Publications by authors named "Sherif Saleh"

17 Publications

  • Page 1 of 1

Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Acute Kidney Disease after an Episode of AKI: A Multicenter Prospective Cohort Study.

Am J Nephrol 2020 21;51(4):266-275. Epub 2020 Feb 21.

Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA,

Background: Persistence of acute kidney disease (AKD) after an episode of acute kidney injury (AKI) is associated with adverse outcomes. Multiple factors contribute to AKD after AKI, but the role of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) remains controversial. We examined if acute exposure to an ACEI/ARB associates with persistent AKD in survivors of AKI.

Methods: Multicenter prospective cohort study of patients whose hospitalization was complicated by AKI and who attended specialized AKI follow-up clinics between 2013 and 2018. Acute exposure was defined as ACEI/ARB exposure for ≥48 h before or during the AKI episode. The primary outcome was AKD (serum creatinine ≥1.5 times above pre-AKI baseline) at the first clinic visit. We used multivariable logistic regression to adjust for potential confounders.

Results: We included 345 survivors of AKI, 112 with persistent AKD at the first outpatient visit. Among 163 patients who were prescribed an ACEI/ARB before hospitalization, only 23% were discharged on an ACEI/ARB. There was no difference in the rate of AKD in patients discharged versus not discharged on an ACEI/ARB (12.5 vs. 15.0%, p = 0.530). Of the patients with AKD, 22 (19.6%) patients had acute ACEI/ARB exposure during the hospitalization. In fully adjusted models, acute exposure to an ACEI/ARB was not associated with AKD at the time of first clinic visit (median [interquartile range] 33 [18-54] days from hospital discharge).

Conclusion: Acute exposure to an ACEI/ARB before or during an episode of AKI was not associated with persistent AKD at the time of first clinic visit suggesting that the receipt of such agents does not impede kidney recovery following AKI. Contrary to prevailing recommendations and current practice, the continued administration of an ACEI/ARB during an episode of AKI or initiation of these agents prior to discharge may be safe.
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February 2020

Prevalence, Risk Factors, Treatment, and Overall Impact of BK Viremia on Kidney Transplantation.

Transplant Proc 2019 Jul - Aug;51(6):1801-1809

Division of Nephrology and Transplantation, University of Kentucky, Lexington, Kentucky. Electronic address:

BK viremia (BKV) is a recognized and potentially serious problem in renal transplantation. The risk factors and the impact of BKV on renal allograft and patient survival are controversial. This study reports an 8-year, single-center experience on the prevalence, risk factors, and outcomes of BKV in kidney transplant recipients. This is a retrospective analysis of all patients who received a kidney transplant at the University of Kentucky and had BK viral titers available from 2009 to 2017. BKV was defined by a polymerase chain reaction viral load of ≥ 10,000 copies per mL. Demographic, clinical, and laboratory data generated during routine outpatient follow up and inpatients records were collected. Independent risk factors for BKV were determined using uni- and multivariate analysis. Graft and patient survival was compared using Kaplan-Meier analysis, and the severity of polyomavirus nephropathy on biopsy was scored using the Banff 2017 classification. We identified 122 BK positive (19%) and 527 BK negative (81%) patients. BKV developed after a median of 115 days (range, 80-249 days) following kidney transplantation. The 1-, 5-, and 10-year graft survival was 97%, 75%, and 33% in the BKV group and 96%, 85%, and 71% in the BK negative group, respectively. Likewise, the 1-, 5-, and 10-year patient survival was 98%, 84%, and 52% in the BKV group and 98%, 92%, and 84% in the BK negative group. Male sex, age at transplantation, maintenance steroids, and alemtuzumab induction were associated with developing BKV in the multivariate analysis. We concluded that BKV is not uncommon after renal transplantation. The determinants for BKV are male sex, older transplant recipients, and maintenance steroids. BKV adversely affected graft and patient survival. A unified approach for BKV and polyomavirus nephropathy treatment is needed.
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November 2019

Validation and Extension of the Ventral Hernia Repair Cost Prediction Model.

