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Sobhy N, Ezzat Y, Gamal SM, Ghoniem SA, Nasr SS, Badran S, Soliman A, Fouad NA. Cumulative pulse methylprednisolone and its relation to disease activity, damage and mortality in systemic lupus erythematosus patients: A post hoc analysis of COMOSLE-EGYPT study. Clin Rheumatol 2024; 43:985-992. [PMID: 38198114 PMCID: PMC10876750 DOI: 10.1007/s10067-023-06858-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To investigate the relation between cumulative intravenous methylprednisolone dose and disease activity, damage, and mortality among a group of Egyptian SLE patients. PATIENTS AND METHODS This is a post hoc analysis of a retrospective multicenter COMOSLE study. Cumulative pulse methylprednisolone dose was abstracted from COMOSLE database. Patients with cumulative pulse dose of ≤ 3.0 g (median dose) were compared to those with cumulative dose of > 3.0 g regarding demographic data, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and The Systemic Lupus International Collaborating Clinics/ACR Damage Index (SLICC) score as well as treatment received. Additionally, at 1.5, 3, 6, and 9 g of cumulative methylprednisolone, patients were compared regarding SLICC score and risk of mortality. RESULTS Patients who received > 3 g of methylprednisolone were statistically significantly younger at disease onset, had longer disease duration, higher SLEDAI score at last visit, and higher SLICC score (p = 003, p = 0.002, p = 0.004 and p = < 0.001, respectively). Additionally, with every gram increase in the cumulative methylprednisolone, there was a significant increase in SLICC score by 0.169 (B = 0.169, CI = 0.122-0.216, p-value = < 0.001) and an increased risk of mortality by 13.5% (hazard ratio (HR) = 1.135, CI = 1.091-1.180, p-value = 0.001). The best cutoff value of methylprednisolone dose at which damage may occur, ranged between 2.75 (with sensitivity of 81.4% and specificity of 33.9%) and 3.25 g (with sensitivity of 48.3% and specificity of 71.5%). CONCLUSION With every gram increase in the cumulative methylprednisolone, there may be increase in damage and mortality, especially in doses exceeding the range of 2.75-3.25 g. Key Points • Treatment of systemic lupus erythematosus should be with the least possible dose of steroids to decrease the risk of damage and mortality. • With every gram increase in the cumulative intravenous methylprednisolone there may be increase in damage and mortality.
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Affiliation(s)
- Nesreen Sobhy
- Rheumatology Department, Cairo University, Cairo, Egypt.
| | - Yasser Ezzat
- Rheumatology Department, Fayoum University, Fayoum, Egypt
| | | | | | - Sarah S Nasr
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Ahmed Soliman
- Department of Dermatology and Venereology, National Research Center Egypt, Cairo, Egypt
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Miedany YE, Abu-Zaid MH, Eissa M, Hassan WA, Mortada M, Tabra SAA, Mohamed SS, Maher SE, Gaafary ME, Medhat BM, Mosa DM, Fouad NA, Amer YA, Nasef SI, Shalaby RH, Adel Y, Elkhalek RA, Mahgoub MY, Lotfy HM. Consensus evidence-based recommendations for transition of care for adolescents with juvenile idiopathic arthritis: meeting patients’, parents’, and rheumatologists’ perspectives. Egypt Rheumatol Rehabil 2023; 50:39. [DOI: 10.1186/s43166-023-00195-9] [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] [Received: 03/31/2023] [Accepted: 05/26/2023] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
Transition of care means the process of educating and empowering adolescents and young adults to take an active role in their own healthcare, develop decision-making skills, and eventually transition from paediatric to adult healthcare providers. Most people do not switch doctors until they are young adults, but it can be beneficial to start preparing children earlier. We aimed to develop a specific toolkit tailored to paediatric and adult rheumatologists to assist them in transitioning of care of young people with juvenile onset rheumatic musculoskeletal diseases from the paediatric to adult rheumatology care.
Results
The expert panel was confined to an online survey (n = 18), all the experts completed the two rounds. At the conclusion of round 2, a total of 10 points were gathered. The range of respondents (ranks 7–9) who agreed with the recommendations was 88.9 to 100%. All 10 clinical standards identified by the scientific committee were written in the same way. Based on the answers to the structured key questions and the literature review, a structured template was developed presenting transition of care integrated pathway.
