Transvenous Lead Extraction of Cardiac Implantable Electronic Devices Indications, Complications and Outcome: An Egyptian Two Years' Experience

BACKGROUND: The growing needs to extract cardiovascular implantable electronic devices warrants the need to improve the outcome and prevent complications. AIM: This study aims to analyse the findings and identify factors associated with complications of Percutaneous Transvenous Lead Extraction in the Critical Care Department, Cairo University. METHODS: We studied 52 candidates for Percutaneous Transvenous Lead extraction of a Permanent Pace Maker (PPM) regarding extraction indications, comorbidities, device type, complications and outcome. Extraction was first attempted by simple manual traction using regular non-locking stylet and if failed, locking stylet, and evolution dilator sheath were used. RESULTS: We extracted 110 leads with a mean lead age of 4.67 ± 3.6 years. The most common extraction indication was an infection (71.15%). Indications correlated significantly with comorbidities (p = 0.024), the most common being Diabetes Mellitus (40.38%). Simple traction was successful in 31 % of the leads, while 69% were extracted using locking stylet and evolution dilator sheath. The method of lead extraction correlated significantly with lead age (P ≤ 0.001). Complications were significantly higher with extraction by evolution dilator sheaths than by simple traction (P = 0.003) and in older patients (P = 0.008). Complications also correlated significantly with extractions indications (p = 0.012), type of PPM (P = 0.037), number of extracted leads (P = 0.041), and lead age (p= 0.011). CONCLUSION: Among the studied variables, extraction indications particularly infection, was the only preventable factor significantly associated with complications. While focusing on preventable factors, improving, implantation and extraction techniques should also be addressed

The impact of homocysteine level on methotrexate induced neurotoxicity in children treated with St. Jude total XV acute lymphoblastic leukemia protocol

Purpose: Methotrexate (MTX) is an antimetabolite that is routinely used in the treatment of hematological malignancies and during its metabolism leads to hyperhomocysteinemia that is associated with neurotoxicity. The purpose of this prospective study is to determine whether the increase in plasma homocysteine (Hcy) concentration is related to MTX-induced neurotoxicity.Methods: We investigated these changes for both newly diagnosed acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL) pediatric patients treated at the National Cancer Institute, Egypt. They were treated according to St. Jude total XV protocol to receive 2.5 or 5 g/m2 MTX as a phase of consolidation and were selected between October 2009 and January 2010.Results: Twenty-nine patients were analyzed, M/F: 20/9, the mean age was 8 +/- 4.4 years. Hcy level above 15 µmol/L was considered positive. Hcy levels mean at diagnosis, pre 1st HD MTX, post 1st HDMTX, Pre 2nd HDMTX, Post 2nd HDMTX were 12.10 µmol/L ± 4.17, 6.90 µmol/L ± 3.02, 17.59 µmol/L ± 6.00, 7.21 µmol/L ± 2.73 and 13.74 µmol/L ± 4.75 respectively. Seventeen patients (58%) had features suggestive of neurotoxicity. Positive Hcy levels were associated with neurotoxicity p = 0.05, higher HDMTX 5 g/m2 P= 0.023. A highly significant relation was found between initial Hcy level at diagnosis and final Hcy level p = 0.001; the same as between Hcy level Post 1st HDMTX and that Post 2nd HDMTX with p = 0.006.Conclusion: plasma Hcy concentration was significantly elevated after HDMTX administration and this elevation is associated with the observed neurotoxicity. Whether the elevation in Hcy concentration can prove an informative biomarker for neurotoxicity requires additional testing with other MTX regimens

Cancer Cells Treated by Clusters of Copper Oxide Doped Calcium Silicate

Purpose: Different compositions of copper oxide (CuO)-doped calcium silicate clusters wereused to treat the cancer cells.Methods: The influence of CuO content on the morphology, drug delivering ability,physicochemical properties and cytotoxicity was investigated.Results: The microcrystalline structure revealed the decrement of the size from (20-36 nm) to(5-7 nm) depending on the copper content percentages. Drug delivering ability of doxycyclinehyclate (Dox) was down regulated from 58% to 28%in the presence of the CuO. The inclusionof CuO and Dox didn’t show any remarkable changes on the physicochemical properties of theCuO-doped calcium silicate nanoparticles.Conclusion: The CuO-doped calcium silicate sample (5 weight %) exhibited great cytotoxicityagainst the tested cell lines compared to the CuO-free sample. CuO-doped materials displayedsignificant anticancer effect; this sheds light on its implication in the treatment of cancer

