bluuebunny/crossref_metadata_2025 huggingface dataset:
Faith (Rom. 3:28; 10:17)
Authors: Walters Adams Gwenfair
Published: November 2024

During the sixteenth century, scripture passage Romans 3:28 served as a key locus for the debate over justification by faith alone. Sola fide became a rallying cry for reformers from across the spectrum of Lutheran, Reformed, and Anabaptist viewpoints. The Council of Trent, however, condemned the doctrine. The definition for faith was both contested and critical, with the reformers emphasizing that what was important was the object of that faith: Jesus Christ and his saving work. Debates emerged over topics such as formed and unformed faith; the roles and interrelationships of caritas (love), the law, works, and faith; the reconciliation of the seeming contradiction of James and Paul on faith and works; the mixed response of Anabaptists to sola fide; and the roles that Scripture and the Holy Spirit play in how one acquires faith.
Introduction
Authors: McNutt Jennifer Powell , Selderhuis Herman J.
Published: November 2024

The Oxford Handbook of the Bible and the Reformation introduces readers to an expansive history of the Bible as it was shaped, shared, and received during the Reformation and across Christian traditions. Over the course of five parts, the volume’s content explores the biblical canon, translation and print, the development of Reformation hermeneutics, the history of Bible commentators, and exegesis relating to key texts and theological themes of Reformation writing and discourse. To engage the subject broadly, intricately, and robustly required a multitude of scholarly hands who hold a range of expertise attuned to the early modern Bible’s composition and position as sacred text and, from the Renaissance era on, printed book. With gratitude to the contributions of over fifty leading scholars and international experts in their respective fields, a fuller account emerges. The importance of the Bible’s role, reach, and authority among early modern European Christians is made evident.
The Latin Bible from the Late Middle Ages to Junius-Tremellius
Authors: McLean Matthew
Published: November 2024

This essay considers the form and status of the Bible in Latin at the close of the Middle Ages and traces out the developments through the sixteenth century. Assumed to be inspired and unchanged, the Latin Bible had come to exist in a number of traditions and had acquired errors and variations with the passing of centuries. Humanist methods of textual criticism and the opportunities presented by moveable type reshaped the Latin Bible, and the Reformation saw the creation of new Latin translations which diverged from the Vulgate, the authority of which was asserted by the Tridentine Church. These processes inspired many remarkable scholarly collaborations and also fierce controversies: the Latin Bible, in all its old and new forms, remained at the very heart of the religious and intellectual transformations of the century. Protestants did not relinquish the Vulgate and Catholic scholars were not ignorant of the critical editions and translations being produced elsewhere.
Printing Bibles during the Reformation
Authors: Severance Diana
Published: November 2024

The spread of the Reformation was in large measure abetted by Gutenberg’s earlier development of printing with moveable metal type. As printing presses sprang up in cities throughout Europe, many focused on printing Bibles. At first, the Latin Vulgate Bible was most printed, but after Luther’s German translation of the Bible, the printing of vernacular Bibles increased. In some places, printing Bibles was restricted; some printers were fined or even executed for not following the censorship laws. A review of the early history of printed Bibles especially in Germany, France, Switzerland, the Netherlands, and England reveals patterns developing in the formatting of Bibles. Printers developed special features which became standard in many Bibles, features such as page headings, prefaces to books, chapter summaries, marginal references, explanatory notes, maps, and woodcut illustrations. All of these would encourage the personal reading and study of the Scriptures which was foundational to the Reformation.
The OXIDATIVE SIGNAL-INDUCIBLE1 kinase regulates plant immunity by linking microbial pattern–induced reactive oxygen species burst to MAP kinase activation
Authors: Ma Miaomiao , Wang Pan , Chen Rubin , Bai Mei , He Zhuoyuan , Xiao Dan , Xu Guangyuan , Wu Hong , Zhou Jian-Min , Dou Daolong , Bi Guozhi , Liang Xiangxiu
Published: November 2024

Plant cell surface–localized pattern recognition receptors (PRRs) recognize microbial patterns and activate pattern-triggered immunity (PTI). Typical PTI responses include reactive oxygen species (ROS) burst controlled by the NADPH oxidase RESPIRATORY BURST OXIDASE HOMOLOG D (RbohD) and activation of the MAP kinase (MAPK) cascade composed of MAPKKK3/5–MKK4/5–MPK3/6. However, the mechanisms through which PRRs regulate and coordinate these immune responses are not fully understood. Here, we showed that Arabidopsis thaliana OXIDATIVE SIGNAL-INDUCIBLE1 (OXI1), a kinase known to be activated by ROS, is involved in the LYK5–CERK1 receptor complex, which recognizes fungal cell wall–derived chitin. The oxi1 mutant exhibits enhanced susceptibility to various pathogens and reduced chitin-induced MAPK activation and ROS burst. We showed that chitin induces the phosphorylation of OXI1 in an RbohD-dependent manner. H2O2 and chitin treatment causes the oxidation of OXI1 at Cys104 and Cys205, which is essential for the kinase activity of OXI1. These oxidation sites are required for chitin-induced MAPK activation and disease resistance. Activated OXI1 directly phosphorylates MAPKKK5 to regulate MAPK activation. Additionally, OXI1 phosphorylates RbohD, suggesting that it may activate RbohD to promote ROS burst to further enhance the long-term MAPK activation. Together, our findings reveal a pathway linking PRR-mediated ROS production to MAPK activation through OXI1.
Incidence of Acute Kidney Injury and Mortality in Critically Ill Patients: Urinary Chloride as a Prognostic Marker
Authors: Elkabarity Reem Hamdy , Emam Dalia Fahmy , Moneim Mohamed Wael Abdel , El Shafei Mahmoud Attia Abdel Rahman
Published: November 2024

