Publications by authors named "Samy Zaky"

21 Publications

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Ulcerative colitis as a possible sequela of COVID-19 Infection: The endless story.

Arab J Gastroenterol 2022 Feb 10. Epub 2022 Feb 10.

Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt. Electronic address:

The coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, is a new type of acute infectious respiratory syndrome that usually presents with mild flu-like symptoms. However, the disease caused widespread illness and death worldwide, and new sequelae are still being discovered. SARS-CoV-2 RNA was isolated from the fecal samples of some infected patients. Many pathogens, including many viral infections, were linked either to the onset or the exacerbation of inflammatory bowel disease (IBD). With this, we report a series of 2 IBD cases that were diagnosed shortly after recovery from COVID-19. This is the first report that discusses the possibility of developing IBD following COVID-19 infection to the best of our knowledge. This could highlight the importance of thoroughly investigating COVID-19 patients who presented with diarrhea, particularly those with bloody diarrhea, and not consider it a simple manifestation of COVID-19 infection.
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http://dx.doi.org/10.1016/j.ajg.2022.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8828424PMC
February 2022

HIV-related stigma and discrimination by healthcare workers in Egypt.

Trans R Soc Trop Med Hyg 2022 Jan 6. Epub 2022 Jan 6.

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

Background: HIV-related stigma and discrimination (SAD) have imposed serious adverse health consequences on people living with HIV (PLHIV), including limited access to medical care and delayed diagnosis, which in turn limits the prevention and control of the disease. This study was conducted to explore the stigmatizing attitudes and behaviors of healthcare workers (HCWs) towards HIV patients and PLHIV.

Methods: A cross-sectional study targeted HCWs who attended the United Conference of Hepatogastroenterology and Infectious Diseases that was held on 25-28 September 2019 in Cairo governorate. A self-administrated questionnaire was completed by 359 HCWs.

Results: The majority of HCWs reported some discriminatory practices when rendering care to HIV patients, with nurses showing the highest significant number of discriminatory practices. A considerable proportion of HCWs reported witnessing HIV-related SAD at their health facilities.

Conclusions: HIV-related SAD was prevalent among HCWs. Hence, HIV-related training relevant to the needs of different groups of HCWs is recommended. Provision of infection control supplies to protect against occupational exposure is also needed. The setting and enforcement of anti-stigma policies and guidelines in various healthcare settings are crucial.
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http://dx.doi.org/10.1093/trstmh/trab188DOI Listing
January 2022

Management of liver disease patients in different clinical situations during COVID-19 pandemic.

Egypt Liver J 2021 26;11(1):21. Epub 2021 Mar 26.

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

Chronic liver diseases are common worldwide, especially in developing countries. The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/(COVID-19) leads to the infection of many patients with underlying chronic liver diseases. As a relatively new disease, management of COVID-19, in the context of chronic liver disease, is mainly based on the experience of the treating physician and the available data. In this review, we summarize the available evidence about the management of liver disease patients, in the context of COVID-19 infection, which can increase the severity of viral hepatitis B. Also, its clearance in HBV patients is delayed. A sixfold increased severity of COVID-19 was reported in obese patients with metabolic associated fatty liver disease (MAFDL). In patients with autoimmune liver disease (AILD), it is not recommended to change their immunosuppressive therapy (as long as they are not infected with COVID-19), in order to avoid a flare of liver disease. However, immunosuppressant drugs should be modified, in the case of infection with COVID-19. To date, no data suggest an increased risk or severity in metabolic liver diseases, such as hemochromatosis, Wilson's disease, or alpha-1 antitrypsin deficiency. Patients with liver cirrhosis should be carefully managed with minimum exposure to healthcare facilities. Basic investigations for follow-up can be scheduled at wider intervals; if patients need admission, this should be in COVID-19-clean areas. Patients with hepatocellular carcinomas may have a poor prognosis according to preliminary reports from China. The course of COVID-19 in liver transplant recipients on immunosuppression seems to have a benign course, based on few reports in children and adults. The hepatotoxicity of COVID-19 drugs ranges from mild liver enzyme elevation to a flare of underlying liver diseases. Therefore, the decision should be customized. Telemedicine can minimize the exposure of healthcare workers and patients to infection with COVID-19 and decrease the consumption of personal protective equipment.
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http://dx.doi.org/10.1186/s43066-021-00091-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994958PMC
March 2021

Development and multicenter validation of FIB-6: A novel, machine learning, simple bedside score to rule out liver cirrhosis and compensated advanced chronic liver disease in patients with chronic hepatitis C.

