Gamal Badra

National Liver Institute, Shabin al-Kum, Al Minūfīyah, Egypt

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Publications (27)67.46 Total impact

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    ABSTRACT: Background: Spontaneous bacterial peritonitis (SBP) is a frequent complication in cirrhotic patients with ascites, with the prevalence ranging between 10 and 30%. Despite early diagnosis and early administration of antibiotics, SBP is associated with high mortality and poor long-term outcome. This study aimed to compare the effectiveness of different regimens of oral antibiotics for prophylaxis of SBP in patients with cirrhosis and ascites who had at least one previous episode of SBP. Patients and methods: In this study, 180 cirrhotic patients with ascites and with a previous history of at least one episode of SBP were randomized to receive different regimens of prophylactic antibiotics for 6 months. They were divided into six groups of 30 patients each who received ciprofloxacin (750 mg once weekly), ciprofloxacin (750 mg twice weekly), norfloxacin (400 mg/day), norfloxacin (400 mg/week), trimethoprim–sulfamethoxazole (180 mg/800 mg/day for 5 days/week), and trimethoprim–sulfamethoxazole (180 mg/800 mg/week). All patients were followed for 6 months to detect the effect of these different regimens in prophylaxis against SBP. Results: The rate of SBP recurrence was 10% in group 1, 10% in group 2, 6.7% in group 3, 10% in group 4, 6.7% in group 5, and 13.3% in group 6. These rates are less than those mentioned in the literature for cirrhotic ascitic patients receiving no antibiotic prophylactic therapy. There was no difference between the different doses of antibiotics used or the different antibiotics, in recurrence of SBP. Conclusion: All regimens used in this study showed comparable effectiveness and adverse effects. Hence, the choice of such regimens should depend on cost effectiveness and patients' tolerability.
    No preview · Article · Jun 2011 · Egyptian Liver Journal
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    ABSTRACT: Cholangiocarcinoma (CC) is a fatal malignancy, the incidence of which is increasing worldwide, with substantial regional variation. Current diagnostic techniques to distinguish benign from malignant biliary disease are unsatisfactory. Metabolic profiling of bile may help to differentiate benign from malignant disease. No previous studies have compared the metabolic profiles of bile from two geographically and racially distinct groups of CC patients. This study aimed to compare metabolic profiles of bile, using in vitro proton magnetic resonance spectroscopy, from CC patients from Egypt and the UK, and from patients with CC and patients with non-malignant biliary disease. A total of 29 bile samples, collected at cholangiography, were analysed using an 11.7-T system. Samples were from eight CC patients in either Egypt (n = 4) or the UK (n = 4) and 21 patients with benign biliary disease (choledocholithiasis [n = 8], sphincter of Oddi dysfunction [n = 8], primary sclerosing cholangitis [n = 5]). Bile phosphatidylcholine (PtC) was significantly reduced in CC patients. Egyptian CC patients had significantly lower biliary PtC levels compared with UK patients. Taurine- and glycine-conjugated bile acids (H-26 and H-25 protons, respectively) were significantly elevated in bile from patients with CC compared with bile from patients with benign diseases (P = 0.013 and P < 0.01, respectively). Biliary PtC levels potentially differentiate CC from benign biliary disease. Reduced biliary PtC in Egyptian compared with UK patients may reflect underlying carcinogenic mechanisms.
