bluuebunny/crossref_metadata_2025 huggingface dataset:
The Efficacy of Ultrasound-Guided Bilateral Quadratus Lumborum Block versus Bilateral Transversus Abdominis Plane Block in Patients Undergoing Total Abdominal Hysterectomy
Authors: Mohammed Yasmeen Khaled , EL- Said Kamel Amr Mohamed , Said Alfred Maurice , Abdelgawad Ahmed Tarek
Published: November 2024

Background

Nerve root or myofascial irritation at the abdominal wall is a common cause of pain following surgeries such as cholecystectomy, cesarean section, prostatectomy, hysterectomy and transplant surgery. Spinal or systemic opioid analgesia techniques are often used to manage pain after abdominal surgeries and appropriate pain management is necessary for optimizing clinical outcomes and patients’ satisfaction. However, complications such as nausea, vomiting and respiratory depressions are often associated with opioid use. As a result, investigation of alternative analgesia regimens to enhance effectiveness in postoperative pain management while improving the safety profile has emerged as a significant field of inquire.

Aim of the Work

To study the analgesic efficacy of ultrasound- guided bilateral trans- muscular quadratus lumborum block (QLB) compared with bilateral transversus abdominis plane (TAP) block on postoperative period regarding pain control, total opioid given in the first 24-hour post-operative, VAS score and first time to ask for analgesia in patients undergoing total abdominal hysterectomy under general anesthesia.

Patients and Methods

After approval of anaesthesiology department scientific and ethical committees in Ain Shams University Hospitals, 50 female patients were included in the study, and were divided into two groups, each group consisted 25 patients. Group A (TAP): Patients in this group received bilateral US guided TAP block at the end of surgery. Group B (QLB): Patients in this group received bilateral US guided QLB block at the end of surgery.

Results

As regard the analgesic parameters recorded; in the current study, the VAS was significantly lower in group B QLB block when compared with that of group A TAP block and showed significant difference between both groups at 2,4,8 and 12 hrs postoperatively. Also, time to rescue analgesia, there was clinically and statistically highly significant longer time to 1st rescue analgesic in group B (QLB block) was 8.68±1.14 hours compared to that of group A (TAP block) was 5.24±1.64 hours. Also in the current study, total pethidine consumption ―mg with the mean total consumption in each of Group was 100.80±35.58 mg in the TAP group compared with 78.00±25.33 mg in the QLB group there was highly statistically significant higher mean of total analgesic consumption in group A compared to Group B.

Conclusion

Bilateral ultrasound-guided QL block provides more potent and longer postoperative analgesia with less analgesia consumption than TAP block after total abdominal hysterectomy.
A Comparative Study between Sub-Sartorial Canal Block and Patient Controlled Analgesia for Postoperative Analgesia after Total Knee Replacement Surgery
Authors: Mohamed Elsayed Yomna Emad , Kamal Manal Mohamed , Mohamed Rania Magdy , Al-shahat Ibrahim Ibrahim
Published: November 2024

Background

Knee arthroscopy is a common orthopaedic procedure worldwide, despite its minimally invasive nature compared to the traditional knee surgery, post-arthroscopic pain may be severe, and the patients generally require a significant amount of opioid-based analgesics after such procedures.

Aim of the Work

To compare the analgesic efficacy and functional recovery of Adductor Canal Block and PCA in patients who have undergone total knee replacement surgeries.

Patients and Methods

This study is a prospective randomized controlled clinical trial. After obtaining approval from the Research Ethical Committee of Ain Shams University, this study will be conducted in the operating theatres of Ain Shams University Hospitals. Through a period of six months.

Results

Peripheral nerve blocks offer effective analgesia and decrease the need for opioids, thereby reducing the complications associated with the use of this class of drug. Pain management regimens following knee arthroscopy include oral analgesics, periarticular injection, peripheral nerve blocks (PNBs), and intravenous patient-controlled analgesia (PCA). The use of an adductor canal block (ACB) that offers almost pure sensory block with minimal motor involvement as part of a multimodal approach to pain control after knee arthroscopy

Conclusion

Effective pain management following total knee arthroplasty (TKA) and knee arthroscopy is crucial for achieving early post-operative mobilization, patient satisfaction, and minimizing complications. Opioids have traditionally been used to manage pain, but their potential side effects, such as vomiting and respiratory depression, have led to a search for alternative approaches.
Comparative Study between Quartz Laser Ablation of Prostate (QLAP) and Transurethral Resection of Prostate (TURP)
Authors: Shaker Hassan S , Saafan Ahmed , Khedr Ashraf , Attia Hatem Soltan
Published: November 2024

Background & Purpose

Pulsed beams produced by laser at wavelength of 2140nm which have above 60% absorption by water that result in vapor bubble which has a destructive effect on tissues and atones (jack hummer effect) but with limited coagulation make it suitable for small sized prostate below 60gm and/or bladder neck incision--. This study was conducted to compare the safety and efficacy of transurethral resection of prostate (TURP) versus Quartz Laser Ablation of prostate (QLAP) regarding patient outcome and intraoperative complications.

Study Design

Prospective, case controlled comparative study.

Setting

Ain Shams, Shaker and Maadi military hospitals.

