Publications by authors named "Mohamed A Mohamed"

75 Publications

Cue-Based Feeding as Intervention to Achieve Full Oral Feeding in Preterm Infants Primarily Managed with Bubble CPAP.

Am J Perinatol 2021 Jun 15. Epub 2021 Jun 15.

Department of Rehabilitation, the George Washington University Hospital, Washington, District of Columbia.

Objective:  Cue-based feeding aims at matching introduction of per oral (PO) feeding with physiological readiness of preterm infants to facilitate PO intake and avoid oral aversion. It was claimed that cue-based feeding may lead to delay in the initiation or achieving full PO feeding in clinical setting primarily using bubble nasal continuous positive airway pressure (CPAP). The study aimed to examine the association of cue-based feeding with time of introduction and completing oral feeding in infants primarily managed with bubble CPAP.

Study Design:  A retrospective analysis where outcomes of preterm infants ≤32 weeks' gestational age (GA) and ≤2,000 g birth weight (BW) were compared after a practice change from volume-based feeding advancement to cue-based feeding. Continuous variables were compared by using -test and multilinear regression analysis to control for confounding variables.

Results:  Of the 311 preterm infants who met inclusion and exclusion criteria, 194 were in the cue-based feeding group and 117 were in the volume-based advancement historical comparison group. There were no differences between groups regarding demographic or clinical variables. Postmenstrual age (PMA) of initial feeding assessment was less in the cue-based feeding group. Age of first PO feeding and when some PO was achieved every feed was mildly delayed in the cue-based feeding compared with comparison group, 34 (±1.3) versus 33.7 (±1.2) weeks, and 36.2 (±2.3) versus 36.0 (±2.4) weeks, ( < 0.01) respectively. However, the age of achieving full PO did not differ between groups, 36.8 (±2.2) versus 36.4 (±2.4) weeks ( = 0.13). There was no difference between groups regarding growth parameters at 36 weeks' PMA or at discharge. Similar results were obtained when examining subcategories of infants ≤1,000 g and 1,001 to 2,000 g.

Conclusion:  Cue-based feeding may not be associated with a delay in achieving full oral feeding or prolongation of the length of stay in preterm infants managed with CPAP.

Key Points: · Cue-based feeding matches introduction of PO feeding with physiological readiness.. · Cue-based feeding may not be associated with a delay in achieving full oral feeding in preterm infants.. · Cue-based feeding is not associated with prolongation of the length of stay in preterm infants.. · Cue based feeding in preterm infants managed with noninvasive bubble CPAP is examined..
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http://dx.doi.org/10.1055/s-0041-1731046DOI Listing
June 2021

Winning the Battle after Three Years of Suffering: A Case of a Refractory Pyoderma Gangrenosum Treatment Challenge.

Case Rep Rheumatol 2021 13;2021:8869914. Epub 2021 Mar 13.

Division of Rheumatology, Department of Internal Medicine, Reid Healthcare System, Indianapolis, IN, USA.

Pyoderma gangrenosum is an uncommon inflammatory disorder characterized by neutrophilic infiltration of the skin. It can present as skin papules or pustules that progress into painful ulcers. 30-40% of the cases are associated with other systemic diseases such as inflammatory bowel diseases, rheumatoid arthritis, and proliferative hematological disorders. Uniquely, this condition has been associated with systemic lupus erythematosus (SLE). The rarity of this disorder poses a diagnostic and therapeutic challenge. We present a case of a 55-year-old female with a history of SLE and chronic right leg ulcer, presented with increased pain from the ulcer associated with a mild flare of her cutaneous lupus; examination revealed circumferential skin ulcer measuring about 25 cm extending around the right leg above the ankle with prominent fibrinous material and surrounding erythema. Blood work showed elevated WBC with neutrophilic predominance. Serology revealed a positive ANA, elevated RNP, smith, and SSA/Ro antibodies with normal anti-CCP level. Skin biopsy was taken, and it showed a diffuse neutrophilic and lymphocytic infiltrate consistent with the diagnosis of pyoderma gangrenosum. The patient was then treated with topical and systemic steroids and sequentially with dapsone, methotrexate, mycophenolate, and cyclosporine for over a two-year period but failed to show any improvement. Therefore, a trial of intravenous immunoglobulin (IVIG) therapy was attempted and produced a dramatic response after two-month infusions characterized by shrinking in the size of the ulcer and resolving pain. We believe that refractory PG poses a therapeutic challenge, and despite a lack of specific guidelines, IVIG can be attempted if initial suppressive treatment fails to show signs of improvement.
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http://dx.doi.org/10.1155/2021/8869914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981170PMC
March 2021

So much nuance: A qualitative analysis of parental perspectives on child passenger safety.

Traffic Inj Prev 2021 4;22(3):224-229. Epub 2021 Mar 4.

Children's National Hospital, Washington, DC.

Objective: To explore barriers and facilitators to optimal child restraint system (CRS) use for diverse parents of newborn infants and to obtain input from parents on the use of technology-assisted remote car seat checks as tools for promoting optimal CRS use.

Methods: Parents were recruited using purposive sampling. Interviews were conducted with English- or Spanish-speaking parents with a full term newborn and regular access to a car. Interviews were conducted by phone, and recorded and transcribed verbatim. Interviews were conducted until thematic saturation was reached. Data were organized for analysis using Atlas.ti, and codes grouped by theme using constant comparison.

