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Raafat M, Morsy MM, Mohamed SI, Hamad MA, Sayed MM. Therapeutic Role of Subcutaneous Access Loop Created Adjunct to Hepaticojejunostomy for Management of Bile Duct Injury. Am Surg 2023; 89:5711-5719. [PMID: 37142256 DOI: 10.1177/00031348231173945] [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: 05/06/2023]
Abstract
BACKGROUND Roux-en-Y hepaticojejunostomy (RYHJ) is usually required for major bile duct injury (BDI) as a definitive treatment. Hepaticojejunostomy anastomotic stricture (HJAS) is the most feared long-term complication following RYHJ. The ideal management of HJAS remains undefined. The provision of permanent endoscopic access to the bilio-enteric anastomotic site can make endoscopic management of HJAS feasible and attractive option. In this cohort study, we aimed to evaluate short- and long-term outcomes of subcutaneous access loop created adjunct to RYHJ (RYHJ-SA) for management of BDI and its usefulness for endoscopic management of anastomotic stricture if occurred. MATERIALS AND METHODS This is a prospective study including patients who were diagnosed with iatrogenic BDI and underwent hepaticojejunostomy with subcutaneous access loop between September 2017 and September 2019. RESULTS This study included a total number of 21 patients whom ages ranged between 18 and 68 years. During follow-up, three cases had HJAS. One patient had the access loop in subcutaneous position. Endoscopy was done but failed to dilate the stricture. The other 2 patients had the access loop in subfascial position. Endoscopy of them failed to enter the access loop due to failure of fluoroscopy to identify the access loop. The three cases underwent redo-hepaticojejunostomy. Parajejunal (parastomal) hernia occurs in 2 patients in whom the access loop was fixed subcutaneous position. CONCLUSION In conclusion, modified RYHJ with subcutaneous access loop (RYHJ-SA) is associated with reduced quality of life and patient satisfaction. Moreover, its role in endoscopic management of HJAS after biliary reconstruction for major BDI is limited.
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Affiliation(s)
- Mohamad Raafat
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Morsy M Morsy
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Salah I Mohamed
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Mostafa A Hamad
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Mostafa M Sayed
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
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2
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Raafat M, Morsy MM, Mohamed SI, Hamad MA, Sayed MM. Hepaticojejunostomy with gastric access loop versus conventional hepaticojejunostomy: a randomized trial. Updates Surg 2023; 75:2157-2167. [PMID: 37556078 PMCID: PMC10710387 DOI: 10.1007/s13304-023-01604-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
Roux-en-Y hepaticojejunostomy (RYHJ) with the provision of "gastric access loop" was developed to shorten the distance traveled by the endoscope to reach hepaticojejunostomy (HJ) anastomotic site. The aim of our study was to assess modified RYHJ with gastric access loop (RYHJ-GA) and compare it with conventional RYHJ (RYHJ-C) regarding short- and long-term outcomes and, moreover, to evaluate the feasibility and results of future endoscopic access of the modified bilio-enteric anastomosis. Patients eligible for RYHJ between September 2017 and December 2019 were allocated randomly to receive either RYHJ-C or RYHJ-GA. Fifty-two patients were randomly assigned to RYHJ-C (n = 26) or RYHJ-GA (n = 26). Three cases in RYHJ-C and 4 cases in RYHJ- GA developed HJ anastomotic stricture (HJAS) (P=0.68). 3 cases of RYHJ-GA had successful endoscopic dilation and balloon sweeping of biliary mud (one case) or stones (2 cases). Revisional surgery was needed in 2 cases of RYHJ-C and 1 case in RYHJ-GA (P=0.68). Modified RYHJ with gastric access loop is comparable to the classic hepaticojejunostomy regarding complications. However, gastric access enables easy endoscopic access for the management of future HJAS. This modification should be considered in patients with a high risk of HJAS during long-term follow-up.The trial registration number (TRN) and date of registration:ClinicalTrials.gov (NCT03252379), August 17, 2017.
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Affiliation(s)
- Mohamad Raafat
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt.
| | - Morsy M Morsy
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt
| | - Salah I Mohamed
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt
| | - Mostafa A Hamad
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt
| | - Mostafa M Sayed
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt
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Taha AMI, Elkoussy AMM, Hamad MA, Ryad HA, Hassan RA. Early Hepatoduodenal Ligament Occlusion Versus Classic Technique During Recipient Hepatectomy for Living Donor Liver Transplant. EXP CLIN TRANSPLANT 2023; 21:345-349. [PMID: 37154594 DOI: 10.6002/ect.2023.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Intraoperative bleeding is commonly encountered during living donor liver transplant procedures and is associated with greater need for blood transfusion, which increases morbidity. Herein, we hypothesized that early and continuous occlusion ofthe hepatic inflow would have a beneficial effect on the living donor liver transplant procedure regarding intraoperative blood loss and operative time. MATERIALS AND METHODS This comparative study prospectively included 23 consecutive patients (the experimental group) who had early inflow occlusion during recipient hepatectomy for living donor liver transplant and compared the outcomes versus 29 consecutive patients who had previously received (immediately before the start of our study) living donor liver transplant by the classic technique. Blood loss and time for hepatic mobilization and dissection were compared between the 2 groups. RESULTS Patient criteria and indication for living donor liver transplant showed no significant difference between the 2 groups. There was a significant decrease in blood loss during hepatectomy in the study group versus the control group (2912 vs 3826 mL, respectively; P = .017). Packed red blood cell transfusion was less in the study group versus the control group (1550 vs 2350 cells, respectively; P < .001). The skin-to-hepatectomy time was not different between the 2 groups. CONCLUSIONS Early hepatic inflow occlusion is a simple and effective technique to reduce intraoperative blood loss and reduce the need for blood transfusion products during living donor liver transplant.
