Zagazig University Research Articles

Optimizing geriatric palliative care in Egypt: Comprehensive patient and family perspectives.

In Egypt, palliative care for geriatric patients is understudied, necessitating exploration for service optimization. Amidst rising chronic illnesses and aging, understanding perspectives of geriatric patients and families is crucial for targeted improvements. This study aims to explore geriatric patients' and their families' perspectives on palliative care in Egypt, seeking opportunities to optimize service delivery for the elderly. Employing a cross-sectional design with 110 geriatric patients and an equal number of family caregivers from the Damietta Oncology Institute and the pain treatment clinics for cancer patients at Zagazig University Hospital, the study focuses on a specialized pain clinic. Validated tools (Palliative Care Outcome Scale, Family Satisfaction with End-of-Life Care [FAMCARE] Scale, Edmonton Symptom Assessment System [ESAS], Caregiver Strain Index [CSI]) assess quality of life, family satisfaction, symptom severity, and caregiver strain. Geriatric patients (mean age: 65.0 ± 8.1 years; 45.5% male, 55.5% female) have diverse diagnoses (e.g., breast cancer 22%). Palliative care outcomes reveal challenges: low emotional well-being (2.6 ± 0.0) and alarming overall quality of life (1.8 ± 0.0). Family dissatisfaction (FAMCARE) is pervasive (total mean score 2.6 ± 0.5). Symptom severity (ESAS) is high, and caregiver strain (CSI) is notable (8.5 ± 2.2). The findings underscore the significance of the challenges faced by geriatric patients and caregivers in palliative care. Patients confront considerable symptom burdens and emotional distress, while caregivers experience notable strain. Urgently needed are targeted interventions designed to enhance patient well-being, alleviate caregiver burden, and elevate satisfaction. The critical importance of implementing these interventions promptly is highlighted, as they are instrumental in improving the overall care experience for geriatric patients and their caregivers. Moreover, the results underscore the imperative of developing comprehensive support mechanisms to address the intricate dimensions of palliative care, ultimately contributing to a more compassionate and effective care continuum.

The possible utility of global longitudinal strain in the risk-stratifying process of non-ST elevation-acute coronary syndrome.

There are various ways that coronary artery disease (CAD) might present itself. Individual risk stratification for non ST-elevation-acute coronary syndrome (NSTE-ACS) patients should determine whether invasive coronary angiography and revascularization should be scheduled. To assess the possible utility of left ventricular global longitudinal strain in the risk-stratifying process of NSTE-ACS. The cardiology department of Zagazig University in Egypt organized and oversaw this cross-sectional study. The practical portion was carried out on 90 patients with NSTE-ACS based on European society of cardiology (ESC) guidelines (and they agreed for invasive strategy) between May 2019 and December 2020 at Salalah Heart Center in Sultanate of Oman. All patients underwent a full clinical examination, 12-lead ECG, and serial high-sensitivity troponin T (hs-TnT) in addition to a thorough history taking process. On patient's admission, the GRACE risk score was assessed. All patients who were suspected of having NSTE-ACS upon admission underwent transthoracic echocardiography, including two-dimensional speckle tracking (2D-ST). Left ventricular global longitudinal strain (LV-GLS %) was measured and analyzed using 2D speckle tracking. SYNTAX Score was determined for all patients. By analysis of the performance of LV-GLS% in prediction of high risk by GRACE score, we found that with cutoff (≥-13.8), the AUC was (0.944) with sensitivity, specificity, PPV, NPV, and accuracy (0.944, 93.3%, 84%, 53.8%, 98.4%, 85.6%), respectively. Global longitudinal strain can predict accurately high-risk NSTE-ACS patients by GRACE score.

Epstein-Barr Virus Promotes Tumorigenicity and Worsens Hodgkin Lymphoma Prognosis by Activating JAK/STAT and NF-κB Signaling Pathways.

