Internal tandem duplication (ITD) of the FLT3 gene (FLT3/ITD) has been linked to poor outcome in ... more Internal tandem duplication (ITD) of the FLT3 gene (FLT3/ITD) has been linked to poor outcome in acute myeloid leukemia (AML). However, the prognostic value of FLT3/ITD in various cytogenetic risk groups is still a matter of debate. The aim of this study was to evaluate the prognostic significance of FLT3/ITD in patients with de novo AML and normal or favorable risk cytogenetics (NFC-AML). Blood samples from 39 patients with AML were subjected to PCR of exons 14 and 15 of the FLT3 gene. Patients included 25 with normal cytogenetics, 8 with t(15;17), 4 with t(8;21) and 2 with inv(16). FLT3/1ITD was found in 6/39 (15.4%) patients, 4 of them showed normal cytogenetic, 1 positive for t(15;17) and 1 positive for t(8;21). Patients were M1 3/13, M2 2/12, M3 1/9, M4 0/4 and M5 0/1. The patients were followed up for a mean of 34.5 +/- 2.3 months. The complete remission (CR) rates for the FLT3/ITD+ and FLTITD- groups were 50% vs 63.6%, while the relapse rates were 50% vs 28.6% respectively. Interestingly, disease free survival (DFS) at 3 years was significantly different in studied patients: DFS was 5% in patients with FLT3/ITD+ vs 30% of patients with FLT3/ITD- (P = 0.001). Our data suggest a possible high prognostic value of FLT3/ITD in patients with normal/favorable cytogenetics.
Background Juvenile idiopathic arthritis (JIA) is children's most common autoimmune musculoskelet... more Background Juvenile idiopathic arthritis (JIA) is children's most common autoimmune musculoskeletal disease. The spectrum of patients' pro les of JIA showed many similarities and differences among different populations. Aim of the work The purpose of this study is to determine the prevalence, subtypes, distribution, and characteristic features of JIA among children in Rheumatology outpatient clinic at Mansoura University Children's Hospital (MUCH). Patients and methods The study was a cross-sectional observational study carried out in the rheumatology outpatient clinic in Mansoura University children's Hospital, on 73 patients diagnosed with JIA according to the International League of Associations for Rheumatology (ILAR) from April 2019 to April 2020. Results There was a statistically signi cant difference between JIA types as regard age of patients, age of onset of disease, duration of the disease affected at the time of diagnosis, fever, rash, and organomegaly with the highest value in psoriatic type. There was a statistically signi cant difference in methotrexate (MTX), Humera, Enbrel, and Le unomaide usage between JIA subtypes. The severity of the disease was correlated signi cantly with laboratory parameters including the erythrocyte sedimentation rate, C reactive protein, and platelets count. MTX, Pulse steroid, Actemra, and Le uonamide usage differed signi cantly according to the severity of the disease while Humera, Endoxan, Enbrel, and NSIAD showed no signi cant difference. Conclusion The types of JIA differ signi cantly from each other as regards fever, rash, and organomegaly with an increase in systemic onset rather than other types. While ophthalmic affection shows no signi cant difference between JIA subtypes. A low percentage of cases had uveitis indicating low severity of disease in the studied cases. Biological treatment was given to severe and resistant cases when indicated.
Background Juvenile idiopathic arthritis (JIA) is children's most common autoimmune musculosk... more Background Juvenile idiopathic arthritis (JIA) is children's most common autoimmune musculoskeletal disease. The spectrum of patients’ profiles of JIA showed many similarities and differences among different populations. Aim of the work The purpose of this study is to determine the prevalence, subtypes, distribution, and characteristic features of JIA among children in Rheumatology outpatient clinic at Mansoura University Children's Hospital (MUCH). Patients and methods The study was a cross-sectional observational study carried out in the rheumatology outpatient clinic in Mansoura University children’s Hospital, on 73 patients diagnosed with JIA according to the International League of Associations for Rheumatology (ILAR) from April 2019 to April 2020. Results There was a statistically significant difference between JIA types as regard age of patients, age of onset of disease, duration of the disease affected at the time of diagnosis, fever, rash, and organomegaly with the ...
Background Neuropsychiatric manifestations of lupus (NPSLE) are considered one of the major and m... more Background Neuropsychiatric manifestations of lupus (NPSLE) are considered one of the major and most devastating lupus manifestations. The aim of this study was to assess the neuropsychiatric manifestations in systemic lupus erythematosus (SLE) patients and estimate the effectiveness of brain magnetic resonance spectroscopy (MRS) and anti-ribosomal P antibody test in early detection of NPSLE. This cross-sectional study was carried out on 50 SLE patients. Demographic, clinical, and therapeutic data were assessed. All patients were subjected to thorough rheumatological and neuropsychiatric evaluation. Serologic tests included antinuclear antibodies, anti-double-stranded DNA, and anti-ribosomal P protein antibodies. Radiologic evaluation included brain MRS. Results The mean age was 26.9 ± 98.9 years; the median disease duration was 18 (0–108) months. Headache was the most common neurological symptom (40%). Depression was not detected in 29 patients (58%), mild in 15 patients (30%), and...
