bluuebunny/crossref_metadata_2025_split huggingface dataset:
Noise Pollution in Intensive Care Unit
Authors: Pal Jagriti , Taywade Manish , Pal Rajni , Sethi Divya 
Published: September 2024

Background
Noise in intensive care units (ICUs) has always been a problem, but noise above the recommended range affects not only the patient but staff as well. It is clear that some noise in the ICU is inevitable, but exceeding the normal range brings various physiologic and psychologic changes, which directly affect health. This review presents a synthesis of noise sources in the ICU and the potential interventions designed to attenuate noise and protect patients.

Materials and Methods
An extensive literature search, using electronic databases such as MEDLINE, PubMed, Google Scholar, and Research gate to understand the noise in ICU, effects of noise, and noise reduction interventions were undertaken.

Results
Findings were such as noise enhances the release of cortisol, increases oxygen consumption, increases sleep disturbances, increases the need for analgesia and sedation, and disrupts circadian rhythm. Many studies reported that measurement was always higher despite implementing noise reduction interventions.

Conclusions
ICU survivors always recall their memories, and for them, ICU admission becomes a negative experience for life. However, the sustainability of any single intervention did not show awe-inspiring results, whereas a bundle kind of interventions did show some effects. However, high-quality evidence demonstrating the benefit of any intervention on patient outcomes is still lacking.
Evolution of Hearing in Young Adults
Authors: Degeest Sofie , Corthals Paul , Keppler Hannah 
Published: September 2024

Context
Young people expose themselves to high levels of noise during various leisure activities and might thus be at risk of acquiring hearing-related problems due to leisure noise exposure.

Aim
The aim of this study was to compare the hearing status, amount of leisure noise exposure, and attitudes and beliefs toward noise, hearing loss, and hearing protection devices (HPDs) in university students at the moment of their enrollment in higher education and after approximately 3 years.

Settings and Design
Thirty-four female university students were tested at the moment of their enrollment in higher education and after approximately 3 years.

Method and Material
Hearing was evaluated using pure-tone audiometry and transient evoked and distortion product otoacoustic emissions. A questionnaire was used to evaluate leisure noise exposure and attitudes and beliefs toward noise, hearing loss, and HPDs.

Results
There were significant differences after the 3-year period: a deterioration in hearing at some tested frequencies, an increase in the occurrence of temporary tinnitus after leisure noise exposure, an increase in noise exposure related to visiting nightclubs and music venues, and differences in attitudes and beliefs toward noise, hearing loss and HPDs.

Conclusions
More longitudinal studies are needed to evaluate the onset and progression of hearing loss due to leisure noise exposure. In the meantime, hearing conservation programs targeting young people should be optimized.
Comparison of rapid intubating conditions between rocuronium and cisatracurium
Authors: Bhat Pai Rohini , Deulkar Anisha , Kambli Deependra , Kanekar Bhagyashri , Volvoikar Pragati , Parsekar Hemant , Kamat Shaila 
Published: September 2024

Background and aims
Cisatracurium has many advantages over other nondepolarizing muscle relaxants; however, for rapid intubation, rocuronium is the preferred drug in lieu of succinylcholine. The aim of this study was to compare the onset time and intubating conditions at 90 s using 0.3 mg/kg cisatracurium (6× ED95) versus 1.2 mg/kg rocuronium (4× ED95).

Material and methods
The study was conducted at a tertiary care hospital as a randomized double-blind prospective study after obtaining the ethical committee clearance. A total of 60 patients were randomly assigned to receive 1.2 mg/kg rocuronium (4× ED95) or 0.3 mg/kg cisatracurium (6× ED95) after premedication with fentanyl-midazolam and induction with propofol-sevoflurane. Laryngoscopy and intubation were done at 90 s. Primary outcomes assessed were laryngoscopy and intubation conditions and onset times. The Student t test was used to compare prospective, repeated measures. χ
2 test was used to test the significance of difference for qualitative variables.

Results
The onset of action of the muscle relaxant was predicted by measuring train-of-four ratio and was found to be significantly longer in the cisatracurium group (149.50±25.064 s) than in the rocuronium group (101±s) (P<0.05). Although the intubating conditions were better in the rocuronium group, cisatracurium also provided good to excellent intubation conditions at 90 s.

