Ahmed Helmy - Academia.edu (original) (raw)
Papers by Ahmed Helmy
Journal of Viral Hepatitis, 2003
Annals of Saudi medicine
Wilson disease (WD) is a rare autosomal recessive disease. Our objective was to describe the dive... more Wilson disease (WD) is a rare autosomal recessive disease. Our objective was to describe the diverse patterns, therapies, and outcomes of this disease. A retrospective study over two decades on WD patients in a tertiary care center in Saudi Arabia. Clinical and laboratory findings of 71 patients with WD were retrieved from their charts, referral notes and our hospital electronic records and were analyzed. The mean age and standard deviation was 16.8 (10.7) years and 56.5% were males. The main manifestations of WD were hepatic, neurological, and mixed in 39 (54.9%), 12 (16.9%), and 20 (28.2%) patients, respectively, and 11 (15.5%) were asymptomatic cases detected by family screening. A family history of WD was positive in 41 (57.7%) patients, and consanguinity of parents was found in 26 (36.6%) patients. The mean (SD) follow-up period was 92.2 (72.9) (range, 1-320) months. Ten (14.1%) patients died during follow up, while 45 (63.4%) and 16 (22.5%) were still on or lost from follow-up...
Annals of Saudi medicine
The epidemiology, clinical characteristics, and natural course of inflammatory bowel disease (IBD... more The epidemiology, clinical characteristics, and natural course of inflammatory bowel disease (IBD) in Saudi Arabia are still largely unknown. Hence, we decided to conduct a large retrospective, cohort study to determine these features of the disease. Retrospective study conducted in a tertiary care hospital in Riyadh from January 1970 to December 2008. We reviewed all the cases of IBD diagnosed and collected all data pertaining to patients with IBD. A total of 312 patients with IBD were included for this analysis, including 197 (63%) patients with Crohn disease (CD) and 115 (37%) patients with ulcerative colitis (UC). The mean age (standard deviation) of patients with IBD was 25.5 (10.6) years; 152 (48.7%) were males and 160 females. The referral rate in the past 10 years was 72.1% compared with preceding 20 years, and 56% (n=178) of patients with IBD were from the central region of Saudi Arabia. The patients were followed up for a mean duration of 9.5 years; during their follow-up,...
Saudi Journal of Gastroenterology, 2013
More than 170 million people throughout the world are infected with Hepatitis C virus (HCV). HCV ... more More than 170 million people throughout the world are infected with Hepatitis C virus (HCV). HCV genotype 4 (HCV-4) is the most common genotype in the Middle East and Africa. It is responsible for > 80% of HCV infections, which has recently also spread to several European countries. [1] Previous studies in Saudi Arabia have indicated that the anti-HCV prevalence was 0.4-1.7% for adults and 0.1% for children. [2-5] The frequency of different genotypes in Saudi Arabia were as followed: HCV-4 genotype (69.2%), genotype 1a (12.8%), genotype 1b (11.4%), genotypes 2b (1.4%), genotype 5 (1.4%), and mixed infections with genotypes 4 and 5 (3.6%). [6] HCV-4 is a very heterogeneous genotype, showing significant genetic divergence compared with other HCV genotypes. Phylogenetic analysis of the NS5B region is commonly used for sub-typing. Until date, the number of sub-types has increased up to 20. [7,8] Of the 20 different subtypes identified, the most common ones are 4a and 4d, while others 4b, 4c, 4e, 4f, 4g, 4h, 4i, 4j, 4k, 4l, 4m, 4n, 4o, 4p, 4q, 4r, 4s, and 4t have been identified in different geographic regions of the world. The full clinical significance of HCV-4 subtypes is not known, because very few studies have correlated HCV-4 subtypes to the epidemiology, natural history, pathogenesis, disease severity, and outcomes of therapy. A recent study from Egypt reported a significant association between subtype 4o and hepatocellular carcinoma. [9] Sub-genotype 4d has been linked particularly in epidemiological studies to intravenous drug abusers in Poland and southern Europe.