Background: Mycophenolic acid (MPA), an efficient immunosuppressive medication used in SLE, is gl... more Background: Mycophenolic acid (MPA), an efficient immunosuppressive medication used in SLE, is glucuronidated by UGTs into an inert 7-O-glucuronide. Studies have shown that the-275T>A and-2152C>T SNPs in the UGT1A9 promoter region are associated with greater hepatic production of UGT1A9 and higher MPA in vitro glucuronidation activity. Subjects and Methods: patients were selected from outpatient Clinics of Rheumatology and immunology department, UGT1A9-275T>A and-2152C>T (SNPs) were genotyped in 50 SLE Egyptian patients and 100 healthy controls using PCR-RFLP. In addition, MPA serum concentrations were measured in patients by homogeneous particle enhanced turbidimetric inhibition immunoassay (PETINIA) technique. Results: UGT1A9-2152C>T and-275T>A distribution of genotypic analysis in SLE patients and controls revealed that the-2152C>T mutation is present in 14% patients and 21% of the control group (P = 0.3), whereas the-275T>A mutation is present in 50% of patients and only in 11% of the control group (P = 0.001). In comparison to the (TT) genotype, the combined (TA+AA) genotype exhibited significant correlation with greater GIT symptoms (68% versus 5%, respectively, P = 0.001). In SLE patients taking MPA with CT+TT genotype against CC genotype,-2152C>T mutations revealed a higher incidence of anemia (85.7% versus%, 30.2 respectively P =0.009). Both SNP genotype carriers had statistically lower C0 MPA values compared to non-carriers (1.25 umol/L (0.62-7.8) versus 4.68 umol/L (0.62-25.9), P = 0.028. Conclusion: Carrier of both UGT1A9-2152C>T and-275T>A SNPS is associated with lower C0 MPA in comparison to non-carrier in Egyptian SLE patients.
Background Eye lesions, occur in nearly half of patients with Behçet’s Disease (BD), can lead to ... more Background Eye lesions, occur in nearly half of patients with Behçet’s Disease (BD), can lead to irreversible damage and vision loss; however, limited studies are available on identifying risk factors for the development of vision-threatening BD (VTBD). Using an Egyptian college of rheumatology (ECR)-BD, a national cohort of BD patients, we examined the performance of machine-learning (ML) models in predicting VTBD compared to logistic regression (LR) analysis. We identified the risk factors for the development of VTBD. Methods Patients with complete ocular data were included. VTBD was determined by the presence of any retinal disease, optic nerve involvement, or occurrence of blindness. Various ML-models were developed and examined for VTBD prediction. The Shapley additive explanation value was used for the interpretability of the predictors. Results A total of 1094 BD patients [71.5% were men, mean ± SD age 36.1 ± 10 years] were included. 549 (50.2%) individuals had VTBD. Extreme ...
Objectives:To delineate the cardiac magnetic resonance (MR) appearances of cardiovascular disease... more Objectives:To delineate the cardiac magnetic resonance (MR) appearances of cardiovascular disease (CVD) in patients with systemic lupus erythematosus (SLE), in comparison with transthoracic echocardiographs.Methods:Cardiac MR was performed on 22 patients with SLE—11 with previous CVD and 11 matched controls—using late gadolinium contrast enhancement (LGE) to identify areas of myocardial scarring; Transthoracic echocardiography (TTE) was performed on the same day.Results:Twenty female and two male patients participated. LGE was seen in 5/11 subjects in the CVD group (4/5 with previous myocardial infarction) and 1/11 in the control group. TTE detected myocardial abnormalities in 2/6 patients with LGE.Conclusion:The cardiac MR appearance of CVD in these patients with SLE was suggestive of coronary disease, rather than cumulative inflammatory muscle damage. Cardiac MR detected more abnormalities than TTE. Further studies of cardiac MR in patients with SLE are warranted to investigate th...
Chronic infection with the hepatitis C virus (HCV) is a major risk factor for the development of ... more Chronic infection with the hepatitis C virus (HCV) is a major risk factor for the development of hepatocellular carcinoma (HCC) worldwide .There is accumulating evidence that the genes controlling the actions of the renninangiotensin system (RAS) may influence malignancy development. The objective of the study was to investigate the relation of angiotensin converting enzymes (ACE &ACE2) genes polymorphisms to (HCC) in a group of Egyptian ( HCV) patients. The study was conducted on 120 Egyptian HCV and 100 HCC patients along with 130 healthy control volunteers. ACE insertion deletion (I/D) gene polymorphism was detected by PCR. ACE2 rs2106809 (C/T) gene Polymorphism was assessed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). HCC patients showed Increased frequency of the ACE D allele (high producing allele) compared to HCV patients and control (p<0.0001). Increased frequency of ACE2 T allele was detected among male HCC patients compared to male H...
Introduction: Resistance to interferon therapy in HCV patients represents a major health problem.... more Introduction: Resistance to interferon therapy in HCV patients represents a major health problem. The aim of the study was to assess the effect of insulin resistance (IR) and hyperferritenemia on the antiviral and immunomodulatory activities of interferon alpha (IFNα) therapy in Egyptian patients with hepatitis C virus (HCV) Design and Methods: The current study is a prospective, observational casecontrol study, a total of 165 patients with HCV recruited from Internal Medicine and Tropical DepartementsMansoura University Hospital, Egypt were enrolled in the study. According to their response to IFN α therapy were classified into responders and non responders. Serum HCV m RNA, glucose, insulin, ferritin and interferon gamma (IFNγ) were measured. (IR) was estimated by the homeostasis model of assessment for insulin resistance (HOMA-IR). Results: Non responder patients revealed elevated levels of serum ferritin and HOMA index accompanied by elevated HCV m RNA and IFN γ levels as compar...
