Digital Commons Network^™

Pain Management For Post-Treatment Survivors Of Complex Cancers: A Qualitative Study Of Opioids And Cannabis, Beatriz Currier

All Publications

Aim: We aimed to understand experiences with opioids and cannabis for post-treatment cancer survivors. Patients & methods: We conducted seven focus groups among head and neck and lung cancer survivors, using standard qualitative methodology to explore themes around 1) post-treatment pain and 2) utilization, perceived benefits and perceived harms of cannabis and opioids. Results & conclusion: Survivors (N = 25) experienced addiction fears, stigma and access challenges for both products. Opioids were often perceived as critical for severe pain. Cannabis reduced pain and anxiety for many survivors, suggesting that anxiety screening, as recommended in guidelines, would improve traditional pain assessment. …

Structural Sex Discrimination: Why Gynecology Patients Suffer Avoidable Injuries And What The Law Can Do About It, Christopher Robertson, Annabel Kupke, Louise P. King

Faculty Scholarship

The nearly four million Americans who undergo gynecological surgeries each year suffer avoidable lifelong, painful, and disabling injuries. This Article diagnoses the root cause in our legal framework for healthcare finance and identifies legal solutions.

America’s public-private system for reimbursing healthcare pays for procedures rather than outcomes, and it pays substantially more for work on male rather than female anatomies. This disparity is due to the federal government’s reliance on a secretive industry committee to set those rates, and the committee’s reliance on junk science surveys, allowing self-interested and gender-biased responses, contrary to objective measures.

As payors disvalue the bodies …

Rethinking Foundations And Analyzing New Conflicts: Teaching Law After Dobbs, Nicole Huberfeld, Linda C. Mcclain, Aziza Ahmed

Faculty Scholarship

This Article draws on our diverse and complementary areas of scholarly expertise and teaching experiences across law school and public health curricula to offer a multidisciplinary model for teaching in a variety of courses after Dobbs. Teaching reproductive rights and justice poses extensive challenges in the wake of Dobbs' overruling Roe v. Wade and Planned Parenthood v. Casey, upending a half century of precedents protecting a constitutional right to abortion, and returning the issue to "the people" and the states. This Article offers theoretical and pedagogical perspectives on teaching courses in Reproductive Rights and Justice, as well …

Evaluation Of Common Complications Following Tetralogy Of Fallot Surgical Repair By Magnetic Resonance Imaging, Zainab Ahmad Ramadan, Mohamed Salah Ayyad

Mansoura Medical Journal

Background: The operative procedures for correction of tetralogy of Fallot (TOF) concentrates on the impact of pulmonary valve regurgitation (PR) on the function of right ventricle (RV) pointing to alleviating right ventricle outflow tract (RVOT) narrowing, and minimizing the PR degree at the same time, closing ventricular septal defect (VSD). Various complications could be encountered after TOF repair as; PR, dilated RV with/without impaired function, RVOT residual obstruction/ dilatation, residual VSD, tricuspid regurge (TR), aortic root dilatation with/without regurge and significant difference in differential pulmonary flow. Objective: Address the most common complications that could be encountered following TOF surgical repair, …

Association Between Serum Procalcitonin Level With Exacerbation Severity In Chronic Obstructive Pulmonary Disease Patients, Dalia Abdellateif Abdelghany, Shimaa R. Hendawy, Rania Mostafa, Heba Wagih Abdelwahab

Mansoura Medical Journal

Background: There is a significant impact on morbidity, mortality, and quality of life due to chronic obstructive pulmonary disease exacerbations. Individuals with acute exacerbation of chronic obstructive pulmonary disease had considerably higher mean serum procalcitonin levels (PCT) compared to individuals with stable chronic obstructive pulmonary disease, according to previous investigations. Objective: This study aimed to assess whether procalcitonin levels were associated with the severity of exacerbations in patients with chronic obstructive pulmonary disease. Methods: thirty-nine patients who were suffering from an acute exacerbation of chronic obstructive pulmonary disease were included. Included patients were classified as having either no respiratory failure, …

