Ultrasound-Guided Erector Spinae Plane Block: A Comparative Study to Assess its Analgesic Efficacy in Pediatric Patients Undergoing Aortic Coarctation Repair

Background: Effective postoperative analgesia is an important aspect of both anesthetic practice and postoperative outcomes. Thoracotomy for the repair of coarctation of the aorta is a painful surgical procedure; inadequate postoperative analgesia may result in postoperative respiratory complications with the possible prolonged need for oxygen therapy. In addition, paradoxical hypertension is a well-recognized complication of repair. We hypothesize that erector spinae plane block (ESPB) by providing adequate analgesia and blocking sympathetic stimulation may reduce opioid consumption, accelerate weaning of oxygen therapy, and reduce the incidence of early postoperative paradoxical hypertension. Material and methods: Open-labeled randomized controlled trial carried out on 40 patients divided into two groups. Group (B) received ESPB before the skin incision and group (C), the control group received no block. Results: Patients who received ESPB had significantly less intraoperative fentanyl consumption than the control group (P-value<0.001), and significantly less postoperative fentanyl consumption by 50% than the control group in the first 12 hours 2.025 ±0.273 μg/kg and 4.05 ±0.527 μg/kg respectively (P-value<0.001). while there was no statistically significant difference between both groups regarding the incidence of postoperative vasodilator infusion for paradoxical hypertension (P-value=0.054), the pediatric anesthesia emergence delirium (PAED) (P-value=0.06) nor the time to wean oxygen supply (P-value=0.49).  Conclusion: Erector spinae plane block effectively reduces postoperative pain in pediatric patients undergoing repair of coarctation of the aorta. However, it did not significantly accelerate weaning from oxygen therapy nor reduce the incidence of vasodilator use for postprocedural hypertension

The unexpected presence of a huge cystic hygroma with thanatophoric dysplasia type I: a case report

Introduction: The presence of a thin-walled, multicystic structure posterior to the fetal head and neck with an intact vertebral column is known as a cystic hygroma. Thanatophoric dysplasia is the most lethal skeletal dysplasia. Thanatophoric dysplasia (TD) is an autosomal dominant disorder with two phenotypes. TD type I is characterized by a normal shaped skull with bowed femurs and micromelia, while TD type II is characterized by straight femurs with a clover-leaf deformity of the skull and micromelia. We report here a case of thanatophoric dysplasia type I associated with cystic hygroma, this association needs further evaluation. Case history: A 30 year old woman was referred at 26 weeks of gestation because of marked polyhydramnios. Ultrasonographic examination of the fetus revealed a narrow chest, protuberant abdomen, short curved femur, normal shaped skull with accidentally cystic hygroma were present. No other anomalies were detected. We explained to the patient the nature and severity of the anomaly and the patient preferred the termination of pregnancy. Induction of abortion was done successfully. Conclusion: This case report has highlighted the association between cystic hygroma and thanatophoric dysplasia type I. To our knowledge, this is the first report in the literature reporting the association of cystic hygroma and thanatophoric dysplasia type I. We believe that this case is useful for obstetricians and pediatricians. We also highly recommend the genetic evaluation of the fetus and parents

Effects of oral ginkgo biloba extract on pregnancy complicated by asymmetrically intrauterine growth restriction: a double-blinded randomized placebo-controlled trial

Objectives: to evaluate the effect of oral ginkgo biloba extract (GB)) on asymmetrical intrauterine growth restriction (IUGR). Study Design: A randomized trial conducted at Assiut Women Health on 226 pregnant women with asymmetrical IUGR. The patients randomly received GB extract or placebo for 6 weeks. The main outcome measures were improvement in fetal weight and feto-maternal blood flow. The data were analyzed by Student’s t- test and chi-squared tests. Result: There was a significant increase in the estimated fetal weight in the GB group (3047+ 127 gm) when compared to the placebo group (2734+ 127 gm) (p= Conclusions: GB extract improves placental functions, Doppler indices and fetal weight in pregnancies complicated with IUGR fetuses

Effects of oral ginkgo biloba extract on pregnancy complicated by asymmetrically intrauterine growth restriction: a double-blinded randomized placebo-controlled trial

Objectives: to evaluate the effect of oral ginkgo biloba extract (GB)) on asymmetrical intrauterine growth restriction (IUGR). Study Design: A randomized trial conducted at Assiut Women Health on 226 pregnant women with asymmetrical IUGR. The patients randomly received GB extract or placebo for 6 weeks. The main outcome measures were improvement in fetal weight and feto-maternal blood flow. The data were analyzed by Student’s t- test and chi-squared tests. Result: There was a significant increase in the estimated fetal weight in the GB group (3047+ 127 gm) when compared to the placebo group (2734+ 127 gm) (p= Conclusions: GB extract improves placental functions, Doppler indices and fetal weight in pregnancies complicated with IUGR fetuses

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Towards practising constructivism in pre-service science teacher education programmes in Egypt : lessons from the British experience

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