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This study examines the sustainability of livestock farming in Jordan’s arid regions, focusing on smallholder Awassi sheep and Baladi goat farming. It assesses breeders, economic factors, herd productivity, and sustainability, evaluating the vitality of these breeds by examining reproductive success through birth and survival rates. In 2021–2022, a total of 53 traditional Awassi sheep and Baladi goat farms in Northern Jordan’s Mafraq Governorate were surveyed using a comprehensive questionnaire to gather data on breeders’ information, farm economics, and herd indicators. Dry seasons in arid lands are tough on sheep and goats, with limited fodder and water availability harming their health and reproductive capacity. While wet seasons bring relief, they can also introduce diseases. Special care for these animals throughout the year is crucial to maintain healthy herds in arid regions. Linear models were employed to analyze sample data, with variance and correlation tests used to explore relationships among variables. Additionally, chi-squared analysis was utilized to assess the impact of male replacement plans on these herds. The main outcomes of this study reveal that breeder indicators pose challenges to the sustainability and growth of Awassi sheep and Baladi goat farming. Conversely, economic indicators suggest a blend of financial stability alongside obstacles related to profitability and resource ownership. Breeder age emerges as a significant factor in livestock herd management, influenced by elements such as experience, resource availability, and adherence to traditional practices. Experience notably influences breeders’ decisions regarding male insemination replacements, likely due to acquired skills. Crop cultivation is shown to reduce fodder costs, thereby enhancing profitability for each young animal sold and consequently increasing the breeders’ returns. Winter conditions elevate animal mortality rates due to cold stress, while other animals within herds contribute to increased kid mortality by facilitating disease transmission. Breeder experience significantly impacts lamb survival, underscoring its importance in ensuring proper care. Increasing ewe proportions within herds enhances lamb production and lowers lamb mortality rates. Effective ram management and yearling lamb sales further contribute to herd health and productivity. A higher proportion of goats within a herd positively correlates with the number of young yearlings sold but inversely affects breeding males and overall kid numbers, indicating a delicate balance that influences herd productivity and mortality rates. Sheep (92.5%) and goat herds (90.6%) demonstrate reproductive success, indicative of superior long-term vitality. While sheep excel in birth rates, survival, and sales, they exhibit lower ewe and lambing percentages. Goat farming demonstrates high birth rates, sales, and overall success but requires particular attention to ensuring kid survival, especially during the winter months. Improving the characteristics of the Awassi sheep and Baladi goat flocks is crucial for ensuring sustainability, achievable through proper care practices in dry lands. In conclusion, despite the challenges, there are promising opportunities to enhance sheep and goat farming in Jordan. Effective management, informed by the breeders’ experience and economics, is crucial. Empowering small-scale herders and implementing targeted interventions, like winter mortality solutions and selective breeding, is vital for sustainable growth.

Primary Graft Dysfunction (PGD) is a major cause of both short-term and long-term morbidity and mortality following lung transplantation. Various donor, recipient, and technical risk factors have been previously identified as being associated with the development of PGD. Here, we present a comprehensive review of the current literature as it pertains to PGD following lung transplantation, as well as discussing current strategies to mitigate PGD and future directions. We will pay special attention to recent advances in lung transplantation such as ex-vivo lung perfusion, thoracoabdominal normothermic regional perfusion, and up-to-date literature published in the interim since the 2016 ISHLT consensus statement on PGD and the COVID-19 pandemic.

