Ahmed Abdel-Razik - Academia.edu (original) (raw)
Papers by Ahmed Abdel-Razik
British Journal of Biomedical Science, 2021
BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The Ame... more BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases (AASLD) recommended endoscopy management as soon as possible and not more than 12 hours after presentation. The United King guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. The aim of the study is to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission. METHODS We recruited 297 patients with AOVH. The patients were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected. RESULTS Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P= 0.001), significant reduction of ammonia levels (P< 0.0001) and significant improvement in associated hepatic encephalopathy grade (p=0.048). There were no major clinical vents in the <12 hour group, but 8 events in the 12-24 hour group (p<0.01). CONCLUSION Endoscopic management of acute esophageal variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding, reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reduce the cost of treatment, benefiting patient satisfaction and hospital bed availability.
British Journal of Biomedical Science, 2021
BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The Ame... more BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases (AASLD) recommended endoscopy management as soon as possible and not more than 12 hours after presentation. The United King guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. The aim of the study is to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission. METHODS We recruited 297 patients with AOVH. The patients were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected. RESULTS Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P= 0.001), significant reduction of ammonia levels (P< 0.0001) and significant improvement in associated hepatic encephalopathy grade (p=0.048). There were no major clinical vents in the <12 hour group, but 8 events in the 12-24 hour group (p<0.01). CONCLUSION Endoscopic management of acute esophageal variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding, reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reduce the cost of treatment, benefiting patient satisfaction and hospital bed availability.
MEJ. Mansoura Engineering Journal
Many authors investigated fuzzy To and fuzzy Ro spaces depending IJpon the ordinary points of a s... more Many authors investigated fuzzy To and fuzzy Ro spaces depending IJpon the ordinary points of a set and not the fuzzy points. It is the pu£"pose of this note to SlJggest new definitions of fuzzy To and flJ zzy Ro-spaces u.s1ng Wong definition of fuzzy pOints. It will be also sho wn that these new definitions are equivalent to those introduced by Srivastava. Moreover the properties of To-ness and Ro-ness are sho wn to be both productive and hereditary and that a topologically generated fuzzy topological space .is To Or Ro if the original topologiCal. space is To or Ro, respectively.
British Journal of Biomedical Science, 2018
The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains... more The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains unclear. We hypothesised links between serum leptin and insulin resistance in non-diabetic patients with chronic viral hepatitis B infection and their relation to liver fibrosis. We recruited 190 untreated patients with chronic HBV infection and 72 healthy controls. Serum leptin, fasting glucose, insulin, liver function tests (LFTs), C-peptide and Homeostasis model assessment-IR (HOMA-IR) were measured/calculated by ELISA and standard techniques. Serum leptin, C-peptide (both p<0.001), HOMA-IR (p=0.021) and several LFTs were increased in patients with chronic HBV-infection. In multivariate regression analysis, both HOMA-IR (p=0.003) and leptin (p=0.002) were significant independent predictors of HBV infection. There were significant positive correlations (p<0.01) between leptin and HOMA-IR (r=0.81), between serum leptin and METAVIR activity (r=0.95), and between HOMA-IR and BMI (r=0.75), fasting glucose (r=0.005), and fasting insulin (r=0.81). Several LFTs, glucose and insulin correlated modestly (r = 0.61 to 0.69, p<0.05) with leptin. . Serum leptin may be related to the rate of fibrosis progression in nondiabetic patients with chronic HBV infection. Follow-up by serial measurement of serum leptin and HOMA-IR in non diabetic HBV-infected patients may be used as a non-invasive marker of early liver fibrosis liver fibrosis.
Journal of Hepatology, 2016
Journal of Public Health and Emergency, 2021
Hepatocellular carcinoma (HCC) is primarily caused by hepatitis C virus (HCV) infection, which is... more Hepatocellular carcinoma (HCC) is primarily caused by hepatitis C virus (HCV) infection, which is treated mainly by direct-acting antiviral agents (DAAs). Compared with interferon therapy, DAAs offer excellent results and tolerable side effects making them the preferred treatment for many groups of patients, especially old and cirrhotic patients. However, there is controversial data regarding HCC occurrence or recurrence following HCV eradication with DAAs, especially in patients with previously treated HCC. Most reports arise from studies restricted by various methodological limitations, thus hampering the interpretation of their results and preventing formulation of solid conclusions. These limitations include small sample size, exclusion of control arms, and inconsistent elimination of HCC or suspicious nodules before DAA treatment. Many of the studies were also not multi-centric, being mainly retrospective, observational studies consisting of a small number of patients and short follow-up time. As a result, the full picture on this issue remains unclear to date. This review evaluates literature data showing the effect of DAAs on HCC recurrence following successful treatment of the tumor. Despite initial negative reports demonstrating an increased risk of HCC recurrence after DAAs therapy, these data cannot be considered definitive and have not been confirmed by most subsequent studies which have shown no increase in HCC recurrence after DAA therapy.
