bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of enteral metoprolol tartrate on hemodynamics and clinical outcomes of septic shock patients of various pretargeted heart rate groups
Authors: Habib Tamer N. , Fayed Akram M. , Marouf Mohamed M. , Ahmed Islam E. 
Published: September 2024

Introduction
Although septic shock mortality has decreased lately due to better identification and timely application of therapies. Research has continued for 20 years, but no therapies have been discovered yet to change sepsis’s course once it is infected.

Objective
The aim of this study was to evaluate the effect of enteral metoprolol tartrate on hemodynamics and clinical outcomes in patients with septic shock grouped into various pretargeted heart rate (HR) groups.

Methods
Septic shock patients (n=90) were randomly assigned directly after the resuscitation into 3 groups (30 in each). Then, treatment with metoprolol tartrate was started. The dose of metoprolol was 25-150 mg every 12 h and increased gradually to reach the pretargeted HR group range; group A (HR = 60-70 beats/min), group B (HR = 71-80 beats/min), and group C (HR = 81-90 beats/min). Metoprolol was continued to maintain the targeted HR till either discharge form intensive care unit (ICU) or death. The primary outcomes measured were mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), serum lactate, and sequential organ failure assessment (SOFA) score.

Results
After 1 day, group A (60-70 beats/min) had a significantly higher MAP (61.73±6.39 mmHg) than group B (51.33±7.76 mmHg) and group C (52.0±7.14 mmHg) (P < 0.001). After 3 days, group A had a significantly improved SvO2, lower serum lactate, and lower SOFA score than the other groups (all P < 0.05). When compared with groups B and C, group A had decreased norepinephrine (NE) requirements (P < 0.001) and shorter ICU stay (P = 0.001).

Conclusion
Targeting HR between 60-70 beats/min using metoprolol tartrate, when compared with higher targets in septic shock after hemodynamic stabilization, was not associated with profound hypotension but also with earlier improved MAP, tissue perfusion measured as SvO2 and serum lactate, and organ failure measured as the SOFA score. It also showed decreased Norepinephrine requirements and a shorter ICU stay, but with no 28-day mortality benefit.
Autologous platelet-rich plasma in the treatment of third-degree pressure ulcers; pilot randomized-controlled trial
Authors: Habib Tamer N. , Fayed Akram M. , Deghady Akram A. , Maklad Osama M. , Ahmed Islam E. 
Published: September 2024

Background
Platelet-rich plasma (PRP) is a mixture of cytokines, thrombocytes as well as multiple growth factors which are produced mainly by α-granules of platelets which enhance the process of natural healing process with less time. The role of autologous PRP in managing nonhealing pressure ulcers has been questioned as it enhances tissue healing by providing the necessary growth factors.

Objectives
Determining the relative efficacy of autologous PRP in treating grade III skin ulcers compared with standard care.

Methods
In this pilot randomized-controlled trial, 28 patients with grade III pressure ulcers in the critical care units of Alexandria Main University Hospital were enrolled and randomized into two groups. Patients of group A were subjected to PRP injections in the periphery of their pressure ulcers along with the standard care, while group B were subjected only to the standard care of pressure ulcers.

Results
PRP group showed significantly reduced mean ulcer volume at week 1 (18.88 vs. 21.42, P=0.047), week 2 (17.14 vs. 21.15, P=0.017), week 3 (14.92 vs. 19.99, P=0.020) and week 4 (10.68 vs. 17.35, P=0.019) than control group. PRP group showed significantly reduced mean ulcer surface area at week 1 (13.76 vs. 14.81, P=0.047), week 2 (10.64 vs. 14.11, P=0.032), week 3 (8.00 vs. 14.17, P=0.013) and week 4 (6.30 vs. 12.94, P=0.023) than control group.

Conclusion
Adding weekly autologous PRP injections to the standard care of noninfected grade III pressure ulcers may be a potentially effective approach. In critically ill patients, it was associated with reduced ulcer volumes, reduced ulcer surface areas, and better healing starting from the first week of injections.
Peribulbar block for retinal surgery comparison among dexmedetomidine, fentanyl, and local anesthesia
Authors: Abu-Elwafa Wesam A. , Ahmed Islam M. , Abdul-Aziz Salah-Eldin A. , Hassan Ahmed H. 
Published: September 2024

Introduction
Among all the regional blocks, the peribulbar block is one of the most popular for most ophthalmic procedures as it has few complications.

