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Kundu A, Patrick E, Currlin S, Madler R, Delgado F, Fahmy A, Verplancke R, Ballini M, Braeken D, de Beeck MO, Maghari N, Otto KJ, Bashirullah R. Using Compound Neural Action Potentials for Functional Validation of a High-Density Intraneural Interface: A Preliminary Study. MICROMACHINES 2024; 15:280. [PMID: 38399008 PMCID: PMC10891740 DOI: 10.3390/mi15020280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
Compound nerve action potentials (CNAPs) were used as a metric to assess the stimulation performance of a novel high-density, transverse, intrafascicular electrode in rat models. We show characteristic CNAPs recorded from distally implanted cuff electrodes. Evaluation of the CNAPs as a function of stimulus current and calculation of recruitment plots were used to obtain a qualitative approximation of the neural interface's placement and orientation inside the nerve. This method avoids elaborate surgeries required for the implantation of EMG electrodes and thus minimizes surgical complications and may accelerate the healing process of the implanted subject.
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Morales MA, Yoon S, Fahmy A, Ghanbari F, Nakamori S, Rodriguez J, Yue J, Street JA, Herzka DA, Manning WJ, Nezafat R. Highly accelerated free-breathing real-time myocardial tagging for exercise cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:56. [PMID: 37784153 PMCID: PMC10544487 DOI: 10.1186/s12968-023-00961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (Ex-CMR) myocardial tagging would enable quantification of myocardial deformation after exercise. However, current electrocardiogram (ECG)-segmented sequences are limited for Ex-CMR. METHODS We developed a highly accelerated balanced steady-state free-precession real-time tagging technique for 3 T. A 12-fold acceleration was achieved using incoherent sixfold random Cartesian sampling, twofold truncated outer phase encoding, and a deep learning resolution enhancement model. The technique was tested in two prospective studies. In a rest study of 27 patients referred for clinical CMR and 19 healthy subjects, a set of ECG-segmented for comparison and two sets of real-time tagging images for repeatability assessment were collected in 2-chamber and short-axis views with spatiotemporal resolution 2.0 × 2.0 mm2 and 29 ms. In an Ex-CMR study of 26 patients with known or suspected cardiac disease and 23 healthy subjects, real-time images were collected before and after exercise. Deformation was quantified using measures of short-axis global circumferential strain (GCS). Two experienced CMR readers evaluated the image quality of all real-time data pooled from both studies using a 4-point Likert scale for tagline quality (1-excellent; 2-good; 3-moderate; 4-poor) and artifact level (1-none; 2-minimal; 3-moderate; 4-significant). Statistical evaluation included Pearson correlation coefficient (r), intraclass correlation coefficient (ICC), and coefficient of variation (CoV). RESULTS In the rest study, deformation was successfully quantified in 90% of cases. There was a good correlation (r = 0.71) between ECG-segmented and real-time measures of GCS, and repeatability was good to excellent (ICC = 0.86 [0.71, 0.94]) with a CoV of 4.7%. In the Ex-CMR study, deformation was successfully quantified in 96% of subjects pre-exercise and 84% of subjects post-exercise. Short-axis and 2-chamber tagline quality were 1.6 ± 0.7 and 1.9 ± 0.8 at rest and 1.9 ± 0.7 and 2.5 ± 0.8 after exercise, respectively. Short-axis and 2-chamber artifact level was 1.2 ± 0.5 and 1.4 ± 0.7 at rest and 1.3 ± 0.6 and 1.5 ± 0.8 post-exercise, respectively. CONCLUSION We developed a highly accelerated real-time tagging technique and demonstrated its potential for Ex-CMR quantification of myocardial deformation. Further studies are needed to assess the clinical utility of our technique.
