bluuebunny/crossref_metadata_2025 huggingface dataset:
P-503 Euploidy rate of day 4 fully developed blastocysts
Authors: Kato M , Tsuji H , Ooyama K , Takahashi M , Kudo C , Ikuta S , Fukunaga N , Asada Y
Published: July 2024

Study question

Do embryos that fully developed to blastocyst at day 4 have high aneuploidy rates as assessed by preimplantation genetic analysis?

Summary answer

Fully developed blastocysts at day 4 had a high euploidy rate.

What is known already

In ART, it is considered important to use good quality blastocysts to increase the pregnancy rate after embryo transfer. Some reports have demonstrated a high pregnancy rate for embryos that fully developed to blastocysts on day 4 after IVF (Ozgur et al., 2021). Furthermore, it has been reported that the speed of embryo development is related to the rate of chromosome aneuploidy (Taylor et al., 2014). There are though, limited reports on the euploidy rate of embryos developed to blastocysts at day 4.

Study design, size, duration

This retrospective study analyzed 763 embryos (from 184 PGT-A cases) that underwent TE biopsy on day 5 between January to December 2022 to determine their ploidy status.

Participants/materials, setting, methods

Embryos cultured in a time-lapse incubator were divided into two groups: those that developed to blastocyst (Gardner’s classification: ≥ expansion grade 3) at day 4 (96-100 h) (D4(+) group) and those that did not develop to full blastocyst at day 4 (D4(-) group) and the euploidy rates were compared. Statistical analysis was performed using Fisher’s exact test to determine significant differences (P < 0.05).

Main results and the role of chance

The euploidy rate of the D4(+) group was 36.5% (80/219), which was significantly higher than the D4(-) group, 23.3% (127/544) (p < 0.01). Moreover, when considering the age of the female, for age ≤39 years, the rates were significantly higher in the D4(+) group (52.1% (61/117) and 35.4% (97/274) p < 0.01 respectively ). For age 40≥ years, it tended to be higher but was not significantly different in the D4(+) group vs D4(-) group (18.6% 19/102 and 11.1% 30/270 respectively). Even when limited to embryos that were graded as good quality blastocysts at day 5, the D4(+) group was significantly higher (p < 0.01) than the D4(-) group (55.0% (60/109) vs 36.1% (90/249)).

Limitations, reasons for caution

This was a retrospective study limited to day 5 embryos with biopsies taken after vitrification-warming.

Wider implications of the findings

These results demonstrate that embryos that had already developed to blastocyst at day 4 had a higher rate of euploidy compared to day 5 blastocysts. Thus, when performing PGT-A, biopsy of embryos that have already developed to blastocyst at day 4 are expected to be prioritised for transfer.

Trial registration number

not applicable
P-514 Unequal pronucleus size is indicative of higher rates of diploidy in 3PN blastocysts
Authors: Stock-Myer S , Kelley R , Lee L  Y S , Agresta F , Gurner K , Williams C , Liew I , Demmers K , Lee E , Knight C , Cattrall F
Published: July 2024

Study question

What proportion of blastocysts developed from 3PN embryos are diploid, and is this associated with the relative size of the pronuclei?

Summary answer

Most 3PN blastocysts with even-sized pronuclei are triploid, while most 3PN blastocysts with uneven-sized pronuclei are diploid.

What is known already

Fertilised oocytes with three pronuclei (3PN, or tripronuclear) are generally considered unsuitable for use due to the high likelihood of triploidy, which is not compatible with an ongoing healthy pregnancy. Recent data on 3PNs with uneven-sized pronuclei (micro-3PN, or 2.1PN) indicates that many may actually be diploid if they form a good quality blastocyst.

Study design, size, duration

Prospective multi-centre study from October 2020 to December 2023. 81 3PN blastocysts from 69 patients were biopsied.

Participants/materials, setting, methods

ICSI-inseminated embryos were assessed on Day 1 and pronuclear size at 18 h post insemination was measured using EmbryoViewer software. Biopsy was performed at the blastocyst stage and genetic testing was performed using the Human Karyomap-12 SNP array to ascertain ploidy status. Pronuclei were classified as “Equal”, “Unequal” (smallest pronucleus is 61%-75% of the largest), or “Micro” (smallest pronucleus is < 60% of the largest).

Main results and the role of chance

94% of the 3PN blastocysts with equal size pronuclei were triploid, and the remaining 6% were complex aneuploid or had genome wide uniparental disomy (n = 36). Of the 3PN blastocysts with unequal pronuclei (n = 19), 42% were triploid, whereas none of the embryos with a micro pronucleus were triploid (n = 26).

Limitations, reasons for caution

Only 3PN embryos that formed a good quality expanded blastocyst were biopsied. Only ICSI-inseminated embryos were included, not IVF. No 3PN embryos were transferred in the study, so any additional pregnancy and birth risks from diploid 3PN embryos are unknown.

Wider implications of the findings

Blastocysts that develop from 3PN oocytes with uneven pronuclei have a greater than 80% chance of diploidy and could be considered for clinical use with PGT. More data is needed to inform clinical guidelines.

Trial registration number

N/A
P-531 Embryo grading in PGT-A testing: does it really matter?
Authors: Terribile M , Finelli R , Thavarajah E , Wilding M , Nargund G
Published: July 2024

Study question

Can embryo morphology grading be a good parameter to predict the embryo transfer’s outcome when euploid embryos are used?

