bluuebunny/crossref_metadata_2025 huggingface dataset:
P-107 Sperm DNA fragmentation impacts embryonic developmental potential but is not associated with PGT-A outcomes
Authors: Okubo T , Omi K , Tomoya S
Published: July 2024

Study question

Does sperm DNA Fragmentation Index (DFI) affect embryonic development and influence Preimplantation Genetic Testing for Aneuploidy (PGT-A) outcomes in IVF?

Summary answer

DFI adversely affects early embryonic development, diminishing blastocyst potential. Nonetheless, PGT-A outcomes are unaffected, underscoring the importance of selecting optimal sperm for enhanced IVF results.

What is known already

Several major factors are thought to cause DFI. The relationship between sperm DFI and IVF results remains debated.

Study design, size, duration

This study was conducted from January 2018 to March 2023, included 56 married couples undergoing IVF after performing a sperm DFI test. The DFI was assessed at the first semen examination and categorized into three groups: low (≤15%), moderate (15-30%), and high (≥30%).

Participants/materials, setting, methods

Intracytoplasmic sperm injection (ICSI) was performed on 1006 mature oocytes, followed by blastocyst culture. A total of 278 blastocysts meeting freezing criteria were vitrified. Trophectoderm biopsies from 216 blastocysts underwent Next-Generation Sequencing for aneuploidy analysis. Statistical analysis utilized the Cochran-Armitage test to compare outcomes among the DFI groups.

Main results and the role of chance

The average age of the husbands and wives who underwent IVF after the DFI examination was 42.3±4.2 and 41.4±2.4 years old. Normal fertility rates after ICSI in low, moderate, and high DFI were 85.5%, 84.5%, and 83.1%, with no significant difference. Similarly, the blastocyst freezing rates were 35.4%, 26.3%, and 29.6%, and tended to decrease as the DFI value increased (p < 0.05). However, the euploid rates for PGT-A were 22.4%, 16.3%, and 18.2%. There were no statistically significant differences between the DFI groups in terms of euploidy.

Limitations, reasons for caution

Cases declining ICSI due to patient preference or historical medical reasons were excluded from this study.

Wider implications of the findings

This suggests that sperm DNA imperfections have a negative impact on the developmental process during the early stages of division, but during late stages of division, the ability to repair DNA works to differentiate into blastocysts with normal developmental potential.

Trial registration number

not applicable
P-340 Reconciling diversity in health and genomic data collection with the regulation of AI in clinical genomics
Authors: Shabani M
Published: July 2024

Study question

How far the existing and emerging EU regulations address concerns about lack of diversity in genomic databases which used to train AI in genomics?

Summary answer

The main regulations in the European Union provide no clear answers for reconciling the need for more diverse genetic data with regulatory standards.

What is known already

AI researchers need high quality genomic data that reflect the underlying diversity of human populations to develop and validate safe, effective, and equitable tools for genomic medicine. The problem is that most of the genomic data that are available to develop such tools are of insufficient quality, due to inappropriate use of population descriptors, and over representative of individuals of European ancestry. We used the example of developing algorithms to calculate polygenic risk scores ( PRS) and concerns about their accuracy for various sub-populations to illustrate our discussion.

Study design, size, duration

We have analysed the relevant EU regulations including, the upcoming AI Act, Medical Devices Regulation ( MDR), In Vitro Diagnostic Medical Devices ( IVDR) and the GDPR to assess how the concerns related to lack of diversity in genetic/genomic databases have been addressed.

Participants/materials, setting, methods

NA.

Main results and the role of chance

The main regulations for clinical AI in the European Union, namely those regulating medical devices, provide no clear answers for reconciling the need for more diverse genetic data with regulatory standards. On the other hand, some of the data protection regulation requirements arising from the EU General Data Protection Regulation (GDPR) may further challenge collection of sensitive attributes such as race/ancestry which might be needed for brining diversity to databases. On the other hand, several interesting impending new regulations addressing AI and algorithms such as the EU’s AI Act may help in some ways, but still fail to ultimately grapple with the fundamental obstacles in producing the diverse genomic data needed to achieve regulatory objectives. In particular, the proposed requirements related to data quality and transparency need to be accompanied by further guidance on how to define representativeness and how to address long-term impact on fairness concerns in the context of medical AI, when the developed tools are not of optimal use for populations not descending from European ancestry.

Limitations, reasons for caution

NA.

Wider implications of the findings

The legal analysis provided in this paper will provide insights for broader types of AI tools which may be implemented in the context of Assisted Reproductive Technologies and beyond.

Trial registration number

NA
P-352 Investigating the association between DMPK CTG repeats and female hypogonadism in patients affected by Type 1 Myotonic Dystrophy
Authors: Micaglio E , Riva A , Tamma A , Villa M , Sabatelli L , Cardani R , Benedetti S , Pappone C , Sorrentino U , Zuccarello D
Published: July 2024

Study question

Is DPKM CTG repeat size correlated with hypogonadism in female patients affected by type 1 Myotonic Dystrophy?

Summary answer

The size of CTG repeats in DPKM gene seems to be correlated with hypogonadism severity in female patients affected by type 1 Myotonic Dystrophy.

What is known already

Type 1 Myotonic Dystrophy (DMT1) is an autosomal dominant degenerative genetic disorder caused by CTG repeats in a single copy of DMPK gene. It is characterized by a broad phenotypic spectrum and a progressive course, involving primarily the muscular and endocrine systems. While DMT1 is a very well-known cause of male hypogonadism, the relationship between DMPK CTG repeats and female hypogonadism is almost unexplored yet.

