Clinical Chemistry Department

  • Overview
  • Vision
  • Mission
  • Head of the Department
  • Staff Members
  • Research field
  • Achievements
  • Techniques
  • Structure
  • Training
  • Services Scope
  • Medical services
  • Publications
To be a central department in research & training is concerning prediction, diagnosis, follow-up and therapeutic monitoring of hepatic, colonic, gastrointestinal and urological diseases and to become a center of excellence serving the surrounding geographical area.

Clinical chemistry department attempts to clarify the pathogenesis, helps in early prediction, diagnosis, and prognosis of chronic liver diseases, GIT, kidney and urogenital tract diseases

The clinical chemistry department has a goal to be a central laboratory in research and training concerning prediction, diagnosis, therapeutic monitoring and follow-up of hepatic, colonic, gastrointestinal, renal and urological diseases. Our core competencies in inspection, verification, testing and certification are being continuously improved to be best in class; aiming to be the most competitive and most productive service provider to our customers and to provide innovative, timely and quality medical laboratory services.
Control, diagnosis and treatment of endemic tropical diseases and their complications (hepatocellular carcinoma, cancer bladder, cardiovascular complications of renal diseases). Moreover; pre- & post-operative monitoring of hepatic and renal transplant subjects.

Dr. Hanan Shawky Amin

E.mail: [email protected]

 

 

Former Heads of Department

Staff Members

    • Prof. Dr. Hosna Mohamed Abdel Rahman
    • Prof. Dr. Mona Mohamed Hassan
    • Prof. Dr. Mohamed Nader Allam
    • Prof. Dr. Iris Guriguis Nessim
    • Prof. Dr. Afaf Ahmed Abdel-Hady
    • Prof. Dr. AbdAllah Morsy Dessouky
    • Prof. Dr. Laila Nessim Kamel
    • Prof. Dr. Azza Saleh Radwan
    • Prof. Dr. Nihal Moustafa EL-Assaly
    • Prof. Dr. Naima Ibrahim El Ashry
    • Prof. Dr. Faten Tharwat Al Shanawany

Researchers:

Assistant Researchers:

FIELD OF RESEARCH

  • Hepatic diseases
  • Hepatocellular carcinoma
  • GIT diseases
  • Renal diseases
  • Cardiovascular complications of renal diseases
  • Urological diseases
  • Cancer Bladder
  • Colorectal cancer
  • Liver transplantation
  • Kidney transplantation

Prediction, early diagnosis, follow up of highly incident diseases in Egypt (chronic hepatitis C viral infection, hepatocellular carcinoma, renal diseases, cardiovascular complications of chronic kidney diseases, autoimmune diseases (Crohn’s and ulcerative colitis), cancer bladder, hepatic and renal transplantation.

Role of genetic variants in pathophysiology of different diseases, studying their role in incidence, prediction, diagnosis and prognosis of diseases.

One of our priorities is providing high quality laboratory services, so we are participating in external quality control program, planning to be accredited with ISO 15189 certificate. 

I- LIVER and GASTRO-INTESTINAL TRACT

Clinical Chemistry Laboratory attempts to clarify the pathogenesis, helps in early prediction, diagnosis and prognosis of chronic liver diseases and GIT diseases. It can also guide therapeutic modalities in liver diseases. In HCC; our laboratory is trying to early detect HCC, spot metastasis, early detection of recurrence and monitoring therapeutic intervention.

II- KIDNEY AND UROGENITAL TRACT DISEASES

Clarification of the pathogenesis of renal and urogenital tract diseases and their early diagnosis and monitoring therapeutic modalities.

MAIN ACHIEVEMENTS

The research members of clinical chemistry department share in many internal and external research projects. Moreover, research professors & associate professors supervise MD & MSC theses in both Clinical Chemistry department & other departments in TBRI.

The following are the main achievements of our department from research projects and theses.

I- Liver and Gastro-intestinal Tract

Chronic liver diseases
Chronic liver diseases (CLD) are the most problematic threat to Egyptian population. Viral hepatitis B and C infections are the most common cause of CLD. Pathogenesis of chronic viral  passes from fibrosis (an imbalance between fibrogenesis and fibrinolysis), through cirrhosis and terminally to HCC.