J Surg Res 2019 12 6;244:153-159. Epub 2019 Jul 6.

Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky. Electronic address:

Background: Repair of ventral and incisional hernias remains a costly challenge for health care systems. In a previous study of a single surgeon's elective open ventral hernia repair (VHR) practice, a cost model was developed, which predicted over 70% of hospital cost variation. The purpose of the present study was to evaluate the ventral hernia cost model with multiple surgeons' elective open VHR cases and extending to include nonelective and laparoscopic VHR.

Materials And Methods: With the University of Kentucky Institutional Review Board approval, elective and emergent cases of open and laparoscopic VHR performed by multiple surgeons over 3 y were identified. Perioperative variables were obtained from the local American College of Surgeons National Surgery Quality Improvement Program database and electronic medical record review. Hospital cost data were obtained from the hospital cost accounting system. Forward multivariable regression of log-transformed costs identified independent cost drivers (P for entry < 0.05, and P for exit > 0.10).

Results: Of the 387 VHRs, 74% were open repairs; mean age was 55 y, and 52% of patients were female. For open, elective cases (n = 211; mean cost of $19,145), the previously reported six-factor cost model predicted 45% of the total cost variation. With all VHRs included, additional variables were found to independently drive costs, predicting 59% of the total cost variation from the base cost. The biggest cost drivers were inpatient status (+$1013), use of biologic mesh (+$1131), preoperative systemic inflammatory response syndrome/sepsis (+$894), and preoperative open wound (+$786).

Conclusions: Ventral hernia repair cost variability is predictable. Understanding the independent drivers of cost may be helpful in controlling costs and in negotiating appropriate reimbursement with payers.
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December 2019

Impact of human leukocyte antigen and calculated panel reactive antibody on BK viremia in kidney transplant recipients: A single-center experience and literature review.

Transpl Infect Dis 2019 Aug 18;21(4):e13071. Epub 2019 May 18.

Division of Nephrology and Transplant Program, University of Kentucky, Lexington, Kentucky.

Background: The aim of this retrospective analysis was to investigate the effect of human leukocyte antigen (HLA) and calculated panel reactive antibody (cPRA) on BK virus activation as evidenced by BK viremia (BKV).

Patients And Methods: At our institution, 649 kidney transplant patients were screened for BKV from 2009 to 2017. Patients were considered to have BKV if they had >10 000 copies/mL of BK DNA in their blood. Donor and recipient HLA and cPRA, demographic, clinical and laboratory data, as well as immunosuppressive medications were collected.

Results: We identified 122 BK positive and 527 BK negative patients. Only 25% of the patients had cPRA of 20% or more, and 64% had more than three HLA-A, -B, and -DR mismatches. In both univariate and multivariate analyses, male gender, age, and maintenance of steroid therapy significantly increased the risk of BKV (P = 0.005, 0.005 and <0.001, respectively). The degree of cPRA and the individual HLA allele and HLA allele matching did not significantly affect BKV.

Conclusion: Neither the degree of HLA mismatching nor cPRA appears to affect BKV. Moreover, no specific HLA allele, HLA allele matching, or cPRA were associated with BKV.
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August 2019

Outcome of Patients With Small Vessel Vasculitis After Renal Transplantation: National Database Analysis.

Transplant Direct 2018 Mar 20;4(3):e350. Epub 2018 Feb 20.

Division of Nephrology, University of Kentucky, Lexington, KY.

Background: Small vessel vasculitis commonly affects the kidney and can progress to end-stage renal disease. The goal of this study is to compare outcomes of patients who received a renal transplant as a result of small vessel vasculitis (group A) with those who received kidney transplants because of other causes (group B).

