Mohamed Amgad

Clinical correlates of common corneal neovascular diseases: a literature review.

A large subset of corneal pathologies involves the formation of new blood and lymph vessels (neovascularization), leading to compromised visual acuity. This article aims to review the clinical causes and presentations of corneal neovascularization (CNV) by examining the mechanisms behind common CNV-related corneal pathologies, with a particular focus on herpes simplex stromal keratitis, contact lenses-induced keratitis and CNV secondary to keratoplasty. Moreover, we reviewed CNV in the context of different types of corneal transplantation and keratoprosthesis, and summarized the most relevant treatments available so far.

Cancer education for medical students in developing countries: Where do we stand and how to improve?

BACKGROUND This article is a review of the literature regarding the state of oncology education for medical students in developing countries, and possible solutions to the problems at hand. METHODS Ovid MEDLINE, PubMed, ERIC, The Cochrane CENTRAL Register of Controlled Trials (CENTRAL) and Google Scholar were searched using the terms oncology, undergraduate, cancer, education and teaching. RESULTS The search resulted in 40 relevant articles in total. Ten articles showed that there is a lack of adequate knowledge in the scientific, clinical and psychological aspects of oncology and palliative care amongst students and physicians in developing countries. Eight articles describe the relevance and usefulness of summer schools, workshops and trainings. The rest of them discuss possible methods of addressing the issue, the most important of which is the inclusion of a clinical oncology rotation in the undergraduate syllabus. CONCLUSION Graduated physicians and medical students are a long way from reaching the standard knowledge and skills required in oncology. Thus, there is a pressing need to reform the undergraduate medical curricula in developing countries in order to increase cancer awareness for better graduated future physicians.

Molecular underpinnings of corneal angiogenesis: advances over the past decade

The cornea is maintained in an avascular state by maintaining an environment whereby anti-angiogenic factors take the upper hand over factors promoting angiogenesis. Many of the common pathologies affecting the cornea involve the disruption of such equilibrium and the shift towards new vessel formation, leading to corneal opacity and eventually-vision loss. Therefore it is of paramount importance that the molecular underpinnings of corneal neovascularization (CNV) be clearly understood, in order to develop better targeted treatments. This article is a review of the literature on the recent discoveries regarding pro-angiogenic factors of the cornea (such as vascular endothelial growth factors, fibroblast growth factor and matrix metalloproteinases) and anti-angiogenic factors of the cornea (such as endostatins and neostatins). Further, we review the molecular underpinnings of lymphangiogenesis, a process now known to be almost separate from (yet related to) hemangiogenesis.

Development of an Arabic version of the National Eye Institute Visual Function Questionnaire as a tool to study eye diseases patients in Egypt.

AIM To develop and test an Arabic version of the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). METHODS NEI-VFQ-25 was translated into Arabic according to WHO translation guidelines. We enrolled adult consenting patients with bilateral chronic eye diseases who presented to 14 hospitals across Egypt from October to December 2012, and documented their clinical findings. Psychometric properties were then tested using STATA. RESULTS We recruited 379 patients, whose mean age was (54.5±15)y. Of 46.2% were males, 227 had cataract, 31 had glaucoma, 23 had retinal detachment, 37 had diabetic retinopathy, and 61 had miscellaneous visual defects. Non-response rate and the floor and ceiling numbers of the Arabic version (ARB-VFQ-25) were calculated. Internal consistency was high in all subscales (except general health), with Cronbach-α ranging from 0.702-0.911. Test-retest reliability was high (intraclass correlation coefficient 0.79). CONCLUSION ARB-VFQ-25 is a reliable and valid tool for assessing visual functions of Arabic speaking patients. However, some questions had high non-response rates and should be substituted by available alternatives. Our results support the importance of including self-reported visual functions as part of routine ophthalmologic examination.

Host immune cellular reactions in corneal neovascularization

Corneal neovascularization (CNV) is a global important cause of visual impairment. The immune mechanisms leading to corneal heme- and lymphangiogenesis have been extensively studied over the past years as more attempts were made to develop better prophylactic and therapeutic measures. This article aims to discuss immune cells of particular relevance to CNV, with a focus on macrophages, Th17 cells, dendritic cells and the underlying immunology of common pathologies involving neovascularization of the cornea. Hopefully, a thorough understanding of these topics would propel the efforts to halt the detrimental effects of CNV.

Extending Ripley's K-Function to Quantify Aggregation in 2-D Grayscale Images.

In this work, we describe the extension of Ripley’s K-function to allow for overlapping events at very high event densities. We show that problematic edge effects introduce significant bias to the function at very high densities and small radii, and propose a simple correction method that successfully restores the function’s centralization. Using simulations of homogeneous Poisson distributions of events, as well as simulations of event clustering under different conditions, we investigate various aspects of the function, including its shape-dependence and correspondence between true cluster radius and radius at which the K-function is maximized. Furthermore, we validate the utility of the function in quantifying clustering in 2-D grayscale images using three modalities: (i) Simulations of particle clustering; (ii) Experimental co-expression of soluble and diffuse protein at varying ratios; (iii) Quantifying chromatin clustering in the nuclei of wt and crwn1 crwn2 mutant Arabidopsis plant cells, using a previously-published image dataset. Overall, our work shows that Ripley’s K-function is a valid abstract statistical measure whose utility extends beyond the quantification of clustering of non-overlapping events. Potential benefits of this work include the quantification of protein and chromatin aggregation in fluorescent microscopic images. Furthermore, this function has the potential to become one of various abstract texture descriptors that are utilized in computer-assisted diagnostics in anatomic pathology and diagnostic radiology.

