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Zakareya T, Akl M, Shibl S, El-Mazaly M, Abdel-Razek W. Utility of prognostic scores in predicting short-term mortality in patients with acute-on-chronic liver failure. Egypt Liver Journal 2022. [DOI: 10.1186/s43066-022-00183-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute-on-chronic liver failure (ACLF) is a distinct syndrome associated with high short-term mortality. Early identification of patients at high risk is essential to determine emergency for transplantation and decide and prioritize the need for intensive care unit (ICU). We aimed to evaluate the performance of the different prognostic scores in the prediction of in-hospital mortality in patients with ACLF. A total of 249 patients with ACLF were included and followed till discharge from the hospital. Univariate and Cox regression analyses were used to assess the performance of liver-specific (Child-Pugh and MELD) and ACLF prognostic scores (CLIF-C OF, CLIF-SOFA, CLIF-C AD, CLIF-C ACLF) in the prediction of in-hospital mortality.
Results
Patients were mostly males (71.1%) with a mean age of 53.9 ± 12.8 years. The etiology of pre-existing liver disease was HCV in 57.8%. Sepsis was the most common precipitating factor (49.8%) and the mortality rate was 74.3%. In univariate analysis, all scores were significantly higher in the deceased group (P<0.0001). AUROC were 0.897, 0.884, 0.870, 0.861, 0.861, and 0.850 for CLIF-C OF, CLIF-C AD, CLIF-C ACLF, Child-Pugh, CLIF-SOFA, and MELD scores, respectively. In multivariate analysis, 2 independent predictors of mortality were identified: CLIF-C ACLF score (OR 3.25, 95% CI 1.03–10.25, P<0.0001) and Child-Pugh class C (OR 1.04, 95% CI 1.02–1.06, P=0.044).
Conclusions
All the studied scores could predict in-hospital mortality of patients with ACLF. However, CLIF-C ACLF and Child-Pugh class performed better as they could significantly and independently predict mortality.
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Abd-Elhamid A, Abd ELRahman A, Aly H, Soliman H, Akl M, elrazik T. Synthesis, Characterization, scaling up and use of Calcium Carbonate Nanoparticles to prepare nanoporous PVC film. Egypt J Chem 2021. [DOI: 10.21608/ejchem.2021.49234.3012] [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: 10/21/2022]
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Akl A, Ibrahim El-Shahate O, Akl M. SAT-471 ISN EDUCATIONAL AMBASSADORS IN NORTH AFRICA: EGYPT AND SUDAN. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.502] [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: 10/24/2022] Open
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Kohla MAS, Fayoumi AE, Akl M, Abdelkareem M, Elsakhawy M, Waheed S, Abozeid M. Early fibrosis regression by shear wave elastography after successful direct-acting anti-HCV therapy. Clin Exp Med 2020; 20:143-148. [PMID: 31792631 DOI: 10.1007/s10238-019-00597-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/09/2019] [Accepted: 11/27/2019] [Indexed: 12/17/2022]
Abstract
Shear wave elastography (SWE) is a noninvasive ultrasound-based marker of hepatic fibrosis not requiring a special device. Successful direct-acting anti-HCV therapy was associated with hepatic fibrosis regression assessed by transient elastography (FibroScan). Data on the utility of SWE in these patients and how early fibrosis can regress after treatment are still lacking. To assess liver fibrosis by SWE before and after direct-acting antiviral treatment of chronic hepatitis C (CHC), we enrolled 165 CHC genotype 4 Egyptian patients treated with different Sofosbuvir-based regimens. Patients' laboratory characteristics, fibrosis biomarkers, namely Fibrosis-4 (FIB-4) index and AST/platelet ratio index (APRI) and liver stiffness measurements (LSM) by SWE were evaluated at baseline, end of treatment (EOT at week 12), week 24 and week 36. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels as well as FIB-4 and APRI indices decreased significantly at EOT, week 24 and week 36 in comparison to baseline (P value < 0.001). Although platelet counts did not significantly differ between baseline and EOT, they increased significantly from EOT to week 24 and week 36 with a P value < 0.001. The mean LSM showed improvement at EOT (7.01 ± 3.59 kpa), week 24 (6.18 ± 3.39 kpa) and week 36 (5.74 ± 3.21 kpa) in comparison to baseline (8.49 ± 0.83 kpa) (P value < 0.001). There is early liver fibrosis regression at EOT and throughout the time after successful treatment with direct-acting antiviral agents (DAAs). SWE is a feasible, easily applicable noninvasive relatively inexpensive assessment method of liver fibrosis.