Methods: This is a retrospective analysis of United Network for Organ Sharing registry data for adult primary kidney transplants from January 2000 to December 2014. Group A patients (N = 2196) were compared with a group B (N = 6588); groups were case matched for age, race, sex, donor type, and year of transplant in a 1:3 ratio.

Results: Renal and patient survivals were better in the group A ( < 0.001). New-onset diabetes after transplant developed in 8.3% of the group A and 11.3% of group B ( < 0.001). Seventeen (0.8%) patients in group A developed recurrent disease. Of these, 7 patients had graft failure, 3 of which were due to disease recurrence. Group A patients had significantly higher risk of developing posttransplant solid organ malignancies (11.3% vs 9.3%, = 0.006) and lymphoproliferative disorder (1.3% vs 0.8%, = 0.026). Independent predictors of graft failure and patient mortality were recipients' morbid obesity, diabetes, age, and dialysis duration (hazard ratio of 1.7, 1.4, 1.1/10 years, and 1.1/year for graft failure, and 1.7, 1.7, 1.6/10 years and 1.1/year for patient mortality, respectively).

Conclusions: Renal transplantation in patients with has favorable long-term graft and patient outcomes with a low disease recurrence rate. However, they may have a higher risk of developing posttransplant malignancies.
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March 2018

Risk-Assessment Score and Patient Optimization as Cost Predictors for Ventral Hernia Repair.

J Am Coll Surg 2018 04 4;226(4):540-546. Epub 2018 Jan 4.

Department of Surgery, University of Kentucky, Lexington, KY; Division of General Surgery, University of Kentucky, Lexington, KY. Electronic address:

Background: Ventral hernia repair (VHR) is associated with complications that significantly increase healthcare costs. This study explores the associations between hospital costs for VHR and surgical complication risk-assessment scores, need for cardiac or pulmonary evaluation, and smoking or obesity counseling.

Study Design: An IRB-approved retrospective study of patients having undergone open VHR over 3 years was performed. Ventral Hernia Risk Score (VHRS) for surgical site occurrence and surgical site infection, and the Ventral Hernia Working Group grade were calculated for each case. Also recorded were preoperative cardiology or pulmonary evaluations, smoking cessation and weight reduction counseling, and patient goal achievement. Hospital costs were obtained from the cost accounting system for the VHR hospitalization stratified by major clinical cost drivers. Univariate regression analyses were used to compare the predictive power of the risk scores. Multivariable analysis was performed to develop a cost prediction model.

Results: The mean cost of index VHR hospitalization was $20,700. Total and operating room costs correlated with increasing CDC wound class, VHRS surgical site infection score, VHRS surgical site occurrence score, American Society of Anesthesiologists class, and Ventral Hernia Working Group (all p < 0.01). The VHRS surgical site infection scores correlated negatively with contribution margin (-280; p < 0.01). Multivariable predictors of total hospital costs for the index hospitalization included wound class, hernia defect size, age, American Society of Anesthesiologists class 3 or 4, use of biologic mesh, and 2+ mesh pieces; explaining 73% of the variance in costs (p < 0.001). Weight optimization significantly reduced direct and operating room costs (p < 0.05). Cardiac evaluation was associated with increased costs.

Conclusions: Ventral hernia repair hospital costs are more accurately predicted by CDC wound class than VHR risk scores. A straightforward 6-factor model predicted most cost variation for VHR.
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April 2018

Predictors of Outcome of Living Donor Liver Transplantation for Hepatocellular Carcinoma.

Indian J Surg 2017 Aug 7;79(4):299-307. Epub 2016 Apr 7.

Department of Hepato-pancreao-biliary & Liver Transplantation Surgery, National Liver Institute, Menoufia University, 32511 Shebin El-koom, Menoufia Egypt.

