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Yassine IA, Shehata H, Hamdy S, Abdel-Naseer M, Hassan T, Sherbiny M, Magdy E, Elmazny A, Shalaby N, ElShebawy H. Effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on the balance and the white matter integrity in patients with relapsing-remitting multiple sclerosis: A long-term follow-up study. Mult Scler Relat Disord 2024; 83:105471. [PMID: 38295628 DOI: 10.1016/j.msard.2024.105471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Repetitive Transcranial Magnetic Stimulation (rTMS) is considered as a safe and non-invasive developing technique used as a therapeutic method for patients with Relapsing-Remitting Multiple Sclerosis (RRMS) who suffer from disturbances in gait and balance. The aim of our study is to evaluate the long-term effect of high frequency rTMS as a therapeutic option for truncal ataxia in RRMS patients and to assess its impact on the integrity of the white matter (WMI), measured in the form of anisotropy metrics using diffusion tensor imaging (DTI). METHODS The study was conducted in two phases: phase I; a randomized, single-blind, sham-controlled phase and phase II was a 12 months longitudinal open-label prospective phase. Phase I of the trial involved the randomization of 43 patients with RRMS and truncal ataxia to either real (n = 20) or sham (n = 19) rTMS (2 participants from each treatment group were excluded from the study; one developed a relapse before treatment, 2 declined to participate, and one did not show up). Phase II involved providing 12 actual treatments cycles to all patients; each cycle length is 4 weeks, repeated four times on a trimonthly basis, forming a total of 48 sessions. DTI was used for assessment of the WMI. All patients performed DTI 3 times: Imaging sessions were conducted at the screening visit, at the end of phase I, and after the last session in phase II for the first, second and third sessions respectively. A figure-of-8-shape coil, employing rTMS protocol and located over the cerebellum, was used. rTMS protocol is formed of 20 trains formed of 50 stimuli with 20 s apart (5 Hz of 80 % of resting Motor Threshold "MT"). The Berg Balance Scale (BBS), Time up and go (TUG) test, and 10-m walk test (10MWT) were first evaluated at the start of each cycle and just after the final rTMS session. RESULTS The genuine rTMS group's 10MWT, TUG, and BBS showed substantial improvement (p < 0.01), which is continued to be improved throughout the study Timeline, with a significant difference observed following the final rTMS session (P< 0.001). A longitudinal increase in FA was observed in both the Cerebello-Thalamo-Cortical (CTC) and Cortico-Ponto-Cerebellar (CPC) bilateral, as indicated by means of Fractional Anisotropy (FA) measures (p < 0.05). CONCLUSION In ataxic RRMS patients, high frequency rTMS over the cerebellum has a long-term beneficial impact on both balance and WMI.
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Affiliation(s)
- I A Yassine
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | - H Shehata
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - S Hamdy
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - T Hassan
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - E Magdy
- Police Hospitals, Cairo, Egypt
| | - A Elmazny
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - N Shalaby
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - H ElShebawy
- Faculty of Medicine, Cairo University, Cairo, Egypt
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Hassan T, Arafa O, Ibrahim T, Sultan A. Dominant A1 Direction as an Additional Factor for Deciding Surgical Approach for A1 Bifurcation Aneurysms. World Neurosurg 2024; 182:e126-e136. [PMID: 37992991 DOI: 10.1016/j.wneu.2023.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Clipping of aneurysms located in the anterior communicating artery (AcomA) is considered a critical surgical procedure for neurosurgeons worldwide because of the complexity of the surgical area. The present study was conducted to discuss the importance of the geometric curvatures and the direction of the dominant A1 artery and their impact on aneurysmal growth direction and choice of side selection of the pterional surgical approach side. METHODS The present study enrolled 183 patients with ruptured AcomA-located aneurysms. The aneurysms were all treated surgically through a pterional approach. Because of multiple dominant A1 directions, we divided the artery into 2 segments, and based on the second segment direction, we categorized the patients into ascending A1, descending A1, and horizontal A1 groups. The ascending group includes the superiorly projecting aneurysms, whereas the horizontal and descending groups include the anteriorly and inferiorly projecting aneurysms, respectively. A contralateral pterional approach to the dominant A1 was chosen for aneurysms with an ascending artery. However, the ipsilateral pterional approach was conducted in the horizontal and descending A1 dominant groups. RESULTS The aneurysmal growth projection axis always follows the direction of the second dominant A1 segment. Full neck control with satisfactory inspection of perforators was achieved through the contralateral approach in most cases of an ascending A1, especially if ipsilateral A2 was posterior to the neck. The A1 segment can be satisfactorily seen from the contralateral exposure before the aneurysmal neck is exposed in ascending A1 geometries. CONCLUSIONS A1 direction is an important additional factor that is to be considered for side selection when deciding pterional exposure of A1 bifurcation aneurysms. Accessing the contralateral dominant ascending A1 has better visualization of the neck than entering from an ipsilateral approach, especially if the ipsilateral A2 was posterior to the neck.
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Affiliation(s)
- Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt.
| | - Omar Arafa
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
| | - Tamer Ibrahim
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
| | - Ahmed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
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Hassan T, Zakaria M, Diaa A, Abdalla AELS, Ahmed ALSMS, Abdelmonem DM, Abdelaziz E. Contribution of T helper 17 cells and interleukin-17 to the pathogenesis of primary immune thrombocytopenia in Egyptian children. Eur J Pediatr 2023; 182:5673-5679. [PMID: 37823926 PMCID: PMC10746750 DOI: 10.1007/s00431-023-05242-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Though pathogenesis of primary immune thrombocytopenia (ITP) is still rendered unclear, yet there are many research efforts that have been directed to the role of T helper 17 (Th17) and interleukin 17 (IL-17) in the pathogenesis of this disease. The Th17 cell, which produces IL-17, is a subset of T helper cells. Interleukin 17 is pro-inflammatory cytokine that is recently proved to have a crucial role in the emergence of autoimmune diseases. We aimed to investigate the role of T helper17 cells and interleukin-17 in the pathogenesis of ITP in Egyptian children. This study was carried out on 100 children with ITP and 100 apparently healthy children as a control group. Patients were subjected to full medical history taking, thorough physical examination and routine investigations according to our local standards. Percentage of Th17 cells was measured by flow cytometry in study groups. Also, serum IL-17 was measured in in study groups by ELISA. Th 17 cells were significantly higher in patients compared to controls. Moreover, 3.1-fold increased serum levels of IL-17 were observed in patients with ITP compared to controls. Newly diagnosed patients had significantly higher percentage of Th-17cells as well as higher IL-17 levels than patients with either persistent or chronic ITP. Conclusion: We concluded that Th 17 cells and IL-17 seem to play an important role in the pathogenesis of ITP in Egyptian children. What is Known -- What is New: • The pathogenesis of ITP is heterogeneous A novel subset of CD4+ T cells, distinct from Th1 and Th2, was recently identified. It is characterized by the production of IL-17 and, therefore, designated as Th17 cells. Several studies support a pivotal role for serum cytokines in the pathogenesis of ITP and provide evidence to suggest that helper Tlymphocytes polarize into Th1 and Th2 immune response. we aimed to investigate the role of T helper17 cells and interleukin-17 in the pathogenesis of ITP in Egyptian children.
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Affiliation(s)
- Tamer Hassan
- Pediatrics, Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Marwa Zakaria
- Pediatrics, Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
| | - Asmaa Diaa
- Pediatrics, Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | | | | | - Doaa M Abdelmonem
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman Abdelaziz
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Hassan T, Refaat M, Issa AM, Sultan A, Ibrahim T. Geometrical Characteristics of Grade III Arteriovenous Malformations That Contribute to Better Outcomes in Endovascular Treatment. World Neurosurg 2023; 180:e749-e755. [PMID: 37821030 DOI: 10.1016/j.wneu.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Grade III brain arteriovenous malformation (AVM) is a distinct subgroup of AVMs that encompasses multiple subtypes according to the Spetzler-Martin classification. METHODS This retrospective study included 61 patients with grade III AVM who underwent embolization between 2010 and 2022. The study analyzed the angioarchitecture of the AVM nidus and evaluated the outcomes of the embolization procedures. RESULTS There were 29 patients (47.5%) with subtype S1E1V1, 20 patients (32.8%) with subtype S2E1V0, and 12 patients (19.7%) with subtype S2E0V1. The rate of complete occlusion in all patients was 47.5% (29 patients). The rate of complete occlusion was higher in cases with a compact nidus (P < 0.001). Several parameters were associated with occlusion of the AVM nidus, including ≤3 arterial feeders (P = 0.017) and presentation with hemorrhage (P = 0.007), with the majority of patients with a compact nidus presenting with hemorrhage. Other factors associated with compact geometry were the presence of a single deep vein, ≤3 arterial feeders, ≤2 superficial draining veins, and an AVM nidus size ≤3 cm. CONCLUSIONS The compact nature of grade III AVM is a crucial predictor for the success of embolization. Several characteristics associated with a compact nidus, such as presentation with hemorrhage and a lower number of arterial feeders, have a significantly higher closure rate. Other factors, such as a single deep draining vein, reduced superficial venous drainage, and small size, show a strong association with complete obliteration.
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Affiliation(s)
- Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt.
| | - Mohamed Refaat
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt; Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
| | - Alaa Mohamed Issa
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
| | - Ahmed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
| | - Tamer Ibrahim
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
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Sultan A, Hassan T, Metwaly TI. Angiographic predictors of spontaneous obliteration of transarterial partially embolized brain arteriovenous malformations. Interv Neuroradiol 2023; 29:371-378. [PMID: 35360965 PMCID: PMC10399512 DOI: 10.1177/15910199221092579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Spontaneous obliteration of cerebral arteriovenous malformations is uncommon but could occur after partial embolization. METHODS A retrospective study of 140 patients that underwent embolization for cerebral AVMs from 2005 to August 2019 using liquid embolic agents. The angiographic outcome of patients was classified as regard complete embolization, partial embolization, and complete obliteration after partial embolization. The parameters studied included size, location, number of arterial feeders, number of draining veins, rupture status, embolic agent, and patient factors as well. RESULTS The study patients included 74 (53%) females and 66 (47%) males. Their age ranged from 7 to 43 years old. One hundred and eight patients (77%) presented with hemorrhage. The AVM grades were grade II in 57 (40.7%) patients and grade III in 56 (39.3%) patients. Sixty-one (43.57%) patients were treated by n-Butyl Cyanoacrylate and 71 (50.71%) patients were treated with Onyx, and both materials were used together in 8 cases. Follow-up angiography was done from 6 to 36 months after embolization. The rate of complete occlusion in all patients was 61.43% (86 patients). There were three groups of patients, the first group had complete occlusion of the nidus at the time of embolization and included 68 (48.57%) patients. The second group had partial embolization with partial occlusion of the nidus 54 patients (38.57%). The 3rd group included 18 patients (12.85%) with complete nidal occlusion on follow up after partial embolization. The delay in the venous drainage of the AVM to the late arterial phase or early venous phase with flow stasis was a significant predictor of future obliteration on follow up after partial embolization. Other significant parameters that were associated with the progressive disappearance of the AVM nidus on follow up after partial embolization are presentation with hemorrhage, AVMs size less than 3 cm, the presence of single draining or double draining veins, superficial venous drainage, and one or 2 arterial feeders. CONCLUSION Spontaneous closure of intracranial arteriovenous malformations after partial embolization may be encountered in cases of stasis of flow during embolization procedure with a delay of the venous drainage. A long-term follow-up of more cases over many years is required to confirm the validity of this conclusion.
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Affiliation(s)
- Ahmed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, & The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
| | - Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, & The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
| | - Tamer Ibrahim Metwaly
- Department of Neurosurgery, Alexandria University School of Medicine, & The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
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Firdous P, Nissar K, Masoodi SR, Wani JA, Hassan T, Ganai BA. HNF1α upregulation and promoter hypermethylation as a cause of glucose dysregulation: a case-control study of Kashmiri MODY population. J Endocrinol Invest 2023; 46:915-926. [PMID: 36331708 DOI: 10.1007/s40618-022-01953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
AIM HNF1α transcription factor regulates a network of genes involved in the development of β-cells and also serves as a model for transcription defects in pancreatic β-cells; mutations in this gene cause MODY. The goal of this study was to assess the promoter methylation and expression profile of the most common MODY causing gene, HNF1α, in Kashmiri MODY patients, as factors responsible for glucose dysregulation, as no such study had been performed on MODY patients in Kashmir previously. METHODS The study included 85 Kashmiri subjects. Samples were extracted for DNA and RNA using standard protocols. The HNF1α promoter methylation profile was assessed by bisulfite conversion of the DNA followed by MSP, whereas qPCR was used for expression analysis. RESULTS The expression of HNF1α was found to be upregulated (p value 0.0349*) in majority of MODY (60%) and T1D (72%) cases (p value 0.0349*). HNF1α expression was 1.33-fold higher in MODY cases with hypermethylated HNF1α promoters (p value 0.0360*). HNF1α expression was upregulated by 2.3-fold in MODY patients with HbA1c levels > 7% (p value 0.0025**). MODY cases with FBS levels > 7.7 mmol/l were upregulated by 0.646-fold than those with FBS levels ≤ 7.7 mmol/l (p value 0.0161*). CONCLUSION In this study, we found that as glucose dysregulation progresses, blood FBS, RBS, and HbA1c levels rise, and that at higher levels, HNF1α expression rises as well. From the results obtained, we may conclude that HNF1α is strongly upregulated in MODY, thus indicating the deleterious effect of over expression of HNF1α gene on glucose regulation.
