1
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Hammam N, Bakhiet A, El-Latif EA, El-Gazzar II, Samy N, Noor RAA, El-Shebeiny E, El-Najjar AR, Eesa NN, Salem MN, Ibrahim SE, El-Essawi DF, Elsaman AM, Fathi HM, Sallam RA, El Shereef RR, Ismail F, Abd-Elazeem MI, Said EA, Khalil NM, Shahin D, El-Saadany HM, ElKhalifa M, Nasef SI, Abdalla AM, Noshy N, Fawzy RM, Saad E, Moshrif A, El-Shanawany AT, Abdel-Fattah YH, Khalil HM, Hammam O, Fathy AA, Gheita TA. Development of machine learning models for detection of vision threatening Behçet's disease (BD) using Egyptian College of Rheumatology (ECR)-BD cohort. BMC Med Inform Decis Mak 2023; 23:37. [PMID: 36803463 PMCID: PMC9938580 DOI: 10.1186/s12911-023-02130-6] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Eye lesions, occur in nearly half of patients with Behçet's Disease (BD), can lead to irreversible damage and vision loss; however, limited studies are available on identifying risk factors for the development of vision-threatening BD (VTBD). Using an Egyptian college of rheumatology (ECR)-BD, a national cohort of BD patients, we examined the performance of machine-learning (ML) models in predicting VTBD compared to logistic regression (LR) analysis. We identified the risk factors for the development of VTBD. METHODS Patients with complete ocular data were included. VTBD was determined by the presence of any retinal disease, optic nerve involvement, or occurrence of blindness. Various ML-models were developed and examined for VTBD prediction. The Shapley additive explanation value was used for the interpretability of the predictors. RESULTS A total of 1094 BD patients [71.5% were men, mean ± SD age 36.1 ± 10 years] were included. 549 (50.2%) individuals had VTBD. Extreme Gradient Boosting was the best-performing ML model (AUROC 0.85, 95% CI 0.81, 0.90) compared with logistic regression (AUROC 0.64, 95%CI 0.58, 0.71). Higher disease activity, thrombocytosis, ever smoking, and daily steroid dose were the top factors associated with VTBD. CONCLUSIONS Using information obtained in the clinical settings, the Extreme Gradient Boosting identified patients at higher risk of VTBD better than the conventional statistical method. Further longitudinal studies to evaluate the clinical utility of the proposed prediction model are needed.
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Affiliation(s)
- Nevin Hammam
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Ali Bakhiet
- Computer Science Department, Higher Institute of Computer Science and Information Systems, Culture and Science City, Giza, Egypt
| | - Eiman Abd El-Latif
- grid.7155.60000 0001 2260 6941Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman I. El-Gazzar
- grid.7776.10000 0004 0639 9286Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Samy
- grid.7269.a0000 0004 0621 1570Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Rasha A. Abdel Noor
- grid.412258.80000 0000 9477 7793Rheumatology Unit, Internal Medicine Department, Tanta University, Gharbia, Egypt
| | - Emad El-Shebeiny
- grid.411775.10000 0004 0621 4712Rheumatology Unit, Internal Medicine Department, Menoufia University, Menoufia, Egypt
| | - Amany R. El-Najjar
- grid.31451.320000 0001 2158 2757Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Nahla N. Eesa
- grid.7776.10000 0004 0639 9286Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed N. Salem
- grid.411662.60000 0004 0412 4932Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Soha E. Ibrahim
- grid.7269.a0000 0004 0621 1570Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina F. El-Essawi
- grid.429648.50000 0000 9052 0245Internal Medicine Department, Rheumatology and Rehabilitation Clinic, National Centre for Radiation Research and Technology, Egyptian Atomic Energy Authority (AEA), Cairo, Egypt
| | - Ahmed M. Elsaman
- grid.412659.d0000 0004 0621 726XRheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hanan M. Fathi
- grid.411170.20000 0004 0412 4537Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Rehab A. Sallam
- grid.10251.370000000103426662Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Rawhya R. El Shereef
- grid.411806.a0000 0000 8999 4945Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Faten Ismail
- grid.411806.a0000 0000 8999 4945Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mervat I. Abd-Elazeem
