bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Perineural versus Systemic Dexamethasone to prolong analgesia after Supraclavicular Nerve Block in patients undergoing Wrist Arthroscopy
Authors: Mohammed A E , Abdellatif A A , Shokry H , Refaat A A N H 
Published: May 2020

Abstract

Background
Poorly controlled acute pain after surgery is associated with a varity of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Wrist arthroscopy is a very common surgery and performed as a day case surgery and need good postoperative analgesia. Many adjuvant drugs are added to bupivacaine to prolong the duration of sensory block like opioids and dexamethasone.

Objective
The aim of this thesis was to study the effect of adding both perineural & systemic dexamethasone as an adjuvant to bupivacaine in supraclavicualr nerve block. The comparison included the the effect on hemodynamics, postoperative pain & postoperative analgesic requirement.

Methods
In our study, 40 patients were randomly divided into two equal groups: Group #1 (20 patients): Block with 18 ml Bupivacaine 0.5% (+ 2 ml Dexamethasone ‘8 mg’) & 2 ml normal saline was injected IV. Group #2 (20 patients): Block with 18 ml Bupivacaine 0.5% (+ 2 ml normal saline) & 2 ml Dexamethasone ‘8 mg’ was injected IV.

Results
Our study showed that addition of 8 mg dexamethasone to bupivacaine in supraclavicular nerve block whether perineural or intravenous prolonged postoperative analgesia with negligible side effects however, slight better outcome for the perineural route.

Conclusion
Dexamethasone was seen to be a potent adjunct to local anaesthetic to prolong post operative analgesia with negligible side effects with slightly better outcome to the perineural route.
Ultrasound Measurement of Inferior Vena Cava Diameter versus Central Venous Pressure as a Tool of Assessment of Intravascular Volume in Adult ICU Patients
Authors: Ghobrial B B , Alansary A M , Aly R M , Bayoumy A M 
Published: May 2020

Abstract

Background
Measurements of central venous pressure (CVP), pulmonary arterial catheterization, esophageal Doppler, ultrasound, and trans-esophageal echocardiography may be used to determine the volume status of critically ill patients. Appropriate interpretation of the information offered by hemodynamic monitoring requires the integration of several variables. Echocardiography is increasingly used as a first tool to identify a problem and help select initial treatment. To improve patient management and outcome, the clinician must understand the advantages and the limitations of the various tools and parameters used during ICU stay.

Aim of the Work
to assess the intravascular volume by comparing between IVC diameter, IVC collapsibility index by ultrasound with central venous pressure (CVP) in critically ill patients.

Patients and Methods
A clinical interventional study was carried out at department of intensive care at Ain Shams University hospitals – Cairo – Egypt., during a three months (from October 2017 till December 2017).This study was approved by Ethical Committee of Faculty of Medicine, Ain Shams University, including the informed consents which were obtained from either the patient or the closest family member.

Results
In our study the IVC Collapsibility Index correlated well with the Central Venous Pressure. The sensitivity and specificity of IVC Collapsibility to Central Venous Pressure were also found to be highly statistically significant. The change in IVC diameters were also found to be statistically significant when compared to Central Venous Pressure.

Conclusion
The IVC CI% can provide a useful guide for noninvasive intravascular volume status and an alternative to CVP measurement assessment in critically ill patients.
Comparison of Analgesic Efficacy of Caudal Dexamethasone versus Intravenous Dexamethasone as an Adjuvant to Caudal Block in Pediatric Patients Undergoing Lower limb orthopedic Surgeries
Authors: Mohamed G S , Abdelatif A A , Menshawey M , Mansour A A S 
Published: May 2020

Abstract

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

Aim of the Work
This study is conducted to evaluate the analgesic effect of dexamethasone when given systemically versus caudally as an adjuvant to caudal block for children undergoing lower limb orthopedic 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.

Results
The results of the study revealed that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain.