Study design, size, duration

We performed a cross–sectional risk study in a cohort of 60 women, with a mean age of 31.5 years (18 to 45 years), referred to our Medical Genetics service for either suspected DMT1 or hypogonadism. The study duration was one year (from November 2022 to November 2023).

Participants/materials, setting, methods

We performed a DMPK–CTG analysis to investigate a possible correlation between CTG and hypogonadism. Based on the analysis, 11 women were diagnosed with DMT1 with associated hypogonadism, 11 with DMT1 without hypogonadism, 22 did not show DMPK expansion but were affected by hypogonadism, while the remaining 16 showed neither DMPK expansion nor hypogonadism. The patients affected by DMT1 performed standard karyotyping, FRAXA and FRAXE genetic testing to exclude alternative genetic causes of premature ovarian failure.

Main results and the role of chance

Our results, are indicative that the severity of hypogonadism in DMT1 patients may correlate with the size of CTG repeats. DMPK CTG repeats ranging from 150 – 1000 (range E2) were associated with milder forms of hypogonadism, while the patients having DMPK expansions within the E3 range (1000 CTG repeats or more) showed hypergonadotropic hypogonadism with both infertility and failure of medically assisted reproduction.

Limitations, reasons for caution

The female patients showing neither DMPK expansion nor hypogonadism did not perform other genetic analysis except DMPK-CTG testing. Moreover, due to the low sample size, our results did not reach statistical significance for a definitive conclusion.

Wider implications of the findings

To the best of our knowledge, this is the first study to show a possible correlation between female hypogonadism and DMPK CTG repeat size in female patients with type 1 myotonic dystrophy. These results, although preliminary, represent a first step in understanding a hitherto misrecognized clinical consequence of the disease.

Trial registration number

Not applicable
P-622 Prospectively randomized study of intraovarian injections of autologous platelet-rich plasma (PRP) into one alternating ovary in Primary Ovarian Insufficiency (POI)
Authors: Barad D  H , Patrizio P , Gayete-Lafuente S , Nicholas C , Albertini D , Gleicher N
Published: July 2024

Study question

Does intraovarian injection of autologous PRP affect ovarian function in women with POI?

Summary answer

Ovaries that were injected with PRP demonstrated a significant increase in follicles >4mm in size compared to the untreated contralateral ovaries.

What is known already

The injection of PRP into ovaries has been reported to improve subsequent ovarian response to ovulation induction in women with POI and is now widely used in fertility centers in women with POI as well as in women with premature ovarian aging (POA). Prospectively randomized studies are, however, lacking.

Study design, size, duration

This is a Randomized Controlled Trial with recruitment from July 2018 - November 2023. 40 patients were screened; 34 qualified. POI was defined by amenorrhea among women < 40 years old, with FSH > 30 mIU/mL, undetectable AMH, and no follicles >4mm. For each participant one ovary was randomly selected for treatment ( with the Sealed Envelope Ltd 2022 tool). The study was powered to detect a 20% response in the treated versus untreated ovary.

Participants/materials, setting, methods

For each patient (n = 34), 10mL of blood was drawn into ReganLab vacutainer and centrifuged. Platelets were re-suspended in 1.5mL of plasma. PRP was injected into the stroma of one randomly selected ovary under iv sedation and ultrasound control. Patients were followed with ultrasounds, estradiol, and FSH q3-4 days for two weeks. Our primary outcome was the development of new follicles >4mm in the treated vs. untreated ovary, using Chi-Square.

Main results and the role of chance

Study population description: age 33.9±5.5 years (range 21-40.4 years); BMI 23.4±4.2; FSH 96.7±27.6 mIU/mL; AMH 0.019±0.03 ng/mL; length of amenorrhea 2.2 years (3 months-14 years). 10 patients developed no follicles > 4 mm, 21/34 (62%) did develop follicles > 4 mm in treated ovaries; 9/34 (26%) developed a follicle > 4 mm in untreated ovaries (Chi-square = 8.59; P = 0.003). Most follicles developed without significant estradiol production; nine showed sufficient follicle development to initiate ovulation induction with initiation of gonadotropins, four produced eggs and one produced an embryo; one patient had four oocytes banked and resumed menses following PRP treatment for several months.

Limitations, reasons for caution

N/A

Wider implications of the findings

This demonstrates the first objective evidence that intraovarian PRP injections into POI ovaries initiate some follicle activation. Though the observed degree of activation was small, findings suggest that remaining follicles in women with POI can be activated through injections into ovaries, suggesting that better agents than PRP may be discovered.

Trial registration number

N/A
P-644 Effect of Letrozole co-stimulation with gonadotropin in women with normal ovarian reserve on oocyte maturation: a Randomized controlled trial
Authors: Laokirkkiat P , Hunsawongsakul D
Published: July 2024

Study question

To define whether letrozole co-stimulation with gonadotropin in normal-ovarian reserve women will improve the number of oocyte maturation.

Summary answer

Letrozole co-stimulation in normal ovarian reserve resulted in a reduced number of MII.

What is known already

Letrozole functions as an aromatase inhibitor. By inhibiting this enzyme, letrozole effectively lowers estrogen levels. Thus, letrozole prevents the estrogen-negative feedback to the HPO axis, which can increase the secretion of gonadotropins from the pituitary gland to promote folliculogenesis. The application of letrozole co-stimulation in women with a normal ovarian reserve is still debated.