Hepatol Res 2022 Feb 24;52(2):165-175. Epub 2021 Nov 24.

Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.

Background: Non-invasive tests (NITs), such as Fibrosis-4 index (FIB-4) and the aspartate aminotransferase-to-platelet ratio index (APRI), developed using classical statistical methods, are increasingly used for determining liver fibrosis stages and recommended in treatment guidelines replacing the liver biopsy. Application of conventional cutoffs of FIB-4 and APRI resulted in high rates of misclassification of fibrosis stages.

Aim: There is an unmet need for more accurate NITs that can overcome the limitations of FIB-4 and APRI.

Patients And Methods: Machine learning with the random forest algorithm was used to develop a non-invasive index using retrospective data of 7238 patients with biopsy-proven chronic hepatitis C from two centers in Egypt; derivation dataset (n = 1821) and validation set in the second center (n = 5417). Receiver operator curve analysis was used to define cutoffs for different stages of fibrosis. Performance of the new score was externally validated in cohorts from two other sites in Egypt (n = 560) and seven different countries (n = 1317). Fibrosis stages were determined using the METAVIR score. Results were also compared with three established tools (FIB-4, APRI, and the aspartate aminotransferase-to-alanine aminotransferase ratio [AAR]).

Results: Age in addition to readily available laboratory parameters such as aspartate, and alanine aminotransferases, alkaline phosphatase, albumin (g/dl), and platelet count (/cm ) correlated with the biopsy-derived stage of liver fibrosis in the derivation cohort and were used to construct the model for predicting the fibrosis stage by applying the random forest algorithm, resulting in an FIB-6 index, which can be calculated easily at http://fib6.elriah.info. Application of the cutoff values derived from the derivation group on the validation groups yielded very good performance in ruling out cirrhosis (negative predictive value [NPV] = 97.7%), compensated advance liver disease (NPV = 90.2%), and significant fibrosis (NPV = 65.7%). In the external validation groups from different countries, FIB-6 demonstrated higher sensitivity and NPV than FIB-4, APRI, and AAR.

Conclusion: FIB-6 score is a non-invasive, simple, and accurate test for ruling out liver cirrhosis and compensated advance liver disease in patients with chronic hepatitis C and performs better than APRI, FIB-4, and AAR.
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http://dx.doi.org/10.1111/hepr.13729DOI Listing
February 2022

Clinical evaluation of pregnant women with SARS-COV2 pneumonia: a real-life study from Egypt.

J Egypt Public Health Assoc 2021 Nov 4;96(1):29. Epub 2021 Nov 4.

MOHP, Cairo, Egypt.

Background: Knowledge about the outcome of COVID-19 on pregnant women is so important. The published literature on the outcomes of pregnant women with COVID-19 is confusing. The aim of this study was to report our clinical experience about the effect of COVID-19 on pregnant women and to determine whether it was associated with increased mortality or an increase in the need for mechanical ventilation in this special category of patients.

Methods: This was a cohort study from some isolation hospitals of the Ministry of Health and Population, in eleven governorates, Egypt. The clinical data from the first 64 pregnant women with COVID-19 whose care was managed at some of the Egyptian hospitals from 14 March to 14 June 2020 as well as 114 non-pregnant women with COVID-19 was reviewed.

Results: The two groups did not show any significant difference regarding the main outcomes of the disease. Two cases in each group needed mechanical ventilation (p 0.617). Three cases (4.7%) died among the pregnant women and two (1.8%) died among the non-pregnant women (p 0.352).

Conclusions: The main clinical outcomes of COVID-19 were not different between pregnant and non-pregnant women with COVID-19. Based on our findings, pregnancy did not exacerbate the course or mortality of COVID-19 pneumonia.
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http://dx.doi.org/10.1186/s42506-021-00092-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567119PMC
November 2021

Predictors for Severity of SARS-CoV-2 Infection Among Healthcare Workers.

