Aims The aim of the Familial Hypercholesterolemia Research Collaboration (FHRC) is to collect dat... more Aims The aim of the Familial Hypercholesterolemia Research Collaboration (FHRC) is to collect date about the clinical, laboratory phenotypes, and treatment strategies of patients with FH all over the world. We present the Egyptian data of this international registry. Methods and Results An online electronic case report form (e-CRF) was prepared to collect data matching the protocol of the FHSC of the European Atherosclerosis Soci- ety (EAS). From August 2017 to March 2021, a total of 228 cases with FH (46% males, mean age 48 ± 14 years) were enrolled. About 71% of whom came from urban areas. The mean Body Mass Index (BMI) was 30 ± 4.9 kg/m2. The most commonly reported concomitant risk factor was hypertension (39%), followed by smoking (22%), and then DM (18%). Median time from diagnosis to enrolment was 7 (range 0.5-20) years. The vast majority (99.1%) were diagnosed based on the Dutch Lipid Clinic criteria, with 14%, 11% and 75% in the definite, probable, and possible categories re...
Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaborat... more Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53•6%] women) from 56 countries were included in the study. Of these, 31 798 (75•4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84•2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46•2 years (IQR 34•3-58•0); median age at diagnosis of familial hypercholesterolaemia was 44•4 years (32•5-56•5), with 40•2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17•4% (2•1% for stroke and 5•2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81•1%) were receiving statins and 3691 (21•2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5•43 mmol/L (IQR 4•32-6•72) among patients not taking lipid-lowering medications and 4•23 mmol/L (3•20-5•66) among those taking them. Among patients taking lipid-lowering medications, 2•7% had LDL cholesterol lower than 1•8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1•8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0•001). Interpretation Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia.
Background 80% of individuals with cancer will require a surgical procedure, yet little comparati... more Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494.
Clinical research in Africa And Middle East: roadmap for reform and harmonisation of the regulato... more Clinical research in Africa And Middle East: roadmap for reform and harmonisation of the regulatory framework and...
International journal of clinical oncology, Jan 28, 2018
Thyroid carcinoma is a very rare tumor in the pediatric age group, accounting for only 1.5-3% of ... more Thyroid carcinoma is a very rare tumor in the pediatric age group, accounting for only 1.5-3% of childhood carcinomas in the United States and Europe. We aimed to identify the risk of a second malignancy among pediatric thyroid cancer survivors. The cohort analysis consisted of pediatric cancer patients aged less than 20 years, diagnosed with a primary thyroid cancer, identified by site code ICD-0-3: C739, and reported to the SEER 9 database between 1973 and 2013. They were followed up until December 31, 2013; the end of the study period, or up to death if earlier. Out of 1769 patients diagnosed primarily with thyroid carcinoma, 42 patients had a total of 45 incidences of subsequent malignancies. The mean age of patients at the initial diagnosis of thyroid cancer was 16 years. Females (90.5%) had a significantly higher incidence of second malignancies (SM) than males (9.5%). The overall Standardized Incidence Ratio (SIR) of SM in the study patients was higher than expected (SIR = 1....
Background: Early restoration of patency of infarct related artery is a universally accepted goal... more Background: Early restoration of patency of infarct related artery is a universally accepted goal in the treatment of acute myocardial infarction. These could be achieved by Primary PCI or fibrinolysis. Primary PCI is preferred reperfusion strategy over fibrinolysis. Identifying initial area at risk in patients with acute myocardial infarction had been shown to have a direct impact on patients adverse clinical outcomes as well as prediction of systolic dysfunction. Area flow index (AFI) calculation in patients with acute myocardial infarction may predict initial area at risk during primary PCI. Aim: To investigate the clinical utility of Area flow index to predict systolic dysfunction and adverse clinical outcomes in patients with acute anterior ST elevation myocardial infarction Patients: 250 consecutive patients with acute anterior ST elevation myocardial infarction treated with primary PCI presenting to Alexandria main university hospital and ICC hospital from June 2013 till December 2014. Methods: Echocardiographic assessment of LV systolic function 5-7 days after myocardial infarction by calculation of ejection fraction using modified simpson method. Area flow index was calculated by dividing culprit segment cross sectional area to total coronary cross sectional area. Where DC is the culprit segment diameter, D1 left anterior descending diameter, D2 left circumflex diameter, D3 right coronary diameter. All patients were followed one month for the occurrence of MACE. Results: Patients were grouped according to their ejection fraction following myocardial infarction into 3 groups:-Group I: severe LV systolic dysfunction EF <30%.-Group II: moderate LV systolic dysfunction EF 30-45%.-Group III: mild LV systolic dysfunction EF>45% There was a significant negative correlation between AFI and LVEF (r=-0. 58, P<0. 001). The mean AFI for patients in group I was 33. 1 ± 7.4, patients in group II was 26. 6 ± 7.4, and those in group III was 20.0 ± 6. 1. AFI>28.4% had a 75.6% sensitivity and 78.1% specificity in predicting severe LV systolic dysfunction. Also the composite one month MACE was higher in the group with AFI>28.4% (p<0. 001). Conclusion: Area flow index calculated from coronary angiography at time of primary PCI is a new strong independent predictor of LV systolic dysfunction and 1month MACE in patients with acute anterior myocardial infarction.
