Publications by authors named "Ahmed El-Sayed"

56 Publications

Unusual collision tumor with infiltrating ductal carcinoma and breast skin squamous cell carcinoma: A case report and literature review.

Int J Surg Case Rep 2021 Jan 5;78:167-171. Epub 2020 Dec 5.

Department of Breast SurgicRal Oncology, King Fahad Specialist Hospital Dammam, Saudi Arabia.

Introduction: Breast cancer is the most common diagnosed cancer among women worldwide. Invasive ductal carcinoma (IDC) is the most common type, on the other hand, squamous cell carcinoma of the skin (SCC) overlying the breast is a rare tumor. The co-presence of two tumor types in one organ is even a rarer entity, termed as collision tumor. Only 3 known cases of collision tumor with breast invasive ductal and skin squamous carcinoma were reported in the literature.

Case Presentation: An otherwise medically free 91-year-old, postmenopausal, female presented with left breast fungating mass for four months. Pre-operative core tissue biopsy and incisional skin biopsy revealed two distinct tumor subtypes of invasive ductal carcinoma, positive for progesterone, estrogen receptors and negative for human epidermal growth factor receptor 2, as well as skin squamous cell carcinoma, and axillary lymph node metastasis. Patient underwent left breast modified radical mastectomy and split skin grafting for wound closure. The final histopathology was consistent with grade 2 IDC. The nipple and areola complex were involved by moderately differentiated squamous cell carcinoma. Currently patient on adjuvant hormonal treatment. Follow up showed no local recurrence or distal metastasis.

Conclusion: Collision tumors of the breast with IDC and SCC of the overlying skin is very rare. The surgeon has to be aware of of such entity as the proper peri-operative management should be tailored to target the most aggressive histologic subtype.
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http://dx.doi.org/10.1016/j.ijscr.2020.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758454PMC
January 2021

Severe cutaneous adverse drug reactions: Incidence, clinical patterns, causative drugs and modalities of treatment in Assiut University Hospital, Upper Egypt.

Dermatol Ther 2020 11 7;33(6):e14176. Epub 2020 Sep 7.

Faculty of Pharmacy, Department of Clinical Pharmacy, Assiut University, Assiut, Egypt.

Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and overlap SJS/TEN are life-threatening diseases that are most frequently caused by drugs. Much debate remains about the role of systemic corticosteroids (SCs) in their treatment. Our aim to determine the incidence, causative drugs, the role and side effects of SCs in severe cutaneous adverse reactions (SCARs), in Assiut University Hospital (AUH). Patients This study was conducted in Department of Dermatology at AUH, from 2012 to 2017. All patients with SJS, overlap SJS/TEN and TEN admitted during this period were included in the study. Eighty-three patients with SCARs were included in this study. The most common type was SJS (67.5%). The incidence ranged from 1.7% in 2012 to 7.7% in 2017. Carbamazepine, valproic acid, lamotrigine, diclofenac sodium, and flucloxacillin-amoxicillin were the most common causative drugs. The most common side effects of SCs were peptic ulcer (55.5%) and hypertension (51.8%). The mortality rate in patients treated with SCs was 100% in TEN, 33.3% in overlap SJS/TEN and 16.3% in SJS. The patients of SCARs must be aware of the causative drugs and must never be re-administered. SCs in treatment of SCARs may increase the complications and the mortality rate.
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http://dx.doi.org/10.1111/dth.14176DOI Listing
November 2020

Stability Study and Clinical Evaluation of Lipid Injectable Emulsion in Parenteral Nutrition Admixtures Used for Preterm Neonates.

Nutr Clin Pract 2020 Jul 16. Epub 2020 Jul 16.

Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt.

Background: Intravenous administration of parenteral nutrition (PN) admixtures containing 4-oil lipid injectable emulsion (ILE) in preterm neonates is usually prohibited because of limited clinical data. The authors evaluated the stability, safety, and efficacy of PN admixtures containing 4-oil ILE, for the first time, in preterm neonates.

Methods: A series of PN admixtures were prepared for consecutive administration in preterm neonates over a period of 15 days. Admixture stability was assessed after 24 hours of storage at 25 and 37 °C via visual inspection and measurement of mean droplet size (MDS). Safety and efficacy of the admixtures in preterm neonates were assessed via serum triglyceride levels and body weight increase measurements, respectively.

Results: PN admixtures were stable at 25 °C and had MDS ˂500 nm. After 15 days, there was a significant increase in body weight (P ≤ .0001) and level of serum triglycerides (P ≤ .0001), compared with the level before PN administration.

Conclusions: PN admixtures containing 4-oil ILE were stable at 25 °C and showed instability at 37 °C. Therefore, it is recommended to keep the temperature during administration of PN admixtures at 25 °C. PN admixtures were well tolerated and safe over a period of 8 days while providing a balanced fatty acid supply. Tight monitoring of serum triglyceride level is essential, particularly in neonates of low birth weight and/or young gestational age, to avoid hypertriglyceridemia. Hence, the use of these PN admixtures is expected to be beneficial in terms of being cost-effective and reducing the contamination risks.
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http://dx.doi.org/10.1002/ncp.10556DOI Listing
July 2020

Ergosterol Peroxide from the Egyptian Red Lingzhi or Reishi Mushroom, Ganoderma resinaceum (Agaricomycetes), Showed Preferred Inhibition of MCF-7 over MDA-MB-231 Breast Cancer Cell Lines.

Int J Med Mushrooms 2020 ;22(4):389-396

Chemistry Department, Faculty of Science, Damietta University, New Damietta City, Egypt; Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA.