Saudi Journal of Gastroenterology, 2008
Background/Aim: This retrospective study assessed the efÞ cacy, safety, and the predictors of sus... more Background/Aim: This retrospective study assessed the efÞ cacy, safety, and the predictors of sustained viral response (SVR) to a 48-week-course of peginterferon α-2a (Pegasys) and ribavirin combination therapy in 335 consecutive Saudi patients with chronic hepatitis C virus (HCV) infection. Materials and Methods: Clinical, biochemical, and virological parameters were collected at time 0 (pretreatment) and at 12, 24, 48, and 72 weeks posttreatment. The mean ± SD age was 49.1 ± 13.0 years; 229 (68.4%) were males, mean ± SD body mass index was 27.8 ± 7.4, 85 (25.4%) were diabetic, 25 (7.5%) had renal impairment, 136 (40.6%) had previously received interferon ± ribavirin therapy, and 247 (73.7%) underwent pretreatment liver biopsy. Patients with genotypes 1, 2 or 3, 4 and mixed genotype were 60 (22.15%), 30 (11.0%), 148 (54.4%), and 34 (12.5%), respectively. Results: Early viral response (≥2-log10 HCV-RNA decline 12 weeks posttreatment) was achieved in 253 (75.3%). Patients who completed 48 weeks of treatment were 292 (87.1%); of these, 121 (75.6%) achieved ETVR, 161 (55.1%) continued to have SVR and 60 (20.5%) had a viral relapse following end-of-treatment response, that is 48.1 and 17.9% of all patients (n = 335), respectively. Nonresponders (NR) were 71 (24.3%) patients and 43 (12.8%) were unable to complete treatment (due to side effects or loss to follow up). Compared to the relapsers, patients with SVR were signiÞ cantly younger (P = 0.000), nondiabetics (P = 0.015), had higher serum albumin (P = 0.007), had less pretreatment inß ammatory grade (P = 0.011), infected with genotypes 2 or 3 (P = 0.014), and treatment-naïve patients (P = 0.001). However, in stepwise multivariate logistic regression analysis, only treatment naiveté and low pretreatment inß ammatory score were the independent predictors of SVR (P = 0.005 and P = 0.018, respectively). Conclusion: Combination therapy, if tolerated and completed, is effective in treating chronic HCV patients, especially those with no previous interferon therapy and lower pretreatment inß ammatory grade.
Saudi Journal of Gastroenterology, 2008
Saudi Journal of Gastroenterology, 2009
Ulcerative colitis is a chronic inflammatory disease that affects the colon and rectum. Its patho... more Ulcerative colitis is a chronic inflammatory disease that affects the colon and rectum. Its pathogenesis is probably multifactorial including the influx of certain cytokines into the colonic mucosa, causing disease activity and relapse. The hypothesis of removing such cytokines from the circulation by leukocytapheresis was implemented to reduce disease activity, maintain remission, and prevent relapse. Many recent reports not only in Japan, but also in the West, have highlighted its beneficial effects in both adult and pediatric patients. Large placebo-controlled studies are needed to confirm the available data in this regard. In this article, we shed some light on the use of leukocyte apheresis in the management of autoimmune diseases, especially ulcerative colitis.
Saudi Journal of Gastroenterology, 2010
Please note that not all the institutions may get mapped due to non-availability of the requisite... more Please note that not all the institutions may get mapped due to non-availability of the requisite information in the Google Map. For AIM of other issues, please check the Archives/Back Issues page on the journal's website.
Obesity Surgery, 2008
Bio-enteric intragastric balloon (BIB) insertion is gaining popularity for weight reduction in ob... more Bio-enteric intragastric balloon (BIB) insertion is gaining popularity for weight reduction in obese patients. We evaluated the efficacy, tolerability, and safety of BIB in the treatment of obesity. A total of 173 Saudi obese patients [mean+/-SD age 34.5 +/- 11.6 years, 58 (33.5%) were men] who underwent BIB (InaMed Corporation, California, USA) insertion were followed up clinically, biochemically, and endoscopically for 6-12 months. The mean+/-SD baseline body weight, excess weight, and body mass index (BMI) were 123.5 +/- 39.6 and 68.9 +/- 40.0 kg and 46.7 +/- 14.1 kg/m(2), respectively. Associated dietary control, exercise, and medical treatment were used in 67 (38.7%), 60 (34.7%), and 3 (1.7%), respectively. BIBs were safely and successfully inserted in 15.1 +/- 6.2 min, filled with 626.2 +/- 41.7 ml methylene blue solution, removed after a period of 189.7 +/- 68.3 days, within 14.1 +/- 6.3 min. BIB was not tolerated for 6 months in 33 (19.8%) patients. Body weight and BMI at 6 and 12 months postinsertion were significantly reduced to 112.5 +/- 35.7 kg and 43.1 +/- 13.1 kg/m(2), and 110.7 +/- 34.5 kg and 42.3 +/- 12.6 kg/m(2), respectively (p < 0.01 versus baseline by one-way ANOVA). Furthermore, the mean absolute weight loss and mean percentage excess weight reduction (EWR) at 6 and 12 months post-BIB insertion were 13.5 +/- 13.5 kg and 19.5 +/- 21.8, and 14 +/- 18.5 kg and 18.0 +/- 25.8, respectively. No mortality or major complications has occurred. EWR of >or=25% occurred in 24.1% and 30.1% of patients at 6 and 12 months postinsertion, respectively. BIB is a safe, simple, and potentially efficient procedure that is well-tolerated by the majority of patients.