Primary percutaneous coronary intervention (P-PCI) has become the preferred reperfusion strategy ... more Primary percutaneous coronary intervention (P-PCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) when performed by an experienced team in a timely manner. However, no consensus exists regarding the management of multivessel coronary disease detected at the time of P-PCI. Aim The aim of this study was to evaluate the use of the residual SYNTAX score (rSS) following a complete vs. culprit-only revascularization strategy in patients with STEMI and multivessel disease (MVD) to quantify the extent and complexity of residual coronary stenoses and their impact on adverse ischemic outcomes. Methods Between October 1, 2012, and November 30, 2013, we enrolled 120 consecutive STEMI patients with angiographic patterns of multivessel coronary artery disease (CAD) who had a clinical indication to undergo PCI. The patients were subdivided into those who underwent culprit-only PCI (60 patients) and those who underwent staged-multivessel PCI during the i...
BACKGROUND The potential benefit of long-term dual antiplatelet therapy (DAPT) for secondary prev... more BACKGROUND The potential benefit of long-term dual antiplatelet therapy (DAPT) for secondary prevention of atherothrombotic events in patients with coronary artery disease (CAD) is unclear. Data from different randomized controlled trials (RCT) using different agents in different subgroups showed inconsistent results. OBJECTIVE The goal of this study was to evaluate the efficacy and safety of long term DAPT for secondary prevention.
Aims Our aim is to describe the clinical characteristics and management of patients hospitalized ... more Aims Our aim is to describe the clinical characteristics and management of patients hospitalized with acute heart failure (HHF) and ambulatory patients with chronic heart failure (CHF) in Egypt and compare them with heart failure (HF) patients from other countries in the European Society of Cardiology-Heart Failure (ESC-HF) registry. Methods and results The ESC-HF Long-term Registry is a prospective, multi-centre, observational study of patients presenting to cardiology centres in member countries of the ESC. From April 2011 to February 2014, a total of 2145 patients with HF were recruited from 20 centres all over Egypt. Of these patients, 1475 (68.8%) were hospitalized with HHF, while 670 (31.2%) had CHF. Less than one-third (32.1%) of all patients were females. HHF patients {median age of 61 years [interquartile range (IQR), 53-69]} were older than CHF patients [median age of 57 years (IQR,46-64)]; P < 0.0001. They had more diabetes mellitus (45.4% vs. 31.8%; P < 0.0001). Left ventricular ejection fraction > 45% was present in 22% of HHF vs. 25.6% of CHF (P = 0.17). Atrial fibrillation existed in about a quarter of all patients (24.5%). Ischaemic heart disease was the main cause of HF in Egyptian patients. All-cause in-hospital mortality was 5%. Egyptian patients presented at a much earlier age than in other regions in the registry. They had more diabetes mellitus. Atrial fibrillation prevalence was remarkably lower. Other co-morbidities (renal dysfunction, stroke, and peripheral arterial disease) occurred less frequently. Conclusion Patients in the Egyptian cohort exhibited distinct features from HF patients in other countries in the ESC-HF Long-term Registry.
