abdelrahman ibrahim abushouk

It is important for all medical and paramedical staff to be aware of basic life support (BLS) maneuvers. In this study, we aimed to evaluate the level of BLS awareness among Egyptian medical students. The level of BLS knowledge was assessed using a validated questionnaire and the results were analyzed using an answer key, prepared from the Advanced Cardiac Life Support (ACLS) manual. We used the Student's t-test to analyze the association between awareness level and year of study, previous BLS training and practical experience. A total of 823 medical students with the mean age of 20.3 ± 2.7 years, from Al-Azhar medical schools completed the questionnaire (463 and 360 in academic and clinical years, respectively). About 72% and 84% of students failed to recognize the proper point of chest compression in adults and infants, respectively. Moreover, the majority (80%) did not know how to give rescue breathing in infants. Only 18% of students correctly identified early signs of shock and only 22% knew how to help patients with myocardial infarction. Being in clinical years, previous BLS training or practical experience were significantly associated with higher BLS knowledge scores (p < 0.001). The level of BLS awareness among Egyptian medical students is generally poor. Introduction of regular BLS courses into the undergraduate curriculum is a must to increase the level of BLS knowledge among Egyptian future physicians.

Atypical femoral fracture (AFF) is a tensile fracture with unique radiographic and clinical features that differ from ordinary osteoporotic femoral fractures. Denosumab is a novel agent that inhibits osteoclastic activity, reducing bone resorption. Within the past few years, several case reports indicated that patients on denosumab prescription are at risk of AFF. The purpose of this review was to discuss the current evidence regarding this association and draw recommendations for clinicians about the use of denosumab in osteoporotic patients, until such evidence is established in future studies.

A computer search of Medline (through PubMed and OVID search) engines was conducted using the following keywords: "Denosumab" and "atypical femoral fractures". Furthermore, we reviewed the reference list of included studies for further citations.

We identified 9 case reports, 5 clinical trials, and 1 prospective observational study that have reported data regarding the incidence of AFF in patients on denosumab prescription.

Denosumab is an effective treatment for osteoporosis; however, there is a growing number of reports regarding its association with AFF. Causality needs verification in future observational and interventional studies; meanwhile, screening for AFF in patients receiving denosumab and reevaluating the optimal antiresorptive therapy in osteoporotic patients is recommended.

In modern medical practice, there is an increasing dependence on imaging techniques in most medical specialties. Radiation exposure during pregnancy may have serious teratogenic effects to the fetus. Therefore, checking the pregnancy status before imaging women of child bearing age can protect against these effects. Lack of international regulations and standard protocols exposes the patient to unexpected fetal radiation effects and the health professionals to medicolegal suits. Recently, the American Academy of Radiology and the European community of Medical Ionizing Radiation Protection released national guidelines regarding pregnancy screening before imaging potentially pregnant females. However, different methods of pregnancy screening exist among different radiology centers. This review aims to discuss the most recent guidelines for imaging females of childbearing age and highlight the need for an international regulation to guide pregnancy screening before diagnostic radiation exposure.

Metformin reduces maternal and neonatal weight gain in gestational diabetes mellitus; however, this effect is poorly investigated in non-diabetic women.

We performed this meta-analysis to investigate the effect of metformin intake during pregnancy on maternal and neonatal outcomes in obese non-diabetic women.

We searched Medline, EMBASE, and Cochrane CENTRAL for eligible randomized controlled trials addressing the efficacy of metformin in pregnant obese non-diabetic women. Data were extracted and analyzed using RevMan software (Version 5.3). Neonatal birth weight was the key outcome. Secondary outcomes included maternal weight gain, the incidence of preeclampsia, and neonatal adverse effects (miscarriage, stillbirth and congenital anomalies).

Pooled data from two RCTs (n=843) showed that metformin caused a significant reduction in maternal gestational weight gain (MD-1.35, 95% CI: [2.08, 0.630]), compared to placebo. The summary effect-estimate did not favor either of the two groups in terms of reduction of neonatal birth weight Z score (MD-0.09, 95% CI: [0.23, 0.06]). Metformin was associated with 41% reduction in the risk of preeclampsia; however, this reduction was not statistically significant [RR 0.59, 95% CI: [0.03, 11.46]). None of the neonatal adverse events including stillbirth [RR 1.14, 95% CI: 0.42, 3.10]) and congenital anomalies (RR= 1.36, 95% CI: [0.58, 3.21]) differed significantly between the two groups.

For obese pregnant women, metformin could decrease gestational weight gain with no significant reduction in neonatal birth weight. In light of the current evidence, metformin should not be used to prevent poor pregnancy outcomes in obese non-diabetic women.

Cardiopulmonary resuscitation (CPR) has been known in its present form since 1960. Different studies have reported variable outcomes among different countries. Therefore, the purpose of this study was to assess the rate of CPR success and the survival rate in managing cardiac arrest among patients in an educational medical center.
This cross-sectional study was performed at Imam Hosein hospital, Tehran, Iran. All patients, admitted to the emergency department with cardiac arrest between March 2007 and January 2008 were included. We used a formerly designed registration form and hospital documentation to retrieve the data of included patients. The main outcomes were the rate of CPR success and the survival rate of these patients.
Totally 855 patients were included, from which 510 (59.64%) were males. The mean age of included patients was 63 ± 17.6. The CPR process was successful among 364 (42.58%) patients. A total number of 101 (11.82%) patients were discharged from the hospital. Different factors as the cause of cardiac arrest and past medical problems affected the probability of CPR success and the survival of patients with cardiac arrest.
Survival rate at hospital discharge was less than one-third of patients and nearly half of the patients received successful CPR. More intensive care unit (ICU) facilities and educational interventions for the emergency staff and the community can enhance the survival of cardiac arrest patients in our health system.

Hemodynamics and venous blood gas (VBG) may be used to guide fluid therapy in septic shock patients. However, the influence of fluid therapy on hemodynamic and blood gas parameters is not fully understood. In this study, we aimed to investigate the effect of fluid therapy on hemodynamic and VBG parameters. This cross-sectional study was conducted from January to April 2016. All patients with diagnosis of severe sepsis were enrolled in the study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), central venous pressure (CVP) shock index, VBG parameters, serum sodium (Na) and chloride (Cl) levels, anion gap, and oxygen saturation (O2sat) were assessed before fluid resuscitation, after resuscitation, and after fluid challenge test. A total of 100 patients were included (mean age were 72.54 ± 12.77 years, 66% male). Fluid therapy significantly increased DBP (df: 2; F= 4.17; p = 0.017), MAP (df: 2; F= 6.06; p= 0.003), and CVP (df: 2; F= 27.54; p < 0.001), while the shock index was significantly reduced After fluid challenge test (df: 2; F= 7.6; p= 0.001). In addition, fluid therapy had no effect on pH (p= 0.90), HCO3 (p= 0.23), base excess (p= 0.13), SCVO2 (p= 0.73), O2sat (p= 0.73), anion gap (p= 0.96), serum Na level (p= 0.71), and serum Cl level (p= 0.64). Administration of fluid therapy in septic shock patients had no significant effect on SBP, heart rate, or blood gas parameters. Future studies on a larger sample of patients should confirm these findings and correlate them to clinical outcomes.

I read with interest your paper entitled "Pre and post-test probabilities and Fagan’s nomogram. I would like to add a note concerning an update on Fagan’s Nomogram. In 2011, a group of researchers published a modern version of the nomogram that they named "Bayes’ theorem nomogram".