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Abdelhakeem, A. K., A. Amin, A. Hasanin, A. Mukhtar, akram eladawy, and S. Kassem, "Validity of Pulse Oximetry-derived Peripheral Perfusion Index in Pain Assessment in Critically Ill Intubated Patients.", The Clinical journal of pain, vol. 37, issue 12, pp. 904-907, 2021. Abstract

OBJECTIVES: Evaluation of pain in critically ill intubated patients is difficult and subjective. This study aimed to evaluate the accuracy of oximetry-derived peripheral perfusion index (PPI) in pain assessment in critically ill intubated patients using the behavioral pain scale (BPS) as a reference.

MATERIALS AND METHODS: This prospective observational study included 35 adult mechanically ventilated surgical patients during their first 2 postoperative days in the intensive care unit. Values of PPI, BPS, Richmond Agitation Sedation Scale (RASS), heart rate, and blood pressure were obtained before and after a standard painful stimulus (changing the patient position) and the ratio between the second and the first reading was calculated to determine the change (Δ) in all variables. The outcomes were the correlation between ΔBPS and ΔPPI as well as other hemodynamic parameters. The ability of the PPI to detect pain (defined as BPS ≥6) was analyzed using the area under receiver operating characteristic curve.

RESULTS: Paired readings were obtained from 35 patients. After the standard painful stimulus, the PPI decreased while the BPS and the Richmond agitation sedation scale increased. The Spearman correlation coefficient (95% confidence interval) between Δ PPI and Δ BPS was 0.41 (0.09-0.65). PPI values showed poor accuracy in detecting pain with area under receiver operating characteristic curve (95% confidence interval): 0.65 (0.53-0.76), with best cutoff value of ≤2.7.

CONCLUSION: The PPI decreased after application of a standard painful stimulus in critically ill intubated patients. ∆PPI showed a low correlation with ∆BPS, and a PPI of ≤2.7 showed a low ability to detect BPS ≥6. Therefore, PPI should not be used for pain evaluation in critically ill intubated surgical patients.

Abdelnasser, A., B. Abdelhamid, A. Elsonbaty, A. Hasanin, and A. Rady, "Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index.", British journal of anaesthesia, vol. 119, issue 2, pp. 276-280, 2017 Aug 01. Abstract

Background: Supraclavicular nerve block is a popular approach for anaesthesia for upper limb surgeries. Conventional methods for evaluation of block success are time consuming and need patient cooperation. The aim of this study was to evaluate whether the perfusion index (PI) can be used to predict and provide a cut-off value for ultrasound-guided supraclavicular nerve block success.

Methods: The study included 77 patients undergoing elective orthopaedic procedures under ultrasound-guided supraclavicular nerve block. After local anaesthetic injection, sensory block success was assessed every 3 min by pinprick, and motor block success was assessed every 5 min by the ability to flex the elbow and the hand against resistance. The PI was recorded at baseline and at 10, 20, and 30 min after anaesthetic injection in both blocked and non-blocked limbs. The PI ratio was calculated as the PI after 10 min divided by the PI at the baseline. Receiver operating characteristic curves were constructed for the accuracy of the PI in detection of block success.

Results: The PI was higher in the blocked limb at all time points, and this was paralleled by a higher PI ratio compared with the unblocked limb. Both the PI and the PI ratio at 10 min after injection showed a sensitivity and specificity of 100% for block success at cut-off values of 3.3 and 1.4, respectively.

Conclusions: The PI is a useful tool for evaluation of successful supraclavicular nerve block. A PI ratio of > 1.4 is a good predictor for block success.

Abdulatif, M., M. Fawzy, H. Nassar, A. Hasanin, M. Ollaek, and H. Mohamed, "The effects of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block: a dose-finding randomised, controlled, double-blind study", Anaesthesia, vol. 71, issue 10, pp. 1177-85, 2016.
Adel, A., W. Awada, B. A. Elhamid, H. Omar, O. A. E. Dayem, A. Hasanin, and A. Rady, "Accuracy and trending of non-invasive hemoglobin measurement during different volume and perfusion statuses.", Journal of clinical monitoring and computing, 2018 Jan 15. Abstract

