effectiveness of oral Gabapentin in decreasing the postoperative pain in pediatric patient undergoing tonsillectomy in the first 0,2,12 24 hours post-operative.

Patients and Methods: Type of study

Prospective randomized control study, study setting: Ain Shams university hospitals, Study period: 3 months from December 2018 to February 2019, Patients were divided randomly into two groups, each group consists of 25 patients:

Group A

Patients in this group received oral Gabapentin dose according to body weight (20mg/kg) at 0,2,12,24hrs post operative,

Group B

Patients in this group received oral paracetamol as analgesics (10-15 mg/kg every 12hours).

Results

The mean age of our study population was around7.2in group A and 7.08 in group B years. This study showed no statisticaly significance differance between group A and B regarding age. The mean body weight of the study was around27.79 for group A and 28.68 for group B.This study showed no statisticaly significance differance between group A and B regarding body weight. The mean HR of group A was lower than group B mean HR. The study shows statistically highly significant reduction of group A post operative heart rate compared to group B. The mean blood pressure of group A was lower than group B mean blood pressure. The study shows statistically highly significant reduction of group A postoperative blood pressure compared to group B. The median VAS score of group A was lower then group B. This study showed statisticaly significance reduction of VAS pain score post operative in group A compared to group B. The median analgesic rescue doses of group A was 2 and for group B was 3.5 so there was a statisticaly significance increase in rescue analgesia use in group B compared with group A.
A Comparative Study between Multimodal Analgesia and Single Mode Analgesia in Lumber Vertebral Surgery
Authors: Abdelhamid H S , Mahmoud D S , Ali A E , Ali H M N N
Published: May 2020

Background

Postoperative pain after spine surgeries is a major concern for the patients, anesthesiologists and surgeons. Nociceptive signals have the capacity to initiate prolonged changes in both the peripheral and central nervous system that will lead to the amplification and prolongation of postoperative pain.

Objective

This study aims to compare between the effect of MMA and single mode analgesia in lumbar spine surgery on intraoperative and early postoperative analgesia, the consumption of morphine in both types and incidence of side effects.

Patients and Methods

In our study a number of 70 patients were scheduled to undergo single or double lumber vertebral discectomy or fixation under general anesthesia and were randomly assigned to one of two groups: Group A: (35 patients) The multimodal group that received preoperative analgesia in the form of paracetamol 1 gm I.V, ketorolac 30 mg and morphine 3 mg I.V. 20-30 min before surgery and intraoperative maintenance of analgesia for this group was done by morphine I.V. infusion in a rate of 1 mg/hour. Group B: (35 patients) The single mode group that received preoperative analgesia in the form of morphine 3 mg I.V 20-30 min before surgery only. Intraoperative maintenance of analgesia for this group was done by morphine I.V. infusion in a rate of 1 mg/hour.

Results

Regarding systolic and diastolic blood pressures and heart rate, there was a significant decrease in intraoperative and early postoperative values in the multimodal group than morphine group. Regarding narcotic consumption there was significant lower consumption in the multimodal group and also significant longer interval time for requesting analgesia.

Conclusion

We concluded that the use of MMA prolonged the duration of postoperative analgesia and decrease the intensity of pain, with stable hemodynamics and without any respiratory burden, furthermore it decreases the consumption of narcotics by decreasing the frequent requesting of analgesia.
Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill
Authors: Fahmy N A , Alfawal S M , Abdelsamie H S , Hassan A M
Published: May 2020

Background

Atrial fibrillation (AF) is the most common sustained arrhythmia affecting humans. It is an electrical disturbance that leads to rapid, disorganized, and asynchronous contraction of the atrial muscle. In clinical practice, it accounts for approximately one-third of hospitalizations for cardiac rhythm disturbances. The incidence of AF increases from less than 0.1% per year in those under 40 years old to exceed 1.5% per year in women and 2% per year in men older than 80 years. Aim of the Work: to discuss the effect of variation in amiodarone use (including dosage and duration) on dysrhythmia recurrence in patients with new-onset AF in ICU.