Ergosterol peroxide and ganoderic acid AMI were isolated for the first time from the mycelium of the Egyptian Ganoderma resinaceum mushroom. The structure of these two metabolites was established by detailed analysis of 1D and 2D NMR. The isolated compounds were tested for their antitumor in vitro activities in MCF-7 and MDA-MB-231 breast cancer cell lines. Ergosterol peroxide showed preferred inhibition of MCF-7 (ER +ve) cell lines relative to MDA-MB-231 (ER -ve) cell lines with an IC50 of 1.18 μM and 12.82 μM respectively. Our data suggest that ergosterol peroxide targets estrogen receptors.
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http://dx.doi.org/10.1615/IntJMedMushrooms.2020034223DOI Listing
February 2021

Identification and Functional Analysis of Temperate Siphoviridae Bacteriophages of .

Viruses 2020 05 31;12(6). Epub 2020 May 31.

Department of Bacteriology and Immunology, Medicum, Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, 00290 Helsinki, Finland.

is an opportunistic pathogen that presents a serious clinical challenge due to its increasing resistance to all available antibiotics. Phage therapy has been introduced recently to treat antibiotic-incurable infections. In search for new specific bacteriophages, 20 clinical strains were used in two pools in an attempt to enrich phages from sewage. The enrichment resulted in induction of resident prophage(s) and three temperate bacteriophages, named vB_AbaS_fEg-Aba01, vB_AbaS_fLi-Aba02 and vB_AbaS_fLi-Aba03, all able to infect only one strain (#6597) of the 20 clinical strains, were isolated. Morphological characteristics obtained by transmission electron microscopy together with the genomic information revealed that the phages belong to the family . The ca. 35 kb genomic sequences of the phages were >99% identical to each other. The linear ds DNA genomes of the phages contained 10 nt cohesive end termini, 52-54 predicted genes, an site and one tRNA gene each. A database search revealed an >99% identical prophage in the genome of strain AbPK1 (acc. no. CP024576.1). Over 99% identical prophages were also identified from two of the original 20 clinical strains (#5707 and #5920) and both were shown to be spontaneously inducible, thus very likely being the origins of the isolated phages. The phage vB_AbaS_fEg-Aba01 was also able to lysogenize the susceptible strain #6597 demonstrating that it was fully functional. The phages showed a very narrow host range infecting only two strains. In conclusion, we have isolated and characterized three novel temperate phages that infect .
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http://dx.doi.org/10.3390/v12060604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354433PMC
May 2020

Human Regulatory T Cells From Umbilical Cord Blood Display Increased Repertoire Diversity and Lineage Stability Relative to Adult Peripheral Blood.

Front Immunol 2020 15;11:611. Epub 2020 Apr 15.

Department of Pathology, Immunology and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL, United States.

The human T lymphocyte compartment is highly dynamic over the course of a lifetime. Of the many changes, perhaps most notable is the transition from a predominantly naïve T cell state at birth to the acquisition of antigen-experienced memory and effector subsets following environmental exposures. These phenotypic changes, including the induction of T cell exhaustion and senescence, have the potential to negatively impact efficacy of adoptive T cell therapies (ACT). When considering ACT with CD4CD25CD127 regulatory T cells (Tregs) for the induction of immune tolerance, we previously reported expanded umbilical cord blood (CB) Tregs remained more naïve, suppressed responder T cells equivalently, and exhibited a more diverse T cell receptor (TCR) repertoire compared to expanded adult peripheral blood (APB) Tregs. Herein, we hypothesized that upon further characterization, we would observe increased lineage heterogeneity and phenotypic diversity in APB Tregs that might negatively impact lineage stability, engraftment capacity, and the potential for Tregs to home to sites of tissue inflammation following ACT. We compared the phenotypic profiles of human Tregs isolated from CB versus the more traditional source, APB. We conducted analysis of fresh and expanded Treg subsets at both the single cell (scRNA-seq and flow cytometry) and bulk (microarray and cytokine profiling) levels. Single cell transcriptional profiles of pre-expansion APB Tregs highlighted a cluster of cells that showed increased expression of genes associated with effector and pro-inflammatory phenotypes (, , and NKG7) with low expression of Treg markers ( and ). CB Tregs were more diverse in TCR repertoire and homogenous in phenotype, and contained fewer effector-like cells in contrast with APB Tregs. Interestingly, expression of canonical Treg markers, such as FOXP3, TIGIT, and IKZF2, were increased in CB CD4CD127 conventional T cells (Tconv) compared to APB Tconv, post-expansion, implying perinatal T cells may adopt a default regulatory program. Collectively, these data identify surface markers (namely CXCR3) that could be depleted to improve purity and stability of APB Tregs, and support the use of expanded CB Tregs as a potentially optimal ACT modality for the treatment of autoimmune and inflammatory diseases.
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http://dx.doi.org/10.3389/fimmu.2020.00611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174770PMC
March 2021

Colon-targeting of progesterone using hybrid polymeric microspheres improves its bioavailability and in vivo biological efficacy.

Int J Pharm 2020 Mar 23;577:119070. Epub 2020 Jan 23.

Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt; Department of Pharmaceutics, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia. Electronic address:

This study aims to enhance progesterone (PG) oral bioavailability via its incorporation into hybrid colon-targeted pectin/NaCMC microspheres (MS) cross-linked with Zn and Al. The MS were characterized for particle morphology, encapsulation efficiency, swelling behavior, drug release, mucoadhesivity and colon-specific degradability. Response-surface methodology was adopted to optimize the fabrication conditions. Enhancement of in vivo drug performance was evaluated through pharmacokinetic and pharmacodynamic studies. The optimized formulation was typically spherical with a mean diameter of 1031 µm and drug entrapment efficiency of 88.8%. This formulation exhibited pH-dependent swelling, negligible drug release in simulated gastric fluid and sustained-release pattern in simulated small intestinal fluid with a mean t of 26.5 h. It also showed prolonged and preferential adhesion to rat colonic mucosa, as well as expedited degradation in presence of rat caecal contents. The MS significantly increased the area under the curve and mean residence time by 1.8 and 2.3-fold, respectively compared to the free drug. Orally administered MS showed ~10 times increase in myometrial thickness compared with the drug suspension and elicited uterine responses very similar to that obtained parenterally. These results confirm the ability of this new carrier system to improve the oral bioavailability of PG and attain adequate clinical efficacy.
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http://dx.doi.org/10.1016/j.ijpharm.2020.119070DOI Listing
March 2020

Gross morphological features of the air sacs of the hooded crow (Corvus cornix).

Anat Histol Embryol 2020 Mar 15;49(2):159-166. Epub 2019 Oct 15.

Department of Anatomy and Embryology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt.

Air sacs are considered to be one of the controlling factors of bird behaviour and habits in addition to their roles in ventilation, regulating body temperature, swimming and flight. As a scavenger and an omnivorous flight bird, air sacs of the hooded crow were the focus of this study. Eight healthy, adult hooded crows were used to examine the morphological characteristics of the air sacs, which were examined grossly and with latex and cast preparations. In general, the morphological overview of the hooded crow air sacs is similar to other avian species. We observed nine air sacs; four paired sacs (cervical, cranial thoracic, caudal thoracic and abdominal air sacs) and one unpaired sac; the clavicular air sac. The cervical air sac communicated to the lung through the medioventral bronchus and had three diverticula; intermuscular, subscapular and subcutaneous. The clavicular air sac communicated with lung through the medioventral bronchus and had subscapular, axillary, humeral, subpectoral and sternal diverticula. The cranial and caudal thoracic air sacs were communicated with lung through the lateroventral bronchi and the both sacs did not have any diverticula. The abdominal air sacs were posterior to the caudal thoracic air sacs. The left abdominal sac was the largest air sac. The right and left abdominal sacs gave off branches to diverticula that pneumatized synsacrum. The abdominal air sacs gave off femoral diverticula behind the hip joint as well as perirenal diverticula.
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http://dx.doi.org/10.1111/ahe.12504DOI Listing
March 2020

A Self-Nanoemulsifying Drug Delivery System for Enhancing the Oral Bioavailability of Candesartan Cilexetil: Ex Vivo and In Vivo Evaluation.

J Pharm Sci 2019 11 23;108(11):3599-3608. Epub 2019 Jul 23.

Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt.

The drug delivery of candesartan cilexetil encounters an obstacle of low absolute oral bioavailability which is attributed mainly to its low aqueous solubility and efflux by intestinal P-glycoprotein (P-gp) transporters. However, the extent of P-gp contribution in the reduced oral bioavailability of candesartan cilexetil is not clear. In this study, a previously developed candesartan cilexetil-loaded self-nanoemulsifying drug delivery system (SNEDDS) was evaluated for its ability to increase the drug oral bioavailability via the inhibition of intestinal P-gp transporters. Despite the developed SNEDDS showing P-gp inhibition activity, P-gp-mediated efflux was found to have a minor role in the reduced oral bioavailability of candesartan cilexetil. On the other hand, the high surfactant concentration used in SNEDDS formulation represents a major challenge toward their widespread application especially for chronically administered drugs. The designed acute and subacute toxicity studies revealed that the degree of intestinal mucosal damage decreases as the treatment period increases. The latter observation was attributed to the reversibility of surfactant-induced mucosal damage. Thus, the developed SNEDDS could be considered as a promising delivery system for enhancing the oral bioavailability of chronically administered drugs.
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http://dx.doi.org/10.1016/j.xphs.2019.07.004DOI Listing
November 2019

Automated Vision-Based High Intraocular Pressure Detection Using Frontal Eye Images.

IEEE J Transl Eng Health Med 2019 8;7:3800113. Epub 2019 May 8.

1Department of Computer Science and EngineeringUniversity of BridgeportBridgeportCT06604USA.

Glaucoma, the silent thief of vision, is mostly caused by the gradual increase of pressure in the eye which is known as intraocular pressure (IOP). An effective way to prevent the rise in eye pressure is by early detection. Prior computer vision-based work regarding IOP relies on fundus images of the optic nerves. This paper provides a novel vision-based framework to help in the initial IOP screening using only frontal eye images. The framework first introduces the utilization of a fully convolutional neural (FCN) network on frontal eye images for sclera and iris segmentation. Using these extracted areas, six features that include mean redness level of the sclera, red area percentage, Pupil/Iris diameter ratio, and three sclera contour features (distance, area, and angle) are computed. A database of images from the Princess Basma Hospital is used in this work, containing 400 facial images; 200 cases with normal IOP; and 200 cases with high IOP. Once the features are extracted, two classifiers (support vector machine and decision tree) are applied to obtain the status of the patients in terms of IOP (normal or high). The overall accuracy of the proposed framework is over 97.75% using the decision tree. The novelties and contributions of this work include introducing a fully convolutional network architecture for eye sclera segmentation, in addition to scientifically correlating the frontal eye view (image) with IOP by introducing new sclera contour features that have not been previously introduced in the literature from frontal eye images for IOP status determination.
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http://dx.doi.org/10.1109/JTEHM.2019.2915534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537927PMC
May 2019

Comparison between curcumin and all-trans retinoic acid in the osteogenic differentiation of mouse bone marrow mesenchymal stem cells.

Exp Ther Med 2019 May 20;17(5):4154-4166. Epub 2019 Mar 20.

