bluuebunny/crossref_metadata_2025 huggingface dataset:
An improvement of pancreaticojejunostomy: double-row and six-suture method pancreaticojejunostomy for pancreaticoduodenectomy
Authors: Deng Hongyang , Xu Xiaodong
Published: November 2024

With the rapid development of pancreaticoduodenectomy (PD) surgery, the incidence of postoperative pancreatic fistula (POPF) and surgical complications has been greatly reduced. The occurrence of POPF is closely related to the quality of the pancreatic reconstruction. Pancreaticojejunostomy (PJ) remains a significant technical challenge, and no PJ has yet been widely recognized. From January 2021 to December 2023, 72 patients underwent PD with double-row and six-suture PJ. The clinical characteristics and postoperative outcomes of these patients were analysed. The median operation time was 240 min (180–540 min). The median intraoperative blood loss was 200 ml (50–600 mL). The postoperative hospital stay was 11 days (8–27 days). Eleven patients (15.3%) had a biochemical fistula and five patients (6.9%) had a grade B POPF. No patient had a grade C POPF or died within 90 days after surgery. Double-row and six-suture PJ is a safe and acceptable PJ.
“Bridging The Gap” Medical Degree Preparatory Program (EMDP2) Military Students Provide Leadership and Mentorship to Classmates
Authors: Russo Christopher , Freedman Benjamin , Evans Andrew , Green Althea , Vietor Robert , Randall Virginia
Published: November 2024

Introduction

The lack of adequate diverse representation (racially, socioeconomically, gender, second career applicants, student parents, etc.) within secondary education in the United States has proven to be a challenging and complex, multifaceted problem, and despite ongoing efforts, one that continues to remain unsolved. These disparities are well known and documented at all levels of education. The Uniformed Services University of Health Sciences is the nation’s only fully federally funded medical school and capitalizes on the preexisting diversity and exceptional training already existing within the U.S. military’s enlisted force through the Enlisted to Medical Degree Preparatory Program (EMDP2). This study aims to investigate how a novel program at a unique military medical school influences medical school class cohorts.

Methods

This study used a traditional thematic qualitative analysis format. Thematic qualitative analysis is a method for identifying, analyzing, organizing, describing, and reporting themes found within survey responses. One hundred nine surveys via SurveyMonkey© were sent to EMDP2 students. Thirty-six surveys were returned for a response rate of 33%. Two co-investigators carefully read each participant response and coded independently line-by-line with constant comparison of each quote. NVivo© software was used to store the data as the counts progressed.

Results

After completion of data collection, results identified the following themes among survey responses being accepted, bridging the gap, feeling valued, gratitude, prior experiences, and professionalism.

Conclusions

Students with prior military experience have a significant impact on our institutions medical school classes. These students provide mentorship and professionalism to their fellow classmates. This study helps educators understand the perspectives and challenges faced by prior-service medical students and appreciate how to use the prior experience of these unique prior-service members to benefit the entire class.
Intramuscular heroin-induced severe rhabdomyolysis and acute kidney injury—a case report
Authors: Dimov Nikolay , Sultana Tahsin , Dafeeah Aishah , Choudhury Hafsa , Nikolov Dimitar
Published: November 2024

Rhabdomyolysis (RM) is characterised by the breakdown of skeletal muscle tissue, releasing toxic intracellular components into circulation. It presents with dark urine, muscle weakness, myalgia, and elevated creatine phosphokinase levels (CPK). Drug-induced RM is aetiologically significant. This case report describes a 25-year-old male who developed severe RM and Acute Kidney Injury (AKI) after intramuscular (IM) heroin administration as a first time user. IM heroin use can induce higher CPK levels due to direct myocyte toxicity and mechanical trauma. The highly vascularised gluteal muscles with type 1 fibres at the injection site likely exacerbated the severity. Additional factors included lower mitochondrial density in males and alcohol exposure. Despite aggressive fluid resuscitation, renal replacement therapy (RRT) was required, and the patient responded well to haemodialysis. This case highlights AKI as a severe complication of IM heroin use, underscoring the need for further research into drug-induced RM.
National eHealth strategy frameworks in Africa: a comprehensive assessment using the WHO-ITU eHealth strategy toolkit and FAIR guidelines
Authors: Olufadewa Isaac Iyinoluwa , Iyiola Opeyemi Paul , Nnatus Joshua , Fatola Kehinde , Oladele Ruth , Olufadewa Toluwase , Adesina Miracle , Udofia Joseph
Published: November 2024