Epstein-Barr virus (EBV) is detected in 40% of patients with Hodgkin lymphoma (HL). During latency, EBV induces epigenetic alterations to the host genome and decreases the expression of pro-apoptotic proteins. The present study aimed to evaluate the expression levels of mRNA molecules and the end product of proteins for the JAK/STAT and NF-κB pathways, and their association with clinicopathological and prognostic parameters in patients with EBV-positive and -negative classical Hodgkin lymphoma (CHL). A prospective cohort study was conducted from 2017 to 2022 at the Faculty of Medicine, Zagazig University Hospital (Zagazig, Egypt). Biopsy samples of 64 patients with CHL were divided into EBV-positive and EBV-negative groups. The expression levels of mRNA molecules (JAK2, STAT1, IRF-1, PD-L1, IFN-γ, NF-κB, Bcl-xL, COX-2) and the end product of proteins (PD-L1, Bcl-xL, COX-2) were determined and compared with clinicopathological and prognostic parameters. Data were analyzed using the Chi square test and Kaplan-Meier estimate. EBV-positive CHL patients were significantly associated with positive expression of mRNAs molecules (P<0.001) and the end product of proteins (P<0.001) for the JAK/STAT and NF-κB pathways, B-symptoms (P=0.022), extra-nodal involvement (P=0.017), and advanced stage of CHL (P=0.018). These patients were more susceptible to cancer progression, higher incidence of relapse (P=0.008), poor disease-free survival rate (P=0.013), poor overall survival rate (P=0.028), and higher mortality rate (P=0.015). Through the activation of JAK/STAT and NF-κB signaling pathways, EBV-positive CHL is associated with poor clinicopathological parameters, higher incidence of disease progression, relapse, and poor overall survival. A preprint of this manuscript is available on research square (doi: 10.21203/rs.3.rs-1857436/v1).

The Role of Sputum Clusterin in Childhood Asthma in Zagazig University ‎Hospitals: A case control Study.‎

The Role of Sputum Clusterin in Childhood Asthma in Zagazig University ‎Hospitals: A case control Study.‎

Design, Installation, and Performance Monitoring of a 105 kWp Rooftop Solar PV System

Rooftop Solar PV systems are gaining growing attention on the path toward carbon neutrality. Hence, a great effort must be exerted to ensure smooth and efficient penetration of such systems into the existing utility grids. In the current work, a 105 kWp rooftop solar system is designed and installed to fulfil part of the electric demand of the faculty of Engineering, Zagazig University, Egypt. The performance parameters of this grid-connected solar PV system are optimized for the least-cost of electricity supply through using industry-standard software NREL SAM. For the current rooftop system, fixed orientation of an optimized tilt angle of 23 degrees is preferred over sun-tracking systems due to the reduced operating and maintenance costs. The annual energy production of the system is 175,700 kWh with a capacity factor of 19.1%. Through using parametric optimization and inter-connected financial analysis algorithms, it was possible to define the least cost for the electricity supplied to the grid to be 0.55 EGP/kWh, which achieves grid parity in Egypt. The project is finically profitable without any subsidy, with a discounted payback period of 7.9 years, and IRR (on equity) of 20.1 % and saves 1882-ton CO2 over its lifetime. Sensitivity analysis showed that the electricity escalation rate greatly enhances the project finances. In the first year of operation, the system performed fairly well compared with the theoretical design, provided that the system is frequently cleaned (at least once a week) and continuously connected.

Assessment of carbapenem resistant Klebsiella pneumoniae in intensive care unit of Zagazig University Hospitals

Assessment of carbapenem resistant Klebsiella pneumoniae in intensive care unit of Zagazig University Hospitals

Pathological, histochemical, and immune-histochemical studies on some canine-skin neoplasm at Sharkia province, Egypt.

