bluuebunny/crossref_metadata_2025 huggingface dataset:
A Cost-Effectiveness Analysis of Lung Cancer Screening With Low-Dose Computed Tomography and a Diagnostic Biomarker
Authors: Toumazis Iakovos , Erdogan S Ayca , Bastani Mehrad , Leung Ann , Plevritis Sylvia K
Published: October 2021

Background

The Lung Computed Tomography Screening Reporting and Data System (Lung-RADS) reduces the false-positive rate of lung cancer screening but introduces prolonged periods of uncertainty for indeterminate findings. We assess the cost-effectiveness of a screening program that assesses indeterminate findings earlier via a hypothetical diagnostic biomarker introduced in place of Lung-RADS 3 and 4A guidelines.

Methods

We evaluated the performance of the US Preventive Services Task Force (USPSTF) recommendations on lung cancer screening with and without a hypothetical noninvasive diagnostic biomarker using a validated microsimulation model. The diagnostic biomarker assesses the malignancy of indeterminate nodules, replacing Lung-RADS 3 and 4A guidelines, and is characterized by a varying sensitivity profile that depends on nodules' size, specificity, and cost. We tested the robustness of our findings through univariate sensitivity analyses.

Results

A lung cancer screening program per the USPSTF guidelines that incorporates a diagnostic biomarker with at least medium sensitivity profile and 90% specificity, that costs $250 or less, is cost-effective with an incremental cost-effectiveness ratio lower than $100 000 per quality-adjusted life year, and improves lung cancer-specific mortality reduction while requiring fewer screening exams than the USPSTF guidelines with Lung-RADS. A screening program with a biomarker costing $750 or more is not cost-effective. The health benefits accrued and costs associated with the screening program are sensitive to the disutility of indeterminate findings and specificity of the biomarker, respectively.

Conclusions

Lung cancer screening that incorporates a diagnostic biomarker, in place of Lung-RADS 3 and 4A guidelines, could improve the cost-effectiveness of the screening program and warrants further investigation.
Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis
Authors: Warnick Jennifer L , Darling Katherine E , West Caroline E , Jones Laura , Jelalian Elissa
Published: October 2021

Objective

Over the past two decades, there has been a steady increase in research focused on the association between weight-based stigma and mental health outcomes in children and adolescents. The present study is a systematic review and meta-analysis of the associations between weight stigma and mental health in youth.

Methods

A systematic search of PubMed, PsychInfo, and Embase databases was conducted in January 2020. Inclusion criteria included the following: (a) examined an association between weight stigma and a mental health outcome, (b) mean sample age <18 (+1 standard deviation) years, (c) written in English, and (d) peer reviewed. Forty eligible articles were identified. The moderating effects of age, sex (percent female), weight status (percent with overweight/obesity), and study quality were examined.

Results

Overall, meta-analytic findings using a random-effects model indicated a statistically significant moderate association between weight stigma and poorer mental health outcomes (r = .32, 95% confidence interval [0.292, 0.347], p < .001). Age and study quality each moderated the association between weight stigma and mental health. Generally, the study quality was fair to poor, with many studies lacking validated measurement of weight stigma.

Conclusions

Although there was a significant association between weight stigma and mental health in youth, study quality hinders the current body of literature. Furthermore, findings highlight the lack of consideration of internalized weight stigma in child populations, the importance of using validated measures of weight stigma, and the need for increased awareness of how these associations affect populations of diverse backgrounds.
Standardizing reverberation-measured Mg II time-lag quasars, by using the radius–luminosity relation, and constraining cosmological model parameters
Authors: Khadka Narayan , Yu Zhefu , Zajaček Michal , Martinez-Aldama Mary Loli , Czerny Bożena , Ratra Bharat
Published: October 2021

We use 78 reverberation-measured Mg II time-lag quasars (QSOs) in the redshift range 0.0033 ≤ z ≤ 1.89 to constrain cosmological parameters in six different cosmological models. The basis of our method is the use of the radius–luminosity or R−L relation to standardize these 78 Mg II QSOs. In each cosmological model, we simultaneously determine R−L relation and cosmological model parameters, thus avoiding the circularity problem. We find that the R−L relation parameter values are independent of the cosmological model used in the analysis, thus, establishing that current Mg II QSOs are standardizable candles. Cosmological constraints obtained using these QSOs are significantly weaker than, but consistent with, those obtained from a joint analysis of baryon acoustic oscillation (BAO) observations and Hubble parameter [H(z)] measurements. So, we also analyse these QSOs in conjunction with the BAO + H(z) data and find cosmological constraints consistent with the standard spatially flat ΛCDM model as well as with mild dark energy dynamics and a little spatial curvature. A larger sample of higher quality reverberation-measured QSOs should have a smaller intrinsic dispersion and so should provide tighter constraints on cosmological parameters.
The BAHAMAS project: evaluating the accuracy of the halo model in predicting the non-linear matter power spectrum
Authors: Acuto Alberto , McCarthy Ian G , Kwan Juliana , Salcido Jaime , Stafford Sam G , Font Andreea S
Published: October 2021

