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Méndez-Sánchez N, Bugianesi E, Gish RG, Lammert F, Tilg H, Nguyen MH, Sarin SK, Fabrellas N, Zelber-Sagi S, Fan JG, Shiha G, Targher G, Zheng MH, Chan WK, Vinker S, Kawaguchi T, Castera L, Yilmaz Y, Korenjak M, Spearman CW, Ungan M, Palmer M, El-Shabrawi M, Gruss HJ, Dufour JF, Dhawan A, Wedemeyer H, George J, Valenti L, Fouad Y, Romero-Gomez M, Eslam M. Global multi-stakeholder endorsement of the MAFLD definition. Lancet Gastroenterol Hepatol 2022; 7:388-390. [PMID: 35248211 DOI: 10.1016/s2468-1253(22)00062-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Nahum Méndez-Sánchez
- National Autonomous University of Mexico, Mexico City, Mexico; Liver Research Unit, Medica Sur Clinic Foundation, Mexico City, Mexico
| | - Elisabetta Bugianesi
- Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Robert G Gish
- Liver Transplant Clinic, Loma Linda University, Loma Linda, CA, USA
| | - Frank Lammert
- Department of Medicine II, Hannover Medical School, Hannover, Germany
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA; Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology and Hepatology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gamal Shiha
- European Liver Patients' Association, Brussels, Belgium; World Hepatitis Alliance, London, UK; African Liver Patient Association, Cairo, Egypt; Association of Liver Patients Care, Mansoura, Egypt; Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Egyptian Liver Research Institute and Hospital, Sherbin, Egypt
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shlomo Vinker
- World Organization of Family Doctors Europe, Ljublijana, Slovenia; European General Practice Research Network, Maastricht, Netherlands; Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Association of Family Physicians, Tel Aviv, Israel; Leumit Health Services, Tel Aviv, Israel
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Laurent Castera
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine and Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
| | - Marko Korenjak
- European Liver Patients' Association, Brussels, Belgium; Association SLOVENIA HEP, Maribor, Slovenia
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mehmet Ungan
- World Organization of Family Doctors Europe, Ljublijana, Slovenia; European General Practice Research Network, Maastricht, Netherlands; Department of Family Medicine, School of Medicine, Ankara University, Ankara, Turkey
| | - Melissa Palmer
- Gannex-Ascletis Pharma, Beijing, China; Liver Consulting, New York, NY, USA
| | - Mortada El-Shabrawi
- Paediatric Hepatology Unit, Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt; The International Society of Tropical Paediatrics, Cairo, Egypt
| | | | - Jean-François Dufour
- Swiss NASH Foundation, Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, Bern, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, University of Milan, Milan, Italy
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt; The Egyptian MAFLD Research Group, Cairo, Egypt
| | - Manuel Romero-Gomez
- UCM Digestive Diseases, Virgen del Rocio University Hospital, Instituto de Biomedicina de Sevilla (HVR/CSIC/US), CIBER Hepatic and Digestive Diseases, University of Seville, Seville, Spain
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia.
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Lashen SA, Shamseya MM, Madkour MA, Abdel Salam RM, Mostafa SS. β-arrestin-2 predicts the clinical response to β-blockers in cirrhotic portal hypertension patients: A prospective study. World J Hepatol 2022; 14:429-441. [PMID: 35317175 PMCID: PMC8891671 DOI: 10.4254/wjh.v14.i2.429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/08/2022] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Portal hypertension, a common complication associated with liver cirrhosis, can result in variceal bleeding, which greatly impacts patient survival. Recently, β-arrestin-2 has been shown to predict the acute hemodynamic response to nonselective β-blocker therapy for cirrhotic portal hypertension. However, more data is needed on the long-term effects of and changes in β-arrestin-2 following nonselective β-blocker therapy.
AIM To investigate the expression and role of β-Arrestin-2 in predicting the long-term response to nonselective β-blockers in cirrhotic portal hypertensive patients.
METHODS We prospectively enrolled 91 treatment-naïve patients with cirrhotic portal hypertension. Baseline clinical and laboratory data were obtained. Gastroscopy was performed for grading and treating varices and obtaining gastric antral biopsies. We measured the serum and antral expression of β-arrestin-2 and obtained Doppler measurement of the portal vein congestion index. Treatment with nonselective β-blockers was then started. The patients were followed up for 18 mo, after which they have undergone a repeat antral biopsy and re-evaluation of the portal vein congestion index.
