Background In pregnancies complicated by preeclampsia (PE), increased impedance in uterine arterial flow is detectable before clinical symptoms appear. Aim To evaluate the value of color Doppler study of uterine artery (UtA) in the prediction of PE in high-risk pregnancy. Patients and methods This prospective cohort research was conducted on 100 pregnant females, aged from less than 20 to more than 35 years, with a BMI more than or equal to 30.5 kg/m 2 , history of PE or eclampsia in a previous pregnancy, history of intrauterine growth restriction or stillbirth, preexisting medical disorders, and abruptio placentae. All patients were subjected to UtA Doppler in the second trimester between 18 and 22 weeks and were followed up. Results Doppler ultrasound findings were significantly higher in individuals with adverse outcomes than normal individuals. UtA resistance index (RI) and pulsatility index (PI) values showed significant predictive value of adverse outcome cases, respectively ( P <0.001), at cutoff values of more than or equal to 0.58 and more than or equal to 1.54 could predict PE case with a sensitivity of 82.35 and 94.12%, specificity of 75.9 and 93.98%, respectively. The UtA PI showed significantly better performance than UtA RI in the prediction of PE in terms of significantly higher area under the curve (0.973 compared with 0.858, respectively, P =0.049). Conclusions UtA Doppler ultrasound is an effective tool for predicting PE and other adverse pregnancy outcomes in high-risk pregnancies. Elevated Doppler indices and the presence of notches are strong indicators of adverse outcomes. The PI has proved to be a more sensitive and specific predictor compared with the RI.
Background The choroid contributes to optic nerve head perfusion, and its vascular dysfunction potentially contributes to glaucoma pathogenesis. Variations in blood flow and choroidal thickness (CT) can influence optic nerve vulnerability, highlighting the choroid’s importance in understanding glaucomatous damage. Aim To evaluate the effect of commonly used glaucoma medications on CT in patients with primary open-angle glaucoma using enhanced depth imaging optical coherence tomography (EDI-OCT). Patient and methods This cross-sectional, comparative, noninvasive study comprised 20 normal eyes and 60 eyes suffering of mild to moderate primary open-angle glaucoma who were under either monotherapy or combined therapy. Participants divided into four groups: Group I (included 20 normal eyes as control group), while Groups II, III, IV comprised glaucomatous eyes treated with (alpha-adrenergic agonists), (combined carbonic anhydrase inhibitors and β-blockers), and (prostaglandin analogues) respectively. CT was assessed at three locations: subfoveal (SFCT), 1 mm nasal, and 1 mm temporal to the fovea by Spectralis HRA-OCT in enhanced depth imaging (EDI) mode. Results Patients receiving combined carbonic anhydrase inhibitor and β-blocker therapy showed significantly decreased subfoveal and parafoveal CT compared with controls and other treatment groups. These findings suggest a more pronounced choroidal thinning effect with this combination. Conclusions Topical antiglaucoma therapy with CAIs and β-blockers may impact ocular perfusion, unlike prostaglandin analogues or alpha-adrenergic agonists. Clinicians should consider these vascular effects, particularly in patients with chorioretinal diseases or compromised ocular circulation when selecting long-term treatment options.
Background Heart block is an important complication following acute coronary syndrome (ACS) and is usually associated with worse outcomes. The atrioventricular block in the context of inferior infarction is often transient and resolves on its own or shortly after reperfusion. On the other hand, which occurs with anterior infarction is infra-Hisian in most cases and has a worse outcome because of the large area of myocardial necrosis. Aim This study aimed to shed light on these blocks complicating ACS in cases presented to the Cardiology Department of Tanta University Hospital from June 2023 to June 2024. Patients and methods Beginning in June 2023 and continuing until the study’s conclusion, 150 cases of ACS who were hospitalized at Tanta University Hospitals’ Cardiology Department and successfully treated with primary percutaneous coronary intervention will be the subject of this prospective study. Patients will be divided into two groups: group I: patients with conduction delay following ACS ( n =75). Group II: patients without conduction delay following ACS ( n =75). Results The two major findings were: patients with these complications tend to be older and with multiple comorbidities. Patients with these complications had worse outcomes. Conclusion Despite the lower incidence of atrioventricular block and intraventricular conduction delay in the context of ACS at the primary percutaneous coronary intervention era, these conduction disorders remain associated with poorer short-term outcomes.
