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Research paper thumbnail of Assessment of Cardiac Functions in Children Suffering from Celiac Disease

Asian Journal of Pediatric Research

Background: Celiac disease (CD) is an autoimmune disorder that occurs in genetically predisposed ... more Background: Celiac disease (CD) is an autoimmune disorder that occurs in genetically predisposed individuals. Among the complications of celiac disease, idiopathic dilated cardiomyopathy and autoimmune myocarditis are popular causes of considerable mortality and morbidity. The objective of this study is to evaluate the heart functioning in CD children. Methods: This cross-sectional study was conducted out on 40 children (twenty Patients diagnosed as having celiac disease and twenty healthy, age and sex matched children send as control group). All participants underwent basic laboratory investigations. Every child had an echocardiogram, which comprised both traditional echocardiography and tissue Doppler imaging. Results: The conventional echocardiographic assessment parameters (LVEED, LVESD, septal thickness, EF% FS%, E/A and TAPSE) were insignificantly different between both groups. There was no statistically substantial variation in mitral anulus velocity (S) and E/A among both gr...

Research paper thumbnail of Magnetic resonance imaging and spectroscopy in evaluation of hypoxic ischemic encephalopathy in pediatric age group

Egyptian Journal of Radiology and Nuclear Medicine, 2021

Hypoxic ischemic encephalopathy is a major cause of pediatric mortality and morbidity, with possi... more Hypoxic ischemic encephalopathy is a major cause of pediatric mortality and morbidity, with possible long-term neurologic sequel, such as cerebral palsy. With improvements in care of at-risk neonates, more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. The aim of the study was to assess the additive role of magnetic resonance spectroscopy over conventional MRI in diagnosis and early prediction of pathological motor development in neonates with hypoxic ischemic encephalopathy. MRS ratios showed significant difference between unfavorable and normal outcome infants. MRS ratios as Lac/Cr, NAA/Cr and NAA/Cho within basal ganglia, thalamus and white matter can significantly differentiate between patients with normal and pathological outcome at 1 year. Lac/Cr positively correlates with the severity of HIE. Both NAA/Cr and NAA/Cho negatively correlate with the severity of the disease. Ratios...

Research paper thumbnail of Evaluation of Ventricular Functions in Egyptian Pediatric Patients with End Stage Kidney Disease

Neonatal and Pediatric Medicine, 2018

Background: In our study, we evaluated the left and right ventricular (LV and RV) functions in ch... more Background: In our study, we evaluated the left and right ventricular (LV and RV) functions in children and adolescents with end stage kidney disease (ESKD) by both conventional and two-dimensional (2D) longitudinal speckle-tracking echocardiography (STE) in both patients with ESKD under conservative measures and those ESKD on maintanance hemodialysis (mHD). Objective of the study: To study ventricular functions in Egyptian Pediatric patients with CRF. Patients and methods: 49 children with CRF (24 on conservative treatment and 25 on rHD) and thirty healthy controls matched for age and sex were included and subjected to history, clinical, laboratory, two-dimensional (2D) STD and tissue Doppler study to measure different echocardiographic parameters focusing on left and right ventricular functions. Results: Longitudinal strains of LV and RV were statistically decreased in diseased children than in healthy ones (-11.3 vs.-14.8, p<0.001 for LV and-9.6 vs.-15.3, P<0.001 for RV). In the HD patients, the longitudinal strain of RV was statistically decreased than in the non-HD patients (p=0.02). The longitudinal strain of RV was in a correlation with LV strain and hypertension. Conclusions: The speckle tracking echocardiography reported early systolic dysfunction of both left and right ventricules in our CRF patients in spite of ordinary ejection fraction (EF) and fractional shortening (FS) by conventional echocardiographic study. Our study raises the importance of echocardiography as the gold standard for diagnosis of myocardial dysfunction in pediatric patients with CRF.

