This randomized parallel controlled trial demonstrates that ultrasound-guided paravertebral block is safe and effective method for relieving post-cardiac surgery sternotomy pain compared with thoracic epidural analgesia but not superior to it.

In this study, Cu2+, Co2+, Ni2+, Mn2+, Zn2+, Fe3+, VO2+, and UO22+ complexes derived from a NNO tridentate chelating hydrazone–oxime, namely, N′‐((2E,3Z)‐3‐(hydroxyimino)butan‐2‐ylidene)benzohydrazide (H2L,1) were prepared. The elemental, thermo‐gravimetric, spectral, molar conductivity, and magnetic measurements were applied to elucidate the compositions and structures of these new compounds. In addition to the density functional theory (DFT), studies were employed to acquire optimal structures and quantum chemical parameters. The analyses indicate that the chelator reacted as a neutral or mononegative tridentate ligand bonded to the metal ions via the enolic/ketonic carbonylic oxygen, protonated/deprotonated oximatic nitrogen, and azomethine nitrogen atoms adopting square planar or distorted octahedral geometry. The structural characterization of hydrazone–oxime and its complexes was supported by DFT calculations according to the DFT‐B3LYP procedure and 6‐311+G(d,p) basis set. The theoretical data revealed that the reactivity of the complexes is greater than the free hydrazone–oxime (H2L,1), and there is a good agreement between the practical and theoretical data. The thermogravimetric investigation shows that the complexes break down in two to four decomposing steps in temperature range extended from 50 to 1000°C. In vitro antimicrobial activity data demonstrated an increase in activity of the hydrazone–oxime (H2L,1), upon chelation, and some metal complexes show enhanced antibacterial and antifungal agents.

Background: The influence of the etiology of mitral valve (MV) lesion on outcomes of concomitant repair for functional tricuspid regurgitation (TR) is not well studied.Our objectives were to compare long-term survival and TR recurrence after tricuspid valve (TV) repair concomitant with surgery for rheumatic versus degenerative MV disease.Methods: We included 480 patients who had concomitant MV and TV surgery from 2009 to 2019. We grouped the patients into Group 1 (n = 345; rheumatic MV) and Group 2 (n = 135; degenerative MV). Propensity score matching identified 104 matched pairs.Results: There was no significant difference in survival between groups before

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Background The optimal venoarterial extracorporeal membrane oxygenation (VA ECMO) cannulation strategy in patients with postcardiotomy cardiogenic shock is still debatable. Studies evaluating the effect of cannulation strategy on long-term survival are scarce. Objectives We investigated the impact of central versus peripheral cannulation strategy for ECMO insertion on hospital outcomes and survival in postcardiotomy cardiogenic shock patients. Methods This retrospective study involved 101 patients who had either central or peripheral ECMO due to postcardiotomy shock between June 2009 and December 2020. Study endpoints were limb ischemia, bleeding, blood transfusion, wound infection, and overall survival. Results Eighty-four patients received central (c) ECMO, and 17 patients had peripheral (p) ECMO. In the group of pECMO, limb ischemia was significantly higher (5 [29.41%] vs 6 [7.14%]; p = .01). Other endpoints were similar in both groups. Thirty-day mortality was nonsignificantly different between both cohorts (cECMO 34 [41.67%] vs pECMO 10 [58.82%]; p = .29). However, overall survival was better with cECMO (Log-rank p = .02). Patients’ age [HR: 1.04 (95% CI: 1.02–1.06); p = .001], pECMO [HR: 1.98 (95% CI: 1.11–3.55), p = .002] and presence of infective endocarditis [HR: 3.54 (95% CI: 1.52–8.24), p = .03] were significant predictors of overall mortality. Conclusions Peripheral ECMO was associated with an increased risk of limb ischemia; however, bleeding, blood transfusion, infection, and 30-day mortality were comparable to central ECMO. Central cannulation was associated with a better 1-year survival rate. Therefore, central cannulation might be the preferred strategy for patients with postcardiotomy cardiogenic shock.

Background Del Nido cardioplegia was recently introduced to adult cardiac surgery with encouraging results. The effect of Del Nido cardioplegia in patients with low ejection fraction (EF) has not been thoroughly evaluated. The objective of this study was to assess the safety of Del Nido cardioplegia in adult patients with low EF compared to intermittent warm blood cardioplegia. Results During 2018 and 2019, 73 adult patients with an EF of ≤ 40% underwent cardiac surgery using Del Nido cardioplegia. The patients were compared to a historical cohort of consecutive patients with low EF who had intermitted warm blood cardioplegia (n = 81). Patients who had Del Nido cardioplegia had significantly lower EuroSCORE II (2.73 (1.7–4.1) vs. 4.5 (2.4–7.4), P = 0.004). There were no differences in creatinine clearance and preoperative echocardiographic data between the groups. Cardiopulmonary bypass and cross-clamp times were non-significantly lower with Del Nido cardioplegia. There were no differences in stroke and postoperative echocardiographic data between the groups. No hospital mortality was reported in both groups. Peak troponin levels were significantly higher in patients who had Del Nido cardioplegia (0.88 (0.58–1.47) vs. 0.7 (0.44–1.01) ng/dL; P = 0.01); however, after multivariable regression analysis, cardiopulmonary bypass time was the only predictor of postoperative troponin level (coefficient 0.005 (95% CI: 0.003–0.008); P < 0.001). ICU stay was significantly longer in patients who had Del Nido cardioplegia (4 (3–6) vs. 2(1–4) days, P < 0.001), while postoperative hospital stay did not differ between the groups. After multivariable regression, the use of intermittent warm blood cardioplegia was significantly associated with shorter ICU stay (coefficient − 1.80 (95% CI − 3.06 – -0.55); P = 0.01). Conclusions Prolonged ICU was reported with Del Nido cardioplegia; however, there were no differences in the duration of hospital stay and the clinical outcomes between the groups. Despite the proven efficacy of intermittent warm blood cardioplegia, the use of Del Nido cardioplegia might be safe in patients with low EF.

Background: Upper gastrointestinal (GI) symptoms are the commonest complaints among the general population and the diseases associated with them carries a significant risk of morbidity and mortality. As early diagnosis and appropriate management of the condition can prevent life threatening complications. Upper GI endoscopy is an effective diagnostic as well as therapeutic tool for the patients presenting with upper GI symptoms.The objective of the study: is to determine the pattern of endoscopic findings in patients referred to endoscopy unit for upper gastrointestinal endoscopic procedures in Fayoum university hospital.Methods: Cross sectional study comprises of 2281 patients presenting with upper gastrointestinal symptoms at Fayoum university Hospital, (both out-patients and referred patients) during the period from January 2018 to May 2020, who underwent upper GI endoscopy.Results: our study showed that the most prevalent age group was aged between 41 and 60 years (37.6%) with male to female ratio was nearly equal and the commonest single indication was epigastric pain and heart burn with percentage of 31.9%.PUD was the most common endoscopic findings either gastritis or erosive gastritis, duedenitis, duodenal and gastric ulcer. Conclusion:PUD was the most common endoscopic findings in the studied group. Diagnostic and therapeutic role of EGD make it a great tool for management different GI tract pathologies.