bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound Diaphragmatic Assessment as a Predictor of Successful Non-Invasive Mechanical Ventilation in Patients with Acute Exacerbation COPD: an Observational Study
Authors: Khalaf Mostafa M I , Abd El-Fattah Mohamed Ismail , Thabet Wael R , Ashoor Tarek M 
Published: July 2024

Abstract

Background
Non-invasive ventilation (NIV) is successful as first-line treatment for patients admitted to hospital with hypercapnic respiratory failure due to AECOPD. Significant diaphragmatic muscle dysfunction (DD) exits in different disease-related and physiological conditions, including COPD. Ultrasonography is considered as a non- invasive and bedside method and commonly applied in intensive care unit (ICU) to assess diaphragmatic function.

Objective
To demonstrate the value of diaphragmatic ultrasound assessment for patients with AECOPD undergoing NIMV.

Patients and Methods
A population of 24 consecutive patients with AECOPD admitted to Ain Shams University Hospitals’ Intensive Care units (ICU) were enrolled. Change in diaphragmatic thickness fraction (ΔDTF) &lt; 20% and diaphragm excursion&lt; 10 mm during tidal volume was the predefined cut-off for identifying DD. Correlations between ΔDTF &lt; 20%, diaphragm excursion&lt; 10 mm and NIV failure and other clinical outcomes were investigated.

Results
24 cases with AECOPD, 33.3% of them (8 cases) had diaphragm dysfunction (DD+) but after NICPAP 2 cases improved and only 6 cases remain with DD and 16 Patients without DD (DD−). DD+ patients had a higher risk for NIV failure than DD−patients (p &lt; 0.011), and this finding was significantly associated with higher in-hospital, and 30-day mortality rates; longer mechanical ventilation duration; higher tracheostomy rate; and longer ICU stay.

Conclusion
AECOPD patients with diaphragmatic dysfunction as diagnosed by US showed higher incidence of NIMV failure, longer MV, ICU length of stay, In- hospital mortality, ICU and MV duration were significantly longer in group with DD. Insignificant difference was found considering mortality after 30 days in patients with or without diaphragm dysfunction.
Safety and Efficacy of N-Acetylcysteine as an Adjuvant Therapy in Critically Ill COVID-19 Patients
Authors: Abdelmonem Hany Saeed , Allah Elgendy Hanaa Mohamed Abd , Kamal El-Din Doaa Mohammed , Elshaer Eman Mohamed 
Published: July 2024

Abstract

Background
COVID-19 may cause pneumonia, acute respiratory distress syndrome, cardiovascular alterations, and multiple organ failure, which have been ascribed to a cytokinestorm, a systemic inflammatory response, and an attack by the immune system. Moreover, an oxidative stress imbalance has been demonstrated to occur in COVID- 19 patients. N- Acetyl-L-cysteine (NAC) is a precursor of reduced glutathione (GSH).

Aim of the Work
we retrospectively will investigate safety and efficacy of NAC dose given in paracetamol toxicity as an adjuvant therapy in critically ill COVID-19 patients with acute respiratory distress and determine whether NAC in high doses can avoid respiratory failure in patients with COVID-19.

Patients and Methods
This was a retrospective observational study in which all cases were collected from ICU of Ain shams university hospitals during COVID-19 outbreak. All data were extracted from clinical records. All patients initially admitted to ICU with SPO2 less than 94 % were included between December 2020 to February 2022. Exclusion Criteria included Need for immediate mechanical ventilation on admission, known allergy or hypersensitivity to NAC, end stage renal and liver diseases, heart failure and pregnancy. All patients with severe COVID-19 (confirmed or suspected received standard care, according to the institutional protocol.

