Search

Purpose: To describe a novel technique of macular hole (MH) repair and compare it to the perfluorocarbon liquid (PFCL)-assisted temporal internal limiting membrane (ILM) flap technique. Methods: Twenty-two eyes of 22 patients with MH were randomized on a 1:1 basis into two groups. Group A cases were treated using the Flip and Fix technique, in which the single-layer ILM flap was flipped, flattened over the macula using PFCL, and fixed in place using two drops of autologous nonheparinized blood over the superonasal and inferonasal edges of the flap (away from the MH center). Group B patients had the classic temporal ILM flap technique without using the PFCL or autologous blood. All patients were followed up for a period of 6 months after the surgery. Results: No significant difference was observed in initial and final visual acuities between Groups A and B. Intraoperative flap displacement did not occur in Group A and occurred in two eyes in Group B (18.2%). One of them showed failed MH closure and required reoperation. These two cases had a final (W shape) MH closure and a worse final vision than the remaining cases, which had either a U shape or V shape final MH closure. Conclusions: The study results show that the Flip and Fix technique is as effective as the PFCL-assisted temporal ILM flap technique and is associated with less ILM flap displacement risk for the repair of macular holes. [ABSTRACT FROM AUTHOR]

Background Central venous catheterization is an important device that is frequently performed for various purposes in operating theatres and intensive care units, there are many different sites that are commonly used for central venous catheterization, and each site has its own advantages, disadvantages, and possible complications. To avoid catheterization failure and mechanical complications, ultrasound guidance is currently recommended in several guidelines and is widely used for central venous catheterization. It has been shown to reduce the incidence of arterial puncture, hematoma formation, pneumothorax, hemothorax, and catheterization failure. The subclavian vein (SCV) catheterization is more comfortable for patients than other sites but has a higher risk of some complication as pneumothorax. The aim of this study was to compare the Supraclavicular and Infraclavicular approaches for ultrasonographic guided right subclavian venous catheterization as regard the accessibility and the safety of both approaches. Methods This randomized controlled study was conducted in Sohag University Hospital after local ethical committee approval, 210 patients had a right subclavian vein catheterization by either the supraclavicular or the infraclavicular approach (105 for each group), using a two dimensional high-frequency ultrasound guide were enrolled in the study regarding the accessibility (time to first puncture and number of punctures) and the complications like arterial puncture, hematoma formation, arrhythmia, and catheter misplacement. Results The infraclavicular approach is more accessible, regarding the number of punctures, for the Supraclavicular approach there were 56 (53.3%) cases needed only one puncture to achieve successful venous puncture and 27 (25.7%) cases needed 2 punctures and 5 (4.8%) needed 3 punctures and 17 (16.2%) failed in catheterization, for the Infraclavicular approach there were 79 (75.2%) of cases in these group needed only one puncture to achieve successful venous puncture and 17 (16.2%) cases needed 2 punctures and 9 (8.6%) failed in catheterization with a significant difference between both groups P value was 0.003. As regard the puncture time, for the Supraclavicular approach 83 (79%) cases successes in less than 3 min, and 22 (21%) cases needed more than 3 min, in the infraclavicular approach 94 (89.5%) cases succeeded in less than 3 min and 11 (10.5%) cases needed more than 3 min at P value 0.037 and had a lower rate of complications than the supraclavicular approach, like arrhythmia, arterial puncture, hematoma formation, catheter misplacement, and postcatheterization infection, but a higher rate of pneumothorax formation however in a nonsignificant way. Conclusion The infraclavicular approach for ultrasound-guided right subclavian venous catheterization is better than the supraclavicular approach due to a higher chance of first pass success rate and a lower rate of complications. [ABSTRACT FROM AUTHOR]

