bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Efficacy of Ultrasound Guided Bilateral Transversus Thoracic Plane Block for Postoperative Pain Control in Cardiac Surgery
Authors: Zakaria Fahim Joustina Nader , Ewess Hassan Bahaa Eldin , Abd-Elsalam Ehab Hamed , EL-Shourbagy Mohammed Sayed 
Published: July 2024

Abstract

Background
Cardiothoracic surgeries are associated with significant pain. Optimal analgesia is a vital part of strategies intended to improve patients' experience and outcomes. Traditionally, analgesia in these types of surgeries has depended on large doses of I.V. opioids.

Aim of the Work
The aim of the study was to evaluate the effect of postoperative bilateral US guided TTPB block on postoperative pain control in patients undergoing cardiac surgery through mid-line sternotomy compared to systemic analgesia.

Patients and Methods
This study is a randomized clinical trial study at Ain-shams University Hospitals, Cairo, Egypt. In our study, patients were randomly allocated into two groups with 40 patients in each group. Group 1 (study group) received TTP block., whereas Group 2(control group) received systemic analgesics. The two groups were compared regarding their demographic data (age, sex, body weight and height), A numerical rating scale (NRS) for sternal pain, morphin consumption during 24 hours after extubation and time of first rescue analgesia, heart rate and blood pressure in icu, time of extubation, ICU length of stay, total length stay of the hospital.

Results
Our study showed that when compared to general anesthesia with systemic opioids, TTPB block is associated with significantly better postoperative pain control.

Conclusion
Tranversus thoracic plaine block is technically simple, safe and very effective technique and can be used as a part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and satisfaction and also helps in superior pulmonary rehabilitation, thus assisting in better outcome and less unwanted side effects of systemic analgesics.
A Comparative Study between Ultrasound Guided Pectoral Nerve Block Type II versus Intravenous Patient Controlled Analgesia for Intra-Operative and Post-Operative Analgesia in Patients Undergoing Modified Radical Mastectomy
Authors: Ali Eman Adel , Salama Awad Hala Gomaa , Tharwat Sayed Ayman Ibraheem , Salem Ahmed Sarah Ahmed 
Published: July 2024

Abstract

Background
Breast surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anaesthesia techniques may improve post-operative analgesia for patients undergoing breast surgery.

Aim of the Work
The primary aim of this study is to compare the efficacy of PECS block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques.

Patients and Methods
This study is a randomized clinical trial study conducted in Ain-shams University Hospitals, Cairo, Egypt for 6 months after medical ethical committee approval. The participants were allocated randomly into two groups of 25 patients each: group A: Patients received general anaesthesia followed by PECS block at the end of the operation before extubation, group B: Patients received general anaesthesia followed by the PCA at the end of surgery after extubation.

Results
The VAS score in the PECS group was statistically significantly lower at the 1st, 2nd and 4th hours. In this case, the use of PECS for postoperative analgesia is as effective as intravenous Morphine PCA in pain treatment, but with less systemic side effect as the nausea and vomiting is significantly higher in the PCA group than the PECS group at the 6th hour, however, the need of intra operative opioids in PCA group is significant.

Conclusion
In modified radical mastectomy, PECS block is as effective as intravenous Morphine PCA in pain treatment. Compared with intravenous PCA, PECS block can be considered as a more preferable method because it can avoid the systemic actions of morphine used for PCA, and can decrease the need of analgesia intra-operative, however PCA analgesic effect last longer, less invasive technique and easier to be used while PECS block require hand skills and limited to 24 hours analgesia only.
Effectiveness of Nutritional Supplementation in Liver Transplant Recipients during Early Postoperative Course: A Systematic Review and Meta-Analysis
Authors: AL Ansary Adel Mohamad , Eldin Amin Ghada Essam , Abdelmotaleb Ammar Mona Ahmed Mohamed , Mohamed EL Anany Reem Hussein 
Published: July 2024

Abstract

Background
Nutrition is an integral part of health maintenance. The liver is the largest and most important metabolic organ, playing a pivotal role in integrating several biochemical pathways of carbohydrate, fat, protein, and vitamin metabolism. Malnutrition is a common complication of end- stage liver disease (ESLD). Progressive deterioration of nutritional status has been associated with poor outcome in cirrhotic patients. Liver transplantation (LT) revolutionized the management of liver disease. Nutritional therapy is an integral part of liver transplant care.