The aim of this work is to study the different factors that affect the outcome of living donor liver transplantation for patients with hepatocellular carcinoma (HCC). Between April 2003 to November 2014, 62 patients with liver cirrhosis and HCC underwent living donor liver transplantation (LDLT) in the National Liver Institute, Menoufia University, Egypt. The preoperative, operative, and postoperative data were analyzed. After studying the pathology of explanted liver; 44 (71 %) patients were within the Milan criteria, and 18 (29 %) patients were beyond Milan; 13 (21.7 %) of patients beyond the Milan criteria were also beyond the University of California San Francisco criteria (UCSF) criteria. Preoperative ablative therapy for HCC was done in 22 patients (35.5 %), four patients had complete ablation with no residual tumor tissues. Microvascular invasion was present in ten patients (16 %) in histopathological study. Seven (11.3 %) patients had recurrent HCC post transplantation. The 1, 3, 5 years total survival was 88.7, 77.9, 67.2 %, respectively, while the tumor-free survival was 87.3, 82.5, 77.6 %, respectively. Expansion of selection criteria beyond Milan and UCSF had no increased risk effect on recurrence of HCC but had less survival rate than patients within the Milan criteria. Microvascular invasion was an independent risk factor for tumor recurrence.
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August 2017

Small for size syndrome difficult dilemma: Lessons from 10 years single centre experience in living donor liver transplantation.

World J Hepatol 2017 Jul;9(21):930-944

Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt.

Aim: To analyze the incidence, risk factors, prevention, treatment and outcome of small for size syndrome (SFSS) after living donor liver transplantation (LDLT).

Methods: Through-out more than 10 years: During the period from April 2003 to the end of 2013, 174 adult-to-adults LDLT (A-ALDLT) had been performed at National Liver Institute, Menoufiya University, Shibin Elkoom, Egypt. We collected the data of those patients to do this cohort study that is a single-institution retrospective analysis of a prospectively collected database analyzing the incidence, risk factors, prevention, treatment and outcome of SFSS in a period started from the end of 2013 to the end of 2015. The median period of follow-up reached 40.50 m, range (0-144 m).

Results: SFSS was diagnosed in 20 (11.5%) of our recipients. While extra-small graft [small for size graft (SFSG)], portal hypertension, steatosis and left lobe graft were significant predictors of SFSS in univariate analysis ( = 0.00, 0.04, 0.03, and 0.00 respectively); graft size was the only independent predictor of SFSS on multivariate analysis ( = 0.03). On the other hand, there was lower incidence of SFSS in patients with SFSG who underwent splenectomy [4/10 (40%) SFSS 3/7 (42.9%) no SFSS] but without statistical significance, However, there was none significant lower incidence of the syndrome in patients with right lobe (RL) graft when drainage of the right anterior and/or posterior liver sectors by middle hepatic vein, V5, V8, and/or right inferior vein was done [4/10 (28.6%) SFSS 52/152 (34.2%) no SFSS]. The 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients with SFSS were 30%, 30%, 25%, 25%, 25% and 25% respectively, while, the 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients without SFSS were 70.1%, 65.6%, 61.7%, 61%, 59.7%, and 59.7% respectively, with statistical significant difference ( = 0.00).

Conclusion: SFSG is the independent and main factor for occurrence of SFSS after A-ALDLT leading to poor outcome. However, the management of this catastrophe depends upon its prevention (., selecting graft with proper size, splenectomy to decrease portal venous inflow, and improving hepatic vein outflow by reconstructing large draining veins of the graft).
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July 2017

Modified Delphi Process for the Development of Choosing Wisely for Inflammatory Bowel Disease.

Inflamm Bowel Dis 2017 06;23(6):858-865

1Mount Sinai Hospital IBD Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; 3Division of Gastroenterology, Department of Medicine, McGill University, Montreal, Québec, Ontario; 4St. Paul's Hospital, Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada; 5Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; 6Division of Gastroenterology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 7Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; 8Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; 9Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; 10Division of Gastroenterology, Department of Medicine, University of Western Ontario, London, Ontario, Canada; 11The Ottawa Hospital IBD Centre, Department of Medicine, University of Ottawa, Ottawa, Canada; 12Division of Gastroenterology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada; 13Division of Gastroenterology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; 14Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; 15Crohn's and Colitis Canada, Toronto, Ontario, Canada; and 16Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California.

