bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Pressure Targeted Modes of Ventilation on Diaphragmatic Function as Assessed Using Ultrasonography in Critically Ill Patients with Cerebral Insult
Authors: Mohamed Youssef Hadeer Mosadek , El Said Kamel Amr Mohamed , Mostafa El-Owaidy Raham Hassan , Maarouf Mohammed Mahmoud , Kamal Mohamed Mohamed
Published: July 2024

Background

Mechanical ventilation (MV) causes diaphragmatic atrophy and reduces diaphragmatic efficiency. Patients with diaphragmatic dysfunction (DD) have longer MV durations and intensive care unit (ICU) stay. There is currently a scarcity of data on the effect of different modes of MV on diaphragmatic function and ultrasound-guided assessment of diaphragmatic efficiency.

Methodology

Sixty mechanically ventilated patients were randomly divided into four equal groups (15 each), patients were ventilated using either Assist Control Pressure Controlled mode (ACPC group)(Group A), Synchronized Intermittent Mandatory Ventilation Pressure Controlled mode (SIMV)(Group S), Bi-level Positive Airway Pressure mode (BiPAP)(Group B), or Pressure Support Ventilation mode (PSV)(Group P). The primary outcomes were diaphragmatic motion & structure in terms of Diaphragmatic Excursion (DE) & Diaphragmatic Thickness Fraction (DTF) respectively. The duration of the ICU stay was the secondary outcome.

Results

The PSV group had the highest DE indicating better diaphragmatic function. In addition, MV for longer durations led to diaphragmatic thinning and decreased DTF resulting in DD.

Conclusion

Among the various modes of ventilation employed in the study, PSV was found to be the mode with the lowest risk of DD.

Trial Registry

PACTR202112653971335.
Erector Spinae Plane Block versus Patient Controlled Analgesia for Postoperative Analgesia in Patient Undergoing Urologic Surgeries with Lumbar Incision
Authors: Farid Hammouda Ahmed Nasser Mohammed , Mohamed Elzahaby Hany Mohamed , El Moneim Nofal Walid Hamed Abd , El-Fattah Ghoneim Mohamed Mohamed Abd
Published: July 2024

Background

Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Urologic surgeries with lumbar incision are usually associated with acute postoperative pain and restricted mobility. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures.

Aim of the Work

The present study was designed to detect the effectiveness of ESPB for post-operative analgesia in urologic surgeries with lumbar incision and its effectiveness to decrease the use of analgesic drugs requirements compared to PCA.

Patietns and Methods

The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients‟ consent. It included a total of 60 adult patients aged 21-60 years, Scheduled for urologic surgeries with lumbar incision e.g: open nephrectomy. Patients were randomly divided into two equal groups, 30 each, according to the inclusion and exclusion criteria. Group A (n = 30): will receive fentanyl 1-2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation in addition 40 ml bupivacaine 0.25% as a single level unilateral injection for ESPB after induction of anesthesia and before skin incision. Group B (n = 30): will receive only fentanyl 1- 2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation and PCA will be started after the end of the surgery.

Results

The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing urologic surgeries with lumbar incision also reduced the total amount of postoperative morphine consumption in comparison to the PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in first 24 hour and Decrease incidence of nausea, vomiting and constipation due to decrease opioids intake.

Conclusion

Ultrasound-guided unilateral ESPB reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients‟ satisfaction in the first 24 hours after urologic Surgeries with Lumbar Incision, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB markably decreased the rate of PONV. This might be because the use of ESPB might have decreased the use of intraoperative opioids.
Effect of Atracurium and Rocuronium on the State and Response Entropy during Isoflurane Anesthesia: Randomized Prospective Study
Authors: Mohamed Hassanien Noran Essam , Bassiouny Mohsen Albdghany , Eldin ElSerwi Heba Bahaa , Ahmed Ashour Tarek Mohamed , Abdelnaiem Ismaiel Mohamed Abdelmohsen
Published: July 2024

Background

Several researches have inspected the impact of inhalation anesthetics, intravenous anesthetics, and muscle relaxants on spectral entropy, but many didn’t evaluate the extent of neuromuscular block. Besides, they didn’t inspect the impact of distinct degrees of neuromuscular blockade on spectral entropy under dissimilar saturations of isoflurane inhalation. Hence, this study evaluated variant degrees of minimum alveolar concentration (MAC) to estimate the isoflurane concentration, along with various level of neuromuscular blockade. Aim of this study is to evaluate the effect of muscle relaxants (atracurium and rocuronium) on entropy readings (state, response entropy and response- state difference) during isoflurane anesthesia. This is a prospective randomized study where forty patients were included and divided into two study groups; patients in Group A received atracurium, while patients in Group R received rocuronium. State and response entropy were observed under MAC 0.8% and 1% under 50% and 100% neuromuscular blockage.

Results

There was a positive correlation between state (SE) and response entropy (RE) at baseline, different MAC, and different train of four (TOF) for both atracurium and rocuronium. State and response entropy decreased with increasing MAC of isoflurane (p < 0.001), while atracurium and rocuronium at TOF 50% and 100% showed no effect on SE or RE or RE-SE (P > 0.05).