Many African nations have developed national eHealth strategies to harness the benefits of digital health solutions. Our study assessed the current state of national eHealth strategies in Africa. A systematic search identified publicly available national eHealth strategy documents published from 2000 to 2023 in Africa. The documents were independently reviewed and scored using the eHealth National Strategy Rating Tool, developed using the WHO-ITU national eHealth strategy toolkit and the Findability, Accessibility, Interoperability and Reusability Guidelines. The eHealth National Strategy Rating Tool covered five domains: (i) eHealth national vision and strategy, (ii) implementation plan, (iii) monitoring and evaluation component, (iv) Findability, Accessibility, Interoperability and Reusability mention and (v) recency of policy development. The study followed a rigorous five-step methodological approach proposed by Arksey & O’Malley (2005). This study found the national eHealth strategies for 34 African countries, with only 16 updated to cover the year 2023 or beyond. Significant variability in the quality and comprehensiveness of national eHealth strategies was observed. Nine countries had ‘strong’, 17 had ‘moderate’, and eight had ‘weak’ eHealth strategies. Critical gaps were identified in the implementation plan, monitoring and evaluation, and the alignment of policies with the Findability, Accessibility, Interoperability and Reusability data principles. Addressing the gaps identified in the development and implementation of national eHealth strategies across Africa by aligning national strategies with global best practices will be crucial for African nations to harness the transformative potential of digital technologies and ensure equitable access to quality healthcare for their populations.
Celibacy and Marriage (Gen. 2)
Authors: Cameron Euan
Published: November 2024

Medieval and early modern exegetes read Genesis 2 for its understanding of the relationship between the male and female sexes, and the purpose of marriage. The formation of Eve from the rib of Adam was interpreted both literally and for its moral and spiritual meaning. Most major reformers wrote commentaries on Genesis. Their approach contrasted with that of Nicholas of Lyra (1270–1349). Lyra’s Postills stressed the biological role of the woman in bearing children. While Protestant reformers followed some of Lyra’s themes, certain distinctly Reformation emphases may be discerned. The text “it is not good for man to be alone” meant that marriage should be available to all. Woman’s role as “helper” was interpreted as one of moral, emotional and spiritual support, not just childbearing. Celibacy was condemned, and marriage was regarded as a companionship of near-equals, and interpreted spiritually, even mystically.
Papacy and Ecclesiastical Authority (Matt. 16:18–19; John 20:23; 21:17)
Authors: Avis Paul
Published: November 2024

This chapter explores questions of ecclesiastical authority in the controversies of the Reformation era with special reference to the text of Matt. 16:18–19 (“You are Peter, and on this rock I will build my church”). The vexed question of the interpretation of Jesus’ words in Matthew, regarding the keys of the kingdom in the early church, the medieval period, and the Reformation era, is outlined. The discussion also impinges on questions of ecclesiastical jurisdiction, penance, excommunication, the marks of a true church, conciliar theory, and the reformers’ reactions to the claims of the papacy. Matters came to a head at the Council of Trent, where it was decreed that all clergy would have to make a profession of obedience to the Holy See. The chapter concludes by summarizing important changes in the theological context of this question since the Reformation.
Packaging “vegetable oils”: Insights into plant lipid droplet proteins
Authors: Cai Yingqi , Horn Patrick J
Published: November 2024

Plant neutral lipids, also known as “vegetable oils”, are synthesized within the endoplasmic reticulum (ER) membrane and packaged into subcellular compartments called lipid droplets (LDs) for stable storage in the cytoplasm. The biogenesis, modulation, and degradation of cytoplasmic LDs in plant cells are orchestrated by a variety of proteins localized to the ER, LDs, and peroxisomes. Recent studies of these LD-related proteins have greatly advanced our understanding of LDs not only as steady oil depots in seeds but also as dynamic cell organelles involved in numerous physiological processes in different tissues and developmental stages of plants. In the past 2 decades, technology advances in proteomics, transcriptomics, genome sequencing, cellular imaging and protein structural modeling have markedly expanded the inventory of LD-related proteins, provided unprecedented structural and functional insights into the protein machinery modulating LDs in plant cells, and shed new light on the functions of LDs in nonseed plant tissues as well as in unicellular algae. Here, we review critical advances in revealing new LD proteins in various plant tissues, point out structural and mechanistic insights into key proteins in LD biogenesis and dynamic modulation, and discuss future perspectives on bridging our knowledge gaps in plant LD biology.
Language in job advertisements and the reproduction of labor force gender and racial segregation
Authors: Hu Yang , Denier Nicole , Ding Lei , Tarafdar Monideepa , Konnikov Alla , Hughes Karen D , Hu Shenggang , Knowles Bran , Shi Enze , Al-Ani Jabir Alshehabi , Rets Irina , Kong Linglong , Yu Dengdeng , Dai Hongsheng , Jiang Bei
Published: November 2024