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Affiliation(s)
- P Firdous
- Centre of Research for Development (CORD), University of Kashmir, Srinagar, Jammu and Kashmir, 190006, India
| | - K Nissar
- Centre of Research for Development (CORD), University of Kashmir, Srinagar, Jammu and Kashmir, 190006, India
- Department of Biochemistry, University of Kashmir, Srinagar, Jammu and Kashmir, 190006, India
| | - S R Masoodi
- Department of Endocrinology, SKIMS, Srinagar, Jammu and Kashmir, 190011, India
| | - J A Wani
- Department of Biochemistry, University of Kashmir, Srinagar, Jammu and Kashmir, 190006, India
| | - T Hassan
- Centre of Research for Development (CORD), University of Kashmir, Srinagar, Jammu and Kashmir, 190006, India
| | - B A Ganai
- Centre of Research for Development (CORD), University of Kashmir, Srinagar, Jammu and Kashmir, 190006, India.
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Zakaria M, Beshir M, Hassan T, Esh A, Abdelaziz E, Tayib R, Nafea A. Role of interleukin 4 (IL4) and interleukin 6 (IL6) in the pathogenesis and prognosis of childhood primary immune thrombocytopenia. Eur J Pediatr 2023:10.1007/s00431-023-04945-x. [PMID: 37097445 DOI: 10.1007/s00431-023-04945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 04/26/2023]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the breakdown of immune tolerance. Impairment of the cellular immunity is primarily evaluated by the levels of the cytokines which can help in predicting the course of ITP. We aimed to assess the levels of IL4 and IL6 in children with ITP and evaluate their role in the pathogenesis and prognosis of this disease. A prospective cohort study was carried on 60 children (15 patients with newly diagnosed ITP, 15 patients with persistent ITP, 15 patients with chronic ITP and 15 healthy children as a control group). Serum IL-4 and serum IL-6 were measured using Human IL-4 and IL-6 ELISA kit in patients and controls. Patients with newly diagnosed and persistent ITP had significantly higher levels of IL4 and IL6 compared to patients with chronic ITP and healthy controls (p < 0.001). The mean serum level of IL4 was 762.0, 741.0, 364.6 and 436.8 pg/ml, and the mean serum level of IL6 was 178.5, 164.4, 57.9 and 88.4 pg/ml for patients with newly diagnosed, persistent, chronic ITP and healthy controls respectively. Serum IL-4 was significantly higher in patients who achieved remission than those who did not improve on first line therapy. CONCLUSION Serum IL-4 and IL-6 may have a role in the pathogenesis of primary ITP. IL-4 seems to be a good predictor to treatment response. WHAT IS KNOWN • There is a delicate balance of specific cytokine levels in immune thrombocytopenia, which has an important role in the immune system and is known to be deregulated in autoimmune diseases. changes in IL-4 and IL-6 might be involved in the pathogenesis of newly diagnosed ITP in both paediatric and adult patients. • We conducted this research study to measure the serum level of IL-4 and IL-6, in newly diagnosed, persistent and chronic ITP patients and study their relation to disease pathogenesis as well as patient's outcome. WHAT IS NEW • We found that IL4 seems to be a good predictor to treatment response and it was a very interesting observation in our study, and to the best of our knowledge, there is no published data about this finding.
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Affiliation(s)
- Marwa Zakaria
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
| | - Mohamed Beshir
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Tamer Hassan
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Asmaa Esh
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman Abdelaziz
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ridha Tayib
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Alaa Nafea
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
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Abe H, Abe S, Acciari VA, Aniello T, Ansoldi S, Antonelli LA, Arbet Engels A, Arcaro C, Artero M, Asano K, Baack D, Babić A, Baquero A, Barres de Almeida U, Barrio JA, Batković I, Baxter J, Becerra González J, Bednarek W, Bernardini E, Bernardos M, Berti A, Besenrieder J, Bhattacharyya W, Bigongiari C, Biland A, Blanch O, Bonnoli G, Bošnjak Ž, Burelli I, Busetto G, Carosi R, Carretero-Castrillo M, Ceribella G, Chai Y, Chilingarian A, Cikota S, Colombo E, Contreras JL, Cortina J, Covino S, D'Amico G, D'Elia V, Da Vela P, Dazzi F, De Angelis A, De Lotto B, Del Popolo A, Delfino M, Delgado J, Delgado Mendez C, Depaoli D, Di Pierro F, Di Venere L, Do Souto Espiñeira E, Dominis Prester D, Donini A, Dorner D, Doro M, Elsaesser D, Emery G, Fallah Ramazani V, Fariña L, Fattorini A, Font L, Fruck C, Fukami S, Fukazawa Y, García López RJ, Garczarczyk M, Gasparyan S, Gaug M, Giesbrecht Paiva JG, Giglietto N, Giordano F, Gliwny P, Godinović N, Green JG, Green D, Hadasch D, Hahn A, Hassan T, Heckmann L, Herrera J, Hrupec D, Hütten M, Imazawa R, Inada T, Iotov R, Ishio K, Jiménez Martínez I, Jormanainen J, Kerszberg D, Kobayashi Y, Kubo H, Kushida J, Lamastra A, Lelas D, Leone F, Lindfors E, Linhoff L, Lombardi S, Longo F, López-Coto R, López-Moya M, López-Oramas A, Loporchio S, Lorini A, Lyard E, Machado de Oliveira Fraga B, Majumdar P, Makariev M, Maneva G, Mang N, Manganaro M, Mangano S, Mannheim K, Mariotti M, Martínez M, Mas Aguilar A, Mazin D, Menchiari S, Mender S, Mićanović S, Miceli D, Miener T, Miranda JM, Mirzoyan R, Molina E, Mondal HA, Moralejo A, Morcuende D, Moreno V, Nakamori T, Nanci C, Nava L, Neustroev V, Nievas Rosillo M, Nigro C, Nilsson K, Nishijima K, Njoh Ekoume T, Noda K, Nozaki S, Ohtani Y, Oka T, Otero-Santos J, Paiano S, Palatiello M, Paneque D, Paoletti R, Paredes JM, Pavletić L, Persic M, Pihet M, Podobnik F, Prada Moroni PG, Prandini E, Principe G, Priyadarshi C, Puljak I, Rhode W, Ribó M, Rico J, Righi C, Rugliancich A, Sahakyan N, Saito T, Sakurai S, Satalecka K, Saturni FG, Schleicher B, Schmidt K, Schmuckermaier F, Schubert JL, Schweizer T, Sitarek J, Sliusar V, Sobczynska D, Spolon A, Stamerra A, Strišković J, Strom D, Strzys M, Suda Y, Surić T, Takahashi M, Takeishi R, Tavecchio F, Temnikov P, Terauchi K, Terzić T, Teshima M, Tosti L, Truzzi S, Tutone A, Ubach S, van Scherpenberg J, Vazquez Acosta M, Ventura S, Verguilov V, Viale I, Vigorito CF, Vitale V, Vovk I, Walter R, Will M, Wunderlich C, Yamamoto T, Zarić D, Hiroshima N, Kohri K. Search for Gamma-Ray Spectral Lines from Dark Matter Annihilation up to 100 TeV toward the Galactic Center with MAGIC. Phys Rev Lett 2023; 130:061002. [PMID: 36827578 DOI: 10.1103/physrevlett.130.061002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/02/2022] [Accepted: 12/15/2022] [Indexed: 06/18/2023]
Abstract
Linelike features in TeV γ rays constitute a "smoking gun" for TeV-scale particle dark matter and new physics. Probing the Galactic Center region with ground-based Cherenkov telescopes enables the search for TeV spectral features in immediate association with a dense dark matter reservoir at a sensitivity out of reach for satellite γ-ray detectors, and direct detection and collider experiments. We report on 223 hours of observations of the Galactic Center region with the MAGIC stereoscopic telescope system reaching γ-ray energies up to 100 TeV. We improved the sensitivity to spectral lines at high energies using large-zenith-angle observations and a novel background modeling method within a maximum-likelihood analysis in the energy domain. No linelike spectral feature is found in our analysis. Therefore, we constrain the cross section for dark matter annihilation into two photons to ⟨σv⟩≲5×10^{-28} cm^{3} s^{-1} at 1 TeV and ⟨σv⟩≲1×10^{-25} cm^{3} s^{-1} at 100 TeV, achieving the best limits to date for a dark matter mass above 20 TeV and a cuspy dark matter profile at the Galactic Center. Finally, we use the derived limits for both cuspy and cored dark matter profiles to constrain supersymmetric wino models.
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Affiliation(s)
- H Abe
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - S Abe
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - V A Acciari
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - T Aniello
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - S Ansoldi
- Università di Udine and INFN Trieste, I-33100 Udine, Italy
| | - L A Antonelli
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - A Arbet Engels
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - C Arcaro
- Università di Padova and INFN, I-35131 Padova, Italy
| | - M Artero
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - K Asano
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - D Baack
- Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - A Babić
- Croatian MAGIC Group: University of Zagreb, Faculty of Electrical Engineering and Computing (FER), 10000 Zagreb, Croatia
| | - A Baquero
- IPARCOS Institute and EMFTEL Department, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - U Barres de Almeida
- Centro Brasileiro de Pesquisas Físicas (CBPF), 22290-180 URCA, Rio de Janeiro (RJ), Brazil
| | - J A Barrio
- IPARCOS Institute and EMFTEL Department, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - I Batković
- Università di Padova and INFN, I-35131 Padova, Italy
| | - J Baxter
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - J Becerra González
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - W Bednarek
- University of Lodz, Faculty of Physics and Applied Informatics, Department of Astrophysics, 90-236 Lodz, Poland
| | - E Bernardini
- Università di Padova and INFN, I-35131 Padova, Italy
| | - M Bernardos
- Instituto de Astrofísica de Andalucía-CSIC, Glorieta de la Astronomía s/n, 18008 Granada, Spain
| | - A Berti
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - J Besenrieder
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - W Bhattacharyya
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - C Bigongiari
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - A Biland
- ETH Zürich, CH-8093 Zürich, Switzerland
| | - O Blanch
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - G Bonnoli
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - Ž Bošnjak
- Croatian MAGIC Group: University of Zagreb, Faculty of Electrical Engineering and Computing (FER), 10000 Zagreb, Croatia
| | - I Burelli
- Università di Udine and INFN Trieste, I-33100 Udine, Italy
| | - G Busetto
- Università di Padova and INFN, I-35131 Padova, Italy
| | - R Carosi
- Università di Pisa and INFN Pisa, I-56126 Pisa, Italy
| | | | - G Ceribella
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - Y Chai
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - A Chilingarian
- Armenian MAGIC Group: A. Alikhanyan National Science Laboratory, 0036 Yerevan, Armenia
| | - S Cikota
- Croatian MAGIC Group: University of Zagreb, Faculty of Electrical Engineering and Computing (FER), 10000 Zagreb, Croatia
| | - E Colombo
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - J L Contreras
- IPARCOS Institute and EMFTEL Department, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - J Cortina
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, E-28040 Madrid, Spain
| | - S Covino
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - G D'Amico
- Department for Physics and Technology, University of Bergen, Norway
| | - V D'Elia
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - P Da Vela
- Università di Pisa and INFN Pisa, I-56126 Pisa, Italy
| | - F Dazzi
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - A De Angelis
- Università di Padova and INFN, I-35131 Padova, Italy
| | - B De Lotto
- Università di Udine and INFN Trieste, I-33100 Udine, Italy
| | - A Del Popolo
- INFN MAGIC Group: INFN Sezione di Catania and Dipartimento di Fisica e Astronomia, University of Catania, I-95123 Catania, Italy
| | - M Delfino
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - J Delgado
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - C Delgado Mendez
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, E-28040 Madrid, Spain
| | - D Depaoli
- INFN MAGIC Group: INFN Sezione di Torino and Università degli Studi di Torino, I-10125 Torino, Italy
| | - F Di Pierro
- INFN MAGIC Group: INFN Sezione di Torino and Università degli Studi di Torino, I-10125 Torino, Italy
| | - L Di Venere
- INFN MAGIC Group: INFN Sezione di Bari and Dipartimento Interateneo di Fisica dell'Università e del Politecnico di Bari, I-70125 Bari, Italy
| | - E Do Souto Espiñeira
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - D Dominis Prester
- Croatian MAGIC Group: University of Rijeka, Department of Physics, 51000 Rijeka, Croatia
| | - A Donini
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - D Dorner
- Universität Würzburg, D-97074 Würzburg, Germany
| | - M Doro
- Università di Padova and INFN, I-35131 Padova, Italy
| | - D Elsaesser
- Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - G Emery
- University of Geneva, Chemin d'Ecogia 16, CH-1290 Versoix, Switzerland
| | - V Fallah Ramazani
- Finnish MAGIC Group: Finnish Centre for Astronomy with ESO, University of Turku, FI-20014 Turku, Finland
| | - L Fariña
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - A Fattorini
- Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - L Font
- Departament de Física, and CERES-IEEC, Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain
| | - C Fruck
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - S Fukami
- ETH Zürich, CH-8093 Zürich, Switzerland
| | - Y Fukazawa
- Japanese MAGIC Group: Physics Program, Graduate School of Advanced Science and Engineering, Hiroshima University, 739-8526 Hiroshima, Japan
| | - R J García López
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - M Garczarczyk
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - S Gasparyan
- Armenian MAGIC Group: ICRANet-Armenia at NAS RA, 0019 Yerevan, Armenia
| | - M Gaug
- Departament de Física, and CERES-IEEC, Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain
| | - J G Giesbrecht Paiva
- Centro Brasileiro de Pesquisas Físicas (CBPF), 22290-180 URCA, Rio de Janeiro (RJ), Brazil
| | - N Giglietto
- INFN MAGIC Group: INFN Sezione di Bari and Dipartimento Interateneo di Fisica dell'Università e del Politecnico di Bari, I-70125 Bari, Italy
| | - F Giordano