25.2-30.2). Predictors of patient satisfaction in the PD group were absence of pain during closur... more 25.2-30.2). Predictors of patient satisfaction in the PD group were absence of pain during closure, decreased TTA, and drastic reductions in TTD; the latter contributed indirectly to significant cost-savings in the PD group (1,282.3 AE118.3 vs. 2,271.4 AE121.1 dollars, respectively; P<0.001) and incremental cost savings by strategy also favored closure over MC ($89,124.5). CONCLUSIONS ProGlide is safe and effective for femoral artery closure in patients who ambulate within 30 min after cardiac catheterization; all of which translated into improved patient satisfaction and substantial cost savings.
The purpose of this study was to compare the impact of incomplete revascularization (IR) plus opt... more The purpose of this study was to compare the impact of incomplete revascularization (IR) plus optimal medical therapy (OMT) to OMT alone on 1 year clinical outcomes in patients with multivessel coronary artery disease (MVD) who were not eligible for coronary bypass graft surgery (CABG). Methods: This is a prospective randomized study conducted on 50 selected patients with chronic stable angina with documented MVD and CABG was refused by the surgeon due to poor distal vessel quality. Patients were randomized 1:1 into two groups, group (I): 25 patients were subjected to OMT alone and group (II): 25 patients were subjected to IR plus OMT. All patients were subjected to 1 year follow up. Results: The baseline patients' details were matched. At 1 year; death occurred slightly more in group II (16% versus 12%; p = 1.000), ACS occurred more in the group I (32% versus 16%; p = 0.321) while freedom from angina occurred more in group II (20% versus 4%; p = 0.189). The OMT alone did not affect neither the level of angina class nor EF; while the IR plus OMT markedly improved the decline in the level of angina class (p = 0.011), but it did not improve EF significantly (p = 0.326). Conclusion: In patients with MVD who were not eligible for CABG; IR plus OMT was not superior to OMT alone in improving the 1 year clinical outcomes except the improvement in the level of angina class, which could be the adopted strategy to improve the quality of life in such patients.
To determine the outcomes of percutaneous coronary intervention (PCI) in patients presenting with... more To determine the outcomes of percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI) according to PCI guidelines. Methods: This study was conducted between January 2008 and December 2010. A total of 450 patients presenting with STEMI underwent PCI: 288 patients underwent primary PCI, and 162 patients underwent non-primary PCI. Results: The mean age at presentation was 55 ± 11.10 years and 89.8% were male. The door-toballoon time was 60 min in primary PCI group (288 patients). The median time between end of failed thrombolytic therapy and the rescue PCI was 420 min (95 patients) versus 810 min after successful thrombolytic therapy (35 patients). Only 32 patients underwent late PCI P 24 h and 648 h without thrombolytic therapy; median time was 2160 min. In-hospital, 30 days and 6-months mortality were respectively 2.1%, 0.7% and 1.1% in primary PCI group while 2.5%, 3.2% and 2.6% in non-primary PCI group. In-hospital, 30 days and 6-months reinfarction occurred in 0.3%, 1.1% and 0.7% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively. In-hospital, 30 days and 6-months TVR occurred in 0.7%, 0.7% and 1.1% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively. Conclusions: This is the first report from Egyptian hospital to provide a comprehensive review of patient characteristics and outcomes of PCI for STEMI. We reported a high initial success rate, excellent short and intermediate-term outcomes.
Aims: Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients... more Aims: Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, a 2007 study reported that only 40-45% of European STEMI patients were treated with PPCI, with large variations in treatment availability between countries. In 2008, the Stent for Life (SFL) initiative was launched by the European Association of Percutaneous Cardiovascular Interventions and EuroPCR in partnership with the European Society of Cardiology (ESC) Working Group on Acute Cardiac Care and country-specific national cardiac societies. The aim is to promote the prioritisation of percutaneous coronary intervention treatment towards those who will benefit most, namely STEMI patients. The following countries are currently participating: Bulgaria,
Myocardial infarction is a medical emergency in which 25 to 35% of patients will die before recei... more Myocardial infarction is a medical emergency in which 25 to 35% of patients will die before receiving medical attention. The Stent for Life registry was launched to access the current situation of the Egyptian population presenting with STEMI, and to determine what were the barriers to providing patients with cardiac problems appropriate care. This registry was conducted at 14 centres covered all the Egyptian regions including 1,324 consecutive patients presenting with STEMI during the period between January 1st, 2011 to November, 2011. Fourteen centres and 38 interventionalists participated in this registry; only six centres are Pilot Centres (fulfilling the criteria for a primary PCI centre) and were assigned at the end of 2011. Cardiovascular risk factors were mainly smoking (60.5%), dyslipidaemia (46.0%), diabetes (51.4%) and hypertension (56.0%). The mean age at presentation was 56.01±10.61years and 75.0% were male. Only 5% of the STEMI patients arrived via the emergency medical system. Thrombus aspiration was done in 42.7% of patients in primary PCI group and 25.9% in rescue PCI group. Bare metal stents (BMS) were used in 80.7% of the stented patients while drug eluting stents (DES) were used in 19.3% of the stented patients. In-hospital mortality was 2.9% (1.4% in primary PCI group, 1.1% in patients treated with thrombolysis and 0.4% in patients receiving no reperfusion therapy). Despite the logistical difficulties, excellent outcomes for acute interventional reperfusion strategy in STEMI can be achieved in our country, possibly similar to those seen in the West. There is a strong need for making the practice of PCI in STEMI more widespread in developing regions.
