Mahmoud El-Meteini | Ain Shams University (original) (raw)

Papers by Mahmoud El-Meteini

Transplantation, Jul 1, 2018

CRAD0001H2307 Introduction Early initiation of everolimus (EVR) with reduced-exposure tacrolimus ... more CRAD0001H2307 Introduction Early initiation of everolimus (EVR) with reduced-exposure tacrolimus (rTAC) has been shown to maintain an efficacy and safety profile comparable to that of a standard-exposure TAC (sTAC) regimen and preserves renal function in living-donor liver transplant recipients (LDLTRs) up to 12 months post-LT. Here, we present 24-month (M) renal function outcomes from the H2307 study involving LDLTRs receiving EVR+rTAC or sTAC regimens. Methods H2307 (NCT01888432) was a 24M, multicentre, open-label trial in which 284 adult de novo LDLTRs were randomized (1:1) on Day 30±5 post-LT to receive EVR+rTAC (EVR trough level [C0]: 3-8 ng/mL; TAC C0: 3-5 ng/mL) or sTAC (TAC C0: randomization (RND)-M4: 8-12 ng/mL; after M4: 6-10 ng/mL) regimen. Efficacy assessment at M24 was incidence of composite efficacy failure of treated biopsy-proven acute rejection, graft loss, or death in EVR+rTAC and sTAC arms. Renal assessments at M24 included estimated glomerular filtration (eGFR [MDRD4]) in overall study population and in patients with hepatocellular carcinoma (HCC). Other assessments included evaluation of proteinuria and renal adverse events (AEs) up to M24. Results Overall results are presented in Table 1. Of 284 randomized patients, 88% in both arms completed the 24M study. At M24, 78% of patients in EVR+rTAC arm were within EVR C0 range although mean TAC C0 was below target range in sTAC arm. EVR+rTAC was non-inferior to sTAC for the primary endpoint of composite efficacy failure at M24 (9.0% vs 8.0%; P<0.001 by one-sided test for non-inferiority). In the overall population, eGFR was comparable between EVR+rTAC and sTAC (78.4 and 75.3 mL/min/1.73 m2) arms, with between-arm least square mean change from RND to M24 not significantly different in the full analysis and on-treatment populations. Among patients with HCC at LT, eGFR was significantly higher in the EVR+rTAC arm (P = 0.009). In overall population, proportion of patients with M24 eGFR ≥60 mL/min/1.73 m2 was higher in the EVR+rTAC (76.4%) vs sTAC (66.9%) arm. Although mean proteinuria and urinary protein creatinine ratio (UPCR) were significantly higher in EVR+rTAC vs sTAC arm (P<0.001), most patients in both arms remained in the low-to-mild categories for proteinuria (>80% with <0.5 g/24 h/SA) and UPCR (>70% with ≥30-<300 mg/g) at M24. Incidence of AEs and AEs leading to study drug discontinuation was comparable between arms; however, discontinuations due to renal AEs such as renal failure and renal impairment were numerically lower in EVR+rTAC vs sTAC arm (Table 2). Conclusions At M24, early EVR initiation with rTAC in LDLTRs resulted in comparable renal function outcomes as sTAC regimen. Significantly better renal function was observed in patients with HCC on EVR+rTAC, which warrants additional analysis. Table. No title available. Table. No title available.

Additional file 1: Supplementary Table 1. Self-reported pre-existing medical conditions among hea... more Additional file 1: Supplementary Table 1. Self-reported pre-existing medical conditions among healthcare workers (n = 4040). Supplementary Table 2. Symptoms reported by healthcare workers (n = 4040). Supplementary Table 3. Factors associated with positive SARS-Co-V2 test among healthcare workers excluding electronic device users (n = 4006).

