bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Study between Femoral Nerve Block and Intravenous Ketamine in Pain Management for Septuagenarian and Octagenerian Patients with Femur Fracture during Positioning before Spinal Anesthesia
Authors: Luka Meleik Amr Magdy , Eldeen Abdelhamid Amr Essam , Refaat Mostafa Sameh Ahmed , Ahmed Mohammed Khaled Mohammed
Published: November 2024

Background

Femur fracture commonly occurs following trauma in elderly patients and central neuraxial block especially spinal anesthesia is more preferred for providing anesthesia for such cases. Proper positioning during spinal anesthesia is a must for a successful procedure, but extreme pain and limb immobility are obstacles for an ideal position for this procedure. Different methods like intravenous fentanyl, ketamine, femoral nerve block or fascia iliaca block have been used to control the pain pre-operatively and improve these patients' positioning.

Aim of the Work

To investigate the effect of Ultrasound guided FNB using 0.25% bupivacaine versus IV analgesic ketamine dose (0.25 mg/kg) in pain control for positioning before spinal anesthesia in patients undergoing surgery for fractured femur. In addition to recording postoperative analgesic effect, postoperative opioid consumption and rate of complications

Patients and Methods

The study was conducted on 60 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee

Results

Results of the study revealed that FNB analgesia was more effective than IV analgesic dose of ketamine for pain control during positioning. The first call for rescue analgesia (morphine), total morphine consumption and postoperative pain scores indicated that the superiority of the FNB technique with opioid sparing effect and lesser complications.

Conclusion

Unlike preoperative intravenous ketamine analgesia, preoperative FNB provided better pain control during positioning for spinal blockade in fractured femur patients. Furthermore, FNB was associated with less adverse effects, better postoperative analgesia and less postoperative opioid consumption.
Ultrasound Guided Erector Spinae Plane Block versus Oblique Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Adults Patients after Laparoscopic Colorectal Surgery
Authors: Shoukry Randa Ali , Hefny Taha Sameh Salem , Elshaeer Eman , Mohab Eldin Hussein Mohamed Halim Amr Mohamed
Published: November 2024

Background

Major abdominal surgery can cause significant post-operative pain and stress. Thoracic epidural analgesia (TEA) remains the gold- standard in its management. However, it is not without side effects or potential risks. Regional techniques might offer an alternative when thoracic epidural analgesia (TEA) is not possible.

Aim of the Work

The aim of this study is to test the efficacy of ultrasound guided erector spinae plane block versus ultrasound guided 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, forty patients scheduled for elective laparoscopic colorectal surgery received general anaesthesia were included. Patients were divided randomly into two groups, each group includes 20 patients. Group T: Patients in this group received ultrasound guided OSTAP block after induction of general anaesthesia. Group E: Patients in this group received ultrasound guided ESP block after induction of general anaesthesia.

Results

As regard the analgesic parameters recorded in the current study; the NRS was significantly lower in Group E (ESP) block when compared with that of Group T (OSTAP) block and showed significant difference between both groups at 4, 6, 8 and 10 hrs postoperatively. Time to rescue analgesia, there was clinically and statistically highly significant longer time to ist rescue analgesic in group E (ESP) block was 15.68+1.50 hours compared to that of group T (OSTAP) block was 9.56+2.41 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 meperidine consumption with the mean total consumption in each group was 75+0.37 mg in the ESP block group compared with 125+0.87 mg in the OSTAP block group there was highly statistically significant higher mean of total analgesic consumption in group T compared to group E.

Conclusion

Erector spinae plane block under ultrasound guidance for laparoscopic colorectal surgery provides a longer duration and better quality of postoperative analgesia, as well as reducing the postoperative analgesic consumption when compared to oblique subcostal transversus abdominis plane block for laparoscopic colorectal surgery. Both blocks are mostly devoid of complications, and they provide reliable and effective postoperative analgesia in patients undergoing laparoscopic colorectal surgery.
Sensitivity of Lung Ultrasound in Early Detection of Increased Extra Vascular Lung Water in Critically Ill (severe) Burn Patients in Intensive Care Unit
Authors: Fekry Shehata Andrew Ashraf , Mohamed AboElella Sahar Kamal , Alsalam Algendy Mohammad Abd , Abdel Hafiez Mohamed Rania Hassan
Published: November 2024

Background

Burn injury, by definition, is not an injury limited to the site of burn, but instead, it is a multi-organ injury with a high incidence of morbidities and mortalities among burned patients. Multiple factors determine the extent of affected organs and the degree of their damage.

Patients and Methods

The study was conducted in Burn ICU in Ain Shams University Hospitals after approval of the ethics committee and written patients’ consent. It included 24 patients aged 24 – 64 years, of both Genders, suffering from severe burn upon admission to Burn ICU in Ain Shams University Hospitals with burn extent equal to or more than 20%, stayed in burn ICU for 14 days or more and showed at least once Lung ultrasound findings related to lung water capable of elevating LUS score more than zero.

