bluuebunny/crossref_metadata_2025_split huggingface dataset:
I Pack Block versus Adductor Canal Block for Post-Operative Pain Management in Total Knee Arthroplasty
Authors: Abd El Latif Hassan Samia Abd El-Mohsen , Abd El Fattah Sayed Amr Mohamed , Abdel Hafiez Mohamed Rania Hassan , Mohamed Elbukhari Mohamed Mahmoud Serry 
Published: July 2024

Abstract

Background
Total knee arthroplasty (TKA) is a highly distressful major surgery, with a significant potential for complications, not only because of the surgical and anesthetic impact of the procedure, but also because of the demographic and clinical characteristics of the target population. Careful pain management is necessary post-operative to achieve early post-operative mobilization while ensuring patient comfort throughout and preventing post-operative complications.

Objective
we aim to compare postoperative pain management and post- operative analgesic consumption between IPACK block and Adductor canal block in total knee arthroplasty cases.

Methods
After obtaining approval from the medical ethical committee in Ain Shams University, this Prospective randomized controlled double-blind clinical trial study was conducted in the operating theatres of Ain shams University Hospitals. Study period March 2022 to August 2022. Physical status: ASA 1 or 2 and candidates for spinal anaesthesia undergoing total knee arthroplasty. Age group: 40-65 years. Sample sizes of 30 patients in total; 15 in group I (group I) and 15 in group II (group A).

Results
As for the comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty, it showed that there is significance regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block.

Conclusion
The comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty showed significant difference regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block. These findings with our study primary and secondary outcomes showed that Adductor canal block has more analgesic effect with respect to IPACK block regarding pain assessment but with no significant difference regarding the by the time till first analgesia postoperative and Total analgesics consumption (in mg.) over 24-hour period post-operative.
Comparative Study between Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Epidural as Postoperative Pain Management in Modified Radical Mastectomy
Authors: Nashed Sherif W , El Shebiny Ahmed A , Sayed Amr G , Farag Michael G 
Published: July 2024

Abstract

Background
Surgery is one of the mainstays of treatment of breast cancer, and modified radical mastectomy (MRM) is one of the standard treatments for multi-centric disease or tumors with extensive coexistent ductal carcinoma in situ, where achieving a clear surgical margin becomes difficult with a segmental mastectomy.

Aim of the Work
to compare between Serratus Anterior plane block and thoracic epidural as efficacy of postoperative analgesia in Modified Radical Mastectomy.

Patients and Methods
This study was prospective controlled single blinded randomized clinical study, carried out in Ain Shams University hospitals, Cairo, Egypt over a period of 6 months. The study included adult female patients undergoing modified radical mastectomy was randomly assigned into two equal groups by computer generated: Group A: Included 15 patients received general anaesthesia preceded by Thoracic Epidural 9 ml of 0.25% Bupivacaine at T4-T5 level. Group B: Included 15patients received general anaesthesia followed by SAP block using only bupivacaine 0.25% (safety dose 3 mg /kg).

Results
The haemodynamic data including heart rate and mean arterial blood pressure show a significant decrease in SAP group less than the TE group. The pain scale (VAS) showed a significant decrease in SAP group less than the TE group. The total opioids consumption was significantly less in SAP than TE group. The first rescue morphine analgesia (min.) was significantly higher in SAP group more than TE group.

Conclusion
The SAP was effective and safe technique which provides better pain relief compared with the TE and reduced post-operative opioid consumption. Also, SAP was effective analgesic technique showing greater hemodynamics stability and less stress response to surgery compared with TE.
The Role of Procalcitonin and Red Cell Distribution Width as Diagnostic and Prognostic Biomarkers in Patients with Sepsis and Septic Shock at Intensive Care Unit
Authors: Shokeir Mohamed Hossam , Gad Ehab Ahmed , Farrag Ossama Mohamed , Mostafa Abdullah Mostafa 
Published: July 2024

Abstract

Background
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be identified as an acute change in total sequential organ failure assessment (SOFA). Septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality. Biomarkers can be used in suspected sepsis for identifying or ruling out sepsis, evaluating the severity and assessing the prognosis and evaluating patients’ response to proper treatment. This study is on procalcitonin (PCT) and red cell distribution width (RDW) as diagnostic and prognostic biomarkers in patients with sepsis and septic shock.

