Mohamed A Sobh

Publications (37)84.88 Total impact

• Article: Association and prognostic impact of persistent left ventricular hypertrophy after live-donor kidney transplantation: a prospective study

  Hussein Attia Sheashaa, Tarek M. Abbas, Nabil A. Hassan, Khaled M. Mahmoud, Amgad E. El-Agroudy, Mohamed A. Sobh, Mohamed A. Ghoneim
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  ABSTRACT: AimPersistent or denovo left ventricular hypertrophy (LVH) is a risk factor for cardiovascular diseases and congestive heart failure following renal transplantation (RT). Our aim was to determine the associations and impact of persistent LVH on RT outcome. Materials and methodsWe included 72 live-donor renal allograft recipients with mean age of 28.5years who had evidence of LVH at time of transplantation and had stable functioning grafts 1year after transplantation. Cardiac status of all recipients was assessed before transplantation and at 1year after transplantation by echocardiography. Recipients were subdivided into two groups according to persistence or regression of LVH 1year after transplantation. The first group included 33 patients who had persistent LVH. The second group included 39 patients in whom LVH had regressed (control group). Both groups were closely followed for 10years. ResultsUnivariate analysis showed that persistent LVH 1year after RT was significantly associated with high serum creatinine, higher incidence of medical infection, and acute and chronic rejection. Chronic rejection and infection were the only valid associations on multivariate logistic regression analysis. Patient and graft survival were significantly lower in the persistent LVH group (P=0.012). ConclusionPersistent LVH may be associated with higher incidence of medical infection and chronic rejection that worsen the prognosis for renal transplant recipients. KeywordsRenal transplantation-Echocardiography-LVH
  Clinical and Experimental Nephrology 04/2012; 14(1):68-74. · 1.37 Impact Factor
• Article: Complications of pediatric live-donor kidney transplantation: a single center’s experience in Egypt

  Amr A. El-Husseini, Mohamed A. Sobh, Mohamed A. Ghoneim
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  ABSTRACT: Our objective was to study the complications of chronic renal failure (CRF) among pediatric live-donor kidney transplant recipients. Between March 1976 and December 2005, 1,785 live-donor kidney transplantations were carried out at our center. Of the recipients, 292 were 20years old or younger (mean age 12.8years, ranging from 4years to 20years). Clinical and laboratory parameters of these 292 patients were analyzed retrospectively. They were 182 boys and 110 girls. Patients who had received transplants before 1988 were treated with prednisolone and azathioprine as combined therapy. From 1988 to 1998, a triple regimen comprising prednisolone, azathioprine and cyclosporineA (CsA) was administered. Tacrolimus and mycophenolate mofetil (MMF) were introduced as primary therapy in 1998. Growth, anemia, infections, and surgical, cardiac, neurologic, bone and other medical complications were assessed. Triple-drug immunosuppression (prednisone + CsA + azathioprine) was used in 68.2% of transplants. Acute rejection rate was 47.6%; chronic rejection rate was 31%. Hypertension (62%) was the commonest complication. Anemia was diagnosed in 61%. A substantial proportion of patients (48%) were short, with height standard deviation scores (SDSs) of less than −1.88. The overall infection rate was high, and the majority (54%) was bacterial. Malignancy was diagnosed in eight (3%) patients. The incidence of urological complications was 14%, and that of vascular complications was 1%. Cardiac complications included left ventricular hypertrophy (LVH) in 47.9% of patients, left atrial enlargement (31.5%) and left ventricular dilatation and systolic dysfunction (13.7% for each). Neuropathic changes were found in 19% of our cases, with the distal muscles of lower limbs more affected. Other complications included avascular bone necrosis in 8% (all of them in the hip joint) and bone loss in 60% of patients. We concluded that, despite the long-term success of pediatric renal transplantation in a developing country, there is a risk of significant morbidity.
  Pediatric Nephrology 04/2012; 23(11):2067-2073. · 2.52 Impact Factor
• Article: Ten-year follow-up of basiliximab induction therapy for live-donor kidney transplant: a prospective randomized controlled study.