J Multidiscip Healthc 2021 25;14:2973-2981. Epub 2021 Oct 25.

Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, Egypt.

Background: Healthcare workers (HCWs) are still at higher risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections than the general population. Identifying risk factors associated with severe SARS-CoV-2 infections is of paramount importance to protect HCWs and the non-infected patients attending different healthcare facilities.

Purpose: To recognize the predictors for severity of SARS-CoV2 infection among HCWs working in either COVID-19 or non-COVID-19 healthcare settings. Also, to assess compliance of HCW to standard precautions of infection control and explore the possible risk factors for SARS-CoV-2 infection among HCWs.

Methods: A cross-sectional study was conducted among HCWs with suspected or confirmed SARS-CoV-2 infection, from different Egyptian governorates. They were asked to fill in a web-based self-reporting questionnaire. The questionnaire assessed the demographic and socio-economic characteristics of participants, compliance of HCWs to standard precautions of infection control and COVID-19 presentation.

Results: Our study enrolled 204 HCWs (52.3% physicians). Infection of SARS-CoV-2 was confirmed in 61.3% by RT- PCR; 35.8% were admitted to hospital, and of these, 3.9% were admitted to the intensive care unit. While 30.4% had mild disease, 48.5% had moderate disease, 17.2% had severe disease and 3.9% had critical disease. Regression analysis for variables predicting COVID-19 severity among study healthcare workers showed that associated chronic diseases and management at home were the main independent variables predicting severity of their SARS-COV-2 infection, while the variables age, sex, residence, occupation or drug history of immunosuppressives had no role in severity prediction.

Conclusion: Associated chronic diseases and management at home were the main independent variables predicting severity of SARS-COV-2 infection among HCWs. So, HCWs with chronic diseases should not work in COVID-19 designated hospitals, and there should be a screening strategy for their infection with SARS-COV-2. HCWs must not be negligent in adhering to strict precautions of infection control. HCWs infected with SARS-COV-2 must be managed in hospital not at home.
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http://dx.doi.org/10.2147/JMDH.S335226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557804PMC
October 2021

Seroprevalence and epidemiological characteristics of HDV infection among HBV patients in the Nile Delta, Egypt.

J Viral Hepat 2022 01 7;29(1):87-90. Epub 2021 Oct 7.

Department of Gastroenterology & Hepatology and Infectious Diseases Department, Al-Azhar University, Cairo, Egypt.

The epidemiology of HDV infection worldwide is obscure. Mapping the epidemiology of the infection is highly required, so, we aimed to estimate the prevalence of hepatitis D virus infection among chronic hepatitis B patients and the epidemiological characteristics in the Nile delta in Egypt. This was a prospective observational cross-sectional study including consecutive chronic hepatitis B patients in the out-patient clinics at the Egyptian Liver Research Institute and Hospital (ELRIAH) and its satellites in the Nile Delta from January 2016 until August 2018. They were recruited from patients enrolled in Educate, Test and Treat program, which was implemented in 73 Egyptian Villages. Subjects were tested by using HBsAg serological rapid diagnostic tests (RDTs), and then HBV DNA by PCR was done in HBsAg-positive cases. HDV IgG antibody testing and confirmatory HDV RNA PCR were done. Complete liver functions, abdominal ultrasonography and FibroScan were also performed. The prevalence of HDV was 3.4% using anti-delta antibody (22/631), and only 8 were positive for HDV RNA (8/22, 36.4%). Overall HDV prevalence using PCR was 8/631(1.27%). HDV-positive cases were mainly males (68.2%). Eight cases were cirrhotic (36.4%), 3 (13.6%) had HCC and 7 (31.8%) were HBeAg positive. HDV prevalence is low among chronic hepatitis B patients in the Nile delta, Egypt. Screening for HDV IgG is recommended in CHB patients who had cirrhosis, HCC or HBeAg positive.
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http://dx.doi.org/10.1111/jvh.13621DOI Listing
January 2022

Protein networks linking Warburg and reverse Warburg effects to cancer cell metabolism.

Biofactors 2021 Sep 28;47(5):713-728. Epub 2021 Aug 28.

Emeritus Prof. Department of Pathology, Yale University, Connecticut, USA.

