Publications by authors named "Mohamed El-Khatib"

13 Publications

  • Page 1 of 1

The Egyptian Collaborative Cardiac Genomics (ECCO-GEN) Project: defining a healthy volunteer cohort.

NPJ Genom Med 2020 23;5:46. Epub 2020 Oct 23.

Aswan Heart Centre, Aswan, Egypt.

The integration of comprehensive genomic and phenotypic data from diverse ethnic populations offers unprecedented opportunities toward advancements in precision medicine and novel diagnostic technologies. Current reference genomic databases are not representative of the global human population, making variant interpretation challenging, especially in underrepresented populations, such as the North African population. To address this, the Egyptian Collaborative Cardiac Genomics (ECCO-GEN) Project launched a study comprising 1000 individuals free of cardiovascular disease (CVD). Here, we present the first 391 Egyptian healthy volunteers recruited to establish a pilot phenotyped control cohort. All individuals underwent detailed clinical investigation, including cardiac magnetic resonance imaging (MRI), and were sequenced using a targeted panel of 174 genes with reported roles in inherited cardiac conditions. We identified 1262 variants in 27 cardiomyopathy genes of which 15.1% were not captured in current global and regional genetic reference databases (here: gnomAD and Great Middle Eastern Variome). The ECCO-GEN project aims at defining the genetic landscape of an understudied population and providing individual-level genetic and phenotypic data to support future studies in CVD and population genetics.
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http://dx.doi.org/10.1038/s41525-020-00153-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584615PMC
October 2020

Chemerin level and the relation to insulin resistance in chronic kidney disease.

Saudi J Kidney Dis Transpl 2019 Nov-Dec;30(6):1381-1388

Department of Radiology, Kasr Al-Ainy Cairo University, Cairo, Egypt.

Chemerin has been associated with different components of the metabolic syndrome, including hypertension, hyperlipidemia, and insulin resistance (IR). The aim of this study was to evaluate serum chemerin level in chronic kidney disease (CKD) patients and its relation to IR. This study was conducted on 80 participants who were classified into three groups: Group I (30 CKD patients with mean age 53 ± 12 years), Group II (30 patients with end-stage renal disease on regular hemodialysis with mean age 48 ± 14.8 years) and Group III having 20 healthy age-and sex-matched controls. Serum chemerin level, fasting blood sugar, fasting insulin, HOMA-IR index calculation, urea, creatinine, estimated glomerular filtration rate, total cholesterol, and triglyceride were measured. Body composition was assessed by dual-energy X-ray absorptiometry. In Groups I and II, we found a significantly higher mean chemerin level compared to healthy controls (P <0.001), a highly significant positive correlation between mean chemerin level and the HOMA-IR index [r = 0.56, P <0.001/(r = 0.53, P <0.001)], and a highly significant negative correlation between mean chemerin level and GFR (r = -0.51, P <0.001/r = -0.46, P <0.001). In Group I, there was also a highly significant positive correlation between mean chemerin and systolic blood pressure (r = 0.31, P <0.05), diastolic blood pressure (r = 0.39, P <0.05 and creatinine (r = 0.34, P <0.05). Chemerin might be considered a uremic IR adipokine marker in CKD Stages 3, 4, and 5.
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http://dx.doi.org/10.4103/1319-2442.275482DOI Listing
August 2020

Atelectasis in Bariatric Surgery: Review Analysis and Key Practical Recommendations.

Turk J Anaesthesiol Reanim 2019 Dec 2;47(6):431-438. Epub 2019 Sep 2.

Department of Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.

Obesity is a condition that affects multiple organ systems, particularly the cardiovascular and respiratory system. In recent years, bariatric surgery has been reported to be the gold standard in the treatment of morbid obesity. Body mass index alone is insufficient to predict risks related to anaesthesia and surgery. Obesity contributes to significant postoperative atelectasis and is considered an independent risk factor for postoperative atelectasis owing to decreased functional residual capacity. The treatment and reversibility of atelectasis developed in obese patients undergoing bariatric surgery are challenging. Therefore, an optimisation of pulmonary functions before surgery, lung-sparing ventilation during the perioperative period, awareness of potential postoperative complications and knowledge about preventive measures and therapeutic approaches have become increasingly important in bariatric surgery. The aim of this review was to aid clinicians in the management of atelectasis in patients undergoing bariatric surgery during the perioperative and postoperative period.
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http://dx.doi.org/10.5152/TJAR.2019.66564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886827PMC
December 2019

Patients with end-stage renal disease: optimal diagnostic and prognostic performance of myocardial gated-SPECT, initial results.

