Publications by authors named "Ahmed Okasha"

45 Publications

Peak systolic velocity of fetal middle cerebral artery to predict anemia in Red Cell Alloimmunization in un-transfused and transfused fetuses.

Eur J Obstet Gynecol Reprod Biol 2021 Mar 29;258:437-442. Epub 2021 Jan 29.

Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt; Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address:

Objective: To assess the accuracy of middle cerebral artery peak systolic velocity (MCA-PSV) in prediction of severe fetal anemia resulting from Red Cell Alloimmunization (Anti-D) in un-transfused and transfused fetuses. In addition to comparing the accuracy of MCA-PSV and the estimation of the daily decline of fetal hemoglobin (Hb), to determine the appropriate time of subsequent transfusions.

Study Design: This was a retrospective study of a series of 84 anaemic fetuses due to Red Cell alloimmunization. During each in-utero transfusion session, measurements of (1)MCA-PSV, (2)pre- and (3)post-transfusion Hb levels were recorded. Receiveroperating characteristics (ROC) curves, negative and positive predictive values of MCA-PSV in predicting severe fetal anemia were calculated. Regression analysis assesses the correlation between fetal HB and MCA-PSV, and between observed and expected fetal hemoglobin levels.

Results: Eighty four anemic fetuses were included in the study and had an in-utero transfusion. The positive predictive value (PPV) of MCAPSV decreased sharply from 86.0 % at the first IUT, to 52.0 % and 52.1 % at the second and third IUTs respectively. According to the ROC curves, setting the cut-off at 1.70 MoM would provide the best performance of MCA-PSV with respect to the timing of the second and third IUT. Setting a higher threshold of 1.70 MoM for the 2nd and 3rd transfusions would increase the PPV from 52.0 % to 96.4 % at the second IUT, and from 52.1%-99.8 % at the third IUT.

Conclusion: In this study we suggest that a higher MCA-PSV (MoM 1.7 in compared to 1.5MOM) can accurately predict the recurrence of severe fetal anemia requiring serial IUTs. In transfused fetuses, MCAPSV accuracy to detect severe anemia decline slightly with increase number of IUT. In addition to that, the mean projected daily decrease in fetal hemoglobin has a similar accuracy to MCA-PSV in predicting moderate to severe fetal anemia.
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http://dx.doi.org/10.1016/j.ejogrb.2021.01.046DOI Listing
March 2021

Possible Role of TGF-1, MMP-2, E-CAD, -Catenin and Antioxidants in Pathogenesis of Placenta Accreta.

Fetal Pediatr Pathol 2020 Nov 11:1-11. Epub 2020 Nov 11.

Pathology, Minia University Faculty of Medicine, El Minia, Egypt.

Objectives: Placenta accreta (PA) can be life-threatening due to postpartum hemorrhage and may lead to cesarean hysterectomy. We investigated the expression of Matrix metalloproteinase-2 (MMP-2), β-catenin, E-cadherin (E-CAD), transforming growth factor β1 (TGF-β1), glutathione peroxidase 1 (GPx-1), reduced glutathione (GSH) and superoxide dismutase (SOD) in PA compared to controls to determine if alterations may contribute to PA. Materials and methods: Twenty six PA and 31 controls were evaluated immunohistochemically for expression of MMP-2, β-catenin and E-CAD on villous and extravillous trophoblasts. TGF-β1 and GPx-1 mRNA levels were evaluated by rt-PCR. We measured biochemical levels of GSH and SOD. Results: Significant increases of MMP-2 immunoexpression, GPx-1 mRNA, SOD and GSH levels, decreases in immunoexpression of E-CAD and β-catenin and TGF-β1 mRNA were found in PA. Conclusion: These findings suggest that loss of cell-cell adhesion and increased antioxidants level may have a role in PA.
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http://dx.doi.org/10.1080/15513815.2020.1843574DOI Listing
November 2020

Normal reference ranges for fetal cardiac function: Assessed by modified Doppler myocardial performance index (Mod MPI) in the Egyptian population.

Eur J Obstet Gynecol Reprod Biol 2020 Aug 21;251:66-72. Epub 2020 May 21.

Department of Paediatrics, Cairo University, Egypt.

Aim: To develop gestational age-based reference ranges for the modified Doppler myocardial performance index (Mod MPI) and to examine the maternal characteristics that affect this measurement.

