bluuebunny/crossref_metadata_2025 huggingface dataset:
Cosmic metal density evolution in neutral gas: insights from observations and cosmological simulations
Authors: Yates Robert M , Péroux Céline , Nelson Dylan
Published: October 2021

We contrast the latest observations of the cosmic metal density in neutral gas ($\rho _{ {met,neu}}$) with three cosmological galaxy evolution simulations: L-Galaxies 2020, TNG100, and EAGLE. We find that the fraction of total metals that are in neutral gas is <40 per cent at 3 ≲ $z$ ≲ 5 in these simulations, whereas observations of damped Lyman-α (DLA) systems suggest ≳ 85 per cent. In all three simulations, hot, low-density gas is also a major contributor to the cosmic metal budget, even at high redshift. By considering the evolution in cosmic SFR density ($\rho _{ {\rm {\small {sfr}}}}$), neutral gas density ($\rho _{ {HI}}$), and mean gas-phase metallicity ($[\langle {} {M/H}\rangle ]_{ {neu}}$), we determine two possible ways in which the absolute $\rho _{ {met,neu}}$ observed in DLAs at high redshift can be matched by simulations: (i) the $\rho _{ {\rm {\small {sfr}}}}$ at $z$ ≳ 3 is greater than inferred from current FUV observations, or (ii) current high-redshift DLA metallicity samples have a higher mean host mass than the overall galaxy population. If the first is correct, TNG100 would match the ensemble data best, however there would be an outstanding tension between the currently observed $\rho _{ {\rm {\small {sfr}}}}$ and $\rho _{ {met,neu}}$. If the second is correct, L-Galaxies 2020 would match the ensemble data best, but would require an increase in neutral gas mass inside subhaloes above $z$ ∼ 2.5. If neither is correct, EAGLE would match the ensemble data best, although at the expense of overestimating $[\langle {} {M/H}\rangle ]_{ {neu}}$. Modulo details related to numerical resolution and H i mass modelling in simulations, these incompatibilities highlight current tensions between key observed cosmic properties at high redshift.
Dark Energy Survey Y3 results: blending shear and redshift biases in image simulations
Authors: MacCrann N , Becker M R , McCullough J , Amon A , Gruen D , Jarvis M , Choi A , Troxel M A , Sheldon E , Yanny B , Herner K , Dodelson S , Zuntz J , Eckert K , Rollins R P , Varga T N , Bernstein G M , Gruendl R A , Harrison I , Hartley W G , Sevilla-Noarbe I , Pieres A , Bridle S L , Myles J , Alarcon A , Everett S , Sánchez C , Huff E M , Tarsitano F , Gatti M , Secco L F , Abbott T M C , Aguena M , Allam S , Annis J , Bacon D , Bertin E , Brooks D , Burke D L , Carnero Rosell A , Carrasco Kind M , Carretero J , Costanzi M , Crocce M , Pereira M E S , De Vicente J , Desai S , Diehl H T , Dietrich J P , Doel P , Eifler T F , Ferrero I , Ferté A , Flaugher B , Fosalba P , Frieman J , García-Bellido J , Gaztanaga E , Gerdes D W , Giannantonio T , Gschwend J , Gutierrez G , Hinton S R , Hollowood D L , Honscheid K , James D J , Lahav O , Lima M , Maia M A G , March M , Marshall J L , Martini P , Melchior P , Menanteau F , Miquel R , Mohr J J , Morgan R , Muir J , Ogando R L C , Palmese A , Paz-Chinchón F , Plazas A A , Rodriguez-Monroy M , Roodman A , Samuroff S , Sanchez E , Scarpine V , Serrano S , Smith M , Soares-Santos M , Suchyta E , Swanson M E C , Tarle G , Thomas D , To C , Wilkinson R D ,   (DES Collaboration)
Published: October 2021

As the statistical power of galaxy weak lensing reaches per cent level precision, large, realistic, and robust simulations are required to calibrate observational systematics, especially given the increased importance of object blending as survey depths increase. To capture the coupled effects of blending in both shear and photometric redshift calibration, we define the effective redshift distribution for lensing, nγ(z), and describe how to estimate it using image simulations. We use an extensive suite of tailored image simulations to characterize the performance of the shear estimation pipeline applied to the Dark Energy Survey (DES) Year 3 data set. We describe the multiband, multi-epoch simulations, and demonstrate their high level of realism through comparisons to the real DES data. We isolate the effects that generate shear calibration biases by running variations on our fiducial simulation, and find that blending-related effects are the dominant contribution to the mean multiplicative bias of approximately $-2{{\ \rm per\ cent}}$. By generating simulations with input shear signals that vary with redshift, we calibrate biases in our estimation of the effective redshift distribution, and demonstrate the importance of this approach when blending is present. We provide corrected effective redshift distributions that incorporate statistical and systematic uncertainties, ready for use in DES Year 3 weak lensing analyses.
Relapsing polychondritis or relapsing polychondritis-like symptoms associated with IgG4-RD. Case reports and review of the literature
Authors: Gallo Jesica Romina , Schmid Maria Marcela , Yanzi Josefina Gallino , Paira Sergio Oscar
Published: October 2021

