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Bench-to-bedside review: Early tracheostomy in critically ill trauma patients
Nehad Shirawi, Yaseen Arabi
Critical Care , 2005, DOI: 10.1186/cc3828
Abstract: Trauma is currently one of the most important causes of morbidity and mortality in the age group between 15 to 35 years [1]. About 500,000 people are hospitalized yearly in the United States as a result of motor vehicular accident-related injuries [1]. In addition, motor vehicle-related deaths and injuries cost the United States more than $150 billion each year [1]. According to World Health Organization statistics for the year 2000, over 50% of global mortality due to road traffic accidents occurs among young adults and the mortality rates per 100,000 is in the range of 18.7 to 34.1 in the Eastern Mediterranean region and between 11.2 and 16.1 in Europe [2]. Many trauma patients require intubation and mechanical ventilation for several reasons, including relief of upper airway obstruction secondary to severe facial or laryngeal trauma, airway access in patients with cervical spine injury, management of retained airway secretions, maintenance of patent airway and airway access for prolonged mechanical ventilation [3]. The percentage of trauma patients who require tracheostomy varies considerably and ranges from 14% to 48% [4-6].Traditionally, tracheostomy has been provided for trauma patients who required endotracheal intubation for a prolonged period of time. In 1989, the American College of Chest Physicians' Consensus Conference on Artificial Airways in Patients Receiving Mechanical Ventilation recommended that tracheostomy should be considered in patients anticipated to require endotracheal intubation for more than 21 days [7]. It also recommended, however, that if tracheostomy is indicated, it should be done early to minimize the duration of translaryngeal intubation and lower the incidence of associated complications. Recently, there has been an increasing trend towards converting endotracheal intubation to tracheostomy at an earlier stage as more evidence supports the benefits of early tracheostomy [5,8-10]. Whited [11] conducted a prospective study involving
Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review
Yaseen Arabi, Samir Haddad, Nehad Shirawi, Abdullah Al Shimemeri
Critical Care , 2004, DOI: 10.1186/cc2924
Abstract: The following data were obtained from a prospective ICU database containing information on all trauma patients who received tracheostomy over a 5-year period: demographics, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II, Glasgow Coma Scale score, Injury Severity Score, type of injuries, ICU and hospital outcomes, ICU and hospital length of stay (LOS), and the type of tracheostomy procedure (percutaneous versus surgical). Tracheostomy was considered early if it was performed by day 7 of mechanical ventilation. We compared the duration of mechanical ventilation, ICU LOS and outcome between early and late tracheostomy patients. Multivariate analysis was performed to assess the impact of tracheostomy timing on ICU stay.Of 653 trauma ICU patients, 136 (21%) required tracheostomies, 29 of whom were early and 107 were late. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II and Injury Severity Score were not different between the two groups. Patients with early tracheostomy were more likely to have maxillofacial injuries and to have lower Glasgow Coma Scale score. Duration of mechanical ventilation was significantly shorter with early tracheostomy (mean ± standard error: 9.6 ± 1.2 days versus 18.7 ± 1.3 days; P < 0.0001). Similarly, ICU LOS was significantly shorter (10.9 ± 1.2 days versus 21.0 ± 1.3 days; P < 0.0001). Following tracheostomy, patients were discharged from the ICU after comparable periods in both groups (4.9 ± 1.2 days versus 4.9 ± 1.1 days; not significant). ICU and hospital mortality rates were similar. Using multivariate analysis, late tracheostomy was an independent predictor of prolonged ICU stay (>14 days).Early tracheostomy in trauma ICU patients is associated with shorter duration of mechanical ventilation and ICU LOS, without affecting ICU or hospital outcome. Adopting a standardized strategy of early tracheostomy in appropriately selected patients m
Assessment of six mortality prediction models in patients admitted with severe sepsis and septic shock to the intensive care unit: a prospective cohort study
Yaseen Arabi, Nehad Al Shirawi, Ziad Memish, Srinivas Venkatesh, Abdullah Al-Shimemeri
Critical Care , 2003, DOI: 10.1186/cc2373
