[Efficacy and Safety of new generic of direct-acting antivirals in the Treatment of Chronic Hepatitis C : about a Moroccan experience]

The management of chronic hepatitis C infection is currently in change. IFN-based treatments were the standard therapy against HCV infection wainting for pending authorization to place the direct-acting antivirals on the market. These new direct-acting antivirals genericconferred good effectiveness and safety for infected patients. The aim of this study was to characterize the treatment response and tolerance of new generics of DAAs in patients infected with Hepatitis C Virus. The study was conducted at the gastroenterology I department of the Military Hospital Mohamed V in Rabat since December 2015. We include all patients infected with HCV: naif relapsing or non-responsive profiles, all genotypes combined, cirrhotic or not. They all received treatment with the new Moroccan generic of direct acting antivirals. Virological response as well as clinical and biochimical tolerances were achieved. Seventy-seven patients with viral hepatitis C were included in the study. The average age of the patients was 61 +/- 11 years old. A slight predominance of women was noted in 52.8% of cases. Genotype1 was predominant in 74% of cases. Half of our patients were cirrhotic. Rapid virologic response [RVR] was obtained in 85.7% of cases. Early virologic response [EVR] was achieved in 97.4% of cases. The sustained virological response [SVR] was of the order of 96.2%. The treatment was generally well tolerated in all our patients. The generic of direct-acting antivirals promise treatments with shorter treatment times, much higher cure rates, and fewer side effects. Viral eradication leads to stabilization or regression of fibrosis

Novel mutations of the arylsulphatase B (ARSB) gene in Indian patients with mucopolysaccharidosis type VI.

Background & objectives: Mucopolysaccharidosis type VI (MPS VI) is a rare, autosomal recessive lysosomal storage disorder caused by deficient enzymatic activity of N-acetyl galactosamine-4-sulphatase resulting from mutations in the arylsulphatase B (ARSB) gene. The ARSB gene is located on chromosome 5q11-q13 and is composed of eight exons. More than hundred ARSB mutations have been reported so far, but the mutation spectrum of MPS VI in India is still unknown. Hence, the aim of the present study was to identify the mutational spectrum in patients with MPS VI in India and to study the genotype-phenotype association and functional outcomes of these mutations. Methods: Molecular characterization of the ARSB gene by Sanger sequencing was done for 15 patients (aged 15 months to 11 yr) who were enzymatically confirmed to have MPS VI. Age of onset, clinical progression and enzyme activity levels in each patient were studied to look for genotype-phenotype association. Haplotype analysis performed for unrelated patients with the recurring mutation W450C, was suggestive of a founder effect. Sequence and structural analyses of the ARSB protein using standard software were carried out to determine the impact of detected mutations on the function of the ARSB protein. Results: A total of 12 mutations were identified, of which nine were novel mutations namely, p.D53N, p.L98R, p.Y103SfsX9, p.W353X, p.H393R, p.F166fsX18, p.I220fsX5, p.W450L, and p.W450C, and three were known mutations (p.D54N, p.A237D and p.S320R). The nine novel sequence variants were confirmed not to be polymorphic variants by performing sequencing in 50 unaffected individuals from the same ethnic population. Interpretation & conclusions: Nine novel mutations were identified in MPS VI cases from India in the present study. The study also provides some insights into the genotype-phenotype association in MPS VI.

Camparison of oral candida flora in patients with coronary atherosclerosis and healthy people

