Mahmoud Nassar
Verified @aucegypt.edu
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Muhammad Ghallab, Magdy Abdelhamid, Mahmoud Nassar, Karim S. Mostafa, Dina H. Salama, Wael Elnaggar, Shaban Alramlawy, Zakaria Alagha, Salma Abdelmoteleb, and Assem Hashad
Springer Science and Business Media LLC
Abstract Background Catheter laboratories are high-radiation exposure environments, especially during X-ray procedures like percutaneous transluminal coronary angioplasty and electrophysiological studies. Radiation exposure poses risks of stochastic (e.g., cancer) and deterministic (e.g., skin changes) effects. This study assessed radiation safety and health practices in a cardiac catheterization unit to optimize radiation safety. A cross-sectional study in Cairo University Hospital (March–September 2019) evaluated 700 patients and healthcare workers. Real-time radiation measurements, educational lectures, and radiation protection measures were implemented in three phases. Data on radiation exposure, procedures, and compliance were collected and analyzed. Results The total procedure time and fluoroscopy time per cardiologist did not significantly differ between phases, but there was a statistically significant reduction in the mean total cumulative radiation doses between Phase I and Phase III for cardiologists (P = 0.013). Among nurses and technicians, there was no significant difference in radiation doses between the two phases. Significant correlations were found between operators' radiation doses, procedure time, and fluoroscopy time. Patients' radiation doses decreased significantly from Phase I to Phase III, with correlations between dose, procedure time, and gender. Compliance with radiation protection measures was suboptimal. Conclusions Compliance with radiation safety standards in the cardiac catheterization unit at the Cairo University Hospital needs improvement. The study highlights the importance of adhering to radiation safety principles and optimizing protective measures to reduce radiation exposure for both patients and healthcare personnel. Despite low compliance, significant reductions in radiation doses were achieved with increased awareness and adherence to specific protection measures. Future efforts should focus on enhancing radiation safety protocols and organ-specific radiation impact assessments.
Hazem Abosheaishaa, Mahmoud Nassar, Omar Abdelhalim, Ammar Ayman Bahbah, Sharif Abbas, Samah M. Morsi, Muhammad Ghallab, Zakaria Alagha, Ahmed Omran, Khaled Elfert,et al.
Ovid Technologies (Wolters Kluwer Health)
Background and objective Non-alcoholic fatty liver disease (NAFLD), characterized by hepatic steatosis without heavy alcohol consumption or other chronic conditions, encompasses a spectrum from non-alcoholic fatty liver to non-alcoholic steatohepatitis leading to cirrhosis. This analysis aimed to investigate the correlation between NAFLD and carotid intimal media thickness (C-IMT), a non-invasive surrogate for atherosclerosis. Methodology Database searches, including PubMed, EMBASE and Cochrane Library, yielded studies up to April 2023. Included were studies exploring the NAFLD-C-IMT relationship in populations aged >18 years. Exclusions comprised non-English papers, those involving animals or pediatric populations and studies lacking control groups. Results No statistical significance was noted between mild and moderate NAFLD compared to the control group regarding C-IMT [95% confidence intervals (CI): −0.03, 0.12] and (95% CI: −0.03, 0.21), respectively. There was a statistically significant difference only in the Severe NAFLD group (P value 0.03). NAFLD with and without metabolic syndrome showed statistically significant differences compared to control regarding C-IMT (95% CI: 0.04, 0.12) and (95% CI: 0.01, 0.07), respectively. Fifty-nine studies were mentioned without classification of NAFLD severity and revealed a high statistically significant difference between NAFLD and controls regarding C-IMT with (95% CI: 0.09, 0.12, P < 0.00001). Stratified analysis according to sex was done in two studies and revealed statistical differences between NAFLD and control regarding C-IMT in both groups. Conclusion This meta-analysis underscores a significant association between NAFLD and increased C-IMT, emphasizing the importance of assessing C-IMT in NAFLD patients to identify cardiovascular risk and tailor therapeutic interventions for improved patient outcomes.