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Affiliation(s)
- Ahmed M I Taha
- From the HPB Surgery and Liver Transplantation Unit, General Surgery Department, El-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
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Eissa RA, Saafan HA, Ali AE, Ibrahim KM, Eissa NG, Hamad MA, Pang C, Guo H, Gao H, Elsabahy M, Wooley KL. Design of nanoconstructs that exhibit enhanced hemostatic efficiency and bioabsorbability. Nanoscale 2022; 14:10738-10749. [PMID: 35866631 DOI: 10.1039/d2nr02043b] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hemorrhage is a prime cause of death in civilian and military traumatic injuries, whereby a significant proportion of death and complications occur prior to paramedic arrival and hospital resuscitation. Hence, it is crucial to develop hemostatic materials that are able to be applied by simple processes and allow control over bleeding by inducing rapid hemostasis, non-invasively, until subjects receive necessary medical care. This tutorial review discusses recent advances in synthesis and fabrication of degradable hemostatic nanomaterials and nanocomposites. Control of assembly and fine-tuning of composition of absorbable (i.e., degradable) hemostatic supramolecular structures and nanoconstructs have afforded the development of smart devices and scaffolds capable of efficiently controlling bleeding while degrading over time, thereby reducing surgical operation times and hospitalization duration. The nanoconstructs that are highlighted have demonstrated hemostatic efficiency pre-clinically in animal models, while also sharing characteristics of degradability, bioabsorbability and presence of nano-assemblies within their compositions.
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Affiliation(s)
- Rana A Eissa
- School of Biotechnology and Science Academy, Badr University in Cairo, Badr City, Cairo 11829, Egypt.
| | - Hesham A Saafan
- School of Biotechnology and Science Academy, Badr University in Cairo, Badr City, Cairo 11829, Egypt.
| | - Aliaa E Ali
- Department of Chemistry, University of Turku, Vatselankatu 2, 20014 Turku, Finland
| | - Kamilia M Ibrahim
- Department of Pharmacology, Faculty of Pharmacy, Ain Shams University, Cairo 11561, Egypt
| | - Noura G Eissa
- School of Biotechnology and Science Academy, Badr University in Cairo, Badr City, Cairo 11829, Egypt.
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Mostafa A Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ching Pang
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA.
| | - Hongming Guo
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA.
| | - Hui Gao
- State Key Laboratory of Separation Membranes and Membrane Processes, School of Materials Science and Engineering, Tiangong University, Tianjin 300387, P. R. China.
| | - Mahmoud Elsabahy
- School of Biotechnology and Science Academy, Badr University in Cairo, Badr City, Cairo 11829, Egypt.
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA.
- Misr University for Science and Technology, 6th of October City, Cairo 12566, Egypt
| | - Karen L Wooley
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA.
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Saud MA, Saud NA, Hamad MA, Farhan Gar L. Role of Salvia officinalis Silver Nanoparticles in Attenuation Renal Damage in Rabbits Exposed to Methotrexate. Arch Razi Inst 2022; 77:151-162. [PMID: 35891727 PMCID: PMC9288605 DOI: 10.22092/ari.2021.356313.1821] [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] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/21/2021] [Indexed: 06/15/2023]
Abstract
Nanomaterials are now considered in an extensive range of applications in various fields such as biotechnology and biomedicine. The present study aimed to investigate the protective role of Salvia officinalis Silver Nanoparticles (SOSNPs) as an anti-oxidant on nephrotic damage induced by methotrexate (MTX) in adult rabbits. Green silver nanoparticles were synthesized using alcoholic extract of Salvia officinalis (S. Officinalis) leaves and were characterized by UV-spectrophotometry and scanning electron microscope. The mixing of the plant extract of S. Officinalis with silver nitrate solution leads to the change of the reaction mixture color to yellowish within 1 h and dark brown after 8 h. For studying the protective role of SOSNPs, a total of 28 adult Wistar albino rabbits were divided into four groups and treated intramuscularly (twice per week) for 45 days as follows: T1: S. Officinalis (150 mg/kg B.W), T2: SOSNPs (150 mg/kg B.W); T3: MTX (0.25 mg/kg B.W) and SOSNPs (150 mg/kg B.W); T4: MTX (0.25 mg/kg B.W). Blood was collected at 0, 15, 30, and 45 days using retro-orbital sinus and cardiac puncture technique, and the serum factors including malondialdehyde (MDA), glutathione (GSH) in serum, creatinine, as well as blood urea nitrogen and uric acid concentrations were measured at the next step. The results indicated that MTX (T4) caused a case of oxidative stress by a significant decrease in GSH and MDA as well as an increase in serum creatinine, urea, and uric acid concentrations. On the other hand, the protective roles of S. Officinalis and SOSNPs given concurrently with MTX were clarified in T2 and T3 groups, where there was the alleviation of renal damage through the correction of the previously mentioned parameters as well as the correction of anti-oxidant status. Finally, the present study documented the anti-oxidant activity and renal protective effects of SOSNPs against the damaging effects of MTX in rabbits.
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Affiliation(s)
- M A Saud
- Biotechnology and Environmental Center, University of Al-Fallujah, Fallujah, Al Anbar, Iraq
| | - N A Saud
- College of Education for Pure Sciences, Department of Biology, University of Anbar, Ramadi, Al Anbar, Iraq
| | - M A Hamad
- Biotechnology and Environmental Center, University of Al-Fallujah, Fallujah, Al Anbar, Iraq
| | - L Farhan Gar
- Biotechnology and Environmental Center, University of Al-Fallujah, Fallujah, Al Anbar, Iraq
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Mohamed N, Hamad MA, Ghaleb AH, Esmat G, Elsabahy M. Applications of nanoengineered therapeutics and vaccines: special emphasis on COVID-19. Immunomodulatory Effects of Nanomaterials 2022. [PMCID: PMC9212255 DOI: 10.1016/b978-0-323-90604-3.00003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nanomedicine provides innovative strategies that had significantly improved drug and gene delivery and allowed control over the engineering of therapeutics, diagnostics, vaccines, and other medical devices, for a diversity of medical applications. This review focuses on the current attempts to develop potent nanoengineered vaccines and therapeutics against coronaviruses, and the recent fabrication strategies and design principles to control acute infections from the escalating SARS-CoV-2 pandemic. Nanomedical approaches provide versatile platforms that can be utilized to enhance the overall potency, safety, and stability of vaccines, thus augmenting the desired immune response. Their modulable conformational features of size, shape, surface charge, antigen display, and composition allow for precise tuning and optimization of the nanoconstructs for the management of a variety of diseases and pathological conditions. The ability to control the release of their encapsulated cargoes and the possibility of surface decoration with various moieties support the construction of multifunctional nanomaterials that ultimately boost and prolong the immune response elicited and/or therapeutic effects, selectively at the diseased tissues and target sites.