1- Diagnosis of GIT Diseases:

A) liver fibrosis

  • Serum aggrecan is an early non-invasive marker for fibrogenesis in chronic HCV patients.
  • Serum hyaluronan, telopeptide (ICTP), collagen type IV-7S (CIV-7S) are non-invasive biomarkers of liver fibrosis. Hyaluronan is the most accurate biomarker for discriminating patients with extensive liver fibrosis from non-extensive one.
  • Serum MMP-1 and TIMP-1 can be used as recent non-invasive biomarkers of liver fibrosis. Serum collagenase matrix metalloproteinase MMP 1 decreases in chronic HCV patients whereas serum tissue inhibitor of metalloproteinase TIMP-1 increases (imbalance between collagen production and degradation).
  • Hepatic tissue fibonectin, plasma fibronectin and serum PIIINP could be considered as reliable biomarkers for hepatic fibrogenesis in chronic liver diseases. Serum fibronectin and PIINP correlates with the stages of hepatic fibrosis.

 B) Liver Cirrhosis

  • Apoptotic markers: proapoptotic sFas and anti-apoptotic: Bcl 2 are important in pathogenesis of cirrhosis. They may also have high positive predictive value for HCC.
  • Serum PIINP is the best for discriminating patients with cirrhosis from those without cirrhosis.
  • Serum caspase (chief mediator of execution phase of apoptosis) is a non-invasive marker in chronic HCV infection to predict early liver cell damage even before rise of liver enzyme.
  • Estimation of hepatocytic iron grade in chronic hepatitis C is an important indicator of the activity score. Alteration in DNA parameters of hepatocytic nuclei was more pronounced in hepatitis C patients and may be due to the effect of accumulated iron leading to hepatocellular necrosis, secondary scarring, regeneration and cirrhosis.
  • Serum p53 over expression, sIL-2R and aflatoxin B1 levels were increased in cirrhotics suggesting early presence in blood prior to the occurence of HCC. Thus it is advisable to perform repeated estimation of these parameters every 3 months in patients who have chronic HBV and/or HCV infection, cirrhosis and high aflatoxin B1 exposure to delineate cases at risk of developping HCC.

C) Hepatocellular Carcinoma

  • CA242, Serum Endostatin and telomerase may be sensitive and specific in detecting early dysplastic changes of the hepatocytes and better in detecting early malignancy of the liver.
  • Seum alpha- L-Fucosidase (α fu) and Fas: They can be used as tumour markers in the diagnosis of HCC especially in cases with low levels of AFP. The combined use of the three markers (AFP, α fu and Fas) lead to increase in the diagnostic of HCC efficacy.
  • Serum squamous cell carcinoma antigen (SCCA): The SCCA antigen represents a useful marker for HCC detection. SSCA with AFP significantly increases the reliability of serologic diagnosis of HCC. It may represent a useful marker for HCC diagnosis especially in patients having atypical enhancement in CT scan.
  • Des-Gamma-Carboxy Prothrombin, PIVKA-II and AFP: DCP is a more accurate and a better prognostic than AFP.
  • Serum Chromogranin- A (Cg-A) and PIVKAII:

The determination of Cg-A and PIVKA II serum values represent a complementary diagnostic tool in monitoring chronic liver disease patients for detection of HCC and significantly related to focal lesion’s size.

  • Serum vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9): Portal vein invasion and metastasis in HCC is a complex process involving multiple factors including VEGF-mediated angiogenesis and MMP-9 -induced degradation of extracellular matrix. Serum VEGF and MMP-9 in HCC might be candidate biomarkers reflecting the disease potential for vascular invasion and metastasis, VEGF being a superior biomarker as it correlated also with tumor size.

D) Hepatic Encephalopathy

  • Plasma met-enkephalin,ß-endorphin and leu-enkephalin levels in human hepatic encephalopathy.
  • Serum levels of astroglial S100β and neuron-specific enolase (NSE) in patients with liver cirrhosis with and without hepatic encephalopathy. Serum S100β seems to be a promising biochemical surrogate marker for the diagnosis of mild cognitive impairment in cirrhotic patients thus allowing proper management of those patients before they progress to more advanced stages of HE.

