bluuebunny/crossref_metadata_2025 huggingface dataset:
P-617 The investigation of the shared genetic architecture between hypothyroidism and age at menopause
Authors: Long P , Ruping Q , Hongmei X
Published: July 2024

Study question

Is there a shared genetic architecture and a putative causal association between hypothyroidism and age at menopause (AM)?

Summary answer

There is a genetic correlation and a causal relationship between Hypothyroidism and AM.

What is known already

Thyroid disease is more common in women. The interplay between thyroid function and the gonadal axes remains interconnected throughout a woman’s reproductive cycle. Notably, the menopausal phase represents a critical period for metabolic alterations, wherein thyroid hormones and metabolic status are intricately intertwined.

Study design, size, duration

Data from publicly available genome-wide association study (GWAS) summary statistics of hypothyroidism (European-based: 51,194 hypothyroidism cases and 443,383 controls) and AM (European-based: N = 141,926) were used to investigate shared genetic assosiation.

Participants/materials, setting, methods

Shared genetics between hypothyroidism and AM were explored using linkage disequilibrium score regression, ρ-HESS, cross-trait meta-analysis, colocalization analysis and summary data-based Mendelian randomization, and investigated causal associations using Mendelian randomization.

Main results and the role of chance

The estimated liability scale of the single nucleotide polymorphisms (SNPs) heritability for AM and hypothyroidism was 13.0% and 5.1%, respectively. A substantial negative genetic association (rg = -0.081, P = 0.0055) was found by bivariate LDSC between hypothyroidism and AM. Local Genetic Correlations identified a strong local signal at 6p21.32-21.33 (chromosome 6: 31571218-32682664) (P = 1.39E-5). Ten important common SNPs were found. Hypothyroidism had a causal effect on AM, but not vice versa. Genetic association between hypothyroidism and AM in blood were enriched in Genotype-Tissue Expression (GTEx) data. In addition, two potentially functional genes, PPM1F and RPL23AP1, were identified to be associated with both hypothyroidism and AM.

Limitations, reasons for caution

Hypothyroidism encompasses primary and secondary forms, and due to limited data availability, our study could not perform phenotype-specific analyses. Second, even though our research identified genes associated with hypothyroidism and AM, more experimental research and long-term studies are required to fully understand the biological mechanisms underlying the observed genetic relationships.

Wider implications of the findings

Our study, thorough genome-wide cross-trait analysis, reveals a shared genetic architecture and causal relationship between hypothyroidism and AM. These may open up a new avenue for future research between hypothyroidism and AM.

Trial registration number

Not applicable
Correlation between kinetic parameters, reactor performance, and biogas and methane potential of co-digestion and mono-digestion of active sludge and olive mill wastewater
Authors: Al bkoor Alrawashdeh Khalideh , Al-Sameraie La’aly , Al Bsoul Abeer , Khasawneh Ayat , Al-Tabbal Jalal
Published: July 2024

Anaerobic co-digestion(AcoD) of active sludge (AS) and olive mill wastewater (OMW) is becoming an increasingly recognized alternative to manage waste and generate renewable energy. A kinetic study of the performance of biochemical methane potential (BMP) and continuous stirred tank reactors (CSTR) bioreactors was conducted to identify critical parameters influencing. Substrates of 100%OMW, 100%AS, 25:75%, 75:25%, and 50:50 were utilized in the BMP and CSTR digesters. To identify the optimum mixing, BMP tests were conducted under three different operating conditions: no mixing (NM), low-continuous mixing intensity (LM) of 25 rpm, and high continuous mixing intensity (HM) of 60 rpm. CSTR with an optimum mixing regime is utilized to identify the optimum substrate. In particular, the removal efficiency of volatile solids (VSs), total chemical oxygen demand (TCOD), and the production of biogas and methane (CH4) were investigated to specify the performance of the anaerobic digestion (AD) process. The results revealed that the optimum mixing regime is LM with BMP tests. Also, the maximum performance in CSTR-ML was achieved by 75:25 AS:OMW, 0.339 Nm3/kg VS of biogas, 69.89% of CH4, and a removal efficiency of 87.12% of VS and 79.23% of TCOD. For BMP tests, the biogas and CH4 yield production kinetics were best fitted by the modified Gompertz models: mono-digestion and co-digestion 75:25 and 50:50 of AS:OMW, while the best-fit model for co-digestion 25:75 was achieved by the transfer model. The production kinetics were well described by modified Gompertz models in CSTR tests. These results point to the possibility of optimizing digester systems on a wide scale using the outputs that have been observed.

Novelty statement. 

This research work provides novel insights into the performance of the digester under diverse mixing conditions and varying co-substrate concentrations of AS:OMW and presents the best model to predicate the biogas and CH4 at various operation conditions.
Type IV secretion system effector sabotages multiple defense systems in a competing bacterium
Authors: Wang Bingxin , Xu Fugui , Zhang Zeyu , Shen Danyu , Wang Limin , Wu Huijun , Yan Qing , Cui Chuanbin , Wang Pingping , Wei Qi , Shao Xiaolong , Wang Mengcen , Qian Guoliang
Published: July 2024

