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Saudi Consensus for GLP-1 RAs Switching Guidance: Consensus Report

International Journal of Clinical Medicine 2022年第1期13卷 22-35页

作者： Saud Alsifri Hussein Elbadawi fahad Alsabaan Abdulraouf Almahfouz Khalid Alyahya eman Shesha Laila Abu Esba Meshal Alnais Raed Aldahash Turky Alharbi Saleh Aljaser Emad R. Issak Endocrinology Department Alhada & Taif Armed Forces Hospitals Taif Saudi Arabia My Clinic Medical Center Jeddah Saudi Arabia Endocrinology Department Security Forces Hospital Riyadh Saudi Arabia Section of Endocrinology Department of Medicine The King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia Pharmacy Department Prince Sultan Military Medical City Riyadh Saudi Arabia Diabetes Center King Salman Hospital Riyadh Saudi Arabia King Abdulaziz Medical City Riyadh Saudi Arabia Internal Medicine and Diabetes King Khalid Hospital Hail Saudi Arabia Department of Medicine King Abdulaziz Medical City National Guard Riyadh Saudi Arabia family Medicine Department Prince Sultan Military Medical City Riyadh Saudi Arabia King Saud bin Abdulaziz University for Health Science Riyadh Saudi Arabia Medicine Department Faculty of Medicine Ain-Shams University Cairo Egypt

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide adequate glycemic control, weight reduction, low risk of hypoglycemia, and CV risk reduction. Their usage for type 2 DM (T2DM) is recommended mainly when hypoglycemia or weight gain should be considered, also, whenever initial therapy is failed. There are many recent updates in the treatment paradigm of T2DM. There are many types of GLP-1RAs, with a knowledge gap regarding switching between the different types. A Saudi task force gathered to develop an explicit, evidence-based consensus for switching between GLP-1RAs, when, why, and how? This article contains the expert panel’s recommendations as a contribution to complement the knowledge gap in this area from the national perspective. As an alternative to intensifying therapy, switching from one GLP-1RA to another has various advantages. Improvements in glycemic control, weight loss, adherence, and medications with established cardiovascular benefits are among them. Also, switching needs to be individualized upon many discussed factors like the dose of the previous GLP1-RA and gastrointestinal adverse effects. Discussion with patients about the why and how to switch is critical.

关键词： Glucagon-Like Peptide-1 Receptor Agonists Switching Type 2 DM Glycemic Control

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Combined radiofrequency and chemoembolization *** in management of hepatocellular carcinoma

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Hepatoma Research 2015年第1期1卷 19-23页

作者： Ahmed Kamal El Dorry eman Mahmoud fathy Barakat Amal Tohamy Abd ElMoez Mervat Abd fatah Mawad Nevien Fouad El-Fouly Mohamed Kamal Shaker Department of Radiology Medicine Faculty of MedicineAin Shams UniversityCairo 11566Egypt Department of Tropical Medicine Faculty of MedicineAin Shams UniversityCairo 11566Egypt Atomic Energy Authority Cairo 13759Egypt

Aim:Hepatocellular carcinoma(HCC)is one of the most common cancers in the *** left untreated,liver cancer has a poor prognosis with more than 90%of patients dying of the disease within 5 years of *** aim of this study is to assess the value of combined radiofrequency ablation(Rfa),followed by trans-arterial chemoembolization(TACE)in the management of ***:Fifty HCC patients with chronic liver disease were categorized into two groups according to the modality of locoregional treatment:25 HCC patients treated with Rfa followed by TACE within 5 days and 25 HCC patients treated with TACE ***:Complete response was achieved in 100%and 84%of the HCC patients after 1 month from combined Rfa-TACE therapy and TACE only *** rate of objective response after 7 months was 84%and 44%in the Rfa-TACE and TACE groups *** year disease free survival rate was 56%and 24%in Rfa-TACE and TACE groups respectively,and overall survival rate was 88%in the Rfa-TACE group and 80%in the TACE only ***:Combined Rfa-TACE appears to be an effective modality and superior to TACE only for the treatment of HCC.

