ABSTRACT
Introduction and aim: chronic hepatitis C infection [CHC] is a global health-care problem with an increasing burden year-by-year, particularly in Egypt. Even with the advent of high sensitive techniques, a subset of patients with positive HCV-Ab and negative HCV-viremia remain challenging. Therefore, we herein tried to determine the prevalence of occult HCV infection in peripherd blood mononuclear cells [PBMCs] of Patients presented with positive serologic test for anti-HCV-Ab and negative serum HCV-RNA-PCR [spontaneously cleared-patients] and also, we followed up those patients
Patients and Methods: between March 2010 to March 2015, a prospective study was designed to include all consecutive patients with HCV-Ab positivity and HCV-RNA negativity who attended to Assiut unit for treatment of viral hepatitis; sector of national committee for contrbl of viral hepatitis. A total of 25 patients were recruited. Spontaneous clearance of serum HCV infection was approved by [HCV-Ab positive using two 3rd generation ELISA tests and serum HCV RNA negative in three consecutive occasion each six months apart]. Follow up serum HCV RNA for patients with Occult 1 HCV Infection every 6 months. The RNA extraction step was performed by a protocol modified from, that of the QIAamp viral RNA kits [Qiagen, courtaboeuf, France]. Blood samples for separation of I PBMCs were collected from all patients. PBMCs were obtained using Ficoll-Hypaque density gradient of EDTA anticoagulated blood according to the manufacturer's instructions [Lymphoflot, Biotest,Dreleich, Germany]. Detection of HCV viral load was performed by kit supplied by applied Biosystem [HCV RT-PCR Kit lot No.]
Results: a total of 25 [21 males, mean age 36.2 +/- 9.1] patients who cleared HCV spontaneously [HCV- Ab positive and serum HCV RNA negative]. The genomic HCV RNA was detected in PBMCs from 3 [12%] of 25 patients. Follow up for those three patients with occult HCV infection were done for 18 months by measuring serum HCV RNA by using highly sensitive real-time Polymerase Chain Reaction [RT-PCR] every 6 months, only single patient became overt HCV with low level of viremia
Conclusion: occult HCV infection was detected in a considerable prevalence in patients in whom apparent clearance of HCV-viral load occurred that entails corporations of HCV-viral assay in PBMCs into the diagnostic algorithm
ABSTRACT
Background/Aim: The use of pegylated interferon-alpha [IFN-alpha] and ribavirin is still an integral part of the standard of care treatment of chronic hepatitis C [CHC] in Egypt until the present time, even after introducing the new era of direct acting antiviral drugs. Such regimens are accompanied by the production of autoantibodies that carries the risk of development of thyroid dysfunction [TD]. The study tries to describe the incidence, long-term outcome, and predictors of TD among Egyptian patients with CHC receiving IFN-based treatment
Patients and Methods: Between January 2013 and August 2014, a prospective study design was conducted to include naive CHC patients [virologically and histopathologically proved] enrolled for INFbased therapy with normal thyroid function profile
Results: A total of 400 patients [mean age was 37.4+9.6 years, 18% were females] were included. At the end of the study period, 12.3% of patients [n=49] developed biochemical TD [TSH<0.3 or >5.0 mIU/L]. At the 12th week after the end of antiviral therapy, 67.3% of them [n=33] were spontaneously normalized. At the 24[th] week, 14.3% of the remaining [n=7] had spontaneously normalized. Female gender was significantly associated with the development of TD
Conclusions: The incidence of TD among the Egyptian patients treated by INF-based antiviral therapy for CHC is not low and more predominant in females. Spontaneous recovery after the end of treatment was common however, it entails a strict follow up
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Hepatitis C, Chronic , Interferons , Ribavirin , Prospective Studies , Incidence , Interferon-alphaABSTRACT
Background: The WHO classified pancreatic neuroendocrine neoplasms (pNEN)in 2010 as G1, G2, and neuroendocrine carcinoma (NEC), according to Ki67labeling index (LI). However, the clinical behavior of NEC is still not fully studied.We aimed to clarify the clinicopathological and molecular characteristics ofNECs.Methods: We retrospectively evaluated the clinicopathological characteristics,KRAS mutation status, treatment response, and the overall survival of elevenpNEC patients diagnosed between 2001 and 2014 according to the WHO 2010.We subclassified WHO-NECs into well-differentiated (WDNEC) and poorlydifferentiatedNEC (PDNEC), the latter further subdivided into large and smallcell type.Results: The median Ki67 LI was 69.1% (range, 40% - 95%) and the mediantumor size was 35 mm. 11 WHO-NECs were subclassified 4 WDNEC and 7PDNEC, and further separated PDNEC into 3 large cell and 4 small cell subtypes.Comparisons of WDNEC vs. PDNEC revealed hypervascularity on CT, 50% (2/4)vs. 0% (0/7) (P = 0.109); median Ki67 LI, 46.3% (40% - 53%) vs. 85% (54% -95%) (P = 0.001); KRAS mutations, 0% (0/4) vs. 85.7% (6/7) (P = 0.015); responserates to platinum-based chemotherapy, 0% (0/2) vs.100% (4/4) (P = 0.067) andmedian survival, 227 vs. 186 days (P = 0.227).Conclusions: The WHO-NEC category may be composed of heterogeneousdisease entities, namely WDNEC and PDNEC. These subgroups tended to exhibitdiffering Ki67 and KRAS mutation profiles, and distinct response to chemotherapy.Further studies for the re-evaluation of the current WHO 2010 classification iswarranted.
