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Sakr M, Badran M, Hassan SA, Elsaqa M, Elwany MA, Deeb NMFE, Sharafeldeen M. Detection of two synchronous histologically different renal cell carcinoma subtypes in the same kidney: a case report and review of the literature. J Med Case Rep 2024; 18:250. [PMID: 38760853 PMCID: PMC11102143 DOI: 10.1186/s13256-024-04527-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/27/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Renal cell carcinoma (RCC) is the dominant primary renal malignant neoplasm, encompassing a significant portion of renal tumors. The presence of synchronous yet histologically distinct ipsilateral RCCs, however, is an exceptionally uncommon phenomenon that is rather under-described in the literature regarding etiology, diagnosis, management, and later outcomes during follow-up. CASE PRESENTATION We aim to present the 9th case of a combination chromophobe RCC (ChRCC) and clear cell RCC (ccRCC) in literature, according to our knowledge, for a 69-year-old North African, Caucasian female patient who, after complaining of loin pain and hematuria, was found to have two right renal masses with preoperative computed tomography (CT) and underwent right radical nephrectomy. Pathological examination later revealed the two renal masses to be of different histologic subtypes. CONCLUSION The coexistence of dissimilar RCC subtypes can contribute to diverse prognostic implications. Further research should focus on enhancing the complex, yet highly crucial, preoperative detection and pathological examination to differentiate multiple renal lesions. Planning optimal operative techniques (radical or partial nephrectomy), selecting suitable adjuvant regimens, and reporting long-term follow-up outcomes of patients in whom synchronous yet different RCC subtypes were detected are of utmost importance.
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Affiliation(s)
- Mohamed Sakr
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Merhan Badran
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt.
| | - Sarah Ahmed Hassan
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Mohamed Elsaqa
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Mohamed Anwar Elwany
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Nevine M F El Deeb
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Mohamed Sharafeldeen
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
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Abourisha E, Sakr M, Srinivasan A, Singh HP. Surgical management of SLAP lesions: Which technique has better surgical outcomes? J Orthop 2024; 50:29-35. [PMID: 38162261 PMCID: PMC10755497 DOI: 10.1016/j.jor.2023.11.053] [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: 11/12/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024] Open
Abstract
Background The gold-standard surgical management for superior labral anterior to posterior (SLAP) lesions is unclear. This meta-analysis compares the outcomes of different surgical SLAP lesion management techniques including labral repair, long head of biceps (LHB) tenodesis and LHB tenotomy with consideration to clinical scores, return to sports, re-operation, range-of-motion and patient satisfaction. Methods PRISMA guidelines were adhered. Web of Science, PubMed, Cochrane Central, Science direct and EMBASE were searched using relevant keywords. Eligible studies were screened, data extracted and synthesised using Review Manager (Version 5.4.1). Bayesian network meta-analysis (NMA) was conducted. Randomised control and clinical trials regarding SLAP lesion management in patients over 18 years old were included. Studies were excluded if patients had concomitant massive tears of the rotator cuff, Bankart lesions or instability of the shoulder. Results Patient satisfaction with LHB tenodesis was superior to superior labral repair. No difference was demonstrated with respect to ASES score, pain VAS score, return to sports and pre-injury activities, reoperation rate or range-of-motion. LHB tenodesis and LHB tenotomy show no difference in ASES score or post operative deformity in management of SLAP lesions. Discussion High-quality, standardised randomised control studies between the different surgical techniques is warranted.
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Affiliation(s)
- Eslam Abourisha
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - Ananth Srinivasan
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Sakr M, Al Kanjo M, Balasundaram P, Kupferman F, Al-Mulaabed S, Scott S, Viswanathan K, Basak RB. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf 2024; 9:e721. [PMID: 38576889 PMCID: PMC10990363 DOI: 10.1097/pq9.0000000000000721] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/26/2024] [Indexed: 04/06/2024] Open
Abstract
Background Current national guidelines recommend against chest X-rays (CXRs) for patients with acute asthma exacerbation (AAE). The overuse of CXRs in AAE has become a concern, prompting the need for a quality improvement (QI) project to decrease CXR usage through guideline-based interventions. We aimed to reduce the percentage of CXRs not adhering to national guidelines obtained for pediatric patients presenting to the Emergency Department (ED) with AAE by 50% within 12 months of project initiation. Methods We conducted this study at a New York City urban level-2 trauma center. The team was composed of members from the ED and pediatric departments. Electronic medical records of children aged 2 to 18 years presenting with AAE were evaluated. Monthly data on CXR utilization encompassing instances where the ordered CXR did not adhere to guidelines was collected before and after implementing interventions. The interventions included provider education, visual reminders, printed cards, grand-round presentations, and electronic medical records modifications. Results The study encompassed 887 eligible patients with isolated AAE. Baseline data revealed a mean preintervention CXR noncompliance rate of 37.5% among children presenting to the ED with AAE. The interventions resulted in a notable decrease in unnecessary CXR utilization, reaching 16.7%, a reduction sustained throughout subsequent months. Conclusions This QI project successfully reduced unnecessary CXR utilization in pediatric AAE. A multi-faceted approach involving education, visual aids, and electronic reminders aligned clinical practice with evidence-based guidelines. This QI initiative is a potential template for other healthcare institutions seeking to curtail unnecessary CXR usage in pediatric AAE.
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Affiliation(s)
- Mohamed Sakr
- From the Department of Pediatrics, Brookdale University Medical Center, One Brookdale Plaza, Brooklyn, N.Y
| | - Mohamed Al Kanjo
- From the Department of Pediatrics, Brookdale University Medical Center, One Brookdale Plaza, Brooklyn, N.Y
| | - Palanikumar Balasundaram
- Division of Neonatology, Department of Pediatrics, Mercy Health - Javon Bea Hospital, Rockford, Ill
| | - Fernanda Kupferman
- From the Department of Pediatrics, Brookdale University Medical Center, One Brookdale Plaza, Brooklyn, N.Y
| | - Sharef Al-Mulaabed
- From the Department of Pediatrics, Brookdale University Medical Center, One Brookdale Plaza, Brooklyn, N.Y
| | - Sandra Scott
- Department of Emergency Medicine, Brookdale University Medical Center, One Brookdale Plaza, Brooklyn, N.Y
| | - Kusum Viswanathan
- From the Department of Pediatrics, Brookdale University Medical Center, One Brookdale Plaza, Brooklyn, N.Y
| | - Ratna B. Basak
- From the Department of Pediatrics, Brookdale University Medical Center, One Brookdale Plaza, Brooklyn, N.Y
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Sakr M, Badran M, Pokhrel P, Asfeen UZ, Badran NN, Badran MW. Neglected ureteral stent in a patient with chronic kidney disease and solitary functioning kidney: case report and review of literature. Ann Med Surg (Lond) 2023; 85:6289-6293. [PMID: 38098554 PMCID: PMC10718373 DOI: 10.1097/ms9.0000000000001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction A ureteral stent is crucial for managing urinary flow obstruction, ureteral reconstructive surgeries, and iatrogenic ureteral injuries. The authors aim to report a case of forgotten double-J stent for 17 years, the longest time reported in literature in a patient with solitary kidney and no typical long-term complications as stones formation and encrustation. Case presentation A 58-year-old male with chronic kidney disease and solitary left kidney presented with left loin pain. With creatinine higher than baseline (6.2 mg/dl), he reported a neglected double-J stent placed 17 years ago in a different hospital. In addition, non-contrast computed tomography and cystoscopy revealed hydronephrosis, cystitis, and an element of infra-vesical obstruction, evident by high bladder neck. Treatment included left percutaneous nephrostomy, but he was readmitted few weeks later for cystoscopy, ureteroscopy, and a new double-J insertion. Due to worsening renal function, he was readmitted four weeks later for cystoscopic removal of the new double-J stent and Transurethral Resection of the Prostate, after which creatinine returned to baseline. Discussion Double-J stents are vital in urological procedures, but neglecting their presence can lead to severe complications like encrustations, stone formation, stent fractures, hydronephrosis, infections, and renal function loss. Treatment of long-term complications is difficult and should consider many factors, including the type and severity of associated complications and the patient's preoperative status. Conclusion Preventing complications from neglected or forgotten double-J stents through patient education and follow-up is crucial, especially in those with solitary functioning kidneys due to the imminent loss of renal function.