Abstract Purpose Since the declaration of COVID-19 as a pandemic, a wide between-country variation was observed regarding in-hospital mortality and its predictors. Given the scarcity of local research and the need to prioritize the provision of care, this study was conducted aiming to measure the incidence of in-hospital COVID-19 mortality and to develop a simple and clinically applicable model for its prediction. Methods COVID-19-confirmed patients admitted to the designated isolation areas of Ain-Shams University Hospitals (April 2020–February 2021) were included in this retrospective cohort study (n = 3663). Data were retrieved from patients’ records. Kaplan–Meier survival and Cox proportional hazard regression were used. Binary logistic regression was used for creating mortality prediction models. Results Patients were 53.6% males, 4.6% current smokers, and their median age was 58 (IQR 41–68) years. Admission to intensive care units was 41.1% and mortality was 26.5% (972/3663, 95% CI 25.1–28.0%). Independent mortality predictors—with rapid mortality onset—were age ≥ 75 years, patients’ admission in critical condition, and being symptomatic. Current smoking and presence of comorbidities particularly, obesity, malignancy, and chronic haematological disorders predicted mortality too. Some biomarkers were also recognized. Two prediction models exhibited the best performance: a basic model including age, presence/absence of comorbidities, and the severity level of the condition on admission (Area Under Receiver Operating Characteristic Curve (AUC) = 0.832, 95% CI 0.816–0.847) and another model with added International Normalized Ratio (INR) value (AUC = 0.842, 95% CI 0.812–0.873). Conclusion Patients with the identified mortality risk factors are to be prioritized for preventive and rapid treatment measures. With the provided prediction models, clinicians can calculate mortality probability for their patients. Presenting multiple and very generic models can enable clinicians to choose the one containing the parameters available in their specific clinical setting, and also to test the applicability of such models in a non-COVID-19 respiratory infection.

Abstract Background Hepatocellular carcinoma (HCC) is one of the main cancers in the world with a high mortality rate. The molecular mechanisms of HCC are poorly understood. Long non-coding RNAs (lncRNAs) have a role in HCC pathogenesis. Glypican3 (GPC3) is a cell surface oncofetal proteoglycan that is expressed in HCC, and its overexpression predicts a poorer prognosis. We aimed to assess the levels of alfa fetoprotein (AFP), lncRNA AF085935 gene expression, and GPC3 protein in HCC patients. Patients and methods The patients were classified into three groups: HCC group, cirrhotic group, and healthy control group. For all groups, we performed clinical examinations, laboratory investigations, and imaging. The levels of AFP, GPC3 protein, and LncRNA gene expression were estimated. A statistical analysis was done. Results Levels of GPC3 and LncRNA gene expression were significantly higher in the HCC group versus other groups. LncRNA gene and GPC3 levels are excellent for the detection of HCC with a sensitivity of 96% and 87%, respectively. Specificity was 81% and 64%, respectively. Linear regression analysis showed that LncRNA gene expression and GPC3 protein are significant predictors for HCC (p = 0 and p = 0.001, respectively). Log rank analysis based on GPC3 and LncRNA gene expression levels in HCC patients showed that high expression of GPC3 and LncRNA is associated with shorter overall survival than those with low expressions (p value

Abstract Background Genetic variants of Patatin-like phospholipase domain-containing protein 3 (PNPLA3) and transmembrane 6 superfamily member 2 (TM6SF2) genes have been reported with the development of hepatocellular carcinoma (HCC). This study aims to explore the role of The PNPLA3 rs738409 and TM6SF2 rs58542926 single-nucleotide polymorphisms (SNPs) on the incidence and survival of HCV-induced HCC in Egyptians. Methods and results This case-control study included (120) HCC and (144) hepatitis C virus (HCV) patients. Baseline clinical, laboratory, tumor characteristics data, HCC recurrence, and overall survival were collected. PNPLA3 rs738409 and TM6SF2 rs58542926 polymorphism were detected by TaqMan allelic discrimination assay. We found that HCC patients were significantly older with male predominance. A significant difference between the TT genotypes of TM6SF2 frequency was observed in HCC compared with HCV patients. Moreover, the T allele of TM6SF2 distributions revealed a significant contribution to the different stages of HCC (p=0.03). Both PNPLA3 rs738409 and TM6SF2 rs58542926 variants showed a significant relation with treatment response according to the modified RECIST criteria. Age and diabetes mellitus were the independent factors associated with the development of HCC by multivariate regression analysis. Conclusions TM6SF2 rs58542926 polymorphism, not PNPLA3 rs738409, could be implicated in the development of HCV-induced HCC and its progression.

