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1. Comparative study between high and low dose methylene blue infusion in septic cancer patients: a randomized, blinded, controlled study

Author

Ehab Hanafy Shaker, Ahmed Mohamed Soliman, Ahmed Abd Elmohsen Bedewy, and Mai Mohamed Elrawas

Subjects
Septic shock, Methylene blue, Cancer, Noradrenaline, Anesthesiology, RD78.3-87.3
Abstract

Abstract Purpose Septic shock is a common threat, and is the primary cause of death in almost all critical care units. Mortality of septic shock remains exceedingly high. The early use of methylene blue (MB) in different doses as adjunctive to vasopressors has promising results. Methods This double-blind, randomized, controlled trial comprised 90 patients divided into 3 groups: Group A received a 100 ml 0.9% NaCl placebo over 20 min; Group B received an MB bolus of 1 mg/kg in 100 ml 0.9% NaCl, and Group C received MB bolus of 4 mg/kg in 100 ml 0.9% NaCl during the same period. Groups B and C were given a 0.25 mg/kg/hour infusion of MB for 72 h after the bolus dose. All patients were started on noradrenaline at an infusion rate of 0.1–0.2 µ/kg/min and were adjusted accordingly to maintain MAP ≥ 65 mmHg. Time of vasopressor discontinuation was the primary outcome while total doses of vasopressors, ventilation days, vasopressors free days, total ICU stay, total hospital stay, and mortality rate were the secondary outcomes. Results Groups B and C exhibited significantly decreased time to vasopressor termination, and vasopressor-free days at 28 days in comparison to Group A. However, there was no significant difference between Groups B and C. Groups B and C had significantly lower noradrenaline dosages compared to Group A, however, no significant difference between Group B and Group C was found. The difference between the three groups in mortality rate was near statistical significance (p = 0.083). Using the logistic regression model, the 4 mg/kg group was protective against mortality with a hazard ratio of 0.29 (95%CI: 0.09–0.90). Conclusion In cancer patients with septic shock, early adjunctive MB delivery reduces the time to a vasopressor stoppage and increases the vasopressor-free days. No significant difference between high and low MB bolus doses, and no significant adverse effects were noted. Compared to placebo, the 4 mg/kg bolus dose shows a survival advantage. Trial registration Prospectively registered at clinicaltrials.gov [NCT 06005558]. (Date of registration 15/08/2023).

Published
2025
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2. Ultrasound-guided continuous erector spinae plane block vs continuous thoracic epidural analgesia for the management of acute and chronic postthoracotomy pain: a randomized, controlled,double-blind trial

Author

Ehab Hanafy Shaker, Mamdouh Mahmoud Elshal, Reham Mohamed Gamal, Norma Osama Abdallah Zayed, Samuel Fayez Samy, Raafat M. Reyad, Mohammed H. Shaaban, Abd Alrahman M. Abd Alrahman, and Ahmed Salah Abdelgalil

Subjects
Anesthesiology, RD78.3-87.3
Abstract

Abstract. Introduction:. Postthoracotomy pain (PTP) is a severe pain complicating thoracic surgeries and its good management decreases the risk of PTP syndrome (PTPS). Objectives:. This randomized controlled study evaluated the efficacy of ultrasound-guided continuous erector spinae plane block (ESPB) with or without dexmedetomidine compared with thoracic epidural analgesia (TEA) in managing acute postoperative pain and the possible emergence of PTPS. Methods:. Ninety patients with chest malignancies planned for thoracotomy were randomly allocated into 3 equal groups. Group 1: TEA (20 mL of levobupivacaine 0.25% bolus, then 0.1 mL/kg/h of levobupivacaine 0.1%), group 2: ESPB (20 mL of levobupivacaine only 0.1% bolus every 6 hours), and group 3: ESPB (20 mL of levobupivacaine 0.25% and 0.5 μg/kg of dexmedetomidine Hcl bolus every 6 hours). Results:. Resting and dynamic visual analog scales were higher in group 2 compared with groups 1 and 3 at 6, 24, and 36 hours and at 8 and 12 weeks. Postthoracotomy pain syndrome incidence was higher in group 2 compared with groups 1 and 3 at 8 and 12 weeks, whereas it was indifferent between groups 1 and 3. The grading system for neuropathic pain score was higher in group 2 compared with groups 1 and 3 at 8 and 12 weeks, whereas it was indifferent between groups 1 and 3. Itching, pruritis, and urine retention were higher in group 1 than in ESPB groups. Conclusion:. Ultrasound-guided ESPB with dexmedetomidine is as potent as TEA in relieving acute PTP and reducing the possible emergence of chronic PTPS. However, the 2 techniques were superior to ESPB without dexmedetomidine. Erector spinae plane block has fewer side effects compared with TEA.

Published
2023
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3. Reduction of hospital bed cost for inpatient overstay through optimisation of patient flow

Author

Ehab Hanafy, Sultanah Alharbi, Abdullah Alasmari, and Alia Ellawindy

Subjects
Medicine (General), R5-920
Abstract

Background Overstay of inpatients is a big challenge to healthcare systems which interferes with the proper utilisation of the available resources and efficient delivery of care. Unnecessary days in the hospital may lead to patient complications including healthcare-associated infections, falls and delirium, which can negatively impact both patient and staff experience. This project aimed to reduce the cost of bed days of inpatient overstay through facilitating the discharge process using a multidisciplinary intervention approach.Methods The root causes of inpatient overstay were defined via a multidisciplinary approach. This project applied the extension Deming Cycle method: Find-Organise-Clarify-Understand-Study-Plan-Do-Check-Act (PDCA). Solutions to the root causes which led to process variation were implemented through three PDCA cycles conducted between January 2019 and July 2020.Results There was a significant reduction in the total number of overstay inpatients, the total number of overstay days, and the related bed costs in the first 3 quarters of 2019. A significant and sustained improvement in the emergency department average boarding time was attained in the first half of 2019 (reduced from 11.9 hours to 1.7 hours). A total estimated cost saving of SR30 000 000 (US$8 000 000) in terms of operational efficiency was achieved.Conclusion Early discharge planning and facilitating the patient discharge process significantly improves the average length of inpatient stay and patient outcomes and decreases hospital costs.

Published
2023
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4. Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Author