Effector proteins secreted by bacteria that infect mammalian and plant cells often subdue eukaryotic host cell defenses by simultaneously affecting multiple targets. However, instances when a bacterial effector injected in the competing bacteria sabotage more than a single target have not been reported. Here, we demonstrate that the effector protein, LtaE, translocated by the type IV secretion system from the soil bacterium Lysobacter enzymogenes into the competing bacterium, Pseudomonas protegens, affects several targets, thus disabling the antibacterial defenses of the competitor. One LtaE target is the transcription factor, LuxR1, that regulates biosynthesis of the antimicrobial compound, orfamide A. Another target is the sigma factor, PvdS, required for biosynthesis of another antimicrobial compound, pyoverdine. Deletion of the genes involved in orfamide A and pyoverdine biosynthesis disabled the antibacterial activity of P. protegens, whereas expression of LtaE in P. protegens resulted in the near-complete loss of the antibacterial activity against L. enzymogenes. Mechanistically, LtaE inhibits the assembly of the RNA polymerase complexes with each of these proteins. The ability of LtaE to bind to LuxR1 and PvdS homologs from several Pseudomonas species suggests that it can sabotage defenses of various competitors present in the soil or on plant matter. Our study thus reveals that the multi-target effectors have evolved to subdue cell defenses not only in eukaryotic hosts but also in bacterial competitors.
A Comparison of Racial and Ethnic Disparities in Complications Following Burn Injury in Adult Patients
Authors: Ragan Mecklin V , Yemele Kitio Sibelle Aurelie , Bergus Katherine C , Wala Samantha J , Patterson Kelli N , Nafiu Olubukola O , Thakkar Rajan K , Schwartz Dana M
Published: July 2024

Burn injury contributes to significant morbidity and mortality in the United States. Despite an increased focus on racial and ethnic disparities in healthcare, there remains a critical knowledge gap in our understanding of the effect of these disparities on complications experienced by burn patients. The American Burn Association’s National Burn Repository data were reviewed from 2010 to 2018. Information regarding demographics, burn mechanism and severity, complications, and clinical outcomes were recorded. Data analysis was performed using 1:1 propensity score matching and logistic regression modeling. A separate analysis of Hispanic and non-Hispanic patients was performed using Chi-squared tests. Among 215,071 patients, racial distribution was 65.16% White, 19.13% Black, 2.18% Asian, 0.74% American Indian/Alaskan Native, and 12.78% other. Flame injuries were the most common cause (35.2%), followed by scald burns (23.3%). All comparisons were made in reference to the White population. Black patients were more likely to die (OR: 1.28; 95% CI, 1.17-1.40), experience all (OR: 1.08; 95% CI, 1.03-1.14), cardiovascular (OR: 1.24; 95% CI, 1.08-1.43), or infectious (OR: 1.64; 95% CI, 1.40-1.91) complications, and less likely to experience airway complications (OR: 0.83; 95% CI, 0.74-0.94). American Indian/Alaskan Native patients were more likely to experience any complication (OR: 1.33; 95% CI, 1.05-1.70). All minority groups had increased length of hospital stay. Black, Asian, and other patients had longer length of ICU stay. Black patients had longer ventilator duration. Among 82 775 patients, 24 075 patients were identified as Hispanic and 58 700 as non-Hispanic. Statistically significant differences were noted between groups in age, total body surface area, proportion of 2nd-degree burn, and proportion of 3rd-degree burn (P < .01). These findings highlight the need for further work to determine the etiology of these disparities to improve burn care for all patients.
How Do Consumers React to Ads That Meddle in Out-Party Primaries?
Authors: Hussein Mohamed A , Lee Courtney , Wheeler S Christian
Published: July 2024

In 2022, Democrats spent $53 million on ads helping far-right candidates win Republican primaries. Paying for ads that support far-right candidates, the reasoning went, could help Democrats win in the general elections because it is easier to beat extreme than moderate candidates. In the current research, we ask: how do consumers react to the use of “meddle ads”? On the one hand, because of rising levels of polarization, consumers might be accepting, or even supportive, of meddle ads. On the other hand, because meddle ads might come across as unethical and risky, consumers might be averse to their use. Across 7 main studies and 10 supplemental studies (N = 7,740) using multiple empirical approaches—including conjoint analysis, vignette studies, incentive-compatible donation studies, and analysis of online comments using human coders and NLP tools—we find that consumers are averse to the use of meddle ads. This aversion is driven by three factors: concerns about the character of the candidate, outcome-related risk (losing elections), and system-related risk (losing trust in democracy). These findings contribute to research on political marketing, provide practical guidance for marketers around meddle ads, and identify a novel type of risk perceptions with implications for consumer behavior research.
Cloning and functional analysis of the juvenile hormone receptor gene CsMet in Coccinella septempunctata
Authors: Cheng Ying , Zhou Yuhang , Li Cao , Jin Jianxue
Published: July 2024

The potential role of the juvenile hormone receptor gene (methoprene-tolerant, Met) in reproduction of Coccinella septempunctata L. (Coleoptera: Coccinellidae)(Coleoptera: Coccinellidae), was investigated by cloning, analyzing expression profiles by quantitative real-time PCR, and via RNA interference (RNAi). CsMet encoded a 1518-bp open reading frames with a predicted protein product of 505 amino acids; the latter contained 2 Per-Arnt-Sim repeat profile at amino acid residues 30–83 and 102–175. CsMet was expressed in different C. septempunctata larvae developmental stages and was most highly expressed in third instar. CsMet expression in female adults gradually increased from 20 to 30 d, and expression levels at 25 and 30 d were significantly higher than levels at 1–15 d. CsMet expression in 20-d-old male adults was significantly higher than in males aged 1–15 d. CsMet expression levels in fat body tissues of male and female adults were significantly higher than expression in the head, thorax, and reproductive system. At 5 and 10 d after CsMet-dsRNA injection, CsMet expression was significantly lower than the controls by 75.05% and 58.38%, respectively. Ovary development and vitellogenesis in C. septempunctata injected with CsMet-dsRNA were significantly delayed and fewer mature eggs were produced. This study provides valuable information for the large-scale rearing of C. septempunctata.
Experience with chemotherapy for postoperative metastases of adenosquamous carcinoma of the esophagogastric junction and pathological study of its development
Authors: Mita Kazuhito , Oda Hideaki , Shimaguchi Mayu , Kouno Michitaka , Toyota Naoyuki , Hatano Minoru , Toyota Tsuyoshi , Sasaki Junichi
Published: July 2024

