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Elsherbini AT, Atta MA, Elshahat S, Emara MH. Atypical Duplex appendix arising from the ascending colon: a case report. J Med Case Rep 2024; 18:188. [PMID: 38549166 PMCID: PMC10979607 DOI: 10.1186/s13256-023-04259-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/10/2023] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Duplex or vermiform appendix refers to the presence of an appendix beside the naturally occurring one. Although, duplex appendix emerges from the caecum most of the time, yet it is encountered in other parts of the colon. Inflammation of duplex appendix may represent not only a clinical, but also a surgical dilemma, and this would be confusing further among patients who already had prior appendectomy. CASE PRESENTATION We present a case of 29-years old Egyptian male patient with history of appendectomy one and half year before presenting to the emergency department with recurrent acute abdominal pain that was linked to duplex appendicitis abnormally emerged from the mid-ascending colon. The first episode was treated conservatively considering atypical right colon diverticulitis as a potential differential diagnosis. Seven months later the patient was treated by laparoscopic appendectomy and experienced an uneventful pot-operative course. CONCLUSION Duplex appendicitis, though rare, should be considered in the differential diagnosis of recurrent acute abdomen even after appendectomy.
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Affiliation(s)
- Ahmed Taha Elsherbini
- Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, 33516, Egypt
- Surgery Department, Alyousif Hospital, Al-Khobar, Saudi Arabia
| | - Mohamed A Atta
- Radiology Department, Alyousif Hospital, Al-Khobar, Saudi Arabia
| | - Sahar Elshahat
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Clinical Pathology Department, Alyousif Hospital, Al-Khobar, Saudi Arabia
| | - Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr Elshikh, 33516, Egypt.
- Medicine Department, Alyousif Hospital, Al-Khobar, Saudi Arabia.
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Emara MH, Mazid U, Elshaer YA, Elkerdawy MA, Malik DF, Mahros AM. Trauma to the solid abdominal organs: The missed dark box of colonoscopy. World J Gastroenterol 2024; 30:624-630. [PMID: 38515946 PMCID: PMC10950622 DOI: 10.3748/wjg.v30.i7.624] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure. Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used, the sedatives used, but to the procedure related as well including bleeding and perforation. Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon, however, serious complications related to the procedure have been reported infrequently in the literature. Life threatening injuries to the spleen, liver, pancreas, mesentery, and urinary bladder have been reported as early as in mid-1970s. These injuries should not be overlooked by clinicians and endoscopists. Steadily increasing abdominal pain, abdominal distension, and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury. Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening. Although conservative management may help, yet they usually need interventional radiology or surgical intervention. Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively. The mechanism of abdominal organ injuries during colonoscopy is not fully understood, however many risk factors have been identified, which can be classified as- organ related, procedure related, and local abdominal factors. Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries. Left lateral position, avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Usama Mazid
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Yasmine A Elshaer
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mahmoud A Elkerdawy
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | | | - Aya M Mahros
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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Emara MH, Abdelaty AI, Elbatae HE, Abdelrazik OM, Elgammal NE. The need for a risk-assessment tool among patients with chronic liver diseases interested in intermittent fasting: Ramadan model. Nutr Rev 2024; 82:240-243. [PMID: 37172268 DOI: 10.1093/nutrit/nuad046] [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] [Indexed: 05/14/2023] Open
Abstract
Liver diseases, especially the chronic type, are a global concern. There is a growing interest in the intermittent fasting model due to its presumed health benefits. Ramadan fasting, although religious fasting, is one of the best examples of intermittent fasting, with some differences, and is observed by more than 1 billion Muslims around the world. This month follows the Arabic Hijri calendar, which is 12 days shorter than the Gregorian calendar; hence, this entire month of fasting may occur in any season of the year. There is evidence that many patients with chronic liver disease are prone to adverse events upon observing this month of continuous intermittent fasting, particularly during the hot summer with prolonged hours of fasting, if they are not adequately addressed and prevented from fasting. There is a need to sound the alarm to develop a risk-assessment tool to omit vulnerable patients with chronic liver disease-who are exempted on religious grounds from observing this pattern of fasting.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Abdelaty I Abdelaty
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Hassan E Elbatae
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Osama Mostafa Abdelrazik
- Department of Hepato-Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Nahla E Elgammal
- Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Emara MH, Ahmed MH, Radwan MI, Emara EH, Basheer M, Ali A, Elfert AA. Post-cholecystectomy iatrogenic bile duct injuries: Emerging role for endoscopic management. World J Gastrointest Surg 2023; 15:2709-2718. [PMID: 38222007 PMCID: PMC10784825 DOI: 10.4240/wjgs.v15.i12.2709] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Post-cholecystectomy iatrogenic bile duct injuries (IBDIs), are not uncommon and although the frequency of IBDIs vary across the literature, the rates following the procedure of laparoscopic cholecystectomy are much higher than open cholecystectomy. These injuries caries a great burden on the patients, physicians and the health care systems and sometime are life-threatening. IBDIs are associated with different manifestations that are not limited to abdominal pain, bile leaks from the surgical drains, peritonitis with fever and sometimes jaundice. Such injuries if not witnessed during the surgery, can be diagnosed by combining clinical manifestations, biochemical tests and imaging techniques. Among such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most appropriate. Surgical approach was the ideal approach for such cases, however the introduction of Endoscopic Retrograde Cholangio-Pancreatography (ERCP) was a paradigm shift in the management of such injuries due to accepted success rates, lower cost and lower rates of associated morbidity and mortality. However, the literature lacks consensus for the optimal timing of ERCP intervention in the management of IBDIs. ERCP management of IBDIs can be tailored according to the nature of the underlying injury. For the subgroup of patients with complete bile duct ligation and lost ductal continuity, transfer to surgery is indicated without delay. Those patients will not benefit from endoscopy and hence should not do unnecessary ERCP. For low-flow leaks e.g. gallbladder bed leaks, conservative management for 1-2 wk prior to ERCP is advised, in contrary to high-flow leaks e.g. cystic duct leaks and stricture lesions in whom early ERCP is encouraged. Sphincterotomy plus stenting is the ideal management line for cases of IBDIs. Interventional radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered anatomy. Future studies will solve many unsolved issues in the management of IBDIs.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohamed I Radwan
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Emad Hassan Emara
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Magdy Basheer
- Department of Surgery, Mansoura University, Mansours 44176, Egypt
| | - Ahmed Ali
- Department of Emergency, Hargeisa Group Hospital, Hargeisa 1235, Somalia
| | - Asem Ahmed Elfert
- Department of Tropical Medicine, Tanta University, Tanta 33120, Egypt
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Emara MH, Mahros AM, Rasheda AMA, Radwan MI, Mohamed B, Abdelrazik O, Elazab M, Elbatae H. Schistosomal (bilharzial) polyps: Travel through the colon and beyond. World J Gastroenterol 2023; 29:4156-4165. [PMID: 37475844 PMCID: PMC10354569 DOI: 10.3748/wjg.v29.i26.4156] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/18/2023] [Accepted: 03/29/2023] [Indexed: 07/10/2023] Open
Abstract
Schistosomiasis (bilharziasis) is a major neglected tropical disease. It is endemic in many tropical and subtropical communities. Schistosomal polyps (S. polyps) are not uncommon presentation of this infection. Although the colon is the most commonly affected organ, many other organs are affected. S. polyps are associated with a variable range of morbidity independent of the Schistosomal infection. S. polyps are frequently described in endemic areas and increasingly reported in non-endemic areas mainly among immigrants and visitors to the endemic areas. This review aimed to increase awareness of practitioners, especially gastroenterologists, for this peculiar type of polyps caused by this neglected infection hence improving patient outcomes. Web-based search of different databases was conducted for the literature focusing the development of S. polyps in the colon and other organs with analysis of the clinical manifestations, diagnosis and treatment. The following key words were used in the search, “Schistosomiasis” OR “Bilharziasis” AND “Polyps” OR “Polyp” AND “Colon” OR “Small intestine” OR “ Duodenum” OR “ Stomach” OR “Esophagus” OR ” Gallbladder” OR” Pharynx” OR “Larynx” OR “Trachea” OR ”Urinary bladder” OR “ Ureter” OR “Renal Pelvis” OR “Urethra”. All publication types including case reports, case series, original research, and review articles were retrieved and analyzed. S. polyps are not infrequent presentation of acute or chronic Schistosomal infection. S. polyps are described in many organs including the bowel, genitourinary tract, skin, gallbladder and the larynx. Presentation of S. polyps is variable and depends on the site, number as well as the polyp size. The relationship of S. polyps to malignant transformation is a matter of discussion. Presence of S. polyps is sometimes the only manifestation of Schistosomiasis. Small polyps can be treated medically with praziquantel, while large accessible polyps are amendable for endoscopic excision through different polyp resection techniques. However, huge, complicated, non-accessible and suspicious polyps are indicated for surgical management or advanced endoscopic resection when appropriate. Clinicians and endoscopists should be aware about these facts when treating patients living in, immigrated from or visiting endemic areas.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Aya M Mahros
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Abdelrahman M Ahmed Rasheda
- Department of Internal Medicine, Gastroenterology Unit, Security Forces Hospital, Ryiadh 11481, Saudi Arabia
| | - Mohamed I Radwan
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Besher Mohamed
- Department of Gastroenterology, Surrey and Sussex Hospitals NHS Trust, Surrey RH1 5RH, United Kingdom
| | - Osama Abdelrazik
- Department of Hepato-Gastroenterology and Infectious Diseases, Al-Azhar University, Cairo 11651, Egypt
| | - Mostafa Elazab
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Hassan Elbatae
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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Abdelkader A, Abdelkhalek R, Hosny H, Emara MH, Elshamy M. Bacterial infections and fever after hepatocellular carcinoma ablation therapy: Predictive role of procalcitonin. Clin Exp Hepatol 2023; 9:122-128. [PMID: 37502430 PMCID: PMC10369656 DOI: 10.5114/ceh.2023.127400] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/01/2023] [Indexed: 07/29/2023] Open
Abstract
Aim of the study Hepatocellular carcinoma (HCC) is a leading cause of mortality among patients with liver cirrhosis. According to the current practice guidelines, different ablations are used either as curative or palliative therapies. The current study aimed at determining bacterial infections as causes of fever and the predictive role of procalcitonin (PCT) among patients with HCC who had ablation therapy. Material and methods This cross sectional study was carried out on 100 patients with HCC during the period from November 2019 to December 2021. All patients were evaluated by full history taking, clinical examination, complete blood picture (CBC), liver biochemistry, coagulation profile, kidney function, C-reactive protein (CRP), serum PCT and blood cultures. All were done for all participants at the 4th day follow-up after the procedures of ablation. HCC was treated according to the guidelines. Results The frequency of fever after HCC ablation was 64% with variable intensities. Bacterial cultures were positive in 20 patients (20%). Twenty-four out of 100 patients had abnormally high PCT level. There was a highly statistically significant increase of PCT level in patients with a high CRP count and positive blood culture, p < 0.05. There was a statistically significant correlation between increased levels of PCT and levels of CRP, WBCs, albumin, AST, ALT, degree of fever, creatinine and BUN. Conclusions Bacterial infection accounts for 20% of fever among HCC patients after ablation therapy. PCT is 100% sensitive and specific for detection of the bacterial causes of fever among those patients.
