bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Harlequin Syndrome Under ECPELLA Support
Authors: Giunta Matteo , Recchia Elisa G. , Capuano Paolo , Toscano Antonio , Attisani Matteo , Rinaldi Mauro , Brazzi Luca 
Published: May 2024

ABSTRACT
The use of ECPELLA in patients with severe lung disease may result in an unfavorable phenomenon of differential hypoxia. The simultaneous evaluation of three arterial blood samples from different arterial line (right radial artery, left radial artery, ECMO arterial line) in patients at risk of Harlequin syndrome (also called differential hypoxemia (DH)) can localize the “mixing cloud” along the aorta. Focusing the attention on the “mixing cloud” position instead of on isolated flows of Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) and Impella CP makes the decision making easier about how to modify MCSs flows according to the clinical context. Herein, we present two cases in which ECPELLA configuration was used to treat a cardiogenic shock condition and how the ECPELLA-induced hypoxia was managed.
The effect of levosimendan on the right ventricular function in patients with right ventricular dysfunction undergoing mitral valve surgery
Authors: Bharathi K.S , Pruthi Gegal , Dhananjaya Manasa , Simha Parimala Prasanna 
Published: May 2024

ABSTRACT

Background:
Right ventricular (RV) dysfunction is an important predictor of both immediate and long-term outcomes in valve surgeries. Levosimendan has proven beneficial in improving RV function.

Aims:
The objective was to study the effect of the addition of levosimendan to the conventional treatment on RV function in patients with RV dysfunction undergoing mitral valve (MV) surgeries.

Setting and Design:
Prospective randomized double-blinded controlled study at a tertiary care institution.

Materials and Methods:
Sixty adult patients aged 15–65 years, with preoperative transthoracic echocardiography (TTE) findings of RV dysfunction posted for elective MV surgery, were randomized into levosimendan (L) group and placebo (P) group. Patients in the L group were administered levosimendan at a rate of 0.1 mcg/kg/min after induction for 24 hrs, whereas patients in the P group were given multivitamin infusion at the same rate. Both the groups received standard inotropic therapy. The hemodynamic and echocardiographic parameters of RV function (RV size, Inferior vena cava (IVC) diameter, RV fractional area change (RVFAC) Tricuspid annular plane systolic excursion (TAPSE), and Systolic Pulmonary Artery Pressure (SPAP) were compared between the groups at 6 hrs, 24 hrs, and 7th day postoperatively.

Results:
All hemodynamic and echocardiographic parameters of RV function like RV size, IVC diameter, RVFAC, TAPSE, and SPAP improved from baseline to 24 hrs in both groups. Levosimendan caused a significant improvement in RV function compared to the P group at 24 hrs and 7th day postoperatively.

Conclusions:
The present study concludes that levosimendan is a promising option in patients with RV dysfunction undergoing MV surgeries.
Use of Methylene Blue to Treat Vasoplegia Syndrome in Cystic Fibrosis Patients Undergoing Lung Transplantation
Authors: Washington Gabriel C. , O’Donnell Christian T. , Madhok Jai , Williams Kiah M. , Hill Charles C. 
Published: May 2024

ABSTRACT

Background:
Several studies have demonstrated the utility of methylene blue (MB) to treat vasoplegic syndrome (VS), but some have cautioned against its routine use in lung transplantation with only two cases described in prominent literature. Cystic fibrosis patients commonly have chronic infections which predispose them to a systemic inflammatory syndrome-like vasoplegic response during lung transplantation. We present 13 cystic fibrosis patients who underwent lung transplantation and received MB for vasoplegic syndrome while on cardiopulmonary bypass, with or without inhaled pulmonary vasodilator therapy.

Methods:
Single-center, retrospective, case series analysis of cystic fibrosis patients who underwent lung transplant and received MB for vasoplegia. We defined the primary outcome as 30-day mortality, and secondary outcomes as primary graft failure, 1-year mortality, postoperative complications, and hemodynamic response to MB.