Conclusion
Cisatracurium can be used to intubate the trachea at 90 s at a dose of 0.3 mg/kg in patients premedicated with fentanyl-midazolam and induced with propofol-sevoflurane, while maintaining hemodynamic stability, without increasing the incidence of adverse effects.
Validity of lung ultrasound FALLS-protocol in differentiating types of shock in critically ill patients
Authors: Mawla Tamer S.A. , Elhameed Aliaa A. , Abdallah Areeg A.Y. , Momtaz Osama M. 
Published: September 2024

Background
Acute circulatory collapse is one of the most familiar challenges in ICUs. It is considered that artefacts generated by lung ultrasound (LUS) can help in diagnosis and management. FALLS-protocol using LUS is a tool proposed for the management of unexplained shock.

Objectives
To investigate the role of LUS FALLS-protocol in differentiating types of shock in critically ill patients.

Patients and methods
A total of 50 patients presented with undiagnosed shock. Fast bedside echocardiography and LUS FALLS-protocol were applied along with inferior vena cava diameter and collapsibility measurement.

Results
A total of 19 patients with septic shock on presentation had A profile in all of them and AB profile in three of them, and after resuscitation, they were transformed to B profile with 100% sensitivity, 90.5% specificity, 90.5% positive predictive value (PPV), and 100% negative predictive value (NPV). Overall, 16 patients with hypovolemic shock had A profile in all of them on presentation and after resuscitation, with 100% sensitivity, 94.1% specificity, 88.9% PPV, and 100% NPV. Moreover, eight patients with cardiogenic shock had B profile in all of them on presentation with 100% sensitivity, 95.2% specificity, 80% PPV, and 100% NPV; three patients with obstructive shock had A profile in all of them on presentation, with 100% sensitivity, 25.5% specificity, 7.9% PPV, and 100% NPV; and two patients with anaphylactic shock had A profile in all of them on presentation and transformed to B profile after resuscitation with 100% sensitivity, 50% specificity, 9.5% PPV, and 100% NPV. Our findings showed preference of FALLS-protocol than inferior vena cava diameter and collapsibility in directing fluid therapy.

Conclusion
Bedside chest ultrasound FALLS-protocol should be considered in the resuscitation pathways with a possible significant effect on patient management.
Serum copeptin level as a prognostic marker for acute ischemic cerebrovascular stroke and cerebral hemorrhage
Authors: Sabry Sherif , Samer Nael , Ibrahim Khaled F. , Mahmoud Mohammed 
Published: September 2024

Objective
To assess the predictive utility of serum copeptin concerning the 30-day mortality among patients presenting with ischemic stroke (IS) or hemorrhagic stroke (HS) acute cerebrovascular stroke. Besides, we aimed to evaluate whether serum copeptin has a role in discriminating between HS and IS.

Background
Since its discovery in early 1970s, copeptin has emerged as an effective predictive marker with high potentials of wide clinical applications due to its stability and robust measure. Serum copeptin can reflect the vasopressogenics in a practical way.

Patients and methods
We performed this prospective study on patients with either IS or HS, as indicated by clinical signs and computed tomography. The serum copeptin level was assessed by sandwich immunoassay at admission. All patients were followed up for 30 days after admission.

Results
Nonsurvivors with acute cerebrovascular stroke exhibited a significantly higher copeptin level than the survivors’ group (P=0.038). Besides, patients with HS exhibited a significantly higher copeptin level than the patients with IS (P=0.042). Copeptin showed good sensitivity (70.6%) and specificity (56.5%) at a cutoff value of 48.8 pmol/l to predict mortality in the whole studied population.

Conclusions
Serum copeptin is a promising prognostic tool for the prediction of short-term mortality in patients with acute cerebrovascular stroke. Besides, the serum copeptin has a fair diagnostic accuracy for the differentiation of IS and HS.
Bupivacaine–lidocaine versus bupivacaine–lidocaine plus dexamethasone in supraclavicular brachial plexus block
Authors: Abdelrazik Amr N. , Ali Ashraf H.I. , Youssef Ibrahim A. , Megalla Sohair A. 
Published: September 2024

Background
To evaluate whether dexamethasone as an adjuvant to bupivacaine–lidocaine mixture in supraclavicular brachial plexus block can enhance the block, prolong the duration of action, and improve postoperative analgesia than a mixture of bupivacaine–lidocaine only.

