Hepatocellular carcinoma post direct anti hepatitis C viral agents; clinical features

Background: Direct Anti Hepatitis C Viral Agents (DAAs) were introduced for Hepatitis C Virus (HCV) infection management, which resulted in high sustained virological response (SVR) in many countries and a low failure rate. However, hepatocellular carcinoma (HCC) post DAAs therapy is controversial; few studies related aggressive pattern HCC to DAAs. Therefore, we aimed to study the hepatocellular carcinoma relation to direct anti-hepatitis C viral drugs. Patients and Methods: This observational cross-sectional study included 67 adults Egyptian HCC patients associated with HCV diagnosed at the Zagazig University Hospitals, who were divided into two groups according to DAAs treatment. Results: HCC is more common in male patients (77.6%) of all studied cases, and those are treated by DAAs (62.7%). The median age of HCC post-DAA was 63(48-83), while 58 (45-75) in HCC patients without DAA, with no significant difference p= 0.053. HCC presented in the non-DAAs treated group, mainly decompensating by hematemesis (HM) (32%). While in the post-DAAs group, HCC was significantly diagnosed primarily with abdominal pain at 31%. There is no significant difference as regards the liver status with frequent liver cirrhosis in both groups, 14(56%) and 32(76.2%). Conclusion: DAAs therapy of HCV added no specific pattern association for hepatocellular carcinoma.

The SARS-COV2 (COVID-19) Pandemic: What Clinicians should Know

In late 2019, a novel coronavirus, now designated SARS-CoV-2, emerged and was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China, named as COVID-19. Since then the waves of the virus exponentially hit many countries around the globe with high rates of spread associated with variable degrees of morbidity and mortality. The WHO announced the pandemic state of the infection in March 2020 and by June 1st 2020 more than 6 million individuals and more than 370 thousands case fatalities were documented worldwide. In this article, we discussed many aspects regarding this emerged infection based on the available evidence aiming to help clinician to improve not only their knowledge but also their practices toward this infection.

The SARS-COV2 (COVID-19) Pandemic: What Clinicians should Know

In late 2019, a novel coronavirus, now designated SARS-CoV-2, emerged and was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China, named as COVID-19. Since then the waves of the virus exponentially hit many countries around the globe with high rates of spread associated with variable degrees of morbidity and mortality. The WHO announced the pandemic state of the infection in March 2020 and by June 1st 2020 more than 6 million individuals and more than 370 thousands case fatalities were documented worldwide. In this article, we discussed many aspects regarding this emerged infection based on the available evidence aiming to help clinician to improve not only their knowledge but also their practices toward this infection.

Identification of the barriers in seeking definite treatment by patients with genitourinary fistulae

To identify the barriers in seeking definite treatment among the patients with urinary fistulae. Department of Obstetric and Gynaecology, Unit II of Liaquat University of Medical and Health Sciences Jamshoro, Pakistan. From 1[st] January 2007 to 31[st] December 2011. All patients with confirmed urogenital fistulae were included in this cross sectional study by consecutive sampling. A pre designed proforma was used to collect the information about demographic features, causes, duration of fistulae, and reasons for delay in reaching for treatment. SPSS program version 10 was used to analyze the data in terms of frequency and percentage. During the study period there were 5013 gynecology based admissions. 232 of these [4.6% of gynecological admission] were registered cases of urogenital fistulae. After the exclusion of 26 recent cases of urinary fistulae; study was carried out on 206 patients. There were 113 cases of obstetrical fistulae while 93 cases were due to iatrogenic insult during gynecological surgeries. Majority [n=164, 77%] of patients were outside from Hyderabad city. The time lapse from symptoms to presentation at treatment centre was longer than one year in patients with obstetrical fistulae, but was shorter [three to six months] in patients with iatrogenic fistula. The main barrier in seeking early treatments in cases with obstetrical fistulae was lack of knowledge about availability of treatment and treatment centre [87.6%]. Financial constraints [55.7%] and lack of attention by family [42%] were the added barriers. Regarding iatrogenic fistulae, a gross neglect of the attending surgeon was obvious. Majority of the cases were misguided about the problem [n=69, 74%]. Misdiagnosis as a case of chronic vaginal discharge was seen in eleven patients. There is a need to disseminate the awareness particularly at community levels with support of media regarding genitourinary fistulae. Fistulae should not occur but if they do, efforts should be made to shorten the time of this terrifying illness

Pattern of ovarian tumours in different age groups: in a gyneacological unit of a tertiary care hospital

