Publications by authors named "Amr Hussein"

21 Publications

  • Page 1 of 1

Systematic Review and Meta-Analysis of Tocilizumab Therapy versus Standard of Care in over 15,000 COVID-19 Pneumonia Patients during the First Eight Months of the Pandemic.

Int J Environ Res Public Health 2021 08 30;18(17). Epub 2021 Aug 30.

Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds LS7 4SA, UK.

Background: Tocilizumab is an anti-IL-6 therapy widely adopted in the management of the so-called "cytokine storm" related to SARS-CoV-2 virus infection, but its effectiveness, use in relation to concomitant corticosteroid therapy and safety were unproven despite widespread use in numerous studies, mostly open label at the start of the pandemic.

Methods: We performed a systematic review and meta-analysis of case-control studies utilising tocilizumab in COVID-19 on different databases (PubMed/MEDLINE/Scopus) and preprint servers (medRxiv and SSRN) from inception until 20 July 2020 (PROSPERO CRD42020195690). Subgroup analyses and meta-regressions were performed. The impact of tocilizumab and concomitant corticosteroid therapy or tocilizumab alone versus standard of care (SOC) on the death rate, need for mechanical ventilation, ICU admission and bacterial infections were assessed.

Results: Thirty-nine studies with 15,531 patients (3657 cases versus 11,874 controls) were identified. Unadjusted estimates ( = 28) failed to demonstrate a protective effect of tocilizumab on survival (OR 0.74 ([95%CI 0.55-1.01], = 0.057), mechanical ventilation prevention (OR 2.21 [95%CI 0.53-9.23], = 0.277) or prevention of ICU admission (OR 3.79 [95%CI 0.38-37.34], = 0.254). Considering studies with adjusted, estimated, tocilizumab use was associated with mortality rate reduction (HR 0.50 ([95%CI 0.38-0.64], < 0.001) and prevention of ICU admission (OR 0.16 ([95%CI 0.06-0.43], < 0.001). Tocilizumab with concomitant steroid use versus SOC was protective with an OR of 0.49 ([95%CI 0.36-0.65], < 0.05) as was tocilizumab alone versus SOC with an OR of 0.59 ([95%CI 0.34-1.00], < 0.001). Risk of infection increased (2.36 [95%CI 1.001-5.54], = 0.050; based on unadjusted estimates).

Conclusion: Despite the heterogeneity of included studies and large number of preprint articles, our findings from the first eight of the pandemic in over 15,000 COVID-19 cases suggested an incremental efficacy of tocilizumab in severe COVID-19 that were confirmed by subsequent meta-analyses of large randomized trials of tocilizumab. This suggests that analysis of case-control studies and pre-print server data in the early stages of a pandemic appeared robust for supporting incremental benefits and lack of major therapeutic toxicity of tocilizumab for severe COVID-19.
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http://dx.doi.org/10.3390/ijerph18179149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431489PMC
August 2021

Admission SpO and ROX index predict outcome in patients with COVID-19.

Am J Emerg Med 2021 Jul 27;50:106-110. Epub 2021 Jul 27.

Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt.

Background: This study aimed to evaluate the accuracy of pulse oximetry-derived oxygen saturation (SpO) on room air, determined at hospital admission, as a predictor for the need for mechanical ventilatory support in patients with Coronavirus Disease-2019 (COVID-19).

Methods: In this retrospective observational study, demographic and clinical details of the patients were obtained during ICU admission. SpO and respiratory rate (RR) on room air were determined within the first 6 h of hospital admission. As all measurements were obtained on room air, we calculated the simplified respiratory rate‑oxygenation (ROX) index by dividing the SpO by the RR. Based on the use of any assistance of mechanical ventilator (invasive or noninvasive), patients were divided into mechanical ventilation (MV) group and oxygen therapy group. The accuracy of the SpO, CT score, and ROX index to predict the need to MV were determined using the Area under receiver operating curve (AUC).

Results: We included 72 critically ill patients who tested COVID-19-positive. SpO on the room air could predict any MV requirement (AUC [95% confidence interval]: 0.9 [0.8-0.96], sensitivity: 70%, specificity 100%, cut-off value ≤78%, P < 0.001). Within the MV group, the use of noninvasive ventilation (NIV) was successful in 37 (74%) patients, whereas 13 patients (26%) required endotracheal intubation. The cut-off ROX value for predicting early NIV failure was ≤1.4, with a sensitivity of 85%, a specificity of 86%, and an AUC of 0.86 (95% confidence interval of 0.73-0.94, P < 0.0001).

Conclusions: A baseline SpO ≤78% is an excellent predictor of MV requirement with a positive predictive value of 100%. Moreover, the ROX index measured within the first 6 h of hospital admission is a good indicator of early NIV failure.
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http://dx.doi.org/10.1016/j.ajem.2021.07.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313790PMC
July 2021

High-Resolution and Large-Detection-Range Virtual Antenna Array for Automotive Radar Applications.

Sensors (Basel) 2021 Mar 2;21(5). Epub 2021 Mar 2.

Electronics and Electrical Communications Engineering Department, Faculty of Engineering, Tanta University, Tanta 31527, Egypt.

