Genetic distance and heterogenecity between quasispecies is a critical predictor to IFN response in Egyptian patients with HCV genotype-4

HCV is one of the major health problem in Egypt, where it is highly prevalent. Genotype 4 is the most common genotype of HCV and its response to treatment is still a controversy. HCV genotype 4 quasispecies diversity within the 5' untranslated region [5'UTR] was studied in a series of 22 native Egyptian patients with chronic hepatitis C virus with no previous treatment who satisfied all NIH criteria for combined treatment of pegylated IFN and ribavirine and was correlated with the outcome of treatment. The study also included 7 control patients with no antiviral treatment. HCV sequencing was done using the TRUGENE HCV 5-NC genotyping kit. At the 48[th] week of treatment, 15 patients [68%] showed virological response. Whereas HCV-RNA was still detected in 7 patients [32%] in this period; of those, 6 experienced a partial virological response followed by viral breakthrough during treatment. Only one patient did not show any virological or chemical response. The four females included in this study were all responders. There was a significant correlation between the response rate and lower fibrosis [p=0.026] as well as the total number of mutation spots [including all the insertions, deletions, transitions and transversions] [p=0.007, p= 0.035]. Patients who responded to interferon treatment had statistically significant less number in both transitions [p=0.007] and the genetic distances between the quasispecies [p= 0.035]. So, viral genetic complexity and variability may play a role in the response to IFN treatment. The consensus alignment of all three groups revealed no characteristic pattern among the three groups. However, the G to A transitions at 160 was observed among non responders who need further study to confirm this observation

Management of relapsed clubfeet by soft tissue distraction using the ilizarov method

Nineteen feet with relapsed clubfeet in 14 patients were treated by soft tissue distraction using the Ilizarov method. There were nine unilateral and five bilateral deformities in ten boys and four girls. They had an average of three [range of 2-5] previous surgical interventions; all were in the form of soft tissue release. The average time taken for the correction of the deformity till frame removal was 10.5 weeks [range of 9-12 weeks] and the average follow up period was 2.4 years [range of 1-4 years]. Twelve feet were graded as excellent, 5 as good and 2 as fair results. The frame was well tolerated by all children and their parents until a full correction of the deformity occurred

community-based study of viral hepatitis infection in Giza Governorate, Egypt: Seroprevalence, risk factors and associated morbidity

Hepatitis viruses are major causes of acute and chronic liver diseases in Egypt. The aim of this study was to investigate the seroprevalence, risk factors and associated morbidity of viral hepatitis in Giza Governorate, Egypt. The study was conducted in 4 rural and 4 semiurban communities and included 2305 subjects selected by a cluster r and om method. They underwent complete clinical and abdominal ultrasonographic [US] assessment and laboratory tests including stool and urine examination, hemoglobin, ALT estimation and viral hepatitis markers by enzyme immunoassay. The latter included anti-HAV IgG, HBsAg, anti-HBc, anti-HBs, anti-HCV and anti-HEV IgG. Subsets of sera were tested for HBV DNA and HGV RNA by specific PCR. The overall prevalence of anti-HCV was 20.9% [age-adjusted prevalence = 24.5%; CI: 22.7-26.3%] and was significantly rising with age from 10% below age of 20 years to 40% among those above 50 years. The infection rate of hepatitis B virus [HBV] was 57.1% with HBsAg carrier rate of 3.6%. Seropositivity of anti-HBs and anti-HBc was very high [45.8% and 44.7%, respectively] and correlated positively with age with no sex-related difference. Combined HCV and HBV infection was evident in 13% of subjects. HBV DNA was detected in 86% of HBsAg-positive cases and in 20% of HBsAg-negative anti-HBc- and anti-HCV-positive cases. Seromarkers for hepatitis B and C were significantly commoner in semiurban than in rural communities. Dental manipulation and previous parenteral antischistosomal therapy were significant risk factors for hepatitis B and C infection. Anti-HAV was positive in 99.7% whereas anti-HEV was positive in HBV= Hepatitis B virus. CLD = Chronic liver disease. HCC = Hepatocellular carcinoma. US = Ultrasonography. ALT = Alanine transaminase. OR = Odds ratio. CI = Confidence interval. 9.2%. HGV RNA was detected in 16.5% of the studied samples. It was always associated with HBV and /or HCV infection. History of hematemesis was recorded in 1.2% of individuals. US examination revealed hepatomegaly in 19.2% of subjects, splenomegaly in 8.2%, bright liver in 31%, coarse liver texture in 10%, periportal fibrosis in 20% and ascites in 2%. These findings were significantly more common in anti-HCV- and HBsAg-positive subjects. ALT elevation was commonest and highest in individuals with positive HBsAg or with HBV-HCV coinfection. Hepatitis B and C infection and associated morbidity still constitute a great health problem in Egypt. Hepatitis A is holoendemic and hepatitis E is endemic. Hepatitis G is always associated with HBV or HCV infection. Occult hepatitis B should be considered in future studies