Background

Acute kidney injury (AKI) is characterized by a rapid decrease in renal function. It is frequent in hospitalized patients and its incidence is higher in critically ill patients. It is associated with high rates of morbidity and mortality. AKI affects over 13 million people per year globally, and results in 1.7 million deaths. It is diagnosed in up to 20% of hospitalized patients and in 30– 60% of critically ill patients. It is the most frequent cause of organ dysfunction in intensive care units and the occurrence of even mild AKI is associated with a 50% higher risk of death.

Objective

To investigate the association between urinary chloride concentrations, AKI and mortality.

Patients and Methods

This prospective observational study has been carried out in Ain Shams University ICUs and included 90 critically ill patients with acute kidney injury during a study period of 6 months.

Results

Our results support a statistically high significant increase in serum chloride levels among non survival cases on the first day of ICU admission, till the 9th day. The present study revealed that urinary chloride level was significantly higher among survivors’ group on all days of ICU admission. There was a significant decrease in overall survival among AKI patients as they had longer ICU stay and 48.8% mortality rate (all non-AKI patients were discharged alive by 4th day).

Conclusion

We found that a lower urinary chloride concentration at the time of ICU admission was associated with higher mortality and higher incidence of AKI in critically ill patients. Urinary chloride measurement may constitute an early and useful prognostic marker for assessment of patients in ICU.
Effectiveness of Ultrasound Guided Quadratus Lumborum Block versus Intravenous Analgesia for Postoperative Pain Management in Patients Undergoing Hip Surgeries
Authors: Kamal Eldeeb Adham Magdy , Taha El-Safty Omar Mohamed , Ahmed Mohamed Saleh , Abd El-Aziz Noha Mohamed
Published: November 2024

Background

Orthopedic operations such as hip and femur fractures can lead to significant postoperative pain. In these patients, nonopioid analgesia techniques are especially important in aging populations when comorbidities are considered.

Aim of the Work

to compare the analgesic efficacy of ultrasound guided Quadratus Lumborum (QL) block versus intravenous analgesia for postoperative pain management in patients undergoing hip surgeries under spinal anesthesia.

Patients and Methods

This prospective interventional study was conducted at Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from January until August 2023. During this study, 40 patients scheduled for hip surgery under spinal anaesthesia were enrolled and divided into two equal groups; quadratus lumborum and control groups, with the same inclusion and exclusion criteria. Total amount of opioid analgesics needed by patients in both groups, pain scores according to the Visual Analog Scale (VAS), first time the patient needed postoperative rescue analgesia, vital data, postoperative length of hospital stay and side effects of drugs were recorded and compared between both groups.

Results

In our study, no differences were noted between groups regarding demographic data “age, sex, ASA and type of operation”. Regarding hemodynamics, our study revealed that at 10, 20, 40 min, PACU at 30 and 1hr, mean arterial pressures and heart rate were statistically significant higher among control cases compared with quadratus lumborum group. Regarding analgesic efficacy, our study revealed that VAS score was statistically significant higher after 4, 6 and 12hrs, need of 1st rescue analgesic was statistically significant faster 3.60 ± 1.06 vs. 18.00 ± 8.49 hours and total narcotics “mg” was statistically significant higher 60.00 ± 16.16 vs. 40.00 ± 13.69 among control cases compared with quadratus lumborum group. Also, our study revealed that hospital stay “days” was statistically significant longer 2.75 ± 0.44 vs. 1.75 ± 0.64 and side effect respiratory depression and vomiting were statistically significant higher among control cases compared with quadratus lumborum group.

Conclusion

QL block is effective for analgesia in patients after hip surgery compared with placebo or no block. QLB as a part of multimodal analgesia protocol reduces opioid consumption and pain scores in patients undergoing hip surgeries. The certainty of evidence based on GRADE was moderate.
APACHE II versus CURB-65 as a Prognostic Score to Assess Severity of Pneumonia Causing Sepsis in Critically Ill Patients
Authors: Saeed Abdelaziz Mohamed , El-sayed Ahmed Mohamed , Mohamed Wael Abdelmonaem , Hassan Ahmed Ali El-Shahat
Published: November 2024

Background

The Pneumonia Severity Index (PSI) and CURB-65 score are commonly used to stratify patients based on mortality risk in both clinical and research settings. However, their comparative predictive accuracy remains a subject of debate.

Aim of the Work

The aim of this study is to compare the efficacy between CURB-65 and APACHE II in assessment of the severity of pneumonia causing sepsis and predicting mortality in critically ill patients.

