Mortada El-shabrawi | Cairo University (original) (raw)

Papers by Mortada El-shabrawi

Effect of medium chain triglycerides enriched formula on growth of biliary atresia patients after Kasai portoenterostomy

Arab Journal of Gastroenterology /Arab Journal of Gastroenterology, Feb 1, 2024

Health-related quality of life and cognitive function in children with Crigler–Najjar syndrome type 1

Paediatrics and international child health, Jan 2, 2024

Letter to the Editor: MAFLD versus MASLD criteria debate- Certainly not for children!

Hepatology, May 28, 2024

Journal of Medical Microbiology, Jul 1, 2011

Background: Gastrointestinal basidiobolomycosis is a rare disease caused by the fungus Basidiobol... more Background: Gastrointestinal basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum. It has been reported in both children and adults. The disease mainly affects the colon and the small bowel; however, cases of the stomach, liver, pancreas, and renal system being affected have been reported. Case report: A 2 year old boy presented with the following symptoms; abdominal pain, vomiting, diarrhea, fever and palpable right iliac fossa mass. Laboratory investigations revealed elevated inflammatory markers and peripheral eosinophilia. Colonoscopy showed severely inflamed mucosa of the terminal ileum, cecum and ascending colon. CT scan of the abdomen demonstrated an inflammatory mass with wall thickening of the terminal ileum and the colon. Surgical exploration demonstrated retroperitoneal mass and inflamed terminal ileum, cecum and ascending colon. Upon laparotomy, multiple internal fistulas involving the bowel loops, the urinary bladder, the right ureter and the gallbladder were observed. Further investigations using histopathology of the resected diseased bowel showed extensive necrosis, multinucleated giant cells and numerous eosinophils and large fungal hyphae surrounded by strongly eosinophilic material were seen in the tissue suggestive of B. ranarum infection. The patient responded well to treatment with voriconazole.

Pediatric Gastroenterology, Hepatology & Nutrition, 2023

Purpose: Pediatric patients in low-income countries are at a high risk of malnutrition. Numerous ... more Purpose: Pediatric patients in low-income countries are at a high risk of malnutrition. Numerous screening tools have been developed to detect the risk of malnutrition, including the Subjective Global Nutritional Assessment (SGNA), Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Nutritional Status and Growth (STRONGkids). However, anthropometry remains the main tool for assessing malnutrition. We aimed to identify the value of four nutritional screening tools versus anthropometry for evaluating the nutritional status of children. Methods: We conducted a cross-sectional study of 1,000 children aged 1-12 years who visited the outpatient clinic of Cairo University Pediatric Hospital. Each participant was evaluated using anthropometric measurements (weight, length/height, and weight for length/height) as well as the PYMS, STAMP, STRONGkids, and SGNA screening tools. The sensitivities and specificities of these four tools were assessed using anthropometry as the gold standard. Results: Of the patients, 1.7% were underweight, 10.2% were wasted, and 35% were stunted. STRONGkids demonstrated the highest sensitivity (79.4%) and a high specificity (80.2%) for detecting malnutrition compared with weight for height, followed by STAMP, which demonstrated lower sensitivity (73.5%) but higher specificity (81.4%). PYMS demonstrated the lowest sensitivity (66.7%) and the highest specificity (93.5%), whereas SAGA demonstrated higher sensitivity (77.5%) and lower specificity (85.4%) than PYMS. Conclusion: The use of nutritional screening tools to evaluate the nutritional status of children is valuable and recommended as a simple and rapid method for identifying the risk of malnutrition in pediatric patients.

