bluuebunny/crossref_metadata_2025 huggingface dataset:
Geographic population structure and distinct intra-population dynamics of globally abundant freshwater bacteria
Authors: Hoetzinger Matthias , Hahn Martin W , Andersson Linnéa Y , Buckley Nathaniel , Ramsin Chelsea , Buck Moritz , Nuy Julia K , Garcia Sarahi L , Puente-Sánchez Fernando , Bertilsson Stefan
Published: July 2024

Implications of geographic separation and temporal dynamics on the evolution of free-living bacterial species are widely unclear. However, the vast amount of metagenome sequencing data generated during the last decades from various habitats around the world provides an unprecedented opportunity for such investigations. Here, we exploited publicly available and new freshwater metagenomes in combination with the genomes of abundant freshwater bacteria to reveal geographic and temporal population structure. We focused on species that were detected across broad geographic ranges at high enough sequence coverage for meaningful population genomic analyses, associated with the predominant freshwater taxa acI, LD12, Polynucleobacter, and Candidatus Methylopumilus. Despite the broad geographic ranges, each species appeared as a sequence-discrete cluster, in contrast to abundant marine taxa, for which continuous diversity structures were reported on a global scale. Population differentiation increased significantly with spatial distance in all species, but notable dispersal barriers (e.g. oceanic) were not apparent. Yet, the different species showed contrasting rates of geographic divergence and strikingly different intra-population dynamics in time series within individual habitats. The change in an LD12 population over 7 years was minor (FST = 0.04) compared to differentiation between lakes, whereas a Polynucleobacter population displayed strong changes within merely 2 months (FST up to 0.54), similar in scale to differentiation between populations separated by thousands of kilometers. The slowly and steadily evolving LD12 population showed high strain diversity, whereas the dynamic Polynucleobacter population exhibited alternating clonal expansions of mostly two strains only. Based on the contrasting population structures, we propose distinct models of speciation.
Analysis on stable imaging and inverse algorithm for artificial source EM data
Authors: Luan Xiaodong , Xue Junjie , Chen Bin , Wu Xin , Ma Xiaoyin
Published: July 2024

The inversion of artificial source electromagnetic (EM) method data fundamentally involves constructing a mathematical relationship between observable data and geological structures. The aim of imaging and inversion is to construct a geophysical model that matches the observable results, thereby realizing the identification of subsurface targets. The results of EM data inversion, due to the simplicity of geophysical models, limit inversion computing efficiency. Moreover, complexity of actual geological structures, and lack of onsite observable data, are often hindered by non-uniqueness. The challenge in the interpretation of artificial source EM data is in enhancing both the precision and expeditiousness of the inversion process. It can be classified into three main types for EM data inversion: direct imaging inversion, deterministic inversion, and stochastic inversion. To enhance computational efficiency and reduce non-uniqueness in the results, effective inversion methods, prior geological information, geophysical data, and comprehensive analysis can help mitigate the issue of non-uniqueness in EM data inversion, thereby leading to more rational geophysical interpretation results. With the progress of technology such as computing centers and the development of artificial intelligence methods, future inversion techniques will become faster, more efficient, and more intelligent, and will be applied to the interpretation of artificial source EM data.
‘I heard about the negotiation with Agostini’
Authors: Dall’Aglio Stefano
Published: July 2024

This article focuses on negotiations that took place between 1667 and 1673 leading to the purchase by Prince-Cardinal Leopoldo de’ Medici (1617–1675) of the bulk of the collections assembled by the antiquary Leonardo Agostini (1593–1676). This was one of the most important acquisitions by the Medici family in the second half of the seventeenth century, and it brought different types of objects into the grand-ducal collections: medals, intaglios, cameos and ancient metal objects. Several go-betweens and experts were involved, the most important being the antiquary Ottavio Falconieri (1636–1675), Leopoldo’s agent in Rome. Recently discovered letters exchanged between Leopoldo and Falconieri shed crucial new light on the whole story.
Actio de in rem verso
Authors: Jefferson Rebecca J W
Published: July 2024

The provenance of many objects once part of the acclaimed Revd William MacGregor collection of Egyptian artefacts is unclear or unknown. Private collectors purchased pieces from the MacGregor collection when it was sold at auction in 1922, many of which eventually made their way into major museums around the world. Today, the provenance information attached to them can usually be traced back through the private owners only as far as MacGregor’s ownership and no further. Recent research has revealed more about MacGregor’s collecting habits, including the fact that Count Riamo d’Hulst was the supplier of MacGregor’s famous obsidian head. Based on a little-known court case in Egypt and previously unseen correspondence between MacGregor and the Swiss archaeologist Édouard Naville, this article sheds further light on the extent to which the count was MacGregor’s regular supplier. It will also demonstrate how this key buyer–seller relationship developed, and how it eventually deteriorated into enmity and legal wrangling.
Neurocognitive outcomes and functional independence in adult survivors of childhood medulloblastoma diagnosed over 3 decades
Authors: Papini Chiara , Mirzaei Sedigheh , Xing Mengqi , Tonning Olsson Ingrid , Salloum Ralph , de Blank Peter M K , Lange Katharine R , King Tricia Z , Srivastava Deokumar , Leisenring Wendy M , Howell Rebecca M , Oeffinger Kevin C , Robison Leslie L , Armstrong Gregory T , Krull Kevin R , Brinkman Tara M
Published: July 2024

Background

Treatment of childhood medulloblastoma has evolved to reduce neurotoxicity while improving survival. However, the impact of evolving therapies on late neurocognitive outcomes and adult functional independence remains unknown.