Results
Patients were randomized into two equal groups (number (n)=40 each) as the N1(NAC) group who was given intravenously, initially 150 mg/kg in 200 mL of 0.9% NaCL for 60 minutes (first bag), followed by 50 mg/kg in 500 mL of 0.9% NaCL for 4 hours (second bag), and then 100 mg/kg in 1000 mL of 0.9%NaCL for 16 hours (third bag) and N2(Non NAC) group who received intravenously N-acetylcysteine (NAC) 600mg /12hr and The primary endpoint was the need for mechanical ventilation. Secondary endpoints were time of mechanical ventilation, admission to the intensive care unit (ICU), time in ICU, and mortality. There were no statistically significant differences between the two groups (p &gt; 0.05) The effect of NAC on mechanical ventilations, mortality, ICU stays, and hospital stays is a matter of controverse in ARDS patients. We found that intravenous high dose of NAC did not improve oxygenation, mortality rate and did not reduce the requirement for mechanical ventilation when administered for COVID 19 patients with ARDS. Also, the duration of ICU and hospital stays were relatively prolonged in the NAC-treated patients. These might be due to prolonged survival time with NAC-treated patients, but not to be detected with the small single centered trial..

Conclusion
Use of high doses of NAC administration can not affect the need of mechanical ventilation, rate of mortality, the need, duration of ICU admission and hospital stays for patients with severe COVID-19.
Comparative Study of Preoperative Ultrasound Guided Pericapsular Nerve Group Block and Femoral Nerve Block for Analgesia before Spinal Anesthesia for Proximal Femur Fracture Fixation
Authors: Mohamed Abd El-Rahman Mahdi Mohamed , El-wahab Amin Korraa Alaa Eldine Abd , Abd El-Megid Khaled Mohamed Maghawry , El- Monem Nofal Walid Hamed Abd , ElsayedEbrahim Nasser Elsayed 
Published: July 2024

Abstract

Background
Proximal femur fractures are most common fractures especially in elderly population. Regional anaesthesia is preferred during surgery in these patients. However, the severe pain associated with these injuries makes appropriate positioning difficult for the regional anaesthesia, thus altering their overall success rate, also the majority of patients often experience moderate to severe postoperative pain.

Aim of the Work
The study aimed to compare between ultrasound guided PENG and FNB using VAS score to assess the overall efficacy for pain relief during patient positioning for spinal anesthesia.

Patients and Methods
After approval of anaesthesiology department scientific and ethical committees in Ain Shams University Hospitals, 50 patients were included in the study, and were divided into two groups (n = 25; each); group PENG and FNB group. The two groups were adequately monitored and assessed before spinal anesthesia and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total amount of analgesia required.

Results
This study documented that PENG block is comparable to femoral block for postoperative pain control. The PENG block has been described very first in 2018 for preoperative management of femur neck fracture. We observed no statistically significant difference in pain scores during positioning for spinal anesthesia and for first 24 hrs post-operative. Similarly, no significant difference was also found in first rescue analgesia time and Cumulative nalbuphine consumption at 24 hours after surgery between the two groups.

Conclusion
In the management of hip fractures, PENG block is not associated in the present study with a significant change in pain score during positioning for spinal anesthesia compared to femoral nerve block.
Association between D-Dimer and the Severity of COVID-19
Authors: Abd-ElAzeiz Mohammed Saeed , El-Hennawi Ahmed Mohamed El-Sayed , Mohamed Wael Abdelmoneim , Mohamed Ali Ahmed Mamdouh 
Published: July 2024

Abstract

Background
Coronavirus disease-2019 (COVID-19) is a global health crisis. The clinical characteristics, disease progression and outcome in children appear significantly milder compared to older individuals. Symptoms, although variable, depend on the stage of the disease, the prior health status, and the presence of comorbidities and other individual features. The risk factors for morbidity and mortality include comorbidities such as diabetes, chronic pulmonary disease, and cardiac pathology. Thus, prompt diagnosis is vital, given the evolution of the disease, with ARDS potentially occurring at 1 week after symptom onset.

Objective
To investigate the prognostic value of D-dimer levels measured on admission in COVID-19 patients.

