Alaa Ismail | Ain Shams University (original) (raw)

Papers by Alaa Ismail

Ain-Shams Journal of Surgery, Jul 1, 2009

The role of stem cells in liver diseases An Essay submitted for partial fulfillment of master deg... more The role of stem cells in liver diseases An Essay submitted for partial fulfillment of master degree in general surgery

Gut, 2005

Background: The response rates and duration of peginterferon alpha (PEG-IFN-a) and ribavirin comb... more Background: The response rates and duration of peginterferon alpha (PEG-IFN-a) and ribavirin combination therapy in chronic hepatitis C genotype 4, the prevalent genotype in the Middle East and Africa, are poorly documented. Aims: To compare the efficacy and safety of 24, 36, or 48 weeks of PEG-IFN-a-2b and ribavirin therapy in chronic hepatitis C genotype 4. Methods: In this prospective, randomised, double blind study, 287 patients with chronic hepatitis C genotype 4 were randomly assigned to PEG-IFN-a-2b (1.5 mg/kg) once weekly plus daily ribavirin (1000-1200 mg) for 24 weeks (group A, n = 95), 36 weeks (group B, n = 96), or 48 weeks (group C, n = 96) and followed for 48 weeks after completion of treatment. Early viral kinetics and histopathological evaluation of pre-and post treatment liver biopsies were performed. The primary end point was viral clearance 48 weeks after completion of treatment. Results: Sustained virological response was achieved in 29%, 66%, and 69% of patients treated with PEG-IFN-a-2b and ribavirin for 24, 36, and 48 weeks, respectively, by intention to treat analysis. No statistically significant difference in sustained virological response rates was detected between 36 and 48 weeks of therapy (p = 0.3). Subjects with sustained virological response showed greater antiviral efficacy (e) and rapid viral load decline from baseline to treatment week 4 compared with non-responders and improvement in liver histology. The incidence of adverse events was higher in the group treated for 48 weeks. Conclusion: PEG-IFN-a-2b and ribavirin for 36 or 48 weeks was more effective in the treatment of chronic hepatitis C genotype 4 than treatment for 24 weeks. Thirty six week therapy was well tolerated and produced sustained virological and histological response rates similar to the 48 week regimen.

Background: Acute appendicitis is the most common acute abdominal condition. For many decades the... more Background: Acute appendicitis is the most common acute abdominal condition. For many decades the diagnosis has depended mainly on clinical examinations, laboratory investigations such as leukocytosis, and abdominal sonography. Occasionally it can be challenging to reach the diagnosis, as there many differential diagnoses for right iliac fossa pains, especially in women. Thus, there is an encouraging demand for laboratory markers for the diagnosis. Objective: Our study aims to the assessment of total serum bilirubin level as a laboratory marker for diagnosing acute appendicitis. Methods: A prospective study collected data from 500 patients. All patients' demographic details, duration of symptoms, vital data, and blood samples were collected on admission for full blood count, and liver function tests including bilirubin. All the removed appendices will be sent for histopathological examination and were classified into 5 groups according to the histological diagnosis, variable from no pathological findings in the First group, to acute necrotizing appendicitis in the fifth group. Results: There were highly major differences between each group as regards the duration of symptoms in hours till the time of taking the samples. There was no difference between the patients regarding the temperature, and the pulse rate, but Total serum bilirubin (TSB) was ≥1.00 (mg/dl), with a sensitivity of 58% and specificity of 82%, with a diagnostic accuracy of 70%. White blood cells (WBCs) were≥11 (×103/µL), with a sensitivity of 68% specificity of 66%, and diagnostic accuracy of 67%. Conclusion: TSB is a valuable indicator of patients having acute appendicitis, with higher specificity than WBCs.