Liver International, 2011
Background and aim: Histological changes in hepatitis C virus (HCV)infected patients with persist... more Background and aim: Histological changes in hepatitis C virus (HCV)infected patients with persistently normal alanine aminotransferase (PNALT) have not been evaluated for updated upper limits of normal (ULN; 19/30 U/L for females/males). We assessed significant fibrosis (ZF2, METAVIR) in patients with PNALT and persistently elevated alanine aminotransferase (PEALT). Patients and methods: Nine hundred and twenty consecutive, unselected HCV patients were stratified into four groups: Group I: (n = 124) PNALT within the updated ULN [0.5 Â ULN
International Journal of Infectious Diseases, 2012
The primary aim of antiviral therapy in patients with chronic hepatitis C is a sustained virologi... more The primary aim of antiviral therapy in patients with chronic hepatitis C is a sustained virological response (SVR), defined as undetectable serum hepatitis C virus (HCV) RNA by a sensitive molecular assay at 24 weeks after the end of treatment. Combination therapy with pegylated interferon (peginterferon) and ribavirin is currently recognized as the standard treatment of chronic hepatitis C, resulting in an SVR rate of 40-50% in patients infected with HCV genotypes 1 and 4, and around 80% in those infected with HCV genotypes 2 and 3. 1-3 Various adverse effects have been reported due to the use of interferon. An influenza-like syndrome, characterized by fever, chills, myalgias, arthralgias, and headache, is the most common adverse effect. Toxicities of the central nervous, hematopoietic, gastrointestinal, urinary, cardiovascular, musculoskeletal, and endocrine systems have also been described. However, ocular toxicity was not reported before the use of interferon for chronic hepatitis. 4 The association of HCV infection and retinopathy has been described in the literature. The reported ophthalmic manifestations of HCV infection are keratoconjunctivitis sicca, ischemic retinopathy, macular edema, and ischemic neuropathy. 5-7 Following the introduction of interferon for the treatment of hepatitis, retinal complications have been reported with a higher prevalence in patients with diabetes. Typical ocular lesions include cotton-wool spots and retinal hemorrhages at the posterior fundus, particularly around the optic disc. Cotton-wool spots and retinal hemorrhages may occur alone or together. Retinal hemorrhages appear as superficial linear and patchy forms, or as white-centered bleeding. The retinopathy may develop unilaterally or bilaterally. Blocking of background fluorescence by retinal hemorrhages and non-perfused areas at the cotton-wool spots can be seen by fluorescein angiography. 8
European Journal of Gastroenterology & Hepatology, 2013
Conclusion Pretreatment serum IP-10 level is a predictor for SVR in HCV-4-infected patients. The ... more Conclusion Pretreatment serum IP-10 level is a predictor for SVR in HCV-4-infected patients. The baseline IP-10 level is significantly lower in responders among HCV genotype-4d patients as compared with 4a patients. Eur J Gastroenterol Hepatol 25:404-410
Arab Journal of Gastroenterology, 2009
Journal of Hepatology, 2008
Gastroenterology, 2009
in 7, 5 and 5 pts resp. Median follow-up was 14 yrs (range 2-30). Hepatic disease was classified ... more in 7, 5 and 5 pts resp. Median follow-up was 14 yrs (range 2-30). Hepatic disease was classified as: decompensated cirrhosis (Child-Pugh B/C), compensated cirrhosis (Child-Pugh A), moderate (abnormal liver biochemistry and radiology, no cirrhosis) or minor (only abnormal liver biochemistry). Mean elemental zinc dose was 147 ± 12 mg/day (range 67-270) at start and 199 ± 20 mg/day (90-360) at end of follow up (P=0.03), without differences between various presentation modes. Side effects were rare, except gastrointestinal complaints. One pt on concomitant anti-epileptics experienced reversible