bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Tight Glycemic Control on Short Term Outcome of Patients with Acute Cerebral Ischemia
Authors: Elmahlawy Ahmed Hamdy , Noureldin Bassel Mohamed , Ibrahim Waleed Abdalla , Kamel Walid Youssef 
Published: November 2024

Abstract

Background
Hyperglycemia is common after acute ischemic stroke and is associated with poor outcomes, including increased in-hospital mortality and poor neurologic function. Various mechanisms for the detrimental effects of hyperglycemia after acute ischemic stroke have been proposed, but a lack of consensus on the pathophysiology of hyperglycemia-aggravated secondary brain injury remains.

Objective
To evaluate the impact of tight glycemic control on short term outcome of patients with acute cerebral ischemic stroke.

Methods
This was a randomized control trial that was conducted at neurological intensive care unit, Ain Shams University Hospitals on 66 patients presenting with acute cerebral ischemia within 12 hours of acute symptoms and admitted to the Casualty. Patients were categorized into two groups: Group (A): the control group (33), with normal glycemic control using insulin infusion on sliding scale. Group (B): the study group (33) that included patients subjected to tight glycemic using insulin infusion on sliding scale.

Results
Our study revealed that, in Group A; 9.1% died, while the Group B; 12.1% of them died with no statistically significant difference between Group A and Group B regarding Death.

Conclusion
Insulin may be the gold standard for the management of hyperglycaemia but tight glycaemic control appears to be ineffective in improving outcomes in patients with acute cerebral ischemic stroke compared to normal glycaemic control. And it increases the incidence of hypoglycemia and hypokalaemia. Thus tight glycaemic control is not recommended in acute ischemic stroke.
Lactate/Albumin Ratio as a Predictor of Mortality in Septic Patients Presenting to Intensive Care Unit
Authors: Aboelfotoh Abdelmotaleb Ahmed Magdy , Nashed Sharif Wadie , Mohamed Ali Ahmed kamal , Shohdy Haidi Nashaat 
Published: November 2024

Abstract

Background
Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis and septic shock are major healthcare problems, impacting millions of people around the world each year and killing between one in three and one in six of those it affects. Early identification and appropriate management in the initial hours after the development of sepsis improve outcomes.

Aim of the Work
to evaluate the prognostic value of the L/A ratio compared to lactate level for predicting sepsis-related 28 days mortality in patients admitted to ICU.

Patients and Methods
This Prospective observational clinical Study was performed in Ain Shams University Hospitals, Cairo, Egypt.

Results
Our study included 50 subjects with a median age of 63 years in non-survival group and 65 years in survival group. There was a female predominance in non-survival population (62.5%vs 37.5%), but There was a male predominance in survival population (55.9%vs 44.1%). The proportion of discharged subjects was 68% and mortality was 32%. Depending on our study results lactate, lactate albumin ratio and hemoglobin were found to be significantly (P &lt; 0.05) in non-survivor than survivor. Also creatinine was highly significant (P &lt; 0.001) in non-survivor than survivor.

Conclusion
Our study found that LA/ALB ratio on the day of admission to the ICU were potential biomarkers to mortality in patients with sepsis. LA/ALB ratio was more sensitive than lactate alone. The L/A ratio shows a positive correlation with lactate levels and APACHE-2, whereas it shows a negative correlation with albumin levels. Prospective studies should be performed to learn more about the role of the L/A ratio sepsis-related mortality.
Comparative Study between Lung Ultrasound as Diagnostic Modality of Lung Aeration versus Computed Tomography in Invasively Ventilated Patient
Authors: Khalil Abdo Ahmed Magdy , Fawwaz Ahmed Ali , Saleh Mostafa Ashraf Nabil , Kamal Mohamed Mohamed 
Published: November 2024

Abstract

Background
Ventilator-associated pneumonia (VAP) is one of the most frequent ICU- acquired infections. Reported incidences vary widely from 5 to 40% depending on the setting and diagnostic criteria. Ventilator-associated pneumonia is associated with prolonged duration of mechanical ventilation and ICU stay.