Research paper thumbnail of Role of BAALC Gene in Prognosis of Acute Lymphoblastic Leukemia in Egyptian Children

Indian Journal of Hematology and Blood Transfusion, 2017

Acute lymphoblastic leukemia (ALL) is characterized by excess bone marrow lymphoblast cell produc... more Acute lymphoblastic leukemia (ALL) is characterized by excess bone marrow lymphoblast cell production. Brain and Acute Leukemia Cytoplasmic gene (BAALC gene) is a recently identified gene on chromosome 8q22.3. The aim of this work was to study the role of BAALC gene in prognosis of ALL in Egyptian children. This study was conducted on 60 children with ALL who were admitted in Oncology Unit in the period from January 2012 to March 2015 including 36 males and 24 females with mean age of 8.74 ± 2.66 years. For all patients the following were done: Full history taking, thorough clinical examination and laboratory investigations including: complete blood count, LDH, bone marrow aspiration, cytochemistry, immunophenotyping, FISH technique for detection of t(12;21) and t(9;22) and assessment of BAALC gene expression by PCR in bone marrow aspirate mononuclear cells at diagnosis before chemotherapy. Positive BAALC gene expression was found in 36 patients (60%) and negative expression in 24 patients (40%). Positive BAALC gene expression group includes 14 males and 22 females with mean age at presentation of 8.45 ± 2.77 years while negative BAALC gene expression group includes 18 males and 6 females with mean age at presentation of 8.61 ± 2.44 years with no significant differences between positive and negative BAALC gene expression groups regarding age, sex, clinical presentations, WBCs and platelets counts, hemoglobin and LDH levels, peripheral blood and BM blast cell counts, immunophenotyping and chromosomal translocations including t(12;21) and t(9;22). There were significant differences in disease outcome between positive and negative BAALC gene expression groups with higher rate of relapse and death and lower rate of complete remission, disease free survival (DFS) and overall survival (OS) in positive BAALC gene expression group compared with negative group (p = 0.028). Multivariate analyses for overall survival and disease free survival shows significant role of BAALC gene expression in OS and DFS. BAALC expression might represent an additional prognostic marker in children with ALL and should be routinely assessed at diagnosis for better prognostic assessment.

Research paper thumbnail of Safety and Efficacy of Prophylactic Amiodarone in Preventing Early Junctional Ectopic Tachycardia (JET) in Children After Cardiac Surgery and Determination of Its Risk Factor

Pediatric Cardiology, 2016

Postoperative arrhythmia is a common complication after open heart surgery in children. JET is th... more Postoperative arrhythmia is a common complication after open heart surgery in children. JET is the most common and dangerous arrhythmia. We aimed to assess safety and efficacy of prophylactic amiodarone in preventing JET in children underwent cardiac surgery and to assess risk factors for JET among our patients. In total, 117 children who underwent cardiac surgery for CHD at Tanta University Hospital from October 2011 to April 2015 were divided in two groups; amiodarone group (65 patients) was given prophylactic amiodarone intraoperatively and placebo group (52 patients). Amiodarone is started as loading dose of 5 mg/kg IV in the operating room after induction of anesthesia and continued for 3 days as continuous infusion 10-15 lg/kg/min. Primary outcome and secondary outcomes of amiodarone administration were reported. We studied pre-, intra-and postoperative factors to determine risk factors for occurrence of JET among these children. Prophylactic amiodarone was found to significantly decrease incidence of postoperative JET from 28.9 % in placebo group to 9.2 % in amiodarone group, and symptomatic JET from 11.5 % in placebo group to 3.1 % in amiodarone group, and shorten postoperative intensive care unit and hospital stay without significant side effects. Risk factors for occurrence of JET were younger age, lower body weight, longer cardiopulmonary bypass, aortic cross-clamp time, hypokalemia, hypomagnesemia, acidosis and high dose of inotropes. JET was more associated with surgical repair of right ventricular outlet obstruction as in case of tetralogy of Fallot and pulmonary stenosis. Most of JET 15/21 (71.4 %) occurred in the first day postoperatively, and 6/21 occurred in the second day (28.6 %). Prophylactic amiodarone is safe and effective in preventing early JET in children after open heart surgery.