Collision avoidance and autonomous control of vehicles have become essential needs for providing a high-quality and safe life. This paper introduces a new generic scheme for a virtual antenna array (VAA) and its application in a train collision-avoidance system (TCAS). The proposed TCAS shall have the capability of identifying the range and angle of an object in front of a moving train and provide the required alerts. Thereby, a new virtual array distribution for both the transmitting and the receiving antenna arrays is introduced to get a long-range object detection and high-resolution multi-input multi-output (MIMO) system. This can be accomplished because the VAA radiation pattern is the multiplication of the radiation patterns for both the transmitting and receiving antenna arrays, which is different than each one of them alone. In this work, the VAA is utilized in radar systems in which the radar range depends on the multiplication of the gain of the transmitting and receiving antennas. So, we introduce a new scheme for the general design of VAA-based radars. A prototype for the antenna system was fixed on a of Texas Instruments platform for the cascading radar. One of the main problems of the VAA is the loss of radiated power in undesired directions, which affects the maximum detection range in beamforming systems and degrades the diversity gain in MIMO applications. These issues have been solved by the introduction of the practical implementation of a proposed high-gain, low side lobe level VAA system for automotive radar that is based on the integration of four AWR1243 RF chips operating in a frequency range of 76 GHz to 81 GHz. It was implemented using low-power 45 nm (TI) RFCMOS technology. The measured gain of the realized VAA was 47.2 dBi, which was 1.815 times higher than that of the Texas instrumentation linear frequency modulated continuous wave (TI' LFMCW) radar, which was 26 dBi. The proposed VAA saved 45% of the required implementation area compared to the TI' LFMCW antenna array. The VAA system was fabricated and tested in an anechoic chamber, and it was found that the simulated and measured patterns of the proposed VAA were highly matched in terms of half-power beamwidth and side lobe level.
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http://dx.doi.org/10.3390/s21051702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957902PMC
March 2021

Splanchnic and systemic circulation cross talks: Implications for hemodynamic management of liver transplant recipients.

Best Pract Res Clin Anaesthesiol 2020 Mar 17;34(1):109-118. Epub 2019 Dec 17.

Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Cairo University, 1 Alsaray st, Almanial, Cairo, Egypt. Electronic address:

The interaction between splanchnic and systemic circulation has many hemodynamic and renal consequences during liver transplant. In a patient with liver cirrhosis, splanchnic vasodilatation causes arterial steal from the systemic circulation into the splanchnic bed, which decreases the effective blood volume. Moreover, rapid volume loading in these patients has less impact on the cardiac output because a higher proportion of infused fluid is shifted to the splanchnic area. Thus, in dissection phase, the traditional approach of volume loading to maintain intraoperative hemodynamic stability not only seems ineffective, but it may also aggravate surgical bleeding. Two approaches of volume therapy have been mentioned to maintain hemodynamic stability during liver transplantation: splanchnic volume reduction by volume restriction with or without phlebotomy to maintain low central venous pressure (CVP), and splanchnic decongestion using splanchnic vasoconstrictors. After reperfusion, an increase in the central blood volume was thought to have a deleterious effect on the new graft function; however, the precise central venous pressure value that causes hepatic congestion after reperfusion is unknown.
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http://dx.doi.org/10.1016/j.bpa.2019.12.003DOI Listing
March 2020

Prophylactic vaginal dinoprostone administration six hours prior to copper-T380A intrauterine device insertion in nulliparous women: A randomized controlled trial.

Contraception 2020 03 4;101(3):162-166. Epub 2019 Dec 4.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: To determine the effectiveness of 3 mg vaginal dinoprostone administered six hours prior to copper intrauterine device (IUD) insertion compared to placebo in increasing ease of insertion and reducing insertion pain among nulliparous women.

Study Design: This was a single-center double-blinded randomized controlled trial (RCT). We randomly divided the two hundred nulliparous women requesting a copper T380A IUD to receive 3 mg vaginal dinoprostone or placebo six hours before IUD insertion. The primary outcome was provider ease of insertion. Patients reported their perceived insertion pain using a 10 cm visual analog scale (VAS). We also reported number of failed IUD insertions.

Results: Baseline characteristics were similar between groups. Ease of insertion score was lower in dinoprostone group than placebo group (3.6 ± 2.5 vs. 5.4 ± 2.8; p < 0.01) denoting easier insertion for clinicians in dinoprostone group. Mean pain score during copper IUD insertion was lower in dinoprostone group (3.7 ± 2.3 vs. 5.0 ± 2.8; p < 0.01). Failed IUD insertion occurred in two cases of dinoprostone group (2%) versus four cases in control group (4%) (p-value; 0.68).

Conclusions: Although vaginal dinoprostone administration six hours prior to copper IUD insertion in nulliparous women leads to an easy IUD insertion, we do not routinely advise it as the reduction in IUD insertion pain scores with vaginal dinoprostone lacked clinical significance.

Implications: In settings where it is feasible to provide dinoprostone vaginally six hours before copper IUD insertion, clinicians will find insertion easier, and nulliparous women may experience somewhat less pain during the procedure. Where waiting six hours is practical, this may prove to be useful.
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http://dx.doi.org/10.1016/j.contraception.2019.10.012DOI Listing
March 2020

Perioperative nonhormonal pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy: a systematic review and network meta-analysis.

Fertil Steril 2020 01 18;113(1):224-233.e6. Epub 2019 Nov 18.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: To synthesize evidence on the most effective pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy.

Design: Systematic review and network meta-analysis of randomized controlled trials (RCTs).

Setting: Not applicable.

Patients: Trials assessing efficacy of pharmacological interventions during different types of myomectomy.

