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Mohsen Salama,&ast; Nehad Darwesh,&ast; Maha Mohammad Elsabaawy,&ast; Eman Abdelsameea,&ast; Asmaa Gomaa,&ast; Aliaa Sabry&ast; Department of Hepatology and Gastroenterology, National Liver Institute, Menofia University, Shebeen El-Kom, Menofia, Egypt&ast;These authors contributed equally to this workCorrespondence: Asmaa Gomaa, National Liver Institute, Menofia University, Shebeen El-Kom, Menofia, Egypt, Tel +20-1006157160, Email aibrahim@liver-eg.orgPurpose: This research was designed to determine the long-term outcomes in patients with liver cirrhosis who achieved sustained virological response (SVR) after direct-acting anti-viral drugs (DAAs) based regimens.Patients and Methods: This study involved 193 patients with HCV-related cirrhosis who had previously completed DAAs regimens and accomplished SVR. Clinical, laboratory, and radiological features at the first and 3rd-year follow-up after the end of treatment were analyzed. Overall survival (OS) and incidence of liver decompensation or hepatocellular carcinoma (HCC) were determined at the 5-year follow-up.Results: About 68.4% of our patients with HCV-related cirrhosis were males and their mean age was 54.8 ± 7.7 years. Follow-up at the first and the 3rd-year showed significant improvements in albumin (P = 0.001), liver enzymes (P = 0.001), alpha-fetoprotein (AFP) (P < 0.001), platelet count (P = 0.001), the model for end-stage liver disease (MELD) score (P = 0.001 and 0.01), FIB4 and Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) scores (p < 0.001). The liver stiffness (LS) also significantly improved (p = 0.001). At the 5th year, the mean OS was 58.3 months, with 14.5% and 17.6% of patients developing de-novo HCC and decompensation, respectively. The mean OS at the 5th-year follow-up was shorter in patients who developed HCC and those with liver decompensation (p = 0.001). Alfa-fetoprotein and LS are predictive factors for HCC development.Conclusion: Despite achieving SVR, continuous surveillance for HCC and new-onset decompensation is mandatory in patients with liver cirrhosis.Keywords: long-term outcomes, cirrhotic patients, sustained virological response, DAAs

Drones have gained increasing attention in the healthcare industry for mobility and accessibility to remote areas. This perspective-based study proposes a drone-based sample collection system whereby COVID-19 self-testing kits are delivered to and collected from potential patients. This is achieved using the drone as a service (DaaS). A mobile application is also proposed to depict drone navigation and destination location to help ease the process. Through this app, the patient could contact the hospital and give details about their medical condition and the type of emergency. A hypothetical case study for Geelong, Australia, was carried out, and the drone path was optimized using the Artificial Bee Colony (ABC) algorithm. The proposed method aims to reduce person-to-person contact, aid the patient at their home, and deliver any medicine, including first aid kits, to support the patients until further assistance is provided. Artificial intelligence and machine learning-based algorithms coupled with drones will provide state-of-the-art healthcare systems technology.

À travers une lecture approfondie de La petite dernière et de ses stratégies narratives, cet article se propose d'envisager l'autofiction de Fatima Daas comme une métonymie du processus de construction d'une subjectivité hétérogène qui se matérialisera dans un double mécanisme: celui de la départenance et de l'ubiquité. S'éloignant des espaces discursifs hégémoniques, cette subjectivité ne résidera ni dans un "ni x, ni y," corolaire de l'entre-deux, ni dans un "tantôt x, tantôt y," écho du bipolarisme, mais dans un "à la fois x et y," avatar de l'ubiquité qui autorisera le "je" à être tout et partout à la fois. [ABSTRACT FROM AUTHOR]

Background and Aims: In response to direct‐acting antivirals (DAAs) therapy, patients who experience a decrease in hepatic venous pressure gradient (HVPG) considerably reduce liver complications and have increased survival. This study aimed to assess the metabolomic changes associated with the changes in HVPG from the start of DAA therapy until 48 weeks after effective DAA therapy in patients with advanced HCV‐related cirrhosis. Methods: We carried out a multicenter longitudinal study in 31 patients with advanced hepatitis C virus (HCV)‐related cirrhosis. We performed a non‐targeted metabolomic analysis using gas chromatography–mass spectrometry and liquid chromatography‐mass spectrometry, as well as analysis of inflammation‐related biomarkers using Luminex technology. The statistical analysis was performed by Generalised Linear Mixed‐effects Models (GLMM), correcting for multiple testing. Results: We found that increases of 2,3‐butanediol (AMR = 1.15; q‐value = 0.023) and taurocholic acid (AMR = 1.06; q‐value < 0.001) were significantly associated with increases in HVPG and inflammatory biomarker levels from before DAA therapy to one year after completion of successful HCV treatment. Conclusions: These metabolites have a potential role as indicators of portal hypertension evolution. [ABSTRACT FROM AUTHOR]