British Journal of Biomedical Science, 2018
Abstract Background and objective: Spontaneous bacterial peritonitis (SBP) is diagnosed by the pr... more Abstract Background and objective: Spontaneous bacterial peritonitis (SBP) is diagnosed by the presence of ≥250 polymorphonuclear neutrophils (PMN)/mm3 in the ascites and the absence of surgically treatable cause of intra-abdominal infection. Blood neutrophil lymphocytic ratio (NLR) is an inexpensive and simple test for inflammation. C-reactive protein (CRP) is an inflammatory marker used for the diagnosis and follow-up of many diseases and morbidities. We aimed to evaluate the clinical utility of combined blood NLR and CRP as a non-invasive test for SBP diagnosis. Methods: Blood NLR was calculated, and CRP value determined in 180 cirrhotic patients with ascites (126 with and 54 without SBP). Sensitivity and specificity of combined blood NLR and CRP values for SBP diagnosis were estimated by receiver operator characteristic curve. Results: Both blood NLR and CRP values were significantly higher in SBP (p < 0.001). For SBP diagnosis, a blood NLR of >2.89 had a sensitivity 80.3% and specificity 88.9%. CRP >11.3 mg/dL had a sensitivity 88.9% and specificity 92.6%. In logistic regression analysis, combined blood NLR and CRP had a sensitivity 95.1% and specificity 96.3% at the same cut off values. Conclusions: Combined NLR and CRP could be used as a novel, simple, low-cost, non-invasive test for SBP diagnosis.
Therapeutic Advances in Gastroenterology, 2016
Background: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and functio... more Background: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose. Methods: Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs). Patients were randomized to receive 175 mg zinc gluconate, 50,000 IU vitamin A, 500 mg vitamin C and 100 mg vitamin E once daily plus lactulose, dose 30–60 ml/day for 3 months [group A ( n = 31)] or initiated and maintained on lactulose dose 30–60 ml/day for 3 months [group B ( n = 27)]. Neuropsychometric tests and laboratory inv...
Journal of Gastrointestinal Cancer, 2016
Background and Aims Ascites with unknown cause remains a diagnostic challenge, which needs novel ... more Background and Aims Ascites with unknown cause remains a diagnostic challenge, which needs novel noninvasive biomarkers for the precise diagnosis. We aimed to evaluate the ascitic fluid and serum C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) as diagnostic markers in the differential diagnosis of malignant and benign ascites. Methods In this prospective work, 315 consecutive patients with ascites were studied. Ascitic fluid and serum levels of CRP and VEGF were evaluated by using an enzyme-linked immunosorbent assay. Results Patients were divided into a benign ascites group (group 1) (n = 256) and a malignant ascites group (group 2) (n = 59). Ascitic and serum CRP were significantly elevated in malignant ascites than benign ascites group [5.
Medical Journal of Viral Hepatitis
Background: There are two variants of spontaneous bacterial peritonitis (SBP) include, culture ne... more Background: There are two variants of spontaneous bacterial peritonitis (SBP) include, culture negative neutrocytic ascites (CNNA) and culture positive SBP. Some suggested that, the clinical presentation of two variants is nearly similar, however, other reported that, patients with culture positive have a more severe course and higher mortality than CNNA. The aim of this study is to determine the clinical characteristics and predictors of CNNA in comparison to culture positive SBP. Materials and methods: This study included 300 consecutive patients with HCV related cirrhotic ascites. All patients underwent abdominal paracentesis and the ascitic fluid was processed for cell count and culture. Clinical and laboratory parameters of these patients were recorded at index admission.. Results: Out of 300 patients included in the study, 150 patients had SBP. Among the 150 patients with SBP, 100 patients were culture positive SBP (culture positive SBP with ascitic fluid PMNL ≥250 cells/m3) and 50 patients were CNNA (culture negative SBP with ascitic fluid PMNL ≥250 cells/m3). Compared to patients with culture positive SBP, patients with CNNA showed, a significant decrease as regards, fever, prevalence of DM, hepatic encephalopathy, platelets, blood PMNL and ascetic PMNL. Logistic regression analysis demonstrated that, decreased platelets count, blood PMNL and ascetic PMNL were independent predictor factors for CNNA. Conclusion: Patients with CNNA have a lower incidence of fever, prevalence of diabetes mellitus, hepatic encephalopathy, blood PMNL and ascetic PMNL versus culture positive SBP. Independent predictors of culture negative SBP are decreased platelets, blood PMNL and ascetic PMNL.