Journal of Internal Medicine: Science & Art

Background: Colon cancer begins in the large intestine (colon) and is aggressive due to late diag... more Background: Colon cancer begins in the large intestine (colon) and is aggressive due to late diagnosis, so there is a poor prognosis and higher mortality rates, as reported. Colon cancer has become a vital research area requiring more investigation of cellular signaling in its initiation and development. Aim: The study aimed to investigate the biological effects of Glycerol in cell proliferation and the possible regulation of cellular signaling by exogenous treatment of Glycerol in colon cancer cells compared with colon mucosal epithelial cells. Materials and Methods: The influence of Glycerol on cell viability rate was monitored by inverted microscopy, and the number of living cells was assessed upon incubation with different concentrations of Glycerol. We further inspected the apoptotic rate of CaCo-2 cells by using Annexin-V staining by flow cytometry. Moreover, we achieved the expression profile of lysosomal-associated proteins, LAMP-1 and LAMP-2, in treated cells using qRT-PCR...

Ain Shams Journal of Surgery, Jul 1, 2008

Ethical research principles are considered universal, transcending geographic, cultural, economic... more Ethical research principles are considered universal, transcending geographic, cultural, economic, legal and political boundaries. Although these principles are universal, the availability of the resources needed to maintain these principles is not universal.

Background: Women with antiphospholipid antibodies (aPL) have a significant risk of reproductive ... more Background: Women with antiphospholipid antibodies (aPL) have a significant risk of reproductive failure and adverse pregnancy outcomes, the recurrent miscarriages, intrauterine fetal deaths, and intrauterine fetal growth restriction is significant among these patients. Women with a history of recurrent abortion and unexplained fetal death or a history of recurrent thrombotic episodes should be screened for the presence of antiphospholipid antibodies. We studied the incidence of anticardiolipin antibodies (aCL) and lupus anticoagulant (LA) factor in recurrent unexplained miscarriages and intrauterine fetal deaths. Subjects and Methods: We performed a cohort study among women who attended the department of Obstetrics and Gynecology, Assiut University hospitals, Assiut, Egypt, between October 2007 and October 2011 after being referred due to recurrent miscarriage (≥ 2 consecutive pregnancy losses). All women underwent a standardized investigation sequence. Women with other reasons for...

Poster: "ESTI 2015 / P-0097 / Image guided lung biopsies: Evolving experience in a large UK ... more Poster: "ESTI 2015 / P-0097 / Image guided lung biopsies: Evolving experience in a large UK district general hospital" by: "A. Ismail, R. Dickens, R. Martins, K. Jayawardhana, P. McParland, R. Clark, E. Heiden, A. Wallis; Portsmouth/UK"

مجلة البحث العلمی فی الآداب, 2017

The language of law has distinct grammatical features that make it different from the other varie... more The language of law has distinct grammatical features that make it different from the other varieties of language. This paper examines two of the function word classes that can be compared according to their function: determiners and pronouns. The corpus used for analysis is an instance of public international law. It is the recent UN human rights treaties of the 2000s, which are Convention on the Rights of Persons with Disabilities (CRPD) in 2006 and International Convention for the Protection of All Persons from Enforced Disappearance (CPED) in 2006. The analysis uses Biber et al."s Longman Grammar of Spoken and Written English (LGSWE) as a framework for the qualitative and functional analyses, and corpus linguistics for the quantitative analysis. The results generally reveal and confirm that the language of law is formal, impersonal, and gender-neutral. In addition, it seeks precision and clarity.

Journal of Al-Azhar University Engineering Sector, 2019

In the current study, potential improvements in both flow field and heat transfer characteristics... more In the current study, potential improvements in both flow field and heat transfer characteristics of a prototype solar chimney for power generation through passive flow control approaches have been numerically examined. The numerical modeling was conducted for three different schemes to enhance the velocity magnitude at the entrance of the chimney. The first scheme is concerned with the effect of the number of turbulent generators on the maximum flow speed obtained while the second scheme deals with the effect of throat area at the entrance of the chimney. The last scheme is related to investigating the effect of making round edges having different radii at the entrance of the chimney.