ABSTRACT
Background: The WHO classified pancreatic neuroendocrine neoplasms (pNEN) in 2010 as G1, G2, and neuroendocrine carcinoma (NEC), according to Ki67 labeling index (LI). However, the clinical behavior of NEC is still not fully studied. We aimed to clarify the clinicopathological and molecular characteristics of NECs. Methods: We retrospectively evaluated the clinicopathological characteristics, KRAS mutation status, treatment response, and the overall survival of eleven pNEC patients diagnosed between 2001 and 2014 according to the WHO 2010. We subclassified WHO-NECs into well-differentiated (WDNEC) and poorlydifferentiated NEC (PDNEC), the latter further subdivided into large and small cell type. Results: The median Ki67 LI was 69.1% (range, 40% - 95%) and the median tumor size was 35 mm. 11 WHO-NECs were subclassified 4 WDNEC and 7 PDNEC, and further separated PDNEC into 3 large cell and 4 small cell subtypes. Comparisons of WDNEC vs. PDNEC revealed hypervascularity on CT, 50% (2/4) vs. 0% (0/7) (P = 0.109); median Ki67 LI, 46.3% (40% - 53%) vs. 85% (54% - 95%) (P = 0.001); KRAS mutations, 0% (0/4) vs. 85.7% (6/7) (P = 0.015); response rates to platinum-based chemotherapy, 0% (0/2) vs.100% (4/4) (P = 0.067) and median survival, 227 vs. 186 days (P = 0.227). Conclusions: The WHO-NEC category may be composed of heterogeneous disease entities, namely WDNEC and PDNEC. These subgroups tended to exhibit differing Ki67 and KRAS mutation profiles, and distinct response to chemotherapy. Further studies for the re-evaluation of the current WHO 2010 classification is warranted.
ABSTRACT
Concomitant hepatitis C virus [HCV] infection and psoriasis vulgaris [PV] are not uncommon coexisting diseases, especially in areas with high viral hepatitis endemicity. To date, data about the interaction between both diseases are scarce. Therefore, we aimed to describe the possible interplay between the HCV viral load and psoriatic activity in concomitant Egyptian diseased patients. Between December 2011 and August 2013, all psoriatic patients attending Assiut University Hospital outpatient clinics were tested for HCV serologic assay. Patients with positively coexisting diseases were further reevaluated for psoriasis area severity index [PASI] score assessment, liver function tests, HCV-RNA-polymerase chain reaction [PCR] assays, and sonographic examination of the liver. For comparative purposes, another matched group [n = 26] with psoriasis only [HCV-negative group] was enrolled as a control. During the period of the study, 20 patients with concomitant PV and HCV infection [HCV-positive group; 50% males, mean age of 44.15 +/- 10.66 years] were recruited. The mean PASI score was 44.75 +/- 10.38 and clinical signs of liver dysfunction were observed in 40% [n = 8], 100% had abnormal liver function tests [n = 20], and 75% had sonographic findings of cirrhosis [n = 15]. The PASI score was significantly higher in the HCV-positive psoriatic group compared to the HCV-negative control [p < 0.001]. Significant correlations were detected between the PASI score and the viral loads, and also with alanine aminotransferase [ALT]. When HCV was found concomitantly with PV, a high possibility of severe disease pattern will be expected that entails special precautions in the treatment process
ABSTRACT
Background and study aims: Data about dual hepatitis C [HCV] and B [HBV] co-infection are still scarce, especially in endemic areas such as Egypt. Therefore, we aimed to characterise the virologic and histologic pattern of dual B/C co-infection in a tertiary care centre in Egypt
Patients and methods: After obtaining approval from the review board, a retrospective design to evaluate the data registry between January 2009 and December 2012 of patients with dual HCV and HBV seropositivity [BC-group] at the Viral Hepatitis Unit in Ministry of Health and Assiut University Hospital, Egypt was conducted. Data for hepatitis B e antigen [HBe-Ag] and anti-HB core status, anti-hepatitis delta virus [anti-HDV], HBV-DNA and HCV-RNA assays and liver biopsy [METAVIR scoring] results were collected. Two other matched groups of mono-HCV [C-group] and HBV [B-group] were selected as controls. All patients were naive for antiviral therapy
Results: A total of 3300 patients were enrolled. Dual infection was observed in 25 [0.7%] patients [all males, mean = 35.2 +/- 10.2 years]. Four patients [16%] were HBe-Ag-positive. Six [24%] patients were HBV-DNA-negative and all were positive for HCV RNA. Between groups, raised alanine aminotransferase [ALT] was found in 76%, 41.7% and 49.2% of the BC, B and C groups, respectively [p = 0.023]. HBV DNA >2000 IU ml[-1] was more in the B-group than in the BC-group [63.9% vs. 36%; p = 0.042] and HCV RNA >800,000 IU ml[-1] was more in the BC-group than in the C-group [28% vs. 12.3%; p = 0.009]. Histologically, there is no statistical significant difference between the three groups
Conclusion: Dual hepatitis B/C infection is not uncommon and their virologic and histologic profile is modest. Further evaluation with regard to treatment and long-term follow-up is warranted