Acta Gastro-Enterologica Belgica, 2015
Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC)... more Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress. We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection. The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR>3 and CHC with HOMA-IR≤3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay. Patients with HOMA-IR>3 had a higher NLR compared with patients with HOMA-IR≤3 [2.61±0.95 and 1.92±0.86, respectively, P<0.001]. The NLR ratio was positively correlated with HOMA-I...
Frontiers in Medicine
Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) ... more Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis. Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up for 1 year. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), vascular endothelial growth factor (VEGF) levels and Fecal H. pylori antigen were evaluated by enzyme-linked immunosorbent assay (ELISA). All patients with positive H. pylori were treated and then followed up for 3 months. Participants with eradicated H. pylori were followed up for one further year. Results: H. pylori-positive patients (48.4%) were associated with increased levels of serum CRP, TNF-α, IL-6, NO, and VEGF, as well as increased incidence of varices, portal hypertensive gastropathy, gastric antral vascular ectasia, hepatocellular carcinoma (HCC), spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein thrombosis (PVT), and hepatorenal syndrome (all P < 0.05). Multivariate analysis models revealed that the presence of H. pylori was an independent risk variable for the development of portal vein thrombosis and hepatocellular carcinoma (P = 0.043, P = 0.037) respectively. After treatment of H. pylori infection, there was a significant reduction in all measured biochemical parameters and reported cirrhotic complications (all P < 0.05). Conclusion: Incidence of PVT and HCC development increased with H. pylori infection through increased inflammatory markers and vascular mediators. Moreover, its eradication may reduce the incidence of these complications.
Helicobacter, Jan 23, 2018
The relationship between Helicobacter pylori (H. pylori) and nonalcoholic fatty liver disease (NA... more The relationship between Helicobacter pylori (H. pylori) and nonalcoholic fatty liver disease (NAFLD) is a matter of debate. We achieved this prospective work to study whether H. pylori infection is a risk factor for NAFLD. A cohort multicenter pilot study of 369 adults without NAFLD at baseline was followed up for 2 years. Serum leptin, insulin, tumor necrosis factor-α, adiponectin, and interleukin-6 were measured using an enzyme-linked immunosorbent assay (ELISA). Homeostasis model assessment of insulin resistance (HOMA-IR) and leptin/adiponectin ratio (LAR) were calculated. Fecal H. pylori antigen was measured by ELISA. A total of 127 participants with H. pylori positive were treated and then followed up for 3 months. Helicobacter pylori-positive patients (46.3%) were associated with an increase in IR, proinflammatory cytokines, C-reactive protein (CRP), LAR, NAFLD-liver fat score (NAFLD-LFS), and hepatic steatosis index (HSI) (all P < 0.01). Multivariate analysis of NAFLD acc...
Acta gastro-enterologica Belgica, 2015
BACKGROUND Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepati... more BACKGROUND Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress. AIM We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection. METHODS The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR>3 and CHC with HOMA-IR≤3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay. RESULTS Patients with HOMA-IR>3 had a higher NLR compared with patients with HOMA-IR≤3 [2.61±0.95 and 1.92±0.86, respectively, P<0.001]. The NLR ratio was po...
Background and Aims: Approximately 30–40% of portal vein thrombosis (PVT) remains of unknown orig... more Background and Aims: Approximately 30–40% of portal vein thrombosis (PVT) remains of unknown origin. The association between non-alcoholic fatty liver disease (NAFLD) and PVT is a matter of debate. This study aimed to investigate the association between PVT and NAFLD. Methods: We included 94 out of 105 consecutive NAFLD patients in this prospective cohort study in addition to 94 from the healthy control group. We evaluated biochemical, clinical, immunological, and histopathological parameters; waist circumference (WC); leptin; adiponectin; and leptin/adiponectin ratio (LAR) for all participants at baseline and every 3 years thereafter. We described the characteristics of participants at baseline and showed individual WC, LAR, and PVT characteristics. Potential parameters to predict PVT development within 9 years were determined. Results: PVT developed in eight (8.5%) patients, mainly in the portal trunk. Univariate analysis showed three PVT-associated factors: diabetes mellitus (P =...