Results:
MB was associated with a significant increase in mean arterial pressure (MAP) (P < 0.001) in all patients, and 84.6% (11/13) of the patients had either a decrease or no change in vasopressor requirement. No patients developed acute primary graft dysfunction and there was 100% 30-day and 1-year survival. One patient required Extracorporeal membrane oxygenation (ECMO) for hypoxemia and 69% (9/13) of the patients had evidence of postoperative right ventricular dysfunction, but no patients required a right ventricular assist device.

Conclusion:
This case series demonstrates the effectiveness of MB in treating vasoplegia in cystic fibrosis patients during lung transplantation, without evidence of primary graft dysfunction, 30-day or 1-year mortality. The safety of MB regarding hypoxemia and increased pulmonary vascular resistance requires further investigation.
Resisting Arrest
Authors: Klompas Allan M. , Kawajiri Hidetake , Sinak Lawrence J. , Pochettino Alberto 
Published: May 2024

ABSTRACT
Although rare, iatrogenic aortocoronary arteriovenous fistulae (ACAVF) occur when a coronary graft is mistakenly anastomosed to an epicardial vein rather than its intended arterial target. Patients may be asymptomatic, demonstrate angina, dyspnea, arrhythmias, syncope, or diminished exercise capacity, and may have wide pulse pressures with evidence of coronary steal. A thorough insight into the disordered anatomy is critical to safely manage a patient for redo cardiac surgery, especially when attempting to arrest the heart. We present a case for redo cardiac surgery of an iatrogenic ACAVF confirmed perioperatively with multiple modalities and its intraoperative management.
Anesthetic Management for Transcatheter Aortic Valve Replacement
Authors: Hayanga Heather K. , Woods Kaitlin E. , Thibault Dylan P. , Ellison Matthew B. , Boh Roosevelt N. , Raybuck Bryan D. , Sengupta Partho P. , Badhwar Vinay , Hayanga J. W. Awori 
Published: May 2024

ABSTRACT

Background:
General anesthesia has traditionally been used in transcatheter aortic valve replacement; however, there has been increasing interest and momentum in alternative anesthetic techniques.

Aims:
To perform a descriptive study of anesthetic management options in transcatheter aortic valve replacements in the United States, comparing trends in use of monitored anesthesia care versus general anesthesia.

Settings and Design:
Data evaluated from the American Society of Anesthesiologists’ (ASA) Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry.

Materials and Methods:
Multivariable logistic regression was used to identify predictors associated with use of monitored anesthesia care compared to general anesthesia.

Results:
The use of monitored anesthesia care has increased from 1.8% of cases in 2013 to 25.2% in 2017 (p = 0.0001). Patients were more likely ages 80+ (66% vs. 61%; p = 0.0001), male (54% vs. 52%; p = 0.0001), ASA physical status > III (86% vs. 80%; p = 0.0001), cared for in the Northeast (38% vs. 22%; p = 0.0001), and residents in zip codes with higher median income ($63,382 vs. $55,311; p = 0.0001). Multivariable analysis revealed each one-year increase in age, every 50 procedures performed annually at a practice, and being male were associated with 3% (p = 0.0001), 33% (p = 0.012), and 16% (p = 0.026) increased odds of monitored anesthesia care, respectively. Centers in the Northeast were more likely to use monitored anesthesia care (all p < 0.005). Patients who underwent approaches other than percutaneous femoral arterial were less likely to receive monitored anesthesia care (adjusted odds ratios all < 0.51; all p = 0.0001).

Conclusion:
Anesthetic type for transcatheter aortic valve replacements in the United States varies with age, sex, geography, volume of cases performed at a center, and procedural approach.
Acute Acquired Immune Thrombocytopenia After Cardiac Surgery
Authors: Auci Elisabetta , Vetrugno Luigi , Riccardi Ilaria , Vendramin Igor , Livi Ugolino , Bassi Flavio , Bove Tiziana 
Published: May 2024

