bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Intracoronary Heavy Thrombus Burden in Patients with ST Elevation Myocardial Infarction Undergoing Primary PCI within 12 Hours from Chest Pain Onset
Authors: Sobhy Besada Kerolos , Zahwy Sherif Samir El , Arab Tamer Mohamed Abu , Bastawy Islam Mahmoud
Published: August 2023

Background

ST segment elevation myocardial infarction (STEMI) comprises approximately 25-40% of myocardial infarction (MI) presentation. The pathophysiology of acute coronary syndrome (ACS) is rupture or erosion of the fibrous cap overlying lipid rich plaques within the arterial tree. This event exposes pro-inflammatory substances, ultimately resulting in platelet aggregation and formation of obstructive thrombus.

Aim of the Work

Identify predictors of heavy thrombus burden in patients with STEMI undergoing primary percutaneous coronary intervention (PCI) within 12 hours from onset of chest pain.

Patients and Methods

Our study included 200 consecutive patients who presented with STEMI and were managed by primary PCI within 12 hours from onset of chest pain. All patients were subjected to thorough history taking ] e.g. Age, HTN, family history of premature coronary artery disease (CAD) and pain to balloon time [, clinical examination, electrocardiogram (ECG), biochemical biomarkers, PCI and transthoracic echocardiography (TTE).

Results

Our study showed that there was significant positive correlation between grading of thrombus burden with age (rho = 0.165; P = 0.020), HTN (rho = 0.143; P = 0.043), number of risk factors (rho = 0.253; P < 0.001), Killip classification (rho = 0.211; P = 0.003), pain to balloon time (rho = 0.453; P < 0.001), ST elevation score (rho = 0.185; P = 0.009), RDW (rho = 0.878; P < 0.001), TLC (rho = 0.445; P < 0.001), troponin (rho = 0.600; P < 0.001), CK-MB (rho = 0.661; P < 0.001) and CPK(rho = 0.533; P < 0.001) and N/L ratio (rho=0.563 ; P = <0.001) also, there was significant negative correlation between grading of thrombus burden with EF (rho = -0.397; P < 0.001).

Conclusion

There was significant positive correlation between age, number of cardiovascular risk factor, pain to balloon time, Killip classification, RDW, TLC, N/L ratio and grading of thrombus burden. Only pain to balloon and RDW were considered as independent predictors of heavy thrombus burden
Evaluation of Radiation Exposure and Image Quality in Congenital Catheterization Laboratory; A Single Centre Comparative Study Using Different Acquisition Modes
Authors: Ahmed Mahmoud Ahmed Abd El-Hamid , RazekEsmail Yasmin Abdel , Zaky Amr Mansour Mohamed , Samir EL-Shahed Ghada
Published: August 2023

Background

The exposure to ionizing radiation delivered during the catheterization procedures has various negative biological effects to the patient, so concern has risen sharply about radiation hazards over the past decade.While angiography imaging system vendors have all made great strides with new technologies that reduce the amount of x-rays needed while maintaining excellent image quality, the procedures have become more complex, lasting longer and require more imaging than standard procedures.

Aim of the Work

To study the effect of lowering radiation dose by using a fluoro angiography on image quality in pediatric cardiac catheterization.

Patients and Methods

We studied 90 patients who underwent cardiac cath. for CHD at Ain Shams University hospital. Patients were randomized into three groups according to mode of acquisition used in procedure (fluro angiography only–cine angiography only–mixed). Radiation indices were measured, also image quality questionnaire was filled by operators after each procedure.

Results

statistically significant difference between three modalities of acquisition as regard the radiation indices (DAP, total air kemra, fluoroscopy time) with p value <0.005. While operators satisfaction with image was nearly the same in the three groups with median score 68.5 (p value 0.681).

Conclusion

Based on the results of the current study it can be concluded that: Mixed imaging acquisition had highest radiation exposure indices in comparison with other two acquisition modalities (fluro angiography only – cine angiography only), with statistically significant difference with fluro only mode (p value <0.005), and no statistically significant deference with cine only mode. Complexity of the procedures & increased the cath. lab machine imaging protocol to 30 fps and repeat the same injection in the cine mode after fluro mode were the most important factors that made mixed acquisition had the highest radiation indices and exposure. Image quality and operators satisfaction were nearly the same in three acquisition modes (fluro-cine-mixed) with median image score 68.5 (p value 0.681), in expense of more radiation exposure in mixed mode. Increase operators awareness to radiation and continuous monitoring of radiation exposure with application of ALARA principles is important to reduce radiation exposure.
Risk of Atrial Fibrillation Induced by Ivabradine in Correlation with Left Atrial Size
Authors: Ibrahim Mahmoud Mahmoud Ali , Sallam Walid Mohamed , Khorshid Hazem Mohamed , Tamara Ahmed Fathy
Published: August 2023

Background

Ivabradine (Procoralan, Servier) is a heart rate lowering drug which acts by specifically inhibiting the pacemaker If current, which causes spontaneous depolarization in the sino-atrial node that regulates the heart rate.

Objective

To correlate Left atrial size with development of AF in patients treated with ivabradine over a 12 week period.

Patients and Methods

Our study was conducted upon 180 patients referred to Ain Shams University Hospital and Misr University for Science and Technology hospital, from September 2020 to February 2021 to undergo treatment for HF or IHD with the appropriate medications with AF being the primary outcome of interest and how it correlates with Ivabradine therapy.