Interventions: Misoprostol, oxytocin, vasopressin, tranexamic acid (TXA), epinephrine, or ascorbic acid.

Main Outcome Measures: Intraoperative blood loss and need for blood transfusion.

Results: The present review included 26 randomized control trials (RCTs) (N = 1627). For minimally invasive procedures (9 RCTs; 474 patients), network meta-analysis showed that oxytocin (mean difference [MD] -175.5 mL, 95% confidence interval [CI] -30.1.07, -49.93), ornipressin (MD -149.6 mL, 95% CI - 178.22, -120.98), misoprostol, bupivacaine plus epinephrine, and vasopressin were effective in reducing myomectomy blood loss, but the evidence is of low quality. Ranking score of treatments included in subgroup analysis of minimally invasive myomectomy showed that oxytocin ranked first in reducing blood loss, followed by ornipressin. For open myomectomy (17 RCTs; 1,153 patients), network meta-analysis showed that vasopressin plus misoprostol (MD -652.97 mL, 95% CI - 1113.69, -174.26), oxytocin, TXA, and misoprostol were effective; however, the evidence is of low quality. Vasopressin plus misoprostol ranked first in reducing blood loss during open myomectomy (P = .97).

Conclusion: There is low-quality evidence to support uterotonics, especially oxytocin, and peripheral vasoconstrictors as effective options in reducing blood loss and need for blood transfusion during minimally invasive myomectomy. Oxytocin is the most effective intervention in minimally invasive myomectomy. For open myomectomy, a combination of uterotonics and peripheral vasoconstrictors is needed to effectively reduce blood loss.
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http://dx.doi.org/10.1016/j.fertnstert.2019.09.016DOI Listing
January 2020

The validity of central venous to arterial carbon dioxide difference to predict adequate fluid management during living donor liver transplantation. A prospective observational study.

BMC Anesthesiol 2019 06 22;19(1):111. Epub 2019 Jun 22.

Department of Surgery, Ain Shams University, Cairo, Egypt.

Background: To assess the validity of central and pulmonary veno-arterial CO gradients to predict fluid responsiveness and to guide fluid management during liver transplantation.

Methods: In adult recipients (ASA III to IV) scheduled for liver transplantation, intraoperative fluid management was guided by pulse pressure variations (PPV). PPV of ≥15% (Fluid Responding Status-FRS) indicated fluid resuscitation with 250 ml albumin 5% boluses repeated as required to restore PPV to < 15% (Fluid non-Responding Status-FnRS). Simultaneous blood samples from central venous and pulmonary artery catheters (PAC) were sent to calculate central venous to arterial CO gap [C(v-a) CO2 gap] and pulmonary venous to arterial CO gap [Pulm(p-a) CO2 gap]. CO and lactate were also measured.

Results: Sixty seven data points were recorded (20 FRS and 47 FnRS). The discriminative ability of central and pulmonary CO gaps between the two states (FRS and FnRS) was poor with AUC of ROC of 0.698 and 0.570 respectively. Central CO gap was significantly higher in FRS than FnRS (P = 0.016), with no difference in the pulmonary CO gap between both states. The central and Pulmonary CO gaps are weakly correlated to PPV [r = 0.291, (P = 0.017) and r = 0.367, (P = 0.002) respectively]. There was no correlation between both CO gaps and both CO and lactate.

Conclusion: Central and the Pulmonary CO gaps cannot be used as valid tools to predict fluid responsiveness or to guide fluid management during liver transplantation. CO gaps also do not correlate well with the changes in PPV or CO.

Trial Registration: Clinicaltrials.gov Identifier: NCT03123172 . Registered on 31-march-2017.
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http://dx.doi.org/10.1186/s12871-019-0776-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589166PMC
June 2019

The Effect of Zumba Exercise on Reducing Menstrual Pain in Young Women with Primary Dysmenorrhea: A Randomized Controlled Trial.

J Pediatr Adolesc Gynecol 2019 Oct 11;32(5):541-545. Epub 2019 Jun 11.

Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Study Objective: To study the effectiveness of performing Zumba exercise on the severity and duration of pain in patients with primary dysmenorrhea.

Design: Randomized controlled trial.

Setting: Cairo University gynecology Hospital and Bahgat gym and fitness center.

Participants: Ninety-eight women diagnosed with primary dysmenorrhea.

Interventions: Study participants were divided randomly into 2 equal groups: group I included women who engaged in Zumba exercise for 60 minutes twice weekly for 8 weeks, and group II was a control group with no intervention.

Main Outcome Measures: The primary outcome was the menstrual pain intensity measured using the visual analogue scale scores at 4 and 8 weeks after starting Zumba exercise. The secondary outcome was the difference in the duration of pain in both groups.

Results: Both groups were homogeneous regarding the baseline demographic characteristics. The severity of primary dysmenorrhea at the beginning of the study was not significantly different between the 2 groups. Menstrual pain intensity was significantly decreased in the Zumba group after 4 and 8 weeks of Zumba compared with the control group (mean difference, -2.94 [95% confidence interval, -3.39 to -2.48] and -3.79 [95% confidence interval, -4.16 to -3.43], respectively; P = .001). Also, the duration of pain was shorter in the Zumba group compared with the control group at 8 weeks (4.92 ± 1.90 vs 9.10 ± 2.92 hours, respectively; P = .001).