Aim
To study the effects of mixing local anesthetic with either dexmedetomidine or fentanyl in the peribulbar block for vitreoretinal surgery.

Patients and methods
The study included 40 adult patients (ASA II–IV) who had a peribulbar block for elective retinal surgery at Sohag University Hospital. All patients received the following combination: lidocaine 2%, bupivacaine 0.5%, hyaluronidase 15 IU/Ml, in addition to either 20 μg of fentanyl (group F) or 20 μg of dexmedetomidine (group D). The duration of postoperative analgesia, the onset, and duration of sensory and motor blocks, along with other complications, were recorded.

Results
The onset time of motor and sensory blocks was significantly longer in group F. For the duration of sensory and motor blocks, group D had a significantly greater duration than group F (P=0.05). Group D took substantially longer to request analgesia than group F (P=0.0002). Total paracetamol consumption was substantially higher in group F than in group D (P=0.001). The overall number of patients who required nalbuphine was substantially higher in group F (P=0.003) than in group D. At 2, 4, and 6 h postoperatively, the visual analog scale was statistically significantly greater in group F than in group D.

Conclusion
Dexmedetomidine-local anesthetic mixture in the peribulbar block for retinal surgery was superior to fentanyl-local anesthetic mixture regarding onset and duration of motor, sensory block, postoperative analgesia, and analgesic requirement.
Assessment of volume responsiveness by ultrasound parameters of carotid blood flow in patients with cardiogenic shock
Authors: Helmy Nehal Y. , Megahed Mohamed A. , Elmenshawy Ahmed M 
Published: September 2024

Introduction
There is no noninvasive method that can reliably and accurately identify fluid responsiveness. As such, in patients with undifferentiated shock, treatment often involves empiric fluid administration, in the hope that volume expansion will increase preload, which will then serve to increase cardiac output. However, for patients on the flat portion of the Starling curve, aggressive fluid administration results in no appreciable increase in cardiac output and may be detrimental to hemodynamically unstable patients.

Objective
The aim of this study was to compare the sensitivity and specificity of cardiac output measurement using bedside ultrasound on carotid artery and Transthoracic Echocardiogram(TTE) while assessing volume responsiveness in cardiogenic shock patients.

Patients and methods
In this prospective observational study, 40 cardiogenic shock patients were enrolled. Carotid artery Doppler ultrasound was performed where carotid blood flow (CBF) was calculated and TTE where cardiac output was calculated before and after passive leg-raising test to assess volume responsiveness.

Results
CBF measurements in comparison with cardiac output for assessment of fluid responsiveness had a sensitivity of 83.33% and specificity of 100%.

Conclusion
Carotid Doppler ultrasound and calculation of CBF is a reliable predictor to fluid responsiveness in patients with cardiogenic shock where transthoracic echocardiography is the gold standard in dynamic monitoring of the change in stroke volume after a maneuver that increases venous return (preload).
Effect of adding dexamethasone to intrathecal bupivacaine on blood sugar of controlled diabetic patients undergoing diabetic foot surgeries
Authors: Ismail Eman A. , Askar Fatma , Toni Asmaa , Elyounsi Mohamed , Askar Omnia 
Published: September 2024

Background
Spinal anesthesia is acceptable in patients undergoing diabetic foot surgery. The duration of the spinal anesthesia has been improved by the addition of other drugs such as opioids, dexmedetomidine, clonidine, and dexamethasone. Dexamethasone may affect blood glucose levels. The primary outcome of the study was the effect of a single dose of intrathecal dexamethasone on blood glucose levels during the first 24 h postoperatively.

Patients and methods
After approval, 60 diabetic patients, American Society of Anesthesiologists grades 2 and 3 with ages ranging from 20 to 70 years were enrolled in this randomized, double-blinded, placebo-controlled trial. All patients who underwent diabetic foot surgery under spinal anesthesia have controlled type II diabetes. Patients were randomly allocated into two equal groups: the control group was given intrathecal 2.5 ml of hyperbaric bupivacaine 0.5% plus 1 ml of 0.9% sodium chloride. The dexamethasone group was given intrathecal 2.5 ml of hyperbaric bupivacaine 0.5% plus 4 mg of dexamethasone.

Results
The control group had significantly lower levels of blood sugar at different times compared with the dexamethasone group. However, at the end of 24 h, nonsignificant changes were present between the two groups. Also, using 200 mg/dl as a cutoff for high blood sugar, there were nonsignificant changes all through the 24 h in both groups. Moreover, dexamethasone prolongs the duration of analgesia and decreases paracetamol requirements during the first 24 h postoperatively.

