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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. Novel Adenosine Deaminase 2 (ADA2) Mutations Associated With Hematological Manifestations

Author: Reem Albalawi MSc, Ehab Hanafy MD, Haifa Alnafea PhD, Mohammed Altowijiry MD, Shaima Riyad MD, Fadwa Abufara MD, and Naif Albolowi MD
Subjects: Medicine (General), R5-920, Pathology, RB1-214
Abstract: Recent progress in laboratory techniques, particularly, identification of novel disease-causing genes, has led to the detection of different gene mutations that might be implicated in the pathogenesis of different hematological disorders like pure red cell aplasia (PRCA) and neutropenia. An autoinflammatory disorder known as deficiency of adenosine deaminase 2 (DADA2) has been recently noticed to present with variable hematologic abnormalities. We report 2 patients who presented with hematologic abnormalities in which 2 ADA2 gene mutations were detected. The first case is a 5-year-old girl who presented with severe PRCA and autoimmune hemolytic anemia without any other manifestation of DADA2 that resulted from a novel CECR1 c.714_738dup, p. (Ala247Glnfs*16) homozygous variant. The second case is a 10-year-old boy, known to have Hodgkin lymphoma and was under follow-up for 6 years; he presented with persistent neutropenia and was discovered to be homozygous for ADA2 c.1447_1451del, p. (Ser483Profs*5). In conclusion, we report two different novels ADA2 variants in two children; the first presented with PRCA and the second presented with persistent neutropenia. This report aims to raise the concerns regarding the use of genetic testing in different hematologic diseases with indefinite etiology, as it will lead to the best therapeutic strategies without the need for unnecessary interventions.
Published: 2021
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7. Characteristics and outcomes of patients with sickle cell disease admitted to pediatric intensive care: A retrospective review

Author: Ehab Hanafy, Mustafa Altoonisi, Al Jawharah Alghuraydh, Areej Alatawi, Badriah Alsabah, Sumayah Alzahrani, Ihab Attili, and Gihan Mahmoud
Subjects: acute chest syndrome, pediatric intensive care unit, saudi arabia, sickle cell disease, stroke, tabuk, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: INTRODUCTION: Sickle cell disease (SCD) is autosomal recessive disorder common in the Kingdom of Saudi Arabia (KSA). This is first study in KSA, and middle-east revealing characteristics of pediatric SCD patients admitted to pediatric intensive care unit (PICU). METHODS: Retrospective review of SCD patients admitted to PICU over 6-years-period (2013–2019). Data collected using patient's files and PICU book. Descriptive analysis and percentages presented in tabulated and graphical form. RESULTS: Fifty-eight patients admitted 93 times to PICU, (4.5% of total PICU admission). Most admissions were from station and emergency room (38, 33 admissions respectively). Admissions categorized into emergency and elective (59, 34 admissions respectively). Average length of stay was 1.9 days. Acute chest syndrome (ACS) (n = 28) represented 30% of admissions, followed by cerebrovascular accident (CVA) (18.2%). Five patients (5.37%) admitted for other neurological causes. Twenty-five (26.8%) admitted electively for stroke prevention, 9 (9.6%) admitted postoperatively. Considerable number of exchange transfusion in 65 (69.8%) admissions. Three needed inotropes, five invasive ventilation. Thirteen/58 (22.4%) had previous stroke, 20 (34.4%) had previous ACS, whereas significant number (n = 37, 63.8%) had frequent vaso-occlusive crisis. Mean white blood cell was 18.37 × 103/μl (emergency group), and 10.4 × 103/μl (elective group). Mean hemoglobin 7.8 g/dl and 9.67 g/dl in emergency and elective groups, respectively. Seventy percent of patients prescribed hydroxyurea and 27% of patients were on regular transfusion. Mortality rate of SCD in PICU was low (n = 2, 3.4%). CONCLUSION: PICU is one of the essential components of comprehensive health-care services for patients with SCD. Cooperation between intensivists, hematologists, and other health-care providers in addition to the early referral of critically ill SCD patients to PICU leads to better disease outcomes.
Published: 2020
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8. Posterior reversible encephalopathy syndrome secondary to asymptomatic poststreptococcal glomerulonephritis in a child with sickle cell anemia: a case report