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Elsabahy M, Song Y, Eissa NG, Khan S, Hamad MA, Wooley KL. Morphologic design of sugar-based polymer nanoparticles for delivery of antidiabetic peptides. J Control Release 2021; 334:1-10. [PMID: 33845056 DOI: 10.1016/j.jconrel.2021.04.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
Zwitterionic polymer nanoparticles of diverse morphologies (spherical, cylindrical, and platelet-like) constructed from biocompatible sugar-based polymers are designed to extend the pharmacological activities of short- and long-acting insulin peptides, thereby providing potential for therapeutic systems capable of reducing the frequency of administration and improving patient compliance. Amphiphilic block copolymers composed of zwitterionic poly(d-glucose carbonate) and semicrystalline polylactide segments were synthesized, and the respective block length ratios were tuned to allow formation of nanoscopic assemblies having different morphologies. Insulin-loaded nanoparticles had similar sizes and morphologies to the unloaded nanoparticle counterparts. Laser scanning confocal microscopy imaging of three-dimensional spheroids of vascular smooth muscle cells and fibroblasts after treatment with LIVE/DEAD® stain and FITC-insulin-loaded nanoparticles demonstrated high biocompatibility for the nanoconstructs of the various morphologies and significant intracellular uptake of insulin in both cell lines, respectively. Binding of short-acting insulin and long-acting insulin glargine to nanoparticles resulted in extended hypoglycemic activities in rat models of diabetes. Following subcutaneous injection in diabetic rats, insulin- and insulin glargine-loaded nanoparticles of diverse morphologies had demonstrated up to 2.6-fold and 1.7-fold increase in pharmacological availability, in comparison to free insulin and insulin glargine, respectively. All together, the negligible cytotoxicity, immunotoxicity, and minimal cytokine adsorption onto nanoparticles (as have been demonstrated in our previous studies) provide exciting and promising evidence of biocompatible nanoconstructs that are poised for further development toward the management of diabetes.
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Affiliation(s)
- Mahmoud Elsabahy
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, TX 77842, USA; Science Academy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt.
| | - Yue Song
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, TX 77842, USA
| | - Noura G Eissa
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Sarosh Khan
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, TX 77842, USA
| | - Mostafa A Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Karen L Wooley
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, TX 77842, USA.
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Elsabahy M, Hamad MA. Design and Preclinical Evaluation of Chitosan/Kaolin Nanocomposites with Enhanced Hemostatic Efficiency. Mar Drugs 2021; 19:md19020050. [PMID: 33499020 PMCID: PMC7911196 DOI: 10.3390/md19020050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
In the current study, hemostatic compositions including a combination of chitosan and kaolin have been developed. Chitosan is a marine polysaccharide derived from chitins, a structural component in the shells of crustaceans. Both chitosan and kaolin have the ability to mediate a quick and efficient hemostatic effect following immediate application to injury sites, and thus they have been widely exploited in manufacturing of hemostatic composites. By combining more than one hemostatic agent (i.e., chitosan and kaolin) that act via more than one mechanism, and by utilizing different nanotechnology-based approaches to enhance the surface areas, the capability of the dressing to control bleeding was improved, in terms of amount of blood loss and time to hemostasis. The nanotechnology-based approaches utilized to enhance the effective surface area of the hemostatic agents included the use of Pluronic nanoparticles, and deposition of chitosan micro- and nano-fibers onto the carrier. The developed composites effectively controlled bleeding and significantly improved hemostasis and survival rates in two animal models, rats and rabbits, compared to conventional dressings and QuikClot® Combat Gauze. The composites were well-tolerated as demonstrated by their in vivo biocompatibility and absence of clinical and biochemical changes in the laboratory animals after application of the dressings.
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Affiliation(s)
- Mahmoud Elsabahy
- Science Academy, Badr University in Cairo (BUC), Cairo 11829, Egypt
- Science Park, Misr University for Science and Technology, Giza 12566, Egypt
- Correspondence: (M.E.); (M.A.H.); Tel.: +20-1000607466 (M.E.); +20-1222438186 (M.A.H.)
| | - Mostafa A. Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Correspondence: (M.E.); (M.A.H.); Tel.: +20-1000607466 (M.E.); +20-1222438186 (M.A.H.)
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Hadiya S, Radwan R, Zakaria M, El-Sherif T, Hamad MA, Elsabahy M. Nanoparticles integrating natural and synthetic polymers for in vivo insulin delivery. Pharm Dev Technol 2020; 26:30-40. [PMID: 33019826 DOI: 10.1080/10837450.2020.1832117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/15/2022]
Abstract
The aims of the current study were to develop insulin-loaded nanoparticles comprised of various polymers at different compositions, and to evaluate their ability to lower blood glucose levels in diabetic rats following subcutaneous and oral administrations. Several combinations of natural and synthetic polymers have been utilized for preparation of nanoparticles including, chitosan, alginate, albumin and Pluronic. Nanosized (170 nm-800 nm) spherical particles of high encapsulation efficiency (15-52%) have been prepared. Composition and ratios between the integrated polymers played a pivotal role in determining size, zeta potential, and in vivo hypoglycemic activity of particles. After subcutaneous and oral administration in diabetic rats, some of the insulin-loaded nanoparticles were able to induce much higher hypoglycemic effect as compared to the unloaded free insulin. For instance, subcutaneous injection of nanoparticles comprised of chitosan combined with sodium tripolyphosphate, Pluronic or alginate/calcium chloride, resulted in comparable hypoglycemic effects to free insulin, at two-fold lower dose. Nanoparticles were well-tolerated after oral administration in rats, as evidenced by by measuring levels of alanine aminotransferase, aspartate aminotransferases, albumin, creatinine and urea. This study indicates that characteristics and delivery efficiency of nanomaterials can be controlled via utilizing several natural/synthetic polymers and by fine-tuning of combination ratio between polymers.