Study Of Serum Bilirubin In Relation To Stable Chronic Coronary Artery Disease Severity And Outcome After Percutaneous Intervention, Khaled E Mahfouz, Ahmed W Suliman, Mahmoud A Youssef, Adel M Osman

Mansoura Medical Journal

Background: Bilirubin is endogenous antioxidant and increased its physiological concentrations reduce severity of coronary artery disease with better prognosis after PCI. Objective: Assess serum bilirubin level in patients with stable chronic coronary artery disease and correlate it with the severity of this disease and outcome after PCI. Methods: Cross sectional prospective observational study included 203 Patient with stable chronic coronary artery disease divided into 2 groups according to bilirubin: group I ≤ 0.6mg/dl group II > 0.6 (up to 1.2) mg/dl 100 cases underwent elective coronary angiography and PCI with full clinical examination, laboratory tests: total serum bilirubin, creatinine, lipid profile, …

Serum Interleukin-22 In Non-Segmental Vitiligo, Fatma Faisal El Dakrory, Maha Elsayed Mahmoud Elsayed, Yousra Ibrahim El-Tantawy Sadeq, Shereen Ezzalregal Alashry

Mansoura Medical Journal

Background: A depigmenting skin condition called vitiligo affects 0.5–2 percent of people globally. It seems to be caused by an interaction between neurological, immunological, and genetic factors. Vitiligo is mediated by cell-mediated reactions, as Th1/Th17 and Tc1 cells. It is thought that the Th17 cell's most specialized cytokine isIL-22. Aim: To explore the blood levels of IL-22 in non-segmental vitiligo and to investigate whether it can be a biomarker in monitoring disease activity and it’s correlation with disease severity. Patient and methods: This study included thirty healthy individuals and sixty non-segmental vitiligo cases (30 with stable vitiligo and 30 with …

Increasing Incidence And Unusual Presentations Of Chickenpox Infection In The Post Covid-19 Era In Egypt, Sara Hamdy, Amany Awad

Mansoura Medical Journal

Background: The aim of the current study was to analyze the incidence and clinical presentations of patients with chicken pox in the post COVID-19 era. Additionally, the management protocols of these patients were highlighted.

Patients and methods: This prospective cohort included 70 patients of Chicken pox diagnosed and managed in a tertiary referral center over a 2-months duration. Patients’ symptoms, complications, treatment, as well as outcomes were documented and analyzed.

Results: a sharp increase in the incidence of chickenpox was observed in our institute compared to the same season in the previous years. Unusual presentations were also …

Ultrasound Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block As Postoperative Analgesia In Patients Undergoing Abdominal Cancer Surgery, Ghada Fouad Amer, Nevert Adel Abdel Ghaffar

Mansoura Medical Journal

Background: Abdominal surgeries are often linked with post-operative pain (POP). The transverse abdominal plane (TAP) block is an efficient method for POP management in these patients. The quadratus lumborum (QL) block (QLB) is another method for the POP control. The current study aims to assess the efficiency and safety of QLB and TAP block for POP control after abdominal cancer surgeries. Methods: 98 cases scheduled for abdominal cancer surgery by using general anesthesia (GA) were comprised in this randomized study. They were randomly divided into 2 equal groups :(QL group) patient received GA plus bilateral QLB, (TAP group) patient received …

Assessment Of Response Of Enteropathic Spondyloarthritis To Different Types Of Biological Therapy; An Egyptian Single Center Study, Fatma Abozeid, Marwa Besar

Mansoura Medical Journal

Introduction: Arthropathy is one of the most prevalent extraintestinal symptoms of inflammatory bowel disease (IBD). It may be either peripheral or axial spondyloarthropathy. Biological treatment as anti-tumor necrosis factor alpha (TNF𝛼) or anti-interleukin 12/23 (anti IL 12/23) have shown efficacy in controlling gut inflammation and reducing joint manifestation. Our aim of the study was to assess the different aspects of response (laboratory , endoscopically and radiologically) of axial arthropathy associated with IBD patients after receiving biological drugs including: anti TNF (infliximab and adalimumab)& anti IL 12/23 (ustekinumab)

Patients & methods:A single center observational study was conducted through one …

