Assal, H. H., M. salah, A. K. Ibrahim, M. Alfishawy, R. Khater, H. H. Masoud, A. M. Eldemerdash, and mohamed ali abd el halim, Respiratory coinfections in COVID-19 patients evaluated by BioFire Pneumonia Panel, , 2021.
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Masoud, H. H., M. M. El-Zorkany, A. A. Ahmed, and H. H. Assal, "Pleural Space Elastance and Its Relation to Success Rates of Pleurodesis in Malignant Pleural Effusion.", Tuberculosis and respiratory diseases, vol. 84, issue 1, pp. 67-73, 2021. Abstract

BACKGROUND: Pleurodesis fails in 10%-40% of patients with recurrent malignant pleural effusions malignant pleural effusion and dyspnea. This study aimed to assess the values of pleural elastance (PEL) after the aspiration of 500 mL of pleural fluid and their relation to the pleurodesis outcome, and to compare the pleurodesis outcome with the chemical characteristics of pleural fluid.

METHODS: A prospective study was conducted in Kasr El-Aini Hospital, Cairo University, during the period from March 2019 to January 2020. The study population consisted of 40 patients with malignant pleural effusion. The measurement of PEL after the aspiration of 500 mL of fluid was done with "PEL 0.5" (cm H2O/L), and the characteristics of the pleural fluid were chemically and cytologically analyzed. Pleurodesis was done and the patients were evaluated one month later. The PEL values were compared with pleurodesis outcomes.

RESULTS: After 4-week of follow-up, the success rate of pleurodesis was 65%. The PEL 0.5 was significantly higher in failed pleurodesis than it was in successful pleurodesis. A cutoff point of PEL 0.5 >14.5 cm H2O/L was associated with pleurodesis failure with a sensitivity and specificity of 93% and 100%, respectively. The patients with failed pleurodesis had significantly lower pH levels in fluid than those in the successful group (p<0.001).

CONCLUSION: PEL measurement was a significant predictor in differentiating between failed and successful pleurodesis. The increase in acidity of the malignant pleural fluid can be used as a predictor for pleurodesis failure in patients with malignant pleural effusion.

Sultan, R. H., M. Abdallah, T. M. Ali, A. E. Ahmed, H. H. Assal, B. H. Elesawy, and O. M. Ahmed, "The Associations between Cytokine Levels, Kidney and Heart Function Biomarkers, and Expression Levels of Angiotensin-Converting Enzyme-2 and Neuropilin-1 in COVID-19 Patients.", Vaccines, vol. 10, issue 7, 2022. Abstract

BACKGROUND: Higher expression of angiotensin-converting enzyme-2 (ACE-2) in addition to neuropilin-1 (NRP-1) can lead to a cytokine storm which is correlated to higher mortality rate and contributes to the progression of renal diseases and the pathogenesis of coronary heart disease (CHD) in COVID-19 patients.

AIM: We herein sought to examine correlations between cytokine levels, ACE-2 and NRP-1 expression, renal function biomarkers, and cardiac enzymes in COVID-19 patients.

PATIENTS AND METHODS: For the study, 50 healthy subjects and 100 COVID-19 patients were enrolled. Then, confirmed cases of COVID-19 were divided into two groups-those with moderate infection and those with severe infection-and compared to healthy controls. Serum creatinine, urea, CK-MB, LDH, troponin I, IL-1β, IL-4, IL-10, IL-17, and INF-γ levels were estimated. We also studied the gene expression for ACE-2 and NRP-1 in blood samples utilizing quantitative real-time polymerase chain reaction (qRT-PCR).

RESULTS: All COVID-19 patients demonstrated a significant increase in the levels of serum creatinine, urea, CK-MB, LDH, and troponin I, as well as examined cytokines compared to the healthy controls. Furthermore, ACE-2 mRNA and NRP-1 mRNA expression levels demonstrated a significant increase in both severe and moderate COVID-19 patient groups. In the severe group, serum creatinine and urea levels were positively correlated with IL-10, INF-γ, NRP-1, and ACE-2 expression levels. Moreover, LDH was positively correlated with all the examined cytokine, NRP-1, and ACE-2 expression levels.

CONCLUSION: Deficits in renal and cardiac functions might be attributable to cytokine storm resulting from the higher expression of ACE-2 and NRP-1 in cases of COVID-19.

Sultan, R. H., B. H. Elesawy, T. M. Ali, M. Abdallah, H. H. Assal, A. E. Ahmed, and O. M. Ahmed, "Correlations between Kidney and Heart Function Bioindicators and the Expressions of Toll-Like, ACE2, and NRP-1 Receptors in COVID-19.", Vaccines, vol. 10, issue 7, 2022. Abstract

BACKGROUND: COVID-19 impacts the cardiovascular system resulting in myocardial damage, and also affects the kidneys leading to renal dysfunction. This effect is mostly through the binding with angiotensin-converting enzyme 2 (ACE2) and Neuropilin-1 (NRP-l) receptors. Toll-Like Receptors (TLRs) typically combine with microbial pathogens and provoke an inflammatory response.