Methods

Adult survivors of childhood medulloblastoma (n = 505; median [minimum–maximum] age, 29 [18–46] years) and sibling controls (n = 727; 32 [18–58] years) from the Childhood Cancer Survivor Study completed surveys assessing neurocognitive problems and chronic health conditions (CHCs). Treatment exposures were categorized as historical (craniospinal irradiation [CSI] ≥ 30 Gy, no chemotherapy), standard-risk (CSI > 0 to <30 Gy + chemotherapy) and high-risk (CSI ≥ 30 Gy + chemotherapy) therapy. Latent class analysis identified patterns of functional independence using employment, independent living, assistance with routine/personal care needs, driver’s license, and marital/partner status. Multivariable models estimated the risk of neurocognitive impairment in survivors versus siblings and by treatment exposure group, and associations between neurocognitive impairment, CHCs, and functional independence.

Results

Survivors in each treatment exposure group had a 4- to 5-fold elevated risk of impaired memory and task efficiency compared to siblings. Contemporary risk-based therapies did not confer lower risk compared to historical therapy. Survivors treated in the 1990s had a higher risk of memory impairment (relative risk [RR] 2.24, 95% confidence interval 1.39–3.60) compared to survivors treated in the 1970s. Sensorimotor, hearing problems, and seizures were associated with 33–34%, 25–26%, and 21–42% elevated risk of task efficiency and memory impairment, respectively. Treatment-related CHCs and neurocognitive impairment were associated with nonindependence.

Conclusions

Despite treatment changes, long-term survivors of childhood medulloblastoma remain at risk for neurocognitive impairment, which was associated with CHCs. Neurocognitive surveillance after contemporary regimens is imperative.
Midazolam versus Ondansetron versus Dexamethasone in Preventing Post-Operative Nausea and Vomiting after Elective Laparoscopic Abdominal Surgeries
Authors: Mohamed El-Taher Walead Abdel-Meged , Mohamed Marwa Mostafa , Ibrahim El Mowafy Ahmed Yousri
Published: July 2024

Background

Laparoscopic surgery is associated with a remarkably high risk of post-operative nausea and vomiting. The reasons for this high rate of PONV include mechanical factors (such as pressure on the stomach and gut caused by the pneumoperitoneum), neural factors (such as vagal reflexes elicited by irritation of parasympathetic nerve endings in the abdomen), and chemical factors (which include speculative considerations regarding a possible influence of CO2 on PONV).

Objective

To compare the effect of midazolam, ondansetron or dexamethasone on prophylaxis against PONV in patients undergoing laparoscopic abdominal surgeries.

Patients and Methods

After approval of anesthesiology department, scientific and ethical committees in Ain Shams University Hospitals, patients were included in the study, and were divided into three groups (n = 40; each); group M (midazolam group) and Group O (ondansetron group) and group D (dexamethasone group).

Results

The three groups were adequately monitored and assessed post-operatively and they were compared regarding post-operative nausea and vomiting outcome by recording the incidence of nausea and vomiting and recording the call for rescue antiemetic. Demographic data, intra-operative hemodynamics and post-operative pain score, occurrence of side effects, sedation score and patient satisfaction scores were also assessed, we found about 95% of (M) group achieve the complete response, that mean midazolam provided PONV prophylaxis comparable to dexamethasone and ondansetron in patients who underwent laparoscopic abdominal surgeries.

Conclusion

From this study, we can conclude that the midazolam is as effective as ondansetron and dexamethasone in reducing the incidence of nausea and vomiting in post-operative period of laparoscopic abdominal surgeries.
Effect of Intra-Operative Erector Spinae Plane Block on Post-Operative Consumption of Opioids after Video-Assisted Thoracoscopic Surgeries (VATS)
Authors: El-Din Shokeir Mohamed Hossam , Kamal Shams Manal Mohamed , Khamis Ahmed Mohamed , Mostafa Mohamed Mohsen
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. Although VATS is less painful than an open thoracotomy, patients may still feel severe pain and restricted mobility during the first few postoperative hours. 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.

Objective

to assess the analgesic efficacy and safety of ultrasound guided ESPB done at lumbar transverse process level in patients undergoing VATS for postoperative analgesia.

Patients 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 30 adult patients aged 21-50 years, Scheduled for lumbar spine surgeries. Patients were randomly divided into two equal groups, 15 each, according to the inclusion and exclusion criteria. Group A (n = 15): Received fentanyl 1-2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation in addition 40 ml bupivacaine 0.25% (20ml on each side) as a single level bilateral injection for ESPB. Group B (n = 15) (the controlled group): Received only fentanyl 1- 2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation.

