Publications by authors named "Mohamed Issa"

40 Publications

Low Turnover Renal Osteodystrophy With Abnormal Bone Quality and Vascular Calcification in Patients With Mild-to-Moderate CKD.

Kidney Int Rep 2022 May 6;7(5):1016-1026. Epub 2022 Mar 6.

Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA.

Introduction: Limited information is available on renal osteodystrophy (ROD) and vascular calcification (VC) during early chronic kidney disease (CKD). This study was designed to evaluate ROD and VC in 32 patients with CKD stages II to IV.

Methods: Patients underwent dual-energy X-ray absorptiometry (DXA) for assessment of bone mineral density (BMD) and trabecular bone score (TBS), thoracic computed tomography for VC scoring using the Agatston method, and anterior iliac crest bone biopsy for mineralized bone histology, histomorphometry, and Fourier transform infrared spectroscopy (FTIR). Classical and novel bone markers were determined in the blood.

Results: Mean estimated glomerular filtration rate (eGFR) was 44 ± 16 ml/min per 1.73 m. Of the patients, 84% had low bone turnover. In Whites, eGFR correlated negatively with the turnover parameter activation frequency (Ac.f) ( -0.48,  = 0.019) and with parameters of bone formation. Most patients had VC (>80%) which correlated positively with levels of phosphorus, c-terminal fibroblast growth factor-23, and activin. Aortic calcifications (ACs) correlated negatively with bone formation rate (BFR) and Ac.f (rho -0.62, -0.61,  < 0.001). TBS correlated negatively with coronary calcification (rho -0.42,  = 0.019) and AC (rho -0.57,  = 0.001). These relationships remained after adjustment of age. The mineral-to-matrix ratio, an FTIR metric reflecting bone quality, was negatively related to Ac.f and positively related to AC.

Conclusion: Low bone turnover and VC are predominant in early stages of CKD. This is the first study demonstrating mineral abnormalities indicating reduced bone quality in these stages of CKD.
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http://dx.doi.org/10.1016/j.ekir.2022.02.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9091581PMC
May 2022

Complete postsurgical left ventricular-aortic discontinuity and pseudoaneurysm formation.

J Card Surg 2022 Apr 29. Epub 2022 Apr 29.

Department of Radiology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.

Background: Left ventricular outflow tract pseudoaneurysm is a rare but potentially fatal complication of aortic valve replacement, infective endocarditis (IE), and suture dehiscence. Left ventricular-aortic discontinuity is a severe and uncommon manifestation of IE. For patients who have a long-standing history of endocarditis, periannular lesions in the aortic valve may rupture, leading to the rare occurrence of complete, or total, left ventricular-aortic discontinuity.

Methods: We present a case of complete postoperative left ventricular-aortic discontinuity and massive circumferential left ventricular outflow tract pseudoaneurysm discovered during a 3-month follow-up visit. Appropriate consent was obtained from all parties before submission of this case report.

Results: Postoperative cardiac computed tomography of a patient demonstrated dehiscence of a recently placed surgical aortic valve from the left ventricular outflow tract, with massive circumferential pseudoaneurysm formation. Only a small remnant of the membranous interventricular septum connected the aortic root to the heart, informing the diagnosis of complete left ventricular-aortic discontinuity.

Conclusion: The clinical presentation of a left ventricular outflow tract pseudoaneurysm with concomitant left ventricular-aortic discontinuity is commonly nonspecific or clinically silent; thus, it requires a high index of suspicion and use of multimodality imaging for diagnosis and management.
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http://dx.doi.org/10.1111/jocs.16553DOI Listing
April 2022

Sickle Cell Intrahepatic Cholestasis: Extremely Rare but Fatal Complication of Sickle Cell Disease.

Cureus 2022 Feb 9;14(2):e22050. Epub 2022 Feb 9.

Gastroenterology and Hepatology, Rutgers New Jersey Medical School, New Jersey, USA.

Sickle cell intrahepatic cholestasis (SCIC) is a rare but potentially fatal complication of sickle cell disease (SCD), with high mortality, observed mainly in patients with homozygous sickle cell anemia. Herein, we have reported a case of severe SCIC with a poor outcome despite aggressive measures including exchange transfusion and use of vasopressors. The patient was admitted with generalized weakness, confusion, rigors, chills, and signs of hepatic failure, such as hyperbilirubinemia, hypoalbuminemia, and coagulopathy. There was no evidence of viral hepatitis or biliary obstruction. The patient received two exchange transfusions, but he continued to deteriorate clinically despite exchange transfusion and developed hemorrhagic shock and multiorgan failure. The patient was made comfort care as per family wishes. This case emphasizes the importance of early diagnosis of sickle cell intrahepatic cholestasis and poor prognosis despite aggressive measures.
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http://dx.doi.org/10.7759/cureus.22050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8916923PMC
February 2022

Predictors of type-2 diabetes remission following bariatric surgery after a two-year follow up.

Asian J Surg 2022 Mar 4. Epub 2022 Mar 4.

General Surgery Department, Kasralainy School of Medicine, Cairo University, Egypt. Electronic address:

Purpose: Bariatric surgery is evolving as a successful tool for managing morbid obesity and T2DM. This study aimed to identify predictors of diabetes remission after two types of bariatric procedures.

