bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study between Erector Spinae Plane Block and Transversus Abdominis Plane Block for Postoperative Pain Management of Patients Undergoing Laparoscopic Cholecystectomy
Authors: Mahrous Mina Adel Shoukri , Kamal Manal Mohamed , Elhennawy Ahmed Mouhamed , Youssef Ahmed Mounir Ahmed
Published: August 2023

Study Objective

Laparoscopic cholecystectomy (LC) is a frequently applied minimally invasive surgery. Intraoperative access is provided with small keyhole entries on the abdominal wall. However, LC causes moderate to severe postoperative pain. Since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post-operative analgesia. The proper management of post-operative pain ensures early ambulation of patients and obviates many post-operative complications. The subcostal approach of TAP block was described by Hebbard et al. for postoperative analgesia especially for upper abdominal surgeries. Ultrasound-guided erector spinae plane (US-ESP) block is a novel technique targeting ventral rami, dorsal rami of the spinal nerves.

Design

Prospective randomized, double blinded study.

Setting

After obtaining approval from the Research Medical Ethical Committee of Faculty of Medicine Ain shams University and obtaining an informed written consent from patients, this study will be conducted in the operating theatres of Ain shams University Hospitals.

Patients

Patients ASA 1 or 2 undergoing laparoscopic cholecystectomy. The patients will be randomly divided into two equal groups, They will be enrolled in group (1) for erector spinae plane block and group (2) for oblique subcostal transversus abdominis plane block. Each group contain 30 patients, 60 patients were included in final analysis

Interventions

Erector spinae plane block was performed in the ESP group and oblique subcostal transversus abdominis block was performed in the OSTAP group.

Measurements

Postoperative nalbuphine consumption and pain scores between groups were compared.

Main Results

Postoperative nalbuphine consumption was 18.31±5.11 mg in the ESP group and 30.51±9.19 mg in the OSTAP group ( p < 0.001). VAS scores at almost all time-points were lower in the ESP group according to the repeated measures analysis.

Conclusion

Ultrasound-guided ESP block reduced postoperative nalbuphine consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery. This technique can be a promising mode of postoperative analgesia
The Use of Lung Ultrasound in the Diagnosis of Weaning-Induced Pulmonary Oedema in Mechanically Ventilated Patients
Authors: Akl Diaa Abd El-khalek , Hosny Mona Refaat , El-hak Ahmed Abd El-dayem Abd , Abd El-Gileel Mohammed Atef Mohammed
Published: August 2023

Background

Studies dealing with the use of lung ultrasound in the context of weaning have rather calculated lung ultrasound scores with aeration loss (without specifically addressing the issue of weaning induced pulmonary oedema “WIPO”) or assessed post-extubation distress. Our study specifically focuses on WIPO. Advantages of lung ultrasound for diagnosing WIPO are numerous. It provides a non-invasive and direct assessment of lung water accumulation by detecting lung interstitial syndrome (the first stage of haemodynamic pulmonary oedema), lung ultrasound is easier to learn and perform compared to Doppler echocardiography and the acquisition and analysis can be performed within 2 min.

Objective

To test the ideal profile (increase in the number of B-lines) for diagnosing WIPO using lung ultrasound to avoid the poor outcome of weaning failure.

Patients and Methods

This study was performed in intensive care units of Ain Shams University hospitals between October 2020 and March 2021. This study was carried out on 51 patients, the final outcome divided this group into three subgroups, successful group include 28 patients (54.9%), failed group without WIPO include 10 patients (19.6%) and failed group with WIPO include 13 patients (25.5%).

Results

The sensitivity of B-line in predict the successful weaning was 95.0, while the specificity was 90.0% and the accuracy was 92.0% at cut off value 5.0. The sensitivity of B-line in predict the WIPO was 90.0, while the specificity was 84.0% and the accuracy was 87.0% at cut off value 5.5.

Conclusion

From the results of this study it was concluded that an increase in the number of Blines ≥ 5 on four anterior points during SBT provided the best accuracy for diagnosing WIPO with lung ultrasound. We suggest calling this sign the WIPO profile. These encouraging results must be confirmed by larger series, so that LUCI may empower the non-invasive monitoring tools, including biochemical indices, for the diagnosis of this common problem.
The Predictive Value of Urinary Trypsinogen-2 Dipstick for Early Diagnosis of Acute Pancreatitis in Intensive Care
Authors: Zaki Mohamed S , Ali Rania M , EL-Naggar Dalia I , Ammar Mohamed M
Published: August 2023

Background

Acute pancreatitis is a sudden inflammation in the pancreas, with potential and variable involvement of adjacent organs or other organ systems.

Aim of the Work

to evaluate the rule of urinary trypsinogen-2 using dipstick test in the diagnosis of acute pancreatitis.