Background Hepatitis C virus (HCV) infection is still a main health problem in hemodialysis (HD) ... more Background Hepatitis C virus (HCV) infection is still a main health problem in hemodialysis (HD) patients. The prevalence of occult hepatitis C infection (OCI) in HD patients may be underestimated, and its possible influence on anemia management has not been studied. We aimed to determine the existence of OCI in Egyptian HD patients as well as its possible effect on anemia management. Patients and methods This cross-sectional multicenter study included 98 HCV-negative HD patients (negative for both anti-HCV antibody and HCV-RNA), 43 anti-HCV-positive HD patients, and 10 volunteer people matched for age and sex as a healthy control group. Serology test for anti-HCV antibody, reverse-transcription PCR for HCV-RNA (both serum and peripheral mononuclear cell (PMNC)), complete blood count (CBC), liver transaminases, serum iron, serum ferritin, and high-sensitivity C-reactive protein (hsCRP) were done. The average erythropoiesis-stimulating agent (ESA) doses were calculated over 6 months,...
Ramadan fasting is obligatory for Muslim healthy adults. However, there are many exemptions from ... more Ramadan fasting is obligatory for Muslim healthy adults. However, there are many exemptions from fasting; including patients, whose diseases will be aggravated by fasting. Muslim patients with different liver diseases are frequently seen in the clinics discussing their intent to fast this month with their treating physicians. To answer our patients’ inquiries about the expected benefits and/or risks of fasting and delivering them the best care, we carried out this review and we draw advices and recommendations based on the available evidence. A web‐based search, combining multiple keywords representing different liver diseases with Ramadan fasting had been carried out. To answer the research question: Do adult Muslim patients with different liver diseases who fast the month of Ramadan have had a deleterious effect on their health in comparison to those who did not fast? Relevant publications were retrieved. No randomized controlled trials were focusing on Ramadan fasting and liver d...
Fertility and sterility, 2016
Thank you to our Reviewers Every paper in Dental Update is considered by two reviewers. I would l... more Thank you to our Reviewers Every paper in Dental Update is considered by two reviewers. I would like to thank all those on the list below for giving their time and expertise in checking the validity of the papers published in Dental Update in 2014 and making suggestions on how papers might be improved.
Saudi Journal of Kidney Diseases and Transplantation
Uromodulin (UMOD) gene polymorphism has been linked with end-stage renal disease. In this researc... more Uromodulin (UMOD) gene polymorphism has been linked with end-stage renal disease. In this research, we studied the prevalence of UMOD rs42993393 T>C in Egyptian hemodialysis (HD) patients and the blood level of UMOD in those patients. The study was a case–control study and included 100 patients on regular HD and 100 healthy control subjects. The blood samples from the studied groups were subjected to the determination of UMOD blood level and molecular study of UMOD rs42993393 T>C genotype by polymerase chain reaction with restriction fragment length polymorphism. The serum UMOD level was significantly low in patients (38.6 7.6 ng/mL) compared to control subjects (221.3 ± 54.2, P = 0.0001). On the other hand, the UMOD rs42993393T>C was significantly increased in TC in patients (28%, odds ratio 1.3–1.0–2.0) compared to controls (22%, P = 0.03), and there was a significant increase in CC in patients (10%) compared to control subjects (3%; P = 0.0001). The T allele was significantly increased in controls compared to patients with a significant increase in C allele in patients compared to controls (P = 0.01). The present study highlights the prevalence of UMOD gene polymorphism at rs42993393T>C. There was a significant prevalence of C allele and C genotypes in HD patients. This finding may indicate that this allele may be a predisposing genotype for renal failure in susceptible patients. On the other hand, the significant reduction of serum UMOD in patients with end-stage renal disease may be attributed to the reduced functioning renal mass.
