bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical Thrombectomy by Rotarex® Device versus Chemical Thrombolysis in The Management of Acute Lower Limb Ischemia (prospective randomized study)
Authors: Ibrahim Hossameldin Ibrahim Abdelhamid , Mahmoud Abdelbary Mostafa Soliman , Abdelsalam Rizk Mohamed Abdelmonem , Omar Abdelmohsen Elkerdawi Sherif Mohamed , Mohamed El-Awady Karim Shalaby
Published: November 2024

Background

Acute limb ischemia (ALI) is one of the most frequent causes for amputation and a potentially life-threatening condition, affecting approximately 1.5 persons per 10 000 per year worldwide.

Aim of the Work

To compare safety (peri operative complications) and efficacy (the success rate, the patency rate and the limb salvage rate) of Percutaneous Mechanical Thrombectomy (PMT) versus Catheter Directed Thrombolysis (CDT) in the management of acute thrombotic lower limb ischemia.

Patients and Methods

This prospective randomized study was conducted on 50 patients with acute thrombotic lower limb ischemia (Rutherford class I, II A) at Ain Shams University Hospitals and Helwan University Hospitals in the period between September 1st, 2021, and August 31st, 2023. Patients were randomized into two groups: Group A: included 25 patients, who were treated with percutaneous mechanical thrombectomy using the Rotarex™S device (Becton, Dickinson and Company, New Jersey, USA) and Group B: included 25 patients, who were treated with catheter directed thrombolysis using drug Actilyse® (Boehringer Ingelheim, Ingelheim am Rhein, Germany) and catheter Fountain® Infusion System with Squirt® (Merit Medical Systems, Inc. California, USA).

Results

In our study, we achieved technical success rate 96% (n = 24) and 80% (n = 20) in group A and group B respectively. Regarding peri operative complications, group A showed 2 cases (8%), (1 perforation and 1 distal embolization / trash foot), and group B showed 2 cases (8%), (1 intracranial hemorrhage and 1 puncture site pseudo aneurysm). 30-day mortality wasn’t reported in any case in group A, while 2 cases were reported in group B. At 1 month follow-up, primary patency rate was 84.0% (21/25) and 81% (17/21) in group A and group B respectively and this rate declined to 62.5% (15/24) and 55.6% (10/18) at 1 year follow up. Late complications (major amputations) were recorded, 1 patient in group A and 2 patients in group B had below knee amputation, non of the patients had above knee amputation in group A, while 3 patients had above knee amputation in group B.

Conclusion

Despite that the results of percutaneous mechanical thrombectomy and catheter directed thrombolysis were comparable, percutaneous mechanical thrombectomy is considered more safe and efficient technique. Percutaneous mechanical thrombectomy was done in single session. PMT had lower mortality and morbidity, higher limb salvage and patency rate than CDT, but in PMT special attention should be given to the potential for distal embolism.
A Comparative Study on the Effect of Melatonin and Orlistat Combination vs. Orlistat Alone on High Fat Diet-Induced Hepatic Changes in the Adult Male Albino Rats (A Histological and Morphometric Study)
Authors: El-Sayed Gehan A , Kamar Sherif A , Mansour Maha A , El-Sayed Sayed M
Published: November 2024

Background

Non-alcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic liver disease, ranging from simple hepatic steatosis (HS), non-alcoholic steatohepatitis (NASH) to advanced liver fibrosis and cirrhosis. Orlistat is a drug approved by the Food and Drug Administration (FDA) for long term management of weight loss, although it was linked to few cases of severe liver injury. Melatonin is one of the most potent antioxidants; it also regulates metabolic processes that lead to obesity and accumulation of fat.

Aim of the Work

to compare the effect of orlistat, melatonin, and their combination on the structural changes of the hepatic tissue of adult male albino rats fed with high fat diet (HFD).

Material and Methods

Thirty adult male albino rats divided into five groups. First group (6 rats) served as (control), second group (6 rats) served as (HFD), third group (6 rats) served as (orlistat-treated), fourth group (6 rats) served as (melatonin-treated), fifth group (6 rats) served as (orlistat and melatonin-treated). Hx&E sections were obtained. Morphometric study and statistical analysis were done.

Results

Tissues from the HFD group showed steatosis, ballooning, and inflammation and all these parameters were moderately improved-except for inflammation which was worsened with orlistat therapy- with both orlistat-treated and melatonin-treated groups. Combined orlistat and melatonin-treated group showed marked improvement of all these parameters as well as marked improvement in the hepatic fibrosis.

Conclusion

Orlistat when combined with melatonin is both safe and effective in comparison to orlistat therapy alone in treatment of obesity induced hepatic changes.
The Possible Effect of Ivermectin on the Liver of Adult Male Albino Rats
Authors: Mohamed Amin Heba Yassin , Tawfik Mohamed Kamal , Ibrahim Hussein Mohamed , Adel Khalifa Engy Mohamed
Published: November 2024

Background

Ivermectin is a Food and Drug Administration (FDA) approved broad-spectrum anti- parasitic agent but not FDA-approved as an antiviral drug. It was shown to have anti-viral activity against a broad range of viruses and its consumption increased significantly during the Coronavirus disease 2019 (COVID-19), the worst pandemic in the past 100 years. So, further studies are required to detect the possible effect on the liver according to the admitted dose of ivermectin when used as an antiviral.