Relapsing polychondritis (RP) is a rare systemic disorder characterised by recurrent, widespread chondritis of the auricular, nasal, and tracheal cartilages. Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated disease characterised by the infiltration of IgG4-bearing plasma cells into systemic organs. However, 25–35% of patients with RP have a concurrent autoimmune disease. The coexistence of RP and IgG4 is rare considering that, to the best of our knowledge, there are only four previous reports of RP or RP-like symptoms associated with IgG4-RD. We herein report two cases which could be RP or RP-like symptoms associated with IgG4-RD.
Prognostic implications of epidermal and platelet-derived growth factor receptor alterations in 2 cohorts of IDHwt glioblastoma
Authors: Alnahhas Iyad , Rayi Appaji , Guillermo Prieto Eibl Maria del Pilar , Ong Shirley , Giglio Pierre , Puduvalli Vinay
Published: October 2021

Background

Glioblastoma remains a deadly brain cancer with dismal prognosis. Genetic alterations, including IDH mutations, 1p19q co-deletion status and MGMT promoter methylation have been proven to be prognostic and predictive to response to treatment in gliomas. In this manuscript, we aimed to correlate other mutations and genetic alterations with various clinical endpoints in patients with IDH-wild-type (IDHwt) glioblastoma.

Methods

We compiled a comprehensive clinically annotated database of IDHwt GBM patients treated at the Ohio State University Wexner Medical Center for whom we had mutational data through a CLIA-certified genomic laboratory. We then added data that is publicly available from Memorial Sloan Kettering Cancer Center through cBioPortal. Each of the genetic alterations (mutations, deletions, and amplifications) served as a variable in univariate and multivariate Cox proportional hazard models.

Results

A total of 175 IDHwt GBM patients with available MGMT promoter methylation data from both cohorts were included in the analysis. As expected, MGMT promoter methylation was significantly associated with improved overall survival (OS). Median OS for MGMT promoter methylated and unmethylated GBM was 26.5 and 18 months, respectively (HR 0.45; P = .003). Moreover, EGFR/ERBB alterations were associated with favorable outcome (HR of 0.37 (P = .003), but only in MGMT promoter unmethylated GBM. We further found that patients with EGFR/ERBB alterations who also harbored PDGFRA amplification had a significantly worse outcome (HR 7.89; P = .025).

Conclusions

Our data provide further insight into the impact of genetic alterations on various clinical outcomes in IDHwt GBM in 2 cohorts of patients with detailed clinical information and inspire new therapeutic strategies for IDHwt GBM.
Adult skills and labor market conditions during teenage years: cross-country evidence from international surveys
Authors: Haraldsvik By Marianne , Strøm Bjarne
Published: October 2021

Do individuals finishing compulsory school in economic downturns end up with higher skills in adulthood than comparable individuals that finish compulsory school in economic upturns? This article answers this question by exploring data on country unemployment rates combined with individual data on educational attainment and adult skills in numeracy and literacy from the Program for the International Assessment of Adult Competencies. We find that completed education is countercyclical, and the same pattern is found for adult skills in numeracy and literacy. The results are fairly robust across different model specifications including fixed country and cohort effects and country-specific cohort trends. The results indicate that the labor market conditions at the time when young people make crucial educational decisions have long-lasting effect on skills and potential earnings in adulthood.
National survey of paediatric vision screening programs across Canada: Identifying major gaps and call to action
Authors: Jindani Yasmin , Nash Dallas , Fleming Natalie , Sabri Kourosh
Published: October 2021

Objective

Paediatric vision screening programs identify children with ocular abnormalities who would benefit from treatment by an eye care professional. A questionnaire was conducted to assess existence and uptake of school-based vision screening programs across Canada. A supplementary questionnaire was distributed among Ontario’s public health units to determine implementation of government mandated vision screening for senior kindergarten children.

Methods

Chief Medical Officers of Health for each province and territory, and Ontario’s thirty-four public health units were sent a questionnaire to determine: 1) whether school-based vision screening is being implemented; 2) what age groups are screened; 3) personnel used for vision screening; 4) the type of training provided for vision screening personnel; and 5) vision screening tests performed.

Results

Of the thirteen provinces/territories in Canada, six perform some form of school-based vision screening. Two provinces rely solely on non-school-based programs offering eligible children an eye examination by an optometrist and three rely on ocular assessment conducted by a nurse at well-child visits. In Ontario, where since 2018 vision screening for all senior kindergarten students is government mandated, only seventeen public health jurisdictions are implementing universal vision screening programs using a variety of personnel ranging from food safety workers to optometrists.