Background The pericapsular nerve group (PENG) block is a localized anesthetic for postoperative shoulder analgesia, performed under ultrasound, targeting only sensory branches, excluding posterior mechanoreceptors. Aim The objective of this study was to assess the effectiveness of preoperative ultrasound-guided PENG in managing postoperative pain following shoulder arthroscopic surgery. Patients and methods This prospective, randomized, controlled, double-blind trial involved 60 adult participants, aged between 21 and 65 years, scheduled for unilateral shoulder arthroscopic procedures. The participants were allocated into two groups: Control group: received a sham PENG block with only 1 ml of saline, and the PENG group: received the actual PENG block containing 15 ml of 0.25% bupivacaine combined with 0.2 mg/ml of dexamethasone. Results The time taken for initial administration of rescue pain relief in group II was significantly longer than in group I, with a significant difference of P =0.001. There was a significant decrease in morphine consumption in group II in comparison with group I. The four-point satisfaction rating showed a significant difference in joint mobility and exercise duration between the PENG and control groups. Patients in the PENG group had significantly lower rates of postoperative nausea and vomiting compared with the control group. However, there was no significant difference in rotator cuff muscle strength between the two groups immediately after surgery or at 3, 6, 9, and 12 h postoperatively. Conclusions Preoperative ultrasound-guided PENG block in shoulder arthroscopy reduces pain, morphine use, rescue analgesia need, nausea/vomiting, and improves satisfaction, without impacting rotator cuff strength.
Background Colorectal cancer is the third most common cancer in (6.1%) and the second most common cancer in mortality (9.2%) worldwide. Aim This work aimed to determine clinico-epidemiological characteristics of rectal cancer, to assess the response and adverse effects of treatment of metastatic and non-metastatic rectal cancer patients and to analysis of different prognostic factors and their impact on survival (disease free survival, overall survival, and progression free survival). Patients and methods This retrospective study was carried out on 200 patients aged more than 18 years old, both sexes, diagnosed with histologically confirmed rectal cancers. Results There was significantly higher overall survival in nonmetastatic patients in males, patients younger than 50 years, patients of performance status 0–1, patients with low grade tumors, with upper-lying rectal tumors, with low T stage, with N0 stage, and significantly lower with elevated carcinoembryonic antigen, intestinal obstruction and bleeding per rectum ( P <0.05). The predictors of the probability of overall survival nonmetastatic patients demonstrated that male sex, associated comorbidities, performance status, grade, and site of the tumor are independent predictors of the probability of overall survival nonmetastatic patients. metastatic patients demonstrated that poor performance status is an independent predictor of the probability of overall survival for metastatic patients. Conclusions Nonmetastatic overall survival and disease-free survival are significantly affected by the grade of the tumor and overall survival also significantly affected by sex, comorbidities, performance status, and tumor site.
Background V-pattern intermittent exotropia (IXT) is defined by greater than or equal to 15 prism diopters (Δ), greater deviation in upgaze than downgaze, with many surgical techniques to overcome it. Aim To assess and compare the surgical outcomes of managing V-pattern IXT without notable inferior oblique overaction (IOOA) managed by bilateral lateral rectus (BLR) recession alone versus BLR recession combined with an upward transposition of lateral rectus insertion by half a tendon width. Patients and methods A randomized, prospective, interventional, comparative study included 20 patients (40 eyes) with V-pattern IXT without significant IOOA. Participants were randomized into two groups: group A ( n =10) underwent BLR recession alone, and group B ( n =10) underwent BLR recession along with upward transposition of the lateral rectus. All patients underwent preoperative and postoperative assessments, including prism cover testing and ocular motility evaluation, with follow-up for 6 months. Outcomes included postoperative alignment, change in V-pattern deviation, and pattern collapse rates. Data analysis was performed using SPSS version 25, considering P values less than 0.05 as statistically significant. Results Both groups showed a significant postoperative reduction in exodeviation. Pattern collapse occurred more frequently in group B, highlighting the added benefit of upward transposition in managing V-pattern deviation. Conclusion Both surgical techniques effectively reduced exodeviation in cases with V-pattern IXT without IOOA. However, the BLR recession combined with upward transposition provided superior efficacy in reducing pattern deviation. Future studies with extended follow-up are recommended to determine the durability of these findings.