Limited data exists on the role of Th17 cells in chronic HCV infected patients, particularly with... more Limited data exists on the role of Th17 cells in chronic HCV infected patients, particularly with regard to hepatic inflammation and fibrosis. We aimed to investigate the relationship between circulating and intrahepatic frequency of Th17 cells and IL-17 serum level and degrees of hepatic inflammation and fibrosis in chronic HCV patients, as well as to evaluate the effect of successful anti-viral therapy on these parameters. This nested longitudinal case control study included 30 treatment-naïve chronic HCV patients and 20 healthy individuals as control. All patients were investigated for circulating Th17 cell percentage (flow cytometry) and intrahepatic Th17 cell percentage (immunohistochemistry) and serum IL-17 (ELISA) at baseline and at week 12 after discontinuation of therapy. Circulating and intrahepatic Th17 cell percentage and serum IL17 level were found to be significantly higher in chronic HCV patients when compared with controls, with significant correlation with Metavir a...
Behçet's disease (BD) is a chronic multisystem variable vessel vasculitis. Disease damage is ... more Behçet's disease (BD) is a chronic multisystem variable vessel vasculitis. Disease damage is irreversible and permanent. Validated tools evaluating damage are limited. Enhancements in the clinical treatment of vasculitis will take place from the development of refined and exclusive indices for individual vasculitic syndromes including BD and attempting their international validation.
Egyptian Journal of Rheumatology and Clinical Immunology, 2014
Background: SLE is an autoimmune multisystem disease which results from both genetic predispositi... more Background: SLE is an autoimmune multisystem disease which results from both genetic predisposition and environmental factors. Ghrelin polypeptide is the natural ligand for the growth hormone secretagogue receptor exerts multiple immune regulatory effects as well as cardiovascular, metabolic and renal effects. On the other hand it was reported that some patients who have received recombinant human INF-α injections to treat chronic viral infections or malignancy have developed de novo SLE which resolves with discontinuation of IFN-α therapy. Our study was conducted to evaluate levels of ghrelin and INF-α in SLE patients, their relation to different clinical manifestations of the disease and their correlation with disease activity markers in such patients. Methods: Fifty four SLE patients and 46 age and sex matched control healthy subjects were included in this study. Both ghrelin hormone and INF-α were measured for all the studied groups using enzyme linked immune sorbent assay (ELISA) kit. We compare serum levels between SLE patients and control subjects also serum levels were correlated to different clinical manifestations and disease activity markers. Results: In this study we found significant increase in ghrelin hormone level in patients with lupus nephritis (p =0,0004) also it positively correlated with SLEDAI (p<0.0001), INFα (r=0.3 & p<0.01), ANA (p<0.0001), dsDNA (p<0.002) and LDL (p=0.03) but there was negative correlation between ghrelin and both body weight and HDL. On the other hand there was no significant change in ghrelin hormone level in SLE patients with mucocutaneous manifestations, articular involvement, Cerebritis, serositis, vasculitis and constitutional symptoms. Conclusion: These data suggest the possible role for ghrelin hormone in the clinical manifestation of SLE patients especially those with lupus nephritis as well as the synchronization of both ghrelin and INFα in the pathogenesis of SLE and their role in disease activity.
Introduction: Anemia develops early in the course of chronic kidney disease and is nearly univers... more Introduction: Anemia develops early in the course of chronic kidney disease and is nearly universal in patients with end-stage renal disease. In the general population, observational studies have shown a link between Helicobacter pylori and iron deficiency, often resulting in iron deficiency anemia. This study was conducted to investigate the effect of H. pylori infection in hemodialysis (HD) patients on parameters of iron deficiency anemia. The relation between H. pylori infection and inflammation as well as hepcidin serum level in HD patient was also identified. Methods: This study included 84 HD patients from dialysis unit in Talkha Central Hospital. Patients were classified into 2 groups according to presence of H. pylori antigen in stool. Results: Helicobacter pylori stool antigen was positive in 47 patients (55.6%). There was a significant male predominance in H. pylori-infected group. Infection with H. pylori was associated with longer dialysis duration and more dyspeptic symptoms. No significant difference was found between infected and noninfected patients regarding hematocrit, hemoglobin, iron, ferritin, nor transferrin saturation. C-reactive protein was significantly higher in H. pylori-positive group. Hepcidin was also higher in the noninfected group but with no significant difference. Conclusions: Patients with longer duration of HD, male sex, and the presence of dyspepsia had higher odds to exhibit H. pylori infection. Helicobacter pylori infection did not seem to have an influence on iron deficiency or anemia severity in HD patients and does not have relation with serum hepcidin level. However, H. pylori may to be related to inflammation in HD patients.
