Reham Abo Elwafa | Faculty Of Medicine, Alexandria (original) (raw)

Papers by Reham Abo Elwafa

Evidence Based Women's Health Journal

Objective: To detect human papilloma virus infections and its different genotypes in cervical can... more Objective: To detect human papilloma virus infections and its different genotypes in cervical cancer cases in Shatby obstetrics and gynecology university hospital of Alexandria medical school. Patients and Methods: An observational analytical prospective cross-sectional study was managed on 70 cervical cancer patients collected from gyne-oncology unit in Shatby obstetrics and gynecology university hospital of Alexandria medical school. Collection of the sample from all cases of the study for human papilloma virus testing and genotyping was done. Result: The study was conducted on 70 cervical cancer cases, considering human papilloma virus testing of the cases, the following results were found, 21 cases out of 70 cases (30%) were negative while 49 cases (70%) were positive. Collectively, 45 cases (64.3%) of the study cervical cancer cases were infected by high-risk HPV types (16,18,31), 4 cases (5,7%) by low-risk HPV types (6,11) and 21 cases (30%) were not infected. Conclusion: The prevalence of high risk human papilloma virus positive cervical cancer cases in al Shatby Alexandria medical school university hospital was 64.3% and 55.4% of all the present study cervical cancer cases were infected by HPV types 16 and 18, the study assured the relationship between cervical cancer and high risk HPV especially types 16 and 18 and denoting the importance of HPV vaccination during adolescence and HPV testing as a screening test to detect early preinvasive cervical lesion.

Asian Pacific Journal of Cancer Prevention

Background: Enhancer of Zeste Homolog 2 (EZH2) is the catalytic subunit of the chromatin modifyin... more Background: Enhancer of Zeste Homolog 2 (EZH2) is the catalytic subunit of the chromatin modifying enzyme polycomb repressive complex 2 (PRC2). As a complex, these proteins selectively silence target genes through trimethylation of histone 3 at lysine 27. EZH2 is strongly oncogenic. It has been observed in various malignancies which makes it an interesting therapeutic target. Whether it functions as a tumor suppressor or oncogene in acute leukemia is not settled. Aim of this work: This study aimed at determining the expression levels of EZH2 gene in a cohort of adult Egyptian patients newly diagnosed with acute myeloid leukemia (AML). Materials and methods: The present study included 45 de novo AML patients and 40 healthy subjects of matched age and sex as a control group. All study participants were subjected to complete blood count (CBC), bone marrow examination, immunophenotyping, conventional cytogenetic studies and Detection of EZH2 gene expression levels by real time quantitative polymerase chain reaction (RQ-PCR). Results: EZH2 was significantly downregulated in AML patients compared to controls (p<0.001). There was no significant difference in EZH2 level when considering age, sex, bone marrow blasts count, cytogenetic studies, type or site of infection. Low EZH2 expression was associated with higher mortality (31 patients, 68.9%). Conclusions: Low EZH2 expression is prevalent in Egyptian AML patients subsequently; it is suggested to function as tumor suppressor gene rather than an oncogene. Moreover, EZH2 downregulation is associated with resistance to chemotherapy and high mortality rate.

Egyptian Journal of Ear, Nose, Throat and Allied Sciences

Objective: Different materials are used to repair skull base defects. Free grafts such as nasal m... more Objective: Different materials are used to repair skull base defects. Free grafts such as nasal mucoperiosteum, fascia lata, fascia temporalis, and adipose tissue are commonly employed and have satisfactory results. However, free grafts, particularly extra-nasal tissues implanted overlay, are usually not entirely integrated, resulting in excessive nasal crusting and patient discomfort in the postoperative months. We attempted in our study to use Leukocyte-and platelet-rich fibrin (L-PRF) membranes in skull base defect reconstruction. Patients and Methods: This prospective controlled study was conducted on 42 patients with spontaneous CSF rhinorrhea who were randomly divided into 2 groups according to the materials used in skull base reconstruction. In group A, the defects were repaired by L-PRF membranes, fascia lata, and mucosal graft while fascia lata and mucosal graft were only used in group B. Results: There was no statistically significant difference between the two groups regarding the early CSF leak. On the other hand, there was a difference related to the postoperative sinonasal crusting which shows a statistical significance. Conclusion: L-PRF membrane was found to be a good sealing material in the repair of CSF leak as it encourages the healing of surrounding tissues and minimizes sinonasal morbidities such as severe crust formation.