Abstract: This cohort, prospective, observational study was conducted in a tertiary care medical/surgical ICU. Consecutive patients meeting the diagnostic criteria for severe sepsis and septic shock during the first 24 hours of ICU admission between March 1999 and August 2001 were included. The data necessary for mortality prediction were collected prospectively as part of the ongoing ICU database. Predicted and actual mortality rates, and standardized mortality ratio were calculated. Calibration was assessed using Lemeshow–Hosmer goodness of fit C-statistic. Discrimination was assessed using receiver operating characteristic curves.The overall mortality prediction was adequate for all six systems because none of the standardized mortality ratios differed significantly from 1. Calibration was inadequate for APACHE II, SAPS II, MPM II0 and MPM II24. However, the customized version of SAPS II exhibited significantly improved calibration (C-statistic for SAPS II 23.6 [P = 0.003] and for customized SAPS II 11.5 [P = 0.18]). Discrimination was best for customized MPM II24 (area under the receiver operating characteristic curve 0.826), followed by MPM II24 and customized SAPS II.Although general ICU mortality system models had accurate overall mortality prediction, they had poor calibration. Customization of SAPS II and, to a lesser extent, MPM II24 improved calibration. The customized model may be a useful tool when evaluating outcomes in patients with sepsis.Severe sepsis and septic shock are major reasons for intensive care unit (ICU) admission and leading causes of mortality in noncoronary ICUs [1-3]. Apart from in the West, little is known about outcomes of patients admitted to the ICU with severe sepsis and septic shock, despite the seriousness of sepsis as a public health problem in developing countries. According to the 1996 World Health Organization Health Report [4], infectious and parasitic diseases caused 17 million out of 50 million deaths globally, including 3.4 milli
Pathogenesis, etiology and treatment of bronchiectasis
AL-Shirawi Nehad,AL-Jahdali Hamdan,Al Shimemeri Abdullah
Annals of Thoracic Medicine , 2006,
Abstract: Bronchiectasis is a chronic lung disease, defined pathologically as irreversible dilatation of the bronchi. The clinical course of the disease is chronic and progressive and in most cases, causes lung damage over many years. There is usually an initial event, which causes impairment of mucociliary clearance of the bronchial tree. The respiratory tract becomes colonized by bacteria that inhibit the ciliary function and promote further lung damage. The hallmark of bronchiectasis, is a chronic cough with mucopurulent or purulent sputum, lasting for months to years and may progress to chronic respiratory failure. Diagnosis of bronchiectasis is suspected on the basis of clinical manifestations. In order to confirm the diagnosis and underlying causes, appropriate investigations must be performed. In this comprehensive review, we discuss the etiology, pathogenesis, clinical presentation, appropriate investigations and management of bronchiectasis.
Intellectual Property in Architecture: Between Legislations and Ethical Manifestations with Special Reference to the Egyptian Case
Nehad Mohamed Eweda
Archnet-IJAR : International Journal of Architectural Research , 2011,
Study the Effect of Gamma Radiation on the Optical Energy Gap of Poly(Vinyl Alcohol) Based Ferrotitanium Alloy Film: Its Possible Use in Radiation Dosimetry  [PDF]
Sayeda Eid, Seif Ebraheem, Nehad M. Abdel-Kader
Open Journal of Polymer Chemistry (OJPChem) , 2014, DOI: 10.4236/ojpchem.2014.42003

Ferrotitanium alloy polymer films, prepared by a simple technique of casting aqueous solutions of poly(vinyl alcohol) PVA containing ferrotitanium alloy on a horizontal glass plate, are useful as routine high-dose dosimeters. These flexible plastic film dosimeters have pale yellow color, are bleached when exposed to gamma rays. The chemical composition of alloy was determined by EDX, and structure of alloy was determined by XRD. The response of these dosimeters depends on the concentration of alloy. The energy band gap Eg was calculated and the effect of gamma radiation on its value was determined. The optical absorption spectra showed that the absorption mechanism is an indirect allowed transition which found that energy band gap Eg decreases after irradiation. The response of these films has negligible humidity effects on the range of relative humidity from 0 to 100%. And also, it exhibits good preand post-irradiation stability in dark and light.