Study design, size, duration

This study is an open-labeled, randomized controlled trial. Letrozole co-stimulation with gonadotropin in women with normal ovarian reserve. The RCT was conducted at the Fertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital in Thailand, from March 2023 to October 2023.

Participants/materials, setting, methods

One hundred forty-four infertile women 18-40 years old with normal ovarian reserve (AMH 1.2-7 ng/ml, AFC ≥ 5) were random to gonadotropin co-stimulation with letrozole 5 mg once daily (n = 72) and gonadotropin alone (n = 72). The number of MII oocytes, follicle-to-oocyte index, GDF-9 and BMP-15 in follicular fluid were assessed.

Main results and the role of chance

Letrozole co-stimulation resulted in a significantly reduced number of MII [8 (4,12) vs 9 (5, 15.8), p = 0.042] and the rate of MII [ 71.7(60, 83.8) vs 80 (66.7, 90), p = 0.013]. However, the number of retrieved oocytes [12 (6,16.8) vs. 12 (6,16), p = 0.335] and FOI [85.7 (57.4,107.5) vs 84.2 [61.8, 112.5], p = 0.396] remained unchanged. The total dose of gonadotropin in the letrozole group was no different from the control group [1,350 (1,200, 1,650) vs 1,500 (1,350, 1,718.8) I.U., p = 0.137]. The duration of ovarian stimulation was shortened in the letrozole group compared to the control group [9 (8, 10) vs 9 (8.3, 10) days, p = 0.027]. The letrozole and control group had a similar level of GDF-9 (0.036 ± 0.003 A.U. vs. 0.028 ± 0.004 A.U., p = 0.119, letrozole and control group, respectively) and BMP-15 (0.034 ± 0.002 A.U. vs. 0.033 ± 0.004 A.U., p = 0.923, letrozole and control group respectively) in follicular fluid.

Limitations, reasons for caution

This study was open-label, with limited generalizability due to 91% of ovarian stimulation being strict to the research protocol (r-FSH and antagonist protocol) and no pregnancy outcome.

Wider implications of the findings

The study showed no benefit of letrozole co-stimulation in women with normal ovarian reserve.

Trial registration number

TCTR20221125002
How Hot is too Hot? Metabolic Responses to Temperature Across Life Stages of a Small Ectotherm
Authors: Segura-Hernández Laura , Hebets Eileen A , Montooth Kristi L , DeLong John P
Published: July 2024

Synopsis

To understand how global warming will impact biodiversity, we need to pay attention to those species with higher vulnerability. However, to assess vulnerability, we also need to consider the thermoregulatory mechanisms, body size, and thermal tolerance of species. Studies addressing thermal tolerance on small ectotherms have mostly focused on insects, while other arthropods, such as arachnids remain understudied. Here, we quantified the physiological thermal sensitivity of the pseudoscorpion Dactylochelifer silvestris using a respirometry setup with a ramping temperature increase. Overall, we found that D. silvestris has a much lower metabolic rate than other organisms of similar size. As expected, metabolic rate increased with body size, with adults having larger metabolic rates, but the overall metabolic scaling exponent was low. Both the temperature at which metabolism peaked and the critical thermal maxima were high (>44°C) and comparable to those of other arachnids. The activation energy, which characterizes the rising portion of the thermal sensitivity curve, was 0.66 eV, consistent with predictions for insects and other taxa in general. Heat tolerances and activation energy did not differ across life stages. We conclude that D. silvestris has low metabolic rates and a high thermal tolerance, which would likely influence how all stages and sexes of this species could endure climate change.
Rhodomyrtone: a new anti-Staphylococcus aureus agent against resistant strains
Authors: Saravolatz Louis D , Pawlak Joan
Published: July 2024

Background

Rhodomyrtone is a novel plant-derived antibiotic compound originally isolated from Rhodomyrtus tomentosa leaf extract.

Objectives

To evaluate the activity of rhodomyrtone against a group of MRSA strains, including isolates with reduced susceptibility or resistance to vancomycin, daptomycin, linezolid and ceftaroline.

Methods

Broth microdilution testing was used to determine the MICs and MBCs of rhodomyrtone, fosfomycin, vancomycin, daptomycin, linezolid and ceftaroline.

Results

ROM had an MIC90 of 1 mg/L against 110 strains of MRSA from blood isolates as well as for all other isolates that were daptomycin resistant, VISA, VRSA or LRSA. The MBC90 were 4 mg/L across all groups tested. Among all S. aureus groups tested the ROM MBC did not exceed 8 mg/L.