The halo model formalism is widely adopted in cosmological studies for predicting the growth of large-scale structure in the Universe. However, to date there have been relatively few direct comparisons of the halo model with more accurate (but much more computationally expensive) cosmological simulations. We test the accuracy of the halo model in reproducing the non-linear matter power spectrum, P(k), when the main inputs of the halo model (specifically the matter density profiles, halo mass function, and linear bias) are taken directly from the BAHAMAS simulations, and we assess how well the halo model reproduces P(k) from the same simulations. We show that the halo model generally reproduces P(k) in the deep non-linear regime (1-halo) to typically a few per cent accuracy, but struggles to reproduce (approx. 15 per cent error) P(k) at intermediate scales of $0.1 \la k \ [h/{\rm Mpc}] \la 3$ at $z$ = 0, marking the transition between the 1-halo and 2-halo terms. We show that the magnitude of this error is a strong function of the halo mass definition (through its effects on radial extent of haloes) and of redshift. Furthermore, we test the accuracy of the halo model in recovering the relative impact of baryons on P(k). We show that the systematic errors in recovering the absolute P(k) largely cancel when considering the relative impact of baryons. This suggests that the halo model can make precise predictions for the baryonic suppression, offering a fast and accurate way to adjust collisionless matter power spectra for the presence of baryons and associated processes.
Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial
Authors: Sisco-Taylor Brittany L , Magel John S , McFadden Molly , Greene Tom , Shen Jincheng , Fritz Julie M
Published: October 2021

Objective

The Fear-Avoidance Model (FAM) of chronic pain posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT’s effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year.

Subjects

Participants were 204 patients with low-back pain of <16 days duration, who enrolled in a clinical trial (NCT01726803) comparing early PT sessions or usual care provided over 4 weeks.

Methods

Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales), and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators.

Results

Early PT led to improvements in disability and pain over 3 months but not 1 year. In the single mediator model, 4-week reductions in pain catastrophizing mediated early PT’s effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations.

Conclusions

In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients’ catastrophizing.
Ultrasound Evaluation of the Respiratory Variations of the Internal Jugular Vein Compared to the Respiratory Variations of the Inferior Vena Cava as a Guidance of Fluid Responsiveness in Septic Shock
Authors: Ali Khalil Ahmed Abd Elalim , Elkadi . Galal Adel Mohamed , Anies Saeid Sherif George , Saleh Gamal Eldin Adel Abd Elhameed
Published: October 2021

Background

Septic shock is one of the most complex hemodynamic failure syndromes. It is the major cause of mortality and morbidity in intensive care unit. Fluid resuscitation is of paramount importance in septic shock. However, its correction should be carefully guided to avoid unnecessary volume expansion. Ultra- sonographic evaluation of fluid responsiveness plays an important role in septic shock.

Objectives

The objective of the study was to verify the feasibility and usefulness of the internal jugular vein distensibility index in prediction of fluid responsiveness in septic shock patients undergoing mechanical ventilation compared to the inferior vena cava distensibility index.

Methodology

The study was carried out in Ain Shams University Hospital from February 2019 to November 2019, on twenty patients 20 patients of both sex who were admitted to the intensive care unit and diagnosed as septic shock (sepsisinduced hypotension persisting despite adequate fluid resuscitation and require vasopressors and serum lactate > 2 mmol/ L) As regard the hemodynamic parameters, patients were classified into two groups: Fluid responders and non-fluid responders.

Results

The study demonstrated that there was a positive correlation between internal jugular vein distensibility index (IJV DI) and inferior vena cava distensibility index (IVC DI) in prediction of fluid responsiveness. IVC DI index cutoff value was > 12.6% with sensitivity 80% and specificity 80% and IJV DI cut off value was >8.4% with sensitivity 86.67% and specificity 80%.

Conclusion

ultra-sonographic assessment of the internal jugular vein distensibility index (IJV DI) and inferior vena cava distensibility index (IVC DI) are useful dynamic indices in assessment of the intravascular volume state in mechanically ventilated septic shock patients. IJV and IVC show comparable value in the prediction of fluid responsiveness.
Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Post-Operative Pain Management after Cesarean Section
Authors: Elsafty Omar Mohamed Taha , Awad Hanan Mahmoud Farag , Ahmed Mohamed Saleh , Mahdy Ahmed Elkholy
Published: October 2021

Background

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

Objectives

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

Patients and Methods

After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, female patients were included in the study, and were divided into three groups (n = 20; each); group QLB and group TAP. Group QLB: Patients (n = 20) of this group received bilateral ultrasound-guided QLB after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%, Group TAP: Patients (n = 20) of this group received bilateral ultrasound-guided TAP block after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%.