 2- Effect of therapeutic modalities in liver diseases

  • The pharmacological approach to reverse portal hypertension and hepatic schistosomal fibrosis in Egypt; controlled experimental study
    PGE1 with PZQ to treat S. mansoni-infected hamsters can modulate liver fibrosis and improves the liver function tests up to normalization. The balance between Th1 and Th2 cytokine levels could be modulated to help reverse or decrease fibrosis in S.mansoni infected hamsters. This may pave the way for clinical application as combined therapy, PZQ and PGE1 may be an effective approach to reverse fibrosis in schistosomiasis through induction of dominant Th1 response.
  • The effect of the use of probiotics in mildly and moderately severe ulcerative colitis
    It is concluded from this study that probiotics can be used in the treatment of patients with mildly to moderately severe ulcerative colitis and can also maintain remission in most patients. Also, urinary excretion of the histamine metabolite UMH is enhanced in IBD. It appears to represent an integrative parameter to monitor clinical and endoscopic disease activity in IBD, which appears to be influenced most likely by mediators released from histamine-containing cells, such as intestinal mast cell subtypes. Its determination is simple, expressive, non-invasive and can be recommended.
  • Effect of pegylated interferon-ribaverin treatment of hcv patients on the levels of insulin, insulin likegrowth factor 1 and insulin like growth factor binding protein-3 before and after treatment in responders
    Estimation of insulin , insulin like growth factor 1 and insulin like growth factor binding protein 3 after a regressed PCR data , are needed to point out regenerative power of the previously HCV affected liver, and can be used as follow up parameters.
  •  Antiviral treatment of Egyptian patients with advanced cirrhosis due to HCV genotype 4; using pegintron and ribavirin effect on reduced glutathione
    It is concluded from this study that glutathione has a direct antiviral effect, as raising glutathione levels leads to lower viral loads, it does indicate that optimal levels of glutathione may be an important factor in controlling HCV infection and patients with advanced cirrhosis but with no contraindication to combination therapy which can be managed in the same way as earlier cases with pegylated IFN and ribavirin showing nearly similar responses and tolerability.
  • Pegylated interferon and lamuvidine in the treatment of Egyptian patients with HBe Ag positive chronic hepatitis B infection: S.ferritin as a marker
    In this study, no significant differences in biochemical and virological response after treatment. Thus, from the virological point of view, two types of therapy are similar and still far from the hope of treatment of HBV. However, the development of YMDD resistance with the use of lamuvidine is a major concern and if a new nucleoside analogue can be added to or replace this drug to delay the development of resistance, such medications would be the best for their safety, route of administration and cost. The more HBsAg and HBeAg seroconversion in patients treated by combination therapy and pegylated interferon than lamuvidine, in addition to the rare development of YMDD mutants and the significantly better histological response; puts pegylated interferon in front of lamuvidine in the treatment of this disease. However, still the seroconversion and viral response is far beyond the goal and the door is widely open for more trials and different combinations to get the best effect adding new drugs recently approved for such infection such as adefovir, enticavir and others. Also, the follow up of serum ferritin levels in patients with chronic viral hepatitis B during treatment might be helpful for monitoring and predicting patients’ responses to the therapy or in other words ferrite level can be used as a monitor for treatment effectiveness.

 3- Pathogenesis of the diseases

  • Arterial compliance, renal, cardiac, endocrine and metabolic disorders as predictor of hypertension syndrome
    The study confirmed that, many of the components of the hypertension as lipid abnormalities, change in renal and endocrine function, insulin resistance and changes in the structure and function of the left ventricle and of vascular smooth muscle in the vasculature precede the onset of high blood pressure, and that impaired homocysteine metabolism may be considered as one component of the hypertension syndrome. In terms of cardiovascular risk, the normotensive offspring with positive family history of hypertension have cardiovascular risk factors similar to that of the subjects with hypertension, the two groups are at similar risk for cardiovascular disease, the only difference being that the normotensive subjects have not yet developed high blood pressure, which seems to be a late manifestation of this disease process. Identification and treatment of these patients earlier in the disease process, before they develop high  blood pressure, might have a bigger impact on the course of the disease and might protect them from developing high blood pressure and perhaps thereby protect them from developing cardiovascular disease.           
  • The role of tumor necrosis factor- alpha and interferon-gamma as proinflammatory cytokines involved in gastritis and peptic ulcers caused by Helicobacter pylori and evaluation of Ig g and CAG a immunodiagnostic markers in humans
    It is important to study the role of cytokines in the inflammatory effect caused by H. pylori infection in patients with gastritis and peptic ulcer and, that the estimation of Ig G positivity and Cag A levels in these patients, offered better immunodiagnostic markers before offering the endoscopy.