Background Percutaneous nephrolithotomy (PCNL) is the best option for the treatment of renal calculi greater than 2 cm in diameter according to recent guidelines. To avoid increased intrarenal pressure and postoperative fever following this procedure with the upper pole hydronephrosis antegrade irrigation through a separate access in the upper pole through a nephrostomy tube has been conducted in the present study to overcome such complications. Objective Assess using of this new technique in lessening the intrarenal pressure and postoperative fever following miniaturized percutaneous nephrolithotomy (mini-PCNL). Patient and methods This prospective nonrandomized clinical study was conducted on patients with a unilateral renal stone size of 20–30 mm without contraindications to mini-PCNL. The preoperative characteristics including age, sex, BMI, stone location, and stone burden were analyzed. The primary end point is to evaluate postoperative fever. The secondary end point is to assess the stone-free rate, hemoglobin deficit, operative time, length of hospital stay, and early postoperative complications. Results Data of 40 patients were gathered. All the procedures were in prone position through two accesses. Results showed no significant difference regarding operative times. The immediate overall stone-free rate was 90%. Regarding hemoglobin deficit was 0.54 ± 0.3 g/dl. The rate of postoperative complications was four (10%) cases. Conclusion Counter-irrigation in mini-PCNL is effective for lessening postoperative fever.
Background Assessing the femoral vein-to-artery (FV/FA) diameter ratio has emerged as an indicator for predicting fluid responsiveness in children. Aim To assess the clinical effectiveness of the FV/FA diameter ratio in predicting dehydration in children. Patients and methods This study was carried out on 85 children aged from 2 to 10 years old, both sexes, scheduled for elective surgery with signs of moderate to severe dehydration in the preoperative period just before induction of anesthesia. All patients were subjected to FV/FA diameter measurement as the primary outcome. Quantitative parametric data were compared between the groups by unpaired Student’s t -test and compared before and after fluid challenge by Paired T -test. Qualitative variables were compared by χ 2 test. The overall diagnostic performance of each test was assessed by the receiver operating characteristic curve analysis. Results FV/FA, expanded FV/FA, and inferior vena cava/aorta diameter ratio was significantly higher after fluid challenge 10 ml/kg and after 30 ml/kg than before fluid challenge ( P <0.001). There was a positive correlation between FV/FA diameter and inferior vena cava/Aorta diameter ratio ( r =0.834 and P <0.001). FV/FA diameter ratio was significantly higher in moderate dehydration than severe dehydration ( P <0.001). FV/FA diameter ratio can predict dehydration in children after fluid challenge ( P <0.001) at cut-off less than or equal to 0.77 with 85.19% sensitivity, 81.03% specificity. Conclusion The FV/FA diameter ratio is a practical and noninvasive tool for predicting fluid responsiveness in children with a cut-off value of less than or equal to 0.77, demonstrating high sensitivity (85.19%) and specificity (81.03%) correlating strongly with dehydration severity.
Background Syndesmotic screw (SS) has been regarded as the gold standard for syndesmotic fixation. Syndesmosis surgical stabilization can also be accomplished by employing the suture button (SB) device, which consists of a fiber thread connecting two small metal buttons. This work aims to compare SB versus SS when treating distal tibiofibular syndesmotic injuries. Patients and methods The team designed a prospective randomized controlled clinical study including 42 cases, with ages between 18 and 60 years old, both sexes, developing ankle syndesmotic diastasis. Cases were categorized into two equal groups: group A, undergoing SB fixation, and group B, undergoing SS fixation. Results Visual analog scale at 6-month follow-up exhibited a significant reduction within group A as opposed to group B ( P =0.011). Range of motion showed a significant increase within group A as opposed to group B ( P <0.001). American orthopedic foot and ankle society (AOFAS) at 6 weeks exhibited a significant increase within group A as opposed to group B ( P <0.001). Postoperative complications exhibited insignificant variance between the groups. Conclusion Patients who had SB treatment had higher American orthopedic foot and ankle society scores and reduced (more favorable) visual analog scale scores for pain when walking, as well as discomfort on resting. Therefore, we can say that, as compared with the SS approach, the SB technique produces better functional outcomes and reduced incidence of damaged implants and joint malreduction. Therefore, at present moment, the SB approach is advised for the treatment of syndesmosis injury.
