Background:Septic shock is a severe form of sepsis characterized by circulatory failure and organ dysfunction, often requiring vasopressor support to maintain adequate mean arterial pressure. Norepinephrine is the recommended first-line vasopressor, but new-onset atrial fibrillation (AF) is a common complication in septic shock patients receiving vasopressors, potentially influenced by vasopressor choice. This study compares the incidence of new-onset AF and related cardiac outcomes in septic shock patients treated with norepinephrine versus phenylephrine. Objective:To compare the incidence of new-onset AF within 72 hours of vasopressor initiation in adult septic shock patients treated with norepinephrine versus phenylephrine. Methods:A retrospective observational cohort study was conducted using the TriNetX database, including adult septic shock patients without prior AF who received either norepinephrine or phenylephrine. Propensity score matching balanced baseline characteristics across cohorts. The primary outcome was incidence of new-onset AF; secondary outcomes included cardioversion events, rate control medication use, other arrhythmias, and embolic stroke incidence. Outcomes were analyzed using Cox proportional hazards models and Kaplan-Meier survival curves. Results:After matching, 138,051 patients were included in each group. New-onset AF occurred in 0.3% of norepinephrine-treated patients versus 0.01% in the phenylephrine group (OR 3.05; 95% CI: 2.55-3.65; p < 0.001). Norepinephrine use was also associated with significantly increased rates of electrical and pharmacological cardioversion, rate control medication utilization, other arrhythmias, and embolic stroke (all p < 0.001). Kaplan-Meier analysis confirmed higher AF incidence in the norepinephrine group (log-rank p < 0.001). Conclusion:In septic shock patients, norepinephrine is associated with a significantly higher risk of new-onset AF and related adverse cardiac events compared to phenylephrine. These findings suggest vasopressor choice may influence arrhythmia risk and highlight the need for prospective studies to guide optimal vasopressor selection and management strategies in this population.
Background:Superficial parotidectomy is the traditional treatment for benign parotid tumors but may be associated with facial nerve dysfunction and other morbidities. Intracapsular parotidectomy has emerged as a function-preserving alternative; however, concerns regarding oncologic safety remain. Randomized evidence comparing both techniques is limited. Therefore, this study aimed to compare their functional and oncologic outcomes. Objective:This study aimed to compare intracapsular parotidectomy and superficial parotidectomy in terms of operative efficiency, complications, facial nerve preservation, and tumor recurrence for benign parotid tumors. Methodology:This multicenter randomized controlled trial included patients with benign parotid tumors who were randomly assigned to undergo either intracapsular or superficial parotidectomy between May 2019 and May 2023, in Cairo, Egypt. Functional outcomes, postoperative complications, and recurrence rates were evaluated. Results:The mean age was 46.3 ± 9.5 years, with a range of 25-65 years. Most patients (84, 70%) were male, while 36 (30%) were female. The intracapsular parotidectomy (ICP) group demonstrated significantly reduced operative time (68.5 ± 12.3 vs. 88.3 ± 14.5 minutes; p = 0.01) and blood loss (120 ± 55.3 vs. 170 ± 50.5 ml; p = 0.001) compared to the superficial parotidectomy (SP) group. Facial nerve injury occurred exclusively in the SP group 9 (15%), including 3 (5%) cases of permanent palsy. Recurrence was observed in 1 (1.7%) ICP case and 3 (5%) SP cases, with no statistically significant difference (P > 0.05). Other complications, including seroma formation and postoperative bleeding, were similarly distributed between the two groups. Conclusion:Intracapsular parotidectomy is a safe, effective, and less invasive alternative to superficial parotidectomy for benign parotid tumors. It offers shorter operative time, reduced bleeding, and improved facial nerve preservation without compromising oncological outcomes. Careful patient selection is essential for optimal results.
