Publications by authors named "Marwa Salama"

20 Publications

  • Page 1 of 1

Remdesivir Efficacy in COVID-19 Treatment: A Randomized Controlled Trial.

Am J Trop Med Hyg 2021 Sep 10. Epub 2021 Sep 10.

Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt.

To date, no antiviral therapy has shown proven clinical effectiveness in treating patients with COVID-19. We assessed the efficacy of remdesivir in hospitalized Egyptian patients with COVID-19. Patients were randomly assigned at a 1:1 ratio to receive either remdesivir (200 mg on the first day followed by 100 mg daily for the next 9 days intravenously infused over 30-60 minutes) in addition to standard care or standard care alone. The primary outcomes were the length of hospital stay and mortality rate. The need for mechanical ventilation was assessed as a secondary outcome. Two hundred patients (100 in each group) completed the study and were included in the final analysis. The remdesivir group showed a significantly lower median duration of hospital stay (10 days) than the control group (16 days; P < 0.001). Eleven of the patients in the remdesivir group needed mechanical ventilation compared with eight patients in the control group (P = 0.469). The mortality rate was comparable between the two groups (P = 0.602). Mortality was significantly associated with older age, elevated C-reactive protein levels, elevated D-dimer, and the need for mechanical ventilation (P = 0.039, 0.003, 0.001, and < 0.001 respectively). Remdesivir had a positive influence on length of hospital stay, but it had no mortality benefit in Egyptian patients with COVID-19. Its use, in addition to standard care including dexamethasone, should be considered, particularly in low- and middle-income countries when other effective options are scarce.
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http://dx.doi.org/10.4269/ajtmh.21-0606DOI Listing
September 2021

Short-term effect of weight loss after bariatric surgery on IOP, RNFL thickness, and the optic nerve head blood flow measured by OCTA.

Eur J Ophthalmol 2021 Oct 7:11206721211048365. Epub 2021 Oct 7.

Cairo University, Cairo, Cairo Governorate, Egypt.

Purpose: To study the influence of weight reduction after bariatric surgery on the intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, and blood flow of optic nerve head by optical coherence tomography angiography (OCTA).

Methods: This prospective observational cohort study included 60 obese patients. Body mass index (BMI), IOP, RNFL, and ganglion cell complex (GCC) thickness, rim area, and radial peripapillary capillary (RPC) vessel density were assessed before and 3 months after bariatric surgery.

Results: The BMI and the IOP showed significant postoperative reduction to 40.45 ± 4.3 kg/m and 14.83 ± 2.5 mmHg while the preoperative results were 51.13 ± 4.83 kg/m and 16.95 ± 4.2 mm ( < 0.0001), respectively. No statistically significant change was detected in the RNFL, GCC thickness, rim area, or the RPC vessel density ( > 0.05). No statistically significant correlation was detected between the BMI changes and changes in the IOP, RNFL thickness, rim area, GCC thickness, or RPC vessel density.

Conclusion: No significant effect of bariatric surgery on the RNFL thickness and the optic nerve head blood flow measured by OCTA despite a significant IOP reduction 3 months post-surgical. OCTA can be a useful tool to assess the short-term influence of significant weight reduction on the retinal microcirculation.

Summary: Despite a significant BMI and IOP reduction following bariatric surgery in obese patients, the vascular flow of the ONH, measured by OCTA, and the RNFL thickness were not significantly affected. The former might be attributed to the complex autoregulatory mechanisms related to the ONH and its microcirculation.
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http://dx.doi.org/10.1177/11206721211048365DOI Listing
October 2021

Molecular prevalence of isolates among Egyptian children with cancer.

J Parasit Dis 2021 Sep 6;45(3):746-753. Epub 2021 Feb 6.

Medical Parasitology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Immunocompromised individuals especially children with cancer are at risk for acquiring cryptosporidiosis, which can result in severe morbidity and mortality. This work was conducted to evaluate the prevalence of parasite and its genotypes in children with cancer. Stool specimens were collected from 145 children in the Oncology unit of Pediatric Department, Zagazig University Hospital, Sharqiyah province, Egypt. infection was evaluated using modified Ziehl-Neelsen (MZN) staining and nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. The prevalence of infection in oncological children was 29.7% using microscopy and 25.5% using nested PCR. Genotypic characterization showed that 23 (62.2%) had , 11 (29.7%) , and 3 specimens (8.1%) were mixed infection of both genotypes. Cryptosporidiosis was significantly associated with diarrhea. However, no statistically significant difference was detected between the age, gender, residency, animal contact and malignancy type concerning to infection. This study concluded that is a prevailing opportunistic parasite among children with cancer. It should be considered in oncological patients especially those suffering from diarrhea which requires proper management to reduce its complications.
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http://dx.doi.org/10.1007/s12639-020-01345-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8368155PMC
September 2021

Changes in the Macular Vascular Density After Bariatric Surgery Measured by Optical Coherence Tomography Angiography.