Subjects

We included 100 patients with lower urinary tract symptoms (LUTS) symptoms secondary to benign prostate enlargement (BPE), and classified them two groups: 50 patients treated by monopolar Transurethral Resection of Prostate (TURP) (Group A), and 50 patients treated by Quartz Laser Ablation of Prostate (QLAP) (Group B).

Methods

All patients were subjected to full history taking, examination, Preoperative laboratory investigations including, Hemoglobin, hematocrit, serum Na and K and serum PSA. Perioperative radiological investigations including, abdominopelvic ultrasound with pre and post void residual urine, transrectal ultrasound to estimate the prostate size and uroflowmetry. Follow up 6 months post operative for any complication, change in IPSS score, serum PSA, urine analysis, post voiding residual and uroflowmetry were evaluated.

Results

In the studied population, the average age was (68.03 ± 8.2) years. Comparative study between two groups revealed non- significant difference among post-operative urological data. However, there is a significant difference in median value of PVR but not in median difference value. Similarly, there is no statistically significant difference as regard to laboratory findings with an exception to potassium level. Regarding post-operative complications; the early complications rate was (28%), and the late complications rate was (25%). Comparative study between the 2 groups revealed non-significant difference as regards post-operative complications (p > 0.05).

Conclusion

To conclude, QLAP technique for management of BPH was proven to be effective in decreasing post-operative PSA, prostate size, IPSS total, and PVR. But, both QLAP and Monopolar TURP techniques had the comparable safety and complications rates.
Efficacy of Holmium Laser Urethrotomy vs in Combination with Intralesional Paclitaxel Injection in the Treatment of Urethral Stricture
Authors: El-Ansary Mahmoud Mohamed Magdy , Safaan Ahmed Mohamed , Mousa Waleed Elsayed , Samir Younan Ramsis
Published: November 2024

Background

Male Urethral strictures are one of the most common reasons for urological admissions. They are associated with urinary tract infections, bladder stones, fistulas, sepsis and possibly renal insufficiency. Minimally invasive surgical approaches are utilized efficiently and safely in the treatment of urethral strictures.

Aim of the Work

To evaluate the outcome of visual internal urethrotomy with a holmium: yttrium- aluminum- garnet laser Vs in combination with intralesional paclitaxel injection.

Patients and Methods

A prospective interventional study that was conducted at Ain Shams University hospitals on 60 patients attending Ain Shams University hospitals Urology clinic for 6 months. Patients were randomly allocated by closed envelop method into either Group A or Group B in a 1: 1 ratio. Group A consists of those who underwent laser internal urethrotomy only, and Group B of those who underwent laser internal urethrotomy with circumferential submucosal paclitaxel injection at the stricture site.

Results

There was statistically significant improvement in IPSS score at 3 months in group B compared to group A with P-value 0.034. There was statistically significant improvement in Q- average at 3 months in group B compared to group A with P-value 0.014. Q-max was slightly improved in group B compared to Group A at 3 months yet there was no statistically significant difference with P-value 0.545. Overall recurrence was less frequent in group B (24.1%) compared to group A (39.3%) with no statistically significant difference with P-value 0.219.

Conclusion

The addition of intralesional paclitaxel injection to the treatment regimen may enhance the outcomes of visual internal urethrotomy for urethral strictures, leading to improved symptom relief and reduced recurrence rates, particularly in the midterm follow-up period. Further research may be warranted to validate these promising results and explore the long-term effects of this combined approach.
Impact of Ureteral Access Sheath during Flexible Ureteroscopy as Regard Complication and Stone Free Rate
Authors: Mourad Mohamed Sherif , Tawfeek Ahmed Mohamed , Osman Mohamed Mostafa Elsayed
Published: November 2024

Background

Ureteral access sheath use has been widely accepted by urologists since older ureteroscopes were difficult to insert into the ureter due to their stiffness, width and limited deflection angles. However, with advancing technology and design improvement, new generation ureteroscopes are thinner and built with lighter and more flexible materials than their older counterparts. This in turn has produced devices that are easier to maneuver, meaning that procedures can be performed without needing UAS thus the actual benefit of UAS was under question.

Objective

To compare the usage of UAS versus not using the UAS during FURS regard operative time, intra operative, postoperative complications and patient satisfaction.

Patients and Methods

120 patients with symptomatic upper ureteric and renal pelvic stone disease were enrolled, they were divided into 2 equal groups one underwent FURS with UAS and the second group underwent FURS without UAS.

Results

There was a statistically significant higher frequency of postoperative complications in No UAS comparing to UAS group with p-value (p < 0.05) in the form of Postoperative fever and Postoperative sepsis. While, there is no statistically significant difference between groups according to OR time (min.), Stone free rate, Hospital stay (hrs.) and Postoperative pain.