Results

The main finding is that the lung ultrasound is a sensitive tool in detection of extra vascular lung water in Burn patients with severe burn of burn surface area 20% or more of the total body surface area in intensive care unit when compared by chest CT and chest x-ray. And, by daily lung ultrasound follow up, early sensitivity of lung ultrasound in detection of extra vascular lung water in comparison with chest x- ray and clinical data is concluded.

Conclusion

Our study showed that lung ultrasound is an early sensitive tool in detection of extra vascular lung water in burn patients with severe burn of burn surface area 20% or more of the total body surface area in intensive care unit.
Erector Spinae Plane Block Combined with Continuous Dexmedetomidine and Lidocaine Infusions as an Opioid-Free Anesthesia in Posterior Spinal Fusion Surgery
Authors: Salama Awad Hala Gomaa , Wasfy Sanaa Farag Mahmoud , Hafez Helmy Amr Fouad , Abbas Hassan Aya Mohamed
Published: November 2024

Background

Lumbar spine surgery is a common type of orthopedic surgery and mostly elective in nature. Conventional spine surgeries (non-minimally invasive) often involve extensive dissection of subcutaneous tissues, bones, and ligaments, laminectomies, discectomies, and instrumentations thus result in a considerable degree of postoperative pain, that can hinder the postoperative recovery, and it includes a high risk of persistent postsurgical pain, with a frequency ranging from 20 % to 40%.

Aim of the Work

We aim to assess intraoperative variation of heart rate (HR) and systolic blood pressure (SBP) as a monitor to guide the antinociceptive component of OFA and if it can provide adequate hemodynamic control and stability during the perioperative period with the impact on patient satisfaction.

Patients and Methods

This interventional, randomized and double–blinded controlled trial study was conducted in the institute Hospitals, Ain Shams University Hospitals from 1 February, 2023 to 31 July, 2023. The purpose of the study was clarified to all patients in full detail, along with details of the anaesthesia technique to be used by both the surgeon and anaesthetist. Moreover, informed consent was signed by all patients who were scheduled for lumbar spine procedures on any levels between L1 and L5. Subjects were eliminated from the study if they refused to participate, were unable to evaluate their level of pain or had an allergy to the study drugs.

Results

Our results indicate that there were no significant differences in SBP and episodes of hypertension between the two groups during various stages of the surgical procedure. However, HR values showed less fluctuations in OFA group starting from after skin incision and throughout different stages of the surgery. Our population who are at high risk of postoperative nausea and vomiting due to previous opioid use on chronic back pain. In our study, incidence of PONV in group OFA was lower than that of in group OA in a period of 24h after surgery (5.7%, 15.7%).

Conclusion

Compared to OA technique, OFA technique, which is represented by non-opioid drugs, lidocaine and dexmedetomidine, may be an alternative anesthesia in patients undergoing posterior lumbar spine fusion surgery. With its non-inferiority of analgesic effect, safe anesthesia, and lower incidence of intraoperative hemodynamics fluctuations and PONV.
Comparative Study between Bupivacaine versus Bupivacaine with Dexmedetomidine in Ultrasound Guided Transversus Abdominis Plane Block as Postoperative Analgesia in Open Inguinal Hernia
Authors: Galal Mahmoud Hadeer Ahmed , Hassan AlaaEid Mohamed , Hussein El Derh Maha Sadek , El Rab Ahmed Ihab Ahmed Gad
Published: November 2024

Background

A recent myofascial plane block, the transversus abdominal plane block (TAP), has been shown to lessen not only postoperative discomfort after surgery of inguinal hernia but also hospital stay. It is our objective to achieve postoperative satisfaction regarding the pain with the least side effects as related with opioids.

Methods

The study was registered at Pan African-Clinical Trial Registry.org with ID of (PACTR 202301487176282), randomized clinical trial, after obtaining approval from the Research Ethical Committee of Ain Shams University, this study was done in the general surgery theatres of Ain Shams University Hospitals for 12 months.

Results

In this study, TAP block with dexmedetomidine was more effective than TAP alone as measured by visual analog scale (VAS) scores, regarding first analgesic request and change in vital data. Significant differences in VAS scores were observed at 6 hours up to 24 hours postoperatively (p < 0.01), but not during the first 6 hours. Heart rate was obviously diminished in the Bupivacaine with Dexmedetomidine (BD) group compared to the Bupivacaine (B) group starting at 2 hours postoperatively, while mean blood pressure was eased from 6 hours up to 24 hours postoperatively. Total analgesic consumption and time to first analgesic request were decreased in the BD group, while the incidence of nausea and vomiting were similar between the two groups.

Conclusions

The addition of dexmedetomidine to bupivacaine in TAP block extends the duration of time at which first dose of rescue analgesia and also reduced the total dose of opioid requirement in the first 24-h postoperatively.
Comparative Study Between Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Erector Spinae Plane Block as Postoperative Pain Management in Modified Radical Mastectomy
Authors: Ibrahim Sherif Farouk , El Azeem Labib Heba Abd , Sayed Amr Gaber , Elias Abd El Malak Mina Anwar
Published: November 2024

Background

Breast cancer is the most common malignancy in women, and its incidence continues to increase. Surgery is one of the mainstays of treatment of breast cancer, and Modified Radical Mastectomy (MRM) is one of the standard treatments for multi-centric disease or tumors with extensive coexistent ductal carcinoma in situ, where achieving a clear surgical margin becomes difficult with a segmental mastectomy.