ABSTRACT
Thrombocytopenia is a common condition that recognizes an infinite number of possible causes, especially in specific settings like the one covered in this case report: the postoperative period of cardiac surgery. We report a case of an old male with multiple comorbidities who underwent a coronary angioplasty procedure and aortic valve replacement. He showed severe thrombocytopenia in the postoperative days. Differential diagnosis required a big effort, also for the experts in the field. Our goal was to aggressively treat the patient with prednisolone, platelets, and intravenous immunoglobulins to maximize the prognosis. Our patient developed no complications and was discharged successfully.
Single Value of NephroCheck™ Performed at 4 Hours After Surgery Does Not Predict Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery
Authors: Kanchi Muralidhar , Sudheshna Karanam D , Damodaran Srinath , Gunaseelan Vikneswaran , Varghese Anup D , Belani Kumar 
Published: May 2024

ABSTRACT

Background:
Quantification of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IFGBP-7), which is commercially known as NephroCheck™(NC) test have been suggested as promising tools for the early detection of acute kidney injury (AKI) after cardiac surgery involving cardio-pulmonary bypass (CPB).

Objectives:
The aim of the present study was to test the hypothesis that single value of postoperative NC test performed at 4 hours after surgery can predict AKI in off-pump coronary artery bypass grafting (OPCABG) surgery.

Setting and Design:
This prospective single-center study was conducted at the tertiary cardiac center in India from December 2017 to November 2018.

Methods:
Ninety adult patients of both sex undergoing elective OPCABG were included. Anesthesia was standardized to all patients. Urine samples were collected preoperatively and at 4 hours after surgery for NC test. Urine output, serum creatinine, estimated glomerular filtration rate (eGFR) were also measured. AKI staging was based on kidney disease improving global outcomes (KDIGO) guidelines.

Statistical Analysis:
To assess the predictability of NC test for the primary endpoint, area under the receiver operating characteristic curve (ROC), was calculated.

Results:
Thirteen patients developed AKI in the study cohort (14.4%) out of which 7 patients (7.8%) developed stage 2/3 AKI and the remaining stage 1 AKI. Baseline renal parameters were similar between AKI and non-AKI group. The area under curve (AUC) of NC test at 4 hours after surgery was 0.60 [95% confidence interval (CI): 0.42-0.77]. Postoperative NC test performed at 4 hours after surgery did not predict AKI in this study population (P = 0.24). There were no significant differences in duration of mechanical ventilation, length of intensive care stay and hospital stay between the two groups (P > 0.05).

Conclusion:
NephroCheck™ test performed at 4 hours after surgery did not identify patients at risk for developing AKI following OPCABG surgery.
Multiparameters Associated to Successful Weaning from VA ECMO in Adult Patients with Cardiogenic Shock or Cardiac Arrest
Authors: Burgos Lucrecia María , Seoane Leonardo , Diez Mirta , Baro Vila Rocío Consuelo , Furmento Juan Francisco , Vrancic Mariano , Aissaoui Nadia 
Published: May 2024

ABSTRACT
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39–50%, I2 7%) and in-hospital mortality rate was 46.6% (95%CI: 33–60%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3–18) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8–26.4 I2 = 0) were higher. They also had lower values of creatinine [MD –0.59 (95%CI: –0.9 to –0.2) I2 = 7%], lactate [MD –3.1 (95%CI: –5.4 to –0.7) I2 = 89%], and creatine kinase [–2779.5 (95%CI: –5387 to –171) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: –0.2–36.2) I2 = 91%, and MD 15.9% (95%CI 11.9–20) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW.
Prevalence of obesity and physical inactivity in Assam, India: Findings from cancer risk factor monitoring survey
Authors: Nath Anita , Barman Debanjana , Sharma Arpita , Lahon Ranjan , Misra Chinmoy 
Published: May 2024

Physical inactivity and obesity have been causing a serious health risk mostly in developed countries, but the threat has also been in the low- and middle-income countries. According to the World Health Organization, excessive fat deposition in the body results in overweight and obesity. Many chronic illness such as type 2 diabetes, cardiovascular disease, and cancer as well are attributed due to obesity. Physical activity has tremendous health benefits in preventing noncommunicable diseases such as cardiovascular diseases, cancer, and diabetes and is a means of primary prevention. The aim of the survey was to generate the prevalence of insufficient physical activity, overweight, and obesity as cancer risk factors and estimate health system response in Assam, Northeastern Region of India.

