Ahmed Mahmoud - Academia.edu (original) (raw)

Papers by Ahmed Mahmoud

The Medical Journal of Cairo University, 2020

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by producti... more Background: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by production of pathogenic autoantibodies against nuclear structures. Lupus nephritis (LN) affects up to 60% of patients with SLE who develop immune complex-mediated renal injury and its squeal. Color Coded Doppler Ultrasound (CCDUS) allows non-invasive method for investigating renal hemodynamics. Renal resistive index (RI) measured using CCDUS reflects intrarenal vascular resistance. RI is an essential parameter in renal Doppler US and integrates arterial compliance, pulsatility and peripheral resistance. Aim of Study: Evaluate the role of Color-Coded Doppler Ultrasound in the assessment of nephritis in SLE patients and correlation between resistivity index (RI) and lupus nephritis pathological classes. Such assessment will help reaching diagnosis, guide the choice of management and monitor the follow-up. Patients and Methods: This study was conducted on ninety six SLE patients with renal affection, diagnosed clinically and laboratory first, then each patient included in the study was subjected to Ultrasound Doppler renal examination and renal biopsy. Twenty subjects with normal renal laboratory, ultrasound and Doppler findings were recruited as a control group. B-Mode ultrasound and Color-coded Doppler examination were performed using GE Logiq p5 Ultrasound machine by (3.5-5MHz) transducer. Doppler parameters were adjusted before Doppler examination scan. First general renal vascularity was checked then RI was calculated in different segments of intra renal arteries at upper, mild and lower poles. RI=(peak systolic velocity-end diastolic velocity)/peak systolic velocity. The normal value is ≈ 0.60 with 0.70 being around the upper limits of normal. Finally, radiological findings were correlated with clinical findings and correlated with biopsy results. Results: The study included 96 SLE patients, their ages ranged from (13-45) mean 28.19 ±8.026. Males represented 12.5% (12 patients) and females represented 87.5% (84 patients). Renal biopsy showed 70 patients (73%) with LN and 26 patients (27%) with no renal affection.

The Egyptian Journal of Hospital Medicine, 2021

Background: Interventional (percutaneous) drainage of abdominal abscesses is a safe and successfu... more Background: Interventional (percutaneous) drainage of abdominal abscesses is a safe and successful method of treatment that avoids many of the disadvantages of traditional surgical drainage. Objective: This study aimed to evaluate factors associated with success or failure for non-operative management of localized intra-abdominal infection ''abscess''. Patients and Methods: This is a prospective single arm descriptive study that has been conducted at Sohag University Hospital from June 2017 to August 2018. This study included 100 patients presented with intra-abdominal localized collection during the period of the study, from June 2017 to August 2018, and presented to Sohag University Hospital, with any sex, age, previous abdominal surgery or clinical presentation. Results: In our studied population, 85 cases of total 100 cases had spontaneous abscesses without any previous abdominal surgeries. 52 cases of them responded successfully to non-operative management while 33 failed. 64 cases of total 100 cases responded successfully to non-operative management, 25 % of them were appendicular/post appendectomy abscesses, 21.88% were liver abscesses, 21.88% were iliopsoas/ iliopsoas and perinephric abscesses. To be noticed that all 14 cases (11 iliopsoas and 3 iliopsoas and perinephric abscesses) responded successfully to non-operative management by 100%. Out of 29 diabetic patients with intra-abdominal abscess, 26 cases of them responded to non-operative management while only 3 cases of them needed surgical intervention. Conclusion: Diabetes mellitus and positive culture of aspirate are predictors for success of non-operative management while high grade fever is predictor for failure.

Ain Shams Journal of Surgery, 2014

Background: Rectal carcinoma constitutes a health problem, previously managed with abdomino-perin... more Background: Rectal carcinoma constitutes a health problem, previously managed with abdomino-perineal resection (APR) which has the impact of poor patient quality of life. With the introduction of the concept of total mesorectal excision (TME) and stapler technology, sphincter saving surgery (SSS) with its better local control and functional status is a better choice than APR. We tried to evaluate the operative safety, long-term oncologic and functional outcomes of SSS in rectal carcinoma. Patients and methods: Between October 2008 and October 2012, patients with rectal carcinoma who presented electively to Sohag University Hospital underwent SSS based on sharp mesorectal excision in the form of anterior resection, low anterior resection and intersphincteric resection were evaluated. Patients were followed up for four years. Results: A total of 60 patients underwent SSS, regarding operative complications; there were 2 ureteric injuries and one bladder injury. Postoperatively, anastomotic leakage occurred in 6.7% of cases. Local recurrence and distant metastases were detected in 8.3% 13.3% respectively. During follow-up, disease-free survival rate was 66.9%, overall survival rate was 93%, 22% of patients had a degree of incontinence. 21.66% had temporary bladder dysfunction. Sexual dysfunction became evident in 30% of male patients. Conclusion: SSS with TME provides a better alternative to APR in rectal carcinoma when feasible.

