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El-Kassas M, Emadeldeen M, Hassany M, Esmat G, Gomaa AA, El-Raey F, Congly SE, Liu H, Lee SS. A randomized controlled trial of SOF/VEL/VOX with or without ribavirin for retreatment of chronic hepatitis C. J Hepatol 2023:S0168-8278(23)00234-9. [PMID: 37088312 DOI: 10.1016/j.jhep.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 12/25/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND & AIMS The combination of sofosbuvir, velpatasvir and voxilaprevir (SOF/VEL/VOX) is recommended retreatment for patients with hepatitis C virus (HCV) infection who failed previous direct-acting antiviral (DAA) treatment. However, whether ribavirin further increases the therapeutic efficacy of SOF/VEL/VOX retreatment remains unclear. We aimed to test this hypothesis by a randomized controlled trial. METHODS We randomly assigned 315 patients with DAA treatment failure from 5 Egyptian sites into two groups. Group A (n=158) received SOF/VEL/VOX for 12 weeks, and group B (n=157) received SOF/VEL/VOX + weight-based ribavirin for 12 weeks. Therapeutic efficacy was defined as SVR12 (undetectable HCV RNA 12 weeks after treatment completion). Safety and tolerability were evaluated by monitoring treatment-related adverse events (AEs) and laboratory abnormalities. RESULTS Seventeen patients in each group were lost to follow-up. SVR12 rates by intention-to-treat (ITT) were 87.3% (138/158), and by per-protocol analysis, 97.8% (138/141) in group A; and 87.9% (138/157) and 98.5% (138/140) in group B (p=NS for ITT and PP). Males comprised 53.9% of group A, and 57.1% in group B (p=0.58), with mean ages of 51.8 and 47.3 years in group A and B, respectively. Both regimens were well-tolerated, with no deaths and only one serious AE (anemia) in group B requiring ribavirin discontinuation. Fifty-five patients in group A vs. 77 in group B experienced any adverse events (p=0.002). CONCLUSION This randomized controlled trial showed equal, high efficacy of both regiments in retreating previous DAA failures, although ribavirin was associated with more adverse events. Therefore SOF/VEL/VOX monotherapy should be the preferred retreatment strategy. IMPACT AND IMPLICATIONS HCV treatment guidelines recommend retreating DAA treatment failures with the combination of sofosbuvir, velpatasvir and voxilaprevir (SOF/VEL/VOX) for 12 weeks. However, whether ribavirin exerts an additional/synergistic effect remains unclear. The present study confirmed that SOF/VEL/VOX without ribavirin is the best regimen for retreating DAA treatment failures, and thus will help clinicians caring for patients who are not cured with a first course of DAA therapy. CLINCIALTRIALS. GOV NUMBER NCT04695769.
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Affiliation(s)
- Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mohammed Emadeldeen
- Gastroenterology and Hepatology Department, National Hepatology & Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt
| | - Mohamed Hassany
- Gastroenterology and Hepatology Department, National Hepatology & Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt
| | - Gamal Esmat
- Hepatology and Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Ali Gomaa
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Fathiya El-Raey
- Department of Hepatology, Gastroenterology and Infectious Disease, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Stephen E Congly
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hongqun Liu
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Samuel S Lee
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
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Fouad Y, Elwakil R, Elsahhar M, Said E, Bazeed S, Ali Gomaa A, Hashim A, Kamal E, Mehrez M, Attia D. The NAFLD-MAFLD debate: Eminence vs evidence. Liver Int 2021; 41:255-260. [PMID: 33220154 DOI: 10.1111/liv.14739] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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] [Received: 10/12/2020] [Revised: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Abstract
Debates are inevitable in science and could be a powerful tool for addressing controversial topics as it promotes critical thinking and inspires individuals to consider alternate viewpoints. However, debates can help only to identify the issues that need to be clarified to address this question, but it can never help resolve the controversy itself. In the era of evidence-based medicine, the need for an evidence-based debate is mandatory. Polarising opinions and major debate have recently arisen in hepatology on the nomenclature and diagnostic criteria for fatty liver disease associated with metabolic dysfunction (non alcoholic fatty liver disease [NAFLD]-metabolic (dysfunction) associated fatty liver disease [MAFLD] debate). The aim of this viewpoint is to suggest a way to settle the debate through evidence. Descriptive review using PubMed to identify literature on the evidence and eminence-based medicine and studies comparing MAFLD and NAFLD criteria. The emerging studies comparing the performance of diagnostic criteria of NAFLD and MAFLD represent the dawn of a new era for reframing the ongoing debate by acquisition of the mandatory evidence that will both resolve the debate and lead to novel avenues of research. In conclusion, the time has come to hold debate and focus on gathering and building the evidence to settle it. It does not matter who wins the debate and once there is robust evidence, we should all follow it wherever it leads.