Conclusions

State and response entropy can be used effectively to evaluate depth of anesthesia at different isoflurane MAC and atracurium or rocuronium doses. Registration number: ClinicalTrials.gov Identifier: NCT 05097508, Registered 5 October 2021 - prospectively registered, http://www.ClinicalTrial.gov
Bupivacaine 0.25% versus Bupivacaine 0.125% with Dexmedetomidine for Transversus Abdominis Plane Block for Post-operative Analgesia in Cesarean Section
Authors: El Ghaffar Omnia Abd , Ewiss Hassan Bahaa El Din , Ahmed Mohamed Saleh , El Derh Maha Sadek
Published: July 2024

Background

Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action.

Objectives

The aim of this study is to compare two different concentration of Bupivacaine 0.25% versus 0.125% added to Dexmedetomidine as adjuvant in TAP block on quality of analgesia for postoperative pain for parturients undergoing elective CS as regard: VAS score for pain after TAB block, hemodynamics stability, first dose of rescue analgesia and the side effects.

Results

We found that Bupivacaine 0.125% with dexmedetomidine is recommended regarding their analgesic properties, and moreover, Bupivacaine 0.25% with dexmedetomidine was proved to prolong the analgesic effect of TAP block in elective CS even with the higher concentrations of local anesthetics is our concern.

Conclusion

TAP block with bupivacaine 0.125% with dexmetomidine is an effective combination used for postoperative pain relief after elective Cs with lower incidence of LAST, hemodynamic stability and lower opioids consumption.
Ultrasound Guided Pectoralis Nerve Block as a Novel Approach in Pacemaker Implantation
Authors: Abdel Fatah Amr Mohamed , Ibrahim Dalia Ahmed , Elgohary Mohamed Osama , Kamal El-Deep Tamer Ahmed , Kamal Eldin Amin Sara Mohamed
Published: July 2024

Background

The use of implantable cardiac electronic devices (CEDs), including pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronized therapy (CRT), is increasing worldwide for the treatment of cardiac arrhythmias. The aim of this work was to evaluate the effectiveness of PECS I, PECS II blocks as the primary anesthesia technique in patients undergoing subcutaneous pacemaker in comparison to local infiltration anesthesia.

Methods

This prospective cohort randomized study was carried out on 40 patients between the ages of 21 to 80 years old undergoing pacemaker implantation in Aswan heart center. Patients were randomly allocated into two equal groups: Group (1): received Pecs block and group (2): control group, received standard local infiltration anesthesia with lidocaine 0.2 (10-15ml).All patients were subjected tolaboratory examinations) Hemoglobin, platelet count international normalized ratio, prothrombin time, partial thromboplastin time), Echocardiography (ECG), VAS, PCIA and preoperative medications.

Results

Number of patients required postoperative analgesia was significantly lower in group 1 compared to the group 2 (P value <0.001). Time to first require analgesia was significantly delayed in PECS blocks group compared to the control group and postoperative analgesia was significantly lower in group 1 compared to the group 2 (P value <0.001). The hospital stay was significantly lower in PECS blocks group compared to control group (<0.001).

Conclusions

Ultrasound guided PECs provided adequate analgesia as shown by reducing the times of start procedure and technique, postoperative pain scores and total opioid usage, delayed the time to first require analgesia and better operator and patient satisfaction in pacemaker implantation as compared to infiltration anesthesia.
Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracoscopic Surgery (VATS)
Authors: Fawzi Hanna Marina Emad , Abdel Latif Samia Abdel Mohsen , Hussien Maamoon Rania Maher , Abdel-Mouty Taher Islam Abdel-Aal
Published: July 2024

Background

Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications.

Aim of the Work

The present study was designed to assess the analgesic efficacy of ultrasound guided Erector Spinae Plane Block done at the fifth thoracic transverse process level in patients undergoing VATS surgeries for postoperative analgesia.

Patients and Methods

This prospective randomized clinical study was conducted in Ain Shams University Hospitals. It included a total of 60 adult patients aged 21-60 years, Scheduled for VATS surgeries. Patients were randomly divided into two equal groups 30 patients each. The ESPB group (n = 30): received ESPB after induction of anaethesia, while the Control group (n = 30): received only fentanyl 1- 2 mcg/kg during induction of anesthesia and additional boluses of fentanyl.5 mcg/kg were given according to the patient’s vital data.

Results

The main finding in this study was that ultrasound guided ESPB provided a good analgesic effect in patients undergoing VATS surgery, it also reduced the need for rescue analgesia and the total amount of postoperative opioid consumption in comparison to controlled group, Prolonged the time to first request of analgesia, allowed early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting.