It was 80 years after the Otto Warburg discovery of aerobic glycolysis, a major hallmark in the understanding of cancer. The Warburg effect is the preference of cancer cell for glycolysis that produces lactate even when sufficient oxygen is provided. "reverse Warburg effect" refers to the interstitial tissue communications with adjacent epithelium, that in the process of carcinogenesis, is needed to be explored. Among these cell-cell communications, the contact between epithelial cells; between epithelial cells and matrix; and between fibroblasts and inflammatory cells in the underlying matrix. Cancer involves dysregulation of Warburg and reverse Warburg cellular metabolic pathways. How these gene and protein-based regulatory mechanisms have functioned has been the basis for this review. The importance of the Warburg in oxidative phosphorylation suppression, with increased glycolysis in cancer growth and proliferation is emphasized. Studies that are directed at pathways that would be expected to shift cell metabolism to an increased oxidation and to a decrease in glycolysis are emphasized. Key enzymes required for oxidative phosphorylation, and affect the inhibition of fatty acid metabolism and glutamine dependence are conferred. The findings are of special interest to cancer pharmacotherapy. Studies described in this review are concerned with the effects of therapeutic modalities that are intimately related to the Warburg effect. These interactions described may be helpful as adjuvant therapy in controlling the process of proliferation and metastasis.
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http://dx.doi.org/10.1002/biof.1768DOI Listing
September 2021

Impact of successful HCV treatment using direct acting antivirals on recurrence of well ablated hepatocellular carcinoma.

Expert Rev Anti Infect Ther 2022 Feb 15;20(2):307-314. Epub 2021 Jul 15.

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

Background: There are many contradictory studies that dealt with hepatocellular carcinoma (HCC) recurrence rate of well ablated hepatitis C virus (HCV) related HCC. We aim to assess the recurrence rate of previously ablated HCC in patients who received direct acting antiviral (DAA) for their HCV.

Research Design And Methods: This is a retrospective data analysis of 523 HCV patients who have a history of successfully ablated HCC and eligible for HCV treatment. Retrieval was done to demographic/clinical data, HCV pretreatment investigations, HCV treatment outcome. Follow up for survival and HCC recurrence was done every 3 months using abdominal ultrasound and alfa-fetoprotein.

Results: Mean age was 53.83 years. Sofosbuvir/daclatasvir/ribavirin was the most used regimen (35.4%) with 438 patients (83.7%) achieved sustained virologic response (SVR). The median duration for surveillance was 159 weeks. Hundred and five patients developed recurrent HCC, with a crude recurrence rate of 20.1%. There was no difference between HCV responders and non-responders in crude recurrence rate (p = 0.94) but HCC developed earlier in non-responders (p = <0.01).

Conclusion: Recurrence of HCC remains a threat in HCV patients even after achieving an SVR. Implementation of long-term surveillance programs is highly recommended.
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http://dx.doi.org/10.1080/14787210.2021.1951230DOI Listing
February 2022

Knowledge, Applicability, and Barriers of Telemedicine in Egypt: A National Survey.

Int J Telemed Appl 2021 9;2021:5565652. Epub 2021 Jun 9.

Hepatogastroenterology and Infectious Diseases Department, Al-Azhar University, Cairo, Egypt.

Objectives: The study is aimed at evaluating knowledge, attitude, and barriers to telemedicine among the general population in Egypt.

Methods: A questionnaire-based cross-sectional design was carried out among the general Egyptian population. A convenience sampling method was used to approach the eligible participants from University Teaching Hospitals of eight governorates from May to July 2020.

Results: A total of 686 participants filled the questionnaire (49.4% were males, mean age 36.7 ± 11.2 years old). Half of the participants stated that they previously used a telemedicine tool, mainly to follow up laboratory results (67.3%). Video or phone calls (39.3%) and mobile applications (23.7%) were the most commonly recognized telemedicine tools by the participants. The included participants exhibited a high level of knowledge and attitude towards telemedicine. On the other hand, 21.9% stated that telemedicine services could jeopardize patient privacy. 32.8% reported that telemedicine service could lead to disclosing medical information to people who are not authorized to do so. Almost half of the participants agreed to strongly agreed that telemedicine service could increase medical errors. 60.80% of the participants said that they are more likely to prefer telemedicine than traditional ways. However, 13.70% stated that telemedicine is more likely to be challenging to use.