Job advertisements (ads) represent the first point of contact between employers and job seekers. By signaling characteristics expected of an ideal candidate, job ads “gatekeep” the labor force and configure its composition. Meanwhile, labor force composition can also shape the wording of job ads. This study develops a multidimensional inventory of gender and EDI (equality, diversity, inclusion) language in job ads. Applying this inventory, it adopts an instrumental-variable approach to disentangle the reciprocal relationships between gender/EDI language in job ads and labor force gender/racial composition. Drawing on the analysis of 28.6 million job ads in the United Kingdom in combination with labor force statistics between 2018 and 2023, the findings reveal three distinct mechanisms through which the bidirectional interplay between language in job ads and labor force composition (re)produces or disrupts labor force gender/racial segregation. They highlight both the benefits and limitations of intervening in the language used in job ads to help reduce labor force gender/racial segregation.
Comparison of Ultrasound-Guided Lumbar Erector Spinae Plane Block and Trans-Muscular Quadratus Lumborum Block for Postoperative Analgesia in Hip and Proximal Femur Surgery
Authors: Abdallah EL-Sayed Abdallah Ibrahim , Tharwat Ayman Ibraheem , Ali Khaled Mostafa , El-Naggar Dalia Ibrahim Mohamed
Published: November 2024

Background

Orthopedic operations for hip and femur fractures can lead to significant postoperative pain. In these patients, different regional anaesthesia techniques play an important role in multimodal analgesia plans. Nonopioid analgesia techniques are especially important in aging populations when comorbidities are considered.

Aim of the Work

to evaluate the effectiveness of ultrasound-guided lumbar Erector Spinae Plane block versus Trans-muscular Quadratus Lumborum block for postoperative analgesia in hip and proximal femur surgery.

Patients and Methods

This study is a double-blind, Prospective, Randomized, Study. This study is conducted at Ain Shams University hospitals, Cairo, Egypt. The study period 6 months.

Results

The current study results revealed three distinct groups were examined: the L-ESB Group, QLB-T Group, and Control Group, each comprising 20 participants. The study aimed to compare the effects of two different interventions, namely L-ESB and QLB-T, against a Control Group. The evaluation was based on a range of parameters, and the outcome measures were assessed using both demographic and clinical variables. In terms of participants' ages, the mean ages and standard deviations were provided for each group. The calculated mean ages were 51.7 years for the L-ESB Group, 52.95 years for the QLB-T Group, and 52.28 years for the Control Group. The slight differences in mean ages, as indicated by a p-value of 0.790 and a similarity measure (§=0.237), suggest that the age distribution across these groups is statistically comparable. Consequently, potential impacts of age-related variations on observed outcomes are likely to be minimal.

Conclusion

The results demonstrated that the interventions exhibited statistically significant influences on various aspects of post-operative recovery, including pain perception, mean arterial blood pressure, heart rate, time to request analgesia, and medication dosages. Notably, the interventions showcased potential benefits in terms of improved pain management and reduced analgesic requirements. These findings underscore the importance of considering individualized interventions for optimal patient care in hip and proximal femur surgery, while acknowledging the potential impact of confounding factors and the need for further studies to establish precise dosage and concentration protocols for local anesthesia.
A Comparative Study between Ultrasound Guided Fascia Iliaca Block and Femoral Nerve Block for Postoperative Analgesia in Total Knee Arthroplasty
Authors: Latif Eskander Fahmy Saad , Samir Elsaeid Ghada Mohamed , Mohamed Abdelmageed Ahmed Mostafa , Abd Elnaby Ahlam Montaser
Published: November 2024

Background

Total knee arthroplasty (TKA) are common surgical procedures for treatment of the degenerative disorders and traumatic diseases. However, a majority of patients often experience moderate to severe postoperative pain after TKA. Postoperative pain control has a significant impact on earlier ambulation, initiation of physiotherapy, and better functional recovery. In addition, effective pain control would lower the length of hospital stay and the risk of thrombotic events which improves patients’ satisfaction.

Aim of the Work

The aim of this study was to assess the efficacy and safety of FICB compared with FNB in patients undergoing total knee arthroplasty.

Patients and Methods

74 patients were included in the study, and were divided into two groups. In FICB group: Patients (n = 37) of this group received ultrasound guided Fascia iliaca compartment block (FICB) after spinal anesthesia using 30-40 ml of 0.25% bupivacaine. While in FNB group: Patients (n = 37) of this group received ultrasound guided femoral nerve block (FNB) after spinal anesthesia using 15-20 ml of 0.25% bupivacaine.

Results

The present study showed that the Fascia iliaca compartment block (FICB) was more efficient than FNB regarding first request analgesic, total pethidine consumption, time of ambulation and kinetic visual Analogue scale. But no significant difference was detected in static Visual Analogue scale and Bromage score. The FNB group had higher kinetic pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively and needed more time to start to ambulate in comparison to patients of FICB group. But the FNB group have almost same values regarding pain measured by static visual analogue scale. And also, FNB group had close values regarding Bromage score in comparison to FICB group.