We report here a case of postoperative recurrent adenosquamous carcinoma (ASC) of the esophagogastric junction (EGJ) treated with S-1 therapy. A 79-year-old woman was diagnosed with carcinoma of the EGJ. Thoracoscopic subtotal esophagectomy was performed, and pathological examination revealed advanced ASC with lymph node metastasis. Five months after surgery, multiple lung metastases and multiple lymph node metastases were observed, and the patient was treated with S-1 monotherapy, which showed partial response and may be effective for advanced ASC of the EGJ. On the other hand, immunohistological analysis of the tumors showed a relatively wide range of areas that could differentiate into both adenocarcinoma and squamous cell carcinoma, suggesting that tumor cells with multidifferentiation potential, or at least the ability to differentiate into both adeno-epithelial and squamous epithelial cells, were the likely source of the tumors.
Inner dusty regions of protoplanetary discs – III. The role of non-radial radiation pressure in dust dynamics
Authors: Vinković Dejan , Čemeljić Miljenko
Published: July 2024

We explore the dynamical behaviour of dust particles that populate the surface of inner optically thick protoplanetary discs. This is a disc region with the hottest dust and is of a great importance for planet formation and dust evolution, but we still struggle to understand all the forces that shape this environment. In our approach, we combine results from two separate numerical studies, one is the wind velocity and density distributions obtained from magnetohydrodynamical simulations of accretion discs, and the other is a high-resolution multigrain dust radiation transfer. In our previous paper in the series, we described the methodology for utilizing these results as an environmental input for the integration of dust trajectories driven by gravity, gas drag, and radiation pressure. Now we have two improvements, we incorporate time changes in the wind density and velocity, and we implement the non-radial radiation pressure force. We applied our analysis on the Herbig Ae and T Tau stars. We confirm that the radiation pressure force can lead to dust outflow, especially in the case of more luminous stars. Additionally, it opposes dust accretion at the inner disc edge and reduces dust settling. These effects are enhanced by the disc wind, especially in the zone where the stellar and the disc magnetic fields meet. Our results suggest that dust grains can stay in the hottest disc region for an extended period and then end up ejected into the outer disc regions.
Mitochondrial-targeted cyclometalated Ir(III)-5,7-dibromo/dichloro-2-methyl-8-hydroxyquinoline complexes and their anticancer efficacy evaluation in Hep-G2 cells
Authors: Meng Ting , Shi Xiongzhi , Chen Hongfen , Xu Zhong , Qin Weirong , Wei Kehua , Yang Xin , Huang Jin , Liao Chuanan
Published: July 2024

Both 8-hydroxyquinoline compounds and iridium (Ir) complexes have emerged as potential novel agents for tumor therapy. In this study, we synthesized and characterized two new Ir(III) complexes, [Ir(L1)(bppy)2] (Br-Ir) and [Ir(L2)(bppy)2] (Cl-Ir), with 5,7-dibromo-2-methyl-8-hydroxyquinoline (HL-1) or 5,7-dichloro-2-methyl-8-hydroxyquinoline as the primary ligand. Complexes Br-Ir and Cl-Ir successfully inhibited antitumor activity in Hep-G2 cells. In addition, complexes Br-Ir and Cl-Ir were localized in the mitochondrial membrane and caused mitochondrial damage, autophagy, and cellular immunity in Hep-G2 cells. We tested the proteins related to mitochondrial and mitophagy by western blot analysis, which showed that they triggered mitophagy-mediated apoptotic cell death. Remarkably, complex Br-Ir showed high in vivo antitumor activity, and the tumor growth inhibition rate was 63.0% (P < 0.05). In summary, our study on complex Br-Ir revealed promising results in in vitro and in vivo antitumor activity assays.
Potential Utility of C-reactive Protein for Tuberculosis Risk Stratification Among Patients With Non-Meningitic Symptoms at HIV Diagnosis in Low- and Middle-income Countries
Authors: Dupnik Kathryn , Rivera Vanessa R , Dorvil Nancy , Duffus Yanique , Akbarnejad Hanane , Gao Yipeng , Liu Jingyi , Apollon Alexandra , Dumont Emelyne , Riviere Cynthia , Severe Patrice , Lavoile Kerlyne , Duran Mendicuti Maria Alejandra , Pierre Samuel , Rouzier Vanessa , Walsh Kathleen F , Byrne Anthony L , Joseph Patrice , Cremieux Pierre-Yves , Pape Jean William , Koenig Serena P
Published: July 2024

Background

The World Health Organization recommends initiating same-day antiretroviral therapy (ART) while tuberculosis (TB) testing is under way for patients with non-meningitic symptoms at HIV diagnosis, though safety data are limited. C-reactive protein (CRP) testing may improve TB risk stratification in this population.