agranulocytosis. Of 12 pts with initial hepatic disease, 2 had decompensated cirrhosis at baseline and both improved to compensated state after initiation of zinc. Two of 5 pts with initial compensated cirrhosis progressed to decompensated state after 16 resp. 18 yrs, and 3 remain stable. Three of 5 pts with moderate or mild liver disease remain stable and 2 improved. Two of 5 pts with exclusive neurological presentation at baseline developed moderate liver disease resp. compensated cirrhosis after 4 resp. 5 yrs treatment. In the hepatic group, apart from improved bilirubin levels, no significant changes occurred in liver biochemistry or function. Neurologic symptoms improved markedly in 9 of 10 pts in the neurologic group, and deteriorated in 1 pt. MRI brain improved in 4, remained stable in 4 and deteriorated in 2 cases. Elevated serum free copper levels normalized (<0.15 mg/L) within one yr zinc in 15/17 pts, without difference between hepatic or neurologic pts. In contrast, adequate 24-hr urinary copper excretion was obtained more often in neurologic than hepatic pts (<100 ug/24 hrs at end of follow up in 5/5 exclusive neurologic pts, 2/5 pts with combined presentation but only 1/7 pts with exclusive hepatic presentation). 24 hr urinary copper excretion (mean±SEM) in neurologic vs exclusive hepatic pts was 494±167 vs 1149±798 (median 390 vs 405) at baseline, 157±29 vs 256±46 after 1 yr and and 100±25 vs 225± 37 μg/24 hrs (P<0.01) at end of follow up. Conclusions: Outcome of exclusive zinc therapy is generally satisfactory in case of neurologic disease. Although even decompensated cirrhosis may improve markedly under this treatment modality, liver disease may also worsen, possibly related to less efficient decoppering in hepatic pts.
Journal of Viral …, 2011
Current guidelines recommend antiviral therapy in chronic hepatitis B (HBV) patients with signifi... more Current guidelines recommend antiviral therapy in chronic hepatitis B (HBV) patients with significant histological disease. We aimed to compare histological fibrosis (METAVIR, ≥F2) in patients with HBV DNA ≥20,000 IU/mL vs. ≥2000 IU/mL and identify predictors of fibrosis. We performed prospective liver biopsies on 203 HBeAg-negative patients in four groups: Group I (n = 55): HBV DNA ≥20,000 IU/mL and persistently elevated alanine aminotransferase (ALT) levels (PEALT; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;40 U/L); Group II (n = 34): HBV DNA ≥20,000 IU/mL and persistently normal ALT (PNALT); Group III (n = 40): HBV DNA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20,000 IU/mL and PEALT; and Group IV (n = 74): HBV DNA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20,000 IU/mL, and PNALT. We reanalysed all groups in relation to updated cut-off for treatable viremia (2000 IU/mL). Genotype D was detected in 86% of patients. Hepatic fibrosis ≥F2 was detected in 72.7%, 52.9%, 57.5% and 18.9% in Groups I-IV, respectively (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Except in Group II with a trend for lower ≥F2 fibrosis (P = 0.067), there was no significant difference by using HBV DNA cut-off 20,000 vs. 2000 IU/mL. Multivariate logistic regression analysis identified study Group IV (OR, 0.0276; CI: 0.088-0.868; P = 0.0276) and milder (A0-1) necroinflammatory grade (OR, 0.135; CI: 0.063-0.287; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) as independent predictors of ≥F2 fibrosis. The specificity, positive and negative predictive values for PEALT in detection of ≥F2 fibrosis for viremia ≥2000 IU/mL (80%, 69% and 65%, respectively) or ≥20,000 IU/mL (86%, 73% and 63%, respectively) were similar, with a marginal gain in sensitivity (51% vs. 42%, respectively). Significant fibrosis is prevalent in a large proportion of HBeAg-negative patients with high viremia and persistently normal ALT. Lower HBV DNA cut-offs could be adopted with marginal gains in fibrosis detection and without loss of diagnostic accuracy.
