Background: Ventilation-associated pneumonia (VAP) is the most frequent infection occurring in pa... more Background: Ventilation-associated pneumonia (VAP) is the most frequent infection occurring in patients after admission to the intensive care unit. It is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation. Aim: To improve care of intubated and ventilated patients in ICU. Methods: 100 patients admitted to the ICU of Suez Canal University Hospital were recruited in a randomized controlled clinical trial. They were all intubated and mechanically ventilated. The patients were then randomly allocated into one of two equal groups; Group A patients were managed with current ICU protocol and Group B patients were managed with ventilator care bundle after its application. The primary outcomes included comparison of incidence of VAP of ventilated patients in ICU with current care management and after implementation of ventilator care bundle. The secondary outcomes included ventilation days, ICU stay, and hospital stay and m...
In recent times, the shape of the beams evolved from wooden sleepers and then to steel sleepers u... more In recent times, the shape of the beams evolved from wooden sleepers and then to steel sleepers until they reached concrete sleepers. These sleepers play a very important role in transferring the loads from the train wheels to the subgrade layers fixed by the railway. This development took place in concrete sleepers until we reached mono-block concrete sleepers. This paper discusses, through laboratory experiments, the effect of ultra-high performance concrete mixtures on the behavior of mono-block concrete sleeper B70. The ability of these new sleepers to resist train loads was also studied, compared to its conventional concrete sleepers. This research aimed to determine through experiment if these sleepers' behavior fulfilled the European requirements standers for prestressed concrete sleepers, and make comparisons between the UHPC sleepers and conventional concrete sleepers. All these sleepers were tested under static load tests at the rail seat and center section and pull-ou...
Objective: To assess serum resistin levels as a predictor of outcome in ICU patients with traumat... more Objective: To assess serum resistin levels as a predictor of outcome in ICU patients with traumatic head injuries at Suez Canal University Hospital, to improve outcomes in such patients. Patients and Methods: In total, 48 patients with severe traumatic brain injury (TBI) were included. Plasma samples were obtained on admission and at days 3 and 5 after TBI. Resistin concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Outcome (morbidity and mortality) was assessed at 14 days in the ICU using the Glasgow Outcome Scale (GOS). Results: The mean age of the patients was 32.3±8.1 years; most were males (91.7%). The mean GOS on admission was 6/15. Most of the patients showed multiple findings on CT (58.3%). Twelve (25%) patients died. A multiple logistic regression model showed that GOS on admission <7/15, random blood sugar (RBS) on admission >200mg/dL, and bilateral non-reactive pupils in the assessment were significant predictors of 14-day mortality (OR...
Purpose: To determine which of the two transversus abdominis plane (TAP) block formulations (Bupi... more Purpose: To determine which of the two transversus abdominis plane (TAP) block formulations (Bupivacaine, Bupivacaine-Morphine) has the most beneficial effect on the postoperative analgesia for 24hrs after Inguinal Herniorrhaphy. Methods: Thirty-six patients undergoing inguinal hernior-raphy with preset criteria after obtaining a written informed consent were randomized into 2 equal groups. Both groups were received Ipsilateral TAP block with landmark technique after receiving standard general anesthesia: Bupivacaine group (BG, n=18); received TAP block with 25ml bupivacaine 0.5% while Bupivacaine-Morphine (BMG, n=18) group; received TAP block with 25ml bupivacaine 0.5%+2mg morphine. Both groups received patient-controlled i.v. morphine. Postoperative pain was assessed (at rest and at movement) using a visual analog pain scale (VAS) and Verbal pain score (VPS) at postanesthesia care unit and 3, 6, 12 and 24h postoperatively as will as first request of morphine, interval consumption ...
... Address for Correspondence: Dr. Hanan Mohamed Kamal, Cardiology Department, Faculty of Medici... more ... Address for Correspondence: Dr. Hanan Mohamed Kamal, Cardiology Department, Faculty of Medicine, Suez Canal University. Page 119. ... 6-Du ZD, Hijazi ZM, Kleinman CS, et al: Comparison between transcatheter and surgical closure of secundum atrial septal ...