Conclusion

Fascia iliaca compartment block is more effective than FNB, for pain relief during the early post- operative period after total knee arthroplasty. Meanwhile, it can reduce the cumulative meperidine consumption.
Impact of Tight Glycemic Control on Short Term Outcome of Patients with Acute Cerebral Ischemia
Authors: Elmahlawy Ahmed Hamdy , Noureldin Bassel Mohamed , Ibrahim Waleed Abdalla , Kamel Walid Youssef
Published: November 2024

Background

Hyperglycemia is common after acute ischemic stroke and is associated with poor outcomes, including increased in-hospital mortality and poor neurologic function. Various mechanisms for the detrimental effects of hyperglycemia after acute ischemic stroke have been proposed, but a lack of consensus on the pathophysiology of hyperglycemia-aggravated secondary brain injury remains.

Objective

To evaluate the impact of tight glycemic control on short term outcome of patients with acute cerebral ischemic stroke.

Methods

This was a randomized control trial that was conducted at neurological intensive care unit, Ain Shams University Hospitals on 66 patients presenting with acute cerebral ischemia within 12 hours of acute symptoms and admitted to the Casualty. Patients were categorized into two groups: Group (A): the control group (33), with normal glycemic control using insulin infusion on sliding scale. Group (B): the study group (33) that included patients subjected to tight glycemic using insulin infusion on sliding scale.

Results

Our study revealed that, in Group A; 9.1% died, while the Group B; 12.1% of them died with no statistically significant difference between Group A and Group B regarding Death.

Conclusion

Insulin may be the gold standard for the management of hyperglycaemia but tight glycaemic control appears to be ineffective in improving outcomes in patients with acute cerebral ischemic stroke compared to normal glycaemic control. And it increases the incidence of hypoglycemia and hypokalaemia. Thus tight glycaemic control is not recommended in acute ischemic stroke.
Lactate/Albumin Ratio as a Predictor of Mortality in Septic Patients Presenting to Intensive Care Unit
Authors: Aboelfotoh Abdelmotaleb Ahmed Magdy , Nashed Sharif Wadie , Mohamed Ali Ahmed kamal , Shohdy Haidi Nashaat
Published: November 2024

Background

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis and septic shock are major healthcare problems, impacting millions of people around the world each year and killing between one in three and one in six of those it affects. Early identification and appropriate management in the initial hours after the development of sepsis improve outcomes.

Aim of the Work

to evaluate the prognostic value of the L/A ratio compared to lactate level for predicting sepsis-related 28 days mortality in patients admitted to ICU.

Patients and Methods

This Prospective observational clinical Study was performed in Ain Shams University Hospitals, Cairo, Egypt.

Results

Our study included 50 subjects with a median age of 63 years in non-survival group and 65 years in survival group. There was a female predominance in non-survival population (62.5%vs 37.5%), but There was a male predominance in survival population (55.9%vs 44.1%). The proportion of discharged subjects was 68% and mortality was 32%. Depending on our study results lactate, lactate albumin ratio and hemoglobin were found to be significantly (P < 0.05) in non-survivor than survivor. Also creatinine was highly significant (P < 0.001) in non-survivor than survivor.

Conclusion

Our study found that LA/ALB ratio on the day of admission to the ICU were potential biomarkers to mortality in patients with sepsis. LA/ALB ratio was more sensitive than lactate alone. The L/A ratio shows a positive correlation with lactate levels and APACHE-2, whereas it shows a negative correlation with albumin levels. Prospective studies should be performed to learn more about the role of the L/A ratio sepsis-related mortality.
Comparative Study between Lung Ultrasound as Diagnostic Modality of Lung Aeration versus Computed Tomography in Invasively Ventilated Patient
Authors: Khalil Abdo Ahmed Magdy , Fawwaz Ahmed Ali , Saleh Mostafa Ashraf Nabil , Kamal Mohamed Mohamed
Published: November 2024

Background

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU- acquired infections. Reported incidences vary widely from 5 to 40% depending on the setting and diagnostic criteria. Ventilator-associated pneumonia is associated with prolonged duration of mechanical ventilation and ICU stay.

Aim of the Work

to evaluate the efficacy of lung ultrasound in diagnosis and follow up of ventilator associated pneumonia in comparison to lung CT and to assess the concordance between lung ultrasound scores and CT aeration scores as assessment tools for lung aeration in different lung regions.

Patients and Methods

To achieve this aim, this study was conducted on 40 Ventilator- associated pneumonia patients who were assessed by lung ultrasound and CT at different time points. The chest CT is ordered by the treating physician as part of clinical care. Then, patients undergo a comprehensive LUS exam in the last minutes before transport to the CT scanner while already connected to the transport ventilator. As part of follow up for each patient LUS will be done at day 0, 3 and 6, while CT at day 0 and 6 of the study (1st LUS and CT).