Journal of Gastrointestinal Cancer
Tony Ibrahim Enzo Ierardi The Editor, Brian I. Carr, and Associate Editors would like to acknowle... more Tony Ibrahim Enzo Ierardi The Editor, Brian I. Carr, and Associate Editors would like to acknowledge the valuable contributions of the reviewers to the journal. We fully understand the burden and effort that are involved in the reviews and are very grateful for your support. We rely on your expertise to maintain the standards of excellent science for the Journal of Gastrointestinal Cancer. https://doi.org/10.1007/s12029-018-0174-4
British Journal of Biomedical Science, 2021
BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The Ame... more BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases (AASLD) recommended endoscopy management as soon as possible and not more than 12 hours after presentation. The United King guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. The aim of the study is to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission. METHODS We recruited 297 patients with AOVH. The patients were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected. RESULTS Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P= 0.001), significant reduction of ammonia levels (P< 0.0001) and significant improvement in associated hepatic encephalopathy grade (p=0.048). There were no major clinical vents in the <12 hour group, but 8 events in the 12-24 hour group (p<0.01). CONCLUSION Endoscopic management of acute esophageal variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding, reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reduce the cost of treatment, benefiting patient satisfaction and hospital bed availability.
British Journal of Biomedical Science, 2021
BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The Ame... more BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases (AASLD) recommended endoscopy management as soon as possible and not more than 12 hours after presentation. The United King guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. The aim of the study is to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission. METHODS We recruited 297 patients with AOVH. The patients were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected. RESULTS Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P= 0.001), significant reduction of ammonia levels (P< 0.0001) and significant improvement in associated hepatic encephalopathy grade (p=0.048). There were no major clinical vents in the <12 hour group, but 8 events in the 12-24 hour group (p<0.01). CONCLUSION Endoscopic management of acute esophageal variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding, reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reduce the cost of treatment, benefiting patient satisfaction and hospital bed availability.
MEJ. Mansoura Engineering Journal
Many authors investigated fuzzy To and fuzzy Ro spaces depending IJpon the ordinary points of a s... more Many authors investigated fuzzy To and fuzzy Ro spaces depending IJpon the ordinary points of a set and not the fuzzy points. It is the pu£"pose of this note to SlJggest new definitions of fuzzy To and flJ zzy Ro-spaces u.s1ng Wong definition of fuzzy pOints. It will be also sho wn that these new definitions are equivalent to those introduced by Srivastava. Moreover the properties of To-ness and Ro-ness are sho wn to be both productive and hereditary and that a topologically generated fuzzy topological space .is To Or Ro if the original topologiCal. space is To or Ro, respectively.
British Journal of Biomedical Science, 2018
The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains... more The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains unclear. We hypothesised links between serum leptin and insulin resistance in non-diabetic patients with chronic viral hepatitis B infection and their relation to liver fibrosis. We recruited 190 untreated patients with chronic HBV infection and 72 healthy controls. Serum leptin, fasting glucose, insulin, liver function tests (LFTs), C-peptide and Homeostasis model assessment-IR (HOMA-IR) were measured/calculated by ELISA and standard techniques. Serum leptin, C-peptide (both p<0.001), HOMA-IR (p=0.021) and several LFTs were increased in patients with chronic HBV-infection. In multivariate regression analysis, both HOMA-IR (p=0.003) and leptin (p=0.002) were significant independent predictors of HBV infection. There were significant positive correlations (p<0.01) between leptin and HOMA-IR (r=0.81), between serum leptin and METAVIR activity (r=0.95), and between HOMA-IR and BMI (r=0.75), fasting glucose (r=0.005), and fasting insulin (r=0.81). Several LFTs, glucose and insulin correlated modestly (r = 0.61 to 0.69, p<0.05) with leptin. . Serum leptin may be related to the rate of fibrosis progression in nondiabetic patients with chronic HBV infection. Follow-up by serial measurement of serum leptin and HOMA-IR in non diabetic HBV-infected patients may be used as a non-invasive marker of early liver fibrosis liver fibrosis.
Journal of Hepatology, 2016
Journal of Public Health and Emergency, 2021
Hepatocellular carcinoma (HCC) is primarily caused by hepatitis C virus (HCV) infection, which is... more Hepatocellular carcinoma (HCC) is primarily caused by hepatitis C virus (HCV) infection, which is treated mainly by direct-acting antiviral agents (DAAs). Compared with interferon therapy, DAAs offer excellent results and tolerable side effects making them the preferred treatment for many groups of patients, especially old and cirrhotic patients. However, there is controversial data regarding HCC occurrence or recurrence following HCV eradication with DAAs, especially in patients with previously treated HCC. Most reports arise from studies restricted by various methodological limitations, thus hampering the interpretation of their results and preventing formulation of solid conclusions. These limitations include small sample size, exclusion of control arms, and inconsistent elimination of HCC or suspicious nodules before DAA treatment. Many of the studies were also not multi-centric, being mainly retrospective, observational studies consisting of a small number of patients and short follow-up time. As a result, the full picture on this issue remains unclear to date. This review evaluates literature data showing the effect of DAAs on HCC recurrence following successful treatment of the tumor. Despite initial negative reports demonstrating an increased risk of HCC recurrence after DAAs therapy, these data cannot be considered definitive and have not been confirmed by most subsequent studies which have shown no increase in HCC recurrence after DAA therapy.