Objective
To identity the efficacy of different dietary nutritional supplements as zinc, vit D and immunonutrients (glutamine, omega 3, arginine and ribonucleic acid) for recipient at early post operative course.

Material and Methods
In this systematic review and meta-analysis we enrolled a total of 7 studies for assessing the clinical outcomes of ICU patients underwent liver transplantation surgery and supplied with dietary supplements during early postoperative period. The studies also assessed the laboratory assessment of patients postoperatively during ICU admission period.

Results
Regarding postoperative dietary supplementations with HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB. Also we did not find significant difference between base line and postoperative in both groups for Mid-arm muscle-circumference (MAMC), Fat mass index (FMI), 6-minute walk test (6MWT), and Handgrip (HG).

Data Sources
Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.

Conclusion
BCAA as dietary supplementation showing a significant favorable effect regarding the baseline and the postoperative BTR levels, also for BCAA levels, Tyrosine levels, prealbumin levels, retinol binding protein and PTINR levels in both intervention and control groups. For HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB.
C-Reactive Protein as an Early Marker of Severity and Outcome in Patients with SARS-CoV-2 Infection
Authors: El-khattab Salwa Omar , Eldin Abdelhamid Amr Essam , Ibrahim Waleed Abdalla , Yousef Elsherif Ahmed Ibrahim , Khalil George Mekhael 
Published: July 2024

Abstract

Background
SARS CoV-2 infection is a major cause of morbidity and mortality worldwide. The incidence of SARS CoV-2 infection is rising with millions of people getting infected daily. Mortality rate varies from a country to the other(0.3-6%), most of which are attributed to respiratory failure. Several studies have been performed to identify biomarkers for use in the early identification of patients at risk.

Aim of the work
This study was done to estimate and evaluate the plasma levels of CRP in patients with SARS CoV-2 and to study the association of CRP levels with severity of disease progression and prognosis of those patients.

Patients and Methods
This retrospective cohort study was conducted on 100 patients admitted to El-Obour Ain Shams University Specialized Hospital for Isolation during the period between January and October 2020.

Results
Regarding history patients whom were old or have any of the following comorbid conditons as hypertension, Diabetes mellitus, chronic liver disease and active cancer were statistically more prone to not surviving. Regarding complete blood picture, there was significant decrease in haemoglobin and or increase in total leukocytic count in those who did not survive. Serum Ferritin and D-Dimer were significantly high in those who did not survive. As regard CRP, it was significantly higher in the non-survivor group, Also it correlated with severity as ICU admission and need of respiratory support. Regarding the ROC curve result the best cut-off of CRP to predict mortality was &gt;129mg/l, with Area under the curve = 0.981, Sensitivity = 90.91%, Specificity= 97.75%, positive predictive value = 83.3% and negative predictive value =98.9%. Regarding the ROC curve result the best cut-off of CRP to predict need of respiratory support was &gt;55.3mg/L, with Area under the curve = 0.976, Sensitivity = 100%, Specificity= 86.21%, positive predictive value = 52.0% and negative predictive value =100.0%. Regarding the ROC curve result the best cut-off of CRP to predict need of ICU admission was &gt;55.3mg/L, with Area under the curve = 0.987, Sensitivity = 100.0%, Specificity= 93.75%, positive predictive value = 80.0% and negative predictive value =100.0%.

Conclusion
Laboratory and clinical medicine groups should actively collaborate and optimize their individual expertise to potentially prove standardized biomarkers assays that will optimize patient care.
Prognostic Value of Cardiac Troponin Release in Head Trauma Patients
Authors: Mohamed Galal Adel , Hussein Noha EL-Sayed , Saleh Ashraf Nabil , Mohammed Mohammed Hassan Hashim 
Published: July 2024

Abstract

Background
Traumatic brain injury (TBI) is defined as damage to the brain sustained after the application of external physical force that causes temporary or permanent functional or structural damage to the brain. TBI stands as a major cause of death among youth in industrialized societies. Brain injury can be mild, moderate, and severe.

