1
|
Hafez W, Rashid A, Abuelsaoud HM, Jose M, Kishk S, Gador M, Emoshe T, Abdulaal F, Nair N, Ahmad M, Rashid VJ, Faheem Y, John S, Ahmed S, Daraghmi A, Soliman R, Abdelrahman A, Mohamed AA, Ghanem M. Evaluating the potential mediating role of ADAMTS13 activity in the relationship between obesity and the severity of COVID-19: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e37806. [PMID: 38608066 PMCID: PMC11018207 DOI: 10.1097/md.0000000000037806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Obesity and low enzyme A disintegrin and metalloproteinase with thrombospondin type-1 motif-13 (ADAMTS13) activity have been linked to poor coronavirus disease 2019 (COVID-19). Given that obesity may influence ADAMTS13 activity, it is feasible; however, it remains unclear whether ADAMTS13 activity acts as a mediator between obesity and COVID-19 outcomes. We investigated the link between body mass index (BMI) and COVID-19 outcomes, using ADAMTS13 activity as a mediator. ADAMTS13 activity was measured in 86 hospitalized COVID-19 patients. BMI, ADAMTS13 activity, and COVID-19 outcomes were assessed. Obese patients had a high odds ratio for low ADAMTS13 levels. When different levels of ADAMTS13 activity were considered, the severity of COVID-19 in obese patients was 4.5 times that in the normal BMI group. Furthermore, increased coagulopathy indicators correlated with low ADAMTS13 activity. Patients with elevated ALT and AST levels showed a 3 to 4-fold increase in the chances of low ADAMTS13 activity (OR:3.19, 95% CI:1.22-8.90, P = .021; OR:2.17, 95% CI:0.91-5.27, P = .082, respectively). When ADAMTS13 activity was considered, obese patients had greater COVID-19 severity and slower viral clearance than those with normal BMI. Low ADAMTS13 activity and impaired liver function are associated with poor COVID-19 outcomes. These findings encourage researchers to use molecular component identification to study the effects of obesity on the von Willebrand factor (VWF)/ADAMTS13 axis, COVID-19 pathogenesis, and outcomes.
Collapse
Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
- Internal Medicine Department, Medical Research and Clinical Studies Institute; The National Research Centre, Cairo, Egypt
| | - Asrar Rashid
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | | | - Mohan Jose
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Samy Kishk
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Muneir Gador
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | | | - Fatema Abdulaal
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Nivedita Nair
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Muhammad Ahmad
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | | | - Youmna Faheem
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Steffi John
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Sabah Ahmed
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Ahmed Daraghmi
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Rami Soliman
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
- National Institute of Chest and Allergy, Egypt
| | - Ahmed Abdelrahman
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
- Internal Medicine Department, Zagazig Faculty of Medicine, Zagazig, Egypt
| | - Ahmed Ali Mohamed
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
- Intensive Care Department, Theodor Bilharz Research Institute, AL Warak, Giza Governorate, Egypt
| | - Mirvat Ghanem
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| |
Collapse
|
2
|
Rashid J, Wu S, Abdelrahman A, McMillan K. Maxillofacial trauma caused by e-scooters: a retrospective review prior to the extension of the UK scheme. Br J Oral Maxillofac Surg 2024; 62:157-163. [PMID: 38238115 DOI: 10.1016/j.bjoms.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
The nationwide extension of the electric scooter (e-scooter) scheme, which began in 2020, aimed to alleviate public transport congestion, to reduce pollution and peak-time road traffic. This retrospective study evaluates the range of e-scooter-related maxillofacial trauma before the recent scheme extension and compares the findings with existing literature on this topic. The Queen Elizabeth Hospital Birmingham, United Kingdom (UK) operates as a Level 1 Regional Major Trauma Centre and serves a population of four million. All patient records between September 2021 to September 2022 were analysed to establish the types of e-scooter-related maxillofacial trauma sustained. A Pearson's chi-squared test was used to assess for significant associations between variables recorded. Falls accounted for the majority of injuries (44.3%), and soft tissue lacerations were the most common maxillofacial injury (38%). Statistically significant results were measured in the following variables: gender and intoxication status (p = 0.007), helmet status and injuries sustained in maxillofacial and non-maxillofacial regions (p = 0.043), mechanism of injury and injuries sustained in both the maxillofacial and non-maxillofacial regions (p = 0.045). E-scooters are an emerging concern within the UK. Further studies across the UK are required to assess the frequency of e-scooter-related injuries. Such data may prove useful in determining the government's decision on e-scooter use on UK roads.
Collapse
Affiliation(s)
- J Rashid
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom.
| | - S Wu
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom.
| | - A Abdelrahman
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom.
| | - K McMillan
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom.
| |
Collapse
|
3
|
Nader S, Massoud A, Al-Obeidat F, Mohamed WF, Hafez W, Rashid A, Yousef OAE, Gador M, Ahmed S, Jose M, Abdelrahman A, Abdelshakour M, Fathey S, Osorio MF, Robles-Velasco K, Cherrez-Ojeda I. Impact of aerobic and resistance training on fatigue, quality of life, and physical activity in prostate cancer patients: a systematic review and meta-analysis. Int J Surg 2024:01279778-990000000-00957. [PMID: 38224407 DOI: 10.1097/js9.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Prostate cancer (PCa) is a prevalent cancer with significant morbidity and mortality rates. In most cases, prostate cancer remains asymptomatic until advanced disease manifests with symptoms, such as benign prostate hyperplasia (BPH). Timely detection and better management have improved overall survival in patients with prostate cancer, and fatigue, reduced physical activity, and impaired quality of life (QoL) remain major challenges that impact daily life. OBJECTIVE This study aimed to systematically review and conduct a meta-analysis to evaluate the impact of aerobic and resistance training on fatigue, quality of life, and physical activity in prostate cancer patients undergoing treatment. MATERIAL METHODS A comprehensive literature search was conducted using the PubMed, Cochrane Library, and clinicaltrials.gov databases, adhering to the PRISMA guidelines. Twenty studies, involving 1393 participants, were included in the final analysis. The inclusion criteria were Studies that evaluated the effects of exercise interventions relative to passive controls in patients with prostate cancer were included. The primary outcomes of interest were fatigue, QoL, and PA.. Data from eligible studies were extracted, and a meta-analysis was performed using RevMan 5.40. RESULTS Twenty studies met our inclusion criteria. Data Analysis of the included studies demonstrated a significant improvement in quality of life among prostate cancer patients in the exercise group compared to the control group (SMD=0.20, 95% CI=0.07 to 0.34, P=0.003). However, there was no significant association between exercise and fatigue (SMD=0.07, 95% CI=-0.13, 0.26, P=0.51). Sensitivity analysis did not alter these findings. Regarding physical activity outcomes, the control group exhibited superior performance in the 400-meter walk test (P<0.05). No significant associations were found between exercise and the 6-meter walk test or up-and-go time. CONCLUSION This systematic review revealed that aerobic and resistance training enhance the quality of life of patients with prostate cancer, although it has a limited impact on fatigue and physical activity levels. These findings advocate a shift in clinical practice and positioning exercise as a core component of comprehensive cancer care. Tailoring exercise regimens according to individual patient needs and treatment stages should become the norm in treatment planning. This approach goes beyond physical wellness and addresses the psychological and emotional facets of cancer management. Moreover, there is an evident need for further research to develop holistic exercise interventions that effectively address the complex dynamics of fatigue, physical activity, and QoL in this patient group.
Collapse
Affiliation(s)
- Simon Nader
- NMC Royal Hospital, AbU Dhabi, United Arab Emirates
| | - Amr Massoud
- NMC Royal Hospital, AbU Dhabi, United Arab Emirates
| | - Feras Al-Obeidat
- College of Technological innovations, Zayed University, Abu Dhabi, United Arab Emirates
| | | | - Wael Hafez
- Healthpoint Hospital, Abu Dhabi, United Arab Emirates
| | - Asrar Rashid
- NMC Royal Hospital, AbU Dhabi, United Arab Emirates
| | | | - Muneir Gador
- NMC Royal Hospital, AbU Dhabi, United Arab Emirates
| | - Sabah Ahmed
- NMC Royal Hospital, AbU Dhabi, United Arab Emirates
| | - Mohan Jose
- NMC Royal Hospital, AbU Dhabi, United Arab Emirates
| | | | | | - Sherihan Fathey
- Faculty of medicine, university of Debrecan, Debrecen, Hungary
| | | | | | | |
Collapse
|
4
|
Cengiz TB, Abdelrahman A, Rohren SA, Doucette J, Ghesani M. The diagnostic accuracy of perfusion-only scan in the diagnosis of pulmonary embolism in the era of COVID-19: A single-center study of 434 patients. Ann Thorac Med 2023; 18:199-205. [PMID: 38058788 PMCID: PMC10697306 DOI: 10.4103/atm.atm_42_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/25/2023] [Accepted: 03/09/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION There is a paucity of data in the literature regarding the diagnostic accuracy of perfusion (Q)-only studies in the absence of ventilation images. This study aims to assess the diagnostic accuracy of Q-only imaging in the pandemic era. METHODS Patients who underwent Q-only imaging for pulmonary embolism between March 2020 and February 2021 were analyzed. Patients who underwent lung quantification analysis were excluded. Q-only test results were reported as per modified PIOPED II criteria and single positron emission tomography/computed tomography (SPECT/CT) imaging was performed as needed. Patients were considered concordant or discordant by correlating the Q-only results with CT angiogram (CTA) or clinical diagnosis made through chart review. The diagnostic accuracy was calculated after excluding intermediate probability and nondiagnostic studies. RESULTS Four hundred and thirty-four patients were identified. One hundred and twenty-eight patients (29.4%) underwent ultrasound Doppler, 37 patients (8.5%) underwent CTA, and 16 patients (3.6%) underwent both. After excluding patients with intermediate probability or nondiagnostic studies and who did not have follow-up (a total of 87 patients [20%]), 347 patients were enrolled in the final analysis. The combined planar and SPECT/CT sensitivity and specificity were 85.4% (72.2%-93.9% confidence interval [CI]) and 98.7% (96.9%-98.6% CI), respectively. The positive predictive value (PPV) of the Q-only imaging was 89.1% (77.3%-95.1% CI) and the negative predictive value (NPV) was 98.2% (96.4%-99% CI). The sensitivity with SPECT/CT reached 100% (CI: 71.5%-100%) with a specificity of 92.3% (CI: 64%-99.8%). The PPV was 85.7% (CI: 62.1%-95.6%) and the NPV was 100%. CONCLUSION Q-only imaging provides clinically acceptable results. The sensitivity of the Q-only scan is increased when coupled with SPECT/CT.
Collapse
Affiliation(s)
- Turgut Bora Cengiz
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Ahmed Abdelrahman
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Scott A. Rohren
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
| | - John Doucette
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Munir Ghesani
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
5
|
Wong KYK, Hughes DA, Debski M, Latt N, Assaf O, Abdelrahman A, Taylor R, Allgar V, McNeill L, Howard S, Wong SYS, Jones R, Cassidy CJ, Seed A, Galasko G, Clark A, Wilson D, Davis GK, Montasem A, Lang CC, Kalra PR, Campbell R, Lip GYH, Cleland JGF. Effectiveness of out-patient based acute heart failure care: a pilot randomised controlled trial. Acta Cardiol 2023; 78:828-837. [PMID: 37694719 DOI: 10.1080/00015385.2023.2197834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Acute heart failure (AHF) hospitalisation is associated with 10% mortality. Outpatient based management (OPM) of AHF appeared effective in observational studies. We conducted a pilot randomised controlled trial (RCT) comparing OPM with standard inpatient care (IPM). METHODS We randomised patients with AHF, considered to need IV diuretic treatment for ≥2 days, to IPM or OPM. We recorded all-cause mortality, and the number of days alive and out-of-hospital (DAOH). Quality of life, mental well-being and Hope scores were assessed. Mean NHS cost savings and 95% central range (CR) were calculated from bootstrap analysis. Follow-up: 60 days. RESULTS Eleven patients were randomised to IPM and 13 to OPM. There was no statistically significant difference in all-cause mortality during the index episode (1/11 vs 0/13) and up to 60 days follow-up (2/11 vs 2/13) [p = .86]. The OPM group accrued more DAOH {47 [36,51] vs 59 [41,60], p = .13}. Two patients randomised to IPM (vs 6 OPM) were readmitted [p = .31]. Hope scores increased more with OPM within 30 days but dropped to lower levels than IPM by 60 days. More out-patients had increased total well-being scores by 60 days (p = .04). OPM was associated with mean cost savings of £2658 (95% CR 460-4857) per patient. CONCLUSIONS Patients with acute HF randomised to OPM accrued more days alive out of hospital (albeit not statistically significantly in this small pilot study). OPM is favoured by patients and carers and is associated with improved mental well-being and cost savings.
