B B Ghobrial

Ain Shams University

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Olfat Ali Mohammed

Ain Shams University

Karim A Sedky

Pain and Rehabilitation Medicine

Sahar M. Talaat

Ain Shams University

Ragaa Aly

Ain Shams University

Angie Magdy Mohammed Hassan

Amal Hamed Rabie

Ain Shams University

Amin Mohammed Alansary

Ain Shams University

Noha M Aboassal

Pain and Rehabilitation Medicine

Ahmed M. Bayoumy

Al-Azhar University

Heba F Toulan

Ain Shams University

Cooperative Institutions

Ain Shams University

Pain and Rehabilitation Medicine

Cairo University

Nuclear Materials Authority

October 6 University

Ain Shams University Hospital

Menoufia University

Al-Azhar University

Egypt-Japan University of Science and Technology

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Association of Glycosylated Hemoglobin Levels with Insulin Resistance in Adolescent among Medical Students Ain Shams University

QJM (2023)

B B Ghobrial Reem Hamdy ElKabarity Angie Magdy Mohammed Hassan

Abstract Background Insulin resistance is a common pathway for the development of glucose metabolism disorders and high blood pressure, all of which are components of the metabolic syndrome. The earlier onset of obesity may cause a longer period of insulin resistance, which may explain the concomitant earlier onset of impaired glucose tolerance in young obese people and adolescents so insulin resistance has been implicated as risk factor for metabolic disorders and it is of real importance to develop simple test that can be used in routine clinical setting for identifying insulin resistant individuals in advance so HOMA-IR(Homeostatic Model Assessment for Insulin Resistance) and HbA1c (glycated haemoglobin) screening to identify young at high risk for insulin resistance and diabetes at an early stage. The study aimed to evaluate the association of HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) and HbA1c levels in overweight and nonoverweight young medical students to assess insulin resistance, a condition that can cause diabetes mellitus and metabolic syndrome in earlier life. Subject and Methods The study was systematic random sample was conducted between 40 overweight and 40 non-overweight students (80 in total). All cases were subjected to history taking, clinical examination and laboratory investigations included HOMA-IR and HbA1c. Results Regarding HOMA-IR in present study they illustrated statistically significant difference between groups with higher levels in overweighed group than for normal weight group.HOMA-IR ≥2.5 was represent (17.5%)of normal weight group and (45.0%) of overweighed group with statistically significant difference. N statistically significant difference regarding Glucose (mg/dl) level for normal and overweighed group. The relation was statistically significant regarding Insulin (mIU/ml) level as it was higher in overweighed group than normal group. Regarding HbA1c% in present study; there is no statistically significant difference between normal group compared to obese group that range within normal values with higher result in obese group. Our study found statistically significant association between HOMA-IR<2.5 and (glucose and insulin), in both groups and for HbA1c in obese group. Also statistically significant positive correlation between HOMA-IR and HbA1c% in all patients. Conclusion Obesity is significantly associated with higher levels of fasting insulin, and HOMA-IR values in adolescents. There is a positive correlation between HbA1c and HOMA-IR

Glycated hemoglobin

Homeostatic model assessment

10.1093/qjmed/hcad069.025

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Ultrasound Measurement of Inferior Vena Cava Diameter versus Central Venous Pressure as a Tool of Assessment of Intravascular Volume in Adult ICU Patients

QJM (2020)

