Wesam Morad - Academia.edu (original) (raw)

Papers by Wesam Morad

Egyptian Journal of Anaesthesia, 2012

Back ground: Some of tense ascitic patients with end stage liver disease and portal hypertension ... more Back ground: Some of tense ascitic patients with end stage liver disease and portal hypertension were presented to our emergency department with surgical acute abdomen that required urgent abdominal surgery which might be associated with inevitable rapid and relatively complete evacuation of this ascitic fluid with possible occurrence of post-paracentesis-induced hypotension. The aims of this study were to compare between the intraoperative use of terlipressin versus norepinephrine for the management of paracentesis induced refractory hypotension not responding to colloid resuscitation or ephedrine in patients with end-stage liver disease during emergency abdominal surgery. Patients and method: Thirty-four patients experienced refractory hypotension during or shortly after the paracentesis process were randomized to receive either bolus dose of terlipressin (1 mg over 30 min) followed immediately by a continuous infusion of 2 lg/kg/h (T group, n = 17) or norepinephrine infusion at starting dose of 0.1 lg/kg/min (N group, n = 17).

Annals of Oncology, 2012

Introduction: Distant metastatic breast cancer is considered to be an incurable disease and there... more Introduction: Distant metastatic breast cancer is considered to be an incurable disease and therefore is only treated with palliative intent. Local treatment is recommended only if the primary tumor is symptomatic. However, recent studies challenge this approach, suggesting that removing the primary tumor may lead to an overall improved survival. We retrospectively reviewed patients who underwent surgical removal of the primary tumor while they were metastatic as regards survival and clinico-pathological data. Patients and methods: In a retrospective review of our database, we collected data of 80 patients who were presented at Menofia oncology department with metastatic breast cancer (MBC) excluding patients above 70 years old and patients with performance status > 2. Patient characteristics and survival were reviewed between the surgical group and non-surgical group. Results: Of the 80 patients with MBC, 40 (50%) underwent surgery either modified radical mastectomy (MRM) or conservative surgery, other 40 (50%) started treatment without surgery. Mean age at diagnosis was 47.33, 44.20 in both groups respectively. Surgery was associated with significantly improved median overall survival (∼ 20 months) versus no surgery (∼ 6.5 months) (P =< 0.05). Conclusion: In our experience here at Menofia oncology department we concluded that surgery of the primary tumor in patients presented with MBC is associated with improved survival. A double blind randomized study is already started at our department to assess these results.

Research in Oncology, 2014

Breast cancer is the most common cancer in women in the world 1. Despite improvement in treatment... more Breast cancer is the most common cancer in women in the world 1. Despite improvement in treatment, 20%-30% of patients with early breast cancer will experience metastatic disease 2. Meanwhile, 6%-10% of patients were to be ill with metastatic disease at the initial diagnosis of breast cancer 3. Hepatic metastases are the one of the most frequent distant metastases of breast cancer 1. Survival rate for patients with hepatic metastases is poor, with a median survival time about 14 months 4. Breast cancer has different molecular subtypes which may be defined by gene expression profiles 5 or immunohistochemical biomarkers 6. It is reported that human epidermal growth factor receptor 2 (HER2)-enriched subtype breast cancers aggressively spread to the liver 7. Endocrine therapy is indicated for estrogen receptor (ER) and/or progesterone receptor (PgR) positive patients with long disease free survival, non life threatening metastatic sites (such disease should be non visceral or asymptomatic visceral disease), and good performance status. Major treatments for hepatic metastases from breast cancers include chemotherapy, surgery, and intervention therapy 8. The aim of this study is to analyze the clinical characteristics and survival of patients with different molecular breast cancer subtypes who developed HM, and to investigate the prognostic and predictive factors that affect clinical outcome.

Clinical & Experimental Hepatology, 2020

Aim of the study: Chronic hepatitis B virus (HBV) infection is one of the major health problems w... more Aim of the study: Chronic hepatitis B virus (HBV) infection is one of the major health problems worldwide. Use of non-invasive tests for assessment of hepatic fibrosis such as the FIB-4 index could be used to avoid liver biopsy. Another promising noninvasive test, FIB-5, could also be used to detect significant hepatic fibrosis. The aim of the study was to compare the use of FIB-5 and FIB-4 as noninvasive markers to assess chronic HBV-related hepatic fibrosis. Material and methods: This study was done on 176 chronic HBV patients who underwent liver biopsy. Grading and staging of liver fibrosis was done according to the METAVIR scoring system. FIB-5 and FIB-4 scores were calculated for all patients. Results: As regards FIB-4 for differentiation between non-significant fibrosis (group I) and significant fibrosis (group II), at a cutoff level of 1.28 with positive predictive value (PPV) 41.4% and specificity 48% while at a cutoff level of 7.08 with PPV 98.8% and specificity 98% for FIB-5. Conclusions: As regards both scores, the FIB-5 score was more specific than FIB-4 for diagnosing significant from nonsignificant hepatic fibrosis in patients with chronic HBV infection.