Results

The current study also measured and compared postoperative VAS score and firs time to rescue analgesia and the total amount of opioid (pethidine) given in the first 24 hours with the standard deviation for each of the two groups studied we found that TAP patients had the highest values compared to the QLB group. This is mainly due to the extension of the local anesthetic agent beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control.

Conclusion

Quadratus lumborum block was the most effective technique in providing analgesia after cesarean section without associated hemodynamic instability in comparison to transversus abdominis plane block and even more time covering to rescue opioid.
A Comparative Study of Preemptive Effect of Pregabalin and Gabapentin on Postoperative Pain After Coronary Artery Bypass Graft Surgery
Authors: Abdelaziz Mohamed Saeed , Mohamed Randa Ali Shoukry , Ismail Mohamed Abdelmohsen Abdelnaeim , Mohamed Ahmed Nabil Ahmed Talaat
Published: October 2021

Background

Pain that pursues coronary artery bypass graft (CABG) surgery is usually associated with increased both recovery duration and hospital stay. Patient outcome could be worsened owing to large doses of opioids for pain control through over sedation, and prolonged mechanical ventilation. This study was designed to evaluate the effect of preemptive gabapentinoids on post CABG surgery pain control.

Objective

to evaluate the effect of pre-operative administration of pregabalin and gabapentin in limiting the post-operative pain in coronary artery bypass surgeries.

Patients and Methods

Type of Study: Prospective double – blinded, randomized controlled Trial. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Study Setting: National Heart Institute, Egypt. Study Period: 6 months. Study Population: adult undergoing coronary artery bypass graft surgeries.

Results

The primary outcome of this study was to compare the effect of gabapentinoids on post CABG pain as reflected by morphine consumption. The secondary outcome was to address the influence of gabapentinoids on patient satisfaction post CABG, the incidence of respiratory depression, nausea, vomiting, ventilatory hours and length of hospital stay.

Conclusion

Pregabalin, and gabapentin both can be effective for reduction of post CABG morphine consumption and have better patient satisfaction if given preemptively with single dose preoperatively.
Evaluation of red cell distribution width (RDW) as a septic marker in comparison with clinical scores and C-reactive protein
Authors: Naga Ali Ahmed , Fattah Mohammed Ismaeil Abdel , Nofal Walid Hamed , AlMenshawe Mohammed Abd-elsalam
Published: October 2021

Background

Challenges of diagnosing and treating sepsis only seem more difficult as incidence increases, patients become older and sicker, and pathogenic organisms evolve. New understanding of inflammatory mediators and pathways, immunity, and genetic variability in this disease state suggests that the current definitions of SIRS, sepsis, severe sepsis, and septic shock are oversimplified.

Objective

The aim of our study is to evaluate the level of RDW, CRP and clinical scores "SOFA and APACHI" as markers in patients with sepsis and their levels on the outcome and resolution of sepsis in ICU.

Methodology

We conducted a prospective observational controlled study on 90 adult persons of both sex, 45 of them are adult patients and served as the study group (Group I), and the other 45 are healthy adult volunteers and served as the control group (Group II). The study group represented patients admitted to the ICU of Intensive Care Unit at Damanhour Medical National Institute who fulfilled the diagnostic criteria for sepsis, severe sepsis and septic shock on arrival to ICU according to the SCCM/ ESICM/ ACCP/ ATS/SIS International Sepsis Definitions Conference.

Results.

In the present study we found that CRP measured on admission was not a predictor of mortality, while that measured at day 5 and day 10 predicted mortality, where there was no statistically significant difference in CRP levels between survivors and non-survivors at the day of admission while there were statistically significant differences between survivors and non survivors according to CRP levels at day 5 (p = 0.001*) and at day 10 (p = 0.001*). It was found also that there were statistically significant differences between survivors and non-survivors according to RDW at day 1(p = 0.011*) and at day 5(p = 0.009*), at day 10 was found there was no statistically significant difference between survivors and non-survivors (p = 0.338).

Conclusion

RDW is a new promising cheap and readily available biomarker that can be able to diagnose patients with sepsis with accuracy comparable to CRP. Also, RDW at admission is able to predict mortality.
Single Intravenous Bolus versus Continuous Infusion of Tranexamic Acid to Reduce Blood Loss in Transurethral Resection of Prostate: a Prospective Randomized Double-Blind Study
Authors: Ghaly Safaa I , Khairy Marwa A , Kamal Mohamed M , Mohammed Eman A
Published: October 2021

Background and aim

Intraoperative use of a single bolus dose of tranexamic acid may not be sufficient to prevent bleeding in the early postoperative period. The present study was carried out to compare the effect of two dose regimens of tranexamic acid in reducing perioperative blood loss and the amount of allogeneic blood transfusion in transurethral resection of prostate.

