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ABSTRACT Background: Sustained virologic response (SVR) rates after directly acting antivirals (DAAs) for hepatitis C virus (HCV) exceed 95%. This encouraged policymakers to put plans to achieve HCV elimination by 2030. The remaining percentage of non-SVR12 can affect HCV eradication strategies in the real-world especially the compliance of large numbers of treated persons to follow up for assessment of virologic response cannot be guaranteed. Objective: We aimed to assess predictors of failure to achieve SVR after receiving sofosbuvir plus NS5A inhibitor as an important step towards achieving better HCV eradication strategies. Methods: During the period from 1st November 2018 to 1st November 2019, 1581 treatment-naive patients received sofosbuvir plus daclatasvir ± ribavirin at our unit and 10 patients were referred to us with HCV relapse after the same regimens. A total of 163 out of the 1581 patients were lost for follow-up before assessment of virologic response and excluded from the analysis. 20 out of the remaining patients failed to achieve SVR12. Data from the 30 patients with non-SVR12 were included in the case-control analysis. Results: Every unit increase in estimated creatinine clearance using modification of diet in renal disease study (MDRD) score, total bilirubin, and INR was associated with 1.03, 13.92, and 80.08 times greater odds of non-SVR12 (P<0.001, P=0.0016, P=0.02) respectively. The presence of liver cirrhosis on ultrasonography increases the odds by 10.03. (P=0.009). Conclusion: Higher MDRD score, INR, total bilirubin, and presence of sonographic features of liver cirrhosis are predictors of failure to achieve SVR12 using sofosbuvir plus NS5A inhibitor.
RESUMO Contexto: As taxas de resposta virológica sustentada (SVR) após ação direta de antivirais (DAAs) para o vírus da hepatite C (VHC) excedem 95%. Isso encorajou os formuladores de políticas a colocar planos para alcançar a eliminação do VHC até 2030. O percentual remanescente de não-respondedores pode afetar as estratégias de erradicação do VHC no mundo real, especialmente a conformidade de um grande número de pessoas tratadas para acompanhamento para avaliação da resposta virológica não pode ser garantida. Objetivo: Nosso objetivo foi avaliar os preditores de não atingir o SVR após receber o inibidor sofosbuvir mais NS5A como um passo importante para alcançar melhores estratégias de erradicação do VHC. Métodos: No período de 1º de novembro de 2018 a 1º de novembro de 2019, 1581 pacientes receberam sofosbuvir mais daclatasvir ± ribavirin em nossa unidade e 10 pacientes foram encaminhados por recaída do VHC após os mesmos regimes. Um total de 163 dos 1581 pacientes foram perdidos para o acompanhamento antes da avaliação da resposta virológica e excluídos da análise. 20 dos demais pacientes não conseguiram a resposta virológica sustentada (SVR12). Os dados de 30 pacientes com não SVR12 foram incluídos na análise caso-controle. Resultados: Cada unidade aumentada no clearence estimado de creatinina usando o escore do estudo Modificação da Dieta em Doença Renal (MDRD), bilirrubina total e INR foram associadas a 1,03, 13,92 e 80,08 vezes maiores chances de não-SVR12 (P<0,001, P=0,0016, P=0,02) respectivamente. A presença de cirrose hepática na ultrassonografia aumenta as chances em 10,03. (P=0,009). Conclusão: Maior escore de MDRD, INR, bilirrubina total e presença de características sonográficas de cirrose hepática são preditores de falha na realização do SVR12 utilizando o inibidor sofosbuvir mais NS5A.