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Affiliation(s)
| | | | - Hanaa Hosny
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed H. Emara
- Faculty of Medicine, Kafrelsheikh University, Kafr El-Shikh, Egypt
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Emara MH, Zaghloul M, Amer IF, Mahros AM, Ahmed MH, Elkerdawy MA, Elshenawy E, Rasheda AMA, Zaher TI, Haseeb MT, Emara EH, Elbatae H. Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics. World J Hepatol 2023; 15:216-224. [PMID: 36926231 PMCID: PMC10011914 DOI: 10.4254/wjh.v15.i2.216] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/25/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
Acute variceal bleeding in patients with liver cirrhosis and portal hypertension (PHT) is the most serious emergency complication among those patients and could have catastrophic outcomes if not timely managed. Early screening by esophago-gastro-duodenoscopy (EGD) for the presence of esophageal varices (EVs) is currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in studies to investigate and validate non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder (GB) wall thickness (GBWT) measurement has been found promising in many published research articles. We aim to highlight the validity of sonographic GBWT measurement in the prediction of EVs based on the available evidence. We searched databases including Cochrane library, PubMed, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cut-offs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy. Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced (grade III-IV) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Ibrahim F Amer
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Aya M Mahros
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mahmoud A Elkerdawy
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Eslam Elshenawy
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Abdelrahman M Ahmed Rasheda
- Department of Internal Medicine, Gastroenterology Unit, Security Forces Hospital, Riyadh 11481, Saudi Arabia
| | - Tarik I Zaher
- Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Mona Talaat Haseeb
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Emad Hassan Emara
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Hassan Elbatae
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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Mohamed SY, Tarek-Hefnawy M, Amer SA, Mansour B, Mostafa-Asla M, Piscoya A, Mansilla-Vivar R, Emara MH. Utility of YouTube online learning for junior gastrointestinal endoscopists: A rewarding or deterring practice? Rev Gastroenterol Peru 2023; 43:20-30. [PMID: 37226066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Endoscopy is a competitive field in clinical practice, in which skilled endoscopists are in high demand. The learning process for Junior Gastrointestinal Endoscopists (JGEs) is difficult, quite long, and technically demanding. This directs JGEs to seek additive learning sources, including online sources. The purpose of this study was to determine the frequency, context, attitudes, perceived benefits, drawbacks, and recommendations for using YouTube videos as an educational platform among JGEs from the uses'prespective. We disseminated a cross-sectional online questionnaire from January 15th to March 17th, 2022, and recruited 166 JGE from 39 different countries. The majority of surveyed JGEs (138, 85.2%) were already using YouTube as a learning tool. The majority of JGEs (97, 59.8%) reported gaining knowledge and applying it in their clinical practice, but 56 (34.6 %) reported gaining knowledge without application in real practice. Most participants (124, 76.5 %) reported missing procedure details in YouTube endoscopy videos. The majority of JGEs (110, 80.9%) reported that YouTube videos are provided by endoscopy specialists. Only one participant, 0.6% out of the 166 JGEs surveyed, disliked video records, including YouTube as a source of learning. Based on their experience, 106 (65.4%) of participants recommended YouTube as an educational tool for the coming generation of JGEs. We consider that YouTube represents a potentially useful tool for JGEs, supplying them with both knowledge and clinical practice tricks. However, many drawbacks could make the experience misleading and time-consuming. Consequently, we encourage educational providers on YouTube and other platforms to upload well-constructed, peerreviewed, interactive educational endoscopy videos.
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Affiliation(s)
- Salem Youssef Mohamed
- Gastroenterology and Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Mahmoud Tarek-Hefnawy
- Faculty of Medicine, Zagazig University, Egypt - Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Samar A Amer
- Department of Community Medicine and Public Health, Faculty of Medicine, Zagazig University, Egypt
| | - Bassam Mansour
- Infectious and Endemic Diseases Department, Faculty of Medicine, Suez Canal University, Egypt
| | | | | | | | - Mohamed H Emara
- Department of Hepatology, Gastroenterology an Infectious Diseases, Kafrelsheikh University, Egypt
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Emara MH, Abdelkader AH, Radwan MS, Elbatae HE, Saeed MA. Long-term use of colchicine: “The time to guard against chronic toxicity among patients of familial Mediterranean fever”. Egypt Rheumatol Rehabil 2023. [PMCID: PMC10068198 DOI: 10.1186/s43166-023-00188-8] [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] [Indexed: 04/05/2023] Open
Abstract
Colchicine is a cheap easily available and accessible drug that has been tried in different diseases which are not limited to gout, familial Mediterranean fever (FMF), Behcet’s disease, and constipation, and has recently been tried for the treatment of COVID-19 and heart diseases. There are many emerging reports of toxicity related to colchicine use. Patients with FMF are using this drug lifelong. We are sounding the alarm for monitoring patients with FMF to guard against chronic colchicine toxicity.
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Affiliation(s)
- Mohamed H. Emara
- grid.411978.20000 0004 0578 3577Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shikh, 33516 Egypt
| | - Abeer Hussein Abdelkader
- grid.31451.320000 0001 2158 2757Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Said Radwan
- grid.411978.20000 0004 0578 3577Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shikh, 33516 Egypt
| | - Hassan E. Elbatae
- grid.411978.20000 0004 0578 3577Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shikh, 33516 Egypt
| | - Maysaa A. Saeed
- grid.31451.320000 0001 2158 2757Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Emara MH, Zaghloul M, Abdel-Gawad M, Makhlouf NA, Abdelghani M, Abdeltawab D, Mahros AM, Bekhit A, Behl NS, Mostafa S, Piscoya A, Abd-Elsalam S, Alboraie M. Effect of COVID-19 on gastrointestinal endoscopy practice: a systematic review. Ann Med 2022; 54:2875-2884. [PMID: 36369765 PMCID: PMC9665076 DOI: 10.1080/07853890.2022.2133163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the emergence of the novel corona virus (SARS-Cov-2) in the late 2019 and not only the endoscopy practice and training but also the health care systems around the globe suffers. This systematic review focused the impact of Corona Virus Disease (COVID-19) on the endoscopy practice. METHODS A web search of different databases combining different search terms describing the endoscopy practice and the COVID-19 pandemic was done. Articles were screened for selection of relevant articles in two steps: title and abstract step and full-text screening step, by two independent reviewers and any debate was solved by a third reviewer. RESULTS Final studies included in qualitative synthesis were 47. The data shown in the relevant articles were evident for marked reduction in the volume of endoscopy, marked affection of colorectal cancer screening, impairments in the workflow, deficiency in personal protective equipment (PPE) and increased likelihood of catching the infection among both the staff and the patients. CONCLUSION The main outcomes from this review are rescheduling of endoscopy procedures to be suitable with the situation of COVID-19 pandemic in each Country. Also, the endorsement of the importance of PPE use for health care workers and screening of COVID-19 infection pre-procedure.Key messagesThe data focussing Gastrointestinal Endoscopy and COVID-19 emerged from different areas around the globe. The data presented on the published studies were heterogeneous. However, there were remarkable reductions in the volume of GI endoscopy worldwideStaff reallocation added a burden to endoscopy practiceThere was a real risk for COVID-19 spread among both the staff and the patients.
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Mariam Zaghloul
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Muhammad Abdel-Gawad
- Hepatology, Gastroenterology, and Infectious Diseases Department, Al-Azhar University, Assiut, Egypt
| | - Nahed A Makhlouf
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Abdelghani
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Doaa Abdeltawab
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Aya M Mahros
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Ahmed Bekhit
- Department of Gastroenterology, Sharqia Health Directorate, Sharqia, Egypt
| | - Nitin S Behl
- Institute of Gastro and liver Diseases, Fortis Hospitals, Ludhiana, India
| | - Sadek Mostafa
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Alejandro Piscoya
- Department of Gastroenterology, Hospital Guillermo Kaelin De la Fuente - EsSalud, Lima, Peru.,Systematic Reviews and Meta-analysis, Clinical Practice Guidelines and Health Technology Assessments Unit, Universidad San Ignacio Loyola, Lima, Peru
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
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11
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Emara MH, Elbatae HE, Ali RF, Ahmed MH, Radwan MS, Elhawary A. Laparoscopy-Assisted Endoscopic Retrograde Cholangiopancreatography: New Insight in Management of Iatrogenic Bile Duct Injury. Middle East J Dig Dis 2022; 14:473-477. [PMID: 37547505 PMCID: PMC10404101 DOI: 10.34172/mejdd.2022.309] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 09/02/2022] [Indexed: 08/08/2023] Open
Abstract
Bile duct injury (BDI) is a severe and sometimes life-threatening complication of cholecystectomy. Several series have described a 0.5% to 0.6% incidence of BDI during laparoscopic cholecystectomy. We received an emergency call from the operating theater by the surgery team to assess an iatrogenic BDI in a 58-year-old man with cirrhosis who presented for laparoscopic cholecystectomy. After many trials by endoscopic retrograde cholangiopancreatography (ERCP) the guide wire passed to the peritoneal cavity and failed to pass proximally. Laparoscopy resumed, and the surgeon tried to pass the flexible guide wire proximally unsuccessfully. Then, a decision to hold the sphincterotome by laparoscopy and passing it proximally in harmony with ERCP was taken, which was successful. A regular ERCP with 10F plastic stent insertion was carried out, and the perforation was secured by the inserted stent without any further surgical intervention. Laparoscopy-assisted ERCP may give new insights into the immediate repair of iatrogenic bile duct injuries.