The Egyptian Journal of Radiology and Nuclear Medicine, 2015

The aim of this study was to assess the role of multi-detector computed tomography (MDCT) in diag... more The aim of this study was to assess the role of multi-detector computed tomography (MDCT) in diagnosis and preoperative staging of solid renal masses. Patients and methods: During two years duration we prospectively evaluated 56 patients with solid renal lesions previously detected by US. All patients underwent multiphasic CT scanning for the kidneys and urinary tract following a preset scanning protocol that included unenhanced, corticomedullary phase (CMP), nephrograhic phase (NP) and excretory phase (EP) scanning. The images obtained in the excretory delayed phase were reconstructed in different planes to obtain 2D and 3D reformatted images providing volume rendering VR and maximum intensity projection (MIP) CTU images. Curved reformatting was sometimes used for the ureter. The numbers of lesions detected in all three phases were determined. Results of CT scan were compared with histopathology or constellation of clinical and imaging patient data. Results: A total of 61 masses were detected in 56 cases, 51 cases had unilateral masses (91%), 5 cases had bilateral masses (9%). The different pathologies encountered in the study were RCC 39 masses (64%), Wilm's tumor 3 masses (4.9%), transitional cell carcinoma 3 masses (4.9%), angiomyolipoma 7 masses (11.5%), lymphoma 6 masses (9.8%), metastasis one mass (1.6%), angiomyolipoma associated with RCC two masses (3.3%). Lymph nodal metastasis, renal vein, IVC thrombosis and distant metastatic spread in different pathologies were assessed. The attenuation HU values calculated in the early CMP for all cases of RCC had a mean value of 80.5 HU (STD 45.7) while the mean values in NP and EP were 70.6 HU (STD 25.4) and 51.3 HU (STD 19.2) respectively. A pattern of enhancement was detected in all cases of RCC in the form of rapid wash out of contrast and decrease of attenuation (HU) by time throughout different phases. Significant difference between HU in CMP and EP in cases of RCC (P value = 0.0002) and difference between HU in NP and EP in cases of RCC (P value < 0.00001) were found.

BMC urology, Jan 20, 2006

The aim of our study was to review the results of microsurgically performed testicular sperm extr... more The aim of our study was to review the results of microsurgically performed testicular sperm extraction (TESE) and to evaluate its possible long term effects on serum testosterone (T). We operated on 48 men (35 +/- 8 years) with non-obstructive azoospermia (NOA). If no spermatozoa were found following a micro epididymal sperm extraction (Silber et al., 1994) and testicular biopsy, testicular microdissection was performed or multiple microsurgical testicular biopsies were taken. The mean follow-up of the serum T was 2.4 +/- 1.1 years. Sperm was retrieved in 17/48 (35%) of the men. The per couple take home baby rate if sperm was retrieved was 4/17 (24%). Serum T decreased significantly at follow-up (p < 0.05) and 5/31 (16%) de novo androgen deficiencies developed In patients with non-obstructive azoospermia in whom no spermatozoa were found following a micro epididymal sperm aspiration and a simple testicular biopsy, we were able to retrieve spermatozoa in 35% of the men. The take ...

Asian Journal of Andrology, 2005

Andrologia, 2003

The aim of this article was to discuss by means of a review of the literature and own study mater... more The aim of this article was to discuss by means of a review of the literature and own study material the multifactorial aetiology of male infertility, extrapolate this hypothesis to male accessory gland infection (MAGI) and relate it to chronic prostatitis and its treatment. Infertility is a multifactorial disease and diagnosis and therapy must be oriented as such. Although the relationship between prostatitis and infertility remains unclear, bacteria, viruses, leucocytes, reactive oxygen species, cytokines, obstruction and immunological abnormalities must be seen as cofactors in the development of infertility in patients with MAGI and prostatitis. Infection, trauma, allergy, neurogenic damage, chemical or mechanical factors can lead to a longlasting inflammation of the prostate or pelvic organs even after eradication of the aetiological agent, and is potentially related to infertility through cytokines. In relation to treatment of infertility, antibiotics play a role in bacterial prostatitis whereas in abacterial prostatitis other treatments like antioxidants, sacral nerve stimulation and anti-inflammatory treatment are worth to be studied in the future.