Conclusion: The Zumba intervention can reduce the severity and duration of menstrual pain thus suggesting that regularly performing Zumba might be a possible complementary treatment for primary dysmenorrhea.
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http://dx.doi.org/10.1016/j.jpag.2019.06.001DOI Listing
October 2019

Effect of ultrafiltration on extravascular lung water assessed by lung ultrasound in children undergoing cardiac surgery: a randomized prospective study.

BMC Anesthesiol 2019 06 4;19(1):93. Epub 2019 Jun 4.

Department of Anesthesia and Intensive Care, Kasr Al Ainy Faculty of Medicine, Cairo University, 7 Elshishiny St., El Maryotia, Faysal, Giza, 12131, Egypt.

Background: Increased lung water and the resultant atelectasis are significant pulmonary complications after cardiopulmonary bypass (CPB) in children undergoing cardiac surgery; these complications are observed after CPB than after anaesthesia alone. Ultrafiltration has been shown to decrease total body water and postoperative blood loss and improve the alveolar to arterial oxygen gradient and pulmonary compliance. This study investigated whether conventional ultrafiltration during CPB in paediatric heart surgeries influences post-bypass extravascular lung water (EVLW) assessed by lung ultrasound (LUS).

Methods: This randomized controlled study included 60 patients with congenital heart disease (ASA II-III), aged 1 to 48 months, with a body weight > 3 kg. Conventional ultrafiltration targeting a haematocrit (HCT) level of 28% was performed on the ultrafiltration group, while the control group did not receive ultrafiltration. LUS scores were recorded at baseline and at the end of surgery. The PaO2/FiO2 ratio (arterial oxygen tension divided by the fraction of inspired oxygen), urine output, and haemodynamic parameters were also recorded.

Results: LUS scores were comparable between the two groups both at baseline (p = 0.92) and at the end of surgery (p = 0.95); however, within the same group, the scores at the end of surgery significantly differed from their baseline values in both the ultrafiltration (p = 0.01) and non-ultrafiltration groups (p = 0.02). The baseline PaO2/FiO2 ratio was comparable between both groups. at the end of surgery, The PaO2/FiO2 ratio increased in the ultrafiltration group compared to that in the non-ultrafiltration group, albeit insignificant (p = 0.16). no correlation between the PaO2/FiO2 ratio and LUS score was found at baseline (r = - 0.21, p = 0.31). On the other hand, post-surgical measurements were negatively correlated (r = - 0.41, p = 0.045).

Conclusion: Conventional ultrafiltration did not alter the EVLW when assessed by LUS and oxygenation state. Similarly, ultrafiltration did not affect the urea and creatinine levels, intensive care unit (ICU) stays, ventilation days, or mortality.

Trial Registration: Clinicaltrials.gov Identifier: NCT03146143 registered on 29-April-2017.
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http://dx.doi.org/10.1186/s12871-019-0771-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547534PMC
June 2019

Validity of mini-fluid challenge for predicting fluid responsiveness following liver transplantation.

BMC Anesthesiol 2019 04 13;19(1):56. Epub 2019 Apr 13.

Medical ICU, Bicêtre Hospital, Paris-South University, Paris, France.

Background: Mini-fluid challenge is a well tested and effective tool to predict fluid responsiveness under various clinical conditions. However, mini-fluid challenge has never been tested in patients with end-stage liver disease. This study investigated whether infusion of 150 ml albumin 5% can predict fluid responsiveness in cirrhotic patients following liver transplant.

Methods: Fifty patients receiving living donor liver transplant were included in the analysis. Mini-fluid challenge composed of 150 ml of albumin 5% administered over 1 min in three consecutive 50-ml fluid boluses. An additional 350 ml was then infused at a constant rate over 15 min (for a total of 500 ml). Stroke volume (SV) was measured as the product of the subaortic velocity time integral (VTI) and left ventricular outflow tract (LVOT) area. Fluid responsiveness was defined as an increase in SV by ≥15% after the infusion.

Results: Fifty patients were enrolled in the study. Fourteen patients were classified with Child A, 15 patients with Child B, and 21 patients with Child C cirrhosis. Thirty four patients were fluid responders and 16 patients were fluid non-responders. After 150 ml of albumin 5%, the SV increased significantly in our cohort. The area under receiver operating curve (AUROC) was 0.7 (95% confidence interval [CI] 0.5-0.8, P = 0.005). In subgroup analysis, the SV increased significantly after mini fluid challenge in the Child A group (P = 0.017) but not Child B or C groups (P = 0.3 and 0.29, respectively). The AUROC for mini-fluid challenge in the Child A group was 0.86 (95% confidence interval [CI] 0.6-0.9, P = 0.0004), while mini-fluid challenge failed to discriminate between responders and non-responders in Child B and C groups.

Conclusion: A mini-fluid challenge of 150 ml albumin 5% can predict fluid responsiveness in liver transplant patients with fair sensitivity and specifiicty. Subgroup analyis revealed that minifluid challenge can predict fluid responsiveness in patients with Child A cirrhosis but not patients with Child B or C cirrhosis.

Trial Registration: NCT03396159 . (Prospective registered). Initial registration date was 10/01/2018.
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http://dx.doi.org/10.1186/s12871-019-0728-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463636PMC
April 2019

Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis.

Fertil Steril 2019 03 2;111(3):553-561.e4. Epub 2019 Jan 2.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: To synthesize the evidence on the most effective medications for the relief of intrauterine device (IUD) insertion-related pain.