Mahmoud Nassar, Anoop Misra, and Zachary Bloomgarden
Wiley
AbstractObjectiveTo assess the association between glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) treatment and the risk of suicide attempts in people with type 2 diabetes (T2D), with a focus on subgroups with and without a history of depression or suicide attempts.MethodsThis retrospective cohort study utilized TriNetX, a federated network of real‐world data. Using the Global Collaborative Network data, we collected electronic medical records from 113 health care organizations with 135 million patient records with 8 million with T2D, 83% from the United States. The four cohorts were identified based on age, medication, diagnosis, and presence of depression or suicide attempts. Analytic methods included measures of association and number of Instances, with propensity score matching employed to mitigate potential confounders. The primary outcome was the incidence of suicide attempts among people with T2D with GLP‐1RA treatment in comparison with dipeptidyl peptidase‐4 inhibitor (DPP‐4i) treatment.ResultsPeople with T2D treated with GLP‐1RA consistently exhibited a lower risk of suicide attempts compared to those treated with DPP‐4i. This was particularly significant in people with a history of depression or suicide attempts. The risk and odds ratios were significantly lower in the GLP‐1RA‐treated cohorts than in DPP‐4i across all analyses.ConclusionAs compared with DPP‐4i, our analysis shows a protective effect associated with GLP‐1RA treatment on the risk of suicide attempts among people with T2D. However, further research, particularly prospective and randomized studies, is necessary to confirm these observations and understand the underlying mechanisms.image
Hazem Abosheaishaa, Mai Hussein, Muhammad Ghallab, Magdy Abdelhamid, Natalie Balassiano, Md Ripon Ahammed, Muhammad Almas Baig, Jawad Khan, Moaz Elshair, Moataz Yousry Soliman,et al.
Elsevier BV
Rubal Bhangal, Ivan Cancarevic, Mahmoud Nassar, and Zaryab Umar
Baishideng Publishing Group Inc.
BACKGROUND Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ systems. Cardiorenal syndrome (CRS) results from pathology occurring in the heart and kidneys along with the consequences of dysfunction in one organ contributing to dysfunction in the other and vice versa. AIM To evaluate the use of erythropoietin (EPO) in patients with CRS and its effects on hemoglobin (Hb), major cardiovascular (CV) events, and hospitalization rates. METHODS On February 24, 2022, searches were conducted using PubMed, MEDLINE, and EMBASE, and 148 articles were identified. A total of nine studies were considered in this systematic review. We assessed the included articles based on the National Heart, Lung, and Blood Institute quality assessment tools for controlled intervention and observational cohort or cross-sectional studies. An assessment of bias risk was conducted on the chosen studies, and data relevant to our review was extracted. RESULTS The systematic review of these studies concluded that most existing literature indicates that EPO improves baseline Hb levels and decreases myocardial remodeling and left ventricular dysfunction without reducing CV mortality. In addition, the effect of EPO on the hospitalization rate of patients with CRS needs to be further studied since this relationship is unknown. Future studies, such as randomized controlled clinical trials and prospective cohort studies, should be conducted to enhance the literature on the potential of EPO therapy in patients with CRS. CONCLUSION Our systematic review suggests that EPO therapy may have a significant role in managing CRS. The review highlights the potential benefits of EPO in improving baseline Hb levels, reducing the risk of major CV events, improving cardiac remodeling, myocardial function, New York Heart Association class, and B-type natriuretic peptide levels. However, the effect of EPO treatment on hospitalization remains unclear and needs further exploration.
Nso Nso, Kelechi Emmanuel, Mahmoud Nassar, Kaveh Rezaei Bookani, Daniel Antwi-Amoabeng, Mohsen Alshamam, Ravali Kondaveeti, Ritika Kompella, Sofia Lakhdar, Vincent Rizzo,et al.
