Ahmed Hamdy

Native Myocardial T1 Mapping, Are We There Yet?

T1 or longitudinal relaxation time is one of the very fundamental magnetic resonance imaging (MRI) time constants and a tissue characterizing parameter. Only during the last decade did it become possible to quantify T1 values of the myocardium through T1 mapping. Evolving from only region of interest analysis and long acquisition times to the pixel-based parametric mapping and short breath-hold sequences, T1 mapping is reaching maturity among cardiac magnetic resonance (CMR) techniques. Both inversion recovery methods such as MOdified Look-Locker Inversion (MOL-LI) and Shortened MOLLI (ShMOLLI) and saturation recovery methods such as Saturation recovery Single-Shot Acquisition (SASHA) are available for T1 quantification with variable degrees of accuracy, precision, and reproducibility. Native (non-contrast) T1 values increase with edema, amyloid deposition, and fibrosis, while they decrease in fat or iron deposition in the myocardium. These features enabled significant expansion of the clinical applications of native T1 mapping where it provides high sensitivity and specificity and even acts as a disease biomarker or a predictor of prognosis. It is of particular usefulness in diffuse myocardial diseases where conventional CMR techniques might be deceiving. A brighter future for the technique is expected if certain challenges are to be faced, examples of which are the need for standardization of normal values, acquisition techniques, and improving analysis tools.

Role of endoscopic ultrasound and endoscopic-ultrasound-guided fine-needle aspiration in endoscopic biopsy negative gastrointestinal lesions

Background and Objectives: Many cases of gastrointestinal (GI) tumors as lymphoma, adenocarcinoma, and most of submucosal tumors (SMT) such as gastrointestinal stromal tumor (GIST) and leiomyoma are difficult to diagnose as they frequently yield negative endoscopic biopsies. We evaluated the accuracy of endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis of endoscopic biopsy negative GI tumors. Patients and Methods: One hundred and nine patients with biopsy negative GI tumors were included in this prospective study. EUS and EUS-FNA were performed to all patients with cytopathologic examination. Results: There were 109 patients with endoscopic biopsy negative GI lesions, including 61 males (56%) and 48 females (44%), with the mean age of 54 years. Sixty-three cases (57.8%) were proved to have malignant lesions, among them there were 15 cases with high-risk GIST as proved by FNA and excision biopsy. Forty-six cases (42.2%) were proved to be benign; among them there were 21 cases presented with non-high-risk GIST. Endoscopic ultrasound had a sensitivity of 96.8%, specificity of 89.1%, positive predictive value (PPV) of 92.4%, negative predictive value (NPV) of 95.3%, and accuracy of 93.6%. EUS-FNA had a sensitivity of 87.3%, specificity of 100%, PPV of 100%, NPV of 85.2%, and accuracy of 92.7%. Conclusion: EUS with EUS-FNA is an accurate procedure in the diagnosis of GI tumors with negative endoscopic biopsies.

Methylene tetrahydrofolate reductase, transforming growth factor-β1 and lymphotoxin-α genes polymorphisms and susceptibility to rheumatoid arthritis

BACKGROUND Rheumatoid arthritis is a widely prevalent autoimmune disorder with suggested genetic predisposition. OBJECTIVES The aim of this study is to detect the pattern of genetic polymorphism of methylene tetrahydrofolate reductase (MTHFR C677 T and A1298 C), transforming growth factor-β1 (TGF-β1 T869 C) and lymphotoxin-α (LT-α A252G) in patients having rheumatoid arthritis and correlate these patterns to disease activity and serum levels of tumor necrosis factor-alpha (TNF-α), B-Cell Activating Factor (BAFF), and osteopontin. METHODS A total of 194 subjects, 90 controls and 104 patients with rheumatoid arthritis were genotyped for MTHFR C677 T and A1298 C, TGF-β1 T869 C and LT-α A252G polymorphisms using a methodology based on PCR-RFLP. Also serum levels of TNF-α, osteopontin and BAFF were measured by ELISA kits. RESULTS The CT genotype and T allele of MTHFR C677 T and GG genotype and G allele of LT-α A252G are associated with the risk of RA and with higher levels of the pro-inflammatory cytokine, TNF-α in patients with rheumatoid arthritis. CONCLUSION Our findings suggest that there is association between MTHFR C677 T and LT-α A252G genes polymorphisms and increased risk of RA in this sample of Egyptian population.

