Publications by authors named "Ahmed Kamel"

74 Publications

Awareness of the Egyptian public about COVID-19: what we do and do not know.

Inform Health Soc Care 2021 Feb 23:1-12. Epub 2021 Feb 23.

Faculty of Pharmacy, Cairo University, Cairo, Egypt.

To survey the health-seeking behaviors and perspectives of the Egyptian population toward the COVID-19 pandemic. A descriptive survey was designed and disseminated via social media platforms. The survey consisted of 32 questions addressing respondent's demographics, knowledge, practice, and attitude toward the COVID-19 pandemic. A total of 25,994 Egyptians participated in the survey from the 29 Egyptian governorates. More than 99% of the respondents were aware of the COVID-19 pandemic. Responses showed split opinions regarding whether people should wear gloves or masks to prevent COVID-19 infection (47.7% and 49.5% replied with "False", respectively). Almost one-quarter (23.1%) of the respondents went to crowded places during the last 14 days. Calling the emergency hotline and self-isolation at home were the most frequent practices to deal with COVID-19 symptoms (34.1% and 44.5%, respectively). A total of 85% of respondents reported their confidence in the Egyptian healthcare system to win the battle against COVID-19 despite the challenges. A vast majority of this large population sample reported reasonable knowledge levels and potentially appropriate practices toward COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/17538157.2021.1883029DOI Listing
February 2021

Characteristics and outcomes of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients admitted to the intensive care unit: A multicenter retrospective cohort study.

J Infect Public Health 2021 Feb 15;14(2):193-200. Epub 2020 Dec 15.

Department of Pediatrics, Amiri Hospital, Kuwait City, Kuwait. Electronic address:

Background: Characteristics of critical Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) infection in children is not well understood. This study described the clinical characteristics of children admitted to intensive care units (ICU) and explored factors associated with the need for invasive ventilation or mortality.

Methods: A multicenter, retrospective, cohort study was conducted over eight medical centers, including all patients younger than 18 years of age and admitted to the ICU due to a direct consequence of coronavirus disease 2019 (COVID-19). Patients who were admitted to the ICU for any alternate reason and tested positive for SARS-CoV-2 by screening test, and patients who were admitted due to multi-inflammatory syndrome in children, were excluded. Demographic, laboratory, imaging, and clinical data were collected. Descriptive statistics were used to compare survivors and non-survivors. Fine and Gray's hazard model was used to estimate the association between clinical variables and ICU death.

Results: During the study period, 25 pediatric COVID-19 patients received care in the ICUs. The median age was 2.78 years (IQR 0.21-8.51), and 60% were male. Only three patients were reported to be previously healthy at admission. Nine (36%) patients required invasive mechanical ventilation, including two were on extracorporeal membrane oxygenation. Four (16%) patients died during ICU care. In univariate analysis, the presence of comorbidity (HR 0.0001; 95%CI 0.00001-0.00016), platelets count (HR 0.99; 95% CI 0.98-0.99), elevated procalcitonin (HR 1.05; 95%CI 1.016-1.09), and circulatory compromise (HR 16.34; 95%CI 1.99-134.35), all at the time of ICU admission, were associated with in-ICU mortality.

Conclusion: Our findings suggest that children admitted to the ICU with SARS-CoV-2 infection, generally, have a favorable outcome. Low platelets count, elevated procalcitonin, presence of comorbidity, and shock at the time of ICU admission were associated with death. This study may shed more light on the disease dynamics of critical pediatric COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jiph.2020.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837314PMC
February 2021

Reply to letter to the editor article "Placenta accreta spectrum: "placenta accreta" is still used".

Arch Gynecol Obstet 2021 Jan 17. Epub 2021 Jan 17.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-020-05932-5DOI Listing
January 2021

Artificial intelligence in radiology: does it impact medical students preference for radiology as their future career?

BJR Open 2020 11;2(1):20200037. Epub 2020 Dec 11.

Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children's Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.

Objective: To test medical students' perceptions of the impact of artificial intelligence (AI) on radiology and the influence of these perceptions on their choice of radiology as a lifetime career.

Methods: A cross-sectional multicenter survey of medical students in Saudi Arabia was conducted in April 2019.

Results: Of the 476 respondents, 34 considered radiology their first specialty choice, 26 considered it their second choice, and 65 considered it their third choice. Only 31% believed that AI would replace radiologists in their lifetime, while 44.8% believed that AI would minimize the number of radiologists needed in the future. Approximately 50% believed they had a good understanding of AI; however, when knowledge of AI was tested using five questions, on average, only 22% of the questions were answered correctly. Among the respondents who ranked radiology as their first choice, 58.8% were anxious about the uncertain impact of AI on radiology. The number of respondents who ranked radiology as one of their top three choices increased by 14 when AI was not a consideration. Radiology conferences and the opinions of radiologists had the most influence on the respondents' preferences for radiology.

Conclusion: The worry that AI might displace radiologists in the future had a negative influence on medical students' consideration of radiology as a career. Academic radiologists are encouraged to educate their students about AI and its potential impact when students are considering radiology as a lifetime career choice.

Advances In Knowledge: Rapid advances of AI in radiology will certainly impact the specialty, the concern of AI impact on radiology had negative influence in our participants and investing in AI education and is highly recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1259/bjro.20200037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748985PMC
December 2020

A multivariate data analysis approach for investigating daily statistics of countries affected with COVID-19 pandemic.

Heliyon 2020 Nov 24;6(11):e05575. Epub 2020 Nov 24.

Department of Biostatistics and Demography, Faculty of Graduate Studies for Statistical Research, Cairo University, Egypt.

Background: To understand the impact and volume of coronavirus (COVID-19) crisis, univariate analysis is tedious for describing the datasets reported daily. However, to capture the full picture and be able to compare situations and consequences for different countries, multivariate analytical models are suggested in order to visualize and compare the situation of different countries more accurately and precisely.

Aims: We aimed to utilize data analysis tools that display the relative positions of data points in fewer dimensions while keeping the variation of the original data set as much as possible, and cluster countries according to their scores on the formed dimensions.