Journal of Zoonotic Diseases and Public Health, 2020

The Medical Journal of Cairo University, 2019

Background: Iron Deficiency is a major health problem in Egypt, especially among children. Severa... more Background: Iron Deficiency is a major health problem in Egypt, especially among children. Several approaches have been used to alleviate such a problem, one of which is dietbased programs. Ascorbic acid has been shown to be an enhancer of iron bioavailability and is readily available in Egypt. Omega-3 is polyunsaturated essential fatty acid which can't be constructed by the body and must be obtained through diet and is important for human health. Omega-3 fatty acids sources include salmon, sardine, tuna, mullet and olive and canola oils. Omega-3 fatty acids have anti-inflammatory properties and are helpful in treatment of many diseases. Aim of Study: The present study was designed to determine if nutritional status could be improved by using a simple school food-based approach of an enhancer (orange and fish) to iron absorption and omega 3 fatty acid supplements. Subjects and Methods: The first phase of the study started in January 2016, and the second phase in November 2016, and the oranges and fish (tuna sandwich) were served within the school lunch program to a group of school children. The period of intervention was 2 months in the 1 st phase, and 4 months in the 2nd phase, to assess the effect of longer periods of intervention. The oranges and fish (tuna sandwich) were provided 6 days a week for both phases duration. A school meal (biscuits fortified with iron) was also provided to those receiving the oranges and tuna sandwich and to the control group who did not receive either orange or fish (tuna sandwich). The children were tested for their hemoglobin, serum ferritin and omega 3 index levels at the beginning and at end of the designated intervention period. Stool analysis for presence of parasites was also performed. Results: During the first phase, there was slight improvement of the mean levels of hemoglobin, ferritin and omega 3 index due to the short duration of orange and tuna sandwich intake. The mean hemoglobin increased from 12.1g/dL to 12.33g/dL, the mean ferritin increased from 26.2ng/ml to 27.6ng/ml while the omega 3 index increased from 1.8% to 2.2%. One hundred and fifty of the intervention children were below 12g/dL (25%). At the post-test, mean hemoglobin for

Gastrointestinal Tumors, 2018

Background and Aims: Matrix metalloproteinase-12 (MMP-12) is involved in tumor invasiveness and m... more Background and Aims: Matrix metalloproteinase-12 (MMP-12) is involved in tumor invasiveness and metastasis and significantly overexpressed in hepatocellular carcinoma (HCC) tissues. We aimed to investigate the diagnostic and prognostic value of blood mRNA MMP-12 overexpression in patients with HCC. Patients and Methods: From January 2017 to June 2017, 100 patients with HCC (HCV-related cirrhosis) and 100 patients with HCV-related cirrhosis (without HCC) were included in this study. All patients were subjected to triphasic CT abdomen when indicated, liver profile, alpha-fetoprotein (AFP), and molecular characterization of metalloproteinase-12 expression. Results: There were no statistically significant differences between both groups regarding CBC parameters and liver profile (p value > 0.05). There was a statistically significant difference between patients with and without HCC regarding blood mRNA MMP-12 overexpression (p value < 0.01), blood mRNA MMP-12, and/or AFP (sensitiv...

Al-Azhar Journal of Pediatrics, 2013

Middle East journal of anaesthesiology, 2015

Fluid overload in infants can result from inappropriate volume expansion (VE). The aim of this wo... more Fluid overload in infants can result from inappropriate volume expansion (VE). The aim of this work was to evaluate the beneficial values of Transoesophageal Doppler TED in intraoperative fluid guidance versus standard clinical monitoring parameters in infants undergoing Kasai operation. Forty infants scheduled for Kasai procedure were randomly allocated into two groups (Doppler and clinical group). In Doppler group decided to provide VE (10-30 m1/kg of Hydroxyethyl starches HES) when the index stroke volume decreased by ≥ 15% from the baseline value, in clinical group, hemodynamic variables triggering colloid administration mean arterial blood pressure (MAP) less than 20% below baseline or central venous pressure (CVP) < 5 cmH2O in both groups: Ringer's acetate was infused at constant rate (6 m 1/kg/h). Standard and TED-derived data were recorded before and after VE. Follow up the postoperative outcome and hospital stay. There were significantly lower mean volume of HES (42....

