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Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO 2 , SpO 2 and PaO 2-to-FiO 2 ratio). Results: Mean PO 2 and SO 2 have increased after using of both venture and Cpap, increase in both PCO 2 and HCO 3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen How to cite this paper:

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Introduction: Patients are treated with many interventionsin intensive care units (ICUs) mostly endotracheal intubation and invasive mechanical ventilation that are considered to be stress conditions. Pain is the commonest bad memorythat patients have during the period of their ICU admission. Agitation may cause accidental events such asremoval of endotracheal tubes or intravascular catheters used for monitoring or injection of life-saving medications. Consequently, sedatives and analgesics are widely used in ICUs. Benzodiazepines like midazolam and lorazepam, Non-benzodiazepines like the short-acting intravenous anesthetic agent like propofol orα2-adrenoceptor agonist sedation like dexmedetomidine. Remifentanil, an opioid, is also used as aunique agent due to its sedative properties. Benzodiazepines action occurs on γ-aminobutyric acid type A (GABAa) receptors, as in part does propofol, however dexmedetomidine is an α2-adrenoceptor agonist, on the other hand remifentanil is a μ-opioid receptor agonist. Benha University Hospitals in the year of 2018. Patients were divided equally into 3 groups according to receiving of Dexmedetomidine, Propofol or Midazolam. Group 1: 20 mechanically ventilated patients received Dexmedetomidine with loading dose 1 µg/kg over 10 minutes with I.V injection and follow by maintaining dose 0.2-0.7 µg/kg/h with continuous I.V infusion. Group 2: 20 mechanically ventilated patients received Propofol with loading dose 1 mg/kg over 5 minutes with I.V injection and follow by maintaining dose 1-3 mg/kg/min with continuous I.V infusion. Group 3: 20 mechanically ventilated patients received Midazolam with loading dose 0.05 mg/kg with I.V injection and follow by maintaining dose 0.05-0.1 mg/kg/h with continuous I.V infusion. Studying the efficacy of Dexmedetomidine, Midazolam and Propfol amongmechanically ventilated patient was done according to: Respiratory rate (RR),Heart rate (HR),Mean arterial blood pressure (MAP),Changes in arterial blood oxygen saturation (SpO2,Length of staying on MV, time of extubation and Occurrence of delirium. Conclusion: Dexmedetomidine provides hemodynamic stability and has no clinically important adverse effects on respiration also provide less number of patients suffering from delirium.

Background: Obesity affects cardiovascular morbidity and mortality, and it increases the risk of coronary artery disease. Despite that, several cardiac surgery risk stratification scores do not consider the effect of obesity on the outcomes. The objective of this research is to study the impact of body mass index (BMI) on morbidity and mortality after coronary artery bypass grafting (CABG) in Egyptian patients. Methods: This prospective cohort study included 200 patients who underwent CABG for atherosclerotic coronary artery disease. Patients were divided into two groups, group A: patients with BMI ≥ 25 Kg/m2 and group B: patients with BMI < 25 Kg/m2. The mean age in group A was 56± 4.95 years vs. 54± 5.5 years in group B (p= 0.102). Male patients presented 58% of the population in group A vs 74% in group B (p= 0.017). 60% of patients were hypertensive in group A compared to 63% in group B (p= 0.66) and 62%, and 48% were diabetics in group A and B respectively (p= 0.04). Results: Postoperatively, there was a significant increase in wound infection (40% vs 8%; p< 0.001), chest infection (47% vs. 10% p< 0.001), surgical re-exploration (28% vs. 1%; p< 0.001), prolonged ICU stays (5.3 ± 2.88 vs. 3.93 ± 1.71 days; p< 0.001), ward stay (11.28 ±8.9 vs. 5.48 ± 2.45 days; p< 0.001), mediastinitis (34% vs. 6%; p< 0.001), the occurrence of sternal wound sinus within 8 months (26% vs. 7%; p< 0.001), in group A more compared to group B. There was no difference in ejection fraction (54.2 ±7.38 vs. 54.7 ± 9.1%; p= 0.69) and mortality (4% vs. 2%; p= 0.68) between groups. Conclusions: BMI 25 Kg/m2 or higher is associated with increased infectious complications and prolonged stay after CABG; however, it did not affect mortality. Optimizing body weight is recommended before elective surgery.