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Affiliation(s)
- Safy Hadiya
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
| | - Radwa Radwan
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
| | - Menna Zakaria
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
| | - Tahra El-Sherif
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mostafa A Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
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Abdelkader A, Fathi HA, Hamad MA, Elsabahy M. Nanomedicine: a new paradigm to overcome drug incompatibilities. J Pharm Pharmacol 2020; 72:1289-1305. [PMID: 32436221 DOI: 10.1111/jphp.13292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/26/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Drug incompatibilities may compromise the safety and effectiveness of combined drugs and result in mild-to-serious clinical complications, such as catheter obstruction, loss of drug efficacy, formation of toxic derivatives and embolism. Various preventive strategies have been implemented to overcome drug incompatibilities with limited success. This review presents an innovative approach to prevent drug incompatibilities via isolating the incompatible drugs into nanostructures. KEY FINDINGS Several examples of incompatible drugs may be loaded separately into nanostructures of various types. Physicochemical characteristics and biocompatibility of the nanomaterials that are being utilized to prevent physicochemical incompatibilities should be carefully considered. CONCLUSIONS There is a new era of exploiting nanomaterials in overcoming various types of physicochemical incompatibilities, with additional benefits of further improvements in pharmacokinetic profiles and pharmacological actions of the administered drugs.
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Affiliation(s)
- Ayat Abdelkader
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
| | - Heba A Fathi
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
| | - Mostafa A Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mahmoud Elsabahy
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt.,Science Academy, Badr University in Cairo, Badr City, Cairo, Egypt.,Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA
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11
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Leonhardt EE, Kang N, Hamad MA, Wooley KL, Elsabahy M. Absorbable hemostatic hydrogels comprising composites of sacrificial templates and honeycomb-like nanofibrous mats of chitosan. Nat Commun 2019; 10:2307. [PMID: 31127114 PMCID: PMC6534699 DOI: 10.1038/s41467-019-10290-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [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] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/01/2019] [Indexed: 11/24/2022] Open
Abstract
The development of hemostatic technologies that suit a diverse range of emergency scenarios is a critical initiative, and there is an increasing interest in the development of absorbable dressings that can be left in the injury site and degrade to reduce the duration of interventional procedures. In the current study, β-cyclodextrin polyester (CDPE) hydrogels serve as sacrificial macroporous carriers, capable of degradation under physiological conditions. The CDPE template enables the assembly of imprinted chitosan honeycomb-like monolithic mats, containing highly entangled nanofibers with diameters of 9.2 ± 3.7 nm, thereby achieving an increase in the surface area of chitosan to improve hemostatic efficiency. In vivo, chitosan-loaded cyclodextrin (CDPE-Cs) hydrogels yield significantly lower amounts of blood loss and shorter times to hemostasis compared with commercially available absorbable hemostatic dressings, and are highly biocompatible. The designed hydrogels demonstrate promising hemostatic efficiency, as a physiologically-benign approach to mitigating blood loss in tissue-injury scenarios.
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Affiliation(s)
- Eric E Leonhardt
- Departments of Chemistry, Chemical Engineering, Materials Science & Engineering, and The Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, TX, 77842-3012, USA
| | - Nari Kang
- Departments of Chemistry, Chemical Engineering, Materials Science & Engineering, and The Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, TX, 77842-3012, USA
| | - Mostafa A Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Karen L Wooley
- Departments of Chemistry, Chemical Engineering, Materials Science & Engineering, and The Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, TX, 77842-3012, USA.
| | - Mahmoud Elsabahy
- Departments of Chemistry, Chemical Engineering, Materials Science & Engineering, and The Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, TX, 77842-3012, USA.
- Department of Pharmaceutics and Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, 71515, Egypt.
- Misr University for Science and Technology, 6th of October City, 12566, Egypt.
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Nashaat D, Elsabahy M, El-Sherif T, Hamad MA, El-Gindy GA, Ibrahim EH. Development and in vivo evaluation of chitosan nanoparticles for the oral delivery of albumin. Pharm Dev Technol 2018; 24:329-337. [PMID: 29781756 DOI: 10.1080/10837450.2018.1479867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/09/2023]
Abstract
Albumin is used as a plasma expander in critically ill patients and for several other clinical applications mainly via intravenous infusion. Oral administration of albumin can improve patient compliance although limited oral bioavailability of proteins is still a major challenge. Although nanomaterials have been extensively utilized for improving oral delivery of proteins, albumin has been utilized only as either a model drug or as a carrier for drug delivery. In the current study, for the first time, chitosan nanoparticles have been developed and extensively optimized to improve oral bioavailability of albumin as a therapeutic protein. Several characterizations have been performed for the albumin-loaded nanoparticles (e.g. drug encapsulation efficiency, DSC, FTIR, particle size, zeta potential, morphology, release kinetics, and enzymatic stability). Nanosized spherical particles were prepared and demonstrated high stability over three months either in a powdered form or as suspensions. Sustained release of albumin over time and high enzymatic stability as compared to the free albumin were observed. In vivo, higher serum concentrations of albumin in normal rabbits and cirrhotic rats were attained following oral and intraperitoneal administrations of the albumin-loaded nanoparticles as compared to the free albumin. The nanoparticles developed in the current study might provide efficient nanovehicles for oral administration of therapeutic albumin.