Conclusion

Good vision is key to physical and emotional development. There is an urgent need for a universal, evidence-based and cost-effective multidisciplinary approach to standardize paediatric vision screening across Canada and break down barriers preventing children from accessing eye care.
A Histomorphometric Study of the Effect of Monosodium Glutamate on the Ileum of Adult Male Albino Rats and the Possible Protective role of Vitamin E
Authors: Aly Heba Mahmoud , Hafez Kawther Ahmed , Abdel Aal Iman Hussein , Abdel Aal Youssef Shoukry , Adel Saad Shereen
Published: October 2021

Background

Monosodium Glutamate (MSG) is one of the most widely used food-additives in commercial foods. Its application has increased over time and it is found in many different ingredients and processed foods obtainable in every market or grocery store. Besides its flavor enhancing effects, MSG has been associated with various forms of toxicity.

Aim of the work

The aim of the present work was to determine the effect of monosodium glutamate on the histology of the ileum of the adult male albino rats and evaluate the protective effect of vitamin E.

Material and methods

30 Adult male albino rats were assigned randomly into three groups; control group, it was further subdivided into three subgroups (IA received no treatment, IB received 2 ml olive oil/day, and IC received 400 IU/kg. BW of Vitamin E dissolved in 2 ml olive oil once daily), MSG group (rats fed 2mg/kg. BW of MSG once daily, orally), and vitamin E treated group (rats fed MSG and received concomitant 400 IU/kg/day vitamin E orally). Weight of rats were measured at the start & end of experiment. At the end of experiment (15 days), rats were euthanized, and ileal specimens were processed into paraffin blocks for light microscopic examination and other specimens were processed into scanning electron microscopic examination. Morphometric study and statistical analysis were done.

Results

The present work demonstrated that MSG induced several histopathological changes of the ileum. Broad, fused villi sloughed epithelial cells and pronounced increase in the number of goblet cells. Massive lymphocyte infiltration and hemorrhage was noticed in the lamina propria. Enterocytes lining crypts showed cytoplasmic vacuolation, pale nuclear staining and loss of demarcation between adjacent cells. Increased villus width, goblet cell and lymphocytes numbers was demonstrated by histomorphometry. Vitamin E treated group showed histopathological findings mostly normalized compared with MSG group. Width and length of villi was reduced, enterocytes appeared healthy and well arranged, reduced inflammatory cell infiltrate and vascular congestion and decreased number of goblet cells was observed.

Conclusion

The present results demonstrated deleterious effects of MSG on the structure of the mucosa of the ileum. It also suggested a novel and favorable protective effect of vitamin E on mucosa of the ileum.
Effect of Hypercholesterolemia on Retina of Adult and Aged Male Albino Rat: A Histological and Immunohistochemical Study
Authors: Abou Sehly Reem Abdelaziz , Sayed Rady Hagar Yousry , Ibrahim Kamal Asaad , Abdel Gawad Fayza Abdel-Raouf , Nadim Hany Shawky
Published: October 2021

Introduction

Age related degeneration (ARD) is the leading cause of irreversible blindness among old people. Epidemiologic studies have suggested that nutritional parameters such as dietary fat and cholesterol may play a role in the pathogenesis of retinal degeneration. High intake of saturated fat and cholesterol is correlated with a higher risk for early ARD which occurs either directly or through the promotion of vascular pathology.

Aim of the work

was to evaluate the early histological and immunohistochemical changes of the retina, induced by hypercholesterolemia in adult male albino rat and comparing these changes with similar results in aged male albino rat and to apply a comparative lipid profile biochemical study between the different groups.

Materials and methods

Forty male albino Sprague Dawley rats were used in the study. They were divided into four groups, ten rats per each; Group I: control adult: aged 3-6 months and group II: control aged: aged 24 months were fed on standard diet, Group III: adult hypercholesterolemic group and group IV: aged hypercholesterolemic group were fed on hypercholesterolemic diet which consisted of the same ingredients of the standard diet except for the cellulose was reduced to (4%) with addition of cholesterol (1%) for duration of 6 weeks. At the end, retinal specimens were collected and processed for light microscopic and immunohistochemical examination.

Results

The aged rats showed marked disruption of the normal histological architecture of retina and affection of each individual retinal layer. Hypercholesterolemia markedly affected the adult rat retina and aggravated the aged retina. The affected retinae showed marked thinning of the retinal thickness, disorganization of the cell within the neuronal cell layer with decreased number of the cells within ganglion-cell layer. Immunohistochemistry revealed significant increase in retinal reactivity to glial fibrillary acidic protein, vascular endothelial growth factor, caspase 3 and nitric oxide synthase by aging and hyperlipidaemia.

Conclusion

The present work suggested that hypercholesterolemia is an important risk factor that can accelerates aging of healthy adult retina producing age related retinal degeneration.
Prognostic Value of Troponin I with Echocardiography Assessment in Septic Patients
Authors: Ibrahim Sherif Farouk , Elagmy Ashraf Elsayed , Abdelsabour Abdelrhman Gamal
Published: October 2021

Background

Sepsis is heterogenous with regard to factors such as causal microorganism, patient predisposition, co-morbidity and response to therapy, a key element and unifying feature is the manifestation of cardiovascular dysfunction. Elevated concentrations of cardiac troponin I (cTnI) are frequently observed in patients with severe sepsis and septic shock even in the absence of an acute coronary syndrome (ACS).