Design

prospective, double-blinded and controlled study.

Setting

Ain Shams University Hospital,

Patients and Methods

50 patients electively posted for transurethral resection of prostate were randomly assigned to receive a single bolus dose of tranexamic acid (10 mg/kg) (Group A), a bolus dose of tranexamic acid (10 mg/kg) followed by infusion (1 mg/kg/h) till 4 h postoperatively (Group B).

Measurements

Total intraoperative blood loss, amount of allogeneic blood transfusion, postoperative drain collections, and hemoglobin and hematocrit levels were recorded at different time intervals. Data obtained after comparing two groups were analyzed using the statistical package for social sciences.

Results

There was no statistically significant difference among patients in both groups regarding intraoperative blood loss and postoperative blood loss at 6 hrs and 48 hrs postoperatively. However the post-operative blood loss at 24 hrs was significantly higher among patients in group A than patients in group B (P-value= 0.014) .

Conclusion

Tranexamic acid causes more effective reduction in post-operative blood loss when used as a bolus followed by an infusion continued in the postoperative period in comparison to its use as a single intravenous bolus in transurethral resection of prostate.
Comparative Study between two Ultrasound Aided Methods in PreoperativeAssessment of Difficult Airway in Obese Patients
Authors: Saleh Galal Aboul-so’od , George Sherif Anis , Abdelhamid Gamal Eldin Adel , Swedan Hazem Sameer
Published: October 2021

Background

Unpredictable difficult laryngoscopy remains a challenge for anaesthesiologists, especially if difficult ventilation occurs. So, accurate airway assessment should always be performed so as to provide appropriate planning and management of expected difficult intubation and to limit any unexpected difficulties. Airway assessment using ultrasound has been proposed recently as a useful, simple and non-invasive bed side tool as an adjunct to clinical methods.

Objective

To establish whether correlations existed between two ultrasound measurements and the Cormack–Lehane grade during direct laryngoscopy, and whether these measurements are useful in predicting are stricted or difficult view especially in morbid obese individuals. The first is the measurement of the hyomental distance of the patient in neutral position of the neck and in fully extended neck calculating the ratio between both of them. While the second is the measurement of anterior cervical soft tissue thickness at three anatomical levels (hyoid bone, thyrohyoid membrane or ‘pre epiglottic space’ and anterior commissure). We chose these two new measurements from among the various ultrasound assessments made in previous studies because of their simplicity of execution in normal clinical and in emergency settings.

Patients and Methods

The current study is a prospective comparative clinical trial of assessment of difficult air way using two different ultrasound aided techniques in comparison to Cormack and lehane scoring system. Those patients were chosen upon some inclusion and exclusion criteria; inclusion criteria were (Age of the patient (25-60y), ASA I-II patients, Obese patients with body mass index > 30 kg /m2 and Pts undergoing bariatric surgery) and exclusion criteria were (Pathology of the airway (tumors), Deformity of the airway anatomy (burns, scars), History of facial, cervical, pharyngeal and epiglottis surgery or trauma, Patients with most teeth lost and Patient refusal).

Results

Regarding U/S measurements in method A patients; the average HMD-neutral of A patients was (53.58±5.33) mm, the average HMD-extension was (58±7.82) mm, and the average HMDR was (1.07±0.06). It showed highly significant decrease in HMD extension and HMDR in difficult group, compared to easy group, in A group of patients (p < 0.01respectively). Non-significant difference as regards HMD-neutral U/S measurements in method A (p > 0.05).

Conclusion

Ultrasonography can be a valuable adjunct in this aspect of airway assessment. Ultrasound assessment of pre-epiglottic tissue thickness at the level of the thyrohyoid membrane may be useful to predict restricted/difficult direct laryngoscopy and difficult intubation. The ratio of hyomental distance between neutral and extended positions may also be a good predictor of difficult direct laryngoscopy.
Comparative Study Between Bupivacaine 0.5% Versus Bupivacaine 0.5% with Fentanyl in TAP Block for Post-Operative Analgesia After Appendectomy
Authors: Seleem Hussein Hamdy Gomaa , Fawzy Hazem Mohammed Abdelrahman , Ahmed Mohammed Saleh , Fahim Hany Magdy
Published: October 2021

Background

Post operative pain and stress is a very known complication of many surgical procedures which represents a burden for the patient and associated with many complications including stress, myocardial ischemia, prolonged hospital stay and the need of extensive post operative analgesia.

Objective

to compare the effectiveness of US guided TAP block using 0.5% bupivacaine versus 0.5% bupivacaine with Fentanyl for postoperative analgesia in patients undergoing appendectomy.