Journal of gastroenterology and hepatology research, Mar 21, 2012

Treatment of the primary cause of many chronic liver diseases (CLDs) may not be possible and seri... more Treatment of the primary cause of many chronic liver diseases (CLDs) may not be possible and serious complications like portal hypertension (PH) must be prevented or controlled enabling the child with CLD to live with a good quality of life. Early detection of PH is achieved by history taking, examination, imaging techniques as well as esophagogastroduodenoscopy (EGD). Primary prevention of first episode of variceal hemorrhage involves use of non-selective β-blocker (NSBB) and rubber band endoscopic variceal ligation (EVL). Management of acute variceal bleeding includes effective resuscitation, prompt diagnosis, control of bleeding and prevention of complications. Prevention of secondary variceal hemorrhage is through a combination of EVL plus pharmacological therapy, other therapies include surgical porto-systemic shunt (PSS) and Meso-Rex bypass. The goal of this review is to highlight the pediatrician role in management of variceal bleeding in children with PH in order to improve their survival and avoid its life-threatening complications..

The added value of brain MR spectroscopy in children with Crigler-Najjar syndrome type-I: correlation with demographic, neurodevelopmental, and laboratory findings

British Journal of Radiology, Mar 1, 2023

Objective The aim of this study is to demonstrate the role of proton magnetic resonance spectrosc... more Objective The aim of this study is to demonstrate the role of proton magnetic resonance spectroscopy (1H-MRS) in the detection of brain microstructural changes in patients with Crigler-Najjar syndrome type-I (CNs-I), and its correlation with demographic, neurodevelopmental and laboratory findings. Methods Prospective study was conducted on 25 children with CNs-I and 25 age and sex-matched children, who served as control. They underwent multivoxel 1H-MRS of basal ganglion at echo time 135–144 ms. N-acetyl aspartate/Creatine (NAA/Cr) and Choline (Ch)/Cr were calculated and correlated with demographic, clinical, and laboratory findings of patients with CNs-I. Results There was a significant difference in NAA/Cr and Ch/Cr between patients and controls. The cut-off value for NAA/Cr and Ch/Cr used to differentiate patients from controls were 1.8 and 1.2 with an area under the curve (AUC) of 0.91 and 0.84 respectively. There was a significant difference in MRS ratios between patients with neurodevelopmental delay (NDD) and patients without NDD. The cut-off values for NAA/Cr and Ch/Cr used to differentiate between patients with NDD and patients without NDD were 1.47 and 0.99, with AUC of 0.87 and 0.8 respectively. The NAA/Cr and Ch/Cr were well correlated with family history (p = 0.006 and p < 0.001) respectively, consanguinity (p < 0.001 and p = 0.001), neurodevelopmental delay (p = 0.001 and p = 0.004), serum bilirubin level (r = −0.77, p < 0.001), (r = −0.49, p = 0.014), phototherapy (p < 0.001 and p = 0.32), blood transfusion (p < 0.001 and p = 0.001) respectively. Conclusion 1H-MRS can be a useful tool in the detection of neurological changes in patients with CNs-I; NAA/Cr and Ch/Cr parameters are well correlated with demographic, clinical, and laboratory findings. Advances in knowledge Our study is the first report on using MRS in assessing neurological manifestations in CNs. 1H-MRS can be a useful tool in the detection of neurological changes in patients with CNs-I.

Liver International, Mar 29, 2022

Part of the Gastroenterology Commons, and the Pediatrics Commons Let us know how access to this d... more Part of the Gastroenterology Commons, and the Pediatrics Commons Let us know how access to this document benefits you This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Pediatrics Faculty Papers by an authorized administrator of the Jefferson Digital Commons.

Adolescent growth: genes, hormones and the peer group. Proceedings of the 20th Aschauer Soiree, held at Glücksburg castle, Germany, 15th to 17th November 2013

PubMed, Mar 1, 2014

The association between poverty, malnutrition, illness and poor socioeconomic conditions on the o... more The association between poverty, malnutrition, illness and poor socioeconomic conditions on the one side, and poor growth and short adult stature on the other side, is well recognized. Yet, the simple assumption by implication that poor growth and short stature result from poor living conditions, should be questioned. Recent evidence on the impact of the social network on adolescent growth and adult height further challenges the traditional concept of growth being a mirror of health. Twenty-nine scientists met at Glücksburg castle, Northern Germany, November 15th - 17th 2013, to discuss genetic, endocrine, mathematical and psychological aspects and related issues, of child and adolescent growth and final height.