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Affiliation(s)
- Mohamed Ahmed Samy Kohla
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt.
| | - Ahmed El Fayoumi
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
| | - Mohamed Akl
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
| | - Mervat Abdelkareem
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
| | - Mahmoud Elsakhawy
- Department of Diagnostic and Interventional Radiology and Medical Imaging, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
| | - Sally Waheed
- Department of Epidemiology and Preventive Medicine, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
| | - Mai Abozeid
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
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Abdelsalam M, Elmorsy E, Abdelwahab H, Algohary O, Naguib M, El Wahab AA, Eldeeb A, Eltoraby E, Abdelsalam A, Sabry A, El-Metwally M, Akl M, Anber N, El Sayed Zaki M, Almutairi F, Mansour T. Urinary biomarkers for early detection of platinum based drugs induced nephrotoxicity. BMC Nephrol 2018; 19:219. [PMID: 30180818 PMCID: PMC6123931 DOI: 10.1186/s12882-018-1022-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 03/01/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nephrotoxicity is a major hazard complicating the use of platinum based drugs (PBD), which can hinder using higher doses protocols to maximize the therapeutic gain. Shortage of serum creatinine level as an accurate biomarker for acute kidney injuries (AKI) necessitates searching for novel biomarkers with better sensitivity and specificity in patients on PBD. METHODS In a prospective cohort design, 132 patients receiving PBD were selected for the study. AKI was diagnosed by continuous follow up of serum creatinine level according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines 2012. Serum creatinine and urinary biomarkers (KIM-1, NGAL and cystatin C) was measured in the day of treatment and for 3 days after PBD cycle. RESULTS AKI occurred in 35 patients (26.52% of patients). KIM-1, Cystatin C, and NGAL showed significant increase in samples collected in the day of AKI in comparison to their corresponding basal levels (P < 0.0001). In addition, significant increase in urinary levels of the biomarkers in samples collected 1 day before AKI in comparison to their basal levels (P < 0.0001, P < 0.0001, and P = 0.013 for KIM-1, NGAL and Cystatin C respectively). Furthermore KIM-1 data showed a significant increase 2 days before serum creatinine rise in comparison to the corresponding KIM-1 levels in patients who developed AKI (P = 0.001). CONCLUSIONS Urinary KIM-1, Cystatin C and NGAL can predict PBD induced AKI in earlier stages than serum createnine. KIM-1 is the most sensitive biomarker for early detection of AKI in patients receiving PBD.
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Affiliation(s)
- Mostafa Abdelsalam
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ekramy Elmorsy
- Department of Forensic Medicine and Clinical Toxicology, Mansoura faculty of Medicine, Mansoura, Egypt
| | - Hassan Abdelwahab
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Osman Algohary
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud Naguib
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Abd El Wahab
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Eldeeb
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ehab Eltoraby
- Internal Medicine Departments, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Abdelsalam
- Internal Medicine Departments, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa Sabry
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed El-Metwally
- Internal Medicine Departments, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Akl
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nahla Anber
- Fellow of Biochemistry, Emergency Hospital, Mansoura University, Mansoura, Egypt
| | | | - Fahad Almutairi
- Department of Biochemistry, Faculty of Science, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Tamer Mansour
- Clinical Pathology Department, Mansoura faculty of Medicine, Mansoura, Egypt
- Department of Population Health and Reproduction, University of California, Davis, California, USA
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Abdelkhalek M, Abd El Wahab A, Sabry A, Awad E, Elbastawessy A, Elgohary O, Elkot M, Hassan H, Eldeep A, El-Metwally M, Akl M, Mansour T, Zaki M. SP208EARLY DETECTION OF ACUTE KIDNEY INJURY IN CANCER PATIENTS RECEIVING PLATINUM BASED CHEMOTHERAPY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx143.sp208] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Bahgat M, Emama M, Refaey M, Abd-Eldayem W, Emara M, El-Sharkawy H, Emara A, Heeba H, Akl M. Study of autoantibodies in Egyptian non-B,non-C chronic hepatitis patients. Afro-Egyptian Journal of Infectious and Endemic Diseases 2011; 1:1-8. [DOI: 10.21608/aeji.2011.8753] [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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Klauschie J, Zanagnolo V, Akl M, Jacob K, Montero R, Magrina J, Wechter M, Kho R. Efficacy and Safety of the Use of Anti-Skid Material in Patient Positioning for Robotic Procedures in Gynecology While in Steep Trendelenburg. J Minim Invasive Gynecol 2009. [DOI: 10.1016/j.jmig.2009.08.586] [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: 11/25/2022]
