Introduction: Postoperative delirium is a common complication of cardiac surgery. This study aimed to assess the effect of supplementing dexmedetomidine infusion with oral melatonin in prevention of postoperative delirium after coronary artery bypass graft surgery. Methods: 110 patients of both sexes above 60 years of age were included. Anesthetic management was standardized. Patients were randomly allocated into one of the two study groups, dexmedetomidine/melatonin (DM) group or dexmedetomidine (D) group. Patients in the DM group received oral Melatonin tablet 5 mg the night before surgery and same dose was repeated every 24 hours for 3 postoperative days. After completion of surgery and upon ICU arrival, patients in both groups received a bolus of 0.4 µg/kg dexmedetomidine followed by 0.2-0.7 µg/kg/h infusion, for 24 maximum hours. Delirium was assessed for 5 days postoperatively at 12 hr intervals using confusion assessment method (CAM) for ICU and after discharge from ICU to surgical ward using CAM. Delirious patients were treated with IV haloperidol. Results: No significant differences between studied groups regarding baseline, preoperative, intraoperative and postoperative characteristics. Incidence of delirium was significantly lower, onset significantly more delayed, and duration was significantly shorter in group-DM as compared to group-D. No significant differences between all cases, cases who had delirium, and cases who did not have delirium in the two groups as regards extubation time, ICU stay, and hospital stay. Conclusion: supplementing dexmedetomidine with melatonin decreases incidence, delays onset, and shortens duration of postoperative delirium in patients above 60 years of age undergoing CABG surgery.

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Background Early and precocious determination of acute kidney injury (AKI) is essential to prevent morbidity and mortality following coronary artery bypass grafting (CABG). Evaluation of the perioperative renal function is substantial using novel biomarkers other than the late traditional method of using serum creatinine. Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker investigated for early detection of AKI in patients undergoing coronary artery bypass grafting, and its role has to be determined in this study. Results Twenty-five patients undergoing elective CABG were enrolled in this cohort study and were assigned into two groups: group I include the patients that did not develop AKI (no AKI group) and group II include the patients that developed AKI (AKI group). Acute kidney injury based on Kidney Disease: Improving Global Outcomes (KDIGO) classification had been developed in 7 patients (28%). Plasma NGAL levels at 6 h were higher in patients who developed AKI compared with those who did not (302 ± 88.02 vs. 116.50 ± 17.33 ng/m, p value < 0.001). The cut-off value of plasma NGAL levels measured 6 h postoperatively was 145 ng/ml and the area under the receiver-operating characteristic (ROC) curve was 0.965. Results of this study showed that plasma NGAL is a robust early biomarker of AKI, which preceded the rise in serum creatinine by many hours. Conclusion This study revealed that earlier diagnosis of acute kidney injury in patients undergoing CABG can be achieved by measuring postoperative plasma NGAL concentration at 6 h.

Background:Pre-eclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs after 20 weeks' gestation. Aim: This work aimed to compare the anti-hypertensive efficacy of oral Labetalol with oral Nifedipine in mild preeclampsia. Materials and Methods:This study was conducted on a total of 100 antenatal mild full term pre-eclamptic women at Ain-Shams University Maternity Hospital ICU and obstetric theater. They were divided into two groups; first group (group A): oral Labetalol was started with a dose of 200 mg and second group (group B): oral Nifedipine was started at dose of 20 mg. Results: Group B had significantly higher number of side effects when compared to group A. None of the patients developed grave complications such as HELLP syndrome, pulmonary edema, coagulopathy, postpartum collapse, the maternal mortality was nil. Thus when patients with preeclampsia are identified and treated at an earlier stage the morbidity and mortality associated with preeclampsia can be significantly reduced. Conclusion:Both oral labetalol and oral Nifedipine are equally efficacious in the control of hypertension in mild preeclampsia. Regarding the drug side effects and tolerability, labetalol was significantly better than Nifedipine. There was no significant difference in the neonatal outcome between the two groups. Thus, labetalol is a better alternative to Nifedipine,as it had lesser side effect profile. However, in a limited resource setting, Nifedipine is an equally effective, cheap and easily available drug for mild preeclampsia.

Background Diabetic ketoacidosis (DKA) is a common cause of intensive care unit (ICU) admission, with high morbidity and mortality rates. A growing body of evidence has suggested that adding insulin Glargine to the standard regimen may facilitate the transition from an intravenous infusion of insulin to subcutaneous injection in the recovery of patients with DKA. Aim of the Work to investigate the effect of adding Insulin Glargine to the standard regimen of treatment of DKA on the recovery process of patients regarding the amount of intravenous insulin infusion and the duration of the patients’ stay in the ICU. Patient and Methods This randomized controlled study was conducted on 50 Egyptian individuals, in National Institute of Diabetes and Endocrinology & Ain Shams University Hospitals. 50 Patients with Diabetic Ketoacidosis diagnosed according to The American Diabetes Association criteria. All patients were divided into 2 groups according the protocol used for treatment: The first group including 25 patients treated only with the standard regimen of intravenous regular insulin infusion (0.1 unit/kg/hour). The second group including 25 patients treated with intravenous regular insulin (0.1 unit/kg/hour) + Iv infusion of normal saline. Results Added insulin Glargine resulted in a significantly shorter length of hospital stay, compared to SOC alone. The present study showed that insulin Glargine led to statistically significant less amount of insulin infused until resolution of DKA than the SOC alone. Conclusion subcutaneous insulin Glargine coadministration with regular insulin results in a shorter length of hospital stay and less amount of infused insulin in DKA patients admitted to ICU. Larger multi-centric trials are still needed to confirm our findings.