- grid.411662.60000 0004 0412 4932Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Emtethal A. Said
- grid.411660.40000 0004 0621 2741Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Noha M. Khalil
- grid.7776.10000 0004 0639 9286Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Shahin
- grid.10251.370000000103426662Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Hanan M. El-Saadany
- grid.412258.80000 0000 9477 7793Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Marwa ElKhalifa
- grid.7155.60000 0001 2260 6941Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samah I. Nasef
- grid.33003.330000 0000 9889 5690Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Ahmed M. Abdalla
- grid.417764.70000 0004 4699 3028Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Nermeen Noshy
- grid.411660.40000 0004 0621 2741Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Rasha M. Fawzy
- grid.411660.40000 0004 0621 2741Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Ehab Saad
- grid.412707.70000 0004 0621 7833Rheumatology Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Abdelhafeez Moshrif
- grid.411303.40000 0001 2155 6022Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
| | - Amira T. El-Shanawany
- grid.411775.10000 0004 0621 4712Rheumatology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Yousra H. Abdel-Fattah
- grid.7155.60000 0001 2260 6941Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hossam M. Khalil
- grid.411662.60000 0004 0412 4932Ophthalmology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Osman Hammam
- grid.252487.e0000 0000 8632 679XDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, New Valley University, New Valley, Egypt
| | - Aly Ahmed Fathy
- grid.252487.e0000 0000 8632 679XOphthalmology Department, Faculty of Medicine, Al-Azhar Assiut University, Assiut, Egypt
| | - Tamer A. Gheita
- grid.7776.10000 0004 0639 9286Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
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2
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Eesa NN, Abdel Nabi H, Owaidy RE, Khalifa I, Radwan AR, NourEl-Din AM, Amer MA, ElShereef RR, Hassan E, Ismail F, El-Gazzar II, Khalil NM, Moshrif AH, Abualfadl E, Tharwat S, Fathi HM, Abd Elazeem MI, El-Shebini E, Samy N, Noshy N, El-Bahnasawy AS, Abdalla AM, Abousehly OS, Mohamed EF, Nasef SI, Elsaman AM, ElKhalifa M, Salem MN, Abaza NM, Fathy HM, Abdel Salam N, El-Saadany HM, El-Najjar AR, El-Hammady DH, Hammam N, Mohammed RH, Gheita TA. Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation. Lupus 2021; 30:2135-2143. [PMID: 34528835 DOI: 10.1177/09612033211043010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aims to present the manifestations of juvenile systemic lupus erythematosus (JSLE) across Egypt, to focus on age at onset and gender-driven influence on disease characteristics, and to compare findings to other countries. METHODS The study included 404 Egyptian children with systemic lupus erythematosus (SLE) presenting to one of the specialized rheumatology centers corresponding to 13 major governorates. Juvenile cases age was ≤ 16°years at the time of recruitment. The SLE Disease Activity Index (SLEDAI) and damage index (DI) were assessed. RESULTS The mean age was 13.2 ± 2.4°years; 355 females and 49 males (7.2:1), and the disease duration was 2.3 ± 1.6 years, while age at disease onset was 11.1 ± 2.5°years. Their SLEDAI was 13.5 ± 12.3, and DI, 0.36 ± 0.78. The overall estimated prevalence of childhood-SLE patients in the recruited cohort in Egypt was 1/100,000 population (0.24/100000 males and 1.8/100000 females). 7.4% developed pre-pubertal SLE (≤ 7 years); 73.3%, peri-pubertal; and 19.3% during early adolescence. The differences according to age group were equal for gender and clinical manifestations except skin lesions present in 59.3% of pre-pubertal onset, 74.6% of peri-pubertal, and 84.2% of adolescents (p = 0.029), and renal involvement in 73.8% of peripubertal, 62.1% of pre-pubertal and 58.9% of adolescents (p = 0.03). Laboratory investigations, SLEDAI, and DI were similar among age categories. Lupus nephritis was more common in Egypt compared to JSLE from other countries. CONCLUSION Our large multicenter study identified that female gender influenced disease characteristics with more frequent skin involvement. Skin lesions were significantly higher in adolescents, while renal involvement in peri-pubertal children.