Conclusion

In the current study we aimed to compare the usage of UAS versus not using the UAS during FURS regard operative time, intra operative, postoperative complications and patient satisfaction. In the included patients, There was a statistically significant higher frequency of postoperative sepsis and fever in No UAS comparing to UAS group, with p-value (p < 0.05). While, there is no statistically significant difference between groups according to operative time “min”, Stone free rate, Hospital stay (hrs.) and Postoperative pain. Moreover, significant association of postoperative sepsis and fever with residual stones in included patients. UAS has superior advantage over no-UAS due to lower incidence of sepsis and fever in the current study.
Double Dose versus Standard Dose of Tamsulosin with Solifenacin for Treatment of Ureteric SRS (Stent Related Symptoms)
Authors: Osman Tarek , Saied Mohamed , Ramadan Mohamed Ramadan Mohamed
Published: November 2024

Background

Ureteral stents provide drainage of the upper urinary tract, when obstruction of the ureter is present or anticipated. Indicated in relieving urinary obstruction, following or prior to ureterorenoscopy, Prophylactic before ESWL, Conservative Treatment of Upper Urinary Tract Trauma to reduces urinary leakage and the risk of strictures, Reconstructive Surgery of the Upper Urinary Tract and identifying the ureter before specific abdominal surgeries. Stent-related symptoms have a high prevalence. They include irritative voiding symptoms including frequency, urgency, dysuria, incomplete emptying; flank and suprapubic pain; incontinence, and hematuria.

Objective

To evaluate the effectiveness of Double dose versus standard dose of tamsulosin with solifenacin in relieving stent related symptoms.

Patients and Methods

A Randomized controlled clinical trial was conducted on 64 Egyptian patients from the outpatient clinic and inpatients Urology department of Ain Shams University Hospital for Six months.

Results

After 2 weeks of medication, the double dose of tamsulosin with solifenacin was more effective for stent-related symptoms than standard dose. There was significant difference in the score between the double dose and the standard dose. Side effects were more frequent among the double dose group with significant difference only in retrograde ejaculation and dry mouth.

Conclusion

Combination therapy of Tamsulosin with solifenacin is effective in relieving stent related symptoms. In some patients who are still complaining even with this combination we can double the dose of tamsulosin and solifinacin in order to relieve the symptoms even if the temporary and accepted side effects will increase.
Healing Evaluation of Varicose Leg Ulcers after Injection Sclerotherapy of Pathological Leg Perforator Veins
Authors: Ateya Beshoy Magdy Alshahat , Mahmoud Abdelbary Mostafa Soliman , Wahba Ramez Mounir , Mahmoud Amr Abdelghaffar , Mohamed El-Awady Karim Shalaby
Published: November 2024

Background

Scottish Guideline defined the chronic venous leg ulcer “as an open lesion between the knee and the ankle joint that remains unhealed for at least four weeks and occurs in the presence of venous disease”. Venous Leg Ulcers (VLUs) account for 70% of all leg ulcers and estimates 1% of the population with a prevalence that increases with age according Edinburgh study, which was a cross-sectional study of a random sample.

Aim of the Work

To evaluate the efficacy of injection sclerotherapy of incompetent perforators in the healing of venous leg ulcers.

Patients and Methods

This study was conducted on 50 patients with chronic venous leg ulcers that had been presented for at least four weeks ago. To evaluate the clinical efficacy of Duplex-guided foam sclerotherapy with compression therapy in comparison with compression therapy alone, we divided the patients with randomization into two groups. Group A was conservatively managed by four-layer compression bandage and Group B was managed by application of duplex guided injection sclerotherapy and four-layer compression bandage.

Results

In our study, there is statistically significant positive correlation between duration of ulcer, ulcer surface area and duration to complete healing. On linear regression analysis of factors significantly correlated with duration of complete healing, only ulcer surface area at start of treatment was significantly associated with it (β = 1.031, p < 0.001). Increased ulcer surface area at start of treatment by 1 cm2 increases duration of healing by about 1 week.

Conclusion

Duplex-guided sclerotherapy is a simple procedure, no hospitalization, no anaesthesia, can be done in outpatient clinic and the patient can return home after 45 min and no work off period. The relative healing period and its evident success, make this the first line treatment for venous ulcer and superior to compression alone.
Predictors and Risk Factors of Wound Complications in Diabetic Patients Post Lower Limb Amputation: A Prospective Study
Authors: Abouzeid Mohamed Mahmoud , Wahba Ramez Mounir , Abdulmonem Ayman Hossameldin , Adly Nahla Nader , Abdullah Mohamed Hosny Ibrahim Mohamed
Published: November 2024

Background

Despite advances in limb-salvage surgery, lower extremity amputation is still commonly required as an end result of the progression of arterial occlusive disease or failed arterial reconstruction. Furthermore, the increasing prevalence of diabetes has led to the appearance of more patients with foot complications leading to eventual lower extremity amputation.

Objective

To investigate the predictors and risk factors associated with wound complications after lower limb amputations in diabetic patients.

Methods

This is a prospective study, in which we follow up diabetic patients who went for lower limb amputation (AKA or BKA) and record the incidence of post operative wound complications. The study included 30 diabetic patients undergoing lower limb amputation in Ain Shams University hospitals, with postoperative follow up for 24 weeks, and the outcome measured is the incidence of post operative complication in relation to preoperative risk factors and predictors.

Results

Regarding the comparison between AKA and BKA it was found that patients who had BKA had higher rates of superficial SSI which were statistically significant (P < 0.05). While patients who had AKA had higher rates of pneumonia and mortality but not statistically significant (P > 0.05). Wound disruption, pulmonary embolism and MI were higher in patients who had BKA but was not statistically significant (P > 0.05). Regarding assessing predictors and risk factors for assessing post operative complications it was found that female gender, smoking and obesity (BMI >30) was statistically significant in assessing the risk factors (P value <0.05). Also regarding other predictors and risk factors of postoperative complication after the end of the study duration it was found that lower HGb levels (Anemia), Hct, ESR and CRP are considered predicators (P-value < 0.05). Other factors such as preoperative sepsis, emergency status and presence of infection were strongly related to post operative complication P-value 0.003 each (P-value < 0.05).

