Fouda, R., M. S. Soliman, M. G. ElAnany, M. Abadeer, and G. Soliman, "Prevalence and risk factors of MRSA, ESBL and MDR bacterial colonization upon admission to an Egyptian medical ICU.", Journal of infection in developing countries, vol. 10, issue 4, pp. 329-36, 2016 Apr 28. Abstract

INTRODUCTION: Bacterial colonization of the skin and mucous membranes of intensive care unit (ICU) patients with virulent organisms such as methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) producers, and multidrug-resistant Gram-negative bacteria (MDR-GNB) frequently results in life-threatening infections. Universal screening of ICU patients upon admission has been suggested. The aim of the current study was to evaluate the prevalence and pattern of MRSA, ESBL, and MDR-GNB colonization in patients upon admission to an Egyptian medical ICU, along with the related demographic and clinical risk factors.

METHODOLOGY: Throat, axillary, and groin swabs were obtained from all study participants in addition to rectal swabs from consenting patients. These swabs were screened for MRSA, ESBL, and MDR-GNB.

RESULTS: Of the patients included in the study, 33%, 13%, and 63% were colonized with ESBL, MDR-GNB, and MRSA organisms, respectively. Those suffering from a more severe disease with a simplified acute physiology score II (SAPS II) > 29 demonstrated higher levels of MDR-GNB colonization upon admission, while MDR-GNB or ESBL colonization upon admission was associated with higher ICU mortality.

CONCLUSIONS: Colonization of ICU patients with superbugs upon admission has an impact on outcome and mortality. In this Egyptian example, colonization rates were higher than in other literature reports, demonstrating the need for routine screening and decolonization, if applicable.

Fouda, R., M. S. Soliman, M. G. ElAnany, M. Abadeer, and G. Soliman, "Prevalence and risk factors of MRSA, ESBL and MDR bacterial colonization upon admission to an Egyptian medical ICU.", Journal of infection in developing countries, vol. 10, issue 4, pp. 329-36, 2016 Apr 28. Abstract

INTRODUCTION: Bacterial colonization of the skin and mucous membranes of intensive care unit (ICU) patients with virulent organisms such as methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) producers, and multidrug-resistant Gram-negative bacteria (MDR-GNB) frequently results in life-threatening infections. Universal screening of ICU patients upon admission has been suggested. The aim of the current study was to evaluate the prevalence and pattern of MRSA, ESBL, and MDR-GNB colonization in patients upon admission to an Egyptian medical ICU, along with the related demographic and clinical risk factors.

METHODOLOGY: Throat, axillary, and groin swabs were obtained from all study participants in addition to rectal swabs from consenting patients. These swabs were screened for MRSA, ESBL, and MDR-GNB.

RESULTS: Of the patients included in the study, 33%, 13%, and 63% were colonized with ESBL, MDR-GNB, and MRSA organisms, respectively. Those suffering from a more severe disease with a simplified acute physiology score II (SAPS II) > 29 demonstrated higher levels of MDR-GNB colonization upon admission, while MDR-GNB or ESBL colonization upon admission was associated with higher ICU mortality.

CONCLUSIONS: Colonization of ICU patients with superbugs upon admission has an impact on outcome and mortality. In this Egyptian example, colonization rates were higher than in other literature reports, demonstrating the need for routine screening and decolonization, if applicable.

Ammar, H., R. Govindu, R. Fouda, W. Zohdy, and E. Supsupin, "Dizziness in a community hospital: central neurological causes, clinical predictors, and diagnostic yield and cost of neuroimaging studies.", Journal of community hospital internal medicine perspectives, vol. 7, issue 2, pp. 73-78, 2017 Mar. Abstract

Objectives: Neuroimaging is contributing to the rising costs of dizziness evaluation. This study examined the rate of central neurological causes of dizziness, relevant clinical predictors, and the costs and diagnostic yields of neuroimaging in dizziness assessment. Methods: We retrospectively reviewed the records of 521 adult patients who visited the hospital during a 12-month period with dizziness as the chief complaint. Clinical findings were analyzed using Fisher's exact test to determine how they correlated with central neurological causes of dizziness identified by neuroimaging. Costs and diagnostic yields of neuroimaging were calculated. Results: Of the 521 patients, 1.5% had dizziness produced by central neurological causes. Gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings predicted central causes. Cases were associated with gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings . Brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 42% and 9.5% of the examined cases, respectively, with diagnostic yields of 3.6% and 12%, respectively. Nine cases of dizziness were diagnosed from 269 brain scans, costing $607 914. Conclusion: Clinical evaluation can predict the presence of central neurological causes of dizziness, whereas neuroimaging is a costly and low-yield approach. Guidelines are needed for physicians, regarding the appropriateness of ordering neuroimaging studies. Abbreviations: OR: odds ratio; CI: confidence interval; ED: emergency department; CT: computed tomography; MRI: magnetic resonance imaging; HINTS: Head impulse, Nystagmus, Test of skew.

Salem, M., R. Fouda, U. Fouda, M. E. L. Maadawy, and H. Ammar, "Rapunzel and pregnancy.", Southern medical journal, vol. 102, issue 1, pp. 106-7, 2009 Jan. Abstract

Rapunzel, the girl with long golden tresses in the fairy tale, inspired Vaughan et al to describe, in 1968, cases of trichobezoar with a long tail causing bowel obstruction as "Rapunzel syndrome." A 22-year-old Egyptian woman had been suffering from episodes of epigastric pain and vomiting throughout her pregnancy and puerperium. After diagnosing pancreatitis, we discovered a trichobezoar in her stomach. In an emergent gastrotomy, she was found to have a gastric trichobezoar with a long tail extending down to her duodenum. This is one of the very few cases of Rapunzel syndrome to be complicated by pancreatitis; to our knowledge, it is the first to be reported postpartum.