Clin Ophthalmol 2021 22;15:3131-3137. Epub 2021 Jul 22.

Ophthalmology Department, Cairo University, Cairo, Egypt.

Purpose: To evaluate the effect of the weight loss, 3 months after bariatric surgery, on the macular thickness and macular vascular density by optical coherence tomography angiography (OCTA).

Methods: Forty obese patients were included in this prospective study. Body mass index (BMI), macular thickness (whole, fovea, parafovea and perifovea), macular vascular density (VD) in superficial capillary plexus (whole, fovea, parafovea and perifovea), and macular vascular density in deep capillary plexus (whole, fovea, parafovea and perifovea) were measured before and 3 months after bariatric surgery.

Results: The BMI was significantly reduced postoperatively to 43.75±4.4 kg/m compared to the preoperative results, 55.31±5.1 kg/m (<0.05). There was significant increase in macular thickness in the fovea and parafovea postoperatively (<0.05) but no significant increase in the perifovea. There was significant increase in macular vascular density in the deep capillary plexus postoperatively (<0.05) but no significant increase in the macular vascular density in the superficial capillary plexus postoperatively (>0.05). Significant correlations were detected between the BMI changes and changes in different macular parameters.

Conclusion: Bariatric surgery showed significant effect on certain indices in macular thickness and macular vascular density, especially in the deep capillary plexus. Therefore, OCTA is considered a valuable tool to assess the short-term changes in macular microcirculation following significant weight reduction.
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http://dx.doi.org/10.2147/OPTH.S317965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315288PMC
July 2021

Efficacy of combined Sofosbuvir and Daclatasvir in the treatment of COVID-19 patients with pneumonia: a multicenter Egyptian study.

Expert Rev Anti Infect Ther 2021 Jul 15:1-5. Epub 2021 Jul 15.

Endemic medicine department, Cairo University Hospitals, Cairo, Egypt.

Background: Limited experimental and clinical evidence suggests a potential role for sofosbuvir/daclatasvir in treating COVID19. We aim to evaluate the efficacy of generic sofosbuvir/daclatasvir in treating COVID-19 patients with pneumonia.

Research Design And Methods: This multicenter prospective study involved 174 patients with COVID-19. Patients were randomized into two groups. Group A (96 patients) received sofosbuvir (400 mg)/daclatasvir (60 mg) for 14 days in combination with conventional therapy. Group B (78 patients) received conventional therapy alone. Clinical, laboratory, and radiological data were collected at baseline, after 7, 14, and 28 days of therapy. Primary endpoint was rate of clinical/virological cure.

Results: A lower mortality rate was observed in group (A) (14% vs 21%, P = 0.07). After 1 month of therapy, no differences were found in rates of ICU admission, oxygen therapy, or ventilation. Additionally, a statistically significant shorter duration of hospital stay (9% vs 12%, P < 0.01) and a faster achievement of PCR negativity at day 14 (84% versus 47%, P < 0.01) were noticed in group (A).

Conclusion: Adding sofosbuvir/daclatasvir to conventional therapy of COVID-19 is promising. Their use is associated with shorter hospital stay, faster PCR negativity and may be reduced mortality.
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http://dx.doi.org/10.1080/14787210.2021.1950532DOI Listing
July 2021

The delayed death-causing nature of Rosmarinus officinalis leaf extracts and their mixture within experimental chronic toxoplasmosis: Therapeutic and prophylactic implications.

Acta Trop 2021 Sep 3;221:105992. Epub 2021 Jun 3.

Medical Parasitology Department, Faculty of Medicine, Zagazig University, Zagazig 44511, Egypt.

Background: The restricted effect, significant toxicity, and emerging resistance of anti-toxoplasmosis synthetic agents impose the search for alternatives. The current research aimed to evaluate the prophylactic and therapeutic efficacy of Rosmarinus officinalis extracts and their mixtures against chronic murine toxoplasmosis and to clarify the phenomenon of delayed death.