Methods

This study aimed to compare the efficacy of CURB-65 and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores in assessing pneumonia-induced sepsis severity and predicting mortality in critically ill patients. Two groups were formed, with Group A assessed using CURB-65 and Group B assessed using APACHE II scores. The study was conducted at the Critical Care department of Ain Shams University Hospitals, Cairo, Egypt.

Results

Our findings were in agreement with previous studies on various parameters such as mean arterial pressure, respiratory rate, and temperature. However, significant differences were observed in pulse and Glasgow Coma Scale (GCS). In contrast to other reports, our study did not find any significant difference in total leukocyte count between the two groups.

Conclusion

The CURB-65 score showed statistically significant differences in certain parameters between the survivor and non-survivor groups. The APACHE II score performed better than CURB-65 as an initial prognostic assessment in patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Moreover, the area under the ROC curve for APACHE II was greater than that for CURB-65, indicating better predictive accuracy for 28-day mortality. The choice between these scoring systems should be carefully considered when assessing the severity and predicting mortality in critically ill patients with pneumonia-induced sepsis. Further studies are warranted to validate these findings and optimize patient outcomes.
Glucocorticoid Treatment Association with Intensive Care Unit Acquired Hypernatremia in Septic Shock Patients
Authors: Mazrou Ayat Mohammed , Wahba Sherif Samir , Wahba Ramy Monier , Gad Ehab Ahmed
Published: November 2024

Background

Hypernatremia is one of the major electrolyte disorders associated with death among critically ill patients. Intensive care unit (ICU)-acquired hypernatremia is a frequent complication, occurring in 4–52% of patients. Even mild hypernatremia seems to be deleterious in ICU patients. This metabolic disturbance has been consistently associated with increased ICU length of stay, morbidity and mortality.

Aim of the Work

this observational prospective study aims to evaluate ICU-acquired hypernatremia in patient in septic shock treated by low dose corticosteroid. Primary aim: What is the incidence of ICU-acquired hypernatremia in patients with septic shock treated with low dose glucocorticoids? Second aim: What are the factors that contribute to the development of ICU-acquired hypernatremia?

Patients and Methods

this study is a prospective cohort study conducted at Ain Shams university hospitals. The duration of the study 6 months and the total of cases is 120 cases with septic shock were enrolled in the study.

Results

Outcomes of the studied patients, we reported 52 (43.33%) patients developed ICU- acquired hypernatremia. The median of ICU stay was 10 days days. Regarding complications, 44 (36. 7%) patients had mechanical ventilation, 42 (35%) patients developed acute kidney injury, 10(8.3%) patients developed GIT bleeding and 6 (5%) patients had major surgery complications. Mortality occurred in 50 (41 %) patients. We proved that there was a significant relationship between incidence of ICU-acquired hypernatremia and duration of steroid administration as hypernatremia was increased in patients administered steroids more than 7 days (P value <0.001). There was a significant relationship between ICU- acquired hypernatremia and sodium bicarbonate as medications, and significant relationship was found between ICU- acquired hypernatremia and complications (mechanical ventilation, acute kidney injury, while insignificant relationship between ICU-aquired hypernatremia and GIT bleeding and major surgery as complications and infusion fluid.

Conclusion

we clearly demonstrated that prolonged duration of corticosteroid even low dose hydrocortisone is strongly associated with ICU acquired hypernatremia, ICU acquired hypernatremia associated with risk factors may decrease free water can patients received, also associated with prolonged ICU stay and increasing risk of mortality. Consequently, when we administer glucocorticoid to critically ill patients, close monitoring of their serum sodium concentrations should be required especially when glucocorticoid is administered for longer periods.
Hyperdynamic Left Ventricular Ejection Fraction as a Predictor of Mortality in Intensive Care Unit Patients with Septic Shock
Authors: Mahmoud Hoda O , AbdelFattah Amr M , AbdelSalam Ehab H , Mahmoud Omar S , Hedia Doaa S
Published: November 2024

Background

A hyperdynamic left ventricle (ejection fraction ≥ 70%) seen on stress radionuclide myocardial perfusion imaging bears strong association with diastolic dysfunction and is therefore a marker of heart failure with preserved ejection fraction in appropriate clinical setting.

Objective

Evaluation of the cause and prognosis of hyperdynamic left ventricular ejection fraction in critically ill patients with sepsis.

Patients and Methods

A total of 235 patients diagnosed as septic shock admitted intensive care unit were enrolled. Patients were admitted to the ICU with a source of infection, diagnosed as sepsis using the Sequential Organ Failure Assessment score (SOFA). The score was calculated at admission and every 24 hours until discharge, using the worst parameters measured during the prior 24 hours. Besides tracing and promptly managing hemodynamic instability signs in patients with septic shock who are included in the study, as per Surviving Sepsis Campaign (SSC) recommendations. Data of past medical history and associated comorbidities were collected. Serum lactate level was measured on daily base. TTE was performed by myself or by the cardiologist (accredited from EMSE; the Egyptian Medical Society of Echocardiography).