Collapse
Affiliation(s)
- K Y K Wong
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - D A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - M Debski
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - N Latt
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - O Assaf
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - A Abdelrahman
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - R Taylor
- Research and Development Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - V Allgar
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
| | - L McNeill
- Accountant, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - S Howard
- Financial Information And Costing Manager, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - S Y S Wong
- Department of Care of the Older Person, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - R Jones
- Public Involvement Group, Research and Development Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - C J Cassidy
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - A Seed
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - G Galasko
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - A Clark
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
| | - D Wilson
- Department of Cardiology, Worcestershire Royal Hospital (Worcestershire Acute Hospital NHS Trust), Worcester, UK
| | - G K Davis
- Cardiorespiratory Research Centre, Edge Hill University Medical School, Ormskirk, UK
| | - A Montasem
- Institute of Life Course and Medical Sciences, School of Dental Sciences, Liverpool University Dental Hospital, University of Liverpool, Liverpool, UK
| | - C C Lang
- Department of Cardiology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - P R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - R Campbell
- Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - G Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - J G F Cleland
- Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| |
Collapse
|
6
|
Elaziz AMA, Soliman M, Abdelrahman A, Abdelaziz T, Battah A, Sheriff H, Elsherif A, Abdelhamid Y. #6306 SUSTAINED LOW-EFFICIENCY DIALYSIS VERSUS CONTINUOUS VENO-VENOUS HEMODIAFILTRATION OUTCOME IN CRITICALLY ILL PATIENTS. Nephrol Dial Transplant 2023; 38. [DOI: 10.1093/ndt/gfad063c_6306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background and Aims
Acute kidney injury due to sepsis is the most common cause of AKI in critical care settings. Different modalities of renal replacement therapies (RRT) have been used to manage this condition including Continuous Renal Replacement Therapy (CRRT) and sustained low efficiency dialysis (SLED). The aim of this work was to compare the outcome of SLED and CRRT in the form of continuous veno-venous hemodiafiltration (CVVDHF) as methods of dialysis in sepsis induced AKI.
Method
We retrospectively analysed data from 120 patients; 20 patients received CVVHDF to manage AKI in the context of sepsis, 47 patients received SLED to manage AKI in the context of sepsis and the third group included 53 patients who have been treated with SLED to manage AKI not due to sepsis. Age was found to be significantly higher in sepsis induced AKI patients treated with SLED than patients treated with CVVHDF (65±10.1# 59.5±9.3 y, p = 0.03). Sex distribution or incidences of hypertension, diabetes mellitus, malignancy or liver disease were not statistically different between groups.
Results
Unadjusted 30 day mortality was 44.7% (21pt) in the SLED group Vs 50% (10pt) in the CVVHDF group, p = 0.07. Adjusted mortality was not statically significant between SLED and CVVHDF (OR 0.97, CI = 0.95-1.06). Hypotension occurred more frequently in patients treated with SLED (24 pt = 51.1% #5 pt = 25%, p < 0.001).Clotting occurred more frequently in the CVVHDF group as compared to SLED group (7 pt = 35% Vs 4pt = 8.5% p < 0.001).
Conclusion
Sustained low efficiency dialysis (SLED) and CVVHDF had comparable 30 day mortality as modalities of RRT in critically ill Patients with sepsis induced AKI. SLED still an attractive alternative to CRRT modalities due to lower cost and lower incidence of complications. Further larger studies are recommended.
Collapse
Affiliation(s)
| | - Mohamed Soliman
- Faculty of Medicine-Cairo University, Critical Care Department, Cairo, Egypt
| | - Ahmed Abdelrahman
- Faculty of Medicine-Cairo University, Nephrology Division-Internal Medicine Department, Cairo, Egypt
| | - Tarek Abdelaziz
- Faculty of Medicine-Cairo University, Nephrology Division-Internal Medicine Department, Cairo, Egypt
| | - Ahmed Battah
- Faculty of Medicine-Cairo University, Critical Care Department, Cairo, Egypt
| | - Hossam Sheriff
- Faculty of Medicine-Cairo University, Critical Care Department, Cairo, Egypt
| | - Ahmed Elsherif
- Faculty of Medicine-Cairo University, Critical Care Department, Cairo, Egypt
| | - Yasser Abdelhamid
- Faculty of Medicine-Cairo University, Nephrology Division-Internal Medicine Department, Cairo, Egypt
| |
Collapse
|
7
|
Jarrah A, Mansour M, Alnasarat A, Abdelrahman A, Damlakhy A, Eltawansy S. Disseminated Legionella Associated With Myocarditis in an Otherwise Immunocompetent Host: A Case Report and Review of the Literature. Cureus 2023; 15:e40529. [PMID: 37461776 PMCID: PMC10350323 DOI: 10.7759/cureus.40529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Legionnaires' disease caused by the bacteria Legionella pneumophila, is considered a type of atypical pneumonia. The disease usually presents with dyspnea, cough, fever, muscle aches, headache, nausea, and vomiting. A milder form of the disease (Pontiac fever) with flu-like illness also exists. In addition to lung infection, extrapulmonary manifestations might occur including sepsis, rhabdomyolysis, neurological impairment, kidney, and liver damage. Myocarditis can be seen as a rare complication in Legionnaires' disease. Here, we are presenting a case of Legionnaires' disease associated with myocarditis in a patient with no predisposing risk factors for severe illness.
Collapse
Affiliation(s)
- Abdullah Jarrah
- Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
| | - Mohamed Mansour
- Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
| | - Ahmad Alnasarat
- Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
| | - Ahmed Abdelrahman
- Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
| | - Ahmad Damlakhy
- Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
| | - Sherif Eltawansy
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| |
Collapse
|
8
|
Swed S, Alibrahim H, Bohsas H, Jawish N, Rais MA, Nasif MN, Hafez W, Sawaf B, Abdelrahman A, Fathey S, Atef Ismail Ahmed Ibrahim I, Almashaqbeh SHA, Yousef Aljawarneh RM, Rakab A, EL-Shafei EHH, Hurlemann R, Elsayed MEG. A multinational cross-sectional study on the awareness and concerns of healthcare providers toward monkeypox and the promotion of the monkeypox vaccination. Front Public Health 2023; 11:1153136. [PMID: 37228716 PMCID: PMC10203626 DOI: 10.3389/fpubh.2023.1153136] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/29/2023] [Indexed: 05/27/2023] Open
Abstract
Background The aim of this study was to explore potential healthcare workers' (HCWs) concerns about the monkeypox virus in order to create practical solutions to manage this disease. Methods Online cross-sectional research was conducted in 11 Arabic countries (Egypt, Saudi Arabia, Yemen, Syria, Libya, Algeria, Tunisia, Iraq, Palestine, Jordan, and Sudan) from 2 August 2022 to 28 December 2022. Results Approximately 82% of respondents felt the need to acquire further information. The acceptability of the vaccine against monkeypox has been indicated by more than half of the participants (54.5%). Furthermore, we state that 45% of the participants are knowledgeable about the monkeypox virus, and 53.1% of the participants have never been affected with COVID-19 before are more worried about COVID-19 than about monkeypox. Participants diagnosed with COVID-19 were 0.63 times less likely to worry about monkeypox than those who were not diagnosed with COVID-19. A greater willingness to get the monkeypox vaccination was seen among the age group 21-30 years (42.4%) compared to the other age groups. Conclusion Most healthcare professionals have a moderate knowledge of the monkeypox virus. Furthermore, they demonstrated a low willingness to get the vaccination against the monkeypox virus.
Collapse
Affiliation(s)
- Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | | | - Nagham Jawish
- Damascus University Faculty of Medicine, Damascus, Syria
| | | | | | - Wael Hafez
- New Medical Centre (NMC) Royal Hospital, Khalifa City, United Arab Emirates
- Medical Research Division, Department of Internal Medicine, The National Research Centre, Cairo, Egypt
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Abdelrahman
- Internal Medicine Department, Faculty of Medicine Zagazig University, Zagazig, Egypt
| | | | | | | | | | - Amine Rakab
- Department of Clinical Medicine, Weill Cornell Medical College, Ar-Rayyan, Qatar
| | | | - Rene Hurlemann
- Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
- Department of Psychiatry, University Hospital Bonn, Bonn, Germany
- Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Mohamed E. G. Elsayed
- Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| |
Collapse
|
9
|
Sritharan R, Arya R, Abdelrahman A, Parmar S, Sharp I, Breeze J. Justifying the implementation of intraoperative computed tomography for midface fracture treatment in improving outcomes. Br J Oral Maxillofac Surg 2023; 61:315-319. [PMID: 37088595 DOI: 10.1016/j.bjoms.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
Intraoperative CT scanning is the international standard for treating midface fractures as it allows intraoperative assessment of reduction and fixation. To our knowledge, no NHS hospital in the UK has this facility yet due to the financial and logistical burden of its implementation. The aim of this study was to determine if complications including the requirement for a return to theatre (RTT) could have been predicted from the post-fixation CT scan. All treated midface fractures that had presented to a regionalised major trauma centre within two years (01 January 2020 - 31 December 2021) were identified. Those developing complications including RTT were determined. All postoperative CT scans (including those without complication or RTT) were re-analysed with the clinicians blinded to the outcomes to determine the positive predictive value (PPV) and negative predictive value (NPV) of requiring RTT to alter plate position intraoperatively based on CT scan alone. In all, there were eight episodes of unplanned return to theatre, resulting in an overall RTT rate of 8/119 (6.7%). When only analysing patients treated for orbital fractures this RTT rises to 8/40 (20%). Of those eight patients who had a postoperative CT and required RTT, this could have been predicted in 7/8 (87.5%). A total of 16/44 (36.4%) patients that did not have RTT would have additionally been recommended to have the plate position altered based on CT alone. Based upon those that had a CT, the PPV of CT alone being able to predict those requiring RTT was 40.6% and the NPV 96.2%. Our results would suggest intraoperative CT would likely have prevented eight patients requiring RTT in two years and could have improved outcomes in 16 cases. In preventing RTT as well as potentially improving the outcomes of a further 16 cases in maxillofacial surgery, the purchase of an intraoperative CT scanner could yield net savings of £75534-£114990 over two years.
Collapse
Affiliation(s)
- R Sritharan
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom.
| | - R Arya
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - A Abdelrahman
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - S Parmar
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - I Sharp
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - J Breeze
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom
| |
Collapse
|
10
|
Swed S, Bohsas H, Alibrahim H, Rakab A, Hafez W, Sawaf B, Amir RM, Motawei AS, Aljabali A, Shoib S, Atef Ismail Ahmed Ibrahim I, Ahmad Almashaqbeh SH, Qaid Shaddad EA, Alqaisi M, Abdelrahman A, Fathey S, Hurlemann R, Elsayed MEG, Barboza JJ, Mohanty A, Rodriguez-Morales AJ, Padhi BK, Sah R. Monkeypox Post-COVID-19: Knowledge, Worrying, and Vaccine Adoption in the Arabic General Population. Vaccines (Basel) 2023; 11:vaccines11040759. [PMID: 37112671 PMCID: PMC10141174 DOI: 10.3390/vaccines11040759] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/31/2023] Open
Abstract
Background: The outbreak of monkeypox was declared a global public health emergency by the World Health Organization on 23 July 2022. There have been 60,000 cases reported worldwide, most of which are in places where monkeypox has never been seen due to the travel of people who have the virus. This research aims to evaluate the general Arabic population in regard to the monkeypox disease, fears, and vaccine adoption after the WHO proclaimed a monkeypox epidemic and to compare these attitudes to those of the COVID-19 pandemic. Methods: This cross-sectional study was performed in some Arabic countries (Syria, Egypt, Qatar, Yemen, Jordan, Sudan, Algeria, and Iraq) between 18 August and 7 September 2022. The inclusion criteria were the general public residing in Arabic nations and being older than 18. This questionnaire has 32 questions separated into three sections: sociodemographic variables, prior COVID-19 exposure, and COVID-19 vaccination history. The second portion assesses the knowledge and anxieties about monkeypox, while the third section includes the generalized anxiety disorder (GAD7) scale. Logistic regression analyses were performed to compute the adjusted odds ratios (aOR) and their confidence intervals (95%CI) using STATA (version 17.0). Results: A total of 3665 respondents from 17 Arabic countries were involved in this study. Almost two-thirds (n = 2427, 66.2%) of the participants expressed more worry about COVID-19 than monkeypox diseases. Regarding the major cause for concern about monkeypox, 39.5% of participants attributed their anxiety to the fear that they or a member of their family may contract the illness, while 38.4% were concerned about monkeypox becoming another worldwide pandemic. According to the GAD 7 score, 71.7% of the respondents showed very low anxiety toward monkeypox and 43.8% of the participants scored poor levels of knowledge about monkeypox disease. Participants with previous COVID-19 infection showed a 1.206 times greater acceptance to receive the monkeypox vaccine than those with no previous infection. A 3.097 times higher concern for monkeypox than COVID-19 was shown by the participants who perceived monkeypox as dangerous and virulent than those who did not. Participants who have a chronic disease (aOR: 1.32; 95%CI: 1.09–1.60); participants worried about monkeypox (aOR: 1.21; 95%CI: 1.04–1.40), and perceived monkeypox as a dangerous and virulent disease (aOR: 2.25; 95%CI: 1.92–2.65); and excellent knowledge level (aOR: 2.28; 95%CI: 1.79–2.90) have emerged as significant predictors. Conclusions: Our study reported that three-fourths of the participants were more concerned about COVID-19 than monkeypox disease. In addition, most of the participants have inadequate levels of knowledge regarding monkeypox disease. Hence, immediate action should be taken to address this problem. Consequently, learning about monkeypox and spreading information about its prevention is crucial.