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Affiliation(s)
- Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hend Abdel Nabi
- Pediatrics Department, Rheumatology and Nephrology Unit, 68782Tanta University, Gharbia, Egypt
| | - Rasha El Owaidy
- Pediatrics Department, Rheumatology Unit, 68792Ain Shams University, Cairo, Egypt
| | - Iman Khalifa
- Pediatrics Department, Rheumatology and Nephrology Unit, 68900Helwan University, Cairo, Egypt
| | - Ahmed R Radwan
- Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt
| | - Abeer M NourEl-Din
- Pediatrics Department, 68787National Research Centre (NRC), Cairo, Egypt
| | - Marwa A Amer
- Rheumatology Department, Faculty of Medicine, 68789Alexandria University, Alexandria, Egypt
| | - Rawhya R ElShereef
- Rheumatology Department, Faculty of Medicine, 68877Minia University, Minia, Egypt
| | - Eman Hassan
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68789Alexandria University, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, 68877Minia University, Minia, Egypt
| | - Iman I El-Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha M Khalil
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 63527Cairo University, Cairo, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, 68820Al-Azhar University, Assuit, Egypt
| | - Esam Abualfadl
- Pediatrics Department, Rheumatology and Nephrology Unit, 68900Helwan University, Cairo, Egypt
- Qena/Luxor hospitals, Qena, Egypt
| | - Samar Tharwat
- Internal Medicine, Rheumatology Unit, 68780Mansoura University, Dakahlia, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, 158405Fayoum University, Fayoum, Egypt
| | - Mervat I Abd Elazeem
- Rheumatology Department, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt
| | - Emad El-Shebini
- Internal Medicine Department, Rheumatology Unit, 68872Menoufiya University, Menoufiya, Egypt
| | - Nermeen Samy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68792Ain-Shams University, Cairo, Egypt
| | - Nermeen Noshy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68792Ain-Shams University, Cairo, Egypt
| | - Amany S El-Bahnasawy
- Rheumatology Department, Faculty of Medicine, 68780Mansoura University, Dakahlia, Egypt
| | - Ahmed M Abdalla
- Rheumatology Department, Faculty of Medicine, 435387Aswan University, Aswan, Egypt
| | - Osama S Abousehly
- Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt
| | - Eman F Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), 68820Al-Azhar University, Cairo, Egypt
| | - Samah I Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Ahmed M Elsaman
- Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt
| | - Marwa ElKhalifa
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68789Alexandria University, Egypt
| | - Mohamed N Salem
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt
| | - Nouran M Abaza
- Rheumatology Department, Faculty of Medicine, 68792Ain Shams University, Cairo, Egypt
| | - Hanan M Fathy
- Pediatrics Department, Rheumatology and Nephrology Unit, 68789Alexandria University, Alexandria, Egypt
| | - Nancy Abdel Salam
- Pediatrics Department, Rheumatology and Nephrology Unit, 68789Alexandria University, Alexandria, Egypt
| | | | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, 68799Zagazig University, Sharkia, Egypt
| | - Dina H El-Hammady
- Rheumatology Department, Faculty of Medicine, 68900Helwan University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, 68797Assuit University, Assuit, Egypt
- Rheumatology Department, 8785University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Reem Ha Mohammed
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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3
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Gheita TA, Hammam N, Fawzy SM, Abd El-Latif E, El-Gazzar II, Samy N, El-Hammady DH, Abdel Noor R, El-Shebini E, El-Najjar AR, Eesa NN, Salem MN, Ibrahim SE, El-Essawi DF, Elsaman AM, Senara S, Fathi HM, Sallam RA, El Shereef RR, Abd Elazeem MI, Fawzy RM, Khalil NM, Shahin D, El-Saadany HM, ElKhalifa M, Nasef SI, Abdalla AM, Noshy N, Said EA, Saad E, Moshrif AH, El-Shanawany AT, Abdel-Fattah YH, Raafat HA, Khalil HM. Development and validation of a Behçet's Disease Damage Index for adults with BD: An Explicit, Composite and Rated (ECR) tool. Int J Rheum Dis 2021; 24:1071-1079. [PMID: 34288457 DOI: 10.1111/1756-185x.14166] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/12/2021] [Accepted: 06/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Behçet's disease (BD) is a chronic multisystem variable vessel vasculitis. Disease damage is irreversible and permanent. Validated tools evaluating damage are limited. Enhancements in the clinical treatment of vasculitis will take place from the development of refined and exclusive indices for individual vasculitic syndromes including BD and attempting their international validation. OBJECTIVES This aim was to develop and validate a simple BD Damage Index (BDI). METHODS This was a nationwide study including 1252 BD patients. The work consisted of 3 stages. Stage 1: items generation for score content. Stage 2: items selection for the draft score was performed by an expert rheumatologist. Stage 3: the content validity of the draft score was assessed and BDI, Vasculitis Damage Index (VDI), Antineutrophil cytoplasmic antibody-associated Vasculitis Index of Damage (AVID) and Combined Damage Assessment Index (CDAI) were calculated and compared. RESULTS The mean age of the BD patients was 36.1 ± 9.9 years. Stages 1 and 2 resulted in a BDI instrument containing 73 items with a maximum score of 100. Stage 3, the VDI, CDAI, AVID, and BDI were 2.9 ± 2.2, 3.1 ± 2.3, 3.1 ± 2.3 and 5.1 ± 2.9, respectively. High correlations (r = .9) between comparable damage scores assured acceptable concurrent validity. CONCLUSION The proposed BDI represents a new robust and potentially useful tool when dealing with BD chronic status.