Objective

To evaluate the prognostic value of (cTnI) with echocardiography assessment in septic patients.

Patients and Methods

This study was conducted at the intensive care units of Ain Shams university hospitals. 20 patients of both sexes with age ranging from 18 to 70 years diagnosed with sepsis admitted to Intensive care unit were included in prospective observational study.

Results

Baseline cTnI had a significant positive correlation with follow up troponine (p = 0.0016).

Baseline EF had a significant negative correlation with follow up troponine (p = 0.036). Using ROC-curve analysis, troponin level at a cutoff point (>1.9) predicted patients with mortality, with good (87%) accuracy, sensitivity= 90% and specificity= 90% (p < 0.01).

Conclusion

Elevated concentrations of cardiac troponin I (cTnI) are frequently observed in patients with sepsis and septic shock even in the absence of an acute coronary syndrome.
Comparison of Haloperidol versus Midazolam for Prevention of Sevoflurane Emergence Agitation in Pediatric patients undergoing Inguinal Surgeries
Authors: El-Shahawy Dalia Tarek Ali Ahmed , Mahmoud Zaki Mohamed Sidky , Ibrahim Dalia Ahmed , El Sayed Ahmed Mohammed
Published: October 2021

Background

Emergence agitation (EA) in children early after sevoflurane anaesthesia is a common postoperative problem, with incidence ranging up to 80%, It is characterized by behavior that can include crying, disorientation, excitation and delirium, several drugs have been tried in this regard including but not limited to propofol, midazolam, ketamine and ketorolac among other drugs.

Aim of the Work

To compare the effect of intravenous Midazolam vs intravenous Haloperidol & in prevention of Sevoflurane Emergence Agitation in pediatric patients undergoing Inguinal Surgeries.

Patients and Methods

This prospective randomized study was done after approval of institutional ethics committee in Ain Shams university Hospitals for 6 months and obtaining an informed written consent from parents. It was designed to include sixty-two pediatric patients, aged 3 to 12 years of both genders, with physical status ASA Ι and ASA ІІ. All surgical procedures were elective of an expected duration of 30 - 60 minutes e.g. inguinal hernia repair, hydrocele, orcheopexy under general anesthesia and caudal block to relief pain. All operations were performed in supine position.

Results

Our study was applied on age group between 3- 12 years old Haloperidol was associated with 24% EA and was also associated with significant delay in eye opening and time till discharge from PACU when compared to Midazolam.

Conclusion

I.V Midazolam is more efficient than I.V Haloperidol for prevention of Sevoflurane Emergence agitation in pediatric patients undergoing inguinal surgeries.
The Effect of Depth of Anaesthesia on the Severity of Mitral Insufficiency by Transesophageal Echocardiography
Authors: Fahmy Nabila Mohamed Abd El Aziz , Hussein Wael Reda , Al Hanash Ehab Essam Khamis
Published: October 2021

Background

The assessment of mitral regurgitation (MR) is complex and complicated by the dynamic nature of this valvular abnormality. Intraoperative transesophageal echocardiography (TEE) is a well-established tool that is used to assess the mitral regurgitation (MR) before and after mitral valve reconstruction.

Objectives

This study conducted in the National Heart Institute in Cairo aimed at assessing the effect of depth of anaesthesia guided by bispectral index on the severity of mitral insufficiency as measured by transesophageal echocardiography.

Patients and Methods

This study was conducted in the National Heart Institute in Cairo. The study was conducted for a period of about six months after the approval from Ethical committee. Informed oral consent for every patient was obtained. Prospective observational cross-sectional study with a random sample of 20 patients at National Heart Institute. A sample size of at least 15 data pairs achieves 80% power to reject the null hypothesis of zero effect size when the population effect size is 0.80 and the significance level (alpha) is 0.05 using a two-sided paired ttest. Adult patients undergoing elective cardiac surgery in National Heart Institute.

Results

The MR severity decreased at a deeper anaesthesia at low BIS than at a shallower anaesthesia at high BIS in patients with organic MR. Eight patients out of twenty patients (40% with organic MR) showed a + 1 grade of improvement in MR grade, by semi-quantitively measuring maximal JA and VC width. Improvement in mitral regurge severity thought to be secondary to unloading effect of general anaesthesia on left ventricle causing a decrease in afterload, preload, and left ventricular dimensions. This study demonstrated that, a comparison between deep anaesthesia and shallow anaesthesia using BIS showed there is a significant reduction in multiple parameters of MR severity assessment secondary to unloading effect of general anaesthesia on left ventricle caused by a decrease in both afterload and preload.