Collapse
|
11
|
Abd-Allah M, Abdelrahman A. An Integrated Ensemble Based Prediction Approach to Quantify and Propagate Uncertainties of Naturally Fractured Carbonate Reservoirs. Day 1 Sun, February 19, 2023 2023. [DOI: 10.2118/213457-ms] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AbstractNaturally fractured reservoirs are holding most of the hydrocarbon proven reserves worldwide. Field development planning and optimization of fractured reservoirs face significant challenges due to fracture system complexity, high reservoir heterogeneity and multiple recovery mechanisms. Fractured systems generally have multiple sets of fractures in different orientations, multiple apertures ranging from tiny fissures to large fracture conduits resulting in complicated fluid flow.Reservoir modeling plays a key role in field optimization by examining reservoir recovery under various scenarios. Traditionally, modeling fractured reservoirs is a deterministic process using a single or few reservoirs model (high, mid, and low cases) without proper integration of seismic-to-simulation reservoir model uncertainties. The full span of possible reservoir models and prediction uncertainty isn't captured nor propagated to economics.This paper presents an integrated forward modeling workflow using a Synthetic 3D model data mimicking a real North Sea field, where static and dynamic models are tightly connected to integrate the impact of uncertainties at different modeling stages (horizon uncertainties, fault uncertainties, petrophysical uncertainties, discrete fracture network (DFN) uncertainties to dynamic simulation).
Collapse
|
12
|
Meumann N, Cabanes-Creus M, Ertelt M, Navarro RG, Lucifora J, Yuan Q, Nien-Huber K, Abdelrahman A, Vu XK, Zhang L, Franke AC, Schmithals C, Piiper A, Vogt A, Gonzalez-Carmona M, Frueh JT, Ullrich E, Meuleman P, Talbot SR, Odenthal M, Ott M, Seifried E, Schoeder CT, Schwäble J, Lisowski L, Büning H. Adeno-associated virus serotype 2 capsid variants for improved liver-directed gene therapy. Hepatology 2023; 77:802-815. [PMID: 35976053 PMCID: PMC9936986 DOI: 10.1002/hep.32733] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/29/2022] [Accepted: 08/07/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND AIMS Current liver-directed gene therapies look for adeno-associated virus (AAV) vectors with improved efficacy. With this background, capsid engineering is explored. Whereas shuffled capsid library screenings have resulted in potent liver targeting variants with one first vector in human clinical trials, modifying natural serotypes by peptide insertion has so far been less successful. Here, we now report on two capsid variants, MLIV.K and MLIV.A, both derived from a high-throughput in vivo AAV peptide display selection screen in mice. APPROACH AND RESULTS The variants transduce primary murine and human hepatocytes at comparable efficiencies, a valuable feature in clinical development, and show significantly improved liver transduction efficacy, thereby allowing a dose reduction, and outperform parental AAV2 and AAV8 in targeting human hepatocytes in humanized mice. The natural heparan sulfate proteoglycan binding ability is markedly reduced, a feature that correlates with improved hepatocyte transduction. A further property that might contribute to the improved transduction efficacy is the lower capsid melting temperature. Peptide insertion also caused a moderate change in sensitivity to human sera containing anti-AAV2 neutralizing antibodies, revealing the impact of epitopes located at the basis of the AAV capsid protrusions. CONCLUSIONS In conclusion, MLIV.K and MLIV.A are AAV peptide display variants selected in immunocompetent mice with improved hepatocyte tropism and transduction efficiency. Because these features are maintained across species, MLIV variants provide remarkable potential for translation of therapeutic approaches from mice to men.
Collapse
Affiliation(s)
- Nadja Meumann
- Institute of Experimental Hematology , Hannover Medical School , Hannover , Germany.,Center for Molecular Medicine Cologne , University of Cologne , Cologne , Germany
| | - Marti Cabanes-Creus
- Translational Vectorology Research Unit , Children's Medical Research Institute , The University of Sydney , Sydney , New South Wales , Australia
| | - Moritz Ertelt
- Institute for Drug Discovery , University Leipzig Medical School , Leipzig , Germany.,Center for Scalable Data Analytics and Artificial Intelligence ScaDS.AI , Dresden/Leipzig , Germany
| | - Renina Gale Navarro
- Translational Vectorology Research Unit , Children's Medical Research Institute , The University of Sydney , Sydney , New South Wales , Australia
| | - Julie Lucifora
- Cancer Research Center of Lyon , Institut National de la Santé et la Recherche Médicale , Lyon , France
| | - Qinggong Yuan
- Department of Gastroenterology, Hepatology, and Endocrinology , Hannover Medical School , Hannover , Germany.,Twincore Centre for Experimental and Clinical Infection Research , Hannover , Germany
| | - Karin Nien-Huber
- Institute for Transfusion Medicine and Immunohematology , Goethe University Hospital Medical School , German Red Cross Blood Donor Service , Frankfurt , Germany
| | - Ahmed Abdelrahman
- Institute for Transfusion Medicine and Immunohematology , Goethe University Hospital Medical School , German Red Cross Blood Donor Service , Frankfurt , Germany
| | - Xuan-Khang Vu
- Institute of Experimental Hematology , Hannover Medical School , Hannover , Germany
| | - Liang Zhang
- Center for Molecular Medicine Cologne , University of Cologne , Cologne , Germany.,Institute of Pathology , University Hospital Cologne , Cologne , Germany
| | - Ann-Christin Franke
- Institute of Experimental Hematology , Hannover Medical School , Hannover , Germany
| | - Christian Schmithals
- Department of Internal Medicine I , University Hospital Frankfurt , Frankfurt , Germany
| | - Albrecht Piiper
- Department of Internal Medicine I , University Hospital Frankfurt , Frankfurt , Germany
| | - Annabelle Vogt
- Department of Internal Medicine I , University Hospital Bonn , Bonn , Germany
| | | | - Jochen T Frueh
- Experimental Immunology , Children's University Hospital , Goethe University Frankfurt , Frankfurt am Main , Germany
| | - Evelyn Ullrich
- Experimental Immunology , Children's University Hospital , Goethe University Frankfurt , Frankfurt am Main , Germany
| | - Philip Meuleman
- Laboratory of Liver Infectious Diseases , Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Steven R Talbot
- Institute for Laboratory Animal Science , Hannover Medical School , Hannover , Germany
| | - Margarete Odenthal
- Center for Molecular Medicine Cologne , University of Cologne , Cologne , Germany.,Institute of Pathology , University Hospital Cologne , Cologne , Germany
| | - Michael Ott
- Department of Gastroenterology, Hepatology, and Endocrinology , Hannover Medical School , Hannover , Germany.,Twincore Centre for Experimental and Clinical Infection Research , Hannover , Germany
| | - Erhard Seifried
- Institute for Transfusion Medicine and Immunohematology , Goethe University Hospital Medical School , German Red Cross Blood Donor Service , Frankfurt , Germany
| | - Clara T Schoeder
- Institute for Drug Discovery , University Leipzig Medical School , Leipzig , Germany
| | - Joachim Schwäble
- Institute for Transfusion Medicine and Immunohematology , Goethe University Hospital Medical School , German Red Cross Blood Donor Service , Frankfurt , Germany
| | - Leszek Lisowski
- Translational Vectorology Research Unit , Children's Medical Research Institute , The University of Sydney , Sydney , New South Wales , Australia.,Military Institute of Medicine , Laboratory of Molecular Oncology and Innovative Therapies , Warsaw , Poland
| | - Hildegard Büning
- Institute of Experimental Hematology , Hannover Medical School , Hannover , Germany.,Center for Molecular Medicine Cologne , University of Cologne , Cologne , Germany
| |
Collapse
|
13
|
Talbot SR, Kumstel S, Schulz B, Tang G, Abdelrahman A, Seume N, Wendt EHU, Eichberg J, Häger C, Bleich A, Vollmar B, Zechner D. Robustness of a multivariate composite score when evaluating distress of animal models for gastrointestinal diseases. Sci Rep 2023; 13:2605. [PMID: 36788346 PMCID: PMC9929045 DOI: 10.1038/s41598-023-29623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
The fundament of an evidence-based severity assessment in laboratory animal science is reliable distress parameters. Many readouts are used to evaluate and determine animal distress and the severity of experimental procedures. Therefore, we analyzed four distinct parameters like the body weight, burrowing behavior, nesting, and distress score in the four gastrointestinal animal models (pancreatic ductal adenocarcinoma (PDA), pancreatitis, CCl4 intoxication, and bile duct ligation (BDL)). Further, we determined the parameters' robustness in various experimental subgroups due to slight variations like drug treatment or telemeter implantations. We used non-parametric bootstrapping to get robust estimates and 95% confidence intervals for the experimental groups. It was found that the performance of the readout parameters is model-dependent and that the distress score is prone to experimental variation. On the other hand, we also found that burrowing and nesting can be more robust than, e.g., the body weight when evaluating PDA. However, the body weight still was highly robust in BDL, pancreatitis, and CCl4 intoxication. To address the complex nature of the multi-dimensional severity space, we used the Relative Severity Assessment (RELSA) procedure to combine multiple distress parameters into a score and mapped the subgroups and models against a defined reference set obtained by telemeter implantation. This approach allowed us to compare the severity of individual animals in the experimental subgroups using the maximum achieved severity (RELSAmax). With this, the following order of severity was found for the animal models: CCl4 < PDA ≈ Pancreatitis < BDL. Furthermore, the robustness of the RELSA procedure and outcome was externally validated with a reference set from another laboratory also obtained from telemeter implantation. Since the RELSA procedure reflects the multi-dimensional severity information and is highly robust in estimating the quantitative severity within and between models, it can be deemed a valuable tool for laboratory animal severity assessment.
Collapse
Affiliation(s)
- Steven R Talbot
- Hannover Medical School, Institute for Laboratory Animal Science, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Simone Kumstel
- Rostock University Medical Center, Rudolf-Zenker-Institute for Experimental Surgery, Schillingallee 69a, 18057, Rostock, Germany
| | - Benjamin Schulz
- Rostock University Medical Center, Rudolf-Zenker-Institute for Experimental Surgery, Schillingallee 69a, 18057, Rostock, Germany
| | - Guanglin Tang
- Rostock University Medical Center, Rudolf-Zenker-Institute for Experimental Surgery, Schillingallee 69a, 18057, Rostock, Germany
| | - Ahmed Abdelrahman
- Rostock University Medical Center, Rudolf-Zenker-Institute for Experimental Surgery, Schillingallee 69a, 18057, Rostock, Germany
| | - Nico Seume
- Rostock University Medical Center, Rudolf-Zenker-Institute for Experimental Surgery, Schillingallee 69a, 18057, Rostock, Germany
| | - Edgar H U Wendt
- Rostock University Medical Center, Rudolf-Zenker-Institute for Experimental Surgery, Schillingallee 69a, 18057, Rostock, Germany
| | - Johanna Eichberg
- Rostock University Medical Center, Rudolf-Zenker-Institute for Experimental Surgery, Schillingallee 69a, 18057, Rostock, Germany
| | - Christine Häger
- Hannover Medical School, Institute for Laboratory Animal Science, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - André Bleich
- Hannover Medical School, Institute for Laboratory Animal Science, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Brigitte Vollmar
- Rostock University Medical Center, Rudolf-Zenker-Institute for Experimental Surgery, Schillingallee 69a, 18057, Rostock, Germany
| | - Dietmar Zechner
- Rostock University Medical Center, Rudolf-Zenker-Institute for Experimental Surgery, Schillingallee 69a, 18057, Rostock, Germany
| |
Collapse
|
14
|
Elmoghrabi A, Shafi I, Abdelrahman A, Osman H, Manasrah N, Zghouzi M, Halboni A, Patino S, Patel NN, Hakim Z, Gardi D, Lakkis N, Alraies MC. Outcomes of Catheter-Based Pulmonary Artery Embolectomy in Patients With Sub-Massive to Massive Pulmonary Embolism. Cureus 2023; 15:e34877. [PMID: 36925989 PMCID: PMC10013309 DOI: 10.7759/cureus.34877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Background Pulmonary embolism (PE) is the third leading cause of cardiovascular death after myocardial infarction and stroke. The ideal therapeutic approach for these patients remains undetermined. We report our single-center outcome data for using a catheter-based pulmonary artery thrombectomy using the FlowTriever (Inari Medical, Irvine, CA) device as management for patients with submassive PE. Methods We retrospectively collected data from a single center of patients who underwent thrombectomy using INARI FlowTriever device. The data on baseline characteristics, procedural and clinical outcomes was collected and analysed Results A total of 38 patients with PE treated endovascularly with the FlowTriever device were identified: 33 with submassive PE and five with massive PE. The mean age was 65.9 years (95% CI 61.9 - 69.8), and most patients were male (73.7%). All patients had right heart strain as the main indication for thrombectomy. Four patients (10.53%) required pressor support before the procedure. In 31 patients, pre- and post-thrombectomy average mean pulmonary artery pressure (mPAP) was improved significantly by 22% (p < 0.01). Two patients had significant adverse events at 48 hours (5.26%). One patient experienced procedure-related access site hematoma and life-threatening bleeding, while another developed intraprocedural-related massive hemoptysis and cardiopulmonary arrest. Overall post-procedural length of stay was 7.7 ± 5.6 days; 52.63% of patients (n = 20) required intensive care. Three patients (7.89%) required pressor support before the procedure, and 78.9% of patients (n = 30 of 38) survived hospital discharge. Thirty patients who survived were discharged with oral anticoagulation. There were no device-related complications. Conclusion Randomized trials of interventional devices for submassive PE are warranted to either support or alert the medical community of the safety and efficacy of their use for patients with submassive and massive PE. In time, pulmonary embolism response team (PERT) may generate outcome data that better inform treatment decisions.