Aim of the Work

The aim of the current work was to study the structural changes in the liver and the biochemical changes in the liver function parameters of adult male albino rats after exposure to ivermectin in two different doses.

Material and Methods

18 adult male albino rats weighing 200 – 250 grams were used in this study. The rats were randomized into 3 groups; Group I was composed of 6 rats and served as the control group without any treatment. Group II (low dose ivermectin treated) was composed of 6 rats and received (0.4 mg/kg body weight) 4 times daily. Group III (high dose ivermectin treated) was composed of 6 rats and received (4 mg/kg body weight) 4 times daily orally via oral gavage for 28 days dissolved in distilled water. At the end of the experiment, blood samples were collected for serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and Albumin. All the animals were sacrificed, and the liver was extracted and processed into paraffin blocks for light microscopic examination and were used for staining with hematoxylin and eosin (H&E), Masson Trichrome, and caspase-3 immunohistochemical reaction. A morphometric study and a statistical analysis were conducted.

Results

The general cellular morphology of the hepatocytes after ivermectin administration was greatly affected. This ranged from cellular swelling with hydropic degeneration and granular cytoplasm up to necrosis of hepatocytes. Other hepatocytes had indistinct cell boundaries and rarefied nuclei. Regarding the portal tract and blood sinusoids, they showed congestion and mononuclear cellular infiltration. Collagen deposition also showed an increase in its deposition around portal tracts and central veins. Caspase-3 showed a positive reaction. All these findings were more obvious in (Group III). Morphometric studies revealed a highly statistically significant increase in the area percentage of collagen fibers deposition and in the area percentage of caspase-3 expression. However, significant deterioration was observed in the level of ALT, AST, and ALP with no statistically significant increase in albumin levels.

Conclusion

Ivermectin oral intake as an antiviral evoked histopathological changes in the tissue when used in low and high doses which are higher doses than those required in treatment when used as an antiparasitic drug.
The Possible Ameliorative Effect of L-Carnitine against Chlorambucil Induced Testicular Oxidative Stress in Adult Male Albino Rat
Authors: Mohammed Elsaid Elrashidy Mennatulla Medhat , Rizkalla Nawal Foad , Sadek Ahmed S , Aziz Diana Eid
Published: November 2024

Background

The upsurge in the use of anticancer agents has generated questions about the safety of these substances on normal tissues. One of these drugs is chlorambucil, which is used in the treatment of CLL (chronic lymphocytic leukemia). Recent clinical observational studies claimed that the use of L- carnitine might have a protective effect against a wide variety of testicular damage that might progress to male infertility.

Aim of the Work

The aim of the current work was to demonstrate the possible protective capacity of L- carnitine on the oxidative histological changes of the testes induced by chlorambucil on adult male albino rat.

Material and Methods

Forty adult male albino rats were assigned into four groups for experiment for 21 successive days. In the control group (I) rats were not subjected to any treatment. In group (II), rats received daily oral L-carnitine in dose of 500 mg per kg per day. In group (III), rats received chlorambucil orally by gastric tube at a dose of 0.2 mg per kg per day dissolved in distilled water. In group (IV), rats were co-administered L-carnitine and chlorambucil. Animals were then sacrificed, and testes specimens were weighted then processed into paraffin blocks, sectioned, and stained with H&E and PAS. Specimens were also processed for semithin sections. Morphometric study and statistical analysis were done.

Results

The histomorphology of the testes sections from chlorambucil treated groups were strongly altered by rarefaction and vacuolization in the seminiferous epithelium, germ cell exfoliation and the presence of giant cells. Further study revealed a high percentage of damaged tubules, decreased germinal epithelial height, and absence of sperms in lumina. Histological examination of testis sections from L-carnitine protected group showed a considerable amelioration of damage and vacuolations. Moreover, many sections showed normal seminiferous tubules with intact spermatogenic cells. In addition to statistically significant increase in number of damaged tubules, statistically significant decrease in weight of testis and germinal epithelial height of seminiferous tubules were found in chlorambucil treated group compared to the control group. However, statistically significant decrease in number of damaged tubules in the L- carnitine protected group was found compared to chlorambucil group. Moreover, there was significant increase in weight of testis of the L- carnitine protected group compared to chlorambucil group.

Conclusion

It is concluded that treatment with antioxidants such as L-carnitine protects against various tissue injuries such as chlorambucil induced testicular damage.
Role of Elevated Arterial Lactate as a Predictor for Contrast Induced Nephropathy Following Percutaneous Coronary Intervention in Diabetic Patients with ACS
Authors: Shawky Elserafy Ahmed , Elshazly Ahmed , Mohamed Ali Baraka Mahmoud , Amin Elsayed Ahmed Shokry
Published: November 2024

Background

Estimated incidence of contrast induced nephropathy (CIN) from variable prospective studies varied widely and ranged from 0% and up to 24%. This is mainly due to the variation in comorbidities, basal creatinine level and other causes of acute kidney injury. The mechanism of CIN is multifactorial. It has been demonstrated that contrast media decreases the antioxidant activity in the nephron and cause direct cytotoxicity to the renal cells, as well.

Objective

To assess the role of elevated arterial lactate as a predictor for contrast induced nephropathy following percutaneous coronary intervention in Diabetic patients with acute coronary syndrome.

Methods

This prospective descriptive study was done on 200 diabetic patients with acute coronary syndrome underwent percutaneous coronary intervention in Ain Shams University during the study period (6 months) from 9/2023 to 2/2024.