    Full-text · Article · Jun 2011 · HPB
  • S El-Masry · M Gouida · G Badra · H Hosny
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    ABSTRACT: Chemokine receptors ( CCR1 and CCR5 ), have been implicated in hepatic inflammation and hepatocellular carcinoma (HCC). The present study aimed to investigate the expressions of CCR1, CCR5 on peripheral blood mononuclear cells (PBMCs) of Egyptian patients with liver cirrhosis (LC) and HCC and their correlation to the severity of liver disease and the clinical features of HCC. Isolated PBMCs from 25 patients with HCC, 10 LC patients and 9 adult healthy controls were stained with monoclonal antibodies against CD4, CD8, CCR1 and CCR5, then detected by using a flow cytometry technique. Patients were diagnosed by abdominal ultrasound (US) and computed tomography (CT) scan findings, biochemical liver function tests, serum alpha-fetoprotein (AFP). Our data revealed that CCR1 and CCR5 expressions in liver cirrhosis patients were significantly higher than healthy controls (P=0.008 and 0.053 respectively), as well as in HCC patients but the increment were not significant (P= 0.120 and 0.216 respectively). The expressions of CCR1 and CCR5 were increased in liver cirrhosis than in HCC patients, but the increment were not significant (P=0.120 and 0.216 respectively). However, both CCR1 and CCR5 were decreased with increasing number of liver tumor in a negative linear regression correlation. Patients with liver cirrhosis or HCC showed lower CD4 and CD8 T cells count compared with healthy controls. In Conclusion The up-regulations of CCR1 and CCR5 in patients with hepatic cirrhosis confirmed the activation of the CC chemokine system in human fibrogenesis and may play a role in recruitment of lymphocytes to the injured liver.
    No preview · Article · Oct 2010
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    ABSTRACT: Liver fibrosis (LF), where the chronic HCV infection is a major cause, is a characteristic of chronic liver diseases. LF results from chronic damage to the liver in conjunction with the accumulation of ECM proteins. Matrix metalloproteinases (MMPs) and their specific inhibitors (TIMPs) are thought to play an essential role in the hepatic lesions. The available data concerning the circulating levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in chronic hepatitis C are not conclusive. Therefore, the present study was designed to seek the relationship between serum MMP-9, and TIMP-1 to liver status in chronic liver disease in fifty patients divided into three groups (chronic hepatitis, liver cirrhosis and hepatocellular carcinoma). MMP-9 and TIMP-1 were analyzed by the enzyme linked immunosorbent assay (ELISA). The results showed that the lowest serum level of MMP-9 was found in chronic hepatitis patients compared to the control ( P < 0.05). Serum MMP-9 is decreasing during progression of chronic hepatitis to cirrhosis showing the least level in the cirrhotic group. Serum TIMP-1 was significantly higher in the cirrhotic group compared to chronic hepatitis ( P < 0.05) and controls ( P < 0.001). MMP-9 was negatively correlated to both TIMP-1 and the histological severity in chronic hepatitis. There was a positive correlation between TIMP-1 and the degree of fibrosis (r = 0.73, P < 0.001). Lastly, there was a statistically significant increase of MMP-9 ( P < 0.001) and TIMP-1 ( P < 0.05) in HCC patients compared with the other groups. In conclusion, these findings raise the possibility of using serum TIMP-1 as a non-invasive assay in liver fibrosis. Further, the altered balance between circulating MMP-9 and TIMP-1 during HCV infection may play an important role in aggravating liver injury progression in chronic liver diseases.
    No preview · Article · Mar 2010 · Acta Microbiologica et Immunologica Hungarica
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    ABSTRACT: Chronic hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease worldwide. It has been shown that Helicobacter pylori (H. pylori) plays an important role in chronic gastritis, peptic ulcer disease and gastric malignancies, and its eradication has been advocated. The association between H. pylori infection and liver cirrhosis in patients with hepatitis C virus has been documented in different parts of the world; nevertheless, no conclusive data is available in Egypt. In the present study, the status of H. pylori infection was sought in 90 patients with chronic HCV infection and in 66 HCV-free healthy controls. The study showed that the H. pylori positivity was increased significantly (P = 0.03) in the HCV-infected patients when compared to that in healthy controls, where H. pylori infection was found in 50 (55.6%) out of 90 of the HCV-infected patients versus 26 (39.4%) out of 66 of the healthy controls. In HCV-infected patients, the prevalence of H. pylori infection was increased significantly (P = 0.04) from chronic active hepatitis to cirrhosis. H. pylori infection was present in 6/18 (33.3%), 10/21 (47.6%), 16/27 (59.3%), 18/24 (75.0%) patients with chronic active hepatitis, Child-Pugh score A, Child-Pugh score B and Child-Pugh score C, respectively. More importantly, the prevalence of H. pylori infection in HCV-infected patients was increased very significantly (P = 0.003) with increasing Meld (model for end-stage liver disease) score. The prevalence of H. pylori was documented in 9/28 (32.1%) patients with Meld score >10 and in 41/62 (66.1%) patients with Meld score >10. It may be stated that our results collectively reflect a remarkable increase in H. pylori prevalence with advancing hepatic lesions, and the eradication treatment may prove beneficial in those patients with chronic hepatitis C.