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Abstract
The clinical application of islet transplantation is limited due to the limited source and the morbidity of systemic immunosuppression to prevent rejection. The two problems can be solved by using encapsulated islets. We have used amniotic membranes as biocompatible natural immune barriers. The objective of this study was to assess the revascularization of the membrane, which is necessary to ensure islet viability when the membrane is used for islet encapsulation. The amniotic membranes, obtained from full-term pregnant female dogs, were molded to form macrocapsules, which were implanted in the peritoneal cavity. The capsules were removed after 3, 10, 15, and 30 days and examined histopathologically using hematoxylin and eosin and by immunohistochemistry for neovascularization using factor VIII to detect angiogenesis. Upon histopathological examination, all specimens showed localized, moderate inflammation and congested blood vessels with no thrombosis or rejection. There was a mild degree of fibroblast proliferation starting from day 10 to day 30. Immunohistochemical staining revealed that the number of blood vessels was 7, 11, 13, 10 per high-power microscopic field on days 3, 10, 15, and 30, respectively. We concluded from this study that implanted amniotic sac capsules were vascularized within the omental tissue from day 10 on with significant blood vessel formation starting on day 3 by immunohistochemical study.
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Affiliation(s)
- M A Mahgoub
- Pancreatic Islet Transplantation and Diabetes Research Unit, Ain Shams University Hospital, Cairo, Egypt.
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Abstract
PURPOSE To assess the role of chemoradiation as a primary treatment for vulvar carcinoma. METHODS AND MATERIALS Between December 1989 and August 1997, there were 14 patients with the diagnosis of squamous cell carcinoma of the vulva. Two patients were excluded from this study because of advanced stage at presentation. Key information about the remaining 12 patients was extracted from their charts. All patients had biopsy prior to treatment, and were treated with chemoradiation. Radiation was administered to the vulva only. Surgical biopsies from the vulva and inguinal nodal dissection were done 4-6 weeks after radiation treatment. All patients were followed for evaluation of response and clinical detection of recurrence. The period of follow-up ranged from 8 to 125 months. Mean follow-up period was 41 months. RESULTS All 12 patients showed complete response to the treatment. Only 1 patient (8.3%) developed local recurrence at 3 months posttreatment. Another patient (8.3%) developed nodal recurrence at 30 months posttreatment. Both patients were salvaged by surgical treatment and remained disease free. The actuarial 5-year disease-free survival was 43%. The actuarial 3-year disease-free survival was 84%. The majority of patients developed mild-to-moderate complications due to chemoradiation. These were well tolerated and responded to medical treatment. None of the patients developed late complications to chemoradiation treatment. CONCLUSIONS Chemoradiation is an effective primary treatment for vulvar carcinoma as shown by these successfully managed cases.
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Affiliation(s)
- A Akl
- Department of Radiation Oncology, Hurley Medical Center, Flint, MI 48503-5993, USA.
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Hassanein H, Akl M, Shaker Z, el-Baz H, Sharmy R, Rabiae I, Botros S. Induction of hepatic egg granuloma hyporesponsiveness in murine schistosomiasis mansoni by intravenous injection of small doses of soluble egg antigen. APMIS 1997; 105:773-83. [PMID: 9368592 DOI: 10.1111/j.1699-0463.1997.tb05083.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This work was designed to test whether hyporesponsiveness to schistosomal egg antigen (SEA) was associated with reduction in size of hepatic granulomas. Multiple small doses of SEA (10 micrograms x 4) were injected intravenously (i.v.) into C57B1/6 mice either at 7 or 30 days prior to cercarial exposure. Eight weeks postinfection, hepatic histopathology and granuloma diameter were studied. SEA-induced lympho-proliferative response, splenic cytokines (IL-2, IL-4 and IL-5) and serum antischistosomal IgG were assessed. Worm burden and tissue egg load were counted. Compared to infected controls, the SEA-treated groups showed decrease in granuloma diameter, remarkable increase in the percentage of degenerated ova within hepatic granulomas and amelioration of histopathological changes. SEA lymphoproliferative response, and levels of Il-2 and IL-4, were lower in SEA-treated groups than infected controls. The levels of IL-5 and antishistosomal IgG were comparable to the infected controls. The intensity of infection was not influenced by i.v. injection of SEA. The present data show that i.v. administration of multiple small doses of SEA induced granulomatous hyporesponsiveness with amelioration of hepatic pathology and acceleration of egg destruction.
