bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Arterial versus Venous Lactate and Base Deficit in Assessing Prognosis of Septic Patients
Authors: Kamel Amr Mohamed Al-Saeed , Thabet Wael Reda Hussein , Fouad Mohamed Emad Eldeen Mohamed
Published: August 2023

Background

Septic shock is a syndrome of pathologic, physiologic, and biochemical disturbances caused by infection, and it is a major public health concern worldwide. Many techniques have been developed for the early detection of septic shock and prompt resuscitation. Lactate-guided resuscitation decreased mortality in patients with septic shock compared to that of resuscitation without lactate monitoring. In 2016, the international consensus launched a new sepsis definition (Sepsis-3), which is composed of the sepsis condition, the need for a vasopressor to maintain a mean arterial pressure of ≥ 65 mmHg and a serum lactate level rising to be ≥ 2 mmol/L in the absence of hypovolemia.

Aim of the Work

The aims of the study are to determine if lactate and standard base deficit can be used interchangeably in patients with septic shock in the emergency setting and to demonstrate whether venous blood gases could act as a surrogate for arterial blood gases in patients with sepsis syndrome.

Patients and Methods

This prospective observational study was conducted on 35 patients admitted to the ICU with a diagnosis of sepsis or septic shock in the Intensive Care Units at Ain Shams University Hospitals through 6 months.

Results

Our study found a significant correlation and high levels of agreement between arterial lactate and peripheral venous lactate in patients admitted to ICU with sepsis indicating the possibility of their interchangeable use. Our data also demonstrated strong correlations across lactate and base excess but not between lactate and anion gap in patients with septic syndrome. The results of our study indicate that base deficit is superior to lactate level as a predictor of mortality. Only, the 2nd arterial and venous base deficit at 24-hours revealed highly significant differences between both survivors and non-survivors.

Conclusion

Our study demonstrated a high level of agreement in the lactate levels as measured on venous samples and arterial samples in patients with septic syndrome; we also demonstrated that lactate and base excess showed a strong correlation with each other, but not with anion gap. Thus, these biomarkers can be used interchangeably to help in the early determination of septic shock, and also venous lactate levels are reliable in the resuscitation of patients with sepsis. A larger multicenter study may be required to confirm the generalizability of our results.
Adductor Canal Block versus Intravenous Patient Controlled Analgesia for Postoperative Pain Control for Primary Total Knee Arthroplasty
Authors: Elsinsar Mohamed Hamza Elsaid , Korraa Alaa Eldin Abd Elwahab Amin , Sharaf Amr Gaber Sayed , Taha Sahar Mohamed Talaat
Published: August 2023

Background

Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility, nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response.

Aim of the Work

to compare efficacy, hemodynamic effects, opiate consumption and side effects of Adductor canal block and intravenous patient-controlled analgesia (PCA) in terms of postoperative primary total knee arthroplasty analgesia.

Patients and Methods

The study was performed upon 60 patients, randomly distributed into two equal groups: Group I: Patients of this group underwent ultrasound guided single shot adductor canal block after the end of surgery and before extubation with 20 ml of bupivacaine 0.5% and Group II: Patients of this group received intravenous patientcontrolled analgesia (PCA) with Nalbuphine after the end of surgery and before extubation. For each patient, the following data were collected: age, sex, weight, height, ASA, hemodynamic changes, VAS, Nalbuphine extradoses consumption, Side effects such as nausea, vomiting, pruritus, urinary retention and hypotension were recorded. Orthopedic rehabilitation indices were assessed by physiotherapy staff.

Results

ACB provided more effective analgesia for the first 6 hours but PCA with nalbuphine was superior after and for the rest of 24 postoperative hours.

Conclusions

Adductor canal block had good control of pain for the first 6 postoperative hours. However, the conventional use of intravenous PCA containing opioids was more effective for the rest of the first 24 postoperative hours.
A Comparison between Sub-Sartorial Canal Block and Femoral Nerve Block for Postoperative Analgesia after Arthroscopic Knee Surgery
Authors: Aboelela Sahar Kamal Mohammed , Alansary Amin Mohammed , Abdou Khaled Mohammed Ahmed Mohammed , Helmy Elsayed Mohamed
Published: August 2023

Background

Knee arthroscopy is a common orthopedic procedure worldwide, despite its minimally invasive nature compared to the traditional knee surgery, post-arthroscopic pain may be severe, and the patients generally require a significant amount of opioid-based analgesics after such procedures.

Aim of the Work

The aim of the study is to compare the analgesic efficacy and functional recovery of ACB and FNB in patients who have undergone knee arthroscopy.

Patients and Methods

In the period from April 2021 to October 2021 sixty patients who underwent Arthroscopic knee surgery were randomly allocated to one of two groups and comparative study was done. Group I (group FNB): (no. 30): Patients received Femoral Nerve Block (FNB) after spinal anaesthesia. Group II (group ACB): (no. 30): Patients received Sub-sartorial canal block (Adductor Canal Block) (ACB) after spinal anaesthesia.