Caustic ingestion in children

Expert Review of Gastroenterology & Hepatology, Sep 1, 2011

Caustic ingestion continues to be a significant problem worldwide especially in developing countr... more Caustic ingestion continues to be a significant problem worldwide especially in developing countries. In 2008 over 200,000 exposures to caustic substances were reported to the National Poison Data System. The presence or absence of symptoms or oral lesions does not predict the existence or severity of lesions. The best predictor of morbidity and mortality is the extent of injury as assessed during initial evaluation. Upper endoscopy remains the mainstay diagnostic modality for the evaluation of patients with caustic ingestion. There is a pressing need for noninvasive diagnostic modalities and effective therapeutic options to evaluate and treat the complications associated with caustic ingestion.

International Journal of Tropical Disease & Health, Jan 10, 2014

Background: Sub-Saharan Africa has a high prevalence of hepatitis B virus (HBV) infections. Healt... more Background: Sub-Saharan Africa has a high prevalence of hepatitis B virus (HBV) infections. Health care workers (HCWs) are at high risk of contracting HBV infection through their occupation. Vaccination of HCWs against HBV is standard practice in many countries, but is often not implemented in resource-poor settings. We aimed with this cross-sectional study to determine HBV prevalence, HCW vaccination status, and the risk factors for HCWs contracting HBV infection in Tanzania. Methods: We enrolled 600 HCWs from a tertiary Tanzanian hospital. Their demographics, medical histories, HBV vaccination details and risk factors for contracting blood-borne infections were collected using a standardized questionnaire. Serum samples were tested for HBV and hepatitis C virus (HCV) markers by ELISA techniques, PCR and an anti-HBs rapid test. HCWs were divided in two subgroups: those at risk of contracting HBV (rHCW 79.2 %) via exposure to potentially infectious materials, and those considered not at risk of contracting HBV (nrHCW, 20.8 %). Results: The overall prevalence of chronic HBV infection (HBsAg+, anti-HBc+, anti-HBs-) was 7.0 % (42/598). Chronic HBV infection was found in 7.4 % of rHCW versus 5.6 % of nrHCW (p-value = 0.484). HCWs susceptible to HBV (HBsAg-, anti-HBc-, anti-HBs-) comprised 31.3 %. HBV immunity achieved either by healed HBV infection (HBsAg-, anti-HBc+, anti-HBs+) or by vaccination (HBsAg-, anti-HBc-, anti-HBs+) comprised 36.5 % and 20.2 %, respectively. 4.8 % of participants had indeterminate results (HBsAg-, anti-HBc+, anti-HBc-IgM-, anti-HBs-). Only 77.1 % of HCWs who received a full vaccination course had an anti-HBs titer >10 ml/U. An anti-HBs point-of-care test was 80.7 % sensitive and 96.9 % specific. There was a significantly higher risk for contracting HBV (anti-HBc+) among those HCW at occupational risk (rHCW) of older age (odds ratios (OR) in rHCW 3.297, p < 0.0001 vs. nrHCW 1.385, p = 0.606) and among those HCW being employed more than 11 years (OR 2.51, p < 0.0001***). HCV prevalence was low (HCV antibodies 1.2 % and HCV-RNA 0.3 %). Conclusions: Chronic HBV infection is common among Tanzanian HCWs. One third of HCWs were susceptible to HBV infection, highlighting the need for vaccination. Due to high prevalence of naturally acquired immunity against HBV pre-testing might be a useful tool to identify susceptible individuals.