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 VATS also reduced the total amount of postoperative morphine consumption in comparison to controlled group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting due to decrease opioids intake.

Conclusion

Ultrasound-guided bilateral erector spinae plane block reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients’ satisfaction in the first 24 hours after VATS, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB slightly decreased the rate of PONV. This might be because the use of ESP might have decreased the use of intraoperative opioids.
Efficacy of Combination Therapy Using Crystalloid, Colloid and Ephedrine in Prevention of Post Spinal Hypotension at Cesarean Delivery
Authors: Elewa Mohammed Ahmed Mahmoud , Ibrahim Ahmed Saeed , Alansary Adel Mohammed
Published: July 2024

Background

Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both.

Objective

To determine the most effective strategy to decrease the incidence and severity of post spinal hypotension by comparing three different combination therapies using crystalloid, colloid and ephedrine at cesarean delivery.

Patients and Methods

After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain Shams University, and written informed consent from all parturients this study was conducted in the operating theatres of Ain Shams Obstetric and Gynecology University Hospitals.

Results

In our study we found that a combination of an ephedrine infusion at 1.25 mg, minute with a crystalloid co-load was more effective in the prevention of hypotension.

Conclusion

Employing all mentioned combination treatments reduced the rate of hypotension occurrence following spinal anesthesia in parturients undergoing cesarean delivery. The most effective method was administration of crystalloid coloading plus ephedrine infusion.
Outcome of High Dose Vitamin D on Prognosis of Sepsis Requiring Mechanical Ventilation: A Randomized Controlled Trial
Authors: AbdElazim Mohamed AbdElmoniem Hassan , Aziz Moustafa Zakaria Abdel , Esmat Ibrahim Mamdouh , Ashoor Tarek Mohammed , GadElrab Ahmed Ihab Ahmed , Anwar Maha Ahmad
Published: July 2024

Background

Critically ill patients have an increased requirement for vitamin D in sepsis and these patients have low levels of vitamin D. The researchers validated the efficiency and safety of high-dose oral vitamin D (50,000 IU) in patients with sepsis requiring mechanical ventilation.

Methods

Seventy five patients were randomly assigned to 2 groups (Group I = 37 patient and Group II = 38 patient) in accordance with the vitamin D treatment regimen: Group I (GI): patients received 50,000 IU vitamin D crushed and diluted in 50 ml of water and delivered to patients in the nasogastric tube (NGT) once daily for 5 consecutive days; Group II (GII): patients received daily requirements of vitamin D (5000 IU/ day) crushed in 50 ml of water and delivered to patients in the nasogastric tube (NGT) once daily for 5 consecutive days. Primary outcome of this study was the change in procalcitonin levels at day 7 and the changes in plasma vitamin D levels were secondary outcomes.

Results

Procalcitonin (PCT) decreased at day 4 and day 7 in study groups, procalcitonin (PCT) levels at days 4, 7 were significantly lower in high dose group (p < 0.032 and p < 0.013, respectively) and procalcitonin (PCT) levels reductions (day 7 – day 0) were significantly higher in high dose group (p < 0.010). Serum vitamin D (25(OH)D) levels increased at day 4 then decreased at day 7 in study groups, serum Vitamin D (25(OH)D) levels at days 4, 7 were significantly higher in high dose group (p < 0.001 and p < 0.001, respectively) and serum Vitamin D (25(OH)D) levels elevations (day 7 – day 0) were significantly higher in high dose group (p < 0.001).

Conclusion

The early use of high-dose oral vitamin D in patients with sepsis requiring mechanical ventilation in combination with the standard treatment for sepsis lowered the procalcitonin level, increased the antioxidant status, and improved the illness severity.

Trial Registration

This trial is registered with ClinicalTrials.gov Identifier (NCT05244018).
Ultrasound Diaphragmatic Assessment as a Predictor of Successful Non-Invasive Mechanical Ventilation in Patients with Acute Exacerbation COPD: an Observational Study
Authors: Khalaf Mostafa M I , Abd El-Fattah Mohamed Ismail , Thabet Wael R , Ashoor Tarek M
Published: July 2024

Background

Non-invasive ventilation (NIV) is successful as first-line treatment for patients admitted to hospital with hypercapnic respiratory failure due to AECOPD. Significant diaphragmatic muscle dysfunction (DD) exits in different disease-related and physiological conditions, including COPD. Ultrasonography is considered as a non- invasive and bedside method and commonly applied in intensive care unit (ICU) to assess diaphragmatic function.

Objective

To demonstrate the value of diaphragmatic ultrasound assessment for patients with AECOPD undergoing NIMV.

Patients and Methods

A population of 24 consecutive patients with AECOPD admitted to Ain Shams University Hospitals’ Intensive Care units (ICU) were enrolled. Change in diaphragmatic thickness fraction (ΔDTF) < 20% and diaphragm excursion< 10 mm during tidal volume was the predefined cut-off for identifying DD. Correlations between ΔDTF < 20%, diaphragm excursion< 10 mm and NIV failure and other clinical outcomes were investigated.