Nucl Med Commun 2013 Apr;34(4):314-21

Departments of Nuclear Medicine, Faculty of Medicine, Cairo University, Egypt.

Purpose: We investigated the role of Tc-99m sestamibi myocardial perfusion gated single photon emission computed tomography (GSPECT) in identifying those patients with end-stage renal disease (ESRD) in whom optimal diagnosis of coronary artery disease and prediction of cardiac events (CEs) could be achieved.

Methods: This was a prospective study that included 41 asymptomatic ESRD patients who had been undergoing hemodialysis for 12 months or less (22 men and 19 women) with restricted selection criteria (asymptomatic traditional risk). Tc-99m sestamibi GSPECT was carried out for all patients, whereas coronary angiography (Cath) was carried out only for abnormal GSPECT patients, with a 2-year follow-up for CEs. Twenty individuals matched for age, sex, and BMI formed the control group.

Results: Of the 41 ESRD patients, 13 showed abnormal GSPECT [11/13 with myocardial perfusion defects and left ventricular dysfunction in concordance with Cath and 2/13 with only left ventricular dysfunction (i.e. stunning)] compared with 1/20 in the control group. None of the patients with negative results experienced CEs (negative predictive value 100%); these patients had a 2-year CE-free survival rate of 100% compared with 46% for patients with positive results on GSPECT (P<0.0001; seven GSPECT-positive patients developed CEs during their follow-up). Patients with positive results were more frequently male (P<0.001), were significantly older (P=0.01), and had highly sensitive C-reactive protein levels (P=0.002). Abnormal GSPECT was the only independent predictor of CEs (95% confidence interval, 7.1-46.7; hazard ratio, 46.1; P<0.001).

Conclusion: GSPECT exhibited optimum performance for coronary artery disease detection and risk stratification in asymptomatic ESRD patients during their first year of regular hemodialysis who were selected according to our modification of the traditional risk category. This may help in selecting suitable candidates for Cath, revascularization, and future renal transplantation.
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http://dx.doi.org/10.1097/MNM.0b013e32835ec88aDOI Listing
April 2013

Relationship of BsmI polymorphism of vitamin D receptor gene with left ventricular hypertrophy and atherosclerosis in hemodialysis patients.

Scand J Clin Lab Invest 2013 Feb 3;73(1):75-81. Epub 2012 Dec 3.

Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Egypt.

Background: Left ventricular hypertrophy (LVH) is a common manifestation of cardiovascular disease and has an important prognostic value in patients with end-stage renal disease (ESRD). Vitamin D receptor (VDR) has been intensively investigated, and one of these (BsmI) already has been associated with survival in the dialysis population.

Objective: The aim of this study was to investigate the role of VDR polymorphism (BsmI) on the development of ventricular hypertrophy and atherosclerosis in hemodialysis patients. Subject and methods. The subjects were 80 patients with end-stage renal disease on maintenance hemodialysis, and 40 healthy controls. Clinical and laboratory parameters, including genetic variation in VDR gene (BsmI), were assessed. In addition, echocardiography and intima-media thickness were performed for all subjects.

Results: There was no significant difference in the distribution of BsmI genotypes either in patients or in the control group. The frequency of the B allele of BsmI polymorphism (41.6%) in dialysis patients was similar to that of healthy control subjects (39.2%). Patients with BB genotype had significantly lower serum concentrations of 25-hydroxy vitamin D compared to both Bb and bb genotypes. The number of B alleles was positively correlated with left ventricular mass index (LVMI), but not with intima-media thickness.

Conclusion: These results suggest that the B alleles of the BsmI polymorphism could be considered as novel markers of altered vitamin D signaling in ESRD patients, and this alteration in BB genotype produces an increase in left ventricle mass.
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http://dx.doi.org/10.3109/00365513.2012.743163DOI Listing
February 2013

CRP and acute renal rejection: a marker to the point.

Int Urol Nephrol 2012 Aug 3;44(4):1251-5. Epub 2012 Jan 3.

Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt.