Objectives The present work was conducted to estimate the prevalence of adult Behçet's disease (B... more Objectives The present work was conducted to estimate the prevalence of adult Behçet's disease (BD) in adult Egyptian and to study the clinical pattern and influence of age at-onset and sex on disease phenotype. Also, we investigated the spectrum of presentation and frequencies along the north-to-south gradient of the country. Patients and method The population-based, multicenter, cross-sectional study included 1526 adult BD patients from 26 specialized Egyptian rheumatology centers. Demographic, clinical, and therapeutic data are assessed for all patients. Results The mean age of patients was 35.7 ± 9.84 years, disease duration 6.58 ± 5.25 years, and age at onset 29.37 ± 8.6 years; 91 were juvenile-onset (JoBD). There were 1102 males and 424 females (M:F 2.6:1). Regarding co-morbidities, 19.92% were diabetic, and 26.05% were hypertensive. The mean body mass index was 27.57 ± 5.24 (43.1% overweight; 25.9% obese). The mean BD current activity form was 4.48 ± 4.28. Regarding the medications use, systemic steroid and colchicine were the most common drugs used (947 (90.2%) and 611 (82.7%), respectively). The overall estimated prevalence of BD in Egypt was 3.6/ 100,000 population being highest in the two main cities: Alexandria (15.27) and Cairo (8.72). Pathergy test was positive in 43.4%. 90.2% were receiving systemic steroids and 8.3%, biologics. Disease characteristics were comparable between JoBD and adult-onset BD cases. Central nervous system (CNS), deep venous thrombosis (DVT), and gastrointestinal (GIT) involvement were significantly higher in males (p = 0.01, p = 0.001, and p = 0.001 respectively) while joint affection (p = 0.001) and disease activity (p = 0.011) were increased in females. Conclusions This study provides current prevalence of BD in Egypt; 3.6/100,000 with no remarkable north-to-south gradient. The sex influences the disease phenotype with the CNS, DVT, and GIT involvement are higher in males, while the joint affection and disease activity were increased in females. Key Points • The prevalence and phenotype of Behçet's disease across Egypt is presented in a multicenter nationwide study. • The potential influence of the age at onset and sex on disease phenotype is highlightened. • A review of the literature worldwide is presented allowing comparisons with studies from other nations.
Background: Depression is common in patients with rheumatoid arthritis and negatively impacts on ... more Background: Depression is common in patients with rheumatoid arthritis and negatively impacts on their quality of life and disease outcomes, including disease activity and treatment response. Several case-finding tools for depression are available, including the PHQ2, which is both valid (1) and easy to use. Objectives: The aim of this study was to compare the prevalence of depression using case finding tools and self-report measures in patients with established RA. Methods: Patients with established RA, attending a nurse-led annual review clinic, which aimed to offer patients a holistic review, were asked to complete a short questionnaire including demographics and self-reported comorbidity. The presence of depression was assessed in 3 ways a) PHQ2 score ≥3 b) Self recorded "ever" depression using the self-administered report comorbidity questionnaire (2) and c) Self report health status using the EQ5D-which includes a statement regarding current anxiety/depression (dichotomised into no anxiety/depression vs. slight/moderate/severe/extremely anxious or depressed. Ethical approval was obtained (15-WS-0063). Results: 179 RA patients provided data. Of these 119 (66%) were female and the mean (sd) age was 67.1 (11.7) years. 59 patients (33%) reported they had ever had depression using the self-report comorbidity questionnaire and 25 (14%) indicated they were currently receiving treatment. 68 (38%) indicated they were currently slightly (or more) anxious or depressed when assessed with the EQ5D. 37 (21%) scored positively on the PHQ2. There was good concordance between the PHQ2 and EQ5D at higher levels of depression, in that all those with severe or extreme anxiety or depression on EQ5D also scored positively on the PHQ2. However, of those with moderate anxiety/depression on EQ5D, 4/14 patients scored less than 3 using the PHQ2 score. Conclusions: Depression is common in patients with established RA. Use of the PHQ2 case-finding questions in patients with established RA, may help clinicians identify patients who may benefit from more detailed assessment of mood and interventions to improve their outcomes. Reliance should not be placed on a single tool, and exploration of mood should be part of routine assessment of a patient with RA.
Clinical medicine insights. Arthritis and musculoskeletal disorders, Jan 7, 2011
To investigate the combined effect of both pioglitazone and methotrexate on disease activity of r... more To investigate the combined effect of both pioglitazone and methotrexate on disease activity of rheumatoid arthritis in a biphasic study; experimental and clinical. EXPERIMENTALLY: 50 rats were divided into 5 equal groups; controls, experimental arthritis, methorexate treated (0.1 mg/Kg daily), pioglitazone-treated (10 mg/kg daily), and methotrexate and pioglitazone treated. Clinically: forty-nine diabetic rheumatoid arthritis patients were included. Patients group consisted of 28 patients and they received pioglitazone 30 mg orally beside their usual treatment. Control group consisted of 21 patients and they continued their usual treatment plus placebo. Disease activity was assessed using DAS28 score. Patients were followed up for 3 months. Pioglitazone produced a significant improvement of serum oxidative stress parameters (P < 0.05), and inflammatory cytokines in the treated arthritic group (P < 0.05). Clinically, the pioglitazone treated group showed significant improvemen...
Conclusion: Hyperprolactinemia detected in a subset of Saudi SLE patients can be predicted by thr... more Conclusion: Hyperprolactinemia detected in a subset of Saudi SLE patients can be predicted by thrombocytopenia and leukocytosis. However, it did not correlate with SLEDAI score of disease activity.