Results

24 cases with AECOPD, 33.3% of them (8 cases) had diaphragm dysfunction (DD+) but after NICPAP 2 cases improved and only 6 cases remain with DD and 16 Patients without DD (DD−). DD+ patients had a higher risk for NIV failure than DD−patients (p < 0.011), and this finding was significantly associated with higher in-hospital, and 30-day mortality rates; longer mechanical ventilation duration; higher tracheostomy rate; and longer ICU stay.

Conclusion

AECOPD patients with diaphragmatic dysfunction as diagnosed by US showed higher incidence of NIMV failure, longer MV, ICU length of stay, In- hospital mortality, ICU and MV duration were significantly longer in group with DD. Insignificant difference was found considering mortality after 30 days in patients with or without diaphragm dysfunction.
Safety and Efficacy of N-Acetylcysteine as an Adjuvant Therapy in Critically Ill COVID-19 Patients
Authors: Abdelmonem Hany Saeed , Allah Elgendy Hanaa Mohamed Abd , Kamal El-Din Doaa Mohammed , Elshaer Eman Mohamed
Published: July 2024

Background

COVID-19 may cause pneumonia, acute respiratory distress syndrome, cardiovascular alterations, and multiple organ failure, which have been ascribed to a cytokinestorm, a systemic inflammatory response, and an attack by the immune system. Moreover, an oxidative stress imbalance has been demonstrated to occur in COVID- 19 patients. N- Acetyl-L-cysteine (NAC) is a precursor of reduced glutathione (GSH).

Aim of the Work

we retrospectively will investigate safety and efficacy of NAC dose given in paracetamol toxicity as an adjuvant therapy in critically ill COVID-19 patients with acute respiratory distress and determine whether NAC in high doses can avoid respiratory failure in patients with COVID-19.

Patients and Methods

This was a retrospective observational study in which all cases were collected from ICU of Ain shams university hospitals during COVID-19 outbreak. All data were extracted from clinical records. All patients initially admitted to ICU with SPO2 less than 94 % were included between December 2020 to February 2022. Exclusion Criteria included Need for immediate mechanical ventilation on admission, known allergy or hypersensitivity to NAC, end stage renal and liver diseases, heart failure and pregnancy. All patients with severe COVID-19 (confirmed or suspected received standard care, according to the institutional protocol.

Results

Patients were randomized into two equal groups (number (n)=40 each) as the N1(NAC) group who was given intravenously, initially 150 mg/kg in 200 mL of 0.9% NaCL for 60 minutes (first bag), followed by 50 mg/kg in 500 mL of 0.9% NaCL for 4 hours (second bag), and then 100 mg/kg in 1000 mL of 0.9%NaCL for 16 hours (third bag) and N2(Non NAC) group who received intravenously N-acetylcysteine (NAC) 600mg /12hr and The primary endpoint was the need for mechanical ventilation. Secondary endpoints were time of mechanical ventilation, admission to the intensive care unit (ICU), time in ICU, and mortality. There were no statistically significant differences between the two groups (p > 0.05) The effect of NAC on mechanical ventilations, mortality, ICU stays, and hospital stays is a matter of controverse in ARDS patients. We found that intravenous high dose of NAC did not improve oxygenation, mortality rate and did not reduce the requirement for mechanical ventilation when administered for COVID 19 patients with ARDS. Also, the duration of ICU and hospital stays were relatively prolonged in the NAC-treated patients. These might be due to prolonged survival time with NAC-treated patients, but not to be detected with the small single centered trial..

Conclusion

Use of high doses of NAC administration can not affect the need of mechanical ventilation, rate of mortality, the need, duration of ICU admission and hospital stays for patients with severe COVID-19.
Comparative Study of Preoperative Ultrasound Guided Pericapsular Nerve Group Block and Femoral Nerve Block for Analgesia before Spinal Anesthesia for Proximal Femur Fracture Fixation
Authors: Mohamed Abd El-Rahman Mahdi Mohamed , El-wahab Amin Korraa Alaa Eldine Abd , Abd El-Megid Khaled Mohamed Maghawry , El- Monem Nofal Walid Hamed Abd , ElsayedEbrahim Nasser Elsayed
Published: July 2024

Background

Proximal femur fractures are most common fractures especially in elderly population. Regional anaesthesia is preferred during surgery in these patients. However, the severe pain associated with these injuries makes appropriate positioning difficult for the regional anaesthesia, thus altering their overall success rate, also the majority of patients often experience moderate to severe postoperative pain.

Aim of the Work

The study aimed to compare between ultrasound guided PENG and FNB using VAS score to assess the overall efficacy for pain relief during patient positioning for spinal anesthesia.

Patients and Methods

After approval of anaesthesiology department scientific and ethical committees in Ain Shams University Hospitals, 50 patients were included in the study, and were divided into two groups (n = 25; each); group PENG and FNB group. The two groups were adequately monitored and assessed before spinal anesthesia and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total amount of analgesia required.