Abstract Introduction Liver resection and local ablation are the two primary curative treatments for early-stage hepatocellular carcinoma (HCC). Microwave ablation (MWA) shows promising performance in terms of early tumor response, recurrence, and survival. This study aims to determine whether MWA would be comparable to liver resection in treating early-stage HCC. Methods This study included patients with hepatitis C-related HCC attending the multidisciplinary HCC clinic, Kasr Al-Ainy Hospital (March 2018 to September 2020). We included adults with early-stage HCC (BCLC stages 0-A). We studied patients and tumor characteristics, HCC treatment response, recurrence, and overall survival. Results Thirty-one patients were treated with liver resection and 41 patients were treated with MWA, including 4 patients who received intraoperative MWA. By the end of the study, 21 patients (28.77%) died. Patients who underwent MWA were younger compared to the hepatectomy group with lower baseline AFP (21 (6.7–54) versus 77 (31.3–136.0), respectively, (P value 0.024) and tumor size (2.78 (0.87) cm versus 3.77 (0.97) cm, respectively, (P value

Background. Lung transplant recipients (LTRs) have an increased risk of COVID-19–related morbidity and mortality. Tixagevimab-cilgavimab (tix-cil) is a long-acting monoclonal antibody combination granted Emergency Use Authorization approval by the US Food and Drug Administration for COVID-19 pre-exposure prophylaxis (PrEP) in immunocompromised patients. We sought to determine whether tix-cil 300–300 mg reduced the incidence and disease severity of severe acute respiratory syndrome coronavirus 2 infection in LTRs during the Omicron wave. Methods. We performed a retrospective, single-center cohort study of LTRs who had received a COVID-19 diagnosis between December 2021 and August 2022. We compared baseline characteristics and clinical outcomes after COVID-19 between LTRs who received tix-cil PrEP and those who did not. We then conducted propensity-score matching based on baseline characteristics and therapeutic interventions and compared clinical outcomes between the 2 groups. Results. Of 203 LTRs who received tix-cil PrEP and 343 who did not, 24 (11.8%) and 57 (16.6%), respectively, developed symptomatic COVID-19 (hazard ratio [HR], 0.669; 95% confidence interval [CI], 0.415-1.079; P = 0.099). The hospitalization rate of LTRs with COVID-19 during the Omicron wave trended lower in the tix-cil group than in the non–tix-cil group (20.8% versus 43.1%; HR, 0.430; 95% CI, 0.165-1.118; P = 0.083). In propensity-matched analyses, 17 LTRs who received tix-cil and 17 LTRs who did not had similar rates of hospitalization (HR, 0.468; 95% CI, 0.156-1.402; P = 0.175), intensive care unit admission (HR, 3.096; 95% CI, 0.322-29.771; P = 0.328), mechanical ventilation (HR, 1.958; 95% CI, 0.177-21.596; P = 0.583), and survival (HR, 1.015; 95% CI, 0.143-7.209; P = 0.988). COVID-19–related mortality was high in both propensity-score–matched groups (11.8%). Conclusions. Breakthrough COVID-19 was common among LTRs despite tix-cil PrEP, possibly due to reduced efficacy of monoclonal antibodies against the Omicron variant. Tix-cil PrEP may reduce the incidence of COVID-19 in LTRs, but it did not reduce disease severity during the Omicron wave.

More than 80% of global hepatocellular carcinoma (HCC) patients are estimated to occur in sub-Saharan Africa (SSA) and Eastern Asia. The most common risk factor of HCC in SSA is chronic hepatitis B virus (HBV) infection, with the incidence highest in West Africa. HBV is highly endemic in SSA and is perpetuated by incomplete adherence to birth dose immunization, lack of longitudinal follow-up care, and impaired access to antiviral therapy. HBV may directly cause HCC through somatic genetic alterations or indirectly through altered liver function and liver cirrhosis. Other risk factors of HCC in SSA include aflatoxins and, to a lesser extent, African iron overload. HIV plus HBV co-infection increases the risk of developing HCC and is increasingly becoming more common because of improving the survival of patients with HIV infection. Compared with the rest of the world, patients with HCC in SSA have the lowest survival. This is partly due to the late presentation of HCC with advanced symptomatic disease as a result of underdeveloped surveillance practices. Moreover, access to care and resource limitations further limit outcomes for the patients who receive a diagnosis in SSA. There is a need for multipronged strategies to decrease the incidence of HCC and improve its outcomes in SSA.