Results

During our study, it was found that ACB is equally effective with FNB in patient satisfaction for post operative analgesia (NRS at 4 hrs, 8 hrs, 12 hrs, 16 hrs, 20 hrs and 24 hrs was non-significant as P value was 0.3, 0.29, 0.1, 0.5, 0.35, 0.87 respectively) but ACB is more effective than FNB in post operative ambulation and rehabilitation after arthroscopic knee surgery (ACB ambulated after 180.7 ± 23.6 mins in ACB and 241.2 ± 29.12 mins in FNB with pvalue <0.001). When compared to our study, it revealed that the group received FNB suffered from quadriceps weakness which interfered with postoperative rehabilitation and early ambulation although postoperative analgesia was equally effective in comparison to the group received ACB.

Conclusion

Our study concluded that Adductor Canal Block is more effective than Femoral Nerve Block in post operative ambulation and equally effective with femoral nerve block in patient satisfaction for post operative analgesia after arthroscopic knee surgery.
Erector Spinae Plane Block for Post-Operative Analgesia in Lumbar Spine Surgeries
Authors: Ibrahim Ahmed Saeed Mohamed , Ibrahim Waleed Abdalla , Mekky Yahia Mamdouh Hassan , Ezz el dien Mohamed Islam
Published: August 2023

Background

Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Lumbar spine surgeries are usually associated with acute postoperative pain and restricted mobility. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures.

Aim of the Work

The present study was designed to assess the analgesic efficacy and safety of ultrasound guided ESPB done at lumbar transverse process level in patients undergoing lumbar spine surgeries for postoperative analgesia.

Patients and Methods

The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients’ consent. It included a total of 70 adult patients aged 21-50 years, Scheduled for lumbar spine surgeries.

Results

The main finding in this study was that ultrasound guided ESPB at level of lumbar process provides a good analgesic effect in patients undergoing lumbar spine surgery as following: Reduced the total amount of postoperative morphine consumption in comparison to controlled group, prolonged the time to first request of analgesia (duration of analgesia), provided early mobilization, increase patient satisfaction in 1st 24 hour, decease incidence of nausea and vomiting due to decrease opioids Intake.

Conclusion

Ultrasound-guided bilateral erector spinae plane block reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients’ satisfaction in the first 24 hours after lumbar spine surgeries, without any associated adverse effects or complications.
Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Intravenous Patient Controlled Analgesia for Post Operative Analgesia in Parturients Undergoing Cesarean Delivery under General Anesthesia
Authors: Hussein Mohamed Tarek , Marzouk Mervat Mohamed , Ahmed Dalia Mahmoud , El-Aziz Heba Fouad Abd
Published: August 2023

Background

Cesarean delivery rates are rising, and efficient postoperative pain management is a key priority of women undergoing cesarean delivery. Inadequate pain management in the acute postoperative period is associated with persistent pain, greater opioid use, delayed functional recovery, and increased postpartum depression. In addition to pain relief, optimal management of patients after cesarean delivery should address the goals of unrestricted maternal mobility, minimal maternal and neonatal side effects, rapid recovery to baseline functionality, and early discharge home.

Aim of the Work

The Primary aim is to compare the efficacy of TAP block versus PCA with IV morphine to Provide Prolonged Post-operative analgesia. Secondary objective is to identify the side effects of both techniques as post operative analgesia.

Patients and Methods

74 patients were randomly allocated to one of 2 groups (n=37; each); group A received general anesthesia followed by US-guided TAB block at the end of the operation before extubation using 20 ml bupivacaine 0.25% bilaterally. Group B: received general anesthesia followed by PCA at the end of operation after extubation via dedicated 20 G canula woth disposable PCA pump of 100 ml volume, through continuous infusion of 2 ml/hr & bolus application of 1 ml with 15 min lock time using 50 mg morphine, 60 mg ketorolac, 2 mg granisetrone & filled with 0.9% normal saline.

Conclusion

when TAP block is given in the volume of 20 mL bilaterally, it is as effective as intravenous Morphine PCA in pain treatment. Compared with intravenous PCA, TAP block can be considered as a more preferable method because it can avoid the systemic actions of morphine used for PCA, and its analgesic effect begins earlier.
A Comparative Study between the Effect of Addition of MgSO4 or Dexamethasone to Bupivacaine on the Prolongation of Ultrasound-Guided Quadratus Lumboram Block in Open Abdominal Surgeries
Authors: El Ella Sahar kamal Abo , Samir Ghada Mohamed , El Mawla Saleh Mohamed Abd , El Shabrawy Moussa El Sayed Moussa
Published: August 2023

Background

Operations 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 regional anethesia.

Aim of the Work

The aim of this study was to assess the analgesic effect of addition dexamethasone or magnesium with bupivacaine in ultrasound-guided QLB to prolong it’s duration in patients undergoing open abdominal surgeries in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions.

Patients and Methods

After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients undergoing open abdominal surgeries were included in the study, and were divided into three groups (n = 22; each); group M, D and group C. In Group A, patients (n = 22) received 20 ml bupivacaine 0.25% plus 5 ml of 10% MgSO. In group B, patients (n = 22) received 20 ml bupivacaine 0.25% plus 8 mg dexamethasone (2 ml) plus 3 ml 0.9% NaCl. In group C (control), patients (n = 22) received 20 ml bupivacaine plus 5 ml 0.9% NaCl.