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Affiliation(s)
- Mohamed Sakr
- Alexandria Faculty of Medicine, Alexandria, Egypt
| | | | - Prakriti Pokhrel
- Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Ummul Z. Asfeen
- New York Medical College, Saint Michael’s Medical Center, Newark, NJ
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Sakr AS, Pławiak P, Tadeusiewicz R, Pławiak J, Sakr M, Hammad M. ECG-COVID: An End-to-End Deep Model Based on Electrocardiogram for COVID-19 Detection. Inf Sci (N Y) 2022; 619:324-339. [PMCID: PMC9673093 DOI: 10.1016/j.ins.2022.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 10/05/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
The early and accurate detection of COVID-19 is vital nowadays to avoid the vast and rapid spread of this virus and ease lockdown restrictions. As a result, researchers developed methods to diagnose COVID-19. However, these methods have several limitations. Therefore, presenting new methods is essential to improve the diagnosis of COVID-19. Recently, investigation of the electrocardiogram (ECG) signals becoming an easy way to detect COVID-19 since the ECG process is non-invasive and easy to use. Therefore, we proposed in this paper a novel end-to-end deep learning model (ECG-COVID) based on ECG for COVID-19 detection. We employed several deep Convolutional Neural Networks (CNNs) on a dataset of 1109 ECG images, which is built for screening the perception of COVID-19 and cardiac patients. After that, we selected the most efficient model as our model for evaluation. The proposed model is end-to-end where the input ECG images are fed directly to the model for the final decision without using any additional stages. The proposed method achieved an average accuracy of 98.81%, Precision of 98.8%, Sensitivity of 98.8% and, F1-score of 98.81% for COVID-19 detection. As cases of corona continue to rise and hospitalizations continue again, hospitals may find our study helpful when dealing with these patients who did not get significantly worse.
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Affiliation(s)
- Ahmed S. Sakr
- Department of Information System, Faculty of Computers and Information, Menoufia University, Egypt
| | - Paweł Pławiak
- Department of Computer Science, Faculty of Computer Science and Telecommunications, Cracow University of Technology, Warszawska 24, 31-155 Krakow, Poland,Institute of Theoretical and Applied Informatics, Polish Academy of Sciences, Bałtycka 5, 44-100 Gliwice, Poland,Corresponding authors
| | - Ryszard Tadeusiewicz
- AGH University of Science and Technology, Department of Biocybernetics and Biomedical Engineering, Krakow, Poland
| | - Joanna Pławiak
- Faculty of Electrical and Computer Engineering, Cracow University of Technology, Warsaw 24, 31-155 Krakow, Poland
| | - Mohamed Sakr
- Computer Science Department, Faculty of Computers and Information, Menoufia University, Egypt
| | - Mohamed Hammad
- Department of Information Technology, Faculty of Computers and Information, Menoufia University, Egypt,Corresponding authors
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Montasser I, Ebada H, Faheem H, Dabbous H, Massoud Y, Salah M, Sakr M, Bahaa M, Monayeri ME, Meteini M. Plasma cell-rich acute rejection after living donor liver transplantation: Unusual or underestimated diagnosis? Journal of Liver Transplantation 2022. [DOI: 10.1016/j.liver.2022.100108] [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: 10/18/2022] Open
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Gendia A, Zyada A, Nasir MT, Elfar M, Sakr M, Rehman MU, Cota A, Clark J. Virtual Reality as a Surgical Care Package for Patients Undergoing Weight Loss Surgery: A Narrative Review of the Impact of an Emerging Technology. Cureus 2022; 14:e29608. [PMID: 36312677 PMCID: PMC9595346 DOI: 10.7759/cureus.29608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/24/2022] Open
Abstract
While bariatric surgery is regarded as the most effective treatment for people with severe and morbid obesity, its pathway is regarded as a complex one due to the multidisciplinary approaches required from pre-surgery education until long-term management. This is essential to maintain weight loss and improve the quality of life after bariatric surgery. Although these approaches are broadened, patient education, pre-operative preparation, behavioural therapy, rehabilitation, and dietary changes are regarded as the main domains in such complex care. With the increase in technological adaptation in medical services, virtual reality (VR) has shown many benefits that can be utilized in the care of bariatric patients undergoing surgery. However, VR has not been innovated to be a multidomain care package in which bariatric patients could benefit throughout their journey from the pre-operative optimization, recovery, and long-term follow-up. This review aims to give a brief description of some of the applications of VR technology and question whether it has the potential to be considered as a virtual ecosystem to improve the bariatric patients’ experience and pathway throughout surgery and follow-up.
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Abd Elaty M, Sakr M, Khalifa T. Fire Endurance of Cellular Lightweight Concrete. International Journal of Advances in Structural and Geotechnical Engineering 2022; 03:33-42. [DOI: 10.21608/asge.2022.152737.1017] [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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Negm M, Bahaa A, Farrag A, Lithy RM, Badary HA, Essam M, Kamel S, Sakr M, Abd El Aaty W, Shamkh M, Basiony A, Dawoud I, Shehab H. Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study. BMC Gastroenterol 2022; 22:203. [PMID: 35462542 PMCID: PMC9036734 DOI: 10.1186/s12876-022-02272-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 01/08/2022] [Accepted: 04/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background Intermittent fasting (IF) during the month of Ramadan is part of the religious rituals of Muslims. The effect of intermittent fasting on disease activity in inflammatory bowel diseases (IBD) is still unknown. This is the first study to assess the effect of IF during Ramadan on inflammatory markers in patients diagnosed with IBD. The effects on clinical disease activity, quality of life, and levels of depression were also assessed. Methods Patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) who intended to observe Ramadan fasting were recruited. The following were assessed immediately before and at the end of Ramadan: Serum CRP and stool calprotectin, partial Mayo score, Harvey Bradshaw index (HBI), Simple IBD questionnaire (SIBDQ), and Hamilton depression scale questionnaire. Results 80 patients diagnosed with IBD were recruited (60 UC, 20 CD). Serum CRP and stool calprotectin did not show a significant change before vs after fasting (median CRP 0.53 vs 0.50, P value = 0.27, Calprotectin 163 vs 218 respectively, P value = 0.62). The partial Mayo score showed a significant rise after fasting (median 1 before vs 1 after fasting, mean: 1.79 vs 2.33 respectively, P value = 0.02). Harvey-Bradshaw index did not show a significant change after fasting (median 4 vs 5, P value = 0.4). Multiple linear regression revealed that older age and a higher baseline calprotectin were associated with a higher change in Mayo score after fasting (P value = 0.02 and P value = 0.01, respectively). No significant change was detected in SIBDQ or Hamilton depression scale scores. Conclusions In patients diagnosed with UC, IF during Ramadan was associated with worsening of clinical parameters, the effect was more pronounced in older patients and those with higher baseline calprotectin levels. However, IF during Ramadan was not associated with an adverse effect on objective inflammatory markers (CRP and calprotectin).
