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Journal Article
Youssf, G., S. Nagy, ahmed talaat, and M. A. Hamid, "P6580 Pattern of 24 hours ambulatory blood pressure readings in hypertensive patients with controlled office blood pressure measurements", European Heart Journal, vol. 39, issue 1, 2018.
Youssef, G., M. Mashaal, D. El Remaisy, K. Sorour, and H. Rizk, "Pericardial Effusion In Prosthetic and Native Valve Infective Endocarditis", Indian Heart Journal, vol. 71, pp. 80-84, 2019. pe_in_ie_paper.pdf
Youssef, G., H. Kassem, O. Ameen, A. H. Taaban, and H. Rizk, "Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care", Egyptian Heart Journal, vol. 69, pp. 177-181, 2017. prehospital_and_hospital_delay_hossams.pdf
van Hagen, I. M., S. A. Thorne, N. Taha, G. Youssef, A. Elnagar, H. Gabriel, Y. ElRakshy, B. Iung, M. R. Johnson, R. Hall, et al., "Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease Results From the Registry of Pregnancy and Cardiac Disease", Circulation, vol. 137, pp. 806-816, 2018. Pregnancy outcome in mitral stenosis.pdf
Sliwa, K., L. Baris, C. Sinning, E. Zengin-Sahm, L. Gumbiene, I. F. Yaseen, G. Youssef, M. Johnson, H. Al-Farhan, Malgorzata Lelonek, et al., "Pregnant Women With Uncorrected Congenital Heart Disease: Heart Failure and Mortality.", JACC. Heart failure, vol. 8, issue 2, pp. 100-110, 2020. Abstract

OBJECTIVES: The purpose of this work was to study maternal and fetal outcomes of women with uncorrected congenital heart disease (CHD).

BACKGROUND: Globally, CHD is an important cause of maternal morbidity and mortality in women reaching reproductive stage. Data are lacking from larger cohorts of women with uncorrected CHD.

METHODS: The 10-year data from the European Society of Cardiology EORP ROPAC (EURObservational Research Programme Registry of Pregnancy and Cardiac disease) registry of women with uncorrected CHD were analyzed.

RESULTS: Of 5,739 pregnancies in 53 countries, 3,295 women had CHD, 1,059 of which were uncorrected cases. Of these, 41.4% were from emerging countries. There were marked differences between the cardiac defects in uncorrected cases versus those in corrected CHD cases with primary shunt lesions (44.7% vs. 32.4%, respectively), valvular abnormalities (33.5% vs. 12.6%, respectively), and Tetralogy of Fallot and pulmonary atresia (0.8% vs. 20.3%, respectively; p < 0.001). In patients with uncorrected CHD, 6.8% were in modified World Health Organization risk class IV, approximately 10% had pulmonary hypertension (PH), and 3% were cyanotic prior to pregnancy. Maternal mortality and heart failure (HF) in the women with uncorrected CHD were 0.7% and 8.7%, respectively. Eisenmenger syndrome was associated with a very high risk of cardiac events (65.5%), maternal mortality (10.3%), and HF (48.3%). Coming from an emerging country was associated with higher pre-pregnancy signs of HF, PH, and cyanosis (p < 0.001) and worse maternal and fetal outcomes, with a 3-fold higher rate of hospital admissions for cardiac events and intrauterine growth retardation (p < 0.001).

CONCLUSIONS: Marked differences between cardiac conditions in pregnant women with uncorrected CHD and those in corrected CHD were found, with a markedly worse outcome, particularly in women with Eisenmenger syndrome and from emerging countries.

Youssef, G., M. Mohamed, M. A. Hamid, and D. El Remisy, "Reasons behind high rate of non-compliance to scheduled office visits in hypertensive patients: results from the Egyptian registry of specialized hypertension clinics.", The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, vol. 74, issue 1, pp. 45, 2022. Abstract

BACKGROUND: Hypertensive patients' compliance to the clinic's follow-up visits is associated with a better blood pressure control. The aim of this study was to detect the reasons of non-compliance to office visits in Egyptian hypertensive patients.

RESULTS: This is an observational, prospective, cross-sectional research study where patients were enrolled from the registry of the specialized hypertension clinics of 9 university hospitals. Those who attended less than 3 office visits, throughout the registry period, were considered non-compliant and were contacted through the phone. A simple questionnaire was prepared, which included questions about the reasons of non-compliance to follow up. There were 3014 patients eligible for inclusion in this study but only 649 patients (21.5%) completed the questionnaire. Patients claimed that the reasons of non-compliance to the follow up visits in the specialized hypertension clinics were as follows: 444 patients (68.4%) preferred to follow up elsewhere mostly in pharmacies, 53 patients (8.2%) claimed that the healthcare service was unsatisfactory, 94 patients (14.5%) were asymptomatic, and 110 patients (16.9%) said that the clinic was far from their homes. Despite non-compliance to office visits, 366 patients (59.2%) were compliant to their antihypertensive medications and 312 (48.1%) patients were compliant to salt restriction. About 34% of patients used herbs, mainly hibiscus, as adjuvant to their antihypertensive medications.

CONCLUSIONS: Reasons for non-compliance to office visits in hypertensive patients were either patient-related, or healthcare-related. To improve patients' compliance, physicians need to educate their patients about hypertension, patients need to follow their doctors' instructions as regard medications, salt restriction and scheduled office visits, and governments need to provide better and cheaper healthcare services.