Conclusion

This reduction in MR severity appeared to be significant enough to modify intraoperative decisions regarding valve surgery by underestimation of valve severity. Thus, strong consideration should be given to thorough preoperative assessment of MR severity, rather than relying on intraoperative findings.
Glucose Intolerance in Intensive Care Patients: Incidence and Outcome
Authors: El Shebiny Ahmed A , Elewa Gamal M , Gouda Ez alregal G , Hashim Reham M
Published: October 2021

Introduction

Critical illness is associated with modification in metabolic status. Insulin resistance and elevated blood glucose levels occur during stressful conditions.

Objective

to evaluate the incidence and outcome of glucose intolerance in intensive care.

Patients and method

This prospective clinical study included 290 patients, admitted to intensive care unit (ICU), from December 2018 to January 2020. They were divided into three groups according to maximum blood glucose level during the initial 48 hours of admission: Normoglycemic, hyperglycemic and hypoglycemic. Each group was subdivided into: known diabetic and not known diabetic. Patients’ age, sex, APACHI II, admission diagnosis were recorded. Blood glucose level was followed every six hours; high blood glucose during first 48 hours of admission was defined as acute hyperglycemia. Use of vasopressor and corticosteroid therapy, type of feeding, days on mechanical ventilation, total days of stay in ICU, and fate of patients were recorded.

Results

Hyperglycemia was common with critical illness. Its incidence was 45.5 % and 67.2% on ICU admission and during 48 hours. after admission respectively;. Of them, 51% were diabetics, while 16.2% were non diabetics. Hyperglycemia was associated with increased morbidity in the form of difficult weaning from mechanical ventilation and long ICU stay. Of hyperglycemic patients, 66.4 % were orally fed.Mortality among normoglycemic patients was 37.5 %; slightly lower than mortality among hyperglycemic patients (39.2%), but without statistical significant difference. Glucose intolerance in critically ill patients was not related to severity of the disease or cause of admission and vasopressors and steroids were not risk factors for glucose intolerance during the initial 48 hrs. of admission

Conclusion

Glucose intolerance is high in intensive care patients and is associated with high morbidity and mortality.
Diagnostic value of ultrasound in cases of pneumonia admitted at intensive care unit: A comparative study with chest x-ray
Authors: Ibrahim Sherif Farouk , Ibrahim Waleed Abdalla , Ahmed Hossam Mohamed Khalaf
Published: October 2021

Background

Pneumonia is consistently among the leading causes of morbidity and mortality worldwide. Defined as acute infection of the lung parenchyma, it is caused by a wide variety of microorganisms, including bacteria, viruses, and fungi. However, pneumonia is often misdiagnosed even now. Early and effective antibiotic treatment is important. An adequate treatment is thus reliant on an early diagnosis of pneumonia, yet the diagnosis is not always clear at presentation to the emergency department (ED). In a retrospective chart review of patients admitted with pneumonia, 22% of patients presented some reason for diagnostic uncertainty that could result in delayed antibiotics delivery.

Objective

The aim of the study was to evaluate the efficacy of LUS in the diagnosis of pneumonia.

Methods

This is a prospective observational study which was conducted on 36 consecutive patients with suspected pneumonia. All patients were admitted to the Hospital, in the period from May 2019 to January 2020.

Results

Chest x-ray diagnosed pneumonia in 66.7% of patients, while lung U/S diagnosed pneumonia in 75% of patients. Lung ultrasound was more sensitive and highly specific for diagnosis of pneumonia as sensitivity and specificity of lung ultrasound was 96.3% and 88.9% respectively while for chest xray was 81.5% and 77.8% respectively. Accuracy of lung ultrasound was 94.4% and that of chest x-ray was 80.6% in relation to CT chest the gold standard with accuracy 100%. Superiority of lung US findings over CXR findings could be explained by high sensitivity & specificity of lung US in diagnosing pneumonia in comparison with chest x ray as high resolution CT is a gold standred for the study.

Conclusion

LUS is a sensitive and highly specific diagnostic tool in pneumonia. Therefore, we hypothesize that Lung US may be considered as the first imaging test inpatients with suspicion of pneumonia. It should be noted, however, that the ability of LUS to detect lung consolidations located in peri-hilar regions is limited. A diagnostic algorithm of pneumonia which includes Lung US should be validated in prospective studies. Monitoring there solution of pneumonia can be another application of Lung US inpatients with pneumonia.
Efficacy of combined ultrasound guided Pectoral Nerve Block (PECS I block and PECS II block) using Bupivacaine with or without Magnesium Sulfate in modified radical mastectomy under general anathesia
Authors: El-Khattab Salwa Omar , Taeimah Mohamed Osman , Seif Mahmoud Mohamed Elsayed
Published: October 2021

Background

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

Objective

To evaluate the Efficacy of combined ultrasound guided Pectoral Nerve Block (PECS I block and PECS II block) using Bupivacaine with or without Magnesium Sulfate in modified radical mastectomy under general anathesia.

Patients and Methods

After obtaining approval from the medical ethical committee in Ain Shams University This study was conducted in the operating theatres of Ain Shams University Hospitals. It included Thirty Female patients undergoing Modified Radical Mastectomy were divided randomly into two groups, each group consisted of 25 patients group I in which patients received general anesthesia followed by PECS BLOCK using only bupivacaine 0.25 % and group II in which patients received general anesthesia followed by PECS BLOCK using bupivacaine 0.25 % plus magnesium sulfate 50% (200mg).