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Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Reda Elwakil
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Medhat Elsahhar
- Egyptian Association for the Study of Liver and Gastrointestinal Disease (EASLGD), Police Medical Academy, Cairo, Egypt
| | - Ebada Said
- Department of Hepatology and gastroenterology, Faculty of Medicine, Banha University, Banha, Egypt
| | - Shamardan Bazeed
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed Ali Gomaa
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | - Almoutaz Hashim
- Department of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia
| | - Enas Kamal
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mai Mehrez
- Department of Hepatology, NTHMRI, Cairo, Egypt
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
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Gomaa AA, El-Latif YMA. Early Prediction of Plant Diseases using CNN and GANs. IJACSA 2021; 12. [DOI: 10.14569/ijacsa.2021.0120563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Saleh AM, Hassan EA, Gomaa AA, El Baz TM, El-Abgeegy M, Seleem MI, Abo-Amer YEE, Elsergany HF, Mahmoud EIED, Abd-Elsalam S. Impact of pre-transplant infection management on the outcome of living-donor liver transplantation in Egypt. Infect Drug Resist 2019; 12:2277-2282. [PMID: 31413604 PMCID: PMC6661986 DOI: 10.2147/idr.s208954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/17/2019] [Indexed: 12/20/2022] Open
Abstract
Background and aim Liver transplantation (LT) has emerged as an established therapeutic option for patients with chronic liver disease. Patients with end-stage liver disease are at high risk of infection with multidrug-resistant organisms, which may affect the outcome of LT. The aim of this study was to evaluate the impact of pre-transplant infection on the outcome of living-donor LT. Methods Prospective follow-up was done for 50 patients with chronic liver disease who had had LT performed from September 2013 to December 2017. We divided patients into group 1 (patients who had had infection within 3 months before transplantation with adequate treatment [n=20]), and group 2 (patients without infection [n=30]). Both groups were followed for 4 months post-operatively. Results Patients with high Model
for End-Stage Liver Disease scores were more susceptible to infection pre- and post-operatively, and chest infection was the most common infection pre-transplant. There were no significant statistical differences regarding hospital and ICU stay and post-operative course between the groups, but the mortality rate was higher in group 1 (40%) than in group 2 (23.3%), and the causes of mortality in the group 1 were mainly due to medical causes (infections and sepsis, 75%) versus 28.6% in group 2. Conclusion Liver-cell failure and concomitant infection 3 months before LT with adequate treatment had no significant statistical differences regarding hospital, ICU stay, or medical complications, but post-operative infection and mortality rate were more frequent in group 1 and the causes of mortality were mainly medical.