Egyptian Journal of Anaesthesia, 2012

Egyptian Liver Journal, 2013

Aim The aim of this study was to evaluate the role of the protein induced by the absence of vitam... more Aim The aim of this study was to evaluate the role of the protein induced by the absence of vitamin K or antagonist II (PIVKA-II) and the lens culinaris fraction of &agr;-fetoprotein (AFP-L3%) in the diagnosis of patients with hepatocellular carcinoma having normal and abnormal AFP levels. Patients and methods This study was carried out on 441 individuals attending the National Liver Institute Hospital. Venous blood samples (10 ml) were drawn from all included patients and tested for liver function, viral markers (HBsAg, HCV Abs), antibilharzial antibodies, AFP, AFP-L3%, and PIVKA-II. Results Accuracy of AFP increased from 60.2 to 87.7% when levels of AFP-L3% and PIVKA-II were taken into consideration in the diagnosis of hepatocellular carcinoma (HCC) in patients with AFP levels less than 400 ng/dl, whereas it decreased from 100.0 to 82.5% when these levels were considered in the diagnosis of patients with AFP levels of 400 ng/dl or higher. Conclusion From the above findings, we conclude that in the HCC group with abnormal AFP levels (≥400 ng/ml), the serum AFP level remains the most useful tumor marker in diagnosis. The mean values of AFP-L3% appear to be more specific than mean AFP values in the diagnosis of HCC group with normal AFP levels (<400 ng/ml) as it is less often elevated in patients having cirrhosis without HCC, which does not hold true for AFP or PIVKA-II, and this implies that AFP-L3% is closely associated with the presence of HCC.

International Journal of Infectious Diseases, 2011

For explore the mechanisms of exercise-induced airway inflammation. Methods: Twenty 8 old male SD... more For explore the mechanisms of exercise-induced airway inflammation. Methods: Twenty 8 old male SD rats were randomly divided into 2 groups: control group (CG, n = 10), experimental group (EG, n = 10). The EG rats underwent a period (120 min/day for 7 day) of exercise on a high speed treadmill (25 m/min). The mRNA expressions of TNF-a, IL-4 and IFN-g in lung tissue were detected by RT-PCR. Results: The mRNA expressions of TNF-a and IL-4 in the lung tissues of EG were 31.4±7.5%, 53.7±8.2% respectively. There was a significant increase in expression of TNF-a and IL-4 in the lung tissues in EG compared with CG, the CG were 12.3±3.6% and 21.4±5.7% (P < 0.01). The mRNA expression of IFN-g in lung tissue was 14.3±5.1%, it is much lower than that in EG compare with CG, CG was 26.5±7.2% (P < 0.05). Conclusion: Strenuous exercise can inhabit the expression of IFN-g and increases the expressions of TNF-a and IL-4 in lung tissue of rats. The changes of inflammation-related cytokines may play a key role in the formation of exerciseinduced airway inflammation.

Anesthesiology, 2005

Background Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotens... more Background Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotension in patients under long-term renin-angiotensin system inhibitor treatment for arterial hypertension. The authors compared the effects of terlipressin and norepinephrine on systemic hemodynamic parameters and gastric mucosal perfusion using a laser Doppler flowmetry technique in patients treated with renin-angiotensin system inhibitors who experienced hypotension at induction of anesthesia. Methods Thirty-two patients scheduled for carotid endarterectomy under general anesthesia and treated with renin-angiotensin system inhibitors had hypotension after induction of general anesthesia. They were randomized to receive 1 mg of terlipressin (n = 16) or norepinephrine infusion (n = 16) to counteract anesthesia-induced hypotension. A laser Doppler probe was introduced into the gastric lumen. All measurements were performed just before surgery, during hypotension, at 30 min, and at 4 h. Resul...

The Egyptian Journal of Biochemistry and Molecular Biology, 2014

Background and objective : Interleukin (IL) 28B single nucleotide polymorphisms (SNP) was recentl... more Background and objective : Interleukin (IL) 28B single nucleotide polymorphisms (SNP) was recently recognized as predictor of SVR in HCV infected patients treated by combination therapy of pegylatedinterferon (Peg-IFN) and ribavirin (RBV). The aim of the current study was to assess IL 28B polymorphism SNP (rs12979860) as a predictor of response to combined Peg-INF/RBV therapy in Egyptian chronic HCV infected patients. Design and methods : The study was conducted on 247 HCV infected patients and 100 apparently healthy control subjects. All patients were treated with PEG-IFN-α/ribavirin; and they were classified according to their response to treatment. Genotyping of IL28B rs12979860 was performed on peripheral blood DNA using polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP) assay. Results: The overall frequency of IL28B genotypes was 24.7%, 50.2% and 25.1% for genotypes CC, CT and TT respectively, while the response rate was 82%, 38.7% and 43.8% for genoty...

The Medical Journal of Cairo University, 2020

Background: Egypt has the highest known prevalence of HCV in the world, a problem which represent... more Background: Egypt has the highest known prevalence of HCV in the world, a problem which represents a major challenge to healthcare policymakers in the country. Aim of Study: This study aimed to highlight on the prevalence of HCV infection in rural areas of this country and to clarify the association between different risk factors and the prevalence of HCV infection. Material and Methods: A screening campaign was conducted in five villages present in rural Menoufia Governorate. Blood samples from consented participants were tested for HCV antibodies. For assessment of the contribution of different risk factors with hepatitis C infection, we interviewed participants to complete the study questionnaire. Results were tabulated and analyzed by suitable statistical tests to assess the prevalence of HCV infection in these areas and possible risk factors that are significantly associated with infection. Results: Out of 14000 participants, 14.8% (n=2071) of the screened sample tested positive for HCV antibodies. Various risk factors were significantly associated with higher risk for acquiring HCV including parenteral antischistosomaiasis therapy, invasive medical procedures and other important risk factors. Conclusion: One of each six in the population of rural Menoufia is seropositive for HCV. Our results thus confirm the severity of the current disease burden in the Nile Delta of Egypt. There are significant risk factors associated with HCV infection, suggesting the need for more strict infection control measures specially upon using invasive medical procedures.