Background The renal Doppler ultrasound shows an effective and reliable method for evaluation of fluid administration and response to fluid in sepsis patients. Aim This research aimed to investigate renal resistive index (RRI) predictive value in sepsis patients in detecting the response to fluid administration, considering the changes in RRI values over 7 days from admission. Patients and methods This prospective observational cohort study was performed on 45 participants who presented to ICU with suspected or evident diagnosis of sepsis based on sepsis 3 criteria. The participants were categorized into two groups: a fluid nonresponsive group ( n =14) and a fluid responsive group ( n =31). Results There were changes in hemodynamics, acid base disturbance and lactate, these changes were going with the changes in RRI values which were high in most of participants on admission and gradually improved in fluid responsive group with fluid resuscitation but elevated or maintained in fluid nonresponsive group. RRI can significantly predict fluid responsiveness with high sensitivity and specificity. Fluid nonresponsive participants possessed a significantly longer ICU stay in comparison with fluid responsive participants ( P <0.001). The mortality rate within 28 days was substantially greater among fluid nonresponsive participants in comparison with fluid responsive participants ( P =0.022). Conclusion Based on Doppler ultrasound, RRI is a rapid, noninvasive, and bedside technique with good predictive value for evaluation fluid administration and predicting fluid responsiveness in sepsis patients. RRI is a valuable tool in predicting fluid responsiveness with high sensitivity and high specificity.
Background Phacoemulsification is the gold-standard cataract extraction technique. However, diabetic patients have increased risk of postoperative macular edema (ME). Spectral-domain optical coherence tomography (OCT) enables early detection of macular changes. Aim To evaluate changes in central macular thickness (CMT) after uncomplicated phacoemulsification with posterior chamber intraocular lens implantation in type II diabetic patients—with and without nonproliferative diabetic retinopathy—using spectral-domain OCT. Patients and methods This prospective interventional study included 60 eyes of 60 diabetic patients: group A (no diabetic retinopathy, n=30) and group B (nonproliferative diabetic retinopathy without ME, n=30). CMT was measured preoperatively and at 1 and 3 months postoperatively using NIDEK retina scan (NIDEK RS)/3000 OCT. Best-corrected visual acuity, intraocular pressure, and cataract grading (early treatment of DR study scale) were recorded. Repeated measures analysis assessed within-group CMT changes; intergroup differences were analyzed using Mann–Whitney and t -tests. Ethics Approval was granted by the Faculty of Medicine’s committee on 30 April 2020 (Approval Code: 33806/4/20). Informed written consent was obtained. Results Patients with no diabetic retinopathy on fluorescein angiography (Figs. 1A, 2A) and OCT (Figs. 1B, 2B) showed CMT increases at 1 month (group A: 234.3 ± 20.1 to 276.2 ± 65.0 µm; group B: 258.4 ± 41.9 to 296.7 ± 66.4 µm; P < 0.001) (Figs. 1C, 2C), with partial regression at 3 months (A: 254.8; B: 258.4) (Figs. 1D, 2D). No significant intergroup differences were noted. Conclusion Phacoemulsification in diabetic eyes causes transient macular thickening peaking at 1 month. OCT is valuable for early ME detection.
