Hosam Zaghloul

A proposed SNOMED CT ontology-based encoding methodology for diabetes diagnosis case-base

Domain knowledge ontology supports the implementation of intelligent Case Based Reasoning (CBR) systems. Standardized terminologies support efficient indexing and processing of patient data. It is an essential element for the implementation of knowledge-based clinical decision support by exploiting pre-defined semantic relationships, both hierarchical and non-hierarchical in nature. Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) is the most comprehensive and complete terminology. This paper proposes an encoding methodology for clinical data using SNOMED CT. A case study for a diabetes diagnosis data set will be tested where SNOMED CT provides a concept coverage of ~75% for its clinical terms. Custom codes will be provided for uncovered terms. The encoded data set is derived from electronic health record database, and it represents a case base knowledge. The collected concept IDs will be used to build a domain ontology for diabetes diagnosis CBR. This ontology contains 550 concept IDs. The encoded case base and the domain ontology can be used to build a knowledge intensive CBR.

Case report evidence of relationships between hepatocellular carcinoma and ochratoxicosis.

Purpose The incidence of Hepatocellular carcinoma (HCC) is on the rise, but what is causing that trend has remained a mystery. Mycotoxins are almost entirely ignored health problems, and sometimes actually naively belittled in advanced medical care. Ochratoxin A (OTA) is one of the most abundant food contaminating mycotoxins worldwide that is carcinogenic, but no studies have evaluated its levels in HCC patients. Therefore, this study was designed to monitor the presence of OTA in the serum of HCC patients and to quantify the strength of the association between OTA and HCC. Methods We conducted a case control-based study on 61 participants. Thirty-nine were HCC cases identified between 2010 and 2012 and individually matched by age, sex, residence and date of recruitment to 22 healthy controls. Serum OTA and alpha-fetoprotein levels were measured by using high-performance liquid chromatography (HPLC) and enzyme-linked immunosorbent assay, respectively. Results HPLC analysis of 61 serum samples indicated that the highest incidence of elevated OTA was found in the HCC group and was 5-fold higher than in the control group. The concentration of OTA in the HCC group ranged between 0.129 and 10.93 ng/mL with a mean value±SD of 1.1±0.3 ng/mL, while in the normal group it ranged between 0.005 and 0.50 ng/mL with a mean value±SD of 0.201±0.02 ng/mL. The odds ratio for HCC patients presenting OTA levels above the cut-off of 0.207 (calculated by the receiver operating characteristic curve) was 9.78 (95% confidence interval = 2.9095–32.9816, P = 0.0002) with respect to normal controls, suggesting that HCC is 9.8 times as frequent in the exposed group to OTA. Conclusion Our results reveal a strong association between the presence of OTA and HCC, which may offer a coherent explanation for much of the descriptive epidemiology of HCC and suggest new avenues for analytical research.

Hepatitis C virus genotype distribution in Egyptian diabetic patients: a preliminary study.

BACKGROUND AND STUDY AIMS There is controversy regarding whether a specific hepatitis C virus (HCV) genotype is associated with diabetes mellitus. This study aimed to investigate HCV genotype distribution in diabetics and its relation to some clinical and laboratory variables in HCV-positive diabetic versus non-diabetic Egyptians in East Delta. PATIENTS AND METHODS The study included 100 HCV-positive patients of which 66 were diabetic in addition to 35 healthy adults as a control group. Clinical assessment, laboratory measurements of plasma glucose, insulin, C-peptide, C-reactive protein (CRP), tumour necrosis factor-α (TNF-α) and liver functions (alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT)) as well as HCV genotype determination were done, and AST/platelet ratio index (APRI) and Homoeostasis Model of Assessment-Insulin Resistance (HOMA-IR) were calculated. RESULTS The main results were the presence of HCV genotype 3, in 31.8% of the diabetic group and in 26.5% of the non-diabetic group, while the remainder of cases had genotype 4, the predominant genotype in Egypt. This is the first report of the presence of HCV genotype 3 in about 30% of an Egyptian cohort. However, there was no significant difference in genotype distribution between both groups. Further, there were significantly higher values of HOMA-IR, insulin and C-peptide in HCV-positive groups in comparison to the control group, while TNF-α was significantly higher in the HCV-positive diabetic group. However, there were no significant differences between both genotypes regarding these parameters. CONCLUSION Although this study reveals for the first time the presence of HCV genotype 3 in a significant percentage of a group of Egyptian patients, where the majority were diabetic, the association between diabetes and certain HCV genotypes could not be confirmed on the basis of our findings. Hence, taking into consideration the impact of such a finding on the treatment decisions of those patients, further studies are warranted to explore these findings to a greater extent.

Montelukast as an add-on treatment in steroid dependant nephrotic syndrome, randomised-controlled trial

BackgroundThe underlying mechanisms of nephrotic syndrome (NS) are still under debate and the need for more effective and less toxic treatment is challenging. We aimed to evaluate the efficacy of montelukast, a leukotriene receptor antagonist as an add-on therapy, and to explore the leukotriene (LT) biology in steroid-dependent nephrotic syndrome (SDNS).MethodsA randomized controlled trial was conducted including 32 patients with SDNS who were randomly assigned to receive standard steroid treatment only [low-dose steroid (LDS) group] or standard steroid therapy plus montelukast (Montelukast group). Urine protein/creatinine ratio, serum albumin, creatinine, cholesterol, and plasma LTs (LTB4/C4/D4/E4) were evaluated in all patients before and after treatment.ResultsAfter treatment, both groups showed a significant decrease of LTB4 and LTC4/D4/E4. Further, the Montelukast group showed a significant decrease in serum creatinine and a significant increase in diastolic blood pressure and protein/creatinine ratio. It also showed a marked decrease in plasma LTC4/D4/E4 compared to the LDS group, although not statistically significant.ConclusionsOur findings highlight the effect of montelukast on renal function, but suggest that the clinical and laboratory efficacy of the addition of montelukast to steroids in maintenance treatment of SDNS is debatable.

Chitosan gold nanoparticles for detection of amplified nucleic acids isolated from sputum

A platform for nucleic acid detection employing chitosan and chitosan coated gold nanoparticles (AuNPs) was developed. Mycobacterium tuberculosis (MTB) was used as a model target. MTB DNA was extracted from sputum using simple total nucleic acid extraction. Following amplification of MTB DNA, chitosan and AuNPs were added to samples. Free chitosan conjugated non-target DNA in negative samples, avoiding AuNP-DNA interaction and hence negative samples remained red. In positive samples, amplified DNA was capable of saturating free chitosan leading to AuNP aggregation where positive samples turned blue. Via visual color detection 15/16 MTB positive samples and 3/3 negative samples were correctly identified. This test is a 1-tube, 1-step assay reducing the risk of contamination in molecular laboratories and is a proof of concept on how chitosan; a cheap polymer could increase the sensitivity of AuNPs towards specific detection of nucleic acids without using target specific oligotargeters or expensive extraction kits.

5′ UTR and NS5B-based genotyping of hepatitis C virus in patients from Damietta governorate, Egypt

Graphical abstract