Methods: This research included two experimental designs, the first to test the preventive and curative efficacy of the extracts and the second to assess delayed death in mice infected with the ME49 strain of Toxoplasma gondii. The essential oils of the plant were analyzed by gas chromatography/mass spectrometry.

Results: Treatment with a mixture of rosemary extracts displayed reduction rates of 81% for T. gondii cyst burden and 23% for cyst viability. The reinfected group with the pretreated cysts reported 93.4% reduction in cyst burden and 95.4% in cyst viability. Moreover, 90% reduction of the infectivity rate was obtained. The therapeutic efficacy of this mixture was superior to its valuable prophylactic effect. Histopathological examination of liver and brain tissue exhibited marked improvement. Both extracts possess free radical scavenging and antioxidant activities evidenced by high expression of iNOS stain. Our results were signified by low BAG-1 gene expression and massive mutilation of T. gondii cyst in the targeted group using scanning electron microscopy. Analysis of R. officinalis revealed the presence of isobornylformate as a novel ingredient.

Conclusions: R. officinalis displays a therapeutic rather than prophylactic potential, indicating the emergence of an effective safe alternative therapy.
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http://dx.doi.org/10.1016/j.actatropica.2021.105992DOI Listing
September 2021

and : a new take on therapy against experimental trichinellosis.

J Helminthol 2021 May 25;95:e26. Epub 2021 May 25.

Department of Medical parasitology, Faculty of medicine, Zagazig University, Zagazig44159, Egypt.

Trichinellosis is a zoonotic disease that endangers human health and can lead to death. Restricted absorption and poor results of conventional therapies demand new effective natural remedies to treat both enteral and parenteral trichinellosis. This study assessed the antiparasitic and anti-inflammatory effects of Citrus limon and Capsicum frutescens on murine trichinellosis and compared them with those of albendazole and prednisolone, which are conventionally used to treat trichinellosis. Overall, 50 Swiss albino male mice were divided into five groups, with ten mice in each group: negative control, positive control, albendazole combined with prednisolone, C. limon, and C. frutescens. Mice were sacrificed 7 and 35 days after infection, for intestinal and muscular phase analyses. Drug efficacies were parasitologically, biochemically, histopathologically and ultrastructurally assessed. Our results demonstrated the efficacy of C. frutescens and C. limon extracts as antiparasitic agents, showing a substantial decrease in adult and larval counts. Moreover, both extracts had the ability to decrease serum tumour necrosis factor-α levels during the intestinal and muscular phases. In addition to the improved histopathological changes in the small intestine and muscles, the destructive effects on adults and larvae were ultrastructurally evident on transmission electron microscopy. In conclusion, C. frutescens and C. limon extracts are promising remedies for the treatment of experimental trichinellosis, particularly, the C. frutescens extract.
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http://dx.doi.org/10.1017/S0022149X21000171DOI Listing
May 2021

The Effect of HCV Eradication after Direct Acting Antiviral Agents on Hepatic Steatosis: A Prospective Observational Study.

Endocr Metab Immune Disord Drug Targets 2021 Jan 25. Epub 2021 Jan 25.

Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta. Egypt.

Background And Aims: Eradication of hepatitis C virus (HCV) by direct-acting-antiviral-agents (DAAs) was followed by fibrosis regression, but little is available about hepatic steatosis changes after DAAs. The aim of this work was to assess the prevalence of hepatic steatosis among HCV Egyptian patients and the long term changes occur after viral eradication.

Methods: This prospective cohort study included 150 HCV patients with significant fibrosis. They were examined by Transient elastography to evaluate liver stiffness measurement (LSM) and hepatic steatosis before treatment, at SVR12 and 1 year after end of therapy.

Results: LSM showed significant positive correlation to pretreatment hepatic steatosis. LSM significantly decreased and hepatic steatosis significantly increased both at SVR12 and one year after DAAs. Patients with steatosis showed significantly higher median LSM and controlled attenuation parameter (CAP) values at: baseline, SVR12, and one year after therapy. Also, the pretreatment steatosis and body mass index (BMI) had significant negative correlation with fibrosis regression one year after therapy in all studied groups.

