Publications by authors named "Shaimaa Soliman"

40 Publications

Knowledge, attitudes, practices and perceived barriers towards research in undergraduate medical students of six Arab countries.

BMC Med Educ 2022 Jan 18;22(1):44. Epub 2022 Jan 18.

Faculty of Medicine, Menoufia University, Shebin El-kom, Egypt.

Background: The involvement of the undergraduates in the research field requires a better view of their potential and the anticipated barriers facing them. This study aims to assess the undergraduates' knowledge, attitudes, practices and perceived barriers towards research in six Arab countries.

Methods: A cross sectional study included medical students from six Arab countries, where a self-administered five-section questionnaire was used to assess the students' demographics, knowledge, attitudes, practices and perceived barriers. The questionnaire was distributed in the online educational platforms of the participating medical schools in the six included countries.

Results: The total sample of recruited students was 2989, the majority of students (91.6%) showed poor level of knowledge regarding research. Generally high levels of positive attitudes towards research, research relevance and usefulness were found, with moderate levels of perception of research anxiety and difficulty. 33.7% (n = 1006) participated in an actual research project before with a mean of .5 publications per student. Cross-sectional studies were the most common type of studies conducted by students (38.6%), followed by case reports (23.9%). Lack of access to lab equipment for lab research (68.1%), the priority of education over research (66.8%), and lack of time because of educational tasks (66.1%) were generally the top perceived barriers towards research practice.

Conclusion: In the current study, the participants showed a poor knowledge level with associated positive attitudes towards research. One third of the students participated in research projects that mostly were cross-sectional studies and case reports. Educational tasks and lack of support were the most prevalent barriers. The students' positive attitudes towards research need to be translated into better knowledge and appropriate practice, which can be done by development of better training systems and more structured mentoring.
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http://dx.doi.org/10.1186/s12909-022-03121-3DOI Listing
January 2022

A Simple Scoring Model Predicting the Outcome of COVID-19 Patients: Tanta COVID score.

Endocr Metab Immune Disord Drug Targets 2021 Nov 25. Epub 2021 Nov 25.

Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

Background & Aim: COVID-19 is a worldwide pandemic with high rates of morbidity and mortality, and an uncertain prognosis leading to an increased risk of infection in health providers and limited hospital care capacities. In this study, we have proposed a predictive, interpretable prognosis scoring system with the use of readily obtained clinical, radiological and laboratory characteristics to accurately predict worsening of the condition and overall survival of patients with COVID -19.

Methods: This is a single-center, observational, prospective, cohort study. A total of 347 patients infected with COVID-19 presenting to the Tanta university hospital, Egypt, were enrolled in the study, and clinical, radiological and laboratory data were analyzed. Top-ranked variables were identified and selected to be integrated into a Cox regression model, building the scoring system for accurate prediction of the prognosis of patients with COVID-19.

Results: The six variables that were finally selected in the scoring system were lymphopenia, serum CRP, ferritin, D-Dimer, radiological CT lung findings and associated chronic debilitating disease. The scoring system discriminated risk groups with either mild disease or severe illness characterized by respiratory distress (and also those with hypoxia and in need for oxygen therapy or mechanical ventilation) or death. The area under the curve to estimate the discrimination performance of the scoring system was more than 90%.

Conclusion: We proposed a simple and clinically useful predictive scoring model for COVID-19 patients. However, additional independent validation will be required before the scoring model can be used commonly.
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http://dx.doi.org/10.2174/1871530321666211126104952DOI Listing
November 2021

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

Remdesivir Efficacy in COVID-19 Treatment: A Randomized Controlled Trial.

Am J Trop Med Hyg 2021 Sep 10. Epub 2021 Sep 10.

Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt.