To determine the frequency and pattern of ovarian tumours in different age groups in a unit of a tertiary level hospital. Retrospective study. Department of Obstetrics and Gynaecology [Unit-II] Liaquat University Hospital [LUH], Hyderabad, Sindh from January 2001 to December 2007. All cases of ovarian tumours with confirmed diagnosis on histopathological examination, managed in gynecological unit II from January 2001 to December 2007 were included in study. Medical case records and histopathological reports were reviewed. The patients with ovarian tumours were divided into three groups on bases of age at time of presentation. Data analysis included were frequency and percentage of histopathological pattern of ovarian tumours in different age groups. Over the study period of 7 years, the total gyneacological admissions in gynecological unit II were 17550, and 813 biopsies were studied in patients who presented with ovarian masses. Out of 813 boipsies, 602 were ovarian neoplasms on histopathological examination, giving a frequency of 3.4%. In relative frequency, 73.08% were benign, 22.75% were malignant and 4.15% were mixed ovarian tumours. Epithelial tumours were the most common type, followed by germ cell tumour and sex cord stromal tumours in all age groups. Mucinous adenocarcinoma was the most common malignant ovarian tumour, in reproductive and perimenopausal age group and germ cell tumour in very young women. Ovarian tumours can present at any age. In all age groups the most common ovarian tumours are epithelial. In younger age group the most common benign tumours are epithelial, and the most common malignant tumours are germ cell. The frequency of malignant and benign ovarian tumours was almost same in both reproductive and perimenopausal age groups, and the most common malignant tumour was mucinous adenocarcinoma.

Uterine rupture at LUMHS: a review of 85 cases

Objective: to evaluate risk factors, management and pregnancy outcome of patients with buterine rupture at teaching hospital

Design: prospective observational study

Setting: obstetrical and Gynecology Unit II, Liaquat University Hospital Hyderabad-Pakistan; from 1st January 2004 to 31st December 2007

Patients and methods: all patients diagnosed as case of intrapartum uterine rupture were approached. A pre-designed proforma was used to collect the demographic features, predisposing risk factors, management and feto-maternal outcome. Data fed to SPSS program version 10 to analyze the results

Results: total maternity admissions were 12678 with 11961 deliveries. A total number of 85 cases of uterine rupture were identified, giving a ratio of 0.7% or 1:141 deliveries. There were 46 cases in scarred and 39 cases with unscarred uteri. Highest incidence was found in age group 25-30 years [57.6%] and in parity group 1-3 [62.3%]. Misuse of oxytocic's [85.8%], scarred uterus [54.1%], obstructed labour [42.3%] and grand multiparty [21%] were found as main predisposing factors. Uterine repair was done in 61% of cases while hysterectomy was performed in 39% cases. Bladder repair was additionally required in 9.5% of cases. There were 6 [7%] maternal and 64 [75%] perinatal deaths due to uterine rupture

Conclusion: uterine rupture is yet a common obstetrical emergency in our area. The significant morbidity and mortality deserves our special attention by a collaborative approach. Regular antenatal checks, careful selection of patients for vaginal delivery, vigilantly monitored labour with smooth switch-over to operative delivery can reduce this drastic obstetrical complication

Risk factors, clinical presentation and management of 62 cases of ectopic pregnancy at tertiary care center

Objective: to observe the risk factors, clinical pattern and management of ectopic pregnancy

Design: descriptive observational study

Place and duration: gynecological Unit II, Liaquat University of Medical and Health Sciences, Hyderabad from January 1st 2006 to April 1st 2008

Patients and methods: all patients with confirmed diagnosis of ectopic pregnancy were included in the study. A pre-formed proforma was used to record the details about the demographic features, pre-existing risk factors for ectopic pregnancy, clinical features at presentation, management and findings at surgery. Data fed to SPSS program version 11 to analyses the results in terms of frequency and percentages

Results: total maternity admissions were 8016 with 62 cases of ectopic pregnancy giving an incidence of 0.8% or 1:129. Mean age was 24 years. Majority of the patients were of low parity [n=34, 54.8%]. Pelvic inflammatory disease [n=22, 35.4%], previous abdominal pelvic surgery [n=16, 26%], previous ectopic [n=4, 6.4%] and infertility [n=22, 35.4%] were seen as the major risk factors. Regarding the clinical pattern; abdominal pain, amenorrhea and collapse appeared as the common clinical presentations. All patients required surgery. Open laparotomy was performed in 56 [90.3%] cases while 6 [9.7%] patients managed laparoscopically. None of the patients found suitable for conservative or medical management. There was no maternal death related to ectopic pregnancy and the postoperative recovery was uneventful

Conclusion: the classic clinical pattern of amenorrhea and abdominal pain was lacking in most of the cases with ectopic pregnancy and there were initial diagnostic difficulties. Pelvic inflammatory disease and history of infertility were the main risk factors. Due to the delay in making diagnosis at early stage, open surgery was required in all cases. This emphasizes the importance of a thorough clinical evaluation and appropriate investigations for patients with high suspicious to benefit our poor patients by the use of recent therapeutic modalities

Evaluation of the hepatoprotective effect of ginkgo biloba extract and its comparison with silymarin on acute hepatic injury caused in rats by the administration of carbon tetrachloride