The evolution of non-invasive hemoglobin measuring technology would save time and improve transfusion practice. The validity of pulse co-oximetry hemoglobin (SpHb) measurement in the perioperative setting was previously evaluated; however, the accuracy of SpHb in different volume statuses as well as in different perfusion states was not well investigated. The aim of this work is to evaluate the accuracy and trending of SpHb in comparison to laboratory hemoglobin (Lab-Hb) during acute bleeding and after resuscitation. Seventy patients scheduled for major orthopedic procedures with anticipated major blood loss were included. Radical-7 device was used for continuous assessment of SpHb, volume status [via pleth variability index (PVI)] and perfusion status [via perfusion index (PI)]. Lab-Hb and SpHb were measured at three time-points, a baseline reading, after major bleeding, and after resuscitation. Samples were divided into fluid-responsive and fluid non-responsive samples, and were also divided into high-PI and low-PI samples. Accuracy of SpHb was determined using Bland-Altman analysis. Trending of SpHb was evaluated using polar plot analysis. We obtained 210 time-matched readings. Fluid non-responsive samples were 106 (50.5%) whereas fluid responsive samples were 104 (49.5%). Excellent correlation was reported between Lab-Hb and SpHb (r = 0.938). Excellent accuracy with moderate levels of agreement was also reported between both measures among all samples, fluid non-responsive samples, fluid-responsive samples, high-PI samples, and low-PI samples [Mean bias (limits of agreement): 0.01 (- 1.33 and 1.34) g/dL, - 0.08 (- 1.27 and 1.11) g/dL, 0.09 (- 1.36 and 1.54) g/dL, 0.01 (- 1.34 to 1.31) g/dL, and 0.04 (- 1.31 to 1.39) g/dL respectively]. Polar plot analysis showed good trending ability for SpHb as a follow up monitor. In conclusion, SpHb showed excellent correlation with Lab-Hb in fluid responders, fluid non-responders, low-PI, and high PI states. Despite a favorable mean bias of 0.01 g/dL for SpHb, the relatively wide levels of agreement (- 1.3 to 1.3 g/dL) might limit its accuracy. SpHb showed good performance as a trend monitor.

Ahmed Hasanin, Akram Eladawy, H. M. Y. S. I. A. L. H. M. D. G. A. M., "Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt", Pan African Medical Journal, vol. 19, pp. 177, 2014.
Ahmed Mukhtar, Ahmed Hasanin, G. O. A. A., "Intraoperative Terlipressin Therapy Reduces the Incidence of Postoperative Acute Kidney Injury After Living Donor Liver Transplantation", Journal of cardiothoracic and vascular anesthesia, 2015.
Ali, H., B. M. A. Elhamid, A. M. Hasanin, A. Abou Amer, and A. Rady, "Ketamine-based Versus Fentanyl-based Regimen for Rapid-sequence Endotracheal Intubation in Patients with Septic Shock: A Randomised Controlled Trial.", Romanian journal of anaesthesia and intensive care, vol. 28, issue 2, pp. 98-104, 2021. Abstract

OBJECTIVE: The aim of this work is to compared ketamine-based versus fentanyl-based regimens for endotracheal intubation in patients with septic shock undergoing emergency surgery.

DESIGN: This was a randomised double-blinded controlled trial.

PARTICIPANTS: Patients with septic shock on norepinephrine infusion scheduled for emergency surgery.

SETTING AND INTERVENTIONS: At induction of anaesthesia, patients were allocated into ketamine group (n=23) in which the participants received ketamine 1 mg/kg, and fentanyl group (n=19) in which the participants received fentanyl 2.5 mcg/ kg. Both groups received midazolam (0.05 mg/kg) and succinyl choline (1 mg/kg).

MEASUREMENT: The primary outcome was mean arterial blood pressure. The secondary outcomes included: heart rate, cardiac output, and incidence of postintubation hypotension defined as mean arterial pressure ≤80% of baseline value.

RESULTS: Forty-two patients were available for final analysis. The mean blood pressure was higher in the ketamine group than in the fentanyl group at 1, 2 and 5 minutes after the induction of anaesthesia. Furthermore, the incidence of postinduction hypotension was lower in the ketamine group than in the fentanyl group (11 [47.8%] versus 16 [84.2%], P-value= 0.014). Other hypodynamic parameters, namely the heart rate and cardiac output, were comparable between both groups; and were generally maintained in relation to the baseline reading in each group.

CONCLUSION: The ketamine-based regimen provided better hemodynamic profile compared to fentanyl-based regimen for rapid-sequence intubation in patients with septic shock undergoing emergency surgery.