Results

The thesis proved that the addition of either magnesium sulfate or dexamethasone to bupivacaine 0.25% in ultrasound guided QLB for open abdominal surgeries hastened the onset, prolonged the duration of sensory block, increased post-operative analgesia and decreased rescue analgesia needed without increasing the risk of adverse effects, with Dexamethasone showed better results.

Conclusion

The addition of either 500 mg magnesium sulfate or 8 mg dexamethasone to 20 ml bupivacaine 0.25% in ultrasound guided quadratus lumborum block for open abdominal surgery prolonged the duration of analgesia significantly and decreased the postoperative analgesic requirement. Hence, this study suggests that either magnesium or dexamethasone may be a useful alternative as an adjuvant to long-acting local anesthetics for quadratus lumborum nerve block with Dexamethasone showed better results.
Use of Lactate Clearance as a Predictor of Mortality Rate after Initial Resuscitation in Patient with Severe Sepsis or Septic Shock
Authors: Sedky Karim A , Ghobrial Bassem B , Aboassal Noha M , Talaat Sahar M
Published: August 2023

Background

Early diagnosis of sepsis is the key for improving the survival. Culture is the diagnostic tool but the microbiological origin of infection is demonstrated in about 2/3rd of cases. Biomarkers have an important place in this process because they can indicate the presence or absence of sepsis and they are also important in evaluating the response to therapy and recovery from sepsis.

Aim of the Work

to find a correlation between the lactate clearance and mortality in patients with severe sepsis.

Patients and Methods

The study was conducted on 60 adult critically ill patients of both sexes with severe sepsis, who were admitted to the unit of Critical Care Unit in Ain Shams University Hospital. All participants were subjected to the following: detailed history, full laboratory and radiological investigations to diagnose sepsis including lactate level on presentation (0 hour), after 6 hours and after 24 hours, then lactate clearance is calculated and patients were divided to lactate clearance group and non-clearance group.

Results

The study showed that clearance patients significantly had lower mortality rate, SOFA score, vasopressor therapy duration, ventilation need and hospital stay days than the non-clearance patients.

Conclusion

Lactate is a good marker for predicting mortality and evaluating the initial resuscitation and management of severe sepsis and septic shock.
Effect of Epidural Dexmedetomidine vs Nalbuphine for Labor Analgesia: A Randomized Clinical Trial
Authors: EL Kabarity Reem Hamdy , El Fawal Sanaa Mohammed , Abd El Tawab Samar Mohammed , Ahmed Nourhan Tarek Fouad
Published: August 2023

Background

The addition of dexmedetomidine or nalbuphine to epidural bupivacaine was tested to reduce labor pain in women undergoing normal delivery.

Patients and Methods

64 patients were randomly allocated into two groups of 32 parturients each with conscent from parturients. Groups A and B received a bolus of 12 ml volume consisting of 11 ml of 0.25% bupivacaine and 0.5 μg/ml dexmedetomidine (1 ml volume) through the epidural catheter and then a top up dose of 6 ml volume consisting of 5 ml of 0.25% bupivacaine and 0.5 μg/ml dexmedetomidine (1 ml volume) were given when VAS score becomes 4 or more and a bolus of 12 ml volume consisting of 11 ml of 0.25% bupivacaine and 10 mg nalbuphine (1 ml volume) through the epidural catheter and then a top up dose of 5 ml of 0.25% bupivacaine and 2 mg nalbuphine (1 ml volume) respectively. Assessments included VAS score for pain, vital data monitoring, recording of duration of stages of labor, neonatal APGAR score and adverse effects.

Results

Parturients in both groups had satisfactory labor analgesia, but those in the dexmedetomidine group had lower pain scores than those in the nalbuphine group. Taking into consideration that dexmedetomidine had a faster onset than nalbuphine.

Conclusion

Epidural dexmedetomidine seems to offer some advantages over epidural nalbuphine.

Thus, it can be used effectively and safely as an adjuvant to epidural bupivacaine in labor analgesia.
Low Dose Caudal vs Dorsal Penile Nerve Block for Postoperative Analgesia after Circumcision
Authors: Zaki Mohamed Sidky Mahmoud , Sersi Mayar Hassan El , Mahrose Ramy Ahmed , Elnaggar Samar Sobhi
Published: August 2023

Background

Circumcision is a painful surgery that is mostly performed under general anesthesia in order to eliminate fear and anxiety. Regional techniques are more effective than systemic opioids, non steroidal anti-inflammatory drugs, and acetaminophen for postoperative analgesia in circumcision, The most preferred techniques are dorsal penile nerve block and caudal block.

Objective

To investigate the effectiveness of post operative analgesia and complications among dorsal penile nerve block, caudal block and the combination of both.

Patients and Methods

Our study was carried out to compare the effectiveness, duration of postoperative analgesia, and the complications among dorsal penile nerve block (DPNB), caudal nerve block (CNB) and the combination of both. This study was carried out on 81 male patients, aged from 3-12 years old & undergoing circumcision. The patients were divided into 3 groups, each is composed of 27 patients; group 1 including DPNB patients, group 2 including CNB patients and group 3 for combined block. This study compared between the three groups regarding the intraoperative vital data (HR,BP), post-operative VAS scores and the complications (nausea, vomiting, urinary retention, itching, constipation & CNS depression).

