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Until 2018, Egypt had the highest prevalence of hepatitis C virus (HCV) infection globally, affecting approximately 7% of the population. Despite efforts in diagnosis and treatment since 2006, nearly 2 million individuals with chronic HCV infection had yet to be diagnosed as of early 2018. In December, 2018, a mass HCV screening campaign for adolescents aged 15-18 years was initiated. Among 3 024 325 adolescents screened, the HCV antibody seroprevalence was 11 477 (0·38%), of whom 8187 (78·7%) were HCV RNA-positive. Sustained virological response 12 weeks after completion of treatment (SVR12) was attained by 7327 (99·6%) adolescents with a fixed-dose combination of generic ledipasvir 90 mg plus sofosbuvir 400 mg. Although mass screening in this age group might not be regularly adopted by many health systems and its cost-effectiveness might be lower than the screening of adults and high-risk groups (eg, patients on haemodialysis, people who inject drugs), breaking the chain of transmission in younger populations should lead to a reduction in HCV incidence and complications, and hasten the elimination of the disease.

Background The researchers conducted the current study to explore the perspectives of people living with HIV (PLHIV) on HIV-related discrimination and the delivery of healthcare services in healthcare settings. Methods An exploratory study using a qualitative approach was conducted among 46 PLHIV who were seeking HIV counselling and treatment from two HIV centres in the Cairo governorate using a purposive sampling technique. Results A thematic content analysis was used to examine the responses. Participants had a combination of positive and negative experiences. Some participants reported staff acceptance and friendliness towards HIV-positive patients on antiretroviral treatment. Most interviewees observed that staff took extra precautions when treating or caring for them. The majority stated that counselling about the effects of the treatment was inadequate and that testing was either too far from their homes or at overcrowded centres with long waiting times. All the interviewees recommended ongoing communication and HIV counselling skills for healthcare providers who are in contact with HIV patients. Conclusion Most of the study participants were not satisfied with HIV services in the participating centres, as well as experiencing stigma. More investment in enhancing the quality of HIV service delivery and reinforcement of health worker competencies, mainly in HIV counselling, may improve satisfaction, bearing in mind HIV-related stigma in the centres involved.

Aim of the study: To determine major predictors for limb salvage (or major amputation) in chronic limb threatening ischemia (CLTI) in Egyptian people. Design: Pilot study, observational analytical study. Patients and Methods: This study was conducted on 224 cases in the Department of Vascular Surgery in Kasr Al-Ainy Hospital – Cairo University between March 2018 to February 2019. The clinical, radiological and operative variables were collected and detect patients who need major amputation in 30 days and verify predictors of limb salvage, which was subjected to univariate analysis in order to determine the most important factors of failure of limb salvage. Results: The TLC, total CK, serum urea level and incomplete foot arch are independent factors directly proportional to the possibility of major amputation. Open interventions and presence of inline distal runoff enter the foot are independent factors inversely proportional to the possibility of major amputation. Anemia and active cardiac condition are risk factors for major amputation. Conclusion: We obtained factors that predict the limb salvage by using of univariate and multivariate analysis. These factors can help the practitioners to predict the limb salvage and guides the consumption of health care resources and personnel.

BACKGROUND: During the ongoing coronavirus disease 2019 pandemic, healthcare workers (HCWs) are presumed to be at increased risk of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transmitting the infection to vulnerable patients if they are not timeously isolated. AIM: This study aimed to determine the point prevalence of SARS-CoV-2 infection in a cohort of HCWs providing oncology services. METHODS AND RESULTS: HCWs in a large referral cancer hospital in Egypt were tested using real-time reverse transcription-polymerase chain reaction (RT-PCR) on nasopharyngeal swabs, and immunochromatography-based rapid serological test (RST). Clinical and epidemiological data were collected. In 2020, 999 HCWs were screened, of whom 86 tested positive for SARS-CoV-2 by RT-PCR (8.6%) and 127 subjects were seropositive for antibodies against SARS-CoV-2 by RST (12.8%). Immunoglobulin M seroprevalence demonstrated considerable concordance with RT-PCR positivity (sensitivity 82.14% and specificity 96.71%). Most HCWs (>95%) reported adherence to personal protective equipment. Patient transporters/cleaner were the group with the highest frequency of positive RT-PCR (19%) whereas laboratory and radiology technicians displayed the lowest frequency. Fever, dry cough, rhinorrhea, shortness of breath, fatigue and diarrhea were significantly associated with RT-PCR positivity, with increased likelihood of being positive with the presence of five or six simultaneous symptoms. CONCLUSIONS: The point prevalence of SARS-CoV-2 infection in screened HCWs is 8.6% by RT-PCR and seroprevalence is 12.8% by RST. Strict measures should be implemented to minimize transmission within healthcare settings and to the community. Our data support the importance of HCWs screening for SARS-CoV-2, taking in account the significant proportion of asymptomatic carriers.

Background Knowledge about the outcome of COVID-19 on pregnant women is so important. The published literature on the outcomes of pregnant women with COVID-19 is confusing. The aim of this study was to report our clinical experience about the effect of COVID-19 on pregnant women and to determine whether it was associated with increased mortality or an increase in the need for mechanical ventilation in this special category of patients. Methods This was a cohort study from some isolation hospitals of the Ministry of Health and Population, in eleven governorates, Egypt. The clinical data from the first 64 pregnant women with COVID-19 whose care was managed at some of the Egyptian hospitals from 14 March to 14 June 2020 as well as 114 non-pregnant women with COVID-19 was reviewed. Results The two groups did not show any significant difference regarding the main outcomes of the disease. Two cases in each group needed mechanical ventilation (p 0.617). Three cases (4.7%) died among the pregnant women and two (1.8%) died among the non-pregnant women (p 0.352). Conclusions The main clinical outcomes of COVID-19 were not different between pregnant and non-pregnant women with COVID-19. Based on our findings, pregnancy did not exacerbate the course or mortality of COVID-19 pneumonia.

