bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting: A Prospective Cohort Study
Authors: Elewa Gamal Eldin M , Elgendy Hanaa A , Ali Amr H , Dabsha Mohamed H 
Published: October 2021

Abstract

Background
Postoperative atrial fibrillation (POAF) is common both after cardiothoracic and non cardiothoracic surgery.In patients undergoing cardiothoracic surgery, the incidence of 16–46% has been reported. Even though POAF can be selflimiting, it may be associated with hemodynamic instability, postoperative stroke, myocardial infarction, ventricular arrhythmias and heart failure.

Objective
To determine the effect of certain predictors on the incidence of postoperative atrial fibrillation during the ICU stay after coronary artery bypass graft surgery.

Patients and Methods
This prospective cohort study was done after approval of the Institutional Review Board and written informed consent from patients or first kin. Patients undergoing isolated CABG or CABG with valve replacement were included and monitored for POAF during their postoperative ICU stay and the potential predictors of POAF as age, sex, smoking and left atrial diameter, serum Potassium and Magnesium levels, CHA2DS2-VASc score, valve replacement and inotropic support were recorded.

Results
123 patients were included in the study, 76.4% were males with a mean age of 57.4 ±8.7 years and mean left atrial diameter 4.1 ±0.52 cm. The incidence of POAF following CABG surgery was almost 33.3%. There was no statistically significant association between POAF and smoking (P = 0.123). However there were statistically significant associations between POAF and CHA2DS2-VASc score, valve replacement (P &lt; 0.001) and inotropic support (P = 0.005). The logistic regression analysis showed that left atrial diameter, CHA2DS2-VASc score and female sex were independent predictors of POAF. In contrary, there were no statistically significant associations between POAF and serum K+ and Mg ++ levels (p &gt; 0.05).

Conclusion
There are a wide range of significant epidemiological, clinical, and operative predictors for the development of post-CABG AF including older age, female gender, large LA diameter, higher CHA2DS2-VASc score, valve replacement and postoperative inotropic support. Nevertheless, further large-scale studies are still needed to confirm our findings.
New Onset of Atrial Fibrillation" as an Outcome Predictor in Critically Ill Patients with Sepsis: A Systemic Review
Authors: Mohamed Mohamed W , Riyad Mostafa K , Khamis Ahmed M , Toulan Heba F 
Published: October 2021

Abstract

Background
Evidence of various cardiac arrhythmias in septic patients has been demonstrated by multiple clinical reports and observations .Most cardiac arrhythmias in sepsis are new-onset and may be related to sepsis-induced myocardial dysfunction, autonomic dysfunction and, most likely also, by impairment and involvement of the cardiac conduction system.

Aim of the Work
to describe the incidence of NOAF and to determine the risk factors associated with its development, as well as its clinical course and its effect on the outcome of patients with sepsis admitted to the ICU.

Patients and Methods
A systematic search was conducted to retrieve articles that investigated the association of NOAF in patients diagnosed with sepsis. We identified potential Englishlanguage sources from the PubMed, Medline, and EMBASE databases. Keywords used were “atrial fibrillation” and (“sepsis” or “septic shock”). In addition, reference lists of any studies meeting inclusion criteria were reviewed manually to identify additional relevant publications.

Results
In our meta-analysis, we found that NOAF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease. Also, we found that NOAF in sepsis patients is significantly associated with increased risk of ICU. In hospital, and After hospital discharge mortality, as well as, increased risk of developing ischemic stroke.

Conclusion
NOAF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease. Our Meta-analysis suggests that it is independently associated with poor outcome. In view of these findings there is a need for better quality observational studies, because reliable identification of patients with sepsis who are prone for the development of AF may allow for early pharmacological interventions to prevent this complication.
Effect of intrathecal Dexmedetomidine on preventing shivering after spinal anesthesia in caesarian section
Authors: Abdelhamid Mostafa Mohammed Mohyeldin , AbdelAleem Azza Atef , Hussien Rania Maher , Khalifa Ahmed Abdelghany 
Published: October 2021

Abstract

Background
Shivering is among the common troublesome complications of spinal anesthesia (SA), and causes discomfort and discontentment in parturients undergoing cesarean section (CS).

Objective
to investigate the effects of intrathecal dexmedetomidine (DEX) as an adjuvant to heavy bupivacaine in the prevention of shivering in those who underwent CS under SA.

