Noninvasive prediction of HCV 4 SVR by 2D US: a randomizedstudy using data mining algorithm

Objective and aim :Hepatitis C virus [HCV] can cause both acute and chronic hepatitis. Antiviral therapy is thecornerstone for the treatment of chronic HCV infection once diagnosis is confirmed by PCR. Thegoal of antiviral therapy is to eradicate HCV RNA or attain sustained virological response [SVR]. In many countries worldwide, including Egypt, HCV infection is treated with a combination of pegylated interferon [and ribavirin [RBV]. Liver fibrosis/cirrhosis stage influences theresponse to pegylated interferon [and RBV. Even with new oral the rapies such as Sovaldimany patients have to continue to be on combination regimens of interferon/RBV or RBV alone. In the current study, we aimed to use data mining analysis to determine sonographic picturesthat can successfully predict SVR in HCV-4 patients before the antiviral therapy

Methods: Eighty-two patients were enrolled in this study and they underwent two-dimensional ultrasound examination before the antiviral therapy. The sonographic data obtained were analyzed with Rapidminer version 4.6 to create a decision tree algorithm for the prediction of SVR

Results: The absence of significant liver fibrosis was a predictive parameter of SVR mainly in those patients without a sonographic picture of cirrhosis. The resulting tree yielded an accuracy, sensitivity, and specificity of 85.82 +/- 10.79, 68.75, and 96.00%, respectively, upon 10-foldcross-validation

Conclusion: In the current study we used decision tree algorithm, one of the most important computational methods and tools for data analysis and predictive modeling in applied medicine, to predict SVR in HCV-infected patients. Two-dimensional ultrasound can give predictive information regarding the treatment outcome before interferon therapy for HCV-4

spirometry and cardiopulmonary exercise performance in pateints with thalassemia major

Lung function abnormalities in patients with thalassemia major are various, complex and of different etiological backgrounds. To evaluate the pulmonary function changes during both rest and integrated cardiopulmonary exercise in patients with thalassemia major, we studied 30 thalassemia major cases with mean age of 18 +/- 13.34 years. Nineteen healthy subjects were enrolled as a control group. Routine laboratory tests as well as assessment of pulmonary function test during both rest and integrated cardiopulmonary exercise were performed for cases and controls, Both forced vital capacity [FVC] and forced expiratory flow in the first second [FEV1] were significantly reduced in cases than in controls [p<0.01 for both], pointing to a restrictive pulmonary dysfunction. Seventy percent of cases had FVC below the normal predicted value. Functional capacity, anaerobic threshold and °2 pulse were significantly reduced in cases than controls [p<0.05]. There is a statistically significant inverse correlation between serum ferritin levels and functional capacity. In the studied thalassemics, restrictive pattern of pulmonary dysfunction is the predominant abnormality. Poor cardiopulmonary exercise performance occurs and is multifactorial

Internal fixation of aseptic non-united fractures of tibia after implant failure by interlocking nail and bone grafting

This study was performed to evaluate the results of internal fixation of non-united fractures of the tibia by interlocking nailing after implant failure. Fourteen patients were included in the study, 10 males and 4 females who were admitted to the Suez Canal university hospital. The average age was 36 years [21-68]. Patients who had non-united fracture tibia after implant failure were the material of this work. Eleven patients had been treated with plate and screws and three by locked intra-medullary nailing. Twelve patients had closed fractures and two had open fractures Gastilo I. The diagnosis of nonunion was made on the absence of progression of the radiological signs of union and the persistence of pain at the fracture site. The mean interval between fracture and secondary surgery was 13 months [6 to 21]. Open technique was used in all patients for removal of tibial plating and Locked intra-medullary nailing and also laying down an iliac bone graft at the non-united fracture Site. Clinical union was proved in all patients with pain-free weight-bearing and this precede radiological union which occurs in all patients after 3 to 9 months with an average of 4 months. Angular and rotational deformities were corrected in all patients and 4 patients had shortening of 1 to 2.5 cm. One patient developed infection but debridement and frequent dressing and antibiotics resulted in relieve of infection after one month and union occurred radiologically after 9 months. Locked nailing, providing stable fixation, with iliac bone graft in patients with aseptic nonunion of the tibia allows physiologic early weight bearing stresses at the fracture site, together with the osteogenic potential of the bone graft, stimulate healing of the nonunion

Evaluation of sensorineural hearing loss in beta-thalassemia major patients under regular chelation therapy

Thalassemia major is a severe anemia of childhood. The life expectancy of beta thalassemia major patients has been improved using new therapeutic approaches. However, new clinical problems such as 1 hearing loss have been reported. This study aimed at identifying the frequency of sensorineural hearing I loss [SNHL] in thalassemic patients, to assess desferrioxamine [DFO] ototoxicity and the risk factors for its development, Twenty nine thalassemia major patients and 15 age and sex matched apparently healthy volunteers [control group] were included in this study. Ali patients were subjected to full clinical and ontological history and clinical, otoscope and audiological examinations. Conventional pure tone audiometry [PTA] revealed that 24.7% of patients had SNHL at 8 KHz of mild to moderately severe degree in children above 72 years. For the extended high frequency audiometry, there was significant hearing affection in 48.3% of children at frequencies up to 18 KHz. Among the thalassemia major patients, auditory brainstem response audiometry [ABR] and transient evoked otoacoustic emissions [TEOAE] results were within normal values except for significant reduction in the whole wave reproducibility and response amplitude. The age, serum ferritin level, DFO dose and duration, serum Hb level did not show significant difference between patients with and without hearing loss

Conclusion: beta thalassemia patients were susceptible to SBHL that usually affects high frequencies. Hearing affection was probably highly dependent on individual susceptibility as no correlation was found between hearing threshold level and serum ferritin level, DFB dose and duration, age, and rate of blood transfusion