Journal of Hepatocellular Carcinoma

Globally, hepatocellular carcinoma (HCC) is the fourth most common cause of death from cancer. Th... more Globally, hepatocellular carcinoma (HCC) is the fourth most common cause of death from cancer. The prevalence of this pathology, which has been on the rise in the last 30 years, has been predicted to continue increasing. HCC is the most common cause of cancer-related morbidity and mortality in Egypt and is also the most common cancer in males. Chronic liver diseases, including chronic hepatitis C, which is a primary health concern in Egypt, are considered major risk factors for HCC. However, HCC surveillance is recommended for patients with chronic hepatitis B virus (HBV) and liver cirrhosis; those above 40 with HBV but without cirrhosis; individuals with hepatitis D co-infection or a family history of HCC; and Nonalcoholic fatty liver disease (NAFLD) patients exhibiting significant fibrosis or cirrhosis. Several international guidelines aid physicians in the management of HCC. However, the availability and cost of diagnostic modalities and treatment options vary from one country to another. Therefore, the current guidelines aim to standardize the management of HCC in Egypt. The recommendations presented in this report represent the current management strategy at HCC treatment centers in Egypt. Recommendations were developed by an expert panel consisting of hepatologists, oncologists, gastroenterologists, surgeons, pathologists, and radiologists working under the umbrella of the Egyptian Society of Liver Cancer. The recommendations, which are based on the currently available local diagnostic aids and treatments in the country, include recommendations for future prospects.

Surgical Endoscopy and Other Interventional Techniques, Sep 1, 2000

Bowel injury is an uncommon but severely hazardous complication of various laparoscopic procedure... more Bowel injury is an uncommon but severely hazardous complication of various laparoscopic procedures. Twelve cases of bowel injuries complicating different laparoscopic procedures were diagnosed or received at Ain Shams University and Menofia University hospitals over the last 3 years. The mechanism of injury was analyzed, the diagnostic methods and surgical management scrutinized, and the prognosis studied. The injuries were attributed to the inadvertant introduction of Veress needles or sharp-tipped trocars or forcible undue dissection. Failure of pneumoperitoneum was implicated in two cases. Faulty judgment of the extent and site of adhesions contributed to the damage in two cases. In four cases, the duodenum was injured. The colon was perforated in six cases, and the small bowel sustained damage in two cases. Three of the patients died, all of duodenal injury. The other nine patients survived by virtue of diagnosis and proper operative management. Every measure should be taken to avoid the occurrence of bowel injury during laparoscopy. Intraoperative or early postoperative diagnosis and proper management of laparoscopic-induced bowel injuries can minimize morbidity and mortality and yield a better prognosis.

Liver transplantation and surgery, 1995

Middle East Current Psychiatry, Sep 5, 2019

Background: Living donor liver transplantation is an effective line of therapy for patients with ... more Background: Living donor liver transplantation is an effective line of therapy for patients with end-stage liver disease. While there are various psychiatric complications that affect donors, only a few studies investigated such complications among Egyptian living donors. Results: The study showed psychiatric morbidity in 15% of donors, especially anxiety disorders and major depression. Donors had high mean scores on psychoticism, neuroticism, impulsivity, and extraversion subscales of the EPQ. Female gender, younger age group, low educational level, managerial work, being the sibs of the recipients, and obtaining high scores in the EPQ were found to be independent risk factors correlated with the development of psychiatric morbidity in liver donors. Conclusion: The increased frequency of psychiatric morbidity among liver donors raises the need for thorough pre-and postoperative psychiatric assessment and monitoring. It is mandatory to investigate the donors' personality traits preoperatively to assess the decision-making process for donation and postoperatively to plan appropriate protective and treatment programs.

