Vision


 We envision that our doctors will positively impact the health of critically ill patients through their leadership, research contributions, and excellence in patient care.

  Mission


We have three missions:

Patient Care:  To improve the standard of practice and ensure the highest quality of care to patients in our hospitals.

Research: Pursue new knowledge through high-quality research that explores unanswered questions and challenges and refines previously established ideas on mechanisms of disease and clinical aspects of critical care medicine. Education: Impart knowledge, instills excitement for learning, and translates and refines questions into focused areas of research for our trainees. 

  Head of the Laboratory


 Associate Prof. Amna Ahmed Metwaly 

E mail: Amnametwaly@hotmail.com

  Former Heads And Staff Members


Former Head 

Associate Prof. Ashraf Abd El-Khalik

Emeritus Prof. Mervat Eldamarawy

Staff Members

 

Emeritus Prof. Mervat Eldamarawy

 

Associate Prof. Ashraf Abd El-khalik

 

Associate Prof. Hesham Darwesh

 

Associate Prof. Fatma Mohmed Nasr

 

Researcher Ibrahim Mohamed AbdElazim

 

Researcher Ehab Esmeel

 

Researcher Ahmed Aly

 

Researcher Shady Mamdooh

 

Assistant Researcher Abdel Wahab Mahmoud Zeid

 

Assistant Researcher Iman Abdel Moneim Ahmed

 

Assistant Researcher Mohamed Amin Abdel Ghani

 

Assistant Researcher Mayada Mahmoud Hussien

 

Assistant Researcher Ahmed Abdul Fattah Al Sherif

 

Assistant Researcher Mohamed Makram Hammam

 

Assistant Researcher Momen Abdel Fadeel Ismael

 

Assistant Researcher Ayman Mahmoud Al-Zamzami

 

Assistant Researcher Mohammed Abdel Azim

 

Assistant Researcher Hamdy Abdel Wareth Abdel Halim

 

Assistant Researcher Mohammed Youssef Abdel Hamid

 

Assistant Researcher Ibrahim Mohammed Eltokhy

 

Assistant Researcher Mohammed Rabie Anwar

 

Assistant Researcher Antonio Safwat Zarif

 

Assistant Researcher Ahmed Samir Shosha

 

Assistant Researcher Ahmed Khairy Moustafa

 

Assistant Researcher Amr Abo Rawash

 

Assistant Researcher Ahmed Al Maghraby

 

Research Assistant Mohammed Abdel Hamid El Shamy

 

Resident Heba Saeed Al Sayed

 

Resident Ahmed Nasser Abdel Fatah

 

Resident Ahmed Mohamad Abdel Mageed

 

Resident Mostafa Abdel Rahman

 

Resident Reham Mohamad Ezzat

 

Resident Eslam Atta Alla

 

Resident Mai Al Raee

 

Resident Amr Al Refaee

 

Resident Yasmin Maher

 

Resident Yasmin Magdy

 

Resident Abdel Rahman Aly

 

Resident Mahmoud Ebrahim

 

Resident Amr Ahmed Abdel Fatah

 

  Field of Research


1- Diagnosis and management of complications of cardiovascular and pulmonary complications of liver diseases; electrolytes, trace elements, hematological and endocrinal disturbances in liver diseases and renal impairment in liver diseases.

     2- Diagnosis, and management of cardiovascular and pulmonary complications of renal diseases and electrolytes, trace elements, hematological and endocrinal disturbances  in  renal diseases.

3- Pathogenesis, diagnosis and management of critically ill patients (either post –surgical or non surgical patients); cardiovascular and pulmonary complications in critically ill patients; renal and liver complications in critically ill patients and electrolytes , trace elements , hematological , metabolic and endocrinal disturbances  in  critically ill patients.

4- Evaluation of different ICU scoring systems in critically ill patients.

  Main Achievements


 Our researches on cardiovascular complications of liver diseases concluded that:

 

1- Patients with liver cirrhosis or NAFLD should be evaluated for CVD risk and could be candidates not only for aggressive treatment of the liver disease, but also for aggressive treatment of underlying CVD risk factors; this would help to modify and potentially decrease the global CVD risk of these patients.