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Hegazy N, Rezq S, Fahmy A. Retraction Note: Mechanisms Involved in Superiority of Angiotensin Receptor Blockade over ACE Inhibition in Attenuating Neuropathic Pain Induced in Rats. Neurotherapeutics 2023; 20:1895. [PMID: 37817048 PMCID: PMC10684449 DOI: 10.1007/s13311-023-01449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
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Alshallash KS, Elnaggar IA, Abd El-Wahed AN, Fahmy A, Tawfeeq AM, Hammad EM, Almashad AA, Elmezien AI, Hamdy AE, Taha IM. Using chitosan nanoparticles and N-acetyl thiazolidine 4-carboxylic acid for olive trees efficiency raising, improving fruits properties and oil quality. BRAZ J BIOL 2023; 83:e273643. [PMID: 37729315 DOI: 10.1590/1519-6984.273643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/11/2023] [Indexed: 09/22/2023] Open
Abstract
Recently exposure of olive trees to many stresses particularly oil varieties led to decline in the olive yield. The target of the study is to improve vegetative growth and increase olive fruits quality as well as the fruit oil % and oil quality by applying chitosan nanoparticles (CHNPs) and N-acetyl thiazolidine 4-carboxylic acid (N-ATCA) under the conditions of Egypt. The experiment was carried out in the seasons of 2021 and 2022 on Arbosana olive trees 8 years old and 4×6 m apart the trees sprayed three times on 15th Sept., 1st Oct. and 15th Oct. with (CHNPs at 500, 1000 and 1500 ppm), (N-ATCA at 50, 100 and 150 ppm) and a combination between them and evaluate the vegetative growth of trees, fruit physiochemical characteristics, and oil properties during both study seasons. The application of CHNPs and N-ATCA and a combination of them led to increasing leaf area, total chlorophyll and proline content also increment fruit weight, flesh weight, oil color and oil % moreover improving the quality of produced oil. The improvement in growth, fruit quality, oil % and oil quality, were associated with increasing concentrations of CHNPs, N-ATCA and a combination of them especially (CHNPs at 1500 ppm + N-ATCA at 100 ppm and CHNPs at 1500 ppm + N-ATCA at 150 ppm). Spraying (CHNPs at 1500 ppm + N-ATCA at 150 ppm) is recommended to improve the tree growth, fruit quality, oil % and quality of Arbosana olive.
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Elabbady A, Boudreau R, Mehrnoush V, Salem M, Fahmy A, Elabbady R, Kotb A. Rapid metachronous bladder metastasis of type 2 papillary renal cell carcinoma. Arch Clin Cases 2023; 10:93-96. [PMID: 37313126 PMCID: PMC10258733 DOI: 10.22551/2023.39.1002.10249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Renal cell carcinoma (RCC) frequently spreads to distant organs like the lung, lymph nodes, bone, and liver. However, there have been some reports of RCC bladder metastasis. We present a case of a 61-year-old man presented with total painless gross hematuria. The patient had a history of right radical nephrectomy for papillary (type 2) RCC, high-grade, pT3a with negative surgical margins. There was no evidence of metastases on 6-month surveillance CT. After one-year post-operation, at this current admission, the cystoscopy discovered a solid bladder mass away from the trigone in the right lateral bladder wall. The resected bladder mass was metastatic papillary RCC with PAX-8 positive but GATA-3 negative on immunostaining. A positron emission tomography scan confirmed multiple lung, liver, and osseous metastases. This case report can highlight the importance of having bladder metastasis in RCC mind, although rare, and may necessitate the surveillance measures like urine analysis at more frequent interval and CT Urography instead of regular CT to detect the RCC metastatic bladder cancer at early stage.
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Massoud A, Fahmy A, Iqbal U, Givigi S, Noureldin A. Real-Time Safe Landing Zone Identification Based on Airborne LiDAR. SENSORS (BASEL, SWITZERLAND) 2023; 23:3491. [PMID: 37050550 PMCID: PMC10099213 DOI: 10.3390/s23073491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
Over the past two decades, there has been a growing demand for generating digital surface models (DSMs) in real-time, particularly for aircraft landing in degraded visual environments. Challenging landing environments can hinder a pilot's ability to accurately navigate, see the ground, and avoid obstacles that may lead to equipment damage or loss of life. While many accurate and robust filtering algorithms for airborne laser scanning (ALS) data have been developed, they are typically computationally expensive. Moreover, these filtering algorithms require high execution times, making them unsuitable for real-time applications. This research aims to design and implement an efficient algorithm that can be used in real-time on limited-resource embedded processors without the need for a supercomputer. The proposed algorithm effectively identifies the best safe landing zone (SLZ) for an aircraft/helicopter based on processing 3D LiDAR point cloud data collected from a LiDAR mounted on the aircraft/helicopter. The algorithm was successfully implemented in C++ in real-time and validated using professional software for flight simulation. By comparing the results with maps, this research demonstrates the ability of the developed method to assist pilots in identifying the safest landing zone for helicopters.
