Tantawy, E. A. E., H. K. Zekri, Z. M. Ezzeldin, and A. I. Amin, "Second course of oral ibuprofen in closure of patent ductus arteriosus in preterm infants: Is it safe?", journal of perinatal neonatal medicine, vol. 4, issue 4, pp. 23-28, 2012.
Rasslan, O., Z. S. Seliem, I. A. Ghazi, M. A. El Sabour, A. A. El Kholy, F. M. Sadeq, M. Kalil, D. Abdel-Aziz, H. Y. Sharaf, A. Saeed, et al., "Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International Nosocomial Infection Control Consortium (INICC) findings.", Journal of infection and public health, vol. 5, issue 6, pp. 394-402, 2012 Dec. Abstract

PURPOSE: To determine the rate of device-associated healthcare-associated infections (DA-HAIs) at a respiratory intensive care unit (RICU) and in the pediatric intensive care units (PICUs) of member hospitals of the International Nosocomial Infection Control Consortium (INICC) in Egypt.

MATERIALS AND METHODS: A prospective cohort DA-HAI surveillance study was conducted from December 2008 to July 2010 by applying the methodology of the INICC and the definitions of the NHSN-CDC.

RESULTS: In the RICU, 473 patients were hospitalized for 2930d and acquired 155 DA-HAIs, with an overall rate of 32.8%. There were 52.9 DA-HAIs per 1000 ICU-days. In the PICUs, 143 patients were hospitalized for 1535d and acquired 35 DA-HAIs, with an overall rate of 24.5%. There were 22.8 DA-HAIs per 1000 ICU-days. The central line-associated blood stream infection (CLABSI) rate was 22.5 per 1000 line-days in the RICU and 18.8 in the PICUs; the ventilator-associated pneumonia (VAP) rate was 73.4 per 1000 ventilator-days in the RICU and 31.8 in the PICUs; and the catheter-associated urinary tract infection (CAUTI) rate was 34.2 per 1000 catheter-days in the RICU.

CONCLUSIONS: DA-HAIs in the ICUs in Egypt pose greater threats to patient safety than in industrialized countries, and infection control programs, including surveillance and guidelines, must become a priority.

Mahmoud, A. - B. S., A. E. Tantawy, A. A. Kouatli, and G. M. Baslaim, "Propranolol: a new indication for an old drug in preventing postoperative junctional ectopic tachycardia after surgical repair of tetralogy of Fallot.", Interactive cardiovascular and thoracic surgery, vol. 7, issue 2, pp. 184-7, 2008 Apr. Abstract

Junctional ectopic tachycardia (JET) is a major cause of postoperative morbidity after complete repair of tetralogy of Fallot (TOF). Propranolol is a known medication used in patients with TOF to prevent and control hypercyanotic spells. Despite this, there is little information regarding the relation between preoperative use of propranolol and the incidence of postoperative JET. The aim of this study was to examine the effect of preoperative use of propranolol on the incidence of postoperative JET after full surgical repair of TOF. A retrospective analysis of 109 patients in whom 57 patients received preoperative propranolol (propranolol group) was compared with 52 patients who did not receive propranolol preoperatively (control group). The incidence of postoperative JET was significantly higher in the control group (38%) than the propranolol group (21%) P=0.042. The propranolol group had significantly less mechanical ventilation time, less ICU stay and less total hospital stay than the control group (P<0.05). Our findings suggest that the preoperative use of propranolol may decrease the incidence of JET after full surgical repair of TOF. A prospective randomized study may help to elucidate the exact relationship between the preoperative use of propranolol and the incidence of postoperative JET.

El Tantawy, A. E., Z. S. Seliem, H. M. Agha, A. A. El-Kholy, and D. M. Abdelaziz, "Epidemiology of nosocomial infections and mortality following congenital cardiac surgery in Cairo University, Egypt.", The Journal of the Egyptian Public Health Association, vol. 87, issue 3-4, pp. 79-84, 2012 Aug. Abstract

BACKGROUND: Nosocomial infections (NI) have been associated with significant morbidity and attributed mortality, as well as increased healthcare costs. Relatively few data on congenital cardiac surgical ICU NI have been reported from developing countries. Little is known about the epidemiology of NI following congenital cardiac surgery in Egypt. The aims of the present study were: (a) to estimate the incidence rate and types of NI among children admitted to Pediatric Surgical Cardiac ICU in Cairo University Children's Hospital (Egypt) and (b) to estimate the mortality rate related to congenital cardiac surgery and identify its contributing risk factors.

PARTICIPANTS AND METHODS: A follow-up study in the period between 1 January 2009 and 1 January 2010 included all patients admitted to the Pediatric Surgical Cardiac ICU in Cairo University, Abo El Reesh Children's Specialized Hospital (Egypt). Data were collected for each patient during the preoperative, intraoperative, and postoperative periods. Certain infection control procedures were carried out in certain months.