  Hussein A Sheashaa, Mohamed A Bakr, Rashad H Rashad, Amani M Ismail, Mohamed A Sobh, Mohamed A Ghoneim
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  ABSTRACT: The effect of basiliximab induction therapy on long-term patient and graft survival is not clear. We sought to evaluate if there is any advantage to routine basiliximab induction on the long-term outcome of living-related donor kidney transplants. One hundred adult recipients with their first kidney allograft were randomized into 2 treatment groups; 1 group received basiliximab, and the second served as a control. All patients received a maintenance triple immunosuppressive therapy (steroids, cyclosporine, microemulsion, and azathioprine). We followed them for 10 years. Basiliximab reduced the proportion of patients who experienced an acute rejection in the first year (18/50) when compared with the control group (31/50) (P = .009), and in 10 years (28/50) when compared with controls (37/50) (P = .059). The cumulative steroid dosage used throughout the study was significantly lower in the basiliximab group. The overall incidence of posttransplant complications was comparable among the 2 groups. There was no significant difference in patient and graft survival; 10-year patient and graft survival were 92% and 76% for basiliximab and 90% and 68% for the control group. Routine basiliximab induction significantly reduces the incidence of acute rejection without any noticeable effects on the long-term renal transplant outcome.
  Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 08/2011; 9(4):247-51.
• Source

  Available from: Ayman Refaie

  Article: Hyperechogenic renal parenchyma in potential live related kidney donors: Does it justify exclusion?

  Mohamed A. Fouda, Ahmed A. Shokeir, Ehab W. Wafa, Ayman F. Refaie, Tarek El Diasty, Mona Abdelrahim, Mohamed A. Sobh, Mohamed A. Ghoneim
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  ABSTRACT: Abstract Objectives To assess the predictive importance of ultrasonic grade 1 hyperechogenicity in potential live related kidney donors in the absence of urinary abnormalities and with perfect renal function. Subjects and methods The study included 34 potential living related kidney donors with this abnormality; their mean (SD, range) age was 32.7 (8.45, 23–48) years. Ten matched healthy donors with normal ultrasonographic appearance of the kidneys were studied as controls. All cases were thoroughly investigated, including measuring glomerular filtration rate by isotopic scintigraphy. The renal reserve was estimated by dopamine and amino-acid infusion in all subjects (study and control groups). A percutaneous renal biopsy was taken from 17 subjects in the abnormal echogenicity group and open renal biopsy was taken from eight of the control subjects. Results The renal reserve was comparable in both groups. Abnormal histopathological changes were found in seven subjects (41%) of the abnormal echogenicity group, i.e. partial glomerulosclerosis in one, mesangial thickening in two, interstitial fibrosis in one, focal tubular atrophy in one, immunoglobulin (Ig M) immune deposits in three and IgA in one. Only one subject in the control group showed mild mesangial thickening. Conclusion Grade 1 echogenicity might be a sign of unrecognized kidney disease. Renal biopsy is mandatory when such related donors are the only available ones. Abnormal histopathology contraindicates donation.
  Arab Journal of Urology. 01/2011; 9(4):235-239.
• Article: Management of sensitized patients awaiting renal transplantation: does sequential therapy of intravenous immunoglobulin and simvastatin offer a solution?

  Khaled M Mahmoud, Mohamed A Sobh, Farha El Shenawy, Amani M Isamil, Megahed Abo El-Magd, Nabil A Hassan, Amgad E El-Agroudy, Hussein A Sheashaa, Gerhard Opelz, Mohamed A Ghoneim
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  ABSTRACT: The value of intravenous immunoglobulin and simvastatin as potential modalities for the treatment of sensitized patients was studied. We aimed to test their efficacy as solo agents to inhibit anti-human leukocyte antigen (HLA) antibodies. We tested samples from 11 adult hemodialysis patients who were waiting for renal allotransplantation at our center, all of whom had persistently positive crossmatches with their living related donors and panel reactive antibody titers more than 20%. All patients received intravenous immunoglobulin (500 mg/kg/day on alternate days for 6 doses). Panel reactive antibody titer measurement and crossmatch testing were carried out after each dose and before each subsequent one. Two months later, 8 patients received simvastatin (20 mg/day) for 2 months. Panel reactive antibody measurement titer and crossmatch testing were carried out every 2 weeks. Only 4 patients showed an insignificant reduction in panel reactive antibody activity (P=0.36). None of them attained a negative crossmatch. Furthermore, simvastatin also resulted in an insignificant reduction of HLA antibodies in 3 patients (P=0.32). We concluded that intravenous immunoglobulin or simvastatin alone cannot effectively inhibit preformed anti-HLA antibodies to allow successful renal transplantation. Further trials of the use of intravenous immunoglobulin and simvastatin with other modalities to desensitize these patients may be warranted.
  European Journal of Pharmacology 05/2007; 561(1-3):202-5. · 2.52 Impact Factor
• Article: Growth in children with chronic renal failure and after renal transplantation.