Results: 30 parents were enrolled. Barriers and facilitators to optimal CRS use were classified into three themes, as were thoughts on the pros and cons regarding remote car seat checks. Themes on barriers and facilitators included motor vehicle and CRS features (such as age and size of the motor vehicle and presence of the Lower Anchors and Tethers for Children LATCH system), resources (availability, accessibility, and accuracy of resources), and parental factors (parental emotions and characteristics). Themes related to pros and cons of remote car seat checks included the ability (and challenge) of remote car seat checks to identify and correct errors, the potential use of remote car seat checks in certain situations (such as CRS transitions and periods of growth), and convenience of remote car seat checks (including increased availability and ease of access). Subthemes with further detail were arranged within each theme identified.

Conclusion: From a parent perspective, there are several identified barriers and facilitators of optimal CRS use. Although car seat checks were identified as a resource, in-person accessibility was an issue, and there were mixed opinions on technology-assisted remote car seat checks. These results provide a foundation for additional study on targeted interventions, including remote interventions for which there is an increased need due to the COVID-19 pandemic.
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http://dx.doi.org/10.1080/15389588.2021.1877276DOI Listing
April 2021

Hydroxychloroquine is associated with slower viral clearance in clinical COVID-19 patients with mild to moderate disease.

Medicine (Baltimore) 2020 Dec;99(52):e23720

Infectious Disease.

Abstract: There are conflicting data regarding the use of hydroxychloroquine (HCQ) in COVID-19 hospitalized patients. The objective of this study was to assess the efficacy of HCQ in increasing SARS-CoV-2 viral clearance.Hospitalized adult patients with confirmed SARS-CoV-2 infection were retrospectively included in the study. The primary outcome was the time from a confirmed positive nasopharyngeal swab to turn negative. A negative nasopharyngeal swab conversion was defined as a confirmed SARS-CoV-2 case followed by 2 negative results using RT-PCR assay with samples obtained 24 hours apart. Multiple linear regression analysis was used to adjust for potential confounders.Thirty-four confirmed COVID-19 patients completed the study. Nineteen (55.9%) patients presented with symptoms, and 14 (41.2%) had pneumonia. Only 21 (61.8%) patients received HCQ. The time to SARS-CoV-2 negativity nasopharyngeal test was significantly longer in patients who received HCQ than those who did not receive HCQ [17 (13-21) vs 10 (4-13) days, P = .023]. HCQ was independently associated with time to negativity test after adjustment for potential confounders (symptoms, comorbidities, antiviral drugs, pneumonia, or oxygen therapy) in multivariable Cox proportional hazards regression analysis (hazard ratio = 0.33, 95% confidence interval: 0.13-0.9, P = .024). On day 14, 47.8% (14/23) patients tested negative in the HCQ group compared with 90.9% (10/11) patients who did not receive HCQ (P = .016).HCQ was associated with a slower viral clearance in COVID-19 patients with mild to moderate disease. Data from ongoing randomized clinical trials with HCQ should provide a definitive answer regarding the efficacy and safety of this treatment.
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http://dx.doi.org/10.1097/MD.0000000000023720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769326PMC
December 2020

A Chaotic-Based Encryption/Decryption Framework for Secure Multimedia Communications.

Entropy (Basel) 2020 Nov 4;22(11). Epub 2020 Nov 4.

Electronics and Communications Engineering Department, Faculty of Engineering, Mansoura University, Mansoura 35516, Egypt.

Chaos-based encryption has shown an increasingly important and dominant role in modern multimedia cryptography compared with traditional algorithms. This work proposes novel chaotic-based multimedia encryption schemes utilizing 2D alteration models for high secure data transmission. A novel perturbation-based data encryption for both confusion and diffusion rounds is proposed. Our chaotification structure is hybrid, in which multiple maps are combined combines for media encryption. Blended chaotic maps are used to generate the control parameters for the permutation (shuffling) and diffusion (substitution) structures. The proposed schemes not only maintain great encryption quality reproduced by chaotic, but also possess other advantages, including key sensitivity and low residual clarity. Extensive security and differential analyses documented that the proposed schemes are efficient for secure multimedia transmission as well as the encrypted media possesses resistance to attacks. Additionally, statistical evaluations using well-known metrics for specific media types, show that proposed encryption schemes can acquire low residual intelligibility with excessive nice recovered statistics. Finally, the advantages of the proposed schemes have been highlighted by comparing it against different state-of-the-art algorithms from literature. The comparative performance results documented that our schemes are extra efficacious than their data-specific counterpart methods.
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http://dx.doi.org/10.3390/e22111253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712162PMC
November 2020

Length of Neuromuscular Re-education Therapy and Growth Parameters in Premature Infants.

Am J Perinatol 2020 Sep 11. Epub 2020 Sep 11.

Department of Neonatology, Pediatrics Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio.

Objective:  Neuromuscular re-education (NMRE) therapy including bracing, containment, facilitation techniques, joint compression, weight (WT) bearing, and myofascial release has been shown to improve neurodevelopmental maturation in premature infants. This study aimed to examine the association of NMRE with growth parameters including WT and length (L) at 36 weeks postmenstrual age (PMA) and at discharge.

Study Design:  We analyzed data of infants <34 weeks gestational age (GA) or <1,800 g birth weight (BW) to examine the association of NMRE with growth parameters using correlation coefficient analysis. The effect of potential confounders was examined using multilinear regression models.