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Hassan E. Elbatae
- Hepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Reda F Ali
- Surgery Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohammed H. Ahmed
- Hepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohamed Said Radwan
- Hepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Abdulhamid Elhawary
- Anaesthesia Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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12
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Alavinejad P, Nayebi M, Parsi A, Farsi F, Maghool F, Alipour Z, Alimadadi M, Ahmed MH, Cheraghian B, Hang DV, Shahrokh S, Emami MH, Hashemi SJ, Alboraie M, Dehnavi D, Riazi M, Seyedian SS, Emara MH, Lenz L, Tran QT, Shahinzadeh S, Daryani NE, Hajiani E, Moghaddam EK, Shahi MM, Rezvanifar M, Azimi T. IS DAIRY FOODS RESTRICTION MANDATORY FOR INFLAMMATORY BOWEL DISEASE PATIENTS: A MULTINATIONAL CROSS-SECTIONAL STUDY. Arq Gastroenterol 2022; 59:358-364. [PMID: 36102432 DOI: 10.1590/s0004-2803.202203000-65] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The role of dairy foods in inflammatory bowel disease (IBD) has been controversial and it is debatable if patients with IBD should avoid milk and dairy products or not, as well as the relationship between these foods and symptoms among those population. OBJECTIVE This multi centric cross-sectional study designed to evaluate if it is really necessary to deprive IBD patients from consumption of dairy foods. METHODS A multicenter study with 12 gastroenterology referral centers in four countries was designed to evaluate gastrointestinal (GI) symptoms after consumption of dairy foods from all outpatients with IBD during 6 months and to compare patients treated at the same centers without IBD (non IBD cases). RESULTS Overall 1888 cases included (872 IBD patients and 1016 non IBD cases). 56.6% of participants were female with average age of 40.1 years. Racially 79.8% participants were Caucasians and originally they were citizens of 10 countries. Relative prevalence of IBD was higher in Africans and Indians and the most frequent prevalence of dairy foods intolerance was seen in Asians. Among IBD patients, 571 cases diagnosed as ulcerative colitis and 189 participants as Crohn's disease. Average duration of diagnosis as IBD was 6.8 years (from 2 months to 35 years). The most prevalent GI symptoms after consumption of all the dairy foods were bloating and abdominal pain. Totally, intolerance of dairy foods and lactase deficiency was more prevalent among IBD patients in comparison with non IBD cases (65.5% vs 46.1%, P=0.0001). But the rate of GI complains among IBD patients who had not any family history of lactase deficiency, history of food sensitivity or both were 59.91%, 52.87% & 50.33% respectively and similar to non IBD cases (P=0.68, 0.98 & 0.99 respectively). CONCLUSION The rate of dairy foods intolerance among IBD patients without family history of lactase deficiency or history of food sensitivity is similar to non IBD cases and probably there is no reason to deprive them from this important source of dietary calcium, vitamin D and other nutrients.
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Affiliation(s)
- Pezhman Alavinejad
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
- World Endoscopy Organization, emerging star group, Munich, Germany
| | - Morteza Nayebi
- Shahid Rajaie Cardiovascular, Medical & Research Center, Tehran, Iran
| | - Abazar Parsi
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Farnaz Farsi
- Minimally invasive surgery research center, Iran University of Mediceal Sciences, Tahran, Iran
| | - Fatemeh Maghool
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zeinab Alipour
- Division of clinical studies, The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mehdi Alimadadi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Golestan, Iran
| | - Mohammed Hussien Ahmed
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Bahman Cheraghian
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Dao Viet Hang
- Internal Medicine Faculty - Hanoi Medical University (HMU), Vietnam
| | - Shabnam Shahrokh
- Research Institute for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hasan Emami
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Jalal Hashemi
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
- World Endoscopy Organization, emerging star group, Munich, Germany
| | - Damoon Dehnavi
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Maryam Riazi
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Seyed Saeid Seyedian
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
- World Endoscopy Organization, emerging star group, Munich, Germany
| | - Luciano Lenz
- Fleury Medicina e Saude, Institute do Cancer do Estado de Sao Paulo, Sao Paulo, Brazil
- World Endoscopy Organization, emerging star group, Munich, Germany
| | - Quang Trung Tran
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Vietnam
- World Endoscopy Organization, emerging star group, Munich, Germany
| | - Sam Shahinzadeh
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | | | - Eskandar Hajiani
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Elham Karimi Moghaddam
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Majid Mohammad Shahi
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Maryam Rezvanifar
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Tahereh Azimi
- Department of nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
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13
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Emara MH, Zaghloul M, Ramadan HKA, Mohamed SY, Tag-Adeen M, Alzamzamy A, Alboraie M, Madkour A, Altonbary AY, Zaher TI, Elhassan AA, Abdeen N, Ahmed MH. Endoscopic resection of superficial bowel neoplasia: The unmet needs in the Egyptian practice. World J Gastrointest Endosc 2022; 14:235-249. [PMID: 35634486 PMCID: PMC9048489 DOI: 10.4253/wjge.v14.i4.235] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/22/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Management of superficial bowel neoplasia (SBN) in early stages is associated with better outcomes. The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques (ERTs). However, there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice.
AIM To investigate the knowledge, attitude, and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units’ infrastructures toward these techniques.
METHODS An online 2-pages questionnaire was used. The first page comprised demographic data, and questions for all physicians, about the knowledge (11 questions) of and attitude (5 questions) toward ERTs as a therapeutic option for SBN. The second page investigated the practice of ERTs by endoscopists (6 questions) and the infrastructures of their endoscopy units (14 questions). The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously.
RESULTS The complete responses were 833/2300 (36.2%). The majority of the participants were males (n = 560, 67.2%), middle-aged (n = 366, 43.9%), consultants (n = 464, 55.7%), gastroenterologists (n = 678, 81.4%), spending ≥ 15 years in practice (n = 368, 44.2%), and were working in university hospitals (n = 569, 68.3%). The majority correctly identified the definition of SBN (88.4%) and the terms polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) (92.1%, 90.2%, and 89.1% respectively). However, 26.9%, 43.2% and 49.5% did not recognize the clear indication of polypectomy, EMR, and ESD respectively. Although 68.1% of physicians are convinced about the ERTs for management of SBN; only 8.9% referred all candidate cases for ERTs. About 76.5% of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9% and 7.2% respectively. About 71.6% and 88.4% of endoscopists did not perform EMR or ESD in the last one year. Consequently, the complication rate reported by endoscopists was limited to 18.1% (n = 103) of endoscopists. Only 25.8% of endoscopists feel confident in the management of ERTs-related complications and a half (49.9%) were not sure about their competency. Regarding the endoscopy units’ infrastructures, only 4.2% of the centers had their endoscopes 100% armed with optical enhancements and 54.4% considered their institutions ready for managing ERTs-related complications. Only 18.3% (n = 104) of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding (26.7%), and perforations (17%).
CONCLUSION A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs. The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| | | | - Salem Youssef Mohamed
- Department of Internal Medicine, Faculty of Medicine, Gastroenterology and Hepatology Unit, Zagazig University, Zagazig 44519, Egypt
| | - Mohammed Tag-Adeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, South Valley University, Qena Faculty of Medicine, Qena 83523, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11841, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo11884, Egypt
| | - Ahmad Madkour
- Department of Endemic Medicine, Helwan University, Cairo 11795, Egypt
| | | | - Tarik I Zaher
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Ahmed Abo Elhassan
- Department of Tropical Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Nermeen Abdeen
- Department of Tropical Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
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14
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Emara MH, Zaghloul M, Ramadan HKA, Mohamed SY, Tag-Adeen M, Alzamzamy A, Alboraie M, Madkour A, Altonbary AY, Zaher TI, Elhassan AA, Abdeen N, Ahmed MH. Endoscopic resection of superficial bowel neoplasia: The unmet needs in the Egyptian practice. World J Gastrointest Endosc 2022; 14:236-250. [DOI: 10.4253/wjge.v14.i4.236] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Management of superficial bowel neoplasia (SBN) in early stages is associated with better outcomes. The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques (ERTs). However, there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice.
AIM To investigate the knowledge, attitude, and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units’ infrastructures toward these techniques.
METHODS An online 2-pages questionnaire was used. The first page comprised demographic data, and questions for all physicians, about the knowledge (11 questions) of and attitude (5 questions) toward ERTs as a therapeutic option for SBN. The second page investigated the practice of ERTs by endoscopists (6 questions) and the infrastructures of their endoscopy units (14 questions). The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously.