    No preview · Article · Jan 2010 · Journal of global infectious diseases

  • No preview · Article · Dec 2008 · Journal of Hepatology
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    Full-text · Article · Nov 2008 · International Journal of Infectious Diseases
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    ABSTRACT: Background/Aim: Hepatic encephalopathy (HE) is frequently observed in patients with advanced liver disease and manifests a wide variety of neuropsychiatric signs and symptoms. Ammonia toxicity and bacterial endotoxins have been suggested as key determinants of HE onset whereas a role for Helicobacter pylori infection has not been established. We investigated the correlation between H. pylori infection and HE severity (evaluated through functional tests) in 60 outpatients with established liver cirrhosis and 20 non-cirrhotic controls. Methods: Fasting arterial blood ammonia, plasma endotoxins, and H. pylori infection status were investigated in all subjects. Results: H. pylori infection was documented in 35/60 (58%) patients and in 6/20 (30%) controls (P = 0.039). Significant differences were observed between patients with and withoutHE for age, presence of ascites, fasting arterial blood ammonia, plasma endotoxin, and H. pylori infection. Further, a significant increase in fasting arterial blood ammonia and plasma endotoxin was associated with H. pylori infection in cirrhotic patients. Last, medical treatment of H. pylori infection led to a significant decrease in HE severity and fasting arterial blood ammonia levels. Conclusion: In conclusion, we submit that H. pylori infection might, in fact, play a role in increasing the circulating levels of ammonia and endotoxins in cirrhotic patients, thus facilitating the onset of HE.
    No preview · Article · Jul 2007 · Hepatology Research

  • No preview · Article · Jul 2007 · Saudi medical journal
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    ABSTRACT: Hepatitis C virus (HCV) is an international medical challenge. In Egypt it is considered to be a major health problem which leads to liver cirrhosis and hepatocellular carcinoma in some individuals. Infection with Schistosoma mansoni (S. mansoni) is endemic in Egypt. The incidence of combined viral hepatitis and schistosomiasis was found to be increasing; however scarce studies investigated the influence of Schistosoma mansoni on the HCV specific immune response. This study included four groups; Group (1): 23 patients with chronic HCV, Group (2): 10 patients with S. mansoni infestation, Group (3): 21 chronic HCV patients coinfected with S. mansoni, Group (4) 10 healthy controls. HCVspecific CD4+ and CD8+ T cell responses were measured by flow cytometery in all groups and correlated with serum HCV RNA level, liver function tests, serum alkaline phosphatase, complete blood count and grade of necroinflammatory activity and stage of fibrosis of hepatic tissue. Patients with chronic HCV had stronger CD4+ T cell response in comparison to coinfected ones. Chronic HCV &S. mansoni coinfected patients had the lowest CD8+ T cell, and significantly higher HCV-RNA titers. There was an inverse relationship between virus load and CD4+ T cell responses. There was a significant negative correlation between CD4+ T cell level and stage of hepatic fibrosis (r= -0.41; p<0.05), and also a significant negative correlations between CD8+ T cell and grade of inflammation and stage of hepatic fibrosis (r = -0.42, p<0.05; r -0.38, p<0.05 respectively). Conclusion: Schistosomiasis is an important factor that may contribute in hepatitis C viral persistence through down regulation of immune response and may enhance liver damage in HCV patients.