Ali, T. M., R. Elwy, B. A. E. Razik, M. A. R. Soliman, M. F. Alsawy, A. Abdullah, E. Ahmed, S. Zaki, A. A. Salem, M. A. Katri, et al., "Risk factors of congenital hydrocephalus: a case-control study in a lower-middle-income country (Egypt).", Journal of neurosurgery. Pediatrics, vol. 31, issue 5, pp. 397-405, 2023. Abstract

OBJECTIVE: Hydrocephalus is the most common brain disorder in children and is more common in low- and middle-income countries. Research output on hydrocephalus remains sparse and of lower quality in low- and middle-income countries compared with high-income countries. Most studies addressing hydrocephalus epidemiology are retrospective registry studies entailing their inherent limitations and biases. This study aimed to investigate child-related, parental, and socioeconomic risk factors of congenital hydrocephalus (CH) in a lower-middle-income country.

METHODS: An investigator-administered questionnaire was used to query parents of patients with CH and controls who visited the authors' institution from 2017 until 2021. Patients with secondary hydrocephalus and children older than 2 years of age at diagnosis were excluded. Uni- and multivariable logistic regression was performed to identify the factors affecting CH development.

RESULTS: Seven hundred forty-one respondents (312 cases and 429 controls) were included in this study. The authors showed that maternal diseases during pregnancy (OR 3.12, 95% CI 1.96-5.03), a lack of periconceptional folic acid intake (OR 1.92, 95% CI 1.32-2.81), being a housewife (OR 2.66, 95% CI 1.51-4.87), paternal illiteracy (OR 1.65, 95% CI 1.02-2.69), parental consanguinity (OR 3.67, 95% CI 2.40-5.69), a history of other CNS conditions in the family (OR 2.93, 95% CI 1.24-7.34), conceiving a child via assisted fertilization techniques (OR 3.93, 95% CI 1.57-10.52), and the presence of other congenital anomalies (OR 2.57, 95% CI 1.38-4.87) were associated with an independent higher odds of a child having CH. Conversely, maternal hypertension (OR 0.22, 95% CI 0.09-0.48), older maternal age at delivery (OR 0.93, 95% CI 0.89-0.97), and having more abortions (OR 0.80, 95% CI 0.67-0.95) were negatively correlated with CH.

CONCLUSIONS: Multiple parental, socioeconomic, and child-related factors were associated with higher odds for developing CH. These results can be utilized to guide parental counseling and management, and direct social education and prevention programs.

Amin, S. M., A. Hasanin, O. S. Elsayed, M. Mostafa, D. KHALED, A. S. Arafa, and A. Hassan, "Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial.", Anaesthesia, critical care & pain medicine, vol. 42, issue 4, pp. 101225, 2023. Abstract

BACKGROUND: The present study aims to compare the hemodynamic profile of lidocaine and fentanyl during propofol induction of general anesthesia.

METHODS: This randomized controlled trial included patients aged above 60 years undergoing elective non-cardiac surgery. The included patients received either 1 mg/kg lidocaine (n = 50) or 1 mcg/kg fentanyl (n = 50) based on total body weight with propofol induction of anesthesia. Patient's hemodynamics were recorded every minute for the first 5 min then every 2 min until 15 min after induction of anesthesia. Hypotension (mean arterial pressure [MAP] <65 mmHg or >30% reduction from baseline) was treated by intravenous 4 mcg bolus of norepinephrine. Outcomes included norepinephrine requirements (primary), the incidence of postinduction hypotension, MAP, heart rate, intubation condition, and postoperative delirium via the cognitive assessment method.

RESULTS: Forty-seven patients in the lidocaine group and 46 patients in the fentanyl group were analyzed. None in the lidocaine group experienced hypotension, while 28/46 (61%) of patients in the fentanyl group developed at least one episode of hypotension requiring a median (25th and 75th quartiles) norepinephrine dose of 4 (0,5) mcg, p-value <0.001 for both outcomes. The average MAP was lower in the fentanyl group than in the lidocaine group at all time points after anesthesia induction. The average heart rate was comparable between the two groups nearly at all time points after anesthesia induction. The overall intubation condition was comparable between the two groups. None of the included patients developed postoperative delirium.

CONCLUSION: Lidocaine-based regimen for induction of anesthesia reduced the risk of postinduction hypotension in older patients compared to the fentanyl-based regimen.

