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Madi M, Alsaad SS, AlAssiry N, Attia D, AlAssiry M, Zakaria O. Multilevel Modeling Analysis of Odontogenic Risk Factors and Nasal Septum Deviation Associated with Maxillary Sinus Mucosal Thickening: A Cone-Beam Computed Tomography Study. Dent J (Basel) 2024; 12:74. [PMID: 38534298 DOI: 10.3390/dj12030074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
(1) Background: In this study, the impact of odontogenic risk factors with nasal septum deviation on maxillary sinus mucosal thickening was assessed using Cone-beam computed tomography CBCT. (2) Methods: A total of 328 maxillary sinus regions from 164 patients (85 males and 79 females) were examined. Images were interpreted by dental specialists and Otolaryngologists. Coronal and sagittal sections were examined to assess the proximity of the root tips of posterior maxillary teeth (RPMT) to the maxillary sinus. The periodontal bone loss for all maxillary posterior teeth was also assessed. Consequently, maxillary sinus mucosal thickening (MT) was further classified into three gradings. Multilevel modeling regression analysis was used due to the hierarchical structuring of the data. Four models were developed, a null model with no factors, a model with tooth-level factors (RPMT, PBL, tooth condition, and root length), a model with patient-level factors (gender and nasal septum deviation), and a model with combined patient- and tooth-level factors. Regression estimates (AOR) and 95% confidence intervals (CIs) of individual and tooth factors were calculated. (3) Results: Multilevel regression analysis showed that RPMT was significantly associated with MT of maxillary sinus (p < 0.001), where patients who had RPMT > 0 had higher odds of MT of maxillary sinus. Tooth condition was also found to be significantly associated with MT of maxillary sinus, where teeth with failed RCT (p < 0.001) and teeth with restorations (p < 0.008) had higher odds of MT of maxillary sinus (AOR = 2.87, 95%CI 1.65, 4.42, AOR = 1.64, 95%CI 1.14, 2.36, respectively). (4) Conclusions: In order to plan preoperative treatment for maxillary posterior teeth, it is important to assess the anatomical relationship between the sinus floor and the root tips of the maxillary posterior teeth. Additionally, we establish a better understanding of the clinician before surgical intervention is conducted.
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Affiliation(s)
- Marwa Madi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Sara S Alsaad
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Nada AlAssiry
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Dina Attia
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Mansour AlAssiry
- Department of Otolaryngology, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
| | - Osama Zakaria
- Department of Biomedical Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
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Attia D, ElKashlan MK, Saleh SM. Early childhood caries risk indicators among preschool children in rural Egypt: a case control study. BMC Oral Health 2024; 24:10. [PMID: 38172841 PMCID: PMC10765893 DOI: 10.1186/s12903-023-03771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Early childhood caries (ECC) is a public health problem, especially in developing countries like Egypt which has an ECC prevalence of 74%. This research aimed to assess the risk indicators associated with ECC in a rural, socially-disadvantaged population in Alexandria, Egypt. METHODS A case-control study was conducted in 8 nurseries of preschool children aged 3 to 5 years in rural, deprived areas in Alexandria, Egypt, from October 2019 till January 2020. Two groups, 93 with ECC and 93 without ECC. A validated questionnaire was used to collect sociodemographic data including age, sex, number of siblings, socioeconomic status, oral health practices including toothbrushing frequency, pattern of dental visits, daily frequency of sugary snacks. Also, salivary pH and buffering capacity were assessed. A trained and calibrated dentist assessed caries status clinically according to the World Health Organization (WHO) criteria using the dmft index and oral hygiene status using Silness and Loe Plaque Index. Chi-squared test, followed by multivariable logistic regression were performed to assess the relation between independent variables and ECC, P < 0.05 was considered to be statistically significant. RESULTS Bivariate analysis showed that age, mother's education, dental visits, dietary habits, Plaque index, salivary pH and buffering capacity were significantly associated with ECC. The significant risk indicators for ECC in multivariable regression were age (AOR = 4.73, 95% CI: 2.76-7.83), mother's education (illiterate vs. university educated, AOR = 28.36, 95% CI: 8.51-112.92), frequency of daily sugary snacks (twice vs. once, AOR = 2.00, 95% CI: 1.29-3.49, and three or more vs. once, AOR = 2.67, 95% CI: 1.72-3.27), night feeding (AOR = 1.89, 95% CI: 1.38-10.21), Plaque index (AOR = 21.34, 95% CI: 5.56-81.99), and salivary pH (AOR = 0.16, 95% CI: 0.05-0.58). CONCLUSION This study suggests that sociodemographic indicators, dietary habits, plaque accumulation and salivary pH are risk indicators for ECC in the studied population.
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Affiliation(s)
- Dina Attia
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Mona K ElKashlan
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Susan M Saleh
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Madi M, Tabassum A, Attia D, Al Muhaish L, Al Mutiri H, Alshehri T, Zakaria O, Aljandan B. Knowledge and attitude of dental students regarding etiology, diagnosis, and treatment of peri-implantitis. J Dent Educ 2024; 88:100-108. [PMID: 37870085 DOI: 10.1002/jdd.13397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/06/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE The objective of this study was to assess the level of knowledge and attitude of dental students about the etiology, diagnosis, and management of peri-implantitis. METHODS An online cross-sectional study that targeted senior undergraduate dental students at the College of Dentistry was conducted. A closed-ended survey consisting of 28 questions was designed. Three sections were created: 1) participants' characteristics; 2) Knowledge of peri-implantitis etiology, risk factors, diagnosis, and complications; 3) The use of antibiotics in peri-implantitis, diagnosis, and treatment methods. SPSS version 22 (IBM Corp.) was used for data analysis. Counts and percentages were calculated for correct answers in each section. RESULTS A total of 267 dental students responded to the questionnaire. The majority of the participants (81.6%) were knowledgeable about peri-implantitis being an inflammatory reaction, and a lesser percentage (77.9%) knew that bacterial plaque is an etiologic factor for peri-implant diseases. 82.0% of the participants identified smoking as a risk factor, followed by periodontitis (80.5%). Regarding implant complications, 57.3% of the participants considered implant mobility as a definitive indication for implant removal. More than half of the participants reported using crater-like bone defects surrounding implants to diagnose peri-implantitis. The most commonly used antibiotic was amoxicillin (34.1%), followed by amoxicillin combined with metronidazole (26.9%). CONCLUSION Most participants had a basic understanding of the etiology and risk factors of peri-implantitis. On the other hand, more courses addressing peri-implantitis diagnosis are needed.
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Affiliation(s)
- Marwa Madi
- Department of Preventive Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Afsheen Tabassum
- Department of Preventive Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dina Attia
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Luba Al Muhaish
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hadeel Al Mutiri
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Turki Alshehri
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Osama Zakaria
- Department of Biomedical Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Badr Aljandan
- Department of Biomedical Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Hong KY, Ghafari A, Mei Y, Williams JS, Attia D, Forsyth J, Wang K, Wyeld T, Sun C, Glogauer M, King TJ. Oral inflammatory load predicts vascular function in a young adult population: a pilot study. Front Oral Health 2023; 4:1233881. [PMID: 37670806 PMCID: PMC10476491 DOI: 10.3389/froh.2023.1233881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/13/2023] [Indexed: 09/07/2023] Open
Abstract
Background The periodontium is a highly vascularized area of the mouth, and periodontitis initiates negative functional and structural changes in the vasculature. However, mild oral inflammation, including levels experienced by many apparently healthy individuals, has an unclear impact on cardiovascular function. The purpose of this pilot study is to investigate the effects of objectively measured whole mouth oral inflammatory load (OIL) on vascular function in apparently healthy individuals. Methods In this cross-sectional and correlational analysis, we recruited 28 young (18-30 years) and systemically healthy participants (16 male, 12 female). Using oral neutrophil counts, a validated measure for OIL, we collected participant's mouth rinse samples and quantified OIL. Blood pressure, arterial stiffness (pulse-wave velocity) and endothelial function (brachial artery flow-mediated dilation) were also measured. Results Only oral neutrophil count significantly predicted flow-mediated dilation % (p = 0.04; R2 = 0.16, β = - 1.05) and those with OIL levels associated with >2.5 × 105 neutrophil counts (n = 8) had a lower flow-mediated dilation % (6.0 ± 2.3%) than those with counts associated with gingival health with less than 2.5 × 105 neutrophil counts (10.0 ± 5.2%, p = 0.05). There were no significant predictors for arterial stiffness. Conclusion We found that OIL was a predictor of reduced flow-mediated dilation. An impairment in flow-mediated dilation is an indicator of future possible risk of cardiovascular disease-one of the leading causes of death in North America. Therefore, this study provides evidence for the importance of oral health and that OIL may impact endothelial function.
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Affiliation(s)
- Ker-Yung Hong
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Avin Ghafari
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Yixue Mei
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Jennifer S. Williams
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Dina Attia
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Jourdyn Forsyth
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Kevin Wang
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Trevor Wyeld
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Chunxiang Sun
- Faculty of Dentistry, University of Toronto, and Dental Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Glogauer
- Faculty of Dentistry, University of Toronto, and Dental Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Trevor J. King
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
- Department of Health and Physical Education, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada
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Fouad Y, Gaber Y, Alem SA, Abdallah M, Abd-Elsalam SM, Nafady S, Attia D, Eslam M. Changes in the Etiologies of Liver Cancer in Upper Egypt over a Decade from 2010 to 2020: A Single Tertiary Care Center Study. South Asian J Cancer 2023. [DOI: 10.1055/s-0043-1771440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
The profile of liver diseases in Egypt is changing dramatically and viral hepatitis is declining, while the fatty liver disease is increasing dramatically. However, the impact of these changes on the profile of hepatocellular carcinoma (HCC) remains uncertain. Therefore, we determined the temporal trends in the etiologies of HCC in Egypt over a decade. We retrospectively analyzed data from consecutive patients who were diagnosed with HCC over 10 years (2010–2020) in a large center in Upper Egypt. Standard tests were utilized to diagnose hepatitis C virus (HCV) and hepatitis B virus. In the absence of other liver disorders, the presence of obesity, or diabetes in the absence of other risk factors, metabolic dysfunction-associated fatty liver disease (MAFLD) was diagnosed. A total of 1,368 HCC patients were included, in which 985 (72%) had HCV, 58 (4%) had hepatitis B virus, and 143 (10.5%) had MAFLD, 1 patient had hemochromatosis, 1 had autoimmune liver disease, and 180 (13%) patients were with unknown cause. The annual proportions of MAFLD-related HCC were increased significantly between 8.3% in 2010 and 20.6% in 2020 (p = 0.001), while HCV-related HCC declined from 84.8 to 66.7% (p = 0.001). Throughout the study period, there were significant increases in the age at diagnosis of HCC, the proportion of female patients, obesity, diabetes, and less severe liver dysfunction at diagnosis (p < 0.05 for all). With the decline of HCV, MAFLD is becoming a major cause of HCC in Egypt, which has increased substantially over the past 10 years. This study urges the creation of comprehensive action strategies to address this growing burden.