RESULTS The complete responses were 833/2300 (36.2%). The majority of the participants were males (n = 560, 67.2%), middle-aged (n = 366, 43.9%), consultants (n = 464, 55.7%), gastroenterologists (n = 678, 81.4%), spending ≥ 15 years in practice (n = 368, 44.2%), and were working in university hospitals (n = 569, 68.3%). The majority correctly identified the definition of SBN (88.4%) and the terms polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) (92.1%, 90.2%, and 89.1% respectively). However, 26.9%, 43.2% and 49.5% did not recognize the clear indication of polypectomy, EMR, and ESD respectively. Although 68.1% of physicians are convinced about the ERTs for management of SBN; only 8.9% referred all candidate cases for ERTs. About 76.5% of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9% and 7.2% respectively. About 71.6% and 88.4% of endoscopists did not perform EMR or ESD in the last one year. Consequently, the complication rate reported by endoscopists was limited to 18.1% (n = 103) of endoscopists. Only 25.8% of endoscopists feel confident in the management of ERTs-related complications and a half (49.9%) were not sure about their competency. Regarding the endoscopy units’ infrastructures, only 4.2% of the centers had their endoscopes 100% armed with optical enhancements and 54.4% considered their institutions ready for managing ERTs-related complications. Only 18.3% (n = 104) of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding (26.7%), and perforations (17%).
CONCLUSION A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs. The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| | | | - Salem Youssef Mohamed
- Department of Internal Medicine, Faculty of Medicine, Gastroenterology and Hepatology Unit, Zagazig University, Zagazig 44519, Egypt
| | - Mohammed Tag-Adeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, South Valley University, Qena Faculty of Medicine, Qena 83523, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11841, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo11884, Egypt
| | - Ahmad Madkour
- Department of Endemic Medicine, Helwan University, Cairo 11795, Egypt
| | | | - Tarik I Zaher
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Ahmed Abo Elhassan
- Department of Tropical Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Nermeen Abdeen
- Department of Tropical Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
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15
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Abstract
BACKGROUND AND PURPOSE The frequency, risk factors as well as the sites of biliary stent migration are variable in the literature. This retrospective study investigated the frequency of biliary stent migration, why biliary stents migrated, how the migrated stents affected the patients, and what are the different techniques retrieved the migrated stents. PATIENTS AND METHODS Out of 876 stented patients, 74 patients (8.4%) had their stents migrated. Patients with and without migrated stents were compared regarding endoscopy and stent-related parameters. The sequels of stent migrations were reported. Furthermore, the methods used for stent retrieval were reviewed. RESULTS Proximal and distal stent migration occurred at a rate of 3 and 5.5%, respectively. The independent predictors for stent migration were moderate to marked common bile duct (CBD) dilation, complete sphincterotomy, the use of balloon dilation, and stent insertion for more than 1 month. Cholangitis and stent obstruction was the most commonly reported adverse event (n = 18, 24.3%). Distal stent migration associated with two cases of bleeding due to duodenal wall injury, and two cases of duodenal perforation. All the retained migrated stents in the current study were retrieved by endoscopy using extraction balloon, Dormia basket, snares, and foreign body forceps. CONCLUSION Biliary stent migration occurs at a rate of 8.4%. Stents do migrate because of dilated CBD, wide sphincterotomy, and biliary balloon dilation. Furthermore, wide, straight stents inserted for more than 1 month easily migrate. The migrated stents migrated intraluminal in the CBD, duodenum or the colon. All the retained migrated stents were retrieved endoscopically.
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh
| | - Mohammed Hussien Ahmed
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh
| | - Ahmed S Mohammed
- Tropical Medicine Department, faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed I Radwan
- Tropical Medicine Department, faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Aya M Mahros
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh
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16
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Elkerdawy MA, Ahmed MH, Zaghloul MS, Haseeb MT, Emara MH. Does gallbladder wall thickness measurement predict esophageal varices in cirrhotic patients with portal hypertension? Eur J Gastroenterol Hepatol 2021; 33:917-925. [PMID: 33908388 DOI: 10.1097/meg.0000000000002024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIM Endoscopy is the gold standard investigation for diagnosis of gastroesophageal varices (GOVs), yet it is invasive, associated with complications. Many noninvasive parameters were investigated to predict the presence of GOVs. The current study investigated gallbladder wall thickening (GBWT) measurement as a noninvasive predictor of GOVs in posthepatitic cirrhotic patients with portal hypertension. PATIENTS AND METHODS In this cross-sectional study, 105 cirrhotic patients were divided into, group I and II according to the presence or absence of GOVs, respectively. Group I subdivided into, groups A and B according to the grade of GOVs either nonadvanced (grades I and II) or advanced (grades III and IV), respectively. Complete history taking, full clinical examination, full investigations, upper endoscopy and abdominal ultrasonography were performed to examine all patients. RESULTS Both groups were comparable in their baseline characteristics except for AST to Platelet Ratio Index and Fibrosis-4 scores, which were significantly higher in group I. GBWT, portal vein diameter and spleen length were significantly associated not only with GOVs but also with its advanced grades. GBWT at a cutoff level >3.1 mm can predict the presence of GOVs with 54.29% sensitivity, 97.14% specificity, 97.4% positive predictive value (PPV), 51.5% negative predictive value (NPV) and 68.5% accuracy. GBWT can predict advanced grades of GOVs at a cutoff level >3.5 mm, with 45% sensitivity, 90% specificity, 64.3% PPV, 80.4% NPV and 77.1% accuracy. CONCLUSION GBWT was associated with the presence of GOVs, and with advanced GOVs in posthepatitis cirrhotic patients with portal hypertension.
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Affiliation(s)
| | - Mohamed H Ahmed
- Department of Hepatology, Gastroenterology and Infectious diseases
| | | | - Mona T Haseeb
- Department of Radiology, Faculty of Medicine, Kafrelsheikh University, Egypt
| | - Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious diseases
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17
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Emara MH, Ali RF, Mahmoud R, Mohamed SY. Postcholecystectomy biliary injuries: frequency, and role of early versus late endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 2021; 33:662-669. [PMID: 33560689 DOI: 10.1097/meg.0000000000002086] [Citation(s) in RCA: 3] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIM Bile duct injuries are not infrequently seen during hepatobiliary surgery, particularly after liver transplantation and cholecystectomy. The current study aims to figure out the frequency of postcholecystectomy biliary injuries (PCBI) and the role of early versus late endoscopic retrograde cholangiopancreatography (ERCP) in their management. PATIENTS AND METHODS Totally 960 cases operated by both laparoscopic and open cholecystectomy were evaluated in the current study. In total, 942 cases were operated in our institutes, by both laparoscopic (n = 925) and open (n = 17) cholecystectomy, and the frequency of PCBI among patients operated in our institutes was (9/942) 0.95%. Additional 18 cases of PCBI referred to our centers were included in the study. One patient was treated by repair during the surgery, in the remaining 26 patients, ERCP management was attempted. The full details of the 26 patients regarding ERCP management were discussed. RESULTS The overall success rate of ERCP management was 88.46% (23/26), whereas 11.54% of cases were treated surgically by choledochal-jejunal anastomosis due to complete common bile duct ligation. There were no differences between patients treated by early (first week) versus late (after the first week) ERCP regarding the needed interventions, type of PCBI, type and diameter of the inserted stents, and the overall success. There were no adverse events associated with ERCP management. CONCLUSIONS ERCP was valuable in the treatment of 88.46% of injured cases. There were no differences between early and late ERCP in the treatment of PCBI. Furthermore, ERCP management was not associated with adverse events.
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department
| | - Reda F Ali
- Surgery Department, Kafrelsheikh University, Kafrelsheikh
| | | | - Salem Y Mohamed
- Department of Internal Medicine, Zagazig University, Zagazig, Egypt
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18
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Emara MH, Salama RI, Hamed EF, Shoriet HN, Abdel-Aziz HR. Non-specific colitis among patients with colitis: frequency and relation to inflammatory bowel disease, a prospective study. Journal of Coloproctology 2021. [DOI: 10.1016/j.jcol.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Background and study aim The term non-specific colitis refers to an inflammatory condition of the colon that microscopically lacks the characteristic features of any specific form of colitis and is commonly seen in pathology reports of colonoscopy biopsies. In fact, it has been questioned whether it is a separate pathological entity or it is merely an intermediate stage in the course of inflammatory bowel disease. This study was conducted to estimate the prevalence of non-specific colitis among patients with colitis and characterize its natural history over a 6 months year period.
Patients and methods Eighty adult patients presented for colonoscopy were enrolled. In the final analysis they were divided into Group A; the non-specific colitis Group and Group B; the inflammatory bowel disease Group. All patients were subjected to: full history taking, full clinical examination, laboratory investigations: which included stool analysis, CRP, ESR, complete colonoscopy and entire random colon biopsies for histopathological examination.
Results Group A included 67 patients (83.75%) while Group B included 13 (16.25%) patients. Patients with IBD had clinical and laboratory features of inflammation significantly higher than patients with non-specific colitis. Six patients (8.95%) of non-specific colitis group developed histologic features of florid inflammatory bowel disease after 6 months. There were no independent predictors of this conversion.
Conclusion Among our 80 patients with colonoscopy and biopsy 67 (83.75%) were diagnosed as non-specific colitis and out of them 6 patients (8.95%) were reexamined after 6 months and proved to have inflammtory bowel disese this change was not linked to predictive factors.
