bluuebunny/crossref_metadata_2025 huggingface dataset:
Continous local Intra –arterial Nimodipine administration in severe symptomatic vasospasm after spontanous subarachnoid hemorrhage:a meta-analysis
Authors: Elshaer A N , Habil I S , Moharram A A , Menshawe M A , Marzouk A M
Published: May 2020

Background

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space (the area between the arachnoid membrane and the pia mater surrounding the brain). SAH is a potentially life threatening condition. Hemorrhage may occur as a result of a head injury or spontaneously (usually from a ruptured cerebral aneurysm). Spontaneous subarachnoid hemorrhage occurs in about one per 10,000 people per year. Females are more commonly affected than males. While it becomes more common with age, about 50% of people present under 55 years old. It is a form of stroke and comprises about 5 % of all strokes. Disturbed conscious level, specially that associated with cerebral arterial vasospasm, remains a major cause of death and disability in the patients with aneurysmal subarachnoid hemorrhage.The classical modality of management for vasospasm was oral calcium channel blockers (nimodipine) with triple-H therapy (Hypedynamic augmentation therapy).

Aim

To evaluate the effect of Continous local Intra –arterial nimodipine administration in severe symptomatic vasospasm after spontanous subarachnoid hemorrhage on mortality and morbidity (symptomtic cerebral ischemia).

Methodology: Studies and participants

In the current meta-analysis, we searched for interventional clinical trials in critically ill adult patients that evaluated to have aneurysmal subarachnoid hemorrhage complicated by severe symptomatic vasospasm (causing delayed cerebral ischemia and neurological deficits) which was refractory to standard hyper dynamic therapy (triple- H therapy) and oral calcium channel blockers (CCBS).

Results

In the current meta-analysis, the duration of infusion of nimodipine was at least for 72 hours. The onset of occurance of cerebral vasodilation after the infusion in all studies by their different doses was 12 hours detected by transcranial doppler. The time of termination of nimodipine infusion is different from patient to other patient depending on clinical improvement ( improvement of consious level or disappearance of the newly developed neurological deficit) and radiological findings that refers to the relief of vasospasm assesed by transcranial doppler and cerebral angiography. Reinfusion of the nimodipine was done in all included studies in case of recurrence of vasospasm causing new neurological deficit or deterioration in the conscious level .

Conclusion

It concluded from the current meta-analysis that, intra-arterial nimodipine infusion is effective and safe treatment for syptomatic refractory vasospasm after aneurysmal subarachnoid hemorrhage.
Comparative Study between 25 Gauge Spinal Needle (Quincke) versus (pencil point) As Regarding incidence of Post Dural Puncture Headache
Authors: Eskander F S L , Ibrahim D A , Hamza A H , Mahmoud M G
Published: May 2020

Background

PDPH can affect patients’ functional recovery and comfort, both are critical factors for patients who expect to resume their daily activities as soon as possible. Especially obstetric patients who will be responsible for a new child.

Objective

The aim of this study is to assess the incidence of PDPH by using the same 25gauge spinal needle but with two different shapes pencil point versus quincke.

Patients and Methods

The study was conducted on 60 randomly chosen patients full filling inclusion criteria in Matarya teaching hospital after approval of the medical ethical committee. They were allocated in two groups of 30 patients each: Group(A) 25 gauge spinal needle (quincke) is used. Group (B) 25 gauge spinal needle (pencil point)is used. The two groups were adequately monitored and assessed intra- and post-operatively and they were compared in vital data as regarding HR, SBP, DBP and the development of PDPH, if developed classified into mild, moderate and severe and assessment of backache.

Results

The results of this study revealed that patients in the study group(A) had more incidence of PDPH 10% compared to 0% in group (B) although still no significant statistical deference but still non beveled spinal needle have lower rates of incidence than quincke (beveled ) spinal needles. Also we found 5 patients out of 30 (16.7%) suffered from backache in group A and one patient (3.3%) suffered from mild backache in group B.

Conclusion

Our study suggests that the use of non beveled spinal needles lead to less incidence rates of PDPH. The frequency and severity of PDPH was higher in 25G cutting spinal(quincke) needle group as compared to non cutting (pencil point)needle. For spinal anesthesia.
A Comparative Study between Effects of Ultrasound Guided Ilioinguinal /Iliohypogastric Nerve Block versus Caudal Block on Postoperative Analgesia in Children Undergoing Inguinal Surgery
Authors: Nafie M M H , Altaher W A , Nassef G N , Ahmed M M W
Published: May 2020

Background

The most commonly performed inguinal surgeries in children include inguinal hernia repair with or without orchidopexy and hydrocele repair. For postoperative pain with these surgeries, a regional analgesic modality such as caudal analgesia (CA), ilioinguinal and iliohypogastric nerve block (IL/IH), or even local infiltration is combined with a general anaesthetic (GA). Regional analgesia techniques are commonly used to facilitate pain control during pediatric surgical practice, decrease parenteral opioids requirements and improve the quality of post-operative pain control and patient-parent satisfaction. When compared to intravenous (IV) opioids, regional techniques reduce the risk of side effects such as somnolence, respiratory depression, emesis, and ileus.