Results

The demographic data (age, weight & height) does not differ between the three groups of the study. There is difference in the VAS score post operatively, being significantly less in the CNB group. There was no significant difference in the percentage of complications between the groups, except for urinary retention being slightly increased in the CNB group.

Conclusion

Our results showed that, CNB is superior to DPNB in intraoperative and postoperative analgesia after circumcision as regarding pain control. However CNB is associated with more complications compared to the DPNB. Also, the results showed that there‟s no need to combine both blocks as it gave the same results as with the CNB alone.
Ultrasound Guided Fascia Iliaca Compartment Block versus Three in One Block for Post Operative Analgesia in Patients Undergoing Hip and Knee Replacement Surgeries
Authors: Hosny El-Sayed Shereen , Ismail El-Seady Mohammed , Khalil George Mikhaiel , Tawab Samar Mohammed Abdel
Published: August 2023

Background

Patients undergoing total hip and knee arthroplasty experience substantial and sustained postoperative pain. Inadequate analgesia may impede physical therapy and rehabilitative efforts and delay hospital dismissal. Peripheral nerve blockade of the lumbosacral plexus has emerged as an analgesic approach. In several studies, unilateral peripheral block provided quality of analgesia and functional outcomes similar to those of continuous epidural analgesia and superior to those of systemic analgesia, but with fewer side effects because of their opioid-sparing properties. Peripheral nerve block techniques may be the optimal analgesic method following total joint arthroplasty.

Aim of the Work

To compare postoperative analgesia between ultrasound-guided FICB and three in one nerve block.

Study design

a prospective randomized double-blinded study.

Patients and Methods

The study was conducted on 80 randomly chosen patients from 21 to 65 years old in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 40 patients group I and group II. After preoperative assessment and obtaining baseline vital data, all patients received spinal anesthesia. Patients in the group I received FICB (35-40 ml of 0.25% bupivacaine). Patients in group II received three in one bock (35-40 mL of bupivacaine 0.25%).

Results

Both FICB and three in one block provided good quality of postoperative analgesia and patient satisfaction as evidenced by low VAS and low postoperative rescue analgesic requirements. Both techniques provided equal sensory blockage of femoral nerve, obturator nerve, and genitofemoral nerve, but sensory blockage of LFC nerve was demonstrated in 92.5% patients in FICB and 62.5% of patients in three in one block, which was significantly lower (p-value <0.001 HS). VAS at 12 hours after surgery during movement of 3.68 ± 2.77 in the FICB group and 4.90 ±0.18 in the 3 in 1 group were statistically significant (P value = 0.007).

Conclusion

The FICB provides a high degree of sensory blockade of the LFC nerve and improves analgesia when continuous passive motion is initiated in the early postoperative period; also, it is easy to perform, reliable and does not threaten any vital organ. Thus, FICB can be recommended as an alternative to three in one block for the treatment of pain after hip and knee arthroplasty.
Comparison of Bilateral Ultrasound-Guided Intermediate Cervical Plexus Block vs Local Wound Infiltration for Postoperative Analgesia in Patients Undergoing Total Thyroidectomy
Authors: Sultan Sherif Sayed Ali , Nofal Walid Hamed , El Naeim Ismaiel Mohamed Abd El Mohsen Abd , Allah Shrouk Mohamed Abd
Published: August 2023

Background

The thyroid gland surgery is a common and painful procedure demanding analgesia. Bilateral intermediate cervical plexus block (BSCPB) could be beneficial for analgesia in thyroid surgery. In this study we will evaluate the analgesic efficacy of ultrasound guided intermediate cervical plexus block vs local wound infiltration in patients undergoing elective thyroidectomy under general anaesthesia.

Objective

To evaluate the analgesic efficacy and possible side effects of ultrasound guided intermediate cervical plexus block vs local wound infiltration in patients undergoing elective thyroidectomy under general anaesthesia as a primary outcome. The secondary outcome is the assessment of the safety of ICPB and the total dose of meperidine used for 24 hours postoperatively.

Patients and Methods

40 patients were divided into two equal groups: Group A: The patients received intermediate cervical plexus block with 10 ml of 0.25% bupivacaine. The same will be repeated on the contralateral side. Group B: Patient will receive local wound infiltration with 20 ml bupivacaine 0.25% under the skin immediately before extubation by the surgeon for pain control.

Results

ICPB group showed significant lower median score compared with LWI group at time 2 hrs, 4 hrs, 6 hrs, 12 hrs The time for first dose meperidine was significantly longer in ICPB group (17.2 ± 3.02 vs 10.15 ± 1.84) while Total 24 h meperidine consumption was significantly less in ICPB (26.25 ± 17.16 vs 36.25 ± 12.76)

Conclusion

Intermediate cervical plexus block provides another safe alternative analgesia compared to superficial blocks and local wound infiltration with better analgesic efficacy.
Analgesic Sparing Effect of Dexamethasone with Levobupivacaine in Quadratus Lumborum Block in Patients Undergoing Unilateral Inguinal Hernia Repair
Authors: Wahba Sherif Samir , Khalaf Khaled Mostafa , Hafez Amr Fouad , Ahmed El Shahawy Yasmin Tarek Ali
Published: August 2023

Background

The QLB is an effective analgesic technique for various abdominal wall incisinos. The QLB covers T7 to L2 dermatomes. Levobupivacaine is a long-acting LA agent, commonly used for peripheral nerve block due to its better safety profile than that of bupivacaine. Dexamethasone as an adjuvant to LA has been shown to prolong the duration of pain-free period, less requirement for rescue opioids consumption, more patient satisfaction and lesser incidence of nausea and vomiting.