Egyptian Liver Journal, 2015

Background/aim Liver biopsy, traditionally considered to be the reference standard for staging fi... more Background/aim Liver biopsy, traditionally considered to be the reference standard for staging fibrosis, has been challenged over the past decade by the development of noninvasive methodologies. Noninvasive methods, initially studied and validated in patients with chronic hepatitis C, are now used increasingly for patients with hepatitis B. However, the usefulness of these markers in the prediction of liver fibrosis in HBeAg negative patients with normal enzymes still needs to be validated. Patients and methods Patients with chronic hepatitis B attending the National Liver Institute Biopsy Unit from September 2010 to September 2013 were included in the present study. For patients with persistently normal alanine aminotransferase greater than 40 (69 patients), the following indirect biochemical indices were measured and compared with the biopsy result: aspartate aminotransferase to alanine aminotransferase ratio (AAR), fibrosis index based on the four factors, aspartate aminotransferase to platelet ratio index, AAR to platelet ratio index, fibroindex, and age–platelet index (API). Results A total of 50 patients suffered from nonsignificant fibrosis (METAVIR F0–F1) and 19 patients suffered from significant fibrosis. &ggr;-Globulin (P=0.001) and &ggr;-glutamyl transferase (P=0.007) were independent predictors of fibrosis. Analysis with receiver operating curve showed that none of the predictors had a powerful diagnostic value. API had the best sensitivity and specificity (sensitivity: 83%; specificity: 58%) for predicting liver fibrosis, followed by fibroindex (sensitivity: 75%; specificity: 54%). Aspartate aminotransferase to platelet ratio index showed a low precision in identifying significant fibrosis, with an area under the curve of 0.6. Conclusion None of the tested noninvasive indices could distinguish the significant liver fibrosis effectively. We suggest the use of platelets, &ggr;-glutamyl transferase and &ggr;-globulins, API, and fibroindex for monitoring disease severity and predicting prognosis. In suspicious cases, a more validated modality such as FibroScan can be performed.

Journal of Liver, Sep 7, 2017

Ain Shams Journal of Surgery, 2012

The Medical Journal of Cairo University, 2018

Background: Prisons are considered facilities liable of high risk of infectious disease. Investig... more Background: Prisons are considered facilities liable of high risk of infectious disease. Investigations carried out in prisons around the world have shown a high prevalence of blood borne hepatitis viruses. As there are few studies aboutblood borne hepatitis viruses knowledge among prisoners and security personnel. Those carried with other populations, point out that the lack of knowledge about the illness is one of the main barriers to the perception of the symptoms, early diagnosis, treatment adherence and cure. Aim of Study: To estimate the level of knowledge, attitudes and practice related to HBV and HCV infections before and after an educational intervention among security personnel and prisoners. Patients and Methods: Self-administered questionnaire was used to assess KAP of HBV and HCV infection of 324 prisoners and 68 security personals pre and post educational intervention. SPSS (Version 20) was used for analysis of data. Results: The mass media were the major source of information (44.5%). Regarding knowledge and attitude about HBV and HCV infection, highly significant improvement (p <0.001) was revealedamong both security personnel and prisoners. Regarding practice, there was no improvement in post-intervention practice of prisoner (p>0.05); however there was improvement in the practice of security personnel (p <0.001). Knowledge and attitude scores of security personnel were evident irrespective of socio-demographic characteristics and history of hepatitis infections. Security personnel who were of urban residence had significantlybetter pre-intervention practice (p=0.006). Overall KAP scores among prisonerswere evident irrespective of socio-demographic characteristics. HBV & HCV infected prisoners (p<0.001) were significantly more knowledgeable about these viruses before educational intervention. Conclusions: We are reporting inadequate level of HBV and HCV awareness among the studied groups. The study confirms the necessity of continuous periodic health education programs as well as immunization programs, infectious disease

Menoufia Medical Journal, 2021

Objectives To estimate the incidence rate of fungal infections after hepatobiliary surgery and id... more Objectives To estimate the incidence rate of fungal infections after hepatobiliary surgery and identification of the risk factors. Background Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients, especially in the ICU, the incidence of invasive candidiasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Participants and methods A prospective cohort hospital-based study was carried out at the National Liver Institute, Menoufia University. The studied group was 210 patients, all of them were examined thoroughly, their data were registered and sampled two times, one at the day of admission to be sure that they are free of fungal infection and the second was after hepatobiliary surgery. A predesigned questionnaire was used, which includes data about personal history, medical history, and suggested risk factors for fungal infections. Results In the present study,...

