Search

Background To identify current risk factors for hepatitis B virus (HBV) transmission in Greater Cairo. Methods A 1:1 matched case–control study was conducted in two ‘fever’ hospitals in Cairo. Acute hepatitis B cases were patients with acute hepatitis, positive HBs antigen, and high anti-HBc IgM titres. Control subjects were acute hepatitis A patients (positive anti-HAV IgM) or relatives of patients diagnosed with acute hepatitis C, identified at the same hospitals, with no past HBV infection (negative anti-HBc) and matched to cases on the same age and sex. Conditional logistic regression was used to identify factors associated with acute hepatitis B. Results Between April 2002 and June 2006, 233 cases and 233 controls were recruited to the study. In multivariate analysis, factors associated with an increased HBV risk in males were illiteracy [odds ratio (OR) = 6.1, 95% confidence interval (CI) = 2.8–13.1], shaving at barbers (OR = 2.1, 95% CI = 1.1–3.9) and injecting drug use (IDU) (OR = 3.4, 95% CI = 1.0–11.4). In females, factors associated with an increased HBV risk were illiteracy (OR = 2.2, 95% CI = 1.0–5.0), recent (Conclusion In this study, HBV transmission took place primarily in the community, whether as a result of recent marriage (presumably first sexual intercourse), shaving at barbershops or IDU, and was more common among illiterates. Health promotion campaigns should be carried out to increase awareness about community transmission of HBV. In addition to routine immunization for infants and other populations, premarital screening might be useful to identify at-risk spouses in order to propose targeted immunization. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) represents an important public health problem in Egypt where up to 90% of HCC cases are attributable to hepatitis C viral (HCV) infection. Serum alpha-fetoprotein is elevated in only ∼60% of HCC patients. The development of effective markers for the detection of HCC could have an impact on cancer mortality and significant public health implications worldwide. The objective of our study was to assess six candidate markers for detection of HCC identified by mass spectrometric analysis of enriched serum. The study examined 78 HCC cases and 72 age- and gender-matched cancer-free controls recruited from the Egyptian population. Matrix-assisted laser desorption–ionization time-of-flight mass spectrometric analysis of enriched low-molecular weight fraction of serum was used for identification of the candidate markers. Our analyses show that all six candidate markers are associated with HCC after adjustment for important covariates including HCV and hepatitis B viral infections. The marker candidates are independently predictive of HCC with areas under the receiver operating characteristic (AuROC) curve ranging from 63–93%. A combination of the six markers improves prediction accuracy to 100% sensitivity, 91% specificity and 98% AuROC curve in an independent test set of 50 patients. Two of the candidate markers were identified by sequencing as fragments of complement C3 and C4. In conclusion, a set of six peptides distinguished with high prediction accuracy HCC from controls in an Egyptian population with a high rate of chronic HCV infection. Further evaluation of these marker candidates for the diagnosis of HCC is needed. [ABSTRACT FROM AUTHOR]

Background: Liver cirrhosis is a pathologic condition characterized by fibrosis of the liver parenchyma and evidence of regenerative activity, resulting in portal hypertension. Portal hypertension plays a crucial role in the transition from the pre-clinical to the clinical phase of the disease. Bleeding from ruptured esophagogastric varices is the most severe complication of cirrhosis and is the cause of death in about one third of cirrhotic patients. Cirrhotic patients frequently undergo screening endoscopy for the presence of varices. These recommendations imply a considerable burden of endoscopies and related costs. Objective: the aim of the study was to determine the predictive value of noninvasive parameters (Rt. lobe diameter/serum albumin ratio) in the prediction of esophageal varices. Subjects and Methods: This study was done on 120 patients divided into four groups: Group A: includes 30 cirrhotic patients with esophageal varices (OVs) grade I to II. Group B: includes 30 cirrhotic patients with OVs grade III to IV. Group C: includes 30 cirrhotic patients without OVs. Group D: includes 30 none cirrhotic patients presented for esophagogastroduodenoscopy (EGD) screening because of other etiologic factors that are not associated with liver cirrhosis. All participants were subjected to clinical examination; laboratory investigations (CBC, Liver function tests including serum albumin concentration, prothrombin time and concentration, modified Child-Pugh score and abdominal ultrasonography (studying the right lobe and left lobe diameter, the presence of periportal thickening, the splenic longest axis and the presence of ascites and Portal vein diameter, Right liver lobe diameter/albumin ratio were calculated for all patients). Upper endoscopy was done for detection and grading of esophageal varices. Results: This study revealed that The predictors that showed statistically significantly associated with the presence of varices were increased right lobe diameter/Albumin ratio, shrunken Rt. hepatic lobe, splenomegaly, thrombocytopenia, and the more advanced liver disease (according to child class scoring of the patients), the more likely the presence of varices. Conclusion: Right lobe diameter/Albumin ratio is good predictor for the presence and grading of esophageal varices. [ABSTRACT FROM AUTHOR]