  Mohamed A Bakr, Amr A El-Husseini, Mohamed A Fouda, Salem A Sallam, Salah M Fayed, Mohamed A Sobh, Mohamed A Ghoneim
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  ABSTRACT: Growth retardation is a major problem for many children with chronic renal failure (CRF) and transplantation. The aim of this study is to assess the relation between height, glomerular filtration rate (GFR), hormonal alterations in children with CRF on regular haemodialysis (HD), and the impact of functioning graft after kidney transplantation.Thirty-six hemodialysed children were included in the study beside 32 pediatric transplants. Mean duration on HD was 14.72 +/- 7.73 months for the CRF group, while the mean interval after transplantation was 1.97 +/- 0.9 years for the second group. Moreover, twenty healthy children of matched age and sex served as controls. Assessment of growth parameters included height, expressed as standard deviation scores (Ht SDS) for chronological age, serum levels of growth hormone (hGH), and parathormone (PTH). Growth performance was evaluated twice: at the start of the study and one year later. Children with CRF and transplantation had significantly higher levels of both serum hGH and PTH compared to their controls, while CRF children experienced significantly higher serum levels of both hGH and PTH compared to those with functioning graft. Furthermore, analysis of our results by non-parametric Kendall's correlation at the start and one year later revealed negative correlation concerning dialysis duration, serum creatinine, and PTH. On the other hand, positive correlation was achieved for serum calcium and GFR.
  International Urology and Nephrology 02/2007; 39(2):635-9. · 1.47 Impact Factor
• Article: Can intravenous immunoglobulin and simvastatin solve the problem of sensitization in renal transplant candidates?

  Khaled M Mahmoud, Mohamed A Sobh, Farha El-Shenawy, Amani M Isamil, Megahed Abo El-Magd, Nabil A Hassan, Amgad E El-Agroudy, Hussein A Sheashaa, Gerhard Opelz, Mohamed A Ghoneim
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  ABSTRACT: The value of intravenous immunoglobulin (IVIG) and simvastatin as potential modalities for the treatment of sensitized patients was evaluated by testing the efficacy of these agents on a relatively large cohort of adult hemodialysis patients (11) who were waiting for renal allotransplantation at our center. The patients had persistently positive crossmatches with their living related donors and a panel reactive antibody titer of more than 20%. All patients received IVIG (500 mg/kg per day on alternate days for a total of six doses); panel reactive antibody (PRA) titer and crossmatch testing were carried out after each dose and before each subsequent one. Two months after the last dose, eight patients received simvastatin (20 mg/day) for a period of 2 months; PRA titer and crossmatch testing were carried out every two weeks. Only four patients showed an insignificant reduction of PRA activity (P = 0.36); no patient attained a negative crossmatch. Simvastatin also resulted in an insignificant reduction of anti-human leukocyte antigen (HLA) antibodies in three patients (P = 0.32). We propose that IVIG or simvastatin alone can not effectively inhibit preformed anti-HLA antibodies to allow successful renal transplantation. Further trials on the use of IVIG and simvastatin with other modalities of treatment to desensitize these patients may be warranted.
  International Urology and Nephrology 02/2007; 39(3):979-81. · 1.47 Impact Factor
• Article: Is it worth using daclizumab induction therapy with mycophenolate mofetil-based immunosuppressive regimens in live related donor kidney transplantation? A long-term follow up.