The Evolution of Undergraduate Medical Student Research Activities: Personal Experience of a Developing Nation’s Uprise

Revolutions are swift, while evolution is typically a slow, incremental process. One of the most notable things that happened after the Egyptian 2011 revolution was the explosive uprising of youth. Regardless of the political turn of events, which is surely not the subject of this piece, it was becoming increasingly clear that something beyond politics was radically changing the academic landscape, particularly among university students. What started as a “revolutionary” interest in science and research quickly transformed into a continuously changing “evolutionary” process. As a finalyear medical student who spent half of his medical school before the revolution, and half of it after the political turmoil, I was lucky to be one of the earliest Bexperiments^ demonstrating the value of strong mentorship on developing an early aptitude for research. One year before the revolution, an oncology summer rotation was developed at the National Cancer Institute (NCI, Cairo University), designed to test the applicability of incorporating oncology rotations into the core medical curriculum in medical schools in developing countries [1]. I joined the course in its second year; the year of the revolution. The course instructor—who later became my long-term research mentor and is co-authoring this opinion piece—integrated an academic writing component into the rotation, as a way to stay in par with the thenbudding interest in research among the revolution youngsters. The result was a published literature review article that he and I co-authored on the very same topic that the oncology summer school addressed: oncology education for medical students in developing countries [2]. I cannot overstate the importance of early research exposure and continuing mentorship on developing my character and research understanding. Three years after my initial research exposure, I now have seven published papers in international peer-reviewed journals (six of which are in PubMedindexed journals), one local and two international conference abstracts and one co-authored book chapter on cancer epidemiology. I appear as the first author on three of the published papers, and as the second author on the other four. But what is it that caused such a paradigm shift? Was it the early sense of achievement? Was I simply lucky to have gained a head start? Perhaps luck had a role, but according to our latest metaanalysis on medical student research, about one in three research projects undertaken by medical students gets published in international peer-reviewed journals [3]. Clearly, I am no special case; I am simply a case study demonstrating the untapped potential of medical student involvement in research. Project after project, I saw my research competence rise and my research confidence grow. I became more systematic in my approach to the literature, understood the importance of good planning and note-taking, became more accustomed to mining for literature Bgaps^, and gained much proficiency in academic writing. Beside its impact on my scientific productivity, my early research experience taught me a lot about my own passions and career aspirations. I was fascinated by the research process so much that I decided to take a gap year to train in basic molecular and developmental biology. Eventually, I ended up learning basic MATLAB programming (which is a scientific computing language) and discovered a passion for integrating bioinformatics and computational tools in biomedical research and medical practice. * Emad Shash emad.shash@nci.cu.edu.eg

Is the Intramedullary Skeletal Kinetic Distractor a Safe Measure for Bone Lengthening? A Systematic Review

Background: The intramedullary skeletal kinetic distractor (ISKD) is one of the relatively recent methods developed to overcome the complications of conventional bone lengthening methods, such as external fixators. These complications include pain, muscle transfixation, pin-tract infection, reduced joint motion, and prolonged fixation time. However, ISKD-specific complications such as uncontrollable lengthening and hardware failure make the outcomes of ISKD lengthening questionable. In this article, we review published literature on the efficacy and complications of the ISKD device. Methods: A database search was conducted in PubMed, Ovid Medline, Ovid Full Text, Springer link, EBSCO Medline, Science Direct, ISI Web of Knowledge, and Google Scholar. We included English articles with extractable data about the study population and outcomes, reporting ISKD implantation in the femur or tibia of skeletally mature patients. The included studies were too heterogeneous for a metaanalysis to be performed. Results: Fifteen of 89 potentially relevant citations were found to match the inclusion criteria. The most common causes of limb-length discrepancy indicating an ISKD implantation were traumatic and congenital. The average lengthening achieved, average patient discharge period, mean follow-up time, average consolidation time and index, average distraction time and index, and number of patients requiring additional operations as well as other outcome measures are discussed in this article. The most common complications were runaway nail, difficulty in achieving lengthening, and poor bone regenerate formation. Conclusion: Even though the classic complications of external lengthening are virtually diminished, alterations to the current design of the ISKD are needed to avoid the distractionrelated complications. Risk of unplanned surgery could be minimized through proper patient selection and proper surgical techniques.

Vectors for Genetically-Encoded Tags for Electron Microscopy Contrast in Drosophila

BackgroundOne of the most notable recent advances in electron microscopy (EM) was the development of genetically-encoded EM tags, including the fluorescent flavoprotein Mini-SOG (Mini-Singlet Oxygen Generator). Mini-SOG generates good EM contrast, thus providing a viable alternative to technically-demanding methods such as immuno-electron microcopy (immuno-EM). Based on the Mini-SOG technology, in this paper, we describe the construction, validation and optimization of a series of vectors which allow expression of Mini-SOG in the Drosophila melanogaster genetic model system.FindingsWe constructed a Mini-SOG tag that has been codon-optimized for expression in Drosophila (DMS tag) using PCR-mediated gene assembly. The photo-oxidation reaction triggered by DMS was then tested using these vectors in Drosophila cell lines. DMS tag did not affect the subcellular localization of the proteins we tested. More importantly, we demonstrated the utility of the DMS tag for EM in Drosophila by showing that it can produce robust photo-oxidation reactions in the presence of blue light and the substrate DAB; the resultant electron micrographs contain electron-dense regions corresponding to the protein of interest. The vectors we generated allow protein tagging at both termini, for constitutive and inducible protein expression, as well as the generation of transgenic lines by P-element transformation.ConclusionsWe demonstrated the feasibility of Mini-SOG tagging in Drosophila. The constructed vectors will no doubt be a useful molecular tool for genetic tagging to facilitate high-resolution localization of proteins in Drosophila by electron microscopy.