Summary answer

Gardner’s grading is a useful predictor of LBR per euploid embryo transferred. Morphologic grading should be used for the embryo selection among euploid blastocysts.

What is known already

When preimplantation genetic testing for aneuploidies (PGT-A) is not performed, the selection of the embryo(s) to be transferred is based on embryo morphology. In PGT-A cycle, some studies have minimised the importance of embryo morphology, when euploid embryos are present. However, others still consider it as good predictor. Understanding the role of morphology in biopsied euploid embryos may help in optimizing frozen embryo transfer cycles.

Study design, size, duration

We retrospectively analysed PGT-A frozen embryo transfers with reported outcome, performed in our clinics between 2018 and 2022. The cycles included were divided into two groups based on Gardner’s grading of euploid embryos transferred: “good” embryos (AA, AB, BA and BB; n = 263) versus “poor” embryos (including AC, CA, BC, CB, and CC; n =112).

Participants/materials, setting, methods

We included in the study only single euploid embryo transfers, double embryos transfers and mosaic embryo transfers excluded. Body mass index (BMI), oocyte age and outcomes (pregnancy and live birth rates) were compared between the two groups. Data was statistically analysed using MedCalc Software, where P < 0.05 was considered as significant.

Main results and the role of chance

A total of 375 embryo transfer cycles were included in the study. Maternal ages were not significantly different between groups (good vs poor embryos) (37.5 vs 38.2). Similarly, oocyte age (37.7 vs 38.1, respectively), and BMI (22 vs 22.7, respectively) did not differ between good and poor embryos. On the contrary, clinical pregnancy (56.6% vs 40.1%) and live birth rates (27.7% vs 13.4%) were significantly higher when morphologically good grade embryos were transferred (p < 0.05). In fact, both rates were significantly higher after the transfer of blastocysts that exhibited A-grade or B-grade in inner cell mass and/or trophectoderm, as opposed to the transfers of blastocysts that exhibited a C-grade trophectoderm and/or inner cell mass.

Limitations, reasons for caution

The findings apply to the participating centres and may not represent worldwide trends. Data was analysed retrospectively, but details of the follow-up on PGT pregnancies and babies born were limited. The degree of blastocyst expansion and the day of biopsy were not taken into consideration in this study.

Wider implications of the findings

The Gardner embryo quality assessment improves the clinics’ ability to prioritize embryos after PGT. Preferential transfer based on morphologic criteria increases the chances of a positive outcome in terms of live birth rates.

Trial registration number

not applicable
P-559 Pregnancy rates in conventional and non-invasive pre-implantation genetic testing – a multicentric retrospective cohort study
Authors: Gamane N , Modi D , Murdia N , Murdia K , Chandra V , Shah N , Bhoi N
Published: July 2024

Study question

To determine the pregnancy rates with embryo diagnosed as euploid by non-invasive preimplantation genetic testing (niPGT-A) and trophectoderm based pre-implantation genetic testing (cPGT-A)

Summary answer

Biochemical pregnancy rates are comparable in couples undergoing transfer with embryos diagnosed as euploid as judged by niPGT-A or cPGT-A

What is known already

NiPGT-A utilizes cell-free DNA in culture media to assess the chromosomal status of embryos. Several studies have shown that the niPGT-A and cPGT-A have a reasonable concordance rate and niPGT-A can be considered as an alternative in predicting the ploidy status of the embryos. However, limited information exist on the clinical outcomes of embryos deemed euploid by niPGT-A.

Study design, size, duration

Data of 1209 participants between June 2022 and Dec 2022 was collected from 46 centers of Indira IVF Hospital. These were couples who had experienced recurrent implantation failures (>3 failed ET), recurrent miscarriages (>2 miscarriages) or had advanced maternal age (>35 years) and opting either for niPGT-A or cPGT-A at our centres for euploid embryo transfers. Women with anatomical uterine defects and Asherman syndrome were excluded.

Participants/materials, setting, methods

Trophectoderm biopsy was done in 1383 Day 5 grade A embryos and PGT-A was done using NGS. Culture media of 3083 Grade A embryos were collected on D5 or D6 and frozen. NGS was done at an external facility. Embryos deemed euploid in either of the groups were transferred. Biochemical pregnancy was determined by measurements of beta hCG.

Main results and the role of chance

There were 906 patients in the niPGT-A group and 303 in the cPGT-A group. The clinical characteristics of the participants were comparable in both groups. Biochemical pregnancy rates were 60% and 69%, respectively. This difference was not statistically significant (p < 0.6). The euploidy rates were comparable in the niPGT-A and cPGT-A groups (40% and 46%) respectively. The aneuploidy rates were lower in the niPGT-A group as compared to the cPGT-A group (15% vs 26%). The mosaicism rates were higher in the niPGT-A group as compared to the cPGT-A group.

Limitations, reasons for caution

This is a preliminary data analysis of only the biochemical pregnancy rates. Clinical pregnancy, miscarriage, and live birth outcomes are subject to further investigation.

Wider implications of the findings

The study will aid IVF specialist to consider niPGT-A as a possible alternative to cPGT-A in clinical practice.