Journal of Geophysical Research: Atmospheres, 2019

This paper presents the results of long-term observations (1964-2010) of direct solar flux at two... more This paper presents the results of long-term observations (1964-2010) of direct solar flux at two stations in the Tatra Mountains in Poland (Central Europe). The measurements obtained from a Linke-Feussner actinometers are used to estimate broadband (0.29-2.9 μm) and wideband (0.53-0.63 μm) aerosol optical depth (BAOD, WAOD). Both BAOD and WAOD at Mount Kasprowy Wierch (1991 m a.s.l.) and in Zakopane (851 m a.s.l) show similar annual cycles with peaks during spring and summer. Coincidence of actinometer observation at the top of the Tatra Mountains and in Zakopane valley allows determination of AOD in the column between 851 and 1991 m a.s.l. Annual variability of both BAOD and WAOD for this layer are similar to PM 10 concentration measurements in Zakopane. Conversely, BAOD and WAOD obtained at both stations show opposing annual variability, which is consistent with AErosol RObotic NETwork (AERONET) and model results in Central Europe. Long-term data show significant reduction of both BAOD and WAOD in Zakopane (-0.0180.

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 15, 2018

The current study aims to compare the analgesic effect of lidocaine-prilocaine (LP) cream with li... more The current study aims to compare the analgesic effect of lidocaine-prilocaine (LP) cream with lidocaine infiltration during repair of perineal tears after vaginal delivery. A single center open-labeled randomized clinical trial was carried out in a tertiary University Hospital between October 2016 and May 2017 (Clinical Trials.Gov: NCT02883179). We included parous women delivered at gestational age > 37 weeks with first or second degree perineal tears. The participants were randomized in a 1:1 ratio to either lidocaine infiltration (Group I); or application of LP cream (Group II) for pain relief during perineal repair. The primary outcome was the difference in mean pain score during perineal repair. Secondary outcomes included the participants' satisfaction, the need for additional anesthesia, the duration of perineal repair and the rate of adverse effects of both medications. The study included 144 participants randomized to both groups. The mean pain score during perineal ...

Phlebology, 2017

Objectives To report on a male cohort with pelvic vein reflux and associated primary and recurren... more Objectives To report on a male cohort with pelvic vein reflux and associated primary and recurrent lower limb varicose veins. Methods Full lower limb duplex ultrasonography revealed significant pelvic contribution in eight males presenting with bilateral lower limb varicose veins. Testicular and internal iliac veins were examined with either one or a combination of computed tomography, magnetic resonance venography, testicular, transabdominal or transrectal duplex ultrasonography. Subsequently, all patients received pelvic vein embolisation, prior to leg varicose vein treatment. Results Pelvic vein reflux was found in 23 of the 32 truncal pelvic veins and these were treated by pelvic vein embolisation. Four patients have since completed their leg varicose vein treatment and four are undergoing leg varicose vein treatments currently. Conclusion Pelvic vein reflux contributes towards lower limb venous insufficiency in some males with leg varicose veins. Despite the challenges, we sugg...

The current study aims to evaluate the effect of peri-conceptional progesterone started early in ... more The current study aims to evaluate the effect of peri-conceptional progesterone started early in the luteal phase before confirmation of pregnancy in preventing miscarriage in women with history of unexplained recurrent miscarriage (RM). The current study was a randomized double blind controlled trial (NCT01608347) conducted at Assiut Women's Health Hospital from 2012 through 2015 included patients of unexplained RM. Participants were randomly assigned to receive either 400 mg progesterone pessaries or placebo twice daily, started in the luteal phase and continued after a positive pregnancy test till 28 weeks of gestation. The main study outcome was the miscarriage rate. Seven hundred women were enrolled (n = 350 in each group). The miscarriage rate was significantly lower in progesterone group (12.4% vs. 23.3% in the placebo group, P = 0.001). There was significant improvement in rate of pregnancy continuation beyond 20 weeks as well as the live birth rate in the progesterone g...