Serum matrix metalloproteinase-9 in acute ischemic stroke and its relation to stroke severity

Background Thrombolytic therapy is currently the only FDA-approved treatment for acute ischemic stroke. Hence, early diagnosis and risk stratification is of great importance in management. Objective The aim of this work was to study serum level of matrix metalloproteinase-9 (MMP-9) within 24 h of acute ischemic stroke onset and its relation with clinical severity. Patients and methods Thirty patients with acute ischemic stroke were subjected to measurement of serum MMP-9 within 24 h of stroke onset and clinical assessment of stroke severity. Thirty healthy volunteers of matched age and sex were included as controls. Results Fifteen male and 15 female patients with a mean age of 61 ± 7.11 years were studied. The mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 11.17 ± 4.76. The mean serum level of MMP-9 in patients was 998.8 ± 154.72 ng/ml, which was significantly higher compared with the serum level of MMP-9 in controls ( P = 0.003). The mean NIHSS of patients with normal serum level of MMP-9 was less than the mean NIHSS in patients with high MMP-9 serum levels ( P = 0.003). There was a significant positive correlation between serum level of MMP-9 and NIHSS score ( r = 0.5; P = 0.005) even after adjustment of other variables )age, sex, diabetes, hypertension, fasting blood sugar, uric acid, serum triglycerides, serum cholesterol, and right and left carotid intima media thickness( ( r = 0.48; P = 0.032). Conclusion Serum MMP-9 level was found to be high in acute ischemic stroke patients and correlated with clinical stroke severity.

Seroprevalence and real-time PCR study of Epstein-Barr virus and the value of screening in pretransplant patients

Objective This study was performed to estimate the prevalence of Epstein-Barr virus immunoglobulin M virus capsid antigen (EBV IgM VCA) among healthy blood donors and to confirm the real risk of transfusion transmission by detection of virus load using PCR quantification. Materials and methods A total of 860 apparently healthy Egyptian blood donors were enrolled and tested for EBV IgM VCA. Quantitative PCR was performed for reactive cases for EBV IgM VCA. Results An overall 38 patients were reactive for EBV IgM VCA, constituting 4.4% of the sample. Reactivity of Epstein-Barr virus did not differ significantly as regards sex distribution, blood grouping, Rh factor positivity, and hemoglobin level, but it was significantly higher among upper Egypt participants than among those from other regions (P = 0.006). There was a very high statistically significant positive correlation between the titer of EBV VCA IgM reactive cases and age in the studied group (P = 0.0001 and r = 0.6). PCR was negative for all of the reactive cases. Conclusion Routine screening for Epstein-Barr virus in blood bags is not economical. Screening is highly recommended only for immunocompromised and pretransplant patients. Viremia is not the role in individuals with EBV IgM positive sera, which in turn changes some concepts in organ transplantation.

Polimorfismos dos genes metilenotetrahidrofolato redutase, fator de crescimento transformador β1 e linfotoxina‐α e susceptibilidade à artrite reumatoide