Results

Our results showed that there was no statistically significant difference between the two groups regarding the incidence of AF (p = 0.587). Likewise, there was no statistically significant difference between the two groups regarding duration till AF at 1st month, 2nd month and 3rd month (p > 0.05). This could be explained by the lower number of patients included in the study as compared to other similar studies. When the entire patient population who developed AF was pooled regardless of their Ivabradine use, there was a statistically significant increase in AF incidence with larger left atrial volume indices.

Conclusion

In the present study, Ivabradine treatment was not associated with a higher incidence of AF in patients with heart failure and/or ischemic heart disease. Also, there was no significant difference in the duration until AF occurrence when it was evaluated at the end of the 1st, 2nd, and 3rd months. Higher LAVI was associated with a higher incidence of AF in the total studied patient population regardless of Ivabradine use.
Correlation between Global Longitudinal and Circumferential Peak Systolic Strain and Coronary Artery Disease Severity as Assessed by the Angiographically Derived SYNTAX Score
Authors: Helmy Marian I , Bastawy Islam M , Esmail Yasmin A , Onsy Ahmed M
Published: August 2023

Aim and objectives

the main objective of the current study is to assess the correlation between the SYNTAX score in patients undergoing elective coronary angiography and the longitudinal and circumferential peak systolic strain performed at rest by speckle tracking echocardiography to predict the presence, extent and severity of coronary artery disease.

Patients and Methods

The study included 60 patients suspected to have coronary artery disease either by symptoms or done a positive non-invasive test for myocardial ischemia with no history of previous ischemia and no previously detected segmental wall motion abnormalities in previous resting echocardiogram. All patients were recruited from the catheter laboratory at the cardiology department of Ain Shams university hospitals and they underwent echocardiographic assessment before elective coronary angiography.

Results

The study included 60 symptomatic patients suspected to have chronic coronary syndrome aging 31 to 77 years (excluding those with significant structural heart disease). All patients underwent clinical evaluation, surface electrocardiogram, transthoracic echocardiographic, twodimensional speckle tracking, and conventional coronary angiography with SYNTAX score calculation. Patients were divided into 3 groups based on the results of the coronary angiogram: normal CAD on angiogram (n = 12), low SS (n = 28, SS < 22), and high SS (n = 20, SS ≥ 22). Age, sex and most of the risk factors had no statistically significant correlation with the SYNTAX score while There was a significant inverse correlation between GLPSS and GCPSS and SS values (r = 0.458, P = 0.0002), (r = 0.411, P = 0.0011) respectively.

Conclusion

The results of our study suggest that GLPSS and GCPSS might be promising for the detection of patients with high SYNTAX score on coronary angiogram. There is an inverse correlation between resting GLPSS and GCPSS and SYNTAX score as assessed by coronary angiography.
Myocardial Safety Following COVID-19 Vaccination
Authors: Barsoum Mina M , Karim Khaled , William Viola , Thabet Sameh
Published: August 2023

Background and Aim

Vaccination is a well-established part of preventive and public health medicine, but is not without risk. COVID-19 vaccination frequently leads to minor side-effects, for example pain, swelling and redness at the site of injection, and systemic symptoms of fatigue, headache, muscle pain, chills and fever; side effects after the second dose may be more intense than the first dose. Among the vaccines, more serious side effects have been reported, including myocarditis. This study was aimed to detect any evidence of myocardial damage after COVID-19 vaccination.

Subjects and methods

We selected 150 subjects (both sexes) randomized into two groups as 75 patients who are fully vaccinated with AstraZeneca vaccine (two doses) the study was conducted at least after two weeks from the second dose of the vaccine and 75 patients who are not vaccinated.

Results

This study was carried on 150 patients, 52 (34.7%) of whom were females, and 98 (65.3%) were males. The mean age of the studied group was (34 years old). The LVEDV (indexed) mean of 45.08 ml/m2 in the cases group and 43.8 ml/m2 in the control group. The EF mean of 63.2% in the cases group and 62.9% in the control group. And the GLS median of -19% in the cases group and -19% in the control group.

Conclusion

COVID-19 vaccination has no evidence association of any myocardial damage. Nevertheless, the advantages of these vaccines for ending the pandemic and/or decreasing the mortality rate outweigh any risk for the rare cardiovascular complications.
Predictors of Reintervention in Infants with Severe Pulmonary Stenosis Undergoing Balloon Pulmonary Valvuloplasty
Authors: Zakaria Mohamed , Elsayed Maiy H , Attia Hebattallah M , Esmail Yasmin Abdel Razek
Published: August 2023

Background

Balloon pulmonary valvuloplasty is the treatment of choice for patients with moderate to severe pulmonary valve stenosis. The procedure is not free of complications and there is still a significant rate of reintervention.

Objective

Describe the short and midterm outcomes in infants undergoing balloon dilatation for severe P.S, to determine predictors of reintervention.

Patients and Methods

All infants with severe congenital valvular PS who underwent interventional cardiac catheterization between October 2020 and april 2021 were reviewed Prospectively. We performed a comparison between those who required reintervention and those who did not, to identify the predictors of reintervention.