The purpose of this study was to compare the impact of incomplete revascularization (IR) plus OMT... more The purpose of this study was to compare the impact of incomplete revascularization (IR) plus OMT to OMT alone on 1 year clinical outcomes (death, hospitalization for decompensated heart failure, acute coronary syndrome (ACS), angina class, ejection fraction (EF) and repeated revascularization) in patients with multivessel coronary artery disease (MVD) who were not eligible for coronary bypass graft surgery (CABG). Methods: This is a prospective randomized study conducted on 50 selected patients with chronic stable angina and without past history of revascularization; they have documented MVD by standard coronary angiography and CABG were the only option of revascularization but were refused by surgeon. All patients had non-viable myocardium documented by viability studies were excluded from the study. Patients were randomized 1:1 into two groups, group (I): 25 patients were subjected to OMT alone and group (II): 25 patients were subjected to IR {PCI in one or two vessel only with drug eluting stents (DES)} plus OMT. All patients were subjected to 1 year follow up. Results: The baseline patients' characteristics were matched in the two studied groups. Also, high syntax score (Ն33) was almost found in majority of patients in both groups (23 patients in OMT group and in 24 patients in IR plus OMT group; p ϭ 1.000). All patients were followed up for 1 year ; death occurred slightly more in IR plus OMT group (16% versus 12%; pϭ1.000), hospitalization for decompensated CHF occurred more in the OMT group (28% versus 12%; pϭ0.289), ACS occurred more in the OMT group (32% versus 16%; pϭ0.321) while freedom from angina occurred more in IR plus OMT group (20% versus 4%; pϭ0.189); however all these differences were not statistically significant. In IR plus OMT group; TVR occurred in 16% of patients while non-TVR in 32% of patients. The OMT alone did not affect neither the level of angina class nor EF; while the IR plus OMT markedly improved the decline in the level of angina class (p ϭ 0.011), but it did not improve EF significantly (p ϭ0.326). Conclusion: In patients with MVD who were not eligible for CABG; IR plus OMT was not superior to OMT alone in improving the 1year clinical outcomes except the improvement in the level of angina class, which could be the adopted strategy to improve the quality of life in such patients.
A cross-sectional descriptive study based on aggregated country-level data on the use of reperfus... more A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. Conclusion Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encouraged.
Accuracy of 64-slice multislice computed tomography for evaluating coronary stent patency: does s... more Accuracy of 64-slice multislice computed tomography for evaluating coronary stent patency: does strut thickness matter? ... No abstract is available. To read the body of this article, please view the Full Text online. ... Visit SciVerse ScienceDirect to see if you have access via your ...
Experimental photoelectron and computational results show diniobium-carbon (Nb(2)C(n)) clusters t... more Experimental photoelectron and computational results show diniobium-carbon (Nb(2)C(n)) clusters to coexist in multiple structural isomers: three-dimensional geometries, planar rings, and linear chains. Three-dimensional clusters having up to five carbons are formed preferentially with Nb-Nb bonding, whereas only Nb-C bonding is observed experimentally at six carbons. Clusters consisting of an odd number of atoms are also observed with linear geometries. The larger binary clusters (n &gt; or = 7) display properties similar to those of pure carbon clusters. We provide evidence for niobium substitution of carbon atoms.