RESULTS A higher serum level and antral expression of β-arrestin-2 was associated with longer bleeding-free intervals, greater reduction in the portal vein congestion index, and improved grade of varices. Among patients with a low β-arrestin-2 expression, 17.6% were nonselective β-blocker responders, whereas, among those with high expression, 95.1% were responders (P < 0.001). A serum β-arrestin-2 value ≥ 2.23 ng/mL was associated with a lower likelihood of variceal bleeding (90% sensitivity and 71% specificity). β-arrestin-2 expression significantly decreased after nonselective β-blocker therapy.
CONCLUSION β-arrestin-2 expression in cirrhotic portal hypertension predicts the clinical response to long-term nonselective β-blocker treatment. Serum β-arrestin-2 is a potential noninvasive biomarker for selecting the candidate patients for nonselective β-blockers.
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Affiliation(s)
- Sameh A Lashen
- Division of Hepatology and Gastroenterology, Faculty of Medicine, Alexandria University, Alexandria 21521, Egypt
| | - Mohammed M Shamseya
- Department of Experimental and Clinical Internal Medicine, Medical Research Institute, Alexandria 21561, Egypt
| | - Marwa A Madkour
- Department of Experimental and Clinical Internal Medicine, Medical Research Institute, Alexandria 21561, Egypt
| | - Radwa M Abdel Salam
- Department of Pathology, Medical Research Institute, Alexandria University, Alexandria 21561, Egypt
| | - Sanaa S Mostafa
- Department of Pathology, Medical Research Institute, Alexandria University, Alexandria 21561, Egypt
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Lashen SA, Metawea MI, Shaaban A. Direct antiviral drugs in the treatment of hepatitis C-infected rheumatoid arthritis Egyptian cohort: safety and clinical impact. Eur J Gastroenterol Hepatol 2021; 33:e239-e246. [PMID: 33252421 DOI: 10.1097/meg.0000000000002015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Data about the safety and efficacy of direct-acting antivirals (DAAs) in the treatment of hepatitis C virus (HCV) patients with concomitant rheumatoid arthritis (RA) are scarce. We assessed the impact and safety of DAAs treatment of hepatitis C on rheumatoid arthritis disease activity. PATIENTS AND METHODS Prospectively, we enrolled 65 patients with RA and HCV. A clinico-laboratory evaluation was done at baseline, including liver assessment and RA disease activity score-28 (DAS28). At 12 weeks of post-DAAs treatment, sustained virologic response (SVR12) and DAS28 were reevaluated. RESULTS The SVR12 was achieved in 59 (90.8%) patients. RA control was achieved in 47 (79.9%) patients. The post SVR12 DAS28 score was significantly lower than the baseline (3.32 ± 0.93 vs. 4.37 ± 0.90; P < 0.001). There was a significant decline in the mean values of serum anticyclic citrullinated peptide, rheumatoid factor, erythrocyte sedimentation rate and C-reactive protein after achieving an SVR12 (30.47 ± 12.37 vs. 57.61 ± 15.91 U/ml; 29.78 ± 19.58 vs. 55.14 ± 16.89 IU/ml; 17.13 ± 10.84 vs. 29.68 ± 14.32 mm/h and 5.76 ± 1.57 vs. 11.44 ± 4.13 mg/l, respectively; P < 0.05). RA activity and antirheumatic drugs were stepped-down [12 (20.3%) and 35 (59.3%) patients showed good and moderate RA response, respectively]. The baseline viral load, absence of cirrhosis and SVR12 were the only predictors of disease control (P < 0.05). No drug-related adverse events or drug-related discontinuation. CONCLUSIONS Unlike interferon, HCV elimination by DAAs significantly improves RA activity and treatment outcome with high safety and efficacy.