Patients and Methods

This was a prospective observational study conducted over 6 months, 60 patients who fulfilled inclusion criteria were included in the study divided in two groups according to amiodarone dosage, each group is 30 patients: Group (A): received a loading dose of amiodarone followed by an infusion (1200mg amiodarone). Group (B): received a loading dose of amiodarone not followed by an infusion (300mg amiodarone).

Results

a significant positive correlation was observed between level of C-reactive protein (CRP) and the rate of AF recurrence. As regard effect of CRP on AF recurrence; in AF recurrent patients, mean is (191±77.3) with range from 15 to 352 which significantly differed from Non-recurrent AF patients, mean is (89±63) with range from 20 to 223 (p value <0.001). AF recurrence was higher in group (B) than group (A),. In group (A) 8 patients had recurrent AF representing 26.7 % and in group (B) 19 patients had AF recurrence representing 63.3% (p value =0.004).

Conclusion

Patients with new-onset AF in (ICU) who are treated with amiodarone should receive a loading dose, immediately followed by an infusion.
Efficacy of Dexmedetomidine as an Adjuvant to Bupivacaine in Peripheral Nerve Block - Three Prospective Randomized Controlled Studies
Authors: Nassif G M , Noreldin B M E , Elazzazi H M M , Abdelmalek F A , Maarouf M M
Published: May 2020

Introduction

Peripheral nerve blocks are frequently used as the sole anesthetic technique or as an adjuvant to general anesthesia, However, the duration of sensory nerve block after single doses of long-acting local anesthetics is not consistent enough to avoid the use of postoperative opioids. Many adjuvants have been added to prolong the duration of nerve block, It was recently suggested that, based on current evidence, perineural dexmedetomidine is the most promising adjuvant to extend the duration of long-acting local anesthetics

Aim

The aim of this work is to study the effects of dexmedetomidine as an adjuvant to bupivacaine in various peripheral nerve blocks. The study will include: supraclavicular brachial plexus block, paravertebral block and femoral nerve block.

Patients

Adult patients of either sex aged 25 – 60 years, ASA physical status I and II, Elective surgeries appropriate for the nerve block.

Methods

patients received bupivacaine 0.5% alone in (group I) or bupivacaine 0.5% combined with 100 dexmedetomidine (group II) in peripheral nerve blocks. Motor and sensory block onset times; durations of blockades and analgesia were recorded

Results

Sensory and motor block onset times were shorter in group II than in group I. Sensory and motor blockade durations were longer in group II than in group I. Duration of analgesia was longer in group II than in group I. Systolic, diastolic arterial blood pressure levels, and heart rate were less in group II.

Conclusion

In the current study, it was obvious that:(Addition of dexmedetomidine to bupivacaine in supraclavicular nerve block, paravertebral nerve block and femoral nerve block has shortened the onset times of both sensory and motor blocks and significantly prolonged their durations, Dexmedetomidine had also the added effect of sedation with minimal side effects, which makes it a beneficial adjuvant to local anesthetics in peripheral nerve blocks, Addition of dexmedetomidine to bupivacaine prolonged the postoperative analgesia with subsequent consumption of less amount of analgesics and The use of ultrasonography in performing nerve blocks significantly reduced the incidence of complications such as pneumothorax or intra-arterial injection and hence, lowered the incidence of systemic toxicity of local anesthetics).
Vasopressors in Septic Shock (A Systematic Review / Meta-Analysis)
Authors: Elkady G A M , Elshafei M M N , Mostafa A N S , Awoad A T A
Published: May 2020

Background

sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. Septic shock occurs in a subset of patients with sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality. Septic shock is defined by persisting hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mm Hg or higher and a serum lactate level greater than 2 mmol/L (18 mg/dL) despite adequate volume resuscitation.

Purpose

to assess the role of Vasopressors in septic shock and compare the effects among different types of vasopressor drugs.

Patients and Methods

this meta-analysis study was done on 18 studies randomized controlled studies on adult patients ( at least 18 years of age ) with septic shock and had reported mortality outcome. The study compared five vasopressors EN, DA, VP, TP and PE with norepinephrine (NE) (the control drug) in efficacy and safety.