African Journal of Urology, 2018

Objectives : To evaluate and analyze the efficacy and the safety of multiple tracts PCNL in manag... more Objectives : To evaluate and analyze the efficacy and the safety of multiple tracts PCNL in management of complex renal calculi. Patients and Methods : The study was conducted during the period between March 2016 till January 2017 on 265 patients with complex renal stones, all patients underwent multiple tracts PCNL, either with double or triple punctures, preoperative and postoperative laboratory and radiological results were compared together in correlation to the stone size, shape and site. Results : The results of our study have shown that increased size and complexity of stones is associated with increased number of punctures needed to achieve stone clearance, and the aggressive approach to complex renal calculi using multiple tracts PCNL is a safe and effective modality in management of complex renal calculi with acceptable complications. ଝ We participate in this research as we aim to evaluate the safety and the efficacy of multiple tracts PCNL in management of complex renal calculi.

Journal of the American College of Cardiology, 2015

Background: Carcinoid tumors are rare, with an incidence of 1 in 100,000 of the general populatio... more Background: Carcinoid tumors are rare, with an incidence of 1 in 100,000 of the general population. Carcinoid heart disease can be the initial presentation of carcinoid tumors in up to 20-50% of the cases. case: A 25-year-old woman presenting to our outpatient cardiology clinic with a 4-year history of progressive shortness of breath. Physical examination was significant for an ejection systolic murmur, heard best at the left upper sternal border grade 3/6, radiating to the back, with a pan-systolic 3/6 murmur at left lower sternal border that increases with inspiration, and a faint rumbling diastolic murmur heard at the left lower sternal border, lung examination was significant for wheezes and abdominal examination revealed hepatomegaly. decision Making: A trans-thoracic echocardiogram (ECHO) revealed mild right ventricular hypertrophy, with a normal function, a thickened tricuspid valve with restricted leaflet motion, severe tricuspid regurgitation and evidence of a thickened pulmonary valve (mean gradient 35mmHg). A cardiac MRI confirmed these finding. A CT scan showed evidence of a larger liver with multiple hyper-vascular lesions, with similar lesions in the mesentery and small bowel, suggestive of a metastatic tumor. Twenty-four hour urine for 5-Hydroxyindoleacetic acid came back positive and liver biopsy revealed a neuro-endocrine tumor. At a multidisciplinary tumor board, the decision was to treat the patient medically with octreotide and chemotherapy (capecitabine and temozolanide) and to repeat the ECHO every 3-6 months for assessment of the valve disease progression. conclusion: Carcinoid heart disease should be considered in the differential diagnosis of right-sided valve lesions. Dyspnea due to carcinoid syndrome is multifactorial and caused early by bronchospasm from the release of vaso-active amines.

Journal of the American College of Cardiology, 2015

background: In the acute setting, clinicians typically focus on excluding a cardiovascular etiolo... more background: In the acute setting, clinicians typically focus on excluding a cardiovascular etiology overlooking other conditions presenting with chest pain. This may result in excess healthcare utilization and work absenteeism. Our aim is to objectively highlight common and treatable mimickers of angina.

Human Reproduction, 1995

In agreement with the recommendations of the World Health Organization (Rowe et al, 1993), it is ... more In agreement with the recommendations of the World Health Organization (Rowe et al, 1993), it is of the utmost importance to categorize precisely every couple with an infertility problem into a well defined diagnostic class. Therapeutic consequences will depend on ...

This study would not have been achievable without the support of several people. I wish to expres... more This study would not have been achievable without the support of several people. I wish to express my gratitude to my supervisor, Prof. Dr. Jennifer Bremer, AUC who was in abundance cooperative and offered precious support, assistance and guidance.