Trial registration number

’not applicable’
Suction Feeding Turned on Its Head: A Functional Novelty Facilitates Lower Jaw Protrusion
Authors: Martinez Christopher M , Mazon Rizelle Mae M , Stiassny Melanie L J
Published: July 2024

Synopsis

Functional novelties play important roles in creating new ways for organisms to access resources. In fishes, jaw protrusion has been attributed to the massive diversity of suction-based feeding systems, facilitating the dominant mode of prey capture in this group. Nearly all fishes that feed by suction use upper jaw protrusion, achieved by rotation of the mandible at its base, which then transmits forward motion to independently mobile upper jaw bones. In this study, by contrast, we explore an unusual form of lower jaw protrusion in the freshwater invertivore, Nannocharax fasciatus, enabled by a novel intramandibular joint (IMJ). We combine morphological, kinematic, and biomechanical data to show that the added mobility created by the IMJ influences the pattern of suction-based prey capture movements and contributes to lower jaw protrusion (increasing it by 25%, based on biomechanical modeling). Interestingly, the upper jaw bones are fused in N. fasciatus and rotate about a single fixed joint, like the lower jaws of most other suction feeding fishes. We suggest that this vertical inversion of the jaw protrusion mechanism for ventrally directed suction-feeding on benthic prey is a likely exaptation, as the IMJ is used for biting in related taxa. This work highlights the ability of novelties to facilitate ecological specialization by enabling new functional capabilities.
Otoliths as chemical archives through ontogeny reveal distinct migratory strategies of Atlantic halibut within the Gulf of St. Lawrence
Authors: Gauthier Charlotte , Fisher Jonathan A D , Robert Dominique , Sirois Pascal
Published: July 2024

In marine fishes of commercial interest, defining habitat use and migration strategies through ontogeny can help better understand the structure and dynamics of harvested populations and guide their management. The present study relied on otolith chemistry to identify three contingents within the Atlantic halibut (Hippoglossus hippoglossus) stock in the Gulf of St. Lawrence (GSL). We differentiated two chemical signatures from otolith edges, one for shallow (<100 m) and another one for deep (>100 m) waters. By identifying transitions between the deep and shallow habitats, we found that most halibut display migrations from the deep waters to shallow waters during the first 3 years of life. After reaching maturity, most halibut distributing in northern regions of the GSL became full-time residents in deep areas of the GSL. In contrast, halibut found in summer on the shallow plateau of the southern GSL displayed migrating behaviour between shallow (summer) and deep (winter) waters throughout their lives, either on an annual or irregular basis. Overall, our results demonstrate that otolith chemical signatures serve as natural markers of geographically distinct marine environments, facilitating the identification and reconstruction of environmental histories of long-lived marine fishes.
Border Barriers and Illicit Trade Flows
Authors: Carter David B , Donahue Bailee , Williams Rob
Published: July 2024

Abstracts

The number of fortified borders around the world has risen precipitously. This surge in walls is an important part of the larger globalization “backlash,” as countries react to the unwanted consequences of economic openness and globalization, with a rise in illicit trade and smuggling being a prominent example. Despite the prominence of the idea that walls are built to combat illicit flows, no research systematically explores how walls generally affect illicit trade. This is a notable omission for at least two reasons. First, the most prominent explanations for wall construction put combating illicit trade front and center. Second, recent work that finds walls significantly reduce legal trade argues that this finding derives from border fortifications diverting illegal trade to ports of entry, which leads to more inspection, security, and transaction costs. We develop a new measure of illicit trade flows using over five decades of product-level data and provide a battery of evidence that shows border barriers increase illicit flows at ports of entry.
Cross-transmission of Acinetobacter junii carrying blaOXA-58 in a neonatal ICU
Authors: Boudjella-Senhadji I , Bour M , Potron A , Lorme F , Belal-Khedim L , Razafimahefa H , Lecointe D
Published: July 2024

Background

Nasal colonization of two preterm infants in our neonatal ICU by Acinetobacter junii carrying the blaOXA-58 carbapenem resistance gene was demonstrated.

Objectives

To study whether the two isolates were identical and to investigate the hypotheses of cross-transmission.

Methods

Antibiotic susceptibility tests of the two isolates were performed by standard diffusion and the MICs of carbapenems determined by the MIC-gradient strip method. The blaOXA-58 gene was detected by PCR. Isolates were compared using SNP analysis performed after WGS. The timelines of the two cases were determined based on the investigations and the study of the patients’ records.

Results

The two isolates corresponded to the same strain, with case 1 being the index case, demonstrating cross-transmission to case 2.

Conclusions

Acquisition of the strain was likely due to the recent carbapenem treatment of case 1 and cross-transmission due to the high amount of care administered to the two preterm infants. This is the first description of cross-transmission of A. junii carrying the blaOXA-58 gene.
Clinical manifestations and treatment outcomes for patients with Pseudomonas endocarditis
Authors: Shah Sunish , Clarke Lloyd , Davis Matthew W , Topal Jeffrey E , Shields Ryan K
Published: July 2024

Objectives

To investigate clinical outcomes of patients with Pseudomonas endocarditis and identify factors associated with treatment failure.