Background: Visualization of collateral circulation to the infarct-related artery on coronary angiography was suggested to predict viability in the infarct zone as demonstrated by dobutamine stress echocardiography. Methods and Materials: We enrolled 30 consecutive patients referred from our catheterization labs with prior Q-wave myocardial infarction at least 6 months before study enrollment. Patients were classified according to the presence of collaterals to the infarct-related artery into two groups: collateral group with Rentrop Grade 1-3 collaterals, and noncollateral group with Rentrop Grade 0 collaterals. Patients underwent resting (99m)Tc-sestamibi imaging study with the administration of trimetazidine, using the standard technique, within 4 days of coronary angiography. Viability in a specific territory was defined when at least 50% of its individual segments were classified as viable. Results: The visualization of collaterals by coronary angiography was able to predict viability in the territory supplied by the infarct-related artery with a sensitivity of 88.2%; specificity of 53.8%; positive and negative predictive values of 71.4% and 77.8%, respectively; and a diagnostic accuracy of 73.3%. The presence of viability increased progressively, in a statistically significant manner, from Rentrop Grade 0 to Grade 1 and Grade 2 [2 (22.2%), 5 (50%), 10 (91%), respectively, P = .04]. Conclusions: Visualization of coronary collaterals to the infarct-related artery by coronary angiography may predict with a high sensitivity but a low specificity the presence of viability in the territory supplied by that artery. [ABSTRACT FROM AUTHOR]

Objective: The aim of this work is to evaluate the safety and efficacy of repeated sessions of photo-activated chromophore for keratitis-cross linking (PACK-CXL) window absorption (WA) for the treatment of resistant bacterial keratitis (BK)., Patients and Methods: This is a retrospective clinical cohort study. Thirty eyes with clinically suspected and lab-confirmed bacterial keratitis, resistant to appropriate antibiotic therapy- which was modified by sensitivity reports- for 2 weeks with failure of epithelialization for 4 weeks after the standard anti-microbial therapy (SAT) together with one setting of PACK-CXL WA were included. If after the first session of PACK-CXL, there is a start of improvement in the form of reduction of the size of corneal ulcer and stromal infiltrates together with the start of epithelialization on clinical examination and AS-OCT, another session of PACK-CXL WA was performed after one week, and so on, till the complete healing and resolution of bacterial keratitis and confirmation by negative bacterial culture. Identification of the micro-organisms was done by lab study before and after treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT)., Results: Thirty eyes of 30 patients were recruited in this study. They were 16 males and 14 females, their mean age was 44.3 ± 5.38 years. The mean ulcer size was 3.96 ± 1.87 (mm 3 ), while the mean size of stromal infiltrates was 4.52 ± 2.24 (mm3). PACK-CXL WA treatment was performed an average of 2.87 times for the 30 eyes. Complete healing and resolution (Successful treatment) was observed in 27 eyes (90%) of cases and failure of epithelialization was observed only in 3 eyes (10%). Complete corneal healing was reported in the second month postoperatively in 90% of eyes., Conclusion and Recommendation: PACK-CXL WA may be a promising, non-invasive treatment option for resistant bacterial keratitis. It may have a synergistic effect with standard antimicrobial treatment (SAT). Also, it can overcome the antibiotics resistance that has become rapidly spreading worldwide. Repeated sessions of PACK-CXL WA may be more effective for the treatment of resistant bacterial keratitis till complete epithelialization and resolution of BK than a single session with few complications. However, further prospective and comparative studies to support the results are needed., (© 2023. The Author(s).)