Journal of Hepatology, 2008
Journal of Viral Hepatitis, 2003
Annals of Saudi medicine
Wilson disease (WD) is a rare autosomal recessive disease. Our objective was to describe the dive... more Wilson disease (WD) is a rare autosomal recessive disease. Our objective was to describe the diverse patterns, therapies, and outcomes of this disease. A retrospective study over two decades on WD patients in a tertiary care center in Saudi Arabia. Clinical and laboratory findings of 71 patients with WD were retrieved from their charts, referral notes and our hospital electronic records and were analyzed. The mean age and standard deviation was 16.8 (10.7) years and 56.5% were males. The main manifestations of WD were hepatic, neurological, and mixed in 39 (54.9%), 12 (16.9%), and 20 (28.2%) patients, respectively, and 11 (15.5%) were asymptomatic cases detected by family screening. A family history of WD was positive in 41 (57.7%) patients, and consanguinity of parents was found in 26 (36.6%) patients. The mean (SD) follow-up period was 92.2 (72.9) (range, 1-320) months. Ten (14.1%) patients died during follow up, while 45 (63.4%) and 16 (22.5%) were still on or lost from follow-up...
Annals of Saudi medicine
The epidemiology, clinical characteristics, and natural course of inflammatory bowel disease (IBD... more The epidemiology, clinical characteristics, and natural course of inflammatory bowel disease (IBD) in Saudi Arabia are still largely unknown. Hence, we decided to conduct a large retrospective, cohort study to determine these features of the disease. Retrospective study conducted in a tertiary care hospital in Riyadh from January 1970 to December 2008. We reviewed all the cases of IBD diagnosed and collected all data pertaining to patients with IBD. A total of 312 patients with IBD were included for this analysis, including 197 (63%) patients with Crohn disease (CD) and 115 (37%) patients with ulcerative colitis (UC). The mean age (standard deviation) of patients with IBD was 25.5 (10.6) years; 152 (48.7%) were males and 160 females. The referral rate in the past 10 years was 72.1% compared with preceding 20 years, and 56% (n=178) of patients with IBD were from the central region of Saudi Arabia. The patients were followed up for a mean duration of 9.5 years; during their follow-up,...
Saudi Journal of Gastroenterology, 2013
More than 170 million people throughout the world are infected with Hepatitis C virus (HCV). HCV ... more More than 170 million people throughout the world are infected with Hepatitis C virus (HCV). HCV genotype 4 (HCV-4) is the most common genotype in the Middle East and Africa. It is responsible for > 80% of HCV infections, which has recently also spread to several European countries. [1] Previous studies in Saudi Arabia have indicated that the anti-HCV prevalence was 0.4-1.7% for adults and 0.1% for children. [2-5] The frequency of different genotypes in Saudi Arabia were as followed: HCV-4 genotype (69.2%), genotype 1a (12.8%), genotype 1b (11.4%), genotypes 2b (1.4%), genotype 5 (1.4%), and mixed infections with genotypes 4 and 5 (3.6%). [6] HCV-4 is a very heterogeneous genotype, showing significant genetic divergence compared with other HCV genotypes. Phylogenetic analysis of the NS5B region is commonly used for sub-typing. Until date, the number of sub-types has increased up to 20. [7,8] Of the 20 different subtypes identified, the most common ones are 4a and 4d, while others 4b, 4c, 4e, 4f, 4g, 4h, 4i, 4j, 4k, 4l, 4m, 4n, 4o, 4p, 4q, 4r, 4s, and 4t have been identified in different geographic regions of the world. The full clinical significance of HCV-4 subtypes is not known, because very few studies have correlated HCV-4 subtypes to the epidemiology, natural history, pathogenesis, disease severity, and outcomes of therapy. A recent study from Egypt reported a significant association between subtype 4o and hepatocellular carcinoma. [9] Sub-genotype 4d has been linked particularly in epidemiological studies to intravenous drug abusers in Poland and southern Europe.