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Kamel S, Sakr M, Hamed W, Eltabbakh M, Sherief A, Rashad H, Elghamrini Y, Elbaz A. Characterization of Crohn's disease patients in Egypt: Risk factors for postoperative recurrence (A cohort study). Ann Med Surg (Lond) 2021; 69:102781. [PMID: 34527234 PMCID: PMC8430268 DOI: 10.1016/j.amsu.2021.102781] [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: 08/10/2021] [Revised: 08/23/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of study to identify the characterizations of Crohn's disease in Egyptian patients and to determine its predictors for postoperative recurrence. METHODS We conducted a retrospective observational cohort study on 15 patients diagnosed as Crohn's disease with surgical interventions. Different characteristics of studied patients were analyzed to determine the risk factors for postoperative recurrence such as age at diagnosis, gender, smoking, main presenting symptom, Montreal classification, perianal disease, laboratory findings and protocol of management including surgical characteristics like age at operation, surgical indication, preoperative medication, surgical approach, and operative findings. RESULTS Nine of the studied patients (60%) suffered from clinical postoperative recurrence with mean duration of 23.5 ± 40.6 months. In comparison the demographic, clinical, operative, and medical treatment data between patients with postoperative recurrence of Crohn's disease and those without recurrence, age at diagnosis (mean age 42.9 years) and age at operation (mean 44.7 years) were found statistically significant in postoperative recurrence group (p-value = 0.001). According to Montreal classification of Crohn's disease, patients >40 years were significantly found in postoperative recurrence group, while patients between 17 and 40 years were significantly found in postoperative non-recurrence group (p-value=0.007) and ileal location of Crohn's disease was found significantly in postoperative recurrent group (p-value=0.044). Postoperative biological therapy significantly decreased the incidence of postoperative recurrence in the current study (p-value= 0.041). CONCLUSIONS Age at diagnosis, age at operation, ileal location of Crohn's disease can significantly predict postoperative recurrence. Also, postoperative biological therapy can significantly decrease the incidence of postoperative recurrence.
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Affiliation(s)
- Shimaa Kamel
- Department of Tropical Medicine, Gastroenterology, and Hepatology, Ain Shams University, Abbasiya, Cairo, Egypt
| | - Mohamed Sakr
- Department of Tropical Medicine, Gastroenterology, and Hepatology, Ain Shams University, Abbasiya, Cairo, Egypt
| | - Waleed Hamed
- Department of Tropical Medicine, Gastroenterology, and Hepatology, Ain Shams University, Abbasiya, Cairo, Egypt
| | - Mohamed Eltabbakh
- Department of Tropical Medicine, Gastroenterology, and Hepatology, Ain Shams University, Abbasiya, Cairo, Egypt
| | - Ahmed Sherief
- Department of Tropical Medicine, Gastroenterology, and Hepatology, Ain Shams University, Abbasiya, Cairo, Egypt
| | - Heba Rashad
- Department of Tropical Medicine, Gastroenterology, and Hepatology, Ain Shams University, Abbasiya, Cairo, Egypt
| | - Yasser Elghamrini
- Department of General Surgery, Ain Shams University, Abbasiya, Cairo, Egypt
| | - Ahmed Elbaz
- Department of Tropical Medicine, Gastroenterology, and Hepatology, Ain Shams University, Abbasiya, Cairo, Egypt
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Montasser IF, Dabbous HM, Salah M, Massoud Y, Ebada H, Sakr M, Atef S, Bahaa M, El Meteini M. Repeated COVID-19 infection in recipients of post-living donor liver transplantation: Two real-life cases. J Liver Transpl 2021; 1:100002. [PMID: 38620819 PMCID: PMC7845542 DOI: 10.1016/j.liver.2021.100002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is an emerging pandemic. The course and management of the disease in the liver transplant setting may be difficult due to a long-standing immunosuppressive state. In Egypt, the only available option is living donor liver transplantation (LDLT). In our centre, we have transplanted 440 livers since 2008. In this study, we report a single-centre experience with COVID-19 infection in long-term liver transplant recipients. A total of 25 recipients (5.7 %) had COVID-19 infections since March 2020. Among these recipients, two developed COVID-19 infections twice, approximately three and two months apart, respectively.
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Affiliation(s)
- I F Montasser
- Department of Tropical Medicine, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - H M Dabbous
- Department of Tropical Medicine, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - M Salah
- Department of Tropical Medicine, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - Y Massoud
- Department of Tropical Medicine, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - H Ebada
- Department of Tropical Medicine, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - M Sakr
- Department of Tropical Medicine, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - S Atef
- Department of Tropical Medicine, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - M Bahaa
- Department of Hepatobiliary Surgery & Liver Transplantation, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - M El Meteini
- Department of Hepatobiliary Surgery & Liver Transplantation, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
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Kamel S, Sakr M, Hamed W, Eltabbakh M, Askar S, Bassuny A, Hussein R, Elbaz A. Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients. World J Gastroenterol 2020; 26:5884-5895. [PMID: 33132642 PMCID: PMC7579751 DOI: 10.3748/wjg.v26.i38.5884] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bowel ultrasound and magnetic resonance enterography (MRE) are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications. They assess the degree of activity, help clinicians to identify patients in need of surgery, and can be used for patient follow-up.
AIM To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease (IBD) patients in Egypt.
METHODS The study was conducted on 40 patients with IBD. All patients were subjected to clinical assessment, laboratory investigations, bowel ultrasound, MRE, and colonoscopy up to the terminal ileum with biopsies for histopathological examination.
RESULTS This study was conducted on 14 patients (35%) with ulcerative colitis and 26 patients (65%) with Crohn's disease; 34 (85%) of these patients had active disease. Bowel ultrasound detected different bowel lesions with the following accuracies: ileum (85%), large bowel (70%), fistula (95%), stricture and proximal dilatation (95%) and abscesses (100%). Also, it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.
CONCLUSION In comparison to MRE, bowel ultrasound is a useful, non-invasive, and feasible bedside imaging tool for the detection of inflammation, detection of complications, and follow-up of IBD patients when performed by the attending physician.
