Ain Shams University Hospitals Research Articles

Comparison of Ultrasound Guided Quadratus Lamborum Plane Block versus Intraperitoneal and Port Sites Bupivacaine Infiltration in Post Operative Analgesia after Laparoscopic Cholecystectomy

Abstract Background Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain. Aim of the Work The aim of this study is to assess the postoperative analgesic efficacy of quadratus lamborum plain block compared to intraperitoneal and periportal infiltration with bupivacaine after laparoscopic cholecystectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods The study was conducted on 70 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective laparoscopic cholecystectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 35 patients each: QL block Group, intraperitoneal and periportal infiltration Group: Results Patients receiving QL block had significantly lower pain scores at rest for 6 hrs and decrease total need of analgesic in first 24 h post operative compared with patients who received Intraperitoneal and port sites infiltration. Conclusion Quadratus Lumborum block was effective in reducing postoperative pain scores for 6 hours and lower total 24 hrs postoperative opioid and analgesic consumption after laparoscopic cholecystectomy under general anesthesia, compared to intraperitoneal and port sites infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Comparative Study between Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Epidural as Postoperative Pain Management in Modified Radical Mastectomy

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.

Association between Sick Euthyroid Syndrome and Poor Prognosis in Severe Burn Patient

Abstract Background Euthyroid sick syndrome (also known as non-thyroidal illness syndrome) can be described as abnormal findings on thyroid function tests that occur in the setting of a non-thyroidal illness (NTI), without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible, study of euthyroid sick syndrome in burn patients. Aim of the Work The aim of study is to examine the ability of Euthyroid sick syndrome in predicting prognosis in severe burn patients. Patients and Methods A case control study was conducted in burn ICU in Ain Shams University Hospitals from march 2022 to September 2022,88 patients were admitted to study with 44 burn case with ESS and 44 burn case without ESS according to inclusion and exclusion criteria. Results The results showed that the group with ESS are more associated with higher rate of morality, hospital stay and more poor prognosis with worse APACHE score levels compared to the burn group with ESS. The study showed that using APACHE score with T3 levels measurements are more accurate in detecting morality in burn ICU patient. Conclusion The study demonstrated that ESS are more associated with higher rate of morality, hospital stay and more poor prognosis with worse APACHE score levels.

Assessment of Serum Autophagy Related Protein Beclin1 in Egyptian Adult Beta Thalathemic Patients

Abstract Background Beta-thalassemia is a chronic hemolytic anemia that is inherited in an autosomal recessive manner. It is characterized by reduced hemoglobin levels and red blood cell production. Aim of the Work Assessment of serum autophagy related protein beclin1 in Egyptian adult beta thalathemic patients and Its relation to ineffective erythropoiesis, transfusion requirements, iron overload. Subjects and Methods This is a case control study which was carried out at Ain Shams university hospitals. Internal medicine department, Clinical hematology and stem cell transplantation unit, outpatient clinic and inpatient department, during the period between January 2022 and August 2022. Results Our study revealed significant decreased fertility between patients group and control group (P = 0.011). Transfusion-dependent beta-thalassemia males have a high proportion of fertility impairment and iron overload might contribute to disturbed sperm quality and testicular tissue injury. Such findings might explain the high prevalence of impaired fertility in transfusion-dependent beta- thalassemia patients which agrees with our results. Also our study revealed significant differences between non-transfusion dependent group and transfusion-dependent group regarding spleen size (cm) below costal margin which was increased in (TD group), transfusion per year (ml/yr)(which was increased in (TD group), virology (HIV, HCV,HBV) revealed that percentage of HCV+ve higher in (TD group) with (P < 0.001): Our study revealed significant difference between non-transfusion- dependent group and Transfusion-dependent group regarding percentage of patients of with positive HCV which was increased in Transfusion-dependent group (P = 0.021): In our study Iron chelation therapy was found to be given in a higher percentage of TD patients compared to non TD patients (P < 0.001). Also our study revealed significant difference regarding cardic function(EF%) between patients group and control group (EF found to be lower in patients group than controls) (P < 0.001): Also our study showed that Beclin-1 level is significantly higher in patients group compared to control group (P < 0.001). We couldn’t find previous studies of Beclin-1 level in thalassemia patients. We postulate that Beclin 1 could be used as a marker of worsening cardiac functions in thalassemia patients, but further studies should measure serial levels of Beclin 1 and correlate it with cardiac parameters over longer periods of follow up. Conclusion Beclin 1 level increased in Adult Beta Thalasemia patients and it can be used as a prognostic marker for Adult Beta Thalasemia patients.