Urinary Vitamin D Binding Protein Level In Egyptian Systemic Lupus Erythematosus Patients: A Potential Biomarker For Lupus Nephritis And Its Association With Renal Activity, Elshahat A. Yousef, Eman Nagy, Omnia M. El Sayed Mohamed, Mohamed S. Elghonimy, Marwa Saleh

Mansoura Medical Journal

Background : Systemic Lupus Erythematosus (SLE) is an autoimmune inflammatory disease affecting various organs, notably the kidneys, leading to lupus Nephritis (LN) in approximately half of patients. Early and accurate diagnosis of lupus nephritis (LN) and initiation of therapy are crucial steps in halting disease progression. Despite its value as a gold standard for diagnosing, classifying, and guiding treatment for LN patients, renal biopsy is expensive, carries risks, and cannot expect the response to immunosuppressive therapy. Methods : The study included 80 SLE patients; 60 patients were biopsy-proven LN (30 patients with active LN, and 30 patients with LN in …

Coload Effect On Cardiac Output Measurement Using Transthoracic Echocardiography In Preeclamptic Patients Undergoing Cesarean Delivery, Sherine Ali Elsayed Bakrey, Aya Hasan Masoud Abdelhady, Alaa El-Din Mazy Abdou Mazy, Maha Ahmed Abo-Zeid Salim

Mansoura Medical Journal

Background: During cesarean delivery (CD) for preeclamptic patients under spinal anaesthesia (SA), much intravenous fluids are avoided. Through transthoracic echocardiography, study conducted to assess the hypothesis that colloid plus crystalloid coload will maintain the cardiac output (CO) than crystalloid fluid alone. Methods: Thirty-four preeclamptic patients, scheduled for elective CD, under SA, were allocated according to the fluid coloading into two groups; Crystalloid group (group I); in which the patients received Ringer’s acetate or Crystalloid-colloid group (group II); in which the patients received 6% Hydroxyethyl starch and Ringer’s acetate. The primary outcome was CO while, left ventricular end diastolic diameter (LVEDD), …

Opioid-Free Anaesthesia During Prolonged Orthotopic Urinary Bladder Diversion Surgery: A Prospective Randomized Comparative Study, Mohamed A Ghanem, Mostafa Ma Saied, Hanan Adly, May E Badr

Mansoura Medical Journal

Background: Opioid-free anaesthesia is becoming a favored strategy among anesthetists. This study aims to compare continuous epidural fentanyl infusion with intrathecal bolus of bupivacaine-dexmedetomidine, which is a low-cost analgesic technique with efficient intraoperative hemodynamic stability, postoperative analgesia, and fewer opioid induced drawbacks in urinary bladder diversion surgery.

Patient and Methods: Our randomized prospective comparative study involved 34 patients prepared for urinary bladder diversion surgery. Patients were distributed into two equivalent groups; group A received continuous epidural infusion of bupivacaine-fentanyl; and group B received intrathecal bolus bupivacaine-dexmedetomidine.

Results: Intraoperatively, Heart rate showed a significant decrease at 2 h in group B …

Ultrasound-Guided Femoro-Sciatic Nerve Block Versus Hemispinal Anesthesia In Acute Lower Limb Ischemia: A Prospective Randomized Comparative Study, Mostafa Sayed Ahmed Mohammed Elawady, Nehal Alaa El-Dien Abbass Hamza, Mohammed Ahmed Ahmed Sultan, Hazem Elsayed Moawad, Tarek Habeeb Ramadan

Mansoura Medical Journal

Background: Acute lower limb ischemia (ALLI) is a critical condition that requires prompt surgical intervention. The choice of anesthetic technique can have a significant impact on patient outcomes. The Purpose of this study was to compare the safety and efficacy of femoro-sciatic nerve block (FSNB) guided by ultrasound and hemispinal anesthesia (HSA) among patients undergoing surgery for acute lower limb ischemia.