Conclusion: Hepatic steatosis is common in HCV Egyptian patients and increases after HCV eradication with DAAs. BMI and CAP values are negatively correlated to hepatic fibrosis regression and positively correlated to steatosis progression one year after DAAs. So, HCV patients with hepatic steatosis may need close follow up for atherosclerotic and HCC risk after DAAs especially if they are overweight.
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http://dx.doi.org/10.2174/1871530321666210125125500DOI Listing
January 2021

Autologous dendritic cells pulsed with lysate from an allogeneic hepatic cancer cell line as a treatment for patients with advanced hepatocellular carcinoma: A pilot study.

Int Immunopharmacol 2020 Mar 10;82:106375. Epub 2020 Mar 10.

Tropical Medicine Department Faculty of Medicine, Tanta University, Egypt.

Objectives: This is a randomized trial adopted to evaluate the safety and efficacy of immunization with specific anti-hepatocellular carcinoma dendritic cells (DCs) in Egyptian patients with advanced hepatocellular carcinoma (HCC) as a treatment or adjuvant therapy in comparison with the traditional therapy.

Methods: This study was conducted on 20 HCC patients who were assigned to four groups according to BCLC staging; group I: HCC patients (stage B) received trans-arterial chemoembolization (TACE) and DCs as an adjuvant therapy; group II: HCC patients (stage B) received TACE only; group III: advanced HCC patients (stage D) received DCs vaccine; group IV: advanced HCC patients (stage D) received supportive treatment. DCs were generated from peripheral blood monocytes and pulsed with a lysate of an allogeneic hepatic cancer cell line (HepG2). Toxicity and immunological response were reported as primary outcomes whereas clinical biochemical and radiological responses were reported as secondary outcomes.

Results: Our study detected that patients who received DCs vaccine (group III) showed mild decrease in Child-Pugh score as well as AFP and PIVKA II levels and developed 20% partial response [PR] 40% stable disease [SD] and 40% progressive disease [PD] compared to the patients of group IV on supportive treatment who developed 100% PD. Although group I patients developed PR (60%) SD (20%) and PD (20%) no significant difference was detected in the clinical biochemical or radiological response between group I and group II patients. DCs vaccine had minimal adverse effects with no autoimmunity and elicited a better immunological response such as increased CD8 cells percentage and number as well as decreased TGFβ levels in the vaccinated patients.

Conclusion: DCs vaccine is safe as it is not associated with significant toxicity. However due to the small number of included patients the efficacy and immune response of using DCs vaccine in the treatment of advanced HCC patients need to be justified by testing of a large cohort.
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http://dx.doi.org/10.1016/j.intimp.2020.106375DOI Listing
March 2020

Sofosbuvir-containing regimens are safe and effective in the treatment of HCV patients with moderate to severe renal impairment.

Liver Int 2020 04 20;40(4):797-805. Epub 2019 Dec 20.

Endemic Medicine and Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background And Aims: This study aimed to assess the safety and efficacy of sofosbuvir (SOF)-based regimens in patients with moderate to severe renal impairment; a subject which has been questioned by many investigators with conflicting results.

Methods: This is a real-life multicentre retrospective cohort study on 4944 chronic Hepatitis C virus (HCV) patients with chronic kidney disease (CKD) (eGFR <60 mL/min/1.73 m ) who received SOF-based therapy in specialized treatment centres affiliated to the National Committee for the Control of Viral Hepatitis in Egypt. The efficacy and safety of SOF-based regimens was assessed.

Results: Week 12 virological response rates were 97.5%, 96.7%, 85.7% and 80% in the total cohort, patients with eGFR <30 mL/min/1.73 m , patients with associated hepatic decompensation and patients on dialysis respectively. Various treatment regimens did not statistically affect the response rates. Treatment experience, cirrhosis and diabetes were predictors of treatment failure on multivariate analysis. Serious adverse events occurred in 0.1% of cases. Forty patients (0.8%) discontinued treatment.

Conclusion: Sofosbuvir-based regimens are effective and safe for treating patients with chronic HCV and moderate to severe CKD, and in those with associated hepatic decompensation.
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http://dx.doi.org/10.1111/liv.14299DOI Listing
April 2020

One-Year Results of Stab Incision Glaucoma Surgery and Radiofrequency-Assisted Stab Incision in Management of Open-Angle Glaucoma.

Middle East Afr J Ophthalmol 2019 Jul-Sep;26(3):141-147. Epub 2019 Sep 30.

Department of Ophthalmology, Cairo University Hospitals, Cairo, Egypt.

Purpose: The aim of the study is to evaluate the surgical outcome of stab incision glaucoma surgery (SIGS) and compare it with radiofrequency-assisted stab incision in the treatment of uncontrolled open-angle glaucoma.