Patients and Methods: After approval of anesthesia, intensive care and pain management department, scientific and ethical committees, and after informed parental written consents, this prospective randomized clinical trial study was conducted in Ain Shams University Hospitals. This study is considered to be a pilot exploratory study. Forty five children patients were included in the study scheduled for elective inguinal surgeries (e.g.; unilateral inguinal hernia repair, hydrocele repair, or orchidopexy). Patients will be randomized using a random number table and the use of a closed envelopes technique to receive either combined general anesthesia with ultrasound guided caudal block (Group A), combined general anesthesia and ultrasound guided ilioinguinal /iliohypogastric block (Group B), or general anesthesia with intravenous morphine (group C).

Results

Among 45 children of (27 boys and 18 girls), aged from one to six years old, ASA physical status I–II who were scheduled for elective unilateral inguinal surgeries, fifteen patients received general anesthesia with ultrasound guided caudal epidural anesthesia (1ml/kg bupivacaine 0.25%), fifteen patients received general anesthesia with ultrasound-guided ilioinguinal/ iliohypogastric nerve block (0.5ml/kg bupivacaine 0.25%) and fifteen patient received general anesthesia with intravenous morphine (0.1 mg/kg).

Conclusion

The current study demonstrated that ultrasound-guided ilioinguinal /iliohypogastric nerve block was more effective than ultrasound guided caudal epidural block or intravenous morphine usage in children aged 1-6 years old undergoing unilateral inguinal surgeries as it carried the advantages of faster onset of action, longer duration of postoperative analgesia, the need of lower volumes of local anesthetic agents with no recorded complications.
Comparative Study between Red Cell Distribution Width and Creatine Kinase-MB as Prognostic Markers in Acute Coronary Syndrome
Authors: Fahmy N M A , Boctor A M S , Haiba D M , Arfa M A M
Published: May 2020

Background

over the last decade, cardiovascular disease (CVD) has become the single largest cause of death worldwide. Low and middle-income countries are seeing an alarming and accelerating increase in the rate of CVD and a higher mortality rate caused by coronary heart disease

Aim of the Work

is to evaluate the possible relationship between red cell distribution width and the adverse clinical outcomes (in hospital course) in patients with acute coronary syndrome.

Patients and Methods

it was a comparative study conducted in the department of ICU in Ain Shams University Hospitals, After approval by medical committee and informed consent, 60 patients (newly admitted to the ICU), with diagnosis of acute coronary syndrome defined by (the criteria of the American College of Cardiology/European Society of cardiology), The study was conducted in the period from June 2018 to July 2018, they were divided into two groups, Group A: 30 Patients have been monitored by CK-MB and, Group B: 30 Patients have been monitored by RDW and CK-MB, We aimed to determine whether RDW, measured on admission and at 6, 12, 24, 48 hours may predict the adverse outcomes of ACS during hospital admission.

Results

our study demonstrated that adverse events were more likely to occur in patients with ACS during short-term follow up if they had higher RDW values.

Conclusion

RDW is independent predictor for worse adverse outcomes in patients with acute coronary syndrome during hospital stay as RDW level was found to be higher in patients whom were heart failure, serious arrhythmia, mechanical complications, Re-infarction.
Myocardial Necrosis in ICU Patients with Severe Hemodynamic Disturbances
Authors: Ghobrial B B , Rabie A H , Toulan H F A , Mohammed O A
Published: May 2020

Background

this prospective comparative observational study, to compare the incidence of myocardial injury in patients with hypovolemic shock versus septic shock, after approval of Ethical committee of critical care department on forty patients in general ICU divided into two groups of twenty patients each equal.

Aim of the Work

to compare the incidence of myocardial injury in patients with hypovolemic shock versus septic shock.

Patients and Methods

this prospective comparative observational study, carried out in Maadi Military Force Hospital, to compare the incidence of myocardial injury in patients with hypovolemic shock versus septic shock, after approval of Ethical committee of critical care department on forty patients in general ICU divided into two groups of twenty patients each equal.

Results

group A has higher values in SOFA score than in Group B, most probably due to toxins affected perfusion of organs and response to resuscitation, beside the poor cellular oxygen utilization, so clinical outcome among the two groups was twenty-four patients died in (sixteen patients in Group A and eight patients in Group B), so in our study there was a higher mortality in Group A patients (Septic shock) than Group B patients (Hypovolemic shock), The deceased patients had higher serum cTnI levels than survivors, this was concordant with Arlati and his colleagues, but there were no significant differences in cardiac troponin.

Conclusion

the incidence of myocardial infarction is increased in Group A (septic patients) more than Group B (hypovolemic patients), most probably due to the maldistribution of coronary blood flow which might produce, for a given level of hypotension, higher amounts of myocardial damage and, consequently, higher levels of troponin I than in hypovolemic shock.
Chest X-Ray vs Chest Computed Tomography in Diagnosis of Various Lung Pathologies in Critically ILL Patients
Authors: Nashed S W , Sayed N , Ali M M M M , Mohammed M M A
Published: May 2020

Background

A CT scanner makes many measurements, from different rotational angles, of X-ray attenuation (weakening in force or intensity) through the cross-sectional plane of the thorax. It then uses these data to reconstruct a digital representation of the cross-section with each pixel of the image representing a measurement of the mean attenuation through the thickness of the predetermined segment. This measurement quantifies the fraction of radiation removed in passing through a given amount of material of a certain thickness.

