Journal of Pediatric infectious diseases, Mar 14, 2019
Background Cytomegalovirus (CMV) has been implicated as one of the etiological factors of immune ... more Background Cytomegalovirus (CMV) has been implicated as one of the etiological factors of immune thrombocytopenia (ITP) in many reports. Objectives We aimed to estimate the frequency of CMV positivity among childhood ITP patients, and to assess its impact on severity of bleeding, chronicity of the disease, and response to therapy. Methods A cross-sectional study was performed including 40 Egyptian pediatric patients with ITP. CMV infection was detected by serological testing and polymerase chain reaction (PCR). Clinical assessment for bleeding severity using ITP bleeding scale (IBLS) and initial response to therapy were included in the study. Results The prevalence of CMV DNAemia among the ITP patients was 72.5%. The virus DNAemia was higher among newly diagnosed ITP cases compared with chronic ones (85 and 60% respectively, p = 0.07). There were no significant differences in age, gender, bleeding severity, or initial clinical presentation in patients who were CMV-PCR positive or negative (p > 0.05). Refractory cases were found in 17.2% of CMV-positive cases compared with 36.4% in CMV-negative ones (p = 0.29). Specificity and sensitivity of serological assay in comparison to PCR were 72.4% and 20.69%, respectively, with a negative predictive value of 25.8%, and a positive predictive value of 66.7%. Conclusion Cytomegalovirus appears to have a high frequency among both newly diagnosed and chronic ITP patients in Egypt. CMV serological assay for IgM was not a good indicator of the presence of viral infection. CMV DNAemia seems to have no significant effect on severity of bleeding, clinical presentation, or outcomes of childhood ITP.
Cystic neuroblastoma is a rare variant of neuroblastoma that is more often completely localized a... more Cystic neuroblastoma is a rare variant of neuroblastoma that is more often completely localized and associated with spontaneous regression. We report the case of a 9-month-old girl having cystic neuroblastoma with liver metastasis that remained asymptomatic for 1 year and 2 months of follow-up and review the literature on the topic.
Background Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) r... more Background Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) regulate the turnover of the extracellular matrix and may modulate the biology of hematopoietic cells. They are key players in many physiological and pathological processes such as development, angiogenesis, connective tissue remodeling, as well as tumor invasion and metastasis. Objectives Estimate marrow MMP-9 expression and detect the levels of TIMP-1 in patients with acute lymphoblastic leukemia (ALL) and correlate these results to the clinical characteristics and survival studies of the patients. Materials and methods Thirty newly diagnosed patients with childhood ALL and 10 healthy control children were studied using real-time PCR for the measurement of mRNA expression of the MMP-9 gene and using the flow cytometric technique for the detection of intracytoplasmic protein levels of TIMP-1 . Results MMP-9 expression was significantly lower in patients compared with the control group, whereas TIMP-1 expression showed no significant difference between both the groups. No significant difference was observed between patients with a high MMP-9 expression and low MMP-9 expression in terms of clinical and laboratory data, except for the platelet count, which was higher in patients with a high MMP-9 expression. Besides CD34 expression, TIMP-1 expression was not significantly related to clinical and laboratory data of the patients studied. The median TIMP-1 expression, but not MMP-9, was significantly associated with the initial response to therapy. However, neither MMP-9 nor TIMP-1 expression was significantly associated with the relapse rate, overall survival, or event-free survival. Conclusion The clinical importance of MMP-9 and TIMP-1 expression in childhood ALL is still unclear. Further larger studies with a longer follow-up period are recommended to confirm the prognostic value of MMP-9 and TIMP-1 expression in pediatric ALL patients.
BackgroundThe COVID‐19 pandemic altered healthcare systems globally, causing delays in care deliv... more BackgroundThe COVID‐19 pandemic altered healthcare systems globally, causing delays in care delivery and increased anxiety among patients and families. This study examined how hospital stakeholders and clinicians perceived the global impact of the COVID‐19 pandemic on children with cancer and their families.MethodsThis secondary analysis examined data from a qualitative study consisting of 19 focus groups conducted in 8 languages throughout 16 countries. A codebook was developed with novel codes derived inductively from transcript review. In‐depth analysis focused on the impact of the COVID‐19 pandemic on children with cancer and their families.ResultsEight themes describing the impact of the pandemic on patients and their families were identified and classified into three domains: contributing factors (COVID‐19 Policies, Cancer Treatment Modifications, COVID‐19 Symptoms, Beliefs), patient‐related impacts (Quality of Care, Psychosocial impacts, Treatment Reluctance), and the central...