  Hussein A Sheashaa, Mohamed A Bakr, Mohamed Ashraf Fouda, Khalid F El-Dahshan, Amany M Ismail, Mohamed A Sobh, Mohamed A Ghoneim
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  ABSTRACT: The aim of this work is to determine the long-term therapeutic benefit(s) of daclizumab induction therapy with triple immunosuppressive protocols including prednisolone, cyclosporine microemulsion (CsA), and mycophenolate mofetil (MMF) in the living related donor kidney transplantation. Twenty-one adult recipients of their first kidney allograft were allocated to receive daclizumab with triple immunosuppressive therapy (steroids, CsA, and MMF). They were compared to 50 recipients of their first grafts who received a maintenance triple immunosuppressive therapy (steroids, CsA, and azathioprine). The patients were followed up for 5 years. Daclizumab group significantly experienced a marked reduction of acute rejection (7/21) when compared to the control group (31/50) with subsequent significant reduction of cumulative steroids doses at the end of 5 years. The overall incidence of post-transplant complications was comparable among the two treatment groups. There was no significant difference in patients and graft survival; 5-year patient and graft survival were 95.3%, 85.7% for daclizumab and 96%, 88% for control group, respectively. Although prophylactic daclizumab with triple immunosuppressive protocol including MMF have drastically reduced the incidence of acute rejections, the graft and patient survival are unchanged in this long-term follow up.
  International Urology and Nephrology 02/2007; 39(1):317-9. · 1.47 Impact Factor
• Article: Pediatric live-donor kidney transplantation in Mansoura Urology & Nephrology Center: a 28-year perspective.

  Amr A El-Husseini, Mohamed A Foda, Mohamed A Bakr, Ahmed A Shokeir, Mohamed A Sobh, Mohamed A Ghoneim
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  ABSTRACT: Our objective was to evaluate our overall experience in pediatric renal transplantation. Between March 1976 and March 2004, 1,600 live-donor kidney transplantations were carried out in our center; 216 of the patients were 18 years old or younger (mean age 12.9 years). There were 136 male patients and 80 female patients. The commonest causes of end-stage renal disease (ESRD) were renal dysplasia (22%), nephrotic syndrome (20%), hereditary nephritis (16%), and obstructive uropathy (16%). Of the donors, 94% were one-haplotype matched and the rest were identical. Pre-emptive transplantation was performed in 51 (23%) patients. Triple-therapy immunosuppression (prednisone + cyclosporine + azathioprine) was used in 78.2% of transplants. Rejection-free recipients constituted 47.7%. Hypertension (62%) was the commonest complication. A substantial proportion of patients (48%) were short, with height standard deviation score (SDS) less than -1.88. The overall infection rate was high, and the majority (53%) of infections were bacterial. The graft survival at 1 year, 5 years and 10 years were 93.4%, 73.3% and 48.2%, respectively, while the patients' survival at 1, 5 and 10 years were 97.6%, 87.8% and 75.3%, respectively. Despite long-term success results of pediatric renal transplantation in a developing country, there is a risk of significant morbidity.
  Pediatric Nephrology 11/2006; 21(10):1464-70. · 2.52 Impact Factor
• Article: Characteristics of long-term live-donor pediatric renal transplant survivors: a single-center experience.

