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Papers by Noha Asem

The Lancet Infectious Diseases, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Journal of Pediatric Infectious Diseases

Objective The novel coronavirus disease 2019 (COVID-19) has made its worldwide spread since its o... more Objective The novel coronavirus disease 2019 (COVID-19) has made its worldwide spread since its outbreak in December 2019. Limited information is available about the epidemiology and clinical characteristics of COVID-19, especially in Africa and Egypt. Methods We aimed to study the clinical and epidemiological characteristics of COVID-19 in Egyptian children. This is an observational retrospective cohort study performed at two specialized COVID-19 isolation hospitals in Egypt. All admitted COVID-19 pediatric patients between March 20, 2020, and May 1, 2020, were included in the study. Discussion This study included 40 COVID-19 confirmed cases (mean age, 9.4 years), 67.5% were male, 85% were asymptomatic, and 15% had mild symptoms. There were no confirmed severe or critically ill cases among the patients. Conclusion COVID-19 runs in a benign course in Egyptian children with no mortality and no significant morbidity.

Infection and Drug Resistance, Apr 1, 2022

Background & Aims: Coronavirus disease 2019 (COVID-19) is a global health problem, presenting wit... more Background & Aims: Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic. Methods: A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists' discussion held in Cairo July 2021 followed by electric voting for each statement. Results: The statements were electronically voted to be either "agree," "not agree," or "neutral." For a statement to be accepted to the consensus, it should have 80% agreement. Conclusion: Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.

Egyptian Liver Journal, 2021

Background Liver biopsy is the standard reference for staging hepatic fibrosis. Non-invasive meth... more Background Liver biopsy is the standard reference for staging hepatic fibrosis. Non-invasive methods for assessment of hepatic fibrosis and cirrhosis are becoming increasingly popular. Objective We aimed at exploring the change in practice regarding the use of liver biopsy and non-invasive methods for staging hepatic fibrosis and cirrhosis among hepatologists. Methods We performed a survey-based study that recruited hepatologists from various Egyptian institutions. Physicians were deemed eligible if they had a degree in internal medicine with hepatology as a subspecialty. We utilized an online-based survey that assessed the acceptability and reliability of liver biopsy, serum biomarkers, and radiological tools for evaluating liver fibrosis and cirrhosis. Results A total of 573 responses were retrieved (response rate = 80.3%). Out of them, 58% were having more than 15 years of experience as a hepatologist. Liver biopsy is still considered the gold standard for assessment of hepatic f...

PLOS Neglected Tropical Diseases, 2020

Neglected tropical diseases (NTDs) are a group of chronic diseases affecting 1.2 billion people w... more Neglected tropical diseases (NTDs) are a group of chronic diseases affecting 1.2 billion people worldwide, with more burden in the developing communities. Improving awareness about NTDs is a powerful affordable long-term intervention for infection control. In literature, there is a limited number of studies in the developing countries assessing the awareness of healthcare providers regarding these diseases. The present study aimed at assessing the awareness of a sample of Cairo University medical and nursing students regarding NTDs. A cross-sectional descriptive study was conducted on 184 medical and nursing students in Cairo University. An anonymous self-administered questionnaire in English language with an estimated completion time of 15 minutes was used for evaluation. It included question categories which cover the knowledge about NTDs and control measures as well as the willingness to participate in NTDs control activities. Content analysis was performed on the materials and s...

TheFaculty of Medicine at Cairo University in Egypt has a responsibility to ensure that scientifi... more TheFaculty of Medicine at Cairo University in Egypt has a responsibility to ensure that scientifically valid research is conducted according to accepted ethical practices that promote the rights and welfare of research subjects. As such, in 2002, the Dean of the Faculty of Medicine established a research ethics committee (REC) to review human subject research conducted by staff at Kasr Al Ainy hospital. Cairo University obtained an FWA from the US Office of Human Research Protections (OHRP); the REC is also registered at OHRP.

COVID-19 pandemic raises an extraordinary challenge to the healthcare systems globally. The gover... more COVID-19 pandemic raises an extraordinary challenge to the healthcare systems globally. The governments are taking key measures to constrain the corresponding health, social, and economic impacts, however, these measures vary depending on the nature of the crisis and country-specific circumstances. Objectives: Considering different incidence and mortality rates across different countries, we aimed at explaining variance of these variables by performing accurate and precise multivariate analysis with aid of suitable predictors, accordingly, the model would proactively guide the governmental responses to the crisis. Methods: Using linear and exponential time series analysis, this research aimed at studying the incidence and mortality rates of COVID-19 in 18 countries during the first six months of the pandemic, and further utilize multivariate techniques to explain the variance in monthly exponential growth rates of cases and deaths with aid of a set of different predictors: the recor...