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Affiliation(s)
- Shimaa Kamel
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed Sakr
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Waleed Hamed
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed Eltabbakh
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Safaa Askar
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Ahmed Bassuny
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Rasha Hussein
- Department of Radiology, Ain Shams University and MR Unit of Misr Radiology Center, Cairo 11566, Egypt
| | - Ahmed Elbaz
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
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El-Meteini M, Sakr M, Eldorry A, Mohran Z, Abdelkader NA, Dabbous H, Montasser I, Refaie R, Salah M, Aly M. Non-Invasive Assessment of Graft Fibrosis After Living Donor Liver Transplantation: Is There Still a Role for Liver Biopsy? Transplant Proc 2019; 51:2451-2456. [PMID: 31358454 DOI: 10.1016/j.transproceed.2019.01.197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
Non-invasive methods have evolved as a surrogate for liver biopsy such as indirect markers (aspartate transaminase to platelet ratio index, fibro-α score), transient elastography (TE), and magnetic resonance elastography (MRE). The aim of this study is to prospectively compare the value of MRE, TE, and indirect markers in detecting and staging allograft fibrosis compared to liver biopsies in patients who have undergone living donor liver transplantation for complications related to hepatitis C virus. A total of 31 living donor liver transplantation recipients with hepatitis C virus recurrence underwent a liver biopsy, TE, and MRE within 3 months of a liver biopsy. Fibrosis was assessed according to the biopsy and staged according to Metavir criteria. There was a significant correlation between both MRE and fibro-α scores, as well as histologic classification by liver biopsy (P = .02, .002). The diagnostic accuracy of MRE and fibro-α scores in diagnosing significant fibrosis (F ≥ 3) was measured as the area under the curve (.708 and .833, respectively). Both methods showed good diagnostic performance. TE and aspartate transaminase to platelet ratio index were insignificantly correlated with the degree of fibrosis in liver biopsy (P value of .134, .535). At a cutoff value of 5.5 kPa, MRE predicted graft fibrosis (Metavir stage ≥ 3) with 71.43% sensitivity, 75% specificity, 45.5% positive predictive value, and 90% negative predictive value; at a cutoff value > 1.47, fibro-α scores predicted significant graft fibrosis (Metavir stage ≥ 3) with 85.7% sensitivity and 70.83% specificity, with a positive predictive value of 46.2% and a negative predictive value of 94.4%. These data suggest that non-invasive methods could be considered a reliable tool in assessing significant graft fibrosis post-living donor liver transplantation.
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Affiliation(s)
- M El-Meteini
- Department of Hepatobiliary Surgery & Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Sakr
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A Eldorry
- Interventional Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Z Mohran
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - N A Abdelkader
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H Dabbous
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - I Montasser
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R Refaie
- Internal Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - M Salah
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - M Aly
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Shaker MK, Montasser IF, Sakr M, Elgharib M, Dabbous HM, Ebada H, Dorry AE, Bahaa M, Meteini ME. Efficacy of loco-regional treatment for hepatocellular carcinoma prior to living donor liver transplantation: a report from a single center in Egypt. J Hepatocell Carcinoma 2018. [PMID: 29520343 PMCID: PMC5833771 DOI: 10.2147/jhc.s147098] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and aim The number of loco-regional therapies (LRTs) for hepatocellular carcinoma (HCC) has increased dramatically during the past decade, bridging or downstaging patients on the waiting list for liver transplantation. This study aimed to analyze the outcomes of LRTs prior to living donor liver transplantation in patients with HCC. Methods Sixty-two HCC patients received living donor liver transplantation at Ain Shams Center for Organ Transplantation over a 2-year period. Data from 29 HCC patients were analyzed. Twenty patients (68.97%) met the Milan Criteria and 4 patients (13.8%) exceeded the Milan Criteria, but met the University of California, San Francisco Criteria. Five patients (17.2%) exceeded the University of California, San Francisco Criteria. All patients underwent preoperative LRTs. The protocol of bridging/downstaging, methods, duration of follow-up, the number of patients who were successfully downstaged before liver transplantation (LT), and their outcomes after LT were recorded. Results There was a decrease in the mean overall size of focal lesions (from mean 5.46 to 4.11 cm) in the last abdominal computed tomography (CT) scan after LRT (p=0.0018). Discrepancies between the radiological findings and histopathology were as follows: in 16 patients (55.17%) the CT findings were consistent with the histopathological examination of the explanted liver. Underestimated tumor stage was documented in 10 patients (34.48%), and was overestimated by CT scan findings in 3 patients (10.34%). The 1-year survival rate was 93%. No patient had HCC recurrence after median follow-up of 21 months (range 1–46 months). Conclusion These results encouraged tumor bridging/downstaging as a potential treatment option among carefully selected patients with HCC beyond conventional criteria for LT. Further studies on a large number of patients are necessary.
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Affiliation(s)
| | | | | | | | | | | | - Ahmed El Dorry
- Department of Radiodiagnosis and Interventional Radiology
| | - Mohamed Bahaa
- Department of Hepatobiliary Surgery and Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - Mahmoud El Meteini
- Department of Hepatobiliary Surgery and Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
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Mohran Z, Sakr M, Barakat E, Elbaz A, Al-Hamid MA, Abou-Elmaaty M. NON-INVASIVE PREDICTORS OF PORTAL HYPERTENSION IN PATIENTS WITH HEPATITIS C VIRUS RELATED HEPATOCELLULAR CARCINOMA. ACTA ACUST UNITED AC 2016; 45:545-54. [PMID: 26939231 DOI: 10.12816/0017914] [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: 11/27/2022]
Abstract
The reference standard for portal venous pressure measurement which is clinically important for estimating the. feasibility of resection of hepatocellular carcinoma is the hepatic venous pressure gradient, which is, invasive and expqnsive. The present study evaluated the noninvasive parameters for assessment of portal hypertension in Child A patients with hepatocellular carcinoma on top of hepatitis C virus. A total of 112 patients were subjected to clinical assessment, biochemical assay, ultrasonographic Doppler study, triphasic spiral abdominal computed tomography, upper gastrointestinal endoscopy and hepatic venous pressure gradient measurement. According to hepatic venous pressure gradient measurement, they were classified into groups: GI: 58 patients with hepatic venous pressure gradient <10 mmHg and GII: 54 patients with hepatic venous pressure gradient > or = 10 mmHg. Significant variables in univariate analysis were included in a multivariate analysis to establish a model for prediction of clinically significant portal hypertension. Results showed that portal vein diameter > or = 1.3 cm, mono or biphasic pattern of flow in hepatic veins and Giannini index < or = 909 were independent risk factors for the clinically significant portal hypertension as indicated by HVPG > or = 10 mmHg. A model with highest likelihood ratio and good fitness was created. This prediction model was displayed by the receiver operating characteristic curve and under the curve area was 0.969 (0.938-1).
