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Papers by hosam Dawod

Research paper thumbnail of The Frequency of Meningitis Cases in Zagazig Fever Hospital: A Cross-sectional Study

Afro-Egyptian Journal of Infectious and Endemic Diseases, 2019

Background and study aim: Meningitis is the inflammation of meninges and can be life-threatening ... more Background and study aim: Meningitis is the inflammation of meninges and can be life-threatening in some cases. The study aimed to determine the frequency and clinical presentations of the meningitis cases in ZagazigFeverHospital to put recommendations to assist in improving the preventive and management measure-ments for meningitis. Patients and Methods: A cross-section study included all of 70 meningitis patients in ZagazigFeverHospital, who fulfilled the selection criteria, over a period of one year from September 2016 to September 2017. The data collection sheet included demographic, clinical assessments, diagnostic lumbar puncture with CSF analysis. Results: The majority of meningitis cases were males (57.1%), from urban areas (67.1%), aged less than ten years or more than forty years, and diagnosed in winter (42.9%), especially in February. According to the CSF culture results, patients were classified into two groups; 87.1% as aseptic meningitis (group A) and 12.8% as bacte...

Research paper thumbnail of Evaluation of some pulmonary functions and pleuropulmonary complications after endoscopic sclerotherapy of gastric fundal varices at Zagazig university hospitals

Egyptian Journal of Chest Diseases and Tuberculosis, 2016

Background Incidence of gastric fundal varices is about 16–70% of patients with portal hypertensi... more Background Incidence of gastric fundal varices is about 16–70% of patients with portal hypertension. It causes upper gastrointestinal bleeding in about 10–15% of cases. There are different methods used for the management of gastric varices. Endoscopic injection of N-Butyl-Cyanoacrylate (NBCA) is considered to be the choice for control of active bleeding from gastric varices. Pulmonary complications of sclerotherapy are common and varying from minor complications to severe complications as pleural effusion, lung collapse, consolidation, adult respiratory distress syndrome and pulmonary embolism. Aim To evaluate pulmonary functions after endoscopic sclerotherapy of gastric fundal varices by N-Butyl-Cyanoacrylate and the effect of incentive spirometry (IS) on post sclerotherapy pulmonary functions. Methods Sixty patients with liver cirrhosis and portal hypertension were included in the study. All patients were subjected to full history and careful clinical examination, upper GI endosco...

Research paper thumbnail of 156 Dickkopf-1 : As a Diagnostic and Prognostic Serum Marker for Hepatocellular Carcinoma

Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70-80% of all liver cancers... more Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70-80% of all liver cancers and the 5-year survival is only 3-5%. This bad prognosis is due to the lack of an effective method for early diagnosis. So, only 30-40% of patients with HCC are suitable for curative treatments at the time of diagnosis. Thus, there is a great need for tools to diagnose HCC early especially in cirrhotic patients. The aim of this work is to assess the validity of serum DKK1 as a diagnostic marker for HCC and to assess prognostic value of serum DKK1 in predicting treatment response, complication and survival in HCC patients. Patients and Methods: This study included 60 Patients divided into two groups. Group A: consisted of 30 patients with post hepatitic C and/or B liver cirrhosis. Group B: consisted of 30 patients with HCC on top of post hepatitic C and/or B liver cirrhosis. Group B patients underwent either radiofrequency ablation or ethanol injection. Clinical assessment, routine laboratory evaluation, CT studies and measurement of serum alpha-fetoprotein (AFP) and DKK1 were performed to all patients and repeated to group B patients 1 and 3 months after treatment. Results: The optimum cut off value of DKK1 for diagnosis of HCC was 4.3 ng/mL (AUC 0.89, sensitivity 66.7% and specificity 96.6%) (P<0.001). While, the optimum cut off value for AFP was > 101 ng/mL with 90% sensitivity and 75.9% specificity (p<0.001). Testing of both DKK1 and AFP increased the diagnostic accuracy for HCC (AUC 0.901, sensitivity 93.3%, and specificity 75.9) (P<0.001). Serum DKK1 level significantly decreases after HCC treatment with either radiofrequency ablation or ethanol injection (P<0.001). Conclusion: Testing of both DKK1 and AFP significantly increased the diagnostic accuracy for HCC. Meanwhile, DKK1 can be used alone for HCC diagnosis even in HCC with inconclusive AFP. DKK1 has a promising prognostic value and can be used for follow up of HCC patients who underwent loco-regional treatment.

Research paper thumbnail of The Assessment of Gastric Antral Wall Thickness in Helicobacter pylori gastritis by Abdominal Ultrasonography, Case-Control Study (2016-2018)

Background and Aim: Abdominal ultrasonography is effective in the visualization of gastric wall l... more Background and Aim: Abdominal ultrasonography is effective in the visualization of gastric wall layers and measuring its thickness. The study aimed to assess gastric antral wall thickness in patients with H. pylori gastritis by abdominal ultrasonography and to study its predictive value in detecting H. pylori gastritis. Materials and Methods: The study included ninety adult individuals, sixty of them had dyspepsia and/or upper abdominal pain and histologically confirmed gastritis, were distributed equally according to the H. pylori infection status into group A (H. pylori gastritis) or B (non-H. pylori gastritis), while, group C included thirty asymptomatic participants with negative H. pylori screening. The participants were subjected to abdominal sonography for measuring the antral wall thickness (AWT), mucosal wall thickness (MLT) and mucosal-to-antral wall thickness ratio (MLT/AWT ratio). Results: The AWT, MLT and MLT/AWT ratio were significantly greater in H. pylori gastritis ...