Results

As regard 28 days mortality distribution; cases in our study were divided into 88 died and 147 living cases. As regard hyper-dynamic EF, our study reported statistically significant higher frequency of hyper-dynamic EF in died group 46 (52.3%) vs. 16 (10.9%) with higher Odds ratio [4.822 “1.467-8.852”]. Multivariate analysis revealed that the most significant predictors of mortality were old age 62.00 ± 17.90 vs. 54.14 ± 15.77 years, low MAP 40.70 ± 7.98 vs. 47.48 ± 4.70 mm/hg, high SOFA score 18.08 ± 1.95 vs. 14.27 ± 1.59, high serum lactate 4.52 ± 2.45 vs. 2.13 ± 1.06 mg/dl. As regard gender; there was a statistically significant higher frequency of male in died comparing to living group.

Conclusion

Hyperdynamic left ventricular ejection fraction has a significant prognostic value in critically ill patients with sepsis. It is a promising echocardiographic parameter in early detection of sepsis-induced cardiomyopathy or cardiovascular dysfunction.
Lactate, Unmeasured Anions and Chloride as Predictors to the Outcome of Critically Ill Patients with Liver Cirrhosis
Authors: Mohamed Dalia Abdelhamid , Nasr Fatma Mohammad , Khamis Ahmed Mohamed , Abdelazeem Ibrahim Mohamed , Elhashala Heba Saeed Elsayed
Published: November 2024

Background

Liver Cirrhosis is widely prevalent worldwide and can be a consequence of different causes, such as obesity, non-alcoholic fatty liver disease, high alcohol consumption, hepatitis B or C infection, autoimmune diseases, cholestatic diseases, and iron or copper overload. Cirrhosis develops after a long period of inflammation that results in replacement of the healthy liver parenchyma with fibrotic tissue and regenerative nodules, leading to portal hypertension.

Aim of the Work

The aim of the present study is to asses effect of serum lactate, Unmeasured anions and Chloride as predictors to the outcome of critically ill patients with liver cirrhosis.

Patients and Methods

This study was conducted on 95 patients divided to 4 groups according type of metabolic acidosis (lactic acidosis group, unmeasured anions acidosis group, hyperchloremic acidosis group, indeterminate acidosis group).

Results

This present study showed strong significance between (lactic acidosis), (unmeasured anion acidosis) and mortality incidence when compared with APACHE II score on day 0 (admission day). Where as hyperchloremia (hyperchloremic acidosis) was independently related to outcome.

Conclusion

The main finding in this study was that lactic acidosis constitutes the most common type of metabolic acidosis at the admission of critically ill patients. lactate, unmeasured anions were independent predictors of outcome. Any elevation in the concentration of these anions was associated with increasing Mortality. While, hyperchloremia was negatively related to mortality.
Sphenopalatine Plexus Block under General Anesthesia versus General Anesthesia Regarding Postoperative Pain Control in Functional Endoscopic Sinus Surgery (FESS)
Authors: Aziz Alawadi Islam Mohamed , Kamal Aboelela Sahar , ElGendy Mohammed Abdelsalam , Khamis Mohammed Ibrahim
Published: November 2024

Background

Functional endoscopic sinus surgery (FESS) is considered one of the most common surgical procedures. General anesthesia (GA) is usually required during FESS. Using regional analgesic techniques along with GA can be used to inhibit or decrease intra-operative and post-operative pain.

Objective

The aim of this work was to assess the effect of sphenopalatine plexus block in FESS using local anesthetics combined with general anesthesia to reduce use of pain killers postoperative.

Methodology

A prospective, randomized, single blinded comparative study conducted in the operating theatres of Ain Shams University Hospitals in a period of 6 months.

Results

Intra-operative vital data between Group 1(no SPGB) and Group 2(received SPGB) showed variations, with group 2 being more stable regarding blood pressure and heart rate. Moreover, post operatively Group 2 had lower VAS score readings and decreased no. of asking for rescue analgesia as compared to group 1. There was highly significant difference in systolic blood pressure between group 1 and group 2 with p value 0.00. There was highly significant difference between group 1 and group 2 regarding diastolic blood pressure with p value 0.00. There was a significant difference in heart rate, being higher in group 1 than group 2 intraoperative, on admission to PACU and 1 hour post-operative with p values 0.005 and 0. 010. There was a highly significant difference between group 1 and group 2 regarding VAS score on admission to PACU and after 1 hour post-operative with p value 0.003 and 0.009 respectively. There was a highly significant statistical difference in the number of doses of analgesia needed between group 1 and group 2 with p value 0.004. There was a highly statistically significant difference between group 1 and group 2 regarding 1st time analgesia was asked with p value 0.000.