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Jiang Y, Da BL, Satiya J, Heda RP, Lau LF, Fahmy A, Winnick A, Roth N, Grodstein E, Thuluvath PJ, Singal AK, Schiano TD, Teperman LW, Satapathy SK. Outcomes after Liver Transplantation with Steatotic Grafts: Redefining Acceptable Cutoffs for Steatotic Grafts. Euroasian J Hepatogastroenterol 2022; 12:S5-S14. [DOI: 10.5005/jp-journals-10018-1361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Fahmy A, Mahfouz W, Elbadry M, Moussa A. Single step track dilatation for percutaneous nephrolithotomy in children. Int Urol Nephrol 2022; 54:2789-2795. [PMID: 35941301 PMCID: PMC9534808 DOI: 10.1007/s11255-022-03314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
Introduction and objectives Data on the use of single step dilatation technique during pediatric percutaneous nephrolithotomy (PCNL) in the literature is sparse. In this prospective randomized study, we aimed to compare the safety, efficacy, and perioperative complications of single step versus serial tract dilatation using Alken metal telescopic dilators during pediatric PCNL. Methods Patients undergoing PCNL were randomized into two groups according to the dilatation technique used. In group A, Alken telescopic serial metal dilatation was utilized, and in group B, single step dilatation was performed. Inclusion criteria included children < 18 years with stone burden from 2 to 4 cm, located in the renal pelvis ± one calyx, who were candidates for PCNL. The primary outcomes were access time and complications’ rate. The secondary outcomes were dilatation fluoroscopy time, operative duration, stone free rate, postoperative hospital stay, hemoglobin deficit, and need for blood transfusion. Both outcomes were evaluated and compared between both treatment groups. Results A total of 70 patients were randomized into group A (35 patients) and group B (35 patients). Access was successfully obtained in all procedures. All the procedures were performed through a single tract. Access time and dilatation fluoroscopy time were shorter in group B (statistically significant). Patients in group A had higher rate of complications (statistically significant). Intraoperative bleeding requiring blood transfusion was less in single track dilatation than serial metal track dilatation. Conclusions Compared to serial metal track dilatation, single step dilatation showed comparable operative time and stone free rate, with significantly reduced access time and dilatation fluoroscopy time.
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Fahmy A, Cirillo J, Rodriguez J, Paskavitz A, Sadhwani T, Waks JW, Manning WJ, Kramer DB, Nezafat R. EXPLAINABLE MACHINE LEARNING MODEL FOR RISK STRATIFICATION OF VENTRICULAR ARRHYTHMIA: A CARDIAC MRI STUDY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02172-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mansour R, El-Fayoumi HM, Fahmy A, Ibrahim IAAEH. Oleic acid acutely impairs glucose homeostasis in standard chow diet but not high-fructose, high-fat diet-fed mice by acting on free fatty acid receptor 1. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20710s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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El-Sayed SS, Shahin RM, Fahmy A, Elshazly SM. Quercetin ameliorated remote myocardial injury induced by renal ischemia/reperfusion in rats: Role of Rho-kinase and hydrogen sulfide. Life Sci 2021; 287:120144. [PMID: 34785193 DOI: 10.1016/j.lfs.2021.120144] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 10/24/2022]
Abstract
AIMS This study was designated to investigate the means through which quercetin confers its cardioprotective action against remote cardiomyopathy elicited by renal ischemia/reperfusion (I/R). Potential involvement of hydrogen sulfide (H2S) and its related mechanisms were accentuated herein. MAIN METHODS In anesthetized male Wistar rats, renal I/R was induced by bilateral renal pedicles occlusion for 30 min (ischemia) followed by 24 h reperfusion. Quercetin (50 mg/kg, gavage) was administered at 5 h post reperfusion initiation and 2 h before euthanasia. Cystathionine β-synthase (CBS) inhibitor, amino-oxyacetic acid (AOAA; 10 mg/kg, i.p) was given 30 min prior to each quercetin dose. KEY FINDINGS Quercetin reversed renal I/R induced derangements; as quercetin administration improved renal function and reversed I/R induced histopathological changes in both myocardium and kidney. Further, quercetin enhanced renal CBS content/activity, while mitigated myocardial cystathionine ɤ-lyase (CSE) content/activity as well as myocardial H2S. On the other hand, quercetin augmented myocardial nitric oxide (NO), nuclear factor erythroid 2-related factor 2 (Nrf2) and its nuclear trasnslocation, glutamate cysteine ligase (GCL), reduced glutathione (GSH) and peroxiredoxin-2 (Prx2), while further reduced lipid peroxidation measured as malondialdehyde (MDA) as well as nuclear factor-kappa B (NF-κB), caspase-3 content and activity, and Rho-kinase activity. SIGNIFICANCE Cardioprotective effects of quercetin may be mediated through regulation of Rho-kinase pathway and H2S production.
