Rasha El‐Ashry

Mansoura University

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Vitamin E and N-Acetylcysteine as Antioxidant Adjuvant Therapy in Children with Acute Lymphoblastic Leukemia

Advances in Hematology (2009)

Youssef Al‐Tonbary Mohammad Al-Haggar Rasha El‐Ashry Sahar El-Dakroory Hanan Azzam

Although cancer therapies have experienced great success nowadays, yet the associated toxic response and free radicals formation have resulted in significant number of treatment-induced deaths rather than disease-induced fatalities. Complications of chemotherapy have forced physicians to study antioxidant use as adjunctive treatment in cancer. This study aimed to evaluate the antioxidant role of vitamin E and N-acetyl cysteine (NAC) in overcoming treatment-induced toxicity in acute lymphoblastic leukaemia (ALL) during the intensive period of chemo-/radiotherapy, almost the first two months of treatment. Forty children newly diagnosed with ALL were enrolled in this study. Twenty children (group I) have taken vitamin E and NAC supplementations with chemotherapy and the other twenty children (group II) have not taken any adjuvant antioxidant therapy. They were evaluated clinically for the occurrence of complications and by the laboratory parameters (blood levels of glutathione peroxidase (Glu.PX) antioxidant enzyme, malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-alpha), liver enzymes, and bone marrow picture). Results revealed reduced chemotherapy and radiotherapy toxicity as evidenced by decreasing level of MDA, increasing level of Glu.Px and decreased occurrence of toxic hepatitis, haematological complications, and need for blood and platelet transfusions in group I compared to group II. We can conclude that vitamin E and NAC have been shown to be effective as antioxidant adjuvant therapy in children with ALL to reduce chemo-/radiotherapy-related toxicities during the initial period of treatment.

Adjuvant Therapy

Malondialdehyde

10.1155/2009/689639

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Citations (58)

Primary Yolk Sac Tumor of the Prostate in a Child: Case Report

Clinical Genitourinary Cancer (2016)

Ahmed Abdelhalim Amira Kamal El-Hawary Tamer E. Helmy Mohamed Dawaba Mahmoud El‐Baz

Orbit (dynamics)

10.1016/j.clgc.2016.04.015

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Primary hepatic non-Hodgkin lymphoma presenting as acute hepatitis in a 2-year-old male

Hematology/Oncology and Stem Cell Therapy (2009)

Youssef Al‐Tonbary Ashraf Fouda Rasha El‐Ashry Khaled Zalata

Hematol Oncol Stem Cell Ther 2(1) First Quarter 2009 hemoncstem.edmgr.com 299 Non-Hodgkin lymphoma (NHL) is the third most common childhood malignancy with an overall incidence of 10.5 per million.1 Its incidence is higher in the Middle East as a result of an increased incidence of endemic Burkitt lymphoma. It is usually restricted to lymphoid tissue such as lymph modes, Peyer patches, and the spleen.1 Primary hepatic NHL is very rare in the pediatric age range. It may be asymptomatic and discovered accidentally or present with non-specific symptoms like abdominal discomfort and/or pain with some constitutional manifestation.2 We report a rare case of primary hepatic NHL presenting as acute hepatitis in a child aged 2.5 years who responded to chemotherapy.

10.1016/s1658-3876(09)50042-8

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Parvovirus B19 Infection in Pediatric Oncology Patients

Journal of Pediatric Hematology/Oncology (2009)

Othman E. Soliman Moustafa Abdelaal Hegazi Rasha El‐Ashry Hosam Zaghloul Bothina A Kora