Methods: This prospective study enrolled 172 patients with morbid obesity associated with T2DM scheduled for bariatric surgery. Two laparoscopic bariatric procedures were done; single anastomosis gastric bypass (SAGB, n = 83) and sleeve gastrectomy (LSG, n = 68). Lipid accumulation product index (LAP) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate lipid profile and insulin sensitivity. Two years after surgery condition of DM was evaluated as complete remission (CR), partial remission (PR), or improvement. The primary outcome measure was predictors of diabetes remission.

Results: Two years after surgery, 151 patients were available for evaluation, where 75 patients (49.7%) achieved CR, while PR was found in 36 (23.8%). CR was significantly associated with younger age, shorter duration of DM (p < 0.001, for both), higher C-peptide and GLP-1 levels (p < 0.001 and p = 0.002, respectively), and bypass surgery (p = 0.027). On multivariate analysis, shorter duration of DM, lower BMI, and higher C-peptide levels were the independent factors predicting CR.

Conclusion: Complete remission of T2DM can be achieved in nearly half of the patients two years after SG or SAGB. The duration of diabetes and preoperative BMI and C-peptide levels are the independent factors predicting complete remissions.
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http://dx.doi.org/10.1016/j.asjsur.2021.12.070DOI Listing
March 2022

Negative Appendicectomy Rate: Incidence and Predictors.

Cureus 2022 Jan 22;14(1):e21489. Epub 2022 Jan 22.

General Surgery, Southend University Hospital, National Health Service (NHS) Trust, Essex, GBR.

Introduction Acute appendicitis is a common emergency surgical presentation. The gold standard treatment is surgery. Like any surgical procedure, appendicectomy is associated with complications. Negative appendicectomy (NA) can occur, and its incidence is 15%-39%. This study aimed to evaluate the rate and predictors of NA in a cohort. Patients and methods A retrospective study over a year through which data of patients who underwent emergency appendicectomies were collected and analyzed. The absence of inflammatory process and/or other significant pathology in the appendix was considered negative for appendicitis. An utter definition of NA was the absence of inflammatory cells in the appendix. The NA rate (NAR) was calculated using the standard criteria (NAR-SDC) and the strict criteria (NAR-STC). The routine laboratory parameters for diagnosing acute appendicitis on admission were collected. Increased inflammatory markers in the form of leucocytosis of total WBC > 11,000 per mm, elevated CPR > 5 mg/L, and isolated elevated total serum bilirubin > 20 µmol/L, were suggestive of acute appendicitis. Results Three hundred and seventy-two patients were included, 179 males and 193 females with a median age were 27 (5-94) years. The median duration of symptoms and waiting time to surgery were two days and one day, respectively. The mean admission WBC, C-reactive protein (CRP) and serum bilirubin levels were 12,600 (3,000-38,000)/mm, 66.9 (1-323) mg/L and 12.7 (4-38) µmol/L respectively. Laparoscopic appendicectomy was performed in 93.5% of patients with a conversion rate of 4.6%. NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was significantly higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower mean total WBC (p-value 0.014), CRP (p-value 0.0001) and total serum bilirubin (p-value 0.0001) levels on admission. Conclusion NA is still a major problem in the management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, duration of symptoms more than three days, and lower total WBC were independent predictors of NA.
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http://dx.doi.org/10.7759/cureus.21489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8859749PMC
January 2022

Swiss cheese interventricular septum presenting with catastrophic stroke: the potential role of ECG-gated CTA.

BJR Case Rep 2022 Jan 12;8(1):20210069. Epub 2021 Nov 12.

Medical College of Georgia at Augusta University, Augusta, Georgia.

Ventricular septal defect is a common congenital cardiac condition that presents in a variety of morphologies. Less commonly, when an individual patient is found to have multiple ventricular septal defects, the term "Swiss cheese ventricular septal defect" is applied. Although not routinely utilized in clinical practice, electrocardiogram (ECG)-gated computed tomographic angiography (CTA) has been shown to provide utility in detecting intracardiac shunts, demonstrating promise in preventing acute strokes secondary to a paradoxical embolus from occurring; this is especially important when atypical cardiac septa are suspected. This case seeks to illustrate how usage of ECG-gated CTA can assist in early detection and prevention of adverse outcomes resulting from an atypical presentation of a ventricular septal defect.
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http://dx.doi.org/10.1259/bjrcr.20210069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8803220PMC
January 2022

Skin Graft Versus Local Flaps in Management of Post-burn Elbow Contracture.

Cureus 2021 Dec 27;13(12):e20768. Epub 2021 Dec 27.

General Surgery, Cairo University Hospital, Cairo, EGY.

Introduction Contracture is a pathological scar tissue resulting from local skin tissue damage, secondary to different local factors. It can restrict joint mobility, resulting in deformity and disability. This study aimed to investigate the outcomes of skin grafts compared to local flaps to reconstruct post-burn elbow contractures. These parameters included regaining function, range of movement, recurrence, and local wound complications. Methodology A retrospective study reviewed 21 patients for elbow reconstruction over 12 months. Only patients with post-burn elbow contracture were included. Other causes, including previous corrective surgery, associated elbow stiffness, and patients who opted out of post-operative physiotherapy, were excluded. Patients were categorized according to the method of coverage into three groups: graft alone (G1), local flap (G2), or combined approach (G3).  Results Females were three times at higher risk to suffer a burn injury, while almost half of the cases were children. Scald injury represented 81% of burn causes. G1,2,3 were used in 47.6%, 42.9% and 9.5% of cases retrospectively. The overall rate of infection was 28.6%. Hundred percent graft taken was recorded in 83.3 % of cases; however, flap take was 91.1%. After 12 months of follow-up, re-contracture was 60% and 22.8% in G1 and G2; however, the satisfaction rate was 70% and 100% in both groups retrospectively. The overall satisfaction was 85.7% in all groups. Conclusion Grafts and local flaps are reasonable options for post contracture release; however, flaps are superior. Coverage selection depends on the lost tissue area and exposure of underlying deep structures. Physiotherapy and patient satisfaction are crucial in the outcomes.
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http://dx.doi.org/10.7759/cureus.20768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8792479PMC
December 2021

Evaluation of the Sublay Mesh Repair Outcomes in Different Types of Ventral Hernia.