Md Hasanuzzaman, Mohamed Ahmed, Ahmed Samir, Charlotte Smith, Lubna Samad, Vaishnavi Govind, Fakher Rahim, Ahmed Moussa, Adesoji O Ademuyiwa, Bobby John, Augusto Zani, Vivek Singh, Muhammad Arshad, Sadaf Altaf, Chan Hon Chui, Pooja Kumari, Thomas Smith, Ayesha Saleem, Matthew HV Byrne, Madhivanan Karthigeyan, Pravin Salunke, Darica Au, Kate Cross, Kokila Lakhoo, Vishal Kumar, Anna Maria Testi, Robyn Brown, Noel Peter, Georgios Tsoulfas, Francesco Pata, Adesoji Ademuyiwa, Tahmina Banu, Bruce Bvulani, Milind Chitnis, Maryam Ghavami Adel, Vrisha Madhuri, Pierfrancesco Lapolla, Andrea Mingoli, Hamidah Alias, Simone de Campos Vieira Abib, Ibukunolu Olufemi Ogundele, Felix M Alakaloko, Emmanuel A Ameh, Laila Hessissen, Kareem O Musa, Georgios Karagiannidis, Manoj Gupta, Maricarmen Olivos, Daniel Rhee, Maryam Khan, Christine Nitschke, Alexandra Valetopoulou, Ashrarur Rahman Mitul, Sabbir Karim, Mahmoud M Saad, Francis Abantanga, Gaetano Gallo, Mohamedraed Elshami, Mahmoud Elfiky, Soham Bandyopadhyay, Muath Alser, Elliott H Taylor, Duha Jasim, Somy Charuvila, Nazmul Islam, William B Lo, Uttam Kumar Nath, Robin Simpson, Zarina Abdul Latiff, Bruno Cirillo, Gioia Brachini, Megan Murphy, Zineb Bentounsi, Anette S Jacobsen, Anna Casey, Mohammed Alhendy, Taiwo Akeem Lawal, Samson Olori, Michael Boettcher, Muhammed Elhadi, Shaun Wilson, Dragana Janić, Amit Sehrawat, Patricia Shinondo, Shireen Anne Nah, Alhassan Abdul-Mumin, Karl-Heinz Frosch, Poorvaprabha Patil, Sarah Muma, Md Asaduzzaman, Athanasios Tragiannidis, Vijayendra Kumar, Mahan Salehi, Sara Ali, Renu Madan, Hafeez Abdelhafeez, Max Pachl, Benjamin Martin, Sonal Nagras, Mihir Sheth, Catherine Dominic, Suraj Gandhi, Divya Parwani, Rhea Raj, Diella Munezero, Rohini Dutta, Nsimire Mulanga Roseline, Kellie McClafferty, Armin Nazari, Smrithi Sriram, Sai Pillarisetti, King-David Nweze, Aishwarya Ashwinee, Gul Kalra, Priyansh Nathani, Khushman Kaur Bhullar, Nehal Rahim, Shweta Madhusudanan, Joshua Erhabor, Manasi Shirke, Aishah Mughal, Sravani Royyuru, Syeda Namayah Fatima Hussain, Daniel Robinson, Mehdi Khan, Alexandre Dukundane, Kwizera Festus, Rohan Pancharatnam, Lorraine Ochieng, Hritik Nautiyal, Leanne Gentle, Ehab Hanafy, Catherine Yang, Gideon Karplus, John Mathew, Olumide Abiodun Elebute, Oluwaseun Ladipo-Ajayi, Okechukwu Hyginus Ekwunife, Sherief Ghozy, Emily Hamilton, Dhruva Ghosh, Ahmed Sherif, Hajar Moujtahid, Ariana Axiaq, Amir Labib, Eman Abdulwahed, Kemal Tolga Saracoglu, Yasin Kara, Ahmed Y Azzam, Omar Elmandouh, Manjul Tripathi, Abdelrahman Azzam, Anfel Bouderbala, Aouabed Nesrine, Ammar Ayman, Mohamed Bonna, Safia Lorabi, Hira Zuberi, Iyad Sultan, Reto M Baertschiger, Kefas John Bwala, AM Umar, Abdurahaman Aremu, Dauda E Suleiman, Tybat Aliyu, Kashaf Turk, Oluseyi Oyebode Ogunsua, Tunde Talib Sholadoye, Musliu Adetola Tolani, Yakubu Alfa, Keffi Mubarak Musa, Ken Muma, Mitchelle Obat, Youssef Sameh Badran, Abdulrahman Ghassan Qasem, Faris Ayasra, Reema Alnajjar, Mohamed Abdel-Maboud, Abdelrahman Bahaa, Ayat M Saadeldin, Mohamed Adwi, Mahmoud Adly, Abdallah Elshenawy, Amer Harky, Kirstie Wright, Jessica Luyt, Olivia White, Nathan Thompson, Imogen Harrison, Sara Kader Alsaeiti, Fatma Saleh Benkhial, Hend Mohammed Masoud, Mabroukah Saeid Alshamikh, Fatma Mohammed Masoud, Nyararai Togarepi, Elaine Carrolan, Ahmed Saleh, Mahmoud Bassiony, Mostafa Qatora, Mohamed Bahaaeldin, Shady Fadel, Yasmine El Chazli, Kamel Hamizi, Mehdi Anouar Zekkour, Rima Rahmoun, Boutheyna Drid, Salma Naje Abu Teir, Mohamed Yazid Kadir, Yassine Zerizer, Nacer Khernane, Brahim Saada, Imane Ammouze, Yahya Elkaoune, Ghita Chaoui, Hajar Benaouda, Meryem Gounni, Narjiss Aji, Joana Mafalda Monteiro, Susana Nunes, Maria do Bom-Sucesso, Kerri Becktell, Md Afruzul Alam, Orindom Shing Pulock, Tasmiah Tahera Aziz, Rosanda Ilic, Danica Grujicic, Tijana Nastasovic, Igor Lazic, Mihailo Milicevic, Vladimir Bascarevic, Radovan Mijalcic, Vuk Scepanovic, Aleksandar Stanimirovic, Aleksandra Paunovic, Ivan Bogdanovic, Shahnoor Islam, AKM Amirul Morshed, Mehnaz Akter, Zannat Ara, Mohammed Tanvir Ahammed, Tania Akter, Kamrun Nahar, Fatema Sayed, Ashfaque Nabi, Elif Akova, Evren Aydogmus, Bekir Can Kendirlioglu, Tufan Hicdonmez, Asim Noor Rana, Mohammed A Azab, Alzhraa Salah Abbas, Olanrewaju Moses, Ibiyeye Taiye Taibat, Taiwo Jones, Kalu Ukoha, Olagundoye Goke, Okorie Ikechukwu, Abiodun Idowu Okunlola, Helga Nauhaus, Danelle Erwee, Agata Chylinska, Prasanna Gomes, Elvercio Pereira de Oliveira Junior, Fabiola Leonelli Diz, Mohamed El Kassas, Usama Eldaly, Ahmed Tawheed, Mohamed Abdelwahab, Oudrhiri Mohammed Yassaad, Bechri Hajar, El Ouahabi Abdessamad, Arkha Yasser, Hessissen Laila, Farah Sameer Yahya, Maria Teresa Peña Gallardo, Jacqueline Elizabeth Montoya Vásquez, Juan Luis García León, Sebastián Shu Yip, Mariam Lami, Harmit Ghattaura, Eric W Etchill, Stacy Cooper, Kevin Crow, Morgan Drucker, Benjamin Shou, Alan Siegel, Gül Nihal Özdemir, Ehab El Refaee, John George Massoud, Ayah Bassam Ibrahim, Ruaa Bassam Ibrahim, Faris Abu Za'nouneh, Toqa Fahmawee, Ghazwani Salman, Ehab Alameer, Al-Mudeer Ali, Ghazwani Yahia, Khozairi Waleed, Khalil Ghandour, Shaima' Al-Dabaibeh, Ammar Al-Basiti, Hazim Ababneh, Omaima El-Qurneh, Yousef Alalawi, Ahmad Al Ayed, Naif Al Bolowi, Heidi Barola, Aubrey L Pagaduan, Jingdan Fan, Olufemi Oni, Janita Zarrish, Ramsha Saleem, Soha Zahid, Atiqa Amirali, Ahsan Nadeem, Sameer Saleem Tebha, Zonaira