Results

thirty five infants were included, having severe PS. Twenty-one infants 21 (60.0%) were males, the mean age was ranged from 7 days to 12 months (mean; 6.08 ± 3.95 months), and the mean weight was 7.37 ± 1.95 kg. twenty infants(20%) required reintervention. Small pulmonary valve annulus diameter with Mean ± SD 5.14 ± 1.07 mm; p = 0.001 and Pulmonary valve annulus z-score were significantly smaller in those who needed reintervention Median(IQR) -2.50 (-3.10 – -2.50), pvalue 0.001, Other predictors for reintervention included, Residual high pulmonary artery pressure after BPV with Median (IQR) 54 (35 – 55) mm Hg, p-value0.001.The immediate and short-term outcome of PBPV was better in patients who did not need reintervention.

Conclusion

Interventional cardiac catheterization shows favorable outcome for patients with severe PS. Predictors for reintervention included the small pulmonary valve annulus diameter and pulmonary valve Z-score, A minor immediate drop in pressure gradient across the pulmonary valve post-intervention has higher rate of reintervention.
The Value of Fructosamine in Prediction of Angiographic Outcomes in Diabetic Patients Presented with Anterior STEMI Undergoing Their First Primary PCI
Authors: Borham Mohammed Borham , Ahmed Mohammed Esmail , Elias Rami Raymond , Desoky Ahmed Ibrahim El
Published: August 2023

Background

Cardiovascular diseases are the leading most common cause of death in industrialized countries. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction and failure of different organs especially heart and blood vessels.

Objective

To study the predictive value of Fructosamine as a marker of short-term glycemic control over 2-3 weeks on the angiographic and clinical outcomes in diabetic patients presented with anterior STEMI in Ain shams university hospital.

Patients and Methods

This is an observational study recruiting 100 patients presented with anterior STEMI who underwent their first primary percutaneous coronary intervention (PPCI) from May 2020 to December 2020.

Results

Angiographic results of patients post PCI were as follows: Regarding Thrombolysis in myocardial infarction (TIMI Flow), 8 patients had TIMI flow 0, 18 had TIMI I, 27 had TIMI II and 37 had TIMI III flow. Regarding myocardial blush grade (MBG) 12 patients had MBG grade 0, 27 had grade I, 20 had grade II and 4 had grade III. During follow up for one-month, Major adverse cardiac events (MACE) occurred in 56% of patients. Measured serum Fructosamine levels were ranging between (233 to 557 µmoll/L) the results showed a strong correlation between serum Fructosamine and TIMI flow MBG. Patients with higher Fructosamine level had worsen TIMI flow and MBG and more occurrence of MACE in diabetic patients after PPCI.

Conclusion

High Fructosamine level can be used as a predictor for worse outcomes in diabetic patients presented with Anterior STEMI.

Abbreviations

STEMI: ST segment elevation myocardial infarction; PPCI: primary percutaneous coronary intervention; TIMI: Thrombolysis in myocardial infarction; MBG: Myocardial blush grade; DM: Diabetes Mellitus; MACE: Major adverse cardiac events
Predictors of Successful Radiofrequency Catheter Ablation of Premature Ventricular Complexes
Authors: Elalfy Mohammed Mahmoud , Zarif John , Ali Ahmed Nabil , Ahmad Rania Samir , Nabih Mervat Aboul Maaty
Published: August 2023

Introduction

Patients with a high premature ventricular complexes PVC burden can benefit from catheter ablation, which is an effective and curative strategy for improving symptoms while simultaneously reducing PVC burden. Depending on the origin of the PVC, catheter ablation can be used as first-line therapy or as a last resort in cases of more rare origins when medication fails or is not tolerated/wanted.

Aim

The aim of this study is to determine the predictors of successful Radiofrequency catheter ablation of premature ventricular complexes.

Participants &Methods

A total of 100 patients with PVCs burden greater than 15% who were scheduled for conventional or 3D ablation at electrophysiology unit of Ain Shams University between 2018 and 2020 were included in the study. Success was defined as acute elimination of PVCs in Cath-lab with a 30 minutes waiting period and PVCs burden <3% on follow up Holter recording.

Results

The success rate was 83% among 100 patients (mean age 41.31 ± 17.69 years, 52% female patients), with 68% of the patients undergoing conventional ablations. Success was predicted by age (<58 years), outflow tract (OT) origin of PVCs, and the existence of a pre-QRS signal on the ablation catheter> 33 msec (Pvalue < 0.001).There was no statistical difference between conventional ablation and 3D ablation in this study regarding predictors of success.

Conclusion

Age, Origin of PVCs and pre-QRS signal are predictors of success of PVCs ablation.

Abbreviations

ECG: electrocardiogram; LVEF: left ventricular ejection fraction; LVOT: left ventricular outflow tract; PVC: premature ventricular contraction; RFCA: radiofrequency catheter ablation; RV: right ventricular/ventricle; RVOT: right ventricular outflow tract; OT: Outflow tract
ICD/CRT-D Registry Ain Shams University Hospitals
Authors: Elnady Mohammed Hafez Abbas , Galal Wagdy Abdelhamid , Tamara Ahmed Fathy , Allam Lamyaa Elsayed
Published: August 2023

Background

The idea of the ICD registry was prompted from the National Coverage Decision that was published by the Centers for Medicare and Medicaid Services (CMS) in 2005 and based on the Sudden Cardiac Death in Heart Failure Trial, Ain Shams University Hospitals aim to take the lead by documenting the first ICD/CRT-D Registry in Egypt.

Aim of the Work

To capture the characteristics, treatments, and outcomes of patients receiving ICDs to improve care for patients receiving ICDs and CRT-Ds in Egypt.

Methods

102 consecutive patient that received an ICD/CRT-D (initial or generator change) for primary or secondary prevention of SCD and came for ICD/CRT-D follow up at Ain Shams University hospitals pacemaker outpatient clinics in a timeline of one year (7-2019 till 11-2020).