Egyptian Journal of Anaesthesia, 2012

Back ground: Some of tense ascitic patients with end stage liver disease and portal hypertension ... more Back ground: Some of tense ascitic patients with end stage liver disease and portal hypertension were presented to our emergency department with surgical acute abdomen that required urgent abdominal surgery which might be associated with inevitable rapid and relatively complete evacuation of this ascitic fluid with possible occurrence of post-paracentesis-induced hypotension. The aims of this study were to compare between the intraoperative use of terlipressin versus norepinephrine for the management of paracentesis induced refractory hypotension not responding to colloid resuscitation or ephedrine in patients with end-stage liver disease during emergency abdominal surgery. Patients and method: Thirty-four patients experienced refractory hypotension during or shortly after the paracentesis process were randomized to receive either bolus dose of terlipressin (1 mg over 30 min) followed immediately by a continuous infusion of 2 lg/kg/h (T group, n = 17) or norepinephrine infusion at starting dose of 0.1 lg/kg/min (N group, n = 17).

Annals of Oncology, 2012

Introduction: Distant metastatic breast cancer is considered to be an incurable disease and there... more Introduction: Distant metastatic breast cancer is considered to be an incurable disease and therefore is only treated with palliative intent. Local treatment is recommended only if the primary tumor is symptomatic. However, recent studies challenge this approach, suggesting that removing the primary tumor may lead to an overall improved survival. We retrospectively reviewed patients who underwent surgical removal of the primary tumor while they were metastatic as regards survival and clinico-pathological data. Patients and methods: In a retrospective review of our database, we collected data of 80 patients who were presented at Menofia oncology department with metastatic breast cancer (MBC) excluding patients above 70 years old and patients with performance status > 2. Patient characteristics and survival were reviewed between the surgical group and non-surgical group. Results: Of the 80 patients with MBC, 40 (50%) underwent surgery either modified radical mastectomy (MRM) or conservative surgery, other 40 (50%) started treatment without surgery. Mean age at diagnosis was 47.33, 44.20 in both groups respectively. Surgery was associated with significantly improved median overall survival (∼ 20 months) versus no surgery (∼ 6.5 months) (P =< 0.05). Conclusion: In our experience here at Menofia oncology department we concluded that surgery of the primary tumor in patients presented with MBC is associated with improved survival. A double blind randomized study is already started at our department to assess these results.

Research in Oncology, 2014

Breast cancer is the most common cancer in women in the world 1. Despite improvement in treatment... more Breast cancer is the most common cancer in women in the world 1. Despite improvement in treatment, 20%-30% of patients with early breast cancer will experience metastatic disease 2. Meanwhile, 6%-10% of patients were to be ill with metastatic disease at the initial diagnosis of breast cancer 3. Hepatic metastases are the one of the most frequent distant metastases of breast cancer 1. Survival rate for patients with hepatic metastases is poor, with a median survival time about 14 months 4. Breast cancer has different molecular subtypes which may be defined by gene expression profiles 5 or immunohistochemical biomarkers 6. It is reported that human epidermal growth factor receptor 2 (HER2)-enriched subtype breast cancers aggressively spread to the liver 7. Endocrine therapy is indicated for estrogen receptor (ER) and/or progesterone receptor (PgR) positive patients with long disease free survival, non life threatening metastatic sites (such disease should be non visceral or asymptomatic visceral disease), and good performance status. Major treatments for hepatic metastases from breast cancers include chemotherapy, surgery, and intervention therapy 8. The aim of this study is to analyze the clinical characteristics and survival of patients with different molecular breast cancer subtypes who developed HM, and to investigate the prognostic and predictive factors that affect clinical outcome.

Clinical & Experimental Hepatology, 2020

Aim of the study: Chronic hepatitis B virus (HBV) infection is one of the major health problems w... more Aim of the study: Chronic hepatitis B virus (HBV) infection is one of the major health problems worldwide. Use of non-invasive tests for assessment of hepatic fibrosis such as the FIB-4 index could be used to avoid liver biopsy. Another promising noninvasive test, FIB-5, could also be used to detect significant hepatic fibrosis. The aim of the study was to compare the use of FIB-5 and FIB-4 as noninvasive markers to assess chronic HBV-related hepatic fibrosis. Material and methods: This study was done on 176 chronic HBV patients who underwent liver biopsy. Grading and staging of liver fibrosis was done according to the METAVIR scoring system. FIB-5 and FIB-4 scores were calculated for all patients. Results: As regards FIB-4 for differentiation between non-significant fibrosis (group I) and significant fibrosis (group II), at a cutoff level of 1.28 with positive predictive value (PPV) 41.4% and specificity 48% while at a cutoff level of 7.08 with PPV 98.8% and specificity 98% for FIB-5. Conclusions: As regards both scores, the FIB-5 score was more specific than FIB-4 for diagnosing significant from nonsignificant hepatic fibrosis in patients with chronic HBV infection.