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Azouz HG, Kozou H, Khalil M, Abdou RM, Sakr M. The correlation between central auditory processing in autistic children and their language processing abilities. Int J Pediatr Otorhinolaryngol 2014; 78:2297-300. [PMID: 25468467 DOI: 10.1016/j.ijporl.2014.10.039] [Citation(s) in RCA: 24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/23/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
Abstract
AIM To study the auditory profile at different levels of the auditory system in children with ASD and to verify the role of (Central) auditory processing disorder as an essential pathology of the autistic disorder or as an associated co-morbidity, and to establish the correlation between CAP findings and the language delay in these cases. PATIENTS The study included 30 children with definite autistic disorder according to DSM-IV-TR criteria and ADI-R among those attending the outpatient neuropsychiatry clinic of Alexandria University Children Hospital at El Shatby. An informed consent was taken from all patients in this part of the study. Confidentiality of the records was maintained. METHODS All cases were subjected to complete history taking and examination; special assessment to language skills and evoked potentials were done. RESULTS The results concluded that (central) auditory processing disorder is an essential pathology of the autistic disorder. Autistic children possess a dysfunctioning or an immature central auditory nervous system at both the brainstem and cortical levels.
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Affiliation(s)
- Hanan Galal Azouz
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
| | - Hesham Kozou
- Audiology Unit, Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University, Egypt
| | - Mona Khalil
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
| | - Rania M Abdou
- Phoniatrics Unit, Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University, Egypt.
| | - Mohamed Sakr
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
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Gawad WA, Khafagy M, Gameil M, Fakr I, Negm M, Mansour O, Loteif M, Sakr M, Shabana A. 244. Pelvic exenteration and composite sacral resection in the surgical treatment of locally recurrent rectal cancer. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.237] [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] Open
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Abdel-Gawad W, Zaghloul A, Fakhr I, Sakr M, Shabana A, Lotayef M, Mansour O. Evaluation of the frequency and pattern of local recurrence following intersphincteric resection for ultra-low rectal cancer. J Egypt Natl Canc Inst 2014; 26:87-92. [PMID: 24841159 DOI: 10.1016/j.jnci.2014.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 12/26/2013] [Accepted: 02/03/2014] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Abdomino-perineal resection has been the standard treatment for rectal tumors located ≤5cm from the anal verge. Recently, intersphincteric resection became a valid option which preserves the bowel continuity with better functional outcome. AIM Is to evaluate the oncological and functional outcome alongside the associated surgical morbidity in patients with T1-3 rectal cancer, who underwent intersphincteric resection (ISR). PATIENTS & METHODS Between the years 2006 and 2011, 55 patients with invasive rectal adenocarcinoma, T1-3 lesions, located 2-5cm from the anal verge underwent ISR with total mesorectal excision. When inevitable, complete. ISR was performed, otherwise partial ISR was done. All T3 patients underwent total meso-rectal excision (TME) while some had lateral lymph node dissection (LND) with concomitant pelvic autonomic nerve preservation (PANP). RESULTS Among the 55 patients, 21 (38.1%) patients were T1-2 and 34 (61.9%) patients were T3. The tumor location range was 0-5cm from the anal verge (median 2.3cm). Partial or complete ISR was done for 35 (63.6%) and 20 (36.4%), respectively. Patients were followed for a median of 1.5 years (range 1-4.6 years). The 3 year local recurrence and distant metastasis free rates were 85.2% and 85.6%, respectively. All the 3 local recurrences occurred in T3 patients group, and had positive circumferential resection margins. Overall 3-year disease-free survival was 82.6%; while the overall 3-year survival was 88.7%. CONCLUSION Intersphincteric resection with TME does not affect the local recurrence or overall survival rate in early rectal cancer T1-2 & 3, with preservation of bowel continuity and better life quality.
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Affiliation(s)
- W Abdel-Gawad
- Surgical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - A Zaghloul
- Surgical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - I Fakhr
- Surgical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt.
| | - M Sakr
- Surgical Pathology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - A Shabana
- Radio-Diagnosis Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - M Lotayef
- Radiation Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
| | - O Mansour
- Medical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt
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Sakr M, Mohamed Z, Atta M, Zalama M. RESPONSE OF FABA BEAN PLANTS TO APPLICATION OF SOME GROWTH PROMOTERS UNDER SALINITY STRESS CONDITIONS. ACTA ACUST UNITED AC 2014. [DOI: 10.21608/jpp.2014.53482] [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: 10/25/2022]
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Sakr M, Abd El-Salam H, Atta M, Abd- El-Aal M. ALLEVIATING THE HARMFUL EFFECT OF SALINITY STRESS ON SOYBEAN PLANTS BY USING SOME PROMOTERS. Journal of Plant Production 2013; 4:205-218. [DOI: 10.21608/jpp.2013.68980] [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: 09/01/2023]
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Shehata F, Abdel Monem N, Sakr M, Kasem S, Balbaa M. Epidermal growth factor, its receptor and transforming growth factor-β1 in the diagnosis of HCV-induced hepatocellular carcinoma. Med Oncol 2013; 30:673. [PMID: 23912699 DOI: 10.1007/s12032-013-0673-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/21/2013] [Indexed: 02/06/2023]
Abstract
In this article, we present a study on the levels of epidermal growth factor (EGF), its phosphorylated receptor (p-EGFR) and transforming growth factor-β1 (TGF-β1) in the sera of patients with hepatocellular carcinoma (HCC) and chronic hepatitis C (CHC) infection. The results reveal significant higher serum levels of EGF and TGF-β1 in patients with HCC compared to their level in patients with CHC infection and control subjects. The levels of p-EGFR in HCC and CHC patients show a highly significant difference between patients. Based on the best cutoff value of 914 pg/ml, EGF shows 63.3 % sensitivity and 87.5 % specificity for HCC patients where the area under the curve is 0.81. The p-EGFR shows sensitivity of 63.3 % and specificity of 100 % where the area under the curve is 0.87 for HCC patients based on the best cutoff value of 39 U/mg protein. The best cutoff value (370 pg/ml) for serum TGF-β1 displays sensitivity of 86.7 % and specificity of 100 %, where the area under the curve is 0.97 for HCC patients.
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Affiliation(s)
- Fatma Shehata
- Oncology Diagnostic Unit, Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Eğin Y, Elsayed S, Sakr M, Akar N. TNF-α-308 G/A Polymorphism in Egyptian Budd-Chiari Syndrome Patients. Turk J Haematol 2012; 29:420-1. [PMID: 24385733 PMCID: PMC3781630 DOI: 10.5505/tjh.2012.71473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/19/2012] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yonca Eğin
- Ankara University, Department of Pediatric Genetics, Ankara, Turkey
| | - Solaf Elsayed
- Ain Shams University, Pediatrics Department, Genetics Unit, Cairo, Egypt
| | | | - Nejat Akar
- TOBB Economy and Technology University Hospital, Ankara, Turkey
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Abstract
Two field experiments were carried out to investigate the role of seed soaking with spermine (Spm, 10 mg/l) and the foliar application of mineral nutrients (K and Zn), alone or in combination, in improving the tolerance of sunflower (
Helianthus annuus
L.) to calcareous and salinity stress conditions. Both the individual treatments and the interaction increased the stem diameter, shoot fresh and dry weights, yield, yield components and oil yield, as well as the concentrations of K, Ca, P and Zn and the K/Na ratio, whereas they decreased the Na concentration in the two growing seasons. The best results were obtained with the K+Zn+Spm treatment in both seasons.It could be concluded that seed soaking with Spm and the foliar application of K and Zn might alleviate the harmful effects of calcareous and salinity stress and enhance the ability of sunflower plants to tolerate these adverse conditions.