To determine the dose of hyperbaric bupivacaine 0.5% required for unilateral spinal anesthesia du... more To determine the dose of hyperbaric bupivacaine 0.5% required for unilateral spinal anesthesia during diagnostic knee arthroscopy. This prospective, randomized, clinical study was performed in 80 patients who were assigned to four groups to receive different doses of intrathecal hyperbaric bupivacaine (5 mg, 7.5 mg, 10 mg and 12.5 mg in Groups 1, 2, 3, and 4 respectively). Onset of sensory and motor block, hemodynamic changes, regression of motor block, and incidence of complications were recorded. Unilateral sensory block was reported in 90% and 85% of patients in Group 1 and Group 2, respectively, but not in any patient in Group 3 and Group 4. Unilateral motor block (modified Bromage scale 0) was reported in 95% of patients in Group 1, 90% in Group 2, and only 5% in Group 3, while no patient in Group 4 showed unilateral motor block. The time required for regression of motor block (Bromage scale 0) was prolonged with higher doses. The incidence of nausea, vomiting, and urine retent...
Context Rational: Several techniques have been proposed to prevent or attenuate the hemodynamic r... more Context Rational: Several techniques have been proposed to prevent or attenuate the hemodynamic responses following laryngoscopy and intubation, preoperative melatonin has a significant analgesic and anxiolytic effect for patients undergoing surgery. Melatonin may play an important role in controlling hypertension also in humans. The current study aimed at assessing the usefulness of melatonin in attenuating the pressor response to direct laryngoscopy and tracheal intubation. Methods: After approval of the ethics committee and informed written patients consent the study was carried out at rotine surgical theatre of the Suez Canal University Hospital, during the peroid from 2011 -2012 on 90 patients with ASA physical status I, II scheduled for any elective surgery under general anesthesia with endotracheal intubation. Patients were randomly allocated according to computer-generated randomization into three groups: Group I (control group); Group II (melatonin 6mg tablet group) and Gro...
Abstract There are a limited number of studies that compared kinemyography (KMG) and mechanomyogr... more Abstract There are a limited number of studies that compared kinemyography (KMG) and mechanomyography in the clinical practice but few studies compared KMG to electromyography (EMG) either in adults and none in children. This study compared the time course data for rocuronium relaxation measured by KMG to that measured by EMG in children 2- 6 years old. Methods: 24 children ASA I or II of both sexes, aged 2- 6 years, scheduled for elective surgery under GA were included in the study. Premed with midazolam 0.3mg/kg orally. Monitoring included ECG, NIBP, pulse oximetry, capnography, anesthetic gas monitor and temperature. NMT monitoring consisted of attaching the pediatric KMG sensor (NMT mechanosensor, for Datex GE, S5) in one hand, while the other hand had a 5 lead EMG (EMG for Datex GE, S5) for simultaneous recoding of both modalities. Anesthesia was induced with fentanyl 2mg/kg and propofol 2mg/kg followed by endotracheal intubation. Ventilation was maintained by endtidal isoflurane 1.2% in 50% oxygen/air to maintain endtidal CO2 32-35mmHg. After 3 minutes of stable supramaximal stimulation, a train of four stimulus was applied every 15sec. each patient had a single dose of 0.6mg/kg rocuronium. The following parameters were collected (1) Lag time, (2) Onset time, (3) Assessing the recovery period by; train of four (TOF) 0.25, 0.50, 0.75 and 0.90. No top-up doses of rocuronium were given. Statistical analysis was done as appropriate. Results: There were no statistically significant differences in the lag time, the onset time, TOF 0.25, 0.5, 0.75 and 0.9 ratios using either EMG or KMG. In addition, there was an excellent degree of agreement between EMG and KMG in measuring TOF ratio during both induction and recovery of rocuronium. Conclusion: KMG showed an excellent degree of agreement with EMG for determination of onset and recovery of a single dose of rocuronium in children. For clinical purposes, time course data obtained from KMG can be interchanged with that data obtained from EMG using rocuronium in
OBJECTIVE To compare two different supraglottic airway devices, the laryngeal mask airway (LMA) a... more OBJECTIVE To compare two different supraglottic airway devices, the laryngeal mask airway (LMA) and the I-gel, regarding easiness of insertion of the device, leak pressure, gastric insufflation, end tidal CO2, oxygen saturation, hemodynamic and postoperative complications in anesthetized, spontaneously ventilated adult patients performing different non-emergency surgical procedures. MATERIALS AND METHODS The study was carried out as a prospective, randomized, clinical trial among 80 patients who underwent different surgical procedures under general anesthesia with spontaneous ventilation in supine position. They were equally randomized into two groups: I-gel and LMA groups. Both the devices were compared with regard to heart rate, arterial BP, SPO2, end-tidal CO2, number and duration of insertion attempts, incidence of gastric insufflation, leak pressure and airway assessment after removal of the device. RESULTS No statistically significant difference was reported between both the g...