Aim of the Work
to evaluate the efficacy of lung ultrasound in diagnosis and follow up of ventilator associated pneumonia in comparison to lung CT and to assess the concordance between lung ultrasound scores and CT aeration scores as assessment tools for lung aeration in different lung regions.

Patients and Methods
To achieve this aim, this study was conducted on 40 Ventilator- associated pneumonia patients who were assessed by lung ultrasound and CT at different time points. The chest CT is ordered by the treating physician as part of clinical care. Then, patients undergo a comprehensive LUS exam in the last minutes before transport to the CT scanner while already connected to the transport ventilator. As part of follow up for each patient LUS will be done at day 0, 3 and 6, while CT at day 0 and 6 of the study (1st LUS and CT).

Results
Mean age of the included patients was 57.7 ± 11.2 years with male predominance (65%). Mean APACHE II score was 20.8 ± 6.39 and mean APACHE II percent was 38.1 ± 15.9. Baseline lung ultrasound reported similar findings to the CT with higher affection of aeration in lower anterior, lower middle, upper posterior (B2 pattern; poor aeration) and lower posterior areas (C pattern) in both lungs. The lung ultrasound score had comparable ability to detect the changes over time and reported similar changes in the same lung areas where significant percent of patients changed from B2 pattern to B1 or A pattern or changed from C pattern to B or A pattern. Overall, at any time points, concordance between the lung ultrasound findings and CT findings was shown as regard lung aeration at different regions in both sides. As regard the association between B- line count score and lung aeration by CT aeration by HU, poor correlations were present, and it was limited to upper anterior lung areas only. Transfer- related complications were reported in 62.5% of patients at day 0 and 27.5% of patients at day 6 with overall incidence (45%). The rate decreased significantly from day 0 to day 6 due to the reported significant improvement in lung condition and presence of patients who were no intubated at day 6. The commonest reported adverse events were hypoxia and hypotension.

Conclusion
lung ultrasound score and B- line percentage score had the ability to detect ventilator associated pneumonia with similar efficacy to lung CT. Also, lung ultrasound is considered a good assessment tool to be used for following up of such patients with good reliability and reproducibility.
Ultrasound-Guided Lumbar Erector Spinae Plane Block versus Intravenous Analgesics for Post-Operative Pain Management in Pediatric Patients Undergoing Inguinal Hernia Surgeries
Authors: El-Momen Mokhtar Abd El-Momen Basant Abd , Elsayed Abdellatif Ayman Ahmad , Lotfy Youssef Nasr Azza Mohamed , Salem Ahmed Sarah Ahmed 
Published: November 2024

Abstract

Background
Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Erector spinae plane Block (ESPB) is a promising technique in the field of pediatric postoperative analgesia considering its safety and simplicity.

Aim of the Work
to assess the analgesic efficacy of ultrasound guided Lumbar ESPB in pediatric patients undergoing unilateral inguinal hernia repair for postoperative analgesia.

Patients and Methods
The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients’ consent. It included a total of 40 pediatric patients aged 1-7 years, Scheduled for unilateral inguinal hernia repair. Patients were randomly divided into two equal groups, 20 each, according to the inclusion and exclusion criteria. Group A (n = 20): Received ultrasound guided ESPB block.Group B (n = 20): (the controlled group): This group didn't not receive any peripheral nerve block. The patient received the intravenous analgesia according to standard protocol. [(0.5 μg/Kg fentanyl) 5 min before skin incision.]

Results
The main finding in this study was that ultrasound guided ESPB at level of Lumbar transverse process provided a good analgesic effect in pediatric patients undergoing unilateral inguinal hernia repair by Prolonging the time to first request of analgesia (duration of analgesia). It also reduced the total amount of Intraoperative and postoperative i.v analgesic consumption in comparison to controlled group without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation.