 

2- Tissue Doppler is more sensitive in diagnosing diastolic dysfunction and can better assess filling dynamics than can conventional Doppler.

-It is important to evaluate cardiovascular function and filling dynamics in every patient with cirrhosis, especially if the patient is a candidate for any intervention that may affect haemodynamics.

 

3- Patients with decompensated liver cirrhosis have low systemic vascular resistance and Doppler echocardiography provides an easy noninvasive tool to assess systemic vascular resistance.

-Follow-up of SVR by Doppler echocardiography may be a predictor for severity of liver disease.

-Measuring IVC diameter and collapsibility are of value in the prediction of intravascular fluid status in liver cirrhosis. This is especially true with renal dysfunction.

 

4-Hyponatremia is a common finding in patients with decompensated liver cirrhosis indicates an advanced disease with severe cardiovascular dysfunction. It is associated with increased risk of hepatic encephalopathy, refractory ascites, illness severity scores, renal failure, infectious complications, and pleural effusion.

 

5- The echocardiographic assessment of EpFT and the carotid Doppler assessment of CIMT may provide appropriate and simple screening markers for subclinical atherosclerosis and cardiovascular risk in patients with chronic hepatitis C virus with and without cirrhosis.

-Patients undergoing LT would likely benefit from echocardiographic assessment of EpFT and carotid Doppler for evaluation of CIMT in addition to stress testing to help identify those patients who are at high or low risk for cardiac outcomes in the LT.

 

6-It is important to understand the benefits and limitations of BNP as a heart failure biomarker in hepatic patients, where the relationship between BNP level and myocardial function is complex and is altered by the liver disease.

 

7-Elevated hs-cTnT level in cirrhotic patients can be considered one of the tools used to early diagnose subclinical myocardial necrosis and cirrhotic cardiomyopathy that can prevent adaptation to acute hemodynamic disturbance such as during liver transplantation or intrahepatic portosystemic shunt.

 

Our researches on cardiovascular complications of renal diseases concluded that:

1-Measurementof CIMT by carotid ultrasound is noninvasive and relatively inexpensive and can be used in addition to echocardiogram repeatedly with no adverse effects to evaluate cardiovascular performance in hemodialysis patients.

 

2-Epicardial fat thickness which can be easily measured by Echocardiography is an effective marker for the prediction of cardiovascular disease risk in hemodialysis patients   and is used as a surrogate marker of early atherosclerosis and was shown to be a strong predictor of future myocardial infarction and stroke.

 

3-CKD patients have high levels of TM, vWF, t-PA, PAI-1 that is correlated with hsCRP and CIMT. So, these abnormalities in hemostasis may account for the increased risk of atherothrombosis in these patients.

 

4- Inflammation and endothelial dysfunction are common pathological events in many diseases, including ischemic heart disease and chronic kidney disease. Thus, determining ways to block inflammatory cytokines may provide a vital approach for preventing, or at least retarding, the progression of such diseases.

 

5- FGF-23 could represent a promising therapeutic target that might improve the fatal prognosis of patients with CKD.

 

6-Hemodialysis patients with a low s-Klotho were more often associated with increased CIMT, LV dysfunction, and CAD, and it seems that there was an independent association between s-Klotho and CIMT, LVEF, and CAD.

 

Our researches on sepsis concluded that:

1-BNP level correlates with the severity of sepsis.

-Atrial ejection force in the third day maybe a good predictor for survival of patients presenting with

sepsis.

2- sepsis carries a high risk of multiorgan dysfunction syndrome and death in critically ill patients.

-PIRO score is an effective model for staging of sepsis and seems to be predictive of mortality.

-Measuring serial procalcitonin levels may be the most useful to understand the trend, identify the peak, and be able to identify resolution of sepsis.

-Early high lactate level is a predictor for poor prognosis of sepsis.

-Adiponectin is similar to procalcitonin in early detection of sepsis and can be used as a prognostic indicator with considering that adiponectin level could be affected by other metabolic disorders.