Conclusions

Rhodomyrtone demonstrated excellent activity against MRSA as well as isolates with resistance or reduced activity to other anti-MRSA drugs including vancomycin, daptomycin and linezolid. Rhodomyrtone may have potential clinical utility when treating patients with infections caused by MRSA including those with reduced susceptibility to first-line anti-MRSA antimicrobial agents.
Constraining fundamental constants with fast radio bursts: unveiling the role of energy scale
Authors: Kalita Surajit
Published: July 2024

Understanding physical mechanisms relies on the accurate determination of fundamental constants, although inherent limitations in experimental techniques introduce uncertainties into these measurements. This paper explores the uncertainties associated with measuring the fine-structure constant ($\alpha$) and the proton-to-electron mass ratio ($\mu$) using observed fast radio bursts (FRBs). We select 50 localized FRBs to quantify the effects of varying this fundamental coupling on the relation between dispersion measure and redshift. By leveraging independent measurements of dispersion measures and redshifts of these FRBs, we constrain the uncertainties in $\alpha$ and $\mu$ approximately to $\Delta \alpha /\alpha =1.99\times 10^{-5}$ and $\Delta \mu /\mu =-1.00\times 10^{-5}$ within the standard $\Lambda$CDM cosmological framework. Remarkably, these constraints improve nearly an order-of-magnitude when considering a dynamical dark energy model. This investigation not only yields one of the most stringent constraints on $\alpha$ and $\mu$ to date but also emphasizes the criticality of accounting for the energy scale of the system when formulating constraints on fundamental parameters.
Levosimendan versus Milrinone in Improving Pulmonary Hypertension after Cardiac Surgery
Authors: Abd El Aziz Fahmy Nabila Mohamed , Abd Elmalek Marcos Fady Adib , Hassan Gouda Hala Saeed , Malky Senada Marina Ghobrial
Published: July 2024

Background

Pulmonary hypertension is a multifactorial disease with a high morbidity and mortality, right ventricular function is the most important predictor of morbidity and mortality in patients suffering from pulmonary hypertension. Milrinone, a phosphodiesterase III inhibitor is commonly used during post cardiopulmonary bypass (CPB) period in combination with adrenaline or noradrenaline to decrease pulmonary artery pressure and to provide synergistic positive inotropic effect. Levosimendan is a calcium sensitizing agent with inotropic, pulmonary vasodilatory, and cardioprotective properties. This study compared levosimendan with milrinone in improving pulmonary hypertension after cardiac surgeries.

Objective

To compare between levosimendan and milrinone in improving pulmonary hypertension after cardiac surgeries.

Patients and Methods

In this study 40 Patients were assigned randomly by using a computer – generated table of random numbers, placing them in sealed envelopes, into two groups: Group M: 20 Patients were received milrinone Group L:20 Patients were received levosimandan.

Results

In this study we compared levosimendan vs milrinone, in levosimendan group there was more significant increase of post operative TAPSE, in milrnone group there was more significant decrease of PAP and RVSP. There was statistically significant difference groups received milrinone in pre, post operative AST, ALT as there was increase in post operative AST and ALT, groups were compared in demographic data (in terms of age, sex, weight and height) and there was no statistically significant difference between groups, were compared as regard CPB and type of surgery and there was no statistically significant difference between groups, were compared in post operative data (in terms of systolic, diastolic blood pressure, heart rate, SPO2, CVP, UOP and extubation time), there was no statistically significant difference between groups, were compared in kidney function (in term of pre and post operative serum creatinine), there was no statistically significant difference between groups, were compared in acid base data (in term of post operative PH), there was no statistically significant difference between groups, were compared in weaning from ventilators (within 24 hours post operative) and there was no statistically significant difference between groups.

Conclusion

We concluded that in levosimendan group there was more significant increase in post operative TAPSI, in milrinone group there was more significant decrease of PAP and RVSP and in milrinone group there was increase in post operative AST/ALT.
A Comparative Study between Sub-sartorial Canal Block and Femoral Nerve Block for Postoperative Analgesia after Arthroscopic Knee Surgery
Authors: Nashed Sherief Wadie , Ghaly Safaa Ishak , Mohammed Haggag Adham Magdy Ahmed , Ahmed Abd-elaleem Ali Ibrahim
Published: July 2024

Background

Knee arthroscopy is a common orthopedic procedure worldwide, despite its minimally invasive nature compared to the traditional knee surgery, post-arthroscopic pain may be severe, and the patients generally require a significant amount of opioid-based analgesics after such procedures. Femoral nerve block (FNB) is commonly used for analgesia inpatients undergoing knee or ankle surgery.

Aim of the Work

The aim of the study is to compare the analgesic efficacy and functional recovery of ACB and FNB in patients who have undergone knee arthroscopy.

Patients and Methods

In the period from April 2021 to October 2021 sixty patients who underwent Arthroscopic knee surgery were randomly allocated to one of two groups and comparative study was done. Group I (group FNB): patients received Femoral Nerve Block (FNB) after spinal anaesthesia, group II (group ACB): Patients received Sub-sartorial canal block (Adductor Canal Block) (ACB) after spinal anaesthesia. After the end of the surgery, the femoral nerve block or adductor canal block will be performed according to patient group allocation.

Results

During our study, it was found that ACB is equally effective with FNB in patient satisfaction for post operative analgesia (NRS at 4 hrs, 8 hrs, 12 hrs, 16 hrs, 20 hrs and 24 hrs was non-significant as P value was 0.3, 0.29, 0.1, 0.5, 0.35, 0.87 respectively) but ACB is more effective than FNB in post operative ambulation and rehabilitation after arthroscopic knee surgery (ACB ambulated after 180.7 ± 23.6 mins in ACB and 241.2 ± 29.12 mins in FNB with pvalue <0.001). Numerous studies compared adductor canal block with femoral nerve block in motor power and analgesia.

