In this study, we aimed to evaluate the ability of central-to-peripheral temperature gradients using thermal imaging to predict in-hospital mortality in surgical patients with septic shock.
This ...prospective observational study included adult patients with septic shock admitted to the intensive care unit postoperatively. Serum lactate (in mmol/L), capillary refill time (CRT) (in seconds), toe (peripheral) and canthal (central) temperature by infrared thermography and the corresponding room temperature in (Celsius °C) were assessed at the time of admission, 6- and 12 h after admission. The canthal-toe and room-toe temperature gradients were calculated. According to their final outcomes, patients were divided into survivors and non-survivors. The ability of canthal-toe temperature gradient (primary outcome), room-toe temperature gradient, toe temperature, serum lactate and CRT, measured at the prespecified timepoints to predict in-hospital mortality was analyzed using the area under receiver operating characteristic curve (AUC).
Fifty-six patients were included and were available for the final analysis and 41/56 (73%) patients died. The canthal-toe and room-toe temperature gradients did not show significant accuracy in predicting mortality at any timepoint. Only the toe temperature measurement at 12 h showed good ability in predicting in-hospital mortality with AUC (95% confidence interval) of 0.72 (0.58-0.84) and a negative predictive value of 70% at toe temperature of ≤ 25.5 °C. Both serum lactate and CRT showed good ability to predict in-hospital mortality at all timepoints with high positive predictive values (> 90%) at cut-off value of > 2.5-4.3 mmol/L for the serum lactate and > 3-4.2 s for the CRT.
In post-operative emergency surgical patients with septic shock, high serum lactate and CRT can accurately predict in-hospital mortality and were superior to thermal imaging, especially in the positive predictive values. Toe temperature > 25.5 °C, measured using infrared thermal imaging can exclude in-hospital mortality with a negative predictive value of 70%.
Methicillin-Resistant Staphylococcus aureus (MRSA) is an important cause of healthcare associated infections globally. New mecA homologue (mecC), was first reported in the UK and Denmark. The mecC ...mediated MRSA is resistant only to Β-lactams antibiotics and is sensitive to other antibiotics. Detecting the prevalence of mecC MRSA provides more options in treatment of MRSA infections. The aim of this study was to prevalence of mecC gene in clinical isolates of MRSA in Ain-Shams university hospitals & to correlate Minimal Inhibitory concentration (MIC) of Oxacillin with the mecC gene expression in MRSA isolates. Fifty MRSA isolates were collected from different intensive care units (ICUs) of Ain-Shams university hospital from April-December 2018. Methicillin resistance was detected by Cefoxitin disc, and antimicrobial susceptibility testing was done for all isolates and its results were interpreted according to Clinical & Laboratory Standards Institute (CLSI) guidelines 2018. Minimal Inhibitory Concentration of Oxacillin was detected using Oxacillin E-test and the results were interpreted according to the manufacturer’s instructions, then Polymerase Chain Reaction was done to detect mecA and mecC genes among MRSA isolates. Fifty isolates were identified as MRSA by Cefoxitin disc out of 163 samples. Twelve isolates were sensitive to Oxacillin while 38 isolates were resistant to Oxacillin. All isolates were positive to mecA gene while only 3 isolates were positive to both mecA and mecC genes. MecC is a new emerging gene responsible for methicillin resistance in staphylococci and was detected in 6 % of the isolates in this study.
To examine the use of Double Crush Syndrome (DCS) hypothesis in CTS patients in order to support or disguard the theory.
This study was conducted on 80 adult patients, 40 presenting with brachialgia ...(Group I) and 40 patients claiming of failed CT release operation (Group II). Diagnostic work up included neurological examination, MRI of cervical spine, Phalens, Tinel’s sign, EMG examination and motor and sensory nerve conduction studies.
EMG examination and nerve conduction studies results show 10 cases with CTS (25%), 20 cases (50%) with DCS and 10 cases (25%) with cervical radiculopathy in group I, while group II proved 10 cases (25%) with CTS and 30 cases (75%) with DCS. Accordingly, studied patients showed 20 cases with CTS (25%), 50 cases with DCS (62.5%) and only 10 cases with cervical radiculopathy alone (12.5%). When comparing the first nerve conduction studies of Group II before the operation and the follow up nerve conduction studies of the same group after the operation we found 32 cases (80%) with improvement of the NCS and 8 cases (20%) with deterioration of the nerve conduction studies results.
The double crush syndrome element should be excluded whenever examining for CTS, to guide for treatment.
DCS hypothesis was supported by this sudy.
The double crush concept has gained some popularity among chiropractors because it seems to provide a rationale for evaluating the condition of the cervical roots when treating CTS, which was supported by this study.