Objective

To compare the chest CT scan and chest x-ray for early detection of pulmonary complications for adults hospitalized in intensive care unit.

Patients and Methods

In the present prospective study, we included 40 adults’ patients, who were hospitalized in Intensive Care Unit (ICU), in order to compare the diagnostic accuracy of chest X-ray and CT scan for early detection of pulmonary complications. Patients were recruited from the ICUs of Ain Shams University and Misr University for Science and Technology Hospitals. They were included whether they had primary respiratory manifestations or started to develop respiratory manifestations during ICU stay.

Results

In the present study, we included 10 patients who were diagnosed with pulmonary embolism. The mean age of the included patients was 59.7 ± 16.3 years old. Five patients were correctly identified by the chest X-ray. Thus, the chest X-ray sensitivity for the detection of pneumonia was 50% and the positive predictive value was 100%.

Conclusion

In our cohort of patients with a wide variety of chest disorders, routine chest X-ray was not useful to clinicians in the diagnosis of lung disease, compared to chest CT. In addition, chest X-ray had a very low sensitivity in specific conditions like pulmonary embolism and pneumothorax.
The Role of Inhaled Corticosteroids and B2 Agonist in Prevention of ARDS in High Risk Patients Admitted to ICU
Authors: Fouad M K , Mohamed M H , Ammar M A M , Ahmad A A A S
Published: May 2020

Background

Acute respiratory distress syndrome (ARDS) is a life threatening respiratory failure due to lung injury from a variety of precipitants. Pathologically ARDS is characterised by diffuse alveolar damage, alveolar capillary leakage, and protein rich pulmonary oedema leading to the clinical manifestation of poor lung compliance, severe hypoxaemia, and bilateral infiltrates on chest radiograph.

Objective

The aim of this study is to evaluate the effect of inhaled corticosteroids and B2 agonist in decreasing the incidence of ARDS in high risk patients admitted to ICU.

Methodology

This prospective study included 100 cases admitted to Ain Shams University hospitals for variable medical problems, and were at risk of ARDS development. There were four drug groups studied in this study according to their role in progression and prevention of ARDS in those hospitalized patients. These drug groups were group C (4ml saline), group S (salbutamol), group F (budesonide), and group M (budesonide and salbutamol).

Results

ARDS was less likely to develop with the use of salbutamol only or combined with budesonide inhalation in groups S and M respectively. The primary outcome was development of ARDS. The secondary outcome was mechanical ventilation and prolonged ICU stay. Six cases (24%) in each of group C and F developed ARDS, mechanical ventilation and prolonged ICU stay. Just two cases (8%) in each of groups S and M developed ARDS, mechanical ventilation and prolonged ICU stay. The difference between the 4 groups in the incidence of ARDS development was not so far, but it was clearly evident.

Conclusion

The use of inhaled beta 2 agonists was associated with decreased risk of ARDS, mechanical ventilation and prolonged ICU stay when adjusted for baseline characteristics, predisposing conditions and severity of illness.
Outcome of Continuous versus Intermittent Application of Meropenem in Critically Ill Patients with Septic Shock
Authors: Abdalalim A A , Nofal W H , Abdelrazik R A , Megahed K M
Published: May 2020

Background

Severe infections in critically ill patients and increasing antibiotic resistance are major healthcare problems affecting morbidity and mortality in the intensive care unit. Antibacterial drug discovery and development have slowed considerably in recent years.

Aim of the Work

Study the outcome of continuous versus intermittent application of meropenem in critically ill patients with septic shock.

Patients and Methods

This study was carried out on one hundred patients of both sex from those admitted to intensive care unit in Damanhour Medical National Institute.An Informed consent was taken from all patients or their next of kin.

Patients were categorized into 2 groups: Group I (Infusion group)

patients received a loading dose of 2g of meropenem I.V over 30 minutes followed by continuous infusion of 4g of meropenem over 24 hours.

Group II (Bolus group)

patients received 2g of meropenem over 30 minutes every 8 hours. Antibiotic therapy stopped at improvement of the clinical state and signs of subsidence of infection (body temperature below 38, 3 °C for more than 24 hours, white blood cells (WBC) count less than 11, 000/mm3 or decrease by 25% of maximal value)minimum time for therapy 5days and maximum time 10 days.

Results

In the present study there were two groups of critically ill patients with septic shock each of 50 patients. Group one was given meropenem after culture and sensitivity as one gram infusion over 360 minutes every 6 hours. The second group was given meropenem also after culture and sensitivity as two grams bolus over 30 minutes every 8 hours. There were no significant differences between the two groups regarding age and sex distribution. On admission the two groups had high APACHE-II score, but with no significant difference. Also there was no significant difference between the two groups regarding the site of infection nor the infecting organism. As regards WBCs count the mean WBC count was higher in group II than in group I on days 1 and 3 of treatment but there was no statistically significant difference.