Ammar, H., and R. Fouda, "Myocarditis.", The New England journal of medicine, vol. 361, issue 4, pp. 423; author reply 423-4, 2009 Jul 23. Abstract
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Fouda, U. M., R. M. Fouda, H. M. Ammar, M. Salem, and M. E. Darouti, "Impetigo herpetiformis during the puerperium triggered by secondary hypoparathyroidism: a case report.", Cases journal, vol. 2, pp. 9338, 2009. Abstract

A 38-year-old multiparous woman with post thyroidectomy hypoparathyroidism developed pruritic erythematous patches with multiple pustules on its margins on her thighs and groin accompanied by fever few days after delivery by caesarean section. Impetigo herpetiformis was diagnosed based on the typical clinicopathological findings. The patient was treated with intravenous fluids, calcium, Calcitrol and corticosteroids. The correction of hypocalcaemia was accompanied with rapid improvement of her skin disease and general condition. Our case is the fourth case of impetigo herpetiformis initially presented during puerperium and the first case of puerperal impetigo herpetiformis that is precipitated by secondary hypoparathyroidism. The awareness of the possible occurrence of impetigo herpetiformis during the puerperium allows early diagnosis, treatment and prevention of maternal complications.

Fouda, R., H. Ammar, R. Edward, W. M. Alnabawy, and I. M. Fouda, "Tuberculous pericarditis associated with hoarseness of voice due to left recurrent laryngeal nerve paralysis.", BMJ case reports, vol. 2011, 2011. Abstract

A 16-years-old Egyptian girl presented with massive pericardial effusion, fever, weight loss and hoarseness of voice. Laryngoscopy showed left vocal cord paralysis. Chest CT revealed pericardial effusion, amalgamated mediastinal lymph nodes and clear lung fields. Pericardial fluid analysis revealed a lymphocytic exudate with high adenosine deaminase enzyme level, negative stains and cultures for bacteria and fungi. Despite a negative nucleic acid test for tuberculosis; antituberculous and corticosteroids therapies resulted in resolution of pericardial effusion after 3 weeks but hoarseness of voice persisted. Few cases of vocal cord paralysis with tuberculous mediastinal lymphadenopathy were reported in English literature.

Ammar, H., and R. Fouda, "An unusual cause of hoarseness.", BMJ case reports, vol. 2012, 2012. Abstract

A 55-year-old man had a 3 month history of hoarseness and choking when he drinks liquids. Physical examination revealed evidence of left sided palsy of 9th, 10th, 11th and 12th cranial nerves. A brain MRI revealed a skull base lytic lesion. The authors diagnosed Collet-Sicard syndrome. The patient was found to have colon cancer. He received palliative skull radiotherapy and died few weeks later in hospice care.

Fouda, R., H. Ammar, E. Sobhy, and A. M. Amin, "Unusual cause of pericardial effusion.", BMJ case reports, vol. 2012, 2012. Abstract

A 65-year-old Egyptian lady suffering from non-alcoholic liver cirrhosis was referred to our unit for evaluation of a massive pericardial effusion. Few weeks before presentation, she suffered from progressive abdominal distention and dyspnoea. She denied fever, rigors or other cardiorespiratory symptoms. Examination revealed shrunken liver, spleenomegaly and ascites. Chest was clear to auscultation and heart sounds were distant. Chest radiograph showed cardiomegaly and clear lung fields. Abdominal ultrasound confirmed the results of abdominal examination. Transthoracic echocardiogram (TTE) revealed a massive pericardial effusion (PEF) and rheumatic mitral stenosis. Chest tomography showed PEF and clear lung fields. One litre of exudate was removed via TTE-guided needle pericardiocentesis. A pericardio-peritoneal shunt was suspected, which was confirmed via a radioisotopic study. This case is among very few cases that reported PEF in a cirrhotic ascetic patient secondary to a radio-isotopically confirmed pericardio-peritoneal shunt in the literature.

Ahmed, M. A. E., R. Fouda, H. Ammar, and S. M. Amin, "Massive pericardial effusion and multiple pericardial masses due to an anterior mediastinal teratoma rupturing in pericardial sac.", BMJ case reports, vol. 2012, 2012. Abstract

A 25 -year-old Egyptian man presented to our unit for the evaluation of a large pericardial effusion. At 1 month before presentation he suffered from daily bouts of fever. Chest x-ray revealed cardiomegaly, echocardiography showed large pericardial effusion and multiple pericardial masses. Needle pericardiocentesis revealed a bloody exudate with no malignant cells. Chest CT showed a well-circumscribed anterior mediastinal cystic mass with a central fat component and foci of calcification. MRI of the chest similarly showed no intracardiac extension. A cystic mass 7×9 cm was removed via a median sternotomy with uneventful postoperative course. Pathological evaluation revealed a benign cystic teratoma and a thymic cyst. Most cystic teratomas are accidentally discovered, large ones can cause symptoms through the compression of mediastinal structures or rupture in pericardial sac.