Objective
This study aims to assess the feasibility of PCT and RDW as early diagnostic and prognostic biomarkers in patients with sepsis and septic shock.

Methods
This is a prospective observational study, in which 100 blood samples of clinically suspected sepsis and septic shock patients’ were included following a convenience sampling technique. PCT and RDW were recorded in day 0, 3, 6, 9 and 12.

Results
A rise in RDW and PCT levels could serve as early indicators of outcome including mortality. We found that baseline RDW cut-off point &gt; 15.6 with sensitivity of 80.0%, specificity of 85.71% while in day 12 cut-off point &gt; 17.3 with sensitivity of 60.0%, specificity of 100.0%. Accordingly PCT cut-off point &gt; 4.1 with sensitivity of 80.0% and specificity of 94.29% in baseline values. While cut-off point in day 12 was &gt; 0.7 with sensitivity of 80.0%, specificity of 97.0%.

Conclusion
A significant concurrence was seen between elevated serum PCT and RDW levels with severity and prognosis of sepsis. They were found to be a good predictor of sepsis and low levels rule out an infection.
A Comparative Study between Continuous Epidural Analgesia versus Ultrasound Guided Continuous Femoral Nerve Block (CFNB) versus Ultrasound Guided Continuous Adductor Canal Block (ACB) for Post-Operative Pain Management after Total Knee Replacement (TKR)
Authors: Nassif Kalad Remon Nadhy , Mahmoud Ali Hoda Omar , Hussein Thabet Wael Reda , Sayed Sharaf Amr Gaber , Abdelghaffar Elsotouhy Abdelrahman Mabrouk 
Published: July 2024

Abstract

Background
Total knee replacement (TKR) is considered a prevailing cause of severe postoperative pain and discomfort among orthopedic surgeries, limiting postoperative ambulation that is important for regaining joint function. Despite being the gold standard, epidural analgesia can be accompanied by diverse complications delaying postoperative ambulation and discharge from hospital. Continuous femoral nerve block (CFNB) and continuous adductor canal block (ACB) are reliable and efficacious regional anaesthesia techniques allowing better control of postoperative pain. This study purposed to compare epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative analgesia & incidence of postoperative complications. The aim of this study is to estimate the efficacy of epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative pain control following total knee replacement and the rate of incidence of associated postoperative complications. This is a prospective randomized controlled study where sixty patients were randomized into three equal groups, patients in group A received epidural analgesia, patients in group B received continuous femoral nerve block while patients in group C received continuous adductor canal block with postoperative continuous infusion of 0.125% bupivacaine with fentanyl 2μg/ml in the three groups at a rate of 5 ml/hr. VAS score was assessed for 48 hours post-operatively and complications were recorded.

Results
Epidural analgesia was superior to CFNB and ACB regarding postoperative pain control using visual analogue scale and postoperative pain control. CFNB and ACB are superior to epidural analgesia regarding postoperative ambulation and postoperative complications.

Conclusions
Continuous epidural analgesia provides superior analgesia following total knee replacement than femoral nerve block and adductor canal block, with relatively more adverse effects like pruritus, post operative nausea, and vomiting (PONV). Both CFNB and ADB are good alternatives with fewer systemic side effects.
Plethysmography Variation Index versus Pulse Pressure Variation as an Indicator of Fluid Responsiveness in Colorectal Surgeries during Immediate Postoperative Period
Authors: Alamir Maye M , El Seidy Mohamed I , Taha Sahar M , Al Gharabawy Wael S , Galal Mohammed A 
Published: July 2024

Abstract

Objective
Goal directed fluid therapy during major abdominal surgery may reduce postoperative morbidity. The Plethysmography Variability Index (PVI), derived from the pulse oximeter waveform, has been shown to be able to predict fluid responsiveness in a number of surgical circumstances. In this study, we will compare the effectiveness and re liability of Plethysmography variation index (PPV) and Pulse pressure variation (PPV) in prediction of fluid responsiveness in all sedated intubated mechanically ventilated patients admitted for postoperative resuscitation in our surgical ICU.