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Background: Patients with coronary slow flow phenomenon (CSFP) exhibit the following characteristics: Predominantly middle-aged males, the majority have mixed pattern angina, persistent chest pain sensations after therapy, and many have had repeated invasive and non-invasive examinations. Objectives: Our study aimed to determine the base of non-invasive predictors of coronary slow flow phenomenon in patients presenting with chronic coronary syndrome. Patients and Methods: This a case-control study included 100 participants of suspected coronary artery disease were divided into two groups matched in age and sex group I: 50 patients with primary CSFP and group II: 50 patients with normal coronary angiography. Each patient was undergoing to demographic data taking, physical investigation, good hydration, restrict fasting hours requested for coronary angiography, 12 lead-Electrocardiogram (ECG)s were obtained for each patient at rest, laboratory parameters, coronary angiography, treadmill exercise ECG, transthoracic echocardiography to assess the thickness of the left ventricle’s (LV) wall, its interior dimensions, as well as the LV’s ejection fraction (EF) using M-mood method and the aortic propagation velocity. Results: male sex and the Canadian Cardiovascular Society Angina grade’s (CCSA) class 3 were significantly decreased in group I compared to group II and male sex, Diabetes mellitus (DM), smoker and CCSA class 4 were substantially increase in group I compared to group II (P <0.05). P wave max, P Wave dispersion (PWd), corrected QT dispersion (QTcd) at resting ECG, T wave inversion and ST Waves segment depression at stress ECG were significantly increase in group I compared to group II. QTc min was significantly lower in group I compared to group II (P <0.05). LA diameter was significantly increased in group I than group II. Aortic propagation velocity was significantly decreased in group I than group II (P <0.05). Hematocrit, total leucocytic count, mean platelet volume and High-sensitivity C-reactive protein (hsCRP) were significantly increase group I compared to group II (P <0.05). Conclusions: Patients suspected of having a coronary artery disease who are diagnosed with coronary slow flow, male sex, dilated LA, CCSA class 3 or 4, elevated hematocrit value, elevated total leucocytic count, increased mean platelet volume, increased HsCRP, P max, PWd, QTcd, T wave inversion, ST segment depression, and decreased aortic propagation were statistically higher in CSFP patient compared to controls
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Systemic lupus erythematosus may rarely present initially with gastroenteric features labelled as lupus enteritis, that may lead to serious complications, if it remains undiagnosed for a long period of time. It is difficult to diagnose because the clinical picture of lupus enteritis mimics gastroenteritis. The diagnosis is made on radiological findings, rather than histopathology, and supported by autoimmune profile. Here is a case of a 40-year lady who presented with diarrhea and vomiting that was unresponsive to treatment with intravenous antibiotics. The diagnosis of lupus enteritis was made on the basis of CT scan abdomen, that showed classic target sign due to bowel edema. There was non-specific inflammation found in the biopsy specimen taken on colonoscopy and her autoimmune workup showed ANA and anti-ds-DNA positive. She was treated with high dose of intravenous steroids and recovered
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Background: Breast cancer is increasingly regarded as a heterogeneous disease which can be classified into distinct molecular subtypes with prognostic significance
Objectives: Retrospective evaluation of the response to neoadjuvant chemotherapy for patients with the major molecular subtypes of breast cancer as classified using immunohistochemical assay and to investigate the patterns of benefit from the neoadjuvant chemotherapy in different molecular subtypes
Materials and methods: ER, PR, HER2 and ki-67 were used to divide102 breast cancer patients treated with neoadjuvant chemotherapy [NCT] into 4 subtypes: luminal A [ER+,PR+,HER2-, and ki-67 14% ; ER+ and/or PR+, HER2+], HER2-overexpression [ER-, PR- and HER2+] and triple-negative [ER-, PR-,and HER2-]
Results: Of the 102 patients analyzed, 9 patients [8.8% of all patients] achieved pCR with 2.6% [2/76] for luminal subgroup, 0.0% [0/8] for HER2-overpression subgroup and 38.9% [7/18] for triple-negative subgroup with a high statistical significant value [p=0.000]
Subject(s)
Humans , Breast Neoplasms/prevention & control , Genes, erbB-2 , Neoadjuvant Therapy , Antineoplastic Agents , Retrospective StudiesABSTRACT
Objectives: The aim of our study is to determine the prevalence of depression among the patients with end stage renal disease and their care givers, and its associated factors at a tertiary care hospital in Karachi Pakistan
Methodology: The type of study is a cross sectional study, conducted for a period of 6 months from June 2015 to November 2015, at a tertiary care hospital in Karachi, Pakistan. The study population consisted of n= 400 individuals [n=200 patients, n=200 attendants]. Beck's Depression Inventory questionnaire was employed to the study participants. Various factors such as gender, education level, employment and marital status, and various co morbidities were studied for their association with depression
Results: The prevalence of severe and moderate depression among the patients undergoing dialysis was 72.5%, and it was 35% among the caregivers having a p value of less than 0.001. The patients at the highest risk of depression were married, unemployed and with an income of less than Rs. 5000/-. The factors that had a positive association with depression were marital status [p value of less than 0.001], employment status [p value 0.01] low level of income [p value of 0.061], females [p value of 0.045], level of education below grade 10 [p value of 0.045]. Anemia showed an association with depression [p value of 0.023]