Research paper thumbnail of The Value of Combined Measuring of the Cerebrospinal Fluid Lactate and ‎Serum Procalcitonin in Diagnosis of Acute Bacterial Meningitis ‎

The Value of Combined Measuring of the Cerebrospinal Fluid Lactate and Serum Procalcitonin in Dia... more The Value of Combined Measuring of the Cerebrospinal Fluid Lactate and Serum Procalcitonin in Diagnosis of Acute Bacterial Meningitis Hosam M Dawod, Ahmed S Awadallah, Seham Mahrous, Ahmed Alwassief, Sameh M Abdel Monem Department of Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt. Medicine Department, Zagazig Fever Hospital, Egypt. Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt. Department of Internal Medicine, Al Azhar University forBoys, Cairo Campus, Egypt.

Research paper thumbnail of Dickkopf-1: As a Diagnostic and Prognostic Serum Marker for Hepatocellular Carcinoma

Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70-80% of all liver cancers... more Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70-80% of all liver cancers and the 5-year survival is only 3-5%. This bad prognosis is due to the lack of an effective method for early diagnosis. So, only 30-40% of patients with HCC are suitable for curative treatments at the time of diagnosis. Thus, there is a great need for tools to diagnose HCC early especially in cirrhotic patients. The aim of this work is to assess the validity of serum DKK1 as a diagnostic marker for HCC and to assess prognostic value of serum DKK1 in predicting treatment response, complication and survival in HCC patients. Patients and Methods: This study included 60 Patients divided into two groups. Group A: consisted of 30 patients with post hepatitic C and/or B liver cirrhosis. Group B: consisted of 30 patients with HCC on top of post hepatitic C and/or B liver cirrhosis. Group B patients underwent either radiofrequency ablation or ethanol injection. Clinical assessment, routine laboratory evaluation, CT studies and measurement of serum alpha-fetoprotein (AFP) and DKK1 were performed to all patients and repeated to group B patients 1 and 3 months after treatment. Results: The optimum cut off value of DKK1 for diagnosis of HCC was 4.3 ng/mL (AUC 0.89, sensitivity 66.7% and specificity 96.6%) (P<0.001). While, the optimum cut off value for AFP was > 101 ng/mL with 90% sensitivity and 75.9% specificity (p<0.001). Testing of both DKK1 and AFP increased the diagnostic accuracy for HCC (AUC 0.901, sensitivity 93.3%, and specificity 75.9) (P<0.001). Serum DKK1 level significantly decreases after HCC treatment with either radiofrequency ablation or ethanol injection (P<0.001). Conclusion: Testing of both DKK1 and AFP significantly increased the diagnostic accuracy for HCC. Meanwhile, DKK1 can be used alone for HCC diagnosis even in HCC with inconclusive AFP. DKK1 has a promising prognostic value and can be used for follow up of HCC patients who underwent loco-regional treatment.

Research paper thumbnail of Evaluation of Carvedilol in Prevention of First Attack of Variceal Hemorrhage in Patients with Liver Cirrhosis

Afro-Egyptian Journal of Infectious and Endemic Diseases

Background and study aim: Carvedilol has beneficial effects on splanchnic haemodynamics following... more Background and study aim: Carvedilol has beneficial effects on splanchnic haemodynamics following acute and chronic administration in cirrhosis. The aim of this study is to evaluate the role of carvedilol in prevention of first variceal bleeding in patients with liver cirrhosis and to compare its effect with that of variceal band ligation (VBL) and propranolol. Patients and methods: Seventy five patients with liver cirrhosis and endoscopically proven esophageal varices (grade II or larger in size with or without variceal red color signs), that have not bled yet were randomized to either VBL performed every 2 weeks until varices were eradicated (25 patients), carvedilol 12.5mg once daily (25 patients) or propranolol titrated to reduce resting pulse by >25% (25 patients) and followed up on the same schedule at 6 and 12 months. Results: Carvedilol had lowest rate of the first variceal bleeding when compared with VBL and propranolol (10%, 12% and 20% respectively). Carvedilol had significantly decreased the percentage of patients with varices grade III or IV over the follow up period (from 40% to 24%). Both carvedilol and propranolol significantly decreased severity of portal hypertensive gastropathy over follow up period. On the other hand, VBL significantly increased severity of portal hypertensive gastropathy. Conclusion: Carvedilol is effective in preventing the first variceal bleeding. Carvedilol is an option for primary prophylaxis in cirrhosis and esophageal varices grade ≥ II in single daily dose of 12.5 mg.