Methods

Adult patients meeting definitive Duke’s criteria for Pseudomonas endocarditis at 11 hospitals were identified between May 2000 and February 2024. Failure was defined as death or microbiological failure by day 42. First-line therapy consisted of cefepime, piperacillin/tazobactam, ceftazidime or ceftolozane/tazobactam alone or in combination.

Results

Forty-eight patients met inclusion criteria; 29% were persons who inject drugs and 13% were organ transplant recipients. Pseudomonas aeruginosa was the causative species in 98% of cases. Patients who experienced 42 day cure were more likely to be initially managed with first-line β-lactam agents compared with those who experienced clinical failure (97% versus 62%, P = 0.004). Treatment with first-line β-lactams was associated with shorter time to treatment initiation and a lower likelihood of infection due to MDR Pseudomonas spp. In the univariate model, patients who experienced 90 day mortality were more likely to have prosthetic valve endocarditis (57% versus 24%, P = 0.02), an intracardiac complication (36% versus 9%, P = 0.04) and a higher median (IQR) Pitt bacteraemia score [2.5 (2–3.8) versus 1 (0–2), P = 0.048]. Combination therapy did not improve clinical outcomes but did increase the rate of adverse effects resulting in drug discontinuation compared with monotherapy, (21% versus 0%, P = 0.08).

Conclusions

This is the largest study of Pseudomonas endocarditis to date. We identified improved clinical outcomes when cefepime, piperacillin/tazobactam, ceftazidime or ceftolozane/tazobactam were used for initial treatment. We did not identify a clinical benefit for combination treatment.
Heritability estimates and genome-wide association study of methane emission traits in Nellore cattle
Authors: Souza Luana Lelis , Dominguez-Castaño Pablo , Gianvecchio Sarah Bernardes , Sakamoto Leandro Sannomiya , Rodrigues Gustavo Roberto Dias , Soares Tainara Luana da Silva , Bonilha Sarah Figueiredo Martins , Marcatto Juliana de Oliveira Santos , Galvão Albuquerque Lucia , Vasconcelos Silva Josineudson Augusto II , Zerlotti Mercadante Maria Eugênia
Published: July 2024

The objectives of the present study were to estimate the heritability for daily methane emission (CH4) and residual daily methane emission (CH4res) in Nellore cattle, as well as to perform genome-wide association studies (GWAS) to identify genomic regions and candidate genes influencing the genetic variation of CH4 and CH4res. Methane emission phenotypes of 743 Nellore animals belonging to 3 breeding programs were evaluated. CH4 was measured using the sulfur hexafluoride (SF6) tracer technique (which involves an SF6 permeation tube introduced into the rumen, and an appropriate apparatus on each animal), and CH4res was obtained as the difference between observed CH4 and CH4 adjusted for dry matter intake. A total of 6,252 genotyped individuals were used for genomic analyses. Data were analyzed with a univariate animal model by the single-step GBLUP method using the average information restricted maximum likelihood (AIREML) algorithm. The effects of single nucleotide polymorphisms (SNPs) were obtained using a single-step GWAS approach. Candidate genes were identified based on genomic windows associated with quantitative trait loci (QTLs) related to the 2 traits. Annotation of QTLs and identification of candidate genes were based on the initial and final coordinates of each genomic window considering the bovine genome ARS-UCD1.2 assembly. Heritability estimates were of moderate to high magnitude, being 0.42 ± 0.09 for CH4 and 0.21 ± 0.09 for CH4res, indicating that these traits will respond rapidly to genetic selection. GWAS revealed 11 and 15 SNPs that were significantly associated (P < 10−6) with genetic variation of CH4 and CH4res, respectively. QTLs associated with feed efficiency, residual feed intake, body weight, and height overlapped with significant markers for the traits evaluated. Ten candidate genes were present in the regions of significant SNPs; 3 were associated with CH4 and 7 with CH4res. The identified genes are related to different functions such as modulation of the rumen microbiota, fatty acid production, and lipid metabolism. CH4 and CH4res presented sufficient genetic variation and may respond rapidly to selection. Therefore, these traits can be included in animal breeding programs aimed at reducing enteric methane emissions across generations.
Influence of habitat on fine-scale space use by brown lemmings (Lemmus trimucronatus) in the High Arctic
Authors: Valcourt Marianne , Fauteux Dominique , Gauthier Gilles
Published: July 2024

Space use by small mammals should mirror their immediate needs for food and predator shelters but can also be influenced by seasonal changes in biotic and abiotic factors. Lemmings are keystone species of the tundra food web, but information on their spatial distribution in relation to habitat heterogeneity is still scant, especially at a fine scale. In this study, we used spatially explicit capture–recapture methods to determine how topography, hydrology, vegetation, and soil characteristics influence the fine-scale spatial variations in summer density of brown lemmings (Lemmus trimucronatus). Lemmings were monitored throughout the summer in wet and mesic tundra habitats and in a predator exclusion grid, which was also located in mesic tundra. We found that in wet tundra, lemming densities were higher at sites with a rugged topography dominated by hummocks, but only during snow melt. In both mesic tundra sites, lemming densities were higher in sites with poor drainage and low aspect throughout the summer. We found no clear association between lemming densities and any tested vegetation or soil variables. Overall, hydrology and topography appear to play a dominant role in small-scale space use of brown lemmings with a secondary role for predator avoidance and food plant abundance.
Reliability and validity of the Japanese version of the Survey of Perceived Organizational Support
Authors: Odagami Kiminori , Nagata Tomohisa , Eguchi Hisashi , Inoue Akiomi , Mafune Kosuke , Mori Koji
Published: July 2024

Objectives

This study aimed to examine the reliability and validity of the Japanese version of the Survey of Perceived Organizational Support (SPOS-J) for the Japanese workforce.