    Full-text · Article · Jan 2007 · HAEMA
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    ABSTRACT: Hepatic schistosomiasis and chronic hepatitis C virus (HCV) are the most prevalent agents causing hepatic fibrosis in humans. Laminin (LA) has been related to liver fibrosis and subsequent development of portal hypertension in chronic liver disease. There are no available data describing the pattern of laminin in combined HCV and schistosoma-infected patients, thus the rationale of this study was to assess the serum LA as an index of liver fibrosis in patients with schistosomiasis and/or chronic viral hepatitis C and to evaluate a developed Slot-Blot Enzyme-Linked Immunosorbant Assay (Slot-Blot-ELISA) as a method of estimation.
    No preview · Article · Jun 2006 · Clinical Biochemistry
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    ABSTRACT: Chronic hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease worldwide and HCV genotype 4 (HCV4) is predominant in African and Middle Eastern countries. It is well established that interferon-a (IFNa) treatment for HCV may trigger serum autoantibodies against pancreatic islet cells (ICA) in a subgroup of patients. Available data on the incidence of ICA during IFNa therapy for chronic HCV4 infection are not conclusive. We investigated the appearance of ICA in 40 naïve Egyptian patients (38 males, 32 +/- 6 years) with histologically defined chronic HCV4 infection undergoing IFNa treatment at a dose of 9-million U/week for 24 weeks. Serum samples were collected at baseline and following IFNa therapy and ICA were detected using indirect immunofluorescence. Baseline evaluation indicated that 2/40 (5%) patients had detectable serum ICA. After the completion of the treatment scheme, 12/38 (32%) previously ICA negative patients became ICA positive; however, no patient developed impaired glucose tolerance (IGT) or diabetes during follow-up. In conclusion, we submit that IFNa treatment for chronic hepatitis C (CHC) may induce serum ICA in one-third of Egyptian patients with HCV4. These autoantibodies, however, do not lead to alterations in glucose metabolism.
    Full-text · Article · Apr 2006 · Clinical and Developmental Immunology
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    M Lotfy · G Badra · W Burham · F Q Alenzi

    Full-text · Article · Feb 2006 · British journal of biomedical science
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    ABSTRACT: Hepatitis C virus infection and schistosomiasis are major public health problems in the Nile Delta of Egypt. The combined viral hepatitis and schistosomiasis incidence was found to be increasing. The present work studied the histopathological and histochemical changes in patients coinfected with chronic HCV and S. manson. Examination of liver section in patients infected with Schistosoma mansoni showed granulomas with different sizes and the hepatic tissue showed many histopathological changes such as congestion of blood vessels, cytoplasmic vacuolation of the hepatocytes and leucocytic infiltrations. Examination of HCV patients' liver section showed macrovesicular steatosis, portal tracts expanded by fibrosis and infiltrated by inflammatory cells. Parenchyma showed areas of spotty necrosis, cytoplasmic vacuolation, and microvesicular to macrovesicular steatosis. In HCV and schistosomiasis patients the liver parenchyma showed cytoplasmic vacuolation and portal area infiltrated with lymphocytes and granulomatous inflammation that reflects the parasitic infection; cirrhotic nodules and disturbed hepatic parenchyma were more common in patients coinfected with HCV and schistosomiasis than in the patients infected with HCV alone. The glycogen and total proteins content showed mild decrease in the two patients group separately but in patients coinfected with HCV and schistosomiasis the liver cells appeared to lose most of its content of glycogen and proteins. So it is recommended to perform a complete analysis and treatment for schistosomiasis, in patients infected with chronic HCV suggesting that, it will help in therapy, preventing acceleration of fibrosis and worsening of their clinical conditions.
