HPV Prevalence and Prognostic Value in a Prospective Cohort of 255 Patients with Locally Advanced HNSCC: A Single-Centre Experience.

Background. HPV is a positive prognostic factor in HNSCC. We studied the prevalence and prognostic impact of HPV on survival parameters and treatment toxicity in patients with locally advanced HNSCC treated with concomitant chemoradiation therapy. Methods. Data on efficacy and toxicity were available for 560 patients. HPV was detected by PCR. Analysis was performed using Kaplan-Meier survival curves, Fisher's test for categorical data, and log-rank statistics for failure times. Results. Median follow-up was 4.7 years. DNA extraction was successful in 255 cases. HPV prevalence was 68.6%, and 53.3% for HPV 16. For HPV+ and HPV-, median LRC was 8.9 and 2.2 years (P = 0.0002), median DFS was 8.9 and 2.1 years (P = 0.0014), and median OS was 8.9 and 3.1 years (P = 0.0002). Survival was different based on HPV genotype, stage, treatment period, and chemotherapy regimen. COX adjusted analysis for T, N, age, and treatment remained significant (P = 0.004). Conclusions. Oropharyngeal cancer is increasingly linked to HPV. This study confirms that HPV status is associated with improved prognosis among H&N cancer patients receiving CRT and should be a stratification factor for clinical trials including H&N cases. Toxicity of CRT is not modified for the HPV population.

The Impact of Hepatitis C Infection and Antiviral Therapy on clinical Outcome in Renal Transplantation Recipients.

Hepatitis C viral infection (HCV) is presently a major problem in renal transplant recipients (RTR) with a high risk of chronicity resulting in liver cirrhosis. We screened 120 RTR (50 live related, 53 live unrelated, and 17 cadaveric); mean age of 45.2 years and mean post-transplant period of 6.8 years. Positive HCV antibodies using RIBA-2 test were detected in 43 patients (35.8%). Polymerase chain reaction was performed on 37 seropositive patients and confirmed viremia in 100% of hem. Forty-one seropositive patients (95.3%) had previous dialysis prior to transplantation; a mean of 4.5 years. Liver disease manifested in only five (11.6%) of the seropositive patients and hypertransaminasemia was detected in 14 (32.6%). Twelve seropositive patients with elevated transaminase levels and/or clinical evidence of liver disease, who all had positive PCR, underwent liver biopsy. Inflammation restricted to portal area was noticed in two, persistent hepatitis in three, chronic active hepatitis in four and cirrhosis in three. There was significantly higher incidence (P< 0.03) of acute graft rejection in the seropositive (23.3%) compared to the seronegative patients (9.1% ). While the difference did not amount to statistical significance for chronic rejection (9.3% and 6.5% respectively). Two patients had acute cellular rejection related to interferon therapy. The leading cause of death was related to liver failure in the seropositive patients and coronary artery disease in he seronegative RTR. In conclusion, there is high incidence of HCV in or renal transplant recipients associated with relatively high morbidity and mortality. At present we are lacking an efficient and well-tolerated antiviral drug.

Acute renal failure: six months pilot study in qatar.

Over a period of six months, 55 patients out of 11,216 (0.49%) admitted to the hospital developed acute renal failure (ARF). The diagnosis of ARF was based on the usual criteria, a sudden rise in blood urea nitrogen and creatinine with or without oliguria. Patients age ranged between 15 and 81 years with a mean of 51.9 years. Renal ischemia (69%) and nephrotoxic drugs (16.3%) were the two main etiologic factors. Among the causes of ischemia, septic shock was the commonest (29%), followed by severe hypotension due to several causes such as hemorrhage, burns, severe diarrhea and cardiogenic shock (25.4%), and ACE inhibitors (10.9%). ARF was associated with an average of 15.8 days stay in hospital versus 5.1 days for the overall hospital admissions. Immediate management of hypotension by intravenous fluid replacement, vasopressor agents and the necessary surgical intervention was appropriately considered. Intravenous frusemide was used for oliguric patients. Intermittent hemodialysis was used in 18 patients and continuous venovenous hemofiltration in six patients. Twelve patients with ARF due to ischemia died, while there were no deaths in the nephrotoxic group (p < 0.05). The overall mortality was (21.8%), which had no correlation with patient age. All non-oliguric patients survived with the mortality being exclusively in the oliguric group.

Hepatitis C virus infection in hemodialysis patients in qatar.