Assessment of Use of Subcutaneous Mastectomy with Silicon Prostheses as Treatment of Early Breast Cancer

Abstract Background Breast cancer is the most common cancer among women and the second most common cause of cancer death in the United States. Approximately 268,600 new breast cancer diagnoses and 41,760 cancer- related deaths in the U.S. were estimated for 2019. SSM (skin sparing mastectomy) is defined as a simple or radical surgery with modified minimal incisions that retain the widest possible coverage and sub-cutaneous breast groove but dry the NAC, flaws of previous biopsies and/or scarring caused by diagnostic percutaneous biopsies. Access to the armpit for a possible sentinel-node biopsy or axillary dissection is obtained through the same incision. An additional incision may be necessary to perform the reconstructive procedure (e.g., microsurgical axillary anastomosis). Objective To study the risks and benefits of use subcutaneous mastectomy with silicon prosthesis as treatment of early breast cancer: as regards the impact of radiotherapy administration on implant, psychological impact, operative time and post-operative complications including complication of silicon, effect on wound healing. Patients and Methods This prospective interventional study was conducted at tertiary care hospital at the general surgery department in Ain Shams University hospitals and Misr University for Science and Technology (MUST) hospital and from November 2021, till July 2022 and performed on total 15 females suffering from stage I-II infiltrating breast carcinomas. Results The current study revealed that mean ±SD of age of the studied cases was 46.3±7.4. Regarding tumor site, LOQ was the most frequent (40.0%), followed by UIQ (33.3%), then UOQ (20.0%) and lastly LIQ (6.7%). Concerning T grades, T1 was in (46.7%), while the remaining (53.3%) were T2. Concerning N grades, N0 was in (73.3%), while the remaining (26.7%) were N1. Sentinel lymph nodes done in 73.3% of cases. As regards operative characteristics, Axillary clearance done in less than half of cases (46.7%), while nipple sparing achieved in less than quarter of cases (20.0%). As regards post-mastectomy treatment, majority of cases (86.7%) received hormonal therapy, adjuvant radiotherapy to axilla was (46.7%), chemotherapy (33.3%), while immunotherapy was (6.7%). As regards postoperative side effects, Pain was the most frequent postoperative side effect; detected in (33.3%) of cases, followed by seroma (20.0%), then flap necrosis (13.3%), and the least frequent was hematoma (6.7%). As regards postoperative patients’ satisfaction, mean ±SD of Postoperative patients’ satisfaction was 7.3±1.5 with range 5.0 − 10.0. Near half of the studied cases (46.7%) had 7.0 − 8.0 satisfaction grade. Conclusion Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate subcutaneous silicon implantation are an acceptable and safe method for breast reconstruction. It offers a number of advantages including ease of dissection for surgeons, improved symmetry, and low complication rates. With improvements in surgical techniques in preserving mastectomy skin flap viability, the traditionally higher rates of complications in subcutaneous implants may be outdated. The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes to evaluate a cost benefit analysis and patient and surgeon assessment of outcomes to directly compare with traditional submuscular single- or 2- stage implant-based reconstruction.

Positive Predictive Value of Thyroid Imaging, Reporting and Data System (TI-RADS) (3-5) When Compared to Fine Needle Aspiration Cytology Results

Abstract Background Thyroid nodules are a very common finding in the population. Evaluation of a patient with a thyroid nodule for possibility of malignancy could be challenging. Ultrasound is one tool that could be of help, several scoring systems are utilized to help differentiate benign from malignant nodules. One of the most used is TIRADS as proposed by ACR. Another invasive tool that could help is fine needle aspiration cytology. Objective Evaluating and comparing the accuracy of TI-RADS in the assessment of suspicious thyroid nodules by matching their results with the results of FNAC. Patients and Methods Our study was conducted on 72 adult patients with thyroid nodules and were referred to undergo FNA procedures in ‘Interventional radiology unit’ at the Radiology Department “Ain Shams University hospitals”, Cairo, Egypt. Results The present study concludes that TIRADS classification as proposed by ACR showed less statistical significance in predicting malignancy when compared to results of fine needle aspiration cytology. However, several components of the TIRADS scoring system were better predictors of malignancy than other components, namely the irregular margin, the taller than wider shape and the presence of calcifications within the nodule. Conclusion Our study concludes that better applying and implementing the TIRADS scoring system by the sonographer or using other scoring system available in evaluating thyroid nodules like ATA scoring system might result in more reliable ultrasound results decreasing the need to do fine needle aspiration.