Cureus 2021 Dec 21;13(12):e20590. Epub 2021 Dec 21.

General Surgery, Cairo University, Cairo, EGY.

Introduction: Ventral hernia repair is one of the challenging surgical operations over time. Several surgical techniques for mesh repair have been described (onlay, inlay, sublay, and underlay repairs). It is suggested that sublay mesh repair has the lowest recurrence and surgical site infection in open anterior abdominal hernia repair. This study aimed to analyze the pros and cons of the sublay mesh in ventral hernia repair to evaluate the significance of this technique as a treatment modality. Hospital stay, acute postoperative complications, and the recurrence rate were the main areas of investigation.

Methods: A retrospective study on 79 patients with ventral hernias who were operated on with sublay mesh repair between January 2015 and December 2018 was conducted. Patients were admitted through the elective route. The study included fit patients with first-time ventral hernias (primary and incisional). Recurrent hernia, patients with decompensated cardiopulmonary disorders, and bleeding disorders were excluded from the project. The project pro forma includes patient's demographics, operative details, length of stay, postoperative complications, and follow-up up to 12 months.

Results: All patients underwent open mesh repair using the sublay technique. The ventral hernia was five times more common in females than males. The mean age of presentation was 44.8 years old. The mean operating time was 67 minutes and a one-day hospital stay. Paraumblical and incisional hernias represented the majority of cases. The component separation approach was added in three cases (3.7%). Simultaneous cholecystectomy was performed in two cases (2.5%). Only six cases (6.3%) developed wound-related complications, while two cases (2.5%) had a recurrence.

Conclusion: The sublay mesh repair is a perfect choice for the repair of ventral abdominal hernia. It is associated with a smooth and short hospital stay and the least incidence of complications and recurrence.
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http://dx.doi.org/10.7759/cureus.20590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8777263PMC
December 2021

Secondary Hyperparathyroidism Before and After Bariatric Surgery: a Prospective Study with 2-Year Follow-Up.

Obes Surg 2022 04 20;32(4):1141-1148. Epub 2022 Jan 20.

General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt.

Purpose: Secondary hyperparathyroidism (SHPT) is linked to obesity. Bariatric surgery may be associated with calcium and vitamin D deficiencies leading to SHPT. This study aimed to detect the prevalence of SHPT before and after bariatric surgery.

Methods: This prospective study assessed the prevalence of SHPT after sleeve gastrectomy (SG, n = 38) compared to one-anastomosis gastric bypass (OAGB, n = 86). All patients were followed up for 2 years. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry.

Results: Of the 124 patients, 71 (57.3%) were females, and 53 (42.7%) were males, with a mean age of 37.5 ± 8.8 years. Before surgery, 23 patients (18.5%) suffered from SHPT, and 40 (32.3%) had vitamin D deficiency. The prevalence of SHPT increased to 29.8% after 1 year and 36.3% after 2 years. SHPT was associated with lower levels of vitamin D and calcium and higher reduction of BMD in the hip but not in the spine. After 2 years, SHPT was associated with a significantly lower T-score in the hip. SHPT and vitamin D deficiency were significantly more common in patients subjected to OAGB compared to SG (p = 0.003, and p < 0.001, respectively). There is a strong negative correlation between vitamin D levels and parathormone levels before and after surgery.

Conclusion: Prevalence of SHPT is high in obese patients seeking bariatric surgery, especially with lower vitamin D levels. Bariatric surgery increases the prevalence of SHPT up to 2 years. Gastric bypass is associated with a higher risk of developing SHPT compared to SG.
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http://dx.doi.org/10.1007/s11695-022-05902-7DOI Listing
April 2022

Nutritional Complications After Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: A Comparative Systematic Review and Meta-Analysis.

Cureus 2022 Jan 11;14(1):e21114. Epub 2022 Jan 11.

General and Laparoscopic Surgery, El Zaitoun Specialized Hospital, Cairo, EGY.

