A meta-analysis of the effect of different neuroprotective drugs in management of patients with traumatic brain injury.

Traumatic brain injury is a major problem worldwide. Our objective is to synthesize available evidence in the literature concerning the effectiveness of neuroprotective drugs (cerebrolysin, citicoline, and piracetam) on Glasgow outcome score (GOS), cognitive performance, and survival in traumatic brain injury patients. Comprehensive search of electronic databases, search engines, and conferences proceedings; hand search journals; searching reference lists of relevant articles, theses, and local publications; and contact of authors for incomplete data were performed. Studies included patients in all age groups regardless of severity of trauma. There was no publication date restriction. Two reviewers independently extracted data from each study. Fixed effect or random effects model selection depends on results of statistical tests for heterogeneity. The literature search yielded 13 studies. Patients treated with cerebrolysin (n = 112) had favorable GOS three times more than controls (OR 3.019; 95 % CI 1.76 to 5.16; p = 0.003*). The odds of cognition improvement in the treatment group was 3.4 times more than controls (OR 3.4; 95 % CI 1.82 to 5.21; p < 0.001*). Survival of cerebrolysin-treated patients did not differ from controls (103 patients; OR = 2.81; 95 % CI 0.905 to 8.76). Citicoline did not improve GOS (1355 patients; OR 0.96; 95 % CI 0.830 to 1.129; p = 0.676), cognitive performance (4 studies; 1291 patients; OR 1.35; 95 % CI 0.58 to 3.16; p = 0.478), and survival (1037 patients; OR = 1.38; 95 % CI 0.855 to 2.239). One study showed a positive effect of piracetam on cognition. Further research with high validity is needed to reach a solid conclusion about the use of neuroprotective drugs in cases of brain injury.

Endoscopic versus percutaneous biliary drainage for resectable pancreatic head cancer with hyperbilirubinemia and impact on pancreaticoduodenectomy: A randomized controlled study.

BACKGROUND: We hypothesized that percutaneous biliary drainage provides more short-term advantages over endoscopic stenting before pancreaticoduodenectomy. METHODS: Between January 2019 and December 2010, a prospective cohort study was conducted. Sixty patients with potentially resectable pancreatic head cancers and high bilirubin levels were stratified into two equal groups according to the method of biliary drainage: endoscopic stenting or percutaneous drainage. The primary outcome measures were operative difficulties and early postoperative morbidity, the secondary outcome was post-drainage complications. RESULTS: Both groups were comparable in age; gender; presenting symptoms, type of malignancy, post-drainage complications, and time intervals between drainage and surgery. Key preoperative significant differences were technically higher but clinical success rates was better in the PTD cohort. ERCP patients had significantly more difficult dissections, more blood loss, longer resection time, more postoperative bile leak, and longer hospital stay. CONCLUSION: From the operative perspective, patients who underwent PTD in the preoperative setting had fewer morbidities and shorter hospital stay. Large scale studies are required to support the validity of these findings in surgical practice.

Predictors of success of treatment of distal two thirds common bile duct strictures: A retrospective Cohort study over two years.

BACKGROUND: Distal biliary stricture is a challenging clinical condition that requires a co-ordinated multidisciplinary approach. THE AIM OF THIS WORK: was to evaluate the predictors of success of different treatment modalities of distal two thirds CBD strictures. PATIENTS AND METHODS: Data were retrieved retrospectively from the medical records of the patients with distal biliary strictures treated in the Main Alexandria University Hospital from June 2013 to June 2015. Patients were classified into three groups according to the intervention performed: (endoscopic, open surgical, and percutaneous). In addition to the forth group that was followed up without intervention. RESULTS: The study included 282 patients. The mean age was 61.1 ± 10.8 years (25-78) years. The most frequent presenting symptom was jaundice. Pancreatic adenocarcinoma was the most common cause followed by fibrotic stricture secondary to stones. CONCLUSION: In univariate analysis, the success of treatment was significantly associated with the pathology of the stricture of the distal two thirds CBD. In the multivariate analysis, only two factors were affecting the success of the treatment; the stricture length and site.

Critical thinking and attitude of physicians toward evidence-based medicine in Alexandria, Egypt.

BACKGROUND: Evidence-based practice is important for developing countries and is expected to thrive in a questioning culture. Experienced physicians differ in the making of clinical judgements, which are often not based on evidence. Although this topic is of paramount importance to the quality of care provided in the university hospitals in Alexandria, little research has been done about attitudes towards evidence-based medicine (EBM), and the extent of physicians' skills to access and interpret evidence. OBJECTIVE: This study aimed to investigate the relation between the attitude towards EBM and the indicators for questioning mind and critical appraisal skills among physicians in Alexandria, Egypt. PARTICIPANTS AND METHODS: In a cross-sectional study, physicians (N=549) were randomly selected from different clinical departments in three of the university hospitals in Alexandria, Egypt using the stratified proportionate random sampling technique. A self-administrated questionnaire modified from the questionnaire used by McColl and colleagues was used. RESULTS: A high percentage of physicians (83%) had positive attitude towards EBM. Feeling knowledge gap every day was reported by 34.2% of the physicians while 55.6% felt knowledge gap less frequently. The percentage of physicians who understood the meaning of different measures used to assess the importance of results and quality of evidence in meta-analysis studies ranged from 10.8 to 24.2%. Higher frequency of feeling knowledge gap in clinical practice and the ability to correctly answer different questions reflecting critical reading skills were all significantly associated with positive attitude towards EBM (P<0.05). A significant association (P<0.05) was also found between the frequency of feeling knowledge gap and the ability to answer questions related to critical reading of literature. CONCLUSION AND RECOMMENDATIONS: This study has identified a significant relation between critical thinking skills and having a positive attitude towards EBM among physicians in the university hospitals in Alexandria. The study supported the hypothesis that strategies that encouraging critical thinking in medical education could improve the attitude of physicians towards EBM. Adopting teaching methods that encourage critical thinking in medical education as well as including the concepts and principals of critical appraisal of scientific research in the syllabus of both undergraduate and postgraduate medical students are recommended.