Publications

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Conference Paper
ElHefnawi, Mahmoud, Mahmoud Abdalla, Safaa Ahmed, Wafaa elakel, Gamal Esmat, Maissa El Raziky, Shaima Khamis, and Marwa Hassan. "Accurate prediction of response to Interferon-based therapy in Egyptian patients with Chronic Hepatitis C using machine-learning approaches." In 2012 IEEE/ACM INTERNATIONAL CONFERENCE ON ADVANCES IN SOCIAL NETWORKS ANALYSIS AND MINING (ASONAM), 771-778., 2012. Abstract
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Journal Article
Lazarus, Jeffrey V., Henry E. Mark, Quentin M. Anstee, Juan Pablo Arab, Rachel L. Batterham, Laurent Castera, Helena Cortez-Pinto, Javier Crespo, Kenneth Cusi, Ashworth M. Dirac et al. "Advancing the global public health agenda for NAFLD: a consensus statement." Nature reviews. Gastroenterology & hepatology 19, no. 1 (2022): 60-78. Abstract

Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.

El-Hawary, Manal A., Mona S. El-Raziky, Gamal Esmat, Hanan Soliman, Amr Abouzied, Maissa El-Raziky, Wafaa El-Alkel, Rokaya El-Sayed, Fatma Shebl, Abdel Aziz Shaheen et al. "Assessment of hepatic fibrosis in pediatric cases with hepatitis C virus in Egypt." WORLD JOURNAL OF GASTROENTEROLOGY 13 (2007): 2846-2851. Abstract
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Elhawary, Eman I., Gamal F. Mahmoud, Mai A. El-Daly, Fatma A. Mekky, Gamal G. Esmat, and Mohamed Abdel-Hamid. "Association of HCV with diabetes mellitus: an Egyptian case-control study." VIROLOGY JOURNAL 8 (2011). Abstract
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Said, M., G. Esmat, M. El-Shazly, A. Yousry, N. El-Garem, S. Megawer, W. Doss, A. Omar, H. El-Karaksy, M. Basiony et al. "Availability of donors for living donor liver transplantation (LDLT) in area endemic for HCV and schistosomiasis." LIVER INTERNATIONAL 26 (2006): 96. Abstract
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Hezode, Christophe, Gideon M. Hirschfield, Wayne Ghesquiere, William Sievert, Maribel Rodriguez-Torres, Stephen D. Shafran, Paul J. Thuluvath, Harvey A. Tatum, Imam Waked, Gamal E. Esmat et al. "BMS-790052, A NS5A REPLICATION COMPLEX INHIBITOR, COMBINED WITH PEGINTERFERON ALFA-2A AND RIBIVIRIN IN TREATMENT-NAIVE HCV-GENO-TYPE 1 OR 4 PATIENTS: PHASE 2B AI444010 STUDY INTERIM WEEK 12 RESULTS." HEPATOLOGY 54 (2011): 474A-475A. Abstract
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Mohamed, Mostafa K., Sylvie Deuffic-Burban, Fabrice Carrat, Gamal Esmat, Alaa Ismail, Hesham El Makhzangy, Bernard Larouze, Ibrahim Abdelbar, Abdel-Rahman El-Zayadi, and Alain-Jacques Valleron. "Burden of hepatitis C-related HCC mortality in Egypt due to pre-2000 infections." JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 21 (2006): A184. Abstract
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"The case for simplifying and using absolute targets for viral hepatitis elimination goals." Journal of viral hepatitis 28, no. 1 (2021): 12-19. Abstract

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries' progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100 000, reduce HBV prevalence among 1-year-olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100 000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.

"The case for simplifying and using absolute targets for viral hepatitis elimination goals." Journal of viral hepatitis 28, no. 1 (2021): 12-19. Abstract

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries' progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100 000, reduce HBV prevalence among 1-year-olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100 000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.