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Affiliation(s)
- Dalia Nashaat
- a Department of Pharmaceutics, Faculty of Pharmacy , Assiut University , Assiut , Egypt
| | - Mahmoud Elsabahy
- a Department of Pharmaceutics, Faculty of Pharmacy , Assiut University , Assiut , Egypt.,b Laboratory for Synthetic-Biologic Interactions, Department of Chemistry , Texas A&M University College Station , TX , USA.,c Misr University for Science and Technology , 6th of October City , Egypt
| | - Tahra El-Sherif
- d Department of Clinical Pathology, Faculty of Medicine , Assiut University , Assiut , Egypt
| | - Mostafa A Hamad
- e Department of Surgery, Faculty of Medicine , Assiut University , Assiut , Egypt
| | - Gamal A El-Gindy
- a Department of Pharmaceutics, Faculty of Pharmacy , Assiut University , Assiut , Egypt
| | - Ehsan H Ibrahim
- a Department of Pharmaceutics, Faculty of Pharmacy , Assiut University , Assiut , Egypt
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Abdelkader A, El-Mokhtar MA, Abdelkader O, Hamad MA, Elsabahy M, El-Gazayerly ON. Ultrahigh antibacterial efficacy of meropenem-loaded chitosan nanoparticles in a septic animal model. Carbohydr Polym 2017; 174:1041-1050. [DOI: 10.1016/j.carbpol.2017.07.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/22/2017] [Accepted: 07/10/2017] [Indexed: 11/30/2022]
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Mohamed HB, El-Shanawany SM, Hamad MA, Elsabahy M. Niosomes: A Strategy toward Prevention of Clinically Significant Drug Incompatibilities. Sci Rep 2017; 7:6340. [PMID: 28740102 PMCID: PMC5524940 DOI: 10.1038/s41598-017-06955-w] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/19/2017] [Indexed: 11/23/2022] Open
Abstract
Drug incompatibilities are considered as one of the most critical problems in intensive care units. In the current study, the ability of nanomaterials to prevent drug incompatibilities in clinical settings has been investigated. As a proof-of-concept, the ability of niosomes to prevent physical and chemical incompatibilities that occur upon mixing acyclovir and vancomycin during management of acute meningitis has been explored. Nanosized spherical particles loaded separately with either vancomycin or acyclovir, with high entrapment efficiency (ca. 46–56%), could be prepared, and sustained release of their entrapped cargoes have been demonstrated over time. We have shown that precipitation, degradation and loss of biological activity of drugs occurred upon mixing solutions of the free drugs. On the contrary, drugs loaded separately inside niosomal structures exhibited high stability, exceptional physical and chemical compatibilities for up to 48 h with complete preservation of the antimicrobial activity of vancomycin. This study opens a venue for a new spectrum of applications of nanomaterials in preventing clinically significant drug incompatibilities, aiming at the reduction of adverse reactions, cost and hospitalization period, and improvement of patient compliance and therapeutic outcomes.
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Affiliation(s)
- Hebatallah B Mohamed
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, 71515, Egypt
| | - Sohair M El-Shanawany
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, 71515, Egypt
| | - Mostafa A Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mahmoud Elsabahy
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, 71515, Egypt. .,Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt. .,Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, Texas, USA. .,Misr University for Science and Technology, 6th of October City, Giza, Egypt.
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Redwan AA, Hamad MA, Omar MA. Pancreatic Pseudocyst Dilemma: Cumulative Multicenter Experience in Management Using Endoscopy, Laparoscopy, and Open Surgery. J Laparoendosc Adv Surg Tech A 2017; 27:1022-1030. [PMID: 28459653 DOI: 10.1089/lap.2017.0006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/13/2022] Open
Abstract
BACKGROUND Pancreatic pseudocyst (PP) is the commonest cystic lesion of the pancreas. Internal drainage of PPs can be accomplished by traditional open or recently by minimally invasive laparoscopic or endoscopic approaches. We aimed to evaluate and compare the clinical outcomes after endoscopic, laparoscopic, and open drainage. METHODS Seventy-one patients with PP underwent endoscopic (n = 35), laparoscopic (n = 4), and open surgical drainage (n = 32). The primary outcome was the success rate. The secondary outcomes were the estimated blood loss, operative time, opioid requirement, morbidity and mortality, length of hospital stay, and recurrence rate. RESULTS The primary success rate was significantly higher for laparoscopic and open groups than for the endoscopic group, but the overall success rate was equivalent across the groups. There were no significant differences in the morbidity, mortality, requirement of blood transfusion, reinterventions, and recurrence rate between the groups. Endoscopic drainage revealed significantly lower blood loss, operative time, opioid requirement, and hospital stay in comparison to open and laparoscopic drainage. CONCLUSION Minimally invasive therapeutic techniques, whether endoscopic or laparoscopic for treatment of PP could be considered valuable, competitive, and promising alternatives for open surgery. Moreover, it is less invasive with less hospitalization and rapid return to work.
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Affiliation(s)
- Alaa A Redwan
- 1 Department of General Surgery, Sohag University , Sohag, Egypt
| | - Mostafa A Hamad
- 2 Department of General Surgery, Assiut University , Assiut, Egypt
| | - Mohammed A Omar
- 3 Department of General Surgery, Qena Faculty of Medicine, South Valley University , Qena, Egypt
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Morsi NG, Ali SM, Elsonbaty SS, Afifi AA, Hamad MA, Gao H, Elsabahy M. Poly(glycerol methacrylate)-based degradable nanoparticles for delivery of small interfering RNA. Pharm Dev Technol 2017; 23:387-399. [PMID: 28347210 DOI: 10.1080/10837450.2017.1312443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nucleic acids therapeutic efficiency is generally limited by their low stability and intracellular bioavailability, and by the toxicity of the carriers used to deliver them to the target sites. Aminated poly(glycerol methacrylate) polymers are biodegradable and pH-sensitive polymers that have been used previously to deliver antisense oligonucleotide and show high transfection efficiency. The purpose of this study is to compare the efficiency and toxicity of aminated linear poly(glycerol methacrylate) (ALT) biodegradable polymer to the most commonly used cationic degradable (i.e. chitosan) and non-degradable (i.e. polyethylenimine (PEI)) polymers for delivery of short interfering RNA (siRNA). ALT, PEI and chitosan polymers were able to form nanosized particles with siRNA. Size, size-distribution and zeta-potential were measured over a wide range of nitrogen-to-phosphate (N/P) ratios, and the stability of the formed nanoparticles in saline and upon freeze-drying was also assessed. No significant cytotoxicity at the range of the tested concentrations of ALT and chitosan nanoparticles was observed, whereas the non-degradable PEI showed significant toxicity in huh-7 hepatocyte-derived carcinoma cell line. The safety profiles of the degradable polymers (ALT and chitosan) over non-degradable PEI were demonstrated in vitro and in vivo. In addition, ALT nanoparticles were able to deliver siRNA in vivo with significantly higher efficiency than chitosan nanoparticles. The results in the present study give evidence of the great implications of ALT nanoparticles in biomedical applications due to their biocompatibility, low cytotoxicity, high stability and simple preparation method.