  Amr A El-Husseini, Mohamed A Foda, Yasser M Osman, Mohamed A Sobh
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  ABSTRACT: To study the characteristics and the predictors of survival observed in our pediatric live-donor renal transplant recipients with an allograft that functioned for more than 10 yr. One hundred fifteen children underwent renal transplantation between 1976 and 1995. Of these, 30 had functioning allografts for more than 10 yr (range, 11-18). The patients included 18 males and 12 females, with a mean age at transplantation of 13 yr (range, 5-18). Characteristics of the patients, data on graft survival, and determinants of outcome were obtained by reviewing all medical charts. At most recent follow-up (January 2005), the mean daily dose of azathioprine was 1.2 mg/kg (range, 1-2) and that of prednisone was 0.16 mg/kg (range, 0.1-0.2). Mean creatinine clearance was 72 mL/min per 1.73 m(2) (range, 45-112). Acute rejection occurred in 14 (47%) patients. Seven patients had one episode, five had two episodes, and two had three episodes of acute rejection. Three patients (10%) developed malignancy. A substantial proportion of patients (44%) were short, with a height standard deviation score (SDS) less than -1.88, which is below the third percentile for age and gender. One quarter of the patients, more commonly the females, were obese. Other complications included osteoporosis in 16 (53%) patients, avascular bone necrosis in four (13%), post-transplantation diabetes mellitus in three (10%), and hypertension in 18 (60%). Twelve (40%) patients were married and 27% had children post-transplantation. The independent determinants of long-term graft survival were acute rejection and post-transplant hypertension. Despite good renal function, long-term pediatric renal transplant survivors are at risk of significant morbidity. The determinants of long-term graft survival are acute rejection and post-transplant hypertension.
  Pediatric Transplantation 06/2006; 10(3):288-93. · 1.48 Impact Factor
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  Available from: Ayman Refaie

  Article: Histologic and clinical findings in living donor allografts with long-term stable function.

  Tarek M Abbas, Ehab W Wafa, Mohamed A Bakr, Ayman F Refaie, Hussein A Sheashaa, Amgad E Elagroudy, Mahmoud A El-Baz, Tarek A Mohsen, Ahmed B Shehab El Dein, Mohamed A Sobh, Mohamed A Ghoneim
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  ABSTRACT: Protocol biopsy is an important strategy which assesses the histological changes that can occur in the renal allograft and adversely affect its outcome. We aimed to evaluate histological changes in long-term living donor transplants. Elective biopsies were done for 120 live donor renal transplant recipients with well-functioning grafts and no rejection history at least 1 year or more after transplant. All patients had serum creatinine levels <2 mg/dl. The histopathological findings using the chronic allograft damage index score were correlated with different clinical and immunological parameters. Chronic tubulointerstitial fibrosis was the most prevalent finding (85% of cases), mostly of mild degree. Normal biopsies were reported in only 7.5% of cases, whereas chronic cyclosporine nephrotoxicity was detected in 5.8% of biopsies. Posttransplant hypertension was significantly correlated with glomerulosclerosis, and posttransplant diabetes with glomerulosclerosis, mesangial matrix increase, tubular atrophy and interstitial fibrosis. The main risk factors associated with a high chronic allograft damage index score were DR mismatching, posttransplant diabetes and time of biopsy. All histopathological changes increased with advancing donor age and declining graft function. Elective biopsies showed that histopathological findings do exist even with stable renal function that may pave the way for predicting long-term graft outcome.
  American Journal of Nephrology 02/2006; 26(5):491-6. · 2.54 Impact Factor
• Article: Study of ochratoxin A as an environmental risk that causes renal injury in breast-fed Egyptian infants.

  Ahmed M Hassan, Hussein A Sheashaa, Mohamed F Abdel Fattah, Alla Z Ibrahim, Osama A Gaber, Mohamed A Sobh
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  ABSTRACT: Ochratoxin A (OTA) constitutes a real human threat. Its presence in human milk has previously been reported in different countries. This study is the first Egyptian report on the presence of OTA in both mothers' milk and infants' sera, addressing its correlation with infants' kidney functions, which was not previously addressed in the literature. Fifty healthy breast-lactating mothers and their infants who were exclusively breast-fed for at least 4 months were included. All of them were subjected to a thorough laboratory evaluation including determination of OTA concentration by high-performance liquid chromatography. Thirty-six mothers (72%) and their infants had been contaminated with OTA. Univariate analysis showed that the presence of OTA was associated with significantly higher levels of urinary beta2 microglobulin and microalbuminuria. Multivariate logistic regression analysis showed that there was a significant correlation between a higher OTA level in infants' sera and the degree of microalbuminuria. Mothers and their infants in our locality are exposed to a high OTA contamination rate (72%). To establish the role of OTA in causation of future renal dysfunction for infants, large controlled studies are warranted.
  Pediatric Nephrology 02/2006; 21(1):102-5. · 2.52 Impact Factor
• Article: Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience.