Patients and Methods

After ethical committee approval and informed consent from the patients, this prospective randomized control study, randomization done by closed envelope method & was performed on total 60 patients who underwent surgical appendectomy in Ain Shams University hospitals for 3 months from January to March 2019.

Results

In our study, 60 patients were randomly divided into 2 equal groups. Control group received bupivacaine only while the fentanyl group in which 50 ug of fentanyl were added to bupivacaine. All patients received equal volumes. Our study showed that addition of a 50 microgram of fentanyl to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the onset of sensory block and prolonged the duration of the sensory block. In addition, fentanyl prolonged the duration of analgesia significantly, as proved by the time of request of first analgesia. Moreover, in fentanyl group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of fentanyl also did not affect the hemodynamics to a significant level. This makes fentanyl with bupivacaine more superior than the use of bupivacaine alone.

Conclusion

Fentanyl as an adjuvant to bupivacaine in Ultra-sound guided TAP block reduced post-operative pain scores, porolonged the duration of analgesia and decreased demand for rescue analgesics.
Validation of the Modified Integrative Weaning Index as a Predictor of Weaning from Mechanical Ventilation in Comparison to Conventional Weaning Indices in Adult Critically Ill Patients
Authors: Barakat Hythem Mohamed Mamdouh Abdelmeguid , El-Kady Galal Adel , El-Ansary Adel Mohammed , El-Gendy Mohammed Abd El-Salam
Published: October 2021

Introduction

Timely recognition of the return to spontaneous ventilation is essential for reducing costs, morbidity, and mortality. Delays in both removing invasive ventilatory support and excessively early removal are correlated with complications that vary according to the severity of the underlying disease. Several weaning indices and predictors were studied in an attempt to evaluate the outcome of removing ventilatory support. However, none of them have yet presented good results in discriminating the outcome of extubation, even those most used in clinical practices.

Aim

The aim of this study is to validate the modified integrative weaning index (mIWI) as a reliable weaning index in comparison to the conventional weaning indices in the weaning of critically ill patients from invasive mechanical ventilation.

Patients

Four hundred patients, above the age of 18 years, on mechanical ventilation for more than 48 hours through an endotracheal tube for any cause were randomly assigned to this study.

Methods

patients ready to be weaned were assessed using mIWI and conventional indices and monitored for 48 hours. The performance of the indices were assessed in both successful and unsuccessful groups.

Results

The performance of the mIWI was not significantly superior to the conventional weaning indices in predicting weaning success or failure than the traditional weaning indices. The cut-off value for the predicting successful weaning from mechanical ventilation for the mIWI was higher than suggested by the original study and yet in agreement with some other studies. The cut-off value for the mIWI is higher in patients above the age of 60 years.

Conclusion

The results of the study revealed that the mIWI is a good predictor of weaning from mechanical ventilation and assessment of pulmonary mechanics and is not significantly superior to the traditional weaning indices, yet is not a good predictor for extubation success.
A comparative study between Bupivacaine volumes on diaphragmatic mobility in Ultrasound guided Supraclavicular Block
Authors: Abdelaziz Israa Tarek Mohamed , El shaer Ahmed Nagah , Elie Tamer Yousef , Mohamed Wael Abd Elaziz
Published: October 2021

Background

Brachial plexus is a complex network of nerves supplying the whole upper limb, with both motor and sensory supply. It arises from the neck and passes through the axilla to the upper limb. It is composed of 5 roots, 3 trunks, 6 divisions, 3 cords, and terminal branches.

Objective

To compare the effect of two different volumes of bupivacaine (20 ml and 25 ml) on diaphragmatic mobility within 15 and 30 minutes from ultrasound guided supraclavicular brachial plexus block in upper limb orthopedic surgeries.

Patients and Methods

In our study, 40 patients were randomly divided into 2 equal groups. Group A received 20 ml of bupivacaine (0.5%) and group B in which patients received 25 ml of bupivacaibe (0.5%). Diaphragmatic excursion measured in both groups after 15 and 30 mins sequentially.

Results

Our study showed that the use of low volume of bupivacine has much lower incidence of phrenic nerve affection, and in turn affection of mobility of the diaphragm measured by diaphragmatic excursion.

Conclusion

Assessment of diaphragmatic excursion is the best indication of phernic nerve injury after supraclavicular block. The use of the ultrasonography is the fastes, easiest and safest method for this assessment. The use of ultrasonography in performing the supraclavicular nerve block decreased significantly the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.
Continuous Femoral Nerve Blockade versus Continuous Epidural Analgesia for Postoperative Pain Relief in Knee Surgeries
Authors: Salama Hala Gomaa , El- Shebiny Ahmed Ali , Aziz Abd Al Aziz Abdullah Abd Al , Shehata Mariam Mahmoud Ahmed Ali
Published: October 2021

Background

The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain). Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved.