Journal of the Egyptian Public Health Association, 2021

Background Knowledge about the outcome of COVID-19 on pregnant women is so important. The publish... more Background Knowledge about the outcome of COVID-19 on pregnant women is so important. The published literature on the outcomes of pregnant women with COVID-19 is confusing. The aim of this study was to report our clinical experience about the effect of COVID-19 on pregnant women and to determine whether it was associated with increased mortality or an increase in the need for mechanical ventilation in this special category of patients. Methods This was a cohort study from some isolation hospitals of the Ministry of Health and Population, in eleven governorates, Egypt. The clinical data from the first 64 pregnant women with COVID-19 whose care was managed at some of the Egyptian hospitals from 14 March to 14 June 2020 as well as 114 non-pregnant women with COVID-19 was reviewed. Results The two groups did not show any significant difference regarding the main outcomes of the disease. Two cases in each group needed mechanical ventilation (p 0.617). Three cases (4.7%) died among the pr...

World Journal of Gastroenterology, 2021

BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus dis... more BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019 (COVID-19) at variable prevalence. Most studies report mild liver function disturbances correlated with COVID-19 severity, though liver failure is unusual. AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15, 2020 to July 29, 2020. Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health. Demographic information, laboratory characteristics, treatments, fibrosis-4 (FIB-4) index, COVID-19 severity, and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms. Follow-ups were conducted until discharge or death. Regression analyses were performed to determine the independent factors affecting mortality. RESULTS This study included 547 patients, of whom 53 (9.68%) died during hospitalization and 1 was discharged upon his request. Patients’ mean age was 45.04 ± 17.61 years, and 21.98% had severe or critical COVID-19. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were available for 430 and 428 patients, respectively. In total, 26% and 32% of patients had elevated ALT and AST, respectively. Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21 (4.91%) and 16 (3.73%) patients, respectively. Male gender, smoking, hypertension, chronic hepatitis C, and lung involvement were associated with elevated AST or ALT. AST was elevated in 50% of patients over 60-years-old. FIB-4 was significantly higher in patients admitted to the intensive care unit (ICU), those with more severe COVID-19, and non-survivors. The independent variables affecting outcome were supplementary vitamin C intake (1 g daily capsules) [odds ratio (OR): 0.05, 95% confidence interval (CI): 0.008–0.337]; lung consolidation (OR: 4.540, 95%CI: 1.155–17.840); ICU admission (OR: 25.032, 95%CI: 7.110–88.128); and FIB-4 score > 3.25 (OR: 10.393, 95%CI: 2.459-43.925). Among 60 (13.98%) patients with gastrointestinal symptoms, 52 (86.67%) had diarrhoea. Patients with gastrointestinal symptoms were predominantly females with higher body mass index, and 50 (83.40%) patients had non-severe COVID-19. CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury. The independent variables affecting mortality were supplementary vitamin C intake, lung consolidation, ICU admission, and FIB-4 score.

Journal of Mental Health, 2021

BACKGROUND Studies have shown that COVID-19 patients experience high levels of anxiety, depressio... more BACKGROUND Studies have shown that COVID-19 patients experience high levels of anxiety, depression, and stress during the pandemic. Patients adopt different coping strategies to reduce their psychological distress. AIM To compare the immediate and long-term psychological impact of COVID-19 disease on patients with and without chronic medical illnesses (CMI) and identify coping styles of both groups during the peak of COVID-19 disease in Egypt. METHODS This is a cohort follow-up study, that included an online survey consisting of General Health Questionnaire-12, Taylor Manifest Anxiety Scale, Beck Depression Inventory and Brief-COPE scale. The Post-Traumatic Stress Disorder (PTSD) Checklist was completed after 6 months. Questionnaires were distributed to adult patients with a confirmed diagnosis of SARS-CoV-2 virus infection during their quarantine in Egypt. RESULTS There was no significant difference between the two groups regarding anxiety and depression during the acute infection. Patients without CMI relied significantly on the use of informational support to cope with COVID-19 disease. Patients with CMI continued to show significant depressive symptoms after 6 months without significant PTSD symptoms. CONCLUSIONS COVID-19 has similar immediate psychological impact on patients with and without CMI. However, patients with CMI continue to show depression on long-term follow-up.