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Affiliation(s)
- Noha G Morsi
- a Assiut International Center of Nanomedicine , Al-Rajhy Liver Hospital, Assiut University , Assiut , Egypt
| | - Shimaa M Ali
- a Assiut International Center of Nanomedicine , Al-Rajhy Liver Hospital, Assiut University , Assiut , Egypt
| | - Sherouk S Elsonbaty
- a Assiut International Center of Nanomedicine , Al-Rajhy Liver Hospital, Assiut University , Assiut , Egypt
| | - Ahmed A Afifi
- a Assiut International Center of Nanomedicine , Al-Rajhy Liver Hospital, Assiut University , Assiut , Egypt
| | - Mostafa A Hamad
- b Department of Surgery, Faculty of Medicine , Assiut University , Assiut , Egypt
| | - Hui Gao
- c School of Chemistry and Chemical Engineering , Tianjin University of Technology , Tianjin , China
| | - Mahmoud Elsabahy
- a Assiut International Center of Nanomedicine , Al-Rajhy Liver Hospital, Assiut University , Assiut , Egypt.,d Laboratory for Synthetic-Biologic Interactions, Department of Chemistry , Texas A&M University , College Station , TX , USA.,e Department of Pharmaceutics, Faculty of Pharmacy , Assiut University , Assiut , Egypt.,f Misr University for Science and Technology , 6th of October City , Egypt
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Elzeny H, Zhang F, Ali EN, Fathi HA, Zhang S, Li R, El-Mokhtar MA, Hamad MA, Wooley KL, Elsabahy M. Polyphosphoester nanoparticles as biodegradable platform for delivery of multiple drugs and siRNA. Drug Des Devel Ther 2017; 11:483-496. [PMID: 28260861 PMCID: PMC5327906 DOI: 10.2147/dddt.s128503] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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] [Indexed: 12/18/2022] Open
Abstract
Delivery of multiple therapeutics and/or diagnostic agents to diseased tissues is challenging and necessitates the development of multifunctional platforms. Among the various strategies for design of multifunctional nanocarriers, biodegradable polyphosphoester (PPE) polymers have been recently synthesized via a rapid and simple synthetic strategy. In addition, the chemical structure of the polymer could be tuned to form nanoparticles with varying surface chemistries and charges, which have shown exceptional safety and biocompatibility as compared to several commercial agents. The purpose of this study was to exploit a mixture of PPE nanoparticles of cationic and neutral surface charges for multiple delivery of anticancer drugs (ie, sorafenib and paclitaxel) and nucleic acids (ie, siRNA). Cationic PPE polymers could efficiently complex siRNA, and the stability of the nanoparticles could be maintained in physiological solutions and upon freeze-drying and were able to deliver siRNA in vivo when injected intravenously in mice. Commercially available cationic polyethylenimine polymer had LD50 of ca. 61.7 mg/kg in mice, whereas no animal died after injection of the cationic PPE polymer at a dose of >130 mg/kg. Neutral PPE nanoparticles were able to encapsulate two hydrophobic drugs, namely, sorafenib and paclitaxel, which are commonly used for the treatment of hepatocellular carcinoma. Mixing the neutral and cationic PPE nanoparticles did not result in any precipitation, and the size characteristics of both types of nanoparticles were maintained. Hence, PPE polymers might have potential for the delivery of multiple drugs and diagnostic agents to diseased tissues via simple synthesis of the individual polymers and assembly into nanoparticles that can host several drugs while being mixed in the same administration set, which is of importance for industrial and clinical development.
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Affiliation(s)
- Hadeel Elzeny
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
| | - Fuwu Zhang
- Departments of Chemistry, Chemical Engineering and Materials Science and Engineering, Texas A&M University, College Station, TX, USA
| | - Esraa N Ali
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
| | - Heba A Fathi
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
| | - Shiyi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Richen Li
- Departments of Chemistry, Chemical Engineering and Materials Science and Engineering, Texas A&M University, College Station, TX, USA
| | | | - Mostafa A Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Karen L Wooley
- Departments of Chemistry, Chemical Engineering and Materials Science and Engineering, Texas A&M University, College Station, TX, USA
- Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA
| | - Mahmoud Elsabahy
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt
- Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut
- Misr University for Science and Technology, 6th of October City, Egypt
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Mekkawy AI, El-Mokhtar MA, Nafady NA, Yousef N, Hamad MA, El-Shanawany SM, Ibrahim EH, Elsabahy M. In vitro and in vivo evaluation of biologically synthesized silver nanoparticles for topical applications: effect of surface coating and loading into hydrogels. Int J Nanomedicine 2017; 12:759-777. [PMID: 28176951 PMCID: PMC5271388 DOI: 10.2147/ijn.s124294] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [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] [Indexed: 11/30/2022] Open
Abstract
In the present study, silver nanoparticles (AgNPs) were synthesized via biological reduction of silver nitrate using extract of the fungus Fusarium verticillioides (green chemistry principle). The synthesized nanoparticles were spherical and homogenous in size. AgNPs were coated with polyethylene glycol (PEG) 6000, sodium dodecyl sulfate (SDS), and β-cyclodextrin (β-CD). The averaged diameters of AgNPs were 19.2±3.6, 13±4, 14±4.4, and 15.7±4.8 nm, for PEG-, SDS-, and β-CD-coated and uncoated AgNPs, respectively. PEG-coated AgNPs showed greater stability as indicated by a decreased sedimentation rate of particles in their water dispersions. The antibacterial activities of different AgNPs dispersions were investigated against Gram-positive bacteria (methicillin-sensitive and methicillin-resistant Staphylococcus aureus) and Gram-negative bacteria (Escherichia coli) by determination of the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs). MIC and MBC values were in the range of 0.93-7.5 and 3.75-15 µg/mL, respectively, which were superior to the reported values in literature. AgNPs-loaded hydrogels were prepared from the coated-AgNPs dispersions using several gelling agents (sodium carboxymethyl cellulose [Na CMC], sodium alginate, hydroxypropylmethyl cellulose, Pluronic F-127, and chitosan). The prepared formulations were evaluated for their viscosity, spreadability, in vitro drug release, and antibacterial activity, and the combined effect of the type of surface coating and the polymers utilized to form the gel was studied. The in vivo wound-healing activity and antibacterial efficacy of Na CMC hydrogel loaded with PEG-coated AgNPs in comparison to the commercially available silver sulfadiazine cream (Dermazin®) were evaluated. Superior antibacterial activity and wound-healing capability, with normal skin appearance and hair growth, were demonstrated for the hydrogel formulations, as compared to the silver sulfadiazine cream. Histological examination of the treated skin was performed using light microscopy, whereas the location of AgNPs in the skin epidermal layers was visualized using transmission electron microscopy.