The effect of Ginkgo biloba extract on acute liver injury caused by CCl4 was studied and compared to that of silymarin in the rat. Ginkgo biloba at doses of 25 or 50 mg/kg or silymarin at dose of 22 mg/kg was given once daily orally for 15 days starting at time of CCI[4] administration. Ginkgo biloba at 50 mg/kg conferred- significant protection against the hepatotoxic actions of CCl[4], reducing serum aspartate aminotransferase [AST], alanine aminotransferase [ALT] and alkaline phosphatase [ALP] levels to 39.6%, 46.8% and 33.1% of that of controls, respectively. In comparison, the elevated serum AST, ALT and ALP levels decreased to 28.4%, 45.1% and 34.2% of controls, respectively by 22 mg kg of silymarin. Histological examination showed marked decrease in centrilobular necrotic areas in rats treated with silymarin or ginkgo biloba. Rats treated with ginkgo biloba revealed more or less normal hepatocyte architecture. Stained sections were subjected to morphometric evaluation using computerized image analyzer. On image analysis, the area of damage was reduced by 34.8%, 65.5% by 25 or 50 mg/kg ginkgo biloba and by 89.2% by 22 mg/kg silymarin, respectively. The study suggests that administration of ginkgo biloba in a model of CCl4 induced liver injury result in less liver damage. Ginkgo biloba might be of value in the therapy of chronic hepatitis

Vinpocetine prevents acute hepatic damage caused by administration of carbon tetrachloride in rats

vinpocetine is a widely used drug for the treatment of cerebrovascular and memory disorders. This study aimed to investigate the effect of vinpocetinc on the acute hepatic injury caused in the rat by the administration of CCl[4] in viva. Vinpocetine [2.1, 4.2, 8.4 mg/kg] or silymarin [30 mg/kg] was given once daily orally simultaneously with CCl[4] and for 15 days thereafter. Liver damage was assessed by determining serum enzyme activities and hepatic histopathology. Stained sections were subjected to morphometric evaluation using computerized image analyzer. The results showed that vinpocetine administered to CCl[4]-treated rats decreased the elevated alanine aminotransferase [ALT] by 49.3, 58.] and 63.6%, aspartate aminotransferase [AST] by 10.5, 22.6 and 27.2% and alkaline phosphatase [ALP] by 52.5, 59.6 and 64.9%, respectively and in a dose-dependent manner. Meanwhile, silymarin reduced elevated ALT, AST and ALP levels by 53.1, 26.9 and 66%, respectively. Histological examination of liver specimens revealed a marked reduction in liver cell necrosis in vinpocetine and silymarin- treated rats compared with vehicle-treated CCl[4]-treated rats. Quantitative analysis of the area of damage showed 85.3% reduction in the area of damage after silymarin and 72.2, 78.9 and 85.3% reduction after vinpocetine treatment at 2.1, 4.2, 8.4 mg/kg, respectively. It is concluded that administration of vinpocetine in a model of CCl4-induced liver injury in rats resulted in reduction of liver damage. The reduction obtained by 4.2 mg/kg of vinpocetine was similar to that obtained by 30 mg/kg silymarin. Therefore, it is suggested that vinpocetine might be a good pharmacological agent in the treatment of liver disease besides its neuroprotective effects

Postpartum choriocarcinoma

Choriocarcinoma, following term pregnancy, is a rare form of gestational trophoblastic disease. The usual presentation is with persistent primary or secondary postpartum hemorrhage, the diagnosis is often delayed because of failure to recognize this mode of presentation of the disease. Early diagnosis is important because this rare condition is potentially curable with appropriate chemotherapy. A case of postpartum choriocarcinoma, following a term pregnancy is reported that was successfully treated with methotrexate therapy and surgery

Protective role of fennel oil against polychlorinated biphenyls [PCBs] induced oxidative stress in rats

Polychlorinated biphenyls [PCBs] are environmental contaminants that have been widely used for various industrial purposes. Human and animals are exposed to PCBs via oral ingestion of contaminated food. PCBs were found to induce reproductive toxicity, immune suppression, birth defects, cancer, developmental and behavioral changes. The aim of the present study was to evaluate the protective role of fennel oil against PCBs toxicity. Forty male Sprague- Dawley rats were divided into four groups, control group, group treated with PCBs [250 micro g/kg b.w] and the groups treated with fennel oil [5mg/kg b.w.] alone or in combination with PCBs for 15 days. The results indicated that treatment with PCBs resulted in a significant increase in ALT, AST, cholesterol, triglycerides, uric acid, TNFa., LPO, NO and CEA, whereas it significantly decreased GPX and SOD. Histopathological examination of the liver, kidney and testis showed severe histological changes. Animals treated with fennel oil alone or plus PCBs were comparable to the controls regarding the biochemical parameters or the histological picture of liver, kidney and testis. It could be concluded that fennel oil has a protective effect against PCBs toxicity. Moreover, the oil was safe and may be used pharmaceutically to protect against the hazardous effects of PCBs