Abstract Background Smoking negatively impacts COVID-19 severity and adverse outcomes. Evidence on whether smoking is associated with SARS-Co-V2 infection and having a positive test is scarce, particularly from low-and middle-income countries, where most of the world’s billion smokers live. The inconsistency in relevant findings calls for study designs and analyses to account for possible confounders including background characteristics and pre-existing co-morbidities, to disentangle the specific effect of smoking. In healthcare workers (HCWs) the frequency of exposure to COVID-19 cases adds another layer of risk that was not factored in previous studies. We examined the association of HCWs’ tobacco/nicotine use (never, former, and current use) with having a positive SARS-Co-V2 test result and symptoms suggestive of infection, accounting for demographics, exposures, and co-morbidities. Methods A prospective cohort study of 4040 healthcare workers with baseline and follow-up screening took place during April–June 2020 in 12 healthcare facilities in Cairo, Egypt. Data on demographics, tobacco/nicotine use (manufactured or roll-your-own cigarettes, waterpipe tobacco, and electronic devices), co-morbidities, symptoms, exposures, and SARS-Co-V2 investigations were analyzed. Multinomial and multivariable logistic regression analyses were performed. Results Overall, 270/4040 (6.7, 95%CI: 5.9–7.5) had positive SARS-CoV-2 tests, 479 (11.9%) were current and 79 (2.0%) were former tobacco/nicotine users. The proportion of positive tests was 7.0% (243/3482, 95%CI: 6.1–7.8) among never, 5.1% (4/79, 95%CI: 0.1–10.0) among former, and 4.8% (23/479, 95%CI: 2.9–6.7) among current users. HCWs’ SARS-CoV-2 test results did not vary significantly by single/multiple or daily/non-daily tobacco/nicotine use. Compared to never users, former users were more likely to self-report a pre-existing medical condition (ORadjusted1.87, 95%CI: 1.05–3.33, p = 0.033), and to experience symptoms suggestive of COVID-19 (ORadjusted1.76, 95%CI: 1.07–2.90, p = 0.027). After adjustment, former (ORadjusted0.45, 95%CI: 0.11–1.89, p = 0.273) and current (ORadjusted0.65, 95%CI: 0.38–1.09, p = 0.101) tobacco/nicotine use was not associated with HCWs’ SARS-CoV-2 positive test results. Conclusions This is the first report on this association from low- and middle-income countries with high tobacco/nicotine use prevalence. In this HCW cohort, having a positive SARS-CoV-2 test was not associated with tobacco/nicotine use after accounting for demographics, exposures, and co-morbidities. Additional population-based studies could use such preliminary evidence to investigate this controversial association.

Background: We examined Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) seroconversion incidence and risk factors 21 days after baseline screening among healthcare workers (HCWs) in a resource-limited setting. Methods: A prospective cohort study of 4040 HCWs took place at 12 university healthcare facilities in Cairo, Egypt; April-June 2020. Follow-up exposure and clinical data were collected through online survey. SARS-CoV-2 testing was done using rapid IgM and IgG serological tests and reverse transcriptase–polymerase chain reaction (RT-PCR) for those with positive serology. Cox proportional hazards modelling was used to estimate adjusted hazard ratios (HR) of seroconversion. Results: 3870/4040 (95.8%) HCWs tested negative for IgM, IgG and PCR at baseline; 2282 (59.0%) returned for 21-day follow-up. Seroconversion incidence (positive IgM and/or IgG) was 100/2282 (4.4%, 95% CI:3.6-5.3), majority asymptomatic (64.0%); daily hazard of 0.21% (95% CI:0.17-0.25)/48 746 person-days of follow-up. Seroconversion was: 4.0% (64/1596; 95% CI:3.1-5.1) among asymptomatic; 5.3% (36/686; 95% CI:3.7-7.2) among symptomatic HCWs. Seroconversion was independently associated with older age; lower education; contact with a confirmed case >15 min; chronic kidney disease; pregnancy; change/loss of smell; and negatively associated with workplace contact. Conclusions: Most seroconversions were asymptomatic, emphasizing need for regular universal testing. Seropositivity was three-fold that observed at baseline. Cumulative infections increased nationally by a similar rate, suggesting HCW infections reflect community not nosocomial transmission.