British Journal of Biomedical Science, 2018
Abstract Background and objective: Spontaneous bacterial peritonitis (SBP) is diagnosed by the pr... more Abstract Background and objective: Spontaneous bacterial peritonitis (SBP) is diagnosed by the presence of ≥250 polymorphonuclear neutrophils (PMN)/mm3 in the ascites and the absence of surgically treatable cause of intra-abdominal infection. Blood neutrophil lymphocytic ratio (NLR) is an inexpensive and simple test for inflammation. C-reactive protein (CRP) is an inflammatory marker used for the diagnosis and follow-up of many diseases and morbidities. We aimed to evaluate the clinical utility of combined blood NLR and CRP as a non-invasive test for SBP diagnosis. Methods: Blood NLR was calculated, and CRP value determined in 180 cirrhotic patients with ascites (126 with and 54 without SBP). Sensitivity and specificity of combined blood NLR and CRP values for SBP diagnosis were estimated by receiver operator characteristic curve. Results: Both blood NLR and CRP values were significantly higher in SBP (p < 0.001). For SBP diagnosis, a blood NLR of >2.89 had a sensitivity 80.3% and specificity 88.9%. CRP >11.3 mg/dL had a sensitivity 88.9% and specificity 92.6%. In logistic regression analysis, combined blood NLR and CRP had a sensitivity 95.1% and specificity 96.3% at the same cut off values. Conclusions: Combined NLR and CRP could be used as a novel, simple, low-cost, non-invasive test for SBP diagnosis.
Therapeutic Advances in Gastroenterology, 2016
Background: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and functio... more Background: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose. Methods: Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs). Patients were randomized to receive 175 mg zinc gluconate, 50,000 IU vitamin A, 500 mg vitamin C and 100 mg vitamin E once daily plus lactulose, dose 30–60 ml/day for 3 months [group A ( n = 31)] or initiated and maintained on lactulose dose 30–60 ml/day for 3 months [group B ( n = 27)]. Neuropsychometric tests and laboratory inv...
Journal of Gastrointestinal Cancer, 2016
Background and Aims Ascites with unknown cause remains a diagnostic challenge, which needs novel ... more Background and Aims Ascites with unknown cause remains a diagnostic challenge, which needs novel noninvasive biomarkers for the precise diagnosis. We aimed to evaluate the ascitic fluid and serum C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) as diagnostic markers in the differential diagnosis of malignant and benign ascites. Methods In this prospective work, 315 consecutive patients with ascites were studied. Ascitic fluid and serum levels of CRP and VEGF were evaluated by using an enzyme-linked immunosorbent assay. Results Patients were divided into a benign ascites group (group 1) (n = 256) and a malignant ascites group (group 2) (n = 59). Ascitic and serum CRP were significantly elevated in malignant ascites than benign ascites group [5.
Medical Journal of Viral Hepatitis
Background: There are two variants of spontaneous bacterial peritonitis (SBP) include, culture ne... more Background: There are two variants of spontaneous bacterial peritonitis (SBP) include, culture negative neutrocytic ascites (CNNA) and culture positive SBP. Some suggested that, the clinical presentation of two variants is nearly similar, however, other reported that, patients with culture positive have a more severe course and higher mortality than CNNA. The aim of this study is to determine the clinical characteristics and predictors of CNNA in comparison to culture positive SBP. Materials and methods: This study included 300 consecutive patients with HCV related cirrhotic ascites. All patients underwent abdominal paracentesis and the ascitic fluid was processed for cell count and culture. Clinical and laboratory parameters of these patients were recorded at index admission.. Results: Out of 300 patients included in the study, 150 patients had SBP. Among the 150 patients with SBP, 100 patients were culture positive SBP (culture positive SBP with ascitic fluid PMNL ≥250 cells/m3) and 50 patients were CNNA (culture negative SBP with ascitic fluid PMNL ≥250 cells/m3). Compared to patients with culture positive SBP, patients with CNNA showed, a significant decrease as regards, fever, prevalence of DM, hepatic encephalopathy, platelets, blood PMNL and ascetic PMNL. Logistic regression analysis demonstrated that, decreased platelets count, blood PMNL and ascetic PMNL were independent predictor factors for CNNA. Conclusion: Patients with CNNA have a lower incidence of fever, prevalence of diabetes mellitus, hepatic encephalopathy, blood PMNL and ascetic PMNL versus culture positive SBP. Independent predictors of culture negative SBP are decreased platelets, blood PMNL and ascetic PMNL.