Qayyum, Sana Tahir, Anneqa Tahir, Rabbey Raza Khan, Ayesha Mehmood, Taimur Iftikhar Qureshi, Victor Calvagna, Nathalie Galea, Matthew R Schuelke, Kirk David Wyatt, Agnes Vojcek, Seham M Ragab, Abdallah R Allam, Eman Ibrahim Hager, Kıvılcım Karadeniz Cerit, Adnan Dağçınar, Tümay Umuroğlu, Ayten Saraçoğlu, Mustafa Sakar, Can Kıvrak, Gül Çakmak, Ibrahim Sallam, Gamal Amira, Mohamed Sherief, Arissa Ikeda, Licia Portela, Marianne Monteiro Garrigo, Fernanda Lobo, Sima Ester Ferman, Andrew Nwankwo Osuigwe, Chisom Adaobi Nri-Ezedi, Eric Okechukwu Umeh, Abiodun Folashade Adekanmbi, Olubunmi Motunrayo Fatungase, Olubunmi Obafemi Obadaini, Sarah Al-Furais, Humaida Hemlae, Sreylis Nay, Fabianne Altruda de Moraes Costa Carlesse, Denis Cozzi, Paolo Musiu, Paolo Sapienza, Martina Zambon, Simona Meneghini, Pierfranco Cicerchia, Abdulrahman Omar Taha, Bouaoud Souad, Mebarki Malika, Bioud Belkacem, Fayza Haider, Halwani Yaninga Fuseini, Peter Gyamfi Kwarteng, Abubakari Bawa Abdulai, Sheba Mary Pognaa Kunfah, Stephanie Ajinkpang, Mary Joan Kpiniong, Kingsley Aseye Hattor, Kingsley Appiah Bimpong, Mohamed Elbahnasawy, Sherief Abdelsalam, Amanpreet Brar, Andreea C Matei, Hira Khalid Zuberi, Kishwer Nadeem, Naema Khayyam, Fatima Ambreen Imran, Nida Zia, Sadia Muhammad, Muhammad Rafie Raza, Muhammad Rahil Khan, Alaa Hamdan, Abdeljawad Mazloum, Ali Abodest, Nisreen Ali, Ammar Omran, Alaa Ahmed, Munawar Hraib, Victor Khoury, Abdulrahman Almjersah, Mohammad Ali Deeb, Akram Ahmed, Ahmad Bouhuwaish, Alqasim Abdulkarim, Marwa Biala, Reem Ghamgh, Amani Alamre, Marwa Shelft, Hoda Tawel, Emmanuel Hatzipantelis, Eleni Tsotridou, Assimina Galli-Tsinopoulou, C-Khai Loh, Doris Lau, Kelvin Ifeanyichukwu Egbuchulem, Olakayode Olaolu Ogundoyin, Isaac Dare Olulana, Oluwasegun Joshua Afolaranmi, AbdulBasit Fehintola, Annika Heuer, Matthias Priemel, Lennart Viezens, Martin Stangenberg, Marc Dreimann, Alonja Reiter, Jasmin Meyer, Leon Köpke, Uduak Offiong, Philip Mari Mshelbwala, Fashie Andrew Patrick, Aminu Muhammed Umar, N Otene ThankGod, Yuki Julius Ng, Syukri Ahmad Zubaidi, Murad Almasri, Rasaq Olaosebikan, Akila Muthukumar, Amon Ngongola, Azad Patel, Abdullahi Nuhu-Koko, Baba Jibrin, Gabriela Guillén, Sergio López, José Andrés Molino, Pablo Velasco, Omar Hamam, Rim Elmandouh, Nensi Melissa Ruzgar, Rachel Levinson, Shashwat Kala, Sarah Ullrich, Emily Christison-Lagay, Janice Hui Ling Wong, Reto Baertschiger, Essam Elhalaby, Guido Seitz, Judith Lindbert, Asimina Galli-Tsinopoulou, Calogero Virgone, Eric Mwangi Irungu, Outani Oumaima, Lily Saldana, Jan Godzinsky, Abdelbasit Ali, Mohamed Bella Jalloh, Nellie Bell, Annette Jacobsen, Israel Fernandez Pineda, Lucas Krauel, Waha Rahama, Hazim Elfatih, Arda Isik, Andrea Hayes-Jordan, Roshni Dasgupta, Krishna Kumar Govindarajan, Marta deAndres Crespo, Nitin James Peters, Santosh Kumar Mahalik, Rajat Piplani, Enono Yhoshu, K S Rajkumar, Sadi A Abukhalaf, Mohammed Miftah Faraj Almihashhish, Eman Salem Muftah Burzeiza, Raja Mari Mohammed Nasef, Benjamin J O'Sullivan, Mohamed Hassanin, Dave R Lal, Brian T Craig, Vishal Michael, M Joseph John, William Bhatti, Swati Daniel, Jyoti Dhiman, Hunar Mahal, Atul Suroy, Shruti Kakkar, Shaina Kamboj, Suraj Singh, AKM Khairul Basher, SM Rezanur Rahman, Md Asif Iqbal, Md Masud Rana, Monica Dobs, Mohamed Atef Mohamed Ghamry, Joana Monteiro, Marco Aurelio Ciriaco Padilha, Lucas Garschagen deCarvalho, Sandip Kumar Rahul, Digamber Chaubey, Rejin Kebudi, Sema Bay Buyukkapu, Kumaravel Sambandan, Smita Kayal, Gunaseelan Karunanithi, Bikash Kumar Naredi, Bibekanand Jindal, Ranya M Baddourah, Ayah Al Shraideh, Ahmad Ozair, Ankur Bajaj, Bal Krishna Ojha, Kaushal Kishor Singh, Atique Anwar, Vinay Suresh, Mohamad K Abou Chaar, Christopher O Bode, Justina O Seyi-Olajide, George C Ihediwa, Edamisan O Temiye, Adeseye M Akinsete, Iqra Effendi, Khaled Mamdouh, Mohamed Atef, Mohamed Faried, Jake A Kloeber, Robert L Owen, Alexander S Roth, J Hudson Barnett, Lucien P Jay, Paul J Galardy, Bernard Mbwele, Irene Nguma, Moshi Moshi Shabani, Amani Twaha, Bilal Matola, Mahmoud Maher Abdelnaby Alrahawy, Simone deOliveira Coelho, Ricardo Vianna deCarvalho, FernandaFerreira daSilva Lima, Moawia Mohammed AliElhassan, Nada Osman Yousif Elhaj, Hytham KS Hamid, Vincent E Nwatah, Adewumi B Oyesakin, RM Jeffri Ismail, Simone deCamposVieira Abib, Mayara Caroline Amorim Fanelli, Fernanda Kelly Marques de Souza, Sandeep Mohindra, Ninad R Patil, Richa Jain, Gopal Nambi, Norehan Johari, Anas Shikha, Win SabaiPhyu Han, Zahidah Ahmad, Yen Yan Lim, Roserahayu Idros, Noorainun Mohd Yusof, David Nelson Jaisingh, Fatema Naser AlFayez, Elana Kleinman, Taylor Ibelli, Rochelle Fayngor, Tzvi Najman, Etai Adam, Daniella Melamed, Cecilia Paasche, Farman Ali Laghari, Zainab Al Balushi, Abdulhakim Awadh SalimAl-Rawas, Ali Al Sharqi, Ammar Saif AlShabibi, Ismail Al Bulushi, Muna Alshahri, Abdulrahman AlMirza, Ola Al Hamadani, Jawaher Al Sharqi, Anisa Al Shamsi, Bashar Dawud, Sareya Al Sibai, Gilbert B Bonsaana, Edmund M Der, Francis A Abantanga, Bardisan Gawrieh, Hassan Salloum, Mohammad Ahmad Almahmod Alkhalil, Waseem Shater, Ali Farid Alelayan, Alaa Guzlan, Asmaa AM Albanna, Dayang AnitaAbdul Aziz, Azrina Syarizad Khutubul Zaman, Biobele J Brown, Ajiboye L Olalekan, Christopher S Lukong, Ezekiel I Ajayi, Luca Pio, Nitin James Peter, Ravi Kishore, Mohammad K Abou Chaar, Dayang Anita Abdul Aziz, Dhruva Nath Ghosh, and Raphael N Vuille-dit-Bille