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Affiliation(s)
- Mohamed H. Emara
- Kafrelshiekh University, Faculty of Medicine, Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelshikh, Egypt
| | - Rasha I. Salama
- Zagazig University, Faculty of Medicine, Tropical Medicine Department, Zagazig, Egypt
| | - Emad F. Hamed
- Zagazig University, Internal Medicine Department, Faculty of Medicine, Zagazig, Egypt
| | - Hebatalla Nabil Shoriet
- Fayoum University, Faculty of Medicine, Tropical Medicine and Gastroenterology Department, Fayoum, Egypt
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Emara MH, Soliman HH, Elnadry M, Mohamed Said E, Abd-Elsalam S, Elbatae HE, Zaher TI, Ezzeldin S Bazeed S, Abdel-Razik A, Youssef Mohamed S, Elfert A. Ramadan fasting and liver diseases: A review with practice advices and recommendations. Liver Int 2021; 41:436-448. [PMID: 33369880 DOI: 10.1111/liv.14775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023]
Abstract
Ramadan fasting is obligatory for Muslim healthy adults. However, there are many exemptions from fasting; including patients, whose diseases will be aggravated by fasting. Muslim patients with different liver diseases are frequently seen in the clinics discussing their intent to fast this month with their treating physicians. To answer our patients' inquiries about the expected benefits and/or risks of fasting and delivering them the best care, we carried out this review and we draw advices and recommendations based on the available evidence. A web-based search, combining multiple keywords representing different liver diseases with Ramadan fasting had been carried out. To answer the research question: Do adult Muslim patients with different liver diseases who fast the month of Ramadan have had a deleterious effect on their health in comparison to those who did not fast? Relevant publications were retrieved. No randomized controlled trials were focusing on Ramadan fasting and liver diseases in the filtered databases, eg Cochrane library. Consequently, non-filtered databases, eg PubMed, Google Scholar and Egyptian Knowledge Bank searched and full-text high-quality research articles were carefully analysed to draw recommendations. Other relevant publications with low quality of evidence like case studies and short communications were also reviewed to address practice advices. Although Ramadan fasting was found beneficial for patients with NAFLD, it was found deleterious to patients with Child B and C cirrhosis and patients with peptic ulcer. Patients with chronic hepatitis, Child A cirrhosis and those with non-complicated liver transplant can fast with prefasting assessment and strict follow up.
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Affiliation(s)
- Mohamed H Emara
- Faculty of Medicine, Department of Hepatology, Gastroenterology and infectious diseases, Kafrelsheikh University, Kafr El-Shikh, Egypt
| | - Hanan H Soliman
- Faculty of Medicine, Tropical medicine and infectious diseases Department, Tanta University, Tanta, Egypt
| | - Mohamed Elnadry
- Faculty of Medicine, Hepato-gastroenterology and infectious diseases Department, Al-Azhar University, Cairo, Egypt
| | - Ebada Mohamed Said
- Faculty of Medicine, Hepatology, Gastroenterology and Infectious Diseases Department, Benha University, Benha, Egypt
| | - Sherief Abd-Elsalam
- Faculty of Medicine, Tropical medicine and infectious diseases Department, Tanta University, Tanta, Egypt
| | - Hassan E Elbatae
- Faculty of Medicine, Department of Hepatology, Gastroenterology and infectious diseases, Kafrelsheikh University, Kafr El-Shikh, Egypt
| | - Tarik I Zaher
- Faculty of Medicine, Department of Tropical Medicine, Zagazig University, Zagazig, Egypt
| | - Shamardan Ezzeldin S Bazeed
- Faculty of Medicine, Tropical Medicine and Gastroenterology Department, South Valley University, Qena, Egypt
| | - Ahmed Abdel-Razik
- Faculty of Medicine, Department of Tropical Medicine, Mansoura University, Mansoura, Egypt
| | - Salem Youssef Mohamed
- Faculty of Medicine, Department of Internal Medicine, Zagazig University, Zagazig, Egypt
| | - Asem Elfert
- Faculty of Medicine, Tropical medicine and infectious diseases Department, Tanta University, Tanta, Egypt
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20
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Ahmed MH, Emara MH, Elfert AA, El-Saka AM, Elfert AA, Abd-Elsalam S, Yousef M. Persistent Colonic Schistosomiasis among Symptomatic Rural Inhabitants in the Egyptian Nile Delta. Mediterr J Hematol Infect Dis 2021; 13:e2021033. [PMID: 34007421 PMCID: PMC8114893 DOI: 10.4084/mjhid.2021.033] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Human schistosomiasis is one of the most important and unfortunately neglected tropical diseases. The aim of the current study was to investigate the prevalence and characteristics of colonic schistosomiasis among symptomatic rural inhabitants of the Middle Northern region of the Egyptian Nile delta. PATIENTS AND METHODS This study recruited 193 inhabitants of the rural community in the Egyptian Nile Delta referred for colonoscopy because of variable symptoms. After giving written informed consent, they were exposed to thorough history, clinical examination, stool analysis, abdominal ultrasonography, and pan-colonoscopy with biopsies. RESULTS Twenty-four cases out of the 193 patients had confirmed active schistosomiasis with a prevalence rate of 12.4%. Bleeding with stool was the predominant manifestation of active Schistosoma infection among the cases either alone or in combination with abdominal pain. On clinical examination, most patients (n=17; 70.8%) did not have organomegaly, and 25% had clinically palpable splenomegaly as far as 75% of them had sonographically detected hepatic periportal fibrosis. Also, 66.6% of patients have significant endoscopic lesions (polyps, ulcers, mass-like lesions), and 16.6% of them had colonic affection beyond the recto-sigmoid region. CONCLUSION Colonic schistosomiasis is still prevalent among the Egyptian Nile Delta's symptomatic rural inhabitants at a rate of 12.4%. Of them, 66.6% had significant endoscopic colorectal lesions. This persistent transmission of schistosomiasis in the Egyptian Nile Delta's rural community sounds the alarm for continuing governmental efforts and plans to screen the high-risk groups. The prevalence rate reported in the current study is lower than the actual prevalence rate of schistosomiasis due to focusing only on a subgroup of individuals.
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Affiliation(s)
- Mohamed Hussien Ahmed
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Amr Asem Elfert
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Aymen M El-Saka
- Department of Pathology, Faculty of Medicine, Tanta University, Egypt
| | - Asem Ahmed Elfert
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sherief Abd-Elsalam
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Yousef
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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21
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Soliman HH, Emara MH, Elkadeem M, Abd-Elsalam S. Modifications of Medical Care of Chronic Liver Diseases During COVID-19 Pandemic: Necessity or Novelty? Infect Disord Drug Targets 2021; 21:e160921189886. [PMID: 33397247 DOI: 10.2174/1871526520666210104152256] [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: 09/11/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
In late 2019, coronavirus-2 (SARS-COV 2) infection emerged in Wuhan, China and spread to all countries making the first pandemic of the 21st century. It seems that this infection will persist which is long enough to obligate modifications in both lifestyle and health care systems. Because chronic liver diseases (CLD) are prevalent all over the world, it is expected to manage patients with CLD and COVID-19. The aim of this review was to shed light on the impact of COVID-19 pandemic on the management of patients with CLD and how to give medical care to CLD patients during COVID-19 pandemic.
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Affiliation(s)
- Hanan Hamed Soliman
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University,Egypt
| | - Mohamed H Emara
- Department of Hepatology, Gastroenterology and infectious disease Faculty of Medicine, Kafrelsheikh University,Egypt
| | - Mahmoud Elkadeem
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University,Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University,Egypt
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22
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Emara MH, Zaghloul MS, Mahros AM, Ema EH. Choledocho-nodal Fistula: Uncommon Cause of Obstructive Jaundice in a Patient with HCC Diagnosed by Combined ERCP/EUS. J Clin Imaging Sci 2021; 11:32. [PMID: 34221641 PMCID: PMC8247659 DOI: 10.25259/jcis_57_2021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023] Open
Abstract
A 58-year-old male patient presented with advanced hepatocellular carcinoma underwent transarterial chemoembolization (TACE) for hepatic focal lesions followed by TACE for a solitary hilar nodal metastasis combined with regorafenib therapy. One month later, the patient developed progressive jaundice. Work-up showed obstructive jaundice with intrahepatic biliary radicles dilatation. The diagnosis and treatment was achieved by combining endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography and showed uncommon cause of obstructive jaundice due to common bile duct compression by a choledocho-nodal fistula following TACE of a metastatic hilar lymph node.
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Affiliation(s)
- Mohamed H. Emara
- Department of Hepatology, Gastroenetrology and Infectious Diseases, Kafrelshiekh University, Kafr Elshikh, Egypt
- Corresponding author: Mohamed H. Emara, Departments of Hepatology, Gastroenetrology and Infectious Diseases, Kafrelshiekh University, 33516, Kafr Elshikh, Egypt.
| | - Mariam S. Zaghloul
- Department of Hepatology, Gastroenetrology and Infectious Diseases, Kafrelshiekh University, Kafr Elshikh, Egypt
| | - Aya M. Mahros
- Department of Hepatology, Gastroenetrology and Infectious Diseases, Kafrelshiekh University, Kafr Elshikh, Egypt
| | - Emad H Ema
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Kafrelshiekh University, Kafr Elshikh, Egypt
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23
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Emara MH, Mazid U, Atta MA, Elshahat S, Mahros AM. Ketonuria with or without ketoacidosis as the presenting manifestation of SARS-CoV-2 (COVID-19) among uncontrolled type 2 diabetic patients. Med Hypotheses 2020; 144:110226. [PMID: 33254533 PMCID: PMC7462884 DOI: 10.1016/j.mehy.2020.110226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023]
Abstract
We present three diabetic patients cases presented with kentonuria as the presenting manifestation of SARS-CoV-2 infection.
