bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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 &lt;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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &lt; 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

Abstract

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.
Plasma Fibrinogen as a Biomarker for Mortality and Hospitalized Exacerbations in People with COPD
Authors: Abd El Hameed Karim Hala Asef , Elassal Gehan Mohamed , Abo Bakr Yosra Tayseer 
Published: November 2024

Abstract

Background
Chronic obstructive pulmonary disease (COPD), predominantly prevalent in smokers, is a chronic inflammatory disorder of the airway and lungs. COPD is one of the most prevalent diseases and the third leading cause of death globally. COPD is a common, preventable, treatable disease that characterize by persistent chest symptoms and airflow limitation due to air way or, and alveolar abnormalities. Fibrinogen is a soluble protein that is produced in the liver and released into the bloodstream, with normal ranges of 200-400 mg/dL or 2-4 g/L. COPD and fibrinogen are associated with frequency of hospitalizatied exacerbations of COPD, and related to the severity of the disease and mortality.

Objective
To explore whether the fibrinogen level affects the mortality and hospitalized excerbations in COPD patients.

Methods
The present study was conducted upon 50 subjects during the period from August 2022 to January 2023 who were admitted to our chest department at Ain Sham University Hospitals.

Results
We made our study on 50 smoker patients, spirometric assessment for all patients was done to confirm COPD diagnosis. The mean age was 59.0± 8.83 years. There were 47 (94%) males and 3 (6%) females with male to female ratio was 16.7:1. Fibrinogen test was done during exacerbation with mean fibrinogen level was 3.64± 1.01 g/L. According to cutoff of fibrinogen level, most of excerbated patients had high fibrinogen level (&gt;3.2). The mean FEV1 was 41.06± 18.75 there was a significant negative correlation between fibrinogen level and FEV1 shows that high fibrinogen level was significantly higher in cases with severe and very severe conditions. Most cases (94%) were discharged while three cases (6%) died shows that there was no significant relation between fibrinogen level and mortality.

Conclusion
Aecopd associated with high fibrinogen level and that the plasma fibrinogen level was increased with decreasing value of FEV1 showing significant negative correlation between plasma fibrinogen level and FEV1% predicated value. this suggests that high plasma fibrinogen level could be a diagnosis of severity of copd and a poor prognostic factor. but no significant relation between fibrinogen level and mortality. the results of the present study, combined with the fact that plasma fibrinogen is a widely and rapidly available, easy to interpret, low-cost biomarker, suggest a possible role for plasma fibrinogen in the identification of copd patients at an increased risk of adverse outcomes.
Use of Venous to Arterial Carbon Dioxide Tension Difference to Guide Resuscitation Therapy in Septic Shock
Authors: Sharkawy Samar Hassan , Mahmoud Mahmoud M , Maguid Abdel latif Mona Mohamed Abdel 
Published: November 2024

Abstract

Background
Early recognition and correction of tissue hypoperfusion is a cornerstone in the management of septic shock patients. The venous to arterial carbon dioxide tension difference, which is a marker of the adequacy of cardiac output to global metabolic demand, is a helpful additional means to detect patients who stay under resuscitation after optimization of o2 derived parameters. In this regard, its monitoring should help the clinicians for the decision of giving therapy targeting at increasing cardiac output.

Aim of the Work
Venous To arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock.

Patients and Methods
This study was a prospective, cross sectional study done on patients recruited from Respiratory ICU at Ain Shams University

Results
The P(v-a)CO2/C(a-v)O2 ratio might provide additional information for assessments of oxygen debt, it may become a specific end point for resuscitation. However, the P(v-a)CO2/C(a-v)O2 ratio depends on complex interactions between the central venous oxygen saturation (Scvo2), P(v-a)CO2, hemoglobin concentration (Hb), arterial oxygen saturation (Sao2), and arterial oxygen tension (Pao2). Thus, many factors can influence the calculation of the P(v-a)CO2/C(a-v)O2 ratio in real clinical practice. The value of the P(v-a)CO2/C(a-v)O2 ratio remains controversial.

Conclusion
In the presence of a normal/high ScvO2 (≥ 70%), an elevated ΔPCO2 still suggests that rising cardiac output can be indicated with the purpose of reducing global tissue hypoxia. However, if both ScvO2 and ΔPCO2 are normal in a state of global anaerobic metabolism, manipulating the microcirculation will probably be ineffective to reduce oxygen deficit.