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Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Cairo, Egypt
| | - Yasmine Gaber
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shereen Abdel Alem
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Abdallah
- Department of Medical Research Division Medicine, National Research Centre, Giza, Egypt
| | - Sherief M. Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Shaymaa Nafady
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Mohamed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia
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Attia D, Abdel Alem S, El-Akel W, Abdel-Razek W, Eslam M, Fouad Y, Waked I. Prevalence and clinical characteristics of patients with metabolic dysfunction-associated fatty liver disease with hepatitis C virus infection-a population-based study. Aliment Pharmacol Ther 2022; 56:1581-1590. [PMID: 36168675 DOI: 10.1111/apt.17233] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/24/2022] [Revised: 04/05/2022] [Accepted: 09/11/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Metabolic-associated fatty liver disease (MAFLD) was proposed in 2020 to identify fatty liver disease associated with metabolic risks. Metabolic abnormalities with hepatitis C virus (HCV) and MAFLD frequently co-exist. However, data on the co-existence are still lacking. AIM To explore the prevalence and characteristics of metabolic profiles among a large cohort of patients with HCV infection between 2007 and 2020 based on new diagnostic criteria METHODS: We recruited 288,222 patients with chronic HCV infection with demographic data, laboratory parameters, and ultrasound from a web-based registry of the National Committee for Control of Viral Hepatitis in Egypt from 2007 to 2020. RESULTS Among the participants, 41.9% (95% CI: 41.69-42.05) met diagnostic criteria for MAFLD, with a significant increase in the period 2014-2020 compared to 2007-2013 (43.3% vs. 19%, respectively). Participants with MAFLD had a high prevalence of obesity, diabetes mellitus and hypertension. The prevalences increased significantly over time (obesity: 66.7% vs. 76.9%, p < 0.01; diabetes mellitus: 14.6% vs. 31.5%, p < 0.01; hypertension: 0.9% vs. 7.6%, p < 0.01; prediabetes: 28.8% vs. 25.9%, p < 0.01) for the periods 2007-2013 and 2014-2020, respectively. The percentage of advanced fibrosis by fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) was significantly higher in participants with MAFLD during 2014-2020 than during 2007-2013 (FIB-4; 18.4% vs. 8% and NFS; 17.1% vs. 7%). CONCLUSION MAFLD is highly prevalent in patients with HCV infection and has risen over time. This rising prevalence parallels the alarming rise in obesity, diabetes mellitus and hypertension. Early detection of metabolic dysfunction in patients with HCV infection is recommended to prevent MAFLD progression.
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Affiliation(s)
- Dina Attia
- Beni-Suef University, Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni Suef, Egypt
| | - Shereen Abdel Alem
- Cairo University, Department of Endemic Medicine, Faculty of Medicine, Cairo, Egypt
| | - Wafaa El-Akel
- Cairo University, Department of Endemic Medicine, Faculty of Medicine, Cairo, Egypt
| | - Wael Abdel-Razek
- Ain Shams University (MOH), Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Cairo, Egypt
| | - Mohamed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Westmead, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Yasser Fouad
- Minia University, Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia, Egypt
| | - Imam Waked
- National Liver Institute, Department of Hepatology, Shebeen el Kom, Egypt
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Attia D, Gomaa A, Abdel Alem S. Letter to the editor: Pitfalls in the outcome differences between NAFLD and MAFLD. Hepatology 2022; 76:E100. [PMID: 35532891 DOI: 10.1002/hep.32563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Dina Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ahmed Gomaa
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Shereen Abdel Alem
- Department of Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Alem SA, Fouad Y, AbdAllah M, Attia D, Kamal I, Said E, Gomaa A, Abd-Elsalam SM, Gaber Y. Hepatologists' awareness and knowledge toward NAFLD and the familiarity with renaming from NAFLD to MAFLD. Endocr Metab Immune Disord Drug Targets 2022; 23:EMIDDT-EPUB-127272. [PMID: 36306455 DOI: 10.2174/1871530323666221028154159] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/18/2022] [Revised: 08/08/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) is an emerging epidemic; it is a negative diagnosis that depends mainly on the presence of hepatic steatosis with or without inflammation after exclusion of other chronic liver diseases and excess alcohol intake. However, the new definition of MAFLD is a shift towards a diagnosis of inclusion based on the presence of metabolic dysfunction, regardless of alcohol consumption or other concomitant liver diseases. Given the growing relevance of the disease, data on hepatologists' views and understanding of NAFLD are limited, we aimed to determine hepatologists' awareness and expertise of NAFLD screening, diagnosis, and therapeutic options as well as the influence of changing the NAFLD name to MAFLD on awareness of the fatty liver disease (FLD). OBJECTIVE Most of the hepatologists agreed that NAFLD can cause serious hepatic illness and may be linked to metabolic risk factors, necessitating a multidisciplinary approach to treatment. Hepatologists have a poor understanding of NAFLD care. The shift in terminology from NAFLD to MAFLD will be more known to hepatologists, and it may offer a better awareness of FLD. METHODS A multicenter online questionnaire of 655 hepatologists was carried out, giving a sample of 207 respondents. A survey composed of 36 questions was used to assess the level of hepatologists' awareness and practices in the screening, diagnosis, and management of NAFLD/MAFLD, as well as their familiarity with the nomenclature change from NAFLD to MAFLD. RESULTS A total of 207 hepatologists were included, of which 107 (51.4%) were males, with a mean age was 36.4 years. 50.2% (n=104) of the hepatologists were oriented with NAFLD. Only 41 (19.8%) realized that NAFLD may frequently result in severe hepatic disease. NAFLD is rarely screened by the majority of the participating hepatologists (118, 57%), and (135, 65.2%) of them use liver biopsy for diagnosis of NAFLD. In (104, 50.2%) of hepatologists, changing the nomenclature of NAFLD was relatively familiar. Furthermore, 71.9% of hepatologists thought that the new nomenclature offers a better awareness of FLD. CONCLUSION A small percentage of hepatologists agreed that NAFLD can cause serious hepatic illness and may be linked to metabolic risk factors, and around half of them realize that NAFLD necessitates a multidisciplinary approach to treatment. Hepatologists have a poor understanding of NAFLD care. The shift in terminology from NAFLD to MAFLD will be more known to hepatologists, and it may offer better awareness of FLD.
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Affiliation(s)
- Shereen Abdel Alem
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mohamed AbdAllah
- Medical Research Division, National Research Centre, Giza, Egypt
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Inas Kamal
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ebada Said
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Gomaa
- Tropical Medicine Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | | | - Yasmine Gaber
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Fouad YM, Gomaa A, El Etreby RM, AbdAllah M, Attia D. Editorial: The Metabolic (Dysfunction)-Associated Fatty Liver Disease (MAFLD) and Non-Alcoholic Fatty Liver Disease (NAFLD) Debate: Why the American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL) Consensus Process is Not Representative. Med Sci Monit 2022; 28:e938066. [PMID: 35993179 PMCID: PMC9462522 DOI: 10.12659/msm.938066] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A debate has recently arisen in hepatology on the redefinition of fatty liver disease associated with metabolic dysfunction. The definition of metabolic (dysfunction)-associated fatty liver disease (MAFLD) has been widely endorsed by multiple stakeholders and societies. More importantly, although robust evidence supports the utility of the definition of MAFLD in clinical practice and research, and for increasing awareness of liver disease, controversy still abounds. Recently, the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) have undertaken similar consensus approaches for MAFLD. However, there are serious concerns with these regional consensus approaches. The views of hepatologists from the Middle East, North Africa, and sub-Saharan Africa are not represented. Also, the selection of experts raises concerns regarding the validity of the outcomes of the expert consensus process. We conclude that unless the process has global involvement, there will be no incentive for global adherence to these regional recommendations. This Editorial aims to highlight these concerns and to call for those involved in leading the AASLD and EASL consensus process to be more inclusive, which may facilitate the adoption of more unified recommendations that have global clinical importance.
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Affiliation(s)
- Yasser Mahrous Fouad
- Department of Endemic Medicine and Gastroenterology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed Gomaa
- Department of Endemic Medicine and Gastroenterology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Rasha Mohamed El Etreby
- Department of Hepatology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed AbdAllah
- Medical Research Division, National Research Centre, Giza, Egypt
| | - Dina Attia
- Department of Endemic Medicine and Gastroenterology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Farhan HM, Abougabal K, Gaber HF, Attia D. Disheveled EGL-10 and pleckstrin domain-containing 5 rs1012068 T/G gene polymorphism among Egyptian chronic HCV-infected patients: disease progression and related complications. Egypt J Immunol 2022; 29:36-43. [PMID: 35758967] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hepatitis C virus (HCV) infection related complications including fibrosis, cirrhosis and hepatocellular carcinoma (HCC) are influenced by host genetic factors. Identification of emerging host genetic variations is of promising value. Disheveled EGL-10 and pleckstrin domain-containing 5 (DEPDC5) rs1012068 T/G gene polymorphism has been implicated in liver disease. This study aimed to assess DEPDC5 rs1012068 T/G gene polymorphism with disease progression and related complications among Egyptian patients with chronic HCV infection. Sixty chronic HCV-infected patients and 60 apparently healthy controls were recruited in this study. Patients were classified into 20 with liver fibrosis, 20 with liver cirrhosis and 20 with HCC; all recruited from Outpatients Clinic and Tropical Medicine Inpatient Department, Faculty of Medicine, Beni-Suef University Hospital. DEPDC5 rs1012068 T/G gene polymorphism was assayed by real time-polymerase chain reaction (RT-PCR) TaqMan allelic discrimination. DEPDC5 rs1012068 GG genotype and G allele variants showed statistically significant higher frequency among patients with liver fibrosis when compared to controls (OR (95% CI) 10.500 (2.086 - 52.851), P= 0.004 and 0.388 (0.155 - 0.971), P= 0.011), respectively. DEPDC5 rs1012068G allele variant showed statistically significant higher frequency among patients with liver fibrosis when compared to HCC patients (OR (95% CI) 3.316 (1.286 - 8.550), P= 0.012) and to both HCC and cirrhosis patients (OR (95% CI) 2.579 (1.187-5.645), P= 0.016). In conclusion, our results suggest that DEPDC5 rs1012068 G allele could be considered genetic risk allele for liver fibrosis and disease progression among Egyptian patients with chronic HCV infection.
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Affiliation(s)
- Hanan M Farhan
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Khadiga Abougabal
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Heba F Gaber
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Dina Attia
- Department of Tropical Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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11
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Farhan H, Abougabal K, Gaber H, Attia D. Disheveled EGL-10 and pleckstrin domain-containing 5 rs1012068 T/G gene polymorphism among Egyptian chronic HCV-infected patients: disease progression and related complications. Egypt J Immunol 2022. [DOI: 10.55133/eji.290305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hepatitis C virus (HCV) infection related complications including fibrosis, cirrhosis and hepatocellular carcinoma (HCC) are influenced by host genetic factors. Identification of emerging host genetic variations is of promising value. Disheveled EGL-10 and pleckstrin domain-containing 5 (DEPDC5) rs1012068 T/G gene polymorphism has been implicated in liver disease. This study aimed to assess DEPDC5 rs1012068 T/G gene polymorphism with disease progression and related complications among Egyptian patients with chronic HCV infection. Sixty chronic HCV-infected patients and 60 apparently healthy controls were recruited in this study. Patients were classified into 20 with liver fibrosis, 20 with liver cirrhosis and 20 with HCC; all recruited from Outpatients Clinic and Tropical Medicine Inpatient Department, Faculty of Medicine, Beni-Suef University Hospital. DEPDC5 rs1012068 T/G gene polymorphism was assayed by real time-polymerase chain reaction (RT-PCR) TaqMan allelic discrimination. DEPDC5 rs1012068 GG genotype and G allele variants showed statistically significant higher frequency among patients with liver fibrosis when compared to controls (OR (95% CI) 10.500 (2.086 – 52.851), P= 0.004 and 0.388 (0.155 – 0.971), P= 0.011), respectively. DEPDC5 rs1012068G allele variant showed statistically significant higher frequency among patients with liver fibrosis when compared to HCC patients (OR (95% CI) 3.316 (1.286 – 8.550), P= 0.012) and to both HCC and cirrhosis patients (OR (95% CI) 2.579 (1.187-5.645), P= 0.016). In conclusion, our results suggest that DEPDC5 rs1012068 G allele could be considered genetic risk allele for liver fibrosis and disease progression among Egyptian patients with chronic HCV infection.