Results

We found that higher pre procedure arterial lactate level was associated with an increased risk of CIN in diabetic patients with ACS after PCI. We found by multivariate analysis that the most statistically significant predictors for occurrence of CIN in the studied group were presence of arterial lactate > 1 and whole procedure time >69 min

Conclusion

Pre procedure arterial lactate is a strong independent predictor of contrast-induced nephropathy in diabetic patient with acute coronary syndrome underwent PCI.
Impact of Cardiac Rehabilitation Program on the Quality of Life of Young Adults versus Elderly Egyptians with Ischemic Heart Disease
Authors: omer Rihan Ann Ibrahim , Shabana Adel Mohamed , Khorshid Hazem Mohamed , Zaki Tarek Muneer
Published: November 2024

Background

Exercise-based cardiac rehabilitation is underutilized in patients after myocardial infarction, especially in the elderly population. The ageing biology of this senior population is definitely unique, and they are more likely to experience different consequences for which cardiac rehabilitation can be especially useful.

Objective

To investigate the impact of a 12-week completed cardiac rehabilitation program on the quality of life of two different age groups with recent myocardial infarction.

Methods

This non-randomized prospective cohort study was conducted on 50 patients, divided into two groups; 25 patients for each, group1 included those more than 60 years, group 2 from 18 to 60 years. Both groups underwent cardiac rehabilitation programs during the period of May 2018 to August 2020 at Ain Shams university hospitals. Quality of life assessment was performed via RAND-36 questionnaire, while depression screening was done via PHQ-9 questionnaire.

Results

Both groups showed improvement in the quality of life after completion of the cardiac rehabilitation program. The younger group achieved better improvement in the domains related to physical functioning, general health, role limitation due to physical health, energy/fatigue, and also showed better improvement in depressive symptoms, dyslipidemia and left ventricular Ejection fraction, whereas the senior group showed better improvement regarding role limitation due to emotional problems.

Conclusion

Exercise training in the context of comprehensive CR program improves quality of life in young as well as elderly patients. The young population improved mainly in the domains related to physical health while the elderly group improved regarding emotional domain in the quality of life questionnaires.
Correlation between Myocardial Strain by 2D Speckle Tracking Echocardiography and Severity of Coronary Artery Disease by Coronary Angiography in Chronic Stable Angina
Authors: Anwar Kamel Daniel Nabil , Salam Fahmy Zainab Abdel , Kadis Viola William
Published: November 2024

Background

CAD is a significant cause of mortality and morbidity, Noninvasive imaging techniques are crucial in the diagnosis and risk stratification of patients with suspected stable angina pectoris. However, invasive coronary angiography remains the gold standard for CAD diagnosis. To enhance patient selection for this procedure, myocardial deformation imaging using strain echocardiography provides a simple and noninvasive method to evaluate LV deformation during myocardial ischemia. Strain echocardiography improves the identification of patients who would benefit from invasive coronary angiography.

Objective

To correlate between severity of coronary artery disease using Gensini score and 2D speckle-tracking derived LV global longitudinal strain.

Patients and Methods

The study included 100 patients with symptoms of chronic stable angina. History taking, cardiac examination, full transthoracic echocardiographic study including assessment of left ventricular global longitudinal strain (GLS) using 2D speckle tracking echocardiography and coronary angiography were done for all patients.

Results

The study concluded that a GLS value of -15% was the optimal cut-off for predicting the presence of significant coronary artery lesions, with a sensitivity of 55.81% and specificity of 82.46%. Correlation analysis revealed a positive correlation between GLS and the Gensini score, indicating that as the Gensini score increased (indicating more severe coronary artery disease), the GLS became less negative.

Conclusion

GLS has significant correlation with Gensini score and aids in detection of significant CAD in patients with chronic stable angina. Myocardial strain by 2-D speckle tracking echocardiography together with Gensini score assessment correlates with the angiographic severity evaluated by coronary angiography in patients with stable angina with good sensitivity and specificity thus facilitating prediction of presence of significant CAD. Accordingly, this promises to be an efficient, non-invasive diagnostic tool that may facilitate early intervention for patients with CAD and application of preventive or treatment measures for patients with chronic coronary syndrome.
Effect of Pre-Procedural Statin/Ezetimibe Combination Therapy Versus Statin Monotherapy on Myocardial No-Reflow Following Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Clinical Trial
Authors: Ahmed Ghada Atef , Abdallah Mina Magued , Abdelrahman Mohamed Ahmed , Sharaf Eldin Ahmed Abdelrahman
Published: November 2024

Aim and Objectives

The aim of the study was to compare the effectiveness of pre- procedural Statin therapy and Statin/Ezetimibe in reducing the no-reflow phenomenon in patients undergoing primary PCI.

Patients and Methods

The study was carried out on 200 patients (age 55.86 ± 11.32) presenting to Ain Shams university hospitals with ST-segment elevation Myocardial Infarction and received the standard of care management which is Primary PCI. The patients were assessed regarding the demographic data, risk factors, symptoms including characterization of chest pain, physical examination, 12 lead ECG, labs, Coronary angiography to identify the coronary anatomy, culprit vessel, TIMI flow score and MBG.