Conclusion: The Egyptian population has high knowledge about the applications of telemedicine. In addition, the vast majority of Egyptians appear to perceive the benefits of telemedicine positively and are willing to use it. However, some barriers that have been found must be taken into consideration to adopt telemedicine successfully, especially for people who are old, are low educated, and live in remote areas. Future studies should address the utility of telemedicine in improving the quality of healthcare and patient's health outcome and quality of life.
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http://dx.doi.org/10.1155/2021/5565652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192215PMC
June 2021

Utility of Lung Ultrasound in Decision-making to Prioritize Hospital Admission for COVID-19 Patients: A Developing Country Perspective.

Curr Med Imaging 2021 ;17(12):1473-1480

Minister of Health and Population, Cairo, Egypt.

Background And Aims: In the midst of this pandemic, planning the prioritization of hospital admissions for patients affected with COVID-19 should be of prime concern, particularly in healthcare settings with limited resources. Thus, in this study, we aimed to develop a novel approach to triage COVID-19 patients and attempt to prioritize their hospital admission using Lung Ultrasonography (LUS). The efficacy of LUS in triaging suspected COVID-19 patients and assessing the severity of COVID-19 pneumonia was evaluated; the findings were then compared with those obtained by chest computed tomography (CT).

Methods: This multicenter, cross-sectional study comprised 243 COVID-19 patients who presented to the emergency department in 3 major university hospitals in Egypt. LUS was performed by an experienced emergency or chest physician, according to the local protocol of each hospital. Demographic, clinical, and laboratory data were then collected from each patient. Each patient was subjected to chest CT scans and LUS.

Results: The mean age of the 243 patients was 46.7 ± 10.4 years. Ground-glass opacity, subpleural consolidation, translobar consolidation, and crazy paving were reported in the chest CT scans of 54.3%, 15.2%, 11.1%, and 8.6% of the patients, respectively. B-line artifacts were observed in 81.1% of the patients (confluent pattern, 18.9%). The LUS findings completely coincided with the CT findings (Kappa agreement value, 0.77) in 197 patients (81.1%) and offered a diagnostic sensitivity of 74%, diagnostic specificity of 97.9%, positive predictive value of 90.2%, and negative predictive value of 93.6% for the COVID-19 patients. Following the addition of O2 saturation to the lung imaging findings, the ultrasound method was able to demonstrate 100% sensitivity and specificity in accurately differentiating between severe and non-severe lung diseases.

Conclusion: LUS with oxygen saturation might prove to be effective in prioritizing the hospital admission of COVID-19 patients, particularly in healthcare settings with limited resources.
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http://dx.doi.org/10.2174/1573405617666210506164243DOI Listing
January 2022

HCC developed in CHC patients who achieved SVR following DAAs tend to display less aggressive pattern.

Clin Res Hepatol Gastroenterol 2021 05 5;45(3):101608. Epub 2021 Jan 5.

Hepato-gastroenterology and Infectious Diseases Department, Al-Azhar University, Cairo, Egypt.

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http://dx.doi.org/10.1016/j.clinre.2020.101608DOI Listing
May 2021

Nomenclature and definition of metabolic-associated fatty liver disease: a consensus from the Middle East and north Africa.

Lancet Gastroenterol Hepatol 2021 01 9;6(1):57-64. Epub 2020 Nov 9.

Egyptian Liver Research Institute and Hospital, Mansoura, Egypt; Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt.

With the increasing prevalence of obesity and type 2 diabetes, fatty liver disease associated with metabolic dysfunction is a global health problem, especially because it is one of the earliest consequences of obesity and it precedes diabetes development. Fatty liver disease associated with metabolic dysfunction is of particular concern in the Middle East and north Africa, where its prevalence is greater than that in the rest of the world. Despite the magnitude of the problem, no regional guidelines have been developed to address this disease. This Review describes suggestions of redefining fatty liver disease associated with metabolic dysfunction, including its terminology and criteria for diagnosis. Experts have raised serious concerns on the current nomenclature, which labels the disease as non-alcoholic fatty liver disease (NAFLD), and its diagnostic criteria. The panel reached a consensus that the disease should be renamed as metabolic-associated fatty liver disease (MAFLD) and that the disease should be diagnosed by positive criteria. The aim is now to work with authorities across the region to implement these proposed changes and reflect them in health-care policy and to improve health care for patients in this region.
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http://dx.doi.org/10.1016/S2468-1253(20)30213-2DOI Listing
January 2021

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

Comparison Between Insecticidal Activity of Lantana camara Extract and its Synthesized Nanoparticles Against Anopheline mosquitoes.