Research paper thumbnail of Circulating Resistin and Visfatin Levels in Patients with Inflammatory Bowel Disease as Predictors of Treatment Response

Afro-Egyptian Journal of Infectious and Endemic Diseases

Background and study aim: Ulcerative colitis (UC) and Crohn's disease (CD) are the common forms o... more Background and study aim: Ulcerative colitis (UC) and Crohn's disease (CD) are the common forms of inflammatory bowel disease (IBD). The etiology and pathogenesis are not fully understood yet. Many studies have been focused on adipokines in the pathogenesis of IBD. IBD is associated with alteration in fat distribution and development of white adipose tissue (WAT) hypertrophy in the mesentery. Most of adepokines are formed in WAT or in immune cells and play an important role in IBD manifestations. The aim of this study was to evaluate the levels of resistin and visfatin in IBD patients before and after treatment. Patients and Methods: 40 patients with IBD who(15 patients with CD and 25 patients with UC) attended to Tropical Medicine and Internal Medicine Departments; Zagazig University Hospitals from March 2012 till December 2013 were included in this study. Serum levels of resistin and visfatin were measured before treatment and 3 months after the treatment. Results: The mean serum levels of resistin in Crohn's disease ranged from 12.2+2 ng/ml to 9.0 + 4.0 (P= 0.1) and the mean serum levels of visfatin in Crohn's disease ranged from 5.6+4.6 ng/ml to 3.4+4.1 ng/ml (P= 0.04) before and after treatment respectively, and the mean serum levels of resistin in ulcerative colitis ranged from 11.2+2 ng/ml to 7.5+ 3.1 ng/ml (P= 0.039) and the mean serum levels of visfatin in ulcerative colitis ranged from 3.7+1.2 to 2.5+1.1 ng/ml (P= 0.004) before and after treatment respectively. Conclusion: The serum levels of resistin and visfatin decreased significantly after treatment induction for IBD , so can be used as a marker for treatment success.

Research paper thumbnail of Value of Child-Turcotte-Pugh Score in Prediction of Treatment Response in “Difficult to Treat” Chronic HCV Cirrhotic Patients

Open Journal of Gastroenterology, 2019

Background and aim: The direct-acting antivirals (DAAs) treatment has greatly improved sustained ... more Background and aim: The direct-acting antivirals (DAAs) treatment has greatly improved sustained virologic response (SVR) in chronic non-cirrhotic hepatitis C virus (HCV) patients and to less extent in those with cirrhosis. There is a stressing need for predicting the outcome of DAAs treatment especially in "difficult to treat" patients. This work aimed to study the value of the Child-Turcotte-Pugh (CTP) score in the prediction of treatment outcome with DAAs in "difficult to treat" chronic HCV patients. Materials and methods: A retrospective cohort study was conducted where files of 120 "difficult to treat" patients were randomly selected from the follow-up clinic. Patients' data were collected before and after treatment including history taking, clinical examination, laboratory investigations, and abdominal ultrasonography. Child-Turcotte-Pugh (CTP) scores were calculated. Results: There was no significant difference in mean Child score between patients with and without SVR before treatment, while this difference became significant after treatment. The patients without complications showed a highly significant decrease in their mean Child score after treatment, while patients with complications did not show any significant differences. Conclusion: The baseline Child-Turcotte-Pugh score cannot predict the treatment response of DAAs in "difficult to treat" chronic HCV patients, but it is significantly associated with the occurrence of complications.

Research paper thumbnail of Combined percutaneous ethanol injection and mitoxantrone versus radiofrequency ablation in the treatment of hepatocellular carcinoma

Medicine Science | International Medical Journal, 2016

New therapeutic choices have been developed for hepatocellular carcinoma, including percutaneous ... more New therapeutic choices have been developed for hepatocellular carcinoma, including percutaneous ablation therapy, transarterial chemoembolization, radiation therapy and molecular target therapy. Ablation of liver tumors is currently the main alternative to liver resection. This work aimed at comparing percutaneous combined local injection of ethanol and mitoxantrone versus percutaneous radiofrequency ablation in the treatment of Hepatocellular Carcinoma. This study included 124 patients with hepatocellular carcinoma, they were randomly divided into two groups; group I (64 patients) treated with local injection of ethanol plus mitoxantrone. Group II (60 patients) treated with radiofrequency ablation. Clinical assessment, laboratory evaluation and CT studies were performed to all patients prior to treatment and at 1, 3, 6, and 12 months' post treatment. The percentage of ablation in both groups at 1, 3, 6 and 12 months were 81.3%, 81.3%,76.6 and 71.9% in group I respectively versus 88.3%, 88.3, 85%% and 81.7% in group II respectively with no statistical significant difference between the two groups. Percentage of ablation in small tumors is higher than large tumors in both groups. Side effects and complications are statistically higher in group II than group I. Combination of percutaneous local injection of ethanol and mitoxantrone is comparable to radiofrequency ablation with less frequent complications in the treatment of Hepatocellular Carcinoma when surgical resection or liver transplantation is not amenable or available.

