Publications by authors named "Sameera Ezzat"

49 Publications

Safety and efficacy of sofosbuvir/ledipasvir and sofosbuvir/daclatasvir in the treatment of hepatitis C in patients with decompensated cirrhosis.

Eur J Gastroenterol Hepatol 2021 Sep 21. Epub 2021 Sep 21.

Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo Tropical medicine, Faculty of Medicine, Alexandria University, Alexandria Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University Department of Internal Medicine, Al-Azhar University Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo Department of community medicine, Faculty of Medicine, Suez Canal University Hepatogastroenterology Department, National Hepatology & Tropical Medicine Research Institute, Cairo Gastroenterology Department, Damietta Cardiology and Gastroenterology Center, Damietta Hepatology and Gastroenterology Department, AGOZA Police Hospital, Cairo Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia, Egypt Hepatology and gastroenterology department, national liver institute.Menoufia University, Egypt.

Background: Hepatitis C virus (HCV)-related decompensated cirrhosis is a severe life-threatening illness. The safety of direct-acting antivirals (DAAs) has opened a gate of hope for that subgroup of patients who were previously contraindicated for interferon therapy.

Objective: We aimed at the investigation of the safety and efficacy of different DAAs regimens in the treatment of HCV-related decompensated cirrhosis patients, to determine sustained virological response (SVR)12 rates and to analyze the factors associated with response.

Methods: A retrospective, single-center study including HCV-related decompensated cirrhosis patients who received DAAs. Demographic, laboratory and clinical data were analyzed. The SVR12 rate was the primary outcome measure. Secondary outcomes included the predictors of response, changes in the baseline model for end-stage liver disease and child-turcotte-pugh (CTP) scores, and fibroindices (APRI and fibrosis-4 index) at 12 weeks after treatment.

Results: In total, 145 eligible patients (141 with CTP class B and 4 with class C) were enrolled in this study. SVR12 was achieved by 88.06% (118/134) of efficacy population on different DAAs regimens, Treatment was discontinued in 11 patients because of severe side effects without any deaths. Younger age showed a significant positive association with SVR12.

Conclusions: DAAs can be used for the treatment of HCV-related decompensated liver disease, with acceptable SVR12 rates and safety profiles.
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http://dx.doi.org/10.1097/MEG.0000000000002287DOI Listing
September 2021

Decreased Incidence of Hepatocellular Carcinoma after Directly Acting Antiviral Therapy in Patients with Hepatitis C-Related Advanced Fibrosis and Cirrhosis.

J Hepatocell Carcinoma 2021 12;8:925-935. Epub 2021 Aug 12.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt.

Background And Aim: Existing data are controversial regarding the incidence of hepatitis C (HCV)-related hepatocellular carcinoma (HCC) following directly acting antiviral (DAA) therapy. This prospective study aimed to assess incidence, and risk factorss of HCC following DAA therapy in patients with HCV-related advanced fibrosis (F3) and cirrhosis (F4).

Methods: Incidence of HCC was calculated in 1,630 patients with HCV-related F3 and F4 treated with DAA prospectively followed for up to 43 months in a single tertiary referral center and compared to historical controls. Risk factors of incident HCC were also determined.

Results: The crude outcome rate was 2.15/100 person-years, significantly lower than a similar historical cohort (5.57/100 person-years). Risk of developing HCC was higher with the presence of cirrhosis (F4 vs F3, AHR 3.59) and treatment failure (vs achieving SVR, AHR 3.37). Presence of decompensated cirrhosis, platelet count <100×10/mL, and high AFP were independent risk factors of developing HCC.

Conclusion: Incidence of HCC was significantly lower in patients with HCV-related advanced fibrosis and cirrhosis treated with DAAs than in a historical cohort of untreated patients. Decompensated cirrhosis, baseline AFP ≥10 ng/mL, diabetes, and nonresponse to DAA were independent risk factors of incident HCC.
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http://dx.doi.org/10.2147/JHC.S295330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367200PMC
August 2021

Effect of disease stage and treatment outcomes on the dynamics of liver functions during and after treatment of hepatitis C with directly acting antivirals.

Eur J Gastroenterol Hepatol 2021 Jan 14. Epub 2021 Jan 14.

aEndemic Medicine Department, Faculty of Medicine, Helwan University bDepartment of Internal Medicine, Al-Azhar University cEndemic Medicine, Hepatology and Gastroenterology, Cairo University dInternal Medicine Department, Helwan University eTropical Medicine Department, Faculty of Medicine Ain Shams University, Cairo fEpidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia gNew Cairo Viral Hepatitis, Treatment Unit, New Cairo Hospital, Cairo hTropical Medicine, Faculty of Medicine, Alexandria University, Alexandria iTropical Medicine Department, National Hepatology and Tropical Medicine Research Institute jGastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Cairo, Egypt.

Background: Virus C infection is recently treated successfully with plenty of direct antiviral agents (DAAs). We aimed to evaluate the effect of disease stage and treatment outcome on the dynamics of liver functions during treatment of hepatitis C with DAAs.

Methods: We reported the liver function in 2354 subjects diagnosed as chronic hepatitis C before, during and after treatment with different DAAs regimens. Patients were classified into two groups according to treatment response with further subclassification according to the presence or absence of cirrhosis, and changes in liver functions were compared in each group and subgroup.

Results: Totally 2213 (94%) achieved sustained virological response (SVR) to DAAs therapy with significant improvement in all liver biochemistry. Also, there was an improvement in the non-SVR group's liver enzymes in relapsers during and after treatment; however, there was no improvement in serum albumin. We noticed a slight increase in serum bilirubin at weeks 4 and 8 for both groups.

Conclusion: DAAs therapy is associated with improvement of the liver biochemical profile and improved outcome in the majority of chronic hepatitis C virus patients due to suppression of viral replication. However, the long-term impact of DAAs therapy needs to be further evaluated.
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http://dx.doi.org/10.1097/MEG.0000000000002043DOI Listing
January 2021

MET canonical transcript expression is a predictive biomarker for chemo-sensitivity to MET-inhibitors in hepatocellular carcinoma cell lines.

J Cancer Res Clin Oncol 2021 Jan 26;147(1):167-175. Epub 2020 Sep 26.

Department of Pathology, National Liver Institute, Menoufia University, Menoufia, Egypt.