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Fouda K, Fahmy A, Aziz K, Aal MA, Naguib A, Nabi NA. Implant Stability Changes for a Single Implant Mandibular Overdenture. Eur J Dent 2021; 16:619-626. [PMID: 34879396 PMCID: PMC9507585 DOI: 10.1055/s-0041-1736416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives
To compare the changes in implant stability for the nonsubmerged and submerged protocols for a single-implant retained mandibular overdenture using Cendres and Metaux Locator attachment throughout a 24-month follow-up.
Materials and Methods
Eighty edentulous patients who were seeking to install a single implant in the midline of the completely edentulous mandible. At the day of implant installation, patients were randomized into two groups using sealed envelopes: the nonsubmerged and submerged groups. After 3 months of healing period, randomization using sealed envelopes was performed and patients were randomized to receive the Cendres and Metaux Locator attachment. The periotest readings were recorded using the Periotest M device, every 3 months for the first year and annually in the second year. The scope of this clinical trial focused only on results of the Cendres and Metaux attachment.
Statistical Analysis
The Mann–Whitney
U
-test was used for comparison between study groups for independent samples. Two-sided
p
-values less than 0.05 were considered statistically significant.
Results
There was no statistically significant difference between the mean periotest readings of both groups throughout the 24-month follow-up. Both groups showed an improvement in mean periotest readings with the submerged group tending to show greater stability at 6, 12, and 24-month follow-ups.
Conclusions
The nonsubmerged and the submerged healing protocols resulted in reliable periotest readings with the submerged group showing greater improvement than the nonsubmerged, although this improvement is nonsignificant when using the Cendres and Metaux attachment for a single mandibular overdenture.
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Fahmy A, Dawoud W, Badawy H, Youssif M, Kamal A, Elgebaly O. Optimum duration of ureteral prestenting dwelling time in children undergoing retrograde intrarenal surgery. J Pediatr Urol 2021; 17:845.e1-845.e6. [PMID: 34452828 DOI: 10.1016/j.jpurol.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/25/2021] [Accepted: 08/06/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Ureteral prestenting before retrograde intrarenal surgery (RIRS) causes passive dilatation of the ureter, improves stone-free rate and is associated with shorter operative time. However, the presence of a ureteric stent may increase the risk for septic complications, which accelerates with increased dwelling time duration. The aim of the present study is to explore the impact of ureteral prestenting timing in a group of children undergoing retrograde intrarenal surgery (RIRS) on perioperative outcomes and complication rates and to define the optimum duration of prestenting dwelling time. PATIENTS AND METHODS A retrospective study on 60 children aged less than 14 years, presented with upper tract urinary stones, who were subdivided into two groups: Group 1 and 2, each included 30 children who had undergone RIRS after ureteric stenting for two weeks and four weeks respectively. Success of ureteroscope introduction, operative time, stone free rate (SFR), intraoperative and postoperative complications and number of retreatment procedures after definitive RIRS were recorded and compared between the two treatment groups. RESULTS Ureteric access was successfully obtained in all children in both groups. Patients in group 1 and 2 had a SFR of 86.6% and 90%, respectively (p = 0.199). The mean operative time of group 1 and 2 were 56.5 and 52.9 min (p = 0.612). Postoperative UTI rates increased with prolonged dwelling time from 6.7% in group 1 to 30% in group 2. No patient in both groups developed high grade complications. CONCLUSIONS Increasing prestenting dwelling time from two to four weeks had no statistically significant effect on the successful ureteroscopic access nor the stone free rate in children undergoing RIRS. Reducing the ureteric stent dwelling time minimizes the rate of postoperative UTI without compromising the success of operative outcomes.