The Egyptian Journal of Hospital Medicine

Background: overactive bladder (OAB) also referred to as the urgency-frequency syndrome, with or ... more Background: overactive bladder (OAB) also referred to as the urgency-frequency syndrome, with or without urge urinary incontinence can considerably impair the patient's quality of life. It is widely accepted that diet and life style modifications, behavioral therapy and medication belong to the standard conservative therapeutic options and considered as the first-line measures. The International Consultation on Incontinence (ICI) guidelines reported that when the first line approach is not fully satisfactory or fails after 8-12 weeks, alternative therapies should be sought out. It is worthwhile and justified to proceed to second-line therapy if patients are refractory to antimuscarinic therapy or if the treatment is contraindicated. Second-line of therapies include less-invasive measures such as percutaneous posterior tibial neve stimulation, sacral neuromodulation, detrusor injections with botulinum toxin (BTX) and whereas more-invasive measures constitute surgical techniques e.g. bladder augmentation or substitution. Pelvic neuromodulation has been proven effective and is today an established treatment option for patients refractory to or intolerant of conservative treatments. Objective: this study aimed to compare between the efficacy of continuous anticholinergic therapy and intermitted anticholinergic therapy for treatment of the overactive bladder. Patients and Methods: our study included 60 patients categorized into two groups: continuous anticholinergic therapy group and intermitted anticholinergic therapy. By using 12 weekly intermitted anticholinergic therapies, remarkable clinical results were obtained. Percent of the patients who complained OAB in the intermitted anticholinergic group reported a statistically significant subjective success. These patients chose to continue treatment to maintain the response. Results: patients in the intermitted anticholinergic therapy group showed significant improvement of frequency (31%) urgency (50%) urge incontinence (50%) and nocturia (53%) compared to propiverine group frequency (50%) urgency (60%) urge incontinence (67%) and nocturia (67%). No serious side effects were reported, in group A 8 patients had horm of dry mouth in 5 cases (16.7%), constipation in 2 cases (67%) 8 blurred vision in one case (33%). In group B, there were 5 patients (16.7%) in the horm of dry mouth in 3 cases (10% constipation in one case (3.3) and blurred vision in one case (3.3%). Conclusion: our study concluded that intermittent anticholinergic therapy induced improvement of bladder over activity symptoms and less side effects than continuous anticholinergic group.

The Medical Journal of Cairo University, 2020

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by producti... more Background: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by production of pathogenic autoantibodies against nuclear structures. Lupus nephritis (LN) affects up to 60% of patients with SLE who develop immune complex-mediated renal injury and its squeal. Color Coded Doppler Ultrasound (CCDUS) allows non-invasive method for investigating renal hemodynamics. Renal resistive index (RI) measured using CCDUS reflects intrarenal vascular resistance. RI is an essential parameter in renal Doppler US and integrates arterial compliance, pulsatility and peripheral resistance. Aim of Study: Evaluate the role of Color-Coded Doppler Ultrasound in the assessment of nephritis in SLE patients and correlation between resistivity index (RI) and lupus nephritis pathological classes. Such assessment will help reaching diagnosis, guide the choice of management and monitor the follow-up. Patients and Methods: This study was conducted on ninety six SLE patients with renal affection, diagnosed clinically and laboratory first, then each patient included in the study was subjected to Ultrasound Doppler renal examination and renal biopsy. Twenty subjects with normal renal laboratory, ultrasound and Doppler findings were recruited as a control group. B-Mode ultrasound and Color-coded Doppler examination were performed using GE Logiq p5 Ultrasound machine by (3.5-5MHz) transducer. Doppler parameters were adjusted before Doppler examination scan. First general renal vascularity was checked then RI was calculated in different segments of intra renal arteries at upper, mild and lower poles. RI=(peak systolic velocity-end diastolic velocity)/peak systolic velocity. The normal value is ≈ 0.60 with 0.70 being around the upper limits of normal. Finally, radiological findings were correlated with clinical findings and correlated with biopsy results. Results: The study included 96 SLE patients, their ages ranged from (13-45) mean 28.19 ±8.026. Males represented 12.5% (12 patients) and females represented 87.5% (84 patients). Renal biopsy showed 70 patients (73%) with LN and 26 patients (27%) with no renal affection.