Conclusion

Surgical site infections (SSIs) following lower extremity amputations (LEAs) are a major cause of patient morbidity and mortality. The objectives of this study were to investigate the incidence of SSI and other wound complications after LEA in diabetic patients and to assess risk factors associated with SSI. This study found that below-the-knee amputation, smoking, obesity, emergency status, anemia, lower hematocrit and preoperative sepsis to be associated with SSIs.
Evaluation of the Role of MicroRNA-663a in Pediatric Lupus Nephritis
Authors: abdelaziz albostany Toulin , Tarek Marwa , Adel Sherihan , Imam Maha , El- Owaidy Rasha , Ahmed Manal Basyouni
Published: November 2024

Background and Aim

Lupus Nephritis (LN) is a serious manifestation of systemic lupus erythematous (SLE) with poor prognosis for pediatric patients resulting in high morbidity and mortality rates. MicroRNAs (miRNAs) are short, non-coding RNAs that serve as epigenetic modulators, affecting gene expression and influencing our understanding of disease causes and pathology. Thus, we sought to explore urinary expression of miR-663a in LN among SLE children.

Patients and Methods

The urinary miR-663a expression levels were estimated in cellular pellets from 15 biopsy-proven active LN patients and 15 healthy controls.

Results

LN patients had significantly higher urinary miR-663a expression levels compared to control group (p < 0.0001).

Conclusion

miR-663a could provide a specific noninvasive diagnostic and follow-up tool for LN patients.
Role of Two Dimensional Left and Right Ventricular Speckle Tracking Echocardiography in Early Detection of Chemotherapy Induced Ventricular Systolic Dysfunction
Authors: Fawzy Ahmed A , El-Menyawi Khaled A , Sallam Walid M , Zahran Mohamed E
Published: November 2024

Background

Cancer and cardiovascular diseases are the main causes of mortality worldwide. Although the incidence of cancer is rising, modern comprehensive management including surgery, chemotherapy and radiotherapy led to decreased mortality and prolonged survival, but also a large spectrum of cardiovascular complications. Since mortality from patients who develop heart failure secondary to chemotherapy is as high as 60% by 2 years. Early detection of subclinical Cancer Therapeutic Related Cardiac Dysfunction (CTRCD) is of utmost importance, conventional EF measurement fails to detect subtle changes in LV function, so a more sensitive tool is needed.

Objective

To detect early subclinical left & right ventricular dysfunction based on measurement of 2D LV & RV speckle tracking derived strain values.

Patients and Methods

The current study is a prospective study which included 101 asymptomatic female patients with newly diagnosed breast cancer who received anthracycline ± trastuzumab based chemotherapy regimen. A comprehensive echocardiographic examination was performed to all patients prior to receiving the chemotherapy (T0), at 3 months (T1) and at 6 months after (T2). All patients had pre- treatment normal LV EF. We aimed at studying the changes in LV & RV mechanics and detecting whether they can help in early prediction of cardiotoxicity. Cardiotoxicity was defined decrease in EF > 10% from baseline value to EF < 55% in asymptomatic patients or > 5% in symptomatic patients “as defined by the cardiac review and evaluation committee (CREC)”.

Results

The mean age of the study population was 48.75±10.07 years. CTRCD occurred in 24 patients (25.5%) with mean EF by Simpson`s method 59.29±3.50 % at (T0), 49.54±5.63% at (T1), 45.79±4.49% at (T2). While in non-CTRCD patients the mean EF was 60.21±2.80% at (T0), 59.13±2.53% at (T1), 58.29±2.63% at (T2). RV systolic function impairment (S`<10 cm/s) was more prevalent occurring in 37 patients representing 39.4% of the study population. By univariate and multivariate regression analysis LV GLS at (T1) (cut-off value <-15% with relative 12.5% reduction from the baseline value) was a strong predictor of CTRCD, but combining LV GLS with RV GLS & RV FWLS was the strongest (AUC=0.947, sensitivity=91.67%, specificity=90%).

Conclusion

Anthracycline ± Trastuzumab treatment leads to changes in LV & RV mechanics with more prevalent deterioration in RV values. Presence of lower LV & RV strain values at the base line together with reduction of these values after chemotherapy treatment both can predict later development of CTRCD. Combining LV GLS with RV GLS & FWLS values at (T1) is the strongest predictor of subsequent CTRCD.
Prevalence and Predictors of Trans Radial Approach Complications in Coronary Angiography and Percutaneous Coronary Intervention
Authors: Korraa Ahmed , Gamal Adel , Badran Haytham , Moussa Mohammed
Published: November 2024

Background

An increasingly popular approach for both diagnostic and interventional coronary procedures is the transradial approach (TRA). When compared to a transfemoral approach (TFA), (TRA)was found to lessen vascular complications. The most frequent and commonly silent transradial approach (TRA) complication is radial artery occlusion (RAO), which is followed by less serious vascular complications including hematoma and radial artery spasm.

Aim and Objectives

Evaluate the prevalence and predictors of complications of transradial approach (TRA) immediately after TR procedure and follow-up by radial artery doppler ultrasonography within 24 hours.