Aims The aim of the Familial Hypercholesterolemia Research Collaboration (FHRC) is to collect dat... more Aims The aim of the Familial Hypercholesterolemia Research Collaboration (FHRC) is to collect date about the clinical, laboratory phenotypes, and treatment strategies of patients with FH all over the world. We present the Egyptian data of this international registry. Methods and Results An online electronic case report form (e-CRF) was prepared to collect data matching the protocol of the FHSC of the European Atherosclerosis Soci- ety (EAS). From August 2017 to March 2021, a total of 228 cases with FH (46% males, mean age 48 ± 14 years) were enrolled. About 71% of whom came from urban areas. The mean Body Mass Index (BMI) was 30 ± 4.9 kg/m2. The most commonly reported concomitant risk factor was hypertension (39%), followed by smoking (22%), and then DM (18%). Median time from diagnosis to enrolment was 7 (range 0.5-20) years. The vast majority (99.1%) were diagnosed based on the Dutch Lipid Clinic criteria, with 14%, 11% and 75% in the definite, probable, and possible categories re...
Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaborat... more Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53•6%] women) from 56 countries were included in the study. Of these, 31 798 (75•4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84•2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46•2 years (IQR 34•3-58•0); median age at diagnosis of familial hypercholesterolaemia was 44•4 years (32•5-56•5), with 40•2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17•4% (2•1% for stroke and 5•2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81•1%) were receiving statins and 3691 (21•2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5•43 mmol/L (IQR 4•32-6•72) among patients not taking lipid-lowering medications and 4•23 mmol/L (3•20-5•66) among those taking them. Among patients taking lipid-lowering medications, 2•7% had LDL cholesterol lower than 1•8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1•8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0•001). Interpretation Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia.
Background 80% of individuals with cancer will require a surgical procedure, yet little comparati... more Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494.
Clinical research in Africa And Middle East: roadmap for reform and harmonisation of the regulato... more Clinical research in Africa And Middle East: roadmap for reform and harmonisation of the regulatory framework and...
International journal of clinical oncology, Jan 28, 2018
Thyroid carcinoma is a very rare tumor in the pediatric age group, accounting for only 1.5-3% of ... more Thyroid carcinoma is a very rare tumor in the pediatric age group, accounting for only 1.5-3% of childhood carcinomas in the United States and Europe. We aimed to identify the risk of a second malignancy among pediatric thyroid cancer survivors. The cohort analysis consisted of pediatric cancer patients aged less than 20 years, diagnosed with a primary thyroid cancer, identified by site code ICD-0-3: C739, and reported to the SEER 9 database between 1973 and 2013. They were followed up until December 31, 2013; the end of the study period, or up to death if earlier. Out of 1769 patients diagnosed primarily with thyroid carcinoma, 42 patients had a total of 45 incidences of subsequent malignancies. The mean age of patients at the initial diagnosis of thyroid cancer was 16 years. Females (90.5%) had a significantly higher incidence of second malignancies (SM) than males (9.5%). The overall Standardized Incidence Ratio (SIR) of SM in the study patients was higher than expected (SIR = 1....
Background: Early restoration of patency of infarct related artery is a universally accepted goal... more Background: Early restoration of patency of infarct related artery is a universally accepted goal in the treatment of acute myocardial infarction. These could be achieved by Primary PCI or fibrinolysis. Primary PCI is preferred reperfusion strategy over fibrinolysis. Identifying initial area at risk in patients with acute myocardial infarction had been shown to have a direct impact on patients adverse clinical outcomes as well as prediction of systolic dysfunction. Area flow index (AFI) calculation in patients with acute myocardial infarction may predict initial area at risk during primary PCI. Aim: To investigate the clinical utility of Area flow index to predict systolic dysfunction and adverse clinical outcomes in patients with acute anterior ST elevation myocardial infarction Patients: 250 consecutive patients with acute anterior ST elevation myocardial infarction treated with primary PCI presenting to Alexandria main university hospital and ICC hospital from June 2013 till December 2014. Methods: Echocardiographic assessment of LV systolic function 5-7 days after myocardial infarction by calculation of ejection fraction using modified simpson method. Area flow index was calculated by dividing culprit segment cross sectional area to total coronary cross sectional area. Where DC is the culprit segment diameter, D1 left anterior descending diameter, D2 left circumflex diameter, D3 right coronary diameter. All patients were followed one month for the occurrence of MACE. Results: Patients were grouped according to their ejection fraction following myocardial infarction into 3 groups:-Group I: severe LV systolic dysfunction EF <30%.-Group II: moderate LV systolic dysfunction EF 30-45%.-Group III: mild LV systolic dysfunction EF>45% There was a significant negative correlation between AFI and LVEF (r=-0. 58, P<0. 001). The mean AFI for patients in group I was 33. 1 ± 7.4, patients in group II was 26. 6 ± 7.4, and those in group III was 20.0 ± 6. 1. AFI>28.4% had a 75.6% sensitivity and 78.1% specificity in predicting severe LV systolic dysfunction. Also the composite one month MACE was higher in the group with AFI>28.4% (p<0. 001). Conclusion: Area flow index calculated from coronary angiography at time of primary PCI is a new strong independent predictor of LV systolic dysfunction and 1month MACE in patients with acute anterior myocardial infarction.