The Egyptian Journal of Hospital Medicine, 2021

Background: Interventional (percutaneous) drainage of abdominal abscesses is a safe and successfu... more Background: Interventional (percutaneous) drainage of abdominal abscesses is a safe and successful method of treatment that avoids many of the disadvantages of traditional surgical drainage. Objective: This study aimed to evaluate factors associated with success or failure for non-operative management of localized intra-abdominal infection ''abscess''. Patients and Methods: This is a prospective single arm descriptive study that has been conducted at Sohag University Hospital from June 2017 to August 2018. This study included 100 patients presented with intra-abdominal localized collection during the period of the study, from June 2017 to August 2018, and presented to Sohag University Hospital, with any sex, age, previous abdominal surgery or clinical presentation. Results: In our studied population, 85 cases of total 100 cases had spontaneous abscesses without any previous abdominal surgeries. 52 cases of them responded successfully to non-operative management while 33 failed. 64 cases of total 100 cases responded successfully to non-operative management, 25 % of them were appendicular/post appendectomy abscesses, 21.88% were liver abscesses, 21.88% were iliopsoas/ iliopsoas and perinephric abscesses. To be noticed that all 14 cases (11 iliopsoas and 3 iliopsoas and perinephric abscesses) responded successfully to non-operative management by 100%. Out of 29 diabetic patients with intra-abdominal abscess, 26 cases of them responded to non-operative management while only 3 cases of them needed surgical intervention. Conclusion: Diabetes mellitus and positive culture of aspirate are predictors for success of non-operative management while high grade fever is predictor for failure.

Ain Shams Journal of Surgery, 2014

Background: Rectal carcinoma constitutes a health problem, previously managed with abdomino-perin... more Background: Rectal carcinoma constitutes a health problem, previously managed with abdomino-perineal resection (APR) which has the impact of poor patient quality of life. With the introduction of the concept of total mesorectal excision (TME) and stapler technology, sphincter saving surgery (SSS) with its better local control and functional status is a better choice than APR. We tried to evaluate the operative safety, long-term oncologic and functional outcomes of SSS in rectal carcinoma. Patients and methods: Between October 2008 and October 2012, patients with rectal carcinoma who presented electively to Sohag University Hospital underwent SSS based on sharp mesorectal excision in the form of anterior resection, low anterior resection and intersphincteric resection were evaluated. Patients were followed up for four years. Results: A total of 60 patients underwent SSS, regarding operative complications; there were 2 ureteric injuries and one bladder injury. Postoperatively, anastomotic leakage occurred in 6.7% of cases. Local recurrence and distant metastases were detected in 8.3% 13.3% respectively. During follow-up, disease-free survival rate was 66.9%, overall survival rate was 93%, 22% of patients had a degree of incontinence. 21.66% had temporary bladder dysfunction. Sexual dysfunction became evident in 30% of male patients. Conclusion: SSS with TME provides a better alternative to APR in rectal carcinoma when feasible.

The Egyptian Journal of Radiology and Nuclear Medicine, 2015

The aim of this study was to assess the role of multi-detector computed tomography (MDCT) in diag... more The aim of this study was to assess the role of multi-detector computed tomography (MDCT) in diagnosis and preoperative staging of solid renal masses. Patients and methods: During two years duration we prospectively evaluated 56 patients with solid renal lesions previously detected by US. All patients underwent multiphasic CT scanning for the kidneys and urinary tract following a preset scanning protocol that included unenhanced, corticomedullary phase (CMP), nephrograhic phase (NP) and excretory phase (EP) scanning. The images obtained in the excretory delayed phase were reconstructed in different planes to obtain 2D and 3D reformatted images providing volume rendering VR and maximum intensity projection (MIP) CTU images. Curved reformatting was sometimes used for the ureter. The numbers of lesions detected in all three phases were determined. Results of CT scan were compared with histopathology or constellation of clinical and imaging patient data. Results: A total of 61 masses were detected in 56 cases, 51 cases had unilateral masses (91%), 5 cases had bilateral masses (9%). The different pathologies encountered in the study were RCC 39 masses (64%), Wilm's tumor 3 masses (4.9%), transitional cell carcinoma 3 masses (4.9%), angiomyolipoma 7 masses (11.5%), lymphoma 6 masses (9.8%), metastasis one mass (1.6%), angiomyolipoma associated with RCC two masses (3.3%). Lymph nodal metastasis, renal vein, IVC thrombosis and distant metastatic spread in different pathologies were assessed. The attenuation HU values calculated in the early CMP for all cases of RCC had a mean value of 80.5 HU (STD 45.7) while the mean values in NP and EP were 70.6 HU (STD 25.4) and 51.3 HU (STD 19.2) respectively. A pattern of enhancement was detected in all cases of RCC in the form of rapid wash out of contrast and decrease of attenuation (HU) by time throughout different phases. Significant difference between HU in CMP and EP in cases of RCC (P value = 0.0002) and difference between HU in NP and EP in cases of RCC (P value < 0.00001) were found.

