bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Efficacy of Ivabradine as a Rate Control for the Heart in Sepsis
Authors: Wahba Sherif Samir , Ramzy Osama , Mohamed Marwa Mamdouh , Borham Ahmed Mohammed Ibrahim 
Published: August 2023

Abstract

Background
Sepsis and septic shock represent a major health problem among the critically ill patients all over the world, with associated substantial morbidity and mortality rates ranging from 18 % to 50 %. The incidence of sepsis has increased steadily over the last three decades, at least in part because of aging western population. Despite our increased understanding, improved support and more powerful antibiotic therapy, sepsis is still reported as the second leading cause of death in non-coronary intensive care units, and the tenth-mostcommon cause of death overall (the first being heart disease). Children under 12 months and elderly have the highest incidence of severe sepsis).

Objective
Evaluation of the role of heart rate control using enteral Ivabradine in the management of patients with sepsis. Assessment of the effect of enteral Ivabradine on outcome of septic patients regarding need for vasopressor therapy, mechanical ventilation, renal replacement therapy, length of ICU stay, in- hospital mortality and 30 days mortality.

Patients and Methods
The study was comparative prospective case / control study conducted on 60 critically ill patients admitted with sepsis and or septic shock to the Critical Care Department at Kobry Elkoba Military complex at 12 month from 8/2019 up to 8/ 2020.

Results
Significant decrease in follow up lactate at end of Ivabradine treatment, compared to control group without Ivabradine treatment (p = 0.025). Significant decrease in follow up of crp level in group A than group B at day 2 and day 4 with (p = 0.013), (p = 0.018) respectively. Significant decrease in heart rate in group A in comparison with group B during first 48 hour with (p = 0.008). Significant difference between group A and group B regarding weaning from mechanical ventilation with (p = 0.001). There was no statistically significant difference found between group A and group B regarding rate of mortality with p-value = 0.606.

Conclusion
Use of enteral Ivabradine can reduce pathologically elevated heart rate in patients with sepsis but didn‘t affect survival, length of ICU stay, between septic patient.
Non-Invasive Positive Pressure Ventilation or Standard Oxygen Therapy as Initial Treatment of Acute Cardiogenic Pulmonary Edema in ICU Patients
Authors: Essam Amr , El Shebeiny Ahmed Ali , Fathy Reham , Elsawy Ahmed Said Mohamed 
Published: August 2023

Abstract

Background
Continuous positive airway pressure ventilation (CPAP) through face mask has been widely used especially in North America, Europe and Australasia to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary edema. Continuous positive airway pressure ventilation (CPAP) is ventilatory support that is given without establishing endotracheal intubation. CPAP avoid complication of endotracheal tube and invasive mechanical ventilation, preserving the patient’s ability to speak, eat, and cough reflex, reduces the need for sedation, potential airway trauma, and the risk of ventilator associated pneumonia.

Objective: Patients and Methods
In our study, 62 patients admitted at critical care unit of the Ain Shams University Hospitals with acute cardiogenic pulmonary edema. Patients divided into two groups. Group I: included 31 patients with acute cardiogenic pulmonary edema receive CPAP with (PS 10 cm h2o, PEEP 5 cm h2o). Group II: included 31 patients with acute cardiogenic pulmonary edema receive Oxygen therapy by face mask. Both groups are compared regarding the following parameter: Pao2, Pco2, respiratory rate and Spo2 on admission, 1-hour and 2-hours, post intervention and after discontinuation of treatment. Both groups were compared regarding the rate of endotracheal intubation, ICU length of stay and hospital mortality.

Results
Our study showed that the respiratory distress was markedly improved in CPAP group compared to oxygen therapy group by face mask as shown in respiratory rate after institution of CPAP (48.31±4.29, 35.84±5.30). In our study, as regarding to ICU length of stay, there was reduction in the intensive care unit length of stay in patient received CPAP compared to length of stay in standard oxygen treatment received group (2.48 ± 0.51 vs. 4.03± 0.65). Our study show that there is reduction in rate of intubation in group I with CPAP compared with group II with oxygen therapy by face mask.