Method
100 patients were placed in two different groups equally where heart rate, PPV, CI, and PVI were recorded on admission. Immediately after volume expansion is performed by infusing saline 500 ml over 30 mins and at the end of volume expansion PPV, CI, PVI will be recorded every 2 hours for the first 24 hours.

Results
Hundred patients aged from 18 to 64 years who were scheduled for colorectal surgery and were to be transferred to the intensive care unit for postoperative care for the f irst 24 hours post operatively who didn’t have any of the exclusion criteria were included in this prospective randomized comparative single blinded research. 100 patients were divided in to “responders” and “non responders”. Both groups received a volume 500 ml saline over 30 minutes immedietly postoperatively. Fluid responsiveness was tested in both groups using PVI (Plethysmography variability index) and PPV ( pulse pressure variation) using cardiac index as a reference parameter. PVI showed accurate fluid responsiveness in comparison with PPV in responders with mean ranging from ( (-6.66 ± 0.90) and (-5.89 ± 1.93) respectively, with a P-value&lt;0.01

Conclusion
This study revealed that after giving a fluid challenge of 500 ml of saline over 30 minutes, a rise in PVI and PPV was demonstrated using cardiac index as a reference for reliability for comparing the effectiveness and accuracy between PVI and PPV.comparing the effectiveness and accuracy between PVI and PPV.PVI and PVI and PPV PPV can be used can be used in assessment of fluid responsiveness of the intubated ventilated sedated patients in assessment of fluid responsiveness of the intubated ventilated sedated patients with sinus rhythm in ICU, and both methods can be performed at the bedside, but with sinus rhythm in ICU, and both methods can be performed at the bedside, but PVI has advantage of being continuousPVI has advantage of being continuous, operator independent, and more reliable, operator independent, and more reliable thanthan PPVPPV.
Effect of Sacubitril / Valsartan Combination on Abnormal ECG Findings in Patients with Heart Failure with Reduced Ejection Fraction
Authors: Aly Ahmed , Shehata Hassan , Allam Lamyaa , Eldamanhoury Hayam 
Published: July 2024

Abstract

Background
The mortality rate of patients suffering from choronic heart failure is still high despite advantages in diagnosis and treatment. A new therapeutic class of agents acting on the renin angiotensin aldosterone system (RAAS) and neutral endopeptidase system has been developed, known as angiotensin receptor neprilysin inhibitors (ARNI). Recently, promising data from its administration have demonstrated a decrease in the mortality rate as compared to angiotensin receptor blocker alone.

Aim of the Work
The aim of this study is to asses effect of Sacubitril/Valsartan combination on abnormal ECG and ECHO parameters in patients with heart failure with reduced ejection fraction as a marker of reverse cardiac remodeling.

Patients and Methods
Our study was conducted at Ain Shams university hospitals and our target population was heart failure patients with reduced ejection fraction planned to initiate Sacubitril \ Valsartan combination therapy. 100 patients were collected from February 2022 to August 2022. It was an interventional study to follow up the effects of the drug on ECG parameters besides ECHO parameters 6 months after drug initiation.

Results
We found that in Sacubitril/Valsartan combination therapy there was significant decrease in HR, QRS width and QTc values which reflects the role of this combination to reduce ventricular arrhythmias and preventing SCD. There was significant increase in the EF which was correlated to the significant decrease in QRS width. There was significant improvement in diastolic dysfunction. There was significant decrease in the LA and LV dimensions giving an explanation of the role of the drug in reverse cardiac remodeling. There was significant improvement in NYHA class reflecting the role of the drug in improving quality of life.

