bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative sperm morphology of 15 species of limpet (Mollusca: Patellogastropoda: Lottioidea) and correlation with current systematics and phylogenies
Authors: Hodgson Alan N , Buckland-Nicks John 
Published: July 2024

ABSTRACT
The spermatozoa of 14 species (four genera) of Lottiidae and one species of Acmaeidae are described by transmission electron microscopy. All have ect-aquasperm, which are relatively small, morphologically simple, free-swimming sperm produced by species with external fertilization. Based on the size, shape and structure of the nucleus and acrosome, as well as features of the mid-piece, several morphological sperm ‘types’ are recognized within the species of Lottioidea described by the present and several previous studies. Sperm morphology largely supports current taxonomy as well as systematic and phylogenetic relationships. However, the morphology of the sperm of Lottia dorsuosa suggests that its generic status should be re-examined. The sperm morphology of Niveotectura pallida (formerly Acmaea pallida) is more similar to that of species of Tectura than of Acmaea mitra, supporting the current placement of N. pallida in the Lottiidae. This result is at odds with the close relationship between N. pallida and A. mitra indicated by recent phylogenies based on molecular data.
Comparison of Post-Operative Analgesia of Caudal versus Dorsal Penile Nerve Blocks for Pediatric Patients Undergoing Hypospadias Repair
Authors: El-Mansoury Yasser Mohamed , Ibrahim Sherif Farouk , El-Fawal Sanaa Mohammed , Habib Mariam Kamal 
Published: July 2024

Abstract

Background
Hypospadias is the second most common congenital disorder in males after cryptorchidism, but it is the most common penile congenital malformation. It is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open. The urethral opening may be located as far down as in the scrotum or perineum. The penis is more likely to have associated ventral shortening and curvature, called chordee, with more proximal urethral defects.

Aim of the Work
The aim of this study is to compare the effectiveness of penile block versus caudal block using bupivacaine on the quality of analgesia after hypospadias repair in pediatrics.

Methodology
This prospective randomized comparative clinical study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 30 male patient aged (1–8) years, ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Penile block (n = 15) received dorsal penile nerve block by using the subpubic approach technique. Group C: Caudal block (n = 15) received caudal epidural block using a 22-G needle in the lateral decubitus position.

Results
There was statistically high significant difference between the two groups in postoperative MAP and HR (p value &lt;0.001) but no statistically significant difference between them in Spo2. FLACC pain scores were significantly lower in group C compared with group P at PACU and 3 hours postoperative (p value &lt;0.001) but no statistically significant difference between them at 6, 9 and 12 hours postoperative. Also, The time for first rescue analgesia was significantly longer in caudal group compared with penile group (P &lt; 0.001) and the total analgesia consumption was also significantly lower (P &lt; 0.001) in group C compared with group P. Postoperative time of ambulation was significantly lower (P &lt; 0.001) in group P compared with group C.

Conclusion
The current study revealed that Caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with Penile block in pediatric patients undergoing hypospadias repair.
Safety and Efficacy of Combined Dexmedetomidine and Bupivacaine versus Bupivacaine Alone in Caudal Block in Pediatric Patients Undergoing Lower Abdominal Surgery
Authors: Salama Hala Gomaa , AlAnsary Adel Mohamad , Kamal El-Din Doaa Mohammed , Eldawy Mahmoud Ramadan 
Published: July 2024

Abstract

Background
Lower abdominal surgeries are one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics is caudal block.

Objective
To evaluate the analgesic effect of dexmedetomidine when given caudally as an adjuvant to caudal block vs bupivacaine alone in caudal block for children undergoing lower abdominal surgeries.

Methods
The study was conducted on 88 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 44 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group BD who would receive caudal dexmedetomidine and Group B who would receive caudal block with Bupivacaine.

Results
There was a highly statically significance between groups according to time to first analgesic requirement (hrs). This table show statically significance difference between groups according to number of paracetamol doses in first 24h. While a statically significant difference between the two groups according to PACERO score. The sedation score was higher in group BD compared to group B. Also a statically significance difference between two groups according to FLACC scale at 8h and 12h. The duration of adequate analgesia (FLACC pain score 4 or less) was significantly higher in group BD compare to group B.

Conclusion
Dexmedetomidine 1 mcg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than bupivacaine alone in caudal block at similar doses in controlling postoperative pain.
Prognostic Value of Neurological Manifestations Related to COVID-19 Positive Patients: Observational Cross-Sectional Study
Authors: Nashed Sherif Wadie , Elsersi Mayar Hassan , AbdelRahman Tamer Nabil , Abd elMaqsoud Abd elQader Ahmed Abd elRazek 
Published: July 2024

Abstract

Background
COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus. Corona virus affects the central nervous system in various different ways either through a retrograde transfer via the olfactory epithelium or through the cribriform bone and reaches the brain directly in seven days’ time or due to disruption of blood brain barrier which occurs during the viremia phase of illness and the virus will enter the brain directly. Another postulated mechanism is the invasion of peripheral nerve terminals by COVID-19 which then gains entry to the CNS through the synapse connected route.