Conclusions
Addition of intrathecal dexamethasone did not change postoperative glycemic evolution in controlled diabetic patients undergoing diabetic foot surgery. However, it significantly prolongs the duration of analgesia and decreases analgesic consumption during the first 24 h postoperatively.
Prediction of protective lung tidal volume using the ulna length in Egyptian adults
Authors: Marie Hosam E.M. , Soliman Fouad I. , Refaie Bahaa M. 
Published: September 2024

Background
Ventilation with low tidal volume (VT) is advised for critically ill patients to protect against ventilator-induced lung injury and provide better clinical outcomes. Previous studies showed poor compliance with using height to predict VT. Ulna length has been used successfully to predict protective low VT. Our study aims to evaluate the ability of ulna length measurement to predict accurate protective lung VT in Egyptian people in reference to their standing height.

Methods
This study included healthy adult volunteers aged greater than or equal to 18 years. The height of each patient was measured while standing upright against a wall. Then, the left ulna was measured with a measuring tape from the olecranon to the mid-point of the styloid process. From ulna length, height was estimated, and protective lung VT was calculated using predicted body weight (PBW).

Results
Total 102 participants were enrolled in this study. The agreement between the calculated VT from standing height and ulna length was analyzed with Bland Altman analysis and showed a bias of (-5.7) ml, and limits of agreements (±1.96 SD) −91 ml to 76 ml in females; when the calculated VT of ulna length was compared with predicted body weight from height, the predicted mean VT was 6.2 ml/kg (95% confidence interval CI 4.5-7.8 ml/kg). In males, using ulna length, the predicted mean VT was 6.1 ml/kg (95% CI 4.8-7.4 ml/kg).

Conclusion
Ulna length can be used to predict protective lung VT in Egyptian people compared with their standing height.
Ultrasound-guided infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for hand and forearm surgeries
Authors: Morsi Yahya H. , Ammar Ramadan A.E. , Elshafie Ahmed M.A. 
Published: September 2024

Background
Pain was identified by the International Association for the Study of Pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage. The incidence of inadequate pain management seems to be high, even in the developed countries. Traumatic upper limbs injuries are accountable for a considerable number of patients, who require care by medical facilities (5–10% of emergency department visits). Regional anesthesia [e.g. brachial plexus block (BPB)] is increasingly taking place in patients with upper limb injuries as it is a logical choice avoiding the side effects of muscle relaxants, narcotics, and potent volatile anesthetics used in general anesthesia. Different additives have been used as an adjuvant with local anaesthetics to achieve dense and prolonged block and adequate postoperative analgesia.

Objective
To evaluate the effects of adding dexmedetomidine to bupivacaine versus bupivacaine alone in infraclavicular BPB with ultrasound guidance for plastic and reconstructive surgeries of the hand and forearm as regards the duration of postoperative analgesia, onset, and the duration of sensory and motor block and postoperative analgesic requirements.

Patients and methods
This randomized double-blind study carried out in Alexandria Main University Hospital on 70 adult patients of both sexes aged from 20 to 40 years, who were evaluated as American Society of Anesthesiologists I or II physical status and were scheduled for plastic and reconstructive surgeries of the hand and forearm.

Results
The results of our study show that the duration of analgesia ranged from 450 to 690 min with a mean value of 588.90±73.15 min in group C ‘control,’ while the duration of analgesia ranged from 990 to 1440 min with a mean value of 1295.10±121.60 min in group D ‘dexmedetomidine.’ Comparing the two groups, there was significant statistical difference in the duration of analgesia between the two groups, showing prolonged duration of analgesia in group D more than in group C.

Conclusion
Administration of bupivacaine with dexmedetomidine in infraclavicular BPB provides prolonged postoperative analgesia without causing a significant hemodynamic instability. Also, coadministration of dexmedetomidine leads to significantly decreased total analgesic doses required postoperatively with minimal side effects.
Intrathecal atropine versus preoperative intravenous ondasetron for prevention of postoperative nausea and vomiting due to intrathecal morphine in perineal surgery
Authors: Soliman Fouad I. , Mousa Elhadad A. , Ahmed Shehab M. , Hassan Ahmed H. 
Published: September 2024

Background
Opioids are frequently added to neuroaxial local anesthetics (LAs). Intrathecal (IT) opioid is not devoid of adverse effects such as postoperative nausea and vomiting (PONV), respiratory depression, and pruritis. IT atropine also carries a significant antiemetic effect, and this can be a valuable modality for the prevention of IT opioid-related PONV. The antagonist of 5-HT3 receptors such as ondasetron which is usually used to decrease the incidence of nausea and vomiting was considered for the prevention and treatment of neuroaxial opioid-induced (PONV).