To date, no antiviral therapy has shown proven clinical effectiveness in treating patients with COVID-19. We assessed the efficacy of remdesivir in hospitalized Egyptian patients with COVID-19. Patients were randomly assigned at a 1:1 ratio to receive either remdesivir (200 mg on the first day followed by 100 mg daily for the next 9 days intravenously infused over 30-60 minutes) in addition to standard care or standard care alone. The primary outcomes were the length of hospital stay and mortality rate. The need for mechanical ventilation was assessed as a secondary outcome. Two hundred patients (100 in each group) completed the study and were included in the final analysis. The remdesivir group showed a significantly lower median duration of hospital stay (10 days) than the control group (16 days; P < 0.001). Eleven of the patients in the remdesivir group needed mechanical ventilation compared with eight patients in the control group (P = 0.469). The mortality rate was comparable between the two groups (P = 0.602). Mortality was significantly associated with older age, elevated C-reactive protein levels, elevated D-dimer, and the need for mechanical ventilation (P = 0.039, 0.003, 0.001, and < 0.001 respectively). Remdesivir had a positive influence on length of hospital stay, but it had no mortality benefit in Egyptian patients with COVID-19. Its use, in addition to standard care including dexamethasone, should be considered, particularly in low- and middle-income countries when other effective options are scarce.
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http://dx.doi.org/10.4269/ajtmh.21-0606DOI Listing
September 2021

A study of anxiety, depression and stress symptoms among Fayoum medical students during COVID-19 lockdown, Egypt.

Egypt J Neurol Psychiatr Neurosurg 2021 10;57(1):123. Epub 2021 Sep 10.

Psychiatry Department, Faculty of Medicine, Fayoum University, POBox: 63514, Faiyum, Egypt.

Background: The widespread pandemic of COVID-19 virus carries not only physical hazards, but also major psychological effects especially among medical students. The aim was to investigate the psychological effects of COVID-19 on medical students and the factors affecting them. The study was carried out with an online questionnaire distributed through Google Forms for medical students at Faculty of Medicine, Egypt. The questionnaire included socio-demographic questions, validated psychometric tools for the assessment of depression, anxiety and stress (Depression Anxiety Stress Scales DASS-21) and the Impact of Event Stress Scale-Revised (IES-R) were applied.

Results: The total number of participants was 282 students. Percentage of participants with clinically significant depression was 75.2%, anxiety was 56.4% and stress was 52.9%. Those showed PTSD probability was 54.3%. The multivariate regression analysis revealed that IES remained significantly associated with gender and previous road accidents, depression and anxiety remained significantly associated with personal history of psychiatric illness, while stress remained significantly associated with gender and previous road accidents.

Conclusions: Medical students were highly depressed, anxious and stressed during period of COVID-19 pandemic. Being a female, having previous history of psychiatric illness and previous road accident were highly associated with increasing the psychological impact of COVID-19.
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http://dx.doi.org/10.1186/s41983-021-00377-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431257PMC
September 2021

Work schedule and substance abuse in vocational students.

J Public Health Res 2021 Aug 4. Epub 2021 Aug 4.

Community, Environmental and Occupational Health Department, Faculty of Medicine, Benha University.

Background: Drug abuse is one of the world's most serious and rapidly rising problems, causing a wide variety of health issues with significant morbidity and mortality. This study aimed to explore the association between part-time work and substance abuse among vocational students.

Design And Methods: We conducted a cross-sectional analytical study that included all part-time working male students from five vocational male schools, and we used a standardized pretested questionnaire after obtaining written informed consent.  A One-Step Multi-Drug Screen Test was used to assess the substances that were abused.

Results: A total of 316 out of the 400 invited students participated in our study. Of the total screened subjects, 26.6 % were abusing substances. Twenty-five (36.2%) day working adolescents, nine (14.0%) night working adolescents, and forty (36.0%) day and night working adolescents were abusers.Tobacco was the most widely abused drug (68%) in the form of smoking, followed by cannabis (24%), marijuana (16.4%), alcohol (10%), and opioid (6.3%). Night workers had significantly lower rates of smoking, cannabis, Marijuana, alcohol, or opioids abuse, and Logistic regression was performed to ascertain the effects of the work schedule on the likelihood that participants have substance abuse; Night workers were 7.14 times less likely to have substance abuse than day workers, while day and night work did not differ from day work.

Conclusions: The prevalence of drug abuse in vocational students is considered high and a serious problem that damages the youth and the community.
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http://dx.doi.org/10.4081/jphr.2021.2395DOI Listing
August 2021

Clinical study evaluating the efficacy of ivermectin in COVID-19 treatment: A randomized controlled study.

J Med Virol 2021 Oct 7;93(10):5833-5838. Epub 2021 Jun 7.

Department of Endemic Medicine, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.