Objective The novel coronavirus disease 2019 (COVID-19) has made its worldwide spread since its outbreak in December 2019. Limited information is available about the epidemiology and clinical characteristics of COVID-19, especially in Africa and Egypt. Methods We aimed to study the clinical and epidemiological characteristics of COVID-19 in Egyptian children. This is an observational retrospective cohort study performed at two specialized COVID-19 isolation hospitals in Egypt. All admitted COVID-19 pediatric patients between March 20, 2020, and May 1, 2020, were included in the study. Discussion This study included 40 COVID-19 confirmed cases (mean age, 9.4 years), 67.5% were male, 85% were asymptomatic, and 15% had mild symptoms. There were no confirmed severe or critically ill cases among the patients. Conclusion COVID-19 runs in a benign course in Egyptian children with no mortality and no significant morbidity.

Samy Zaky,1,* Hanaa K Fathelbab,2 Mohamed Elbadry,3,* Fathiya El-Raey,4,* Sherief M Abd-Elsalam,5 Hoda A Makhlouf,6 Nahed A Makhlouf,7 Mohamed A Metwally,8 Fatma Ali-Eldin,9 Ali Abdelazeem Hasan,6 Mohamed Alboraie,10 Ahmed M Yousef,11 Hanan M Shata,12 Alshaimaa Eid,1,* Noha Asem,13 Asmaa Khalaf,14 Mohamed A Elnady,15 Mohamed Elbahnasawy,16 Ahmed Abdelaziz,4 Shaker W Shaltout,17 Eman E Elshemy,1,* Atef Wahdan,18 Mohamed S Hegazi,4 Amin Abdel Baki,19,* Mohamed Hassany19 On behalf of Ministry of Health and Population COVID-19 board and Egyptian Society of fever (ESF) and UCHID-COVID-19 special interest group1Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt; 2Department of Endemic diseases; Minia University, Minia, Egypt; 3Department of Endemic Medicine, Helwan University, Cairo, Egypt; 4Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt; 5Department of Tropical Medicine, Tanta University, Tanta, Egypt; 6Department of Chest, Assiut University, Assiut, Egypt; 7Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt; 8Department of Hepatology, Gastroenterology, and Infectious Diseases, Benha University, Benha, Egypt; 9Department of Tropical medicine; Ain Shams University, Cairo, Egypt; 10Department of Internal Medicine; Al-Azhar University, Cairo, Egypt; 11Department of Community and Industrial Medicine, Damietta, Al-Azhar University, Damietta, Egypt; 12Department of Chest Medicine; Mansoura University, Mansoura, Egypt; 13Department of Public Health and Community Medicine, Cairo University and Ministry of Health and Population, Cairo, Egypt; 14Department of Radiology, Minia University, Minia, Egypt; 15Department of Pulmonary Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt; 16Department of Emergency Medicine and Traumatology, Tanta University, Tanta, Egypt; 17Department of Tropical Medicine, Port Said University, Port Said, Egypt; 18Department of Chest Diseases, Damietta, Al-Azhar University, Damietta, Egypt; 19Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt*These authors contributed equally to this workCorrespondence: Sherief M Abd-Elsalam, Department of Tropical Medicine, Tanta University, Tanta, Egypt, Tel +201063319696, Email sherif.abdelbaky@med.tanta.edu.egBackground & Aims: Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic.Methods: A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists’ discussion held in Cairo July 2021 followed by electric voting for each statement.Results: The statements were electronically voted to be either “agree,” “not agree,” or “neutral.” For a statement to be accepted to the consensus, it should have 80% agreement.Conclusion: Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.Keywords: lung ultrasound, consensus, coronavirus disease 2019, Egypt

Studies have shown that COVID-19 patients experience high levels of anxiety, depression, and stress during the pandemic. Patients adopt different coping strategies to reduce their psychological distress.To compare the immediate and long-term psychological impact of COVID-19 disease on patients with and without chronic medical illnesses (CMI) and identify coping styles of both groups during the peak of COVID-19 disease in Egypt.This is a cohort follow-up study, that included an online survey consisting of General Health Questionnaire-12, Taylor Manifest Anxiety Scale, Beck Depression Inventory and Brief-COPE scale. The Post-Traumatic Stress Disorder (PTSD) Checklist was completed after 6 months. Questionnaires were distributed to adult patients with a confirmed diagnosis of SARS-CoV-2 virus infection during their quarantine in Egypt.There was no significant difference between the two groups regarding anxiety and depression during the acute infection. Patients without CMI relied significantly on the use of informational support to cope with COVID-19 disease. Patients with CMI continued to show significant depressive symptoms after 6 months without significant PTSD symptoms.COVID-19 has similar immediate psychological impact on patients with and without CMI. However, patients with CMI continue to show depression on long-term follow-up.