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Dawood W, Youssif M, Badawy H, Ghozlan A, Orabi S, Fahmy A. Laparoscopic staged management of high intrabdominal testis: A prospective randomized study. J Pediatr Surg 2021; 56:2385-2391. [PMID: 33814186 DOI: 10.1016/j.jpedsurg.2021.02.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To prospectively compare outcomes and complications of both staged laparoscopic techniques used in management of high intrabdominal testis (IAT). MATERIALS AND METHODS Forty five patients were included in the study in whom unilateral high IAT were identified and were subjected to two-stage laparoscopic orchiopexy. Patients were prospectively randomized into two groups according to laparoscopic technique in use; either two stage Fowler-Stephens laparoscopic orchiopexy (FSLO) or staged laparoscopic traction orchiopexy (SLTO). Intraoperative evaluation for the distance of the testis from the internal ring, state of the internal ring (closed or open), operative time (min), intraoperative and early postoperative complications were recorded after first stage. Surgical outcomes of both techniques included operative time, intraoperative complications, success rate, final scrotal site position, testicular size and vascularity, and these were recorded within 48h of the second stage procedure and at 6 month follow-up. RESULTS Staged FSLO was performed on 25 testes. Four cases were lost during follow up. Out of these 21 cases, one child had an atrophic testis before the second stage based on previously recorded operative size. SLTO was done on 20 testes. We had 2 cases of fixation suture slippage rendering a total of 18 patients who underwent second stage operation. No patients converted from laparoscopic to open surgery. At 6 month follow-up visits, 27 testes were found on examination to have a low scrotal position, (14 in the FSLO group and 13 in the SLTO group), 9 testes in high scrotal position (5 in the FSLO group and 4 in the SLTO group). Testicular ascent occurred in one patient in each group. Testicular atrophy was identified in 3 cases among the FS group, while no case of testicular atrophy occurred in the traction group of patients (p = 0.048). CONCLUSIONS Both staged laparoscopic techniques had comparable success rates as regard final scrotal position for high undescended IAT in children, and were associated with no intra or post operative complications. SLTO had a better outcome as it was not associated with any testicular atrophy compared to FSLO at 6 months follow up.
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Fahmy A, Saad K, Sameh W, Elgebaly O. Planned percutaneous nephrolithotomy in patients who initially presented with urosepsis: Analysis of outcomes and complications. Arab J Urol 2021; 20:36-40. [PMID: 35223108 PMCID: PMC8881061 DOI: 10.1080/2090598x.2021.2002635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To compare the outcomes and complications of planned percutaneous nephrolithotomy (PCNL) in patients with a prior urosepsis episode to those without. Patients and Methods We recorded patients who presented initially with obstructive urosepsis, as identified by systemic inflammatory response syndrome and obstructing kidney stones. We compared the surgical outcomes and complications among those patients who had planned PCNL after control of prior urosepsis with urgent decompression and antibiotics (Group A) to a group who presented for PCNL with no previous history of a septic presentations (Group B). A 1:1 matched-pair analysis was performed using four parameters (age, gender, body mass index, and American Society of Anesthesiologists classification) to eliminate potential allocation bias. Primary outcomes included were stone-free rate (SFR) and complication rate. Secondary outcomes included were operative time, estimated blood loss, and duration of postoperative hospital stay. Results A total of 80 patients underwent PCNL (48 male and 32 females) divided equally between both treatment groups, with a mean (interquartile range) age of 47 (19–75) years. There were no differences in demographic data or stone characteristics between both groups. Both groups had comparable SFRs (92.5% vs 97.5%, P = 0.212) and mean operative time (77 vs 74 min, P = 0.728) (Table 2). Patients in Group A had a significantly higher overall complications rate (35% vs 10%, P = 0.03) . There were no postoperative mortalities and the mean length of hospital stay was significantly longer in Group A patients compared to group B (4.2 vs 1.5 days, P = 0.042). Conclusions : Planned PCNL after decompression for urolithiasis-related sepsis has comparable operative time and SFR but higher complication rates and longer postoperative hospital stay. This is critical in counselling patients prior to definitive treatment of kidney stones after urgent decompression for urosepsis and for adequate preoperative planning and preparation. Abbreviations: ASA: American Society of Anesthesiologists; BMI: body mass index; ICU: intensive care unit; IQR: interquartile range; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; PCN: percutaneous nephrostomy; PCNL: percutaneous nephrolithotomy; SFR: stone-free rate; URS; ureteroscopy; US: ultrasonography
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Badawy H, Dawood W, Soliman A, Fahmy A, Mahfouz W, Moussa A, Assem A, Eid A, Elsayed S, Gawan A, Hanno A, Youssef M. Reply to letter to the editor: Staged repair of proximal hypospadias-reporting outcome of staged tubularized autograft repair (STAG). J Pediatr Surg 2021; 56:2124. [PMID: 34229877 DOI: 10.1016/j.jpedsurg.2021.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
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Laurent E, Saleh M, Vusirikala A, Castillo T, Kuzhupilly R, Fahmy A, Tsekes D. 741 Restarting Elective Orthopaedic Surgery During The COVID-19 Pandemic: Experiences and Patient Outcomes. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The COVID-19 pandemic resulted in postponing all non-urgent elective surgeries from April 2020. As we emerged from the first peak, restarting non-urgent services such as elective orthopaedic surgery was important for patients with chronic debilitating conditions. Our hospital successfully restarted orthopaedic surgery during the pandemic to help improve the quality of life of patients. This study describes the development of local protocols and pathways to allow for a safe restart of elective orthopaedic surgery in a COVID-19 free site. It presents the morbidity and mortality outcomes of those patients.