Results

Our study compared 100 patients who received high intensity Statin/Ezetimibe combination before primary PCI and 100 patients who received high intensity statin only. Among the case group, 72% were smokers, 33% were diabetic and 24% were hypertensive, 94% presented with killip 1, 5 with killip 2, 1% with killip 3, 70% were anterior STEMI, 2% Lateral, 18% inferior and 10% posterior. Among the control group 75% were smokers, 18% were diabetic and 24% were hypertensive, 95 % presented with killip 1, 3% with killip 2, 2% with killip 3, 49% were anterior STEMI, 6% Lateral, 34% inferior and 11% posterior. The study revealed that there was no statistically significant difference between the two groups, group A (case group) and group B (control group) regarding the occurrence of no reflow, 7 no reflow patients in group A versus 8 in group B, with a P-value of 0.788. There was no significant difference between the two groups in the tissue perfusion post primary PCI as being assessed by TIMI flow classification and myocardial blush grade.

Conclusion

Statin/Ezetimibe combination did not result in a significant reduction in the incidence of no-reflow in STEMI patients in comparison to Statins alone. Although the occurrence of MACE was less in the case group, the exact effect on in-hospital MACE could not be detected due to the small number of total MACE in the study. Larger additional randomized studies are needed to establish the effect of preprocedural high-dose Statin/Ezetimibe combination therapy on angiographic results in patients who undergo primary PCI.
Role of Speckle Tracking in Detection and Short Term Follow Up of Right Ventricular Systolic Dysfunction in Patients with Acute Inferior STEMI
Authors: Aboellil Hassan Samieh , Sallam Walid Mohammed , Arab Tamer Abo , Aboul Soud Mona Ibrahim
Published: November 2024

Background

The right ventricle (RV) is a thin-walled chamber characterized by functioning under low oxygen demands and pressure. RV is perfused throughout the cardiac cycle in both systole and diastole. These factors make RV less susceptible to infarction compared to the left ventricle. Successful primary PCI in patients with RV infarction has shown to regain the RV systolic function and is associated with better in-hospital morbidity and mortality. Speckle tracking derived strain provides accurate assessment of the RV global and segmental myocardial function.

Objective

To assess RV systolic function in inferior STEMI using 2D echocardiography speckle tracking derived longitudinal strain early after primary PCI and follow up 3 months later.

Methods

This prospective cohort study was conducted at Ain Shams University Hospitals. 50 patients underwent successful (PCI) after inferior STEMI. Another 50 healthy individuals were examined “to obtain reference values for RV FWS”.

Results

RV function parameters showed good prognosis 3 months after primary PCI: TAPSE (39 patients “78%” showed improvement Vs 11 “22%” that had no change), also Fractional area change (FAC) (42 patients “84 %” improved Vs 8 non improved patients “16%”) finally Free wall strain showed the better improvement (44 patients “88 %” improved).

Conclusion

Among the echo Doppler parameters, FAC and. RV speckle tracking derived strain parameters were the most sensitive in assessment of RV function impairment and recovery after inferior STEMI.
Glycated Hemoglobin as a Predictor of No Reflow in Diabetic Patients with ST Segment Elevation Myocardial Infarction Managed by Primary Percutaneous Coronary Intervention
Authors: Mohamed Farag Ibrahim Ahmed , Hashem Ahmed Reda , Elias Ramy Raymond
Published: November 2024

Background

Prognosis after myocardial infarction in patients with diabetes mellitus is worse compared with patients without diabetes mellitus, even in the setting of optimal reperfusion strategy involving primary percutaneous intervention (PCI).

Objective

To detect the correlation between HbA1C and no reflow in diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Methods

In this comparative cross-sectional study, we examined 62 diabetic patients who experienced an acute STEMI and had undergone PCI at Ain Shams University Hospitals and Nasr City Hospital for Health Insurance in a period of six months starting from February 2023 till August 2023. These patients were divided into two groups. Group 1 consisted of 31 diabetic patients who exhibited normal blood flow following PCI. Group 2 included an equal number of patients (31) who demonstrated no-reflow phenomenon.

Results

A total of 62 participants were included, with 5 females (8.1%) and 57 males (91.9%), ranging in age from 39 to 83 years. The mean age of the participants was 61.1 years. Statistical analysis showed no significant differences in age and gender distribution between the normal flow group and the no-reflow group, with p-values of 0.151 and 0.641, respectively. There was no statistically significant difference between the two groups regarding physical examination except for diastolic blood pressure that was lower in no reflow group. Also, There was no statistically significant difference between the two groups regarding HbA1C level. Mean with 95% confidence interval (CI) of 7.69 (6.86 – 8.52) in normal flow group and 8.05 (7.02 – 9.7) in no reflow group.

Conclusion

In this study of diabetic patients with STEMI undergoing primary PCI, we found no statistically significant correlation between HbA1C levels and the occurrence of the “no reflow” phenomenon., although there was a trend towards higher HbA1C in the no reflow group which may need conducting large-scale studies involving a more diverse population.
Registry of Transcatheter Aortic Valve Implantation (TAVI) for Patients with Severe Aortic Stenosis at Ain Shams University Hospitals
Authors: Yahya Mohamed , Baraka Mahmoud , Kamal Diaa Eldin , Elsayed Ahmed
Published: November 2024

Background

TAVI is now the standard of care for inoperable patients and a valid alternative to surgery for many high-risk patients (5). it has shown non-inferiority to SAVR in patients with intermediate risk for cardiac surgery, Other recent trials have assessed the safety of TAVI in low-risk patients such as the PARTNER 3, Nordic NOTION 2 and the Medtronic TAVR low risk trial.