Results

Males were around two thirds of cases (68.6%), and more than half of cases (52%) were smokers. Implantation for primary prevention of SCD was in 58.8% of patients. Most of cases had their ICDs follow-up at a time between 1 to 3 years after implantation. HFrEF was significantly more common in primary prevention group (93.3%) of patients of primary prevention group, while IsHD was the most common comorbidity in patients that had ICD implantation for secondary prevention of SCD (66.7% of them). Total complication rate was 6.86% including, pocket hematoma occurred in 2.9% of cases, and lead dislodgment that required repositioning without a plan to add a transvenous lead occurred in 3.9% of cases. Beta Blockers and Amiodarone were the most common drugs used among patients as regard 88.2% and 65.7% respectively. VTs and NSVTs were the most frequent post implantation events among the studied cases 45.1% and 42.2% respectively. 52% of patients had ATP therapy to events, Failed ATP therapy occurred in 60% of them. 33.3% of patient received ICD shock therapy, Inappropriate Shocks was in 20.6% of them. 50.9% of the patients had a bradycardia pacing as about 34% of patient had CRT-D for pump failure. VF detection zone interval was significantly longer in primary prevention group. No significant differences according to implantation indication regarding VT2 zone interval. Regarding VT1 zone; monitor only was the mainly action in 58.7% of patients. Only 20.6% of patients had VT1 zone off.

Conclusion

This observational and descriptive study provides strong evidence that ICD has an effective role to improve survival in primary and secondary prevention of SCD. We noticed increase in implantation rate of ICD for primary prevention of SCD who gain great benefits from the device later on, minimal complication rate of ICD implantation.
Assessment of Left Atrial Function in Ischemic Heart Patients before and after Cardiac Rehabilitation Using Speckle Tracking Echocardiography
Authors: Alijla Salah , Desoky Ahmed El , Said Khaled
Published: August 2023

Background

Coronary heart disease (CHD) is one of the most common forms of heart disease. It affects the heart by restricting or blocking the flow of blood around it. This can lead to anginal pain or myocardial infarction. Exercisebased cardiac rehabilitation aims to restore people with CHD to health through combination of exercise with education and psychological support.

Aim of the Work

to evaluate left atrial function in ischemic patients before and after cardiac rehabilitation using speckles tracking.

Patients and Methods

The study included 60 individuals who were recruited from Ain Shams University hospital. All patients were recruited from the cardiac rehabilitation unit. These patients had recent MI that was successfully revascularized one month before inclusion. They were recruited in the period between December 2019, and complete in December 2020, Echocardiography (including 2D STE for assessment of LA function) was performed at baseline, and after a 3-month follow-up for all patients.

Results

This result reveal that CR could improve LV global and regional function and should be used routinely as a part of management of patient after acute myocardial infarction, also LA function improved Regarding LA diameter (considered as the standard single plane dimension of left atrium) dropped from 36.93 ± 4.60 mm to 33.85 ± 4.86 after CR showing highly significant change, Left atrial volume index (LAVI) dropped from 20.63 ± 8.05 mL/m2 to 17.40 ± 6.37, after CR, Showing highly significant changes, Peak atrial longitudinal strain mean value and systolic strain rate median, both improved significantly (p < 0.001) after cardiac rehabilitation, with the former increasing from 15.21 ± 5.49 cm/s to 20.69 ± 8.13 cm/s and the latter increasing from 0.4 (0.25 ‒ 0.75)s-1 to 0.65 (0.5 ‒ 1.1) s-1. after CR.

Conclusion

Speckle tracking imaging of left atrium has proved to be a feasible and reproducible tool for the assessment of left atrial mechanics. With significant improvement in left atrial function after 3 months of exercise training CR program.
Efficacy of Radiofrequency Catheter Ablation versus Antiarrhythmic Drugs in Treating High Burden Premature Ventricular Contractions in Children with Structurally Normal Heart
Authors: Alahwany Salaheldin Hefny , Abdelhamid Galal Wagdy , Ghaniem Mazen Tawfik , Khalifa Maha Mohamed , Allam Lamyaa Elsayed
Published: August 2023

Background

Scarce literature on whether antiarrhythmic drugs (AADs) or radiofrequency catheter ablation (RFCA) is more efficacious when treating idiopathic high burden premature ventricular contractions (PVCs) in children with many questions remain unanswered in this age group.

Objectives

To compare the efficacy of RFCA versus AADs on high burden idiopathic PVCs in children.

Methods

A total of 60 eligible child ≤18 years with High burden PVCs (≥10% of total beats per day) that were treated by either AADs (group A) or RFCA (group B). Both Baseline and followup clinical symptoms were collected, Physical examination, repeat standard ECG, standard or 12-lead Holter recording, and echocardiography were performed.

Results

Among RFCA (n = 30) and AADs (n = 30) groups, treatment success was 80.0% and 20.0% respectively, while AADs medications cessation was 73.3% and 26.7% respectively, the differences were statistically significant.

Conclusion

RFCA appears to be more efficacious than AADs in PVC reduction and consequently AADs medications cessation postablation. Performing RFCA in children with classical mapping and navigation was a safe and highly effective therapeutic option.