Method
This is a prospective cohort study evaluating all patients undergoing non-emergency orthopaedic procedures through a COVID-19 free pathway in a DGH from 18th May – 10th July 2020. 104 patients were identified, and their outcomes analysed during the 2 weeks following their surgery.
Results
No patients developed COVID-19 in the 2-weeks post-operative period. There were no ITU admissions or in-hospital deaths. 22(21.15%) out of 104 patients developed 23 complications within 2 weeks of surgery. These included: TIA, PE, AF, superficial wound infection, oozy wound and post-operative anaemia. They all made full recovery. There was no statistical difference in the development of complications for age (< 70; >70), gender, BMI, or ASA grades.
Conclusions
This study describes a roadmap to setting up a protocolised elective operating service for orthopaedic surgery. It has shown that standardised protocols in a COVID-19 free site, pre-operative COVID-19 testing and adherence to national guidelines on self-isolation prior to surgery can help prevent COVID-19 infection and its related risks post-operatively.
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Addison P, Weinstein J, Zarif D, Fahmy A, Grodstein E, Lau L. Therapeutic Lymphangiography for Persistent Lymphatic Leak After Kidney Transplant: A Novel Technique. EXP CLIN TRANSPLANT 2021; 20:768-770. [PMID: 34498555 DOI: 10.6002/ect.2021.0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lymphatic leakage is a common and well-described complication after kidney transplantation, occurring in up to 25% of patients. Accumulation of lymph is due to the surgical disruption of recipient lymphatic channels accompanying the external iliac vessels, complicated by lower extremity edema, wound breakdown, infection, and, if unresolved, graft loss due to extrinsic compression. In this report, we describe the novel use of diagnostic and therapeutic lymphangiography to successfully treat lymphatic leak after renal transplant that was resistant to drain placement, sclerotherapy, and laparoscopic peritoneal window creation. We also describe the methodology, indications, and contraindications and conclude that this technique is well-tolerated and offers a good option for complex lymph leaks that do not respond to conventional treatment. Further studies are required to compare its efficacy with other standard methods, including sclerotherapy and laparoscopic peritoneal fenestration, as the primary treatment modality.
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Fahmy A, Elgebaly O, Elsawy MM, Orabi S. Role of tadalafil in enhancing visualization of posterior urethra prior to combined voiding cystourethrogram and retrograde urethrogram: a retrospective analysis. Abdom Radiol (NY) 2021; 46:4332-4337. [PMID: 33983471 DOI: 10.1007/s00261-021-03109-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To show utility of tadalafil in enhancing visualization of posterior urethra in patients with urethral stricture. METHODS We retrospectively reviewed the records of adults male who failed to delineate the posterior urethra while undergoing combined voiding cystourethrogram and retrograde urethrogram (VCUG and RUG), as a part of preoperative assessment of stricture length and location before urethral reconstruction. The study was repeated 24 h later after a single dose of tadalafil 20 mg was administrated 2 h before the procedure (Tadalafil group). A control group who did not receive any medication was used for comparison (control group). This study was carried out in between March 2016 and August 2019. RESULTS Thirty patients were included in the tadalafil group and equal number of patients was used as control group for comparison. The etiologies of strictures were pelvic fracture urethral distraction defect (39 patients), bulbar stricture with complete obliteration (15 patients) and post catheterization (6 patients). Success rate of opening bladder outlet on initiation of voiding was 90% in tadalafil group and 40% in the control group (P = 0.0004). None of the men reported any serious adverse events after oral administration of the drug. Almost all AEs were mild and well-tolerated. CONCLUSION Tadalafil effectively relaxes the bladder neck and the posterior urethra prior to combined VCUG and RUG in urethral stricture patients. Tadalafil was safe with no serious adverse effects when administered prior to performing the test. This prevents the patients from undergoing further invasive or expensive diagnostic techniques, moreover, tadalafil assisted in preoperative surgical preparation and patient's counseling.