Journal of Pediatric infectious diseases, Mar 14, 2019
Background Cytomegalovirus (CMV) has been implicated as one of the etiological factors of immune ... more Background Cytomegalovirus (CMV) has been implicated as one of the etiological factors of immune thrombocytopenia (ITP) in many reports. Objectives We aimed to estimate the frequency of CMV positivity among childhood ITP patients, and to assess its impact on severity of bleeding, chronicity of the disease, and response to therapy. Methods A cross-sectional study was performed including 40 Egyptian pediatric patients with ITP. CMV infection was detected by serological testing and polymerase chain reaction (PCR). Clinical assessment for bleeding severity using ITP bleeding scale (IBLS) and initial response to therapy were included in the study. Results The prevalence of CMV DNAemia among the ITP patients was 72.5%. The virus DNAemia was higher among newly diagnosed ITP cases compared with chronic ones (85 and 60% respectively, p = 0.07). There were no significant differences in age, gender, bleeding severity, or initial clinical presentation in patients who were CMV-PCR positive or negative (p > 0.05). Refractory cases were found in 17.2% of CMV-positive cases compared with 36.4% in CMV-negative ones (p = 0.29). Specificity and sensitivity of serological assay in comparison to PCR were 72.4% and 20.69%, respectively, with a negative predictive value of 25.8%, and a positive predictive value of 66.7%. Conclusion Cytomegalovirus appears to have a high frequency among both newly diagnosed and chronic ITP patients in Egypt. CMV serological assay for IgM was not a good indicator of the presence of viral infection. CMV DNAemia seems to have no significant effect on severity of bleeding, clinical presentation, or outcomes of childhood ITP.
Cystic neuroblastoma is a rare variant of neuroblastoma that is more often completely localized a... more Cystic neuroblastoma is a rare variant of neuroblastoma that is more often completely localized and associated with spontaneous regression. We report the case of a 9-month-old girl having cystic neuroblastoma with liver metastasis that remained asymptomatic for 1 year and 2 months of follow-up and review the literature on the topic.
Background Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) r... more Background Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) regulate the turnover of the extracellular matrix and may modulate the biology of hematopoietic cells. They are key players in many physiological and pathological processes such as development, angiogenesis, connective tissue remodeling, as well as tumor invasion and metastasis. Objectives Estimate marrow MMP-9 expression and detect the levels of TIMP-1 in patients with acute lymphoblastic leukemia (ALL) and correlate these results to the clinical characteristics and survival studies of the patients. Materials and methods Thirty newly diagnosed patients with childhood ALL and 10 healthy control children were studied using real-time PCR for the measurement of mRNA expression of the MMP-9 gene and using the flow cytometric technique for the detection of intracytoplasmic protein levels of TIMP-1 . Results MMP-9 expression was significantly lower in patients compared with the control group, whereas TIMP-1 expression showed no significant difference between both the groups. No significant difference was observed between patients with a high MMP-9 expression and low MMP-9 expression in terms of clinical and laboratory data, except for the platelet count, which was higher in patients with a high MMP-9 expression. Besides CD34 expression, TIMP-1 expression was not significantly related to clinical and laboratory data of the patients studied. The median TIMP-1 expression, but not MMP-9, was significantly associated with the initial response to therapy. However, neither MMP-9 nor TIMP-1 expression was significantly associated with the relapse rate, overall survival, or event-free survival. Conclusion The clinical importance of MMP-9 and TIMP-1 expression in childhood ALL is still unclear. Further larger studies with a longer follow-up period are recommended to confirm the prognostic value of MMP-9 and TIMP-1 expression in pediatric ALL patients.
BackgroundThe COVID‐19 pandemic altered healthcare systems globally, causing delays in care deliv... more BackgroundThe COVID‐19 pandemic altered healthcare systems globally, causing delays in care delivery and increased anxiety among patients and families. This study examined how hospital stakeholders and clinicians perceived the global impact of the COVID‐19 pandemic on children with cancer and their families.MethodsThis secondary analysis examined data from a qualitative study consisting of 19 focus groups conducted in 8 languages throughout 16 countries. A codebook was developed with novel codes derived inductively from transcript review. In‐depth analysis focused on the impact of the COVID‐19 pandemic on children with cancer and their families.ResultsEight themes describing the impact of the pandemic on patients and their families were identified and classified into three domains: contributing factors (COVID‐19 Policies, Cancer Treatment Modifications, COVID‐19 Symptoms, Beliefs), patient‐related impacts (Quality of Care, Psychosocial impacts, Treatment Reluctance), and the central...
Uploads
Papers by Iman Ragab