Background Acute kidney injury (AKI) is developing as a frequent and significant coronavirus illness [coronavirus disease 2019 (COVID-19)] sequela owing to the spread of the virus in 2019. A few trials, meanwhile, have focused on AKI managed with renal replacement therapy (AKI-RRT). Aim To evaluate the effectiveness of early renal replacement treatment in COVID-19 AKI cases. Patients and methods A total of 100 individuals with AKI and confirmed COVID-19 infection participated in this case–control research. All participants were split into two groups: group A included 50 COVID-19-confirmed diagnosis patients with AKI and group B included 50 COVID-19-confirmed diagnosis patients without AKI. Following ICU admission, we collected laboratory results, physiological parameters, drugs, therapies, and organ support (including RRT), as well as clinical events like mortality. Results Use of invasive ventilation, vasopressor, deep sedation, and RRT was significantly higher in group A. When compared with patients with AKI who did not get RRT, 14 (28%) patients who had RRT were younger, had greater creatinine and blood urea nitrogen levels, and experienced oliguria more often. Five patients had at least one session of intermittent hemodialysis, and all patients experienced continuous venovenous hemofiltration. Considering mortality, hospital mortality and 60-day mortality rate were significantly higher in group A. However, there was no substantial variation between the two groups regarding ICU mortality, 28-day mortality, and RRT mortality. Age, baseline creatinine, and effective RRT were the independent predictors linked to 60-day mortality in the multiple logistic regression analysis. Conclusion Patients with AKI who need RRT had a nonsignificantly higher death rate than COVID-19-infected patients without AKI. Age, initial creatinine, and RRT effectiveness were all independent variables linked to 60-day mortality. [ABSTRACT FROM AUTHOR]

Background Severe acute pain occurs in more than 10% of patients within the first 36 h after a cesarean section and can significantly impact women's satisfaction. The aim of this study was to compare the transversus abdominis plane (TAP) block for postoperative pain relief following cesarean section operations with the most famous analgesia (intrathecal morphine) used for a cesarean section regarding its efficacy and complications. Patients and methods This interventional double-blinded randomized controlled study was carried out on 60 cases, who underwent an elective cesarean delivery. They were randomized into two groups; patients were divided into two equal groups. Group M received intrathecal 150 μg morphine in a 0.5 ml volume, mixed with 10 mg of hyperbaric bupivacaine 0.5% in a 2 ml volume (total volume 2.5 ml). Group B received intrathecal 10 mg hyperbaric bupivacaine 0.5% 2 ml volume+0.5 saline (total volume 3 ml) and at the end of surgery the patient received bilateral TAP block with a 20 ml volume of 0.25% bupivacaine on each side. Results Postoperative heart rate, respiratory rate, oxygen saturation, mean arterial blood pressure, and intraoperative Bromage score were insignificantly different at all-time measurements between both groups. Visual analog score and postoperative Bromage score at 2, 3, and 4 h were higher in group B than group M (P<0.001). Time of rescue analgesia was significantly prolonged in group M than group B (P<0.001). Total paracetamol and morphine doses were significantly lower in group M than group B (P<0.001). Conclusions TAP block is a good alternative technique to intrathecal morphine in reducing postcesarean section pain, with less postoperative nausea and vomiting and pruritus compared with intrathecal morphine (ITM). [ABSTRACT FROM AUTHOR]

Purpose: To evaluate current practice patterns for Egyptian ophthalmologists in the diagnosis of diabetic retinopathy (DR) and explore potential implications of these approaches on management.Methods: Cross-sectional survey conducted in Egypt amongst practicing ophthalmologists.Results: The study had 203 responses (~6% of all Egyptian ophthalmologists). A majority of respondents were general ophthalmologists (78.2%), practicing for five to ten years (41.9%). In patients with DR and no diabetic macular edema (DME), 33.0% of respondents would use FA in patients with mild DR, 44.3% in patients with moderate DR and 51.2% in patients with severe non-proliferative diabetic retinopathy (NPDR). Color imaging (CI) was used by less than 1% as the sole imaging modality for any level of DR. Approximately 70% of respondents used fluorescein angiography (FA) to grade and base treatment decisions for DR, either alone or in conjunction with dilated eye exams and/or CI. Given the known more severe appearance of DR on FA than on standard color imaging upon which treatment guidelines are based, use of FA as the primary modality over a one-year period could result in PRP that would otherwise not be suggested in approximately 78,820 eyes at an additional cost of $10.1 million US dollars. These numbers are projected to double by 2045.Conclusion: Given that FA detects significantly greater pathology than CI, and that treatment and follow-up recommendations are based on CI, its use as the primary imaging modality in DR grading may result in apparently significantly higher DR severity, with subsequently increased procedures and associated costs. [ABSTRACT FROM AUTHOR]