Journal of Zoonotic Diseases and Public Health, 2020

The Medical Journal of Cairo University, 2019

Background: Iron Deficiency is a major health problem in Egypt, especially among children. Severa... more Background: Iron Deficiency is a major health problem in Egypt, especially among children. Several approaches have been used to alleviate such a problem, one of which is dietbased programs. Ascorbic acid has been shown to be an enhancer of iron bioavailability and is readily available in Egypt. Omega-3 is polyunsaturated essential fatty acid which can't be constructed by the body and must be obtained through diet and is important for human health. Omega-3 fatty acids sources include salmon, sardine, tuna, mullet and olive and canola oils. Omega-3 fatty acids have anti-inflammatory properties and are helpful in treatment of many diseases. Aim of Study: The present study was designed to determine if nutritional status could be improved by using a simple school food-based approach of an enhancer (orange and fish) to iron absorption and omega 3 fatty acid supplements. Subjects and Methods: The first phase of the study started in January 2016, and the second phase in November 2016, and the oranges and fish (tuna sandwich) were served within the school lunch program to a group of school children. The period of intervention was 2 months in the 1 st phase, and 4 months in the 2nd phase, to assess the effect of longer periods of intervention. The oranges and fish (tuna sandwich) were provided 6 days a week for both phases duration. A school meal (biscuits fortified with iron) was also provided to those receiving the oranges and tuna sandwich and to the control group who did not receive either orange or fish (tuna sandwich). The children were tested for their hemoglobin, serum ferritin and omega 3 index levels at the beginning and at end of the designated intervention period. Stool analysis for presence of parasites was also performed. Results: During the first phase, there was slight improvement of the mean levels of hemoglobin, ferritin and omega 3 index due to the short duration of orange and tuna sandwich intake. The mean hemoglobin increased from 12.1g/dL to 12.33g/dL, the mean ferritin increased from 26.2ng/ml to 27.6ng/ml while the omega 3 index increased from 1.8% to 2.2%. One hundred and fifty of the intervention children were below 12g/dL (25%). At the post-test, mean hemoglobin for

Gastrointestinal Tumors, 2018

Background and Aims: Matrix metalloproteinase-12 (MMP-12) is involved in tumor invasiveness and m... more Background and Aims: Matrix metalloproteinase-12 (MMP-12) is involved in tumor invasiveness and metastasis and significantly overexpressed in hepatocellular carcinoma (HCC) tissues. We aimed to investigate the diagnostic and prognostic value of blood mRNA MMP-12 overexpression in patients with HCC. Patients and Methods: From January 2017 to June 2017, 100 patients with HCC (HCV-related cirrhosis) and 100 patients with HCV-related cirrhosis (without HCC) were included in this study. All patients were subjected to triphasic CT abdomen when indicated, liver profile, alpha-fetoprotein (AFP), and molecular characterization of metalloproteinase-12 expression. Results: There were no statistically significant differences between both groups regarding CBC parameters and liver profile (p value > 0.05). There was a statistically significant difference between patients with and without HCC regarding blood mRNA MMP-12 overexpression (p value < 0.01), blood mRNA MMP-12, and/or AFP (sensitiv...

Al-Azhar Journal of Pediatrics, 2013

Middle East journal of anaesthesiology, 2015

Fluid overload in infants can result from inappropriate volume expansion (VE). The aim of this wo... more Fluid overload in infants can result from inappropriate volume expansion (VE). The aim of this work was to evaluate the beneficial values of Transoesophageal Doppler TED in intraoperative fluid guidance versus standard clinical monitoring parameters in infants undergoing Kasai operation. Forty infants scheduled for Kasai procedure were randomly allocated into two groups (Doppler and clinical group). In Doppler group decided to provide VE (10-30 m1/kg of Hydroxyethyl starches HES) when the index stroke volume decreased by ≥ 15% from the baseline value, in clinical group, hemodynamic variables triggering colloid administration mean arterial blood pressure (MAP) less than 20% below baseline or central venous pressure (CVP) < 5 cmH2O in both groups: Ringer's acetate was infused at constant rate (6 m 1/kg/h). Standard and TED-derived data were recorded before and after VE. Follow up the postoperative outcome and hospital stay. There were significantly lower mean volume of HES (42....

