Publications by authors named "Mona H Ismail"

13 Publications

  • Page 1 of 1

Concomitant hepatic tuberculosis and hepatocellular carcinoma: a case report and review of the literature.

BMC Surg 2021 Jan 2;21(1). Epub 2021 Jan 2.

Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia.

Background: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare.

Case Presentation: We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis.

Conclusion: A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.
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http://dx.doi.org/10.1186/s12893-020-01021-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777399PMC
January 2021

Gastrointestinal stromal tumors. A clinicopathological study.

Saudi Med J 2019 Feb;40(2):126-130

Department of Surgery, College of Medicine, King Fahad Hospital of the University, University of Imam Abdurahman Bin Faisal, Al Khobar, Kingdom of Saudi Arabia. E-mail.

Objectives: To evaluate the clinical presentations and immunohistochemical (IHC) properties of gastrointestinal stromal tumors (GISTs) and to compare them to internationally published data.

Methods: Thirty-six patients diagnosed with GISTs between January 1997 and December 2015 were retrospectively studied in 2 tertiary hospitals. Immunohistochemical staining was carried out prospectively when it has not been completed fully at the beginning. Results: The median age of patients was 54 years  (range; 17-81 years). Predominantly, we found more females were affected. The male to female ratio was 1:1.7. The most frequently affected organs were the stomach (63.8%) followed by small bowel (25%) and colorectal region (8.4%). Abdominal pain was the most frequent presentation in 33.3% of the patients then gastrointestinal (GI) bleeding in 30.5%. Most of the gastric GISTs were at early stages at presentation: stage 1 and II (60.8%), while in non-gastric GISTs, the tumor stage was advanced: stage III and IV (69.3%). The IHC characteristic of GIST in descending order showed positivity for vimentin (88.9%), CD117 (83.3%), CD34 (77.8%), Ki67 (63.9%), SMA (38.9%), desmin (27.8%), and S100 (19.4%).

Conclusion: Gastrointestinal stromal tumors in our study demonstrates a major similar feature as the published international data. However, minor differences do exist in terms of clinical features and immunohistochemistry.
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http://dx.doi.org/10.15537/smj.2019.2.23913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402471PMC
February 2019

Greater prevalence of comorbidities with increasing age: Cross-sectional analysis of chronic hepatitis B patients in Saudi Arabia.

Saudi J Gastroenterol 2019 May-Jun;25(3):194-200

Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Saudi Arabia.

Background/aims: Middle Eastern countries, including Saudi Arabia to some extent, are endemic for chronic hepatitis B (CHB) infection which could be associated with high mortality and comorbidities risk. However, limited data characterizing this CHB population exists. Our aim was to characterize and compare CHB patients in 2015 with those in 2010 and 2012 in Saudi Arabia.

Patients And Methods: We conducted and compared three cross-sectional analyses of adult patients with CHB defined as either positive hepatitis B surface antigen or documented CHB history in 2010, 2012, and 2015. Data were accessed from the multicenter Systematic Observatory Liver Disease Registry (SOLID).

Results: A total of 765 CHB patients were identified in 2010 (n = 274), 2012 (n = 256), and 2015 (n = 235). Median age was significantly higher in 2015 (47 years) compared to 2010 and 2012 (42 years;P < 0.05). The proportions of patients with hepatocellular carcinoma (range 1-12%) and cirrhosis (range 5-23%) were significantly higher in 2015 compared to 2010 and 2012 (P < 0.05). Compared to 2010, patients in 2015 had significantly (P < 0.05) higher prevalence of coronary artery disease (10% vs. 4%) and hyperbilirubinemia (18% vs. 9%). Although not significant, there was a numerical increase in 2015 in chronic kidney disease (9% vs. 7% in 2010;P= 0.559) and hepatic steatosis (32% vs. 25% in 2010;P= 0.074). Significantly more patients in 2015 (P < 0.05) were treatment experienced (23% vs. 5% in 2010/2012) and switched treatment (17% vs. 1-2% in 2010/2012).

Conclusions: Between 2010 and 2015, the CHB population in Saudi Arabia had significantly aged and was more likely to develop liver disease sequelae and other comorbidities.
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http://dx.doi.org/10.4103/sjg.SJG_447_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526730PMC
April 2020

Association of Uncoupling Protein 1 (UCP1) gene polymorphism with obesity: a case-control study.

BMC Med Genet 2018 11 20;19(1):203. Epub 2018 Nov 20.

Department of Biochemistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia.

Background: Obesity is one of the main causes of morbidity and mortality worldwide. More than 120 genes have been shown to be associated with obesity related phenotypes. The aim of this study was to determine the effect of selected genetic polymorphisms in Uncoupling protein 1 (UCP1) and Niemann-Pick C1 (NPC1) genes in an obese population in Saudi Arabia.