Subjects and Methods

This prospective registry observational study involved 250 patients who underwent either diagnostic coronary angiography, elective PCI, or primary PCI by TRA. It was carried out at Ain Shams University Hospitals and October 6 University Hospital.

Result

RAO, affected 20% of patients who underwent a TR procedure, which was the most frequent complication, followed by hematomas and spasms, each affected 8% of patients. It is noteworthy that none of the patients experienced hemorrhage, pseudoaneurysms, or AV fistula. Univariate and multivariate regression analysis revealed that, factors independently associated with TRA complications were patients in the age group (≥ 60 years old) (OR = 19.33, 95%CI: 9.09 to 41.11, P < 0.001) and female patients (OR = 2.67, 95%CI: 1.56 to 4.55, P < 0.001), and according to the periprocedural factors to be wrap closure by rolled gauze (OR = 15.17, 95%CI: 8.03 to 28.65, P < 0.001) and delayed time of compression release (OR = 2.97, 95%CI: 2.07 to 4.26, P < 0.001).

Conclusion

Older patients, female patients, lower BMI, longer procedure duration, more number of catheters used, wrap closure with rolled gauze, and delayed time of compression were the predictors of transradial approach (TRA) complications immediately following TR procedure and in the follow-up by radial artery Doppler ultrasonography within 24 hours. RAO, which affected 20% of patients who underwent a TR procedure, was the most frequent complication, followed by hematomas and spasms, each affected 8% of patients. It is noteworthy that none of the patients experienced hemorrhage, pseudoaneurysms, or AV fistula.
Evaluation of Right Atrial Function by 2D Speckle Tracking Echocardiography in Patients Undergoing Primary Percutaneous Coronary Intervention after Inferior ST Segment Elevation Myocardial Infarction
Authors: Mamdouh Mikhail , Karim Khalid , Missiri Ahmed El , Onsy Ahmed
Published: November 2024

Aim and Objectives

The aim of the study is to evaluate right atrial function by 2D speckle tracking echocardiography in patients undergoing primary percutaneous coronary intervention after inferior ST segment elevation myocardial infarction.

Patients and Methods

This study included 100 patients diagnosed with Inferior STEMI subdivided into patients with RV infarction (26 patients) and those without RV Infarction (74 patients) in the ER fulfilling the inclusion criteria compared to the Control Group (50 patients) of healthy individuals matched in the same age group with no history of acute coronary syndrome and no cardiovascular risk factors, these patients were assessed demographic data, risk factors, general examination, local examination, laboratory measure, ECG and full echocardiographic assessment including 2DSTE evaluation of the RA.

Results

In our study the results showed that RA strain during reservoir phase (RASr) and RA strain during conduit phase (RAScd) were reduced among the patients with inferior wall MI compared to the control group (P-value: <0.001), While RA strain during contractile phase (RASct) was preserved among the patients group (P-value: <0.001), Also RA total emptying fraction (RA EF) and RA total emptying volume (RA EV) were preserved among the patients group compared to the control group (P-value: 0.095, 0.062 respectively). Then we compared the patients with inferior wall myocardial infarction with RV infarction to the patients with no RV infarction, The results showed that RA strain during reservoir, conduit and contractile phases were preserved among the patients with RV infarction compared to those without RV infarction (P-value: 0.196, 0.118, 0.266 respectively), While RA EF and RA EV were significantly reduced among the patients with RV infarction compared to those without RV infarction (P-value: 0.029, 0.038 respectively), There was a positive correlation between RA EF with RV functions parameters as TAPSE (r: 0.377, P-value: <0.001), FAC (r: 0.425, P-value: <0.001), Also There was a positive correlation between RA EV with RV functions parameters as TAPSE (r: 0.239, P-value: 0.017), FAC (r: 0.378 P-value: <0.001)

Conclusion

RA strain during reservoir phase (RASr) and RA strain during conduit phase (RAScd) were significantly lower in patients with inferior wall myocardial infarction compared to the control group, while RA strain during contractile phase (RASct),RA Emptying Fraction (RA EF) and RA Emptying Volume were preserved among the patients with inferior wall myorcardial infarction compared to control group. Patients with inferior wall myocardial infarction with RV infarction have lower RA emptying fraction (RA EF) and RA emptying volume than those without RV infarction.
Ablation Targets of Scar-Related Ventricular Tachycardia Identified by Dynamic Functional Substrate Mapping
Authors: Gamal Elewa Mohammad , Altoukhy Sherif , Abdelfattah Badran Haitham , Eldamanhoury Hayam , Kamel Zarif John
Published: November 2024

Background

Dynamic functional substrate mapping of scar-related ventricular tachycardia offers better identification of ablation targets with limited number of ablation lesions. Several functional substrate mapping approaches have been proposed, including Decrement-evoked potential (DEEP) mapping. The aim of our study was to compare the short and long term efficacy of a DEEP-guided strategy versus that of a fixed-substrate strategy for the ablation of scar-related ventricular tachycardia (VT).

Methods

In this single-blind randomized trial, forty consecutive patients presenting for ablation of scar-related VT were randomized to either a DEEP-guided or a substrate-guided ablation strategy. Late potentials were tagged and ablated in the non-DEEP group, while those in the DEEP group were subjected to RV extrastimulus pacing after a drive train. Only potentials showing significant delay were ablated. Patients in both groups were followed for a median duration of 12 months.