Eley, V., A. Hasanin, R. Landau, D. Benhamou, F. J. Mercier, and L. Bouvet, "Antibiotic prophylaxis in obstetric care: is universal administration warranted?", Anaesthesia, critical care & pain medicine, vol. 42, issue 3, pp. 101235, 2023.
Elhamid, B. A., mohamed emam, M. Mostafa, A. Hasanin, W. Awada, A. Rady, and H. Omar, "The ability of perfusion index to detect segmental ulnar nerve sparing after supraclavicular nerve block.", Journal of clinical monitoring and computing, vol. 34, issue 6, pp. 1185-1191, 2020. Abstract

Supraclavicular nerve block (SCB) is a commonly used regional block for upper extremity surgery. The most common form of failure of SCB is ulnar segmental sparing. We aimed to evaluate the accuracy of perfusion index (PI) in early detection of segmental sparing of the ulnar component of SCB. A prospective observational study included adult patients scheduled for surgery under ultrasound-guided SCB. PI was simultaneously measured at the index finger and little finger. PI was recorded every minute for the first 10 min after SCB. PI ratio was calculated at every measurement point as PI/baseline PI. The area under the receiver operating characteristic (AUROC) curve was calculated for the ability of PI ratio to detect segmental ulnar sparing with comparison of little finger readings to the index finger readings. Forty-nine patients were available for the final analysis. Nine patients (18%) had segmental ulnar sparing. PI ratio at the little finger showed excellent predictive ability for ulnar sparing starting from the fifth minute (AUROC 0.92 [0.8-0.98], cutoff value ≤ 1.71) and reached the highest value at the seventh minute (AUROC 0.96 [0.86-1], cutoff value ≤ 1.35), whereas PI ratio at the index finger showed poor predictive ability. When using the PI for evaluation of successful SCB, segmental ulnar sparing could be accurately detected when the PI was measured at the little finger and not at the index finger. An increase of 71% in PI at the little finger 5 min after SCB could accurately rule out ulnar sparing.Clinical trial identifier NCT03880201. Clinical trial registration;draw=2&amp;rank=1 .

Elmetwally, S. A., A. Hasanin, L. Sobh, M. Gohary, K. Sarhan, and D. Ghazy, "Semi-sitting position enhances gastric emptying of clear fluids in children: A randomized controlled trial", Egyptian Journal of Anaesthesia, vol. 36, pp. 170-175, 2020.
Elshal, M. M., A. M. Hasanin, M. Mostafa, and R. M. Gamal, "Plethysmographic Peripheral Perfusion Index: Could It Be a New Vital Sign?", Frontiers in medicine, vol. 8, pp. 651909, 2021. Abstract

The plethysmographic peripheral perfusion index (PPI) is a very useful parameter with various emerging utilities in medical practice. The PPI represents the ratio between pulsatile and non-pulsatile portions in peripheral circulation and is mainly affected by two main determinants: cardiac output and balance between sympathetic and parasympathetic nervous systems. The PPI decreases in cases of sympathetic predominance and/or low cardiac output states; therefore, it is a useful predictor of patient outcomes in critical care units. The PPI could be a surrogate for cardiac output in tests for fluid responsiveness, as an objective measure of pain especially in un-cooperative patients, and as a predictor of successful weaning from mechanical ventilation. The PPI is simple to measure, easy to interpret, and has continuously displayed variables, making it a convenient parameter for detecting the adequacy of blood flow and sympathetic-parasympathetic balance.

Elsherbiny, M., A. Hasanin, S. Kasem, M. Abouzeid, M. Mostafa, A. Fouad, and Y. Abdelwahab, "Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial.", BMC anesthesiology, vol. 23, issue 1, pp. 329, 2023. Abstract

BACKGROUND: We aimed to compare the hemodynamic effect of two ratios of propofol and ketamine (ketofol), namely 1:1 and 1:3 ratios, in rapid-sequence induction of anesthesia for emergency laparotomy.

METHODS: This randomized controlled study included adult patients undergoing emergency laparotomy under general anesthesia. The patients were randomized to receive either ketofol ratio of 1:1 (n = 37) or ketofol ratio of 1:3 (n = 37). Hypotension (mean arterial pressure < 70 mmHg) was managed by 5-mcg norepinephrine. The primary outcome was total norepinephrine requirements during the postinduction period. Secondary outcomes included the incidence of postinduction hypotension, and the intubation condition (excellent, good, or poor).

