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Kotb MA, Fawaz LA, Zeitoun RA, Shaalan YM, Aly N, Abd El Kader H, El Tagy G, Esmat H, Hamza AF, Abd El Baky H. Bone demineralization in a cohort of Egyptian pediatric liver transplant recipients: Single center pilot study. Medicine (Baltimore) 2022; 101:e31156. [PMID: 36397404 PMCID: PMC10662835 DOI: 10.1097/md.0000000000031156] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/14/2022] [Indexed: 11/19/2022] Open
Abstract
Liver transplantation (LT) is the definitive treatment of end-stage liver disease. The long-term survival following LT spurred more interest in improving the quality of life of patients. This was a cohort study that included 23 pediatric liver transplant recipients who underwent LT due to hereditary or metabolic liver diseases. Bone health assessment was performed at their last follow up clinically (anthropometric measures), biochemically and radiologically (Dual Energy X-ray Absorptiometry [DEXA] scans). Poor bone health was defined as z-score <-1. Mean age at LT was 5.77 years (standard deviation [SD] 3.64) and 43% were males. Biliary atresia was the most common cause of end stage liver disease (35%). Mean age at follow up was 14 years (SD 5.48) and mean follow up was 8 years (SD 4.12 years). Eleven patients (48%) had poor bone health (osteopenia 22% and osteoporosis 26%). On univariate analysis, being on steroids at last follow up (odds ratio [OR] 13.2, 95% confidence interval [CI] 1.23-140.67, P = .03), weight at last follow up (OR 0.45, 95% CI 0.20-0.99, P = .04), platelets at last follow up (OR 0.98, 95% CI 0.96-s0.99, P = .02), hemoglobin at last follow up (OR 0.33, 95% CI 0.12-0.89, P = .03) were significantly associated with poor bone health. None of the variables were significant on multivariate analysis. At most recent follow up, 48% of patients demonstrated poor bone health by DEXA scans. More studies are required to evaluate predictors of poor bone health after LT in children.
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Affiliation(s)
- Magd A. Kotb
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Lubna A. Fawaz
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | | | | | - Nazira Aly
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | | | - Gamal El Tagy
- Department of Pediatric Surgery, Cairo University, Cairo, Egypt
| | - Haytham Esmat
- Department of Pediatric Surgery, Cairo University, Cairo, Egypt
| | - Alaa F. Hamza
- Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
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Kotb MA, Kotb A, Talaat S, Shehata SM, El Dessouki N, ElHaddad AA, El Tagy G, Esmat H, Shehata S, Hashim M, Kotb HA, Zekry H, Abd Elkader HM, Kaddah S, Abd El Baky HE, Lotfi N. Congenital aflatoxicosis, mal-detoxification genomics & ontogeny trigger immune-mediated Kotb disease biliary atresia variant: SANRA compliant review. Medicine (Baltimore) 2022; 101:e30368. [PMID: 36181129 PMCID: PMC9524989 DOI: 10.1097/md.0000000000030368] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Biliary atresia (BA) is the most common indication for pediatric liver transplantation. We describe The BA variant: Kotb disease. Liver tissue in the Kotb disease BA is massively damaged by congenital aflatoxicosis resulting in inflammation, adhesions, fibrosis, bile duct proliferation, scarring, cholestasis, focal syncytial giant cell transformation, and typical immune response involving infiltration by CD4+, CD8+, CD68+, CD14+, neutrophil infiltration, neutrophil elastase spill, heavy loads of aflatoxin B1, accelerated cirrhosis, disruption of p53 and GSTPi, and have null glutathione S transferase M1 (GSTM1). All their mothers are heterozygous for GSTM1. This inability to detoxify aflatoxicosis results in progressive inflammatory adhesions and obliterative cholangiopathy early in life. The typical disruption of both p53 and GSTPi causes loss of fidelity of hepatic regeneration. Hence, regeneration in Kotb disease BA typically promotes accelerated cirrhosis. The immune response in Kotb disease BA is for damage control and initiation of regeneration, yet, this friendly fire incurs massive structural collateral damage. The Kotb disease BA is about actual ongoing hepatic entrapment of aflatoxins with lack of ability of safe disposal due to child detoxification-genomics disarray. The Kotb disease BA is a product of the interaction of persistent congenital aflatoxicosis, genetic lack of GSTM1 detoxification, ontogenically impaired activity of other hepatic detoxification, massive neutrophil-elastase, immune-induced damage, and disturbed regeneration. Ante-natal and neonatal screening for aflatoxicosis, avoiding cord milking, and stringent control of aflatoxicosis content of human, poultry and live-stock feeds might prove effective for prevention, prompt diagnosis and management based on our recent understanding of its patho-genomics.