Researchers around the world are working at record speed to find the best ways to treat and prevent coronavirus disease 2019 (COVID-19). This study aimed to evaluate the efficacy of ivermectin for the treatment of hospitalized mild to moderate COVID-19 infected patients. This was a randomized open-label controlled study that included 164 patients with COVID-19. Patients were randomized into two groups where Group 1 (Ivermectin group) included patients who received ivermectin 12 mg once daily for 3 days with standard care and Group 2 (control group) included patients who received standard protocol of treatment alone for 14 days. The main outcomes were mortality, the length of hospital stay, and the need for mechanical ventilation. All patients were followed up for 1 month. Overall, 82 individuals were randomized to receive ivermectin plus standard of care and 82 to receive standard of care alone. Patients in the ivermectin group had a shorter length of hospital stay (8.82 ± 4.94 days) than the control group (10.97 ± 5.28 days), but this was not statistically significant (p = 0.085). Three patients (3.7%) in each group required mechanical ventilation (p = 1.00). The death rate was three patients in the ivermectin group (3.7%) versus four patients (4.9%) in the control group without any significant difference between the two groups (p = 1.00). Although there was no statistically significant difference in any endpoints by ivermectin doses (12 mg/day for 3 days); there was an observed trend to reducing hospital stay in the ivermectin-treated group.
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http://dx.doi.org/10.1002/jmv.27122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242425PMC
October 2021

Effects of remote virtual work environment during COVID-19 pandemic on technostress among Menoufia University Staff, Egypt: a cross-sectional study.

Environ Sci Pollut Res Int 2021 Oct 25;28(38):53746-53753. Epub 2021 May 25.

Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Shebin Al-Kom, Menoufia, Egypt.

Technostress during the COVID-19 pandemic has become more prevalent as a result of the global preventive measures applied to limit the spread of infection. These measures included remote working from home in both public and private organizations. The objective of this study is to study technostress and challenges of remote virtual work environment among university staff members at Menoufia University, Egypt. A cross-sectional study was conducted over Menoufia University academic staff members in Egypt. The participants were chosen from both practical and theoretical colleges in Menoufia University using a multistage random sample. Tarfadar technostress questionnaire was used. Cortisol blood level was measured for all participants. This study included 142 participants. The mean age of the group was 36.32±6.41 years. 52.1 percent worked in practical colleges, and 60.6% were lecturers or higher. Their mean cortisol level was 15.61±7.07mcg/dl. Participants who were females, reside in rural areas, held a lecturer or higher position, had poor work-environment WiFi, and lacked technical training had significantly higher levels of technostress subscales. Most of the technostress subscales were significantly correlated with age and blood cortisol levels. The predictors of work overload in multivariate regression were female gender and a work environment with poor WiFi. Female gender, theoretical colleges, being lecturer or higher, and poor WiFi were the predictors for invasion. Among university staff members, technostress was found to be evident. High levels of technostress were significantly influenced by age, higher professions, female gender, and a bad workplace environment.
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http://dx.doi.org/10.1007/s11356-021-14588-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143901PMC
October 2021

The effect of ketogenic diet escalation in adolescents and adults with drug-resistant epilepsy: a prospective study.

Nutr Neurosci 2021 May 20:1-10. Epub 2021 May 20.

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

Background: Ketogenic diet (KD) is an accepted and effective treatment modality in patients with drug-resistant epilepsy (DRE). Different versions of ketogenic diets have been studied, however, the effect of ratio escalation in adolescence and adults has not been previously investigated.

Methods: The current open-labeled interventional study was conducted on 80 patients with drug-resistant epilepsy DRE, 40 patients (intervention group) were exposed to dietary intervention besides their regular antiseizure medication (ASM) and compared to 40 control patients. The intervention group received Ketogenic diet in 2:1 ratio for 1 month then were divided into 2 subgroups, group A1 continued the 2:1 ratio for another 2 months while group A2 escalated to 3:1 dietary regimen. Socio-demographic, anthropometric measurements, epilepsy clinical parameters, and laboratory tests were recorded in addition to safety and tolerability documentation. The response rate was recorded after 1month and 3month.

Results: Significant decrease in seizure frequency and severity were detected in Group A1 and A2 patients compared to controls after the 3 month period of intervention with significant improvement of quality of life scores in both subgroups. Both subgroups also showed comparable results regarding their response rate to KD. Better acceptance of diet taste were reported by subgroup A1 with a significantly higher lipid profile detected in subgroup A2.