Patients and methods
In all, 60 patients were posted for elective and emergent upper limb orthopedic surgery (below shoulder joint), under supraclavicular brachial plexus block guided by a nerve stimulator. Patients were randomly divided into two equal groups: group C (the control group, n=30) received 40 ml solution containing local anesthetics only. Group D (the dexamethasone group, n=30) received a 40 ml solution containing local anesthetics plus 4 mg dexamethasone. Primary outcomes were onset time of sensory and motor block, and duration of sensory and motor block, which were assessed in minutes. Secondary outcomes were pain assessment using a scoring system based on the visual analog scale, time to first analgesic requirement, and total analgesic consumption.

Results
Duration of sensory and motor block in the dexamethasone group were significantly longer than the control group (753±68.04 vs. 565±30.85 min and 733.66±69.77 vs. 547.16±29.38 min, respectively). For visual analog scale, while comparing the two groups, the differences were significant at 9, 12, and 18 h after surgery in favor of the dexamethasone group. The time to first analgesic request was significantly longer in the dexamethasone group in comparison to the control group. The total analgesic requirement was also significantly lower in the dexamethasone group in comparison to the control group.

Conclusion
The use of dexamethasone at a dose of 4 mg as an adjuvant to local anesthetics provided effective prolongation in the duration of sensory and motor block, prolonged time to first analgesic request, and reduced the total analgesic consumption.
Prevalence and risk factors for depressive symptoms in physicians working in the icus in alexandria main university hospital
Authors: Zaytoun Tayseer M. , Hamdy Haitham M. , Siaf Moaz 
Published: September 2024

Introduction
Depression can lead to significant emotional distress or impairment in social life, home life, and work. Both depression and substance disorders have been identified as major risk factors for the high rate of suicides among physicians, with more than 90% of those physicians who suicide having a history of mood disorder and/or substance abuse. Therefore, interest in the psychological well-being of physicians has increased recently, warranting further research regarding factors that influence the mental health of physicians. Worldwide prevalence of depression among physicians is around 28.8% (20–40%). Both developing and developed countries were high in the prevalence of depression in physicians. The percentage was more marked in a study from Egypt (73.8%) and USA (41%). Fewer studies are found in Asian countries. But the rate was high eventually (30.1%).

Objective
The aim of the study was to estimate the prevalence of depressive symptoms among critical care residents in Alexandria Main University Hospital and to identify the risk factors among them.

Patients and methods
This study implemented a cross-sectional survey. We present a questionnaire to each doctor, which includes three sections: sociodemographic information, lifestyle- and work-related characteristics, and Patient Health Questionnaire-9 survey.

Results
Three quarter of the surveyed ICU physicians reported moderate to severe depressive symptoms. In women, the level of stress is significantly higher than in men. In people working in the 12 and 24-h system and taking overtime hours, the stress level was the highest. Poor patient outcome and decisions with do-not-resuscitate are contributing with more depressive symptoms. Physically active physicians have less depressive symptoms.

Conclusion
Prevalence of depressive symptoms was high among Alexandria Main University Hospital residents. Lack of support and large number of patients along with poor patient outcome and long working hours were the most relevant risk factors.
Preoperative topical lidocaine in pediatric squint surgeries
Authors: Salem Abeer S. , Mohamed Dina Moustafa , Aboul Fetouh Iman S. , Khattab Rehab S. , Mahmoud Sara R. 
Published: September 2024

Aims
To assess the safety and efficacy of lidocaine gel 2% used in pediatric squint surgeries to prevent the oculocardiac reflex intraoperatively and reduce postoperative pain and agitation.

Settings and design
This single-blinded, randomized trial was carried out at the Research Institute of Ophthalmology, Egypt.

Patients and methods
Forty-eight children (2–13 years old) of both sexes scheduled for squint surgeries were randomly allocated into two groups (24 patients each): the lidocaine gel group and the control group. In the experimental group, we applied lidocaine gel 2% abundantly below both eyelids of the surgical eye for at least 3 min before surgical incision, while nothing was applied to patients in the control group. Patients were monitored intraoperatively and postoperatively, and the outcomes were recorded.

