Shahera el-etreby
, Al Manşūrah

Medicine, Biology, Education

M.D. Internal Medicine
8.83

Publications

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    Magdy Hamed Attwa · Shahira Aly El-Etreby
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    ABSTRACT: Hepatocellular carcinoma (HCC) is ranked as the 5(th) common type of cancer worldwide and is considered as the 3(rd) common reason for cancer-related deaths. HCC often occurs on top of a cirrhotic liver. The prognosis is determined by several factors; tumour extension, alpha-fetoprotein (AFP) concentration, histologic subtype of the tumour, degree of liver dysfunction, and the patient's performance status. HCC prognosis is strongly correlated with diagnostic delay. To date, no ideal screening modality has been developed. Analysis of recent studies showed that AFP assessment lacks adequate sensitivity and specificity for effective surveillance and diagnosis. Many tumour markers have been tested in clinical trials without progressing to routine use in clinical practice. Thus, surveillance is still based on ultrasound (US) examination every 6 mo. Imaging studies for diagnosis of HCC can fall into one of two main categories: routine non-invasive studies such as US, computed tomography (CT), and magnetic resonance imaging, and more specialized invasive techniques including CT during hepatic arteriography and CT arterial portography in addition to the conventional hepatic angiography. This article provides an overview and spotlight on the different diagnostic modalities and treatment options of HCC.
    06/2015; 7(12):1632-51. DOI:10.4254/wjh.v7.i12.1632
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    ABSTRACT: A 32-year-old female presented with 5-year history of iron deficiency anemia, marked pallor and edema of both lower limbs. Laboratory investigations including complete blood count, blood film, iron studies, lipid profile, ascitic fluid analysis, test of stool for occult blood and alpha 1 anti-trypsin. Upper, lower gastrointestinal (GIT) endoscopies, and enteroscopy were performed. Imaging techniques as abdominal ultrasonography and computed tomography were done. Echocardiography, lymph node biopsy and bone marrow examination were normal. The case was diagnosed as Waldmann's disease with protein losing enteropathy and recurrent GIT bleeding. Management started with low fat diet with medium chain triglyceride, octreotide 200 μg twice a day, tranexamic acid and blood transfusion. Then, exploratory laparotomy with pathological examination of resected segment was done when recurrent GIT bleeding occurred and to excluded malignant transformation.
    05/2015; 7(5):567-572. DOI:10.4253/wjge.v7.i5.567
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    ABSTRACT: Racial differences and broad spectrum response to anti-hepatitis C (anti-HCV) therapy suggest a possible role for host genetic diversity in treatment outcomes. We aim to determine the association and predictive value of certain human leukocyte antigen (HLA) class I alleles with either susceptibility to viral clearance or persistence following pegylated interferon (Peg-IFN) plus ribavirin therapy in chronic hepatitis C (HCV) genotype 4 patients in Egypt. This study included 200 unrelated chronic HCV patients who received Peg-IFN plus ribavirin therapy [112 patients with sustained virological response (SVR) and 88 non-responders (NR)]. Serological testing of HLA class I antigens (HLA-A and HLA-B alleles) were performed by standard complement-dependent microlymphocytotoxicity assay. The frequency of HLA-A01 was significantly higher in SVR than in NR cases [OR: 0.51; 95% CI: 0.27-0.981; P = 0.042], while the frequency of alleles B38 (P = 0.011), B40 (P < 0.001) and B41 (P < 0.001) was significantly higher in NR cases (OR/95% CI: 7.05/(1.39-18.01), 10.31/3.14-36.1 . On logistic regression analysis, presence of the HLA-A01 allele was associated with SVR (OR: 0.50; 95% CI: 0.28-0.89; P = 0.02) and HLA-B38 can predict non response to therapy (OR: 7.92; 95% CI: 1.67-37.54; P = 0.009) with an overall accuracy of 60%.Severe fibrosis (OR: 3.035; 95% CI: 1.521-6.091; P = 0.002), high viremia (OR: 2.69; 95% CI: 1.11-6.53; P = 0.005) and steatosis (OR: 2.1; 95% CI: 1.002-3.90; P = 0.041) predicted no response with an overall accuracy of 81.8%. HLA-A01 and HLA-B38 alleles are associated with and may have a role in the outcome of response to Peg-IFN plus ribavirin therapy in Egyptian patients diagnosed with chronic HCV infection. The use of immunologic markers to predict the outcome of treatment may help pharmacogenetic personalization of treatment for HCV infection.