II – Diagnosis of Kidney diseases:

  • Potential alterations of proinflammatory cytokine (IL-1) and chemokines (MCP-1 and RANTES) in hemodialysis patients
    HD causes activation of cytokines, where plasma levels of IL-1, MCP-1 and RANTES are increased in HD patients and probably result from either inadequate clearance or enhanced synthesis and release. As the three studied molecules initiate renal inflammation and injury, the blockade of induction of these cytokines may be an attractive target for therapeutic intervention.
  • Evaluation of the role of hyperhomocysteinemia and serum apoptotic markers in patients with diabetic nephropathy
    The significantly raised plasma homocysteine in late diabetic nephropathy and its correlation with serum creatinine highlights its importance as a contributing risk factor for development and progression of renal damage. Further longitudinal studies are mandatory to elucidate whether reduction of plasma homocysteine by folate and vitamin B12 therapy might diminish the progression and complications of DN.

Meanwhile the early elevation of both pro-apoptotic: sFas, and sFas-L and anti-apoptotic: Bcl-2 serum markers might help as early predictive biomarkers of DN even before the onset of micro-albuminuria. Much work remains to be done in the new millennium to identify novel therapeutic strategy to control disregulation of apoptosis, a hallmark in DN to halt its progression and achieve an enormous clinical challenge.                         

III) Diagnosis of Bladder Carcinomas

  • Evaluation of circulating angiogenic factor levels: Endostatin and basic fibroblast growth factor in patients with carcinoma of the bladder
    It is apparent that angiogenesis in carcinoma of the bladder is under the concerted inhibitory endostatin and stimulatory bFGF effects and both interplay in tumor progression. Circulating levels of endostatin and bFGF may be used as non-invasive, reliable angiogenic biomarkers for early prediction of cancer bladder. Moreover monitoring cancer bladder with serial endostatin estimation, could anticipate detection of early metastases; reduce intercystoscopy interval in follow-up of patients. Most importantly, estimation of serum endostatin as anti-angiogenic factor opened new avenues for promising therapeutic targets in cancer bladder.

Research professors participated as external examiners in MD & MSC theses in Clinical and Chemical Pathology Departments, faculty of medicine (Cairo & Ein Shams universities).

  • Automated auto-analyzers: two Beckman Coulters AU480  and ILAB Aries for routine laboratory work.
  • Spectrophotometric analysis: manual estimation of serum albumin, protein, AST, ALT, Gamma GT, Bilirubin (total and direct), BUN, creatinine and glucose for training purposes.
  • Point of care testing (POCT) for detection of cardiac biomarkers: CK-MB mass, d-Dimer and Troponin I.
  • Ion Selective Electrodes: estimation of potassium, sodium and chloride on I – lyte Instrumentational laboratory devices.
  • Potentiometric analysis: estimation of PH, ionized calcium, bicarbonate, CO2, PO2, chloride, potassium and sodium on Gem Premier 3000 machine.
  • Chemiluminescence for performance of hormones, tumor markers and drug levels on Siemens Advia Centaur CP instrument.
  • ELISA for performance of research analytes.
  • Electrophoresis for protein and lipid fractionation.
  • RT-PCR for detection of gene expression, genetic polymorphisms.

The Clinical Chemistry Laboratory consists of:

** Research laboratory for performing the researches in the different fields of Clinical Chemistry with special attention to hepatic, gastrointestinal, renal and urological diseases together with their associated cardiovascular complications and genetic polymorphisms, which are the main concern of the research strategy of Theodor Bilharz Research Institute (TBRI).

** Outpatient laboratory undertaking the routine chemistry tests for the patients visiting different TBRI clinics daily; as well as the inpatients in the different clinical departments at the institute during morning and day hours.

**Emergency laboratory for performance of analytical tests to critically ill patients admitted to the inpatients of clinical departments at the institute during mid and night shifts.