关键词： Hepatocellular carcinoma radiofrequency trans-arterial chemoembolization

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Effect of Optimization of Hemodialysis on Ophthalmological Variables in Patients with End Stage Renal Disease

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Open Journal of Ophthalmology 2023年第4期13卷 398-406页

作者： Nashaat Shawky Zaky eman Gamal Megahed Sherein Mahmoud Hagras Abd Elmonaem Abo Elfetoh Elhesy Ahmed Mohamed Naguib Attiya Salwa Mahmoud Elwasif Mohamed Abdul Kader Sobh Adel Elsayed Ellayeh Ophthalmology Department Faculty of Medicine Mansoura University Mansoura Egypt Nephrology Department Mansoura Urology and Nephrology Center Mansoura Egypt Internal Medicine Department Faculty of Medicine Mansoura University Mansoura Egypt

Background: Conventional hemodialysis (HD) used in treating end stage renal disease (ESRD) can result in multiorgan insult including the eye-owing to the resultant reperfusion after the ischemic event. Optimization of HD can be done using a process called remote ischemia which includes applying cycles of brief, nonlethal ischemia followed by reperfusion to one limb. This method sends signal to the end organs to prepare themselves for the upcoming ischemia thus preventing their injury. Aim: To evaluate the effect of remote ischemia preconditioning in HD on ophthalmological variables. Patients and Methods: A pre-post interventional analytical study conducted on patients receiving hemodialysis. Remote ischemia preconditioning was done before each HD session incorporating 3 cycles of alternating ischemia and reperfusion (5 minutes each) performed in the upper limb using sphygmomanometer cuff. Ophthalmic examination was done at baseline and 3 months after HD optimization. Assessment was done half to one hour pre- and post-session for visual acuity, corneal, conjunctival deposits, tear break up time (TBUT), anterior chamber depth and central macular thickness. Results: The study included 50 eyes of 25 patients with almost equal gender distribution and mean age of 37.52 ± 9.824 years. They were maintained on hemodialysis for median 10 years (range 3-25 years). The commonest cause of ESRD was hypertension. The studied ocular parameters showed insignificant change after pre-conditioned HD except for TBUT that was statistically longer (p = 0.018). Conclusion: Optimization of hemodialysis using remote ischemia does not seem to have significant ocular effect apart from prolonged TBUT. .

关键词： Hemodialysis Optimization Tear Break Up Time Ophthalmology

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Barriers for resuming endoscopy service in the context of COVid-19 pandemic:A multicenter survey from Egypt

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World Journal of Gastroenterology 2020年第43期26卷 6880-6890页

作者： Omar Elshaarawy Sameh Aldesoky Lashen Nahed A Makhlouf Doaa Abdeltawab Mariam Salah Zaghloul Rasha M Ahmed Hayam fathy Shimaa Afifi Muhammad Abdel-Gawad eman Abdelsameea Sherief Abd-Elsalam Salem Youssef Mohamed Mohammed Tag-Adeen Mina Tharwat Ahmed Alzamzamy Ahmed Nasr Bekhit Alshaimaa M Eid Abeer Awad Mohamed-Naguib Wifi Mohammad Aamr Waleed A Abd El Dayem Mohamed Alboraie Department of Hepatology Gastroenterology and Liver TransplantationNational Liver InstituteMenoufia UniversityShebine Elkom 32511Egypt Department of Internal Medicine and Center of Alcohol Research and Liver Diseases Salem Medical CenterHeidelberg UniversityHeidelberg 69121Germany Department of Internal Medicine Faculty of MedicineUniversity of AlexandriaAlexandria 21521Egypt Department of Tropical Medicine and Gastroenterology Faculty of MedicineAssiut UniversityAssiut 71515Egypt Department of Hepatology Gastroentrology and Infectious DiseasesKafrelsheikh UniversityFaculty of MedicineKafrelsheikh 33565Egypt Department of Internal Medicine Faculty of MedicineAssiut UniversityAssiut 71515Egypt National Hepatology and Tropical Medicine Research Institute Cairo 11638Egypt Department of Hepatology Gastroenterology and Infectious DiseasesFaculty of MedicineAl-Azhar UniversityAssiut 71524Egypt Department of Tropical Medicine and Infectious Diseases Faculty of MedicineTanta UniversityTanta 31527Egypt Department of Internal Medicine Gastroenterology and Hepatology UnitFaculty of MedicineZagazig UniversityZagazig 44519Egypt Department of Internal Medicine Gastroenterology UnitQena Faculty of MedicineSouth Valley UniversityQena 83523Egypt Department of Tropical Medicine and Gastroenterology Faculty of MedicineAswan UniversityAswan 81528Egypt Department of Gastroenterology and Hepatology Military Medical AcademyCairo 11771Egypt Department of Tropical Medicine Zagazig General HospitalZagazig 42511Egypt Department of Hepatology and Gastroenterology and Infectious Disease Faculty of MedicineAlAzhar UniversityCairo 11562Egypt Department of Internal Medicine Faculty of MedicineCairo UniversityCairo 11759Egypt Department of Hepatology and Gastroentorolgy Shebin Elkom Teaching HospitalShebine Elkom 3521Egypt Department of Tropical Medicine Faculty of MedicineZagazig UniversityZagazig 44519Egypt Department of Internal Medicine Al-Azhar UniversityCairo 11651Egypt