Results

Mean age of the included patients was 57.7 ± 11.2 years with male predominance (65%). Mean APACHE II score was 20.8 ± 6.39 and mean APACHE II percent was 38.1 ± 15.9. Baseline lung ultrasound reported similar findings to the CT with higher affection of aeration in lower anterior, lower middle, upper posterior (B2 pattern; poor aeration) and lower posterior areas (C pattern) in both lungs. The lung ultrasound score had comparable ability to detect the changes over time and reported similar changes in the same lung areas where significant percent of patients changed from B2 pattern to B1 or A pattern or changed from C pattern to B or A pattern. Overall, at any time points, concordance between the lung ultrasound findings and CT findings was shown as regard lung aeration at different regions in both sides. As regard the association between B- line count score and lung aeration by CT aeration by HU, poor correlations were present, and it was limited to upper anterior lung areas only. Transfer- related complications were reported in 62.5% of patients at day 0 and 27.5% of patients at day 6 with overall incidence (45%). The rate decreased significantly from day 0 to day 6 due to the reported significant improvement in lung condition and presence of patients who were no intubated at day 6. The commonest reported adverse events were hypoxia and hypotension.

Conclusion

lung ultrasound score and B- line percentage score had the ability to detect ventilator associated pneumonia with similar efficacy to lung CT. Also, lung ultrasound is considered a good assessment tool to be used for following up of such patients with good reliability and reproducibility.
Ultrasound-Guided Lumbar Erector Spinae Plane Block versus Intravenous Analgesics for Post-Operative Pain Management in Pediatric Patients Undergoing Inguinal Hernia Surgeries
Authors: El-Momen Mokhtar Abd El-Momen Basant Abd , Elsayed Abdellatif Ayman Ahmad , Lotfy Youssef Nasr Azza Mohamed , Salem Ahmed Sarah Ahmed
Published: November 2024

Background

Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Erector spinae plane Block (ESPB) is a promising technique in the field of pediatric postoperative analgesia considering its safety and simplicity.

Aim of the Work

to assess the analgesic efficacy of ultrasound guided Lumbar ESPB in pediatric patients undergoing unilateral inguinal hernia repair for postoperative analgesia.

Patients and Methods

The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients’ consent. It included a total of 40 pediatric patients aged 1-7 years, Scheduled for unilateral inguinal hernia repair. Patients were randomly divided into two equal groups, 20 each, according to the inclusion and exclusion criteria. Group A (n = 20): Received ultrasound guided ESPB block.Group B (n = 20): (the controlled group): This group didn't not receive any peripheral nerve block. The patient received the intravenous analgesia according to standard protocol. [(0.5 μg/Kg fentanyl) 5 min before skin incision.]

Results

The main finding in this study was that ultrasound guided ESPB at level of Lumbar transverse process provided a good analgesic effect in pediatric patients undergoing unilateral inguinal hernia repair by Prolonging the time to first request of analgesia (duration of analgesia). It also reduced the total amount of Intraoperative and postoperative i.v analgesic consumption in comparison to controlled group without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation.

Conclusion

Ultrasound-guided Lumbar ESPB provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements in pediatric patients underwent unilateral inguinal hernia repair.
Comparative Study between Computed Tomography of Brain and Trans-Cranial Ultrasonography in Detecting Midline Shift in Severe Traumatic Brain Injury
Authors: Abdelhamid Faisal Said , Alagamy Ashraf Elsayed , Rashed Mohamed Mohsen , Elgouhary Mohamed Osama , Shehata Wahba Kamal Abdelrahman
Published: November 2024

Background

Traumatic brain injury (TBI) is the leading cause of mortality and morbidity in patients in the age group of 18–45 years. Most of the victims survive with significant disabilities, culminating in a major socioeconomic burden for both patients and their families.

Objective

To study the ability of trans-cranial ultrasonography in detecting and measuring midlineshift in comparison to computed tomography of brain in severe traumatic brain injury.

Patients and Methods

This was a cross-sectional comparative study that was conducted at Ain Shams university hospital’s intensive care units. The study was carried out on 40 adult critically ill patients of both sexes with severe traumatic brain injury underwent conservative treatment for 48 hours. Patients were randomly enrolled in 6 months.

Results

There was a high statistical significance correlation between measurements of midline shift by ultrasound (U/S) with the two methods of measurement by computed tomography (CT) “CT 1 and CT 2” on admission and also after 48 hours from admission. In this study, measurements of midline shift (MLS) in less than 8 mm is more accurate and the more increase in MLS may increase the difference between U/S and CT measurements of MLS.

Conclusion

This study suggests that transcranial sonography “TCS” could detect and measure MLS with reasonable accuracy as compared with the gold standard method computed tomography “CT” in severe traumatic brain injury patients on conservative treatment that it could serve as a bedside tool to facilitate early diagnosis and follow up treatment of midline shift specially in patients with MLS less than 8 mm however patients with MLS 8 mm or more need to be furtherly assessed.
Effect of Addition of Hyaluronidase as an Adjuvant to Lidocaine and Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block
Authors: Gabra Kerollos Ayoub , Nashed Sherif Wadie , Ibrahim Dalia Ahmed
Published: November 2024

Background

Regional anesthesia for the upper extremity has been gaining popularity due to the several advantages it has over general anesthesia. Some of these advantages include: improved postoperative pain and decreased postoperative narcotic consumption and recovery time. The brachial plexus block, especially the supraclavicular block, is a commonly used peripheral block technique for the upper extremity, used in both in-patient and out-patient settings, as well as for post- operative pain control.