Methods: We prospectively studied 44, ASA Ⅱ-Ⅲ patients whose surgeries were planned for management of acute lower limb ischemia. Eligible patients were randomly allocated into two groups to be given either HSA or ultrasound-guided FSNB. The duration of the …

Audit Of Management Of Diabetic Ketoacidosis In Mansoura Specialized Medical Hospital, Walaa M Abd-El-Fatah, Omnia I State, Basma Z Elmorsy

Mansoura Medical Journal

Background: Egypt is listed among the world's top ten countries regarding the highest number of people with diabetes mellitus (DM). Diabetic ketoacidosis (DKA) is a medical emergency which is associated with significant mortality and morbidity in diabetic patients. It is also a common reason for hospitalization and thus is associated with significantly high costs. However, DKA is a potentially reversible condition provided that an emergency and immediate medical attention, appropriate diagnosis and therapy were provided.

Aim: auditing the adherence to protocol for the management of DKA in our Mansoura University Hospital (Specialized Medical Hospital) in Egypt from May 2021 to …

Evaluation Of Low Dose Intrathecal Bupivacaine With Dexmedetomidine In Geriatric Patients Undergoing Traumatic Hip Surgery, Rania E. Elbadrawy, Sherine A Bakrey, Reem Abdelraouf Elsharkawy

Mansoura Medical Journal

Abstract: Background: Spinal anesthesia (SA) is typically utilized during surgical treatment of severe hip fractures. Searching for early ambulation and reduction of frequency and severity of hypotension, and after adding dexmedetomidine (DEX), different intrathecal (IT) dosages of 0.5% hyperbaric bupivacaine had been used to determine the lowest dosage that will result in a good block without hemodynamic instability. Methods: At random, 78 patients were divided into three groups. A 7.5 mg of 0.5% hyperbaric bupivacaine was administered in the first group10 mg in the second and 12.5 mg in the third group. Dexmedetomidine (5 μg) was added to each group. …

The Effect Of Ultrasound-Guided Thoracic Retrolaminar Block Versus Erector Spinae Plane Block On Opioid Consumption After Pediatric Open-Heart Surgery: A Randomized Controlled Non-Inferiority Study, Ahmed Abdellatif Elsayed Abdelwahab, Ghada Fathy Elrahmawy, Ibrahim Ibrahim Abdelbaser, Rania Elmohamady Elbadrawy

Mansoura Medical Journal

Background Pain following open cardiac surgery in pediatric patient is crucial for the anesthesiologist Objective to compare a single-shot US-guided bilateral thoracic retrolaminar block (TRLB) and erector spinae plane block (ESPB) as regarding 24 hours postoperative opioid analgesic requirements as primary outcome, while time to first rescue analgesic, the post-operative pain score and rate of block-related complications were secondary outcomes Methods Each study group included 50 patients. TRLB group received 0.4 ml/kg bupivacaine (BPV) 0.25% injected under US guidance bilaterally as the needle touched the lamina of the T4 vertebra; while ESPB group received 0.4 ml/kg BPV 0.25% injected under …

Pathogenic Role Of Angiopoietin-1 And -2 In Community-Acquired Pneumonia Among A Cohort Of Egyptian Children From Rural Areas Of Delta Region, Magdy Mohamed Ebrahim Zedan, Nashwa Khairat Abousamra, Engy Osman Ahmed, Asmaa Salah Ali Gebril

Mansoura Medical Journal

Background: Both an uncontrolled host response and the direct actions of pathogenic agents can be responsible for pneumonia-induced pulmonary hyperpermeability. Two well-known factors that contribute to angiogenesis and regulate inflammation and vascular leakage are angiopoietin-1 (Ang 1) and angiopoietin-2 (Ang 2). Aim: Assessment of Ang 1 and Ang 2 serum levels as indicators of the severity and phenotypes of community-acquired pneumonia (CAP). Subjects and methods: From September 2023 to February 2024, a case-control study was carried out at Mansoura University Children Hospital (MUCH) to assess the serum levels of Ang-1 and Ang-2 as indicators of the severity and phenotypes of …

Is Hyponatremia A Predictor Of Severity And Mortality In Covid 19 Patients?, Manal Mohammed Reda Algharbawy, Mohamed Maher El-Gamal, Eman Ali Ahmed Ali

Mansoura Medical Journal

BACKGROUND: Hyponatremia is one of the commonest water–electrolyte imbalances in the body. It can occur in coincidence with many diseases and its presence can affect the disease outcome.