Methods: Principal component analysis (PCA) and Partitioning around medoids (PAM) clustering algorithms were used to analyze data of 56 countries, 82 countries and 91 countries with COVID-19 at three time points, eligible countries included in the analysis are those with total cases of 500 or more with no missing data.

Results: After performing PCA, we generated two scores: Disease Magnitude score that represents total cases, total deaths, total actives cases, and critically ill cases, and Mortality Recovery Ratio score that represents the ratio between total deaths to total recoveries in any given country.

Conclusion: Accurate multivariate analyses can be of great value as they can simplify difficult concepts, explore and communicate findings from health datasets, and support the decision-making process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.heliyon.2020.e05575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685045PMC
November 2020

Pneumatic vs laser lithotripsy for mid-ureteric stones: Clinical and cost effectiveness results of a prospective trial in a developing country.

Arab J Urol 2020 Apr 15;18(3):181-186. Epub 2020 Apr 15.

Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt.

Objective: To compare the management of large ureteric stones (>10 mm) with ureterorenoscopy (URS) and laser or pneumatic lithotripsy, and their associated costs.

Patients And Methods: Our prospective study followed the tenets of the Declaration of Helsinki and included 101 patients with large mid-ureteric stones eligible for URS and lithotripsy, and was conducted between January 2018 and August 2019. Patients were randomly divided into two groups: Group 1 had laser lithotripsy, while the Group 2 had lithotripsy using a pneumatic energy source.

Results: Operative time was significantly longer in cases using pneumatic lithotripsy ( < 0.001). The stone-free rate (SFR) on the first postoperative day was 94% and 92.5% for laser and pneumatic lithotripsy respectively, and there were no statistically significant differences in terms of early (day 1) or late (day 30) SFRs between the groups. Complications were classified according to the Clavien-Dindo Grading System, all complications were Grade
Conclusion: The type of lithotripsy did not affect the SFR or complications. However, laser lithotripsy was much more expensive than pneumatic lithotripsy.

Abbreviations: KUB: plain abdominal radiograph of the kidneys, ureters and bladder; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: Ureterorenoscopy; US: ultrasonography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/2090598X.2020.1749800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473316PMC
April 2020

Anticoagulation outcomes in hospitalized Covid-19 patients: A systematic review and meta-analysis of case-control and cohort studies.

Rev Med Virol 2020 Oct 6:e2180. Epub 2020 Oct 6.

Clinical Pharmacy Department, College of Pharmacy, Cairo University, Cairo, Egypt.

Background: Coagulopathy and thromboembolic events are common in Covid-19 patients and are poor prognostic factors. Controversy exists regarding the potential of anticoagulation (AC) to reduce mortality and incidence of thromboembolic events in Covid-19 patients. The current systematic review and meta-analysis investigated the association between anticoagulants and mortality in adult hospitalized COVID-19 patients using the available published non-randomized studies.

Methods: Google Scholar, PubMed, Scopus, the Cochrane Library and Clinical Trials.gov were searched for relevant studies. A meta-analysis of adjusted and unadjusted estimates was performed. The relative risk was used as a measure of effect. The random-effects model was used to pool estimates using the generic inverse variance method.

Results: Sixteen studies were included in the quantitative data synthesis. Results showed a statistically significant association between AC and mortality (RR = 0.56, 95% CI 0.36; 0.92, p = 0.02). Both therapeutic (Relative risk [RR] = 0.4, 95% CI 0.27; 0.57) and prophylactic AC (RR = 0.54, 95% CI 0.41; 0.71) were associated with lower risk of mortality. Pre-admission AC was not associated with mortality (RR = 0.84, 95% CI 0.49; 1.43, p > 0.05) while prophylactic AC was associated with higher risk of mortality compared to therapeutic AC (RR = 1.58, 95% CI 1.34; 1.87, p < 0.001).

Conclusion: Findings support the association of AC with mortality in Covid-19 patients. The results, synthesized from mostly low-quality studies, show that prophylactic and therapeutic AC might reduce mortality in Covid-19 patients. Findings suggest that therapeutic doses might be associated with better survival compared to prophylactic doses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/rmv.2180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646049PMC
October 2020

Sesquiterpene lactones; Damsin and neoambrosin suppress cytokine-mediated inflammation in complete Freund's adjuvant rat model via shutting Akt/ERK1/2/STAT3 signaling.

J Ethnopharmacol 2021 Feb 23;266:113407. Epub 2020 Sep 23.

Pharmacology Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt. Electronic address:

Ethnopharmacologial Relevance: Although Damsissa (Ambrosia maritima) is traditionally used as anti-inflammatory and diuretic, the biological activity and mechanism of action of its major constituents are to be elucidated.

Aim: to decipher the anti-arthritic potential of damsin (DMS) and neoambrosin (NMS) and to unfold their molecular signaling in complete Freund's adjuvant (CFA)-induced arthritis model.

Materials And Methods: the right hind paw was inoculated with CFA (0.1 ml) at day 0 and 7 while treatments were started from the 14 day and continued for 2 weeks. Rats were randomly assigned into 4 groups; normal group (NRML), CFA-induced arthritis group, CFA-induced arthritis treated with DMS and NMS (10 mg/kg/day) as 3 and 4 group; respectively.

Results: Throughout experimental period, treatments ameliorated the increase of paw volume, knee joint diameter and nociception tests as reflected in open field arena. Also, DSM and NMS suppressed phosphorylation of Akt, STAT-3, ERK1/2 which was further mirrored by inactivation of GSK3β and downregulation of MCP-1 together with CCN1 and NF-kβ in hind paw tissue. Concomitantly, inflammation markers; TNF-α, IL-6, -12 were lowered as confirmed microscopically during examination of hind paw tissue.

Conclusion: DSM and NMS-induced suppression of NF-kβ subdues clinical features of RA most probably through repression of Akt/ERK1/2/STAT3 pathway. Therefore, DMS and NMS can serve as safe and effective treatment for rheumatoid arthritis, one of the most disabling chronic, inflammatory and painful autoimmune disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jep.2020.113407DOI Listing
February 2021

Immunomodulatory effect of diallyl sulfide on experimentally-induced benign prostate hyperplasia via the suppression of CD4+T/IL-17 and TGF-β1/ERK pathways.