Purpose: Long interspersed nuclear element 1 (LINE-1 or L1) is a dominant non-long terminal repeat (non-LTR) retrotransposon in the human genome that has been implicated in the overexpression of MET. Both the canonical MET and L1-MET transcripts are considered to play a role in hepatocellular carcinoma (HCC) development. The aim of this study was to assess the utility of canonical MET, L1-MET, and MET protein expressions as predictive biomarkers for chemo-sensitivity to MET-inhibitors in HCC cell lines in vitro. Additionally, we assessed their expression in tumour tissues from Egyptian HCC patients.

Methods: MET and L1-MET expressions were assessed by qRT-PCR in six liver cancer cell lines (SNU-387, SNU-475, SK-HEP-1, PLC/PRF/5, SNU-449 and SNU-423) and 47 HCC tumour tissues. MET protein expression was measured by western blot in cell lines and immunohistochemistry in the tumours. Cell proliferation assay was used to assess the effect of crizotinib and tivantinib on the six liver cancer cell lines in correlation with the expression of MET, L1-MET and MET.

Results: The antitumor effect of crizotinib and tivantinib correlated with MET gene expression but not with L1-MET transcript or MET protein expressions. No significant difference was observed between HCC tumours and non-tumour samples in MET and L1-MET transcripts expression. There were no significant correlations between the 2-year overall survival rate and the MET, L1-MET transcripts and the MET protein expression.

Conclusion: MET RNA expression could be useful biomarker for tivantinib and crizotinib targeted therapy in HCC. The value of assessment of MET protein expression is limited.
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http://dx.doi.org/10.1007/s00432-020-03395-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855026PMC
January 2021

The Responses of Biobanks to COVID-19.

Biopreserv Biobank 2020 Dec 31;18(6):483-491. Epub 2020 Aug 31.

National Liver Disease Biobank, Institute of Liver and Biliary Sciences, New Delhi, India.

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http://dx.doi.org/10.1089/bio.2020.29074.mkhDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869526PMC
December 2020

HBVsvp-Pulsed Dendritic Cell Immunotherapy Induces Th1 Polarization and Hepatitis B Virus-Specific Cytotoxic T Lymphocytes Production.

Infect Drug Resist 2020 5;13:2699-2709. Epub 2020 Aug 5.

Virology & Immunology Department, National Cancer Institute, Cairo University and Children Cancer Hospital, Cairo 57357, Egypt.

Background: In chronic hepatitis B virus (CHB) patients, both dendritic cells (DCs) and T cells are functionally impaired and consequently the HBV-specific cellular immune responses are downregulated. The present study aims to investigate whether monocyte-derived DC (MoDCs)-pulsed-HBV subviral particles (HBVsvp) can polarize Th1 cells to induce HBV-specific cytotoxic T-lymphocytes (CTL) responses in CHB patients.

Methods And Materials: To this end, the human hepatoma HepG2.2.15 cell line was used to produce HBVsvp as a culturing system, and HBVsvp were concentrated for highly virus titer using the polyethylene glycol protocol. Peripheral blood mononuclear cells (PBMCs), collected from CHB patients and healthy donors, were differentiated into MoDCs and T cells. PBMCs-derived MoDCs were first pulsed with HBVsvp and then cultured with PBMCs-derived T cells. MoDCs and/or T subsets cells were identified for phenotypic activation by FACS analysis. The cytokine secretion of IL-4, IL-12, and IFN-γ in the culture supernatants was detected.

Results: The MoDCs were restored for their activation upon pulsing with HBVsvp in vitro, as identified by significantly overexpression of both CD86 and HLA-DR, and overproduction of IL-4 and IL-12. Furthermore, MoDCs-pulsed-HBVsvp induced Th1 frequencies and activated HBV-specific CTL to produce significantly highest amount of IFN-γ. Enhanced HBV-specific CTL led to strong cytolytic capacity against HepG2.2.15.

Conclusion: Overall, our data suggest that in vitro activation of MoDCs with HBVsvp overcomes the functionally impaired DCs and T cells in CHB patients offering a promising tool for therapeutic or vaccine-based approaches against HBV.
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http://dx.doi.org/10.2147/IDR.S265681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418458PMC
August 2020

Hepatocellular Carcinoma (HCC) in Egypt: A comprehensive overview.

J Egypt Natl Canc Inst 2020 Jan 16;32(1). Epub 2020 Jan 16.

Department of Epidemiology and Prevention Medicine, National Liver Institute, Menoufia University, Menoufia, Egypt.

Background: Worldwide, hepatocellular carcinoma (HCC) is a universal problem and its epidemiological data showed variation from place to place. Hepatocellular carcinoma (HCC) is the sixth and fourth common cancer in worldwide and Egypt, respectively. Egypt ranks the third and 15 most populous country in Africa and worldwide, respectively. The aim of this review is to compare the status of HCC in Egypt to that in the worldwide from different issues; risk factors, screening and surveillance, diagnosis and treatment, prevention, as well as research strategy.

Main Body: The risk factors for HCC in Egypt are of great importance to be reported. The risk factor for HCC are either environmental- or host/genetic-related risk factors. In the last years, there is a tangible improvement of both screening and surveillance strategies of HCC in Egypt. The unprecedented national screening campaign launched by the end of 2018 is a mirror image of this improvement. While the improvement of the HCC prevention requires the governmental health administration to implement health policies. Although the diagnosis of Egyptian HCC patients follows the international guidelines but HCC treatment options are limited in terms of cost. In addition, there are limited Egyptian reports about HCC survival and relapse. Both basic and clinical HCC research in Egypt are still limited compared to worldwide.

Short Conclusion: Deep analysis and understanding of factors affecting HCC burden variation worldwide help in customization of efforts exerted to face HCC in different countries especially large country like Egypt. Overall, the presence of a research strategy to fight HCC in Egyptian patients will help in the optimum allocation of available resources to reduce the numbers of HCC cases and deaths and to improve the quality of life.
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http://dx.doi.org/10.1186/s43046-020-0016-xDOI Listing
January 2020

Retreatment of chronic hepatitis C patients who failed previous therapy with directly acting antivirals: A multicenter study.

Int J Infect Dis 2020 Jul 20;96:367-370. Epub 2020 Apr 20.

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Egypt.

Aim Of The Study: The current study aimed to evaluate the efficacy of different DAAs regimens in the treatment of chronic hepatitis C (CHC) Egyptian patients who failed to achieve SVR after their treatment with SOF-based regimens.

Methods: This was a retrospective observational multicenter study that included CHC patients that failed to achieve cure on SOF-based regimens who were re-treated using different DAAs regimen and were allocated according to national guidelines for the treatment of hepatitis C. Primary outcome was to assess the SVR12 rate among prior non-responders after retreatment with a second course of DAAs.