    No preview · Conference Paper · Jan 2006
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    ABSTRACT: Hepatitis C has emerged as a major worldwide public health problem. The host immune response to HCV infection is composed of both a non-specific immune response, including interferon (IFN) production and natural killer (NK) cell activity, and a virus-specific immune response, including humoral and cellular components. Susceptibility to infection has been related to immunological disturbances. Several studies have provided experimental evidence of disorders of both cellular and humoral immunity. The present study was carried out to evaluate the serum immunoglobulins level (IgG, IgM, IgA) and IgG-subclasses (IgG1-4) in chronic hepatitis C patients in comparison with healthy control patients. This study included 50 patients with biochemical, serologic, virologic, and histologic evidence of chronic hepatitis C. Total IgG, IgA, and IgM were assayed by nephelometry. IgG subclasses were assayed using human IgG subclasses enzyme immunoassay. The results showed a significant increase of total serum IgG and IgM levels found in patients with chronic HCV compared with the healthy control patients (P < 0.001 for each). There was a statistically significant difference in the IgG subclasses (IgG1 to IgG4) between the patients and controls (P < 0.001 for each). On the other hand, no significant difference was found between patients and healthy controls in IgA level (P = 0.4). The normal total serum immunoglobulins pattern is apparently shifted in chronic hepatitis C infection in the Egyptian patients. This pattern may include an ethnic or biologic background and could be used in the differentiation of the patients with minimal liver disease.
    No preview · Article · Jan 2006 · Journal of Immunoassay and Immunochemistry

  • No preview · Article · Jan 2006
  • Tarek A. Salem · Mohamed F. El-Refaei · Gamal A. Badra
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    ABSTRACT: It has been postulated that liver disease and cholestasis affects polymorph nuclear leuko- cytes function by impeding chemotaxis, phagocytosis and superoxide anion release in experimental animals. The aim is to evaluate the antioxidant status and phagocytic activity of neutrophils in chronic liver disease patients. Four groups of individual have been involved in this study: Group I composed of 15 patients with primary biliary cirrhosis; group II included 15 patients with primary sclerosing cholangitis; group III included 15 patients with chronic viral hepatitis C and group IV composed of 15 healthy non smoker individuals. Levels of catalase, superoxide dismutase, reduced glutathione, glu- tathione peroxidase and malondialdehyde were assessed in both serum and neutrophils homogenates. The function of neutrophils was estimated by nitro blue tetrazolium reduction assay (NBT). A marked significant decrease in the antioxidant status was observed in serum and neutrophilsí homogenate of patients with chronic liver diseases compared to healthy subjects p
    No preview · Article · Jul 2005 · HAEMA
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    Full-text · Article · Mar 2005 · Indian Journal of Gastroenterology
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    Full-text · Article · Jan 2005
  • I M El-Kady · M Lotfy · G Badra · S El-Masry · I Waked
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    ABSTRACT: Schistosoma mansoni infection is characterized by a strong T-helper type 2 (Th2) cell-associated immune response, but in the case of viral infection, it is associated with interferon-gamma (IFN-gamma) increase and induction of Th1 immune response. Few data are available about the immune response of cases infected with combined hepatitis C virus (HCV) and schistosomiasis. Thus, the investigation of the cytokine pattern in patients coinfected with both HCV and Schistosoma mansoni was our rationale. This study included four patient groups: Group 1 included 20 patients infected with chronic HCV, Group 2 included 15 patients infected with schistosomiasis alone, Group 3 included 20 patients with chronic HCV and schistosomiasis and Group 4 included 15 healthy control individuals with matched age and sex. Serum levels of IFN-gamma, interleukin (IL)-4, IL-10 and IL-18 were measured in all groups by enzyme-linked immunosorbent assay. The results showed that the patients infected with HCV had significantly higher serum levels of IFN-gamma and IL-18 compared with the controls and with the patients with schistosomiasis and coinfection (P < 0.001). On the other hand, serum levels of IL-4 and IL-10 were significantly higher in patients with schistosomiasis and coinfection compared with the control group (P < 0.001 and 0.0001, respectively) and with the HCV patients (P < 0.05 and P < 0.001, respectively). A significant increase in serum levels of IL-4 and IL-10 was also found in HCV patients compared with the control (P < 0.05). Schistosomiasis appears to induce a Th2 cytokine profile, with increase in serum levels of IL-4 and IL-10, even in the presence of HCV coinfection. In conclusion, schistosomiasis may downregulate the stimulatory effect of HCV on Th1 cytokines and this may lead to the chronicity of HCV infection in coinfected patients.
    No preview · Article · Jan 2005 · Scandinavian Journal of Immunology