AIM: This work aims to compare the changes in kidney and heart function bioindicators and expressions of TLRs (TLR2 and TLR2) as well as ACE2 and NRP-l receptors in moderate and severe COVID-19 patients. The correlations between kidney and heart function bioindicators and expressions of these receptors are also studied.

PATIENTS AND METHODS: In this study, 50 healthy control and 100 COVID-19 patients (55 males and 45 females) were enrolled. According to WHO guidelines, these participants were divided into severe (50 cases) and moderate (50 cases). Serum creatinine, blood urea, CK-MB, LDH, and Troponin I were estimated. We measured the gene expression for Toll-Like Receptors (TLR2 and TLR4), ACE2, and NRP-1 in the blood samples using quantitative real-time PCR (qRT-PCR).

RESULTS: In comparison with the healthy group, all patients exhibited a significant elevation in serum creatinine, urea, cardiac enzymes (CK-MB and LDH), and CRP. Serum Troponin I level was significantly increased in severe COVID-19 patients. Furthermore, all studied patients revealed a significant elevation in the expression levels of TLR2, TLR4, ACE2, and NRP-1 mRNA. In all patients, CK-MB, ACE2, and NRP-1 mRNA expression levels were positively correlated with both TLR2 and TLR4 expression levels. Moreover, serum creatinine and urea levels were positively correlated with both TLR2 and TLR 4 expression levels in the severe group only. In the moderate group, serum CK-MB activity and Troponin I level had a significant positive correlation with both NRP-1 and ACE2 expression levels, while serum urea level and LDH activity had a significant positive correlation with NRP-1 only. In severe patients, the increases in serum creatinine, urea, CK-MB, and LDH were significantly associated with the elevations in both ACE2 and NRP-1 expression levels, whereas serum Troponin I level had a positive direct relationship with NRP-1 only.

CONCLUSIONS: Our study concluded that expression levels for TLR2, TLR4, ACE2, and NRP-1 mRNA in both severe and moderate patients were positively correlated with renal biomarkers and cardiac enzymes. Innate immune markers can be important because they correlate with the severity of illness in COVID-19.

Assal, H. H., S. M. Abdelrahman, M. A. A. Abdelbasset, M. Abdelaziz, I. M. Sabry, and M. M. Shaban, "Presepsin as a Novel Biomarker in predicting In-hospital Mortality in Patients With COVID-19 Pneumonia.", International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, vol. 118, pp. 155-163, 2022. Abstract

OBJECTIVES: Different biomarkers such as C-reactive protein (CRP), serum ferritin and D-dimer are used in prognostic assessment of patients with COVID-19 pneumonia. Presepsin (PSP) is a soluble CD14 subtype that has recently been proposed as a novel biomarker in patients with sepsis. The aim of the current study was to detect the relation of PSP to the outcome of COVID-19 as well as its relation to other inflammatory biomarkers.

METHODS: This multicenter retrospective observational study was conducted in Saudi Arabia and Misr International Hospital, Egypt, from January 2021 to May 2021. Hospitalised patients who had positive throat swab of SARS-CoV-2 and radiological evidence of viral pneumonia (moderate and severe forms) were included in the study. Demographics and clinical features, as well as laboratory parameters, including serum ferritin, CRP, D-dimer and PSP, of enrolled patients were retrospectively collected. Pneumonia severity index (PSI) was used to evaluate the severity of pneumonia.

RESULTS: A total of 202 hospitalised patients who were diagnosed with COVID-19 pneumonia and tested positive for SARS-CoV-2 RNA were enrolled in our study. Of 202 hospitalised patients, 67 (33.17%) required intensive care unit (ICU) admission. A total of 176 (87.1%) patients survived and were discharged, whereas 26 (12.9%) patients did not survive. PSP level was found to be significantly elevated in nonsurvivor versus survivor group (median [IQR] 978.5 [755.8-1400] vs 516.5 [343.3-720], P<0.001) as well as in ICU versus non-ICU patients (median [IQR] 800 [631-1200] and 446 [320-626], respectively) (P<0.001). Elevated levels were also found to be associated with increased length of hospital stay. Levels above 775 pg/mL were found to be associated with in-hospital mortality (specificity 80%, sensitivity 73%).

CONCLUSION: Elevated PSP levels indicated poor outcomes in hospitalised patients with COVID-19 pneumonia and were associated with in-hospital mortality.

Zaid, A. A. A., I. S, and H. H. Assal, "EFFECT OF SMOKING CESSATION ON AIRWAY INFLAMMATION IN COPD ", Egyptian Journal of Bronchology , vol. 7, issue 1, pp. 13-19, 2013. effect_of_smoking_cessation_on_airway_inflammation_in_copd.pdf
Abdelaziz, M. A., H. H. Mohammed, A. A. A. Zaid, H. H. Assal, and R. A. Rashad, "Serum procalcitonin and high sensitivity C-reactive protein in distinguishing ADHF and CAP", Egyptian Journal of Chest Diseases and Tuberculosis, vol. 63, pp. 455-462, 2014. serum_procalcitonin_and_high_sensitivity_c-reactive.pdf