Methods

In this baseline analysis of 498 adults (>18 years) with TB symptoms at HIV diagnosis who were enrolled in a trial of rapid ART initiation in Haiti, we describe test characteristics of varying CRP thresholds in the diagnosis of TB. We also assessed predictors of high CRP as a continuous variable using generalized linear models.

Results

Eighty-seven (17.5%) participants were diagnosed with baseline TB. The median CRP was 33.0 mg/L (interquartile range: 5.1, 85.5) in those with TB, and 2.6 mg/L (interquartile range: 0.8, 11.7) in those without TB. As the CRP threshold increased from ≥1 mg/L to ≥10 mg/L, the positive predictive value for TB increased from 22.4% to 35.4% and negative predictive value decreased from 96.9% to 92.3%. With CRP thresholds varying from <1 to <10 mg/L, a range from 25.5% to 64.9% of the cohort would have been eligible for same-day ART and 0.8% to 5.0% would have untreated TB at ART initiation.

Conclusions

CRP concentrations can be used to improve TB risk stratification, facilitating same-day decisions about ART initiation. Depending on the CRP threshold, one-quarter to two-thirds of patients could be eligible for same-day ART, with a reduction of 3- to 20-fold in the proportion with untreated TB, compared with a strategy of same-day ART while awaiting TB test results.
Molecular tumor board: molecularly adjusted therapy upon identification and functional validation of a novel ALK resistance mutation in a case of lung adenocarcinoma
Authors: Arndt Annette , Neumann Christian , Riecke Armin , Bauer Arthur , Müller Matthias , Wölfle-Guter Manuela , Grunert Michael , Busch Hauke , Künstner Axel , von Bubnoff Nikolas , Fliedner Stephanie , Greinert Dina , Osius Jasmin , Nagarathinam Kumar , Steinestel Konrad , Gorantla Sivahari Prasad , Gebauer Niklas , Witte Hanno M
Published: July 2024

We report a case of a long-term surviving patient with EML4/ALK translocated non–small cell adenocarcinoma of the lung in UICC8 stage IVA. During recurrence under continuous crizotinib therapy, a hitherto insufficiently characterized missense mutation in the ALK gene (Arg1181His) was identified through targeted sequencing. The aforementioned EML4/ALK translocation could still be detected in this situation. Employing a 3D reconstruction of the ALK tertiary structure, considering its interaction with various ALK inhibitors at the molecular binding site, our analysis indicated the presence of a mutation associated with crizotinib resistance. To validate the biological relevance of this previously unknown mutation, we carried out an in vitro validation approach in cell culture in addition to the molecular diagnostics accompanied by the molecular tumor board. The tumor scenario was mimicked through retroviral transfection. Our comparative in vitro treatment regimen paired with the clinical trajectory of the patient, corroborated our initial clinical and biochemical suspicions. Our approach demonstrates preclinical, in silico, and clinical evidence of a novel crizotinib resistance mutation in ALK as well as sensitivity toward brigatinib and potentially lorlatinib. In future cases, this procedure represents an important contribution to functional diagnostics in the context of molecular tumor boards.
Cisplatin eligibility in the neoadjuvant setting of patients with muscle-invasive bladder cancer undergoing radical cystectomy
Authors: Pichler Renate , Fritz Josef , Mari Andrea , Cadenar Anna , von Deimling Markus , Marcq Gautier , del Giudice Francesco , Leonardo Costantino , Bologna Eugenio , Mori Keiichiro , Tahbaz Rana , De Santis Maria , Klatte Tobias , Erber Barbara , Lackner Felizian , Kronbichler Andreas , Seeber Andreas , Fisch Margit , Moschini Marco , Pradere Benjamin , Mertens Laura S
Published: July 2024

Background

To examine the agreement of different calculated estimated glomerular filtration rate (eGFR) formulas and measured creatinine clearance (CrCI) at the primary diagnosis of muscle-invasive bladder cancer (MIBC).

Materials and Methods

We performed a multicenter analysis of patients with MIBC, treated with cisplatin-based neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), or with RC alone, between 2011 and 2021. Baseline eGFR was computed using 4 calculated serum equations including Cockcroft-Gault (CG), MDRD, CKD-EPI 2009, and race-free CKD-EPI 2021. To examine the association between calculated eGFR and measured CrCI, subgroup analyses were performed among patients in whom measured 24-hour urine CrCl was determined. Cisplatin-ineligibility was defined as CrCI and/or eGFR < 60 mL/minute per 1.73 m2.

Results

Of 956 patients, 30.0%, 33.3%, 31.9%, and 27.7% were found to be cisplatin-ineligible by the CG, MDRD, CKD-EPI, and race-free CKD-EPI equations (P = .052). The concordance between calculated eGFR formulas was rated substantial (Cohen’s kappa (k): 0.66-0.95). Among the subgroup (n = 245) with measured CrCl, 37 (15.1%) patients had a CrCI less than 60 mL/minute. Concordance between measured CrCl and calculated eGFR was poor (ĸ: 0.29-0.40). All calculated eGFR formulas markedly underestimated the measured CrCI. Specifically, 78%-87.5% of patients with a calculated eGFR between 40 and 59 mL/minute exhibited a measured CrCI ≥ 60 mL/minute.