Internal tandem duplication (ITD) of the FLT3 gene (FLT3/ITD) has been linked to poor outcome in ... more Internal tandem duplication (ITD) of the FLT3 gene (FLT3/ITD) has been linked to poor outcome in acute myeloid leukemia (AML). However, the prognostic value of FLT3/ITD in various cytogenetic risk groups is still a matter of debate. The aim of this study was to evaluate the prognostic significance of FLT3/ITD in patients with de novo AML and normal or favorable risk cytogenetics (NFC-AML). Blood samples from 39 patients with AML were subjected to PCR of exons 14 and 15 of the FLT3 gene. Patients included 25 with normal cytogenetics, 8 with t(15;17), 4 with t(8;21) and 2 with inv(16). FLT3/1ITD was found in 6/39 (15.4%) patients, 4 of them showed normal cytogenetic, 1 positive for t(15;17) and 1 positive for t(8;21). Patients were M1 3/13, M2 2/12, M3 1/9, M4 0/4 and M5 0/1. The patients were followed up for a mean of 34.5 +/- 2.3 months. The complete remission (CR) rates for the FLT3/ITD+ and FLTITD- groups were 50% vs 63.6%, while the relapse rates were 50% vs 28.6% respectively. Interestingly, disease free survival (DFS) at 3 years was significantly different in studied patients: DFS was 5% in patients with FLT3/ITD+ vs 30% of patients with FLT3/ITD- (P = 0.001). Our data suggest a possible high prognostic value of FLT3/ITD in patients with normal/favorable cytogenetics.
Background Juvenile idiopathic arthritis (JIA) is children's most common autoimmune musculoskelet... more Background Juvenile idiopathic arthritis (JIA) is children's most common autoimmune musculoskeletal disease. The spectrum of patients' pro les of JIA showed many similarities and differences among different populations. Aim of the work The purpose of this study is to determine the prevalence, subtypes, distribution, and characteristic features of JIA among children in Rheumatology outpatient clinic at Mansoura University Children's Hospital (MUCH). Patients and methods The study was a cross-sectional observational study carried out in the rheumatology outpatient clinic in Mansoura University children's Hospital, on 73 patients diagnosed with JIA according to the International League of Associations for Rheumatology (ILAR) from April 2019 to April 2020. Results There was a statistically signi cant difference between JIA types as regard age of patients, age of onset of disease, duration of the disease affected at the time of diagnosis, fever, rash, and organomegaly with the highest value in psoriatic type. There was a statistically signi cant difference in methotrexate (MTX), Humera, Enbrel, and Le unomaide usage between JIA subtypes. The severity of the disease was correlated signi cantly with laboratory parameters including the erythrocyte sedimentation rate, C reactive protein, and platelets count. MTX, Pulse steroid, Actemra, and Le uonamide usage differed signi cantly according to the severity of the disease while Humera, Endoxan, Enbrel, and NSIAD showed no signi cant difference. Conclusion The types of JIA differ signi cantly from each other as regards fever, rash, and organomegaly with an increase in systemic onset rather than other types. While ophthalmic affection shows no signi cant difference between JIA subtypes. A low percentage of cases had uveitis indicating low severity of disease in the studied cases. Biological treatment was given to severe and resistant cases when indicated.
Background Juvenile idiopathic arthritis (JIA) is children's most common autoimmune musculosk... more Background Juvenile idiopathic arthritis (JIA) is children's most common autoimmune musculoskeletal disease. The spectrum of patients’ profiles of JIA showed many similarities and differences among different populations. Aim of the work The purpose of this study is to determine the prevalence, subtypes, distribution, and characteristic features of JIA among children in Rheumatology outpatient clinic at Mansoura University Children's Hospital (MUCH). Patients and methods The study was a cross-sectional observational study carried out in the rheumatology outpatient clinic in Mansoura University children’s Hospital, on 73 patients diagnosed with JIA according to the International League of Associations for Rheumatology (ILAR) from April 2019 to April 2020. Results There was a statistically significant difference between JIA types as regard age of patients, age of onset of disease, duration of the disease affected at the time of diagnosis, fever, rash, and organomegaly with the ...
Background Neuropsychiatric manifestations of lupus (NPSLE) are considered one of the major and m... more Background Neuropsychiatric manifestations of lupus (NPSLE) are considered one of the major and most devastating lupus manifestations. The aim of this study was to assess the neuropsychiatric manifestations in systemic lupus erythematosus (SLE) patients and estimate the effectiveness of brain magnetic resonance spectroscopy (MRS) and anti-ribosomal P antibody test in early detection of NPSLE. This cross-sectional study was carried out on 50 SLE patients. Demographic, clinical, and therapeutic data were assessed. All patients were subjected to thorough rheumatological and neuropsychiatric evaluation. Serologic tests included antinuclear antibodies, anti-double-stranded DNA, and anti-ribosomal P protein antibodies. Radiologic evaluation included brain MRS. Results The mean age was 26.9 ± 98.9 years; the median disease duration was 18 (0–108) months. Headache was the most common neurological symptom (40%). Depression was not detected in 29 patients (58%), mild in 15 patients (30%), and...