Research paper thumbnail of Histopathological Assessment of Dyspepsia in the Absence of Endoscopic Mucosal Lesions

Euroasian Journal of Hepato-Gastroenterology, 2016

EJOHG INTRODUCTION Dyspepsia is a term used for acute, chronic, or recurrent pain or discomfort c... more EJOHG INTRODUCTION Dyspepsia is a term used for acute, chronic, or recurrent pain or discomfort centered in the upper abdomen. It may be associated with upper abdominal fullness, early satiety, and bloating, burning, belching, nausea, retching, and vomiting. 1 Dyspepsia occurs in 25% of adult population and accounts for 5% of general clinics visits. 2 Approximately 25% of patients with dyspepsia have an organic cause and up to 75% have functional dyspepsia. 3 Patients with symptoms of dyspepsia who have not investigated are defined as having uninvestigated dyspepsia. 4 In patients with dyspepsia who are investigated, major causes include medications, functional dyspepsia, chronic peptic ulcer disease, and malignancy. 2 Other minor causes include pancreatic and hepatobiliary tract disease, motility disorders, infiltrative diseases of the

Research paper thumbnail of Value of Serum- Ascites Albumin Gradient in Prediction of Presence and Severity of Gastric Varices in Cirrhotic Ascitic Patients

Afro-Egyptian Journal of Infectious and Endemic Diseases, Dec 20, 2019

Background and aim of the work: Gastric varices (GV) are an ominous complication of portal hypert... more Background and aim of the work: Gastric varices (GV) are an ominous complication of portal hypertension (PH). The prediction of GV is a mandatory request to avoid their risky bleeding. This work aimed at evaluating the value of Serum-Ascitic Albumin Gradient (SAAG) in prediction of the presence and severity of GV in cirrhotic ascitic patients. Patients and methods: A descriptive cross-sectional study was conducted on 75 cirrhotic ascitic patients. All participants were subjected to full history taking, thorough clinical examination and laboratory investigations including liver function tests, complete blood count, kidney function tests and hepatitis markers including anti hepatitis C virus antibody (HCV-Abs) and hepatitis B surface antigen (HBs-Ag). Abdominal ultrasonography and abdominal diagnostic paracentesis with calculation of SAAG were also done. Patients were also subjected to upper gastrointestinal (GI) endoscopy and they were divided into two main groups according to the presence or absence of GV. Patients with GV were further classified into three groups depending on the form and size of GV. Results: SAAG-at a cut off value ≥ 2.4 gm/dl-predicted the presence of gastric varices with 93.28 % specificity, 59.92 %positive predicting value, 66.67% sensitivity and 96.5% negative predicting value. SAAG value also showed a highly significant increase with the progression of grades of GV. Conclusion: Serum-ascites albumin gradient (SAAG) could be considered as an efficient non-invasive predictor for the presence of GV and could reflect the severity of G.V in cirrhotic ascitic patients.

Research paper thumbnail of Evaluation of some pulmonary functions and.pdf

Background: Incidence of gastric fundal varices is about 16-70% of patients with portal hypertens... more Background: Incidence of gastric fundal varices is about 16-70% of patients with portal hypertension. It causes upper gastrointestinal bleeding in about 10-15% of cases. There are different methods used for the management of gastric varices. Endoscopic injection of N-Butyl-Cyanoacrylate (NBCA) is considered to be the choice for control of active bleeding from gastric varices. Pulmonary complications of sclerotherapy are common and varying from minor complications to severe complications as pleural effusion, lung collapse, consolidation, adult respiratory distress syndrome and pulmonary embolism.

Research paper thumbnail of Restrictive versus Liberal Blood(1).pdf

Background and Study Aim: Esophageal variceal bleeding is a major medical emergency and one of th... more Background and Study Aim: Esophageal variceal bleeding is a major medical emergency and one of the most important indications for hospital admission and for blood transfusion. However, the safest and the effective blood transfusion strategy is controversial. Here, we studied the safety and the effectiveness of the restrictive versus liberal transfusion strategies in patients with esophageal variceal bleeding. Patients and Methods: The study included 342 patients with esophageal variceal bleeding. Patients were divided into 2 groups: group I (Restrictive strategy) transfusion when the hemoglobin level is ≤7 g/dl and group II (Liberal strategy): transfusion when the hemoglobin level is ≤9 g/dl. All patients were subjected to complete blood counts, liver and kidney profiles, coagulation profile, pelvi-abdominal ultrasonography and upper GI endoscopy. Clinical outcome measures include rebleeding, infection, allergic transfusion reactions thromboembolic events, and mortality. Results: Of all patients admitted to hospital with esophageal variceal bleeding, the number of transfused RBCs units and hospital stay were more in the liberal transfusion strategy. Also, the overall rate of complications was higher in the liberal transfusion strategy (49.7% versus 38.5% in the restrictive transfusion strategy). The most common complications were rebleeding (26.9%) and infection (21.6%). As regard the death rate, 13 cases (7.6%) died in the restrictive transfusion strategy versus 25 cases (14.6%) in the liberal transfusion one. Conclusions: For esophageal variceal bleeding, restrictive transfusion strategy is better than the liberal one as regard cost-effectiveness, risk of complications and hospital stay with no harm and less mortality as compared to liberal strategy.

