Publications

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Book Chapter
M.A., K., Elmahdy H.N., M. F., Shaker C.W., Refaey M.A., and R. K.W.Y., "Recognition of Heart Murmur Based on Machine Learning and Visual Based Analysis of Phonocardiography.", Intelligent Computing. SAI 2018. Advances in Intelligent Systems and Computing,: Springer, Cham, 2019.
Conference Paper
Kotb, M. A., "EXTRAHEPATIC BILIARY ATRESIA; KOTB DISEASE IS POTENTIALLY PREVENTABLE", Excellence in Pediatrics Conference, London, UK, December, 2015.
Journal Article
Kotb, M. A., "Aflatoxins in Infants with Extrahepatic Biliary Atresia", Med. J. Cairo Univ., vol. 83, issue March 1, pp. 207-210,, 2015. Aflatoxins in Infants with Extrahepatic Biliary Atresia
Kotb, M. A., and M. Aziz, "Antineutrophil cytoplasmic antibodies and other antibodies in neonatal hepatitis and extrahepatic biliary atresia.", Scientific Medical Journal , vol. 12, issue 3, pp. 41-51, 2000.
El-Karaksy, H., M. El-Shabrawi, N. Mohsen, M. Kotb, N. El-Koofy, and N. El-Deeb, "Capillaria philippinensis: a cause of fatal diarrhea in one of two infected Egyptian sisters.", Journal of tropical pediatrics, vol. 50, issue 1, pp. 57-60, 2004 Feb. Abstract

Capillaria philippinensis is an emerging infection in Egypt. Reports in children are scarce. We report here two sisters with C. philippinensis infection, aged 8 and 12 years. Their father was a fisherman and they had a habit of picking small pieces of uncooked fish to eat while their mother prepared their meals. They came from El-Menia governorate, which lies in the northern part of Upper Egypt. Most reported cases from Egypt come from this governorate and nearby areas. Both sisters had persistent profuse watery diarrhea of 12 months' duration. Their weights were below the 5th percentile for age. Both were hypoalbuminemic, but only the younger had pedal edema. Both had hypokalemia and hyponatremia. During the course of their illness they were repeatedly admitted to different hospitals and received intravenous fluids, but the correct diagnosis was not reached. Diagnosis was made by stool examination at our hospital when eggs and larvae were detected in stool samples. Although a diagnosis was promptly made, the older sister who suffered from pneumonia and septic shock unfortunately died a few days after admission. The younger sister was treated successfully with albendazole 200 mg twice daily. Diarrhea abated, pedal edema disappeared, and she started to gain weight.

Kotb, M. A., I. Draz, C. W. Basanti, S. T. El Sorogy, H. M. Abd Elkader, H. Esmat, H. Abd El Baky, and D. S. Mosallam, "Cholestasis In Infants With Down Syndrome Is Not Due To Extrahepatic Biliary Atresia: A Ten-Year Single Egyptian Centre Experience.", Clinical and experimental gastroenterology, vol. 12, pp. 401-408, 2019. Abstract

Purpose: We aimed to define the clinical presentations, course and outcome of cholestasis in infants with Down syndrome (trisomy 21) who presented to the Pediatric Hepatology Clinic, New Children Hospital, Cairo University, Egypt.

Methods: Retrospective analysis of data of cohort of infants with Down syndrome and cholestasis who followed up during 2005-2015.

Results: Among 779 infants with cholestasis who presented during 2005-2015, 61 (7.8%) had Down syndrome. Six dropped out. Among the 55 who followed-up for a mean duration +SD = 12.1 ± 16.7 months, none had extrahepatic biliary atresia (EHBA), 37 (63.3%) had neonatal hepatitis and 18 (32.7%) had non-syndromic paucity of intrahepatic biliary radicals. Fourteen (25.4%) had associated congenital heart disease. Only 35 (63.3%) cleared the jaundice. Twenty-nine (52.7%) received ursodeoxycholic acid (UDCA); of them, 13 cleared the jaundice, one improved, 14 progressed and one died, compared to 22 who cleared the jaundice of the 26 who did not receive UDCA. Only three of those who did not receive UDCA progressed and none died. UDCA carried a 3.4-fold risk of poor prognosis (= 0.001). UDCA use was associated with more complications (= 0.016) in those with Down syndrome and cholestasis.