Egyptian Liver Journal, Aug 2, 2022

Asian Pacific Journal of Cancer Prevention, 2021

al., 2019). Hence, to help develop better prognosis and treatment options for AML patients, it is... more al., 2019). Hence, to help develop better prognosis and treatment options for AML patients, it is required to identify new biomarkers to improve diagnosis, prognosis, and treatment results. As the Human Genome Project showed that about 98% of the 3 billion base pairs that make up the human

Egyptian Rheumatology and Rehabilitation, 2019

Objective To evaluate the role of soluble Fas (sFas) and soluble Fas ligand (sFasL) in the pathog... more Objective To evaluate the role of soluble Fas (sFas) and soluble Fas ligand (sFasL) in the pathogenesis of distal symmetrical polyneuropathy (DSPN) in patients with type 2 diabetes mellitus, and to analyze the relationship between these apoptotic markers with clinical parameters and electrophysiologic profile of DSPN, as well as with different diabetic factors among those patients. Patients and methods The study included 60 Egyptians with type 2 diabetes mellitus. All patients were evaluated clinically for DSPN by using Michigan Neuropathy Screening Instrument. Electrophysiological diagnosis of DSPN was based on the criteria suggested by the European Standardized Telematic tool to Evaluate Electrodiagnostic Methods group. Diabetic patients were divided into two groups according to the electrophysiological findings: group A included patients with DSPN (N=42), and group B included patients without DSPN (N=18). The severity of DSPN among group A patients was assessed clinically using Toronto Clinical Neuropathy Score and electrophysiologically by the severity score proposed by Hidasi and colleagues. The study also included 30 healthy volunteers as a control group. Serum levels of sFas and sFasL were assessed in all the studied groups. Results Serum level of sFas was significantly elevated in diabetic patients with DSPN compared with diabetics without DSPN and nondiabetic control (P=0.029 and 0.000). Receiver operating characteristic (ROC) curve analysis detected that sFas was statistically significant in discriminating between diabetic patients with DSPN from those patients without DSPN with an accuracy of 66%. The cutoff point that has the highest sensitivity (61%) and specificity (62%) was 33.3 ng/ml. Serum level of sFas showed a positive significant correlation with the electrophysiological severity of DSPN (P=0.020). Serum level of sFasL did not show statistically significant difference between all the studied groups. Conclusion Fas-mediated apoptosis has an important role in the development of diabetic DSPN and is correlated with its electrophysiological severity.

Indian Journal of Hematology and Blood Transfusion

Platelet transfusion is crucial in the management of various conditions such as quantitative and ... more Platelet transfusion is crucial in the management of various conditions such as quantitative and qualitative platelet disorders. A serious problem that impacts public health is the shortage of Platelet concentrates (PCs) that frequently affect few blood donors’ countries, such as Egypt. This has necessitated the need to establish novel standards for determining the quality of PC during storage. It was found that microRNAs (miRNA) differential expression profile is a helpful tool for recognition of physiological platelet changes during storage. The aim of the current study was to highlight the role of platelet miRNA-326 and its putative target apoptotic genes, Bcl-xL and Bak, and their role in platelet storage lesion (PSL). Differential expression of miRNA-326 and its target genes in the apoptotic pathway, Bcl-xL and Bak was done using quantitative real time PCR (QR-PCR) on different storage points at day 0, day 3 and day 5 in blood bank. The results of the current study revealed ove...