Background: Mycophenolic acid (MPA), an efficient immunosuppressive medication used in SLE, is gl... more Background: Mycophenolic acid (MPA), an efficient immunosuppressive medication used in SLE, is glucuronidated by UGTs into an inert 7-O-glucuronide. Studies have shown that the-275T>A and-2152C>T SNPs in the UGT1A9 promoter region are associated with greater hepatic production of UGT1A9 and higher MPA in vitro glucuronidation activity. Subjects and Methods: patients were selected from outpatient Clinics of Rheumatology and immunology department, UGT1A9-275T>A and-2152C>T (SNPs) were genotyped in 50 SLE Egyptian patients and 100 healthy controls using PCR-RFLP. In addition, MPA serum concentrations were measured in patients by homogeneous particle enhanced turbidimetric inhibition immunoassay (PETINIA) technique. Results: UGT1A9-2152C>T and-275T>A distribution of genotypic analysis in SLE patients and controls revealed that the-2152C>T mutation is present in 14% patients and 21% of the control group (P = 0.3), whereas the-275T>A mutation is present in 50% of patients and only in 11% of the control group (P = 0.001). In comparison to the (TT) genotype, the combined (TA+AA) genotype exhibited significant correlation with greater GIT symptoms (68% versus 5%, respectively, P = 0.001). In SLE patients taking MPA with CT+TT genotype against CC genotype,-2152C>T mutations revealed a higher incidence of anemia (85.7% versus%, 30.2 respectively P =0.009). Both SNP genotype carriers had statistically lower C0 MPA values compared to non-carriers (1.25 umol/L (0.62-7.8) versus 4.68 umol/L (0.62-25.9), P = 0.028. Conclusion: Carrier of both UGT1A9-2152C>T and-275T>A SNPS is associated with lower C0 MPA in comparison to non-carrier in Egyptian SLE patients.
Background Eye lesions, occur in nearly half of patients with Behçet’s Disease (BD), can lead to ... more Background Eye lesions, occur in nearly half of patients with Behçet’s Disease (BD), can lead to irreversible damage and vision loss; however, limited studies are available on identifying risk factors for the development of vision-threatening BD (VTBD). Using an Egyptian college of rheumatology (ECR)-BD, a national cohort of BD patients, we examined the performance of machine-learning (ML) models in predicting VTBD compared to logistic regression (LR) analysis. We identified the risk factors for the development of VTBD. Methods Patients with complete ocular data were included. VTBD was determined by the presence of any retinal disease, optic nerve involvement, or occurrence of blindness. Various ML-models were developed and examined for VTBD prediction. The Shapley additive explanation value was used for the interpretability of the predictors. Results A total of 1094 BD patients [71.5% were men, mean ± SD age 36.1 ± 10 years] were included. 549 (50.2%) individuals had VTBD. Extreme ...
Objectives:To delineate the cardiac magnetic resonance (MR) appearances of cardiovascular disease... more Objectives:To delineate the cardiac magnetic resonance (MR) appearances of cardiovascular disease (CVD) in patients with systemic lupus erythematosus (SLE), in comparison with transthoracic echocardiographs.Methods:Cardiac MR was performed on 22 patients with SLE—11 with previous CVD and 11 matched controls—using late gadolinium contrast enhancement (LGE) to identify areas of myocardial scarring; Transthoracic echocardiography (TTE) was performed on the same day.Results:Twenty female and two male patients participated. LGE was seen in 5/11 subjects in the CVD group (4/5 with previous myocardial infarction) and 1/11 in the control group. TTE detected myocardial abnormalities in 2/6 patients with LGE.Conclusion:The cardiac MR appearance of CVD in these patients with SLE was suggestive of coronary disease, rather than cumulative inflammatory muscle damage. Cardiac MR detected more abnormalities than TTE. Further studies of cardiac MR in patients with SLE are warranted to investigate th...
Chronic infection with the hepatitis C virus (HCV) is a major risk factor for the development of ... more Chronic infection with the hepatitis C virus (HCV) is a major risk factor for the development of hepatocellular carcinoma (HCC) worldwide .There is accumulating evidence that the genes controlling the actions of the renninangiotensin system (RAS) may influence malignancy development. The objective of the study was to investigate the relation of angiotensin converting enzymes (ACE &ACE2) genes polymorphisms to (HCC) in a group of Egyptian ( HCV) patients. The study was conducted on 120 Egyptian HCV and 100 HCC patients along with 130 healthy control volunteers. ACE insertion deletion (I/D) gene polymorphism was detected by PCR. ACE2 rs2106809 (C/T) gene Polymorphism was assessed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). HCC patients showed Increased frequency of the ACE D allele (high producing allele) compared to HCV patients and control (p<0.0001). Increased frequency of ACE2 T allele was detected among male HCC patients compared to male H...
Introduction: Resistance to interferon therapy in HCV patients represents a major health problem.... more Introduction: Resistance to interferon therapy in HCV patients represents a major health problem. The aim of the study was to assess the effect of insulin resistance (IR) and hyperferritenemia on the antiviral and immunomodulatory activities of interferon alpha (IFNα) therapy in Egyptian patients with hepatitis C virus (HCV) Design and Methods: The current study is a prospective, observational casecontrol study, a total of 165 patients with HCV recruited from Internal Medicine and Tropical DepartementsMansoura University Hospital, Egypt were enrolled in the study. According to their response to IFN α therapy were classified into responders and non responders. Serum HCV m RNA, glucose, insulin, ferritin and interferon gamma (IFNγ) were measured. (IR) was estimated by the homeostasis model of assessment for insulin resistance (HOMA-IR). Results: Non responder patients revealed elevated levels of serum ferritin and HOMA index accompanied by elevated HCV m RNA and IFN γ levels as compar...