Inflammopharmacology 2020 Oct 12;28(5):1407-1420. Epub 2020 Aug 12.

Biochemistry Department, Faculty of Pharmacy, Cairo University, Kasr El Aini St., Cairo, 11562, Egypt.

Benign prostatic hyperplasia (BPH) is a nonmalignant enlargement of the prostate common in older men. Diallyl sulfide (DAS), a major component of garlic, has been reported to possess antioxidant, anti-inflammatory, and antiproliferative effects. However, the underlying protective immunomodulatory mechanism of DAS on BPH remains vague. Herein, experimental BPH was induced in rats by daily subcutaneous injection of testosterone propionate (TP) (3 mg/kg, s.c.) for 4 weeks. In parallel, finasteride (Fin) (5 mg/kg, p.o) or DAS (50 mg/kg, p.o.) was administered orally during BPH induction. TP-induced histological alterations and the immune-inflammatory cascade. On the other hand, DAS or Fin administration alleviated all abnormalities induced testosterone. Fin and DAS administration markedly reduced prostate weight by 53% with Fin, and by 60% with DAS. Moreover, serum testosterone and DHT were reduced by 55% and 52%, respectively, with Fin and by 68% and 75%, respectively, with DAS, in concordance with decreased protein expression of androgen receptor (AR), and prostate-specific antigen (PSA). Furthermore, both regime lessen immune-inflammatory milieu, as evidenced by decrease CD4+ T-cells protein expression and associated inflammatory cytokines. Concomitantly, Fin and DAS exhibited marked mitigation in insulin-like growth factor-1 (IGF-1), transforming growth factor-beta1 (TGF-β1), and phosphorylated extracellular signal-regulated kinase (ERK1/2) signaling. Besides alleviating oxidative stress by 53% and 68% in prostatic MDA and by 27% and 7% in prostatic iNOS with Fin and DAS, respectively. In conclusion, this work highlighted a potential therapeutic approach of DAS as a dietary preventive agent against BPH via its anti-inflammatory and immunomodulatory effect along with suppression of the ERK pathway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10787-020-00743-1DOI Listing
October 2020

The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders.

Arch Gynecol Obstet 2020 11 1;302(5):1143-1150. Epub 2020 Aug 1.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt.

Purpose: To assess the value of various grey-scale ultrasound, 2D color Doppler, and 3D power Doppler sonographic markers in predicting major intraoperative blood loss during planned cesarean hysterectomy for cases diagnosed with placenta accreta spectrum (PAS) disorders.

Methods: 50 women diagnosed with PAS were scanned the day before planned delivery and hysterectomy for various sonographic markers indicative of placental invasion. These women were then later divided according to blood loss in two groups: group A (minor hemorrhage, < 2500 ml), and group B (major hemorrhage, > 2500 ml), and the data were analyzed.

Results: The odds ratio (OR) for major hemorrhage was as follows for the following sonographic markers: 'number of lacunae > 4' OR 3.8 95% CI (1.0-13.8) (p = 0.047); 'subplacental hypervascularity' OR 10.8 95% CI (1.2-98.0) (p = 0.035); 'tortuous vascularity with 'chaotic branching' OR 10.8 95%CI (1.2-98.0) (p = 0.035); 'numerous coherent vessels involving the serosa-bladder interface OR 14.6 95% CI (2.7-80.5) (p = 0.002); and 'presence of bridging vessels OR 2.9 95% CI (1.4-6.9) (p = 0.005). Only the presence of numerous coherent vessels involving the bladder-serosal interface (p = 0.002) was proven to be independent predictor of major hemorrhage during hysterectomy.

Conclusion: The use of 2D color Doppler and 3D power Doppler can help predict massive hemorrhage in cases of PAS disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-020-05707-yDOI Listing
November 2020

The effect of early administration of rectal progesterone in IVF/ICSI twin pregnancies on the preterm birth rate: a randomized trial.

BMC Pregnancy Childbirth 2020 Jun 9;20(1):351. Epub 2020 Jun 9.

The Egyptian IVF center Maadi, 3, St. No. 161-Hadayek El-Maadi, 11431, Cairo, Egypt.

Background: The rate of multiple pregnancies in IVF/ICSI ranges from 20 to 30%. The incidence of preterm birth in multiple pregnancies is as high as 60% and is even higher in pregnancies conceived after IVF & ICSI. The effect of progesterone on prevention of preterm birth in twins is controversial. Our group has proven a positive effect in reduction of preterm birth, by starting progesterone from the mid-trimester, in exclusively IVF/ICSI singleton pregnancies but not twins. The purpose of our current study was to explore the effect of earlier administration of natural progesterone, in IVF/ICSI twin pregnancies starting at 11-14 weeks for prevention of preterm birth.

Methods: This is a double-blind, placebo controlled, single center, randomized clinical trial. Women with dichorionic twin gestations, having an IVF/ICSI trial were randomized to receive natural rectal progesterone (800 mg daily) vs placebo, starting early from 11 to 14 weeks. They also received oral and vaginal antimicrobial agents as part of our routine treatment for vaginitis and urinary tract infection. They were randomized regardless of cervical length and had no previous history of preterm birth or known Mullerian anomalies. The primary outcome was spontaneous preterm birth rate before 37 weeks. The secondary outcome was; spontaneous preterm birth before 34, 32, 28 weeks and neonatal outcome.

Results: A total of 203 women were randomized to both groups, final analysis included 199 women as 4 were lost to follow up. The base line characteristics as well as gestational age at delivery were not significantly different between the study and the placebo group (34.7 ± 3.6 vs 34.5 ± 4.5, P = 0.626). Progesterone administration was not associated with a significant decrease in the spontaneous preterm birth rates before 37 weeks (73.5% vs 68%, P = 0.551), before 34 (20.6% vs 21.6%, P = 0.649), before 32 (8.8% vs 12.4%, P = 0.46) & before 28 (4.9% vs 3.1%, P = 0.555) weeks.