Research paper thumbnail of The Frequency of Meningitis Cases in Zagazig Fever Hospital: A Cross-sectional Study

Afro-Egyptian Journal of Infectious and Endemic Diseases, 2019

Background and study aim: Meningitis is the inflammation of meninges and can be life-threatening ... more Background and study aim: Meningitis is the inflammation of meninges and can be life-threatening in some cases. The study aimed to determine the frequency and clinical presentations of the meningitis cases in ZagazigFeverHospital to put recommendations to assist in improving the preventive and management measure-ments for meningitis. Patients and Methods: A cross-section study included all of 70 meningitis patients in ZagazigFeverHospital, who fulfilled the selection criteria, over a period of one year from September 2016 to September 2017. The data collection sheet included demographic, clinical assessments, diagnostic lumbar puncture with CSF analysis. Results: The majority of meningitis cases were males (57.1%), from urban areas (67.1%), aged less than ten years or more than forty years, and diagnosed in winter (42.9%), especially in February. According to the CSF culture results, patients were classified into two groups; 87.1% as aseptic meningitis (group A) and 12.8% as bacte...

Research paper thumbnail of Evaluation of some pulmonary functions and pleuropulmonary complications after endoscopic sclerotherapy of gastric fundal varices at Zagazig university hospitals

Egyptian Journal of Chest Diseases and Tuberculosis, 2016

Background Incidence of gastric fundal varices is about 16–70% of patients with portal hypertensi... more Background Incidence of gastric fundal varices is about 16–70% of patients with portal hypertension. It causes upper gastrointestinal bleeding in about 10–15% of cases. There are different methods used for the management of gastric varices. Endoscopic injection of N-Butyl-Cyanoacrylate (NBCA) is considered to be the choice for control of active bleeding from gastric varices. Pulmonary complications of sclerotherapy are common and varying from minor complications to severe complications as pleural effusion, lung collapse, consolidation, adult respiratory distress syndrome and pulmonary embolism. Aim To evaluate pulmonary functions after endoscopic sclerotherapy of gastric fundal varices by N-Butyl-Cyanoacrylate and the effect of incentive spirometry (IS) on post sclerotherapy pulmonary functions. Methods Sixty patients with liver cirrhosis and portal hypertension were included in the study. All patients were subjected to full history and careful clinical examination, upper GI endosco...

Research paper thumbnail of 156 Dickkopf-1 : As a Diagnostic and Prognostic Serum Marker for Hepatocellular Carcinoma

Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70-80% of all liver cancers... more Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70-80% of all liver cancers and the 5-year survival is only 3-5%. This bad prognosis is due to the lack of an effective method for early diagnosis. So, only 30-40% of patients with HCC are suitable for curative treatments at the time of diagnosis. Thus, there is a great need for tools to diagnose HCC early especially in cirrhotic patients. The aim of this work is to assess the validity of serum DKK1 as a diagnostic marker for HCC and to assess prognostic value of serum DKK1 in predicting treatment response, complication and survival in HCC patients. Patients and Methods: This study included 60 Patients divided into two groups. Group A: consisted of 30 patients with post hepatitic C and/or B liver cirrhosis. Group B: consisted of 30 patients with HCC on top of post hepatitic C and/or B liver cirrhosis. Group B patients underwent either radiofrequency ablation or ethanol injection. Clinical assessment, routine laboratory evaluation, CT studies and measurement of serum alpha-fetoprotein (AFP) and DKK1 were performed to all patients and repeated to group B patients 1 and 3 months after treatment. Results: The optimum cut off value of DKK1 for diagnosis of HCC was 4.3 ng/mL (AUC 0.89, sensitivity 66.7% and specificity 96.6%) (P<0.001). While, the optimum cut off value for AFP was > 101 ng/mL with 90% sensitivity and 75.9% specificity (p<0.001). Testing of both DKK1 and AFP increased the diagnostic accuracy for HCC (AUC 0.901, sensitivity 93.3%, and specificity 75.9) (P<0.001). Serum DKK1 level significantly decreases after HCC treatment with either radiofrequency ablation or ethanol injection (P<0.001). Conclusion: Testing of both DKK1 and AFP significantly increased the diagnostic accuracy for HCC. Meanwhile, DKK1 can be used alone for HCC diagnosis even in HCC with inconclusive AFP. DKK1 has a promising prognostic value and can be used for follow up of HCC patients who underwent loco-regional treatment.

Research paper thumbnail of The Assessment of Gastric Antral Wall Thickness in Helicobacter pylori gastritis by Abdominal Ultrasonography, Case-Control Study (2016-2018)

Background and Aim: Abdominal ultrasonography is effective in the visualization of gastric wall l... more Background and Aim: Abdominal ultrasonography is effective in the visualization of gastric wall layers and measuring its thickness. The study aimed to assess gastric antral wall thickness in patients with H. pylori gastritis by abdominal ultrasonography and to study its predictive value in detecting H. pylori gastritis. Materials and Methods: The study included ninety adult individuals, sixty of them had dyspepsia and/or upper abdominal pain and histologically confirmed gastritis, were distributed equally according to the H. pylori infection status into group A (H. pylori gastritis) or B (non-H. pylori gastritis), while, group C included thirty asymptomatic participants with negative H. pylori screening. The participants were subjected to abdominal sonography for measuring the antral wall thickness (AWT), mucosal wall thickness (MLT) and mucosal-to-antral wall thickness ratio (MLT/AWT ratio). Results: The AWT, MLT and MLT/AWT ratio were significantly greater in H. pylori gastritis ...