Methods: The genotypes of rs1800592, rs10011540 and rs3811791 (UCP1 gene) and rs1805081 and rs1805082 (NPC1 gene) were determined in a total of 492 subjects using TaqMan chemistry by Real-time PCR. In addition, capillary sequencing assay was performed to identify two specific polymorphisms viz., rs45539933 (exon 2) and rs2270565 (exon 5) of UCP1 gene.

Results: A significant association of UCP1 polymorphisms rs1800592 [OR, 1.52 (1.10-2.08); p = 0.009] was observed in the obese cohort after adjusting with age, sex and type 2 diabetes. Further BMI based stratification revealed that this association was inconsistent with both moderate and extreme obese cohort. A significant association of UCP1 polymorphisms rs3811791 was observed only in the moderate-obese cohort [OR = 2.89 (1.33-6.25); p = 0.007] but not in the extreme-obese cohort indicating an overlying genetic complexity between moderate-obesity and extreme-obesity. The risk allele frequencies, which were higher in moderate-obese cohort, had abnormal HDL, LDL and triglyceride levels.

Conclusion: The rs1800592 and rs3811791 of UCP1 gene are associated with obesity in general and in the moderate-obese group in particular. The associated UCP1 polymorphisms in the moderate-obese group may regulate the impaired energy metabolism which plays a significant role in the initial stages of obesity.
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http://dx.doi.org/10.1186/s12881-018-0715-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247512PMC
November 2018

Analysis of the Impact of Common Polymorphisms of the FTO and MC4R Genes with the Risk of Severe Obesity in Saudi Arabian Population.

Genet Test Mol Biomarkers 2018 Mar 21;22(3):170-177. Epub 2018 Feb 21.

3 Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University , Dammam, Saudi Arabia .

Background: Obesity has reached epidemic proportions worldwide resulting in a serious public health problem. In Saudi Arabia, 28.7% of the population is obese due largely to the adoption of western dietary patterns over the last decade. The fat-mass and obesity associated (FTO) and melanocortin-4 receptor (MC4R) genes are ubiquitously expressed in the brain and pancreatic islets, and are the main link between the central nervous system and energy homeostasis based on food intake and energy expenditure. Genetic variants in the FTO and MC4R genes have been strongly associated with an increased obesity risk.

Aim: To identify novel mutations in the MC4R gene and to perform correlation analyses of the known variants rs9939609 and rs1421085 in the FTO gene and rs17782313 near the MC4R gene in an obese Saudi population.

Materials And Methods: A total of 136 obese patients and 104 healthy controls from King Fahd Hospital, Al-Khobar, were genotyped for single-nucleotide polymorphisms within or near the FTO and MC4R genes using the TaqMan assay. Leptin levels were determined by enzyme-linked immunosorbent assay. Targeted sequencing of MC4R exon was done by Sanger sequencing method.

Results: The study included 58 obese males and 78 obese females with a mean age of 39.78 ± 12.77 years and a mean body mass index (BMI) of 42.65 ± 9.03 kg/m. A significant increase in the levels of leptin and triglycerides was associated with an increase of BMI. Other factors such as lactate dehydrogenase, gamma-glutamyltransferase, and high-density lipoprotein were also significantly higher in the severely obese cohort. The FTO polymorphisms were associated with a significantly increased risk for obesity and in BMI-stratified cohort, rs9939609 (T/A: odds ratio [OR] = 1.73, p = 0.007) and rs1421085 (T/C: OR = 1.56, p = 0.03) showed even stronger association. Genotyping for the near MC4R polymorphism, rs17782313 revealed an association with moderately obese patients (T/C: OR = 1.73, p = 0.038).

Conclusion: The studied FTO gene polymorphisms were found to be significantly associated with increased BMI and were highly significantly associated with severe obesity. These FTO gene polymorphisms combined with a high-fat diet appear to promote early-onset obesity in the Saudi population. FTO polymorphisms appear to be universally associated with the risk of obesity, and further investigation into this genetic locus may provide clues for potential therapeutic targets.
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http://dx.doi.org/10.1089/gtmb.2017.0218DOI Listing
March 2018

Validation of the postgraduate hospital educational environment measure at a Saudi university medical school.

Saudi Med J 2014 Jul;35(7):734-8

Department of Physiology and Medical Education, College of Medicine, King Fahd Hospital of the University, University of Dammam, PO Box 2208, Al-Khobar 31952, Kingdom of Saudi Arabia. E-mail:

Objective: The English version of the postgraduate hospital educational environment measure (PHEEM) was evaluated to determine its psychometric properties, validity, and internal consistency. The instrument was used to measure the clinical learning environment in the hospital setting of a Saudi university medical school.