Patients and Methods

This cross-sectional study was carried out in surgical intensive care unit, Ain Shams University hospitals, during a period of 6 months. Forty five patients were included in our study, thirty patients were diagnosed as acute pancreatitis and fifteen patients weren’t diagnosed as acute pancreatitis through cross sectional study. All patients were subjected to full history taking, full clinical examination, laboratory investigations including serum levels of renal function tests, CBC, total and direct bilirubin, liver enzymes, alkaline phosphatase, INR, amylase and lipase. Urinary trypsinogen-2 dipstick test was done. Also, radiological examinations were done using ultrasonography of abdomen and pelvis, computed tomography of the abdomen.

Results

The most common cause of acute pancreatitis was gall stone obstructive pancreatitis (70%) and we found that serum amylase and lipase were elevated in (83.3% and 86.7% respectively) in acute pancreatitis patients. While the sensitivity of urinary trypsinogen-2 dipstick test was 93.3% in acute pancreatitis patients. The specificity of serum amylase, serum lipase was 73.3% for both of them, while the specificity of urinary trypsinogen-2 was 100% in diagnosis of acute pancreatitis.

Conclusion

In-conclusion urinary trypsinogen-2 dipstick test is a promising low cost, bed side and easy test to be done in the diagnosis of acute pancreatitis.
Effect of Platelet Rich Plasma Therapy for Shoulder Osteoarthritis: Double Blinded Randomized Controlled Study
Authors: Elfatah Amr Mohammed Abd , Taeimah Mohamed Osman , Hasan Marwa Mostafa , Ismael Mohammed Salah Abd Allah
Published: August 2023

Background

Platelet-rich plasma (PRP) is widely used in musculoskeletal conditions and orthopaedic surgery ranging from clinic-based injections for tendinopathies to intra-operative application to augment soft-tissue healing. It has been used in knee osteoarthritis, rotator cuff tears, elbow epicondylitis, anterior cruciate ligament reconstruction, shoulder impingement syndrome and various tendinopathies to date, with an expanding list of indications. While available evidence supports the use of PRP in the management of lateral epicondylitis and knee osteoarthritis, there is limited clinically significant evidence for other indications

Aim of the Work

This study aims to evaluate the efficacy of platelet-rich plasma as a treatment for primary and secondary shoulder osteoarthritis pain.

Patients and Methods

A prospective, double-blinded randomized control study in Ain Shams University Hospitals from 3 to 6 months. The patients were divided into 2 groups using computerized generated randomization. The control group received 5 ml 0.9% saline injection in the intra-articular shoulder (between glenohumeral joint). The study group received 5 ml of PRP treatment.

Results

The study results showed: All demographic data (age, sex, weight and BMI) and chronic diseases were insignificantly different between both groups, all medical data (chronic diseases, type of osteoarthritis, severity of symptoms, time of symptoms, radiological finding and type of treatment) were insignificantly different between both groups, NRS was significantly lower in study group compared to control group at ―2nd evaluation post injection|| and was insignificantly different between both groups at ―1st evaluation post injection||. (P < 0.05), range of movement was insignificantly different between both groups at 2nd evaluation post injection and injection related complications (inflammation and infection) were insignificantly different between both groups.

Conclusion

In general, efficacy was observed in treatment with PRP alone in shoulder osteoarthritis. However, patients receiving PRP treatment are less likely to experience post-injection pain and are more likely to recover faster when compared to patients receiving saline alone.
Ultrasound Guided Pectoral Nerve Block (PEC I) versus Serratus Anterior Plane block (SAPB) for Postoperative Analgesia in Modified Radical Mastectomy
Authors: Fawzy Hazem Mohamed , Shoukry Randa Ali , Elmaksoud Eman Shawky Abd , Mohamed Nada Ezzat Hussein
Published: August 2023

Background

Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. A procedure called Modified radical mastectomy is now a standard surgical treatment for early stage breast cancers. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Though various risk factors have been suggested, inappropriate acute postoperative pain management has been associated with the development of chronic postmastectomy pain, a complex post-surgical pain syndrome that may occur following any type of breast surgery.

Objective

To evaluate the effectiveness of ultrasound guided pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) for postoperative Analgesia in modified radical mastectomy

Methods

This is Randomized controlled double blind clinical trial was conducted in the operating theatres of Ain Shams University Hospitals for 6 months after approval of ethical committee of faculty of medicine, Ain Shams Univeristy on 64 female patients undergoing Modified Radical Mastectomy divided randomly into two groups, each group consisted of 32 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB).

Results

There was a statistically significant decrease mean of group II compared to group I according to postoperative systolic blood pressure (mmHg) from 1 hr. to 6 hrs. While there was no statistically significant difference between groups according to postoperative diastolic blood pressure (mmHg). However, a statistically significant decrease mean of group II compared to group I according to postoperative heart rate (beat/min) from 1 hr. to 6 hrs was found. A statistically significant decrease mean of group II compared to group I according to numeric rating score for pain from 1 hr to after 6 hrs also was found. The current study shows highly statistically significant difference between groups according to time of first analgesia (hour), number of patients who received postoperative Diclofenac 75 mg and total consumption of Diclofenac 75 mg.

