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Rituximab for the Treatment of Multiple Sclerosis: A Retrospective Observational Cohort in Morocco

Case Reports in Clinical Medicine 2022年第10期11卷 448-456页

作者： Siham Bouchal Nabila Lahmadi Sara Zejli Naima Chtaou youssef Hafidi Faouzi Belahsen Department of Neurology Hassan II University Teaching Hospital Fez Morocco Laboratory of Epidemiology Clinical Research and Health Community Faculty of Medicine and Pharmacy Sidi Mohammed Ben Abdellah University Fez Morocco Department of Pharmacology Hassan II University Teaching Hospital Fez Morocco

Background: RITUXIMAB (RTX) is a chimeric anti-CD20 monoclonal antibody that has initially demonstrated efficacy in patients with B-cell lymphoma. Then, over time, it has demonstrated its efficacy in systemic inflammatory diseases and recently in neurological diseases such as multiple sclerosis (MS). Here we describe our experience with rituximab from one MS center from MOROCCO. Objectives: To investigate the safety and efficacy of Rituximab in MS in a Moroccan population. Methods: A retrospective uncontrolled observational single-center study from January 2017 to July 2020, was including all off-label Rituximab-treated patients with MS with at least 6 months of follow-up. Outcome data were collected and evaluated relapse rate, EDSS score, and adverse events (AEs) from the medical charts. Adverse events grade according to the Common Terminology Criteria for Adverse Events. Results: A total of 63 MS patients were treated with RTX, 47 patients were included, while 12 cases had just initiated treatment and 4 cases were lost to follow-up. The mean age of the patients was 39 ± 12 years with a female predominance (F/M: 1.6). All forms of MS were included, 83% of whom had relapsing-remitting MS. The duration of disease progression was 8 ± 5 years. Median EDSS before RTX initiation was 5.5 (0 - 7). 51% of patients were treated with RTX as second-line therapy after failure of other disease-modifying therapies, whereas 34% received it as first-line therapy. The annualized relapse rates decreased from 0.8 to 0.2 after RTX treatment. The Median EDSS remained unchanged at 71%. Radiological stability was noted in 83.7%, while 13.5% had a single new T2 lesion. Infusion-related AEs occurred during 27.6% of infusions and most were mild. Simple infection grades ≤ 2 were noted in 19%. Abortion occurred in only one patient. Conclusion: Our study confirms the usability of rituximab treatment for MS in the MOROCCO healthcare environment.

关键词： B-Lymphocyte CD20 Multiple Sclerosis Rituximab Moroccan Population

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Role of endoscopic ultrasound in pediatric patients: A single tertiary center experience and review of the literature

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World Journal of Gastrointestinal Endoscopy 2020年第10期12卷 355-364页

作者： Ahmed youssef Altonbary Hazem Hakim Wagdi Elkashef Department of Gastroenterology and Hepatology Mansoura Specialized Medical HospitalMansoura UniversityMansoura 35516Egypt Department of Pathology Mansoura UniversityMansoura 35111Egypt

BACKGROUND Although endoscopic ultrasound(EUS)is now widely available and has an established role in adults,the utility of EUS and EUS-guided fine needle aspiration(EUS-FNA)in pediatrics is insufficiently described compared to adults and is supported by only a few *** To report the experience of a single tertiary center in the use of EUS and EUS-FNA in a pediatric population and to further assess its safety,feasibility,and clinical impact on *** A retrospective study of 13 children(aged 18 years or younger)identified from our medical database was conducted.A retrospective review of demographic data,procedure indications,EUS findings,and the clinical impact of EUS on the subsequent management of these patients was *** During the 4-year study period,a total of 13(1.7%)pediatric EUS examinations out of 749 EUS procedures were performed in our *** mean age of these 8 females and 5 males was 15.6 years(range:6-18).Six of the 13 EUS examinations were pancreatobiliary(46.1%),followed by mediastinal 2/13(15.4%),peri-gastric 2/13(15.4%),abdominal lymphadenopathy 1/13(7.7%),tracheal 1/13(7.7%)and rectal 1/13(7.7%).Overall,EUS-FNA was performed in 7 patients(53.8%)with a diagnostic yield of 100%.The EUS results had a significant impact on clinical care in 10/13(77%)*** complications occurred in these patients during or after any of the *** EUS and EUS-FNA in the pediatric population are safe,feasible,and have a significant clinical impact on the subsequent management;thus avoiding invasive and unnecessary procedures.