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children

Published
2022
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5. Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

Author

Mohamed Ahmed, Ahmad Mansour, Ahmed Samir, Charlotte Smith, Lubna Samad, Vaishnavi Govind, Fakher Rahim, Augusto Zani, Muhammad Arshad, Sadaf Altaf, Chan Hon Chui, Pooja Kumari, Thomas Smith, Ayesha Saleem, Darica Au, Kate Cross, Kokila Lakhoo, Anna Maria Testi, Robyn Brown, Noel Peter, Francesco Pata, Adesoji Ademuyiwa, Tahmina Banu, Bruce Bvulani, Milind Chitnis, Maryam Ghavami Adel, Matthew H V Byrne, Pierfrancesco Lapolla, Andrea Mingoli, Lucy Davies, Dennis Mazingi, Hamidah Alias, Simone de Campos Vieira Abib, Ibukunolu Olufemi Ogundele, Laila Hessissen, Mohammad Ahmad, Maricarmen Olivos, Daniel Rhee, Maryam Khan, Christine Nitschke, Alexandra Valetopoulou, Ashrarur Rahman Mitul, Sabbir Karim, Gaetano Gallo, Mohamedraed Elshami, Mahmoud Elfiky, Soham Bandyopadhyay, Muath Alser, Elliott H Taylor, Duha Jasim, Somy Charuvila, Nazmul Islam, William B Lo, Robin Simpson, Zarina Abdul Latiff, Bruno Cirillo, Gioia Brachini, Megan Murphy, Zineb Bentounsi, Anette S Jacobsen, Anna Casey, Abdulrasheed A Nasir, Taiwo Akeem Lawal, Samson Olori, Michael Boettcher, Muhammed Elhadi, Shaun Wilson, Dragana Janić, Patricia Shinondo, Shireen Anne Nah, Alhassan Abdul-Mumin, Dayang Anita Abdul Aziz, J Benjamin, Karl-Heinz Frosch, Poorvaprabha Patil, Sarah Muma, Emmanuel Uwiringiyimana, Athanasios Tragiannidis, Mahan Salehi, Sara Ali, Hafeez Abdelhafeez, Max Pachl, Benjamin Martin, Sonal Nagras, Mihir Sheth, Catherine Dominic, Suraj Gandhi, Divya Parwani, Rhea Raj, Diella Munezero, Rohini Dutta, Nsimire Mulanga Roseline, Kellie McClafferty, Armin Nazari, Smrithi Sriram, Sai Pillarisetti, Aishwarya Ashwinee, Gul Kalra, Priyansh Nathani, Khushman Kaur Bhullar, Nehal Rahim, Shweta Madhusudanan, Joshua Erhabor, Manasi Shirke, Aishah Mughal, Sravani Royyuru, Daniel Robinson, Mehdi Khan, Alexandre Dukundane, Kwizera Festus, Rohan Pancharatnam, Lorraine Ochieng, Hritik Nautiyal, Leanne Gentle, Ehab Hanafy, Catherine Yang, John Mathew, Olumide Abiodun Elebute, Oluwaseun Ladipo-Ajayi, Okechukwu Hyginus Ekwunife, Sherief Ghozy, Aya Zazo, Salah Eddine Oussama Kacimi, Ahmed Sherif, Krithi Ravi, Nermin Badwi, Hajar Moujtahid, Ariana Axiaq, Eman Abdulwahed, Kemal Tolga Saracoglu, Yasin Kara, Ahmed Y Azzam, Omar Elmandouh, KingDavid Nweze, Syeda Namayah Fatima Hussain, Marta de Andres Crespo, Fatumata Jalloh, Shahnur Shah, Rohini Rajpal, Masooma Rana, Muskaan Abdul Qadir, Abdelrahman Azzam, Mayara Fanelli, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Isadora Schwaab Guerini, Anfel Bouderbala, Sarah Alfurais, Mohamed Gamal, Yara Hijazi, Shatha Tailakh, Hamza AlNaggar, Zain Douba, Sewar Elejla, Abdullah Eldaly, Ekram Sharashi, Tamara Elyan, Aouabed Nesrine, Ammar Ayman, Mohamed Bonna, Safia Lorabi, Hassan Alalami, Rawan Yasser Emam, Mohamad K Abou Chaar, Hira Zuberi, Iyad Sultan, Dhruv Nath Ghosh, Nitin James Peters, Reto M Baertschiger, Kefas John Bwala, AM Umar, Abdurahaman Aremu, Dauda E Suleiman, Tybat Aliyu, Kashaf Turk, Oluseyi Oyebode Ogunsua, Tunde Talib Sholadoye, Musliu Adetola Tolani, Yakubu Alfa, Keffi Mubarak Musa, Mwangi Irungu, Ken Muma, Mitchelle Obat, Youssef Sameh Badran, Abdulrahman Ghassan Qasem, Faris Ayasra, Reema Alnajjar, Mohamed Abdel-Maboud, Abdelrahman Bahaa, Ayat M Saadeldin, Mohamed Adwi, Mahmoud Adly, Abdallah Elshenawy, Amer Harky, Kirstie Wright, Jessica Luyt, Olivia White, Nathan Thompson, Imogen Harrison, Sara Kader Alsaeiti, Fatma Saleh Benkhial, Mohammed Miftah Faraj Almihashhish, Eman Salem Muftah Burzeiza, Raja Mari Mohammed Nasef, Hend Mohammed Masoud, Mabroukah Saeid Alshamikh, Fatma Mohammed Masoud, Nyararai Togarepi, Elaine Carrolan, Mohamed Hassanin O'Sullivan, Ahmed Saleh, Mahmoud Bassiony, Mostafa Qatora, Mohamed Bahaaeldin, Shady Fadel, Yasmine El Chazli, Kamel Hamizi, Mehdi Anouar Zekkour, Rima Rahmoun, Boutheyna Drid, Salma Naje Abu Teir, Mohamed Yazid Kadir, Yassine Zerizer, Nacer Khernane, Brahim Saada, Imane Ammouze, Yahya Elkaoune, Ghita Chaoui, Hajar Benaouda, Meryem Gounni, Narjiss Aji, Joana Mafalda Monteiro, Susana Nunes, Maria do Bom-Sucesso, Dave R. Lal, Brian T. Craig, Kerri Becktell, Md Afruzul Alam, Orindom Shing Pulock, Tasmiah Tahera Aziz, Rosanda Ilic, Danica Grujicic, Tijana Nastasovic, Igor Lazic, Mihailo Milicevic, Vladimir Bascarevic, Radovan Mijalcic, Vuk Scepanovic, Aleksandar Stanimirovic, Aleksandra Paunovic, Ivan Bogdanovic, Shahnoor Islam, AKM Amirul Morshed, A. K. M. Khairul Basher, Mehnaz Akter, S. M. Rezanur Rahman, Zannat Ara, Mohammed Tanvir Ahammed, Tania Akter, Kamrun Nahar, Fatema Sayed, Ashfaque Nabi, Md. Asif Iqbal, Md. Masud Rana, Md. Asaduzzaman, Md. Hasanuzzaman, Elif Akova, Evren Aydogmus, Bekir Can Kendirlioglu, Tufan Hicdonmez, Arshiya Adhnon, Asim Noor Rana, Hani Humad, Anjan Madasu, Mohammed A Azab, Alzhraa Salah Abbas, Olanrewaju Moses, Ibiyeye Taiye Taibat, Taiwo Jones, Kalu Ukoha, Olagundoye Goke, Okorie Ikechukwu, Abiodun Idowu Okunlola, Helga Nauhaus, Danelle Erwee, Agata Chylinska, Prasanna Gomes, Marco Aurelio Ciriaco Padilha, Elvercio Pereira de Oliveira Junior, Lucas Garschagen de Carvalho, Fabiola Leonelli Diz, Mohamed El Kassas, Usama Eldaly, Ahmed Tawheed, Mohamed Abdelwahab, Oudrhiri Mohammed Yassaad, Bechri Hajar, El Ouahabi Abdessamad, Arkha Yasser, Hessissen Laila, Farah Sameer Yahya, Yasir Al-Agele, Maria Teresa Peña Gallardo, Jacqueline Elizabeth Montoya Vásquez, Juan Luis García León, Sebastián Shu Yip, Mariam Lami, Harmit Ghattaura, Eric W Etchill, Stacy Cooper, Kevin Crow, Morgan Drucker, Benjamin Shou, Alan Siegel, Gül Nihal Özdemir, Ehab El Refaee, John George Massoud, Ayah Bassam Ibrahim, Ruaa Bassam Ibrahim, Faris Abu Za'nouneh, Ranya M. Baddourah, Toqa Fahmawee, Ayah Al_Shraideh, Ghazwani Salman, Ehab Alameer, Al-Mudeer Ali, Ghazwani Yahia, Khozairi Waleed, Mohamad K. Abou Chaar, Khalil Ghandour, Shaima' Al-Dabaibeh, Ammar Al-Basiti, Hazim Ababneh, Omaima El-Qurneh, Yousef Alalawi, Ahmad Al Ayed, Naif Al Bolowi, Amos HP Loh, Heidi Barola, Aubrey L Pagaduan, Jingdan Fan, Adesoji O. Ademuyiwa, Christopher O. Bode, Justina O. Seyi-Olajide, Felix M. Alakaloko, George C. Ihediwa, Kareem O. Musa, Edamisan O. Temiye, Olufemi Oni, Adeseye M. Akinsete, Janita Zarrish, Ramsha Saleem, Soha Zahid, Atiqa Amirali, Ahsan Nadeem, Sameer Saleem Tebha, Zonaira Qayyum, Sana Tahir, Anneqa Tahir, Rabbey Raza Khan, Ayesha Mehmood, Taimur Iftikhar Qureshi, Victor Calvagna, Nathalie Galea, Matthew R Schuelke, Jake A. Kloebe, Robert L. Owen, Alexander S. Roth, J. Hudson Barnett, Lucien P. Jay, Kirk David Wyatt, Paul J. Galardy, Agnes Vojcek, Mahmoud Maher Abdelnaby Alrahawy, Seham M Ragab, Abdallah R Allam, Eman Ibrahim Hager, Kıvılcım Karadeniz Cerit, Adnan Dağçınar, Tümay Umuroğlu, Ayten Saraçoğlu, Mustafa Sakar, Can Kıvrak, Gül Çakmak, Ibrahim Sallam, Gamal Amira, Mohamed Sherief, Simone de Oliveira Coelho, Arissa Ikeda, Licia Portela, Marianne Monteiro Garrigo, Ricardo Vianna de Carvalho, Fernanda Lobo, Sima Ester Ferman, Fernanda Ferreira da Silva Lima, Moawia Mohammed Ali Elhassan, Nada Osman Yousif Elhaj, Hytham K. S. Hamid, Emmanuel A. Ameh, Vincent E. Nwatah, Adewumi B. Oyesakin, Andrew Nwankwo Osuigwe, Chisom Adaobi Nri-Ezedi, Eric Okechukwu Umeh, Nellie Patiala, Abiodun Folashade Adekanmbi, Olubunmi Motunrayo Fatungase, Olubunmi Obafemi Obadaini, Sarah Al-Furais, Humaida Hemlae, Sreylis Nay, R M Jeffri Ismail, Simonede Campos Vieira Abib, Fabianne Altruda de Moraes Costa Carlesse, Mayara Caroline Amorim Fanelli, Fernanda Kelly Marques de Souza, Denis Cozzi, Paolo Musiu, Paolo Sapienza, Martina Zambon, Simona Meneghini, Pierfranco Cicerchia, Abdulrahman Omar Taha, Bouaoud Souad, Mebarki Malika, Bioud Belkacem, Ayman Meelad, Hajier Salim Alrashed, Fayza Haider, Fatema Naser Al Fayez, Halwani Yaninga Fuseini, Peter Gyamfi Kwarteng, Abubakari Bawa Abdulai, Sheba Mary Pognaa Kunfah, Gilbert B. Bonsaana, Stephanie Ajinkpang, Edmund M. Der, Francis A. Abantanga, Mary Joan Kpiniong, Kingsley Aseye Hattor, Kingsley Appiah Bimpong, Mohamed Elbahnasawy, Sherief Abdelsalam, Reto M. Baertschiger, Amanpreet Brar, Andreea C Matei, Hira Khalid Zuberi, Kishwer Nadeem, Naema Khayyam, Fatima Ambreen Imran, Nida Zia, Sadia Muhammad, Muhammad Rafie Raza, Muhammad Rahil Khan, Alaa Hamdan, Abdeljawad Mazloum, Ali Abodest, Nisreen Ali, Bardisan Gawarieh, Ammar Omran, Almed Moussa, Alaa Ahmed, Munawar Hraib, Victor Khoury, Abdulrahman Almjersah, Mohammad Ali Deeb, Almahmod Alkhalil, Akram Ahmed, Ali Alelayan, Ali Hammed, Wassem Shater, Ahmad Bouhuwaish, Alqasim Abdulkarim, Marwa Biala, Reem Ghamgh, Amani Alamre, Marwa Shelft, Asmaa A. M. Albanna, Hoda Tawel, Emmanuel Hatzipantelis, Eleni Tsotridou, Assimina Galli-Tsinopoulou, C-Khai Loh, Doris Lau, Azrina Syarizad Khutubul, Raphael N. Vuille-dit-Bille, Stefan G. Holland-Cunz, Nima Allafi, Kelvin Ifeanyichukwu Egbuchulem, Olakayode Olaolu Ogundoyin, Isaac Dare Olulana, Biobele J. Brown, Oluwasegun Joshua Afolaranmi, AbdulBasit Fehintola, Annika Heuer, Matthias Priemel, Lennart Viezens, Martin Stangenberg, Marc Dreimann, Alonja Reiter, Jasmin Meyer, Leon Köpke, Uduak Offiong, Philip Mari Mshelbwala, Fashie Andrew Patrick, Aminu Muhammed Umar, N Otene ThankGod, Kazeem O. O. Ibrahim, Dupe S. Ademola-Popoola, Olayinka T. Sayomi, Alege Abdurrzzaq, Ademola A. Adeyeye, Khadijah O. Omokanye, Lukman O Abdur-Rahman, Olubisi Olutosin Bamidele, Shakirullah AbdulAzeez, Aminat Akinoso, Michael O. Adegboye, Yuki Julius Ng, Syukri Ahmad Zubaidi, Murad Almasri, Rasaq Olaosebikan, Akila Muthukumar, Amon Ngongola, Azad Patel, Abdullahi Nuhu-Koko, Baba Jibrin, Ajiboye L. Olalekan, Christopher S. Lukong, Ezekiel I. Ajayi, Gabriela Guillén, Sergio López, José Andrés Molino, Pablo Velasco, Omar Hamam, Rim Elmandouh, Nensi Melissa Ruzgar, Rachel Levinson, Shashwat Kala, Sarah Ullrich, Emily Christison-Lagay, Aya Sabry Mortada, Mahmoud Ahmed Ebada, Eman Seif Alnaser Solimam, Khaled Abualkher, Amr Mohammed Elsayed Yousf, Mohamed Mohamed Holail, Reem Mohamed Almowafy, Janice Hui Ling Wong, Reto Baertschiger, Essam Elhalaby, Mahmoud M. Saad, Guido Seitz, Judith Lindbert, Francis Abantanga Georgios Tsoulfas, Asimina Galli-Tsinopoulou, Calogero Virgone, Mohammad K. Abou Chaar, Eric Mwangi Irungu, Outani Oumaima, Lily Saldana, Jan Godzinsky, Abdelbasit Ali, Mohamed Bella Jalloh, Nellie Bell, Annette Jacobsen, Israel Fernandez Pineda, Lucas Krauel, Waha Rahama, Hazim Elfatih, Arda Isik, Andrea Hayes-Jordan, and Roshni Dasgupta

Subjects
Medicine
Abstract

Objectives Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.Design A multicentre, international, collaborative cohort study.Setting 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.Participants Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measure All-cause mortality at 30 days and 90 days.Results 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p

Published
2022
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6. Comparative study between high and low dose methylene blue infusion in septic cancer patients: a randomized, blinded, controlled study.