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Affiliation(s)
- Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt.,Division of Rheumatology, University of California San Francisco, San Francisco, CA, USA
| | - Samar M Fawzy
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eiman Abd El-Latif
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman I El-Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Samy
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Dina H El-Hammady
- Rheumatology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Rasha Abdel Noor
- Internal Medicine Department, Rheumatology Unit, Tanta University, Gharbia, Egypt
| | - Emad El-Shebini
- Internal Medicine Department, Rheumatology Unit, Menoufia University, Menoufia, Egypt
| | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed N Salem
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Soha E Ibrahim
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina F El-Essawi
- Rheumatology Unit (NCRRT), Internal Medicine Department, Atomic Energy Authority (AEA), Cairo, Egypt
| | - Ahmed M Elsaman
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Soha Senara
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Rehab A Sallam
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Rawhya R El Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mervat I Abd Elazeem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Rasha M Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Noha M Khalil
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Shahin
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Hanan M El-Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Marwa ElKhalifa
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samah I Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Ahmed M Abdalla
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt.,Division of Rheumatology, Internal Medicine Department III, Medical University of Vienna, Vienna, Austria
| | - Nermeen Noshy
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Emtethal A Said
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Ehab Saad
- Rheumatology Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
| | - Amira T El-Shanawany
- Rheumatology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Yousra H Abdel-Fattah
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hala A Raafat
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam M Khalil
- Ophthalmology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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4
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Gheita TA, Noor RA, Abualfadl E, Abousehly OS, El-Gazzar II, El Shereef RR, Senara S, Abdalla AM, Khalil NM, ElSaman AM, Tharwat S, Nasef SI, Mohamed EF, Noshy N, El-Essawi DF, Moshrif AH, Fawzy RM, El-Najjar AR, Hammam N, Ismail F, ElKhalifa M, Samy N, Hassan E, Abaza NM, ElShebini E, Fathi HM, Salem MN, Abdel-Fattah YH, Saad E, Abd Elazim MI, Eesa NN, El-Bahnasawy AS, El-Hammady DH, El-Shanawany AT, Ibrahim SE, Said EA, El-Saadany HM, Selim ZI, Fawzy SM, Raafat HA. Adult systemic lupus erythematosus in Egypt: The nation-wide spectrum of 3661 patients and world-wide standpoint. Lupus 2021; 30:1526-1535. [PMID: 33951965 DOI: 10.1177/09612033211014253] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to present the epidemiology, clinical manifestations and treatment pattern of systemic lupus erythematosus (SLE) in Egyptian patients over the country and compare the findings to large cohorts worldwide. Objectives were extended to focus on the age at onset and gender driven influence on the disease characteristics. PATIENTS AND METHOD This population-based, multicenter, cross-sectional study included 3661 adult SLE patients from Egyptian rheumatology departments across the nation. Demographic, clinical, and therapeutic data were assessed for all patients. RESULTS The study included 3661 patients; 3296 females and 365 males (9.03:1) and the median age was 30 years (17-79 years), disease duration 4 years (0-75 years) while the median age at disease onset was 25 years (4-75 years). The overall estimated prevalence of adult SLE in Egypt was 6.1/100,000 population (1.2/100,000 males and 11.3/100,000 females).There were 316 (8.6%) juvenile-onset (Jo-SLE) and 3345 adult-onset (Ao-SLE). Age at onset was highest in South and lowest in Cairo (p < 0.0001). CONCLUSION SLE in Egypt had a wide variety of clinical and immunological manifestations, with some similarities with that in other nations and differences within the same country. The clinical characteristics, autoantibodies and comorbidities are comparable between Ao-SLE and Jo-SLE. The frequency of various clinical and immunological manifestations varied between gender. Additional studies are needed to determine the underlying factors contributing to gender and age of onset differences.