Author: Ehab Hanafy, Duaa Alshareef, Suhaila Osman, Abdullah Al Jabri, Faisal Nazim, and Gihan Mahmoud
Subjects: Sickle cell anemia, Posterior reversible encephalopathy syndrome, Stroke, Hypertension, Glomerulonephritis, Medicine
Abstract: Abstract Background Posterior reversible encephalopathy syndrome is a neurotoxic condition that occurs as a result of the failure of posterior circulatory autoregulation in response to acute changes in blood pressure. Overperfusion with resultant disruption of the blood-brain barrier results in vasogenic edema, but not infarction. Posterior reversible encephalopathy syndrome can be the presenting feature of postinfectious glomerulonephritis, which has been reported in approximately 5% of hospitalized children, and it has been reported in very few cases of adult patients with sickle cell anemia. We report a very rare case of posterior reversible encephalopathy syndrome that occurred in a child with sickle cell anemia. This presentation should be differentiated from other neurologic manifestations that occur in patients with sickle cell anemia, because management is totally different. Case presentation We report what is to our knowledge the first reported case of a 9-year-old Saudi girl with sickle cell anemia who developed posterior reversible encephalopathy syndrome secondary to asymptomatic poststreptococcal glomerulonephritis. This occurred after full recovery from acute chest syndrome and severe vaso-occlusive crisis. Conclusions The purpose of this report is to emphasize that all efforts should be made to explore the causes of different neurologic manifestations that occur in patients with sickle cell anemia, because this will require different pathways of management.
Published: 2018
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9. Iron Overload and Platelet Function Defects

Author: Abdulkader A. Dahi MD, Ehab Hanafy MD, and Mohammed Al Pakra MD
Subjects: Medicine (General), R5-920, Pathology, RB1-214
Abstract: Acquired platelet function defect might be a consequence of iron overload. Even though there are various complications of iron overload, only few reports have indicated some correlations with platelets dysfunction. We report a child with Diamond-Blackfan anemia who has significant complications from iron overload due to chronic blood transfusion, and one of these complications is acquired platelet function defect that manifests with frequent episodes of epistaxis. Therefore, we emphasize the necessity for further studies to confirm direct correlation between iron overload as a causative agent and platelets dysfunction. And we recommend screening for platelets function in patients receiving chronic blood transfusion aiming at possible prevention of any life-threatening bleeding.
Published: 2016
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10. Myelodysplastic Syndrome Presenting as Amegakaryocytic Thrombocytopenia in a Collodion Baby

Author: Mohammed Al Pakra MD, Abdullah Al Jabri MD, and Ehab Hanafy MD
Subjects: Medicine (General), R5-920, Pathology, RB1-214
Abstract: We report a rare case of myelodysplastic syndrome that presented early as amegakaryocytic thrombocytopenia in a collodion baby, which is a rare congenital disorder characterized by thick, taut membrane resembling oiled parchment or collodion, which is subsequently shed. To our knowledge, this is the first reported case of a collodion baby who presented with amegakaryocytic thrombocytopenia and who has a significant family history of the same condition. We document the rarity of this possible association and also the need for further study to establish whether a causal relationship exists.
Published: 2015
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11. 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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12. 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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13. 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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14. 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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15. 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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16. 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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17. Ultrasound Guided Continuous Erector Spinae Plane Block versus Patient Controlled Analgesia in Open Nephrectomy for Renal Malignancies: A Randomized Controlled Study

Author: Abdelgalil, Ahmed Salah, primary, Ahmed, Ahmed Mansour, additional, Gamal, Reham M, additional, Elshal, Mamdouh Mahmoud, additional, Bakeer, Ahmed Hussein, additional, and Shaker, Ehab Hanafy, additional
Published: 2022
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18. Outcomes of multidisciplinary team interventions in the management of sickle cell disease patients with opioid use disorders

