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Papers by marwa zakaria

Research paper thumbnail of Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology—A Limited-Resource Country Perspective

Research paper thumbnail of Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using ‘Adapted ADAPTE’

Annals of hematology, Feb 22, 2024

Research paper thumbnail of Diagnosis, management and prevention of Pediatric Acute Hemolytic Anemia: Egyptian adapted evidence-based clinical practice guidelines

Egyptian Pediatric Association Gazette

Background Acute hemolytic anemia (AHA) is a common emergency in pediatric emergency departments,... more Background Acute hemolytic anemia (AHA) is a common emergency in pediatric emergency departments, hence the need to adapt pre-existing high-quality practice guidelines for the diagnosis, management, and prevention of AHA to be available for national use. Methods The guideline panel used the adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to be used in low-resource countries. Results The guideline provided approach to a child with AHA: laboratory diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, autoimmune hemolytic anemia (AIHA), and hemolytic uremic syndrome (HUS); treatment of AHA including indications for red cell transfusion, medical treatment, plasma exchange, and indications of antibiotic in HUS; how to avoid further episodes of hemolysis; and when...

Research paper thumbnail of Contribution of T helper 17 cells and interleukin-17 to the pathogenesis of primary immune thrombocytopenia in Egyptian children

European Journal of Pediatrics, Oct 11, 2023

Research paper thumbnail of Place of Emicizumab in the Management of Hemophilia A: Review Article

The Egyptian Journal of Hospital Medicine, Apr 1, 2023

Emicizumab (Hemlibra®), By connecting FIXa and FX, In hemophilia A patients, a recombinant, human... more Emicizumab (Hemlibra®), By connecting FIXa and FX, In hemophilia A patients, a recombinant, humanized, Absent activated factor VIII (FVIII) is successfully functionally restored by a bispecific monoclonal antibody. Subcutaneous emicizumab has been approved in a number of countries for the routine prevention of bleeding episodes in patients with moderate to severe hemophilia A, with or without the use of FVIII inhibitors. In phase III clinical investigations, emicizumab prophylaxis significantly decreased annualized bleeding rates in adults and adolescents with hemophilia A with or without inhibitors and avoided or significantly reduced bleeding in children with hemophilia A with or without inhibitors. Regular use of emicizumab improved health-related quality of life with no discomfort. Emicizumab, regardless of the presence or absence of inhibitors, provides a consistent and frequently well-tolerated alternative to conventional FVIII replacement medications for the prevention of bleeding episodes in people with hemophilia A. This is because of the delivery method's practicality and the flexible dosage schedules (maintenance doses every 1, 2, or 4 weeks).

Research paper thumbnail of Role of interleukin 4 (IL4) and interleukin 6 (IL6) in the pathogenesis and prognosis of childhood primary immune thrombocytopenia

European Journal of Pediatrics, Apr 25, 2023

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the breakdown of immune t... more Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the breakdown of immune tolerance. Impairment of the cellular immunity is primarily evaluated by the levels of the cytokines which can help in predicting the course of ITP. We aimed to assess the levels of IL4 and IL6 in children with ITP and evaluate their role in the pathogenesis and prognosis of this disease. A prospective cohort study was carried on 60 children (15 patients with newly diagnosed ITP, 15 patients with persistent ITP, 15 patients with chronic ITP and 15 healthy children as a control group). Serum IL-4 and serum IL-6 were measured using Human IL-4 and IL-6 ELISA kit in patients and controls. Patients with newly diagnosed and persistent ITP had significantly higher levels of IL4 and IL6 compared to patients with chronic ITP and healthy controls (p < 0.001). The mean serum level of IL4 was 762.0, 741.0, 364.6 and 436.8 pg/ml, and the mean serum level of IL6 was 178.5, 164.4, 57.9 and 88.4 pg/ml for patients with newly diagnosed, persistent, chronic ITP and healthy controls respectively. Serum IL-4 was significantly higher in patients who achieved remission than those who did not improve on first line therapy. Conclusion: Serum IL-4 and IL-6 may have a role in the pathogenesis of primary ITP. IL-4 seems to be a good predictor to treatment response. What Is Known: • There is a delicate balance of specific cytokine levels in immune thrombocytopenia, which has an important role in the immune system and is known to be deregulated in autoimmune diseases. changes in IL-4 and IL-6 might be involved in the pathogenesis of newly diagnosed ITP in both paediatric and adult patients. • We conducted this research study to measure the serum level of IL-4 and IL-6, in newly diagnosed, persistent and chronic ITP patients and study their relation to disease pathogenesis as well as patient's outcome. What Is New: • We found that IL4 seems to be a good predictor to treatment response and it was a very interesting observation in our study, and to the best of our knowledge, there is no published data about this finding.

