Mayssa Saadeh

King Abdullah International Medical Research Center, Ar Riyāḑ, Ar Riyāḑ, Saudi Arabia

Are you Mayssa Saadeh?

Claim your profile

Publications (4)17.91 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Interferon (IFN)-based therapy in chronic hepatitis C virus (HCV)-infected renal transplant (RT) recipients has been associated with a high risk of acute allograft rejection (AAR) and poor efficacy. We assessed the safety and efficacy of PegIFNα-2a and ribavirin (RBV) combination therapy in HCV-infected RT recipients. METHODS: Thirty-two adult RT recipients of >12 months duration, infected with HCV genotypes 1 (62.5%) and 4 (37.5%), and significant fibrosis (Metavir ⩾F2) were recruited in an open-label trial with PegIFNα-2a 135-180 μg/week, plus RBV 200-1200 mg/day for 48 weeks, based on estimated glomerular filtration rate. Safety assessments were performed weekly for 4 weeks, 2-weekly for 8 weeks, and 6-weekly for 36 weeks. Study end-points were sustained virologic response (SVR) or development of AAR. Allograft biopsies were performed for 20% increase in creatinine from pretreatment levels, or optionally at week 12 on surveillance protocol. Renal safety was compared with matched untreated historical controls (n=31). RESULTS: None of the treated patients showed AAR when biopsied for raised creatinine (12.5%) or during surveillance (37.5%), with incremental and sustained creatinine increases occurring in 6.3% treated patients and 16.1% of untreated controls (P = 0.148) by week 72 assessment. Mean pretreatment and end-of-assessment creatinine in treated patients remained similar (106.8±32.0vs.113.4±62.8,respectively; P=0.140), while levels increased significantly in the controls (106.6±35.6vs.142.5±93.0,respectively; P=0.013). Rapid, early virologic response (EVR) and SVR occurred in 12.5%, 56.3% and 37.5%, respectively. SVR was similar in both genotypes (P=1.000). PegIFN and RBV dose reductions were required in 34.4% and 78.1%, respectively; discontinuation was required in 12.5%. Binary logistic regression identified only EVR (OR, 20.4; 95% CI: 2.2-192.6; P=0.008) as an independent predictor of SVR. CONCLUSIONS: PegIFN/RBV therapy is not associated with AAR in RT recipients at low risk for rejection but has modest efficacy in the treatment of HCV.
    Journal of Hepatology 02/2013; · 9.86 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Histological changes in hepatitis C virus (HCV)-infected patients with persistently normal alanine aminotransferase (PNALT) have not been evaluated for updated upper limits of normal (ULN; ≤ 19/30 U/L for females/males). We assessed significant fibrosis (≥ F2, METAVIR) in patients with PNALT and persistently elevated alanine aminotransferase (PEALT). Nine hundred and twenty consecutive, unselected HCV patients were stratified into four groups: Group I: (n = 124) PNALT within the updated ULN [0.5 × ULN (corresponding to ≤ 19 U/L) for females; 0.75 × ULN (corresponding to ≤ 30 U/L) for males]; Group II (n = 173): PNALT ≤ 1 × ULN but greater than Group I; Group III (n = 313): PEALT 1-2 × ULN; and Group IV (n = 310): PEALT > 2 × ULN. PNALT was defined as ≥ 3 determinations within the normal range over ≥ 6 months. Advanced ≥ F3 and ≥ F2 fibrosis increased incrementally across Groups I; II; III; and IV: 24.2 and 45.2%; 25.4 and 56.1%; 36.1 and 64.2%; and 50 and 77.1% respectively (P<0.0001 for both). Multivariable logistic regression analysis identified age [odds ratio (OR), 1.05; 95% confidence intervals (CI): 1.02-1.08; P<0.0001], alanine aminotransferase (ALT) groups (OR 1.38; 95% CI: 1.03-1.83; P = 0.030), presence of moderate-severe steatosis (OR 2.70; 95% CI: 1.19-6.15; P = 0.018) and ≥ A2 necroinflammation (OR 17.9; 95% CI: 8.88-36.20; P < 0.0001) as independent predictors of ≥ F2 fibrosis. Updated ULN for ALT were better at excluding ≥ F2 fibrosis compared with traditional ULN (90.6 vs. 74.2%, P = 0.0041) but less specific (20.8 vs. 44%, P = 0.0007) with similar positive/negative predictive values. HCV patients with 'updated' normal ALT have the lowest prevalence of significant fibrosis, although utilizing these levels without resorting to biopsy would miss significant fibrosis in almost one-half of such patients.