Collapse
Affiliation(s)
- Adel Elmoghrabi
- Cardiology, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Irfan Shafi
- Cardiology, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Ahmed Abdelrahman
- Cardiology, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Heba Osman
- Internal Medicine/Pediatrics, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center, Sinai Grace Hospital - Wayne State University, Detroit, USA
| | - Mohamed Zghouzi
- Internal Medicine, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Adnan Halboni
- Internal Medicine, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Skarlet Patino
- Cardiology, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Neel N Patel
- Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, USA.,Graduate Medical Education, B J Medical College, Ahmedabad, IND
| | - Zaher Hakim
- Cardiology, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Delair Gardi
- Cardiology, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Nasser Lakkis
- Cardiology, Detroit Medical Center - Wayne State University, Detroit, USA
| | - M Chadi Alraies
- Cardiology, Detroit Medical Center - Wayne State University, Detroit, USA
| |
Collapse
|
15
|
Abdelrahman A, Smith AS, Sengupta K. Observing Membrane and Cell Adhesion via Reflection Interference Contrast Microscopy. Methods Mol Biol 2023; 2654:123-135. [PMID: 37106179 DOI: 10.1007/978-1-0716-3135-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Reflection interference contrast microscopy (RICM) is an optical microscopy technique ideally suited for imaging adhesion. While RICM (and the closely related interference reflection microscopy (IRM)) has been extensively used qualitatively or semiquantitatively to image cells, including immune cells, it can also be used quantitatively to measure membrane to surface distance, especially for model membranes. Here, we present a protocol for RICM and IRM imaging and the details of semiquantitative and quantitative analysis.
Collapse
Affiliation(s)
- Ahmed Abdelrahman
- Aix Marseille University, CNRS, CINAM, Turing Centre for Living Systems, Marseille, France
| | - Ana-Sunčana Smith
- PULS Group, Department of Physics, Centre for Computational Materials and Processes, Friedrich Alexander University Erlangen-Nürnberg, IZNF, Erlangen, Germany.
- Group for Computational Life Sciences, Division of Physical Chemistry, Ruđer Bošković Institute, Zagreb, Croatia.
| | - Kheya Sengupta
- Aix Marseille University, CNRS, CINAM, Turing Centre for Living Systems, Marseille, France
| |
Collapse
|
16
|
Matthews P, Matthews P, Tolia J, Abdelrahman A, Hall T. 17. A first cycle audit of CT staging scans for head and neck cancer patients. Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2022.11.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
17
|
McGoldrick D, McGoldrick D, Edwards J, Abdelrahman A, Praveen P, Parmar S. 18. Admission patterns and outcomes of post-operative oral cavity and oropharyngeal cancer patients admitted to critical care: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
18
|
Glover S, Glover S, Abdelrahman A, Blore C, Breeze J, Sharp I. 114. The rounding of the inferior rectus muscle in orbital floor fractures- a clinically significant finding? Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2022.11.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
19
|
Sritharan R, Sritharan R, Arya R, Abdelrahman A, Sharp I, Breeze J. 42. Intra-operative CT scanning for mid face fracture fixation – Can we improve outcomes and introduce costs savings? Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2022.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
20
|
Hanemann CO, Abdelrahman A, Adams C, Sahm F, Urbanic-Purkart T, Khalil M, Vergura R, Morelli C. BIOM-56. MIR-497 AND 219 IN BLOOD AID MENINGIOMA CLASSIFICATIONMIR-497 AND 219 IN BLOOD AID MENINGIOMA CLASSIFICATION. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
There is a need for blood biomarkers for meningioma. The role of circulating micro RNA in cancer diagnosis has been the objective of several studies. One of the extensively studied miRNA in different types of cancer is the microRNA-497 (miR-497). This study systematically evaluated miR-497 as a meningioma biomarker for disease diagnosis and classification. We studied exosomal and serum miR-497 in 74 meningioma samples (WHO grade I=25, WHO grade II=25, and WHO grade III=24), and 53 healthy controls. We also tested two different normalisers, endogenous and external, and evaluated their impact on the diagnostic value of miR-497. Another microRNA studied in meningioma is miR-219, which increased with increasing tumour grade. We combined miR-497 and miR-219 and estimated the sensitivity and specificity of the joint biomarkers to indicate meningioma grade and the relationship between miR-497 and miR-219 expression level and methylation class of meningioma. The serum and exosomal level of miR-497 distinguished meningioma from the control samples. Moreover, miR-497 was a suitable identifier for meningioma grade. When we combined miR-497 and miR-219, the efficacy of the combined biomarker was higher than miR-497 or miR-219 when used individually in meningioma classification. Both miR-497 and miR-219 showed a noticeable change with the methylation class of meningioma.
Collapse
Affiliation(s)
| | - Ahmed Abdelrahman
- Peninsula Medical School, University of Plymouth , Plymouth , United Kingdom
| | - Claire Adams
- Peninsula Medical School, University of Plymouth , Plymouth , United Kingdom
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, and Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK) and German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | | | - Michael Khalil
- Department of Neurology, Medical University of Graz , Graz , Austria
| | | | | |
Collapse
|
21
|
Abdelrahman A, Negroni C, Sahm F, Adams CL, Urbanic-Purkart T, Khalil M, Vergura R, Morelli C, Hanemann CO. miR-497 and 219 in blood aid meningioma classification. J Neurooncol 2022; 160:137-147. [PMID: 36076132 DOI: 10.1007/s11060-022-04126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The current WHO classification and methylation status help predict meningioma recurrence and prognosis. However, up to date, there is no circulating biomarker showing clinical value in meningioma diagnosis or classification. Circulating miRNAs showed the potential to be used as cancer biomarkers in various tumours. This research evaluated specific miRNAs, miR-497 and miR-219, as convenient and efficient predictors of meningioma grades. METHODS We studied serum and exosomal levels of miR-497 in 74 meningioma samples (WHO grade I = 25, WHO grade II = 25, and WHO grade III = 24) and 53 healthy controls. The serum level of miR-219 was studied in 56 meningioma samples WHO grade I = 22, WHO grade II = 14, and WHO grade III = 20). We used qPCR for miRNA quantification. We also tested two different normalisers, endogenous and external, and evaluated their impact on the diagnostic value of miR-497. RESULTS The serum and exosomal levels of miR-497 distinguished meningioma from the control samples. Moreover, miR-497 was a suitable identifier for meningioma grade. When we combined miR-497 and miR-219, the efficacy of the combined biomarker was higher than miR-497 or miR-219 when used individually in meningioma classification. Both miR-497 and miR-219 showed a noticeable change with the methylation class of meningioma. CONCLUSION This study shows that serum miR-497 is an effective and easy-to-measure biomarker for meningioma diagnosis and classification. Moreover, when we combined miR-497 and miR-219, the combined biomarker showed enhanced accuracy in meningioma classification. Furthermore, this is the first study to evaluate the correlation between serum circulating miRNA and the methylation status in meningioma.
Collapse
Affiliation(s)
- Ahmed Abdelrahman
- Peninsula Medical School, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth, PL6 8BU, UK
| | - Caterina Negroni
- Peninsula Medical School, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth, PL6 8BU, UK
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, 69126, Heidelberg, Germany
| | - Claire L Adams
- Peninsula Medical School, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth, PL6 8BU, UK
| | - Tadeja Urbanic-Purkart
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | | | | | - Clemens Oliver Hanemann
- Peninsula Medical School, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth, PL6 8BU, UK.
| |
Collapse
|
22
|
Hafez W, Abdelrahman A. Factors Influencing Disease Stability and Response to Tocilizumab Therapy in Severe COVID-19: A Retrospective Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11081078. [PMID: 36009949 PMCID: PMC9405062 DOI: 10.3390/antibiotics11081078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 01/08/2023] Open
Abstract
(1) Background: The efficacy of tocilizumab in COVID-19 has been doubted. The study aimed to investigate factors affecting disease stability and response to tocilizumab among severe COVID-19 patients. (2) Methods: This was a cohort study of 70 severe COVID-19 patients at NMC Royal Hospital, UAE, from April to June 2020. (3) Results: Elderly patients and those with cardiovascular comorbidities had a higher risk of unstable COVID-19 (p = 0.025). Regarding tocilizumab therapy timing, compared to the critical group receiving tocilizumab, the unstable severe patients receiving tocilizumab had a significantly higher rate of improvement (86%). In contrast, the late critical subgroup showed a significantly increased mortality rate (52.9%). The risk for secondary infection and adverse events following tocilizumab was higher in the late critical group than in the unstable severe and early critical groups (p = 0.024 and p = 0.006, respectively). Therapeutic doses of anticoagulation and high-dose vitamin D were correlated with better outcomes than the prophylactic dose and the treatment dose of vitamin D (p < 0.001 and p = 0.07, respectively). (4) Conclusions: elderly patients and those with cardiovascular disease developed unstable COVID-19. Tocilizumab is a potentially effective choice against severe and critical COVID-19. Early tocilizumab administration combined with therapeutic dose anticoagulation and high vitamin D doses could improve the patients’ outcomes.
Collapse
Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, Abu Dhabi P.O. BOX 764659, United Arab Emirates
- The Medical Research Division, Department of Internal Medicine, The National Research Centre, Cairo 12622, Egypt
- Correspondence: ; Tel.: +971-2203-5000
| | - Ahmed Abdelrahman
- NMC Royal Hospital, Abu Dhabi P.O. BOX 764659, United Arab Emirates
- Internal Medicine Department, Zagazig School of Medicine, Zagazig 44519, Egypt
| |
Collapse
|
23
|
Hafez W, Ahmed S, Abbas N, Ahmed K, Kamran S, Arya A, Rao SR, Abdelshakor M, Ali S, Sebastian H, Tariq M, Lal K, Abdelrahman A. ABO Blood Group in Relation to COVID-19 Susceptibility and Clinical Outcomes: A Retrospective Observational Study in the United Arab Emirates. Life (Basel) 2022; 12:life12081157. [PMID: 36013335 PMCID: PMC9410437 DOI: 10.3390/life12081157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/21/2022]
Abstract
(1) Background: The association between ABO blood groups and COVID-19 outcomes was investigated in several studies. The results were controversial. This study aimed to explore the association between ABO blood groups and COVID-19 outcomes. (2) Methods: This retrospective study included 303 COVID-19 patients treated at the NMC Royal Hospital in the United Arab Emirates between 8 April 2020 and 30 June 2020. (3) Results: The mean age of patients included in the study was 39.3 ± 10.7 years, and 72.9% of patients were males. The prevalence of blood groups O, A, B, and AB was 40.3%, 27.7%, 25.1%, and 6.9%, respectively. The correlation between ABO blood groups and COVID-19 outcomes was insignificant except in the AB group, with significantly higher odds of disease severity. Increased age, higher body mass index (BMI), and being of male gender increased the risk for pneumonia among all blood groups. Both increased age and higher BMI increased the risk of mortality, and increased age increased the risk of disease severity. Troponin and platelet counts were significantly different in the A group compared to the non-A groups. Time to viral clearance was not different among blood groups. However, adjustment for Rh groups resulted in a significantly shorter time in the B group. (4) Conclusions: There was no significant association between ABO blood groups and COVID-19 outcomes, with the exception of group AB.