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelshiekh University, KAFR ELSHIEKH, Egypt; Department of Medicine, Alyousef Hospital, Alkhobar, KSA.
| | - Usama Mazid
- Department of Medicine, Alyousef Hospital, Alkhobar, KSA; Tanta Hospital for Tropical Diseases, Tanta, Egypt
| | - Mohammed Ali Atta
- Department of Radiology, Al-Mahalla General Hospital, Almehala, Egypt; Department of Radiology, Alyousef Hospital, Alkhobar, KSA
| | - Sahar Elshahat
- Clinical Pathology Department, Alazhar University,(Faculty of Medicine for Girls), Alzahraa Hospital, Cairo, Egypt; Department of Clinical Pathology, Alyousef Hospital, Alkhobar, KSA
| | - Aya Mohammed Mahros
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelshiekh University, KAFR ELSHIEKH, Egypt
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24
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Alboraie M, Piscoya A, Tran QT, Mendelsohn RB, Butt AS, Lenz L, Alavinejad P, Emara MH, Samlani Z, Altonbary A, Monged A, Lemmers A, Sudovykh I, Ho DQD, Ghazanfar S, Kamau E, Iqbal S, Tan DMY, Liao WC, Vignesh S. The global impact of COVID-19 on gastrointestinal endoscopy units: An international survey of endoscopists. Arab J Gastroenterol 2020; 21:156-161. [PMID: 32912748 PMCID: PMC7448955 DOI: 10.1016/j.ajg.2020.08.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & STUDY AIMS Corona virus disease-19 (COVID-19) pandemic has markedly impacted routine medical services including gastrointestinal (GI) endoscopy. We aim to report the real-life performance in high volume GI endoscopy units during the pandemic. PATIENTS AND METHODS A web-based survey covering all aspects of daily performance in GI endoscopy units was sent to endoscopy units worldwide. Responses were collected and data were analyzed to reveal the effect of COVID-19 pandemic on endoscopy practice. RESULTS Participants from 48 countries (n = 163) responded to the survey with response rate of 67.35%. The majority (85%) decreased procedure volume by over 50%, and four endoscopy units (2.45%) completely stopped. The top three indications for procedures included upper GI bleeding (89.6%), lower GI bleeding (65.6%) and cholangitis (62.6%). The majority (93.9%) triaged patients for COVID-19 prior to procedure. N95 masks were used in (57.1%), isolation gowns in (74.2%) and head covers in (78.5%). Most centers (65%) did not extend use of N95 masks, however 50.9% of centers reused N95 masks. Almost all (91.4%) centers used standard endoscopic decontamination and most (69%) had no negative pressure rooms. Forty-two centers (25.8%) reported positive cases of SARS-CoV-2 infection among patients and 50 (30.7%) centers reported positive cases of SARS-CoV-2 infection among their healthcare workers. CONCLUSIONS Most GI endoscopy centers had a significant reduction in their volume and most procedures performed were urgent. Most centers used the recommended personal protective equipment (PPE) by GI societies however there is still a possibility of transmission of SARS-CoV-2 infection in GI endoscopy units.
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Affiliation(s)
- Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.
| | - Alejandro Piscoya
- Hospital Guillermo Kaelin De la Fuente - EsSalud, Lima, Peru; Systematic Reviews and Meta-analysis, Clinical Practice Guidelines and Health Technology Assessments Unit - Universidad San Ignacio de Loyola, Lima, Peru
| | - Quang Trung Tran
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Viet Nam; Department of Medicine A, University Medicine Greifswald, D-17475 Greifswald, Germany
| | - Robin B Mendelsohn
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Amna Subhan Butt
- Section of Gastroenterology at Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Luciano Lenz
- Fleury Medicina e Saúde, Sao Paulo, Brazil; Cancer Institute of Sao Paulo State - Icesp, Sao Paulo, Brazil
| | - Pezhman Alavinejad
- Alimentary Tract Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelshiekh University, Kafrelshiekh, Egypt
| | - Zouhour Samlani
- Gastroenterology and Hepatology Department, King Mohamed VI University Hospital. Cadi Ayyad University, Marrakesh, Morocco
| | - Ahmed Altonbary
- Department of Gastroenterology and Hepatology, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
| | - Ashraf Monged
- Endoscopy Unit, Royal College of Surgeons of Ireland Hospitals Group, Dublin, Ireland
| | - Arnaud Lemmers
- Erasme Hospital, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (université Libre de Bruxelles), Brussels, Belgium
| | - Irina Sudovykh
- State Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia
| | | | | | - Edna Kamau
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya
| | - Shahzad Iqbal
- Department of Medicine, Hofstra Northwell School of Medicine, NY, USA
| | - Damien Meng Yew Tan
- Department Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Wei-Chih Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shivakumar Vignesh
- Division of Gastroenterology and Hepatology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
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25
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Elsadek HM, Abdelbaser ES, Emara MH, Soliman HH, Farag AA. Morbidity and mortality during hepatitis C treatment using sofosbuvir and daclatasvir with or without ribavirin, in a cohort of Egyptian patients. Eur J Gastroenterol Hepatol 2020; 32:1046-1053. [PMID: 33216478 DOI: 10.1097/meg.0000000000001695] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Though direct-acting antiviral agents (DAAs) therapy is associated with a high cure rate of hepatitis C virus infection, a potential risk of serious adverse events (SAEs) exists. The aim of this study was to determine the incidence and predictors of morbidity and mortality related to DAAs therapy. METHODS This prospective study was conducted on a real word cohort of 1562 treatment naïve chronic hepatitis C (CHC) Egyptian patients, who received 12-weeks therapy with sofosbuvir (SOF) plus daclatasvir (DCV) ± ribavirin (RBV). The incidence and predictors of SAEs and mortality during treatment course and over the following 12 weeks were recorded. RESULTS The mean age of study participants was 51.38 ± 9.70 years (55.22%, males). Liver cirrhosis was defined in 72.4% of participants. SAEs were recorded in 120 participants (7.68%), including hepatic decompensation, gastrointestinal bleeding, anemia and hepatocellular carcinoma. Nine patients (0.58%) died and 69 patients (4.42%) discontinued therapy due to SAEs. Severity of cirrhosis was the significant predictor of morbidities and mortality. Hepatic decompensation was predicted by baseline serum albumin [cutoff value: 3.00 g/dL, area under the receiver operating characteristic curve (AUROC): 0.953] and serum bilirubin (cutoff value: 1.75 mg/dL, AUROC: 0.940). CONCLUSION The risk of morbidity and mortality related to SOF/DCV ± RBV therapy in CHC patients is small and is significantly linked to advanced cirrhosis.
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Affiliation(s)
- Hany M Elsadek
- Gastroenterology and Hepatology Unit, Internal Medicine Department
| | | | - Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh
| | - Hanan H Soliman
- Community Medicine Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Alaa A Farag
- Gastroenterology and Hepatology Unit, Internal Medicine Department
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26
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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27
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Elgammal N, Zaher TI, Elkomy H, Abdelmoaty AA, Abdallah M, Emara MH. How frequent is sleep-disordered breathing among Egyptian cirrhotic adults? Clin Exp Hepatol 2020; 6:150-157. [PMID: 32728633 PMCID: PMC7380477 DOI: 10.5114/ceh.2020.95940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/19/2020] [Indexed: 02/07/2023] Open
Abstract
AIM OF THE STUDY Liver cirrhosis is an irreversible destructive liver disease that is associated with a wide range of complications. Among the recognized comorbidities of liver cirrhosis are sleep-disordered breathing (SDB), which is being more and more often described among cirrhotics. This study aimed to detect the prevalence of SDB among Egyptian post-viral cirrhotic adults. MATERIAL AND METHODS This study enrolled 48 post-viral cirrhotic patients and 16 apparently healthy control subjects. All patients and controls were evaluated by thorough history taking, full clinical examination, laboratory investigations, the Epworth Sleepiness Scale questionnaire, the Berlin Questionnaire and polysomnography. RESULTS Patients and controls were comparable as regards baseline demographics. Patients with liver cirrhosis had higher frequency of SDB compared to controls (56.2% vs. 12.5%, p = 0.002). The most frequently encountered SBD patterns among cirrhotics were obstructive sleep apnea and apnea hypopnea index. Moreover, SDB was more severe among cirrhotics (25% were mild, 16.6% were moderate and 14.6% were severe obstructive sleep apnea - OSA) compared to the healthy controls (all were mild). CONCLUSIONS It seems that post-viral cirrhotic patients had a wide range of SDB with variable degrees of severity compared to the healthy controls.
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Affiliation(s)
- Nahla Elgammal
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Tarik I Zaher
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hoida Elkomy
- Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohamed Abdallah
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelshiekh University, Kafr Elshikh, Egypt
- Address for correspondence Dr. Mohamed H Emara, Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelshiekh University, Kafr Elshikh, 33516, Egypt, e-mail:
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28
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Elbatee HE, Emara MH, Zaghloul MS, Ahmed MH, Radwan MI, Seif AS, Elmoghazy MB, Elkashef WF. Huge bilharzial polyp mimicking colon cancer. JGH Open 2020; 4:280-283. [PMID: 32280778 PMCID: PMC7144792 DOI: 10.1002/jgh3.12181] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 02/05/2023]
Abstract
Bilharziasis (Schistosomiasis) is the third devastating tropical disease globally and is endemic in many countries including Egypt. The pathology of chronic colonic schistosomiasis results from egg-induced immune response, granuloma formation, and associated fibrotic changes that may manifest as bloody diarrhea, cramping, and, eventually, inflammatory colonic polyposis. Huge polyps complicating schistosomiasis are not frequently reported in the literature. Also, huge polyps as a sole manifestation of intestinal bilharziasis are rather rarely reported. Here, we report an Egyptian male patient who presented with bleeding per rectum with a huge polyp on colonoscopy, with morphological traits that mimicked colon cancer and proved to be of bilharzial etiology after surgical excision.