Background This work aimed to identify the mathematical model and ecological determinants of COVID-19 infection and mortality across different countries during the first six months of the pandemic. Methodology In this study, authors used the online available data sources of randomly selected 18 countries to figure out potential determinants of COVID-19 transmissibility and mortality. The studied variables were environmental factors (daily average temperature, daily humidity), socioeconomic attributes (population age structure, count and density, human development index, per capita income (PCI), gross domestic product, internet coverage) mobility trends and chronic diseases. Researchers used the linear and exponential time series analysis, and further utilized multivariate techniques to explain the variance in the monthly increase in cases and deaths. Results In the first two months, the R2 of linear models for the cases and deaths were higher than that of the corresponding R2 of the exponential model. Later one, R2 of the exponential model was occasionally relatively higher than that of the linear model. The exponential growth rate of new cases was significantly associated with mobility trends (β = 0.00398, P = 0.002), temperature (β = 0.000679, P = 0.011), humidity (β = 0.000249, P < 0.001), and the proportion of population aged ≥65 years (β = -0.000959, P = 0.012). Similarly, the exponential growth rate of deaths was significantly associated with mobility trends (β = 0.0027, P = 0.049), temperature (β = 0.0014, P < 0.001), humidity (β = -0.0026, P < 0.001), and PCI of countries. During this period, COVID-19 transmissibility was evident to be controlled as soon as social mobility is decreased by about 40% of the baseline over 3 months controlling for the other predictors. Conclusion Controlling of COVID-19 pandemic is based mainly on controlling social mobility. Role of environmental determinants like temperature and humidity was well noticed on disease fatality and transmissibility. Socio-demographic determinants of COVID-19 spread and fatality included modifiable risk factors like PCI and non-modifiable risk factors like ageing., Covid-19; Incidence rate; Mortality rate; Social mobility; Ecological factors; Contact frequency.

BACKGROUND: Egypt is among the world top 10 countries in diabetes prevalence. It is the first country among the MENA region. Healthy lifestyle education and support help people with diabetes to improve health outcomes. Many physical and psychological barriers can hinder patients from following a healthy lifestyle. AIM: This study aimed to examine the effect of lifestyle modification educational sessions in helping Egyptian patients to overcome main barriers of diabetes self-management through improving nutritional behaviours, physical activity, medication compliance, and blood glucose monitoring. METHODS: A cohort study included 205 patients with type 2 diabetes. Baseline assessment of patients' lifestyle behaviours and barriers using personal diabetes questionnaire of Louisville University, with both anthropometric and blood glucose assessment. Interventional lifestyle health education was provided weekly through multiple integrated techniques, followed by a post-intervention assessment to evaluate the effect of the health education sessions. Statistical analysis was done to identify any statistically significant difference before and after the health education intervention. RESULTS: There was a significant improvement of the post-education mean scores of the studied behaviours when compared with the pre-education scores of the participants’ behaviours (p < 0.001). There was also a significant reduction in the barriers facing patients to diabetes self-management including nutritional barriers (P < 0.001), medication compliance barriers (P < 0.001) with a percent change (43%), physical activity barriers (p < 0.001), and blood glucose monitoring (p < 0.001) with a percent change (44%).There was a statistically significant positive correlation between improvement of medication compliance (P = 0.027), blood glucose monitoring(P = 0.045), and glycated haemoglobin of the study participants CONCLUSION: lifestyle modification education of type 2 diabetic patients can overcome the main barriers of following a healthy lifestyle and improve their anthropometric measures and blood glucose level.

Background: The rapid worldwide spread of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or COVID-19 pandemic from its epicentre; Wuhan has led to an epidemiological breakdown. Egypt reported its first COVID-19 case on Feb 14, 20202,3. Thereafter, Egypt scaled-up preventive measures, with a partial lockdown starting on March 25. Several therapeutic agents along with Convalescent Plasma Transfusion are under investigation and data from Convalescent Plasma Transfusions (CPT) have been receiving a lot of attention, after Emergency approvals from the Food and Drug Administration (FDA) suggesting that it may provide a clinical effect in the treatment of SARS-COV-2 Importance: Early and effective treatment of COVID-19 is vital for control of SARS-CoV-2 infection Methods: -Designs: An interventional, single-arm, non-randomized clinical trial conducted in Egypt from April 15 to July 21, 2020. -Settings: This was a multi-centre study conducted in 3 hospitals in Egypt. -Participants: a total of 94 COVID-19 laboratory-confirmed patients using qRT-PCR were enrolled in the study. -Intervention: All patients were administered with two plasma units (each unit is 200cc). The volume of donated plasma was 800cc. -Main Outcome and Measures: Primary measure was the degree of clinical improvement among the COVID-19 patients who received CPT within seven days Results: A total of 94 patients were enrolled who received CPT either within seven days or after seven days of hospitalization. 82 were severely ill, 12 were critically ill. The average age remained 58 years (±SD 15.1 years). Male were 69% and 49% patients got cured while 51% died with CFR 51%. 75% deaths were above 45years of age. The symptoms were dyspnoea (55%), fever (52%), cough (46%), and loss of taste and smell (21%), and cyanosis (15%). The most common co-morbidities among the 60 years age group Hypertension (57%) and Chronic Heart Disease (24%) were reported. CPT within seven days remained significant as compared with the CPT after seven days with the number of days to cure (p=0.007) and ICU stay (P=0.008) among severely ill cured cases. Conclusions: Among patients with COVID-19 and severe or critical illness, the use of CPT along with routine standard therapy resulted in a statistically significant improvement when administered within seven days of hospital admission. However, plasma transfusion, irrespective of days to transfusion may not help treat critically ill patients. The overall mean time to cure in severely ill patients was 15 days if CPT provided within seven days with 65% cure rate. Trial Registration: Clinical Intervention identifier: MOHP_COVID-19_Ver1.1 registered April 2020 Keywords: Covid 19 pandemic, Convalescent plasma, SARS-CoV-2

IntroductionSince the worldwide emergence of the COVID-19, several protocols were used by different healthcare organisations. We evaluated in this study the demographic and clinical characteristics of COVID-19 disease in Egyptian population with special consideration for its mortality predictors.Methodology8162 participants (mean age 48.7±17.3 years,54.5% males) with RT-PCR positive COVID-19 were included. The electronic medical records were reviewed for demographic, clinical, laboratory, and radiologic features. The primary outcome was the in-hospital mortality rate.ResultsThe in-hospital mortality was 11.2%. There was a statistically significant strong association of in-hospital mortality with age >60 years old (OR:4.7; 95% CI 4.1-5.4;p3.1 (OR:6.4; 95% CI 4.4-9.5;P< 0.001), and ground glass opacities (GGOs) in CT chest (OR:3.5; 95% CI 2.84-4.4;PConclusionsThis multicenter, retrospective study ascertained the higher in-hospital mortality rate in Egyptian COVID-19 patients with different comorbidities.