Conclusion: We did not come across EHBA among neonates and infants with Down syndrome in 10 years. Non-syndromic paucity is associated with favorable outcome in infants with Down syndrome. UDCA use in cholestasis with Down syndrome is associated with poor outcome.

Soliman, N. A., M. M. Nabhan, S. M. Abdelrahman, H. Abdelaziz, R. Helmy, K. Ghanim, H. M. Bazaraa, A. M. Badr, O. A. Tolba, M. A. Kotb, et al., "Clinical spectrum of primary hyperoxaluria type 1: Experience of a tertiary center.", Nephrologie & therapeutique, vol. 13, issue 3, pp. 176-182, 2017 May. Abstract

BACKGROUND AND AIM: Primary hyperoxalurias are rare inborn errors of metabolism resulting in increased endogenous production of oxalate that leads to excessive urinary oxalate excretion. Diagnosis of primary hyperoxaluria type 1 (PH1) is a challenging issue and depends on diverse diagnostic tools including biochemical analysis of urine, stone analysis, renal biopsy, genetic studies and in some cases liver biopsy for enzyme assay. We characterized the clinical presentation as well as renal and extrarenal phenotypes in PH1 patients.

METHODS: This descriptive cohort study included patients with presumable PH1 presenting with nephrolithiasis and/or nephrocalcinosis (NC). Precise clinical characterization of renal phenotype as well as systemic involvement is reported. AGXT mutational analysis was performed to confirm the diagnosis of PH1.

RESULTS: The study cohort included 26 patients with presumable PH1 with male to female ratio of 1.4:1. The median age at time of diagnosis was 6 years, nevertheless the median age at initial symptoms was 3 years. Thirteen patients (50%) were diagnosed before the age of 5 years. Two patients had no symptoms and were diagnosed while screening siblings of index patients. Seventeen patients (65.4%) had reached end-stage renal disease (ESRD): 6/17 (35.3%) during infancy, 4/17 (23.5%) in early childhood and 7/17 (41.29%) in late childhood. Two patients (7.7%) had clinically manifest extra renal (retina, heart, bone, soft tissue) involvement. Mutational analysis of AGXT gene confirmed the diagnosis of PH1 in 15 out of 19 patients (79%) where analysis had been performed. Fifty percent of patients with maintained renal functions had projected 10 years renal survival.

CONCLUSION: PH1 is a heterogeneous disease with wide spectrum of clinical, imaging and functional presentation. More than two-thirds of patients presented prior to the age of 5 years; half of them with the stormy course of infantile PH1. ESRD was the commonest presenting manifestation in two-thirds of our cohort.

Kotb, M. A., A. F. Hamza, H. Abd El Kader, M. El Monayeri, D. S. Mosallam, N. Ali, C. W. S. Basanti, H. Bazaraa, H. A. Rahman, M. M. Nabhan, et al., "Combined liver-kidney transplantation for primary hyperoxaluria type I in children: Single Center Experience.", Pediatric transplantation, vol. 23, issue 1, pp. e13313, 2019 02. Abstract