Gastroenterology Review

Introduction: Extra-pulmonary manifestations of the Coronavirus disease of 2019 (COVID-19) have b... more Introduction: Extra-pulmonary manifestations of the Coronavirus disease of 2019 (COVID-19) have been increasingly reported, especially gastrointestinal and hepatic system dysfunction. The concern of faecal-oral transmission for COVID-19 was raised. Aim: To study the trend of faecal calprotectin in COVID-19 patients with intestinal symptoms. Material and methods: Forty confirmed cases of COVID-19 infection presenting with diarrhoea were subjected to a thorough history taking, clinical examination, and routine laboratory investigations. They were treated according to the Egyptian MOH guidelines. Faecal calprotectin (FC) concentration was measured at initial presentation and after 3 months. Those who had persistently elevated levels ≥ 200 μg/g were subjected to colonoscopic examination and histopathological examination. Forty confirmed cases of COVID-19 without diarrhoea were recruited as a control group in the initial FC evaluation. Results: Faecal calprotectin was found to be significantly elevated in the studied COVID-19 patients who presented with diarrhoea, with a mean value 260 ±80 μg/g compared to the those without diarrhoea, with a mean value of 31.6 ±12.9 μg/g (p < 0.001). Moreover, 20% (8 patients) had an elevated level exceeding 200 μg/g 3 months after recovery; among them, 5 patients showed mild colonoscopic changes whereas 3 patients showed severe ileocolitis. Out of the 3 patients with marked ileocolitis, 2 showed histopathological changes raising the diagnosis of Crohn's disease. Conclusions: Faecal calprotectin was found to be elevated in COVID-19 patients with intestinal symptoms, especially diarrhoea, with or without colonoscopic and histopathological changes.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Background: An adnexal mass patient is a common cause of hospital admission. The differentiation ... more Background: An adnexal mass patient is a common cause of hospital admission. The differentiation between malignant and benign cases is an important step in the management of such patients. The risk of malignancy index (RMI) is a simple scoring system depend on ultrasound data, menopausal status and serum concentrations of CA-125 tumor marker and has a great value in differentiation between benign and malignant adnexal masses. 4 different types of risk of malignancy index are created. The objective of the study was to compare the diagnostic performance of the four malignancy risk indices in differentiating benign and malignant ovarian tumors.Methods: This prospective study was performed on 60 patients with an adnexal mass confirmed on vaginal ultrasound.Results: There was statistical significance difference between the 4 types of RMI in benign and malignant groups. RMI 1, RMI 2, and RMI 3 had nearly the same area under the ROC curve; however, at the cut-off of>58.41, RMI 3 was mor...

Background: Plasma cell myeloma (PCM) is one of the most common hematological malignancies. Despi... more Background: Plasma cell myeloma (PCM) is one of the most common hematological malignancies. Despite advances in myeloma treatment, it remains an incurable disease. Studying the molecular bases of PCM has become essential to understand the pathobiology of the disease and hence for better management. The role of miRNAs is evolving in many malignancies, their use as markers for diagnosis, prognosis or as therapeutic modalities is promising. This study aimed at investigating the role of miR-181a and its target genes BCL2 and NOVA1 in PCM. Methods: The expression of miR-181a and its target genes BCL2 and NOVA1 was studied in bone marrow samples of 50 newly diagnosed PCM patients compared to 50 control subjects using real time quantitative polymerase chain reaction (RQ-PCR). Results: miR-181a, BCL2 and NOVA1 were found to be significantly upregulated among PCM patients compared to controls. There was a statistically significant positive correlation between miR-181a and BCL2. Furthermore, ...

Egyptian Journal of Obesity, Diabetes and Endocrinology, 2020

Background Male hypogonadism is a clinical and biochemical syndrome that results from failure to ... more Background Male hypogonadism is a clinical and biochemical syndrome that results from failure to produce adequate testosterone levels, normal sperm count, or both. Male hypogonadism may adversely affect multiple organ functions and quality of life. Vitamin D is a steroid hormone; the major action of vitamin D is linked to maintaining musculoskeletal health. However, several epidemiological studies have suggested extraskeletal benefits of vitamin D. There is an accumulating body of evidence which suggests that vitamin D is involved in reproductive and gonadal functions. Although some studies have demonstrated that vitamin D levels are positively associated with androgen levels and that vitamin D supplementation may increase testosterone levels, other studies have observed a U-shaped association of vitamin D and hypogonadism in middle-aged men, in contrast, other studies fail to find an association between vitamin D and testosterone especially in young healthy men after exclusion of other confounding factors. Thus, the aim of our study was to study the possible association of vitamin D status with male hypogonadism among different age groups. Patients and methods The study included 80 men. Group I included 40 male patients aged 20 to less than 45 years who were further subdivided into two subgroups: group Ia included 20 male patients diagnosed with hypogonadism and group Ib included 20 eugonadal men serving as a control. Group II: included 40 male patients aged 45–70 years subdivided into two subgroups: group IIa included 20 male patients diagnosed with hypogonadism and group IIb included eugonadal men serving as a control. Using enzyme-linked fluorescent assay technique, serum total testosterone (TT), 25-hydroxyvitamin D3 [25(OH)D3], luteinizing hormone, follicle stimulating hormone, estradiol, and prolactin were assessed for all enrolled individuals. Sex-hormone-binding globulin (SHBG) was assessed using the electrochemiluminescence immunoassay technique. Free androgen index (FAI) was calculated using the equation [100×TT (nmol/l)/SHBG (nmol/l)]. Results It was found that TT, FAI, and SHBG were lower in hypogonadal men versus eugonadal men in both groups, there was no significant statistical difference between hypogonadal men in groups I and II as regards TT and SHBG (P=0.708, 0.124, respectively), whereas FAI was found to be significantly statistically lower in hypogonadal men aged 45–70 years as compared with hypogonadal men aged 20 to less than 45 years (P=0.021). There was a high prevalence of vitamin D deficiency and insufficiency in both hypogonadal and eugonadal men in the four studied subgroups. 25(OH)D3 was not statistically different between subgroups in both groups (P=0.681, 0.823, respectively), whereas 25(OH)D3 was significantly higher in hypogonadal men in group II versus hypogonadal men in group I (P=0.037). 25(OH)D3 was found to be positively correlated with TT, FAI, and SHBG, but not to serum estradiol, prolactin. Correlation of 25(OH)D3 was stronger in hypogonadal men aged 45–70 years (P=0.001) as compared with hypogonadal men aged from 20 to less than 45 years (P=0.023). Conclusion Low vitamin D is associated with male hypogonadism across all age groups. This association is more pronounced in elderly hypogonadal men with vitamin D deficiency.