Conclusion
Continuous positive air way pressure CPAP is widely used in North America, Europe and Australasia for patients with severe ACPE. There are clear mechanistic reasons why these interventions work in acute pulmonary edema. In conclusion, patients with acute cardiogenic pulmonary edema, CPAP safely provides earlier improvement of dyspnea, respiratory distress and oxygen saturation, and decrease ICU length of stay, improved endotracheal intubation and survival rate than does oxygen therapy.
Association of Glycosylated Hemoglobin Levels with Insulin Resistance in Adolescent among Medical Students Ain Shams University
Authors: Ghobrial Bassem Boules , ElKabarity Reem Hamdy , Hassan Angie Magdy Mohammed 
Published: August 2023

Abstract

Background
Insulin resistance is a common pathway for the development of glucose metabolism disorders and high blood pressure, all of which are components of the metabolic syndrome. The earlier onset of obesity may cause a longer period of insulin resistance, which may explain the concomitant earlier onset of impaired glucose tolerance in young obese people and adolescents so insulin resistance has been implicated as risk factor for metabolic disorders and it is of real importance to develop simple test that can be used in routine clinical setting for identifying insulin resistant individuals in advance so HOMA-IR(Homeostatic Model Assessment for Insulin Resistance) and HbA1c (glycated haemoglobin) screening to identify young at high risk for insulin resistance and diabetes at an early stage. The study aimed to evaluate the association of HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) and HbA1c levels in overweight and nonoverweight young medical students to assess insulin resistance, a condition that can cause diabetes mellitus and metabolic syndrome in earlier life.

Subject and Methods
The study was systematic random sample was conducted between 40 overweight and 40 non-overweight students (80 in total). All cases were subjected to history taking, clinical examination and laboratory investigations included HOMA-IR and HbA1c.

Results
Regarding HOMA-IR in present study they illustrated statistically significant difference between groups with higher levels in overweighed group than for normal weight group.HOMA-IR ≥2.5 was represent (17.5%)of normal weight group and (45.0%) of overweighed group with statistically significant difference. N statistically significant difference regarding Glucose (mg/dl) level for normal and overweighed group. The relation was statistically significant regarding Insulin (mIU/ml) level as it was higher in overweighed group than normal group. Regarding HbA1c% in present study; there is no statistically significant difference between normal group compared to obese group that range within normal values with higher result in obese group. Our study found statistically significant association between HOMA-IR&lt;2.5 and (glucose and insulin), in both groups and for HbA1c in obese group. Also statistically significant positive correlation between HOMA-IR and HbA1c% in all patients.

Conclusion
Obesity is significantly associated with higher levels of fasting insulin, and HOMA-IR values in adolescents. There is a positive correlation between HbA1c and HOMA-IR
Ultrasound Guided Quadratus Lumborum Block Compared to Caudal Bupivacaine/Neostigmine in Pediatric Lower Abdominal Surgeries: A Randomized Controlled Trial
Authors: Ashoor Tarek M , Eldeen Eman Mohamed Zain , Reyad Mostafa Kamel , Hasseb Ahmad M , Esmat Ibrahim M 
Published: August 2023

Abstract

Background
The postoperative analgesia in pediatric patients undergoing lower abdominal surgeries could be achieved by Quadratus lumborum block (QLB) or Caudal block (CB). The combination of neostigmine and bupivacaine shortens the onset and increases the duration of regional blocks.

Methods
80 pediatric patients undergoing lower abdominal surgeries under general anesthesia were randomized to receive either QLB using bupivacaine or CB using bupivacaine/neostigmine mixture. Time to first needed rescue analgesia was considered as a primary outcome while pain score, blood glucose level, nausea, vomiting, bradycardia, hypotension and urinary pretension were considered as secondary outcomes.