Conclusion: According to the results of our study a significant number of patients who were undergoing maintenance hemodialysis were depressed, and were two times likely to be depressed when compared to their care givers. Marriage and unemployment were the factors most associated with symptoms of depression. Household income showed a negative relation, but gender and education level were found to be not related to the incidence of depression
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Objectives: The aim of our study is to determine the prevalence of pulmonary hypertension in patients who undergo dialysis on a regular basis, as it has been associated with increased morbidity and mortality is the patient population
Methodology: The type of study is a cross sectional study conducted for a period of one year duration from April 2014 to March 2015, at a tertiary care hospital in Karachi, Pakistan. The study population consisted of n=90 patients with end stage renal disease, who undergo regular dialysis on maintenance basis, and had trans thoracic echocardiography performed, various parameters including the systolic pulmonary arterial pressure were recorded. A pulmonary arterial pressure greater than 30mm of Hg at rest was defined as pulmonary hypertension, and it was further divided into three sub categories mild [ btw 30-40mm of Hg ], moderate [ btw 45-65mm of Hg ], severe [ greater than 65 mm of Hg ]. Variables such as age, gender, duration on maintenance dialysis, vascular access utilized were recorded. Data was analyzed using SPSS version 20
Results: Out of the total n=90 patients, n= 40 were males, and n= 50 were females, the mean duration of time duration of dialysis was 16.29 +/- 12.1 months. N= 52 patients were found to have pulmonary hypertension, and the mean value for the pulmonary arterial pressure was 38.4 +/- 19.18 mm of Hg, the mean age of patients having pulmonary hypertension was 53.45 +/- 12.4 years. Pulmonary hypertension was more common in the females as compared to the males [ n= 32 versus n= 19 ], Pulmonary hypertension was found to be greater in patients who had been on dialysis for less than 20 months duration, and it was also noticed that the longer the duration of hemodialysis the more severe the pulmonary hypertension
Conclusion: According to the results of our study patients on maintenance hemodialysis are at an increased risk of developing pulmonary hypertension, it is more common in the females, and has a strong correlation with the duration of maintenance hemodialysis and the arteriovenous access utilized
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Introduction: urinary tract infections are common in women of developing countries which results in substantial morbidity and health care cost. The Urogenital fistula is frequently related to gynecological conditions
Material and Methods: this is a prospective study was carried out in the Department of Nephrology, Abbasi Shaheed Hospital from March 2011 to May 2014. 79 patients with urogenital fistula, irrespective of cause of the fistula, with ages between 18-60 years were included in this study. Patients were referred to nephrology clinic. A detail medical history was taken from each patient for episodes of urinary tract infection and the treatment given during the last six months. Patients were educated how to collect midstream morning urine sample. Urine sample were taken from all symptomatic and asymptomatic patients for culture examination and send to laboratory within an hour
Results: we have found that out of 72 patients studied for UTI, 89 percent of the studied patients had culture proven UTI. Recurrent UTI is very common in patients with uro-genital fistulas and 72 percent of patients experienced an average of 03 episodes of symptomatic UTIs during last six months. Relapses are more frequent than re-infections. Culture proven but asymptomatic infections were seen in 39 percent of patients. Mean infectious episodes rate during last six months was 3. 73 percent of the observed episodes were symptomatic, while asymptomatic bacteriuria was seen in 27 percent of patients. The most frequent Bacteria is E. coli followed by Pseudomonas aerugenosa and Enterobacter species. These were the most common pathogen isolated which are highly resistant to Amoxicillin, Cotrimoxazole, Fluoroquinolones and Cephalosporins. We found that the isolated pathogens are mostly sensitive to Piperacillin- Tazobactam and Carbepenem groups of Drugs
Conclusion: we concluded that Urogenital fistula in developing countries are most regularly linked to Gynecological surgery whereas in developing countries, complicated childbirth is the most common cause. Recurrent infections are more frequent in patients with urogenital fistula and mostly represent relapse rather than re-infection. Relapsing infection warrants extensive evaluation of urinary tract and extended period of antimicrobial therapy with appropriate antibiotics
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BACKGROUND: Alkali-burned corneas can seldom heal properly to restore corneal transparency. Treatment of this severe disorder of the ocular surface remains a challenge. AIM OF THE WORK: was to investigate whether systemically transplanted bone marrow mesenchymal stem cells (BM-MSCs) can promote corneal wound healing after alkali burn. MATERIAL AND METHODS: Thirty five male New Zealand rabbits were used in this study. The animals were divided into three groups. Group I; the control group was sham operated. Group II; corneal alkali burn was created. Group III; underwent corneal alkali burn then treated with BM-MSCs. All corneas were collected after fourteen and twenty eight days. Evaluation using H&E, PAS & alkaline phosphatase reaction was carried out. Immune histo-chemical staining for CD44 and vimentin was performed as well. RESULTS: the corneal epithelium of (Group II) showed marked alterations. Vascularization, cellular infiltration and irregularity of the collagen fibers were also seen in the substantia propria. Increase in the thickness of the Descemet's membrane was noticed as well. On the other hand, at the time of 28 days, Group III rabbits showed best histological results with nearly healed corneas compared to other groups. Meanwhile, vimentin was more strongly expressed in Group III assessing the differentiating ability of BM-MSCs. CONCLUSION: BM-MSCs could effectively promote corneal alkali burn healing.