Background And Aims: The prevalence and incidence of inflammatory bowel disease (IBD) in North America is among the highest in the world and imparts substantial direct and indirect medical costs. The Choosing Wisely Campaign was launched in wide variety of medical specialties and disciplines to reduce unnecessary or harmful tests or treatment interventions.

Methods: The Choosing Wisely list for IBD was developed by the Canadian IBD Network for Research and Growth in Quality Improvement (CINERGI) in collaboration with Crohn's and Colitis Canada (CCC) and the Canadian Association of Gastroenterology (CAG). Using a modified Delphi process, 5 recommendations were selected from an initial list of 30 statements at a face-to-face consensus meeting.

Results: The 5 things physicians and patients should question: (1) Don't use steroids (e.g., prednisone) for maintenance therapy in IBD; (2) Don't use opioids long-term to manage abdominal pain in inflammatory bowel disease (IBD); (3) Don't unnecessarily prolong the course of intravenous corticosteroids in patients with acute severe ulcerative colitis (UC) in the absence of clinical response; (4) Don't initiate or escalate long-term medical therapies for the treatment of IBD based only on symptoms; and (5) Don't use abdominal computed tomography (CT) scan to assess IBD in the acute setting unless there is suspicion of a complication (obstruction, perforation, abscess) or a non-IBD etiology for abdominal symptoms.

Conclusions: The Choosing Wisely recommendations will foster patient-physician discussions to optimize IBD therapy, reduce adverse effects from testing and treatment, and reduce medical expenditure.
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June 2017

Effect of dexmedetomidine on hepatic ischemia-reperfusion injury in the setting of adult living donor liver transplantation.

Clin Transplant 2016 Apr 3;30(4):470-82. Epub 2016 Mar 3.

Clinical Biochemistry, National Liver Institute, Menoufia University, ShebeenAlkoom, Menoufia, Egypt.

Objective: The aim of this study was to investigate the hypothesis that intraoperative infusion of dexmedetomidine can exert a protective effect against hepatic ischemia-reperfusion injury (IRI) in adult living donor liver transplantation (LDLiver transplantation).

Patients And Methods: Forty recipients were allocated into: control group (group I; n = 20) that received a placebo; and dexmedetomidine group (group II; n = 20) that received a continuous intraoperative infusion of 0.8 μg/kg/h of dexmedetomidine. Data collected were AST, ALT, bilirubin, INR, and lactate, at baseline, immediately post-operatively, and on post-operative days 1, 3, and 5. Intercellular adhesion molecule-1 (ICAM-1) was measured at: baseline, 2 and 6 h after reperfusion, and on post-operative day 1. At the end of the surgery, a liver biopsy was sent for histopathological assessment.

Results: No significant difference was noticed in either group regarding MELD score, baseline AST, ALT, bilirubin, INR, or lactate. Dexmedetomidine tended to decrease blood pressure and heart rate, but the comparison was insignificant. Group II showed significantly attenuated levels of ICAM-1 and significantly minimal histopathological changes. The laboratory changes showed significantly lower AST, ALT, bilirubin, INR, and lactate in group II.

Conclusions: Dexmedetomidine exerted protective effects against hepatic IRI during adult LDLiver transplantation, as indicated by suppression of ICAM-1, better scores of histopathological assessment, and augmented post-operative liver function tests.
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April 2016

Effect of omega-3 on hepatic regeneration in adult living donors undergoing hepatic resections for liver transplantation: A randomized controlled trial.

J Crit Care 2016 Feb 5;31(1):157-62. Epub 2015 Oct 5.

National Liver Institute Menoufia University, Egypt.