Research paper thumbnail of Role of serum cystatin C in the prediction of acute kidney injury following pediatric cardiac surgeries: A single center experience

Research paper thumbnail of Association between ATP binding cassette gene member 1 polymorphism and glucocorticoid response in children with immune thrombocytopenia

Research paper thumbnail of Cerebral sinuses thrombosis prior to the diagnosis of acute lymphoblastic leukemia in a child: A case report

SAGE Open Medical Case Reports

Acute lymphoblastic leukemia is the most common malignancy in children. In children, venous throm... more Acute lymphoblastic leukemia is the most common malignancy in children. In children, venous thromboembolism is relatively common. In most cases, venous thromboembolism manifests in patients who are diagnosed with acute lymphoblastic leukemia. Several risk factors associated with acute lymphoblastic leukemia predispose patients to the development of venous thromboembolism. Unlike most reported cases of venous thromboembolism, herein we report a child who developed cerebral venous sinus thrombosis prior to the diagnosis of acute lymphoblastic leukemia. The patient recovered from an attack of acute gastroenteritis with sepsis, pancytopenia, and disseminated intravascular coagulation 2 weeks before the development of thrombosis. Her laboratory workup for coagulopathy and disseminated intravascular coagulation was normal at the time of diagnosis of cerebral sinus thrombosis. The genetic workup for thrombophilia risk identified several genetic thrombophilia mutations: the homozygous facto...

Research paper thumbnail of Contribution of interleukin 27 serum level to pathogenesis and prognosis in children with immune thrombocytopenia

Research paper thumbnail of Augmented Genetic Risk of Thrombophilia in Pediatric Acute Lymphoblastic Leukemia: Case report and Review of Literature

Acute Lymphoblastic Leukemia (ALL) is the most common malignancy in children. Venous thromboembol... more Acute Lymphoblastic Leukemia (ALL) is the most common malignancy in children. Venous thromboembolism (VTE) is relatively common in children with acute ALL that usually appears after the diagnosis or during therapy secondary to many associated risk factors. Here in we report for the first time a child who developed cerebral venous sinus thrombosis (CVST) prior to the diagnosis of ALL.

Research paper thumbnail of Prevalence of Acute Kidney Injury in Pediatric Patients with Congenital Heart Disease Following Open Heart Surgery

The Egyptian Journal of Hospital Medicine, 2021

Background: Acute kidney injury (AKI) occurs in approximately 40% of children undergoing cardiac ... more Background: Acute kidney injury (AKI) occurs in approximately 40% of children undergoing cardiac surgery and is a risk factor for morbidity and mortality. Such injury leads to several complications, including fluid and electrolyte disturbances. Objective: To determine prevalence of acute kidney injury in pediatric patients with congenital heart disease following open heart surgery. Patients and Methods: We conducted a case control study on 20 patients with congenital heart disease (10 males and 10 females) with mean age of 3.39 ± 1.17 years old, and a range from 1 to 5 years old. They were recruited from Pediatric Cardiothoracic Unit, Zagazig University Hospital and 20 sex and age matched healthy children worked as control group. Results: The mean age of our patients was 3.39 ± 1.17 years old with a range from 1 to 5 years. 50% were males and 50 % were females with no statistically significant difference between both groups regarding age and sex. about 1/3 of the studied group had A...