Conclusion: KD has a beneficial effect as adjunctive treatment in adolescents and adults with DRE. Escalation from 2:1 to 3:1 ratio is associated with less compliance rather than better response in patients with DRE.
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http://dx.doi.org/10.1080/1028415X.2021.1927604DOI Listing
May 2021

Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials.

Nat Commun 2021 04 15;12(1):2349. Epub 2021 Apr 15.

Infectious and Tropical Diseases Department, Angers University Hospital, Angers, France.

Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/ ). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality has been extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses include patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20; I² = 0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I² = 0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.
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http://dx.doi.org/10.1038/s41467-021-22446-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050319PMC
April 2021

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

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

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

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

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

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

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

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

Efficacy and safety of ombitasvir/paritaprevir/ritonavir/ribavirin in management of Egyptian chronic hepatitis C virus patients with chronic kidney disease: A real-life experience.

Medicine (Baltimore) 2020 Oct;99(42):e21972

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

Treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease was difficult in the past because of the use of interferon (IFN). It was associated with high risk IFN-related adverse reactions due to reduced renal clearance of IFN. This study aimed to evaluate the antiviral efficacy, safety, and tolerability of ombitasvir/paritaprevir/ritonavir/ribavirin in chronic kidney disease patients infected with chronic HCV.This observational, open-label prospective study was carried out on 103 patients infected chronic HCV with different grades of renal impairment. Paritaprevir/ritonavir and ombitasvir (75/50/12.5 mg) twice daily plus ribavirin were given to the patients for 12 weeks. Dose adjustment of ribavirin was done according to degree of renal impairment.Sustained virological response (12 weeks after the end of treatment) occurred in 101 patients (98.1%). Anemia occurred in 48 patients. No serious adverse events were observed in any patient.Paritaprevir/ritonavir and ombitasvir plus ribavirin for 12 weeks was considered to be safe and effective in the treatment of chronic HCV infected patients with varying degrees of renal impairment.
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http://dx.doi.org/10.1097/MD.0000000000021972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572016PMC
October 2020

Positive Effect of Helicobacter pylori Treatment on Outcome of Patients With Chronic Spontaneous Urticaria.

Am J Clin Pathol 2021 02;155(3):405-411

Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt.

Objectives: The association between Helicobacter pylori and chronic spontaneous urticaria (CSU) is controversial. Therefore, we aimed to directly diagnose H pylori by polymerase chain reaction (PCR) in gastric tissue from patients with CSU and to investigate the association between H pylori eradication therapy and CSU remission.

Methods: Twenty-seven of 72 patients with CSU who were positive for H pylori stool antigen and PCR in gastric biopsy specimens were randomized to receive either anti-H pylori treatment or placebo.

Results: Patients with H pylori were found to have significantly lower hemoglobin concentrations with microcytic hypochromic anemia and a significantly higher occurrence of dyspepsia symptoms. All H pylori-treated patients (except two) showed significant improvement of the urticaria itching and red wheals after 2 weeks of therapy compared with the placebo group (P < .001). The response rate to treatment was 85.7% (12 patients; 95% confidence interval, 64.3%-100.0%). The two patients who failed to eradicate H pylori had an H pylori strain resistant to amoxicillin.

Conclusions: An association was observed between CSU and presence of H pylori infection in the gastric tissue. Whether this is a causal relationship or not remains to be discovered, but treatment of H pylori can significantly improve the symptoms of CSU.
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http://dx.doi.org/10.1093/ajcp/aqaa134DOI Listing
February 2021

Platelet Count Improvement after Chronic Hepatitis C Treatment among Cirrhotic Patients Who Achieved Sustained Virological Response: Realworld Results from 2186 Patients in Egypt.

Endocr Metab Immune Disord Drug Targets 2021 ;21(7):1300-1305

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

Background And Aims: This study aimed to assess the changes in platelet counts of patients with liver cirrhosis due to chronic HCV, who achieved sustained virological response (SVR) after taking direct acting antivirals (DAAs) in a large cohort study in Egypt.