Conclusions

Comparing calculated eGFR formulas, similar percentages of patients with MIBC were deemed cisplatin-ineligible. However, a significant number of patients could be upgraded by being cisplatin-fit based on measured CrCI, particularly when the calculated eGFR was falling within the gray range of 40-59 mL/minute.
Effects of Continuous versus Single Dose Spinal Anesthesia in Octogenarians Undergoing Hip Surgery: Randomized Control Trial
Authors: Mady Eman Z , ELzahaby Hany M , Elsersi Mayar H , Ahmad Aya H
Published: July 2024

Background

Continuous spinal anesthesia (CSA) is an anesthetic technique that offers several clinical advantages for anesthesia and analgesia in elderly patients. The level of sensory blockade can be titrated to the desired dermatomal level with great precision with intrathecal (IT) catheters, allowing better control of the hemodynamic consequences of sympathetic blockade associated with spinal anesthesia compared to epidural or single shot spinal techniques. Octogenarians are expected to suffer more from hemodynamic instability with spinal anesthesia.

Objective

The primary outcome is to compare the incidence of hypotension (defined as decrease in mean arterial blood pressure > 20% from the base line) in continuous spinal anesthesia CSA versus single dose spinal anesthesia in octogenarians undergoing hip surgery. The secondary outcome is to determine the total use of vasopressor (Ephedrine) and the incidence of spinal complications as nausea, vomiting and post Dural puncture headache.

Methods

This is a randomized controlled clinical trial done at Ain-shams University Hospitals, Cairo, Egypt within a period of 6 months from approval of medical ethics committee. Twenty patients in CSA group received increments of (0.5 ml) of plain bupivacaine 0.5% until T10 level blockade is achieved. Twenty patients in SDA group received single shot of (2.5ml) of bupivacaine 0.5%.

Results

The main finding of this study is that while MAP was significantly lower between 5-35 minutes (<0.001), it was significantly higher between 40-75 minutes in SDA group than CSA group (0.05).Total bupivacaine dose was significantly higher in SDA (12.5±0.8) group than CSA group (7.6±1.3) (p < 0.001). The total ephedrine dose needed was significantly higher in the SDA group (19.5 ±11.3) than in CSA group (4.5±1.7) (p.0.006).

Conclusion

The main finding of this study is that for octogenarians undergoing hip surgery, while MAP was significantly lower between 5-35 minutes, it was significantly higher between 40-75 minutes in single dose spinal anesthesia group than continuous spinal anesthesia group. Episodes of bradycardia were similar in both groups. The bupivacaine dose as well as total ephedrine dose was significantly higher in SDA group than CSA group. Groups were similar in the incidence of postoperative complications related to the neuraxial blockade. The impact of these changes on the overall cardiovascular status and outcome in octogenarians undergoing hip surgery could not be determined from our study design.
Effect of Interleukin-6 Inhibitor (Tocilizumab) in Treatment of Severe Cases of COVID-19 in Intensive Care Unit, Prospective Clinical Trial
Authors: Fahmy Salama George Atef , Mahmoud Hoda Omar , Moris Kerolos Emad , Hussein Wael Reda
Published: July 2024

Background

COVID-19 is a respiratory disease induced by a novel coronavirus (SARS- CoV-2), having already caused more than 2.5 million deaths over the world. Most people with COVID-19 have only mild or uncomplicated symptoms.

Aim of the Work

to study the effect of using Tocilizumab in treatment of severe cases of COVID-19 in ICU.

Patients and Methods

is a clinical trial study (Analytic, Intervention study, single arm, prospective); this study was carried out at Ain shams university hospitals.

Results

The mean Time to death from receiving Tocilizumab was 6.1888 ± 0.6 SD (Days), the mean Hospital length of stay 14.94 ± 1.85 SD (Days), the number of patients required Mechanical Ventilation was 29 Patients, the mean Duration of mechanical ventilation was 15.19 ± 1.094SD (Days), the number of patients who demonstrated clinical improvement was 38 (73%) and the number of patients who discharged alive was 31 (60%).

Conclusion

in critically ill adult patients with Covid-19 receiving organ support in ICUs, treatment with the interleukin-6 receptor antagonists, Tocilizumab improved outcomes, including survival. Many patients achieved clinical improvement and were eventually discharged from the hospital.
Intravenous Dexamethasone versus intrathecal Dexamethasone in Prolonging the Duration of Spinal Anesthesia and Postoperative Analgesia in Elective Cesarean Section
Authors: Mohamed Radwa Tarek , Hammad Raafat Abdelazim , Kamar Noha Mohamed , Mohamed Marwa Mamdouh
Published: July 2024

Background

Spinal anesthesia is the most commonly used technique for cesarean section as it is very economical and easy to administer. The short duration of action of local anesthetic drugs has created a matter of concern for anesthesiologists.

Aim of the Work

To compare the efficacy of intrathecal dexamethasone with intravenous dexamethasone as an adjuvant to prolong the sensory block obtained by spinal anesthesia and postoperative analgesia in cesarean section.

Participants and Methods

66 pregnant women scheduled for cesarean section were randomly allocated to one of three groups including (22) patients each. All the patients received injection of heavy bupivacaine 0.5% 10 mg through spinal anesthesia, with adding 1 mL of 0.9% saline and normal saline 2 mL intravenously (control group), or 0.5 mL (2mg) dexamethasone diluted in 0.5 ml of 0.9% saline intrathecally with normal saline 2 mL intravenously (IT group ), or dexamethasone 2 mL (8mg) intravenously with intrathecal injection of heavy bupivacaine 0.5% 2 mL plus 1 mL of 0.9% saline (IV group ) with overall 3 ml volume intrathecally in each group. Duration of sensory block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded.