Patients And Methods: A prospective, interventional study included 50 eyes who were assigned into two equal groups: Group A underwent stab incision procedure with preoperative subconjunctival (SC) mitomycin-C (MMC) and Group B underwent radiofrequency-assisted technique without MMC. Intraoperative and postoperative complications, visual acuity, intraocular pressure (IOP), and bleb status were evaluated up to 12 months.

Results: Mean preoperative IOP in Group A was 26.96 ± 2.42 reduced to 13.43 ± 2.31 while in Group B was 27.20 ± 3.57 reduced to 15.48 ± 3.68 mmHg ( < 0.001) with a mean reduction of 50.61% ± 8.42% and 43.56% ± 12.83%, 12 months postoperatively in Groups A and B, respectively. Non-basal peripheral iridectomy was the most encountered intraoperative complication in 8 eyes (32%) and 9 eyes (36%) and hypotony was the most reported postoperative complication in 5 eyes (20%) and 9 eyes (36%) in Groups A and B, respectively. Flat bleb area had been reported at the end of follow-up time in 3 eyes (13%) and 7 eyes (30%) in Groups A and B, respectively. Complete success rate was 52.2% and 28.6% while qualified success rate was 28.8% and 42.9% in Groups A and B, respectively.

Conclusion: SIGS with SC MMC is an effective and safe procedure in IOP lowering, while radiofrequency-assisted stab incision had high incidence of subconjunctival scarring and ostium closure.
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http://dx.doi.org/10.4103/meajo.MEAJO_153_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788308PMC
January 2020

Predictors for Fibrosis Regression in Chronic HCV Patients after the Treatment with DAAS: Results of a Real-world Cohort Study.

Endocr Metab Immune Disord Drug Targets 2020 ;20(1):104-111

Department of Tropical Medicine, Tanta University, Tanta, Egypt.

Introduction: The goal of treatment of chronic hepatitis C (HCV) is viral eradication. However, obtaining histological regression is even more important, because it will reduce the overall morbidity and mortality related to cirrhosis. Introduction of direct-acting antivirals (DAAs) in HCV improves rates of sustained virologic response (SVR). However, fibrosis regression has not been extensively assessed. The aim of this study was to detect the factors affecting fibrosis regression in chronic HCV patients treated with interferon containing regimens versus interferon-free DAA regimens.

Methods: This prospective observational cohort study was conducted at the Tropical Medicine and Infectious Diseases Department, Tanta University, Egypt, between October 2015 and December 2017. Transient elastography (FibroScan®) examination was performed before therapy, at SVR12, 6 months and 1 year after completing therapy for cured patients.

Results: Reduction in fibrosis was reported in; 46.7% and 49.3% of patients with moderate fibrosis, and 89% and 78.7% of patients with advanced fibrosis after one year of interferon containing and interferon free DAAs regimens respectively. Using multiple regression analysis; it was found that BMI, degrees of hepatic stiffness and steatosis were related to regression of hepatic fibrosis after therapy.

Conclusion: DAAs with or without interferon resulted in a significant reduction of liver fibrosis. BMI, steatosis and liver stiffness were independent factors for fibrosis regression in chronic HCV patients treated with DAAs. Further studies are needed to explore the mechanism by which steatosis affects HCV related fibrosis regression after treatment with DAAs.
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http://dx.doi.org/10.2174/1871530319666190826150344DOI Listing
November 2020

Epidemiology of liver cancer in Nile delta over a decade: A single-center study.

South Asian J Cancer 2018 Jan-Mar;7(1):24-26

Department of Medical Oncology, Tanta University Faculty of Medicine, Tanta, Egypt.

Background: In Egypt, there has been a remarkable increase in the proportion of hepatocellular carcinoma (HCC) among chronic liver diseases patients. This rising proportion may be explained by the increasing risk factors as hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, improvement of the diagnostic tools of HCC as well as the extended survival among patients with cirrhosis to allow time for some of them to develop HCC. The aim of this study was to study the epidemiology of HCC in Nile delta over the last decade.

Methods: The study was carried out on patients diagnosed as HCC in liver cancer clinic in Tanta University Hospital, Egypt, from January 2005 to January 2015. This retrospective study reviewed the files of HCC patients with special stress on age, sex, residence, occupation, smoking, and viral markers.