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El-Fayoumi S, Mansour R, Mahmoud A, Fahmy A, Ibrahim I. Pioglitazone Enhances β-Arrestin2 Signaling and Ameliorates Insulin Resistance in Classical Insulin Target Tissues. Pharmacology 2021; 106:409-417. [PMID: 34082428 DOI: 10.1159/000515936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pioglitazone is a thiazolidinedione oral antidiabetic agent. This study aimed to investigate the effects of pioglitazone as insulin sensitizer on β-arrestin2 signaling in classical insulin target tissues. METHODS Experiments involved three groups of mice; the first one involved mice fed standard chow diet for 16 weeks; the second one involved mice fed high-fructose, high-fat diet (HFrHFD) for 16 weeks; and the third one involved mice fed HFrHFD for 16 weeks and received pioglitazone (30 mg/kg/day, orally) in the last four weeks of feeding HFrHFD. RESULTS The results showed significant improvement in the insulin sensitivity of pioglitazone-treated mice as manifested by significant reduction in the insulin resistance index. This improvement in insulin sensitivity was associated with significant increases in the β-arrestin2 levels in the adipose tissue, liver, and skeletal muscle. Moreover, pioglitazone significantly increased β-arrestin2 signaling in all the examined tissues as estimated from significant increases in phosphatidylinositol 4,5 bisphosphate and phosphorylation of Akt at serine 473 and significant decrease in diacylglycerol level. CONCLUSION To the best of our knowledge, our work reports a new mechanism of action for pioglitazone through which it can enhance the insulin sensitivity. Pioglitazone increases β-arrestin2 signaling in the adipose tissue, liver, and skeletal muscle of HFrHFD-fed mice.
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Singer PS, Sethna C, Molmenti E, Fahmy A, Grodstein E, Castellanos‐Reyes L, Fassano J, Teperman L. COVID-19 infection in a pediatric kidney transplant population: A single-center experience. Pediatr Transplant 2021; 25:e14018. [PMID: 33813782 PMCID: PMC8250351 DOI: 10.1111/petr.14018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/03/2021] [Accepted: 03/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The clinical course of SARS-CoV-2 in the pediatric kidney transplant population is not well described. METHODS We performed a retrospective cohort study of a pediatric kidney transplant population at a New York transplant center. Baseline characteristics and clinical course of patients with SARS-CoV-2 positivity (Ab or PCR) were described, and comparison between COVID-positive and COVID-negative transplant patients was performed. RESULTS Twenty-two patients had COVID-19 IgG testing performed, eight of whom also had PCR testing. 23% of our cohort had evidence of COVID-19 infection. Four patients had positive IgG only, and one patient had a positive PCR. All five patients with a positive COVID test were female. Two patients had COVID-19 symptoms, which were mild. Of the symptomatic patients, one had a positive PCR at time of symptoms, while the other had a negative PCR during symptoms but subsequently had positive IgG. As compared to patients with COVID-19 negative results, those with COVID-19 positivity were significantly more likely to have a known COVID-19 exposure, and were also more likely to be female. There was no significant difference in time from transplant between the groups. Those in the COVID-positive group had higher baseline antimetabolite dose and CNI troughs, although these did not reach statistical significance. CONCLUSIONS Pediatric kidney transplant recipients are at risk for development of COVID-19 infection. While this population may be more at risk for SARS-CoV-2 infection due to their immunosuppressed status, their clinical course appears mild and similar to a healthy pediatric population.