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Affiliation(s)
- Magd A. Kotb
- Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt
- *Correspondence: (e-mail: )
| | - Ahmed Kotb
- Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt
| | - Sahar Talaat
- Department of Pathology, Faculty of Medicine, Cairo University, Egypt
| | - Sherif M. Shehata
- Department of Pediatric Surgery, Faculty of Medicine, Tanta University, Egypt
| | - Nabil El Dessouki
- Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed A. ElHaddad
- Department of Pediatric Surgery, Faculty of Medicine, Tanta University, Egypt
| | - Gamal El Tagy
- Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Egypt
| | - Haytham Esmat
- Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Egypt
| | - Sameh Shehata
- Department of Pediatric Surgery, Faculty of Medicine, Alexandria University, Egypt
| | - Mohamed Hashim
- Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt
| | - Hanan A. Kotb
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Egypt
| | - Hanan Zekry
- Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt
| | | | - Sherif Kaddah
- Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Egypt
| | | | - Nabil Lotfi
- Faculty of Medicine, Cairo University, Egypt
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Kotb M, Mosallam D, Ragab H, Abd El Baky H, El Hatw A, Hamza A, Abd El Kader H, El Tagy G, Esmat H, Shehata S, Sabry N. Management and Outcome of Chylous Ascites in Children: A CARE compliant Case Series. Pediatric Sciences Journal 2020; 1:34-40. [DOI: 10.21608/cupsj.2020.31018.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Kotb MA, Draz I, Basanti CW, El Sorogy ST, Abd Elkader HM, Esmat H, Abd El Baky H, Mosallam DS. Cholestasis In Infants With Down Syndrome Is Not Due To Extrahepatic Biliary Atresia: A Ten-Year Single Egyptian Centre Experience. Clin Exp Gastroenterol 2019; 12:401-408. [PMID: 31695469 PMCID: PMC6815214 DOI: 10.2147/ceg.s216189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/17/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose We aimed to define the clinical presentations, course and outcome of cholestasis in infants with Down syndrome (trisomy 21) who presented to the Pediatric Hepatology Clinic, New Children Hospital, Cairo University, Egypt. Methods Retrospective analysis of data of cohort of infants with Down syndrome and cholestasis who followed up during 2005-2015. Results Among 779 infants with cholestasis who presented during 2005-2015, 61 (7.8%) had Down syndrome. Six dropped out. Among the 55 who followed-up for a mean duration +SD = 12.1 ± 16.7 months, none had extrahepatic biliary atresia (EHBA), 37 (63.3%) had neonatal hepatitis and 18 (32.7%) had non-syndromic paucity of intrahepatic biliary radicals. Fourteen (25.4%) had associated congenital heart disease. Only 35 (63.3%) cleared the jaundice. Twenty-nine (52.7%) received ursodeoxycholic acid (UDCA); of them, 13 cleared the jaundice, one improved, 14 progressed and one died, compared to 22 who cleared the jaundice of the 26 who did not receive UDCA. Only three of those who did not receive UDCA progressed and none died. UDCA carried a 3.4-fold risk of poor prognosis (p= 0.001). UDCA use was associated with more complications (p= 0.016) in those with Down syndrome and cholestasis. Conclusion We did not come across EHBA among neonates and infants with Down syndrome in 10 years. Non-syndromic paucity is associated with favorable outcome in infants with Down syndrome. UDCA use in cholestasis with Down syndrome is associated with poor outcome.
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Affiliation(s)
- Magd A Kotb
- Pediatrics Department, Faculty of Medicine, Kasr Al Ainy, Cairo University, Cairo, Egypt
| | - Iman Draz
- Pediatrics Department, Faculty of Medicine, Kasr Al Ainy, Cairo University, Cairo, Egypt
| | - Christine Ws Basanti
- Pediatrics Department, Faculty of Medicine, Kasr Al Ainy, Cairo University, Cairo, Egypt
| | | | - Hesham M Abd Elkader
- Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Haytham Esmat
- Department of Pediatric Surgery, Cairo University, Cairo, Egypt
| | - Hend Abd El Baky
- Pediatrics Department, Faculty of Medicine, Kasr Al Ainy, Cairo University, Cairo, Egypt
| | - Dalia Sayed Mosallam
- Pediatrics Department, Faculty of Medicine, Kasr Al Ainy, Cairo University, Cairo, Egypt
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Mounts A, De La Rocque S, Fitzner J, Garcia E, Thomas H, Brown D, Schuster H, Vandemaele K, Esmat H, Eremin S, Mafi A. The early response to a novel coronavirus in the Middle East. East Mediterr Health J 2013. [DOI: 10.26719/2013.19.supp1.s19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mounts A, De La Rocque S, Fitzner J, Garcia E, Thomas HL, Brown D, Schuster H, Vandemaele K, Esmat H, Eremin S, Mafi A. The early response to a novel coronavirus in the Middle East. East Mediterr Health J 2013; 19 Suppl 1:S19-S25. [PMID: 23888791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The detection of a novel coronavirus in patients from the Arabian Peninsula in late 2012 raised serious concerns of a possible international outbreak. Ministries of health of the three affected countries invited missions from the World Health Organization to participate in a review of data and capacity to detect and respond to further cases. Recommendations were made for investigations to answer critical questions about human-to-human transmission and the geographic extent of the virus. Additional recommendations were made to improve surveillance capacity by acquiring the capacity to test for the virus and enhance syndromic surveillance. Available evidence continues to suggest an unknown animal reservoir for the virus with sporadic zoonotic transmission the primary epidemiological pattern of transmission. Human-to-human transmission, while it can occur, does not appear to be sustained in the community.
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Affiliation(s)
- A Mounts
- Global Infuenza Programme, World Health Organization, Geneva, Switzerland.
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