Background: Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have been shown to improve liver regeneration in experimental models. Aim was to evaluate the effects of ω-3 PUFAs on hepatic regeneration in adult living donors undergoing partial hepatectomy for liver transplantation (LDLT).

Methods: Forty LDLT donors were categorized into 2 groups: received either intravenous ω-3 PUFA-enriched lipid emulsion 20% infusion 7 mL/kg once a day for 2 days before surgery and postoperative day (POD) 0 (S group) or glucose 5% (C group). Hepatic regeneration was assessed by volume of the liver after 1 month using computed tomography, and serial serum levels of hepatocyte growth factor were measured at POD 1, 3, and 5.

Results: Liver volume after 1 month was significantly larger in the S group than the C group (1286.75 ± 122.781 cm(3) vs 1169.15 ± 128.3, respectively; P = .00). Both the regeneration index and the regeneration percentage were significantly higher in the S group than the C group (P = .02 and P = .00, respectively). Serum levels of hepatocyte growth factor were significantly higher in the S group on POD 1, 3, and 5 than the C group ([in pg/mL] 188.10 ± 74.25 vs 123.30 ± 13.56, P = .00; 127.55 ± 32.40 vs 109.25 ± 8.89, P = .02; and 109.45 ± 21.44 vs 96.70 ± 5.57, P = .01; respectively).

Conclusion: Omega-3 polyunsaturated fatty acids effectively promoted liver regeneration and functional recovery following portal hypertension in the setting of LDLT.
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February 2016

Toxicological and biochemical studies on Schinus terebinthifolius concerning its curative and hepatoprotective effects against carbon tetrachloride-induced liver injury.

Pharmacogn Mag 2015 May;11(Suppl 1):S93-S101

Department of Pharmacology, Faculty of Veterinary Medicine, University of Suez Canal, Ismailia 41522, Egypt.

Background: Recently, many efforts have been made to discover new products of natural origin which can limit the xenobiotic-induced hepatic injury. Carbon tetrachloride (CCl4) is a highly toxic chemical that is widely used to study hepatotoxicity in animal models.

Objective: The present study was conducted to investigate the curative and protective effects of Schinus terbenthifolius ethanolic extract against CCl4 -induced acute hepatotoxicity in rats.

Materials And Methods: S. terbenthifolius extract was orally administered in a dose of 350 mg dried extract/kg b.wt. before and after intoxication with CCl4 for curative and protective experiments, respectively. A group of hepatotoxicity indicative enzymes, oxidant-antioxidant capacity, DNA oxidation, and apoptosis markers were measured.

Results: CCl4 increased liver enzyme leakage, oxidative stress, hepatic apoptosis, DNA oxidation, and inflammatory markers. Administration of S. terebinthifolius, either before or after CCl4 intoxication, significantly decreased elevated serum liver enzymes and reinstated the antioxidant capacity. Interestingly, S. terebinthifolius extract inhibited hepatocyte apoptosis as revealed by approximately 20 times down-regulation in caspase-3 expression when compared to CCl4 untreated group. On the other hand, there was neither protective nor curative effect of S. terebinthifolius against DNA damage caused by CCl4.

Conclusion: The present study suggests that S. terebinthifolius extract could be a substantially promising hepatoprotective agent against CCl4 toxic effects and may be against other hepatotoxic chemical or drugs.
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May 2015

Iatrogenic biliary injuries: multidisciplinary management in a major tertiary referral center.

HPB Surg 2014 10;2014:575136. Epub 2014 Nov 10.

Department of Hepatobiliary Surgery, National Liver Institute, Menophyia University, Shiben Elkom, Egypt.