Conclusion
The developed rheumatology-specific guideline offers adolescents and young adults a focussed, multidisciplinary transition of care approach with equity of access, quality of care and flexibility and set up standards for transitional care for young adults with juvenile rheumatological diseases.
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Miedany YE, Abu-Zaid MH, Eissa M, Hassan WA, Mortada M, Tabra SAA, Mohamed SS, Maher SE, Gaafary ME, Medhat BM, Mosa DM, Fouad NA, Amer YA, Nasef SI, Shalaby RH, Adel Y, Elkhalek RA, Mahgoub MY, Lotfy HM. E07 Development of a coordinated transitional care program on adolescents with juvenile idiopathic arthritis: looking through the patient lens. Rheumatology (Oxford) 2023; 62. [DOI: 10.1093/rheumatology/kead323.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
Transition of care means the process of educating and empowering adolescents and young adults to take an active role in their own healthcare, develop decision-making skills, and eventually transition from paediatric to adult healthcare providers. Most people don't switch doctors until they are young adults, but it can be beneficial to start preparing children earlier.
Objectives
To provide a toolset specifically suited for adult and paediatric rheumatologists to help them transition the care of children with rheumatic diseases from adult to paediatric rheumatology care.
Methods
The preliminary scientific committee identified a total of ten major clinical questions in this study, which was conducted to obtain expert consensus. To reach consensus on the transition of care for young adults and adolescents with rheumatic diseases, the core leadership team sought out researchers and clinicians with expertise in both paediatric and adult rheumatic diseases management.
Results
The expert panel's participation was restricted to an online survey (n = 18); each expert completed both rounds. After round 2, a total of 10 points had been collected. 88.9% to100% of respondents (ranks 7–9) indicated they agreed with the recommendations. The scientific committee's 10 clinical standards were all prepared in the same style. A structured template describing the integrated pathway for transition of care was developed using the responses to the structured key questions and the results of the literature review.
Conclusion
The created rheumatology-specific guideline provides young adults with juvenile rheumatic diseases with a focused, multidisciplinary transition of care strategy with equity of access, quality of care, and flexibility and establishes standards for transitional care.
Ethics
This study was performed in accordance with the Helsinki Declaration. The ‘Clinical, Evidence-based, Guidelines’ (CEG) initiative protocol was approved the local ethical committee: ethical approval code: 34842/8/21, ethical board Tanta University.
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Affiliation(s)
- Yasser El Miedany
- Christ Church University , Kent, UK
- H. Senior Clinical Lecturer, King's College London , UK
| | | | | | - Waleed A Hassan
- Rheumatology and Rehabilitation, Benha University , Benha, Egypt
| | | | | | - Sally S Mohamed
- Rheumatology and Rehabilitation, Cairo University , Cairo, Egypt
| | | | - Maha El Gaafary
- Community Medicine and Public Health, Ain Shams University , Cairo, Egypt
| | - Basma M Medhat
- Rheumatology and Rehabilitation, Cairo University , Cairo, Egypt
| | - Doaa Mosad Mosa
- Rheumatology, Faculty of Medicine, Mansoura University , Mansoura, Egypt
| | | | | | - Samah Ismail Nasef
- Rheumatology and Rehabilitation, Suez Canal University , Ismailia, Egypt
| | - Radwa H Shalaby
- Rheumatology and Rehabilitation, Tanta University, Tanta , Egypt
| | - Yasmin Adel
- Rheumatology and Rehabilitation, Mansoura University , Egypt
| | | | | | - Hala M Lotfy
- Pediatric Rheumatology, Cairo University , Cairo, Egypt
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El Miedany Y, Salah S, Lotfy HM, Abu-Zaid MH, Mohamed SS, Maher SE, El Gaafary M, Abdulhady H, Farag Y, Eissa M, Radwan A, Medhat BM, El Mikkawy DME, Hassan WA, Mosa DM, El Deriny G, Mortada M, Osman NS, Fouad NA, Amer YA, Nasef SI, Abushady H, Galal S, El-Latif EA, Maria D, Shabana AH, Tabra SA. Egyptian evidence-based consensus on clinical practice recommendations for the management of Kawasaki disease. Egypt Rheumatol Rehabil 2023; 50:21. [PMCID: PMC10088797 DOI: 10.1186/s43166-023-00180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/10/2023] [Indexed: 09/02/2023] Open
Abstract
Background Kawasaki disease (KD) is an acute, self-limited febrile disease of unidentified cause that mostly affects children less than 5 years of age. This work aimed to provide an appropriate Egyptian evidence-based consensus on clinical practice recommendations for the management of Kawasaki disease. The main objective of this study, which employed the Delphi method, was to reach a consensus among experts on a treat-to-target management approach for KD. Results The expert panel was confined to an online survey (n =26), and all the expert completed the three rounds. At the conclusion of round 3, a total of 17 recommendation items were gathered, which were divided into two sections. The range of respondents (ranks 7–9) who agreed with the recommendations was 92.3 to 100%. All 17 clinical standards identified by the scientific committee were written in the same way. There have been algorithms proposed for managing various KD conditions. Conclusion The developed evidence-based consensus recommendations for the diagnosis and management of KD represent an up-to-date document that focuses on clinical management questions which are generally posed to health care professionals involved in the management of KD. This guideline was developed considering experience with and availability of treatment and diagnostic options in Egypt.