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12
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Farahat TM, Ungan M, Vilaseca J, Ponzo J, Gupta PP, Schreiner AD, Al Sharief W, Casler K, Abdelkader T, Abenavoli L, Alami FZM, Ekstedt M, Jabir MS, Armstrong MJ, Osman MH, Wiegand J, Attia D, Verhoeven V, Amir AAQ, Hegazy NN, Tsochatzis EA, Fouad Y, Cortez-Pinto H. The paradigm shift from NAFLD to MAFLD: A global primary care viewpoint. Liver Int 2022; 42:1259-1267. [PMID: 35129258 DOI: 10.1111/liv.15188] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/09/2022] [Accepted: 01/31/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Taghreed M Farahat
- The Egyptian Family Medicine Association (EFMA), WONCA East Mediterranean, Department of Public Health and Community Medicines, Menoufia University, Menoufia, Egypt
| | - Mehmet Ungan
- The Turkish Association of Family Physicians (TAHUD), WONCA Europe, Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Josep Vilaseca
- Barcelona Esquerra Primary Health Care Consortium, Barcelona, Spain.,WONCA Europe, Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Faculty of MedicineUniversity of Vic - Central University of Catalonia, Vic, Barcelona, Spain
| | - Jacqueline Ponzo
- WONCA Iberoamericana, Departamento de Montevideo, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Pramendra Prasad Gupta
- WONCA South Asia, Department of General Practice and Emergency Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Andrew D Schreiner
- Departments of Medicine Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Wadeia Al Sharief
- President Emirates Family Medicine Society, President Family Medicine Scientific Council in Arab Board for Medical Specialization Council, Director Medical Education & Research Department, Dubai, UAE
| | - Kelly Casler
- Director of Family Nurse Practitioner Program, The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Tafat Abdelkader
- Algerian Society of General Medicine/Societe Algerienne De Medecine Generale (SAMG), Algeria
| | - Ludovico Abenavoli
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Mattias Ekstedt
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Matthew J Armstrong
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mona H Osman
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Veronique Verhoeven
- Department of FAMPOP (Family Medicine and Population Health), University of Antwerp, Antwerpen, Belgium
| | | | - Nagwa N Hegazy
- The Egyptian Family Medicine Association (EFMA), WONCA East Mediterranean, Department of Public Health and Community Medicines, Menoufia University, Menoufia, Egypt
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minya, Egypt
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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13
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Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Sherief Abdel Salam
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed AbdAllah
- Medical Research Division, National Research Centre, Giza, Egypt
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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14
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Fouad Y, Palmer M, Chen M, Regev A, Banerjee R, Myers R, Riccio R, Torstenson R, Younes R, Arora PS, Landgren H, Karsdal MA, Blake M, Shapiro DA, Gruss HJ, Sheikh MY, Attia D, Bollipo S, Smith AD, Freilich B, Gish RG, Schuppan D. Redefinition of Fatty Liver Disease from NAFLD to MAFLD through the Lens of Drug Development and Regulatory Science. J Clin Transl Hepatol 2022; 10:374-382. [PMID: 35528969 PMCID: PMC9039717 DOI: 10.14218/jcth.2021.00408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/12/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 12/04/2022] Open
Abstract
Metabolic (dysfunction)-associated fatty liver disease (MAFLD) affects a third of the population and is a leading cause of liver-related death. Since no effective treatments exist, novel approaches to drug development are required. Unfortunately, outdated terminology and definitions of the disease are hampering efforts to develop new drugs and treatments. An international consensus panel has put forth an influential proposal for the disease to be renamed from nonalcoholic fatty liver disease (NAFLD) to MAFLD, including a proposal for how the disease should be diagnosed. As allies with the many stakeholders in MAFLD care-including patients, patients' advocates, clinicians, researchers, nurse and allied health groups, regional societies, and others-we are aware of the negative consequences of the NAFLD term and definition. We share the sense of urgency for change and will act in new ways to achieve our goals. Although there is much work to be done to overcome clinical inertia and reverse worrisome recent trends, the MAFLD initiative provides a firm foundation to build on. It provides a roadmap for moving forward toward more efficient care and affordable, sustainable drug and device innovation in MAFLD care. We hope it will bring promising new opportunities for a brighter future for MAFLD care and improve care and outcomes for patients of one of the globe's largest and costliest public health burdens. From this viewpoint, we have revisited this initiative through the perspectives of drug development and regulatory science.
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Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology, and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
- Correspondence to: Yasser Fouad, Endemic Medicine Department, Minia University, Main Road, Minia 11432, Egypt. Tel: +20-1091318555, Fax: +20-1-114721500, E-mail: ; Detlef Schuppan, Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA. Tel: +49-6131-17-7356, Fax: +49-6131-177357, E-mail:
| | - Melissa Palmer
- Gannex/Ascletis Pharma Co Ltd, Beijing, China
- Liver Consulting LLC, New York, NY, USA
| | - Minjun Chen
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - Arie Regev
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Rob Myers
- Gilead Sciences Inc, Foster City, CA, USA
| | | | | | - Ramy Younes
- Boehringer Ingelheim International, GmbH, Ingelheim, Germany
| | | | | | | | | | | | | | | | - Dina Attia
- Gastroenterology and Hepatology Department, Beni-Suef University, Beni Suef, Egypt
| | - Steven Bollipo
- Department of Gastroenterology and Endoscopy, John Hunter Hospital, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | | | | | - Robert G. Gish
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, CA, USA
| | - Detlef Schuppan
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Correspondence to: Yasser Fouad, Endemic Medicine Department, Minia University, Main Road, Minia 11432, Egypt. Tel: +20-1091318555, Fax: +20-1-114721500, E-mail: ; Detlef Schuppan, Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA. Tel: +49-6131-17-7356, Fax: +49-6131-177357, E-mail:
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15
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El-Shabrawi M, Memon I, Attia D, El-Koofy NM. The International Society of Tropical Paediatrics (ISTP) endorses the redefinition of fatty liver disease. J Hepatol 2022; 76:738-739. [PMID: 34813920 DOI: 10.1016/j.jhep.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Mortada El-Shabrawi
- Paediatric Hepatology Unit, Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Iqbal Memon
- Sir Syed College of Medical Sciences for Girls, Karachi, Pakistan
| | - Dina Attia
- Gastroenterology, Hepatology and Endemic Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Nehal M El-Koofy
- Paediatric Hepatology Unit, Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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16
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Ebeid B, Eid RA, Attia D, Daoud SA, Tawfik MM, Abdel Fattah AM. Prevalence of Microscopic Colitis in Diarrhea-predominant Irittable Bowel Syndrome Patients: Cohort Study From Upper Egypt. J Clin Gastroenterol 2022; 56:e232-e238. [PMID: 34334761 DOI: 10.1097/mcg.0000000000001592] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM There is controversy about colonoscopy and taking biopsy from the normal colonic mucosa in patients with a clinical diagnosis of diarrhea-predominant irritable bowel syndrome (D-IBS). This study aims to estimate the prevalence of microscopic colitis (MC) in D-IBS patients and to select patients without the well-known alarming features who will benefit from colonoscopy and biopsies from the normal colonic mucosa. PATIENTS AND METHODS We performed a cohort cross-sectional study over 6 months duration in a total of 129 patients with Rome III criteria of D-IBS after excluding cases with features of organic diseases. Cases were subjected to colonoscopy and biopsies from the colonic mucosa that seemed normal. RESULTS Histopathologic examination of biopsies taken from cases with normal colonic mucosa revealed 86 (71.66%) cases with nonspecific colitis, 26 (21.66%) cases with MC and 8 (6.66%) cases with ulcerative colitis. Concomitant immunologic diseases (P=0.00005) and triggering drugs intake (P=0.006) were significantly more common in the MC group. The mean duration of diarrhea in MC patients was significantly longer than that of nonspecific colitis and ulcerative colitis patients (P=0.0006). CONCLUSIONS Prevalence of MC in D-IBS patients from Upper Egypt is relatively high (21.66%). Concomitant immunologic diseases, possible triggering drugs intake, and long duration of diarrhea are significant risk factors for undiagnosed MC in D-IBS patients.
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Affiliation(s)
- Basel Ebeid
- Departments of Gastroenterology, Hepatology and Endemic Medicine
| | - Ragaey A Eid
- Departments of Gastroenterology, Hepatology and Endemic Medicine
| | - Dina Attia
- Departments of Gastroenterology, Hepatology and Endemic Medicine
| | - Sahar A Daoud
- Pathology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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17
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Attia D, Aty NA, Shawket A, Said E, Fouad Y. MAFLD Not NAFLD is Associated with Impairment of Health-related Quality of Life. J Clin Transl Hepatol 2022; 10:4-5. [PMID: 35233367 PMCID: PMC8845146 DOI: 10.14218/jcth.2021.00485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Dina Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Egypt
| | - Nadia Abdel Aty
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Ain Shams University, Egypt
| | - Ahmed Shawket
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Assiut University, Egypt
| | - Ebada Said
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Benha University, Egypt
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Egypt
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18
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Fouad Y, Esmat G, Elwakil R, Zakaria S, Yosry A, Waked I, El-Razky M, Doss W, El-Serafy M, Mostafa E, Anees M, Sakr MA, AbdelAty N, Omar A, Zaki S, Al-zahaby A, Mahfouz H, Abdalla M, Albendary M, Hamed AK, Gomaa A, Hasan A, Abdel-baky S, El sahhar M, Shiha G, Attia D, Saeed E, Kamal E, Bazeed S, Mehrez M, Abdelaleem S, Gaber Y, Abdallah M, Salama A, Tawab DA, Nafady S. The egyptian clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease. Saudi J Gastroenterol 2022; 28:3-20. [PMID: 35083973 PMCID: PMC8919931 DOI: 10.4103/sjg.sjg_357_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 11/04/2022] Open
Abstract
The landscape of chronic liver disease in Egypt has drastically changed over the past few decades. The prevalence of metabolic-associated fatty liver disease (MAFLD) has risen to alarming levels. Despite the magnitude of the problem, no regional guidelines have been developed to tackle this disease. This document provides the clinical practice guidelines of the key Egyptian opinion leaders on MAFLD screening, diagnosis, and management, and covers various aspects in the management of MAFLD. The document considers our local situations and the burden of clinical management for the healthcare sector and is proposed for daily clinical practical use. Particular reference to special groups was done whenever necessary.