Cutaneous neoplastic disorders are often observed in small mammal pets, such as dogs, regardless of their gender. An important objective of this work was to give a full account of the clinical, pathological, and immune-histochemical features of several skin tumors in dogs. This study was a case series in the hospital clinic, Faculty of Veterinary Medicine, Zagazig University, Egypt. Twenty-five dogs (14 males and 11 females) were examined clinically during the period from March 2022 to October 2023. The skin swelling was collected from affected animals and then subjected to a detailed histopathological study to record the different gross and microscopic findings and confirm the diagnosis by immunohistochemistry. Skin neoplasia in dogs was exposed to various clinical signs, and the dogs' ages ranged between 3 and 11 years. Concerning tumor features, the majority of neoplasms were malignant (65.52%) more than benign (34.48%). The study revealed the presence of 29 cases of dogs showed neoplasia with different prevalence rates including squamous cell carcinoma (13.79%), mast cell tumor (6.89%), basal cell tumors (10.34%), histiocytoma (6.89%), trichoepithelioma (10.34%), transmissible venereal tumor (10.34%), trichilemmoma (3.44%), scalp paraganglioma (3.44%), pilomatricoma (10.34%), malignant melanomas (17.24%), and miscellaneous cases as fat necrosis (6.89%), in males and females dogs with different histopathological lesions and immunohistochemistry expressions for pan-cytokeratin (CK), melanocyte-differentiation antigens (S100 protein), and synaptophysin. Malignant melanomas (17.24%) are the extremely common cutaneous tumors diagnosed in this study. Meanwhile, benign tumors such as trichilemmoma, trichoepithelioma, pilomatricoma, and paraganglioma are less frequent in dogs.

Autistic Traits in Patients with Obsessive-Compulsive Disorder at Zagazig University Hospitals

Autistic Traits in Patients with Obsessive-Compulsive Disorder at Zagazig University Hospitals

Time management and Academic Stress of Nursing Students at Faculty of Nursing Zagazig University

Time management and Academic Stress of Nursing Students at Faculty of Nursing Zagazig University

Internet Addiction among Zagazig University Students and Its Association with Mental Health Using Arabic Version of Depression Anxiety Stress Scale

Internet Addiction among Zagazig University Students and Its Association with Mental Health Using Arabic Version of Depression Anxiety Stress Scale

Prevalence and outcome of inborn errors of metabolism among high-risk neonates: an Egyptian single-center study

Background Inborn errors of metabolism (IEM) are genetic disorders caused by incompetence in enzymatic reactions of intermediary metabolism due to an insufficient amount or unstable form of the involved enzyme. Aim To assess the prevalence and outcome of IEM among high-risk neonates for early diagnosis and detection of treatable causes to minimize morbidity and mortality rate in neonates. Methods This cross-sectional study was carried out on 684 neonates at the Neonatal Intensive Care Unit in the Pediatrics Department at Zagazig University Children’s Hospital from February 2020 to February 2023. Extended metabolic screen (EMS) was done for full-term neonates and preterm of more than 32 weeks of gestation. Further investigations such as plasma ammonia, plasma lactate, urine organic acid analysis, blood gas, serum anion gap, and the blood glucose level were also measured. Results The prevalence of IEM was 4.4%. The most common presentations among the cases of IEM were not doing well, respiratory distress, encephalopathy, and convulsion. As regards provisional diagnosis, 11 cases were diagnosed as maple syrup urine disease, 5 cases with glycine encephalopathy, 5 cases with medium-chain acyl CoA dehydrogenase deficiency,4 cases with methylmalonic acidemia, 2 cases with isovaleric acidemia, 2 cases with citrullinemia type 1, and one case with propionic academia; 12 (40%) of IEM cases died. Conclusion IEM disorders are not rare diseases in high-risk neonates with attention to consanguinity, which is a common tradition in our country. The delay in diagnosis of IEM leads to high morbidity and mortality.