Primary hyperoxalurias are rare inborn errors of metabolism with deficiency of hepatic enzymes that lead to excessive urinary oxalate excretion and overproduction of oxalate which is deposited in various organs. Hyperoxaluria results in serious morbid-ity, end stage kidney disease (ESKD), and mortality if left untreated. Combined liver kidney transplantation (CLKT) is recognized as a management of ESKD for children with hyperoxaluria type 1 (PH1). This study aimed to report outcome of CLKT in a pediatric cohort of PH1 patients, through retrospective analysis of data of 8 children (2 girls and 6 boys) who presented by PH1 to Wadi El Nil Pediatric Living Related Liver Transplant Unit during 2001-2017. Mean age at transplant was 8.2 ± 4 years. Only three of the children underwent confirmatory genotyping. Three patients died prior to surgery on waiting list. The first attempt at CLKT was consecutive, and despite initial successful liver transplant, the girl died of biliary peritonitis prior to scheduled renal transplant. Of the four who underwent simultaneous CLKT, only two survived and are well, one with insignificant complications, and other suffered from abdominal Burkitt lymphoma managed by excision and resection anastomosis, four cycles of rituximab, cyclophosphamide, vincristine, and prednisone. The other two died, one due to uncontrollable bleeding within 36 hours of procedure, while the other died awaiting renal transplant after loss of renal graft to recurrent renal oxalosis 6 months post-transplant. PH1 with ESKD is a rare disease; simultaneous CLKT offers good quality of life for afflicted children. Graft shortage and renal graft loss to oxalosis challenge the outcome.

Kotb, M. A., and N. Sabry, "Depression and body image in children with chronic liver disease. A cross-sectional study", Current Psychiatry , vol. 10, issue 2, pp. 168-181, 2003.
Kotb, M. A., N. El-Koofy, W. N. Lotfi, and M. Kamal, "Doppler assessed haemodynamic changes in infants and children suffering cholestasis.", The Gazette of Egyptian Pediatric Association , vol. 48, issue 3, pp. 345-356, 2000.
Kotb, M. A., O. Afify, E. M. Hawary, and S Okasha, M Isa, "EEG changes in liver glycogenoses: a crosssectional study.", Alexandria Journal of Pediatrics , vol. 18, issue 1, pp. 61-65, 2004.
Kotb, M. A., A. Idrees, W. N. Lotfi, G. Taha, and M. Aziz, "Elevated levels of interleukin 18 in children with acute and chronic liver disease: Further evidence of T-cell- mediated liver injury.", Alexandria Journal of Pediatrics, vol. 16, issue 2, pp. 327-332, 2002.
Kotb, M. A., E. M. Razky, H. M. E. Karaksy, M. S. E. Razky, S Okasha, M Isa, R. Hussein, E. N. Dessouky, M. M. E. Barbary, E. H. Tantawy, and W. Mostafa, "Evaluation of TC sign by 3 dimensional sonography in extrahepatic biliary atresia: A prospective study. ", The Medical Journal of Cairo University, vol. 78, issue 4 suppl, pp. 103-106, 2005.
Kotb, M. A., A. Kotb, M. F. Sheba, N. M. El Koofy, H. M. El-Karaksy, M. K. Abdel-Kahlik, A. Abdalla, M. E. El-Regal, R. Warda, H. Mostafa, et al., "Evaluation of the triangular cord sign in the diagnosis of biliary atresia.", Pediatrics, vol. 108, issue 2, pp. 416-20, 2001 Aug. Abstract

BACKGROUND: Infantile cholestasis continues to represent a diagnostic challenge. It is very important to diagnose surgically correctable disorders, such as biliary atresia, in a timely manner to prevent progressive damage to the liver. It has been recently suggested that the triangular cord (TC) sign is a simple and useful tool in the diagnosis of biliary atresia.

METHODS: We prospectively studied 65 infants presenting with conjugated hyperbilirubinemia (age range: 32-161 days). All patients underwent ultrasonographic examination with a 7.0-MHz transducer (Acuson, Mountain View, CA). The TC was defined as a triangular, or tubular, echogenic density seen immediately cranial to the portal vein bifurcation.