Coronary atherosclerosis is a common disorder of the arteries and may block the arteries and cause heart disease. Recently several studies have indicated a role of infectious agents in atherosclerosis and obstructive coronary artery disease. Candida species are normal flora of the human oral cavity and can enter in the blood stream and damage inner walls of coronary arteries by several mechanisms. Thus this study was done to compare the oral candida flora in healthy people and patient with coronary atherosclerosis. In this study, we compared oral candida flora in 90 patients with coronary atherosclerosis and 90 healthy people. All specimens were obtained from oral cavity by swab and cultured on CHOROMagar Candida medium. Identification of isolated colonies was done by RapID yeast plus system. The data were analyzed using the chi-square test. In this study 55.4% [N=61] of patient and 44.6% [N=49] of control group had candida colonization in their oral cavity. Candida albicans was the most common species isolated in both groups. Candida glabrata, Candida krusei, Candida tropicalis and Candida parapsilosis were the most common non albicans species. Although no significant difference was observed between candida colonization in patients and controls, the differences between isolated colony numbers in patient and healthy group were significant [p=0.001]. Hypercolonization of candida species in oral cavity may lead to invasion and enter the organism in the blood stream and damage the coronary arteries

Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder

OBJECTIVE: We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. MATERIALS AND METHODS: 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. RESULTS: Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high. CONCLUSIONS: Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.

Surgical management of renal cell carcinoma with inferior vena caval thrombus: a teaching hospital experience.

PURPOSE: To evaluate the outcome of patients of renal cell carcinoma (RCC) with inferior vena caval (IVC) thrombus treated by radical nephrectomy and IVC thrombectomy in terms of clinical and pathological factors and prognosis. MATERIALS AND METHODS: Sixty-three consecutive patients of RCC with IVC thrombus who underwent radical nephrectomy with IVC thrombectomy between June 1993 and May 2003 were included in this retrospective analysis. Data was analyzed in terms of clinical factors, such as level of thrombus and pathological factors, such as grade, local invasion and N status. RESULTS: Tumor thrombus level was infrahepatic in 35 patients, retrohepatic in 20 and suprahepatic in 8, including 5 with right atrial thrombus. The immediate post-operative mortality was 3% and the incidence of major post-operative complications was 34%, but most of them improved after conservative management except one who needed surgery for burst abdomen. The disease free survival (DFS) was 48.5%, 50.6%, 66.6% and 40% for infrahepatic, retrohepatic, suprahepatic and intra-atrial tumors, respectively. Of the histological types, patients with clear cell tumors had the best prognosis; those with granular cell had the worst prognosis (DFS of 53.5% vs 33.3%, though statistically not significant). Grade-2 tumors had better prognosis than grade-4 tumors (DFS 66.6% vs 0%, P < 0.001). Sixty-eight percent of patients without perinephric fat invasion were free of disease as compared to 31% of those with perinephric fat invasion (P < 0.01). Further, N status showed DFS of 60.9% in patients with negative nodes and 30% in patients with positive nodes (P < 0.05). CONCLUSION: Though surgery for RCC with IVC thrombus has high morbidity, it can give good results in terms of prolonged DFS in expert hands. Regarding long-term survival, pathological factors, such as local stage and grade, are more important than clinical factors, such as level of thrombus.

Clinicopathological analysis of ovarian tumours

To study the relative frequency and histological pattern of ovarian tumours in various age groups. The study was carried out in the Histopathology department, AFIP Rawalpindi from Jan 2002 to Jun 2003 One hundred and ninety four specimens of ovarian tumours were received in Histopathology department, AFIP Rawalpindi. All the surgical specimens were fixed in 10% formalin and routinely processed. The sections were then cut and stained with Haematoxylin and Eosin. The histological typing of ovarian tumours was done according to WHO classification of 2003. The main bulk comprised surface epithelial tumours [73%]. Among them, 107 [75.33%] were benign neoplasms and 35 [24.09%] were malignant. There were 40 [21%] germ cell tumours, 10 [5%] sex cord stromal tumours and 2 [1%] metastatic tumours. The benign category comprised 88 cases of serous cystadenoma, 34 cases of mature cystic teratomas and 19 mucinous cystadenomas. In the malignant group, there were 15 serous cystadenocarcinomas, 10 endometrioid carcinomas, 7 mucinous cystadenocarcinomas, 2 yolk sac tumours and 2 cases of granulosa cell tumour. Benign tumours were mostly diagnosed in 3rd and 4th decades of life, whereas malignant tumours were seen after 40 years, with exception of malignant germ cell tumours, which were mostly found in younger age groups. There were minor differences from local studies. The overall frequency of various tumour groups was very similar to that in the west with some difference in tumour types