To evaluate the prevalence of hepatitis C virus (HCV) infection and the histopathological aspects of this infection among regular hemodialysis patients, we followed 130 patients on regular dialysis screened for HCV antibodies by enzyme-linked immunosorbent assay (ELISA). Confirmatory testing was done using a second generation recombinant immunosorbant assay (RIBA). Fifty eight patients (44.6%) were antibody positive at the start of the study. There was a significant relationship between the presence of anti-HCV antibody and the increased period on dialysis (54.3 months in the sero-positive group, compared to 22.2 months in the sero-negative group, (P < 0.001). There was no statistical correlation with the history of blood transfusion or the serum iron level. Liver biopsies in eight sero-positive patients with abnormal liver enzymes showed chronic active hepatitis in six and chronic persistent hepatitis in two cases. Such findings of gross hepatic involvement in anti-HCV positive hemodialysis patients strongly support the arguments for antiviral therapy with Interferon in these patients, in the attempt to prevent further hepatic damage, before they receive renal allografts.

The aetiology of chronic renal failure in adult Sudanese patients.

One hundred adult Sudanese patients who presented to Soba University Hospital (SUH) with established chronic renal failure (CRF) were studied to determine the aetiology. Thirty-eight had chronic glomerulonephritis, 12 renal calculi, nine diabetic renal disease, seven chronic pyelonephritis, five sequelae of acute renal failure (ARF), four renal vascular disease, three polycystic disease of the kidneys, and two obstructive uropathy. In 20 patients the aetiology was not determined because of late presentation to hospital. The results were compared with those of the developed countries, which differ greatly from Sudan in climate, diet, race, culture and social habits. The main differences were in the prevalence of renal calculi which, although being the second commonest cause of CRF in the Sudan, were rare in European countries. Also, diabetes mellitus was a much commoner cause of CRF in Sudan than Europe. Other aetiological factors were similar.

Eight years study of Sudanese renal allograft recipients at Soba University Hospital.

Forty sudanese renal allograft recipients were followed up at Soba University Hospital (SUH), Khartoum, Sudan, for varying periods between January 1978 and October 1985 accruing 1417 patient-months of observation. 21 transplant operations were done in United Kingdom, 11 in Kuwait, 1 in Sudan, while the rest were done in other European and Arab countries. There were 27 males and 13 females with the age ranging between 10 and 48 years with a mean of 30.15. Thirty eight patients received live related (LR) donor kidneys and two were transplanted with cadaver kidneys. Four patients had a second graft because of early loss of the first. Seven patients died, 3 because of chronic rejection, 3 had severe intractable diarrhoea and one died because of an unrelated cause. The 30 patients who had their transplantation 2 years ago or more were studied for the 2-year survival. Twenty seven of these were alive and well with functioning grafts giving a patient and graft survival of 90%. The complications encountered are discussed.

Chronic renal failure in Khartoum, Sudan.

A study of the clinical presentation and conceivable causes of chronic renal failure (CRF) in 61 Sudanese patients in Khartoum is presented. The clinical features involved almost all the systems, however, gastrointestinal and cardiovascular signs and symptoms predominated. The causes of chronic renal failure in Sudan and Sweden are also studied for comparison. The causes of CRF in Sudan are chronic glomerulonephritis, obstructive nephropathy (stone disease), hypertension and diabetes mellitus in that order. The main causes of CRF in Sweden are chronic glomerulonephritis, diabetes mellitus and chronic pyelonephritis. Of the 61 Sudanese patients 16 have kidney transplants, only one in Sudan, three patients are on regular hemodialysis, nine patients are on intermittent peritoneal dialysis, 16 are on conservative treatment and 17 died during the course of treatment.

Fetal immune response following maternal diphtheria during early pregnancy.

A pregnant Sudanese woman contracted pharyngeal diphtheria during the first trimester of gestation. She had a severe diphtheritic toxaemia and paralysis of all four limbs but made a full recovery from these manifestations. Pregnancy, apart from vaginal bleeding, was not interrupted. At term she was delivered of a female baby who was physically normal but had a very high level of IgA in cord blood. Diphtheria in adults is a rare disease and the occurrence of diphtheria in a pregnant woman has not, as yet, been reported. Accordingly it is not known how fetal growth and development progress in the presence of diphtheria toxin in the maternal circulation. Similarly the effects on fetal immune responses of an acute maternal infection like diphtheria occurring in early pregnancy are not known.