BMC urology, Jan 20, 2006

The aim of our study was to review the results of microsurgically performed testicular sperm extr... more The aim of our study was to review the results of microsurgically performed testicular sperm extraction (TESE) and to evaluate its possible long term effects on serum testosterone (T). We operated on 48 men (35 +/- 8 years) with non-obstructive azoospermia (NOA). If no spermatozoa were found following a micro epididymal sperm extraction (Silber et al., 1994) and testicular biopsy, testicular microdissection was performed or multiple microsurgical testicular biopsies were taken. The mean follow-up of the serum T was 2.4 +/- 1.1 years. Sperm was retrieved in 17/48 (35%) of the men. The per couple take home baby rate if sperm was retrieved was 4/17 (24%). Serum T decreased significantly at follow-up (p < 0.05) and 5/31 (16%) de novo androgen deficiencies developed In patients with non-obstructive azoospermia in whom no spermatozoa were found following a micro epididymal sperm aspiration and a simple testicular biopsy, we were able to retrieve spermatozoa in 35% of the men. The take ...

Asian Journal of Andrology, 2005

Andrologia, 2003

The aim of this article was to discuss by means of a review of the literature and own study mater... more The aim of this article was to discuss by means of a review of the literature and own study material the multifactorial aetiology of male infertility, extrapolate this hypothesis to male accessory gland infection (MAGI) and relate it to chronic prostatitis and its treatment. Infertility is a multifactorial disease and diagnosis and therapy must be oriented as such. Although the relationship between prostatitis and infertility remains unclear, bacteria, viruses, leucocytes, reactive oxygen species, cytokines, obstruction and immunological abnormalities must be seen as cofactors in the development of infertility in patients with MAGI and prostatitis. Infection, trauma, allergy, neurogenic damage, chemical or mechanical factors can lead to a longlasting inflammation of the prostate or pelvic organs even after eradication of the aetiological agent, and is potentially related to infertility through cytokines. In relation to treatment of infertility, antibiotics play a role in bacterial prostatitis whereas in abacterial prostatitis other treatments like antioxidants, sacral nerve stimulation and anti-inflammatory treatment are worth to be studied in the future.

African Journal of Urology, 2018

Objectives : To evaluate and analyze the efficacy and the safety of multiple tracts PCNL in manag... more Objectives : To evaluate and analyze the efficacy and the safety of multiple tracts PCNL in management of complex renal calculi. Patients and Methods : The study was conducted during the period between March 2016 till January 2017 on 265 patients with complex renal stones, all patients underwent multiple tracts PCNL, either with double or triple punctures, preoperative and postoperative laboratory and radiological results were compared together in correlation to the stone size, shape and site. Results : The results of our study have shown that increased size and complexity of stones is associated with increased number of punctures needed to achieve stone clearance, and the aggressive approach to complex renal calculi using multiple tracts PCNL is a safe and effective modality in management of complex renal calculi with acceptable complications. ଝ We participate in this research as we aim to evaluate the safety and the efficacy of multiple tracts PCNL in management of complex renal calculi.