Patients and Methods
We performed a retrospective observational study to investigate the prognostic value of D-dimer levels measured on admission in patients infected with novel Coronavirus Disease 2019 (COVID-19). The study enrolled 80 consecutive critically ill patients with test confirmed COVID-19 status attending Ain Shams University Hospital, intensive care units (Dimerdash Hospital). We retrospectively collected demographic, clinical data, laboratory parameters and prognosis.

Results
The best cutoff of D dimer in prediction of severe disease is ≥ 308 with area under curve of 0.897, sensitivity of 87%, specificity of 80.7%, positive predictive value (PPV) of 64.5%, negative predictive value of 93.9% and overall accuracy of 82.5% (p &lt; 0.001). Statistically, there is statistically significant association between D dimer (≥308) and disease severity where D dimer significantly increased risk of having severe disease by 27.9 folds. The best cutoff of D dimer in prediction of mortality is ≥ 376 with area under curve of 0.839, sensitivity of 82.6%, specificity of 82.5%, positive predictive value (PPV) of 65.5%, negative predictive value of 92.2% and overall accuracy of 82.5% (p &lt; 0.001). Statistically, there is significant association between D dimer (≥376) and mortality where D dimer significantly increased risk of mortality by 22.4 folds. In our study, there is statistically significant association between D dimer (≥376) and overall survival which was significantly higher in those with D dimer &lt;376.

Conclusion
The prognosis of COVID-19 is poor in some group of patients. Unfortunately, an effective, globally accepted treatment algorithm for the treatment of COVID-19 has not yet been established. Additionally, the importance of anticoagulant therapy is increasing, as thrombotic events play a major role in mortality.
Role of Apigenin in Rats with Type 1 Diabetic Complications
Authors: Sherif Sara Gamal , Tarek Marwa , Sabry Yasmine Gamal , AbouGhalia Azza Hassan 
Published: July 2024

Abstract

Background and Aim
The main factor contributing to diabetes morbidity and mortality is cardiovascular problems. Apigenin, a naturally occurring flavonoid with anti-inflammatory and anti-diabetic characteristics, was investigated for its cardioprotective potential.

Methods
Type 1 diabetes model was induced using single injection of streptozotocin and diabetic rats were injected with apigenin. ECG recording and measurement of blood pressure were performed. Biochemical analyses of serum glucose, lipid profile, and creatine kinase were done. Histological examination of cardiac tissues was also performed.

Results
Diabetic rats had higher levels of glucose and creatine kinase, and impaired lipid profile as compared to the control group. Apigenin improved glycemic control, dyslipidemia, and cardiac function markers. Diabetic group had significantly higher blood pressure values as compared to the control group. The mean systolic and diastolic blood pressure levels dropped after apigenin treatment. ECG showed decrease in heart rate and increase in R-voltage after apigenin-injection as compared to diabetic rats. Moreover, apigenin-injection resulted in reduced histological changes of cardiac tissues compared to diabetic rats.

Conclusion
Apigenin could serve as potential therapeutic agent to reverse effects of hyperglycemia and its cardiovascular complications in diabetes.
Ticagrelor versus Clopidogrel in Prevention of No Reflow after 1ry PCI in Diabetic Patients with STEMI
Authors: Gamal Mohamed , Elshawa AbdElzaher Khalil , AbdElmonaem Moustafa Mohamed , Hamza Hassan Mohamed Atef , Hamid Galal Wagdy Abdel 
Published: July 2024

Abstract

Background
Adequacy of coronary flow can be judged upon using several methods like TIMI Grade and myocardial blush grade. No-reflow phenomenon, defined as incomplete reperfusion at the microvascular level despite adequate patency of the occluded artery, remains an important limitation of primary percutaneous intervention in STEMI patients nowadays. We aim in this study to investigate the relationship between the antiplatelet loading dose whether to be Ticagrelor or Clopidogrel and post intervention coronary flow, bleeding risk in these patients.

