BackgroundDexmedetomidine infusion improves oxygenation and lung mechanics in patients with chronic obstructive lung disease; however, its effect in patients with restrictive lung disease has not been thoroughly investigated yet. The aim of this work was to evaluate the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease.MethodsForty-two morbidly obese patients scheduled for bariatric surgery were included in the study. Patients were randomized to receive either dexmedetomidine infusion at a bolus dose of 1mcg/Kg followed by infusion at 1 mcg/Kg/hour for 90 min (Dexmedetomidine group), or normal saline infusion (Control group). Both groups were compared with regard to: oxygenation {P/F ratio: PaO2/fraction of inspired oxygen (FiO2)}, lung compliance, dead space, plateau pressure, blood pressure, and heart rate.ResultsDexmedetomidine group showed significant improvement of the PaO2/FiO2 ratio, and higher lung compliance compared to control group by the end of drug infusion. Dexmedetomidine group demonstrated decreased dead space, plateau pressure, blood pressure, and heart rate compared to control group by the end of drug infusion.ConclusionA 90-min dexmedetomidine infusion resulted in moderate improvement in oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease.Trial registrationclinicaltrials.gov: NCT02843698 on 20 July 2016.
A variety of marketed drugs belonging to various therapeutic classes are known to cause nephrotoxicity. Nephrotoxicity can manifest itself in several forms depending on the specific site involved as well as the underlying pathophysiological mechanisms. As they often coexist with other pathophysiological conditions, the steps that can be taken to treat them are often limited. Thus, drug-induced nephrotoxicity remains a major clinical challenge. Prior knowledge of risk factors associated with special patient populations and specific classes of drugs, combined with early diagnosis, therapeutic drug monitoring with dose adjustments, as well as timely prospective treatments are essential to prevent and manage them better. Most incident drug-induced renal toxicity is reversible only if diagnosed at an early stage and treated promptly. Hence, diagnosis at an early stage is the need of the hour to counter it. Significant recent advances in the identification of novel early biomarkers of nephrotoxicity are not beyond limitations. In such a scenario, mathematical modeling and simulation (M&S) approaches may help to better understand and predict toxicities in a clinical setting. This review summarizes pathophysiological mechanisms of drug-induced nephrotoxicity, classes of nephrotoxic drugs, management, prevention, and diagnosis in clinics. Finally, it also highlights some of the recent advancements in mathematical M&S approaches that could be used to better understand and predict drug-induced nephrotoxicity.
Background: Urethroplasty is open surgical reconstruction of urethral stricture disease and it depends on the site of stricture and the used technique either by excision and primary anastomosis, on-lay repair, stricture excision and augmented anastomosis, flap-based repair, and staged repair. Objective: This study aimed to improve postoperative outcomes of the buccal mucosal graft harvest site by comparing closure versus non-closure of the harvest site. Patient and Methods: This prospective comparative study was conducted on 34 patients with urethral stricture planned to be managed by buccal mucosal graft (BMG) urethroplasty. Those 34 patients attended to urology outpatient clinic at Zagazig university hospital from September 2019 to December 2020. Results: Intraoperatively, two patients were found to have short stricture (approximately 1 cm) with dense spongiofibrosis and they were managed by anastomotic urethroplasty. Post-operative pain was maximal on the first day in both groups but it was more significant in the closure group by the second day. Conclusions: Buccal mucosal graft harvesting is well tolerated by all patients. The pain appears to be worse in the immediate postoperative period after suturing the harvest site.
Study objectives: This study was designed to evaluate how the anesthesiologists in Cairo University Hospitals are adherent in their practice to the latest ASA guidelines for management of difficult airway in order to stand on the current status and establish a basis for improvement. Methods: This is a survey study included 190 anesthesiologists from the faculty members of Cairo university hospitals. All of them completed the study questionnaire. Main results: A 77.9% of the responders admitted their use of the ASA Algorithm during their practice. For anticipated difficult airway, 74% would employ regional anesthesia as first choice while 52% and 54% would use Supraglottic airway devices and awake Fiberoptic respectively. For unanticipated failed intubation with adequate mask ventilation, 90% would use a supraglottic airway device as their first choice while 85% and 90% would wake up the patient, perform awake fiberoptic intubation and make an emergency invasive airway access respectively. For failed intubation with difficult/impossible mask ventilation, 87% would use a supraglottic airway device while 51% and 28% would perform needle cricothyroidotomy and percutaneous tracheostomy respectively. Awake fiberoptic intubation and intubation with direct laryngoscope using intravenous induction and succinylcholine were the most frequently used techniques in different clinical scenarios. Conclusion: The practice of anesthesiologists in Cairo university hospitals is close to the recommendations of the ASA guidelines for management of difficult airway. There is increased skills in fiberoptic bronchoscopes and SGA with increased frequency of difficult airway managements training courses; however, they need to improve their skills in awake fiberoptic intubations technique and they need to be trained on invasive airway management access to close the discrepancy between their theoretical choices in different situations and their actual skills.