Results:  Study includes 253 premature infants. Average GA was 30 weeks (±2) and BW was 1,315 g (±416), 49.8% were females and 65% were African Americans. NMRE has inverse correlation with WT at birth and at 36 weeks PMA, -0.66 (<0.001) and -0.21 (<0.001), respectively, but not at the time of discharge. NMRE has direct correlation with change in WT from birth to 36 weeks PMA and time of discharge, 0.50 (<0.001) and 0.62 (<0.001), respectively, and from the time of starting therapy to 36 weeks PMA or discharge, 0.25 (<0.001) and 0.51 (<0.001), respectively. There was no negative correlation between NMRE with daily WT gain from birth to 36 weeks PMA or to discharge, -0.05 (0.43) and -0.07 (0.23), respectively, or from the time of starting therapy to 36 weeks PMA, -0.09 (0.14). There was an inverse correlation between NMRE with average WT gain per day from the time of starting therapy to discharge, -0.26 (<0.001), Similar findings were found examining the correlation between NMRE and changes in L. Multilinear regression analysis examining the relationship while controlling for GA, BW, sex, and race; socioeconomic variables; and concurrent massage therapy and sensory integration revealed similar results.

Conclusion:  NMRE, aimed to enhance neurodevelopmental outcomes of premature infants, may not have a negative impact on their physical growth.

Key Points: · NMRE has been introduced in the care of premature infants to improve neurodevelopmental outcomes.. · It was hypothesized that NMRE may cause stress and lead to failure to thrive or suboptimal growth.. · The association of the duration of NMRE with length and weight gain in very low birth weight infants was examined, and there was no negative correlation..
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http://dx.doi.org/10.1055/s-0040-1716492DOI Listing
September 2020

Misdiagnosis of imported malaria from African areas due to an increased prevalence of gene deletion: the Djibouti case.

Emerg Microbes Infect 2020 Dec;9(1):1984-1987

Laboratoire d'analyse médicale Mer Rouge, Djibouti, République de Djibouti.

Following the diagnosis of a malaria case imported from Djibouti and not detected by a pfHRP2-based rapid diagnostic test (RDT), we investigated the prevalence of the -deleted parasites in Djibouti using 378 blood samples collected between January and May 2019, from Djiboutian patients with suspected malaria. Malaria diagnosis by quantitative PCR confirmed the presence of for 20.9% (79/378) samples while RDTs did not detect HRP2 antigen in 83.5% (66/79) of these samples. Quantitative PCRs targeting the genes confirmed the absence of both genes for 86.5% of strains. The very large number (86.5%) of f parasites lacking the genes observed in this study, now justifies the use of non-HRP2 alternative RDTs in Djibouti. In this area and in most countries where HRP2-based RDTs constitute the main arsenal for malaria diagnosis, it is important to implement a systematic surveillance and to inform biologists and clinicians about the risk of malaria misdiagnosis. Further investigations are needed to better understand the mechanism of selection and diffusion of the -deleted parasites.
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http://dx.doi.org/10.1080/22221751.2020.1815590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534257PMC
December 2020

The association of maternal hypertensive disorders with neonatal congenital heart disease: analysis of a United States cohort.

J Perinatol 2020 11 28;40(11):1617-1624. Epub 2020 Aug 28.

Division of Newborn Services, The George Washington University Hospital, Washington, DC, USA.

Objective: To examine the association of any type of maternal hypertensive disorders of pregnancy (HDP) and neonatal congenital heart diseases (CHD).

Study Design: We compared the prevalence of CHD between neonates born to mothers with HDP to those delivered to mothers without HDP among 24,525,889 hospital records of living infants, from a national database. We controlled for multiple confounding factors by using multiple logistic regression analysis.

Results: Infants delivered to mothers with HDP had higher prevalence of CHD compared to infants born to mothers without HDP [5.20% vs. 1.47%; aOR: 2.51(2.38-2.64), p < 0.001]. Maternal diabetes was more frequent among infants born to mothers with HDP and was independently associated with CHD [aOR 5.14 (5.04-5.23), p < 0.001].

Conclusion: Infants born to mothers with hypertension had almost a threefold increase in CHD compared with those born to mothers without hypertension. Further studies are needed to investigate the underlying mechanism and direction of this association.
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http://dx.doi.org/10.1038/s41372-020-00795-9DOI Listing
November 2020

Changes in cerebral tissue oxygenation and fractional oxygen extraction with gestational age and postnatal maturation in preterm infants.

J Perinatol 2021 Apr 22;41(4):836-842. Epub 2020 Aug 22.

Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.

Objective: This study examined the correlation of cerebral tissue oxygen saturation (SctO) and cerebral tissue fractional oxygen extraction (cFTOE) with gestational age (GA) and postnatal age over the first 28 days of life.

Study Design: Preterm infants with birth weight (BW) <1500 g were monitored with near-infrared spectroscopy (NIRS) during the first 28 days of life. SctO and cFTOE measurements were analyzed using a linear mixed model.

Results: A total of 70 preterm infants were included. Mean SctO decreased with increasing GA; SctO was 76.4% and 74.6% in the first 24 h for infants 24 and 28-week GA, respectively. For infants born at 24 and 28 it decreased to 52.9% and 58.4% at 28 days of life, respectively. cFTOE increased with increasing GA and postnatal age.