Aim of the Work
To compare between the effects of preoperative loading dose of Ticagrelor and clopidogrel in Diabetic STEMI patients undergoing primary percutaneous coronary intervention regarding prevention of no reflow, Instent thrombosis and short term bleeding risk. Myocardial reperfusion was judged upon using TIMI Grade and myocardial blush grade.

Patients and Methods
a single center prospective randomized controlled trial based at the coronary care units in Ain shams university hospitals. The study included Three hundred Diabetic patients presenting to Ain shams university hospitals diagnosed with STEMI in the ER fulfilling the inclusion criteria were randomized to receive Ticagrelor (150 patients) or receiving clopidogrel (150 patients)

Results
As regard TIMI flow there was statistically highly significant highly significant difference between two studied groups with P value 0.000 where in group A 64 % of patients developed TIMI III flow, 22.7 % with TIMI II flow, 12.7% with TIMI I and 0.7% with TIMI 0 While in group B 86% of patients developed TIMI III flow, 9.3% of them developed TIMI II, 3.3 % developed TIMI I flow and 1.3 % developed TIMI 0. As regard MBG there was statistically highly significant difference between two groups with P value 0.00 where in group A where percentage of patients with MBG grades 0,1,2 and 3 were 4%, 16 %,18 % and 62 % respectively while in group B percentage of patients with MBG grades 0,1,2 and 3 were 1.3 %, 3.3 %, 9.3 % and 86 % respectively. As regard echo EF, there was statistically significant difference between two groups with P value 0.036 where mean EF in patients with group A was 40.50 ± 7.93 while the mean EF in patients with group B was 42.55 ± 8.88 .

Conclusion
Ticagrelor loading before primary PCI resulted in improved post-procedural TIMI flow. It also increased the post-procedural MBG. This resulted in a significant increase in the number of patients having more post-procedural Ejection fraction as measured by modified Simpson’s method. However, it did not decrease incidence of in-hospital MACE. Also there was no significant increase in risk of major nor minor bleeding in both young and elderly patients.
Effect of High Dose Atorvastatin and Allopurinol Preloading on No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction
Authors: Ezzat Zaky Mina Faried , Said Othman Khaled Mohamed , Fouad Khalid Ahmed , Bastawy Islam Mahmoud 
Published: July 2024

Abstract

Background
No reflow is linked to worse prognosis post revascularization, so preventing no reflow is better than treating it.

Objective
this study aims to evaluate the effect of adding high-dose allopurinol and atorvastatin in preventing NRP when given before undergoing primary PCI in patients presenting with STEMI.

Patients and Methods
This study recruited 300 patients who were classified into 3 groups (100 each), Group A: patients were preloaded with high dose Allopurinol and Atorvastatin on top of the standard of care treatment according to the European society of cardiology guidelines. Group B: patients were preloaded with high dose Atorvastatin only on top of the standard of care treatment, Group C: were only preloaded with the standard care treatment according to the European society of cardiology guidelines, each group was subjected to the same pre procedural laboratory tests, primary percutaneous coronary intervention was done by the most experienced operator available according to the European society of cardiology guidelines.

Results
Percentage of post procedural no reflow was significantly lower in patients who were preloaded with high dose Allopurinol and Atorvastatin compared to the other 2 groups (highest with group C) (Group A: 11%, Group B: 23%, Group C: 39%).

Conclusion
preloading patients before primary percutaneous coronary intervention in patients presenting with ST elevation myocardial infarction with high dose Allopurinol and Atorvastatin significantly decreases incidence of post procedural no reflow.
Role of Strauss ECG criteria as predictor of response in patients undergoing cardiac resynchronization therapy
Authors: Shoman Khaled , Effat Emad , Badran Haitham , Eldamanhory Hayam 
Published: July 2024

Abstract

Background
Cardiac resynchronization therapy( CRT) is a standard treatment in patients with heart failure, however, approximately 20–40% of recipients of (CRT) do not respond to it based on the current patients’ election criteria. The purpose of this study was to identify the baseline parameters that predict the CRT response and how the ECG morphology can affect the outcome.