Limited data exists on the role of Th17 cells in chronic HCV infected patients, particularly with... more Limited data exists on the role of Th17 cells in chronic HCV infected patients, particularly with regard to hepatic inflammation and fibrosis. We aimed to investigate the relationship between circulating and intrahepatic frequency of Th17 cells and IL-17 serum level and degrees of hepatic inflammation and fibrosis in chronic HCV patients, as well as to evaluate the effect of successful anti-viral therapy on these parameters. This nested longitudinal case control study included 30 treatment-naïve chronic HCV patients and 20 healthy individuals as control. All patients were investigated for circulating Th17 cell percentage (flow cytometry) and intrahepatic Th17 cell percentage (immunohistochemistry) and serum IL-17 (ELISA) at baseline and at week 12 after discontinuation of therapy. Circulating and intrahepatic Th17 cell percentage and serum IL17 level were found to be significantly higher in chronic HCV patients when compared with controls, with significant correlation with Metavir a...
Behçet's disease (BD) is a chronic multisystem variable vessel vasculitis. Disease damage is ... more Behçet's disease (BD) is a chronic multisystem variable vessel vasculitis. Disease damage is irreversible and permanent. Validated tools evaluating damage are limited. Enhancements in the clinical treatment of vasculitis will take place from the development of refined and exclusive indices for individual vasculitic syndromes including BD and attempting their international validation.
Egyptian Journal of Rheumatology and Clinical Immunology, 2014
Background: SLE is an autoimmune multisystem disease which results from both genetic predispositi... more Background: SLE is an autoimmune multisystem disease which results from both genetic predisposition and environmental factors. Ghrelin polypeptide is the natural ligand for the growth hormone secretagogue receptor exerts multiple immune regulatory effects as well as cardiovascular, metabolic and renal effects. On the other hand it was reported that some patients who have received recombinant human INF-α injections to treat chronic viral infections or malignancy have developed de novo SLE which resolves with discontinuation of IFN-α therapy. Our study was conducted to evaluate levels of ghrelin and INF-α in SLE patients, their relation to different clinical manifestations of the disease and their correlation with disease activity markers in such patients. Methods: Fifty four SLE patients and 46 age and sex matched control healthy subjects were included in this study. Both ghrelin hormone and INF-α were measured for all the studied groups using enzyme linked immune sorbent assay (ELISA) kit. We compare serum levels between SLE patients and control subjects also serum levels were correlated to different clinical manifestations and disease activity markers. Results: In this study we found significant increase in ghrelin hormone level in patients with lupus nephritis (p =0,0004) also it positively correlated with SLEDAI (p<0.0001), INFα (r=0.3 & p<0.01), ANA (p<0.0001), dsDNA (p<0.002) and LDL (p=0.03) but there was negative correlation between ghrelin and both body weight and HDL. On the other hand there was no significant change in ghrelin hormone level in SLE patients with mucocutaneous manifestations, articular involvement, Cerebritis, serositis, vasculitis and constitutional symptoms. Conclusion: These data suggest the possible role for ghrelin hormone in the clinical manifestation of SLE patients especially those with lupus nephritis as well as the synchronization of both ghrelin and INFα in the pathogenesis of SLE and their role in disease activity.
Introduction: Anemia develops early in the course of chronic kidney disease and is nearly univers... more Introduction: Anemia develops early in the course of chronic kidney disease and is nearly universal in patients with end-stage renal disease. In the general population, observational studies have shown a link between Helicobacter pylori and iron deficiency, often resulting in iron deficiency anemia. This study was conducted to investigate the effect of H. pylori infection in hemodialysis (HD) patients on parameters of iron deficiency anemia. The relation between H. pylori infection and inflammation as well as hepcidin serum level in HD patient was also identified. Methods: This study included 84 HD patients from dialysis unit in Talkha Central Hospital. Patients were classified into 2 groups according to presence of H. pylori antigen in stool. Results: Helicobacter pylori stool antigen was positive in 47 patients (55.6%). There was a significant male predominance in H. pylori-infected group. Infection with H. pylori was associated with longer dialysis duration and more dyspeptic symptoms. No significant difference was found between infected and noninfected patients regarding hematocrit, hemoglobin, iron, ferritin, nor transferrin saturation. C-reactive protein was significantly higher in H. pylori-positive group. Hepcidin was also higher in the noninfected group but with no significant difference. Conclusions: Patients with longer duration of HD, male sex, and the presence of dyspepsia had higher odds to exhibit H. pylori infection. Helicobacter pylori infection did not seem to have an influence on iron deficiency or anemia severity in HD patients and does not have relation with serum hepcidin level. However, H. pylori may to be related to inflammation in HD patients.