Linear Measurement of Females' Vocal Fold Across Different Ages

Abstract Background One of the most complex oragns of the human body is the larynx so Understanding its morphology is an important step toward understanding the detailed laryngeal anatomy, and physiology. Different studies have described the linear measurements of the larynx in different measuring methods. but no studies have been structured to describe vocal fold length in vivo in females at different stages of their lives.The vocal instrument is comprised of the vibratory body, the respiratory power source and the oropharyngeal resonating chambers. Voice is characterized by its intensity, frequency, and harmonics. The harmonics are hormonally dependent. Aim of the Work The aim of this study is to screen the membranous vocal fold length in different ages throughout females’ life and if it is affected by hormonal changes in their lives or not. Study Design a comparative cross-sectional study. Patients and Methods This comparative cross-sectional study was carried out on 120 Egyptian Arabic speaking apparently healthy females at the outpatient clinic of the Units of Phoniatrics, ENT Department of both Ain Shams University Hospitals and Zagazig University Hospitals. Results It was obvious that female’s larynx is affected by age and sex hormones that is reflected on the laryngeal structure and function. Although the results showed non significant relation between the length of the membranous part to aging this may be due to small sample size that could not reflect that difference. Conclusion The vocal imprint is characteristic to each individual. It reveals personality and translates emotions. The voice evolves with age. It bears both the scars of life, as well as its joys and pleasures. Nevertheless, the human voice remains intangible and a fertile field for future research in the cycle of life.

Neuromuscular Phrenic Nerve Ultrasound versus Nerve Conduction Study of Phrenic Nerve in Amyotrophic Lateral Sclerosis

Abstract Background Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disorder that is, characterized by progressive loss of the upper (UMNs) and lower motor neurons (LMNs) at the spinal or bulbar level. In the most advanced stages, ALS patients will develop symptoms of dyspnea due to weakness of respiratory muscles and subsequently death in ALS. Objective To compare between neuromuscular ultrasound and nerve conduction study of phrenic nerve in the assessment of pulmonary function in Amyotrophic lateral sclerosis patients. Patients and Methods This was a case control study performed in Ain Shams University Hospitals in the period from 2/2022 to 8/2022. The study included 15 patients diagnosed with Amyotrophic lateral sclerosis according to El Escorial revised criteria and 15 healthy people served as controls. Patients were randomized by a simple computer generated method into two groups: A study group (n = 15) and a control group (n = 15). Results This study showed that PNCS is more sensitive than CSA in the assessment of respiratory affection in ALS. PNCS is simple and easy to do and doesn’t need a highly equipped device. Also PN amplitude has a normal value and many studies were done about it. To our knowledge no research studies this correlation between PN CSA and PN amplitude in the assessment of respiratory affection among ALS patients. Conclusion Electrodiagnosis and Neuromuscular ultrasound have a valuable role in the diagnosis and monitoring ALS patients. This study showed that PNCS is more sensitive than PN CSA by NMUS in the assessment of respiratory affection in ALS. PNCS is simple and easy to do and doesn’t need a highly equipped device. Also there were well established reference values as many researches studied electrophysiology of phrenic nerve.