- INFN MAGIC Group: INFN Sezione di Bari and Dipartimento Interateneo di Fisica dell'Università e del Politecnico di Bari, I-70125 Bari, Italy
| | - P Gliwny
- University of Lodz, Faculty of Physics and Applied Informatics, Department of Astrophysics, 90-236 Lodz, Poland
| | - N Godinović
- Croatian MAGIC Group: University of Split, Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture (FESB), 21000 Split, Croatia
| | - J G Green
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - D Green
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - D Hadasch
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - A Hahn
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - T Hassan
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, E-28040 Madrid, Spain
| | - L Heckmann
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - J Herrera
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - D Hrupec
- Croatian MAGIC Group: Josip Juraj Strossmayer University of Osijek, Department of Physics, 31000 Osijek, Croatia
| | - M Hütten
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - R Imazawa
- Japanese MAGIC Group: Physics Program, Graduate School of Advanced Science and Engineering, Hiroshima University, 739-8526 Hiroshima, Japan
| | - T Inada
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - R Iotov
- Universität Würzburg, D-97074 Würzburg, Germany
| | - K Ishio
- University of Lodz, Faculty of Physics and Applied Informatics, Department of Astrophysics, 90-236 Lodz, Poland
| | - I Jiménez Martínez
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, E-28040 Madrid, Spain
| | - J Jormanainen
- Finnish MAGIC Group: Finnish Centre for Astronomy with ESO, University of Turku, FI-20014 Turku, Finland
| | - D Kerszberg
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - Y Kobayashi
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - H Kubo
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - J Kushida
- Japanese MAGIC Group: Department of Physics, Tokai University, Hiratsuka, 259-1292 Kanagawa, Japan
| | - A Lamastra
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - D Lelas
- Croatian MAGIC Group: University of Split, Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture (FESB), 21000 Split, Croatia
| | - F Leone
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - E Lindfors
- Finnish MAGIC Group: Finnish Centre for Astronomy with ESO, University of Turku, FI-20014 Turku, Finland
| | - L Linhoff
- Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - S Lombardi
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - F Longo
- Università di Udine and INFN Trieste, I-33100 Udine, Italy
| | - R López-Coto
- Università di Padova and INFN, I-35131 Padova, Italy
| | - M López-Moya
- IPARCOS Institute and EMFTEL Department, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - A López-Oramas
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - S Loporchio
- INFN MAGIC Group: INFN Sezione di Bari and Dipartimento Interateneo di Fisica dell'Università e del Politecnico di Bari, I-70125 Bari, Italy
| | - A Lorini
- Università di Siena and INFN Pisa, I-53100 Siena, Italy
| | - E Lyard
- University of Geneva, Chemin d'Ecogia 16, CH-1290 Versoix, Switzerland
| | | | - P Majumdar
- Saha Institute of Nuclear Physics, A CI of Homi Bhabha National Institute, Kolkata 700064, West Bengal, India
| | - M Makariev
- Institute for Nuclear Research and Nuclear Energy, Bulgarian Academy of Sciences, BG-1784 Sofia, Bulgaria
| | - G Maneva
- Institute for Nuclear Research and Nuclear Energy, Bulgarian Academy of Sciences, BG-1784 Sofia, Bulgaria
| | - N Mang
- Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - M Manganaro
- Croatian MAGIC Group: University of Rijeka, Department of Physics, 51000 Rijeka, Croatia
| | - S Mangano
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, E-28040 Madrid, Spain
| | - K Mannheim
- Universität Würzburg, D-97074 Würzburg, Germany
| | - M Mariotti
- Università di Padova and INFN, I-35131 Padova, Italy
| | - M Martínez
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - A Mas Aguilar
- IPARCOS Institute and EMFTEL Department, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - D Mazin
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - S Menchiari
- Università di Siena and INFN Pisa, I-53100 Siena, Italy
| | - S Mender
- Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - S Mićanović
- Croatian MAGIC Group: University of Rijeka, Department of Physics, 51000 Rijeka, Croatia
| | - D Miceli
- Università di Padova and INFN, I-35131 Padova, Italy
| | - T Miener
- IPARCOS Institute and EMFTEL Department, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - J M Miranda
- Università di Siena and INFN Pisa, I-53100 Siena, Italy
| | - R Mirzoyan
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - E Molina
- Universitat de Barcelona, ICCUB, IEEC-UB, E-08028 Barcelona, Spain
| | - H A Mondal
- Saha Institute of Nuclear Physics, A CI of Homi Bhabha National Institute, Kolkata 700064, West Bengal, India
| | - A Moralejo
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - D Morcuende
- IPARCOS Institute and EMFTEL Department, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - V Moreno
- Departament de Física, and CERES-IEEC, Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain
| | - T Nakamori
- Japanese MAGIC Group: Department of Physics, Yamagata University, Yamagata 990-8560, Japan
| | - C Nanci
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - L Nava
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - V Neustroev
- Finnish MAGIC Group: Space Physics and Astronomy Research Unit, University of Oulu, FI-90014 Oulu, Finland
| | - M Nievas Rosillo
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - C Nigro
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - K Nilsson
- Finnish MAGIC Group: Finnish Centre for Astronomy with ESO, University of Turku, FI-20014 Turku, Finland
| | - K Nishijima
- Japanese MAGIC Group: Department of Physics, Tokai University, Hiratsuka, 259-1292 Kanagawa, Japan
| | - T Njoh Ekoume
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - K Noda
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - S Nozaki
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - Y Ohtani
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - T Oka
- Japanese MAGIC Group: Department of Physics, Kyoto University, 606-8502 Kyoto, Japan
| | - J Otero-Santos
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - S Paiano
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - M Palatiello
- Università di Udine and INFN Trieste, I-33100 Udine, Italy
| | - D Paneque
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - R Paoletti
- Università di Siena and INFN Pisa, I-53100 Siena, Italy
| | - J M Paredes
- Universitat de Barcelona, ICCUB, IEEC-UB, E-08028 Barcelona, Spain
| | - L Pavletić
- Croatian MAGIC Group: University of Rijeka, Department of Physics, 51000 Rijeka, Croatia
| | - M Persic
- Università di Udine and INFN Trieste, I-33100 Udine, Italy
| | - M Pihet
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - F Podobnik
- Università di Siena and INFN Pisa, I-53100 Siena, Italy
| | | | - E Prandini
- Università di Padova and INFN, I-35131 Padova, Italy
| | - G Principe
- Università di Udine and INFN Trieste, I-33100 Udine, Italy
| | - C Priyadarshi
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - I Puljak
- Croatian MAGIC Group: University of Split, Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture (FESB), 21000 Split, Croatia
| | - W Rhode
- Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - M Ribó
- Universitat de Barcelona, ICCUB, IEEC-UB, E-08028 Barcelona, Spain
| | - J Rico
- Institut de Física d'Altes Energies (IFAE), The Barcelona Institute of Science and Technology (BIST), E-08193 Bellaterra (Barcelona), Spain
| | - C Righi
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - A Rugliancich
- Università di Pisa and INFN Pisa, I-56126 Pisa, Italy
| | - N Sahakyan
- Armenian MAGIC Group: ICRANet-Armenia at NAS RA, 0019 Yerevan, Armenia
| | - T Saito
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - S Sakurai
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - K Satalecka
- Finnish MAGIC Group: Finnish Centre for Astronomy with ESO, University of Turku, FI-20014 Turku, Finland
| | - F G Saturni
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | | | - K Schmidt
- Technische Universität Dortmund, D-44221 Dortmund, Germany
| | | | - J L Schubert
- Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - T Schweizer
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - J Sitarek
- University of Lodz, Faculty of Physics and Applied Informatics, Department of Astrophysics, 90-236 Lodz, Poland
| | - V Sliusar
- University of Geneva, Chemin d'Ecogia 16, CH-1290 Versoix, Switzerland
| | - D Sobczynska
- University of Lodz, Faculty of Physics and Applied Informatics, Department of Astrophysics, 90-236 Lodz, Poland
| | - A Spolon
- Università di Padova and INFN, I-35131 Padova, Italy
| | - A Stamerra
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - J Strišković
- Croatian MAGIC Group: Josip Juraj Strossmayer University of Osijek, Department of Physics, 31000 Osijek, Croatia
| | - D Strom
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - M Strzys
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - Y Suda
- Japanese MAGIC Group: Physics Program, Graduate School of Advanced Science and Engineering, Hiroshima University, 739-8526 Hiroshima, Japan
| | - T Surić
- Croatian MAGIC Group: Ruđer Bošković Institute, 10000 Zagreb, Croatia
| | - M Takahashi
- Japanese MAGIC Group: Institute for Space-Earth Environmental Research and Kobayashi-Maskawa Institute for the Origin of Particles and the Universe, Nagoya University, 464-6801 Nagoya, Japan
| | - R Takeishi
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - F Tavecchio
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - P Temnikov
- Institute for Nuclear Research and Nuclear Energy, Bulgarian Academy of Sciences, BG-1784 Sofia, Bulgaria
| | - K Terauchi
- Japanese MAGIC Group: Department of Physics, Kyoto University, 606-8502 Kyoto, Japan
| | - T Terzić
- Croatian MAGIC Group: University of Rijeka, Department of Physics, 51000 Rijeka, Croatia
| | - M Teshima
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - L Tosti
- INFN MAGIC Group: INFN Sezione di Perugia, I-06123 Perugia, Italy
| | - S Truzzi
- Università di Siena and INFN Pisa, I-53100 Siena, Italy
| | - A Tutone
- National Institute for Astrophysics (INAF), I-00136 Rome, Italy
| | - S Ubach
- Departament de Física, and CERES-IEEC, Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain
| | | | - M Vazquez Acosta
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, E-38200 La Laguna, Tenerife, Spain
| | - S Ventura
- Università di Siena and INFN Pisa, I-53100 Siena, Italy
| | - V Verguilov
- Institute for Nuclear Research and Nuclear Energy, Bulgarian Academy of Sciences, BG-1784 Sofia, Bulgaria
| | - I Viale
- Università di Padova and INFN, I-35131 Padova, Italy
| | - C F Vigorito
- INFN MAGIC Group: INFN Sezione di Torino and Università degli Studi di Torino, I-10125 Torino, Italy
| | - V Vitale
- INFN MAGIC Group: INFN Roma Tor Vergata, I-00133 Roma, Italy
| | - I Vovk
- Japanese MAGIC Group: Institute for Cosmic Ray Research (ICRR), The University of Tokyo, Kashiwa, 277-8582 Chiba, Japan
| | - R Walter
- University of Geneva, Chemin d'Ecogia 16, CH-1290 Versoix, Switzerland
| | - M Will
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - C Wunderlich
- Università di Siena and INFN Pisa, I-53100 Siena, Italy
| | - T Yamamoto
- Japanese MAGIC Group: Department of Physics, Konan University, Kobe, Hyogo 658-8501, Japan
| | - D Zarić
- Croatian MAGIC Group: University of Split, Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture (FESB), 21000 Split, Croatia
| | - N Hiroshima
- Department of Physics, University of Toyama, 3190 Gofuku, Toyama 930-8555, Japan
- RIKEN iTHEMS, Wako, Saitama 351-0198, Japan
| | - K Kohri
- Theory Center, IPNS, KEK, Tsukuba, Ibaraki 305-0801, Japan
- The Graduate University for Advanced Studies (SOKENDAI), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
- Kavli IPMU (WPI), UTIAS, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
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Zakaria M, Al-Akhras A, Hassan T, Sherief L, Magdy W, Raafat N. FcγRIIa and FcγRIIIa genes polymorphism in Egyptian children with primary immune thrombocytopenia. Hematol Transfus Cell Ther 2023; 45:58-65. [PMID: 34266810 PMCID: PMC9938460 DOI: 10.1016/j.htct.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/26/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Phagocytosis of autoantibody-sensitized coated platelets through Fc gamma receptors on phagocytic cells is an important mechanism of thrombocytopenia in primary immune thrombocytopenia (ITP). OBJECTIVE We aimed to investigate the contribution of the FcγRIIa and FcγRIIIa genes polymorphism to the risk of ITP and their association with disease characteristics in Egyptian children. METHODS A case control study was conducted on eighty children with primary ITP and eighty age and sex healthy matched subjects as a control group. The FcγRIIa and FcγRIIIa genes polymorphism was detected using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS We found that the FcγRIIa-131H and -131R allele frequencies were 51.3 % and 48.7%, respectively, in children with ITP, versus 75% and 25%, respectively, in controls (p = 0.002). The compound heterozygous HR genotype was significantly higher in ITP patients (p < 0.05). The FcγRIIIa-158F and -158V allele frequencies were 46.3% and 53.7%, respectively, in children with ITP, versus 70% and 30%, respectively, in controls (p = 0.002). The compound heterozygous VF genotype was significantly higher in ITP patients (p < 0.05). The combined HR/FV genotype was 47.5% in ITP patients, versus 10% in controls (p < 0.001). No significant difference was found between children with newly diagnosed ITP and those who developed chronic ITP, regarding the frequency distribution of the FcγRIIa and FcγRIIIa alleles and genotypes (p > 0.05). CONCLUSION There is a possible association of the FcγRIIa and FcγRIIIa genes polymorphism with the risk for, and genetic susceptibility to ITP in Egyptian children, but large-scale studies are still needed to support our findings.