Cardiac affection in lysosomal storage disorders and effect of enzyme replacement therapy

Background Cardiac dysfunction is a serious problem in the majority of lysosomal storage diseases (LSDs), emerges silently, and contributes significantly to early mortality. Aim To detect the cardiac affection of LSDs and to evaluate the effectiveness of enzyme replacement therapy. Patients and methods This cross-sectional study was conducted on 30 children with a confirmed diagnosis of LSDs, who were under enzyme replacement therapy at the Pediatric Metabolic and Genetic Clinic of Zagazig University Children Hospital during the period of 6 months from June 2022 to December 2022. An echocardiographic examination was conductede for all patients before and after treatment. Results Ejection fraction (EF) was significantly increased after treatment than before treatment (P value &lt;0.001). In the MPS IV (Morquio) group, valvular lesions, ventricular hypertrophy, and pulmonary pressure were insignificantly different between the studied children before and after treatment. Conclusion Ejection fraction in the MPS IV (Morquio) group was significantly improved after treatment than before treatment.

Inferior vena cava collapsibility index as a predictor of hypotension after induction of general anesthesia in hypertensive patients

BackgroundHypertensive patients are more susceptible to develop hypotension after the induction of general anesthesia (GA), most likely due to hypovolemia. An inferior vena cava collapsibility index (IVCCI) > 40–50% can predict hypotension after the induction of GA in the general population by variable accuracies. The current study aimed to investigate IVCCI% as a predictor of postinduction hypotension in hypertensive patients undergoing noncardiac surgery.MethodsUltrasound IVCCI % was assessed for all controlled hypertensive patients immediately before induction of GA. After induction of GA, patients were diagnosed with postinduction hypotension if their systolic arterial pressure (SAP) dropped by ≥ 30% of the baseline value and/or mean arterial pressure (MAP) dropped to < 65 mmHg up to 15 min after intubation. The receiver operating characteristic (ROC) curve of IVCCI% was compared to patients’ classification either developing hypotension after induction of GA or not as a gold standard.ResultsOf the 153 patients who completed the study, 62 (40.5%) developed hypotension after the induction of GA, and 91 (59.5%) did not. An IVCCI > 39% predicted the occurrence of postinduction hypotension with high accuracy (84%) (AUC 0.908, P < 0.001). The area of uncertainty (by gray zone analysis) of IVCCI lies at values from 39 to 45%. This gray zone included 21 patients (13.7% of all patients).ConclusionAn inferior vena cava collapsibility index > 39% before anesthetic induction can be a simple noninvasive reliable predictor of hypotension after the induction of GA for hypertensive patients not treated with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and undergoing noncardiac surgery.Trial registrationThis clinical trial was approved by the Institutional Review Board (IRB) at Zagazig University (ZUIRB #9424 dated 03/04/2022), and patients’ informed consent for participation in the study was obtained during the period from May 2022 to May 2023. All study procedures were carried out in accordance with the ethical standards of the Helsinki Declaration of 2013.

Added Value of Diffusion Weighted Magnetic Resonance Imaging in ‎evaluation of Perianal Fistula at Zagazig University Hospitals

Added Value of Diffusion Weighted Magnetic Resonance Imaging in ‎evaluation of Perianal Fistula at Zagazig University Hospitals

Epidural nalbuphine versus dexmedetomidine as adjuvants to bupivacaine in lower limb orthopedic surgeries for postoperative analgesia: a randomized controlled trial

