bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-invasive Hemodynamic Monitoring in Prediction of the Outcome and Prognosis in Sepsis
Authors: Zaki M S M , Kassem A A A , Mohamed R H A , Guirguis N N M 
Published: May 2020

Abstract

Background
Complex disease syndromes such as sepsis require multimodal diagnostic and therapeutic approaches. Besides the diagnosis of septic shock and early causal therapy, one major challenge in its treatment remains the resuscitation and management of cardiocirculatory and respiratory dysfunction. As Pulmonary artery catheterization poses significant risks and requires specialized training. Technological advances allow for more readily available, noninvasive clinical measurements of hemodynamics. Impedance cardiography (ICG) offers the potential for safe, noninvasive hemodynamic monitoring that can be easily applied.

Objective
To evaluate the effect of cardiac index, mean arterial blood pressure, heart rate, and oxygen delivery as measured noninvasively by impedance cardiography (ICG) in prediction of the outcome and prognosis in sepsis.

Patients and Methods
This is a prospective, observational convenience trial of patients presenting to the ED or the ICU with severe sepsis or septic shock. The patients were part of a cohort that was followed at day 1, day 3 and day7, or until hospital discharge or in-hospital death. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Oral informed consent is obtained from the patient or designated surrogate before data collection begins.

Results
Twenty-three were enrolled; three were excluded due to an inability to complete data acquisition. The mean cardiac index in nonsurvivors (2.3 L / minÆm2, 95% CI = 2.1 to 2.6) was less than that for survivors (3.3, 95% CI = 2.9 to 3.5). Oxygen delivery as well as lactate were less in non-survivors group. A cardiac index of &lt; 2.5 L / minÆm2 had a sensitivity of 43% (95% CI = 18% to 71%), specificity of 93% (95% CI = 80% to 95%), for predicting in-hospital mortality.

Conclusions
Early, noninvasive measurement of the cardiac index in critically ill severe sepsis and septic shock patients can be performed in the ED for those who meet criteria for EGDT. There appears to be an association between an initial lower cardiac index as measured noninvasively and in-hospital mortality.
Effect of Aging on the Cornea of Male Albino Rat and Possible Therapeutic Role of Royal Jelly
Authors: Elareny H R , Ahmed A I , Alneklawy A F , Tawfik M K 
Published: May 2020

Abstract

Introduction
Nowadays interest in aging has greatly increased, Aging is a complex natural process involving every molecule, cell, and organ in the body that is associated with tissue dysfunction in many organs. Aging of the cornea causes major eye effects and leads to substantial cost in medical and social terms. These effects include the highly prevalent dry eye disease (DED) that affects both visual function and quality of life in elderly. Symptoms of (DED) include, ocular pain, visual disturbances, and increase lacrimation. Functional foods such as Royal jelly (RJ) have a growing attention because of consumers increasing concerns about their health. Its importance not only for its nutritional properties but also for its functional and biological properties such as antioxidant, anti-inflammatory, antibacterial, antiviral, and anti-ulcerous activities. It is used as a cheap natural source in daily life and medicine. (RJ) is a complex substance composed of proteins, sugars, lipids, amino acids, vitamins, and minerals.

Aim
The present study aimed to investigate the histological effect of aging on the cornea of male albino rat and possible therapeutic role of (RJ) on senile group.

Materials and Methods
Twenty-four male albino rats were used in this study divided into Group I: consisted of 6 adult male rats aged 3- 6 months. Group II: consisted of 18 senile male rats aged 18-24 months, were further subdivided into three subgroups as follows: Group II A: (n = 6) negative control senile rats, not subjected to any procedure for 4 weeks. Group II B: (n = 6) control senile rats and were given distilled water by oral gavage once daily for 4 weeks. Group II C: (n = 6) senile rats were given (RJ) by oral gavage dissolved in distilled water once daily for 4 weeks. At the end of the experiment, rats were sacrificed after being deeply anesthetized with ether according to the protocol of the Committee of Animal Research Ethics (CARE). The cornea of each animal was carefully dissected out after death and immediately fixed in 10% formalin for preparation of paraffin blocks 5 micrometer thickness. Sections were stained with hematoxylin and eosin (I-I&E), Masson's trichrome and periodic acid-Schiff (PAS). Statistical analysis and quantitative morphometric study were done.