Objective
Myocardial dysfunction is frequently described as an underlying cause of mortality in traumatic brain injury (TBI) known as brain-cardiac link. The impact on prognosis of a disease remains uncertain. The present study aimed at investigating the correlation between serum cTnI levels as a biochemical marker of myocardial damage and morbidity, mortality of the patients with mild to moderate TBI.

Patients and Methods
This study was conducted to investigate the relationship between TBI and cTnI elevation, as well as the prognostic usefulness of this relationship and morbidity, mortality in patients with mild to moderate TBI. It has been claimed that there is a relationship between cardiac injury and mortality rate in TBI patients.

Results
In the present study, there was a non-significant relation between incidence of mortality and cause & type of injury among studied cases. This study revealed that there is significant relation between incidence of mortality and hospitalization characteristics (length of ICU stay, GCS, troponin level) among studied cases. However, there is a non-significant relation between incidence of mortality and length of hospital stay, AIS, GOS and troponin release. Results of binary logistic regression for prediction of mortality among studied cases were significant in GCS and troponin; however, were non-significant in length of ICU. Regarding validity of troponin in prediction of mortality among studied cases in the present study population, AUC of troponin was 0.912 (95% CI: 0.756-1.0) with cutoff point 0.265 (P &lt; 0.001).

Conclusion
A non-significant relation was found between release of troponin and cause & type of injury among the studied cases. In addition, there was a non-significant relation between troponin level and mode & type of injury. Increased cTnI levels could be a predictor of mortality among patients with TBI.
Efficacy and Safety of Tocilizumab with Methylprednisolone versus Methylprednisolone Only as a Treatment for Severe Covid-19 Patients
Authors: Elsharnouby Noha Mohamed , Elgendy Mohammed Abdelsalam , Abd Elrahman Heba Mahmoud , Elshoura Ahmed Emam 
Published: July 2024

Abstract

Background
SARS-CoV-2 was identified as a worldwide fatal pandemic that causes acute respiratory infections. The aim of this work was to compare the effect of Using combined therapy: (tocilizumab with Methylprednisolone) versus using (Methylprednisolone alone) as immuno-modulatory therapy on 28 days mortality mortality, need for mechanical ventilation & adverse effects.

Methods
This retrospective observational cohort study was carried out on 60 patients diagnosed as having covid 19 infection with cytokine storm and severe acute respiratory syndrome during the period(2020-2021). Patients were divided into 2 groups: (TCZ+MP)group received 2 doses of tocilizumab within 24 hrs (5 mg/kg in each dose) in addition to a dose of methylprednisolone(2mg/kg/day)for7days and(MP)group:received only a dose of methylprednisolone (2 mg\kg\day) for 7days. All patients were subjected to routine laboratory investigations (Complete blood count, liver function tests, kidney function tests, LDH, ferritin, D-dimer, frequent ABGs (P/F ratio), CRP, IL6, procalcitonin& albumin), and radiology investigation (Chest x-ray and CT chest).

Results
60 patients with ARDS(both genders) were included in this study, in TCZ+MPgroup, 8(26.67%) of 30 patients died, compared to 17(56,67%) of 30patients in (MP)group, so mortality rate was significantly lower in patients on TCZ+MPgroup than those on (MP)group (P value =0.018). In TCZ+MPgroup, 12(40%) of 30 patients needed mechanical ventilation compared to 22(73.33%) of 30 patients in MP group, so Number of patients who required mechanical ventilation was significantly lower in patients on TCZ+MPgroup than MP group (P value = 0.009). Adverse effects of intervention drugs after 28 days were insignificantly different between both groups (P value = 0.018).

Conclusions
In patients with severe COVID-19 infection, combination therapy of tocilizumab &methylprednisolone reduced mortality rate and need for mechanical ventilation as compared with the use of methylprednisolone alone.
Metabolic Syndrome as A Prognostic Factor for Outcome of Severe SARS-COV-2 Cases
Authors: Mohamed Sakr Heba Ahmed , El Shaer Ahmed Nagah , Hilal Abdo Amr Mohamed , Refaat Sameh Ahmed , Hamza Amr Hosni 
Published: July 2024

Abstract

Background
SARS-COV-2 (Coronavirus Disease-2019), a disease caused by the coronavirus. SARS-CoV-2 (Sever Acute Respiratory Syndrome-Coronavirus-2) has emerged as a rapidly spreading communicable disease affecting more than 100 countries across the globe at present.