Methods: This was a cross-sectional study, comprised of 1021 healthy pregnancies between 20+0 to 35+6 weeks' gestation. They were all undergoing ultrasound examination in Cairo Fetal Medicine Unit (CAIFM) in Cairo University, Egypt from 1st April 2017 till 1st April 2019. Mod MPI was obtained used method described by Friedman et al. (2003). Median and SD models were fitted between Mod MPI and gestational age. The distributions of Mod MPI Z-scores were examined in relation to maternal characteristics RESULTS: The normal Mod MPI in second and third trimester (20 + 1 to 35 + 6 weeks' gestation) was 0.408 ± 0.08. Mod MPI was not affected by maternal age, body mass index (BMI) or parity (p value 0.5, 0.6 and 0.2 respectively).

Conclusion: This study established normal reference ranges for Mod MPI according to gestational age and generated a graph with 5th,10th, 90th and 95th centiles. Maternal characteristics as age, BMI or parity do not affect value of Mod MPI.
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http://dx.doi.org/10.1016/j.ejogrb.2020.05.011DOI Listing
August 2020

Cilostazol protects against cyclophosphamide-induced ovarian toxicity in female rats: role of cAMP and HO-1.

Toxicol Mech Methods 2020 Sep 12;30(7):526-535. Epub 2020 Jun 12.

Department of Pharmacology, Faculty of Medicine, Minia University, Minya, Egypt.

Cancer rates have been increased among women of reproductive age nowadays. Hence, many young female will be exposed to chemotherapeutic agents as cyclophosphamide (CP), carrying the hazards on female fertility. Cilostazol is a selective phosphodiesterase-3 inhibitor drug which exhibits antioxidant, anti-inflammatory, and anti-apoptotic activities. We aimed in this study to explore the possible protective effects of cilostazol against CP-induced ovarian damage in female rats. Cilostazol (10 mg/kg/day) was administered orally for 10 days in presence and absence of CP (150 mg/kg IP single dose) treatment. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), and anti-Müllerian hormone (AMH) levels were determined. Ovarian oxidative stress parameters along with inflammatory biomarkers were measured. 3,5-Cyclic adenosine monophosphate (cAMP) ovarian level was detected. Ovarian histopathological examination and caspase-3 immunohistochemical study were evaluated. CP-treated rats showed a significant increase in serum levels of FSH and LH with decreased serum E2 and AMH levels with an increase in the ovarian inflammatory and oxidative stress biomarkers besides a significant decrease in cAMP ovarian level with an evident histopathological picture of ovarian damage and a high caspase-3 immunoexpression. Cilostazol pretreatment significantly restored the distributed hormonal levels, the oxidative stress and inflammatory biomarkers to their normal levels with marked improvement in histopathological picture of ovarian damage with a significant decrease in caspase-3 immunoexpression. These data suggest that cilostazol protects against CP- induced ovarian damage, which may be related to an increase in cAMP with subsequent anti-inflammatory, antioxidant, and anti-apoptotic properties.
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http://dx.doi.org/10.1080/15376516.2020.1774829DOI Listing
September 2020

Clinical and surgical aspects of congenital lobar over-inflation: a single center retrospective study.

J Cardiothorac Surg 2020 May 19;15(1):102. Epub 2020 May 19.

Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Qena, Egypt.

Background: Congenital lobar overinflation (CLOI) is one of the most important causes of infantile respiratory distress (RD). We aim to evaluate our experience in CLOI management emphasizing on clinical features, diagnostic modalities, surgery and outcomes.

Methods: This is a retrospective study for all CLOI cases undergoing surgical management at Qena University Hospital. Demographic data, clinical data, radiographic findings, surgery and postoperative follow-up were reviewed.

Results: A total of 37 neonates and infants with CLOI were presented to our center between January 2015 and January 2019; their mean age was 111.43 ± 65.19 days and 22 were males. All cases presented with RD; and cyanosis in 19 cases. 15 cases presented with recurrent pneumonia and fever. Diminished breath sounds on the affected side and wheezes were the main clinical findings in 30 and 22 cases respectively. On CXR, emphysema was detected in all cases. A confirmatory CT chest was done for all cases. Left upper lobe was affected in 23 cases, right middle lobe in 7 and right upper lobe in 7 cases. Lobectomy was done in thirty-one cases; their mean age at surgery was 147.58 ± 81.49 days and 19 were males. Postoperative complications were noted in 5 cases and postoperative ventilation was required for 2 of them. No morbidity or mortality was reported. The follow-up duration ranged from 3 months to 1 year and all patients were doing well except one case that lost follow up after 3 months.

Conclusion: CLOI is a rare bronchopulmonary malformation that requires a high index of clinical suspicion, especially in persistent and recurrent infantile RD. CT chest is the most useful diagnostic modality. Early management of CLOI improves outcome and avoid life-threatening complications. Surgical management is the treatment of choice in our center without recorded mortality.
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http://dx.doi.org/10.1186/s13019-020-01145-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236189PMC
May 2020

Validity of serum amyloid A and HMGB1 as biomarkers for early diagnosis of gastric cancer.

