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Background: the persistence of hepatitis B virus [HBV] DNA in liver tissue or serum in the absence of detectable hepatitis B surface antigen [HBsAg] is called occult hepatitis B infection [OBJ]. Both HBV and hepatitis C virus [HCV] are transmitted parenterally, and coinfection is not uncommon, particularly in countries with a high prevalence of one or both viruses
Aim: this study was conducted to assess OBI prevalence in Egyptian patients with HCV related liver diseases, see if anti-HBc alone can. consider a good marker for detection of OBI, to record the serological profile of occult HB V infected patients, and to detect the clinical impact of this coinfection
Methods: after exclusion of HBsAg positive patients, serum samples from 128 Egyptian patients with HCV related liver diseases were included in our study. All the patients were positive for anti-HCV and HCV RNA, and negative for HBsAg. Serum samples were collected and subjected to fiver function tests and virological assays for HBsAg,
Results: occult HBV infection was detected in 21% of our patients with the highest prevalence found in patients with hepatocellular carcinoma [HCC] [44.4%] followed by patients with cirrhosis [22.2%] then chronic hepatitis C patients [16.3%]. Occult HBV infection can be found in both patients who show previous hepatitis B infection, [22%], and in those who were negative for anti-HBc, [19%]. Occult HBV infection was detected with the highest prevalence in patients with anti-HBc only [51.8%], followed by patients with negative all serological markers [29.6%], then [11.1%] were anti-HBc and anti-HBs, and finally [7.4%] were anti-HBc and anti. HBe. Patients co-infected with occult hepatitis B had significantly a higher prevalence of sever fibrosis [12/27 OBJ versus 13/101 HCV only infected patient, P<0.01] and significantly higher prevalence of decompensated liver disease [3/4 OBJ versus 3/14 HCV only infected patient, P<0.05]
Conclusion: OBJ is highly prevalent in Egypt. It is frequently associated with HCV-related chronic liver diseases and it may play a major role as an etiological agent for hepatocellular carcinoma in these patients. Occult HBV infection may have a clinical significance as it may increase the liver fibrosis and worsen the liver disease in HCV patients but we think that it doesn't affect the HCV response to combination therapy
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Staphylococcus aureus, a major cause of potentially life threatening infections acquired in health care and community settings, has developed resistance to most classes of antimicrobial agents with dramatic increase in the number of health care associated infections due to methicillin resistant S. aureus [MRSA]. During the period of our study 974 S. aureus strains were isolated from different types of infections in different wards of Mansoura University Hospitals [MUH], 530 [54.4%] isolates were methicillin sensitive S. aureus [MSSA] and 444 [45.6%] isolates were MRSA. Simplified population analysis of MRSA strains revealed, 27 [6.08%] heterogeneous vancomycin intermediate sensitive S. aureus [hVISA], 12 [2.70%] vancomycin intermediate sensitive S. aureus [VISA], while 2 [0.45%] isolates were vancomycin resistant S. aureus [VRSA]. hVISA strains were isolated from different infections, mainly from blood stream infections [29.63%] and infected skin ulcers and bedsores [29.63%], where the 12 VISA strains were isolated from infected skin ulcers and bedsores [41.66%], infected surgical wounds [41.66%] and lower respiratory tract infections [16.67]. The 2 VRSA isolates were isolated from blood stream infection [one case] and an infected bedsore [the other case]. One of the 2 VRSA cases was isolated from children hospital and the other one was isolated from medical wards. Minimal inhibitory concentration [MIC] of different antimicrobial agents for S. aureus with diminished sensitivity to vancomycin was done by microdilution method revealing a significant difference in resistance among VISA, hVISA and VRSA with vancomycin, linzolide, meropenem. Time kill study of different antibiotics for VRSA isolates showed that, vancomycin exhibited no kill activity at 1X MIC, but killing activity was achieved only at 2X and 4X. Other tested antibiotics were significantly had killing activity more than vancomycin at concentration of 1X MIC. Daptomycin, quinipristin/dalfopristin, tigecyclin, meropenem, ciprofloxacin, and erythromycin were significantly had killing activity more than linezolide at concentration of 1X MIC. In conclusion, the first two identified VRSA isolates from children hospital and medical wards still susceptible to some antibiotics which are not used widely such as, daptomycin, quinipristin/dalfopristin and tigecyclin, also hVISA and VISA had antimicrobial susceptibility pattern similar to VRSA isolates