ABSTRACT Background: Cardiotoxicity remains a major limitation in breast cancer treatment, especially with anthracyclines and radiotherapy. Early biomarkers may improve risk stratification. Methods: This retrospective cohort study included breast cancer patients treated between 2020 and 2023 with chemotherapy and/or radiotherapy. Troponin I (TPI) and N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured at baseline and at three, six, 12, 18, 24, 30, and 36 months. Cardiotoxicity was defined per European Society of Cardiology (ESC) guidelines as a ≥10% drop in left ventricular ejection fraction (LVEF) to <53% or >15% relative reduction in global longitudinal strain (GLS). Receiver operating characteristic (ROC) analysis, logistic regression, and mixed-effects models assessed associations. Results: A total of 190 patients were included; 141 patients (74.2%) developed cardiotoxicity within 12 months. At six months, NT-proBNP (median: 212.6 pg/mL) and TPI (0.038 ng/mL) were significantly higher in the cardiotoxic group ( p < 0.01). ROC area under the curve (AUC) for NT-proBNP at six months was 0.83 (95% CI: 0.77–0.89); for TPI, AUC = 0.79 (95% CI: 0.73–0.86). Multivariable regression showed both biomarkers remained independent predictors of cardiotoxicity after adjustment for GLS and cumulative anthracycline dose (NT-proBNP: OR 1.78 [95% CI 1.22–2.61], p = 0.003). Conclusion: In this real-world breast cancer cohort, serial NT-proBNP and TPI monitoring, particularly at 3 and 6 months, provided meaningful early prognostic information for subsequent cardiotoxicity beyond baseline assessment alone. When integrated with echocardiographic surveillance, these biomarkers may support earlier identification of high-risk patients, more tailored cardio-oncology follow-up, and timely cardioprotective intervention, although prospective external validation is required before routine implementation.
ABSTRACT Background: Managing umbilical hernia in cirrhotic patients is complex. No prior national studies have examined the outcomes associated with treatment approaches for this demographic. Objectives: To evaluate the results of cirrhotic patients with umbilical hernia treated conservatively compared to those who underwent elective surgical hernia repair. Methodology: This is a retrospective cohort study conducted over 5 years period from January 2017 to December 2022 at King Abdulaziz Medical City and King Abdullah Specialized Children’s Hospital in Riyadh, Saudi Arabia. A comparison was conducted between those who underwent elective umbilical hernia repair and those treated conservatively. A chi-square test was used for categorical variables, while t-test and analysis of variance were used for numerical and categorical variables. Results: The study included 70 patients, out of which 54 patients initially planned for conservative treatment, and 21 eventually underwent emergent umbilical hernia repair. In the elective surgery group, 11 (68.8%) had a Child A score, whereas the emergency group had 9 patients (42.9%) with a Child B score and 10 patients (47.6%) with a Child C score ( p = 0.001). Post-operatively, 12 patients (57.1%) required intensive care unit (ICU) admissions in the emergency group compared to only 2 patients (12.5%) in the elective group ( p = 0.006). Conclusion: Expectant management of cirrhotic patients with umbilical hernia and ascites often results in a higher complication rate, frequently leading to emergency surgery, which is associated with significant morbidity. In contrast, elective hernia repair typically results in fewer complications and is therefore recommended.
Background:Endothelial dysfunction, defined by decreased bioavailability of nitric oxide (NO) and increased levels of asymmetric dimethylarginine (ADMA), has been proposed to play a central role in Coronary Artery Disease (CAD) pathophysiology. A selective β-blocker, nebivolol, could offer benefits in affecting this pathway after revascularization. Objective:The objective of this study is to determine the influence of nebivolol on serum NO levels and ADMA in patients with CAD who underwent successful elective percutaneous coronary intervention (PCI). Methods:In this prospective randomized double-blind placebo-controlled clinical study, 172 subjects with confirmed obstructive CAD and scheduled for PCI were recruited. After successful revascularization, patients were randomized to receive nebivolol 5 mg once daily (n = 89) or placebo (n = 83) for 42 days. Serum NO (μmol/L) and ADMA (ng/mL) were assessed at baseline and day 42 by colorimetry and ELISA, respectively. Paired t-tests and Analysis of Covariance (ANCOVA) analyses were performed for comparisons within and between the groups, respectively, after adjustment for baseline values. Results:The baseline clinical parameters and biomarker values were found to be equivalent between groups. After 42 days of therapy, there was a marked increase in serum NO levels among the nebivolol group (from 85.25 ± 9.8 to 128.47 ± 6.2; p < 0.001), whereas there was no change in the placebo group (p = 0.85). Simultaneously, there was a decrease in the levels of ADMA in the nebivolol-treated subjects (from 169.68 ±12.8 to 153.70 ±12.7; p < 0.001) and no change in the placebo-treated group. The ANCOVA analysis between the two groups for both markers was found to be highly significant at Day 42 (p < 0.001), independent of concomitant medications or baseline profiles. Conclusion:In patients after PCI, treatment for 42 days was found to significantly enhance NO availability and decrease systemic ADMA concentration by nebivolol. These results clearly establish that nebivolol has the potential to restore vascular homeostasis in the high-risk vascular window, hence making it an ideal supplementary treatment for patients having atherosclerotic diseases.