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Affiliation(s)
- Aml I Mekkawy
- Department of Pharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Sohag University, Sohag
| | | | | | - Naeima Yousef
- Department of Botany and Microbiology, Faculty of Science
| | | | | | | | - Mahmoud Elsabahy
- Department of Pharmaceutics, Faculty of Pharmacy
- Assiut International Center of Nanomedicine, Al-Rajhi Liver Hospital, Assiut University, Assiut, Egypt
- Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA
- Misr University for Science and Technology, 6th of October, Egypt
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Mohamed NK, Hamad MA, Hafez MZ, Wooley KL, Elsabahy M. Nanomedicine in management of hepatocellular carcinoma: Challenges and opportunities. Int J Cancer 2016; 140:1475-1484. [DOI: 10.1002/ijc.30517] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/30/2016] [Accepted: 11/08/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Nourhan K. Mohamed
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University; Egypt
| | - Mostafa A. Hamad
- Department of Surgery; Faculty of Medicine, Assiut University; Egypt
| | - Mohamed Z.E. Hafez
- Department of Internal Medicine; Faculty of Medicine, Aswan University; Egypt
| | - Karen L. Wooley
- Departments of Chemistry; Chemical Engineering and Materials Science and Engineering, Texas A&M University; College Station TX
- Laboratory for Synthetic-Biologic Interactions; Department of Chemistry, Texas A&M University; College Station TX
| | - Mahmoud Elsabahy
- Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University; Egypt
- Laboratory for Synthetic-Biologic Interactions; Department of Chemistry, Texas A&M University; College Station TX
- Department of Pharmaceutics; Faculty of Pharmacy, Assiut University; Egypt
- Misr University for Science and Technology; 6th of October City Egypt
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Abstract
Endogenous alcohol has been applied for spontaneous ethanol production via different metabolic pathways of the human body. Auto-brewery syndrome describes the patients with alcohol intoxication after ingesting carbohydrate-rich meals. The main objective of this study is to investigate the effect of diabetes mellitus (DM), liver cirrhosis (LC) and presence of both (DM and LC) on blood alcohol concentration (BAC) especially after carbohydrate ingestion. BAC has been measured by headspace gas chromatography-mass spectrometry in three groups of humans namely control, DM, LC and both (DM and LC) groups. The results showed that BAC in control group was 0.01-.3 mg/dL with mean 0.3 ± 0.41 mg/dL. In patients with DM, BAC is significantly higher than that of control group 4.85 ± 3.96 mg/dL. In patients with LC, BAC was 3.45 ± 2.65 mg/dL. In patients with both DM and LC, BAC increases to reach 10.88 ± 5.36 mg/dL. Endogenous ethanol production appears to increase in DM and LC. Also, it increased much more in patients with both diseases, but it did not reach toxic levels. On comparing BAC and blood glucose level in each group, all groups show insignificant correlations ( p > 0.05).
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Affiliation(s)
- E M Hafez
- 1 Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Minia University, Minia, Egypt
| | - M A Hamad
- 1 Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Minia University, Minia, Egypt
| | - M Fouad
- 2 Department of Tropical medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - A Abdel-Lateff
- 3 Department of Pharmacognosy, Faculty of Pharmacy, Minia University, Minia, Egypt.,4 Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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Hamad MA, El-Amin H. Bilio-entero-gastrostomy: prospective assessment of a modified biliary reconstruction with facilitated future endoscopic access. BMC Surg 2012; 12:9. [PMID: 22720668 PMCID: PMC3411507 DOI: 10.1186/1471-2482-12-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 06/21/2012] [Indexed: 11/23/2022] Open
Abstract
Background Hepaticojejunostomy (HJ) is the classical reconstruction for benign biliary stricture. Endoscopic management of anastomotic complications after hepaticojejunostomy is extremely difficult. In this work we assess a modified biliary reconstruction in the form of bilio-entero-gastrostomy (BEG) regarding the feasibility of endoscopic access to HJ and management of its stenosis if encountered. Methods From October 2008 till February 2011 all patients presented to the authors with benign biliary stricture who needed bilio-enteric shunt were considered. For each patient bilio-entero-gastrostomy (BEG) of either type I, II or III was constructed. In the fourth week postoperatively, endoscopy was performed to explore the possibility to access the biliary anastomosis and perform cholangiography. Results BEG shunt was performed for seventeen patients, one of whom, with BEG type I, died due to myocardial infarction leaving sixteen patients with a diagnosis of postcholecystectomy biliary injury (9), inflammatory stricture with or without choledocholithiasis (5) and strictured biliary shunt (2). BEG shunts were either type I (3), type II (3) or type III (10). Endoscopic follow up revealed successful access to the anastomosis in 14 patients (87.5%), while the access failed in one type I and one type II BEG (12.5%). Mean time needed to access the anastomosis was 12.6 min (2-55 min). On a scale from 1–5, mean endoscopic difficulty score was 1.7. One patient (6.25%), with BEG type I, developed anastomotic stricture after 18 months that was successfully treated endoscopically by stenting. These preliminary results showed that, in relation to the other types, type III BEG demonstrated the tendency to be surgically simpler to perform, endoscopicall faster to access, easier and with no failure. Conclusions BEG, which is a modified biliary reconstruction, facilitates endoscopic access of the biliary anastomosis, offers management option for its complications, and, therefore, could be considered for biliary reconstruction of benign stricture. BEG type III tend to be surgically simpler and endoscopically faster, easier and more successful than type I and II.