 

 

Our researches on the effect of the abdominal perfusion pressure on visceral circulation in critically ill patients with multiorgan dysfunction concluded that:

1- Considering APP as a measure of visceral perfusion instead of IAP alone if feasible. Avoiding extensive positive fluid balance and deal seriously with fluid overload.

 

Our researches on scanning of electron microscopic Biofilm grading and ventilator associated pneumonia in relation to duration of intubation concluded that:

1- Biofilm formation and grading as well as bacterial colonization with multidrug-resistant (MDR) bacteria were time dependent in patients on mechanical ventilation in ICU which may enhance their morbidity and mortality rates. 

-Also a role of ETT biofilm is emphasized in the pathogenesis and prognostic outcome of VAP in patients intubated for a prolonged period. 

 

  Running Techniques


               1.  Insertion of central venous access.

2.  Insertion of endotracheal tube.

3.  Insertion of temporary pacemakers.

4.   Right heart catheterization and interpretation of hemodynamic profiles.

5.  Inpatient and emergency consultation.

6.  Interpretation of radiological imaging.

7.  Conscious sedation and narcotic prescription

8.  ECG interpretation.

9.  Carotid massage.

10.  Elective cardioversion.

11.  Pleural, peritoneal & pericardial tapping.

12.  Basic & advanced cardiac life support.

13.  Performing of Echocardiography and its interpretation.

14.  Performing of Abdominal ultrasonography and its interpretation.

15. Performing ultrasonography on Carotid and peripheral vessels.

  Laboratory Structure and Facilities


 The Critical Care Department consists of:

A- 11 beds (2 isolation room and 9 rooms contact isolation)

B- 7 Ventilators

C- 3 D.C. Shock Device.

D- 11 Monitors and one central monitor station.

E- 11 Syringe Pumps.

F- 4 ECG Devices.

G- 2 Laryngoscopes.

H- 2 Nebulizer Devices.

I- 1 Portable X-Ray.

J- 4 Suction Devices.

K- 11 Air Mattresses.

L- 2 Crush Tables.

M- 3 Blood Sugar Measurement device.

N- 6 Sphygmomanometers.

O- 2 Trolleys.

P- Echocardiograhy machine

Q-Portable ultrasound Machine

R- Holter device (24 hour ECG Monitoring)

  Training facilities


 A- Training courses in different I.C.U procedures e.g. central line insertion, arterial line insertion, endotracheal intubation& E.C.G. interpretation.

B- Training courses are dealing with different equipments in I.C.U e.g. echocardiography, syringe pumps& mechanical ventilators.

C- Training courses are dealing with critical cases referred from different hospitals & dealing with different types of shocks, myocardial infarction, respiratory failure, heart failure &electrolyte imbalance.

D- Training courses are dealing with postoperative critical cases and their complications from different specialties as:

  - Surgery.

  - Urology.

  - Gastroenterology and Hepatology.

  - Nephrology.

E- Continuous nursing & doctors training on infection control in I.C.U.

  Scope of Services


* Periodic lectures and scientific meetings for residents and physicians.

* Periodic training programs for nursing staff and workers in order to improve the level of services provided to the patients.

* Daily morning report to discuss the progress of the patients’ conditions and effectiveness of the treatment.

* Admission, discharge and referral of patients with daily on-call schedule for emergencies.

* Examine patients in the outpatient clinic.

  Routine out and in patient services


 A)Routine activities

1.     Managing of adult patients presenting with illness, injuries, and disorder of cardiovascular system (acute MI cases, unstable angina, malignant ventricular arrhythmias, acute pulmonary edema).

2.     Monitoring and preventing complication in high risk patients undergoing major surgical procedures.

3.     Management of patients presenting with respiratory failure and requiring mechanical ventilation as ARDS.

4.     Management of patients presenting with coma.

5.     Management of patients presenting with acute renal failure.

6.     Management of advanced systemic sepsis.

7.     Management of patients with coagulopathies or uncontrolled bleeding.

8.     Management of hepatic failure.

9.     Inpatient and emergency consultation.

10.           Outpatient department, cardiothoracic and internal medicine consultation.

11.           Nutrition in ICU.

12.            Echocardiography for critically ill patients to help their diagnosis and management and for evaluation of patients preoperatively and for patients from outpatient clinics.