BACKGROUND: Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019 (COVID-19) at variable prevalence. Most studies report mild liver function disturbances correlated with COVID-19 severity, though liver failure is unusual. AIM: To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes. METHODS: This multicentre cohort study was conducted on 547 Egyptian patients from April 15, 2020 to July 29, 2020. Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health. Demographic information, laboratory characteristics, treatments, fibrosis-4 (FIB-4) index, COVID-19 severity, and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms. Follow-ups were conducted until discharge or death. Regression analyses were performed to determine the independent factors affecting mortality. RESULTS: This study included 547 patients, of whom 53 (9.68%) died during hospitalization and 1 was discharged upon his request. Patients' mean age was 45.04 ± 17.61 years, and 21.98% had severe or critical COVID-19. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were available for 430 and 428 patients, respectively. In total, 26% and 32% of patients had elevated ALT and AST, respectively. Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21 (4.91%) and 16 (3.73%) patients, respectively. Male gender, smoking, hypertension, chronic hepatitis C, and lung involvement were associated with elevated AST or ALT. AST was elevated in 50% of patients over 60-years-old. FIB-4 was significantly higher in patients admitted to the intensive care unit (ICU), those with more severe COVID-19, and non-survivors. The independent variables affecting outcome were supplementary vitamin C intake (1 g daily capsules) [odds ratio (OR): 0.05, 95% confidence interval (CI): 0.008-0.337]; lung consolidation (OR: 4.540, 95%CI: 1.155-17.840); ICU admission (OR: 25.032, 95%CI: 7.110-88.128); and FIB-4 score > 3.25 (OR: 10.393, 95%CI: 2.459-43.925). Among 60 (13.98%) patients with gastrointestinal symptoms, 52 (86.67%) had diarrhoea. Patients with gastrointestinal symptoms were predominantly females with higher body mass index, and 50 (83.40%) patients had non-severe COVID-19. CONCLUSION: Few Egyptian patients with COVID-19 developed a significant liver injury. The independent variables affecting mortality were supplementary vitamin C intake, lung consolidation, ICU admission, and FIB-4 score.

COVID-19 pandemic raises an extraordinary challenge to the healthcare systems globally. The governments are taking key measures to constrain the corresponding health, social, and economic impacts, however, these measures vary depending on the nature of the crisis and country-specific circumstances.ObjectivesConsidering different incidence and mortality rates across different countries, we aimed at explaining variance of these variables by performing accurate and precise multivariate analysis with aid of suitable predictors, accordingly, the model would proactively guide the governmental responses to the crisis.MethodsUsing linear and exponential time series analysis, this research aimed at studying the incidence and mortality rates of COVID-19 in 18 countries during the first six months of the pandemic, and further utilize multivariate techniques to explain the variance in monthly exponential growth rates of cases and deaths with aid of a set of different predictors: the recorded Google mobility trends towards six categories of places, daily average temperature, daily humidity, and key socioeconomic attributes of each country.ResultsThe analysis showed that changes in mobility trends were the most significant predictors of the incidence and mortality rates, temperature and humidity were also significant but to a much lesser extent, on the other hand, the socioeconomic attributes did not contribute significantly to explaining different incidence and mortality rates across countries.ConclusionChanges in mobility trends across countries dramatically affected the incidence and mortality rates across different countries, thus, it might be used as a proxy measure of contact frequency.

COVID-19 patients, especially those with chronic medical illnesses (CMI), may use different coping strategies, to reduce their psychological distress while facing the COVID-19 infection. The aim was to compare anxiety, depression and coping styles between patients infected with COVID-19 disease with and without CMI during the peak of COVID-19 disease in Egypt. This is a cross sectional study, that included an online survey consisting of Arabic versions of General Health Questionnaire-12, Taylor Manifest Anxiety Scale (TMAS), Beck Depression Inventory (BDI) and Brief-COPE scale. Questionnaires were distributed to adult patients with a confirmed diagnosis of SARS-CoV-2 virus infection during their quarantine in Egypt. One hundred ninety-nine patients responded to the survey, where 46.73% of them had CMI. Religion, emotional support, use of informational support and acceptance were the most used coping strategies by participants. Avoidant coping strategies were frequently used by divorced patients, home quarantined individuals, patients who developed COVID-19 related anxiety/depression and patients who didn’t receive hydroxyl-chloroquine. Approach strategies were frequently used by patients with mild COVID-19. Understanding the used coping strategies has implications for how individuals might be helped to manage their illness during the current presentation and intervene with development of serious long-term mental health conditions.