Non-Invasive High Frequency Oscillatory Ventilation versus Continuous Positive Airway Pressure in Preterm Neonates With Respiratory Distress Syndrome

Abstract Background Respiratory distress syndrome (RDS) is the main cause of respiratory failure in preterm neonates, its incidence varies from 80% to 25% depending on gestational age. When optimal prenatal care is provided, the best approach to treat RDS, according to several recent trials, consists of providing continuous positive airway pressure (CPAP) from the first minutes of life using short binasal prongs or masks, followed by early selective surfactant administration for babies with worsening oxygenation and/or increasing work of breathing. Any effort must be done to minimize the time under invasive mechanical ventilation (IMV). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a new mode of non-invasive ventilation that connects non-invasive circuits to high-frequency ventilators, through which gas exchange is achieved by the superposition of high-frequency oscillation over continuous positive flow. Compared with other non-invasive ventilation modes, nHFOV combines the advantages of nCPAP and high-frequency ventilation, making it more effective at maintaining alveolar stability, eliminating CO2, and limiting barotrauma. Objective To investigate the effectiveness of nasal high frequency oscillatory ventilation in comparison to nCPAP as a primary mode of respiratory support in preterm neonates with respiratory distress syndrome. Methods This randomized controlled trial that was conducted on 90 neonates diagnosed with RDS at the Neonatal Intensive Care Units (NICUs), Ain Shams University Hospitals throughout six months. Results In the current study, there was a significant decrease in FiO2 needs in nHFOV group vs. nCPAP group, the median (IQR) (30% (21 to 37) vs. 31% (30 to 40) respectively, P-value=0.030), but non significant difference in RDS according to total Silverman score in nHFOV group vs. nCPAP group with median (IQR) total Silverman score (4 (4 to 5)vs. 4 (3 to 6) respectively, P-value= 0.474). Conclusion Using nHFOV is better than nCPAP in decreasing the need of FiO2.

Evaluation of Micro-Needling Followed by Metformin Solution versus Micro-Needling Followed by Tranexamic Acid Solution in Treatment of Melasma: A Comparative Split Face Study

Abstract Background Melasma is a common acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face, more frequently affecting women of reproductive age. Various underling risk factors have been implicated in the etiology of melasma including; Genetic factors, pregnancy, oral contraceptives, endocrine dysfunction, hormone treatments, cosmetic contact sensitivity and exposure to ultraviolet (UV) light. Management of melasma is a frustrating experience both for the treating doctors and patients because of its recurrent and often recalcitrant nature. Numerous therapeutic modalities have been tried for this condition such as hydroquinone, kligman’s formula (hydroquinone + steroid + tretinoin), kojic acid, azelaic acid, arbutin, ascorbic acid, chemical peels, lasers, tranexamic acid, rucinol, oligopeptides, silymarin, orchid extracts, and various botanical extracts with variable success rates. Objectives Our aim was to assess and compare the therapeutic effects of topical metformin solution 30% with microneedling versus topical tranexamic acid (4mg\ml) solution with microneedling in treating patients with facial melasma. Patients and Methods This is a split-face study included 35 patients with facial melasma. The patients recruited from the Outpatient Dermatology Clinic at Ain Shams University Hospitals. Topical metformin 30% solution with microneedling sessions were done for the right side of the face (4sessions - two weeks apart), and topical tranexamic acid solution (4mg/ml) with microneedling on the left side of the face (4 sessions – two weeks apart). The patients were followed up for 3 months. The response of treatment was evaluated by Hemi MASI score and Antera 3D camera. Results Our study revealed that both microneedling followed by topical metformin solution and microneedling followed by topical TXA solution were efficient in treatment of facial melasma as shown by significant decrease in h-MASI score and average melanin level assessed by Antera camera. Although statistically insignificant, the percentage of change in h- MASI score was more evident with TXA treatment than metformin treatment. The side effects were limited and transient in the form of erythema, burning sensation, and xerosis. The main problem with either treatment was the high relapse rate. Conclusion Both metformin and tranexamic acid applied topically following microneedling sessions led to statistically significant improvement of melasma according to Hemi MASI scores. Topical metformin appears to be a promising therapeutic option in the treatment of melasma without serious adverse effects.