BackgroundAdministration of adjuvant drugs epidurally in combination with local anesthetics offers new dimensions in the management of postoperative pain. This study aimed to compare the addition of either nalbuphine or dexmedetomidine to epidural bupivacaine for postoperative analgesia in lower limb orthopedic surgeries under combined spinal-epidural anesthesia.MethodsThis prospective randomized double-blind study included 69 patients scheduled for lower limb orthopedic surgeries. Anesthesia was started with 15 mg hyperbaric bupivacaine 0.5% intrathecally, and then an epidural bolus dose of 12 ml (10 ml 0.25% bupivacaine with 2 ml normal saline in group C, 2 ml (10 mg) nalbuphine in group N or dexmedetomidine 2 ml (100 µg) in group D was administered when sensory regression to T10. Postoperatively, when visual analogue scale (VAS) was ≥ 3, an epidural top-up dose of 8 ml (6 ml 0.25% bupivacaine plus 2 ml normal saline in group C, 2 ml (2 mg) nalbuphine in group N or 20 µg dexmedetomidine (2 ml) in group D was given. The primary outcome was to evaluate the duration of postoperative analgesia and secondary outcomes were any side effects and patient satisfaction.ResultsThe onset of epidural analgesia was 17.83 ± 2.53 versus 13.39 ± 1.27 versus 12.17 ± 1.27 min in groups C, N and D, respectively (p value < 0.001). The mean duration of analgesia was 241.3 ± 14.24 versus 318.38 ± 22.54 versus 365.87 ± 18.01 min in groups C, N and D, respectively (p value < 0.001). The mean sedation score was less in group C than group N and D (P < 0.001). The patient satisfaction score showed the lowest degree of satisfaction in group C (p value < 0.001). Top-up doses consumed and total analgesic requirements were lower in groups N and D than in group C. There was a statistically significant difference between the studied groups regarding VAS over time (p value < 0.001), intraoperative bradycardia (p value 0.029), and shivering (p value 0.029).ConclusionThe addition of either nalbuphine or dexmedetomidine to epidural bupivacaine was effective for postoperative analgesia in terms of onset, duration, and patient satisfaction with the superiority of dexmedetomidine over nalbuphine.Trial registrationApproval from the research ethics committee of the Faculty of Medicine, Zagazig University was obtained with the reference number (ZU-IRB#:7045-15-8-2021) and it was registered under clinicaltrials.gov (NCT05041270) on registration date 13/09/2021.

Pattern of Acute Poisoning Exposure Before, During and After the COVID-19 Pandemic: A Retrospective Study at Poison Control Centre- Zagazig University Hospitals

Pattern of Acute Poisoning Exposure Before, During and After the COVID-19 Pandemic: A Retrospective Study at Poison Control Centre- Zagazig University Hospitals

Postmenopausal Health Maintenance Among Zagazig University Employees; Gap Between Reality and Expectation

Postmenopausal Health Maintenance Among Zagazig University Employees; Gap Between Reality and Expectation

Alexithymia, resilience and suicidal ideation among patients with obsessive–compulsive disorder

BackgroundObsessive–compulsive disorder (OCD) is a psychiatric illness with a considerable risk of alexithymia, and suicide may make this risk worse. This study aimed to assess alexithymia, resilience, and suicidal ideation among patients with obsessive–compulsive disorder. A cross-sectional study was established at the psychiatric outpatient clinic at Zagazig University Hospitals in addition to Abbasyia Hospital for Mental Health in Cairo City. A purposive sample of 140 obsessive–compulsive patients. Five tools were used for data collection, including the socio-demographic questionnaire, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Toronto Alexithymia Scale (TAS-20), the Resilience Scale, and the Scale for Suicidal Ideation (SSI).ResultsThe study findings demonstrated that in excess of two-thirds of the studied subjects had mild obsessive–compulsive disorder, slightly more than two-thirds of them suffered from alexithymia, more than half of patients had a moderate level of resilience, and the majority of them had suicidal ideation. Patients’ obsessive–compulsive score was a statistically significant positive predictor for suicidal ideation.ConclusionsA positive and significant correlation was found between patients’ obsessive–compulsive scores and both alexithymia and suicidal ideation scores. Negatively significant correlations were found between resilience and each patient’s obsessive–compulsive score, alexithymia, and suicidal ideation. Therefore, it is recommended implementing longitudinal studies to establish the causality between OCD Sufferers’ resilience, alexithymia, and ideations of suicide.