Context Rational: Several techniques have been proposed to prevent or attenuate the hemodynamic r... more Context Rational: Several techniques have been proposed to prevent or attenuate the hemodynamic responses following laryngoscopy and intubation, preoperative melatonin has a significant analgesic and anxiolytic effect for patients undergoing surgery. Melatonin may play an important role in controlling hypertension also in humans. The current study aimed at assessing the usefulness of melatonin in attenuating the pressor response to direct laryngoscopy and tracheal intubation. Methods: After approval of the ethics committee and informed written patients consent the study was carried out at rotine surgical theatre of the Suez Canal University Hospital, during the peroid from 2011 – 2012 on 90 patients with ASA physical status I, II scheduled for any elective surgery under general anesthesia with endotracheal intubation. Patients were randomly allocated according to computer-generated randomization into three groups: Group I (control group); Group II (melatonin 6mg tablet group) and Gr...
Background: The responsibility of the anesthesiologist is to maintain airway patency for better o... more Background: The responsibility of the anesthesiologist is to maintain airway patency for better oxygenation. Perhaps the most dangerous incident for the anesthesiologist, are encountering the scenario in which intubation and ventilation in a patient are impossible. The study of mask ventilation is far more limited. The first significant manuscript focused on mask ventilation was published in 2000. In this study we studied the effect of position on the Mallampati class, and its accuracy in the prediction of difficult mask ventilation. Methods: After ethics committee approval; Three hundred thirty patients were examined, in both supine and upright positions for the assessment of the Mallampati airway class. The results of the two different situations were evaluated for the prediction of difficult mask ventilation. The sensitivity, specificity, positive and negative predictive values were obtained. Results: In this study, 88 (26.66%) patients had difficult mask ventilation. (21.21%) wi...
Background: Ventilation-associated pneumonia (VAP) is the most frequent infection occurring in pa... more Background: Ventilation-associated pneumonia (VAP) is the most frequent infection occurring in patients after admission to the intensive care unit. It is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation. Aim: To improve care of intubated and ventilated patients in ICU. Methods: 100 patients admitted to the ICU of Suez Canal University Hospital were recruited in a randomized controlled clinical trial. They were all intubated and mechanically ventilated. The patients were then randomly allocated into one of two equal groups; Group A patients were managed with current ICU protocol and Group B patients were managed with ventilator care bundle after its application. The primary outcomes included comparison of incidence of VAP of ventilated patients in ICU with current care management and after implementation of ventilator care bundle. The secondary outcomes included ventilation days, ICU stay, and hospital stay and m...
In recent times, the shape of the beams evolved from wooden sleepers and then to steel sleepers u... more In recent times, the shape of the beams evolved from wooden sleepers and then to steel sleepers until they reached concrete sleepers. These sleepers play a very important role in transferring the loads from the train wheels to the subgrade layers fixed by the railway. This development took place in concrete sleepers until we reached mono-block concrete sleepers. This paper discusses, through laboratory experiments, the effect of ultra-high performance concrete mixtures on the behavior of mono-block concrete sleeper B70. The ability of these new sleepers to resist train loads was also studied, compared to its conventional concrete sleepers. This research aimed to determine through experiment if these sleepers' behavior fulfilled the European requirements standers for prestressed concrete sleepers, and make comparisons between the UHPC sleepers and conventional concrete sleepers. All these sleepers were tested under static load tests at the rail seat and center section and pull-ou...
Objective: To assess serum resistin levels as a predictor of outcome in ICU patients with traumat... more Objective: To assess serum resistin levels as a predictor of outcome in ICU patients with traumatic head injuries at Suez Canal University Hospital, to improve outcomes in such patients. Patients and Methods: In total, 48 patients with severe traumatic brain injury (TBI) were included. Plasma samples were obtained on admission and at days 3 and 5 after TBI. Resistin concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Outcome (morbidity and mortality) was assessed at 14 days in the ICU using the Glasgow Outcome Scale (GOS). Results: The mean age of the patients was 32.3±8.1 years; most were males (91.7%). The mean GOS on admission was 6/15. Most of the patients showed multiple findings on CT (58.3%). Twelve (25%) patients died. A multiple logistic regression model showed that GOS on admission <7/15, random blood sugar (RBS) on admission >200mg/dL, and bilateral non-reactive pupils in the assessment were significant predictors of 14-day mortality (OR...