Objectives: C-reactive protein (CRP) is increased in end-stage renal disease patients. Recent studies have shown positive associations between inflammatory markers and cardiovascular mortality in kidney transplant recipients. The aim of the present study was to examine the correlation between CRP and early detection of renal allograft rejection. Furthermore, investigate the association between pretransplant levels of CRP with the development of acute renal allograft rejection as a possible predictive marker.

Methods: Ninety-one renal transplant recipients were sequentially analyzed. The median follow up of patients was 8 weeks. Basal and 8 weeks post transplant CRP levels were assessed.

Results: CRP levels were significantly higher in allograft rejection both in the pretransplant (n = 25, P = 0.001) and postransplant (n = 33, P = 0.001) phases when compared to those without rejection. By stepwise multiple regression analysis, rejection in transplanted patients was independently correlated to albumin/creatinine ratio and CRP 8 weeks after transplantation.

Conclusion: Elevated pretransplant serum CRP level is a risk predictor for acute rejection episodes and may be a useful predictive marker in the follow-up of post-transplantation patients.
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http://dx.doi.org/10.1007/s11255-011-0098-4DOI Listing
August 2012

Correlations of urinary biomarkers, TNF-like weak inducer of apoptosis (TWEAK), osteoprotegerin (OPG), monocyte chemoattractant protein-1 (MCP-1), and IL-8 with lupus nephritis.

J Clin Immunol 2011 Oct 21;31(5):848-56. Epub 2011 Jun 21.

Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: This case-controlled study was designed to correlate urinary biomarkers, TNF-like weak inducer of apoptosis (TWEAK), osteoprotegerin (OPG), monocyte chemoattractant protein-1 (MCP-1), and interleukin-8 (IL-8) levels, with renal involvement in a cohort of systemic lupus erythematosus (SLE) patients to examine their diagnostic performance.

Patients And Methods: In 73 SLE patients, and in 23 healthy volunteers, urinary levels of TWEAK, OPG, MCP-1, and IL-8 levels were measured. Disease activity was assessed by total SLE disease activity index, and renal activity by renal activity index (rSLEDAI), and both were correlated with urinary biomarkers. Sensitivity, specificity, and predictive values of individual biomarkers to predict lupus nephritis were also calculated.

Results: Significantly higher levels of urinary biomarkers were observed in SLE patients with lupus nephritis (LN) compared with those without LN (TWEAK, p < 0.001; MCP-1, p < 0.001; OPG, p < 0.001; IL-8, p < 0.032). Other significantly higher levels were observed in SLE patients with LN compared with control subjects (TWEAK, MCP-1, OPG, and IL-8 p < 0.001). Positive correlations were observed between rSLEDAI and TWEAK (r = 0.612 and p < 0.001), MCP-1 (r = 0.635 and p < 0.001), and OPG (r = 0.505 and p < 0.001).

Conclusions: Urinary levels of TWEAK, OPG, and MCP-1 positively correlate with renal involvement as assessed by rSLEDAI with reasonable sensitivity, specificity, and predictive values to detect lupus nephritis while IL-8 was not significantly associated with global or rSLEDAI.
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http://dx.doi.org/10.1007/s10875-011-9555-1DOI Listing
October 2011

Relationship of increased circulating adrenomedullin with cardiac dysfunction, inflammation, oxidative stress and volume overload in hemodialysis patients.

Scand J Clin Lab Invest 2011 May 24;71(3):208-15. Epub 2011 Jan 24.

Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Egypt.

Adrenomedullin (AM) is a peptide involved in cardiovascular homeostasis. The aim of our study was to investigate whether circulating AM might be related to cardiac function, volume overload, oxidative stress and inflammation in hemodialysis patients. Plasma adrenomedullin, C-reactive protein (CRP), oxidized LDL (ox-LDL), lipoprotein (a), systolic and diastolic cardiac functions were assessed before hemodialysis in 80 patients as well as in 40 healthy control subjects. Plasma adrenomedullin levels were significantly higher in the hemodialysis group compared to the control group. Plasma adrenomedullin levels were negatively correlated with systolic and diastolic blood pressure, S/D ratio, deceleration time, left ventricular ejection fraction, ox-LDL and lipoprotein (a). However, it was positively correlated with CRP, delta body weight, mitral E/A wave, and inferior vena cava diameter. Higher plasma adrenomedullin levels may provide a possible index of cardiac dysfunction, systemic inflammation, and volume overload conditions in haemodialysis patients with concomitant cardiovascular disease. In addition, the negative correlation between ox-LDL, lipoprotein (a) and adrenomedullin may suggest that endogenous AM is an important protective factor in anti-atherosclerosis and might be useful as a new target for prevention and therapy for the disease.
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http://dx.doi.org/10.3109/00365513.2011.553967DOI Listing
May 2011

Association of fetuin-A and cardiac calcification and inflammation levels in hemodialysis patients.

