Three regimens for re-treatment failure of Sofosbuvir-based therapy for chronic hepatitis-C genotype-4: a cohort study

ABSTRACT Despite the high sustained virologic response (SVR) rates of direct-acting antiviral (DAAs) therapy, a small number of patients does not eradicate the virus, and these patients represent a challenge. This study aims to compare the outcomes of three second-line regimens for DAAs-experienced patients with chronic hepatitis C (CHC). This prospective observational study was conducted at the Damanhur Viral Hepatitis Center from January 2017 to February 2020. We included patients with CHC who did not achieve SVR after the complete course of Sofosbuvir/Daclatasvir±Ribavirin (SOF/DAC±RBV). The primary endpoint was SVR-12 after re-treatment. This study included 360 patients (with a mean age of 51.53±11.38 years). Approximately 51.1% of the patients were males, and 65.5% had liver cirrhosis. All patients of group 1 (45 patients) received SOF/VEL/VOX over 12-weeks; SVR-12 was achieved in 44 patients (97.8%). Group 2 (28 patients) received SOF/DAC/RBV over 24-weeks; (one patient was lost during follow-ups and one patient discontinued treatment due to hepatic decompensation). SVR-12 was achieved in 25 patients (96.2%). Group 3 (287 patients) received SOF/Ombitasvir/Paritaprevir/Ritonavir/RBV) over 12-weeks. Eight patients were lost during follow-ups, and one patient discontinued treatment due to grade 4 adverse events. SVR-12 was achieved in 276 patients (99.3%). There was no difference between the groups regarding their age, gender distribution, baseline viral load or comorbidities. Adverse events (thrombocytopenia, anemia, hyperbilirubinaemia and prolonged INR) were significantly higher in group 3, while group 1 did not experience any. The three studied retreatment regimens can be used for DAAs treatment-experienced patients considering availability. The SOF/VEL/VOX combination had the least adverse events.

End-to-end anal sphincter repair in treatment of post-traumatic fecal incontinence

The present report describes the end-to-end technique of anal sphincter repair in a 36-year-old female patient with post-vaginal delivery fecal incontinence (FI). The patient had a history of two vaginal deliveries and the symptoms of FI were observed after the second delivery. On assessment of the severity of FI using the Wexner incontinence score, the patient had a score of 12. Endoanal ultrasonography revealed an anterior defect of the external anal sphincter extending from 11 to 3 o'clock. The patient had no previous anal surgery and did not have any medical comorbidities. The operation time was 45minutes. No intraoperative complications were recorded. At 12 months of follow-up, the patient showed significant improvement in the continence state, with her Wexner score dropping to 4. No postoperative complications were recorded. We can conclude that end-to-end anal sphincter repair is a technically feasible operation that confers satisfactory improvement in the continence state without imposing much tension on the site of sphincter repair. (AU)

Thalassemia major: transplantation or transfusion and chelation

Thalassemia is the most common monogenic hematologic disease that affects millions in the world and kills thousands of patients every year. Without transfusion or transplantation, patients with thalassemia major are expected to die within months of diagnosis. However, long-term transfusion and chelation therapy is highly challenging for many developing countries where the disease is prevalent, representing a major and unsustainable health burden. Stem cell transplantation is the only cure for thalassemia. It has witnessed major developments that have made it less toxic, more successful, and feasible for a larger number of patients with diverse comorbidities and from a wider range of donors. Advances in human leukocyte antigen typing have greatly refined alternate donor selection with results of matched unrelated donors similar to matched sibling donors. Novel strategies such as haploidentical and cord blood transplantation have increased the possibility of patients with no healthy donor to get a better opportunity to survive and avoid chronic transfusion complications. Cost-effectively, transplantation should be considered the primary treatment of choice in the presence of a suitable related or unrelated donor and at centers with a satisfactory experience in the field of transplantation and particularly, in managing those with thalassemia. Despite some complications such as graft-versus-host disease and late conditioning effects, the overall improvement in the quality of life of thalassemia is difficult to deny. Unfortunately, the number of transplants for thalassemia represents only a minority of all transplants conducted globally and the essential requirement for transplants for thalassemia in limited-resources countries should mandate the transplant societies, including Worldwide Network for Blood and Marrow Transplantation, to collaborate to help initiate and support specialized transfusion and transplant programs for managing thalassemia

Embodiment of religious figures in the Iranian drama and relationship to mental image in adolescents

Problem: This study discuss the following question: What is the relationship between the embodiment of religious figures in the Iranian drama and the mental image of them in adolescents?