Background Carbon dioxide (CO 2 ) has anesthetic potency and effectively influences the circulatory system. There’s a relationship between end-tidal carbon dioxide (EtCO 2 ) levels and the anesthetic’s requirements during the surgical procedure. Aims We aimed to evaluate how varying EtCO 2 levels influence end-tidal sevoflurane (EtSevo) concentration in patients undergoing laparoscopic cholecystectomy. Patients and methods A total of 90 patients aged 30–65, both sexes, American Society of Anesthesiology class I-II, undergoing elective laparoscopic cholecystectomy were recruited for this randomized double-blinded prospective study. Patients were classified by computer-generated random sequence into three equal groups (L, N, and H). The measured EtSevo concentration at 30 min after pneumoperitoneum was the primary outcome. Results EtSevo at all recordings presented statistically significant variance ( P <0.05). The overall sevoflurane consumption in group L was significantly higher than in group N, and group H ( P <0.001). There was a statistically significant variance in the patients’ number who needed to increase sevoflurane and IV bolus fentanyl between the three studied groups ( P <0.05). The intracranial pressure and surgical field quality comparisons showed no statistically significant differences. ( P >0.05). Conclusions The high EtCO 2 levels (40–45 mmHg) could be valuable in patients undergoing laparoscopic cholecystectomy as it had better hemodynamic stability, lower-end-tidal and total consumption of sevoflurane with an effective anesthesia depth and nonclinical significant changes in ABG and no changes in intracranial pressure and surgical field quality assessments compared with the low EtCO 2 (25–30 mmHg) and normal EtCO 2 (30–40 mmHg).
Background Vitamin D deficiency contributes to rheumatoid arthritis (RA) activity. It regulates the immune response through various pathways. Augmented pain perception in vitamin D deficiency is linked to increased sensitivity of the nerves. Aim Assessment of vitamin D levels in RA patients and their correlation with disease activity, as well as any potential association between vitamin D and neuropathic pain (NP). Patients and methods The study included 40 RA patients and 40 matched apparently healthy controls without NP. Patients were divided into two groups: group I: ( n =20), RA patients with NP (LANSS≥12), group II: ( n =20), RA patients without NP (LANSS<12). Vitamin D levels were measured in RA patients and controls. RA patients with NP and controls were evaluated by nerve conduction study. Disease activity score 28 (DAS28) was assessed. Results RA patients had significantly lower vitamin D than controls (16.68 ± 7.37 ng/ml and 24.4 ± 6.02 ng/ml vs. 29.86 ± 4.09 ng/ml; P <0.001). Serum vitamin D was correlated inversely with LANSS, DAS28, and modified health assessment questionnaire in RA patients. Carpal tunnel syndrome was detected in (65%), peripheral polyneuropathy in (50%), and mononeuritis multiplex in (10%) of RA patients with NP. Conclusion Vitamin D deficiency is more prevalent in RA, associated with high DAS28, and could be a cause of NP.
Background Albuminuria represents a biomarker for cardiovascular disease risk and a predictor of chronic kidney disease onset. Increased urinary albumin excretion is a sign of systemic vascular illness, which includes arterial stiffness, myocardial capillary dysfunction, and kidney injury. An elevated risk for micro-vascular disease, coronary artery disease, stroke, heart failure (HF), and arrhythmias associated with albuminuria. Nowadays, a number of substances can diminish albuminuria and lower the cardiovascular disease risk however, there is still little albuminuria screening. Aim Understand albuminuria occurrence in patients with established HF to ascertain the association between HF class and albuminuria and demonstrate that albuminuria is reversible with HF medication. Patients and methods The upcoming research involved 100 participants diagnosed with impaired systolic function; albuminuria was estimated by urinary albumin/creatinine ratio in two random urine samples before and after improvement. Two groups of patients were formed. Group A: patients with albuminuria being measured before and after improvement of HF manifestations. Group B: patients without albuminuria being measured before and after improvement of HF manifestations. Results Micro-albuminuria presented in one-third of HF patients, with no correlation between albuminuria and HF class. After HF medication, there was a significant drop in albuminuria. Conclusion Micro-albuminuria presented in 36% and macro-albuminuria in 12% of HF patients, mostly had diabetes, hypertension, or decreased estimated glomerular filtration rate. After treatment, albuminuria significantly improved without discernible relationship to HF class. Further testing for underlying renal impairment is necessary if persistent albuminuria after treatment.