RESULTS: Thirty-seven patients in the ketofol-1:1 and 35 patients in the ketofol 1:3 group were analyzed. The total norepinephrine requirement was less in the ketofol-1:1 group than in the ketofol-1:3 group, P-values: 0.043. The incidence of postinduction hypotension was less in the ketofol-1:1 group (4 [12%]) than in ketofol-1:3 group (12 [35%]), P-value 0.022. All the included patients had excellent intubation condition.

CONCLUSION: In patients undergoing emergency laparotomy, the use of ketofol in 1:1 ratio for rapid-sequence induction of anesthesia was associated with less incidence of postinduction hypotension and vasopressor consumption in comparison to the 1:3 ratio with comparable intubation conditions.


Eltrabili, H. H., A. Hasanin, M. S. Soliman, A. M. Lotfy, W. I. Hamimy, and A. H. M. E. D. M. MUKHTAR, "Evaluation of Diaphragmatic Ultrasound Indices as Predictors of Successful Liberation From Mechanical Ventilation in Subjects With Abdominal Sepsis", Respiratory Care, vol. 64, issue 5, pp. 564-569, 2019.
Fathy, S., A. Hasanin, M. Mostafa, E. Ramzy, K. Sarhan, T. Almenesey, A. G. Safina, Osama Hosny, G. A. Hamden, A. A. Gado, et al., "The benefit of adding lidocaine to ketamine during rapid sequence endotracheal intubation in patients with septic shock: A randomised controlled trial.", Anaesthesia, critical care & pain medicine, vol. 40, issue 1, pp. 100731, 2021. Abstract

BACKGROUND: Patients with septic shock commonly require endotracheal intubation under general anaesthesia in the operating theatre, the emergency department, and the intensive care unit. Hypotension is a serious complication after induction of general anaesthesia, especially in patients with circulatory failure. No randomised controlled trials had previously investigated protocols for induction of anaesthesia in septic shock patients. The aim of the current work is to compare two protocols, lidocaine-ketamine combination versus ketamine full-dose for rapid-sequence endotracheal intubation in patients with septic shock.

METHODS: Forty-four adult patients, with septic shock, scheduled for emergency surgical intervention were enrolled in this randomised, double-blinded, controlled study. Patients were randomised to receive either 1 mg/kg ketamine (ketamine group, n = 22) or 0.5 mg/kg ketamine plus 1 mg/kg lidocaine (ketamine-lidocaine group, n = 22) for induction of anaesthesia in addition to 0.05 mg/kg midazolam (in both groups). Our primary outcome was the mean arterial pressure (MAP). Other outcomes included frequency of post-induction hypotension, heart rate, and cardiac output.

RESULTS: Forty-three patients were available for final analysis. The average MAP reading in the first 5 min post-induction was higher in ketamine-lidocaine group than in the ketamine group {82.8 ± 5.6 mmHg and 73 ± 10.2 mmHg, P < 0.001}. Furthermore, the incidence of post-intubation hypotension was lower in the ketamine-lidocaine group than in the ketamine group {1 patient (5%) versus 17 patients (77%), P < 0.001}. The ketamine-lidocaine group showed higher MAP in almost all the readings after induction compared to ketamine group. Other haemodynamic variables including cardiac output and heart rate were comparable between both study groups.

CONCLUSION: Lidocaine-ketamine combination showed less incidence of hypotension compared to ketamine full-dose when used for rapid-sequence endotracheal intubation in patients with septic shock. REGISTRATION URL:;rank=1.

Fathy, S., A. Hasanin, M. Raafat, M. Mostafa, A. fetouh, M. E. Sayed, E. M. Badr, H. M. Kamal, and A. Z. Fouad, "Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation", Journal of intensive care, vol. 8, pp. 20, 2020.
Gamal, M., A. Hasanin, N. Adly, M. Mostafa, A. M. Yonis, A. Rady, N. M. AbdAllah, M. Ibrahim, and M. Elsayad, "Thermal Imaging to Predict Failed Supraclavicular Brachial Plexus Block: A Prospective Observational Study.", Local and regional anesthesia, vol. 16, pp. 71-80, 2023. Abstract

BACKGROUND: Successful brachial plexus blockade produces sympathetic blockade, resulting in increased skin temperature in the blocked segments. This study aimed to evaluate the accuracy of infrared thermography in predicting failed segmental supraclavicular brachial plexus block.