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Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Cairo, Egypt,Address for correspondence: Dr. Yasser Fouad, Professor of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Minia University, Minia 61519, Egypt. E-mail:
| | - Gamal Esmat
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reda Elwakil
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Serag Zakaria
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Yosry
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Imam Waked
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El Kom, Egypt
| | - Maissa El-Razky
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wahid Doss
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Magdy El-Serafy
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mahmood Anees
- Department of Gastroenterology and Hepatology, Tanta, Egypt
| | - Mohamed A. Sakr
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nadia AbdelAty
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ashraf Omar
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samy Zaki
- Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, Egypt
| | - Amgad Al-zahaby
- Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, Egypt
| | - Hamdy Mahfouz
- Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Assuit, Egypt
| | - Maysaa Abdalla
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud Albendary
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Mansura University, Mansura, Egypt
| | - Abdel-Khalek Hamed
- Department of Internal Medicine, Hepatology, and Diabetes, Egyptian Military Medical Academy, Cairo, Egypt
| | - Ahmed Gomaa
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Adel Hasan
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Suez Canal University, Suez, Egypt
| | - Sherif Abdel-baky
- Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Medhat El sahhar
- Egyptian Association for the Study of Liver and Gastrointestinal Disease (EASLGD), Police Medical Academy, Cairo, Egypt
| | - Gamal Shiha
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ebada Saeed
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Benha University, Benha, Egypt
| | - Enas Kamal
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Cairo, Egypt
| | - Shamardan Bazeed
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mai Mehrez
- Department of Hepatology, NTHMRI, Cairo, Egypt
| | - Shereen Abdelaleem
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmine Gaber
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Abdallah
- Department of Medical Research Division Medicine, National Research Centre, Giza, Egypt
| | - Asmaa Salama
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Doaa A. Tawab
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Shaymaa Nafady
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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19
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Chen J, Duangthip D, Gao SS, Huang F, Anthonappa R, Oliveira BH, Turton B, Durward C, El Tantawi M, Attia D, Heima M, Muthu MS, Maharani DA, Folayan MO, Phantumvanit P, Sitthisettapong T, Innes N, Crystal YO, Ramos-Gomez F, Medina AC, Lo ECM, Chu CH. Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions. Front Oral Health 2021; 2:670154. [PMID: 35048013 PMCID: PMC8757786 DOI: 10.3389/froh.2021.670154] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/07/2021] [Indexed: 12/05/2022] Open
Abstract
Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions. Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country. Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0-5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA). Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers.
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Affiliation(s)
- Jieyi Chen
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | | | | | - Fang Huang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Robert Anthonappa
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | | | - Bathsheba Turton
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - Callum Durward
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - Maha El Tantawi
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Dina Attia
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Masahiro Heima
- Faculty of Dentistry, Kagoshima University, Kagoshima, Japan
| | - Murugan Satta Muthu
- Centre for Early Childhood Caries Research (CECCRe), Sri Ramachandra Institute of Higher Education and Research, Chennai, India
- Adjunct Research Associate, Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | | | | | | | | | - Nicola Innes
- School of Dentistry, Cardiff University, Cardiff, United Kingdom
| | - Yasmi O. Crystal
- College of Dentistry, New York University, New York, NY, United States
| | - Francisco Ramos-Gomez
- School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
| | | | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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20
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Clayton M, Fabrellas N, Luo J, Alghamdi MG, Hafez A, Qadiri TA, Owise N, Attia D. From NAFLD to MAFLD: Nurse and allied health perspective. Liver Int 2021; 41:683-691. [PMID: 33453067 DOI: 10.1111/liv.14788] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 12/23/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 02/13/2023]
Abstract
Fatty liver disease associated with metabolic dysfunction is the most prevalent liver disease worldwide, though both patient and health professional still lack awareness of it. An international consensus panel has produced what is sure to be an influential report renaming the disease from non-alcoholic fatty liver disease (NAFLD) to metabolic (dysfunction) associated fatty liver disease (MAFLD) and suggesting how the disease should be diagnosed. This viewpoint explores the call from the perspective of nurse and allied health practitioners. This group have raised serious concerns on the existing nomenclature, which labels the disease as NAFLD, and its diagnostic criteria, including provoking nurse role confusion and representing a major barrier to various key aspects; patient-nurse communications, patient awareness, partnership working, motivation of patients to undertake lifestyle changes and multiple health behaviour change promotion and nurse-led clinics. Therefore, they are enthusiastically supportive of this call to reframe the disease that we believe will ultimately have a positive impact on nurse-patient communication, and through this, improve patient care and quality of life and reduce burden on health system.
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Affiliation(s)
- Michelle Clayton
- Lecturer in Liver Care, School of Healthcare, University of Leeds and Liver Nurse Educator, Leeds Liver Unit, St James's University Hospital, Chair of The British Liver Nurses' Association (BLNA), Leeds, UK
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Jinkai Luo
- Department of Nursing, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mohammed G Alghamdi
- Ministry of Health, President of the Saudi Nurses Association at Saudi Commission for Health Specialties (SCFHS), Riyadh, Saudi Arabia
| | - Azaa Hafez
- Faculty of Nursing, Minia University, Minia, Egypt
| | | | - Nevin Owise
- Birzeit University, Modern university of college, Palestine medical complex, Palestine
| | - Dina Attia
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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21
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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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22
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Fouad Y, Gomaa A, Attia D. The EMRG Consortium: a gate to identify the burden of metabolic (dysfunction)-associated fatty liver disease in Egypt. Ther Adv Endocrinol Metab 2021; 12:20420188211054678. [PMID: 34733466 PMCID: PMC8559195 DOI: 10.1177/20420188211054678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Ahmed Gomaa
- Department of Hepatology and Gastroenterology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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23
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Falcón J, Torriglia A, Attia D, Viénot F, Gronfier C, Behar-Cohen F, Martinsons C, Hicks D. Exposure to Artificial Light at Night and the Consequences for Flora, Fauna, and Ecosystems. Front Neurosci 2020; 14:602796. [PMID: 33304237 PMCID: PMC7701298 DOI: 10.3389/fnins.2020.602796] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
The present review draws together wide-ranging studies performed over the last decades that catalogue the effects of artificial-light-at-night (ALAN) upon living species and their environment. We provide an overview of the tremendous variety of light-detection strategies which have evolved in living organisms - unicellular, plants and animals, covering chloroplasts (plants), and the plethora of ocular and extra-ocular organs (animals). We describe the visual pigments which permit photo-detection, paying attention to their spectral characteristics, which extend from the ultraviolet into infrared. We discuss how organisms use light information in a way crucial for their development, growth and survival: phototropism, phototaxis, photoperiodism, and synchronization of circadian clocks. These aspects are treated in depth, as their perturbation underlies much of the disruptive effects of ALAN. The review goes into detail on circadian networks in living organisms, since these fundamental features are of critical importance in regulating the interface between environment and body. Especially, hormonal synthesis and secretion are often under circadian and circannual control, hence perturbation of the clock will lead to hormonal imbalance. The review addresses how the ubiquitous introduction of light-emitting diode technology may exacerbate, or in some cases reduce, the generalized ever-increasing light pollution. Numerous examples are given of how widespread exposure to ALAN is perturbing many aspects of plant and animal behaviour and survival: foraging, orientation, migration, seasonal reproduction, colonization and more. We examine the potential problems at the level of individual species and populations and extend the debate to the consequences for ecosystems. We stress, through a few examples, the synergistic harmful effects resulting from the impacts of ALAN combined with other anthropogenic pressures, which often impact the neuroendocrine loops in vertebrates. The article concludes by debating how these anthropogenic changes could be mitigated by more reasonable use of available technology - for example by restricting illumination to more essential areas and hours, directing lighting to avoid wasteful radiation and selecting spectral emissions, to reduce impact on circadian clocks. We end by discussing how society should take into account the potentially major consequences that ALAN has on the natural world and the repercussions for ongoing human health and welfare.
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Affiliation(s)
- Jack Falcón
- Laboratoire Biologie des Organismes et Ecosystèmes Aquatiques (BOREA), MNHN, CNRS FRE 2030, SU, IRD 207, UCN, UA, Paris, France
| | - Alicia Torriglia
- Centre de Recherche des Cordeliers, INSERM U 1138, Ophtalmopole Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Université de Paris - SU, Paris, France
| | - Dina Attia
- ANSES, French Agency for Food, Environmental and Occupational Health & Safety, Maisons-Alfort, France
| | | | - Claude Gronfier
- Lyon Neuroscience Research Center (CRNL), Waking Team, Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Francine Behar-Cohen
- Centre de Recherche des Cordeliers, INSERM U 1138, Ophtalmopole Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Université de Paris - SU, Paris, France
| | | | - David Hicks
- Inserm, CNRS, Institut des Neurosciences Cellulaires et Intégratives, Université de Strasbourg, Strasbourg, France
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24
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Shiha G, Alswat K, Al Khatry M, Sharara AI, Örmeci N, Waked I, Benazzouz M, Al-Ali F, Hamed AE, Hamoudi W, Attia D, Derbala M, Sharaf-Eldin M, Al-Busafi SA, Zaky S, Bamakhrama K, Ibrahim N, Ajlouni Y, Sabbah M, Salama M, Anushiravani A, Afredj N, Barakat S, Hashim A, Fouad Y, Soliman R. Nomenclature and definition of metabolic-associated fatty liver disease: a consensus from the Middle East and north Africa. Lancet Gastroenterol Hepatol 2020; 6:57-64. [PMID: 33181119 DOI: 10.1016/s2468-1253(20)30213-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [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] [Received: 04/13/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
With the increasing prevalence of obesity and type 2 diabetes, fatty liver disease associated with metabolic dysfunction is a global health problem, especially because it is one of the earliest consequences of obesity and it precedes diabetes development. Fatty liver disease associated with metabolic dysfunction is of particular concern in the Middle East and north Africa, where its prevalence is greater than that in the rest of the world. Despite the magnitude of the problem, no regional guidelines have been developed to address this disease. This Review describes suggestions of redefining fatty liver disease associated with metabolic dysfunction, including its terminology and criteria for diagnosis. Experts have raised serious concerns on the current nomenclature, which labels the disease as non-alcoholic fatty liver disease (NAFLD), and its diagnostic criteria. The panel reached a consensus that the disease should be renamed as metabolic-associated fatty liver disease (MAFLD) and that the disease should be diagnosed by positive criteria. The aim is now to work with authorities across the region to implement these proposed changes and reflect them in health-care policy and to improve health care for patients in this region.