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Zakaria M, Hassan T, Refaat A, Fathy M, Hashem MI, Khalifa N, Ali AA, Elhewala A, Ramadan A, Nafea A. Role of serum cystatin C in the prediction of acute kidney injury following pediatric cardiac surgeries: A single center experience. Medicine (Baltimore) 2022; 101:e31938. [PMID: 36626503 PMCID: PMC9750614 DOI: 10.1097/md.0000000000031938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Intense contemporary research is directed towards validating novel biomarkers to predict acute kidney injury (AKI) in children undergoing cardiothoracic surgeries. We aimed to evaluate the role of cystatin C in early prediction of AKI following cardiac surgery in children with congenital heart disease. Prospective observational cohort study was conducted on 40 children with congenital heart disease undergoing cardiac surgery. 40 healthy children with matched age and sex were enrolled as a control group. Children were subjected to physical examination, routine blood tests, echocardiography, and measurement of plasma cystatin C level on different occasions. The median age of the patients was 3.65 years, a range from 1 to 5 years with no significant difference regarding the age and sex of cases and control groups. The mean serum cystatin C level in patients was 0.75 ± 0.15, 1.35 ± 0.34 and 1.21 ± 0.38 mg/dL (preoperative, at 6 h and at 24 h postoperative, respectively) with statistically significant difference P < .05. 30% of the patients developed postoperative AKI with significantly higher serum cystatin C at 6 hours postoperative >1.33 mg/dL compared to preoperative level p P < .05. Serum cystatin C level was positively correlated with cardiac bypass time, ischemic time and length of hospital stay at 6 hours postoperative. Serum cystatin C is a sensitive marker for early detection of AKI following cardiac surgery in children with congenital heart disease and it was positively correlated with cardiac bypass time, ischemic time and length of hospital stay.
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Affiliation(s)
- Marwa Zakaria
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- *Correspondence: Marwa Zakaria, Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt (e-mail: )
| | - Tamer Hassan
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali Refaat
- Cardiothoracic Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Manar Fathy
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mustafa I.A. Hashem
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Naglaa Khalifa
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A. Ali
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elhewala
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Ramadan
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Alaa Nafea
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Elbiheery S, Badr M, Hassan T, Abd El Fattah N. Plasma Level of Matrix Metalloproteinase 9 In Beta Thalassemia. Zagazig University Medical Journal 2022; 0:0-0. [DOI: 10.21608/zumj.2022.161721.2639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Zakaria M, Hassan T, Fawzy A, Fathy M, Abdelazeem M, Magdy Abdelnour H, Abdelstar E, Nafea A, Ali AA. Association between ATP binding cassette gene member 1 polymorphism and glucocorticoid response in children with immune thrombocytopenia. Medicine (Baltimore) 2022; 101:e29894. [PMID: 35839018 DOI: 10.1097/md.0000000000029894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ATP binding Cassette gene member 1 (ABCB1) polymorphism has been incriminated in susceptibility to many malignant, infectious and autoimmune diseases. Recently, it was reported that ABCB1 polymorphisms might have a link to disease progression as well as response to therapy. We aimed to study the association between ABCB1 gene polymorphism and glucocorticoid response in children with newly diagnosed immune thrombocytopenia (ITP). A case control study was conducted on 90 newly diagnosed children with ITP and 90 healthy controls over a period of 1 year. ABCB1 (C3435T) polymorphism was determined by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) in patients and controls. There was no significant difference between patients and controls as regards to frequency of different ABCB1 genotypes (CC, CT, and TT genotypes were 44.4%, 36.7%, and 18.9% respectively in patients and 48.9%, 38.9%, and 12.2% respectively in controls, P value = 0.18). 80% of patients who received steroids alone or steroids in combination with intravenous immunoglobulin showed complete recovery. There was highly significant relationship between ABCB1 genotypes and response to steroids where 55 % of responders had CC (wild) genotype while 40 % of nonresponders had TT (mutant) genotype. We concluded that ABCB1 gene polymorphism may contribute to the response to steroids in Egyptian children with ITP where patients with homozygous CC genotype responded better to steroids than patients with homozygous TT genotype. These results may help us choose the appropriate initial treatment in these children.
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Affiliation(s)
- Marwa Zakaria
- Pediatric Department, Zagazig University, Zagazig, Egypt
| | - Tamer Hassan
- Pediatric Department, Zagazig University, Zagazig, Egypt
| | - Amal Fawzy
- Medical Biochemistry Department, Zagazig University, Zagazig, Egypt
| | - Manar Fathy
- Pediatric Department, Zagazig University, Zagazig, Egypt
| | | | | | - Eman Abdelstar
- Pediatric Department, Zagazig University, Zagazig, Egypt
| | - Alaa Nafea
- Pediatric Department, Zagazig University, Zagazig, Egypt
| | - Ahmed A Ali
- Pediatric Department, Zagazig University, Zagazig, Egypt
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Hassan T, Abdel Rahman D, Raafat N, Fathy M, Shehab M, Hosny A, Fawzy R, Zakaria M. Contribution of interleukin 27 serum level to pathogenesis and prognosis in children with immune thrombocytopenia. Medicine (Baltimore) 2022; 101:e29504. [PMID: 35758390 PMCID: PMC9276440 DOI: 10.1097/md.0000000000029504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
Concepts surrounding the mechanisms of thrombocytopenia in ITP have shifted from the traditional view of autoantibody mediated platelet destruction to more complex mechanisms in which impaired platelet production, T-cell-mediated effects, and disturbed cytokine profiles play a role. Interleukin 27 (IL-27) plays pleiotropic roles in immunomodulation and autoimmune diseases.We aimed to determine the level of IL-27 in patients with ITP and its relationship to patient and disease characteristics as well as disease chronicity and response to treatment.Sixty childrens with primary immune thrombocytopenia were consequetively enrolled in this study as well as 20 age and sex matched healthy controls.ITP patients had significantly higher levels of IL-27 than controls (770.6 and 373.8 pg/ml, respectively). Patients with acute ITP had the highest levels of IL-27 among patient groups, while patients in remission had the lowest IL-27 levels (860.1and 622.9 pg/ml, respectively). Patients who received IVIG and combined steroids plus IVIG had significantly higher IL-27 levels than others. Patients who received Eltrombopag had significantly lower IL-27 levels than others.IL-27 seems to play a role in pathogenesis of childhood ITP. IL-27 can be used as a predictor for disease occurrence as well as responsiveness to treatment.
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Hassan T. Forensic psychiatry in Pakistan: Where next following the Supreme Court judgement. Eur Psychiatry 2022. [PMCID: PMC9566293 DOI: 10.1192/j.eurpsy.2022.1536] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
No statutory mental health services exist for justice-involved individuals in Pakistan. The lack of expertise in forensic psychiatry serves to deny individuals with mental illness the critical support needed for mental healthcare and adequate court dispositions with serious unintended consequences including capital punishment for those who could otherwise be deemed treatment and not punishment worthy. A landmark judgement by the Supreme Court of Pakistan in February 2021 criticized the lack of forensic psychiatry expertise in Pakistan and directing the development of forensic mental health services and forensic psychiatry training in Pakistan.
Objectives
The key objectives are: 1. Understanding the timeline of how justice invloved individuals are manged by psychiatric services 2. The importance of the Supreme Court of Pakistan Judgement in affecting change 3. Highlights on how Queen’s University will enhance forensic psychiatry in Pakistan
Methods
A literature review and personal networking facilitated the collection of important data in how justice invloved individuals are supported in Pakistan. The author has published and presented to Pakistani psychiatrists and the Pakistani judiciary on this topic. Queen’s University is aiming to implement a 3-year plan to develop an online curriculum and certificate course to help train the trainers.
Results
In the Pakistan’s most populous province, Punjab, prevalence rates for psychotic illnesses (3.7%), major depression (10%), and personality disorders (65%) among men with higher rates for psychotic disorders (4.0%) and major depression (12%) among women.
Conclusions
In conclusion there is a dire need to develop forensic psychiatry in Pakistan and other low/middle income countries.
Disclosure
No significant relationships.
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Wali Y, Hassan T, Charoenkwan P, Trompeter S, Tartaglione I, Origa R, Gamberini MR, Viprakasit V, Izquierdo M, Opio S, Roy T, Taher A. Crushed deferasirox film-coated tablets in pediatric patients with transfusional hemosiderosis: Results from a single-arm, interventional phase 4 study (MIMAS). Am J Hematol 2022; 97:E292-E295. [PMID: 35570412 DOI: 10.1002/ajh.26598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Yasser Wali
- Department of Child Health Sultan Qaboos University Hospital Muscat Oman
| | - Tamer Hassan
- Department of Pediatrics Zagazig University Zagazig Egypt
| | | | - Sara Trompeter
- Department of Haematology University College London NHS Hospitals Foundation Trust and NHS Blood and Transplant London UK
| | - Immacolata Tartaglione
- Department of General and Specialized Surgery for Women and Children University of Campania “Luigi Vanvitelli” Caserta Italy
| | - Raffaella Origa
- Ospedale Pediatrico Microcitemico “A.Cao”, A.O. “G.Brotzu” ‐ Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | | | - Vip Viprakasit
- Department of Pediatrics and Internal Medicine Siriraj Hospital Bangkok Thailand
| | | | | | - Tania Roy
- Novartis Healthcare Pvt Ltd Hyderabad India
| | - Ali Taher
- Division of Hematology and Oncology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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Goldstein I, Hassan T, Li J, Riad M, Vignesh S, Zou K. Treatment and comorbidities of patients with erectile dysfunction before and during COVID-19 in the United States: A real-world data analysis. J Sex Med 2022. [PMCID: PMC9080966 DOI: 10.1016/j.jsxm.2022.03.428] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Introduction Objectives Methods Results Conclusions Disclosure
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Hassan T, Badr M, Hanna D, Arafa M, Elhewala A, Dabour S, Shehata S, Rahman DA. Retinopathy in Egyptian patients with sickle cell disease: A cross-sectional study. Medicine (Baltimore) 2021; 100:e28355. [PMID: 34941149 PMCID: PMC8702288 DOI: 10.1097/md.0000000000028355] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
Sickle cell disease (SCD) is a disorder that causes red blood cells to become sticky and rigid. Sickle cells can block blood flow in small blood vessels depriving the eye of oxygen and cause damage. This is called sickle retinopathy that can progress to severe proliferative sickle cell retinopathy, bleeding into the eye, detachment of the retina or even loss of vision.To assess ocular manifestations and detect frequency of retinopathy in patients with SCD.Cross-sectional study was conducted on 32 patients with SCD. They were 22 males and 10 females with mean age of 12 years. Routine investigations as well as ophthalmological examination including visual acuity, fluorescein angiography and optical coherence tomography were done.We found that 8 patients (25%) suffered from proliferative retinopathy, 10 patients (31%) showed tortuous retinal veins, while 14 patients (44%) were normal. All patients showed macular thinning on optical coherence tomography examination.We concluded that frequency of retinopathy in patients with SCD is more than expected and it was higher in patients who started transfusion at a later age. More attention should be paid for this problem and close observations and follow up is strongly needed.