RESULTS: The TC sign was identified in 25 infants, and all of them had histologic features suggestive of biliary atresia; the diagnosis was confirmed at surgery by gross morphology of hepatobiliary system, and liver biopsy, with or without intraoperative cholangiogram. Among the 40 patients who did not have the TC sign, 6 had paucity of the intrahepatic bile ducts. Three had alph-1-antitrypsin deficiency, and 31 had neonatal hepatitis. None of the 40 patients who did not have the TC sign developed acholic stools. Seven patients with biliary atresia were followed by ultrasonographic examination for 6 months after the Kasai procedure. The TC sign disappeared in all patients after the surgery; however, the TC sign reappeared in 3 patients who developed progressive cholestasis after the procedure.

CONCLUSION: The TC sign is a simple, timesaving, and reliable diagnostic tool in the evaluation of infants with infantile cholestasis. The TC sign may also prove to be helpful in following patients after hepatoportoenterostomy. We suggest a new diagnostic strategy for patients suspected to have biliary atresia. When the TC sign is visualized, the patient should undergo intraoperative cholangiogram to confirm the diagnosis of biliary atresia, reserving percutaneous liver biopsy for those patients in whom the TC sign could not be detected.

Kotb, M. A., Mahmould A, Moussa S, and A. HH., "Fragile X syndrome and other cytogenetic abnormalities presenting by poor school performance in boys with no dysmorphic features.", The Gazette of Egyptian Pediatric Association , vol. 48, issue 2, pp. 157-175, 2000.
Habib, E. E., M. Aziz, and M. Kotb, "Genetic polymorphism of folate and methionine metabolizing enzymes and their susceptibility to malignant lymphoma.", Journal of the Egyptian National Cancer Institute, vol. 17, issue 3, pp. 184-92, 2005 Sep. Abstract

BACKGROUND: Folate and methionine metabolism is involved in DNA synthesis and methylation. Polymorphisms in the genes of folate metabolism enzymes have been associated with some forms of cancer. In the present study, 2 polymorphisms were evaluated for a folate metabolic enzyme, methylene-tetrahydrofolate reductase (MTHFR), and one was evaluated for methionine synthase (MS). The 2 polymorphisms MTHFR 677 C-->T and MTHFR 1298 A-->C, are reported to reduce the enzyme activity, which causes intracellular accumulation of 5, 10- methylene-tetrahydrofolate and results in a reduced incidence of DNA double strand breakage. The MS 2756 A-->G polymorphism also reduces the enzyme activity and results in the hypomethylation of DNA.

PATIENTS AND METHODS: To test this hypothesis, genetic polymorphisms in the folate metabolic pathway were investigated using the DNA from a case-control study on 31 patients having malignant lymphoma from the Oncology Outpatient Clinic of the New Children's Hospital, Cairo University and 30 controls who were actually normal children attending for vaccination to the same hospital.

RESULTS: We found that there is a higher susceptibility with the MTHFR 677CC and MTHFR 1298 AA genotypes (OR=4.3, 95% CI 1.12-16). When those harbor at least one variant allele in either polymorphism of MTHFR they were defined as reference. For the MS 2756 AG genotype polymorphism there was also a higher susceptibility to developing malignant lymphoma (OR=2.6; 95% CI 1.1- 6.4).

CONCLUSION: Results suggest that folate and methionine metabolism may play an important role in the pathogenesis of malignant lymphoma. Further studies to confirm this association and detailed biologic mechanisms are now required.

El-Raziky, M. S., M. El-Hawary, N. El-Koofy, S Okasha, M Isa, M. Kotb, K. Salama, G. Esmat, M. El-Raziky, A. M. Abouzied, and H. El-Karaksy, "Hepatitis C virus infection in Egyptian children: single centre experience.", Journal of viral hepatitis, vol. 11, issue 5, pp. 471-6, 2004 Sep. Abstract