Conclusions: There is an inverse relationship between SctO and gestational age and postnatal age but a direct relationship between cFTOE with GA and postnatal age.
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http://dx.doi.org/10.1038/s41372-020-00794-wDOI Listing
April 2021

Renal Transplant Recipient with Concurrent COVID-19 and Stenotrophomonas maltophilia Pneumonia Treated with Trimethoprim/Sulfamethoxazole Leading to Acute Kidney Injury: A Therapeutic Dilemma.

Am J Case Rep 2020 Aug 16;21:e926464. Epub 2020 Aug 16.

Division of Pulmonary and Critical Care, Ascension St Mary's Hospital, Saginaw, MI, USA.

BACKGROUND Although coronavirus disease 2019 (COVID-19) manifests primarily as a lung infection, its involvement in acute kidney injury (AKI) is gaining recognition and is associated with increased morbidity and mortality. Concurrent infection, which may require administration of a potentially nephrotoxic agent, can worsen AKI and lead to poor outcomes. Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus associated with nosocomial infections, especially in severely immunocompromised and debilitated patients. Trimethoprim/sulfamethoxazole combination (TMP/SMX) is considered the treatment of choice but can itself lead to AKI, posing a significant challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. CASE REPORT A 64-year-old male with end-stage renal disease and post renal transplant presented with severe respiratory symptoms of COVID-19 and was intubated upon admission. His renal functions were normal at the time of admission. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia requiring administration of TMP/SMX. However, TMP/SMX led to the development of AKI, which continued to worsen despite appropriate management including hemodialysis. This coincided with and most likely resulted in the patient's clinical deterioration and ultimate death. CONCLUSIONS The etiology of kidney disease involvement in patients with COVID-19 is still evolving and appears to be multifactorial. The condition can significantly worsen especially when nephrotoxic agents are given, probably due to a cumulative or synergistic effect. Great caution should be taken when administering nephrotoxic agents in the setting of COVID-19 as it can lead to adverse patient outcomes.
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http://dx.doi.org/10.12659/AJCR.926464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447293PMC
August 2020

Management of benign prostate hyperplasia (BPH) by combinatorial approach using alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors.

Eur J Pharmacol 2020 Sep 25;883:173301. Epub 2020 Jun 25.

Sulaiman AlRajhi University, Al Bukairiyah, Kingdom of Saudi Arabia. Electronic address:

Currently, the main available treatments for benign prostate hyperplasia (BPH) are alpha-1 adrenergic receptor antagonists (ARAs), 5-alpha reductase inhibitors (5-αRI), anticholinergics, and Phosphodiesterase-5 inhibitors. Recent studies support the combined therapy approach using ARAs with 5-αRI for lower urinary tract symptoms (LUTS) in BPH patients at risk of clinical progression. We aimed to review BPH management in select group of randomized controlled trials by combination therapy with ARAs and 5-αRIs compared to monotherapy with either drug with respect to the safety and efficacy. A total of 6 randomized controlled trials (RCTs) involving comparison of combination therapy with monotherapy using ARAs and 5-αRIs were retrieved from PubMed Central and reviewed for international prostate symptom score (IPSS), quality of life (QoL), post-residual urinary flow rate (PUF), and clinical progression. The results significantly favour the treatment group that received the combination therapy in comparison with the groups receiving monotherapy. However, outcome with regard to prostate volume showed insignificant improvement when the combination therapy is compared with 5- αRIs alone, rather than ARAs. In conclusion, combination therapy using ARAs and 5-αRI is better than monotherapy in the patients of BPH. Fixed dose combination (FDC), a type of combination, is also cost-effective and its side-effects profile resembles to that of monotherapy.
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http://dx.doi.org/10.1016/j.ejphar.2020.173301DOI Listing
September 2020

Reduced Graphene Oxide Nanosheet-Decorated Copper Oxide Nanoparticles: A Potent Antifungal Nanocomposite against Fusarium Root Rot and Wilt Diseases of Tomato and Pepper Plants.

Nanomaterials (Basel) 2020 May 24;10(5). Epub 2020 May 24.

Mycology and Disease Survey Research Department, Plant Pathology Research Institute, Agricultural Research Center, Giza 12619, Egypt.

Sustainable use of nanotechnology in crop protection requires an understanding of the plant's life cycle, potential toxicological impacts of nanomaterials and their mechanism of action against the target pathogens. Herein, we show some properties of a candidate antifungal nanocomposite made from copper oxide (CuO; otherwise an essential soil nutrient) nanoparticles (NPs), with definite size and shape, decorating the surface of reduced graphene oxide (rGO) nanosheets. The successful preparation of the rGO-CuO NPs was confirmed by spectroscopic and microscopic analyses, and its antifungal activity against wild strains of affecting tomato and pepper plants was successfully confirmed. A comparative analysis in vitro indicated that this nanocomposite had higher antifungal activity at only 1 mg/L than the conventional fungicide Kocide 2000 at 2.5 g/L. Further investigation suggested that rGO-CuO NPs creates pits and pores on the fungal cell membranes inducing cell death. results indicated that only 1 mg/L from the nanocomposite is required to reduce Fusarium wilt and root rot diseases severity below 5% for tomato and pepper plants without any phytotoxicity for about 70 days. Comparatively, 2.5 g/L of Kocide 2000 are required to achieve about 30% disease reduction in both plants. The present study contributes to the concept of agro-nanotechnology, showing the properties of a novel ecofriendly and economic nanopesticide for sustainable plant protection.
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http://dx.doi.org/10.3390/nano10051001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281300PMC
May 2020

A Rare and Fatal Case of Hemophagocytic Lymphohistiocytosis Associated with Sarcoidosis.