Results: Our study included 172 patients who failed to achieve SVR after treatment with SOF-based treatment regimen [age: 51.2 ± 11.3, 58.7% men]. Included patients were retreated using SOF/DCV/RBV, SOF/ r/PAR /OMB /RBV, SOF/DCV/SIM, SOF/LDV ± RBV or SIM/SOF. SVR12 was successfully attained in 95.35% (164/172) of the included non-responders.

Conclusion: The current multicenter study proved the efficacy of various DAAs regimens issued by the National Committee for Control of Viral Hepatitis for retreatment of relapsed CHC Egyptian patients.
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http://dx.doi.org/10.1016/j.ijid.2020.04.022DOI Listing
July 2020

Transcriptionally Active Androgen Receptor Splice Variants Promote Hepatocellular Carcinoma Progression.

Cancer Res 2020 02 4;80(3):561-575. Epub 2019 Nov 4.

Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio.

Owing to the marked sexual dimorphism of hepatocellular carcinoma (HCC), sex hormone receptor signaling has been implicated in numerous aspects of liver cancer pathogenesis. We sought to reconcile the clear contribution of androgen receptor (AR) activity that has been established in preclinical models of HCC with the clinical failure of antagonists in patients with advanced HCC by evaluating potential resistance mechanisms to AR-targeted therapy. The locus was interrogated for resistance-causing genomic modifications using publicly available primary HCC datasets (1,019 samples). Analysis of HCC tumor and cell line RNA-seq data revealed enriched expression of constitutively active, treatment-refractory AR splice variants (AR-SV). HCC cell lines expressed C-terminal-truncated AR-SV; 28 primary HCC samples abundantly expressed AR-SV. Low molecular weight AR species were nuclear localized and constitutively active. Furthermore, AR/AR-SV signaling promoted AR-mediated HCC cell progression and conferred resistance to AR antagonists. Ligand-dependent and -independent AR signaling mediated HCC epithelial-to-mesenchymal transition by regulating the transcription factor SLUG. These data suggest that AR-SV expression in HCC drives HCC progression and resistance to traditional AR antagonists. Novel therapeutic approaches that successfully target AR-SVs may be therapeutically beneficial for HCC. SIGNIFICANCE: Treatment-refractory, constitutively active androgen receptor splice variants promote hepatocellular carcinoma progression by regulating the epithelial-to-mesenchymal transition pathway.
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http://dx.doi.org/10.1158/0008-5472.CAN-19-1117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002251PMC
February 2020

A significant upsurge of body mass index in patients with chronic hepatitis C successfully treated with direct-acting antiviral regimens.

Turk J Gastroenterol 2019 08;30(8):708-713

Endemic Medicine and Hepato-Gastroenterology Department, Cairo University School of Medicine, Cairo, Egypt.

Background/aims: There is less data regarding the changes in body mass index (BMI) after treating hepatitis C virus (HCV) patients with new direct-acting antiviral agents (DAAs). This study aimed to assess the changes in BMI in chronic HCV patients treated with DAAs in Egypt and to explore other factors influencing this change.

Materials And Methods: The data of chronic HCV patients who received antiviral therapy with new DAAs in one of Egypt's specialized viral hepatitis treatment centers were retrospectively analyzed. In addition to the routine clinical and laboratory workup, changes in body weight during and after treatment were monitored and BMI was calculated. Viral load was measured at 12 weeks post-treatment to assess a sustained virological response. Patients with documented thyroid abnormalities, bariatric surgery, or ensuing special diets were excluded. BMI of >30 was taken as the cutoff for pa¬tients with obesity.

Results: The study included 162 patients with a mean age of 48.56±11.49 years, of whom 61.1% were males, 16% were treatment-experienced, 12% were diabetic, and 29% were obese. Treatment duration was 12 weeks in 84% of patients and 24 weeks in 16% of patients. There was a significant increase in BMI post-treatment as compared to pretreatment measures (28.68±5.35 vs 28.18±4.55) (p=0.03). BMI changes were constant regardless of cirrhosis or previous treatment experience.

Conclusion: Treatment of chronic HCV with DAAs was associated with increased body mass index. Further studies are needed to explore if this effect is secondary to treatment with DAAs or is an improvement in the liver function and lifestyle of treated patients.
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http://dx.doi.org/10.5152/tjg.2019.18514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699564PMC
August 2019

Egyptian liver library: An indexed database for liver disease evidence in Egypt.

Arab J Gastroenterol 2019 Jun 4;20(2):109-113. Epub 2019 Jun 4.

Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.

Liver diseases are among the most challenging health care problems worldwide. In Egypt, we established different care programs to combat liver diseases including schistosomiasis and viral hepatitides. A lot of research work addressing liver diseases in Egypt have been published with special focus on these two major fields. Other liver disease seems to be neglected although present and contributing to the liver disease burden in Egypt. In this report we reviewed the available evidence published from Egypt and elucidate areas of weakness and future research needs. Our search for Egyptian liver disease evidence retrieved 4683 articles, 67% of them were relevant to the topic. Out of the relevant articles; 1646/3265 (50.4%) were discussing clinical science, 1131 (34.7%) were discussing basic science and 488 (14.9%) were discussing both basic and clinical sciences. Cairo university (16.8%, n = 513) and Mansoura university (9.3%, n = 285) had the largest number of publications related to liver disease in Egypt respectively. The most commonly reported diseases were hepatitis C in 719/3361 articles (21.4%), parasitic liver infestations in 663 articles (19.7%), hepatocellular carcinoma in 544 articles (16.2%), liver fibrosis or cirrhosis in 537 articles (16%), and drug induced liver injury in 516 articles (15.4%). Most of the reviewed articles (36%) were discussing treatment of chronic liver diseases (n = 1201) followed by diagnostics (28%, n = 940), pathogenesis and pathophysiology (21%, n = 706). This review will direct attention to areas with less research like hepatitis B related liver disease, HIV/HCV co-infections, and non-alcoholic fatty liver disease (NAFLD) to encourage future research in these topics. In conclusion; our results ring a bell inviting the development of a roadmap for liver research in Egypt targeting to put future policies to cover areas of weakness in liver research with an ultimate goal of tackling liver disease and its overwhelming socioeconomic burden in our developing country.
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http://dx.doi.org/10.1016/j.ajg.2019.05.004DOI Listing
June 2019

Real-world results of direct-acting antivirals use for the treatment of chronic hepatitis C in old patients.