Conclusion

Ultrasound-guided erector spinae plane block was found statistically significantly in reducing postoperative opioid consumption, alleviating postoperative pain scores and improving patients’ satisfaction in the first 24 hours after VATS surgeries, without associated adverse effects as postoperative nausea and vomiting, nerve injury, respiratory depression and hematoma formation.
A Comparative Study between Ultrasound Guided Interscalene and Ultrasound Guided Suprascapular Nerve Blocks in Postoperative Pain and Hand Motor Power Affection in Shoulder Scope Surgeries
Authors: Mohamed Hashem Mohamed Medhat , Ibrahim Sherif Farouk , Mansour Waleed Ahmed , Abdelaziz Noha Mohamed , Fahmy Neveen Gerges
Published: July 2024

Background

Interscalene approach of brachial plexus nerve block is recognized as the gold standard technique for postoperative pain control after shoulder scope surgeries. However, it is associated with major adverse effects and patient discomfort due to paralysis of the hand muscles. The suprascapular nerve block is considered to be a safe and effective alternative to interscalene nerve block for shoulder surgery without affecting the motor function of the hand muscles and other serious complications of interscalene nerve block, especially in ambulatory surgery.

Aim of the work

The aim of this study is to compare interscalene and suprascapular nerve block in terms of postoperative pain, opioid consumption, and hand grip strength in shoulderscopic surgeries.

Patients and Methods

This prospective, randomized trial was done in Ain Shams University Hospitals. A sample of 50 patients; 25 patients in each group, namely Group ISB (interscalene approach of brachial plexus block) and Group SSNB (suprascapular nerve block). Visual Analogue Scale (VAS) was used to assess Shoulder pain at rest and upon flexion in the first 24 hours. The degree of hand motor power affection, the total amount of opioids used as rescue analgesia, and the incidence of complications were also recorded.

Results

The findings revealed no statistically significant difference between groups (p-value > 0.05) in pain control all over the 24 hours by VAS score at rest and at arm flexion. SSNB received a larger total narcotic dose (60±26.02) mg of pethidine than ISB (52±22.73). However, there was no statistical difference between them throughout the 24 hours regarding total narcotic consumption and 1st time for pethidine administration. The ISB group showed a statistically significant reduction in the hand power grip strength postoperatively (83.68±4.75 %).

Conclusions

The results of the present study favour SSNB as the first choice of pain control after shoulderscopic surgeries for a patient scheduled for early home discharge because of the complete recovery of the hand muscles’ motor power.
Evaluation of the Efficacy of Targeted Microbiome Therapy in Non-Alcoholic Steatohepatitis Rat Model
Authors: Salah Noha , Matboli Marwa , Mansour Amal , Abo El Magd Nagwa M , Kamel Hassan Amany Helmy Hasanin Mohamed , Eissa Sanaa
Published: July 2024

Non-alcoholic steatohepatitis (NASH) is the clinically aggressive variant of non-alcoholic fatty liver disease. Hippo pathway dysregulation can contribute to NASH development and progression. The use of probiotics is effective in NASH management. Our aim is to investigate the efficacy of kefir Milk in NASH management via modulation of hepatic mRNA-miRNA based panel linked to NAFLD/NASH Hippo signaling and gut microbita regulated genes which was identified using bioinformatics tools. Firstly, we analyzed mRNAs (SOX11, SMAD4 and AMOTL2), and their epigenetic regulator (miR-6807) followed by validation of target effector proteins (TGFB1, IL6 and HepPar1). Molecular, biochemical, and histopathological, analyses were used to evaluate the effects of kefir on high sucrose high fat (HSHF) diet -induced NASH in rats. We found that administration of Kefir proved to prevent steatosis and development of the inflammatory component of NASH. Moreover, Kefir improved liver function and lipid panel. At the molecular level, kefir down-regulated the expression of miR 6807-5p with subsequent increase in the expression of SOX 11, AMOTL2 associated with downregulated SMAD4, resulting in reduction in the expression of the inflammatory and fibrotic markers, IL6 and TGF-β1 in the treated and prophylactic groups compared to the untreated rats. In conclusion, Kefir suppressed NASH progression and improved both fibrosis and hepatic inflammation. The produced effect was correlated with modulation of SOX11, SMAD4 and AMOTL2 mRNAs) – (miR-6807-5p) – (TGFB, IL6 and, HepPar1) expression.
Investigating the Effect of Phototherapy on Expression of CXCR3-B Gene in Vitiligo
Authors: Mansour Amal Abdelsalam , Diab Heba Mahmoud , Badawy Seham Adel , Hay Ibrahim Nesma Hussein Abdel , Mohammed Agag Fatma Al-Zahraa
Published: July 2024

Background

Vitiligo is acquired depigmentary disorder characterized by destruction of the epidermal melanocytes leading to the loss of the skin color. Oxidative stress, genetic susceptibility together with autoimmunity are the main players of melanocytic destruction aetiopathogenesis.

Aim of the Work

The primary aim of the work was to investigate the effect of phototherapy (NBUVB and excimer laser) on CXCR3B expression in vitiligo. The secondary aim was to confirm the claim of causal relationship between CXCR3B levels and vitiligo in an attempt to evaluate CXCR3B role in the pathogenesis of vitiligo.