Prevalence of chronic complications and associated factors in type 2 diabetes

To determine the prevalence of chronic complications and associated factors in type 2 diabetes in 500 diabetic patients, age >/= 25 years, attending the clinic of Diabetic Association of Pakistan [DAP], Karachi. Every 5th registered diabetic patient >/= 25 years age, was examined for the presence/absence of micro and macro vascular complications and associated factors. Blood samples were collected for HbA1c, lipid profile and serum creatinine. Urine was examined for albumin and microalbumin. Of the 500 diabetic patients examined [160 males, 340 females, mean age 55.2 10.6 years], retinopathy was seen in 43%, neuropathy in 39.6% and foot ulcers in 4%. Nephropathy was found in 20.2%, and was significantly associated with hypertension. The prevalence of microvascular complications was higher in the group of patients with HbA 1 c >8% and was significantly related to duration of diabetes, hypertension and obesity. Hypertension was manifest in 64.6% patients, 61% had raised Body Mass Index and Waist Hip Ratio was more than normal in 88% subjects. Macrovascular complications were encountered in 102 diabetic patients, with angina in 85 [17%], heart attack in 25 [5%] and stroke in 13 [2.6%]. The prevalence of diabetic microvascular complications was higher in people with poor glycaemic control, longer duration of diabetes and associated hypertension and obesity

Factors of hearing impairment among Saudi children: a comparative epidemiological study

To determine and compare the various risk factors for hearing impairment in the four major regions of Saudi Arabia. Materials and Nine thousand five hundred forty children below the age of 15 were surveyed from the four major provinces of Saudi Arabia. A questionnaire was filled and an ENT examination with audiological assessement were carried out for each child. The various risk factors were studied. Nine thousand, five hundred and forty children were screened. Out of these 13% were hearing impaired and 8% were at risk of hearing impairment. Consanguinous marriages, failure to attend antenatal clinics, abnormal pregnancy and labour, prematurity, lack of immunization, xenthematous diseases and jaundice were the risk factors for hearing impairment, The Western and Southern regions of Saudi Arabia were found to have the highest rate of some of these risk factors. Conclusions: Consanguinous marriages should be discouraged. Attendance of antenatal clinics and immunization should be encouraged through proper health education and counseling programmes

Does intrauterine insemination in Saudi female cause production of antisperm antibodies?

To determine the possibility of inducing antisperm antibodies in patients undergoing intrauterine insemination with motile sperms from the husband. Clinico-immunological prospective study. King Abdulaziz University Hospital. Fifty patients undergoing Intrauterine Insemination [IUI], were tested for developing antisperm antibodies using agglutination test, complement mediated immobilization test, and immunoglobin specific indirect immunobead assay. Incidence and type of antisperms antibodies. Forty seven out of 50 patients remained negative for antisperm antibodies after 2-6 cycles of IUI. Detection of antisperm antibodies after IUI was evident in 3 patients [6 percent]. Intrauterine insemination does not appear to cause a significant or lasting immune response

use of ovarian KTP laser drilling in the treatment of anovulatroy infertility and polycystic ovarian disease

Determine the efficacy of unilateral laparoscopic ovarian drilling in the management of resistant ovarian syndrome. Design: A prospective randomized study of 20 women treated over a period of two years with follow-up till 8 months after the last woman was treated. Setting: Reproductive Endocrine Unit, King Abdulaziz University Hospital and Dr Soliman Fakeeh Hospital. Patients: 20 patients with refractory anovulatory infertility. All of these 20 women had been treated medically but without success. Intervention: Laparoscopic ovarian drilling by KTP/532 Laser. Main Outcome Measures: Rate of ovulation and endocrinal changes after ovarian drilling by KTP/532 laser. Unilateral ovarian drilling by KTP laser lead to ovulation from both ovaries. Seventy percent of the patients who had unilateral laser cauterisation had ovulation from both ovaries. In the responder group, there was a significant fall in LH concentration. The mechanism of action of KTP laser drilling of ovaries is by correcting the abnormal hormonal status. Unilateral ovarian drilling leads to bilateral ovarian activity