Background The most common long-term complication of phacoemulsification cataract surgery is posterior capsule opacification or secondary cataract. Currently, neodymium-doped yttrium aluminum garnet is the most efficacious treatment for visually significant posterior capsule opacification in pseudophakic eyes. Laser capsulotomy is another option. Aims This study aimed to evaluate the central retina’s response to yttrium aluminum garnet laser capsulotomy using optical coherence tomography. Patients and methods This cross-sectional comparative study was carried out on 30 pseudophakic eyes of 30 patients who underwent phacoemulsification at the Ophthalmic Department, Faculty of Medicine, Tanta University. All patients underwent examination of visual acuity, intraocular pressure measurement, fundus examination, spectral domain optical coherence tomography, and slit lamp biomicroscopy. Results The mean central retinal thickness and all retinal quadrants in the inner circle (3 mm diameter) showed a highly significant difference ( P <0.01) between the preoperative and 1-month postoperative values. In comparison to preoperative and 1-month postoperative values, the mean central retinal thickness and all retinal quadrants in the outer circle (5 mm diameter) exhibited a statistically significant difference ( P <0.05). The two parameters exhibited a highly significant positive correlation ( r =0.8201, P <0.001). Conclusions Immediately following the neodymium-doped yttrium aluminum garnet laser capsulotomy, the visual axis was cleared of opacification, resulting in an immediate enhancement in visual functions.
Background In sports medicine, MRI has emerged as a noninvasive diagnostic technique for assessing various injuries. T2 mapping of articular cartilage can be used to identify early subclinical cartilage affection. Aim To analyze the effectiveness of MRI in diagnosing various knee joint ailments in children and teenagers. Patients and methods 50 children and adolescents, both sexes, aged between 6 and 18 years, complaining of knee joint injuries connected to sports, participated in this prospective research. MRI was performed on all children and adolescents. Results In comparing arthroscopies and surgery results to MRI findings, regarding anterior cruciate ligament injury, out of 18 MRI reported cases of anterior cruciate ligament tear, there were 16 true positive and 2 true negative. Only 3 cases of posterior cruciate ligament injury were evaluated with 100% sensitivity and specificity. Regarding medial meniscus injury, it has a sensitivity and specificity of 87.5 and 90.6%, respectively, compared with lateral meniscus sensitivity of 69.2% and specificity of 97.2%, 4 false negative cases of lateral meniscus root tear. Adding the T2 mapping sequence to conventional MRI increased its sensitivity to detect early focal cartilage affection from 50 to 85.7%. Conclusion MRI was proven to be the optimal imaging modality to evaluate different patterns on knee joint sports injury as it detects not only the type but also the extent of injury and thus predicts the proper timing for athletes to return to play and guide sports regimens modification.
Background Thoracotomy is a severe burden on children and is well-known to induce intense, acute pain. Aim To evaluate the effectiveness of serratus anterior plane block (SAPB) and thoracic erector spinae plane block (ESPB) in reducing pain in pediatric patients following thoracotomy. Patients and methods This prospective randomized study involved 105 participants aged two to seven years planned for thoracotomy. All individuals were classified into three equal groups: group I: administered general anesthesia (GA) alone as a control group, group II: administered GA with ultrasound guided SAPB, and group III: administered GA with ultrasound-guided ESPB. Results Groups II and III had substantially lower Face, leg, activity, cry, and consolability score (FLACC) at 3 h compared with group I, although there was not a substantial distinction between groups II and III. Face, leg, activity, cry, and consolability score was found to be considerably lower in groups II and III at 6–8 h compared with group I and III than group II. Time of first rescue analgesia was significantly higher in (group II and III) compared with group I and III compared with group II. Conclusion Both SAPB and ESPB provide superior analgesic effects in comparison with control in children who underwent thoracotomy. However, as compared with SAPB, ESPB offers better analgesia with delayed time of first-rescue analgesia, more hemodynamic stability, lower morphine consumption, and pain scores.
