bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Acute Kidney Injury and Mortality in Critically Ill Patients: Urinary Chloride as a Prognostic Marker
Authors: Elkabarity Reem Hamdy , Emam Dalia Fahmy , Moneim Mohamed Wael Abdel , El Shafei Mahmoud Attia Abdel Rahman 
Published: November 2024

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Conclusion
The results of the study showed that Gabapentin is as effective as Metoclopramide in prevention of opioid induced pruritus in spinal anesthesia. But, Gabepentin improved to be slightly more effective in reducing the severity of pruritus than Metoclopramide.