Author

Shaker, Ehab Hanafy, Soliman, Ahmed Mohamed, Bedewy, Ahmed Abd Elmohsen, and Elrawas, Mai Mohamed

Subjects
METHYLENE blue, PLACEBOS, DATA analysis, STATISTICAL sampling, BLIND experiment, SAMPLE size (Statistics), LOGISTIC regression analysis, CANCER patients, RANDOMIZED controlled trials, TREATMENT effectiveness, MANN Whitney U Test, DESCRIPTIVE statistics, SEPTIC shock, INTRAVENOUS therapy, DRUG efficacy, ANALYSIS of variance, STATISTICS, COMPARATIVE studies, VASOCONSTRICTORS, CONFIDENCE intervals, DATA analysis software, PHARMACODYNAMICS, EVALUATION
Abstract

Purpose: Septic shock is a common threat, and is the primary cause of death in almost all critical care units. Mortality of septic shock remains exceedingly high. The early use of methylene blue (MB) in different doses as adjunctive to vasopressors has promising results. Methods: This double-blind, randomized, controlled trial comprised 90 patients divided into 3 groups: Group A received a 100 ml 0.9% NaCl placebo over 20 min; Group B received an MB bolus of 1 mg/kg in 100 ml 0.9% NaCl, and Group C received MB bolus of 4 mg/kg in 100 ml 0.9% NaCl during the same period. Groups B and C were given a 0.25 mg/kg/hour infusion of MB for 72 h after the bolus dose. All patients were started on noradrenaline at an infusion rate of 0.1–0.2 µ/kg/min and were adjusted accordingly to maintain MAP ≥ 65 mmHg. Time of vasopressor discontinuation was the primary outcome while total doses of vasopressors, ventilation days, vasopressors free days, total ICU stay, total hospital stay, and mortality rate were the secondary outcomes. Results: Groups B and C exhibited significantly decreased time to vasopressor termination, and vasopressor-free days at 28 days in comparison to Group A. However, there was no significant difference between Groups B and C. Groups B and C had significantly lower noradrenaline dosages compared to Group A, however, no significant difference between Group B and Group C was found. The difference between the three groups in mortality rate was near statistical significance (p = 0.083). Using the logistic regression model, the 4 mg/kg group was protective against mortality with a hazard ratio of 0.29 (95%CI: 0.09–0.90). Conclusion: In cancer patients with septic shock, early adjunctive MB delivery reduces the time to a vasopressor stoppage and increases the vasopressor-free days. No significant difference between high and low MB bolus doses, and no significant adverse effects were noted. Compared to placebo, the 4 mg/kg bolus dose shows a survival advantage. Trial registration: Prospectively registered at clinicaltrials.gov [NCT 06005558]. (Date of registration 15/08/2023). [ABSTRACT FROM AUTHOR]

Published
2025
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7. Original research: Dexmedetomidine versus ketamine in erector spinae plane block for postoperative analgesia following modified radical mastectomy: A prospective randomized controlled blinded study.

Author

Shaker, Ehab Hanafy, Soliman, Ahmed M, Bedewy, Ahmed Abd Elmohsen, and Adlan, Suzan

Abstract

Background: A significant postoperative pain has been documented in numerous breast cancer cases following modified radical mastectomy (MRM). We evaluated the effectiveness of dexmedetomidine (DEX) versus ketamine as adjuvants to local anaesthetic in erector spinae plane block (ESPB) in MRM. Methods: In this randomized controlled trial, 75 women with breast cancer scheduled for MRM were included. All patients underwent ESPB with 30 ml 0.25% bupivacaine and randomized into three equal groups: group A, ESPB group; group B: received 1 µg/kg DEX with the ESPB; and group C: given 0.5 mg/kg Ketamine with the block. Results: Compared with group A, VAS score at rest as well as movement were lower considerably in groups B and C (p < 0.05) at 6 h, 12 h, and 24 h. Group B had lower VAS scores at rest at 12 h and 24 h and during movement at 6 h, 12 h, and 24 h (p < 0.05) than group C. In comparison to A Group; B and C Groups required considerably less time to rescue analgesia and consumed significantly fewer total opioids (p < 0.05 and p < 0.001, respectively). In addition, total number of patients who required additional analgesia was markedly reduced in groups B and C compared to group A ;(p < 0.05). Conclusion: In MRM surgery, the postoperative opioids consumption and VAS values were lower in both groups DEX and ketamine as an adjuvant to bupivacaine which enhanced the analgesic profile and prolonged ESPB duration compared to ESPB alone, with DEX being superior to ketamine. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Ultrasound-guided continuous erector spinae plane block vs continuous thoracic epidural analgesia for the management of acute and chronic postthoracotomy pain: a randomized, controlled,double-blind trial

Author

Shaker, Ehab Hanafy, primary, Elshal, Mamdouh Mahmoud, additional, Gamal, Reham Mohamed, additional, Zayed, Norma Osama Abdallah, additional, Samy, Samuel Fayez, additional, Reyad, Raafat M., additional, Shaaban, Mohammed H., additional, Abd Alrahman, Abd Alrahman M., additional, and Abdelgalil, Ahmed Salah, additional

Published
2023
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9. Genotype and Phenotype of Adenosine Deaminase 2 Deficiency: a Report from Saudi Arabia

Author

Fahad Alabbas, Talal Alanzi, Abdulrahman Alrasheed, Mohammed Essa, Ghaleb Elyamany, Abdulrahman Asiri, Sajdi Almutairi, Sulaiman Al-Mayouf, Abdullatif Alenazi, Danyah Alsafadi, Walid Ballourah, Naif Albalawi, Ehab Hanafy, Abdulqader Al-Hebshi, Seham Alrashidi, Fatma Albatniji, Huda Alfaraidi, Tahani Bin Ali, Mansour Al Qwaiee, Maryam AlHilali, Hayam Aldeeb, Ali Alhaidey, Hassan Aljasem, Sami Althubaiti, and Abdulrahman Alsultan

Subjects
Immunology, Immunology and Allergy
Abstract

Adenosine deaminase 2 deficiency (DADA2), a rare and potentially fatal systemic autoinflammatory disease, is characterized by low or lack of ADA2 activity due to ADA2 mutations. DADA2 symptoms are variable and include vasculitis, immunodeficiency, and cytopenia. Minimal data are available from Saudi Arabia. This retrospective study conducted at seven major tertiary medical centers examined the phenotypic and genotypic variabilities, clinical and diagnostic findings, and treatment outcomes among 20 Saudi patients with DADA2 from 14 families. The median age of the study cohort was 9.5 years (4-26 years). The clinical presentation was before the age of 5 months in 25% of patients. Homozygous c.1447-1451del mutation was the most frequent ADA2 alteration (40%), followed by c.882-2A:G (30%). All tested patients exhibited absent or near-absent ADA2 activity. Phenotypic manifestations included stroke (40%), hematological abnormalities (95%), lymphoproliferation (65%), and recurrent infection (45%). Five and three patients had extracranial vasculitis features and Hodgkin lymphoma, respectively. Atypical manifestations included growth retardation (30%) and transverse myelitis. Anti-tumor necrosis factor (anti-TNF) therapy was the main treatment. Some patients underwent blood transfusion, splenectomy, cyclosporine and colony-stimulating factor therapies, and hematopoietic stem cell transplantation due to anti-TNF therapy failure. Fulminant hepatitis and septic multiorgan failure caused mortality in three patients. Thus, this study revealed the variability in the molecular and clinical characteristics of DADA2 in the study cohort with predominant aberrant hematological and immunological characteristics. Consensus diagnostic criteria will facilitate early diagnosis and treatment. Additionally, disease registries or large prospective studies are needed for evaluating rare disease complications, such as cancer.

Published
2022
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10. Ultrasound Guided Continuous Erector Spinae Plane Block versus Patient Controlled Analgesia in Open Nephrectomy for Renal Malignancies: A Randomized Controlled Study

Author

Ahmed Salah Abdelgalil, Ahmed Mansour Ahmed, Reham M Gamal, Mamdouh Mahmoud Elshal, Ahmed Hussein Bakeer, and Ehab Hanafy Shaker

Subjects
Anesthesiology and Pain Medicine, Journal of Pain Research
Abstract

Ahmed Salah Abdelgalil, Ahmed Mansour Ahmed, Reham M Gamal, Mamdouh Mahmoud Elshal, Ahmed Hussein Bakeer, Ehab Hanafy Shaker Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, EgyptCorrespondence: Ahmed Salah Abdelgalil, Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, 11796, Egypt, Email ahmed.salah@nci.cu.edu.egBackground: It is critical to manage acute postoperative pain for patient satisfaction and better outcome. Erector spinae plane block (ESPB) can produce sensory blocking on both visceral and somatic levels. This study aimed to evaluate the ESPB efficacy in controlling acute postoperative pain in open nephrectomy for renal malignancies.Methods: This prospective randomized, controlled, open-label trial included 60 cases scheduled for open nephrectomy for renal malignancy under general anesthesia. Cases were assigned randomly into two equal groups. Group E administered continuous preoperative unilateral ESPB (20mL bupivacaine 0.25% bolus then 6 mL/h 0.1% for 48 hours). Group C administered intravenous (IV) patient-controlled analgesia (PCA) morphine (0.01 mg/kg/h). Postoperative analgesia was managed by morphine (3 mg IV in group E or 0.01 mg/kg bolus with a 15-min lockout in group C) to keep the visual analog scale (VAS) scores < 4.Results: Intraoperative fentanyl consumption and total morphine consumption in 1st 48 hours postoperatively were significantly lower in group E than group C (P= 0.001 and < 0.001, respectively). The time to first analgesic request was significantly longer in group E than group C (P < 0.001). VAS scores at movement and rest were significantly lower in group E than group C (P < 0.001).Conclusion: In renal malignancies, ESPB provided better analgesia with prolonged time and lower pain scores at both rest and movement compared to IV PCA following open nephrectomy.Keywords: erector spinae plane block, PCA, analgesia, nephrectomy, renal malignancy