Background: There are several dangers and adverse effects associated with red blood cell transfusions, which are often administered after surgery due to anemia. Our aim is to assess the significance of hemoglobin level and subclinical iron insufficiency on perioperative morbidity and mortality in patients having heart surgery. Patients and Methods: This study was conducted on 30 patients undergoing different cardiac surgeries during the period from May 1, 2021, and April 30, 2022. Results: Negative correlation between hospital length of stay and both hemoglobin and serum iron levels (r = -0.807, p 0.001). Patients who required a blood transfusion, developed an infection, had problems, were admitted to ICU, or died, had substantially lower iron levels than the rest of the patients (p 0.001). those showed statistically significant association between Hb and the occurrence of problems (AUC = 0.994, p 0.001). The sensitivity is 100% and the specificity is 91.3%. Complications are strongly predicted by serum iron levels (AUC = 0.988, p 0.001). ICU admission may be predicted with high accuracy by Hb (AUC = 1.000, p 0.001). The sensitivity and specificity are both one hundred percent at a cut off value of 9. ICU admission can be predicted with a high degree of accuracy by serum iron levels (AUC=1.000, p0.001). The sensitivity and specificity are both one hundred percent at a cutoff value of 80. Conclusion: The results of cardiac surgery were worse for patients who had anemia prior to surgery.

Background:VATS and transthoracic ultrasound-guided Abram`s needle biopsy are important techniques in diagnosis of pleural diseases, as they are more accurate than blind closed pleural biopsies. Patients & Methods: This is a prospective study, which included 60 patients of undiagnosed pleural diseases who were randomly divided into two groups: group A (30 patients) who underwent VATS biopsy, and group B (30 patients) who underwent U/S guided Abram`s needle biopsy. Efficacy and safety and of both procedures were compared. Results: There were no perioperative mortality and both procedures were safe. A definitive histopathological diagnosis was obtained in 30 patients (100%) in group A and in 26 patients (86.7%) in group B. Complications in group A were minor bleeding in 1 (14.3%), lung collapse in 3 (42.9%), empyema in 1 (14.3%), prolonged air leakage in 1(14.3%) and wound infection in 1 (14.3%). Complications in group B were empyema in 1 (12.5%), hemoptysis in 2 (25%), vasovagal attack in 1 (12.5%) and pneumothorax in 4 (50%). Conclusions: VATS is a safe and accurate method for diagnosis of pleural lesions and pleural effusions and more sensitive than US guided Abram`s needle biopsy. VATS is an effective method in diagnosis of pleural effusion due to both pleural and pulmonary causes. The results of U/S guided Abram`s needle biopsy for pleural causes of pleural effusions is better than the results of U/S guided Abram`s needle biopsy for pulmonary causes of pleural effusions.

P. aeriogenosa is an opportunistic pathogen frequently associated to nosocomial infections ,especially in immunocompromised hosts.Biofilm production is an important mechanism for the survival of Pseudomonas aeruginosa and its relationship with antimicrobial resistance represents a challenge for patient therapeutics . Pseudomonas aeruginosa is an opportunistic pathogen frequently associated to nosocomial infections ,especially in immunocompromised hosts.The aim of this study to assess the role of some selected genes and the formation of biofilm in clinically isolates of drug resistant Pseudomonas aeruginosa.This study included 35 patients who were admitted in different inpatient departments at a Benha University Hospital and Benha Children Hospital during the period from August 2018 to December 2019.The samples were tips of indwelling medical device and urine samples were taken from patients using urinary catheters. These isolates were tested from antibiotic sensitivity by disk diffusion method and were screened phenotypically for biofilm formation by Congo Red Agar (CRA) method and Tissue Culture Plate (TCP) technique .The antibiogram of all isolates was determined and reveald that (XDR were 54.3%) ,(MDR were 8.6%)and (Non MDR/XDR were 37.1%). The presence of RhlI and PelB genes in biofilm forming P. aeruginosa isolates was tested by using polymerase chain reaction (PCR).The results revealed the presence of these genes in both strong and weak biofilm producer isolates.These final results showed the significance of these genes in biofilm formation and suggest the presence of other factors which may contribute in determining the degree of biofilm formation in P. aeriogenosa.