Results
Light microscopic examination of corneas of senile rats revealed different pathological changes included irregularity in the surface epithelium as well as surface erosions and cytoplasmic vacuolations. The stroma showed widely separated collagen fibers with decreased keratocyte density. It was concluded that (RJ) supplementation to senile rats obviously unproved all layers of the cornea histologically.
Minimally Invasive versus Conventional Approach for Mitral Valve Surgery
Authors: ElKerdany A B , Elghanam M A , Gamal M A , Abdelmoneim T M E 
Published: May 2020

Abstract

Introduction
Full median sternotomy has been well established as a standard approach for all types of open heart surgery for many years. Although well established, the full sternotomy incision has been frequently criticized for its length, post operative pain and possible complications. Minimally invasive mitral valve surgery can be an appealing feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. We here made meta-analysis to compare perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease.
Methods A systematic review of studies comparing perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease, from 2012 up to 2017. Review Manager 5.2 (Cochrane Collaboration) was employed to analyze the results. The outcomes of interest are mortality, cerebrovascular accidents, wound infection, reexploration due to bleeding, and LVEF assessment post-surgery.
Results 12 studies involving 10279 patients were included in the meta-analysis. The 30-day mortality was significantly decreased with MIMVS; 1.6% in the MIMVS group and 2.9% in the group treated through a conventional sternotomy. Cerebrovascular events were significantly decreased with MIMVS; the stroke rate was 0.9% in MIMVS patients and 3% in patients treated via a conventional sternotomy. Wound infections, reexploration due to bleeding, and LVEF did not differ significantly between both groups.
Conclusion The perioperative outcome is more or less similar for minimally invasive mitral valve surgery and conventional mitral valve surgery performed via median sternotomy. Given balance in outcomes, MIMVS is at least as safe as the standard approach and can be considered a routine and standard approach for mitral valve surgery.
Correlation between Atherogenic index and the severity of coronary artery disease in diabetic patients undergoing elective coronary angiography using Gensini score
Authors: Elyamani A S , Elnozahi M A , Abdelmoteleb A M 
Published: May 2020

Abstract

Background
Dyslipidemia is one of the most important factors for CAD. Atherogenic index of plasma (AIP) is a new indicator involved in dyslipidemia. However, its relation with CAD severity in diabetic patients is not well established yet.

Aim of the Study
To study the relationship between atherogenic index of plasma and severity of coronary artery disease (CAD) in the diabetic patients.

Methods
Our study was conducted on 150 diabetic patient with stable CAD undergoing elective coronary angiography in Al-Agoza Hospital from april 2016 to august 2018. Atherogenic index was calculated from the logarithmically transformed ratio of concentrations of TGs to HDL-C obtained from the patient’s lipid profile. correlation of the AIP and the severity of CAD according to Gensini scoring system was done.

Results
AIP had a statistically significant positive relation with IDDM (p = 0.033), NIDDM (p = 0.033), HTN (p = 0.024), dyslipedemia (p = 0.042). And a highly significant positive correlation with FBS (p &lt; 0.001, r = 0.479) and HbA1c (p &lt; 0.001, r = 0.538), proximal LAD lesions (p = 0.002), LCX (p &lt; 0.001), and the number of vessls affected (p = 0.005). AIP Also had a highly significant positive correlation with severity of CAD in terms of Gensini score (p &lt; 0.001, r = 0.692).

Conclusion
AIP is considered a good predictor of CAD severity and multivessel affection in diabetic patients.
Impact of Admission Glycated Hemoglobin on Angiographic Characteristics and Short Term Clinical Outcomes of Non-diabetic patients with Acute ST Elevation Myocardial Infarction
Authors: Elabd A A I , Helmi H G M , Alfiky E M A , Bassily R A Y 
Published: May 2020

Abstract

Background
Coronary artery disease is the most important cause of death in industrialized countries. Diabetes mellitus is one of the most important modifiable risk factors of coronary artery disease. It increases the risk of coronary artery disease by 2 to 4-fold. Interestingly, this increased risk is not confined to patients with DM, but non-diabetic patients with impaired glucose tolerance (IGT) also may have an increased incidence of cardiovascular complications. Moreover, increased admission glucose levels may be related to a higher mortality rates in patients with acute myocardial infarction (AMI), regardless of diabetic status.