Abbreviations

AADs: antiarrhythmic drugs; BBB: bundle branch block; CCB: calcium channel blocker; ECG: electrocardiogram; LVEDD: left ventricular end-diastolic dimension; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic dimension; LVOT: left ventricular outflow tract; NSVT: non sustained ventricular tachycardia; PVC: premature ventricular contraction; RFCA: radiofrequency catheter ablation; RV: right ventricular/ventricle; RVOT: right ventricular outflow tract
The Value of Neutrophil-to-Monocyte-Plus-Lymphocyte Ratio as a Marker for Discriminating Pulmonary Tuberculosis from Community Acquired Pneumonia
Authors: Mohammed Effat A , Koraa Emad Eldin A , Osman Nehad M
Published: August 2023

Background

Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. On the other hand, pneumonia is usually caused by viral or bacteria and less commonly by other microorganisms.

Objectives

To evaluate the value of Neutrophil to Monocyte plus lymphocyte ratio (NMLR) as a marker for discriminating pulmonary tuberculosis from community acquired pneumonia.

Patients and Methods

A case control study, was conducted at Abbassia Chest Hospital and included 60 patients with pulmonary infection (TB and community acquired pneumonia, 30 patients in each group) and 30 healthy controlled individuals. All patients subjected to full history, physical examination, Chest X-ray and 2 cc of blood sample was collected for total and differential peripheral leucocytic count before starting antibiotic therapy, Neutrophil-toMonocyte-Plus-Lymphocyte Ratio (NMLR) was calculated as the quotient of the absolute neutrophils, Monocyte and lymphocyte counts and Neutrophil-to-Lymphocyte Ratio (NLR) was calculated).

Result

The study involved 90 subjects; the mean of age of TB patients was (29±8.17) years, which significantly lower than other with community acquired pneumonia (40.4±16.81) years. Moreover, male sex was significantly associated with TB group. By blood analysis, NLR and NMLR were significantly higher in pneumonia than TB or control group, P value< 0.001 for both. Also, NLR > 2.96 and NMLR >2.385 cutoff values have sensitivity and specificity of 90% and 100% respectively for both.

Conclusion

We concluded that Cutoff value of NLR > 2.96 and NMLR >2.385 may use for prediction of pneumonia and T.B. the modified blood indices as NLR and NMLR had the capability to discriminate between inflammatory condition as pneumonia and TB and healthy condition as same as ordinary marker like CRP and ESR did.
Role of GeneXpert in Diagnosis of Smear Negative Pulmonary Tuberculosis
Authors: Helmy Khaled Mohamed Wagih , Elsayed Mohamed Ali , Othman Marwa Ibrahim
Published: August 2023

Background

Pulmonary TB considered as a global health problem with specific concern in developing countries that need rapid methods in diagnosis with accurate results.

Objective

To evaluate the diagnostic yield of GeneXpert assay in diagnosis of TB infection in patients with negative sputum smear.

Methods

A total 346 cases with suspect clinical and radiological finding for TB infection was subjected to direct sputum analysis under microscope to find acid fast bacilli (AFB); the negative smear then subjected to GeneXpet assay analysis and sputum culture on LJ media.

Results

All cases with negative GeneXpert results, had negative culture, while 45 cases of 50 that had positive GeneXpert assay finding showed positive culture. The diagnostic yield of test was excellent (94.7%). The sensitivity, specificity, PPV and NPV were 100, 89.8, 90 and 100 respectively.

Conclusion

The performance of GeneXpert assay in diagnosing TB among smear negative patients was reasonable, and may fast the decision of treatment.
The Reliability of Ultrasound in Diagnosis of Idiopathic Pulmonary Fibrosis
Authors: Farrag Mohamed Ali , Elembaby Dalia Abd El-Sattar , Pasha Mohamed Ali Ahmed El
Published: August 2023

Background

Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause. IPF is the most common and severe form of idiopathic interstitial pneumonia, with an unpredictable and variable clinical course, and is associated with an extremely poor prognosis.

Objective

To determine role of Ultrasound in diagnosis of idiopathic pulmonary fibrosis.

Patients and Methods

This cross-sectional study was conducted at tertiary care hospital at Ain Shams University hospitals from May 2021 till November 2021 and performed on total 60 patients diagnosed with idiopathic pulmonary fibrosis and had previous clinical features, documented high-resolution computed tomography (HRCT) scan findings and comparing it with lung ultrasound findings.

Results

Consequently, B-lines number and Pleural lines thickness statistically had significant high diagnostic performance in the diagnosis of IPF with cut-off of ≥ 3.0 which indicates that B-lines number ≥3.0 and Pleural lines thickness ≥3.0 mm had perfect sensitivity and LR+, while Pleural lines interruption had perfect specificity. B-lines number ≥3.0 had highest diagnostic accuracy, Youden’s index and kappa. Our research study revealed that B-lines number and Pleural lines thickness statistically were significantly higher in multiple zones spread cases (p value<0.001). Pleural lines interruption statistically was significantly more frequent in multiple zones spread cases.

Conclusion

As evident from the current study, this study introduced and thoroughly evaluated lung US features, which showed a high correlation with the high-resolution CT findings. Chest ultrasound could constitute an additional monitoring tool for IPF, which is a rapidly progressive disease, usable by the pulmonologist at the patient’s bedside or during a consultation, easily available, non-irradiating, achievable in a short time and immediately informative, for a trained sonographer.
Impact of qSOFA Score on the Outcome of Patients in ICU with Respiratory Tract Infection
Authors: Younes Kedis Mohamed , Wagih Khaled Mohamed , Gomaa Ashraf Adel
Published: August 2023

Background

The quick Sequential Organ Failure Assessment (qSOFA) score is a bedside prompt that may identify patients with suspected infections who are greater risk for poor outcome in the intensive care unit (ICU).