Research paper thumbnail of Ocular radiological findings in Children with Acute Lymphoblastic Leukemia: a cross sectional study

Zagazig university medical journal, 2021

Research paper thumbnail of First Report of Acute Lymphoblastic Leukemia in an Egyptian Child with β-Thalassemia Major

Hemoglobin, 2015

Abstract β-Thalassemia (β-thal) is the most common hereditary anemia in humans. With improvement ... more Abstract β-Thalassemia (β-thal) is the most common hereditary anemia in humans. With improvement of treatment protocols, patients are living longer and new complications have emerged. Few articles have reported the occurrence of malignancies among patients with β-thal in different parts of the world. We herein report the first pediatric patient with β-thal major (β-TM), who developed acute lymphoblastic leukemia in Egypt with analysis of the different theories of pathogenesis.

Research paper thumbnail of Renal Presentation in Pediatric Acute Leukemia

Medicine, 2015

Renal enlargement at time of diagnosis of acute leukemia is very unusual. We here in report 2 ped... more Renal enlargement at time of diagnosis of acute leukemia is very unusual. We here in report 2 pediatric cases of acute leukemia who had their renal affection as the first presenting symptom with no evidences of blast cells in blood smear and none of classical presentation of acute leukemia. The first case is a 4-year-old girl who presented with pallor and abdominal enlargement. Magnetic resonance imaging showed bilateral symmetrical homogenous enlarged kidneys suggestive of infiltration. Complete blood picture (CBC) revealed white blood count 11 Â 10 9 /L, hemoglobin 8.7 g/dL and platelet count 197 Â 10 9 /L. Bone marrow aspiration was performed, and diagnosed precursor B-cell ALL was made. The child had an excellent response to modified CCG 1991 standard risk protocol of chemotherapy with sustained remission, but unfortunately relapsed 11 month after the end of therapy. The second child was 13-month old, presented with pallor, vomiting, abdominal enlargement, and oliguria 2 days before admission. Initial CBC showed bicytopenia, elevated blood urea, creatinine, and serum uric acid, while abdominal ultrasonography revealed bilateral renal enlargement. Bone marrow examination was done and showed 92% blast of biphenotypic nature. So, biphynotypic leukemia with bilateral renal enlargement and acute renal failure was subsequently diagnosed. The patients admitted to ICU and received supportive care and prednisolone. Renal function normalized and chemotherapy was started. The child achieved complete remission with marked reduction of kidney size but, unfortunately she died from sepsis in consolidation phase of therapy. This case demonstrates an unusual early renal enlargement in childhood acute leukemia. Renal involvement of acute leukemia should be considered in child presenting with unexplained bilateral renal enlargement with or without renal function abnormalities and bone marrow examination should be included in the workup.

Research paper thumbnail of Genetic polymorphism of vitamin D receptors and plasminogen activator inhibitor‐1 and osteonecrosis risk in childhood acute lymphoblastic leukemia

Molecular Genetics & Genomic Medicine, 2021

Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children, represent... more Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children, representing one-quarter of all pediatric cancers (Seibel et al., 2008). The survival of children with acute lymphoblastic leukemia has increased in the last years due to the progressive intensification of multiagent chemotherapy. Osteonecrosis is one of the most common and debilitating therapy-related side effects of anti-leukemic treatment and can adversely affect