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Affiliation(s)
- M. Sakr
- 1 Mansoura University Agricultural Botany Department, Agricultural Faculty Mansoura Egypt
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Al-Mutawakel K, Scutaru C, Shami A, Sakr M, Groneberg DA, Quarcoo D. Scientometric analysis of the world-wide research efforts concerning Leishmaniasis. Parasit Vectors 2010; 3:14. [PMID: 20202187 PMCID: PMC2845575 DOI: 10.1186/1756-3305-3-14] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [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: 10/30/2009] [Accepted: 03/04/2010] [Indexed: 11/10/2022] Open
Abstract
ABSTRACT BACKGROUND Leishmaniasis is a chronic disease that is found in various countries of the world. The aim of the current study was to investigate the impact of leishmaniasis on the world's research output. The present study assessed benchmarking of research output for the period between 1957 and 2006. Using large database analyses, research in the field of leishmaniasis was evaluated. Furthermore, cooperation between different countries was identified. RESULTS The number of publications increased with time. Most publications came from Western countries such as the US, UK or Germany. Interestingly, countries like Brazil and India had a high research output. We found a substantial amount of cooperation between countries. CONCLUSION Although leishmaniasis is of limited geographic distribution it attracts a wide research interest. The central hub of research cooperation is the USA.
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Affiliation(s)
- K Al-Mutawakel
- Department of Dermatology and Venerology, Sana'a University Faculty of Medicine and Dentistry, Sana'a, Yemen.
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Eid N, Abdeldaeim H, Hamdy S, Sakr M, Zahran A, Marzouk E. MP-07.03: Percutaneous Nephrolithotomy in Kidneys with Rotation and Fusion Anomalies: CT Versus IVU Planned Accesses. Urology 2009. [DOI: 10.1016/j.urology.2009.07.971] [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: 10/20/2022]
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Ismail HR, Youssef M, Sakr M, Hussein T, Zahran AM. Non-tensile tunica albuginea plication for the correction of penile curvature. Afr J Urol 2009. [DOI: 10.1007/s12301-009-0019-2] [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: 10/19/2022] Open
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Bond G, Pièche S, Sonicki Z, Gamaluddin H, Guindi ME, Sakr M, Seddawy AE, Abouzaid M, Youssef A. A clinical decision rule for triage of children under 5 years of age with hydrocarbon (kerosene) aspiration in developing countries. Clin Toxicol (Phila) 2009; 46:222-9. [DOI: 10.1080/15563650701801218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abd EI-Rahman, A, Sakr M. PHYSIOLOGICAL PERFORMANCE OF RICE PLANTS AS AFFECTED BY DIFFERENT LEVELS OF COPPER AND NITROGEN FERTILIZERS. Journal of Plant Production 2004; 29:3253-3259. [DOI: 10.21608/jpp.2004.238654] [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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Loutfi I, Sakr M, Al-Shummari AM. Minimizing radiation exposure from patients treated with iodine-131 for hyperthyroidism using a lead collar: a simple and effective approach. Med Princ Pract 2003; 12:203-7. [PMID: 12966190 DOI: 10.1159/000072284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Received: 05/14/2002] [Accepted: 12/31/2002] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To construct a lead collar useful for shielding the electromagnetic radiation from the thyroid of patients treated with radioiodine (131)I for hyperthyroidism, thereby reducing the radiation emitted from these patients. MATERIALS AND METHODS A specially designed cervical lead collar was used to shield radiation exposure from 'hot thyroids' of 20 patients treated with iodine-131 for hyperthyroidism. The collar was made of lead strips stacked together around a plastic neck support fastened around the patient's neck. Measurements of the radiation exposure rate were obtained at increasing distances from the patients (50, 100, 200 cm), with and without the lead collar, at various times after (131)I treatment. RESULTS Radiation exposure measurements over 3 weeks showed relatively high exposure rates in the first week after treatment. The radiation exposure from the patients wearing the lead collar was half that found in the same patients not wearing the collar. CONCLUSION The use of the lead collar significantly reduced the radiation exposure of patients' surroundings. It was particularly useful in patients who could not abide strictly to the standard restrictive protocols after treatment with (131)I.
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Affiliation(s)
- Issa Loutfi
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait.
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Sakr M, Kendall R, Angus J, Sanders A, Nicholl J, Wardrope J, Saunders A. Emergency nurse practitioners: a three part study in clinical and cost effectiveness. Emerg Med J 2003; 20:158-63. [PMID: 12642530 PMCID: PMC1726060 DOI: 10.1136/emj.20.2.158] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [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: 11/04/2022]
Abstract
AIMS To compare the clinical effectiveness and costs of minor injury services provided by nurse practitioners with minor injury care provided by an accident and emergency (A&E) department. METHODS A three part prospective study in a city where an A&E department was closing and being replaced by a nurse led minor injury unit (MIU). The first part of the study took a sample of patients attending the A&E department. The second part of the study was a sample of patients from a nurse led MIU that had replaced the A&E department. In each of these samples the clinical effectiveness was judged by comparing the "gold standard" of a research assessment with the clinical assessment. Primary outcome measures were the number of errors in clinical assessment, treatment, and disposal. The third part of the study used routine data whose collection had been prospectively configured to assess the costs and cost consequences of both models of care. RESULTS The minor injury unit produced a safe service where the total package of care was equal to or in some cases better than the A&E care. Significant process errors were made in 191 of 1447 (13.2%) patients treated by medical staff in the A&E department and 126 of 1313 (9.6%) of patients treated by nurse practitioners in the MIU. Very significant errors were rare (one error). Waiting times were much better at the MIU (mean MIU 19 minutes, A&E department 56.4 minutes). The revenue costs were greater in the MIU (MIU pound 41.1, A&E department pound 40.01) and there was a great difference in the rates of follow up and with the nurses referring 47% of patients for follow up and the A&E department referring only 27%. Thus the costs and cost consequences were greater for MIU care compared with A&E care (MIU pound 12.7 per minor injury case, A&E department pound 9.66 per minor injury case). CONCLUSION A nurse practitioner minor injury service can provide a safe and effective service for the treatment of minor injury. However, the costs of such a service are greater and there seems to be an increased use of outpatient services.
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Affiliation(s)
- M Sakr
- Accident and Emergency Department, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
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Abstract
A case is reported of atrial fibrillation in a young healthy man after head injury and the possible causes are discussed. The atrial fibrillation reverted spontaneously to normal rhythm in two days. The authors are not aware of a similar report in the literature.
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Affiliation(s)
- P Muthu
- Accident and Emergency Department, University Hospital Nottingham NHS Trust, Queen's Medical Centre, Nottingham, UK.