Backround Oncology patients are at particular risk for parvovirus B19 infection, which may cause severe, persistent, usually nonspecific illness in this group. Aim This study was designed to assess the prevalence and impact of parvovirus B19 in pediatric oncology patients receiving chemotherapy, and to define the optimal diagnostic tests in such patients. Subjects and Methods Fifty-nine children under chemotherapy (39 with acute lymphocytic leukemia and 20 with solid tumors) with mean age of 4.96±1.94 years, in addition to 30 healthy children of matched age and sex, were enrolled in this study. Clinical and laboratory data were collected by examination and from patients' records. Specific parvovirus B19 immunoglobulin (Ig) M and IgG antibodies were assessed by enzyme-linked immunosorbent assay, and parvovirus DNA was detected by nested polymerase chain reaction (PCR) for all patients and controls. Results Parvovirus DNA was detected in 16 (27.1%), IgM in 3 (5.1%), and IgG in 36 (61%) patients. IgM had sensitivity, specificity, and accuracy of 18.75%, 100%, and 77.9%, respectively, whereas those of IgG were 81.25%, 53.4%, and 61%, respectively. PCR-positive patients had significantly higher frequency of unexplained anemia, red blood cell transfusions, and longer hospital stay than PCR-negative patients (P<0.001). Multiple linear regression analysis showed that unexplained anemia and multiple red blood cell transfusions were the most important variables that can predict PCR positivity. Conclusions Parvovirus B19 is not an uncommon problem in pediatric oncology patients who exhibited weak antibody response and nonspecific clinical features. Screening of these patients with PCR rather than serology is recommended when infection is suspected.

10.1097/mph.0b013e3181983b2d

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Citations (23)

Effect of Amlodipine on Hepatitis C Virus Induced Portal Hypertension in Children with Acute Leukemia

Journal of Applied Research (2010)

Rasha El‐Ashry Hala Abdel Malek Essam Ghayaty Ahmed Elgendy

Background: Children with acute leukemia are at high risk of hepatitis C infection, either by imunosuppression secondary to chemotherapy or by multiple transfusions of blood products during the course of the disease. Hepatitis C constitute a major problem during management of acute leukemias due to resultant Portal hypertension, or bleeding esophageal varices. Chronic HCV infection is a major cause of liver cirrhosis and hepatocellular carcinoma in leukemic survivors. Aim: In the present study we tested the effect of Amlodipine on children of acute lymphoblastic leukemia having portal hypertention secondary to hepatitis c infection during maintenance chemotherapy Results: From this study, we found that Amlodipine was effective in reducing the elevated portal blood pressure to normal level in doses which doesnot interfer with mechanism of action of chemotherapy Conclusion: Treatment with Amlodipine can be used to control portal hypertension in leukemic children having hepatitis c virus induced portal hypertension.

Amlodipine

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DESCRIPTIVE EPIDEMIOLOGY OF HEMOPHILIA AND OTHER COAGULATION DISORDERS IN MANSOURA , EGYPT

Mediterranean Journal of Hematology and Infectious Diseases (2010)

Youssef Al Tonbary Rasha El‐Ashry Maysaa El Sayed Zaki

Hemophilia represent the most severe inherited bleeding disorder (INB) , it’s thought to affect inviduals from all geographical areas in equal frequency. In Egypt which has a population of approximately (80million) consanguineous marriage are frequent, therefore autosomal recessive coagulation disorders reach a higher prevalence than in many other countries.The primary aim of this study was to describe the epidemiological situation of hemophilia in Mansoura, Egypt ,as based on retrospective analysis of clinical records Mansoura University Children Hospital between years 2000 and 2008. The second aim was to assess the orthopedic complications and occurrence of hepatitis C in those patients and relate this status to the type of replacement therapy received prior to the study.The study included 72 children with hematological disorders registered from 2000 to 2008 in MUCH. The hemophilic patient was defined as a person with physician-diagnosed hemophilia A or B and a measured factor VIII or IX activity level of 30% or less. Persons with acquired inhibitors of FVIII or FIX excluded. Severity level was categorized as mild if the factor activity level was 6–30%, moderate if 1–5% and severe if

Factor IX

Factor XI

10.4084/mjhid.2010.025

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Citations (31)

Prognostic factors of germ cell and sex cord-stromal ovarian tumors in pediatric age: 5 years experience.

PubMed (2013)