关键词： Endoscopic ultrasound Endoscopic ultrasound-guided fine needle aspiration Pediatric

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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,<0.001 and 0.02,respectively)and Odd’s ratio(0.15,1.8 and 0.16,respectively).CONCLUSION The COVID-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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A Case Report of Alloimmune Hepatitis after Direct-acting Antiviral Treatment in a Liver Transplant Patient

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Journal of Clinical and Translational Hepatology 2020年第4期8卷 459-462页

作者： Catherine Choi youssef Botros Jamil Shah Pei Xue Anja Jones Mark Galan Raquel Olivo Mumtaz Niazi Flavio Paterno James Guarrera Nikolaos T.Pyrsopoulos Department of Internal Medicine Rutgers New Jersey Medical SchoolNewarkNJUSA Division of Gastroenterology St.Joseph’s University Medical CenterPatersonNJUSA Division of Gastroenterology&Hepatology The Brooklyn Hospital CenterBrooklynNYUSA Rutgers New Jersey Medical School NewarkNJUSA Department of Pathology Immunology&Laboratory MedicineRutgers New Jersey Medical SchoolNewarkNJUSA Division of Gastroenterology&Hepatology Department of MedicineRutgers New Jersey Medical SchoolNewarkNJUSA Division of Liver Transplantation&Hepatobiliary Surgery Department of SurgeryRutgers New Jersey Medical SchoolNewarkNJUSA

Direct-acting antiviral (DAA) therapy is often well-tolerated, and adverse events from DAA therapy are uncommon. We report a case of a woman who underwent orthotopic liver transplant for chronic hepatitis C infection and later devel-oped alloimmune hepatitis shortly after starting DAA therapy for recurrent hepatitis C infection. The patient developed acute alloimmune hepatitis approximately 2 weeks after starting treatment with sofosbuvir, velpatasvir, and voxilap-revir. This case report proposes a dysregulation of immune surveillance due to the DAA stimulation of host immunity and rapid elimination of hepatitis C viral load as a precipitating factor for the alloimmune process, leading to alloimmune hepatitis in a post-transplant patient who starts on DAA.

关键词： Autoimmune hepatitis Hepatitis C Liver transplant

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Vitamin D Deficiency and Insufficiency in Northeast Tennessee

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Health 2020年第9期12卷 1085-1094页

作者： Arun Joseph Kattakayam Donovan Reed Sajin M. Karakattu Beth Bailey Millard Ray Lamb Paul O. Lewis Dima youssef Department of Internal Medicine Norwalk Hospital Norwalk CT USA Texas Oculoplastics Consultants TOC Eye & Face Austin TX USA Department of Internal Medicine Division of Pulmonary and Critical Care East Tennessee State University Johnson City TN USA Department of Family Medicine East Tennessee State University Johnson City TN USA Recovery Associates Johnson City TN USA Department of Pharmacy Johnson City Medical Center Johnson City TN USA Department of Internal Medicine Division of Infectious Diseases East Tennessee State University Johnson City TN USA