Purpose: To determine which of the two transversus abdominis plane (TAP) block formulations (Bupi... more Purpose: To determine which of the two transversus abdominis plane (TAP) block formulations (Bupivacaine, Bupivacaine-Morphine) has the most beneficial effect on the postoperative analgesia for 24hrs after Inguinal Herniorrhaphy. Methods: Thirty-six patients undergoing inguinal hernior-raphy with preset criteria after obtaining a written informed consent were randomized into 2 equal groups. Both groups were received Ipsilateral TAP block with landmark technique after receiving standard general anesthesia: Bupivacaine group (BG, n=18); received TAP block with 25ml bupivacaine 0.5% while Bupivacaine-Morphine (BMG, n=18) group; received TAP block with 25ml bupivacaine 0.5%+2mg morphine. Both groups received patient-controlled i.v. morphine. Postoperative pain was assessed (at rest and at movement) using a visual analog pain scale (VAS) and Verbal pain score (VPS) at postanesthesia care unit and 3, 6, 12 and 24h postoperatively as will as first request of morphine, interval consumption ...
... Address for Correspondence: Dr. Hanan Mohamed Kamal, Cardiology Department, Faculty of Medici... more ... Address for Correspondence: Dr. Hanan Mohamed Kamal, Cardiology Department, Faculty of Medicine, Suez Canal University. Page 119. ... 6-Du ZD, Hijazi ZM, Kleinman CS, et al: Comparison between transcatheter and surgical closure of secundum atrial septal ...
To determine the dose of hyperbaric bupivacaine 0.5% required for unilateral spinal anesthesia du... more To determine the dose of hyperbaric bupivacaine 0.5% required for unilateral spinal anesthesia during diagnostic knee arthroscopy. This prospective, randomized, clinical study was performed in 80 patients who were assigned to four groups to receive different doses of intrathecal hyperbaric bupivacaine (5 mg, 7.5 mg, 10 mg and 12.5 mg in Groups 1, 2, 3, and 4 respectively). Onset of sensory and motor block, hemodynamic changes, regression of motor block, and incidence of complications were recorded. Unilateral sensory block was reported in 90% and 85% of patients in Group 1 and Group 2, respectively, but not in any patient in Group 3 and Group 4. Unilateral motor block (modified Bromage scale 0) was reported in 95% of patients in Group 1, 90% in Group 2, and only 5% in Group 3, while no patient in Group 4 showed unilateral motor block. The time required for regression of motor block (Bromage scale 0) was prolonged with higher doses. The incidence of nausea, vomiting, and urine retent...
Context Rational: Several techniques have been proposed to prevent or attenuate the hemodynamic r... more Context Rational: Several techniques have been proposed to prevent or attenuate the hemodynamic responses following laryngoscopy and intubation, preoperative melatonin has a significant analgesic and anxiolytic effect for patients undergoing surgery. Melatonin may play an important role in controlling hypertension also in humans. The current study aimed at assessing the usefulness of melatonin in attenuating the pressor response to direct laryngoscopy and tracheal intubation. Methods: After approval of the ethics committee and informed written patients consent the study was carried out at rotine surgical theatre of the Suez Canal University Hospital, during the peroid from 2011 -2012 on 90 patients with ASA physical status I, II scheduled for any elective surgery under general anesthesia with endotracheal intubation. Patients were randomly allocated according to computer-generated randomization into three groups: Group I (control group); Group II (melatonin 6mg tablet group) and Gro...