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 for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post operative hemodynamics were also assessed.

Conclusion

The addition of 200 mg of magnesium sulfate to bupivacaine in an ultrasound-guided Pectoral Nerve Block significantly reduce postoperative opioid consumption, prolong the duration of the analgesia, and reduce the VAS score without significant side effects after Modified Radical Mastectomy under general anesthesia.
Norepinephrine versus Ephedrine Boluses To Treat Spinal-Induced Hypotension in Cesarean Deliveries
Authors: Abo Kamar Mohamed M , Shams Manal M , AbdelAziz Mai M , Selima Wessam Z
Published: October 2021

Corresponding Background

Cesarean sections normally require an anesthetic block at T4 level, so hypotension is reported to occur in up to 80% of spinal anesthesia cases. When maternal hypotension associated with spinal anesthesia for cesarean section is severe and sustained, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow with consecutive fetal hypoxia, acidosis, and neurological injury.

Aim of the Work

to compare the administration of intermittent i.v. boluses of norepinephrine and ephedrine to counterbalance the hypotensive effect of spinal anesthesia during cesarean delivery. The results of the study showed that compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery. Furthermore, the numbers of boluses of vasopressors used during spinal anesthesia were lower in norepinephrine compared with the use of ephedrine.

Conclusion

Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.
Comparative Study between Bupivacaine-Dexmedetomidine versus Bupivacaine-Dexamethasone in Skin Infiltration as Post-Operative Analgesia for Patients undergoing Abdominoplasty Surgeries
Authors: Fawaz Ahmed Ali , Youssef Osama Ramzy , Ahmed Ahmed Mounir , Salama Mohamed Adel Abdelfattah
Published: October 2021

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 postoperative 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

To compare skin infiltration with bupivacaine-dexmedetomidine mixture versus bupivacaine-dexamethasone mixture for analgesia in abdominoplasty under general anesthesia.

Patients and Methods

A prospective randomized clinical trial study was conducted in Ain Shams university hospital on 40 adult patients undergoing Abdominoplasty surgeries. The patients were randomly divided into two groups using their computer-generated random numbers will be enrolled in group I for bupivacaine-dexmedetomidine and group II for bupivacaine-dexamethasone.

Results

This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics.

Conclusion

Wound infiltration with bupivacaine -dexmedetomidine mixture provides prolonged local anesthetic effect, decreases the need for rescue analgesics, and provides better sedation than bupivacaine–dexamethasone mixture in patients undergoing Abdominoplasty surgeries.
Clinical and Laboratory Prognosis of Patients at Risk for Traumatic ARDS
Authors: Eshohady Mohamed Ahmed Mohamed , El Kady Galal Adel , Zakry Milad Ragaey
Published: October 2021

Background

Trauma victims who survive their initial injuries to hospitalization in the intensive care unit (ICU) face the possibility of life-threatening complications such as multiple organ failure (MOF), the leading cause of death in these patients. Acute respiratory distress syndrome (ARDS) is the most frequent manifestation of MOF after trauma.

Objective

Diagnosis of traumatic patients who are at risk of developing ARDS based on clinical and laboratory findings and their proper management.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2020.

Data Extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Conclusion

Identifying potentially causal and modifiable factors that could lead to the development and testing of preventative ARDS therapies has been slow in part because of an incomplete understanding of which patients are likely to develop ARDS after major trauma. There are several ARDS predictors including an injury severity score (ISS), Acute Physiology and Chronic Health Evaluation (APACHE) II Score and others which try to identify trauma patients at greatest risk for ARDS. However, despite the intense research, only few effective therapies for ARDS have been postulated, including the lung protection strategies.
Comparative Study between Automatic Tube Compensation (ATC) and Pressure Support Ventilation (PSV) as a Mode of Weaning from Mechanical Ventilation in Patients with Respiratory Failure
Authors: Elshaer Ahmed N , Elshebiny Ahmed A , Habib Mariam K , Abdelrasol Mohammed G
Published: October 2021

Background

Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube (ETT). Weaning from mechanical ventilation (MV) is a challenge. Its prolongation is related to increased mortality.

Aim of the Work

is to assess the value of ATC in predicting successful weaning and hastening the weaning process. This study will compare the benefits and effects of ATC versus PSV as weaning modes on spontaneous breathing trials and work of breathing.

Patients and Mehtods

This prospective non randomized was done on 50 adult patients admitted to the Critical Care Medicine Department in Ain shams University Hospital presenting with ARF and mechanically ventilated for at least 24 hours. They were divided into two groups:

Group I

“ATC group” Each underwent a 1-hour spontaneous breathing trial, using ATC mode and

Group II

“PSV group” PSV mode was used.

