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Ashraf Omar,1 Ahmed Kaseb,2 Tamer Elbaz,1 Mohamed El-Kassas,3 Amr El Fouly,3 Abdel Fatah Hanno,4 Ahmed El Dorry,5 Ahmed Hosni,6 Amr Helmy,7 Amr S Saad,8 Ashwaq Alolayan,9 Basem Elsayed Eysa,10 Emad Hamada,11 Hamdy Azim,11 Hany Khattab,12 Hesham Elghazaly,8 Hesham Tawfik,13 Hisham Ayoub,14 Hussein Khaled,11 Ibtessam Saadeldin,11 Imam Waked,15 Eman MF Barakat,16 Mahmoud El Meteini,17 Mohamed Hamed Shaaban,6 Mohamed EzzElarab,10 Mohamed Fathy,17 Mohamed Shaker,5 Mohamed Sobhi,5 Mohamed Kamal Shaker,16 Mohamed ElGharib,5 Mohammed Abdullah,11 Mohesn Mokhtar,11 Mostafa Elshazli,18 Omar Mohamed Khaleil Heikal,14 Osama Hetta,5 Reda Mahmoud ElWakil,16 Sameh Abdel Wahab,5 Samir Shehata Eid,19 Yousri Rostom20 On behalf of the Egyptian Liver Cancer Committee Study Group1Department of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA; 3Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt; 4Department of Gastroenterology, Faculty of Medicine, Alexandria University, Alexandria, Egypt; 5Department of Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 6Department of Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt; 7Department of Surgery, National Liver Institute Menoufia University, Menoufia, Egypt; 8Department of Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 9Department of Oncology, National Guard Hospital, Riyadh, Saudi Arabia; 10Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 11Department of Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt; 12Department of Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 13Department of Oncology, Faculty of Medicine, Tanta University, Tanta Egypt; 14Department of Gastroenterology, Military Medical Academy, Cairo, Egypt; 15Department of Gastroenterology, Menoufia Liver Institute, Menoufia, Egypt; 16Department of Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 17Department of Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 18Department of Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt; 19Department of Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt; 20Department of Oncology, Faculty of Medicine, Alexandria University, Alexandria, EgyptCorrespondence: Ashraf Omar, Department of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt, Email abdelazizashraf@hotmail.comAbstract: Globally, hepatocellular carcinoma (HCC) is the fourth most common cause of death from cancer. The prevalence of this pathology, which has been on the rise in the last 30 years, has been predicted to continue increasing. HCC is the most common cause of cancer-related morbidity and mortality in Egypt and is also the most common cancer in males. Chronic liver diseases, including chronic hepatitis C, which is a primary health concern in Egypt, are considered major risk factors for HCC. However, HCC surveillance is recommended for patients with chronic hepatitis B virus (HBV) and liver cirrhosis; those above 40 with HBV but without cirrhosis; individuals with hepatitis D co-infection or a family history of HCC; and Nonalcoholic fatty liver disease (NAFLD) patients exhibiting significant fibrosis or cirrhosis. Several international guidelines aid physicians in the management of HCC. However, the availability and cost of diagnostic modalities and treatment options vary from one country to another. Therefore, the current guidelines aim to standardize the management of HCC in Egypt. The recommendations presented in this report represent the current management strategy at HCC treatment centers in Egypt. Recommendations were developed by an expert panel consisting of hepatologists, oncologists, gastroenterologists, surgeons, pathologists, and radiologists working under the umbrella of the Egyptian Society of Liver Cancer. The recommendations, which are based on the currently available local diagnostic aids and treatments in the country, include recommendations for future prospects.Keywords: hepatocellular carcinoma, clinical recommendations, Egyptian society of liver cancer, hepatitis c virus, Egypt, guidelines