Conclusion

Our study concluded that Adductor Canal Block is more effective than Femoral Nerve Block in post operative ambulation and equally effective with Femoral nerve block in patient satisfaction for post operative analgesia after arthroscopic knee surgery.
Ultrasound-Guided Quadratus Lumborum Block Using Bupivacaine versus Bupivacaine – Dexamethasone as Postoperative Analgesia in Laparoscopic Cholecystectomy
Authors: Helmy Mohamed Ahmed Hassan , Mohamed Gihan seif-elnasr , Abusinna Rasha Gamal , Noser Mohamed Abdallah
Published: July 2024

Background

The QLB is an effective analgesic technique for various abdominal wall incisions. The QLB covers T7 to L2 dermatomes by the spread of LA drugs either into the paravertebral space or in the thoracolumbar plane, through iliohypogastric and ilioinguinal nerves, A and C fiber nociceptors, mechanoreceptors and high-density network of lumbar sympathetic fibers.

Objective

To assess the analgesic sparing effect of adding Dexamethasone to Bupivacaine in Quadratus lumborum block in patients undergoing Laparoscopic cholecystectomy under general anesthesia.

Patients and Methods

Sixty patients scheduled for elective Laparoscopic cholecystectomy surgeries under general anesthesia were included in this study, they were divided into two groups. Group A (perineural dexamethasone and bupivacaine group) [n = 30] Those cases will receive 2ml volume of dexamethasone (8mg) combined with 18 ml of bupivacaine of 0.25% concentration. Group B (perineural bupivacaine group) [n = 30] Those cases will receive perineural 18 ml bupivacaine (0.25%) combined with 2 ml normal saline.

Results

At the end of this study we found that The addition of dexamethasone to bupivacaine in QLB in Laparoscopic cholecystectomy surgeries provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to bupivacaine alone group.

Conclusion

The addition of dexamethasone to Bupivacaine in lateral QLB in Laparoscopic cholecystectomy surgery provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to bupivacaine alone group.
Comparative Study between Dexmedetomidine and Nitroglycerin as a Hypotensive Agent and Their Effects on Bleeding in Functional Endoscopic Sinus Surgery
Authors: Nasr Nermeen Sadeq , El Haleem Ali Gehan Abd , Abdel Naiem Mohammad Abdel Mohsen , El Din Soliman Aisha Galal
Published: July 2024

Background

Rhino-sinusitis is commonly treated with FESS. However, there can be serious complications associated with this procedure during peri-operative period like orbital cellulitis, optic nerve injuries, meningitis, etc. Their incidence increases with excessive bleeding during surgery. So Controlled hypotension is used reducing arterial blood pressure 30-40% below its normal range.

Objective

Primary aim: Comparing Dexmedetomidine and Nitroglycerine for inducing controlled hypotension in patients undergoing FESS with recording total intraoperative fentanyl consumption and recording of total local vasoconstrictor used by the surgeon. Secondary aim: Assessment of time to full recovery after extubation with recording of time to first analgesic used after recovery and its total dose for the first 24 hours.

Materials and Methods

In this study we compare Demedetomidine and Nitroglycerine in achieving hypotensive anaesthesia. The study is conducted in Anesthesiology Department, Faculty of medicine, Ain shams University. The study period is 6 months. The sample size is 50 patients divided in two groups randomly (Group I and Group II). Each group has 25 patients. Group I received Demedetomidine. Group II received Nitroglycerine.

Results

we find that the mean HR was significantly lower in Group I compared to Group II at all the times of measurements. The MAP was significantly lower in Group I compared to Group II after infusion of study drugs, after induction of anesthesia, after intubation and 5 min after intubation. However, the desired MAP for intra-operative induced hypotension could be achieved in all the two groups. Also we find that intra-operative Fentanyl requirement is significantly reduced in the Dexmedetomidine group as compared to the other group. The patients in group I had a longer time to full recovery. We also observe a significant delay in the first postoperative analgesic request in group I as compared to group II. It has been shown that perioperative analgesic requirements are significantly reduced with intra-operative use of Dexmedetomidine infusion. The patients in the Dexmedetomidine group had significantly higher sedation scores compared to group II. The incidence of postoperative shivering was significantly lower in the Dexmedetomidine group. The most frequent reported side-effect with Dexmedetomidine is dry mouth, which can be easily managed.

Conclusion

Dexmedetomidine provided better hemodynamic stability and comparable operative field visibility to nitroglycerine during FESS. Dexmedetomidine provides an additional benefit of reducing the analgesic requirements and providing postoperative sedation.
Association between Sick Euthyroid Syndrome and Poor Prognosis in Severe Burn Patient
Authors: Salah Afify Galal Abo Elsoud , Tharwat Sayed Ayman Ibrahim , Abdel Hafiez Mohamed Rania Hassan , Mostafa Ali Nahla Ahmed
Published: July 2024

Background

Euthyroid sick syndrome (also known as non-thyroidal illness syndrome) can be described as abnormal findings on thyroid function tests that occur in the setting of a non-thyroidal illness (NTI), without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible, study of euthyroid sick syndrome in burn patients.

Aim of the Work

The aim of study is to examine the ability of Euthyroid sick syndrome in predicting prognosis in severe burn patients.

Patients and Methods

A case control study was conducted in burn ICU in Ain Shams University Hospitals from march 2022 to September 2022,88 patients were admitted to study with 44 burn case with ESS and 44 burn case without ESS according to inclusion and exclusion criteria.

Results

The results showed that the group with ESS are more associated with higher rate of morality, hospital stay and more poor prognosis with worse APACHE score levels compared to the burn group with ESS. The study showed that using APACHE score with T3 levels measurements are more accurate in detecting morality in burn ICU patient.