Saudi Journal of Gastroenterology, 2008
Background/Aim: This retrospective study assessed the efÞ cacy, safety, and the predictors of sus... more Background/Aim: This retrospective study assessed the efÞ cacy, safety, and the predictors of sustained viral response (SVR) to a 48-week-course of peginterferon α-2a (Pegasys) and ribavirin combination therapy in 335 consecutive Saudi patients with chronic hepatitis C virus (HCV) infection. Materials and Methods: Clinical, biochemical, and virological parameters were collected at time 0 (pretreatment) and at 12, 24, 48, and 72 weeks posttreatment. The mean ± SD age was 49.1 ± 13.0 years; 229 (68.4%) were males, mean ± SD body mass index was 27.8 ± 7.4, 85 (25.4%) were diabetic, 25 (7.5%) had renal impairment, 136 (40.6%) had previously received interferon ± ribavirin therapy, and 247 (73.7%) underwent pretreatment liver biopsy. Patients with genotypes 1, 2 or 3, 4 and mixed genotype were 60 (22.15%), 30 (11.0%), 148 (54.4%), and 34 (12.5%), respectively. Results: Early viral response (≥2-log10 HCV-RNA decline 12 weeks posttreatment) was achieved in 253 (75.3%). Patients who completed 48 weeks of treatment were 292 (87.1%); of these, 121 (75.6%) achieved ETVR, 161 (55.1%) continued to have SVR and 60 (20.5%) had a viral relapse following end-of-treatment response, that is 48.1 and 17.9% of all patients (n = 335), respectively. Nonresponders (NR) were 71 (24.3%) patients and 43 (12.8%) were unable to complete treatment (due to side effects or loss to follow up). Compared to the relapsers, patients with SVR were signiÞ cantly younger (P = 0.000), nondiabetics (P = 0.015), had higher serum albumin (P = 0.007), had less pretreatment inß ammatory grade (P = 0.011), infected with genotypes 2 or 3 (P = 0.014), and treatment-naïve patients (P = 0.001). However, in stepwise multivariate logistic regression analysis, only treatment naiveté and low pretreatment inß ammatory score were the independent predictors of SVR (P = 0.005 and P = 0.018, respectively). Conclusion: Combination therapy, if tolerated and completed, is effective in treating chronic HCV patients, especially those with no previous interferon therapy and lower pretreatment inß ammatory grade.
Saudi Journal of Gastroenterology, 2008
Saudi Journal of Gastroenterology, 2009
Ulcerative colitis is a chronic inflammatory disease that affects the colon and rectum. Its patho... more Ulcerative colitis is a chronic inflammatory disease that affects the colon and rectum. Its pathogenesis is probably multifactorial including the influx of certain cytokines into the colonic mucosa, causing disease activity and relapse. The hypothesis of removing such cytokines from the circulation by leukocytapheresis was implemented to reduce disease activity, maintain remission, and prevent relapse. Many recent reports not only in Japan, but also in the West, have highlighted its beneficial effects in both adult and pediatric patients. Large placebo-controlled studies are needed to confirm the available data in this regard. In this article, we shed some light on the use of leukocyte apheresis in the management of autoimmune diseases, especially ulcerative colitis.
Saudi Journal of Gastroenterology, 2010
Please note that not all the institutions may get mapped due to non-availability of the requisite... more Please note that not all the institutions may get mapped due to non-availability of the requisite information in the Google Map. For AIM of other issues, please check the Archives/Back Issues page on the journal's website.
Obesity Surgery, 2008
Bio-enteric intragastric balloon (BIB) insertion is gaining popularity for weight reduction in ob... more Bio-enteric intragastric balloon (BIB) insertion is gaining popularity for weight reduction in obese patients. We evaluated the efficacy, tolerability, and safety of BIB in the treatment of obesity. A total of 173 Saudi obese patients [mean+/-SD age 34.5 +/- 11.6 years, 58 (33.5%) were men] who underwent BIB (InaMed Corporation, California, USA) insertion were followed up clinically, biochemically, and endoscopically for 6-12 months. The mean+/-SD baseline body weight, excess weight, and body mass index (BMI) were 123.5 +/- 39.6 and 68.9 +/- 40.0 kg and 46.7 +/- 14.1 kg/m(2), respectively. Associated dietary control, exercise, and medical treatment were used in 67 (38.7%), 60 (34.7%), and 3 (1.7%), respectively. BIBs were safely and successfully inserted in 15.1 +/- 6.2 min, filled with 626.2 +/- 41.7 ml methylene blue solution, removed after a period of 189.7 +/- 68.3 days, within 14.1 +/- 6.3 min. BIB was not tolerated for 6 months in 33 (19.8%) patients. Body weight and BMI at 6 and 12 months postinsertion were significantly reduced to 112.5 +/- 35.7 kg and 43.1 +/- 13.1 kg/m(2), and 110.7 +/- 34.5 kg and 42.3 +/- 12.6 kg/m(2), respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01 versus baseline by one-way ANOVA). Furthermore, the mean absolute weight loss and mean percentage excess weight reduction (EWR) at 6 and 12 months post-BIB insertion were 13.5 +/- 13.5 kg and 19.5 +/- 21.8, and 14 +/- 18.5 kg and 18.0 +/- 25.8, respectively. No mortality or major complications has occurred. EWR of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=25% occurred in 24.1% and 30.1% of patients at 6 and 12 months postinsertion, respectively. BIB is a safe, simple, and potentially efficient procedure that is well-tolerated by the majority of patients.