To test value of electrophysiologic studies in confirming lumbo-sacral radiculopathies in patients with questionable MRI findings for nerve root compression.
The study was conducted on 80 adult ...patients with sciatica, weakness of myotomal distribution in one limb, hypoesthesia in dermatomal distribution, all with MRI findings of focal disc protrusion/bulge with questionable nerve root compromise not correlating with the clinical symptoms.
25% of cases were acute, 60% subacute, and 15% were chronic. Clinical picture was sciatica with +ve SLRT in 35% of cases, L5 myotomal weakness in 30% of cases, S1 myotomal weakness 15% of cases, L5/S1 myotomal weakness in 15% of cases, sensory deficit in 4% of cases, back pain in 1.25% of cases. Positive EMG findings were found in 96.3% of cases, 96.3% had +ve lower limb findings, 57.5% had +ve paraspinal muscles findings, 70% had small CMAP amplitude, and 7.5% had active denervating potentials. 44% of cases were treated conservatively, while 56% of cases underwent surgery. There was a statistically significant association between the EMG results and clinical picture of radiculopathy, while there was no statistical significance between the MRI findings and the clinical picture of radiculopathy.
Electrophysiological studies are efficacious in diagnosing and predicting prognosis of lumbo-sacral radiculopathies.
The proper management decision should be based on the triad of imaging, electrophysiological tests and clinical context.
MRI accuracy in detecting nerve root compromise is questionable by conflicting reports including this study.
Abstract Background This study aimed to evaluate the accuracy of ankle blood pressure measurements in relation to invasive blood pressure in the lateral position. Methods This prospective ...observational study included adult patients scheduled for elective non-cardiac surgery under general anesthesia in the lateral position. Paired radial artery invasive and ankle noninvasive blood pressure readings were recorded in the lateral position using GE Carescape B650 monitor. The primary outcome was the ability of ankle mean arterial pressure (MAP) to detect hypotension (MAP < 70 mmHg) using area under the receiver operating characteristic curve (AUC) analysis. The secondary outcomes were the ability of ankle systolic blood pressure (SBP) to detect hypertension (SBP > 140 mmHg) as well as bias (invasive measurement – noninvasive measurement), and agreement between the two methods using the Bland-Altman analysis. Results We analyzed 415 paired readings from 30 patients. The AUC (95% confidence interval CI) of ankle MAP for detecting hypotension was 0.88 (0.83–0.93). An ankle MAP of ≤ 86 mmHg had negative and positive predictive values (95% CI) of 99 (97–100)% and 21 (15–29)%, respectively, for detecting hypotension. The AUC (95% CI) of ankle SBP to detect hypertension was 0.83 (0.79–0.86) with negative and positive predictive values (95% CI) of 95 (92–97)% and 36 (26–46)%, respectively, at a cutoff value of > 144 mmHg. The mean bias between the two methods was − 12 ± 17, 3 ± 12, and − 1 ± 11 mmHg for the SBP, diastolic blood pressure, and MAP, respectively. Conclusion In patients under general anesthesia in the lateral position, ankle blood pressure measurements are not interchangeable with the corresponding invasive measurements. However, an ankle MAP > 86 mmHg can exclude hypotension with 99% accuracy, and an ankle SBP < 144 mmHg can exclude hypertension with 95% accuracy.
