Publications by authors named "Mohamed Samir Abd El Ghafar"

7 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

Efficacy of favipiravir in COVID-19 treatment: a multi-center randomized study.

Arch Virol 2021 Mar 25;166(3):949-954. Epub 2021 Jan 25.

Department of Chest Diseases, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

No specific antiviral drugs have been approved for the treatment of COVID-19. This study aimed to evaluate the efficacy of favipiravir in treatment of COVID-19. This was a multicenter randomized controlled study including 96 patients with COVID- 19 who were randomly assigned into a chloroquine (CQ) group and a favipiravir group. None of the patients in the favipiravir group needed mechanical ventilation (p = 0.129). One patient (2.3%) in the favipiravir group and two patients (4.2%) in the CQ group died (p = 1.00). Favipiravir is a promising drug for COVID-19 that decreases the hospital stay and the need for mechanical ventilation.ClinicalTrials.gov Identifier NCT04351295.
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http://dx.doi.org/10.1007/s00705-021-04956-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829645PMC
March 2021

Do Zinc Supplements Enhance the Clinical Efficacy of Hydroxychloroquine?: a Randomized, Multicenter Trial.

Biol Trace Elem Res 2021 Oct 27;199(10):3642-3646. Epub 2020 Nov 27.

Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.

No specific treatment for COVID-19 infection is available up till now, and there is a great urge for effective treatment to reduce morbidity and mortality during this pandemic. We aimed to evaluate the effect of combining chloroquine/hydroxychloroquine (CQ/HCQ) and zinc in the treatment of COVID-19 patients. This was a randomized clinical trial conducted at three major University hospitals in Egypt. One hundred ninety-one patients with a confirmed diagnosis of COVID-19 infection were randomized into two groups: group I (96) patients received both HCQ and zinc, and group II (95) received HCQ only. The primary endpoints were the recovery within 28 days, the need for mechanical ventilation, and death. The two groups were matched for age and gender. They had no significant difference regarding any of the baseline laboratory parameters or clinical severity grading. Clinical recovery after 28 days was achieved by 79.2% in the zinc group and 77.9% in zinc-free treatment group, without any significant difference (p = 0.969). The need for mechanical ventilation and the overall mortality rates did not show any significant difference between the 2 groups either (p = 0.537 and 0.986, respectively). The age of the patient and the need for mechanical ventilation were the only risk factors associated with the patients' mortality by the univariate regression analysis (p = 0.001 and < 0.001, respectively). Zinc supplements did not enhance the clinical efficacy of HCQ. More randomized studies are needed to evaluate the value of adding zinc to other therapies for COVID 19. ClinicalTrials.gov Identifier: NCT04447534.
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http://dx.doi.org/10.1007/s12011-020-02512-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695238PMC
October 2021

Tanta Protocol for Management of COVID-19: Perspectives from a Developing Country.

Endocr Metab Immune Disord Drug Targets 2020 Nov 17. Epub 2020 Nov 17.

Opthalmology Department, Tanta University, Tanta. 0.

In late 2019, SARS-COV-2 disease is firstly discovered in Wuhan, China and it reached millions of people worldwide. Later, the World Health Organization (WHO) described COVID-19 as the first pandemic invading the world in 21st century. The WHO has declared that the emerging infection will last long enough to force adjustments not only in people's lifestyles but also in health care system. This amendment is expected to spread through many medical practices and specialties. A lot of diagnostic and therapeutic modalities have been proposed for COVID-19 management. The best strategy for management of patients requires a multi-disciplinary team approach with correct decision regarding the right timing of each modality of treatment. The participating multidisciplinary team for COVID-19 management includes six infectious diseases experts in Tanta University; one critical care management expert; an emergency medicine expert and two pharmacists in Tanta University. In this review, we reported our multi-disciplinary team experience with up to date literature guidance to propose a valid protocol for management of COVID-19 patients in limited resources setting.
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http://dx.doi.org/10.2174/1871530320999201117142305DOI Listing
November 2020

Hydroxychloroquine in the Treatment of COVID-19: A Multicenter Randomized Controlled Study.

Am J Trop Med Hyg 2020 10;103(4):1635-1639

Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.

The COVID-19 pandemic is showing an exponential growth, mandating an urgent need to develop an effective treatment. Indeed, to date, a well-established therapy is still lacking. We aimed to evaluate the safety and efficacy of hydroxychloroquine (HCQ) added to standard care in patients with COVID-19. This was a multicenter, randomized controlled trial conducted at three major university hospitals in Egypt. One hundred ninety-four patients with confirmed diagnosis of COVID-19 were included in the study after signing informed consent. They were equally randomized into two arms: 97 patients administrated HCQ plus standard care (HCQ group) and 97 patients administered only standard care as a control arm (control group). The primary endpoints were recovery within 28 days, need for mechanical ventilation, or death. The two groups were matched for age and gender. There was no significant difference between them regarding any of the baseline characteristics or laboratory parameters. Four patients (4.1%) in the HCQ group and 5 (5.2%) patients in the control group needed mechanical ventilation ( = 0.75). The overall mortality did not differ between the two groups, as six patients (6.2%) died in the HCQ group and 5 (5.2%) died in the control group ( = 0.77). Univariate logistic regression analysis showed that HCQ treatment was not significantly associated with decreased mortality in COVID-19 patients. So, adding HCQ to standard care did not add significant benefit, did not decrease the need for ventilation, and did not reduce mortality rates in COVID-19 patients.
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http://dx.doi.org/10.4269/ajtmh.20-0873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543820PMC
October 2020

Vasopressin Continuous Infusion Improves Intracranial Pressure and Patient Outcomes after Surgical Clipping or Endovascular Coiling of Cerebral Aneurysm.

Anesth Essays Res 2019 Jul-Sep;13(3):528-534

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

Background: Hypertensive therapy prevents vasospasm-related delayed ischemic neurologic deficit and infarcts. New alternatives would include vasopressin which has vasoconstrictive effects and positive influence on cerebral perfusion pressure (CPP) and intracranial pressure (ICP).

Aims: The aim of this study is to demonstrate the value of vasopressin intravenous infusion (IVI) in decreasing ICP and preventing vasospasm following surgical clipping or endovascular coiling.

Settings And Design: A triple-blind prospective randomized controlled study.

Subjects And Methods: Thirty patients, 25-60 years, both genders, had undergone surgical clipping or endovascular coiling for a cerebral aneurysm, World Federation of Neurosurgical Societies (WFNS) grade 1-3 (15 patients in each); Group I (Vasopressin): 0.1-0.4 unit/min and Group II (Norepinephrine): 5-20 ug/min with target systolic blood pressure 160-180 mmHg.

Statistical Analysis: SPSS version 25 software was used for analysis.

Results: Invasive mean arterial pressure (MAP) showed the insignificant difference between the two groups, but ICP showed a significant decrease in Group V from hour 24 to 168 hence calculated CPP showed a significant increase in Group V at most times from hour 36 to 168. Glasgow Coma Scale showed a significant decrease in Group N from hour 138 due to the occurrence of vasospasm. The incidence of vasospasm, mechanical ventilation, and 28-day mortality were significantly lower in Group V with 81% risk reduction of vasospasm and better survival.

Conclusion: Vasopressin IVI improved ICP, MAP, CPP and patient outcomes safely by reducing the incidence of cerebral vasospasm, and 28-day mortality after clipping or coiling of the cerebral aneurysm.
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http://dx.doi.org/10.4103/aer.AER_30_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775829PMC
October 2019
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