Objectives

To assess the impact of qSOFA score on the outcome of patients in ICU with respiratory tract infection.

Patients and Methods

This Observational prospective study study carried out at ICU department of Ain Shams University Hospitals and Al Mahala Chest Hospital during the period from 1 February 2020 till March 2021 and included 122 patients presented by respiratory infection. Diagnosis of infection based on clinical, laboratory, radiological and/or microbiological evidence in accordance with guidelines for diagnosis of infection. All patients subjected to full history, physical examination, full laboratory tests (including arterial blood gas, complete blood cell with differentiation, international normalized ratio, kidney function tests, liver function tests, random blood sugar, C-reactive protein, erythrocyte sedimentation rate, serum sodium and serum potassium), chest X-ray and/or computerized tomography of chest, sputum cytological analysis and sputum culture. Measurement of qSOFA done in all patients.

Results

The median of qSOFA score in survivors was 0 while in nonsurvivors 1 at admission and after 48 hours with a significant difference between both groups. In overall patients qSOFA cutoff 1 has sensitivity and specificity 70% & 80.37%, respectively.

Conclusion

The qSOFA scores were associated with in hospital mortality, hospital admission, ICU admission, and hospital length of stay in patients likely to be admitted both with and without suspected infection, qSOFA is an easy tool that can be used to predict outcomes.
Factor V Leiden (FVL), Prothrombin G20210A and MTHFR C677T Mutations among Patients of Budd-Chiari Syndrome
Authors: Ghaffar Afaf Abdel Aziz Abdel , Hamza Mohamed Tarif , Ahmad Ahmad Mahmoud
Published: August 2023

Background

Many studies ask whether screening Factor V Leiden (FVL), Prothrombin G20210A and Methyl Tetra Hydro Folate Reductase (MTHFR) C677T Mutations should be routinely performed in patients with Budd–Chiari syndrome (BCS). However, the prevalence of these mutations in such patients is substantially variable.

This is the first study in clinical pathology department in Ain Shams University to evaluate the importance of this mutational screening in patients with Budd-Chiari syndrome to detect occult genetic susceptibility to thrombophilia.

Aim of the Work

This study aims to detect Factor V Leiden (FVL), Prothrombin G20210A and MTHFR C677T Mutations among Patients with Budd-Chiari Syndrome.

Patients and Methods

This study was a cross sectional study conducted on 35 newly of Budd Chiari syndrome patients who were attending tropical department at Ain Shams University Hospitals during the period from April 2020 to January 2021. Informed consent was obtained from all patients in the study.

Results

results of our study revealed that JAK2 mutation it was detected in 17.1% of patients (6 patients), While PGM was detected in 2.9% of our patients. Furthermore Factor V Leiden Mutation was detected in 65.7%of patients and MTHFR mutation was detected in 48.6% of patients.

The present study found no significant statistical difference between patients with Factor V Leiden Mutation & patients with normal Factor V Leiden regarding CBC parameters, levels of ANA, ACL IgM, ACL IgG, PC Deficiency, PS Deficiency and AT III Deficiency. In addition, our study revealed that there was no effect of MTHFR Mutation & JAK2 Mutation on levels of ANA, ACL IgM, ACL IgG, PC Deficiency, PS Deficiency and AT III Deficiency. Also there was no effect for MTHFR Mutation & JAK2 Mutation on outcome of patients, survival and response to treatment.

Conclusion

BCS is associated usually with genetic thrombophilia. Most commonly Factor V Leiden Mutation in 65.7%, followed by MTHFR mutation in 48.6% of our patients. Although, only Factor V Leiden Mutation has an effect on patients Outcome, Survival and Response to treatment through its effect on CBC parameters, levels of ANA, ACL IgM, ACL IgG, PC Deficiency, PS Deficiency and AT III Deficiency. Otherwise, JAK2 Mutation have significant effect on hemopoiesis.
NMDA, AMPA and GABA Receptor Antibodies: Relation to Clinical and Electrophysiological Findings in Drug-Resistant Epilepsy
Authors: Tuhami Ahmed Magdy , Talkhan Hala Ahmed , El Rakawi Mahmoud Hemeda , El-Shennawy Dina El-Sayed , El Najjar Marwa Rushdy , El-Aziz Doaa Mohammed Abd
Published: August 2023

Background

Epilepsy is a neurological disorder characterized by sudden recurrent episodes of convulsions, sensory disturbance, or loss of consciousness, resulting from abnormal electrical brain activity. It can have both genetic and acquired causes, with interaction of these factors in many cases. Auto-antibodies against synaptic receptors have been detected in a number of neurological conditions such as anti-NMDA receptor encephalitis and limbic encephalitis. Recently, three types of synaptic receptors have been the subject of research as regarding their role in the normal physiology of the nervous system, and their involvement in various neurological conditions. These receptors include AMPA receptors, NMDA receptors and GABAB receptors. Antibodies directed against these receptors may be the underlying cause of many cases of drug resistant epilepsy.

Objectives

To determine the prescence of autoantibodies against AMPA, NMDA and GABAB receptors in drug-resistant epilepsy and their correlation with clinical and electrophysiological findings.