Patients and Methods

A prospective cohort study in department of Dermatology, Venereology and Andrology Ain Shams University, (El Demerdash and Al-Haud Al-Marsoud) vitiligo clinics and Biochemistry Department Ain Shams University between 2020 - 2022. In our study we measured CXCR3B mRNA expression in skin of vitiligo patients before and after generalized ‘NBUVB’ and targeted ‘Excimer laser’ phototherapy. Our study was conducted on 25 patients suffering from non-segmental vitiligo. All biopsies were stored in -80C till RNA extraction that was performed using QIAGEN RNeasy Mini Kit, QuantiTect Reverse Transcription Kit and QuantiNova SYBR Green PCR Kit.

Results

We found that CXCR3B mRNA expression was significantly increased after phototherapy that is well known for immune modulatory properties. Moreover this was higher in excimer group therapy than NBUVB. Such findings highlight CXCR3B as an inherit defect in skin of patients with vitiligo and raise questions about its possible roles in maintaining vitiligo or causing relapses.

Conclusion

CXCR3B mRNA levels were significantly increased after treatment with either NBUVB or Excimer laser compared to mRNA levels before therapy. From our results we can conclude that elevated CXCR3B mRNA levels are obviously characteristic to patients with vitiligo and suggestive of persistent inherit defect of their melanocytes. It may also be responsible for the relapse and chronicity of vitiligo.
Impact of 3D TEE guided ASD transcatheter closure on procedure outcome and radiation exposure
Authors: EL Okl Reham Atef , Mosa Tarek khairy , Mansour Amr , Ezzeldin Dina , Roushdy Alaa , EL Fiky Azza
Published: July 2024

Background

Transcatheter ASD device closure of secondum ASD is widely accepted in closure of ASD. Radiation exposure increases the risk of cancer for both patients and staff members, fusion of 3- D TEE and fluoroscopy has helped us decrease radiation exposure during whole procedure.

Aim

to assess feasibility of 3 D TEE guidance in transcatheter ASD closure and assess its value in reducing radiation exposure as compared to control patients.

Methods

This study was conducted on 30 patients with secundum ASD referred to cardiology department - Ain Shams University for percutaneous ASD device closure under 3D TEE guidance and 54 control patients who performed percutaneous ASD device closure using conventional method. we calculated total procedure time (min), total DAP (mGy/cm2), (FT) fluoroscopy time (min), total air kerma (mGy), maximum ASD diameter (mm) and we recorded implanted device size and device type for all the patients.

Results

There was no significant difference between both groups regarding FT, total air kerma, dose area product. Operative time of study group was significantly longer than control group although FT reduced significantly in last case of the study. In the last 10 cases of the study radiation exposure decreases and was significantly lower than control group.

Conclusion

The Use of 3 D-TEE by well-trained imaging cardiologist on tracking catheter during percutaneous ASD device closure decrease significantly radiation exposure of patients as well as medical personnel.
Three years' registry on myocardial perfusion imaging patients in Ain shams university nuclear cardiology unit
Authors: Alzebak Osama , Mansour Hazem , Rayan Mona , Adel Amr
Published: July 2024

Background

The development in nuclear myocardial perfusion imaging (MPI) has provided diagnostic and prognostic implications in CAD patients, leading to an explosive increase in the performanceofthesestudies. Thisexpansionofimagingspectrumisassociatedwithwidespread concern regarding imaging utilization and increased healthcare costs. There is no comparative data that guide the use of these modalities with respect to appropriateness and patients’ benefit. Targeted data collection, through registry studies, enable analysis of both quality and outcomes with big advantages of reflecting real world daily practice and identifying the gaps in care which may not otherwise be feasible in high-quality randomized control trials.

Objective

To explore the extent to which stress myocardial perfusion imaging (MPI) studies met published appropriate use criteria (AUC), and the real world practice in the nuclear cardiology unit of Ain shams University.

Patients and Methods

It was a retrospective cohort study that included 2598 patients who underwent myocardial perfusion imaging in Ain Shams university nuclear cardiology unit throughout the period from January 2017 to December2019. All patients were subjected to thorough demographic data, history of cardiovascular risk factors (arterial hypertension, diabetes mellitus, smoking, family history of premature cardiovascular diseases), indication of the test, preprocedural ECG, ejection fraction by echocardiography, previous coronary angiography and PCI or CABG, calculation of pretest probability and Framingham risk score, determination of appropriateness use criteria and stress-rest Tc 99m imaging to detect the presence of ischemia and one day Tc 99m imaging to detect viability.

Results

The study included 2598 patients with mean age of 57.76 years, with male predominance (68.1%), 38.2% were diabetics and 53% had hypertension. The most common indications to undergo MPI was the exclusion of CAD as a cause of chest pain in 38.8% of patients followed by the evaluation of symptomatic post PCI patients in 21.9%. Moreover 63.8% of patients showed appropriate tests, while 18.6% of patients showed uncertain tests. Whereas 17.6% of patients had inappropriate studies. 81% of appropriate tests showed positive results of SPECT. Whereas in the inappropriate and the uncertain category, the negative test for ischemia predominated.

