Prevalence and Risk factors of overt- and occult Hepatitis C virus infection among Chronic Kidney Disease patients under regular Hemodialysis in Egypt

Background: hepatitis C virus [HCV] infection is a major health problem. It is more prevalent among chronic kidney disease [CKD] patients. Occult HCV infection, a new, entity has been described

Aims: to find out prevalence of occult HCV infection among CKD patients under regular hemodialysis [RHD] and to define epidemiology of HCV infection among them

Patients and Methods: a sample of 100 CKD patients under RHD was recruited. A questionnaire form was used to collect data. HCV-RNA was tested in serum to detect overt HCV infection patients. HCV-RNA was tested in peripheral blood mononuclear cells of undetected HCV-RNA patients' serum to determine those with occult HCV infection. Rest of the patients was considered HCV free. Biochemical tests were done to all patients

Results: prevalence of overt and occult HCV infection among CKD patients under RHD was 34.0% and 27.3%, respectively. Liver and renal function tests were significantly higher among the overt and occult HCV patients compared to negative HCV patients. Liver function tests were significantly lower among the occult compared to overt HCV patients. Overt HCV patients had significant risk factors compared to negative HCV patients; age group 40-59 years [OR=9.34] and rural residence [OR=3.14]. Also, significant clinical risk factors were the overweight, history of blood transfusion 5>/= times/year, history of nonmedical bloody manipulations, and history of IV drug abuse [OR=3.23, 5.96, 8.28, 7.08, respectively]. Occult HCV patients had significant risk factors compared to negative HCV patients; age group 60 >/= years and rural residence [OR=6.25 and 6.73, respectively]. Significant clinical risk factor was the history of nonmedical bloody manipulations [OR=11.5]

Conclusions and Recommendations: prevalence of overt- and occult HCV infection is high in CKD patients under RHD; this has important clinical and public health implications. There are many significant socio-demographic and clinical risk factors for these infections. A close monitoring of the HD patients and testing them for HCV-RNA in PBMCs yearly to adopted a proper management. Also, more studies on bigger number of patients are required to understand real epidemiology of this health problem

Tenecteplase in prosthetic mitral valve thrombosis

In the few reported cases of prosthetic mitral valve thrombosis, where surgical intervention was considered as high risk, fibrinolytic therapy had proved life saving. The authors present clinical, laboratory, and imaging data from such a patient, with prosthetic mitral valve thrombosis and its successful management with tenecteplase. The use of tenecteplase as a viable fibrinolytic agent for the first time was justified, due to the lack of immunogenicity concerns compared to streptokinase

Giant cell tumour of the distal radius: wide resection and reconstruction by non-vascularised proximal fibular autograft

<p><b>INTRODUCTION</b>Giant cell tumours of the bone are aggressive and potentially malignant lesions. Juxtaarticular giant cell tumours of the lower end radius are common and present a special problem of reconstruction after tumour excision. Out of the various reconstructive procedures described, non-vascularised fibular autograft has been widely used with satisfactory functional results.</p><p><b>MATERIALS AND METHODS</b>Ten patients with a mean age of 33.4 years, with either Campanacci grade II or III histologically proven giant cell tumours of lower end radius were treated with wide excision and reconstruction with ipsilateral non-vascularised proximal fibular autograft. Host graft junction was fixed with dynamic compression plate (DCP) in all cases. Wrist ligament reconstruction and fixation of the head of the fibula with carpal bones and distal end of the ulna using K-wires and primary cancellous iliac crest grafting at graft host junction was done in all cases.</p><p><b>RESULTS</b>The follow-up ranged from 30 to 60 months (mean, 46.8). At last follow-up, the average combined range of motion was 100.5 degrees with range varying from 60 degrees to 125 degrees. The average union time was 7 months (range, 4 to 12). Non-union occurred in 1 case. Graft resorption occurred in another case. Localised soft tissue recurrence occurred in another case after 3 years and was treated by excision. There was no case of graft fracture, metastasis, death, local recurrence or significant donor site morbidity. A total of 3 secondary procedures were required.</p><p><b>CONCLUSIONS</b>Enbloc resection of giant cell tumours of the lower end radius is a widely accepted method. Reconstruction with non-vascularised fibular graft, internal fixation with DCP with primary corticocancellous bone grafting with transfixation of the fibular head and wrist ligament reconstruction minimises the problem and gives satisfactory functional results.</p>

Serum ferritin: a noval coronary artery disease risk factor

Strong epidemiological evidence is available that iron is an important factor in the process of atherosclerosis. Therefore, it has been hypothesized that the assessment of novel markers help to identify persons prone to premature CAD. The aim of the study is to assess the potential role of ferritin as an independent risk factor promoting atherosclerosis. 45 patients with CAD were studied and subdivided into 3 main groups; group 1: patients with chronic., stable angina group 2: patients with unstable angina, group 3: patients with acute myocardial infarction and additional group 4 of 15 subjects as a control. All patients and control were subjected to accurate history taking, clinical examination and a variety of laboratory investigations in association with s. ferritin and plasma malondialdehyde level [MDA]. It was found that patients with CAD whether chronic stable angina, unstable angina, or acute myocardial infarction had a significant higher serum ferritin level than the control subjects: mean s. ferritin: 702.46 +/- 211.36 ng/L versus 195.66 +/- 41.46 ng/L, P-value 0.001 also the CAD patients had a higher oxidative stress represented by lipid proxidation product MDA [Malondialdehyde]: mean MDA in umol/L 0.780 +/- 0.213 versus 0.375+0.198/umol/L for the control subjects, P-value 0.01. Serum ferritin could be considered a novel, and independent CAD risk factor associated with increased oxidative stress in th n of increased lipid peroxidation and hence MDA