Objective

The aim of this study is to evaluate the efficacy of hyaluronidase as an adjuvant to the mixture of LAs in ultrasound-guided supraclavicular brachial plexus block.

Methods

This A randomized, prospective, double-blinded, controlled study operating theaters of Orthopedic Surgery Department and Reconstructive Surgery and Burns Department at Ain Shams University Hospitals included forty patients from July 2020 to December 2020 (six month).

Results

There was no statistically significant difference between the two studied groups regarding the sensory (group A: 642.5 ± 47.97 mins, group B: 610.5 ± 57.9 mins) and motor (group A: 660.5 ± 47.29 mins, group B: 625.5 ± 57.28 mins) block durations despite the shorter block duration of group B in which hyaluronidase was used, as well as regarding the time of first analgesic dose demand (group A: 649.5 ± 48.74 mins, group B: 618 ± 58.05 mins). The total dose of morphine given during the first 24 hours postoperatively was significantly lower in group A in which Hyaluronidase was not used (10.7 ± 1.56 mg).

Conclusion

This study showed that the addition of hyaluronidase to the local anesthetics during ultrasound-guided supraclavicular block shortened the onset of the sensory and motor block, and consequently, the anesthetic time before the start of surgery. The use of hyaluronidase also decreased the total duration of the sensory and motor block, as well as the postoperative time of the first analgesic demand, though were not significant statistically. Regarding complications (injection site hematoma, horner's syndrome, phrenic nerve block ….etc), the difference between the two groups was also significant statistically.
A Randomized Trial for Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy: Intravenous Lidocaine Infusion vs. Ultrasound Guided Erector Spinae Plane Block
Authors: Abd-Allah Kirolos Hany , Elnasr Mohamed Gihan Seif , Esmat Ibrahim Mamdouh , Mohamed Noha Refaat , Ashoor Tarek Mohamed
Published: November 2024

Author affiliations:

1. Kirolos Hany Abd-Allah Shawky, MB, BCh, Resident of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo, Egypt; Email:

2. Gihan Seif Elnasr Mohamed, Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University. Abbasseya, Cairo, Egypt; Email:

3. Ibrahim Mamdouh Esmat, Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University. Abbasseya, Cairo, Egypt; Email:

4. Noha Refaat Mohamed, Assistant Professor of Clinical Pathology, Faculty of Medicine, Ain Shams University. Abbasseya, Cairo, Egypt; Email:

5. Tarek Mohamed Ashoor, Assistant Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University. Abbasseya, Cairo, Egypt; Email:
Comparative Study of the Efficacy of Intravenous Dexmedetomidine versus Intraperitoneal Bupivacaine-Dexmedetomidine for Postoperative Analgesia after Laparoscopic Cholecystectomy
Authors: Ghaly Tawadros Safaa Ishak , Mohamed Nasr El-Din Dalia Abd El-Hamid , Louis Wassily Maria Asaad , Abd El-Fattah Abd El-Aziz Mohamed Maher
Published: November 2024

Background

Although laparoscopic operations are minimally invasive, many patients report moderate-to- severe pain in the early postoperative period, which is multifactorial and requires multimodal analgesia to relieve it. Pain after laparoscopic surgery is caused by three mechanisms: parietal, visceral, and shoulder pain. As a result, numerous studies were done to develop methods for good postoperative pain control.

Aim of the Work

This study aims to compare the efficacy of intravenous dexmedetomidine versus intraperitoneal bupivacaine-dexmedetomidine for postoperative analgesia after laparoscopic cholecystectomy.

Patients and Methods

The study was conducted on 52 patients aged 21 to 60 years, of American Society of Anesthesiologists (ASA) class I or II scheduled for elective laparoscopic cholecystectomy under general anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated to two groups of 26 patients each: Group A: (n = 26): Patients received an intravenous infusion of 50 ml of normal saline containing dexmedetomidine 1μg/kg over 10 minutes after removal of the gall bladder, Group B: (n = 26): Patients received intraperitoneal instillation of dexmedetomidine 1μg/kg plus 40 ml of bupivacaine 0.25%.