Cancer Manag Res 2020 8;12:117-126. Epub 2020 Jan 8.

Clinical Pathology Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt.

Background And Aim: Gastric carcinomais a frequent neoplasm with poor outcome, and its early detection would improve prognosis. This study was designed to evaluate the possible use of new biomarkers, namely SAA and HMGB1, for early diagnosis of gastric cancer.

Methods: A total of 100 patients presenting with gastric symptoms were included. All patients underwent upper endoscopic evaluation, histopathological diagnosis and serum CEA, SAA, and HMGB1 measurements.

Results: Patients were classed endoscopically with neoplastic, inflammatory, and normal-appearing gastric mucosa: 50, 25, and 25 patients, respectively. Histologically, half the patients had chronic gastritis and the remaining cases gastric carcinoma of diffuse (n=28) or intestinal (n=22) type. SAA at cutoff of 18.5 mg/L had the best validity to differentiate gastritis from gastric carcinoma, with AUC, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 0.99, 98%, 100%, 100%, and 98%, respectively, followed by HMGB1 at cutoff of 14.5 pg/μL, with AUC, sensitivity, specificity, PPV, and NPV of 0.91, 70%, 96%, 94.6%, and 76.2%, respectively. Sensitivity, specificity, PPV, and NPV of serum CEA at cutoff of 2.9 ng/mL to differentiate gastritis from gastric carcinoma were 42%, 72%, 60%, and 55.4%, respectively, with AUC of 0.53. Nonetheless, higher serum levels of both SAA and HMGB1 reflected higher tumor grade (=0.027 and =0.016, respectively) and advanced tumor stage (-OBrk-0.001 for both).

Conclusion: Serum levels of both SAA and HMGB1 could be of great value for early diagnosis of gastric carcinoma, comparable to the diagnostic role of serum CEA, which is not valid for early diagnosis of gastric cancer.
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http://dx.doi.org/10.2147/CMAR.S207934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958557PMC
January 2020

Relative frequency of acute pancreatitis from dengue outbreaks as a late complication, in Egypt.

Virusdisease 2019 Dec 11;30(4):498-503. Epub 2019 Dec 11.

4Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt.

Patients with dengue virus infection have a different symptoms range from asymptomatic to sever form depending on primary and secondary immune status of host, infecting genotype and patient's age. The current study aimed to describe the clinical and laboratory profile of dengue fever outbreak and acute pancreatitis as a late complication, in Egypt, as two case reports only were available in literature regarding this issue. This prospective cohort study was carried out on 100 patients confirmed to have dengue disease out of 200 clinically suspected patients. Clinical, laboratory (serology for dengue specific IgM, real-time PCR for dengue virus, serum amylase and lipase) and abdominal multi-slice CT were done to all included patients. All patients presented with fever, headache and fatigue, which are the main clinical manifestations of dengue fever. The mean age of studied patients was 40.34 ± 15.74 years. Thirteen patients (13%), with their mean age 44.57 ± 11.53, presented after 3 months with typical clinical, laboratory and radiological manifestations of acute pancreatitis with positive serum dengue virus IgM, antibodies and negative serum dengue virus PCR. So, acute pancreatitis as a late complication of dengue fever disease should be keep in mind for its early diagnosis and management, thus minimize the morbidity and mortality from dengue fever.
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http://dx.doi.org/10.1007/s13337-019-00556-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917677PMC
December 2019

Therapeutic effect of liraglutide on expression of CTGF and BMP-7 in induced diabetic nephropathy.

J Cell Biochem 2019 10 24;120(10):17512-17519. Epub 2019 May 24.

Department of Pathology, Faculty of Medicine, Minia University, Minya, Egypt.

Introduction: Diabetic nephropathy (DN) is one of the critical complications of diabetes mellitus and the main cause of chronic renal dysfunction. The pathogenic mechanism causing the disease remains unclear and there is a lack of effective treatment methods so novel strategies are needed for DN management. The aim of this study, therefore, is to evaluate the effect of liraglutide as glucagon-like peptide-1 analogue and its underlying mechanisms on induced DN in rats MATERIALS AND METHODS: Sixty rats were divided into control group, diabetic group, and liraglutide-treated group. At the end of experiment, renal CTGF and BMP-7 messeger RNA expression were determined. Blood sugar, serum urea, and creatinine were measured. Also, histopathological changes were studied.