Primary percutaneous coronary intervention (P-PCI) has become the preferred reperfusion strategy ... more Primary percutaneous coronary intervention (P-PCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) when performed by an experienced team in a timely manner. However, no consensus exists regarding the management of multivessel coronary disease detected at the time of P-PCI. Aim The aim of this study was to evaluate the use of the residual SYNTAX score (rSS) following a complete vs. culprit-only revascularization strategy in patients with STEMI and multivessel disease (MVD) to quantify the extent and complexity of residual coronary stenoses and their impact on adverse ischemic outcomes. Methods Between October 1, 2012, and November 30, 2013, we enrolled 120 consecutive STEMI patients with angiographic patterns of multivessel coronary artery disease (CAD) who had a clinical indication to undergo PCI. The patients were subdivided into those who underwent culprit-only PCI (60 patients) and those who underwent staged-multivessel PCI during the i...
BACKGROUND The potential benefit of long-term dual antiplatelet therapy (DAPT) for secondary prev... more BACKGROUND The potential benefit of long-term dual antiplatelet therapy (DAPT) for secondary prevention of atherothrombotic events in patients with coronary artery disease (CAD) is unclear. Data from different randomized controlled trials (RCT) using different agents in different subgroups showed inconsistent results. OBJECTIVE The goal of this study was to evaluate the efficacy and safety of long term DAPT for secondary prevention.
Aims Our aim is to describe the clinical characteristics and management of patients hospitalized ... more Aims Our aim is to describe the clinical characteristics and management of patients hospitalized with acute heart failure (HHF) and ambulatory patients with chronic heart failure (CHF) in Egypt and compare them with heart failure (HF) patients from other countries in the European Society of Cardiology-Heart Failure (ESC-HF) registry. Methods and results The ESC-HF Long-term Registry is a prospective, multi-centre, observational study of patients presenting to cardiology centres in member countries of the ESC. From April 2011 to February 2014, a total of 2145 patients with HF were recruited from 20 centres all over Egypt. Of these patients, 1475 (68.8%) were hospitalized with HHF, while 670 (31.2%) had CHF. Less than one-third (32.1%) of all patients were females. HHF patients {median age of 61 years [interquartile range (IQR), 53-69]} were older than CHF patients [median age of 57 years (IQR,46-64)]; P < 0.0001. They had more diabetes mellitus (45.4% vs. 31.8%; P < 0.0001). Left ventricular ejection fraction > 45% was present in 22% of HHF vs. 25.6% of CHF (P = 0.17). Atrial fibrillation existed in about a quarter of all patients (24.5%). Ischaemic heart disease was the main cause of HF in Egyptian patients. All-cause in-hospital mortality was 5%. Egyptian patients presented at a much earlier age than in other regions in the registry. They had more diabetes mellitus. Atrial fibrillation prevalence was remarkably lower. Other co-morbidities (renal dysfunction, stroke, and peripheral arterial disease) occurred less frequently. Conclusion Patients in the Egyptian cohort exhibited distinct features from HF patients in other countries in the ESC-HF Long-term Registry.