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Affiliation(s)
- Sameh A Lashen
- Department of Internal Medicine, Hepatology and Gastroenterology Division
| | - Marwa I Metawea
- Department of Internal Medicine, Hepatology and Gastroenterology Division
| | - Ahmed Shaaban
- Department of Internal Medicine, Rheumatology and Immunology Division, University of Alexandria, Alexandria, Egypt
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Makhlouf NA, Abdel-Gawad M, Mahros AM, Lashen SA, Zaghloul M, Eliwa A, Elshemy EE, Ali-Eldin Z, Abdeltawab D, El-Raey F, Omran D, Khalaf M, Fanous N, Abdelmohsen AS, Abu-Elfatth A, Abdelghani M, Farouk M, Abdelaziz M, Alboraie M. Colorectal cancer in Arab world: A systematic review. World J Gastrointest Oncol 2021; 13:1791-1798. [PMID: 34853651 PMCID: PMC8603455 DOI: 10.4251/wjgo.v13.i11.1791] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/08/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) is increasing among young individuals in the Arab world as well as in other regions of the world. AIM To explore the incidence and prevalence of CRC in the Arab world. METHODS The PubMed, Scopus, Web of Science, EBSCO and Wiley databases were searched to retrieve relevant articles irrespective of the language or the publication year. The search terms were "("colon OR rectum OR sigmoid OR rectal OR colonic OR colorectal") AND ("cancer OR malignancy OR malignant OR neoplasm") AND ("Jordan" OR "United Arab Emirates" OR "Bahrain" OR "Tunisia" OR "Algeria" OR "Djibouti" OR "Saudi Arabia" OR "Sudan" OR "Syria" OR "Somalia" OR "Iraq" OR "Oman" OR "Palestine" OR "Qatar" OR "Comoros" OR "Kuwait" OR "Lebanon" OR "Libya" OR "Egypt" OR "Morocco" OR "Mauritania" OR "Yemen"). Reviews, meta-analyses, and articles containing nonoriginal data were excluded. Retrieved articles were screened, and relevant data were extracted. Descriptive statistics were used for data analysis. RESULTS Nine studies were included. Five of the studies provided information regarding the prevalence of CRC. The prevalence of CRC was 0.72% in Saudi Arabia and 0.78% in the United Arab Emirate, while in Egypt, it ranged from 0.4% to 14%. Four studies showed information regarding the incidence. The annual incidence rate of CRC in Qatar was 7.5/100000/year. In Egypt, the crude incidence rate (CIR) in males was 3.1 for colon cancer and 1 for rectal cancer, while in females, it was 2.3 for colon cancer and 0.8 for rectal cancer. The age-standardized rate for CRC incidence in 2003 was 36.90 for males, 26.50 for females, and 30.49 for both sexes in Saudi Arabia. In 2016, the CIRs in Saudi Arabia were 3.6 and 2.1 in females for colon cancer and rectal cancer, respectively, while in males, it was 3.3 and 2.8 for colon cancer and rectal cancer, respectively. One study in Egypt revealed that 25% of CRC cases occurred among individuals younger than 40 years old. CONCLUSION There is a considerable prevalence of CRC in some Arab countries. More studies are needed to explore the incidence and prevalence of CRC in the rest of the Arab world.
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Affiliation(s)
- Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Muhammad Abdel-Gawad
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Al-Azhar University, Assiut 71631, Egypt
| | - Aya M Mahros
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafrelsheikh 33656, Egypt
| | - Sameh A Lashen
- Department of Internal Medicine, Alexandria University, Alexandria 21521, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafrelsheikh 33656, Egypt
| | - Ahmed Eliwa
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Eman E Elshemy
- Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo 11651, Egypt
| | - Zainab Ali-Eldin
- Department of Internal Medicine, Ain Shams University, Cairo 11646, Egypt
| | - Doaa Abdeltawab
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Fathiya El-Raey
- Department of Hepatogastroenterology and Infectious diseases, Faculty of Medicine, Al-Azhar University, Damietta 34511, Cairo, Egypt
| | - Dalia Omran