Objective

Compare the benefits of continuous femoral nerve block (CFNB) with those of continuous epidural analgesia CEPA for postoperative pain management after Knee surgeries.

Methods

This study is a randomized controlled clinical trial was conducted in Ain Shams University Hospitals after obtaining approval from the Research Ethical Committee of Ain Shams University during a period of three months. Patients undergoing primary unilateral TKA for osteoarthritis, were recruited at least one day prior to the scheduled surgery, male and female patients.

Results

There was significant difference in terms of pain scoring between continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) in the first 6 hours, 12 hours, 24 hours, 48 hours, 72 hours but non significant difference in incidence of side effects

Conclusion

Our study showed that CEA had optimal analgesia and pain control than CFNB in management of post operative pain after total knee replacement.
Tranversus Abdominus Plane Block with or without Magnesium Sulphate on Postoperative Pain Control after Open Appendectomy Operation
Authors: Elzyat Menna A , Kaschef Nevine A , Hussien Rania M , Armanios Simon H
Published: October 2021

Background

Patients undergoing Open Appendectomy experience pain postoperatively, requiring a multimodal approach to analgesia. The transversus abdominis plane (TAP) block seems to be an ideal approach. This block may be achieved using bupivacaine with adjuvants such as magnesium sulfate, which we were used in this study.

Aim of the Work

to detect the efficacy and safety of magnesium sulphate as an adjuvant to the analgesia offered by local anesthetic in ultrasound guided TAP block in patients undergoing open appendectomy.

Patients and Methods

A prospective double blinded randomized controlled trial was conducted on 60 patients undergoing open appendectomy at Ain Shams University Hospital, Cairo, Egypt.

Results

Our study concluded that co administration of 500mg MgSo4 to 0.5 % bupivacaine in US guided TAP block lead to: Significant decrease in VAS pain score especially at 4hrs, 6hrs and 12hrs,1st rescue dose of nalbuphine was delayed. And number of patients require rescue doses of nalbuphine in 1st 4 hrs, while only 2 patients require rescue doses of nalbuphine between 4&6 hrs.4 patients require rescue doses of nalbuphine between 6&12 hrs, while 26 patients require rescue doses of nalubuphine between 12&24hrs. we also cocluded that there were a significant decrease in HR and MABP especially at 4hrs and 6 hrs postoperative,.

Conclusion

MgSO4 as an adjuvant to bupivacaine in Ultra-sounded guided TAP block reduces post-operative pain scores, prolong the duration of analgesia and decreases demand for rescue analgesics.
Comparative Study between Opioid-Free General Anesthesia by Dexmedetomidine and Opioid-Based General Anesthesia in Rhinoplasty Surgeries
Authors: Rashad Mohamed Nagdy , Akl Diaa Abdel khalek , Ammar Mona Ahmed , ElGharabawy Wael Sayed
Published: October 2021

Background

The use of opioid-free analgesic technique have the propensity to decrease and even avoid many of these side effects and lead to early oral intake, early ambulation, earlier hospital discharge, and lesser readmission rates to the hospital in the post-operative period.

Aim of the Work

to compare the effect of opioid-free using Dexmedetomidine and opioid-based using Fentanyl on hemodynamics (inducing deliberate hypotension and providing a better surgical field exposure), post-operative pain intensity and the incidence of side effects in patients scheduled for rhinoplasty surgeries.

Patients and Methods

This study included Fifty adult patients undergoing rhinoplasty surgery. Patients were randomly divided into two equal groups. Group D received Dexmedetomidine and Group F received Fentanyl. Patients are ASA physical status I, age group ranged from 18 to 45 years.

Results

The study revealed a statistically significant decrease mean of group D compared to group F according to intraoperative mean arterial blood pressure. statistically significant decrease mean of group D compared to group F according to intraoperative heart rate (beat/min).

Conclusion

We found that dexmedetomidine is better than fentanyl for patients who undergo rhinoplasty surgeries to achieve controlled hypotension, decrease dosages of postoperative analgesics, prolong the duration of postoperative analgesia and decrease postoperative nausea and vomiting.
Comparison of Analgesic Efficacy between Bupivacaine with Dexamethasone and Bupivacaine Alone in Caudal Block for Pediatric Patients Undergoing Open Inguinal Hernia Repair
Authors: Mohammed Mohammed A , Kamaly Ayman M , Nasr Thabet A , Azim Heba A
Published: October 2021

Background

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

Objective

To evaluate the analgesic effect of dexamethasone when given caudally as an adjuvant to caudal block vs bupivacaine alone in caudal block for children undergoing open inguinal hernial repair surgeries.

Methods

The study is a prospective double – blinded randomized controlled trial conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group BD who would receive caudal dexamethasone added to Bupivacaine and Group B who would receive caudal block with Bupivacaine.