Objective

This Study compared between Serratus Anterior Plane block and Thoracic Erector spinae block as efficacy of postoperative analgesia in Modified Radical Mastectomy.

Patients and Methods

This was a prospective controlled double blinded randomized clinical study that was conducted at Ain Shams University hospitals, Cairo, Egypt on Adult female patients undergoing modified radical mastectomy and were randomly assigned into two equal groups by computer generated method: Group A (control group): patients received general anaesthesia followed by Serratus Anterior plane block using only 20 ml 0.25% Bupivacaine (safety dose 3mg/kg). Group B(study group): patients received general anaesthesia followed by Thoracic Erector Spinae block using only 20ml bupivacaine 0.25 %. (safety dose 3mg /kg).

Results

In this study, we found that the postoperative VAS scores were better in Group SAP at 2nd, 4th, 6th and 12th hr as compared to group TES. The incidence of PONV and the requirement of Ondansetron were found to be similar in both groups. None of the patients in either group developed technique-related complications like hemodynamic instability, intravascular injection, pneumothorax, local anaesthetic systemic toxicity, and adverse effects like pruritus and respiratory depression.

Conclusion

USG-SAPB was effective and safe technique which provides better pain relief compared with the USG-TESP and reduced post operative opioid consumption. Therefore, the SAP can be used safely for post operative analgesia for patients undergoing MRM surgery to avoid the risk of developing chronic post mastectomy pain which reduces quality of life.
Hybrid Anesthesia for Ambulatory Knee Arthroscopy Using Intrathecal Prilocaine and Adductor Canal Block vs Intrathecal Bupivacaine Alone: A Randomized Controlled Trial
Authors: Nashed Mina Magdy , Elnasr Mohamed Gihan Seif , Esmat Ibrahim Mamdouh , Ashoor Tarek Mohamed
Published: November 2024

Background

One of the most popular orthopedic surgeries is knee arthroscopy. It is challenging to provide adequate analgesia with motor preservation to allow for a shorter hospital stay and a faster recovery. Good pain control and side effects reduction can be done easily using the multimodal analgesia methods. There are various analgesic drugs and techniques can be used as patient education, pre-emptive analgesia, pharmacological methods and regional analgesia technique.

Aim of the Work

To compare between combined intrathecal prilocaine and adductor canal block vs intrathecal bupivacaine alone regarding the duration of motor block in ambulatory knee arthroscopy.

Patients and Methods

The study was conducted on eighty random patients who were scheduled to undergo knee arthroscopy and were divided into two equal groups (40 each).

Results

Patients were monitored and assessed post-operatively for 24 hours and they were compared regarding time of motor block regression to Bromage score 1 starting from spinal block, sensory block duration, postoperative analgesic effect (pain scale), postoperative opioid consumption, spontaneous bladder voiding, postoperative patient satisfaction level and the incidence of PONV and headache. The side effects were also monitored, managed and compared.

Conclusion

the spinal anesthesia for knee arthroscopic surgeries, using the hyperbaric prilocaine 2%, causes shorter motor block duration than using the bupivacaine, which leads to earlier post-operative ambulation and discharge and better patient satisfaction. Additionally, using the ACB reduces the need for opiods during the first 24 hours following the surgery in conjunction with other pain management techniques for knee arthroscopy. Also, it preserves the quadriceps muscle power, which is important for early ambulation and patient satisfaction.
Serum Ferritin versus C-Reactive Protein in Predicting Outcome and Mortality in Corona Virus Disease 2019 (Covid-19) A Retrospective Observational Study
Authors: Eldin Shokeir Mohamed Hossam , Mohamed Abu Sinna Rasha Gamal , Nassif George Maher , Kader El-Sayed Mansy Mohammed Ahmed Abdel
Published: November 2024

Background

In coronavirus disease 2019 (COVID-19), finding sensitive biomarkers is critical for detecting severe cases early and intervening effectively. Very few studies evaluated how ferritin and CRP are altered in COVID-19. Therefore, it is of clinical significance to evaluate the disease severity and investigate ferritin and CRP in patients with COVID-19.

Objective

To explore the infection biomarkers, including ferritin and CRP in ICU patients with COVID-19. We will aim to describe the clinical characteristics of infection markers in patients with COVID-19.

Patients and Methods

After approval of anesthesiology department and scientific and ethical committees, this retrospective observational study was carried out on 105 consecutive patients with confirmed COVID-19 status attending Ain Shams University Hospital, intensive care units during a 6-month period from January 2020 to July 2020; divided into 2 groups; severe and critically ill cases.

Results

As regards the follow-up laboratory data, there was a significant increase in follow-up CRP, ferritin, D-dimer and PTT in critical group; compared to severe group. Our study showed that there was a highly significant difference between the 2 groups as regards the need of mechanical ventilation and mortality rate, as 68.3% of critical cases need mechanical ventilation and 58.5% died. As regard the length of stay in the ICU, the critical group had longer stay in the ICU in comparison to the severe group, although this difference was not statistically significant.