Rift Valley Fever – epidemiological update and risk of introduction into Europe

Rift Valley fever (RVF) is a vector-borne disease transmitted by a broad spectrum of mosquito species, especially Aedes and Culex genus, to animals (domestic and wild ruminants and camels) and humans. Rift Valley fever is endemic in sub-Saharan Africa and in the Arabian Peninsula, with periodic epidemics characterised by 5–15 years of inter-epizootic periods. In the last two decades, RVF was notified in new African regions (e.g. Sahel), RVF epidemics occurred more frequently and low-level enzootic virus circulation has been demonstrated in livestock in various areas. Recent outbreaks in a French overseas department and some seropositive cases detected in Turkey, Tunisia and Libya raised the attention of the EU for a possible incursion into neighbouring countries. The movement of live animals is the most important pathway for RVF spread from the African endemic areas to North Africa and the Middle East. The movement of infected animals and infected vectors when shipped by flights, containers or road transport is considered as other plausible pathways of introduction into Europe. The overall risk of introduction of RVF into EU through the movement of infected animals is very low in all the EU regions and in all MSs (less than one epidemic every 500 years), given the strict EU animal import policy. The same level of risk of introduction in all the EU regions was estimated also considering the movement of infected vectors, with the highest level for Belgium, Greece, Malta, the Netherlands (one epidemic every 228–700 years), mainly linked to the number of connections by air and sea transports with African RVF infected countries. Although the EU territory does not seem to be directly exposed to an imminent risk of RVFV introduction, the risk of further spread into countries neighbouring the EU and the risks of possible introduction of infected vectors, suggest that EU authorities need to strengthen their surveillance and response capacities, as well as the collaboration with North African and Middle Eastern countries.info:eu-repo/semantics/publishedVersio

Correlation of texture feature analysis with bone marrow infiltration in initial staging of patients with lymphoma using 18F−fluorodeoxyglucose^{18}F-fluorodeoxyglucose positron emission tomography combined with computed tomography

Purpose: To explore whether radiomic features of fluorine-18-fluorodeoxyglucose ($^{18}F-FDG$) positron emission tomography-computed tomography (PET/CT) has association with bone marrow infiltration (BMI) in comparison to other conventional PET metrics. Material and methods: Forty-four patients (with pathologically proven lymphoma disease) underwent staging $^{18}F-FDG PET/CT$ scan. Primary tumour was semi-automatically or manually segmented with a threshold standardised uptake value (SUV) of 3. A total of 73 features were extracted from eight different textures. Spearman correlation was used to test the correlation of features with conventional quantitative metrics such as SUV, metabolic tumour volume, and total lesion glycolysis. Specificity and sensitivity (including 95% confidence intervals [CI]) for each of the studied parameters were derived using receiver operative characteristic (ROC) curves. Univariate and multivariate analyses were used to identify independent predictors associated with BMI. Results: Correlation between conventional PET metrics and features ranged between 0.50 and 0.97 for positive correlation (33 significant association features) and ranged from -0.52 to -0.97 for inverse correlation (three significant association features) for both strong and moderate correlations. Analysis of ROC curves showed that high-intensity long-run emphasis 4 bin, high-intensity large zone emphasis 64 bin, long-run emphasis (LRE) 64 bin, large-zone emphasis 64 bin, max spectrum 8 bin, busyness 64 bin, and code similarity 32 and 64 bin were significant discriminators of BMI among other features (area under curve > 0.682, p < 0.05). Univariate analyses of texture features showed that code similarity and long-run emphasis (both 64 bin) were significant predictors of bone marrow involvement. Multivariate analyses revealed that LRE (64 bin, p = 0.031) with an odds ratio of 1.022 and 95% CI of (1.002-1.043) were independent variables for bone marrow involvement. Conclusions: $^{18}F-FDG PET/CT$ radiomic features are synergistic to visual assessment of BMI in patients diagnosed with lymphoma using $^{18}F-FDG PET/CT$. Further assessment of long-run emphasis is highly warranted