Objectives: To compare the transvesical transabdominal repair of vesicovaginal fistula with novel extravesical transabdominal repair with respect to operative time, blood loss, hospital stay, catheterization time, postoperative lower urinary tract symptoms, urodynamic changes, and recurrence rate. Methods: A prospective randomized controlled study of 94 consecutive female patients who underwent transabdominal vesicovaginal fistula (VVF) repair from March 2013 to March 2018 in our center. The patients had high vesicovaginal fistula that could not be operated on transvaginally: 47 cases were treated with extravesical transabdominal technique, and 47 cases were treated with transvesical transabdominal technique. The primary endpoint is the functional outcome regarding postoperative lower urinary tract symptoms (LUTS); secondary outcomes are early recovery and success rates. The follow-up period was 3 months for reporting and dealing with any complications. Results: There was no significant difference between the groups regarding demographic data. Extravesical repair of VVF had significantly higher (106.56±10.46 min) operating time than transvesical repair (95.08±7.6 min) P <0.001. There was no significant difference regarding intraoperative blood loss between the extravesical (365.42±81.29 mL) and transvesical (353.12±73.9 mL) groups; P = 0.44). The extravesical group had a significant shorter hospital stay (62.35±12.25 hours) than the transvesical repair group (85.07±12.0 hours) P < 0.001. Postoperative storage LUTS 6 weeks assessed by Overactive Bladder Symptom Score was significantly lower for extravesical repair (1.75±0.59) than for transvesical repair (6.87±2.24) P = 0.001). This was confirmed by urodynamic evaluation. Two patients (4.2%) in the transvesical group but none in the extravesical group experienced fistula recurrence. Conclusions: The extravesical transabdominal approach for repair of vesicovaginal fistula is a novel, successful, and versatile technique with reduced hospital stay, reduced postoperative LUTS and possibly fewer recurrences than the transvesical technique, and should be considered for all VVF requiring abdominal repair.
The purpose of this study was to evaluate and anticipate the outcome of daily use of tadalafil in patients with erectile dysfunction using elastography. 183 volunteers and 183 patients with erectile dysfunction were included. Pretreatment SWE readings for our patients were calculated with a linear probe. IIEF score Q was measured once at the start of the study for volunteers and twice for patients, one prior to the start of tadalafil administration and the other on one year of 5 mg daily tadalafil after the second post-washout (one month post-treatment stopped). There was no significant difference between patients and volunteers in mean age or risk factors except in SWE values as mean SWE of volunteers was 14.03 ± 1.54 kpasc, while mean SWE of patients was 21.278 ± 8.228 kpasc. The presence of comorbid diabetes, severe disease and pre-SWE ≥23.635 was significantly associated with poor outcome. We conclude that penile SWE could be useful to select probable good responders for a continuous tadalafil use, thus avoiding the unnecessary cost and time in non-responders.
Background: Fracture penis is an uncommon injury presenting to the emergency department (ED). Underreporting of this condition occurs due to personal embarrassment. Patients often delay in seeking medical attention; they may withhold the condition for a significant amount of time. ED physicians need to be aware of the social inhibitions and the need for early diagnosis and prompt treatment. A delay in treatment increases the risk of complications such as ischemia, necrosis and penile deformity. Fracture penis is caused by rupture of the tunica albuginea of one or both corpora cavernosa by a blunt trauma to the erect penis. Diagnosis is usually clinical as evident by the characteristic history and clinical presentation. Diagnostic imaging modalities aid in the management of the fracture and associated injuries if present. Nevertheless, prompt recognition and initiation of treatment can significantly reduce the chances of post-injury complications. Findings: We present a case of penile fracture in a young male who came to the hospital after hearing popping sound followed by sudden detumescence while having intercourse along with urethral bleeding, with no swelling or deformity of penis. Conclusion: Our case report is an attempt to raise the suspicion of fracture penis in case of typical history; even without physical findings that necessitates an immediate surgical exploration.
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