Objective
To evaluate the Strauss ECG criteria as predictor of response in patients undergoing Cardiac resynchronization therapy.

Material and Methods
From March 2020 to March 2022, 70 patients underwent CRT or CRT-D insertion with LBBB morphology in Ain Shams university hospitals, Cardiology department were enrolled in the study. All patients subjected to history, clinical examination, Electrocardiogram and echocardiography before CRT insertion and after 6 months. We analyzed the QRS morphology of the patients with LBBB-like pattern as we classified patients in two groups, Strauss LBBB criteria (SLBBB) which was (a QRS duration of &lt; 140 ms for men and &lt;130 ms for women, along with mid-QRS notching or slurring in at least 2 of the leads V1, V2, V5, V6, I, or aVL and also rS or QS morphology in lead V1 patients) and the other group that was not meeting the previous criteria as non-strauss LBBB (non-SLBBB), also all patients subjected to echocardiography ( conventional 2D and speckle tracking “global longitudinal strain and global circumferential strain), Ejection fraction was assessed together with LV volumes and speckle tracking to assess response to CRT.

Results
Out of 70 patients, 3 patients missed the 6 months follow up after CRT implantation, so the study enrolled 67 patients that have been classified according to ECG morphology of LBBB to 37 patients with non-Strauss ECG criteria- one of whom died after 4 months- and 30 patients with Strauss ECG criteria. The number of responders in the study was 50 patients with percentage 75.8%, 52% of CRT responder (26 patients) had non Strauss ECG criteria while 48% of CRT responders (24 patients) had Strauss ECG criteria with P value=0.463. While there was no statistical significance of overall CRT response nor 6 months hospitalization and mortality between patients of Strauss and non-Strauss ECG criteria, there was a significant improvement in NYHA class, EF assessed by biplane Simpson’s, End- systolic volume, Global longitudinal strain and Global circumferential strain by speckle tracking echocardiography in patients with Strauss ECG criteria of LBBB.

Conclusion
There is no statistical significance in overall CRT response nor the 6 months hospitalization and mortality after 6 months of follow up between patients with Strauss and non-Strauss ECG criteria of LBBB, however, patients with Strauss ECG criteria have better improvement in NYHA class, echocardiographic parameters such as EF and ESV and speckle tracking parameters (GLS and GCS).
Correlation Between High-sensitive Troponin Level, Neutrophil Lymphocyte ratio and SYNTAX score in Acute Myocardial Infarction patients undergoing Coronary Angiography
Authors: Orz Mahmoud , Abdelhamid Ibrahim , Amin Youssef , Tamara Ahmed 
Published: July 2024

Abstract

Background
Acute myocardial infarction is one of the leading causes of death in the developed world. The prevalence of the disease approaches three million people worldwide. Acute myocardial infarction divided into two categories, non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI).

Objective
To assess the value of using high sensitive troponin and the neutrophil lymphocyte ratio as marker to predict the complexity of angiographic coronary anatomy in AMI patients assessed by SYNTAX Score.

Patients and Methods
this study included 100 patients who presented to emergency department of Ain Shams University Hospitals and Misr University for Science and Technology (MUST) hospital, between November/2021 and May/2022 diagnosed with AMI and underwent coronary angiography with or without stent implantation. Serum sample for differential CBC count was obtained to assess NLR as will as zero point high sensitive troponin to be correlation SYNTAX score.

Results
The study showed that there was a significant correlation between the NLR and the complexity of coronary lesions assessed by SYNTAX score, but the study couldn’t found any correlation between the high sensitive troponin level and the complexity of coronary lesions. Also the study showed there were no correlation between NLR and either TIMI follow or MBG. The conducted patients in the study were categorized in a tripartite fashion according to their SYNTAX score (low: 0 to 22, intermediate: 23 to 32, high: &gt;32).

Conclusion
An increased in neutrophil lymphocyte ratio on admission is a strong and independent predictor of the complexity of the coronary lesions, but there is no significant correlation between High sensitive troponin level and the complexity of coronary lesion .