Background & Aims: In the midst of this pandemic, planning the prioritization of hospital admissions for patients affected with COVID-19 should be of prime concern, particularly in healthcare settings with limited resources. Thus, in this study, we aimed to develop a novel approach to triage COVID-19 patients and attempt to prioritize their hospital admission using Lung Ultrasonography (LUS). The efficacy of LUS in triaging suspected COVID-19 patients and assessing the severity of COVID-19 pneumonia was evaluated; the findings were then compared with those obtained by chest computed tomography (CT). Method: This multicenter, cross-sectional study comprised 243 COVID-19 patients who presented to the emergency department in 3 major university hospitals in Egypt. LUS was performed by an experienced emergency or chest physician, according to the local protocol of each hospital. Demographic, clinical, and laboratory data were then collected from each patient. Each patient was subjected to chest CT scans and LUS. Results: The mean age of the 243 patients was 46.7 ± 10.4 years. Ground-glass opacity, subpleural consolidation, translobar consolidation, and crazy paving were reported in the chest CT scans of 54.3%, 15.2%, 11.1%, and 8.6% of the patients, respectively. B-line artifacts were observed in 81.1% of the patients (confluent pattern, 18.9%). The LUS findings completely coincided with the CT findings (Kappa agreement value, 0.77) in 197 patients (81.1%) and offered a diagnostic sensitivity of 74%, diagnostic specificity of 97.9%, positive predictive value of 90.2%, and negative predictive value of 93.6% for the COVID-19 patients. Following the addition of O2 saturation to the lung imaging findings, the ultrasound method was able to demonstrate 100% sensitivity and specificity in accurately differentiating between severe and non-severe lung diseases. Conclusion: LUS with oxygen saturation might prove to be effective in prioritizing the hospital admission of COVID-19 patients, particularly in healthcare settings with limited resources.

Introduction: The recently discovered novel coronavirus disease (COVID-19) has emerged in Wuhan, China, since January 2020. Egypt reported a low incidence of infection when compared with other countries. The aim of the study was to assess the characterization of COVID-19 infection among the Egyptian population. Methodology: Data were collected from a single COVID-19 quarantine hospital in Cairo. A total number of 195 cases were included with their clinical, laboratory, and radiological data. Results: Three different age groups behaved differently for COVD-19 infection. The pediatric age group was asymptomatic entirely, the middle age group (18-50 years) were asymptomatic in 53.3% of cases, while 77.9% of those above 50 years were symptomatic (p ≤ 0.001). The latter group had a high incidence of COVID-pneumonia in (83.1%), and moderate to critical presentations were encountered in 66.3% of them. Neutrophil to lymphocyte (N/L) ratio correlated directly with the age and case severity. C-reactive protein (CRP) and computed tomography scan chest (CT-chest) had added value on COVID-19 diagnosis in suspected cases. Conclusions: In Egypt, patients above 50 years are at a higher risk for symptomatic COVID-19 infection and leaner for moderate to critical COVID-19 presentation. The triad of CT-chest, CRP, and N/L ratio could be an integrated panel for assessing disease severity.

Objective: The aim of our study was to assess the knowledge and attitudes of married Egyptian women towards the different methods of contraception, examining the role of employment and education in...

Background and aims Treatment of hepatitis C virus (HCV) after successfully treated hepatocellular carcinoma (HCC) becomes possible with the introduction of direct-acting antivirals because of their favorable efficacy, safety, and short period of treatment. Few data are available on the results of treatment using different direct-acting antiviral regimens in successfully treated HCC and a lot of debate about its role in tumor recurrence. Methods Sixty-two HCV-related HCC patients were enrolled in the study after successfully treated HCC; the studied population included either Child–Pugh ‘A’ or ‘B7’. The patients were subcategorized to receive one of the following regimens: group 1: sofosbuvir (SOF)+ribavirin (RBV) for 24 weeks, group 2: SOF+simeprevir for 12 weeks, group 3: SOF+daclatasvir for 24 weeks, and group 4: SOF+daclatasvir+RBV for 12 weeks. The overall median follow-up period is 12 months after treatment initiation. Results All treatment regimens were tolerable for all patients, with no reported major adverse events during treatment. The overall sustained virologic response rate was 64.5%, with the highest result in group 4 and the lowest result in group 1; 87.5 and 26.7%, respectively. HCC recurrence was observed in 42% of patients; 80.7% of these patients developed recurrence within 6 months of treatment initiation. Conclusion Treatment of HCV in successfully treated HCC is feasible, with the best results achieved using multiple direct-acting antivirals and RBV; a high rate of HCC recurrence was observed, especially within the first 6 months of treatment initiation (ClinicalTrials.gov no: NCT02771405).

Background and study aim Transient elastography is widely used to assess fibrosis stage in chronic hepatitis C (CHC). We aimed to establish and validate different transient elastography cut-off values for significant fibrosis and cirrhosis in CHC genotype 4 patients. Patients and Methods The data of 100 treatment-naive CHC patients (training set) and 652 patients (validation set) were analysed. The patients were subjected to routine pretreatment laboratory investigations, liver biopsy and histopathological staging of hepatic fibrosis according to the METAVIR scoring system. Transient elastography was performed before and in the same week as liver biopsy using FibroScan (Echosens, Paris, France). Transient elastography results were correlated to different stages of hepatic fibrosis in both the training and validation sets. Results ROC curves were constructed. In the training set, the best transient elastography cut-off values for significant hepatic fibrosis (≥F2 METAVIR), advanced hepatic fibrosis (≥F3 METAVIR) and cirrhosis (F4 METAVIR) were 7.1, 9 and 12.2 kPa, with sensitivities of 87%, 87.5% and 90.9% and specificities of 100%, 99.9% and 99.9%, respectively. The application of these cut-offs in the validation set showed sensitivities of 85.5%, 82.8% and 92% and specificities of 86%, 89.4% and 99.01% for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, respectively. Conclusion Transient elastography performs well for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, with validated cut-offs of 7.1, 9 and 12.2 kPa, respectively, in genotype 4 CHC patients.