Research paper thumbnail of Assessment of Cardiac Functions in Children Suffering from Celiac Disease

Asian Journal of Pediatric Research

Background: Celiac disease (CD) is an autoimmune disorder that occurs in genetically predisposed ... more Background: Celiac disease (CD) is an autoimmune disorder that occurs in genetically predisposed individuals. Among the complications of celiac disease, idiopathic dilated cardiomyopathy and autoimmune myocarditis are popular causes of considerable mortality and morbidity. The objective of this study is to evaluate the heart functioning in CD children. Methods: This cross-sectional study was conducted out on 40 children (twenty Patients diagnosed as having celiac disease and twenty healthy, age and sex matched children send as control group). All participants underwent basic laboratory investigations. Every child had an echocardiogram, which comprised both traditional echocardiography and tissue Doppler imaging. Results: The conventional echocardiographic assessment parameters (LVEED, LVESD, septal thickness, EF% FS%, E/A and TAPSE) were insignificantly different between both groups. There was no statistically substantial variation in mitral anulus velocity (S) and E/A among both gr...

Research paper thumbnail of Magnetic resonance imaging and spectroscopy in evaluation of hypoxic ischemic encephalopathy in pediatric age group

Egyptian Journal of Radiology and Nuclear Medicine, 2021

Hypoxic ischemic encephalopathy is a major cause of pediatric mortality and morbidity, with possi... more Hypoxic ischemic encephalopathy is a major cause of pediatric mortality and morbidity, with possible long-term neurologic sequel, such as cerebral palsy. With improvements in care of at-risk neonates, more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. The aim of the study was to assess the additive role of magnetic resonance spectroscopy over conventional MRI in diagnosis and early prediction of pathological motor development in neonates with hypoxic ischemic encephalopathy. MRS ratios showed significant difference between unfavorable and normal outcome infants. MRS ratios as Lac/Cr, NAA/Cr and NAA/Cho within basal ganglia, thalamus and white matter can significantly differentiate between patients with normal and pathological outcome at 1 year. Lac/Cr positively correlates with the severity of HIE. Both NAA/Cr and NAA/Cho negatively correlate with the severity of the disease. Ratios...

Research paper thumbnail of Evaluation of Ventricular Functions in Egyptian Pediatric Patients with End Stage Kidney Disease

Neonatal and Pediatric Medicine, 2018

Background: In our study, we evaluated the left and right ventricular (LV and RV) functions in ch... more Background: In our study, we evaluated the left and right ventricular (LV and RV) functions in children and adolescents with end stage kidney disease (ESKD) by both conventional and two-dimensional (2D) longitudinal speckle-tracking echocardiography (STE) in both patients with ESKD under conservative measures and those ESKD on maintanance hemodialysis (mHD). Objective of the study: To study ventricular functions in Egyptian Pediatric patients with CRF. Patients and methods: 49 children with CRF (24 on conservative treatment and 25 on rHD) and thirty healthy controls matched for age and sex were included and subjected to history, clinical, laboratory, two-dimensional (2D) STD and tissue Doppler study to measure different echocardiographic parameters focusing on left and right ventricular functions. Results: Longitudinal strains of LV and RV were statistically decreased in diseased children than in healthy ones (-11.3 vs.-14.8, p<0.001 for LV and-9.6 vs.-15.3, P<0.001 for RV). In the HD patients, the longitudinal strain of RV was statistically decreased than in the non-HD patients (p=0.02). The longitudinal strain of RV was in a correlation with LV strain and hypertension. Conclusions: The speckle tracking echocardiography reported early systolic dysfunction of both left and right ventricules in our CRF patients in spite of ordinary ejection fraction (EF) and fractional shortening (FS) by conventional echocardiographic study. Our study raises the importance of echocardiography as the gold standard for diagnosis of myocardial dysfunction in pediatric patients with CRF.