Journal of the American College of Cardiology, 2015

Background: Carcinoid tumors are rare, with an incidence of 1 in 100,000 of the general populatio... more Background: Carcinoid tumors are rare, with an incidence of 1 in 100,000 of the general population. Carcinoid heart disease can be the initial presentation of carcinoid tumors in up to 20-50% of the cases. case: A 25-year-old woman presenting to our outpatient cardiology clinic with a 4-year history of progressive shortness of breath. Physical examination was significant for an ejection systolic murmur, heard best at the left upper sternal border grade 3/6, radiating to the back, with a pan-systolic 3/6 murmur at left lower sternal border that increases with inspiration, and a faint rumbling diastolic murmur heard at the left lower sternal border, lung examination was significant for wheezes and abdominal examination revealed hepatomegaly. decision Making: A trans-thoracic echocardiogram (ECHO) revealed mild right ventricular hypertrophy, with a normal function, a thickened tricuspid valve with restricted leaflet motion, severe tricuspid regurgitation and evidence of a thickened pulmonary valve (mean gradient 35mmHg). A cardiac MRI confirmed these finding. A CT scan showed evidence of a larger liver with multiple hyper-vascular lesions, with similar lesions in the mesentery and small bowel, suggestive of a metastatic tumor. Twenty-four hour urine for 5-Hydroxyindoleacetic acid came back positive and liver biopsy revealed a neuro-endocrine tumor. At a multidisciplinary tumor board, the decision was to treat the patient medically with octreotide and chemotherapy (capecitabine and temozolanide) and to repeat the ECHO every 3-6 months for assessment of the valve disease progression. conclusion: Carcinoid heart disease should be considered in the differential diagnosis of right-sided valve lesions. Dyspnea due to carcinoid syndrome is multifactorial and caused early by bronchospasm from the release of vaso-active amines.

Journal of the American College of Cardiology, 2015

background: In the acute setting, clinicians typically focus on excluding a cardiovascular etiolo... more background: In the acute setting, clinicians typically focus on excluding a cardiovascular etiology overlooking other conditions presenting with chest pain. This may result in excess healthcare utilization and work absenteeism. Our aim is to objectively highlight common and treatable mimickers of angina.

Human Reproduction, 1995

In agreement with the recommendations of the World Health Organization (Rowe et al, 1993), it is ... more In agreement with the recommendations of the World Health Organization (Rowe et al, 1993), it is of the utmost importance to categorize precisely every couple with an infertility problem into a well defined diagnostic class. Therapeutic consequences will depend on ...

This study would not have been achievable without the support of several people. I wish to expres... more This study would not have been achievable without the support of several people. I wish to express my gratitude to my supervisor, Prof. Dr. Jennifer Bremer, AUC who was in abundance cooperative and offered precious support, assistance and guidance.

The Egyptian Journal of Hospital Medicine

Background: overactive bladder (OAB) also referred to as the urgency-frequency syndrome, with or ... more Background: overactive bladder (OAB) also referred to as the urgency-frequency syndrome, with or without urge urinary incontinence can considerably impair the patient's quality of life. It is widely accepted that diet and life style modifications, behavioral therapy and medication belong to the standard conservative therapeutic options and considered as the first-line measures. The International Consultation on Incontinence (ICI) guidelines reported that when the first line approach is not fully satisfactory or fails after 8-12 weeks, alternative therapies should be sought out. It is worthwhile and justified to proceed to second-line therapy if patients are refractory to antimuscarinic therapy or if the treatment is contraindicated. Second-line of therapies include less-invasive measures such as percutaneous posterior tibial neve stimulation, sacral neuromodulation, detrusor injections with botulinum toxin (BTX) and whereas more-invasive measures constitute surgical techniques e.g. bladder augmentation or substitution. Pelvic neuromodulation has been proven effective and is today an established treatment option for patients refractory to or intolerant of conservative treatments. Objective: this study aimed to compare between the efficacy of continuous anticholinergic therapy and intermitted anticholinergic therapy for treatment of the overactive bladder. Patients and Methods: our study included 60 patients categorized into two groups: continuous anticholinergic therapy group and intermitted anticholinergic therapy. By using 12 weekly intermitted anticholinergic therapies, remarkable clinical results were obtained. Percent of the patients who complained OAB in the intermitted anticholinergic group reported a statistically significant subjective success. These patients chose to continue treatment to maintain the response. Results: patients in the intermitted anticholinergic therapy group showed significant improvement of frequency (31%) urgency (50%) urge incontinence (50%) and nocturia (53%) compared to propiverine group frequency (50%) urgency (60%) urge incontinence (67%) and nocturia (67%). No serious side effects were reported, in group A 8 patients had horm of dry mouth in 5 cases (16.7%), constipation in 2 cases (67%) 8 blurred vision in one case (33%). In group B, there were 5 patients (16.7%) in the horm of dry mouth in 3 cases (10% constipation in one case (3.3) and blurred vision in one case (3.3%). Conclusion: our study concluded that intermittent anticholinergic therapy induced improvement of bladder over activity symptoms and less side effects than continuous anticholinergic group.