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Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly is a medical specialist MBBCH; M.S.C Cairo University; ACLS -EP; ATLS-SL (South Africa) Critical care course program-USA Disastrous medicine; STEMI-certificate AHA Hospital management and infection control diplomas Cairo University. Author of Critical Care Professional Handbook. Dr Khalad is Head of CME in Egypt for MEMP Ltd.
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly is a medical specialist MBBCH; M.S.C Cairo University; ACLS -EP; ATLS-SL (South Africa) Critical care course program-USA Disastrous medicine; STEMI-certificate AHA Hospital management and infection control diplomas Cairo University. Author of Critical Care Professional Handbook. Dr Khalad is Head of CME in Egypt for MEMP Ltd.

Approach to vasopressor medications in shock states

Vasopressors are medications that causes vasoconstriction; some of them have additional inotropic effect. By maintaining end-organ perfusion; the role of vasopressors remains critical to prevent irreversible organ injury and failure, and their use is usually accompanied by fluid resuscitation for adequate patient outcomes. Vasopressor agents are used clinically in the treatment of arterial hypotension in shock states. Shock is best defined as inadequate blood flow to meet the metabolic needs of the tissues. The most common reasons for shock are the cardiac output is low relative to the global demand, despite increased O2 extraction by the tissues; or perfusion pressure is inadequate such that blood flow distribution to metabolically active tissues is inadequate, despite an otherwise adequate cardiac output.

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1. Jentzer JC, Coons JC, Link CB, Schmidhofer M. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. Journal of cardiovascular pharmacology and therapeutics. 20(3):249-60. 2015.

2. Senz A, Nunnink L. Review article: inotrope and vasopressor use in the emergency department. Emerg Med Australas. 2009 Oct;21(5):342-51.

3. Bangash MN, Kong ML, Pearse RM. Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol. 2012 Apr;165(7):2015-33.

4. Tisdale JE, Patel RV, Webb CR, Borzak S, Zarowitz BJ. Proarrhythmic effects of intravenous vasopressors. Ann Pharmacother. 1995 Mar. 29(3):269-81.

5. Hollenberg SM. Vasoactive drugs in circulatory shock. American journal of respiratory and critical care medicine. 183(7):847-55. 2011.

Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly is a medical specialist MBBCH; M.S.C Cairo University; ACLS -EP; ATLS-SL (South Africa) Critical care course program-USA Disastrous medicine; STEMI-certificate AHA Hospital management and infection control diplomas Cairo University. Author of Critical Care Professional Handbook. Dr Khalad is Head of CME in Egypt for MEMP Ltd.
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly is a medical specialist MBBCH; M.S.C Cairo University; ACLS -EP; ATLS-SL (South Africa) Critical care course program-USA Disastrous medicine; STEMI-certificate AHA Hospital management and infection control diplomas Cairo University. Author of Critical Care Professional Handbook. Dr Khalad is Head of CME in Egypt for MEMP Ltd.

Life-threatening complications of diabetes

he management of severe hypoglycemia and hyperglycemia in relation to the life-threatening complications of diabetes by Dr Khaled Mohammed Aly.

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  1. Inzucchi SE, Bergenstal RM, Buse JB, et al; American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Diabetes Care. 2012;35(6):1364-1369.

2. [Guideline] American Diabetes Association Professional Practice Committee. American Diabetes Association clinical practice recommendations: 2013. Diabetes Care. January 2013. 36 (suppl 1):S1-S110.

3. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003 Jan. 26 Suppl 1:S5-20.

4. Stern MP. Do non-insulin-dependent diabetes mellitus and cardiovascular disease share common antecedents?. Ann Intern Med. 1996 Jan 1. 124(1 Pt 2):110-6.

5. Haffner SM, D’Agostino R Jr, Mykkanen L, Tracy R, Howard B, Rewers M, et al. Insulin sensitivity in subjects with type 2 diabetes. Relationship to cardiovascular risk factors: the Insulin Resistance Atherosclerosis Study. Diabetes Care. 1999 Apr. 22(4):562-8.