Results

This study documented that PENG block is comparable to femoral block for postoperative pain control. The PENG block has been described very first in 2018 for preoperative management of femur neck fracture. We observed no statistically significant difference in pain scores during positioning for spinal anesthesia and for first 24 hrs post-operative. Similarly, no significant difference was also found in first rescue analgesia time and Cumulative nalbuphine consumption at 24 hours after surgery between the two groups.

Conclusion

In the management of hip fractures, PENG block is not associated in the present study with a significant change in pain score during positioning for spinal anesthesia compared to femoral nerve block.
Association between D-Dimer and the Severity of COVID-19
Authors: Abd-ElAzeiz Mohammed Saeed , El-Hennawi Ahmed Mohamed El-Sayed , Mohamed Wael Abdelmoneim , Mohamed Ali Ahmed Mamdouh
Published: July 2024

Background

Coronavirus disease-2019 (COVID-19) is a global health crisis. The clinical characteristics, disease progression and outcome in children appear significantly milder compared to older individuals. Symptoms, although variable, depend on the stage of the disease, the prior health status, and the presence of comorbidities and other individual features. The risk factors for morbidity and mortality include comorbidities such as diabetes, chronic pulmonary disease, and cardiac pathology. Thus, prompt diagnosis is vital, given the evolution of the disease, with ARDS potentially occurring at 1 week after symptom onset.

Objective

To investigate the prognostic value of D-dimer levels measured on admission in COVID-19 patients.

Patients and Methods

We performed a retrospective observational study to investigate the prognostic value of D-dimer levels measured on admission in patients infected with novel Coronavirus Disease 2019 (COVID-19). The study enrolled 80 consecutive critically ill patients with test confirmed COVID-19 status attending Ain Shams University Hospital, intensive care units (Dimerdash Hospital). We retrospectively collected demographic, clinical data, laboratory parameters and prognosis.

Results

The best cutoff of D dimer in prediction of severe disease is ≥ 308 with area under curve of 0.897, sensitivity of 87%, specificity of 80.7%, positive predictive value (PPV) of 64.5%, negative predictive value of 93.9% and overall accuracy of 82.5% (p < 0.001). Statistically, there is statistically significant association between D dimer (≥308) and disease severity where D dimer significantly increased risk of having severe disease by 27.9 folds. The best cutoff of D dimer in prediction of mortality is ≥ 376 with area under curve of 0.839, sensitivity of 82.6%, specificity of 82.5%, positive predictive value (PPV) of 65.5%, negative predictive value of 92.2% and overall accuracy of 82.5% (p < 0.001). Statistically, there is significant association between D dimer (≥376) and mortality where D dimer significantly increased risk of mortality by 22.4 folds. In our study, there is statistically significant association between D dimer (≥376) and overall survival which was significantly higher in those with D dimer <376.

Conclusion

The prognosis of COVID-19 is poor in some group of patients. Unfortunately, an effective, globally accepted treatment algorithm for the treatment of COVID-19 has not yet been established. Additionally, the importance of anticoagulant therapy is increasing, as thrombotic events play a major role in mortality.
Role of Apigenin in Rats with Type 1 Diabetic Complications
Authors: Sherif Sara Gamal , Tarek Marwa , Sabry Yasmine Gamal , AbouGhalia Azza Hassan
Published: July 2024

Background and Aim

The main factor contributing to diabetes morbidity and mortality is cardiovascular problems. Apigenin, a naturally occurring flavonoid with anti-inflammatory and anti-diabetic characteristics, was investigated for its cardioprotective potential.

Methods

Type 1 diabetes model was induced using single injection of streptozotocin and diabetic rats were injected with apigenin. ECG recording and measurement of blood pressure were performed. Biochemical analyses of serum glucose, lipid profile, and creatine kinase were done. Histological examination of cardiac tissues was also performed.

Results

Diabetic rats had higher levels of glucose and creatine kinase, and impaired lipid profile as compared to the control group. Apigenin improved glycemic control, dyslipidemia, and cardiac function markers. Diabetic group had significantly higher blood pressure values as compared to the control group. The mean systolic and diastolic blood pressure levels dropped after apigenin treatment. ECG showed decrease in heart rate and increase in R-voltage after apigenin-injection as compared to diabetic rats. Moreover, apigenin-injection resulted in reduced histological changes of cardiac tissues compared to diabetic rats.

Conclusion

Apigenin could serve as potential therapeutic agent to reverse effects of hyperglycemia and its cardiovascular complications in diabetes.
Ticagrelor versus Clopidogrel in Prevention of No Reflow after 1ry PCI in Diabetic Patients with STEMI
Authors: Gamal Mohamed , Elshawa AbdElzaher Khalil , AbdElmonaem Moustafa Mohamed , Hamza Hassan Mohamed Atef , Hamid Galal Wagdy Abdel
Published: July 2024

Background

Adequacy of coronary flow can be judged upon using several methods like TIMI Grade and myocardial blush grade. No-reflow phenomenon, defined as incomplete reperfusion at the microvascular level despite adequate patency of the occluded artery, remains an important limitation of primary percutaneous intervention in STEMI patients nowadays. We aim in this study to investigate the relationship between the antiplatelet loading dose whether to be Ticagrelor or Clopidogrel and post intervention coronary flow, bleeding risk in these patients.