Background: The role of vitamin D in population subgroups throughout the world continues to be a topic of interest among researchers. Current evidence demonstrates that treating vitamin D deficiency plays a significant role in improving mortality in hospitalized patients, reducing hospital length of stay, and boosting innate immune system. Vitamin D levels vary with age, gender, body mass index (BMI) and geographical area. The purpose of this study is to evaluate vitamin D levels in a cohort of patients in Northeast Tennessee. Study: This institutional review board-approved, retrospective study evaluated vitamin D levels of patients obtained from Mcleod Cancer and Blood center. Vitamin D levels were collected over a 2-year period and classified as deficient (30 ng/mL). Data were then stratified based on patient characteristics (age, gender, body mass index (BMI), race, seasons, and place of residence) and compounds of vitamin D (D2 and D3). Results: There were 2011 individuals included, with only 44.3% having replete levels and 21.4% with levels less than 20 ng/mL. Females with vitamin D deficiency are more likely to have levels below 20 ng/ml compared to males (18.6% vs. 23%, respectively, p = 0.003). Regarding BMI, the highest levels were reported in normal weight and overweight. With regards to age, advanced age (≥70) was associated with the highest levels and most replete patients. Winter months were associated with the lowest levels of vitamin D. Higher vitamin D levels were found in individuals over 70 years, normal weight and overweight category. Conclusion: Testing vitamin D levels in high-risk groups becomes of utmost importance in areas with longer winter months, obese and underweight patients. Vitamin D levels should be routinely tested and treated in vulnerable populations.

关键词： Vitamin D Vitamin D Deficiency Vitamin D Insufficiency Northeast Tennessee

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Fat injection to correct contour deformities of the reconstructed breast:a single surgeon experience

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Plastic and Aesthetic Research 2015年第1期2卷 115-119页

作者： youssef Tahiri Jonathan Kanevsky Joshua Vorstenbosch James Lee Karl Schwarz Department of Surgery Division of Plastic and Reconstructive SurgeryRiley Hospital for ChildrenIndiana UniversityIndianapolisIN 46202USA Department of Surgery Division of Plastic and Reconstructive SurgeryMcGill University Health CentreMontrealQC H3G 1B3Canada Department of Surgery Section of Plastic SurgeryUniversity of ManitobaWinnipegMB R3T 2N2Canada Schwarz Plastic Surgery MontrealQC H3G 1B9Canada

Aim:Autologous fat grafting has gained acceptance as a technique to improve aesthetic outcomes in breast *** purpose of this study was to share our clinical experience using autologous fat injection to correct contour deformities during breast ***:A single surgeon,prospectively maintained database of patients who underwent autologous fat injection during breast reconstruction from January 2008 to November 2013 at McGill university Health center was *** characteristics,breast history,type of breast reconstruction,volume of fat injected,and complications were ***:One hundred and twenty-four patients benefited from autologous fat injection from January 2008 to November 2013,for a total of 187 treated *** patients were on average 49.3 years old(±8.9 years).Fat was harvested from the medial thighs(20.5%),flanks(39.1%),medial thighs and flanks(2.9%),trochanters(13.3%),medial knees(2.7%),and abdomen(21.9%).An average of 49.25 mL of fat was injected into each reconstructed breast.A total of 187 breasts in 124 patients were lipo-infiltrated during the second stage of breast *** breasts(in 12 separate patients)were injected several years after having undergone lumpectomy and *** the 187 treated breasts,118 were reconstructed with expanders to implants,45 with deep inferior epigastric perforator flaps,9 with latissimus dorsi flaps with implants,4 with transverse rectus abdominis myocutaneous flaps,and 13 had previously undergone lumpectomy and *** complications were noted in the entire series,for a rate of 3.2%.All were in previously radiated *** follow-up time was 12 months(range:2-36 months).Conclusion:Fat injection continues to grow in popularity as an adjunct to breast *** experience demonstrates a low complication rate as compared to most surgical interventions of the breast and further supports its safety in breast ***

关键词： Breast contour deformities fat injection

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Assessment of Heavy Metals Content in Sewage Discharges from Health Structure in Mauritania

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Journal of Pharmacy and Pharmacology 2022年第6期10卷 190-194页