Methods

The translation of the SPOS into Japanese followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force guidelines. An online baseline survey with 6220 Japanese workers assessed the SPOS-J and related scales, followed by a follow-up survey with 452 respondents 2 weeks later. We developed the SPOS-J and evaluated its factorial, convergent, and known-group validities, as well as its internal consistency, test–retest reliability, and interpretability.

Results

Exploratory and confirmatory factor analysis (EFA and CFA) indicated that the SPOS-J, diverging from the original version’s 1-factor structure, adopted a 2-factor structure comprising 2 subscales: the SPOS-J (Sufficiency of Positive Aspects [SPA]) and the SPOS-J (Minimality of Negative Aspects [MNA]). The final version of the SPOS-J, consisting of 8 items selected by the item response theory analysis, demonstrated acceptable model fit in the CFA. Cronbach a values for SPOS-J (SPA) and SPOS-J (MNA) were .92 and .84; intraclass coefficients were 0.72 and 0.55, respectively. The correlations between SPOS-J (SPA) and related variables, as well as the score distributions by demographic characteristics, supported the convergent and known-group validity of SPOS-J (SPA). In contrast, SPOS-J (MNA) showed lower correlation coefficients with all related variables and supported known-group validity.

Conclusions

The SPOS-J (SPA), a subscale of the 8-item SPOS-J, is a reliable and valid measure for assessing perceived organizational support among Japanese workers.
Physical activity and exercise motivation of multiple myeloma patients: a prospective cross-sectional study
Authors: Räder Jan , Ihorst Gabriele , Möller Mandy-Deborah , Pahl Antonia , Greil Christine , Dreyling Esther , Arends Jann , Deibert Peter , Wäsch Ralph , Engelhardt Monika
Published: July 2024

Background

Multiple myeloma (MM) is the second most common hematological malignancy with its prevalence increasing. Patients with symptomatic MM can show numerous comorbidities, affecting their quality of life (QoL). Physical activity (PA) may improve QoL but is not a standardized intervention of comprehensive cancer centers (CCCs). Since data on the PA of patients with MM are scarce, we aimed to prospectively assess fitness levels and patients’ motivation to join PA-interventions at our CCC.

Methods

We generated an exercise questionnaire to interview consecutive patients MM. We prospectively collected data on (a) past and current PA, defined by the World Health Organization (WHO) recommendations, (b) knowledge on exercise effects, (c) exercise motivation, and (d) willingness to participate in PA-interventions. Demographics, comorbidities, response, progression-free survival (PFS), and overall survival (OS) were assessed in 211 symptomatic patients MM.

Results

While our patients were elderly and most showed bone involvement, their PA was similar to healthy individuals. Aerobic PA (≥ 60 minutes/week) was performed by 65%, and 25% exercised ≥ 150 minutes/week. WHO PA recommendations were fulfilled by 17% of patients. No sport activities or complete physical inactivity were observed in 35% and 16%, respectively. Notably, 38% were motivated to join MM-specific sport interventions. Self-reported knowledge of PA-induced benefits for patients cancer was high (82%), but only 27% knew which exercises were safe to perform.

Conclusion

This study provides an overview of the PA of patients MM. Our results suggest that the PA of patients MM might not be much lower than in the age-matched general population.
Effect of Dexamethasone as a Local Anesthetic Adjuvant on Duration of Post Operative Analgesia for Ultrasound Guided Transabdominal Plane Block in Appendectomy – A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Mohamed Hassan Alaa Eid , Said Boctor Alfred Maurice , Moris Misak Kerolos Emad , El Mohaimen Bakr Sarah Ahmed Hanee Abd
Published: July 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 is to evaluate the effect of adding dexamethasone as a perineural adjuvant on the post operative duration of action of Transversus Abdominus Plane (TAP) block in patients undergoing appendectomy.

Patients and Methods

The study was conducted on 30 randomly chosen patients aged 17 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for appendectomy under general anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 15 patients each:

Results

Dexamethasone as an adjuvant to LA has been shown to prolong the duration of pain-free period, less requirement for rescue opioids consumption, more patient satisfaction. A similar finding was observed in our study.

Conclusion

The addition of dexamethasone to bupivacaine in TAP block in appendectomy provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of VAS score compared to bupivacaine alone group.
D-Dimer as a Predictor of Disease Outcome in Intensive Care SARS-COV-2 Patients: A Retrospective Study
Authors: Gadalla Raouf Ramzy , Hilal Abdou Amr Mohammed , Mohamed Abdellatif Nourhan Osama
Published: July 2024

Background

The novel coronavirus, designated SARS-COV-2, has caused a pandemic of respiratory illness termed coronavirus disease 2019 (COVID-19). One of the key issues has been the very high number of patients presenting to hospitals that clearly overwhelms the capacities available, especially the need for critical care support. Therefore, early and effective predictors of clinical outcomes has been urgently needed for risk stratification of COVID-19 patients.