Methods

The study was conducted on 17 epilepsy patients (12 males and 5 females) who were sampled for both CSF and blood. All CSF and serum samples were examined by the Indirect Immunofluorescence cell based technique for the detection of AntiAMPAR, Anti-NMDAR and Anti-GABAB antibodies.

Results

Only one case tested positive for Anti-NMDAR antibodies in CSF, while all other serum and CSF samples were negative for other antibodies. These results are still in process since our data will be used in a further study related to auto-immune drug-resistant epilepsy patients involving other auto-antibodies such as Ant-LGI1, Anti-CASPR2 and Anti-DPPX antibodies.

Conclusion

Testing Anti-NMDAR antibodies can be promising in detecteing drug resistant epilepsy patients even after receiving immunomodulatory treatment protocols.
Expression Pattern and Prognostic Implication of SALL4 Gene in Acute Myeloid Leukemia
Authors: Shalaby Nahela Ahmed , Khattab Ahmed Mahmoud Taha , Ibrahim Shereen Abd El-Monem
Published: August 2023

Background

Acute myeloid leukemia (AML) is a clonal disorder arises from the differentiation arrest of myeloid precursor and malignant proliferation of a bone marrow derived, self-renewing stem or progenitor cells in the bone marrow (BM) and blood.

Aim of the Work

To characterize the expression pattern of SALL4 gene in patients with acute myeloid leukemia and to determine its prognostic impact.

Patients and Methods

This study was conducted on 20 Egyptian AML patients (recruited from hematology units of Internal Medicine department, Ain shams University Hospitals) and 10 patients as controls. All patients were subjected to full history taking, thorough clinical examination, complete blood count, BM aspiration cytochemical analysis, flow-cytometric immunophenotyping of BM blasts using acute leukemia panel and cytogenetic analysis using FISH technique and RT-PCR to measure SALL4 gene expression in AML cases and controls.

Results

Our results showed highly significant difference between expression of SALL 4 gene in AML patients than control group with RQ median in AML cases 15.46 and in control group 0.4 (p value 0.000). Non significant results about prognosios was reached

Conclusion

SALL4 gene expression is constitutive in De-novo AML cases.
Evaluation of Polymyxin NP Test as a Rapid Method for Detection of Colistin Resistance in Enterobacteriaceae
Authors: El-masry Shereen Ahmed , Fahim Noha Alaa Eldin , Mohammed El-Beih AmiraSaad
Published: August 2023

Background

The carbapenemase-producing Enterobacteriaceae are among the most clinically significant multidrug-resistant bacteria. Its rise has led to an increase in the use of the polymixin B and colistin because of limited effective alternative antibiotic treatment.

Aim of the Work

Evaluation of the diagnostic efficacy of the rapid polymyxin NP test for the detection of colistin-resistant Enterobacteriaceae.

Materials and Methods

The study included a total of 42 Enterobacteriaceae isolates. All isolates were subjected to determination of the minimum inhibitory concentration (MIC) for colistin and polymyxin B using the broth microdilution method and detection of colistin-resistant isolates using the polymyxin NP test.

Results

Compared to the colistin MIC, the polymyxin NP test overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 64.7%, 92%, 84.6% and 79.3% respectively. On the other hand, a higher sensitivity (91.6%), specificity (93.3%), PPV (84.6%) and NPV (95.5%) were obtained when the results were compared to the polymyxin B MIC results.

Conclusion

The rapid polymyxin NP test is easy-to-perform, rapid, sensitive, specific test that can be used for the routine detection of polymyxin resistant Enterobacteriaceae particularly in poor resource laboratories.
The Effect of Lactoferrin Supplementation on Iron level and Haematological Parameters after Sleeve Gastrectomy
Authors: Reda Randa , Mohamed Omnia , El Fouly Mohamed , Samy Hassan Asmaa
Published: August 2023

Background

Sleeve gastrectomy (SG) is one of the most effective bariatric surgery methods of treatment for obesity. It can cause nutritional deficiencies and lead to anemia at the same time.

Aim and objectives

To evaluate the effect of lactoferrin supplementation on iron level and haematological parameters after three months of supplementations for sleeve gastrectomy patients.

Subjects and Methods

This study is a randomized control clinical study, Forty patients after sleeve gastrectomy divided into two groups as follows: (Group 1): 20 cases received ferrous sulphate capsule once daily for 3 consecutive months, (Group 2): 20 cases received lactoferrin sachet twice daily for 3 consecutive months with ferrous sulfate capsule once daily.

Result

There is a significant increase in hemoglobin, HCT, and RBCs after 3-months follow up on ferrous sulfate supplementation. Meanwhile, there is a significant decrease in serum ferritin after 3 months follow up. However, the improvement in hematological parameters was more significant in the group of lactoferrin with ferrous sulfate.

Conclusion

Oral lactoferrin was better tolerated and more acceptable in combination with oral iron with higher increase in hematological parameters when compared to oral iron therapy alone over three-months treatment.
The Expression of CD47 and Its Association with Other Biochemical Storage Lesions in Stored Non-Leucoreduced versus Leucoreduced Red Blood Cell Units
Authors: Abdel-Messih Ibrahim Y , Bassiouny Noha , Nader Hebat Allah , Khaled Dalia
Published: August 2023

Background

The emergent need for blood transfusion required blood storage at low temperature which induced biochemical and biomechanical changes, collectively known as RCSL(red cell storage lesion). CD47 is an integrin associated protein which decreases with PRBCs(packed red blood cells) prolonged storage that possibly leads to less effective blood transfusion. Electrolyte imbalance occurs due to inactivation of Na+/K+ ATPase pump in low temperature which inturn leads to continuous increase of extracellular potassium which is considered life threatening for patients with renal failure or those with massive transfusions.

