ABSTRACT
Background and study aims: Mutations within the major hydrophilic region [MHR] of the hepatitis B surface antigen [HBsAg] have been reported in relation to viral persistence by evasion from vaccine and immunotherapy, severity of liver disease and lack of detection by commercial kits. The aim of this study was to elucidate the circulation of hepatitis B virus [HBV] genotypes, subgenotypes and serotypes in Egypt, with recognition of the pattern and prevalence of MHR mutations possibly occurring during the course of the disease
Patients and methods: Eighty-eight samples from patients with chronic HBV infection were included in the study. The surface protein-encoding gene [S gene] in the HBV genome was subjected to amplification and partial sequencing
Results: Based on phylogenetic analysis, only genotype D was found circulating among patients. The majority of isolates belonged to subgenotype D3 [86.3%], followed by D7 [8%], then D5 [3.4%] and lastly D1 [2.3%]. Two subtypes were identified: ayw2 [97%] and ayw3 [2%]. The 'w' sub-determinant was not defined in one isolate [1%]. A significant proportion of patients [13/88, 14.8%] exhibited mutations in the MHR, 10 of whom harboured mutations in the 'a' determinant region and three outside. The first loop comprised four patients with three mutations [P127S, P127T and Y134F]. The second loop contained six patients, all with one mutation, S143L, which was most frequently encountered in this study [6.8%]
Conclusions: We conclude that genotype D, subgenotype D3 and HBsAg subtype ayw2 are the most common types circulating in Egypt, which account for 100%, 86.3% and 97% of the population, respectively, with a moderate degree of MHR mutations
ABSTRACT
To evaluate the role of rosiglitazone in treatment of obese polycystic ovarian women with insulin resistance and its effect on ovulation induction and pregnancy outcome together with looking for any synergistic effect of metformin when combined with rosiglitazone. Double blind, randomized, prospective, placebo-controlled trial. Kasr El-Aini Teaching Hospital Cairo University, Egypt. 75 obese women with PCOS and insulin resistance. Patients were divided into three groups with 25 women each. During the first month, the first group received rosiglitazone alone, the second group received a combination of resiglitazone-metformin and the third group received placebo. All participants had a base-line measurement of total testosterone level together with and oral glucose tolerance test for determination of insulin resistance in terms of fasting glucose and insulin and peak insulin levels. Ovulation was then induced for all patients using CC and HMG for one month while continuing the original medication. Re-assessment of total testosterone level and fasting glucose and insulin was then done at the end of the two months study period. Primary outcome measures are changes in serum total testosterone level and in measures of insulin resistance. The secondary outcome measures are the occurrence of ovulation and pregnancy rates. The two groups receiving insulin sensitizers showed marked improvement in insulin resistance. However, no improvement in hyperandrogenemia was elicited which may be due short duration of exposure. They also demonstrated high ovulation and pregnancy rates with a significant difference compared to the placebo group. These findings suggest that short-term rosiglitazone therapy is effective in improving insulin sensitivity and patient's response to induction of ovulation in obese PCOS cases with insulin resistance. Furthermore, combination of metformin-rosiglitazone did not prove superiority over the use of rosiglitazone alone