作者： Mohamed Bouna Ammar Brahim Ahmed Dick Yahya Maham Ould Sidi Hanan Deih Hana youssef Learoussy Med Abderrahmane Sanhoury Vadly Sadegh Mohamed Fekhaoui Geo-biodiversity and Natural Patrimony Laboratory Scientific InstituteMohamed V UniversityRabatMorocco Research Unit of the Water PollutionEnvironmentFSTUniversity of Nouakchott Al-AasryaMauritania National Laboratory for the Quality Control of Medicines(LNCQM) NouakchottMauritania Laboratory of Bioactive Molecules FSTSidi Mohamed Ben Abdellah UniversityFezMorocco Materials Chemistry Research Unit Department of ChemistryFSTUniversity of Nouakchott Al-AasryaMauritania Central Purchasing center for Medicines Medical Equipment and Consumables

This study was carried to assess the quality of liquid waste produced by the Nouakchott Friendship hospital in Mauritania,the aim is to quantify different heavy metals obtained from discharge of the hospital waste six heavy metals(arsenic,lead,cobalt,chromium,cadmium and copper)were object of *** was carried using inductively coupled plasma-optical emission spectrometry(ICP-OES)method and the standards used are those of the *** average content of heavy metals in different samples is different:Arsenic(4.625μg/L),Lead(3.800μg/L),Cyanide(0.05μg/L),Chromium(0.013μg/L),Cadmium(hospital were very loaded with pollutants,this may constitute a threat to the environment and a potential health risk for human,since the continuous introduction of these heavy metals into aquatic medium could be harmful through bioaccumulation and biomagnifications.

关键词： Heavy metals waste ICP-OES pollutants health risk

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Cardiac Surgery in Octogenarians and Beyond: Single center Experience

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Open Journal of Thoracic Surgery 2013年第2期3卷 51-56页

作者： Reda E. Al-Refaie Hashem Aliter Ricardo Gallo Ali youssef Mushabab Al-Murayeh Edwin Ravikumar Department of Cardiac Surgery and Car- diology Armed Forces Hospitals Southern Region Khamis Mushayt KSA Department of Cardiothoracic Surgery Mansoura University Hospitals Mansoura Egypt

Background: Increasing numbers of octogenarians and improvements in surgical techniques and postoperative care have resulted in increasing cardiac operations in this age. The aim is to analyze our experience of cardiac surgery on octogenarians and beyond concerning postoperative morbidities and mortality. Methods: 67 octogenarians and nonagenarians underwent open heart surgery in our hospital between 2001 to 2009 were retrospectively reviewed. Data included baseline preoperative status, intraoperative and perioperative course, and immediate outcomes. Results: The mean age was 86.22 ± 6.1 years. 86.6% patients were males. Symptoms were dyspnea;Class II in 13.4%, Class III in 55.2%, Class IV in 31.4% patients;angina in 82.1%, and CHF in 25.4% patients. The mean EF was 37.8% ± 10. Risk factors include smoking in 52.2%, DM in 37.3%, hypertension in 28.4%, obesity in 25.4%, previous MI in 22.4%, COPD in 17.9%, renal insufficiency in 11.9%, pulmonary hypertension in 7.5%, PVD in 6%, and cerebrovascular disease in 3% patients. The procedures were isolated CABG in 73%, AVR in 9%, MVR in 6%, CABG/valve in 9%, and MVR and AVR in 3% patients. Complications were 18%. It included renal impairment in 18%, arrhythmias in 14.9%, bleeding in 6%, prolonged ventilation in 13.4%, CHF in 4.5%, gastrointestinal bleeding in 4.5%, wound infection in 7.5%, and cerebrovascular accident in 3%. hospital mortality was 9% patients. Conclusions: Cardiac surgery can be performed safely with acceptable hospital morbidity and mortality in octogenarians and beyond. Early referral and proper selection of patients are mandatory to improve immediate postoperative survival.

关键词： Coronary Artery Bypass Graft Valve Octogenarians Nonagenarian

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