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Affiliation(s)
- H Hassanein
- Department of Immunology, Theodor Bilharz Research Institute, Guiza, Egypt
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Omar MM, el-Ansary M, Mostafa I, Akl M, el-Sherbini E, el-Badrawy N, Hunter MS. Helicobacter pylori among Egyptian patients with chronic liver diseases. A comparative study. J Egypt Soc Parasitol 1997; 27:563-70. [PMID: 9257995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The prevalence of Helicobacter pylori in Egyptian patients with different stages of liver diseases was compared to those with normal liver status. Eighty patients subjected to upper gastrointestinal endoscopy were enrolled. They were divided according to their liver status into two groups; the first patients with liver cirrhosis and the second who had no liver affection. Gall bladder diseases were excluded by abdominal ultrasound examinations. Endoscopic antral mucosal biopsies were used for H. pylori screening by both culture and urease test, and for histopathological examinations. Both groups were matched as regards age, sex, and socioeconomic conditions. Culture was positive in 42.2% and 40.7% of patients in both groups respectively (P > 0.05). Urease test showed positive results in 58% and 76.6% in both groups respectively (P > 0.05). Helicobacter pylori prevalence showed no significant differences between both studied groups as regards age, sex, or type of gastric lesions. Furthermore, liver status in patients with chronic liver diseases does not play a role in distribution of infection. The study shows the high prevalence of H. pylori among Egyptians and the absence of a relation between H. pylori and chronic liver diseases.
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Affiliation(s)
- M M Omar
- Theodore Bilharz Research Institute, Giza, Egypt
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Abstract
BACKGROUND Immediate-type allergic reactions to latex products have become increasingly recognized in hospital workers. OBJECTIVE This study was designed to assess the prevalence of latex sensitization by skin testing and specific IgE testing in a group of hospital employees and compare these with each subject's self-reported allergic history. METHODS Volunteers were recruited from selected departments. Each was tested with epicutaneous skin test with latex glove extract and commercial environmental allergens, had blood drawn for latex-specific IgE testing (AlaSTAT brand of ELISA), and was given a questionnaire for general and latex allergy history. RESULTS There were 135 participants. Eleven (8.2% of sample, 95% confidence interval 3.4% to 13.0%) were skin test positive for latex reagent, and seven of these (5.2% of sample) reported allergic symptoms to latex contact. Testing for latex-specific IgE (ELISA) showed 6.7% with class II or higher reaction. There was high correlation of the two tests, with ELISA showing a sensitivity of 63.6% and a specificity of 98.4% with reference to skin testing. In this sample, 16% reported some upper respiratory symptoms in association with latex contact, although only one-third of this group was skin test positive. Past history of allergic or atopic disease was poorly predictive of skin or blood test reactivity. A reaction to a greater number of environmental allergens was associated with positive latex skin test reactivity. CONCLUSION Testing for latex sensitivity in this hospital sample revealed more than 5% of workers developed clinical allergies to latex and continued to remain occupationally in contact with latex. In vitro testing is a potential substitute for the more technically difficult skin testing.
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Affiliation(s)
- T Kibby
- Mallinckrodt, Inc., St Louis, Missouri, USA
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Abstract
We report a case of schistosomal orchitis simulating malignancy. The patient presented with a unilateral hydrocele, testicular enlargement and loss of testicular sensation. Orchiectomy was performed because of suspected malignancy. Tissue diagnosis was schistosomiasis. The incidence, pathogenesis and pathology of genital schistosomiasis are discussed, and the literature is reviewed.
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Affiliation(s)
- N E Mikhail
- Department of Surgery, Theodor Bilharz Research Institute, Academy of Scientific Research, Cairo, Egypt
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