Research paper thumbnail of The Value of Combined Measuring of the Cerebrospinal Fluid Lactate and ‎Serum Procalcitonin in Diagnosis of Acute Bacterial Meningitis ‎

The Value of Combined Measuring of the Cerebrospinal Fluid Lactate and Serum Procalcitonin in Dia... more The Value of Combined Measuring of the Cerebrospinal Fluid Lactate and Serum Procalcitonin in Diagnosis of Acute Bacterial Meningitis Hosam M Dawod, Ahmed S Awadallah, Seham Mahrous, Ahmed Alwassief, Sameh M Abdel Monem Department of Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt. Medicine Department, Zagazig Fever Hospital, Egypt. Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt. Department of Internal Medicine, Al Azhar University forBoys, Cairo Campus, Egypt.

Research paper thumbnail of Dickkopf-1: As a Diagnostic and Prognostic Serum Marker for Hepatocellular Carcinoma

Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70-80% of all liver cancers... more Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70-80% of all liver cancers and the 5-year survival is only 3-5%. This bad prognosis is due to the lack of an effective method for early diagnosis. So, only 30-40% of patients with HCC are suitable for curative treatments at the time of diagnosis. Thus, there is a great need for tools to diagnose HCC early especially in cirrhotic patients. The aim of this work is to assess the validity of serum DKK1 as a diagnostic marker for HCC and to assess prognostic value of serum DKK1 in predicting treatment response, complication and survival in HCC patients. Patients and Methods: This study included 60 Patients divided into two groups. Group A: consisted of 30 patients with post hepatitic C and/or B liver cirrhosis. Group B: consisted of 30 patients with HCC on top of post hepatitic C and/or B liver cirrhosis. Group B patients underwent either radiofrequency ablation or ethanol injection. Clinical assessment, routine laboratory evaluation, CT studies and measurement of serum alpha-fetoprotein (AFP) and DKK1 were performed to all patients and repeated to group B patients 1 and 3 months after treatment. Results: The optimum cut off value of DKK1 for diagnosis of HCC was 4.3 ng/mL (AUC 0.89, sensitivity 66.7% and specificity 96.6%) (P<0.001). While, the optimum cut off value for AFP was > 101 ng/mL with 90% sensitivity and 75.9% specificity (p<0.001). Testing of both DKK1 and AFP increased the diagnostic accuracy for HCC (AUC 0.901, sensitivity 93.3%, and specificity 75.9) (P<0.001). Serum DKK1 level significantly decreases after HCC treatment with either radiofrequency ablation or ethanol injection (P<0.001). Conclusion: Testing of both DKK1 and AFP significantly increased the diagnostic accuracy for HCC. Meanwhile, DKK1 can be used alone for HCC diagnosis even in HCC with inconclusive AFP. DKK1 has a promising prognostic value and can be used for follow up of HCC patients who underwent loco-regional treatment.

Research paper thumbnail of Evaluation of Carvedilol in Prevention of First Attack of Variceal Hemorrhage in Patients with Liver Cirrhosis

Afro-Egyptian Journal of Infectious and Endemic Diseases

Background and study aim: Carvedilol has beneficial effects on splanchnic haemodynamics following... more Background and study aim: Carvedilol has beneficial effects on splanchnic haemodynamics following acute and chronic administration in cirrhosis. The aim of this study is to evaluate the role of carvedilol in prevention of first variceal bleeding in patients with liver cirrhosis and to compare its effect with that of variceal band ligation (VBL) and propranolol. Patients and methods: Seventy five patients with liver cirrhosis and endoscopically proven esophageal varices (grade II or larger in size with or without variceal red color signs), that have not bled yet were randomized to either VBL performed every 2 weeks until varices were eradicated (25 patients), carvedilol 12.5mg once daily (25 patients) or propranolol titrated to reduce resting pulse by >25% (25 patients) and followed up on the same schedule at 6 and 12 months. Results: Carvedilol had lowest rate of the first variceal bleeding when compared with VBL and propranolol (10%, 12% and 20% respectively). Carvedilol had significantly decreased the percentage of patients with varices grade III or IV over the follow up period (from 40% to 24%). Both carvedilol and propranolol significantly decreased severity of portal hypertensive gastropathy over follow up period. On the other hand, VBL significantly increased severity of portal hypertensive gastropathy. Conclusion: Carvedilol is effective in preventing the first variceal bleeding. Carvedilol is an option for primary prophylaxis in cirrhosis and esophageal varices grade ≥ II in single daily dose of 12.5 mg.

