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Decompressive Craniotomy and Fast-Track Duraplasty in Acute Subdural Hematomas

Open Journal of Modern Neurosurgery 2019年第1期9卷 35-42页

作者： Ehab El Refaee ahmed elsayed ahmed El-Fiki Hisham El Shitany Department of Neurosurgery Cairo University Cairo Egypt

Background: Traumatic subdural hematoma is one of the severe injuries to brain with high mortality rates. Dural opening is often associated with brain herniation against the dural edges due to associated edema that would lead to venous infarction. Aim: The objective of this study is to describe a technical note that would allow fast and effective closure of the dura after hematoma evacuation via duraplasty with analysis of the safety and competency of the technique. Subjects and Methods: The fast-track technique was implemented in 15 successive cases with acute subdural hematoma where the fascia lata flap was prepared and sutured to the planned dural incision before opening the dura, which allowed fast and effective closure of the dura before brain herniation. Subdural bridges were planned by using Gelfoam to prevent venous compression. Analysis of the technique effectiveness was performed by the operative detection of brain herniation, as well as clinical and radiological follow-up of patients. Results: All patients had a Glasgow coma score (GCS) below six before the operation. Mean time from trauma to surgery was five hours. The dura could be effectively closed with no brain herniation in all cases. Nine patients survived (60%), where five of them ended up in a vegetative state. Of these two recovered and three continued in a persistent vegetative state. The mortality rate was 40%. Post-operative infarction was detected in post-operative imaging of four patients. Conclusion: The fast-track duraplasty technique is fast and effective in prevention of brain herniation during surgery with favorable clinical outcome in comparison with the poor and severely deteriorated preoperative clinical presentation. More studies to evaluate the impact of the technique on the survival rate are warranted.

关键词： Traumatic Subdural Hematoma Decompressive Craniotomy Duraplasty

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Big Data Flow Adjustment Using knapsack Problem

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Journal of Computer and Communications 2018年第10期6卷 30-39页

作者： Eyman Yosef ahmed Salama M. elsayed Wahed Department of Mathematics Faculty of Sience Bour Said University Bour Said Egypt Faculty of Computers and Informatics Suez Canal University Ismailia Egypt

The advancements of mobile devices, public networks and the Internet of creature huge amounts of complex data, both construct & unstructured are being captured in trust to allow organizations to produce better business decisions as data is now pivotal for an organizations success. These enormous amounts of data are referred to as Big Data, which enables a competitive advantage over rivals when processed and analyzed appropriately. However Big Data Analytics has a few concerns including Management of Data, Privacy & Security, getting optimal path for transport data, and Data Representation. However, the structure of network does not completely match transportation demand, i.e., there still exist a few bottlenecks in the network. This paper presents a new approach to get the optimal path of valuable data movement through a given network based on the knapsack problem. This paper will give value for each piece of data, it depends on the importance of this data (each piece of data defined by two arguments size and value), and the approach tries to find the optimal path from source to destination, a mathematical models are developed to adjust data flows between their shortest paths based on the 0 - 1 knapsack problem. We also take out computational experience using the commercial software Gurobi and a greedy algorithm (GA), respectively. The outcome indicates that the suggest models are active and workable. This paper introduced two different algorithms to study the shortest path problems: the first algorithm studies the shortest path problems when stochastic activates and activities does not depend on weights. The second algorithm studies the shortest path problems depends on weights.

关键词： 0 - 1 knapsack Problem Big Data Big Data Analytics Big Dao Ta Inconsistencies

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Forehead Flap in Coverage of Nasal Defects: Our Experience

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Modern Plastic Surgery 2020年第1期10卷 1-8页

作者： Mohamed elsayed Mohamed Mohamed ahmed Fathy Mohamed Eldehn Department of Plastic Surgery Ahmed Maher Teaching Hospital Cairo Egypt Department of ENT Kasr Al-Ainy Medical School Cairo Egypt

Background: Coverage of post-traumatic or post-oncosurgical nasal defects is a very challenging procedure. Small nasal defects may be covered by skin grafts or small local flaps while larger nasal defects require more complex flap coverage techniques as using tissue expanders, prefabricated flaps or free flaps. The forehead flap has been used for centuries and remains a workhorse flap for reconstruction of large and complex nasal defects. Aim: evaluate the feasibility and versatility of forehead flap for resurfacing nasal defects. Materials and Methods: 12 patients underwent coverage of nasal defects after trauma or tumor excision using forehead flaps. All flaps needed a second stage for flap separation 3 weeks after the time of operation. The size of the harvested flap, the harvesting time, results of transferred flaps, patient satisfaction and flap-related complications were analyzed. Results: 12 patients (10 males and 2 females) underwent reconstruction of different nasal defects using 12 forehead flaps. The overall complications occurred in 2 patients. The remaining 10 patients showed no complications and passed an uneventful follow-up period. 7 Patients were very satisfied, 4 were satisfied and only one patient was not satisfied as she was 23 years old young female and was subjected to human bite. Follow-up periods ranged from 6 to 12 months. Conclusion: Nasal defects can successfully be managed with the forehead flap. Probably, the flap provides the best result due to the good matching of the skin in terms of color, texture, and thickness. Also, despite the increasing use of free flaps, the forehead flap is still a valid and safe option for nasal defects coverage that allows good aesthetics and functional outcomes.