Research paper thumbnail of Target Therapy in Neuroblastoma

Neuroblastoma - Current State and Recent Updates, 2017

Neuroblastoma is an embryonal malignancy that originates in the sympathetic nervous system. It is... more Neuroblastoma is an embryonal malignancy that originates in the sympathetic nervous system. It is the most common solid tumor in infants and the most frequent extracranial solid tumor in children. Neuroblastoma accounts for 10% of childhood malignancies with 75% occurring in children <4 years. Stage, age, clinical and tumor genomic features are the principal criteria for determining treatment policy. Treatment modalities traditionally employed in the management of neuroblastoma are surgery, chemotherapy, and radiotherapy. Intensive multimodal treatment in patients with neuroblastoma has resulted in improved survival rates. However, there is a considerable percentage of patients with refractory and relapsed disease. Targeted therapy for neuroblastoma involves treatment aimed at molecular targets that have a unique expression in this childhood cancer. A large number of molecular targets have been identified for the treatment of high-risk and relapsed neuroblastoma. Treatment in this way aims at providing a more selective way to treat the disease and decreasing toxicities associated with the conventional treatment regimen.

Research paper thumbnail of Introductory Chapter: β-Thalassemia

Research paper thumbnail of FcγRIIa and FcγRIIIa genes polymorphism in Egyptian children with primary immune thrombocytopenia

Hematology, Transfusion and Cell Therapy, 2021

Phagocytosis of autoantibody-sensitized coated platelets through Fc gamma receptors on phagocytic... more Phagocytosis of autoantibody-sensitized coated platelets through Fc gamma receptors on phagocytic cells is an important mechanism of thrombocytopenia in primary immune thrombocytopenia (ITP). Objective: We aimed to investigate the contribution of the FcgRIIa and FcgRIIIa genes polymorphism to the risk of ITP and their association with disease characteristics in Egyptian children. Methods: A case control study was conducted on eighty children with primary ITP and eighty age and sex healthy matched subjects as a control group. The FcgRIIa and FcgRIIIa genes polymorphism was detected using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: We found that the FcgRIIaÀ131H and À131R allele frequencies were 51.3 % and 48.7%, respectively, in children with ITP, versus 75% and 25%, respectively, in controls (p = 0.002). The compound heterozygous HR genotype was significantly higher in ITP patients (p < 0.05). The FcgRIIIa-158F and À158V allele frequencies were 46.3% and 53.7%, respectively, in children with ITP, versus 70% and 30%, respectively, in controls (p = 0.002). The compound heterozygous VF genotype was significantly higher in ITP patients (p < 0.05). The combined HR/FV genotype was 47.5% in ITP patients, versus 10% in controls (p < 0.001). No significant difference was found between children with newly diagnosed ITP and those who developed chronic ITP, regarding the frequency distribution of the FcgRIIa and FcgRIIIa alleles and genotypes (p > 0.05). Conclusion: There is a possible association of the FcgRIIa and FcgRIIIa genes polymorphism with the risk for, and genetic susceptibility to ITP in Egyptian children, but large-scale studies are still needed to support our findings.

Research paper thumbnail of Serum endocan and endothelial dysfunction in childhood acute lymphoblastic leukemia survivors: a tertiary center experience

Therapeutic Advances in Chronic Disease, 2021

Background: An increased risk of cardiovascular complications is reported in survivors of childho... more Background: An increased risk of cardiovascular complications is reported in survivors of childhood acute lymphoblastic leukemia (ALL). Early identification of impaired vascular health may allow for early interventions to improve outcomes. Aim: The study was conducted to assess the endothelial dysfunction in ALL survivors using a new marker, serum endocan, and measurement of the mean common carotid arteries intima media thickness (cIMT). Methods: A case-control study was conducted on 100 childhood ALL survivors (aged 6–18 years), with 80 healthy age and sex-matched children as a control group. Lipid profile, hepatitis markers, and serum ferritin where measured, in addition to the measurement of serum endocan. and cIMT by B-mode high-resolution ultrasonography for all study participants. Results: Triglycerides, total cholesterol, post prandial glucose, and serum ferritin were significantly higher in ALL survivors than controls ( p < 0.05). Dyslipidemia was detected in 6% of ALL su...