Methods: This cross-sectional study was performed in a Saudi medical school between June and August 2012. The postgraduate hospital educational environment measure was administered to interns (house officers) and residents rotating at a Saudi university hospital. Means and mean ranks were calculated. The effects of training stage (intern versus resident) and gender (male versus female) on the PHEEM scores were estimated. Construct validity was measured using exploratory factor analysis, and internal consistency was measured using Cronbach's alpha.

Results: In this study, 193 interns and residents responded to the PHEEM. The response rate was 100%. The internal consistency of the 40-item questionnaire was 0.936 (Cronbach`s alpha) with a maximum score of 160. The PHEEM mean score was 89.21 +/- 21.6.

Conclusion: The PHEEM is a valid and highly reliable instrument that can be applied to measure the educational environment among interns and residents in hospital-based clerkships. The hospital training environment was positive, and the interns were more satisfied than the residents. Gender had no influence on the perceptions of the hospital`s educational environment.
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July 2014

Prediction of sustained virologic responses to combination therapy of pegylated interferon-α and ribavirin in patients with chronic hepatitis C infection.

Authors:
Mona H Ismail

J Family Community Med 2013 Jan;20(1):35-40

Department of Internal Medicine, Division of Gastroenterology, University of Dammam, College of Medicine, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia.

Background And Aim: Hepatitis C virus (HCV) infection is a major health problem worldwide. Genotype-4 is the most common genotype in Saudi Arabia. The response to treatment with pegylated interferon-α combined with ribavirin in chronic HCV infection varies. This study aimed at investigating the pre- and on-treatment predictors of sustained virologic response (SVR) in patients with chronic hepatitis C (CHC) infection.

Patients And Methods: Clinical data of 48 patients with CHC treated with standard HCV antiviral combination therapy, between January 2005 and December 2010, at a Saudi University hospital, were retrospectively reviewed for age, sex, body mass index, liver enzymes, HCV-RNA viral load, liver biopsy, and response to treatment. The primary end point was SVR defined as undetectable HCV-RNA by polymerase chain reaction (PCR) 24 weeks after the end of treatment. Univariable logistic regression was used to explore the association between the different variables and SVR. These independent predictors of SVR were then analyzed with multivariable logistic regression analysis.

Results: Of the 48 treated patients, 25 (52%) were females and 27 (56%) were Saudi. The mean age was 43 years (43 ± 10 years). Twenty-four (50%) had genotype-4, and 26 (54%) had liver biopsy. The overall SVR rate was 75% (36/48) and was 83.3% (20/24) among genotype-4 patients. Baseline factors associated with SVR identified by univariate logistic regression were genotype-4 and early viral response (EVR), defined as a drop of ≥2 log in serum HCV viral load after 12 weeks of initiation of combination therapy (P = 0.001). However, in stepwise regression analysis, the independent factor associated with the effect of antiviral therapy was genotype-4. When on-treatment variables were included, EVR (P = 0.003) and low baseline viral load (P = 0.048) were highly predictive of SVR.

Conclusions: Of our HCV-treated patients, 75% had SVR. HCV genotype-4, EVR, and low baseline viral load were predictive of SVR.
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http://dx.doi.org/10.4103/2230-8229.108182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663162PMC
January 2013

Frequency of low bone mineral density in Saudi patients with inflammatory bowel disease.

Saudi J Gastroenterol 2012 May-Jun;18(3):201-7

Division of Gastroenterology, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia.

Background/aims: Metabolic bone disease is common in patients with inflammatory bowel disease (IBD). Our aim was to determine the frequency of bone loss among Saudi patients with IBD and possible contributing risk factors.

Settings And Design: We retrospectively reviewed Saudi patients with IBD, between 18 and 70 years of age, who had bone mass density (BMD) determined by dual-energy X-ray absorptiometry scanning at one of three hospitals in the Kingdom of Saudi Arabia from 2001 to 2008.

Patients And Methods: Case notes and BMDs results were carefully reviewed for demographic and clinical data. Low bone mass, osteopenia, and osteoporosis were defined according to the WHO guidelines.

Statistical Analysis Used: Predictive factors for BMD were analyzed using group comparisons and stepwise regression analyses.

Results: Ninety-five patients were included; 46% had Crohn's disease (CD) and 54% had ulcerative colitis (UC). The average age was 30.9±11.6 years. Using T-scores, the frequency of osteopenia was 44.2%, and the frequency of osteoporosis was 30.5% at both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our results revealed a positive correlation between the Z-score in both the lumbar spine and the proximal femur and body mass index (BMI) (P=0.042 and P=0.018, respectively). On regression analysis BMI, age, and calcium supplementation were found to be the most important independent predictors of BMD.

Conclusions: Saudi patients with IBD are at an increased risk of low BMD and the frequency of decreased BMD in Saudi patients with CD and UC were similar. BMI and age were the most important independent predictors of low BMD.
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http://dx.doi.org/10.4103/1319-3767.96458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371423PMC
October 2012

Nonalcoholic fatty liver disease and type 2 diabetes mellitus: the hidden epidemic.