Collapse
Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
- The Medical Research Division, Department of Internal Medicine, The National Research Center, Cairo 12622, Egypt
- Correspondence: ; Tel.: +971-2203-5000
| | - Shougyat Ahmed
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Nihad Abbas
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Kamran Ahmed
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Samera Kamran
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Arun Arya
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Srinivasa Raghu Rao
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Mahmoud Abdelshakor
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Sara Ali
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Honeymol Sebastian
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Mishal Tariq
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Kumar Lal
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Ahmed Abdelrahman
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
- Internal Medicine Department, Zagazig School of Medicine, Zagazig 44519, Egypt
| |
Collapse
|
24
|
Hafez W, Ziade MA, Arya A, Saleh H, Abdelrahman A. The significance of antiglobulin (Coombs) test reactivity in patients with COVID-19. Immunobiology 2022; 227:152240. [PMID: 35839729 PMCID: PMC9258419 DOI: 10.1016/j.imbio.2022.152240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/17/2022] [Accepted: 07/02/2022] [Indexed: 12/15/2022]
Abstract
Previous case reports have described patients with COVID-19-associated autoimmune hemolytic anemia (AIHA), and cold agglutinin disease (CAD) which is characterized by a positive direct antiglobulin (DAT) or "Coombs" test, yet the mechanism is not well understood. To investigate the significance of Coombs test reactivity among COVID-19 patients, we conducted a retrospective study on hospitalized COVID-19 patients treated at NMC Royal Hospital between 15 April and 30 May 2020. There were 27 (20%) patients in the Coombs-positive group and 108 (80%) in the Coombs-negative group. The cold agglutinin titer was examined in 22 patients due to symptoms suggestive of cold agglutinin disease, and all tested negative. We demonstrated a significant association with reactive Coombs test results in univariate analysis through clinical findings such as ICU admission rate, the severity of COVID-19, and several laboratory findings such as CRP, D-dimer, and hemoglobin levels lactate dehydrogenase, and RDW-CV. However, only hemoglobin levels and disease severity had a statistically significant association in multivariate analysis. A possible explanation of COVID-19-associated positive Coombs is cytokine storm-induced hyperinflammation, complement system activation, alterations of RBCs, binding of SARS-CoV-2 proteins to hemoglobin or its metabolites, and autoantibody production. Coombs-positive patients were tested for hemolysis using indirect bilirubin, consumed haptoglobin, and/or peripheral smear that ruled out any evidence of hemolysis. Understanding this etiology sheds new light on RBC involvement as a pathophysiological target for SARS-CoV-2 by interfering with their function; consequently, therapies capable of restoring RBC function, such as erythrocytapheresis, could be repurposed for the treatment of worsening severe and critical COVID-19.
Collapse
Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates; Medical Research Division, Department of Internal Medicine, The National Research Center, Cairo, Egypt.
| | - Mohamad Azzam Ziade
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Arun Arya
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Husam Saleh
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Ahmed Abdelrahman
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates; Internal Medicine Department, Zagazig School of Medicine, Zagazig, Egypt
| |
Collapse
|
25
|
Hussein A, Abdelrahman A, Elabd M, Gaafar S. O-071 In progestin primed double stimulation protocol: Is luteal phase stimulation more effective than follicular phase stimulation in poor responders? A randomized controlled study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is follicular phase or luteal phase stimulation more effective in progestin primed double stimulation protocol in poor responders?
Summary answer
The luteal phase stimulation was more effective than follicular phase stimulation in the progestin primed dual stimulation protocol in poor responders.
What is known already
Poor ovarian responders involve 9–24% of patients undergoing in vitro fertilization (IVF), with the management of these patients posing an everyday practical challenge.
Owing to the follicular waves theory, two or three waves of folliculogenesis were detected during the interovulatory interval, two consecutive ovarian stimulation protocols could be initiated in the follicular phase and the subsequent luteal phase. This is an effective way to increase the number of oocytes and embryos obtained over a relative short period of time. Furthermore, there is increasing evidence that progestins can be a reliable method of preventing premature LH surge during ovarian stimulation.
Study design, size, duration
This was a randomized controlled study performed at the Infertility and Assisted Reproduction Unit of ElShatby Maternity Hospital, Alexandria University and Madinah Fertility Centre. The study was conducted on 90 infertile women with poor ovarian response as defined by the Bologna criteria. 7 patients were excluded due to protocol violation, loss to follow-up and patient withdrawal. The study commenced in September 2020 and was finalized in September 2021.
Participants/materials, setting, methods
Group 1
45 patients were given the progestin primed double stimulation protocol. Dydrogesterone was started from the first day of the ovulation induction till the end of luteal phase stimulation. Embryo transfer was scheduled in a subsequent cycle.
Group 2
45 patients were given the flexible GnRh antagonist protocol in 2 cycles. The best blastocyst from either cycle was transferred in the second cycle.
Main results and the role of chance
When comparing the follicular and luteal phases, the M2 oocytes number retrieved in the luteal phase was statistically significantly higher than the follicular phase, with the median number of 4 oocytes against a median number of 2 oocytes (P value 0.001). The fertilization rate was significantly higher in the M2 oocytes of the luteal phase stimulation (P value 0.04). The resultant embryos from the luteal stimulation phase were statistically significantly higher than the follicular phase, with the median number of 3 embryos against a median number of 1 embryo (P value <0.001). However, we found that the days of controlled ovarian hyperstimulation were statistically significant higher in stimulation of the luteal phase with the median of 12 days against the 10 days seen in follicular phase stimulation (P value 0.002). Consequently, the total dosage of gonadotropins was statistically significant higher in the luteal phase with a P value of 0.007.
After Subgroup analysis, Poseidon Group 4 patients demonstrated that a significantly higher number of oocytes were retrieved after the progestin primed double stimulation than after two waves of flexible GnRh antagonist stimulation (median of 12 oocytes against a median of 10 oocytes with P value 0.01).
Limitations, reasons for caution
Firstly, preimplantation genetic testing was not performed to detect euploid embryos which could be vital when comparing both the phases and the protocols. Secondly, despite the importance of the live birth rate as an outcome measure, we did not enroll this measure.
Wider implications of the findings
In the light of our findings, we recommend the usage of progestin primed dual stimulation protocol in poor responder patients. Additionally, we call for multicentric randomized controlled research to verify this protocol as a first-line treatment protocol in poor responder patients.
Trial registration number
ClinicalTrials.gov ID: NCT04537078
Collapse
Affiliation(s)
- A Hussein
- ElShatby Maternity Hospital- Alexandria University, Obstetrics and Gynecology, Alexandria , Egypt
| | - A Abdelrahman
- ElShatby Maternity Hospital- Alexandria University, Obstetrics and Gynecology, Alexandria , Egypt
| | - M Elabd
- ElShatby Maternity Hospital- Alexandria University, Obstetrics and Gynecology, Alexandria , Egypt
| | - S Gaafar
- ElShatby Maternity Hospital- Alexandria University, Obstetrics and Gynecology, Alexandria , Egypt
| |
Collapse
|
26
|
Abuzeid O, Abdelrahman A, LaChance J, Herrera K, Garry D, Abuzeid M. O-058 Obstetric outcomes of twin gestation after In-Vitro Fertilization and Embryo Transfer (IVT-ET) treatment in patients who underwent hysteroscopic septoplasty for subseptate uterus. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is there an associated increased risk of preterm birth (PTB) in patients who underwent hysteroscopic septoplasty for subseptate uterus (SSU) with twin gestation through IVF-ET?
Summary answer
This study suggests an increased risk of PTB in patients, who underwent hysteroscopic septoplasty for SSU, and subsequently conceived twins after IVF-ET treatment.
What is known already
In general, the incidence of PTB is higher after IVF-ET treatment. In addition, Müllerian uterine anomalies, such as unicornuate uterus, are considered risk factors for PTB, even with singleton pregnancy. Furthermore, historical data suggest that some patients with uterine anomaly may have cervical incompetence. Twin gestation is associated with PTB in approximately 50% of cases. It is assumed that the obstetric outcome of twin gestation after successful septoplasty should be no different from those with normal uterine cavity. The impact of previous septoplasty for SSU on the obstetric outcomes of twin gestation after IVF-ET treatment has not been adequately studied.
Study design, size, duration
This retrospective cohort study included 377 fertility patients who received treatment between 2006-2019. The study group included 162 patients who underwent hysteroscopic septoplasty for SSU and subsequently conceived dichorionic-diamniotic (DI-DI) twins after IVF-ET treatment (Group 1). The control group included 215 patients who had normal endometrial cavity on hysteroscopy (#109) or Transvaginal 3D ultrasound scan with saline sonohysterogram (#106) and subsequently conceived DI-DI twins after IVF-ET treatment (Group 2).
Participants/materials, setting, methods
This study was conducted at an infertility clinic affiliated with an academic hospital. Demographic, clinical, and obstetric outcome data were collected for both groups and compared using appropriate statistical methods. PTB, severe PTB, extreme PTB, and peri-viable birth were defined as < 37 weeks, <32 weeks, <28 weeks and between 20 weeks-25 weeks 6 days gestation respectively.
Main results and the role of chance
There was no significant difference in mean age, BMI and infertility duration or in the incidence of smoking, primary infertility, tubal factors and unexplained infertility between the two groups. There was significantly lower mean baseline FSH levels (p < 0.01), lower incidence of male infertility (p < 0.001) and higher incidence of ovulatory disorders (p < 0.001) and endometriosis (p < 0.05) in Group 1 compared to Group 2. As expected, there was past history of lower parity rate (p < 0.01) and higher miscarriage rate (p < 0.001) in Group 1 compared to Group 2 prior to septum division. There was significantly higher incidence of PTB (72.8% vs 56.3%, p < 0.01), severe PTB (20.3% vs 8.2%, p < 0.01), extreme PTB (8.3% vs 3.9%, p < 0.05), and peri-viable birth (6.3% vs 1.9%, p < 0.05) in Group 1 compared to Group 2. There was no significant difference in cesarean section rate (82.8% vs 87.5%, p = 0.349) between Group1 and Group 2 respectively. There was significantly lower gestational age at birth in weeks (34.0 + 4.0 vs 35.6 + 3.0, p < 0.001), birth weight of the first newborn (2180.5 + 717.9 vs 2436.4 + 606.6, p < 0.001), and the second newborn (2235.2 + 674.2 vs 2398.0 + 537.9, p < 0.05) in grams in Group 1 compared to Group 2.
Limitations, reasons for caution
Our study has limitations being retrospective in nature. Data on cervical length measurements via ultrasound, if performed, was not available. However, recall bias was prevented by retrieving data from that submitted to the Society of Assisted Reproductive Technology. Additionally, procedural variation was reduced as this was a single-center study.
Wider implications of the findings
Our study suggests that twin gestation after IVF-ET in patients who underwent successful hysteroscopic septoplasty for SSU may increase the likelihood of PTB. Such patients may require increased surveillance with ultrasound cervical length and signs for preterm labor. Future research should focus on measures to reduce PTB in such patients.
Trial registration number
Not Applicable
Collapse
Affiliation(s)
- O Abuzeid
- Renaissance School of Medicine at Stony Brook University, Maternal Fetal Medicine , Nesconset, U.S.A
| | - A Abdelrahman
- St. Joseph Mercy Oakland Hospital, Maternal Fetal Medicine , Pontiac, U.S.A
| | - J LaChance
- Hurley Medical Center/Michigan State University, Department of Research , Flint, U.S.A
| | - K Herrera
- Renaissance School of Medicine at Stony Brook University, Department of Obstetrics and Gynecology , Stony Brook , U.S.A
| | - D Garry
- Renaissance School of Medicine at Stony Brook University, Department of Obstetrics and Gynecology , Stony Brook , U.S.A
| | - M Abuzeid
- Department of Obstetrics and Gynecology- Hurley Medical Center/Michigan State University, Division of Reproductive Endocrinology and Infertility , Rochester, U.S.A
| |
Collapse
|
27
|
Abdelrahman A, McGoldrick D, Aggarwal A, Idle MR, Praveen P, Martin T, Parmar S. Retropharyngeal lymph node metastasis in oral cancer. Systematic review and survival analysis. Br J Oral Maxillofac Surg 2022; 60:563-569. [PMID: 35337688 DOI: 10.1016/j.bjoms.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Metastasis to retropharyngeal lymph nodes (RPLN) from oral squamous cell carcinoma is rare and associated with poor outcomes. The poor prognosis of RPLN is multifactorial and includes the clinicopathological aggressiveness of the primary disease and the late presentation. The aim of this systematic review is to assess the evidence on RPLN in patients diagnosed with oral squamous cell carcinoma (OSCC), the quality of the diagnostic modalities and the available treatment options. We aimed to analyse the overall survival of these patients diagnosed with RPLN. METHODS A systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The initial literature search generated 289 articles. A total of 11 papers satisfied our criteria. Eight papers provided enough data to perform survival analysis and 3 papers compared the diagnostic modalities used in the detection of RPLN. RESULTS A total of 73 OSCC patients diagnosed with RPLN metastasis were identified. The most common primary tumour subsites included the tongue (20), buccal mucosa (15) and gingiva (11). The cumulative 5-year OS rate was 17.8% while the 2-year overall survival was 35.9%. CONCLUSION The presence of nodal metastasis is an independent prognostic factor in head and neck cancer. In this study, RPLN metastasis had a poorer prognosis (5 years overall survival is 17.8%) when compared to the survival rate of oral cancer without RPLN metastasis (5 years overall survival is 40%). There was no statistically significant difference between the overall survival in primary RPLN metastasis and recurrent RPLN disease.