Key Laboratory of Animal Breeding, Reproduction and Molecular Design of Jiangsu Province, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu 225009, P.R. China.

The use of bone marrow mesenchymal stem cells (BMSCs) has great potential in cell therapy, particularly in the orthopedic field. BMSCs represent a valuable renewable cell source that have been successfully utilized to treat damaged skeletal tissue and bone defects. BMSCs can be induced to differentiate into osteogenic lineages via the addition of inducers to the growth medium. The present study examined the effects of all-trans retinoic acid (ATRA) and curcumin on the osteogenic differentiation of mouse BMSCs. Morphological changes, the expression levels of the bone-associated gene markers bone morphogenetic protein 2, runt-related transcription factor and osterix during differentiation, an mineralization assay, and changes in osteocalcin expression revealed that curcumin supplementation promoted the osteogenic differentiation of BMSCs. By contrast, the application of ATRA increased osteogenic differentiation during the early stages, but during the later stages, it decreased the mineralization of differentiated cells. In addition, to the best of our knowledge, the present study is the first to examine the effect of curcumin on the osteogenic potency of mouse embryonic fibroblasts (MEFs) after reprogramming with human lim mineralization protein (hLMP-3), which is a positive osteogenic regulator. The results revealed that curcumin-supplemented culture medium increased hLMP-3 osteogenic potency compared with that of MEFs cultured in the non-supplemented medium. The present results demonstrate that enrichment of the osteogenic culture medium with curcumin, a natural osteogenic inducer, increased the osteogenic differentiation capacity of BMSCs as well as that of MEFs reprogrammed with hLMP-3.
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http://dx.doi.org/10.3892/etm.2019.7414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447915PMC
May 2019

Heterologous expression, purification, immobilization and characterization of recombinant α-amylase AmyLa from Laceyella sp. DS3.

Int J Biol Macromol 2019 Jul 3;132:1274-1281. Epub 2019 Apr 3.

Botany and Microbiology Department, Faculty of Science, Damietta University, Egypt. Electronic address:

AmyLa α-amylase gene from Laceyella sp. DS3 was heterologously expressed in E. coli BL21. E. coli BL21 maximally expressed AmyLa after 4 h of adding 0.02 mM IPTG at 37 °C. The recombinant AmyLa α-amylase was purified 2.19-fold through gel filtration and ion exchange chromatography. We immobilized the purified recombinant AmyLa α-amylase on four carriers; chitosan had the best efficiency. The recombinant free and the immobilized AmyLa α-amylase showed optimum activity in the pH ranges of 6.0-7.0 and 4.0-7.0, respectively and possessed an optimum temperature of 55 °C. The free enzyme had activation energy, Km, and Vmax of 291.5 kJ, 1.5 mg/ml, and 6.06 mg/min, respectively. The immobilized enzyme had activation energy, Km, and Vmax of 309.74 kJ, 6.67 mg/ml, and 50 mg/min, respectively. The immobilized enzyme was calcium-independent and insensitive (relative to the free enzyme) to metals. It could also be reused for seven cycles.
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http://dx.doi.org/10.1016/j.ijbiomac.2019.04.010DOI Listing
July 2019

Survey on Implementation of One Health Approach for MERS-CoV Preparedness and Control in Gulf Cooperation Council and Middle East Countries.

Emerg Infect Dis 2019 03;25(3)

In 2015, a One Health Working Group was established in Qatar to conduct a survey in the Gulf Cooperation Council countries, Egypt, and Jordan to monitor preparedness of public health and veterinary health authorities in response to the Middle East respiratory syndrome coronavirus epidemic. All but 1 country indicated they established joint One Health policy teams for investigation and response. However, the response to the questionnaires was largely limited to veterinary authorities. Critical barriers and limitations were identified. National and regional leaders, policy makers, and stakeholders should be prompted to advocate and enhance adoption of the One Health framework to mitigate the risk for Middle East respiratory syndrome and other emerging zoonotic diseases.
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http://dx.doi.org/10.3201/eid2503.171702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390738PMC
March 2019

Knowledge, Attitude, and Practice Regarding Zika Among Travelers to Brazil: Qatar's Airport Study 2017.

Cureus 2018 Sep 10;10(9):e3280. Epub 2018 Sep 10.

Epidemiology and Public Health, Ministry of Public Health, Doha, QAT.

Background The Zika virus has become an international health issue and poses a systematic risk for a growing number of travelers. Qatar is no exception to this status, where its Hamad International Airport (HIA) has become an important hub for many travelers to and from affected countries. Thus, it is a national necessity to determine the knowledge, attitude, and practice of travelers' regarding this emerging disease in the State of Qatar. Methods This was a cross-sectional study that employed a self-administered questionnaire (n=100) and was conducted at Hamad International Airport. Descriptive and inferential statistical tests were applied to analyze the data using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics 21, IBM Corporation, Armonk, NY, USA, 2014). Results The majority of travelers (75%) reported hearing about the Zika disease prior to their current flight, mainly from the media (73%) and the internet (46%). The majority of participants (69%) knew about the vector-borne transmission and symptomatology of a Zika infection while more than half (54%) correctly identified effective methods to prevent infection. Regarding their attitude, less than two-thirds (58%) of the participants agreed that pregnant women must postpone their travel to any Zika-affected area. Regarding their practice, only a quarter of the sampled travelers (24%) sought pre-travel medical advice before going to Brazil. Comparing the knowledge score among different education levels, we found that high-school students scored significantly better than those with diplomas and bachelors, p=0.042 and p=0.012, respectively. Conclusion The survey findings revealed that the knowledge of Zika infection is low among travelers to Brazil. Thus, stronger efforts to educate travelers about Zika are recommended. It is also vital that travelers be encouraged to seek proper medical advice prior to travel.
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http://dx.doi.org/10.7759/cureus.3280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333323PMC
September 2018

Direct conversion of mouse embryonic fibroblast to osteoblast cells using hLMP-3 with Yamanaka factors.