Current Medical Imaging Formerly Current Medical Imaging Reviews, 2021

Background & Aims: In the midst of this pandemic, planning the prioritization of hospital admissi... more Background & Aims: In the midst of this pandemic, planning the prioritization of hospital admissions for patients affected with COVID-19 should be of prime concern, particularly in healthcare settings with limited resources. Thus, in this study, we aimed to develop a novel approach to triage COVID-19 patients and attempt to prioritize their hospital admission using Lung Ultrasonography (LUS). The efficacy of LUS in triaging suspected COVID-19 patients and assessing the severity of COVID-19 pneumonia was evaluated; the findings were then compared with those obtained by chest computed tomography (CT). Method: This multicenter, cross-sectional study comprised 243 COVID-19 patients who presented to the emergency department in 3 major university hospitals in Egypt. LUS was performed by an experienced emergency or chest physician, according to the local protocol of each hospital. Demographic, clinical, and laboratory data were then collected from each patient. Each patient was subjected t...

The Journal of Infection in Developing Countries, 2020

Introduction: The recently discovered novel coronavirus disease (COVID-19) has emerged in Wuhan, ... more Introduction: The recently discovered novel coronavirus disease (COVID-19) has emerged in Wuhan, China, since January 2020. Egypt reported a low incidence of infection when compared with other countries. The aim of the study was to assess the characterization of COVID-19 infection among the Egyptian population. Methodology: Data were collected from a single COVID-19 quarantine hospital in Cairo. A total number of 195 cases were included with their clinical, laboratory, and radiological data. Results: Three different age groups behaved differently for COVD-19 infection. The pediatric age group was asymptomatic entirely, the middle age group (18-50 years) were asymptomatic in 53.3% of cases, while 77.9% of those above 50 years were symptomatic (p ≤ 0.001). The latter group had a high incidence of COVID-pneumonia in (83.1%), and moderate to critical presentations were encountered in 66.3% of them. Neutrophil to lymphocyte (N/L) ratio correlated directly with the age and case severity. ...

Heliyon, 2021

Background: This work aimed to identify the mathematical model and ecological determinants of COV... more Background: This work aimed to identify the mathematical model and ecological determinants of COVID-19 infection and mortality across different countries during the first six months of the pandemic. Methodology: In this study, authors used the online available data sources of randomly selected 18 countries to figure out potential determinants of COVID-19 transmissibility and mortality. The studied variables were environmental factors (daily average temperature, daily humidity), socioeconomic attributes (population age structure, count and density, human development index, per capita income (PCI), gross domestic product, internet coverage) mobility trends and chronic diseases. Researchers used the linear and exponential time series analysis, and further utilized multivariate techniques to explain the variance in the monthly increase in cases and deaths. Results: In the first two months, the R 2 of linear models for the cases and deaths were higher than that of the corresponding R 2 of the exponential model. Later one, R 2 of the exponential model was occasionally relatively higher than that of the linear model. The exponential growth rate of new cases was significantly associated with mobility trends (β ¼ 0.00398, P ¼ 0.002), temperature (β ¼ 0.000679, P ¼ 0.011), humidity (β ¼ 0.000249, P < 0.001), and the proportion of population aged !65 years (β ¼-0.000959, P ¼ 0.012). Similarly, the exponential growth rate of deaths was significantly associated with mobility trends (β ¼ 0.0027, P ¼ 0.049), temperature (β ¼ 0.0014, P < 0.001), humidity (β ¼-0.0026, P < 0.001), and PCI of countries. During this period, COVID-19 transmissibility was evident to be controlled as soon as social mobility is decreased by about 40% of the baseline over 3 months controlling for the other predictors. Conclusion: Controlling of COVID-19 pandemic is based mainly on controlling social mobility. Role of environmental determinants like temperature and humidity was well noticed on disease fatality and transmissibility. Socio-demographic determinants of COVID-19 spread and fatality included modifiable risk factors like PCI and non-modifiable risk factors like ageing.