Conclusion

SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after modified radical mastectomy under general anesthesia, compared to PEC 1 block.
Dexmedetomidine versus Fentanyl as Adjuvant to Propofol Total Intravenous Anesthesia during Endoscopic Retrograde Cholangial-Pancreatography Procedure
Authors: Reyad Mostafa Kamel , Anis Sherif George , Mahran Mostafa Gamaledin , Aguer Nyanriak Thon
Published: August 2023

Background

Various types of sedation and analgesia technique have been used during endoscopy procedures. Providing an adequate regimen of sedation/analgesia might be considered an art, influencing several aspects of endoscopic procedures: the quality of examination, the patient’s cooperation and the patient and physician’s satisfaction with sedation

Objective

To compare the effects of Dexmedetomidine/Propofol and Fentanyl/Propofol combination for conscious sedation in patients undergoing ERCP regarding hemodynamic changes, patients and endoscopists satisfaction.

Patients and Methods

Ninety four (94) ages 18-70 ASA ı-ıı were enrolled in this study. Patients were allocated randomly into two equal groups D/P and F/P groups. Patients received either Fentanyl 1 µg/kg or Dexmedetomidine 1 µg/kg for 10 min, followed by maintenance dose 0.2 µg to 0.5 µg/kg/min. combined with propofol 1 mg/kg IV and maintenance 3 mg/kg/h regimen. With requiring additional dose if sedation level did not reached. Conduct open airway technique was used while applying o through nasal cannula 3 L/min. (MAP, HR and SPO) were recorded before and after sedation procedures then every 10 min. till the end of procedure, recovery time, postoperative complications, patients and endoscopists were recorded.

Results

the intra procedure HR, and BP showed statistical significant differences between both groups throughout the procedure with lower value in group D/P (p = 0.042) while there were no statistical significance differences regarding MAP and SPO. During postoperative procedure BP and MAP was statistical significant lower in D/P group (p = 0.015). Post procedure recovery time was shorter in group D/P (p = 0.049), regarding PONV was higher in D/P compared to F/P (p = 0.03), both group were statistical significant satisfied.

Conclusion

In our study we concluded that Dexmedetomidine/ Propofol combination provided adequate sedation with hemodynamic and respiratory stability with accepted few side effects and a good satisfication scores for patients and endoscopists. It was a good competitive to standard sedative as Fentanyl/Propofol in moderate sedation during ERCP.
A Comparison between Intravenous Ketamine and Magnesium Sulphate for Prevention of Intraoperative Shivering in Patients Undergoing Spinal Anesthesia
Authors: Kamaly Ayman Mokhtar , Wahba Rami Mounir , Fathy Galal Reham , Mahomud Omar Ahmed Sameh
Published: August 2023

Background

Post-anesthetic shivering is a frequent complication of spinal and epidural anesthesia causing many complications intra and post operatively. This randomized controlled study aimed to compare Ketamine versus Magnesium sulphate in prevention of intraoperative shivering after spinal anesthesia.

Aim of Work

To compare the efficacy and safety of low doses of ketamine versus magnesium sulphate as preventive agents of shivering in patients undergoing spinal anesthesia for surgery.

Patients and Methods

The current randomized double-blinded clinical trial was conducted in Ain Shams university hospitals. It included 75 patients who underwent diabetic foot debridement surgeries under spinal anesthesia and met the selection criteria. After intrathecal injection, the patients were classified into three groups: Group K who received ketamine 0,5 mg/kg. diluted in a 100 ml of normal saline and given over 15 minutes, prophylactically. Group M received Magnesium sulphate 30 mg/kg. diluted in a 100 ml of normal saline and given over 15 minutes prophylactically. Group P received a 100 ml bolus of physiological solution given over 15 minutes.

Results

Both Ketamine and Magnesium sulphate showed better results in the control of shivering than the control group (p = 0.035), reduced requirement of pethidine (p = 0.022) and both showed significant effect in delaying the onset of shivering (p = 0.001). The ketamine group had less incidence of shivering, more delayed onset and lesser dose of pethidine required than the Magnesium group but not enough to be statistically significant.

Ketamine also showed less incidence of hypotension following spinal anesthesia (p = 0.03) but much more incidence of heavy sedation and hallucinations (p = 0.000)

Conclusion

Both ketamine and Magnesium sulphate are effective agents in controlling shivering after spinal anesthesia. They reduce the incidence of shivering, delay the onset of shivering if it occurs and reduces the required dose of pethidine to resolve shivering with minimal side effects. Ketamine has a probable protective effect against hypotension after spinal anesthesia.
A Comparative Study between Dexmedetomidine and Dexamethasone as Adjuvants to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries
Authors: shoqier Mohamed Hossam , El Agamy Ashraf El Sayed , Selima Wessam Zaher , Mohamed Omar Medhat
Published: August 2023

Background

Brachial plexus blocks are among the most commonly performed peripheral nerve blocks for upper extremity surgeries in clinical practice. It offers many advantages over general anaesthesia for upper limb surgeries such as sympathetic block, better postoperative analgesia, high success rate and fewer side effects.

Objective

To compare the efficacy of bupivacaine plus dexamethasone versus bupivacaine plus dexmedetomidine as adjuvants on the block characteristics including: onset and duration of sensory and motor blockade, duration of postoperative analgesia, the first analgesic request time, adverse effect and hemodynamic parameters of patients.