El-Kady, N., Z. Salama, G. Esmat, H. Elsergany, and I. Hamza. "Changes in the hepatic and splenic arterial flow volume and resistance indices in cirrhotic patients." LIVER INTERNATIONAL 26 (2006): 49. Abstract
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Zakaria, Soheir, Rabab Fouad, Olfat Shaker, Sami Zaki, Ahmed Hashem, Samer S. El-Kamary, Gamal Esmat, and Serag Zakaria. "Changing patterns of acute viral hepatitis at a major urban referral center in Egypt." CLINICAL INFECTIOUS DISEASES 44 (2007): E30-E36. Abstract
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ABDELWAHAB, MF, G. Esmat, M. Milad, S. ABDELRAZEK, and GT Strickland. "CHARACTERISTIC SONOGRAPHIC PATTERN OF SCHISTOSOMAL HEPATIC-FIBROSIS." AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE 40 (1989): 72-76. Abstract
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Mabrouk, Mahasen, Maissa El-Raziky, Naglaa Zayed, Rabab Salama, Wafaa El-Akel, Tahany Awad, Mohammad El Beshlawy, and Gamal Esmat. "Clinical, biochemical and pathological profiles of 5464 Egyptian chronic hepatitis C-infected patients." Hepato-gastroenterology 60, no. 127 (2013): 1731-5. Abstract

BACKGROUND/AIMS: In Egypt, hepatitis C virus (HC is highly endemic with at least 91% are genotype-4. However, HCV-specific burden data for Egypt are scarce. The study aims to identify clinical, biochemical and pathological features of chronic HCV population in Egypt.

METHODOLOGY: We analyzed retrospective data of 5,464 HCV-antibody and PCR positive patients attending pre-treatment assessment at one of the National Treatment Centers, Cairo, Egypt.

RESULTS: Chronic HCV patients were males (81.4%) in their productive age, mean body mass index (BMI): 28 kg/m2. Laboratory profile demonstrated mean platelet count 214 x 10(3)/µ L with only 14% having thrombocytopenia, amino-transferases were mildly elevated: mean AST, ALT were 56 and 63 respectively,low viraemia: 50% had viral load <100 (x 10(3)) IU/mL,and median AFP level 3.3 ng/mL. Liver biopsy revealed ≤A2 in 92% of patients; 80% had ≤F2 and 7.3 % had F4 according to the METAVIR score. Meta regression demonstrated that advanced stages of fibrosis were significantly correlated with platelet count, AST/ALT ratio, AFP levels and BMI (p <0.001). However there was no correlation with viral load.

CONCLUSIONS: To our knowledge, this is the first study on nationwide scale that provided the demographic, biochemical,and histological characteristics for this number of chronic HCV patients presumably genotype-4.

Abdel-Rahman, Mahasen, Mohammad El-Sayed, Maissa El Raziky, Aisha Elsharkawy, Wafaa El-Akel, Hossam Ghoneim, Hany Khattab, and Gamal Esmat. "Coinfection with hepatitis C virus and schistosomiasis: Fibrosis and treatment response." WORLD JOURNAL OF GASTROENTEROLOGY 19 (2013): 2691-2696. Abstract
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El Makhzangy, H., C. Rekacewicz, SI Shouman, HN Mohamed, G. Esmat, A. Ismail, R. Rafaat, M. El Hosseiny, M. El Daly, S. El Kafrawy et al. "Combined pegylated interferon alpha-2a and ribavirin in treatment of chronic hepatitis C in Egypt (ANRS 1211 trial)." JOURNAL OF HEPATOLOGY 42 (2005): 203. Abstract
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Mohsen, A., E. M. Ibrahim, S. Al Aidi, S. El Mango, A. Bernier, M. El Daly, M. El Gafaary, Abdel M. Hamid, G. Esmat, M. Gadallah et al. "COMMUNITY TRANSMISSION OF HEPATITIS C VIRUS AMONG EGYPTIANS: ANALYSIS OF A 10 YEARS CASE-CONTROL STUDY." JOURNAL OF HEPATOLOGY 58 (2013): S398. Abstract
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El-Sayed, M., M. El-Raziky, A. Elsharkawy, H. Khattab, A. H. K. Abdelmaksoud, M. K. Ashour, and G. Esmat. "COMPARISON BETWEEN DIFFUSION-WEIGHTED MRI, FIBROSCAN AND HISTOPATHOLOGY FOR ASSESSMENT OF LIVER FIBROSIS IN CHRONIC HCV PATIENTS." JOURNAL OF HEPATOLOGY 58 (2013): S185. Abstract
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Bonnard, P., A. Elsharkawy, K. Zalata, E. Delarocque-Astagneau, L. Biard, L. Le Fouler, A. B. Hassan, M. Abdel-Hamid, M. El-Daly, M. E. Gamal et al. "Comparison of liver biopsy and noninvasive techniques for liver fibrosis assessment in patients infected with HCV-genotype 4 in Egypt." Journal of viral hepatitis (2014). Abstract