Dual Mobility Cup in Total Hip Arthroplasty

Abstract Background Proximal femoral fractures are considered a common problem in the elderly. Osteoporosis and the risk of fall especially in old age add to the complexity of management of these types of fractures. These fractures can be managed with different types of implants e.g. Dynamic hip screw, proximal femoral nail, proximal femoral plate, etc.. Aim of the Work Prospective clinical trial study to assess the role of dual mobility unconstrained acetabular components in preventing and treating instability. Patients and Methods In the period between December 2014 to April 2017 a prospective study was conducted involving 25 patients with high risk of dislocation underwent total hip replacement using dual mobility cup either as primary hip arthroplasty or revision hip arthroplasty. All cases were operated upon in Ain Shams University Hospitals and the follow up of the cases was 1 year. Results There were no cases of prosthesis dislocation or loosening. There were only two cases of superficial wound infections who improved with wound debridement. Studies showed that the dual mobility cup did a great success in reduction in the risk of dislocation in specific conditions as patients with polio and other neuromuscular disorders and other risk factors for head dislocation. Conclusion Conversion of a failed implant to a total hip implant is a good and safe option in treatment of such cases. Dual mobility cups decreased the risk of dislocation in such cases with increased longevity of the prosthesis and a considerably accepted range of motion of the hip joint.

Carotid Intima-Media Thickness as a Cardiovascular Risk Factor in Patients with Chronic Kidney Disease

Abstract Background Atherosclerosis is a systemic arterial disease which frequently involve multiple vascular beds. Etiologically, cases of atherosclerosis occurring in different arterial vascular beds may share the same set of traditional risk factors. Aim of the Work In this present study we aimed to- evaluate the effect of chronic kidney disease on carotid intima media thickness as a cardiovascular risk factor in these patients. Patients and Methods This is a Case-control study conducted at Ain shams university hospitals during the period between January 2022 and June 2022. Results We found that patients with chronic kidney disease had significantly higher values of carotid intima media thickness (mean value of 1.10± 0.16 mm) versus control group (mean value of 0.49± 0.15mm).Also we noticed that with progression of kidney disease carotid intima media thickness (CIMT) becomes higher.CIMT showed a trend of gradual increase with decreased eGFR.Also we found that CIMT correlated positively with age, blood pressure, serum reatinine, urea and total cholesterol, but negatively with eGFR and we found that patients with diabetes and hypertension had CIMT higher than patients without diabetes and hypertension.The ROC curve analysis showed that the AUC for using eGFR cut off value of ≤ 75 mL/min for predicting CIMT thickness (>0.7 mm) was 1.And both the specificity and Sensitivity of eGFR in predicting CIMT thickening to be 100%. Conclusion Carotid IMT is significantly increased in Chronic kidney disease patients and may be usefully applied for risk stratification in this group of patients.Our study shows that, eGFR (≤ 75ml/min) has a positive predictive value for CIMT thickness(>0.7mm) with specificity and sensitivity 100%.

Midazolam versus Ondansetron versus Dexamethasone in Preventing Post-Operative Nausea and Vomiting after Elective Laparoscopic Abdominal Surgeries

Abstract Background Laparoscopic surgery is associated with a remarkably high risk of post-operative nausea and vomiting. The reasons for this high rate of PONV include mechanical factors (such as pressure on the stomach and gut caused by the pneumoperitoneum), neural factors (such as vagal reflexes elicited by irritation of parasympathetic nerve endings in the abdomen), and chemical factors (which include speculative considerations regarding a possible influence of CO2 on PONV). Objective To compare the effect of midazolam, ondansetron or dexamethasone on prophylaxis against PONV in patients undergoing laparoscopic abdominal surgeries. Patients and Methods After approval of anesthesiology department, scientific and ethical committees in Ain Shams University Hospitals, patients were included in the study, and were divided into three groups (n = 40; each); group M (midazolam group) and Group O (ondansetron group) and group D (dexamethasone group). Results The three groups were adequately monitored and assessed post-operatively and they were compared regarding post-operative nausea and vomiting outcome by recording the incidence of nausea and vomiting and recording the call for rescue antiemetic. Demographic data, intra-operative hemodynamics and post-operative pain score, occurrence of side effects, sedation score and patient satisfaction scores were also assessed, we found about 95% of (M) group achieve the complete response, that mean midazolam provided PONV prophylaxis comparable to dexamethasone and ondansetron in patients who underwent laparoscopic abdominal surgeries. Conclusion From this study, we can conclude that the midazolam is as effective as ondansetron and dexamethasone in reducing the incidence of nausea and vomiting in post-operative period of laparoscopic abdominal surgeries.