Objective

To assess the analgesic sparing effect of adding dexamethasone to levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair under general anesthesia.

Patients and Methods

After approval of the anesthesiology department and scientific and ethical committees, this prospective double blind randomized clinical trial study was conducted in Ain Shams University Hospitals. Sixty patients scheduled for elective ingunial surgeries under general anesthesia were included in this study.

Results

Our study did not have any complications associated with the use of dexamethasone with levobupivacaine in QLB. Type 1 QLB failed to provide postoperative analgesia in surgeries involving dissection in the retroperitoneal area as there were high chances of damaging the thoracolumbar fascia.

Conclusion

The addition of dexamethasone to levobupivacaine in QLB in unilateral inguinal hernia repair surgery provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to levobupivacaine alone group.
The Effect of Low Dose Nalbuphine or Ketamine in the Prevention of Emergence Agitation after Sevoflurane Anesthesia in Children Undergoing Tonsillectomy with or without Adenoidectomy
Authors: Ahmed Tarek M Ashor , Mostafa Zakaria Abdelaziz , Ismail Yasser Alaa , Haiba Diaaeldein Mahmoud
Published: August 2023

Background

Emergence agitation (EA) in children is increased after sevoflurane anesthesia. Nalbuphine and midazolam have been used for prophylactic treatment with controversial results.

Patients and Methods

Totally, 90 children between 4 and 10 years of age and of American Society of Anesthesiologists I-II undergoing adenotonsillectomy under sevoflurane-based anesthesia were enrolled in the study. Children were randomly allocated to one of the three groups: group N received nalbuphine 0.1 mg/kg, group K received ketamine 0.25 mg /kg and group S received the equivalent volume saline. The study medications will be given after discontinuation of sevoflurane by the end of surgery. In the post anesthesia care unit EA was assessed with emergence agitation scale upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25) and 30 min (T30).

Results

In the PACU, the incidence of EA (emergence agitation scale) were significantly lower in the N Group (6.6%) and K Group (16.6%) compared to S group (33%) with (p = 0.044), the duration in PACU was significantly prolonged in S group compared to K group and N group (p- value 0.011), more patients experienced postoperative pain (mCHEOPS) in S group compared to N group and K group ( p-value 0.001).

Conclusion

Nalbuphine 0.1 mg/kg or ketamine 0.25 mg/kg are effective in preventing emergence agitation following sevoflurane-anesthetized adenotonsillectomy paediatric patients.
Effect of Kefir Extract against Sodium Hydroxide Induced Corrosive Esophageal Injury in Adult Male Albino Rats
Authors: Mahmoud Nesma Kamal , El Hamied Hemmat Abd El Kader Abd , Aal Youssef Shoukry Abdel , Gaber Noha Mohamed
Published: August 2023

Background

Ingestion of corrosive substances and its long-term effect on the gastrointestinal system especially the esophagus is considered as an important public health issue in spite of the multiple efforts to educate the public. Mucosal injury begins within minutes of caustic ingestion. Kefir extract is fermented milk, produced from grains that comprise a specific and complex mixture of bacteria and yeasts that live in a symbiotic association, this symbiotic culture of bacteria and yeast forms “grains” that resemble cauliflower. The grains are soft, gelatinous white biological mass, compromised of proteins, lipids and soluble polysaccharide that surround bacteria and yeast. It is prepared by inoculating cow, goat, or sheep milk with kefir grains for about 24 hours at room temperature.

Aim of the Work

The aim of the present work was to investigate the possible curative role of kefir on the structure of esophageal mucosa when injured after corrosive agent.

Material and Methods

Thirty adult male albino rats were used in this study. The rats were randomized into four groups: The control group was further subdivided into two subgroups (I a served as a negative control, I b received one ml of kefir once daily orally), the corrosive esophagitis group (rats received one ml of 5% NaOH orally and sacrificed on the same day), spontaneous healing group (rats received one ml of 5% NaOH orally and left for seven days) and the kefir treated group (rats received one ml of 5% NaOH orally and then received one ml of kefir once daily orally for seven days). At the end of experiment, rats were euthanized, and esophageal specimens were processed into paraffin blocks for light microscopic examination and other specimens were processed into scanning electron microscopic examination.

Results

The general cellular morphology of the esophageal mucosa after NAOH administration was greatly affected. Erosions of the epithelial covering with shedding of the epithelial cells in the lumen, loss of keratin layer, and massive lymphocyte infiltration were noticed in the lamina propria. Kefir treated group for seven days showed histopathological findings mostly normalized compared with corrosive esophagitis group; normal appearance of the surface mucosa was detected with restoration of keratin layer and reduced inflammatory cell infiltrate and vascular congestion were observed.