Results

Twenty patients were allocated to the DEEP group while the other 20 were allocated to the non-DEEP group. Twelve patients (60%) in the DEEP group had ischemic cardiomyopathy versus 10 patients (50%) in the non-DEEP group (P- value 0.525). Intraoperatively, the median percentage of points with LPs was 19% in the DEEP group and 20.6% in the non-DEEP group (P-value 1). The median percentage of LPs demonstrating DEEP was 5.8% for the DEEP group which is much higher than the total number of LPs in the same group (P value 0.00). VT non-inducibility was successfully accomplished in 16 patients (80%) in the DEEP group versus 17 patients (85%) in the non-DEEP group (P value 0.597). After a median follow up duration of 12 months, the VT recurrence rate was 65% in both groups (P value 0.311) with a dropout rate of 10% in the DEEP group. As for the secondary endpoints, all-cause mortality rates were 20% and 25% in the DEEP and non-DEEP groups respectively (P-value 0.342).

Conclusion

DEEP-assisted mapping and ablation of scar-related ventricular tachycardia is a feasible strategy with comparable short and long term outcomes to a fixed- substrate-based strategy with more specific ablation targets. Further large-scale randomized trials that integrate recent mapping technologies with novel functional substrate mapping protocols are recommended to improve ablation outcomes.
Impact of Prosthesis Oversizing on Clinical Outcomes of Trans Catheter Aortic Valve Implantation Using Self Expandable Evolute R Valve
Authors: Elnwagy Mohamed Moustafa , Barka Mahmoud Mohamed , Saber Hafez Mohamed , Kamal Diaa , Mostafa Ahmad E , Elsayed Maiy Hamdy
Published: November 2024

Background

Transcatheter Aortic Valve Implantation (TAVI) has a growing target population after being indicated even in low-surgical-risk patients with severe symptomatic aortic stenosis. However, postoperative short- and long-term outcomes can be compromised due to para-valvular leakage (PVL). A lot of manoeuvres have been investigated to decrease this partially avoidable operational hazard. Oversizing is a main technique to decrease the PVL, despite being itself a risky procedural step. Many studies have been conducted to identify the optimum degree of oversizing. However, studies about oversizing by more than 20% are less frequent.

Objectives

In this study, we are trying to prove the safety and efficacy of oversizing equal to or more than 20%. Avoiding new-onset conduction disturbance, coronary encroachment, annular injury, and decreasing the PVL were our primary end points. Our secondary end point was to find predictors for new-onset conduction disturbance and para-valvular leakage in a specific low-risk population.

Methods

We initially included 209 patients who underwent TAVI using self-expandable valves. 66 patients were excluded because of the baseline conduction disturbance and lack of sufficient data, so 143 patients, 60 (42.0%) females and 83 (58.0%) males, were enrolled in our study as two groups: Group A included 97 patients with an oversizing index (OI) of less than 20%, and group B included 46 patients with an OI of 20% or more. We conducted a new technique for more accurate measuring of the OI in the context of the implantation depth, and our patients were categorized using this technique. The study was done retrospectively for 49 patients and prospectively for the rest of the patients.

Results

Our findings have met our primary end point in terms of the safety and efficacy of extreme oversizing. There was no significant difference between both groups in terms of new-onset conduction disturbance (NOCD), with zero cases of annular rupture or coronary encroachment. In terms of efficacy There was zero percent of significant PVL (grade 2 or more) in the extreme oversizing group versus 14.4% of significant PVL in the other group (P value 0.007). The ROC curve found that the minimum depth of implantation-derived oversizing (DIDO) to predict no significant PVL was 17%.

Conclusion

In a matched cohort, the depth of implantation can affect the degree of oversizing, especially in the larger valve sizes, as the deeper we implant the valve, the less than expected the degree of oversizing is in traditional methods of calculation. In the absence of severe LVOT calcification, the optimum index of the depth of implantation-derived oversizing (DIDO) is at least 17% to prevent significant PVL.
Effect of Atrial High-Rate Episodes (AHRE) on the Response to Cardiac Resynchronization Therapy (CRT) in Heart Failure Patients with Reduced Ejection Fraction (HFrEF)
Authors: Mahmoud Youssef , Altoukhy Sherif , El-Damanhoury Hayam , Cardiology Lamyaa Allam
Published: November 2024

Aim and Objectives

To evaluate the burden and impact of AHRE on the functional capacity and quality of life of HFrEF patients treated with CRT.

Patients and Methods

This study included a group of 100 HFrEF patients treated with CRT who came for regular follow up at electrophysiology clinic. Device interrogation was done to assess the burden of AHRE, followed by assessment of functional capacity using the standard 6-minute walk test and assessment of quality of life using the Minnesota living with heart failure questionnaire.

Results

There was no statistically significant correlation between AHRE prevalence and distance walked during 6MWT, however, when compared to the distance expected for an equivalent healthy individual, there was a highly statistically significant difference (82.02±17.22% in non-AHRE group vs. 75.15±15.78% in AHRE group, P-Value <0.001). As regards the quality of life, there was a statistically significant correlation between the prevalence of AHRE and the total MLHFQ score (mean score of 36.97±7.76 in non-AHRE group vs 46.76±9.82 in AHRE group, P-value 0.032), however there was no statistically significant correlation with QoL class (28.8% poor QoL in non-AHRE group vs 50% in AHRE group, P-value 0.09).