Results: Over the last decade, 1440 HCC patients were diagnosed or referred to liver cancer clinic in Tropical Medicine Department in Tanta University Hospital from January 2005 to January 2015. The mean age of HCC patients was 56.13 ± 9.53 years. Nearly, half of the patients with HCC were smokers and quarter of HCC patients were diabetics. HBV surface antigen-positive patients were only 3.26%, and the majority of patients were HCV-Ab positive (94.86% of patients).

Conclusions: In Nile delta, hepatitis C rather than hepatitis B was linked to the development of HCC in our region which may be related to the high prevalence of HCV in this area.
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http://dx.doi.org/10.4103/sajc.sajc_82_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865090PMC
March 2018

IMMUNOGENICITY ASSESSMENT FOR LUNG-STAGE AND BIOMPHALARIA ALEXANDRINA COCKTAIIVACCINE IN SCHISTOSOMA MANSONI INFECTED MICE.

J Egypt Soc Parasitol 2016 Dec;46(3):633-645

The availability of a new vaccine is usually needed as an additional component to chemotherapy for control of schistosomiasis. Different strategies of different types of vaccines were assessed to decrease morbidity but did not give the best protection. The study assessed the efficacy of BAAP, SLAP and their combined preparations together with BCG adjuvant as an effective anti-schistosomal vaccine.

Methodology: Six groups of Swiss albino mice were used; (Gl) as a control, (G2) infected non immunized; (G3) infected and supported by Adj.; (G4) infected; vaccinated with BAAP and supported by Adj.; (G5) infected, vaccinated with SLAP and supported by Adj. and the target group (G6) infected, vaccinated with combined antigens (BAAP + SLAP) and supported by Adjuvant. Mice were sacrificed 8 weeks post infection for assessment the effect of our vaccine through parasitological, histopathological, serological and immunohisto- chemical study. The vaccination of mice with BAAP, SLAP and Adjuvant followed by challenge S. mansoni infection resulted in highest reduction percentages (92% & 86%) for mean numbers of adult burdens and fecal egg counts respectively,(82.4%, 81%) for granuloma number and diameter respectively compared with other groups. The improvement % of all measured enzymes was higher in G6 than other groups.IL1O was significantly increased in G6 than other groups; also, TNF was significantly decreased in G6 than other groups.
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December 2016

COMPARISON OF IMMUNOCHROMATOGRAPHIC TEST AND MICROSCOPY IN THE DETECTION OF SOME ENTERIC PROTOZOA IN STOOL SAMPLES.

J Egypt Soc Parasitol 2016 Dec;46(3):625-632

Infection with pathogenic intestinal protozoa. as Giardia lamblia,, Entamoeba histolytica and Cryptosporidium parvum cause considerable gastrointestinal morbidity, malnutrition and mortality worldwide, especially among young children in developing countries. The present study was carried out on 71 cases (44 males & 27 females) chosen from Pediatric and Internal Medicine Inpatient and Outpatient Clinics of Zagazig University Hospitals, complaining of different gastrointestinal troubles with an age range of 6-60 years. Also, 20 apparently healthy individuals (11 males & 9 females) cross matched were considered as a control negative group. All stool samples were examined by direct wet smears, concentration techniques, staining of the smears using trichrome stain and Modified Ziehl-Neelsen method. Copro-antigen detection in faecal sample was by using quick immunochromatographic test. A total of 71 cases suffering from different GIT manifestations showed G. lamblia (30.7%), Cryptosporidium parvum (19.8%), EntamoebahistolyticalE. dispar (11%) and mixed infection of three protozoa (6.6%). However, by copro-antigen G. lamblia was positive in (31.8%) of C. parvum in (20.9%); E. histolytica/E. dispar in (11%) of cases. Immunochromatography/copro-antigen test recorded sensitivity and spec- ificity of (100%) and (96.6%) respectively in G. lamblia detection. For C. parvum, sensitivity was (100%) and specificity was (97.1%) while for E. histolytica/E. dispar. sensitivity and specificity were (100%) for both. Immunochromatographic assay proved to be simple, easy and useful in confirming absence or the presence of intestinal protozoan infection in clinically suspected cases with negative stool examination.
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December 2016

Molecular approach for detecting early prepatent Schistosoma mansoni infection in Biomphalaria alexandrina snail host.

J Parasit Dis 2016 Sep 25;40(3):805-12. Epub 2014 Sep 25.