The following equipment are present in the department:

  • Two Beckman Coulter auto-analyzers AU 480.
  • I LAB auto-analyzer.
  • Three Spectrophotometers = IRMA INC, 5010 and ROBONIK.
  • Two I – lyte Instrumentational laboratory for measuring Na, K and Cl.
  • Two Blood gases and electrolytes analyzers: ABG Gem Premier 3000 instrument.
  • Cobas H232 platform.
  • Chemiluminescence (ADVIA Centaur – CP).
  • Chromate ELISA plate-reader.
  • Cooling centrifuge.
  • Horizontal electrophoresis unit for paper electrophoresis.
  • Horizontal shaker thermally-controlled.
  • Autoclaves, dry-air oven, incubators with and without shakers and water baths.

Training of students, laboratory personnels, medical and paramedical staff for all laboratory techniques.

Training courses for:

  • Laboratory errors and quality control; the course implied the following: Basic laboratory principles, types of laboratory errors, quality control, quality assurance and quality improvement: Concepts and implementations.
  • Interpretation of diagnostic tests in clinical chemistry laboratory.
  • Laboratory updates in chronic kidney diseases.
  • High light on Molecular techniques and applications.
  1. Specialization:
    The assay of various chemical constituents in blood, urine, other biological fluids or tissues that help in the clarification of the abnormal metabolic processes which underlie symptoms of the diseases, thus helping prediction, early diagnosis, follow up, management and prognosis.
  1. Scientific and technological experience:
    The staff members experience the performance of different analytical techniques applied in the clinical chemistry department including:
    • Photometric measurements for quantitation of different analytical tests (colorimetry, spectrophotometry, fluorometry, flame emission, atomic absorption, turbidimetry).
    • Separation techniques: immunoassay technique, enzyme linked immunosorbent assay (ELISA).
    • Chemiluminescence for performance of all hormones, tumor markers and drug levels.
    • Electrochemical techniques: potentiometric analysis.
    • Performance of molecular techniques in the central laboratory.
  1. Performance of hepatic function panel, renal function panel, cardiac enzymes, blood gas analysis, blood glucose, thyroid panel, lipid panel, tumor markers.

Cardiac Enzymes

  •  CK(total)
  •  CK- MB
  •  LDH
  •  CKM-MB mass
  •  Troponin
  •  d-Dimer

Hepatic Function Panel

  •  Albumin
  •  Total protein
  •  AST (SGOT)
  •  ALT ( SGPT)
  •  T. bilirubin
  •  D. bilirubin
  •  GGT
  •  ALP
  • Amylase
  • Lipase

Blood Gases Analysis

  •  pH
  •  pCO2
  •  pO2
  •  HCO3
  •  T CO2
  •  Oxygen saturation

 

Renal Function Panel

  •  Urea
  •  Creatinine
  •  Estimated GFR
  •  Creatinine clearance
  •  Uric Acid
  •  Sodium
  •  Choride
  •  Potassium
  •  Phosphorus
  •  Magnesium
  • Total calcium
  • Ionized calcium (  Ca++)
  • Iron
  • TIBC
  • 24 hr urinary proteins
  • Microalbuminuria (Alb/Creat ratio) and albumin excretion rate

Thyroid and Parathyroid hormones

  •  TSH
  •  Free T3
  •  Free T4
  •  Intact Parathormone

Blood Glucose

  •  Glucose fasting
  •  Glucose 2hr post-prandial
  •  Glucose random
  •  Glucose tolerance curve
  •  HBA1c

Ascitic fluid analysis

 

Pleural fluid analysis

 

Lipid Panel

  •   T. cholesterol
  •  HDL- C
  •  LDL -C
  •  Triglycerides

Therapeutic drug monitoring

  •  Cyclosporin
  •  Tacrolimus

Tumor Markers

  •  PSA(total)
  •  PSA(free)
  •  AFP
  • CEA
  • CA19-9

Nessim I, Abdel wahab A, Madani H, waked E, Abdelkhalek A, Mabrouk K (2011). Evaluation of serum osteoprotegrin and ferritin A levels in Egyptian patients with chronic kidney disease. J. comparative clinical pathology springer Vol 20 Issue 5: 421-425.