6. Rodbard HW, Jellinger PS, Davidson JA, Einhorn D, Garber AJ, Grunberger G, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract. 2009 Sep-Oct. 15(6):540-59

7. Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, et al. Executive summary: guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2011 Jun. 57(6):793-8.

8. Gerstein HC, Miller ME, Genuth S, Ismail-Beigi F, Buse JB, Goff DC Jr, et al. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med. 2011 Mar 3. 364(9):81828.

9. Diabetes Advocacy: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S152-3

10. Weiss JS, Sumpio BE (February 2006). “Review of prevalence and outcome of vascular disease in patients with diabetes mellitus”. European Journal of Vascular and Endovascular Surgery. 31 (2): 143–50

11. Granberg V, Ejskjaer N, Peakman M, Sundkvist G (August 2005). “Autoantibodies to autonomic nerves associated with cardiac and peripheral autonomic neuropathy”. Diabetes Care. 28 (8): 1959–64

12. Ichinose K, Kawasaki E, Eguchi K (2007). “Recent advancement of understanding pathogenesis of type 1 diabetes and potential relevance to diabetic nephropathy”. Am. J. Nephrol. 27 (6): 554– 64

Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly is a medical specialist MBBCH; M.S.C Cairo University; ACLS -EP; ATLS-SL (South Africa) Critical care course program-USA Disastrous medicine; STEMI-certificate AHA Hospital management and infection control diplomas Cairo University. Author of Critical Care Professional Handbook. Dr Khalad is Head of CME in Egypt for MEMP Ltd.
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly is a medical specialist MBBCH; M.S.C Cairo University; ACLS -EP; ATLS-SL (South Africa) Critical care course program-USA Disastrous medicine; STEMI-certificate AHA Hospital management and infection control diplomas Cairo University. Author of Critical Care Professional Handbook. Dr Khalad is Head of CME in Egypt for MEMP Ltd.

An insight on critical care in obstetrics

Pregnancy-related complications constitute a significant part in critical care, in this article Dr Khaled provides an insight on critical care in obstetrics. He highlights that the most common indications for ICU admission are postpartum hemorrhage, pregnancy induced hypertension, and related disorders.

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1-Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive Care Med 2010; 36:1465.

2-Chesnett AN. Physiology of normal pregnancy. Crit Care Clin. 2004;20:609615.

3-Lapinsky SE, Kruczynski K, Slutsky AS. Critical care in the pregnant patient. Am J Respir Crit Care Med. 1995;152:427-455.

4-Callaghan WM. Overview of maternal mortality in the United States. Semin Perinatol 2012; 36:2.

5-Chantry AA, Deneux-Tharaux C, Bonnet MP, Bouvier-Colle MH. Pregnancyrelated ICU admissions in France: trends in rate and severity, 2006-2009. Crit Care Med 2015; 43:78.

6-American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 170: Critical Care in Pregnancy. Obstet Gynecol 2016; 128:e147. Reaffirmed 2017.

7-Committee on Obstetric Practice. Committee Opinion No. 692: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period. Obstet Gynecol 2017; 129:e90.

8-Vasquez DN, Das Neves AV, Vidal L, et al. Characteristics, Outcomes, and Predictability of Critically Ill Obstetric Patients: A Multicenter Prospective Cohort Study. Crit Care Med 2015; 43:1887.

9-Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165.

Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly is a medical specialist MBBCH; M.S.C Cairo University; ACLS -EP; ATLS-SL (South Africa) Critical care course program-USA Disastrous medicine; STEMI-certificate AHA Hospital management and infection control diplomas Cairo University. Author of Critical Care Professional Handbook. Dr Khalad is Head of CME in Egypt for MEMP Ltd.
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly
Dr Khaled Mohamed Aly is a medical specialist MBBCH; M.S.C Cairo University; ACLS -EP; ATLS-SL (South Africa) Critical care course program-USA Disastrous medicine; STEMI-certificate AHA Hospital management and infection control diplomas Cairo University. Author of Critical Care Professional Handbook. Dr Khalad is Head of CME in Egypt for MEMP Ltd.

Hypertensive emergencies

An approach to understanding hypertensive emergencies written by Dr Khaled Mohamed of International SOS.

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