Published
2022
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11. Knowledge, attitudes and practices of parents of children with sickle cell disease towards vaso occlusive crisis in Tabuk area, Saudi Arabia: A cross-sectional study

Author

Sawsan Mohammed Al Blewi, Ziad Saleh D Albalwi, Abdullah I Altidlawi, Lena Defallah G Alzahrani, Rawan Defallah G Alzahrani, Laila Abdullah S Al-Anazi, Mohand Basher Gahesh Albalawi, Abdulrahman Arshed N Alharfy, Naif Mohammed Al-Balawi, Ehab Hanafy, Yassmeen Hmoud Suliman Alblowi, Khaled Abdullah S Alasmari, and Amal Abdullah Ayed Albalwi

Published
2023
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13. Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

Author

Global Health Research Group on Children’s Non-Communicable Diseases Collaborative: Soham Bandyopadhyay, Noel, Peter, Kokila, Lakhoo, Simone de Campos Vieira Abib, Hafeez, Abdelhafeez, Shaun, Wilson, Max, Pachl, Benjamin, Martin, Sonal, Nagras, Mihir, Sheth, Catherine, Dominic, Suraj, Gandhi, Divya, Parwani, Rhea, Raj, Diella, Munezero, Rohini, Dutta, Nsimire Mulanga Roseline, Kellie, Mcclafferty, Armin, Nazari, Smrithi, Sriram, Sai, Pillarisetti, Kingdavid, Nweze, Aishwarya, Ashwinee, Gul, Kalra, Poorvaprabha, Patil, Priyansh, Nathani, Khushman Kaur Bhullar, Muhammed, Elhadi, Maryam, Khan, Nehal, Rahim, Shweta, Madhusudanan, Joshua, Erhabor, Manasi, Shirke, Aishah, Mughal, Darica, Au, Mahan, Salehi, Sravani, Royyuru, Mohamed, Ahmed, Syeda Namayah Fatima Hussain, Daniel, Robinson, Anna, Casey, Mehdi, Khan, Alexandre, Dukundane, Kwizera, Festus, Vaishnavi, Govind, Rohan, Pancharatnam, Lorraine, Ochieng, Elliott, H Taylor, Hritik, Nautiyal, Marta de Andres Crespo, Somy, Charuvila, Alexandra, Valetopoulou, Krithi, Ravi, Fatumata, Jalloh, Nermin, Badwi, Shahnur, Shah, Rohini, Rajpal, Masooma, Rana, Muskaan Abdul Qadir, Emmanuel, Uwiringiyimana, Abdelrahman, Azzam, Mayara, Fanelli, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Isadora Schwaab Guerini, Anfel, Bouderbala, Sarah, Alfurais, Mohamed, Gamal, Yara, Hijazi, Shatha, Tailakh, Hamza, Alnaggar, Zain, Douba, Sewar, Elejla, Abdullah, Eldaly, Ekram, Sharashi, Ahmad, Mansour, Tamara, Elyan, Aouabed, Nesrine, Ammar, Ayman, Aya, Zazo, Mohamed, Bonna, Safia, Lorabi, Hassan, Alalami, Rawan Yasser Emam, Soham, Bandyopadhyay, Muath, Alser, Mohamad, K Abou Chaar, Dennis, Mazingi, Hira, Zuberi, Iyad, Sultan, Dhruv Nath Ghosh, Nitin James Peters, Reto, M Baertschiger, Augusto, Zani, Lucy, Davies, Kefas John Bwala, M Umar, A, Abdurahaman, Aremu, Dauda, E Suleiman, Tybat, Aliyu, Ayesha, Saleem, Muhammad, Arshad, Kashaf, Turk, Sadaf, Altaf, Oluseyi Oyebode Ogunsua, Tunde Talib Sholadoye, Musliu Adetola Tolani, Yakubu, Alfa, Keffi Mubarak Musa, Mwangi, Irungu, Ken, Muma, Sarah, Muma, Mitchelle, Obat, Youssef Sameh Badran, Abdulrahman Ghassan Qasem, Faris, Ayasra, Reema, Alnajjar, Mohamed, Abdel-Maboud, Abdelrahman, Bahaa, Ayat, M Saadeldin, Mohamed, Adwi, Mahmoud, Adly, Abdallah, Elshenawy, Amer, Harky, Leanne, Gentle, Kirstie, Wright, Jessica, Luyt, Olivia, White, Charlotte, Smith, Nathan, Thompson, Thomas, Smith, Imogen, Harrison, Ashrarur Rahman Mitul, Sabbir, Karim, Nazmul, Islam, Sara Kader Alsaeiti, Fatma Saleh Benkhial, Mohammed Miftah Faraj Almihashhish, Eman Salem Muftah Burzeiza, Raja Mari Mohammed Nasef, Hend Mohammed Masoud, Mabroukah Saeid Alshamikh, Fatma Mohammed Masoud, William, B Lo, Nyararai, Togarepi, Elaine, Carrolan, Benjamin, J, Mohamed Hassanin O'Sullivan, Ahmed, Saleh, Mahmoud, Bassiony, Mostafa, Qatora, Mohamed, Bahaaeldin, Shady, Fadel, Yasmine El Chazli, Kamel, Hamizi, Mehdi Anouar Zekkour, Rima, Rahmoun, Boutheyna, Drid, Salma Naje Abu Teir, Mohamed Yazid Kadir, Yassine, Zerizer, Nacer, Khernane, Brahim, Saada, Imane, Ammouze, Yahya, Elkaoune, Hajar, Moujtahid, Ghita, Chaoui, Hajar, Benaouda, Meryem, Gounni, Narjiss, Aji, Laila, Hessissen, Joana Mafalda Monteiro, Susana, Nunes, Maria do Bom-Sucesso, Dave, R Lal, Brian, T Craig, Kerri, Becktell, Tahmina, Banu, Md Afruzul Alam, Orindom Shing Pulock, Tasmiah Tahera Aziz, Rosanda, Ilic, Danica, Grujicic, Tijana, Nastasovic, Igor, Lazic, Mihailo, Milicevic, Vladimir, Bascarevic, Radovan, Mijalcic, Vuk, Scepanovic, Aleksandar, Stanimirovic, Aleksandra, Paunovic, Ivan, Bogdanovic, Shahnoor, Islam, Akm Amirul Morshed, A K, M Khairul Basher, Mehnaz, Akter, M Rezanur Rahman, S, Zannat, Ara, Mohammed Tanvir Ahammed, Tania, Akter, Kamrun, Nahar, Fatema, Sayed, Ashfaque, Nabi, Md Asif Iqbal, Md Masud Rana, Asaduzzaman, Md, Hasanuzzaman, Md, Kemal Tolga Saracoglu, Elif, Akova, Evren, Aydogmus, Bekir Can Kendirlioglu, Tufan, Hicdonmez, Arshiya, Adhnon, Asim Noor Rana, Hani, Humad, Anjan, Madasu, Ahmed, Y Azzam, Mohammed, A Azab, Sherief, Ghozy, Alzhraa Salah Abbas, Olanrewaju, Moses, Ibiyeye Taiye Taibat, Taiwo, Jones, Kalu, Ukoha, Olagundoye, Goke, Okorie, Ikechukwu, Abiodun Idowu Okunlola, Milind, Chitnis, Helga, Nauhaus, Danelle, Erwee, Robyn, Brown, Agata, Chylinska, Robin, Simpson, Prasanna, Gomes, Marco Aurelio Ciriaco Padilha, Elvercio Pereira de Oliveira Junior, Lucas Garschagen de Carvalho, Fabiola Leonelli Diz, Mohamed El Kassas, Usama, Eldaly, Ahmed, Tawheed, Mohamed, Abdelwahab, Oudrhiri Mohammed Yassaad, Bechri, Hajar, El Ouahabi Abdessamad, Arkha, Yasser, Hessissen, Laila, Farah Sameer Yahya, Yasir, Al-Agele, Maria Teresa Peña Gallardo, Jacqueline Elizabeth Montoya Vásquez, Juan Luis García León, Sebastián Shu Yip, Mariam, Lami, Matthew H, V Byrne, Duha, Jasim, Harmit, Ghattaura, Eric, W Etchill, Daniel, Rhee, Stacy, Cooper, Kevin, Crow, Morgan, Drucker, Megan, Murphy, Benjamin, Shou, Alan, Siegel, Yasin, Kara, Gül Nihal Özdemir, Mahmoud, Elfiky, Ehab El Refaee, John George Massoud, Ayah Bassam Ibrahim, Ruaa Bassam Ibrahim, Faris Abu Za'nouneh, Ranya, M Baddourah, Toqa, Fahmawee, Ayah Al