Samhan Y, Hassan M, El-shanawani F, Fathallah A, El-Fandy G (2011). In vivo caspase and TRAIL changes as apoptotic markers following different anesthetics. Egyptian  journal of parasitology, Korean journal of Anesthesiology.

El-shanawani F, Ghaly A, Attia M, Hassan M (2013). Role of Calprotectin and Ghrelin in diagnosis of post ERCP Pancreatitis. Journal of Egyptian  Society of parasitology, vol.40, no 3.

Nasr F, Metwaly A, Sabry A, Hassan M, Desouky A (2013). VEGF and PDG in liver cirrhosis and their relation to echocardiographic parameters and cardio-intima- media thickness. Life science journal vol 10 (4), 1102-1110.

Waked E, El-shanawani F, Rafaat M, Metwaly A, Abdel-Khalek A, Hassan M, Abu taleb H (2013). Bone specific ALP and cardiovascular morbidity among patients on maintenance hemodialysis. African Journal of Nephrology .

Ashraf Abdel Khalik Barakat, Manar Abd El-Rouf Raafat Ameen, Amna Ahmed Metwaly, Fatma Mohammed Nasr, Nevine Sherif Ali Khalil, Iris Nessim: (2014). Cardiovascular calcification in chronic hemodialysis patients: Contributors interplay. American Journal of Life Science : 2(5): 251-259.

Hanan A Elnahas, Salwa K ElNabarawy, Afaf A Abdel Hady, Ahmed M Abdel Hady (2014): Effect of the methanol extracts of three dietary plants growing  in Egypt on mice fed with high fat diet.  Journal of Applied Pharmaceutical Science 4 (5), 104-111.

Afaf A.Abdel-Hady and Hanan A.El-Nahas (2014). Evaluation of the antioxidant activity and the acute oral toxicity of three plants extracts on albino mice.  Middle East Journal of Applied Sciences 4 (2), 207-216.

Nessim I, Abdel wahab A, Madani H, waked E, Abdelkhalek A, Mabrouk K (2011). Evaluation of serum osteoprotegrin and fetiuin A levels in Egyptian patients with chronic kidney disease. J. comparative clinical pathology springer 00580-011 1281-1289.

N. Kamel, M. Akl, N. El Badrawy, A. Anass, T. Abou Shousha, I. Mostafa, S. Hunter (2015). Plasma and tissue fibronectin and serum procollagen III peptide in chronic liver disease patients as reliable biomarkers for hepatic fibrogenesis.  Clin Chem Lab Med. 2015; 53,S1450.

N. Kamel and A. Kenawi (2015). Effect of renal transplantation on serum hepatocyte growth factor levels in hemodialysis patients with HCV infection: Clin Chem Lab Med;53, S1075.

dr.Laila Kamel presented a poster entitled: Effect of renal transplantation on serum hepatocyte growth factor levels in hemodialysis patients with hepatitis C infection in 21ST IFCC-EFLM European Congress of Clinical Chemistry and Laboratory Medicine –Euromedlab Paris 2015 ; 21-25.

El-Shishtawy S, Sherif N, Abdallh E, Kamel L, Shemis M, Saleem AA, Abdalla H, El Din H (2015). Occult Hepatitis C Virus Infection in Hemodialysis Patients; Single Center Study. Electron Physician. 20; 7 (8): 1619-25.

Samhan Y, Radwan K, Youssef M, Ebied R, Zeidan M, El Bendary O, Hassan M (2016). Hemodynamic changes and stress response during BIS-guided TCI anesthesia with propofol-fentanyl in laparoscopic versus open cholecystectomy,  Egyptian Journal of Anaesthesia ; 32, 45–53.

Abdallah E , Mosbah O, G Khalifa G, Metwaly A, El-Bendary O (2016).  Assessment of the relationship between serum soluble Klotho and carotid intima media thickness and left ventricular dysfunction in hemodialysis patients , Kidney Res Clin Pract 35, 42-49.

El-Shishtawy SHMosbah OSherif N, Metwaly AHanafy AKamel L. (2016). Association of chitotriosidase enzyme activity and genotype with the risk of nephropathy in type 2 diabetes. Association between serum visfatin and carotid atherosclerosis in diabetic and non-diabetic patients on maintenance hemodialysis. Electron Physician. 25; 8 (2): 1966-72.