Author: Ashraf Sanad, Ehab Hanafy, Osama Mukhtar, Wael Yassin, and Omar Al Zahrani
Subjects: Adult, Male, Emergency Medical Services, medicine.medical_specialty, Time Factors, Cost effectiveness, Narcotic, Cost-Benefit Analysis, medicine.medical_treatment, Psychological intervention, Pain, Anemia, Sickle Cell, 030204 cardiovascular system & hematology, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Patient Education as Topic, length of stay, medicine, Humans, Pain Management, 030212 general & internal medicine, Medical prescription, cost-effectiveness, Aged, Retrospective Studies, Aged, 80 and over, Patient Care Team, business.industry, opioid use disorder, Opioid use disorder, Retrospective cohort study, General Medicine, Middle Aged, Patient Acceptance of Health Care, Opioid-Related Disorders, medicine.disease, Drug Utilization, Analgesics, Opioid, Pain Clinics, Practice Guidelines as Topic, opioid consumption, Cohort, Emergency medicine, Health Resources, Female, Original Article, business
Abstract: Objectives : To identify the magnitude of opioid use disorder (OUD) among sickle cell disease (SCD) patients; emphasize on multidisciplinary team (MDT) role; estimate cost-effectiveness following the proper use of therapeutic guidelines; and facilitate the reduction of emergency room (ER) visits and the length of stay (LOS). Methods : Th is retrospective cohort study included SCD patients aged 14 years and above, who have OUD. Data was collected between January 2016 and December 2018. Data included ER visits, hospital LOS, opioid consumption, and narcotic prescription tracking. The target group was followed with a set of interventions for pain management and healthcare resource utilization. Results : Twenty one SCD patients were identified with OUD. Following the interventions, there was a statistically significant decrease in ER visits of these OUD patients (from 8709 visits in 2016 to only 94 in 2018). Morphine consumption decreased by 82% and meperidine by 60%, over the 3-year period. Moreover, there was a huge reduction in both ER and LOS costs for this cohort of patients. Conclusion : Establishing an MDT and a series of interventions for SCD patients with OUD, including educational activities for caregivers and patients; establishing a palliative/pain clinic and a SCD addiction clinic; and implementing an adequate opioid prescription tracking system resulted in a significant reduction in both the cost and number of ER visits and hospital LOS and dramatically decreased opioid consumption. Saudi Med J 2020; Vol. 41 (10): 1104-1110 doi: 10.15537/smj.2020.10.25386 How to cite this article: Omar Al Zahrani, Ehab Hanafy, Osama Mukhtar, Ashraf Sanad, Wael Yassin. Outcomes of multidisciplinary team interventions in the management of sickle cell disease patients with opioid use disorders. A retrospective cohort study. Saudi Med J 2020; Vol. 41 (10): 1104-1110. doi: 10.15537/smj.2020.10.25386
Published: 2020
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19. 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

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

Author: Abdelgalil,Ahmed Salah, Ahmed,Ahmed Mansour, Gamal,Reham M, Elshal,Mamdouh Mahmoud, Bakeer,Ahmed Hussein, Shaker,Ehab Hanafy, Abdelgalil,Ahmed Salah, Ahmed,Ahmed Mansour, Gamal,Reham M, Elshal,Mamdouh Mahmoud, Bakeer,Ahmed Hussein, and Shaker,Ehab Hanafy
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, nephrecto
Published: 2022

