Advanced Quantitative Echocardiography: Guiding Therapy for Heart Failure

The aim of this thesis was to investigate the potential application of echocardiography for an efficient management of heart failure (HF) patients. The thesis is presented in four parts as follows: part I (introduction), part II (assessment of global left ventricular systolic function), part III (assessment of cardiac resynchronization therapy), and part IV (summary and conclusion). The general introduction (Chapter 1) of this thesis provides an overview of HF management using cardiac resynchronization therapy (CRT). HF constitutes an increasing and prevalent health burden worldwide. Echocardiography is a versatile non-invasive imaging modality that can be used for an efficient management of HF by proper diagnosis and guiding therapeutic interventions. Accurate assessment of left ventricular (LV) volumes and ejection fraction (LV-EF) would have important prognostic implications. CRT is a technique in which atrio-biventricular pacing is used to improve clinical and echocardiographic outcome for selected HF patients. The rationale behind CRT is the restoration of atrio-ventricular, inter-ventricular and intra-ventricular synchrony by stimulation of the delayed ventricular sites. It results in effective LV filling and emptying, reducing ventricular size improving ventricular geometry and most importantly improves survival. However, these impressive results of CRT are not seen in ~30% of patients. There are several unresolved and potentially other undetected reasons behind the high percentage of CRT failure. The echocardiography may improve the efficacy of CRT by reducing the non –response rate. The potential fields of echocardiography are: proper selection of candidates; optimization of atrio- and inter-ventricular pacing; guiding lead placement and proper detection of the response to CRT by accurate assessment of atrial and ventricular structure and function. These fields are mostly the topics of this thesis

Role of multi-slice CT angiography versus Doppler ultrasonography and conventional angiography in assessment of aorto-iliac arterial disease

AbstractThe new clinical entity, known as aorto-iliac atherosclerosis obliterans or aorto-iliac occlusive disease (AIOD), is one of the most frequent clinical problems confronted by vascular surgeons today. Digital subtraction angiography is considered the gold standard technique in assessment of these arteries. However, the invasiveness of the procedure, and radiation exposure led to the need for less and non-invasive imaging techniques.ObjectiveThe aim of this study is to evaluate the MDCT angiography as a recent non invasive technique for investigating aorto-iliac arterial disease as compared to CCD and DSA.Materials and methodsThis study included 16 patients (12 males & 4 females) with an age range of 33–75years. All of these patients underwent MDCT angiography and CCD. Only 13 patients underwent DSA. The arterial tree of the lower limbs was divided into 31 arterial segments. Each segment was evaluated and given a grade from 0 to 4 according to its appearance in the three modalities.ResultsThere was a 98.7% agreement between the findings of DSA and MDCT angiography. While agreement between DSA and CCD was 96.1%.ConclusionConsidering conventional angiography as the gold standard, MDCT angiography shows higher sensitivity (98.7%) than color coded Doppler ultrasonography (96.2%) in the assessment of aorto-iliac arterial disease

Impact of technological changes and economic liberalization on agricultural labor employment and Productivity

Egypt has passed dramatic economic changes over the last two decades. Such program has different impacts on agricultural sector performance, including the mechanization, expansion and substitutability for human labor. Therefore the objectives of this study are to assess the impacts oftechnological changes and economic liberalization on agricultural labor employment and Productivity. The analytical procedures included was the estimation of crop production function for rice before and after the economic reform application in agricultural sector. The study used two field survey data in two sucessive periods conducted in "Sharkia Governorate". It was concluded that the optimum allocation of inputs for rice production implied to decrease the human labor use on farms, even though under the export border price of rice. It means that such major crop in Egypt as a case study of the agricultural sector can not provide a feasible employment opportunity for human labor. To reach amaximum income from such agricultural activities a less labor intensity should be used. Positive analysis approach showed that the employment of human labor has decreased by almost one-fourth due to all technological changes and economic reform policies practiced over the last decade. The normative approach analysis (least cost combination of inputs), showed that the human labor employment should be decreased by about two-thirds, in order to maximize income. All economic criteria, derived from the normative approach analysis,in this study showed that the growth in production and maximization of income must rely upon physical and biological technologies (new varieties, fertilizers and mechanization of farm operations. Rural development programs and economic development plants should create employment opportunities for such excess agriculture labor,either in agricultural related industries of non-agricultural small industries in villages or other economic activities in rural towns, in order to keep agriculture growing at an economic competitive performance

Can copper amino acid chelates reduce the physiological strain of growing rabbits under summer conditions?