Conclusion

Administration of meropenem on cultured based treatment as 1g/6hrs infusion compared to 2g/8hrs bolus was associated with significant reduction of WBCs count, CRP levels, SOFA score and ICU stay. Improved clinical outcome, reduction in bacterial growth and decreased mortality were better in the infusion group but not significant.
Influence of Preemptive Intravenous Ibuprofen on Post-Operative Pain and Opioid Consumption after Laparoscopic Cholecystectomy
Authors: Hamad R A , Shams M K , Kamal M M , Hissein D M
Published: May 2020

Background

cholecystectomy is the most common abdominal surgical procedure in developed countries, and is generally performed laparoscopically. Laparoscopic cholecystectomy is regarded as the gold standard surgical technique for gallstone diseases. This procedure results in less postoperative pain, a better cosmetic outcome, shorter hospitalization faster healing, and earlier mobilization than open cholecystectomy.

Aim of the Work

the purpose of this study is to investigate the effects of a single preemptive dose of IV ibuprofen on postoperative pain and opioid consumption in patients undergoing laparoscopic cholecystectomy.

Patients and Methods

this study will be a prospective study on patients who are scheduled for laparoscopic cholecystectomy will be informed about the different components of postoperative pain they would experience, and they will be selected by the same investigator for their ability to differentiate these pain components and to use the visual analog scale. After approval of the local ethics committee.

Results

this study showed that a single preemptive dose of IV ibuprofen reduced 24-hour opioid consumption and was effective in the emergence of lower pain scores in the postoperative period. In addition, IV ibuprofen significantly reduced rescue analgesic use. In addition IV ibuprofen has played a key role with opioid sparing effect.

Conclusion

a single preemptive dose of 400 mg resulted in better pain scores by reducing postoperative opioid use in the 1st 24 hours in patients undergoing laparoscopic cholecystectomy by 45%. It also reduced rescue analgesic use in the postoperative period and opioid-related side-effects such as nausea-vomiting.
Effect of Pentoxifylline on Organ Dysfunction and Mortality in Severe Sepsis
Authors: Hasan B E , Elgendy H A , Abdelkawe A S , Ibrahim H M
Published: May 2020

Background

sepsis and infection are among the leading causes of death world-wide. The annual burden of sepsis in high income countries is rising with mortality of 40%. Despite these figures from industrialized countries, the largest part of the global sepsis burden occurs in middle and low- income countries, 90% of the world wide deaths from pneumonia, meningitis or other infections occur in less developed countries.

Aim of the Work

to evaluate the therapeutic efficiency of pentoxifylline as an adjuvant therapy in treatment of severe sepsis and its effect in multiple organ dysfunction and mortality in septic patients.

Materials and Methods

this is a randomized double blinded prospective study conducted from January 2015 to March 2016 included total sample size 52 cases (we used organ dysfunction as a primary outcome with proposed large effect size (0.8) and alfa=0.05 and power=0.80, so, 26 cases were needed in each group).

Results

we included 52 patients with sepsis who were divided in 1: 1 ratio to receive pentoxifylline or not. The average age of the included patients was almost 53 years, with no statistically significant different between both groups (p = 0.902); while the majority of the included patients were males, with no significant difference between both groups (p = 0.99). The mean weight was similar between both groups (84.50 ±11.25 vs. 83.65 ±10.54 years; p = 0.78) and chest disorders were the main cause of sepsis in both groups.

Conclusion

we concluded that PTX as an adjuvant therapy had no significant influence on the SOFA score, lactate level, CRP level, and pro-calcitonin level compared to control. Moreover, there were no statistically significant differences in terms of length of hospital stay, need for HD, need for vasopressor and inotropic, need for MV, and mortality rate. Further large clinical trials are recommended to assess the effectiveness of PTX especially with regards to organ failure, survival, and dose dependency.
Postnatal Development of the Hippocampus in Male Albino Rats: A Histomorphometric Study
Authors: Baraka A A A , Hafez K A , Othman A I A , Sadek A M M
Published: May 2020

Introduction

In recent year deterioration in cognitive, learning, and memory become one of the significant problems in human life. Hippocampus is a pivotal part of the brain’s limbic system which serves a critical role in memory, learning process and regulating the emotions. In most regions of the brain, neurons are generated only at specific periods of early development, and not born in the adulthood. In contrast, hippocampal neurons are generated throughout development and adult life. The hippocampal dentate gyrus was reported to be one of the few regions of the mammalian brain where neurogenesis continue to occur throughout adulthood. The neurogenesis in the dentate gyrus was thought to play an important role in hippocampus-dependent learning and memory. The hippocampal formation is composed of the hippocampus proper, the dentate gyrus and the subiculum. The hippocampus proper is the largest part and is subdivided into fields designated as Cornu Ammonis or Ammon’s horn (CA) from CA1 to CA4. Ammon's horn is continuous with the subiculum, which acts as the main output source of the hippocampal formation.

Aim of the Study

To study the postnatal development of the hippocampal formation.

Materials and Methods

Five male albino rats from the following postnatal ages day 1, week 1, week 2, week3 and week 4 were studied by histological, immunohistochemical, and morphometric methods.