Objective

To evaluate the value of D-dimer blood levels on intensive care unit (ICU) admission as a predictor of disease severity and mortality in COVID-19 ICU admitted patients.

Patients and Methods

The current study included the records of 465 patients who were admitted to Ain Shams University isolation hospitals ICU during the time period between 1/1/2021 and 1/6/2021.

Results

There are many studies that have tried to correlate between D dimer levels and COVID-19 outcome. by comparing these studies we find that the value of D-dimer levels as a predictor of disease outcome is quite obvious. Trying to find opposing literature to the previous findings is a difficult process as the great majority of the literature that tried to link D-dimer levels to COVID -19 outcomes have eventually come to the same conclusion which is proving that there is a significant relationship between D-dimer levels and disease outcome and that morbidity and mortality risk increases with elevated D-dimer levels.

Conclusion

In COVID-19 patients, D-dimer levels on admission to ICU and 48 hours afterwards can be a reliable indicator of the disease prognosis as high D-dimer levels are associated with increased need for mechanical ventilation and mortality with cutoff values 1.39 for initial D-dimer and 1.02 for D-dimer level after 48 hours.
Comparative Study between Fentanyl and Dexmedetomidine as Adjuvants to Bupivacaine 0.5% in Ultrasound-Guided TAP Block for Postoperative Pain Management after Elective Cesarean Section
Authors: Al-Sayed Mohammed Aya Anwar , Hussein Noha Sayed , Tharwat Ayman Ibraheem , El-Shafeey Ahmed El-Sayed
Published: July 2024

Background

Analgesia is very important after cesarean section because it improves ambulation and enables the mother to give optimal care for the neonate in the immediate postoperative period. Opioids are widely used, but their side effects limit their application. Transversus abdominis plane (TAP) block has been proved to be a useful and safe alternative technique to provide analgesia following abdominal surgeries.

Objective

to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to bupivacaine in TAP block under ultrasound-guidance after cesarean section in a randomized controlled trial.

Patients and Methods

In our study, 40 patients were randomly divided into 2 equal groups. The control group received 50 mcg of fentanyl added to bupivacaine on each side. The study group received 50 mcg of dexmedetomidine added to bupivacaine on each side. All patients received equal volumes. Our study showed that addition of a 50 mcg of dexmedetomidine to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the hemodynamic stability of the patients. In addition, dexmedetomidine prolonged the duration of analgesia significantly, as proved by the time of request of first rescue analgesia. Moreover, in dexmedetomidine group, postoperative analgesic requirements were greatly lesser than that of fentanyl group. This makes dexmedetomidine with bupivacaine more superior than the use of fentanyl with bupivacaine.

Results

In our study, the total rescue analgesia consumed in 24 h postoperatively which was pethidine was less in the TAP-D group (75 ± 25.6 mg) than in the TAP-F group (112.5 ± 42.5 mg). In this study, regarding the measurement the time to the first dose of analgesic received postoperatively, there was a long duration needed in TAP-D group compared to the TAP-F (control group) with the p- value < 0.0001. The time to the first rescue analgesia in the TAP-D group was (659.7 ± 20.99 min.) and for the TAP-F group, it was (512.75 ± 18.1 min.).

Conclusion

Dexmedetomidine delayed the time to first rescue analgesia when added to bupivacaine in TAP block using ultrasound-guided technique and improved patients’ outcome with decrease in the total pethidine consumption and more hemodynamic stability in comparison to the addition of fentanyl to bupivacaine.
Comparison between Standard Dose Methyl-Prednisolone and Mega Dose Methyl-prednisolone As Regards Outcome in SARS.COV.2 Patients in Intensive Care Unit: A Retrospective Study
Authors: El Shaer Ahmed Nagah , Hilal Abdou Amr Mohammed , Haiba Ali Diaaeldein Mahmoud , Shafik Tawfik Marina Refaat
Published: July 2024

Background

Deadly pandemics and disease emergences are not new phenomena: they have been challenging human existence throughout recorded history. Some have killed sizeable percentages of humanity, but humans have always searched for, and often found, ways of mitigating their deadly effects.

Objective

to compare between standard dose methyl prednisolone (1-2 mg/kg) and mega dose methyl prednisolone (0.5 g to 1g) as regards outcome reflected by mortality rate, percentage of mechanically ventilated patients and ICU length of stay of COVID 19 patients admitted in ICU.

Patients and Methods

After obtaining approval from the Research Ethical Committee of Ain Shams University (FMASU MS 41/2022) this study was obtained from Ain Shams University Isolation Hospitals records. Group A: Patients admitted in ICU, COVID PCR positive and requiring oxygen therapy who received methyl prednisolone standard dose (1-2 mg/kg). Group B: Patients admitted in ICU, COVID PCR positive and requiring oxygen therapy who received methyl prednisolone mega dose (0.5-1 g per day).

Results

This study showed that there is no significant statistical difference between receiving standard dose and mega dose methyl prednisolone as regards mortality rate or need for mechanical ventilation.