Scand J Clin Lab Invest 2010 Dec 21;70(8):575-82. Epub 2010 Oct 21.

Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: Vascular calcification is commonly found in chronic kidney disease (CKD) patients and it is one of the predictors of cardiovascular death. Recently, several studies have demonstrated that low fetuin-A levels are associated with mortality in uremic patients. Objectives. To investigate the importance of non-traditional risk factors of calcification including fetuin-A, IL-6 and high sensitivity CRP (hsCRP) in hemodialysis patients and their relationship to the extent of cardiac calcification by means of multislice computed tomography (MSCT), and echocardiography.

Patients And Methods: The study was conducted on 70 hemodialysis patients as well as 20 healthy control subjects. All patients were subjected to MSCT for evaluation of calcium score in the coronary arteries as well as echocardiography for detecting valvular calcification. In addition, the patients were sampled for evaluation of inflammatory markers such as hsCRP and IL-6 and also fetuin-A.

Results: Mean serum fetuin-A was significantly lower in hemodialysis patients than controls subjects. By dividing the patients into tertiles of serum fetuin-A, a significant association between low levels of fetuin-A and high calcium score and valvular calcification were found. Multiple regression analysis showed that calcium scoring and IL-6 were the most independent risk factors for serum fetuin-A levels.

Conclusion: Serum fetuin-A showed important association with coronary, valvular calcification and inflammation in hemodialysis patients. Assessment of both cardiac calcification and serum levels of fetuin-A may be of value to identify those subjects at higher risk of development and progression of vascular lesion and may be a novel therapeutic approach.
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http://dx.doi.org/10.3109/00365513.2010.528445DOI Listing
December 2010

Apelin: a potential link between inflammation and cardiovascular disease in end stage renal disease patients.

Scand J Clin Lab Invest 2010 Oct;70(6):421-7

Department of Medical Biochemistry, Kasr El-Aini School of Medicine, Cairo University, Egypt.

Background And Objectives: Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis patients. Increasing evidence suggests a role for apelin in the pathology of the cardiovascular system. In the present study, the plasma level of apelin was studied in patients with hemodialysis to assess the effect of renal transplantation and dialysis session on plasma apelin and whether circulating apelin levels reflect cardiovascular homeostasis and inflammation in these patients.

Patients And Methods: Plasma apelin, high sensitive CRP (hsCRP) and IL-6 levels were investigated in 30 end stage renal disease (ESRD) patients on maintenance hemodialysis (HD), a group of 15 HD patients scheduled for renal transplantation and a group of 15 HD patients on maintenance HD, as well as ten healthy volunteer subjects who served as controls. An echocardiography was performed for all subjects.

Results: Plasma apelin levels were significantly lower in hemodialyzed patients compared to controls. Plasma apelin was also found to be positively correlated with left ventricular end systolic dimension (LVESD), left ventricular end diastolic dimension (LVEDD), interventricular septum (IVS), right ventricle (RV), left atrium (LA), Aorta (Ao), while, it was negatively correlated with hsCRP and IL-6 in ESRD patients. Regarding the effect of hemodialysis on plasma apelin levels, no significant effect was found after a single hemodialysis session, while levels increased significantly in the early post-transplant period.

Conclusions: Apelin is related to echocardiographic features and inflammatory markers in hemodialyzed patients. Apelin may provide a mechanism for systemic inflammatory monitoring and adaptive regulation of cardiovascular function.
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http://dx.doi.org/10.3109/00365513.2010.504281DOI Listing
October 2010

Early diagnostic markers for contrast nephropathy in patients undergoing coronary angiography.

Angiology 2010 Nov 7;61(8):731-6. Epub 2010 Jun 7.

Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Egypt.