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Affiliation(s)
- Gamal Shiha
- Egyptian Liver Research Institute and Hospital, Mansoura, Egypt; Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Khalid Alswat
- Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Maryam Al Khatry
- Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, United Arab Emirates
| | - Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Necati Örmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Imam Waked
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El Kom, Egypt
| | - Mustapha Benazzouz
- Service of Medicine C, Centre Hospitalier Universaitaire Ibn Sina, Rabat, Morocco
| | - Fuad Al-Ali
- Department of Gastroenterology, Royal Hayat Hospital, Faculty of Medicine, Kuwait University, Kuwait
| | - Abd Elkhalek Hamed
- Department of Internal Medicine, Hepatology, and Diabetes, Egyptian Military Medical Academy, Cairo, Egypt
| | - Waseem Hamoudi
- Internal Medicine Department, Al-Bashir Hospital, Amman, Jordan
| | - Dina Attia
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Moutaz Derbala
- Gastroenterology and Hepatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Sharaf-Eldin
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Said A Al-Busafi
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Samy Zaky
- Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, Egypt
| | - Khaled Bamakhrama
- Department of Gastroenterology, Rashid Hospital, Dubai, United Arab Emirates
| | - Nazir Ibrahim
- Department of Gastroenterology and Hepatology, Al-Kalamoon University, Damascus, Syria
| | - Yousef Ajlouni
- Department of Internal Medicine, Royal Medical Services, King Hussein Medical City, Amman, Jordan
| | - Meriam Sabbah
- Department of Gastroenterology, Habib Thameur Hospital, Tunis, Tunisia
| | - Mohsen Salama
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El Kom, Egypt
| | - Amir Anushiravani
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nawel Afredj
- Hepatology Unit, Department of Medicine Mustapha Hospital, Algiers, Algeria
| | - Salma Barakat
- National Center for Gastrointestinal and Liver Diseases, Ibn Sina Hospital, Ministry of Health, Khartoum, Sudan
| | - Almoutaz Hashim
- Department of Internal Medicine, Jeddah University, Jeddah, Saudi Arabia
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minya University Hospitals, Minya, Egypt
| | - Reham Soliman
- Egyptian Liver Research Institute and Hospital, Mansoura, Egypt; Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt
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25
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Niaudet A, Attia D, Merckel O. Effets sanitaires des systèmes d’éclairage à LED. ARCH MAL PROF ENVIRO 2020. [DOI: 10.1016/j.admp.2020.03.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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El Tantawi M, Aly NM, Attia D, Abdelrahman H, Mehaina M. Dentist availability in Egypt: a 20-year study of supply, potential demand and economic factors. East Mediterr Health J 2020; 26:1078-1086. [PMID: 33047799 DOI: 10.26719/emhj.20.008] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/07/2019] [Indexed: 11/09/2022]
Abstract
Background Egypt is one of the most populated countries in the Eastern Mediterranean Region with historically large numbers of trained professionals providing services in and outside the country. Data about dentist availability are needed to plan for workforce production and training. Aims We assessed dentist availability in Egypt including (1) changes over 20 years; (2) spatial distribution; and (3) association with supply, potential demand for care and economic conditions. Methods In an ecological study (1995-2014), we used data from the Central Agency for Public Mobilization and Statistics. The outcome variable was dentist availability (dentists per 1000 population). The explanatory variables were: (1) population size; (2) number of dental graduates; (3) previous dentist availability; (4) increase in wages; and (5) percentage of population migrating internally seeking jobs. We assessed variation in availability using statistical process control and spatial autocorrelation. The impact of explanatory variables was assessed using general linear models with partial η2 to measure effect size. Results Dentists per 1000 population were randomly distributed over the country and the ratio reached 0.18 in 2014, indicating a shortage despite the increasing number of dental graduates since 1995 (667.1%). Previous dentist availability (η2 = 0.60) and increase in wages (η2 = 0.48) had the greatest impact on dentist availability. Conclusions Egypt faces a problem of dentist shortage that has not been offset by the increase in dental graduates. Improving the economic conditions and incorporating health care into the national development plan may improve the situation.
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Affiliation(s)
- Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Egypt
| | - Nourhan M Aly
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Egypt
| | - Dina Attia
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Egypt
| | - Hams Abdelrahman
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Egypt
| | - Mohamed Mehaina
- Alexandria and Mediterranean Research Center, Bibliotheca Alexandrina, Egypt
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27
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Fouad Y, Waked I, Bollipo S, Gomaa A, Ajlouni Y, Attia D. What's in a name? Renaming 'NAFLD' to 'MAFLD'. Liver Int 2020; 40:1254-1261. [PMID: 32301554 DOI: 10.1111/liv.14478] [Citation(s) in RCA: 183] [Impact Index Per Article: 45.8] [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: 03/17/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 12/13/2022]
Abstract
In medicine, language matters and the words used to name and describe a disease can have a profound impact on patients and their families. Over the last two decades, many criticisms have been voiced about the nomenclature and definition of non-alcoholic fatty liver disease (NAFLD) in regards not only to the prominent role that alcohol plays in the definition but also on the negative impacts of the nomenclature including trivialization, stigmatization and less consideration of the disease in health policy. Recently, a consensus of international experts proposed that the disease acronym be changed from NAFLD to metabolic (dysfunction) associated fatty liver disease or 'MAFLD'. This change goes far beyond a mere semantic revision and may be the first step that catalyses the process to better conceptualize the disease for health promotion, patient orientation, case identification, ongoing clinical trials and for health services delivery. Here we review the history of, and definitions of MAFLD in the context of advancing our understanding of the pathogenesis of the disease. We also address the reasons, signals, promises, challenges and the way going forward from the name change from various stakeholder perspectives.
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Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University Hospitals, Minya, Egypt
| | - Imam Waked
- Hepatology Department National Liver Institute, Menoufia University, Shebeen El Kom, Egypt
| | - Steven Bollipo
- Department of Gastroenterology and Endoscopy, John Hunter Hospital, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Ahmed Gomaa
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Yousef Ajlouni
- Gastroenterology and Hepatology Departement, King Hussein Medical Center, Amman, Jordan
| | - Dina Attia
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni-suef, Egypt
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28
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Kamal EM, El-Shabrawi M, El-Khayat H, Yakoot M, Sameh Y, Fouad Y, Attia D. Effects of sofosbuvir/ledipasvir therapy on chronic hepatitis C virus genotype 4, infected children of 3-6 years of age. Liver Int 2020; 40:319-323. [PMID: 31758735 DOI: 10.1111/liv.14308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/06/2019] [Revised: 10/04/2019] [Accepted: 11/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Treatment of children aged 3-6 genotype 4 is still limited by the interferon side effects. We aimed in this study to evaluate the effectiveness and safety of sofosbuvir/ledipasvir in children (3-6 years) genotype 4 chronic HCV-infected patients. METHODS In total, 22 consecutive chronic HCV-infected patients (mean age 4.8 ± 0.9years, 19 males) were included in this prospective study. All patients received sofosbuvir 200 mg/ledipasvir 45 mg in a single oral daily dose. Patients were randomly subdivided into two groups according the duration of treatment into 8 and 12 weeks. All the clinical and laboratory data were collected. All the side effects were recorded from the patients or their parents. Follow-up were made at Week 4, 8 and 12 and 12 weeks after the end of treatment (SVR12). RESULTS The overall SVR12 rate was 100%. At Week 4, 9/11 patients in the 12-week group (81.8%; 95% CI: 52.3%-94.7%) achieved virologic negativity, vs 10/11 (90.9%; 95% CI: 62.3%-98.4%) in the 8-week group. At Week 8, 10/11 (90.8%; 95% CI: 62.3%-98.4%) in the 12-week group vs 11/11 (100%; 95% CI: 74.1%-100%) in the 8-week group were virologically negative. The reported side effects were cough, abdominal pain, nausea, vomiting and diarrhoea especially early in the treatment. The main complaint was difficulty in swallowing the tablets in the youngest patient at the beginning of the course of treatment. All patients were compliant to treatment. CONCLUSION Sofosbuvir/ledipasvir combination is safe and tolerable in the chronic infected HCV genotype 4 infected children (3-6 years). The 8-week treatment duration is similarly effective as the 12-week duration.
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Affiliation(s)
- Enas M Kamal
- Department of Gastroenterology, Hepatology and Endemic Medicine, Minia University Hospitals, El Minia, Egypt
| | - Mortada El-Shabrawi
- Pediatric and Pediatrics Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hisham El-Khayat
- Department of Gastroenterology, Hepatology and Endemic Medicine, Theodore Bilharz Research Institute, Giza, Egypt
| | | | - Yehia Sameh
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni-suef, Egypt
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Minia University Hospitals, El Minia, Egypt
| | - Dina Attia
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni-suef, Egypt
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29
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Nasser MZ, Zayed NA, Mohamed AM, Attia D, Esmat G, Khairy A. Circulating microRNAs (miR-21, miR-223, miR-885-5p) along the clinical spectrum of HCV-related chronic liver disease in Egyptian patients. Arab J Gastroenterol 2019; 20:198-204. [PMID: 31806407 DOI: 10.1016/j.ajg.2019.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/07/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND STUDY AIMS MicroRNAs (miRNAs), small single stranded RNAs, function in the post-transcriptional regulation of gene expression and incorporated in pathogenesis of HCV related chronic liver disease. This study was designed to evaluate the significance of serum miR-21, miR-223, and miR-885-5p as biomarkers in various clinicopathological stages of HCV related chronic liver disease. PATIENTS AND METHODS Serum miR-21, miR-223, and miR-885-5p were quantified by quantitative RT PCR in 60 patients with HCV-related liver disease (presumably genotype 4), in addition to 25 healthy controls. HCV patients were classified into: chronic non-cirrhotic HCV (n = 15), HCV related liver cirrhosis (n = 15), and hepatocellular carcinoma (HCC) (n = 30). RESULTS Serum levels of miR-885-5p in cirrhotic patients ± HCC (n = 45) were significantly higher than the non-cirrhotic patients (n = 15); p = 0.007 and healthy control; p = 0.001. However, no such significance was detected between HCC and non-HCC HCV patients; p = 0.12. Serum miRNA-885-5p was able to discriminate cirrhosis ± HCC from healthy controls using ROC analysis; AUC 0.85, 87% sensitivity and 80% specificity. On the other hand, HCC patients had significantly higher serum miR-2 1evels than non-HCC patients (non-cirrhotic and cirrhotic groups, n = 30); p = 0.048 and the control group; p = 0.002. ROC could differentiate HCC from control group; AUC 0.89, 80% sensitivity, 80% specificity. Both serum bilirubin and albumin showed significant weak correlation with miRNA-885-5p (r = 0.42, p = 0.001) and (r = -0.27, p = 0.04), respectively but no such correlation was observed with serum miRNA-21. In contrast, miRNA-223 showed no significant difference across the studied groups. CONCLUSION Along the spectrum of HCV-related chronic liver disease, miR-885-5p could be a potential marker for advanced liver damage while miR-21 could be a helpful diagnostic marker for HCC.
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Affiliation(s)
- Mona Zaky Nasser
- Clinical Pathology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Naglaa Ali Zayed
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Dina Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Gamal Esmat
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Khairy
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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30
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El-Shabrawi MHF, Sherief LM, Yakoot M, Kamal NM, Almalky MA, AbdElgawad MM, Mahfouz AA, Helmy S, Kamal EM, Attia D, El-Khayat HR. Effects of dual sofosbuvir/daclatasvir therapy on, chronic hepatitis C infected, survivors of childhood malignancy. World J Clin Cases 2019; 7:2247-2255. [PMID: 31531319 PMCID: PMC6718790 DOI: 10.12998/wjcc.v7.i16.2247] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 04/09/2019] [Revised: 06/13/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Childhood cancer survivors are potentially at a higher risk of infection with hepatitis C virus (HCV). The effects of all-oral direct-acting antiviral therapy (DAA) on both the HCV infection as well as the state of cancer remission have not been well investigated in this population.
AIM To test the effects of dual sofosbuvir/daclatasvir (SOF/DCV) therapy in the treatment of chronic HCV in survivors of hematologic malignancy in pediatric age group.
METHODS We conducted a prospective, uncontrolled, open-label multicenter study. A total of 20 eligible, chronic HCV, genotype-4, infected children who had been in continuous complete remission from hematologic cancer (leukemia/lymphoma) for at least one year were included in the study. All patients were treated with combined SOF/DCV for 12 wk. Patients were monitored throughout the study till 12 wk after end of treatment for safety and efficacy outcomes including the sustained virologic response 12 (SVR12) rate, hematological indices, liver and kidney functions.