Research paper thumbnail of Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology—A Limited-Resource Country Perspective

Research paper thumbnail of Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using ‘Adapted ADAPTE’

Annals of hematology, Feb 22, 2024

Research paper thumbnail of Diagnosis, management and prevention of Pediatric Acute Hemolytic Anemia: Egyptian adapted evidence-based clinical practice guidelines

Egyptian Pediatric Association Gazette

Background Acute hemolytic anemia (AHA) is a common emergency in pediatric emergency departments,... more Background Acute hemolytic anemia (AHA) is a common emergency in pediatric emergency departments, hence the need to adapt pre-existing high-quality practice guidelines for the diagnosis, management, and prevention of AHA to be available for national use. Methods The guideline panel used the adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to be used in low-resource countries. Results The guideline provided approach to a child with AHA: laboratory diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, autoimmune hemolytic anemia (AIHA), and hemolytic uremic syndrome (HUS); treatment of AHA including indications for red cell transfusion, medical treatment, plasma exchange, and indications of antibiotic in HUS; how to avoid further episodes of hemolysis; and when...

Research paper thumbnail of Contribution of T helper 17 cells and interleukin-17 to the pathogenesis of primary immune thrombocytopenia in Egyptian children

European Journal of Pediatrics, Oct 11, 2023

Research paper thumbnail of Place of Emicizumab in the Management of Hemophilia A: Review Article

The Egyptian Journal of Hospital Medicine, Apr 1, 2023

Emicizumab (Hemlibra®), By connecting FIXa and FX, In hemophilia A patients, a recombinant, human... more Emicizumab (Hemlibra®), By connecting FIXa and FX, In hemophilia A patients, a recombinant, humanized, Absent activated factor VIII (FVIII) is successfully functionally restored by a bispecific monoclonal antibody. Subcutaneous emicizumab has been approved in a number of countries for the routine prevention of bleeding episodes in patients with moderate to severe hemophilia A, with or without the use of FVIII inhibitors. In phase III clinical investigations, emicizumab prophylaxis significantly decreased annualized bleeding rates in adults and adolescents with hemophilia A with or without inhibitors and avoided or significantly reduced bleeding in children with hemophilia A with or without inhibitors. Regular use of emicizumab improved health-related quality of life with no discomfort. Emicizumab, regardless of the presence or absence of inhibitors, provides a consistent and frequently well-tolerated alternative to conventional FVIII replacement medications for the prevention of bleeding episodes in people with hemophilia A. This is because of the delivery method's practicality and the flexible dosage schedules (maintenance doses every 1, 2, or 4 weeks).

Research paper thumbnail of Role of interleukin 4 (IL4) and interleukin 6 (IL6) in the pathogenesis and prognosis of childhood primary immune thrombocytopenia

European Journal of Pediatrics, Apr 25, 2023

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the breakdown of immune t... more Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the breakdown of immune tolerance. Impairment of the cellular immunity is primarily evaluated by the levels of the cytokines which can help in predicting the course of ITP. We aimed to assess the levels of IL4 and IL6 in children with ITP and evaluate their role in the pathogenesis and prognosis of this disease. A prospective cohort study was carried on 60 children (15 patients with newly diagnosed ITP, 15 patients with persistent ITP, 15 patients with chronic ITP and 15 healthy children as a control group). Serum IL-4 and serum IL-6 were measured using Human IL-4 and IL-6 ELISA kit in patients and controls. Patients with newly diagnosed and persistent ITP had significantly higher levels of IL4 and IL6 compared to patients with chronic ITP and healthy controls (p < 0.001). The mean serum level of IL4 was 762.0, 741.0, 364.6 and 436.8 pg/ml, and the mean serum level of IL6 was 178.5, 164.4, 57.9 and 88.4 pg/ml for patients with newly diagnosed, persistent, chronic ITP and healthy controls respectively. Serum IL-4 was significantly higher in patients who achieved remission than those who did not improve on first line therapy. Conclusion: Serum IL-4 and IL-6 may have a role in the pathogenesis of primary ITP. IL-4 seems to be a good predictor to treatment response. What Is Known: • There is a delicate balance of specific cytokine levels in immune thrombocytopenia, which has an important role in the immune system and is known to be deregulated in autoimmune diseases. changes in IL-4 and IL-6 might be involved in the pathogenesis of newly diagnosed ITP in both paediatric and adult patients. • We conducted this research study to measure the serum level of IL-4 and IL-6, in newly diagnosed, persistent and chronic ITP patients and study their relation to disease pathogenesis as well as patient's outcome. What Is New: • We found that IL4 seems to be a good predictor to treatment response and it was a very interesting observation in our study, and to the best of our knowledge, there is no published data about this finding.