Objective
To assess the prognostic impact of admission HbA1c in patients without known diabetes mellitus who were admitted with acute ST elevation myocardial infarction, on outcome of 1ry PCI and short-term outcome of adverse cardiac events.

Material and Methods
This is an observational, this study was conducted at Coronary care unit & coronary catheterization lab unit of cardiology department in Ain Shams University & specialized hospitals. The study period was 6 months (From 1-9-2018 till 1-3-2019).

Results
100 patients without prior diagnosis of DM were included in our study population Three categories of patients were created according to HbA1c level: Group 1 (&lt; 5.7%): 46 patients (46%); Group 2 (5.5 to 6.4%): 38patients (38%); Group 3 (&gt;6.5%): 16 patients (16%).
Baseline characteristics of the study population are shown in Table 1.
The mean age of our sample was 55.06 ± 11.73 years and 96% were males.
There was highly statistically significant difference found between DM groups regarding SYNTAX score with P-value (0.002) & another highly significant difference in EF between the 3 groups.

Conclusion
The present study showed that admission higher HbA1c level in non-diabetic patients presented by acute STEMI is associated with more severe CAD, lower rate of complete revascularization TIMI 3, and higher incidence of adverse cardiac events and mortality. Introducing measurement of HbA1c in the CCU seems to be a simple method to obtain important information on mortality risk.
Echocardiographic Assessment of Aortic Pulse Wave Velocity as a New Diagnostic Parameter for Left Ventricular Diastolic Dysfunction
Authors: Ammar M A S , Elshazly A M , Ismail M F , Helmy H G M 
Published: May 2020

Abstract

Background
The association between increased arterial stiffness and Left ventricular (LV) diastolic dysfunction (DD) has been well characterized, suggesting a close interaction between the arterial system and the left ventricle. Aortic pulse-wave velocity (PWV) is a measure of aortic stiffness, and it has an established prognostic role in cardiovascular diseases and in the general population.

Aim
Evaluation of aortic PWV assessed by echocardiography as a new diagnostic parameter for LV DD by correlation with current echocardiographic LV DD indices, and also evaluation of aortic PWV prognostic value in patients with DD by correlation with Brain natriuretic peptide (BNP).

Methods
This study was conducted at Ain-Shams and Helwan University hospitals from December 2017 to December 2018. It included 100 subjects aged from 55 to 60 years; they were divided into two groups, 1st group (case group): 80 patients with asymptomatic LV DD with preserved ejection fraction ≥50%, 2nd group (control group): 20 patients with normal diastolic function. All patients were subjected to full history and thorough physical examination. BNP, ECG and full echocardiography with assessment of aortic PWV were done.

Results
A total of 100 patients were enrolled, 38 (47.5%) males in case group vs. 9 (45%) in control group. Hypertension, diabetes and dyslipidemia were significantly higher in case vs. control (P-values: &lt;0.001, 0.005, 0.002 respectively). Aortic PWV has significant positive correlation with both age and body mass index (r = 0.422, r = 0.847 respectively with P &lt; 0.001 for both). Aortic PWV has significant positive correlation with E/e’ (r = 0.957, P &lt; 0.001), tricuspid regurge velocity (r = 0.941, P &lt; 0.001), and left atrial volume index (r = 0.947, P &lt; 0.001), but it has significant negative correlation with septal e’ (r=-0.970, P &lt; 0.001) and lateral e’ (r=-0.932, P &lt; 0.001). Aortic PWV has significant positive correlation with plasma BNP level (r = 0.958, P &lt; 0.001). Aortic PWV was significantly higher in case vs. control group with mean values (15.5±1.32 vs. 10.11±0.78 m/s respectively; P &lt; 0.001). The area under the ROC curve for aortic PWV to detect DD was 0.86 (95% CI, 0.76–0.98; P &lt; 0.001) and the optimal cutoff point of 12.5 m/s produced 92.3% sensitivity and 75.0% specificity (the positive and negative predictive values were 93.5 and 72.7%, respectively with an accuracy of 89.0%).