Aim of the Work

To compare between the effects of preoperative loading dose of Ticagrelor and clopidogrel in Diabetic STEMI patients undergoing primary percutaneous coronary intervention regarding prevention of no reflow, Instent thrombosis and short term bleeding risk. Myocardial reperfusion was judged upon using TIMI Grade and myocardial blush grade.

Patients and Methods

a single center prospective randomized controlled trial based at the coronary care units in Ain shams university hospitals. The study included Three hundred Diabetic patients presenting to Ain shams university hospitals diagnosed with STEMI in the ER fulfilling the inclusion criteria were randomized to receive Ticagrelor (150 patients) or receiving clopidogrel (150 patients)

Results

As regard TIMI flow there was statistically highly significant highly significant difference between two studied groups with P value 0.000 where in group A 64 % of patients developed TIMI III flow, 22.7 % with TIMI II flow, 12.7% with TIMI I and 0.7% with TIMI 0 While in group B 86% of patients developed TIMI III flow, 9.3% of them developed TIMI II, 3.3 % developed TIMI I flow and 1.3 % developed TIMI 0. As regard MBG there was statistically highly significant difference between two groups with P value 0.00 where in group A where percentage of patients with MBG grades 0,1,2 and 3 were 4%, 16 %,18 % and 62 % respectively while in group B percentage of patients with MBG grades 0,1,2 and 3 were 1.3 %, 3.3 %, 9.3 % and 86 % respectively. As regard echo EF, there was statistically significant difference between two groups with P value 0.036 where mean EF in patients with group A was 40.50 ± 7.93 while the mean EF in patients with group B was 42.55 ± 8.88 .

Conclusion

Ticagrelor loading before primary PCI resulted in improved post-procedural TIMI flow. It also increased the post-procedural MBG. This resulted in a significant increase in the number of patients having more post-procedural Ejection fraction as measured by modified Simpson’s method. However, it did not decrease incidence of in-hospital MACE. Also there was no significant increase in risk of major nor minor bleeding in both young and elderly patients.
Effect of High Dose Atorvastatin and Allopurinol Preloading on No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction
Authors: Ezzat Zaky Mina Faried , Said Othman Khaled Mohamed , Fouad Khalid Ahmed , Bastawy Islam Mahmoud
Published: July 2024

Background

No reflow is linked to worse prognosis post revascularization, so preventing no reflow is better than treating it.

Objective

this study aims to evaluate the effect of adding high-dose allopurinol and atorvastatin in preventing NRP when given before undergoing primary PCI in patients presenting with STEMI.

Patients and Methods

This study recruited 300 patients who were classified into 3 groups (100 each), Group A: patients were preloaded with high dose Allopurinol and Atorvastatin on top of the standard of care treatment according to the European society of cardiology guidelines. Group B: patients were preloaded with high dose Atorvastatin only on top of the standard of care treatment, Group C: were only preloaded with the standard care treatment according to the European society of cardiology guidelines, each group was subjected to the same pre procedural laboratory tests, primary percutaneous coronary intervention was done by the most experienced operator available according to the European society of cardiology guidelines.

Results

Percentage of post procedural no reflow was significantly lower in patients who were preloaded with high dose Allopurinol and Atorvastatin compared to the other 2 groups (highest with group C) (Group A: 11%, Group B: 23%, Group C: 39%).

Conclusion

preloading patients before primary percutaneous coronary intervention in patients presenting with ST elevation myocardial infarction with high dose Allopurinol and Atorvastatin significantly decreases incidence of post procedural no reflow.
Role of Strauss ECG criteria as predictor of response in patients undergoing cardiac resynchronization therapy
Authors: Shoman Khaled , Effat Emad , Badran Haitham , Eldamanhory Hayam
Published: July 2024

Background

Cardiac resynchronization therapy( CRT) is a standard treatment in patients with heart failure, however, approximately 20–40% of recipients of (CRT) do not respond to it based on the current patients’ election criteria. The purpose of this study was to identify the baseline parameters that predict the CRT response and how the ECG morphology can affect the outcome.

Objective

To evaluate the Strauss ECG criteria as predictor of response in patients undergoing Cardiac resynchronization therapy.

Material and Methods

From March 2020 to March 2022, 70 patients underwent CRT or CRT-D insertion with LBBB morphology in Ain Shams university hospitals, Cardiology department were enrolled in the study. All patients subjected to history, clinical examination, Electrocardiogram and echocardiography before CRT insertion and after 6 months. We analyzed the QRS morphology of the patients with LBBB-like pattern as we classified patients in two groups, Strauss LBBB criteria (SLBBB) which was (a QRS duration of < 140 ms for men and <130 ms for women, along with mid-QRS notching or slurring in at least 2 of the leads V1, V2, V5, V6, I, or aVL and also rS or QS morphology in lead V1 patients) and the other group that was not meeting the previous criteria as non-strauss LBBB (non-SLBBB), also all patients subjected to echocardiography ( conventional 2D and speckle tracking “global longitudinal strain and global circumferential strain), Ejection fraction was assessed together with LV volumes and speckle tracking to assess response to CRT.