Results: Liraglutide can improve renal alterations associated with diabetes as it reduced CTGF expression and increased BMP-7 expression. In the same time, it could improve histopathological changes and renal function tests.

Conclusion: These findings influence the beneficial use of liraglutide for the management of DN in patients with diabetes mellitus.
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http://dx.doi.org/10.1002/jcb.29015DOI Listing
October 2019

Variants of CDKAL1 rs7754840 (G/C) and CDKN2A/2B rs10811661 (C/T) with gestational diabetes: insignificant association.

BMC Res Notes 2018 Mar 15;11(1):181. Epub 2018 Mar 15.

Biochemistry Department, National Research Centre, El Buhouth St., Dokki, Giza, 12622, Egypt.

Objectives: Pathophysiological similarity exists between gestational diabetes mellitus (GDM) and type 2 diabetes mellitus with common genetic origin. Genetic liability for GDM in our population is still not researched. The goal was to reveal the genotypic and allele frequency differences of 2 single nucleotide polymorphisms (SNPs) namely, CDKAL1 (rs7754840) and CDKN2A/2B (rs10811661) between GDM pregnancies and normal pregnancies. We assessed them by real time polymerase chain reaction using Taqman allelic discrimination assays. We included 47 GDM pregnant subjects and 51 normal glucose tolerance (NGT) pregnant women as controls.

Results: The genotype frequencies in the GDM group and the NGT group of rs7754840-GG/GC/CC were 6.4/15.7% (3/8), 55.3/45.1% (26/23) and 38.3/39.2% (18/20) respectively. Also, those of rs10811661-CC/CT/TT were 74.5/14.9/4.3% (38/7/2) and 80.9/19.6/5.9% (38/10/3) respectively. The allele frequencies in the GDM group and the NGT group of C/G and T/C were 66/34% (62/32), 61.8/38.2% (63/39) and 11.7/88.3% (11/83), 15.7/84.3% (16/86) respectively. There were no statistical differences between the two groups in allele frequencies and genotype frequencies (all P > 0.05). Non-significant association was seen in the two SNPs of CDKAL1 and CDKN2A/B genes with GDM. Further studies are essential to validate data.
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http://dx.doi.org/10.1186/s13104-018-3288-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856327PMC
March 2018

Antipsychotic Polypharmacy and Its Relation to Metabolic Syndrome in Patients With Schizophrenia: An Egyptian Study.

J Clin Psychopharmacol 2018 Feb;38(1):27-33

Purpose/background: Few studies have examined the relationship between antipsychotic polypharmacy and metabolic syndrome in schizophrenia. Some studies suggest that antipsychotic polypharmacy may be associated with greater metabolic risk, whereas other studies suggest that this is uncertain. To date, there have been no studies in Egypt or the Arab world that have investigated this relationship. We sought to compare subjects with schizophrenia receiving antipsychotic polypharmacy and monotherapy as regards metabolic outcomes and to investigate medication-related factors associated with metabolic syndrome.

Methods/procedures: We recruited 118 subjects with schizophrenia and compared between those receiving antipsychotic polypharmacy (86 subjects) and monotherapy (32 subjects) as regards demographic, clinical, metabolic, and antipsychotic medication characteristics. We examined the effect of antipsychotic-related factors an outcome of metabolic syndrome.

Findings/results: The prevalence of metabolic syndrome in our sample was 38.1%. Except for gender, there was no statistically significant difference as regards demographic and clinical characteristics, rates of metabolic syndrome, or for individual metabolic parameters. We found a statistically significant difference (P < 0.05) between the 2 groups as regards the number, dose, and duration of intake and for the number of subjects receiving typical antipsychotics (oral and depot) and a number of individual antipsychotic medications. Using logistic regression, receiving haloperidol depot was the only antipsychotic-related factor predictive for metabolic syndrome.

Implications/conclusions: The prevalence of metabolic syndrome does not differ in schizophrenia whether patients are receiving polypharmacy and monotherapy nor do they differ for individual metabolic parameters. Most antipsychotic-related characteristics did not predict for metabolic syndrome.
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http://dx.doi.org/10.1097/JCP.0000000000000815DOI Listing
February 2018

Inhibition of NF-κB/TNF-α pathway may be involved in the protective effect of resveratrol against cyclophosphamide-induced multi-organ toxicity.

Immunopharmacol Immunotoxicol 2017 Aug 2;39(4):180-187. Epub 2017 May 2.

d Department of Biochemistry, Faculty of Medicine , Minia University , El-Minia , Egypt.

Context: Cyclophosphamide (CyP), an efficient anticancer drug, may damage normal human cells. Resveratrol (RES), a natural polyphenol, has a diverse pharmacological properties.