21. 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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22. Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Author: 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, King-David, 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 deAndres Crespo, Somy, Charuvila, Alexandra, Valetopoulou, Amanpreet, Brar, Hira, Zuberi, Imane, Ammouze, Dhruva, Ghosh, Nitin James Peters, 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, Eric 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, Santosh Kumar Mahalik, Rajat, Piplani, Enono, Yhoshu, Manoj, Gupta, Uttam Kumar Nath, Amit, Sehrawat, S Rajkumar, K, Vivek, Singh, Sadi, A Abukhalaf, Ashrarur Rahman Mitul, Sabbir, Karim, Nazmul, Islam, Sara Kader Alsaeiti, Fatma Saleh Benkhial, Mohammed Miftah Faraj Almihashhish, Eman Salem Muftah Burzeiza, Hend Mohammed Masoud, Mabroukah Saeid Alshamikh, Raja Mari Mohammed Nasef, Fatma Mohammed Masoud, William, B Lo, Nyararai, Togarepi, Elaine, Carrolan, Benjamin, J O'Sullivan, Mohamed, Hassanin, Ahmed, Saleh, Mahmoud, Bassiony, Mostafa, Qatora, Mohamed, Bahaaeldin, Shady, Fadel, Yasmine El Chazli, Anfel, Bouderbala, Kamel, Hamizi, Safia, Lorabi, Mehdi Anouar Zekkour, Rima, Rahmoun, Boutheyna, Drid, Salma Naje Abu Teir, Mohamed Yazid Kadir, Yassine, Zerizer, Nacer, Khernane, Brahim, Saada, 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, Vishal, Michael, M Joseph John, William, Bhatti, Bobby, John, Swati, Daniel, Jyoti, Dhiman, Hunar, Mahal, Atul, Suroy, Rosanda, Ilic, Danica, Grujicic, Tijana, Nastasovic, Igor, Lazic, Mihailo, Milicevic, Vladimir, Bascarevic, Radovan, Mijalcic, Vuk, Scepanovic, Aleksandar, Stanimirovic, Aleksandra, Paunovic, Ivan, Bogdanovic, Shruti, Kakkar, Shaina, Kamboj, Suraj, Singh, Shahnoor, Islam, Akm Amirul Morshed, Akm 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, Ahmed, Y Azzam, Mohammed, A Azab, Sherief, Ghozy, Alzhraa Salah Abbas, Monica, Dobs, Mohamed Atef Mohamed Ghamry, Mohammed, Alhendy, Joana, Monteiro, 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 deCarvalho, 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, Sandip Kumar Rahul, Vijayendra, Kumar, Digamber, Chaubey, Maria Teresa Peña Gallardo, Jacqueline Elizabeth Montoya Vásquez, Juan Luis García León, Sebastián Shu Yip, Georgios, Karagiannidis, Rejin, Kebudi, Sema Bay Buyukkapu, Krishna Kumar Govindarajan, Kumaravel, Sambandan, Smita, Kayal, Gunaseelan, Karunanithi, Bikash Kumar Naredi, Bibekanand, Jindal, Mariam, Lami, Matthew Hv 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, Ahmad, Ozair, Ankur, Bajaj, Bal Krishna Ojha, Kaushal Kishor Singh, Atique, Anwar, Vinay, Suresh, Mohamad, K Abou Chaar, Iyad, Sultan, Khalil, Ghandour, Shaima', Al-Dabaibeh, Ammar, Al-Basiti, Hazim, Ababneh, Omaima, El-Qurneh, Yousef, Alalawi, Ahmad Al Ayed, Ehab, Hanafy, Naif Al Bolowi, 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, Iqra, Effendi, Taimur Iftikhar Qureshi, Pooja, Kumari, Mohamed, Bonna, Khaled, Mamdouh, Mohamed, Atef, Mohamed, Faried, Victor, Calvagna, Nathalie, Galea, Ariana, Axiaq, Matthew, R Schuelke, Jake, A Kloeber, Robert, L Owen, Alexander, S Roth, Catherine, Yang, J Hudson Barnett, Lucien, P Jay, Kirk David Wyatt, Paul, J Galardy, Bernard, Mbwele, Irene, Nguma, Moshi Moshi Shabani, Amani, Twaha, Bilal, Matola, Agnes, Vojcek, Mahmoud Maher Abdelnaby Alrahawy, Seham, M Ragab, Abdallah, R Allam, Eman Ibrahim Hager, Abdelrahman, Azzam, Ammar, Ayman, Kıvılcım Karadeniz Cerit, Adnan, Dağçınar, Tümay, Umuroğlu, Ayten, Saraçoğlu, Mustafa, Sakar, Can, Kıvrak, Gül, Çakmak, Ibrahim, Sallam, Gamal, Amira, Mohamed, Sherief, Ahmed, Sherif, Simone deOliveira Coelho, Arissa, Ikeda, Licia, Portela, Marianne Monteiro Garrigo, Ricardo Vianna deCarvalho, Fernanda, Lobo, Sima Ester Ferman, FernandaFerreira daSilva Lima, Moawia Mohammed AliElhassan, Nada Osman Yousif Elhaj, Hytham Ks Hamid, Emmanuel, A Ameh, Vincent, E Nwatah, Adewumi, B Oyesakin, Andrew Nwankwo Osuigwe, Okechukwu Hyginus Ekwunife, Chisom Adaobi Nri-Ezedi, Eric Okechukwu Umeh, Nellie, Bell, 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, Simone