Subject(s)
Animals , Humans , Male , Rabbits , Alkalies , Alkaline Phosphatase , Bone Marrow , Burns , Collagen , Cornea , Descemet Membrane , Epithelium, Corneal , Hand , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells , Vimentin , Wound HealingABSTRACT
BACKGROUND AND OBJECTIVES: Variety of pathological factors including viral hepatitis, alcohol and drug abuse, metabolic diseases, autoimmune diseases and congenital abnormalities can cause hepatic injury. Liver transplantation is the treatment of choice for end-stage liver diseases, however, it faces several difficulties. So the aim of the work is to evaluate the effect of bone marrow derived mesenchymal stem cells (BM-MSCs) on the liver structure in carbon tetra chloride CCL4 induced liver fibrosis in rats. MATERIALS AND RESULTS: BM-MSCs were isolated and characterized from long bones of twenty male albino rats. Sixty female rats were divided into the following two groups: Group I; thirty rats which were the control group. Group II; thirty rats were injected intra-peritoneal (IP) by CCL4 twice weekly for four weeks and was further subdivided into the following three subgroups: Subgroup IIA (CCL4 alone); included ten rats which were sacrificed after this four weeks. Subgroup IIB (CCL4/MSCs); included ten rats which were IP injected by a single dose of BM-MSCs and were sacrificed after four weeks. Subgroup IIC (CCL4/recovery); included ten rats which were left for another four weeks without any intervention. Histological examination of liver specimens showed that CCl4 caused variable pathological changes with elevated liver enzymes. Injection of BM-MSCs revealed an improvement in the histological picture of the liver and its enzymatic profile. On the other hand, most of the pathological lesion were still detected in rats of recovery group. CONCLUSIONS: BM-MSC could restore the liver structure and function in experimental model of liver fibrosis.
Subject(s)
Animals , Female , Humans , Male , Rats , Autoimmune Diseases , Bone Marrow , Carbon , Characidae , Congenital Abnormalities , Fibrosis , Hand , Hepatitis , Liver , Liver Cirrhosis , Liver Diseases , Liver Transplantation , Mesenchymal Stem Cells , Metabolic Diseases , Models, Theoretical , Substance-Related DisordersABSTRACT
Adiponectin is an adipose tissue derived mediator with significant anti atherosclerotic properties and is involved in the regulation of insulin sensitivity and lipid oxidation, a few studies were done in acute phase of myocardial infarction, especially in none obese patients. The study investigated the association between adiponectin concentration and acute phase of myocardial infarction [MI] in non obese men patients. The results showed that adiponectin levels in patients with AMI [5.2ug/ml] were significantly lower than that of control group [7.5ug/ml] [P<0.001]. Lower adiponectin levels were independently associated with higher risk of AMI [odd ratio= 6.12, 95% CIs: 2.4-18.6; P=<0.001]. Adiponectin levels were negatively correlated with triglyceride [r=-0.34] in case group and [r=-0.41] in control group [P< 0.001]. In addition, negatively correlated with BMI [r=-0.27] in case group and [r=-0.23] in control group [P< 0.001], but adiponectin levels is positively correlated with HDL-Cholesterol [r= 0.45] in case group and [r=0.51] in control group with [P<0.001]
Subject(s)
Humans , Male , Adiponectin/blood , /etiology , Body Mass Index , Cholesterol, HDL/blood , Triglycerides/blood , MaleABSTRACT
Twenty five male albino rats were used in the current study to evaluate the role of garlic extract in management of coronary artery changes that result on top of intake of high cholesterol diet. The animals were divided into 5 equal groups. Group I was a control group. Group II was given garlic extract orally. Group III allowed high cholesterol diet in the form of egg yolk. Group IV received garlic extract concomitantly with the high cholesterol diet [HCD]. Group V was given high cholesterol diet, then the diet was stopped and garlic extract was allowed for 2 weeks. After the end of the experiment the left side of the heart was dissected out. The specimens were possessed sections were cut and stained by H and E, aldehyde fuchsin and oil red-O stain. Blood samples were collected for measuring of blood cholesterol level. Following intake of high cholesterol diet accumulation of fat was observed in the intima and media. There was highly significant increase in the intimal and medial thickness. The