Results

The study groups, There was significantly higher post-operative analgesic duration (8.73 ± 2.64) hours compared to addition of Intravenous Dexamethasone (4.91 ± 1.02) hours or using hyperbaric bupivacaine alone (3.43 ± 0.71) hours with p-value <0.001. There was no effect on the time of onset of sensory block with no significant complications were detected.

Conclusion

The addition of 2mg dexamethasone intrathecally as an adjuvant to spinal anesthesia during cesarean section prolong the duration of sensory block and postoperative analgesia.
A Comparative Study Between Ultrasound-Guided Ilioingunial/Iliohypogastric Nerve Block versus Transverse Abdominis Plane Block in Patients Undergoing Oblique Inguinal Hernia Repair
Authors: Fahmy Adel Mikhael , Kamal Karim Youssef , Abdallah Abdelaziz , Ashour Abdelrahman Hassan
Published: July 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 and prolonged hospital stay.

Objective

Regional anesthesia by (Ultrasound guided (US) Transversus abdominis plane block (TAP) or Ultrasound guided ilioinguinal and iliohypogastric nerves (IIN+IHN) block may be used as components of multimodal anesthesia with a comparable effect. In the present study, Bupivacaine is used to compare between them following inguinal hernia repair.

Patients and Methods

The study was conducted on 60 randomly chosen patients aged above 18 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective unilateral open inguinal hernia repair under general anesthesia, in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups. TAP block Group: received general anesthesia and (0.2 mL/kg of 0.25% bupivacaine per side), by midaxillary approach, under ultrasound guidance, the probe was placed transversely between the iliac crest and costal margin. Ilioinguinal/ iliohypogastric nerves block group: received general anesthesia, with (0.2 mL/kg of 0.25% bupivacaine per side). The inferior portion of linear ultrasound transducer will be placed over the anterior superior iliac spine with the superior margin of the transducer pointed directly in an oblique plane toward the umbilicus. The superior margin of the ultrasound transducer was slowly rotated superiorly and inferiorly until the fascial plane between the internal oblique and transverse abdominis muscle is identified.

Results

The results of the study revealed that patients received IIN+IHN block had significantly lower pain scores at 8, 12, 16, 20, and 24 hrs after operation, delayed time for rescue analgesia and decreased total need of analgesic in the first 24hrs post-operative compared to patients who received TAP nerves block.

Conclusion

IIN+IHN block was effective in reducing postoperative pain scores for 4-6 hours, lowering total 24-h postoperative opioid and analgesic consumption and delaying the need for rescue analgesia after inguinal hernia repair under general anesthesia, compared to TAP nerves block. It will be more useful to study in high-risk hypertensive and cardiac patients and to correlate with plasma catecholamine levels, which reflect the stress response and it is necessary to evaluate postoperative pain on movement in farther studies.
Bupivacaine/Dexmedetomidine versus Bupivacaine Alone in Caudal Block for Toddlers Undergoing Unilateral Open Inguinal Hernia Repair
Authors: Ahmed Ahmed Ali Fawaz , Nasr El Din Dalia Abdel Hamid Mohamed , Abd-Elfattah Ghoneim Mohamed Mohamed , Elsayed Khalil Mona Mohamed Magdy
Published: July 2024

Background

Unilateral open inguinal hernia repair surgeries are one of the most frequently performed operations in the pediatric population. Regional anesthetic techniques are commonly used for better control of pain in pediatrics. the most widely used technique of regional anaesthesia in pediatrics is the caudal block.

Objective

To evaluate the analgesic and sedative effect of dexmedetomedine when given caudally as an adjuvant to bupivacaine in caudal block vs bupivacaine alone in toddlers undergoing unilateral Open inguinal hernia repair surgeries.

Patients and Methods

The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia.

Results

The result of the study reveals that the addition of dexmedetomedine at 1μg/kg to bupivacaine 0.25% in caudal blocks can effectively prolong the duration of postoperative analgesia and causes better sedation than using bupivacaine alone in caudal blocks at similar doses in pediatrics.

Conclusion

From our study we can conclude that the addition of dexmedetomedine at 1μg/kg to bupivacaine 0.25% in caudal blocks can effectively prolong the duration of postoperative analgesia and causes better sedation in the toddlers undergoing unilateral open inguinal hernia repair surgeries. It is better than using bupivacaine alone in caudal blocks at similar doses.
Prognostic Value of C-Reactive Protein in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Admitted to Intensive Care Unit
Authors: Ali Sultan Sherif Sayed , Ali Elshebiny Ahmed , Khamis Ahmed Mohamed , Mounir Ramy Wahba , Masoud Ali Khedr Masoud Mostafa
Published: July 2024

Background

Chronic obstructive pulmonary disease (COPD) is a leading and increasing cause of worldwide morbidity and mortality. Recently, COPD has gained interest as a major public health concern and is currently the focus of intense research because of its persistently increasing prevalence, mortality, and disease burden. COPD is the third leading cause of death in the world, and further increases in its prevalence and mortality can be predicted in the coming decades.

Aim of the Work

The aim of the present work was to detect the possible role of CRP levels in predicting the prognosis of ICU admitted patients with AECOPD.

Patients and Methods

This prospective Cross sectional study was conducted on 66 adult patients of both sexes admitted to the ICUs of Al-Mabarra governmental hospital in Port Said and Ain Shams University Hospitals.