Conclusions: Rectal natural progesterone starting from the first trimester in IVF/ICSI twin pregnancies did not reduce spontaneous preterm birth.

Trial Registration: The trial was registered on 31 January 2014 at www.ISRCTN.com, number 69810120.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12884-020-03033-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285559PMC
June 2020

Redox-responsive biocompatible nanocarriers based on novel heparosan polysaccharides for intracellular anticancer drug delivery.

Asian J Pharm Sci 2020 Jan 17;15(1):83-94. Epub 2018 Dec 17.

School of Pharmaceutical Sciences, Jiangnan University, Wuxi 214122, China.

Heparosan is a natural precursor of heparin biosynthesis in mammals. It is stable in blood circulation but can be degraded in lysosomes, showing good biocompatibility and long circulation features. So heparosan can be designed as anticancer drug carriers to increase tumor selectivity and improve the therapeutic effect. A novel redox-sensitive heparosan-cystamine-vitamin E succinate (KSV) micelle system was constructed for intracellular delivery of doxorubicin (DOX). Simultaneously, the redox-insensitive heparosan-adipic acid dihydrazide-vitamin E succinate copolymer (KV) was synthesized as control. DOX-loaded micelles (DOX/KSV) with an average particle size of 90-120 nm had good serum stability and redox-triggered depolymerization. drug release test showed that DOX/KSV micelles presented obvious redox-triggered release behavior compared with DOX/KV. Cytotoxicity and cell uptake were investigated using MGC80-3 tumor cells and COS7 fibroblast-like cells. The cell survival rate of blank micelles was more than 90%, and the cytotoxicity of DOX/KSV in MGC80-3 cells was higher than in COS7 cells, indicating that the carrier has better biocompatibility and less toxicity side effect. The cytotoxicity of DOX/KSV against MGC80-3 cells was significantly greater than that of free DOX and DOX/KV. Furthermore, compared with DOX/KV in MGC80-3 cells, DOX/KSV micelles uptook more anticancer drugs and then released DOX faster into the cell nucleus. The micelles were endocytosed by multiple pathways, but clathrin-mediated endocytosis was the main pathway. Therefore, heparosan polysaccharide could be a potential option as anticancer carrier for enhancing efficacy and mitigating toxicity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajps.2018.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066043PMC
January 2020

Pharyngeal flap for a poorly repaired cleft palate with posterior palatal defect.

Int J Pediatr Otorhinolaryngol 2020 Jun 4;133:109977. Epub 2020 Mar 4.

Department of Otolaryngology (Phoniatric Unit), Cairo University, Cairo, Egypt.

Objective: Posterior palatal defect after cleft palate (CP) repair is not a rare problem, it may cause velopharyngeal insufficiency (VPI). The aim of this study was to assess the effectiveness of a superiorly-based pharyngeal flap (PF) with modification of its end to accommodate the defect in treatment of post-palatoplasty VPI.

Methods: Thirteen children with VPI due to posterior palatal defect after CP repair were included in this study. PF was used in treatment of all patients, the lower end of the flap was fashioned in a V-shape to accustom the shape of the defect with peeling of its overlying mucosa to enhance wound healing. The PF was inserted deeply into a tunnel created within the defect between the oral and nasal layers of the palate. Pre- and postoperative evaluation using auditory perceptual assessment (APA), nasometric assessment and velopharyngoscopy were performed.

Results: Significant improvement of APA and nasalance score for both oral and nasal sentences was achieved. Also, velopharyngoscopy showed complete velopharyngeal closure in all patients postoperatively.

Conclusion: A modified PF is an effective treatment for VPI caused by posterior palatal defect that may be encountered after CP repair.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2020.109977DOI Listing
June 2020

Concomitant adenotonsillectomy and cleft palate repair in one sitting.

Eur Arch Otorhinolaryngol 2020 Apr 25;277(4):1133-1137. Epub 2020 Jan 25.

Department of Otolaryngology, Faculty of Medicine, Cairo University, el-salam st., King Faisal, above el-baraka bank, Giza, Cairo, Egypt.

Purpose: When adenotonsillar hypertrophy (ATH) is encountered in children during cleft palate (CP) repair, the decision for adenotonsillectomy is challenging. The aim of this study was to evaluate the effectiveness of adenotonsillectomy done during CP repair for children with ATH on speech and breathing.

Methods: Nine children with CP and ATH underwent adenotonsillectomy prior to palatoplasty in same sitting. The age of patients ranged between 1.5 and 3.5 years with a mean age of 2.3 years at the time of operation. Auditory perceptual assessment (APA), nasometric assessment, and velopharyngeal function evaluation were performed when the children reached the age of 4 years.

Results: No children developed obstructive breathing episodes postoperatively as witnessed by parents. APA showed normal nasality in six patients and mild hypernasality in three patients. Nasalance scores for both nasal and oral sentences were found to be comparable with that of normal children of the same age. Velopharyngeal closure was seen competent in four patients, borderline competent in three patients, and borderline incompetent in two patients.

Conclusion: Performing adenotonsillectomy during CP repair does not deleteriously affect the speech and it prevents the occurrence of postoperative obstructive breathing episodes that may be caused by the hypertrophied tonsils and/or adenoid.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-020-05814-1DOI Listing
April 2020

Association between pet ownership and cardiovascular risks and mortality: a systematic review and meta-analysis.

J Cardiovasc Med (Hagerstown) 2020 May;21(5):359-367

Evidence Based Medicine Research Group.