Int J Biochem Cell Biol 2019 01 16;106:84-95. Epub 2018 Nov 16.

Key Laboratory of Animal Breeding, Reproduction and Molecular Design for Jiangsu Provience, College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, China. Electronic address:

Large bone defects and bone loss after fractures remain significant challenges for orthopedic surgeons. Our study aims to find an available, applicable and biological treatment for bone regeneration overcoming the limitations in ESC/iPSC technology. We directly reprogrammed the mouse embryonic fibroblast (MEF) into osteoblast cells using different combinations of Yamanaka factors with human lim mineralization protein-3 (hLMP-3). LMP is an intracellular LIM-domain protein acting as an effective positive regulator of the osteoblast differentiation. After transduction, cells were cultured in osteogenic medium, and then examined for osteoblast formation. The expression of osteogenic markers (BMP2, Runx2 and Osterix) during reprogramming and in vitro mineralization assay revealed that the best reprogramming cocktail was (c-Myc - Oct4) with hLMP-3. In addition, both immunofluorescent staining and western blot analysis confirmed that osteocalcin (OCN) expression increased in the cells treated with the c-Myc/Oct4/hLMP3 cocktail than using hLMP-3 alone. Furthermore, this reprogramming cocktail showed efficient healing in an induced femoral bone defect in rat animal model one month after transplantation. In the present study, we reported for the first time the effect of combining Yamanaka factors with hLMP-3 to induce osteoblast cells from MEF both in vitro and in vivo.
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http://dx.doi.org/10.1016/j.biocel.2018.11.008DOI Listing
January 2019

High Intraocular Pressure Detection from Frontal Eye Images: A Machine Learning Based Approach.

Annu Int Conf IEEE Eng Med Biol Soc 2018 Jul;2018:5406-5409

This paper presents a novel framework to detect the status of intraocular pressure (normal/high) using solely frontal eye image analysis. The framework is based on machine learning approaches to extract six features from frontal eye images. These features include Pupil/Iris ratio, red area percentage, mean redness level of the sclera, and three novel features from the sclera contour (angle, area and distance). Four hundred frontal eye images were used as the image database. The images were taken and annotated by ophthalmologists at Princess Basma Hospital. The proposed framework is fully automated and once the six features were extracted, two classifiers (decision tree and support vector machine) were applied to obtain the status of the eye in terms of eye pressure. The overall accuracy of the proposed framework is 95.5% using the decision tree classifier.
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http://dx.doi.org/10.1109/EMBC.2018.8513645DOI Listing
July 2018

Ledipasvir and Sofosbuvir in the Treatment of Early Hepatitis C Virus Infection in HIV-Infected Men.

Open Forum Infect Dis 2018 Oct 21;5(10):ofy238. Epub 2018 Sep 21.

Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

Background: Treatment of HIV-infected men during early hepatitis C virus (HCV) infection with interferon results in a higher cure rate with a shorter duration of treatment than during chronic HCV infection. We recently demonstrated that this phenomenon applied to interferon-free treatment as well, curing most participants with short-course sofosbuvir and ribavirin. Due to the significantly higher potency of the ledipasvir/sofosbuvir (LDV/SOF) combination, we hypothesized that we would be more successful in curing early HCV infections using a shorter course of LDV/SOF than that used for treating chronic HCV infections.

Methods: We performed a prospective, open-label, consecutive case series study of 8 weeks of LDV/SOF in HIV-infected men with early genotype 1 HCV infection. The primary end point was aviremia at least 12 weeks after completion of treatment.

Results: We treated 25 HIV-infected men with early sexually acquired HCV infection with 8 weeks of LDV/SOF, and all 25 (100%) were cured. Twelve (48%) reported sexualized drug use with methamphetamine.

Conclusions: Eight weeks of LDV/SOF cured all 25 HIV-infected men with early HCV infection, including those who were actively using drugs. Based on these results, we recommend treatment of newly HCV-infected men during early infection, regardless of drug use, to both take advantage of this 8-week treatment and to decrease further HCV transmission among this group of men.
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http://dx.doi.org/10.1093/ofid/ofy238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189631PMC
October 2018

The inflection point: a torque reference for lingual bracket positioning on the palatal surface curvature of the maxillary central incisor.

Prog Orthod 2018 Oct 8;19(1):39. Epub 2018 Oct 8.

Department of Developmental Sciences, Division of Orthodontics, Faculty of Dentistry, Beirut Arab University (BAU), Beirut Campus, Main Building, 1st Floor, Tareek El Jadida P.O. Box 11-5020 Riad El Solh 11072809, Beirut, Lebanon.

Background: Contrary to buccal orthodontics, lingual orthodontics has no reference for vertical bracket positioning on the maxillary central incisor. The aim of this study was to provide a reference point in relation to torque for lingual bracket positioning on the palatal surface curvature (PSC) of the maxillary central incisor.

Methods: Cone beam computed tomography (CBCT) radiographs of 50 right maxillary central incisors from archives of a dental radiographic center were transferred to Photoshop, where their PSC was traced using pen-tool. The PSC torque angle values of the incisors were calculated in Excel using cubic poly-Bezier curves at 0.5-mm increments and at the inflection point of PSC. Descriptive statistics for the torque angle values of the increments and for the inflection point for the 50 incisors were then calculated. One-way ANOVA test was used to detect systematic differences between the increments, and Tukey test was used post-hoc.