Collapse
Affiliation(s)
- A Abdelrahman
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - D McGoldrick
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - A Aggarwal
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - M R Idle
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - P Praveen
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - T Martin
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - S Parmar
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| |
Collapse
|
28
|
Sheha A, darwish E, Abdelrahman A, Abd-Elhafez A. ROLE OF MAGNETIC RESONANCE IMAGING IN DIAGNOSIS OF ENDOMETRIOSIS. Ain Shams Medical Journal 2022; 73:245-253. [DOI: 10.21608/asmj.2022.252395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
29
|
McGoldrick DM, Edwards J, Abdelrahman A, Praveen P, Parmar S. Admission patterns and outcomes of post-operative oral cavity and oropharyngeal cancer patients admitted to critical care in the UK: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Br J Oral Maxillofac Surg 2022; 60:1108-1113. [DOI: 10.1016/j.bjoms.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
|
30
|
Nada A, Shabana A, Elsaadany A, Abdelrahman A, Gaballah AH. Superior mesenteric artery thrombosis and small bowel necrosis: An uncommon thromboembolic manifestation in COVID-19 pneumonia. Radiol Case Rep 2022; 17:821-824. [PMID: 35003481 PMCID: PMC8719856 DOI: 10.1016/j.radcr.2021.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 12/15/2022] Open
Abstract
Thromboembolism is a recognized complication in patients with COVID-19 infection. It is believed that coagulopathy results secondary to severe inflammatory response syndrome with release of cytokines, viral activation of coagulation cascade or viral related vasculitis. Both arterial and venous thromboembolic complications have been described, however venous thromboembolic complications are much far common. We present an uncommon thromboembolic complication of the superior mesenteric artery in a 49-year-old male with COVID-19 pneumonia. The patient also developed segmental infarct of his renal transplant. Patients with SARS-COV-2 infection should be closely evaluated and monitored for the development of thromboembolic complications. Prompt evaluation with CT angiography of suspected thromboembolism could help early diagnosis and treatment which can reflect better patients' outcomes.
Collapse
Affiliation(s)
- Ayman Nada
- Department of Radiology, University of Missouri, One Hospital Dr., Columbia, MO 65212, USA
| | | | | | - Ahmed Abdelrahman
- Department of Radiology, University of Missouri, One Hospital Dr., Columbia, MO 65212, USA
| | - Ayman H Gaballah
- Department of Radiology, University of Missouri, One Hospital Dr., Columbia, MO 65212, USA
| |
Collapse
|
31
|
Siddig A, Abbasher Hussien Mohamed Ahmed K, Abdelrahman A, Abbasher A, Abbasher AA, Abbasher M, Hussien A. COVID-19 and cognitive impairment: A cross-sectional clinic-based study. Brain Behav 2022; 12:e2538. [PMID: 35195949 PMCID: PMC8933761 DOI: 10.1002/brb3.2538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/08/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with dementia are more prone to acquire COVID-19 infection. Patients with COVID-19 showed a tendency to develop cognitive impairment. OBJECTIVES We aimed to study the clinical manifestations of COVID-19 infection among adult Sudanese demented patients and the prevalence of cognitive impairment among adult Sudanese nondemented patients. METHODOLOGY This is a descriptive cross-sectional study that took place in Sudan, Khartoum state in the period (September to December 2021) in a private neurology/psychiatry clinic. A total of 135 adult Sudanese patients were included in this study and were divided into two groups. The first group consists of 100 patients with a known history of dementia that got infected recently with COVID-19, while the second group consists of 35 patients who developed some sort of cognitive impairment after recovering from COVID-19 infection. Regarding the second group, cognitive functions were assessed by senior consultant neurologist and senior consultant psychiatrist using a well validated neuropsychological measure. RESULTS Out of 100 patients in the first group, females were 60 and males were 40. Age distribution is between 63 and 98. The common presenting symptoms of COVID-19 among this group were cough and fever (90 patients), diarrhea and vomiting (5 patients), breathlessness (4 patients), coughing of blood (5 patients), convulsions (1 patient), paraplegia (1 patient), and hemiplegia (1 patient). Regarding the second group, age distribution varied from 30 to 80 years. Cognitive functions impairment was noticed as follows: memory recall (22%), memory recognition (23%), memory encoding (24%), processing speed (16%), executive functioning (19%), phonemic fluency (17%), and category fluency (17%). CONCLUSION Patients with dementia are more susceptible to develop COVID-19 infection. Patients with COVID-19 Infection are at risk of developing some sort of cognitive impairment after recovery.
Collapse
Affiliation(s)
- Amira Siddig
- Faculty of Medicine, AlNeelain University, Khartoum, Sudan
| | | | - Ahmed Abdelrahman
- Department of Psychiatry, Daoud Research Group Charity Clinic, Khartoum, Sudan
| | | | | | | | | |
Collapse
|
32
|
Kilbane Myers J, Abdelrahman A, Akpunonu B. Lung Cancer Metastasis to the Pituitary Gland. Cureus 2022; 14:e22608. [PMID: 35371745 PMCID: PMC8958116 DOI: 10.7759/cureus.22608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 12/05/2022] Open
Abstract
Common sites of lung cancer metastasis include the bone, brain, liver, and adrenal gland. Cancer metastasis to the pituitary gland or sellar region is a rare finding. Here, we present a case of pituitary gland metastasis from underlying lung cancer in a patient presenting with a predominance of pituitary symptoms over respiratory symptoms. A 48-year-old female was admitted to the hospital with progressive visual deficits, intractable headaches, constant nausea and vomiting, fatigue, polyuria, and polydipsia for about three months, all consistent with pituitary symptoms associated with secondary adrenal insufficiency, secondary hypothyroidism, and central diabetes insipidus. A brain MRI done two months earlier revealed a large mass in the pituitary gland and sella turcica area. Biochemical test abnormalities consistent with pituitary hormonal insufficiencies were noted, and subsequent imaging showed an enlarging pituitary mass and extensive metastases to the bones, brain, liver, adrenal gland, and lymph nodes. Bone biopsy was consistent with poorly differentiated adenocarcinoma of the lung as the primary site. The young age of this patient is uncommon compared to most patients with pituitary metastasis. Worsening pituitary symptoms with an enlarging pituitary mass and widespread metastases should alert consideration for pituitary metastasis and a search for a primary cancer site. Pituitary metastasis portrays a poor prognosis.
Collapse
|
33
|
Hafez W, Ziade MA, Arya A, Saleh H, Ali S, Rao SR, Fdl Alla O, Ali M, Zouhbi MA, Abdelrahman A. Reduced ADAMTS13 Activity in Correlation with Pathophysiology, Severity, and Outcome of COVID-19: A Retrospective Observational Study. Int J Infect Dis 2022; 117:334-344. [PMID: 35167969 PMCID: PMC8839807 DOI: 10.1016/j.ijid.2022.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low ADAMTS13 activity has been suggested to be an interplaying factor in the pathogenesis of COVID-19, considering that it is a thromboinflammatory disease with high risk of microthrombosis. OBJECTIVES The study aimed to explore the correlation between ADAMTS13 activity and the pathophysiological pathway of COVID-19. METHODS We carried out a retrospective observational study of 87 patients with COVID-19 in NMC Royal Hospital, Abu Dhabi, UAE. ADAMTS13 activity was measured and compared with patients' characteristics and clinical outcomes. RESULTS Low ADAMTS13 activity was associated with pneumonia (p = 0.007), severity of COVID-19 (p <0.001), and mechanical ventilation rates (p = 0.018). Death was more frequently observed among patients (5 patients) with low ADAMTS13 activity compared with normal activity (1 patient), as well as inflammatory markers. Decreased ADAMTS13 activity increased with the risk of pneumonia, severity of COVID-19, need for mechanical ventilation, and use of anticoagulants ([OR = 4.75, 95% CI 1.54-18.02, p = 0.011], [OR = 6.50, 95% CI 2.57-17.74; p <0.001], [OR = 4.10, 95% CI 1.29-15.82; p = 0.024], [OR = 8.00, 95% CI 3.13-22.16; p <0.001], respectively). The low ADAMTS13 activity group had a slightly longer time to viral clearance than the normal ADAMTS13 activity group, but it was not statistically significant (20 days, 95% CI 16-27 days vs 17 days, 95% CI 13-22 days; p = 0.08; Log rank = 3.1). CONCLUSIONS Low ADAMTS13 activity has been linked to pneumonia, COVID-19 severity, use of anticoagulants, and need for mechanical ventilation but not to mortality. We propose rADAMTS13 as a novel treatment for severe COVID-19.
Collapse
Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates; Medical Research Division, Department of Internal Medicine, The National Research Centre, 33 El Buhouth St, Ad Doqi, Dokki, Cairo Governorate 12622, Egypt.
| | - Mohamad Azzam Ziade
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Arun Arya
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Husam Saleh
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Sara Ali
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Srinivasa Raghu Rao
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Osman Fdl Alla
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Mohamed Ali
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Mouhamad Al Zouhbi
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Ahmed Abdelrahman
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates; Internal Medicine Department, Zagazig School of medicine, Zagazig, Egypt
| |
Collapse
|
34
|
Abd-Allah M, Abdelrahman A, Van Den Brul L, Taha T, Javed MA. Probabilistic Economical Evaluation for Business Decisions Through Integrated Uncertainty Assessment and Reliable Ensemble-Based Production Forecasts. Day 2 Tue, November 16, 2021 2021. [DOI: 10.2118/207317-ms] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
Economic evaluation of exploration and production projects ensures a positive return for asset operators and stakeholders and evaluates risk in field development decisions related to both reservoir model uncertainties and fluctuations in oil and gas prices. Traditionally, such evaluation is performed manually and deterministically using single or limited number of cases (limited number of reservoir models and few values of economic parameters). Such traditional approach does not integrate seismic-to-simulation reservoir model uncertainties, the reservoir model used is often unreliable due to inconsistent property modifications during the history matching process, full span of prediction uncertainty isn't properly propagated for economic evaluation and the whole process is not fully automated.
This paper presents an integrated and automated forward modelling approach where static and dynamic models are connected to integrate the impact of uncertainties at the different modelling stages (seismic interpretation through geological modelling to dynamic simulation and further to economic evaluations). The approach is demonstrated using synthetic 3D model data mimicking a real North Sea field. It starts by building an integrated modelling workflow that can capture the various reservoir model uncertainties at different stages to automatically generate multiple probable model realisations. Proxy models are constructed and used to refine the history match in successive batches. For each prediction development scenario, prediction probabilities are estimated using posterior ensemble of geologically consistent runs that matches historical observed data. The ensemble of reservoir models is automatically evaluated against different possible economic scenarios.
The approach presents a seamless and innovative workflow that benefits from new-generation hardware and software, enables faster simultaneous realisations, produces consistent and more reliable reservoir models. Probabilistic economic evaluation concept is implemented to calculate the statistical probabilities of economic indicators.
Collapse
|
35
|
Ravi K, Bentounsi Z, Tariq A, Brazeal A, Daudu D, Back F, Elhadi M, Badwi N, Shah SSNH, Bandyopadhyay S, Khalil H, Kimura H, Sekyi-Djan MN, Abdelrahman A, Shaheen A, Mbonda Noula AG, Wong AT, Ndajiwo A, Souadka A, Maina AN, Nyalundja AD, Sabry A, Hind B, Nteranya DS, Ngugi DW, de Wet E, Tolis EA, Wafqui FZ, Essangri H, Moujtahid H, Moola H, Narain K, Ravi K, Wassim K, Odiero LA, Nyaboke LS, Metwalli M, Naisiae M, Pueschel MG, Turabi N, El Aroussi N, Makram OM, Shawky OA, Outani O, Carides P, Patil P, Halley-Stott RP, Kurbegovic S, Marchant S, Moujtahid S, El Hadrati S, Agarwal T, Kidavasi VA, Agarwal V, Steyn W, Matumo W, Fahmy YA, Omar Z, Amod Z, Eloff M, Hussein NA, Sharma D. Systematic analysis of authorship demographics in global surgery. BMJ Glob Health 2021; 6:bmjgh-2021-006672. [PMID: 34666988 PMCID: PMC8527109 DOI: 10.1136/bmjgh-2021-006672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/09/2021] [Indexed: 02/06/2023] Open
Abstract
Background Global surgery has recently gained prominence as an academic discipline within global health. Authorship inequity has been a consistent feature of global health publications, with over-representation of authors from high-income countries (HICs), and disenfranchisement of researchers from low-income and middle-income countries (LMICs). In this study, we investigated authorship demographics within recently published global surgery literature. Methods We performed a systematic analysis of author characteristics, including gender, seniority and institutional affiliation, for global surgery studies published between 2016 and 2020 and indexed in the PubMed database. We compared the distribution of author gender and seniority across studies related to different topics; between authors affiliated with HICs and LMICs; and across studies with different authorship networks. Results 1240 articles were included for analysis. Most authors were male (60%), affiliated only with HICs (51%) and of high seniority (55% were fully qualified specialist or generalist clinicians, Principal Investigators, or in senior leadership or management roles). The proportion of male authors increased with increasing seniority for last and middle authors. Studies related to Obstetrics and Gynaecology had similar numbers of male and female authors, whereas there were more male authors in studies related to surgery (69% male) and Anaesthesia and Critical care (65% male). Compared with HIC authors, LMIC authors had a lower proportion of female authors at every seniority grade. This gender gap among LMIC middle authors was reduced in studies where all authors were affiliated only with LMICs. Conclusion Authorship disparities are evident within global surgery academia. Remedial actions to address the lack of authorship opportunities for LMIC authors and female authors are required.