Conclusion

The study demonstrated that ESS are more associated with higher rate of morality, hospital stay and more poor prognosis with worse APACHE score levels.
Peri-Operative Use of Ketamine Infusion versus Dexmedetomidine Infusion for Analgesia in Obese Patients Undergoing Bariatric Surgery: A Double-Blinded Three-Armed Randomized Controlled Trial
Authors: Mahfouz Khalil Belal Nabil , Hussein Elderh Maha Sadek , Rasoul Khaja Mohamed Abdel , El-Shaer Ahmed Nagah , Hassan Ali Bahaa El-Din Ewees , Awad Taeimah Mohamed Osman
Published: July 2024

Background

The development of different techniques in bariatric surgeries has required the development of novel anesthetic techniques to reduce the incidence of complications and improve post-operative patient outcomes. Ketamine and dexmedetomidine have been used for their peri-operative analgesic profiles in different studies.

Methods

Ninety patients were studied and randomized equally into three groups. The Ketamine group received a bolus dose (0.3 mg/kg) of ketamine over 10 min followed by an infusion (0.3 mg/kg/h). The Dexmedetomidine group received a bolus dose (0.5 mcg/kg) of dexmedetomidine over 10 min followed by an infusion (0.5 mcg/kg/h). The control group received normal saline infusion. The total morphine dose was the primary outcome, and intra-operative fentanyl requirements, time to extubation, post-operative nausea and vomiting (PONV), Numerical Rating Scale (NRS) scores, and Modified Observer’s Agitation/Sedation Scale (MOASS) scores were secondary outcomes of the study.

Results

The Dexmedetomidine group showed decreased intra-operative fentanyl requirements (160.000 ± 42.345 µcg), less time to extubation (3.700 ± 0.925 min), and better scores on MOASS than the other groups. Post-operative NRS scores and the morphine requirement in the Ketamine group (1.867 ± 2.921 mg) were lower than in the other groups. The Dexmedetomidine group showed the lowest scores for PONV.

Conclusions

The Dexmedetomidine group showed lower total fentanyl doses, a significantly shorter time to extubation, better MOASS scores, and lower PONV. The Ketamine group showed significantly lower NRS scores and morphine doses than the other two groups. Dexmedetomidine was effective on the reduction of intraoperative fentanyl requirement with early extubation, and ketamine was effective on the reduction of postoperative pain.

Trial Registration

This trial has been registered on clinicaltrials.gov registry (NCT04576975) since 06/10/2020.
Predicting and Measuring Fluid Responsiveness by Hemodynamic Indices versus Transthoracic Echocardiography in Clinically Shocked Patients
Authors: Nour Eldin Bassel M , Said Sherif G , Michael Hany V , Ghatas Basem G
Published: July 2024

Background

In the last decades dynamic measures had evolved as a better solution to predict fluid responsiveness in clinically shocked patients, out of multiple dynamic parameters we chose transthoracic echocardiographic based measurements of variations of aortic blood flow and inferior vena caval diameter.

Aim of the Work

to assess accuracy of transthoracic echo measured variation in aortic blood flow and inferior vena caval diameter with limited bolus crystalloid infusion in predicting fluid responsiveness in patients with clinical shock.

Patients and Methods

This study included 51 selected Patients with acute circulatory failure secondary to clinical shock admitted to ICU. All patients had undergone basic transthoracic echocardiographic (TTE) assessment of aortic blood flow (using left ventricular outflow tract velocity time integral as a surrogate) and inferior vena caval diameter changes with respiratory cycle, these measures were obtained at time of diagnosis of shock and repeated after infusion of 300 ml crystalloid fluid bolus (over fifteen minutes).

Results

Our results had revealed significant difference between responders and non-responders regarding aortic flow variation after fifteen minutes.

Conclusion

Based on the results obtained in this study, it was proved that transthoracic echocardiography can be used as an accurate method to predict fluid responsiveness in shocked patient with fluid challenge.
Comparison of Ultrasound Guided Quadratus Lamborum Plane Block versus Intraperitoneal and Port Sites Bupivacaine Infiltration in Post Operative Analgesia after Laparoscopic Cholecystectomy
Authors: Ibrahim Sherif Farouk , Saleh Mostafa Ashraf Nabil , Hilal Abdou Amr Mohammed , Sayed Yasmeen Abdel-Hamed
Published: July 2024

Background

Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain.

Aim of the Work

The aim of this study is to assess the postoperative analgesic efficacy of quadratus lamborum plain block compared to intraperitoneal and periportal infiltration with bupivacaine after laparoscopic cholecystectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received.

Patients and Methods

The study was conducted on 70 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective laparoscopic cholecystectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 35 patients each: QL block Group, intraperitoneal and periportal infiltration Group:

Results

Patients receiving QL block had significantly lower pain scores at rest for 6 hrs and decrease total need of analgesic in first 24 h post operative compared with patients who received Intraperitoneal and port sites infiltration.

Conclusion

Quadratus Lumborum block was effective in reducing postoperative pain scores for 6 hours and lower total 24 hrs postoperative opioid and analgesic consumption after laparoscopic cholecystectomy under general anesthesia, compared to intraperitoneal and port sites infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.
Awareness of Food, Supplement, and Drug Interactions among Oncology Patients on Oral Chemotherapy
Authors: Abdelsamie Ghada , Noureldine Ahmed , Elsayed Zeinab , Abdelaziz Khaled
Published: July 2024

Background

Food-drug interactions (FDIs) are very common, but under-reported due to a lack of proper history or lack of knowledge and limited research. Our study highlights the knowledge gap among oncology patients treated with capecitabine regarding food-oral chemotherapy interactions.