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Affiliation(s)
| | - Essam Ali Hassan
- Tropical Medicine Department, Fayoum University, Al Fayyum, Egypt
| | - Ahmed Ali Gomaa
- Tropical Medicine Department, Fayoum University, Al Fayyum, Egypt
| | | | - Mohamed El-Abgeegy
- Liver Transplantation Team, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohamed Ismail Seleem
- Liver Transplantation Team, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Yousry Esam-Eldin Abo-Amer
- Hepatology, Gastroenterology, and Infectious Diseases Department, Mahala Hepatology Teaching Hospital, Gharbia, Egypt
| | - Heba Fadl Elsergany
- Liver Transplantation Team, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
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Omar H, El Akel W, Elbaz T, El Kassas M, Elsaeed K, El Shazly H, Said M, Yousif M, Gomaa AA, Nasr A, AbdAllah M, Korany M, Ismail SA, Shaker MK, Doss W, Esmat G, Waked I, El Shazly Y. Generic daclatasvir plus sofosbuvir, with or without ribavirin, in treatment of chronic hepatitis C: real-world results from 18 378 patients in Egypt. Aliment Pharmacol Ther 2018; 47:421-431. [PMID: 29193226 DOI: 10.1111/apt.14428] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment of chronic hepatitis C using combination of sofosbuvir (SOF) and daclatasvir (DCV) was used in several clinical trials and multicentre studies, which were somewhat limited to genotypes 1-3. The national program in Egypt is using SOF-DCV combination for large scale treatment. AIM To assess the efficacy and safety of combined SOF-DCV in treating patients with HCV-G4 in a real-world setting. METHODS Data and outcome of chronic HCV patients who were treated for 12 weeks with generic medications: DCV 60 mg plus SOF 400 mg ± ribavirin (RBV) within the national hepatitis C treatment program in Egypt are presented. Treatment-naïve patients without cirrhosis were treated without RBV, and those who had cirrhosis or were treatment-experienced (interferon experienced or SOF experienced) received RBV. Efficacy and safety were assessed, and baseline factors associated with sustained virological response at post-treatment week 12 (SVR12) were explored. RESULTS During the first 2 months of the programme, 18 378 patients with HCV-G4 started treatment with SOF-DCV with or without RBV. Overall, 95.1% achieved SVR12 (95.4% among patients treated without RBV and 94.7% for patients treated with RBV, P = .32). Treatment was prematurely discontinued in only 1.5% of patients. The most common events leading to discontinuation were patient withdrawal (n = 76) and pregnancy (n = 5). Five deaths occurred within this group. CONCLUSIONS Real-world experience of generic SOF-DCV in patients with chronic HCV-G4 proved to be safe and associated with a high SVR12 rate, in patients with different stages of fibrosis.
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Affiliation(s)
- H Omar
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - W El Akel
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - T Elbaz
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M El Kassas
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - K Elsaeed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H El Shazly
- National Liver Institute, Menoufiya University, Shebeen EL Kom, Egypt
| | - M Said
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Yousif
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A A Gomaa
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - A Nasr
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - M Korany
- National Committee for Control of Viral Hepatitis, Cairo, Egypt
| | - S A Ismail
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - M K Shaker
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - W Doss
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - G Esmat
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - I Waked
- National Liver Institute, Menoufiya University, Shebeen EL Kom, Egypt
| | - Y El Shazly
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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el-Hawey AM, Abdel-Rahman AH, Agina AA, Amer MM, Hashem YA, Gomaa AA, Abou el-Dahab MO, Tolba MA. Prevalence and morbidity of schistosomiasis among rural fishermen at two Egyptian villages (Gharbia Governorate). J Egypt Soc Parasitol 1995; 25:649-57. [PMID: 8586860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
210 fishermen and 210 farmers from two Egyptian villages (Gharbia Governorate) were selected. Their main clinical manifestations were terminal haematuria in 17.1% and 10%, dysuria in 16.7% and 6.7%, renal colic in 13.3% and 2.4%, dysentery in 10.5% and 3.8%, bloody stool in 8.1% and 2.9%, pallor in 28.8% and 15.2%, hepatomegaly in 10.5% and 4.3% and splenomegaly in 8.6% and 3.8% in fishermen and farmers respectively with significant values among fishermen when compared with farmers. Abdominal ultrasonography of fishermen showed higher morbidity rates than farmers as regards hepatosplenomegaly, grades of periportal fibrosis, portal vein diameter, stones in Kidneys and urinary bladder as well as calcification of urinary bladder. S. mansoni prevalence was 72.4% in fishermen and 4.57% in farmers with highly significant value in fishermen when compared with farmers (P < 0.01). Geometric egg count (gm/stool) was 430 +/- 259 and 236 +/- 161 in fishermen and farmers respectively with highly significant difference (P < 0.001). All urine samples were negative for S. haematobium. The socioeconomic status of all individuals showed no significant difference between the two groups. It was concluded that fishermen had a higher S. mansoni prevalence, infection intensity and morbidity than farmers. This may be due to more water contact activities. A snail population survey of the river and main canals was recommended.