Methods: This multicenter observational retrospective study was carried out on 2500 chronic hepatitis C virus (HCV) infected patients who achieved (SVR) after treatment with direct acting antiviral drugs (DAA). HCV infection was confirmed by positive PCR for HCV RNA infection. SVR was defined as a negative PCR test for HCV-RNA 12 weeks after completion of DAA therapy. Platelets count was measured before therapy, during therapy, at the end of treatment, and 12 weeks after the end of the treatment.

Results: There were 2186 patients enrolled in the study; 1866 (85.4%) were treatment naïve. There were 1006 (46%) males and 1180 (54%) females. Mean age was 50.82± 11.66 years, 2142 (98%.0) patients achieved SVR, 2118 (96.9%) patients had Child -Pugh class A cirrhosis, and 68 (3.1%) had Child -Pugh class B liver cirrhosis. A significant increase in the platelets count was detected at the end of treatment in comparison to the pretreatment levels (P<0.001), and after achieving SVR (P <0.001) when compared to the pretreatment values.

Conclusion: Improvement of platelets count occurs after HCV therapy with DAAS in patients with liver cirrhosis. These results suggested that HCV eradication may have a role in the improvement of platelet count.
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http://dx.doi.org/10.2174/1871530320666200917113650DOI Listing
January 2021

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

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

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

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

Quadruple Therapy Offers High SVR Rates in Patients with HCV Genotype 4 with Previous Treatment Failure.

Adv Virol 2020 24;2020:9075905. Epub 2020 Jul 24.

Tropical Medicine Department, Tanta University, Tanta, Egypt.

Background And Aims: Direct-acting antivirals (DAAs) have made a revolution in hepatitis C virus (HCV) treatment with promising reduction of HCV infection and disease morbidities. However, unfortunately, treatment failure still occurs in about 5-15% of patients treated with DAA-based combination regimens. The primary aim of the study was to assess the efficacy and safety of a quadruple regimen of (sofosbuvir, daclatasvir, and simeprevir with a weight-based ribavirin) in chronic HCV DAAs-experienced patients.

Methods: This observational, open-label prospective study was carried out on 103 genotype 4 hepatitis C virus-infected patients who failed to achieve SVR12 after sofosbuvir-daclatasvir with or without ribavirin. Patients were treated for three months with sofosbuvir (400 mg), daclatasvir (60 mg), and simeprevir (150 mg) with a weight-based ribavirin dosage (1000-1200 mg/d). Response to treatment was determined by quantitative PCR for HCV at 3 months after the end of treatment (SVR12), and adverse events during the treatment were recorded.

Results: SVR was achieved in 100 patients (97.1%) at week 12 after treatment. No dangerous or life-threatening adverse events were recorded.

Conclusions: Retreatment of HCV genotype 4 patients with quadruple therapy is a good therapeutic option and achieves high response rates with minimal side effects.
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http://dx.doi.org/10.1155/2020/9075905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396033PMC
July 2020

A scoping review of the impact of COVID-19 pandemic on surgical practice.

Ann Med Surg (Lond) 2020 Sep 9;57:24-36. Epub 2020 Jul 9.

Faculty of Medicine, University of Algiers, Algiers, Algeria.

Background: The current COVID-19 pandemic has challenged the infrastructure of the healthcare systems. To cope with the pandemic, substantial changes were introduced to surgical practice and education all over the world.

Methods: A scoping search in PubMed and Google Scholar was done using the search terms: " They were either searched individually or in combination. All relevant articles of any study design (published within December 15, 2019, till the mid of June 2020), were included and narratively discussed in this review.

Results: Sixty-six articles were reviewed in this article. Through these articles, we provide guidance and recommendations on the preoperative preparation and safety precautions, intraoperative precautions, postoperative precautions, postoperative complications (related to COVID-19), surgical scheduling, emergency surgeries, elective surgeries, cancer surgery, psychological impact on surgical teams, and surgical training during the COVID-19 pandemic.

Conclusion: COVID-19 pandemic has affected nearly all aspects of surgical procedures, scheduling, and staffing. Special precautions were taken before, during, or after surgeries. New treatment and teaching modalities emerged in response to the pandemic. Psychological support and training platforms are necessary for the surgical team.
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http://dx.doi.org/10.1016/j.amsu.2020.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347302PMC
September 2020

MicroRNA signature in hepatocellular carcinoma patients: identification of potential markers.