deCamposVieira 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, Manjul, Tripathi, Sandeep, Mohindra, Vishal, Kumar, Ninad, R Patil, Richa, Jain, Renu, Madan, Madhivanan, Karthigeyan, Pravin, Salunke, Gopal, Nambi, Abdulrahman Omar Taha, Janice Hui Ling Wong, Norehan, Johari, Anas, Shikha, Win SabaiPhyu Han, Zahidah, Ahmad, Yen Yan Lim, Roserahayu, Idros, Noorainun Mohd Yusof, David Nelson Jaisingh, Aouabed, Nesrine, Bouaoud, Souad, Mebarki, Malika, Bioud, Belkacem, Fayza, Haider, Fatema Naser AlFayez, Fakher, Rahim, Elana, Kleinman, Taylor, Ibelli, Emily, Hamilton, Rochelle, Fayngor, Tzvi, Najman, Gideon, Karplus, Etai, Adam, Daniella, Melamed, Cecilia, Paasche, Amir, Labib, 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, 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, Reto, M Baertschiger, Andreea, C Matei, Augusto, Zani, Lubna, Samad, Hira Khalid Zuberi, Kishwer, Nadeem, Naema, Khayyam, Fatima Ambreen Imran, Nida, Zia, Sadia, Muhammad, Muhammad Rafie Raza, Muhammad Rahil Khan, Alaa, Hamdan, Ammar, Omran, Ahmed, Moussa, Bardisan, Gawrieh, Hassan, Salloum, Alaa, Ahmed, Abdeljawad, Mazloum, Ali, Abodest, Nisreen, Ali, Munawar, Hraib, Victor, Khoury, Abdulrahman, Almjersah, Mohammad Ali Deeb, Mohammad Ahmad Almahmod Alkhalil, Akram, Ahmed, Waseem, Shater, Ali Farid Alelayan, Alaa, Guzlan, Ahmad, Bouhuwaish, Alqasim, Abdulkarim, Eman, Abdulwahed, Marwa, Biala, Reem, Ghamgh, Amani, Alamre, Marwa, Shelft, Asmaa Am Albanna, Hoda, Tawel, Emmanuel, Hatzipantelis, Athanasios, Tragiannidis, Eleni, Tsotridou, Assimina, Galli-Tsinopoulou, Dayang AnitaAbdul Aziz, Zarina Abdul Latiff, Hamidah, Alias, C-Khai, Loh, Doris, Lau, Azrina Syarizad Khutubul Zaman, 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, 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, Reto, Baertschiger, Essam, Elhalaby, Muath, Alser, Mahmoud, M Saad, Luca, Pio, Guido, Seitz, Judith, Lindbert, Francis, Abantanga, Georgios, Tsoulfas, Asimina, Galli-Tsinopoulou, Nitin James Peter, Vrisha, Madhuri, Ravi, Kishore, Maryam Ghavami Adel, Virgone, Calogero, Francesco, Pata, Gaetano, Gallo, Mohammad, K Abou Chaar, Dayang Anita Abdul Aziz, Outani, Oumaima, Zineb, Bentounsi, Adesoji, Ademuyiwa, Dhruva Nath Ghosh, Lily, Saldana, Jan, Godzinsky, Abdelbasit, Ali, Dragana, Janic, Mohamed Bella Jalloh, Annette, Jacobsen, Chan Hon Chui, Israel Fernandez Pineda, Lucas, Krauel, Maricarmen, Olivos, Waha, Rahama, Hazim, Elfatih, Raphael, N Vuille-Dit-Bille, Arda, Isik, Asim Noor Rana, Kate, Cross, Andrea, Hayes-Jordan, Roshni, Dasgupta, Mohamedraed, Elshami, Collaborative, Global Health Research Group on Children’s Non-Communicable Diseases, and Bandyopadhyay S., Peter N., Lakhoo K., Abib S. d. C. V. , Abdelhafeez H., Wilson S., Pachl M., Martin B., Nagras S., Sheth M., et al.
Subjects: Social Sciences and Humanities, Health (social science), Social Sciences (SOC), Sosyal Bilimler ve Beşeri Bilimler, Epidemiology, IMPACT, SOCIAL SCIENCES, GENERAL, LOW-INCOME, Sağlık Bilimleri, paediatrics, REGISTRIES, Sociology, Occupational Therapy, Neoplasms, Epidemiyoloji, Health Sciences, ADOLESCENTS, Genel Sosyal Bilimler, Humans, cancer, Sosyal ve Beşeri Bilimler, Social Sciences & Humanities, Prospective Studies, Child, Sosyoloji, Pandemics, Halk, Çevre ve İş Sağlığı, Güvenlik Araştırması, RISK, PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH, PEDIATRIC CANCER, COVID-19, health systems, CHILDHOOD-CANCER, SARS-CoV-2, MORTALITY, Health Policy, Public Health, Environmental and Occupational Health, General Social Sciences, Sosyal Bilimler Genel, CARE, KAMU, ÇEVRE VE İŞ SAĞLIĞI, İş Sağlığı ve Terapisi, SURVIVAL, Sosyal Bilimler (SOC), Safety Research, Sağlık (sosyal bilimler)
Abstract: IntroductionChildhood 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.MethodsProspective cohort study in 109 institutions in 41 countries. Inclusion criteria: children ResultsAll-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3–11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); pConclusionsChildren with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.
Published: 2022

