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Background: Polytrauma is a leading cause of death globally and usually involving young victims. Takotsubo cardiomyopathy (TCM) is a serious clinical presentation of myocardial dysfunction characterized by acute, transient, and reversible heart failure syndrome owing to regional wall abnormalities of the ventricular myocardium associated with ECG changes and rising of myocardial biomarkers in the absence of cardiac condition causing the temporary ventricular dysfunction. Objective: To detect the prevalence of stress cardiomyopathy among polytrauma patients attending to Emergency Hospital Mansoura University. Patients and methods: The current study was a cross sectional study conducted on 500 patients who attended to Emergency Department, Emergency Hospital Mansoura University, suffering from polytrauma within the period from August 2019 to August 2020. Results: Prevalence of cardiomyopathy among the studied trauma patients was 4.4%. Mode of trauma (either blunt or penetrating) had no effect in the incidence of cardiomyopathy. Sequential organ failure assessment (SOFA) score and revised trauma score (RTS) demonstrated positive correlation with incidence of cardiomyopathy among polytrauma cases (P

Background: Trauma-related deaths are one of the top 10 causes of death. Resuscitation in trauma and critically ill patients are challenging. Clinical and laboratory parameters are used to verify the different measurements. Lactate is a diagnostic and prognostic biomarker in sepsis and trauma. Objective: The aim of the current work was to investigate lactate clearance in patients admitted to emergency department (ED) and compare with the revised trauma score to predict mortality rate in polytrauma patients. Patients and methods: This prospective case-control study included a total of 200 polytraumatic patients with availability of Blood sampling, admitted to Department of Emergency Medicine, Mansoura University Hospitals. This study was conducted over a period of 12 months. Serum lactate was collected in tubes before receiving any type of treatment. The analysis was performed within 1 h from blood collection and six hours. Results: Regarding association with mortality, Lactate first hour, Lactate after 6 hours and Lactate clearance demonstrated significant correlation with it (P 0.05). Regarding association with incidence of discharge for ICU, type of injury and Revised trauma score were correlated with it (P

Background: Severe traumatic brain injury (TBI) is associated with paroxysmal sympathetic hyperactivity (PSH), which is characterized by catecholamine surge. β-blockers can break this cycle by protecting β-receptor rich brain cells to decrease the cerebral oxygen demand, which may attenuate cerebral ischemia and secondary brain injury. In addition, β-blockers are beneficial to decrease hypermetabolism, lighten cardiac workload and ischemia, and lessen cerebral oxygen demand in head injury. Objective: The purpose of the study was to evaluate the effect of beta blockers (propranolol) on patients with acute TBI. Patients and methods: A total of 400 patients who were presented and admitted to Mansoura University Emergency Hospital (MUEH) surgical ICU with TBI were enrolled in this study. The enrolled patients were divided equally and randomly into 2 groups: Propranolol group (200 patients) who received IV propranolol and control group (200 patients) who received the standard medical and surgical care without propranolol. Results: The clinical outcome of the studied cases were obviously better in propranolol group (P

Background: Acute mesenteric ischemia (AMI) is an emergency condition, which is accompanied by fatal complications. Clinical signs and symptoms are often unspecific. In addition, there is no single laboratory test to diagnose acute mesenteric ischemia. Early and accurate diagnosis of intestinal ischemia is important to provide rapid and correct treatment and reduce morbidity and mortality rates. Objective: To determine the clinical predictors of outcome in patients with acute mesenteric ischemia at Emergency Hospital, Mansoura University. Materials and Methods: This was a prospective study, which was conducted on patients that were admitted to Emergency Hospital, Mansoura University over a year from December 2019 to December 2020. All patients above 18 years old with acute mesenteric ischemia were included while whom less than 18 years old were excluded. Results: this study had 50 patients (21 males and 29 females) with average age of 66 years old. The results showed that majority of the studied cases died, while only 42% (21 cases) of AMI cases survived. Hypercholesterolemia was considered the most frequently reported Co-morbidity followed by HTN, AF and lastly DM and cardiomegaly. There were statistically significant differences as regards co-morbidities (presence of 2 or more co-morbidities). Conclusion: Acute Mesenteric Ischemia is a serious condition with high mortality rate especially in advanced age and in cases associated with comorbidities, presence of 2 or more co-morbidities, hypertension, hypercholesterolemia, past surgical history increase the incidence of death.