Results

Dexamethasone addition shows statistically significance difference between two groups according to FLACC scale at 4h, 8h and 12h. The duration of adequate analgesia (FLACC pain score 4 or less) was significantly higher in group BD compared to group B.

Conclusion

Dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than bupivacaine alone in caudal block at similar doses in controlling postoperative pain.
A Comparative Study between Caudal and Penile Blockade in Pediatric Patients Undergoing Hypospadias Repair
Authors: Eldemirdash Mona Ismail Mohammed Fadl , Gadalla Raouf Ramzy , Fahmy Neveen Gerges , Maky Yahia Mamdouh Hassan
Published: October 2021

Background

Regional anesthesia, in combination with general anesthesia, is frequently used for children undergoing surgical procedures.

Aim of the Work

to compare postoperative analgesia between caudal block and penile block with bupivacaine in elective hypospadias repair cases in pediatric patients.

Patients and Methods

This study is a randomized clinical study conducted in the operating theaters of pediatric surgery unit in Ain shams university hospitals. The study was performed after ethical committee approval and informed consent from the parents after full explanation of the procedure, possible side effects and complications. This study was done in the period between March 2019 and August 2019.it included sixty male children undergoing hypospadias repair.

Results

Postoperative pain was evaluated by FLACC pain score at PACU, 2, 4 and 8, 12, 16 and 24 hrs. There was a significant increase in the pain score in group C starting from the fourth hour postoperativly and thereafter every hour, while the lowest pain scores were recorded in group P (P < 0.05). Also, the time to first need for rescue analgesia was significantly shorter in group C (240 +/-105 min) compared with group P (720 +/-301) (P>0.01).The total rescue analgesic requirement was significantly lower in group P (168.26 +/22.69) than group C (573.8+/- 124.1) (P < 0.01).Postoperative time of ambulation was significantly lower in group C (6.95+/- 3.22) compared with group P (5.28+/-1.99) (P < 0.01).

Conclusion

Dorsal penile nerve block in children undergoing penile surgery provides effective and a longer duration of postoperative analgesia and decreased postoperative analgesic requirements with more hemodynamic stability both intraoperatively and postoperatively, as it is safer and easier to perform, with higher success rates than caudal epidural block, which is invasive and shows some difficulty in practice.
A Comparative Study between Dexamethasone versus Paracetamol Added to Xylocaine in Local Intravenous Anesthesia in Upper Limb Minor Surgeries
Authors: Elkabarity Reem Hamdy , Labib Heba Abdel Azim , Elfar Marwa Mamdouh , Sharaf Mostafa Mohamed Mohamed Ibrahim
Published: October 2021

Background

Intravenous regional anesthesia (IVRA) is a technically simple, reliable and costeffective method of regional anesthesia for short operative procedures of the extremities. It is easy to be administered, of lower cost compared with general anesthesia, no need for deep sedation and can be used for emergency operations on extremities for patients with full stomach.

Objective

Comparison between the anesthetic and analgesic parameters in local intravenous anesthesia by adding Paracetamol and Dexamethasone to xylocaine.

Patients and methods

This study was carried out in Ain Shams University hospitals for six months (from August 2018 to February 2019) on 45 patients of both sexes aged 20-50 years belonging to ASA I & II undergoing forearm and hand surgeries using IVRA.

Results

There was no significant difference between group (P), Group (C) as regard sensory, motor recovery times, both had a shorter sensory and motor block time need to an opioid dose as an analgesic dose. Group (D) had the fastest sensory and motor block time and more prolonged recovery time than group (P) and group (C) need less opioid dose as analgesia for controlling pain. As regard postoperative analgesic requirements. Group (D) and group (P) needed less analgesic doses than group (C) but there was no significant difference between group (P) and group (C).

Conclusion

Addition of 8 mg Dexamethasone as adjuvant to xylocaine for intravenous regional anesthesia led to: Reduction the dose of xylocaine used for IVRA, Shortening the sensory and motor block onset times, Prolong the sensory and motor block recovery times, and Reduction the postoperative analgesic requirement with satisfaction for patient and surgeon.
Comparative study of the performance of SOFA and qSOFA versus SIRS criteria for predicting mortality among septic patients admitted to the intensive care unit
Authors: Aly Naglaa Mohammad , Hussein Mustafa Mansour , Allah Mohammad Mohammad Kamal Abd , Abd-El Magid Mustafa Youssef
Published: October 2021

Background

Sepsis is considered one of a life-threatening condition among intensive care unit (ICU) patients. Although, there are evidence-based management guidelines, sepsis still remains a leading cause of death with in-hospital mortality ranging from 22.8% to 48.7%. Previously sepsis was defined as systemic inflammatory response to infection, which could be diagnosed by meeting two or more Systemic Inflammatory Response Syndrome (SIRS) criteria, along with a known or suspected infection. Even though the SIRS criteria were sensitive, but they were not specific enough to differentiate between sepsis and other inflammatory conditions.