: The aim of the study was to determine the association between pet ownership and cardiovascular risk factors and mortality. Electronic search was conducted through nine databases including PubMed for relevant publications reporting cardiovascular events and mortality among pet owners. Meta-analysis was used to pool the results. Of a total of 2818 reports screened, 26 studies were included in our systematic review and meta-analysis. Higher survival rate was observed in the pet owners group after pooling nonadjusted and adjusted hazard ratios for cardiovascular mortality at 0.73 [95% confidence interval (CI) 0.62-0.86] and 0.81 (0.68-0.97), respectively. A similar trend was observed for the pooled nonadjusted hazard ratio for overall mortality 0.73 (0.62-0.87) but not the adjusted hazard ratio 0.40 (0.04-3.78). Cat owners have a reduction in cardiovascular mortality but not overall mortality after pooling the adjusted hazard ratio 0.79 (0.63-0.99) and 1.04 (0.90-1.21), respectively. However, no significant association between dog owners and survival rate was observed for overall and cardiovascular-specific mortality. Pet owners had significantly lower heart rate (mean difference 95% CI: -2.32 (-3.07 to -1.57), mean arterial pressure -2.60 (-4.25 to -0.95) and SBP -1.69 (-3.06 to -0.31) but not DBP -0.23 (-1.05 to 0.60). No significant difference was observed between pet owners and nonpet owners in prevalence of hypertension. Our study draws attention to the beneficial effects of the human--pet bond; therefore, we recommend pet acquisition for better cardiovascular outcomes after controlling for zoonotics and pet-induced allergies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2459/JCM.0000000000000920DOI Listing
May 2020

Vildagliptin Attenuates Huntington's Disease through Activation of GLP-1 Receptor/PI3K/Akt/BDNF Pathway in 3-Nitropropionic Acid Rat Model.

Neurotherapeutics 2020 01;17(1):252-268

Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Governorate, Giza, Egypt.

Vildagliptin (Vilda), a dipeptidyl peptidase-4 (DPP-4) inhibitor, has been highlighted as a promising therapeutic agent for neurodegenerative diseases as Alzheimer's and Parkinson's diseases. Vilda's effect is mostly linked to PI3K/Akt signaling in CNS. Moreover, PI3K/Akt activation reportedly enhanced survival and dampened progression of Huntington's disease (HD). However, Vilda's role in HD is yet to be elucidated. Thus, the aim of the study is to uncover the potentiality of Vilda in HD and unfold its link with PI3K/Akt pathway in 3-nitropropionic acid (3NP) rat model. Rats were randomly assigned into 4 groups; group 1 received saline, whereas, groups 2, 3 and 4 received 3NP (10 mg/kg/day; i.p.) for 14 days, concomitantly with Vilda (5 mg/kg/day; p.o.) in groups 3 and 4, and wortmannin (WM), a PI3K inhibitor, (15 μg/kg/day; i.v.) in group 4. Vilda improved cognitive and motor perturbations induced by 3NP, as confirmed by striatal histopathological specimens and immunohistochemical examination of GFAP. The molecular signaling of Vilda was estimated by elevation of GLP-1 level and protein expressions of survival proteins; p85/p55 (pY458/199)-PI3K, pS473-Akt. Together, it boosted striatal neurotrophic factors and receptor; pS133-CREB, BDNF, pY515-TrKB, which subsequently maintained mitochondrial integrity, as indicated by enhancing both SDH and COX activities, and the redox modulators; Sirt1, Nrf2. Such neuroprotection restored imbalance of neurotransmitters through increasing GABA and suppressing glutamate as well PDE10A. These effects were reversed by WM pre-administration. In conclusion, Vilda purveyed significant anti-Huntington effect which may be mediated, at least in part, via activation of GLP-1/PI3K/Akt pathway in 3NP rat model.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13311-019-00805-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007456PMC
January 2020

Burnout Phenomenon and Its Predictors in Radiology Residents.

Acad Radiol 2020 07 16;27(7):1033-1039. Epub 2019 Oct 16.

Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children's Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.

Rationale And Objectives: The purpose of this study is to evaluate the prevalence of burnout and its associated risk factors in radiology residents in Saudi Arabia.

Materials And Methods: This cross-sectional study was conducted in February 2019, and all radiology residents in Riyadh, Saudi Arabia, were invited to complete a survey that contained a validated measure of burnout (Maslach Burnout Inventory-Human Services Survey) alongside possible predictors of burnout.

Results: A total of 108 responses were received, for a response rate of 49.7%. High overall burnout was reported by 24.1% of respondents, high emotional exhaustion (EE) by 56.5%, high depersonalization by 31.5%, and low sense of personal accomplishment (PA) by 64.8%. The significant predictors of burnout included satisfaction with work/life balance (OR = 0.35, 95% CI = 0.03 to 0.43, p = 0.002) and exercising (OR = 0.31, 95% CI = 0.1 to 1, p = 0.07). Married residents were more prone to have a low sense of PA in addition to dissatisfied residents with hospital staff appreciation (OR = 4.8, 95% CI = 1.48 to 15.5, p = 0.01) and (OR = 0.59, 95% CI = 0.37 to 0.94, p = 0.03), respectively.

Conclusion: One-fourth of the radiology residents studied showed high rates of burnout, and more than half the residents reported high rates of EE. The residents scored very poorly in the sense of PA. The radiology residents who were satisfied with their work/life balance had lower burnout rates, in addition to lower EE and a higher sense of PA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acra.2019.09.024DOI Listing
July 2020

Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology.

J Natl Compr Canc Netw 2019 09;17(9):1109-1133

National Comprehensive Cancer Network.

Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract that has increased in incidence across recent years. Often diagnosed at an advanced stage, outcomes for SBA are worse on average than for other related malignancies, including colorectal cancer. Due to the rarity of this disease, few studies have been done to direct optimal treatment, although recent data have shown that SBA responds to treatment differently than colorectal cancer, necessitating a separate approach to treatment. The NCCN Guidelines for Small Bowel Adenocarcinoma were created to establish an evidence-based standard of care for patients with SBA. These guidelines provide recommendations on the workup of suspected SBA, primary treatment options, adjuvant treatment, surveillance, and systemic therapy for metastatic disease. Additionally, principles of imaging and endoscopy, pathologic review, surgery, radiation therapy, and survivorship are described.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.6004/jnccn.2019.0043DOI Listing
September 2019

Treatment of post-adenotonsillectomy velopharyngeal stenosis with bivalved uvular flaps.