OBJECTIVE OF THE STUDY: to evaluate the relation between serum sodium level and both COVID disease severity and mortality.

METHODS: Study included 164 patients admitted to hospital with COVID-19. Serum sodium was measured on admission. 65 patients had serum sodium more than 135 mmol/l (either normal serum sodium or mild hypernatremia) while the remaining 99 had hyponatremia. Patients were treated and followed till discharge or death. Study included 3 categories of disease …

Guillain-Barré Syndrome In Adults And Children: Differences In Clinical Features, Mahmoud Moaness Elbialy, Maha H. Khalil, Khaled Fathy, Hossam Egila

Mansoura Medical Journal

Background: Guillain-Barré Syndrome (GBS) is an autoimmune disease (AID) affecting peripheral nervous system (PNS) stimulated by either infectious (such as Campylobacter jejuni, Cytomegalovirus, Epstein-Barr virus, human immunodeficiency virus (HIV), Zika virus and SARS-CoV-2 infection) or noninfectious factors. It may occur at any age, and it is the commonest etiology of acute flaccid paralysis in pediatrics. Patients present with progressive and symmetric muscle weakness with absent or depressed deep tendon reflexes and might also have sensory manifestations such as Paresthesia in the hands and feet, dysautonomia and cranial nerve affection such as facial palsy or bulbar affection Aim: This study assessed …

Temporal Lobe Epilepsy And Obesity In Adults, Mahmoud Fathy Saleh, Mohammed Abbas, Mostafa Mansour, M. Saad

Mansoura Medical Journal

Background: Epilepsy is a common, chronic, and disabling neurologic state. Medial temporal lobe epilepsy (TLE) is the commonest, and best-defined, form of symptomatic localization-related epilepsy. Obesity-induced mitochondrial dysfunction and oxidative stress are thought to participate in the initiation and progression of epilepsy. Obesity is a potentially preventable predisposing factor for drug resistant epilepsy (DRE).

Objective: the aim of this study was to investigate the association of TLE with obesity and the effect of obesity on seizure control.

Methods: This case control study was carried out on 50 patients with TLE and was divided into two groups, …

Neurosymbolic Value-Inspired Ai (Why, What, And How), Amit Sheth, Kaushik Roy

Publications

The rapid progression of Artificial Intelligence (AI) systems, facilitated by the advent of Large Language Models (LLMs), has resulted in their widespread application to provide human assistance across diverse industries. This trend has sparked significant discourse centered around the ever-increasing need for LLM-based AI systems to function among humans as part of human society, sharing human values, especially as these systems are deployed in high-stakes settings (e.g., healthcare, autonomous driving, etc.). Towards this end, neurosymbolic AI systems are attractive due to their potential to enable easy-tounderstand and interpretable interfaces for facilitating valuebased decision-making, by leveraging explicit representations of shared values. …

Causal Event Graph-Guided Language-Based Spatiotemporal Question Answering, Kaushik Roy, Alessandro Oltramari, Yuxin Zi, Chathurangi Shyalika, Vignesh Narayanan, Amit Sheth

Publications

Large Language Models have excelled at encoding and leveraging language patterns in large text-based corpora for various tasks, including spatiotemporal event-based question answering (QA). However, due to encoding a text-based projection of the world, they have also been shown to lack a fullbodied understanding of such events, e.g., a sense of intuitive physics, and cause-and-effect relationships among events. In this work, we propose using causal event graphs (CEGs) to enhance language understanding of spatiotemporal events in language models, using a novel approach that also provides proofs for the model’s capture of the CEGs. A CEG consists of events denoted by …

Exploring Alternative Approaches To Language Modeling For Learning From Data And Knowledge, Yuxin Zi, Kaushik Roy, Vignesh Narayanan, Amit Sheth

Publications

Despite their wide applications to language understanding tasks, large language models (LLMs) still face challenges such as hallucinations - the occasional fabrication of information, and alignment issues - the lack of associations with human-curated world models (e.g., intuitive physics or common-sense knowledge). Additionally, the black-box nature of LLMs makes it highly challenging to train them meaningfully in order to achieve a desired behavior. Specifically, the attempt to adjust LLMs’ concept embedding spaces can be highly intractable, which involves analyzing the implicit impact on LLMs’ numerous parameters and the resulting inductive biases. This paper proposes a novel architecture that wraps powerful …