Conclusion
From our study, we can conclude that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain.
Effect of Preoperative Pregabalin on Stress Response during Laryngoscopy, Intubation and Postoperative Analgesia in Normotensive Normoglycemic Patients Undergoing Abdominal Hysterectomy
Authors: Gadelrab I A , Ali H A H , Wahba S S , Tharwat A I , Mohamed D S 
Published: May 2020

Abstract

Introduction
abdominal hyterectomy is common operation and have many indications. Laryngoscopy and intubation induce marked sympathetic hemodynamic effect resulting in cardiac response which may be fatal in some patients. Postoperative pain in the form of hyperalgesia caused by surgical trauma can lead to chronic postoperative pain. Preemptive analgesia is a concept in managing postoperative pain. Preemptive analgesia prevents sensitization of peripheral and central pain pathways caused by tissue damage. Pregbalin is thought to supress the hemodynamic effect of intubation and to have analgesic effect.

Aim
The aim of this work is to evaluate the effects of different doses of pregabalin as a premedication to attenuate cardiovascular response during laryngoscopy and intubation. Intubation-induced hyperglycemia will be also assessed, in addition to the effect of the drug on postoperative analgesia in normotensive normoglycemic patients undergoing abdominal hysterectomy.

Subjects and Methods
The current study was performed as a randomized, prospective, placebo-controlled, and double blind study on 120 female patients ASA I, scheduled for elective abdominal hysterectomy under general anesthesia and meeting the inclusion criteria, were allocated into four groups. Group A (n = 30) were given placebo 2 hrs preoperatively, Group B, C and D were given oral pregablin in the following doses 75 mg, 150 mg and 300 mg recpectively. preoperative vital data (systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate were measured before intubation and after intubation by 2, 4 and 6 minutes. Capillary blood glucose was measured before and after intubation. Intraoperative and postoperative analgesic consumption were recorded. Anesthetic and surgical techniques were standardized.

Results
The increase in hemodynamic parameters were minimized by pregablinin 150 and 300 mg when compared to the control group and patients received 75 mg. The intraoperative and postoperative consumption of analgesia were decreased in the groups receiving 150 and 300 mg.

Conclusion
Oral pregablin in 150 and 300 mg in the present study attenuates hemodynamic responses tolaryngoscopy and intubation. Oral pregablin in 150 and 300 mg decreases the consumption of analgesics intraoperatively and postoperatively.
Comparison between Dexmedetomidine and Propofol for Sedation in Mechanically Ventilated Intensive Care Patients
Authors: Latif F S , Thabet W R H , Haiba D M , Ebrahim M A A 
Published: May 2020

Abstract

Background
Critically ill patients are submitted to several interventions that can lead to distress and pain, like endotracheal intubation, mechanical ventilation, and central venous and arterial catheterization. Indeed, pain is one of the most common memories from patients admitted to intensive care unit (ICU) and can lead to agitation and its consequences, as accidental extubation, and removal of intravascular devices. Accordingly, one of the most used drugs for patients in the ICU are sedatives and analgesics

Objectives
The aim of the study is to compare dexmedetomidine and propofol for sedation in mechanically ventilated intensive care patients according to vital data and laboratory findings during sedation to figure out efficacy and safety profiles between both drugs in sedation, weaning and facilitating extubation in intensive care unit

Patients and Methods
This study was performed on 40 patients divided into 2 groups equally one group received propofol and the other group received dexmedetomidine as a sedative during mechanical ventilation. We collected vital and heamodynamics data and laboratory findings during the time of sedation in ICU.

Results
All the 40 patients completed the study. The demographic profiles of both the groups were comparable. These groups were also comparable with respect to baseline vital parameters and baseline investigations. The study groups included both surgical and medical patients.
There were no statistically significant differences between the two patient groups with respect to age, weight, gender and APACHE II score.