Results

with comparison of the five vasopressors to NE, Vasopressin and its long acting analogue Terlipressin proved to be the competiting agents to NE but not the replacement choices due to many limitations to the study.

Conclusion

norepinephrine remains the first choice vasopressor to treat patients with septic shock. The use of vasopressin or terlipressin as a first line vasopressor for the support of MAP is not recommended.
Efficacy of Perineural versus Systemic Dexamethasone to prolong analgesia after Supraclavicular Nerve Block in patients undergoing Wrist Arthroscopy
Authors: Mohammed A E , Abdellatif A A , Shokry H , Refaat A A N H
Published: May 2020

Background

Poorly controlled acute pain after surgery is associated with a varity of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Wrist arthroscopy is a very common surgery and performed as a day case surgery and need good postoperative analgesia. Many adjuvant drugs are added to bupivacaine to prolong the duration of sensory block like opioids and dexamethasone.

Objective

The aim of this thesis was to study the effect of adding both perineural & systemic dexamethasone as an adjuvant to bupivacaine in supraclavicualr nerve block. The comparison included the the effect on hemodynamics, postoperative pain & postoperative analgesic requirement.

Methods

In our study, 40 patients were randomly divided into two equal groups: Group #1 (20 patients): Block with 18 ml Bupivacaine 0.5% (+ 2 ml Dexamethasone ‘8 mg’) & 2 ml normal saline was injected IV. Group #2 (20 patients): Block with 18 ml Bupivacaine 0.5% (+ 2 ml normal saline) & 2 ml Dexamethasone ‘8 mg’ was injected IV.

Results

Our study showed that addition of 8 mg dexamethasone to bupivacaine in supraclavicular nerve block whether perineural or intravenous prolonged postoperative analgesia with negligible side effects however, slight better outcome for the perineural route.

Conclusion

Dexamethasone was seen to be a potent adjunct to local anaesthetic to prolong post operative analgesia with negligible side effects with slightly better outcome to the perineural route.
Ultrasound Measurement of Inferior Vena Cava Diameter versus Central Venous Pressure as a Tool of Assessment of Intravascular Volume in Adult ICU Patients
Authors: Ghobrial B B , Alansary A M , Aly R M , Bayoumy A M
Published: May 2020

Background

Measurements of central venous pressure (CVP), pulmonary arterial catheterization, esophageal Doppler, ultrasound, and trans-esophageal echocardiography may be used to determine the volume status of critically ill patients. Appropriate interpretation of the information offered by hemodynamic monitoring requires the integration of several variables. Echocardiography is increasingly used as a first tool to identify a problem and help select initial treatment. To improve patient management and outcome, the clinician must understand the advantages and the limitations of the various tools and parameters used during ICU stay.

Aim of the Work

to assess the intravascular volume by comparing between IVC diameter, IVC collapsibility index by ultrasound with central venous pressure (CVP) in critically ill patients.

Patients and Methods

A clinical interventional study was carried out at department of intensive care at Ain Shams University hospitals – Cairo – Egypt., during a three months (from October 2017 till December 2017).This study was approved by Ethical Committee of Faculty of Medicine, Ain Shams University, including the informed consents which were obtained from either the patient or the closest family member.

Results

In our study the IVC Collapsibility Index correlated well with the Central Venous Pressure. The sensitivity and specificity of IVC Collapsibility to Central Venous Pressure were also found to be highly statistically significant. The change in IVC diameters were also found to be statistically significant when compared to Central Venous Pressure.

Conclusion

The IVC CI% can provide a useful guide for noninvasive intravascular volume status and an alternative to CVP measurement assessment in critically ill patients.
Comparison of Analgesic Efficacy of Caudal Dexamethasone versus Intravenous Dexamethasone as an Adjuvant to Caudal Block in Pediatric Patients Undergoing Lower limb orthopedic Surgeries
Authors: Mohamed G S , Abdelatif A A , Menshawey M , Mansour A A S
Published: May 2020

Background

Lower limb orthopedic surguries are one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics is caudal block.

Aim of the Work

This study is conducted to evaluate the analgesic effect of dexamethasone when given systemically versus caudally as an adjuvant to caudal block for children undergoing lower limb orthopedic surgeries.