A systematic review and meta-analysis were carried out involving studies that compared the nutritional complications of Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB); these included the incidence of malnutrition as well as deficiencies of other nutritional elements, such as total protein, albumin, calcium and iron. A comprehensive search strategy was implemented in PubMed, Embase, and the Cochrane Library. Effect sizes included the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs), as well as mean differences (MDs) and 95% CIs of the percentage total weight loss (%TWL) and excess weight loss percentage (%EWL). Thirteen studies were included (12,964 patients, 66.27% females, 53.82% underwent OAGB). At the longest follow-up period (≥3 years), OAGB was associated with significantly higher %TWL (MD=5.41%, 95%CI, 1.52 to 9.29) and %EWL (MD=13.81%, 95%CI, 9.60 to 18.02) compared to RYGB. However, OAGB procedures were associated with malnutrition (OR=3.00, 95%CI, 1.68 to 5.36, p<0.0001), hypoalbuminemia (OR=2.38, 95%CI, 1.65 to 3.43, p<0.0001), hypoproteinemia (OR=1.85, 95%CI, 1.09 to 3.14, p=0.022), anemia (OR=1.38, 95%CI, 1.08 to 1.77, p=0.011), and hypocalcemia (OR=1.78, 95%CI, 1.01 to 3.12, p=0.046). On subgroup analyses, the proportions of anemia and hypoalbuminemia remained significantly higher at longer follow-up periods and in studies published in Asia. Despite the favorable weight loss profile, the unfavorable nutritional consequences of OAGB merits further investigations to explore the malabsorptive element, ethnic variation, and the role of biliopancreatic limb length.
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http://dx.doi.org/10.7759/cureus.21114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752406PMC
January 2022

The Impact of Drain and Reinforcement on the Outcomes of Bariatric Surgery: A Prospective Study.

Cureus 2021 Dec 13;13(12):e20382. Epub 2021 Dec 13.

General Surgery, Sunderland Royal Hospital, Sunderland, GBR.

Purpose We aimed to investigate the impact of reinforcement and abdominal drains on the outcome of laparoscopic sleeve gastrectomy (LSG). Methods The present study was a prospective study that included obese patients scheduled to undergo LSG. Patients were assigned to receive drain, reinforcement, or both according to the surgeon's preference and followed up for one month after surgery. The present study's primary outcome was the identification of the association between intraoperative drain/reinforcement and the incidence of postoperative complications. Results A total of 125 (20.3%) patients received intraoperative drains. The proportion of postoperative morbidity was comparable between the drain and non-drain groups (3.2% versus 1.6%; p = 0.25). Patients in the drain group had similar incidence of blood transfusion (2.4% versus 1.7% in non-drain group; p = 0.43) and postoperative leakage (0.8% versus 0.2% in non-drain group; p = 0.36). The incidences of blood transfusion (p = 0.56) and reoperation (p = 0.98) were comparable between the drain and non-drain groups. There were no statistically significant differences between the drain and non-drain groups regarding postoperative mortality and wound infection (p > 0.05). On the other hand, 440 (71.3%) patients received reinforcement. The proportion of postoperative morbidity was comparable between the reinforcement and non-reinforcement groups (1.6% versus 2.8%, p = 0.07). Patients in the reinforcement group were less likely to develop postoperative bleeding (0.7% versus 4% in the non-reinforcement group; p = 0.004), while no significant difference was detected in terms of postoperative leakage (p = 0.33) and in-hospital mortality. Conclusion In conclusion, abdominal drainage did not reduce the complications of LSG patients. Reinforcement has some role in controlling the bleeding but not leaks. Both techniques did not significantly impact the mortality rate. In the future, additional, large randomized trials are needed to examine the gastrointestinal-related quality of life.
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http://dx.doi.org/10.7759/cureus.20382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8673688PMC
December 2021

A biological sub-sequences detection using integrated BA-PSO based on infection propagation mechanism: Case study COVID-19.

Expert Syst Appl 2022 Mar 20;189:116063. Epub 2021 Oct 20.

Department of Mathematics, Faculty of Science, Zagazig University, Zagazig 44519, Egypt.

The longest common consecutive subsequences (LCCS) play a vital role in revealing the biological relationships between DNA/RNA sequences especially the newly discovered ones such as COVID-19. FLAT is a Fragmented local aligner technique which is an accelerated version of the local pairwise sequence alignment algorithm based on -heuristic algorithms. The performance of FLAT needs to be enhanced since the huge length of biological sequences leads to trapping in local optima. This paper introduces a modified version of FLAT based on improving the performance of the BA algorithm by integration with particle swarm optimization (PSO) algorithm based on a novel infection mechanism. The proposed algorithm, named BPINF, depends on finding the best-explored solution using BA operators which can infect the agents during the exploitation phase using PSO operators to move toward it instead of moving toward the best-exploited solution. Hence, moving the solutions toward the two best solutions increase the diversity of generated solutions and avoids trapping in local optima. The infection can be propagated through the agents where each infected agent can transfer the infection to other non-infected agents which enhances the diversification of generated solutions. FLAT using the proposed technique (BPINF) was validated to detect LCCS between a set of real biological sequences with huge lengths besides COVID-19 and other well-known viruses. The performance of BPINF was compared to the enhanced versions of BA in the literature and the relevant studies of FLAT. It has a preponderance to find the LCCS with the highest percentage (88%) which is better than other state-of-the-art methods.
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http://dx.doi.org/10.1016/j.eswa.2021.116063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527645PMC
March 2022

Clinical experience with a chlorhexidine-coated PICC: A prospective, multicenter, observational study.

J Vasc Access 2021 Oct 9:11297298211049648. Epub 2021 Oct 9.

Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA.

Introduction: This study evaluated a chlorhexidine-coated peripherally inserted central catheter (PICC) and the incidence of associated complications within both inpatient and outpatient populations.

Methods: This IRB-approved, multicenter, prospective observational study was performed at three large teaching hospitals in the US. All adults who required a PICC for ⩾14 days were considered. Patients were monitored throughout entire catheter dwell. Duplex venous ultrasounds were performed before insertion, after 10 to 14 days of dwell time, and upon removal. Data was collected from the hospital, outpatient clinic, and patient PICC diary records.