Aim

The aim of this study was to evaluate the clinical and echocardiographic outcomes in patients undergoing successful TAVI at Ain Shams University Hospitals during six months follow-up after the procedure, according to the Valve Academic Research Consortium-3 (VARC-3). (9)

Methods

This is a retrospective & prospective cohort Study. It was conducted in cardiology department, Ain Shams University Hospitals in the period of November 2022 to May 2023.it included (151) patients who were treated with TAVI in Ain Shams University Hospitals in the period From January 2020 to October 2022 retrospectively and from November 2022 to May 2023 prospectively29 patients were missed during follow up and excluded due to incomplete data and failure of follow up, to end the study with (122) patients, fulfilling the inclusion criteria.

Results

Regarding death as the most objective and unbiased endpoint, our registry reported a 30-day survival rate of (97.5%), and a six-month survival rate of (96.7%). Regarding symptomatology, our registry shows high significant improvement of symptoms with 99 (81.1%) of patients were asymptomatic at follow up, p-value (<0.001), and the majority of patients with NYHA III (73%) & IV (26.2%) at baseline show high significant improvement with majority of patients at NYHA I (91.8%) & II (7.4%) at follow up with p-value (<0.001). Based on echocardiography assessment in our registry, TAVI significantly improved the patient’s hemodynamics. The mean pre- and post-procedural left ventricular ejection fraction were 59.10 ± 14.62 and 62.70 ± 11.75 respectively with p-value (<0.001), also patients with reduced EF% show significant improvement with mean pre- and post-procedural LV EF% 33.44 ± 8.42 and 42.16 ± 8.40 respectively with p-value (<0.001), The mean pre- and post-procedural pressure gradient (MPG) was 50.12 ± 14.00 and 6.13 ± 1.58 respectively with p-value (<0.001), with more than (99%) absence of moderate or severe valvular leak.

Conclusions

Our registry shows favourable short-term clinical outcomes in unselected TAVI patients, The study found that TAVi candidates in Egypt were younger, had a lower risk for cardiac surgery, and had lower rates of post-procedural complications and mortality than other international all-comer registries, denoting the procedure as safe and beneficial especially by accumulating experience and technical advances in devices and not only add years to patients life by reducing all-cause mortality but also add life to their years by improving quality of life.
Effect of Blood Pressure Control on Left Atrium Functions as Assessed by 2D Echocardiography in Newly Diagnosed Patients with Systemic Hypertension
Authors: Ahmed Elsawye Mostafa Mohamed , Alaa Aly Azza Omran , Ali Moussa Mohamed Khaled , Aly Khaled , El-Salam Zainab Abd
Published: November 2024

Aim and Objectives

The aim of the study is to study the effect of adequate blood pressure control on left atrial functions measured by 2D echocardiography in newly diagnosed patients with systemic hypertension.

Patients and Methods

The study was carried out on 50 Patients with recently diagnosed systemic arterial hypertension and uncontrolled on medications presenting to Ain Shams university hospitals. The patients were assessed regarding the demographic data, risk factors, general examination, local examination, ECG, echocardiography and laboratory measures. Then follow up done after 6 months of proper control of blood pressure (BP) according to JNC 10 in the form of ECG and Echocardiograph

Results

In our study the results showed PALS (peak atrial longitudinal strain) showed increase with change of the mean from 35.04 ± 4.33 to 38.92 ± 5.52with P-value below 0.001. PACS (peak atrial contraction strain)showed increase with change of the mean from 17.38 ± 4.67 to 20.46 ± 4.39 with P-value below 0.001. Mitral peak early (E) and septal and lateral mitral annular velocities and their average (e`) E/e' showed decrease with change of the mean from 8.8 ± 0.93 to 7.8 ± 1.16 with P-value below 0.001. LASI(left atrium stiffness index) showed decrease with change of the mean from 0.24 ± 0.04 to 0.2 ± 0.03with P-value below 0.001.

Conclusion

Our study demonstrated that speckle tracking imaging could be used to detect subtle impairment of LA (left atrium) function in patients with hypertension. proper control of blood pressure in hypertensive patients lead to improvement in PALS, PACS, E/e' and LASI. The clinical usefulness of LA function by STE (speckle tracking echocardiography) in hypertensive patients merits further investigations to better precision of the role of the LA study in the prediction of atrial fibrillation, and the risk of heart failure with preserved ejection fraction.
Registry of Management of Collaterals Post Cavo-Pulmonary Anastomosis and Its Impact on Patients with Single Ventricle Physiology Presented to Ain Shams University
Authors: El-deen Hasan Nehad El-sayed Nour , Samir ElShahed Ghada , Esmail Yasmin Abd El-Razek
Published: November 2024

Background

the bidirectional Glenn shunt is still an essential step in physiologically single ventricle heart repair; as it offers excellent palliation, BDG shunt increases pulmonary blood flow, allows pulmonary arteries growth and improves arterial oxygen saturation. It also enables ventricular volume unloading, associated with a reduction in ventricular end-diastolic volume and ventricular hypertrophy, thus improves survival and quality of life.

Aim of the Work

to register all patients post cavopulmonary anastomosis who developed collateral channels (including venovenous, aortopulmonary collaterals or collaterals to pulmonary veins) and the different methods of management followed and the impact of this management on patients with single ventricle physiology.