- Department of Endemic Medicine, Cairo University, Cairo 12613, Egypt
| | - Marwa Khalaf
- Department of Tropical Medicine and Gastroenterology, Assiut Liver Center, Assiut 71511, Egypt
| | - Nancy Fanous
- Department of Gastroenterology, Hepatology and Endoscopy, Police Authority Hospital, Cairo 12654, Egypt
| | - Ahmed Shawkat Abdelmohsen
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ahmed Abu-Elfatth
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohamed Abdelghani
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mahmoud Farouk
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohamed Abdelaziz
- Department of Clinical Oncology and Nuclear Medicine, Al-Azhar University, Cairo 11824, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
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Hablass FH, Lashen SA, Alsayed EA. Efficacy of Lactoferrin with Standard Triple Therapy or Sequential Therapy for Helicobacter pylori Eradication: A Randomized Controlled Trial. Turk J Gastroenterol 2021; 32:742-749. [PMID: 34609303 PMCID: PMC8975506 DOI: 10.5152/tjg.2021.20923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bovine lactoferrin addition to regimens of Helicobacter pylori treatment has been tried, with conflicting results. AIM To assess the effect of bovine lactoferrin in addition to the anti-H. pylori treatment. METHODS We enrolled 400 H. pylori-infected patients who were randomized into 4 equal groups: (A): proton-pump-based triple therapy (PpTT) for 2 weeks, (B): sequential therapy for 2 weeks, (C): proton-pump-based triple therapy plus bovine lactoferrin for 2 weeks, and (D): sequential therapy plus bovine lactoferrin for 2 weeks. RESULTS In the per-protocol analysis, the success in groups A, B, C, and D were 70.3%, 82.8%, 85.6%, and 94.5%, respectively (P < .001). The treatment success rate for the sequential therapy plus bovine lactoferrin regimen was significantly higher than that with sequential therapy alone (94.5% vs. 82.8%, P = .013). The same applied for proton-pump-based triple therapy (85.6% vs. 70.3%, P = .014). The addition of bovine lactoferrin and the presence of endoscopic corpus gastritis were independent predictors for successful eradication of H. pylori. CONCLUSION Bovine lactoferrin could hasten the effectiveness of the proton-pump-based triple therapy or sequential therapy for H. pylori eradication.
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Kamal A, Elmoety AAA, Rostom YA, Shater MS, Lashen SA. Hepatocellular carcinoma recurrence after directly acting antivirals for chronic hepatitis C: a 2-year follow-up study. Clin Exp Hepatol 2021; 7:66-73. [PMID: 34027117 PMCID: PMC8122091 DOI: 10.5114/ceh.2021.104397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023] Open
Abstract
AIM OF THE STUDY Data regarding hepatocellular carcinoma (HCC) recurrence after directly acting antivirals for hepatitis C are contradictory. Our aim was to study the HCC recurrence in patients who received directly acting antivirals after tumor ablation. MATERIAL AND METHODS This retrospective study included all Child-Pugh A and B patients with hepatitis C related < 5 cm single or up to 3 HCC without any vascular or extrahepatic involvement whose lesions were managed using microwave or radiofrequency ablation at the Internal Medicine Department of Alexandria Faculty of Medicine, in the period from 1 January 2016 to 31 December 2016, and then received directly acting antivirals. RESULTS Data from 52 patients were analyzed. Throughout the 2 years from ablation, 42.3% of patients experienced tumor recurrence (22 out of 52 patients). In addition, two subjects died and 4 subjects were lost to follow-up before any tumor recurrence. CONCLUSIONS Although our study included both modified Child-Pugh A and B patients and included lesions up to 5 cm treated using thermal ablation, the 2-year HCC recurrence rate was similar to that previously reported after surgical resection or radiofrequency ablation of lesions up to 3 cm in Child-Pugh A patients before development of directly acting antivirals.