Design: Systematic review and network meta-analysis of randomized controlled trials (RCTs).

Setting: Not applicable.

Patient(s): Patients undergoing IUD insertion who received different medications for pain relief versus those who received placebo.

Intervention(s): Electronic search in the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and ScienceDirect.

Main Outcome Measure(s): Visual analog scale (VAS) pain score during tenaculum placement, IUD insertion, and 5 to 20 minutes after insertion, the score of easiness of insertion and the need for additional analgesics.

Result(s): The present review included 38 RCTs (n = 6,314 patients). The network meta-analysis showed that lidocaine-prilocaine cream (genital mucosal application) statistically significantly reduced pain at tenaculum placement compared with placebo (mean difference -2.38; 95% confidence interval, -4.07 to -0.68). In the ranking probability order, lidocaine-prilocaine cream ranked the highest in reducing the pain at tenaculum placement, followed by lidocaine (paracervical). Similarly, lidocaine-prilocaine cream ranked as the highest treatment in pain reduction during IUD insertion, followed by lidocaine (paracervical).

Conclusion(s): Lidocaine-prilocaine cream is the most effective medication that can be used for IUD insertion-related pain. Other medications are not effective.
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http://dx.doi.org/10.1016/j.fertnstert.2018.11.012DOI Listing
March 2019

Construction of an Arabic computerized battery for cognitive rehabilitation of children with specific learning disabilities.

Neuropsychiatr Dis Treat 2018 21;14:2123-2131. Epub 2018 Aug 21.

Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Purpose: The aim of this study was to design an Arabic computerized battery of cognitive skills for training children with specific learning disabilities (SLD).

Subjects And Methods: Nineteen students from fourth grade primary schools in Assiut, Egypt, who were previously diagnosed with SLD, agreed to participate in the rehabilitation program. The study passed through four stages: first stage, detailed analysis of the cognitive profile of students with SLD (n=19), using a previously constructed diagnostic cognitive skill battery, to identify deficits in their cognitive skills; second stage, construction of an Arabic computerized battery for cognitive training of students with SLD; third stage, implementation of the constructed training program for the students, each tailored according to his/her previously diagnosed cognitive skill deficit/deficits; and fourth stage, post-training re-evaluation of academic achievement and cognitive skills' performance.

Results: Students with SLD have a wide range of cognitive skill deficits, which are more frequent in auditory cognitive skills (68.4%) than in visual cognitive skills (64.1%), particularly in phonological awareness and auditory sequential memory (78.9%). Following implementation of the training program, there was a statistically significant increase (<0.001) in the mean scores of total auditory and visual cognitive skills, as well as in academic achievement (<0.001) of the study group.

Conclusion: Remediation-oriented diagnosis of cognitive skills, when tailored according to previously diagnosed cognitive deficits, leads to the improvement in learning abilities and academic achievement of students with SLD.
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http://dx.doi.org/10.2147/NDT.S155987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110296PMC
August 2018

Risk of subsidence and peri-prosthetic fractures using collared hydroxyapatite-coated stem for hip arthroplasty in the elderly.

Hip Int 2018 Nov 4;28(6):663-667. Epub 2018 May 4.

Trauma and Orthopaedics, Warwick Hospital, UK.

Introduction: Subsidence has been noted with both cemented and uncemented stems in hip arthroplasty. On most occasions, it's minimal (i.e. less than 2 mm) and stabilises at 1 year. However, when its progressive and significant, it causes loss of length and horizontal offset, and when symptomatic warrants a revision.

Materials And Methods: A retrospective radiological review of the patient database was carried out to identify all patients with age ≥ 70 years who underwent elective hip arthroplasty using uncemented HA coated collared stem and had radiographs at 1 year follow up. A total of 176 patients were identified from January 2009 to June 2010. 2 independent investigators classified the proximal femur based on Dorr type and calculated the subsidence based on Engh and Massin method of calculating the distance between the tip of greater trochanter and shoulder of the prosthesis.

Results: 7 patients (4 Bs, 2 As, 1 C) had a subsidence of ≥ 2 mm (2-3.2 mm) at 1 year. None of them was symptomatic. 1 of them was secondary to a missed calcar crack and continued to subside for 9 mm before it stabilised on the lesser trochanter at 4 years follow up. There were Dorr 22 (12.5%) type A, 147(83.5%) type B and 7(4%) type C. The mean age was 77.4 years (70-91 years) and male: female ratio was 7:15. 3 patients had an intraoperative calcar crack requiring cabling. All were mobilised full weight-bearing postoperatively, and none had a subsidence of >2 mm at 1 year follow-up.

Discussion: Our subgroup analysis identified that subsidence can happen when the collar is "non-functional" and the initial press fit of the stem wasn't achieved. It can also occur in an event of calcar crack, which is missed intraoperatively. In cases of calcar crack which went on to have to cable during the primary procedure, it neither changed the post-operative rehabilitation nor did it show an increased risk of subsidence.

Conclusion: A fully hydroxyapatite (HA) coated collared stem, when used in elderly age group for elective THR, has only 2% risk of intraoperative periprosthetic fracture. There's a 4% risk of radiologically significant subsidence (i.e. ≥2 mm), however, it has not proven to be clinically significant in our study. Dorr canal type had no bearing on either risk of periprosthetic fracture or subsidence. Collared stems did not have a statistically significant difference in risk of subsidence and peri-prosthetic fracture in comparison to un-collared stem, although there was a non-significant trend in favour of collar use.
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http://dx.doi.org/10.1177/1120700017754085DOI Listing
November 2018

Effects of bacterial translocation on hemodynamic and coagulation parameters during living-donor liver transplant.