Patients and Methods

our registry included 56 patients who underwent bidirectional Glenn procedure referred for follow up in Ain Shams university hospital from March 2022 till February 2023.

Results

Our patients underwent bidirectional Glenn shunt at a median age of 2.08 (1-3) years which is considered a relatively old age compared to registries conducted in developed countries but similar to others studies that have been made in developing countries like Pakistan, India and Iran. In our study, we evaluated veno-venous and aorto-pulmonary collaterals in patients with bidirectional Glenn shunt. We studied prevalence and predictors of their development. We also studied different lines of management, the effect and complications of this management. Among the 56 patients included in our registry 41 patients (73.2%) had veno-venous collaterals and 37 patients (66.1%) had aorto-pulmonary collaterals. In our registry, we showed that transcatheter occlusion of collaterals is an effective and safe line of management of veno-venous and aorto-pulmonary collaterals, 7 patients underwent transcatheter closure of collterals, one of them underwent successful closure of aorto-pulmonary collaterals while the other 6 patients underwent veno-venous collaterals closure. In our registry, there was a statistically highly significant increase in SO2 (%) after trans-catheter closure of veno-venous collaterals (82.83 ± 9.87 Vs 69.83 ± 10.91) with p-value = 0.008.

Conclusion

the need for larger registries of post bidirectional Glenn shunt and post Fontan patients in our country is mandatory to cover different aspects of follow up and management of these patients that will give us more knowledge and experience that will result in improvement in the public health services for those selected population and will help us provide them a better quality of life and improve associated cardiac morbidity and mortality.
The Correlation between Serum Level of NT-Pro Brain Natriuretic Peptide and Hemodynamically Significant Ventricular Septal Defects
Authors: Robel El-abd Tawadrous Peter , Roushdy Alaa Mahmoud , Nossier Heba Mohamed
Published: November 2024

Background

Ventricular septal defect (VSD) is the most common congenital heart disease accounting for 40% of all congenital heart diseases. An isolated VSD accounts for more than 20% of all congenital heart diseases.

Aim of the Work

We aimed in this study to correlate the serum level of NT Pro-BNP with different 2D and 3D variables and the hemodynamic significance of ventricular septal defects including LV volumes, dimensions, functions and left to right shunt quantification (Qp/Qs) measured by 2D echocardiogram.

Patients and Methods

Our study included 60 patients in the pediatric age group (up to18 years old) who were referred for elective echocardiogram in the congenital and structural heart disease unit cardiology department in Ain Shams University hospital. Patients with VSD were divided into three equal subgroups according to shunt quantification (Qp/Qs): group (1) included patients with (Qp/Qs <1.5), group (2) included patients with (Qp/Qs>1.5-2) and group (3) included patients with (Qp/Qs >2).

Results

There was a highly significant positive correlation between Pro-BNP level and echocardiographic shunt quantification by QP_QS (p < 0.001). And there was a highly significant positive correlation between Pro-BNP and echocardiographic VSD Size (r = 0.8) & Mean. PAP (0.8). A highly significant positive correlation between Pro-BNP and indexed LVEDV and indexed LVESV by 2D and 3D echocardiography was also noticed. Also there was a highly significant negative correlation between Pro- BNP and EF by m mode and a significant negative correlation with LV EF by Simpsons method and LV EF by 3D echocardiography. In our study with ROC curve analysis a cut-off point of discriminating patients with QP/QS <1.5 from those >1.5 was 98 pg/ml that had the highest balanced sensitivity and specificity to predict significant shunt with sensitivity = 97.5 % and specificity = 90 %.

Conclusion

Pro-BNP level correlates with the amount of left to right shunt (Qp/Qs ratio) in children with VSD. Therefore, pro-BNP can be used as a screening tool for evaluating hemodynamic load in these patients.
Incidence of Subclinical Venous Thromboembolism after Pulmonary Resection for Lung Cancer
Authors: Barien Mohamed M , El-Nori Ahmed A , Mostafa Ahmed M , El-Sayed Hany H
Published: November 2024

Background

Deep venous thrombosis DVT, in post-surgical patients, is more common in lung cancer patients undergoing resection. The combination of malignancy, surgical trauma, chemotherapy, and smoking are all synergistic factors raising the risk. Most of the patients developing post-operative DVT are subclinical and asymptomatic. Subclinical DVT means presence of thrombus in deep veins of lower limb without any signs and symptoms. DVT can be prevented more successfully in its subclinical phase than that in its clinical phase.

Aim

The present study was undertaken to estimate the occurrence and associated risk factors of subclinical deep vein thrombosis at our institute after lung resection for lung cancer patients in the elective and urgent setting.

Methods

This is a prospective study of 150 patients who underwent different types of lung resection for lung cancer. Patients younger than 18 years old, symptoms of lower limb DVT and pregnant patients were excluded. Caprini risk score was assessed in all patients. All patients received prophylactic stockings and anticoagulant. On the 5th postoperative day, a duplex venous ultrasound of bilateral lower limbs was performed in every asymptomatic patient to look for presence of thrombus in the deep veins.