 B) Scientific and Clinical Services:

Service / Consultation

Requesting Department

Provided Services

Pre-operative Assessment

- General Surgery.

- Urological Surgery.

- Emergency Operations.

-Emergency Department.

- Nephrology Department

- GIT Department.

- Outpatient Clinics.

Anesthesia, surgical ICU and pain management department.

- Preoperative assessment and management of patients before and after major Surgeries.

- Admission, Diagnosis and Treatment of Critically ill patients from ER and different departements.

Admission of Critically ill patients from ER, OR and wards.

  Projects


Project

Researcher

Early diagnosis of Cardiovascular Complications in Chronic Liver Diseases

Prof. Amna Metwaly

Early diagnosis and detection of cardiovascular complications in patients with sepsis and septic shock.

Prof. Ashraf Abdel Khalek

  Publications


 

1-Mohab H. Halim, Nabila A. Abdallah, Halla M. Ragab, Nouran El Ghandour and Mervat El Damarawy:( 2005): Role of Non-Invasive Biomarkers in the Assessment of Liver Condition in Chronic Hepatitis C Egyptian Patients and if they Correlate with the Severity of Liver Affection. Med. J. Cairo University, Vol. 73, No. 4: 49-62.

2-Nouran El-Ghandour, Hala Aly Gamal El-Din, Mervat El-Damarawy, Motaz Abou El-Azm and Mohab Halim (2006): Role of Vascular Endothelial Growth Factor and Tissue Factor in Non-Diabetic Egyptian Patients with Peripheral Arterial Disease and the Relation between Angiogenesis and Thrombogenesis. The Egyptian Hear J., Vol. 58, No. 1: 155-163,.

3-Nouran El-Ghandour, Hala Aly Gamal El-Din, Mervat El-Damarawy, Motaz Abou El-Azm and Mohab Halim (2006): Role of Vascular Endothelial Growth Factor and Tissue Factor in Non-Diabetic Egyptian Patients with Peripheral Arterial Disease and the Relation between Angiogenesis and Thrombogenesis. The Egyptian Hear J., Vol. 58, No. 1: 155-163.

4- Naema El-Ashry, Mervat El-Damarawy, Mohamed Salem and Sherif Mogawer (2007): Large Volume Abdominal Paracentesis Effect on some Humoral Factors and Cardiac Performance in Patients with Liver Cirrhosis and Tense Ascites. Journal of the Egyptian Society of Parasitology, Vol.37, No. 2: 571-584.

5- Naema I. El-Ashry, Nihal M. El-Assaly, Imam Wakid and Mervat El-Damarawy (2007): Role of Inflammatory Cytokines (TNF-α and IL-6) in Evaluation of Anemia in CRF patients. The New Egyptian J. of Medicine, Vol. 37, No.4: 217-227.

6- Naema El-Ashry, Mervat El-Damarawy, Mohamed Salem and Sherif Mogawer:( 2007): Large Volume Abdominal Paracentesis Effect on some Humoral Factors and Cardiac Performance in Patients with Liver Cirrhosis and Tense Ascities. Journal of the Egyptian Society of Parasitology, Vol.37, No. 2: 571-584.

7-Denver Peritoneovenous Shunt in the Management of Refractory Ascitis due to Chronic Liver Diseases (2007): Impact of Patients Selection on its Outcome. Journal of the Egyptian Society of Parasitology, Vol. 37, No. 3,: 1159-1174.