Mol Biol Rep 2020 Jul 19;47(7):4945-4953. Epub 2020 May 19.

Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

MicroRNAs (miRNAs) play important roles in liver pathologies and they are potential biomarkers for diagnosis of liver diseases progression. Changes in miRNA sera expression can be used as non-invasive biomarkers for hepatocellular carcinoma (HCC). The aim of the study was to identify the miRNome profiling of HCC and its diagnostic value in distinguishing HCC from healthy individuals. Expression profiles of miRNAs in serum samples of 20 HCC patients and 10 healthy controls were detected. Whole miRNome profiling was done using next generation sequencing. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic performance of the deregulated miRNAs for discriminating HCC cases from healthy controls. MiRNA 142 was highly expressed in HCC (P value = 0.023) while miRNAs 191, 22, and 126 were higher in the controls (P value = 0.005, 0.034, 0.010 respectively). We have identified 5 novel miRNAs and they were highly expressed in HCC than controls. Analysis of ROC curve demonstrated that these deregulated miRNAs can be used as a reliable biomarker for detection of HCC with high diagnostic accuracy (AUC = 0.93). We have detected a panel of serum miRNAs that can be used as a reliable noninvasive screening biomarker of HCC. The study recommends further research to shed light on a possible role of the newly discovered novel miRNAs in HCC pathogenesis.
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http://dx.doi.org/10.1007/s11033-020-05521-4DOI Listing
July 2020

Angiotensin-converting enzyme insertion/deletion (ACE I/D) gene polymorphism in Egyptian children with congenital heart disease.

Birth Defects Res 2020 08 28;112(13):963-969. Epub 2020 Apr 28.

Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Background: Congenital heart diseases (CHDs) are the leading cause of infant deaths worldwide. The relationship between angiotensin-converting enzyme (ACE) gene polymorphism and CHDs is not clear. The aim of this work is to assess the presence of an association between ACE I/D polymorphism and CHD in Egyptian population.

Subjects And Methods: Seventy CHD cases and 70 controls were incorporated in this study. DNA was isolated from their peripheral blood, and then ACE I/D gene polymorphism was tested by polymerase chain reaction (PCR).

Results: There was no significant difference among the frequencies of the DD, II, and DI genotypes in patients and controls (26 [37.1%], 37 [53.3%], and 4 [5.7%], 5 [6.7%]), 40 (57.2%), 28 (40%), respectively (p value = 1 and OR [95% CI] = 1.1). There was no significant difference between D allele (DD + DI) and II genotype distribution among patients and controls (p value = 1 and OR [95% CI] = 1.2 [0.3-2.9]). Moreover, there was no difference between I allele (II + DI) and DD frequency (p value = 0.2 and OR [95% CI] = 0.6 [0.3-1.2]).

Conclusions: ACE I/D gene polymorphism might not be a risk factor of CHD in Egyptian children. Additional widespread studies are needed to affirm these data.
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http://dx.doi.org/10.1002/bdr2.1700DOI Listing
August 2020

Orphenadrine in treatment of muscle cramps in cirrhotic patients: a randomized study.

Eur J Gastroenterol Hepatol 2020 08;32(8):1042-1045

Department of Tropical medicine, Faculty of Medicine, Tanta University.

Objective: Many patients of liver cirrhosis are complaining of muscle cramps, which are annoying to them. There is no effective treatment for muscle cramps in cirrhotic patients till now. This study purposed to evaluate efficacy and safety of orphenadrine in the treatment of muscle cramps in cirrhotic patients.

Methods: One hundred and twenty four patients who had muscle cramps three or more times weekly were included. They were divided into two arms: 62 patients administrated orphenadrine and 62 administrated placebo. They were followed up till 2 weeks after the end of therapy. Muscle cramps were evaluated using questionnaire as regards severity, duration, and frequency. Also, side effects of orphenadrine were recorded.

Results: Frequency, duration of muscle cramps, and pain score improved significantly after 1 month of orphenadrine therapy in comparison to placebo. Few side effects were recorded in the form of dry mouth, drowsiness, and nausea.