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Affiliation(s)
- Yasser El Miedany
- Canterbury Christ Church University, Kent, England
- King’s College London, London, England
| | - Samia Salah
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Hala M. Lotfy
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | | | | | | | - Maha El Gaafary
- Community Medicine and Public Health, Ain Shams University, Cairo, Egypt
| | - Hala Abdulhady
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - Yomna Farag
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Mervat Eissa
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | - Ahmed Radwan
- Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | - Basma M. Medhat
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | | | | | - Doaa Mosad Mosa
- Rheumatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mohamed Mortada
- Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | | | | | | | | | - Hend Abushady
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Salwa Galal
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | | | - Dina Maria
- Cardiology, Tanta University, Tanta, Egypt
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El Miedany Y, Kamel NS, Abu-Zaid MH, El Hadidi K, Mahmoud GA, Sarhan E, El Gaafary M, Abdel-Nasser A, Abualfadl EM, Azim AA, Fathi NA, Mokbel A, Hassan W, Tabra SAA, Eissa M, Mortada M, Fouad NA, Elnemr R, Mansour AE, Elaraby I, Medhat BM, Mohamed SS, Abdelradi ER, Ibrahim RA, Saber S. Egyptian evidence-based consensus on clinical practice recommendations for the management of lupus nephritis. Egypt Rheumatol Rehabil 2022. [DOI: 10.1186/s43166-022-00146-w] [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
Lupus nephritis (LN) affects a substantial number of the patients living with Systemic lupus erythematosus (SLE), representing a major cause of morbidity and mortality. Patients with lupus nephritis should be referred to a lupus nephritis expert who can confirm the diagnosis, assess the level of disease activity, and offer guidance on treatment and monitoring of the disease, as well as its consequences and side effects. The aim of this guideline was to develop recommendations for the management of adult lupus patients, including lupus nephritis diagnosis, assessment, and monitoring.
Nineteen key clinical questions were identified by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for LN. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 2-round Delphi process was conducted with 24 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.
Results
An online questionnaire was sent to an expert panel who participated in the two rounds (response rate 100%). At the end of round 2, a total of 19 recommendation items, categorized into 11 sections to address the main LN categories, were obtained. The percentage of those who agreed with the recommendations (ranks 7–9) ranged from 90.5 to 100%. The phrasing of all 19 clinical standards identified by the scientific committee was agreed upon (i.e., 75% of respondents strongly agreed or agreed).
Conclusion
These recommendations provide an updated consensus on the pharmacological treatment of lupus nephritis and strategies to reach optimal treat to target outcomes in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.
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El Miedany Y, Kamel NS, Abu-Zaid MH, El Hadidi K, Mahmoud GA, El Gaafary M, Sarhan E, Abdel-Nasser A, Abualfadl EM, Azim AA, Fathi NA, Mokbel A, Hassan W, Eissa M, Tabra SAA, Mortada M, Fouad NA, Elnemr R, Mansour AE, Elaraby I, Medhat BM, Mohamed SS, Abdelradi ER, Ibrahim RA, Saber S. Egyptian recommendations for treating to target of lupus nephritis: an evidence-based consensus on clinical practice recommendations for the management of lupus nephritis and pregnancy. Egypt Rheumatol Rehabil 2022. [DOI: 10.1186/s43166-022-00142-0] [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
Nephritis is known to be one of the most serious complications of lupus and a strong predictor of poor outcome. This study was carried out aiming at setting up an up-to-date recommendation for the management of women living with lupus nephritis and planning for a family throughout conception, pregnancy, and the postpartum period.