MATERIALS AND METHODS:
This survey was undertaken as a part of Cancer Research in the North East Region, a multidisciplinary program run by the ICMR-NCDIR, Bengaluru, to prevent and control cancer in the northeastern states. The survey adapted the multistage cluster random sampling method for the cancer profile in the PBCR covering areas in Assam. Study Population – The target population for the survey was defined as all residents aged 18 years or above.

RESULTS:
The percentage of prevalence of overweight (body mass index [BMI] ≥25.0) by place of residence shows that 21.8% were urban and 11.5% were rural. Gender wise, 10.9% were male and 17.4 were female, of the total 14.1%. Prevalence of obesity (BMI ≥30.0) by place of residence shows 4.3% urban 1.3% rural, while in terms of gender, 1.5% of males and 2.8% of females. The total percent is 2.1%. 95.0% have sufficient physical activity and 5.0% have insufficient physical activity.

CONCLUSION:
The high prevalence of good physical activity, low prevalence of obesity and overweight and higher prevalence of tobacco consumption in these areas reflect the leading sites of cancers in the registries in Assam. Lifestyle modification and behavioral changes can significantly reduce the burden of cancer and improve health benefits.
Association between QTc-interval prolongation and increased risk of cardiac arrhythmia in critically ill patients
Authors: Othman Youssef A. , Khalil Nahla S. , El-Sharkawy Fatma M. , Sayed Mohammed S. 
Published: May 2024

Background
Prolongation of the QT interval is associated with lethal arrhythmias. Early identification of QT/QTc prolongation followed by appropriate clinical interventions can avert this potentially lethal arrhythmia.

Aim of the study
To assess the association between QTc-interval prolongation and increased risk of cardiac arrhythmia in critically ill patients.

Research design
A descriptive correlational research design was utilized.

Setting
The study was conducted in the Critical Care Department, Al-Manial University Hospital, Cairo University.

Patients and methods
A purposive sample consisted of 270 adult patients.

Tools of data collection
An assessment sheet consists of two parts: part I: patients’ demographic and medical data, and part II: QT-interval monitoring sheet.

Results
The mean age of the study sample was 60.16±16.05, and 53.3% were males. Also, there was a statistically significant difference in patients’ QTc mean through five observations (f=19.086; P≤0.001). Moreover, there was no significant statistical difference in patients’ QT average means through five observations by their laboratory investigations and their diagnosis (P>0.05, P=0.133), respectively.

Conclusion
The highest prolongation of QTc was in torsade de pointes, and the lowest QTc prolongation was in atrial fibrillation.

Recommendation
Nursing assessment of critically ill patients in association with QTc calculation for early detection of lethal cardiac arrhythmia.
The effect of digital citizenship and cyberloafing on under graduate nursing students academic performance
Authors: Mohamed Sara A.A. , Al- Fattah Magda A. A.-H. A. , Ragab Om Hashem G. 
Published: May 2024

Background
Nursing students must be adequately aware by digital citizenship to avoid cyberloafing that directly influence on their academic performance.

Aim of the study
This study aimed to assess the effect of digital citizenship and cyber loafing on under graduate nursing student’s academic performance.

Design
A descriptive, cross-sectional correlational research design was used.

Setting
The study was conducted at Faculty of Nursing Sohag University.

Subjects
870 nursing students were selected randomly by using stratified random sample technique.

Tools
Four tools were used: Personal characteristics and academic data form, digital citizenship questionnaire, cyber Loafing questionnaire and under graduate nursing students’ academic performance audit form.

Results
The current study revealed that nearly two thirds (66.2%) of the studied students had average level of digital citizenship, less than three fifths (58.9%) of the studied students had high level of cyber Loafing and more than two fifths (42.1%) of the studied students have high level of academic performance.

Conclusion
There was a highly statistically significant negative correlation between the students’ academic performance and cyber loafing, also there is statistically significant positive correlation between the total studied students’ academic performance and digital citizenship.