In Egypt, as elsewhere, liver biopsy (LB) remains the gold standard to assess liver fibrosis in chronic hepatitis C (CHC) and is required to decide whether a treatment should be proposed. Many of its disadvantages have led to develop noninvasive methods to replace LB. These new methods should be evaluated in Egypt, where circulating virus genotype 4 (G4), increased body mass index and co-infection with schistosomiasis may interfere with liver fibrosis assessment. Egyptian CHC-infected patients with G4 underwent a LB, an elastometry measurement (Fibroscan(©) ), and serum markers (APRI, Fib4 and Fibrotest(©) ). Patients had to have a LB ≥15 mm length or ≥10 portal tracts with two pathologists blinded readings to be included in the analysis. Patients with hepatitis B virus co-infection were excluded. Three hundred and twelve patients are reported. The performance of each technique for distinguishing F0F1 vs F2F3F4 was compared. The area under receiver operating characteristic curves was 0.70, 0.76, 0.71 and 0.75 for APRI, Fib-4, Fibrotest© and Fibroscan©, respectively (no influence of schistosomiasis was noticed). An algorithm using the Fib4 for identifying patients with F2 stage or more reduced by nearly 90% the number of liver biopsies. Our results demonstrated that noninvasive techniques were feasible in Egypt, for CHC G4-infected patients. Because of its validity and its easiness to perform, we believe that Fib4 may be used to assess the F2 threshold, which decides whether treatment should be proposed or delayed.

Bonnard, P., M. El-Kassas, M. Gamal, A. B. Hassan, L. Le Fouler, A. Elsharkawy, E. Delarocque-Astagneau, M. El-Sayed, A. Abd El Hay, M. Abdel-Hamid et al. "COMPARISON OF LIVER BIOPSY, ELASTOMETRY AND SERUM MARKERS FOR LIVER FIBROSIS ASSESSMENT IN GENOTYPE 4 HCV-INFECTED PATIENTS IN EGYPT. RESULTS OF THE ANRS12184 STUDY." JOURNAL OF HEPATOLOGY 58 (2013): S287. Abstract
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Shehab, H., I. Elattar, T. Elbaz, M. Mohey, and G. Esmat. "CUFA algorithm: assessment of liver fibrosis using routine laboratory data." Journal of viral hepatitis 21, no. 12 (2014): 956-64. Abstract