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Affiliation(s)
- Tamer Hassan
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Badr
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Diana Hanna
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Arafa
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elhewala
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherief Dabour
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Saad Shehata
- Damanhour Teaching Hospital, Damanhour, El Beheira Governorate, Egypt
| | - Doaa Abdel Rahman
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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18
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Elalfy MS, Eltonbary KYEM, El Ghamry IR, Elalfy O, Wahid M, Badr M, Hassan T, Mansour A, Meabed M, El-Hawy M, Youssry I, Abd Elhady M, Elshanshory M, Elsayh K, Hassab HM. Intracranial hemorrhage in primary immune thrombocytopenia (ITP): 20 years' experience in pediatrics. Eur J Pediatr 2021; 180:1545-1552. [PMID: 33452569 DOI: 10.1007/s00431-020-03923-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
Incidence of intracranial hemorrhage (ICH) among children with primary immune thrombocytopenia (ITP) varies among different studies. We published data during the period of 1997-2007 of ICH in children with primary ITP, addressing risk factors and outcome. The aim of this study is to assess changes in incidence, risk factors, and outcome of ICH in children with ITP from last decade and to report the overall 20 years' experience. We compared 2008-2018 with the decade before it. Data of children with ITP and ICH during study period and ITP control cases were analyzed. Neurosurgical intervention and outcome were also reported. A total of 4340 children with primary ITP were evaluated. Twenty-five (0.63%) ICH events were reported over 2 decades. Head trauma, hematuria, and platelet counts < 10 × 109/L were the risk factors mostly associated with ICH. Overall mortality was 24%, and a further 28% had neurologic sequelae. Neurosurgical intervention was done in 12% of cases with good outcome.Conclusion: Persistent platelet counts < 10 × 109/L were a significant risk factor for ICH in both time periods, while head trauma and hematuria were more reported in the period of 2008-2018 as significant risk factors for ICH. Outcome was comparable in both periods. What is Known: • ICH is a rare complication of ITP; however, early recognition of risk factors and aggressive treatment might lead to complete recovery without sequalae. Platelet counts less than < 10 × 109/L are the main risk factor for ICH. Few studies reported other significant risk factors. What is New: • Hematuria and head trauma are significant risk factors for ICH in ITP, in addition to having a persistently low platelet count < 10 × 109/L. (more than 90 days in chronic ITP, 45 days in persistent and 21 days in acute ITP) • Combined treatment with IVIG and HDMP followed by platelet transfusion was associated with complete recovery without sequelae in almost 50% of patients.
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Affiliation(s)
- Mohsen Saleh Elalfy
- Department of Pediatric Hematology/Oncology, Ain Shams University, Cairo, Egypt
| | | | - Islam R El Ghamry
- Department of Pediatric Hematology/Oncology, Ain Shams University, Cairo, Egypt
| | - Omar Elalfy
- Department of Complementary Medicine, National Research Center, Cairo, Egypt
| | - Marwa Wahid
- Department of Pediatric Hematology/Oncology, Ain Shams University, Cairo, Egypt
| | - Mohamed Badr
- Department of Pediatric Hematology/Oncology, Zagazig University, Zagazig, Egypt
| | - Tamer Hassan
- Department of Pediatric Hematology/Oncology, Zagazig University, Zagazig, Egypt
| | - Ahmed Mansour
- Department of Pediatric Hematology/Oncology, Mansoura University, Mansoura, Egypt
| | - Mohamed Meabed
- Department of Pediatric Hematology/Oncology, Beni Suef University, Beni Suef, Egypt
| | - Mahmoud El-Hawy
- Department of Pediatric Hematology/Oncology, Menoufia University, Shibin Al Kawm, Menoufia, Egypt
| | - Ilham Youssry
- Department of Pediatric Hematology/Oncology, Cairo University, Cairo, Egypt
| | - Marwa Abd Elhady
- Department of Pediatric Hematology/Oncology, Cairo University, Cairo, Egypt
| | | | - Khalid Elsayh
- Department of Pediatric Hematology/Oncology, Assiut University, Assiut, Egypt
| | - Hoda M Hassab
- Department of Pediatric Hematology/Oncology, Alexandria University, Alexandria, Egypt
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Hassan A, Latif MT, Soo CI, Faisal AH, Roslina AM, Ban Andrea YL, Hassan T. Corrigendum to "Short communication: Diagnosis of lung cancer increases during the annual southeast Asian haze periods" [Lung Cancer 113 (2017) 1-3]. Lung Cancer 2021; 154:229. [PMID: 33678457 DOI: 10.1016/j.lungcan.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Hassan
- Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, University Kebangsaan, 56000 Cheras, Malaysia; Department of Clinical Oncology, University Technology MARA, 40450 Shah Alam, Malaysia
| | - M T Latif
- School of Environmental and Natural Resource Sciences, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; Institute for Environment and Development (Lestari), Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
| | - C I Soo
- Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, University Kebangsaan, 56000 Cheras, Malaysia
| | - A H Faisal
- Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, University Kebangsaan, 56000 Cheras, Malaysia
| | - A M Roslina
- Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, University Kebangsaan, 56000 Cheras, Malaysia
| | - Y L Ban Andrea
- Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, University Kebangsaan, 56000 Cheras, Malaysia
| | - T Hassan
- Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, University Kebangsaan, 56000 Cheras, Malaysia.
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20
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Mansour OY, Ramadan I, Elfatatry A, Hamdi M, Abudu A, Hassan T, Eldeeb H, Marouf H, Mogahed M, Farouk M, Abas M, Hamed M, Afify M, Abdallah T, Zaidat O. Using ESN-Smartphone Application to Maximize AIS Reperfusion Therapy in Alexandria Stroke Network: A Stroke Chain of Survival Organizational Model. Front Neurol 2021; 12:597717. [PMID: 33708169 PMCID: PMC7940834 DOI: 10.3389/fneur.2021.597717] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
Background: In developing countries like Egypt, the clinical workflow of stroke management is poorly established due to the lack of awareness of the stroke patients concerning their need of therapeutic intervention and the poor identification of facilities equipped to treat stroke. Hence, establishing a stroke system of care in developing countries that can efficiently and rapidly triage patients to the appropriate reperfusion therapy center is imperative to improving stroke management and outcomes. Aims: To evaluate a pilot experience in stroke hospital identification and expediting decision-making in AIS treatment through the Alexandria stroke network and Egyptian Stroke Network (ESN)-app. Methods: Between 2017 and 2019, seven hospitals registered themselves on the AS-Network as pilot hospitals. The ESN-application was used to detect stroke type, tele-connect stroke teams and hospitals, track triage of patients to equipped facility in real time, and streamline stroke workflow. The quality of and time required for stroke management were compared between 84 patients with acute ischemic stroke (AIS) whose treatment involved the ESN-app and 276 patients whose treatment did not. Results: During this pilot study, 360 AIS cases received reperfusion therapy, 84 of which were indicated by the ESN-app. The use of the application was associated with the significant drop in time metrics for the reperfusion AIS-patients (door-in-door-out time; 56 ± 34 min vs. 96 ± 45 min, door-to-groin puncture time; 50 ± 7 min vs. 120 ± 25 min, door-to-needle time; 55 ± 12 min vs. 78 ± 16 min with p < 0.0001). Its use was also associated with higher rates of excellent outcomes at the 90-day follow-up (without ESN-app vs. with ESN-app, 67.9 vs. 47.1%, p = 0.001) but no difference in 90-day mortality or symptomatic intracerebral hemorrhage (without ESN-app vs. with ESN-app, 9.5 vs. 11.2% and 4.8 vs. 5.1%, p > 0.05). Conclusion: Our pilot experience demonstrated that the use of the ESN-app expedited the stroke treatment workflow and facilitated tele-connection between registered stroke facilities. Additionally, its use might be associated with achieving higher rates of excellent outcomes at 90 days, where a larger scale study is needed for more confirmation.
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Affiliation(s)
- Ossama Yassin Mansour
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Louran Comprehensive Stroke Center, Alexandria, Egypt.,Mabaret Elasafra Hospital, Alexandria, Egypt.,Shark el Madina Ministry of Health Hospital, Alexandria, Egypt.,Department of Neurology, Damanhur Medical National Institute, Damanhur, Egypt.,Elandalusia General Hospital, Alexandria, Egypt
| | - Ismail Ramadan
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt
| | - Amer Elfatatry
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt
| | - Mohamed Hamdi
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt
| | - Ashraf Abudu
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt
| | - Tamer Hassan
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Louran Comprehensive Stroke Center, Alexandria, Egypt
| | - Hany Eldeeb
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Mabaret Elasafra Hospital, Alexandria, Egypt
| | - Hazem Marouf
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Mabaret Elasafra Hospital, Alexandria, Egypt
| | | | - Mohamed Farouk
- Shark el Madina Ministry of Health Hospital, Alexandria, Egypt
| | - Mohamed Abas
- Department of Neurology, Damanhur Medical National Institute, Damanhur, Egypt
| | - Mervat Hamed
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Elandalusia General Hospital, Alexandria, Egypt
| | | | - Tamer Abdallah
- Stroke Center, Semouha Emergency University Hospital, Alexandria, Egypt.,Stroke Unit, Elhadara University Hospital, Alexandria, Egypt.,Louran Comprehensive Stroke Center, Alexandria, Egypt
| | - Osama Zaidat
- Bon Secours Mercy Health System, Neuroscience Institute, St. Vincent Hospital, Toledo, OH, United States
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21
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Ramos-Araque ME, Siegler JE, Ribo M, Requena M, López C, de Lera M, Arenillas JF, Pérez IH, Gómez-Vicente B, Talavera B, Portela PC, Guillen AN, Urra X, Llull L, Renú A, Nguyen TN, Jillella D, Nahab F, Nogueira R, Haussen D, Then R, Thon JM, Esparragoza LR, Hernández-Pérez M, Bustamante A, Mansour OY, Megahed M, Hassan T, Liebeskind DS, Hassan A, Bushnaq S, Osman M, Vazquez AR. Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry. BMC Neurol 2021; 21:43. [PMID: 33514335 PMCID: PMC7846488 DOI: 10.1186/s12883-021-02075-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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] [Received: 11/18/2020] [Accepted: 01/19/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. METHODS We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20-6/16/20). RESULTS Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41-18.87, p = 0.01). In that model, older age (aOR 2.05 per decade, 95%CI 1.35-3.11, p < 0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02-1.21, p = 0.01) were also independently predictive of mortality. CONCLUSIONS Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.
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Affiliation(s)
- María E Ramos-Araque
- Institute of Biomedical Research of Salamanca, Department of Neurology, Hospital Universitario de Salamanca, Salamanca, Spain
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - James E Siegler
- Cooper Neurologic Institute, Cooper University Hospital, Camden, NJ, USA.
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain
- Departament of Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain
- Departament of Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Cristina López
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Mercedes de Lera
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Juan F Arenillas
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Isabel Hernández Pérez
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Beatriz Gómez-Vicente
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Blanca Talavera
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Ana Nuñez Guillen
- Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, Spain
| | - Xabier Urra
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Laura Llull
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Arturo Renú
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Thanh N Nguyen
- Department of Neurology, Department of Radiology, Department of Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Dinesh Jillella
- Department of Neurology, Emory University School of Medicine, Atlanta, USA
| | - Fadi Nahab
- Department of Neurology, Emory University School of Medicine, Atlanta, USA
| | - Raul Nogueira
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA
| | - Diogo Haussen
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA
| | - Ryna Then
- Cooper Neurologic Institute, Cooper University Hospital, Camden, NJ, USA
| | - Jesse M Thon
- Cooper Neurologic Institute, Cooper University Hospital, Camden, NJ, USA
| | - Luis Rodríguez Esparragoza
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria Hernández-Pérez
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alejandro Bustamante
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ossama Yassin Mansour
- Neurology Department, Stroke and neurointervention unit, Alexandria University, Alexandria, Egypt
| | - Mohammed Megahed
- Critical care Department, Alexandria University, Alexandria, Egypt
| | - Tamer Hassan
- Neurosurgery Department, Stroke and Neurointervention unit, Alexandria University, Alexandria, Egypt
| | - David S Liebeskind
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, USA
| | - Ameer Hassan
- Department of Clinical Neuroscience Research, Valley Baptist Medical Center, Harlingen, TX, USA
- Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Saif Bushnaq
- Neuroscience Institute, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA
| | - Mohamed Osman
- Neuroscience Institute, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA
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Hesham M, Hassan T, Fawzy A, Mohamed N, Alhejny E, Fathy M, El Gebaly S, Zakaria M. PTPN22 gene polymorphism as a genetic risk factor for primary immune thrombocytopenia in Egyptian children. Expert Rev Hematol 2020; 14:877-881. [PMID: 33064968 DOI: 10.1080/17474086.2020.1838895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Several genetic and non-genetic risk factors are implicated in the etiology and pathogenesis of primary immune thrombocytopenia (ITP). Protein tyrosine phosphatase non-receptor 22 gene (PTPN22) plays an important role in regulation of signal transduction through the T-cell receptors. PTPN22 1858 C > T single nucleotide polymorphism was reported to be associated with increased risk of autoimmune diseases. There are very few studies investigating the role of PTPN22(SNP) 1858 C > T in childhood ITP. METHODS This case-control study was designed for assessing the contribution of PTPN22 1858 C > T polymorphism to the risk of ITP in Egyptian children. Eighty children with newly diagnosed ITP were recruited from pediatric hematology out-patient clinic. Also, eighty age and sex-matched healthy children were enrolled as a control group. PTPN22 1858 C/T SNP gene polymorphism was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS Frequency of PTPN22 1858 C/T genotypes CT, CC, and TT were 32.5,55, and 12.5% in patients versus 10, 90, and 0% in controls (p < 0.05).TT genotype was significantly associated with higher risk of ITP (OR = 17.8(0.94-333.35), 95% CI, and P = 0.02). CONCLUSION PTPN22 gene polymorphism may play a pivotal role in genetic predisposition to ITP and disease progress in Egyptian children.