Egyptian Journal of Anaesthesia, 2012

Egyptian Liver Journal, 2013

Aim The aim of this study was to evaluate the role of the protein induced by the absence of vitam... more Aim The aim of this study was to evaluate the role of the protein induced by the absence of vitamin K or antagonist II (PIVKA-II) and the lens culinaris fraction of &agr;-fetoprotein (AFP-L3%) in the diagnosis of patients with hepatocellular carcinoma having normal and abnormal AFP levels. Patients and methods This study was carried out on 441 individuals attending the National Liver Institute Hospital. Venous blood samples (10 ml) were drawn from all included patients and tested for liver function, viral markers (HBsAg, HCV Abs), antibilharzial antibodies, AFP, AFP-L3%, and PIVKA-II. Results Accuracy of AFP increased from 60.2 to 87.7% when levels of AFP-L3% and PIVKA-II were taken into consideration in the diagnosis of hepatocellular carcinoma (HCC) in patients with AFP levels less than 400 ng/dl, whereas it decreased from 100.0 to 82.5% when these levels were considered in the diagnosis of patients with AFP levels of 400 ng/dl or higher. Conclusion From the above findings, we conclude that in the HCC group with abnormal AFP levels (≥400 ng/ml), the serum AFP level remains the most useful tumor marker in diagnosis. The mean values of AFP-L3% appear to be more specific than mean AFP values in the diagnosis of HCC group with normal AFP levels (<400 ng/ml) as it is less often elevated in patients having cirrhosis without HCC, which does not hold true for AFP or PIVKA-II, and this implies that AFP-L3% is closely associated with the presence of HCC.

International Journal of Infectious Diseases, 2011

For explore the mechanisms of exercise-induced airway inflammation. Methods: Twenty 8 old male SD... more For explore the mechanisms of exercise-induced airway inflammation. Methods: Twenty 8 old male SD rats were randomly divided into 2 groups: control group (CG, n = 10), experimental group (EG, n = 10). The EG rats underwent a period (120 min/day for 7 day) of exercise on a high speed treadmill (25 m/min). The mRNA expressions of TNF-a, IL-4 and IFN-g in lung tissue were detected by RT-PCR. Results: The mRNA expressions of TNF-a and IL-4 in the lung tissues of EG were 31.4±7.5%, 53.7±8.2% respectively. There was a significant increase in expression of TNF-a and IL-4 in the lung tissues in EG compared with CG, the CG were 12.3±3.6% and 21.4±5.7% (P < 0.01). The mRNA expression of IFN-g in lung tissue was 14.3±5.1%, it is much lower than that in EG compare with CG, CG was 26.5±7.2% (P < 0.05). Conclusion: Strenuous exercise can inhabit the expression of IFN-g and increases the expressions of TNF-a and IL-4 in lung tissue of rats. The changes of inflammation-related cytokines may play a key role in the formation of exerciseinduced airway inflammation.

Anesthesiology, 2005

Background Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotens... more Background Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotension in patients under long-term renin-angiotensin system inhibitor treatment for arterial hypertension. The authors compared the effects of terlipressin and norepinephrine on systemic hemodynamic parameters and gastric mucosal perfusion using a laser Doppler flowmetry technique in patients treated with renin-angiotensin system inhibitors who experienced hypotension at induction of anesthesia. Methods Thirty-two patients scheduled for carotid endarterectomy under general anesthesia and treated with renin-angiotensin system inhibitors had hypotension after induction of general anesthesia. They were randomized to receive 1 mg of terlipressin (n = 16) or norepinephrine infusion (n = 16) to counteract anesthesia-induced hypotension. A laser Doppler probe was introduced into the gastric lumen. All measurements were performed just before surgery, during hypotension, at 30 min, and at 4 h. Resul...

The Egyptian Journal of Biochemistry and Molecular Biology, 2014

Background and objective : Interleukin (IL) 28B single nucleotide polymorphisms (SNP) was recentl... more Background and objective : Interleukin (IL) 28B single nucleotide polymorphisms (SNP) was recently recognized as predictor of SVR in HCV infected patients treated by combination therapy of pegylatedinterferon (Peg-IFN) and ribavirin (RBV). The aim of the current study was to assess IL 28B polymorphism SNP (rs12979860) as a predictor of response to combined Peg-INF/RBV therapy in Egyptian chronic HCV infected patients. Design and methods : The study was conducted on 247 HCV infected patients and 100 apparently healthy control subjects. All patients were treated with PEG-IFN-α/ribavirin; and they were classified according to their response to treatment. Genotyping of IL28B rs12979860 was performed on peripheral blood DNA using polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP) assay. Results: The overall frequency of IL28B genotypes was 24.7%, 50.2% and 25.1% for genotypes CC, CT and TT respectively, while the response rate was 82%, 38.7% and 43.8% for genoty...

The Medical Journal of Cairo University, 2020

Background: Egypt has the highest known prevalence of HCV in the world, a problem which represent... more Background: Egypt has the highest known prevalence of HCV in the world, a problem which represents a major challenge to healthcare policymakers in the country. Aim of Study: This study aimed to highlight on the prevalence of HCV infection in rural areas of this country and to clarify the association between different risk factors and the prevalence of HCV infection. Material and Methods: A screening campaign was conducted in five villages present in rural Menoufia Governorate. Blood samples from consented participants were tested for HCV antibodies. For assessment of the contribution of different risk factors with hepatitis C infection, we interviewed participants to complete the study questionnaire. Results were tabulated and analyzed by suitable statistical tests to assess the prevalence of HCV infection in these areas and possible risk factors that are significantly associated with infection. Results: Out of 14000 participants, 14.8% (n=2071) of the screened sample tested positive for HCV antibodies. Various risk factors were significantly associated with higher risk for acquiring HCV including parenteral antischistosomaiasis therapy, invasive medical procedures and other important risk factors. Conclusion: One of each six in the population of rural Menoufia is seropositive for HCV. Our results thus confirm the severity of the current disease burden in the Nile Delta of Egypt. There are significant risk factors associated with HCV infection, suggesting the need for more strict infection control measures specially upon using invasive medical procedures.

