Ashraf Andraos - Academia.edu (original) (raw)
Papers by Ashraf Andraos
Background: cardiac device infection (CDI) is a devastating complication of permanent pacemakers ... more Background: cardiac device infection (CDI) is a devastating complication of permanent pacemakers (PPM) or implantable cardioverter-defibrillators (ICD). The incidence and outcome of endocarditis among patients (Pts) with CDI is not well defined. The Aim of this Study: Is to report the experience in the prevalence, clinical presentations and management of bacterial endocarditis (BE) among patients with CDI in a tertiary care cardiac center over 25 years. Methods: A total of 2630 cardiac devices implanted in a cohort of 2367 patients (pts) over 25 years were studied. Out of these, 117 (4.4%) Pts presented with CDI. Clinical, bacteriologic and both transthoracic (TTE) and transoesophageal Echocardiographic (TEE) assessments were done. Results: Of the 117 Pts with CDI (90 males, age ranging 18-82 yrs, mean=63 ±6 ys), 87 (74%) had redo procedures (battery replacement in 50, repositioning of leads in 12, device extrusion in 15 or evacuation of significant haematoma in 10 pts). Of these 87...
Conventional bypass grafting using cardioplegic arrest continues to be associated with some compl... more Conventional bypass grafting using cardioplegic arrest continues to be associated with some complications that may negate an otherwise successful procedure. Interest in offpump bypass grafting (OPCABG) in the mid-1990s presented surgeons with the option of revascularization without the potential complications of extracorporeal support if CPB can be avoided; a reduction in peri-operative morbidity and mortality is anticipated. The Aim of our Study: Is to compare both techniques regarding mortality, morbidity, complications and brain injury in both groups of patients with ischemic heart disease. Patients and Methods: Eighty patients (pts) were subjected to CABGs, 40 with off pump (group I-gpI) and the other 40 pts with on pump (group II-gpII) techniques. Patients in both groups were matching as regards age, sex, risk factors, and number of bypassed coronaries. Pre-operatively and postoperatively all patients were subjected to clinical examination, ECG, chest X-ray, transthoracic echoc...
Open Access Macedonian Journal of Medical Sciences, 2021
Background: It has been demonstrated that the use of cardiac implanted electronic devices (CIED)... more Background: It has been demonstrated that the use of cardiac implanted electronic devices (CIED) improve mortality and survivability in a variety of patient populations. Nevertheless, CIED related infection is a serious complication characterized by a high rate of mortality and morbidity. Objectives: To evaluate the prevalence of CIED related infections, risk factors, clinical and demographic characteristics, causative organisms, and the management and outcome of patients presented in the Critical Care Department, Cairo University. Methods: A retrospective analysis was conducted in 1871 individuals who had been implanted with a cardiac device with a total number of devices of 1968 and 2270 procedures performed from January 2007 to December 2017. Results: 59 infectious episodes were identified with an estimated incidence of 2.99% of inserted devices and 2.6% of total procedures. The infection rate was considerably higher in patients with multiple procedures than those who had a sin...
Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± ... more Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± 1.4 93.2 ± 1.5 Set temperature, 37°C AH (mgH 2 O/l) 34.5 ± 1.6* 38.7 ± 2.2 † 43.1 ± 1.1 RH (%) 91.8 ± 3.2 87.7 ± 7.4 † 94.6 ± 0.9 *P < 0.05 vs DAR HC and MR 730, † P < 0.05 vs MR 730.
Critical Care, 2004
Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± ... more Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± 1.4 93.2 ± 1.5 Set temperature, 37°C AH (mgH 2 O/l) 34.5 ± 1.6* 38.7 ± 2.2 † 43.1 ± 1.1 RH (%) 91.8 ± 3.2 87.7 ± 7.4 † 94.6 ± 0.9 *P < 0.05 vs DAR HC and MR 730, † P < 0.05 vs MR 730.
International Journal of Cardiology, 2010
Objective: Patients (pts) with symptomatic calcified aortic stenosis (CAS) who are poor candidate... more Objective: Patients (pts) with symptomatic calcified aortic stenosis (CAS) who are poor candidates for surgery or disqualified from aortic valve replacement (AVR) often require elective, urgent or emergent BAV either as a bridge to transcatheter valve implantation (TAVI), AVR or as a palliative treatment. We aimed at exploring the hemodynamic results and clinical outcome of BAV performed in CAS pts with overt heart failure (HF) who are not good candidates for AVR due to multiple risk factors. Methods: CAS pts with aortic valve area <1cm 2 , NYHA class IV and Logistic Euroscore >15% were treated with BAV by the femoral artery approach.