Journal of the Egyptian Women's Dermatologic Society, 2021

Background IL17F rs763780 polymorphism results in substitution of histidine to arginine at amino ... more Background IL17F rs763780 polymorphism results in substitution of histidine to arginine at amino acid 161, leading to upregulation of IL17F and increased propensity to autoimmune diseases. The single nucleotide polymorphism rs2275913 (G197A) involves a substitution of the guanine by an adenine nucleotide base in IL17A gene promotor which plays a key role in regulation of cytokine transcription. The relation of IL17 polymorphisms however to psoriasis risk and response to methotrexate has not been previously studied in Egyptians. Objective To study the relation of IL17A (rs2275913 G>A) and IL17F (rs2397084 T>C) polymorphisms to psoriasis risk and assess their predictive role regarding response to methotrexate. Patients and methods The study was conducted in two phases. First, a case–control study including 100 patients with chronic plaque psoriasis and 100 healthy control patients was conducted for IL17A (rs2275913) and IL17F (rs2397084) polymorphisms by real-time PCR. Second, a cohort study was adopted where the patients with psoriasis were treated with methotrexate weekly intramuscularly (0.6 mg/kg) for 12 weeks and followed for clinical response. Results IL17F TT genotype was more frequent in patients (87%) than controls (68%), whereas TC genotype was more frequent in controls (32%) than patients (13%). TT genotype was associated with increased risk of psoriasis, whereas the TC allele was associated with a decreased risk. There was no significant difference regarding IL17A GG, GA, and AA genotype frequencies between patients and controls. Psoriasis area and severity index greater than or equal to 75% was achieved in 22 patients (73.3%) with the TT genotype and eight patients (26.7%) with TC genotype (P=0.019). Conclusion IL17F (rs2397084 T>C) TT genotype could be considered a susceptibility marker in Egyptian patients. Psoriatic patients with TT genotype and T allele of IL17F (rs2397084 T>C) are likely to show a better response to methotrexate.

Viral immunology, 2020

Hepatitis C virus (HCV) infection is a major worldwide problem with the highest incidence rates i... more Hepatitis C virus (HCV) infection is a major worldwide problem with the highest incidence rates in Egypt. It affects B cells that serve as reservoirs for persistent HCV, resulting in phenotypic B cell alterations. Interleukin-7 (IL-7) is a cytokine with antiviral activity, important for B cell physiology. In addition, B cell-intrinsic toll-like receptor-7 (TLR7) signaling is required for optimal B cell responses during chronic viral infection, and the deficiency of TLR7 in B cells is sufficient to significantly impact antibody responses. Based on their known immunomodulatory effects, we hypothesized that direct-acting antiviral interferon-free therapy may affect TLR7 expression and the exhausted peripheral B cell compartment with the possibility of their restoration in patients who achieved a sustained virological response and their correlation to IL-7 level. This prospective study was accomplished on 80 Egyptian HCV patients and 75 controls. Frequencies of peripheral B cell subsets...