Results

Out of 150 patients enrolled in the study, we completed the study on 147 patients. According to the results of Doppler US, the patients were divided into 2 groups: group 1 (n = 143) post-lung resection and no DVT. Group 2 (n = 4) with post-lung resection subclinical DVT. 4 patients (2.721%) developed subclinical deep vein thrombosis. No patient developed postoperative clinical DVT. Incidence was maximum in the group with longer ICU stay (P-value = 0.04.). Among the various pathologies, incidence was more in patients who received preoperative chemotherapy (P-value = 0.001). One patient (25%) died in the group who developed subclinical DVT while no mortality was observed in the No DVT group.

Conclusion

It can be concluded that incidence of subclinical deep vein thrombosis is low in the post operative period among the patients undergoing lung resection for lung cancer. However, patients of old age, those with preoperative chemotherapy and those with longer periods of immobilization are at a higher risk to develop postoperative DVT despite anticoagulant prophylaxis. It might be justified to screen these high-risk groups to detect subclinical DVT to allow for post discharge prophylaxis.
Comparing the Outcome of Using High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for Chronic Obstructive Pulmonary Disease Patients with Acute Hypercapnic Respiratory Failure
Authors: Mahmoud Farrag Mohamed Ali , Abdel Kader Maryam Ali , Sultan Dina Ruby , El Mashad Alaa Gamal Youssef
Published: November 2024

Background

Noninvasive ventilation (NIV) is frequently employed as a treatment option for acute hypercapnic respiratory failure (AHRF) resulting from chronic obstructive pulmonary disease (COPD). Limited research has substantiated the claims made in recent studies regarding the feasibility of employing high flow nasal cannula (HFNC).

Aim

Our study assessed the outcome of using HFNC versus NIV for COPD patients with AHRF.

Patients and Methods

Eighty COPD patients with AHRF were confined to the respiratory intensive care unit (RICU) at Ain Shams university hospitals from December 2021 to 2023 and subdivided into 2 groups (40/group), where the first group was placed on NIV, while the second group was placed on HFNC. Data during their hospital stay as demographic data, vital data, arterial blood gases, device duration, treatment failure and mortality were recorded.

Results

The majority were males with mean age 63.75 ± 9.05 years along with treatment failure and complications 25%,27.5% in NIV versus 45%,10% in HFNC respectively, with longer hospital stay in NIV (10-15 days) to (7-10 days) in HFNC with no difference in mortality rate in both groups.

Conclusion

NIV and HFNC were both modalities for treating COPD with AHRF with no confirmed superiority of any of them; as treatment failure was apparently lower in NIV than HFNC along with apparently faster improvement in ventilatory and respiratory status but significantly NIV group was superior in length of hospitalization and incidence of complications than HFNC with no difference in mortality in both groups.
Assessment of Navigation Bronchoscopy with ROSE Technique in Detection of Peripheral Lung Lesions
Authors: Ibrahim EL Assal Gehan Mohamed , Taha Madkour Ashraf Mokhtar , Said Mohamed El Maraghy Ashraf Abbas , Eldin Mohamed Haytham Salah , Mahdy Manal Mohamed El , Abdelhakim Mayada Amr Helmy , Diab Haytham Samy
Published: November 2024

Background

Solitary pulmonary nodules (SPNs) are often found incidentally on chest radiographs or computed tomography (CT) scans and are quite common. Management of the SPNs generally depends on the clinical suspicion of cancer. While most small nodules can be followed by imaging alone, those ranging in size between 10 mm and 30 mm in diameter are often considered too large for watchful waiting.

Aim of the Work

To assess the role of navigation bronchoscopy in detecting peripheral lung lesions with ROSE technique at the Bronchoscopy Unit in Ain Shams University Hospitals.

Patients and Methods

The study was conducted at bronchoscopy unit in Ain Shams university Hospital, it was included 35 patients underwent navigation bronchoscopy with ROSE technique, provided that there is no contraindication for fibreoptic bronchoscopy.

Results

The diagnositic yield of navigation bronchoscopy was positive in 78.3% of cases, with 60% of cases’ lesions was malignant. And these results were matching with universal studies. Complications occurred in 8.7% of cases only and were mild controllable bleeding, no pneumothorax was detected. There was a highly significant difference between negative and positive pathologically diagnosed cases groups as regard Bronchus sign, as about 94 % of positive Bronchus sign cases were positive by final pathology compared to only 20% of negative sign cases.

Conclusion

ROSE was conclusive in most cases and was matching with the final diagnosis. It was complementary and had additive value to the procedure as it gave us a hint about the preliminary diagnosis and had decreased the time for procedure.
Conservative versus Liberal Oxygenation in Chest Diseases
Authors: Mohamed Aya M , Diab Haytham S , Hendawy Mahmoud M , Hussein Ahmed M , Mahmoud Nihad M
Published: November 2024

Background

Conservative oxygen therapy is a good alternative to liberal oxygen therapy, as it overcomes libral oxygen therapy induced hyperoxia and reduces its harmful and undesirable effects such as lung injury and, lung collapse, acute respiratory distress syndrome.

Objective

To systematically review the efficacy and safety of conservative versus liberal oxygen therapy, and to measure the caliber of trachea and main bronchi at the start and end of treatment by oxygen therapy to show if it has an effect on anteroposterior and transverse dimensions of trachea and main bronchi.

Patients and Methods

A prospective study was conducted on 72 subject were divided into 2 groups. 36 patients received liberal oxygen (group A), 36 patients received conservative oxygen (group B).