Conclusion
HR, QRS width and QTc were significantly decreased with Sacubitril/Valsartan combination therapy through the follow up period reflecting the effect of the drug on ECG. EF, LA dimension and LVID were improving with Sacubitril/Valsartan combination therapy through the follow up period which give an explanation of the combination therapy for its role in reverse cardiac remodeling. NYHA class of our patients was improving through follow up period which means this drug improves quality of life and reduces hospitalization.
The Value of 24 Hour Ambulatory Blood Pressure Measurement vs Home/in-office BP measurement in predicting left ventricular Mass Index in Egyptian Hypertensive Patients on Medical Treatment
Authors: Abdelkarim Hanan , Rayan Mona , Keaddes Viola , Hennawy Bassam 
Published: July 2024

Abstract

Background
An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. An estimated 46% of adults with hypertension are unaware that they have the condition. Less than half of adults (42%) with hypertension are diagnosed and treated.

Aim of the work
To determine the value of 24hour ambulatory blood pressure monitoring vs in office /home BP measurement in predicting left ventricular mass index in Egyptian hypertensive adults receiving anti hypertensives medications.

Patients and Methods
The present study included 100 known hypertensive patients. All were on either one or two anti-hypertensive drugs, and were coming in for follow up in the period between January 2021 and July 2022. The study setting was Ain Shams University hospitals and national heart institute.

Results: Conclusion
Ambulatory blood pressure monitoring was superior to office and home blood pressure measurement in assessing left ventricular mass index in hypertensive Egyptian medicated patients. There was a discordance between ambulatory blood pressure monitoring and home / office-BP measurement in detecting controlled hypertension status of patients.
Evaluation of the GeneXpert MTB/RIF Assay for Rapid Diagnosis of Tuberculosis and Detection of Rifampin Resistance in Tuberculous Patients Admitted to Abbassia Chest Hospital
Authors: Ahmed Mona Mansour , Al Adawy Eman Ramzy Ali , Mohammed Rehab M , Galal Hamed Amal Hamed 
Published: July 2024

Abstract

Background
Tuberculosis is considered one of the major infectious diseases especially in the developing countries and a significant diagnostic and therapeutic challenge worldwide. Gene Xpert MTB/RIF assay is a diagnostic test which depends on a real-time polymerase chain reaction for rapid diagnosis of Mycobacterium Tuberculosis and rifampicin resistance in a single test.

Aim
To evaluate the diagnostic utility of Gene Xpert MTB/RIF assay for rapid diagnosis of pulmonary and extrapulmonary tuberculosis as well as the detection of rifampin resistance in specimens obtained from suspected tuberculous patients in Abbassia Chest Hospital.

Patients and Methods
Pulmonary and extrapulmonary samples from 77 cases with suspected TB were collected. All retrieved samples were examined with: direct smear microscopy for AFB, culture for Mycobacterium tuberculosis (L.J. media) along with Drug susceptibility testing (D.S.T.) for positive cultures. As well as the gene Xpert MTB/RIF assay and their results were compared to those of both culture and D.S.T. (as gold standard reference methods).

Results
Gene Xpert MTB/RIF assay showed the highest sensitivity, negative predictive value (NPV) and diagnostic accuracy in detection of pulmonary TB (96.4, 96.4 and 93.1% respectively), with 90%specificity. Xpert MTB/RIF assay showed the lowest sensitivity in diagnosing TB pleural effusion (66.6%) but with the highest specificity and positive predictive value (PPV) (100% for both). As regards diagnosing TB lymphadenitis, gene Xpert MTB/RIF assay showed 75% sensitivity and the lowest specificity (33.3%). Considering rifampin resistance, gene Xpert MTB/RIF assay showed 100% specificity in detection of RIF- Resistance with variable sensitivity according to the type of TB, being the highest in pulmonary TB (90.9% sensitivity).