Objectives:Identify the habits and patterns and density View teenagers Iranian drama which embody religious figures and motives of watching her, Knowledge of the mental image in adolescents for religious figures, and Come to know the relationship between the embodiment of religious figures in the Iranian drama and the mental image of them in adolescents

Type and Methodology: The study is belonged to descriptive studies, survey method was used

Sample: A sample of adolescents to examine the relationship between watching the Iranian drama which embodied religious figures and formed a mental picture they have from those figures seen through, and Field sample applied on a stratified random sample of 400 single-strong adolescents [Male/ Female] in Cairo Governorate [High School] who are watching the Iranian drama that embodied the religious figures

Instruments: Questionnaire Form: to collect data under the frame of survey methodology by sample

Results: That 83.4% of respondents reject the embodiment and the emergence of religious figures [Prophets-Companions] in the Iranian drama, while 9.9% were neutral, and in contrast, 6.7% of them agree to the embodiment and the emergence of religious figures [Prophets-Companions] in the Iranian drama. That 63.4% of me respondents do not accept the image that embodied the religious figures in Iran's drama, while 31.6% of them accept them sometimes, and 5.1% of them accept them always. 43% of the respondents, first thing remember him when he comes respondents said religious figure, which looked at is a personal drama that appeared in this business sometimes form, while in contrast, 26.7% of them remember the other things, and 30.2% of them remembers always. Test the validity of hypotheses, the first hypothesis is proven wrong: no statistically significant correlation between the reflected image for the embodiment of religious figures and intensity of exposure. There were statistically significant differences between the respondents about the respondents believe that religious figures provided in the Iranian drama figures are close to the real figures depending on the type

Leukemia during pregnancy: long term follow up of 32 cases from a single institution

Background and objectives: There is limited information regarding the outcome of patients treated for leukemiaduring pregnancy. This study was performed on all cases of leukemia during pregnancy identified in our institution leukemia database

Patients and Methods: It is a retrospective study from our existing database. Thirty two cases were identified among the cohort of patients treated for acute and chronic leukemia between January 1991 and July 2003

Results: Among the acute leukemia patients [n = 21], 10 patients [47.6%] received chemotherapy during pregnancy, seven had live birth and three had spontaneous abortion. No teratogenicity or congenital malformations or postnatal complication were reported. The remaining 11 [52.4%] were not given chemotherapy while pregnant; three patients presented after 34 weeks of gestation ending in normal live births and then received chemotherapy and eight patients had abortion before starting chemotherapy. Among the chronic myeloid leukemia [CML] patients [n = 11], nine patients received hydroxyurea, one patient received alfa-interferon and one patient was treated with leukapheresis. Eight patients had normal live births and three patients had abortion. Out of the 32 patients, 18 patients [56.2%] subsequently underwent HLA matched sibling allogeneic stem cell transplantation, seven for acute myeloid leukemia [AML], two for acute lymphocytic leukemia [ALL] and nine for CML. After a median follow up of 16 years, five patients [15.6%] are alive in remission [one from chemotherapy group and four from SCT group]

Conclusions: Our report lends credence to the safety and feasibility of administering anti-leukemic therapy in acute and chronic leukemias during pregnancy although acute leukemia patients had possibly a poor long term outcome compared to non-pregnant patients

Contribution of different mechanisms to the resistance to fluoroquinolones in clinical isolates of Salmonella enterica

OBJECTIVES: To study the potential factors include gene mutation, efflux pump and alteration of permeability associated with quinolone-resistance of Salmonella enterica strains isolated from patients with acute gastroenteritis and to evaluate the degree of synergistic activity of efflux pump inhibitors when combined with ciprofloxacin against resistant isolates. METHODS: Antimicrobial resistance patterns of fifty-eight Salmonella isolates were tested. Five isolates were selected to study the mechanism of resistance associated with quinolone group, including mutation in topoisomerase-encoding gene, altered cell permeability, and expression of an active efflux system. In addition, the combination between antibiotics and efflux pump inhibitors to overcome the microbial resistance was evaluated. RESULTS: Five Salmonella isolates totally resistant to all quinolones were studied. All isolates showed alterations in outer membrane proteins including disappearance of some or all of these proteins (Omp-A, Omp-C, Omp-D and Omp-F). Minimum inhibitory concentration values of ciprofloxacin were determined in the presence/absence of the efflux pump inhibitors: carbonyl cyanide m-chlorophenylhydrazone, norepinephrin and trimethoprim. Minimum inhibitory concentration values for two of the isolates were 2-4 fold lower with the addition of efflux pump inhibitors. All five Salmonella isolates were amplified for gyrA and parC genes and only two isolates were sequenced. S. Enteritidis 22 had double mutations at codon 83 and 87 in addition to three mutations at parC at codons 67, 76 and 80 whereas S. Typhimurium 57 had three mutations at codons 83, 87 and 119, but no mutations at parC. CONCLUSIONS: Efflux pump inhibitors may inhibit the major AcrAB-TolC in Salmonella efflux systems which are the major efflux pumps responsible for multidrug resistance in Gramnegative clinical isolates.