RESULTS The intent-to-treat SVR12 rate was 20 of 20 (100%; 95%CI: 84%-100%). All patients showed normalized liver enzymes from week-4. All hematological indices, liver and kidney functions were kept normal throughout the study. No fatalities or treatment-emergent serious or severe adverse events were reported throughout the study.
CONCLUSION SOF/DCV combined therapy could be used safely and effectively in the treatment of chronic HCV genotype-4 infection in leukemia/lymphoma treated children. No relapses were detected during treatment and throughout the follow up period for either the original malignant disease or the HCV infection.
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Affiliation(s)
| | - Laila M Sherief
- Paediatric Hematology-Oncology Department, Zagazig Faculty of Medicine, Zagazig 21121, Egypt
| | - Mostafa Yakoot
- Internal medicine, Pediatrics and Hepatology, Green Clinic and Research Center, Alexandria University, Alexandria 21121, Egypt
| | - Naglaa M Kamal
- Paediatric Hepatology Department, Cairo Faculty of Medicine, Cairo 11559, Egypt
| | - Mohamed A Almalky
- Paediatric Hematology-Oncology Department, Zagazig Faculty of Medicine, Zagazig 21121, Egypt
| | - Manal M AbdElgawad
- Paediatric Hepatology Department, Alexandria Faculty of medicine, Alexandria 21121, Egypt
| | - Aml A Mahfouz
- Paediatric Hepatology Department, Alexandria Faculty of medicine, Alexandria 21121, Egypt
| | - Sherine Helmy
- Innovations & Research, Pharco Corporation, Alexandria 21121, Egypt
| | - Enas M Kamal
- Endemic medicine and Hepatology Department, Minia University, Minia 22233, Egypt
| | - Dina Attia
- Endemic medicine and Hepatology Department, Beni-suef University, Beni-suef 62511, Egypt
| | - Hisham R El-Khayat
- Gastroenterology and Endemic Medicine Department, Theodore Research Institute, Cairo 23323, Egypt
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Attia D, Rodt T, Marquardt S, Hinrichs J, Meyer BC, Gebel M, Wacker F, Manns MP, Potthoff A. Shear wave elastography prior to transjugular intrahepatic portosystemic shunt may predict the decrease in hepatic vein pressure gradient. Abdom Radiol (NY) 2019; 44:1127-1134. [PMID: 30288582 DOI: 10.1007/s00261-018-1795-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to treat portal hypertension complications. Our aim was to evaluate liver and spleen stiffness measurement (LSM and SSM, respectively) changes using acoustic radiation force impulse imaging (ARFI) in comparison to Child-Pugh scores for predicting hepatic venous pressure gradient (HVPG) decreases after TIPS implantation. METHODS This prospective study included 31 consecutive clinically significant portal hypertension patients with TIPS indication. All patients received LSM and SSM before TIPS, at baseline, 2 days (follow-up 1) and 6 weeks (follow-up 2) post-implantation. HVPG was performed during the TIPS procedure. RESULTS The mean decrease in HVPG after TIPS was 63%. LSM and SSM decreased significantly between baseline and follow-up 2 (p < 0.001 and p < 0.001, respectively). At baseline, follow-up 1 and follow-up 2, significant correlations were detected between mean SSM and mean HVPG (p = 0.026; p = 0.018; p = 0.002, respectively). HVPG decreased to ≤ 10 mmHg in 61% of patients for which LSM, SSM, and Child-Pugh score were predictors (p = 0.033, p = 0.002 and p = 0.030, respectively). The area under the curve (AUC) for LSM, SSM, and Child-Pugh was 0.88, 0.90, and 0.84, respectively, with close sensitivity and specificity. SSM had the highest diagnostic accuracy for predicting an HVPG decrease to ≤ 10 mmHg in comparison to LSM and Child-Pugh score. CONCLUSION Spleen stiffness is superior to liver stiffness and Child-Pugh score as a non-invasive surveillance tool for evaluating patients with clinically significant portal hypertension (HVPG ≥ 10 mmHg) prior to TIPS.
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Affiliation(s)
- Dina Attia
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Mokbel Street, Beni-Suef, 62511, Egypt.
| | - Thomas Rodt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Steffen Marquardt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael Gebel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Lipinski M, Saborowski M, Heidrich B, Attia D, Kasten P, Manns MP, Gebel M, Potthoff A. Clinical characteristics of patients with liver cirrhosis and spontaneous portosystemic shunts detected by ultrasound in a tertiary care and transplantation centre. Scand J Gastroenterol 2018; 53:1107-1113. [PMID: 30270689 DOI: 10.1080/00365521.2018.1498913] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The clinical relevance of spontaneous portosystemic shunts detected by ultrasound is insufficiently investigated. The aim of this retrospective study was to assess the frequency and clinical relevance of spontaneous portosystemic shunts in patients with liver cirrhosis. METHODS We evaluated portosystemic shunts, liver cirrhosis and spleen size by ultrasound in 982 patients with liver cirrhosis and correlated these with laboratory results, clinical data and the incidence of clinical endpoint deaths, liver transplantation and the development of HCC during the follow-up period (mean 1.26 ± 1.53 years [range 0-7.2 years]). RESULTS Portosystemic shunts were detected in 34% of the patients. These patients had a higher rate of alcohol-related cirrhosis (37% vs. 30%, p = .003), a higher MELD score (p < .001) and Child-Pugh grade (p < .001), as well as more frequent hepatic encephalopathy (p < .001) and oesophageal varices (p < .003). The most frequent portosystemic shunt in this cohort was an umbilical vein shunt (69%) followed by splenorenal (16%), mesenteric (7%) and combined/other shunts (8%). Patients with umbilical vein shunts had a higher rate of alcohol-related cirrhosis (p = .041) and suffered more frequently from Child B/C stages (p = .03), hepatorenal syndrome (p = .03), massive ascites (p = .001) and spontaneous bacterial peritonitis (p = .011). CONCLUSIONS Patients with portosystemic shunts that are detected by ultrasound should be monitored carefully as these patients are associated with advanced liver disease and multiple clinical risk factors.
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Affiliation(s)
- Michael Lipinski
- a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany
| | - Michael Saborowski
- a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany
| | - Benjamin Heidrich
- a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany
| | - Dina Attia
- a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany
| | - Philipp Kasten
- a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany
| | - Michael P Manns
- a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany
| | - Michael Gebel
- a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany
| | - Andrej Potthoff
- a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany
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Pietsch V, Deterding K, Attia D, Ringe KI, Heidrich B, Cornberg M, Gebel M, Manns MP, Wedemeyer H, Potthoff A. Long-term changes in liver elasticity in hepatitis C virus-infected patients with sustained virologic response after treatment with direct-acting antivirals. United European Gastroenterol J 2018; 6:1188-1198. [PMID: 30288281 DOI: 10.1177/2050640618786067] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Received: 04/25/2018] [Accepted: 06/08/2018] [Indexed: 12/12/2022] Open
Abstract
Background The use of interferon-free direct-acting antiviral agents (DAAs) is associated with a rapid short-term decrease in liver stiffness in chronic hepatitis C-infected patients with sustained virologic response (SVR). Objective The objective of this article is to evaluate long-term changes in liver elasticity in hepatitis C patients with SVR using transient elastography (TE), FIB-4 and APRI. Methods A total of 143 patients were treated with DAAs and reached SVR. Patients received TE measurement (median (range)) at treatment start (baseline), follow-up week 24 (FU24) and follow-up week 96 (FU96). Laboratory data were examined at each date and FIB-4 and APRI were calculated. Results Liver elasticity showed a significant decrease from baseline to FU24 (13.1 (3.1-75) kPa to 9.3 (2.9-69.1) kPa; p < 0.0001) and declined further until FU96 (7.9 (2.4-59.3) kPa; p < 0.0001). Liver inflammation and liver function parameters normalised during long-term follow-up. Progression of liver stiffness between FU24 to FU96 despite viral clearance was observed in 24 patients (17%). Long-term liver stiffness progression was associated with aspartate aminotransferase levels and TE change from baseline to FU24. Conclusion During long-term follow-up, the majority of patients with SVR had further improved liver stiffness values. Still, a significant proportion of patients may show long-term liver stiffness progression and thus continued TE follow-up is recommended.
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Affiliation(s)
- Veronika Pietsch
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Katja Deterding
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology and Hepatology, University of Essen, Essen, Germany
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Kristina Imeen Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael Gebel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael Peter Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology and Hepatology, University of Essen, Essen, Germany
| | - Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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34
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Attia D, El Saeed K, Elakel W, El Baz T, Omar A, Yosry A, Elsayed MH, Said M, El Raziky M, Anees M, Doss W, El Shazly Y, Wedemeyer H, Esmat G. The adverse effects of interferon-free regimens in 149 816 chronic hepatitis C treated Egyptian patients. Aliment Pharmacol Ther 2018; 47:1296-1305. [PMID: 29504152 DOI: 10.1111/apt.14538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/01/2017] [Revised: 10/30/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Interferon-free regimens are associated with high sustained virological response; however, associated adverse effects have yet to be fully reported. AIM To evaluate the adverse effects associated with the different direct-acting antiviral drug (DAA) regimens in Egyptian patients. METHODS This multicenter retrospective study included all adverse effects during and after treatment with DAA regimens of 149 816 chronic hepatitis C treated Egyptian patients. Patients received sofosbuvir (SOF)/ribavirin (RBV) (n = 21 835), SOF/simeprevir (n = 24 215) SOF/daclatasvir (DCV) (n = 58 477), SOF/DCV/RBV (n = 45 188) and paritaprevir/ombitasvir/ritonavir/RBV (n = 101). The duration of treatment varied between 12 and 24 weeks. All changes in the treatment regimens, discontinuation, mortality, and serious side effects were reported. RESULTS Adverse effects developed in 2475 (1.7%) (mean age [54 ± 9], male gender [53%]) patients. Serious side effects developed in 68% of these patients, and SOF/RBV was the most common causing regimen (73%, P < 0.001). Anaemia and hyperbilirubinemia were the most common side effects (731/149816, 0.5% and 463/149816, 0.3%, respectively) and SOF/RBV (588/21835, 3% and 353/21835, 1.6%, respectively) showed the highest incidence in the treated patients. Hepatocellular carcinoma and mortality were reported in 0.02% and 0.06% of all treated patients, respectively. Patients with liver cirrhosis showed higher incidence of serious side effects (Log rank P = 0.045) and mortality (Log rank P = 0.025) than patients without liver cirrhosis. Male gender (P = 0.012), lower haemoglobin (P < 0.001), platelets (P < 0.001) and albumin (P = 0.001), higher bilirubin (P = 0.002) and cirrhosis (P < 0.001) were factors associated with serious side effects development. CONCLUSION Adverse effects associated with DAAs are few, anaemia being the most common. SOF/RBV regimen showed the highest rate of side effects while SOF/DCV showed the least.