Pak J Biol Sci 2019 Jan;22(7):327-334

Background And Objective: Malaria is still a severe health problem especially in developing countries which occur and young children are the most affected. The present study was designed to compare the insecticidal potential of Lantana camara leaves extract alone and its synthesized nanoparticles against Anopheles multicolor.

Materials And Methods: Copper nanoparticles CuNPs were synthesized by green bio-reduction method using aqueous extract of leaves of Lantana camara plant. The CuNPs formation was confirmed by ultraviolet visible spectrophotometer (UV-VIS) and Transitional Electron Microscopy (TEM). The application of L. camara extract and its synthesized CuNPs on different stages of A. multicolor were adopted.

Results: The biosynthesized CuNPs were spherical with the average sizes of 11-17.8 nm. The highest insecticidal effect (100% of larval mortality) achieved at high dose (140 ppm) of L. camara leaves extract alone comparing with that occur at low dose (20 ppm) of CuNPs synthesized L. camara leaves. The LC50 and LC90 for the 4 instar larvae were 63.5 and 119.9 ppm for plant extract alone compared to 12.6 and 18.4 ppm for CuNPs preparation.

Conclusion: So, this study proved that CuNPs preparation of L. camara leaves is highly efficient compared to the plant extract alone and more economic as less quantities were used. Also, awareness against invasion of Anopheles mosquito vectors with effective preventive measures to protect from malaria infection.
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http://dx.doi.org/10.3923/pjbs.2019.327.334DOI Listing
January 2019

Nanomedicine as a putative approach for active targeting of hepatocellular carcinoma.

Semin Cancer Biol 2021 02 14;69:91-99. Epub 2019 Aug 14.

Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Electronic address:

The effectiveness of chemotherapy in hepatocellular carcinoma (HCC) is restricted by chemo-resistance and systemic side effects. To improve the efficacy and safety of chemotherapeutics in HCC management, scientists have attempted to deliver these drugs to malignant tissues using targeted carriers as nanoparticles (NPs). Among the three types of NPs targeting (active, passive, and stimuli-responsive), active targeting is the most commonly investigated in HCC treatment. Despite the observed promising results so far, clinical research on nanomedicine targeting for HCC treatment still faces many challenges.These include batch-to-batch physicochemical properties' variations, limiting large scale production and insufficient data on human and environmental toxicities. This review summarized the characteristics of different nanocarriers, ligands, targeted receptors on HCC cells and provided recommendations to overcome the challenges, facing this novel line of treatment for HCC.
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http://dx.doi.org/10.1016/j.semcancer.2019.08.016DOI Listing
February 2021

Fib-4 Predicts Early Hematological Adverse Events Induced by Interferon-Based Triple Therapy in Chronic Hepatitis C Virus Patients.

J Interferon Cytokine Res 2019 02 18;39(2):85-94. Epub 2019 Jan 18.

5 Damietta Fever Hospital, Damietta, Egypt.

Interferon-alpha (IFN-α)-based therapy is associated with several hematological adverse events in hepatitis C virus (HCV)-infected patients with advanced fibrosis. We performed this study to evaluate the association between Fibrosis-4 (Fib-4) index and hematological adverse events in patients with chronic HCV infection, undergoing IFN-α-based triple therapy. We included 120 HCV-infected patients, receiving triple therapy: weekly PegIFN-α, daily ribavirin (1,000-1,200 mg), and daily sofosbuvir (400 mg) for 12 weeks. We compared Fib-4 scores for patients who developed hematological adverse events at weeks 4 (w4) and w12 of treatment and w12 post-treatment versus those who did not. Treatment with the aforementioned triple regimen was associated with a sustained virological response (SVR)-12 rate of 93.9%. We found no significant associations (P > 0.05) between SVR12 rate and the degree of fibrosis or the risk of hematological adverse events. The Fib-4 score could predict patients who developed hematological adverse events (anemia, leukopenia, and neutropenia) in the first month of treatment, but not in later stages. A Fib-4 cutoff value of 3.59 had high specificity for anemia, leukopenia, and neutropenia (85.1%, 87.2%, and 88.2%, respectively), but had low sensitivity for detecting the 3 events. In conclusion, the Fib-4 score may predict early hematological adverse effects in HCV-infected patients on IFN-based triple therapy.
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http://dx.doi.org/10.1089/jir.2018.0131DOI Listing
February 2019