Conclusion
This study evaluated dexmedetomidine versus propofol for sedation in mechanicaly ventilated patients in ICU. We conclude that adequate level of sedation can be achieved by both dexmedetomidine and propofol
Continous local Intra –arterial Nimodipine administration in severe symptomatic vasospasm after spontanous subarachnoid hemorrhage:a meta-analysis
Authors: Elshaer A N , Habil I S , Moharram A A , Menshawe M A , Marzouk A M 
Published: May 2020

Abstract

Background
Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space (the area between the arachnoid membrane and the pia mater surrounding the brain). SAH is a potentially life threatening condition. Hemorrhage may occur as a result of a head injury or spontaneously (usually from a ruptured cerebral aneurysm). Spontaneous subarachnoid hemorrhage occurs in about one per 10,000 people per year. Females are more commonly affected than males. While it becomes more common with age, about 50% of people present under 55 years old. It is a form of stroke and comprises about 5 % of all strokes. Disturbed conscious level, specially that associated with cerebral arterial vasospasm, remains a major cause of death and disability in the patients with aneurysmal subarachnoid hemorrhage.The classical modality of management for vasospasm was oral calcium channel blockers (nimodipine) with triple-H therapy (Hypedynamic augmentation therapy).

Aim
To evaluate the effect of Continous local Intra –arterial nimodipine administration in severe symptomatic vasospasm after spontanous subarachnoid hemorrhage on mortality and morbidity (symptomtic cerebral ischemia).

Methodology: Studies and participants
In the current meta-analysis, we searched for interventional clinical trials in critically ill adult patients that evaluated to have aneurysmal subarachnoid hemorrhage complicated by severe symptomatic vasospasm (causing delayed cerebral ischemia and neurological deficits) which was refractory to standard hyper dynamic therapy (triple- H therapy) and oral calcium channel blockers (CCBS).

Results
In the current meta-analysis, the duration of infusion of nimodipine was at least for 72 hours. The onset of occurance of cerebral vasodilation after the infusion in all studies by their different doses was 12 hours detected by transcranial doppler. The time of termination of nimodipine infusion is different from patient to other patient depending on clinical improvement ( improvement of consious level or disappearance of the newly developed neurological deficit) and radiological findings that refers to the relief of vasospasm assesed by transcranial doppler and cerebral angiography. Reinfusion of the nimodipine was done in all included studies in case of recurrence of vasospasm causing new neurological deficit or deterioration in the conscious level .

Conclusion
It concluded from the current meta-analysis that, intra-arterial nimodipine infusion is effective and safe treatment for syptomatic refractory vasospasm after aneurysmal subarachnoid hemorrhage.
Comparative Study between 25 Gauge Spinal Needle (Quincke) versus (pencil point) As Regarding incidence of Post Dural Puncture Headache
Authors: Eskander F S L , Ibrahim D A , Hamza A H , Mahmoud M G 
Published: May 2020

Abstract

Background
PDPH can affect patients’ functional recovery and comfort, both are critical factors for patients who expect to resume their daily activities as soon as possible. Especially obstetric patients who will be responsible for a new child.

Objective
The aim of this study is to assess the incidence of PDPH by using the same 25gauge spinal needle but with two different shapes pencil point versus quincke.

Patients and Methods
The study was conducted on 60 randomly chosen patients full filling inclusion criteria in Matarya teaching hospital after approval of the medical ethical committee. They were allocated in two groups of 30 patients each: Group(A) 25 gauge spinal needle (quincke) is used. Group (B) 25 gauge spinal needle (pencil point)is used. The two groups were adequately monitored and assessed intra- and post-operatively and they were compared in vital data as regarding HR, SBP, DBP and the development of PDPH, if developed classified into mild, moderate and severe and assessment of backache.

Results
The results of this study revealed that patients in the study group(A) had more incidence of PDPH 10% compared to 0% in group (B) although still no significant statistical deference but still non beveled spinal needle have lower rates of incidence than quincke (beveled ) spinal needles. Also we found 5 patients out of 30 (16.7%) suffered from backache in group A and one patient (3.3%) suffered from mild backache in group B.

