A Polymorphism in the Microsomal Triglyceride Transfer Protein Can Predict the Response to Antiviral Therapy in Egyptian Patients with Chronic Hepatitis C Virus Genotype 4 Infection

BACKGROUND/AIMS: A polymorphism in the microsomal triglyceride transfer protein (MTP) is associated with hepatic fibrosis, and carriers showed higher levels of steatosis, higher levels of hepatitis C virus (HCV) RNA and advanced fibrosis. The aim of this study was to study MTP expression pattern in HCV patients and impact of the MTP polymorphism on the response to antiviral therapy. METHODS: One hundred consecutive naive HCV genotype 4 patients were recruited to receive antiviral therapy, and 40 control subjects were also recruited. Demographic, laboratory, and histopathology data were collected. DNA was isolated, and the samples were subjected to polymerase chain reaction analysis and genotyping for MTP by restriction fragment length polymorphism analysis. RESULTS: Patients and controls were age- and sex-matched (male/female, 56/44, age, 39.2+/-7.8 years for patients with HCV; male/female, 18/22, age, 38.1+/-8.1 years for controls). MTP single nucleotide polymorphisms (SNPs) (GG, GT, TT) and alleles (G, T) in the patients versus the controls were 70%, 21%, 9% & 80.5%, 19.5% versus 10%, 87.5%, 2.5% & 53.8%, 46.3%, respectively (p=0.0001). The sustained viral response (SVR) of the patients was 60%. SNPs in MTP genotypes (GG, GT, and TT) and alleles (G and T) in the responders and nonresponders were 71.7%, 25%, 3.3% & 84.2%, 15.8% versus 67.5%, 15%, 17.5% & 75%, 25% (p=0.038 and p=0.109, respectively). A multivariate analysis showed that the GT genotype was an independent predictor of SVR (area under the curve 90% and p=0.0001). CONCLUSIONS: MTP could be a new predictor for SVR to antiviral therapy in patients with HCV genotype 4 infection.

Radial approach and single wiring as first intentional strategies in chronic total occlusions of the left anterior descending coronary artery

Percutaneous coronary intervention [PCI] for chronic total occlusion [CTO] of the left anterior descending coronary artery [LAD] specifically is associated with improved long-term 5 years survival as compared to PCI failure. Simpler PCI techniques may be successful and safer than complex techniques which are perceived to have high failure rates and technical complexity. We aimed to describe the safety and effectiveness of first intentional single wiring and radial approach in the treatment of patients with a CTO of the native LAD coronary artery at Toulouse Rangueil university hospitals. The study was a single center prospective registry. All patients showed evidence of myocardial viability in LAD territory. The operators' initial strategy was to start by a radial access as a first choice whenever feasible; if not, a femoral access was chosen. The initial strategy for lesion crossing in either antegrade or retrograde approaches was single wiring by lesion crossing using one guidewire [GW] as a simple technique. A total of 30 patients with 30 LAD CTO lesions [100%] were recorded. Mean age was 71.6 + 15 years, 77% were males and 23% were females. The access route was radial 66% of the time and femoral 54% of the time and with double access for contralateral injection in 40% of the patients. Sheaths and catheters sizes 6F were used in 53% of the patients, and 7F in 73% of the patients. Overall lesion success rate was 83% of lesions. Single wiring was the prevailing technique used in 97% of successful lesions [83% of total cases], while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% of our total study cases with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% of our cases with a GW success rate of 67%. Q-wave myocardial infarction [MI], stent thrombosis, stroke, emergency coronary artery bypass graft [CABG], major bleeding, radiation dermatitis, cardiac tamponade or clinical perforation requiring any hemostatic maneuvers did not occur. There was a post-procedural Troponin rise of 3x normal levels in 30% of patients, and contrast induced nephropathy in 7%. Intra-aortic balloon counterpulsation [IABCP] was used in 3% of patients and cardiac death occurred in 3% of patients. Single wiring and radial access as initial strategies in PCI for LAD-CTO lesions in either approaches antegrade or retrograde are associated with a high procedural success rate and an acceptable incidences of adverse events

Titanium elastic nail fixation of diaphyseal humeral fracture in multiply traumatized adolescent and young adults

Non operative treatment is the mainstay in isolated humeral shaft fractures, as opposed to multiple trauma patients where operative stabilization is often necessary. Multiple methods of internal fixation of these fractures are in practice with no clear cut merits of one method over the other. This is a prospective study to review the clinical and functional outcome of fixing diaphyseal humeral fractures in adolescents and young adults with multiple trauma by titanium elastic nails. Diaphyseal humeral shaft fracture in eighteen multiply injured adolescent and young adult patients were treated with closed intramedullary titanium elastic nailing. Modified antegrade technique was used in 6 patients and retrograde technique was used in 12 patients. Average patient age was 26-years; and average follow-up duration was 17-months. The primary outcome measures were function and pain assessment at six months using the American Shoulder and Elbow Surgeons [ASES] score for 13 activities of daily living. Follow up of sixteen fractures showed that fourteen [88%] united primarily at an average of 10 weeks. Functional assessment at six months, using American Shoulder and Elbow Surgeons [ASES] score showed an average of 46 points. Secondary surgery was performed in two patients; one bone grafting for delayed union with eventual healing, and one patient had plating of fracture after development of a gap and soft tissue interposition. There was no deep infection or iatrogenic radial nerve injury. Closed stabilization of humeral shaft fracture by titanium elastic nail in this study provide a stable fixation, yielding overall good clinical and functional outcome in the multiply injured patient and served as simple, safe and fast procedure with minimal morbidity

Evaluation of serum plasminogen activator inhibitor-1 [PAI-1] in type 2 diabetic patients

This study was performed on 20 nonsmoking, normotensive type 2 female diabetic patients with normal renal and hepatic functions. They were divided into two groups: Group 1 included ten controlled type 2 diabetic patients on oral hypoglycemics with a mean age of 53.9 +/- 5.23 years [range 45-60 years] and mean diabetes duration of 5.7 +/- 2.6 years and group 2 included ten uncontrolled type 2 diabetic patients on oral hypoglycemics with a mean age of 49 +/- 5.01 years [range 40-56 years] and mean diabetes duration of 11.6 +/- 3.7 years. A determination of plasma insulin level using enzyme linked immunosorbent assay [ELISA] and the plasma level of plasminogen activator inhibitor-1 [PAI-1] was done using Biopool Tint Elize test. Ten age and sex matched normal subjects were included in the study as a control group. The results of this study indicated that among type 2 diabetic patients, PAI-1 was elevated among uncontrolled diabetic patients. It proved to have an important role in the development of ischemic heart disease as an example of macrovascular diabetic complication, especially if associated with dyslipidemia

Biochemical analysis of hydatid cyst fluid and protoscolices

Hydatid cysts of a number of animal intermediate hosts namely camel cattle, goat, sheep and pig were analyzed for carbohydrates, enzymes, lipids, minerals and proteins. A large number of amino acids was detected both in the fluid and protoscolices. The protein content was higher in the latter. A considerable amount of calcium was present in the protoscolices compared with the fluid. Nucleic acids RNA and DNA were detected in the protoscolices hydrolysate while small amounts were found in hydatid fluid