Ten key clinical questions were identified by the scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. The literature review team performed a systematic review to summarise evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for women living with lupus nephritis (LN) and planning for a family. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-Based Medicine (CEBM) system. A 2-round Delphi process was conducted with 24 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.
Results
An online questionnaire was sent to an expert panel who participated in the two rounds (response rate 100%). At the end of round 2, a total of 20 recommendation items, categorised into 10 domains to address the main LN with pregnancy categories, were obtained. The percentage of those who agreed with the recommendations (rank 7–9) ranged from 88.5 to 100%. On the phrasing of all the clinical standards defined by the scientific committee, a consensus was reached (i.e., 75% of respondents strongly agreed or agreed). An algorithm for the management of LN with pregnancy has been suggested.
Conclusion
These recommendations provide an updated consensus on the pharmacological treatment of LN with pregnancy and strategies to reach optimal outcomes for both the mother and newborn in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient’s situation.
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Abu-Zaid MH, Salah S, Lotfy HM, El Gaafary M, Abdulhady H, Tabra SAA, Salah H, Farag Y, Eissa M, Maher SE, Radwan A, El-Shanawany AT, Medhat BM, El Mikkawy D, Mosad Mosa D, El Deriny G, Mortada M, Osman NS, Fouad NA, Elkaraly NE, Mohamed SS, Hassan WA, Amer YA, Nasef SI, El Miedany Y. Consensus evidence-based recommendations for treat-to-target management of immunoglobulin A vasculitis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211059610. [PMID: 34917176 PMCID: PMC8669874 DOI: 10.1177/1759720x211059610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
IgA vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is the most common cause of systemic vasculitis in childhood. Given its potential life-threatening systemic complications, early and accurate diagnosis as well as management of IgAV represent a major challenge for health care professionals. This study was carried out to attain an evidence-based expert consensus on a treat-to-target management approach for IgAV using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the patient, intervention, comparison, and outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the IgAV management. The core leadership team identified researchers and clinicians with expertise in IgAV management in Egypt upon which experts were gathered from different governorates and health centers across Egypt. Delphi process was implemented (two rounds) to reach a consensus. An online questionnaire was sent to expert panel (n = 26) who participated in the two rounds. After completing round 2, a total of 20 recommendation items, categorized into two sections were obtained. Agreement with the recommendations (rank 7-9) ranged from 91.7-100%. Consensus was reached (i.e. ⩾75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the diagnosis and management have been suggested. This was an expert, consensus recommendations for the diagnosis and treatment of IgAV and IgA vasculitic nephritis, based on best available evidence and expert opinion. The guideline presented a strategy of care with a pathway to achieve a state of remission as early as possible. Plain Language Summary Given its potential life-threatening systemic complications, early and accurate diagnosis of immunoglobulin A vasculitis represents a major challenge for health care professionals. This work provided cornerstone principles for the management of the condition. Adopting PICO approach and implementing Delphi process a consensus was reached on evidence-based treat-to-target treatment recommendations. This will endorse enhancement and consistency of care of this cohort of patients in standard practice.
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Affiliation(s)
| | - Samia Salah
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Hala M Lotfy
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Maha El Gaafary
- Community Medicine and Public Health, Ain Shams University, Cairo, Egypt
| | - Hala Abdulhady
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | | | - Hala Salah
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Yomna Farag
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | | | | | - Ahmed Radwan
- Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | | | - Basma M Medhat
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | - Dalia El Mikkawy
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | | | | | - Mohamed Mortada
- Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | | | | | | | - Sally S Mohamed
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | - Waleed A Hassan
- Rheumatology and Rehabilitation, Benha University, Benha, Egypt
| | - Youmna A Amer
- Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
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Abu-Zaid MH, Tabra SA, Salah S, Lotfy H, Abdulhady H, Salah H, El Gaafary M, Farag Y, Eissa M, Maher SE, Radwan A, El-Shanawany AT, Medhat BM, El Mikkawy D, Mosa DM, El Deriny G, Mortada M, Osman NS, Fouad NA, Elkaraly NE, Mohamed SS, Hassan WA, Amer Y, Nasef SI, El Miedany Y. P063 Consensus-based recommendations for treat to target management of immunoglobulin A vasculitis. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab722.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
IgAvasculitis (IgAV) is the commonest cause of vasculitis in childhood.