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Affiliation(s)
- Hassan E Elbatee
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of MedicineKafrelsheikh UniversityKafrelsheikhEgypt
| | - Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of MedicineKafrelsheikh UniversityKafrelsheikhEgypt
| | - Mariam S Zaghloul
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of MedicineKafrelsheikh UniversityKafrelsheikhEgypt
| | - Mohammed H Ahmed
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of MedicineKafrelsheikh UniversityKafrelsheikhEgypt
| | - Mohamed I Radwan
- Tropical Medicine Department, Faculty of MedicineZagazig UniversityZagazigEgypt
| | - Ahmed S Seif
- Tropical Medicine, Hepatology and Gastroenterology DepartmentShebin Elkom Teaching HospitalShebinelkomEgypt
| | - Magdy B Elmoghazy
- Department of General Surgery, Faculty of MedicineMansoura UniversityMansouraEgypt
| | - Wagdi F Elkashef
- Department of Pathology, Faculty of MedicineMansoura UniversityMansouraEgypt
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29
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Radwan MI, Emara MH, Zaghloul MS, Zaghloul AMS. Double plastic stenting for inoperable malignant biliary stricture among cirrhotic patients as a possible cost-effective treatment: a pilot study. Eur J Gastroenterol Hepatol 2019; 31:1057-1063. [PMID: 31045612 DOI: 10.1097/meg.0000000000001425] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIM Endoscopic retrograde cholangiopancreatography (ERCP) has evolved as the main therapeutic intervention for hepatobiliary disorders. Palliative stenting for inoperable cases is associated with better morbidity and mortality than surgery. This work aimed at assessing the effect of insertion of two plastic stents in inoperable malignant biliary stricture among cirrhotic patients regarding stent patency, quality of life (QOL), and cost. PATIENTS AND METHODS This multicenter study included 72 cirrhotic patients presented for ERCP with an inoperable malignant biliary stricture. All patients underwent ERCP after preoperative optimization with sphincterotomy, balloon dilatation, and insertion of two plastic stents of 10 Fr. Evaluation included stent patency at 6 months, effect on the QOL using EORTC QLQ-C30 (version 3), adverse events, and the cost. RESULTS Patients included 67% of males and had an age range of 48-88 years (mean: 70 years). In all, 92% of stents were patent at 6 months. Significant improvement in serum total bilirubin and all items of QOL questionnaire at 6 months after the procedure was reported. Cholangitis and pancreatitis were reported in 25 and 8% of cases, respectively. The cost of insertion of two plastic stents and the daily cost of the procedure regarding the effect on QOL were low. CONCLUSION Double plastic stenting of the common bile duct seems effective at 6 months of follow-up among cirrhotic patients with inoperable malignant biliary obstruction. Furthermore, it seems also valuable in improving laboratory findings and QOL among those patients with an acceptable cost.
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Affiliation(s)
- Mohamed I Radwan
- Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig
| | - Mohamed H Emara
- Department of Hepatology, Gastroenetrology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mariam S Zaghloul
- Department of Hepatology, Gastroenetrology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Radwan MI, Emara MH, Ibrahim IM, Moursy ME. Large Balloon Dilatation Versus Mechanical Lithotripsy After Endoscopic Sphincterotomy in the Management of Large Common Bile Duct Stones in Cirrhotic Patients: A Randomized Study. J Clin Gastroenterol 2019. [PMID: 29521723 DOI: 10.1097/mcg.0000000000001000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIM Removal of large common bile duct (CBD) stones is one of the challenges faced during endoscopic retrograde cholangiopancreatography, and it seems more difficult in cirrhotic patients because of suspected higher rates of adverse events, especially bleeding diathesis. This study aimed at comparing the success rate and complications between mechanical lithotripsy (ML) and large balloon dilation (LBD) after endoscopic sphincterotomy in patients with liver cirrhosis. PATIENTS AND METHODS Ninety-eight cirrhotic patients with calcular obstructive jaundice were included and randomly divided into 2 groups: group A comprising 49 patients treated by LBD and group B comprising 49 patients treated by ML. All patients underwent sphincterotomy initially. All patients were subjected to thorough history taking and complete clinical examination. Pancreatic enzyme concentrations were measured 4 hours before and 24 hours after the procedure, and complete blood cell count and liver function tests were performed before and the morning after the procedure. Before and during endoscopic retrograde cholangiopancreatography, stone size and number were verified. RESULTS The success rate for CBD clearance was 98% and 93.8% for LBD and ML, respectively. The rate of adverse events in this study was 10.2% (10/98), and bleeding was the commonest reported complication (5/10). Group B developed more (16.3%) adverse events than group A (4.1%), and the difference was statistically significant (P=0.04). CONCLUSION Endoscopic sphincterotomy followed by LBD is a safe and effective treatment for large CBD stones in cirrhotic patients in comparison with sphincterotomy followed by ML.
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Affiliation(s)
- Mohamed I Radwan
- Tropical Medicine Department, Faculty of Medicine, Zagazig University
| | - Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Ibrahim M Ibrahim
- Tropical Medicine Department, Faculty of Medicine, Zagazig University
| | - Mahmoud E Moursy
- Gastroenterology Department, Al-Ahrar Teaching Hospital, Zagazig
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Abstract
Helicobacter pylori (H pylori) infection is the most frequent infection worldwide and it has been postulated that it predisposes to multiple enteric pathogens and diarrheal diseases. Salmonella infection is common in tropical and under developed communities and is associated with wide range of diseases from gastroenteritis to typhoid fever. This study aimed at detecting the impact of H pylori infection on the incidence of salmonella infections.The study participants were sampled from cohorts of patients in four university hospitals in different Egyptian Governorates. Their age ranged from 20 to 59 years and followed up for a rising Widal test. Case patients (n = 109) were subjects who visited the outpatient clinic because of diarrhea and typhoid like illness. They were either positive for H pylori stool antigen (n = 53) or negative to it (n = 56). All patients were subjected to thorough history taking, clinical examination, routine laboratory investigations, abdominal ultrasonography, H pylori stool antigen detection, and serial Widal test assay.The proportion of salmonella-infected subjects was lower among case patients with H pylori infection (22.6%) than among those negative for H pylori (33.9%) albeit not statistically significant (adjusted odds ratio [OR], 0.57; 95% confidence interval [CI], 0.24-1.33; P = .21). The association persisted nonsignificant after adjusting for sociodemographic variables (adjusted OR, 0.5; 95% CI, 0.18-1.39; P = .18). In a multivariate analysis that adjusted for sex, dietary habits, socioeconomic status, and educational level subjects who eat outdoors were associated with a significantly greater risk of salmonella typhi infection.Our findings suggest that there is no association between H pylori infection and salmonella infection in patients presented with typhoid fever or typhoid like illness.
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Affiliation(s)
- Rasha I. Salama
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig
| | - Mohamed H. Emara
- Hepatology, Gastroenetrology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh
| | - Hanan M. Mostafa
- Internal Medicine Department, Medical Research Institute, Alexandria University, Alexandria
| | | | | | | | - Mariam Salah Zaghloul
- Hepatology, Gastroenetrology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh
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Emara MH, Elhawari SA, Yousef S, Radwan MI, Abdel-Aziz HR. Emerging Role of Probiotics in the Management of Helicobacter pylori Infection: Histopathologic Perspectives. Helicobacter 2016; 21:3-10. [PMID: 25997615 DOI: 10.1111/hel.12237] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is growing evidence from preclinical and clinical studies that emphasizes the efficacy of probiotics in the management of Helicobacter (H) pylori infection; it increased the eradication rate, improved patient clinical manifestations and lowered treatment associated side effects. AIM In this review we documented the potential ability of probiotics to ameliorate H. pylori induced histological features. MATERIALS AND METHODS We searched the available literature for full length articles focusing the role of probiotics on H. pylori induced gastritis from histologic perspectives. RESULTS Probiotics lowered H. pylori density at the luminal side of epithelium, improved histological inflammatory and activity scores both in the gastric corpus and antrum. This effect persists for long period of time after discontinuation of probiotic supplementation and this is probably through an immune mechanism. CONCLUSIONS The current evidence support the promising role of probiotics in improving H. pylori induced histopathological features both in gastric antrum and corpus and for long periods of time. Because increased density of H. pylori on the gastric mucosa is linked to more severe gastritis and increased incidence of peptic ulcers, we can infer that a reduction of the density might help to decrease the risk of developing pathologies, probably the progression toward atrophic gastritis and gastric adenocarcinoma. These effects together with improving the H. pylori eradication rates and amelioration of treatment related side effects might open the door for probiotics to be added to H. pylori eradication regimens.
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Affiliation(s)
- Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Soha A Elhawari
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Salem Yousef
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed I Radwan
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Hesham R Abdel-Aziz
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
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Mohamed SY, Emara MH, Hussien HI, Elsadek HM. Changes in portal blood flow and liver functions in cirrhotics during Ramadan fasting in the summer; a pilot study. Gastroenterol Hepatol Bed Bench 2016; 9:180-8. [PMID: 27458510 PMCID: PMC4947132 DOI: pmid/27458510] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM Assessment of short term changes in portal blood flow and long term changes in liver functions in cirrhotic patients who chose to fast during the month of Ramadan in summer. BACKGROUND During Ramadan, healthy Muslims obligated to fast from predawn to sunset. PATIENTS AND METHODS Forty cirrhotic patients intended to fast during the month of Ramadan in the year 2014, were examined by Congestion index (CI) as a non-invasive indicator of short term changes in the portal blood flow, while liver function tests were determined as an indicator of long term changes in liver functions. RESULTS A total of 38 patients completed the whole month fasting and two patients discontinued fasting due to variceal bleeding. The complicated patients were 7. CI showed a statistically significant increase from fasting to postprandial status (P<0.001), with statistically significant increases from fasting to postprandial status in Child class A (P<0.001), and B (P<0.001). We did not find a statistical significance between patients with complications and those without complications (P=0.6). There was a statistically significant rise in the serum bilirubin after Ramadan. Deterioration noticed as advanced Child classes, development of lower limb edema, increasing ascites, increasing jaundice and overt encephalopathy. CONCLUSION Cirrhotic patients showed significant short-term changes in the portal blood flow. However, these changes are not linked to complications or deterioration of liver functions and accommodated especially in patients with Child class A and B. Child class C patients should not fast.