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Affiliation(s)
- D Attia
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Beni-suef University, Beni-suef, Egypt
| | - K El Saeed
- Department of Tropical Medicine, Ain Shams University, Cairo, Egypt
| | - W Elakel
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - T El Baz
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A Omar
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A Yosry
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M H Elsayed
- National Committee of Viral Hepatitis MOH, Ain Shams University, Cairo, Egypt
| | - M Said
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M El Raziky
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Anees
- Department of Tropical Medicine, Tanta University, Tanta, Egypt
| | - W Doss
- National Committee of Viral Hepatitis MOH, Cairo University, Cairo, Egypt
| | - Y El Shazly
- National Committee of Viral Hepatitis MOH, Ain Shams University, Cairo, Egypt
| | - H Wedemeyer
- Department of Hepatology, Gastroenterology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - G Esmat
- National Committee of Viral Hepatitis MOH, Cairo University, Cairo, Egypt
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35
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El-Khayat HR, Kamal EM, El-Sayed MH, El-Shabrawi M, Ayoub H, RizK A, Maher M, El Sheemy RY, Fouad YM, Attia D. The effectiveness and safety of ledipasvir plus sofosbuvir in adolescents with chronic hepatitis C virus genotype 4 infection: a real-world experience. Aliment Pharmacol Ther 2018; 47:838-844. [PMID: 29349793 DOI: 10.1111/apt.14502] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 07/20/2017] [Revised: 08/10/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The combination of ledipasvir plus sofosbuvir was recently approved for treatment of adolescent (12-17 years) HCV genotype 1, 4, 5 & 6 patients. However, few clinical trials have been performed in genotype 1 patients. AIM To investigate the effectiveness and safety of ledipasvir plus sofosbuvir in chronic HCV adolescent patients with genotype 4 in the real world. METHODS This prospective multicentre (six centres) open-label study included 144 adolescent chronic HCV patients with genotype 4 (mean age 14 ± 2, 69% males). All patients received a combination tablet containing 400 mg sofosbuvir and 90 mg ledipasvir once daily for 12 weeks. Laboratory and virological markers were evaluated at baseline, week 4, week 8 and week 12 (EOT), and 12 weeks after end of treatment (SVR12). RESULTS SVR12 was observed in 142/144 patients (99%). The relapsers occurred in previous naïve patients (n = 2/128, 2%), while the experienced patients showed 100% SVR12. SVR12 was 98% in F0/F1 patients in comparison to 100% in F2 patients (P = 0.552). No serious side effects were observed, nor was treatment discontinuation or death. Headache was the most common side effect in all patients (20%). In experienced patients, pruritus (31%, P = 0.007), diarrhoea (44%, P < 0.001) and skin rash (19%, P = 0.002) were higher than in naïve patients. CONCLUSIONS A ledipasvir plus sofosbuvir regimen is well tolerated and effective, and can be used safely in treating adolescent patients with chronic hepatitis C genotype 4.
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Affiliation(s)
- H R El-Khayat
- Department of Gastroenterology, Hepatology and Endemic Medicine, Theodore Bilharz Research Institute, Cairo, Egypt
| | - E M Kamal
- Department of Gastroenterology, Hepatology and Endemic Medicine, Minia University Hospitals, Minia, Egypt
| | - M H El-Sayed
- Rheumatology Department, Cairo University Hospitals, Cairo, Egypt
| | - M El-Shabrawi
- Rheumatology Department, Cairo University Hospitals, Cairo, Egypt
| | - H Ayoub
- Department of Gastroenterology, Hepatology and Endemic Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - A RizK
- Rheumatology Department, Cairo University Hospitals, Cairo, Egypt
| | - M Maher
- Department of Gastroenterology, Hepatology and Endemic Medicine, Egyptian Military Academy, Cairo, Egypt
| | - R Y El Sheemy
- Department of Gastroenterology, Hepatology and Endemic Medicine, Minia University Hospitals, Minia, Egypt
| | - Y M Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Minia University Hospitals, Minia, Egypt
| | - D Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-suef University, Beni-suef, Egypt
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Attia D, Bantel H, Lenzen H, Manns MP, Gebel MJ, Potthoff A. Liver stiffness measurement using acoustic radiation force impulse elastography in overweight and obese patients. Aliment Pharmacol Ther 2016; 44:366-79. [PMID: 27363528 DOI: 10.1111/apt.13710] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 02/12/2016] [Revised: 02/28/2016] [Accepted: 06/08/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity and overweight are global health problems. AIM To evaluate the diagnostic accuracy of liver stiffness measurement (LSM) using acoustic radiation force impulse (ARFI) elastography in overweight and obese patients for staging liver fibrosis. METHODS Ninety-seven patients (mean age: 50 years, 50% male) with body mass index (BMI) ≥25 kg/m(2) (mean BMI: 31 kg/m(2) ) were prospectively enrolled. All patients underwent ARFI elastography and liver biopsy. In 87/97 patients, transient elastography (TE) was performed (M- and XL-probes). Patients were divided into two groups respectively: overweight: BMI <30 kg/m(2) (n = 61); and obese: BMI ≥30 kg/m(2) (n = 26). RESULTS Acoustic radiation force impulse elastography correlated with liver fibrosis in overweight (r = 0.84, P < 0.0001) and obese patients (r = 0.85, P < 0.0001), while no correlation was observed with steatosis, steatohepatitis and BMI. Area under the curve detecting liver cirrhosis for ARFI and TE were 0.97 in overweight and 0.94 and 0.92 in obese patients. In both groups, the failure rate was lower for ARFI than TE. ARFI of liver segment 8 showed a lower discordance than TE in both groups (overweight: 3% vs. 12%, P = 0.002; obese: 8% vs. 27%, P = 0.034). Steatosis and steatohepatitis were neither predictors of discordance nor of performance in LSM by ARFI or TE in both groups. CONCLUSIONS In overweight and obese patients, acoustic radiation force impulse can diagnose liver cirrhosis and significant fibrosis with high diagnostic accuracy. Liver stiffness measurement using the XL-probe reduces the influence of BMI, steatosis and steatohepatitis. The failure and discordance rates were lower for acoustic radiation force impulse than transient elastography in both patients groups.
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Affiliation(s)
- D Attia
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - H Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - H Lenzen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - M P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - M J Gebel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - A Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Attia D, Schoenemeier B, Rodt T, Negm AA, Lenzen H, Lankisch TO, Manns M, Gebel M, Potthoff A. Evaluation of Liver and Spleen Stiffness with Acoustic Radiation Force Impulse Quantification Elastography for Diagnosing Clinically Significant Portal Hypertension. Ultraschall Med 2015; 36:603-610. [PMID: 26565516 DOI: 10.1055/s-0041-107971] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Hepatic vein pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension (CSPH). The aim of this study was to investigate-in comparison to HVPG-the ability to diagnose CSPH by liver and spleen stiffness measurements obtained by acoustic radiation force impulse (ARFI) imaging. MATERIALS AND METHODS A total of 78 patients (mean age: 53 ± 13 years, 62 % male) with chronic liver disease were enrolled in this study. Each patient received liver (LSM) and spleen (SSM) stiffness measurements by ARFI, an HVPG measurement and a transjugular liver biopsy on the same day. Patients were classified according to their HVPG into three different groups: HVPG < 10 mmHg, HVPG ≥ 10-< 12 mmHg and HVPG ≥ 12 mmHg. RESULTS LSM, SSM were significantly higher in patients with HVPG ≥ 10 - < 12 in comparison to HVPG < 10 mmHg (p < 0.001 and p < 0.001, respectively), and in patients with HVPG ≥ 12 mmHg in comparison to ≥ 10 - < 12 mmHg (p < 0.001 and p < 0.001, respectively). LSM and SSM were able to diagnose HVPG ≥ 10 mmHg and HVPG ≥ 12 mmHg with high diagnostic performance (AUC LSM: 0.93 and 0.87, respectively; AUC SSM: 0.97 and 0.95, respectively). The AUC of SSM in predicting esophageal varices (EVs) plus HVPG ≥ 10 mmHg and EVs plus HVPG ≥ 12 mmHg were higher compared to LSM in both groups of patients (SSM: 0.90 and 0.93 vs. LSM: 0.84 and 0.88, respectively). No significant difference between both AUCs was detected in the different HVPG groups. In the multivariate -analysis SSM remained a factor predicting HVPG (HVPG > 10 mmHg p = 0.007; HVPG ≥ 12 mmHg p = 0.003). CONCLUSION LSM and SSM by ARFI are noninvasive diagnostic tools that may help in diagnosing CSPH. LSM and SSM could be used as a guiding noninvasive screening tool in patients with esophageal varices requiring endoscopic evaluation.
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Affiliation(s)
- D Attia
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - B Schoenemeier
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - T Rodt
- Hannover Medical School, Diagnostic and Interventional Radiology, Hannover, Germany
| | - A A Negm
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - H Lenzen
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - T O Lankisch
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - M Manns
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - M Gebel
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - A Potthoff
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
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Potthoff A, Attia D, Pischke S, Mederacke I, Beutel G, Rifai K, Deterding K, Heiringhoff K, Klempnauer J, Strassburg CP, Manns MP, Bahr MJ. Long-term outcome of liver transplant patients with Budd-Chiari syndrome secondary to myeloproliferative neoplasms. Liver Int 2015; 35:2042-9. [PMID: 25736096 DOI: 10.1111/liv.12816] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 12/22/2014] [Accepted: 02/21/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND A considerable proportion of patients receiving liver transplants for Budd-Chiari syndrome (BCS) suffer from myeloproliferative neoplasms (MPN). This study evaluated the long-term prognosis of liver-transplanted patients with BCS secondary to MPN and the effect of immunosuppression on MPN progression. METHODS A total of 78 patients with BCS were evaluated between 1982 and 2013. Of those, 40 patients suffered from polycythaemia vera (PV) and essential thrombocythaemia (ET). One patient had primary myelofibrosis (PMF). All patients received the standard immunosuppressive regimen. We retrospectively evaluated the long-term survival, clinical course and laboratory parameters of patients with MPN. RESULTS Exactly 29/41 patients (71%) with MPN survived ≥ 3 years [mean age 36 ± 11 years; females n = 27 (93%)]. Mean follow-up after orthotopic liver transplantation (OLT) was 12.4 ± 7.3 years (range 3-28 years). Five- and 10-year survival rates were not significantly different in patients with and without MPN (P = 0.81 and P = 0.66 respectively) or in patients with PV and ET (P = 0.29 and P = 0.55 respectively). Thrombosis and bleeding developed in 7/29 (24%) long-term MPN survivors with no significant difference between ET and PV (P = 0.18). In the long-term follow-up, there was no evidence of progression to overt myelofibrosis or acute myeloid leukaemia (AML). In the uni- and multivariate Cox-regression analyses, MPN did not influence survival after OLT. CONCLUSIONS Budd-Chiari syndrome patients with and without underlying MPN had similar long-term survival rates after OLT. There was no evidence of enhanced progression of MPN after OLT secondary to immunosuppressive therapy. However, major haemorrhage and recurrent thrombosis contributed to morbidity and mortality after OLT in those patients.