Background Platelet-rich plasma (PRP) is a mixture of cytokines, thrombocytes as well as multiple growth factors which are produced mainly by α-granules of platelets which enhance the process of natural healing process with less time. The role of autologous PRP in managing nonhealing pressure ulcers has been questioned as it enhances tissue healing by providing the necessary growth factors. Objectives Determining the relative efficacy of autologous PRP in treating grade III skin ulcers compared with standard care. Methods In this pilot randomized-controlled trial, 28 patients with grade III pressure ulcers in the critical care units of Alexandria Main University Hospital were enrolled and randomized into two groups. Patients of group A were subjected to PRP injections in the periphery of their pressure ulcers along with the standard care, while group B were subjected only to the standard care of pressure ulcers. Results PRP group showed significantly reduced mean ulcer volume at week 1 (18.88 vs. 21.42, P=0.047), week 2 (17.14 vs. 21.15, P=0.017), week 3 (14.92 vs. 19.99, P=0.020) and week 4 (10.68 vs. 17.35, P=0.019) than control group. PRP group showed significantly reduced mean ulcer surface area at week 1 (13.76 vs. 14.81, P=0.047), week 2 (10.64 vs. 14.11, P=0.032), week 3 (8.00 vs. 14.17, P=0.013) and week 4 (6.30 vs. 12.94, P=0.023) than control group. Conclusion Adding weekly autologous PRP injections to the standard care of noninfected grade III pressure ulcers may be a potentially effective approach. In critically ill patients, it was associated with reduced ulcer volumes, reduced ulcer surface areas, and better healing starting from the first week of injections. [ABSTRACT FROM AUTHOR]

Introduction Although septic shock mortality has decreased lately due to better identification and timely application of therapies. Research has continued for 20 years, but no therapies have been discovered yet to change sepsis's course once it is infected. Objective The aim of this study was to evaluate the effect of enteral metoprolol tartrate on hemodynamics and clinical outcomes in patients with septic shock grouped into various pretargeted heart rate (HR) groups. Methods Septic shock patients (n=90) were randomly assigned directly after the resuscitation into 3 groups (30 in each). Then, treatment with metoprolol tartrate was started. The dose of metoprolol was 25-150mg every 12 h and increased gradually to reach the pretargeted HR group range; group A (HR=60-70 beats/ min), group B (HR=71-80 beats/min), and group C (HR=81-90 beats/min). Metoprolol was continued to maintain the targeted HR till either discharge form intensive care unit (ICU) or death. The primary outcomes measured were mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), serum lactate, and sequential organ failure assessment (SOFA) score. Results After 1 day, group A (60-70 beats/min) had a significantly higher MAP (61.73±6.39 mmHg) than group B (51.33±7.76 mmHg) and group C (52.0±7.14 mmHg) (P < 0.001). After 3 days, group A had a significantly improved SvO2, lower serum lactate, and lower SOFA score than the other groups (all P < 0.05). When compared with groups B and C, group A had decreased norepinephrine (NE) requirements (P < 0.001) and shorter ICU stay (P=0.001). Conclusion Targeting HR between 60-70 beats/min using metoprolol tartrate, when compared with higher targets in septic shock after hemodynamic stabilization, was not associated with profound hypotension but also with earlier improved MAP, tissue perfusion measured as SvO2 and serum lactate, and organ failure measured as the SOFA score. It also showed decreased Norepinephrine requirements and a shorter ICU stay, but with no 28-day mortality benefit. [ABSTRACT FROM AUTHOR]