Egyptian Journal of Anaesthesia, 2021

ABSTRACT Background: Acute kidney injury (AKI) is a common complication associated with cardiac s... more ABSTRACT Background: Acute kidney injury (AKI) is a common complication associated with cardiac surgery with cardiopulmonary bypass (CPB) with a deleterious effect on morbidity and mortality. The current study aimed to determine the efficacy of preoperative creatine kinase-MB (CK-MB) level for the prediction of occurrence and severity of AKI. Settings and Design: This study was a prospective cross-sectional observational study. Methods: The study was carried out on 74 pediatric patients aged less than 18 years scheduled for elective congenital cardiac surgery using CPB. The prevalence of AKI within 72 hours was defined according to the three-stage Acute Kidney Injury Network (AKIN) criteria. Logistic regression analysis was done and adjusted odds ratio (OR) and confidence intervals at 95% (95% CI) were calculated. Results: AKI had developed in 25 patients (33.78%) by the second postoperative day. Patients who developed AKI had higher mean levels of preoperative CK-MB compared with patients without AKI (P = 0.002). Lower mean age, longer duration of surgery, bypass time, and cross-clamp time were independently associated with AKI (p < 0.015, 0.001, 0.001and 0.001, respectively). Patients who developed AKI had a longer duration of mechanical ventilation (MV) (OR 1.3, 95% CI 1.147–1.691) so; they required longer intensive care unit (ICU) stay. Conclusion: CK-MB can be a useful biomarker for detecting early AKI after congenital cardiac surgery and predicting adverse clinical outcomes.

Egyptian Journal of Anaesthesia, 2020

Hematology & Transfusion International Journal, 2019

Background: MicroRNAs are recently identified class of small single stranded RNA molecules of 21-... more Background: MicroRNAs are recently identified class of small single stranded RNA molecules of 21-23 nucleotides that regulate gene expression at the posttranscriptional level. Chronic lymphocytic leukemia (CLL) is characterized by a typical defect in apoptosis resulting in accumulation of mature resting B cells within the peripheral blood, bone marrow and lymphoid organs. One of the relevant microRNAs to CLL is microRNA-196a2, as its potential targets of action include genes involved in apoptosis regulation. The single nucleotide polymorphism (SNP) in microRNA-196a2 rs11614913 C/T has been implicated as possible biomarker associated with multiple kinds of cancers. While multiple recent studies showed that genetic polymorphisms play an influential role in CLL susceptibility, the role of microRNA-196a2 SNP rs11614913in CLL remains elusive. Patients and methods: The present study was conducted on 40 newly diagnosed Egyptian CLL patients and 40 control subjects. Genotyping of microRNA-1...

Cancer Research, 2020

Colorectal cancer (CRC) is a global burden, with an expected 2.2 million annual cases and 1.1 mil... more Colorectal cancer (CRC) is a global burden, with an expected 2.2 million annual cases and 1.1 million deaths by 2030. Nearly 90% of CRC cases occur in people over the age of 50. However, early onset (<50 years) of CRC is increasing in Egypt. Prior studies suggest that alteration in microbiome composition (dysbiosis) disturbs the symbiotic relationship between the colorectum and resident micro-organisms and promotes CRC. We hypothesize that, for Egyptians, microbiome dysbiosis is responsible for early-onset of CRC. We further hypothesize that there is cross-talk between the microbiome, tumor molecular features, and the immune microenvironment. Thus, we investigated the molecular profiling of these patients via integrated transcriptional-microbiome analysis. We assessed the colonic microbiota and the expression of specific host response genes in normal colonic mucosal samples from 8 healthy individuals and samples from 20 Egyptian CRC patients. A retrospective convenience sample de...

Egyptian Journal of Obesity, Diabetes and Endocrinology, 2017

Background Obesity is considered to be a worldwide health problem. Obese individuals are at a hig... more Background Obesity is considered to be a worldwide health problem. Obese individuals are at a high risk of developing dyslipidemia, hypertension, impaired glucose tolerance, insulin resistance, and consequent increase of the risk of metabolic and cardiovascular diseases. In obesity, elevated insulin resistance is observed, which may be associated with disturbances in zinc status in the body. The few studies concerning the status of zinc and its relationship with insulin resistance in obese children and adolescents have brought inconclusive results. Aims The aims of this work were to study the level of serum zinc in obese children and adolescents and to evaluate its potential relation to obesity, insulin resistance, and lipid profile. Patients and methods Thirty obese children and adolescents and 30 healthy controls aged 5–19 years were recruited for the study. Lipid profile, serum zinc, fasting plasma glucose, and fasting insulin were measured. Insulin resistance was calculated according to the homeostatic model of assessment for insulin resistance and quantitative insulin-sensitivity check index. Results Obese individuals had significantly higher serum triglycerides, total cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose, fasting blood insulin, and homeostatic model of assessment for insulin resistance, whereas high-density lipoprotein cholesterol and quantitative insulin-sensitivity check index were significantly lower in obese children than in healthy controls (all P<0.05). The serum concentration of zinc was significantly lower in obese individuals compared with control. There was a positive significant correlation between serum zinc level and high-density lipoprotein (r=0.511, P<0.05). Conclusion Obese children and adolescents have a poorer zinc status than children and adolescents of normal weight, which may affect lipid profile.