Objectives: HIV/hepatitis C virus (HCV) co‐infection among people who inject drugs (PWID) remains a global health problem. The goal of our study was to evaluate, in a real‐world setting, success rates of sustained virological response (SVR) using direct‐acting antivirals (DAAs) to treat a population of PWID living with HCV/HIV. Methods: This was a prospective single‐center observational study. We collected demographic, socioeconomic, and clinical data pertaining to HIV and HCV infection in PWID with several barriers to care. We identified risk factors for SVR failure. Results: Among 130 individuals retained to HIV care, we planned HCV treatment in 119/130 (91.5%); 106/119 (89.1%) started treatment with DAAs and 100/106 (94.3%) completed treatment. People not starting treatment were more often in active opioid drug use (odds ratio [OR] 0.25; 95% confidence interval [CI] 0.07–0.97, p = 0.045) and benzodiazepine abuse (OR 0.25; 95% CI 0.07–0.95, p = 0.042). Only 86/100 (86%) were tested for SVR at 12 weeks (SVR12) and 72/86 (83.7%) achieved SVR. PWID in opioid substitution programmes tended to return for SVR12 testing more often (54.7% vs. 30%, p = 0.081). Individuals in active opioid drug use (OR 0.226; 95% CI 0.064–0.793, p = 0.02) or with poor adherence (OR 0.187; 95% CI 0.043–0.814, p = 0.025) were less likely to achieve SVR. At the end of our study period, 113/119 (95%) treatment‐eligible patients remained alive. HCV infection was cured in 68/113 (61.1%) people. Conclusions: Our findings underscore the importance of prioritizing combatting substance use to achieve HCV elimination goals. A systematic approach with effort to overcome barriers to receiving and completing treatment and encourage to enrol in opioid substitution programmes if not possible to completely abstain from use, can help increase chances of HCV cure. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) was first identified in 1989. The situation in Egypt is really dire. The prevalence of HCV genotype 4 (GT-4) is 14.7%. About 10% of the middle-aged population (ages 15 to 59) is infected with HCV. As a result, the Hepatitis C virus is considered extremely contagious. The introduction of the directly acting antiviral medications (DAAs), sofosbuvir or simeprevir, in GT-4 patients with PEGylated interferon (PEG-IFN) and ribavirin (RBV) in a 12-week regimen substantially increased sustained virological response (SVR) rates for HCV GT-4 in 2014. Daclatasvir (DCV) is the first DAA identified in the family of HCV NS5A inhibitors with antiviral activity against a variety of HCV genotypes. It is well tolerated and safe, with a low risk of drug-drug interactions and resistance. Many investigations have discovered a rapid initial viral decline followed by a gradual decline in viral RNA, demonstrating DCV's inhibitory effect on viral reproduction, assembly, and secretion. DCV is a CYP3A4 substrate as well as a substrate for P-glycoprotein (P-gp), the most common drug efflux transporter, which are both expressed in hepatocytes and enterocytes, however it is not a BCRP substrate (Breast Cancer Resistence Protein). Concomitant treatment of DCV with other medications targeting CYP3A4 or P glycoprotein may change its pharmacokinetic characteristics.

In Egypt, Sofosbuvir (SOF) in combination with Dataclasvir (DCV) is the broadly used DAAs with excellent therapeutic profile. This study is designed to explore the relation between IL28B/TLR4 genetic variants and each of the followings; HCC development post SOF/DCV treatment, progression to HCC in naïve patients and SOF/DCV therapy outcome. A total of 493 blood samples were collected (controls (n = 70); HCV patients treated with SOF/DCV (n = 252) of whom 65 patients developed HCC, 187 patients didn't develop HCC (125 responders, 62 relapsers); naïve HCV patients (n = 171) had early (n = 48), late liver fibrosis (n = 21) and HCC (n = 102)). Both SNPs were genotyped using a TaqMan 5′ allelic discrimination assay. At IL28B rs12979860 SNP, the C allele was significantly correlating with the response rate more than T allele (OR 1.9, 95% CI 1.29–2.9, p = 0.004), while at TLR4 rs4986791 SNP, no association was found (OR 6.5, 95% 0.57–75.28, p = 0.09). Both SNPs couldn't detect the probability for HCC emergence after treatment. In naïve patients, the protective alleles were detected in their lowest frequency in HCC patients (p = 0.1, for rs12979860 and, p = 0.001 for rs4986791). SOF/DCV combination improved SVR rates in HCV genotype 4a infected patients regardless of IL28B genotype, with the best rates in those lacking the T allele.