Department of Medical Parasitology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

The present study aimed to evaluate a polymerase chain reaction (PCR) assay used for detection of Schistosoma mansoni infection in Biomphalaria alexandrina snails in early prepatent period and to compare between it and the ordinary detection methods (shedding and crushing). Biomphalaria alexandrina snails are best known for their role as intermediate hosts of S. mansoni. DNA was extracted from infected snails in addition to non-infected "negative control" (to optimized the efficiency of PCR reaction) and subjected to PCR using primers specific to a partial sequence of S. mansoni fructose-1,6-bus phosphate aldolase (SMALDO). SMALDO gene was detected in the infected laboratory snails with 70, 85, and 100 % positivity at the 1st, 3rd, and 7th day of infection, respectively. In contrast, the ordinary method was not sensitive enough in detection of early prepatent infection even after 7 days of infection which showed only 25 % positivity. By comparing the sensitivity of the three methods, it was found that the average sensitivity of shedding method compared to PCR was 23.8 % and the average sensitivity of crushing method compared to PCR was 46.4 % while the sensitivity of PCR was 100 %. We conclude that PCR is superior to the conventional methods and can detect positive cases that were negative when examined by shedding or crushing methods. This can help in detection of the areas and times of high transmission which in turn will be very beneficial in planning of the exact timing of the proper control strategy.
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http://dx.doi.org/10.1007/s12639-014-0583-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996196PMC
September 2016

Prevalence of hepatocellular carcinoma in chronic hepatitis C patients in Mid Delta, Egypt: A single center study.

J Egypt Natl Canc Inst 2016 Dec 1;28(4):257-262. Epub 2016 Jul 1.

Public Health and Community Medicine Departments, Faculty of Medicine, Tanta University, Egypt.

Background And Aim: Hepatocellular carcinoma (HCC) has an increasing incidence worldwide. In this study we aimed to assess the prevalence of HCC among HCV patients in our center in Mid Delta, Egypt.

Patients And Methods: During the period between April 2013 and January 2015, we screened sequentially chronic HCV patients attending inpatient wards or outpatient Clinic of Tropical Medicine Department in Tanta University Hospital for HCC. Individuals with focal lesion in Ultrasound (US) and/or serum α-fetoprotein (AFP) level >200ng/ml were examined by triphasic computed tomography scanning (CT), and/or magnetic resonance imaging (MRI).

Results: Among 514 HCV patients interviewed and accepted sharing in this study, 90 (17.5%), 144 (28%), and 280 (54.5%) were Child A, B, and C, respectively. We found that 108/514 patients (21%) had focal lesion detected by US. Also, 89/514 (17.3%) had elevated AFP >200, 13 of them (14.6%) had no focal lesion on US, but further work up showed HCC in 2 of them. Overall HCC diagnosis was confirmed in 103 cases, 94 of them (91.3%) were Child B or C. Occurrence of HCC was significantly higher in smokers, diabetics, patients with decompensated liver and those with positive family history of HCC. Only 20/103 (19.4%) were candidates to curative treatments, 8 of them were Child A asymptomatic and discovered accidentally during screening.

Conclusion: The high prevalence of HCC in our HCV patients (22%) was mainly associated with decompensated cirrhosis. A national surveillance program for the detection of HCC in cirrhotic HCV Egyptian patients by combining ultrasound examination and AFP is highly recommended.
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http://dx.doi.org/10.1016/j.jnci.2016.06.001DOI Listing
December 2016

Combined intrastromal astigmatic keratotomy and laser in situ keratomileusis flap followed by photoablation to correct post-penetrating keratoplasty ametropia and high astigmatism: One-year follow-up.

J Cataract Refract Surg 2015 Oct;41(10):2251-7

From Kasr El Aini Hospital, Cairo University, Cairo, Egypt.

Purpose: To evaluate a new technique combining intrastromal astigmatic keratotomy (AK) with a laser in situ keratomileusis (LASIK) flap followed by excimer laser photoablation to correct post-penetrating keratoplasty (PKP) high astigmatism and ametropia.

Setting: Kasr El Aini Hospital, Cairo University, Cairo, Egypt.

Design: Prospective interventional uncontrolled case series.

Methods: Patients with post-PKP high astigmatism and ametropia had paired intrastromal AK with LASIK flap using the M2 microkeratome followed 2 to 3 months later by excimer laser photoablation. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), mean refractive spherical equivalent (SE), and mean cylinder after each step and at the 1-year follow-up.