Abstract Background The current COVID-19 pandemic has resulted in marked and rapid changes to the standing policies of radiology departments globally. The aim of this review article is to describe the various processes implemented by a radiology department in an educational institution in a resource limited country during the COVID-19 crisis, giving insights into the adopted strategies in other institutions in developed countries. Main body Our preparedness strategy was directed into five main domains: protection and wellness of radiology faculty and staff, radiological examinations and patients’ safety, education, research, and financial support. By implementing new strategies, we found that work reorganization through the use of home PACS provided safe and effective reporting service, low infection rate with zero mortality, and online lectures and theses defense were successful. Furthermore, governmental support and donations were helpful in facing financial challenges during the pandemic. A comprehensive literature review search for policies adopted by other radiology departments in the world was performed. The adopted strategies of various centers are generally similar to ours aiming for mitigating the spread of the virus, keeping good patients’ care, and maintaining the educational process. Few policy differences across institutions were found in the reporting strategy of COVID-19 pneumonia and according to the availability of resources. Conclusion Covid-19 pandemic has opened the door for changes in the radiology department policies with renewed focus on educational, clinical, and scientific strategies. Documentation of the dynamic modifications of everyday practices and lessons learned are important as a reference for preparedness for possible second surge or future crisis.

Background. Persistent orthostatic hypotension (OH) is a lesser-known complication of lung transplantation (LTx). In this retrospective case series, we describe the clinical manifestations, complications, and treatment of persistent OH in 13 LTx recipients. Methods. We identified LTx recipients who underwent transplantation between March 1, 2018, and March 31, 2020, with persistent symptomatic OH and retrospectively queried the records for clinical information. Results. Thirteen patients were included in the analysis, 9 (69%) had underlying pulmonary fibrosis, and 12 (92%) were male. The median age, height, and body mass index at LTx were 68 years, 70 inches, and 27 kg/m2, respectively. Six (46%) patients were deceased at the time of chart abstraction with a median (IQR) posttransplant survival of 12.6 months (6, 21); the 7 remaining living patients were a median of 19.6 months (18, 32) posttransplant. Signs and symptoms of OH developed a median of 60 (7, 75) days after transplant. Patients were treated with pharmacological agents and underwent extensive physical therapy. Most patients required inpatient rehabilitation (n = 10, 77%), and patients commonly developed comorbid conditions including weight loss, renal insufficiency with eGFR

The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion . A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.

BackgroundResearch has revealed that asymptomatic and pre-symptomatic infections are important contributors to the transmission of SARS-CoV-2 in populations. In Egypt, the true prevalence of infections is veiled due to the low number of screening tests. The aim of this study was to determine the SARS-CoV-2 PCR positivity rate as well the seroprevalence of the SARS-CoV-2 antibodies before the ultimate development of a second wave of the epidemic in Cairo, Egypt.MethodsOur study was carried out between May 5 and the end of October 2020. It included all patients requiring admission to Ain Shams University hospitals. An interview questionnaire was used to collect demographic and clinical data. Laboratory tests for all participants included RT-PCR and total antibody assay for SARS-CoV-2.ResultsA total of 4,313 subjects were enrolled in our study, with females representing 56% of the sample. Adults and middle-aged individuals represented around 60% of the study sample. The positivity rate of SARS-CoV-2 PCR was 3.84% (95% CI 3.29-4.48), and the SARS-CoV-2 antibody seroprevalence was 29.82% (95% CI: 28.16-31.51). Males showed a higher risk for getting the COVID-19 infection, while middle-age group had significantly higher antibody seroprevalence rates.ConclusionSARS-CoV-2 infection imposes a high burden on the community as detected by high seroprevalence rates.