BMC Anesthesiol 2018 04 25;18(1):46. Epub 2018 Apr 25.

Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Cairo University, 1 Alsaray st, Almanial, Cairo, Egypt.

Background: Bacterial translocation (BT) has been proposed as a trigger for stimulation of the immune system with consequent hemodynamic alteration in patients with liver cirrhosis. However, no information is available regarding its hemodynamic and coagulation consequences during liver transplantation.

Methods: We screened 30 consecutive adult patients undergoing living-donor liver transplant for the presence of BT. Bacterial DNA, Anti factor Xa (aFXa), thromboelastometry, tumor necrosis factor-α TNF-α, and interleukin-17 (IL-17) values were measured in sera before induction of anesthesia. Systemic hemodynamic data were recorded throughout the procedures.

Results: Bacterial DNA was detected in 10 patients (33%) (bactDNA(+)). Demographic, clinical, and hemodynamic data were similar in patients with presence or absence of bacterial DNA. BactDNA(+) patients showed significantly higher circulating values of TNF-α and IL-17, and had significantly higher clotting times and clot formation times as well as significantly lower alpha angle and maximal clot firmness than bactDNA(-) patients, P < 0.05. We found no statistically significant difference in aFXa between the groups, P = 0.4. Additionally, 4 patients in each group needed vasopressor agents, P = 0.2. And, the amount of transfused blood and blood products used were similar between both groups.

Conclusion: Bacterial translocation was found in one-third of patients at the time of transplantation and was largely associated with increased markers of inflammation along with decreased activity of coagulation factors.

Trial Registration: Trial Registration Number: NCT03230214 . (Retrospective registered). Initial registration date was 20/7/2017.
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http://dx.doi.org/10.1186/s12871-018-0507-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921288PMC
April 2018

Vaccines Meet Big Data: State-of-the-Art and Future Prospects. From the Classical 3Is ("Isolate-Inactivate-Inject") Vaccinology 1.0 to Vaccinology 3.0, Vaccinomics, and Beyond: A Historical Overview.

Front Public Health 2018 5;6:62. Epub 2018 Mar 5.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

Vaccines are public health interventions aimed at preventing infections-related mortality, morbidity, and disability. While vaccines have been successfully designed for those infectious diseases preventable by preexisting neutralizing specific antibodies, for other communicable diseases, additional immunological mechanisms should be elicited to achieve a full protection. "New vaccines" are particularly urgent in the nowadays society, in which economic growth, globalization, and immigration are leading to the emergence/reemergence of old and new infectious agents at the animal-human interface. Conventional vaccinology (the so-called "vaccinology 1.0") was officially born in 1796 thanks to the contribution of Edward Jenner. Entering the twenty-first century, vaccinology has shifted from a classical discipline in which serendipity and the Pasteurian principle of the three s (isolate, inactivate, and inject) played a major role to a science, characterized by a rational design and plan ("vaccinology 3.0"). This shift has been possible thanks to Big Data, characterized by different dimensions, such as high volume, velocity, and variety of data. Big Data sources include new cutting-edge, high-throughput technologies, electronic registries, social media, and social networks, among others. The current mini-review aims at exploring the potential roles as well as pitfalls and challenges of Big Data in shaping the future vaccinology, moving toward a tailored and personalized vaccine design and administration.
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http://dx.doi.org/10.3389/fpubh.2018.00062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845111PMC
March 2018

The intraoperative therapeutic equivalence of balanced vs saline-based 6% hydroxyethyl starch 130/0.4 and their influence on perioperative acid-base status and renal functions.

J Clin Anesth 2016 Aug 23;32:267-73. Epub 2016 Apr 23.

Anesthesia & SICU Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Study Objective: This study was designed to evaluate the therapeutic equivalence of balanced 6% hydroxyethyl starch (HES) 130/0.4 (Tetraspan) vs saline-based 6% HES 130/0.4 (Voluven) regarding the volume effect and the effect on acid-base status and renal functions in patients undergoing major urologic procedures.

Design: Randomized comparative trial.

Setting: Operating room and ward.

Patients: Forty patients, American Society of Anesthesiologists statuses 1 and 2.

Intervention: Patients were randomly allocated to receive either Voluven (n = 20) or Tetraspan (n = 20).

Measurements: Hemodynamic variables. Laboratory variables in the form of arterial blood gases, serum chloride and sodium levels, hemoglobin level, international normalized ratio, and kidney and liver functions were measured after induction of anesthesia (T1), at the end of surgery (T2), and on the first postoperative day (T3).

Main Results: Both groups were comparable regarding the total amount of study drugs and crystalloid consumption. No significant difference in hemoglobin levels between both groups, but there were significant differences between T1 and T2 hemoglobin within both groups and T3 hemoglobin in the Tetraspan group. Both groups were comparable regarding the renal functions, but there was a significant difference between T1 and T2 creatinine within both groups. No significant differences between both groups in liver functions and coagulation profile, but there were significant differences between values at T1, T2 and T3 within each group. Relative to baseline, both pH and bicarbonate decrease significantly in both groups. In the Voluven group, bicarbonate decreased significantly at the end of surgery relative to the Tetraspan group. Serum electrolytes did not vary between both groups.