BACKGROUND The current coronavirus disease 2019(COVid-19)pandemic has affected routine endoscopy service across the gastroenterology *** led to the suspension of service provision for elective *** To assess the potential barriers for resuming the endoscopy service in *** A national online survey,four domains,was disseminated over a period of 4 wk in August *** primary outcome of the survey was to determine the impact of the COVid-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s).RESULTS A hundred and thirteen Egyptian endoscopy centers participated in the *** waiting list was increased by≥50% in 44.9% of areas with clusters of COVid-19 cases(n=49)and in 35.5% of areas with sporadic cases(n=62).Thirty nine(34.8%)centers suffered from staff shortage,which was considered a barrier against service resumption by 86.4% of centers in per-protocol *** multivariate analysis,the burden of cases in the unit locality,staff shortage/recovery and the availability of separate designated rooms for COVid-19 cases could markedly affect the resumption of endoscopy practice(P=0.029,id-19 pandemic has led to restrictions in endoscopic *** staff shortage/recovery and the availability of COVid-19 designed rooms are the most important barriers against *** working hours and dividing endoscopy staff into teams may help to overcome the current situation.

关键词： COVid-19 Endoscopy Practice Pandemic Egypt Barriers

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HBV vaccine efficacy and detection and genotyping of vaccineé asymptomatic breakthrough HBV infection in Egypt

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World Journal of Hepatology 2011年第6期3卷 147-156页

作者： eman AE Abushady Magda MA Gameel John D Klena Salwa F Ahmed Kouka SE Abdel-wahab Sanya M fahmy Microbiology department Faculty of Medicine Nourthern Border UniversityArar 1321Saudi Arabia Microbiology department Faculty of MedicineAL-Azhar UniversityCairo R695-11651Egypt Molecular Epidemiology unit Clinical Trials ProgramNAMRU-3Cairo 11157Egypt Pediatric department Faculty of MedicineAL-Azhar UniversityCairo R695-11651Egypt

AIM:To evaluate the impact of mass vaccination against the hepatitis B virus (HBV) in Egypt,and to search for vaccinee asymptomatic breakthrough HBV infection and its ***:Seven hundred serum samples from vaccinated children and adults (aged 2-47 years) were used for quantitative and qualitative detection of HBsAb by *** hundred and sixty serum samples representing undetectable or low or high HBsAb were screened for markers of active HBV infection (HBsAg,HBcAb (IgG) and HBeAb by ELISA,plus HBsAg by AxSYM) and HBV-DNA genotyping by nested multiplex PCR and by DNA ***:It was found that 65% of children aged 2-4 years,and 20.5% aged 4-13 years,as well as 45% adults were good responders to HBV vaccination mounting protective level *** responders were 28%,59.5% and 34%,and non-responders were 7%,20% and 21% respectively,in the three studied *** of asymptomatic HBV infections were HBsAg detected by ELISA in 2.5% vs 11.39% by *** markers were HBcAb (IgG) in 1.38%,HBeAb in 0.83%,and HBV-DNA in 7.8%.All had HBV genotype E ***:It is concluded that HBV vaccine is efficient in controlling HBV infection among children and *** vaccine breakthrough infection was by HBV genotype E.A booster dose of vaccine is recommended,probably four years after initial vaccination.

关键词： HBV vaccine evaluation Egyptain children Adults Genotype E vaccine escape HBV

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Pancreatic injury in patients with septic shock: A literature review

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World Journal of Gastrointestinal Oncology 2016年第7期8卷 526-531页

作者： Anis Chaari Karim Abdel Hakim Kamel Bousselmi Mahmoud Etman Mohamed El Bahr Ahmed El Saka eman Hamza Mohamed Ismail Elsayed Mahmoud Khalil Vipin Kauts William Francis Casey Department of Intensive Care King Hamed University Hospital

Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention.