23. Characteristics and outcomes of patients with sickle cell disease admitted to pediatric intensive care: A retrospective review

Author: Areej Mohammed Alatawi, Ehab Hanafy, Sumayah Alzahrani, Badriah Abdulrahman Al-Sabah, Mustafa M Altoonisi, Gihan Mahmoud, Ihab Riad Attili, and Al Jawharah Alghuraydh
Subjects: Pediatric intensive care unit, Retrospective review, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, business.industry, Mortality rate, medicine.medical_treatment, Exchange transfusion, acute chest syndrome, Hematology, Disease, medicine.disease, stroke, Acute chest syndrome, lcsh:RC666-701, Intensive care, Emergency medicine, medicine, saudi arabia, sickle cell disease, business, tabuk, Stroke, pediatric intensive care unit
Abstract: INTRODUCTION: Sickle cell disease (SCD) is autosomal recessive disorder common in the Kingdom of Saudi Arabia (KSA). This is first study in KSA, and middle-east revealing characteristics of pediatric SCD patients admitted to pediatric intensive care unit (PICU). METHODS: Retrospective review of SCD patients admitted to PICU over 6-years-period (2013–2019). Data collected using patient's files and PICU book. Descriptive analysis and percentages presented in tabulated and graphical form. RESULTS: Fifty-eight patients admitted 93 times to PICU, (4.5% of total PICU admission). Most admissions were from station and emergency room (38, 33 admissions respectively). Admissions categorized into emergency and elective (59, 34 admissions respectively). Average length of stay was 1.9 days. Acute chest syndrome (ACS) (n = 28) represented 30% of admissions, followed by cerebrovascular accident (CVA) (18.2%). Five patients (5.37%) admitted for other neurological causes. Twenty-five (26.8%) admitted electively for stroke prevention, 9 (9.6%) admitted postoperatively. Considerable number of exchange transfusion in 65 (69.8%) admissions. Three needed inotropes, five invasive ventilation. Thirteen/58 (22.4%) had previous stroke, 20 (34.4%) had previous ACS, whereas significant number (n = 37, 63.8%) had frequent vaso-occlusive crisis. Mean white blood cell was 18.37 × 103/μl (emergency group), and 10.4 × 103/μl (elective group). Mean hemoglobin 7.8 g/dl and 9.67 g/dl in emergency and elective groups, respectively. Seventy percent of patients prescribed hydroxyurea and 27% of patients were on regular transfusion. Mortality rate of SCD in PICU was low (n = 2, 3.4%). CONCLUSION: PICU is one of the essential components of comprehensive health-care services for patients with SCD. Cooperation between intensivists, hematologists, and other health-care providers in addition to the early referral of critically ill SCD patients to PICU leads to better disease outcomes.
Published: 2020

24. Tumor Histopathological Response to Neoadjuvant Chemotherapy in Childhood Solid Malignancies: Is it Still Impressive?

Author: Faisal Nazim, Gelan Gadelkarim, Mohammed Al Pakrah, Abdulaziz Dasaq, Abdullah Al Jabri, and Ehab Hanafy
Subjects: 0301 basic medicine, Oncology, medicine.medical_specialty, Prognostic variable, Modern medicine, Histopathological response, Adjuvant chemotherapy, medicine.medical_treatment, histopathologic response, Kaplan-Meier Estimate, tumor necrosis, Disease-Free Survival, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Internal medicine, medicine, Humans, Child, Neoadjuvant therapy, Chemotherapy, business.industry, General Medicine, Hematology/Oncology, Neoadjuvant Therapy, Surgery, Regimen, 030104 developmental biology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Histopathology, pediatric solid tumors, business, neoadjuvant chemotherapy
Abstract: The management of oncological malignancies has significantly improved over the last decades. In modern medicine, new concepts and trends have emerged paving the way for the era of personalized and evidence-based strategies adapted to the patients’ prognostic variables and requirements. Several challenges do exist that are encountered during the management, including the difficulty to assess chemotherapy response with certainty. Having known that neoadjuvant chemotherapy might be the only solution for a proportion of patients with tumors that are unresectable at diagnosis, emergence of strategies that use risk group-directed therapy became an integral part in the management of oncological malignancies. Tumor histopathological change post neoadjuvant chemotherapy is one of the most important predictors of management outcome and is being used in many chemotherapy protocols as an essential determinant of the most suitable postoperative chemotherapy regimen. Bone tumors are the classic models of this approach; however, other childhood solid tumors show significant variations in outcome as a result of tumor histopathological response to neoadjuvant chemotherapy. The aim of this review is therefore to summarize the significance of histopathological responses seen after neoadjuvant chemotherapy in childhood solid tumors. Moreover, it suggests that the effect on tumor histopathology through modifying neoadjuvant chemotherapy and, on the other hand, toxicities from intensifying adjuvant chemotherapy might either necessitate the change of a number of arm groups in different protocol regimens or include newer chemotherapeutic agents adjuvantly for better outcome and lesser toxicities in poor tumor histopathological responders.
Published: 2018
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25. 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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26. Acute soft head syndrome and a mini review of bone and neurologic complications in patients with sickle cell disease