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Zhran M, Moursy A, Lynn TM, Fahmy A. Effect of urea fertilization on growth of broad bean (Vicia faba L.) under various nickel (Ni) levels with or without acetic acid addition, using 15N-labeled fertilizer. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:2423-2431. [PMID: 32926286 DOI: 10.1007/s10653-020-00707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
Although nickel (Ni) has direct relationship with nitrogen metabolism of plants, the high dose of Ni fertilizer in broad bean plants may affect the nitrogen use efficiency (NUE), impair plant development and even cause Ni pollution in soil. Thus, a pot experiment was set up to study the effect of urea fertilization on N-uptake, root and shoots' Ni content as well as growth of broad bean plants under different levels of Ni, using 15N tracer technique. 15N-labeled urea (5% 15N atom excess) was added at three doses (0, 30 and 60 mg N kg-1 soil). Nickel sulfate (NiSO4) was also applied at three levels (0, 50 and 100 mg Ni kg-1 soil). The experiment was laid out with or without acetic acid in randomized complete block design in three replicates. Treatment with the addition of 60 mg N + 50 mg Ni showed the highest values in dry weights of root and shoots, N-uptake by shoots, nitrogen derived from fertilizer (Ndff %) and NUE % by shoots in both with or without acetic acid solution. Higher rate of Ni addition can decrease shoot and root biomass by inhibiting the ability of the plant to uptake the nitrogen efficiently. However, addition of acetic acid solution induced the improvement of NUE % and Ndff % by shoot and root of broad bean plants. This study provides insight into how to improve plant yield without damaging the soil health and will be helpful to create a better world with sustainable agriculture.
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Dawood W, Youssif M, Badawy H, Ghozlan A, Orabi S, Fahmy A. Laparoscopic staged management of high Intrabdominal testis: A prospective randomized study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kundu A, Fahmy A, Madler R, Otto K, Patrick E, Principe J, Maghari N, Bashirullah R. A multi-channel peripheral nerve stimulator with integrate-and-fire encoding. J Med Eng Technol 2021; 45:187-196. [PMID: 33729074 DOI: 10.1080/03091902.2021.1891311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Activation of peripheral nervous system (PNS) fibres to produce variable tactile and proprioceptive sensations in advanced bidirectional prosthetic limbs relies on neural stimulators with high spatial selectivity, dynamic range and resolution. A multi-channel application-specific integrated circuit (ASIC) is developed for PNS fibre activation using a wide dynamic range (10 nA-5 mA), high-resolution (30 nA step, 100 ns pulse accuracy) current stimulator, dissipating 0.73-2.75 mW at 3 V. The ASIC also enables encoding of external pressure signals via an integrate-and-fire methodology. Electrophysiological data of compound nerve action potentials were recorded for a range of stimulus amplitudes and pulse widths. This data was used to benchmark the performance of the ASIC with a known neural stimulator.
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Soliman E, Shewaikh SM, Fahmy A, Elshazly S. Entacapone scavenges peroxynitrite and protects against kidney and liver injuries induced by renal ischemia/reperfusion in rats. Int Urol Nephrol 2021; 53:1713-1721. [PMID: 33675481 DOI: 10.1007/s11255-021-02827-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute kidney injury (AKI), secondary to renal ischemia/reperfusion (I/R), is a serious problem associated with high mortality. The pathophysiology of AKI after renal I/R involves peroxynitrite production; hence, scavenging this metabolite may rescue AKI. Entacapone is a catechol-O-methyl transferase (COMT) inhibitor which elicits antioxidant activity by scavenging peroxynitrite. Therefore, we hypothesized that the peroxynitrite scavenging activity of entacopone protects against AKI after renal I/R injury in rats. METHODS Male Wistar rats were given either entacapone or a well-known peroxynitrite scavenger (FeTPPS) daily for 10 days before I/R procedures. I/R was induced by occluding both renal pedicles for 45 min followed by reperfusion for 24 h. RESULTS Pre-treatment with either entacapone or FeTPPS improved renal function as indicated by a significant reduction in serum creatinine and urea when compared to I/R group (P < 0.05). I/R injury increased renal levels of NO (4-folds, P < 0.05), iNOS (4-folds, P < 0.05), and 3-nitrotyrosine (5-folds, P < 0.05) compared to sham control. These effects were abrogated in animals pre-treated with entacapone or FeTPPS before being subjected to I/R (P < 0.05). In addition, entacapone or FeTPPS significantly inhibited I/R-induced elevation in renal TNF-α levels (78% and 58%, respectively) and caspase-3 activity (72% and 56%, respectively) indicating the reduction of both inflammation and apoptosis in the kidney (P < 0.05). The two drugs also improved kidney and liver functions in rats with renal I/R injury. CONCLUSION Our study showed that entacapone and FeTPPS protected against AKI and remote liver damage associated with renal I/R and this effect might be due to scavenging peroxynitrite and reducing nitrosative stress.
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