Conclusion: Orphenadrine is considered as promising safe drug for treatment of muscle cramps associated with liver cirrhosis.
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http://dx.doi.org/10.1097/MEG.0000000000001622DOI Listing
August 2020

Is Hepatitis B Surface Antigen (HB s Ag) Enough Alone as a Screening Test for HBV Infection in Rheumatic Disease Patients Before Starting Immunosuppressive Therapies? A Cross-sectional Study.

Infect Disord Drug Targets 2020 ;20(6):878-883

Department Tropical Medicine, Tanta University, Tanta, Egypt.

Background & Objectives: Prevalence of hepatitis B virus in patients with rheumatic diseases has been reported differently among studies. The loss of immune control in these patients may result in the reactivation of HBV replication within hepatocytes. Considering the lifelong use of multiple anti-rheumatic drugs, screening for HBV is recommended before starting immunosuppressive or immunomodulatory therapy. The aim of this study was to select the best and simplest test for screening of HBV in rheumatic patients.

Methods: This study was carried out in 102 patients with different rheumatic diseases. Screening to all patients for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibodies and human immune deficiency virus antibodies (HIV) was done. HBV core antibodies and real time PCR to detect HBV DNA were done.

Results: The mean age of the patients was 37.18 ± 12.37 years, 3.9% of them were males and 96.1% were females. HBsAg had 100% Sensitivity, 100% Specificity, 100% PPV, 100% NPV and 99.0% accuracy. While, anti-HBc had 100% Sensitivity, 78% Specificity, 8% PPV, 100% NPV and 78% accuracy in the screening of HBV.

Conclusions: HBs Ag was found to be superior to antiHBc for screening for HBV infection in rheumatic patients.
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http://dx.doi.org/10.2174/1871526519666191212094141DOI Listing
September 2021

Serum Alpha-fetoprotein Levels and Response to Direct Antiviral Therapy in Patients with Chronic Hepatitis C: Real-world Results from 1716 Patients in Egypt.

Endocr Metab Immune Disord Drug Targets 2019 ;19(7):1005-1011

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

Background & Aims: Direct Antiretroviral Agents (DAAs), sofosbuvir-based therapies, have opened a new era in the treatment of chronic HCV infection. The aim of the study was to investigate the potential use of baseline and in serial serum, AFP levels as a predictor for response to DAAs in patients with Chronic Hepatitis C.

Methods: This multicenter observational study was carried out on 1716 chronic hepatitis C virusinfected patients who received direct anti-viral drugs for 12 weeks. The primary end point was sustained virological response at 12 weeks after the end of treatment determined by quantitative PCR for HCV RNA. Serum AFP was quantitatively assessed at baseline then after 12week after stoppage of treatment (SVR12).

Results: SVR12 rate was 97.8%. Elevated serum AFP was significantly higher in non -SVR group p value (<0.001). There was a significantly marked decrease in AFP after treatment in comparison to pretreatment values. The multivariate logistic regression analysis on the resulting significant variable from the univariate analysis revealed that only AFP was significantly related to the response to direct antiviral therapy in patients with chronic hepatitis C with p <0.001, OR 1.10 (95% CI 1.07:1.12). Other sociodemographic (e.g. Age, gender, BMI, ..) or laboratory factors (Hb, ANC, WBCs, …) did not show any significant association with the patients' response to treatment.

Conclusions: Serum AFP levels were a predictor for response in patients with chronic HCV with the administration of direct antiviral drugs.
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http://dx.doi.org/10.2174/1871530319666190204154830DOI Listing
March 2020

Rescue therapy for chronic hepatitis C virus infection after repeated treatment failures: Impact on disease progression and risk of hepatocellular carcinoma.

Hepatol Res 2019 Apr 28;49(4):377-384. Epub 2019 Jan 28.

Department of Tropical Medicine, Tanta University, Tanta, Egypt.

Aim: Retreatment after previous failure of direct-acting antivirals for hepatitis C virus (HCV) infection is a challenging decision. The importance of achieving viral eradication on modification of disease progression and outcome, including the risk of hepatocellular carcinoma (HCC), remains a critical issue to be evaluated.

Methods: One hundred patients with repeated failure of sofosbuvir and ribavirin or triple therapy with sofosbuvir, ribavirin, and daclatasvir were divided into a study group (n = 50) given rescue therapy (sofosbuvir, daclatasvir, simeprevir, and ribavirin) or a control group (n = 50) matched for age, sex, and pretreatment variables (Child-Turcotte-Pugh score and Fibrosis-4 score). Follow-up was undertaken after the last non-response to detect serious adverse events, such as hepatic decompensation and development of HCC.