Objective: To test possible protective effect of RES on multi-organ damage caused by CyP.

Materials And Methods: RES (10 mg/kg/day) was administered orally for 8 days. In independent rat groups, CyP toxicity was induced via a single dose of 150 mg/kg i.p. 3 days before the end of experiment, with or without RES treatment.

Results: Compared to control, CyP caused significant increase in organ-to-body weight ratios of heart, kidney and liver, with deterioration in their functional parameters; namely serum creatine kinase, blood urea nitrogen, creatinine, alanine aminotransferase and aspartate aminotransferase. CyP also caused distortion in these organs' histology, with significant tissue oxidative stress, manifested by decrease in reduced glutathione and catalase, as well as increase in malondialdehyde and nitric oxide levels. Furthermore, CyP caused multi-organ inflammatory effects as shown by increased tumor necrosis factor-α levels, as well as up-regulation of nuclear factor-κB expressions. Using RES concurrently with CyP restored heart, kidney and liver functional parameters, as well as their normal histology. RES also reversed oxidative stress, as well as inflammatory signs caused by CyP alone.

Conclusions: RES may be beneficial adjuvant that confers multi-organ protection against CyP toxicity via antioxidant and anti-inflammatory mechanisms.
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http://dx.doi.org/10.1080/08923973.2017.1318913DOI Listing
August 2017

A plea to change the misnomer ECT.

World Psychiatry 2014 Oct;13(3):327

Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

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http://dx.doi.org/10.1002/wps.20143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219080PMC
October 2014

The FOUR score predicts mortality, endotracheal intubation and ICU length of stay after traumatic brain injury.

Neurocrit Care 2014 Dec;21(3):496-504

Department of Anesthesia & Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Background: The Glasgow Coma Scale (GCS) is the most widely accepted scale for assessing levels of consciousness, clinical status, as well as prognosis of traumatic brain injury (TBI) patients. The Full Outline of UnResponsiveness (FOUR) score is a new coma scale developed addressing the limitations of the GCS. The aim of this prospective cohort study was to compare the performance of the FOUR score vs. the GCS in predicting TBI outcomes.

Methods: From April to July 2011, 60 consecutive adult patients with TBI admitted to the Alexandria Main University Hospital intensive care units (ICU) were enrolled in the study. GCS and FOUR score were documented on arrival to emergency room. Outcomes were in-hospital mortality, unfavorable outcome [Glasgow outcome scale extended (GOSE) 1-4], endotracheal intubation, and ICU length of stay (LOS).

Results: Fifteen (25 %) patients died and 35 (58 %) had unfavorable outcome. When predicting mortality, the FOUR score showed significantly higher area under receiver operating characteristic curve (AUC) than the GCS score (0.850 vs. 0.796, p = 0.025). The FOUR score and the GCS score were not different in predicting unfavorable outcome (AUC 0.813 vs. 0.779, p = 0.136) and endotracheal intubation (AUC 0.961 vs. 0.982, p = 0.06). Both scores were good predictors of ICU LOS (r (2) = 0.40 [FOUR score] vs. 0.41 [GCS score]).

Conclusions: The FOUR score was superior to the GCS in predicting in-hospital mortality in TBI patients. There was no difference between both scores in predicting unfavorable outcome, endotracheal intubation, and ICU LOS.
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http://dx.doi.org/10.1007/s12028-014-9995-6DOI Listing
December 2014

Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry.

Eur Arch Psychiatry Clin Neurosci 2012 Jun;262 Suppl 1:1-48

3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6 Odysseos str./1st Parodos Ampelonon str., Pylaia, Thessaloniki, Greece.

The current statement is a systematic review of the available data concerning the efficacy of medication treatment of bipolar disorder (BP). A systematic MEDLINE search was made concerning the treatment of BP (RCTs) with the names of treatment options as keywords. The search was updated on 10 March 2012. The literature suggests that lithium, first and second generation antipsychotics and valproate and carbamazepine are efficacious in the treatment of acute mania. Quetiapine and the olanzapine-fluoxetine combination are also efficacious for treating bipolar depression. Antidepressants should only be used in combination with an antimanic agent, because they can induce switching to mania/hypomania/mixed states/rapid cycling when utilized as monotherapy. Lithium, olanzapine, quetiapine and aripiprazole are efficacious during the maintenance phase. Lamotrigine is efficacious in the prevention of depression, and it remains to be clarified whether it is also efficacious for mania. There is some evidence on the efficacy of psychosocial interventions as an adjunctive treatment to medication. Electroconvulsive therapy is an option for refractory patients. In acute manic patients who are partial responders to lithium/valproate/carbamazepine, adding an antipsychotic is a reasonable choice. The combination with best data in acute bipolar depression is lithium plus lamotrigine. Patients stabilized on combination treatment might do worse if shifted to monotherapy during maintenance, and patients could benefit with add-on treatment with olanzapine, valproate, an antidepressant, or lamotrigine, depending on the index acute phase. A variety of treatment options for BP are available today, but still unmet needs are huge. Combination therapy may improve the treatment outcome but it also carries more side-effect burden. Further research is necessary as well as the development of better guidelines and algorithms for the step-by-step rational treatment.
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http://dx.doi.org/10.1007/s00406-012-0323-xDOI Listing
June 2012