Results: A total of 103 patients, 56% male, with mean BMI 29 ± 8.8, were enrolled. The majority (79%) of patients were from high-risk groups-cancer, infectious diseases, transplant, and trauma. Primary treatment indications were antibiotics (66.99%) and chemotherapy (25.24%). Double lumen PICCs (59.2%) were favored clinically, as was basilic vein placement (71.84%). Mean catheter dwell was 47.01 ± 25.82 days. Three (3, 2.9%) central line-associated bloodstream infections (CLABSI) were reported. Four patients (4.6%) reported symptomatic catheter-related thrombosis (CRT), confirmed with ultrasound. Three patients (3.4%) had ultrasound-confirmed fibroblastic sleeve (FS). Eight patients (9.2%) who entered the study with pre-existing superficial thrombosis, had complete resolution at the time of catheter removal. The incidence of CLABSI was 0.82/1000 days. The combined CRT and FS rate was 6.9%.

Conclusion: Based upon the observational findings of this study, chlorhexidine-coated PICC technology may be considered for use in patient populations who are at moderate to high-risk for catheter-related complications in both inpatient and outpatient settings.
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http://dx.doi.org/10.1177/11297298211049648DOI Listing
October 2021

Impact of intravenous access site on attenuation for thoracic computed tomographic angiography: A time-matched, nested, case-control study.

J Vasc Access 2021 Sep 23:11297298211046756. Epub 2021 Sep 23.

Chandler Medical Center, University of Kentucky, Lexington, KY, USA.

Background: The objective of this study was to evaluate whether the choice of intravenous access (IVA) site affects aortic attenuation during thoracic computed tomographic angiography (T-CTA) and any associated risks with intravenous device placement.

Methods: All T-CTA exams performed between 1/1/2013 and 8/14/2015 were retrospectively reviewed to identify those performed with contrast media injection via alternative (i.e. non-antecubital) IVA ( = 1769). Using time matching, antecubital IVA exams ( = 1769) were selected as controls. For each exam, attenuation was measured in the ascending aorta. Patient and technical data was subsequently collected from all 3538 patients included in this study. Multiple linear regression was used to determine if IVA site affected attenuation. Lastly, data related to extravasations for the entire T-CTA cohort were collected and compared.

Results: Hand/wrist, arm, and central venous access device IVA were all equivalent to antecubital IVA in terms of attenuation ( = 0.579,  = 0.599, and  = 0.522 respectively). Forearm and intraosseous IVA had significantly higher attenuation ( = 0.010 and  = 0.002, respectively) than antecubital IVA. Right-sided IVA was associated with a small attenuation increase of 11 Hounsfield Units ( < 0.001) compared to left-sided IVA. In terms of extravasation, antecubital IVA was equivalent to hand/wrist, forearm, and upper arm IVA ( = 0.778,  = 0.060, and  = 0.090 respectively).

Conclusions: Satisfactory aortic attenuation achieved with non-antecubital IVA is equivalent to attenuation achieved with antecubital IVA for T-CTA imaging. The risk of contrast media extravasation in peripheral IVA devices was relatively low, however, appropriate IVA site selection should be considered an important factor for successful administration of contrast media for future imaging studies. This prevents undue harm to patients through preventable device failures when using a peripheral IV device in areas of high flexion/range of movements undergoing pressure injection for contrast media.
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http://dx.doi.org/10.1177/11297298211046756DOI Listing
September 2021

Developing, validating and implementing performance metrics to evaluate the health and safety performance of sustainable building projects.

Int J Occup Saf Ergon 2021 Sep 22:1-13. Epub 2021 Sep 22.

Department of Civil Engineering, University of Manitoba, Canada.

This research aims to develop, validate and implement health and safety performance metrics to evaluate the health and safety performance of sustainable building projects throughout their design and construction in Manitoba. Thirty-four metrics were developed following a detailed literature review and validated by expert judgement based on analytic soundness, practicality and predictability. Only 25 metrics satisfied these criteria, of which five were implemented via data collected on seven sustainable buildings and seven non-sustainable buildings. The results showed that sustainable building projects had 12.7% higher recordable injuries rates than non-sustainable projects, although the difference was statistically insignificant. Findings from this research showed that for sustainable and non-sustainable building, PM 19 'The percentage of workers with unsafe behaviour based on conducted safety observations' had a statistically significant and strong negative correlation with PM 8 'The percentage of workers who attended safety meetings' and with PM 21 'The percentage of the total workdays in which safety meetings were held'. The findings of this research can be used by general contractors and safety practitioners looking to enact evidence-based guidance to manage safety proactively on site and improve health and safety performance of their sustainable building projects.
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http://dx.doi.org/10.1080/10803548.2021.1960701DOI Listing
September 2021

Expeditious COVID-19 similarity measure tool based on consolidated SCA algorithm with mutation and opposition operators.

Authors:
Mohamed Issa

Appl Soft Comput 2021 Jun 20;104:107197. Epub 2021 Feb 20.

Computer and Systems Department, Faculty of Engineering, Zagazig University, Zagazig, Egypt.