Conclusion
Echocardiographic assessment of aortic PWV appears not only to be a highly sensitive, reliable, easy, rapid and practical parameter for LV DD detection but also has a promising prognostic value in patients with LV DD.
Demographic data and predictors of acute myocardial infarction in Egyptian young adults
Authors: Halim M M , Kamal D A , Onsy A M , Rayan M M 
Published: May 2020

Abstract

Background
Myocardial Infarction carries a significant morbidity, psychological effects, and financial constraints for the patient and the family when it occurs at young age. However there is limited data on the clinical features of young adults with AMI in Egypt and the Middle Eastern region. We therefore sought to investigate the clinical profile, risk factors and angiographic variables of this age group in Egypt.

Aim of the Work
To determine the clinical profile and prevalence of different risk factors including Cigarette Smoking, Tramadol use, Cannabis smoking, HDL & LDL levels, stressful lifestyle and bad sleeping habits in Egyptian patients presented with Myocardial Infarction for the first time at age ≤45 years.

Methods
We conducted a cross sectional observational study on 106 consecutive patients aged ≤45 years admitted with 1st time myocardial infarction in the period between February 2018 and August 2018 at Ain Shams University, Egypt. Clinical, and Angiographic variables were recorded from all patients.

Results
Out of 1207 patients admitted with 1st time MI, 106 were young that gave a prevalence of 8.8% in our center. Out of 106 patients, 101 were male. Mean age was 39.19 yrs. 71 patients had ST elevation myocardial infarction (MI) (67%) and 35 had non ST elevation MI (33%). Anterior wall MI was present in 49 patients (46.2%), inferior wall MI in 20 patients (18.9%) and lateral wall MI in 2 patients (1.9%). 93 patients (88%) were smokers, 31 patients (29.2%) were Tramadol users, 43 patients(40.6%) smoked cannabis, 50 patients (47.2%) had bad sleeping habits, 29 patients (27.4%) had high stress levels, 37 patients (34.9%) were hypertensive, 22 patients were diabetic (20.8%). Family history of CAD was present in 20 (18.9%) patients. Low High-density lipoprotein (HDL) was seen in 47 patients (44.3%), and high Low-density lipoprotein in 20 patients (18.9%). LAD was involved in 56% of patients, with a significant association between Tramadol use and LAD involvement. We found significant association between both Tramadol use and Cannabis smoking and the presence of Heavy thrombus burden in Coronary Angiography.

Conclusion
AMI in the young almost exclusively occurs in male, Anterior wall MI is most common, with LAD being involved in around half of patients. Smoking, hypertension, low HDL, Tramadol use, Cannabis smoking, and bad sleeping habits are the major risk factors. Tramadol use was associated with significant affection of LAD. Tramadol use and Cannabis smoking were associated with high thrombus burden on coronary angiography,
Value of 3D Rotational Angiography in Congenital Heart Diseases
Authors: Amin Y M , Ezzeldin D A , Roshdy A M , Atteya H M , Elsayed M H 
Published: May 2020

Abstract

Background
Cardiac catheterization continues to be the gold standard in the management of CHD because of its diagnostic accuracy and therapeutic advantages. Among the recent advances in cardiac catheterization is the use of 3DRA which has been introduced in CHDs nearly 10 years ago after its long use in neuroradiology with good outcomes.

Objective
The aim of this work is to describe our initial experience with rotational angiography at Ain Shams University and compare between conventional and rotational angiography in terms of contrast, radiation and procedure time.

Patients and Methods
The study included 100 patients presenting to Ain Shams University Hospital pediatric cath lab in the period between February 2017 and July 2018. Fifty patients underwent rotational angiography (RA) and 50 underwent conventional angiography. The 2 groups were matched regarding age, sex, weight, diagnosis and the procedure performed.

