Search

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]

Background Embolic myocardial infarction is an uncommon but increasingly recognized complication of infective endocarditis (IE). Although the incidence is low and ranges from 1% to 10%, the mortality rate is high (64%). The characteristics of septic embolism on presentation are nonspecific and usually are unrecognized by clinicians. This case report aims to build a high index of suspicion among clinicians for IE presenting with the complication of embolic myocardial infarction especially in patients with indwelling venous catheters. Case Summary A 62-year-old woman with end-stage renal disease on haemodialysis presented with shortness of breath and desaturation. Her history was significant for end-stage renal disease managed with regular haemodialysis by a right-sided double-lumen tunnelled catheter. An initial diagnosis was made of pulmonary embolism, and management with intravenous heparin was initiated. She subsequently developed inferolateral ST-elevation myocardial infarction, and treatment with percutaneous coronary intervention to the posterior descending artery failed. Then, the patient developed complete heart block, aortic valve vegetation, acute severe aortic regurgitation, and shock. Discussion Acute coronary syndrome is usually an early and uncommon complication of IE and the risk of embolism decreases after antibiotic therapy is initiated. Due to the low incidence of coronary events in IE, only case reports have been published. Most patients with septic pulmonary embolism have a presentation similar to that for pneumonia. The diagnosis is therefore often delayed, which consequently influences prognosis. Our case report presents an example of IE-related multiple systemic embolization with poor patient outcome due to delayed diagnosis. [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]

The G-ROP model was proposed to improve the retinopathy of prematurity (ROP) screening efficiency. It is based on gestational age, birth weight and postnatal weight gain. The current study aimed to validate the G-ROP model's ability to predict ROP in cohorts of premature infants from Egypt and the United Kingdom (UK). We retrospectively reviewed the records of preterm infants born between 1st of January and 30th of June 2018 with a known outcome for ROP screening and regular weight measurements until day 39 after birth. We applied the G-ROP model to the study group and calculated the sensitivity of the model for detecting Early Treatment of ROP (ETROP) study type 1 ROP and for any ROP and calculated the reduction of the number of infants requiring ROP screening by the model application. We applied the G-ROP model on 605 infants (504 from Egypt and 101 from the UK). The model successfully predicted all type 1 ROP cases (100% sensitivity) in both cohorts (95% confidence interval [CI], 91.1–100% in the Egyptian cohort and 65.5–100% in the UK cohort). The model reduced the number of infants requiring screening by 14.1% in the Egyptian cohort and 21.8% in the UK cohort. The G-ROP model was successfully validated for detecting type 1 ROP and in both cohorts from Egypt and the UK. [ABSTRACT FROM AUTHOR]

A field experiment was conducted in new reclaimed areas to improve avocado trees water productivity cultivated under deficit irrigation and mulching. The deficit irrigation treatments were 90, 80, 70, and 60% of reference evapotranspiration (ETo). Results revealed that The average water requirements during different avocado trees physiological growth stages were 613, 1509, 1755, 1391, and 632 m³ /fed for flowering to end of fruit set, fruit set to approximately 50% of the expected market fruit size, during the fruit growth stage, during the fruit ripening stage, and during the flower bud formation stage, respectively. These values represent approximately 10.4%, 25.6%, 29.7%, 23.6%, and 10.7% of the total yearly water requirement. The averages irrigation frequency were 2.45, 2.61, 2.72, 2.87, and 3.91day for 100, 90, 80, 70 and 60% ETo treatments, respectively. The highest crop water productivity value of 1.24 kg/m³ water was attained at 70% ETo followed by 1.18 kg/m³ water at 80% ETo while the least crop water productivity (1.06 kg/m³ water) was realized at 100% ETo. The crop water requirement of 5110 m³ /fed/year with high irrigation frequency is recommended for mulched sandy soil cultivated with avocado trees. [ABSTRACT FROM AUTHOR]