Background: Vascular injury resulting from trauma is a leading cause of morbidity and mortality worldwide. Exsanguination is perhaps the most important cause of potentially preventable death after injury. The resulting ischemic tissue damage leads to high rates of amputation in a characteristically young and active population. Objective: To determine the incidence of vascular injuries, modes and mechanisms of trauma and their relations with regional vascular injury distribution and the outcome of vascular injuries in polytrauma patients. Patients and methods: This is a prospective observational analytical (cohort) study that included 520 patients who were presented by multiple causes of trauma to Mansoura University Emergency Hospital, Mansoura, Egypt. A level 1-trauma center with about 250,000 visits and 25000 trauma cases admission per year. This study was conducted over the period of 1 year from January 2019 to December 2019. Results: According to abbreviated injury scale (AIS) ≥3, patients with vascular injuries had considerable more severe injuries than other patients. The most common regions with vascular injuries were peripheral vascular injuries in 95.8% [52.6% in lower limb and 43.2% in upper limb], followed by central vascular injuries in 4.2% [1.6% in neck, 1.6% in thorax and 1 % in abdomen]. Blunt trauma was considerably more common than penetrating trauma in both groups. Moreover, blunt trauma was more common in all regional vascular injuries (66.7% of neck, 75% of lower limb, and 100% of thoracic and abdominal vascular injuries) except upper limb (in 47.8%). Conclusion: The vascular trauma is associated with more injury severity AIS, injury severity score (ISS) and higher mortality rate than other polytrauma patients.

Background: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage secondary to TBI is associated with a high risk of coagulopathy, which leads to increasing risk of hemorrhage growth, poor functional outcome and higher mortality rate. The hemostatic drug tranexamic acid with anti-fibrinolytic activity is usually used in patients with trauma. Because of its potential role in reducing hematoma size, which prevents secondary TBI, it has been considered a possible therapy to improve the clinical outcome in patients with TBI. Objective: To evaluate the effect of tranexamic acid on volume changes of intracranial bleeding in patients with TBI admitted to Emergency Department at Mansoura University Emergency Hospital. Patients and methods: This is prospective interventional study randomized controlled trials carried out on 100 patients with TBI and admitted at Mansoura University Emergency Hospital; a level 1 trauma center with about 250,000 visits and 25000 trauma cases admission per year, through one year from October 2019 to October 2020. Results: The clinical outcome was better in tranexamic group as it was associated significantly with improved motor GCS and less need for neurosurgical intervention. The secondary outcome was much better in tranexamic acid group which was associated with less hospital LOS, better GOS and less mortality rate. Conclusion: Early administration of tranexamic acid (within 3 hours of injury onset) can limit the extent of bleeding before the hemorrhagic volume may become dangerous, while late administration can be useless.

Background SOX18 is an integral transcription factor that is involved in endothelial cells differentiation during both angiogenesis and lymphangiogenesis. Therefore, it has been implicated in tumor progression and metastasis. Objective To study SOX18 expression in nonmelanoma skin cancers (NMSCs) in comparison to seborrheic keratosis (SK) and normal control skin, and to assess its probable role in tumor evolution and progression. Patients and methods This study was conducted on 60 specimens of NMSCs: 30 basal cell carcinomas (BCC) and 30 squamous cell carcinomas (SCC), 30 specimens of SK, and 30 normal skin specimens. All were examined for immunohistochemical expression of SOX18 antibody. Additionally, morphometric assessment of vessel density (blood & lymphatic) in each specimen was estimated. Results Significant SOX18 overexpression was observed in all studied cutaneous tumors in comparison to control skin. The highest score of SOX18 expression was detected in SCC, then BCC, and the least expression was reported in SK with significant difference between them. Furthermore, significant upregulation of SOX18 expression was observed in high-risk types of both BCC and SCC compared to low-risk types. Stromal vessel density showed significant differences between the studied tumors with the highest mean value in SCC, followed by BCC and then SK. Positive correlation between SOX18 expression in the studied tumors and their vessel density was detected. Conclusions SOX18 may have a potential role in the evolution as well as progression of NMSCs, possibly through induction of both angiogenesis and lymphangiogenesis. Furthermore, it could be beneficial for prediction of NMSC patients with poor prognosis.