Mona Wassef,1 Ahmed Mukhtar,2 Ahmed Nabil,3 Moushira Ezzelarab,1 Doaa Ghaith1 1Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Anesthesia and Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, EgyptCorrespondence: Doaa GhaithDepartment of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, 1st Al-Saray Street, Al-Manial, Cairo 11559, EgyptTel +20 100 1857775Email doaa.ghaith@kasralainy.edu.egIntroduction: Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance.Purpose: We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University.Patients and Methods: Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing Enterobacteriaceae and multidrug resistant Acinetobacter baumannii colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection.Results: Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p< 0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd’s ratio (OR’s ratio = 0.3) confidence interval (95% CI 0.14– 0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%). On the other hand, A. baumannii was the commonest organism to be isolated during phase III with (38.5%) preceding K. pneumoniae (30%).Conclusion: Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.Keywords: colonization, OXA 48, MDR- Acinetobacter, ICU

Hamdy A Azim,1 Ashraf Omar,2 Hesham Atef,1,† Heba Zawahry,3 Mohamed K Shaker,4 AH Kamel Abdelmaksoud,5 Mohamed EzzElarab,6 Omar Abdel-Rahman,7 Mohamed Ismail,8 Loay Kassem,1 Imam Waked9 1Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of Medical Oncology, National Cancer Institute, Cairo, Egypt; 4Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 5Department of Diagnostic and Intervention Radiology, Cairo University, Cairo, Egypt; 6National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 7Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 8Clinical Oncology Department, Cairo Oncology Center, Cairo, Egypt; 9Institute of Liver Disease, Menoufiya University, Menoufiya, Egypt †Dr Hesham Atef passed away on November 16, 2017, during the preparation of the manuscript Background: Phase II trials found that tegafur–uracil (UFT) is an effective drug in hepatocellular carcinoma (HCC), while preclinical data suggested that its combination with sorafenib may have a promising activity. Our Phase II randomized trial aimed to evaluate efficacy and tolerability of sorafenib plus UFT vs sorafenib in advanced HCC.Methods: Patients with advanced HCC, with no prior systemic therapy, were randomized to receive either UFT at 125 mg/m2 twice daily for 4 out of 5 weeks plus sorafenib at 400 mg twice daily (arm 1) or single agent sorafenib at 400 mg twice daily (arm 2). Primary end point was time to progression (TTP).Results: Between March 2012 and March 2014, 76 eligible patients – out of 143 preplanned – were randomized. The study was terminated early because of futility. This is the final analysis of the study, after a median follow-up of 10.2 months and death of 86% of randomized patients (n=64). Median TTP was 7.5 months and 8.2 months in arms 1 and 2 respectively (HR: 1.07; 95% CI, 0.52–2.22; P=0.855), while the median overall survival was 8.2 months and 10.5 months respectively (HR: 1.58; 95% CI: 0.90–2.76, P=0.112). Nine patients (25%) in the combination arm discontinued treatment because of toxicity vs eight patients (21.1%) in the sorafenib monotherapy arm (P=0.899).Conclusion: In patients with advanced HCC, adding UFT to sorafenib is feasible, but it did not improve efficacy outcome over sorafenib monotherapy. Keywords: advanced hepatocellular carcinoma, sorafenib, tegafur/uracil, Egypt