Conclusion: Both balanced 6% HES 130/0.4 (Tetraspan) and saline-based 6% HES 130/0.4 (Voluven) were equally effective for hemodynamic stabilization of patients undergoing major urologic procedures without any significant impact on acid-base status or renal functions.
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http://dx.doi.org/10.1016/j.jclinane.2016.01.025DOI Listing
August 2016

Cryptorchidism and Fertility.

Clin Med Insights Reprod Health 2015 22;9:39-43. Epub 2015 Dec 22.

Professor of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Cryptorchidism, the failure of one or both testes to descend into the scrotum prenatally, occurs in 2.4%-5% of newborns. Many of these testes will descend spontaneously shortly after birth, but ~23% will remain undescended unless surgery is performed. Bilaterally cryptorchid men have a six times greater risk of being infertile when compared with unilaterally cryptorchid men and the general male population. Approximately 10% of infertile men have a history of cryptorchidism and orchidopexy. The main reasons for infertility in men with a history of cryptorchidism treated by orchidopexy are maldevelopment of the testes and an improper environment for the normal development of the testes, hyperthermia, and antisperm antibodies.
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http://dx.doi.org/10.4137/CMRH.S25056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689328PMC
January 2016

Impact of nocturnal sleep deprivation on declarative memory retrieval in students at an orphanage: a psychoneuroradiological study.

Neuropsychiatr Dis Treat 2013 27;9:403-8. Epub 2013 Mar 27.

Educational Psychology Department, Faculty of Education, Assiut, Arab Republic of Egypt.

Background And Methods: This study investigated the effects of sleep deprivation on total and partial (early and late) declarative memory and activation in the areas of the brain involved in these activities. The study included two experiments. Experiment 1 included 40 male residents of an orphanage aged 16-19 years, who were divided into four groups (n = 10 each) and subjected to total sleep deprivation, normal sleep, early-night sleep deprivation, or late-night sleep deprivation. Experiment 2 included eight students from the same institution who were divided into the same four groups (n = 2) as in experiment 1. Declarative memory was tested using lists of associated word pairs in both experiments, and activation of the relevant brain regions was measured before and after retrieval by single-photon emission computed tomography for subjects in experiment 2 only.

Results: Students subjected to normal sleep had significantly higher scores for declarative memory retrieval than those subjected to total sleep deprivation (P = 0.002), early-night sleep deprivation (P = 0.005), or late-night sleep deprivation (P = 0.02). The left temporal lobe showed the highest rate of activity during memory retrieval after normal sleep, whereas the frontal, parietal, and right temporal lobes were more active after sleep deprivation.

Conclusion: Both slow wave sleep and rapid eye movement sleep play an active role in consolidation of declarative memory, which in turn allows memory traces to be actively reprocessed and strengthened during sleep, leading to improved performance in memory recall.
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http://dx.doi.org/10.2147/NDT.S38905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616140PMC
April 2013

Recoverability of renal function after treatment of adult patients with unilateral obstructive uropathy and normal contralateral kidney: a prospective study.

Urology 2004 Oct;64(4):664-8

Department of Urology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt.

Objectives: To study the methods of prediction of recoverability of renal function after the treatment of adult patients with unilateral obstructive uropathy and a normal contralateral kidney.

Methods: This prospective study included 91 consecutive adult patients with the diagnosis of unilateral obstructive uropathy and a normal contralateral kidney. All patients had a nonequivocal cause of obstruction that was successfully relieved after treatment. All patients underwent plain abdominal x-ray, gray-scale ultrasonography, Doppler ultrasonography, excretory urography, and technetium-99m-diethylenetriamine pentaacetic acid radioisotope renography before and after treatment. Patients were seen regularly at 3, 6, and 12 months for a mean duration of 13 +/- 6 months (range 6 to 36). At each visit, ultrasonography and renography were performed, and excretory urography was performed at least once during follow-up. Several renographic and ultrasound parameters were studied before and after treatment to evaluate their value in predicting the recoverability of renal function. The difference between the selective renographic glomerular filtration rate (GFR) of the ipsilateral kidney before treatment and its mean value after treatment was considered as the reference variable to which all other variables were compared. All prognostic parameters were evaluated by both univariate and multivariate analyses.

Results: On univariate analysis, the factors that significantly affected the recoverability of renal function after the relief of obstruction included preoperative renographic GFR, renal perfusion, parenchymal thickness, parenchymal echogenicity, corticomedullary differentiation, reduction of the renal resistive index of the corresponding kidney, and compensatory hypertrophy of the contralateral normal kidney. However, using multivariate analysis, only the preoperative selective renographic GFR and renal perfusion of the corresponding kidney sustained their statistical significance as independent factors affecting renal functional recovery. A preoperative GFR value of 10 mL/min/1.73 m2 was estimated as the cutoff point that can determine the best prediction of stabilization or improvement of renal function after the relief of obstruction.

Conclusions: Preoperative renographic clearance and perfusion of the corresponding kidney were the only predictors of recoverability of unilateral renal obstruction. Kidneys with a renographic GFR of less than 10 mL/min/1.73 m2 were irreversibly damaged. Improvement or stabilization of function can be expected after relief of obstruction of kidneys with a renographic GFR of 10 mL/min/1.73 m2 or greater.
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http://dx.doi.org/10.1016/j.urology.2004.05.018DOI Listing
October 2004

Colorimetric evaluation of the influence of five different restorative materials on the color of veneered densely sintered alumina.