Method
100 cases of ASA I-II aged 18 and 45 who planned to do elective perineal surgery, and receiving bupivacaine spinal anesthesia were randomly divided into two equal groups. Group (A) cases received IT hyperbaric bupivacaine (10 mg 0.5%) in combination with morphine 250 μg and atropine sulphate 100 μg. Before anesthesia, group (B) participants received IT hyperbaric bupivacaine (10 mg 0.5%) and 250 μg of morphine and 4 mg IV ondansetron. Follow-up for PONV attacks, vital signs, and side effects in the two groups.

Results
The occurrence of postoperative nausea were 4 and 18% in group A and B, respectively (P value=0.049) while postoperative vomiting was 0 and 12% in group A and B, respectively (P value=0.027). The occurrence of sedation, mouth dryness, headache, and drowsiness were more in group A compared with group B.

Conclusion
IT atropine is more effective than IV ondasetron preoperative in relieving PONV related to IT morphine, sedation is the frequent side effect occurred in IT atropine, headache is the frequent side effect occurred in the ondasetron group
A propensity score matching analysis for CPAP versus conventional oxygen therapy as a ceiling of care in COVID-19-associated type 1 respiratory failure
Authors: Yasser Noeman-Ahmed , Ashraf Roshdy , Abdulla Bedir , Iman El Sayed , Maryam Noeman , Gouri Koduri , Vinod Warrier , Sriya Gokaraju , Patrice Ayuen , Nour Abualela , Shashank Sharma , Duncan J. Powrie 
Published: September 2024

Background
Continuous positive airway pressure (CPAP) is increasingly used as a ward ceiling of care. Nevertheless, little is known about its effectiveness.

Objective
A retrospective study to explore whether CPAP therapy as a ceiling of care improves outcome in coronavirus disease 2019 (COVID-19)-infected patients with acute respiratory failure.

Methods
A retrospective cohort study was conducted on adult COVID-19-infected patients admitted to two UK hospitals from the March 1 to June 30, 2020. All patients experienced type 1 respiratory failure and were not suitable for intubation. They were divided into two groups: patients for CPAP versus conventional oxygen therapy (COT).

Results
A total of 39 patients received CPAP, whereas 247 received COT. CPAP group patients were more hypoxic (mean SpO2 86.5% vs. 91%, P=0.003), younger (mean±SD: 71.8±8.8 vs. 80.7±9.8 years, P<0.001), and less frail than the COT group [median (interquartile range) clinical frailty score 4 (3–5) vs. 6 (4–7), P<0.001]. Overall, 35 patients died in the CPAP group (89.7%) compared with 185 patients in the COT group (74.9%) (P=0.041). Propensity score matching of the two groups showed that CPAP was still associated with higher mortality (90.3 vs. 67.7%, P=0.029). Length of hospital stay was similar in both groups (mean±SD 9.2±7.3 vs. 9.7±8.6 days, P=0.719).

Conclusion
In COVID-19-infected patients presenting with type 1 respiratory failure and deemed not suitable for escalation to intubation, the use of CPAP therapy does not carry extra benefit than COT. In such patients, COT appears to be the appropriate measure. Further studies are required to corroborate these findings.
Management of cerebral vascular spasm in posttraumatic subarachnoid hemorrhage using a combination therapy of oral nimodipine and intravenous milrinone
Authors: Fathi Heba M. , Medhat Marwa M. 
Published: September 2024

Background
Intravenous milrinone has been investigated for management of vasospasm after aneurysmal subarachnoid hemorrhage (SAH); however, its role in vasospasm after traumatic SAH is still under evaluation.

Patients and methods
A total of 30 patients with cerebral vascular spasm after traumatic SAH were randomly divided into two equal groups. Group H was given nimodipine (60 mg/4 h) orally or via nasogastric tube and then combination of induced hypertension, hypervolemia, and hemodilution (triple-H therapy). Group M was given nimodipine (60 mg/4 h) orally or in the nasogastric tube and then intravenous milrinone bolus of 0.1–0.2 mg/kg followed by intravenous infusion of 0.75–1.25 μg/k/min. The infusion was continued for 72 h before gradual discontinuation at a rate of 0.25 μg/kg/min every 24 h until complete weaning. For refractory cases in both groups, emergency angioplasty was done. Primary outcome was the transcutaneous cerebral regional oxygen saturation 14 days after starting treatment. Secondary outcomes were the Glasgow coma score 14 days after starting treatment, infarction rate, ICU and hospital stays, and modified Rankin scale and Glasgow outcome scale at 3 and 6 months after starting treatment.