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Affiliation(s)
- Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology, Hepatology and Endemic Medicine, Beni Suef University, Beni Suef, Egypt
| | - Sven Pischke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Gernot Beutel
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Kinan Rifai
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Katja Deterding
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Karlheinz Heiringhoff
- Department of Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- Department of Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Christian P Strassburg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Matthias J Bahr
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Potthoff A, Schettler A, Attia D, Schlue J, Schmitto JD, Fegbeutel C, Strüber M, Haverich A, Manns MP, Wedemeyer H, Gebel M, Schneider A. Liver stiffness measurements and short-term survival after left ventricular assist device implantation: A pilot study. J Heart Lung Transplant 2015; 34:1586-94. [PMID: 26169664 DOI: 10.1016/j.healun.2015.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/12/2015] [Accepted: 05/28/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hepatic dysfunction can contribute to the clinical outcome of patients with end-stage chronic heart failure (HF). This pilot study evaluated the importance of liver stiffness (LS) measurements by acoustic radiation force impulse (ARFI) imaging elastography in patients with end-stage chronic HF who underwent left ventricular assist device (LVAD) implantation. METHODS The study enrolled 28 patients (23 men), mean age of 54 ± 11 years, with end-stage chronic HF selected for LVAD implantation. At baseline, all patients received LS measurements using ARFI elastography. Hepatic venous pressure gradient measurements and transjugular liver biopsies were performed in 16 patients. Liver stiffness was measured 21 days (Follow-up 1, n = 23) and 485 ± 136 days (Follow-up 2, n = 13) after LVAD implantation. Patients were classified according to their baseline LS into Group I (low baseline LS [no significant fibrosis = Metavir F < 2]) or Group II (high baseline LS [significant fibrosis = Metavir F ≥ 2]). RESULTS LS at baseline was higher in Group II than in Group I (p < 0.001) and decreased significantly after LVAD implantation (Follow-up 1, p = 0.002; Follow-up 2, p = 0.002). Baseline LS correlated with liver fibrosis (p = 0.049) and central venous pressure (p = 0.001). Non-survivors showed higher LS (p = 0.019), bilirubin (p = 0.018), Model for End-Stage Liver Disease score (p = 0.001), and liver fibrosis (p = 0.004) compared with the survivors. In the univariate analysis, LS was a significant factor (p = 0.017) in predicting survival after LVAD implantation. CONCLUSIONS ARFI elastography shows that LS is influenced by central venous congestion and histologic changes of the liver in patients with end-stage chronic HF. LS may predict the outcome in patients after LVAD implantation.
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Affiliation(s)
- Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology.
| | - Anika Schettler
- Department of Gastroenterology, Hepatology and Endocrinology
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Endocrinology; Departement of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | | | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christine Fegbeutel
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Martin Strüber
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; Heart Center Leipzig, Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology
| | | | - Michael Gebel
- Department of Gastroenterology, Hepatology and Endocrinology
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Attia D, Gheita T, El Awar A, Abd Alaal A, Ayoub M. AB0619 Isotypes of Anti-Beta 2- Glycoprotein I in Systemic Lupus Erythematosus Patients: Correlation with Clinical Manifestations, Laboratory Features and Association with Antiphospholipid Syndrome. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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von Hahn T, Bange FC, Westhaus S, Rifai K, Attia D, Manns M, Potthoff A, Gebel M. Ultrasound presentation of abdominal tuberculosis in a German tertiary care center. Scand J Gastroenterol 2014; 49:184-90. [PMID: 24325727 DOI: 10.3109/00365521.2013.865258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Abdominal tuberculosis (TB) is a relatively rare disease in most of Europe and the typical clinical and sonographic findings in this setting have not been studied. We aimed to define sonographic findings that should alert an examiner to the possibility of abdominal TB in a low endemic region. METHODS Case records of 17 patients with proven (n = 11) or highly likely (n = 6) abdominal TB detected in the gastrointestinal ultrasound unit at a German tertiary care center in 2003-2013 were analyzed retrospectively. Findings were compared with reported series from high-prevalence regions. RESULTS While 76% of patients had an immigrant background, only 35% had a condition associated with immunosuppression. Lymphadenopathy was present in all cases of abdominal TB, while it was absent in 28% of patients from a control group with proven abdominal sarcoidosis. Moreover, retroperitoneal lymphadenopathy was significantly more common in TB. Other findings in patients with abdominal TB in descending order of frequency were ascites, altered hepatic texture, splenomegaly, splenic lesions, peritoneal thickening, intestinal wall lesions, hepatic lesions and hepatomegaly. 76% of abdominal TB patients had 2 or more pathological findings. CONCLUSIONS Multiple pathological intra-abdominal findings including lymphadenopathy should alert the examiner to the possibility of abdominal TB.
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Affiliation(s)
- Thomas von Hahn
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover , Hannover , Germany
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El Raziky M, Attia D, El Akel W, Shaker O, Khatab H, Abdo S, Elsharkawy A, Esmat G. Hepatic fibrosis and serum alpha-fetoprotein (AFP) as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment. Arab J Gastroenterol 2013; 14:94-8. [PMID: 24206736 DOI: 10.1016/j.ajg.2013.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 03/19/2012] [Revised: 08/28/2012] [Accepted: 05/02/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND STUDY AIM Elevated levels of alpha-fetoprotein (AFP) can be seen in patients with chronic hepatitis C (CHC) and liver cirrhosis without hepatocellular carcinoma and were negatively associated with treatment response. However, factors associated with its changes are not identified. We aimed in this study to verify a cut-off value for AFP as a predictor of response to standard of care (SOC) antiviral therapy in Egyptian chronic hepatitis C virus (HCV)-infected patients and identify factors associated with its changes post treatment. PATIENTS AND METHODS A total of 175 chronic non-cirrhotic HCV-infected patients were evaluated for baseline serum AFP and liver biopsy were classified according to Ishak scoring system of hepatic fibrosis. All patients were scheduled to receive SOC antiviral therapy for 48weeks and had been followed up to week 72. Reassessment of AFP and repeated liver biopsy at week 72 were feasible only in 79 patients. RESULTS High baseline AFP levels were observed in non-respondents (non-sustained virological respondents (non-SVRs)) (P<0.01); the AFP level decreased in all patients post treatment (P=0.01), especially in the SVRs (P<0.01). In multivariate analysis, hepatic fibrosis was a predictor of response to treatment (P=0.02), while body mass index (BMI) (25-30kgm(-2)), hepatic activity (A2), hepatic fibrosis stage (F2-F4) and fibrosis improvement were predictors of AFP difference (P=0.007, 0.01, 0.012, <0.001, 0.030, and 0.018), respectively. The diagnostic performance to predict the HCV treatment response was best by adding both AFP and hepatic fibrosis stage factors; the best cut-off value for AFP was 3.57ngdl(-1) with 50% sensitivity and 68% specificity with area under the curve (AUC) of 0.55 and for hepatic fibrosis stage was 3, with a sensitivity of 88%, a specificity of 30% with an AUC of 0.58. CONCLUSION In chronic HCV-infected patients, serum AFP below 3.57ngdl(-1) and hepatic fibrosis ⩽stage 3 are expected to have good response to treatment; BMI (25-30kgm(-1)), A2, fibrosis >2 and fibrosis improvement predict AFP change post treatment.
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Affiliation(s)
- Maissa El Raziky
- Endemic Medicine, Hepatogastroenterology Department, Cairo University, Cairo, Egypt.
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Esmat G, Elsharkawy A, El Akel W, Fouad A, Helal K, Mohamed MK, Attia D, Khattab H, Doss W, Labib S. Fibroscan of chronic HCV patients coinfected with schistosomiasis. Arab J Gastroenterol 2013; 14:109-12. [PMID: 24206738 DOI: 10.1016/j.ajg.2013.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 02/07/2013] [Revised: 06/06/2013] [Accepted: 07/28/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND STUDY AIMS Both hepatitis C virus (HCV) and schistosomiasis are highly endemic in Egypt and coinfection is frequently encountered. Such coinfection is responsible for leading to a more severe liver disease. Hence, the aim of the study was to assess the fibroscan in chronic HCV patients coinfected with Schistosoma. PATIENTS AND METHODS This study included 231 chronic HCV patients. Routine pre-treatment work-up was done including anti-schistosomal antibodies. Liver stiffness measurements using fibroscan and reference needle-liver biopsy were done. Patients were categorised into two groups: HCV patients with positive schistosomal serology and HCV patients with negative schistosomal serology. RESULTS Anti-schistosomal antibody was positive in 29% of the studied population. Positive schistosomal serology status was significantly associated with the disagreement between the results of liver biopsy (Metavir) and the fibroscan results (p value=0.02), which was more obvious in F2 and F3 fibrosis stages. The sensitivity of fibroscan for the detection of the F2 stage decreased from 64% among negative schistosomal serology patients to 30.8% among positive schistosomal serology patients, and for the F3 stage it decreased from 43.8% to 21.4%, respectively. Multivariate logistic regression showed that fibrosis stages (F0-F1 and F4) were the most independent factors that were associated with the agreement between fibroscan and liver biopsy (odds ratio (OR) 3.4, 7.12 and p value <0.001, <0.001, respectively). CONCLUSION Although the sensitivity of fibroscan for the detection of fibrosis stages (F2 and F3) was impaired in patients with positive schistosomal serology, fibrosis stages (F0-F1 and F4) were the most independent factors associated with the agreement between fibroscan and liver biopsy.
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Affiliation(s)
- Gamal Esmat
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Salem D, El-Serafy M, Obeida E, Al-Akel W, El-Raziki M, Attia D, Hassan M. The combination of endoglin and FIB-4 increases the accuracy of detection of hepatic fibrosis in chronic hepatitis C patients. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojgas.2012.22013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Behar-Cohen F, Martinsons C, Viénot F, Zissis G, Barlier-Salsi A, Cesarini JP, Enouf O, Garcia M, Picaud S, Attia D. Light-emitting diodes (LED) for domestic lighting: any risks for the eye? Prog Retin Eye Res 2011; 30:239-57. [PMID: 21600300 DOI: 10.1016/j.preteyeres.2011.04.002] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 04/21/2011] [Accepted: 04/29/2011] [Indexed: 12/11/2022]
Abstract
Light-emitting diodes (LEDs) are taking an increasing place in the market of domestic lighting because they produce light with low energy consumption. In the EU, by 2016, no traditional incandescent light sources will be available and LEDs may become the major domestic light sources. Due to specific spectral and energetic characteristics of white LEDs as compared to other domestic light sources, some concerns have been raised regarding their safety for human health and particularly potential harmful risks for the eye. To conduct a health risk assessment on systems using LEDs, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), a public body reporting to the French Ministers for ecology, for health and for employment, has organized a task group. This group consisted physicists, lighting and metrology specialists, retinal biologist and ophthalmologist who have worked together for a year. Part of this work has comprised the evaluation of group risks of different white LEDs commercialized on the French market, according to the standards and found that some of these lights belonged to the group risk 1 or 2. This paper gives a comprehensive analysis of the potential risks of white LEDs, taking into account pre-clinical knowledge as well as epidemiologic studies and reports the French Agency's recommendations to avoid potential retinal hazards.
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Affiliation(s)
- F Behar-Cohen
- Inserm UMRS 872, Physiopathology of Ocular Diseases: Therapeutic Innovations, Centre de Recherche des Cordeliers, Paris, France.
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Nordin JY, Attia D. [Fractures of the upper end of the femur in adults. Etiology, mechanism, diagnosis, development, prognosis, treatment]. Rev Prat 1993; 43:223-8. [PMID: 8502945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J Y Nordin
- Service d'orthopédie et traumatologie, hôpital Avicenne, Bobigny
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de Gennes C, Le Thi Huong DU, Raguin G, Godeau P, Attia D, Bousquet JC. [Tropical myositis simulating arthritis of the hip]. Rev Rhum Mal Osteoartic 1990; 57:238-9. [PMID: 2339275] [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: 12/31/2022]
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