Shraideh, Ghazwani, Salman, Ehab, Alameer, Al-Mudeer, Ali, Ghazwani, Yahia, Khozairi, Waleed, Khalil, Ghandour, Shaima', Al-Dabaibeh, Ammar, Al-Basiti, Hazim, Ababneh, Omaima, El-Qurneh, Yousef, Alalawi, Ahmad Al Ayed, Ehab, Hanafy, Naif Al Bolowi, Amos Hp Loh, Anette, S Jacobsen, Heidi, Barola, Aubrey, L Pagaduan, Jingdan, Fan, Olumide Abiodun Elebute, Adesoji, O Ademuyiwa, Christopher, O Bode, Justina, O Seyi-Olajide, Oluwaseun, Ladipo-Ajayi, Felix, M Alakaloko, George, C Ihediwa, Kareem, O Musa, Edamisan, O Temiye, Olufemi, Oni, Adeseye, M Akinsete, Janita, Zarrish, Ramsha, Saleem, Soha, Zahid, Atiqa, Amirali, Ahsan, Nadeem, Sameer Saleem Tebha, Zonaira, Qayyum, Sana, Tahir, Anneqa, Tahir, Rabbey Raza Khan, Ayesha, Mehmood, Taimur Iftikhar Qureshi, Pooja, Kumari, Victor, Calvagna, Nathalie, Galea, Ariana, Axiaq, Matthew, R Schuelke, Jake, A Kloebe, Robert, L Owen, Alexander, S Roth, Catherine, Yang, J Hudson Barnett, Lucien, P Jay, Kirk David Wyatt, Paul, J Galardy, Agnes, Vojcek, Mahmoud Maher Abdelnaby Alrahawy, Seham, M Ragab, Abdallah, R Allam, Eman Ibrahim Hager, Kıvılcım Karadeniz Cerit, Adnan, Dağçınar, Tümay, Umuroğlu, Ayten, Saraçoğlu, Mustafa, Sakar, Can, Kıvrak, Gül, Çakmak, Ibrahim, Sallam, Gamal, Amira, Mohamed, Sherief, Ahmed, Sherif, Simone de Oliveira Coelho, Arissa, Ikeda, Licia, Portela, Marianne Monteiro Garrigo, Ricardo Vianna de Carvalho, Fernanda, Lobo, Sima Ester Ferman, Fernanda Ferreira da Silva Lima, Moawia Mohammed Ali Elhassan, Nada Osman Yousif Elhaj, Hytham K, S Hamid, Emmanuel, A Ameh, Vincent, E Nwatah, Adewumi, B Oyesakin, Andrew Nwankwo Osuigwe, Okechukwu Hyginus Ekwunife, Chisom Adaobi Nri-Ezedi, Eric Okechukwu Umeh, Nellie, Patiala, Ibukunolu Olufemi Ogundele, Abiodun Folashade Adekanmbi, Olubunmi Motunrayo Fatungase, Olubunmi Obafemi Obadaini, Sarah, Al-Furais, Humaida, Hemlae, Sreylis, Nay, John, Mathew, M Jeffri Ismail, R, Simonede Campos Vieira Abib, Fabianne Altruda de Moraes Costa Carlesse, Mayara Caroline Amorim Fanelli, Fernanda Kelly Marques de Souza, Pierfrancesco, Lapolla, Andrea, Mingoli, Denis, Cozzi, Anna Maria Testi, Paolo, Musiu, Paolo, Sapienza, Gioia, Brachini, Martina, Zambon, Simona, Meneghini, Pierfranco, Cicerchia, Bruno, Cirillo, Abdulrahman Omar Taha, Bouaoud, Souad, Mebarki, Malika, Bioud, Belkacem, Ayman, Meelad, Hajier Salim Alrashed, Fayza, Haider, Fatema Naser Al Fayez, Fakher, Rahim, Alhassan, Abdul-Mumin, Halwani Yaninga Fuseini, Peter Gyamfi Kwarteng, Abubakari Bawa Abdulai, Sheba Mary Pognaa Kunfah, Gilbert, B Bonsaana, Stephanie, Ajinkpang, Edmund, M Der, Francis, A Abantanga, Mary Joan Kpiniong, Kingsley Aseye Hattor, Kingsley Appiah Bimpong, Mohamed, Elbahnasawy, Sherief, Abdelsalam, Ahmed, Samir, Amanpreet, Brar, Andreea, C Matei, Lubna, Samad, Hira Khalid Zuberi, Kishwer, Nadeem, Naema, Khayyam, Fatima Ambreen Imran, Nida, Zia, Sadia, Muhammad, Muhammad Rafie Raza, Muhammad Rahil Khan, Alaa, Hamdan, Abdeljawad, Mazloum, Ali, Abodest, Nisreen, Ali, Bardisan, Gawarieh, Ammar, Omran, Almed, Moussa, Alaa, Ahmed, Munawar, Hraib, Victor, Khoury, Abdulrahman, Almjersah, Mohammad Ali Deeb, Almahmod, Alkhalil, Akram, Ahmed, Mohammad, Ahmad, Ali, Alelayan, Ali, Hammed, Wassem, Shater, Ahmad, Bouhuwaish, Alqasim, Abdulkarim, Eman, Abdulwahed, Marwa, Biala, Reem, Ghamgh, Amani, Alamre, Marwa, Shelft, Asmaa A, M Albanna, Hoda, Tawel, Emmanuel, Hatzipantelis, Athanasios, Tragiannidis, Eleni, Tsotridou, Assimina, Galli-Tsinopoulou, Dayang Anita Abdul Aziz, Zarina Abdul Latiff, Hamidah, Alias, C-Khai, Loh, Doris, Lau, Azrina Syarizad Khutubul, Raphael, N Vuille-Dit-Bille, Stefan, G Holland-Cunz, Nima, Allafi, Taiwo Akeem Lawal, Kelvin Ifeanyichukwu Egbuchulem, Olakayode Olaolu Ogundoyin, Isaac Dare Olulana, Biobele, J Brown, Oluwasegun Joshua Afolaranmi, Abdulbasit, Fehintola, Annika, Heuer, Christine, Nitschke, Michael, Boettcher, Matthias, Priemel, Lennart, Viezens, Martin, Stangenberg, Marc, Dreimann, Alonja, Reiter, Jasmin, Meyer, Leon, Köpke, Karl-Heinz, Frosch, Samson, Olori, Uduak, Offiong, Philip Mari Mshelbwala, Fashie Andrew Patrick, Aminu Muhammed Umar, N Otene ThankGod, Abdulrasheed, A Nasir, Kazeem O, O Ibrahim, Dupe, S Ademola-Popoola, Olayinka, T Sayomi, Alege, Abdurrzzaq, Ademola, A Adeyeye, Khadijah, O Omokanye, Lukman, O Abdur-Rahman, Olubisi Olutosin Bamidele, Shakirullah, Abdulazeez, Aminat, Akinoso, Michael, O Adegboye, Shireen Anne Nah, Yuki Julius Ng, Syukri Ahmad Zubaidi, Murad, Almasri, Sara, Ali, Rasaq, Olaosebikan, Akila, Muthukumar, Patricia, Shinondo, Amon, Ngongola, Bruce, Bvulani, Azad, Patel, Abdullahi, Nuhu-Koko, Baba, Jibrin, Ajiboye, L Olalekan, Christopher, S Lukong, Ezekiel, I Ajayi, Gabriela, Guillén, Sergio, López, José Andrés Molino, Pablo, Velasco, Omar, Elmandouh, Omar, Hamam, Rim, Elmandouh, Nensi Melissa Ruzgar, Rachel, Levinson, Shashwat, Kala, Sarah, Ullrich, Emily, Christison-Lagay, Aya Sabry Mortada, Mahmoud Ahmed Ebada, Eman Seif Alnaser Solimam, Khaled, Abualkher, Amr Mohammed Elsayed Yousf, Mohamed Mohamed Holail, Reem Mohamed Almowafy, Salah Eddine Oussama Kacimi, Janice Hui Ling Wong, Reto, Baertschiger, Essam, Elhalaby, Mahmoud, M Saad, Guido, Seitz, Judith, Lindbert, Francis Abantanga Georgios Tsoulfas, Asimina, Galli-Tsinopoulou, Maryam Ghavami Adel, Virgone, Calogero, Francesco, Pata, Gaetano, Gallo, Mohammad, K Abou Chaar, Eric Mwangi Irungu, Outani, Oumaima, Zineb, Bentounsi, Adesoji, Ademuyiwa, Lily, Saldana, Jan, Godzinsky, Abdelbasit, Ali, Dragana, Janic, Mohamed Bella Jalloh, Nellie, Bell, Annette, Jacobsen, Chan Hon Chui, Israel Fernandez Pineda, Lucas, Krauel, Maricarmen, Olivos, Waha, Rahama, Hazim, Elfatih, Arda, Isik, Kate, Cross, Andrea, Hayes-Jordan, Roshni, Dasgupta, Mohamedraed, Elshami, and Bandyopadhyay S., Peter N., Lakhoo K., Vieira Abib S. d. C. , Abdelhafeez H., Wilson S., Pachl M., Martin B., Nagras S., Sheth M., et al.