Background Inflammatory markers like interleukin-6 (IL-6) are linked to the worse outcome in coronavirus disease 2019 (COVID-19) cases. Other markers such as C-reactive protein are not as reliable as IL-6 in predicting respiratory failure. Aim To assess the function of IL-6 as a predictor of COVID-19 severity. Patients and methods A total of 50 severe and critical patients with PCR-confirmed COVID-19 were included. All enrolled patients followed the case definition for confirmed cases of Egyptian national protocol for COVID-19 issued by MOHP. Clinical assessment, imaging, and laboratory data were recorded at admission. Pulmonary function was evaluated by SpO2/FiO2 ratio. Outcomes included hospital stay, prognosis of the disease, complications, death rate, and discharge, which were recorded during the follow-up. Results The elevated IL-6 group showed a significantly higher critical rate (87.1%) than the normal IL-6 group (26.3%) (P<0.0001), and the improvement rate was higher in the normal IL-6 group (73.7%). Moreover, the death rate was significantly greater in the elevated IL-6 group (38.7%) than the normal IL-6 group (10.5%) (P=0.033). The cutoff value of IL-6 levels in prediction of severity and mortality of COVID-19 was assessed. Our receiver operating characteristic results revealed that IL-6 cutoff value is higher than 50.27 for severity and the cutoff value is greater than 120.83 for mortality. The sensitivity values of IL-6 for severity and mortality were 93.3 and 90.5%, respectively, and the specificity values were 90.0 and 86.7%, respectively. Conclusion Elevated levels of serum IL-6 in COVID-19-infected patients were related with a variety of adverse outcomes, including severe illness, mechanical ventilation, and acute respiratory distress syndrome. When it came to accurately predicting the severity and mortality of COVID-19, the optimum IL-6 cutoff levels were 50.27 and 120.83 pg/ml, respectively. [ABSTRACT FROM AUTHOR]

Introduction Ilioinguinal and iliohypogastric (IIIH) nerve blocks help to manage postoperative pain that occurs following inguinal hernia repair or varicocelectomy. Aim The study aimed to compare the effect of adding magnesium sulfate or dexamethasone to levobupivacaine for iliohypogastric and ilioinguinal nerve blocks, in terms of postoperative analgesic length, visual analog scale ratings, first analgesic requirements, and hemodynamic changes. Patients and methods The study included 86 patients, aged 20-70 years, who were divided into two groups (D and M). Patients in group D received 9ml of 0.5% levobupivacaine for the nerve block plus 1ml dexamethasone (8 mg), whereas patients in groupMreceived 9ml 0.5% levobupivacaine plus 1ml magnesium sulfate 10% (100 mg). Postoperative analgesia, visual analog scale scores, and any complications were documented. Results Group D had a significantly longer analgesic time. A significantly lower amount of analgesic was consumed on the first postoperative day with significantly low pain score as compared with group M. Conclusion The addition of dexamethasone to levobupivacaine for IIIH nerve blocks improved the postoperative analgesia. [ABSTRACT FROM AUTHOR]