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Affiliation(s)
- Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rasha Abdel Noor
- Internal Medicine Department, Rheumatology Unit, Tanta University, Gharbia, Egypt
| | - Esam Abualfadl
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt.,Qena/Luxor Hospitals, Qena, Egypt
| | - Osama S Abousehly
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Iman I El-Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rawhya R El Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Soha Senara
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Ahmed M Abdalla
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Noha M Khalil
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M ElSaman
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Samar Tharwat
- Rheumatology Unit, Internal Medicine, Mansoura University, Dakahlia, Egypt
| | - Samah I Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Eman F Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Nermeen Noshy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Dina F El-Essawi
- Internal Medicine Department, Rheumatology Unit, Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
| | - Rasha M Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt.,Rheumatology Department, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Marwa ElKhalifa
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nermeen Samy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Eman Hassan
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nouran M Abaza
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Emad ElShebini
- Internal Medicine Department, Rheumatology Unit, Menoufiya University, Menoufiya, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mohamed N Salem
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Yousra H Abdel-Fattah
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ehab Saad
- Rheumatology Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mervat I Abd Elazim
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amany S El-Bahnasawy
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Dina H El-Hammady
- Rheumatology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Amira T El-Shanawany
- Rheumatology Department, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
| | - Soha E Ibrahim
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Emtethal A Said
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Hanan M El-Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
| | - Zahraa I Selim
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Samar M Fawzy
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hala A Raafat
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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5
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Gheita TA, Salem MN, Eesa NN, Khalil NM, Gamal NM, Noor RA, Moshrif AH, Shereef RE, Ismail F, Noshy N, Fawzy RM, Elshebini E, Khalifa I, Saadany HE, Tharwat S, El-Najjar A, Fattah YA, Sallam R, El-Bahnasawy AS, Gharbia O, Hassan E, ElShanawany A, Mohamed EF, Senara S, Ismail M, Nasef SI, Abdalla AM, Elessawi D, Fawzy SM, Alfadl EA, Khalifa A, Abaza NM. Rheumatologists' practice during the Coronavirus disease 2019 (COVID-19) pandemic: a survey in Egypt. Rheumatol Int 2020; 40:1599-1611. [PMID: 32710198 PMCID: PMC7380140 DOI: 10.1007/s00296-020-04655-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 06/06/2020] [Accepted: 07/11/2020] [Indexed: 12/18/2022]
Abstract
The aim of this work is to trace how rheumatologists all over Egypt are approaching the COVID-19 pandemic and what changes it has brought about in the patients' care with special attention to its effect on vulnerable rheumatic disease (RD) patients. This survey further aims to help inform the rheumatology community about the changes in practice during the COVID-19 pandemic. The survey included 26 questions distributed to University staff members across Egypt members of the Egyptian College of Rheumatology (ECR). It takes 5-10 min to fill out. The practice setting of participating rheumatologists included University Teaching Hospitals that are the main rheumatology and clinical immunology service providers for adults and children RD patients. There was an overall agreement across the country in the responses to the survey that took a median time of 7 min to fill in. Potential changes in rheumatology outpatient practice by staff members evolved since the COVID-19 pandemic. None of the university rheumatology staff members has prescribed chloroquine or HCQ to prevent or treat COVID-19 in a non-hospitalized patient who was not previously on it. Twenty-three recommended decrease/avoid NSAIDs if the RD patient had confirmed COVID-19 or symptoms. There is an agreement to the key emerging frontline role of rheumatologists in treating COVID-19. During the pandemic, RD cases requiring admission were dealt with by several modified strategies. The overall agreement among the different university rheumatology departments during such critical situation has provoked the ECR to consider providing provisional guidelines for dealing with RD patients during this global catastrophe.