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Affiliation(s)
- Ahmed Kamal
- Hepatology Unit, Internal Medicine Department, Alexandria University, Egypt
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Abdelaty TAEF, Morsy EY, El-Sayed ET, El-Rahmany SM, Lashen SAA. Plasma microRNA-192 expression as a potential biomarker of diabetic kidney disease in patients with type 2 diabetes mellitus. Clinical Diabetology 2020. [DOI: 10.5603/dk.2020.0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Elshaarawy O, Lashen SA, Makhlouf NA, Abdeltawab D, Zaghloul MS, Ahmed RM, Fathy H, Afifi S, Abdel-Gawad M, Abdelsameea E, Abd-Elsalam S, Mohamed SY, Tag-Adeen M, Tharwat M, Alzamzamy A, Bekhit AN, Eid AM, Awad A, Aamr M, Dayem WAAE, Wifi MN, Alboraie M. Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt. World J Gastroenterol 2020; 26:6880-6890. [PMID: 33268968 PMCID: PMC7684458 DOI: 10.3748/wjg.v26.i43.6880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The current coronavirus disease 2019 (COVID-19) pandemic has affected routine endoscopy service across the gastroenterology community. This led to the suspension of service provision for elective cases. AIM To assess the potential barriers for resuming the endoscopy service in Egypt. METHODS A national online survey, four domains, was disseminated over a period of 4 wk in August 2020. The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s). RESULTS A hundred and thirteen Egyptian endoscopy centers participated in the survey. The waiting list was increased by ≥ 50% in 44.9% of areas with clusters of COVID-19 cases (n = 49) and in 35.5% of areas with sporadic cases (n = 62). Thirty nine (34.8%) centers suffered from staff shortage, which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis. In multivariate analysis, the burden of cases in the unit locality, staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice (P = 0.029, < 0.001 and 0.02, respectively) and Odd's ratio (0.15, 1.8 and 0.16, respectively). CONCLUSION The COVID-19 pandemic has led to restrictions in endoscopic volumes. The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery. Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.
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Affiliation(s)
- Omar Elshaarawy
- Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Egypt
- Department of Internal Medicine and Center of Alcohol Research and Liver Diseases, Salem Medical Center, Heidelberg University, Heidelberg 69121, Germany
| | - Sameh Aldesoky Lashen
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria 21521, Egypt
| | - Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Doaa Abdeltawab
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mariam Salah Zaghloul
- Department of Hepatology, Gastroentrology and Infectious Diseases, Kafrelsheikh University, Faculty of Medicine, Kafrelsheikh 33565, Egypt
| | - Rasha M Ahmed
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Hayam Fathy
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Shimaa Afifi
- National Hepatology and Tropical Medicine Research Institute, Cairo 11638, Egypt
| | - Muhammad Abdel-Gawad
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt
| | - Eman Abdelsameea
- Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Egypt
| | - Sherief Abd-Elsalam
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Salem Youssef Mohamed
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Mohammed Tag-Adeen
- Department of Internal Medicine, Gastroenterology Unit, Qena Faculty of Medicine, South Valley University, Qena 83523, Egypt
| | - Mina Tharwat
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Aswan University, Aswan 81528, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo 11771, Egypt
| | - Ahmed Nasr Bekhit
- Department of Tropical Medicine, Zagazig General Hospital, Zagazig 42511, Egypt
| | - Alshaimaa M Eid
- Department of Hepatology and Gastroenterology and Infectious Disease, Faculty of Medicine, AlAzhar University, Cairo 11562, Egypt
| | - Abeer Awad
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11759, Egypt
| | - Mohammad Aamr
- Department of Hepatology and Gastroentorolgy, Shebin Elkom Teaching Hospital, Shebine Elkom 3521, Egypt
| | - Waleed A Abd El Dayem
- Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Mohamed-Naguib Wifi
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11759, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo 11651, Egypt
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Lashen SA, Elshafei MM, Hablass FH, Alsayed EA, Hassan AA. Liver stiffness as a predictor of hepatocellular carcinoma behavior in patients with hepatitis C related liver cirrhosis. Hepatobiliary Pancreat Dis Int 2020; 19:22-28. [PMID: 31831335 DOI: 10.1016/j.hbpd.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/25/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Risk stratification and prognostication of hepatocellular carcinoma (HCC) help to improve patient outcome. Herein we investigated the role of liver stiffness measurement (LSM) in the prediction of HCC behavior. METHODS Totally 121 naïve patients with HCC were included. HCC radiological evaluation and staging were done. LSM was measured using virtual touch quantification. Patients were divided into early to intermediate HCC (BCLC-0, A and B) and late HCC (BCLCC and D). HCC was treated according to the BCLC stage. HCC recurrence-free interval was estimated. RESULTS The mean LSM inside the tumor was significantly lower than the peri-tumoral area and the cirrhotic non-cancerous liver parts (P < 0.001). In late HCCs stage, the mean LSM inside the tumor and in the peri-tumoral tissue was lower than the corresponding values in the early to intermediate HCCs stage (P < 0.001). LSM inside the tumor and in the peri-tumoral tissue negatively correlated with serum AFP, tumor vascular invasion, and stage (P < 0.05). The recurrence-free interval was directly correlated to LSM inside the tumor and inversely to LSM in cirrhotic non tumorous liver part. Kaplan-Meier analysis showed that the recurrence-free interval was significantly longer in patients with LSM inside the tumor of ≥1.25 m/s compared to those with LSM inside the tumor of <1.25 m/s. CONCLUSIONS LSM can serve as a potential non-invasive predictor for HCC clinical behavior and the recurrence-free interval following loco-regional treatments.