Collapse
Affiliation(s)
- Krithi Ravi
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zineb Bentounsi
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aiman Tariq
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Davina Daudu
- The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
| | - Francesca Back
- University of Oxford Medical Sciences Division, Oxford, UK
| | | | - Nermin Badwi
- Zagazig University Faculty of Human Medicine, Zagazig, Egypt.,InciSioN Egypt, Zagazig, Egypt
| | | | | | - Halimah Khalil
- Birmingham Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | | | | | - Ahmed Shaheen
- Alexandria University Faculty of Medicine, Alexandria, Egypt
| | | | - Ai-Ting Wong
- Red Cross War Memorial Children's Hospital, Rondebosch, South Africa
| | | | - Amine Souadka
- National Institute of Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | | | | | | | - Bourja Hind
- Ibn Rochd University Hospital Center, Casablanca, Morocco
| | - Daniel Safari Nteranya
- Department of Surgery, Official University of Bukavu, Bukavu, Congo.,Association of Future African Neurosurgeons, Yaoundé, Cameroon
| | | | - Elsa de Wet
- University of the Free State, Bloemfontein, South Africa
| | | | - F Z Wafqui
- Faculty of Medicine and Pharmacy, Casablanca, Morocco
| | - Hajar Essangri
- National Institute of Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | - Hajar Moujtahid
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Husna Moola
- University of Cape Town, Rondebosch, South Africa
| | - Kapil Narain
- University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Krupa Ravi
- University of Oxford Medical Sciences Division, Oxford, UK
| | - Kyrillos Wassim
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | | | | | | | - Maryanne Naisiae
- University of Nairobi College of Health Sciences, Nairobi, Kenya
| | | | - Nafisa Turabi
- Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
| | - Nouhaila El Aroussi
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Omar Mohamed Makram
- Department of Cardiology, Faculty of Medicine, October 6 University, 6th of October City, Egypt.,London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Omar A Shawky
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Oumaima Outani
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Peter Carides
- University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | | | - Sabina Kurbegovic
- Medical Faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Sara Moujtahid
- Ibn Sina University Hospital Center, Rabat, Morocco.,Mohammed V University, Rabat, Morocco
| | - Soukaina El Hadrati
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | | | | | | | - Wilme Steyn
- Chris Hani Baragwanath Hospital, Bertsham, South Africa
| | | | | | - Zaayid Omar
- Rondebosch Medical Centre, Cape Town, South Africa
| | - Zachary Amod
- University of Cape Town, Rondebosch, South Africa
| | - Madelein Eloff
- University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | | | - Dhananjaya Sharma
- Department of Surgery, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
| |
Collapse
|
36
|
Singh K, Abdelrahman A, Abdalla S. 1412 De Garengeot's Hernia Complicated by Perforated Appendicitis and Groin Abscess: Report of A Rare Surgical Emergency. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
De Garengeot's hernia is a rare subtype of femoral hernia which contains the vermiform appendix. Acute appendicitis in a femoral hernia is even more unusual, accounting for 0.08% - 0.13% of all cases of femoral hernias.
Case presentation
A 91-year-old woman was referred with a painful, cellulitic right groin mass. A computed tomography scan demonstrated a right-sided femoral hernia containing a loop of bowel and a collection in the right groin containing fluid and gas. The patient had early dementia but no other major medical co-morbidities. At surgery, she was found to have perforated appendicitis in a right femoral hernia. Most of the appendix and sac had fully disintegrated, forming a large abscess cavity beneath the skin in the right groin which extended down to the upper labia majora. The appendix tip was lying deep within the abscess cavity. A modified McEvedy approach was used to access the peritoneal cavity for the appendicectomy and sutured repair of the femoral neck. The groin abscess cavity was drained and managed with a negative pressure (VAC) dressing.
Discussion
De Garengeot's hernia is often difficult to diagnose pre-operatively and reporting of cross-sectional imaging may not always be reliable. Currently, there is no gold standard method for repairing these hernias. However, the modified McEvedy approach is well-described and is the preferred technique for emergent femoral hernia presentations. It provides sufficient access to manage both appendicitis and the femoral hernia. Adjuncts such as negative pressures dressings may be used to manage concomitant abscess cavities.
Collapse
Affiliation(s)
- K Singh
- University Hospital Lewisham, London, United Kingdom
| | - A Abdelrahman
- University Hospital Lewisham, London, United Kingdom
| | - S Abdalla
- University Hospital Lewisham, London, United Kingdom
| |
Collapse
|
37
|
Sarai R, Abdelrahman A, Rehman KU. 823 The ‘Blue Blood' Chicken Thigh Model: Microsurgery Simulation Teaching for Surgical Trainees. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
The simulation of microsurgery via various models helps surgical trainees to further their instrument handling and techniques. This model allows trainees to strengthen hand-microscope-eye coordination; a crucial ability required when handling critical vessels and tissues. The ‘Blue Blood’ Chicken Thigh Model imitates delicate vessels enabling the enhancement of dexterity.
Aim
To raise awareness amongst trainees in how the model may be used as a simulation tool for learning. To outline the arrangement of the ‘Blue Blood’ chicken thigh model allowing the practice of exceptionally fine suturing such as end-end anastomosis and end-side anastomosis. To improve trainee confidence in instrument handling and technique.
Method
A Microsurgery course was set up for maxillofacial surgical trainees within the West Midlands Deanery in November 2019. Detailed steps of dissecting the femoral vessels and preparing the ‘Blue Blood’ Chicken Thigh Model were presented. Microsurgical tools were then used to practise end-end and end-side anastomosis.
Results
The feedback received from the trainees was positive and it is hoped this will become an annual session for all trainees. Many trainees felt this was a resourceful tool to help them practise - even at home.
Conclusions
It is important for trainees to be able to display precise hand-eye movements especially when concerned with anastomosis techniques. This model will allow trainees to be able to simulate such an environment outside of theatre where they can spend time to hone skills and become comfortable with handling finer tissues and instruments.
Collapse
Affiliation(s)
- R Sarai
- New Cross Hospital, Wolverhampton, United Kingdom
| | | | - K U Rehman
- New Cross Hospital, Wolverhampton, United Kingdom
| |
Collapse
|
38
|
Borghol K, Abdelrahman A, Pigadas N. Guided botulinum toxin injection to the lateral pterygoid muscles for recurrent dislocation of the temporomandibular joint. Br J Oral Maxillofac Surg 2021; 59:845-846. [PMID: 34256957 DOI: 10.1016/j.bjoms.2020.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Affiliation(s)
- K Borghol
- Royal Wolverhampton NHS Foundation Trust, Wolverhampton, WV10 0QP.
| | - A Abdelrahman
- Royal Wolverhampton NHS Foundation Trust, Wolverhampton, WV10 0QP.
| | - N Pigadas
- Royal Wolverhampton NHS Foundation Trust, Wolverhampton, WV10 0QP.
| |
Collapse
|
39
|
Nassereddine A, Abdelrahman A, Benard E, Bedu F, Ozerov I, Limozin L, Sengupta K. Ligand Nanocluster Array Enables Artificial-Intelligence-Based Detection of Hidden Features in T-Cell Architecture. Nano Lett 2021; 21:5606-5613. [PMID: 34170136 DOI: 10.1021/acs.nanolett.1c01073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Protein patterning has emerged as a powerful means to interrogate adhering cells. However, the tools to apply a sub-micrometer periodic stimulus and the analysis of the response are still being standardized. We propose a technique combining electron beam lithography and surface functionalization to fabricate nanopatterns compatible with advanced imaging. The repetitive pattern enables a deep-learning algorithm to reveal that T cells organize their membrane and actin network differently depending upon whether the ligands are clustered or homogeneously distributed, an effect invisible to the unassisted human eye even after extensive image analysis. This fabrication and analysis toolbox should be useful, both together and separately, for exploring general correlation between a spatially structured subcellular stimulation and a subtle cellular response.
Collapse
Affiliation(s)
- Aya Nassereddine
- Aix Marseille Univ, CNRS, CINAM, 13009 Marseille, France
- Aix Marseille Univ, CNRS, INSERM, LAI, Turing Centre for Living Systems, 13009 Marseille, France
| | - Ahmed Abdelrahman
- Aix Marseille Univ, CNRS, CINAM, 13009 Marseille, France
- Aix Marseille Univ, CNRS, INSERM, LAI, Turing Centre for Living Systems, 13009 Marseille, France
| | | | - Frederic Bedu
- Aix Marseille Univ, CNRS, CINAM, 13009 Marseille, France
| | - Igor Ozerov
- Aix Marseille Univ, CNRS, CINAM, 13009 Marseille, France
| | - Laurent Limozin
- Aix Marseille Univ, CNRS, INSERM, LAI, Turing Centre for Living Systems, 13009 Marseille, France
| | - Kheya Sengupta
- Aix Marseille Univ, CNRS, CINAM, 13009 Marseille, France
| |
Collapse
|
40
|
Shaker M, Hashem E, Abdelrahman A, Okba A. Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Anatomical Aspects and Radiation Considerations from a Case Series of 210 Patients. The Arab Journal of Interventional Radiology 2021. [DOI: 10.1055/s-0041-1729134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Context Prostatic artery embolization (PAE) has been established as a safe and effective treatment option for symptomatic benign prostatic hyperplasia (BPH). Thorough knowledge of detailed prostatic artery (PA) anatomy is essential.
Aims The aim of this study was to provide a pictorial review of PA anatomy and prevalence of related anatomical variants, in addition to other anatomical and radiation dose considerations.
Settings and Design Case series and review of literature.
Materials and Methods We performed PAE for 210 patients from November 2015 to November 2020 under local anesthesia only. Anatomy, procedure duration, fluoroscopy time, radiation dose, technical success, and complications were analyzed.
Statistical Analysis Used Descriptive statistics were analyzed using Microsoft Excel software.
Results A total of 210 patients (420 sides) were analyzed. Double arterial supply on the same side was noted in 12 patients (5.7%). In 10 patients (4.7%), only a unilateral PA was identified. In two patients (0.9%), no PA could be identified. Frequencies of PA origins were calculated. Penile, rectal, and vesical anastomoses were identified with 79 (18.8%), 54 (12.9%), and 41 (9.8%) of PAs, respectively. Median skin radiation dose, procedure time, and fluoroscopy time were 505 mGy, 73 and 38 minutes, respectively. Complications occurred in nine patients (4.3%), none of them was major.
Conclusions Knowledge of PA anatomy is essential when treating BPH by PAE for optimum results. There is no enough evidence to support routine use of preoperative computed tomography angiography and intraoperative cone-beam computed tomography as means of improving safety or efficacy.