The effect of planning design on thermal comfort in outdoor spaces

Urban outdoor spaces are considered essential elements of cities, where the greatest amount of human contact and interaction takes place. That is the reason why there is increasing public interest in the quality of open urban spaces as they can contribute to the quality of life within cities, or contrarily increase isolation and social exclusion. There are a lot of factors influencing the success of the outdoor spaces; one of the principal factors is the microclimatic comfort. In the hot areas, the outdoor thermal comfort conditions during the daytime are often far above acceptable comfort standards due to intense solar radiation and high solar elevations. The variation of the urban spaces\u27 configuration can generate significant modifications of the microclimatic parameters. Design decisions such as street and sidewalk widths, shading structures, materials, landscaping, building heights, and inducing air flow have a significant impact on the pedestrian thermal comfort and subsequently on the use of the urban environment. Although it has been established that the vegetation elements should be considered as one of the main tools that can be used in improving the thermal comfort in outdoor spaces, the integration of the climate dimension in the planting design process in urban spaces is lacking because of insufficient interdisciplinary work between urban climatology, urban design and landscape architecture. The primary aim of this research is to study the influence of some of the design decision for the plantation elements in outdoor spaces on the thermal comfort of its users. This will provide landscape designers and decision makers with the appropriate tools for effectively assessing the development of urban environment while considering the microclimate of outdoor spaces. A special emphasis is put on summertime conditions in Egypt. Findings of this research will contribute to sustainable urban design of outdoor spaces.<br /

The impact of homocysteine level on methotrexate induced neurotoxicity in children treated with St. Jude total XV acute lymphoblastic leukemia protocol

Purpose: Methotrexate (MTX) is an antimetabolite that is routinely used in the treatment of hematological malignancies and during its metabolism leads to hyperhomocysteinemia that is associated with neurotoxicity. The purpose of this prospective study is to determine whether the increase in plasma homocysteine (Hcy) concentration is related to MTX-induced neurotoxicity.Methods: We investigated these changes for both newly diagnosed acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL) pediatric patients treated at the National Cancer Institute, Egypt. They were treated according to St. Jude total XV protocol to receive 2.5 or 5 g/m2 MTX as a phase of consolidation and were selected between October 2009 and January 2010.Results: Twenty-nine patients were analyzed, M/F: 20/9, the mean age was 8 +/- 4.4 years. Hcy level above 15 µmol/L was considered positive. Hcy levels mean at diagnosis, pre 1st HD MTX, post 1st HDMTX, Pre 2nd HDMTX, Post 2nd HDMTX were 12.10 µmol/L ± 4.17, 6.90 µmol/L ± 3.02, 17.59 µmol/L ± 6.00, 7.21 µmol/L ± 2.73 and 13.74 µmol/L ± 4.75 respectively. Seventeen patients (58%) had features suggestive of neurotoxicity. Positive Hcy levels were associated with neurotoxicity p = 0.05, higher HDMTX 5 g/m2 P= 0.023. A highly significant relation was found between initial Hcy level at diagnosis and final Hcy level p = 0.001; the same as between Hcy level Post 1st HDMTX and that Post 2nd HDMTX with p = 0.006.Conclusion: plasma Hcy concentration was significantly elevated after HDMTX administration and this elevation is associated with the observed neurotoxicity. Whether the elevation in Hcy concentration can prove an informative biomarker for neurotoxicity requires additional testing with other MTX regimens.</p

Laryngeal ultrasound versus cuff leak test in prediction of post-extubation stridor

Background: Cuff leak test (CLT) has been proposed as a simple method of predicting post-extubation stridor (PES), however due to different cut-off point of cuff-leak volume between previous studies, the laryngeal ultrasonography (US) including measurement of air column width was used to predict PES. The aim of the present study was to evaluate the value of laryngeal US versus cuff leak test in predicting PES. Methods: The study included fifty patients admitted to the Critical Care Department, Cairo University Hospitals from the period of November 2014 to January 2016, intubated for at least 24 h and examined prior to extubation using CLT and laryngeal ultrasound. Results: Four cases developed PES. CLT identified PES patients with a sensitivity of 75%, with PPV of 50% for leakage volume of 132.5 ml. Laryngeal ultrasound showed a sensitivity of 50% for those patients with air column width before deflation less than 10.955 mm and air column width difference (ACWD) of 0.905 mm with PPV of 11.8% and 14.3% for both respectively. Conclusion: Both CLT and laryngeal US might have low sensitivity and PPV in predicting PES and should be used with caution in prediction of PES