Incidence of Pancreatic Leakage in Isolated Biliary Limb Roux-en-Y Reconstruction in Whipple Procedure

Abstract Background Whipple is currently the procedure of choice in the treatment of localized pancreatic cancer. Isolated Roux-en-Y loop pancreaticojejunostomy was proposed as a method of reconstruction following pancreaticoduodenectomy. The idea is to isolate the bile from pancreatic secretions to minimize pancreatic enzyme activation and ultimately pancreatic fistula formation. It was also proposed that if a pancreatic fistula develops, it will be a pure fistula and thereby more benign as opposed to a mixed pancreatic fistula containing bile. Objective To estimate the incidence of pancreatic fistula in patients undergoing isolated Roux-en- Y hepaticojejunostomy reconstruction following pancreaticoduodenectomy. Patients and Methods In this prospective observational study, our aim is to calculate the incidence of post-operative pancreatic fistula in 20 patients that underwent Roux-en-Y isolated biliary limb reconstruction following pancreaticoduodenectomy for the treatment of pancreatic cancer. The study includes patients that underwent this procedure at Ain Shams University Hospitals in the period between January 2021 and July 2022 with a post-operative follow up period of 3 weeks. Patients were diagnosed with pancreatic cancer using MRI or CT scans with some of them also undergoing endoscopic US with biopsy. They were then admitted to one of the two main Ain Shams University Hospitals for pre-operative preparation. Results Our study did no estimate post-operative complications such as delayed gastric emptying and wound infection. Pancreaticoduodenectomy is a major surgery that carries a significant burden in terms of morbidity and mortality. Post-operative pancreatic fistula can be fatal as it can lead to vascular pseudoaneurysms that may fatally rupture. The idea behind using isolated biliary limb roux-en-y reconstruction is to alleviate the morbidity caused by post-operative pancreatic fistula. Conclusion Further comparative studies with a higher number of patients are recommended to assess and compare the value of isolated biliary limb reconstruction when compared to conventional reconstruction.

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

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.

The Association of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio to the Prognosis of Acute Kidney Injury Patients

Abstract Background Acute kidney injury (AKI) is an increasingly common problem facing clinicians, especially nephrologists, intensive care physicians, general physicians and surgeons. Acute kidney injury is a heterogeneous group of conditions characterized by a sudden decrease in glomerular filtration rate, manifested by an increase in serum creatinine concentration or oliguria, and classified by stage and cause. Aim of the Work The aim of the study was to evaluate the prognostic ability of the Neutrophil to Lymphocyte ratio, Platelet to Lymphocyte ratio and neutrophil to lymphocyte and platelet ratio in adult patients with acute kidney injury with various etiologies and to evaluate their role in the prediction of both morbidity and mortality over period of three months. Patients and Methods To achieve this goal, we conducted this study on 102 patients who developed acute kidney injury during hospital admission in Ain Shams University hospitals. Results he study found no significant differences between PLR and NLP ratios among different AKI stages. NLP ratio showed an inverse correlation with serum creatinine and a positive correlation with estimated Glomerular Filtration Rate (eGFR), while PLR did not show significant correlation. NLP ratio had the ability to predict the outcome of AKI with significant differences between mortality and recovery cases, while PLR did not have significant ability to predict outcome. NLP ratio showed high sensitivity and specificity in predicting the need for vasopressors, mechanical ventilation, or hemodialysis, while PLR had moderate sensitivity and high specificity in predicting recovery. The study had some limitations, including not enrolling non-AKI control group and not evaluating the effect of certain treatments on the studied markers. Conclusion The study had the advantages of being conducted on relatively large sample size and included patients of variable causes of admission. The included patients had also variable causes of AKI and of different AKI stages. The study had some limitations as we did not enroll non- AKI control group. We did not evaluate the effect of certain treatment modalities as some antibiotics or interventions on the studied markers.