Ameliorative effect of grapefruit juice on amiodarone-induced cytogenetic and testicular damage in albino rats

Objective:To evaluate the ameliorative role of grapefruit juice on the cytogenetic and testicular damage induced by the antiarrythmic drug amiodarone in albino rats. Methods: Animals were divided into four groups. Group I was considered as control. Group II was given grapefruit juice at a dose level of 27 mL/kg body weight. Group III was orally administered amiodarone (18 mg/kg body weight) daily for 5 weeks. Animals were sacrificed after 5 weeks of treatment. Bone marrow was collected from the femurs for analysis of chromosomal aberrations and mitotic indices. Testes were removed and stained with H&E for histological examination. Sperms were collected from epidedymis for detection of sperm head abnormalities. Comet assay was used to detect DNA damage. Results: Amiodarone treatment caused a significant increase in the percentage of chromosomal aberrations, decreased the mitotic index and increased DNA damage. The testis showed many histopathological alterations, inhibition of spermatogenesis and morphometric changes. The number of sperm head abnormalities was increased. Treating animals with amiodarone and grapefruit juice caused a reduction in chromosomal aberrations, mitotic index, DNA damage and testicular alterations caused by amiodarone. Conclusions:The results of this study indicated that grapefruit juice ameliorates the cytotoxicty and testicular alterations induced by amiodarone in albino rats and this is may be due to the potent antioxidant effects of its components.

offensive efficiency of the high-level handball players of the front and the rear lines

The aim of this study was to investigat the offensive efficiency of the professional handball players forming the front and rear lines. Our investigation was carried out on four matches [final, semi-finals and classifying match] at the 19th male Handball World Championship "Tunisia 2005". Finalist teams were Tunisia, France, Croatia, and Spain. Matches were recorded using 5 digital camcorders [SONY, DCL, and TRY 130E]. Number of passes and the length of the attacks were determined by software [STUDIO 9]. Speed of the ball at the different shootings was calculated by REG A VI software, version 2.57, 2004. Work was dissociated according to 2 variables namely axes and lines. Players of lateral axes [A4] and front basis [LI] were shorter and thinner than those of the central axis [A3] and rear basis [L2]. No differences were observed between lines and axes in age. The analysis of the total shootings to the goal shows that the players of lines and axes present very close values in each team, excepting the Croatian L2 compared to the Tunisian L2. Players of the rear Croatian basis present also a number of attacks concluded by a non-successfully cadred shooting greater than all other groups. In the Spanish group, a significant difference among number of passes concluded by a non-successfully cadred shooting between lines, and front basis vs central axis was noted. No significant difference was found between lines and axes in the Croatian team. Regarding the velocity of shooting, excepting the Croatian team, no differences were found between lines and axes of the other teams. No differences were also noted in the attack duration between lines and axes in Croatian and Tunisian teams. In the Spanish team, duration of attacks concluded by a cadred shooting was most important when finished by an L2 or an A3 player. The present results demonstrate that finalist teams were found to be clearly characterized by L2 and A3 players taller and weightier than those of LI and A4. Organized attack was generally concluded by shooting done by an L2 or an A4 player and the shooting velocity did not significantly determine the offensive efficiency

Gadolinium-DTPA: a contrastagent for conventional x-ray and CT examinations; when? why and how?

It was noticed that Gadolinium-based contrast agents produced vascular and tissue enhancement on computed tomographic [CT] scans obtained in patients after magnetic resonance [MR] imaging examinations. It also have been used as an alternative to iodinated contrast agents in angiography. This study was performed to assess more systematically the potential utility of gadolinium based contrast agent at both CT and conventional X-ray procedures .Fifteen patients were examined with Gd-DTPA as a contrast medium for CT of Brain [5 patients], CT abdomen [5 patients] and another five patients underwent routine intravenous urography [IVU] examination. Single cut level dynamic scan for CT examinations performed after intravenous injection of the Gd-DTPA as a bolus technique and time enhancement curves for different tissues of interest were drown. Gd-DTPA showed satisfactory diagnostic visualization of the urinary system, good contrast visualization of the veins, and Good enhancement of the brain vascularity, but milder degrees of tissue enhancement for parenchymatous organs occurred however the aorta showed good diagnostic enhancement. We concluded that gadolinium may be an alternative CT contrast agents for patients who cannot receive iodinated contrast agents and in whom contrast-enhanced CT is the examination of choice. While the current high cost of gadolinium-based contrast agents might prohibit their routine use, the cost might be justifiable in various infrequent clinical situations, particularly for vascular studies

antioxidant status in some asthmatic children

Thirty subjects with stable controlled asthma, they had extrinsic atopic asthma and 20 age and sex matched controls, were included in this study. Children with asthma showed significantly an increased malondialdehyde [MDA] level compared with the controls. The increase in MDA and the reduction in GPX activity may have etiological implications for asthma. Hence, glutathione, vitamin A as well as zinc might be recommended as adjuvant therapy in asthma. Also, good dietetic intake of high biological value protein was recommended for asthmatics