Conclusion

AHRE is associated with a significant decline in functional status and perceived quality of life in HFrEF patients treated with CRT. Presence of AHRE longer than 5 minutes during CRT interrogation at least 6 months after implantation was associated with a poorer performance on 6MWD as well as a higher MLHFQ score denoting a decline in perceived quality of life.
Different Strategies in Management of Deep Sternal Wound Infection
Authors: Ammar Ayman Mahmoud , Helmy Ali Ahmed , Hikal Tamer Shahat , Ibrahim Ibrahim Anas
Published: November 2024

Background

The consequences of Deep Sternal wound infection (DSWI) can be catastrophic with increased morbidity and mortality, and decreased life expectancy, so one must have a low threshold for diagnosis and a clear management algorithm. Several approaches to the treatment of DSWI have been described, with no real consensus as to the single best specific treatment methodology. This study will compare the outcome of different strategies in management of deep sternal wound infection.

Objective

To systematically review the outcome after different methods in management of deep sternal wound infection. To compare between outcome data of different methods in management of deep sternal wound infection.

Materials and Methods

We prepared this systematic review with a careful following of the Cochrane Handbook for Systematic Reviews of Interventions. We also adhered to The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines during the design of our study.

Results

We obtained 98 articles from PubMed, 161 articles from Scopus, 0 article from Cochrane library and 122 from web of science. 141 duplicated articles were removed using Endnote X8 program (Thompson Reuter, USA), 240 articles manually underwent titles and Abstracts screening and 107 articled underwent full-text review.

Conclusion

Ten studies with a total number of 940 patients who underwent treatment with either traditional surgery or VAC for management of DSWI, the mean age of included cases was around 70 years old, with nearly equal distribution of male and female gender. The pooled estimate of meta-analysis showed there is no statistically significant difference between both groups regarding length of hospital stay (MD = 3.44, 95%CI = [-8.47, 15.35], or length of ICU admission (MD = 0.29, 95%CI = [-3.66, 4.23], there is no statistically significant difference between both groups regarding survival outcomes on the short term (30-day mortality, 90-day mortality and hospital mortality), mid-term (one year mortality and one year survival) and long term (two and five years survival), (OR = 1.63, 95%CI = [0.07, 37.1]), (OR = 0.40, 95%CI = [0.07, 2.11]), (OR = 1.61, 95%CI = [0.57, 4.52]) and (OR = 1.75, 95%CI = [0.64, 4.79]) respectively. No significant difference between either group regarding treatment failure, reoperation rate nor recurrent sternal fistulas (OR = 0.58, 95%CI = [0.01, 38.52]), (OR = 0.91, 95%CI = [0.23, 3.57]), (OR = 0.91, 95%CI = [0.23, 3.57]) respectively. On the other hand, VAC showed a significantly lower infection rate in comparison with surgery (OR = 0.26, 95%CI = [0.13, 0.55]).
Assessment of Atypical Pneumonia by Chest Ultrasonography
Authors: Sayed Ahmed Sameh , Ahmed Mona Mansour , Wagih Khaled Mohamed , Diab Haytham Samy , Hussein Ahmed Mohamed
Published: November 2024

Background

Patients who get infected with pneumonia exhibit similar clinical presentations despite having different causative organisms; thus, a rapid and easy test is needed to differentiate between the diseases. Here, we use lung ultrasound to discriminate between causative organisms in correlation with other diagnostic modalities.

Methods

This descriptive cross-sectional study was carried out on 67 patients diagnosed with atypical pneumonia admitted at Ain Shams university hospitals in the period from July 2019 to June 2021. Study population was divided into three groups according to the causative agent based on the results of PCR: Group 1 included 23 patients (Influenza A), Group 2 included 30 patients (COVID-19) and Group 3 included 14 patients (Atypical organisms). Included patients underwent lung ultrasound scan via a 12-zone scanning protocol and CT scan with 24 hours in between. The present study was approved by the ethical committee at our institution.

Results

The mean age ranged from 39.93 ± 19.26 SD to 60.3 ± 13.02 SD years, 64.17% of them were males. There was also a highly statistically significant difference between the three groups as regard B-lines and thickened pleural line being higher among group 2, 100% of cases had b-lines in their chest ultrasound assessment while thickened pleural line was found in 53.3% of cases. Dynamic air bronchogram was found with higher percentage in group 3 (71.4%) with a highly significant association. Higher mean Soldati score was associated with more severe disease among cases with viral pneumonia.

Conclusions

Lung ultrasound may be used as an aiding tool to estimate the etiology of atypical pneumonia. It can be useful during pandemics of acute respiratory diseases for rapid triage and stratification of patients as through calculation of modified Soldati score and detection of the most common finding. Also modified Soldati score can correlate with disease severity.
Study of Smoking Habit in Healthcare Workers in Police Academy Hospital
Authors: Abozahra Asmaa K E A , Ahmed Noha O , Mohamed Yasser M , El Naggar Taher A
Published: November 2024

Introduction

The act of smoking involves burning a substance and tasting or inhaling the smoke. More than 5 million fatalities worldwide each year are related to tobacco usage. Prevalence of tobacco use in healthcare workers (HCW) is influenced by country income level, occupation, and sex that enlightened us that this group of people uses tobacco is seriously unnoticeable area.