Mental health research in the Arab world.

Soc Psychiatry Psychiatr Epidemiol 2012 Nov 3;47(11):1727-31. Epub 2012 Mar 3.

Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon.

Purpose: To assess the progression of mental health research over four decades in the Arab world.

Methods: Publications on mental health in 21 Arab countries from 1966 to 2006 were screened using PubMed and Psychinfo. Data were collected and analyzed for Arab authors and affiliations, publication year, topic and type of journal.

Results: In 40 years (1966-2005), the Arab world published 2,213 articles on a vast variety of topics, most common being mood, anxiety and substance use disorders, and mostly in international journals. By the last decade, the total yearly publications increased about eightfold since the first two decades, and nearly doubled from the third one. The disparity of output was high across countries. The highest yearly output was from Egypt, Saudi Arabia, Kuwait and Lebanon. Per million population, the top four producing countries were Kuwait, Bahrain, Lebanon and United Arab Emirates.

Conclusions: Over a decade, the Arab world produced approximately 17% of the global output of mental health publications/million population and was comparative to Latin American and Caribbean countries. There is a wide gap in comparison with the industrialized world, with a fertile ground for cross-cultural and genetic studies.
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http://dx.doi.org/10.1007/s00127-012-0487-8DOI Listing
November 2012

Mental health services in the Arab world.

World Psychiatry 2012 Feb;11(1):52-4

1Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

This paper summarizes the current situation of mental health services in the Arab world. Out of 20 countries for which information is available, six do not have a mental health legislation and two do not have a mental health policy. Three countries (Lebanon, Kuwait and Bahrain) had in 2007 more than 30 psychiatric beds per 100,000 population, while two (Sudan and Somalia) had less than 5 per 100,000. The highest number of psychiatrists is found in Qatar, Bahrain and Kuwait, while seven countries (Iraq, Libya, Morocco, Somalia, Sudan, Syria and Yemen) have less than 0.5 psychiatrists for 100,000 population. The budget allowed for mental health as a percentage from the total health budget, in the few countries where information is available, is far below the range to promote mental health services. Some improvement has occurred in the last decade, but the mental health human resources and the attention devoted to mental health issues are still insufficient.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266748PMC
http://dx.doi.org/10.1016/j.wpsyc.2012.01.008DOI Listing
February 2012

Subthreshold psychiatry.

Authors:
Ahmed Okasha

Int Psychiatry 2011 Nov 1;8(4):79-81. Epub 2011 Nov 1.

Director, WHO Collaborating Center for Research and Training in Mental Health, Okasha Institute of Psychiatry, Ain Shams University, Egypt, email

Are we in need of including in our diagnostic systems a new category of subthreshold psychiatry? Studies have shown that we are faced in our daily clinical practice with many patients who do not fulfil the criteria of either ICD-10 or DSM-IV (at best they may be included under 'atypical', 'unspecified' or 'not elsewhere classified'). Subthreshold cases or prodromal psychotic or non-psychotic clinical cases are encountered frequently in clinical practice, especially primary care (Knappe , 2008), but because of some ethical and nosological issues their needs are unmet. Pharmacological interventions for such conditions are denied in some countries, especially with managed care, where maximisation of profit and minimisation of cost are often the main objectives. It has been reported that the early treatment of many disorders ensures a better outcome and better assimilation in society and reduces residual manifestations of disease. Recent data suggest that the impairment and disability caused by subsyndromal disorders are almost equal to those caused by syndromal ones. We need more scientific data and research studies to evaluate the course, outcome and value of treating such disorders.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735034PMC
November 2011

Would the use of dimensions instead of categories remove problems related to subthreshold disorders?

Authors:
Ahmed Okasha

Eur Arch Psychiatry Clin Neurosci 2009 Nov;259 Suppl 2:S129-33

Institute of Psychiatry, Ain Shams University, Cairo 3 Shawarby Street, Kasr El Nil, Cairo, Egypt.