Conclusion

We have established that appropriateness criteria are effective in identifying appropriateness of SPECT in a university center located in Cairo. Also, we concluded that in our unit the appropriate tests were more prominent than inappropriate and unclassified tests. Most of the appropriate studies were positive for ischemia. While, most of the inappropriate and uncertain tests were normal and the commonest cause of referral for MPI was exclusion of CAD as a cause of chest pain.
Short term clinical outcomes of Complex Percutaneous Coronary Intervention in patients with intermediate to high SYNTAX score: Ain Shams complex PCI Registry
Authors: Mohamed Labib Mohamed Mostafa , Mahmoud Abdellatif Yasser AlaaEldin , Abu Arab Tamer Mohamed
Published: July 2024

Background

Risk stratification is an important and essential component in proper patient counseling when dealing with complex coronary anatomy and decision making between either coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI). The SYNTAX score was pioneered as an anatomical-based risk score that aided in this decision-making process.

Objective

To develop an electronic registry for patients with complex coronary anatomy with intermediate to high SYNTAX score undergoing non-emergent PCI who were indicated for CABG but either they were rejected by the surgeons or they refused it.

Patients and Methods

Our registry was conducted on 193 patients presented during eight months from the first of July 2021 till the end of February 2022 to Ain Shams University Hospitals and underwent PCI.

Results

comparing the intermediate to high SYNTAX score groups, there is a statistically significant increase in the in hospital and short term MACE and mortality with high SYNTAX score patients, while there was no difference regarding in hospital CIN. Regarding MACE it significantly increases in patients with anemia, CKD, LV dysfunction. For multivariate analysis it is shown that both incomplete revascularization and clinical SYNTAX II are independent predictors for the occurrence of short term MACE.

Conclusion

Both incomplete revascularization and clinical SYNTAX II score are independent predictors of short term (6 months) occurrence of MACE.
Prognostic Utility of Ratio of Systolic Blood Pressure to Left Ventricular End- Diastolic Pressure Post Successful Primary Percutaneous Coronary Intervention in Prediction of Major Adverse Cardiac Events in Patients with ST-segment Elevation Myocardial Infarction
Authors: Said Mohamed Mohamed Ahmed , Mahmoud Yasser Alaaeldin , Said Khaled Mohamed , Hassan Osama Mohamed
Published: July 2024

Background

Of all causes of Cardiovascular disease (CVD), ischemic heart disease (IHD) remains the major contributor, accounting for half of all CVD-associated morbidity and mortality. IHD as measured by the Global Burden of Disease project is driven predominantly by acute myocardial infarction (MI) and, to a lesser extent, angina.

Aim of the Work

To evaluate the prognostic utility of the ratio of SBP/LVEDP at the time of PPCI in prediction of MACE both in-hospital and during 3-months follow up in patients presented with STEMI with a single vessel disease.

Patients and Methods

This was a prospective study that was conducted on 153 patients presented with STEMI and underwent successful PPCI for a single vessel disease in Ain-Shams University Hospitals and Nasr City Health Insurance Hospital in the period from March 2019 to March 2021.

Results

Our results demonstrated, that SBP/LVEDP ratio can be used to predict MACE occurrence at a cutoff level of ≤ 3.9, and can be used to predict patients who are MACE-free at cutoff level of ≥ 9.2. The lower ratio of SBP/LVEDP (≤3.9) was detected at 27 patients (17.6%) from the whole study population (153 patients) with higher statistical significance difference of older age group. Different risk factors and positive family history showed no statistical significance difference with lower ratio. In this study, lower ratio showed higher statistical significant difference in anterior STEMI group, lower EF% “Simpson”, higher LVESV, DD grade II, higher WMSI, with the culprit lesion vessel when its LAD, with higher LVEDP, lower invasive SBP, and lower invasive DBP. This study found that lower ratio had a better prognostic ability with a higher AUC (0.880) when compared to the widely used GRACE and TIMI risk scores. Lower ratio ≤3.9 showed higher statistical significant difference with higher GRACE RS and higher TIMI RS when compared with higher ratio. Our ratio had a strong prognostic ability in prediction of MACE with lower ratio with higher statistical significant difference of occurrence of MACE in 26 patients (96.3%, P = 0.000) when compared with patients with the same ratio but without occurrence of MACE in 1 patient (3.7%).

Conclusion

Our study concluded that SBP/LVEDP is an easily rapidly determined ratio at the time of PPCI that can provide important prognostic information regarding risk stratification of STEMI patients, with a high predictive ability for occurrence of MACE at a cutoff point of ≤ 3.9, during hospital stay and short term follow up.
Incidence and Prognostic Value of Single Lead QRS Fragmentation in Successfully Revascularized Inferior STEMI Patients
Authors: Elbialy Hashish Sherif Abdelhamid , Sharafeldin Ahmed Abdelrahman , Amin Sameh Attia
Published: July 2024

Background

the main therapeutic strategy for acute ST segment elevation myocardial infarction (STEMI) is the rapid restoration of epicardial blood flow in the infarcted related artery (IRA). Primary percutaneous coronary intervention (pPCI) is the most effective and recommended therapeutic intervention for the reperfusion strategy.

Aim of the Work

to investigate the incidence of QRS fragmentation among successfully revascularized inferior STEMI patients including single lead fragmentation (sl-fQRS) and classic QRS fragmentation (fQRS) and the prognostic importance of (sl-QRS) in patients with inferior STEMI who achieved TIMI 3 flow by primary PCI and its relation to results of angiography, poor prognosis prediction including in hospital mortality and Major Adverse Cardiac Events (MACE).