Adenoids in adults

This is a prospective study of one hundred patients [18-38 yrs] with nasal obstruction as their main complaint. They were investigated clinically to verify the presence of adenoid enlargement, including nasal endoscopy and plain X-ray to the nasopharynx [soft tissue neck lateral view]. Enlarged adenoid was diagnosed in seven [7%] patients. They were visualized endoscopically, shown radiologically and confirmed by histopathology. Adenoidectomy successfully relieved the patient's symptoms without recurrence for the follow-up period of an average of 18 months. Nasal endoscopic examination should be included in the diagnostic work-up of nasal disorders. If not available, X-ray to nasopharynx should be included in the investigation of adult patients with nasal obstruction. The diagnosis of adenoid enlargement in adults should not be disregarded on account of age only

Fetal macrosomia.what to do?

This is a two year retrospective review of 221 pregnancies that resulted in the delivery of an infant weighing 4000 gm or more [macrosomic babies]. Women delivering macrosomic fetuses were significantly older, of high parity, obese [> 90 Kg] and had higher frequency of postmaturity than the control. The macrosomic infant was more often male and had more birth trauma and shoulder dystocia but not to a statistically significant level. The method of delivery of a macrosomic baby should be individually considered as some women can achieve vaginal delivery of "very macrosomic baby" without significant increase in the maternal and perinatal mortality or morbidity, although in our series there was a relatively higher rate of delivery by caesarian section

Fetal heart and vibroacoustic stimulation the first Saudi experience

The response of the term fetuses to the external sound stimulation had been already documented in the literature. This showed increase in the fetal heart rate [FHR] reactivity and Fetal Body Movements. However, the effect of this external sound stimulation on premature fetuses has not been fully documented. The aim of this study is to define the FHR changes after external vibration acoustic stimulus in a group of preterm healthy fetuses at 32 - 34 weeks. There was an immediate increase in the basal FHR in premature fetus at 32-34 weeks and significant increase in the mean duration of FHR acceleration. There was no significant change in the number of acceleration or fetal heart variability in these fetuses and no increase in the gross body fetal movements after vibroacoustic stimulation

comparative study of different treatments of hemorrhoids

Hemorrhoid is a common anal problem in our country that is currently treated by many different methods. Three modalities were assessed in a randomized prospective trial in which 848 patients with a second-degree hemorrhoid were treated by rubber band ligation [470 patients], injection sclerotherapy [280 patients], or cryosurgery [98 patients]. The effectiveness of each method was assessed clinically at 3, 6, 9, and 12 months after initial treatment, and determined by improvement in presenting symptoms. All patients complained of rectal bleeding and prolapse of the hemorrhoid on defecation, but only 69% had anal pain and 14% suffered from pruritus ani. Rubber band ligation was found to be superior to the other methods, and displayed statistical significance when compared to injection sclerotherapy and cryosurgery

Jeddah experience in the management of high anal fistula

Twenty-six [26] transsphincteric anal fistulae with secondary high extensions and sixteen [16] suprasphincteric anal fistulae with secondary high extensions have been treated successfully over a period of 3 years. The operative technique depends on exploration of the intersphincteric plane with removal of the primary source of the infection, together with excision of the primary tract, and drainage of the secondary high extensions. The patients have been followed for 2 years without recurrence. Continence for flatus and liquid feces was 92.1% and 96.15%, respectively, in the transsphincteric and 75% and 93.75%, respectively, in the suprasphincteric group but the continence for solid feces was 100% in both. Thus, the so-called excision technique for treatment of high fistula is safe and results are excellent