Objectives: To validate the diagnostic performance of Hepa-Index in predicting different stages of hepatic fibrosis in Egyptian patients with chronic hepatitis C (CHC). Methods: Hundred treatment naive chronic hepatitis C Egyptian patients were prospectively enrolled between June 2014 and January 2015. They were subjected to: platelet count, alpha-2-macroglobulin ( α 2-MG), total bilirubin, gamma glutamyl transpeptidase (GGT), total cholesterol, liver biopsy and histopathological staging of hepatic fibrosis according to METAVIR scoring system. Hepa-Index was calculated according to the formula: Hepa-Index=exp (-0.021 x platelet +1.65 x α 2-MG+0.2 x total bilirubin + 0.026 x GGT -1.215 x total cholesterol) / (1+exp (-0.021 x platelet + 1.65 x α 2-MG + 0.2 x total bilirubin +0.026 x GGT -1.215 x total cholesterol). Results: Hepa-Index correlates positively with the stage of hepatic fibrosis. Cut off values of Hepa-Index were: 0.2 for predicting significant hepatic fibrosis (≥F2 METAVIR), 0.3 for severe hepatic fibrosis (≥F3 METAVIR) and 0.4 for cirrhosis (F4 METAVIR). Hepa-Index was able to detect significant fibrosis with sensitivity of 69.4%, specificity of 76.3% and AUROC of 0.803. Hepa-Index was also able to detect severe hepatic fibrosis with sensitivity of 79.2%, specificity of 64.5% and AUROC of 0.783 and cirrhosis with sensitivity of 81.8%, specificity of 68.5% and AUROC of 0.744. Conclusion: Hepa-Index is a good non-invasive biomarkers panel that can be used for non-invasive assessment of hepatic fibrosis in chronic hepatitis C patients. Saudi Med J 2017; Vol. 38 (11): 1137-1142 doi: 10.15537/smj.2017.11.21220 How to cite this article: Alboraie M, Schutte K, Khairy M, Elsharkawy M, Asem N, Elghamry F, et al. Validation of Hepa-index as a non-invasive biomarkers panel for assessment of hepatic fibrosis in Egyptians with chronic hepatitis C. Saudi Med J . 2017 Nov;38(11):1137-1142. doi: 10.15537/smj.2017.11.21220.

Background Patient safety is regarded as a global problem by which both developed and developing worlds are affected. It is defined as avoidance and prevention of patient injuries or adverse events, which could result during health care delivery. This study aimed to identify physicians’ knowledge, influence, and attitude toward patient’s safety in the faculty of medicine, Cairo university. Materials and methods A cross-sectional study was conducted on 187 postgraduate physicians of different specialties working in the faculty of medicine, Cairo University. Anonymous self-administered questionnaires were distributed. The questionnaire is one of a series of tools designed for evaluation of the pilot implementation of the World Health Organization patient safety curriculum for medical schools. Results Calculated attitude score was relatively higher than influence, then knowledge score (median scores were 4.25, 3.1, and 2.5 respectively). There was no difference in knowledge, attitude, and influence scores by different personal characteristics as gender, specialty, workplace, graduation year except for higher influence score among physician who received inpatient safety training (p = 0.016). There was a weak positive significant correlation between knowledge and influence scores and between influence and attitude scores (r = 0.25, p = 0.002; r = 0.27, p < 0.001 respectively). Conclusion Higher patient safety positive attitude than influence and knowledge is pinpointed in physicians of different specialties in the faculty of medicine, Cairo University. This raises the attention to the importance of implementation of continuing patient safety education programs.

Background Congenital adrenal hyperplasia (CAH) is a chronic disorder causing adrenal insufficiency and hyperandrogenism affecting the quality of life (QOL). The objective of the study was to assess the health-related QOL (HRQOL) in Egyptian children and adolescents with CAH and to identify factors affecting it. Methods This cross-sectional study included 200 CAH patients (with 21-hydroxylase deficiency [21-OHD]) who were assessed according to their age, sex, clinical phenotype, timing of genitoplasty, hospital admissions within the last year, compliance to treatment, regularity of follow-up, presence of complications and hormonal control. HRQOL was assessed using the World Health Organization (WHO)QOL-BREF questionnaire with four domains analyzed independently including physical, psychological, social and environmental domains, with higher scores indicating better QOL. Results The study included 140 females and 60 males with a mean age of 6.6 ± 4.5 years, and 88% were salt-wasting (SW). Older patients had significantly lower QOL scores (r = − 0.151, p = 0.033). The physical domain correlated significantly with the degree of virilization (r = − 0.491, p = 0.001) and frequency of hospitalization (r = − 0.495, p Conclusions HRQOL was relatively more affected in CAH patients with older age, poor hormonal control, high frequency of hospital admissions and those who developed complications.

Background and study aims Multiple noninvasive methods have been used successfully in the prediction of fibrosis. However, their role in the prediction of response to hepatitis C virus (HCV) antiviral therapy is debatable. The aim of this study was to validate and compare the diagnostic performance of FibroScan, APRI (aspartate aminotransferase (AST)-to-platelet ratio index), FIB4, and GUCI (Goteborg University Cirrhosis Index) for the prediction of hepatic fibrosis and treatment outcome in HCV-infected patients receiving pegylated interferon and ribavirin (PEG-IFN/ribavirin). Patients and methods This study included 182 Egyptian patients with chronic HCV infection. They were classified into two groups based on the stages of fibrosis: mild to significant fibrosis (F1–F2) and advanced fibrosis (F3–F4). The APRI, FIB4, and GUCI scores were calculated before the antiviral treatment. The FibroScan was performed for all patients before treatment. Results Stiffness and FIB4 have greater sensitivity and specificity in detecting advanced fibrosis of 80%, 77% and 88%, 84%, respectively. Based on multivariate regression analysis, FIB4, body mass index (BMI), and alpha-fetoprotein (AFP) level were found to be statistically significant predictors of advanced fibrosis ( p -value: 0.000, 0.011, and 0.001, respectively) with odds ratio (OR: 3.184, 1.170, and 1.241, respectively). With respect to virological response, the stiffness, APRI, FIB4, and GUCI were significantly lower in sustained virological responders. However, these are not good predictors of response to PEG-IFN/ribavirin therapy. AFP was the only statistically significant predictor of response ( p = 0.002) with OR of 1.141 in multivariate regression analysis. Conclusion FibroScan and noninvasive scores such as APRI, FIB4, and GUCI can be used as good predictors of liver fibrosis in chronic hepatitis C. However, they are not good predictors of response to PEG-IFN/ribavirin therapy.

