bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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&gt;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

Abstract

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) &gt; 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) &gt; 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

Abstract

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

Abstract

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

Abstract

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 &lt; 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&gt; -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 &lt; 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 .