Subjects
Adolescent, Retinal Neoplasms, Temel Tıp Bilimleri, Medicine (miscellaneous), Assessment and Diagnosis, global surgery, Sağlık Bilimleri, Temel Bilgi ve Beceriler, Genel Tıp, Fundamental Medical Sciences, Pathophysiology, Clinical Medicine (MED), paediatrics, Cohort Studies, TIP, GENEL & DAHİLİ, Health Sciences, Internal Medicine, EPIDEMIOLOGY, Humans, Klinik Tıp (MED), Aile Sağlığı, Child, MEDICINE, GENERAL & INTERNAL, Developing Countries, Pandemics, Dahiliye, Patofizyoloji, paediatric oncology, public health, Developed Countries, COVID-19, Hodgkin Disease, Klinik Tıp, CHILDHOOD-CANCER, Fundamentals and Skills, General Medicine, CLINICAL MEDICINE, CARE, Değerlendirme ve Teşhis, Tıp, General Health Professions, Medicine, Tıp (çeşitli), Family Practice, Genel Sağlık Meslekleri
Abstract

ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.DesignA multicentre, international, collaborative cohort study.Setting91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.ParticipantsPatients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measureAll-cause mortality at 30 days and 90 days.Results1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (pConclusionsThe COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

Published
2022

14. Genotype and Phenotype of Adenosine Deaminase 2 Deficiency: The Experience From Saudi Arabia

Author

Fahad Alabbas, Talal Alanzi, Abdulrahman Alrasheed, Mohammed Essa, Ghaleb Elyamany, Abdulrahman Asiri, Sajdi Almutairi, Sulaiman Al-Mayouf, Abdullatif Alenazi, Danyah Alsafadi, Walid Ballourah, Naif Albalawi, Ehab Hanafy, Abdulqader Al-Hebshi, Seham Alrashidi, Fatma Albatniji, Huda Alfaraidi, Tahani Bin Ali, Mansour Al Qwaiee, Maryam AlHilali, Hayam Aldeeb, Ali Alhaidey, Hassan Aljasem, Sami Althubaiti, and Abdulrahman Alsultan

Abstract

PurposeDADA2 is a rare and potentially fatal systemic autoinflammatory disease characterized by reduced or absence of ADA2 enzyme activity resulting from mutations in the ADA2 gene. Symptoms of DADA2 are variable and include vasculitis, immune dysregulation, and cytopenia. Scattered Saudi cases of DADA2 have been reported. We describe clinical, molecular, and outcome characterization of Saudi cases focused on phenotypic variability of DADA2.Methods To summarize the clinical features of Saudi patients with DADA2, we conducted a retrospective observational study in the seven major tertiary medical centers. Analysis of clinical characteristics, diagnostic findings, and treatment outcomes was obtained.ResultsWe identified 21 individuals with DADA2 from 14 families. At the time of the study, the patient's age was between 4 and 26 years (median age of 11.3 years). 20 patients presented during childhood. Homozygous c1447-1451del of ADA2 was the most frequently observed mutation in 38%, followed by c882-2A: G in 29%. Absent ADA2 activity was identified in all tested patients with homozygous mutations. Phenotypic manifestations included vasculopathy (stroke or cutaneous lesion) in 48%, cytopenia in 95%, autoinflammatory features such as intermittent fever, transaminases, and hepatosplenomegaly, and or immunodeficiency in 71% of the patients. 4 patients presented with Hodgkin lymphoma and one patient presented with clinical features mimic transverse myelitis, adding to the clinical spectrum of DADA2. Anti-tumor necrosis factor (anti-TNF) is the main treatment. However, regular blood transfusion, splenectomy, cyclosporine, and hematopoietic stem cell transplant (HSCT) were initiated in other patients because of anti-TNF failure. Morality was reported in 3 patients due to fulminant hepatitis and septic multi-organ failure.ConclusionOur cohort expands the variability of molecular and clinical characteristics of DADA2. Hematological phenotype predominates in the patients. Consensus diagnostic criteria are required to facilitate early diagnosis and initiation of prompt therapy. Evaluation of the rare disease complications such as cancer needs large prospective studies or disease registries

Published
2022
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15. Role of recombinant human growth hormone in weaning of prolonged ventilation after major abdominal cancer surgeries; open-label, placebocontrolled, randomized trial.

Author

Shaker, Ehab Hanafy and Kamel, Mahmoud Ahmed

Subjects
*HUMAN growth hormone, *ARTIFICIAL respiration, *ONCOLOGIC surgery, *ABDOMINAL surgery, *VENTILATION, *BLOOD sugar, *VENTILATOR-associated pneumonia
Abstract

Objective: The use of recombinant human growth hormone (rhGH) in difficult to wean patients with prolonged ventilation periods may increase the likelihood of weaning and thus reduce the mechanical ventilation time. This placebo-controlled randomized study aimed to assess the efficacy of rhGH on the weaning of prolonged mechanical ventilation. Study Design: The study was conducted in the National Cancer Institute, Cairo, Egypt, from March 2018 to August 2018. Enrolled patients (60) were randomized to the GH group and the control group, 30 in each group. Before randomization, the same management was offered to both groups. After randomization, in the GH group, patients received 4 IU rhGH IM, twice per day for ten days. In the control group, patients received placebo injections (saline) at the same intervals and conditions with the continuation of the regular ICU management given to both groups. The primary outcome measurement was the proportion of patients weaned in both groups. Results: There was no statistically significant difference (P > 0.05) between the two groups regarding their baseline data in terms of age, BMI, and gender. Ventilation days were significantly lower in the GH group than in the control group; 33.20 ± 16.57 vs. 48.73 ± 10.66 days (P < 0.001). The number of failed-to- wean patients was significantly lower in the GH group than the control group [10 (33.33%) vs. 22 (73.33%); (P = 0.002)]. The odds ratio (OR) was 0.18 (95% CI: 0.06-0.55), the Absolute Risk Reduction (ARR) was 0.4 (95% CI: 0.17-0.63) and the Number Needed to Treat (NNT) was 2.5 (95% CI: 1.58-5.93). In addition, the study showed no significant differences between the GH group and the control group concerning the blood pressure, blood sugar. During the study period, there was no statistically significant difference between groups as regards the incidence of ventilator-associated pneumonia (VAP) or the number of deaths. Conclusion: The use of rhGH in cases difficult-to-wean patient with prolonged ventilation period increases the likelihood of weaning and reduces the mechanical ventilation time [ABSTRACT FROM AUTHOR]

Published
2022
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18. Ultrasound-guided inferior vena cava collapsibility index as a predictor of fluid responsiveness in septic cancer patients.

Author

Gaafar, Mohamed Ahmed, Soliman, Ahmed M., Ahmed, Naglaa Abdallah, Kotb, Tamer Ahmed, and Shaker, Ehab Hanafy

Subjects
*VENA cava inferior, *CANCER patients, *SEPTIC shock, *FLUID therapy, *INTENSIVE care units
Abstract

Background & objective: Intravenous fluid therapy is a critical step in the resuscitation of patients suffering from sepsis and septic shock. Meticulous hemodynamic monitoring is necessary before as well as during the fluid therapy to avoid under-as well as over-loading the patient. An evaluation of fluid status has been suggested to be done noninvasively using the inferior vena cava collapsibility index (IVC-CI). We assessed the effectiveness of IVC-CI in evaluating septic patients' responses to fluid therapy at our institution. Methodology: Forty cancer patients with spontaneous breathing, who met sepsis criteria and were admitted to the intensive care unit, were included in this cross-sectional study. Over the course of three hours, the patients received crystalloids intravenously at a rate of 30 ml/kg, while CVP, ultrasonography guided IVC-CI measurement, and the vital sign monitoring was done every 30 min. Patients were divided into a responder group and a non-responder group based on a 10% change in cardiac output (CO) one hour later. IVC-CI variations in the volume responsiveness prediction served as the main outcome measure. Results: According to the change in CO one hour after starting fluid treatment, 29 patients (72.5%) were classified as fluid responsive and the remaining 11 (27.5%) as fluid non-responsive. In the two groups, HR and IVC-CI decreased significantly; whereas MAP, CVP, and CO increased significantly. ROC-curve analysis showed a percent change ≥ 3.4% of IVC-CI predicted positive responsiveness with a sensitivity of 72.4% and a specificity of 63.6%. These values were 79.3% and 72.7%, respectively, for a change ≥ 6.3% after one hour. The baseline value of IVC-CI was not predictive of responsiveness. Conclusion: In cancer patients with sepsis or septic shock, the change in inferior vena cava collapsibility index during the first hour of fluid therapy can predict fluid responsiveness with a moderate degree of accuracy. [ABSTRACT FROM AUTHOR]

Published
2024
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23. Evaluating the Efficacy and Safety of a Single-Dose Tranexamic Acid in Reducing Blood Loss During Cytoreductive Surgery Followed by Hyperthermic Intraperitoneal Chemotherapy: A Randomized Comparative Pilot Study.

Author

Shaker EH, Soliman AM, Hussein AF, Fayek ES, and Elrawas MM

Abstract

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC), following cytoreductive surgery (CRS), is a lengthy procedure, usually associated with considerable bleeding due to the extensive nature of surgery. Various techniques have been used to decrease blood transfusion requirements., Objectives: This study aimed to evaluate the possible advantage of a single dose of tranexamic acid (TA) in such surgeries., Methods: In this randomized comparative pilot study, 60 patients scheduled to undergo CRS followed by HIPEC were randomly assigned to 2 equal groups: group 1 (TA group) that received 10 mg/kg of TA in 100 mL of 0.9% NaCl over 20 minutes after the induction of anesthesia and before surgical incision, and group 2 (control group) that received a placebo of 100 mL of 0.9% NaCl during the same time interval. The primary endpoint was the blood loss volume. The secondary endpoints were the number of patients requiring transfusion and the occurrence of any postoperative thrombotic events 30 days after surgery. Serum creatinine levels were measured before the operation and on postoperative days 1, 3, and 5. Intraoperative and first 24 hours urine outputs were also recorded. The levels of hemoglobin (Hb) were measured before the operation, immediately after the operation, and 5 days postoperatively., Results: Compared to the control group, the TA group exhibited lower intraoperative blood loss, as well as lower blood loss on postoperative day 1 and in total blood loss (P = 0.006, 0.035, and 0.001, respectively). However, the blood loss on the remaining postoperative days was comparable between both groups. Intraoperative blood transfusion requirements were lower in the TA group (P = 0.032) than in the control group. The total number of units of blood and plasma transfused was also lower in the TA group both intra and postoperatively (0.007, 0.40, and 0.032, 0.008, respectively) than in the control group. Hemoglobin levels, serum creatinine levels, and urine outputs during the first 24 hours postoperatively were comparable between the 2 groups. The thromboembolic events within 30 days were also comparable between the 2 groups., Conclusions: Administering a single dose of TA between the induction of anesthesia and the surgical incision may reduce blood loss and transfusion rates in CRS followed by HIPEC without causing significant adverse effects. It is a promising approach in surgeries where massive blood loss is expected shortly after anesthesia induction. This can minimize the drawbacks of repeated blood transfusions during and after the operation without causing significant adverse effects. Besides reducing the need for repeated blood transfusions, it would also reduce the costs of blood/blood products and the risks of transfusion., Competing Interests: The authors declare no conflict of interests., (Copyright © 2023, Ehab Hanafy et al.)

Published
2023
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