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Affiliation(s)
- Mervat Hesham
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Tamer Hassan
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amal Fawzy
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Noura Mohamed
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ebtihaj Alhejny
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Manar Fathy
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherief El Gebaly
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Marwa Zakaria
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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23
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O'Reilly M, Gillen C, Meehan C, Counihan I, Hassan T. Pulmonary Rehabilitation Programme: A Transcendence During Covid-19 Pandemic. Ir Med J 2020; 113:141. [PMID: 35603491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- M O'Reilly
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
| | - C Gillen
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
| | - C Meehan
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
| | - I Counihan
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
| | - T Hassan
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
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24
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Saqr KM, Rashad S, Tupin S, Niizuma K, Hassan T, Tominaga T, Ohta M. What does computational fluid dynamics tell us about intracranial aneurysms? A meta-analysis and critical review. J Cereb Blood Flow Metab 2020; 40:1021-1039. [PMID: 31213162 PMCID: PMC7181089 DOI: 10.1177/0271678x19854640] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the plethora of published studies on intracranial aneurysms (IAs) hemodynamic using computational fluid dynamics (CFD), limited progress has been made towards understanding the complex physics and biology underlying IA pathophysiology. Guided by 1733 published papers, we review and discuss the contemporary IA hemodynamics paradigm established through two decades of IA CFD simulations. We have traced the historical origins of simplified CFD models which impede the progress of comprehending IA pathology. We also delve into the debate concerning the Newtonian fluid assumption used to represent blood flow computationally. We evidently demonstrate that the Newtonian assumption, used in almost 90% of studies, might be insufficient to describe IA hemodynamics. In addition, some fundamental properties of the Navier-Stokes equation are revisited in supplementary material to highlight some widely spread misconceptions regarding wall shear stress (WSS) and its derivatives. Conclusively, our study draws a roadmap for next-generation IA CFD models to help researchers investigate the pathophysiology of IAs.
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Affiliation(s)
- Khalid M Saqr
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan.,Department of Mechanical Engineering, College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport, Alexandria, Egypt
| | - Sherif Rashad
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Simon Tupin
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, Egypt
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Makoto Ohta
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
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25
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Affiliation(s)
- T Hassan
- Department of Urology, Hôpital Henri-Mondor, France
| | | | - A Ingels
- Department of Urology, Hôpital Henri-Mondor, France.
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26
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Zineldin M, Hassan T, Vasicheva V. Emotional Support and its Medical and Healthcare Implications: A Mind and Body Approach. J of Medical Sciences 2020. [DOI: 10.3923/jms.2020.60.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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27
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Hassan T, Sultan A, Ibrahim T, El-Saadany WF. The Impact of Angiographic Geometry on the Clinical Presentation of True Vein of Galen Aneurysmal Malformations. Pediatr Neurosurg 2020; 55:344-350. [PMID: 33440394 DOI: 10.1159/000512213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND PURPOSE Vein of Galen aneurysmal malformations (VGAM) may carry life-threatening and catastrophic sequelae in children. Their clinical presentations are differently variable between cardiac and cerebral syndromes. There may be a possible relationship between the Galenic angioarchitecture and the clinical presentation. We aimed to study the effect of the venous outflow impairment on the incidence of high-flow heart failure and the incidence of hydrocephalus. MATERIALS AND METHODS The angiographies of 21 patients with true VGAM have been studied. MR angiography, 3-dimensional CT angiogram (3D CTA), and conventional digital subtraction angiography were performed for all patients with true VGAM. Transarterial embolization was done in 1 or more sessions for all cases. RESULTS Among the 21 cases, 14 cases were mural type, 5 cases were choroidal type, and 2 cases were mixed. Hydrocephalus was observed more in infants (92.3%), mural types (92.9%), giant and supergiant (87.5%) aneurysms, and in cases with persistent limbic circle (90.91%). All cases of hydrocephalus were associated with significant stenosis (>70%) of the Falcine sinus draining system (100%). CONCLUSION Significant stenosis (>70%) of the draining sinus is a significant factor for VGAM aneurysmal enlargement and occurrence of hydrocephalus. Probably, venous outflow impairment decreases the incidence of high-flow heart failure and increases the incidence of hydrocephalus.
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Affiliation(s)
- Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, Egypt,
| | - Ahmed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, Egypt
| | - Tamer Ibrahim
- Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, Egypt
| | - Waleed F El-Saadany
- Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, Egypt
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28
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Yoon S, Wong S, Ahmad N, Mariapun S, Hassan T, Padmanabhan H, Lim J, George A, Thong M, Chng G, Teo S, Bleiker E, Woo Y. Mainstreaming genetic counselling for genetic testing of BRCA1/2 in ovarian cancer patients in Malaysia (MaGIC study). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz446.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Nafea OE, Zakaria M, Hassan T, El Gebaly SM, Salah HE. Subclinical nephrotoxicity in patients with beta-thalassemia: role of urinary kidney injury molecule. Drug Chem Toxicol 2019; 45:93-102. [PMID: 31905029 DOI: 10.1080/01480545.2019.1660362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We aimed to investigate the role of urinary kidney injury molecule-1 (KIM-1) in detection of subclinical nephrotoxicity in patients with Beta-thalassemia (β-TM) in relation to chelation therapy and to correlate the urinary KIM-1 level with other clinical and laboratory findings. We conducted a cross-sectional study on 66 thalassemic patients. Their ages range from 7 to 22 years. Routine kidney indices and novel urinary KIM/creatinine ratio (UKIM-1/Cr) were measured. Estimated glomerular filtration rate (eGFR) was calculated. Results indicate that the level of serum creatinine was significantly higher in patients on deferasirox therapy than patients on deferoxamine and deferiprone therapy [median(IQR), 0.85(0.63-0.99), 0.50(0.34-0.58) and 0.44(0.36-0.45)] mg/dL, respectively, p < 0.001]. The median(IQR) level of eGFR was significantly lower in patients on deferasirox therapy than patients on deferoxamine and deferiprone therapy [63.3(56.5-92.1), 117.3(91.9-162) and 136.7(109.4-157.6)] ml/min/1.73 m2, respectively, p < 0.001]. The mean level of UKIM-1/Cr was significantly higher in patients on deferasirox therapy than patients on deferoxamine and deferiprone therapy (7.0 ± 1.9, 4.1 ± 1.7 and 4.2 ± 1.5) ng/mg creatinine, respectively, p < 0.001). We concluded that urinary KIM-1 is an early predictive biomarker for decline in eGFR in patients with β-TM on deferasirox therapy. The appropriate chelation therapy and good monitoring of those patients are intensely needed for early detection of renal dysfunction and timely intervention.
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Affiliation(s)
- Ola E Nafea
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Marwa Zakaria
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Tamer Hassan
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Sherif M El Gebaly
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Hosam E Salah
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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30
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Hassan T, Zakaria M, Fathy M, Arafa M, El Gebaly S, Emam A, Abdel Wahab A, Shehab M, Salah H, Malek M, El Gerby K. Association between genotype and disease complications in Egyptian patients with beta thalassemia: A Cross-sectional study. Sci Rep 2018; 8:17730. [PMID: 30531823 PMCID: PMC6286337 DOI: 10.1038/s41598-018-36175-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/26/2018] [Accepted: 11/11/2018] [Indexed: 01/19/2023] Open
Abstract
In beta thalassemia, the degree of globin chain imbalance is determined by the nature of the mutation of the β-gene. β° refers to the complete absence of production of β-globin on the affected allele. β+ refers to alleles with some residual production of β-globin. The homozygous state results in severe anemia that necessitates regular blood transfusion. On the other hand, frequent blood transfusion can lead to iron overload resulting in progressive dysfunction of the heart, Liver as well as multiple endocrinopathies. We studied the impact of genotype on the development of disease complications in patients with β thalassemia. A Cross sectional study was carried on 73 patients with beta thalassemia. Genotyping was determined by DNA sequencing technique. Routine investigations as well as MRI liver and heart were performed to assess iron overload. We found that β+β+ was the most common genotype in our patients followed by β°β° and β°β+. Mean Liver iron content (LIC) was significantly higher in β°β° compared to β°β+ and β+β+ genotypes and mean cardiac T2* was significantly lower in β°β° compared to β°β+ and β+β+ genotypes. Hepatic complications, hepatitis C, cardiac complications and some endocrinopathies were significantly higher in patients with β°β° genotype compared to other genotypes which explain the role of the underlying genetic defect in thalassemia patients in development of disease complications.
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Affiliation(s)
| | | | - Manar Fathy
- Pediatric, Zagazig University, Zagazig, Egypt
| | | | | | - Ahmed Emam
- Pediatric, Zagazig University, Zagazig, Egypt
| | | | | | - Hosam Salah
- Clinical pathology, Zagazig University, Zagazig, Egypt
| | - Mai Malek
- Microbiology, Zagazig University, Zagazig, Egypt
| | - Khaled El Gerby
- Radiodiagnosis departments, Zagazig University, Zagazig, Egypt
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31
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Saqr KM, Mansour O, Tupin S, Hassan T, Ohta M. Evidence for non-Newtonian behavior of intracranial blood flow from Doppler ultrasonography measurements. Med Biol Eng Comput 2018; 57:1029-1036. [PMID: 30523533 DOI: 10.1007/s11517-018-1926-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 08/02/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
Abstract
Computational fluid dynamics (CFD) studies of intracranial hemodynamics often use Newtonian viscosity model to close the shear rate term in the Navier-Stokes equation. This is based on a commonly accepted hypothesis which state that non-Newtonian effects can be neglected in intracranial blood flow. This study aims to examine the validity of such hypothesis to guide future CFD studies of intracranial hemodynamics. Doppler ultrasonography (DUS) measurements of systolic and diastolic vessel diameter and blood velocity were conducted on 16 subjects (mean age 50.6). The measurements were conducted on the internal carotid (ICA), middle cerebral (MCA), and anterior communicating (AComA) arteries. Systolic and diastolic wall shear stress (WSS) values were calculated via the Hagen-Poiseuille exact solution using Newtonian and three different non-Newtonian models: namely Carreau, power-law and Herschel-Bulkley models. The Weissenberg-Rabinowitsch correction for blood shear-thinning viscosity was applied to the non-Newtonian models. The error percentage between the two sets of models was calculated and discussed. The Newtonian hypothesis was tested statistically and discussed using paired t tests. Significant differences (P < 0.0001) were found between the Newtonian and non-Newtonian WSS in ICA. In MCA and AComA, similar differences were found except in the systole and diastole for the Herschel-Bulkley and power-law models (P = 0.0669, P = 0.7298), respectively. The error between the Newtonian and non-Newtonian models ranged from - 27 to 30% (0.2 to 2.2 Pa). These values could affect the physical interpretation of IA CFD studies. Evidence suggests that the Newtonian assumption may be inappropriate to investigate intracranial hemodynamics. Graphical abstract The WSS estimation error resulting from using the Newtonian assumption compared to three non-Newtonian models for ICA, MCA, and AComA in systole and diastole conditions, based on TCCD measurements of 16 subjects. The error due to the Newtonian assumption ranged from 0.2 to 2.2 Pa (- 27 to 30%). These values could affect the physical interpretation of IA CFD studies.