Aim of the Work

The aim of our study is to Evaluate the expression of CD47 by flow cytometry with other biochemical storage changes (pH, sodium and potassium ions) in CPD/SAGM packed non-leucoreduced Group(A) versus CPD/SAGM leucoreduced Group(B) red blood cell units at different storage times (on day 7, 14, 28 from date of red blood cells collection).

Subjects and Methods

450 ml of whole blood is obtained into Quadruple blood bags and further subdivided into 20 non-leucoreduced units and 20 leucoreduced units. Non-leucoreduced and leucoreduced units are stored at 4 ± 2◦C. Samples are taken from each packed red blood cell unit at days 7,14 and 28 and tested for (Na+&K+) ions, pH and CD47 marker by flow cytometry.

Results

Both leucoreduced and non-leucoreduced units show a highly significant decrease in sodium, pH and CD47 expression and a highly significant increase in potassium level. However, there was no statistically significant difference found between 2 studied groups regarding sodium & potassium level, pH and CD47 expression on packed red cells except for sodium on 28th day which was slightly higher in leucoredced than non-leucoreduced units.

Conclusion

Red cell storage lesion is an inevitable process. Our study showed a highly statistically significant decrease in CD47 by flow cytometry in both leucoreduced and non-leucoreduced PRBCs along the storage period from day 7 to day 28. Red cell concentrates show significant decrease in sodium and pH and increase in the level of potassium during storage. Unlike many other studies, leucoreduction didn’t affect the expression of neither CD47 nor biochemical parameters (Na, K and pH) from day 7 to day 28 of PRBc storage.
New Prognostic Indicators in CLL: Relation to Disease Burden
Authors: El Hamid Mohamed Amal Abd , Safwat Nesma Ahmed , Kader Gelan Hosny Abbas Abdel
Published: August 2023

Background

Identifying prognostic markers is important for the clinical and pathological course of chronic lymphocytic leukemia (CLL). Cluster of differentiation CD49d expression and percentage of smudge cells in CLL patients have recently been reported as newer prognostic factor.

Aim of the Study

To estimate CD49d expression as an independent prognostic marker in CLL patients and to investigate its relation to the known prognostic factors

Methods

Thirty adults with CLL were enrolled. Smudge cells percentage was calculated by microscopic evaluation of blood smears. Testing of cluster of differentiation CD49d expression was done by flowcytometry and detection of ataxia telangiectasia mutated (ATM) gene, protein 53(P53) gene deletions and trisomy 12 were performed using fluorescent in situ hybridization (FISH).

Results

CD49d expression was associated with lymphadenopathy, splenomegaly, advanced staging, high total leucocytic count, immunophenotyping scoring, CD38 positivity, short LDT, low smear cell percentage, and presence of p53 deletion. Low percentage of Smear cell (<30%) showed a significantly higher incidence of lymphadenopathy and organomegaly. Additionally, it was associated with a high total leucocytic count, low platelet count, high atypical lymphocytic count and typical IPT scoring, shorter LDT, positive CD38 expression and CD49d expression and ATM and P53 deletions.

Conclusion

CD49d expression and low smudge cell percent were consistently associated with poor prognostic indicators, suggesting that they could be considered as adverse predictors and they should be merged together to improve the power of the prognostic panels of CLL in the clinical setting.
Study of the Effect of ABCB1 Single Nucleotide Polymorphism on Tacrolimus Dose Requirements in Liver Transplant Patients
Authors: El-hadidi Eman Saleh , El-Din Maha Mohsen Kamal , Saab Azza Abd El-rahman , Ali Heba Hassan , Shararah Maram Saeed AbdEl-baki
Published: August 2023

Background

Liver transplantation (LT) is the only effective radical cure for all types of end stage liver diseases. Major advances have been made in the field of liver transplantation due to improvements in surgical techniques and organ conservation as well as optimization of intensive care and immunosuppressive management.

Aim of the Work

The aim of the present work is to assess the influence of ABCB1 gene polymorphism of liver transplant recipients on blood level and dose requirements of oral tacrolimus, in an attempt to help in designing an individualized tacrolimus regimen for Egyptian liver transplant recipient.

Patients and Methods

The study included 25 liver transplant recipients and their respective donors. All subjects of this study were subjected to full medical history, Clinical evaluation, Laboratory investigations, and ABCB1 gene polymorphism evaluation by RT-PCR. Tacrolimus trough level was evaluated for all the recipients during the first 3 months post transplantation.

Results

The present study revealed that the presence of CC genotype was significantly correlated to the effect on tacrolimus C/D ratio and Weight adjusted tacrolimus dose during the first week of the first and 2nd month (Z = -2.108, P < 0.05) but not the 3rd month post transplantation (p-value >0.05). Subjects carrying CC genotype required higher doses of tacrolimus to achieve the desired trough levels compared to subjects carrying CT and TT genotypes. The same effect was observed over the whole period of the study but the results were statistically non-significant (p-value>0.05). Recipients who received liver tissue from donors carrying CC genotype also required higher doses of tacrolimus and reached lower levels of blood tacrolimus trough levels.

Conclusion

The present study revealed that ABCB1 CC genotype of both recipients and donors of liver transplantation was significantly associated with increased required tacrolimus dose early after liver transplantation reaching statistically significant level in the first week of the first and second months.