Aim of the Work
To illuminate to what extent metabolic syndrome can be used as a prognostic factor for outcomes of patients infected with SARS-COV-2. Primary outcome measure is ICU stay and outcome. Secondary outcome measures are Patients requiring MV and mortality.

Patients and Methods
This was a retrospective study in order to illuminate to what extent metabolic syndrome can be used as a prognostic factor for outcomes of patients infected with SARS-COV-2, with Primary outcome measure which was ICU stay and outcome, and Secondary outcome measures were Patients requiring MV and mortality. Ninety patients admitted to ICU for Pneumonic COVID-19 with a confirmed positive RT-PCR for COVID-19 and chest computed tomography was divided into two groups in Ain-shams University hospitals.

Results
Components of metabolic syndrome such as hypertension, type 2 diabetes mellitus (T2DM), and obesity are highly prevalent and significantly increase the risk of hospitalization and mortality in SARS-COV-2 patients.

Conclusion
MetS is a better prognostic indicator for severe disease outcomes in patients with COVID-19 than its individual components. Patients with MetS had a significantly higher need for ICU admission irrespective of their age, sex, or race. The need for mechanical ventilation was also higher across all patients with MetS. The association of MetS with higher mortality was significant for females, patients younger than 65 years of age.
Norepinephrine versus Ephedrine in Prevention of Hypotension after Spinal Anesthesia in Cesarean Section
Authors: Moneam El Sheikh Alaa Nagi Abdel , Taha Elsafty Omar Mohamed , Abdellatif Ayman Ahmed 
Published: July 2024

Abstract

Background
Spinal anesthesia is the preferred anesthetic method for elective cesarean section in obstetric anesthesia practice. Cesarean sections normally require an anesthetic block at T4 level, so hypotension is reported in up to 80% of spinal anesthesia cases.

Aim of the Work
This study aims to compare norepinephrine versus ephedrine in Prevention of hypotension in CS under spinal anesthesia.

Patients and Methods
The study was a clinical Prospective, double–blinded and randomized study, the operating theatres of Ain Shams University Hospitals over one year.

Results
We administered the vasopressors by iv infusion when SBP drops 20% below the baseline. We found that no significant difference between both groups regarding fetal Apgar score. We compared two different vasopressors and we chose the regimen of iv infusion.

Conclusion
We found lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia in the patients treated with norepinephrine.
Nutritional Support for ICU Patients Receiving Extracorporeal Membrane Oxygenation Therapy: A Meta-Analysis
Authors: Mohamed Elfiky Amira Ahmed , El Sharnouby Noha Mohamad , Moustafa Moustafa El-Houssinie , Allah El Gendy Hanaa Abd 
Published: July 2024

Abstract

Background
ECMO constitutes a mechanical technique that provides extracorporeal gas exchange or/and circulatory support for patients with refractory life-threatening pulmonary or/ and cardiac failure. There is infrequent evidence regarding the optimal nutritional management and related clinical outcomes for adult critically-ill patients receiving ECMO.

Objective
This study was conducted to evaluate the effect of nutritional intervention on clinical outcomes in adult critically ill patients receiving Extracorporeal Membrane Oxygenation Therapy.

Methodology
Advanced search was conducted in Medline, PubMed, google scholar and the Egyptian Knowledge Bank for cohort studies that were published in English until September 2020.

Inclusion Criteria
cohort studies which assess nutrition support in adult critically-ill patients receiving ECMO therapy, and include at least one of these outcomes a) 28-day mortality, b) length of ICU stay, C) duration of mechanical ventilation and d) incidence of infection.

Exclusion Criteria
duplicate reports, Abstracts, case reports, case series, review articles, editorials and clinical guidelines. In addition, studies with unavailable full text or studies with different outcomes were excluded.