Authors:
Mona H Ismail

Am J Med Sci 2011 Jun;341(6):485-92

Division of Gastroenterology, Department of Internal Medicine, College of Medicine, King Fahad Hospital, University of Dammam, Al-Khobar, Saudi Arabia.

Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized cause of liver disease worldwide. With obesity being a universally important risk factor, NAFLD is now receiving greater attention as a public health issue, and the burden of NAFLD is expected to increase in years to come. The prevalence of NAFLD among subjects with diabetes and with severe obesity is on the rise around the world, including in Saudi Arabia. Efforts in developing new strategies for its prevention, diagnosis and management are needed to alter the course of this disease. The purpose of this review is to enhance awareness about the close interrelationship between NAFLD and type 2 diabetes mellitus and recent diagnostic and treatment advances in the field.
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http://dx.doi.org/10.1097/MAJ.0b013e3182018598DOI Listing
June 2011

Reversal of hepatic fibrosis: pathophysiological basis of antifibrotic therapies.

Hepat Med 2011 Jul 4;3:69-80. Epub 2011 Jul 4.

Dipartimento di Medicina Interna Center for Research, High Education and Transfer, Università degli Studi di Firenze, Florence, Italy.

Chronic liver injuries of different etiologies eventually lead to fibrosis, a scarring process associated with increased and altered deposition of extracellular matrix in the liver. Progression of fibrosis has a major worldwide clinical impact due to the high number of patients affected by chronic liver disease which can lead to severe complications, expensive treatment, a possible need for liver transplantation, and death. Liver fibrogenesis is characterized by activation of hepatic stellate cells and other extracellular matrix producing cells. Liver fibrosis may regress following specific therapeutic interventions. Other than removing agents causing chronic liver damage, no antifibrotic drug is currently available in clinical practice. The extent of liver fibrosis is variable between individuals, even after controlling for exogenous factors. Thus, host genetic factors are considered to play an important role in the process of liver scarring. Until recently it was believed that this process was irreversible. However, emerging experimental and clinical evidence is starting to show that even cirrhosis in its early stages is potentially reversible.
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http://dx.doi.org/10.2147/HMER.S9051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3846600PMC
July 2011

Glypican-3-Expressing Hepatocellular Carcinoma in a Non-Cirrhotic Patient with Nonalcoholic Steatohepatitis: Case Report and Literature Review.

Authors:
Mona H Ismail

Gastroenterology Res 2010 Oct 20;3(5):223-228. Epub 2010 Sep 20.

College of Medicine, University of Dammam, Consultant Hepatologist and Gastroenterologist, Division of Gastroenterology, Department of Internal Medicine, King Fahad Hospital of the University, Saudi Arabia; Department of Internal Medicine, Division of Gastroenterology & Multiorgan Transplant Programme, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Nonalcoholic steatohepatitis (NASH) is now considered as the major cause of cryptogenic cirrhosis, which can progress to HCC. Glypican-3 is a member of the Heparan Sulfate Proteoglycan (HSP) family that plays a role in cell growth, differentiation, and migration. Glypican-3 is significantly up-regulated in a majority of HCCs compared to normal and benign liver samples. Glypican-3 protein is detectable in around 40-53% of HCC patients whereas it is not detectable in the serum of healthy individuals. There are several reports of HCC arising in the setting of non-cirrhotic NASH. This report describes a case of HCC that expressed Glypican-3 and arose in a 47-year-old female with noncirrhotic NASH.
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http://dx.doi.org/10.4021/gr224wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139721PMC
October 2010

Reversal of liver fibrosis.

Saudi J Gastroenterol 2009 Jan;15(1):72-9

Department of Internal Medicine, Division of Gastroenterology at King Fahad Hospital of the University, Al-Khobar, Saudi Arabia.

Hepatic fibrosis is a scarring process associated with an increased and altered deposition of extracellular matrix in the liver. It is caused by a variety of stimuli and if fibrosis continues unopposed, it would progress to cirrhosis which poses a significant health problem worldwide. At the cellular and molecular level, this progressive process is characterized by cellular activation of hepatic stellate cells and aberrant activity of transforming growth factor-beta with its downstream cellular mediators. Liver biopsy has been the reference test for assessment of hepatic fibrosis, but because of its limitations, noninvasive markers of liver fibrosis were developed. Liver fibrosis or cirrhosis was considered irreversible in the past but progress of research on the molecular pathogenesis of liver fibrosis has shown that hepatic cellular recovery is possible. Currently, no acceptable therapeutic strategies exist, other than removal of the fibrogenic stimulus, to treat this potentially devastating disease.
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http://dx.doi.org/10.4103/1319-3767.45072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702953PMC
January 2009