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Affiliation(s)
- Sameh A Lashen
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
| | - Mohamed M Elshafei
- Department of Radiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Fahmy H Hablass
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Eman A Alsayed
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Asmaa A Hassan
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, University of Alexandria, Alexandria, Egypt
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Kamal A, Elmoety AAA, Rostom YAM, Shater MS, Lashen SA. Percutaneous radiofrequency versus microwave ablation for management of hepatocellular carcinoma: a randomized controlled trial. J Gastrointest Oncol 2019; 10:562-571. [PMID: 31183208 PMCID: PMC6534711 DOI: 10.21037/jgo.2019.01.34] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancer related deaths. Radiofrequency ablation (RFA) and microwave ablation (MWA) are effective measures for HCC management. Although MWA is usually considered to be superior to RFA in the medical community, clinical studies showed contradictory results. We aimed to compare the efficacy of both techniques using a randomized controlled trial. METHODS We had assessed all patients with definite HCC who were referred to our unit during the period from mid-June 2017 to mid-December 2017 for inclusion in the study. After fulfilling the criteria, patients were randomized to either RFA or MWA. Achieving complete ablation was ensured. Patients were followed up every 3 months after the procedure to detect any tumor recurrence. RESULTS There were no statistically significant differences between both techniques regarding complications, local tumor recurrence, development of de novo HCC lesions and changes in the modified Child-Pugh score. Time of ablation using MWA was significantly shorter than RFA (P<0.001). CONCLUSIONS RFA and MWA are comparable techniques for HCC treatment. Our group couldn't prove any superiority of MWA over RFA except for the shorter time needed for ablation.
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Affiliation(s)
- Ahmed Kamal
- Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amr Aly Abd Elmoety
- Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yousri Abdel Meguid Rostom
- Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Said Shater
- Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sameh Aldesoky Lashen
- Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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11
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Lashen SA, Shamseya MM, Madkour MA, Aboufarrag GA. Tolerability and effectiveness of generic direct-acting antiviral drugs in eradication of hepatitis C genotype 4 among Egyptian patients. Liver Int 2019; 39:835-843. [PMID: 30549417 DOI: 10.1111/liv.14022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/19/2018] [Accepted: 12/02/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND We investigated tolerability and effectiveness of generic, less expensive direct antiviral drugs in the treatment of hepatitis C virus genotype 4 (HCV GT-4) in an Egyptian cohort. PATIENTS AND METHODS Retrospectively, we analysed data from 648 patients with HCV GT4 attending Alexandria Main University Hospital from January 2016 to May 2017 [488 treatment naïve/160 treatment-experienced/288 with chronic hepatitis/360 with cirrhosis]. Patients received generic sofosbuvir/ledipasvir (n = 168, treatment naïve = 136, treatment-experienced = 32) or sofosbuvir/daclatasvir (n = 480, treatment naïve = 352, treatment-experienced = 128) ± ribavirin. We assessed sustained virologic response 12 weeks after treatment, non-response, relapse, treatment discontinuation and drug adverse reactions. RESULTS An overall sustained virologic response 12 weeks after treatment was achieved in 97.8%, non-response in 0.6%, relapse in 0.3% and discontinuation of treatment in 1.3% of patients. Sofosbuvir/ledipasvir ± ribavirin regimen attained an overall sustained virologic response 12 weeks after treatment in 96.4% of patients (100% of treatment-experienced vs 95.6% of treatment naïve, P = 0.28), vs 98.3% for sofosbuvir/daclatasvir ± ribavirin regimen (100% of treatment-experienced vs 97.7% of treatment naïve, P = 0.08). No severe drug adverse events or deaths were reported except anaemia due to ribavirin. CONCLUSION Generic direct antiviral drugs used in treating Egyptian patients with HCV GT-4 demonstrated equal potency, safety and tolerability compared to original brands, with low cost which would help to provide treatment to a larger scale of patients.