Results

In our study, it was noticed that duration of NIMV (Days) ranged from 2 h - 11 days in low group and ranged from 1 day - 14 days in high group, While Duration of IMV (Days) ranged from 2 h – 7 days in low group and ranged from 3 day - 18 days in high group. In the present study, we found that 33patients were discharged after improvement (100%) from low group (it reflects the benefit of grouping our study cases), while 26patients were discharged after improvement (78.79%), and 7 patients (21.21%) unfortunately were dead from high group. In the current study, as regards the correlation between CRP with MV, ICU stay and hospital stay, it was noticed that the serum CRP level was significantly elevated in relation to increased period of IMV days (r = 0.714, p = <0.001), NIMV days (r = 0.491, p = <0.001), ICU stay (r = 0.690, p = <0.001) and hospital stay (r = 0.686, p = <0.001).

Conclusion

The following conclusion was obtained from the current study: CRP as biological marker was noticed to be elevated in patients with AECOPD who needed ICU admission. CRP is good indicator of future increase of MV days, hospital stay and ICU stay. There was a significant relation between CRP level and mortality. 100% of our study cases of low group discharged on improvement it reflects the benefit of grouping our study cases. There was no significant relation between CRP level and development of acute heart failure regarding the inclusion criteria in the study.
Comparative Study between High Caloric Nutrition and Net Caloric Nutrition and Their Correlation with Organs Failure and Mortality in Acute Respiratory Distress Syndrome Patients
Authors: Sabri Hussein Hassan , Sultan Sherif Sayed , Taeimah Mohamed Osman , Ramzy Tadrous Rafik Alfy , Abdel-Ghaffar Ahmed Elsaid
Published: July 2024

Background

Acute respiratory distress syndrome (ARDS) is an acute life threatening inflammatory lung injury manifested by hypoxia and stiff lungs due to increased pulmonary vascular permeability and almost always requiring mechanical ventilation support. ARDS represents an acute response to diverse provoking trigger factors and etiologies, resulting in bilateral lung opacities on radiography and hypoxemia.

Objective

To compare between high caloric nutrition and net caloric nutrition in ARDS patients regarding the mortality rates and the incidence of multiple organ failure.

Patients and Methods

This was a prospective, cohort, randomized, comparative study that was conducted on include adults’ patients with ARDS who was admitted to ICU Units in El Galaa Military Hospitals throughout 6 months.

Results

Regarding our primary outcomes, we found that there was no difference found between two groups regarding Hospital mortality, and there was statistically significant difference found between two groups regarding Survival at 60 days. While for the secondary outcomes in our study, we found that there was no difference found between two groups regarding infections, ICU mortality, ICU duration of stay and duration of hospital stay.

Conclusion

No difference was found between high caloric nutrition and net caloric nutrition in terms of the mortality rates and the incidence of multiple organ failure among ARDS patients.
Analgesic Effect of Intrathecal Nalbuphine versus Intrathecal Fentanyl as Adjuvant to 0.5% Bupivacaine for Cesarian Section under Spinal Anaesthesia
Authors: Marzouk Mervat Mohammad , Elsayed El Hennawy Ahmed Mohammad , Mohammad Kamal Mohammad , Abdnagho Abdelnour Tadrous Nabiel
Published: July 2024

Background

One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. The use of opioids in intrathecal or epidural anesthesia has become common to increase postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use.

Objective

To assess the postoperative analgesic requirements and the spinally mediated analgesic effects of intrathecal nalbuphine as an adjuvant to intrathecal bupivacaine after cesarean section in comparison to intrathecal bupivacaine with fentanyl.

Methods

This randomized comparative clinical trial was conducted in Ain Shams University Hospitals’ operating rooms on 48 patients undergoing cesarean section within a period of six months after approval of ethical committee of Faculty of Medicine, Ain Shams University.

Results

This study showed that the addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the demographic data, duration of operation, maximum sensory level, and maximum motor blockade level. Adding to this, there was also no significant changes regarding the vital data of the patients. On the other hand, there was a significant difference regarding the duration of analgesia which was longer with nalbuphine. It was also noticed that with nalbuphine less patients required rescue analgesia in comparison to fentanyl. There was higher number of side effects recorded with fentanyl in comparison to nalbuphine.

Conclusion

Either intrathecal nalbuphine (0.8 mg) or intrathecal fentanyl (25 μg) combined with Bupivacaine improves intraoperative analgesia and prolongs post- operative analgesia in cesarean section. There was statistically significant difference between them, intrathecal nalbuphine had a prolonged duration of post-operative analgesia, lesser amount of rescue analgesia needed and fewer side effects than intrathecal fentanyl.
Peripheral Perfusion Index as a Predictor of Post-Spinal Hypotension in Patients Undergoing Lower Abdominopelvic Surgeries
Authors: Mohamed Sadek Sohair Abbas , Anis Saïd Sherif George , Adel Abdelhameed Gamal Eldin , Mohamed Ahmed Mohamed Khaled
Published: July 2024

Background

One of the main complications of spinal anesthesia is post spinal hypotension. And since noninvasive hemodynamic & blood pressure monitoring are the standards in most surgical procedures, ensuring best & safest monitoring standards has been of utmost importance. The use of plethysmography in anesthesia monitoring has become one of the essential tools in any anesthetic procedures. However, its varying interpretations & usages haven't been explored to the fullest.

Objective

To assess predictability of baseline peripheral perfusion index to Post spinal hypotension in patients undergoing elective lower abdomino-pelvic surgeries.

Methods

This Prospective Observational study was conducted in Ain Shams University Hospitals’ operating rooms. And was conducted over a period of 6 months after approval of ethical committee of Faculty of Medicine, Ain Shams University, All patients undergoing elective lower abdominopelvic surgeries at El-demerdash Hospital of Surgery during the study period. Surgeries include inguinal / inguinoscrotal hernia repair, paraumbilical hernia repair, lower laparotomies, transurethral resection of bladder tumor, simple gynecological procedures.