Conclusion

NAOH is capable of producing injury to esophageal mucosa. The present study showed a novel and favorable effect of kefir on the structure and function of the esophageal mucosa.
The Potential Link between Obesity, Synbiotics Intake and Inflammasomes in an Animal Model
Authors: Medhat Christeen , Mohamad Magda I , Sallam Reem M
Published: August 2023

Background

Obesity is one of the major public health problems worldwide, being considered a global epidemic. A growing body of evidence highlights the relevance of inflammasomes as a consequence of metabolic disorders and obesity. NLRP3 is the most studied component of the inflammasomes. Gut microbes contribute to the subclinical systemic inflammation that ultimately leads to the development of pathologies such as obesity, insulin resistance. Therefore, the use of intestinal microbiota modulators (e.g probitoics, prebiotics, or both as synbiotics) may improve several metabolic and immune functions. Recently, the link between these modulators and NLRP3 in obesity is less investigated.

Aim of the Work

to study the potential involvement of inflammasomes as an indicator for the efficacy of synbiotics in alleviating diet-induced obesity.

Materials and Methods

Thirty adult male Wistar rats were randomly divided into four groups (7 rats /group): normal control group (receiving normal diet), HFD (high fat diet) group, normal group receiving synbiotics, and HFD rats receiving synbiotics. After eight weeks, all rats were sacrificed then WAT (visceral, subcutaneous), brown adipose tissue, and liver were obtained. The body weight of each rat was measured weekly. The expression of NLRP3 was performed by real-time PCR.

Results

HFD induced a significant weight gain compared to normal diet (p < 0.05). However, synbiotics administration could not affect such weight gain in rats receiving HFD with synbiotics (p > 0.05). The expression of NLRP3, pre-inflammatory marker, is elevated in adipose and liver tissues in HFD group compared to normal diet group (p < 0.05). However, synbiotics successfully reduced the expression of NLRP3 in all previous tissues (p < 0.05).

Conclusion

the intake of synbiotics could disrupt the inflammatory consequences of obesity through targeting the expression of NLRP3. Thereby, synbiotics might be a promising potential therapeutic agent in treatment of obesity.
Comparison between Myocardial Glycogen Storage in CABG after Using Blood Cardioplegia versus HTK Solution
Authors: Ammar Ashraf El Sebaei Ayman Mahmoud , Hikal Tamer Shahat , Elnaggar Abdelrahman Ahmed Abdelrahman Mousa
Published: August 2023

Background

Inadequate myocardial protection in long ischaemic periods followed by reperfusion is an issue of concern in cardiac surgery. Cardioplegic solutions improve the tolerance to ischaemia and reperfusion by preserving myocardial energy reserves, preventing osmotic and electrolyte imbalances and buffering acidosis.

Objective

This somewhat surprising given the high number of procedures performed worldwide with this cardioplegic solution. As such, the purpose of this study was to assess the safety of the HTK solution when compared with our standard blood cardioplegia in coronary artery bypass graft operations via assessment of myocardial glycogen storage.

Patients and Methods

This was a retrospective, convenient, non- randomized study conducted on 40 consecutive patients who underwent isolated elective CABG at department of cardiothoracic surgery at Ain Shams University Hospitals. The aim of the study was to compare early outcomes of Custodiol versus blood cardioplegia in coronary artery bypass graft surgery via assessment of glycogen storage in myocarduim via assessment of myocardial glycogen storage. at Ain Shams University Hospitals.

Results

There was no statistically significant difference between the two groups of myocardial glycogen storage post-operative.

Conclusion

There was statistically significant difference between the pre and post-operative in both custodial and blood cardioplegia. There was no statistically significant difference between the two groups of myocardial protection in mortality and morbidity. Custodiol cardioplegia is an easy technique and simple without need of preparation or repeated administration.
Effect of Cardiac Rehabilitation on the Psychological Changes in Post Myocardial Infarction Patients
Authors: Osman Abdishakur Abdulkadir , Saleh Ayman , khorsheed Hazem , Etraby Shahab , Habiby Mohamoud El
Published: August 2023

Objectives

To assess the effect of cardiac rehabilitation on the psychological changes in post myocardial infarction (MI) patients.

Background

Cardiac rehabilitation (CR) is a acceptable treatment strategy adding to the basic medical plan for the patients with coronary artery disease.

Subjects and methods

A prospective study that was conducted on 60 myocardial infarction patients and they were subdivided into 2 groups; group 1 included 30 myocardial infarction patients who underwent cardiac rehablitation and group 2: included 30 myocardial infarction patients who didn’t undergo cardiac rehablitation. All the included subjects underwent full history taking, full examination and echocradiography and psychological evaluation tests (state–trait anxiety inventory (STAI), Beck depression inventory (BDI) and hospital anxiety and depression scale (HADS)), before and after cardiac rehablitation.

Results

Comparison between the 2 groups regarding cardiac changes on follows up, there was significant difference between 2 groups regarding Left ventricular end diastolic diameter (LVEDD), Left ventricular end systolic diameter (LVESD) and ejection fraction (EF) (P-value = 0.0001, 0.0082 & 0.0261). Comparison between the 2 groups regarding psychiatric changes on follows up revealed that there was significant difference as regard STAI, BDI and HADS (P-value = 0.0001, 0.0.0001 & 0.0001).

Conclusion

Cardiac rehabilitation in post-MI patients could have beneficial effects on cardiac function without adversely affecting LV remodeling or causing serious cardiac complications. Participating in a cardiac rehablitation beneficially contributed to a decrease in depression and anxiety manifestations in post-MI patients.