Rasha El‐Ashry Reda Hemida Hosam Goda El‐Said Abdel‐Hady

Ovarian tumors in the pediatric age group are not infrequent. Germ-cell tumors are the commonest ovarian neoplasm in the first two decades of life. Sex cord-stromal tumors are the most common ovarian tumors to cause precocious puberty in girls.This retrospective study included all managed cases of malignant germ-cell and sex cord-stromal tumors in the pediatric age (less than 18 years). The medical records of the admitted cases from first of January, 2008 to 31 December, 2012 were reviewed and the following information was collected: patient age, clinical presentation, surgical stage, tumor histology, therapy, clinical course, and outcome. Serum alpha-fetoprotien on admission was studied.The study included 42 pediatric cases of germ-cell and granulosa cell tumors of the ovary. Mean age of the cases was 11.26 years (range: 7-15 years). Abdominal pain was the commonest presentation. Twenty-two cases (52.4%) were diagnosed as stage I disease. Twenty-eight cases (66.7%) were exposed to fertility sparing surgery. Age of the patient and site of tumor were significantly correlated to the survival (p value: 0.04 & 0.09 respectively). The correlations of stage of the disease, use of pre-operative chemotherapy, and type of surgical interference were highly significant (P value: 0.007, 0.001, and 0.001 respectively). Tumor size and histologic types were not significantly correlated to survival (P value: 0.19 & 0.67 respectively).The cumulative survival rate was 76.2%. The correlations of stage of the disease, use of pre-operative chemotherapy, and type of surgical interference were highly significant. Tumor size and histologic types were not significantly correlated to survival. Initial level of alpha-fetoprotein was not significantly correlated to survival or recurrence.

Endodermal sinus tumor

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Bone mineral density in newly diagnosed children with neuroblastoma

Pediatric Blood & Cancer (2010)

Youssef Al‐Tonbary Magdy El-Ziny Ashraf A. Elsharkawy Amany K. El‐Hawary Rasha El‐Ashry

Neuroblastoma is the second most common extracranial malignant tumor of childhood and the most common solid tumor of infancy which is characterized by bone metastasis. Previous reports on bone mineral density (BMD) in patients with leukemia and solid malignancies concentrate on long-term survivors and on the effect of chemotherapeutic agents and irradiation. Also, evaluation of BMD in neuroblastoma was reported in few studies which were conducted upon adult survivors of childhood cancer. Previous studies on both acute leukemia and lymphoma patients suggested that the disease process itself played a role in decrease BMD.We evaluated 27 patients with newly diagnosed neuroblastoma for both lumbar (L2-L4) BMD and total BMD using dual energy X-ray absorptiometery (DXA) scan to highlight the effect of neuroblastoma as a disease process on BMD as this disease characterized by bone metastasis.Three out of the 27 patients showed low bone mass in both lumbar and total BMD studies.Low bone mass may occur in early disease process of neuroblastoma and it is important to consider BMD assessment during the early course of the disease as well as the long-term survivors as a part of the patient screening in suspected cases.

10.1002/pbc.22880

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Citations (18)

Deviation from Guidelines in Use of Eltrombopag and Romiplostim in Clinical Practice for Children with Primary Immune Thrombocytopenia; Multi-Center Egyptian Experience

Blood (2019)

Mohsen Saleh Elalfy Tamer Hassan Khalid I. Elsayh Mohamed Maebid Hoda Hassab

Eltrombopag

Romiplostim

Thrombopoietin receptor

10.1182/blood-2019-121994

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Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology—A Limited-Resource Country Perspective

Children (2024)

Galila M. Mokhtar Ashraf Abdelbaky Amira Adly Dina Ezzat Gehan Lotfy Abdel Hakeem

Background: Thrombocytopenia is a prevalent presentation in childhood with a broad spectrum of etiologies, associated findings, and clinical outcomes. Establishing the cause of thrombocytopenia and its proper management have obvious clinical repercussions but may be challenging. This article provides an adaptation of the high-quality Clinical Practice Guidelines (CPGs) of pediatric thrombocytopenia management to suit Egypt’s health care context. Methods: The Adapted ADAPTE methodology was used to identify the high-quality CPGs published between 2010 and 2020. An expert panel screened, assessed and reviewed the CPGs and formulated the adapted consensus recommendations based on the best available evidence. Discussion: The final CPG document provides consensus recommendations and implementation tools on the management of isolated thrombocytopenia in children and adolescents in Egypt. There is a scarcity of evidence to support recommendations for various management protocols. In general, complete clinical assessment, full blood count, and expert analysis of the peripheral blood smear are indicated at initial diagnosis to confirm a bleeding disorder, exclude secondary causes of thrombocytopenia and choose the type of work up required. The International Society of Hemostasis and thrombosis–Bleeding assessment tool (ISTH-SCC BAT) could be used for initial screening of bleeding manifestations. The diagnosis of immune thrombocytopenic purpura (ITP) is based principally on the exclusion of other causes of isolated thrombocytopenia. Future research should report the outcome of this adapted guideline and include cost-analysis evaluations.

10.3390/children11040452

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Citations (1)