Int J Pediatr Otorhinolaryngol 2019 Nov 23;126:109600. Epub 2019 Jul 23.

Department of Otolaryngology, Faculty of Medicine, Fayoum University, Egypt.

Objective: Velopharyngeal stenosis (VS) is a rare devastating complication of adenotonsillectomy that causes obstructive sleep apnea (OSA). Its treatment is challenging and has a high recurrence rate. The aim of this study was to assess the efficacy of a bivalved uvular flap technique with topical application of mitomycin C for treatment of this problem.

Study Design: Case series.

Methods: Fourteen children with VS after adenotonsillectomy were treated with a bivalved uvular flap technique with application of mitomycin C after release of the adhesions and removal of scar tissue. Preoperative and postoperative evaluation of patients were performed. Flexible nasopharyngoscopy was used to assess the patency of the velopharynx, and apnea/hypopnea (A/H) index and minimum O saturation were measured before and after surgery.

Results: Adequate patent airway was obtained in all patients as seen by oropharyngeal examination and flexible nasopharyngoscopy. Additionally, significant improvement in A/H index and minimum O saturation were achieved postoperatively.

Conclusion: The bivalved uvular flap technique with topical application of mitomycin C after removal of scar tissue is an effective treatment for VS that may follow adenotonsillectomy in children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2019.109600DOI Listing
November 2019

Liposome-based codelivery of celecoxib and doxorubicin hydrochloride as a synergistic dual-drug delivery system for enhancing the anticancer effect.

J Liposome Res 2020 Sep 12;30(3):285-296. Epub 2019 Jul 12.

Department of Pharmaceutics, School of Pharmaceutical Sciences, Jiangnan University, Wuxi, China.

Combination therapy with conventional chemotherapeutic drugs strongly demonstrates a good approach to reduce cytotoxicity, resistance, and the dose of the potent anticancer drugs. The purpose of this research was to design and characterize liposome incorporating celecoxib (CEL) and doxorubicin hydrochloride (DOX) and investigate the anti-tumor efficacy of this combination on different tumor cells. A simple comparison study had been performed for liposomes formulation using thin-film hydration method and pH-gradient method. HSPC-incorporated liposomes were chosen for encapsulation of both CEL and DOX. The formulations showed small particle size and polydispersity index with high encapsulation efficiency. DOX/CEL liposomes displayed the strongest cytotoxicity against B16 and MGC80-3 cells in comparison to the corresponding drug solutions. By incorporation of both agents, a significant reduction in IC50 from 0.927 to 0.198 µg/ml and from 0.81 to 0.535 µg/ml against B16 cells and MGC80-3 cells, respectively, was observed. CEL also significantly improved the intracellular retention and accumulation of DOX . Our data suggest that the developed liposomal formulation proved to be the most effective formulative strategy as a dual drug delivery system for incorporation of both doxorubicin HCL and CEL and could be considered a useful tool for enhancing the therapeutic efficacy of the anticancer drug.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08982104.2019.1634724DOI Listing
September 2020

One-year evaluation of clinical and immunological efficacy and safety of sublingual versus subcutaneous allergen immunotherapy in allergic conjunctivitis.

Graefes Arch Clin Exp Ophthalmol 2019 Sep 17;257(9):1989-1996. Epub 2019 Jun 17.

Department of Respiratory Medicine, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.

Background: The aim of this study is to evaluate the clinical and immunological efficacy and safety of allergen immunotherapy (AIT) in patients with allergic conjunctivitis (AC) and to compare between sublingual and subcutaneous routes of administration.

Methods: A prospective comparative case series study was performed on 100 patients with IgE-mediated AC. Patients were referred to allergy clinics for skin prick test (SPT) and AIT. Patients with positive SPT and high-serum IgE level were enrolled in this study. Patients were divided into two groups: sublingual immunotherapy (SLIT) group (50 patients) and subcutaneous immunotherapy (SCIT) group (50 patients). Both groups were followed for 1 year. Efficacy was assessed clinically by comparing pre- and post-treatment symptoms and medication scores and assessed immunologically by comparing pre- and post-treatment serum IgE level and wheal diameter of SPT. Safety of the therapy was assessed by the occurrence of adverse reactions and patient tolerability to the therapy.

Results: Patients were either mono- or polysensitized to different allergens. Aeroallergens were significantly more common than food allergens (P = 0.00). The most prevalent aeroallergens were pollens (40%) and house dust (30%). At 12-month follow-up, both routes SLIT and SCIT led to a statistically significant clinical and immunological improvement (P < 0.05). This improvement was evident in all follow-up parameters including total ocular symptom score (TOSS), medication score, total serum IgE level, and wheal diameter of skin prick test (SPT). There was no significant difference between the two routes of administration (SLIT & SCIT) in any of the follow-up parameters (P > 0.05). Patients were able to tolerate the allergen therapy without developing any serious adverse events.

Conclusion: Aeroallergen polysensitization is common among patients with AC. SPT should be included in the diagnostic workup of those patients. AIT is a safe and effective treatment option for patients with AC as it has the potential to achieve significant reduction in symptom and medication scores without ocular or systemic side effects. There is no significant difference between both routes of administration either SLIT or SCIT in achieving clinical and immunologic improvement; so the patient can choose his preferred method for therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00417-019-04389-wDOI Listing
September 2019

The measurement of endometrial volume and sub-endometrial vascularity to replace the traditional endometrial thickness as predictors of fertilization success.

Gynecol Endocrinol 2019 Nov 21;35(11):949-954. Epub 2019 Apr 21.

Department of Obstetrics and Gynecology, Cairo University , Cairo , Egypt.