8-Nihal M. El-Assaly, Naema I. El-Ashry, Omnia El Bendary, Shendy M. Shendy,Mervat El Damarawy, M. Ali Saber and Ehab El-Dabaa (2007): The Clinical and Prognostic Value of Insulin, Growth Hormone, TNF-αR (P55) and IL-1 Receptor Antagonist (IL-1ra) in Chronic Hepatitis Due to HCV Genotype 4 before and after Combination Therapy with Pegylated Interferon α-2a and Ribavirin.The Egyptian Medical J. of the National Research Center, Vol. 6, No. 1: 38-45.

9-Naema I El-Ashry, Amany El-Sawaf, Shindy M. Shindy and Mervat El-Damarawy (2007): Role of Cytokines (IL1-β, IL2, IL6 and IL8) in Some Extrahepatic Manifestations of Chronic HCV Patients, Sjogren Syndrome. Med. J. Cairo University, Vol. 75, No. 1: 31-36.

10- Desouky A M, Raafat M, Metwaly A A, El Shmaa A, Abdallah E. Compliance, (2007): Renal, Cardiac, Endocrine and metabolic Disorders as a Predictors of Hypertension Syndrome. Journal of Medical Science, 7(4):503-15.

11- Abdallah M Dessouky, Emmam Waked, Amna A Metwaly, M Osama Taha, Fatma A Morad, Azza Al Shmaa, Afaf Abdel-Hady and Ghada Kh Zayet (2007): ADMA and Cardiovascular morbidity in patients with end-stage renal disease. African Journal of nephrology 11: 71-102.

12- Manal Diab, Mervat El-Damarawy and Mohamed Shemis: (2008): Rapid Identification of Methicillin-Resistant Staphylococci Bacteremia Among Intensive Care Unit Patients. Medscape J Med. Vol. 10, No. 5: 126.


13- Mervat El-Damarawy, Hanan Zeidan and Salwa Suwailem:( 2008): Myocardial Performance Index in Patients with Chronic Obstructive Pulmonary Disease.
Egyptian Heart Journal,).


14-Mervat EL-Damarawy, Ayman Saleh, Tarek Khairy Abdel Dayem:( 2008): Prevalence and Predictors of Carotid Artery Stenosis in Patient with Critical Limb Ischemia. Egyptian Heart Journal,


16- Nevine Fam and Mervat El-Damarawy (2008): CTX-M-15 Extended-Spectrum Beta-Lactamases Detected from Intensive Care Unit of an Egyptian Medical Research Institute.Medical Sciences, Vol. 3, No. 1: 84-91.

17- Nihal M. El-Assaly, Naema I El-Ashry, Emam Waked and Mervat El-Damarawy (2008): Gonadal Dysfunction in Chronic Renal Failure. Australian Journal of Basic and Applied Sciences, Vol.2, No.3:481-487.

18-Ahmed A, Abd El-Sadek S, El-Shamaa A and El- Sheikh N.(2009): Study of Neuropeptide Y and its Relation to the Cardiovascular Complications in End Stage Renal Disease World Journal of Medical Sciences,4(1):22-32.

19- Waked E, Metwaly A, Abd Allah E, Assal H S, Younes K . (2009): Heart Rate Variability in Patients with Diabetic Nephropathy. Kidney 18:241-246.

20-Waked E, El Bendary O, Metwaly A, Younes K, Assal H S, Sayed H A. (2009) : Adrenomedullin in patients with type 2 diabetes and kidney disease African Journal of nephrology 13: 19-25.

21- Amin.M.; Hazem Hossam, H.; Abd El- Khalik, A. and Khaled, H. (2009): Diabetes Mellitus in Association with Hepatic Encephalopathy in Patients with HCV Cirrhosis: Correlation with ICU Outcome. Egypt. J. Schistosomiasis Infect. Endem. Dis. 31, 85

22. Abdel Meseih M, AbuEita A, Ouda N, Ismail N, Saad Eldeen S, El Damarawy M, Waked E, Ghaly A and ElGanzory H (2010) – Biofilm and Device-Associated Infections. Egyptian Journal of Medical Laboratory Sciences 19(2) :95-105

23- El Assaly N, Abdel Hady A, El Shanawany F, Waked E, Metwaly A, Abdel Khalik (2010): A. Study of Urotensin, Nitric Oxide and Macrophage-Colony Stimulating Factor (M-CSF) in Chronic Kidney Disease with Cardiac Dysfunction. Research Journal of Medicine and Medical Sciences, 5(1): 72-78.