Research paper thumbnail of Circulating Resistin and Visfatin Levels in Patients with Inflammatory Bowel Disease as Predictors of Treatment Response

Afro-Egyptian Journal of Infectious and Endemic Diseases

Background and study aim: Ulcerative colitis (UC) and Crohn's disease (CD) are the common forms o... more Background and study aim: Ulcerative colitis (UC) and Crohn's disease (CD) are the common forms of inflammatory bowel disease (IBD). The etiology and pathogenesis are not fully understood yet. Many studies have been focused on adipokines in the pathogenesis of IBD. IBD is associated with alteration in fat distribution and development of white adipose tissue (WAT) hypertrophy in the mesentery. Most of adepokines are formed in WAT or in immune cells and play an important role in IBD manifestations. The aim of this study was to evaluate the levels of resistin and visfatin in IBD patients before and after treatment. Patients and Methods: 40 patients with IBD who(15 patients with CD and 25 patients with UC) attended to Tropical Medicine and Internal Medicine Departments; Zagazig University Hospitals from March 2012 till December 2013 were included in this study. Serum levels of resistin and visfatin were measured before treatment and 3 months after the treatment. Results: The mean serum levels of resistin in Crohn's disease ranged from 12.2+2 ng/ml to 9.0 + 4.0 (P= 0.1) and the mean serum levels of visfatin in Crohn's disease ranged from 5.6+4.6 ng/ml to 3.4+4.1 ng/ml (P= 0.04) before and after treatment respectively, and the mean serum levels of resistin in ulcerative colitis ranged from 11.2+2 ng/ml to 7.5+ 3.1 ng/ml (P= 0.039) and the mean serum levels of visfatin in ulcerative colitis ranged from 3.7+1.2 to 2.5+1.1 ng/ml (P= 0.004) before and after treatment respectively. Conclusion: The serum levels of resistin and visfatin decreased significantly after treatment induction for IBD , so can be used as a marker for treatment success.

Research paper thumbnail of Value of Child-Turcotte-Pugh Score in Prediction of Treatment Response in “Difficult to Treat” Chronic HCV Cirrhotic Patients

Open Journal of Gastroenterology, 2019

Background and aim: The direct-acting antivirals (DAAs) treatment has greatly improved sustained ... more Background and aim: The direct-acting antivirals (DAAs) treatment has greatly improved sustained virologic response (SVR) in chronic non-cirrhotic hepatitis C virus (HCV) patients and to less extent in those with cirrhosis. There is a stressing need for predicting the outcome of DAAs treatment especially in "difficult to treat" patients. This work aimed to study the value of the Child-Turcotte-Pugh (CTP) score in the prediction of treatment outcome with DAAs in "difficult to treat" chronic HCV patients. Materials and methods: A retrospective cohort study was conducted where files of 120 "difficult to treat" patients were randomly selected from the follow-up clinic. Patients' data were collected before and after treatment including history taking, clinical examination, laboratory investigations, and abdominal ultrasonography. Child-Turcotte-Pugh (CTP) scores were calculated. Results: There was no significant difference in mean Child score between patients with and without SVR before treatment, while this difference became significant after treatment. The patients without complications showed a highly significant decrease in their mean Child score after treatment, while patients with complications did not show any significant differences. Conclusion: The baseline Child-Turcotte-Pugh score cannot predict the treatment response of DAAs in "difficult to treat" chronic HCV patients, but it is significantly associated with the occurrence of complications.

Research paper thumbnail of Combined percutaneous ethanol injection and mitoxantrone versus radiofrequency ablation in the treatment of hepatocellular carcinoma

Medicine Science | International Medical Journal, 2016

New therapeutic choices have been developed for hepatocellular carcinoma, including percutaneous ... more New therapeutic choices have been developed for hepatocellular carcinoma, including percutaneous ablation therapy, transarterial chemoembolization, radiation therapy and molecular target therapy. Ablation of liver tumors is currently the main alternative to liver resection. This work aimed at comparing percutaneous combined local injection of ethanol and mitoxantrone versus percutaneous radiofrequency ablation in the treatment of Hepatocellular Carcinoma. This study included 124 patients with hepatocellular carcinoma, they were randomly divided into two groups; group I (64 patients) treated with local injection of ethanol plus mitoxantrone. Group II (60 patients) treated with radiofrequency ablation. Clinical assessment, laboratory evaluation and CT studies were performed to all patients prior to treatment and at 1, 3, 6, and 12 months' post treatment. The percentage of ablation in both groups at 1, 3, 6 and 12 months were 81.3%, 81.3%,76.6 and 71.9% in group I respectively versus 88.3%, 88.3, 85%% and 81.7% in group II respectively with no statistical significant difference between the two groups. Percentage of ablation in small tumors is higher than large tumors in both groups. Side effects and complications are statistically higher in group II than group I. Combination of percutaneous local injection of ethanol and mitoxantrone is comparable to radiofrequency ablation with less frequent complications in the treatment of Hepatocellular Carcinoma when surgical resection or liver transplantation is not amenable or available.