Conclusion
Our study suggests that the use of non beveled spinal needles lead to less incidence rates of PDPH. The frequency and severity of PDPH was higher in 25G cutting spinal(quincke) needle group as compared to non cutting (pencil point)needle. For spinal anesthesia.
A Comparative Study between Effects of Ultrasound Guided Ilioinguinal /Iliohypogastric Nerve Block versus Caudal Block on Postoperative Analgesia in Children Undergoing Inguinal Surgery
Authors: Nafie M M H , Altaher W A , Nassef G N , Ahmed M M W 
Published: May 2020

Abstract

Background
The most commonly performed inguinal surgeries in children include inguinal hernia repair with or without orchidopexy and hydrocele repair. For postoperative pain with these surgeries, a regional analgesic modality such as caudal analgesia (CA), ilioinguinal and iliohypogastric nerve block (IL/IH), or even local infiltration is combined with a general anaesthetic (GA). Regional analgesia techniques are commonly used to facilitate pain control during pediatric surgical practice, decrease parenteral opioids requirements and improve the quality of post-operative pain control and patient-parent satisfaction. When compared to intravenous (IV) opioids, regional techniques reduce the risk of side effects such as somnolence, respiratory depression, emesis, and ileus.
Patients and Methods: After approval of anesthesia, intensive care and pain management department, scientific and ethical committees, and after informed parental written consents, this prospective randomized clinical trial study was conducted in Ain Shams University Hospitals. This study is considered to be a pilot exploratory study. Forty five children patients were included in the study scheduled for elective inguinal surgeries (e.g.; unilateral inguinal hernia repair, hydrocele repair, or orchidopexy). Patients will be randomized using a random number table and the use of a closed envelopes technique to receive either combined general anesthesia with ultrasound guided caudal block (Group A), combined general anesthesia and ultrasound guided ilioinguinal /iliohypogastric block (Group B), or general anesthesia with intravenous morphine (group C).

Results
Among 45 children of (27 boys and 18 girls), aged from one to six years old, ASA physical status I–II who were scheduled for elective unilateral inguinal surgeries, fifteen patients received general anesthesia with ultrasound guided caudal epidural anesthesia (1ml/kg bupivacaine 0.25%), fifteen patients received general anesthesia with ultrasound-guided ilioinguinal/ iliohypogastric nerve block (0.5ml/kg bupivacaine 0.25%) and fifteen patient received general anesthesia with intravenous morphine (0.1 mg/kg).

Conclusion
The current study demonstrated that ultrasound-guided ilioinguinal /iliohypogastric nerve block was more effective than ultrasound guided caudal epidural block or intravenous morphine usage in children aged 1-6 years old undergoing unilateral inguinal surgeries as it carried the advantages of faster onset of action, longer duration of postoperative analgesia, the need of lower volumes of local anesthetic agents with no recorded complications.
Comparative Study between Red Cell Distribution Width and Creatine Kinase-MB as Prognostic Markers in Acute Coronary Syndrome
Authors: Fahmy N M A , Boctor A M S , Haiba D M , Arfa M A M 
Published: May 2020

Abstract

Background
over the last decade, cardiovascular disease (CVD) has become the single largest cause of death worldwide. Low and middle-income countries are seeing an alarming and accelerating increase in the rate of CVD and a higher mortality rate caused by coronary heart disease

Aim of the Work
is to evaluate the possible relationship between red cell distribution width and the adverse clinical outcomes (in hospital course) in patients with acute coronary syndrome.

Patients and Methods
it was a comparative study conducted in the department of ICU in Ain Shams University Hospitals, After approval by medical committee and informed consent, 60 patients (newly admitted to the ICU), with diagnosis of acute coronary syndrome defined by (the criteria of the American College of Cardiology/European Society of cardiology), The study was conducted in the period from June 2018 to July 2018, they were divided into two groups, Group A: 30 Patients have been monitored by CK-MB and, Group B: 30 Patients have been monitored by RDW and CK-MB, We aimed to determine whether RDW, measured on admission and at 6, 12, 24, 48 hours may predict the adverse outcomes of ACS during hospital admission.