Hazem El-Akabawy, Emad Omer, Hossam Mowafy, Iris Nessim, and Ahmed Maghraby (2017). Clinical Evaluation of plasma Gelsolin as a novel marker for sepsis: comparison with Procalcitonin regarding early diagnosis and prognosis in septic patients. Biolife Journal, 5 (4): 416-427.

Mohammed S. Hassan, Mounis Sedira, Muhamed Hussein, Eman Fouad, Neamat Ibrahim, Iris Nessim (2018). Ultrasound Guided Rectus Sheath Block or Field Block for Midline Hernia Repair: A Comparative Study. Proceedings of Anaesthesiology Annual Meeting, American Society of Anesthesiologists, A2274.

Khaled M Mohammad, Nihal MS El-Assaly, Nadida AH Goher, Walaa A Rabe (2019). Evaluation of the role of miRNA 122a and telomerase in hepatocellular carcinoma patients, Journal of Advanced Research (16); 159-169.

Ranya M. El-Sheikh, Soheir S. Mansy, Iris G. Nessim, Hala N. Hosni, Ali El Hindawi, Moataz H. Hassanein and Ahmed S. AbdelFattah (2019). Carbamoyl Phosphate Synthetase 1 (CPS1) as a Prognostic Marker in Chronic Hepatitis C Infection. APMIS : 127; 2 : 51-111.

Fatma A. Fathy. Elmougy, Reham A. Mohamed, Mona M. Hassan, Suzan M. Elsheikh, Fatma-elzahraa M. Ahmed, Rady E. Elaraby (2019). Study of serum microRNA19a and microRNA223 as potential biomarkers for early diagnosis of hepatitis C virus-related hepatocellular carcinoma.  Gene Reports; 15: 100398.1-9.

Asmaa Mohamed Fteah, Asmaa Ismail Ahmed, Nehad Ahmed Mosaad, Mona Mohamed Hassan, Sherif Hamdy Mahmoud (2019). Association of MicroRNA 196a and 499 Polymorphisms with Development of Cirrhosis and Hepatocellular Carcinoma Post-HCV Infection in Egyptian Patients. Asian Pacific Journal of Cancer Prevention, 20: 3479-3485.

Doaa Mamdouh Aly, Nadida Abulhamid Gohar, Afaf Ahmed Abd El-Hady, Marwa Khairy, Mona Mohsen Abdullatif (2020). Serum microRNA let-7a-1/let-7d/let-7f and miRNA 143/145 Gene Expression Profiles as Potential Biomarkers in HCV Induced Hepatocellular Carcinoma: Asian Pacific Journal of Cancer Prevention, 21(2), 555-562.

Mohamed F & Osman M & Nessim Iris & Abdelmageed A & Waked E (2020). Study of The Polymorphism BsmI and TaqI in Vitamin D Receptor Gene in Egyptian Patients with Chronic Kidney Disease. QJM: International Journal of Medicine, 113.

Malak Nabil Amin; Manar abd El Raouf Raafat; Emam Abd ElLatif Waked; Aya Abdelghany; Laila Nessim Kamel; Tarek Mahmoud Diab and Mohamed Abbas Shemis (2020). CLINICAL SIGNIFICANCE OF URINARY MESSENGER RNA EXPRESSION OF ALPHA ACTIN, SYNAPTOPODIN, PODOCIN, AND PODOCALYXIN IN PROTEINURIC PATIENTS. European Journal of Molecular & Clinical Medicine. ISSN 2515-8260 Volume 7, Issue 11.

Ahmed El-Maghraby, Hossam Mowafy, Emad Omer, Hazem El-Akabawy, Iris Nessim (2021). Diagnostic and Prognostic Value of Plasma Gelsolin in Multiorgan Failure in Patients with Sepsis. J Med Sci; 9(B):29-35.

Heba Sharafelldin, Abdalla Morsy, Hany Elghobary, Enas Osman, Normeen Rady (2021). Association between TNF-α, Interleukin-18 Polymorphisms and Risk of Hepatocellular Carcinoma in Egyptian patients. Asian Pacific Journal of Cancer Prevention, 22 (3), 887-891.