Results

The general architecture of the hippocampus proper with its polymorphic, pyramidal, and molecular layers was present at day1, whereas the details of the adult structure appeared at week 2. In the dentate gyrus, distinct lamination appeared at week 1 and its maturation continued with the production of neurons at the interhilar zone that peaked at week 2. The number and density of pyramidal axons and dendrites increase by age. Astrocytes increased in size and staining affinity for glial filaments, and acquired a stellate shape with age. Furthermore, the number of granule cell layers increased concomitantly with the increase in thickness of the molecular and polymorphic layers of both the hippocampus proper and the dentate gyrus.

Conclusion

The important sequences of events in the growth and maturation of the hippocampal formation in male albino rat occurred in the first 2 postnatal weeks.
Association of mean platelet volume with angiographic thrombus burden and short-term outcome in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Suwailem S M , Elhammady W A , Elserafy A S , Fakhry H M , Zahran M E , Araquib A K
Published: May 2020

Background

Coronary artery disease (CAD) represents a leading cause of death worldwide. Given it adverse prognosis, risk stratification of patients with an acute coronary syndrome (ACS) remains a challenging issue. In this regard, different biomarkers are becoming more and more important in the diagnosis, assessment and outcome prediction. For the development of atherothrombosis, platelets have a huge part to play. Mean platelet volume (MPV), a unique measure of platelet size, is an indicator of platelet reactivity and suggests that MPV could be a biomarker of the risk and prognosis of patients with STEMI.

Aim and Objectives:to test the predictive value of MPV for angiographic thrombus burden and short term outcomes in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).

Patients and Methods

all patients presented with acute STEMI to the cardiology department of Ain Shams university hospitals, with Pain to door time less than 12 hours and underwent PPCI. MPV was measured on admission. Angiographic thrombus burden and post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded. Patients were followed up for 3 to 6 months.

Results This study included 72 patients with STEMI who underwent PPCI. The patients’ ages ranged between 33 and 73 years old (mean age 53.22 ± 9.96years). This study included 62 males and 10 females. The MPV of the studied cases was 9.97 ± 1.31 fl. MPV was higher among patients with HTB (11.42±1.007 vs. 9.53±1.039.P 0.00) and patients with (MBG (0-1) and TIMI flow>3) (10.59±1.839vs. 9.81±1.092, P 0.004 and 10.49±1.191vs. 9.81±1.309, P 0.04 respectively).with short term follow up12 patients had heart failure requiring hospitalization and they had a higher MPV (10.81 ± 1.21 vs. 9.74 ± 1.3, p 0.01). In binary logistic regression analysis, the MPV was an independent predictor of TG after STEMI (odds ratio 7.278, and P value (0.000), CI (2.518-21.036)).

Conclusion

MPV may be a useful biomarker that can help in identification of higher-risk patients with large intracoronary thrombus burden, who might require more potent antiplatelet therapy.
Correlation between Risk Score Systems and the extent of Coronary Artery Disease detected by Multislice Computed Tomography
Authors: Azab S S , Farouk M M , Almahmoudy A M , Hasanin A G
Published: May 2020

Background

Risk stratifying patients for cardiovascular diseases is crucial to formulate early effective prevention strategies. Risk scoring systems (RSS) as Framingham Risk Score (FRS) and the Systematic Coronary Risk Evaluation (SCORE) have been designed for early predictions of cardiovascular events in 10-year time.

Objectives

To study the correlation between Risk Score Systems and the extent of Coronary Artery Disease detected by Coronary CT angiography.

Methods

This analysis concluded 120 patients without known coronary disease referred to CCTA from January to June 2018. The extent of CAD, calcium score, coronary plaque burden, composition and distribution were assessed. The Framingham and SCORE risk scores were calculated, then correlation between them was done.

Results

This included 120 patients (mean age 54 + 9 years, 55% male patients). MSCT detected the presence of coronary lesions in 53.3% of the cases, 18.3% of them were with obstructive plaques (stenosis ≥ 50% in the LM or ≥ 70% in any other vessel). Both RSS had a good diagnostic value where SCORE was found to have a higher predictive value (area under ROC curves, 0.754 vs 0.711 for SCORE and FRS respectively). Low SCORE risk category showed the least number of patients with significant CAD (1/22 = 4.5%), compared to those with low risk using FRS (7/85 = 8.2%). High risk SCORE category included more patients with significant CAD (9/23 = 39%), compared to patients with FRS high risk category (3/10 = 30%). A high versus low risk SCORE was related to a higher plaque burden severity (mean burden 57.20=9.75 vs 50.17 + 9.75, respectively, P-value=0.008) and to a great incidence of Calcium Score (CS) > 100 (mean calcium 101.39 + 113.30 vs 3.18 + 13.40, respectively, P-value=0.000). A high versus low risk FRS was related to a higher plaque burden severity (mean burden 60.90 + 15.6 vs 54.06 + 8.04, respectively, P-value=0.039) and to a great incidence of Calcium Score (CS) > 100 (mean calcium 122.40 + 143.89 vs 26.84 + 81.75, respectively, P-value=0.001).