Results
The time to first rescue of analgesia was significantly longer in QLB group (p=˂ 0.001) and rate of rescue analgesia requirements was significantly lower in quadratus lumborum group (p=˂ 0.001), while time to perform the block and block failure were significantly higher in QLB group. Side effects were infrequent and non-significant among groups.

Conclusion
Postoperative analgesia for pediatric patients undergoing lower abdominal surgeries could be safely and effectively achieved by Quadratus lumborum block and caudal bupivacaine/neostigmine mixture block with priority to caudal block.
Comparison between Levosimendan versus Beta Agonists in Preservation of Renal Function in Cardiac Surgery Patients with Low Cardiac Output Syndrome
Authors: Hassab Gamal Saad Abdelhamid , Mustafa Zakaria Abdelaziz , Elkhattab Salwa Omar , Kamal Mohamed Mohamed 
Published: August 2023

Abstract

Background
Acute kidney injury post cardiac surgery in patients who develop low cardiac output syndrome (LCOS) postoperatively is a serious complication. Many studies have been performed to assess the effect of inotropic agents on cardiac function when administered postoperatively, some studies performed to evaluate the nephroprotective effect of conventional inotropic agents as compared to levosimendan.

Objective
To evaluate the possible nephroprotective effect of Levosimendan as compared to betaagonists in cardiac surgery patients with LCOS.

Patients and Methods
It is a randomized prospective comparative study at Ain Shams university hospitals from December 2020 to May 2021. A total of 60 patients who have developed low cardiac output syndrome post cardiac surgery divided into two groups of 30 patients each. Group A received beta-agonists (dobutamine 2 - 20 µ/kg/min or adrenaline 0.01 to 0.5 mcg/kg/minute) and Group B received levosimendan for 24 h at a rate of 0.1 mcg/kg/min to a target dose of 12.5 mg. we assessed the incidence of renal failure in these patients. We assessed the progress of acute kidney injury in patients who developed acute renal impairment at diagnosis of LCOS in both treatment groups. Parameters assessed include hemodynamics and renal function parameters.

Results
The incidence of acute kidney injury at diagnosis of LCOS postoperative was 30% (n = 9) in each group, 44% of them in the control group (n = 4) developed renal failure at discharge from ICU and none of the study group patients developed renal failure at discharge. At time of discharge from ICU the incidence of renal failure in beta – agonist group was 13.3% while the incidence in the levosimendan group was 0%.

Conclusion
Levosimendan has a nephroprotective effect that plays a role in preservation of renal functions and decreasing the incidence of kidney failure in patients with LCOS post cardiac surgery as compared to beta – agonists.
Convalescent Plasma Transfusion for Treatment of Corona Virus Disease 2019 (COVID-19) Infection: A Systematic Review
Authors: Hakim Sameh M , Elhakim Ashraf M H , Amer Akram M , Chikhouni Ghoson M A 
Published: August 2023

Abstract

Background and object
The coronavirus disease 2019 (COVID-19) represents a major global challenge with more than 200 million confirmed cases and over 4.5 million deaths till now. Unfortunately, therapeutic options are still limited and under trial. Convalescent plasma (CP) has emerged as a treatment modality based on previous use in similar viral outbreaks and early clinical trials, but there is still a controversy regarding its efficacy in COVID-19 patients. The aim of this systematic review is to examine evidence on the value of CP as a potential therapy for COVID-19 patients.

Methods
The current review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. A literature search was conducted on multiple databases including Medline/PubMed, Web of Science, Cochrane library, Wiley Online Library, Scopus and Google Scholar. Databases were searched for eligible studies using the following keywords: COVID-19, novel corona virus, SARS-COV-2, convalescent plasma, and convalescent plasma therapy (CPT). Data extraction and risk of bias assessments were performed by independent two reviewers. Clinical studies comparing CP combined with standard treatment for COVID-19 versus standard treatment only were eligible, including RCTs, non-randomized clinical trials (NRCTs) and case series. We only included studies published in English but there was no restriction on the year of publication, country where study was conducted or age or sex of patients. The primary outcome was mortality rate. Secondary outcomes were time to clinical improvement, need for mechanical ventilation, intensive care or hospital length of stay and incidence of transfusion-related adverse outcomes.