To assess the value of endometrial thickness, volume, and sub-endometrial perfusion in women undergoing IVF. In 82 women candidate for ICSI, endometrial thickness and sub-endometrial perfusion were measured with a trans-vaginal 2 D ultrasound and 3 D power Doppler respectively on day of hCG trigger and Embryo transfer (ET). The primary outcome was the clinical pregnancy rate. Endometrial volume showing a statistically significant difference between pregnant and nonpregnant women (4.11 ± 1.19 vs. 3.4 ± 1.1  = .019) on day of triggering and at ET (4.02 ± 1.15 vs. 3.45 ± 0.90,  = .022). VFI was significantly higher in pregnant group at both days of triggering and ET (0.54 ± 0.48 vs. 0.33 ± 0.31 and 0.47 ± 0.22 vs. 0.34 ± 0.2,  = .02). At cutoff values of 3.265 and 2.95 cm3 (70 & 80% sensitivity, specificity 64.5 & 51.6%, a positive predictive value 38.9 & 34.8%, and negative predictive value 87.0 & 88.9%) to predict pregnancy on the day of hCG trigger & ET respectively. Cutoff value for Endometrial VFI on the day of ET was 0.674 (sensitivity of 70%, specificity of 80.6%, PPV 53.8%, and NPV 89.3%). Higher endometrial volume and VFI were associated with pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09513590.2019.1604660DOI Listing
November 2019

Reply to the comments on "Modified hysterectomy for placenta increta and percreta: modifications of what?"

Arch Gynecol Obstet 2019 06 20;299(6):1753-1755. Epub 2019 Mar 20.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-019-05118-8DOI Listing
June 2019

Derma roller® microneedles-mediated transdermal delivery of doxorubicin and celecoxib co-loaded liposomes for enhancing the anticancer effect.

Mater Sci Eng C Mater Biol Appl 2019 Jun 25;99:1448-1458. Epub 2019 Feb 25.

Department of Pharmaceutics, School of Pharmaceutical Sciences, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, PR China. Electronic address:

The topical delivery of chemotherapeutics is a promising approach for the management of skin disorders. However, diverse pharmaceutical strategies are essential to allow penetration of large quantities of drugs to tumor tissue. Herein, an attempt was made to investigate the use of Derma roller® microneedles in combination with doxorubicin HCl (DOX) and celecoxib (CEL) co-loaded liposomes as a potential therapeutic approach for the management of melanoma. DOX/CEL co-loaded liposomes/Gels were prepared and characterized. The results showed that microneedle pretreatment with liposomes gel increased DOX penetration into the skin approximately 2-fold compared with the passive delivery. Both CEL liposomes and DOX liposomes caused significant growth inhibition on B16 cells. Besides, DOX/CEL co-loaded liposome was found more cytotoxic than DOX/CEL solution and single drug loaded liposome. The transdermal delivery of DOX/CEL co-loaded liposome successfully inhibited subcutaneous melanoma in female BALB/nude mice, and the co-administration of DOX/CEL with liposomes was better and significantly enhanced the antitumor effect more than single-drug-loaded liposomes. Furthermore, Dermarollers treatment prior to gel application strongly improved the tumor inhibition rate. DOX/CEL co-loaded liposome delivery via microneedles is a promising strategy for skin tumor treatment with targeting inhibition efficiency and negligible side effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.msec.2019.02.095DOI Listing
June 2019

Elucidation of cellular uptake and intracellular trafficking of heparosan polysaccharide-based micelles in various cancer cells.

Int J Biol Macromol 2019 Jun 6;130:755-764. Epub 2019 Mar 6.

Department of Pharmaceutics, School of Pharmaceutical Sciences, Jiangnan University, Wuxi 214122, PR China. Electronic address:

Heparosan polysaccharide, known as a heparin precursor, can be used in drug delivery systems due to its good biocompatibility and anti-cancer effect. But few studies on the cellular uptake mechanism of heparosan polysaccharide-based nanocarrier have been investigated. Therefore, the intracellular trafficking and the uptake mechanism of heparosan-based micelles by different tumor cells were investigated in this study. Heparosan-cholesterol amphipathic conjugates (KC) were constructed and doxorubicin (DOX) was loaded to prepare DOX/KC micelles. Different cancer cells were selected to find out the influence on DOX/KC uptake. There was an obvious difference in cytotoxicity and cellular uptake of DOX/KC in various cancer cells. Interestingly, DOX/KC micelles exhibited the strongest cytotoxicity against MGC80-3 cells and displayed highly cellular uptake by B16 cells. The results of the uptake mechanism showed that the internalization of DOX/KC micelles into MGC80-3 cells and A549 cells was mainly through clathrin-mediated endocytosis and macropinocytosis, while micropinocytosis, clathrin-mediated endocytosis and clathrin/caveolae -independent multi-pathways all contributed to the uptake of micelles in B16 cells. Furthermore, after being internalized by MGC80-3 cells, DOX/KC could escape from the lysosome and simultaneously be transported into the nucleus and mitochondria resulting in the greatest cytotoxicity. These results indicate that heparosan-based drug delivery systems may have different uptake and subcellular distribution behavior in tumor cells, and they will achieve the maximum efficacy only in specific kind of cancers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijbiomac.2019.02.133DOI Listing
June 2019

Fabrication and characterization of collagen-heparin-polypyrrole composite conductive film for neural scaffold.

Int J Biol Macromol 2019 May 15;129:895-903. Epub 2019 Feb 15.

Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Pharmaceutical Sciences, Jiangnan University, Wuxi 214122, China. Electronic address:

In this work, a conductive film consisted of polypyrrole-heparin-collagen (PHC film) was fabricated as a potential neural scaffold. Heparin was initially modified with pyrrole, which was further polymerized with pyrrole monomer under the catalysis of ferric trichloride. Then collagen was added and crosslinked through amide bond, as well as physical interaction with pyrrole through hydrogen bond. In this system, heparin and collagen contributed to improving the biocompatibility, because they were the major component of the extracellular matrix. Additionally, heparin was verified to promote nerve cells growth. The physicochemical properties of PHC film were verified, including structure, morphological analysis, degradation, swelling, electrical properties and so on. Combined with the promotion results of pheochromocytoma cells growing, this PHC film is expected to be a promising alternative for nerve regeneration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijbiomac.2019.02.087DOI Listing
May 2019

The effect of hypertrophied tonsils on the velopharyngeal function in children with normal palate.