Conclusion

Risk score correlates well with the extent of CAD detected by MSCT where SCORE had a higher predictive value than FRS.
Correlation of Echocardiographic Variables with Exercise Capacity in Patients with Pulmonary Hypertension due to Congenital Heart Diseases
Authors: Elsayed B H A , Zaky A M M , Roshdy A M , Attia H M
Published: May 2020

Background

Pulmonary arterial hypertension (PAH) is a disease of the pulmonary circulation with resultant effects on the right heart. Conceptually, left heart anatomy and function should be normal in patients with PAH. However, the RV and left ventricle (LV) do not function in isolation, sharing a common pericardial sac and inter-ventricular septum which in turn refers to the significance of assessment of both ventricles which has implications for patient prognosis with PAH.

Aim

Study the correlation between echocardiographic hemodynamic parameters and functional capacity in patients with pulmonary hypertension due to congenital heart disease and detection which parameter is the most independent predictor of functional capacity in patients with PAH-CHD.

Methodology

The study was conducted in the period from November 2016 to September 2017 including 34 patients who had been diagnosed with pulmonary arterial hypertension associated with congenital heart diseases (PAH-CHD). All of them were recruited from the congenital heart diseases unit at Ain Shams University hospital. The studied group was divided into two groups in a cross-sectional study: Group I: This included 21 patients with functional capacity according the 6MWT less than 330 m as an average for all subjects. Group II: This included 13 patients with functional capacity more than 330 m. Patients’ participation was voluntary and the subject had the right to withdraw from the study at any time without affecting his/her further medical care.

Results

The whole study population was divided according to the 6MW distance into two groups less than 330 and more than or equal 330 m. Comparing the 6MWD of each patient with the different Echocardiographic variables of systolic & diastolic dysfunction revealed that the group of shorter 6MW distance had higher RVSP, MPAP, E/e’ ratio, LVMPI and RVMPI, while they had lower LV e’ TDI, LV GRS, RV FAC and RV GLS (less negative value). Multivariate analysis of these Echocardiographic variables revealed that MPAP is independent predictor of 6MWD & thus an independent predictor of functional capacity in PAH-CHD patients.

Conclusion

Assessment of RV and LV function in PAH-CHD patients is important. Strain measurement by STE provides valuable information on the quantitative RV and LV functional assessment in the setting of volume and pressure overload. The MPAP and saturation were found to be the most independent predictors affecting the functional capacity of the patients with PAH-CHD.

Recommendations

Assessment of functional capacity in patients with PH using the 6MWT is recommended as a routine investigation from diagnosis and during follow-up and correlated with the echocardiographic variables, it has been shown to be practical and feasible and provides an easy and not expensive tool for clinical and prognostic assessment.
The Relationship between the Blood Flow Volume of the Arteriovenous Fistula and its Early Effect on the Pulmonary Artery Pressure and the Left Ventricular Dimensions and Functions
Authors: Lotfy A A , Elfiky E M , Ali A N , Diab O A
Published: May 2020

Background

Cardiovascular complications are leading cause of the death in hemodialysis patients. One of these complications is pulmonary hypertension which complicates chronic renal failure in 12–45% of cases and causes an increase in all-cause mortality of 2-3 folds in the dialysis population. Another complication is left ventricular hypertrophy which is a strong predictor of morbidity and mortality in patients with ESRD. Arteriovenous fistulas increase cardiac output and lead to significant increases in both the mass and the diameter of the left ventricular wall in the long-term duration. There is evidence that A-V fistula creation is a major risk factor for developing a new onset Congestive Heart Failure

Aim of the Work

Our study aimed to assess the relationship between blood flow volume of arteriovenous fistula (AVF) and its effect on the Pulmonary Artery Pressure (PAP) and the Left Ventricular (LV) dimensions and functions and to find out the cut off value of the AVF blood flow volume above which the cardiac dimensions and functions start to get affected.

Methods and Results

The study included 50 individuals selected from Internal Medicine and Nephrology outpatient clinics and inpatient wards at Ain Shams University Hospitals during the period from November 2016 until October 2018 who underwent full echocardiography studies once at the beginning of the study and once after 3 months and also underwent Duplex sonography on arteriovenous fistula to measure blood flow rate. The results showed that after 3 months the only significant changes were the ejection fraction (P-value of 0.029), the fractional shortening (P-value of 0.009), and the E/A ratio (p-value of 0.005). Also, the results showed a correlation between AVF blood flow volume and LV internal dimensions. Left ventricular end-diastolic diameter (LVEDD) and Left ventricular end-systolic diameter (LVESD) increased significantly in patients with AVF blood flow volume of 1010 ml/min or above and 1120 ml/min or above respectively. Surprisingly, PASP showed no statistically significant change in our study.

Conclusion

Our study concluded that high flow AVF affect cardiac dimensions and functions. We proved that a cut off value of AVF blood flow volume affecting LV dimensions and functions can be reached and in our study, a value of 1010 ml/min or above affected the LVEDD and a value of 1120 ml/min or above affected the LVESD. Surprisingly, in our study, the PASP did not show a positive correlation with AVF blood flow volume.
Pilot study to predict future cardio-vascular events by novel 3D- echocardiography Global area strain in STEMI patients managed by primary PCI
Authors: Alashry A M , Esmail Y A , Saad M T , Abdelhalim W A , Elfiky A A
Published: May 2020

Background

Three-dimensional speckle tracking echocardiography (STE) is an ideal modality for accurate assessment of myocardial deformation, the Novel 4D-Global Area strain (GAS) is a very sensitive parameter in detection of subtle changes involving the myocardium as it encompasses both global longitudinal and global circumferential strains .