Acta Gastro-Enterologica Belgica, 2015
Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC)... more Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress. We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection. The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR>3 and CHC with HOMA-IR≤3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay. Patients with HOMA-IR>3 had a higher NLR compared with patients with HOMA-IR≤3 [2.61±0.95 and 1.92±0.86, respectively, P<0.001]. The NLR ratio was positively correlated with HOMA-I...
Frontiers in Medicine
Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) ... more Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis. Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up for 1 year. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), vascular endothelial growth factor (VEGF) levels and Fecal H. pylori antigen were evaluated by enzyme-linked immunosorbent assay (ELISA). All patients with positive H. pylori were treated and then followed up for 3 months. Participants with eradicated H. pylori were followed up for one further year. Results: H. pylori-positive patients (48.4%) were associated with increased levels of serum CRP, TNF-α, IL-6, NO, and VEGF, as well as increased incidence of varices, portal hypertensive gastropathy, gastric antral vascular ectasia, hepatocellular carcinoma (HCC), spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein thrombosis (PVT), and hepatorenal syndrome (all P < 0.05). Multivariate analysis models revealed that the presence of H. pylori was an independent risk variable for the development of portal vein thrombosis and hepatocellular carcinoma (P = 0.043, P = 0.037) respectively. After treatment of H. pylori infection, there was a significant reduction in all measured biochemical parameters and reported cirrhotic complications (all P < 0.05). Conclusion: Incidence of PVT and HCC development increased with H. pylori infection through increased inflammatory markers and vascular mediators. Moreover, its eradication may reduce the incidence of these complications.
Helicobacter, Jan 23, 2018
The relationship between Helicobacter pylori (H. pylori) and nonalcoholic fatty liver disease (NA... more The relationship between Helicobacter pylori (H. pylori) and nonalcoholic fatty liver disease (NAFLD) is a matter of debate. We achieved this prospective work to study whether H. pylori infection is a risk factor for NAFLD. A cohort multicenter pilot study of 369 adults without NAFLD at baseline was followed up for 2 years. Serum leptin, insulin, tumor necrosis factor-α, adiponectin, and interleukin-6 were measured using an enzyme-linked immunosorbent assay (ELISA). Homeostasis model assessment of insulin resistance (HOMA-IR) and leptin/adiponectin ratio (LAR) were calculated. Fecal H. pylori antigen was measured by ELISA. A total of 127 participants with H. pylori positive were treated and then followed up for 3 months. Helicobacter pylori-positive patients (46.3%) were associated with an increase in IR, proinflammatory cytokines, C-reactive protein (CRP), LAR, NAFLD-liver fat score (NAFLD-LFS), and hepatic steatosis index (HSI) (all P < 0.01). Multivariate analysis of NAFLD acc...
Acta gastro-enterologica Belgica, 2015
BACKGROUND Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepati... more BACKGROUND Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress. AIM We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection. METHODS The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR>3 and CHC with HOMA-IR≤3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay. RESULTS Patients with HOMA-IR>3 had a higher NLR compared with patients with HOMA-IR≤3 [2.61±0.95 and 1.92±0.86, respectively, P<0.001]. The NLR ratio was po...
Background and Aims: Approximately 30–40% of portal vein thrombosis (PVT) remains of unknown orig... more Background and Aims: Approximately 30–40% of portal vein thrombosis (PVT) remains of unknown origin. The association between non-alcoholic fatty liver disease (NAFLD) and PVT is a matter of debate. This study aimed to investigate the association between PVT and NAFLD. Methods: We included 94 out of 105 consecutive NAFLD patients in this prospective cohort study in addition to 94 from the healthy control group. We evaluated biochemical, clinical, immunological, and histopathological parameters; waist circumference (WC); leptin; adiponectin; and leptin/adiponectin ratio (LAR) for all participants at baseline and every 3 years thereafter. We described the characteristics of participants at baseline and showed individual WC, LAR, and PVT characteristics. Potential parameters to predict PVT development within 9 years were determined. Results: PVT developed in eight (8.5%) patients, mainly in the portal trunk. Univariate analysis showed three PVT-associated factors: diabetes mellitus (P =...