Research paper thumbnail of Histopathological Assessment of Dyspepsia in the Absence of Endoscopic Mucosal Lesions

Euroasian Journal of Hepato-Gastroenterology, 2016

EJOHG INTRODUCTION Dyspepsia is a term used for acute, chronic, or recurrent pain or discomfort c... more EJOHG INTRODUCTION Dyspepsia is a term used for acute, chronic, or recurrent pain or discomfort centered in the upper abdomen. It may be associated with upper abdominal fullness, early satiety, and bloating, burning, belching, nausea, retching, and vomiting. 1 Dyspepsia occurs in 25% of adult population and accounts for 5% of general clinics visits. 2 Approximately 25% of patients with dyspepsia have an organic cause and up to 75% have functional dyspepsia. 3 Patients with symptoms of dyspepsia who have not investigated are defined as having uninvestigated dyspepsia. 4 In patients with dyspepsia who are investigated, major causes include medications, functional dyspepsia, chronic peptic ulcer disease, and malignancy. 2 Other minor causes include pancreatic and hepatobiliary tract disease, motility disorders, infiltrative diseases of the

Research paper thumbnail of Value of Serum- Ascites Albumin Gradient in Prediction of Presence and Severity of Gastric Varices in Cirrhotic Ascitic Patients

Afro-Egyptian Journal of Infectious and Endemic Diseases, Dec 20, 2019

Background and aim of the work: Gastric varices (GV) are an ominous complication of portal hypert... more Background and aim of the work: Gastric varices (GV) are an ominous complication of portal hypertension (PH). The prediction of GV is a mandatory request to avoid their risky bleeding. This work aimed at evaluating the value of Serum-Ascitic Albumin Gradient (SAAG) in prediction of the presence and severity of GV in cirrhotic ascitic patients. Patients and methods: A descriptive cross-sectional study was conducted on 75 cirrhotic ascitic patients. All participants were subjected to full history taking, thorough clinical examination and laboratory investigations including liver function tests, complete blood count, kidney function tests and hepatitis markers including anti hepatitis C virus antibody (HCV-Abs) and hepatitis B surface antigen (HBs-Ag). Abdominal ultrasonography and abdominal diagnostic paracentesis with calculation of SAAG were also done. Patients were also subjected to upper gastrointestinal (GI) endoscopy and they were divided into two main groups according to the presence or absence of GV. Patients with GV were further classified into three groups depending on the form and size of GV. Results: SAAG-at a cut off value ≥ 2.4 gm/dl-predicted the presence of gastric varices with 93.28 % specificity, 59.92 %positive predicting value, 66.67% sensitivity and 96.5% negative predicting value. SAAG value also showed a highly significant increase with the progression of grades of GV. Conclusion: Serum-ascites albumin gradient (SAAG) could be considered as an efficient non-invasive predictor for the presence of GV and could reflect the severity of G.V in cirrhotic ascitic patients.

Research paper thumbnail of Evaluation of some pulmonary functions and.pdf

Background: Incidence of gastric fundal varices is about 16-70% of patients with portal hypertens... more Background: Incidence of gastric fundal varices is about 16-70% of patients with portal hypertension. It causes upper gastrointestinal bleeding in about 10-15% of cases. There are different methods used for the management of gastric varices. Endoscopic injection of N-Butyl-Cyanoacrylate (NBCA) is considered to be the choice for control of active bleeding from gastric varices. Pulmonary complications of sclerotherapy are common and varying from minor complications to severe complications as pleural effusion, lung collapse, consolidation, adult respiratory distress syndrome and pulmonary embolism.

Research paper thumbnail of Restrictive versus Liberal Blood(1).pdf

Background and Study Aim: Esophageal variceal bleeding is a major medical emergency and one of th... more Background and Study Aim: Esophageal variceal bleeding is a major medical emergency and one of the most important indications for hospital admission and for blood transfusion. However, the safest and the effective blood transfusion strategy is controversial. Here, we studied the safety and the effectiveness of the restrictive versus liberal transfusion strategies in patients with esophageal variceal bleeding. Patients and Methods: The study included 342 patients with esophageal variceal bleeding. Patients were divided into 2 groups: group I (Restrictive strategy) transfusion when the hemoglobin level is ≤7 g/dl and group II (Liberal strategy): transfusion when the hemoglobin level is ≤9 g/dl. All patients were subjected to complete blood counts, liver and kidney profiles, coagulation profile, pelvi-abdominal ultrasonography and upper GI endoscopy. Clinical outcome measures include rebleeding, infection, allergic transfusion reactions thromboembolic events, and mortality. Results: Of all patients admitted to hospital with esophageal variceal bleeding, the number of transfused RBCs units and hospital stay were more in the liberal transfusion strategy. Also, the overall rate of complications was higher in the liberal transfusion strategy (49.7% versus 38.5% in the restrictive transfusion strategy). The most common complications were rebleeding (26.9%) and infection (21.6%). As regard the death rate, 13 cases (7.6%) died in the restrictive transfusion strategy versus 25 cases (14.6%) in the liberal transfusion one. Conclusions: For esophageal variceal bleeding, restrictive transfusion strategy is better than the liberal one as regard cost-effectiveness, risk of complications and hospital stay with no harm and less mortality as compared to liberal strategy.