Objective

To compare between the ability of SOFA score, the quick SOFA (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) to predict ICU mortality.

Patients and Methods

Randomized prospective comparative study conducted in El Haram Specialized Hospital. The study included 75 patients. We calculated SOFA, SIRS, and qSOFA scores based on physiological and laboratory data that were collected upon admission to the ICU. Standard criteria were applied with a threshold of 2 or more points for each scoring system. The baseline SOFA score was assumed to be zero for patients without a known preexisting organ dysfunction. The baseline total SOFA score was considered to be 4 for patients undergoing chronic dialysis, and 2 or 3 for cirrhotic patients, depending on baseline bilirubin levels.

Results

ROC curve analysis between survival and each of SIRS, qSOFA and SOFA, it shows that SOFA score presented the best discrimination with an AUC of 0.993 (95% CI 0.981–100).

Conclusion

In patients with suspected infection admitted to an ICU, an increase in SOFA score had greater prognostic accuracy for in-hospital mortality than SIRS criteria or qSOFA. These findings suggest that SIRS and qSOFA may have limited use for predicting mortality in an ICU setting.
A comparative study between bupivacaine-dexmedetomidine mixture versus bupivacaine-magnesium mixture in Pre-incision skin infiltration for para-umbilical hernia repair regarding their intraoperative and postoperative analgesic effect
Authors: Kandeel Nahla Y , Bassiony Mohsen A , Soliman Ahmed K , Toulan Heba F
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 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

to compare skin infiltration with bupivacaine-dexmedetomidine mixture versus bupivacainemagnesium mixture for analgesia in patients undergoing para-umbilical hernia repair under general anesthesia. magnesium.

Results

This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics which can be explained by different mechanisms: inhibition of painconduction in C -fibers, decreased in the production of inflammatory cytokines, the vasoconstrictive effect of 2 on vascular smooth muscle prolongs the time of analgesia, inhibition of tetrodotoxin-sensitive Na+ channels, and the absorption of dexmedetomidine to systemic circulation resulting in supraspinal analgesia.

Patients and Methods

A prospective randomized clinical trial study was conducted in Ain Shams university hospital on 44 adult patients undergoing para umbilical hernia or infra umbilical incisional hernia repair. The patients were randomly divided into two groups using their computer-generated random numbers will be enrolled in group D for bupivacaine-dexmedetomidine and group M for bupivacaine-

Conclusion

Pre-skin incision wound infiltration with dexmedetomidine–bupivacaine mixture provides prolonged local anesthetic effect, decreases the need for rescue analgesics, and provides better sedation than bupivacaine–magnesium sulfate mixture or bupivacaine alone in patients undergoing surgeries for hernia repair.
Comparative Study Between Caudal Block And Local Wound Infiltration In Inguinal Hernia Repair In Pediatric Patients
Authors: Mageed Azza Mohamed Shafeek Abdel , Hussaein Wael Reda , Hafiez Rania Hassan Abdel , Hammouda Tarek Atef Abdullah
Published: October 2021

Background

Postoperative analgesia can be provided by a multimodal approach includes opioids, nonsteroidal anti-inflammatory drugs, paracetamol infusion and regional anesthetic techniques such as local infiltration or nerve blocks. In contrast to opioids, local anesthetics can be administered safely and in recent guidelines regional anesthesia is accepted as the cornerstone of postoperative pain relief in the pediatric patients.

Objective

Compare the postoperative analgesic effectiveness of local wound infiltration of bupivacaine against bupivacaine administered caudally in pediatric patients undergoing unilateral inguinal hernia repair.

Patients and methods

This study was carried out in Ain Shams University hospitals on 40 pediatric patients of both sexes aged from 6 months to 7 years belonging to ASA I or II undergoing elective unilateral inguinal hernia repair. They were randomly allocated into two groups: group C receiving caudal block, group L receiving local wound infiltration. Hemodynamic changes, postoperative pain score using FLACC pain score, postoperative analgesia and complications were recorded.

Results

There was no significant difference between the two groups as regard demographic data or hemodynamic variables. Pain score shows no statically significant differences between two groups in the first hour. But statistically significant decrease in FLACC score after (1, 2 and 3 hours) in group C in comparison with group L.decreased significantly in group C after 1 hour postoperative. Duration of analgesia longer in group C with no significant difference in total amount of postoperative analgesia. There was significant increase in incidence in complications in group C than group L

Conclusion

Caudal block provides better and longer analgesia but requires experience and may lead to complications. In contrast, wound infiltration is simple without significant side effects. Therefore, local wound infiltration may be a preferred technique for producing postoperative analgesia in pediatric inguinal hernia repair.