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Objective: Budd-Chiari syndrome is a multifactorial disease in which several prothrombotic disorders may predispose patients to the development of thrombosis at this uncommon location (hepatic veins). The aim of this study was to determine the prevalence and characteristics of inherited thrombophilia in Egyptian Budd-Chiari syndrome patients.Materials and Methods: The study included 47 Budd-Chiari syndrome patients (20 children and 27 adults). Genotyping of Factor V G1691A (Leiden), prothrombin G20210A (PT), and methylenetetrahydrofolate reductase C677T were performed using real-time PCR and fluorescence melting curve detection analysis.Results: Factor V Leiden was observed in 29 patients (61.7%). It is the only factor that caused Budd-Chiari syndrome in 18 of the patients and in 5 of the patients with inferior vena cava involvement. Myeloproliferative disease was noted in 12 (25.5%) patients, antiphospholipid syndrome in 5 (10.6%), and Behcet’s disease in 3 (6.4%). Interestingly, 3 of the children with Budd-Chiari syndrome had lipid storage disease.Conclusion: Factor V Leiden was a major etiological factor in Egyptian Budd-Chiari syndrome patients, which may have been related to the high frequency of this mutation in the study region. Factor V Leiden was also a strong thrombophilic factor and the leading cause of inferior vena cava thrombosis in these patients. Lipid storage disease should be included as a risk factor for Budd-Chiari syndrome.

Neuroblastoma is a high-grade malignancy of childhood. It is chemo- and radio-sensitive but prone to relapse after initial remission. The aim of the current study was to study the results of the first- and second-line chemotherapy on the short-term response and long-term survival of children, and to further describe the side effects of treatment. Ninety-five children with advanced neuroblastoma were included in the study, divided into two groups according to the treatment strategy: 65 were treated by first-line chemotherapy alone, and 30 children who were not responding or relapsed after first-line chemotherapy were treated by second-line chemotherapy. External beam radiotherapy was given to bone and brain secondary cancers when detected. Staging workup was performed before, during and after management. Response was documented after surgery for the primary tumor. Median follow up was 32 months (range 24-60 months). Chemothe rapy was continued until toxicity or disease progression occurred, indicating interruption of chemotherapy. Patients received a maximum of 8 cycles. Toxicity was mainly myelo-suppression, with grade II-III severity in 60% of the firstline and 70% of the second-line chemotherapy patients. Median total actuarial survival was nearly 51 months for the first-line chemotherapy group and 30 months for the second-line line group, with a statistically significant difference between the two groups (P

Mohamed M S Farag,1 Reda A Suef,1 Ghada M Al-Toukhy,2 Mohamed A Selim,1 Mostafa A Elbahnasawy,1 Nahla El Sharkawy,3 Sameera Ezzat,4 Nashwa Shebl,5 Mohamed T M Mansour6 1Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo 11884, Egypt; 2Virology & Immunology Department, Children’s Cancer Hospital, Cairo 57357, Egypt; 3Clinical Pathology Department, National Cancer Institute, Cairo University and Children Cancer Hospital, Cairo 57357, Egypt; 4Epidemiology & Preventive Medicine Department, National Liver Institute, Menoufia University, Al Minufya, Egypt; 5Hepatology Department, National Liver Institute, Menoufia University, Al Minufya, Egypt; 6Virology & Immunology Department, National Cancer Institute, Cairo University and Children Cancer Hospital, Cairo 57357, EgyptCorrespondence: Mohamed M S FaragBotany and Microbiology Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo 11884, EgyptTel +20 2 100 670 4553Fax + 20 2 22629358Email mohamed.farag@azhar.edu.egBackground: In chronic hepatitis B virus (CHB) patients, both dendritic cells (DCs) and T cells are functionally impaired and consequently the HBV-specific cellular immune responses are downregulated. The present study aims to investigate whether monocyte-derived DC (MoDCs)-pulsed-HBV subviral particles (HBVsvp) can polarize Th1 cells to induce HBV-specific cytotoxic T-lymphocytes (CTL) responses in CHB patients.Methods and Materials: To this end, the human hepatoma HepG2.2.15 cell line was used to produce HBVsvp as a culturing system, and HBVsvp were concentrated for highly virus titer using the polyethylene glycol protocol. Peripheral blood mononuclear cells (PBMCs), collected from CHB patients and healthy donors, were differentiated into MoDCs and T cells. PBMCs-derived MoDCs were first pulsed with HBVsvp and then cultured with PBMCs-derived T cells. MoDCs and/or T subsets cells were identified for phenotypic activation by FACS analysis. The cytokine secretion of IL-4, IL-12, and IFN-γ in the culture supernatants was detected.Results: The MoDCs were restored for their activation upon pulsing with HBVsvp in vitro, as identified by significantly overexpression of both CD86 and HLA-DR, and overproduction of IL-4 and IL-12. Furthermore, MoDCs-pulsed-HBVsvp induced Th1 frequencies and activated HBV-specific CTL to produce significantly highest amount of IFN-γ. Enhanced HBV-specific CTL led to strong cytolytic capacity against HepG2.2.15.Conclusion: Overall, our data suggest that in vitro activation of MoDCs with HBVsvp overcomes the functionally impaired DCs and T cells in CHB patients offering a promising tool for therapeutic or vaccine-based approaches against HBV.Keywords: CHB, MoDCs-pulsed-HBVsvp, HBV-specific CTL, immunotherapy

Objective: To evaluate safety and efficacy of intrathecal nalbuphine as an adjuvant to intrathecal bupivacaine in obstetric, urological, and lower orthopedic surgeries. Design: Randomized, controlled trial. Methods: The study included 60 patients (20-60 years-old) who were American Society of Anesthesiologists physical status I or II and were scheduled for obstetric, urological, or lower orthopedic surgeries under spinal anesthesia. The patients were randomly allocted into three groups. All groups received 2.5 ml of 0.5% hyperbaric bupivacaine by intrathecal injection. In addition, group I received 0.5 ml of normal saline, group II received 0.2 mg of nalbuphine, and group III received 0.4 mg of nalbuphine. The primary outcomes were the effective analgesic time, the onset and duration of sensory and motor block. Secondary outcomes were the hemodynamic effects. Results: The patients in group II and III had significantly earlier onset of sensory and motor block, longer duration of analgesia, and higher level of maximum sensory block compared to patients in group I. Meanwhile, there was no reported hemodynamic instability. Conclusions: In spinal anesthesia, adding nalbuphine to bupivacaine had several benefits regarding the duration of analgesia, the onset of sensory and motor blocks and the sensory level, without significant adverse events. [ABSTRACT FROM AUTHOR]