Background Although all participants with prostate cancer (PCa) firstly respond to androgen-deprivation treatment (ADT), after a long period of ADT, nearly all patients with hormone-sensitive prostate cancer (HSPC) progress to castration-resistance prostate cancer (CRPC). With ADT, prostate-specific antigen (PSA) is a significant biomarker of PCa development, with studies indicating that shorter delay to the formation of castration-resistant PCa can be indicated by lower PSA levels and longer time to PSA Nadir [time to nadir (TTNs)]. Aim This study aimed to discover clinical predictors of early responsiveness to ADT that were linked with a less time to castration resistance in metastatic PCa. Patients and methods This retrospective multivariate descriptive analysis study included 100 patients with metastatic prostatic cancer at the Department of Clinical Oncology, Tanta University. Results There was a substantial variation in time to castration resistance across Gleason score groups. There was no substantial connection between time to castration resistance and age, bone metastasis, or starting PSA level; however, there was a significant correlation between time to castration resistance and Gleason score, PSA nadir, and time to PSA nadir. Multivariate Cox regression analysis revealed a substantial connection between Gleason score, PSA nadir, and time to nadir and progress to castration resistance. Initial PSA levels were not substantially associated with progression to castration resistance in multivariate Cox regression analysis. Conclusion Higher Gleason grade group, higher PSA nadir, and shorter TTN were associated with higher risk of progression to castration-resistant PCa in patients with mPCa.
Background Dexmedetomidine (DEX), an alpha-2 agonist, supplements local anesthetics in neuraxial and peripheral nerve blocks. This study examined the effects of adding DEX to bupivacaine in ultrasonography-guided quadratus lumborum block (USG-QLB) for postoperative analgesia in laparoscopic cholecystectomy (LC). Aim To evaluate the effect of adding DEX as an adjuvant to bupivacaine in USG-QLB for postoperative analgesia in LC. Patients and methods This prospective randomized controlled double-blinded study included 96 elective LC patients aged 21–65 of both sexes. Group I (bupivacaine group) received general anesthesia and bilateral USG-transmuscular QLB (TMQLB) with (20 ml bupivacaine 0.25%). Group II (bupivacaine+DEX group) received general anesthesia and bilateral USG-TMQLB with (20 ml bupivacaine 0.25%+DEX 1 μg/kg). Results Group II had significantly lower mean arterial blood pressure following surgery compared to group I, with no significant differences before or after skin incision (5, 15, or 30 min). Group II, lower heart rate changes after skin incision compared to group I. Group II had smaller change in the numerical rating scale at 6, 12, and 18 h compared to group I, but no significant difference immediately after discharge. In group II, intraoperative fentanyl and postoperative morphine were significantly lower than in group I. Conclusion DEX added to bupivacaine in USG-TMQLB for LC enhanced analgesia and hemodynamic stability by lowering mean arterial blood pressure, heart rate, and pain ratings, reducing opioid consumption, and delaying rescue analgesia.
Background Fibromyalgia syndrome is characterized by fatigue, general pain and sleep disorder. Studies found that fibromyalgia patients are more exposed to vitamin D deficiency and that supplementation may be an effective treatment. Aim To evaluate the vitamin D level in individuals with primary fibromyalgia and its correlation with the clinical, functional, and psychological status of these patients and to evaluate the impact of vitamin D therapy on these individuals. Patients and methods The study included 30 patients diagnosed with primary fibromyalgia, in addition to 15 healthy volunteers matched in age and sex. Serum vitamin D level was evaluated in all participants. The participants were allocated into two groups based on levels of serum vitamin D. Group 1 included 21 patients with reduced levels and group 2 included nine patients with normal levels. All patients received pregabalin and tricyclic antidepressants plus a weekly dosage of 50 000 IU vitamin D for group 1 for 2 months. Results Vitamin D was deficient in 70% of patients and in 13.3% of control groups. A substantial variation existed among groups 1 and 2 before treatment in all scales and the fibromyalgia impact questionnaire and visual analog scale scales only after treatment ( P =0.009 and 0.005, respectively). A substantial association existed among serum level of vitamin D and visual analog scale, fibromyalgia impact questionnaire scales before and after treatment in group 1. While there was no significant correlation in group 2. Conclusion Vitamin D supplementation may be an effective fibromyalgia therapeutic approach.