Assessment of Usual Fruit, Vegetable and Vitamin C Intakes in a Sample of Egyptian Children: Pilot Study  [PDF]
Laila Hussein, Nehad Hassan, Mahmoud Mohamad, Sahar Abdel Aziz
Food and Nutrition Sciences (FNS) , 2015, DOI: 10.4236/fns.2015.610096
Abstract: The objective was to create an Egyptian database on the contributors of fruit and vegetables in the diets of preschool children and to estimate the usual daily intakes of fruits, vegetables and vitamin C. A total of 59 healthy boys and girls aged 2.5 - 6 years attending day care centers in urban Giza governorate completed the study by interviewing their mothers on 6x non-consecutive days using the 24 h dietary recall. Participants were classified according to age, gender and socioeconomic class. Prevalence of daily consumptions of fruits and vegetables amounted to 22% and 54%, respectively of the total children. The daily intakes of fruits and vegetables averaged 117.5 and 56.4 g, respectively. The consumption of different types of fruits and vegetables was unevenly distributed by different personal and social variables. Estimated daily vitamin C supply from the diet was 38 mg per child, which satisfied the respective recommended nutrient intake (RNI) of 30 mg for the first six years of life. However, the diet of 15% of the children covered less than 75% of RNI. Top fruits contributing to vitamin C were oranges, guava, watermelon, pears and grapes. Extra foods such as chipsy was consumed by 81% of the children, contributed 18% to daily vitamin C supply and also 58.6 mg sodium. A multilevel intervention strategy is warranted for promoting daily fruit and vegetable intake and healthy eating in early childhood.
Cloning and Expression of Human Membrane-Bound and Soluble Engineered T Cell Receptors for Immunotherapy
Nehad M. Alajez,Saman Eghtesad
Journal of Biomedicine and Biotechnology , 2006,
Abstract: We report here the design and construction of several gene vectors for expression in mammalian cells of membrane-bound and soluble human T cell receptors (TR). We designed a vector (TR-ALPHA-IRES-TR-BETA pEF4) that encodes high-level expression of the full-length TR on the surface of T cells. Furthermore, we engineered TR that does not require the presence of endogenous CD3 molecules for surface expression and thus expression is not limited to T cells. We also constructed a vector encoding a single-chain TR (scTR) as a fusion protein of V-ALPHA-V-BETA-C-BETA with CD3Z. Since it is encoded and expressed as a single molecule, this scTR is well suited for gene therapy. Lastly, we successfully used a mammalian expression vector for generation of soluble human TR. The approaches we used here for manipulation of a human tumor-specific TR can be useful for other investigators interested in TR-based immunotherapy.
Fuzzy -uniform spaces
Khaled A. Hashem,Nehad N. Morsi
International Journal of Mathematics and Mathematical Sciences , 2006, DOI: 10.1155/ijmms/2006/25094
Abstract: The main purpose of this paper is to introduce a new structure that is a fuzzy TL-uniform space. We show that our structure generates a fuzzy topological space, precisely, a fuzzy T-locality space. Also, we deduce the concept of level uniformities of a fuzzy TL-uniformity. We connect the category of fuzzy TL-uniform spaces with the category of uniform spaces. We establish a necessary and sufficient condition, under which a fuzzy TL-uniformity is probabilistic pseudometrizable. Finally, we define a functor from the category of fuzzy TL-uniform spaces into the category of fuzzy T-locality spaces and we show that it preserves optimal lifts.
Comprehensive Analysis of rsSNPs Associated with Hypertension Using In-Silico Bioinformatics Tools  [PDF]
Alsadig Gassoum, Nahla E. Abdelraheem, Nehad Elsadig
Open Access Library Journal (OALib Journal) , 2016, DOI: 10.4236/oalib.1102839
Genetic epidemiological studies have suggested that several genetic variants increase the risk for hypertension. It is likely that a number of genes rather than a single gene account for the heritability of this complex disorder. However, the genetic analysis of hypertension produced complex, inconsistent and nonreproducible results, which makes it difficult to draw conclusions about the association between specific genes and hypertension. Material and methods: In this study, we aimed to analyze SNPs that had been investigated in hypertension. These SNPs were collected from text-mind hypertension, obesity and diabetic (T-HOD) data base program, during the period of 31 may 2016. SNPs lists which were reported with hypertension were collected in excel file sheet and processed for analysis using different types of bioinformatics tools and programs. Results: SNPs were evaluated for their deleterious effect on the protein function and stability, in the present study, 7 SNPs were predicted deleterious (A288S, M731T, R172C, R50Q, G460W, K197N, G75V). Mutation3D server showed 3 of mutations (STEA4, PLD2, AZIN2, rs28933400, rs2286672, rs16835244 genes and corresponding rsSNPs respectively) were found to increase risk to hypertension.
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