COVID-19 is a global pandemic that aroused the interest of scientists to prevent it and design a drug for it. Nowadays, presenting intelligent biological data analysis tools at a low cost is important to analyze the biological structure of COVID-19. The global alignment algorithm is one of the important bioinformatics tools that measure the most accurate similarity between a pair of biological sequences. The huge time consumption of the standard global alignment algorithm is its main limitation especially for sequences with huge lengths. This work proposed a fast global alignment tool (G-Aligner) based on meta-heuristic algorithms that estimate similarity measurements near the exact ones at a reasonable time with low cost. The huge length of sequences leads G-Aligner based on standard Sine-Cosine optimization algorithm (SCA) to trap in local minima. Therefore, an improved version of SCA was presented in this work that is based on integration with PSO. Besides, mutation and opposition operators are applied to enhance the exploration capability and avoiding trapping in local minima. The performance of the improved SCA algorithm (SP-MO) was evaluated on a set of IEEE CEC functions. Besides, G-Aligner based on the SP-MO algorithm was tested to measure the similarity of real biological sequence. It was used also to measure the similarity of the COVID-19 virus with the other 13 viruses to validate its performance. The tests concluded that the SP-MO algorithm has superiority over the relevant studies in the literature and produce the highest average similarity measurements 75% of the exact one.
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http://dx.doi.org/10.1016/j.asoc.2021.107197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895693PMC
June 2021

Arteriolymphatic Fistula: An Unusual Cause of Spontaneous Swelling of the Right Lower Extremity.

JACC Cardiovasc Interv 2021 02 13;14(3):347-349. Epub 2021 Jan 13.

Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA; Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jcin.2020.11.035DOI Listing
February 2021

Analyzing COVID-19 virus based on enhanced fragmented biological Local Aligner using improved Ions Motion Optimization algorithm.

Appl Soft Comput 2020 Nov 3;96:106683. Epub 2020 Sep 3.

Hubei Engineering Research Center on Big Data Security, School of Cyber Science & Engineering, Huazhong University of Science and Technology, Wuhan 430074, China.

SARS-CoV-2 (COVID-19) virus is a havoc pandemic that infects millions of people over the world and thousands of infected cases dead. So, it is vital to propose new intelligent data analysis tools and enhance the existed ones to aid scientists in analyzing the COVID-19 virus. Fragmented Local Aligner Technique (FLAT) is a data analysis tool that is used for detecting the longest common consecutive subsequence (LCCS) between a pair of biological data sequences. FLAT is an aligner tool that can be used to find the LCCS between COVID-19 virus and other viruses to help in other biochemistry and biological operations. In this study, the enhancement of FLAT based on modified Ions Motion Optimization (IMO) is developed to produce acceptable LCCS with efficient performance in a reasonable time. The proposed method was tested to find the LCCS between Orflab poly-protein and surface glycoprotein of COVID-19 and other viruses. The experimental results demonstrate that the proposed model succeeded in producing the best LCCS against other algorithms using real LCCS measured by the SW algorithm as a reference.
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http://dx.doi.org/10.1016/j.asoc.2020.106683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467904PMC
November 2020

Factors influencing the use of adaptive radiation therapy in vulvar carcinoma.

Rep Pract Oncol Radiother 2020 Sep-Oct;25(5):709-713. Epub 2020 Jul 10.

Department of Radiation Oncology, King Hussein Cancer Center, PO Box 1269, Amman 11941, Jordan.

Aim: We aim to evaluate the variables affecting the frequency of adaptive radiotherapy (ART) in vulvar cancer.

Background: ART may be needed throughout a definitive RT course for vulvar carcinoma due to changes in patient's anatomy and tumor response.

Materials And Methods: Charts of patients charts who had been treated with definitive concurrent chemo-radiotherapy for vulvar carcinoma, between January 2015 and December 2019 were inquired. Radiation therapy was delivered using intensity modulated radiotherapy (IMRT) with daily image-guided radiotherapy (IGRT). ART was defined as re-simulation and re-planning based on deformation in the irradiated volume by more than 1 cm. Univariate analysis was conducted to study the impact of patient's demographics as well as tumor characteristics on the frequency of ART.

Results: 22 patients were eligible for analysis. Median age at diagnosis was 55 years (range 43-82). Radiotherapy dose was 60-66 Gy over 30-35 fractions (fx). Median primary tumor volume was 30cc (9-140). Median Body Mass Index (BMI) was 32 (range 21-40). Thirteen out of 22 patients (59%) required ART, with median timing at 25 fx (19-31). On univariate analysis, larger primary tumor volume (> = 30cc) was associated significantly with increased frequency of ART ( value = 0.0005). There was no significant impact of ART on the frequency with respect to patient's age, BMI, tumor stage, grade and location.

Conclusion: Changes in radiation target volume are common among vulvar carcinoma patients who are treated with definitive radiotherapy, especially large primary tumors. This review highlights the importance of ART for patients with vulvar carcinoma treated with definitive radiotherapy.
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http://dx.doi.org/10.1016/j.rpor.2020.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358621PMC
July 2020

Improved EOG Artifact Removal Using Wavelet Enhanced Independent Component Analysis.

Brain Sci 2019 Dec 4;9(12). Epub 2019 Dec 4.

Department of Electrical Engineering and Information Systems, Faculty of Information Technology, University of Pannonia, Egyetem u.10, 8200 Veszprém, Hungary.

