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No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

Background and Study Aims: Auto-immune hepatitis (AIH) in children is a rare chronic progressive liver disorder. It is characterised serologically by high aminotransferase levels, elevated immunoglobulin G (IgG) and the presence of autoantibodies. AIH is divided into two types according to the autoantibody profile. This study aims to assess frequency, clinical manifestations, biochemical features and outcome of AIH in children attending Assuit University Hospitals in Upper Egypt with acute icteric hepatitis and seronegative viral markers (anti-hepatitis A virus (HAV) IgM, HbsAg, anti-hepatitis C virus (anti-HCV) Ab)., Patients and Methods: The study includes 34 children with AIH, diagnosed on the basis of the International Scoring Criteria of Auto-immune Hepatitis, recruited from Assuit University Hospitals, during the period from January 2005 to December 2009. All patients received prednisolone 2mgkg(-1)day(-1). Follow-up was done for 1year., Results: Among 34 children diagnosed as AIH, 24 were females (70.5%) and 10 were males (29.5%). Jaundice represented the most consistent finding in all patients. According to the autoantibody profile, 25 children were classified as type 1 and nine children were classified as type 2. Corticosteroid therapy was started. Complete remission was observed in 67.6% of patients and partial remission in 17.6%. There was no significant statistical difference in clinical and biochemical features of AIH in patients regarding the response to treatment. Mild side effects of steroid therapy were encountered in 48.2% of patients. After complete withdrawal of corticosteroids, six patients (20.7%) developed relapse., Conclusion: AIH type 1 was the main form of AIH in children referred to Assiut University Hospitals. Girls were more affected than boys. AIH type 1 exhibited a more active, ongoing immunologic process. Steroid alone can be used successfully in most cases. Children with AIH type 2 had a higher frequency of relapse after corticosteroid withdrawal. Further studies on a larger number of cases and long-term follow-up are recommended., (Copyright © 2011 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.)

Background: There is scarcity of data concerning the management of bleeding junctional gastroesophageal varices., Aim: Our aim was to compare the efficacy and safety of endoscopic variceal ligation (EVL) with cyanoacrylate injection for the treatment of bleeding junctional varices., Methods: One hundred fifty patients with bleeding junctional varices were included in the study. Patients were subjected after randomization to either EVL of junctional varices (group 1:75 patients) or cyanoacrylate injection (group 11:75 patients). Endoscopic sessions were continued till obliteration of the varices. Clinical as well as biochemical parameters and severity of liver disease were assessed in all patients., Results: Control of active variceal bleeding was achieved in 61 patients (81%) in group I and in 68 patients (91%) in group II with no significant difference (p = 0.07). Re-bleeding was seen in 12 patients (16%) in group I and 5 patients in group II (6%). Junctional varix obliteration was achieved after one session in 33% of patients in group I and 52% of patients in group II, however after 2 sessions it was achieved in 67% in group I and 93 % in group II. After 3 sessions variceal obliteration was achieved in 99% in group 1. Fever, chest pain and dysphagia were observed more frequently in group II than in group I. Long term complications including spontaneous bacterial peritonitis, hepatic encephalopathy and hepatorenal syndrome were also observed more frequently group II than in group I., Conclusion: EVL may be a good alternative to cyanoacrylate injection in treatment of bleeding junctional varices.

Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. Neurobrucellosis is one of the complications. The objective of this study was to determine neuropsychiatric manifestations among patients with brucellosis. Twenty-seven consecutive patients with brucellosis (14 patients with manifest neurological manifestation and 13 patients without apparent neurological manifestation) were recruited from Assiut University hospital and compared with 50 healthy controls matched with respect to age, sex, and social economic and educational levels. They were subjected to systemic, meticulous neuropsychiatric evaluations, laboratory, radiological, neurophysiology, and psychometric assessment with Mini-Mental State Examination, Wechsler Memory Scale-Revised. and Hamilton Depression Rating. Overt or apparent neurological manifestation was recorded in 14 patients (51.85%) and 13 patients (48.15%) with brucellosis without apparent neuropsychiatric involvement. Central nervous system (CNS) involvement (vascular stroke, meningeoencephalitis, and dementia) was recorded in 9 patients (33.3%) and 6 patients (22.2%) had peripheral nervous sytem (PNS) involvement (polyneuropathy, radiculoapathy, and polyradiculoneuropathy). Depression was recorded in 7 (29.2%) patients; 3 patients (21.4%) of the neurobrucellosis group and 4 patients (30.8%) with brucellosis without neurological manifestations. Patients with brucellosis (neurobrucellosis and patients without neurological manifestations) reported highly significant impairment in some cognitive function measures (mental control, logical memory, visual reproduction) and higher scores on depressive symptoms compared with controls. Patients with a Brucella infection usually manifest central nervous system involvement. Clinicians, especially serving in endemic areas or serving patients coming from endemic areas, should consider the likelihood of neurobrucellosis in patients with unexplained neurological and psychiatric symptoms, and should perform the necessary tests, including cognitive function and depression tests.

Hepatitis E virus (HEV) infection is a common cause of acute viral hepatitis (AVH) in Egypt. We aimed to identify risk factors of HEV among acute hepatitis cases, measure HEV specific immune response to differentiate between symptomatic and asymptomatic infections. The study included symptomatic acute hepatitis (AH) patients (n = 235) and asymptomatic contacts (n = 200) to HEV cases. They completed a lifestyle questionnaire, screened for common hepatotropic viruses. Blood and serum samples were collected from patients and contacts after onset of disease and follow-up samples collected until convalescence. PBMC were separated and tested for specific HEV T-cell response by INF-gamma ELISPOT assay. Serum samples were tested for IgM and IgG anti-hepatitis E virus by ELISA. IgM antibodies to HAV were detected in 19 patients (8.1%), 37 (15.7%) with HBV, 10 (4.3%) with HCV. HEV infection was identified in 42 (16%) patients with AVH. Of the 200 contacts, 14 (7%) had serological evidence of recent HEV asymptomatic infection, showed stronger CMI responses than HEV infected subjects (2540 +/- 28 and 182 +/- 389 ISCs/106 cells, respectively; P < 0.05). In conclusion, HEV is a major cause of AVH in Egypt. Asymptomatic HEV patients are likely to have stronger immune responses including CMI responses, than symptomatic cases.