Eur Geriatr Med 2019 Apr 24;10(2):295-302. Epub 2019 Jan 24.

Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Background And Aim: Old people with chronic hepatitis C (HCV) were considered a difficult-to-treat category with more frequent adverse events until recently. Interferon-free direct-acting antivirals (DAAs) improved treatment adherence and quality of life of old patients. In this study, we aimed at reporting the real-world efficacy and safety of DAAs, in addition to predictors of sustained virological response (SVR) in old chronic HCV population.

Methods: This is a prospective observational intention-to-treat analysis that included old chronic hepatitis C genotype-4 patients (> 65 years) treated in a single specialized viral hepatitis treatment center in Egypt. Treatment regimens were allocated according to national guidelines for treatment of hepatitis C. Primary outcome was undetectable HCV-RNA at 12-week post-treatment by PCR. Secondary outcomes were identification of predictors of SVR and assessment of safety related issues.

Results: Our study included 864 patients (64% females) with mean age of 67.7 ± 2.8 years. Overall SVR rate was 98.9% while SVR rates for sofosbuvir/daclatasvir/ribavirin, paritaprevir/ombitasvir/ritonavir/ribavirin, sofosbuvir/daclatasvir, sofosbuvir/ledipasvir/ribavirin, sofosbuvir/simeprevir/daclatasvir/ribavirin, sofosbuvir/simeprevir, interferon/sofosbuvir/ribavirin and sofosbuvir/ribavirin were 100%, 100%, 100%, 100%, 100%, 99.3%, 98% and 94.2%, respectively. DAAs were well tolerated. None of the patients discontinued the treatment due to adverse effects. Higher albumin, higher platelet count, lower bilirubin and lower stage of fibrosis were among predictors of favourable response.

Conclusion: Different DAAs regimens were safe and effective in old Egyptian patients with chronic HCV.
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http://dx.doi.org/10.1007/s41999-019-00167-3DOI Listing
April 2019

Advanced parental age as risk factor for childhood acute lymphoblastic leukemia: results from studies of the Childhood Leukemia International Consortium.

Eur J Epidemiol 2018 Oct 14;33(10):965-976. Epub 2018 May 14.

Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

Advanced parental age has been associated with adverse health effects in the offspring including childhood (0-14 years) acute lymphoblastic leukemia (ALL), as reported in our meta-analysis of published studies. We aimed to further explore the association using primary data from 16 studies participating in the Childhood Leukemia International Consortium. Data were contributed by 11 case-control (CC) studies (7919 cases and 12,942 controls recruited via interviews) and five nested case-control (NCC) studies (8801 cases and 29,690 controls identified through record linkage of population-based health registries) with variable enrollment periods (1968-2015). Five-year paternal and maternal age increments were introduced in two meta-analyses by study design using adjusted odds ratios (OR) derived from each study. Increased paternal age was associated with greater ALL risk in the offspring (OR 1.05, 95% CI 1.00-1.11; OR 1.04, 95% CI 1.01-1.07). A similar positive association with advanced maternal age was observed only in the NCC results (OR 0.99, 95% CI 0.91-1.07, heterogeneity I = 58%, p = 0.002; OR 1.05, 95% CI 1.01-1.08). The positive association between parental age and risk of ALL was most marked among children aged 1-5 years and remained unchanged following mutual adjustment for the collinear effect of the paternal and maternal age variables; analyses of the relatively small numbers of discordant paternal-maternal age pairs were not fully enlightening. Our results strengthen the evidence that advanced parental age is associated with increased childhood ALL risk; collinearity of maternal with paternal age complicates causal interpretation. Employing datasets with cytogenetic information may further elucidate involvement of each parental component and clarify underlying mechanisms.
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http://dx.doi.org/10.1007/s10654-018-0402-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384148PMC
October 2018

An account of the real-life hepatitis C management in a single specialized viral hepatitis treatment centre in Egypt: results of treating 7042 patients with 7 different direct acting antiviral regimens.

Expert Rev Gastroenterol Hepatol 2018 Dec 24;12(12):1265-1272. Epub 2018 May 24.

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

Background: A large Egyptian treatment program for HCV was launched in2014 after the introduction of direct-acting antiviral agents (DAAs). This program depended mainly on establishing specialized independent centres for HCV treatment. These centres represent the major strengths in the Egyptian model of care, as they provide integrated care for HCV patients and have enabled Egypt to treat more than one million patients in 3 years. The New Cairo Viral Hepatitis Treatment Center (NCVHTC) is an example of these specialized centres.

Methods: The Egyptian experience in the management of HCV was evaluated by analysing the data of real-life HCV management in the NCVHTC from 2014 to 2017. Results of different treatment regimens in addition to their strengths, limitations and areas for improvement are discussed in this report.

Results: A total of 7042 HCV patients have been evaluated for treatment in the NCVHTC. Among them, 5517 patients received treatment by seven different DAA regimens with excellent results.

Conclusions: All regimens were highly effective at treating HCV in a real-life setting, apart from SOF/RBV, which was the least effective. A nationwide screening program and enhancing the follow-up of treated patients are the main missing pillars in the Egyptian model.
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http://dx.doi.org/10.1080/17474124.2018.1476137DOI Listing
December 2018

Spur-of-the-Moment Modification in National Treatment Policies Leads to a Surprising HCV Viral Suppression in All Treated Patients: Real-Life Egyptian Experience.

J Interferon Cytokine Res 2018 02 22;38(2):81-85. Epub 2018 Jan 22.

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

The aim of this study was to retrospectively analyze the outcome of an unscheduled change in national Egyptian policies for the treatment of hepatitis C virus (HCV), which was transpired as a result of a reduction in interferon supplies, and to manage patients who already started interferon-based therapy. After completing a priming 4-weeks course of sofosbuvir/pegylated interferon/ribavirin (SOF/PEG IFN/RBV), a 12-weeks course of sofosbuvir/daclatasvir (SOF/DCV) combination was initiated. We evaluated the sustained virologic response at 12 weeks posttreatment (SVR12) for 2 groups of patients; Group 1, which included patients who had the previous regimen with IFN priming, and group 2, which included the first consecutive group of patients who received SOF/DCV for 12 weeks from the start without IFN priming. All group 1 patients (1,214 patients) achieved SVR12 (100%) and this was statistically significant when compared with the overall SVR12 in group 2 [8,869 patients with sustained virologic response [SVR] of 98.9%] (P value <0.001). No serious adverse events were reported in both groups. In this real-life treatment experience, interferon-based directly acting antiviral treatment with SOF/PEG IFN/RBV as a priming for 4 weeks, followed by SOF/DCV combination for 12 weeks, led to HCV viral suppression in all treated patients.
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http://dx.doi.org/10.1089/jir.2017.0121DOI Listing
February 2018

Macrophage Migration Inhibitory Factor (MIF) Gene Promotor Polymorphism Is Associated with Increased Fibrosis in Biliary Atresia Patients, but Not with Disease Susceptibility.