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Affiliation(s)
- A M el-Hawey
- Department of Tropical Medicine, Faculty of Medicine, Al Azhar University, Nasr City, Cairo
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Abstract
This investigation examines the possibility of interaction between tranylcypromine and butorphanol in comparison to pethidine. The LD50 of pethidine and butorphanol were determined in mice pretreated with the non-selective monoamine oxidase (MAO) inhibitor, tranylcypromine orally for 8 days or with oral saline solution. Tranylcypromine decreased the LD50 of both pethidine and butorphanol by 78% and 41%, respectively. Anesthetized rabbits with halothane pretreated with tranylcypromine or saline were given pethidine (5 mg/kg i.v.) or butorphanol (0.5, 1 and 2 mg/kg i.v.). Pethidine produced a marked increase in blood pressure in rabbits pretreated with tranylcypromine and did not affect significantly the heart rate. Butorphanol did not affect either blood pressure or heart rate at doses of 0.5 or 1 mg/kg. However, the largest dose of butorphanol (2 mg/kg) produced hypotension and tachycardia in rabbits pretreated with tranylcypromine. Neither pethidine nor butorphanol affected the temperature of anesthetized rabbits pretreated with tranylcypromine or saline.
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Affiliation(s)
- A A Gomaa
- Department of Pharmacology, Faculty of Medicine, Assiut University, Egypt
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8
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Abstract
Recent data have shown that administration of prostaglandin inhibitors to patients with hypercalciuric nephrolithiasis decreased urinary calcium excretion, implying a possible role for prostaglandins in calcium excretion. To explore this hypothesis, we investigated the effect of single dose or 7 days' administrations of aspirin (100 mg/kg orally) or indomethacin (20 mg/kg, orally) on the urinary and serum concentrations of calcium, magnesium and inorganic phosphate. Experiments were performed in normocalcaemic and hypercalcaemic rats. Hypercalcaemia and hypercalciuria were induced in male Wistar albino rats by administration of vitamin D3 (20,000 IU/daily) for 7 days. Aspirin and indomethacin both significantly lowered the urinary calcium excretion in normocalciuric and hypercalciuric rats. The acute administration of indomethacin caused greater reduction of calcium excretion than that produced by the acute administration of aspirin, whereas aspirin showed greater activity than indomethacin after the long-term use of each. Aspirin induced hypocalcaemia in normocalcaemic rats and abolished the hypercalcaemia in hypercalcaemic rats. On the contrary, indomethacin, a specific prostaglandin biosynthesis inhibitor, increased serum levels of calcium. Hypophosphataemia was observed only after the administration of a single dose of aspirin in normocalcaemic rats, while the reduction of urinary phosphate excretion was investigated in hypercalciuric rats after the acute and chronic administration of indomethacin. Serum levels of phosphate were not altered significantly by acute or chronic administration of indomethacin. A single dose of indomethacin significantly reduced urinary excretion of magnesium in both groups of rats. However, the acute and chronic administration of aspirin resulted in non-significant changes in serum and urinary concentrations of magnesium. These data suggest that aspirin has hypocalcaemic and hypocalciuric actions while indomethacin has only a hypocalciuric effect. Aspirin may produce these actions by two mechanisms, one of them like that of indomethacin which is dependent on the inhibition of biosynthesis of prostaglandins, and another possible mechanism that is not related to the inhibition of prostaglandin biosynthesis. This suggestion may be supported by the discrepancy between the effects of aspirin and indomethacin on the renal handling and serum concentrations of magnesium and inorganic phosphate.
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Affiliation(s)
- A A Gomaa
- Department of Pharmacology and Biochemistry, Faculty of Medicine, Assiut University, Egypt
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Abstract
The effect of two doses of bromocriptine, a dopamine agonist, on morphine-induced analgesia, tolerance and dependence was investigated in mice. Bromocriptine at doses of 0.04 and 0.08 mg/kg did not affect the baseline tail flick latency of mice but potentiated the morphine analgesia. Pretreatment of mice with 5 mg/kg of sulpiride, a D-2 antagonist, not only blocked the effect of 0.08 mg/kg of bromocriptine but also antagonized the morphine analgesia. Control animals given daily injections of 10 mg/kg of morphine rapidly developed tolerance to the analgesic effect. A combined treatment of bromocriptine with morphine given daily suppressed the development of tolerance to morphine analgesia. However, development of tolerance to morphine analgesia was not significantly modified in the animals treated daily with bromocriptine (0.08 mg/kg) plus sulpiride (5 mg/kg). Acute dependence was induced by the administration of 100 mg/kg of morphine. The administration of bromocriptine 30 min before naloxone significantly decreased the ED50 value for naloxone for inducing jumping in mice. Coadministration of sulpiride and bromocriptine attenuated the ability of bromocriptine to potentiate the withdrawal syndrome of morphine dependence. The results indicate that bromocriptine potentiates morphine analgesia, suppresses the development of tolerance to morphine analgesia but exacerbates opiate withdrawal signs in morphine-dependent mice. These effects of bromocriptine appear to be mediated via D-2 receptors.