24-Abdallah E A, Waked E, Metwaly A, Abdel Khalek A. ((2010): The Role of Arterio-Venous Shunt in the Pathogenesis of Pulmonary Hypertention in Patients with End-stage Renal Disease. Kidney 19:239–243.

25- Shehata M, Al Abd D, El Shanawani F, Abdallah E, darwish H, Moghazy M F, Metwaly A, Abdel Hadi A A. (2010): Cadherin 5 and Annexin V as Circulating Endothelial Microparticles: markers for Atherosclerotic Vascular Lesions in patients with Chronic Renal failure. Kidney 19:307-313.

26- Abed N, Hamed L, Metwaly A, Mahfouz M. (2010): Gastrointestinal failure score alone and in combination with SOFA in the assessment of the critically ill patient. The Medical journal of Cairo University 78 (2):115-126.

27- Abdallah E, Waked E, Nabil M , Abdel-khalek A, Metwaly A.( 2011): Carotid intima media thickness, left ventricular hypertrophy and weekly averaged blood pressure in hemodialysis patients. J. Egypt. Soc. Parasitol.,41(1), 141-154.

28- Waked E, EL Shanawani F, Raafat M, Metwaly A, Abdel Khaled A, Hassan M and Abu Taleb H . (2011): Bone specific alkaline phosphatase and cardiovascular morbidity among patients on maintenance hemodialysis. Life Science Journal; 8 (4); 1078-1087.

29- Nessim, I. G.; Abd El-Wahab, A., Madani,H.A.; Waked, E.; Abd El-Khalek. A and Mabrook, K. (2011): Evaluation of serum Osteoprotegrein and Fetuin A levels in Egyptian patients with chronic kidney disease. Comp. Clin. Pathol.; 7,1281

30. Badr M, Hamed G, Heikal A and Darwish H (2011): Prevalence of adrenocortical insufficiency in patients with liver cirrhosis with septic shock and in patients with hepatorenal syndrome. The Journal of American Science, 7 (6) :1545-1553

31. El Damarawy M, Hamed G, Heikal A, Darwish H (2012): MELD score as a predictor for hepatoadrenal syndrome. The Journal of American Science,8 (7):1545-1553

32. Shawky A, Mohamed A, Hussein M, Sany D, Darwish H (2012) Value of RIFLE classification for predicting outcome of critically ill cirrhotic patients. African Journal of Nephrology, 16 (2) :159 – 168.

33- Raafa M, Metwaly A, Abdel Khalik A , Abu Zikri N, Madkour M and Hussein N (2012): Inflammatory and nutritional biomarkers : Role as Non-Traditional Risk factors for cardiovascular morbidity in patients with Chronic kidney disease. Life Sci J, 9 (2): 1109-1116.

34- Abdel khalik A, Metwaly A, Mohammad F. Nasr, Al Damarawy M, Youssef Y. (2012): Evaluation of Carotid Intima- Media Thickness, Left Ventricular Mass and Left Atrium Diameter in Chronic Liver Diseases. Life Science Journal; 9 (2): 1199-1206.

35-Mohammad F. Nasr , Metwaly A., Abdel Khalik A., Amal I. Sabry A. I., Hassan M. and Desouky A. M . (2013): VEGF and PDGF in liver cirrhosis and their relation to echocardiographic parameters and Carotid Intima-Media Thickness Life Science Journal; 10 (4):1102- 1110.

36-Mohsen Maher,TarekYossef,HeshamDarwesh, Ahmed El Saady, Amal I. Sabry, Waled A Hamed and Antonio Safwat. (2013):Role of interleukin 6 as a predictor of hepatic encephalopathy in critically ill patients.
Life Science Journal,10 (12s) :987-991.