Research paper thumbnail of Role of BAALC Gene in Prognosis of Acute Lymphoblastic Leukemia in Egyptian Children

Indian Journal of Hematology and Blood Transfusion, 2017

Acute lymphoblastic leukemia (ALL) is characterized by excess bone marrow lymphoblast cell produc... more Acute lymphoblastic leukemia (ALL) is characterized by excess bone marrow lymphoblast cell production. Brain and Acute Leukemia Cytoplasmic gene (BAALC gene) is a recently identified gene on chromosome 8q22.3. The aim of this work was to study the role of BAALC gene in prognosis of ALL in Egyptian children. This study was conducted on 60 children with ALL who were admitted in Oncology Unit in the period from January 2012 to March 2015 including 36 males and 24 females with mean age of 8.74 ± 2.66 years. For all patients the following were done: Full history taking, thorough clinical examination and laboratory investigations including: complete blood count, LDH, bone marrow aspiration, cytochemistry, immunophenotyping, FISH technique for detection of t(12;21) and t(9;22) and assessment of BAALC gene expression by PCR in bone marrow aspirate mononuclear cells at diagnosis before chemotherapy. Positive BAALC gene expression was found in 36 patients (60%) and negative expression in 24 patients (40%). Positive BAALC gene expression group includes 14 males and 22 females with mean age at presentation of 8.45 ± 2.77 years while negative BAALC gene expression group includes 18 males and 6 females with mean age at presentation of 8.61 ± 2.44 years with no significant differences between positive and negative BAALC gene expression groups regarding age, sex, clinical presentations, WBCs and platelets counts, hemoglobin and LDH levels, peripheral blood and BM blast cell counts, immunophenotyping and chromosomal translocations including t(12;21) and t(9;22). There were significant differences in disease outcome between positive and negative BAALC gene expression groups with higher rate of relapse and death and lower rate of complete remission, disease free survival (DFS) and overall survival (OS) in positive BAALC gene expression group compared with negative group (p = 0.028). Multivariate analyses for overall survival and disease free survival shows significant role of BAALC gene expression in OS and DFS. BAALC expression might represent an additional prognostic marker in children with ALL and should be routinely assessed at diagnosis for better prognostic assessment.

Research paper thumbnail of Safety and Efficacy of Prophylactic Amiodarone in Preventing Early Junctional Ectopic Tachycardia (JET) in Children After Cardiac Surgery and Determination of Its Risk Factor

Pediatric Cardiology, 2016

Postoperative arrhythmia is a common complication after open heart surgery in children. JET is th... more Postoperative arrhythmia is a common complication after open heart surgery in children. JET is the most common and dangerous arrhythmia. We aimed to assess safety and efficacy of prophylactic amiodarone in preventing JET in children underwent cardiac surgery and to assess risk factors for JET among our patients. In total, 117 children who underwent cardiac surgery for CHD at Tanta University Hospital from October 2011 to April 2015 were divided in two groups; amiodarone group (65 patients) was given prophylactic amiodarone intraoperatively and placebo group (52 patients). Amiodarone is started as loading dose of 5 mg/kg IV in the operating room after induction of anesthesia and continued for 3 days as continuous infusion 10-15 lg/kg/min. Primary outcome and secondary outcomes of amiodarone administration were reported. We studied pre-, intra-and postoperative factors to determine risk factors for occurrence of JET among these children. Prophylactic amiodarone was found to significantly decrease incidence of postoperative JET from 28.9 % in placebo group to 9.2 % in amiodarone group, and symptomatic JET from 11.5 % in placebo group to 3.1 % in amiodarone group, and shorten postoperative intensive care unit and hospital stay without significant side effects. Risk factors for occurrence of JET were younger age, lower body weight, longer cardiopulmonary bypass, aortic cross-clamp time, hypokalemia, hypomagnesemia, acidosis and high dose of inotropes. JET was more associated with surgical repair of right ventricular outlet obstruction as in case of tetralogy of Fallot and pulmonary stenosis. Most of JET 15/21 (71.4 %) occurred in the first day postoperatively, and 6/21 occurred in the second day (28.6 %). Prophylactic amiodarone is safe and effective in preventing early JET in children after open heart surgery.