Results: The study comprised 20 eyes (20 patients). All parameters were significantly improved in all patients by the last follow-up visit. The mean UDVA improved from 1.07 logMAR ± 0.2 (SD) preoperatively to 0.23 ± 0.18 logMAR (P < .001), the mean CDVA improved from 0.79 ± 0.18 logMAR to 0.12 ± 0.12 logMAR (P < .001), the mean refractive SE improved from -5.04 ± 2.62 diopters (D) to -1.47 ± 1.32 D (P = .001), and the mean cylinder reduced from -5.39 ± 0.98 D to -1.05 ± 0.71 D (P < .001). The mean correction index was 0.84 ± 0.10, and the mean flattening index was 0.83 ± 0.10. Thirty-five percent of cases developed microperforations, and 15% developed epithelial ingrowth.

Conclusion: This combined approach allowed for the correction of high astigmatism and ametropia following PKP; however, epithelial ingrowth requiring intervention is a complication to be considered.

Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.
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http://dx.doi.org/10.1016/j.jcrs.2015.10.028DOI Listing
October 2015

Seven-day storage of pneumatically dissected Descemet's endothelial grafts with and without Dua's layer.

Acta Ophthalmol 2016 Mar 27;94(2):e130-4. Epub 2015 Aug 27.

Ophthalmology, Cairo University, Cairo, Egypt.

Purpose: To evaluate the efficacy of big-bubble (BB) technique in separating Dua's layer together with the Descemet's membrane endothelial (DE) graft and the effect of 7-day storage of the prepared tissues on the endothelial cells.

Method: This is an experimental study in which 21 human corneo-scleral tissues unsuitable for transplantation were used. Grafts were mounted on artificial chamber; epithelial side-up with BB technique was used to detach the DE graft. The resultant tissues were stored in tissue culture medium for 7 days. Dua's layer presence, endothelial cell density (ECD), endothelial cell loss and viability were assessed after the dissection and at 7 days after storage.

Results: Complete detachment of DE grafts was achieved in 20 cases (95.24%). Histological analysis revealed Dua's layer presence in 14 cases (70%). The mean ECD for the corneas before dissection was 2375 ± 338 cells/mm(2) with significant reduction to 2200 ± 319 cells/mm(2) (p < 0.00001) with endothelial cell loss of 7.3 ± 3.5% and non-viable cells of 6.5 ± 2.5% at the end of the 7-day storage. On comparing the dissected DE grafts with Dua's layer versus those without at 1 day after dissection and at 7 days after storage, we found no statistically significant changes in endothelial cell loss (p = 0.387; p = 0.836 respectively) and non-viable cells percentage (p = 0.180; p = 0.260, respectively).

Conclusion: Big-bubble technique is reproducible in dissecting DE grafts with minimal damage to the endothelial cells. The percentage of endothelial cell loss and non-viable cells is similar in the DE grafts with/without Dua's layer after 7-day storage.
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http://dx.doi.org/10.1111/aos.12823DOI Listing
March 2016

Evaluation of Artisan aphakic intraocular lens in cases of pediatric aphakia with insufficient capsular support.

J AAPOS 2015 Jun;19(3):242-6

Ophthalmology Department, Faculty of Medicine, Cairo University & Research Institute of Ophthalmology, Cairo, Egypt.

Purpose: To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support.

Methods: In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients >2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth <3 mm, central endothelial cell density (CECD) <2500 cells/mm(²), uncontrolled glaucoma, or uveitis were excluded. Best-corrected visual acuity, intraocular pressure (IOP), and CECD were measured at 1, 6, and 12 months postoperatively.

Results: A total of 25 aphakic eyes of 18 patients (mean age, 7.86 ± 3.08 years) with insufficient capsular support for a standard posterior chamber IOL were included, 18 eyes with subluxated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95 ± 0.36; for patients with subluxation, 0.7 ± 0.26. Values improved at 1 year to 0.38 ± 0.15 (P < 0.002) and 0.3 ± 0.2 (P < 0.0001), respectively. One year after surgery the CECD (2892.64 ± 441.79 cells/mm(²)) was significantly reduced from the preoperative and 1 month postoperative values (3573.36 ± 468.9 cells/mm(2), 3081 ± 495 cells/mm(²); P < 0.0001, P < 0.02 resp.). Two cases (8%) developed traumatic dislocation. Pupillary block occurred in 1 case (4%).

Conclusions: Artisan IOL implantation for pediatric aphakia achieved a good visual outcome.
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http://dx.doi.org/10.1016/j.jaapos.2015.03.014DOI Listing
June 2015
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