    Liver international: official journal of the International Association for the Study of the Liver 08/2011; 31(7):1039-46. · 3.87 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Current guidelines recommend antiviral therapy in chronic hepatitis B (HBV) patients with significant histological disease. We aimed to compare histological fibrosis (METAVIR, ≥F2) in patients with HBV DNA ≥20,000 IU/mL vs. ≥2000 IU/mL and identify predictors of fibrosis. We performed prospective liver biopsies on 203 HBeAg-negative patients in four groups: Group I (n = 55): HBV DNA ≥20,000 IU/mL and persistently elevated alanine aminotransferase (ALT) levels (PEALT; >40 U/L); Group II (n = 34): HBV DNA ≥20,000 IU/mL and persistently normal ALT (PNALT); Group III (n = 40): HBV DNA <20,000 IU/mL and PEALT; and Group IV (n = 74): HBV DNA <20,000 IU/mL, and PNALT. We reanalysed all groups in relation to updated cut-off for treatable viremia (2000 IU/mL). Genotype D was detected in 86% of patients. Hepatic fibrosis ≥F2 was detected in 72.7%, 52.9%, 57.5% and 18.9% in Groups I-IV, respectively (P < 0.0001). Except in Group II with a trend for lower ≥F2 fibrosis (P = 0.067), there was no significant difference by using HBV DNA cut-off 20,000 vs. 2000 IU/mL. Multivariate logistic regression analysis identified study Group IV (OR, 0.0276; CI: 0.088-0.868; P = 0.0276) and milder (A0-1) necroinflammatory grade (OR, 0.135; CI: 0.063-0.287; P < 0.0001) as independent predictors of ≥F2 fibrosis. The specificity, positive and negative predictive values for PEALT in detection of ≥F2 fibrosis for viremia ≥2000 IU/mL (80%, 69% and 65%, respectively) or ≥20,000 IU/mL (86%, 73% and 63%, respectively) were similar, with a marginal gain in sensitivity (51% vs. 42%, respectively). Significant fibrosis is prevalent in a large proportion of HBeAg-negative patients with high viremia and persistently normal ALT. Lower HBV DNA cut-offs could be adopted with marginal gains in fibrosis detection and without loss of diagnostic accuracy.
    Journal of Viral Hepatitis 07/2011; 18(7):e217-25. · 3.08 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Multiple surveys of medical residents have shown a high incidence of harassment and discrimination in academic health centers. Harassment has a negative effects on residents' health and on their ability to function. No previous study has documented the prevalence of harassment and discrimination among residents in Saudi Arabia. We aimed in this study to assess the prevalence of harassment and discrimination among residents at a tertiary care academic hospitals in Saudi Arabia. Cross-sectional survey conducted at National Guard Hospitals in Riyadh, Jeddah and Al-Ahsa'a from 27 July to 20 August 2010. The survey included questions on the prevalence of harassment of different types, inlcuding verbal, academic, physical and sexual harassment, as well as discrimination on the basis of gender, region of origin or physical appearance. Of 380 residents, 213 (56%) returned a completed questionnaire (123 male, 57.8%). At least one of type of harassment and discrimination was reported by 83.6% of respondents. The most frequently reported forms were verbal harassment and gender discrimination (61.5% and 58.3%, respectively). Sexual harassment was commonly reported (19.3%) and was experienced significantly more often by female residents than by male residents (P=.0061). Harassment and discrimination of Saudi residents is common with more than three-quarters reporting having had such an experience. Identification of the risk factors is a necessary first step in clarifying this issue and could be used when planning strategies for prevention.
    Annals of Saudi medicine 33(2):134-9. · 1.10 Impact Factor