RESULTS: Of 175 patients, NI were identified in 119 (68%). Poor hand hygiene was associated with increased NI in certain months of the study duration. NI were significantly higher at a younger age [median 9 (5-30) months, P<0.03]. Mortality was found in 54 patients, that is, 31% of the study population. Mortality was significantly observed with younger age, higher complexity score for congenital cardiac lesions, prolonged cardiopulmonary bypass and ischemic times, NI, prolonged mechanical ventilation, prolonged central line insertion, and the use of total parenteral nutrition. Mortality among the NI patients was found in 44 of 119 (37%). On carrying out a multivariate analysis, Acute Physiology and Chronic Health Evaluation II score [P<0.001, odds ratio (OR) 1.13, 95% confidence interval (CI) 1-1.2], age (P<0.001, OR 0.3, 95% CI 0.2-0.4), and prolonged duration of mechanical ventilation (P<0.03, OR 2.8, 95% CI 1.1-7.2) were identified as risk factors of mortality.

CONCLUSION AND RECOMMENDATIONS: NI rate and subsequent mortality were high among cases followed up during the period from 1 January 2009 to 1 January 2010 in the University Children's Hospital (Cairo, Egypt). Early surgical interference, enforcement of proper infection control practices, especially hand hygiene, can reduce NI and trials for early extubation from mechanical ventilation might improve outcome following congenital cardiac surgery in pediatrics.

El Tantawy, A. E., S. Imam, H. Shawky, and T. Salah, "Diaphragmatic nerve palsy after cardiac surgery in children in Egypt: outcome and debate in management.", World journal for pediatric & congenital heart surgery, vol. 4, issue 1, pp. 19-23, 2013 Jan. Abstract

INTRODUCTION: Diaphragmatic paralysis (DP) due to phrenic nerve injury is a complication which occurs in association with congenital cardiac surgery and may be a life-threatening event in infants and young children. Information about this complication is still scarce from the developing countries.

METHODS: Retrospective study evaluated the incidence of DP among 414 patients who underwent congenital cardiac surgery in Abo Elriesh Children's Specialized Hospital, Cairo University, Egypt, in the duration from April 2009 to December 2011.

RESULTS: Incidence of DP was 3.6% (15 of 414 cases). Median age of affected patients was 10 months (ranged from 1 month to 13 years). Diagnosis of DP was observed after ventricular septal defect repair (3.9%), Glenn anastomosis (8.6%), Tetralogy of Fallot repair (4.3%), Senning operation (10%), arterial switch operation (3.2%), Fontan procedure (33%), coarctation of the aorta repair (7%), and pulmonary artery banding (6.4%). Diaphragmatic plication was performed in 4 of 15 cases. Patients with DP had significantly prolonged mechanical ventilation duration as compared to unaffected patients (median 120, range 48-600 vs 4, range 0-48 hours, P < .000). They also had a higher incidence of nosocomial pneumonia in 8 of 15 (53%) cases, longer duration of intensive care unit stay (median 15, range 4-62 days, P < .006), and significant mortality in 7 of 15 (46%; P < .004). Mortality among patients who underwent diaphragm plication was 1 of 4 (25%).

CONCLUSION: Diaphragmatic paralysis is a relatively rare complication of congenital cardiac surgery in children. Its occurrence is associated with increased morbidity and mortality. A high index of clinical suspicion, utilization of bedside diagnostic tools, and a policy of early plication for certain patients may lead to improved outcomes.

El Tantawy, A. E., S. Emam, H. Shawky, and T. Salah, "Response to the letter "diaphragmatic nerve palsy after cardiac surgery in children: outcome and debate in management".", World journal for pediatric & congenital heart surgery, vol. 4, issue 3, pp. 327, 2013 Jul. Abstract
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Agha, H. M., S. A. El-Saiedi, M. F. Shaltout, H. S. Hamza, H. H. Nassar, D. M. Abdel-Aziz, and A. E. El Tantawy, "Incomplete RV Remodeling After Transcatheter ASD Closure in Pediatric Age.", Pediatric cardiology, 2015 May 17. Abstract

Published data showing the intermediate effect of transcatheter device closure of atrial septal defect (ASD) in the pediatric age-group are scarce. The objective of the study was to assess the effects of transcatheter ASD closure on right and left ventricular functions by tissue Doppler imaging (TDI). The study included 37 consecutive patients diagnosed as ASD secundum by transthoracic echocardiography and TEE and referred for transcatheter closure at Cairo University Specialized Pediatric Hospital, Egypt, from October 2010 to July 2013. Thirty-seven age- and sex-matched controls were selected. TDI was obtained using the pulsed Doppler mode, interrogating the right cardiac border (the tricuspid annulus) and lateral mitral annulus, and myocardial performance index (MPI) was calculated at 1-, 3-, 6- and 12-month post-device closure. Transcatheter closure of ASD and echocardiographic examinations were successfully performed in all patients. There were no significant differences between two groups as regards the age, gender, weight or BSA. TDI showed that patients with ASD had significantly prolonged isovolumetric contraction, relaxation time and MPI compared with control group. Decreased tissue Doppler velocities of RV and LV began at one-month post-closure compared with the controls. Improvement in RVMPI and LVMPI began at 1-month post-closure, but they are still prolonged till 1 year. Reverse remodeling of right and left ventricles began 1 month after transcatheter ASD closure, but did not completely normalize even after 1 year of follow-up by tissue Doppler imaging.

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