Ovid Technologies (Wolters Kluwer Health)
Background: Heart failure (HF) is a global disorder affecting around 6.2 million Americans aged 20 years and above. Neurovegetative disorders are common among such patients, and depression is a major problem that affects 20% to 40% of them. Cognitive behavioral therapy (CBT) is a type of treatment that produces the most favorable results compared to other psychotherapies, especially among patients with depression and anxiety. We aim to summarize and synthesize evidence regarding the efficacy of CBT for patients with HF. Methods: We conducted this study by searching PubMed, Scopus, and Web of Science for relevant studies about CBT use in patients with HF. The outcomes were pooled as mean difference (MD) or standard MD with a 95% CI. The analysis was performed using the RevMan software. Results: Combined data from 9 randomized controlled trials (1070 patients) revealed that CBT can alleviate both depression symptoms in HF patients when measured using different scales after 3 months of follow-up (standard MD, −0.18 [95% CI, −0.33 to −0.02]; P = 0.03) and the quality of life after 3 and 6 months of follow-up (MD, 4.92 [95% CI, 1.14–8.71]; P = 0.01 and MD, 7.72 [95% CI, 0.77–14.68]; P = 0.03, respectively). Conclusion: CBT is an effective type of psychotherapy for dealing with depression, mediocre quality of life, and defective physical functioning; therefore, it should be considered in HF patients’ care.
Thoraya Mohamed Ahmed, Mahmoud Nassar, Hanaa Ahmed Abdallah Mohamed, Khaled El‐sayed Elhadidy, Hanan Mohamed Farhan, Ahmed Sayed Abd El Basset, Riem M. Elmessiery, and Mahmoud Farid Kamel
Wiley
INTRODUCTION
Insulin resistance and obesity have been associated with irisin, a protein in fat cells. The levels of irisin in patients with type 2 diabetes mellitus (T2DM) were significantly lower than those in non-diabetics. This study aimed to examine the relationship between serum irisin levels and endothelial dysfunction in patients with T2DM.
METHODS
There were 90 participants in this study. We matched 65 patients with T2DM with 25 healthy control participants. A series of tests were performed on the participants, including fasting blood glucose, 2 hours postprandial blood glucose, glycated haemoglobin, triglycerides (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TG/HDL-C ratio and albumin/creatinine ratio. In addition to measuring high-sensitivity C-reactive protein (hs-CRP). Enzyme-linked immunosorbent assay (ELISA) technique was used for estimating irisin concentrations.
RESULTS
Flow-mediated dilation (FMD) was significantly lower in patients with T2DM; however, there was a non-statistically significant difference between healthy controls and patients with T2DM regarding serum Irisin level. CRP and LDL levels were inversely correlated with circulating irisin levels. In a stepwise regression analysis, only the hs-CRP and LDL were statistically significant in predicting irisin level.
CONCLUSIONS
In patients with T2DM, serum levels of irisin were inversely correlated with hyperglycaemia, body mass index and per cent body fat; this suggests that detecting irisin levels early can prevent cardiovascular diseases from progressing. According to the study results, serum irisin serves as a predictive marker for early cardiovascular disease, thus preventing the disease from progressing. There is a need for further research in order to understand how irisin contributes to the development of atherosclerosis and the development of diabetic complications.
Mahmoud Nassar, Hazem Abosheaishaa, Awadhesh Kumar Singh, Anoop Misra, and Zachary Bloomgarden
Wiley
BACKGROUND
Patients with diabetes are more likely to suffer COVID-19 complications. Using noninsulin antihyperglycemic medications (AGMs) during COVID-19 infection has proved challenging. In this study, we evaluate different noninsulin AGMs in patients with COVID-19.
METHODS
We searched Medline, Embase, Web of Science, and Cochrane on 24 January 2022. We used the following keywords (COVID-19) AND (diabetes mellitus) AND (antihyperglycemic agent). The inclusion criteria were studies reporting one or more of the outcomes. We excluded non-English articles, case reports, and literature reviews. Study outcomes were mortality, hospitalization, and intensive care unit (ICU) admission.