Research paper thumbnail of Role of serum cystatin C in the prediction of acute kidney injury following pediatric cardiac surgeries: A single center experience

Research paper thumbnail of Association between ATP binding cassette gene member 1 polymorphism and glucocorticoid response in children with immune thrombocytopenia

Research paper thumbnail of Cerebral sinuses thrombosis prior to the diagnosis of acute lymphoblastic leukemia in a child: A case report

SAGE Open Medical Case Reports

Acute lymphoblastic leukemia is the most common malignancy in children. In children, venous throm... more Acute lymphoblastic leukemia is the most common malignancy in children. In children, venous thromboembolism is relatively common. In most cases, venous thromboembolism manifests in patients who are diagnosed with acute lymphoblastic leukemia. Several risk factors associated with acute lymphoblastic leukemia predispose patients to the development of venous thromboembolism. Unlike most reported cases of venous thromboembolism, herein we report a child who developed cerebral venous sinus thrombosis prior to the diagnosis of acute lymphoblastic leukemia. The patient recovered from an attack of acute gastroenteritis with sepsis, pancytopenia, and disseminated intravascular coagulation 2 weeks before the development of thrombosis. Her laboratory workup for coagulopathy and disseminated intravascular coagulation was normal at the time of diagnosis of cerebral sinus thrombosis. The genetic workup for thrombophilia risk identified several genetic thrombophilia mutations: the homozygous facto...

Research paper thumbnail of Contribution of interleukin 27 serum level to pathogenesis and prognosis in children with immune thrombocytopenia

Research paper thumbnail of Augmented Genetic Risk of Thrombophilia in Pediatric Acute Lymphoblastic Leukemia: Case report and Review of Literature

Acute Lymphoblastic Leukemia (ALL) is the most common malignancy in children. Venous thromboembol... more Acute Lymphoblastic Leukemia (ALL) is the most common malignancy in children. Venous thromboembolism (VTE) is relatively common in children with acute ALL that usually appears after the diagnosis or during therapy secondary to many associated risk factors. Here in we report for the first time a child who developed cerebral venous sinus thrombosis (CVST) prior to the diagnosis of ALL.

Research paper thumbnail of Prevalence of Acute Kidney Injury in Pediatric Patients with Congenital Heart Disease Following Open Heart Surgery

The Egyptian Journal of Hospital Medicine, 2021

Background: Acute kidney injury (AKI) occurs in approximately 40% of children undergoing cardiac ... more Background: Acute kidney injury (AKI) occurs in approximately 40% of children undergoing cardiac surgery and is a risk factor for morbidity and mortality. Such injury leads to several complications, including fluid and electrolyte disturbances. Objective: To determine prevalence of acute kidney injury in pediatric patients with congenital heart disease following open heart surgery. Patients and Methods: We conducted a case control study on 20 patients with congenital heart disease (10 males and 10 females) with mean age of 3.39 ± 1.17 years old, and a range from 1 to 5 years old. They were recruited from Pediatric Cardiothoracic Unit, Zagazig University Hospital and 20 sex and age matched healthy children worked as control group. Results: The mean age of our patients was 3.39 ± 1.17 years old with a range from 1 to 5 years. 50% were males and 50 % were females with no statistically significant difference between both groups regarding age and sex. about 1/3 of the studied group had A...