Results
7 studies with a total number of 2358 patients were included in the meta-analysis. Estimates and their 95% confidence intervals (CI) were calculated, then pooled for analysis. Nutrition support in adult critically ill patients receiving ECMO was significantly related to 28-day mortality ( 95% CI 0.428 = 0.329–0.527; p &lt; 0.001), increased ICU length of stay ( 95% CI 29.512 (22.930–36.095), and P value &lt; 0.001), duration of mechanical ventilation (95% CI 17.985 = 4.682–31.288; p &lt; 0.008) and incidence of infection ( 95% CI 0.105 ( 0.066 – 0.144), and P value &lt; 0.001).

Conclusion
The study indicates positive association between effective nutrition support and clinical outcomes for adult critically-ill patients receiving ECMO therapy.
Intrathecal Dexmedetomidine versus Intrathecal Dexamethasone as Adjuvants to Hyperbaric Bupivacaine to Prolong the Duration of Sensory Block in Patients Undergoing Lower Abdominal Surgeries
Authors: Mohamed El taher Waleed Abdel Magied , Salam Elgendy Mohamed Abdel , Attia Engy Samy , Atwa Ali Ali Mohamed 
Published: July 2024

Abstract

Background
Dexmedetomidine can be added to local anesthetics in spinal anesthesia to speed up the block, reduce postoperative pain, increase block duration, and reduce analgesic use. Dexamethasone is used intravenously to lessen shivering because it reduces the body's inflammatory response and tissue temperature gradient. It can also be safely injected into the cerebrospinal fluid as an adjuvant to local anesthetics to improve the quality of regional anesthesia. Intrathecal dexamethasone added to Bupivacaine increased spinal anesthetic sensory block duration without affecting onset time or consequences.

Aim
Comparing the onset and duration of sensory block and Analgesia and onset and duration of motor block and hemodynamic stability when intrathecal 5 mcg Dexmedetomidine added to 15mg heavy bupivacaine 0.5% to that of 4mg dexamethasone when added to 15 mg heavy bupivacaine 0.5% in patients underwent lower abdominal surgeries under spinal anesthesia.

Subject and Methods
This study was conducted at Faculty of Medicine; Ain-Shams University Hospitals on 50 patients.

Results
VAS was significantly lower in group B compared to group A at 8hr and 12hr measurements. there is a significant difference between the groups regarding sensory block duration, motor block duration, onset of sensory block, onset of motor block, time to 2 segment regression, and time to request of 1st analgesia. postoperative opioid consumption was significantly lower in group B always compared to group A.

Conclusion
adverse events. The current study showed that both Dexmedetomidine and dexamethasone were safe and effective as intrathecal adjuvants in lower abdominal surgeries. Both drugs resulted in comparable hemodynamic stability and incidence of
Correlation between Central Venous Pressure and Inferior Vena Cava Diameter for Fluid Assessment in Patients with Chronic Obstructive Pulmonary Disease
Authors: El Deen Habib Ahmed Salah , Nashed Sherif Wadih , Othman Toaima Mohamed Mohamed , Mohamed Abdel Wahab Wael Abdel Moneim 
Published: July 2024

Abstract

Background
Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death globally.3 Although COPD primarily affects the lungs, it is now also recognized as a complex multi-component disease characterized by chronic systemic inflammation that frequently coexists with other conditions known as co morbidities.

Objective
To determine the correlation between central venous pressure (CVP) and the IVC collapsibility index for estimating the fluid status in COPD patients.

Patients and Methods
After obtaining the approval of the Ain Shams University Ethical Committee and written informed consent, 20 patients aged 21 - 60 years of either sex, admitted in the ICU of Ain Shams teaching hospitals who have a functioning central venous catheter inserted for any clinical indication, were involved in this correlational study. CVP measurements were taken with the patient in the supine position from the zero point and the middle line.

Results
The current study showed that there was no statically significant correlation Between CVP (cmH2O) and Heart Rate (beat /min), MABP (mmHg), IVCd max (cm) and IVC CI % at Baseline, After PLR test, After Bolus fluid administration, After 3 hours and After 6 hours.

Conclusion
The measurement of the IVC diameter has a good correlation with CVP and useful for assessment of the volume status. The measurement of the IVC by ultrasonography may be an important additional evaluation of critically ill patients.