Ann Hum Genet 2017 Sep 28;81(5):177-183. Epub 2017 Jun 28.

Department of Ophthalmology, The Ohio State University, Columbus, Ohio, USA.

Two polymorphisms, rs755622 and rs5844572, in the promoter region of the macrophage migration inhibitory factor (MIF) gene influence the basal and/or induced transcriptional activity and have been linked to several inflammatory and autoimmune diseases. The aim of this study was to investigate the association between these two polymorphisms and disease susceptibility in patients with biliary atresia (BA). Allele frequencies of rs755622 and rs5844572 were assessed in 60 Egyptian infants with a confirmed diagnosis of BA. DNA was extracted from archival material. For the rs755622, samples were tested using Taqman real-time PCR, and for the rs5844572, samples were tested using fluorescence-based genotyping. The allele frequency in the general population was assessed in 141 healthy adults from the same geographical location. No statistical differences were observed in the allele frequencies of either rs755622 or rs5844572 between BA patients and controls. The homozygous and heterozygous short repeats (5/5, or 5/X) of rs5844572 were observed more frequently (16/28, 57.1%) in BA patients with mild to moderate fibrosis compared with those with marked fibrosis (10/32, 31.3%). The difference was statistically significant (P  =  0.032). In conclusion, we observed no association between MIF rs755622 and rs5844572 polymorphisms and susceptibility to BA; however, the rs5844572 could be linked to the rate of progression of the disease and extent of fibrosis.
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http://dx.doi.org/10.1111/ahg.12199DOI Listing
September 2017

Corrigendum to "Risk stratification and pattern of cardiotoxicity in pediatric Ewing sarcoma" [J. Egypt Natl. Cancer Instit. 29 (2017) 53-56].

J Egypt Natl Canc Inst 2017 06 7;29(2):119. Epub 2017 Jun 7.

Department of Public Health, National Liver Institute, Menufeya University, Egypt.

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http://dx.doi.org/10.1016/j.jnci.2017.06.001DOI Listing
June 2017

Assessment of liver fibrosis with acoustic radiation force impulse imaging versus liver histology in patients with chronic hepatitis C: a pilot study.

Eur J Gastroenterol Hepatol 2017 Aug;29(8):951-955

Departments of aHepatology bRadiology cEpidemiology dPathology, National Liver Institute, Menoufiya University, Shebeen Al-Kom, Egypt eDepartment of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.

Background: Acoustic radiation force impulse imaging (ARFI) involves the mechanical excitation of tissues using short-duration acoustic pulses to generate localized displacements in tissue. The displacements results in shear-wave propagation, tracked by ultrasonography (US) correlation-based methods and recorded in meters per seconds.

Aim: To compare (ARFI) integrated into a conventional US with the standard histological examination of liver biopsy specimens for the assessment of liver fibrosis.

Materials And Methods: Histological fibrosis staging with standard liver biopsy using the Metavir scoring system as well as fibrosis assessment using ARFI were performed to 80 patients with chronic hepatitis C over a 3-month period.

Results: ARFI findings were identical to the biopsy findings in 61 (76.25%) patients.Fifty-eight (67.5%) patients with an early fibrosis stage (F0, F1, and F2) by histology had identical fibrosis stages using ARFI.Only 20 out of 26 patients with an advanced fibrosis stage (F3 and F4) using ARFI had advanced fibrosis histologically. In the advanced fibrosis stages, the sensitivity of ARFI was 70% and specificity was 80%, with positive and negative predictive values of 53.8 and 88.9%, respectively. The accuracy of detection of advanced fibrosis by ARFI was 77.5%.

Conclusion: ARFI imaging is a promising noninvasive US-based method for the assessment of liver fibrosis.
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http://dx.doi.org/10.1097/MEG.0000000000000903DOI Listing
August 2017

Risk stratification and pattern of cardiotoxicity in pediatric Ewing sarcoma.

J Egypt Natl Canc Inst 2017 Mar 20;29(1):53-56. Epub 2017 Mar 20.

Department of Public Health, National Liver Institute, Menufeya University, Egypt.

Introduction: Anthracycline chemotherapy contributes to improved outcomes in Ewing sarcoma; however, the most feared complication is cardiotoxicity. Echocardiograms were routinely used to monitor cardiac function after anthracycline treatment. Nevertheless, indices chosen to assess cardiac toxicity vary significantly among different centers, and no uniform protocol has been accepted as ideal.

Methods: This retrospective study included children with Ewing sarcoma treated at Children's Cancer Hospital Egypt over 4years. All echocardiograms and related clinical assessments were reviewed.

Results: In total, 149 patients (median age 11years; range 1-18years) were included. Although all patients had a reduced ejection fraction compared with their baseline echocardiogram, only 39 patients developed cardiotoxicity (26%): 43% acute-onset, 36% chronic early-onset, and 21% chronic late-onset. There were no statistically significant association between the frequency of myocardial dysfunction and risk factors, including age, sex, follow-up duration, cumulative doxorubicin dose, and mediastinal irradiation. Over one-third (39%) of the patients with cardiac toxicity regained normal cardiac parameters, whereas seven patients died of acute cardiac toxicity.

Conclusion: The routine use of echocardiography to screen for anthracycline-induced cardiac toxicity before and during chemotherapy identified myocardial dysfunction. Early medical intervention can improve cardiac parameters. Improved screening techniques with better sensitivity and predictability are needed.
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http://dx.doi.org/10.1016/j.jnci.2016.12.001DOI Listing
March 2017

Association of Toll-Like Receptor 3 and Toll-Like Receptor 9 Single Nucleotide Polymorphisms with Hepatitis C Virus Infection and Hepatic Fibrosis in Egyptian Patients.

Am J Trop Med Hyg 2017 03 6;96(3):720-726. Epub 2017 Apr 6.

Clinical Pathology Department, National Institute of Neuromotor System, Cairo, Egypt.