Background. Iatrogenic biliary injuries are considered as the most serious complications during cholecystectomy. Better outcomes of such injuries have been shown in cases managed in a specialized center. Objective. To evaluate biliary injuries management in major referral hepatobiliary center. Patients & Methods. Four hundred seventy-two consecutive patients with postcholecystectomy biliary injuries were managed with multidisciplinary team (hepatobiliary surgeon, gastroenterologist, and radiologist) at major Hepatobiliary Center in Egypt over 10-year period using endoscopy in 232 patients, percutaneous techniques in 42 patients, and surgery in 198 patients. Results. Endoscopy was very successful initial treatment of 232 patients (49%) with mild/moderate biliary leakage (68%) and biliary stricture (47%) with increased success by addition of percutaneous (Rendezvous technique) in 18 patients (3.8%). However, surgery was needed in 198 patients (42%) for major duct transection, ligation, major leakage, and massive stricture. Surgery was urgent in 62 patients and elective in 136 patients. Hepaticojejunostomy was done in most of cases with transanastomotic stents. There was one mortality after surgery due to biliary sepsis and postoperative stricture in 3 cases (1.5%) treated with percutaneous dilation and stenting. Conclusion. Management of biliary injuries was much better with multidisciplinary care team with initial minimal invasive technique to major surgery in major complex injury encouraging early referral to highly specialized hepatobiliary center.
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December 2014

Antiobesity, antioxidant and cytotoxicity activities of newly synthesized chalcone derivatives and their metal complexes.

Eur J Med Chem 2014 Apr 15;76:517-30. Epub 2014 Feb 15.

Biochemistry Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt.

Four sets of rationally designed chalcones were prepared for evaluation of their antiobesity, antioxidant and cytotoxicity activities. These sets include nine oleoyl chalcones as mimics of oleoyl estrone, three monohydroxy chalcones (chalcone ligands), Schiff base-derived chalcones and four copper as well as zinc complexes. Oleoyl chalcones 4d, 4e and particularly 6a as an isosteric isomer of oleoyl estrone, were as active as Orlistat on weight loss and related metabolic parameters using male SD rats in vivo. Chalcone ligands 10a-c and Schiff base-derived chalcones 11 and 14a,b were weakly antioxidants, while, the copper and zinc complexes 15a-d were good antioxidants with zinc chelates 15b,d being more active than their copper analogues 15a,cin vitro. Compounds 10c and 14a showed good cytotoxicity activities as Doxorubicin against PC3 cancer cell line in vitro, while, the copper complex 15c showed promising activity with IC₅₀ value of 5.95 μM. The estimated IC₅₀ value for Doxorubicin was 8.7 μM. Chalcones 14a,b are bifunctional probes for potential investigations in cancer diagnosis and radiotherapy by complexation with Gd(3+) or metal radioisotopes followed by posttranslation of Shiga toxin B-subunits that target globotriosyl ceramide expressing cancer cells.
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April 2014

Circadian rhythm of metabolic changes associated with summer heat stress in high-producing dairy cattle.

Trop Anim Health Prod 2010 Aug 11;42(6):1119-25. Epub 2010 Mar 11.

Department of Reproduction, Obstetrics and Herd Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.