Results
our study demonstrated that adverse events were more likely to occur in patients with ACS during short-term follow up if they had higher RDW values.

Conclusion
RDW is independent predictor for worse adverse outcomes in patients with acute coronary syndrome during hospital stay as RDW level was found to be higher in patients whom were heart failure, serious arrhythmia, mechanical complications, Re-infarction.
Myocardial Necrosis in ICU Patients with Severe Hemodynamic Disturbances
Authors: Ghobrial B B , Rabie A H , Toulan H F A , Mohammed O A 
Published: May 2020

Abstract

Background
this prospective comparative observational study, to compare the incidence of myocardial injury in patients with hypovolemic shock versus septic shock, after approval of Ethical committee of critical care department on forty patients in general ICU divided into two groups of twenty patients each equal.

Aim of the Work
to compare the incidence of myocardial injury in patients with hypovolemic shock versus septic shock.

Patients and Methods
this prospective comparative observational study, carried out in Maadi Military Force Hospital, to compare the incidence of myocardial injury in patients with hypovolemic shock versus septic shock, after approval of Ethical committee of critical care department on forty patients in general ICU divided into two groups of twenty patients each equal.

Results
group A has higher values in SOFA score than in Group B, most probably due to toxins affected perfusion of organs and response to resuscitation, beside the poor cellular oxygen utilization, so clinical outcome among the two groups was twenty-four patients died in (sixteen patients in Group A and eight patients in Group B), so in our study there was a higher mortality in Group A patients (Septic shock) than Group B patients (Hypovolemic shock), The deceased patients had higher serum cTnI levels than survivors, this was concordant with Arlati and his colleagues, but there were no significant differences in cardiac troponin.

Conclusion
the incidence of myocardial infarction is increased in Group A (septic patients) more than Group B (hypovolemic patients), most probably due to the maldistribution of coronary blood flow which might produce, for a given level of hypotension, higher amounts of myocardial damage and, consequently, higher levels of troponin I than in hypovolemic shock.
Chest X-Ray vs Chest Computed Tomography in Diagnosis of Various Lung Pathologies in Critically ILL Patients
Authors: Nashed S W , Sayed N , Ali M M M M , Mohammed M M A 
Published: May 2020

Abstract

Background
A CT scanner makes many measurements, from different rotational angles, of X-ray attenuation (weakening in force or intensity) through the cross-sectional plane of the thorax. It then uses these data to reconstruct a digital representation of the cross-section with each pixel of the image representing a measurement of the mean attenuation through the thickness of the predetermined segment. This measurement quantifies the fraction of radiation removed in passing through a given amount of material of a certain thickness.

Objective
To compare the chest CT scan and chest x-ray for early detection of pulmonary complications for adults hospitalized in intensive care unit.

Patients and Methods
In the present prospective study, we included 40 adults’ patients, who were hospitalized in Intensive Care Unit (ICU), in order to compare the diagnostic accuracy of chest X-ray and CT scan for early detection of pulmonary complications. Patients were recruited from the ICUs of Ain Shams University and Misr University for Science and Technology Hospitals. They were included whether they had primary respiratory manifestations or started to develop respiratory manifestations during ICU stay.

Results
In the present study, we included 10 patients who were diagnosed with pulmonary embolism. The mean age of the included patients was 59.7 ± 16.3 years old. Five patients were correctly identified by the chest X-ray. Thus, the chest X-ray sensitivity for the detection of pneumonia was 50% and the positive predictive value was 100%.

Conclusion
In our cohort of patients with a wide variety of chest disorders, routine chest X-ray was not useful to clinicians in the diagnosis of lung disease, compared to chest CT. In addition, chest X-ray had a very low sensitivity in specific conditions like pulmonary embolism and pneumothorax.