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Affiliation(s)
- A A Gomaa
- Department of Pharmacology, Anaesthesia and Neurology, Faculty of Medicine, Assiut University, Egypt
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Abstract
The effect of adenosine triphosphate (ATP) on the expression of opiate withdrawal was examined using a chronic model of morphine-dependence. ATP was studied for its ability to modify or block jumping in morphine-abstinent mice. In mice administered 2 mg/kg ATP intravenously, the naloxone ED50 for withdrawal jumping increased by 11-fold in comparison to saline-treated mice. Nalaxone-precipitated morphine-withdrawal in the rats, has been shown to induce a specific pattern of intestinal hypermyoelectric activity and to increase the arterial blood pressure. Administration of ATP at dose of 1 and 2 mg/kg intravenously inhibited the induction of hypermyoelectric activity pattern in 80 and 100% of animals tested respectively. ATP also blocked the increase in mean arterial blood pressure seen during withdrawal in a dose-dependent fashion. Investigations were carried out to determine if blocking of the alpha 2-adrenoreceptors with yohimbine would result in an alteration in antiwithdrawal action of ATP. Yohimbine reversed the effect of ATP in blocking naloxone-precipitated withdrawal on the myoelectric activity of jejunum and colon, however, it failed to antagonize the effect of ATP on withdrawal jumping and to block the effect of ATP on the pressor response produced by naloxone in morphine-dependent animals.
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Affiliation(s)
- A A Gomaa
- Department of Pharmacology, Faculty of Medicine, Assiut University, Egypt
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Abstract
Adenosine triphosphate (ATP) injected intravenously in mice was found to have dose-dependent analgesic activity in the hot plate and phenylquinone-induced stretching assays. ATP prolonged the hot plate latency (ED50 value of 1 (0.7-1.4) mg/kg) and inhibited phenylquinone-induced writhing (ED50 value of 0.4 (0.31-0.52) mg/kg). Low doses of ATP produced a potent antinociceptive effect without any significant depression of locomotor activity. Treatment of mice for either 4 days or 14 days with ATP did not result in development of physical dependence on or tolerance to ATP. The analgesic action of ATP was not antagonized by naloxone at 1 and 5 mg/kg. ATP analgesia was antagonized, in a dose-related fashion, by Ca++ ion injected intracerbroventricularly which may indicate that Ca++ plays a role in ATP-induced antinociception.
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Affiliation(s)
- A A Gomaa
- Department of Pharmacology, Faculty of Medicine, Assiut University, Egypt
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Abstract
The influence of a single dose of aspirin on the pharmacokinetics of the synthetic progestogen norethindrone was studied in rabbits. It was found that neither the 24-hr plasma levels nor the pharmacokinetic parameters of norethindrone following intravenous dosing were significantly altered by aspirin. However, after oral administration of norethindrone, the area under the plasma norethindrone versus time curve was significantly decreased by aspirin from 0.72 +/- 0.058 ng/ml X hr to 0.49 +/- 0.046 ng/ml X hr (mean +/- S.E) and the oral bioavailability was reduced from 56 +/- 4.2% to 38 +/- 3.6%, perhaps due to increased gut wall metabolism of norethindrone by aspirin.