Whole-food phytochemicals antioxidative potential in alloxan-diabetic rats.

Toxicol Rep 2018 12;5:240-250. Epub 2018 Jan 12.

Tropical Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Background: The importance of whole-food antioxidants in terms of promoting antioxidant recycling in the body in complex human diseases is not fully understood. We aim to discuss the benefits of whole-food antioxidants in ameliorating the diabetic complications and to address the effect of germination versus heat processing or drying on the potential therapeutic effect of whole grains and legumes. We studied the antioxidant status of alloxan-diabetic (AD) male Spargue Dawley rats, injected intraperitoneally with alloxan dose of 150 mg/kg body weight, and fed on experimental diets based on the flour of soybean, broadbean and whole-wheat for five weeks.

Results: Diabetes-induced oxidative stress in liver was manifested by significant increase in hepatic malondialdehyde (MDA), erythrocytes superoxide dismutase (eSOD) and plasma alpha-tocopherol (α-T) levels, reduction in hepatic glutathione (GSH) levels and catalase (CAT) activity. Consumption of soybean and whole-wheat both had beneficial effects on the oxidative status of AD rats more than broadbean. Feeding dried wheat was effective in improving MDA, GSH and α-T levels. Soybeans and wheat lowered triacylglycerols (TAGs) and tended to lower total cholesterol. Germination enhanced the effect of soybeans on TAGs and in the case of soy and wheat enhanced the effect on total cholesterol.

Conclusion: Whole foods containing naturally occurring phytochemicals and antioxidant vitamins such as legumes and whole grains are recommended, alongside medication, for controlling hyperglycaemia, blood lipids and oxidative status in diabetes.
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http://dx.doi.org/10.1016/j.toxrep.2018.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977378PMC
January 2018

Risk of hepatitis B virus reactivation with direct-acting antivirals against hepatitis C virus: A cohort study from Egypt and meta-analysis of published data.

Liver Int 2018 12 22;38(12):2159-2169. Epub 2018 May 22.

Unité d'Epidémiolotie des Maladies Emergentes, Institut Pasteur, Paris, France.

Background & Aims: Hepatitis B virus (HBV) reactivation in chronic hepatitis C (CHC) patients treated with direct-acting antivirals (DAAs) became an issue. However, its frequency has been poorly estimated, because of the varying definitions used and evaluation of heterogeneous study populations, including those concurrently treated for HBV.

Methods: We prospectively followed HBV surface antigen (HBsAg)-positive Egyptians undergoing interferon-free DAAs, to estimate the risk of HBV reactivation and HBV-related hepatitis. We also conducted a meta-analysis to estimate the reactivation risk using published data obtained from a systematic review of PubMed/Embase, in addition to our Egyptian data. We applied a standard definition of HBV reactivation proposed by the international liver associations (APASL and AASLD).

Results: Of 4471 CHC patients, 35 HBsAg-positive patients started interferon-free DAAs without HBV nucleos(t)ide analogues in our Egyptian cohort. Ten experienced HBV reactivation (28.6%), of whom 1 developed hepatitis (10.0%). Our systematic review identified 18 papers. The pooled reactivation risk in HBsAg-positive patients was 18.2% (95% CI: 7.9%-30.7%) without HBV therapy and 0.0% (95% CI: 0.0%-0.0%) with HBV nucleos(t)ide analogue. The pooled risk of hepatitis in those with HBV reactivation was 12.6% (95% CI: 0.0%-34.7%). The pooled reactivation risk in HBsAg-negative, antibody to HBV core antigen-positive (anti-HBc-positive) patients was negligible (0.1%, 95% CI: 0.0%-0.3%), irrespective of the presence of antibody to HBsAg (anti-HBs).