Purpose: To evaluate the safety and efficacy of stromal lenticule obtained from small-incision lenticule extraction (SMILE) surgery versus amniotic membrane graft (AMG) augmented with platelet-rich plasma (PRP) for the treatment of perforated corneal ulcers and compare the results between the two groups., Patients and Methods: This is a comparative retrospective study that included 40 eyes with medium-sized corneal perforations, which were classified into two equal groups of 20 eyes each; group (A) was treated with SMILE lenticule graft and group (B) was treated with AMG augmented with PRP. Pre- and postoperative evaluations were carried out using both slit-lamp (SL) examination and anterior segment optical coherence tomography (AS-OCT), including closure of perforation, complete healing, and best corrected visual acuity (BCVA)., Results: Complete closure of the perforation was achieved in both groups. However, healing was faster in the SMILE lenticule group than in the AMG with PRP group (P < 0.05). Complete healing was achieved in both groups: 100% in SMILE lenticule group and 95% in AMG with PRP group (P > 0.05). Both groups had few insignificant complications (30% in each), which were managed., Conclusion: Both methods achieved adequate healing of corneal perforations within few weeks without significant complications. However, the stromal lenticule obtained from small-incision lenticule extraction (SMILE) surgery tended to be safer with faster healing than AMG with PRP., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Hip arthroscopy for treatment of femoroacetabular impingement (FAI) has shown significant pain and functional improvement. However, the differential outcome of each of the FAI morphological types in contrast to one another remains largely unknown. This study was conducted to detect a possible difference in outcome among different FAI types treated using hip arthroscopy., Methods: In this prospective non randomized comparative study, after exclusion of non-FAI cases and cases with advanced arthritic changes, 90 hips in 85 patients that had hip arthroscopy for the treatment of FAI between 2011 and 2015 in our center were analyzed. The collected patient reported outcome measures (PROMs) included visual analog scale (VAS) of pain, the modified Harris hip score (mHHS), and the non arthritic hip score (NAHS) both preoperatively and at final follow-up. Patient satisfaction was collected at final follow-up. Postoperative PROMs were subjected to three main comparisons based on each of FAI type, labral procedure, and extent of cartilage damage. Repeat comparison based on FAI type after matching of exact chondrolabral condition was also attempted., Results: Mean follow-up was 32.8 months (five patients lost from follow-up). There was a significant improvement in the overall PROMs. This improvement was significantly higher in the cam group in contrast to the mixed group. After matching for chondrolabral condition, this difference was consistent and more evident., Discussion: The outcome of arthroscopic treatment of pure cam FAI is significantly better than that of mixed FAI. Matching of the same chondrolabral condition and repeating the comparison yields similar results., (© The Authors, published by EDP Sciences, 2019.)

Summary: Forty patients ASA I, II undergoing vitrectomy due to vitreous hemorrhage not associated with retinal detachment were divided into two groups randomly, each of them with 20 patients. In Control group patients received local anaesthetic only, while Fentanyl group receive 20 mcg fentanyl added to local anaesthetic, the onset and duration of lid and globe akinesia were assessed at 1,3,5 and 10 min. Postoperative VAS was recorded each hour up to 6(th) hour. The results show statistically significant difference between the two groups in the onset of lid akinesia. Fentanyl group had faster onset of lid akinesia and had significantly longer duration of akinesia (196.5 +/- 14.24 min). There is statistically significant difference between the two groups in the onset of globe akinesia at 3, 5 min. Fentanyl group had faster onset than Control group and had longer duration of globe akinesia (294 +/- 17.89 min). Fentanyl group had prolonged duration of analgesia 3.25+/-0.67 hr as compared to 1.85+/-0.67 in Control group, P=0.00 postoperatively. There were statistically significant differences between the two groups as regard the mean VAS in 1,2,3,4 hours, Fentanyl group had lower median pain score than Control group. Addition of fentanyl to local anaesthetic mixtures fasters the onset and prolong the duration of akinesia and improve quality of postoperative pain in peribulbar block.