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Affiliation(s)
- Salem Y Mohamed
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Hala Im Hussien
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Hany M Elsadek
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
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Emara MH, Darwiesh EM, Bihery AS, Zaher TI. Endoscopic injection of autologous blood versus diluted epinephrine for control of actively bleeding gastroduodenal ulcers: a randomized-controlled study. Eur J Gastroenterol Hepatol 2014; 26:1267-72. [PMID: 25171029 DOI: 10.1097/meg.0000000000000180] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A preliminary report showed that autologous blood is an effective and easily applicable technique that can control actively bleeding gastroduodenal ulcers. The aim of this study was to test whether an endoscopic injection of autologous blood is comparable to an endoscopic injection of diluted epinephrine in controlling bleeding from gastroduodenal ulcers. PATIENTS AND METHODS A total of 100 patients with actively bleeding gastroduodenal ulcers were assigned randomly to either an autologous blood injection (group A, n=50) or a diluted epinephrine injection (group B, n=50) along the edges of the ulcers. Groups were compared for rates of initial hemostasis, rebleeding, and complications. RESULTS All patients initially achieved hemostasis (100%). Rebleeding occurred in four patients from group A (8%) and five patients from group B (10%). Two patients in group B developed cardiovascular complications (arrhythmia and ischemic heart attack), whereas none in group A developed complications. CONCLUSION Autologous blood is effective, comparable to diluted epinephrine in achieving initial hemostasis from actively bleeding gastroduodenal ulcers, associated with an 8% rebleeding rate, and led to no complications.
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Affiliation(s)
- Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Abstract
BACKGROUND Foreign bodies (FBs) in the upper gastrointestinal tract are produced chiefly by accidental swallowing but rarely produce symptoms. Removal of FBs is not an infrequent challenge for upper gastrointestinal endoscopy. The aim of this study is to elicit our experience in a 5-year period in dealing with FBs in the upper gastrointestinal tract using upper endoscopy. METHODS This retrospective study was conducted at Zagazig University Hospitals, Egypt, over a 5-year period. We reviewed all patients' files with full notations on age, sex, type of FB and its anatomical location, treatments, and outcomes (complications, success rates, and mortalities). Patients with incomplete files and those with FBs not identified at the endoscopic examination were excluded. RESULTS A total of 45 patients were identified. Their ages ranged from 6 months to 102 years. Slight male predominance was noticed (53.3%). The most frequent presentation was a history of FB ingestion without any associated manifestations (44.4%). Coins were the most commonly encountered FBs (14/45). Esophagus was the most common site of trapping (27/45). The overall success rate was 95.6% (43/45). Upper endoscopy successfully resolved the problem by either FB removal (41/43) or dislodgment of the impacted fleshy meat to the stomach (2/43). Two cases were referred for surgical removal. The rate of complications was 6.7%. Furthermore, no mortalities due to FB ingestion or removal had been reported throughout the study. CONCLUSION Our experience with FB removal emphasizes its importance and ease when performed by experienced hands, at well-equipped endoscopy units, and under conscious sedation in most cases, with high success rates and minor complications.
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Affiliation(s)
- Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Correspondence: Mohamed H Emara, Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt, Tel +20 10 0272 4482, Email
| | - Ehab M Darwiesh
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M Refaey
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherif M Galal
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Emara MH, Mohamed SY, Abdel-Aziz HR. Lactobacillus reuteri in management of Helicobacter pylori infection in dyspeptic patients: a double-blind placebo-controlled randomized clinical trial. Therap Adv Gastroenterol 2014; 7:4-13. [PMID: 24381643 PMCID: PMC3871281 DOI: 10.1177/1756283x13503514] [Citation(s) in RCA: 50] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The eradication rate of Helicobacter pylori following the standard triple therapy is declining. This study was conducted to test whether the addition of Lactobacillus reuteri to the standard triple therapy improves the eradication rates as well as the clinical and pathological aspects in H. pylori infection. METHODS A total of 70 treatment-naïve patients were randomly assigned into group A (the L. reuteri treated group) and group B (the placebo control group). Patients were treated by the standard triple therapy for 2 weeks and either L. reuteri or placebo for 4 weeks. They were examined by symptom questionnaire, H. pylori antigen in stool, upper endoscopy with biopsies for rapid urease test and histopathological examination before treatment and 4 weeks after treatment. RESULTS The eradication rate of H. pylori infection was 74.3% and 65.7% for both L. reuteri and placebo treated groups, respectively. There was a significant difference regarding the reported side effects, where patients treated with L. reuteri reported less diarrhea and taste disorders than placebo group. A significant difference within each group was observed after treatment regarding Gastrointestinal Symptom Rating Scale (GSRS) scores; patients treated with L. reuteri showed more improvement of gastrointestinal symptoms than the placebo treated group. The severity and activity of H. pylori associated gastritis were reduced after 4 weeks of therapy in both groups. The L. reuteri treated group showed significant improvement compared with the placebo treated group. CONCLUSION Triple therapy of H. pylori supplemented with L. reuteri increased eradication rate by 8.6%, improved the GSRS score, reduced the reported side effects and improved the histological features of H. pylori infection when compared with placebo-supplemented triple therapy.
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Affiliation(s)
- Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Al-Kornish Street, Zagazig 44519, Egypt
| | - Salem Y Mohamed
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hesham R Abdel-Aziz
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Abstract
Liver biopsy is the gold standard for assessment of hepatic fibrosis although it is associated with many complications. We reported a 28-year-old chronic HCV patient who developed gall bladder hematoma with hemobilia and melena after liver biopsy. The hematoma resolved with conservative management.
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Affiliation(s)
- Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ibrahim M Ibrahim
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Corresponding author: Ibrahim M Ibrahim, Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
| | - Mohamed I Radwan
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Pasha HF, Radwan MI, Hagrass HA, Tantawy EA, Emara MH. Cytokines genes polymorphisms in chronic hepatitis C: impact on susceptibility to infection and response to therapy. Cytokine 2013; 61:478-84. [PMID: 23219017 DOI: 10.1016/j.cyto.2012.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 10/31/2012] [Accepted: 11/02/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cytokines play a key role in the regulation of immune responses. In hepatitis C virus infection, the production of abnormal cytokine levels appears to contribute in the progression of the disease, viral persistence, and affects response to therapy. Cytokine genes polymorphisms located within the coding/regulatory regions have been shown to affect the overall expression and secretion of cytokines. The aim of the study was to evaluate the association of of IL28B rs12979860, TGF-β1-509, TNF-α 308, and IL-10-1082 polymorphisms with the susceptibility to hepatitis C virus genotype 4 infection and response to pegylated interferon-α and ribavirin therapy. METHODS IL28B, TGF-β1 and TNF-α genes polymorphisms were genotyped using polymerase chain reaction (PCR)-based restriction fragment length polymorphism assay while IL-10 gene polymorphism was detected by sequence specific primer-PCR in 220 healthy individuals and 440 hepatitis C infected patients (220 sustained virological response and 220 non-responder to combination therapy). RESULTS IL28 B CT and TT, TGF-β1 CT and TT and TNF-α AG and AA genotypes were significantly associated with susceptibility to hepatitis C infection and response to therapy. While no association was found between IL-10 gene polymorphism and susceptibility to HCV infection and response to treatment. CONCLUSIONS These results suggested that inheritance of IL28B CT and TT, TGF-β1 CT and TT and TNF-α AG and AA genotypes which appear to affect the cytokine production may be associated with susceptibility to HCV infection and resistance to combined antiviral therapy.
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Affiliation(s)
- Heba F Pasha
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Emara MH, Radwan MI. Successful treatment of activated occult hepatitis B in a non-responder chronic hepatitis C patient. Virol J 2011; 8:518. [PMID: 22078891 PMCID: PMC3256239 DOI: 10.1186/1743-422x-8-518] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 11/14/2011] [Indexed: 02/07/2023] Open
Abstract
We reported a 23 years old male with chronic hepatitis C virus infection, discontinued from pegylated interferon/ribavirin combination therapy due to a lack of early virological response. He has developed activation of occult hepatitis B virus that was successfully treated by a one year of lamivudine therapy.
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Affiliation(s)
- Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Mohamed I Radwan
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt
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Emara MH, El-Gammal NE, Mohamed LA, Bahgat MM. Occult hepatitis B infection in egyptian chronic hepatitis C patients: prevalence, impact on pegylated interferon/ribavirin therapy. Virol J 2010; 7:324. [PMID: 21083926 PMCID: PMC2998483 DOI: 10.1186/1743-422x-7-324] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 11/17/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic HCV infection combined with occult hepatitis B infection has been associated with liver enzymes flare, advanced hepatic fibrosis and cirrhosis, poor response to standard interferon-α, and increased risk of HCC. This study aimed to elucidate the prevalence of occult hepatitis B infection in Egyptian chronic HCV patients, and to clarify its role in non-response of those patients to pegylated interferon/ribavirin therapy. This study enrolled 155 consecutive chronic HCV patients under pegylated interferon/ribavirin therapy. All patients were exposed to clinical assessment, biochemical, histological and virological examinations. HBV parameters (HBV DNA, anti-HBc, anti-HBs) and patients' response status to the combination therapy were determined. RESULTS In this study, occult hepatitis B infection occurs in 3.9% of Egyptian chronic HCV patients; tends to affect younger age patients, associated with higher base line HCV viral load, less hepatic fibrosis than monoinfected patients. This occult hepatitis B infection is not a statistically significant cause of non-response to pegylated interferon/ribavirin therapy. Anti-HBs was not associated with any biochemical, histological or virological abnormalities in those patients, contrary to low response rate to therapy and higher HCV viral load that was observed with anti-HBc. CONCLUSIONS Detection of HBV DNA in HBsAg negative chronic HCV patients plays a non significant role in non-response of Egyptian patients to pegylated interferon/ribavirin therapy.
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Affiliation(s)
- Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nahla E El-Gammal
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Lamiaa A Mohamed
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Maged M Bahgat
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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