Scientific progress fostered in DSM and ICD over the past quarter of century has significantly increased awareness of the limitation of categorical definitions of mental illness. Disorders highly merge into another with no natural boundary in between. The addition of continuous, "dimensional" measures into the various diagnostic domains might help resolve some of the critical taxonomic issues currently facing the field of mental health. It was overtly recognized that both categorical and dimensional approaches to diagnosis are important both for clinical work and for research, and that the ideal taxonomy would offer both. Within each diagnostic entity, there are multiple options for creating a dimensional scale based on a categorical definition. The ICD 10 and DSM IV have no place for subthreshold disorders except in atypical, not otherwise specified or to marginalize its existence with subsequent suffering and impairment of the patients. The chapter will discuss how the subthreshold affective, psychotic, anxiety, cognitive and substance abuse and other psychiatric disorders contribute to psychiatric morbidity and impairment. The chapter discusses the impairment and suffering of patients with subthreshold various psychiatric disorders and how its inclusion in a dimensional approach may result in ameliorating the suffering of that group as their current status may initiate some ethical considerations for their management.
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http://dx.doi.org/10.1007/s00406-009-0052-yDOI Listing
November 2009

Would the use of dimensions instead of categories remove problems related to subthreshold disorders?

Authors:
Ahmed Okasha

Eur Arch Psychiatry Clin Neurosci 2009 Nov;259 Suppl 2:S129-33

Institute of Psychiatry, Ain Shams University, Cairo 3 Shawarby Street, Kasr El Nil, Cairo, Egypt.

Scientific progress fostered in DSM and ICD over the past quarter of century has significantly increased awareness of the limitation of categorical definitions of mental illness. Disorders highly merge into another with no natural boundary in between. The addition of continuous, "dimensional" measures into the various diagnostic domains might help resolve some of the critical taxonomic issues currently facing the field of mental health. It was overtly recognized that both categorical and dimensional approaches to diagnosis are important both for clinical work and for research, and that the ideal taxonomy would offer both. Within each diagnostic entity, there are multiple options for creating a dimensional scale based on a categorical definition. The ICD 10 and DSM IV have no place for subthreshold disorders except in atypical, not otherwise specified or to marginalize its existence with subsequent suffering and impairment of the patients. The chapter will discuss how the subthreshold affective, psychotic, anxiety, cognitive and substance abuse and other psychiatric disorders contribute to psychiatric morbidity and impairment. The chapter discusses the impairment and suffering of patients with subthreshold various psychiatric disorders and how its inclusion in a dimensional approach may result in ameliorating the suffering of that group as their current status may initiate some ethical considerations for their management.
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http://dx.doi.org/10.1007/s00406-009-0052-yDOI Listing
November 2009

Introduction to the forum: Is cannabis consumption a lifestyle or brain disease?

Authors:
Ahmed Okasha

Curr Opin Psychiatry 2008 Mar;21(2):114-5

Institute of Psychiatry, Ain Shams University, Kasr El Nil, Cairo, Egypt.

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http://dx.doi.org/10.1097/YCO.0b013e3282f57dccDOI Listing
March 2008

World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia.

Schizophr Res 2008 Mar 19;100(1-3):20-38. Epub 2008 Feb 19.

University of Florida, Tallahassee, USA.

Data from two major government-funded studies of comparative antipsychotic effectiveness in schizophrenia contradict the widely prevalent belief that the newer second-generation medications are vastly superior to the older first-generation drugs. This has caused uncertainty among patients, clinicians and policy-makers about the relative utility of first- and second- generation antipsychotic agents in its treatment. To reduce confusion and provide a contextual understanding of the new data, the World Psychiatry Association Section on Pharmacopsychiatry comprehensively reviewed the literature on the comparative effectiveness of different antipsychotic treatments for schizophrenia and developed this update. Utilizing data from the approximately 1,600 randomized controlled trials of antipsychotic treatment in schizophrenia, we applied the two indirect and one direct method to comparing the effectiveness of 62 currently-available antipsychotic agents. The subclasses of 51 first-generation and 11 second-generation antipsychotics were both found to be very heterogeneous, with substantial differences in side-effect profiles among members. Second-generation antipsychotic agents were found to be inconsistently more effective than first-generation agents in alleviating negative, cognitive, and depressive symptoms and had a lower liability to cause tardive dyskinesia; these modest benefits were principally driven by the ability of second-generation antipsychotics to provide equivalent improvement in positive symptoms along with a lower risk of causing extrapyramidal side-effects. Clozapine was found to be more efficacious than other agents in treatment-refractory schizophrenia. There were no consistent differences in efficacy among other second-generation antipsychotic agents; if such differences exist, they are likely small in magnitude. Dosing was found to be a key variable in optimizing effectiveness of both first- and second- generation antipsychotic agents. There was enormous individual variability in antipsychotic response and vulnerability to various adverse effects. In contrast to their relatively similar efficacy in treating positive symptoms, there were substantial differences among both first- and second- generation antipsychotic agents with regard to their propensity to cause extrapyramidal, metabolic and other adverse effects; second-generation agents have a lower liability to cause acute extrapyramidal symptoms and tardive dyskinesia along with a tendency to cause greater metabolic side-effects than first-generation agents. Based on these data about the comparative effectiveness of different antipsychotic treatment options, we summarize elements of current best antipsychotic practice for the treatment of schizophrenia and discuss the role of government and the pharmaceutical industry in obtaining and disseminating information which can facilitate best practice.
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http://dx.doi.org/10.1016/j.schres.2007.11.033DOI Listing
March 2008