Sara M Esmat,1 Mohammad R Aboulfotouh,1 Moushira H Ezzelarab,2 Shaimaa A Abdalgeleel,3 Doaa A Tolba1 1Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of Biostatistics and Epidemiology, National Cancer Institute, Cairo University, Cairo, EgyptCorrespondence: Sara M EsmatDepartment of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, 11562, EgyptTel +201069186501Email dr.sara_mamdouh@hotmail.comIntroduction: Ophthalmologists are at a high risk of coronavirus disease 2019 (COVID-19) infection owing to their working environments and proximity to patients during examinations. Compliance with infection control measures in examination offices can lessen the risk of infection to this group. In Egypt, several deaths from COVID-19 have been reported among ophthalmologists; therefore, we studied the prevalence of COVID-19 infections in this group and assessed ophthalmologists’ commitments to recommended infection control measures.Aim: To evaluate the rate of COVID-19 infections among ophthalmologists, identify risk factors for infections, and evaluate ophthalmologists’ commitments to infection control measures in their medical facilities.Methods: An online questionnaire was designed and distributed to ophthalmologists in the Cairo Governorate from May 1, 2021 to mid-June 2021.Results: Out of 161 responders, the percentage of COVID-19 infections was 52.8% (85 responders). This was significantly higher among younger ophthalmologists (P-value = 0.019) and those with fewer years of experience (P-value = 0.010). Adopting full precautions while examining patients with or without respiratory illness were significantly associated with a lower infection rate (P-value = 0.019 and 0.046, respectively). A significantly higher infection rate was reported for ophthalmologists who examined known COVID-19 patients at outpatient clinics, even when taking precautions (P-value = 0.032). A lower rate of COVID-19 infection was significantly associated with adopting full precautions while operating on suspected or nonsuspected COVID-19 patients (P-value = 0.007 and 0.003, respectively).Conclusion: Both young age and limited experience were significant infection risk factors in our study. The most important infection control measures that significantly decreased infection risks were adherence to full protective measures while working in outpatient clinics and operating rooms.Keywords: COVID-19, infection control, ophthalmologists

Memory T cell (Tmem) responses play a critical role in the outcome of allo‐transplantation. While the role of the T‐box transcription factor Eomesodermin (Eomes) in the maintenance of antigen‐specific Tmem is well studied, little is known about Eomes+CD8+T cell responses after transplantation. We evaluated the phenotype and function of allo‐reactive Eomes+CD8+T cells in healthy volunteers and kidney transplant patients and their relation to transplant outcome. High Eomes expression by steady‐state CD8+T cells correlated with effector and memory phenotype. Following allo‐stimulation, the expression of both the T‐box proteins Eomes and T‐bet by proliferating cells increased significantly, where high expression of Eomes and T‐bet correlated with higher incidence of allo‐stimulated IFNγ+TNFα+ CD8+T cells. In patients with no subsequent rejection, Eomes but not T‐bet expression by donor‐stimulated CD8+T cells, increased significantly after transplantation. This was characterized by increased EomeshiT‐bet‐/lo and decreased Eomes‐/loT‐bethi CD8+T cell subsets, with no significant changes in the EomeshiT‐bethi CD8+T cell subset. No upregulation of exhaustion markers programmed‐death‐1 (PD‐1) and cytotoxic‐T‐lymphocyte‐associated‐antigen‐4 (CTLA4) by donor‐stimulated Eomes+CD8+T cells was observed. Before transplantation, in patients without rejection, there were higher incidences of EomeshiT‐bet‐/lo, and lower incidences of EomeshiT‐bethi and Eomes‐/loT‐bethi donor‐stimulated CD8+T cell subsets, compared to those with subsequent rejection. Overall, our findings indicate that high Eomes expression by allo‐stimulated T‐bet+CD8+T cells is associated with enhanced effector function, and that an elevated incidence of donor‐stimulated CD8+T cells co‐expressing high levels of Eomes and T‐bet before transplantation, may correlate with an increased incidence of acute cellular rejection. [ABSTRACT FROM AUTHOR]

At evaluation of contact dermatitis caused by solid material, patch testing is usually performed with the material as such and with extracts of it. In this study, optimization of the extraction technique monitored by quantitative HPLC analysis of the extracted haptens is described for mercaptobenzothiazole derivatives. Several solvents with different properties are included. Acetone has traditionally been a solvent widely used for the extraction of organic haptens from solid products. However, acetone and other ketones are not inert solvents. The rubber accelerators 2-(4-morpholinyl mercapto) benzothiazole (MMBT) and N-cyclohexyl-2-benzothiazyl sulfenamide (CBS) react with acetone, yielding 2 new compounds. which were isolated and characterised by NMR and MS. For the extraction of solid rubber products, methyl tert-butyl ether (MTBE) was found to be a more suitable solvent which is unreactive to most common haptens. [ABSTRACT FROM AUTHOR]