Methods
A prospective double-blind conducted at Ain Shams University hospitals on 100 parturients who are undergoing CS under Spinal anesthesia over a period of six months starting from December 2018 to May 2019 at Ain shams university hospitals. Patients were randomly subdivided into 2 groups of 50 patients each, Group BD: 5 micrograms DEX was added to 12.5 mg 0.5% heavy bupivacaine. Group BN: 0.5 mL 0.9% normal saline was added to the 12.5mg 0.5% of heavy bupivacaine.

Results
The incidence of shivering was significantly higher in the BN group (56%) than the BD group (24%). Likewise, the intensity of shivering was significantly higher in the BN group than the BD group.

Conclusion
Intrathecal DEX in conjugation with heavy bupivacaine reduced the incidence and intensity of shivering in patients undergoing cesarean section after spinal anesthesia and did not increase the incidence of hypotension or bradycardia.
Neutrophil-to-lymphocyte count ratio in predicting prognosis of septic shock patients
Authors: Mahmoud Hoda Omar , Fahmy Niven Gerges , Ammar Mona Ahmed Mohamed Abdelmotaleb , ELryany Mostafa Mansour Mohamed Elsaid 
Published: October 2021

Abstract

Background
Septic shock is one of the most common causes of admission to the intensive care unit in the world and one of the most common causes of death among intensive care patients. Since the definition of sepsis and septic shock and many studies have been designed to understand everything about sepsis regarding mechanism, pathophysiology, complications, diagnosis, management and all other aspects.

Objective
To find the association between neutrophil to lymphocyte count ratio and the mortality from septic shock patients. The work aims also to determine if this ratio can be used as a prognostic marker of septic shock patients and to compare this ratio with other sepsis markers as C-reactive protein (CRP) and procalcitonin.

Patients and Methods
This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 125 patients between January 2018 to January 2019. The ethics committee of our institution approved the study protocol, and written informed consent was obtained from each patient’s family.

Results
In our study, the neutrophils count was significantly increased in survived patients compared with early and late mortality patients in day 1 while lymphocytes count was lower in survived patient than early and late mortality patients and the NLCR in our study was higher in survived patients than early and late mortality patients. In day 4, our results revealed significant increase in neutrophils count in patients of late mortality compared with its count in survived patients, while lymphocytes didn't show any significant difference compared with its count in survived patients with significant increase in NLCR in patients of late mortality compared with those of survived patients in day 4. Both CRP and procalcitonin are increased in patients of early and late mortality groups compared with its value in survived patients in day 1 and 4.

Conclusion
This study demonstrates a real relationship between the NLCR and the risk of death in septic shock patients. Septic shock patients at risk of early death presented a low NLCR at admission, although late death was associated with an increased NLCR during the first 5 days. Early and late death should be distinguished because they may involve different underlying mechanisms, and the NLCR might be considered as a discriminant indicator of early or late death. In addition, our findings provide more insight into biology. The circulating neutrophil and lymphocyte trends observed in this study offer an interesting mechanistic viewpoint. We observed that circulating lymphocytes and the NLCR behave in opposite ways in early- and late death patients, supporting the hypothesis that divergent mechanisms could be involved in these two groups.
Weaning Outcomes of using Post-Extubation High Flow Nasal Oxygen versus Continuous Positive Airway Pressure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients
Authors: Khaled M.M , Alfred M.S , Mohamed Abd El Salam M.E , Mustafa Kamel A.F 
Published: October 2021

Abstract

Background
Mechanical ventilation is a daily event in any ICU, using HFNO as a weaning facilitating strategy for mechanically ventilated patients after passing Spontaneous Breathing Trial (SBT) recently considered to reduce complications associated with invasive ventilation.

Objectives
To compare high-flow conditioned oxygen therapy versus non -invasive ventilation using continuous positive airway pressure (CPAP) for preventing post-extubation respiratory failure and reintubation in acute exacerbation of chronic obstructive pulmonary disease patients after weaning from mechanical ventilation and to follow patients for ICU and hospital lengh of stay ICU and hospital mortality.

Patients and Methods
This prospective randomized controlled study, including 60 patients admitted to the intensive care unit at Al- Mataria teaching hospital. Approval of the ethical committee of Al-Mataria teaching hospital was obtained before the start of patient’s recruitment. Patients who successfully extubated were equally randomized (sequential) to enter either group I or group II. Study group (I): included 30 patients subjected to high flow nasal oxygen after extubation for 24 hrs. Control group (II): included another 30 patients on non-invasive CPAP after extubation for 24 hrs.