关键词： Septic shock Pancreas Lipase Amylase Prognosis

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Aspartate transaminase to platelet ratio index in hepatitis C virus and Schistosomiasis coinfection

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World Journal of Gastroenterology 2015年第46期21卷 13132-13139页

作者： Moutaz Derbala Mohammed Elshiekh Elbadri Aliaa Mohamed Amer Saad Al Kaabi Khaleel Hassan Sultan Yasser Medhat Kamel eman Hassan Satti Elsayed Tony Yervant Avades Prem Chandra fatma M Shebl Gastroenterology and Hepatology Hamad Medical CorporationHamad General Hospital Gastroenterology and Hepatology Theodor Bilharz Research Institute Medical Department Weill Cornell Medical College Laboratory Medicine and pathology Hematology SectionHamad Medical CorporationHamad General Hospital General Medicine Medical EducationHamad Medical CorporationHamad General Hospital Department of Laboratory Medicine and Pathology Hamad Medical CorporationHamad General Hospital Medical Research Center Hamad Medical CorporationHamad General Hospital Chronic Disease Epidemiology DepartmentYale School of Public Health

AIM: To assess the diagnostic accuracy,of aminotransferase-to-platelet ratio index(APRI) alone and with antischistosomal antibody(Ab) in patients with hepatitis C virus(HCV) and schistosomiasis coinfection. METHODS: This retrospective study included medical records of three hundred and eighty three Egyptianmen patients who had undergone percutaneous liver biopsy between January 2006 to April 2014 in tertiary care hospital in Qatar for diagnosis or monitoring purpose were selected. Data of patients > 18 years of age were included in the study. The values of HCV RNA titer and antischistosomal antibody titer were also taken into consideration. Patients were excluded from the study if they had any other concomitant chronic liver disease,including; history of previous antiviral or interferon therapy,immunosuppressive,therapy,chronic hepatitis B infection,human immunodeficiency virus co-infection,autoimmune hepatitis,decompensated liver disease,hepatocellular carcinoma,prior liver transplantation,and if no data about the liver biopsy present. RESULTS: Median age of patients was 46 years. About 7.1% had no fibrosis,whereas 30.4%,37.5%,20.4%,and 4.6% had fibrosis of stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ respectively. In bivariate analysis,APRI score,levels of AST,platelet count and age of patient showed statistically significant association with liver fibrosis(P failed to show a significant association. The respective AUC values for no fibrosis,significant fibrosis,severe fibrosis and cirrhosis of APRI score were 63%,73.2%,81.1% and 88.9% respectively. This showed good sensitivity and specificity of APRI alone for grading of liver fibrosis. But the inclusion of anti-Schistosoma antibody did not improve the prediction of fibrosis stage. CONCLUSION: The study results suggest that noninvasive biochemical markers like APRI are sensitive and specific in diagnosing the degree of fibrosis and cirrhosis in patient

关键词： Hepatitis C Schistosomiasis Aspartate transaminase

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The Use of Standardized Reporting and Time-in-Range in the Management of Diabetes: A Consensus Report

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International Journal of Clinical Medicine 2021年第8期12卷 316-327页

作者： Saud Al Sifri Adnan Alshaikh Bassam Bin-Abbas eman Sheshah fahad Al Sabaan Mohammed Al-Dawish Mohammed Al-Dubayee Naweed Al-Zaman Raed A. Al-Dahash Saad Alzahrani Emad R. Issak Endocrinology and Diabetes Department Alhada and Taif Armed Forces Hospitals Taif Saudi Arabia Pediatrics Department King Abdulaziz Medical City—Ministry of National Guard Health Affairs King Khalid National Guard Hospital Jeddah Saudi Arabia Pediatrics Department King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia Endocrinology Department King Salman hospital Riyadh Saudi Arabia Endocrinology Department Security forces hospital program Riyadh Saudi Arabia Endocrinology Department Prince Sultan Military Medical City (PSMMC) Riyadh Saudi Arabia Pediatrics Department Ministry of National Guard Health Affairs-Riyadh Riyadh Saudi Arabia Endocrinology Department Taibah University Madina Saudi Arabia Internal Medicine Department King Abdulaziz Medical City—National Guard Riyadh Saudi Arabia Endocrinology Department Medical Director OEMC King Fahad Medical City Riyadh Saudi Arabia Internal Medicine Department Faculty of Medicine Ain-Shams University Cairo Egypt