B B Ghobrial Amin Mohammed Alansary Ragaa Aly Ahmed M. Bayoumy

Abstract Background Measurements of central venous pressure (CVP), pulmonary arterial catheterization, esophageal Doppler, ultrasound, and trans-esophageal echocardiography may be used to determine the volume status of critically ill patients. Appropriate interpretation of the information offered by hemodynamic monitoring requires the integration of several variables. Echocardiography is increasingly used as a first tool to identify a problem and help select initial treatment. To improve patient management and outcome, the clinician must understand the advantages and the limitations of the various tools and parameters used during ICU stay. Aim of the Work to assess the intravascular volume by comparing between IVC diameter, IVC collapsibility index by ultrasound with central venous pressure (CVP) in critically ill patients. Patients and Methods A clinical interventional study was carried out at department of intensive care at Ain Shams University hospitals – Cairo – Egypt., during a three months (from October 2017 till December 2017).This study was approved by Ethical Committee of Faculty of Medicine, Ain Shams University, including the informed consents which were obtained from either the patient or the closest family member. Results In our study the IVC Collapsibility Index correlated well with the Central Venous Pressure. The sensitivity and specificity of IVC Collapsibility to Central Venous Pressure were also found to be highly statistically significant. The change in IVC diameters were also found to be statistically significant when compared to Central Venous Pressure. Conclusion The IVC CI% can provide a useful guide for noninvasive intravascular volume status and an alternative to CVP measurement assessment in critically ill patients.

Intravascular volume status

Intravascular Ultrasound

Gold standard (test)

10.1093/qjmed/hcaa039.044

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Use of Lactate Clearance as a Predictor of Mortality Rate after Initial Resuscitation in Patient with Severe Sepsis or Septic Shock

QJM (2023)

Karim A Sedky B B Ghobrial Noha M Aboassal Sahar M. Talaat

Abstract Background Early diagnosis of sepsis is the key for improving the survival. Culture is the diagnostic tool but the microbiological origin of infection is demonstrated in about 2/3rd of cases. Biomarkers have an important place in this process because they can indicate the presence or absence of sepsis and they are also important in evaluating the response to therapy and recovery from sepsis. Aim of the Work to find a correlation between the lactate clearance and mortality in patients with severe sepsis. Patients and Methods The study was conducted on 60 adult critically ill patients of both sexes with severe sepsis, who were admitted to the unit of Critical Care Unit in Ain Shams University Hospital. All participants were subjected to the following: detailed history, full laboratory and radiological investigations to diagnose sepsis including lactate level on presentation (0 hour), after 6 hours and after 24 hours, then lactate clearance is calculated and patients were divided to lactate clearance group and non-clearance group. Results The study showed that clearance patients significantly had lower mortality rate, SOFA score, vasopressor therapy duration, ventilation need and hospital stay days than the non-clearance patients. Conclusion Lactate is a good marker for predicting mortality and evaluating the initial resuscitation and management of severe sepsis and septic shock.

SOFA score

10.1093/qjmed/hcad069.086

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Myocardial Necrosis in ICU Patients with Severe Hemodynamic Disturbances

QJM (2020)

B B Ghobrial Amal Hamed Rabie Heba F Toulan Olfat Ali Mohammed

Abstract Background this prospective comparative observational study, to compare the incidence of myocardial injury in patients with hypovolemic shock versus septic shock, after approval of Ethical committee of critical care department on forty patients in general ICU divided into two groups of twenty patients each equal. Aim of the Work to compare the incidence of myocardial injury in patients with hypovolemic shock versus septic shock. Patients and Methods this prospective comparative observational study, carried out in Maadi Military Force Hospital, to compare the incidence of myocardial injury in patients with hypovolemic shock versus septic shock, after approval of Ethical committee of critical care department on forty patients in general ICU divided into two groups of twenty patients each equal. Results group A has higher values in SOFA score than in Group B, most probably due to toxins affected perfusion of organs and response to resuscitation, beside the poor cellular oxygen utilization, so clinical outcome among the two groups was twenty-four patients died in (sixteen patients in Group A and eight patients in Group B), so in our study there was a higher mortality in Group A patients (Septic shock) than Group B patients (Hypovolemic shock), The deceased patients had higher serum cTnI levels than survivors, this was concordant with Arlati and his colleagues, but there were no significant differences in cardiac troponin. Conclusion the incidence of myocardial infarction is increased in Group A (septic patients) more than Group B (hypovolemic patients), most probably due to the maldistribution of coronary blood flow which might produce, for a given level of hypotension, higher amounts of myocardial damage and, consequently, higher levels of troponin I than in hypovolemic shock.

10.1093/qjmed/hcaa039.069

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