Electroencephalography (EEG) signals are frequently contaminated with unwanted electrooculographic (EOG) artifacts. Blinks and eye movements generate large amplitude peaks that corrupt EEG measurements. Independent component analysis (ICA) has been used extensively in manual and automatic methods to remove artifacts. By decomposing the signals into neural and artifactual components and artifact components can be eliminated before signal reconstruction. Unfortunately, removing entire components may result in losing important neural information present in the component and eventually may distort the spectral characteristics of the reconstructed signals. An alternative approach is to correct artifacts within the independent components instead of rejecting the entire component, for which wavelet transform based decomposition methods have been used with good results. An improved, fully automatic wavelet-based component correction method is presented for EOG artifact removal that corrects EOG components selectively, i.e., within EOG activity regions only, leaving other parts of the component untouched. In addition, the method does not rely on reference EOG channels. The results show that the proposed method outperforms other component rejection and wavelet-based EOG removal methods in its accuracy both in the time and the spectral domain. The proposed new method represents an important step towards the development of accurate, reliable and automatic EOG artifact removal methods.
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http://dx.doi.org/10.3390/brainsci9120355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956025PMC
December 2019

Coronary Artery Involvement in Segmental Arterial Mediolysis: A Case Report.

Radiol Cardiothorac Imaging 2019 Aug 29;1(3):e190035. Epub 2019 Aug 29.

Divisions of Cardiovascular and Thoracic Radiology (M.A.W., H.K., M.I., D.R., V.G.), Cardiovascular Medicine (M.A.W., A.R.E., V.G.), and Vascular Surgery (M.S.), and Departments of Obstetrics and Gynecology (D.R.) and Family and Community Medicine (M.S.), University of Kentucky Chandler Medical Center, UK HealthCare Enterprise, 800 Rose St, Room HX-313A, Lexington, KY 40536-0293.

Segmental arterial mediolysis (SAM) is an increasingly recognized disorder affecting small- to medium-sized muscular arteries. A patient with SAM involving the visceral arteries who was also found to have multivessel coronary artery involvement is described. The patient underwent a battery of biochemical, imaging, and genetic tests to exclude other vasculitides and connective tissue disorders. The aim is to shed light on the potential for SAM to affect the coronary arteries and recommend screening of the coronary arteries of patients with SAM. © RSNA, 2019.
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http://dx.doi.org/10.1148/ryct.2019190035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977705PMC
August 2019

Fetus in fetu: A rare case of intra-abdominal mass.

Radiol Case Rep 2019 Sep 20;14(9):1171-1174. Epub 2019 Jul 20.

Radiology resident Suez Canal University, Egypt.

Fetus in fetu is uncommon cause of retroperitoneal mass in infancy that resulted from abnormal embryogenesis. Clinical manifestations vary and mostly presented at infancy It is differentiated from teratoma through its location, benign course, and identification of limb buds and well-organized organs. Radiologically, identification of long bones and organized vertebral bodies are core in the diagnosis. Presented is 4 days-old male with abdominal distention as the main manifestation. Definite radiological diagnosis was done by Ultrasound (US) and computed tomography scan.
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http://dx.doi.org/10.1016/j.radcr.2019.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656986PMC
September 2019

Congenital intravascular abdominal aortic band initially thought to be a metallic foreign body: Characterization using microanatomical CT reconstruction technique.

Radiol Case Rep 2019 Sep 15;14(9):1127-1131. Epub 2019 Jul 15.

Department of Radiology, Gill Heart Institute, University of Kentucky Chandler Medical Center, Lexington, KY, USA.

We present a patient with the initial misdiagnosis of a metallic foreign body in the abdominal aorta. Computed tomographic angiography utilizing microanatomical reconstruction technique revealed the structure to instead be a partially calcified abdominal aortic congenital fibrous band. Most congenital fibrous bands spanning the aortic lumen are proximal within the aorta and are thought to be supportive structures of the aortic valve leaflets. Congenital fibrous bands distal to the sinotubular junction are quite rare.
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http://dx.doi.org/10.1016/j.radcr.2019.06.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637249PMC
September 2019

Manual on-the-fly physician postprocessing of computed tomographic angiography data guides embolotherapy of atypical bleeding following paracentesis; a case report.

Clin Imaging 2019 Nov - Dec;58:1-4. Epub 2019 Jun 5.

Department of Radiology, University of Kentucky Chandler Medical Center, Lexington, KY, United States of America; Department of Medicine, Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky Chandler Medical Center, United States of America. Electronic address:

Major bleeding, typically due to laceration of abdominal wall arteries or venous varices, is a rare but serious complication of paracentesis. We report a case of major bleeding post paracentesis to evidence that a sequence of 1) customized post processing of computed tomographic angiography data for periprocedural guidance, followed by 2) transcatheter cyanoacrylate glue embolotherapy, is the optimal treatment of this complication.
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http://dx.doi.org/10.1016/j.clinimag.2019.03.006DOI Listing
February 2020

The augmented role of pancreatic imaging in the era of endoscopic necrosectomy: an illustrative and pictorial review.

Abdom Radiol (NY) 2020 05;45(5):1534-1549

Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA.

Endoscopic cystogastrostomy for mature pancreatic collections has long been recognized. However, FDA approval of newer lumen-apposing metallic stents in 2014 has now brought pancreatic necrosectomy to the endoscopic realm. Endoscopic drainage of Walled-off necrosis and direct endoscopic necrosectomy are technically challenging procedures with higher rates of complications. Collaborative clinical decision making both pre- and post-procedurally between the radiologist, endoscopist, and the surgeon can greatly improve outcomes in necrotizing pancreatitis. Herein, we review the basic pathophysiology that underlies progressive radiographic findings in NP, value of preprocedural imaging, current management algorithms, newer tools, and techniques as well as potential post-procedure complications on imaging follow-up after endoscopic interventions in necrotizing pancreatitis.
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http://dx.doi.org/10.1007/s00261-019-02093-1DOI Listing
May 2020

Prescribing of proton pump inhibitors for gastrointestinal bleeding prophylaxis in the Lebanese outpatient setting: patterns, compliance with guidelines and risks.