Introduction Among all the regional blocks, the peribulbar block is one of the most popular for most ophthalmic procedures as it has few complications. Aim To study the effects of mixing local anesthetic with either dexmedetomidine or fentanyl in the peribulbar block for vitreoretinal surgery. Patients and methods The study included 40 adult patients (ASA II-IV) who had a peribulbar block for elective retinal surgery at Sohag University Hospital. All patients received the following combination: lidocaine 2%, bupivacaine 0.5%, hyaluronidase 15 IU/Ml, in addition to either 20 µg of fentanyl (group F) or 20 μg of dexmedetomidine (group D). The duration of postoperative analgesia, the onset, and duration of sensory and motor blocks, along with other complications, were recorded. Results The onset time of motor and sensory blocks was significantly longer in group F. For the duration of sensory and motor blocks, group D had a significantly greater duration than group F (P=0.05). Group D took substantially longer to request analgesia than group F (P=0.0002). Total paracetamol consumption was substantially higher in group F than in group D (P=0.001). The overall number of patients who required nalbuphine was substantially higher in group F (P=0.003) than in group D. At 2, 4, and 6 h postoperatively, the visual analog scale was statistically significantly greater in group F than in group D. Conclusion Dexmedetomidine-local anesthetic mixture in the peribulbar block for retinal surgery was superior to fentanyl-local anesthetic mixture regarding onset and duration of motor, sensory block, postoperative analgesia, and analgesic requirement. [ABSTRACT FROM AUTHOR]

Purpose To provide an Arabic translated, cross-culturally adapted version of the Lacrimal System Questionnaire (Lac-Q) and to validate the translated version. Materials and methods Arabic translation of the Lac-Q passed four stages: forward translation of the original English version to Arabic, backward translation to English, comparison of the original and the backward translated versions, and then a final review of the created Arabic version by an expert committee. Revalidation involved asking each participant after signing an informed consent to complete the Arabic version of the Lac-Q preoperatively, 6 and 12 weeks postoperatively. The surgical success was assessed 12 weeks postoperatively by Jones test 1 and by asking the patients to complete a satisfaction form with the surgical outcome. The patient reported being 'satisfied' or 'not satisfied' according to the improvement of the symptoms and if he/she believed further treatment was required. Results The Arabic version of the questionnaire was completed by 39 patients, where 11 of them had bilateral surgery done in the same sitting. We found a statistically significant positive correlation between patients' social and eye symptom scores (preoperatively and 6 and 12 weeks postoperatively). Good internal consistency and test–retest reliability were confirmed by calculated Cronbach's alpha and intraclass correlation coefficient, respectively. In addition, good discriminative validity was confirmed by a statistically significant difference between the scores of the diseased eye before the surgery and the eyes treated surgically. The score difference between the patients with successful and failed surgeries was statistically significant confirming good responsiveness of the studied version. Conclusion The Arabic version of the Lac-Q is a valuable tool to assess the lacrimal symptoms. [ABSTRACT FROM AUTHOR]

Introduction The postdural puncture headache (PDPH) is one of the spinal and epidural anesthesia complications. It can be induced by using large gauge-cutting needles or performing numerous trials. Conservative treatment was the primary option for the management of PDPH, sphenopalatine ganglion block (SPGB) can be a suitable and safe option for the treatment of PDPH. Aim The aim was to verify the efficacy and safety of transnasal SPGB using either lidocaine 2% or bupivacaine 0.5% as a treatment line for PDPH versus the conventional conservative treatment. Patients and methods In total, 120 patients with PDPH following cesarean section under spinal anesthesia were assigned and divided into three groups. Group L (n=40) received transnasal SPGB (lidocaine 2%), group B (n=40) received transnasal SPGB (bupivacaine 0.5%), and group C (n=40) received conservative treatment for 24 h [intravenous (IV) paracetamol 1 g/8 h]. The headache severity was measured by the visual analog scale (VAS) at 0 min, 30 min, 6 h, 12 h, and 24 h post treatment. Results No significant difference in the VAS from the baseline between the groups L and B was observed. VAS values were significantly lower in both groups when compared with patients in group C (P<0.05). No significant differences from baseline mean blood pressure, heart rate, or other complications (such as bleeding), were observed between the three groups at any timepoint. Conclusion The headache severity in PDPH cases might be reduced more efficiently through SPGB using either lidocaine or bupivacaine, unlike other conservative treatments such as paracetamol. [ABSTRACT FROM AUTHOR]