Results
Our results showed lower rate of reintubation in HFNO group (n = 6) 20%, compared to NIV group(n = 7) 23. 3 %, higher PaO2 in HFNO group immediate, 2 hrs post extubation. No significant differences found regarding mortality rate between both study groups (8/30) 26. 6 % in HFNO group, while (9/30) 30 % in NIV group, p (Ns). Arterial PH was significantly lower in NIV group immediately after extubation.

Conclusion
HFNO compared to NIV alone showed lower rate of reintubation when used immediately after planned extubation. Patients weaned using HFNO showed higher PaO2 2hrs postextubation. HFNO compared to NIV alone didn’t affect hospital stay.
Effectiveness of Intrathecal Administration of Bupivacaine with Fentanyl versus Nalbuphine for Elective Cesarean Section
Authors: Rahman Nada Mohamed Bahaa Eldin Mostafa Abdel , Maghawry Khaled Mohammed , Mostafa Raham Hasan , Ezzat Ahmed Wagih 
Published: October 2021

Abstract

Background
Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia.

Objectives
The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives.

Methods and material
After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg)

Results
The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups.

Conclusions
We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine.
Comparative Study Between Neostigmine Versus Sugammadex in Obese Patients Undergoing Laparoscopic Surgery
Authors: Zaghlol Mohammed A , Boctor Alfred M , Abd-Elhamed Hadyl M , Abd-Elhak Ahmed A , Bakheat Ramadan R 
Published: October 2021

Abstract

Background
Complete and rapid reversal of the effects of neuromuscular blocker drugs is a primary element of safety in anaesthesia. Neuromuscular conduction that is not completely improved leads to post-operative residual curarisation and the development of complications that are related to respiration.

Aim of the Work
to compare between the effect of neostigmine and sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization and respiratory complications in the obese patients undergoing laparscopic surgery.

Patients and Methods
We carried out this randomized clinical study on sixty four patients operated upon at General Surgery Department at Armed Forces Hospitals. Patients and Methods: In this study, 64 patients of either sex with average age ranging from 18-65 years, ASA (I,II), submitted for bariatric gastric sleeve operation were included in this study. Patients were randomly classified into 2 equal groups; Group S (sugammadex, n = 32) and group N (neostigmine, n = 32). Results: no significant differences between both groups regarding age, gender, BMI and ASA. But, we showed statistically a high significant difference between both groups regarding TOF0.9 and significant differences between both groups regarding PACU and operative room time.

Conclusion
This study verified the efficiency of sugammadex over neostigmine for full and timely reversal of neuromuscular blockade induced by a rocuronium, in morbidly obese patients undergoing laparoscopic bariatric surgery.
Comparative Evaluation of Hemodynamic Stability and Recovery during Conscious Sedation by Dexmedetomidine-Fentanyl Versus Ketamine- Fentanyl in procedures outside the operating room
Authors: Abd-El Razek Sarah A , El-shafei Mohamed N , Mostafa Ashraf N , Ahmed Ibrahim M 
Published: October 2021

Abstract

Background
Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, Email: predictable recovery with minimal post-operative sequels.

Aim of the Work
to study the effect of dexemdetomidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure.

Patients and Methods
In our study, 50 patients were randomly divided into 2 equal groups. group DF received dexmedtomidine loading dose 1 μg/kg over 10 min and followed by 0.5 μg/kg/hr infusion till completion of surgery. And group KF received ketamine 0.5 mg/kg slow intravenous Bolus.

Results
Our study showed that dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines, and propofol.

Conclusion
dexmedetomidine in combination with fentanyl is useful to provide conscious sedation for non operating room procedures in adults and it may be a valuable alternative to ketamine.
Spirometric Assessment Before and After treatment of Prostatic Hyperplasia in Patients with Chronic Obstructive Pulmonary Disease
Authors: Dayem Aya Mohamed Mohamed Abdel , Elsayed Tarek Osman , Salem Hala Mohamed , Hiekal Abdel Hamid Mohammed Shawky 
Published: October 2021

Abstract

Background
Chronic Obstructive Pulmonary Disease (COPD) predominantly prevalent in men, is a chronic inflammatory disorder of the airway and lungs. COPD is associated with increased risk of Benign prostatic hyperplasia (BPH). Judging from the association between COPD and BPH in ageing male population, and the samilarities between receptors in airways and the urinary bladder.

Objectives
the aim of the study was to show the effect of treatment of symptomatic BPH on the airways of COPD patients by spirometric assessment before and after starting treatment of BPH.