Patients and Methods

After obtaining approval from the medical ethical committee in El Demerdash Ain Shams University Hospital, this study was conducted in El Demerdash Ain Shams University Hospital. It included patients scheduled for elective upper limb orthopedic and plastic surgery. A written informed consent was obtained from every patient after explaining the procedure.

Results

Regarding demographic data and operative characteristics there were no statistically significant difference between the two groups. The current study showed that the addition of dexmedetomidine to bupivacaine for supraclavicular brachial plexus block leads to prolongation of motor and sensory block duration, prolongation of duration of analgesia and decrease in total 24 hrs analgesia in comparative to dexamethasone.

Conclusion

Regarding comparison between dexmedetomidine and dexamethasone as an additive to bupivacaine in ultrasound guided supraclavicular block, it could be concluded that the addition of dexmedetomidine to bupivacaine shortened the onset times of both sensory and motor blocks, significantly prolonged their durations and prolonged the analgesia of brachial plexus block with subsequent consumption of less amounts of postoperative analgesics. Also the use of ultrasound guided technique decreased the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.
The Efficacy of Ultrasound Guided Bilateral Pectoralis Nerve Block for Postoperative Pain Control in Cardiac Surgery, Randomized Control Trial
Authors: Elshaer Ahmed Nagah , ElMalek Fady Adib Abd , Taher Islam Abdel-Aal Abdel-Mouty , Elhelaly Omar Ragaie Mohamed
Published: August 2023

Background

Cardiothoracic surgeries are associated with significant pain. Optimal analgesia is a vital part of enhanced recovery after surgery strategies intended to improve patients' perioperative experience and outcomes. Traditionally, analgesia in these types of surgeries has depended on large doses of I.V. opioids. This is particularly pertinent given the current focus on removing needless perioperative opioid administration, and thereby decreasing the potential for opioid side effects.

Aim of the Work

The aim of the study was to evaluate the effect of postoperative bilateral US guided Pecs block on postoperative pain control in patients undergoing cardiac surgery through mid-line sternotomy compared to systemic analgesia.

Patients and Methods

Approval was obtained from the research ethics committee of Faculty of Medicine; Ain Shams University and a written informed consent was taken from each patient to participate in the study, patients were randomly allocated into two groups with 15 patients in each group. Group 1 (control group) received systemic analgesics, whereas Group 2 (study group) received pecs block.

Results

Our study showed that when compared to general anesthesia with systemic opioids, PECs block is associated with significantly better postoperative pain control.

Conclusion

Pecs block is technically simple, safe and very effective technique and can be used as a part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and satisfaction and also helps in superior pulmonary rehabilitation, thus assisting in better outcome and less unwanted side effects of systemic analgesics.
Evaluation of Ain Shams University Hospitals Clinical Pathway for Pulmonary Artery Banding
Authors: Samir Khaled Mohamed , Kamel Waleed Ismail , Abdelfattah Mohamed Adel , Salem Ahmed Hussein Afifi
Published: August 2023

Background

Pulmonary artery banding (PAB) remains a useful surgical palliation for small neonates and early infants with excessive pulmonary blood flow who are unable or difficult to withstand an open heart surgery using cardiopulmonary bypass or in developing countries where the facilities not suitable for primary corrective surgery in those infants.

Objectives

In our current study we aimed to study clinical pathway of cases underwent PAB at ASU hospital pediatric cardiac surgery department with discussion of different causes of mortality and morbidity.

Patients and Methods

Study done by data collection retrospectively of 50 patients underwent pulmonary artery banding in the period from January 2018 to December 2019 who fulfilling the inclusion criteria with evaluation of different clinical pathways for the outcome mainly morbidities and mortality.

Results

We found that the major risk factors of mortality in cases underwent PAB in ASU hospitals includes patients diagnosed with TGA, low preoperative so2 ≤85, ventilation is high risk factor for mortality so it is recommended to extubate those patients on table or shortly after discharge to ICU as soon as possible, duration of intubation: the longer the duration of intubation, the higher the mortality, postoperative PG across band ≤45.that indicator for a loose band with still persistent pulmonary overflow, re-intubation, post operative morbidities are highly associated with mortality, 11 out of 12 mortality cases suffered from postoperative complications (91.7 % of mortality cases) that includes poor chest condition, stroke, postoperative convulsions and pulmonary hemorrhage. These morbidities result in prolonged intubation and prolonged ICU stay.

Conclusion

Pulmonary artery banding is palliative procedure done in infants with pulmonary artery overflow with unprotected pulmonary circulation in variable congenital cardiac diseases (VSD, single ventricle, TGA) as a primary stage for total repair when the infant gain weight and get older, the suitable age for banding is < 6 months.
Correlation of Serum Uric Acid Levels with Coronary Flow in Patients with STsegment Elevation Myocardial Infarction Undergoing Primary Coronary Intervention
Authors: Sharafeldin Abdelrahman Ahmed Abdelrahman , Sallam Walid Mohamed , Hammady Walid Abdel Azim El
Published: August 2023

Background

Worldwide, ischemic heart disease is the single most common cause of death and its frequency is increasing. STEMI is a significant cause of morbidity and mortality in patients with coronary heart disease.