The outcome of hepatitis C virus (HCV) infection acquired in childhood is uncertain because of the diversity of the epidemiological and clinical features of infection and disease. The aim of this study was to determine the outcome of HCV infection in 105 Egyptian children who tested positive for HCV antibody (anti-HCV). The data of 105 anti-HCV-positive children presenting to the Pediatric Hepatology Unit, Cairo University Children's Hospital, between 1995 and 2002, were retrospectively analysed for risk factors. Seventy-four children with available polymerase chain reaction results were further analysed clinically, serologically and histologically. The age range was 1.3-22 years, with a mean of 11.2 +/- 4.9 years. History of blood transfusion was found in 81 children (77%). HCV RNA was detected in 58.1% of 74 children. Persistently elevated alanine aminotransferase (ALT) levels were present in 40 patients (54.1%). Hepatitis B virus markers (HBsAg and/or anti-HBc) were detected in 18 patients (24.3%). Twenty-six of the 43 HCV RNA-positive children underwent a diagnostic liver biopsy that showed chronic hepatitis in 19 patients (73.1%), cirrhosis in one case only (3.8%), and normal biopsy findings in seven children (26.9%). Blood transfusion remains a major risk of HCV transmission among Egyptian children. HCV infection is not always benign in the childhood period. ALT levels remain elevated in half of the children and histological abnormalities are detected in three quarters of HCV RNA-positive cases.

HOSNI, H. N., M. M. Kamel, M. A. Kotb, and M. GHEITH, "Histopathological Study of Upper Gastrointestinal Tract for Helicobacter Pylori and Giardiasis in Egyptian Children", Med. J. Cairo Univ., vol. 80, issue 1, pp. 283-291, 2012.
Kotb, M. A., A. El Henawy, S. Talaat, M. Aziz, G. H. El Tagy, M. M. El Barbary, and W. Mostafa, "Immune-mediated liver injury: prognostic value of CD4+, CD8+, and CD68+ in infants with extrahepatic biliary atresia.", Journal of pediatric surgery, vol. 40, issue 8, pp. 1252-7, 2005 Aug. Abstract

BACKGROUND: Hepatic fibrosis and cirrhosis develop progressively in extrahepatic biliary atresia (EHBA) despite timely surgical intervention.

PURPOSE: The aim of the study was to define CD4+ helper T lymphocytes, cytotoxic CD8+ T lymphocytes, and CD68+ (macrophages) infiltration of portal tracts and lobules and hepatic fibrosis as possible predictive measures of outcome of infants having EHBA.

METHODS: The outcome of 32 infants with EHBA was correlated to their percutaneous biopsy and postportoenterostomy core liver tissue infiltration by CD4+, CD68+, and CD8+ cells and to the degree of detected fibrosis.

RESULTS: Portoenterostomy cores were heavily infiltrated by CD4+, CD8+, and CD68+, compared with the preoperative liver biopsy (P = .008, .004, and .017, respectively). Infants having favorable outcome had more macrophage infiltration in portoenterostomy core compared with those having an unfavorable outcome (25.66 +/- 29.77 per HPF compared with 11.62 +/- 4.58, P = .000). Mean CD4+/CD8+ ratio was 1.54 +/- 1.37 in those who died within 18 months postoperatively and 0.733 +/- 0.48 in others (P = .021).

CONCLUSION: Immune-mediated destruction of portal tracts is an integral part of pathogenesis of EHBA.

Mohsen, N. A., M. A. Kotb, Abd El Fattah MM, and I. HA, "Interaction of tumor necrosis factor alpha and nitric oxide in pediatric chronic liver diseases", The Arab Journal of Laboratory Medicine, vol. 25, issue 1, pp. 97-106, 1999.
Marwa Geith, Ayman A. El-Badry, E. Y. Abu-Sarea, and Magd A. Kotb, "Intestinal Parasitosis and Pediatric Hepatic Disease: Corproscopy and Immuno Molecular Assays", Journal of the Egyptian Society of Parasitology , vol. 48, issue 2, pp. 475-480, 2018.
EE Habib EE, M. S. M. El-Minawi, and M. A. Kotb, "Late effects and audiologic findings of childhood acute lymphblastic leukemia and lymphoma survivors treated by chemotherapy with or without cranial irradiation. ", Scientific Medical Journal , vol. 18, issue 2, pp. 14-27, 2006.