The Journal of the Egyptian Public Health Association, Nov 7, 2022

Background: Respiratory tract infections (RTIs) are among the most commonly encountered major pub... more Background: Respiratory tract infections (RTIs) are among the most commonly encountered major public health problems, with a higher prevalence of lower RTIs among children and more generally the poor. The present study aimed to describe the pattern of respiratory tract infections in Egyptian children aged under 5 years and explore possible associations between socio-demographics and nutritional status and types of RTIs. Methods: Over 6 months beginning in September 2018 (including one winter season), a cross-sectional, observational, epidemiological study was conducted on a sample of patients with upper and lower RTIs diagnosed clinically and/or radiologically in the outpatient clinics at Cairo University Children's Hospital in Egypt. An interview questionnaire was employed to collect socio-demographic and nutritional data. Heights/lengths and weights were measured and analyzed using the World Health Organization's (WHO) Anthro Plus [Computer Program]. Patients with pneumonia (n = 28) were compared to 97 healthy children of the same age and sex. Results: The total number of children diagnosed with upper and lower respiratory infections was 611. Malnutrition was present in 12.4% of all children with upper and lower RTIs. Lower RTI and malnutrition were substantially more prevalent among children aged under 2 years (p = 0.048 and p < 0.001, respectively). The strongest predictor of lower RTI was a younger age (OR 0.797, CI 0.713-0.89, p < 0.001). Conclusion: At our center, approximately one-third of infections in under-fives were lower RTI. Malnutrition was one of the significant risk factors for lower RTI in children below 2 years. The nutritional status of infants and young children should be improved by encouraging exclusive breastfeeding during the first 6 months of life and strengthening the healthcare and nutritional counseling available for vulnerable children, particularly in rural regions.

Assessment of Healthcare Service Provision to Pediatric Patients With Chronic Diseases During the COVID-19 Lockdown

Asia Pacific journal of health management, Apr 9, 2023

Italian Journal of Pediatrics, 2011

Background: Spontaneous bacterial peritonitis (SBP) is a serious complication in infants and chil... more Background: Spontaneous bacterial peritonitis (SBP) is a serious complication in infants and children with chronic liver disease (CLD); however its diagnosis might be difficult. We aimed to study the feasibility of diagnosing SBP by routine ascitic fluid tapping in infants and children with CLD. Methods: We enrolled thirty infants and children with biopsy-proven CLD and ascites. Ascitic fluid was examined for biochemical indices, cytology and cell count. Aerobic and anaerobic bacteriological cultures of ascitic fluid were preformed. Direct smears were prepared from ascitic fluid deposit for Gram and Zheil-Nelson staining. Results: Patients were divided into three groups: Group I included five patients with SBP in which the cell count was ≥ 250/mm 3 and culture was positive (16.7%), Group II, eight patients with culture negative neutrocytic ascites (CNNA) with cells ≥ 250/mm 3 and negative culture (26.7%) and Group III, seventeen negative patients (56.6%) in which cells were <250/mm 3 and culture was negative. None of our patients had bacteriascites (i.e. culture positive with cells <250/mm 3). Presence of fever was significantly higher in SBP and CNNA. The mean lactate dehydrogenase (LDH) level was significantly higher in ascitic fluid in the infected versus sterile cases (p < 0.002). A ratio of ascitic/serum LDH ≥ 0.5 gave a sensitivity of 80%, specificity of 88%, positive predictive value (PPV) of 66.7%, negative predictive value (NPV) of 93.7% and accuracy of 63.3%. The mean pH gradient (arterial-ascitic) was significantly higher in SBP and CNNA cases when compared to the negative cases (p < 0.001). Ascitic fluid protein level of ≤ 1 gm/dl was found in 13/30 (43.3%) of studied cases with a sensitivity of 100%, specificity of 64.7%, PPV of 45.5%, NPV of 100% and diagnostic accuracy of 53.3% (p = 0.0001). Conclusions: SBP is a rather common complication in children with CLD. Culture of the ascitic fluid is not always diagnostic of infection. Biochemical parameters of the ascitic fluid definitely add to the diagnostic accuracy. LDH ascitic/serum ratio ≥ 0.5, an arterial-ascitic pH gradient ≥ 0.1 and total ascitic fluid protein ≤ 1 gm/dl are the most significant parameters suggesting infection.