A Comparative Study between Fascia Iliaca Block and Femoral Nerve Block for Postoperative Analgesia after Intertrochanteric Fracture Surgery

Abstract Background Intertrochanteric fracture surgery is a common orthopedic procedure worldwide, pain may be severe, and the patients generally require a significant amount of opioid-based analgesics after such procedures. Peripheral nerve blocks offer effective analgesia and decrease the need for opioids, thereby reducing the complications associated with the use of this class of drug. Pain management regimens following Intertrochanteric fracture surgery include oral analgesics, periarticular injection, peripheral nerve blocks (PNBs), and intravenous patient- controlled analgesia (PCA). Objective To compare the analgesic efficacy and functional recovery of Fascia iliaca block and FNB in patients who have undergone Hip surgery. Methods This prospective randomized clinical trial study was conducted in Ain Shams University hospital after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent Intertrochanteric fracture surgery under spinal anaesthesia regarding postoperative pain and early ambulation were included in the study their ages range between 40 to 75 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30). Results The two groups were compared as regard pain control post operatively. Numerical rating scale (NRS) was used to assess pain post operatively and used at regular interval (PACU, After 15min., After 30min., After 45min., After 1 hr., After 1.5 hrs., After 2 hrs., After 4 hrs., After 6 hrs., After 8 hrs., After 10 hrs., After 12 hrs., After 14 hrs., After 16 hrs., After 18 hrs., After 20 hrs., After 22 hrs. and After 24 hrs.). And there is no significant difference between two groups, with p- value (p > 0.05 NS). As regard to total dose of narcotics used in each group, there is no difference in postoperative nalbuphine consumption. The two groups are compared as regard to quadriceps weakness, onset of ambulation and there was a significant difference between two groups. Conclusion Fascia iliaca block is more effective than Femoral Nerve Block in in patient satisfaction for post-operative analgesia and equally effective with femoral nerve block in post-operative ambulation after Intertrochanteric fracture surgery.

Correlation between Severity of Lung Disease in COVID-19 Infection and Acute CNS Abnormalities

Abstract Background Sever acute respiratory syndrome corona virus 2 (SARS-COV 2) began in Wuhan,China,in December 2019 and has rapidely spread around the world to become pandemic,as COVID-19 can produce pathologic changes in chest imaging,COVID-19 related brain imaging findings are also well known. Aim of the Work The aim of this current study is to correlate retrospectively between the severity of lung affection in patients with COVID-19 infections and development of acute CNS abnormalities. Patients and Methods This study is Retrospective study, the study was conducted at Ain Shams University Hospitals over a course of six months from march 2022 to September 2022 and the main source of data for this study was the archived CT and MRI imaging of the patients referred to the department of Radiology. Our inclusion criteria were patients that diagnosed with sever acute respiratory syndrome corona virus 2 infection with acute neurologic manifestation and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale 0-5 (0 correspond to no involvement and 5 > 75% involvement),A CT lung severity score was determined as the sum of lung involvement,ranging from 0 (no involvement) to 25 (maximum involvement). Results A total 55 patients met the inclusion criteria,In attempt to describe and evaluate the brain and lung imaging correlation in patients with COVID-19, Compared to 20 patients without acute abnormal findings on neuroimaging,there were 35 patients with acute abnormal findings on neuroimaging and those patients were found to have significantly higher mean CT lung severity score (p < 0.0001) and they are more likely to present with ischemic stroke (14, 40%), A threshold of CT lung severity score > 18 was found to be 97% sensitive and 90% specific for acute abnormal findings on neuroimaging, the neuroimaging hallmark of these patients were acute ischemic infarcts (40%),invasive fungal sinusitis (22.9.%), Isolated cavernous sinus thrombosis,PRES,and vasculitis (each one 8.6%),cerebral venous sinus thrombosis other than cavernous sinus (5.7%),cerebritis and abnormal white matter signal (each one 2.8%).The predominant CT chest findings were peripheral ground -glass opacities with or with out consolidation. Conclusion The CT lung severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestation. This can be used as predictive tool in patients management to improve clinical outcome.

Utility of Neonatal Pain, Agitation and Sedation Scale and Amplitude Integrated Electroencephalogram for Detection of Different Levels of Sedation in NICUs