Conclusions: We confirmed high HBV reactivation risk in HBsAg-positive patients undergoing DAAs, with only a minority developing clinically important hepatitis. The risk is negligible for HBsAg-negative anti-HBc-positive patients.
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http://dx.doi.org/10.1111/liv.13874DOI Listing
December 2018

Significance of Glypican-3 in Early Detection of Hepatocellular Carcinoma in Cirrhotic Patients.

J Gastrointest Cancer 2019 Sep;50(3):434-441

Department of Biochemistry and Nutrition, Faculty of Women for Arts, Sciences and Education, Ain Shams University, Heliopolis, Cairo, Egypt.

Background: Egypt has high incidence of hepatocellular carcinoma (HCC). This is due to wide spread of hepatitis C virus (HCV) infection which is responsible for most of the cases of liver cirrhosis. The major diagnostic techniques for HCC include serum markers and various imaging modalities. Glypican 3 (GPC3) protein is highly expressed in HCC, but not in normal liver tissue. The significance of GPC3 as a predictor or diagnostic tool for human tumors other than HCC is unclear.

Aim: To quantitatively assess the role of GPC3 in diagnosis of HCC in comparison to α-fetoprotein (AFP), ultrasonography (US), and computerized tomography (CT).

Patients And Methods: This cross-sectional study enrolled 85 subjects: 40 cirrhotic patients with primary HCC, 30 cirrhotic patients without HCC, and 15 healthy individuals. All patients were recruited from the Gastroenterology and Tropical Departments and outpatient clinics of New Damietta Hospital during the period from November 2010 to August 2012.

Results: GPC3 is positive in some HCC patients with normal levels of AFP. AFP has lower sensitivity (67.5%) compared to higher sensitivity of GPC3 (82.5%), and near specificity (61.2%) to GPC3 (57.8%).

Conclusion And Significance: The combined serum AFP and GPC3 significantly increased the sensitivity of HCC diagnosis. Although GPC3 is better than AFP in diagnosis of HCC, it still lacks the 100% sensitivity and specificity because some patients have negative or normal level of GPC3 (below the cutoff point 1.5 ng/ml) despite being diagnosed by triphasic CT.
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http://dx.doi.org/10.1007/s12029-018-0095-2DOI Listing
September 2019

Real life Egyptian experience of efficacy and safety of Simeprevir/Sofosbuvir therapy in 6211 chronic HCV genotype IV infected patients.

Liver Int 2017 04 4;37(4):534-541. Epub 2016 Nov 4.

Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt.

Background & Aims: Major changes have emerged during the last few years in the therapy of chronic HCV. Several direct acting antiviral agents have been developed showing potent activity with higher rates of sustained virological response, even in difficult-to-treat patients. This study explores real life experience concerning efficacy, safety and possible predictors of response for the first cohort of Egyptian patients with chronic HCV genotype IV treated with Sofosbuvir/Simprevir combination therapy.

Methods: This real life study recruited the first (6211) chronic HCV genotype IV Egyptian patients, who received antiviral therapy in viral hepatitis specialized treatment centres affiliated to the National committee for control of viral hepatitis. All enrolled patients received 12 weeks course of daily combination of sofosbuvir (400 mg) and simeprevir (150 mg). Patients were closely monitored for treatment safety and efficacy.

Results: Overall sustained virological response 12 rate was 94.0% while the end of treatment response rate was 97.6%. sustained virological response 12 rates in easy and difficult-to-treat groups were 96% and 93% respectively. Univariate and multivariate logistic regression analysis revealed significant association of low albumin (<3.5), cirrhosis and Fib-4 score (>3.25) with treatment failure. Fatal adverse events occurred in 23/6211 cases (0.37%) due to liver cell failure adverse events or SAEs leading to treatment discontinuation occurred in 97 patients (1.6%).

Conclusion: Sofosbuvir/Simeprevir combination is an effective and well tolerated regimen for patients with chronic HCV genotype IV.
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http://dx.doi.org/10.1111/liv.13266DOI Listing
April 2017
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