Abstract There are a limited number of studies that compared kinemyography (KMG) and mechanomyogr... more Abstract There are a limited number of studies that compared kinemyography (KMG) and mechanomyography in the clinical practice but few studies compared KMG to electromyography (EMG) either in adults and none in children. This study compared the time course data for rocuronium relaxation measured by KMG to that measured by EMG in children 2- 6 years old. Methods: 24 children ASA I or II of both sexes, aged 2- 6 years, scheduled for elective surgery under GA were included in the study. Premed with midazolam 0.3mg/kg orally. Monitoring included ECG, NIBP, pulse oximetry, capnography, anesthetic gas monitor and temperature. NMT monitoring consisted of attaching the pediatric KMG sensor (NMT mechanosensor, for Datex GE, S5) in one hand, while the other hand had a 5 lead EMG (EMG for Datex GE, S5) for simultaneous recoding of both modalities. Anesthesia was induced with fentanyl 2mg/kg and propofol 2mg/kg followed by endotracheal intubation. Ventilation was maintained by endtidal isoflurane 1.2% in 50% oxygen/air to maintain endtidal CO2 32-35mmHg. After 3 minutes of stable supramaximal stimulation, a train of four stimulus was applied every 15sec. each patient had a single dose of 0.6mg/kg rocuronium. The following parameters were collected (1) Lag time, (2) Onset time, (3) Assessing the recovery period by; train of four (TOF) 0.25, 0.50, 0.75 and 0.90. No top-up doses of rocuronium were given. Statistical analysis was done as appropriate. Results: There were no statistically significant differences in the lag time, the onset time, TOF 0.25, 0.5, 0.75 and 0.9 ratios using either EMG or KMG. In addition, there was an excellent degree of agreement between EMG and KMG in measuring TOF ratio during both induction and recovery of rocuronium. Conclusion: KMG showed an excellent degree of agreement with EMG for determination of onset and recovery of a single dose of rocuronium in children. For clinical purposes, time course data obtained from KMG can be interchanged with that data obtained from EMG using rocuronium in
OBJECTIVE To compare two different supraglottic airway devices, the laryngeal mask airway (LMA) a... more OBJECTIVE To compare two different supraglottic airway devices, the laryngeal mask airway (LMA) and the I-gel, regarding easiness of insertion of the device, leak pressure, gastric insufflation, end tidal CO2, oxygen saturation, hemodynamic and postoperative complications in anesthetized, spontaneously ventilated adult patients performing different non-emergency surgical procedures. MATERIALS AND METHODS The study was carried out as a prospective, randomized, clinical trial among 80 patients who underwent different surgical procedures under general anesthesia with spontaneous ventilation in supine position. They were equally randomized into two groups: I-gel and LMA groups. Both the devices were compared with regard to heart rate, arterial BP, SPO2, end-tidal CO2, number and duration of insertion attempts, incidence of gastric insufflation, leak pressure and airway assessment after removal of the device. RESULTS No statistically significant difference was reported between both the g...
Context Rational: Several techniques have been proposed to prevent or attenuate the hemodynamic r... more Context Rational: Several techniques have been proposed to prevent or attenuate the hemodynamic responses following laryngoscopy and intubation, preoperative melatonin has a significant analgesic and anxiolytic effect for patients undergoing surgery. Melatonin may play an important role in controlling hypertension also in humans. The current study aimed at assessing the usefulness of melatonin in attenuating the pressor response to direct laryngoscopy and tracheal intubation. Methods: After approval of the ethics committee and informed written patients consent the study was carried out at rotine surgical theatre of the Suez Canal University Hospital, during the peroid from 2011 – 2012 on 90 patients with ASA physical status I, II scheduled for any elective surgery under general anesthesia with endotracheal intubation. Patients were randomly allocated according to computer-generated randomization into three groups: Group I (control group); Group II (melatonin 6mg tablet group) and Gr...
Background: The responsibility of the anesthesiologist is to maintain airway patency for better o... more Background: The responsibility of the anesthesiologist is to maintain airway patency for better oxygenation. Perhaps the most dangerous incident for the anesthesiologist, are encountering the scenario in which intubation and ventilation in a patient are impossible. The study of mask ventilation is far more limited. The first significant manuscript focused on mask ventilation was published in 2000. In this study we studied the effect of position on the Mallampati class, and its accuracy in the prediction of difficult mask ventilation. Methods: After ethics committee approval; Three hundred thirty patients were examined, in both supine and upright positions for the assessment of the Mallampati airway class. The results of the two different situations were evaluated for the prediction of difficult mask ventilation. The sensitivity, specificity, positive and negative predictive values were obtained. Results: In this study, 88 (26.66%) patients had difficult mask ventilation. (21.21%) wi...
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