Conclusion

This study showed that there is no significant statistical difference between receiving standard dose and mega dose methyl prednisolone as regards mortality rate or need for mechanical ventilation. But showed significant statistical difference as regards ICU length of stay denoting that patients received mega dose methyl prednisolone showed increased ICU stay.
Fascia Iliaca Block versus Femoral Nerve Block as Post Operative Analgesia in Total Hip Arthroplasty
Authors: Reyad Mostafa Kamel , Ahmad Mohamed Saleh , Koraitam Ahmed Farouk , Hanafy Abdelrahman Mohamed
Published: July 2024

Background

Total hip arthroplasty (THA) 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 THA. 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.

Objective

To assess the efficacy and safety of FICB compared with FNB.

Patients and Methods

After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients were included in the study, and were divided into two groups (n = 20; each); group FICB and FNB group. Group FICB: Patients (n = 20) of this group received ultrasound guided Fascia iliaca compartment block (FICB) before spinal anesthesia using 20-40 ml of 0.25% bupivacaine. Group FNB: Patients (n = 20) of this group received ultrasound guided femoral nerve block (FNB) before spinal anesthesia using 20-40 ml of 0.25% bupivacaine.

Results

The two groups were adequately monitored and assessed 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. Demographic data, post-operative hemodynamics, and sedation score were also assessed.

Conclusion

Fascia iliaca compartment block is effective for pain relief during the early post- operative period after total hip arthroplasty. Meanwhile, it can reduce the cumulative meperidine consumption and the risk of opioid-related adverse effects.
The Impact of Administration of Chlorpheniramine/Paracetamol versus Paracetamol Only on the Postoperative Agitation after Orofacial Cleft Repair Procedures in Pediatrics
Authors: Ghany Bassiouney Mohsen Abdel , Talat Taha Sahar Mohamed , Abdel Rahman Tamer Nabil Ibrahim , El Sayed Hafez Rana Magdy
Published: July 2024

Background

term “emergence delirium” first appeared in medical literature in early 1960s. While it is frequently used interchangeably with emergence agitation, it is described as temporary dissociated state of consciousness following anaesthesia discontinuation.

Aim and Objectives

aim was to study the role of pre-emptive Chlorpheniramine as an adjuvant to paracetamol in the prevention of emergence agitation in orofacial cleft repair surgeries. Studied cases& techniques: study was prospective, Randomized, Double-Blind Clinical research done at Ain-shams University Hospitals, Cairo, Egypt for 6 months after Medical Ethical Committee approval for children within 3 month up to 18 years with cleft lip or/with cleft palate.

Results

On comparison of facial express score between group A & group B, group A showed significant decrease in facial express score compared to group B as the median (IQR) facial express score in group A was 2.0 (2.0- 4.0) and 4.0 (2.0-8.0) in group B.

Conclusion

We deduced that preoperative chlorpheniramine 0.2 mg/kg and paracetamol 15mg/kg before skin incision is effective medication that can be used to stop or decrease severity of emergence agitation while causing minimal cardio- respiratory depression. It also enhanced quality of healing in post-anesthesia care unit.
Dexmedetomidine versus Dexamethasone as Adjuvant to Bupivacaine in Fascia Iliaca Block in Knee Arthroscopy for Postoperative Pain
Authors: Ahmed Abou El-magd Tark Ahmed Mahmoud , El Aziz Fahmy Nabila Mohamed Abd , El Hamed Mohamed Tawfek Hadeel Magdy Abd , Mohammed Haggag Adham Magdy Ahmed
Published: July 2024

Background

Knee arthroscopy is one of the most frequently performed interventions in orthopedic surgery that is commonly performed on a day-case basis. It allows the diagnosis and management of a wide range of knee problems without making a large incision, thus decreasing soft tissue trauma. However, postoperative pain is a common upsetting symptom following arthroscopic knee surgery that if inadequately treated, leads to prolonged duration of the functional rehabilitation of the knee, recovery time and the length of hospital stay thus a significant increase in the medical care costs.

Aim of the Work

To compare the adjuvant effect of adding dexmedetomidine and/or dexamethasone to bupivacaine while using facsia iliaca block for knee arthroscopy and their efficacy in achieving postoperative analgesia.

Patients and Methods

The type of study was a prospective double – blinded randomized controlled Trial conducted in Ain Shams University hospitals, Cairo, Egypt at 6 months. Patients aged 20 to 60 years scheduled for elective knee arthroscopy under spinal anesthesia were included to receive FICB.

Results

In general, there was no significant difference between the three study groups regarding general patient characteristics as well as operative time. That ensured proper randomization conducted between our study groups. Additionally, that should nullify any bias that may have skewed the results in favor of one group rather than another one. There was statistically significant difference between groups according to heart rate from after 2hrs to after 24hrs this was also observed while measuring the systolic blood pressure and diastolic blood pressure but there was no significant difference between group B and C.

Conclusion

Our study shows that adding Dexmedetomidine and/or Dexamethasone (8mg) to Bupivacaine for FICB significantly prolonged the duration of block and decreased the requirement of rescue analgesics as compared to patients who received Bupivacaine alone. FICB is relatively easy and safe to perform. In our study we did not encounter any complication while doing the procedures and also by adding dexmedetomidine and/or dexamethasone (8mg).
Emergence Agitation after Nasal Surgery: A Randomized Controlled Comparison between Melatonin and Mirtazapine
Authors: Abdoh Algohary Mohammed Osama , ElKady Galal A , Esmat Ibrahim M , Hasseb Ahmad M , Ashoor Tarek M
Published: July 2024

Background: Aim of the Work

To evaluate the efficacy of melatonin versus mirtazapine administration in preventing emerging agitations in adults following nose surgery.