Results

There was a statistically significant difference between both groups regarding pain control and postoperative analgesic requirements while there was no significant difference between both groups regarding the demographic data and postoperative side effects (hypotension, bradycardia, nausea, and vomiting). Both intravenous dexmedetomidine and intraperitoneal bupivacaine-dexmedetomidine were effective for postoperative pain control after laparoscopic cholecystectomy but the intraperitoneal route provided a longer duration of analgesia and the lower postoperative analgesic consumption

Conclusion

The present study concluded that patients who received intraperitoneal administration of bupivacaine-dexmedetomidine had less VAS with a longer duration of analgesia and lower postoperative analgesic consumption than those who received intravenous dexmedetomidine.
A Comparative Study between the Analgesic Efficacy of Ultrasound Guided Interscalene Block vs General Anesthesia in Patients Undergoing Shoulder Arthroscopy
Authors: Ibrahim Mohammed Khater Mariam Ali , Ramzy Gadalla Raouf , Kamal El Din Doaa Mohammed , Ahmed Youssef Ahmed Monier
Published: November 2024

Background

Shoulder arthroscopy can effectively treat a number of injuries and diseases of the shoulder on an ambulatory basis. Although shoulder arthroscopy is considered minimally invasive, it is associated with severe intraoperative and postoperative pain. Hence, it requires adequate analgesia and muscle relaxation for the procedure. For shoulder arthroscopy, regional anesthesia is better than general anesthesia (GA) because of the extended postoperative analgesia and rapid recovery towards discharge.

Aim of the Work

to compare the analgesic efficacy of ultrasound guided Interscalene block alone without GA VS general anesthesia as regards the postoperative pain management, analgesics requirements and hospital stay during shoulder arthroscopy.

Patients and Methods

Type of Study: a prospective, randomized, comparative study. Study Setting: After obtaining approval from the Research Ethical Committee of Ain Shams University, this study will be conducted in the operating theatres of Ain Shams University Hospitals. Study Period: Six months (started from FEB. 2023 to AUG. 2023).

Results

In our study, regarding VAS score among the studied patients, The pain threshold score using VAS score at different times postoperatively showed non-significant difference between the ISB all times, with p-values <0.001 for VAS 1, VAS 6, VAS 12, VAS 18 except at VAS 24 HR a significant difference at p value 0.887 was found but still the VAS score was less than 4, So, no pain killers were given. Surprisingly a reported improvement in expression of postoperative pain was noticed later on. This is may be due to the very dense block offered by interscalene brachial plexus block. Regarding the assessment of patient„s vital data represented in the heart rate and mean arterial blood pressure our study shows highly statistically significant higher mean in group G compared to group I according to heart rate from at0hr to after 20hrs with p-value <0.05, while after 24hrs insignificant with p-value >0.05 NS with almost the same results for mean arterial blood pressure. Our study demonstrates that ISB provides a better hemodynamic stability postoperatively regarding the control of heart rate avoiding the unwanted catastrophic tachycardia and lower mean arterial blood pressure while maintain adequate desirable tissue perfusion without the need of toxic mega opioid rescue doses.

Conclusion

Ultrasound guided ISB for shoulders arthroscopic surgical operation provides greater pain-free period, lesser opioid requirement, and lesser PACU stay duration in patients receiving this block
Comparative Study between Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Block in Post-Operative Pain Management after Cesarean Section
Authors: Marzouq Mervat Mohamed , Haggag Adham Magdy , Hesham Mariam Mohamed , El Shabrawy Asmaa Ismail
Published: November 2024

Background

Cesarean section rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization.

Aim of the Work

The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans- muscular QLB compared with TAP block during cesarean section surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions.

Patients and Methods

After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, female patients were included in the study, and were divided into two groups (n = 25; each); group QLB and group TAP. Group QLB: Patients (n = 25) of this group received bilateral ultrasound-guided QLB after induction of spinal anesthesia using (2-2.5 mg/kg of bupivacaine not to exceed 175 mg per dose and maximum 400mg/24h) without exceeding the toxic dose 3 mg/kg. Group TAP: Patients (n = 25) of this group received bilateral ultrasound-guided TAP block after induction of spinal anesthesia using (2-2.5 mg/kg of bupivacaine not to exceed 175 mg per dose and maximum 400mg/24h) without exceeding the toxic dose 3 mg/kg.

Results

The present study showed that the quadratus lumborum block was more efficient than the tansversus abdominis plane block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) indicated that the superiority of the QL block technique over the TAP block technique. The patients of group TAB had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group QLB. This is mainly due to the extension of the local anesthetic agent in QLB beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control.

Conclusion

Quadratus lumborum block was the most effective technique in providing analgesia after cesarean section in comparison to transversus abdominis plane block and even more time covering to rescue opioid.
Comparative Study for Postoperative Ultrasound Guided Pericapsular Nerve Group Block and Femoral Nerve Block for Postoperative Pain Management Analgesia for Bipolar Hemiarthtroplasty
Authors: Ibrahim Dalia Ahmed , Abdelhakam Galal Mahmoud Ahmed , Abdelmaksoud Mohamed Nabil , Lwiz Morcos Marihan Adel
Published: November 2024

Background

Proximal femur fractures are most common fractures especially in elderly population. Regional anaesthesia is preferred during surgery in these patients. However, the severe pain associated with these injuries makes appropriate positioning difficult for the regional anaesthesia, thus altering their overall success rate, also the majority of patients often experience moderate to severe postoperative pain.