IntroductionSince the worldwide emergence of the COVID-19, several protocols were used by differe... more IntroductionSince the worldwide emergence of the COVID-19, several protocols were used by different healthcare organisations. We evaluated in this study the demographic and clinical characteristics of COVID-19 disease in Egyptian population with special consideration for its mortality predictors.Methodology8162 participants (mean age 48.7±17.3 years,54.5% males) with RT-PCR positive COVID-19 were included. The electronic medical records were reviewed for demographic, clinical, laboratory, and radiologic features. The primary outcome was the in-hospital mortality rate.ResultsThe in-hospital mortality was 11.2%. There was a statistically significant strong association of in-hospital mortality with age >60 years old (OR:4.7; 95% CI 4.1-5.4;p<0.001), diabetes mellitus (OR:4.6; 95% CI 3.99-5.32;p<0.001), hypertension (OR:3.9; 95% CI 3.4-4.5;p<0.001), coronary artery disease (OR:2.7; 95% CI 2.2-3.2;p<0.001), chronic obstructive pulmonary disease (OR:2.1; 95% CI 1.7-2.5;p&lt...

COVID-19 patients, especially those with chronic medical illnesses (CMI), may use different copin... more COVID-19 patients, especially those with chronic medical illnesses (CMI), may use different coping strategies, to reduce their psychological distress while facing the COVID-19 infection. The aim was to compare anxiety, depression and coping styles between patients infected with COVID-19 disease with and without CMI during the peak of COVID-19 disease in Egypt. This is a cross sectional study, that included an online survey consisting of Arabic versions of General Health Questionnaire-12, Taylor Manifest Anxiety Scale (TMAS), Beck Depression Inventory (BDI) and Brief-COPE scale. Questionnaires were distributed to adult patients with a confirmed diagnosis of SARS-CoV-2 virus infection during their quarantine in Egypt. One hundred ninety-nine patients responded to the survey, where 46.73% of them had CMI. Religion, emotional support, use of informational support and acceptance were the most used coping strategies by participants. Avoidant coping strategies were frequently used by divor...

Pediatric Gastroenterology, Hepatology & Nutrition, 2020

Purpose: The outcome predictors of Kasai portoenterostomy (KPE) for biliary atresia (BA) are cont... more Purpose: The outcome predictors of Kasai portoenterostomy (KPE) for biliary atresia (BA) are controversial. This study aimed to identify possible short-term outcome predictors of KPE for BA in infants. Methods: This retrospective study included infants with BA who underwent KPE between

Background and Study Aims: The risk of hepatocarcinogenesis depends on background liver factors, ... more Background and Study Aims: The risk of hepatocarcinogenesis depends on background liver factors, of which fibrosis is a major determinant. Serum markers and scores are of increasing importance in noninvasive diagnosis of hepatic fibrosis. Our aim was to predict the occurrence of hepatocellular carcinoma (HCC) using a non-invasive fibrosis score calculated using routine patient data. Patients and mthods: Our retrospective study included 1,291 hepatitis C related-HCC Egyptian patients (Group 1) recruited from the multidisciplinary HCC clinic, Faculty of Medicine, Cairo University in the period between February 2009 and June 2016 and 1072 chronic hepatitis C-naïve patients (Group 2) with advanced fibrosis (!F3) and cirrhosis (F4). King score, Fibro Q score, Aspartate aminotransferase-toplatelet ratio index (APRI), AST to ALT ratio (AAR), LOK score, Göteborg University Cirrhosis Index (GUCI), Fibro-a and Biotechnology Research Center (BRC) scores were calculated for all patients. Regression analysis and receiver operating characteristics (ROC) were used to calculate the sensitivity, specificity and predictive values for significant scores with the best cutoff for predicting HCC. A regression equation was used to calculate predicted probabilities of HCC using the following variables; age, gender, haemoglobin, international normalised ratio (INR), albumin and alpha fetoprotein. The appropriate score cutoff points yielding optimal sensitivity and specificity were determined by ROC curve analysis. Results: There was a highly significant difference between the two groups for all calculated scores (P = 0.0001). Our new score, the Hepatocellular Carcinoma Multidisciplinary Clinic-Cairo University (HMC-CU) score (Logit probability of HCC = À 2.524 + 0.152*age-0.121*Hb À 0.696*INR-1.059*Al b + 0.022*AFP + 0.976*Sex. Male = 1, Female = 0), with a cutoff of 0.559 was superior to other scores for predicting HCC, having a sensitivity of 90% and specificity of 80.6%. Conclusion: The HMC-CU score is a promising, easily calculated, accurate, cost-effective score for HCC prediction in chronic HCV patients with advanced liver fibrosis.