Conclusion

High baseline and follow up laboratory tests of CRP and serum ferritin both can be used as a predictor of outcome and mortality in COVID 19 infection. There is significant positive correlation between age, CRP and duration of stay in the ICU. Also there was a significant positive correlation between CRP, ferritin and duration of stay in the ICU. The increase in age and CRP; had an independent effect on increasing ICU stay. Increase in CRP levels; had an independent effect on increasing the probability of severity of COVID-19 infection. While ferritin shows a significant effect on increasing the probability of severity of COVID-19 infection in univariate analysis. Ferritin level at a cut-off point (>598) predict mortality outcome, with good (89%) accuracy, sensitivity (93.8%) and specificity (42.9%). Also, CRP level at cut-off point (>25) predict mortality outcome, with lower (80%) accuracy, sensitivity (87%) and specificity (33.3%).
Analgesic Efficacy and Safety of Ultrasound Guided Scalp Nerve Blocks in Supratentorial Craniotomies: A Randomized Controlled Trial
Authors: Ibrahim Sherif Farouk , Labeb Heba abdelazem , Metwally Aboelnile Diaaeldin Badr , Abdelalem Eldaoushy Mostafa Ibrahem
Published: November 2024

Background

Multimodal analgesia is considered the cornerstone in controlling intraoperative and post operative pain in patients undergoing brain surgeries. A good control of strong noxious stimulations in supratentorial craniotomies allows a maintenance of an intraoperative hemodynamic stability and a post operative pain relief. Scalp sensory nerve block is considered one of the multimodal techniques to control intra and post operative pain, preventing the increase in intracranial pressure (ICP) and hypertension, which may be harmful, especially for patients with cerebral aneurysms. Also decreasing systemic analgesia and opioid that may alter conscious level of the patients allows better assessment and examination after surgery.

Objective

To compare the analgesic efficacy and safety of ultrasound use in performing scalp sensory nerve block compared to blind classical infiltration technique.

Methods

This randomized prospective controlled trial was conducted on 40 randomly chosen patients American Society of Anesthesiologists (ASA) class I or II scheduled for elective supratentorial craniotomy (supratentorial mass lesion or aneurysm clipping) under general anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee.

Results

Intraoperative hemodynamic monitoring showed that there was a statistically significant decrease in HR, SINBP values in SBU group at time of skin incision (SI) compared to baseline values (before performing scalp block). Also Rates of both propofol and Fentanyl consumption showed a statistically significant decrease in SBU group at all time points of concern compared to baseline values. Postoperatively, patients received ultrasound guided scalp block had significantly lower pain scores after operation, with a significant increase in time for rescue analgesia and significant decrease in total amount of morphine needed in the first 24 hr post-operative compared to patients who received blind scalp block by local infiltration.

Conclusion

Ultrasound use in performing scalp block, is considered of choice for maintaining patient safety, intraoperative hemodynamic control and enhancing post-operative recovery.
Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-Operative Analgesia Following Knee Arthroscopy
Authors: Mohammed Nada Sami Abdelfattah , Mohammed Hadil Magdy Abdelhamid , Habashi Samuel Habashi Daniel , Saleh Sara Hossameldin Taha
Published: November 2024

Background

In arthroscopic knee surgery, managing postoperative pain is crucial for patient outcomes. Dexamethasone, combined with local anesthetics in adductor canal block, offers potential advantages, such as vasoconstriction and anti-inflammatory effects. This approach proves safe, prolongs sensory block duration, delays the need for analgesics, and enhances patient satisfaction, addressing challenges associated with epidural analgesia and femoral nerve block. Overall, it signifies a valuable strategy in anesthesia practice, contributing to prolonged analgesia, reduced opioid use, and faster recovery in knee arthroscopy.

Aim of the Work

The study aims to assess the effectiveness of perineural dexamethasone combined with bupivacaine in adductor canal block for postoperative pain control following knee arthroscopy with spinal anesthesia. The primary focus is on determining the duration of postoperative analgesia. Secondary objectives involve evaluating the effectiveness of analgesia one day after surgery and assessing opioid consumption.

Patients and Methods

This randomized, double-blinded controlled trial at Ain Shams University hospitals investigates the efficacy of adductor canal block with dexamethasone in knee arthroscopy under spinal anesthesia. Sixty adult patients are randomly assigned to receive either bupivacaine with dexamethasone (Group A) or bupivacaine with saline (Group B). Primary outcomes include postoperative analgesia duration, and secondary outcomes involve morphine use, patient demographics, surgical time, and complication rates. Ethical considerations and detailed study procedures are outlined, ensuring patient safety and methodological rigor.

Results

In a randomized study for arthroscopic knee surgery, dexamethasone added to bupivacaine in adductor canal block significantly extended sensory block duration and delayed the time to first analgesic requirement. Visual analog scale scores were lower, and morphine consumption was reduced over 24 hours postoperatively. While systemic effects of dexamethasone were not assessed, consistent with other studies, its addition to local anesthetics in various nerve blocks demonstrated prolonged analgesia. Patient satisfaction was notably higher in the dexamethasone group, likely influenced by increased pain relief duration and reduced side effects.