Method

A cross-sectional study was conducted among 110 breast and colon cancer patients, purposively sampled from the chemotherapy outpatient clinic from June 2021 to December 2021. A structured questionnaire and interviews were used to collect data, we asked them about the information they had received from the doctor and the way they were taking the medicine. Data were analyzed using SPSS, and the p-value of p < 0.05 was considered significant.

Results

Regarding the sociodemographic and clinical data of participants, their ages widely ranged from 20-83 years old, and their mean age was 54.78±13.18. The majority of participants were females 81(73.6%), non-employed 86(78.2%), colon cancer 72(65.5%) and received ≤4 cycles 66 (60%). Still, there is poor awareness concerning FDI among oncology patients and most participants were unaware of the possible interactions of capecitabine with grapefruits, vitamins, herbs, and antioxidants, but the majority 92 (83.6%) were taking their medication correctly concerning meal recommendations and only 18(16.4% )were not taking capecitabine within 30 minutes of meals. The current study showed that patients’ knowledge was not associated with age, sex, education, marital status, or occupation. The main factors that affected knowledge in the current study were the cancer site and the number of treatment cycles, as colon cancer patients and those who have received four or fewer cycles had better doctor-patient communication.

Conclusion

There is a lack of awareness about interactions between oral chemotherapy and various nutrients and supplements among patients in the current study. Patient education and better doctor-patient communication are recommended to ensure optimal oral chemotherapy intake and patient safety.
Bilateral Erector Spinae Plane Block versus Oblique Subcostal Transversus Abdominal Plane Block for Postoperative Analgesia of Adults Patients Undergoing Laparoscopic Cholecystectomy
Authors: Soliman Yassa Marco Ashraf , Eldin Nooh Nehal Gamal , Hefny Taha Sameh Salem , Elkomos Saman Poula Michael
Published: July 2024

Background

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

Aim of the Work

to test the efficacy of ultrasound guided bilateral erector spinae plane block versus ultrasound guided bilateral oblique subcostal tap block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used.

Patients and Methods

In the current study fifty eight patients scheduled for elective laparoscopic cholecystectomy received general anesthesia were included. Patients were divided randomly into two groups, each group consisted 29 patients. Group A: Patients in this group received bilateral US guided ESP block at the end of surgery. Group B: Patients in this group received bilateral US guided OSTAP block at the end of surgery.

Results

As regard the analgesic parameters recorded; in the current study, the VAS was significantly lower in group A (ESP block) when compared with that of group B (OSTAP block) and showed significant difference between both groups at 6,8 and 10hrs postoperatively. Also, time to rescue analgesia, there was clinically and statistically highly significant longer time to 1st rescue analgesic in group A (ESP block) was 15.25±1.50 hours compared to that of group B (OSTAP) was 9.86±2.01 hours These findings were in an array with a case series done by Luis-Navarro and his colleagues who reported that the first rescue analgesic was required only at 16 hours after ESP block. In the current study, total morphine consumption “mg” with the mean total consumption in each of Group was 4.45±0.42 mg in the ESP group compared with 5.44±0.37 mg in the OSTAP group there was highly statistically significant higher mean of total analgesic consumption in group B compared to Group A.

Conclusion

bilateral ultrasound-guided ESP block provides more potent and longer postoperative analgesia with less morphine consumption than OSTAP block after laparoscopic cholecystectomy
Patient Self-Proning with High-Flow Nasal Cannula Improves Oxygenation in ARDS Patients: A Randomized Clinical Trial
Authors: Mahmoud Mohamed Sidky , Abdallah ElGendy Hanaa Mohamed , Youssri Mahmoud Noura M , Aly ElGendy MohamedAbd Elsalam , Nassar Nasrallah Beshoy Zarief
Published: July 2024

Background

Acute respiratory distress syndrome is a severe lung disease caused by a variety of direct and indirect insults. It is characterized by acute onset of tachypnea, hypoxemia, and loss of lung compliance. Significant atelectasis is also frequently present. It is associated with increased length of stay in the intensive care unit (ICU), long hospital stay, higher hospital charges as well as increased morbidity and mortality. However, it can be treated if dealt with promptly.

Objective

This work aims to evaluate the effect of self-proning with a high-flow nasal cannula in patients with ARDS on oxygenation and incidence of intubation.

Results

High flow nasal cannula and Proning was effective in improving oxygenation of the mild ARDS patients and decreasing the incidence of intubation (11 patients intubated in group 1, 4 in group 2), mortality(35 survived in group 1,42 in group 2) and ICU stay in these patients.

Conclusions

HFNC AND PRONING succeeded in prophylaxis against intubation in mild ARDS patients in ICU. And they succeeded in decreasing ICU stay days and improving the outcome of mild ARDS patients.