Aim of the Work

The study aimed to compare between ultrasound guided PENG and FNB using VAS score to assess the overall efficacy for pain relief during patient positioning for spinal anesthesia.

Patients and Methods

After approval of anaesthesiology department scientific and ethical committees in Ain Shams University Hospitals, 50 patients were included in the study, and were divided into two groups (n = 25; each); group PENG and FNB group. The two groups were adequately monitored and assessed before spinal anesthesia and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total amount of analgesia required.

Results

This study documented that PENG block is comparable to femoral block for postoperative pain control. The PENG block has been described very first in 2018 for preoperative management of femur neck fracture. We observed no statistically significant difference in pain scores during positioning for spinal anesthesia and for first 24 hrs post-operative. Similarly, no significant difference was also found in first rescue analgesia time and Cumulative nalbuphine consumption at 24 hours after surgery between the two groups.

Conclusion

In the management of hip fractures, PENG block is not associated in our study with a significant change in pain score postoperatively compared to femoral nerve block.
Effect of Dexamethasone as an adjuvant to Bupivacaine in caudal block for Postoperative Analgesia in Pediatric Patients undergoing Orchidopexy
Authors: Saad Emam Mohamed Hilal Merna Hazem , Abdelmegeed Elsayed Waleed Mohamed , Alansary Adel Mohamad , Mohamed Fouad Farouk
Published: November 2024

Background

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

Aim of the Work

to evaluate the analgesic effect of dexamethasone when given as an adjuvant to caudal block in children undergoing orchidopexy surgery.

Patients and Methods

The study was conducted on 40 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 20 patients.

Results

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 bupivacaine alone in caudal block at similar doses in controlling postoperative pain.

Conclusion

we can conclude that adding 0.1 mg/kg of dexamethasone to 0.5 ml/kg of 0.25% bupivacaine effectively improves the analgesic duration in single-shot caudal anesthesia.
Comparative Study between Ultrasound Guided Quadratus Lumborum Block vs Intraperitoneal and Perioportal Bupivacaine Infiltration as Post Operative Analgesia after Laparoscopic Cholecystectomy
Authors: Sayed Ahmed Omran Hany Abd El-Fattah , EL-Din EL-Ozairy Hala Salah , Salem Ahmed Sarah Ahmed , Phillip Hanna Mina Salib
Published: November 2024

Background

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

Objective

To test the efficacy of QL block versus intraperitoneal and periportal infiltration with local anesthetic agent in providing postoperative analgesia after laparoscopic cholecystectomy.

Patients and Methods

Double-blinded randomized controlled clinical study [both the patient and the operator (the surgeon in intraperitoneal and periportal bupivacaine and the anesthetist in QL block) were blinded], After Approval was obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University.

Results

The results of the study revealed that the Patients receiving QLB had significantly longer time to first rescue analgesic and significantly lower total opioid consumption in first 24 h post operative compared with patients who received Intraperitoneal and periportal infiltration.

Conclusion

Bilateral QL block was effective in providing postoperative analgesia (significantly longer time to first rescue analgesia) and reduced postoperative opioid consumption in the first 24-h after laparoscopic cholecystectomy under general anesthesia, compared to intraperitoneal and periportal infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.
Comparison between Pectoral Plane Block (PECS 1 and 2) and Patient Controlled Intravenous Analgesia after Breast Surgeries
Authors: Mahmoud Hoda Omar , Alansary Amin Mohammed , Ibrahim Koraitim Ahmed Farouk , Ewais Mohamed Abdelhamid
Published: November 2024

Background

Breast cancer has continued to be the most common cancer among women, accounting for 31% of all new cancer cases in the female population. Every/ year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for early-stage breast cancers.

Aim of the Work

The primary aim of this study is to compare the efficacy of PECS 1,2 block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques, as well as intra-operative analgesia.

Patients and Methods

A randomized controlled Clinical trial in Ain Shams University Hospitals, Cairo, Egypt (EL Demrdash hospital and Combined operations) for 6 months carried out on women who undergo breast surgeries.

Results

The Results shows that the VAS score in the PECS group was highly significant lower at the 1st, 2nd and 4th hours postoperative, the time interval for the 1st dose of rescue analgesia was higher in PECS group, there was significant difference regarding heart rate and blood pressure between both groups at 1st, 2nd, 4th and 8th hours postoperative in favor for PECS group, regarding o2 saturation it was significant only after 1 hour postoperative, regarding nausea and vomiting there was significant difference in nausea in favor for PECS block while regarding vomiting it was non- significant, regarding sedation it didn’t occur in neither group so it was not applicable.

Conclusion

In modified radical mastectomy, PECS block is more effective than intravenous PCA in pain management postoperative, better effect on vital data like heart rate, blood pressure and o2 saturation, it also lowers the analgesic drugs consumption postoperative. Moreover, PECS block is more preferable method because it avoids the systemic side effect of morphine used for PCA like nausea and vomiting. PCA analgesic effect needs time to start its action.