Results
Group M showed significant increase in regional oxygen saturation and Glasgow coma score; decrease in infarction rate, ICU stay, and hospital stay; and improvement in modified Rankin scale and Glasgow outcome scale. Significance was set at P value less than 0.05.

Conclusion
The combination of oral nimodipine and intravenous milrinone improves the outcome of vasospasm in posttraumatic SAH.
Continuous positive airway pressure as a useful tool in coronavirus disease 2019-related acute hypoxemic respiratory failure
Authors: Noeman Ahmed Yasser , Setty Niranjan , Roshdy Ashraf , Powrie Duncan J. , Amran Dora A. , Elsheikh Alguili , Gokaraju Sriya , Tear Anne , Noeman Maryam , Darda Maria , El Sayed Iman , Karunanithi Vijayalakshmi , Mahalingam Aarani , Shafiq Muhammad , Abdul-Khaliq Iman , Samuel Johnson 
Published: September 2024

Background
Many coronavirus disease 2019 (COVID-19) patients suffering acute hypoxemic respiratory failure (AHRF), fail to respond to conventional oxygen therapy (COT). Subsequently, some centers escalate to continuous positive airway pressure (CPAP), while others resort directly to invasive mechanical ventilation (IMV). We conducted a study to compare the use of CPAP versus COT alone in COVID-19-related AHRF.

Patients and methods
It is a retrospective cohort study of laboratory-confirmed COVID-19 patients suffering AHRF and deemed eligible for IMV escalation at three university hospitals (United Kingdom) during a 3-month period. The primary endpoint was the need for intubation and the secondary endpoint was 60-day mortality.

Results
In total, 174 patients were included. In total, 84 patients received CPAP (group 1) and 90 received only COT (group 2). Both groups had comparable demographic criteria and disease severity. There was nonsignificant reduction in the need for IMV when using CPAP compared with COT alone (50 vs. 76.6%, P=0.866). Sixty-day mortality was significantly higher in group 2 (25 vs. 37.8%, P=0.02). COT as stand-alone therapy for COVID-19 patients (group 2) was associated with a significant increased relative risk of death (relative risk 2.14, 95% confidence interval 1.39–3.29) corresponding to a number needed to treat of 3.74 (95% confidence interval 2.47–7.73). Among patients who progressed to IMV, there was no difference in the risk of mortality between the two groups.

Conclusion
Introducing CPAP rather than escalating FiO2 or endotracheal intubation in COVID-19 cases refractory to COT is safe and associated with improved mortality. Clinical trials are needed to guide the optimum timing and selection of patients most likely to benefit.
Ultrasound-guided paravertebral block for inguinal herniorrhaphy
Authors: Ali Hani G. , Elnegeery Naglaa A.E. 
Published: September 2024

Background
There has been an increasing trend toward performing inguinal repair surgeries under regional anesthetic techniques like paravertebral block (PVB). Neostigmine has been used as an adjuvant to local anesthetics, but the existing research studies are few. This study was conducted to evaluate the efficacy of neostigmine as an adjuvant to local anesthesia used for PVB in inguinal hernia repair procedures.

Patients and methods
This prospective randomized study included 72 patients prepared for elective inguinal hernia repair under PVB. They were allocated into two groups: the neostigmine group received a mixture of bupivacaine and neostigmine (5 μg/kg), whereas the control group received bupivacaine alone. During the postoperative period, pain score, hemodynamic parameters, first analgesic request, total analgesic consumption, and the incidence of adverse effects were noted and recorded.

Results
Both groups showed comparable findings regarding age and weight. However, the number of patients requiring rescue analgesia showed a significant increase in the control group. Moreover, controls reported significantly earlier first analgesic requests. Both diclofenac and fentanyl consumptions were increased without neostigmine administration. Pain score was significantly better with neostigmine at 4 and 6 h after surgery. Hemodynamic parameters were almost comparable between the two groups.

Conclusion
Neostigmine appears to be an efficient adjuvant to local anesthetics when administered during PVB as it significantly improves its analgesic profile. Its administration should be encouraged in clinical practice.