Results
The median age in the study was 4 years with a median weight of 15.5 kg. The study included 44 patients with PDA, 42 (95%) underwent PDA closure. 30 patients had PS of which 28 underwent BPV (93%). 8 patients had CoA, 6 had CoA balloon +/- stenting (75%). 12 patients were postGlenn, 2 had TOF, 2 had AS and 2 had history of TOF repair with either RPA or LPA stenosis. Diagnostic quality imaging was obtained in 74% of cases. The RA cases were divided into earlier and later groups which were compared with each other and with the conventional angiography group. The procedure time decreased significantly in the later RA cases (38 minutes compared to 49 minutes in earlier cases) but was still significantly more than the conventional angiography group (33 minutes). Total contrast decreased in later cases (3.56 ml/kg) but was still more than conventional angiography cases (2.55 ml/kg). Less DAP was needed in later RA cases than earlier cases and conventional cases (10 Graycm2, 24 Graycm2 and 16 Graycm2 respectively). The more procedure time in RA group can be explained by the time lost in preparing the room for 3DRA and processing of the reconstructed image. The more contrast is related to the routine use of biplane in conventional group and the simplicity of procedures involved in our study requiring little contrast and fewer injections in conventional angiography.

Conclusion
RA can be safely performed in diagnostic and interventional cases for better visualization of extra cardiac structures with significant reduction of radiation exposure on the expense of some more time and contrast. RA requires time to master it in a way that makes it a valuable additional tool in the cath lab.
Image quality and attenuation values of multidetector CT coronary angiography using high iodine-concentration contrast material: A comparison of the use of iopromide 300 and iopromide 370
Authors: Darwish A K M , Farouk M M , Hafez H , Adel A 
Published: May 2020

Abstract

Background
Iodine concentration is one of the main determinants of arterial enhancement in CTA, and current low-osmolar and iso-osmolar nonionic CM for intravascular administration still come in a handful of molecules, but a relatively wide range of different iodine concentrations. This gives the opportunity to optimize CTA protocols as a function of several factors such as patient characteristics, CT technology, and CM features in an attempt to maximize the diagnostic yield of CTA examinations while considering patient safety and avoiding unnecessary extra costs.

Objective
To compare image quality and attenuation values of multidetector CT coronary angiography (MDCT) between iopromide 300 and iopromide 370 and to evaluate whether the higher iodine contrast material has better image quality or not.

Material and Methods
Patients were prospectively enrolled and were randomized into two groups (group A, 30 patients received iopromide 300, iodine flux 1.2g I/s; group B, 30 patients received iomeprol 370, iodine flux 1.48g I/s). CT attenuation values were measured in the proximal end coronary arteries,ascending aorta and main pulmonary artery. The image quality of 15 coronary artery segments was graded by cardiologist in consensus with the use of a four-point scale (1 excellent enhancement to 4 poor enhancement). Non-parametric statistical approaches were used to compare the two groups.

Results
No statistically significant differences were found between the mean attenuation values (302 HU for iopromide 300 and 326 HU for iopromide 370, P = 0.175) in the coronary arteries in the two groups. The mean attenuation value of the proximal ascending aorta (AA)and main pulmonary artery (MPA) was found to be 345+/-63 HU and 241+/- 89 in group A respectively, whereas the mean attenuation value in proximal ascending aorta and main pulmonary artery in group B was found to be 348+/-74 and 238+/- 50 respectively. No significant difference was found between iopromide 300 and iopromide 370 in terms of contrast enhancement at the level of great arteries, P value AA = 0.826 and P value for MPA = 0.884. 92.9% of coronary arterial segments got score (range 1–2) in group A whereas 93.6 of coronary arterial segments got score (range 1-2) in group with no statistically significant difference P value = 0.755.

Conclusion
With the current CT technology iopromide 300 is not inferior to iopromide 370 in terms of coronary artery attenuation values and image quality. Iopromide 300 provides similar enhancement of coronary arteries and excellent image quality as compared with iopromide 370 using identical amount of total iodine with fewer cost and less estimated adverse effects owing to low iodine concentration of iopromide 300.