Patients and Methods

This prospective randomized clinical trial study was conducted at Ain Shams University Hospitals, Cairo, Egypt. One hundred and sixty five (165) consecutive patients scheduled for elective nasal surgery under general anesthesia where nasal packing was packed in both sides. The patients' age was above 21 years old from both genders and with the American Society of Anesthesiologists physical status classification (ASA) I or II.

Results

The mirtazapine category had the greatest patients` satisfactions scores 24 hours after surgery, followed by the melatonin category, while the control group had the lowest score. There were statistically significant differences between the control group and other categories, but not between the mirtazapine and melatonin groupings.

Conclusion

Prophylactic administration of melatonin or mirtazapine attenuated emergence agitation with minimal hazards in patients scheduled for nasal surgery under general anesthesia with priority to mirtazapine.
Use of Dexmedetomidine versus Nitroglycerine to Provide Hypotensive Anesthesia in ENT Surgeries (Functional Endoscopic Sinus Surgery)
Authors: Yahia Nashwa Hasan , Ewais Hasan Bahaa El Deen , Magdi Rania , Ahmed Mohamed Saleh
Published: July 2024

Background

controlled (deliberate/induced) hypotension is a technique by which the arterial blood pressure is lowered in a controllable manner to reduce surgical blood loss and improve the operative field visibility. There are pharmacological and nonpharmacological techniques for inducing hypotension. The nonpharmacological methods for deliberate hypotension include positioning and positive pressure ventilation to control venous return.

Aim of the Work

to evaluate the efficacy of dexmedetomidine (DEX) as a hypotensive agent in comparison to nitroglycerin (NTG) in FESS regarding the bloodless field, reduction of mean arterial blood pressure, decrease inhalational anesthetic requirements (MAC), decrease perioperative opioid requirements, increase the time to first postoperative analgesic request and recovery profile and increase hemodynamics stability.

Patients and Methods

we conducted this study on 20 patients who were planned to perform functional endoscopic sinus surgery and were randomly distributed into 2 equal groups: 10 patients received dexamedotomidine and equal number of patients received nitroglycerine. Serial measurements of mean arterial blood pressure and heart rate were obtained and records between both groups were compared.

Results

There were statistically significant differences between both groups regarding heart rate as mean values of heart rate were lower among dexamedotomidine group. There were no statistically significant differences between both groups regarding mean arterial blood pressure values at different time points during the operation. Regarding the period after stopping infusion, mean values of heart rate and blood pressure were lower among dexamedotomidine group than nitroglycerine group after 5 minutes and after 10 minutes and the differences had statistically significant differences. Regarding postoperative period, both groups were comparable regarding heart rate and blood pressure immediately postoperative.

Conclusion

From the results of this study, we could conclude that both Dexmedetomidine and Nitroglycerin can be effectively used in induced hypotensive anesthesia for ENT surgery as FESS. Both groups were comparable with intra operative MAP with no statistically significant differences. This study also show that Dexmedetomidine has added advantages as better haemodynamic stability than Nitroglycerin (No rebound HTN, no tachycardia). Has sedative and analgesic effect, reduce requirement of anesthetic agents and perioperative analgesia. Postoperative recovery score (Time to reach modified Aldert score more than nine significantly higher. Postoperative complication as nausea and vomiting is less.
Propofol/Dexmedetomidine versus Desflaurane Effects on Post Hepatectomy Hepatocellular Injury
Authors: Lashin Ola A , Ghoneim Mohamed M , Elzahaby Hany M , Rashid Mohamed M , Taha Sahar M
Published: July 2024

Objective

The Pringle maneuver used during hepatectomy causes ischemic reperfusion injury to the liver remnant. In this study, we compared the effect of maintenance of general anesthesia with propofol dexmedetomidine intravenous infusion versus desflurane inhalational anesthesia on post hepatectomy hepatocellular injury in patients undergoing partial hepatectomy during the first six postoperative days.

Method

Group A (15 patients) received total intravenous anesthesia with a combination of propofol and dexmedetomidine for anesthesia maintenance. and Group B (15 patients) received desflurane for anesthesia maintenance. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum albumin, serum bilirubin, prothrombin time and international normalized ratio (INR) were measured before surgery and at 1, 3, and 6 days after surgery.

Results

Transaminase levels, which were comparable in both groups, peaked between the first and the third postoperative days. Peak alanine aminotransferase was 224.27±29.7 and 318.20±52.5 U/L in the group A and group B, respectively (P < 0.001). Peak aspartate aminotransferase was 265.60±22.3 U/L in group A and 349.27±56.1 U/L in group B (P < 0.001). Albumin levels at day one showed no significant differences between both groups but at days 3 and 6, group A showed significantly higher albumin levels than group B. Other liver function tests including serum albumin, total and direct bilirubin, PT and INR showed lower values in propofol/dexmedetomidine group.

Conclusion

The main finding of this study is that propofol/dexmedetomidine as a technique for maintenance of anesthesia resulted in less hepatocellular injury and better hepatic functions than desflurane in patients undergoing partial hepatectomy during the first 6 postoperative days.