Role of serum biomarkers in predicting management strategies for acute pulmonary embolism

BackgroundAcute pulmonary embolism (APE) is a condition that can be fatal. The severity of the disease influences therapeutic decisions, and mortality varies significantly depending on the condition's severity. Identification of patients with a high mortality risk is crucial. Since inflammation, hemostatic, and coagulation abnormalities are linked to APE, serum biomarkers may be helpful for prognostication. AimTo evaluate the significance of serum biomarkers in APE risk assessment and the suitability of these biomarkers for management and decision-making. MethodsThis study involved 60 adult patients with APE who were divided according to risk categorization. It was conducted in Chest, Cardiology and Internal Medicine department, Zagazig University Hospitals from December 2022 to May 2023. Several hematological biomarkers and their significance in APE risk assessment were measured with a comparison with the latest risk stratification methods which include haemodynamic measures and right ventricular (RV) dysfunction echocardiographic markers. ResultsEach risk group involved 20 patients (high, intermediate (10 were intermediate-high and 10 were intermediate-low) and low risk group). They were 34 females and 26 males with the mean ± SD of their age was 59.25 ± 13.06 years. Regarding hematological biomarkers, there were statistically significant differences as regards; lymphocytes, platelet to lymphocyte ratio (PLR), albumin, blood urea nitrogen (BUN), C-reactive protein (CRP) and D-dimer with highly statistically significant differences as regards; neutrophil to lymphocyte ratio (NLR), BUN to albumin (B/A) ratio, troponin I (TnI), and brain natriuretic peptide (BNP). TnI had the highest specificity and predictive value positive (PVP) and BNP had the highest sensitivity and predictive value negative (PVN) in predicting high risk groups. The Lymphocyte and NLR showed the lowest sensitivity and the albumin and B/A ratio had the lowest specificity. Regarding transthoracic echocardiography (TEE); there was a statistically significant increase regarding pulmonary artery systolic pressure (PASP) and a highly statistically significant increase regarding the right ventricle/left ventricle (RV/LV) ratio. There were statistically significant decreases regarding tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity of tricuspid annulus (S′) among risk groups. ConclusionAPE prognosis can be judged accurately by simultaneously measuring a few biomarkers along with haemodynamic variables and echocardiographic parameters of RV dysfunction.

COVID-19 Infection and Diabetes

Abstract Background Hyperglycemia is one of the most important independent risk factors that affect the prognosis and outcome of COVID-19 patients. Coronavirus disease 2019 infection is associated with poor glycemic control. This study's objectives were to determine the effect of hyperglycemia on the prognosis and outcome of COVID-19 patients and to detect whether COVID-19 infection can induce new-onset diabetes. Patients and Methods This cohort study was carried out on 240 hospitalized Egyptian COVID-19 patients, at Zagazig University Hospital isolation intensive care unit, between March 2020 and March 2021. They compared patients with diabetes and uncontrolled hyperglycemia against each other and COVID-19 patients without diabetes or uncontrolled hyperglycemia. Baseline demographic data, clinical features, and laboratory analysis were collected. Clinical outcome was evaluated via hospital stay and survival rate. Patients with uncontrolled hyperglycemia and nondiabetic patients were followed up 1 year after the hospital discharge to detect the development of new-onset diabetes. Result The diabetic group had the highest creatinine level, and the nondiabetic group had a minor C-reactive protein and D-dimer. The difference is significant between diabetic and nondiabetic groups concerning hospital stay. The nondiabetic group had the shortest hospital stay. There is a statistically substantial relationship between mortality and the glycosylated hemoglobin, serum creatinine, C-reactive protein, D-dimer, and serum ferritin. A total of 46.6% of survivors in the uncontrolled hyperglycemic group and 3.4% in the nondiabetic group developed diabetes mellitus during follow-up. There is a statistically significant relationship between new-onset diabetes mellitus and D-dimer. Conclusions Coronavirus disease 2019 can induce diabetes mellitus in vulnerable patients (presented with uncontrolled hyperglycemia at admission). In addition, COVID-19 patients with diabetes or uncontrolled hyperglycemia have worse outcomes and poor prognoses.