Research paper thumbnail of Ocular radiological findings in Children with Acute Lymphoblastic Leukemia: a cross sectional study

Zagazig university medical journal, 2021

Research paper thumbnail of First Report of Acute Lymphoblastic Leukemia in an Egyptian Child with β-Thalassemia Major

Hemoglobin, 2015

Abstract β-Thalassemia (β-thal) is the most common hereditary anemia in humans. With improvement ... more Abstract β-Thalassemia (β-thal) is the most common hereditary anemia in humans. With improvement of treatment protocols, patients are living longer and new complications have emerged. Few articles have reported the occurrence of malignancies among patients with β-thal in different parts of the world. We herein report the first pediatric patient with β-thal major (β-TM), who developed acute lymphoblastic leukemia in Egypt with analysis of the different theories of pathogenesis.

Research paper thumbnail of Renal Presentation in Pediatric Acute Leukemia

Medicine, 2015

Renal enlargement at time of diagnosis of acute leukemia is very unusual. We here in report 2 ped... more Renal enlargement at time of diagnosis of acute leukemia is very unusual. We here in report 2 pediatric cases of acute leukemia who had their renal affection as the first presenting symptom with no evidences of blast cells in blood smear and none of classical presentation of acute leukemia. The first case is a 4-year-old girl who presented with pallor and abdominal enlargement. Magnetic resonance imaging showed bilateral symmetrical homogenous enlarged kidneys suggestive of infiltration. Complete blood picture (CBC) revealed white blood count 11 Â 10 9 /L, hemoglobin 8.7 g/dL and platelet count 197 Â 10 9 /L. Bone marrow aspiration was performed, and diagnosed precursor B-cell ALL was made. The child had an excellent response to modified CCG 1991 standard risk protocol of chemotherapy with sustained remission, but unfortunately relapsed 11 month after the end of therapy. The second child was 13-month old, presented with pallor, vomiting, abdominal enlargement, and oliguria 2 days before admission. Initial CBC showed bicytopenia, elevated blood urea, creatinine, and serum uric acid, while abdominal ultrasonography revealed bilateral renal enlargement. Bone marrow examination was done and showed 92% blast of biphenotypic nature. So, biphynotypic leukemia with bilateral renal enlargement and acute renal failure was subsequently diagnosed. The patients admitted to ICU and received supportive care and prednisolone. Renal function normalized and chemotherapy was started. The child achieved complete remission with marked reduction of kidney size but, unfortunately she died from sepsis in consolidation phase of therapy. This case demonstrates an unusual early renal enlargement in childhood acute leukemia. Renal involvement of acute leukemia should be considered in child presenting with unexplained bilateral renal enlargement with or without renal function abnormalities and bone marrow examination should be included in the workup.

Research paper thumbnail of Genetic polymorphism of vitamin D receptors and plasminogen activator inhibitor‐1 and osteonecrosis risk in childhood acute lymphoblastic leukemia

Molecular Genetics & Genomic Medicine, 2021

Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children, represent... more Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children, representing one-quarter of all pediatric cancers (Seibel et al., 2008). The survival of children with acute lymphoblastic leukemia has increased in the last years due to the progressive intensification of multiagent chemotherapy. Osteonecrosis is one of the most common and debilitating therapy-related side effects of anti-leukemic treatment and can adversely affect