Results

This study showed that Perfusion index can be used as a predictor for hypotension in patients undergoing elective lower abdominopelvic surgeries under spinal anesthesia. Patients with baseline PI > 0.9 are at greater risk of developing hypotension after spinal anesthesia when compared with those with baseline PI ≤ 0.9. Hence, peripheral perfusion index usage can be recommended in this regard.

Conclusion

This study concluded that Perfusion index can be used as a predictor for hypotension in patients undergoing elective lower abdominopelvic surgeries under spinal anesthesia. Patients with baseline PPI >0.9 are at greater risk of developing hypotension after spinal anesthesia when compared with those with baseline PPI ≤0.9 .Hence, peripheral perfusion index usage can be recommended in this regard.
Effect of Calcium Ionophore on the Embryonic Outcome of the Intracytoplasmic Sperm Injection in Female Patients with Good & Bad Quality Oocytes: Histomorphometric Study
Authors: Baraka Aya Abdrabo , Hafez Kawther A , Elgamal Hatem H R , Desouky Ahmed M , Fetouh Marwa A
Published: July 2024

Introduction

Fertilization failure is the most common problem in assisted reproductive technology . In incident of ovum and/or spermatozoa correlated fertilization difficulties after intracytoplasmic sperm injection, approaches of modified ICSI techniques, which can be done using Ca 2+ ionophores. The objective of the research Effectiveness of Ca 2+ ionophores was studied on the embryonic outcome in female patients with bad quality oocytes while her partner has normal semen analysis.

Materials and Methods

Thirty-eight couples have undergone ICSI, with female age ranging between 40 to 45 years old. The retrieved oocytes were subdivided into 4 groups; good quality oocytes, good quality ovums with adding Ca 2+ ionophore treatment, bad quality ovums in addition, bad quality ovums with adding Ca 2+ ionophore treatment, all were inserted by the corresponding sperms. Examination of the embryos was done on day two after fertilization, cleavage stage, and blastulation stage.

Results

Treated good quality oocytes showed fertilization of (92%) of the oocytes compared to (68%) of the untreated good quality oocytes. Treated bad quality oocytes showed fertilization of (85%) of the oocytes compared to (65%) of the untreated bad quality oocytes. The quality of embryos was enhanced on day two after fertilization, day three (cleavage stage), and day five (blastulation stage) in both treated groups than in the untreated ones.

Conclusion

The activated oocytes resulted in better fertilization and embryonic development. Therefore, ICSI combined with artificial oocyte activation using Ca 2+ ionophore is useful in mid-age female patients with good and bad quality oocytes regardless the cause.
Effect of Consumption of Caffeinated Energy Drinks on the Myocardium of the Adult Male Albino Rat (A Histological and Morphometric Study)
Authors: Hakim Magdoline Helmy , Saleh Soheir Ibrahim , Amin Mariam Asaad , Helmi Abaas Maha Abbas
Published: July 2024

Background

Energy drinks are non-alcoholic beverages containing mainly caffeine. Chronic consumption of energy drinks may be associated with increased blood pressure, and cardiac work load, as well as, increased heart rate. Energy drinks consumption has been related to myocardial infarction in healthy young adult.

Aim of the Work

The aim of the present work was to study the harmful effect of energy drinks histologically and morphometrically, on the myocardium of the adult male albino rats.

Material and Methods

20 Adult male albino rats aging 4-6 moths were divided randomly into two groups; Group I (Control group) which consisted of 10 male albino rats with free access to food (rat chew) and water and Group II (Experimental group): 10 male albino rats which received 3.75 ml/kg body weight red bull through oral gavage daily for 4 weeks with free access to food (rat chew) and water. At the end of experiment, rats werescarificed, and cardiac muscle was extracted and processed into paraffin blocks for light microscopic examination. Morphometric study and statistical analysis were done.

Results

The present work demonstrated that Red Bull induced several histopathological changes of the cardiac muscle. The results showed the cardiac muscle of rats with irregularities in the arrangement of fibers and wide spaces in between. Some cardiomyocytes showed areas of pale stained sarcoplasm, partial loss of the cross striations and ill-defined intercalated discs. Localized areas of hyaline degeneration and areas of tissue disruption were also noticed with less frequently localized coalesced cytoplasmic vacuoles. The nuclei of the cardiomyocytes appeared small, darkly stained, and pyknotic. Others were flattened and deeply stained. Congested, and thick walled blood vessels were also observed, with mononuclear cellular infiltrations. In Masson’s Trichrome sections, relative increase in collagen deposition between the cardiac muscle fibers was observed which was associated with focal fibrous degeneration. Examination of the semithin sections showed partial disruption of the cardiomyocytes. The nuclei of the cardiomyocytes were small, darkly stained with perinuclear degeneration. Some nuclei were eccentric, or with an irregular outline, and peripheral chromatin condensation. The characteristic finding was the presence of longitudinal wavy cardiac muscle fibers with relatively wide spaces in between and localized areas of partially lost cross striations and intercalated discs. Dilated, thick walled blood vessels was noticed between the bundles of cardiac muscle. Mononuclear inflammatory cellular infiltrations were also detected.

Conclusion

The present study demonstrated the degenerative and cardiotoxic effects of Red Bull as an example of energy drinks on the histological structure of the cardiac muscle.