RESULTS
The use of metformin rather than other glucose-lowering medications was associated with statistically significant lower mortality (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.47, 0.77, p < .001). Dipeptidyl peptidase-4 inhibitor (DPP-4i) use was associated with statistically significantly higher hospitalization risk (RR: 1.44, 95% CI: 1.23, 1.68, p < .001) and higher risk of ICU admissions and/or mechanical ventilation vs nonusers (RR: 1.24, 95% CI: 1.04, 1.48, p < .02). There was a statistically significant decrease in hospitalization for SGLT-2i users vs nonusers (RR: 0.89, 95% CI: 0.84-0.95, p < .001). Glucagon-like peptide-1 receptor agonist (GLP-1RA) use was associated with a statistically significant decrease in mortality (RR: 0.56, 95% CI: 0.42, 073, p < 0.001), ICU admission, and/or mechanical ventilation (RR: 0.79, 95% CI: 0.69-0.89, p < .001), and hospitalization (RR: 0.73, 95% CI: 0.54, 0.98, p = .04).
CONCLUSIONS
AGM use was not associated with increased mortality. However, metformin and GLP-1RA use reduced mortality risk statistically significantly. DPP-4i use was associated with a statistically significant increase in the risk of hospitalization and admission to the ICU.
Jasmine Tidwell, Natalie Balassiano, Anjiya Shaikh, and Mahmoud Nassar
Baishideng Publishing Group Inc.
Primary sclerosing cholangitis (PSC) is a chronic and progressive immune-mediated cholangiopathy causing biliary tree inflammation and scarring, leading to liver cirrhosis and end-stage liver disease. Diagnosis of PSC is challenging due to its nonspecific symptoms and overlap with other liver diseases. Despite the rising incidence of PSC, there is no proven medical therapy that can alter the natural history of the disease. While liver transplantation (LT) is the most effective approach for managing advanced liver disease caused by PSC, post-transplantation recurrence of PSC remains a challenge. Therefore, ongoing research aims to develop better therapies for PSC, and continued efforts are necessary to improve outcomes for patients with PSC. This article provides an overview of PSC’s pathogenesis, clinical presentation, and management options, including LT trends and future aspects. It also highlights the need for improved therapeutic options and ethical considerations in providing equitable access to LT for patients with PSC. Additionally, the impact of liver transplant on the quality of life and psychological outcomes of patients with PSC is discussed. Ongoing research into PSC’s pathogenesis and post-transplant recurrence is crucial for improved understanding of the disease and more effective treatment options.
Raju Vaishya, Anoop Misra, Mahmoud Nassar, and Abhishek Vaish
Springer Science and Business Media LLC
Mahmoud Nassar, Anoop Misra, and Zachary Bloomgarden
Springer International Publishing
Nso Nso, Akwe Nyabera, Mahmoud Nassar, Yolanda Mbome, Kelechi Emmanuel, Mohsen Alshamam, Vickram Sumbly, Laura Guzman, Tanveer Shaukat, Rubal Bhangal,et al.
Public Library of Science (PLoS)
Background Gastrointestinal (GI) cancers are common and fatal. Improved cancer-directed therapies, with thier substantial role in improving cancer-specific survival, may increase non-cancer mortality−including cardiovascular mortality−in these patients. Aim To identify the risk factors of cardiovascular mortality in GI adenocarcinoma patients. Methods Data of GI adenocarcinoma patients were gathered from the Surveillance, Epidemiology, and End Results database. We used Pearson’s chi-square test to assess the relationships between categorical variables. We used the Kaplan-Meyer test in the univariate analysis and Cox regression test for the multivariate analysis. Results Among 556,350 included patients, 275,118 (49.6%) died due to adenocarcinoma, 64,079 (11.5%) died due to cardiovascular causes, and 83,161 (14.9%) died due to other causes. Higher rates of cardiovascular mortality were found in patients ≥ 50 years (HR, 8.476; 95% CI, 7.91–9.083), separated (HR, 1.27; 95% CI, 1.184–1.361) and widowed (HR, 1.867; 95% CI, 1.812–1.924), patients with gastric (HR, 1.18; 95% CI, 1.1–1.265) or colorectal AC (HR, 1.123; 95% CI, 1.053–1.198), and patients not undergone surgery (HR, 2.04; 95% CI, 1.958–2.126). Lower risk patients include females (HR, 0.729; 95% CI, 0.717–0.742), blacks (HR, 0.95; 95% CI, 0.924–0.978), married (HR, 0.77; 95% CI, 0.749–0.792), divorced (HR, 0.841; 95% CI, 0.807–0.877), patients with pancreatic AC (HR, 0.83; 95% CI, 0.757–0.91), and patients treated with chemotherapy (HR, 0.416; 95% CI, 0.406–0.427). Conclusions Risk factors for cardiovascular mortality in GI adenocarcinoma include advanced age, males, whites, separated and widowed, gastric or colorectal adenocarcinoma, advanced grade or advanced stage of the disease, no chemotherapy, and no surgery. Married and divorced, and patients with pancreatic adenocarcinoma have a lower risk.