Conclusion
Ultrasound-guided Lumbar ESPB provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements in pediatric patients underwent unilateral inguinal hernia repair.
Comparative Study between Computed Tomography of Brain and Trans-Cranial Ultrasonography in Detecting Midline Shift in Severe Traumatic Brain Injury
Authors: Abdelhamid Faisal Said , Alagamy Ashraf Elsayed , Rashed Mohamed Mohsen , Elgouhary Mohamed Osama , Shehata Wahba Kamal Abdelrahman 
Published: November 2024

Abstract

Background
Traumatic brain injury (TBI) is the leading cause of mortality and morbidity in patients in the age group of 18–45 years. Most of the victims survive with significant disabilities, culminating in a major socioeconomic burden for both patients and their families.

Objective
To study the ability of trans-cranial ultrasonography in detecting and measuring midlineshift in comparison to computed tomography of brain in severe traumatic brain injury.

Patients and Methods
This was a cross-sectional comparative study that was conducted at Ain Shams university hospital’s intensive care units. The study was carried out on 40 adult critically ill patients of both sexes with severe traumatic brain injury underwent conservative treatment for 48 hours. Patients were randomly enrolled in 6 months.

Results
There was a high statistical significance correlation between measurements of midline shift by ultrasound (U/S) with the two methods of measurement by computed tomography (CT) “CT 1 and CT 2” on admission and also after 48 hours from admission. In this study, measurements of midline shift (MLS) in less than 8 mm is more accurate and the more increase in MLS may increase the difference between U/S and CT measurements of MLS.

Conclusion
This study suggests that transcranial sonography “TCS” could detect and measure MLS with reasonable accuracy as compared with the gold standard method computed tomography “CT” in severe traumatic brain injury patients on conservative treatment that it could serve as a bedside tool to facilitate early diagnosis and follow up treatment of midline shift specially in patients with MLS less than 8 mm however patients with MLS 8 mm or more need to be furtherly assessed.
Effect of Addition of Hyaluronidase as an Adjuvant to Lidocaine and Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block
Authors: Gabra Kerollos Ayoub , Nashed Sherif Wadie , Ibrahim Dalia Ahmed 
Published: November 2024

Abstract

Background
Regional anesthesia for the upper extremity has been gaining popularity due to the several advantages it has over general anesthesia. Some of these advantages include: improved postoperative pain and decreased postoperative narcotic consumption and recovery time. The brachial plexus block, especially the supraclavicular block, is a commonly used peripheral block technique for the upper extremity, used in both in-patient and out-patient settings, as well as for post- operative pain control.

Objective
The aim of this study is to evaluate the efficacy of hyaluronidase as an adjuvant to the mixture of LAs in ultrasound-guided supraclavicular brachial plexus block.

Methods
This A randomized, prospective, double-blinded, controlled study operating theaters of Orthopedic Surgery Department and Reconstructive Surgery and Burns Department at Ain Shams University Hospitals included forty patients from July 2020 to December 2020 (six month).

Results
There was no statistically significant difference between the two studied groups regarding the sensory (group A: 642.5 ± 47.97 mins, group B: 610.5 ± 57.9 mins) and motor (group A: 660.5 ± 47.29 mins, group B: 625.5 ± 57.28 mins) block durations despite the shorter block duration of group B in which hyaluronidase was used, as well as regarding the time of first analgesic dose demand (group A: 649.5 ± 48.74 mins, group B: 618 ± 58.05 mins). The total dose of morphine given during the first 24 hours postoperatively was significantly lower in group A in which Hyaluronidase was not used (10.7 ± 1.56 mg).