Toll-like receptors (TLRs) are recognized as fundamental contributors to the immune system function against infections. Hepatitis C virus (HCV) infection represents a global health problem especially in Egypt having the highest HCV prevalence worldwide where HCV infection is a continuing epidemic. The aim of the present study was to investigate the possible association between genetic variation in TLR-3 and TLR-9 and HCV infection and hepatic fibrosis in chronic HCV-positive Egyptian patients. The present study included 100 naïve chronic HCV-positive patients and 100 age- and sex-matched healthy controls. Genotyping of TLR-3 (_7 C/A [rs3775296]), TLR-3 (c.1377C/T [rs3775290]) and TLR-9 (1237T/C [rs5743836]) were done by polymerase chain reaction restriction fragment length polymorphism technique. Frequency of polymorphic genotypes in TLR-3 (_7 C/A), TLR-3 (c.1377C/T) and TLR-9 (1237T/C) were not significantly different between studied HCV-positive patients and controls with values 0.121, 0.112, and 0.683, respectively. TLR-3 c.1377 T-allele was associated with advanced stage of hepatic fibrosis ( = 0.003).
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http://dx.doi.org/10.4269/ajtmh.16-0644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5361552PMC
March 2017

Environmental, maternal, and reproductive risk factors for childhood acute lymphoblastic leukemia in Egypt: a case-control study.

BMC Cancer 2016 08 20;16:662. Epub 2016 Aug 20.

Lombardi Cancer Center, Georgetown University, Washington, DC, USA.

Background: Acute lymphocytic leukemia (ALL) is the most common pediatric cancer. The exact cause is not known in most cases, but past epidemiological research has suggested a number of potential risk factors. This study evaluated associations between environmental and parental factors and the risk for ALL in Egyptian children to gain insight into risk factors in this developing country.

Methods: We conducted a case-control design from May 2009 to February 2012. Cases were recruited from Children's Cancer Hospital, Egypt (CCHE). Healthy controls were randomly selected from the general population to frequency-match the cumulative group of cases by sex, age groups (<1; 1 - 5; >5 - 10; >10 years) and region of residence (Cairo metropolitan region, Nile Delta region (North), and Upper Egypt (South)). Mothers provided answers to an administered questionnaire about their environmental exposures and health history including those of the father. Odds ratios (ORs) and 95 % confidence intervals (CI) were calculated using logistic regression with adjustment for covariates.

Results: Two hundred ninety nine ALL cases and 351 population-based controls frequency-matched for age group, gender and location were recruited. The risk of ALL was increased with the mother's use of medications for ovulation induction (ORadj = 2.5, 95 % CI =1.2 -5.1) and to a lesser extend with her age (ORadj = 1.8, 95 % CI = 1.1 - 2.8, for mothers ≥ 30 years old). Delivering the child by Cesarean section, was also associated with increased risk (ORadj = 2.01, 95 % CI =1.24-2.81).

Conclusions: In Egypt, the risk for childhood ALL appears to be associated with older maternal age, and certain maternal reproductive factors.
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http://dx.doi.org/10.1186/s12885-016-2689-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992254PMC
August 2016

Comparison of AFP-L3 and p53 Antigen Concentration with Alpha-Fetoprotein as Serum Markers for Hepatocellular Carcinoma.

Clin Lab 2016 ;62(6):1121-9

Background: Hepatocellular carcinoma (HCC) has the worst prognosis among all major cancers, largely due to the lack of sensitive diagnostic markers. We aimed to compare three HCC tumor markers, alpha-fetoprotein (AFP), p53, and AFP-L3%, to evaluate whether measuring serum p53 levels and AFP-L3% has an additive diagnostic value for detection of HCC.

Methods: A total of 86 patients with chronic liver diseases were included. HCC was detected in 68 (79.1%) patients. Twenty healthy age-matched volunteers served as healthy controls. Serum concentrations of AFP, AFP-L3, and p53 protein were measured. The correlations between the three markers with status of viral hepatitis, liver function tests, and Child-Pugh scores were determined.

Results: HCC patients showed significantly higher percentages of cirrhosis and Child-Pugh grade C (p < 0.001 and 0.05, respectively) compared with non-HCC group. AFP-L3% and p53 levels were significantly (p < 0.001, 0.0001, respectively) higher in HCC than non-HCC patients. AFP-L3% was found significantly correlated with Child-Pugh classification (p < 0.05) and alkaline phosphatase (p < 0.01). While, p53 significantly correlated with age and HCV positivity. ROC curve analysis showed that the highest specificity and sensitivity of the studied parameters are gained at cutoffs of 15%, 120.5 ng/mL, and 0.14 ng/mL for AFP-L3, AFP, and p53; respectively. Combining AFP-L3 and p53 improved sensitivity to 95.4% with a specificity of 85%.

Conclusions: No significant correlation was found between AFP, AFP-L3%, and p53; however, the simultaneous determination of the three tumor markers yielded a better diagnostic accuracy and sensitivity in the detection of HCCs than each biomarker alone.
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http://dx.doi.org/10.7754/clin.lab.2015.151102DOI Listing
September 2016

A change roadmap towards research paradigm in low-resource countries: retinoblastoma model in Egypt.

Int Ophthalmol 2017 Feb 25;37(1):111-118. Epub 2016 Apr 25.

Research Department, Children's Cancer Hospital - Egypt 57357, 1 Sekket Al-Imam, Sayeda Zainab, Cairo, 11441, Egypt.

Research on childhood diseases represents a great global challenge. This challenge is maximized in both childhood cancer disciplines and developing world. In this paper, we aim at describing our institution experience in starting a structured childhood cancer research program in one of the developing countries in a short time based on philanthropic efforts. We used retinoblastoma as an example for what was conducted in this program. Starting in 2008, this program included improving clinical practice and its related supporting services besides developing new research services that both complement the clinical activities and pave the way towards creating a research foundation in the country. Results included developing hospital standard treatment protocols, developing national clinical trials, joining international consortia for childhood cancers clinical trials, developing data collection tools and real-time analytics, establishing a biobanking facility, and developing highly qualified team for conducting clinical, epidemiologic, and translational research studies. Moreover, this effort resulted in improving both clinical practice and patients' awareness nationally. This model can be used for other startup facilities that aim at finding answers for their national health problems in low-resource setting.
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http://dx.doi.org/10.1007/s10792-016-0233-4DOI Listing
February 2017

Caesarean delivery and risk of childhood leukaemia: a pooled analysis from the Childhood Leukemia International Consortium (CLIC).