Results

Out of 70 patients, 3 patients missed the 6 months follow up after CRT implantation, so the study enrolled 67 patients that have been classified according to ECG morphology of LBBB to 37 patients with non-Strauss ECG criteria- one of whom died after 4 months- and 30 patients with Strauss ECG criteria. The number of responders in the study was 50 patients with percentage 75.8%, 52% of CRT responder (26 patients) had non Strauss ECG criteria while 48% of CRT responders (24 patients) had Strauss ECG criteria with P value=0.463. While there was no statistical significance of overall CRT response nor 6 months hospitalization and mortality between patients of Strauss and non-Strauss ECG criteria, there was a significant improvement in NYHA class, EF assessed by biplane Simpson’s, End- systolic volume, Global longitudinal strain and Global circumferential strain by speckle tracking echocardiography in patients with Strauss ECG criteria of LBBB.

Conclusion

There is no statistical significance in overall CRT response nor the 6 months hospitalization and mortality after 6 months of follow up between patients with Strauss and non-Strauss ECG criteria of LBBB, however, patients with Strauss ECG criteria have better improvement in NYHA class, echocardiographic parameters such as EF and ESV and speckle tracking parameters (GLS and GCS).
Correlation Between High-sensitive Troponin Level, Neutrophil Lymphocyte ratio and SYNTAX score in Acute Myocardial Infarction patients undergoing Coronary Angiography
Authors: Orz Mahmoud , Abdelhamid Ibrahim , Amin Youssef , Tamara Ahmed
Published: July 2024

Background

Acute myocardial infarction is one of the leading causes of death in the developed world. The prevalence of the disease approaches three million people worldwide. Acute myocardial infarction divided into two categories, non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI).

Objective

To assess the value of using high sensitive troponin and the neutrophil lymphocyte ratio as marker to predict the complexity of angiographic coronary anatomy in AMI patients assessed by SYNTAX Score.

Patients and Methods

this study included 100 patients who presented to emergency department of Ain Shams University Hospitals and Misr University for Science and Technology (MUST) hospital, between November/2021 and May/2022 diagnosed with AMI and underwent coronary angiography with or without stent implantation. Serum sample for differential CBC count was obtained to assess NLR as will as zero point high sensitive troponin to be correlation SYNTAX score.

Results

The study showed that there was a significant correlation between the NLR and the complexity of coronary lesions assessed by SYNTAX score, but the study couldn’t found any correlation between the high sensitive troponin level and the complexity of coronary lesions. Also the study showed there were no correlation between NLR and either TIMI follow or MBG. The conducted patients in the study were categorized in a tripartite fashion according to their SYNTAX score (low: 0 to 22, intermediate: 23 to 32, high: >32).

Conclusion

An increased in neutrophil lymphocyte ratio on admission is a strong and independent predictor of the complexity of the coronary lesions, but there is no significant correlation between High sensitive troponin level and the complexity of coronary lesion .
Impact of Exercise-Based Cardiac Rehabilitation on Metabolic Syndrome in Post-Acute Coronary Syndrome Patients
Authors: Awaleh Ahmed , Khorshid Hazem , Karem Khalid
Published: July 2024

Background

Metabolic syndrome (MetS) is characterized by a cluster of cardiovascular risk factors including hypertension (HTN), impaired fasting blood sugar (FBS), increased central obesity (WC) and dyslipidemia; hypertriglyceridemia (TG) and low high-density lipoprotein- cholesterol (HDL-C). The MetS adversely affects cardiovascular outcomes, individuals with at least 4 out of 5 features of MetS have a 3.7-fold increased risk of coronary artery diseases at a 5-year follow-up.

Objective

to determine the effectiveness of exercise based-cardiac rehabilitation (CR) program on MetS in post-Acute Coronary Syndrome (ACS) patients versus guideline directed medical therapy over a 12 weeks period.

Patients and Methods

The study included 62 patients who suffered from ACS with evidence of MetS. All patients were recruited from Ain Shams University Hospitals (ASUHs) from July 2021 to December 2021 and were assessed at baseline and after 12 weeks of follow up for MetS parameters. After approval by the local ethics committee all patients were provided voluntary informed consent. The study subjects were classified into two groups: Group A (case group): included 32 patients who completed at least 80% of 12 weeks of CR program in ASUHs. Group B (control group): included 30 patients who did not attend the CR program and completed 12 weeks of guideline directed medical therapy alone.

Results

The results revealed that -when compared group A at baseline and after 12 weeks of CR-program there was a significant reduction in WC, FBS and TG levels, while there was a significant rise in HDL-C level. However, there was no statistically significant difference found regarding BP in this group. Regarding group B there was no statistically significant difference between the baseline MetS parameters and at follow up after 12 weeks of guideline directed medical therapy alone.

Conclusion

The present study revealed that there was a statistically significant improvement regarding WC, FBS, TG and HDL after completion of 12 weeks of the CR Program, while there was no statistically significant difference found regarding BP in the study group. In the control group there was no statistically significant difference found at baseline and follow up after 12 weeks of guideline directed medical care alone. Thus, the exercise-based CR program is superior than the regular medical care alone in improving the WC, FBS, TG and HDL.