37- Mohsen Maher,TarekYossef, Amal I. Sabry,Shereen A. Saleh and H. Alkady. (2013):
Hyponatremia and zinc deficiency as a risk factor for hepatic encephalopathy in cirrhotic patients.Life Science Journal10 (3) :1493-1500.

38. Alsherif A, Darwesh H, Badr M, El DamarawyM,Shawky A, Emam A (2013) – SOFA score as a predictor of mortality in cirrhotic patients. Life Science Journal 10 (2) :2384 – 2392

39. Badawi H, El Damarawy M, Atteya A, Bastawesy R, El Said M, Helmy A, Helmy O and Ismail E (2014) – Detection of Bioliogical Nano-Particles in Egyptian Patients with Coronary Artery Disease. Life science Journal; 11 (2)
40- Abd El-Khalik A, Raafat A, Metwaly A, Mohammad F Nasr, Sherif N, Nessim I. (2014): Cardiovascular calcification in chronic hemodialysis patients: Contributors interplay. American journal of life science; 2(5): 251- 259.

41- Hatem H. Elatroush, Nashwa Abed, Amna A. Metwaly, MohamedI. Afify, Mayada M. Hussien. (2014): The effect of the rising abdominal perfusion pressure on kidney Function assessed by the RIFLE criteria in critically ill patients with multiorgan dysfunction American Journal of Life Sciences; 2(6): 333-337.

42- Emam Waked; Emad Abdallah; Ashraf Abd El-Khalik; Malak Nabil and Faten El-Shanawani. (2014): The Prognostic value of N-Terminal-ProBrain Natriuretic Peptide in the Diagnosis and to Detect the Progression of Left Ventricular Mass and Function in Patients with Chronic Kidney Disease. Life Science Journal;11(8). 51-59

43-Mohamed Badr Salim, Hesham Elaasr, Ashraf Wadee, Mervat El Damarawy, AlaaAshour, Fatma Mohammad Nasr. (2014): Atrial Ejection Force and Brain Natriuretic Peptide as Markers for Mortality in Sepsis. The Egyptian Journal of critical care medicine, http://dx.doi.org/10.1016/j.ejccm.2014.11.001

44- Abd El-Khalik A Barakat, Mohammed A Nasr, Metwaly A, Abd El-Rouf M RaafatAmeen. (2015): Correlation between Epicardial Fat Thickness and Cardiovascular Risk in Hemodialysis Patients. American Journal of Internal Medicine; 3(3): 86-94.

45- H. EL Atroush , N. Abed , A. Metwaly , M. Afify , M. Hussien . (2015): The effect of the abdominal perfusion pressure on visceral circulation in critically ill patients with multiorgan dysfunction. The Egyptian Journal of critical care medicine; 3,63-67.

46- Abd El-Khalik A, Mohammad F Nasr, Metwaly A, El-Ghannam A. (2015): Systemic vascular resistance and fluid status in patients with decompensated liver cirrhosis with or without functional renal failure in Egypt. Electronic Physician.; 7(4(: 1174-1182.

47- Mohammad F Nasr, Metwaly A, Abdel khalik A, Darwish H. (2015): Cardiac dysfunction in liver cirrhosis: a tissue Doppler imaging study from Egypt Electronic Physician; 7(4): 1135-1143.

48- Abd El-Khalik A Barakat, Metwaly A, Mohammad F Nasr, El-Ghannam M, Darwish A El-Talkawy, Abu Taleb H.( 2015): Impact of hyponatremia on frequency of complications in patients with decompensated liver cirrhosis. Electronic Physician; 7 ( 6): 1349-1358 .
49- ManarRaafat, Mona Madkour, AmnaMetwaly, Fatma Mohammad Nasr, Osama Mosbah, Noha El-Sheikh.( 2015): Clinical significance of FGF-23 in Chronic Kidney Disease. Patients. Sch. J. App. Med. Sci.,; 3(2C):741-750.

50- Manal Zahran, Fatma Mohammad Nasr, AmnaMetwaly, Noha El-Sheikh, NevineSherif Ali Khalil and TarekHarb. (2015): The Role of Hemostatic Factors in Atherosclerosis in Patients with Chronic Renal Disease. Electronic Physician.; 7 (5): 1270-1276.