Patients and Methods
The present study was conducted upon 60 subjects during the period from March 2019 to August 2019 in Ain Sham University Hospitals.

Type of Study
prospective study, there were two groups of patients first group received tamsulosin and the second group received tamsulosin and solifenacin

Results
By comparison of the two groups, there was non-significant change. as regard percent of change of forced vital capacity (FVC), first group’s median was 7.9% and second group median was 5.6%. as regard percent of change of forced expiratory volume 1 (FEV1), in first group’s median was 5.7% and second group’s median was 7.4%.

Conclusion
There was significant improvement in spirometric values in each group before and after starting treatment, but by comparison between the two groups, there was insignificant change.
Value of Neutrophil to Lymphocyte Ratio in Prognosis of Elderly Patients with Community Acquired Pneumonia Compared to CRP Level
Authors: Elassal Gehan M , Elsayed Mohamed A , Shehata Amal M 
Published: October 2021

Abstract

Background
Community-acquired pneumonia (CAP) is a common, potentially fatal disease despite advances in both diagnosis and treatment. Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. Community acquired pneumonia (CAP) is a frequent and severe infection associated with a high mortality.

Objectives
This work aims to evaluate the role of neutrophil/lymphocyte ratio in prognosis of elderly patients with community acquired pneumonia compared to CRP level.

Patients and Methods
This prospective study was conducted upon 30 elderly patients in chest department at Ain shams University hospitals with community acquired pneumonia. All patients were diagnosed as having CAP by presence of new infiltrates in chest radiography associated with clinical picture. Clinical examination, traditional tests such as Confusion, Urea, Respiratory rate, Blood pressure, aged 65 and older (CURB-65), CRP level and NLR were evaluated at admission and after two weeks of admission. The predictive value for 30-day mortality of traditional tests and NLR were compared.

Results
The present study found that mean age of the studied cases was 72.9 ± 5.14 years old, 20 (66.7%) of patients were males while 10 (33.3%) were females. All patients had co-morbidities with diabetes mellitus and renal impairment the most common by percentage of 36.7%. There was highly significant correlation between neutrophil/lymphocyte count ratio (NLCR), neutrophil count and lymphocytic count and the outcome of CAP patients (p = 0.000, 0.004, 0.000 respectively) compared to other inflammatory biomarkers like WBC count (p = 0.02) and CRP (p = 0.521) and CURB-65 score (p = 0.074). This study showed that no deaths occurred in patients with NLR below 10, mortality was 8.3% in patients with NLR between 10 and 20 and 91.7% in patients with a NLR above 20. NLCR remain high with no significant difference in follow up labs among patients who died.

Conclusion
NLR showed emerging prognostic value in predicting outcome and 30day mortality rate in community acquired pneumonia. Unlike many other inflammatory markers and bioassays, NLR is an inexpensive, easy to handle, cost effective and readily available marker that is obtained from basic blood count providing an additional advantage in predicting hospitalization period and mortality.
Laryngeal air column width ratio in predicting postextubation stridor
Authors: Elsayed Amira Ahmed , Mansour Mona , Ali Tamer Mohamed 
Published: October 2021

Abstract

Background
Cuff leak test (CLT) has been used widely to assess upper airway patency before extubation but with low positive predictive value. Aim To assess the diagnostic accuracy of the airway column width ratio (ACWR) in predicting postextubation stridor (PES).

Patients and methods
50 Patients who intubated &gt;24 hours were observed for postextubation stridor and reintubation. Laryngeal ultrasound was done to measure the ACW with ETT cuff deflated immediately after intubation and 3–4 h before extubation. Cuff leak test was done.

Results
Fifty patients were included with mean age 58 ± 14.71 years, 68% were males and 32% were females. PES developed in 8% of patients. There was highly statistically significant difference between both groups regarding ACW before extubation and ACW ratio (p-value =0.006 and 0.000 respectively). The mean ACW ratio in stridor group (0.79 ± 0.03) was significantly lower than in non-stridor group (0.94 ± 0.04). Reintubation was higher in stridor group (100%) than non-stridor group (23.9%), P = 0.001. There was statistically significant higher duration of mechanical ventilation in stridor group (7.50 ± 0.58 vs. 4.23 ± 2.50 days, P = 0.013). A cut off point of ACW ratio ≤0.81 has a sensitivity 100% and Specificity 100%.

Conclusion
ACW showed excellent utility in prediction of patients with PES. Air column width ratio of ≤ 0.81 was a good predictor of PES.