Objectives The present work was conducted to estimate the prevalence of adult Behçet's disease (B... more Objectives The present work was conducted to estimate the prevalence of adult Behçet's disease (BD) in adult Egyptian and to study the clinical pattern and influence of age at-onset and sex on disease phenotype. Also, we investigated the spectrum of presentation and frequencies along the north-to-south gradient of the country. Patients and method The population-based, multicenter, cross-sectional study included 1526 adult BD patients from 26 specialized Egyptian rheumatology centers. Demographic, clinical, and therapeutic data are assessed for all patients. Results The mean age of patients was 35.7 ± 9.84 years, disease duration 6.58 ± 5.25 years, and age at onset 29.37 ± 8.6 years; 91 were juvenile-onset (JoBD). There were 1102 males and 424 females (M:F 2.6:1). Regarding co-morbidities, 19.92% were diabetic, and 26.05% were hypertensive. The mean body mass index was 27.57 ± 5.24 (43.1% overweight; 25.9% obese). The mean BD current activity form was 4.48 ± 4.28. Regarding the medications use, systemic steroid and colchicine were the most common drugs used (947 (90.2%) and 611 (82.7%), respectively). The overall estimated prevalence of BD in Egypt was 3.6/ 100,000 population being highest in the two main cities: Alexandria (15.27) and Cairo (8.72). Pathergy test was positive in 43.4%. 90.2% were receiving systemic steroids and 8.3%, biologics. Disease characteristics were comparable between JoBD and adult-onset BD cases. Central nervous system (CNS), deep venous thrombosis (DVT), and gastrointestinal (GIT) involvement were significantly higher in males (p = 0.01, p = 0.001, and p = 0.001 respectively) while joint affection (p = 0.001) and disease activity (p = 0.011) were increased in females. Conclusions This study provides current prevalence of BD in Egypt; 3.6/100,000 with no remarkable north-to-south gradient. The sex influences the disease phenotype with the CNS, DVT, and GIT involvement are higher in males, while the joint affection and disease activity were increased in females. Key Points • The prevalence and phenotype of Behçet's disease across Egypt is presented in a multicenter nationwide study. • The potential influence of the age at onset and sex on disease phenotype is highlightened. • A review of the literature worldwide is presented allowing comparisons with studies from other nations.
Background: Depression is common in patients with rheumatoid arthritis and negatively impacts on ... more Background: Depression is common in patients with rheumatoid arthritis and negatively impacts on their quality of life and disease outcomes, including disease activity and treatment response. Several case-finding tools for depression are available, including the PHQ2, which is both valid (1) and easy to use. Objectives: The aim of this study was to compare the prevalence of depression using case finding tools and self-report measures in patients with established RA. Methods: Patients with established RA, attending a nurse-led annual review clinic, which aimed to offer patients a holistic review, were asked to complete a short questionnaire including demographics and self-reported comorbidity. The presence of depression was assessed in 3 ways a) PHQ2 score ≥3 b) Self recorded "ever" depression using the self-administered report comorbidity questionnaire (2) and c) Self report health status using the EQ5D-which includes a statement regarding current anxiety/depression (dichotomised into no anxiety/depression vs. slight/moderate/severe/extremely anxious or depressed. Ethical approval was obtained (15-WS-0063). Results: 179 RA patients provided data. Of these 119 (66%) were female and the mean (sd) age was 67.1 (11.7) years. 59 patients (33%) reported they had ever had depression using the self-report comorbidity questionnaire and 25 (14%) indicated they were currently receiving treatment. 68 (38%) indicated they were currently slightly (or more) anxious or depressed when assessed with the EQ5D. 37 (21%) scored positively on the PHQ2. There was good concordance between the PHQ2 and EQ5D at higher levels of depression, in that all those with severe or extreme anxiety or depression on EQ5D also scored positively on the PHQ2. However, of those with moderate anxiety/depression on EQ5D, 4/14 patients scored less than 3 using the PHQ2 score. Conclusions: Depression is common in patients with established RA. Use of the PHQ2 case-finding questions in patients with established RA, may help clinicians identify patients who may benefit from more detailed assessment of mood and interventions to improve their outcomes. Reliance should not be placed on a single tool, and exploration of mood should be part of routine assessment of a patient with RA.
Clinical medicine insights. Arthritis and musculoskeletal disorders, Jan 7, 2011
To investigate the combined effect of both pioglitazone and methotrexate on disease activity of r... more To investigate the combined effect of both pioglitazone and methotrexate on disease activity of rheumatoid arthritis in a biphasic study; experimental and clinical. EXPERIMENTALLY: 50 rats were divided into 5 equal groups; controls, experimental arthritis, methorexate treated (0.1 mg/Kg daily), pioglitazone-treated (10 mg/kg daily), and methotrexate and pioglitazone treated. Clinically: forty-nine diabetic rheumatoid arthritis patients were included. Patients group consisted of 28 patients and they received pioglitazone 30 mg orally beside their usual treatment. Control group consisted of 21 patients and they continued their usual treatment plus placebo. Disease activity was assessed using DAS28 score. Patients were followed up for 3 months. Pioglitazone produced a significant improvement of serum oxidative stress parameters (P < 0.05), and inflammatory cytokines in the treated arthritic group (P < 0.05). Clinically, the pioglitazone treated group showed significant improvemen...
Conclusion: Hyperprolactinemia detected in a subset of Saudi SLE patients can be predicted by thr... more Conclusion: Hyperprolactinemia detected in a subset of Saudi SLE patients can be predicted by thrombocytopenia and leukocytosis. However, it did not correlate with SLEDAI score of disease activity.
Uploads
Papers by Dina shahine