Liver International, 2011
Background and aim: Histological changes in hepatitis C virus (HCV)infected patients with persist... more Background and aim: Histological changes in hepatitis C virus (HCV)infected patients with persistently normal alanine aminotransferase (PNALT) have not been evaluated for updated upper limits of normal (ULN; 19/30 U/L for females/males). We assessed significant fibrosis (ZF2, METAVIR) in patients with PNALT and persistently elevated alanine aminotransferase (PEALT). Patients and methods: Nine hundred and twenty consecutive, unselected HCV patients were stratified into four groups: Group I: (n = 124) PNALT within the updated ULN [0.5 Â ULN
International Journal of Infectious Diseases, 2012
The primary aim of antiviral therapy in patients with chronic hepatitis C is a sustained virologi... more The primary aim of antiviral therapy in patients with chronic hepatitis C is a sustained virological response (SVR), defined as undetectable serum hepatitis C virus (HCV) RNA by a sensitive molecular assay at 24 weeks after the end of treatment. Combination therapy with pegylated interferon (peginterferon) and ribavirin is currently recognized as the standard treatment of chronic hepatitis C, resulting in an SVR rate of 40-50% in patients infected with HCV genotypes 1 and 4, and around 80% in those infected with HCV genotypes 2 and 3. 1-3 Various adverse effects have been reported due to the use of interferon. An influenza-like syndrome, characterized by fever, chills, myalgias, arthralgias, and headache, is the most common adverse effect. Toxicities of the central nervous, hematopoietic, gastrointestinal, urinary, cardiovascular, musculoskeletal, and endocrine systems have also been described. However, ocular toxicity was not reported before the use of interferon for chronic hepatitis. 4 The association of HCV infection and retinopathy has been described in the literature. The reported ophthalmic manifestations of HCV infection are keratoconjunctivitis sicca, ischemic retinopathy, macular edema, and ischemic neuropathy. 5-7 Following the introduction of interferon for the treatment of hepatitis, retinal complications have been reported with a higher prevalence in patients with diabetes. Typical ocular lesions include cotton-wool spots and retinal hemorrhages at the posterior fundus, particularly around the optic disc. Cotton-wool spots and retinal hemorrhages may occur alone or together. Retinal hemorrhages appear as superficial linear and patchy forms, or as white-centered bleeding. The retinopathy may develop unilaterally or bilaterally. Blocking of background fluorescence by retinal hemorrhages and non-perfused areas at the cotton-wool spots can be seen by fluorescein angiography. 8
European Journal of Gastroenterology & Hepatology, 2013
Conclusion Pretreatment serum IP-10 level is a predictor for SVR in HCV-4-infected patients. The ... more Conclusion Pretreatment serum IP-10 level is a predictor for SVR in HCV-4-infected patients. The baseline IP-10 level is significantly lower in responders among HCV genotype-4d patients as compared with 4a patients. Eur J Gastroenterol Hepatol 25:404-410
Arab Journal of Gastroenterology, 2009
Journal of Hepatology, 2008
Gastroenterology, 2009
in 7, 5 and 5 pts resp. Median follow-up was 14 yrs (range 2-30). Hepatic disease was classified ... more in 7, 5 and 5 pts resp. Median follow-up was 14 yrs (range 2-30). Hepatic disease was classified as: decompensated cirrhosis (Child-Pugh B/C), compensated cirrhosis (Child-Pugh A), moderate (abnormal liver biochemistry and radiology, no cirrhosis) or minor (only abnormal liver biochemistry). Mean elemental zinc dose was 147 ± 12 mg/day (range 67-270) at start and 199 ± 20 mg/day (90-360) at end of follow up (P=0.03), without differences between various presentation modes. Side effects were rare, except gastrointestinal complaints. One pt on concomitant anti-epileptics experienced reversible agranulocytosis. Of 