It is characterized by small vessel vasculitis of the skin, gastrointestinal tract, kidneys, joints, and, rarely, the lungs and the central nervous system. There is paucity of international guidelines for management of IgA V. the Objective is to develop guidelines specific for Egyptian children with IgA vasculitis.
Method
This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for IgA vasculitis using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. Delphi process was implemented (2-rounds) to reach a consensus.
Results
An online questionnaire were sent to expert panel (n = 26) who participated in the two rounds. At the end of round 2, a total of 20 recommendation items, categorized into 2 sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the management have been suggested.
Conclusion
This was an expert, consensus recommendations for the diagnosis and treatment of IgA V and IgA V nephritis, based on best available evidence and expert opinion.
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Affiliation(s)
| | | | - S Salah
- Egyptian Academy of Bone Health
| | - H Lotfy
- Egyptian Academy of Bone Health
| | | | - H Salah
- Egyptian Academy of Bone Health
| | | | - Y Farag
- Egyptian Academy of Bone Health
| | - M Eissa
- Egyptian Academy of Bone Health
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Amer
- Egyptian Academy of Bone Health
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El Miedany Y, Hassan M, Salah S, Lotfy H, Abdulhady H, Salah H, El Gaafary M, Abd El-Latif E, Farag Y, Eissa M, Esam Maher S, Radwan A, El-Shanawany AT, Medhat BM, El Mikkawy D, Mosa DM, El Deriny G, Mortada M, Osman NS, Fouad NA, Elkaraly NE, SMohamed S, Tabra S, Hassan WA, Amer Y, Nasef SI. P016 Updated Clinical Practice Guidelines for JIA management adopting Treat to Target approach: the Egyptian College of Paediatric Rheumatology initiative. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab722.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is an unmet need from paediatric rheumatologists and rheumatologists, managing children with JIA, for a well formulated guidelines aiming at achieving better outcomes of their patients. To establish adequate and easily adopted guidelines in management of different variants of JIA in a relatively low resources country.
Method
This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for Juvenile Idiopathic Arthritis using Delphi technique. The preliminary scientific committee identified a total of 17 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the benefits and harms associated with JIA treatments. The core leadership team identified researchers and clinicians with expertise in JIA management in Egypt upon which Experts were gathered from different governorates and health centres across Egypt. Delphi process was implemented (2-rounds) to reacha consensus on the management recommendations of Egyptian JIA patients. Results: An online questionnaire were sent to expert panel (n = 27), of whom 26 participated in the two rounds. At the end of round 2, a total of eighteen (18) recommendation items, categorized into 4 sections to address the main 4 JIA categories, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.2–100% (average 86.8%). Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 18 clinical standards identified by the scientific committee. Algorithms for the management of JIA polyarthritis, oligoarthritis and systemic JIA have been suggested.
Conclusion
A wide and representative panel of experts established a consensus regarding the management of JIA in Egypt. The developed guidelines provide a comprehensive approach to the management of JIA for ll Egyptian healthcare professionals who are involved in its management for follow up and frequent evaluation of these guidelines.
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Salah S, Lotfy H, Hassan M, Abdulhady H, Salah H, El Gaafary M, Abd El-Latif E, Farag Y, Eissa M, Esam Maher S, Radwan A, El-Shanawany AT, Medhat BM, El Mikkawy D, Mosa DM, El Deriny G, Mortada M, Osman NS, Fouad NA, Elkaraly NE, Mohamed SS, Tabra S, Hassan WA, Amer Y, Nasef SI, El Miedany Y. P050 Consensus based practice guidelines for the management and treatment of Juvenile familial Mediterranean fever: the Egyptian College of Paediatric Rheumatology initiative. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab722.042] [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: 11/12/2022] Open
Abstract
Abstract
Background
Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease, with the highest prevalence amongst Mediterranean countries including Egypt (where there is high carrier rate of MEFV gene), characterized by recurrent attacks of fever and polyserositis. Mutations in the MEFV gene encoding pyrin has been associated with the disease, which causes exaggeration of the inflammatory response through uncontrolled interleukin production. Issuing updated treatment recommendations are vital for the treating healthcare professionals to get well acquainted with its diagnosis & treatment. To produce consensus-based recommendations to guide the early diagnosis, management and follow-up of patients with FMF.