Conclusion

Bilateral SPGB given intra-oral after induction of Anesthesia in FESS helps maintain patients vitally stable intraoperative as well as gives post- operative analgesia for patients at least 2 hours postoperatively with lower VAS score, and less number of doses of rescue analgesia needed post-operative, as compared to patients who didn’t receive local anesthesia along with General anesthesia.
Study of Effects of Preoperative Modafinil on Recovery Profile of Morbidly Obese Patients Scheduled for Bariatric Surgery
Authors: Ali Sultan Sherif Sayed , Mahmoud Khamis Ahmed Mohamed , Mohamed Gadouh Fouad Farouk , Zaki Ghali John Adel
Published: November 2024

Background

Obesity is a worldwide epidemic, bariatric surgery is currently the most effective treatment for obesity with clinically significant long-term weight loss. Delayed recovery from anesthesia remains one of the biggest challenging events that involve the anesthesiologist. The time to emerge from anesthesia is affected by patient factors, anesthetic factors, duration of surgery, and painful stimulation. Modafinil is a wakefulness-inducing compound prescribed for treatment of excessive daytime sleepiness because of sleep disturbances such as OSA or narcolepsy and also used in the management of fatigue associated with different conditions including depression, cancer, or tiredness in military personnel.

Aim of the Work

This study was designed to study effects of preoperative Modafinil on recovery profile of morbidly obese patients scheduled for bariatric surgery.

Patients and Methods

It was conducted to 20 patients of both sexes, scheduled for bariatric surgeries. Cases were aged 18-60 years, ASA physical status ІІ or III with BMI 40-50 kg/m2.

Results

Immediate recovery time, cognitive recovery, emotional (general) status, discharge from PACU according to modified Aldrete score. There is no significant difference between the two groups in terms of demographic characteristics including age, sex, weight, ASA, surgery type and duration.

Conclusion

Modafinil significantly enhanced immediate post anesthesia recovery, however our results didn’t show statistical significance regarding cognitive recovery, emotional, general status and Modified Aldrete Score when compared to placebo.
Comparative Study between the Effects of Dexamethasone versus Dexmedetomidine as Additives to Transversus Abdominal Block on Post-Operative Analgesia in Elective Caesarean Sections
Authors: Latif Fahmy Saad , Ashoor Tarek Mohammed , Refaat Sameh Ahmed , Mohamed Mahdy Mahmoud Samir
Published: November 2024

Background

The transversus abdominis plane (TAP) block is a peripheral nerve block designed to anesthetize the nerves supplying the anterior abdominal wall (T6 to L1). It was first described in 2001 by Rafi as a traditional blind landmark technique using the lumbar triangle of Petit. Dexamethasone acts locally on nociceptive C-fibers (through glucocorticoid receptors) to increase the activity of inhibitory potassium channels, thus decreasing their activity. The combined use of a local anesthetic agent and dexmedetomidine, applied in a TAP block, which targets peripheral nociceptive receptors, may be an ideal protocol for pain control after abdominal surgery.

Aim and Objectives

The main and primary goal of this research is to compare the efficacy and safety of dexmedetomidine and dexamethasone as a local anesthetic adjuvant to bupivacaine in TAP block for patients scheduled for elective CS. The secondary goal is to assess the effect of both additives as regard the duration of block.

Subjects and Methods

This was a Double blinded 2-arms parallel controlled trial, which was conducted in Ain Shams University Hospitals for 6 months, it was carried out on 50 full term pregnant women.

Result

Data showed no statistically significant difference according to demographic data, medical history, laboratory investigation (Mean±SD), heart rate, mean arterial blood pressure mmHg, mean random blood sugar, VAS score, time to need analgesics, and Side effects between groups.

Conclusion

the current study showed that both dexmedetomidine and dexamethasone were equally safe and effective as a local anesthetic adjuvant to bupivacaine in TAP block for patients scheduled for elective CS.
Prophylactic preoperative administration of oral gabapentin versus metoclopramide for prevention of opioid induced pruritis in spinal anesthesia.
Authors: Aziz Abd El-shahid Marina Edwar , Kamal Shams Manal Mohammad , Abd El-Rahman Ali Heba Mahmoud , Mohammad Douaa Galal Mohammad
Published: November 2024

Background

Spinal opioids have become a mainstay of clinical pain management in labor, in perioperative care, and in chronic pain management. Spinal opioids are frequently co- administered with local anesthetics to provide analgesia requiring lower doses of each agent, thus minimizing most undesirable side effects. Most opioid-induced side effects such as nausea, vomiting, and respiratory depression are more commonly observed following systemic administration.8 By contrast, pruritus is more commonly observed following intrathecal or epidural administration, particularly in obstetric patients.

Aim of the Work

to compare the efficacy of gabapentin versus metoclopramide for prevention of intrathecal opioids induced pruritus.

Patients and Methods

This study is a double blinded prospective randomized controlled clinical trial. This study conducted at Ain Shams University Hospital. The period of the study is a 6 months. 62 adult patients undergoing elective operations under spinal anesthesia at Ain Shams University hospital.