Aim of the Work

Our study aimed to assess the impact of Uric acid level prior to primary PCI in patients presenting with acute STEMI on myocardial perfusion.

Patients and Methods

This is an interventional randomized controlled clinical trial conducted the coronary care units and coronary catheterization lab unit of the cardiology department and ER in Ain Shams University Hospitals between January 2021 and June 2021. The study was conducted in Ain Shams University hospitals on 80 patients presented from 2020 till the end of June 2021 with ST segment elevation myocardial infarction and underwent primary PCI. They were divided into two groups. The first group was hyperuricemic while the second group had normal uric acid blood level. Both groups received the standard care for acute STEMI patients which is the primary percutaneous intervention in addition to medications.

Results

Results for age, gender, hypertension, smoking, family history dyslipidemia, and diabetes did not show any statistical significance of value between the cases and control groups. In the control group, there were 19 patients with TIMI flow less than III and MBG less than III. Meanwhile, in the cases group, there were 8 patients with TIMI flow less than III and 7 patients MBG less than III. This difference was statistically significant with a P-value of 0.010 regarding TIMI flow score while a highly significant statistical difference of P-value 0.003 regarding MBG.

Conclusion

Our study concluded that normal uric acid level before primary PCI is associated with improved post-procedural TIMI flow and MBG.
Utility of Right-Electrocardiogram Chest Leads in Localization of Accessory Pathways in Patients with Wolf-Parkinson-White Syndrome
Authors: Ramadan Abdullah , ALtoukhy Sherif , Tawfik Mazin
Published: August 2023

Background

Prediction of the precise location of an Accessory Pathway (AP) prior to the ablation procedure is of clinical importance. Several algorithms have been published to localize the AP on a surface 12-lead electrocardiogram (ECG). Most of them are based on analysis of delta wave morphology or QRS polarity. However, they are somewhat complicated, and an accurate determination of the delta wave morphology or QRS polarity are occasionally difficult, and their accuracy are still limited. Recently a new published algorithm using right-sided ECG chest leads for the prediction site of an AP is figured out and still under study for measuring its accuracy.

Aim of the Work

The aim of this study is to evaluate the accuracy of the utility of rightsided ECG Chest leads in the localization of APs in patients with manifest pre-excitation pattern in 12-lead ECG in prospective manner.

Patients and Methods

This study included 35 patients in whom successful ablation of manifest Wolff-Parkinson-White (WPW) syndrome was performed in prospective manner. Standard 12-lead ECG and right-sided chest ECG waveforms were recorded before the procedure.

Results

There were 13, 10, and 12 patients with left, right, and septal APs, respectively. All left AP patients had type A (RS morphology) in V1 and 12 of them in V4R leads, only 1 had type B in V4R lead. Of the 10 right AP patients, 5 had type B (rS morphology) in V1 while all 10 patients had type B in V4R. Of the 12 septal AP patients, 9 had type C (QS or Qr morphology) in V1, while 2 of the 12 patients had type B, and 1 of 12 patients had type A. All the 12 septal AP patients had type C in V4R.

Conclusions

The QRS morphology of V1 and V4R leads could predict the site of AP in patients with WPW syndrome with overall accuracy of 85.7% and 98%, respectively.

Abbreviations

AP: Accessory Pathway; ECG: Electrocardiogram; EPS: Electrophysiology study; RF: Radiofrequency; WPW: Wolff-Parkinson-White
Impact of Sacubitril/Valsartan Combination on Prevalence of Arrhythmia in Heart Failure Patients with Reduced Ejection Fraction
Authors: Abdelsamee Ahmed M , Eldamnahoury Hayam , Allam Lamyaa , Shehata Hassan
Published: August 2023

Aim and Objectives

The aim of this study was to assess the effect of Sacubitril/Valsartan combination on prevalence of arrhythmias in HFrEF patients and compare it with patients on ACEI or ARBs only in addition to echo parameters follow up.

Patients and Methods

This study was conducted at Ain Shams university and Nasr city insurance hospitals and our target population was heart failure patients with reduced ejection fraction on either Sacubitril\Valsartan combination therapy (Group A) or on ACEI or ARBs (Group B) for at least 3 months, it was an observational study to follow up the burden of arrhythmia among heart failure patients by 48 hours holter monitoring at 3 and 6 months besides Echo parameters follow up.