    Archives of Iranian medicine 02/2013; 16(2):68-73. · 1.11 Impact Factor
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    01/2013; 41(4):336. DOI:10.4103/1110-1415.126199
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    ABSTRACT: Syndecan-1 is a trans-membrane heparan sulfate proteoglycan that localizes in epithelial cells and has been shown to be present in normal hepatocytes. It is thought to be involved in processes such as cell growth, differentiation and adhesion. However, the clinical data regarding syndecan-1 in patients with hepatocellular carcinoma (HCC) are scarce and controversial. Therefore, we need to evaluate the effects of HCC on the serum levels of syndecan-1. Thus, 40 patients with HCC and 31 patients with liver cirrhosis were physically examined. Blood samples were taken for measurements of routine markers (sGPT, sGOT, bilirubin, albumin, and α-fetoprotein), as well as serum levels of interleukin (IL)-6 and syndecan-1. Patients with liver cirrhosis showed significant increase in serum IL-6 as compared with HCC patients and the control subjects. Serum level of syndecan-1 was significantly increased in HCC patients as compared with the cirrhotic and control groups. In addition, significant positive correlations between syndecan-1 and serum levels of ALT, AST in HCC patients were found. Moreover, syndecan-1 increased significantly with increasing stage of Barcelona-Clinic Liver Cancer Group diagnostic and treatment strategy. In conclusion, the development of HCC is accompanied by a significant elevation in serum syndecan-1 levels. The increase in serum syndecan-1 may be linked with progression of HCC.
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    ABSTRACT: Background Chronic hepatitis C (CHC) is associated with multiple extrahepatic manifestations, including the recently recognized effect on pulmonary function tests (PFTs) and lung parenchyma. Aim To evaluate changes in PFTs and lung parenchyma in asymptomatic Egyptian patients with a CHC infection. Patients and methods This cross-sectional study included 70 CHC patients. All patients were subjected to a liver biopsy. Fibrosis stage and activity grade were assessed according to the METAVIR scoring system using scale ranges from 0 to 4. All patients were subjected to PFTs, measurement of arterial blood gases, and high-resolution computed tomography (HRCT) of the chest. All smokers, obese (BMIZ30) patients, and patients with known pulmonary disease were excluded. Results An alteration in PFTs was observed in 29 (41.42%) patients out of 70. A restrictive pattern was found in 27 patients (38.57%), in whom forced vital capacity and the total lung capacity values were reduced to less than 80% of the predicted values. Forced expiratory volume in 1 s/forced vital capacity value was more than 70%. Also, HRCT of the chest showed interstitial pulmonary fibrosis (IPF) with either an interstitial or an alveolar pattern with a total score not exceeding 2. These findings correlated significantly with the PFTs results. Also, there was no significant correlation between the presence of a restrictive pattern in PFTs or IPF in HRCT with other parameters in terms of age, BMI, sex, liver fibrosis, activity score, level of viremia, and duration of disease. Conclusion Hepatitis C virus could be a trigger factor for alterations in PFTs and lung parenchyma in the studied asymptomatic Egyptian patients with a CHC genotype 4 infection. HRCT AQ2 could be a sensitive, noninvasive method for the early detection of IPF in these patients.
    07/2012; DOI:10.1097/01.ELX.0000415485.73087.c8
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    EASL; 04/2012
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    ABSTRACT: 1. HCV could be a trigger factor for alterations in PFTs and lung parenchyma in the studied asymptomatic Egyptian patients with CHC-genotype 4 infection. 2. HCRT and Alveolar–arterial O 2 gradient can be used as sensitive methods for early detection of IPF in those patients. 3. Pegylated interferon may induce worsening of chest disease irrespectively of the patient outcomes. 