Recommendations
Provide educational program for students about negative effect of cyber loafing and Provide special course about digital citizenship for faculty student.
Analysis of cardiopulmonary resuscitation outcomes among critically ill patients at a university hospital, Kafr-El-Sheikh Governorate
Authors: Khedr Hamada A.E.M. , Morsy Warda Y.M. , Elreheim Fatma S.A.A. , Zahra Ahmed M. 
Published: May 2024

Background
Cardiopulmonary resuscitation (CPR) is a vital intervention in managing critically ill patients experiencing cardiac arrest (CA). Understanding the factors influencing CPR outcomes is crucial for optimizing resuscitation strategies and improving patients’ survival rates.

Aim
To analyze the outcome of CPR among critically ill patients.

Research questions
To fulfill the aim of this study, four research questions were formulated.

Design
A descriptive exploratory research design was used.

Setting
Three ICUs affiliated to a university hospital in Kafr-El-Sheikh, Egypt.

Sample
A purposive sample that included 69 CA patients for 7 months, and a convenience sample of 97 members of the emergency response team working at the above-mentioned setting.

Tools
Three tools were formulated.

Results
The highest age category (31.9%) of CA patients was of 61–70 years. Over 7 months, the frequency of CA among critically ill patients was 7.61%. Regarding ICUs’ preparedness, institutional factors affecting emergency readiness had an unsatisfactory practice level (mean±SD=17.04±2.10), and crash cart preparedness was at mean±SD=30.42±4.32. The study showed unsatisfactory practice levels related to International Liaison Committee on Resuscitation 2020 guidelines for total advanced cardiac life support (ACLS) performance with a mean score and SD of 87.81±18.19. Patient outcomes showed a 10.1% overall survival rate at ICU discharge, 82.6% experiencing return of spontaneous circulation, and 89.9% experiencing brain death. Clinical high-risk scores against National Early Warning Score 2 were 98.2 and 88.2% on the first and last days, respectively. Poor cerebral performance category outcome scores were found at 96.5 and 88% on the first and last days, respectively. However, there were insignificant statistical correlations (P>0.05) between different patients’ outcomes and total adult ACLS role during CA based on International Liaison Committee on Resuscitation guidelines 2020.

Conclusion
CA among critically ill patients creates a significant burden for healthcare facilities and continues to be associated with a high mortality rate. The institutional factors affecting CPR outcomes among CA patients concerning preparedness level have a significant influence on survival. Conversely, the majority of resuscitated patients experienced return of spontaneous circulation, indicating successful initial efforts with severe neurological disability.

Recommendations
Hospital preparedness for CA situations has to be severely considered through implementing and regularly reviewing institutional policies and ensuring the availability and functionality of necessary resources. Update regular continuous educational programs toward enhancing the performance of emergency response team focusing on ACLS guidelines. Replication of this study on a larger probability sample from different geographical locations in Egypt is recommended.
Relationship between authentic leadership style and staff nurse’s loyalty
Authors: Ali Azza M. , El-Molla Magda , Gaber Shreen 
Published: May 2024

Background
Nowadays, achievement of staff nurse’s loyalty is a critical problem that worries health organization and head nurses. Several ways are proposed to solve this problem, through improving leadership styles, especially authentic style.

Aim
To assess the relationship between authentic leadership style and staff nurse’s loyalty.

Design
A descriptive correlational design was used.

Setting
The study was conducted at New Kasr El-Aini University Hospital, Cairo University, Egypt.

Patients
A convenient sample of 200 staff nurses was selected to participate in the study.
Tools Two tools were used: (a) staff nurses’ loyalty questionnaire and (b) authentic leadership style questionnaire.

Results
The current study revealed that staff nurses’ perception of the authentic leadership style levels showed low level (48%) among their leaders, and nearly half (49.05%) of staff nurses had low loyalty level. In addition, the current study revealed that there was a statistically significance correlation between authentic leadership styles and loyalty (P<0.05).

Conclusion
The study concluded that there was a statistically significant correlation between head nurses’ authentic leadership styles and staff nurse’s loyalty.

Recommendations
A strategic plan should be created by hospital management to increase nurses’ loyalty. Hospital administrators should select head nurses based on pre-requisite criteria not only based on their years of experience, on their capabilities as a leaders to lead others in their job, and on their level of goal achievement as a leader.