Causal Neuro-Symbolic Ai: A Synergy Between Causality And Neuro-Symbolic Methods, Utkarshani Jaimini, Cory Henson, Amit Sheth

Publications

Causal Neuro-Symbolic AI combines the benefits of causality with Neuro-Symbolic Artificial Intelligence (NeSyAI). More specifically, it (1) enriches NeSyAI systems with explicit representations of causality, (2) integrates causal knowledge with domain knowledge, and (3) enables the use of NeSyAI techniques for causal AI tasks. The explicit causal representation yields insights that predictive models may fail to analyze from observational data. It can also assist people in decision-making scenarios where discerning the cause of an outcome is necessary to choose among various interventions.

Ontolog Summit 2024 Talk Report: Healthcare Assistance Challenges-Driven Neurosymbolic Ai, Kaushik Roy

Publications

Although Artificial Intelligence technology has proven effective in providing healthcare assistance by analyzing health data, it still falls short in supporting decision-making. This deficiency largely stems from the predominance of opaque neural networks, particularly in mental health care AI applications, which raise concerns about their unpredictable and unverifiable nature. This skepticism hinders the transition from information support to decision support. This presentation will explore neurosymbolic approaches that combine neural networks with symbolic control and verification mechanisms. These approaches aim to unlock AI’s full potential by enhancing information analysis and decision-making support for healthcare assistance1.

Neurosymbolic Customized And Compact Copilots, Kaushik Roy, Megha Chakraborty, Yuxin Zi, Manas Gaur, Amit Sheth

Publications

Large Language Models (LLMs) are credible with open-domain interactions such as question answering, summarization, and explanation generation [1]. LLM reasoning is based on parametrized knowledge, and as a consequence, the models often produce absurdities and inconsistencies in outputs (e.g., hallucinations and confirmation biases) [2]. In essence, they are fundamentally hard to control to prevent off-the-rails behaviors, are hard to fine-tune, customize for tailored needs, prompt effectively (due to the “tug-of-war” between external and parametric memory), and extremely resource-hungry due to the enormous size of their extensive parametric configurations [3,4]. Thus, significant challenges arise when these models are required to perform …

Analysis Of Bankruptcy Prediction Of Shipping Industry - Machine Learning Approach, Minsu Kwon

Plymouth Business School Theses

The Korean shipping industry's vulnerability to economic crises, such as the 2016 bankruptcy of Hanjin Shipping, highlights the need for robust bankruptcy prediction methods, particularly for small and medium-sized enterprises (SMEs). This research aims to identify key risk factors for predicting bankruptcy in shipping companies from Korean industry by leveraging financial, non-financial, and economic data through advanced machine learning models, including Extreme Gradient Boosting (XGBoost) and Long Short-Term Memory (LSTM) networks. A comprehensive literature review and interviews with industry practitioners were conducted to refine the variables used in the models. These models predict bankruptcy across 1, 3, and 5-year horizons, …

How Do Followers Experience Shared Leadership As A Lived Experience?Understanding The Relationality, Processes And Practices Informing Such Collaboration., Sybille Erika Schiffmann

Plymouth Business School Theses

How do followers experience shared leadership as a lived experience? Understanding the relationality, processes and practices informing such collaboration. Within shared leadership research culture, the aspiration is to explore “leadership as a dynamic interactive influence process”’ at the group level, supporting goal achievement (Pearce and Conger, 2003, P.1). However, the motivation of much research has focused on performance improvement, whereby discrete leadership variables are examined, using reductionist methods, to determine relevant linkages to team effectiveness (Denis et al., 2012. See also Fairhurst et.al, 2020). In expanding understanding of shared leadership from a follower perspective, enabling a fuller appreciation of how …

2024 January, Morehead State University. Office Of Communications & Marketing.

Morehead State Press Release Archive, 1961 to the Present

Press releases for January of 2024.