Human Reproduction Update, 2016

conclusion: This review successfully explored the important psychosocial aspects of oocyte donati... more conclusion: This review successfully explored the important psychosocial aspects of oocyte donation. In general terms the attitudes and feeling of patients involved from all sides of the donation process were extremely positive. A number of key and consistent issues emerged which demonstrated differences and similarities between the different donor groups, as well as a greater understanding of the recipient. With regard to psychosocial well-being, the results were reassuring throughout all donor groups, especially the egg share donors. Although it seems the 2005 legislative changes in the UK have not caused the anticipated dramatic decrease in gamete donation, oocyte donation still falls far short of demand. The UK has an increasing population of patients from different ethnic backgrounds and same sex relationships seeking oocyte donation, with very few studies including these groups of patients. An increased number of well-designed studies looking into the psychological issues surrounding gamete donation of different patient groups, could allow more directed assessment and counselling of oocyte donors and recipients, with a resulting increase in donor recruitment.

Middle East Fertility Society Journal, 2016

ABSTRACT Objective: The study aims to state the effectiveness of a new combination treatment comp... more ABSTRACT Objective: The study aims to state the effectiveness of a new combination treatment composed of folic acid, doxycycline, low dose aspirin and natural progesterone in cases of recurrent early pregnancy loss. Study design: A clinical comparative hospital-based study. Setting: Women Health Hospital – Assiut University – Egypt. Materials and methods: All patients with recurrent early pregnancy loss at 10 weeks or less attending our antenatal care unit were included. The patients were recruited over a period of 16 months and allocated into two groups. The study group received a regimen of folic acid, doxycycline, aspirin, and progesterone. The control group did not receive the previous regimen in the proposed way. The main outcome measures the live birth rate and complications of pregnancy in both groups. Results: Three hundred patients were recruited, with 150 women in each group. A high rate of live births was found in the study group (76.0%) more than the control group (59.3%). Women in the Control Group reported more complications (76.0% vs. 51.3%). These were mainly abortion (40.0% vs. 23.3%), pre-eclampsia (16.0% vs. 10.7%) and oligohydramnios (10.0% vs. 6.7%). Conclusion: The implementation of combination treatment of folic acid, doxycycline, low dose aspirin and natural progesterone resulted in a significant increase in the live birth rate, a significant reduction in miscarriages, and lower incidence of complications in patients with recurrent early pregnancy loss.

British Journal of Hospital Medicine, 2015

Journal of Gynecologic Surgery, 2015

Background: Abdominal pregnancy is a rare form of ectopic gestation. Early diagnosis of this rare... more Background: Abdominal pregnancy is a rare form of ectopic gestation. Early diagnosis of this rare condition is difficult, owing to its atypical presentation and low index of suspicion. The characteristic history is that of abdominal pain, vaginal bleeding, and symptoms related to the gastrointestinal tract. These symptoms are occasionally overlooked, and the diagnosis is often missed. Case: A 20 year-old woman, gravida 2, para 0 + 1, 30 weeks' pregnant, presented with abdominal pain and absent foetal movements for 7 days. There was no history of pain prior to this episode, and she had no vaginal bleeding during pregnancy. She reported that she had regular antenatal care with 3 ultrasound scans confirming a normal pregnancy. On examination, the fetal position was transverse with easily palpable fetal parts. Fetal heart sounds were audible. Ultrasound examination revealed an unexpectedly empty uterus with a 30 week-old fetus and an extrauterine placenta. Magnetic resonance imaging (MRI) confirmed the previous findings. Laparotomy was performed to extract the fetus and the placenta. Results: The patient's postoperative course was uneventful, and she was discharged after 5 days. The neonate died after 2 weeks because of severe respiratory distress syndrome. Conclusions: Despite being very rare, abdominal pregnancy should be suspected regardless of gestational age. The presence of easily palpable fetal parts and an empty uterus should warrant the diagnosis. Good quality antenatal care is mandatory for early detection of this rare condition, Ultrasound examination remains the ''gold standard'' for initial diagnosis. However, MRI may be necessary to confirm the diagnosis. (J GYNECOL SURG 31:40)