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Affiliation(s)
- Khalid M Saqr
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, 980-8577, Japan. .,College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport (AASTMT), Abu Kir, Alexandria, 1029, Egypt. .,Research Center for Computational Neurovascular Biomechanics (RCCNB), Smouha University Hospital, Alexandria University, Alexandria, 21648, Egypt.
| | - Ossama Mansour
- Research Center for Computational Neurovascular Biomechanics (RCCNB), Smouha University Hospital, Alexandria University, Alexandria, 21648, Egypt.,Department of Neurology, Stroke Unit, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, 21514, Egypt
| | - Simon Tupin
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, 980-8577, Japan
| | - Tamer Hassan
- Research Center for Computational Neurovascular Biomechanics (RCCNB), Smouha University Hospital, Alexandria University, Alexandria, 21648, Egypt.,Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, 21514, Egypt
| | - Makoto Ohta
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, 980-8577, Japan
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32
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Yoon S, Ahmad Bashah N, Wong S, Mariapun S, Padmanabhan H, Hassan T, Lim J, Lau S, Rahman N, Thong M, Ch'Ng G, Teo S, Bleiker E, Woo Y. Mainstreaming genetic counselling for genetic testing of BRCA1 and BRCA2 in ovarian cancer patients in Malaysia (MaGiC study). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy483.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Yoon S, Bashah N, Wong S, Mariapun S, Hassan T, Padmanabhan H, Lim J, Lau S, Rahman N, Thong M, Ch'Ng G, Teo S, Bleiker E, Woo Y. Mainstreaming genetic counselling for genetic testing of BRCA1 and BRCA2 in ovarian cancer patients in Malaysia (MaGiC study). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx729.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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34
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Hassan T, Badr M, Safy UE, Hesham M, Sherief L, Beshir M, Fathy M, Malky MA, Zakaria M. Target Therapy in Neuroblastoma. Neuroblastoma - Current State and Recent Updates 2017. [DOI: 10.5772/intechopen.70328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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35
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Shahbah D, Hassan T, Morsy S, Saadany HE, Fathy M, Al-Ghobashy A, Elsamad N, Emam A, Elhewala A, Ibrahim B, Gebaly SE, Sayed HE, Ahmed H. Oral magnesium supplementation improves glycemic control and lipid profile in children with type 1 diabetes and hypomagnesaemia. Medicine (Baltimore) 2017; 96:e6352. [PMID: 28296769 PMCID: PMC5369924 DOI: 10.1097/md.0000000000006352] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Dietary supplementation with magnesium (Mg) in addition to classical therapies for diabetes may help in prevention or delaying of diabetic complications.We aimed to evaluate the status of serum Mg in children with type 1 diabetes and assessing its relationship to glycemic control and lipid profile. Then evaluating the effect of oral Mg supplementation on glycemic control and lipid parameters.We included 71 children at Pediatric Endocrinology Outpatient Clinic, Zagazig University, Egypt with type 1 diabetes and assessed HBA1c, lipid profile, and serum Mg at the start of study. Patients with serum Mg level < 1.7 mg/dL were given 300 mg Mg oxide for 3 months. After that we reevaluated HBA1c, lipid profile, and serum Mg in all patients.The study included 71 patients with type 1 diabetes (32 males and 39 females); their mean age was 9.68 ± 3.99 years. The mean serum Mg level was 1.83 ± .27 mg/dL. Hypomagnesemia was detected in 28.2% study patients. Serum Mg was found to be positively correlated with high density lipoprotein, mean corpuscular volume and platelet count (P < 0.001), and negatively correlated with age, HbA1c, triglycerides, total cholesterol, low density lipoprotein, and duration of diabetes (P < 0.001). There was significant reduction in HBA1c in group given Mg supplementation. HBA1c was initially 10.11% ± 0.87%. After 3 months of oral Mg supplementation it is reduced to 7.88% ± 0.42% (P < 0.001). There was statistically significant difference in lipid parameters in hypomagnesemic diabetic patients before and after Mg supplementation with significant reduction in serum triglycerides, LDL, and total cholesterol following Mg supplementation with P < 0.001. Although HDL shows a significant increase after Mg supplementation in hypomagnesemic diabetic children with P < 0.001.Correction of hypomagnesemia in type 1 diabetic children with oral Mg supplements is associated with optimization of glycemic control and reduction of atherogenic lipid fraction as well as increase in protective lipid fraction.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Hanan Ahmed
- Department of Clinical Pathology, Zagazig University, Zagazig, Egypt
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Hassan T, Abdel-Fattah F, Farid A, Kamel E. EFFECT OF FEEDING GUAVA WASTE ON GROWTH PERFORMANCE, DIET DIGESTIBILITY, CARCASS CHARACTERISTICS AND PRODUCTION PROFITABILITY OF OSSIMI LAMBS. ACTA ACUST UNITED AC 2016. [DOI: 10.21608/ejnf.2016.74985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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37
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Hassan T, Badr M, El Safy U, Hesham M, Sherief L, Zakaria M. β-Thalassemia: Genotypes and Phenotypes. Epidemiology of Communicable and Non-Communicable Diseases - Attributes of Lifestyle and Nature on Humankind 2016. [DOI: 10.5772/64644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Shahbah D, El Naga AA, Hassan T, Zakaria M, Beshir M, Al Morshedy S, Abdalhady M, Kamel E, Rahman DA, Kamel L, Abdelkader M. Status of serum magnesium in Egyptian children with type 1 diabetes and its correlation to glycemic control and lipid profile. Medicine (Baltimore) 2016; 95:e5166. [PMID: 27893657 PMCID: PMC5134850 DOI: 10.1097/md.0000000000005166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Diabetes mellitus has been suggested to be the most common metabolic disorder associated with magnesium deficiency, having 25% to 39% prevalence. This deficit could be associated with the development of late diabetic complications, especially macroangiopathy.We aimed to evaluate the status of serum Mg in children with type 1 diabetes and assess its relation to glycemic control and lipid profile.We included 71 Egyptian children with type 1diabetes having their follow-up at Pediatric Endocrinology outpatient clinic, Zagazig University Hospital and 71 age- and sex-matched control. We measured Serum magnesium, HbA1c, and lipid profile in all study subjects.Diabetic children had significantly lower serum magnesium level compared to control children (1.83 ± .27 mg/dL in diabetic children versus 2.00 ± .16 mg/dL in control children). Taking cut-off level of serum magnesium <1.7 mg/dL for definition of hypomagnesemia, hypomagnesemia was detected in 28.2% of diabetic children compared to 9.9% of control children. In diabetic patients, there was statistically significant difference in HbA1c between hypomagnesemic and normomagnesemic group being higher in the low magnesium group, as it is mean ± SD was 11.93 ± 3.17 mg/dL in group I versus 8.92 ± 0.93 mg/dL in the normomagnesemic group. Serum magnesium was found to be positively correlated with HDL (P < 0.001), and negatively correlated with age, HbA1c, triglycerides, total cholesterol, LDL, and duration of diabetes (P < 0.001).We concluded that total serum magnesium was frequently low in Egyptian children with type 1 diabetes and it is correlated with HbA1c and with lipid profile. Hypomagnesemia was more evident in patients with poor diabetic control and those with higher atherogenic lipid parameters. We suggest that low serum magnesium may be included in pathogenesis of poor glycemic control and abnormal lipid profile in children with type 1 diabetes. We need to perform further studies on giving magnesium supplements in diabetic children with hypomagnesemia to observe the effect of correction of serum magnesium on glycemic control, lipid profile, and the risk of diabetic complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lamiaa Kamel
- Department of Clinical Pathology, Zagazig University, Egypt
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Sultan A, Hassan T, Aziz W, Ibrahim T, Yehia A, Mansour O. Predictive Factors of the Management of Spinal Cord Arteriovenous Fistulas. Turk Neurosurg 2016; 28:118-127. [PMID: 27593843 DOI: 10.5137/1019-5149.jtn.18009-16.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Spinal cord arteriovenous fistulas are rare cause of progressive myelopathy. The predictive factors of their outcome after endovascular or surgical treatment are still controversial. MATERIAL AND METHODS Twenty patients were diagnosed with spinal arteriovenous fistulas; 13 of them had dural and 7 had perimedullary fistulas (1 Dorsal and 6 Ventral). Surgery, endovascular or both treatments were used. RESULTS Ten of the 13 patients in the dural group were surgically treated, while 2 were managed by embolization and one combined. Seven patients improved, while 6 patients showed stationary clinical course after intervention. Five patients in the perimedullary group were embolized with clinical improvement, 1 patient refused intervention, and 1 patient had surgery. Clinical improvement was significantly correlated to the duration of symptoms before intervention (p=0.012), and preoperative neurological condition (p=0.001). No significant correlation was found with age, anatomic level of the fistula, fistula type, and type of intervention. CONCLUSION Microsurgery was preferred for dural and dorsally located perimedullary fistula, while embolization was preferred for ventrally located ones. Clinical improvement was significantly correlated with early intervention and preoperative neurological condition of the patient. Age of the patient, fistula type, fistula location, and type of intervention did not show significant relation to the outcome. Patients could benefit from intervention even if they present with poor neurological condition.
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Affiliation(s)
- Ahmed Sultan
- Alexandria University, Department of Neurosurgery, Alexandria, Egypt
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Badr M, Hassan T, Sakr H, Karam N, Rahman DA, Shahbah D, Zakaria M, Fehr S. Chemotherapy-induced neutropenia among pediatric cancer patients in Egypt: Risks and consequences. Mol Clin Oncol 2016; 5:300-306. [PMID: 27588196 PMCID: PMC4998081 DOI: 10.3892/mco.2016.957] [Citation(s) in RCA: 10] [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: 10/19/2015] [Accepted: 04/18/2016] [Indexed: 11/05/2022] Open
Abstract
Chemotherapy-induced neutropenia (CIN) is the major dose-limiting toxicity of systemic chemotherapy and it is associated with significant morbidity, mortality and treatment cost. The aim of the present study was to identify the risk factors that may predispose pediatric cancer patients who receive myelosuppressive chemotherapy to CIN and associated sequelae. A total of 113 neutropenia episodes were analyzed and the risk factors for CIN were classified as patient-specific, disease-specific and regimen-specific, while the consequences of CIN were divided into infectious and dose-modifying sequelae. The risks and consequences were analyzed to target high-risk patients with appropriate preventive strategies. Among our patients, 28% presented with a single neutropenia attack, while 72% experienced recurrent attacks during their treatment cycles. The mean absolute neutrophil count was 225.5±128.5 ×109/l (range, 10-497 ×109/l), starting 14.2±16.3 days (range, 2-100 days) after the onset of chemotherapy and resolving within 11.2±7.3 days, either with (45.1%) or without (54.9%) granulocyte colony-stimulating factor (G-CSF). No significant association was observed between any patient characteristics or disease stage and the risk for CIN. However, certain malignancies, such as acute lymphocytic leukemia (ALL), neuroblastoma and Burkitt's lymphoma, and certain regimens, such as induction block for ALL and acute myelocytic leukemia, exerted the most potent myelotoxic effect, with severe and prolonged episodes of neutropenia. G-CSF significantly shortened the duration of the episodes and enhanced bone marrow recovery. Febrile neutropenia was the leading complication among our cases (73.5%) and was associated with several documented infections, particularly mucositis (54.9%), respiratory (45.1%), gastrointestinal tract (38.9%) and skin (23.9%) infections. A total of 6% of our patients succumbed to infection-related complications. Neutropenia was responsible for treatment discontinuation (13.3%), dose delay (13.3%) and dose reduction (5.3%) in our patients. The mean cost for each episode in our institution was 9,386.5±6,688.9 Egyptian pounds, which represented a significant burden on health care providers.
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Affiliation(s)
- Mohamed Badr
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharqia 44111, Egypt
| | - Tamer Hassan
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharqia 44111, Egypt
| | - Hanan Sakr
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharqia 44111, Egypt
| | - Nehad Karam
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharqia 44111, Egypt
| | - Doaa Abdel Rahman
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharqia 44111, Egypt
| | - Doaa Shahbah
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharqia 44111, Egypt
| | - Marwa Zakaria
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharqia 44111, Egypt
| | - Sahbaa Fehr
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharqia 44111, Egypt
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Sultan AE, Hassan T. Infantile Dural Arteriovenous Fistula of the Transverse Sinus Presenting with Ocular Symptoms, Case Reports and Review of Literature. J Korean Neurosurg Soc 2016; 59:296-301. [PMID: 27226864 PMCID: PMC4877555 DOI: 10.3340/jkns.2016.59.3.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 12/22/2014] [Accepted: 03/09/2015] [Indexed: 11/27/2022] Open
Abstract
Dural arteriovenous fistula (DAVF) of the transverse sinus with ophthalmic manifestations in young children are rare. We reviewed two cases of direct AVF of the transverse sinus with ocular manifestations managed at our institution. The first, a 2.5 years old male child presented with left exophthalmos. Angiography revealed AVF between the occipital artery and the transverse sinus. The second, a 2 years old female child, complained of left exophthalmos. Imaging studies showed bilateral direct AVFs of the transverse sinus with bilateral dysmaturation of the sigmoid sinus. Transarterial embolization was done in both cases. Clinical and radiological follow up revealed complete cure.This report suggests that DAVF of the transverse sinus supplied by the external carotid branches can present with ophthalmic manifestations especially if there is distal venous stenosis or obliteration involving sigmoid sinus. Transarterial embolization using coils and liquid embolic agents could be safe and feasible to obliterate the fistula.
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Affiliation(s)
- Ahmed Elsayed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
| | - Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
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Al-Akhras A, Badr M, El-Safy U, Kohne E, Hassan T, Abdelrahman H, Mourad M, Brintrup J, Zakaria M. Impact of genotype on endocrinal complications in β-thalassemia patients. Biomed Rep 2016; 4:728-736. [PMID: 27284414 DOI: 10.3892/br.2016.646] [Citation(s) in RCA: 18] [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] [Received: 11/23/2015] [Accepted: 02/18/2016] [Indexed: 01/27/2023] Open
Abstract
In β-thalassemia, certain mutations cause a complete absence of β-globin chain synthesis, termed β0-thalassemia, while others may allow certain β-globin production and are termed β+- or β++-thalassemia. The homozygous state results in severe anemia, which requires regular blood transfusion. By contrast, frequent blood transfusion can in turn lead to iron overload, which may result in several endocrinal complications. The present study aimed to investigate the impact of genotype on the development of endocrine complications in β-thalassemia patients. A cross-sectional study was conducted on 100 thalassemia patients >10 years. A data abstraction form was designed to capture the appropriate information from the individual medical records, including full clinical, laboratory, transfusion and chelation data. The genotype of the patients was identified by the DNA sequencing technique. Growth retardation and hypogonadism were the most prominent endocrinal complications (70 and 67%, respectively) followed by hypothyroidism, diabetes mellitus and hypoparathyrodism (8, 8 and 7%, respectively). The most common mutations identified were IVS-1-110, IVS-1-1 and IVS-1-6 (63, 47 and 41%, respectively). Patients with the β0β0 genotype had a significantly higher prevalence of growth retardation, hypogonadism, hypothyroidism and hypoparathyrodism compared to those with the β0β+ and β+β+ genotypes (P<0.001, P<0.001, P<0.001 and P=0.037, respectively). Patients with the homozygous IVS-11-745 mutation had a significantly higher prevalence of diabetes (P=0.001). The underlying genetic defect in thalassemia patients is a contributing factor for the development of endocrinal complications, as patients with the more severe defects have a greater rate of iron loading through higher red cell consumption.