Open Access Macedonian Journal of Medical Sciences, 2019

BACKGROUND: Egypt is among the world top 10 countries in diabetes prevalence. It is the first cou... more BACKGROUND: Egypt is among the world top 10 countries in diabetes prevalence. It is the first country among the MENA region. Healthy lifestyle education and support help people with diabetes to improve health outcomes. Many physical and psychological barriers can hinder patients from following a healthy lifestyle. AIM: This study aimed to examine the effect of lifestyle modification educational sessions in helping Egyptian patients to overcome main barriers of diabetes self-management through improving nutritional behaviours, physical activity, medication compliance, and blood glucose monitoring. METHODS: A cohort study included 205 patients with type 2 diabetes. Baseline assessment of patients' lifestyle behaviours and barriers using personal diabetes questionnaire of Louisville University, with both anthropometric and blood glucose assessment. Interventional lifestyle health education was provided weekly through multiple integrated techniques, followed by a post-intervention a...

Journal of the Egyptian Public Health Association, 2019

Background: Patient safety is regarded as a global problem by which both developed and developing... more Background: Patient safety is regarded as a global problem by which both developed and developing worlds are affected. It is defined as avoidance and prevention of patient injuries or adverse events, which could result during health care delivery. This study aimed to identify physicians' knowledge, influence, and attitude toward patient's safety in the faculty of medicine, Cairo university. Materials and methods: A cross-sectional study was conducted on 187 postgraduate physicians of different specialties working in the faculty of medicine, Cairo University. Anonymous self-administered questionnaires were distributed. The questionnaire is one of a series of tools designed for evaluation of the pilot implementation of the World Health Organization patient safety curriculum for medical schools. Results: Calculated attitude score was relatively higher than influence, then knowledge score (median scores were 4.25, 3.1, and 2.5 respectively). There was no difference in knowledge, attitude, and influence scores by different personal characteristics as gender, specialty, workplace, graduation year except for higher influence score among physician who received in patient safety (p = 0.016). There was a weak positive significant correlation between knowledge and influence scores and between influence and attitude scores (r = 0.25, p = 0.002; r = 0.27, p < 0.001 respectively). Conclusion: Higher patient safety positive attitude than influence and knowledge is pinpointed in physicians of different specialties in the faculty of medicine, Cairo University. This raises the attention to the importance of implementation of continuing patient safety education programs.

Journal of Hepatology, 2019

Background and aims: Per AASLD-IDSA guideline, HCV treatment should be prioritized in HCV-HIV coi... more Background and aims: Per AASLD-IDSA guideline, HCV treatment should be prioritized in HCV-HIV coinfected patients (pts). We evaluated access to direct-acting antiviral agents (DAAs). Method: Trio Health HIV network consists of 10 treatment centres providing care for 34, 000 HIV pts from 50 states, DC, and Puerto Rico in the US. We evaluated and verified Rx for pts with HCV-HIV on HIV regimens in Jan 1, 2016-Oct 31, 2018 at 5 sites. Pts with < 6 months follow-up or on clinical trials were excluded. Subgroups were compared using descriptive statistics, predictors of Rx and fill were evaluated via logistic regression. Results: Of 1452 pts, 51% were prescribed DAAs, of those prescribed 87% filled Rx, therefore 44% of the pts ultimately received a DAAs. Differences were found in characteristics of Rx and Fill groups (Table). Rx were more likely to smoke, have higher BMI, Charlson comorbidity index (CCI), cirrhosis, less control of HIV, less likely to be black; Fill were less likely to use alcohol, had lower ALT values, and longer follow-up. Conclusion: Despite guideline recommendations, less than half of HIV-HCV coinfected pts on HIV Rx were treated for HCV. Unlike HCV monoinfected pts, once prescribed, coinfected pts do not appear to face significant access barriers to DAAs from payers and the key care access issue is under prescribing. THU-136 Ledipasvir/sofosbuvir for 8 weeks cures genotype 4 chronic hepatitis C in non-cirrhotic children and adolescents