Objectives

To investigate the predictive value of four dimensional (4D) strain echocardiography for major adverse cardio-vascular events (MACE) in ST-elevation acute myocardial infarction (STEMI) after successful reperfusion by primary PCI.

Methods

171 patients who underwent successful primary PCI were enrolled and properly examined by 2D and 4D echocardiography with 4D strain parameters evaluation then followed up all-over a year for the occurrence of Major adverse Cardiovascular Events (MACE) .

Results

Thirty two MACE were recorded in 170 patients who completed the follow-up period for one year, compared with those without MACE, patients with MACE had PTCA done during the index Primary PCI intervention, had multi-vessel CAD affection, higher LVEDD, higher LVESD, lower 2D- LVEF, higher WMSI, higher baseline HR, higher EDV and ESV, lower 3D- LVEF, higher 3D-GLS, 3D-GCS and 3D-GAS with lower 3D-GRS, all with p-values < 0.005. Multi-variant logistic regression analysis showed that GAS was the most powerful predictor for MACE among our study population with the best cut-off value of 3D-GAS> -17, with p-value of (0.008) OR (20.668), CI (2.227-191.827) with relative risk of adverse events of 18.205 (95% CI 6.976- 47.506 – P value < 0.001).

Conclusion

Our data supports the superiority of 4D strain echocardiography parameters specially GAS for prediction of adverse clinical events among patients managed by successful primary PCI .
Left Ventricular Systolic and Diastolic Functions after Cardiac Rehabilitation in Successfully Revascularized Patients with Acute Myocardial Infarction
Authors: Rashed M I A S , Bastawy I M , Khorshid H M , Sharafeldin A A
Published: May 2020

Background

Coronary artery disease (CAD) is a widely prevalent disease with many adverse sequelae. As survival after myocardial infarction or coronary revascularization has improved, cardiac rehabilitation and secondary prevention services have become more important. Advances in ultrasound such as Doppler imaging, strain or strain rate imaging provide comprehensive information on left ventricle (LV) myocardial contractility.

Objective

to evaluate the possible early effect of intensive supervised Cardiac rehabilitation on the LV systolic and diastolic functions in patients with acute myocardial infarction (AMI) who had been successfully revascularized by primary percutaneous coronary intervention (PCI) using two dimensional (2D) speckle tracking and doppler imaging.

Patients and Methods

thirty patients with AMI and successfully revascularized by primary PCI were enrolled in the study. LV global longitudinal strain (LVGLS) analysis was performed using 2D speckle tracking echocardiography before and after Cardiac rehabilitation. LV ejection fraction (EF) was measured using the modified Simpson’s method. Pulsed-wave Doppler at the tip of mitral valve leaflets was also done allowing us to measure the early (E) and late (A) diastolic filling velocities, E/A ratio. The LV tissue velocity was measured by TDI of the lateral mitral annulus (e’) and E/e’ was calculated and LV diastolic dysfunction (DD) grade was estimated.

Results

There was significant improvement in LVEF measurements before and after Cardiac rehabilitation (47.50 ± 6.42 before vs. 52.17 ± 6.64 after; p = 0.000).The improvement in 2D speckle tracking LVGLS after Cardiac rehabilitation was statistically significant (p = 0.000). the diastolic function as assessed by TDI after a 3-month program of exercise-based cardiac rehabilitation has improved with decrease in the number of patients with DD grade I and increase in the number of normal diastolic function with p-value P < 0.01(highly significant).

Conclusion

cardiac rehabilitation has beneficial effects on LVGLS, LVEF as well as diastolic function after AMI and successful revascularization.
Polymer free drug-eluting stents versus durable polymer drug-eluting stents in elective percutaneous coronary interventions in patients with stable coronary artery disease patients
Authors: Altoukhy S M A , Rezq A A A , Anany B A M , Elhamady W A M , Metwally M F , Taher M A A
Published: May 2020

Aim

To compare the inflammatory response of polymer-free versus permanent polymer drug-eluting stents in patients with stable coronary artery disease undergoing elective PCI, and the effect of this inflammatory response on the 6 month clinical outcomes.

Methods

This randomized prospective comparative study was conducted on 100 patients with stable coronary artery disease planned for elective PCI divided into 50 patients with deployed permanent polymer DES (PP-DES) groups and 50 patients with polymer free DES (PF-DES). Blood samples were taken to assess serum level of hsCRP before the procedure and the first day after the procedure. The target end points were the recurrence of effort angina, incidence of target lesion revascularization (TLR) over a period of 6 months and the inflammatory response by measuring the percentage of rise in hsCRP level.