Mobile - bearing knee arthroplasty: clinical results

Twenty three primary cemented mobile-bearing total knee arthroplasties were implanted in nineteen patients. All implants were of a posterior cruciate-retaining design and allow translation of the polyethylene in the anteroposterior plane and its rotation about the longitudinal axis of the limb. Fifteen patients [17 knees] had osteoarthritis and four patients [6 knees] had rheumatoid arthritis. The average follow-up was 30 months. Preoperatively, the average flexion contracture was 11.5° [range, 0°-25°] and the range of motion 100° [range, 50°-130°] At final follow-up, no knee had a flexion contracture. The average postoperative range of motion was 120° [range, 80°-140°]. Preoperatively the average knee score was 38 points, the average function score was 42 points and the average pain score was 16 points according to the scoring system of the Knee Society. At the time of most recent follow-up, the average knee score was 90 points, the average function score was 82 points and the average pain score was 43 points. Nineteen knees [82.6%] in this study had no evidence of radiolucent lines around any component. Superficial infection was detected in one knee. Patellar dislocation occurred in two knees [3-4 weeks postoperatively] which needed lateral retinacular release

Ethanolamine oleate 7 N butyl 2cyanoacrylate for management of patients with advanced bleeding oesophageal varices

This work compared between the sclerosant agent ethanolamine oleate 5% and the tissue adhesive substance, isobutyle.2 cyanoacrylate [histo-acryl blue] for the management of 42 patients with advanced bleeding oesophageal varices [grade III and IV]. Twenty nine patients were injected by ethanolamine oleate and 13 patients were injected by bucrylate. This study proved the value of bucrylate in the initial controI of acute massive bleeding [92.3%] and prevention of recurrent bleeding in all cases. In the ethanolamine group faillure of initial cnotrol of bleeding occurred in one case [35%], however, reccurent bleeding occurred in 4 cases [13%]. The mortality rate was 7.7% in the bucrylate group and 10.3% in Ihe ethanolamine group. The duration of injection therapy for variceal oblitration and the number of sessions were greatly reduced in the bucrylate group compared with the ethanolamine group. The mean duration was 1.1 weeks and the number of sessions was 15 + 0.8 in the bucrylate group versus 105 weeks and 55 + 15 sessions repectively in the ethanolamine group. Tissue adhesive material seems to be the best to be used for oblitration of huge varices and those not responding to the conventional sclerotherapy.It stops acute variceal haemorrhage definitively and prevents recurrence of bleeding. It reduces the duration and number of sessions needed for variceal oblitration with minimal complications

Gastric varices: magnitude, imaging and endoscopic management

This study evaluated the magnitude of gastric varices among patients presented to Kasr El Aini Hospital by variceal bleeding. The value of abdominal ultrasonography in recognition of the gastric varices was discussed. Also this work reports the results of a trial comparing ethanolamine oleate 5% as sclerosant agent and the tissue adhesive bucrylate in the endoscopic management of patients with bleeding gastric varcies. In the present study 65 out of 970 patients with variceal bleeding had primary gastric varices [6.7%]. Gastric varices alone were found in 5 cases [0.5%]. Eleven patients [2.9%] developed secondary gastric varices after complete eradication of the oesophageal varices in 376 patients. Abdominal ultrasonography was done for 50 patients with oesophago - gastric varices [20 patients with oesophageal varices, 10 with oesophgeal varices with gastric extension and 20 patients with primary gastric varices].Twenty five patients were examined before and after sclerotherapy. We found statistical positive relations between gastric varcies and gastro-splenic and coronary collaterals as detected by sonography and also between sclerosis of oesphageal varices and the increase in the diameter of the splenic vein and the development of gastrosplenic collateral. From the ultrasonography and the radiological results a hypothesis of gastric varix formation is postulated. Tissue adhesive bucrylate is the drug of choice if compared with ethanolamine oleate in management of patients with bleeding gastric varices. Initial control of the total bleeding episodes was significantly high in patients in the bucrylate therapy [93.3%] compared to the sclerosis group [52.6%]. Better survival and bleeding free survival in the bucrylate group compared to the sclerosis group [P < 0.05]. Eradication of varcies was significantly high in the bucrylate group [80.9%] compared to 7.1% in the sclerosis group