关键词： Nasal Defects Forehead Flap Flap Coverage Nasal Reconstruction

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Validation of prognostic indices in Egyptian Budd-Chiari syndrome patients: A single-center study

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World Journal of Gastroenterology 2017年第4期23卷 629-637页

作者： Mohammad Sakr Sara M Abdelhakam Soheir A elsayed Enas H Allam Amir M Farid Waleed Abdelmoaty Azza M Hassan Mohamed Shaker Mohamed El-Gharib ahmed Eldorry Department of Tropical Medicine Faculty of MedicineAin Shams University Department of Community Environmental and Occupational MedicineFaculty of MedicineAin Shams University Department of Radiodiagnosis and Interventional Radiology Faculty of MedicineAin Shams University

AIMTo compare predictive ability of Budd-Chiari syndrome (BCS) prognostic indices (PIs) for one-year survival and Transjugular intrahepatic portosystemic shunt (TIPS) *** retrospective study enrolled 194 Egyptian patients with primary BCS who presented to the Budd-Chiari Study Group of Ain Shams University Hospital. Calculation of the available PIs was performed using Child-Pugh and model for end-stage liver disease scores, BCS-specific PIs (Clichy, New Clichy and Rotterdam) for all patients, and BCS-TIPS PI only for patients who underwent TIPS. The overall one-year survival rate and the one-year shunt patency rate for TIPS were *** overall one-year survival rate was 69.6%, and the New Clichy PI revealed the best validity for its prediction at a cut-off value of 3.75, with sensitivity and specificity of 78% and 73.3%, respectively [area under receiver operating characteristic curve (AUC) = 0.806]. The one-year survival rate post-TIPS was 89.7%, and the BCS-TIPS score demonstrated validity for its prediction at a cut-off value of 3.92 (sensitivity and specificity were 71.4% and 64.5%, respectively) (AUC = 0.715). Logistic regression analysis revealed that the New Clichy PI (P = 0.030), high serum total bilirubin (P = 0.047) and low albumin (P < 0.001) were independent factors for predicting mortality within one year. The one-year shunt patency rate in TIPS was 80.2%, and none of the PIs exhibited significant validity for its *** New Clichy score could independently predict the one-year survival in Egyptian BCS patients.

关键词： Budd-Chiari syndrome Prognostic indices New Clichy score One-year survival Transjugular intrahepatic portosystemic shunt

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Sepsis patient evaluation emergency department (SPEED) score & mortality in emergency department sepsis (MEDS) score in predicting 28-day mortality of emergency sepsis patients

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Chinese Journal of Traumatology 2019年第6期22卷 316-322页

作者： Adel Hamed Elbaih Zaynab Mohammed elsayed Rasha Mahmoud ahmed Sara ahmed Abd-elwahed Department of Emergency Medicine Faculty of MedicineSuez Canal UniversityIsmailiaEgypt Department of Emergency Medicine Sulaiman Al-Rajhi CollegesFaculty of MedicineSaudi Arabia

Purpose:Sepsis is a common acute life-threatening condition that emergency physicians routinely *** options within the Emergency Department(ED)are limited due to lack of infrastructure,consequently limiting the use of invasive hemodynamic monitoring or imaging *** mortality rate due to sepsis can be assessed via multiple scoring systems,for example,mortality in emergency department sepsis(MEDS)score and sepsis patient evaluation in the emergency department(SPEED)score,both of which quantify the variation of mortality rates according to clinical findings,laboratory data,or therapeutic *** study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency ***:The study is a cross-sectional,prospective study including 61 sepsis patients in ED in Suez Canal University Hospital,Egypt,from August 2017 to June *** were selected by two steps:(1)suspected septic patients presenting with at least one of the following abnormal clinical findings:(a)body temperature higher than 38℃ or lower than 36℃,(b)heart rate higher than 90 beats/min,(c)hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg,and(d)white blood cell count higher than 12,000/μL or lower than 4000/μL;(2)confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment(SOFA)score following *** inclusion criteria included adult patients with an age≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed *** were shortly follow-up for the 28-day *** patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting *** receiver operating characteristic curves were also done for MEDS and SPE

关键词： Sepsis Sepsis patient evaluation emergency department score Mortality in emergency department sepsis score Mortality

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