Patients and Methods

this prospective cohort study was carried out on 150 patients with successfully revascularized inferior STEMI patients by primary PCI, Patients were recruited postoperative from cardiology department, Ain Shams University Hospitals after undergoing Coronary Angiography for myocardial infarction which is the standard of care for such patients for follow-up during the study period (6 months). All patients were given informed consent. The study protocol was approved by the ethical committee, Faculty of Medicine, Ain Shams University.

Results

150 patients with acute myocardial infarction, who were referred to the cardiology department for primary PCI, were eligible to participate in the study. Their mean age was 54.45 ± 11.11 years old. Most of them were males (78.7% of patients, 118 patients). 95 patients (63.3% of patients) had history of smoking wether current or ex-smokers. Nearly, one third of patients (34.7% of patients, 52 patients) were diabetic. Similarly, 34.7% of patients (52 patients) were dyslipidemic. 43.3% of patients (65 patients) were hypertensive. Their mean BMI was 26.69 ± 2.65 kg/m2. Most of patients (76.7% of patients, 115 patients) had positive family history.

Conclusion

The concept of at least two derivations is mentioned for the classical definition of fQRS, and only one lead with fQRS has not been accepted for the presence of fQRS. However, we showed that sl-fQRS is associated with MACE and higher risk. Therefore, instead of the concept of at least two derivations, the presence of fQRS in only one lead and/or ≥1 leads with fQRS may also be enough when describing the patients under high cardiac risk.
The Role of Cardiopulmonary Exercise Testing in Assessment of Patients with Interstitial Lung Disease
Authors: Wgeih Khaled Mohammed , Gomaa Ashraf Adel , Abd ElDayem Aya Mohammed , Saad Ahmed Mahmoud
Published: July 2024

Background

Cardiopulmonary exercise testing (CPET) is considered as the gold standard for evaluating the causes of exercise intolerance in patients with pulmonary and cardiac disease, and is based on the principle that system failure typically occurs while the system (e.g muscle-energetic, cardiovascular or pulmonary) is under stress.

Objective

To evaluate the role of cardiopulmonary exercise test in assessment of patients with interstitial lung disease.

Patients and Methods

This is observational study included 30 consecutive examined with the diagnosis of ILDs in Kobry El Kopa military hospital. The study was carried out over the period from February 2016 to August 2019. All patients with dyspnea to be investigated and ILDs diagnosed and assessed in rehabilitation department who undergo cardio pulmonary exercise test.

Results

Reduction on the compliance of the lung and/ or chest wall cause change in lung volumes and tachypnea during exercise. Also agreed with harris EzeAo Who showed that alterations on breathing pattern such as lower Vt, increased respiratory effort, rapid shallow breathing were reported in individual with interstitial lung diseases.

Conclusion

The pathophysiology of ILD has a negative impact on the ventilatory, cardiovascular, and skeletal muscle responses to exercise, thereby leading to exertional dyspnea and reduced exercise capacity. CPET is an excellent tool for assessing the severity of exertional dyspnea and mechanisms of exercise limitation in patients with various forms of cardiorespiratory disease; however, its application in ILD has remained limited. A growing body of evidence supports the use of CPET in patients with ILD. CPET is currently used to assess functional capacity, to inform exercise prescription, and to evaluate the effects of various interventions. Recent findings highlight that, in addition to its current uses, CPET-derived measures may help improve the management of patients with ILD. Despite these recent advances, additional research is required in order to confirm the utility of CPET in this population.
Validity of A new Weaning Index of Discontinuation From Mechanical Ventilation in Intensive Care Unit
Authors: Kamal Eman Sabry , Al Rahman Salem Gamal Abd , Dwedar Ibrahim Aly , El Embabi Dalia Abd El Sattar
Published: July 2024

Background

Failure to wean from mechanical ventilation (MV) is a frequent problem in the intensive care unit (ICU) setting. Herein, we investigate a new WI measured at the initial spontaneous breathing trial (SBT) in order to predict successful liberation from MV in mechanically ventilated ICU cases.

Patients and methods

This prospective cross-sectional study consisted of two phases; Phase I was designed to create a new WI from the criteria of 60 mechanically ventilated patients, while Phase II aimed to assess the accuracy of that index in another 40 patients. Patients aged older than 18 years who were receiving controlled-mode MV from day 3 to day 14 and planned to be weaned off MV were included in our study. Contrarily, patients with prior history of poor tolerance to SBT, weaning failure were excluded. Additionally, we also excluded patients with neurological or neuromuscular disorders, tracheostomy, pregnancy, or an active COVID-19 infection.