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Backgrounds: cirrhotic cardiomyopathy characterized by baseline increased cardiac output, attenuated systolic contractile and diastolic relaxant responsiveness to inotropic and chronotropic stimuli Elevated TNF-alfa has been demonstrated in cirrhotic patients. However, it is poorly known whether there is a relationship between this cytokine and the development of cirrhotic cardiomyopathy
Objective: to study cardiac abnormalities in patients with liver cirrhosis and ascites with mid without renal impairment [RI], and to assess the role of TNF-alfa in the development of this cardiac dysfunction
Subjects and Methods: we studied 40 patients with liver cirrhosis and ascites [2O patients without RI [aged 42.21 +/- 3.73 years] and 20 patients with RI [aged 42.63 +/- 4.1 years] l and 10 age-matched healthy control subjects. Full history and complete clinical examination were done with the following investigations: complete blood picture fating and postprandial blood sugar S.creatkine. S. bilirubin, S.abumin, prothrombin time, S. transaminase [ALT and AST], plasma and ascetic fluid TIVF-alfa abdominal ultrasonography, resting ECG and echocardiography
Results: plasma TNF-alfa was significantly higher in the studied two ascetic groups compared to the control group [28.1 +/- 5.85, 64.2 +/- 9.13 vs 1.9 +/- 1.31 pg/ml, respectively, [P> 0.001]. also plasma and ascetic TNF-alfa were significantly higher in ascetic group with. RI compared to ascetic group without RI [64.2 +/- 9.13 vs 28.1 +/- 5.85 pg/ml, 152.3 +/- 17: 14 vs 49.2 +/- 5.56 pg/ml respectively, p<0.001]. There were significant increase in left atrial diameter [LAD] and right ventricular end diastolic diameter [RVDD] in the ascetic two groups compared to control group [37.7 +/- 5.1, 40.9 +/- 4.66 vs 30.1 +/- 4.61mm 30.01 +/- 4.32, 33 +/- 4.82 vs 19.2 +/- 5.52 mm respectively, [P<0,00l], also there were significant increase in LaD and RVDD in acetic group with RI compared to ascetic group without RI [40.9 +/- 4.66 vs 37.7 +/- 5.1mm, 33 +/- 4.82 vs 30.01 +/- 4.32mm respectively, P<0.05]. A significant decrease in E/A ratio was found in both ascetic groups compared to control group 10.98 +/- 0.12. 0.9 +/- 0.09 vs 1.11 +/- 0.06, P<0.05] and in ascetic group with RI compared to ascetic group without RI [0.9+8.09 vs 8.98+0.12, P>0.025].There was non significant change in systolic function in ascetic group without RP compared to control group [P<0.05], however, systolic dysfunction was detected in ascetic group RI compared to both control group and ascetic group without RI [P<0.05]. There were significant positive correlation between both plasm and arctic TNF-alfa and parameters of both diastolic and systolic dysfunction
Conclusion: cirrhotic patients with ascites diastolic dysfunction and increase in TNF-alfa where systolic function is still normal. With the development of rend impairment systolic dysfunction occur with associated more increase in TNF-alfa which may suggest a mechanistic role of TNF-alfa in the development of cirrhotic cardiomyopathy
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The effectiveness of expensive laminoplasty procedure in treatment of cervical spondylotic myelopathy was evaluated in 13 patients. Midsagittal splitting of the laminae from C3-C7 was performed. The laminae were thinned out at their lateral ends in the form of gutters to facilitate the elevation of the splitted laminae. The patients were followed up for 20 months on average. The patients were evaluated according to the Japanese Orthopedic Association [JOA] score for cervical spondylotic myelopathy. An improvement of their neurological score was noted. The complications were few in the form of temporary C5 radiculopathy in one patient, which improved spontaneously, and a persistence of neck pain in two patients