Author: AbdulKareem Alenazi, Ehab Hanafy, Nadia Abdullah, Saad Al Amri, Amal Al Balawi, Gihan Mahmoud, and Nazim Faisal
Subjects: medicine.medical_specialty, Severe headache, business.industry, Osteomyelitis, Infarction, Disease, medicine.disease, Surgery, Mini review, Skull, medicine.anatomical_structure, medicine, In patient, business, Complication
Abstract: Introduction: Acute soft head syndrome is a rare complication in patients with sickle cell disease (SCD) that is characterized by progressive skull pain and swelling, it is usually related to skull bone infarction and full recovery is achieved with conservative management. This case represents a very rare association of sickle cell disease and acute soft head syndrome that necessitates to be differentiated from other bone and neurologic presentations occurring in this entity of patients. Case: We report a rare case of an 11 years old Saudi male patient with sickle cell disease who developed acute soft head syndrome that presented with severe headache. An underlying osteomyelitis of skull and lower limb bones couldn’t be excluded and the patient had full recovery after conservative treatment. Conclusion: Acute soft bone syndrome seldomly occurs in SCD, however, its presentations mimics those of bone and neurologic complications so differentiation is essential in order to set up a clear plan of management.
Published: 2019
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27. Unusual presentation and special sites involvement in langerhans cell histiocytosis

Author: Yousef Al Atawi, Fabiana Morosini, Ehab Hanafy, Nazim Faisal, Ziyad Albalawi, and Faisal Abuammah
Subjects: Pathology, medicine.medical_specialty, Histiocytosis, Langerhans cell histiocytosis, business.industry, Glanzmann thrombasthenia, medicine, Plasmacytoma, Presentation (obstetrics), medicine.disease, business
Published: 2018
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28. A case of Evans syndrome associated with autoimmune thyroiditis

Author: Mashael Alanazi, Ebtesam Alanazi, Gihan Mahmoud, Nazim Faisal, Khaled Alanazi, and Ehab Hanafy
Subjects: Asplenia, medicine.medical_specialty, Evans syndrome, business.industry, Wiskott–Aldrich syndrome, medicine.disease, Dermatology, Thyroiditis, Hereditary spherocytosis, Autoimmune thyroiditis, Myeloproliferative Disorders, Medicine, business, Myelofibrosis
Published: 2018
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29. Effectiveness of multimodal preemptive analgesia in major pediatric abdominal cancer surgery

Author: Ghobrial, Hossam Zarif, primary and Shaker, Ehab Hanafy, primary
Published: 2019
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30. Mechanical Design and Control with Human Factors in Ship Design: Improving Ship Environmental Impact Towards a Green Policy

Author: Duan Feng Han, Ehab Hanafy, Hany Abdelkhalek, and Liang Tian Gao
Subjects: Engineering, Process (engineering), business.industry, Control (management), General Engineering, Naval architecture, Variable (computer science), Risk analysis (engineering), Order (exchange), Forensic engineering, Mechanical design, Environmental impact assessment, business, Engineering design process
Abstract: Decades of engineering practice have undoubtedly proven that the human operator is a complex variable that warrants significant consideration during the first stages of design and throughout the entire operational lifetime of a system. However, human factors are frequently neglected during the design process and during the systems operation. When human factors are not adequately addressed, people make errors and safety is severely compromised, the consequences of which are well documented. However, the process of integrating human factors into the design process is still maturing. Fortunately, there are ways for the designer to effectively screen and select which human factors elements should receive consideration for a particular project. Human stressors one of Elements should be included, specially factors that cause fatigue and human error.Noise and vibration are important reasons which cause human fatigue and has a significant impact on human performance. The international regulations, ship owners and many countries give a serious concern to this issue specially when designing a new ship to gain the "Green policy" or "Green ship" label by reducing and enhancement ship environmental impact, they adopted technological methods and solutions to achieve that goal. In this paper we will present a review for those methodologies and design procedures for new vessels to enhance this issue as a green policy, which reflect many benefits on human stressors, in order to activate and enrich the role of human factors in ship design.
Published: 2014
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31. Sacrococcygeal Atypical Teratoid/ Rhabdoid Tumor in an Infant