Long-term survival after lung transplant remains severely limited by chronic lung allograft dysfunction. Antibody-mediated rejection of lung transplant allografts is usually caused by donor-specific antibodies (DSAs) directed toward donor human leukocyte antigens (HLAs). Typically, patients with antibody-mediated rejection have significantly higher circulating DSAs and increased mean fluorescence intensity than those without antibody-mediated rejection. However, some patients with antibody-mediated rejection have low mean fluorescence intensities, partly due to the “sponge effect” related to DSAs binding to HLA molecules within the lung. Herein, we report the case of an 18-year-old, female lung transplant recipient who required retransplantation and developed circulating DSAs directed toward the first allograft but detected in circulation only after retransplantation. The present case draws attention to a rare finding of sponge effect in a patient with antibody-mediated rejection leading to allograft failure.

In this work, the aerodynamic performance of four types of bird’s airfoils (eagle, stork, hawk, and albatross) at low Reynolds number and a range of angles of attack during fixed (unflapping) gliding flight was numerically investigated utilizing open-source computational fluid dynamics (CFD) code Stanford University unstructured (SU2) and K-ω Shear Stress Transport (K-ω SST) turbulence model. The flow of the simulated cases was assumed to be incompressible, viscous, and steady. For verification and comparison, a low Reynolds number man-made Eppler 193’s airfoil was simulated. The results revealed that stork has the greatest aerodynamic efficiency followed by albatross and eagle. However, at zero angle of attack, the albatross aerodynamic efficiency exceeded all the other birds by a significant amount. In terms of aerodynamics efficiency, stork’s and albatross’s airfoils performed better than Eppler 193 at angles of attack less than 8°, while at a higher angle of attack all studied birds’ airfoils performed better than Eppler 193. The effect of surface permeability was also investigated for the eagle’s airfoil where the permeable surface occupied one-third of the total airfoil surface. Permeability increased the generated lift and the aerodynamic efficiency of the eagle’s airfoil for angles of attack less than 10°. The increase reached 58% for the lift at zero angle of attack. After the specified angle, the permeability had an adverse effect on the flow which may be due to the transition to turbulent ahead of the permeable section.

Introduction and aim. The correlation between interleukin-28B (IL-28B) polymorphisms and chronic hepatitis C (CHC) progression is debatable. Here, we aimed to evaluate the relation between IL-28B C/T genotypes and the development of cirrhotic liver. Extracellular matrix (ECM) proteins, FibroScan and model for end-stage liver disease (MELD) were used to substantiate the severity of liver disease.Material and methods. IL-28B rs12979860, liver stiffness and ECM proteins were assessed in 272 CHC patients.Results. Cirrhosis percentage increased to 10%, 52% and 96% with the increasing number of T alleles (CC, CT and TT, respectively). Also, elevated ECM proteins levels were correlated with the increasing number of T alleles. Interestingly, among cirrhotic patients, liver stiffness, MELD and ECM proteins were significantly (P < 0.0001) higher in patients with TT more than CT genotype. FibroScan, hyaluronic acid, Laminin, Collagen IV and the N-terminal pro-peptide of collagen type III have high accuracy to differentiate liver status in CC from TT genotype. Area under receiver-operating characteristic curve (95% CI) were 1.0 (1.0-1.0), 0.97 (0.961.0), 0.93 (0.85-1.0), 0.98 (0.97-1.0) and 0.93 (0.91-0.97), respectively.Conclusion. This study suggests that IL-28B T allele affects the natural course of CHC type 4 and also suggests that carriage of the IL-28B C allele protects from unfavorable clinical outcomes in CHC as coexistence of C allele with T allele reduced cirrhosis severity.