Background Hepatitis C virus (HCV) infection is still a main health problem in hemodialysis (HD) ... more Background Hepatitis C virus (HCV) infection is still a main health problem in hemodialysis (HD) patients. The prevalence of occult hepatitis C infection (OCI) in HD patients may be underestimated, and its possible influence on anemia management has not been studied. We aimed to determine the existence of OCI in Egyptian HD patients as well as its possible effect on anemia management. Patients and methods This cross-sectional multicenter study included 98 HCV-negative HD patients (negative for both anti-HCV antibody and HCV-RNA), 43 anti-HCV-positive HD patients, and 10 volunteer people matched for age and sex as a healthy control group. Serology test for anti-HCV antibody, reverse-transcription PCR for HCV-RNA (both serum and peripheral mononuclear cell (PMNC)), complete blood count (CBC), liver transaminases, serum iron, serum ferritin, and high-sensitivity C-reactive protein (hsCRP) were done. The average erythropoiesis-stimulating agent (ESA) doses were calculated over 6 months,...
Ramadan fasting is obligatory for Muslim healthy adults. However, there are many exemptions from ... more Ramadan fasting is obligatory for Muslim healthy adults. However, there are many exemptions from fasting; including patients, whose diseases will be aggravated by fasting. Muslim patients with different liver diseases are frequently seen in the clinics discussing their intent to fast this month with their treating physicians. To answer our patients’ inquiries about the expected benefits and/or risks of fasting and delivering them the best care, we carried out this review and we draw advices and recommendations based on the available evidence. A web‐based search, combining multiple keywords representing different liver diseases with Ramadan fasting had been carried out. To answer the research question: Do adult Muslim patients with different liver diseases who fast the month of Ramadan have had a deleterious effect on their health in comparison to those who did not fast? Relevant publications were retrieved. No randomized controlled trials were focusing on Ramadan fasting and liver d...
Fertility and sterility, 2016
Thank you to our Reviewers Every paper in Dental Update is considered by two reviewers. I would l... more Thank you to our Reviewers Every paper in Dental Update is considered by two reviewers. I would like to thank all those on the list below for giving their time and expertise in checking the validity of the papers published in Dental Update in 2014 and making suggestions on how papers might be improved.
Saudi Journal of Kidney Diseases and Transplantation
Uromodulin (UMOD) gene polymorphism has been linked with end-stage renal disease. In this researc... more Uromodulin (UMOD) gene polymorphism has been linked with end-stage renal disease. In this research, we studied the prevalence of UMOD rs42993393 T>C in Egyptian hemodialysis (HD) patients and the blood level of UMOD in those patients. The study was a case–control study and included 100 patients on regular HD and 100 healthy control subjects. The blood samples from the studied groups were subjected to the determination of UMOD blood level and molecular study of UMOD rs42993393 T>C genotype by polymerase chain reaction with restriction fragment length polymorphism. The serum UMOD level was significantly low in patients (38.6 7.6 ng/mL) compared to control subjects (221.3 ± 54.2, P = 0.0001). On the other hand, the UMOD rs42993393T>C was significantly increased in TC in patients (28%, odds ratio 1.3–1.0–2.0) compared to controls (22%, P = 0.03), and there was a significant increase in CC in patients (10%) compared to control subjects (3%; P = 0.0001). The T allele was significantly increased in controls compared to patients with a significant increase in C allele in patients compared to controls (P = 0.01). The present study highlights the prevalence of UMOD gene polymorphism at rs42993393T>C. There was a significant prevalence of C allele and C genotypes in HD patients. This finding may indicate that this allele may be a predisposing genotype for renal failure in susceptible patients. On the other hand, the significant reduction of serum UMOD in patients with end-stage renal disease may be attributed to the reduced functioning renal mass.
Journal of Gastrointestinal Cancer
Tony Ibrahim Enzo Ierardi The Editor, Brian I. Carr, and Associate Editors would like to acknowle... more Tony Ibrahim Enzo Ierardi The Editor, Brian I. Carr, and Associate Editors would like to acknowledge the valuable contributions of the reviewers to the journal. We fully understand the burden and effort that are involved in the reviews and are very grateful for your support. We rely on your expertise to maintain the standards of excellent science for the Journal of Gastrointestinal Cancer. https://doi.org/10.1007/s12029-018-0174-4