The Journal of Pathology, Jul 7, 2021

High-grade dysplasia carries significant risk of transformation to hepatocellular carcinoma (HCC)... more High-grade dysplasia carries significant risk of transformation to hepatocellular carcinoma (HCC). Despite this, at the current standard of care, all non-malignant hepatic nodules including high-grade dysplastic nodules are managed similarly. This is partly related to difficulties in distinguishing high-risk pathology in the liver. We aimed to identify chromosome arm-level somatic copy number alterations (SCNAs) that characterise the transition of liver nodules along the cirrhosis-dysplasia-carcinoma axis. We validated our findings on an independent cohort using blood-derived cell-free DNA. A repository of non-cancer DNA sequences obtained from patients with HCC (n = 389) was analysed to generate cutoff thresholds aiming to minimise false-positive SCNAs. Tissue samples representing stages from the multistep process of hepatocarcinogenesis (n = 184) were subjected to low-pass whole genome sequencing. Chromosome arm-level SCNAs were identified in liver cirrhosis, dysplastic nodules, and HCC to assess their discriminative capacity. Samples positive for 1q+ or 8q+ arm-level duplications were likely to be either HCC or high-grade dysplastic nodules as opposed to low-grade dysplastic nodules or cirrhotic tissue with an odds ratio (OR) of 35.5 (95% CI 11.5-110) and 16 (95% CI 6.4-40.2), respectively (p < 0.0001). In an independent cohort of patients recruited from Nottingham, UK, at least two out of four alterations (1q+, 4qÀ, 8pÀ, and 8q+) were detectable in blood-derived cell-free DNA of patients with HCC (n = 22) but none of the control patients with liver cirrhosis (n = 9). Arm-level SCNAs on 1q+ or 8q+ are associated with high-risk liver pathology. These can be detected using low-pass sequencing of cell-free DNA isolated from blood, which may be a future early cancer screening tool for patients with liver cirrhosis.

Journal of Hepatology, 1994

In end-stage cirrhosis complicated by variceal hemorrhage, attempts to reduce portal pressure by ... more In end-stage cirrhosis complicated by variceal hemorrhage, attempts to reduce portal pressure by treatments such as portosystemic shunts also decrease sinusoidal perfusion and risk impairing liver function. It has been suggested that encouraging portal flow to pass through the cirrhotic liver by mechanical action could cause a decrease in distal (splanchnic) portal pressure on one hand, and improve liver function on the other. The aim of this work was to evaluate the hemodynamic and functional effects of a 30-min pump-driven increase in portal blood flow through the liver of patients with end-stage cirrhosis before the anhepatic phase of liver transplantation. Basel portal flow (800 +/- 270 ml.min-1) was increased two fold (n = 10) or four fold (n = 9). When the flow was doubled, splanchnic portal pressure decreased 17.9 +/- 11.3% (from 31.8 +/- 5.3 to 26.0 +/- 5.8 mmHg, n = 10; p < 0.001); when flow was increased four fold, splanchnic portal pressure decreased 39.2 +/- 15.4% (from 32.8 +/- 5.0 to 19.9 +/- 6.0 mmHg, n = 9; p < 0.001). The comparison of indocyanine green clearance between basal and doubled portal flow demonstrated an increase of 32.1 +/- 26.9% (n = 5; p = 0.053). Histological analysis demonstrated sinusoidal dilatation in three out of ten livers. These results, as well as previous studies using isolated perfused cirrhotic rat or human livers, suggest that portal pumping should be explored as a treatment for certain sclerotherapy-resistant cirrhotic patients, with variceal hemorrhage and liver failure.

Middle East Current Psychiatry, Jan 14, 2022

Background: Liver transplantation (LT) helped to save the life of end stage liver disease (ESLD) ... more Background: Liver transplantation (LT) helped to save the life of end stage liver disease (ESLD) patients; however, there is a debate on the persistence of cognitive impairment. The study aimed to evaluate cognitive functions in patients with ESLD before and after liver transplantation and to assess its relation to hepatic encephalopathy (HE). Thirty recipients 47.6 ± 11 years undergone living donor liver transplantation at the transplantation center of both Ain Shams Center for Organ Transplant and Egypt air organ transplant unit were prospectively assessed by Trail Making Test, Wechsler Memory Scale-Revised, Benton Visual Retention-for the evaluation of cognitive functions before and 3 months after transplantation. Results: The mean age of the patients was 47.6 ± 11 years, 17 males and 13 females. Eight out of 30 (26.7%) had past history of hepatic encephalopathy. The study reported significant improvement in the post-operative 3 months scores of Trail Making Test part (A), the digit span forward test, digit span backward test and the correct score difference of the Benton Visual Retention, as p value was (0.02), (0.01) (0.02), and (0.01) respectively, compared to the preoperative scores. However, there was no difference in the scores of part (B), verbal association I, II, information subtest of WMS. Cognitive performance showed no significant difference between patients with or without history of HE. Conclusions: Patients with ESLD have significant cognitive impairment that showed improvement after LT; HE did not correlate with cognitive function. Hence, transplantation has a favorable outcome on the cognitive impairment.