Results

The incidence of failed weaning was 33.3% in phase I, and 35% in phase II. Pulmonary causes were the most common indication in both groups. Multivariate regression analysis was done for phase I variables, and the following equation was created; (((Cough strength* 0.743) - 1.927) *0.05 + ((PaCO2 (mmHg)* - 0.126) + 6.786) *0.08 + ((mean airway pressure (CmH2O) * -1.304) + 14.119) *0.193 + ((PaO2/FIO2 * 0.268) - 58.555) *0.328 + ((rapid shallow breathing index * -0.485) + 24.406) *0.353). Using a cut-off value of > 0.69 and applying this index in phase II, it showed a mean value of -1.43 and 4.67 in the failure and success groups, respectively (p < 0.001). This new WI with cutoff value (> 0.69) had 88.5% sensitivity, 57.1% specificity, and a 77.5% accuracy to predict the success of weaning from MV.

Conclusion

We developed a new WI with good sensitivity and moderate specificity for predicting successful weaning from MV in ICU patients. Its use should be encouraged in the ICU setting, especially by less experienced ICU physicians.
X-ray Repair Cross Complementing 1 (XRCC1) Gene Polymorphism in Hepatocellular Carcinoma (HCC)
Authors: Ali Shaaban Menat Allah , Abdelhamed Nada Atef , Saad Wessam El-Sayed , Kamal El-Din Maha Mohsen Mohamed , Mahmoud Marwa Elazab
Published: July 2024

Background

Several risk factors for hepatocellular carcinoma (HCC) have been identified, including chronic infection of hepatitis B virus (HBV) and hepatitis C virus (HCV). Nevertheless, only a fraction of infected patients develops HCC during their lifetime suggesting that genetic factors might modulate HCC development. The human X-ray repair cross- complementing protein 1 (XRCC1) gene encodes for one of the major repair factors involved in base excision repair (BER), which is reported to be associated with the risk of several cancers. A few studies have explored the association between risk of hepatocellular carcinoma (HCC) and single-nucleotide polymorphisms (SNPs) in different DNA repair genes.

Aim of the Work

to investigate the possible association between XRCC1-G28152A (rs25487) single nucleotide polymorphism (SNP) and hepatocellular carcinoma (HCC) in chronic hepatitis C patients.

Patients and Methods

The study included 35 patients who had HCC and 15 patients who had liver cirrhosis. XRCC1 gene polymorphism was done to all participants by RT-PCR After collection of relevant clinical data and basic laboratory tests.

Results

A statistically higher frequency of XRCC1 (GG, GA) genotypes and increased (G) allele frequency in patients with HCC was found in comparison to cirrhotic HCV patients as well as control group but Our results revealed that the genotypic and allelic frequencies of XRCC1 gene polymorphism rs25487 didn’t show statistically significant difference between HCC patients group and liver cirrhosis control group.

Conclusion

The present study had demonstrated that there was no significant association between XRCC1 gene polymorphism (rs25487) and HCC in the sample of Egyptian population included in our study. Also, non-significant differences among the XRCC1 genotypes and alleles were found regarding age, sex, BMI and laboratory data including CBC, AFP, coagulation profile (PT, INR), liver function test ( total protein, albumin, AST, total bilirubin and direct bilirubin), BCLC and Milan criteria. While a statistically significant difference was observed as regards PTT and ALT between genotypes.
A Comparative Study on the Efficacy and Safety of 10% Topical Minoxidil versus 5% Topical Minoxidil in the Treatment of Male Pattern Hair Loss
Authors: Ali El-sayed Mahinaz El-sayed , Abdel Fattah Nermeen Samy , Afify Ahmed Abd-elfattah
Published: July 2024

Background

Androgenetic alopecia is a genetically disorder characterized by the gradual conversion of terminal hairs into vellus hairs, called miniaturized hairs. It is an extremely common disease that affects men and women. Specifically, DP cells that are the main regulators of hair growth and are the only site of 5α-DHT action. Male-pattern hair loss; Male note gradual recession of the frontal hair line early in the process. Men present with gradual thinning in the temporal areas, producing a reshaping of the anterior part of the hair line.

Aim of this Study

To evaluate and compare topical minoxidil 10% versus topical minoxidil 5% in the treatment of MPHL as regards the efficacy, safety and side effects. This study included 51 patients with MPHL divided into 2 groups received topical minoxidil 5% 1ml twice daily for 6 months and the second group received topical minoxidil 10% 1ml twice daily for 6 months.

Patients and Methods: Results

The current study revealed that there was significant difference between the studied groups as regard the percentage of improvement in Frontal Total hair count with superiority for 10% group. But the improvement in other parameters were comparable between the studied groups. Comparison of treatment response in both groups revealed nearly the same efficacy of both concentrations of topical minoxidil 5% and 10% in MPHL, higher concentration more than 5% could decrease the compliance and the tolerance.

Conclusion

We found that using higher doses of topical minoxidil was associated with higher improvement in frontal total hair count and higher side effects.
Meta-Analysis in Comparison between Cisplatin with Radiotherapy and Cetuximab with Radiotherapy in the Management of Locally Advanced Head and Neck Squamous Cell Carcinoma
Authors: Elnashar Abdelhamid Abdelhamid , Mikahail Peter Milad , Mohammed Mohammed Abdelaleem , Omran Mohammed Mansour
Published: July 2024

Background

Nowadays there is an increasing in the numbers of cases of head and neck squamous cell carcinoma (HNSCC) all over the world. Which affect upper aerodigestive tract including the nasopharynx, paranasal sinuses, oral cavity, oropharynx, hypopharynx and larynx.