Am J Case Rep 2020 Apr 21;21:e921306. Epub 2020 Apr 21.

Department of Rheumatology, Henry Ford Hospital, Detroit, MI, USA.

BACKGROUND Sarcoidosis is a systemic inflammatory disorder characterized by a classic pathologic feature of non-caseating granulomas involving any organ system. Hemophagocytic lymphohistiocytosis (HLH) is a catastrophic cytokine surge characterized by dysregulation of the macrophage response, which can be rapidly fatal. Recognition of HLH has been increasing over the past decade. HLH can present with features of sepsis that can make the diagnosis challenging and requires high clinical suspicion. CASE REPORT We report a case of a 48-year-old African American male with a past medical history of sarcoidosis infiltrating the lymph nodes, liver, and bone marrow with initial presentation of abdominal pain, nausea, vomiting, and weight loss of 100 pounds over 8 months. Sepsis was suspected, but the patient clinically deteriorated with vancomycin and cefepime. Fevers, bone marrow biopsy, anemia, thrombocytopenia, elevated ferritin, and elevated soluble receptor interleukin 2 confirmed HLH. The patient was treated with etoposide and dexamethasone with poor response and died from cardiac arrest. CONCLUSIONS Sarcoidosis associated with HLH is an extremely rare phenomenon with only 10 cases reported in the literature. Early clinical suspicion can be challenging as this condition is a sepsis-mimicker. To reduce mortality, prompt initiation of therapy is a key determinant in patients who are clinically deteriorating despite treatment for sepsis.
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http://dx.doi.org/10.12659/AJCR.921306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193225PMC
April 2020

Ligation of patent ductus arteriosus in very low birth weight premature infants.

Pediatr Neonatol 2020 08 24;61(4):399-405. Epub 2020 Mar 24.

Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA. Electronic address:

Background: Patent ductus arteriosus (PDA) is frequently encountered in premature infants. Optimal management of PDA remains undefined. We aim to assess the national trend for PDA ligation over 18 years and evaluate mortality and associated morbidities.

Methods: We used data from the National Inpatient Sample (NIS) and KID of the Healthcare Cost and Utilization Project (HCUP) from 1998 to 2015. All infants with gestational age 24-32 weeks and birth weight <1500 g were included. Patients with PDA were classified into two groups: those who did and did not receive surgical ligation. Associated mortality and morbidities were compared.

Results: A total of 429,900 neonatal admissions were identified. Of them, 149,473 (34.8%) infants had PDA. PDA-ligated infants were 27,364 (6.4%). PDA ligation was more likely in those with smaller gestational age and with birth weight <1000 g. A steady decline in PDA ligation was noticed since 2004. The mortality rate in PDA-ligated infants was less than in PDA-non-ligated infants (7.5% vs. 8.9%; OR = 0.82; 95% CI: 0.78-0.86; p < 0.001). However, the prevalence rates of pulmonary hemorrhage and necrotizing enterocolitis (NEC) were greater in PDA-ligated infants (OR = 1.58; 95% CI: 1.49-1.67; p < 0.001, and OR = 1.32; 95% CI: 1.26-1.38; p < 0.001, respectively).

Conclusions: Ligation of PDA has been steadily declining since 2004. Despite higher morbidities, PDA-ligated infants had less mortality.
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http://dx.doi.org/10.1016/j.pedneo.2020.03.009DOI Listing
August 2020

An experience with a bubble CPAP bundle: is chronic lung disease preventable?

Pediatr Res 2020 09 17;88(3):444-450. Epub 2020 Jan 17.

The George Washington University Hospital, Washington, DC, USA.

Background: Continuous positive airway pressure (CPAP) is associated with marginal decrease in chronic lung disease (CLD). This study aims to report outcomes, with focus on CLD, of preterm infants managed with a bubble CPAP (b-CPAP) bundle of care.

Methods: Infants <1500 g were stratified into four groups depending on intubation status through first 3 days of life. The incidence of mortality, CLD and other morbidities were compared over four chronological epochs. Outcomes of the most recent epoch were compared to contemporaneous benchmarks from Vermont Oxford Network (VON).

Results: Of 773 infants (median GA = 28 weeks, average BW = 995 g), 24.5% were intubated in DR and 11.7% in the first day of life. Mechanical ventilation, bCPAP and oxygen days in survivors were 1.5, 29 and 14, respectively. Overall incidence of CLD was 6.4% that remained consistent in the four epochs (7.6%, 7.5%, 5.8% and 5%), respectively. In comparison to VON, CLD was significantly less (p < 0.001). Initial DR intubation was not associated with increased CLD compared to initial management with CPAP that required subsequent intubation.

Conclusion: It is feasible and sustainable to administer a b-CPAP bundle of care to decrease CLD. Cluster randomized trials are needed to validate the reproducibility of this approach.
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http://dx.doi.org/10.1038/s41390-020-0763-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223768PMC
September 2020

Myco-engineered gold nanoparticles from Jahnula aquatica coated with ampicillin/amoxicillin and their antibacterial and anticancer activity against cancer cells.

