Characteristics of headache attributed to COVID-19 infection and predictors of its frequency and intensity: A cross sectional study.

OBJECTIVE: To study the characteristics of headache attributed to COVID-19 infection and predictors of its severity. METHODS: A cross-sectional study involved 172 individuals who had headache due to COVID-19 infection. A detailed analysis of such headache was done through a face-to-face interview. Patients with any other form of secondary headache were excluded. Labs, including lymphocytic count, C-reactive protein, D-dimer and ferritin and chest imaging, were made available. RESULTS: THE: majority of our patients had a diffuse headache (52.9%). It was pressing in 40.7%, with median intensity of 7 (assessed by visual analogue scale) and median frequency of 7 days/week. Patients with preexisting primary headache (52.9%) had significantly more frequent COVID-19 related headache than those without (47.1%) (p = 0.001). Dehydrated patients (64.5%) had more frequent COVID-19 related headache than those who were not dehydrated (35.5%) (p = 0.029). Patients with fever (69.8%) had significantly higher frequency and intensity of COVID-19 related headache compared to those without fever (30.2%) (p = 0.003, 0.012). Patients with comorbidities (19.8%) had significantly higher frequency and intensity of headache than those without comorbidities (80.2%) (p = 0.006, 0.003). After multiple linear regression, primary headache disorders, dehydration and comorbidities were considered predictors of frequency of COVID-19 related headache. Meanwhile, fever and dehydration were predictors of pain intensity. CONCLUSION: Healthcare providers of COVID-19 patients need to be aware of frequency and intensity predictors of COVID-19 related headache: Primary headache disorders, fever, dehydration, and comorbidities.

Results of Coronary Artery Bypass Grafting Alone Versus Combined Surgical Revascularization and Mitral Repair In Patients with Moderate Ischemic Mitral Regurgitation

BACKGROUND: This is a prospective randomized-controlled study done to evaluate the best surgical option for moderate ischemic mitral regurgitation through either coronary artery bypass grafting only or by performing additional mitral repair. METHODS: Over a nine-month period, 60 patients with ischemic heart disease associated with moderate ischemic mitral regurgitation were equally divided into two groups. Group 1 included 30 patients who had coronary artery bypass grafting with mitral valve repair; Group 2 included 30 patients who had only coronary artery bypass grafting. RESULTS: There were no significant differences between the study groups, regarding operative data, apart from the cardiopulmonary bypass time and aortic cross-clamp time, which were significantly longer in group 1 (P < 0.001). Only one patient died in group 1 due to severe myocardial dysfunction. During the follow up, the NYHA class improved in group 1, from 2.7 to 1.35 (P < 0.004), compared with group 2, where the NYHA class improved from 2.6 to 1.72 (P = 0.07). The degree of MR improved in 28 patients (93%) in group 1 and 22 patients (73%) in group 2 (P < 0.0001). CONCLUSION: The study revealed many advantages of adding mitral repair to surgical revascularization in patients with moderate ischemic mitral regurgitation, with improvement in the degree of MR and NYHA functional class. On the other hand there were no significant differences between the groups, regarding the postoperative course and incidence of mortality.

Patients risk factors as predictors of surgical wound infection following open heart surgery

Background: Median sternotomy wound infections are infrequent yet potentially fatal complication following cardiac surgery. The reported incidence of sternal infections ranges from 0.9 to 20%, and the incidence of mediastinitis is 1­2% in most studies. Several studies have examined and identified possible causes and risk factors associated with sternal infections. They include patient-related risk factors, and procedure-related factors. Aim of the study is the assessment of the patient's risk factors related to incidence of infection. Patients and Methods: ninety-eight cardiac surgery patients operated via median sternotomy were included in the study and the role of patient related factors (age, gender, obesity and diabetes mellitus) in the incidence of postoperative superficial and deep sternal wound infection was accessed. Results: Sternal wound infection (SWI) developed in 18 patients (18.36%). 15 patients (15.3%) had superficial SWI while 3 patients (3.06%) had deep SWI. The most common causative organism in our study was staph. aureus especially MRSA.Conclusion: Patient-related risk factors such as age, gender, obesity and diabetes mellitus are important risk factors in the development sternal wound infection

Left ventricular function as an independent prognostic factor for coronary artery bypass surgery

Background : Studies have suggested that patients with severe impairment of left ventricular function had a poor outcome following CABG surgery. Objectives: Evaluation of the role of pre-operative left ventricular function on the early post-operative mortality and morbidity following CABG. Patients and methods: This study was carried out from August 2016 to January 2017 including 40 patients undergoing CABG surgery. Patients were divided into two equal groups each containing 20 patients. Group A contained 20 patients with pre-operative ejection fraction > 50%, while group B contained 20 patients with pre-operative ejection fraction < 50%. Results: Mortality was 2 patients in group A (10%) compared to 5 patients in group B (25%) (P value = 0.031). The mean ICU stay in group A was 3.29 ± 1.49 days compared to 4.22 ± 1.98 days in group B (P value = 0.028). Pre-operative renal dysfunction improved in 2 patients (10%) from group A, compared to 1 patient (5%) in group B (P value = 0.555). Conclusion: Left ventricular function as an independent factor is a good prognostic factor regarding the early postoperative outcome in coronary artery bypass grafting including mortality, operative times, ICU stay and hospital stay

Incisional negative pressure wound therapy (INPWT) for coronary artery bypass grafting patients

Background: Surgical site infections are major complications of coronary artery bypass grafting using bilateral internal thoracic arteries. In this study we reviewed the results of using INPWT for high risk patients with coronary artery bypass grafting (CABG) using bilateral internal mammary arteries. Patients and methods: From January 2013 to December 2016, patients with coronary artery bypass grafting using bilateral mammary arteries were enrolled in this study. Patients were from Kasr El-Einy, Beni-Suef and Fayoum University Hospitals. The total number was 427 patients, where INPWT was used in 161 patient, and conventional sterilized dressing was done in 266 patients. 2 groups were matched for statistical analysis, the first group was the control and the second group was where INPWT was used. Results: The results related to sternal wound infections were similarly attributed to the conventional group (10.9%) and the INPWT group (10.2%) (P=1.00). Patients treated with INPWT had less rate of infection than those with conventional dressing (5.5% versus 10.2%, P= 0.210), this difference was not statistically significant. Interaction tests also showed comparable results for SSI (surgical site infections) among patients with or without significant co-morbidities. Conclusion: This study suggests that the use of INPWT did not decrease the incidence of sternal wound infections in patients who had CABG surgery using bilateral internal mammary harvesting (BIMA). A larger randomized study is needed to evaluate the efficacy of this technique