Conclusion

We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg) dexamethasone to (0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.
Effect of Dexamethasone versus Low Dose Ketamine on Post Spinal Hypotension in Caesarian Section
Authors: Mohamed Khairy Noha Tarek , Saied Hatem , Anis Sherif George , Elfattah Elwaraky Mohamed Maher Abd
Published: November 2024

Background

Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Cesarean sections normally require an anesthetic block at T4 level, so hypotension is reported in up to 80% of spinal anesthesia cases.

Aim of the Work

To assess the effect of prophylactic sub-anesthetic dose of ketamine versus the effect of Dexamesathone to prevent maternal hypotension after spinal anaesthesia in cesarean section.

Patients and Methods

This study is a randomized controlled study this study done in obstetrics and Gynecology Department, Ain Shams hospitals at 3 months and the females undergoing caesarian section under spinal anesthesia.

Results

The study revealed that ketamine group showed significant lower incidence of postspinal hypotension compared to the control group 5, 10, 15, 20 minutes. Whereas the dexamethasone group showed significant reduction in incidence of postspinal hypotension when compared to the control group only at the first 5 minutes, while comparing both ketamine and dexamethasone groups the incidence of hypotension was not significant. Also, observed that total ephidren dose significantly decreased in ketamine group compared to control group. And sedation scores in the first 30 min were higher in ketamine group. HR wasn’t affected. No changes in APGAR score were noticed between the two groups. No side effects from ketamine except for nystagmus.

Conclusion

the randomized controlled study conducted in the Obstetrics and Gynecology Department at Ain Shams hospitals investigated the effects of dexamethasone and low-dose ketamine on post-spinal hypotension in caesarean deliveries. The study compared three groups: a ketamine group, a dexamethasone group, and a control group.
The Incidence of Acute Kidney Injury and Its Correlation to Serum Lactate as a Predictive Value for in Hospital Mortality in Patients with Sepsis
Authors: Meselhy Ibrahim Rasha Taha El , Wahba Sherif Samir , Abdelmoneem Alhadidy Mohamed Alaaeldin , Farrag Ossama Mohamed
Published: November 2024

Background

Sepsis-induced acute kidney injury (S-AKI) is a frequent outcome in hospitalized and critically ill patients, increasing the risk of developing chronic comorbidities. The recent Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) now recommends using the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) as screening tools for sepsis and prognosis, replacing serum lactate.

Objective

To investigate the relationship between sepsis-associated acute kidney injury (S-AKI) and serum lactate levels as potential predictors of in-hospital mortality in hospitalized and critically ill patients.

Methods

This Prospective observational study study was conducted in Intensive Care Units of Ain Shams University Hospitals and research committee over 6 months from December 2022 to June 2023. 75 patients was admitted to Ain Shams intensive care unit

Results

Elevated lactate levels in septic patients, especially in combination with AKI, were associated with a higher incidence of organs impairment and a poorer clinical outcome. Early detection and management of elevated lactate levels and organs impairment may improve clinical outcomes in these patients. The study showed higher lactate level is accompined by more organ failure and increase mortality as in group A which had mortality rate higher than group B and C. It also correlates with long stay in ICU and hospital.

Conclusion

The study findings indicate that elevated lactate levels in septic patients, particularly when accompanied by AKI, are linked to a greater occurrence of more organs impairment and unfavorable clinical outcome of patients who were classified into 3 groups the first had sepsis and developed aki and high serum lactate and the second had sepsis and developed aki with normal lactate and the third group had sepsis without aki.
Comparative Study between Ultrasound Guided Quadratus Lumborum versus Ilioingunial/Iliohypogastric Nerves Block as Post-Operative Analgesia for Patients Undergoing Inguinal Hernia Repair Surgeries
Authors: Wahba Rezk-Allah Sherif Samir , Abdelsalam Ehab Hamed , Ahmed Sally Hamdy Abdelaziz , Abdelhalim Elsonbati Reem Ashraf
Published: November 2024

Background

Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs.

Aim of the Work

The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans- muscular QLB compared with ilioinguinal-iliohypogastric nerve block in the postoperative period after inguinal hernia repair surgeries 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, patients were divided into two groups (n = 22; each); group QLB and group ILI/IHG.

Results

The present study showed that the quadratus lumborum block was more efficient than the ilioinguinal-iliohypogastric nerves block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (Numerical Rating Scale) indicated that the superiority of the quadratus lumborum block technique affected the ilioinguinal-iliohypogastric nerves block technique. The patients of group ilioinguinal-iliohypogastric nerves block 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 quadratus lumborum block. Regarding NRS score postoperatively, our study found that NRS score was significantly lower in group A when compared with group B.