Egyptian Liver Journal, 2015

Background/aim Liver biopsy, traditionally considered to be the reference standard for staging fi... more Background/aim Liver biopsy, traditionally considered to be the reference standard for staging fibrosis, has been challenged over the past decade by the development of noninvasive methodologies. Noninvasive methods, initially studied and validated in patients with chronic hepatitis C, are now used increasingly for patients with hepatitis B. However, the usefulness of these markers in the prediction of liver fibrosis in HBeAg negative patients with normal enzymes still needs to be validated. Patients and methods Patients with chronic hepatitis B attending the National Liver Institute Biopsy Unit from September 2010 to September 2013 were included in the present study. For patients with persistently normal alanine aminotransferase greater than 40 (69 patients), the following indirect biochemical indices were measured and compared with the biopsy result: aspartate aminotransferase to alanine aminotransferase ratio (AAR), fibrosis index based on the four factors, aspartate aminotransferase to platelet ratio index, AAR to platelet ratio index, fibroindex, and age–platelet index (API). Results A total of 50 patients suffered from nonsignificant fibrosis (METAVIR F0–F1) and 19 patients suffered from significant fibrosis. &ggr;-Globulin (P=0.001) and &ggr;-glutamyl transferase (P=0.007) were independent predictors of fibrosis. Analysis with receiver operating curve showed that none of the predictors had a powerful diagnostic value. API had the best sensitivity and specificity (sensitivity: 83%; specificity: 58%) for predicting liver fibrosis, followed by fibroindex (sensitivity: 75%; specificity: 54%). Aspartate aminotransferase to platelet ratio index showed a low precision in identifying significant fibrosis, with an area under the curve of 0.6. Conclusion None of the tested noninvasive indices could distinguish the significant liver fibrosis effectively. We suggest the use of platelets, &ggr;-glutamyl transferase and &ggr;-globulins, API, and fibroindex for monitoring disease severity and predicting prognosis. In suspicious cases, a more validated modality such as FibroScan can be performed.

Journal of Liver, Sep 7, 2017

Ain Shams Journal of Surgery, 2012

The Medical Journal of Cairo University, 2018

Background: Prisons are considered facilities liable of high risk of infectious disease. Investig... more Background: Prisons are considered facilities liable of high risk of infectious disease. Investigations carried out in prisons around the world have shown a high prevalence of blood borne hepatitis viruses. As there are few studies aboutblood borne hepatitis viruses knowledge among prisoners and security personnel. Those carried with other populations, point out that the lack of knowledge about the illness is one of the main barriers to the perception of the symptoms, early diagnosis, treatment adherence and cure. Aim of Study: To estimate the level of knowledge, attitudes and practice related to HBV and HCV infections before and after an educational intervention among security personnel and prisoners. Patients and Methods: Self-administered questionnaire was used to assess KAP of HBV and HCV infection of 324 prisoners and 68 security personals pre and post educational intervention. SPSS (Version 20) was used for analysis of data. Results: The mass media were the major source of information (44.5%). Regarding knowledge and attitude about HBV and HCV infection, highly significant improvement (p <0.001) was revealedamong both security personnel and prisoners. Regarding practice, there was no improvement in post-intervention practice of prisoner (p>0.05); however there was improvement in the practice of security personnel (p <0.001). Knowledge and attitude scores of security personnel were evident irrespective of socio-demographic characteristics and history of hepatitis infections. Security personnel who were of urban residence had significantlybetter pre-intervention practice (p=0.006). Overall KAP scores among prisonerswere evident irrespective of socio-demographic characteristics. HBV & HCV infected prisoners (p<0.001) were significantly more knowledgeable about these viruses before educational intervention. Conclusions: We are reporting inadequate level of HBV and HCV awareness among the studied groups. The study confirms the necessity of continuous periodic health education programs as well as immunization programs, infectious disease

Menoufia Medical Journal, 2021

Objectives To estimate the incidence rate of fungal infections after hepatobiliary surgery and id... more Objectives To estimate the incidence rate of fungal infections after hepatobiliary surgery and identification of the risk factors. Background Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients, especially in the ICU, the incidence of invasive candidiasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Participants and methods A prospective cohort hospital-based study was carried out at the National Liver Institute, Menoufia University. The studied group was 210 patients, all of them were examined thoroughly, their data were registered and sampled two times, one at the day of admission to be sure that they are free of fungal infection and the second was after hepatobiliary surgery. A predesigned questionnaire was used, which includes data about personal history, medical history, and suggested risk factors for fungal infections. Results In the present study,...