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Affiliation(s)
- M Sakr
- Accident and Emergency Department, Queen's Medical Centre, Nottingham
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Abstract
BACKGROUND We aimed to assess the care and outcome of patients with minor injuries who were managed by a nurse practitioner or a junior doctor in our accident and emergency department. METHODS 1453 eligible patients, over age 16 years, who presented at our department with minor injuries were randomly assigned care by a nurse practitioner (n=704) or by a junior doctor (n=749). Each patient was first assessed by the nurse practitioner or junior doctor who did a clinical assessment; the assessments were transcribed afterwards to maintain masked conditions. Patients were then assessed by an experienced accident and emergency physician (research registrar) who completed a research assessment, but took no part in the clinical management of the patient. A standard form was used to compare the clinical assessment of the nurse practitioner or junior doctor with the assessment of the research registrar. The primary outcome measure was the adequacy of care (history taking, examination of patient, interpretation of radiographs, treatment decision, advice, and follow-up). FINDINGS Compared with the rigorous standard of the experienced accident and emergency research registrar, nurse practitioners and junior doctors made clinically important errors in 65 (9.2%) of 704 patients and in 80 (10.7%) of 749 patients, respectively. This difference was not significant. The nurse practitioners were better than junior doctors at recording medical history and fewer patients seen by a nurse practitioner had to seek unplanned follow-up advice about their injury. There were no significant differences between nurse practitioners and junior doctors in the accuracy of examination, adequacy of treatment, planned follow-up, or requests for radiography. Interpretation of radiographs was similar in the two groups. INTERPRETATION Properly trained accident and emergency nurse practitioners, who work within agreed guidelines can provide care for patients with minor injuries that is equal or in some ways better than that provided by junior doctors.
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Affiliation(s)
- M Sakr
- Department of Accident and Emergency Medicine, Northern General Hospital, Sheffield, UK
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Edhouse JA, Sakr M, Angus J, Morris FP. Suspected myocardial infarction and left bundle branch block: electrocardiographic indicators of acute ischaemia. J Accid Emerg Med 1999; 16:331-5. [PMID: 10505911 PMCID: PMC1347050 DOI: 10.1136/emj.16.5.331] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the use of thrombolytic treatment in patients with suspected acute myocardial infarction (AMI) and left bundle branch block (LBBB). To evaluate electrocardiographic criteria for the identification of AMI in the presence of LBBB, and examine the implications of using these criteria in the clinical setting. METHODS A retrospective study over two years, based in two Sheffield teaching hospitals. Patients presenting with LBBB and suspected AMI were studied by analysis of an AMI database. The proportion of patients with LBBB and AMI receiving thrombolysis, and the in-hospital delay before the start of treatment, were used as indicators of current performance. Three predictive criteria were applied to the electrocardiograms (ECGs) retrospectively, and their ability to identify acute ischaemic change assessed. The implications of using the predictive criteria in the clinical setting were explored. RESULT Twenty three per cent (5/22) of patients with LBBB and AMI did not receive thrombolysis, in the absence of documented contraindications. The mean in-hospital treatment delay for thrombolysed patients was 154 minutes. Forty eight per cent (16/33) of those thrombolysed did not have a final clinical diagnosis of AMI. In the majority of cases (8/12), the decision not to administer thrombolysis was based on a single ECG recording. The presence of any of the predictive electrocardiographic criteria was associated with a diagnosis of AMI, with a sensitivity of 0.79 (95% confidence interval 0.63 to 0.95), specificity 1, positive predictive value 1, and negative predictive value 0.79. The kappa scores between four independent observers showed either substantial or near perfect agreement. CONCLUSION Currently, thrombolytic treatment is under-utilised in patients with LBBB and AMI, and those who are thrombolysed endure lengthy delays before treatment. Patients with any of the predictive criteria should be thrombolysed immediately. When the diagnosis is in doubt, serial ECGs may demonstrate evolving ischaemic change.
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Affiliation(s)
- J A Edhouse
- Accident and Emergency Department, Northern General Hospital, Sheffield.
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Edhouse JA, Sakr M, Wardrope J, Morris FP. Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department. J Accid Emerg Med 1999; 16:325-30. [PMID: 10505910 PMCID: PMC1347049 DOI: 10.1136/emj.16.5.325] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the safety and efficiency with which the accident and emergency (A&E) department provides thrombolytic treatment for patients with acute myocardial infarction (AMI). METHODS A prospective observational study based in a teaching hospital for one year. All patients who presented with the clinical and electrocardiographic indications for thrombolytic treatment were studied. Patients were grouped according to route of admission. After logarithmic transformation, the "door to needle times" of the groups were compared using a two tailed Student's t test. Arrhythmias and complications after thrombolytic treatment were noted. The appropriateness of the treatment was assessed retrospectively by review of the clinical records and electrocardiograms, judged against locally agreed eligibility criteria. RESULTS Data from 153 patients were analysed; 138/153 (90%) patients were admitted via the A&E department. The shortest door to needle times were seen in those patients thrombolysed by A&E staff within the A&E department (mean 43.8 minutes). The transfer of A&E patients to the coronary care unit (CCU) was associated with a significant increase in the door to needle time (mean 58.8 minutes, p = 0.004). Only one malignant arrhythmia occurred during the administration of thrombolysis in the A&E department, and this was managed effectively. No arrhythmias occurred during transfer of thrombolysed patients to the CCU. In every case, the decision to administer thrombolysis was retrospectively judged to have been appropriate. CONCLUSIONS The A&E department provides appropriate, safe, and timely thrombolytic treatment for patients with AMI. Transferring A&E patients to the CCU before thrombolysis is associated with an unnecessary treatment delay.
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Affiliation(s)
- J A Edhouse
- Accident and Emergency Department, Northern General Hospital, Sheffield.
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Awad AT, el-Husseini G, Anwar M, Abu-Nasr A, Anwar AA, Sakr M. Bilateral primary breast cancers: a clinicopathological study of the second primary. Int Surg 1996; 81:57-60. [PMID: 8803708 DOI: pmid/8803708] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Out of 2238 patients with breast cancer 35 developed carcinoma of the contralateral breast. Thirty-three developed metachronous tumours while two developed synchronous tumours. The thirty-five patients were followed up for periods between 4-8 years. The majority of patients belonged to the fourth decade and the peak incidence of developing a metachronous tumour occurred three to five years after diagnosis of the first primary. T2 lesions were the most frequent initial primaries and N1 lesions were commoner than N2. IDC was the commonest histopathological subtype. The overall two-year survival rate was 57.1% (20/35).
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Affiliation(s)
- A T Awad
- Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
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Abstract
Patients with schistosomiasis and portal hypertension have significantly lower levels of hydroxyproline in their saphenous veins and anterior rectus sheaths than do individuals without schistosomal hepatic fibrosis. The stomach of patients with schistosomal portal hypertension demonstrates an increased number of lymphatics by lymphangiography. The disrupted lymph node architecture in these patients could be partially responsible for dilation, tortuosity, and retrograde lymph flow in the gastric lymphatics. These histological and lymphangiographic findings could be attributed to the effect of venous and patients with decompensated schistosomal portal hypertension revealed edema of the entire esophageal wall with lymphatic dilation and tortuosity. Based upon these data, we suggest that the varices that develop in patients with schistosomal portal hypertension occur as a consequence of an increased portal venous pressure together with acquired lymphangiectasia as well as an intrinsic weakness of the walls of the portosystemic venous channels.