Purpose The outcome predictors of Kasai portoenterostomy (KPE) for biliary atresia (BA) are controversial. This study aimed to identify possible short-term outcome predictors of KPE for BA in infants. Methods This retrospective study included infants with BA who underwent KPE between January 2015 and December 2017 and were followed up for at least 6 months after surgery at the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Egypt. The short-term outcome was jaundice clearance within 6 months following surgery. All data were compared between the jaundice free group and those with persistent jaundice to identify the predictors of jaundice clearance. Results The study included 75 infants. The mean age at the time of surgery was 82.43±22.77 days (range, 37-150 days), and 28 (37.3%) infants cleared their jaundice within 6 months postoperative. Age at surgery did not significantly affect the outcome (p=0.518). Infants with persistent jaundice had significantly higher pre-operative levels of aspartate aminotransferase (AST) than those who were jaundice free (p=0.041). Receiver operating characteristic curve analysis showed that preoperative AST ≤180 IU/L was predictive of a successful KPE, with sensitivity 74.5% and specificity 60.7%. Infants with bile plugs in liver biopsy had a 6-fold higher risk of persistent jaundice than those without bile plugs (95% confidence interval: 1.59-20.75, p=0.008). Conclusion Jaundice clearance after KPE for BA can be predicted using preoperative AST and presence of bile plugs in liver biopsy.

The aim of our study was to assess the knowledge and attitudes of married Egyptian women towards the different methods of contraception, examining the role of employment and education in modulating contraceptive behaviour.A cross-sectional survey was conducted among 2360 Egyptian women between 15 and 45 years of age who were attending outpatient clinics at a university hospital in Cairo between August 2017 and January 2018. The survey collected sociodemographic data as well as information on education, employment, knowledge about contraceptive methods, current and previous use of contraception, source of family planning advice and side effects from previous contraceptive use.The response rate was 90.2%. Current use of a contraceptive method was 38.3%. The intrauterine device (IUD) was the leading contraceptive method (50.7%), followed by oral contraceptives (OCs) (23.6%). Contraceptive prevalence was significantly higher among working women (p .001), whose primary choice was OCs, while IUD use was significantly higher among non-working women (p .001). Contraceptive prevalence was highest among women with secondary school education or higher (41.6%).Both employment status and educational level of the surveyed women played a significant role in their contraceptive behaviour.

Background and Study Aims The risk of hepatocarcinogenesis depends on background liver factors, of which fibrosis is a major determinant. Serum markers and scores are of increasing importance in non-invasive diagnosis of hepatic fibrosis. Our aim was to predict the occurrence of hepatocellular carcinoma (HCC) using a non-invasive fibrosis score calculated using routine patient data. Patients and mthods Our retrospective study included 1,291 hepatitis C related-HCC Egyptian patients (Group 1) recruited from the multidisciplinary HCC clinic, Faculty of Medicine, Cairo University in the period between February 2009 and June 2016 and 1072 chronic hepatitis C-naive patients (Group 2) with advanced fibrosis (≥F3) and cirrhosis (F4). King score, Fibro Q score, Aspartate aminotransferase-to-platelet ratio index (APRI), AST to ALT ratio (AAR), LOK score, Goteborg University Cirrhosis Index (GUCI), Fibro-α and Biotechnology Research Center (BRC) scores were calculated for all patients. Regression analysis and receiver operating characteristics (ROC) were used to calculate the sensitivity, specificity and predictive values for significant scores with the best cut-off for predicting HCC. A regression equation was used to calculate predicted probabilities of HCC using the following variables; age, gender, haemoglobin, international normalised ratio (INR), albumin and alpha fetoprotein. The appropriate score cut-off points yielding optimal sensitivity and specificity were determined by ROC curve analysis. Results There was a highly significant difference between the two groups for all calculated scores (P = 0.0001). Our new score, the Hepatocellular Carcinoma Multidisciplinary Clinic-Cairo University (HMC-CU) score (Logit probability of HCC = − 2.524 + 0.152*age – 0.121*Hb − 0.696*INR – 1.059*Alb + 0.022*AFP + 0.976*Sex. Male = 1, Female = 0), with a cut-off of 0.559 was superior to other scores for predicting HCC, having a sensitivity of 90% and specificity of 80.6%. Conclusion The HMC-CU score is a promising, easily calculated, accurate, cost-effective score for HCC prediction in chronic HCV patients with advanced liver fibrosis.

Background and study aims Chronic infection caused by Helicobacter pylori ( H. pylori ) is associated with chronic gastritis, peptic ulcer disease, and gastric cancer. Eradication of H. pylori reduces morbidity of chronic gastritis and incidence of gastric cancer in high-risk population. We aimed at testing the efficacy of clarithromycin-based triple therapy and bismuth-based quadruple therapy for eradicating H. pylori in patients with chronic gastritis in Kuwait. Patients and methods A total of 218 dyspeptic patients from different countries who were proved to have chronic gastritis by endoscopy and gastric biopsy were enroled. All of them were naive to H. pylori eradication therapy. They were randomised into two groups: group A, received triple therapy (omeprazole, amoxicillin, and clarithromycin) for 10 days; and group B, received quadruple therapy (omeprazole, bismuth subcitrate potassium, tetracycline, and metronidazole) for 10 days. All patients were tested for eradication of H. pylori by carbon-13 urea breath test 4 weeks after treatment. Results Total response rate of eradication therapy in both groups was 77.5% ( n = 169). However, group B ( n = 100) had a higher eradication rate (88%) than group A ( n = 118) (68.6%). H. pylori eradication rate was significantly higher in males (84.2%) than females (70.2%) in both groups ( p Conclusion Bismuth-based quadruple therapy is more effective as a first-line therapy than clarithromycin-based triple therapy for eradicating H. pylori in patients with H. pylori -related chronic gastritis in Kuwait.