Results
Based on the selection criteria, 23 articles were eligible including 8 RCTs and 15 controlled nonrandomized studies of interventions (NRSIs). Nearly all RCTs had low risk of bias. However, the risk of bias was considered to be high in all NRSIs. Our review showed that CP reduced overall mortality significantly in only 3 RCTs and 5 NRSIs and improved clinical outcomes significantly in only one RCT and 6 NRSIs. The time to clinical improvement, ICU stay, and need for mechanical ventilations were significantly better in CP groups in limited numbers of studies. The overall incidence of severe transfusionrelated adverse outcomes was low.

Conclusions
Current evidence regarding the benefit of CP in moderate to severe COVID-19 is nonconclusive. Most evidence is derived from NRSI that suffer from significant risk of bias. Evidence from RCTs carries low risk of methodological bias but clinical benefit of CP is inconsistent across studies. CP seems to be associated with no increased risk of serious transfusion-related adverse outcome. More welldesigned RCTs are still needed to elucidate the actual role of CP in patients with COVID-19.
Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-operative Analgesia Following Knee Arthroscopy
Authors: Hassan Bahaa Eldeen Ewais , Taha Sameh Salem Hefni , El Derh Maha Sadek Hussein , Sayed Hassan Taha Kandil Hassan 
Published: August 2023

Abstract

Background
Arthroscopic knee surgery refers to a large variety of surgical interventions in the knee, and numerous analgesic regimens have been investigated in order to find the best combination of analgesics for these procedures. The post-operative pain response depends on the type and duration of surgical intervention, and it can be challenging to predict which analgesic regimen will be the most appropriate for each patient until after surgery.

Aim of the Work
Assessing the effect of adding dexamethasone perineurally to bupivacaine in adductor canal block for post operative analgesia following knee arthroscopy under spinal anaesthesia regarding; duration of postoperative analgesia as a primary objective and one-day postoperative analgesic and opioid consumption as a secondary objective.

Patients and Methods
The type of study was a randomized prospective double blinded controlled clinical trial at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months, Adult patients undergoing Knee Arthroscopy under Spinal Anaesthesia will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group A (study group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 8 mg dexamethasone (2 ml), Group B (control group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 2 ml of Normal saline.

Results
There was a highly statistically significant difference between groups according to analgesic duration (time of first call for analgesics) (min) with p-value (p &lt; 0.001). The highest value was found in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier compared to group A. There was a highly statistically significant difference between groups according to cumulative morphine consumption “mg” with p-value (p &lt; 0.001). The highest value was found in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A.

Conclusion
We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg)dexamethasone to(0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.
The Effect of Volume Preload versus Ephedrine Infusion for Prevention of Hypotension due to Spinal Anesthesia for Cesarean Section
Authors: El-Shaer Ahmed Nagah , El-Hamid Hadil Magdy Abd , Saleh Mohamed Abd El-Mawla , Mahmoud Ismail Farid Ibrahim 
Published: August 2023

Abstract

Background
Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. We hypothesized that using ephedrine to maintain maternal blood pressure during spinal anesthesia for cesarean delivery provides better hemodynamic stability with subsequent better maternal and neonatal outcomes compared to volume preload.

Aim of the Work
We compared volume preload and ephedrine infusion to guard against the hypotensive effect of spinal anesthesia during cesarean delivery.

Patients and Methods
After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain Shams University, and written informed consent this study was conducted in the operating theaters of Ain Shams University Hospitals. This study was a randomized Controlled Clinical Trial. Adult parturients undergoing cesarean section under spinal anesthesia randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group (A) received Volume Preload, group (B) received Ephedrine Infusion.

Results
The results of the study showed that compared with volume preload, ephedrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery.