Aim

Aim of this work is to study the smoking habit among 110 male healthcare workers in police Academy hospital and their trend to quit.

Patients and Methods

Every participant in this study was subjected to full history taking, clinical examination, smoking questionnaire and chest X-ray for patients with respiratory symptoms.

Results

Starting smoking is at age ranging from 14 to 40 years with mean of 20.97 years. Age of participants ranged from 19 to 55 years with mean of 30.92 years All studied participants were current cigarette smokers. On asking participants about how they accept being smokers, 46.4% of them saw that smoking is acceptable. All participants agreed with discouraged picture on packs. There is statistically non-significant relation between previous attempts for smoking and either level of craving, smoking if ill or cannot stop smoking despite severe illness.

Conclusion

Healthcare professionals at Police Academy Hospital frequently smoke cigarettes, and this habit often develops at a young age mostly as a result of social influence. Health issues and financial concerns were the main factors that prompted them to try quitting, as the majority of them spend a sizeable portion of their monthly income on cigarette
The Effect of COVID-19 Vaccines (Available in Egypt) on D-Dimer and Platelets Count in Kafr El-Sheikh Governorate
Authors: Fayez Botros Demiana Medhat , Mohamed Abd El Fattah Nevine Mohamed , Mohamed Mahmoud Mokhtar
Published: November 2024

Background

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, led to the development of various vaccines, including mRNA (Pfizer, Moderna), vector (AstraZeneca, Johnson & Johnson), and inactivated virus (Sinopharm, Sinovac) types. Although generally safe, rare cases of thromboembolic events associated with vector vaccines have been reported. Governments, like Egypt, prioritize vaccine distribution. Common side effects include mild reactions, and overall, vaccines play a crucial role in mitigating the pandemic.

Aim of the Work

This study in Kafr El Sheikh, Egypt, investigates the effects of COVID-19 vaccines on D-dimer levels, platelet counts, and various short-term complications, including general, local, and chest-related issues.

Patients and Methods

A cross-sectional study at Kafr El Sheikh Chest Hospital involving 88 participants above 18 years assessed the impact of AstraZeneca and Pfizer COVID-19 vaccines. It included medical history, clinical examination, and laboratory investigations, with ethical approval and minimal risks. Statistical analysis utilized SPSS version 20, presenting qualitative and quantitative data. The study found significance at p < 0.05.

Results

This Kafr El Sheikh study on 88 individuals receiving AstraZeneca and Pfizer COVID-19 vaccines found no significant differences in D-dimer, platelet counts, or chest symptoms between the two groups. AstraZeneca was associated with higher constitutional symptoms, while Pfizer resulted in more pain at the injection site. Overall, both vaccines demonstrated safety.

Conclusion

This study concludes that the second doses of AstraZeneca and Pfizer COVID- 19 vaccines show similar safety profiles regarding D-dimer, platelet counts, and symptoms. Both vaccines demonstrate overall safety and efficacy, supporting their continued use in mitigating the impact of the pandemic.
Effect of Tocilizumab and Remdesivir on the Outcome of Patients with Covid 19 Pneumonia Admitted to Alabbasia Chest Hospital ICU
Authors: Tag Eldin Mohammed Awad , Abd Elhamid Mahmoud Mohammed , Mohammed Attia Habiba Fawzy
Published: November 2024

Background

Coronavirus is one of the major pathogens that primarily targets the human respiratory system. Previous coronaviruses outbreaks of (CoVs) include the severe acute respiratory syndrome (SARS)-CoV and the Middle East respiratory syndrome (MERS)-CoV which have been considered as great public health threat.

Aim of the Work

This study aimed to find Effect of Tocilizumab and Remdesivir on the outcome of Patients with Covid 19 Pneumonia Admitted to Alabbasia Chest Hospital ICU.

Patients and Methods

This retrospective observational study was conducted on 90 cases of COVID 19 patients admitted to Respiratory Intensive Care Unit (RICU) in Abbassia Chest Hospital during the period between January 2021 to June 2021 and all the cases were subjected to full history taking, laboratory investigations and radiological assessment with chest x-ray and computed tomography.

Results

This current study showed that there was no statistically difference in the need of mechanical ventilation beween the patients who received Tocilizumab, the patients who received Remdisivir and the patients who received standard treatment. This study found that there was no statistically difference in the number of days on mechanical ventilation when it happened beween the patients who received Tocilizumab, the patients who received Remdisivir and the patients who received standard treatment. This current work showed that there was no statistically difference in the total length of staying at ICU beween the patients who received Tocilizumab, the patients who received Remdisivir and the patients who received standard treatment. This study revealed that there was no statistically difference in the final outcome beween the patients who received Tocilizumab, the patients who received Remdisivir and the patients who received standard treatment. This work showed that there was no statistically difference in the cause of death when happened beween the patients who received Tocilizumab, the patients who received Remdisivir and the patients who received standard treatment. These results could be attributed to the small sample size included in the current study which could affect the statistical significance level.

Conclusion

From this study we concluded that there was no statistically significant difference in the need of mechanical ventilation, number of days on mechanical ventilation, total length of staying at ICU, final outcome, and cause of death when it happened between the patients who received Tocilizumab, patients who received Remdisivir and the patient who received standard treatment.