Collapse
Affiliation(s)
- Mohamed Shaker
- Department of Diagnostic and Interventional Radiology, Ain Shams University, Cairo, Egypt
| | - Essam Hashem
- Department of Department of Diagnostic and Interventional Radiology, Ain Shams University, King’s College Hospital, Cairo, Egypt
| | | | - Ahmed Okba
- Department of Diagnostic and Interventional Radiology, Ain Shams University, Cairo, Egypt
| |
Collapse
|
41
|
Ayesh H, Burmeister C, Abdelrahman A, Beran A. Hypopituitarism as the Initial Presentation of Pituitary Metastasis From Lung Cancer. J Endocr Soc 2021. [PMCID: PMC8090577 DOI: 10.1210/jendso/bvab048.1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: The annual incidence of hypopituitarism 4.2 cases of 100,000. Causes include primary tumor, metastasis, and non-tumor causes such as radiation therapy, infiltrative lesions, infection, and traumatic brain injury. Metastatic pituitary tumors constitute about 7-9% of the cases, with lung and breast cancers are the most common primary tumors. Case Presentation: 48-year-old Caucasian female patient with 30 pack-year smoking history presented to the emergency department with abdominal pain, diarrhea, fatigue, and headache. Review of systems was significant for loss of appetite, left eye visual field defect, anorexia, cold intolerance, and shortness of breath. Physical examination was remarkable for decreased visual acuity. Vital signs notable for hypotension BP 92/63. Notable labs include glucose of 53 mg/dL, TSH 0.50 [0.49 - 4.67 uIU/mL], low free T4 0.52 ng/dL, low FSH 1.3 mIU/ml, low LH <0.2 mIU/ml, low ACTH 1.4 pg/mL, low morning cortisol 2.2 ug/dL, low DHEA-SO4 3ug/dL, low IGF-1 16 ng/ml. She was diagnosed with hypopituitarism and started on IV hydrocortisone 50 mg every 6 hours with 75 mcg levothyroxine daily. MRI brain showed interval growth of pituitary lesion into the suprasellar cistern with a mass-effect on the optic chiasm measuring 2.4 X1.6X 1.9 cm with a lesion in the right cerebellar hemisphere. Vertebral MRI showed multiple metastatic lesions in cervical/thoracic/lumbar vertebral bodies. On day two of hospital stay, she developed hypertonic hyponatremia (sodium 156 mmol/L, urine osmolarity 81 mOsm/kg, plasma osmolarity 328 mOsm/kg), and she was started on desmopressin 2 mg IV for diabetes insipidus. CT chest showed spiculated left upper lobe mass consistent with primary malignancy, and biopsy showed metastatic poorly differentiated epithelial malignancy likely from lung primary. Patient was discharged on desmopressin 100 mcg nightly, hydrocortisone 20 mg morning with 10 mg evening, levothyroxine 100 mcg daily with plans for further oncologic workup. Discussion: Patient’s 2011 MRI brain showed a mildly enlarged pituitary gland. MRI brain two months before admission showed a pituitary gland diameter of 1.6 cm, while an MRI at presentation showed a pituitary gland size of 2.4 cm with a new cerebellar lesion. She reported symptoms of nausea, vomiting, and weakness for more than one year ago but biochemical testing was not performed. The fact that the patient had pituitary enlargement eight years ago likely delayed the diagnosis of pituitary metastasis. Patient age precluded lung cancer screening despite smoking history and family history of lung cancer. Conclusion: Symptomatic patients with pituitary enlargement on brain imaging may benefit from a close follow-up and biochemical testing for early diagnosis and treatment, especially if they have risk factors for malignancy.
Collapse
|
42
|
Ayesh H, Burmeister C, Abdelrahman A, Beran A, Suri P. A Case of Autoimmune Polyglandular Syndrome Type 3b Initially Presenting as Generalized Weakness in an Elderly Patient. J Endocr Soc 2021. [PMCID: PMC8089860 DOI: 10.1210/jendso/bvab048.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Introduction: Autoimmune polyglandular syndrome (APS) is a multiorgan genetic autoimmune disease. APS-3B subtype is autoimmune thyroiditis with pernicious anemia. In this case, we will discuss an elderly female patient diagnosed with APS-3B.
Case Presentation: A 69-year-old Caucasian female patient with a past medical history of autoimmune thyroiditis presented to the emergency department with a two-month history of generalized weakness and nausea. Associated symptoms included shortness of breath and diarrhea. Review of systems was otherwise unremarkable. Physical exam was positive for depigmented skin macules over the upper extremities. Lab results showed hemoglobin 8.2 [11.7 - 15.5 g/dL], MCV 121[80 - 100 fL], platelets 144,000 [150 - 450 X10E9/L], WBC 1.9 [4.0 - 11.0 X10E9/L], LDH 1153[100 - 235 U/L], TSH 0.28[0.49 - 4.67 uIU/mL], free T4 1.7 [0.61 - 1.60 ng/dL], direct Coombs test negative. Iron saturation 55%, vitamin B12 level <50 [180 - 914 pg/mL], folate >25[>5.8 ng/mL], total bilirubin 2.3 [0.3 - 1.2 mg/dL], haptoglobin <30 [32 - 228 mg/dL], AST 43 [0 - 41 U/L], reticulocyte 1.4%. Blood smear showed absolute neutropenia with flow cytometry unremarkable. Chest x-ray and urinalysis were negative. Immunofixation showed low IgM 44 [45 - 281 mg/dL], low IgG 619 [635 - 1,741 mg/dL]. Intrinsic factor antibodies (IF-Ab) were positive. Hematology reported that hemolytic anemia is less likely given Coombs test was negative. About 1.5% of Vitamin B12 deficiency present with a hemolytic picture due to ineffective erythropoiesis while Coombs test help to differentiate it from autoimmune hemolytic anemia. Diagnosis of pernicious anemia was made and the patient started on vitamin B12 injections. The combination of pernicious anemia, autoimmune thyroiditis, and vitiligo supported the diagnosis of autoimmune APS-3B. There was a normalization of vitamin B12 level and symptomatic improvement on a one-week follow-up.
Discussion: The patient was diagnosed with autoimmune thyroiditis in 2014 with positive anti-TPO antibodies and elevated TSH; she required levothyroxine supplementation since diagnosis. Hypothyroidism causes macrocytic anemia, which may delay pernicious anemia diagnosis. APS-3B is associated with HLA-B8 and/or DR3 and DR5. Many studies reported that autoantibodies can be detected before developing symptoms of organ involvement. Thorough family history provides support for autoantibody testing to detect cases of APS-3B earlier. Active surveillance and early diagnosis will help minimize invasive testing such as bone marrow biopsy, so proper history taking is a key factor to early diagnose these conditions.
Conclusion: APS-3B is a rare disorder. Diagnosis is difficult hypothyroidism causes macrocytic anemia. Early detection of APS-3B may help to prevent complications that increase the risk of mortality and morbidity, particularly in the elderly population.
Collapse
Affiliation(s)
| | | | | | | | - Pooja Suri
- Promedica Toledo Hospital, Toledo, OH, USA
| |
Collapse
|
43
|
Jevon P, Abdelrahman A, Pigadas N. Management of odontogenic infections and sepsis: an update. BDJ Team 2021. [PMCID: PMC7891927 DOI: 10.1038/s41407-021-0520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
44
|
Abdelrahman A, Sarai R, Pigadas N. Association between human papillomavirus and the oral anatomical subset of head and neck cancer: a systematic review. Br J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.bjoms.2020.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Abdelrahman A, Mahon N, Pearce C. 3D printed surgical guides to access impacted mandibular premolars. Br J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.bjoms.2020.10.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
46
|
Abdelrahman A, Debski M, More R, Eichhofer J, Patel B. One-year outcomes of percutaneous coronary intervention in native coronary arteries versus bypass grafts in patients with prior coronary artery bypass graft surgery. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with prior coronary artery bypass graft (CABG) surgery often require percutaneous coronary intervention (PCI). Data are still limited in regards to the outcomes of native versus graft PCI after CABG.
Methods
We performed a retrospective study in a tertiary reference cardiac centre of consecutive patients who underwent PCI after CABG. The data were collected for patients who underwent either native or graft PCI from January 2008 to December 2018. Major adverse cardiac events (MACE) included death or myocardial infarction (MI) or revascularization. All outcomes were assessed at 1-year after each index procedure.
Results
A total of 445 PCI were performed in 410 patients (209 had native PCI and 201 had graft PCI). The groups of patients with native vessel PCI and graft PCI were statistically comparable regarding their baseline characteristics. In multivariable Cox regression graft PCI relative to native PCI was an independent risk factor for MACE (hazard ratio [HR] 1.818, 95% confidence interval [CI] 1.148–2.878).
Conclusion
Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of MACE at 1-year and this was mainly driven by MI and revascularization.
MACE outcomes
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A Abdelrahman
- Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - M Debski
- Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - R More
- Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - J Eichhofer
- Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - B Patel
- Blackpool Victoria Hospital, Blackpool, United Kingdom
| |
Collapse
|
47
|
Abstract
The management of odontogenic infections has improved over recent decades, but further improvements are still required. The ongoing education of GDPs and their dental teams on this issue continues to be important, especially during the current COVID-19 pandemic, where remote triage poses additional difficulties and challenges.Odontogenic infections can lead to sepsis, a potentially life-threatening condition caused by the body's immune system responding in an abnormal way. This can lead to tissue damage, organ failure and death. A patient with non-odontogenic-related infection could also present with sepsis at a dental practice. Early recognition and prompt management of sepsis improves outcomes. GDPs and their dental teams should be trained in the recognition and management of sepsis. Age-specific sepsis decision support tools have been developed by the UK Sepsis Trust to help dental staff recognise and manage patients with suspected sepsis.The aim of this article is to provide an update on the management of odontogenic infections and sepsis.
Collapse
Affiliation(s)
- Phil Jevon
- Academy Tutor, Medical Education, Manor Hospital Walsall, UK.
| | | | - Nick Pigadas
- Consultant Maxillofacial/Head and Neck Surgeon, Manor Hospital Walsall, UK
| |
Collapse
|
48
|
Abdelrahman A, Nada A, Park E, Humera A. Neurological involvement and MRI brain findings in an adult with hemolytic uremic syndrome: A case report. Radiol Case Rep 2020; 15:2056-2058. [PMID: 32944099 PMCID: PMC7481498 DOI: 10.1016/j.radcr.2020.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022] Open
Abstract
Hemolytic uremic syndrome is a frequent complication of shiga toxin producing Escherichia coli in pediatric population. It rarely affects adults with extremely rare neurological manifestation. We present a case of hemolytic uremic syndrome in a 64-year-old male who presented with a bloody diarrhea 30 minutes after eating an expired meat sandwich. Shiga-toxin producing Escherichia coli O157:H7 was confirmed as the causative agent. The patient developed neurological manifestations with persistent encephalopathy that ultimately leads to his death after 22 days of hospitalization. Magnetic resonance imaging findings was significant for signal changes in the thalami, tectum, insulae, and central pons, impressive of hemolytic uremic syndrome.
Collapse
Key Words
- ADC, Apparent diffusion coefficient
- CNS, Central nervous system
- CT, Computed tomography
- DWI, Diffusion weighted imaging
- E. Coli, Escherichia coli
- EHEC, Enterohemorrhagic Escherichia Coli
- FLAIR, Fluid attenuated inversion recovery
- GCS, Glasgow coma scale
- HUS, Hemolytic Uremic Syndrome
- Hemolytic uremic syndrome
- IV, Intravenous
- MRI
- MRI, Magnetic resonance imaging
- NICU, Neurological intensive care unit
- Neurological complications
- STEC, Shiga toxin producing E. Coli
Collapse
Affiliation(s)
- A Abdelrahman
- Department of Radiology, University of Missouri, 3500 S Scott Blvd, Apt 5, Columbia, MO 65203, USA
| | - A Nada
- Department of Radiology, University of Missouri, 3500 S Scott Blvd, Apt 5, Columbia, MO 65203, USA
| | - E Park
- Department of Radiology, University of Missouri, 3500 S Scott Blvd, Apt 5, Columbia, MO 65203, USA
| | - A Humera
- Department of Radiology, University of Missouri, 3500 S Scott Blvd, Apt 5, Columbia, MO 65203, USA
| |
Collapse
|
49
|
Sharafeddin M, Abd Allah A, Abdelrahman A. Presepsin and Resistin as Diagnostic Markers for Bacterial Infection in Patients with Decompensated Cirrhosis. Afro-Egyptian Journal of Infectious and Endemic Diseases 2020; 0:0-0. [DOI: 10.21608/aeji.2020.36097.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
50
|
Nada A, Abdelrahman A, Cunningham C, Cousins J. Radio-pathological review of a metastatic renal cell carcinoma within a meningioma: A case report of collision tumor. Radiol Case Rep 2020; 15:637-640. [PMID: 32256926 PMCID: PMC7113407 DOI: 10.1016/j.radcr.2020.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/23/2020] [Accepted: 02/26/2020] [Indexed: 01/05/2023] Open
Abstract
We report a case of a collision tumor, a meningioma complicated with metastasis from a primary renal cell carcinoma. A 75-year-old man, with known history of renal cell carcinoma, and 10-year history of stable meningioma developed neurological symptoms. Computed tomography and magnetic resonance imaging revealed left frontal intracranial extra-axial mass with imaging criteria suspicious for an atypical meningioma or hemangiopericytoma. Given the history of a known primary, the possibility of brain metastasis was included. Pathology confirmed the presence of metastatic renal cell carcinoma nidus with a surrounding meningioma. Tumor-to-tumor metastasis or collision tumor is a very rare phenomenon. Atypical radiologic findings with positive history of a primary extracranial tumor should raise the suspicion of potential metastases.
Collapse
Affiliation(s)
- Ayman Nada
- Department of Radiology, University of Missouri Health Care, Columbia, MO, USA
| | - Ahmed Abdelrahman
- Department of Radiology, University of Missouri Health Care, Columbia, MO, USA
| | | | - Joseph Cousins
- Department of Radiology, University of Missouri Health Care, Columbia, MO, USA
| |
Collapse
|