BACKGROUND Rheumatoid arthritis is a widely prevalent autoimmune disorder with suggested genetic predisposition. OBJECTIVES The aim of this study is to detect the pattern of genetic polymorphism of methylene tetrahydrofolate reductase (MTHFR C677T and A1298C), transforming growth factor-β1 (TGF-β1 T869C) and lymphotoxin-α (LT-α A252G) in patients having rheumatoid arthritis and correlate these patterns to disease activity and serum levels of tumor necrosis factor-alpha (TNF-α), B-Cell Activating Factor (BAFF), and osteopontin. METHODS A total of 194 subjects, 90 controls and 104 patients with rheumatoid arthritis were genotyped for MTHFR C677T and A1298C, TGF-β1 T869C and LT-α A252G polymorphisms using a methodology based on PCR-RFLP. Also serum levels of TNF-α, osteopontin and BAFF were measured by ELISA kits. RESULTS The CT genotype and T allele of MTHFR C677T and GG genotype and G allele of LT-α A252G are associated with the risk of RA and with higher levels of the pro-inflammatory cytokine, TNF-α in patients with rheumatoid arthritis. CONCLUSION Our findings suggest that there is association between MTHFR C677T and LT-α A252G genes polymorphisms and increased risk of RA in this sample of Egyptian population.

Study of the LMNA 1908 C/T gene polymorphism in type 2 diabetic Egyptians with vascular complications

Aims/introduction Vascular complications are the main cause of morbidity and mortality in type 2 diabetic patients. Genetic susceptibility is associated with the evolution of diabetic complications. One such gene is the lamin A and C gene located on chromosome 1q21, a susceptibility locus for type 2 diabetes mellitus, and encodes nuclear lamins A and C. The LMNA 1908 C/T polymorphism has been reported to be associated with dyslipidemia, metabolic syndrome, and obesity, suggesting that this polymorphism increases the risk of atherosclerosis and vascular disease. The present study aims to elucidate the association between the LMNA 1908 C/T single nucleotide polymorphism and the prevalence of vascular complications in a sample of type 2 diabetic Egyptian patients. Materials and methods Genomic DNA from 47 type 2 diabetic patients with vascular complications and 20 control participants was analyzed for the LMNA 1908 C/T polymorphism using PCR-RFLP. Results Carriers of the LMNA 1908 T-allele showed a significantly higher prevalence in patients with diabetic nephropathy than carriers of the C-allele (P < 0.05). Multiple regression analysis showed that the LMNA 1908 T-allele tended to be independent risk factor for diabetic nephropathy (P = 0.012, odds ratio = 5.460). Conclusion The findings of this study suggest that the LMNA 1908 C/T single nucleotide polymorphism is associated with the development of diabetic nephropathy in Egyptian type 2 diabetic patients.

Serum Adipokines in Patients with Non-alcoholic Fatty Liver Disease - Is there a Role for Predicting the Severity of Liver Disease?

Introduction: Non-alcoholic fatty liver disease (NAFLD) is considered to be among the most common liver diseases world-wide. NAFLD encompasses a broad spectrum of pathological conditions ranging from Simple Steatosis (SS) to steatohepatitis (NASH), fibrosis and finally even cirrhosis. Adiponectin (A) has been associated with inhibition of fibrogenesis and liver protection while Leptin (L) contributes to fibrogenesis in various chronic liver diseases, notably in NASH. The aim of work: To determine the validity of serum adipokines including leptin, adiponectin, and A/L ratio to act as potential markers for NAFLD and to discriminate NASH from SS. Patients and methods: Eighty four patients who have bright liver on abdominal ultrasonography and 28 healthy individuals served as control group. Serum Leptin and Adiponectin were estimated by ELISA technique. Liver biopsy was done for 46 patients and according to histopathological examination they were divided into 21 patients with SS and 25 patients with NASH. Results: The serum concentration of adiponectin was significantly lower in NASH than SS group (P<0.001). There was no significant difference between serum concentration of leptin in both groups (P=0.4). A/L ratio in NASH group was significantly lower than SS group (P<0.001). Adiponectin was negatively correlated with BMI, total cholesterol and LDL-C in both groups. A/L ratio in NASH group was significantly positively correlated with adiponectin (P<0.001) while it was significantly negatively correlated with leptin (P<0.001). In SS group A/L ratio was significantly negatively correlated with leptin (r=-0.863, P<0.001). Conclusion: In patients with NAFLD, the serum adiponectin and A/L ratio can discriminate simple steatosis from NASH and predict the severity of liver injury