Serum levels of alpha-fetoprotein (AFP) were reported to increase in patients with significant or advanced hepatic fibrosis. Combination of non-invasive tests decreases the use of liver biopsy in large proportion of chronic HCV patients. The aim of the study was to compare and combine AFP with commonly used non-invasive fibrosis tests in novel scores for prediction of different stages of hepatic fibrosis. Six hundred and fifty two treatment naive chronic hepatitis C patients were enrolled. Demographic data, basic pre-treatment laboratory tests including complete blood count (CBC), liver biochemical profile and renal functions test, international normalized ratio (INR) in addition to AFP, liver stiffness measurement (LSM) by Fibroscan and liver biopsies were retrospectively analyzed. AST to Platelet Ratio Index (APRI) and FIB-4 scores were calculated. Different predictive models using multivariate logistic regression analysis were generated and presented in equations (scores) composed of a combination of AFP, LSM plus FIB-4/APRI scores. AFP was correlating significantly with LSM, FIB-4, and APRI scores. Areas under receiver operating characteristic curves (AUROCs) for predicting significant hepatic fibrosis, advanced hepatic fibrosis, and cirrhosis were 0.897, 0.931, and 0.955, respectively, for equations (scores) containing AFP, LSM, and FIB-4. AUROCs for predicting significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis were 0.897, 0.929, and 0.959, respectively, for equations (scores) containing AFP, LSM, and APRI. The study shows that combining AFP to serum biomarkers and LSM increases their diagnostic performance for prediction of different stages of liver fibrosis.

TheFaculty of Medicine at Cairo University in Egypt has a responsibility to ensure that scientifically valid research is conducted according to accepted ethical practices that promote the rights and welfare of research subjects. As such, in 2002, the Dean of the Faculty of Medicine established a research ethics committee (REC) to review human subject research conducted by staff at Kasr Al Ainy hospital. Cairo University obtained an FWA from the US Office of Human Research Protections (OHRP); the REC is also registered at OHRP.

Aim Serum markers and developed scores are of rising importance in non-invasive diagnosis of hepatic fibrosis. Aspartate aminotransferase-to-platelet ratio index (APRI), FIB-4 and Forns' index are validated scores used for diagnosis of liver fibrosis. The Egy-Score is a newly developed score for detection of hepatic fibrosis with promising results. We aimed to assess the accuracy of the Egy-Score in the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis compared to APRI, FIB-4 and Forns' in chronic hepatitis C virus (HCV) patients. Methods A retrospective study including 100 chronic hepatitis C naive Egyptian patients was performed. Patients were classified according to stages of fibrosis into three groups: significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4). Egy-Score, APRI, FIB-4 and Forns' index were calculated. Regression analysis and receiver–operator curves were plotted to assess the sensitivity, specificity and predictive values for the significant scores with the best cut-off for diagnosis. Results An Egy-Score of 3.28 or more was superior to APRI, FIB-4 and Forns' index for detecting advanced fibrosis with a sensitivity of 91% and specificity of 78%. An Egy-Score of 3.67 or more was superior to APRI, FIB-4 and Forns' index for detecting cirrhosis with a sensitivity of 82% and specificity of 87%. Forns' index was superior to Egy-Score, FIB-4 and APRI for detecting significant fibrosis. Conclusion The Egy-Score is a promising, accurate, easily calculated, cost-effective score in the prediction of hepatic fibrosis in chronic HCV patients with superiority over APRI, FIB-4 and Forns' index in advanced hepatic fibrosis and cirrhosis.

Serum markers and developed scores are of rising importance in non-invasive diagnosis of hepatic fibrosis. Aspartate aminotransferase-to-platelet ratio index (APRI), FIB-4 and Forns' index are validated scores used for diagnosis of liver fibrosis. The Egy-Score is a newly developed score for detection of hepatic fibrosis with promising results. We aimed to assess the accuracy of the Egy-Score in the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis compared to APRI, FIB-4 and Forns' in chronic hepatitis C virus (HCV) patients.A retrospective study including 100 chronic hepatitis C naïve Egyptian patients was performed. Patients were classified according to stages of fibrosis into three groups: significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4). Egy-Score, APRI, FIB-4 and Forns' index were calculated. Regression analysis and receiver-operator curves were plotted to assess the sensitivity, specificity and predictive values for the significant scores with the best cut-off for diagnosis.An Egy-Score of 3.28 or more was superior to APRI, FIB-4 and Forns' index for detecting advanced fibrosis with a sensitivity of 91% and specificity of 78%. An Egy-Score of 3.67 or more was superior to APRI, FIB-4 and Forns' index for detecting cirrhosis with a sensitivity of 82% and specificity of 87%. Forns' index was superior to Egy-Score, FIB-4 and APRI for detecting significant fibrosis.The Egy-Score is a promising, accurate, easily calculated, cost-effective score in the prediction of hepatic fibrosis in chronic HCV patients with superiority over APRI, FIB-4 and Forns' index in advanced hepatic fibrosis and cirrhosis.