Results

In the present study we have found that the use of ATC during a spontaneous breathing trial was as effective as PSV in predicting the ability of patients to maintain spontaneous, unassisted breathing for more than 48 hours after removal of the endotracheal tube. In our study, there was no significant difference in the number of patients who tolerated the spontaneous breathing trial and then extubated between ATC and PSV groups (60 % vs. 56% respectively, p > 0.05). Both modes had comparable sensitivity, and +ve predictive value. Sensitivity was 80.0% versus 75.0% and the positive predictive value was 88.0%, versus 87.0% for ATC versus PSV respectively. The specificity was comparable (76.8% versus 80.0 % in ATC versus PSV respectively). ATC group had higher negative predictive than PSV group (82.0% versus 70.1%, respectively). In our study, criteria for successful extubation were met in 56.0%. In ATC group 60.0% met the criteria for successful extubation vs. 60% in PSV group. In the present study it was found that male patients were the most predominant in both groups (72.0% in ATC group and 68% in PSV group). This is expected as cigarette smoking is prevalent among males and is the single most important and most prevalent risk factor for the development of COPD. In our study, about one third of patients had COPD exacerbation as a cause for ARF.

Conclusion

In ICU population, ATC was safe, reliable, and can be reasonably used for weaning trials. ATC confers a potential benefit in weaning duration, weaning category, number of Ss, failure of first SBT extubation outcome, ICU length of stay, complication, and mortality rate. In addition, ATC improves the predictive value of RR/TV and IWI in predicting weaning success.
A comparison of intranasal dexmeditomidine versus intranasal midazolam as a pre anesthetic medication in children undergoing adenotonsillectomy
Authors: El Zoghby Nourhan M , Mohammed Ahmed S , El Hennawy Ahmed M , Wahba Ramy M
Published: October 2021

Background

Adenotonsillectomy is one of the most common surgical procedures performed on pediatric patients. Relieving pre- and post-operative anxiety is an important concern for the pediatric anesthesiologist. Aim of the Work: to compare dexmedetomidine with midazolam effect on preoperative sedation, the ease of children parent separation, the mask tolerance, intraoperative hemodynamics stability, emergence of anesthesia and postoperative analgesia.

Patients and Methods

A Prospective, randomized and double blind controlled clinical trial was done after approval of institutional ethics committee in Ain Shams university Hospitals for 6 months and obtaining an informed written consent from parents. It was designed to include fifty pediatric patients, aged 5 to 10 years old of both genders, with physical status ASA Ι.

Results

statistically significant increase mean of Dexmedetomidine compared to midazolam according to sedation score after 15min. to after 45min.

Conclusion

Premedication with intranasal dexmedetomidine 1 μg/kg attained significant and satisfactory sedation with better parent separation and lower anxiety levels without any adverse effects as compared with intranasal midazolam 0.2 mg/kg in children undergoing adenotonsillectomy.
Optimum End Tidal Sevoflurane Concentration Required for Intravenous Cannulation in Children
Authors: Noureldin Bassel Mohamed Essam , Seif Eman Mohamed Kamal Abo , Eltawansy Omar Mohamed Mohamed , Ghoneim Mohamed Mohamed Abdel Fattah
Published: October 2021

Background

Inhalation mask induction is a cornerstone of pediatric anesthesia. Because of their natural aversion to needles, healthy children are usually anesthetized by mask prior to intravenous insertion. The early insertion of an intravenous access provides a means for administering fluids and drugs if an untoward event occurs during inhalational induction. Sevoflurane is the inhalation agent most commonly used for mask inductions in pediatric anesthesia, having largely replaced halothane for this purpose.

Objectives

The aim of the study was to evaluate the optimum end tidal concentration of Sevoflurane at which an intravenous cannulation can be successfully attempted without movement in pediatric patients.

Patients and Methods

In this clinical trial, pediatric subjects of either sex aged 2-5 years, weighing 10-20 kg were included.

Results

Showed that an end tidal sevoflurane of 1.46% has 50% probability for successful intravenous cannulation without movement in children.

Conclusion

We conclude that an end tidal sevoflurane of 1.46% has 50% probability for successful intravenous cannulation in un- premedicated children aged between 2 and 5 years.
Incidence Of Post-Operative Delirium In Geriatric Patients Undergoing Hip Replacement Surgery Using Pre-Operative Haloperidol
Authors: Eskander Fahmy Saad Latif , Hakim Karim Youssef Kamal , Ibrahim Dalia Ahmed , El-Mallah Wael Safwat
Published: October 2021

Background

Delirium is acute onset & fluctuating disturbance in mental state that causes patient appear confused, disoriented or with difficulty to focus and with decline in cognitive function (memory, orientation, speech), circadian disturbance and behavior of patient either agitated or sleepy,in other words sudden confusion. Delirium, also known as acute confusional state, is an organically-caused decline from a previously baseline level of mental function that develops over a short period of time (hours to days). Delirium is not a disease itself, but a syndrome encompassing disturbances in attention, consciousness, and cognition. It may also involve other neurological deficits, like psychomotor disturbances (e.g. hyperactive, hypoactive, or mixed), impaired sleepwake cycle, emotional disturbances, and perceptual disturbances (e.g. hallucinations and delusions).