51- Metwaly A, Abdel khalik A, Mohammad F Nasr, Ismail A Sabry, Fathy M Gouda, Hassan M. ; (2015): Brain Natriuretic Peptide in Liver Cirrhosis and Fatty Liver: Correlation with Cardiac Performance. Electronic Physician; 8 (2): 1984-1993.

52- Mohammed Amin Abd-Elghany, Nahed Salah Eldin, Sherif Wadie, Mervat Mohammed El- Damarawy, Fady Adib Abd-El-Malek, Ashraf Abd El-Khalik Barakat (2015): Adiponectin as a Predictor for the Severity of Sepsis in ICU Patients. American Journal of Internal Medicine.; 3(1): 6-14.

53- Shendy Mohammed Shendy, Mohamed Darwish El-Talkawy, Abdel Aziz Ali Saleem, WaelSafwat, Mona Adel, Ashraf Abd El- Khalik and Hoda Abu Taleb.( 2015): Relation between Non-Alcoholic Fatty Liver Disease and Epicardial Fat in Metabolic Syndrome. The Egyptian Journal of Hospital Medicine., 60, 314-323.

54- Hassan S El-Shishtawy, Mosbah O, Sherif N, Metwaly A, Hanafy A, Kamel L.( 2016): Association between serum visfatin and carotid atherosclerosis in diabetic and non-diabetic patients on maintenance hemodialysis. Electronic Physician.; 8(2): 1966-1972.

55- AbdallahA ;Mosbah O; Khalifa G; Metwaly A; El-Bendary O. (2016): Assessment the relationship between serum soluble klotho and carotid intima-media thickness and left ventricular dysfunction in hemodialysis patients. Kidney Res Clin Pract 35 42-49.

56- Magda Azmy, Lobna Ghanem, Fatma Kassem, Doaa Gamal, Ashraf Abdelkhalek, Emtethal El-Kholy, Mervat Abo EL Eneen (2016): Scanning Electron Microscopic Biofilm Grading and Ventilator Associated Pneumonia in Relation to Duration of Intubation. EJMM, 25, 3, 81-88.

57- Ashraf Abd El-KhalikBarakat, Fatma Mohammad Nasr , Amna Ahmed Metwaly, Sherif Morsy , Mervat El damarawy.( 2016):Atherosclerosis in chronic hepatitis C virus patients with and without liver cirrhosis. Egyptian Heart Journal; 62(2), 139-147.

58- Noha El Sheikh, Nevin Sherif, Mervat Eldamarawy, Ahmed Ali, Amal I. Sabri (2016): The link between bone disease and cardiovascular complications in hemodialysis patients. Electronic Physician 6, 8(6): 2483-2488.

59-Rania K. Darwish, Afaf Abd El-Hady, Doa M. Aly, Amal I. Sabry and Fatma A. Fathy. The role of intercellular adhesion molecule-1 gene polymorphism in the development of cardiovascular disease.

60- A. A. E.-K. Barakat, F.M. Nasr, A.A. Metwaly, S. Morsy, M. El Damarawy (2017): Atherosclerosis in chronic hepatitis C virus patientswith and without liver Cirrhosis. The Egyptian Heart Journal 69, 139-147.

61- Ashraf Abd El-Khalik Barakat, Fatma Mohammad Nasr, Amna Ahmed Metwaly, Amal I. Sabry, Mona Hassan (2017): High Sensitivity Troponin T Level and Cardiovascular Performance in Patients with Liver Cirrhosis. High Sensitivity Troponin T Level and Cardiovascular Performance in Patients with Liver Cirrhosis. Int J Med Res Prof.; 3(3):155-58.

62- Ashraf Abd El-Khalik Barakat, Fatma Mohammad Nasr, Amna Ahmed Metwaly (2017): Tissue Doppler Study of Right and Left Ventricular Function in Nonalcoholic Fatty Liver Disease. Int J Med Res Prof.; 3(3):53-59.