Methods
The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by the core team.
A qualitative synthesis of scientific evidence based on systematic review and clinical experience was conducted to compile evidence for the diagnosis and management of FMF.
A consensus process was conducted among the expert panel to generate the final recommendations and grade their strength.
3 rounds of Delphi process were carried out.
Results
Following 3 Delphi rounds, recommendations were developed for: early diagnosis, who to treat, treatment targets, genetic testing and its interpretation in association with clinical presentation, treatment of FMF and dealing with acute attacks, monitoring of management, identify treatment response, systemic affection, persistent attacks or inflammation, resistant cases, protracted symptoms, as well as remission status.
Algorithm for patients’ diagnosis and management is provided.
The final document comprises 12 recommendations, each presented with its degree of agreement (0–10), Level of agreement, grade of recommendation and rationale. The degree of agreement was >7/10 in all instances.
Conclusion
This guideline provides comprehensive approach to the accurate diagnosis and effective management/monitoring of FMF. It also represents a model for the incorporation of medical genetics practice into the more traditional domains of general medicine.
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Mohammed SR, Shaker OG, Mohammed AA, Fouad NA, Hussein HA, Ahmed NA, Ahmed OM, Ali DY, Mohamed MM, Ibrahim AA. Impact of miR-155 (rs767649 A>T) and miR-146a (rs57095329 A>G) polymorphisms in System Lupus Erythematosus susceptibility in an Egyptian cohort. Eur Rev Med Pharmacol Sci 2021; 25:1425-1435. [PMID: 33629312 DOI: 10.26355/eurrev_202102_24850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Systemic Lupus Erythematosus (SLE) is an autoimmune inflammatory disease. miR-155 and miR-146a were expressed in many autoimmune diseases such as rheumatoid arthritis. The aim of this study was to examine miR-155 rs767649 and miR-146a rs57095329 polymorphisms in SLE susceptibility in an Egyptian cohort and to investigate the correlation between them and clinical data and disease activity. PATIENTS AND METHODS The two SNPs were analyzed in 120 patients with SLE and 100 healthy controls using RT-PCR. RESULTS The TT genotype and T allele of miR-155 rs767649 were associated with a significant increase in the risk of SLE, particularly in females. On the other hand, miR-146a (rs57095329) polymorphism was not associated with SLE risk. The AT/TT genotypes of miR-155 rs767649 showed higher distributions among patients with higher SLEDAI and nephritis. CONCLUSIONS This study had demonstrated for the first time the association between miR-155 rs767649 and the risk of development of SLE in an Egyptian cohort, mostly in females.
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Affiliation(s)
- S R Mohammed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
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12
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El Miedany Y, Abu-Zaid MH, El Gaafary M, El Naby MMH, Fathi N, Saber HG, Hassan W, Eissa M, Mohannad N, Khaled H, Mortada M, Nasef SI, Galal S, Ghaleb R, Tabra SAA, Mohamed SS, Medhat BM, Aly HM, Elolemy G, Fouad NA, Ganeb SS, Adel Y, Ibrahim MME, Farouk O, Gadallah N. Egyptian consensus on treat-to-target approach for osteoporosis: a clinical practice guideline from the Egyptian Academy of bone health and metabolic bone diseases. Egypt Rheumatol Rehabil 2021. [DOI: 10.1186/s43166-020-00056-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15 clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service.
Results
The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested.
Conclusion
A wide and representative panel of experts established a consensus regarding the management of osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management.