Biotechnol Lett 2020 Jan 15;42(1):151-170. Epub 2019 Nov 15.

Nanotechnology & Advanced Nano-Materials Laboratory (NANML), Plant Pathology Research Institute, Agricultural Research Center, Giza, 12619, Egypt.

Introduction: Antibiotics play an important role in medical treatments. However, the multidrug resistance (MDR) bacteria impairs their functionality. Therefore, drug delivery represents the solution for this problem. Many techniques and methods are used in drug delivery, however nanoparticles conjugated drug is one of the most effective and promising techniques. The current work investigates a one-step method of extracellular biosynthesis of gold nanoparticles (AuNPs) and their biocompatibility in antibiotic delivery, where the synthesized AuNPs were loaded with Ampicillin/Amoxicillin.

Results: Both ampicillin and amoxicillin antibiotics are successfully conjugated with the Au NPs surface (the potential efficiency), especially, at the smaller particle size. Where, the Au NPs with particle size of 8 m size reveals a promising activity against cancer cells with 48 µg/mL inhibitory concentration (IC) after 24 h of their exposure to HeLa cells, and induction of apoptosis was also noticed on HeLa treated cells.

Conclusions: The bio-synthesised Au NPs using Jahnula. aquatica fungi show a promising nanocarrier biocompatibility drug delivery system in cancer clinical treatments, in particular for antibiotics delivery antibiotics in pharmaceutical applications with large-scale commercial production. To the best of our knowledge, freshwater fungi have never been exploited for AuNPs synthesis.
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http://dx.doi.org/10.1007/s10529-019-02764-5DOI Listing
January 2020

Continuous positive airway pressure and high flow nasal cannula: the search for effectiveness continues.

Pediatr Res 2020 01 22;87(1):11-12. Epub 2019 Oct 22.

Division of Newborn Services, The George Washington University Hospital, Washington, DC, USA.

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http://dx.doi.org/10.1038/s41390-019-0626-yDOI Listing
January 2020

New Approach for Securing and Dating Valuable Printed Documents.

Glob Chall 2019 Oct 28;3(10):1800097. Epub 2019 May 28.

Forgery Research Department Medico-legal Sector Ministry of Justice Cairo 11461 Egypt.

This work deals with using a novel approach for securing and dating printed documents, which will detect any forging crime present. In this respect, the coded dots matrices (machine identification code (MIC)) for the used printers are extracted via a binary system of base 2 (0, 1). The UV ink used in the printing process is prepared from novel fluorescence compounds together with polyvinyl alcohol. Different Xerox models of color laser printers are used for printing the document designs. The data obtained reveal that the investigated approach is succeeded in specifying the date of the printing process together with translating the embedded data of the printer to visible information, which can be tracked under a UV lamp. This innovative approach will assist workers in examining the questioned document by specifying the authorized date and position of printed documents from the MIC.
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http://dx.doi.org/10.1002/gch2.201800097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777380PMC
October 2019

Isolated right atrial rupture from blunt trauma: a case report with systematic review of a lethal injury.

J Cardiothorac Surg 2019 Feb 4;14(1):28. Epub 2019 Feb 4.

Trauma Department, Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA.

Background: Isolated right atrial rupture (IRAR) from blunt chest trauma is rare. There are no physical exam findings and non-invasive testing specific to the condition, which result in diagnostic delays and poor outcomes. We present a case of IRAR along with a systematic review of similar cases in the literature.

Case Report: A 23-year-old male presented following a motor vehicle accident (MVA). He was bradycardic and hypotensive during transportation; and required intubation. There were contusions along the right chest wall with clear breath sounds, and no jugular venous distension, muffled heart sounds. Hemodynamic status progressively worsened, ultimately leading to his death. However, no external sources of bleeding or evidence of cardiac tamponade was found.

Methods: A search of PubMed, Ovid, and the Cochrane Library using: (Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right Atrium OR Right Atrial). Articles were included if they were original articles describing cases of IRAR.

Results: Forty-five reports comprising seventy-five (n = 75) cases of IRAR.

Conclusion: IRAR most commonly occurs following MVAs as the result of blunt chest trauma. Rupture occurs at four distinct sites and is most commonly at the right atrial appendage. IRAR is a diagnostic challenge and requires a high index of suspicion, as patients' hemodynamics can rapidly deteriorate. The presentations vary depending on multiple factors including rupture size, pericardial integrity, and concomitant injuries. Cardiac tamponade may have a protective effect by prompting the search for a bleeding source. A pericardial window can be diagnostic and therapeutic in IRAR. Outcomes are favourable with timely recognition and prompt surgical intervention.
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http://dx.doi.org/10.1186/s13019-019-0836-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360731PMC
February 2019

Hydrochemical Analysis and Fuzzy Logic Method for Evaluation of Groundwater Quality in the North Chengdu Plain, China.

Int J Environ Res Public Health 2019 01 23;16(3). Epub 2019 Jan 23.

Faculty of Geoscience and Environmental Engineering, Southwest Jiaotong University, Chengdu 611756, China.