Results: For all incisors, increments incisal to inflection point exhibited progressive decrease in torque angle values from the first-calculated increment to inflection point while increments cervical to inflection point exhibited progressive increase from inflection point to last-calculated increment. Mean torque angle values of all the increments and inflection point showed high standard deviations and vast range of values. One-way ANOVA test was highly statistically significant (p < 0.0001) and most pairwise comparisons of the increments using Tukey test were significant.

Conclusions: Inflection point can be used as a reference for bracket positioning on PSC. Cervically oriented shifts in vertical bracket position cause crown labial/root palatal movement cervical to inflection point and crown palatal/root labial movement incisal to it. A scientific mathematical justification for customized bracket torque prescriptions on PSC of maxillary central incisor was also provided.
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http://dx.doi.org/10.1186/s40510-018-0234-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174120PMC
October 2018

Bridging medical simulation with computer science and engineering: A growing field of study.

Nurse Educ Today 2018 Dec 4;71:1-6. Epub 2018 Sep 4.

Health Sciences, University of Bridgeport, 169 University Avenue, Bridgeport, CT 06604, United States of America.

Background: Medical simulation has become an essential educational tool in the curricula of healthcare professionals. A literature review revealed a knowledge gap in healthcare simulation education with respect to the technological expertise required to operate highly sophisticated simulation equipment. With this motivation, a case study was designed to determine if implementing on-site technological expertise allows for the facile navigation of high fidelity manikins. Next, a research study was conducted to evaluate engineering students understanding of simulation, and their interest to attend a program in medical simulation.

Objectives: To determine if on-site technological expertise lifts barriers associated with manikin use and to assess levels of understanding and interest among engineering students following exposure to the technology used in healthcare simulation.

Design: A prospective, descriptive study with pre-post surveys.

Settings: The Nursing Skills and Simulation Center at a New England University campus.

Participants: Engineering students attending 6 different engineering programs (Computer Science, Computer Engineering, Mechanical Engineering, Biomedical Engineering, Electrical Engineering and Technology Management) and having different educational levels (undergraduate and graduate).

Methods: Two assessments were applied to engineering students attending a class on technology used in healthcare simulation. A pre-test measured the understanding and interest of students in the engineering/computer science courses before attending a simulation class. A post-test assessment measured their improvement in understanding and interest to learn more about simulation technologies.

Results: Statistical analysis and comparisons of pre-and post-test assessments show a 23% gain in understanding of this field following exposure to the healthcare simulation class. Furthermore, post test results show greater than 67% of those surveyed have an interest in attending a program in healthcare simulation.

Conclusions: The results indicate the collaboration of nursing and engineering has lifted known barriers to simulation education, and reveal engineering students have an interest in the field of medical simulation.
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http://dx.doi.org/10.1016/j.nedt.2018.08.011DOI Listing
December 2018

Microfabrication of Net Shape Zirconia/Alumina Nanocomposite Micro Parts.

Nanomaterials (Basel) 2018 Aug 5;8(8). Epub 2018 Aug 5.

School of Engineering, University of Birmingham, Birmingham B15 2TT, UK.

Recently, there are growing demands in manufacturing of net shape micro parts for wide range of applications due to the increasing interest in miniaturization. In this paper, the fabrication of tetragonal phase zirconia/alumina (YSZ/Al₂O₃) nanocomposite micro-parts with high quality is presented. The fabrication process is based on soft lithography and colloidal powder dispersion. Experimental results showed that by optimizing the soft lithography and the dispersion process, it was possible to produce high-resolution micro-parts with well dispersed alumina. The X-ray diffraction results had confirmed the important role of the alumina particles in eliminating the emergence of monoclinic phase while the microstructures reveal a pure tetragonal phase. In addition, the sintered YSZ/Al₂O₃ micro parts achieved micro hardness with 20% superior to the pure YSZ sintered micro-parts with the addition of 5% alumina.
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http://dx.doi.org/10.3390/nano8080593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116201PMC
August 2018

Self-emulsifying drug-delivery systems modulate P-glycoprotein activity: role of excipients and formulation aspects.

Nanomedicine (Lond) 2018 Jul 3;13(14):1813-1834. Epub 2018 Aug 3.

Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt.

Self-emulsifying drug-delivery systems (SEDDS) have been widely employed to ameliorate the oral bioavailability of P-glycoprotein (P-gp) substrate drugs and to overcome multidrug resistance in cancer cells. However, the role of formulation aspects in the reduced P-gp activity is not fully understood. In this review, we first explore the role of various SEDDS excipients in the reduced P-gp activity with the main emphasis on the effective excipient concentration range for excipient-mediated modulation of P-gp activity and then we discuss the synergistic effect of various formulation aspects on the excipient-mediated modulation of P-gp activity. This review provides an approach to develop a rationally designed SEDDS to overcome P-gp-mediated drug efflux.
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http://dx.doi.org/10.2217/nnm-2017-0354DOI Listing
July 2018

Role of self-emulsifying drug delivery systems in optimizing the oral delivery of hydrophilic macromolecules and reducing interindividual variability.

Colloids Surf B Biointerfaces 2018 Jul 26;167:82-92. Epub 2018 Mar 26.

Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt. Electronic address:

Self-emulsifying drug delivery systems (SEDDS) have been widely employed to improve the oral bioavailability of poorly soluble drugs. In the past few years, SEDDS were extensively investigated to overcome various barriers encountered in the oral delivery of hydrophilic macromolecules (e.g., protein/peptide therapeutics and plasmid DNA (pDNA)), as well as in lowering the effect of food on drugs' bioavailability. However, the main mechanism(s) by which SEDDS could achieve such promising effects remains not fully understood. This review summarizes the recent progress in the use of SEDDS for protecting protein therapeutics and/or pDNA against enzymatic degradation and increasing the oral bioavailability of various drug substances regardless of the dietary condition. Understanding the underlying mechanism(s) of such promising applications will aid in the future development of rationally designed SEDDS. Entrapment of hydrophilic macromolecules in the oil phase of the formed emulsion is critical for protection of the loaded cargoes against enzymatic degradation and the enhancement of oral bioavailability. On the other hand, drug administration as a preconcentrated solution in the SEDDS preconcentrate allows the process of drug absorption to occur independently of the dietary condition, and thus reducing interindividual variability that results from concomitant food intake.
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http://dx.doi.org/10.1016/j.colsurfb.2018.03.034DOI Listing
July 2018

Genetic polymorphisms of TP53 Arg72Pro and Pro47Ser among Egyptian patients with colorectal carcinoma.

Arch Physiol Biochem 2019 Jul 21;125(3):255-262. Epub 2018 Mar 21.

b Department of Biochemistry , College of Science, Damietta University , New Damietta , Egypt.

Background: Previous reports demonstrated the role of TP53 gene polymorphisms with CRC risk among several ethnic populations. The purpose of this study is to assess the association of the TP53 Arg72Pro and Pro47Ser variants with CRC risk among Egyptian patients.

Subjects And Methods: This work was conducted on 120 unrelated CRC Egyptian patients who were compared to 140 healthy controls. DNA was genotyped for these variants using the PCR-RFLP technique.

Results: CRC patients observed a significant association of the rare genotype of TP53 Arg72Pro polymorphism compared with healthy controls. On the contrast, all genetic models showed no statistical association of TP53 Pro47Ser polymorphism among CRC patients compared with healthy controls. On the contrast, CRC patients of the TP53 gene polymorphisms indicated no significant difference regarding their clinical and laboratory markers.

Conclusions: Our findings indicate a strong association with TP53 Arg72Pro variant within increased risk of CRC among Egyptian patients.
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http://dx.doi.org/10.1080/13813455.2018.1453522DOI Listing
July 2019

Effet d’un vernis fluoré dans la prévention d’une déminéralisation de l’émail autour et en dessous des attaches orthodontiques.

Int Orthod 2018 03 2;16(1):1-11. Epub 2018 Mar 2.

Département d'orthodontie, faculté dentaire, université arabe de Beyrouth, Beyrouth, Liban; Université d'Alexandrie, Alexandrie, Égypte.

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http://dx.doi.org/10.1016/j.ortho.2018.01.006DOI Listing
March 2018

The effect of fluoride varnish in preventing enamel demineralization around and under orthodontic bracket.

Int Orthod 2018 03 2;16(1):1-11. Epub 2018 Mar 2.

Department of Orthodontics, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon; Alexandria University, Alexandria, Egypt.

Aim: The aim of this study was to evaluate in vitro the effectiveness of fluoride Vanish™ in preventing enamel demineralization around and under orthodontic brackets, using a laser fluorescence monitoring device on a group of teeth, using a laser fluorescence monitoring device on a group of extracted teeth with bonded brackets.

Methods: Orthodontic brackets were bonded to 32 extracted premolars. Buccal surfaces of teeth were divided into two halves: mesial and distal, fluoride Vanish™ (3M Unitek, Monrovia, CA, USA) was applied only on the distal half while the mesial one served as control half. Teeth were subjected to two demineralization cycles in standard demineralization solution. Enamel demineralization was measured on both varnished and non-varnished halves at baseline, after first and second demineralization cycles and under the brackets after debonding using laser fluorescence device Diagnodent pen. Data were analyzed using Friedman test followed by Wilcoxon test. Differences were considered statistically significant at P<0.001.

Results: Statistically significant differences were observed between the varnished and non-varnished halves after the first and second demineralization cycles at P<0.001. No significant difference was found between baseline readings and under the brackets in both halves.

Conclusion: Fluoride varnish application is effective in preventing enamel demineralization around orthodontic brackets. Fluoride varnish has insignificant effect on enamel mineral content under orthodontic brackets.
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http://dx.doi.org/10.1016/j.ortho.2018.01.005DOI Listing
March 2018

Q fever in Egypt: Epidemiological survey of Coxiella burnetii specific antibodies in cattle, buffaloes, sheep, goats and camels.

PLoS One 2018 21;13(2):e0192188. Epub 2018 Feb 21.

Mansoura Provincial Laboratory, Institute of Animal Health Research, Mansoura, Egypt.

Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii. Clinical presentation in humans varies from asymptomatic to flu-like illness and severe sequelae may be seen. Ruminants are often sub-clinically infected or show reproductive disorders such as abortions. In Egypt, only limited data on the epidemiology of Q fever in animals are available. Using a stratified two stage random sampling approach, we evaluated the prevalence of Coxiella burnetii specific antibodies among ruminants and camels in 299 herds. A total of 2,699 blood samples was investigated using enzyme-linked-immunosorbent assay (ELISA). Coxiella burnetii specific antibodies were detected in 40.7% of camels (215/528), 19.3% of cattle (162/840), 11.2% of buffaloes (34/304), 8.9% of sheep (64/716) and 6.8% of goats (21/311), respectively. Odds of seropositivity were significantly higher for cattle (aOR: 3.17; 95% CI: 1.96-5.13) and camels (aOR: 9.75; 95% CI: 6.02-15.78). Significant differences in seropositivity were also found between domains (Western Desert, Eastern Desert and Nile Valley and Delta) and 25 governorates (p < 0.001), respectively. Animal rearing in the Eastern Desert domain was found to be a significant risk factor (aOR: 2.16; 95% CI: 1.62-2.88). Most seropositive animals were older than four years. No correlation between positive titers and husbandry practices or animal origin were found (p > 0.05). Only 8.7% of the interviewed people living on the farms consumed raw camel milk and none reported prior knowledge on Q fever. Findings from this nationwide study show that exposure to Coxiella burnetii is common in ruminants and camels. Disease awareness among physicians, veterinarians and animal owners has to be raised. Future epidemiological investigations have to elucidate the impact of Q fever on human health and on the economy of Egypt.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192188PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821454PMC
March 2018

Development and in vitro/in vivo performance of self-nanoemulsifying drug delivery systems loaded with candesartan cilexetil.