Results

Our study included 2 groups. Group A (30 patients on Sacubitril/Valsartan combination therapy and mean age was 58.23 ± 4.80 years, 73.3% of patients were males and 26.7% females). Group B (30 patients on ACEIs or ARBs with mean age 56.37 ± 4.49 years, 80.0% of patients were males and 6 % females). There was no significant difference regarding the medical history, risk factors and NYHA classification of heart failure. The patients were classified into ischemic and non-ischemic cardiomyopathy patients and there was no significant difference between both groups. Group A was characterized by significant decrease in QTc values which reached the lowest values after 6 months, in the opposite side; group B was associated with increasing QTc values through the follow up period. As regards echocardiographic parameters we have found that left ventricle ejection fraction was improving to reach the highest values after six months in group A but we did not find significant improvement of left ventricle ejection fraction in group B. Other echocardiography parameters in group A including LA, LVIDd, RVSP and SWMA were improved by the end of the study but we have found that LA diameter was increasing in group B. In group A, burden of ventricular ectopics was found to be decreasing through the follow up period but there was no significant change of ventricular ectopics incidence in group B by the end of the study.

Conclusion

Sacubitril/Valsartan combination therapy was superior to ACEIs in reducing ventricular ectopics which means that this drug plays a role in preventing SCD. Ejection fraction in Sacubitril/Valsartan combination group was improving through the follow up period. Echocardiographic parameters were improving in Sacubitril/Valsartan group as regard LA, LVIDd and RVSP. Functional capacity in Sacubitril/Valsartan combinations group was improving through follow up period which means this drug reduces hospitalization.
The Immediate and Short-Term Outcomes of Patients with ST Elevation Myocardial Infarction with High Thrombus Burden Receiving Intracoronary Verapamil versus Epinephrine during Primary Percutaneous Coronary Intervention
Authors: Rafek Ahmed , Zahran Mohamed , Saber Mohamed
Published: August 2023

Background

When total coronary artery occlusion was found in the early hours of transmural myocardial infarction, most of our research interest and treatment strategies focused on epicardial coronary arteries. Little attention, however, is paid to the coronary microvasculature. When a coronary artery is occluded, detrimental changes occur in the cardiac capillaries and arterioles. After relief of the occlusion, blood flow to the ischemic tissue may still be impeded, a phenomenon known as no reflow. This abstract attempt to provide an in-depth understanding of this phenomenon and comparative review of two intracoronary agents used in no reflow settings.

Aim of the Study

This study is a comparative prospective study designed to compare between two agents‟ verapamil and adrenaline in treatment of no reflow in patients presenting with STEMI (ST elevation myocardial infarction) and a high thrombus burden developing no reflow during PPCI.

Patients and Methods

This study is a comparative prospective clinical trial designed to compare between two agents‟ verapamil and adrenaline in treatment of no reflow in patients presenting with STEMI and a high thrombus burden developing no reflow during PPCI.

Results

We have compared two of the proposed agents adrenaline and verapamil in the management of CNF and found out that verapamil is better in terms of improving LV functions but not the coronary flow. This further supported the consideration that MVO and CNF are two different entities and that we should be fully satisfied with restoration of coronary flow however all possible solutions should be spent to achieve adequate coronary perfusion so as not to give any change to MVO and microvascular dysfunction. We need a better understanding of the pathology of CNF and MVO for better solutions. It is time that we include agents more concerned with the ischemic reperfusion injury, looking at it not solely as a mechanical issue but also as an inflammatory and cellular pathology. Fighting the No reflow should be broad spectrum until such time we have a deep insight to the main pathology behind it.

Conclusion

The study concluded that the verapamil and adrenaline were not superior the standard treatment in term of TFG, but the verapamil was superior to both groups in improving the MBG while the adrenaline was not superior to the control group. The short-term outcomes were better in verapamil group than the adrenaline and control group who were equivocal.
Left Ventricular Function in Recovered COVID 19 Patients Using 4-Dimension Echocardiography
Authors: Osama Aly , Mansour Hazem , William Viola , Adel Walaa
Published: August 2023

Aim and Objectives

The aim of the Work was to study the effect of COVID 19 on Left Ventricular Function and dimensions using 4D Echocardiography in recovered patients

Patients and Methods

This study is a pilot study on 30 patients who are recovered from COVID19 to study LV function using 4D Echocardiography.

Results

our study showed that 50% of our patients with COVID 19 had abnormal LV global longitudinal strain.

Conclusion

In patients with COVID-19 infection, we did full study 2D echocardiography in addition to GLS & 4D echocardiography on the left ventricle and we concluded that LV global longitudinal strain was altered and it showed that 50% of our patients had abnormal LV global longitudinal strain by Speckle Tracking Echocardiography
Incidence of Documented Atrial Arrhythmias in Patients with Dual Chamber Cardiac Implantable Devices
Authors: Ellaban M , Shehata H , Katta A , Mortada A
Published: August 2023

Background

Atrial fibrillation (AF) is the most common sustained atrial arrhythmia, and is associated with increased risks of morbidity and mortality. Integrated management including anticoagulation therapy in patients with AF is increasingly recognized, but there are still a substantial number of AF patients admitted with stroke, heart failure, and other complications. This can be to some extent due to asymptomatic nature of AF as approximately one-third of patients did not report any symptoms commonly attributable to AF (e.g., palpitations, shortness of breath, or chest pain), leading to a prolonged delay in AF diagnosis and timely initiation of anticoagulation therapy. In many cases, asymptomatic AF is diagnosed only after the onset of complications such as ischemic stroke or congestive heart failure has occurred.

