WoS İndeksli Yayınlar Koleksiyonu

Permanent URI for this collectionhttps://hdl.handle.net/20.500.14627/6

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Author: search.filters.author.Elewa, MandyLanguage: search.filters.language.en

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  • Article
    Efficacy and Safety of Deferiprone for Parkinson’s Disease: A Systematic Review and Meta-Analysis of Motor Function and Overall Disease Severity
    (Springer-Verlag Italia SRL, 2026) Ehab, Menna; Ibrahim, Ismail A.; Hekal, Rawan Gameel; Solah, Israa A.; Ezz-Alarab, Moaz; Elewa, Mandy; Zidat, Ayham R. A.
    Background The accumulation of iron in brain regions is one of the characteristics of Parkinson's disease (PD). Deferiprone (DFP) is an iron chelator that reduces iron overaccumulation in certain diseases. The efficacy and safety of DFP in the management of PD have been assessed; however, the results remain controversial. Method A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A comprehensive search was conducted across five databases to identify all randomized clinical trials and observational studies. The primary outcomes included changes in motor function (MDS-UPDRS III) and overall disease severity (MDS-UPDRS total score). Additionally, the safety of DFP was assessed by analyzing adverse events. A network meta-analysis using a random-effects model was conducted. Results Four randomized clinical trials were identified. The studies included 567 patients with early-stage PD. The DFP doses across the included studies ranged from 3.75 to 15 mg/kg twice daily. None of the doses showed a significant Improvement in motor function (I2 = 0%), or in overall disease severity (I2 = 82.5%), compared with placebo in the network analysis. However, a non-significant improvement in motor function was observed at 7.5 mg/kg twice daily, whereas higher doses were associated with worsening clinical scores. Adverse events were generally mild, although there were some safety concerns at higher doses. Conclusion DFP can reduce accumulated iron across brain regions. However, current evidence does not support the use of DFP for the clinical and symptomatic management of PD within the assessed range of doses and treatment periods.
  • Article
    Ramadan Fasting and Seizure Activity in Adults with Epilepsy: A Systematic Review and Meta-Analysis
    (Academic Press Inc Elsevier Science, 2026) Ibrahim, Ismail A.; Shaaban, Sally; Elewa, Mandy; Rahman, Muhammad Samir Haziq Bin Abd; Mohamed, Lobna Ahmed; Talaia, Ahmed M.; Khoo, Ching Soong; Haziq bin Abd Rahman, Muhammad Samir
    Purpose: Ramadan fasting in Muslims entails abstaining from food and fluids from dawn to sunset, which can influence sleep patterns, medication timing, and food intake. Building on evidence that ketogenic diets and intermittent fasting may improve seizure control, we aim to analyze the link between intermittent Ramadan fasting in adults with epilepsy and seizure activity. Method: We systematically searched PubMed, Scopus, Web of Science, Cochrane Library, and Embase between 2000 and January 2025 for articles that appeared between these dates. The terms used for searching included fasting in Ramadan with epilepsy or seizures. The seizure frequency and seizure status of the participants are the outcomes that we analyzed. Two reviewers independently screened and extracted data, with a third resolving any differences that arose between them. Meta-analysis was done using the random-effects model with statistical heterogeneity using the I2 statistic. Results: Of the 1485 articles, only eight were found to be relevant, and 4 of these included 564 patients who met the inclusion criteria. The analysis of the pooled data demonstrated that 61.1% of patients remained seizure-free throughout Ramadan (95% CI: 38.8%-83.4%), with considerable heterogeneity (I2 = 87.7%). Seizure risk was higher in patients on polytherapy with poor baseline seizure control, increased fasting times, or high potassium levels. In contrast, extended seizure-free intervals and increased sleep duration pre-Ramadan were good predictors of safe fasting, and each seizure-free week increased the chance of remaining seizure-free by 10%, as did each extra hour of sleep by 30%. Seizure frequency increases were caused by interruption of daily rhythms, psychological tension, tiredness, and extended fasting. Conclusion: While many patients remained seizure-free during Ramadan, high study variability highlights the need for standardized research. With proper medical supervision, fasting may be safely practiced for selected epilepsy patients.