Conclusion

Quadratus Lumborum block was the most effective technique in providing analgesia after inguinal hernia repair surgeries in comparison to Ilioinguinal/Iliohypogastric nerves block and even more time covering to rescue opioid.
Comparison of the Efficacy and Safety of Combined Extracorporeal Shock-Wave Therapy (ESWT) with Phytotherapy versus ESWT Alone in Chronic Prostatitis Category IIIB
Authors: Yaseen Mohammed Mohammed , Mousa Waleed Elsayed , Sadeq Mohammed Metwally , Georgui Elias Mina Atef , Mohammad Ebraheem Rashed Mostafa Mohammad , Ahmed Abdullah Mohamed Abdelmonem
Published: November 2024

Background

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the four categories of chronic prostatitis. It is a prevalent and poorly understood disease. The widespread presence of CPPS is over 90–95% among all the four categories of prostatitis.

Objective

To compare the efficacy and safety of ESWT combined with Phytotherapy and ESWT alone in treatment of chronic prostatitis category IIIB.

Patients and Methods

This prospective comparative clinical study (double armed) included 30 patients with clinical diagnosis of CP/CPPS were enrolled in the study. The patients were randomly allocated to either the ESWT plus Phytotherapy group (group A; n = 15) or the ESWT only group (group B; n = 15). A total of eight ESWT treatment sessions, once weekly were administered alone or in combination with Phytotherapy. Each session consisted of 3,000 shock waves. Phytotherapy that contains powder extract of (saw palmetto, tomato, uva ursi, pygeum, pumpkin) 1 capsule twice daily for 8 weeks. The changes in urinary symptoms, pain and quality of life were considered the main outcome measures and were assessed at baseline, after 4 and 8 weeks from the start of treatment, and 2 and 4 months after the end of treatment by National Institutes of Health-developed Chronic Prostatitis Symptom Index (NIH-CPSI).

Results

When we compared both groups of patients at the end of the study as regards Pain, Urination, Qol, and total score of NIH-CPSI, we find a significant improvement in both groups equally, as Independent t-test and Mann-Whitney test showed no significant difference between group A and group B (p > 0.05).

Conclusion

The study shows that ESWT is an effective and safe treatment modality for CP/CPPS, whether combined with Phytotherapy or not.
Transurethral Intraprostatic Injection of Botulinum Toxin Type A for the Treatment of Category III Chronic Prostatitis: A Randomized Sham Controlled Study
Authors: Osman El-Sayed Tarek , Shabayek Mohamed Ismail , Sadek Ahmed Tarek Mohamed
Published: November 2024

Background

Chronic non-bacterial prostatitis (CNBP) is a common disease associated with pain, urinary and sexual symptoms. Diagnosis and treatment of CNBP is usually difficult and requires multiple approaches and usually with unsatisfactory outcomes.

Aim and Objectives

to assess the effectiveness of the intraprostatic Botulinum toxin type A (BONT-A) in the treatment of refractory CNBP in a randomized sham-controlled trial.

Subject and Methods

70 patients with refractory CNBP were equally randomized into two groups. Patients in treatment group (group 1) received transurethral intraprostatic BONT-A injection, whereas patients in sham group (group 2) received transurethral intraprostatic saline injection. Baseline national institute of health chronic prostatitis symptom index (NIHCPSI) was evaluated before intervention and reassessed after 1, 3 and 6 months following treatment.

Result

Age, prostate size, duration of symptoms as well as baseline total NIHCPSI were not statistically significantly different between both groups before intervention (30.29 vs. 29.8 for group 1 vs. group 2 respectively, p = 0.583). We found statistically significantly reduction of NIHCPSI total score in group 1 compared to group 2 at all intervals of follow up (27.21 vs. 29.03, p = 0.037, 24.97 vs. 28.59, p < 0.001 and 21.76 vs. 27.27, p < 0.001, at 1, 3 and 6 months respectively). Mean pain subscale scores statistically significantly decreased in group 1 compared to group 2 from baseline (14.77 and 14.06 for group 1 and group 2 respectively, p = 0.127) to 12.52 and 13.79, p = 0.010, 11.53 and. 13.25 p < 0.001 and 10 and 13.33, p < 0.001 after 1, 3 and 6 months respectively. Similarly, mean quality of life score statistically significantly improved in group 1 compared to group 2 from baseline (7.74 and. 8.40 for group 1 and. group 2 respectively, p = 0.038), then after 1, 3 and 6 months (6.09 vs. 7.88, p < 0.001, 5.56 vs. 7.81, p < 0.001 and 4.74 vs. 7.39, p < 0.001 respectively). Mean urinary symptoms scores statistically significantly decreased in group 1 compared to group 2 at all follow up intervals from baseline (7.77 and. 7.34 for group 1 and group 2 respectively, p = 0.136), to 6.15 vs. 7.06, p < 0.001, 5.75 vs. 6.97, p < 0.001, 4.91 vs. 6.58 p < 0.001 after 1, 3 and 6 months respectively. Maximal effect of treatment with BONT-A was at 6 months. Mild dysuria and hematuria were the only two postoperative complications encountered after intervention in both groups.

Conclusion

Transurethral intraprostatic injection of BONT-A is a safe and effective treatment for refractory CNBP.
Efficacy of Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy in Combination with Fluoroscopy versus Fluoroscopy as a Single Imaging Modality
Authors: Gad Hany Hamed , El-Baz Ahmed Gamal El-Din , Badawy Mohammed Hussein , El-Saeed Mohamed Hassan , Rashed Kareem Ayman
Published: November 2024

Background

Renal stone is one of the most common renal diseases worldwide. There are several modalities for treatment of renal stone disease, one of these modalities is the use of percutaneous nephrolithatomy (PCNL) surgery which can be done either under fluoroscopic or ultrasound guidance which has significantly reduced x-ray exposure risk to medical personnel and patients.