Results

The demographic data (age, gender, and ASA physical status) was statistically non- significant. The mean age was 35.1 years old in Group G and 36.8 years old in Group M with a P value of 0.569. The female-to-male ratio was 63.1 % in Group G and 82.3% in Group M with a P value of 0.607. In Group G, 71 % were of ASA 1 physical status and 29 % of ASA 2 physical status while in Group M, 67.7% were of ASA 1 physical status and 32% of ASA 2 physical status with a P value of 0.783. The whole incidence of pruritus in the two groups was 31.5%, (48.8% in group G and 45.2% in group M). There is no statistically significant difference, with a p-value 0.799. As for the severity, both drugs showed reduction of VAS score from the first hour after intrathecal fentanyl injection. Gabapentin showed to be more potent in decreasing the severity of pruritus as 2 patients only needed rescue treatment compared to 5 patients from metoclopramide group (but insignificant difference with p value 0.341). The overall incidence of nausea was 17.7% (22.58 in Gabapentin group and 12.9% in metoclopramide group). As for the incidence of vomiting, the whole incidence was 11.29% (16.13% in Gabapentin group and 6.45% in metoclopramide group). There was no statistically significant difference with a p-value 0.118 for nausea and p-value 0.374 for vomtitng.

Conclusion

The results of the study showed that Gabapentin is as effective as Metoclopramide in prevention of opioid induced pruritus in spinal anesthesia. But, Gabepentin improved to be slightly more effective in reducing the severity of pruritus than Metoclopramide.
Comparison of Ultrasound Guided Bilateral Rectus Sheath Block versus Local Wound Infiltration for Post Operative Analgesia in Patients undergoing Laparotomy with Midline Incision
Authors: Kamal Karim Youssef , Hazem Ashraf Mahmoud , Nassif George Maher , Kamal Mohy Merna Mohamed
Published: November 2024

Background

Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs.

Aim of the Work

The aim of this study is to assess the postoperative analgesic efficacy of Rectus Sheath Block (RSB) compared local wound infiltration after midline incision regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received.

Patients and Methods

The study was conducted on 56 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective midline expolaratory surgery. in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 28 patients each:

Results

Patients receiving RSB block had significantly lower pain scores at rest for 24 hr after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received wound infiltration of local anaesthetic.

Conclusion

U/S-guided rectus sheath block is more effective analgesic technique than local infiltration of the surgical wound, with longer duration of action and pethidine -sparing effect during the postoperative period after midline exploratory surgeries.
Validation of a Proposed Equation for Calculation of the Optimal Depth of Central Venous Catheter Inserted via the Right Internal Jugular Vein using the Middle Approach in Adult Patients
Authors: Hakim Sameh Michel , Elgouhary Mohamed Osama , Akhnokh Mina Reda Noaman
Published: November 2024

Background

A central venous catheter (CVC) is utilized for the monitoring of central venous pressure (CVP) and the administration of vasoactive drugs and fluids.

Aim of the Work

The aim of this study was to validate a proposed equation for evaluation of the optimal depth of central venous catheter inserted via the right internal jugular (IJV) vein using the middle approach in adult patients.

Patients and Methods

40 adult patients scheduled for open cardiac surgery were enrolled in whom TEE monitoring is indicated or preferred.

Results

Postoperative CXR showed that none of the patients in whom CVC placement was guided by TEE had their CVC tip placed below the level of the carina. The hypothetical position of the CVC tip as guided with surface landmark-based formula would have been below the carina in 6 (15%) of patients. The corresponding percentages for the C-length method and Pere’s formula would have been 45% and 100% respectively.

Conclusion

The central venous catheter tip was evaluated with the TEE and we were able to verify the accuracy of the proposed equation that was introduced by regression analysis of the results they got by placing the CVC tips in the mid SVC based on surface landmarks.
Red Cell Distribution Width as a Predictor for Post-Operative Atrial Fibrillation after Open Heart Surgeries
Authors: Mohamed Abdelaal Wael Ahmed , Saleh Ashraf Nabil , Ahmed Mohamed Ahmed Abdou Khaled Mohamed , Youssef Mohamed Ali
Published: November 2024

Background

Post operative Atrial Fibrillation is the most common type of arrythemia after open heart surgeries with incidence 30- 50%, in this study we investigated the relationship between RDW and the prediction of post operative atrial fibrillation, the eligiable patients were 76 patients, the duration of study was 2 months of data collection, patients were included according to the inclusion criteria mentioned earlier.

Objective

To evaluate the effectiveness of RDW preoperatively as predictor of incidence of post operative atrial fibrillation (POAF) in patients undergoing open heart surgeries.

Patients and Methods

Type of Study: Prospective observational study. Study Setting: To be conducted in Ain Shams University Hospitals cardiothoracic ICU unit on a postoperative patients with open heart surgeries after applying exclusion criteria.

Results

In our study of the risk factors for prediction of Atrial fibrillation, we found that COPD patients carry higher risk for POAF in comparison to non COPD patients with a p value

Conclusion

POAF remains one of the most challenging post operative complications after cardiac surgeries. Pre operative identification and classifications of high risk patients can contribute in decreasing the post operative morbidity and mortality after cardiac surgeries. The interpretation of CBC findings including RDW value along with the results of our study augment the valuable use of RDW as a novel biomarker for prediction of POAF. Other Inflammatory markers needs to be investigated to detect it’s reliability for prediction of POAF after cardiac surgeries and the interventions that can be taken to decrease the incidence of POAF after cardiac surgeries which includes the usage of anti –oxidants which needs further investigations and research.
Comparative Study between the Effect of Ultrasound Guided Erector Spinae Plane Block (ESPB) versus Serratus Anterior Plane Block (SAPB) for Postoperative Analgesia in Modified Radical Mastectomy Patients
Authors: Megeed Mohamed Al-Taher Waleed Abdel , Hussein Ahmed Noha Sayed , Khamis Mohamed Ibrahim , Ahmed Mohamed Ashraf
Published: November 2024

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.