Objective
To determine the prevalence of neurological symptoms and complications in COVID-19 patients and if we can use the neurological symptoms and its relevance as prognostic factors for disease severity.

Patients and Methods
This was a cross sectional study that was conducted on COVID-19 positive patients admitted to isolation ICU Ain Shams University Hospital through 4 months.

Results
The present study aimed to provide a comprehensive overview of neurologic manifestations associated with SARS-CoV-2 infection and to describe the clinical course and outcomes of COVID-19 patients with neurologic manifestations. Our results highlight the broad spectrum of neurological manifestations associated with SARS-CoV- 2 infection: the majority of neurologic manifestations were altered mental status (27.7%), anosmia (13.8%) followed by headache (12.5%).

Conclusion
the neurological manifestations are common in Covid-19 patients. There is an association between the presence of neurological manifestations and mortality.
Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Regional Anesthesia with Tourniquet for Hand Flexor Tendon Repair Surgeries in Adults
Authors: Kamaly Ayman Mokhtar , Amin Mohammed Salwa Omar El-Khatab , Ahmed Shaker Mohammed Khaled Abdelhameed , Metri Bakhtan Mina Bakhtan 
Published: July 2024

Abstract

Background
Flexor tendon injuries represent a significant percentage of admissions in emergency departments in Egypt. A bloodless surgical field is important to perform a hand surgery. Traditionally, a tourniquet is used for hemostasis, and the standered anesthetic techniques utilized in hand surgery were general anesthesia, intravenous regional anesthesia, or brachial plexus block. Recently the evolving Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique where patient is operated on under local anesthesia and hemostasis is achieved via adrenaline could be a better choice. Aim of this work is to compare the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and patient satisfaction with WALANT versus supraclavicular brachial plexus block (SC-BPB ) with tourniquet, in patients undergoing flexor tendon repair.

Patients and Methods
In the current study 52 patients who underwent flexor tendon intervention were divided randomly into two groups, each group consisting of 26 patients. Group A: Patients in this group received WALANT. Group B: Patients in this group received SC-BPB with a tourniquet applied to the arm.

Results
Intraoperative Wong-Baker Faces scale revealed no statistically significant difference in intraoperative pain scores in both groups, except during injection (p = 0.04). Tourniquet-related pain was reported in 23% of patients of SC-BPB group (p = 0.001). Induction time was significantly shorter in WALANT (p &lt; 0.01) but time needed to obtain sufficient hemostasis is significantly more in WALANT than SC-BPB (p &lt; 0.01) while surgical time was similar in both groups (p = 0.538). Blood loss in spite of being minimal it was statistically significant higher in WALANT (p &lt; 0.01).

Conclusion
WALANT anesthesia was found to be better alternative to SC-BPB in flexor tendon repair surgeries in adults being more simple technique and no need for special skills or ultrasound device, less time consumed in induction and less injection pain also no tourniquet-related pain, intraoperative active motion of the hand is preserved facilitating surgical technique, better effect on postoperative analgesia and more patient and surgeon satisfaction.
Retrospective Analysis of Paraparalysis/Paraparesis Post Aortic Aneurysm Endovascular Repair
Authors: Hashem Elrifay Amr Mohamed Mohamed , Mohamed Hassan Alaa Eid , Ali Badr Naglaa Mohammad , Hefney Sameh Salem , Elsayed-Awad Hamdy , Ahmed Youssef Ahmed Monier 
Published: July 2024

Abstract

Objective
Paralysis post TEVAR is a challenging complication, this study discusses its incidence, Risk factors, clinical outcome, reversibility, protective strategy and associated mortality.

Methods
Retrospective study Conducted on patients underwent thoracic and thoracoabdominal aortic Aneurysm Endovascular Repair in Last 11 years (January 2012 till June 2022) in single center as regard incidence, personal history, medical and surgical risk factors, preventive strategies, reversibility of paralysis and associated mortality. Data was obtained from records; paralysis was diagnosed through clinical examination immediately after emergence from anesthesia and frequently post operatively in SICU or even word and after discharge in follow-up outpatient clinic visits.