Objective

To evaluate the efficacy of the ultrasound-guided PCNL in combination with fluoroscopy to minimize exposure time to radiation, risk of accidental injury to adjacent organs, blood loss and increased stone clearance rate versus usage of fluoroscopy as a single imaging modality in PCNL.

Patients and Methods

This prospective randomized comparative clinical trial study was conducted on 40 patients for the treatment of stone(s) located in the kidney more than 2 cm or refractory to shockwave therapy, patients were divided into 2 groups, 20 patients each; Group I: ultrasound-guided PCNL in combination with fluoroscopy and Group II: use of fluoroscopy as a single imaging modality, the study was carried on at Urology department, Faculty of medicine, Ain Shams University and Urology department, Theodor Bilharz Research Institute.

Results

As regard post operative complications in studied groups, in group I, there were 3 patients (15%) with post-operative fever versus 4 patients (20%) in group II. In group I, there was 1 patient (5%) with post-operative leakage versus 3 patients (15%) in group II. In group II, there was 1 patient (5%) with post-operative blood transfusion versus 0 patients (0%) in group I with no statistical difference. With respect to post-operative hospital stay and need for second operation between studied groups, there was a highly statistical significant (p-value < 0.001) increased post- operative hospital stay in group II (3.5 ± 1.05) when compared with group I (1.9 ± 0.9). While, as regard need for second operation and type of the operation, there were no statistical differences between the studied groups. But, there was high statistical significant difference (p-value < 0.001) decreased x-ray exposure time in group I (43.2 ± 11.3 sec) when compared to group II (314 ± 84.2 sec).

Conclusion

Combined ultrasonic and fluoroscopic guided PCNL had shorter x-ray exposure time. Combined ultrasonic and fluoroscopic guided PCNL had less Hb drop and intraoperative complications. However it still had longer surgery duration. Combined ultrasonic and fluoroscopic guided PCNL showed less postoperative pain and analgesic consumption. Combined ultrasonic and fluoroscopic guided PCNL had shorter hospital stay. Regarding the outcome and complications, in general, there is no statistical significant difference between these two groups.
Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones in Egyptian Population
Authors: Fathy Zaher Mohamed Tarek Mohamed , Mohamed Mohamed Saeed Salim , Khella Kirillos Raafat Nashed
Published: November 2024

Background

Urolithiasis is one of the most common disorders of the urinary tract with life-time prevalence of up to 15% with men affected three times more than women.

Aim of the Work

To assess the efficacy of Tamsulosin plus Tadalafil as medical expulsive therapy (MET) in comparison to tamsulosin monotherapy for the treatment of lower ureteric stones with renal colic.

Patients and Methods

This Randomized Clinical Trial was conducted in the Urology Department, Ain Shams University Hospitals and Kobry El-Kobba Military Hospital. This study was conducted on 80 patients within the whole experiment. Participants were divided into two groups through random computer-generated numbers; Group A was treated with tamsulosin plus tadalafil, and Group B was treated with tamsulosin only.

Results

The current study showed mean expulsion time in Group A ranged from 1 to 2 week with mean ± SD = 1.72 ± 0.45 while in Group B the mean expulsion time ranged from 2 to 3 week with mean ± SD = 2.28 ± 0.45 with highly statistically significant difference (p = <.001) between the two groups. We showed there was a statistical significant difference between the two groups regarding mean no. of colic episodes and emergency visits among the studied groups.

Conclusion

We assess the efficacy of Tamsulosin plus Tadalafil as medical expulsive therapy (MET) in comparison to Tamsulosin monotherapy for the treatment of lower ureteric stones with renal colic. The addition of tadalafil with tamsulosin increases ureteric stone expulsion quite significantly along with significant control of pain, significantly less analgesic requirement and fewer hospital visits.
Impact of Hyperuricemia on Left Ventircular Function in Hypertensive Patients Presented to Ain Shams University Hospitals
Authors: Zahraa Mostafa Fatma El , El Sayed Abd El Rahman , Galal Haitham
Published: November 2024

Background

The association between serum uric acid and cardiovascular diseases has long been recognized. Aim: The aim of study was to assess the left ventircular function in hypertensive patients with or without hyperuricemia.

Patients and Methods

This prospective, comparative, cross sectional study involved 300 patients coming to cardiology clinic for clinical assessment. The study was performed in the cardiology department, faculty of medicine, Ain Shams university hospital at the period from july 2022 to march 2023.

Results

The results of the study show a significant difference in the tie index among the three groups (Hypertension with Hyperuricemia, Hypertension without Hyperuricemia, and Control). The median tie index was highest in the Hypertension with Hyperuricemia group (0.46) followed by the Hypertension without Hyperuricemia group (0.42) and was lowest in the control group (0.37). The difference in tie index between the groups was statistically significant with a p-value of <.001.