  Amr A El-Husseini, Mohamed A Foda, Ahmed A Shokeir, Ahmed B Shehab El-Din, Mohamed A Sobh, Mohamed A Ghoneim
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  ABSTRACT: To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post-transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post-transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post-transplant hypertension. The independent determinants of graft survival in live-donor pediatric and adolescent renal transplant recipients are acute rejection and post-transplant hypertension.
  Pediatric Transplantation 01/2006; 9(6):763-9. · 1.48 Impact Factor
• Article: Neurophysiologic changes in live related kidney transplant children and adolescents.

  Amr A El-Husseini, Mohammad Abu-Hegazy, Abd El-Halim El-Tantawi, Mohamed A Sobh, Mohamed A Ghoneim
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  ABSTRACT: Uremic neuropathy is one of the most debilitating symptoms associated with end stage renal disease. In adults the only potential cure for uremic neuropathy is renal transplantation. No studies have investigated the neurophysiologic abnormalities among pediatric renal transplant recipients. The objective of this study is to describe the incidence, nature and factors affecting neurophysiologic abnormalities in young renal transplant recipients. Neurophysiologic study was performed for 31 of our live related pediatric renal transplant recipients; they were 21 males and 10 females. The mean age at transplantation was 13.2 +/- 3.1 yr. The neurophysiologic studies were performed at different time points after transplantation (range 12-60 months), with a mean period of follow-up after transplantation 3.2 +/- 1.1 yr. Electromyography of the following muscles was tested: abductor pollicis brevis of the thenar eminence, biceps brachii, extensor digitorum brevis and rectus femoris. The median and lateral popliteal nerves were tested for estimating the motor conduction velocity. Neuropathic changes were found in 19% of our cases with more affection of the distal muscles of lower limbs. Motor conduction velocities were reduced, distal latencies were lengthened, and motor unit action potentials were reduced or dispersed. The predictors for development of neuropathy by multivariate analysis were the cumulative steroid dose and graft dysfunction. These results suggest that neuropathy is prevalent among young pediatric renal transplants. The independent predictors for development of neuropathy are graft dysfunction and anemia. It is unclear how significant these findings are in view of absent clinical signs and symptoms. This may represent an early stage of a disease that is still silent.
  Pediatric Transplantation 11/2005; 9(5):579-83. · 1.48 Impact Factor
• Article: Does provision of a higher Kt/V urea make a difference? A hemodialysis controversial issue.

  Tarek M Abbas, Hussein A Sheashaa, Mohamed A Saad, Mohamed A Sobh
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  ABSTRACT: Adequate dialysis cannot be ascertained on the sole base of a normal or even a high Kt/V(urea) so the impetus of this study was to use the neurophysiologic studies as a marker of the biologic status of the hemodialysis patients to assess the optimum level of Kt/V(urea). This study was carried out on 20 patients (15 men and 5 women) on maintenance hemodialysis; their ages ranged from 18 to 66 years. Initially, the patients were subjected to thorough clinical and laboratory investigations, and their dialysis adequacy was assessed by studying their urea kinetic modeling and neurophysiologic studies (Phase I). Dialysis was optimized to achieve a target Kt/V(urea) of 1.3 in Phase II and 1.5 in Phase III. The duration of each phase was six months at the end of which all patients were thoroughly reevaluated. Nutrition was not manipulated during the study. A neurophysiologic study showed a significant improvement of polyphasicity pattern of both proximal and distal muscles of the upper and lower limbs concomitant with improvement of quality of life on achieving a Kt/V(urea) of 1.5 (p < 0.001). There was no significant change of the duration and amplitude of all studied muscles, however. Conclusion: Achieving a Kt/V(urea) of 1.5 is a more suitable target for hemodialysis patients because it may be an avenue for improving the neuromuscular functions of these patients.
  Hemodialysis International 04/2005; 9(2):153-8. · 1.54 Impact Factor
• Article: Serotyping of hepatitis C virus in hemodialysis patients: comparison with a standardized genotyping assay.