internal elastic lamina was seen to be disorganized and discontinous in some areas. The endothelium of the intima showed localized areas of hyperplasia and there was adherence of blood elements to it. Giving garlic extract concomitantly with high cholesterol diet resulted in a histological picture of the coronary arteries more or less similar to that of the control group. When garlic was given after stopping of the high cholesterol diet, the histological picture of the coronary arteries did not show a significant improvement. In view of the previous results it could be concluded that garlic could be used as a protective agent against the changes produced by high cholesterol diet on the coronary arteries. It's role in treatment was not as that when used as a prophylactic measure
Subject(s)
Male , Animals, Laboratory , Coronary Vessels/pathology , Histology , Protective Agents , Garlic , Treatment Outcome , Rats , MaleABSTRACT
To compare the extent of subclinical macrovascular disease [atherosclerosis] and the related potential vascular risk factors including thrombotic variables in patients with well controlled rheumatoid arthritis [RA], and in population controls. Fifty RA patients were compared with an age and sex matched fifty controls. Traditional vascular risk factors such as smoking, high blood pressure, blood sugar, lipids and steroid usage were assessed. Also thrombotic variables including plasma fibrinogen, von Willebrand factor antigen [vWE], tissue plasminogen activator antigen [t-PA] and fibrin D-dimer were assessed. Non invasive vascular tests including; carotid duplex scanning for measuring common carotid artery intima-media thickness [IMT], QT dispersion on ECG [QTD], and ankle-brachial blood pressure index [ABPI] were performed for patients and controls. The average IMT mean [SE] in RA patients was 0.79 [0.07] mm, compared with 0.63 [0.04] mm in the control group [P=0.001, MW]. QTD was higher in RA patients; mean [S.E] 58 [3.6] ms compared with 44 [2.9] ms for controls [P0.001, MW]. Low ABPI [< 1.0] was found in 14 out of 50 RA patients [28%] vs 3 out of 50 controls [6%] [P=0.001, X2 - test], all these results were statistically significant. There were no significant differences in the prevalence of traditional risk factors between RA patients and controls. RA patients who received long-term steroid showed significant positive correlation in the prevalence of macrovascular disease; IMT [P=0.02], QTD [P=0.032], and ABPI [0.03], Pearson's correlation test. Significant elevations of thrombotic variables were found in RA patients [fibrinogen [P=0.001], vWF [P=0.001], t-PA [P=0.006] and fibrin D-dimer [P=0.028], t-test] compared with controls. High thrombotic variables within the RA patients correlated positively with the prevalence of macrovascular disease. PA patients have an increased risk for subclinical macrovascular disease [atherosclerosis] as shown by the high prevalence of carotid disease [increased IMT], cardiac disease [prolonged QTD] and peripheral arterial disease [lower ABPI]. Among the related vascular risk factors, we found that long term steroid therapy and increased thrombotic variables are potential risk factors
Subject(s)
Humans , Male , Female , Cardiovascular System , Thrombosis , Atherosclerosis , Risk Factors , Echocardiography , Body Mass Index , Hypertension , Smoking , Diabetes MellitusABSTRACT
Thirty women with acne vulgaris, twenty of whom had moderate to severe acne and ten had mild acne and ten controls between the age 16-24 years were studied. Hormonal levels included serum LH, FSH and testosterone in the early follicular phase. Grades of hirsuitism and menstrual irregularities were recoded. Pelvic ultrasonography for polycystic ovaries [PCO] was done in all subjects. Fifteen patients with moderate to severe acne and two in mild acne had polycystic ovaries upon ultrasonography. Patients with polycystic ovaries were detected to have at least one hormonal abnormality
Subject(s)
Humans , Female , Acne Vulgaris , Luteinizing Hormone/blood , Follicle Stimulating Hormone/blood , Testosterone/blood , HirsutismABSTRACT
In this study, the use of ilizarov method to treat six severely deformed feet with satisfactory results in terms of function and appearance was documented. A persistent reduction of ankle joint motion was commonly found. The ilizarov apparatus appeared to be an effective and safe method in the treatment of complex foot deformities due to its three-dimensional nature