Conclusion

This study reveals that hyperuricemia is widespread in our study population with systemic hypertension and both are positively correlated. Hyperuricemia was associated with LVH. Thus, the study recommends a repetitive evaluation of serum UA in all hypertensive patients. As it suggests that hyperuricemia is an early marker of increased left ventricular mass that can be used to identify a hypertensive population with cardiac TOD.
Impact of Angiotensin Receptor-Neprilysin Inhibitor Therapy on Cardiac Remodeling in Patients with Heart Failure and Reduced Ejection Fraction
Authors: Sadek Mahmoud Hazem , Aboul-Saud Mona Ibrahim , Missiri Ahmad El , El-Din Yasser Alaa
Published: November 2024

Background

Structural alterations in cardiac structures in response to hemodynamic and neurohormonal factors are the main drivers of heart failure progression. In the combination ARNI, molecular synergy may reverse or reduce left ventricular remodeling. Speckle-tracking echocardiography (STE) is an established echocardiographic modality with clinical applications in the diagnosis and prognosis of many cardiac diseases.

Aim of the Study

The study was done to evaluate the possible impact of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) therapy on cardiac remodeling using echocardiographic parameters including 2D and 3D global longitudinal strain (GLS) in heart failure patients with reduced ejection fraction

Patients and Methods

This prospective observational study included a total of eighty heart failure patients were divided into two arms. The first arm included forty symptomatic patients started on ARNI and the second arm was forty symptomatic patients on an optimal dose of ACE-I or ARBs, receiving standard treatment of heart failure and who were followed up for six months. All patients underwent echocardiography to assess baseline values including indexed LV volumes, 2D STE and 3D STE before initiating ARNI therapy and after a 6 month follow up period.

Results

Both groups had no significant differences at baseline regarding demographic data and baseline echocardiographic findings, After 6 months follow up period, significant reduction in LV indexed volumes in ARNI group compared to ACE-I/ ARB group (P < 0.001), improvement in LVEF ARNI group compared to ACE-I/ ARB (P = 0.011), 2D LV GLS ARNI compared to ACE-I/ ARB (P < 0.001) and no improvement in LV mass index. Significant reduction in LAVi ARNI compared to ACE-I/ ARB (P = 0.013), significant reduction in E/A ARNI compared to E/A ACE-I/ ARB (P = 0.043) and no improvement in lateral E/e’.

Conclusion

The use of ARNI for HF patients with reduced LV systolic function, followed up for a mean duration of 6 months, induced LV reverse remodeling in those patients as observed in a significant improvement in LV performance seen in both 2D-3D volumetric echocardiographic parameters, improved LVEF and longitudinal LV systolic function represented in 2D and 3D GLS.
Role of Preprocedural Multi Detector Computed Tomography Angiography in Prediction of Complexity & Outcome of Coronary Chronic Total Occlusion Percutaneous Coronary Intervention
Authors: Mostafa Manar , Darahim Khalid , Onsy Ahmed , Gamal Sahar , Farouk Mohamed
Published: November 2024

Background

Chronic Coronary Total Occlusion (CTO) is considered one of the most challenging obstructive coronary artery diseases that had been widely managed medically or referred for bypass surgeries due to their complex nature which remained an obstacle for the operators. Coronary CT- angiography was used to develop easy predictive tools for CTO percutaneous intervention.

Objectives

To evaluate the ability of the CCTA and CT-RECTOR score to predict time-efficient guidewire (GW) crossing through a chronic total occlusion.

Patients and Methods

The present study included 40 patients with CTO lesions. All were subjected to preoperative CTO assessment using CCTA and CCA before an attempt of PCI to a CTO in the period between January 2022 and May 2023. The study was held in Ain Shams University hospitals and National Heart Institute.

Results

We divided the patients into two groups according to GW crossing within 30 minutes. Group 1 included patients with successful GW crossing within 30 min, group 2 included patients with failed GW crossing within 30 min. We compared the two groups according to demographic data and we found that males are more common to have CTO lesions (87.5%) which were predominantly located in RCA (50% of total no. with 76.9% of them in failed group, p = 0.018). Our results showed that CTOs with occlusion length ≥ 20 mm or calcification increased in failed group, but was not statistically significant (84.6% in failed group (p = 0.161) and 46.3% in failed group (p = 0.432) respectively). In addition, there was a statistical significance between presence of blunt stump (76.9% in failed group vs 29.6% in successful group, p = 0.004), a previous failed CTO-PCI attempt (53.8% in failed group vs 14.8% in successful group p = 0.009), and using retrograde wiring techniques (p = 0.003) between the successful and failed groups. Indicating that these points were important predictors of procedural failure. We compared CTO characteristics between CCTA-derived CT-RECTOR score and CA-derived J-CTO score. with increased score points, the probability of PCI difficulty and GW crossing failure increased. CT-RECTOR score was found to have the better ability for prediction of GW crossing within 30 min and CTO-PCI difficulty (p = 0.028).

Conclusion

CT-RECTOR score was superior to J-CTO score in the assessment and prediction of GW crossing difficulty within 30 minutes and final procedural outcomes.