Aim of the Work

The aim of this work is to evaluate the effectiveness of ultrasound guided erector spinae plane block (ESPB) versus Serratus Anterior plane block (SAPB) as a postoperative Analgesia in Modified Radical Mastectomy.

Patients and Methods

After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospitals. It included 64 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 32 patients group I in which patients received ESPB and group II in which patients received SAPB.

Results

The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the numeric rating score system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post operative hemodynamics were also assessed.

Conclusion

Both Erector spinae plane block and serratus anterior plane block provide good analgesic control after modified radical mastectomy but the ESPB is more superior compared to SAPB in postoperative hemodynamics and pain score.
Postoperative Pulmonary Functions Evaluation for Recently Recovered Covid-19 Positive Patients Posted for Surgeries under General Anaesthesia
Authors: Mohamed Basiony El-Ansary Samir El-Ansary , El Hakim Ashraf Mahmoud Hazem , Sayed Amr Gaber , Shokry Abdel Aziz Mohamed Raafat
Published: November 2024

Introduction

Since COVID-19 can impact virtually all major organ systems, the timing of surgery after a Covid-19 diagnosis is important when considering the risk of postoperative complications.

Objective

Evaluation of the pulmonary functions of recently recovered COVID positive patients after general anesthesia.

Methods

During this study, 30 recently recovered COVID positive patients, 4-8 weeks after the end of symptoms with a history of mild to moderate Covid-19 infection. Post-operative spirometry was performed after 8 hours and compared with the pre-operative one. Patients were divided into two groups, mild and moderate regarding severity of symptoms. Each group was further divided into two subgroups; first subgroup included 4 weeks post-Covid patients and second subgroup included 5 to 8 weeks post-Covid patients.

Results

There were no significant differences between study groups as regard postoperative pulmonary functions, intra operative hemodynamic instability, post-operative hypoxemia PSO2 < 90, post-operative nausea and vomiting.

Conclusions

Patients should avoid elective surgery shortly after infection, unless the benefits of doing so exceed the risk of waiting. Individualised multidisciplinary risk assessment for patients requiring elective surgery after SARS-CoV-2 infection is recommended.
Hypophosphatemia as a Prognostic Value in Acute Exacerbation of COPD: Prospective Study
Authors: Mohammed Abdelhakem Ali Mohammed Mohsen , Elhamid Hatem Said Abd , Labib Heba Abdel Azim , Mohamed EL Naggar Dalia Ibrahim
Published: November 2024

Background

Acute exacerbation of chronic obstructive disease leads to repeated hospital admissions and is associated with a high mortality rate, making it a leading cause of disability and morbidity. Phosphorus is an important and essential electrolyte that plays a significant role in various physiological and cellular biochemical processes, including adenosine triphosphate high energy bonds, which affect muscle contractility, cellular integrity, and other biological functions.

Aim of the Work

to evaluate the prognostic effects of hypophosphatemia in acute exacerbation of COPD patients and evaluate the correlation between phosphorus levels and the severity of acute exacerbation of COPD.

Patients and Methods

a prospective comparative study that was conducted on patients admitted to ER previously diagnosed as COPD with Gold score (moderate IIA to very severe IV) suffering from acute exacerbation of COPD at Ain Shams University Hospital throughout 6 months.

Results

The study found a male predominance (85%) among the included COPD patients with acute exacerbation. COPD patients with hypophosphatemia were significantly associated with a need for mechanical ventilation and failed weaning. Blood gas analysis is an important method in ICU departments which can evaluate the condition and progress of patients with acute exacerbation of COPD.

Conclusion

Hypophosphatemia was found to be a predictor of failure in weaning from mechanical ventilation among patients with acute exacerbation of COPD. Treatment with phosphorus improves outcomes and reduces the duration of mechanical ventilation.
The use of End Expiratory Occlusion Test vs. Inferior Vena Cava Respiratory Variation for the prediction of volume responsiveness in mechanically ventilated patients with sepsis
Authors: ElSayed Abd El Maksoud Nevein Fawzy , Elewa Gamal Eldin Mohammad Ahmad , Sayed Ahmed El Sers Mayar Hassan , Emam Ali Nawar Dalia Fahmy , Ahmad Youssef, Eldemerdash Dr Ahmad Moneer
Published: November 2024

Sepsis being a chief prominent fatal condition in critically ill patients. In septic shocked patients, the first-line therapeutic intervention is fluid resuscitation in an attempt to improve their cardiac output (COP). However, fluids must be given only if the chance of improving COP exists. So, assessing fluid responsiveness is crucial. To our knowledge, yet no studies comparing the End- expiratory-occlusion (EEO) test and the variation of the inferior-vena-cava diameter with respiration (ΔIVC) in hypovolemic cases. So, our aim is to use both tests as indices for responsiveness to fluid in septic mechanically ventilated (MV) patients. The Patients and Method: Thirty four MV septic patients were enrolled and baseline COP assessment was performed followed by an EEO test applied to each patient, after which, COP was measured to detect the probable responders (defined as an increased COP by ≥ 15%) and non-responders. Then, ΔIVC was assessed for the same patients to predict the probable responders (with ΔIVC >12%) and non-responders. Finally, fluid therapy was initiated as per the guidelines of surviving sepsis campaign (2021) followed by COP re-assessment to determine actual fluid responders\non-responders.