The current study aimed to investigate the circadian rhythm of blood metabolic parameters associated with summer heat stress (HS) in dairy cows. Ten healthy lactating Holstein Friesian cows were followed during HS for three successive days at six different time points. Blood was sampled from each cow starting from 07:00 AM: ; at 4-h intervals. Ambient air temperature and relative humidity were recorded, and temperature-humidity index (THI) was calculated as well. Respiration rate (RR) and rectal temperature (RT) were recorded for each cow at the time of blood sampling. Concentrations of glucose, non-esterified fatty acids (NEFA), total cholesterol (TC) and urea were measured in each blood sample. The THI values were >68 at all times of the day, and the highest values were recorded at 11:00 AM: , 03:00 PM: and 07:00 PM: (80.9, 83.7, and 80.8, respectively). All the cows showed a significantly higher RR and RT coinciding with higher THI values (93 +/- 4 and 39.6 +/- 0.1; 90.2 +/- 3.4, and 40.1 +/- 0.1; 87.6 +/- 4.1, and 39.8 +/- 0.1, respectively, P < 0.05). The concentrations of glucose were the lowest at 11:00 AM: and 03:00 PM: (3.75 +/- 0.1 and 3.44 +/- 0.1 mmol/L, respectively, P < 0.05). Decreased glucose concentrations coincided with increased NEFA concentrations, (0.43 +/- 0.01 and 0.56 +/- 0.02 mmol/L, respectively, P < 0.05), and were highly negatively correlated (r = -0.50, P < 0.001). The highest urea and TC concentrations were registered at 11:00 AM: (6.11 +/- 0.15 mmol/L and 109.9 +/- 2.2 mg/dl, respectively) whereas the lowest urea and TC values were recorded at 03:00 AM: (4.97 +/- 0.18 mmol/L and 99.5 +/- 1.7 mg/dl, respectively, P < 0.05). The results of the present study indicate that there was a circadian variation in glucose, NEFA, urea, and TC resulting in the most unfavorable metabolic condition during the hottest moment of the day in dairy cattle. Earlier work revealed that HS-metabolic changes are reflected in the follicular fluid. The circadian changes observed in the present study associated with HS may imply that also the microenvironment of the oocyte is affected.
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August 2010

Second trimester maternal serum cystatin C levels in preeclamptic and normotensive pregnancies: A small case-control study.

Hypertens Pregnancy 2010 Jan;29(1):112-9

Homerton University Hospital NHS Foundation Trust, London, UK.

Background/aims: Cystatin C (CC) is a marker of glomerular filtration rate (GFR) and is elevated in cases of established preeclampsia (PE). It also has widespread presence in extracellular space and high levels in PE might reflect placental ischemia. The aim of this study was to measure CC levels in the second trimester in women who subsequently develop PE and in those who remained normotensive.

Methods: Maternal serum taken at time of the anomaly scan from 15 women was analysed for CC and creatinine levels. Six women later developed PE and 9 remained normotensive.

Results: Cystatin C levels were significantly higher in women who developed preeclampsia (mean value 0.76 vs. 0.53 mg/L, p = 0.008). However, creatinine levels showed no statistical difference (mean value 76.1 vs. 65.5 micromol/L, p = 0.066). The range of CC was 0.41-0.55 mg/L in normotensive pregnancies and 0.50-1.26 mg/L in pregnancies with PE.

Conclusion: This small observational study showed that serum CC is raised as early as the second trimester in women who subsequently develop PE in third trimester. Larger studies are needed to evaluate the potential role of CC as an early marker for the prediction of PE.
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January 2010

Comparative changes in the serum concentrations of inhibin-B, prolactin, gonadotropins and steroid hormones at different reproductive States in domestic Turkey hens.

J Reprod Dev 2009 Oct 14;55(5):523-8. Epub 2009 Jul 14.

Animal Production Department, Faculty of Agriculture, Suez Canal University, Ismailia, Egypt.

The present study was undertaken to compare the changes in circulating levels of inhibin-B, prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol-17beta, progesterone and testosterone during the different reproductive states of turkey hens. Blood samples were collected during different reproductive states, at laying, incubating and out of lay. Inhibin-B was measured by ELISA, while other hormones were determined by Chemiluminescent Microparticle Immunoassay (CMIA). The results revealed highly significant differences among the hen's states for all serum hormone concentrations. The highest levels of inhibin-B and prolactin were observed in incubating hens, while the lowest values were observed in laying hens. In contrast, the highest levels of FSH, LH, estradiol-17beta, progesterone and testosterone were found in the laying group, while the lowest values were found in the incubating group. The progesterone level was higher in the laying group compared with the other groups. These results clearly demonstrate that negative correlation was found between both the inhibin-B and prolactin levels and the gonadotropin and steroid hormone concentrations during the different reproductive states of the turkey hens. In addition, the results suggest that inhibin-B may be involved in control of FSH and LH secretion.
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October 2009