Lancet Haematol 2016 Apr 27;3(4):e176-85. Epub 2016 Feb 27.

Department of Pediatrics, University of Minnesota, MN, USA.

Background: Results from case-control studies have shown an increased risk of acute lymphoblastic leukaemia (ALL) in young children born by caesarean delivery, and prelabour caesarean delivery in particular; however, an association of method of delivery with childhood leukaemia subtypes has yet to be established. We therefore did a pooled analysis of data to investigate the association between childhood leukaemia and caesarean delivery.

Methods: We pooled data from 13 case-control studies from the Childhood Leukemia International Consortium done in nine countries (Canada, Costa Rica, Egypt, France, Germany, Greece, Italy, New Zealand, and the USA) for births from 1970-2013. We analysed caesarean delivery overall and by indications that probably resulted in prelabour caesarean delivery or emergency caesarean delivery. We used multivariable logistic regression models, adjusted for child's birthweight, sex, age, ethnic origin, parental education, maternal age, and study, to estimate odds ratios (ORs) and 95% CIs for the risk of ALL and acute myeloid leukaemia (AML) in children aged 0-14 years at diagnosis.

Findings: The studies provided data for 8780 ALL cases, 1332 AML cases, and 23 459 controls, of which the birth delivery method was known for 8655 (99%) ALL cases, 1292 (97%) AML cases, and 23 351 (>99%) controls. Indications for caesarean delivery were available in four studies (there were caesarean deliveries for 1061 of 4313 ALL cases, 138 of 664 AML cases, and 1401 of 5884 controls). The OR for all indications of caesarean delivery and ALL was 1·06 (95% CI 0·99-1·13), and was significant for prelabour caesarean delivery and ALL (1·23 [1·04-1·47]; p=0·018). Emergency caesarean delivery was not associated with ALL (OR 1·02 [95% CI 0·81-1·30]). AML was not associated with caesarean delivery (all indications OR 0·99 [95% CI 0·84-1·17]; prelabour caesarean delivery 0·83 [0·54-1·26]; and emergency caesarean delivery 1·05 [0·63-1·77]).

Interpretation: Our results suggest an increased risk of childhood ALL after prelabour caesarean delivery. If this association is causal, maladaptive immune activation due to an absence of stress response before birth in children born by prelabour caesarean delivery could be considered as a potential mechanism.

Funding: National Cancer Institute.
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http://dx.doi.org/10.1016/S2352-3026(16)00002-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5283076PMC
April 2016

Clinical Research Recession: Training Needs Perception Among Medical Students.

J Cancer Educ 2017 Dec;32(4):728-733

Department of Research, Children Cancer Hospital Egypt, 1 Seket Al-Emam Street - El-Madbah El-Kadeem Yard - El-Saida Zeinab, 57357, Cairo, Egypt.

Clinical research is an integrated part of medical education. There is a noticeable decrease in the number of physician-scientists in developing countries, which is reflected by a decrease in research output and publications from these countries. We conducted a survey aiming to identify the gaps in clinical research training from the perspective of medical students. The results can be used to customize future clinical research trainings. The survey tool was divided into six modules which represent the cornerstones of clinical research based on similar surveys done for the same purpose. For each module, questions covered the perceived knowledge of its aspects and how much relevant the responder thought it was to clinical research. Five hundred one candidates have filled the survey. Evidence-based medicine (EBM) had the highest knowledge score of 2.20/4, while "clinical trials execution" knowledge got the lowest score of 1.64/4. Responders perceived EBM as the most relevant aspect of clinical research (3.39/4), while research ethics received the lowest score 3.18/4. "Clinical trials execution" had the largest gap of a difference calculated as 1.60, while EBM had the lowest gap of 1.20. More attention must be paid to clinical research training for medical students in developing countries. These trainings have to be customized to focus on clinical trial execution, research methodology, and biostatistics. In parallel, awareness campaigns targeted toward the medical community emphasizing the importance of the ethics as an aspect of clinical research should be established.
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http://dx.doi.org/10.1007/s13187-016-0995-4DOI Listing
December 2017

Biorepository for Pediatric Cancer with Minimal Resources: Meeting the Challenges.

Biopreserv Biobank 2016 Feb 21;14(1):9-16. Epub 2015 Dec 21.

1 Biorepository and Biospecimen Research, Children's Cancer Hospital , Cairo, Egypt .

Background: Conducting high throughput -omics research requires high quality, data-rich biospecimens to unravel factors underlying childhood cancers; this is an extra burden in a limited resources country. For this purpose, Children's Cancer Hospital (CCHE), the largest pediatric cancer hospital worldwide, established a cutting-edge Biorepository and Biospecimen Research Facility (CCHE-BBR).

Objective: To present a step-by-step guide to establishing a hospital-based biorepository with limited resources, and working in collaboration with different hospital facilities to supply the research community with high quality data-rich biospecimens fit for a wide range of research purposes. This approach will foster research in the era of personalized precision medicine.

Methods: CCHE-IRB approved the collection and storage of biospecimens from patients and parents for future research. We focused on staff training, recruiting qualified scientists, and establishing the infrastructure. The CCHE Biorepository developed strict standardized procedures for sample acquisition, processing, annotation, storage, and distribution based on ISBER Best Practices and CAP-accreditation guidelines. We collect samples at different clinical time points (e.g., at remission and/or relapse) as well as parents' samples for genetic studies. Using CaTissue®, an electronic storage management system, allowed sample annotation and full integration with clinical data and the cancer registry.

Results: In 2 years, we succeeded in establishing a well-designed biorepository within our regulations, bylaws, and SOPs, and with a minimal budget. We store high quality blood derivatives, CSF, and malignant/normal tissue samples.

Conclusion: Building a high quality biorepository with minimal-resources to encourage research is possible. Having the suitable infrastructure with a significant number of clinically annotated samples can play a major role in international research projects, sharing samples and/or data with other groups.
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http://dx.doi.org/10.1089/bio.2015.0004DOI Listing
February 2016

Parental perceptions of congenital cardiovascular malformations in their children.

Cardiol Young 2016 Aug 12;26(6):1158-67. Epub 2015 Nov 12.

5Georgetown University,Washington,District of Columbia,United States of America.