12 pts with initial hepatic disease, 2 had decompensated cirrhosis at baseline and both improved to compensated state after initiation of zinc. Two of 5 pts with initial compensated cirrhosis progressed to decompensated state after 16 resp. 18 yrs, and 3 remain stable. Three of 5 pts with moderate or mild liver disease remain stable and 2 improved. Two of 5 pts with exclusive neurological presentation at baseline developed moderate liver disease resp. compensated cirrhosis after 4 resp. 5 yrs treatment. In the hepatic group, apart from improved bilirubin levels, no significant changes occurred in liver biochemistry or function. Neurologic symptoms improved markedly in 9 of 10 pts in the neurologic group, and deteriorated in 1 pt. MRI brain improved in 4, remained stable in 4 and deteriorated in 2 cases. Elevated serum free copper levels normalized (<0.15 mg/L) within one yr zinc in 15/17 pts, without difference between hepatic or neurologic pts. In contrast, adequate 24-hr urinary copper excretion was obtained more often in neurologic than hepatic pts (<100 ug/24 hrs at end of follow up in 5/5 exclusive neurologic pts, 2/5 pts with combined presentation but only 1/7 pts with exclusive hepatic presentation). 24 hr urinary copper excretion (mean±SEM) in neurologic vs exclusive hepatic pts was 494±167 vs 1149±798 (median 390 vs 405) at baseline, 157±29 vs 256±46 after 1 yr and and 100±25 vs 225± 37 μg/24 hrs (P<0.01) at end of follow up. Conclusions: Outcome of exclusive zinc therapy is generally satisfactory in case of neurologic disease. Although even decompensated cirrhosis may improve markedly under this treatment modality, liver disease may also worsen, possibly related to less efficient decoppering in hepatic pts.
Journal of Viral …, 2011
Current guidelines recommend antiviral therapy in chronic hepatitis B (HBV) patients with signifi... more Current guidelines recommend antiviral therapy in chronic hepatitis B (HBV) patients with significant histological disease. We aimed to compare histological fibrosis (METAVIR, ≥F2) in patients with HBV DNA ≥20,000 IU/mL vs. ≥2000 IU/mL and identify predictors of fibrosis. We performed prospective liver biopsies on 203 HBeAg-negative patients in four groups: Group I (n = 55): HBV DNA ≥20,000 IU/mL and persistently elevated alanine aminotransferase (ALT) levels (PEALT; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;40 U/L); Group II (n = 34): HBV DNA ≥20,000 IU/mL and persistently normal ALT (PNALT); Group III (n = 40): HBV DNA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20,000 IU/mL and PEALT; and Group IV (n = 74): HBV DNA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20,000 IU/mL, and PNALT. We reanalysed all groups in relation to updated cut-off for treatable viremia (2000 IU/mL). Genotype D was detected in 86% of patients. Hepatic fibrosis ≥F2 was detected in 72.7%, 52.9%, 57.5% and 18.9% in Groups I-IV, respectively (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Except in Group II with a trend for lower ≥F2 fibrosis (P = 0.067), there was no significant difference by using HBV DNA cut-off 20,000 vs. 2000 IU/mL. Multivariate logistic regression analysis identified study Group IV (OR, 0.0276; CI: 0.088-0.868; P = 0.0276) and milder (A0-1) necroinflammatory grade (OR, 0.135; CI: 0.063-0.287; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) as independent predictors of ≥F2 fibrosis. The specificity, positive and negative predictive values for PEALT in detection of ≥F2 fibrosis for viremia ≥2000 IU/mL (80%, 69% and 65%, respectively) or ≥20,000 IU/mL (86%, 73% and 63%, respectively) were similar, with a marginal gain in sensitivity (51% vs. 42%, respectively). Significant fibrosis is prevalent in a large proportion of HBeAg-negative patients with high viremia and persistently normal ALT. Lower HBV DNA cut-offs could be adopted with marginal gains in fibrosis detection and without loss of diagnostic accuracy.
Journal of Hepatology, 2008