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Affiliation(s)
- Sameh A Lashen
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Mohammed M Shamseya
- Department of Experimental and Clinical Internal Medicine, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Marwa A Madkour
- Department of Experimental and Clinical Internal Medicine, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Galal A Aboufarrag
- Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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12
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Ibrahim EH, Marzouk SA, Zeid AE, Lashen SA, Taher TM. Role of the von Willebrand factor and the VITRO score as predictors for variceal bleeding in patients with hepatitis C-related cirrhosis. Eur J Gastroenterol Hepatol 2019; 31:241-247. [PMID: 30281535 DOI: 10.1097/meg.0000000000001272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Noninvasive methods have been established to detect clinically significant portal hypertension in liver cirrhosis with variable limitations. The von Willebrand factor (vEF) has been found to increase in liver cirrhosis. AIM The aim of this study was to explore the vEF and VITRO (von Willebrand factor antigen/platelet ratio) score in the prediction of variceal bleeding in patients with portal hypertension. MATERIALS AND METHODS Fifty patients with hepatitis C-related liver cirrhosis (25 patients with variceal bleeding and 25 without variceal bleeding) as well as 80 healthy controls were included. Laboratory investigations and upper gastrointestinal endoscopy were performed in all patients. Serum vEF was measured in the patient and the control group. The VITRO score was calculated. RESULTS The mean levels of the vEF antigen and the VITRO score were higher in patients with variceal bleeding compared with patients without variceal bleeding and controls (P<0.001). At levels of at least 100.1 ng/ml and at least 0.732, the vEF and the VITRO score could predict variceal bleeding with a sensitivity and a specificity of 92 and 99.9% for the vEF and 80 and 68% for the VITRO score (area under the curve=0.982 and 0.843), respectively. Levels of vEF were correlated positively with esophageal varices grade. CONCLUSION Serum vEF level and the VITRO score are potential noninvasive biomarkers for the prediction and risk stratification of variceal bleeding in hepatitis C-related liver cirrhosis.
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Affiliation(s)
| | - Salah A Marzouk
- Department of Clinical and Chemical Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Ahmed E Zeid
- Department of Internal Medicine, Hepatobiliary Unit
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Lashen SA, Shamseya MM, Madkour MA. Hepatocellular Carcinoma Occurrence/Recurrence after Direct-Acting Antivirals for Hepatitis C in Egyptian Cohort: Single-Center Experience. Dig Dis 2019; 37:488-497. [PMID: 31216532 DOI: 10.1159/000501072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/20/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Conflicting data have been published about the risk of hepatocellular carcinoma (HCC) following direct-acting antivirals (DAAs). We investigated the incidence of HCC occurrence/recurrence after DAAs therapy. PATIENTS AND METHODS Retrospectively, we analyzed data of 392 patients with F3-4 fibrosis and cirrhosis treated by DAAs during the period from August 2015 to May 2018. In HCC-experienced patients, HCC treatment modality, and the duration between HCC management and DAAs initiation were recorded. In all patients, pretreatment clinicolaboratory evaluation, and imaging before, during and after DAAs were done. RESULTS De novo HCC occurred in 7.6% of naïve patients, while recurrence appeared in 28% of patients with previous HCC. Pretreatment alpha-fetoprotein was an independent predictor of HCC occurrence, while the time between HCC ablation and the beginning of DAAs was the only predictor of HCC recurrence (p < 0.001). Half of the patients who started DAAs before 6 months had HCC recurrence, while patients who started DAAs at ≥6 months had no recurrence (p< 0.0001). CONCLUSIONS Although HCC occurrence after DAAs was not high, recurrence was apparently high. Pretreatment alpha-fetoprotein is a predictor for de novo HCC. The time between HCC ablation and DAAs was the strongest predictor of recurrence.
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Affiliation(s)
- Sameh A Lashen
- Department of Internal Medicine, Faculty of Medicine, Alexandria, Egypt,
| | - Mohammed M Shamseya
- Department of Experimental and Clinical Internal Medicine, Medical Research Institute, University of Alexandria, Alexandria, Egypt
| | - Marwa A Madkour
- Department of Experimental and Clinical Internal Medicine, Medical Research Institute, University of Alexandria, Alexandria, Egypt
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