Objective

To compare the using of radiotherapy (RT) with cisplatin versus cetuximab with RT in the treatment of locally advanced head and neck squamous cell carcinoma (LA-HNSCC). The comparison between these two treatment regimens will be done in terms of overall survival rate and toxicity.

Patients and Methods

We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists.

Results

cetuximab with RT is associated with lower overall survival compared to cisplatin with RT in management of locally advanced head and neck squamous cell carcinoma, also patient treated with cetuximab were associated with higher rates of mortality compared to those treated with cisplatin

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2020.

Conclusion

According to our study in the comparison between cisplatin with RT versus cetuximab with RT, cetuximab with RT is associated with lower overall survival compared to cisplatin with RT in management of locally advanced head and neck squamous cell carcinoma, also patient treated with cetuximab were associated with higher rates of mortality compared to those treated with cisplatin
Assessment of the Role of Keratin 18 and High Mobility Group Box 1 Biomarkers for Early Prediction of Drugs and Chemicals Induced Hepatotoxicity A Prospective Study in the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH)
Authors: Ebeid Ghada Mohamed , Abd Manal El Sayed , Eglal El Salam , Awady Hassan El , Hussien Rania
Published: July 2024

Background

Drug-induced hepatotoxicity represents a major clinical problem worldwide. Hepatotoxicity may be caused by drugs, chemicals used in laboratories and industries or natural products and rodenticides such as metal phosphides. Early identification of hepatotoxicity would facilitate patient- individualized treatment strategies. New biomarkers (HMGB1and K18) used to identify subsequent acute liver injury (ALI) in patients on admission to the hospital.

Objectives

This study aims to assess the role of keratin 18 and high mobility group box 1 biomarkers in early prediction of drugs and chemicals induced hepatotoxicity for better outcome and to compare these new liver biomarkers with the currently used parameters (ALT & AST) in the early prediction of drugs and chemicals induced hepatotoxicity.

Methods

This prospective study was conducted on 50 adult patients of both sex presented to the PCC- ASUH with acute intoxication of hepatotoxic drugs or chemicals. For all patients, we measured high mobility group box-1 (HMGB1), keratin-18 (K18), AST and ALT on admission then patients were followed- up for development of liver injury . Subjects were classified into group I (control group), group II (no liver affection) and group III (with liver affection). Receiver operator characteristic (ROC) curve was used to compare sensitivity and specificity to report liver injury versus alanine transaminase (ALT) and aspartate transaminase (AST).

Results

This study showed that HMGB1 and K18 were much more elevated in patients who developed liver injury in the first hospital presentation when ALT and AST were within normal ranges with a highly significant difference between the hepatotoxic and non-hepatotoxic group. ROC analysis showed that HMGB1 and K18 were more sensitive than ALT and AST and more specific than AST in predicting ALI.

Conclusion

Elevations in plasma HMGB1, and K18 identified subsequent ALI development in patients on admission to the hospital, soon after drug and chemical overdose, and in patients with ALT and AST in the normal range.
Meta-Analysis of Predictive Value of Ki-67 before Neoadjuvant Chemotherapy in Breast Cancer Patients
Authors: El Rahman Sami Ahmed Abd , El Din Osman Ahmed Gamal , Ragheb Ayoub Bishoy Refaat , Maurice Gerges Andrew Malek
Published: July 2024

Background

Breast cancer is the second most common malignancy among female patients. Early breast cancer is considered potentially curable. Immunohistochemistry has an important role in the pathology of breast disease. It is widely used to localize specifically proteins in cells and tissues. Ki-67, a marker of cell proliferation, is a specific nuclear antigen expressed in all phases of the cell cycle, which can be readily detected using immunohistochemistry methods. Many guidelines and international groups concluded that measurement of Ki-67 could be important both in standard clinical practice and within clinical trials.

Objective

To clarify relation between expression of Ki67 and response of malignant cells to neoadjuvant chemotherapy in breast cancer.

Methods

The search was directed through PubMed / MEDLINE, Scopes, Web of science, and the Cochrane Library for information from inception to July 1, 2022, with a combination of the following terms: “Ki-67”, “breast cancer” and “NCT”. More searches by Google Scholar have been used to supplement the search with the sites mentioned above. Abstract-based eligibility studies were obtained, and the manuscripts were fully reviewed. Report bibliographies that meet the eligibility criteria were reviewed for further studies.

Results

A recently published meta-analysis reported that a high Ki-67 level was associated with a high pCR rate. Our results demonstrate that patients with a Ki- 67 are more sensitive to NCT, have higher pCR rates, and benefit more from NCT compared to those with a low Ki-67. However, it remains unclear whether other factors such as therapy regimens and cycles of NCT, the clinical stage, and tumor location have an impact on Ki-67-based health outcomes.

Conclusion

The meta-analysis reported here demonstrates that pretherapeutic Ki-67 is associated with pCR in breast cancer patients undergoing neo-adjuvant chemotherapy.