Conclusion
Furthermore, the numbers of boluses of vasopressors used during spinal anesthesia were lower in ephedrine compared with volume preload.
Value of C-reactive Protein Level to Distinguish between Ischemic and Hemorrhagic Stroke
Authors: El-shaer Ahmed Nagah , Ibrahim Dalia Ahmed , Fouly Mohamed Abdelmoneim , Muhammed Mahmoud Abdel-Hamid 
Published: August 2023

Abstract

Background
Stroke is considered as a life threatening case in neurological patients. It is one of the leading causes of morbidity and mortality worldwide, as cerebrovascular accidents rank first in the frequency and importance among all neurological disease. Spontaneous ICH accounts for approximately 20% of all strokes, and it is characterized by high rates of mortality and residual disability among survivors.

Aim of the Work
To detect the value of serum CRP level in differentiation between ischemic and hemorrhagic stroke.

Patients and Methods
We conducted a prospective cross section study which included patients who were diagnosed with acute stroke through the period Jan 2021 and July 2021, we recruited 72 patients who were admitted to stroke unit of Ain shams university, they were subsequently divided based on etiology of the stroke into 2 groups: Ischemic stroke group: 36 patients and hemorrhagic stroke group: 36 patients.

Results
We conducted a cross section analytical study to compare the CRP level among egyptian cohort of patients (n = 72) who were diagnosed with acute ischemic (n = 36) versus hemorrhagic strokes (n = 36) who were admitted to emergency of Ain shams university, aiming to detect the value of serum CRP level in differentiation between ischemic and hemorrhagic stroke. In the present study we found that there was a statistically significant difference between the studied groups and CRP on day 0, mean CRP during Hospital Stay and CRP at discharge.

Conclusion
Elevated CRP levels are associated with excessive risk of ischemic stroke but not hemorrhagic stroke. The serum CRP level can be used as a predictor for ischemic stroke in the general population.
Comparative Study between Erector Spinae Plane Block and Transversus Abdominis Plane Block for Postoperative Pain Management of Patients Undergoing Laparoscopic Cholecystectomy
Authors: Mahrous Mina Adel Shoukri , Kamal Manal Mohamed , Elhennawy Ahmed Mouhamed , Youssef Ahmed Mounir Ahmed 
Published: August 2023

Abstract

Study Objective
Laparoscopic cholecystectomy (LC) is a frequently applied minimally invasive surgery. Intraoperative access is provided with small keyhole entries on the abdominal wall. However, LC causes moderate to severe postoperative pain. Since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post-operative analgesia. The proper management of post-operative pain ensures early ambulation of patients and obviates many post-operative complications. The subcostal approach of TAP block was described by Hebbard et al. for postoperative analgesia especially for upper abdominal surgeries. Ultrasound-guided erector spinae plane (US-ESP) block is a novel technique targeting ventral rami, dorsal rami of the spinal nerves.

Design
Prospective randomized, double blinded study.

Setting
After obtaining approval from the Research Medical Ethical Committee of Faculty of Medicine Ain shams University and obtaining an informed written consent from patients, this study will be conducted in the operating theatres of Ain shams University Hospitals.

Patients
Patients ASA 1 or 2 undergoing laparoscopic cholecystectomy. The patients will be randomly divided into two equal groups, They will be enrolled in group (1) for erector spinae plane block and group (2) for oblique subcostal transversus abdominis plane block. Each group contain 30 patients, 60 patients were included in final analysis

Interventions
Erector spinae plane block was performed in the ESP group and oblique subcostal transversus abdominis block was performed in the OSTAP group.

Measurements
Postoperative nalbuphine consumption and pain scores between groups were compared.

Main Results
Postoperative nalbuphine consumption was 18.31±5.11 mg in the ESP group and 30.51±9.19 mg in the OSTAP group ( p &lt; 0.001). VAS scores at almost all time-points were lower in the ESP group according to the repeated measures analysis.

Conclusion
Ultrasound-guided ESP block reduced postoperative nalbuphine consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery. This technique can be a promising mode of postoperative analgesia