Objective

This work aims at documenting atrial arrhythmias in patients with dual chamber cardiac implantable devices.

Patients and Methods

This study included 200 patients who were undergoing follow up of dual chamber cardiac implantable devices. The study was carried out in pacemaker follow up clinics at Ain Shams University hospitals and National Heart Institute.

Results

According to the results of the current study we concluded diabetes Mellitus, ischemic heart diseases, decreased function (EF ≤ 48%) and dilated LA & LV dimensions (LVIDd >48 mm, LVIDs >41 mm, LA diameter >52 mm), are significant factors associated with AHREs in patients with dual chamber cardiac implantable devices. But unfortunately we cannot assess precisely the impact of AHRE on stroke or thromboembolism development in such patients due to the relatively small number of patients were included in the present study, which may have reduced the detection power and possibly influenced the validity of some results.

Conclusion

Diabetes Mellitus, ischemic heart diseases, decreased function (EF ≤ 48%) and dilated LA & LV dimensions (LVIDd >48 mm, LVIDs >41 mm, LA diameter >52 mm), are significant factors associated with AHREs in patients with dual chamber cardiac implantable devices.

Abbreviations

AF: Atrial fibrillation; AHRE: Atrial high rate episodes; AT: Atrial Tachycardia; BMI: Body mass index; CI: Confidence intervals; CIED: Cardiac implantable electronic devices; CRT: Cardiac resynchronization therapy; DDD: Dual chamber Device DM: Diabetes Mellitus; ECG: Electrocardiogram; EF: Ejection Fraction; HbA1c: Hemoglobin A1c; HR: Hazard Ratio; ICD: Implantable cardioverter defibrillator; IHD: Ischemic heart disease; INR: International Normalized Ratio; LA: Left atrium; LVIDd: Left ventricular internal dimensions (Diastole); LVIDs: Left ventricular internal dimensions (Systole); MOST: Mode Selection Trial; OR: Odds ratio; ROC: Receiver operating characteristic curve; AUC: Area Under Curve; SCAF: Subclinical AF
Correlation between Heart Rate Recovery & Global Longitudinal Strain in Heart Failure Patients Subjected to Cardiac Rehabilitation
Authors: Basem Mohamed , Kadry Ahmed , Khorshid Hazem , Samir Sameh , Mahdy Mohsen
Published: August 2023

Background

Cardiac rehabilitation is a medically supervised program designed to improve cardiovascular outcomes after MI, heart failure, angioplasty, or heart surgery. It is a complex intervention that involves a variety of therapies, including supervised exercise training, health education and risk factor modification, behavior change, social and psychological support.

Objective

To study the correlation between heart rate recovery & global longitudinal strain in heart failure patients subjected to cardiac rehabilitation.

Patients and Methods

This study was conducted in the cardiac rehabilitation (CR) unit in the cardiology department of Ain Shams University hospital between December 2019 and December 2020 to investigate the correlation between heart rate recovery & global longitudinal strain in heart failure patients subjected to cardiac rehabilitation.

Results

Our study is the first study that investigated the correlation between HRR and GLS in ischemic heart failure patients subjected to cardiac rehabilitation.

Conclusion

Exercise-based cardiac rehabilitation leads to improvement in the functional capacity of ischemic heart failure patients as reflected by the improvement in HRR and also leads to IMPROVEMENT in LV functions as reflected by the improvement in GLS. Moreover, METs and HR reserve was improved significantly with CR.
Role of Colchicine in Reduction of No Reflow Phenomenon in Patients with Acute ST-Segment Myocardial Infarction, Undergoing Primary Percutaneous Coronary Intervention
Authors: Sadek Nardine , Karem Khalid , William Viola , Elrahman Ahmed Abd
Published: August 2023

Aim and objectives

The aim of this work is to study the efficacy of colchicine administration as a preventive tool for No Reflow in patients with STEMI undergoing primary PCI.

Patients and Methods

The study included 100 patients who presented with acute STEMI to the cardiology department of Ain Shams university hospitals and underwent primary PCI (percutaneous coronary intervention). They were divided into two groups where the first group received colchicine (1 mg) besides guideline recommended therapy before primary PCI and the 2nd group served as a control group and received guideline recommended therapy. Post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded.

Results

The majority of patients in both groups had the LAD as the culprit vessel for their presentation(63%). In the control group there were 19 patients with TIMI flow less than 3 and 20 patients with MBG less than 3. Meanwhile in the cases group there was 8 patients with TIMI flow less than 3 and 7 patients with MBG less than 3. This difference was statistically significant with a P value of 0.013. There were 40 patients in the cases group who received loading clopidogrel (600 mg) as premedications before Primary PCI (80%) vs 25 patients (50%) in the control group which was statistically highly significant with a P value of 0.002. In addition, Intracoronary medications (adrenaline, verapamil, tirofiban that where given during the procedure) used in 2 patients from the cases group vs 10 from the control group which was statistically significant with a P value of 0.014. There was not a statistically significant difference between the two groups regarding presenting balloon dilatation. Whereas, Post stenting balloon dilatation showed a statistically significant relationship of P value 0.014 which was done in 2 patients from the cases group vs 10 patients from the control group.

