Chronic hepatitis C treatment: a systematic review

Background: Chronic hepatitis C [CHC] infection affects almost 3% of the global population and can lead to cirrhosis, liver failure, and hepatocellular carcinoma in a significant number of those infected. Thus, there is a compelling need to develop and introduce new therapeutics with a direct-acting antiviral effect in order to target various stages of the HCV lifecycle for HCV eradication without concomitant interferon

Study Objective: to provide treatment recommendations for chronic HCV for specialists and generalists based on published evidence

Methods: A literature search of Web of Science, Scopus, Embase, Agricola, Cochrane Library, Cinahl Plus, Google Scholar, and Oaister was conducted from 1990 to 2016, records were filtered according to the Inclusion criteria and 27 hits were yielded

Results: Hepatitis C virus genotype 1 is more difficult to cure than genotype 2 or genotype 3. Patients with HCV genotype 1 should receive treatment with sofosbuvir + pegylated interferon + ribavirin because of the shorter duration of therapy and high rates of SVR [89%-90%]. Simeprevir + pegylated interferon + ribavirin is an alternative for patients with HCV genotype 1 [SVR, 79%-86%]. Patients with HCV genotypes 2 and 3 should receive therapy with sofosbuvir + ribavirin alone [SVR for genotype 2, 12 weeks' duration: 82%-93%; SVR for genotype 3, 24 weeks' duration, 80%-95%]. Patients with HIV-HCV coinfection and patients with compensated cirrhosis [ie, cirrhosis but preserved synthetic liver function] should receive the same treatment as HCV-monoinfected patients

Conclusion: A growing body of evidence suggests that recently developed HCV combined treatment modalities have transformed chronic HCV into a routinely curable disease being relatively available and well tolerated,which can potentially reduce the need for liver transplantation and reduce HCV-related mortality. Treatment protocol for genotype1 is based on a combined regimen of Pegylated interferons with ribavirin and sofosbuvir or simeprevir while Sofosbuvir with ribavirin alone should be used to treat patients infected with HCV genotypes 2 and 3. Patients coinfected with human immunodefiency virus and HCV genotype 1 should be treated for HCV with pegylated interferons, ribavirin, and sofosbuvir by a physician with experience in treating this particular group of patients and familiar with potential drug interactions

Accidental genital trauma in the female children in Jordan and the role of forensic medicine

To evaluate the frequency and the nature of genital trauma in female children in Jordan, and to stress the role of forensics. This is a cross-sectional study conducted between March 2008 and December 2011 in Jordan University Hospital, Amman, Jordan. Sixty-three female children were examined for genital trauma after immediate admission. The mechanism of injury was categorized and reported by the examiners as either straddle, non-straddle blunt, or penetrating. Straddle injury was the cause of injuries in 90.5% of patients, and contusions were the significant type of injury in 34% of patients, followed by abrasions in both labia majora and labia minora. Only one case suffered from non-intact hymen and 2 had hematuria. These 3 cases [4.7%] required surgical intervention and follow-up after 2 weeks. Straddle injuries were the main cause of genital trauma and rarely affect the hymen; however, due to the sensitivity of the subject and the severity of the traumas, forensic physicians should provide consultation and cooperate with gynecologists to exclude or confirm hymenal injuries, where empathy is necessary to mitigate tension associated with such injuries for the sake of the child and the parents as well, along with good management of the injury type

Worsening cholestasis after endoscopic retrograde cholangiopancreatography

Prolonged cholestasis is a rare complication of endoscopic retrograde cholangiopancreatography [ERCP] with few cases reported in literature. A case of a 39-year-old Jordanian woman who presented with abdominal pain and jaundice was reported. Clinical investigations revealed cholestasis with dilatation of the intrahepatic biliary system. A cholecystectomy had been performed 15 years earlier. ERCP findings were consistent with a mild biliary obstruction. The symptoms were thought to be due to a biliary stone that had passed spontaneously. Her abdominal pain subsided and she was discharged. A few days later the patient's jaundice worsened and she developed severe pruritus. A viral and autoimmune screen were negative and a repeat abdominal ultrasound was normal. She was treated with ursodeoxycholic acid for 10 days, but with no improvement. The patient declined to undergo a liver biopsy. A dramatic improvement was achieved following a short course of oral corticosteroids

Knowledge, attitude and practice towards immunizations among mothers in a traditional city in the United Arab Emirates

The United Arab Emirates [UAE] has a high coverage of childhood immunizations, but since coverage highly depends on the knowledge and attitude of mothers, it is important to assess these in a rapidly developing and changing society. The survey enrolled 217 women attending maternity clinics in Al Ain, a traditional desert city in the Emirate of Abu Dhabi, UAE and estimated the prevalence of a positive attitude towards immunizations. Knowledge and attitude variables as well as factors related to these variables were explored. Having a positive attitude towards immunizations was prevalent in 93% of mothers. Three factors significantly related to a positive attitude arose: knowledge, education and Arab nationality. Three factors associated with knowledge also arose: education, receipt of information on immunizations from health professionals and, again, Arab nationality. Despite the currently highly prevalent positive attitude towards immunizations in the United Arab Emirates, information by health professionals should focus more on parents with lower education and those of non- Arab nationality

Migration of an intrauterine contraceptive device into the sigmoid colon

We present a case of migrating copper-T intrauterine contraceptive device [IUCD] into the bowel wall at the recto-sigmoid junction, and the colonoscopic retrieval of the device. This case introduces the possibility of safe rectal retrieval of migrating IUCD implanted into the bowel wall

Radiological mainfestions of madura foot in the eastern province of Saudi Arabia

A total of 29 patients with mycologically and histopatologically proven mycetomas were examined for radiological manifestations from April 1984 to March 1996. Twenty cases were actinomycotic mycetomas, while nine were maduromycotic myctomas. Plain x-rays of the regions of interest were taken in all the cases and CT scan was performed on five selected cases to compare the findings. Soft tissue changes were observed in all the examined cases, while bony changes were observed in 16 [55.7%]. CT scan is useful for showing soft tissue changes, erosion and destruction of bone in cases with an early infection only, which cannot be demonstrated in plain radiographs

Limitations of tympanometry in diagnosis of otitis media with effusion

Some dismatch was noticed between results of automatic tympanometric screening and operative findings in cases of otitis media with effusion. Many cases which had type-B preoperative tympanogram showed no fluid during myringotomy. This prompted us to study this phenomenon in 50 patients with type B tympanogram. To assess the accuracy of doagnosis of otitis media with effusion, the tympanometric results were correlated to history clinical findings and audiometry in cooperative patients. This will help us to limit the increasing number of unnecessary myringotomies based on false tympanometric results which was shown by this study to have an accuracy of 75.26% only

Leprosy: an unexpected presentation

A case of a 70 years-old Kuwaiti woman was presented with severe epistaxis. Physical examination was unremarkable for skin lesions or facial deformities. Nasal examination revealed nasal hypoalgesia and bleeding from a localized mass. Histological examination of the excised mass revealed granuloma and modified Zeil-Nelson stain confirmed the presence of mycobacterium leprae. In this patient, nasal hypoalgesia, epistaxis, and the localized nasal granuloma were the only manifestations of an active infectious disease