Results
A study carried on 137 patients, 15 patients of them developed lower limb paralysis with incidence of 10.9%, 3 patients of them (23.1%) developed paralysis immediately post operative, 4 patients developed paralysis in day 1 post operative (30.8%). And the rest of patients developed delayed onset paralysis (more than 24 Hour post procedure), The latest one developed paralysis 26 days post operative, 8 of paralyzed patients had spinal cord imaging (MRI) 4 of them (50%) didn’t show any abnormality and 3 of them (37.5%) showed spinal cord ischemia and 1 patient didn’t tolerate the MRI machine so the study was discontinued. According to reversibility, 9 patients had complete reversal of their motor and sensory symptoms to the baseline preoperative status. 2 patients had partial reversal of their symptoms, and 4 patients had persistent symptoms without any improvement despite the routine management that included elevating MAP and draining CSF to less than 10 mmHg in order to maintain spinal cord perfusion pressure at level of 80 mmHg and giving naloxone. Data showed 12 out of 81 patients (14.8%) who had functioning spinal drain developed paralysis. Duration of procedure is the most affecting risk factor on paralysis, patients with mean duration of 270 minutes had higher risk of paralysis.

Conclusion
Prediction of paralysis post TEVAR is still difficult and data analysis showed that the duration of procedure is the only statistically significant variable that we can rely on.
Impact of Pressure Targeted Modes of Ventilation on Diaphragmatic Function as Assessed Using Ultrasonography in Critically Ill Patients with Cerebral Insult
Authors: Mohamed Youssef Hadeer Mosadek , El Said Kamel Amr Mohamed , Mostafa El-Owaidy Raham Hassan , Maarouf Mohammed Mahmoud , Kamal Mohamed Mohamed 
Published: July 2024

Abstract

Background
Mechanical ventilation (MV) causes diaphragmatic atrophy and reduces diaphragmatic efficiency. Patients with diaphragmatic dysfunction (DD) have longer MV durations and intensive care unit (ICU) stay. There is currently a scarcity of data on the effect of different modes of MV on diaphragmatic function and ultrasound-guided assessment of diaphragmatic efficiency.

Methodology
Sixty mechanically ventilated patients were randomly divided into four equal groups (15 each), patients were ventilated using either Assist Control Pressure Controlled mode (ACPC group)(Group A), Synchronized Intermittent Mandatory Ventilation Pressure Controlled mode (SIMV)(Group S), Bi-level Positive Airway Pressure mode (BiPAP)(Group B), or Pressure Support Ventilation mode (PSV)(Group P). The primary outcomes were diaphragmatic motion & structure in terms of Diaphragmatic Excursion (DE) & Diaphragmatic Thickness Fraction (DTF) respectively. The duration of the ICU stay was the secondary outcome.

Results
The PSV group had the highest DE indicating better diaphragmatic function. In addition, MV for longer durations led to diaphragmatic thinning and decreased DTF resulting in DD.

Conclusion
Among the various modes of ventilation employed in the study, PSV was found to be the mode with the lowest risk of DD.

Trial Registry
PACTR202112653971335.
Erector Spinae Plane Block versus Patient Controlled Analgesia for Postoperative Analgesia in Patient Undergoing Urologic Surgeries with Lumbar Incision
Authors: Farid Hammouda Ahmed Nasser Mohammed , Mohamed Elzahaby Hany Mohamed , El Moneim Nofal Walid Hamed Abd , El-Fattah Ghoneim Mohamed Mohamed Abd 
Published: July 2024

Abstract

Background
Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Urologic surgeries with lumbar incision are usually associated with acute postoperative pain and restricted mobility. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures.

Aim of the Work
The present study was designed to detect the effectiveness of ESPB for post-operative analgesia in urologic surgeries with lumbar incision and its effectiveness to decrease the use of analgesic drugs requirements compared to PCA.

Patietns and Methods
The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients‟ consent. It included a total of 60 adult patients aged 21-60 years, Scheduled for urologic surgeries with lumbar incision e.g: open nephrectomy. Patients were randomly divided into two equal groups, 30 each, according to the inclusion and exclusion criteria. Group A (n = 30): will receive fentanyl 1-2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation in addition 40 ml bupivacaine 0.25% as a single level unilateral injection for ESPB after induction of anesthesia and before skin incision. Group B (n = 30): will receive only fentanyl 1- 2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation and PCA will be started after the end of the surgery.

Results
The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing urologic surgeries with lumbar incision also reduced the total amount of postoperative morphine consumption in comparison to the PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in first 24 hour and Decrease incidence of nausea, vomiting and constipation due to decrease opioids intake.