Unlabelled: The present work aimed to prove the usage of neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for kidney injury and to assess the relationship between NGAL and serum creatinine and cystatin C in patients with normal serum creatinine undergoing percutaneous coronary angiography. Thirty patients with normal serum creatinine undergoing coronary angiography were enrolled. Estimation of blood glucose, glycosylated hemoglobin, lipid profile, creatinine, NGAL, and cystatin C were done before coronary angiography for all patients. Serum creatinine, NGAL and cystatin C were evaluated again at 4 and 24 hours after coronary angiography. There was a significant increase in serum NGAL level 4 hours and 24 hours after coronary interventions compared to the baseline value before coronary angiography. Before coronary angiography, serum NGAL was positively correlated with serum creatinine, and cystatin C.

Conclusion: Serum NGAL and cystatin C could be valuable in the detection of early renal impairment after coronary angiography.
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http://dx.doi.org/10.1177/0003319710373093DOI Listing
November 2010

The relation between dual energy x-ray absorptiometry measurement of body fat composition and plasma ghrelin in patients with end-stage renal disease.

Saudi Med J 2009 Jan;30(1):109-15

Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: To clarify the role of ghrelin in malnutrition in uremia and its relationship to fat composition using dual x-ray absorptiometry (DXA).

Methods: This is a cohort study including Group I: 60 patients with end stage renal disease 30 on hemodialysis [group IA] and 30 pre-dialysis [group IB] and Group II: 20 controls. This study was carried out in Cairo University Hospital, Kasr Al-Aini, Cairo, Egypt in 2007. Body fat composition (total, differential, and lean body mass) was assessed using DXA, and plasma ghrelin was measured.

Results: Ghrelin was significantly higher in hemodialysis and pre-dialysis groups compared to the control group, and higher in hemodialysis group compared to the pre-dialysis group. In hemodialysis, ghrelin was negatively correlated with weight, body mass index (BMI), and truncal fat mass, and positively correlated with serum creatinine. In pre-dialysis, ghrelin inversely correlated with weight, BMI, and truncal fat mass, and positively correlated with serum creatinine, lean body mass. In control, plasma ghrelin showed negative correlation with weight, BMI, truncal fat mass, and body fat mass, and positive correlation with lean body mass.

Conclusion: Ghrelin was markedly elevated in renal failure due to its decrease in excretion. Negative correlation between ghrelin and fat composition was detected in dialysis patients. Serial evaluation of body fat composition using DXA is recommended for assessment of nutritional status of those patients.
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January 2009

The effect of injection of two vs 10 mL saline on the subsequent spread and quality of epidural analgesia in parturients.

J Clin Anesth 2006 Dec;18(8):575-9

Department of Anesthesiology, American University of Beirut-Medical Center, POB 11-0236, Beirut, Lebanon.

Objective: To determine whether two vs 10 mL of saline injected into the epidural space affects the subsequent spread and quality of epidural analgesia in parturients.

Design: Randomized, double-blinded, placebo-controlled study.

Setting: Delivery room.

Patients: 105 ASA physical status I and II parturients requesting epidural analgesia.

Interventions: After identification of the epidural space by the loss-of-resistance technique using normal saline, two mL of saline was then injected into the epidural space in the 2-mL group (n = 53) and 10 mL in the 10-mL group (n = 52). Five minutes after the test dose, patients received 10 mL of bupivacaine (0.1%) with fentanyl two microg mL(-1).

Measurements: 25 minutes after the initial bolus of bupivacaine and fentanyl, spread of block, subsequent pain relief, and influence of the volume of the injected saline on the ease of epidural catheter insertion and on the incidence of blood vessel trauma and paresthesia were evaluated.

Results: The total number of dermatomes blocked for cold and pinprick sensation in the 10-mL group was significantly more than in the 2-mL group (19 [6-29] vs 15 [4-27] for cold sensation, P = 0.000; and 15 [3-29] vs 11.5 [3-26] for pinprick sensation, P = 0.001). However, the visual analog pain scale and need for supplemental analgesia were similar between the two groups. The epidural catheter was easily inserted in 94.2% of the 2-mL group and 100% of the 10-mL group. The incidence of blood vessel trauma was low and the incidence of paresthesia was high without any significant difference between the two groups.

Conclusions: 10 mL saline was associated with a higher total number of dermatomes blocked for both cold and pinprick sensation than the two mL saline. However, the pain relief was adequate in both groups, and two mL saline was as effective as the 10 mL in the ease of catheter insertion and prevention of intravascular cannulation.
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http://dx.doi.org/10.1016/j.jclinane.2006.03.015DOI Listing
December 2006