Int J Pediatr Otorhinolaryngol 2019 Apr 16;119:59-62. Epub 2019 Jan 16.

Department of Otolaryngology, Faculty of Medicine, Beni-Suef University, Egypt.

Objective: Tonsillar hypertrophy may affect velopharyngeal closure and speech resonance. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with normal palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance.

Methods: Eighty seven children with hypertrophied tonsils and normal palate were subjected to tonsillectomy for indications other than speech problems. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech (APA) and nasometric assessment of nasalance was measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy.

Results: Thirteen patients were excluded from the study because of associated adenoid hypertrophy. The mean baseline of APA scores showed insignificant changes postoperatively. However, significant postoperative changes of nasometric parameters were detected, and the overall postoperative nasalance score was improved for nasal and oral sentences. Also, improvement of velopharyngeal closure was observed postoperatively with accession of palatal mobility and significant increase in coronal closure pattern.

Conclusion: hypertrophied tonsils may impair velopharyngeal function in children with normal palate by hindering palatal elevation. Tonsillectomy is a beneficial procedure for such patients as it can improve the velopharyngeal closure and speech resonance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2019.01.017DOI Listing
April 2019

Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt.

Arch Gynecol Obstet 2019 03 4;299(3):695-702. Epub 2019 Jan 4.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt.

Purpose: To evaluate the effect of a modified type II radical hysterectomy on maternal morbidities and mortality in cases with abnormally invasive placenta (AIP).

Methods: 63 cases with AIP were managed at one of the largest referral centers in Egypt in a prospective study design. This technique entails devascularization of the uterus laterally on both sides and to clamp the uterus at the lowest possible point just below the level of the placenta while sparing the ureters.

Results: The difference between pre- and post-operative hemoglobin was only about 1 gm/dl, and the mean blood loss was 1673 ± 958 ml. There was a significant drop in the post-operative need for blood and blood product replacement, packed red blood cells (p = 0.013), fresh red blood cells (p < 0.001), and plasma units (p = 0.012). Operative time (skin to skin) averaged 190 ± 58.2 min as the technique is slow and utilizes meticulous hemostatic steps. ICU admission was 4.8% with a mean total hospital stay of 8.6 ± 3.6 days. Histopathological examination revealed 58 cases of placenta increta and five percreta cases. We also had 16 bladder injuries (25.4%) and two ureteric injuries, and no maternal mortalities.

Conclusion: This technique reduces maternal morbidity and mortality while performing cesarean hysterectomy for cases with AIP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-018-5027-7DOI Listing
March 2019

Implication of CDKAL1 single-nucleotide polymorphism rs 9465871 in obese and non-obese Egyptian children.

Med J Malaysia 2018 10;73(5):286-290

National Research Centre, Medical Division, Clinical & Chemical Pathology Department, Cairo, Egypt.

Introduction: CDKAL1 single-nucleotide polymorphism rs 9465871variant is a risk locus for Type 2 Diabetes (T2DM).The study evaluated the associations of CDKAL1- rs9465871 with glycosylated hemoglobin A1C Level (HbA1c), fasting insulin level, insulin resistance and metabolic syndrome among obese and non- obese Egyptian children.

Materials And Methods: The study included 43 obese children and 40 normal weight children. Anthropometric body measurements, bio-specimen and biochemistry assays were done. Genotyping of rs9465871 (CDKAL1) was conducted.

Results: The percentages of the CC, CT, and TT genotypes of rs9465871in the lean children were 15%, 42.5%, and 42.5%, respectively. Regarding obese children, the frequencies were 18.6%, 58.1% and 23.3% respectively with no significant statistical difference. Comparison between the CDKAL1 rs 9465871 polymorphism showed that the highest value of fasting insulin was recorded in CC genotype (22.80± 15.18 [uIU/mL] P<.014). Levels of HOMA-IR, FBS and HBA1C were highest in CC group with no statistical significant differences. However, fasting insulin level was higher in the CC group than in the TT+ CT group (P<.01). A higher level of HbA1c was found among CC group at CDKAL1-rs9465871 (5.9%) than TT+CT genotype group (5.6%), with no statistical significant difference. There was increase in the risk of type 2 diabetes the percentages were 78.6% and 46.4% respectively when comparing CC with TT+CT genotype groups ( P<.039). CC group was not associated with significant increase in metabolic syndrome.

Conclusion: There is a significant risk association between CDKAL1-rs9465871polymorphism and development of T2DM in a subset of the Egyptian children.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2018

Multicenter randomized controlled trial assessing the impact of a cervical traction maneuver (Amr's maneuver) on the incidence of postpartum hemorrhage.

Int J Gynaecol Obstet 2019 Jan 22;144(1):56-61. Epub 2018 Oct 22.

ClinAmygate, Cairo, Egypt.

Objective: To assess the impact of a cervical traction maneuver (Amr's maneuver) used in conjunction with active management of the third stage of labor (AMTSL) on the incidence of postpartum hemorrhage (PPH).

Method: The present multicenter randomized controlled trial was conducted in Cairo between March 1, 2016, and June 30, 2017. Women aged at least 18 years who had singleton pregnancies and were candidates for vaginal delivery were enrolled. After block randomization, AMTSL was performed for all participants. Following placental delivery, Amr's maneuver using cervical traction for 90 seconds was carried out in the study group. The primary outcome, incidence of PPH (>500 mL blood loss) within 6 hours of delivery, was compared between the study and control groups in an intention-to-treat analysis.

Results: There were 852 patients randomized to the study (n=426) and control (n=426) groups. The incidence of PPH was significantly lower in the study group compared with the control group (6 [1.4%] vs 19 [4.5%]; P=0.015). Absolute risk reduction of 3.1% (95% CI 0.8-5.6), relative risk reduction of 0.32 (95% CI 0.13-0.78), and number needed to treat of 33 (95% CI 129-18) were observed in the study group.

Conclusion: Amr's maneuver was effective in decreasing the incidence of PPH. ClinicalTrials.gov Identifier: NCT02660567.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.12687DOI Listing
January 2019