Results

There was no statistically significant difference in the clinical outcome in the first six months between the patients who had PP-DES and the patients who had PF-DES regarding recurrence of effort angina (p-value = 0.822) and TLR (p-value = 0.727), with no patients developing myocardial infarction or stent thrombosis. There was a statistically significant inflammatory response after stent deployment in both groups represented by a significant rise in the serum level of hsCRP on the first day after the procedure in both groups (p-value < 0.001), but there was no statistically significant difference in the inflammatory response between PP-DES and PF-DES (p-value = 0.978). The number of patients having recurrence of anginal symptoms and TLR with hsCRP rise ≥ 11.36% was higher than those having the same with hsCRP < 11.36%. However, this difference was not statistically significant regarding recurrence of anginal symptoms (p = 0.057) and TLR (p = 0.092).

Conclusion

The PF-DES was proved to be non-inferior to PP-DES regarding the short-term clinical outcome and the early inflammatory response. It was concluded that the presence of polymeric coating in PP-DES did not add to the magnitude of the inflammatory response and it did not significantly increase the incidence of recurrence of anginal symptoms and TLR in this group of patients.
Effect of cardiac rhythm on serum levels of the inflammatory mediators; Interleukin-6 and C-Reactive Protein in patients with chronic rheumatic heart disease
Authors: Mohammad A M Y , Rifaie O A , Hamza M A , Amin S A
Published: May 2020

Background

Rheumatic fever has a marked tendency to recur leading to high risk of chronic heart lesions or worsening lesions in patients with previous rheumatic heart disease. For secondary prevention of RF, long acting penicillin can be used. Some rheumatic heart disease patients suffer from atrial fibrillation. Cardiac rhythm may affect the response of the body to the long acting penicillin, so it would be helpful to study the effect of cardiac rhythm on serum levels of inflammatory mediators in patients with chronic rheumatic heart disease.

Objectives

Our study is a prospective cross-sectional controlled study that aims to study the effect of cardiac rhythm on serum levels of the inflammatory mediators; C-Reactive Protein and Interleukin-6 in patients with chronic rheumatic heart disease.

Methods

The study included 70 rheumatic heart disease patients on regular long acting penicillin. Patients were divided into to 2 groups: Group A; 56 patients with rheumatic heart disease who have sinus rhythm, and Group B; 14 patients with rheumatic heart disease who have atrial fibrillation (AF) and Group C; control group of 10 healthy individuals.

Results

There was no significant difference between sinus patients and AF patients in CRP and IL-6 levels (p = 0.3050 and 0.6758, respectively). Also, there was no significant difference between 15, 21 and 30 days regimens of penicillin in CRP and IL-6 levels (p = 0.9467and 0.0795, respectively). IL6 values were significantly correlated with CRP values (r = 0.5435, p < 0.0001). There was a significant difference in CRP and IL-6 levels between compliant and non-compliant patients (p = 0.0053 and 0.0308).

Conclusion

Our study results disprove that cardiac rhythm has an effect on the serum levels of the inflammatory mediators C-Reactive Protein and Interleukin-6 in chronic rheumatic heart disease. Our study also disproves the preference of any regimen of long acting penicillin (15 days, 21 days and 30 days) over each other for secondary prevention of chronic rheumatic heart disease. Our study results emphasized that chronic rheumatic heart disease is an inflammatory process mediated with some mediators as CRP and IL-6 that are strongly correlated with each other.
Prevalence of Peripheral Arterial Disease among End Stage Renal Disease Patients
Authors: Morkos R R W , Shabana A M , Elserafy A S , Hanna H F
Published: May 2020

Background

Patients with End Stage Renal Disease are more susceptible to develop Peripheral Arterial Disease. so, screening is helpful for early diagnosis.

Objectives

The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD.

Aim of Study

The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD.

Patients and Methods

The study included 100 asymptomatic patients on regular hemodialysis and below 60 years old to be screened for presence of PAD. Patients who refused the test, above 60 years old, or diabetic have been excluded from the study. All selected patients have been subjected to complete history taking, full clinical examination including extremities examination, Lab workup including; CBC, liver function test, kidney function test, A1C level, lipid profile, Resting 12 lead ECG, Echocardiography to assess systolic function, valvular disease, and resting SWMA, and ABI assessment using the Doppler. Patients then were divided into two groups; control group who has negative PAD with ABI > 0.9 and study group who has PAD with ABI ≤ 0.9.

Results

It was found that the prevalence of PAD among ESRD patients is 26%. Regarding the laterality; 21% had bilateral PAD and the rest 5% had unilateral disease. The results showed that females had statistically significant higher risk of developing PAD that males. 55% of patients were females and the other 45% were males. 36.4% of females studied had positive ABI but only 13.3% of studied males found positive for PAD. The p value was 0.017. The study showed also that A1C level in patients who have no diabetes carries statistically significant results. The mean A1C level for the study group was 5.56 ± 0.70 and the control group was 4.92 ± 0.73. The p value was 0.000. The A1C level cut off value was > 5.3. This means that patients who have A1C > 5.3 should be paid more attention and be screened because they have higher risk to develop PAD.

Conclusion

Renal impairment is an important risk factor for developing PAD in absence of traditional risk factors such as DM, hypertension, or dyslipidemia. Prevalence of PAD was 26% in our study. ABI is a simple non-invasive modality of screening for PAD. Females are at higher risk to develop PAD than males by ∼ 2.7 fold. Although diabetes is absent, A1C level > 5.3 is significantly correlating with the risk of PAD.