Patients and Methods

The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 25 patients.

Results

The results of the study revealed that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain.

Conclusion

From our study, we can conclude that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain.
Effect of Preoperative Pregabalin on Stress Response during Laryngoscopy, Intubation and Postoperative Analgesia in Normotensive Normoglycemic Patients Undergoing Abdominal Hysterectomy
Authors: Gadelrab I A , Ali H A H , Wahba S S , Tharwat A I , Mohamed D S
Published: May 2020

Introduction

abdominal hyterectomy is common operation and have many indications. Laryngoscopy and intubation induce marked sympathetic hemodynamic effect resulting in cardiac response which may be fatal in some patients. Postoperative pain in the form of hyperalgesia caused by surgical trauma can lead to chronic postoperative pain. Preemptive analgesia is a concept in managing postoperative pain. Preemptive analgesia prevents sensitization of peripheral and central pain pathways caused by tissue damage. Pregbalin is thought to supress the hemodynamic effect of intubation and to have analgesic effect.

Aim

The aim of this work is to evaluate the effects of different doses of pregabalin as a premedication to attenuate cardiovascular response during laryngoscopy and intubation. Intubation-induced hyperglycemia will be also assessed, in addition to the effect of the drug on postoperative analgesia in normotensive normoglycemic patients undergoing abdominal hysterectomy.

Subjects and Methods

The current study was performed as a randomized, prospective, placebo-controlled, and double blind study on 120 female patients ASA I, scheduled for elective abdominal hysterectomy under general anesthesia and meeting the inclusion criteria, were allocated into four groups. Group A (n = 30) were given placebo 2 hrs preoperatively, Group B, C and D were given oral pregablin in the following doses 75 mg, 150 mg and 300 mg recpectively. preoperative vital data (systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate were measured before intubation and after intubation by 2, 4 and 6 minutes. Capillary blood glucose was measured before and after intubation. Intraoperative and postoperative analgesic consumption were recorded. Anesthetic and surgical techniques were standardized.

Results

The increase in hemodynamic parameters were minimized by pregablinin 150 and 300 mg when compared to the control group and patients received 75 mg. The intraoperative and postoperative consumption of analgesia were decreased in the groups receiving 150 and 300 mg.

Conclusion

Oral pregablin in 150 and 300 mg in the present study attenuates hemodynamic responses tolaryngoscopy and intubation. Oral pregablin in 150 and 300 mg decreases the consumption of analgesics intraoperatively and postoperatively.
Comparison between Dexmedetomidine and Propofol for Sedation in Mechanically Ventilated Intensive Care Patients
Authors: Latif F S , Thabet W R H , Haiba D M , Ebrahim M A A
Published: May 2020

Background

Critically ill patients are submitted to several interventions that can lead to distress and pain, like endotracheal intubation, mechanical ventilation, and central venous and arterial catheterization. Indeed, pain is one of the most common memories from patients admitted to intensive care unit (ICU) and can lead to agitation and its consequences, as accidental extubation, and removal of intravascular devices. Accordingly, one of the most used drugs for patients in the ICU are sedatives and analgesics

Objectives

The aim of the study is to compare dexmedetomidine and propofol for sedation in mechanically ventilated intensive care patients according to vital data and laboratory findings during sedation to figure out efficacy and safety profiles between both drugs in sedation, weaning and facilitating extubation in intensive care unit

Patients and Methods

This study was performed on 40 patients divided into 2 groups equally one group received propofol and the other group received dexmedetomidine as a sedative during mechanical ventilation. We collected vital and heamodynamics data and laboratory findings during the time of sedation in ICU.

Results

All the 40 patients completed the study. The demographic profiles of both the groups were comparable. These groups were also comparable with respect to baseline vital parameters and baseline investigations. The study groups included both surgical and medical patients.

There were no statistically significant differences between the two patient groups with respect to age, weight, gender and APACHE II score.

Conclusion

This study evaluated dexmedetomidine versus propofol for sedation in mechanicaly ventilated patients in ICU. We conclude that adequate level of sedation can be achieved by both dexmedetomidine and propofol