Results

In comparing the 2 groups, there was no statically significant difference between the two groups concerning hospital acquired infection but hospital acquired pneumonia was high in group A (p value < 0.05). Furthermore, length of hospital stay was statically significant higher in group A (p value < 0.001). Although arrhythmia was statically significant higher in group B (p value < 0.05). On other hand there was no statically difference between two groups as regarded vasopressor dose, new organ dysfunction, mechanical ventilation free days, attempts to lower use of mandatory MV mode which might indicate earlier attempts to wean patients, ARDS as a new complication, ICU mortality, hospital mortality and 30day mortality (p value > 0.05).

Conclusion

Both libral and conservative oxygen therapy have advantages and disadvantages, and we did not find a clear difference between both choices. Each of the two options is left to the physician, who decides to choose one of the two options according to his exeperience and the patient's condition.
Prevalence of Fungal Pneumonia among Respiratory Illness Patients
Authors: El Sharkawy Samar Hassan , Abd El Kader Maryam Aly , Atiatullah Hoda , Mohamed Zaki Sherif , Mohamed Nasr El Din Mahmoud Reham
Published: November 2024

Background

Fungal pneumonia is an infectious process in the lungs caused by one or more endemic or opportunistic fungi. Fungal infection occurs following the inhalation of spores, inhalation of conidia, or by the reactivation of a latent infection. Hematogenous dissemination frequently occurs, especially in an immunocompromised host. Endemic fungal pathogens (e.g. Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Sporothrix schenckii, Cryptococcus neoformans) cause infection in healthy hosts and in immunocompromised persons. Opportunistic fungal organisms (e.g. Candida species, Aspergillus species, Mucor species) tend to cause pneumonia in patients with congenital or acquired defects in host immune defenses.

Aim of the Work

To assess the prevalence of fungal Infection in a group of Chest Patients and to identify their pattern.

Patients and Methods

After ethical committee approval and informed consent from the patients, this prospective cross-sectional study was performed on a total of 110 patients with history of preexisting lung disease and immunosuppression from corticosteroids who were admitted in Ain Shams University from March 2021 till February 2022.

Results

As evident from the current study, the prevalence of pulmonary fungal infection was 36.4% in patients with respiratory diseases and the most common significant independent risk factors and comorbid disease were Diabetes mellitus and Quinolones for getting fungal infection.

Conclusion

Pulmonary fungal infection important problem in patients with respiratory diseases especially in patients who are admitted to the respiratory ICU regardless of their age, sex, fungal species, Covid-19 vaccination, antibiotics used, laboratory or CT findings.
Comparative Study between the Vitek2 and the API 20 Strept Regarding the Identification of Medically Relevant Streptococci
Authors: Hafez Hala Mahmoud , Anwar Maha Ahmad , Abd El Atty Merna Hassan
Published: November 2024

Background

Streptococci are gram-positive bacteria that are incriminated in many healthcare and community-acquired infections worldwide. Accurate identification of the organism to the species level is important to determine the pathogenic potential of individual species and monitor trends in antimicrobial susceptibility and emerging infections.

Aim and Objectives

In the present work we aimed to compare between the Vitek2 GP ID cards and the API® rapid ID20 Strept regarding the identification of medically relevant Streptococci.

Methods

This was a Cross-sectional descriptive study that was carried out at the Central Microbiology Laboratory, Clinical Pathology Department, Ain Shams University Hospitals during the period between August 2021 and February 2022. A Total 50 Medically relevant isolates of Streptococci recovered from different clinical samples were subjected to species identification using The API® rapid ID20 Strept and the VITEK® 2 system using the GP ID card.

Results

A statistically excellent agreement (%) = 45/50 = 90%; Disagreement (%) = 5/50= 10% was observed between VITEK® 2 system and the API® rapid ID20 Strept method regarding the identification results of the Streptococci spp. with (k = 0.90 and p-value <0.001).

Conclusion

VITEK® 2 as an automated system provides very good and trustable accuracy and has dominate advantages in identification time as compared to manual API microsystems in clinical lab.
BRCA1/BRCA2 Germline Gene Mutations in Breast Cancer Egyptian Female Patients
Authors: Elsayed Sally , Talkhan Hala Ahmed , Mamdouh Rasha , Sabry Elkady Mohamed , Elkabarity Rania Hamdy , Wahba Nancy Samir
Published: November 2024

Breast cancer (BC) is the most commonly diagnosed cancer and the leading cause of cancer related deaths among women worldwide. Deleterious germline mutations in BRCA1 and BRCA2 genes underlie a major proportion of the inherited predisposition to BC and may lead to more aggressive disease. However, in many developing countries, including Egypt, knowledge of the prevalence of BRCA1/2 mutations among women with BC is sparse. The aim of the current study was to evaluate the contribution of germline mutations in BRCA1/2 to BC among Egyptian female patients. A case control study was conducted and included 30 Egyptian adult females diagnosed with BC, and 20 age matched Egyptian healthy females as control group. Real time polymerase chain reaction (PCR) was used for detection and allelic discrimination of BRCA1 mutations (185delAG, 4153delA, 5382insC, 3819delGTAAA, 3875delGTCT, 300T>G, 2080delA) and BRCA2 mutation (6174delT) in all included subjects. None of the studied mutations of the BRCA1 and BRCA2 genes were detected in BC patients or in the healthy control group included in the study.

Key words: Breast cancer, BRCA1, BRCA2, gene mutation, prevalence.