Abbreviations

A-state: State-anxiety A-trait, Trait-anxiety; BDI: Beck depression inventory; BP: Blood pressure; CAD: Coronary artery disease; HADS: Hospital Anxiety and Depression Scale; HF: Heart failure; LVEF: Left ventricular ejection fraction; MI: Myocardial infarction; STAI: State–trait anxiety inventory
Neutrophil-to-Lymphocyte Ratio and Mean Platelet Volume in Predicting Coronary No-Reflow in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Authors: Eltelawy Ahmed , Othman khaled Said , Fakhry Hany Mohamed , El Etriby Shehab Adel
Published: August 2023

Background

This study was designed to investigate the role of neutrophil-to- lymphocyte ratio and mean platelet volume in predicting coronary no-reflow in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Objectives

knows the role of neutrophil-to-lymphocyte ratio and mean platelet volume in predicting coronary no-reflow in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Patients and Methods

The patients were divided into 2 groups according to TIMI flow grades after primary PCI. 50 patients with TIMI flow grade 3 formed (reflow group) and 50 patients with TIMI flow grades 0-2 formed (no reflow group).

Results

Cases which manipulated with post stent dilatation in no reflow group were significantly higher than in the reflow group (P = 0.028). EF by M mode was significantly lower in the no reflow group cases compared to those of reflow group (P = 0.040). Absolute lymphocytes were significantly higher in the no reflow group cases compared to those of reflow group (P = 0.001). Neutrophils to lymphocytes ratio were significantly higher in the no reflow group cases compared to those of reflow group (P = 0.011). MPV was significantly higher in the no reflow group cases compared to those of reflow group (P = 0.001). Hb level was significantly higher in the no reflow group cases compared to those of reflow group (P = 0.005). Mean platelet volume and Neutrophil to lymphocyte ratio are considered a promising positive predictors of no-reflow phenomenon after primary PCI.

Conclusion

Mean platelet volume is considered as a promising positive predictor of no-reflow phenomenon after primary PCI. Post stent dilatation and EF by M mode are new independent factors for predicting no-reflow phenomenon in patients 1 undergoing PPCI. Neutrophils to lymphocytes ratio has a role in predicting no reflow phenomenon in patients undergoing PPCI.
Impact of Right Ventricle Lead Position on Left Ventricular Function in Permanent Single and Dual Chamber Pacemakers
Authors: Hawass Ahmed N , Ramadan Ahmed Y , Ali Ahmed N , Tamara Ahmed M
Published: August 2023

Aim and objectives

To identify the short term effect of the pacemaker RV lead position related electric remodeling on LV systolic function

Patients and Methods

The study included 30 patients who presented with an indication of permanent pacing to the cardiology department of Ain Shams university hospitals and underwent permanent single or dual-chamber pacemaker insertion, 15 patients each with right ventricular (RV) apical pacing (RV apex), and 15 patients nonapical pacing (mid septal). 2D speckle tracking imaging technique was used for quantification of global longitudinal function of the left ventricle and dyssynchrony evaluation before pacemaker implantation and after a 3-month follow-up.

Results

2D speckle tracking echocardiography 3 months follow up post pacing revealed impairment of global longitudinal strain in all patients and Intraventricular dyssynchrony was significantly more in apical location compared to a non-apical location (radial dyssynchrony: 108.67 ± 11.68 msec vs. 80.53 ± 8.17 msec, p-value < 0.001) with more difference (50.53 ± 13.30 msec) in apical location compared to non-apical location difference (29.87 ± 6.64 msec), p-value < 0.001.

Conclusion

By the analysis of 2D speckle tracking echocardiography, In the short-term follow-up, we found that radial dyssynchrony was more in apical location when compared to the non-apical location of RV lead. The RV septal pacing is a better alternative in terms of less dyssynchrony compared to RV apical pacing. Older age, the higher percentage of pacing, and device type are prognostic factors for the development of pacemaker-induced cardiomyopathy.
Assessment of Left Ventricular Function Using Two- And Three-Dimensional Speckle Tracking Echocardiography among Healthy Egyptian Pediatric-Aged Children
Authors: Taalab Hany Nazmy , Sayegh Aya Tarek El , kamel Heba Mohamed , Attia Hebatalla
Published: August 2023

Background

Accurate measurements of left ventricular volumes and function are important in the management of patients with various cardiac abnormalities. Speckle tracking echocardiography has shown to be accurate in detecting subclinical myocardial dysfunction when most of the conventional echocardiograph parameters were normal or reported inconsistent results

Aim of the Study

To establish normal values for the LV systolic function among healthy Egyptian pediatric population using 2D and 3D speckle tracking Echocardiography.

Patients and Methods

the study included 200 subjects who attended cardiology department Ain Shams University for elective echocardiology below 6 years of age with unremarkable history and no chronic illness affecting LV function with normal 2D echocardiography.

Results

The study involved 200 subjects with age ranged from 0.1 to 5.9 years and its mean was 3.8±1.5 years. 104 were males representing 52% of subjects of the study while females were 96 representing 48%. Their weight ranged from 3.5 to 28 Kg and its mean was 17.14±4.9 Kg. Their height ranged from 0.11 to 1.24 M and its mean was 1.012±0.178 M. Body surface area ranged from 0.22 to 1.1 Kg/m2 and its mean was 0.695±0.151 Kg/m2.