Conclusion

Colchicine loading before primary PCI resulted in improved postprocedural TIMI flow, MBG.
Cough Augmentation Techniques for Weaning in Critically Ill Patients from Mechanical Ventilation
Authors: Elassal Gehan Mohammed , El-Maraghy Ashraf , ElSheiry Eman Mosaad Saad
Published: August 2023

Background

Retained sputum conflicts the weaning trial, as well as increase the risk of chest infection and prolong the time on mechanical ventilation

Objective

To evaluate the impact of using mechanical exsufflators insufflators as cough augmentation technique on outcome of weaning, in addition to assessing the rate of successful weaning using NIV and T-tube mode.

Methods

A randomizes control trial that included 30 patients divided into 2 groups; the first weaned by NIV mode, the second by T-tube mode. All patients prepared equally for spontaneous breathing trial (SBT), and using ME-I frequently just before SBT.

Results

The rate of successful weaning in all cases was 66.6% (20 patients of 30), the rate was higher in groups that weaned by T-tube than NIV mode (86.67% versus 46.67%), P = 0.01. Moreover, the number of ME-I cycle was significantly higher in group with successful weaning than other group, P = 0.02.In addition, the ventilation support time was significantly longer in failed group than the successful one, P < 0.001.

Conclusion

The use of MI-E just before the weaning trial enhance the outcome of weaning, moreover, the weaning trial by T-tube mode gave a higher successful rate during spontaneous breathing trial (SBT).
Study of the Correlation between CT Pattern and Clinical Presentation in Confirmed Cases of COVID-19 Pneumonia
Authors: Mostafa Kareem Y , Wagih Khaled M , Elmaraghy Ashraf A
Published: August 2023

Background

In Febreury, 2020 with start of COVID pandemic, chest CT outperformed lab testing in the diagnosis of 2019 novel corona virus disease (COVID-19). The researchers concluded that CT should be used as the primary screening tool for COVID-19 Early identification and treatment are therefore essential in COVID-19 management.

Patients & Methods

We Observationally collected the records of patients with RT-PCR-confirmed COVID-19 in Ain-Shams University Hospitals from 12th of June 2021 till 12th of August 2021. A total of 100 patients with consecutively laboratory-confirmed COVID-19. All patients performed HRCT chest in the time of their presentations and the different CT findings were mentioned and severity of the disease were calculated according to summation of the areas affected in different lung lobes in both lobes using the Total Severity Score and accordingly cases classified into mild, moderate and severe. All clinical data including non-respiratory & respiratory symptoms were recorded as well as oxygen saturation and correlated with CT severity.

Results

Mean age was 59.22 ±13.76 years; 65% were males and 35% were females. Non-respiratory symptoms only were present in 10 % of cases and respiratory symptoms were present in 90% of cases. The most common chest symptom was cough in 72% of our patients followed by dyspnea in 65% of them. The most common non-respiratory manifestations, were fever in 60 %, followed by fatigue in 15%, headache in 15% and diarrhea in 27% of patients. The most common CT findings were bilateral GGOs (63%), unilateral GGOs (17 %), both consolidation and GGOs (6%), while 9% had GGOs and crazy paving. According to severity index, 52 patients (52 %) were mild, 38 patients (38 %) were moderate and 10 patients (10 %) were advanced. There was a highly significant negative relation between radiological severity and oxygen saturation i.e., the more the severity score, the lower the oxygen saturation.

Conclusion

Bilateral peripheral (Ground Glass Opacities) GGO is the most common finding in COVID. CT severity score correlate significantly with Body aches, cough & dyspneawith negative correlation between CT severity score and oxygen saturation.
Value of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF) in Discriminating Candida Species
Authors: Hafez Hala M , Elanany Mervat G , Alshahat Ahmed F , Abdel Halim Rania M
Published: August 2023

Background

Matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI TOF-MS) allows rapid and accurate identification of Candida species. Phenotypic identification of Candida species remains labor- and time consuming, and the results may sometimes be inconclusive. Rapid and reliable species identification of Candida is essential for antifungal treatment due to speciesspecific susceptibility patterns.

Objectives

We evaluated the performance of MALDI TOF-MS (VITEK MS) compared with conventional VITEK 2 YST (V2C) for identification of clinically important Candida strains.

Subject and Methods

A total of 50 Candida isolates collected from different clinical samples submitted to the Main Microbiology Laboratory Ain Shams University Hospitals, were included in this study. Candida species were identified by conventional phenotypic tests as Gram stain, culture morphology and with automated V2C panels as well as with VITEK MS.

Results

There was a total agreement of (100%) between VITEK MS and V2C at the level of the genus and (96%) at the level of the species. The most common isolates identified were C.tropicalis followed by C. albicans in urinary samles.

Conclusion

VITEK MS is a rapid and reliable method in comparison to V2C for identification of Candida strains in Microbiology Clinical Laboratory.