25.2-30.2). Predictors of patient satisfaction in the PD group were absence of pain during closur... more 25.2-30.2). Predictors of patient satisfaction in the PD group were absence of pain during closure, decreased TTA, and drastic reductions in TTD; the latter contributed indirectly to significant cost-savings in the PD group (1,282.3 AE118.3 vs. 2,271.4 AE121.1 dollars, respectively; P<0.001) and incremental cost savings by strategy also favored closure over MC ($89,124.5). CONCLUSIONS ProGlide is safe and effective for femoral artery closure in patients who ambulate within 30 min after cardiac catheterization; all of which translated into improved patient satisfaction and substantial cost savings.
The purpose of this study was to compare the impact of incomplete revascularization (IR) plus opt... more The purpose of this study was to compare the impact of incomplete revascularization (IR) plus optimal medical therapy (OMT) to OMT alone on 1 year clinical outcomes in patients with multivessel coronary artery disease (MVD) who were not eligible for coronary bypass graft surgery (CABG). Methods: This is a prospective randomized study conducted on 50 selected patients with chronic stable angina with documented MVD and CABG was refused by the surgeon due to poor distal vessel quality. Patients were randomized 1:1 into two groups, group (I): 25 patients were subjected to OMT alone and group (II): 25 patients were subjected to IR plus OMT. All patients were subjected to 1 year follow up. Results: The baseline patients' details were matched. At 1 year; death occurred slightly more in group II (16% versus 12%; p = 1.000), ACS occurred more in the group I (32% versus 16%; p = 0.321) while freedom from angina occurred more in group II (20% versus 4%; p = 0.189). The OMT alone did not affect neither the level of angina class nor EF; while the IR plus OMT markedly improved the decline in the level of angina class (p = 0.011), but it did not improve EF significantly (p = 0.326). Conclusion: In patients with MVD who were not eligible for CABG; IR plus OMT was not superior to OMT alone in improving the 1 year clinical outcomes except the improvement in the level of angina class, which could be the adopted strategy to improve the quality of life in such patients.
To determine the outcomes of percutaneous coronary intervention (PCI) in patients presenting with... more To determine the outcomes of percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI) according to PCI guidelines. Methods: This study was conducted between January 2008 and December 2010. A total of 450 patients presenting with STEMI underwent PCI: 288 patients underwent primary PCI, and 162 patients underwent non-primary PCI. Results: The mean age at presentation was 55 ± 11.10 years and 89.8% were male. The door-toballoon time was 60 min in primary PCI group (288 patients). The median time between end of failed thrombolytic therapy and the rescue PCI was 420 min (95 patients) versus 810 min after successful thrombolytic therapy (35 patients). Only 32 patients underwent late PCI P 24 h and 648 h without thrombolytic therapy; median time was 2160 min. In-hospital, 30 days and 6-months mortality were respectively 2.1%, 0.7% and 1.1% in primary PCI group while 2.5%, 3.2% and 2.6% in non-primary PCI group. In-hospital, 30 days and 6-months reinfarction occurred in 0.3%, 1.1% and 0.7% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively. In-hospital, 30 days and 6-months TVR occurred in 0.7%, 0.7% and 1.1% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively. Conclusions: This is the first report from Egyptian hospital to provide a comprehensive review of patient characteristics and outcomes of PCI for STEMI. We reported a high initial success rate, excellent short and intermediate-term outcomes.
Aims: Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients... more Aims: Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, a 2007 study reported that only 40-45% of European STEMI patients were treated with PPCI, with large variations in treatment availability between countries. In 2008, the Stent for Life (SFL) initiative was launched by the European Association of Percutaneous Cardiovascular Interventions and EuroPCR in partnership with the European Society of Cardiology (ESC) Working Group on Acute Cardiac Care and country-specific national cardiac societies. The aim is to promote the prioritisation of percutaneous coronary intervention treatment towards those who will benefit most, namely STEMI patients. The following countries are currently participating: Bulgaria,
Myocardial infarction is a medical emergency in which 25 to 35% of patients will die before recei... more Myocardial infarction is a medical emergency in which 25 to 35% of patients will die before receiving medical attention. The Stent for Life registry was launched to access the current situation of the Egyptian population presenting with STEMI, and to determine what were the barriers to providing patients with cardiac problems appropriate care. This registry was conducted at 14 centres covered all the Egyptian regions including 1,324 consecutive patients presenting with STEMI during the period between January 1st, 2011 to November, 2011. Fourteen centres and 38 interventionalists participated in this registry; only six centres are Pilot Centres (fulfilling the criteria for a primary PCI centre) and were assigned at the end of 2011. Cardiovascular risk factors were mainly smoking (60.5%), dyslipidaemia (46.0%), diabetes (51.4%) and hypertension (56.0%). The mean age at presentation was 56.01±10.61years and 75.0% were male. Only 5% of the STEMI patients arrived via the emergency medical system. Thrombus aspiration was done in 42.7% of patients in primary PCI group and 25.9% in rescue PCI group. Bare metal stents (BMS) were used in 80.7% of the stented patients while drug eluting stents (DES) were used in 19.3% of the stented patients. In-hospital mortality was 2.9% (1.4% in primary PCI group, 1.1% in patients treated with thrombolysis and 0.4% in patients receiving no reperfusion therapy). Despite the logistical difficulties, excellent outcomes for acute interventional reperfusion strategy in STEMI can be achieved in our country, possibly similar to those seen in the West. There is a strong need for making the practice of PCI in STEMI more widespread in developing regions.
