Comparison between the effect of two regimens for hepatitis c treatment [qurevo and ribavirin] and [sofosbuvir, daclatsvir and ribavirin] on patients above and below the age of 60 years

Background: the goal of antiviral treatment is to prevent complications of the disease, mainly cirrhosis and HCC. New therapy options, known as direct acting antiviral [DAA] regimens, offer the promise of increased success rates complimented by shorter treatment durations, improve side effect profiles, and simplified treatment monitoring

Aim of the Work: to compare between the effect of oral antiviral treatment especially [Quervo and Ribavirin] and [Sofosbuvir, Daclatasvir and Ribavirin] between elderly patients above 60 years and young people below this age as regard: Response to treatment, Development of complication

Patients and Methods: the study was conducted on 100 Egyptian patients they were divided into 2 groups each one received one of the two treatment regimens then each group divided into 2 subgroups, subgroup A include patients below 60 years and subgroup B include patients above 60 years. The selected patients were subjected to History taking, Complete physical examination, Pelviabdominal ultrasound, Laboratory investigations: complete blood count, bilirubin and liver enzymes before and after treatment, INR, creatinine, albumin, HBs Ag, HIV antibodies and Alpha feto proteins, HCV RNA

Results: there is no significant difference between two treatment regimens. Both regimens show cure rate about 94%, 96% achieved SVR with [sofosbuvir daclatasvir and ribavirin regimen], [quervo and ribavirin regimen] respectively. Both regimens are effective in elderly patients above 60 years as young patients below this age in both regimens, response of treatment in both regimens in elderly patients above 60 years is 96%. Gender doesn't affect treatment outcome. Anemia develop in 34% of patients receiving sofosbuvir, daclatasvir and ribavirin regimen, and in 58% of patients receiving quervo and ribavirin regimen. Females developed anemia more frequent than males in both regimens. Both regimens developed hepatobiliary complication, 12%, 18% developed hyperbilirubinemia with [sofosbuvir daclatasvir and ribavirin regimen], [quervo and ribavirin regimen] respectively

Conclusion: treatment with [sofosbuvir daclatasvir and ribavirin regimen] or [quervo and ribavirin regimen] is highly effective with little differences between them; also age and gender have no role in achieving SVR Complications such as anemia and hyperbilirubinemia occur in treatment with both regimens and more frequent with [quervo and ribavirin regimen]

Comparison of bone density of femoral neck and spine in interstitial lung disease and chronic obstructive pulmonary disease

To determine bone mineral density [BMD] of femoral neck and spine in Interstitial Lung Disease [ILD] and chronic obstructive pulmonary disease [COPD] to avoid fractures at those points. The study was conducted on seventy patients complaining of low back pain and pain related to hip joint. Their mean age was 39 +/- 7 years. They were subjected to full history taking, physical examination, pulmonary function tests [PFT], plain chest X-ray and routine laboratory investigations. According to PFT, patients were grouped into patients with obstructive pattern and patients with restrictive pattern, taking steroids or not. They were all examined with dual energy X-ray absorptiometry [DXA]. Twenty-five patients on oral steroids showed femoral osteopenia 32% and osteoporosis 48%. Twenty-five patients on inhaled steroids showed osteopenia 48%, osteoporosis 12%. Twenty patients taking no steroids showed 7% osteoporosis, no osteopenia. As regard spine DXA, patients on oral steroids showed 40%, osteopenia, 12%, and osteoporosis. Those on inhaled steroids showed 32% osteopenia, 4% osteoporosis. Patients taking no steroids showed 25% osteopenia. In patients taking oral or inhaled steroids, there was no significant difference between total femur and spine density with DXA [p=0.177 for oral and p=0.112 for inhaled steroids]. However, there was significant difference between femoral neck and spine density with DXA [p=0.002 for oral, p=0.000 for inhaled steroids]. Obstructive or restrictive lung disease patients have low bone mineral density, significantly more in those under steroid therapy, especially femoral neck. DXA neck femur could be a screening test for such patients on steroid therapy

Serum chemokines in lupus nephritis and SLE disease activity

To estimate the serum macrophage inflammatory protein-1alpha [MIP-1alpha] and serum/urinary monocyte chemoattractant protein-1 [MCP-1] in systemic lupus erythematosus [SLE] patients. This is in order to highlight their possible roles in the pathogenesis of SLE, disease activity and renal involvement. Forty SLE patients [group I] and 20 apparently healthy controls [group II] were included in the study. SLE patients were subdivided into group IA patients with active lupus nephritis [13 patients] and group IB patients without nephritis [27 patients]. Nephritis was diagnosed by active urinary sediments, impaired serum creatinine or creatinine clearance and graded by renal biopsy according to the WHO classification. SLE activity was measured using SLEDAI. The serum MIP-1 and serum/urinary MCP-1 were measured in all patients and controls using the ELISA technique. SLE patients had a significantly higher level of serum MIP-1alpha in group IA [105.2 +/- 12.9 pgm/mL] and group IB [93.9 +/- 3.5 pgm/mL] when compared to the control group [69.1 +/- 4.9 pgm/mL]. Also, there was a significant positive correlation [p<0.05] between MIP-Ialpha and both clinical [SLEAI], serological [dsDNA, ESR levels] parameters of disease activity and serum/urinary MIP1alpha. There was a statistically significant difference between the means of MCP-1 [serum 16.40 +/- 5.97 and urinary 21.20 +/- 3.12] among the controls and SLE group IA [serum 488.6 + 354.61, urinary 590.3 +/- 339.54], also between the controls and SLE group IB [serum 32.20 +/- 12.65, urinary 35.5 +/- 18.55]. The serum and urinary MCP-1 showed positive correlation with disease activity [SLEDAI], serum creatinine, and creatinine clearance. Also, urinary MCP-1 had positive correlation with ESR. Again, there was a significant difference between groups IA and IB regarding serum levels of MIP-1alpha and serum/urinary MCP-1 [p < 0.05]. The levels of serum MIP-1alpha and the serum/urinary MCP-1, may be used as laboratory parameters of disease activity in SLE and may reflect its immunopathogentic role and proinflammatory activity in SLE. Also, the urinary MCP-1 may be a useful simple tool for monitoring disease activity of lupus nephritis