J Esthet Restor Dent 2003 ;15(6):353-60; discussion 361

Department of Operative Dentistry, School of Dentistry, National and Kapodistrian University, Athens, Greece.

Purpose: Since the introduction of densely sintered alumina ceramic material in prosthetic dentistry for the fabrication of all-ceramic crowns, no scientific data have been presented on the color of these restorations in combination with different restorative materials. The purpose of this in vitro study was to evaluate the influence of five different restorative materials used for implant abutments or posts and cores on the color of veneered densely sintered alumina.

Materials And Methods: Sixty discs, 0.6 mm in thickness and 10 mm in diameter, were made out of densely sintered alumina ceramic material (Procera, Nobel Biocare, Gothenburg, Sweden) and veneered using feldspathic porcelain (AllCeram, Ducera, Rosbach, Germany) for a total thickness of 2 mm. Ten of the discs were evaluated colorimetrically using the CIE, L*, a*, b* system (control group). In addition, 50 discs, 3 mm in thickness and identical diameter, were fabricated using the following restorative materials (five different materials used on 10 specimens each): (1) high-precious gold alloy, (2) aluminum-oxide ceramic material, (3) titanium metal alloy, (4) yttrium-stabilized zirconium dioxide ceramic material, and (5) glass-ceramic material. The 50 veneered densely sintered alumina specimens were bonded to the 50 restorative specimens using an autopolymerizing luting composite. L*, a*, b* color coordinates were measured 10 times for each veneered densely sintered alumina specimen. Color differences were calculated using the equation DeltaE = [(DeltaL*)2 + (Deltaa*)2 + (Deltab*)2] 1/2. DeltaE values correspond to differences between the control group and each of the five materials groups.

Results: Mean color differences (DeltaE) and SDs for each group were as follows: DeltaE (1) = 1.42 +/- 0.5, DeltaE (2) = 1.53 +/- 0.5, DeltaE (3) = 1.55 +/- 0.4, DeltaE (4) = 1.95 +/- 0.5, DeltaE (5) = 1.23 +/- 0.3. All restorative materials induced changes to the densely sintered alumina color relative to the original color. One-way analysis of variance (ANOVA) tests showed statistically significant differences in DeltaE between the groups; however, the Student-Newman-Keuls test revealed that the only statistically significant difference was between groups 4 and 5. Color differences between the groups were not visually perceivable (DeltaE < 2).

Clinical Significance: Within the limits of this in vitro study, veneered densely sintered alumina adhesively fixed with dentine-like cement, successfully masks the shade of different metal or ceramic restorative materials.
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http://dx.doi.org/10.1111/j.1708-8240.2003.tb00308.xDOI Listing
May 2004

Fracture strength after dynamic loading of endodontically treated teeth restored with different post-and-core systems.

J Prosthet Dent 2002 Apr;87(4):438-45

Department of Biological and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, USA.

Statement Of Problem: Prefabricated metal and ceramic posts can be used with direct or indirect cores as an alternative to the conventional cast post and core. It is unclear how the fracture strength of zirconia posts with composite or ceramic cores and titanium posts with composite cores compares to the fracture strength of gold posts and cores after dynamic loading.

Purpose: This study compared the fracture strength of endodontically treated, crowned maxillary incisors with limited ferrule length and different post-and-core systems after fatigue loading.

Material And Methods: Sixty-four caries-free, human maxillary central incisors were divided into 4 groups. After root canal treatment, Group 1 was restored with titanium posts and composite cores, Group 2 with zirconia posts and composite cores, and Group 3 with zirconia posts and heat-pressed ceramic cores. Teeth restored with cast-on gold posts and cores served as the controls (Group 4). Teeth were prepared with a circumferential shoulder including a 1 to 2 mm ferrule; all posts were cemented with an adhesive resin cement, restored with complete-coverage crowns, and exposed to 1.2 million load cycles (30 N) in a computer-controlled chewing simulator. Simultaneous thermocycling between 5 degrees C and 55 degrees C was applied for 60 seconds with an intermediate pause of 12 seconds. All specimens that did not fracture during dynamic loading were loaded until fracture in a universal testing machine at a crosshead speed of 1.5 mm/min; loads were applied at an angle of 130 degrees at the incisal edge. Fracture loads (N) and modes (repairable or catastrophic) were recorded. The Kruskal-Wallis test was used to compare fracture loads among the 4 test groups. Analyses were conducted both with and without the specimens that failed during the chewing simulation. A Fisher exact test was performed to detect group differences in fracture modes. A significance level of P<.05 was used for all comparisons.

Results: The following survival rates were recorded after the chewing simulation: 93.8% (Group 1), 93.8% (Group 2), 100% (Group 3), and 87.5% (Group 4). The median fracture strengths for Groups 1 to 4 were 450 N, 503 N, 521 N, and 408 N, respectively. No significant differences were detected among the groups. The use of zirconia posts resulted in a nonsignificant lower number of catastrophic root fractures.

Conclusion: Within the limitations of this study, the results suggest that zirconia posts with ceramic cores can be recommended as an alternative to cast posts and cores. If a chairside procedure is preferred, zirconia or titanium posts with composite cores can be used. Clinical trials are required to verify these in vitro results.
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http://dx.doi.org/10.1067/mpr.2002.123849DOI Listing
April 2002
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