Results

Sixty-seven% of the cases were responding to fluid. Receiver operating characteristic showed areas under curve for EEO and ΔIVC in predicting responsiveness to fluid were 0.597 and 0.925, respectively. EEO (32.4%) was predictive with 47.8% sensitivity and 100% specificity. The ΔIVC (64.7%) was predictive with 91.3% sensitivity and 100% specificity.

Conclusion

IVC-respiratory-variation showed better values in prediction of response to fluid in MV patients with sepsis than EEO test.
Efficacy of Pericapsular Nerve Group Block (PENG BLOCK) in the Perioperative Period for Patients Undergoing Hip Surgery
Authors: Mahmoud Ahmed Sherif Khairy , Ibrahim Ahmed Saeed , Ismail Wafaa Elsayed , Fouly Mohamed Abdelmoneim
Published: November 2024

Background

Proximal femur fractures are common fractures especially in elderly population and produce routine problems for trauma. It is common that they lead to immobility or hindrance in daily life. In addition, elderly people can have surgical problems as well as multiple medical complications (Schuetze et al., 2019).

Aim of the Work

The study aimed to Studying the effect of the pericapsular nerve group (PENG) block on providing perioperative analgesia and improving functional recovery following total hip arthroplasty.

Patients and Methods

This prospective randomized controlled trial study was conducted in Ain Shams University Hospitals. Thirty six adult patients scheduled for proximal femur fracture fixation under spinal anaesthesia were included in this study. The patients' age was above 18 years old and with the American Society of Anaesthesiologists (ASA) Class I, II and III. At the the beginning of the surgery, patients were randomized using a random number table and the use of a closed envelopes technique were used to receive either ultrasound guided pericapsular nerve group block (PENG) block, or normal saline (no PENG block), each group constitutes 18 patients.

Results

As regarding time of 1st rescue analgesia our study revealed that there was significant shorter duration to first rescue analgesia in control group as mean time in control group was 13 hours compared to 19 hours in PENG group. As regarding to total morphine consumption our study revealed marked decrease in morphine consumption in the 1st 24 hours post operatively with mean 3mg in PENG group and 6mg in control group. As regarding the mobility after surgery we found that 17 patients out of 18 who received PENG block could stand at 24 hours post operatively in comparison to only 6 patients in control group.

Conclusion

The other aspect that should be discussed is that the PENG block provides only anterior hip capsule analgesia. Although the anterior capsule innervation is responsible for the majority of hip-related pain, it omits the posterior capsule, which is innervated by the nerve to the quadratus femoris and from the superior gluteal nerve, both from the sacral plexus.
A Comparative Controlled Study of Preoperative Skin Infiltration with Bupivacaine-Dexmedetomidine versus Bupivacaine-Magnesium for Pain Control Analgesia in Para Umbilical Hernia regarding Their Perioperative Analgesic Effect
Authors: Ali Naglaa Mohamed , Mohammed Ammar Mona Ahmed , Mawla Saleh Mohamed Abdel , Abdel Razek Ahmed Tasneem Fathy
Published: November 2024

Background

Postoperative pain and opioid-related adverse drug events are still among the principal factors affecting the rapid recovery and discharge of patients undergoing surgery. Wound pain at rest and on movement is one of the main sources of postoperative pain. In addition, skin traction stimulation, which can be caused by respiratory movement and the daily activities of patients after surgery, further aggravates the severity of wound pain, resulting in restlessness and insomnia and even inducing serious symptoms such as wound tear and infection. The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses. The technique of wound infiltration analgesia has been shown to play an active role in relieving postoperative pain and reducing opioid consumption.

Aim of the Work

Comparing the effectiveness of pre-incision skin infiltration with bupivacaine- dexmedetomidine mixture versus bupivacaine-magnesium mixture for elective para umbilical hernia repair.

Patients and Methods

A Prospective randomized, double blinded controlled study was conducted in Ain Shams university hospital on 75 adult patients undergoing para umbilical hernia or infra umbilical incisional hernia repair. They will be randomly divided into three groups. Method of randomization using computer generated number list using opaque sealed envelopes. Patients will be enrolled in group B for bupivacaine alone, group D for bupivacaine-dexmedetomidine and group M for bupivacaine-magnesium.

Results

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

Conclusion

Dexmedetomidine is found to be an effective adjuvant to bupivacaine for local wound infiltration analgesia in terms of effective analgesic duration, need for rescue analgesic and better pain scores in the immediate postoperative period, and provides better sedation than bupivacaine–magnesium sulfate mixture or bupivacaine alone in patients undergoing surgeries for hernia repair.