[EN] This study was conducted at the Poultry Research Centre, Faculty of Agriculture, Alexandria University, Egypt, during the summer season (July and August months) 2018. For five weeks, until 63 d of age, a total number of 140 weaned V line rabbits were randomly distributed into seven groups of 20 rabbits each. Rabbits of groups 2 and 3 were fed basal diet plus copper sulphate (100 and 200 mg Cu-Sul/kg, respectively). Groups 4 and 5 were fed basal diet plus copper methionine (100 and 200 mg Cu-Meth/kg, respectively) and groups 6 and 7 were fed basal diet plus copper glycine (100 and 200 mg Cu-Gly/kg, respectively), while the first group was fed basal diet only as control. Rabbits fed diet supplemented with higher level (200 mg/kg) of Cu-Meth or Cu-Gly chelates had significantly higher body weight and daily body weight gain (P<0.05) compared to those fed diets supplemented with both levels of Cu-Sul. Rabbits fed diets supplemented with Cu-Meth or Cu-Gly chelates had significantly increased (P<0.05) red blood cells, lymphocyte, high-density lipoprotein and Cu values in blood. Within the studied Cu sources, serum total lipids values of rabbits were significantly lower than in the control group. However, serum total antioxidant capacity, glutathione peroxidase and superoxide dismutase were higher by both organic chelates studied than other groups. In general, copper supplementation improves productive performance and physiological status under summer conditions.Goodb, F.; Soliman, F.; Elghalid, O.; Abd El-Hady, AM. (2022). Can copper amino acid chelates reduce the physiological strain of growing rabbits under summer conditions?. World Rabbit Science. 30(4):277-286. https://doi.org/10.4995/wrs.2022.1384827728630

Protective effect of camel milk as anti-diabetic supplement: biochemical, molecular and immunohistochemical study

Background: Diabetes is a serious disease affects human health. Diabetes in advanced stages is accompanied by general weakness and alteration in fats and carbohydrates metabolism. Recently there are some scientific trends about the usage of camel milk (CM) in the treatment of diabetes and its associated alterations. CM contains vital active particles with insulin like action that cure diabetes and its complications but how these effects occur, still unclear.Materials and Methods: Seventy-five adult male rats of the albino type divided into five equal groups. Group 1 served as a negative control (C). Group 2 was supplemented with camel milk (CM). Diabetes was induced in the remaining groups (3, 4 and 5). Group 3 served as positive diabetic control (D). Group 4 served as diabetic and administered metformin (D+MET). Group 5 served as diabetes and supplemented with camel milk (D+CM). Camel milk was supplemented for two consecutive months. Serum glucose, leptin, insulin, liver, kidney, antioxidants, MDA and lipid profiles were assayed. Tissues from liver and adipose tissues were examined using RT-PCR analysis for the changes in mRNA expression of genes of carbohydrates and lipid metabolism. Pancreas and liver were used for immunohistochemical examination using specific antibodies.Results: Camel milk supplementation ameliorated serum biochemical measurements that altered after diabetes induction. CM supplementation up-regulated mRNA expression of IRS-2, PK, and FASN genes, while down-regulated the expression of CPT-1 to control mRNA expression level. CM did not affect the expression of PEPCK gene. On the other hand, metformin failed to reduce the expression of CPT-1 compared to camel milk administered rats. Immunohistochemical findings revealed that CM administration restored the immunostaining reactivity of insulin and GLUT-4 in the pancreas of diabetic rats.Conclusion: CM administration is of medical importance and helps physicians in the treatment of diabetes mellitus.Keywords: Camel milk, Diabetes, Gene expression, Immunohistochemistr

Can frozen-section analysis of ureteric margins at the time of radical cystectomy predict upper tract recurrence?

Objective: To summarise the currently available literature and analyse available results of the outcome of intraoperative frozen-section analysis (FSA) on upper urinary tract recurrence (UUTR) after radical cystectomy (RC). Materials and methods: A systematic review of the literature was performed according to the Cochrane Reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Articles discussing ureteric FSA with RC were identified. Results: The literature search yielded 21 studies, on which the present analysis was done. The studies were published between 1997 and 2019. There were 10 010 patients with an age range between 51 and 95 years. Involvement of the ureteric margins was noted in 2–9% at RC. The sensitivity and specificity of FSA were ~75% and 99%, respectively. Adverse pathology on FSA and on permanent section, prostatic urothelial carcinoma involving the stroma but not prostatic duct, and ureteric involvement on permanent section were all more likely to develop UUTR. Neither evidence of ureteric involvement nor ureteric margin status on permanent section were significant predictors of overall survival. Conclusion: Routine FSA is mandatory for a tumour-free uretero–enteric anastomosis and is predictive of UUTR. To lower the UUTR, FSA is not necessary if the ureters are resected at the level where they cross the common iliac vessels. FSA is indicated whenever the surgeon encounters findings suspicious of malignancy, e.g. ureteric obstruction, periureteric fibrosis, diffuse carcinoma in situ, induration or frank tumour infiltration of the distal ureter is discovered unexpectedly during surgery, and prostatic urethral involvement. Abbreviations CIS: carcinoma in situ; FSA: frozen-section analysis; HR: hazard ratio; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RC: radical cystectomy; (UT)UC: (upper tract) urothelial carcinoma; UUT(R): upper urinary tract (recurrence)