Sofia Lakhdar, Mahmoud Nassar, Shabnam Shatabdi, Chandan Buttar, Adriana Abrudescu, and Theo Trandafirescu
SAGE Publications
Patients with antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis who were on immunosuppressive therapy with corticosteroids may be susceptible to cavitary lesions. 1 Only a few cases have been reported in the literature to date. Immunosuppression was shown to improve prognosis in patients with vasculitis. However, adverse therapy events and the risk of opportunistic infections become a major cause of morbidity and mortality in this specific patient population. We present a case of a 75-year-old female who was diagnosed and treated in our hospital for ANCA-associated vasculitis and returned within a few weeks of medical therapy and was found to have developed cavitation concerning for worsening vasculitis or an opportunistic fungal infection or combination of both. Given the risk of severe complications from opportunistic fungal infections, close monitoring and prophylactic antifungal therapy should be considered. Further studies are needed to evaluate the benefit of prophylaxis in this patient population.
Mahmoud Nassar, Victoria Ghernautan, Nso Nso, Akwe Nyabera, Francisco Cuevas Castillo, Wan Tu, Luis Medina, Camelia Ciobanu, Mostafa Alfishawy, Vincent Rizzo,et al.
Ovid Technologies (Wolters Kluwer Health)
The gastrointestinal tract (GI) is the second most affected organ system in individuals suffering from systemic/localized scleroderma (SSc) or localized scleroderma. SSc can affect any part of the GI, between the oral cavity and anorectum. The annual incidence of SSc in the United States is estimated to be 19.3 cases per million adults, with the highest incidence reported in people aged 44 to 55. Females are 5 times more likely than males to suffer from SSc. Morbidity and mortality rates associated with SSc are predominantly elevated among patients with GI manifestations. Esophageal and intestinal manifestations impact 90% and 40% to 70% of patients with systemic scleroderma, respectively. SSc patients are known to suffer from small bowel hypomotility and small intestinal bacterial overgrowth, which cause malabsorption and malnutrition, ultimately contributing to the 50% mortality rate. Fecal incontinence is a common symptom of SSc that can lead to depression. SSc patients may suffer from gastrointestinal complications that can negatively impact their quality of life on a daily basis. Multidisciplinary approaches are necessary for systematically managing gastrointestinal complications associated with SSc. A prospective study should focus on developing targeted therapies to improve recovery patterns and prognosis in cases of SSc. This article summarizes the epidemiology, commonly reported clinical manifestations, complications, and available treatments for treating GI pathology in SSc patients.
Hanan Mohamed Farhan, Mahmoud Nassar, Mansour Hassan Ahmed, Khadiga Abougabal, and Niveen Abd Elazim Taha
Elsevier BV
S. Lakhdar, Chandan Buttar, Mahmood Nassar, C. Ciobanu, Rima Patel and M. Munira
Merjona Saliaj, Matthew Li, Vincent Rizzo, Mahmoud Nassar, Nso Nso, Zarwa Idrees, Luis A. Medina, Anastasia Novikov, Salim Yaghi, Francisco J. Cuevas,et al.