Australian Journal of …, 2009
Treatment of patients with acute respiratory failure (ARF) often involves mechanical ventilation ... more Treatment of patients with acute respiratory failure (ARF) often involves mechanical ventilation via endotracheal intubation. Non-invasive positive pressure ventilation (NIV) using Bi-level positive airway pressure (BiPAP) can be a safe and effective means of improving gas exchange. The aim of the present study is to: 1) Assess non-invasive positive pressure ventilation (BiPAP) as an alternative way for ventilation in ARF, and to 2) Determine factors that can predict the successful use of BiPAP. Thirty patients with acute respiratory failure (both type I and II) were enrolled in the study and divided into two groups. Group I included 10 patients who were subjected to invasive mechanical ventilation. Group II included 20 patients were subjected to NIV using BiPAP. Both groups were compared regarding the following parameters: arterial blood gases (ABG) on admission, 30 minutes after beginning of mechanical ventilation, 1 ½ hour then once daily. Complications namely ventilator 2 associated pneumonia (VAP), skin necrosis and CO narcosis; static compliance and resistance were measured at day one and day two. Compared to group I, group II patients were associated with similar improvement in ABGs data at 30 minutes and at discontinuation of ventilation (Table 1). Group II patients showed significantly lower incidence in VAP (20% vs 80%), shorter duration of mechanical ventilation (3±3 vs 6±5 days, P = 0.006), with shorter length of hospital stay (5.8±3.6
Indian Journal of Critical Care Medicine
Background: Critical illness due to infective endocarditis (IE) has high in-hospital mortality. B... more Background: Critical illness due to infective endocarditis (IE) has high in-hospital mortality. Besides being a cause of sepsis, this disease has the potential nature to affect multiple organs. Patients and methods: Data for 84 patients managed at the critical care medicine unit at Cairo University for 7 years were surveyed for IE using modified Dukes criteria. Among the patient group with a verified diagnosis of IE, patient characteristics (age and comorbidities), the grade of diagnosis, the blood culture result, echocardiographic findings, minor diagnostic signs (fever, presence of prosthetic valves and pacemaker, vascular phenomena, immunologic phenomena) and clinical complications (heart failure, septic shock, neurologic complications renal failure) were studied regarding their association to in-hospital mortality. Incidence of clinical complications was compared to the control group with sepsis due to other causes. Results: The mortality rate in the IE group is 18.8%. Factors showing significant association to in-hospital mortality are; septic shock p = 0.01, neurological complications p = 0.025 (especially cerebral hemorrhage p = 0.025), indicated non-performed surgery p = 0.008, and presence of underlying heart failure with reduced ejection fraction (HFrEF), p = 0.002. Incidence of clinical complications showed no significant difference in IE patients and patients with other causes of sepsis except heart failure which showed significantly increased incidence in the IE group, p = 0.004. Conclusion: Septic shock, neurological complications, indicated nonperformed surgery, and presence of underlying HFrEF are in-hospital mortality risk factors in critically ill patients due to IE. In-hospital mortality and clinical complication incidence (except heart failure) are similar to other causes of sepsis.
Background: cardiac device infection (CDI) is a devastating complication of permanent pacemakers ... more Background: cardiac device infection (CDI) is a devastating complication of permanent pacemakers (PPM) or implantable cardioverter-defibrillators (ICD). The incidence and outcome of endocarditis among patients (Pts) with CDI is not well defined. The Aim of this Study: Is to report the experience in the prevalence, clinical presentations and management of bacterial endocarditis (BE) among patients with CDI in a tertiary care cardiac center over 25 years. Methods: A total of 2630 cardiac devices implanted in a cohort of 2367 patients (pts) over 25 years were studied. Out of these, 117 (4.4%) Pts presented with CDI. Clinical, bacteriologic and both transthoracic (TTE) and transoesophageal Echocardiographic (TEE) assessments were done. Results: Of the 117 Pts with CDI (90 males, age ranging 18-82 yrs, mean=63 ±6 ys), 87 (74%) had redo procedures (battery replacement in 50, repositioning of leads in 12, device extrusion in 15 or evacuation of significant haematoma in 10 pts). Of these 87...
Conventional bypass grafting using cardioplegic arrest continues to be associated with some compl... more Conventional bypass grafting using cardioplegic arrest continues to be associated with some complications that may negate an otherwise successful procedure. Interest in offpump bypass grafting (OPCABG) in the mid-1990s presented surgeons with the option of revascularization without the potential complications of extracorporeal support if CPB can be avoided; a reduction in peri-operative morbidity and mortality is anticipated. The Aim of our Study: Is to compare both techniques regarding mortality, morbidity, complications and brain injury in both groups of patients with ischemic heart disease. Patients and Methods: Eighty patients (pts) were subjected to CABGs, 40 with off pump (group I-gpI) and the other 40 pts with on pump (group II-gpII) techniques. Patients in both groups were matching as regards age, sex, risk factors, and number of bypassed coronaries. Pre-operatively and postoperatively all patients were subjected to clinical examination, ECG, chest X-ray, transthoracic echoc...
Open Access Macedonian Journal of Medical Sciences, 2021
Background: It has been demonstrated that the use of cardiac implanted electronic devices (CIED)... more Background: It has been demonstrated that the use of cardiac implanted electronic devices (CIED) improve mortality and survivability in a variety of patient populations. Nevertheless, CIED related infection is a serious complication characterized by a high rate of mortality and morbidity. Objectives: To evaluate the prevalence of CIED related infections, risk factors, clinical and demographic characteristics, causative organisms, and the management and outcome of patients presented in the Critical Care Department, Cairo University. Methods: A retrospective analysis was conducted in 1871 individuals who had been implanted with a cardiac device with a total number of devices of 1968 and 2270 procedures performed from January 2007 to December 2017. Results: 59 infectious episodes were identified with an estimated incidence of 2.99% of inserted devices and 2.6% of total procedures. The infection rate was considerably higher in patients with multiple procedures than those who had a sin...
Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± ... more Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± 1.4 93.2 ± 1.5 Set temperature, 37°C AH (mgH 2 O/l) 34.5 ± 1.6* 38.7 ± 2.2 † 43.1 ± 1.1 RH (%) 91.8 ± 3.2 87.7 ± 7.4 † 94.6 ± 0.9 *P < 0.05 vs DAR HC and MR 730, † P < 0.05 vs MR 730.
Critical Care, 2004
Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± ... more Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± 1.4 93.2 ± 1.5 Set temperature, 37°C AH (mgH 2 O/l) 34.5 ± 1.6* 38.7 ± 2.2 † 43.1 ± 1.1 RH (%) 91.8 ± 3.2 87.7 ± 7.4 † 94.6 ± 0.9 *P < 0.05 vs DAR HC and MR 730, † P < 0.05 vs MR 730.
International Journal of Cardiology, 2010
Objective: Patients (pts) with symptomatic calcified aortic stenosis (CAS) who are poor candidate... more Objective: Patients (pts) with symptomatic calcified aortic stenosis (CAS) who are poor candidates for surgery or disqualified from aortic valve replacement (AVR) often require elective, urgent or emergent BAV either as a bridge to transcatheter valve implantation (TAVI), AVR or as a palliative treatment. We aimed at exploring the hemodynamic results and clinical outcome of BAV performed in CAS pts with overt heart failure (HF) who are not good candidates for AVR due to multiple risk factors. Methods: CAS pts with aortic valve area <1cm 2 , NYHA class IV and Logistic Euroscore >15% were treated with BAV by the femoral artery approach.
Australian Journal of …, 2009
Treatment of patients with acute respiratory failure (ARF) often involves mechanical ventilation ... more Treatment of patients with acute respiratory failure (ARF) often involves mechanical ventilation via endotracheal intubation. Non-invasive positive pressure ventilation (NIV) using Bi-level positive airway pressure (BiPAP) can be a safe and effective means of improving gas exchange. The aim of the present study is to: 1) Assess non-invasive positive pressure ventilation (BiPAP) as an alternative way for ventilation in ARF, and to 2) Determine factors that can predict the successful use of BiPAP. Thirty patients with acute respiratory failure (both type I and II) were enrolled in the study and divided into two groups. Group I included 10 patients who were subjected to invasive mechanical ventilation. Group II included 20 patients were subjected to NIV using BiPAP. Both groups were compared regarding the following parameters: arterial blood gases (ABG) on admission, 30 minutes after beginning of mechanical ventilation, 1 ½ hour then once daily. Complications namely ventilator 2 associated pneumonia (VAP), skin necrosis and CO narcosis; static compliance and resistance were measured at day one and day two. Compared to group I, group II patients were associated with similar improvement in ABGs data at 30 minutes and at discontinuation of ventilation (Table 1). Group II patients showed significantly lower incidence in VAP (20% vs 80%), shorter duration of mechanical ventilation (3±3 vs 6±5 days, P = 0.006), with shorter length of hospital stay (5.8±3.6
Indian Journal of Critical Care Medicine
Background: Critical illness due to infective endocarditis (IE) has high in-hospital mortality. B... more Background: Critical illness due to infective endocarditis (IE) has high in-hospital mortality. Besides being a cause of sepsis, this disease has the potential nature to affect multiple organs. Patients and methods: Data for 84 patients managed at the critical care medicine unit at Cairo University for 7 years were surveyed for IE using modified Dukes criteria. Among the patient group with a verified diagnosis of IE, patient characteristics (age and comorbidities), the grade of diagnosis, the blood culture result, echocardiographic findings, minor diagnostic signs (fever, presence of prosthetic valves and pacemaker, vascular phenomena, immunologic phenomena) and clinical complications (heart failure, septic shock, neurologic complications renal failure) were studied regarding their association to in-hospital mortality. Incidence of clinical complications was compared to the control group with sepsis due to other causes. Results: The mortality rate in the IE group is 18.8%. Factors showing significant association to in-hospital mortality are; septic shock p = 0.01, neurological complications p = 0.025 (especially cerebral hemorrhage p = 0.025), indicated non-performed surgery p = 0.008, and presence of underlying heart failure with reduced ejection fraction (HFrEF), p = 0.002. Incidence of clinical complications showed no significant difference in IE patients and patients with other causes of sepsis except heart failure which showed significantly increased incidence in the IE group, p = 0.004. Conclusion: Septic shock, neurological complications, indicated nonperformed surgery, and presence of underlying HFrEF are in-hospital mortality risk factors in critically ill patients due to IE. In-hospital mortality and clinical complication incidence (except heart failure) are similar to other causes of sepsis.