ELFaramawy, A., G. Youssef, W. ElAroussy, D. El Remisy, H. El Deeb, A. Abdelaal, and M. M. Ibrahim, "Registry of the Egyptian specialized hypertension clinics: patient risk profiles and geographical differences.", Journal of human hypertension, vol. 34, issue 7, pp. 520-527, 2020. Abstract

Data regarding the prevalence and characteristics of cardiovascular (CV) risk factors among Egyptian hypertensive patients are limited. Nationwide Specialized Hypertension Clinics (SHCs) were initiated for screening, investigating, and treating hypertensive patients. This study aimed to determine the clinical characteristics and the CV risk profile of hypertensive Egyptians attending SHCs. Data from 4701 hypertensive patients were collected from the SHCs of nine university hospitals representing the different geographical regions of Egypt. Data collection started in October 2014 and ended in September 2017. Data included blood pressure (BP) measurements, clinical data, socio-demographic characteristics, anthropometric measurements, and cardiovascular risk profiles. The patients' mean age was 51.8 ± 11.5 years, 58.7% were older than 50 years, and 58.5% were females. The mean office systolic and diastolic BP values were 145.2 ± 22.4 and 88.7 ± 12.9 mmHg, respectively. Regarding CV risk factors, 58.6% were obese, 23.4% were smokers, and 25.1% had diabetes mellitus. Obesity was more prevalent in females than males (65.7% vs. 53.0%, p < 0.001, respectively), while dyslipidaemia and smoking were significantly more common in male patients. The highest levels of BP and the highest global risk were observed in the inhabitants of the Delta region, despite their younger age. In conclusion, this study revealed a high prevalence of modifiable CV risk factors among a cohort of Egyptian hypertensive patients attending SHCs. The pattern of the risk factors across the different geographic regions may be attributed to rapid urbanization. Governmental and community-based approaches are needed for better control of hypertension and its associated CV risk factors.

Abdelaal, A., G. Youssef, A. ELFaramawy, D. El Remisy, H. El Deeb, W. E. Arousssy, and M. M. Ibrahim, "Registry of the Egyptian specialized hypertension clinics: Sex‐related differences in clinical characteristics and hypertension management among low socioeconomic hypertensive patients", Journal of clinical hypertension, pp. 1-9, 2021.
Ghareeb, S., G. Youssef, H. S. Ghareeb, H. A. El-Mageed, M. H. Mesalm, R. Talaat, A. Eltawil, D. M. Hasan, and M. M. Ibrahim, "Results of a project to calibrate mercury sphygmomanometer blood pressure-measuring devices in Egypt.", Journal of human hypertension, vol. 35, pp. 921-926, 2021. Abstractcalibration_paper_2021.pdf

Hypertension (HTN) is a common health problem and a major cardiovascular risk factor. Accurate measurement of blood pressure (BP) is mandatory for proper diagnosis and follow-up. The aim of this study was to evaluate the accuracy of mercury sphygmomanometer BP-measuring devices in public hospitals in Cairo, Egypt. Fifty public hospitals were included, and 10% of all mercury sphygmomanometer devices in each hospital were tested. Assessment included physical condition (e.g., mercury status, lid of the device, state of the rubber tubes), leakage rate, and calibration accuracy (as compared with a reference device). Devices were approved as accurate when they could successfully pass all three assessment tests. The total number of sphygmomanometer devices was 465. The overall pass rate was 1.3% (six devices). Twenty-five (5.2%) devices passed all of the physical tests, 50 (10.8%) passed the leakage test, and 50 (16.5%) passed the calibration accuracy test. There were 162 (34.8%) devices that showed a high leakage rate (>80 mmHg) and thus were not tested for calibration accuracy. In conclusion, most of the mercury sphygmomanometer devices in hospitals are neglected and not checked regularly for any errors. A plan should be made to gradually replace those failed devices with new, validated, and well-calibrated devices, preferably devices that do not contain mercury.

Youssef, G., "Salt and hypertension: current views", E-journal of Cardiology Practice, vol. 22, issue 3, 2022.
Janhangeer, M. I., G. Youssef, W. El Naggar, and D. El Remisy, "Subtle right ventricular dysfunction in asymptomatic chronic heavy cigarette smokers: a speckle tracking case-control study.", The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, vol. 73, issue 1, pp. 25, 2021. Abstractsubtle_rv_dysfunction.pdf

BACKGROUND: Chronic heavy cigarette smoking can affect the right ventriclular function. The standard echocardiography may not show early right ventricular functional changes, and a more sensitive measure is needed. The aim of this work was to evaluate the subtle subclinical effects of chronic heavy cigarette smoking on the right ventricular function. The study included 55 healthy asymptomatic chronic heavy cigarette smokers (smoking history of at least 5 pack-years and a daily cigarette consumption of at least 1 pack) and 35 healthy non-smoking control subjects. Patients underwent a full clinical assessment and a conventional as well as a 2D-speckle tracking transthoracic echocardiography of the right ventricle and data was compared between the 2 groups.

RESULTS: The mean age was 32.9 ± 7.2 years in smokers and 30.9 ± 7.9 years in non-smokers (p = 0.227). The 2 groups showed comparable conventional right ventricular systolic and diastolic functions. Smokers showed a significantly lower (less negative) right ventricular global longitudinal strain (- 19.0 ± 3.2% vs. - 24.5 ± 3.5%, p < 0.001). Patients with a higher daily cigarette consumption showed a poorer right ventricular global longitudinal strain (p = 0.014).

CONCLUSION: Chronic heavy cigarette smoking can adversely affect the right ventricular function, a finding that can be easily missed by conventional echocardiography and can be better detected by the right ventricular speckle tracking.

Youssef, G., "Valvular heart diseases in women", Egyptian Heart Journal, vol. 73, pp. 58, 2021. valvular_hd_review_article.pdf
Magazine Article