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Abdelaleem OO, Fouad NA, Shaker OG, Hussein HA, Ahmed FA, Ali DY, Elsayed HS. Association of miR-146a rs57095329 with Behçet's disease and its complications. Br J Biomed Sci 2020; 78:63-66. [PMID: 32569501 DOI: 10.1080/09674845.2020.1786284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Behçet's disease is a chronic relapsing and remitting autoimmune multisystem inflammatory disease characterised by oral aphthae, genital ulcers, skin lesions, gastrointestinal involvement, arthritis, vascular lesions and neurological manifestations. We hypothesised a link between rs57095329 of miR-146a and Behçet's disease, with further links with common clinical features. METHODS We tested our hypothesis in 130 Behçet's disease patients and 131 age and sex-matched healthy controls. Behcet's disease current activity index (BDCAI) was used to assess patients' disease activity status. MiR-146a (rs57095329) was genotyped in all participants using RT-PCR and results in patients analysed according to clinical features. RESULTS The frequency of the GG and AG genotypes in rs57095329 were strongly associated with Behçet's disease (adjusted OR 8.05, 95% CI 3.63-17.82; P < 0.001 and OR 2.26, 95% CI 1.27-4.04; P = 0.006, respectively), and in dominant (GG+AG > AA) and recessive (GG > AA+AG) models (both P < 0.001). Additionally, G allele distribution was significantly greater in Behçet's disease compared with controls (OR 2.85, 95% CI 1.98-4.11, P < 0.001). The AA genotype and A allele were linked to oral ulcers, the GG genotype and G allele to neurological disease, and the GG genotype and G allele to ocular disease (all P < 0.01). There were no links with genital ulceration, skin lesions, vascular disease or the result of the pathergy test. CONCLUSION The miR-146a (rs57095329) is associated with Behçet's disease and certain genotypes and alleles with oral ulcers, and with ocular and neurological manifestations.
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Affiliation(s)
- O O Abdelaleem
- Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University , Al Fayyum, Egypt
| | - N A Fouad
- Rheumatology and Rehabilitation Department, Fayoum University , Al Fayyum, Egypt
| | - O G Shaker
- Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - H A Hussein
- Internal Medicine Department, Fayoum University , Al Fayyum, Egypt
| | - F A Ahmed
- Microbiology Department, Fayoum University , Al Fayyum, Egypt
| | - D Y Ali
- Clinical Pathology, Faculty of Medicine, Fayoum University , Al Fayyum, Egypt
| | - H S Elsayed
- Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University , Al Fayyum, Egypt
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Ali MA, Shaker OG, Khalefa AA, Abdelwahed MY, Ali E, Ezzat EM, Elghobary HA, Awaji AA, Fouad NA, Ayoub SE. Serum long noncoding RNAs FAS-AS1 & PVT1 are novel biomarkers for systemic lupus erythematous. Br J Biomed Sci 2020; 77:208-212. [PMID: 32614682 DOI: 10.1080/09674845.2020.1765459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Systemic Lupus Erythematous (SLE) is a chronic systemic autoimmune disorder whose diagnosis depends on combination of multiple factors. Circulating lncRNAs could serve as diagnostic non-invasive biomarkers for SLE. We hypothesised that serum FAS-AS1 and PVT1 are new biomarkers for SLE that relate to clinical features and laboratory markers. Materials and Method: Measurement of serum FAS-AS1 & PVT1 by qRT-PCR, analysis of the association between two RNAs and the clinical data, activity index and laboratory markers by standard routine methods. Results: There was a significant relative increased serum FAS-AS1 (median (IQR) 2.19 (0.13-8.62) and a significant reduced PVT1 (median (IQR) 0.52 (0.01-7.55) in SLE patients compared to controls (P < 0.0001 for FAS-AS1 and = 0.007 for PVT1). Serum FAS-AS1 and PVT1 were positively correlated (r= 0.37, P = 0.001). Higher FAS-AS1 was significantly linked with nephritis (P = 0.011), positive anti-dsDNA (P= 0.01) and lower serum PVT1 was significantly associated with oral ulcers (P= 0.023), photosensitivity (P= 0.017), and neurological manifestations (P= 0.041). Serum PVT1 negatively correlated with age (r= -0.52, P< 0.0001) and ESR level (r= -0.29, P= 0.011) in SLE patients. No correlation between disease activity and serum FAS-AS1 or PVT1 was detected. Conclusions: Our study provides evidence that serum FAS-AS1 and PVT1 are new biomarkers for SLE.