METHODS: This prospective observational study included adult patients undergoing upper-limb surgery under supraclavicular brachial plexus block. Sensation was evaluated at the dermatomal distribution of the ulnar, median, and radial nerves. Block failure was defined as absence of complete sensory loss 30 min after block completion. Skin temperature was evaluated by infrared thermography at the dermatomal supply of the ulnar, median, and radial nerves at baseline, 5, 10, 15, and 20 min after block completion. The temperature change from the baseline measurement was calculated for each time point. Outcomes were the ability of temperature change at each site to predict failed block of the corresponding nerve using area under receiver-operating characteristic curve (AUC) analysis.

RESULTS: Eighty patients were available for the final analysis. The AUC (95% confidence interval [CI]) for the ability of temperature change at 5 min to predict failed ulnar, median, and radial nerve block was 0.79 (0.68-0.87), 0.77 (0.67-0.86), and 0.79 (0.69-0.88). The AUC (95% CI) increased progressively and reached its maximum values at 15 min (ulnar nerve 0.98 [0.92-1.00], median nerve 0.97 [0.90-0.99], radial nerve 0.96 [0.89-0.99]) with negative predictive value of 100%.

CONCLUSION: Infrared thermography of different skin segments provides an accurate tool for predicting failed supraclavicular brachial plexus block. Increased skin temperature at each segment can exclude block failure in the corresponding nerve with 100% accuracy.

Gamal, M., B. A. Elhamid, D. Zakaria, O. A. E. Dayem, A. Rady, M. Fawzy, and A. Hasanin, "Evaluation of Noninvasive Hemoglobin Monitoring in Trauma Patients with Low Hemoglobin Levels.", Shock (Augusta, Ga.), vol. 49, issue 2, pp. 150-153, 2018 Feb. Abstract

OBJECTIVE: Bleeding is a leading cause of death among trauma patients. Delayed assessment of blood hemoglobin level might result in either unnecessary blood transfusion in nonindicated patients or delayed blood transfusion in critically bleeding patients. In this study, we evaluate the precision of noninvasive hemoglobin monitoring in trauma patients with low hemoglobin levels.

METHODS: We included trauma patients with low hemoglobin levels (less than 8 g/dL) scheduled for surgical intervention. Blood samples were obtained on admission and after each blood unit with concomitant measurement of serum hemoglobin using radical-7 Masimo device. The change in blood hemoglobin after every transfused blood unit was also assessed by both methods (change in noninvasive Masimo hemoglobin [Delta-Sp-Hb] and change in laboratory hemoglobin [Delta-Lab-Hb]). The precision of Masimo hemoglobin level (Sp-Hb) compared with Laboratory hemoglobin level (Lab-Hb) was determined using both Bland-Altman and Pearson correlation analyses.

RESULTS: One hundred eighty-four time-matched samples were available for final analysis. Bland-Altman analysis showed excellent accuracy of Sp-Hb compared with Lab-Hb with mean bias of 0.12 g/dL and limits of agreement between -0.56 g/dL and 0.79 g/dL. Excellent correlation was reported between both measures with Pearson correlation coefficient of 0.872. Excellent agreement was also reported between both Delta-Sp-Hb and Delta-Lab-Hb with mean bias of -0.05 and limits of agreement from -0.62 to 0.51 CONCLUSIONS:: Sp-Hb showed accurate precision in both absolute values and trend values compared with Lab-Hb measurement in trauma patients with low hemoglobin levels.

Gamal, R. M., M. Mostafa, A. M. Hasanin, S. A. Khedr, A. S. Abdelgalil, and M. M. Elshal, "Evaluation of the accuracy of oscillometric non-invasive blood pressure measurement at the ankle in children during general anesthesia.", Journal of clinical monitoring and computing, vol. 37, issue 5, pp. 1239-1245, 2023. Abstract