British Journal of Hospital Medicine, 2013

A 48-year-old black male, of Nigerian heritage, presented with a 24-hour history of frontal heada... more A 48-year-old black male, of Nigerian heritage, presented with a 24-hour history of frontal headache of gradual onset. The headache characteristic was migranous, being described as throbbing in nature and located to the right frontal area with associated blurring of vision. Although similar to prior frequent headaches, there was now increasing unsteadiness on walking. Diagnosed 10 years earlier with Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease, the initial presentation was with oral and genital ulceration. Recurrent episodes of headache caused by neurological flare-ups resulted in a stroke at the age of 46 years. This previous stroke was ischaemic in character with involvement of the brainstem, pons, midbrain and right cerebral peduncle with extension into the right internal capsule. Surveillance brain imaging (computed tomographic and magnetic resonance imaging with venography) 10 months earlier showed brainstem disease activity (Figure 1a) with disease quiescence a month later (Figure 1b) following an escalation of immunosuppressant therapy. Regular medications comprised prednisolone 10 mg (however, regular recurrences had resulted in him taking doses of between 20 and 30 mg/day of prednisolone for most of the past 24 months) and azathioprine 150 mg daily, aspirin 75 mg daily, one adcal D3 twice daily with weekly alendronic acid, and omeprazole 20 mg daily. For headache he took topiramate 25 mg daily and for depression mirtazepine 15 mg daily. The patient was also addicted to a high level of cannabis use which he was reluctant to stop as he felt it helped his symptoms. On examination he was apyrexial and cardiovascularly stable. Neurological examination revealed a residual horizontal nystagmus to the right on lateral gaze, mild left hemiparesis with moderate spasticity, in addition to dysarthria and dysphonia from his prior stroke. A new feature was an exacerbation of gait unsteadiness. Blood tests were unremarkable and specifically the erythrocyte sedimentation rate was normal at 2 mm/hr (normal range 0-10 mm/hr). Immediate therapy involved an increase in steroid dosage to methyl prednisolone 1 g/day for 3 days, followed by oral prednisolone 60 mg daily. This was maintained for 2 weeks and then reduced by 10 mg/week to a maintenance dose of 10 mg/day. Magnetic resonance scanning revealed a marked increase in inflammation of the brainstem (Figure 1c). The patient required physiotherapy and occupational therapy with psychiatric input and was able to leave the hospital after 29 days.

Gynecological Surgery, 2014

The current case series was done to evaluate the feasibility of transfundal hysteroscopy (TFH) in... more The current case series was done to evaluate the feasibility of transfundal hysteroscopy (TFH) in helping the development of new cervical canal in cases with cervical aplasia. Five cases with obstructive cervicovaginal agenesis with hematometra were included in this report. Laparoscopicguided TFH was done in conjunction with endoscopic canalization to all cases. Additional retropubic balloon vaginoplasty (BV) was needed in three cases with associated vaginal aplasia. The hysteroscope was passed through the uterine fundus. After complete washing, the endometrial lining was inspected, and a properly located intrauterine catheter coming out from the vagina or vaginal dimple was used to drain the uterine cavity and maintain the cervical tract. The procedure was done successfully in all cases with adequate drainage of hematometria. Additional time needed for TFH was between 4 to 15 min. Second-look hysteroscopy revealed adequate canalization in all cases. The five cases had regular menstrual cycles up to the sixth postoperative month. In conclusion, TFH is a safe and feasible procedure as a harmonizing technique during endoscopic canalization of cervical atresia with or without BV in cases of obstructive Müllerian anomalies. The procedure accelerates the drainage of uterine contents and localizes the correct site of draining catheter.