Psychiatry and political-institutional abuse from the historical perspective: the ethical lessons of the Nuremberg Trial on their 60th anniversary.

Prog Neuropsychopharmacol Biol Psychiatry 2007 May 15;31(4):791-806. Epub 2006 Dec 15.

Neuropsychopharmacology Unit, Pharmacology Department, University of Alcalá, Madrid, Spain.

Sixty years ago at the Nuremberg Trials, 23 Nazi leaders were tried as war criminals, in what was known as "The Doctors' Trial". This trial exposed a perverse system of the criminal use of medicine in the fields of public health and human research. These practices, in which racial hygiene constituted one of the fundamental principles and euthanasia programmes were the most obvious consequence, violated the majority of known bioethical principles. Psychiatry played a central role in these programmes, and the mentally ill were the principal victims. The aim of the present work is to review, from the historical perspective, the antecedents of the shameful euthanasia programmes for the mentally ill, the procedures involved in their implementation and the use of mentally ill people as research material. The Nuremberg Code, a direct consequence of the Doctors' Trial, is considered to be the first international code of ethics for research with human beings, and represented an attempt to prevent any repeat of the tragedy that occurred under Nazism. Nevertheless, the last 60 years have seen continued government-endorsed psychiatric abuse and illegitimate use of psychoactive drugs in countries such as the Soviet Union or China, and even in some with a long democratic tradition, such as the United States. Even today, the improper use of psychiatry on behalf of governments is seen to be occurring in numerous parts of the globe: religious repression in China, enforced hospitalization in Russia, administration of psychoactive drugs in immigrant detention centres in Australia, and the application of the death penalty by lethal injection and psychiatric participation in coercive interrogation at military prisons, in relation to the USA. The Declaration of Madrid in 1996 constituted the most recent attempt to eradicate, from the ethical point of view, these horrendous practices. Various strategies can be used to combat such abuses, though it is uncertain how effective they are in preventing them.
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http://dx.doi.org/10.1016/j.pnpbp.2006.12.007DOI Listing
May 2007

The Presidential WPA Program on Child Mental Health.

Authors:
Ahmed Okasha

World Psychiatry 2003 Oct;2(3):129-30

President, World Psychiatric Association.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525109PMC
October 2003

The Declaration of Madrid and its implementation. An update.

Authors:
Ahmed Okasha

World Psychiatry 2003 Jun;2(2):65-7

President, World Psychiatric Association.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525091PMC
June 2003

WPA proposal regarding the escalation of violence in the Middle East.

Authors:
Ahmed Okasha

World Psychiatry 2003 Feb;2(1):1-2

President, World Psychiatric Association.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525054PMC
February 2003

The Declaration of Madrid and its implementation.

Authors:
Ahmed Okasha

World Psychiatry 2002 Jun;1(2):125-6

Chairman, WPA Ethics Committee WPA President Elect.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489862PMC
June 2002

The strategy and policies of the WPA.

Authors:
Ahmed Okasha

World Psychiatry 2002 Oct;1(3):129-30

President, World Psychiatric Association.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489855PMC
October 2002

Mental health in Africa: the role of the WPA.

Authors:
Ahmed Okasha

World Psychiatry 2002 Feb;1(1):32-5

WHO Collaborating Center for Training and Research in Mental Health, Ain Shams University, 3 Shawarby Street, Kasr El Nil, Cairo, Egypt.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489826PMC
February 2002

The WPA Cairo Declaration.

Authors:
Ahmed Okasha

World Psychiatry 2006 Feb;5:60

President, 13th World Congress of Psychiatry; WPA Immediate Past President.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472269PMC
February 2006