European Neuropsychopharmacology, Oct 1, 2013

The Egyptian Journal of Hospital Medicine, Jul 1, 2018

Background: cognitive control refers to the ability to regulate, coordinate, and sequence thought... more Background: cognitive control refers to the ability to regulate, coordinate, and sequence thoughts/actions in accordance with the current task goals. It comprises a set of components including task switching, updating and response inhibition and coordinating multiple simultaneous operations. The fronto parietal network has been suggested as a neural basis for cognitive control. Liver transplantation is one of the most dynamic fields in modern medicine and is a lifesaving option for patients with end stage liver disease. Since the first successful transplantation in 1967, liver transplantation has been performed in many centers worldwide saving thousands of liver failure patients. Aim of the Work: based on that, our study aimed to assess cognitive functions, depression, and anxiety in patients with end stage liver disease before and after liver transplantation, then compare between both. Patients and Methods: the study involved convenience sample of 44 recipients with ESLD prepared for liver transplant, 30 of which completed the study and 14 cases dropped out. Results: all data were recorded and statistical analysis was done using the Statistical Package for Social Science SPSS-20th version. The results were tabulated, grouped and statistically analyzed using the suitable statistical parameters. For description analysis. Conclusion: more liver impairment as estimated by Child Pugh score and MELD score associated with more impairment in cognitive tasks. In the current study the presence or absence of hepatic encephalopathy had no relation to cognitive function.

Gut, Jun 1, 2016

Conclusion In the primary care population that was screened for major risk factors of chronic liv... more Conclusion In the primary care population that was screened for major risk factors of chronic liver disease, a raised BMI and type 2 diabetes accounted for over 80% of those with clinically significant chronic liver disease. Population based interventions are urgently required to address obesity and type 2 diabetes which are likely to contribute to the burden of cirrhosis in the next decade. REFERENCE 1 Roulot D, et al. Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years. Gut 2011;60 (7):977-84.

Surgical Endoscopy, 1993

We describe the technique of thoracoscopic removal of benign tumors of the esophagus. The technic... more We describe the technique of thoracoscopic removal of benign tumors of the esophagus. The technical problems of this new approach are described in the context of our initial experience of four cases.

Ain Shams Journal of Surgery, Jul 1, 2007

Journal of Digestive Diseases, Nov 1, 2015

Understanding issues pertaining to quality of life is essential for any disease, particularly in ... more Understanding issues pertaining to quality of life is essential for any disease, particularly in liver transplantation recipients. Of this study was to evaluate the impact of liver transplantation on the Quality of life in Egyptian recipients METHODS: Prospective study carried out in Ain Shams Center for Organ Transplantation, Cairo, Egypt. It included 35 recipients evaluated for health related quality of life using Short Form 36 score (arabic version) and Beck Depression Inventory scores pre-transplantation 1, 3and 6 months after. The mean age for the patients was 49.27 ± 8.16.Seventeen patients were highly educated.Our results showed statistically significant improvement in all dimensions of health related quality of life after liver transplantation. Physical functioning was 45.00 ± 34.34 before liver transplantation while one month and six months after liver transplantation it was 57.50 ± 20.66 and 74.83 ± 19.27 respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.001). Seventeen patients completed their first year after transplantation, the results showed statistically significant improvement in all dimensions of Health related quality of life one year after liver transplantation except in the mental health, role emotional and social function domains. Health related quality of life is important aspect of liver transplantation procedure that shouldn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t be neglected. This article is protected by copyright. All rights reserved.

Journal of Liver Transplantation