The purpose of this study was to compare the impact of incomplete revascularization (IR) plus OMT... more The purpose of this study was to compare the impact of incomplete revascularization (IR) plus OMT to OMT alone on 1 year clinical outcomes (death, hospitalization for decompensated heart failure, acute coronary syndrome (ACS), angina class, ejection fraction (EF) and repeated revascularization) in patients with multivessel coronary artery disease (MVD) who were not eligible for coronary bypass graft surgery (CABG). Methods: This is a prospective randomized study conducted on 50 selected patients with chronic stable angina and without past history of revascularization; they have documented MVD by standard coronary angiography and CABG were the only option of revascularization but were refused by surgeon. All patients had non-viable myocardium documented by viability studies were excluded from the study. Patients were randomized 1:1 into two groups, group (I): 25 patients were subjected to OMT alone and group (II): 25 patients were subjected to IR {PCI in one or two vessel only with drug eluting stents (DES)} plus OMT. All patients were subjected to 1 year follow up. Results: The baseline patients' characteristics were matched in the two studied groups. Also, high syntax score (Ն33) was almost found in majority of patients in both groups (23 patients in OMT group and in 24 patients in IR plus OMT group; p ϭ 1.000). All patients were followed up for 1 year ; death occurred slightly more in IR plus OMT group (16% versus 12%; pϭ1.000), hospitalization for decompensated CHF occurred more in the OMT group (28% versus 12%; pϭ0.289), ACS occurred more in the OMT group (32% versus 16%; pϭ0.321) while freedom from angina occurred more in IR plus OMT group (20% versus 4%; pϭ0.189); however all these differences were not statistically significant. In IR plus OMT group; TVR occurred in 16% of patients while non-TVR in 32% of patients. The OMT alone did not affect neither the level of angina class nor EF; while the IR plus OMT markedly improved the decline in the level of angina class (p ϭ 0.011), but it did not improve EF significantly (p ϭ0.326). Conclusion: In patients with MVD who were not eligible for CABG; IR plus OMT was not superior to OMT alone in improving the 1year clinical outcomes except the improvement in the level of angina class, which could be the adopted strategy to improve the quality of life in such patients.
A cross-sectional descriptive study based on aggregated country-level data on the use of reperfus... more A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. Conclusion Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encouraged.
Accuracy of 64-slice multislice computed tomography for evaluating coronary stent patency: does s... more Accuracy of 64-slice multislice computed tomography for evaluating coronary stent patency: does strut thickness matter? ... No abstract is available. To read the body of this article, please view the Full Text online. ... Visit SciVerse ScienceDirect to see if you have access via your ...
Experimental photoelectron and computational results show diniobium-carbon (Nb(2)C(n)) clusters t... more Experimental photoelectron and computational results show diniobium-carbon (Nb(2)C(n)) clusters to coexist in multiple structural isomers: three-dimensional geometries, planar rings, and linear chains. Three-dimensional clusters having up to five carbons are formed preferentially with Nb-Nb bonding, whereas only Nb-C bonding is observed experimentally at six carbons. Clusters consisting of an odd number of atoms are also observed with linear geometries. The larger binary clusters (n &gt; or = 7) display properties similar to those of pure carbon clusters. We provide evidence for niobium substitution of carbon atoms.
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Papers by Mohamed Sobhy