We assessed parental attitudes towards congenital cardiovascular malformations in their children in a cross-sectional study in Egypt. Parents face many problems related to concerns about their child's prognosis, but these associations with parental stress have never been evaluated in Egypt or examined in relation to religiosity in a predominantly Muslim society. Accordingly, we conducted interviews in Cairo with mothers of 99 sequential infants born with conotruncal heart malformations (cases) and 65 mothers of age-matched controls. The survey assessed healthcare access and usage, knowledge of congenital cardiovascular malformations, religiosity, the Locus of Control Scale, and the Parenting Stress Index. Results showed that 45% of the mothers of cases had correct knowledge about their child's diagnosis; 85% were satisfied with the clinical care; and 79% reported that the cost of care was burdensome. Compared with parents of cases, parents of controls were more likely to report stress overall and all its subscales. Regarding belief about locus of control over health, God as a determining factor was given the highest endorsement. Mothers in the congenital cardiovascular malformations group reported a higher level of parental locus of control than did those in the control group. The correlations between stress and locus of control were stronger in the control than in the case group. Religiosity was related neither to stress nor to locus of control. Future studies can explore the roles that personal, familial, and societal factors play in exacerbating or reducing stress levels among parents of sick children, particularly in developing countries where economic pressures are acute.
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http://dx.doi.org/10.1017/S104795111500253XDOI Listing
August 2016

Pediatric brain tumors in a low/middle income country: does it differ from that in developed world?

J Neurooncol 2016 Jan 29;126(2):371-6. Epub 2015 Oct 29.

Radiotherapy Department, Children's Cancer Hospital Egypt (CCHE) and National Cancer Institute, Cairo University, 1 Sekket El Emmam, Sayeda Zainab, Cairo, Egypt.

Central nervous system (CNS) tumors are the most frequent solid tumors in children and adolescents. The epidemiology of these tumors differs in areas of the world. However, very little data is available in the low/middle income countries (LMIC). The aim of this study is to describe the characteristics of primary childhood brain tumors treated at a leading LMIC pediatric cancer hospital and its difference from that in other countries. One thousand one hundred fourteen children and adolescent having CNS tumors were treated in the largest pediatric cancer hospital in the Middle East during a period of 5½ years. They were diagnosed histopathologically in 80.2 %, through medical imaging in 19.4 % and via both tumor markers and imaging in the remaining 0.4 % of cases. Through epidemiological analysis was performed using all available patients' data revealed that 96 % of the patients had primary brain tumors, while only 4 % the primary lesion was in the spinal cord. The most common histological type was astrocytic tumor (30.0 %, pilocytic (GI) = 13.2 %, GII = 10.5 % and GIII + IV (high grade) = 6.3 %) followed by embryonal tumor (23.2 %, medulloblastoma = 18.7 %, PNET = 2.8 %, ATRT = 1.5 % and ependymoblastoma = 0.2 %) then ependymoma in 8.7 %, craniopharyngeoma in 5.3 %. The mean age at diagnosis was 7.1 ± 4.2 years which did not differ significantly by gender nor residency but it differed by the pathological subtype. The frequency of each pathological type was different among different age groups. Though the present study was a hospital-based analysis in a low/middle income country, yet it did not differ from the well-established population-based study reports in the high income countries.
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http://dx.doi.org/10.1007/s11060-015-1979-7DOI Listing
January 2016

Clinical presentation of intraocular retinoblastoma; 5-year hospital-based registry in Egypt.

J Egypt Natl Canc Inst 2015 Dec 17;27(4):195-203. Epub 2015 Oct 17.

Children's Cancer Hospital Egypt, 57357 Cairo, Egypt; Cairo University School of Medicine, Cairo, Egypt. Electronic address:

Purpose: To study the presenting signs of Retinoblastoma in Egypt at Egypt's main pediatric oncology referral center.

Methods: This is a prospective descriptive study (hospital-based registry) conducted at Children's Cancer Hospital Egypt between July 2007 and December 2012.

Results: Out of 262 patients diagnosed with retinoblastoma, 244 were suffering from intra-ocular disease at presentation. One hundred thirty-nine (57%) patients presented with unilateral disease, while 105 (43%) suffered bilateral disease. The mean age at presentation was 20.6 ± 17 months, averaging 18.87 ± 11.76 months for bilateral and 25.72 ± 18.78 months for unilateral disease. The most common clinical presentation was leukocoria in 180 (73.8%) patients, strabismus in 32 (13.1%) patients and decreased visual acuity in 12 (4.9%) patients. Group D and E disease represented 62% of all affected eyes. Patients with advanced disease (Group C-E) had longer duration of symptoms.

Conclusion: In Egypt, retinoblastoma patients present more frequently with advanced disease. There is an ever-increasing need to develop a national team dedicated to studying disease significance and formulating a national awareness program.
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http://dx.doi.org/10.1016/j.jnci.2015.09.002DOI Listing
December 2015

Impact of nitazoxanide on sustained virologic response in Egyptian patients with chronic hepatitis C genotype 4: a double-blind placebo-controlled trial.

Eur J Gastroenterol Hepatol 2016 Jan;28(1):42-7

Departments of aHepatology bClinical Biochemistry cPathology dEpidemiology, National Liver Institute, Menoufiya University, Menoufiya, Egypt.

Background: Nitazoxanide, approved for the treatment of Cryptosporidium parvum and Giardia lamblia, was found to inhibit hepatitis C virus replication.

Aim: The aim of this study was to assess the impact of nitazoxanide as an add-on therapy to pegylated interferon α-2a and ribavirin on sustained virologic response (SVR) in patients with chronic hepatitis C.

Patients And Methods: A total of 200 patients with chronic hepatitis C were enrolled in the study, assigned randomly in a 1 : 1 ratio to two groups: group A (placebo group) and group B (nitazoxanide group). Five patients withdrew from the study after they signed the consent form.A total of 195 patients were evaluated: 97 patients in group A versus 98 patients in group B at a dose of 500 mg twice daily. Placebo and nitazoxanide were administered as an add-on therapy to pegylated interferon α-2a plus ribavirin following a 12-week lead-in phase. SVR was evaluated. Statistical analysis was carried out using the SPSS software.

Results: The mean age of the patients in group A was 46.5 versus 45.7 years in group B. In group A, 85 out of 97 (87.6%) patients were men and in group B, 84 out of 98 (85.7%) patients were men.In group A, 59 out of 97 (60.82%) patients achieved an SVR versus 57 out of 98 (58.16%) patients in group B (P=0.70); this difference was not significant.

Conclusion: Our data did not show any significant impact of nitazoxanide on SVR.
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http://dx.doi.org/10.1097/MEG.0000000000000492DOI Listing
January 2016
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