Helmy, M. A., L. Magdy Milad, S. H. Osman, M. A. Ali, and A. Hasanin, "Diaphragmatic excursion: A possible key player for predicting successful weaning in patients with severe COVID-19", Anaesth Crit Care Pain Med, vol. 40, issue 3, pp. 100875, 2021.
Ahmed Ali, M., E. S. Mikhael, A. Abdel Kader, L. Mansour, R. Elessawy, R. Elsayed, A. Eladawy, and A. Mukhtar, "Interleukin-17 as a predictor of sepsis in polytrauma patients: a prospective cohort study.", European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2017 Sep 15. Abstract

Sepsis is one of the most serious complications after major trauma, and may be associated with increased mortality. We sought to determine whether there is an association between serum levels of interleukin-17 (IL-17) at the time of admission to the intensive care unit (ICU) and the development of sepsis. We evaluated 100 adult patients with major trauma admitted to the surgical ICU over a 6-month period. Serum levels of IL-17, IL-6, and TNF-α were determined by enzyme-linked immunosorbent assays (ELISA). The IL-17 rs1974226 genotype was determined by real-time PCR. In both non-adjusted and adjusted analyses, IL-17 was the only biomarker significantly associated with sepsis [median serum IL-17 of 72 pg/mL in sepsis versus 37 pg/mL in those without sepsis, P = 0.0001; adjusted odds ratio (OR) 3.2, P = 0.02]. No significant association was found among IL-17 rs1974226 genotypes and related serum cytokine levels. These data suggest that elevated serum IL-17 may increase the susceptibility for septic complications in polytrauma patients and so could be a useful biomarker for trauma patient management.

Habib, S. F., A. H. M. E. D. M. MUKHTAR, H. M. Abdelreheem, M. M. Khorshied, R. E. Sayed, M. H. Hafez, H. M. Gouda, D. M. Ghaith, A. M. Hasanin, A. S. Eladawy, et al., "Diagnostic values of CD64, C-reactive protein and procalcitonin in ventilator-associated pneumonia in adult trauma patients: a pilot study.", Clinical chemistry and laboratory medicine, vol. 54, issue 5, pp. 889-95, 2016 May. Abstract

BACKGROUND: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections; however, its diagnosis remains difficult to establish in the critical care setting. We investigated the potential role of neutrophil CD64 (nCD64) expression as an early marker for the diagnosis of VAP.

METHODS: Forty-nine consecutive patients with clinically suspected VAP were prospectively included in a single-center study. The levels of nCD64, C-reactive protein (CRP), and serum procalcitonin (PCT) were analyzed for diagnostic evaluation at the time of intubation (baseline), at day 0 (time of diagnosis), and at day 3. The receiver operating characteristic curves were analyzed to identify the ideal cutoff values.

RESULTS: VAP was confirmed in 36 of 49 cases. In patients with and without VAP, the median levels (interquartile range, IQR) of nCD64 did not differ either at baseline [2.4 (IQR, 1.8-3.1) and 2.6 (IQR, 2.3-3.2), respectively; p=0.3] or at day 0 [2 (IQR, 2.5-3.0) and 2.6 (IQR, 2.4-2.9), respectively; p=0.8]. CRP showed the largest area under the curve (AUC) at day 3. The optimum cutoff value for CRP according to the maximum Youden index was 133 mg/dL. This cutoff value had 69% sensitivity and 76% specificity for predicting VAP; the AUC was 0.73 (95% CI, 0.59-0.85). The nCD64 and PCT values could not discriminate between the VAP and non-VAP groups either at day 0 or day 3.

CONCLUSIONS: The results of this pilot study suggest that neutrophil CD64 measurement has a poor role in facilitating the diagnosis of VAP and thus may not be practically recommended to guide the administration of antibiotics when VAP is suspected.

Rasmy, I., hossam mohamed, N. Nabil, S. Abdalah, A. Hasanin, akram eladawy, M. Ahmed, and A. Mukhtar, "Evaluation of Perfusion Index as a Predictor of Vasopressor Requirement in Patients with Severe Sepsis.", Shock (Augusta, Ga.), vol. 44, issue 6, pp. 554-9, 2015 Dec. Abstract

We evaluated the ability of perfusion index (PI) to predict vasopressor requirement during early resuscitation in patients with severe sepsis. All consecutive patients with clinically suspected severe sepsis as defined by the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference were included. Perfusion variables included PI, arterial lactate level, central venous oxygen saturation, and the difference between central venous carbon dioxide and arterial carbon dioxide pressures, and were recorded before resuscitation and 6 h thereafter. We enrolled 36 patients with severe sepsis. Twenty-one patients required vasopressors, whereas 15 did not. The cut-off of the PI value for predicting vasopressor requirement was ≤0.3. This cut-off value had a sensitivity of 100% and a specificity of 93%; the area under the curve was 0.96 (95% confidence interval 0.8-0.99, P < 0.0001). The cut-off of the arterial lactate level for predicting vasopressor requirement was ≥1.8 mg dL. This cut-off value had a sensitivity of 82% and a specificity of 80%; the area under the curve was 0.84 (95% confidence interval 0.68-0.94, P < 0.0001). Other perfusion variables failed to predict vasopressor requirement in patients with severe sepsis. We concluded that PI and arterial lactate level are good predictors of vasopressor requirement during early resuscitation in patients with severe sepsis. Further studies are warranted to investigate whether monitoring PI during resuscitation improves the outcome of patients with septic shock.

Mukhtar, A., A. Zaghlol, R. Mansour, A. Hassanin, akram eladawy, hossam mohamed, and M. A. Ali, "Reduced incidence of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia in trauma patients: A new insight into the efficacy of the ventilator care bundle.", Trauma, vol. 16, issue 3, pp. 202-206, 2014.