Example

Trial registration: PACTR202204746577792. Registered 14 April 2022 - Retrospectively registered, http://www.pactr.org/PACTR202204746577792
Use of Corticosteroids on Prophylaxis of New-Onset Atrial Fibrillation after Cardiac Surgery
Authors: Abdelsattar Mohamed , Radwan Abdelrahman , Nashed Sherif Wadie , Elagamy Ashraf Elsayed , Hesham Elshaer Eman Mohamed
Published: July 2024

Background

Most cardiac operations are performed under cardiopulmonary bypass(CPB); however, it is well known that cardiopulmonary bypass often causes systemic inflammatory response syndrome (SIRS). Cardiac tissue inflammation induced by the CPB and surgical trauma has been previously hypothesized to cause POAF. The relationship between inflammation and atrial fibrillation after cardiac surgery is further strengthened by studies that showed that corticosteroid (CS) prophylaxis can reduce the occurrence of atrial fibrillation after cardiac surgery.

Aim of the Work

to determine the efficacy of corticosteroids in prophylaxis of POAF and shorten length of intensive care unit (ICU) and hospital stay.

Patients and Methods

This is randomized controlled clinical trial on 84 patients who underwent their first elective cardiac surgery under cardiopulmonary bypass in Ain Shams University Hospitals. Patients were randomized into two equal groups (n = 42 each) as the control group who underwent a standard cardiopulmonary bypass without any additional medication which was performed under the supervision of a specialized elite and experts in their specialization, and the Methylprednisolone (MP) group who was given 1 g of methylprednisolone (divided into 250 mg every 6h once in the ICU), The primary outcome is the overall occurrence of postoperative AF during the first 72 hours after cardiac surgery. Secondary outcomes are the length of hospital stay, and intensive care unit (ICU) stay.

Results

This study revealed that using corticosteroids effective in reducing the incidence of POAF without increasing the incidence of postoperative complications and adverse effects due to corticosteroids therapy. This study showed decreased risk of developing AF in patients undergoing cardiac surgery. The incidence of POAF was found be significant lower in MP group 16.7% (7 patients developed AF) versus 35.7% in the control group (15 patients developed AF) (p 0.047).

Conclusion

Use of Corticosteroids is effective in prophylaxis of POAF in patients undergoing elective cardiac surgery in terms of reducing its incidence and decreasing the length of ICU and hospital stay.
CHA2DS2-VASc Score is a Predictor of No-Reflow in Patients with ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Intervention
Authors: Eldin Hossam Shams , Farag Nabil , Salam Ahmed Abdel , Eletriby Shehab
Published: July 2024

Background

regardless of the magnitude of the infarction, no-reflow is a source of numerous problems, including heart failure, stroke, and death. The CHA2DS2-VASc score is a combination of many risk variables for thromboembolic lesions, the most serious consequences of atrial fibrillation. Current guidelines propose using the CHA2DS2-VASc risk score to estimate thromboembolic events in individuals with atrial fibrillation. It has been demonstrated to be a predictor of problems following acute coronary crises.

Aim of the Work

to assess the role of CHA2DS2-VASc score in prediction of the no-reflow among patients with ST-segment elevation myocardial infarction (STEMI) who was treated with primary PCI.

Subjects and Methods

this is a prospective observational study which was done at cardiology department of Ain Shams University on 300 patients.

Results

the most frequent factor was female sex (43.7%), followed by Diabetes mellitus (27.0%) according to CHA2DS2-VASc score. CHA2DS2-VASc score items statistically were significantly more frequent in no reflow cases except Age ≥75. CHA2DS2-VASc score and its modification significantly had low diagnostic performance in predicting no reflow. Modified was higher than original.

Conclusion

all CHA2DS2-VASC items were proved to be factors affecting no reflow occurrence in the Egyptian population except Age ≥75 and congestive heart failure due to their low prevalence. The CHA2DS2-VASC score had no high diagnostic characteristics in Egyptian population, the postulated modification of CHA2DS2-VASC score gave no better diagnostic characteristics.
Fibromyalgia in Patients with Obstructive Sleep Apnea Patients
Authors: Elsayed Galal Iman Hassan , El-Zohiery Abeer , Ahmed ElBagalaty Mohamed Fathi , Hasan Madbouly Hassnaa Abdelmomen
Published: July 2024

Background

Obstructive sleep apnea (OSA) and Fibromyalgia (FM) concomitantly form an extremely important association because in addition to its adverse effects on the quality of life, it contributes to the mortality rates. Studies evaluating the relationship between OSA, and FM have been conducted in very small patient groups. However, the results are controversial. In our study we aimed to investigate the prevalence of fibromyalgia in obstructive sleep apnea patients because of the similarities between the symptoms of FM and OSA.

Methods

This cross-sectional study was conducted upon 49 patients already diagnosed with OSA. Patients were recruited from the sleep lab of chest department Ain Shams university Hospitals in the period between August 2021 and August 2022. Overnight diagnostic PSG was performed to all patients Then we tested widespread pain index (WPI) and system severity scale (sss) on patients who have OSA by PSG to diagnose FM. The following investigations were done for patients who were suspected of having secondary fibromyalgia: Hepatitis C virus antibodies, Vitamin D level, Complete blood count, Thyroid functions, C-reactive protein, Erythrocyte sedimentation rate and Autoimmune markers.

Results

Out of 49 patients; 10.2% (5 patients) were fibromyalgia positive using WPI and SSS, and all of them had Secondary FM. The only significant negative correlation was observed between SSS score and REM latency (r: -0.370, P-value: 0.009). All other correlations were statistically non-significant.

Conclusion

Secondary FM among OSA patients is not uncommon. Monitoring serum Vitamin D levels in OSA patients in recommended.