Objective

To determine incidence of post-operative delirium in geriatric patients undergoing hip replacement surgery using pre-operative haloperidol.

Patients and Methods

This study is conducted through geriatric patients undergoing orthopedic surgery and the incidence of pre.& post-operative delirium. This randomized, double-blind, placebo-controlled trial was conducted post-operative surgical ICU in Demerdash hospital which was closed unit and had the same well-established pain, sedation and delirium assessment practices. A delirium was monitored through CAM score in their stay in ICU (max. for &7 days from admission post-operative).

Results

Several trials stated that the usage of Haloperidol pre-operative decrease the duration and the severity of Delirium rather than the incidence of delirium. In our trial we will detect the incidence of delirium with using prophylactic haloperidol in geriatric patients undergoing Hip replacement surgery. In our study revealed that using prophylactic pre-operative haloperidol decrease the incidence of delirium among geriatric patient as well as decreasing both the duration and the severity of delirium among the study group.

Conclusion

Our study and results revealed that Haloperidol as antipsychotic drug have beneficial effect on reduction of incidence of delirium in post-operative geriatric patients, also it showed effect on duration of delirium and severity of the disease as well as ICU stay.
Role of Capnograghy during weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease
Authors: Ali Ramy Karem Ali , Mostafa Yasser Mosafa Mohammed , Ali Tamer Mohammed
Published: October 2021

Background

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation associated with an enhanced chronic inflammatory response in the airway, acute exacerbations of COPD can lead to progressive respiratory failure necessitating mechanical ventilation. Weaning of these patients may prove difficult and a spontaneous breath trial should be provided before the decision of extubation.

Aim

To evaluate the role of capnograghy in COPD patients during weaning from mechanical ventilation.

Subject and methods

This was a cross sectional prospective study conducted on 50 patients who were admitted at the Respiratory Intensive Care Unit of Abbassia Chest hospital and diagnosed as COPD and on mechanical ventilation. During the weaning trial, the role of capnography device evaluated considering the ability of Pet CO2 parameter in predicting hypercapnia and subsequently weaning outcome

Results

The changes in ABG reading before and after the SBT, PaCO2 and Pet CO2 showed significant elevation at the end of SBT,P=0.001 for both, while O2 saturation was significantly decrease at the end of SBT, P0.001.

Conclusion

The study found that Pa CO2 and PetCO2 are correlated to each other before, during and after SBT. Most of the studies that was found reported that PetCO2 is highly correlated with Paco2 and that PetCO2 may be a rapid and reliable predictor of arterial PaCO2 in respiratory distress.
Modulation of Autophagy Signal Pathway in Type 2 Diabetes Mellitus Rat Model Using Phytochemical Extracts
Authors: Mohamed Sanaa Eissa , Mohamed Amany Helmy , Bekhit Meram Mohamed , Sayed Maha Saad Zenhom
Published: October 2021

Background

Type 2 DM is a chronic metabolic disease characterized by insulin resistance and beta cell dysfunction. It is an extremely heterogeneous disease in which the insulin resistance and beta cell dysfunction resulted from environmental and genetic factor. Type 2 diabetes is the most prevalent form of diabetes worldwide and account for 90% of cases globally. It represents a major public health threat and considered as a principal cause of morbidity and mortality affecting almost 6% of the world’s population. Patients with type 2 diabetes usually have insulin resistance and relative insulin deficiency and are often associated with a strong genetic predisposition.

Objective

To retrieve potential miRNA-associated ceRNAs Linked to autophagy, insulin resistance and type 2 DM from Public microarray databases followed by validation of the chosen network in animal model. To evaluate the efficacy of Isorhamentin as a potential therapeutic strategy to modulate the autophagy pathway and IR in type 2 DM.

Patients and Methods

This study was done at Medical Biochemistry Department, Faculty of Medicine, Ain Shams University during the period from December 2019 – June 2020 and included 50 wistar male rats. 50 Male Wistar rats weighed (140-150g), age nearly two months, were purchased from the Holding Company for Biological Products and Vaccines. They were acclimatized to laboratory environment for at least one week with free access to water and food before induction of diabetes. Experiment for eight weeks duration was planned after a pilot study was performed for determination of the most effective and least toxic STZ dose.

Results

Our study demonstrated that “Isorhamentin” can be potential treatment in type 2 diabetes mellitus through modulation of Autophagy signaling pathway related genes and ceRNA network. Isorhamentin down-regulates the expression of m-tor mRNA and it up-regulates the expression of miR-1.

Conclusion

The results of our study Support our previous hypothesis that miR-1 miRNA and mTOR mRNA act as ceRNA network and might play an important role in the pathogenesis of autophagy and insulin resistance and T2DM.And could be potential therapeutic target by isorhamentin to modulate the expression of the deregulated network in type 2 DM.