Conclusion
Gene Xpert MTB/RIF assay could be used as the first line diagnostic tool for diagnosis of pulmonary TB because of its high diagnostic yield. Yet, it’s not recommended to replace the culture for diagnosing extrapulmonary TB especially in diagnosing tuberculous pleural effusion (pauci-bacillary specimens) which has limited diagnostic utility. Also, the assay showed 100% specificity in diagnosing rifampicin resistance guiding physicians to justifiably starting second line anti-TB treatment.
Immunophenotypic Evaluation of Circulating Monocyte Subsets in Beta Thalassemia Major Patients
Authors: Mahmoud Abdelghaffar Marwa Abdelmoniem , Wahba Mona Ahmed , Pessar Shaimaa Abdelmalik 
Published: July 2024

Abstract

Background
β-thalassemia is a major public health problem in Egypt with particularly high incidence due to strong cultural preference for consanguineous marriages, and the high carrier rate. Iron overload, which is caused by increased gut iron absorption secondary to ineffective erythropoiesis, and regular blood transfusion is linked to accumulation within different organs with subsequent organ dysfunction. Monocytes are important lineages of innate immunity which activate the adaptive immune response and play a pivotal role in the host response to pathogens. Human blood monocyte subsets classification is based on the expression of CD14 and CD16 cell surface receptors.

Aim of the Work
To evaluate the circulating monocyte subsets in β-thalassemia major (β-TM) patients and its potential role in prediction of iron overload and chronic inflammation in β- thalassemia major patients.

Patients and Methods
A Case-Control study conducted on 40 previously diagnosed beta thalassemia major patients attending the outpatient clinic of Ain Shams University Pediatric Hospital, and 20 age and sex matched healthy control subjects. CBC, iron profile, CRP and immunophenotyping for monocyte subsets classification were done.

Results
Non classical monocytes were found statistically significantly higher in thalassemic patients especially in those with serum ferritin level &lt; 1000 ng/ml (P value &lt; 0.01). In addition, classical monocytes were found to be statistically significantly lower among the patients’ group (P value &lt; 0.01). A negative correlation was found between intermediate monocytes and Transferrin saturation percent (TS%) suggesting its protective role in iron overload thalassemia patients. By using ROC curve, non- classical monocytes predicted ferritin &lt; 1000 ng/ml at a cutoff point of 17.8 % and 0.05 x 10∧9/L for relative and absolute counts respectively.

Conclusion
All monocyte subsets proposed to have role in predicting iron overload and chronic inflammation β-TM patients. We recommend further studies on β-TM patients with the engagement of activity assays of monocyte subsets to clarify the co-regulatory role in iron hemostasis and chronic inflammation.
Penile Length and Circumference among Adult Egyptians
Authors: Aldaeji Ahmad Hasan , Sallam Mohamed Abdelnaeem , El-Fattah Afifi Ahmed Abd 
Published: July 2024

Abstract

Background
accurate measurement of penile length is important for both clinical and academic purposes. For this reason, a standard practice for measurement has been defined to maintain consistency. Rather than measuring a flaccid penis, which offers limited clinical significance, stretched penile length (SPL) measurement is considered best practice for adult men as it most closely replicates normal erect penile length.

Aim of the Work
to assess the stretched penile length and penile circumference in a sample of physically normal Egyptian men and to determine the penile anthropometry-somatometric parameters relationship.

Patients and Methods
The current study demonstrated that the mean stretched penile length of this sample of Egyptian men was 13.0 ±1.9 cm and the flaccid penile circumference was 9.3±1.1; which are consistent with the results of previous studies done in Egypt and with studies done within the same geographical region. There were significant positive correlations between penile measures and height, weight, and BMI with no significant correlations between penile measures and age. Our study results revealed as well that there was no significant difference between age grades regarding penis length and penis circumference. The previous correlations agree with most of the studies except for BMI which remains controversial whether it has positive or negative correlation with the penile anthropometry.

Results
revealed that alcohol use and smoking were significant factors that decrease penis length and circumference. This could be attributed to the associated erectile dysfunctions revealed in previous studies to be found in smokers and alcohol drinkers, in addition to the findings that postulate that erectile dysfunction could shorten the penile measurements. Nonetheless, further studies are needed to clarify these associations.

Conclusion
Concern over penile size is not uncommon. The results of this study help to establish a reference range for male genital size among adult Egyptian men, which should be helpful for andrologists in counselling patients. As evident from the current study, the mean stretched penile length of Egyptian men was 13.0 ±1.9 cm and the flaccid penile circumference was 9.3±1.1 with significant positive correlations between penile measures and height, weight, and BMI. Moreover, penile anthropometry was significantly lower in smokers and alcohol users.