Abstract Background Sedatives are essential drugs in every intensive care unit used to ensure the patient's optimal level of comfort. Avoiding conditions of over and under sedation is a challenge in a neonatal intensive care setting. To date, there are no definitions of optimal levels of sedation in neonates. Testing the hypothesis that if a combined use of Neonatal Pain, Agitation and Sedation Scale (N- PASS) and amplitude integrated electroencephalography (aEEG) score might be helpful to distinguish different levels of neonatal sedation and therefore useful in titration of the drugs used. Aim of the Work The primary aim of the present study is to assess Neonatal Pain, Agitation and Sedation Scale (N-PASS) and amplitude integrated electroencephalography (aEEG) in the detection of different levels of neonatal sedation. Patients and Methods This was prospective observational study conducted on 30 full term neonates on mechanical ventilation reciving sedation (midazolam,fentanyl). we divided our patients into two groups (lightly sedated and deeply sedated patients) according to dose of sedation which determined by the expert opinion according to the clinical condition of the patients. all patients were subjected to the following:(demographic data, clinical signs & symptoms, laboratory investigations, N-PASS and aEEG before and after sedation from march 2021 to August 2022 to evaluate N-PASS and aEEG in the detection of different levels of neonatal sedation. Results In our study which was conducted on 30 patients admitted to NICU at Ain shams university hospitals, our patients were of mean gestational age 38.34, all patients presented with respiratory distress, were mechanically ventilated and received sedation (midazolam, fentanyl). we divided our patients into two groups (lightly sedated patients who were 11 patients (36.7%), deeply sedated patients who were 19 patients ( 63.3% ) according to dose of sedation. There was a significant decrease of co2 level in deeply sedated patients, mean co2 after deep sedation 43.36 mmHg while mean co2 after light sedation 51.52 mmHg (p 0.034),and regarding N-PASS significant decrease in N-PASS total score after sedation (p < 0.001 ),and regarding aEEG significant decrease of total burdjalov score after sedation (p < 0.001 ) Conclusion We recommend combining a clinical scoring system such as the N-PASS, with a continuous brain activity monitor such as the aEEG for assessing the level of sedation in neonates.

Evaluation of Eosinophil-Derived Neurotoxin Level and Asthma Severity in Isolated Asthma in Comparison to Asthma with Allergic Comorbidity

Abstract Background Asthma and associated type 2 inflammation are observed in 50–70% of patients with asthma and eosinophilic inflammation is a common feature in many asthma patients, and is associated with a higher risk of a more severe disease. Esinophilic Derived Neurotoxin (EDN) it’s useful as a clinical biomarker for the diagnosis and monitoring of asthma. High levels of EDN have been observed in patients with asthma, with higher levels measured during asthma exacerbations than in those with stable asthma. Objective To compare the association of the level of Esinophilic Derived Neurotoxin and burden of asthma in patients with asthma with Allergic comorbidities such as rhinitis and / or eczema compared to patients with asthma alone. Methods A cross sectional study included 100 adult patients, 50 patients diagnosed as asthma according to GINA guidelines and 50 patients diagnosed as asthma with allergic comorbidity such as Allergic rhinitis and/or eczema were selected from those who presented to the Allergy and clinical immunology clinics at Ain Shams University Hospitals during the period between January to July 2022. Results 50% of the studied population had bronchial asthma alone while the remaining had asthma with allergic comorbidities with most of them had asthma with allergic rhinitis and Most of the patients with allergic rhinitis had mod/severe persistent AR. 77% of total patients had positive SPT and 23% had negative SPT. Most of the patients had positive result for dust mites (Dermatophagoides farina 35% and Dermatophagoides pteronyssinus 30%) followed by pollens (mugwort 27%, rye grass 26% and tobacco 13%) and Animal dander (horse hair 15%, sheep wool 14%, cat hair 13% and dog hair 12%). The Median (IQR) of absolute eosinophil count and total IgE were higher in patients with asthma with Allergic comorbidities [0.68 (0.58 – 0.83) cells/mm3 and 155 (120 – 350) IU/ml respectively] while patients with asthma alone were 0.25 (0.12 – 0.45) cells/mm3 and 68.5 (29 – 123) IU/ml respectively. Our study showed the Median (IQR) of Serum EDN level was higher in patients with asthma with Allergic comorbidities [34 (28 – 40) ng/ml] compared to the patients with asthma alone [15(11 – 18) ng/m]. The quality of life and asthma control test was poor in asthmatic patients with allergic comorbidities compared to patients with asthma alone. Conclusion Serum EDN, Absolute Eosinophilis and total IgE can be used as a marker of T2 inflammation of air ways as their levels were higher in asthma with Allergic comorbidities. Asthma with comorbidities has more symptom burden with poorer quality of life and lower asthma control test than asthma alone; with more concern to be taken for those patients with asthma comorbidities as they have more severe asthma and poorer quality of life