Male infertility has become a significant health issue over the past few decades, and various factors such as lifestyle choices, hormonal imbalances, and genetic abnormalities contribute to this ...condition. Genetic disorders are responsible for about 15% of cases of male infertility, impacting processes like sperm production and sperm quality. Spermatogenesis, the complex process of generating mature sperm, involves numerous molecular and cellular pathways. One such pathway is ubiquitination, which plays a vital role in normal sperm production by managing protein balance in the testes. Ubiquitination is a highly conserved, multistep enzymatic process of post-translational modification of target protein by covalent attachment of ubiquitin determine the stability and/or activity of the target proteins. Cullin‐RING E3 ligases (CRLs) are multi-subunit complexes comprise the largest family of RING‐based E3 ubiquitin ligases that catalyze final step of ubiquitination to transfer ubiquitin to target proteins. DDB1- and CUL4-associated factors (DCAFs) have been reported to serve as substrate receptors for the Cullin4‐RING E3 ligases (CRL4) complexes to recruit diverse proteins for ubiquitination and thus confer specificity to CRL4s. DCAF17 is a member of DCAF protein family and mutations in the gene encoding this protein cause a rare autosomal recessive genetic disorder known a Woodhouse-Sakati syndrome (WSS), which is characterized by hypogonadism, alopecia, diabetes mellitus and mental retardation. However, the role of DCAF17 is unknown. To investigate the role of DCAF17, a knockout mouse model for Dcaf17 gene was generated using gene targeting approach through Cre/LoxP strategy. Disruption of Dcaf17 in mice caused male infertility due to severe defects in spermatogenesis and testicular function. To further characterize the effect of Dcaf17 on spermatogenesis at cellular and molecular level, various cell and molecular biology techniques such as qRT-PCR, Western blotting and immunofluorescence imaging techniques were employed to evaluate the expression of different genes and proteins involved in ubiquitination, chromatin modification and chromatin remodeling. Our results showed that disruption of Dcaf17 can have complex effects on the expression of chromatin modification enzymes, remodeling factors, ubiquitination and genes involved in spermatogenesis, potentially contributing to disruptions in germ cell development and male fertility. Although the disruption of Dcaf17 altered the differential expression of chromatin modification enzymes and remodeling factors (Tnp2, Prm2, Tnp1, Prm1, Ube2e3, Suv39h1, Prmt8, Ube2a, Tnp1, Nsd1, Suv39h1, Mecp2, Cul4b and Prmt8), the translational levels of these proteins show comparable differences between WT and Dcaf17 KO. Findings of our research are novel and significant because they provide a basis for further studies to elucidate molecular mechanisms underlying the function of DCAF17 in ormal spermatogenesis and male fertility. It will also open a door to develop new possible diagnostic and, possibly, therapeutic tools for male infertility disorders.
To evaluate the effect of different frequencies of repetitive transcranial magnetic stimulation( rTMS) on cognitive function in stroke patients.
The study was conducted on 30 right handed stroke ...patients with right sided hemiparesis and history of stroke from 6 to 20months. They were divided into two equal groups; group I receiving 10Hz frequency of rTMS and group II receiving 5Hz in 10 sessions. Each session included 6 trains and 7min duration. They were evaluated by Addenbrooke Cognitive Examination Revised Test (ACER) and transcranial doppler (TCD) for blood flow velocity (BFV) in affected middle cerebral artery pre and post- treatment with rTMS.
There was a significant differences in blood flow velocity in the affected side (left MCA) in both groups (p<0.05) with improvement of (20.02%, 11.41%) respectively. There was also a significant differences in total ACER Test in both groups (p<0.05) with improvement of (33.5%, 25%) respectively. A significant positive correlation (p<0.05) between improvement percentage of blood flow and improvement percentage of total ACER Test in both groups was found.
This study showed significant increase in the BFV in the MCA and the total ACER score after applying high frequencies of rTMS, supported by many authors.
High frequency rTMS plays a major role in improving the cognitive impairment in stroke patients.
Repetitive transcranial magnetic stimulation should be considered a future cornerstone in neurorehabilitation and therapy.
•Liver resection surgery is associated with substantial postoperative pain.•Subcostal transversus abdominis plane block is the suggested regional block.•Erector spinae plane block reduced opioid ...consumption.•Erector spinae plane block prolonged the duration of analgesia.
The aim of this study was to compare the analgesic efficacy of erector spinae plane block (ESPB) in relation to subcostal transversus abdominis plane block (TAPB) in patients undergoing open liver resection surgery.
In this randomized controlled trial, we included adult patients undergoing open liver resection surgery. After induction of general anaesthesia, the included patients were randomized to receive either ESPB (n = 30) or subcostal TAPB (n = 30). Postoperative pain was assessed using the numeric rating scale (NRS) at rest and during cough. Intravenous morphine boluses were used for management of breakthrough pain intra- and postoperatively. The study’s primary outcome was morphine consumption during the first 24 h postoperatively. Secondary outcomes included intraoperative morphine consumption, time to first postoperative morphine requirement, incidence of complications, and patient satisfaction.
Sixty patients were included and were available for the final analysis in this study. The intra-and postoperative morphine consumption were less in the ESPB group than the subcostal TAPB group (median quartiles morphine dose: 0 0−0 vs 2 0−5 mg, p = 0.007 and 20 15–20 vs 25 20−30 mg, p = 0.006, respectively). The time to first morphine requirement was longer in the ESPB group (median quartiles: 6.5 5.5−6.5 h) than the subcostal TAPB group (median quartiles: 4.3 1.0−6.5 h), P = 0.013. Patients in the ESPB group had lower incidence of sedation and higher level of satisfaction than the subcostal TAPB group.
In patients undergoing open liver resection surgery, ESPB provided superior analgesic properties than subcostal TAPB.
Clinical trial registration: NCT05253079, Principal investigator: Maha Mostafa, Date of registration: February 23, 2022.
URL: https://clinicaltrials.gov/ct2/show/NCT05253079
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