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Affiliation(s)
- M A Ali
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University Fayoum, Egypt
| | - O G Shaker
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - A A Khalefa
- Department of Physiology, Faculty of Medicine, Zagazig University , Zagazig, Egypt
| | - M Y Abdelwahed
- Department of Physiology, Faculty of Medicine, Fayoum University , Fayoum, Egypt
| | - Egi Ali
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University , Fayoum, Egypt
| | - E M Ezzat
- Department of Internal Medicine, Faculty of Medicine, Fayoum University , Fayoum, Egypt
| | - H A Elghobary
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - A A Awaji
- University of Tabuk, University College of Taymaa, Faculty of Science, Biology Department , Tabuk, Saudi Arabia
| | - N A Fouad
- Faculty of Medicine, Department of Rheumatology and Rehabilitation, Fayoum University , Fayoum 63514, Egypt
| | - S E Ayoub
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University Fayoum, Egypt
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15
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Akintayo RO, Akpabio A, Kalla A, Dey D, Migowa A, Olaosebikan H, Bahiri R, El Miedany Y, Hadef D, Hamdi W, Oyoo O, Slimani S, Yerima A, Taha Y, Adebajo A, Adelowo O, Tikly M, Ghozlani I, Abdelghani KB, Fouad NA, Mosad D, El Mikkawy D, Abu-Zaid MH, Abdel-Magied RA. COVID-19 and the practice of rheumatology in Africa: big changes to services from the shockwave of a pandemic. Ann Rheum Dis 2020; 80:e100. [PMID: 32611599 DOI: 10.1136/annrheumdis-2020-218273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 01/23/2023]
Affiliation(s)
| | - Akpabio Akpabio
- Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Asgar Kalla
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Dzifa Dey
- Department of Medicine and Therapeutics, University of Ghana Medical School, Korle bu Teaching Hospital, Accra, Ghana
| | - Angela Migowa
- Paediatrics and Child Health, Aga Khan University Faculty of Health Sciences East Africa, Nairobi, Kenya
| | | | - Rachid Bahiri
- Rheumatology, El Ayachi Hospital, Medical university, Rabat, Morocco
| | | | - Djohra Hadef
- Department of Paediatrics, Faculty of Medicine, Batna 2 University, Batna, Algeria
| | - Wafa Hamdi
- Kassab institute of orthopedics, Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Omondi Oyoo
- Department of clinical medicine and therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Samy Slimani
- Rheumatology, Atlas Clinic of Rheumatology, Batna, Algeria
| | - Abubakar Yerima
- Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Yassmin Taha
- Department of Paediatrics, Ahmed Gasim Children's Hospital, Khartoum, Sudan
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Olufemi Adelowo
- Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Mohammed Tikly
- Division of Rheumatology, Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Doaa Mosad
- Pediatrics Department, Mansoura University, Mansoura, Egypt
| | - Dalia El Mikkawy
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
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16
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Abstract
Extruded polystyrene rigid foams have attracted a great attention as a superior load-bearing thermal insulation material since their implementation in building construction. One of the most common application areas of this type of thermal insulation material is under raft foundations, where the foam normally undergoes high levels of compression loads. The purpose of this research is to determine how to simulate and optimize the structural response of extruded polystyrene under compression stresses. The optimization has been achieved through investigating the relation between the foam microstructure and the global mechanical properties. The foam was first examined using X-ray tomography imaging technique to acquire some morphological information about the microstructure. The obtained morphological data of extruded polystyrene boards were then utilized to develop microstructure-based finite element models based on the so-called idealized realistic Kelvin cell. The finite element simulation was accomplished with the help of the nanoindentation technology to explore the mechanical properties of the cell wall material. The finite element models were validated by comparisons between the simulated and the experimental results. It has been found that the mechanical properties of the foam in different loading directions can be adequately simulated using the approach of the idealized realistic Kelvin cell. With the help of these models, a parameter study was carried out. This study included the effect of cell size and cell anisotropy on the mechanical response of extruded polystyrene boards under compression stresses. Charts relating between the foam microstructure characteristics and the compression behavior were generated based on the parametric study.
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Affiliation(s)
- E Sadek
- Institute of Building Physics, Leibniz University Hannover, Hannover, Germany
| | - NA Fouad
- Institute of Building Physics, Leibniz University Hannover, Hannover, Germany
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Kite ME, Russo NF, Brehm SS, Fouad NA, Hall CC, Hyde JS, Keita GP. Women psychologists in academe. Mixed progress, unwarranted complacency. Am Psychol 2001; 56:1080-98. [PMID: 11802644] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- M E Kite
- Department of Psychological Science, Ball State University, Muncie, IN 47306, USA.
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