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Affiliation(s)
- Mostafa A Hamad
- Department of General Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Helmy AA, Hamad MA, Aly AM, Sherif T, Hashem M, El-Sers DA, Semieka M. Novel technique for biliary reconstruction using an isolated gastric tube with a vascularized pedicle: a live animal experimental study and the first clinical case. Ann Surg Innov Res 2011; 5:8. [PMID: 21985492 PMCID: PMC3198750 DOI: 10.1186/1750-1164-5-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 10/10/2011] [Indexed: 12/24/2022]
Abstract
Background Biliary tract reconstruction continues to be a challenging surgical problem. Multiple experimental attempts have been reported to reconstruct biliary defects with different materials and variable outcome. Our aim was to evaluate a new method for biliary reconstruction using an isolated pedicled gastric tube in a live animal trial and also to present the first clinical case. Methods Seven mongrel dogs underwent biliary reconstruction using gastric tube harvested, completely separated from the greater curvature, and based on a vascularized pedicle with the right gastroepiploic vessels. The tube was interposed between the common bile duct (CBD) and the duodenum. Postoperative mortality, morbidity, liver functions, gross and microscopic histological picture were assessed. The first clinical case was also presented where, in a patient with post-cholecystectomy biliary injury, an isolated pedicled gastric tube was interposed between the proximal and distal ends of the CBD. Results One dog did not recover from anesthesia and another one died postoperatively from septic peritonitis. Five dogs survived the procedure and showed uneventful course and no cholestasis. The mean anastomotic circumference was 4.8 mm (range 4-6) for CBD anastomosis and 6.2 mm (range 5-7) for duodenal anastomosis. Histologically, anastomotic sites showed good evidence of healing. In the first clinical case, the patient showed clinical and biochemical improvement. Endoscopic retrograde cholangiography was feasible and assured patent biliary anastomoses. Conclusion In mongrel dogs, biliary reconstruction using pedicled gastric tube interposition between CBD and duodenum is feasible with satisfactory clinical results, anastomotic circumference and histological evidence of healing. The technique is also feasible in human and seems to be promising.
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Affiliation(s)
- Ashraf A Helmy
- Department of General Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Hamad MA, Thabet M, Badawy A, Mourad F, Abdel-Salam M, Abdel-Rahman MET, Hafez MZED, Sherif T. Laparoscopic versus open cholecystectomy in patients with liver cirrhosis: a prospective, randomized study. J Laparoendosc Adv Surg Tech A 2010; 20:405-9. [PMID: 20518688 DOI: 10.1089/lap.2009.0476] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Gallstones are more common in patients with liver cirrhosis than in healthy individuals. Higher morbidity and mortality were reported in cirrhotic patients with either laparoscopic or open cholecystectomy. The aim of this study was to compare laparoscopic and open cholecystectomy in cirrhotic patients with symptomatic cholelithiasis in a prospective, randomized manner. MATERIALS AND METHODS Thirty patients with symptomatic cholelithiasis associated with Child-Pugh class A or B liver cirrhosis were prospectively and randomly grouped equally to either laparoscopic or open cholecystectomy. The two groups were compared regarding operative time, morbidity, mortality, postoperative liver function, and hospital stay. RESULTS The two groups were comparable regarding demographic data, preoperative and postoperative Child-Pugh scoring, mean operative time (57.3 minutes for laparoscopic and 48.5 for open), and complications (33.3% for each). Hospital stay was shorter for the laparoscopic group. One conversion (6.7%) to open surgery was reported. No periopertive mortality occurred in either group. CONCLUSIONS For Child-Pugh class A and B cirrhotics, laparoscopic cholecystectomy is comparable to the open approach regarding operative time, morbidity, mortality, and effect on liver function, but with shorter hospital stay. Considering the other well-documented advantages of the laparoscopic approach, namely, less pain, earlier mobilization and feeding, and better cosmoses, laparoscopic cholecystectomy would be the first choice in cirrhotic patients.
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Affiliation(s)
- Mostafa A Hamad
- Department of Surgery, Assiut University Hospital, Assiut, Egypt.
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Abstract
BACKGROUND Even though the safety and efficacy of sutured anastomosis have been proved in open surgery, laparoscopic sutured anastomosis is rarely performed because it is difficult and time-consuming. We aim at description of a standardized technique for laparoscopic sutured anastomosis of the bowel and definition of its learning curve. METHODS Fifty-six laparoscopic sutured anastomoses of cow small intestine were performed in a laparoscopic simulator. In a survival animal trial, 10 end-to-end, 2 gastrojejunostomy, 2 cholecystojejunostomy, 2 colocolic, and one side-to-side anastomoses were performed, using the same technique. RESULTS In the survival cases, we had no leaks or obstruction, minimal adhesions, and only one stenotic gastrojejunostomy. The mean end-to-end anastomotic time was 50 min. The technique was suitable for most sites in the GIT. The learning phase required 40 anastomoses in the simulator. CONCLUSIONS The described technique seems relatively fast, safe, and universal, and it needs about 40 anastomoses to be mastered.
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Affiliation(s)
- M A Hamad
- Department of General Surgery, Assiut University Hospital, Assiut, Egypt.
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Hamad MA, El-Khattary OAI. Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study. Surg Endosc 2003; 17:1426-8. [PMID: 12802665 DOI: 10.1007/s00464-002-8620-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [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: 10/17/2002] [Accepted: 11/21/2002] [Indexed: 10/26/2022]
Abstract
BACKGROUND Spinal anesthesia has been successfully used to perform various laparoscopic procedures. However, laparoscopic cholecystectomy under spinal anesthesia has not been reported. Is this feasible? METHODS Ten successive laparoscopic cholecystectomies were performed under spinal anesthesia. The surgical technique was modified using nitrous oxide insufflation, lower levels of intraabdominal pressure, modified trocar sites, and minimal surgical manipulation. We used spinal anesthesia by intrathecal hyperbaric 10-12 mg bupivacaine with 10 microg fentanyl to give an anesthetic level at T8-T6. RESULTS The mean age was 39.3 years and there were four females. Only one patient was converted to general anesthesia due to intolerable shoulder pain. One patient vomited intraoperatively. Nine patients considered the procedure well tolerated under spinal anesthesia. The mean operative time was 47.4 min. Postoperatively, there were minimal pain and no vomiting. CONCLUSIONS Laparoscopic cholecystectomy can be performed successfully under spinal anesthesia and is well tolerated.
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Affiliation(s)
- M A Hamad
- Department of General Surgery, Assiut University Hospital, 71516 Assiut, Egypt.
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