Regarding the 2D speckle tracking parameters: longitudinal strain ranged from -18.6% to -24.6% with its mean was -21.314±1.57%. Circumferential strain was from -16.7% to 23.4% and its mean -19.02±1.23%. And radial strain ranged from 36.4% to 52.6% with mean 42.392±2.794%.

Regarding the 3D speckle tracking data: longitudinal strain ranged from -17% to -30% with its mean was -20.73±2.039%. Circumferential strain was from -11% to -21% with its mean -13.259±4.670%. And radial strain ranged from 41% to 61% with its mean 47.511±4.82%.
Effect of Cardiac Rehabilitation Program on Right Ventricular Function after Acute Inferior Wall Myocardial infarction
Authors: Salem Hazem S E , Kadry Ahmed , Khorshid Hazem , Dayem Khairy A
Published: August 2023

Aim and objectives

To assess the role of cardiac rehabilitation on right ventricular (RV) functional recovery by 2D speckle-tracking echocardiography (STE) in a cohort of patients with successful reperfusion after the first episode of acute inferior myocardial infarction (MI) associated with RV infarction.

Patients and Methods

Fifty patients who underwent successful percutaneous coronary intervention (PCI) after inferior MI mainly associated with ECG criteria of RV infarction were prospectively included (56.08 ± 10.79 years, 40 Men). Twenty-five patients started an exercisebased cardiac rehabilitation (exCR) program after 2-4 weeks of discharge; another twenty-five patients, who were taken as the control group, received the usual care but didn’t participate in the cardiac rehabilitation program. Both groups received guideline-directed medical therapy (GDMT). Echocardiography (including 2D STE and conventional parameters for assessment of RV systolic function ) was performed at baseline, and after a 3-month follow-up for all patients. High levels of strain impairment were observed in both groups at baseline. All parameters improved at 3-month follow-up compared to baseline. Nevertheless, RV global longitudinal strain (GLS) and free wall strain (FWS) improved significantly for patients who completed the cardiac rehabilitation program compared to the control group.

Conclusion

Cardiac rehabilitation is effective in improving RV strain parameters in patients who developed acute inferior MI associated with RV infarction. Future studies should directly assess the prognostic significance of STE measures of RV function in this population.
The Impact of Dapagliflozin on Cardiac LV Systolic Function in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Who Developed Post MI LV Dysfunction
Authors: Wasfy Karim , Altoukhy Sherif , ElRahman Mohamed Abd
Published: August 2023

Aim and objectives

To study the impact of dapagliflozin on LV systolic function in patients with ST Elevation Myocardial Infarction undergoing primary percutaneous Coronary Intervention who developed post MI LV dysfunction.

Patients and Methods

The study included 80 patient who presented with ST-segment elevation myocardial infarction and underwent primary PCI at the catheterization lab unit, Cardiology department, Ain Shams University. The patients were divided into 2 groups. The standard treatment was given to all patients according to the ESC guidelines including: ACEI or ARNi, a beta-blocker, and an MRA[1] uptitrated according to the clinical state of the patient. The study medication was 10 mg of dapagliflozin[1] given once daily in the morning to the case group and a placebo medication to the control group. LVEF was assessed in both groups post primary PCI and at follow-up after 3 months by the same Echo machine GE VIVED S5 after the procedure since first of June 2021 till end of January 2022.

Results

There were no statistically significant difference between both groups regarding gender distribution, mean age, and the incidence of different risk factors of CAD (smoking, Diabetes and hypertension). Regarding pain to door (PTD) time, there was no statistically significant difference between case and control groups (P-value = 0.695), and anterior STEMI was the most common presentation in both groups (90% in the case group and 77.5% in the control group in the control group). Subsequently, there was no statistically significant difference between case and control groups regarding TIMI flow, and post-MI EF with mean range 34.88% ± 3.55% in the case group and 34.58% ± 3.65% in the control group (P = 0.711).

On the other hand, there was statistically significant improvement in follow-up EF in the case group which showed a mean range of 45.36% ± 7.13% in comparison with the control group which showed a mean range of 41.80% ± 6.93% (P = 0.027).

Conclusion

Dapagliflozin administration in the early phase after STEMI results in significant improvement in LV systolic function in comparison with the placebo.

Abbreviations

ACE-I: Angiotensin-converting enzyme inhibitor; ACS: Acute coronary syndrome; ARNI: Angiotensin receptor-neprilysin inhibitor; CBC: Complete blood picture; DM: Diabetes Mellitus; ECG: Electrocardiogram; FH: Family History; GLS: Global longitudinal strain; HF: Heart Failure; HFrEF: Heart Failure reduced Ejection Fraction; HTN: Hypertension IV: Intravenous; LV: Left ventricle; LVEF: Left ventricular ejection fraction; MI: Myocardial Infarction; MRA: Mineralocorticoid receptor antagonists; PCI: Primary percutaneous coronary intervention; SD: Standard deviation; SGLT-2: Sodium-glucose cotransporter-2 inhibitors; SPSS: Statistical Package for the Social Science; STEMI: ST-segment elevation myocardial infarction; T2D: Type 2 Diabetes Mellitus