Results: The study group achieved sustained virologic response (SVR) in 47 of 50 (94%) patients. The control group had significantly higher HCC rates than the study group (7 vs. 1 patients), with an odds ratio of 5.44. The rescue therapy was associated with significantly longer time to the occurrence of adverse events. Repeated treatment failures were associated with progression of FibroScan values in the control group (21 ± 4.5 vs. 10 ± 1.5 kPa, P = 0.001); achieving SVR in the study group stopped fibrosis progression despite non-significant increase from baseline (13.2 ± 3.2 vs. 10.6 ± 0.6, P = 0.12).

Conclusions: Rescue treatment for HCV infection was highly effective in achieving SVR, less expensive than the newer agents, and is associated with diminished risk of serious adverse events, mainly HCC in these patients.
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http://dx.doi.org/10.1111/hepr.13303DOI Listing
April 2019

Outcomes of Treatment and Predictors of Response to Sofosbuvir Plus Simeprevir in Hepatitis C Virus with Genotype-4 Infection.

Infect Disord Drug Targets 2020 ;20(3):389-395

Department of Tropical Medicine & Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt.

Background & Aims: Treatment plan of chronic HCV infection has dramatically improved after the introduction of different groups of Direct-Acting Antiviral (DAA) drugs. These drugs have been found to be safe and effective. Sofosbuvir (SOF) plus simeprevir (SMV) regimen has been shown to be tolerable and effective in treatment of patients with HCV genotype 1. The aim of the study was to evaluate the safety and the efficacy of combined sofosbuvir plus simeprevir treatment in genotype 4 chronic HCV patients.

Methods: This open-label multicenter prospective study was carried out on 381 Egyptian patients with chronic hepatitis C virus- infection. Treatment experienced and treatment-naive patients were included. Subjects administrated a regimen of sofosbuvir (400 mg/ day) plus semiprevir (150 mg /day) for twelve weeks. Sustained Virological Response (SVR) was confirmed by undetectable HCV RNA by quantitative PCR 3 months after the end of the treatment.

Results: 97.6% (372 /381) of patients had SVR. None of the studied clinical and demographic characteristics were associated with the SVR status. However, patients who failed to achieve SVR showed low albumin level and high total leucocyte. The most common side effects of the studied regimen were headache, fatigue, itching, photosensitivity, and cough.

Conclusions: Twelve weeks' regimen of sofosbuvir plus simeprevir was considered to be safe and tolerable in the treatment of HCV genotype 4; also it was associated with high SVR (97.6%).
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http://dx.doi.org/10.2174/1871526519666181218104600DOI Listing
April 2021

Randomized-controlled trial of methocarbamol as a novel treatment for muscle cramps in cirrhotic patients.

Eur J Gastroenterol Hepatol 2019 04;31(4):499-502

Department of Tropical Medicine, Tanta University, Tanta.

Background: Muscle cramps occur in 29-88% of patients with liver cirrhosis. They adversely affect quality of life. This study aimed to evaluate the efficacy and safety of methocarbamol as a novel therapy in controlling muscle cramps in cirrhotic patients.

Patients And Methods: This study was carried on 100 patients with liver cirrhosis in addition to chronic hepatitis C who presented with frequent muscle cramps (≥three cramps per week). Half of these patients received methocarbamol and the other half received placebo. This was done through equal randomization. Questionnaires on muscle cramp were answered. Patients were evaluated before, after 1 month of treatment, and 2 weeks after washout of treatment in terms of severity, duration, and frequency of cramps. Liver, renal functions, and electrolytes were analyzed. Also, any side effect was detected.

Results: Patients who were treated with methocarbamol showed a significant decrease in the frequency and duration of cramps. Also, the pain score improved significantly. However, no significant changes were observed in the placebo group. Few side effects of methocarbamol were recorded, including dry mouth and drowsiness.

Conclusion: Methocarbamol seems to be a promising safe and well-tolerated medication, and plays a role in the treatment of muscle cramps in patients with liver cirrhosis.
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http://dx.doi.org/10.1097/MEG.0000000000001310DOI Listing
April 2019
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