This study aimed to evaluate the accuracy of oscillometric blood pressure measurement at the ankle in children using invasive blood pressure as reference standard. This prospective observational study included children undergoing noncardiac surgery. Paired radial invasive and ankle non-invasive blood pressure measurements were obtained. Delta blood pressure was calculated as the difference between two consecutive readings. The primary outcome was the mean bias and agreement between the two methods using the Bland-Altman analysis. The ISO standard was fulfilled if the mean bias between the two methods was ≤ 5 ± 8 mmHg. Other outcomes included the trending ability of ankle blood pressure using the four-quadrant plot and the accuracy of ankle measurement to detect hypotension using area under receiver operating characteristic curve (AUC) analysis. We analyzed 683 paired readings from 86 children. The mean bias between the two methods for systolic, diastolic, and mean blood pressure (SBP, DBP, MAP) was - 7.2 ± 10.7, 4.5 ± 12.8, and - 1.8 ± 8.2 mmHg, respectively. The concordance rate of ankle blood pressure was 72%, 71%, and 77% for delta SBP, DBP and MAP, respectively. The AUC (95% confidence interval) for ankle MAP ability to detect hypotension was 0.91 (0.89-0.93) with negative predictive value of 100% at cut-off value ≤ 70 mmHg, We concluded that in pediatric population undergoing noncardiac surgery, ankle blood pressure was not interchangeable with the corresponding invasive readings with the ankle MAP having the least bias compared to SBP and DBP. An ankle MAP > 70 mmHg can exclude hypotension with negative predictive value of 100%.

Ghaith, D. M., R. M. Hassan, and A. Hasanin, "Rapid identification of nosocomial Acinetobacter baumannii isolated from a surgical intensive care unit in Egypt", Annals of Saudi Medicine, vol. 35, issue 6, pp. 440-4, 2015.
Habib, S., A. Mukhtar, H. Abdelreeem, M. Khorshied, R. E. Sayed, M. Hafez, H. Gouda, doaa ghaith, A. Hasanin, A. El-adawy, 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.
Hammad, Y., A. Hasanin, A. Elsakka, A. Refaie, D. Abdelfattah, and S. A. El Rahman, "Thoracic Fluid Content: A Novel Parameter for Detection of Pulmonary Edema in Parturients With Preeclampsia", Journal of Clinical Monitoring and Computing, vol. 33, issue 4, pp. 413-418, 2019.
Hasanin, A., M. Abdulatif, and M. Mostafa, "Maternal hypotension and neonatal sequelae. Comment on Br J Anaesth 2020; 125: 588-95.", British journal of anaesthesia, vol. 127, issue 1, pp. e10-e11, 2021.
Hasanin, A. M., A. Abou Amer, Y. S. Hassabelnaby, M. Mostafa, A. Abdelnasser, S. M. Amin, M. Elsherbiny, and S. Refaat, "The use of epinephrine infusion for the prevention of spinal hypotension during Caesarean delivery: A randomized controlled dose-finding trial.", Anaesthesia, critical care & pain medicine, vol. 42, issue 3, pp. 101204, 2023. Abstract

BACKGROUND: This study aimed to compare three epinephrine doses for the prevention of spinal hypotension during Caesarean delivery.

METHODS: This randomized controlled trial included full-term pregnant women undergoing elective Caesarean delivery under spinal anesthesia. The participants received prophylactic epinephrine infusions at rates of 0.01, 0.02, or 0.03 mcg/kg/min. Spinal hypotension (systolic blood pressure <80% of baseline) was managed with a 9-mg ephedrine bolus. The primary outcome was the incidence of spinal hypotension. Secondary outcomes included total ephedrine requirement, the incidence of severe spinal hypotension, excessive tachycardia and hypertension, and neonatal outcomes.

RESULTS: The final analysis included 271 patients. The incidence of hypotension was lowest in the 0.03 mcg group (11/90 [12%]), followed by the 0.02 mcg (32/91 [35%]) and the 0.01 mcg (55/90 [61%]) groups (p < 0.001). The median ephedrine requirements (quartiles) were also the lowest in the 0.03 mcg group (0 [0-0] mg), followed by the 0.02 mcg (0 [0-9] mg) and the 0.01 mcg (9 [0-18] mg) groups. The incidence of severe hypotension was lower in the 0.03 mcg and 0.02 mcg groups than in the 0.01 mcg group (3/90 [3%], 5/91 [6%], and 15/90 [17%], respectively). The incidences of excessive tachycardia, hypertension, and neonatal outcomes were comparable among the groups.

CONCLUSION: The use of epinephrine to prevent spinal hypotension during Caesarean delivery is feasible and effective. An initial dose of 0.03 mcg/kg/min produced the lowest incidence of hypotension compared to 0.02 mcg/kg/min and 0.01 mcg/kg/min doses. The three doses were comparable in terms of the incidence of tachycardia, hypertension, and neonatal outcomes.

STUDY REGISTRATION: Identifier: NCT05279703.