Research paper thumbnail of Target Therapy in Neuroblastoma

Neuroblastoma - Current State and Recent Updates, 2017

Neuroblastoma is an embryonal malignancy that originates in the sympathetic nervous system. It is... more Neuroblastoma is an embryonal malignancy that originates in the sympathetic nervous system. It is the most common solid tumor in infants and the most frequent extracranial solid tumor in children. Neuroblastoma accounts for 10% of childhood malignancies with 75% occurring in children <4 years. Stage, age, clinical and tumor genomic features are the principal criteria for determining treatment policy. Treatment modalities traditionally employed in the management of neuroblastoma are surgery, chemotherapy, and radiotherapy. Intensive multimodal treatment in patients with neuroblastoma has resulted in improved survival rates. However, there is a considerable percentage of patients with refractory and relapsed disease. Targeted therapy for neuroblastoma involves treatment aimed at molecular targets that have a unique expression in this childhood cancer. A large number of molecular targets have been identified for the treatment of high-risk and relapsed neuroblastoma. Treatment in this way aims at providing a more selective way to treat the disease and decreasing toxicities associated with the conventional treatment regimen.

Research paper thumbnail of Introductory Chapter: β-Thalassemia

Research paper thumbnail of FcγRIIa and FcγRIIIa genes polymorphism in Egyptian children with primary immune thrombocytopenia

Hematology, Transfusion and Cell Therapy, 2021

Phagocytosis of autoantibody-sensitized coated platelets through Fc gamma receptors on phagocytic... more Phagocytosis of autoantibody-sensitized coated platelets through Fc gamma receptors on phagocytic cells is an important mechanism of thrombocytopenia in primary immune thrombocytopenia (ITP). Objective: We aimed to investigate the contribution of the FcgRIIa and FcgRIIIa genes polymorphism to the risk of ITP and their association with disease characteristics in Egyptian children. Methods: A case control study was conducted on eighty children with primary ITP and eighty age and sex healthy matched subjects as a control group. The FcgRIIa and FcgRIIIa genes polymorphism was detected using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: We found that the FcgRIIaÀ131H and À131R allele frequencies were 51.3 % and 48.7%, respectively, in children with ITP, versus 75% and 25%, respectively, in controls (p = 0.002). The compound heterozygous HR genotype was significantly higher in ITP patients (p < 0.05). The FcgRIIIa-158F and À158V allele frequencies were 46.3% and 53.7%, respectively, in children with ITP, versus 70% and 30%, respectively, in controls (p = 0.002). The compound heterozygous VF genotype was significantly higher in ITP patients (p < 0.05). The combined HR/FV genotype was 47.5% in ITP patients, versus 10% in controls (p < 0.001). No significant difference was found between children with newly diagnosed ITP and those who developed chronic ITP, regarding the frequency distribution of the FcgRIIa and FcgRIIIa alleles and genotypes (p > 0.05). Conclusion: There is a possible association of the FcgRIIa and FcgRIIIa genes polymorphism with the risk for, and genetic susceptibility to ITP in Egyptian children, but large-scale studies are still needed to support our findings.

Research paper thumbnail of Serum endocan and endothelial dysfunction in childhood acute lymphoblastic leukemia survivors: a tertiary center experience

Therapeutic Advances in Chronic Disease, 2021

Background: An increased risk of cardiovascular complications is reported in survivors of childho... more Background: An increased risk of cardiovascular complications is reported in survivors of childhood acute lymphoblastic leukemia (ALL). Early identification of impaired vascular health may allow for early interventions to improve outcomes. Aim: The study was conducted to assess the endothelial dysfunction in ALL survivors using a new marker, serum endocan, and measurement of the mean common carotid arteries intima media thickness (cIMT). Methods: A case-control study was conducted on 100 childhood ALL survivors (aged 6–18 years), with 80 healthy age and sex-matched children as a control group. Lipid profile, hepatitis markers, and serum ferritin where measured, in addition to the measurement of serum endocan. and cIMT by B-mode high-resolution ultrasonography for all study participants. Results: Triglycerides, total cholesterol, post prandial glucose, and serum ferritin were significantly higher in ALL survivors than controls ( p < 0.05). Dyslipidemia was detected in 6% of ALL su...