  Essam M Elsawy, Mohamed A Sobh, Farha A El-Chenawi, Ihab M Hassan, Ahmad B Shehab El-Din, Mohamed A Ghoneim
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  ABSTRACT: The aims of this study were to investigate the prevalence of hepatitis C virus (HCV) genotypes and serotypes in anti-HCV-positive hemodialysis patients and determine the concordance between genotyping and serotyping methods. Sixty-two hemodialysis patients were included in this study. HCV RNA was determined using polymerase chain reaction assay and genotypes using a line probe assay. HCV serotyping was performed with competitive enzyme-linked immunosorbent assay. Genotype 4 (52 patients) was the most predominant genotype, followed by type 1 (10 patients). The most prevalent HCV serotype was type 4 (41 patients), followed by serotype 1 (6 patients). We detected multiple serotypes in 4 patients and untypeable strains in 11. The overall sensitivity of serotyping assay was 82% for the study patients. According to the genotyping results, the sensitivity of serotyping was 60% and 86.5% for HCV types 1 and 4, respectively. There was a 100% concordance between results of serotyping and genotyping in the identification of HCV type 1 and 91% concordance in HCV type 4. Serological typing method may be of great value in microbiology laboratories that require a simple assay for identification of HCV genotypes, although the sensitivity of this assay may be limited by the immunocompetence of infected hemodialysis patients.
  Diagnostic Microbiology and Infectious Disease 03/2005; 51(2):91-4. · 2.53 Impact Factor
• Article: Interferon therapy in hemodialysis patients with chronic hepatitis C: study of tolerance, efficacy and post-transplantation course.

  Ihab M Mahmoud, Mohamed A Sobh, Ahmed F El-Habashi, Samir T Sally, Mahmoud El-Baz, Essam El-Sawy, Mohamed A Ghoneim
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  ABSTRACT: The potential benefit of pre-transplant treatment of chronic hepatitis C on long-term evolution after renal transplantation is not clear. Fifty successive renal transplant candidates had their sera positive for HCV RNA and a biopsy-proven chronic hepatitis. Out of these, 18 patients received a standard course of interferon-alpha2b (IFN; 3 MU three times weekly after hemodialysis sessions for 6 months). IFN was discontinued in 2 patients (11%) due to persistent leukopenia. HCV RNA turned negative in 10 patients of the treatment group and in none of the control group. Two patients of the IFN group had a virological relapse post-transplantation. Post-transplant follow-up periods were 41.5 +/- 15 and 50 +/- 16 months for the treated and control groups respectively. Transaminases remained normal in all patients of the IFN group after transplantation. In contrast, biochemical evidence of acute and chronic hepatitis was observed in 5 (p = 0.03) and 13 (p = 0.002) patients, respectively, of the control group. Logistic regression analysis identified non-receiving IFN before transplantation as a risk factor for post-transplant hepatic dysfunction (odds ratio = 11.7, p = 0.003) and for chronic allograft nephropathy (odds ratio = 11.6, p = 0.02). IFN-treated patients had a significantly better post-transplant hepatic function and significantly lower rates of chronic allograft nephropathy.
  Nephron Clinical Practice 02/2005; 100(4):c133-9. · 2.04 Impact Factor
• Article: Acute postinfectious crescentic glomerulonephritis: clinicopathologic presentation and risk factors.