Results
There was a lower median postoperative face, leg, activity, cry, and consolability scale in the lidocaine gel group (3.0, interquartile range=2.5–5.0) than in the control group (4.0, interquartile range=1.5–7.0) with no significant difference (P=0.770). The incidence of bradycardia was lower with lidocaine gel 2% use (16.7%) compared with the control group (41.7%), but this difference was not statistically significant (P=0.057). We found no complications except for two patients in the control group who had fever and flushing due to atropine administration.

Conclusion
Application of lidocaine gel 2% below both lids of the surgical eye in pediatric squint surgery under general anesthesia is safe with no observed systemic side effects. However, it has no adjuvant effects in reducing postoperative pain and agitation or preventing intraoperative oculocardiac reflex.
Diagnostic accuracy of lung ultrasound in acute heart failure
Authors: Yahia Mohamed , Soliman Mahmoud , Fawzy Mohamed , Sultan Hatem 
Published: September 2024

Background and objective
Although acute heart failure (AHF) is a common cause of dyspnea, its diagnosis still represents a challenge. Lung ultrasound is an emerging point-of-care diagnostic tool, but its diagnostic performance for AHF is still under evaluation. We evaluated the accuracy and clinical usefulness of combining lung ultrasound with clinical assessment compared with the use of chest radiography, echocardiography, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in conjunction with clinical evaluation for diagnosing AHF in the emergency department.

Patients and methods
A total of 47 patients presenting with dyspnea and symptoms suggestive of AHF were evaluated by NT-proBNP, echocardiography, and chest radiography. Lung ultrasound was done to look for the presence of diffuse B-lines.

Results
Lung ultrasound showed a sensitivity of 91.9% and a specificity of 100% in diagnosing AHF comparable to plasma NT-proBNP, which had a sensitivity of 100% and a specificity of 60%. It was also superior to other methods of diagnosing AHF namely chest radiograph. Lung ultrasound showed a significant correlation with the echocardiography findings (P=0.001).

Conclusion
The implementation of lung ultrasound with the clinical evaluation improves accuracy of diagnosis of AHF in the emergency department.
Postoperative analgesic effect of hyaluronidase versus dexamethasone as additives to bupivacaine in transversus abdominis plane block for inguinal hernia repair: prospective, randomized, and double-blinded controlled study
Authors: Elsayed Hitham M. , Badawy Fawzy Abbas , Raheem Mohammed A. 
Published: September 2024

Background
Inguinal hernia repair is associated with severe postoperative pain. Transversus abdominus plain block has been proved to provide effective analgesia for somatic lower abdominal pain. Several adjuvants have been added to local anesthetic to improve the quality of analgesia. This study compares the additive effect of hyaluronidase versus dexamethasone to improve the quality of analgesia of transversus abdominus plain block for inguinal hernia repair.

Patients and methods
This prospective, randomized, controlled, and double-blind study was carried out in Sohag University Hospital between November 2020 and February 2021. Seventy-five participants scheduled for inguinal hernia repair were included and randomly assigned into control, hyaluronidase, and dexamethasone groups. Exclusion criteria were neurological, psychiatric, neuromuscular, cardiovascular, pulmonary, renal, hepatic disease, alcoholism or drug abuse, pregnancy or lactating women, and patients receiving adrenoceptor agonist or antagonist therapy or chronic analgesic therapy, patients with morbid obesity, coagulopathy, and known allergy to study medications, and sepsis surgical scar at the site to be operated upon and those who refuse.
We targeted from this study to assess time to first analgesia, consumption of morphine, and visual analog scale at rest and during physical activity.
Also, we targeted to assess heart rate, noninvasive blood pressure, SpO2%, and adverse effects (nausea and vomiting, respiratory depression).

Results
Our study showed comparable analgesic efficacy for hyaluronidase versus dexamethasone with longer time to the first request of analgesia, less morphine consumption, and less side effects compared with these two groups to the control group.