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Affiliation(s)
- A Aboul-Enein
- Department of Surgery, School of Medicine, University of Alexandria, Egypt
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Sakr M, Zetti G, McClain C, Gavaler J, Nalesnik M, Todo S, Starzl T, Van Thiel D. The protective effect of FK506 pretreatment against renal ischemia/reperfusion injury in rats. Transplantation 1992; 53:987-91. [PMID: 1374948 PMCID: PMC3229300 DOI: 10.1097/00007890-199205000-00004] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The effect of pretreatment with FK506 on renal ischemia and reperfusion (I/R) injury was investigated using a rat model. Animals were assigned to one of two groups (20 rats each). Group 1 animals (controls) received 0.5 ml saline while group 2 animals received FK506 (0.3 mg/kg), administered intravenously 24 hr prior to the induction of renal ischemia. A 60-min period of ischemia of the right kidney was induced, and upon reperfusion a left nephrectomy was performed. Blood samples for estimation of BUN, creatinine, and tumor necrosis factor were collected on days 0 (preischemia), 1, 2, 3, 5, 7, and 10 (postischemia). Rats were sacrificed after day 10 and renal tissue was examined histologically. All animals survived the ischemic episode. FK506 pretreatment significantly reduced the serum levels of BUN (P less than 0.02), creatinine (P less than 0.02), and TNF (P less than 0.05) as compared with that seen in controls. Histologically, at day 10, the kidneys showed the expected sequelae of prior renal I/R with various degrees of tubular damage. However, no objective differences were evident between the two groups. Based upon these data, it can be concluded that (1) FK506 pretreatment ameliorates the functional renal injury associated with I/R, (2) renal ischemia induces the release of TNF, and (3) FK506 pretreatment results in a significant inhibition of TNF production. These data suggest that the release of TNF may be responsible for the increasing of BUN and creatinine levels seen after renal I/R and that pretreatment of renal donors with FK506 may improve renal function in the immediate post-transplant period.
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Affiliation(s)
- M Sakr
- Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania 15261
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Sakr M, Hassanein T, Gavaler J, Abu-Elmagd K, Fung J, Gordon R, Starzl T, Van Thiel D. Cytomegalovirus infection of the upper gastrointestinal tract following liver transplantation--incidence, location, and severity in cyclosporine- and FK506-treated patients. Transplantation 1992; 53:786-91. [PMID: 1373535 PMCID: PMC2962610 DOI: 10.1097/00007890-199204000-00016] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
One hundred and forty randomly selected liver transplant recipients were studied before and after primary orthotopic liver transplantation for the presence or absence of CMV enteritis. Following OLTx, 65 patients were treated with cyclosporine A and 75 were treated with FK506. The two groups were similar with regard to the incidence, location, and outcome of their upper gastrointestinal CMV infection. Prior to OLTx, only one patient had evidence of enteric CMV infection. The incidence of CMV enteritis post-OLTx was 27.7% in the CsA-treated group and 20% in the FK-treated group. During the first posttransplant month, no patient in the FK-treated group developed CMV enteritis, compared with 11.5% of the patients who were treated with CsA (P less than 0.05). Gastric CMV was found in over 80% of those positive for any organ in either group. In addition to CMV infection of the upper gastrointestinal tract, clinically evident CMV disease involved more nonenteric organs in the CsA-treated group than in the FK-treated group. In the CsA-treated group, CMV-negative patients had a statistically higher 1-year survival rate (100%) than CMV-positive patients (77.8%) (P less than 0.05). In the FK-treated group, no difference in survival was observed between CMV-positive or CMV-negative cases at 1 year. Of the patients on CsA, 20% received OKT3 for persistent rejection, as compared with 13% in the FK-treated group. The patients receiving both CsA and OKT3 had a higher rate of upper gastrointestinal CMV infection than did FK-treated patients who also received OKT3 therapy (38.5% versus 20%, respectively). Based upon these data, it can be concluded that (1) patients receiving FK have a lower incidence of enteric CMV infection; (2) following OLTx, upper gastrointestinal CMV infection presents later in FK-treated patients; (3) the stomach is the most frequently involved organ in the UGIT; (4) FK-treated liver recipients have less severe enteric CMV infection than do CsA-treated patients; (5) enteric CMV is not a major cause of mortality in liver transplant recipients; and (6) in patients receiving FK, those who require OKT3 therapy do not appear to be at a greater risk for the development of CMV enteritis than those who do not.
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Affiliation(s)
- M Sakr
- Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania 15261
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Sakr M, Zetti G, Gavaler J, Farghali H, Venkataramanan R, Carrieri G, Starzl T, Van Thiel D. Effect of renal ischemia on plasma levels of FK 506 in rats. Transplant Proc 1992; 24:425-8. [PMID: 1371625 PMCID: PMC2954665 DOI: pmid/1371625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Sakr
- Department of Surgery, University of Pittsburgh, School of Medicine, Pennsylvania
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Abstract
The effect of FK 506 pretreatment on renal ischemia and reperfusion (I/R) injury was investigated. Adult male rats were assigned to one of two groups (20 animals each). Group 1 (controls) received 0.5 mL saline while group 2 received FK 506 (0.3 mg/kg) intravenously 24 h prior to the induction of renal ischemia. After a 60-min period of ischemia of the right kidney, a left nephrectomy was performed. Blood for BUN, creatinine, and tumor necrosis factor (TNF) was obtained prior to ischemia and on days 1, 2, 3, 5, 7, and 10. All surviving animals were sacrificed at day 10. FK 506 pretreatment reduced the serum levels of BUN (p less than .02), creatinine (p less than .02) and TNF (p less than .05) as compared to that seen in controls. Based upon these data, it appears that: (a) renal ischemia induces the release of TNF; (b) FK 506 pretreatment inhibits TNF production; and (c) FK 506 reduces renal injury association with I/R.
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Affiliation(s)
- D H Van Thiel
- Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania 15213
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Farghali H, Sakr M, Gasbarrini A, Venkataramanan R, Gavaler J, Starzl TE, Van Thiel DH. Effect of FK 506 chronic administration on bromosulphthalein hepatic excretion in rats. Transplant Proc 1991; 23:2802-4. [PMID: 1721283 PMCID: PMC2965618 DOI: pmid/1721283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- H Farghali
- Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania
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Farghali H, Sakr M, Gasbarrini A, Williams DS, Dowd SR, Ho C, Van Thiel DH. A biochemical and 31P-NMR investigation of the effect of FK 506 and cyclosporine pretreatment on immobilized hepatocytes perifused with ethanol. Transplant Proc 1991; 23:2805-8. [PMID: 1721284 DOI: pmid/1721284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- H Farghali
- Department of Surgery, University of Pittsburgh School of Medicine, PA 15213
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Abstract
The effects of the Ca-blocker nifedipine on the contractile response to K and NA in isolated human pulmonary vessels were studied. Specimens of macroscopically normal pulmonary vessels, obtained from patients undergoing surgery for lungtumours were carefully dissected and cut into rings. The results suggest that nifedipine, by blocking the entry of extracellular calcium, inhibits K-induced contractions in isolated pulmonary vessels. The effect is more pronounced on K than on NA-induced response in both the pulmonary arteries and veins.
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