Conclusion
Ultrasound-guided unilateral ESPB reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients‟ satisfaction in the first 24 hours after urologic Surgeries with Lumbar Incision, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB markably decreased the rate of PONV. This might be because the use of ESPB might have decreased the use of intraoperative opioids.
Effect of Atracurium and Rocuronium on the State and Response Entropy during Isoflurane Anesthesia: Randomized Prospective Study
Authors: Mohamed Hassanien Noran Essam , Bassiouny Mohsen Albdghany , Eldin ElSerwi Heba Bahaa , Ahmed Ashour Tarek Mohamed , Abdelnaiem Ismaiel Mohamed Abdelmohsen 
Published: July 2024

Abstract

Background
Several researches have inspected the impact of inhalation anesthetics, intravenous anesthetics, and muscle relaxants on spectral entropy, but many didn’t evaluate the extent of neuromuscular block. Besides, they didn’t inspect the impact of distinct degrees of neuromuscular blockade on spectral entropy under dissimilar saturations of isoflurane inhalation. Hence, this study evaluated variant degrees of minimum alveolar concentration (MAC) to estimate the isoflurane concentration, along with various level of neuromuscular blockade. Aim of this study is to evaluate the effect of muscle relaxants (atracurium and rocuronium) on entropy readings (state, response entropy and response- state difference) during isoflurane anesthesia. This is a prospective randomized study where forty patients were included and divided into two study groups; patients in Group A received atracurium, while patients in Group R received rocuronium. State and response entropy were observed under MAC 0.8% and 1% under 50% and 100% neuromuscular blockage.

Results
There was a positive correlation between state (SE) and response entropy (RE) at baseline, different MAC, and different train of four (TOF) for both atracurium and rocuronium. State and response entropy decreased with increasing MAC of isoflurane (p &lt; 0.001), while atracurium and rocuronium at TOF 50% and 100% showed no effect on SE or RE or RE-SE (P &gt; 0.05).

Conclusions
State and response entropy can be used effectively to evaluate depth of anesthesia at different isoflurane MAC and atracurium or rocuronium doses. Registration number: ClinicalTrials.gov Identifier: NCT 05097508, Registered 5 October 2021 - prospectively registered, http://www.ClinicalTrial.gov
Bupivacaine 0.25% versus Bupivacaine 0.125% with Dexmedetomidine for Transversus Abdominis Plane Block for Post-operative Analgesia in Cesarean Section
Authors: El Ghaffar Omnia Abd , Ewiss Hassan Bahaa El Din , Ahmed Mohamed Saleh , El Derh Maha Sadek 
Published: July 2024

Abstract

Background
Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action.

Objectives
The aim of this study is to compare two different concentration of Bupivacaine 0.25% versus 0.125% added to Dexmedetomidine as adjuvant in TAP block on quality of analgesia for postoperative pain for parturients undergoing elective CS as regard: VAS score for pain after TAB block, hemodynamics stability, first dose of rescue analgesia and the side effects.

Results
We found that Bupivacaine 0.125% with dexmedetomidine is recommended regarding their analgesic properties, and moreover, Bupivacaine 0.25% with dexmedetomidine was proved to prolong the analgesic effect of TAP block in elective CS even with the higher concentrations of local anesthetics is our concern.

Conclusion
TAP block with bupivacaine 0.125% with dexmetomidine is an effective combination used for postoperative pain relief after elective Cs with lower incidence of LAST, hemodynamic stability and lower opioids consumption.
Ultrasound Guided Pectoralis Nerve Block as a Novel Approach in Pacemaker Implantation
Authors: Abdel Fatah Amr Mohamed , Ibrahim Dalia Ahmed , Elgohary Mohamed Osama , Kamal El-Deep Tamer Ahmed , Kamal Eldin Amin Sara Mohamed 
Published: July 2024

Abstract

Background
The use of implantable cardiac electronic devices (CEDs), including pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronized therapy (CRT), is increasing worldwide for the treatment of cardiac arrhythmias. The aim of this work was to evaluate the effectiveness of PECS I, PECS II blocks as the primary anesthesia technique in patients undergoing subcutaneous pacemaker in comparison to local infiltration anesthesia.

Methods
This prospective cohort randomized study was carried out on 40 patients between the ages of 21 to 80 years old undergoing pacemaker implantation in Aswan heart center. Patients were randomly allocated into two equal groups: Group (1): received Pecs block and group (2): control group, received standard local infiltration anesthesia with lidocaine 0.2 (10-15ml).All patients were subjected tolaboratory examinations) Hemoglobin, platelet count international normalized ratio, prothrombin time, partial thromboplastin time), Echocardiography (ECG), VAS, PCIA and preoperative medications.

Results
Number of patients required postoperative analgesia was significantly lower in group 1 compared to the group 2 (P value &lt;0.001). Time to first require analgesia was significantly delayed in PECS blocks group compared to the control group and postoperative analgesia was significantly lower in group 1 compared to the group 2 (P value &lt;0.001). The hospital stay was significantly lower in PECS blocks group compared to control group (&lt;0.001).

Conclusions
Ultrasound guided PECs provided adequate analgesia as shown by reducing the times of start procedure and technique, postoperative pain scores and total opioid usage, delayed the time to first require analgesia and better operator and patient satisfaction in pacemaker implantation as compared to infiltration anesthesia.