Ovid Technologies (Wolters Kluwer Health)
Aims This study aimed to investigate the potential of tocilizumab therapy in minimizing mortality and mechanical ventilation (MV) requirements among hospitalized COVID-19 patients. Methods A single-center, retrospective, observational cohort study of 375 patients with severe COVID-19 (from March 1 to April 22, 2020) included 150 patients treated with tocilizumab and 225 consecutive control patients adjusted for age and sex. Both groups received concomitant standard of care treatments in addition to tocilizumab. The statistical methods relied on survival analyses, conditional logistic regression models, and contingency analyses. The outcomes included in-hospital mortality and the MV requirement. Results Tocilizumab associated with improved in-hospital mortality (34.7% vs 46.7%, P = 0.0136) and lower requirement for MV on days 1, 3, and 5 after treatment (P = 0.005, P < 0.0001, and P = 0.0021, respectively). Lower mortality was observed if tocilizumab was administered within 48 hours after admission (P = 0.0226). Older age and low blood oxygen saturation on admission decreased the odds of survival (P < 0.005). Conclusions Our study demonstrates a significant reduction in mortality and decreased requirement of MV with tocilizumab treatment in addition to the standard of care. Early administration of tocilizumab within 48 hours reduces the risk of mortality.
Nso Nso, Mahmoud Nassar, Milana Zirkiyeva, Sofia Lakhdar, Tanveer Shaukat, Laura Guzman, Mohsen Alshamam, Allison Foster, Rubal Bhangal, Solomon Badejoko,et al.
Elsevier BV
Arman Shafiee, Mohammad Mobin Teymouri Athar, Mahmoud Nassar, Niloofar Seighali, Dlnya Aminzade, Payam Fattahi, Maryam Rahmannia, and Zahra Ahmadi
Elsevier BV
Mahmoud Nassar, Nso Nso, Kelechi Emmanuel, Mohsen Alshamam, Most Sirajum Munira, and Anoop Misra
Elsevier BV
Mathias Clarysse, Laurens J Ceulemans, Lucas Wauters, Nicholas Gilbo, Viktor Capiau, Gert De Hertogh, Wim Laleman, Chris Verslype, Diethard Monbaliu, Jacques Pirenne,et al.
Baishideng Publishing Group Inc.
BACKGROUND Predispositions for severe coronavirus disease 2019 (COVID-19) are age, immunosuppression, and co-morbidity. High levels of maintenance immunosuppression render intestinal transplant (ITx) patients vulnerable for severe COVID-19. COVID-19 also provokes several gastroenterological pathologies which have not been discussed in ITx, so far. CASE SUMMARY During the second European COVID-19 wave in November 2020, an ITx recipient was admitted to the hospital because of electrolyte disturbances due to dehydration. Immunosuppression consisted of tacrolimus, azathioprine, and low-dose corticosteroids. During hospitalization, she tested positive on screening COVID-19 nasopharyngeal polymerase chain reaction swab, while her initial test was negative. She was initially asymptomatic and had normal inflammatory markers. Tacrolimus levels were slightly raised, as Azathioprine was temporarily halted. Due to elevated D-dimers at that time, prophylactic low-molecular weight heparin was started. Seven days after the positive test, dyspnea, anosmia, and C-reactive protein increase (25 mg/L) were noted. Remdesivir was administered during 5 d in total. High stomal output was noted in two consecutive days and several days thereafter. To exclude infection or rejection, an ileoscopy and biopsy were performed and excluded these. Four weeks later, she was discharged from the hospital and remains in good health since then. CONCLUSION Early eradication of severe acute respiratory syndrome coronavirus 2 in ITx recipients may be warranted to prevent acute rejection provocation by it.
Mahmoud F. Kamel, Mahmoud Nassar, Amira Elbendary, Abdelrahman Gamal Abdelaziz Mohamed, Mahmoud Gouda Abdullah, Hassan Ramdan Abdelazeem Gomaa, Ebram Medhat Ibrahim Awad, Heba H. Mahmoud, Mohamed A. Elfiki, Nilly H. Abdalla,et al.
Elsevier BV
Nso Nso, Mahmoud Nassar, Sofia Lakhdar, Sostanie Enoru, Laura Guzman, Vincent Rizzo, Most S. Munira, Farshid Radparvar, and Senthil Thambidorai
Elsevier BV
Nso Nso, Kelechi Emmanuel, Mahmoud Nassar, Rubal Bhangal, Sostanie Enoru, Adedapo Iluyomade, Jonathan D. Marmur, Onyedika J. Ilonze, Senthil Thambidorai, and Hakeem Ayinde
Elsevier BV