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Affiliation(s)
- Ahmed Al-Akhras
- Department of Pediatrics, Zagazig University, Zagazig 44111, Egypt
| | - Mohamed Badr
- Department of Pediatrics, Zagazig University, Zagazig 44111, Egypt
| | - Usama El-Safy
- Department of Pediatrics, Zagazig University, Zagazig 44111, Egypt
| | - Elisabeth Kohne
- Department of Pediatrics and Adolescents, Laboratory of Hemoglobinopathy, University of Ulm, D-89069 Ulm, Germany
| | - Tamer Hassan
- Department of Pediatrics, Zagazig University, Zagazig 44111, Egypt
| | | | - Mohamed Mourad
- Department of Clinical Pathology, Zagazig University, Zagazig 44111, Egypt
| | - Joaquin Brintrup
- Department of Pediatrics and Adolescents, Laboratory of Hemoglobinopathy, University of Ulm, D-89069 Ulm, Germany
| | - Marwa Zakaria
- Department of Pediatrics, Zagazig University, Zagazig 44111, Egypt
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Abouzeid W, Hassan T, Abo Rahma H, Azab A. Full-Endoscopic Soft Tissue Approach for Lumbar Disc Herniation. Egyptian Spine Journal 2016. [DOI: 10.21608/esj.2016.3986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sultan A, Hassan T, Aboul-Enein H, Mansour O, Ibrahim T. The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas. Interv Neuroradiol 2016; 22:482-8. [PMID: 26934897 DOI: 10.1177/1591019916633244] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 01/01/2016] [Accepted: 01/25/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Solid cerebellar hemangioblastomas are highly vascular lesions and may cause catastrophic hemorrhage during excision. METHODS This retrospective study enrolled 10 patients (7 men and 3 women, with a mean age of 38.2 ± 12.5 years) with solid cerebellar hemangioblastomas. All patients had a solitary tumor and underwent surgical resection of the lesion through a suboccipital approach. The basic features, serial radiographic examinations, and operative records were analyzed. RESULTS The most common presenting symptoms were headache (100%), ataxia (100%), and long tract manifestations (60%). Three patients had experienced failed surgery previously due to massive intraoperative bleeding. Three patients were confirmed as having Von Hippel-Lindau disease. The average size of the tumor was 40.7 ± 8.7 mm in its maximal diameter (range 25-58 mm). Total endovascular occlusion obtained in six patients, near total occlusion in three patients, and incomplete occlusion in one patient. Nine (90.0%) patients underwent gross total resection and one (10.0%) underwent partial resection. After the primary surgery, eight (80.0%) patients experienced improvement in their symptoms, two (20.0%) maintained their pre-treatment status, and none showed neurological deterioration following tumor resection. Blood loss during surgery after embolization was minimal and controllable. CONCLUSION Preoperative embolization improves safety and efficacy of the microsurgical excision of such tightly located very vascular tumors. Embolization changes the concept of this lesion surgery into piecemeal removal rather than a total mass extraction technique. Liquid agents are superior to particles in obliteration of such lesions.
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Affiliation(s)
- Ahmed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
| | - Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
| | - Hisham Aboul-Enein
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| | - Osama Mansour
- The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt Department of Interventional Neurology, Alexandria University School of Medicine, Egypt
| | - Tamer Ibrahim
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
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Heichel J, Hassan T, Bredehorn-Mayr T, Wienke A, Struck HG. [External Dacryocystorhinostomy--Analysis of Patient Material of the University Hospital Halle from 2000 to 2011]. Klin Monbl Augenheilkd 2016; 233:29-37. [PMID: 26797884 DOI: 10.1055/s-0041-110133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of this retrospective study was to collect additional data on the long-term success (LTS) of external dacryocystorhinostomy (ext-DCR) and the impact of pre-, intra- and postoperative factors on the surgical outcome. This was intended to increase the precision of the indication for DCR. METHOD A retrospective, non-comparative study was conducted on 637 ext-DCR due to dacryocystitis performed at the Department of Ophthalmology, University Hospital Halle. This included all surgical interventions on patients of at least 11 years of age. Using standardised questionnaires and patient records, 60.75 % (n = 387) of patients were surveyed. Follow-up was 1.0 to 12.0 years (mean, 4.0 years). RESULTS Analysis of patient satisfaction showed satisfactory (20.2 %) and very satisfactory (74.2 %) results. LTS was 94.4 % (n = 365). Factors negatively influencing postoperative outcome were prior surgical interventions of nose and/or sinus, previous ext-DCR and transcanalicular lacrimal surgery. Surgical outcome was positively influenced by lacrimal sac size and lacrimal stenting. Large saccus lacrimales and use of monocanalicular intubates improved LTS. CONCLUSIONS LTS of ext-DCR shows very good results, thus underlining its superiority to other surgical approaches. Special attention should be paid to diseases and previous surgical interventions on the nose and/or sinus that effect the lacrimal duct system. Therefore, a special committee of ENT physicians and ophthalmologists has been established at the Department of Ophthalmology, University Hospital Halle. From the surgical point of view, it is important to create an adequate mucosal anastomosis using lacrimal and nasal mucosa. Restoration is possible with lacrimal stent materials. The indication for ext-DCR was restricted by competition with transcanalicular endoscopic interventions to preserve physiological lacrimal drainage.
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Affiliation(s)
- J Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | - T Hassan
- Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | - T Bredehorn-Mayr
- Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | - A Wienke
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | - H-G Struck
- Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
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Binbay A, Chadwick A, Hassan T. VALIDATION OF RISK STRATIFICATION MODELS FOR LONE ACUTE SUDDEN HEADACHE (LASH)—HOW FAR HAVE WE TRAVELLED? Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hassan T, Rashad S, Aziz W, Sultan A, Ibrahim T. Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience. J Stroke Cerebrovasc Dis 2015; 24:2824-38. [PMID: 26409721 DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/10/2015] [Accepted: 08/14/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cavernous sinus (CS) fistulas are classified into traumatic and spontaneous. Traumatic carotid-cavernous fistulas (CCFs) are usually direct internal carotid artery (ICA) high-flow fistulas; whereas spontaneous CCFs are usually dural, low-flow fistulas and generally possess less severe symptoms than direct carotid-cavernous fistulas. METHODS This study involved 34 patients who were classified into 2 groups: Group A included 26 patients with direct carotid-cavernous fistula; and Group B included 8 patients with indirect dural cavernous fistula. All patients had ocular manifestations. One patient had subarachnoid hemorrhage. Coils were used alone in 19 cases of direct fistula and in 1 case of dural fistulas. Coils and Onyx (Covidien, Mansfield, MA, USA) were used in 7 cases of direct fistula and in 2 cases of dural fistulas. Onyx alone was used to treat 5 cases with dural fistulas but none of the cases with direct fistulas. Covered stents and coils were used in 2 cases of direct fistulas. RESULTS All patients in both groups showed full recovery of their clinical signs and symptoms. Only 1 procedure-related complication was observed (3%) in which a patient had an embolic event and trigeminal dysesthesia as a result of Onyx reflux through external carotid artery-ICA anastomosis. CONCLUSION Coils are superior solid embolic agents used for the treatment of direct high-flow fistulas, while Onyx is more valuable in dural low-flow CCF. Onyx shortens the procedure time and decreases procedure cost. Onyx injection inside the CS proper through the transarterial or transvenous route may be safer than Onyx injected inside dural arteries supplying the CS. However, more cases are needed to determine this.
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Affiliation(s)
- Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt.
| | - Sherif Rashad
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| | - Waseem Aziz
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| | - Ahmed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| | - Tamer Ibrahim
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
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Al-Tonbary Y, Badr M, Mansour A, El Safy U, Saeed S, Hassan T, Elashery R, Nofal R, Darwish A. Clinico-epidemiology of neuroblastoma in north east Egypt: A 5-year multicenter study. Oncol Lett 2015; 10:1054-1062. [PMID: 26622625 DOI: 10.3892/ol.2015.3335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/22/2015] [Indexed: 12/12/2022] Open
Abstract
Neuroblastoma, an embryonal malignancy of the sympathetic nervous system, is the most frequent extracranial solid tumor The clinico-epidemiological features of neuroblastoma in infants and children were investigated between January 2005 and January 2010 at the Pediatric Oncology units of Mansoura, Zagazig, and Tanta University Children's Hospitals (Egypt). Of 142 cases of neuroblastoma, 10 were omitted from the study due to defective data. The median age of the patients was 30 months, with 75.8% aged ≥1 year and 24.2% aged <1 year at time of diagnosis. The male-to-female ratio was 1.06. Suprarenal glands were the most common primary tumor site (72.7%). The majority of the patients (76.7%) had stage IV disease. Favorable pathology was observed in 43.8% of patients, while 56.2% exhibited unfavorable pathology. The estimated survival rate of patients was 30.7±10.0%, and mean survival time was 24.2±5.2 months. The rate of mortality was 28.6% for patients aged <1 year, and 81.8% for those aged ≥1 year (P=0.005). For patients with favorable pathology, the rate of mortality was significantly lower (28.6%) compared with that of patients with unfavorable pathology (77.8%; P=0.049). Although the association between outcome and each of the primary tumor sites, children's oncology group risk and gender was statistically insignificant, a large effect size was identified between outcome and primary tumor site, as well as children's oncology group risk and a medium effect size was identified between outcome and gender. Additionally, an age of ≥1 year was associated with unfavorable pathology (P=0.024), stage IV disease (P=0.026) and a suprarenal primary tumor site (P=0.001).
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Affiliation(s)
- Youssef Al-Tonbary
- Department of Pediatric Hematology and Oncology, Mansoura University Children's Hospital, Mansoura, Dakahlia 35516, Egypt
| | - Mohamed Badr
- Department of Pediatric Hematology and Oncology, Zagazig University Children's Hospital, Zagazig, Sharqia 44111, Egypt
| | - Ahmed Mansour
- Department of Pediatric Hematology and Oncology, Mansoura University Children's Hospital, Mansoura, Dakahlia 35516, Egypt
| | - Usama El Safy
- Department of Pediatric Hematology and Oncology, Zagazig University Children's Hospital, Zagazig, Sharqia 44111, Egypt
| | - Shebl Saeed
- Department of Pediatric Hematology and Oncology, Tanta University Children's Hospital, Tanta, Gharbia 31111, Egypt
| | - Tamer Hassan
- Department of Pediatric Hematology and Oncology, Zagazig University Children's Hospital, Zagazig, Sharqia 44111, Egypt
| | - Rasha Elashery
- Department of Pediatric Hematology and Oncology, Mansoura University Children's Hospital, Mansoura, Dakahlia 35516, Egypt
| | - Rofida Nofal
- Department of Pediatric Hematology and Oncology, Zagazig University Children's Hospital, Zagazig, Sharqia 44111, Egypt
| | - Ahmad Darwish
- Department of Pediatric Hematology and Oncology, Mansoura University Children's Hospital, Mansoura, Dakahlia 35516, Egypt
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Ramirez Perdomo S, Hassan T. Sexual Assaults in a Forensic Population. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31937-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Raafat N, El Safy U, Khater N, Hassan T, Hassan B, Siam A, Youssef A, El Shabrawy A. Assessment of cognitive function in children with beta-thalassemia major: a cross-sectional study. J Child Neurol 2015; 30:417-22. [PMID: 25296920 DOI: 10.1177/0883073814550827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/14/2014] [Indexed: 11/17/2022]
Abstract
Multiple risk factors contribute to cognitive impairment in children with β-thalassemia major. For a more refined understanding of this issue, we attempted to evaluate cognitive function in β-thalassemia major patients and identify the relationship between possible cognitive dysfunction and the following: demography, transfusion and chelation characteristics, iron overload, and disease complications. We studied 100 β-thalassemia major children and 100 healthy controls who matched well in terms of age, sex, and socioeconomic status. All participants underwent psychometric assessment using Wechsler Intelligence Scale for Children-Third Edition, Arabic version. The mean Full-Scale IQ and Performance IQ of patients were significantly lower than those of controls, whereas no significant difference was found for Verbal IQ. No significant relationship existed between IQ and any of the assessed parameters. We concluded that Performance IQ, not Verbal IQ, was significantly affected in β-thalassemia major patients, but there was no clear association between IQ and any of the parameters.
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Affiliation(s)
- Nelly Raafat
- Department of Psychiatry, Zagazig University, Zagazig, Egypt
| | - Usama El Safy
- Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Nahed Khater
- Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Tamer Hassan
- Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Basheir Hassan
- Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Ahmed Siam
- Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Amira Youssef
- Department of Psychiatry, Zagazig University, Zagazig, Egypt
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