Staging of liver fibrosis is an integral part of the management of HCV. Liver biopsy is hampered by its invasiveness and possibility of sampling error. Current noninvasive methods are disadvantaged by their cost and complexity. In this study, we aimed at developing a noninvasive method for the staging of liver fibrosis based only on routine laboratory tests and clinical data. Basic clinical and laboratory data and liver biopsies were collected from 994 patients presenting for the evaluation of HCV. Logistic regression was used to create a model predictive of fibrosis stages. A sequential test was then developed by combining our new model with APRI. In the training set (497) a model was created by logistic regression for the prediction of significant fibrosis (≥F2), it included platelets, AST and age (PLASA). The areas under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 0.753, 66.8, 71.4, 69.8, 68.4, respectively, while in the validation set (497), they were 0.777, 66.7, 72.8, 68.6 and 71, respectively. These were the best performance indicators when compared to APRI, FIB-4, King's score, platelets, fibrosis index, age-platelet index and Lok index in the same set of patients. A sequential test was then developed including APRI followed by PLASA [Cairo University Fibrosis Assessment (CUFA) algorithm], this allowed saving 20% and 34% of liver biopsies for patients being tested for significant fibrosis and cirrhosis, respectively. In conclusion, the CUFA algorithms at no cost allow saving a significant proportion of patients from performing a liver biopsy or a more complex costly test. These algorithms could be used as the first step in the assessment of liver fibrosis before embarking on the more costly advanced serum markers, Fibroscan or liver biopsy.

Waked, Imam, Waheed Doss, Manal Hamdy El-Sayed, Chris Estes, Homie Razavi, Gamal Shiha, Ayman Yosry, and Gamal Esmat. "The current and future disease burden of chronic hepatitis C virus infection in Egypt." Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology 15, no. 2 (2014): 45-52. Abstract
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Ragab, Dina, Melissa Laird, Darragh Duffy, Armanda Casrouge, Rasha Mamdouh, Amal Abass, Dina El Shenawy, Abdelhadi M. Shebl, Wagdi F. Elkashef, Khaled R. Zalata et al. "CXCL10 antagonism and plasma sDPPIV correlate with increasing liver disease in chronic HCV genotype 4 infected patients." CYTOKINE 63 (2013): 105-112. Abstract
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Hézode, Christophe, Gideon M. Hirschfield, Wayne Ghesquiere, William Sievert, Maribel Rodriguez-Torres, Stephen D. Shafran, Paul J. Thuluvath, Harvey A. Tatum, Imam Waked, Gamal Esmat et al. "Daclatasvir plus peginterferon alfa and ribavirin for treatment-naive chronic hepatitis C genotype 1 or 4 infection: a randomised study." Gut (2014). Abstract

OBJECTIVE: To evaluate the safety and efficacy of daclatasvir, an HCV NS5A inhibitor with pangenotypic activity, administered with peginterferon-alfa-2a/ribavirin.

DESIGN: In this Phase 2b double-blind, placebo-controlled study, treatment-naive adults with HCV genotype 1 (N=365) or 4 (N=30) infection were randomly assigned (2:2:1) to daclatasvir 20 mg or 60 mg, or placebo once daily plus weekly peginterferon-alfa-2a and twice-daily ribavirin. Daclatasvir recipients achieving protocol-defined response (PDR; HCV-RNA

Hezode, Christophe, Gideon M. Hirschfield, Wayne Ghesquiere, William Sievert, Maribel Rodriguez-Torres, Stephen D. Shafran, Paul J. Thuluvath, Harvey A. Tatum, Imam Waked, Gamal E. Esmat et al. "Daclatasvir, an NS5A Replication Complex Inhibitor, Combined With Peginterferon Alfa-2a and Ribavirin in Treatment-Naive HCV-Genotype 1 or 4 Subjects: Phase 2b COMMAND-1 SVR12 Results." HEPATOLOGY 56 (2012): 553A-554A. Abstract
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Zekri, Abdel-Rahman N., Rabab A. N. Moharram, Waleed S. Mohamed, Abeer A. Bahnassy, Hanaa Alam M. El-Din, Maha M. Abo-Shadi, Naglaa A. Zayed, Husseim El-Magzangy, Ashraf O. Abdel-Aziz, and Gamal Esmat. "Disease progression from chronic hepatitis C to cirrhosis and hepatocellular carcinoma is associated with repression of interferon regulatory factor-1." EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY 22 (2010): 450-456. Abstract
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