4. So, screening for pulmonary disease is suggested in CHC patients before starting antiviral therapy 100 patients with CHC genotype 4 78 patients continued the course of treatment till 48 weeks 30 with restrictive PFTs+ positive HRCT 14 patients improved PFTS and HRCT findings 12 SVR 2 NR 16 patients remains with restrictive PFTs+ positive HRCT 14 SVR 2 NR 48 patients with initial normal PFTs and HRCT 35 patients remain with normal PFTs and HRCT 29 SVR 6 NR 13 patients developed restrictive PFTs and positive HRCT findings 11 SVR 2 NR 22 patients were excluded; 18 not achieved EVR and 4 patients stopped at week 24 (1 due interstitial pneumonitis and 3 due to breakthrough) ntroduction I Chronic hepatitis C (CHC) triggers multiple extrahepatic immune-lymphoproliferative disorders which might include 'idiopathic' pulmonary fibrosis. This can be detected by effects on pulmonary function tests (PFTs) ± high resolution computed tomography (HRCT) of the chest. Moreover, interferon therapy alone or in combination with ribavirin has been associated with pulmonary complications. Aim of the work: to evaluate changes in PFTs and HRCT of the chest in asymptomatic Egyptian patients with CHC and the effects of interferon/ribavirin therapy Patients and methods: This prospective cohort included 100 patients with chronic HCV-genotype 4. All patients received on a fixed weekly dose of 180 μg of peginterferon α-2a in combination with ribavirin in dose adjusted to body weight. All patients subjected to PFTs, arterial blood gases (ABGs) and HRCT of the chest before and after treatment. HRCT showed lower lung lobes shows interlobular septal thickening of both sides and minimal ground glass opacity in left side. (before treatment). HRCT showed interlobular septal thickening of both sides and bilateral ground glass opacity and honeycomb appearance 24 weeks after treatment SVR sustained virological response, NR non responder
    APASL; 02/2012
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    ABSTRACT: To evaluate the role of 64 multidetector CT angiography in preoperative evaluation of hepatic artery in candidates who underwent hepatic resection.Materials and methodsSixty-seven patients underwent triphasic CT scan using 64 multidetector CT scanner. They were 33 with hepatocellular carcinoma, 21 with solitary metastases, seven potential donors for liver transplantation, five with gaint haemangiomas, and one with large primary Non-Hodgkin lymphoma. The images were analyzed for the depiction of hepatic artery. The frequencies of anatomical variants of the hepatic artery were evaluated based on the classification proposed by Michels’ in 1966. The findings was compared and correlated with operative data.ResultsType I variant was seen in 43 patients (64.2) and variants were seen in other 24 patients (35.8%). We found seven patients with type II variant, 11 patients with type III variant, two patients with type V variant, and two patients with VI variant. There were two patients with type variants did not fit Michels’ classification. In 55 patients, the surgical findings concurred with 64 MDCT angiography findings (100%).Conclusion64 MDCT angiography is an effective, high-resolution, noninvasive imaging technique that readily demonstrates the hepatic arterial map with direct impact on treatment decisions including patient selection for hepatic resection.
    06/2011; 42(2):133-137. DOI:10.1016/j.ejrnm.2011.06.004
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    ABSTRACT: Syndecan-1 is a trans-membrane heparan sulfate proteoglycan that localizes in epithelial cells and has been shown to be present in normal hepatocytes. It is thought to be involved in processes such as cell growth, differentiation and adhesion. However, the clinical data regarding syndecan-1 in patients with hepatocellular carcinoma (HCC) are scarce and controversial. Therefore, we need to evaluate the effects of HCC on the serum levels of syndecan-1. Thus, 40 patients with HCC and 31 patients with liver cirrhosis were physically examined. Blood samples were taken for measurements of routine markers (sGPT, sGOT, bilirubin, albumin, and α-fetoprotein), as well as serum levels of interleukin (IL)-6 and syndecan-1. Patients with liver cirrhosis showed significant increase in serum IL-6 as compared with HCC patients and the control subjects. Serum level of syndecan-1 was significantly increased in HCC patients as compared with the cirrhotic and control groups. In addition, significant positive correlations between syndecan-1 and serum levels of ALT, AST in HCC patients were found. Moreover, syndecan-1 increased significantly with increasing stage of Barcelona-Clinic Liver Cancer Group diagnostic and treatment strategy. In conclusion, the development of HCC is accompanied by a significant elevation in serum syndecan-1 levels. The increase in serum syndecan-1 may be linked with progression of HCC.
    Scientia Pharmaceutica 01/2011;

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