  Amr A El-Husseini, Hussein A Sheashaa, Alaa A Sabry, Fatma E Moustafa, Mohamed A Sobh
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  ABSTRACT: Glomerular crescent formation is a feature of the most severe forms of human glomerulonephritis. The postinfectious form of rapidly progressive glomerulonephritis with crescents is a form of immune complex glomerulonephritis which seem to have a better prognosis. A relatively poorer prognosis for crescentic postinfectious glomerulonephritis in South Africa has been reported. In the present study, we have tried to determine the mode of presentation, and the prognostic factors for renal and patient outcome for cases with postinfectious crescentic glomerulonephritis (CGN). Between 1990 and 2000 a total number of 128 patients with CGN were managed at our center, among them 23 cases were diagnosed as postinfectious CGN. They were followed-up for a mean period of 40.1 +/- 28.9 months. Among them 12 were males and 11 were females. The median age was 12.35 years (range 4-55 years). The median serum creatinine at presentation was 7.24 mg/dl (range 1.3-14.5 mg/dl). We studied the clinical, laboratory and histopathological data .of our cases and their impact on the renal and patient outcome. By univariate study the risk factors for renal dysfunction were the age, hypertension, and nephrotic range proteinuria during the follow-up period. By multivariate analysis only the, hypertension, and presence of nephrotic range proteinuria during the follow-up period were the significant risk factors. The risk factors that significantly affected patient mortality were hypertension and serum creatinine at last follow-up. postinfectious CGN is a severe form of glomerulonephritis that usually presents with rapidly progressive renal failure. The persistence of hypertension and nephrotic range proteinuria during the follow-up are major bad prognostic predictors for renal dysfunction.
  International Urology and Nephrology 02/2005; 37(3):603-9. · 1.47 Impact Factor
• Article: A prospective randomized study for the treatment of bone loss with vitamin d during kidney transplantation in children and adolescents.

  Amr A El-Husseini, Amgad E El-Agroudy, Moharam El-Sayed, Mohamed A Sobh, Mohamed A Ghoneim
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  ABSTRACT: The effect of treatment with alfacalcidol on post-transplantation bone loss in children and adolescents was investigated. Of the 63 young patients who received renal transplant and were subjected to dual-energy x-ray absorptiometry (DEXA), 30 patients had low-bone mineral density (BMD) (z-score < or = -1) and were enrolled into the study. Their mean age at the time of transplantation was 14.5 +/- 4.0 years and the mean duration after transplantation was 48 +/- 34 months. Patients with low BMD were randomized into two equal homogeneous groups: group 1 (control) received placebo and group 2 received daily alfacalcidol 0.25 microg by mouth. Parameters of bone metabolism (intact parathyroid hormone, serum osteocalcin and urinary deoxypyridinoline) and BMD were assessed before and after the study period. After 12 months of treatment BMD at the lumber spine decreased from -2.2 to -2.5 in group 1 while it increased from -2.1 to -0.6 in group 2 (p < 0.001). Serum intact parathyroid hormone level decreased significantly in group 2 (p = 0.042). Apart from transient hypercalcemia in 1 patient in group 2, no other significant adverse effects were noted. This study suggested the value of alfacalcidol in the treatment of bone loss in young renal transplant recipients.
  American Journal of Transplantation 01/2005; 4(12):2052-7. · 6.39 Impact Factor
• Article: A Prospective Randomized Study for the Treatment of Bone Loss with Vitamin D During Kidney Transplantion in Children and Adolescents

  Amr A. El-Husseini, Amgad E. El‐Agroudy, Moharam El‐Sayed, Mohamed A. Sobh, Mohamed A. Ghoneim
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  ABSTRACT: The effect of treatment with alfacalcidol on post-transplantation bone loss in children and adolescents was investigated.Of the 63 young patients who received renal transplant and were subjected to dual-energy x-ray absorptiometry (DEXA), 30 patients had low-bone mineral density (BMD) (z-score ≤−1) and were enrolled into the study. Their mean age at the time of transplantation was 14.5 ± 4.0 years and the mean duration after transplantation was 48 ± 34 months. Patients with low BMD were randomized into two equal homogeneous groups: group 1 (control) received placebo and group 2 received daily alfacalcidol 0.25 μg by mouth. Parameters of bone metabolism (intact parathyroid hormone, serum osteocalcin and urinary deoxypyridinoline) and BMD were assessed before and after the study period.After 12 months of treatment BMD at the lumber spine decreased from −2.2 to −2.5 in group 1 while it increased from −2.1 to −0.6 in group 2 (p < 0.001). Serum intact parathyroid hormone level decreased significantly in group 2 (p = 0.042). Apart from transient hypercalcemia in 1 patient in group 2, no other significant adverse effects were noted.This study suggested the value of alfacalcidol in the treatment of bone loss in young renal transplant recipients.
  American Journal of Transplantation 11/2004; 4(12):2052 - 2057. · 6.39 Impact Factor