Conclusion
This study showed that the addition of hyaluronidase to the local anesthetics during ultrasound-guided supraclavicular block shortened the onset of the sensory and motor block, and consequently, the anesthetic time before the start of surgery. The use of hyaluronidase also decreased the total duration of the sensory and motor block, as well as the postoperative time of the first analgesic demand, though were not significant statistically. Regarding complications (injection site hematoma, horner's syndrome, phrenic nerve block ….etc), the difference between the two groups was also significant statistically.
A Randomized Trial for Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy: Intravenous Lidocaine Infusion vs. Ultrasound Guided Erector Spinae Plane Block
Authors: Abd-Allah Kirolos Hany , Elnasr Mohamed Gihan Seif , Esmat Ibrahim Mamdouh , Mohamed Noha Refaat , Ashoor Tarek Mohamed 
Published: November 2024

Abstract
Author affiliations:
1. Kirolos Hany Abd-Allah Shawky, MB, BCh, Resident of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo, Egypt; Email:
2. Gihan Seif Elnasr Mohamed, Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University. Abbasseya, Cairo, Egypt; Email:
3. Ibrahim Mamdouh Esmat, Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University. Abbasseya, Cairo, Egypt; Email:
4. Noha Refaat Mohamed, Assistant Professor of Clinical Pathology, Faculty of Medicine, Ain Shams University. Abbasseya, Cairo, Egypt; Email:
5. Tarek Mohamed Ashoor, Assistant Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University. Abbasseya, Cairo, Egypt; Email:
Comparative Study of the Efficacy of Intravenous Dexmedetomidine versus Intraperitoneal Bupivacaine-Dexmedetomidine for Postoperative Analgesia after Laparoscopic Cholecystectomy
Authors: Ghaly Tawadros Safaa Ishak , Mohamed Nasr El-Din Dalia Abd El-Hamid , Louis Wassily Maria Asaad , Abd El-Fattah Abd El-Aziz Mohamed Maher 
Published: November 2024

Abstract

Background
Although laparoscopic operations are minimally invasive, many patients report moderate-to- severe pain in the early postoperative period, which is multifactorial and requires multimodal analgesia to relieve it. Pain after laparoscopic surgery is caused by three mechanisms: parietal, visceral, and shoulder pain. As a result, numerous studies were done to develop methods for good postoperative pain control.

Aim of the Work
This study aims to compare the efficacy of intravenous dexmedetomidine versus intraperitoneal bupivacaine-dexmedetomidine for postoperative analgesia after laparoscopic cholecystectomy.

Patients and Methods
The study was conducted on 52 patients aged 21 to 60 years, of American Society of Anesthesiologists (ASA) class I or II scheduled for elective laparoscopic cholecystectomy under general anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated to two groups of 26 patients each: Group A: (n = 26): Patients received an intravenous infusion of 50 ml of normal saline containing dexmedetomidine 1μg/kg over 10 minutes after removal of the gall bladder, Group B: (n = 26): Patients received intraperitoneal instillation of dexmedetomidine 1μg/kg plus 40 ml of bupivacaine 0.25%.

Results
There was a statistically significant difference between both groups regarding pain control and postoperative analgesic requirements while there was no significant difference between both groups regarding the demographic data and postoperative side effects (hypotension, bradycardia, nausea, and vomiting). Both intravenous dexmedetomidine and intraperitoneal bupivacaine-dexmedetomidine were effective for postoperative pain control after laparoscopic cholecystectomy but the intraperitoneal route provided a longer duration of analgesia and the lower postoperative analgesic consumption

Conclusion
The present study concluded that patients who received intraperitoneal administration of bupivacaine-dexmedetomidine had less VAS with a longer duration of analgesia and lower postoperative analgesic consumption than those who received intravenous dexmedetomidine.
A Comparative Study between the Analgesic Efficacy of Ultrasound Guided Interscalene Block vs General Anesthesia in Patients Undergoing Shoulder Arthroscopy
Authors: Ibrahim Mohammed Khater Mariam Ali , Ramzy Gadalla Raouf , Kamal El Din Doaa Mohammed , Ahmed Youssef Ahmed Monier 
Published: November 2024

Abstract

Background
Shoulder arthroscopy can effectively treat a number of injuries and diseases of the shoulder on an ambulatory basis. Although shoulder arthroscopy is considered minimally invasive, it is associated with severe intraoperative and postoperative pain. Hence, it requires adequate analgesia and muscle relaxation for the procedure. For shoulder arthroscopy, regional anesthesia is better than general anesthesia (GA) because of the extended postoperative analgesia and rapid recovery towards discharge.