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Affiliation(s)
- Tamer A. Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed N. Salem
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Nahla N. Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha M. Khalil
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nada M. Gamal
- Rheumatology Department, Faculty of Medicine, Assuit University, Asyut, Egypt
| | - Rasha Abdel Noor
- Rheumatology Unit, Internal Medicine Department, Tanta University, Gharbia, Tanta, Egypt
| | | | - Rawhya El Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Nermeen Noshy
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Rasha M. Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Benha, Egypt
| | - Emad Elshebini
- Rheumatology Unit, Internal Medicine Department, Menoufiya University, Menoufiya, Egypt
| | - Iman Khalifa
- Pediatric Rheumatology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hanan El Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Tanta, Egypt
| | - Samar Tharwat
- Rheumatology Unit Internal Medicine Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
| | - Amany El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Zagazig, Egypt
| | - Yousra Abdel Fattah
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rehab Sallam
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
| | - Amany S. El-Bahnasawy
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
| | - Ola Gharbia
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
| | - Eman Hassan
- Rheumatology Unit Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amira ElShanawany
- Rheumatology Department, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
| | - Eman F. Mohamed
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Soha Senara
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mervat Ismail
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Samah I. Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Ahmed M. Abdalla
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Dina Elessawi
- Rheumatology Unit Internal Medicine Department, Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Samar M. Fawzy
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esam Abu Alfadl
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
- Qena/Luxor Hospitals, Qena, Egypt
| | - Asmaa Khalifa
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Nouran M. Abaza
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - The ECR COVID19-Study Group
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Assuit University, Asyut, Egypt
- Rheumatology Unit, Internal Medicine Department, Tanta University, Gharbia, Tanta, Egypt
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Asyut, Egypt
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Benha, Egypt
- Rheumatology Unit, Internal Medicine Department, Menoufiya University, Menoufiya, Egypt
- Pediatric Rheumatology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Tanta, Egypt
- Rheumatology Unit Internal Medicine Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Zagazig, Egypt
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
- Rheumatology Unit Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Rheumatology Department, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rheumatology Unit Internal Medicine Department, Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
- Qena/Luxor Hospitals, Qena, Egypt
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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6
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Gheita TA, El-Latif EA, El-Gazzar II, Samy N, Hammam N, Abdel Noor RA, El-Shebeiny E, El-Najjar AR, Eesa NN, Salem MN, Ibrahim SE, El-Essawi DF, Elsaman AM, Fathi HM, Sallam RA, El-Shereef RR, Abd-Elazeem MI, Said EA, Khalil NM, Shahin D, El-Saadany HM, ElKhalifa MS, Nasef SI, Abdalla AM, Noshy N, Fawzy RM, Saad E, Moshrif AH, El-Shanawany AT, Abdel-Fattah YH, Khalil HM. Correction to: Behçet's disease in Egypt: a multicenter nationwide study on 1526 adult patients and review of the literature. Clin Rheumatol 2019; 38:2649-2650. [PMID: 31302857 DOI: 10.1007/s10067-019-04653-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The author wishes to correct the record and clarify that in the original version of this article in the Discussion section under "Prevalence over the country governorates" inadvertently presented incorrect data cited in the reference [30].
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Affiliation(s)
- Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Eiman Abd El-Latif
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman I El-Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Samy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Rasha A Abdel Noor
- Internal Medicine Department, Rheumatology Unit, Tanta University, Tanta, Gharbia, Egypt
| | - Emad El-Shebeiny
- Internal Medicine Department, Rheumatology Unit, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
| | - Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed N Salem
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Soha E Ibrahim
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina F El-Essawi
- Internal Medicine Department, Rheumatology Unit (NCRRT), Atomic Energy Authority (AEA), Cairo, Egypt
| | - Ahmed M Elsaman
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Rehab A Sallam
- Rheumatology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Rawhya R El-Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mervat I Abd-Elazeem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Emtethal A Said
- Rheumatology Department, Faculty of Medicine, Benha University, Benha, Kalubia, Egypt
| | - Noha M Khalil
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Shahin
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Hanan M El-Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Marwa S ElKhalifa
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samah I Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Ahmed M Abdalla
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt.,Internal Medicine Department III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Nermeen Noshy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Rasha M Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Benha, Kalubia, Egypt
| | - Ehab Saad
- Rheumatology Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Abdel-Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
| | - Amira T El-Shanawany
- Rheumatology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | - Yousra H Abdel-Fattah
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hossam M Khalil
- Ophthalmology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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7
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Gheita TA, El-Latif EA, El-Gazzar II, Samy N, Hammam N, Abdel Noor RA, El-Shebeiny E, El-Najjar AR, Eesa NN, Salem MN, Ibrahim SE, El-Essawi DF, Elsaman AM, Fathi HM, Sallam RA, El-Shereef RR, Abd-Elazeem MI, Said EA, Khalil NM, Shahin D, El-Saadany HM, ElKhalifa MS, Nasef SI, Abdalla AM, Noshy N, Fawzy RM, Saad E, Moshrif AH, El-Shanawany AT, Abdel-Fattah YH, Khalil HM. Behçet’s disease in Egypt: a multicenter nationwide study on 1526 adult patients and review of the literature. Clin Rheumatol 2019; 38:2565-2575. [DOI: 10.1007/s10067-019-04570-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/14/2019] [Accepted: 04/18/2019] [Indexed: 12/19/2022]
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