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Affiliation(s)
- A A Gomaa
- Department of Pharmacology, Faculty of Medicine, Assiut University, Egypt
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Shaaban MM, Odlind V, Salem HT, Abdullah KA, Gomaa AA. Levonorgestrel concentrations in maternal and infant serum during use of subdermal levonorgestrel contraceptive implants, Norplant, by nursing mothers. Contraception 1986; 33:357-63. [PMID: 3089681 DOI: 10.1016/0010-7824(86)90097-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The transfer of levonorgestrel to infants was studied in 42 lactating women in whom the contraceptive subdermal implants, Norplant, were inserted 30 to 40 days postpartum. The women breastfed their infants for one year. Simultaneous mother and infant blood samples were taken once during the year. The levonorgestrel serum concentrations were measured by radioimmunoassay. During the first postinsertion month, the levonorgestrel concentration in the infants serum amounted, on the average, to 5% of the maternal concentration. Thereafter, the ratio ranged from 8 to 13%. The implications of this finding are discussed.
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Gomaa AA. The effect of thiabendazole on pain threshold. Acta Pharmacol Toxicol (Copenh) 1985; 57:18-22. [PMID: 4050451 DOI: 10.1111/j.1600-0773.1985.tb00003.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Thiabendazole significantly increased the reaction time to thermal stimulus. However, in mice treated with morphine, the reaction time was not in any way different from those treated with combined doses of thiabendazole and morphine. Thiabendazole was found to have an antinociceptive action. The protective dose for 50% of animal (ED50) against p-benzoquinone-induced writhing reflex was found to be 310 mg/kg. The ED50 for aspirin alone was 140 mg/kg. When the ED50 of aspirin was determined in combination with different dose levels of thiabendazole, it showed a marked reduction in the values reaching 50 mg/kg, when 300 mg of thiabendazole was used in combination. Toxicological studies revealed that the oral LD50 for thiabendazole in mice was 2200 mg/kg, and when combined with 140 mg/kg of aspirin, the LD50 was reduced to 900 mg/kg. These findings indicate that thiabendazole possesses an analgesic activity which is potentiated by aspirin, though aspirin was found to significantly enhance its toxicity.
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Shaaban MM, el-Nashar IM, Ghaneimah SA, Gomaa AA, Salah M, Abdel-Aleem AM. Hormonal changes during the first year of use of subdermal levonoregestrel implants, Norplant. Contraception 1984; 30:391-405. [PMID: 6440735 DOI: 10.1016/0010-7824(84)90031-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sixty-three women had NORPLANT implants inserted during the first eight days of the menstrual cycle. Blood specimens were withdrawn at the time of insertion and every three days during one of the following months of observation; the first, third, sixth, ninth and twelfth month after insertion. Ten subjects were sampled at multiple times during implant use. A total of 83 months of observation was available. The serum concentrations of levonorgestrel (LNG), FSH, LH, prolactin (PRL), estradiol (E2) and progesterone (prog) were measured in each specimen. LNG concentration rapidly declined during the first 15 days of use, the decline became more gradual during the subsequent two weeks, and an almost steady level was reached during the remainder of the year. There were no significant trends of change in the levels of FSH, LH, E2 and prog during the year. Frequent peaks in E2 concentration were observed and were generally associated with or followed by LH surges. PRL concentration showed a slight but significant rise during the second half of the year. Rises in prog concentration suggestive of ovulation occurred in 36 percent of the months of observation. However, in all these instances, there were evidences suggestive of deficient luteal phase. The bleeding episodes were usually, but not always, related to decline in E2 and prog concentrations.
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Gomaa AA, Osman FH, Salem HT, Abdel Wareth AA. A study of interaction between levonorgestrel and ethanol. Contraception 1984; 29:535-42. [PMID: 6432432 DOI: 10.1016/s0010-7824(84)80015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Female Wistar rats were pair-fed a diet containing either ethanol (5%) or isocaloric carbohydrate substituent. After 6 weeks, a single dose (5 micrograms/kg) of levonorgestrel was given to the animals in each group either orally, subcutaneously or intravenously. Plasma levels of levonorgestrel at different time intervals were measured by RIA. Chronic alcohol administration did not affect plasma levels of levonorgestrel after oral administration. When the drug was given subcutaneously, plasma levels and AUC were significantly decreased in the alcoholic compared to control group. Following intravenous administration, the elimination half-life of levonorgestrel was shorter while the metabolic clearance was higher in the alcohol-treated group rather than the control group.
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Gomaa AA. [Effect of potassium and calcium ions on the spontaneous electric activity of isolated nerve chains of Dendrolimus pini L. larvae]. Vestn Leningr Univ Biol 1969; 4:86-94. [PMID: 5396659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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