Author: Ehab Hanafy and Mohammed Al Pakra
Subjects: Pathology, medicine.medical_specialty, business.industry, Gynecologic oncology, Sacrum, medicine.disease, Metastasis, medicine.anatomical_structure, Prostate, Surgical oncology, Epidemiology of cancer, Atypical teratoid rhabdoid tumor, Medicine, business, Lung cancer
Abstract: We present a case of Atypical Teratoid/ Rhabdoid Tumor (AT/RT) arising from the sacrum in an 8 months old infant, who was given chemotherapy and had total surgical excision of the tumor. It is well-known that tumors arising from the sacrococcygeal area are very rare and most of them are metastasis derived from lung, breast, kidney, prostate, head and neck, gastrointestinal or skin cancers, and to our knowledge this is the first documented case of AT/RT arising from the sacrococcygeal area in an Infant.
Published: 2015
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32. Glioblastoma multiforme occurring in a child with acute lymphoblastic leukemia

Author: Mohammed Al Pakra, Abdullah Al Jabri, Hussam Yousef El Hag, Gihan Mahmoud, and Ehab Hanafy
Subjects: Oncology, medicine.medical_specialty, business.industry, medicine.medical_treatment, Lymphoblastic Leukemia, Central nervous system, medicine.disease, Radiation therapy, 03 medical and health sciences, Leukemia, 0302 clinical medicine, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Internal medicine, medicine, business, 030217 neurology & neurosurgery, Glioblastoma
Abstract: Introduction: radiation therapy is an established cause of secondary neoplasia in the central nervous system. Few reports of glioblastoma multiforme following radiation therapy have been documented. case report: We herein
Published: 2016
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33. Low Dose Versus High Dose Methylene Blue in Septic Patients

Author: Ehab Hanafy Shaker, Associate Professor of Anesthesia, ICU and Pain management
Published: 2024

34. Dexmedetomedine and Ketamine in Erector Spinae Block for Postoperative Analgesia Following Mastectomy.

Author: Ehab Hanafy Shaker, Associate Professor of Anesthesia, ICU and Pain management
Published: 2023

35. 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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36. Evaluating the Sensory Index for Success of Trigeminal RF

Author: Ehab Hanafy Shaker, Associate Professor of Anesthesia, ICU and Pain management
Published: 2023

37. Erector Spinae Plane Block for Post-thoracotomy Pain Control

Author: Ehab Hanafy Shaker, Assistant professor of Anesthesia, intensive care and pain releif
Published: 2022

38. Erector Spinae Plane Block for Post-nephrectomy Pain

Author: Ehab Hanafy Shaker, Assistant professor of Anesthesia, intensive care and pain releif
Published: 2022

39. Intraperitoneal Tramadol Versus Dexmedetomedine for Analgesia After Abdominal Laparoscopic Cancer Surgeries

Author: Ehab Hanafy Shaker, Assistant professor of Anesthesia, intensive care and pain releif
Published: 2022

40. the Value of Sensory Index in Trigeminal Neuralgia

Author: Ehab Hanafy Shaker, Associate Professor of Anesthesia, intensive care and Pain releif
Published: 2021

41. the Effect of Dexmedetomidine and Magnesium Sulfate in Open Resection of Pheochromocytoma

Author: Ehab Hanafy Shaker, lecturer of anesthesia ,critical care and pain medicine
Published: 2021

42. Effects of Growth Hormone on Difficult Ventilator Weaning Patients

Author: Ehab Hanafy Shaker, Principal investigator
Published: 2019

43. Crystalloids Versus Colloids Versus Hypertonic Saline as a Co-load During Spinal Anesthesia.

Author: Ehab Hanafy Shaker, lecturer of anesthesia ,critical care and pain medicine
Published: 2018

44. Lung Ultrasound in Detection of Extravascular Lung Water in Septic Patients.

Author: Ehab Hanafy Shaker, lecturer of anesthesia ,critical care and pain medicine
Published: 2018

45. Ultrasound-guided Serratus Block and the Emergence of Post-thoracotomy Pain Syndrome

Author: Ehab Hanafy Shaker, Principal investigator
Published: 2018

46. Multimodal Analgesia in Major Abdominal Pediatric Cancer Surgeries

Author: Ehab Hanafy Shaker, Clinical professor of Anesthesia ,Critical care and Pain medicine
Published: 2018

47. Levosimendan for Cardiac Patients Undergoing Major Abdominal Cancer Surgeries

Author: Ehab Hanafy Shaker, Principal investigator
Published: 2018

48. Combined Fluoroscopy and CT Guided Radiofrequency Ablation of Thoracic Dorsal Root Ganglia in Severe Thoracic Pain

Author: Ehab Hanafy Shaker, lecturer of anesthesia ,critical care and pain medicine
Published: 2018

49. 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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