Journal of Child Neurology, Dec 27, 2021

Purpose: To prospectively compare diffusion tensor imaging (DTI) measures of axial diffusivity ()... more Purpose: To prospectively compare diffusion tensor imaging (DTI) measures of axial diffusivity (), radial diffusivity (Ќ), mean diffusivity (MD), and fractional anisotropy (FA) along the auditory pathway of patients with sensorineural hearing loss (SNHL) and normal controls. Materials and Methods: In 37 individuals with SNHL and 10 healthy controls, two regions of interest (ROIs) positioned along the auditory pathway-the lateral lemniscus (LL) and the inferior colliculus (IC)-were investigated bilaterally using diffusion tensor imaging at 3 T. SNHL patients were divided into three groups: patients with bilateral hearing loss, patients with unilateral hearing loss, and patients with partial hearing loss. DTI measures (, Ќ, MD, FA) of both ROIs were determined in all subjects. Results: The FA value was reduced and the Ќ was increased both at the lateral lemniscus and the inferior colliculus of patients with SNHL compared with controls. Similar changes were seen between the ipsilateral and contralateral LL and IC for patients of unilateral profound hearing loss. No changes were observed in any other parameters. Conclusion: In SNHL patients DTI showed a high radial diffusivity that consequently led to a decreased fractional anisotropy in the LL and the IC.

Adolescent growth: genes, hormones and the peer group

Journal of Medical Microbiology, Sep 1, 2011

Aims and objectives: In this study, we aimed to examine the epidemiology, clinical characteristic... more Aims and objectives: In this study, we aimed to examine the epidemiology, clinical characteristics, histopathology findings, management, and ancillary techniques which are important for diagnosis, management, and outcome of an uncommon manifestation caused by the Basidiobolus ranarum. Materials and methods: This is a case series of five interesting cases of gastrointestinal basidiobolomycosis (GIB). This study was conducted in the histopathology department at the Royal hospital which is a tertiary care institution. Cases diagnosed with all types of fungal gastrointestinal disease between 2008 and 2015 were reviewed. Cases with morphological features of basidiobolomycosis were retrieved and the diagnosis was confirmed by a senior pathologist. Results: Five cases were identified. Out of five patients, four were misdiagnosed with other types of fungal infections which resulted in high morbidity and mortality. This case series revealed that the majority of patients identified are pediatrics (60%). Further, (60%) were from the same region (Ad Dakhiliyah). All patients presented with unspecific gastrointestinal symptoms that clinically mimic serious diseases. Additionally, all patients shared similar radiological findings and laboratory investigations. Conclusion: Diagnosis of GIB requires a high index of suspicion, increased awareness of this rare disease aid in early diagnosis and promote an early start of treatment. Since there is a resemblance in the clinical features of inflammatory and neoplastic bowel disease, GIB should be considered in the differential diagnosis.

The Asia Pacific Pediatric Association (APPA) position statement on the MAFLD definition of fatty liver disease

Therapeutic Advances in Chronic Disease

Frontiers in Pediatrics

Dubin-Johnson syndrome (DJS) is an often-missed diagnosis of neonatal cholestasis. We report two ... more Dubin-Johnson syndrome (DJS) is an often-missed diagnosis of neonatal cholestasis. We report two patients with DJS, who presented with neonatal cholestasis. The first patient underwent extensive investigations for infantile cholestasis with no definitive etiology reached; the diagnosis of DJS was missed until the age of 14 years old. The diagnosis was confirmed genetically with c.2273G > T, p.G758V mutation in exon 18 of the ABCC2 gene. The 2nd patient is a 7-day-old baby, the son of the 1st patient who gave birth to him at the age of 21 years old. He was diagnosed with DJS at the age of 2 weeks based on normal clinical and laboratory workup apart from direct hyperbilirubinemia. He had the same mutation as his mother in homozygous status. The husband was heterozygous for the same mutation. DJS is one of the often-missed differential diagnoses of neonatal cholestasis. It should be suspected in patients of infantile cholestasis, who have an, otherwise, normal physical examination, ...