Groundwater is a major water resource in the North Chengdu Plain, China. The research objective is to determine the quality and suitability of groundwater for drinking purposes within the vicinity of a shallow, unconsolidated aquifer of Quaternary age. In this study, a detailed investigation was conducted to define the hydrochemical characteristics that control the quality of groundwater, based on traditional methods. Considering the uncertainties linked with water resources and the environmental complications, the fuzzy logic method was used in the determination of groundwater quality for more precise findings that support decision-making. To achieve such an objective, sixteen water quality guidelines were used to determine groundwater quality status in six selected wells. The results showed that the groundwater is neutral, very hard, and fresh in nature. Dominating cations and anions are in the order of Ca 2 + > Na + > Mg 2 + > K + and HCO 3 - > SO 4 2 - > Cl - . The Piper trilinear diagram demonstrates that the hydrochemical facies of groundwater are mostly of Ca-HCO 3 type. Statistical analysis denotes a positive correlation between most of the chemical parameters. The study took the results of the fuzzy logic evaluation method into consideration, to classify the samples into five groups according to the Chinese groundwater quality standard (GB/T 14848-93) for their suitability for domestic use. The results demonstrated that the quality of the groundwater samples is within grade II and III, and is suitable for drinking purposes. The comprehensive evaluation of groundwater quality is critical to aid sensitive policy decisions, and the proposed approach can guarantee reliable findings to that effect. The results of this study would also be helpful to future researches related to groundwater quality assessment.
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http://dx.doi.org/10.3390/ijerph16030302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388187PMC
January 2019

Contingencies on the workshop for bronchopulmonary dysplasia classification.

J Pediatr 2019 04 24;207:263-264. Epub 2018 Dec 24.

Columbia University-Morgan Stanley Children's Hospital New York, New York.

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http://dx.doi.org/10.1016/j.jpeds.2018.11.055DOI Listing
April 2019

Left Atrial Myxoma Embolization Presenting as Acute Limb Ischemia: An Unusual Presentation.

Cureus 2018 Jun 8;10(6):e2764. Epub 2018 Jun 8.

Vascular Surgery, Michigan Vascular Center.

Cardiac myxomas are rare with reported incidences of less than 0.03%. Cardiac myxomas are most commonly observed in the left atrium. Their clinical manifestations vary and most are non-specific to the diagnosis. The most common extra-cardiac manifestations are thrombo-embolic infarcts from tumor embolization. A previously healthy 55-year-old man presented with findings suggestive of acute arterial limb ischemia. Following surgical treatment of his acute presentation, a left atrial mass was found on echocardiography suggesting that the embolization was secondary to a cardiac myxoma. The patient was discharged without complication. Embolic myxoma should be included in the differential in younger, previously healthy patients presenting with acute arterial limb ischemia without obvious cause. Our patient's dramatic presentation with a single acute event, however, prompted immediate treatment and resulted in a functional recovery with minimal complications.
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http://dx.doi.org/10.7759/cureus.2764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082586PMC
June 2018

Comparative mechanics of diverse mammalian carotid arteries.

PLoS One 2018 10;13(8):e0202123. Epub 2018 Aug 10.

College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC, United States of America.

The prevalence of diverse animal models as surrogates for human vascular pathologies necessitate a comprehensive understanding of the differences that exist between species. Comparative passive mechanics are presented here for the common carotid arteries taken from bovine, porcine, ovine, leporine, murine-rat, and murine-mouse specimens. Data is generated using a scalable biaxial mechanical testing device following consistent circumferential (pressure-diameter) and axial (force-length) testing protocols. The structural mechanical response of carotids under equivalent loading, quantified by the deformed inner radius, deformed wall thickness, lumen area compliance and axial force, varies significantly among species but generally follows allometric scaling. Conversely, descriptors of the local mechanical response within the deformed arterial wall, including mean circumferential stress, mid-wall circumferential stretch, and mean axial stress, are relatively consistent across species. Unlike the larger animals studied, the diameter distensibility curves of murine specimens are non-monotonic and have a significantly higher value at 100 mmHg. Taken together, our results provide baseline structural and mechanical information for carotid arteries across a broad range of common animal models.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202123PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086448PMC
February 2019

Comparative DFT Computational Studies with Experimental Investigations for Novel Synthesized Fluorescent Pyrazoline Derivatives.

J Fluoresc 2018 Jul 29;28(4):913-931. Epub 2018 Jun 29.

Chemistry Department, Faculty of Science, Al-Azhar University, Cairo, Egypt.

A novel series of pyrazoline derivatives were synthesized and their spectral properties were characterized via FT-IR, H, and C NMR. The electronic transitions and fluorescence properties were tracked via UV-Vis and emission spectrometry. The density functional theory (DFT) calculations have been also computed to get spot onto the geometry, electronic transitions and spectroscopic properties theoretically that has been compared with the encountered experimental ones. Moreover, the dipole moment, optimized energy, HOMO - LUMO energies and band gaps were calculated for novel candidates pyrazoline derivatives with highly fluorescence quantum yield.
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http://dx.doi.org/10.1007/s10895-018-2254-zDOI Listing
July 2018

Too Hot for Your Pocket! Burns From E-Cigarette Lithium Battery Explosions: A Case Series.

J Burn Care Res 2018 10;39(6):1043-1047

Trauma Services, Hurley Medical Center/Michigan State University, College of Human Medicine, Flint.