Purpose: The purpose of this study was to assess the role of dynamic contrast enhanced and diffusion MR imaging in the detection of tumor viability after radiofrequency and microwave ablation therapy of hepatocellular carcinoma. Subjects and methods: The study was done on 50 patients with HCC underwent radiofrequency or microwave ablation. Patients were classified into resolved group if there’s no MRI evidence of tumor viability at the ablated lesion and unresolved group if there’s evidence of tumor viability. Results: In the early 1 month post-ablation period, heterogenous signal of the ablation zone in the precontrast T1 and T2 images was noted that gradually become more homogenous in the 3–12 months follow-up. Ill defined persistent perilesional enhancement is considered as a benign finding that was present in 100% of patients imaged within the 1st month and persists only in 5% after 9–12 months. The mean ADC value of the malignant lesions was 0.91 ± 0.09 × 10−3 mm2/s, while the mean ADC value of the benign post-ablation parenchymal changes was 1.29 ± 0.12 × 10−3 mm2/s with a cutoff value of 1.05 × 10−3 mm2/s. Conclusion: MRI provides a powerful tool in the assessment of treatment response after RFA and MWA of hepatocellular carcinoma.

Background. Lung transplant recipients are treated with a 3-drug immunosuppressive regimen that consists of a calcineurin inhibitor, an antiproliferative agent, and a corticosteroid. Calcineurin inhibitors are the backbone of this regimen, and tacrolimus is used more often than cyclosporine, because tacrolimus is the more potent of the two agents. Tacrolimus-induced hyponatremia has been described among kidney transplant recipients, but not among lung transplant recipients. Methods. We conducted a retrospective chart review of patients who underwent lung transplant at our institution and went on to develop severe hyponatremia. Results. We identified 5 lung transplant recipients who developed severe hyponatremia after lung transplantation (median nadir, 117 mEq/L; interquartile range, 116-119 mEq/L). Time to development of hyponatremia ranged from 3 to 85 days posttransplant. Hyponatremia persisted in these patients despite fluid restriction, salt tablets, diuretics, and fludrocortisone therapy. Hyponatremia resolved in 3 patients and significantly improved in 2 patients after they were switched from a tacrolimus-based immunosuppressive regimen to a cyclosporine-based regimen. Conclusion. Transitioning from a tacrolimus- to a cyclosporine-based immunosuppressive regimen may resolve or improve severe hyponatremia in lung transplant recipients.

Pulmonary alveolar proteinosis (PAP) is a progressive lung disease characterized by accumulated surfactant-like lipoproteinaceous material in the alveoli and distal bronchioles. This accumulation is the result of impaired clearance by alveolar macrophages. PAP has been described in 11 solid organ transplant recipients, 9 of whom were treated with mammalian target of rapamycin inhibitors. We report a case of a lung transplant recipient treated with prednisone, mycophenolate mofetil (MMF), and tacrolimus who ultimately developed PAP, which worsened when MMF was replaced with everolimus.

Introduction-Aim. Health-Related Quality of Life (HRQOL) has become an important focus of patient care and clinical outcomes research with the improvement in patient and graft survival after liver transplantation (LT). The current study was designed to evaluate the post-transplant HRQOL profiles using the Liver Disease Quality of Life 1.0 (LDQOL 1.0) Questionnaire and demonstrate the possible effect of peri-transplant clinical covariates on these profiles.Material and methods. Participants included pre-transplant group (waiting-list patients n = 50) and post-transplant group (mean 5 ± 4 years after deceased or living donor LT n = 103) who were recruited from 3 specialized centers in Egypt. We applied the LDQOL 1.0 questionnaire; a 111-item containing the Short Form-36 version 2.0 (SF-36v2) as a generic component supplemented by 75 disease-specific items. The etiology of cirrhosis, co-morbidities, model for end-stage liver disease (MELD), Child-Pugh class and post-operative complications were analyzed.Results. All recipients had significant higher HRQOL scores than patients in waiting-list using both questionnaire components. Recipients with pre-LT MELD ≥ 15, Child-Pugh class C, history of hepatocellular carcinoma (HCC) demonstrated low HRQOL scores. Recipients without post-operative surgical complications had a statistically better HRQOL using the disease-specific, but not the SF-36v2 component. On the other hand, both components demonstrated non-significant lower scores in recipients with rejection episodes, cytomegalovirus (CMV) infection and hepatitis C recurrence had compared to those without medical complications.Conclusion. Generally HRQOL improves dramatically after LT as assessed by LDQOL questionnaire. Moreover, combined questionnaires can provide accurate information about the possible impaired HRQOL post-LT due to pre-transplant disease severity and post-operative complications.