Key words: Metabolic Syndrome, Cardiac Rehabilitation, Exercise Training, ACS. Abbreviations and Acronyms.

Acronyms:

ACS: Acute Coronary Syndrome

ASUHs: Ain Shams University Hospitals

BP: Blood Pressure

CR: Cardiac Rehabilitation FBS: Fasting Blood Sugar

HDL-C: High Density Lipoprotein-Cholesterol HTN: Hypertension

MetS: Metabolic Syndrome

TG: Triglyceridemia

WC: Central Obesity
Correlation between Glycated Hemoglobin, Extra cranial Carotid Artery Disease, Peripheral Arterial Disease in Type ll Diabetic Patients with Coronary Artery Disease
Authors: Mohammed Darwish Mohammed Nabil , Fahmy Ahmed Mohammed , Mousa Mohammed Abomandour , Ahmed Abdelrazek Ahmed Farouk
Published: July 2024

Background

Diabetes mellitus (DM) is the most common endocrine disorder where the body does not either produce enough insulin or has a resistance to the circulating insulin, and is characterized by high blood sugar levels over prolonged periods. DM is a growing global health issue. In 2000, DM affected an estimated 171 million people in the whole world increased on 2011 to more than 366 million people and expected to be more than 552 million by 2030.

Aim of the Work

to correlate between HBA1C, carotid, peripheral and coronary artery disease in type II DM patients.

Patients and Methods

This is an observational study conducted at the coronary care unit & coronary catheterization lab unit of National Institute of Diabetes and Endocrinology, Egypt. Its aim was to correlate between HBA1C, carotid, peripheral and coronary artery disease in type II DM patients. 122 patients with eligible criteria were recruited to the study after signing consent. A full history was taken from every patient, a full clinical examination, 12 lead-ECG, Echocardiography, Carotid duplex, ABI measurement, HbA1C and Invasive non emergent coronary angiography were done.

Results

Data was collected, tabulated, and analyzed, which revealed that carotid IMT in patients with HbA1C >7% was significantly higher than those with HbA1C<7, HbA1C had a significant positive correlation with carotid IMT, ABI was significantly lower in patients with HbA1C>7% compared to those with HbA1C<7%, ABI had a significant negative correlation with carotid IMT, Number of diseased coronary vessels was significantly higher in patients with higher HbA1C >7% compared to those with HbA1C>7%, ABI had a significant negative correlation with number of diseased coronary vessels and IMT had a significant positive correlation with number of diseased coronary vessels in patients with higher HbA1C >7% with no significant correlation in those with HbA1C<7%, HbA1C can significantly predict peripheral artery disease and carotid atherosclerosis.

Conclusion

HbA1C correlates significantly with Carotid atherosclerosis, PAD and CAD severity based on number of diseased coronary vessels in uncontrolled TIIDM patients. Also, PAD and carotid atherosclerosis correlate significantly with CAD severity based on number of diseased coronary vessels in uncontrolled TIIDM patients. Also, PAD correlates significantly with carotid atherosclerosis in uncontrolled TIIDM patients. HbA1C can significantly predict carotid artery disease and PAD.
Effectiveness of cupping and aversion therapies as adjuvant methods for smoking cessation
Authors: Saeed Adel M , Mohammed Rehab M , Abdel Salama Mohammed Ayman
Published: July 2024

Background

Tobacco addiction affects both the mind and the body. Most people find that a mix of medicine, a strategy to change personal habits, and emotional support is the most effective way to quit. The aim of the work was to compare between the effectiveness of cupping therapy and aversion therapy as adjuvant methods in smoking cessation program.

Patients and methods

A prospective randomized study was done on 60 smokers recruited from Ain Shams University Hospitals who were divided into three groups. Group I : included 20 participants subjected to counseling only (the five A’S); Group II : included 20 participants subjected to counseling and aversion therapy using onion-powdered cigarettes by mixing tobacco with dried onion powder by an equal amount; Group III: included 20 participants subjected to counseling and a monthly bloodletting cupping session for 3 consecutive months, follow up visits were conducted every 2 weeks for 3 months to assess outcome and withdrawal symptoms.

Results

There was no statistically significant difference (p value >0.05) between the success rate in the three different groups. The success rate of quitting was the same among smokers in group I and group III ( complete success 10% and partial success 10%), while the success rate of quitting among smokers in group II was ( complete success 0% and partial success 15%). There were significant statistical correlations (P < 0.05) found between the outcome and the age, occupation, duration and pack/year smoking, while there was insignificant statistical difference (P < 0.05) between the outcome and marital status, comorbidities and previous quitting attempts. There was no significant difference between three groups in the frequency of withdrawal symptoms during follow up visits, while there was significant statistic reduction in frequency of dizziness, headache and fatigue between follow up visits in the three groups, weight gain increased during follow up visits.

Conclusion

Using adjuvant methods like aversion and bloodletting cupping therapy in smoking cessation programs doesn’t seem to produce significant change in success rate of quitting smoking.