Int J Pharm Pract 2019 Aug 3;27(4):386-392. Epub 2019 Apr 3.

Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon.

Objectives: To determine patterns of proton pump inhibitor (PPIs) prescribing for gastrointestinal bleeding prophylaxis (GIBP) in the Lebanese outpatient setting, to assess their compliance with guidelines for approved GIBP indications and to delineate independent factors that are associated with non-compliance.

Methods: A community-based multicentre cross-sectional study was conducted. Eligible patients were those who presented to the community pharmacy setting with a PPI prescription for GIBP. Prescriptions were reviewed by a clinical pharmacist to ascertain their compliance with guidelines approved for GIBP indications. Several variables were tested to determine independent factors that were associated with guidelines non-compliance.

Key Findings: Of the 720 reviewed PPI prescriptions, 297 (41.25%) were found to be compliant with guidelines approved for GIBP indications. The presence of two or more comorbid conditions, prescribing initiated by a primary care physician, patients taking three or more medications, and prescribing of NSAIDs including low-dose aspirin were found to be independent factors that were significantly associated with PPI prescribing non-compliance (P ≤ 0.05). PPIs were also inappropriately coprescribed with corticosteroids (102 (24.1%)), selective serotonin reuptake inhibitors (SSRIs) (48 (11.4%)), amoxicillin-clavulanic acid (20 (4.7%)) and bisphosphonates (13 (3.1%)) for GIBP.

Conclusion: This study demonstrated that PPIs were appropriately prescribed for GIBP in less than the half of the study patients. The need for improvement of clinical practice in this regard is therefore indispensable since inappropriate prescribing is costly and put the patient at risk for adverse health outcomes. Strategies to alter inappropriate prescribing may include education, guidelines awareness and decision support systems.
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http://dx.doi.org/10.1111/ijpp.12537DOI Listing
August 2019

Systemic artery-pulmonary artery fistulae of adult bronchopulmonary dysplasia characterized with dynamic CT angiography and multiphase 3D-volumetric reconstruction: a case report.

Cardiovasc Diagn Ther 2019 Feb;9(1):55-59

Department of Radiology, University of Kentucky, Lexington, KY, USA.

We present a case of bronchopulmonary dysplasia in an adult survivor to demonstrate the utility of dynamic computed tomography angiography and multiphase 3D-volumetric reconstruction for complete characterization of the systemic artery-pulmonary artery fistulae which can occur with this pathological entity.
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http://dx.doi.org/10.21037/cdt.2018.09.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382651PMC
February 2019

Microvascular volume visualization utilizing computed tomographic angiography data facilitates resection of a complicated massive congenital hemangioma.

Clin Imaging 2019 May - Jun;55:8-11. Epub 2019 Jan 17.

Department of Radiology, University of Kentucky Chandler Medical Center, Lexington, KY, United States of America.

CT angiography (CTA) can be used for planning procedural and operative therapies for neonatal vascular lesions, such as congenital hemangiomas (CH), that are too morbid for medical therapy. Neonatal anatomy can be displayed within a small enough field-of-view that the nominal resolution of a modern CT scanner can be realized with a standard 512 × 512 storage matrix, yielding isometric ultrahigh resolution data and allowing for microvascular volume visualization. This case report details the creation and use of microvascular volume visualizations of CTA data during pre-procedural planning for treatment of this pathological entity.
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http://dx.doi.org/10.1016/j.clinimag.2019.01.015DOI Listing
October 2019

Early TIPS failure in association with left mesenterico-gonadal spontaneous portosystemic venous shunt; a case report.

Clin Imaging 2019 Jan - Feb;53:200-203. Epub 2018 Oct 27.

Department of Radiology, University of Kentucky Chandler Medical Center, Lexington, KY, United States of America. Electronic address:

Transjugular intrahepatic portosystemic shunt (TIPS) periprocedural thrombosis rates have fallen significantly since the introduction of polytetrafluoroethylene-covered stent grafts. We present a case of a cirrhotic patient with portal hypertension presenting with early TIPS thrombosis in association with an underlying competing spontaneous left mesenterico-gonadal venous shunt, an uncommon variant of spontaneous portal systemic shunt (SPSS). The patient presented with bleeding distal duodenal varices refractory to endovascular therapy, and although a successful TIPS procedure was performed for this indication, early thrombosis was determined by follow-up abdominopelvic computed tomographic angiography (CTA) scan. Despite undergoing a standard TIPS revision procedure, blood flow through the TIPS remained hepatofugal. During a TIPS revision, portal vein angiography revealed competing large inferior mesenteric vein (IMV) varices shunting into the left renal vein via the left gonadal vein. The initial abdominal CTA was later reviewed by a non-invasive cardiovascular radiologist, and the presence of the competing left mesenterico-gonadal shunt was retrospectively identified. Radiologists interpreting CTA exams should be aware of SPSS generally and mesenterico-gonadal shunts specifically. Pre-procedural knowledge of underlying SPSS can affect post procedural outcomes and should be emphasized in the final CTA report.
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http://dx.doi.org/10.1016/j.clinimag.2018.10.023DOI Listing
March 2019
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