The use of electronic cigarettes (ECs) has been on the rise with increased number of battery explosions causing burns. This study is a retrospective review of patients who presented with burns caused by EC explosions.Here, we present a case series of eight patients sustaining burns from EC explosions, within a year, to elucidate the pattern of such burns and to provide a treatment guideline.All of them were males. Five patients had partial-thickness burns and three had full-thickness burns. TBSA ranged from 4 to 16% (burns to lower extremity [n = 7], hand [n =3], scrotum/penis [n =2], chest [n = 1]). None had inhalation injuries. Two patients (29%) required skin grafting. EC explosion is predominantly attributed to its lithium-ion battery. Several types of injuries can occur, including chemical and thermal burns, inhalation injuries, metal poisoning, etc. There are currently no specific guidelines on the management of burns due to lithium-ion battery exposure. Herein, we recommend the following: Initial assessment of injuries should accompany the Advanced Trauma Life Support guidelines; serum levels of lithium, cobalt, and manganese should be checked and elevated levels should be monitored; patients should be monitored for signs of metal toxicity; wound should be extensively debrided and irrigated to remove any residual materials; and litmus test should be performed to check for alkali pH prior to irrigation with water or other aqueous solutions.
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http://dx.doi.org/10.1093/jbcr/irx015DOI Listing
October 2018

Acute Appendicitis in Young Children: A Persistent Diagnostic Challenge for Clinicians.

Cureus 2018 Mar 19;10(3):e2347. Epub 2018 Mar 19.

Department of Combined Internal Medicine-Pediatrics, Hurley Medical Center.

Acute appendicitis is a grave and life-threatening condition in children, accounting for one to two cases per 10,000 in children less than four years' old. Prompt diagnosis and management are imperative to prevent serious complications, such as abscess formation, perforation, bowel obstruction, peritonitis, and sepsis. In young children, however, the diagnosis of this condition is challenging. The delayed utilization of imaging may further delay the diagnosis due to concerns of exposure to ionizing radiation. Even with a prompt diagnosis, controversy persists regarding medical versus operative management in these young patients. We report a case of a 21-month-old female who presented with fever, non-bilious, non-bloody emesis, and decreased tolerance for liquids and solids. The initial physical exam and imaging were suggestive of non-obstructive bowel distention. The patient was admitted to the pediatric floor. Overnight, the patient's condition deteriorated severely and became septic. Repeat imaging revealed a 9-cm appendicular mass and a ruptured appendix. Antibiotic coverage was then broadened and the patient was transferred to the critical care unit for more intensive management. The patient's septic condition improved over the upcoming few days and the parents elected to perform an elective appendectomy following resolution of the condition. Atypical presentations are common in this population. The difficulty in obtaining a reliable history and physical examination findings makes the diagnosis even more challenging. Moreover, concerns with radiation exposure may delay the diagnosis and increase the risk of perforation and peritonitis. Thus, clinicians should have a high index of suspicion for acute appendicitis, particularly in young children, as this condition is commonly missed on initial presentation.
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http://dx.doi.org/10.7759/cureus.2347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959314PMC
March 2018

Response to Letter to the Editor.

J Perinatol 2018 07 24;38(7):945. Epub 2018 May 24.

Department of Neonatology at Cleveland Clinic Children's Hospital, Cleveland, OH, USA.

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http://dx.doi.org/10.1038/s41372-018-0114-yDOI Listing
July 2018

Reconstitution reveals motor activation for intraflagellar transport.

Nature 2018 05 9;557(7705):387-391. Epub 2018 May 9.

Physik Department E22, Technische Universität München, Garching, Germany.

The human body represents a notable example of ciliary diversification. Extending from the surface of most cells, cilia accomplish a diverse set of tasks. Predictably, mutations in ciliary genes cause a wide range of human diseases such as male infertility and blindness. In Caenorhabditis elegans sensory cilia, this functional diversity appears to be traceable to the differential regulation of the kinesin-2-powered intraflagellar-transport (IFT) machinery. Here we reconstituted the first, to our knowledge, functional multi-component IFT complex that is deployed in the sensory cilia of C. elegans. Our bottom-up approach revealed the molecular basis of specific motor recruitment to the IFT trains. We identified the key component that incorporates homodimeric kinesin-2 into its physiologically relevant context, which in turn allosterically activates the motor for efficient transport. These results will enable the molecular delineation of IFT regulation, which has eluded understanding since its discovery more than two decades ago.
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http://dx.doi.org/10.1038/s41586-018-0105-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5967604PMC
May 2018

Synthesis, quantitative structure-property relationship study of novel fluorescence active 2-pyrazolines and application.

R Soc Open Sci 2018 Mar 14;5(3):171964. Epub 2018 Mar 14.

Forgery Research Department, Medico-legal Sector, Ministry of Justice, Cairo, Egypt.

A variety of fluorescence-active fluorinated pyrazolines was synthesized in good yields through cyclocondensation reaction of propenones with aryl hydrazines . Some of the synthesized compounds provided promising fluorescence properties with quantum yield () higher than that of quinine sulfate (standard reference). Quantitative structure-property relationship studies were undertaken supporting the exhibited fluorescence properties and estimating the parameters governing properties. Five synthesized fluorescence-active pyrazolines (, , , and ) with variable were selected for treating two types of paper sheets (Fabriano and Bible paper). These investigated fluorescence compounds, especially compounds and , provide improvements in strength properties of paper sheets. Based on the observed performance they can be used as markers in security documents.
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http://dx.doi.org/10.1098/rsos.171964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882720PMC
March 2018