Eur J Pharm Sci 2017 Nov 6;109:503-513. Epub 2017 Sep 6.

Department of pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt. Electronic address:

Candesartan cilexetil is widely used in the management of hypertension and heart failure. The drug delivery encounters obstacles of poor aqueous solubility, efflux by intestinal P-glycoprotein and vulnerability to enzymatic degradation in small intestine. Self-nanoemulsifying drug delivery systems (SNEDDS) loaded with candesartan cilexetil were successfully developed to overcome such obstacles. Preliminary screening was carried out to select proper surfactant, co-surfactant and oil combination for successful SNEDDS formulation. All screened excipients were reported for their P-glycoprotein and cytochrome P450 3A4 (CYP3A4) modulation activity. Ternary and pseudo ternary diagrams were constructed to optimize the system. Peppermint oil and clove oil showed a high emulsification ability. The nature of obtained dispersions was identified to be nanoemulsions. Twenty-four formulations were evaluated for stability, robustness to dilution and self-emulsification efficiency. All formulations showed a very short emulsification time of <2min. The emulsification efficiency was significantly superior at pH6.8, at which the largest self-emulsifying region was also observed. Eight formulations were selected for further characterization according to cloud point measurement; mean droplet size, poly dispersity index (PDI) and zeta potential determination in addition to in vitro drug release study. All selected formulations showed very high cloud points (70-90°C), ultrafine mean droplet size (12±1.4 to 24.5±2.13nm), very low PDI values (0.015-0.1305) and almost a complete drug release after 12h. Formulation F15 (Peppermint oil 55% w/w: Cremophor RH40 25% w/w: Labrasol 20% w/w) was selected for further characterization. Its droplet size showed robustness to different dilution folds with different media and its TEM photograph showed spherical particles without any apparent aggregation even after 24h. Formulation F15 successfully controlled the systolic blood pressure of hypertensive rats for 24h with the maximum effect was observed after 2h. These results indicate that, SNEDDS could be promising delivery systems with a rapid onset of action and prolonged therapeutic effect of candesartan cilexetil.
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http://dx.doi.org/10.1016/j.ejps.2017.09.001DOI Listing
November 2017

Risk Factors for Primary Middle East Respiratory Syndrome Coronavirus Infection in Camel Workers in Qatar During 2013-2014: A Case-Control Study.

J Infect Dis 2017 06;215(11):1702-1705

Department of Viroscience, Erasmus Medical Center,Rotterdam, the Netherlands.

The transmission routes and risk factors for zoonotic Middle East respiratory syndrome coronavirus (MERS-CoV) infections are still unknown. We used the World Health Organization questionnaire for MERS-CoV case-control studies to assess risk factors for human MERS-CoV seropositivity at a farm complex in Qatar. Nine camel workers with MERS-CoV antibodies and 43 workers without antibodies were included. Some camel-related activities may pose a higher risk of MERS-CoV infection, as may cross-border movements of camels, poor hand hygiene, and overnight hospital stays with respiratory complaints. The risk factors identified in this study can be used to develop infection prevention and control measures for human MERS-CoV infections.
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http://dx.doi.org/10.1093/infdis/jix174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107360PMC
June 2017

The frequency and nature of medication errors in hospitalized patients with acute coronary syndrome.

Int J Clin Pharm 2017 Jun 3;39(3):542-550. Epub 2017 Apr 3.

Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt.

Background Cardiovascular medications have been commonly associated with medication errors. Objective The objective of this study was to investigate the incidence and predictors of medication errors in patients with acute coronary syndrome. Setting the coronary care unit of a university teaching hospital. Methods This was a prospective observational study on 150 patients admitted to the coronary care unit between August 2014 and July 2015. Main outcome measure The principal outcome was the number (frequency) of encountered medication errors. Results Of total 5790 prescription items reviewed, 547 (9.4%) potential medication errors were identified of which 523 (9.0%) were prescribing errors and 24 were monitoring errors. The most frequent prescribing errors were dosing errors (231, 42.2%) followed by loading dose omission error (91, 16.6%), omission of essential drugs on 1st day (43, 7.9%), and timing error (40, 7.3%). Errors frequently encountered with drugs such as aspirin, enoxaparin, beta-blockers followed by angiotensin-converting enzyme inhibitors and clopidogrel. Multivariate logistic regression analysis revealed that renal impairment (OR 6.02; 95% CI 1.4-35.4; p = 0.02) and longer duration of hospital stay (OR 4.01; 95% CI 1.5-10.7; p = 0.005) were predictors of the higher incidence of medication errors. Conclusion Prescribing and monitoring errors in coronary care unit are frequent and avoidable, with the majority of errors were ranked to be of mild to moderate severity. Dosing errors, omission of essential drugs and monitoring errors were most common error types encountered. Dosage adjustment based on estimation of the glomerular filtration rate immediately after admission help avoiding dosage-related errors.
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http://dx.doi.org/10.1007/s11096-017-0457-zDOI Listing
June 2017