Conclusion
Adding hyaluronidase or dexamethasone to bupivacaine not only prolonged the duration of analgesia and decreased the consumption of opioids but also decreased the incidence of adverse effects.
Validation of lung sonography in the implementation of open lung strategy as a recruitment maneuver versus traditional sustained inflation in acute respiratory distress syndrome patients
Authors: Mohamed Mohamed S. , El Maraghi Sameh , Saber Hamdy , Abu Hamela Mohamed F. , Abdalal Ahmed A. 
Published: September 2024

Introduction
Acute respiratory distress syndrome (ARDS) is a serious problem in critically ill patients with high mortality rates. Lung recruitment maneuvers (RM) are important in the treatment of ARDS with an aim to improve oxygenation. There are many approved methods for lung recruitment like the traditional sustained inflation technique and the stepladder positive end-expiratory pressure (PEEP) titration technique. The traditional methods to evaluate RM like computed tomography and pressure–volume curves showed some limitation and disadvantages. Thus, bedside ultrasonography (US) could be a safe bedside tool to evaluate lung aeration and the effectiveness of RM defining the optimum PEEP needed and preventing lung overdistension.

Aim
To evaluate the usefulness of lung US as a guide to follow up RM by PEEP titration technique in comparison to sustained inflation technique.

Patients and methods
In all, 40 ARDS patients were segregated into two groups: group 1 included 20 patients who were subjected to traditional sustained inflation RM and group 2 included 20 patients were subjected to sonar-guided lung recruitment. US scoring, PO2, PO2/FiO2, and lung compliance were used to evaluate the pulmonary recruitment end point defining the best PEEP.

Results
Lung compliance, PO2, and PO2/FiO2 were significantly increased after RM in both groups (P<0.05); however, there was no statistically significant difference between the two groups. The best PEEP in group 1 and group 2 were 20.60±3.485 and 15.90±5.340, respectively, with a significant difference between the two groups (P=0.002). There was no statically significant difference between the two groups regarding complication, vent days and ICU days.

Conclusion
Bedside US can be very useful in the evaluation and management of mechanically ventilated patients in ICUs and to guide the RM in ARDS patients. There is no significant difference between the sustained inflation RM and the sonar-guided stepwise PEEP titration RM regarding oxygenation and compliance except for the level of PEEP reached, which is lower in the stepwise PEEP titration group giving less potentiality for complications.
Assessment of risk stratification scoring systems in upper gastrointestinal bleeding patients in the emergency department
Authors: ElBarragah Kesmat Abdelhamid , Elrewiny Mohamed Tawfiq , Ahmed Ezzat Ali , Sabry Ahmed Abdelfattah 
Published: September 2024

Background
Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency presented to the emergency department that requires early assessment and management. Many risk stratification scores have been developed to predict the clinical outcomes in patients with UGIB. The commonly used risk scores the Rockall scoring systems (PRS and FRS), Glasgow–Blatchford score (GBS) and AIMS65 score.

Aim
The aim of the present study was to assess and compare the ability of the wildly used risk scores the RS, GBS, and AIMS65 to predict the clinical outcomes in UGIB patients Patients and methods
One hundred patients (age >18 years) with acute UGIB in the emergency department of Alexandria Main University Hospital were prospectively studied. All the study scores were calculated and compared using the area under the receiver operating characteristic curve (AUC) method to evaluate the performance of each score to predict the mortality, blood transfusion, endoscopic intervention, ICU admission, rebleeding, and length of hospital stay.

Results
Among the one hundred patients included in the study, 65% were males with a median of age 58 years. 56% had esophageal varices and 63% with liver disease. All the used scores were statistically significant in predicting all clinical outcomes. GBS had the best AUC among the AIMS65, PRS, and FRS scores in predicting mortality with (AUC= 0.80 vs. 0.76, 0.69), blood transfusion need with (AUC= 0.92 vs. 0.88, 0.87), ICU admission with (AUC= 0.86 vs. 0.83, 0.81), rebleeding with (AUC= 0.81 vs. 0.77, 0.69), and length of hospital stay with (AUC= 0.81 vs. 0.75. 0.79).

Conclusion
All the study scores (GBS, AIMS65, PRS, and FRS) were able to predict the clinical outcomes in the UGIB patients. GBS was the best performing risk score among the four scores for predicting all the clinical outcomes (mortality, blood transfusion, rebleeding, ICU admission, and length of hospital stay) except the prediction of endoscopic intervention in our study population.