Aim of the Work
to compare the analgesic efficacy of ultrasound guided Interscalene block alone without GA VS general anesthesia as regards the postoperative pain management, analgesics requirements and hospital stay during shoulder arthroscopy.

Patients and Methods
Type of Study: a prospective, randomized, comparative study. Study Setting: After obtaining approval from the Research Ethical Committee of Ain Shams University, this study will be conducted in the operating theatres of Ain Shams University Hospitals. Study Period: Six months (started from FEB. 2023 to AUG. 2023).

Results
In our study, regarding VAS score among the studied patients, The pain threshold score using VAS score at different times postoperatively showed non-significant difference between the ISB all times, with p-values &lt;0.001 for VAS 1, VAS 6, VAS 12, VAS 18 except at VAS 24 HR a significant difference at p value 0.887 was found but still the VAS score was less than 4, So, no pain killers were given. Surprisingly a reported improvement in expression of postoperative pain was noticed later on. This is may be due to the very dense block offered by interscalene brachial plexus block. Regarding the assessment of patient„s vital data represented in the heart rate and mean arterial blood pressure our study shows highly statistically significant higher mean in group G compared to group I according to heart rate from at0hr to after 20hrs with p-value &lt;0.05, while after 24hrs insignificant with p-value &gt;0.05 NS with almost the same results for mean arterial blood pressure. Our study demonstrates that ISB provides a better hemodynamic stability postoperatively regarding the control of heart rate avoiding the unwanted catastrophic tachycardia and lower mean arterial blood pressure while maintain adequate desirable tissue perfusion without the need of toxic mega opioid rescue doses.

Conclusion
Ultrasound guided ISB for shoulders arthroscopic surgical operation provides greater pain-free period, lesser opioid requirement, and lesser PACU stay duration in patients receiving this block
Comparative Study between Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Block in Post-Operative Pain Management after Cesarean Section
Authors: Marzouq Mervat Mohamed , Haggag Adham Magdy , Hesham Mariam Mohamed , El Shabrawy Asmaa Ismail 
Published: November 2024

Abstract

Background
Cesarean section rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization.

Aim of the Work
The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans- muscular QLB compared with TAP block during cesarean section surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions.

Patients and Methods
After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, female patients were included in the study, and were divided into two groups (n = 25; each); group QLB and group TAP. Group QLB: Patients (n = 25) of this group received bilateral ultrasound-guided QLB after induction of spinal anesthesia using (2-2.5 mg/kg of bupivacaine not to exceed 175 mg per dose and maximum 400mg/24h) without exceeding the toxic dose 3 mg/kg. Group TAP: Patients (n = 25) of this group received bilateral ultrasound-guided TAP block after induction of spinal anesthesia using (2-2.5 mg/kg of bupivacaine not to exceed 175 mg per dose and maximum 400mg/24h) without exceeding the toxic dose 3 mg/kg.

Results
The present study showed that the quadratus lumborum block was more efficient than the tansversus abdominis plane block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) indicated that the superiority of the QL block technique over the TAP block technique. The patients of group TAB had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group QLB. This is mainly due to the extension of the local anesthetic agent in QLB beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control.

Conclusion
Quadratus lumborum block was the most effective technique in providing analgesia after cesarean section in comparison to transversus abdominis plane block and even more time covering to rescue opioid.