Introduction: The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia mandates the search for each method that can help in better control of diabetes. Methods: The gathered task force gath-ered to develop an explicit, evidence-based consensus for the use of time-in-range targets as guidance for better glycemic control while using continuous glucose monitoring (CGM). This article has the recommenda-tions of this expert panel. Results: HbA1c and self-monitoring blood glu-cose (SMBG) are not enough to detect blood glucose (BG) fluctuations on a daily basis. The incorporation of technology like FreeStyle Libre with its applications like Libre View is now used in many institutes in Saudi Ara-bia. This system is comprehensive and has all the standardized metrics needed. However, training and support are always needed. Barriers and challenges include the awareness & experience of the technology, the time barrier, the patients’ barriers, the technical barriers, and of course, the availability barrier. All the barriers and challenges should be dealt with by designing new training programs. Conclusion: The expert panel recom-mended using CGMs technology in people with type 1 diabetes (T1DM) children and adults, type 2 diabetes (T2DM) on multiple insulin injections, gestational diabetes (GDM) who need further glycemic control, and those at high risk for hypoglycemia. In addition, we recommend using them for a short period for those who require intensive BG control or during acute illness or stress. In addition, Ambulatory Glucose Profile (AGP) could be used as an educational tool for any individuals with DM to study the im-pact of certain elements of lifestyle modifications on their immediate BG level.

关键词： Diabetes Time in Range Glycemic Control HbA1c

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Phenolic Contents and Antioxidant Activities of Green Tea with and without Lemon

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Natural Science 2016年第6期8卷 247-255页

作者： Ayat B. Al-Ghafari Ayat M. Shorbaji Lamya A. AL-Sarori eman O. Baduwailan Aisha A. Basaar Huda A. Al Doghaither Hala F. Al-Marzouki Ulfat M. Omar Department of Biochemistry Faculty of Science King Abdulaziz University Jeddah KSA

Tea is the most widely consumed beverage throughout the world, after water and is considered as a good antioxidant nutrient against free radical reactions. Lemons are citrus fruits that are very common in many parts of the world and are well known for their health benefits. In this study, different assays were used to evaluate total phenolic content and antioxidant activities of green tea with and without lemon. Our results showed that green tea with lemon has higher phenolic content, stronger reducing power than green tea without lemon;and exhibits a significant inhibition of 2,2-Diphenyl-1-picrylhydrazyl (DPPH) and hydrogen peroxide (H2O2). However, both samples exhibited high ferrous chelating activity with no significant difference among each other indicating a good antioxidant potential for both. This is a comparative study between green tea and green tea supplemented with lemon. The study contributes to a better understanding about how the addition of supplements like lemon might influence the antioxidant activity of tea.

关键词： Antioxidant Activity Green Tea Lemon Metal Chelation Phenolic Compounds Radical Scavenging Component

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Bidirectional Recurrent Nets for ECG Signal Compression

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Journal of Computer Science Research 2022年第4期4卷 15-25页

作者： eman AL-Saidi Khalil El Hindi Computer Science Department King Saud UniversityRiyadhSaudi Arabia

Electrocardiogram(ECG)is a commonly used tool in biological diagnosis of heart *** allows the representation of electrical signals which cause heart muscles to contract and ***,accurate deep learning methods have been developed to overcome manual diagnosis in terms of time and ***,most of current automatic medical diagnosis use long electrocardiogram(ECG)signals to inspect different types of heart ***,ECG signal files tend to require large storage to store and may cause significant overhead when exchanged over a computer *** raises the need to come up with effective compression methods for ECG *** this work,the authors investigate using BERT(Bidirectional Encoder Representations from Transformers)model,which is a bidirectional neural network that was originally designed for natural *** authors evaluate the model with respect to its compression ratio and information preservation,and measure information preservation in terms of the of the accuracy of a convolutional neural network in classifying the decompressed *** results show that the method can achieve up to 83%saving in ***,the classification accuracy of the decompressed signals is around 92.41%.Furthermore,the method enables the user to balance the compression ratio and the required accuracy of the CNN classifiers.

关键词： BERT model Convolutional neural networks(CNN) Data compression Deep learning ECG diagnosis

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