Seroprevalence of anti-WNV IgG antibodies and WNV-RNA in Egyptian blood donors.

Transmission of West Nile virus (WNV) from asymptomatic donors has been reported during blood transfusions and organ transplants in humans. In this work, we aimed to investigate the presence of WNV antibody and WNV RNA in blood donors to evaluate the sero-prevalence of WNV and risk for WNV transmission. One hundred and sixty blood donors were tested for the presence of anti-WNV IgG by ELISA and for WNVs 1 and 2 RNA by RT-PCR. About 55% of blood donors were seropositive for WNV IgG antibodies, with significantly higher percentage of positive donors coming from rural areas and Nile Delta region compared to other donors. Using RT-PCR all donors were negative for viral RNA of both WNV lineages 1 and 2. High sero-prevelance of WNV antibodies in asymptomatic blood donors denotes endemicity of the WNV in Egypt and points to the importance of routine screening of blood donors for WNV RNA. On the other hand the absence of WNV RNA by RT-PCR indicates apparent low risk of the blood products as regards WNV transmission. Further studies into significance of WNV seronegativity among Rh negative donors and into the use of WNV seropositive blood in prophylaxis or treatment of WNV neuroinvasive disease are recommended. J. Med. Virol. 89:1323-1329, 2017. © 2017 Wiley Periodicals, Inc.

Intraoperative parathyroid hormone as an indicator for parathyroid gland preservation in thyroid surgery.

BACKGROUND: Intra-operative parathyroid hormone (PTH) levels have successfully been used to assess surgical ablation of parathyroid adenomas, the use of this same test to predict preservation of viable gland has not been widely used. AIM: to test the sensitivity and specificity of intraoperative rapid PTH assay test in predicting permanent postoperative hypoparathyroidism, and applicability to guide the search for inadvertently removed parathyroid glands for possible auto transplantation. PATIENTS AND METHODS: 52 patients undergoing total thyroidectomy for non-malignant thyroid diseases were included. Intraoperative rapid PTH assay test was performed. If levels were reduced, or less than 3 parathyroid glands were detected, removed thyroid gland was examined for unintentionally removed parathyroid tissue for possible auto transplantation. RESULTS: There was a strong correlation between intraoperative rapid PTH assays and those taken 24 hours after surgery, 16 out of 52 patients had reduction of the PTH intraoperatively to levels below 25 pg/ml, of them, 11 patients (who had values between 15-24 pg/ml) recovered to normal PTH levels within 4 weeks, while the 5 patients with intraoperative PTH levels below 15 pg/ml failed to regain normal PTH levels up to 12 weeks postoperatively, even in those patients where parathyroid tissue was auto transplantated. The 4 patients who had parathyroid tissue reimplanted intraoperatively restored some of their parathyroid function as indicated by relative rise of their PTH levels, but did not reach even the low normal levels. (ROC) curve for prediction of early hypoparathyroidism using intraoperative rapid PTH assay was statistically highly significant with optimal cutoff value for predicting early hypocalcaemia level <27 pg/ml, (sensitivity 100%, specificity 68.2%). (ROC) curves for predicting permanent hypoparathyroidism using intraoperative rapid PTH assay or standard PTH assay taken 24 hours after surgery were statistically significant with optimal cutoff value PTH level <12 pg/ml on the intraoperative PTH curve or <15 pg/ml on the postoperative PTH curve (sensitivity 100%, specificity 100%). CONCLUSION: Intraoperative PTH assay may allow intraoperative monitoring of parathyroid function, predicting postoperative outcomes, may identify patients at risk of developing postoperative hypoparathyroidism, guiding surgeons to re-examine removed specimens for inadvertently removed parathyroid tissue with possible auto transplantation, or more practically a guide to early replacement therapy to prevent hypocalcaemia, leading to safe and early hospital discharge. Limitations in our study to be reconsidered in further studies, are relative small sample size, inability for randomisation, and the variable values reported for the cut off value of PTH causing hypocalcaemic symptoms needing intervention.

Virtue of adding prokinetics to proton pump inhibitors in the treatment of laryngopharyngeal reflux disease: prospective study.

OBJECTIVE: This study aimed to assess the virtue of adding prokinetics to proton pump inhibitors (PPIs) in the treatment of laryngopharyngeal reflux (LPR) with regard to symptom and sign improvement and reduction in recurrence rates after cessation of treatment. PATIENTS AND METHODOLOGY: One hundred patients were divided by blind random card selection into two groups, 50 per group. The first group received itopride, a prokinetic agent, with a PPI, and the second group received a PPI and a placebo, both for a period of 8 weeks. They were followed up on a monthly basis for 16 weeks, with documentation of the symptom and sign scores with each visit and with photographic documentation. RESULTS: Eighty-seven patients completed the study. The results showed significant improvement in group A when compared to group B with regard to improvement rates and degrees of subjective and objective improvement, with significantly less recurrence of symptoms. CONCLUSION: Adding prokinetics to PPIs in the treatment of LPR improves the outcome, shortens the need for oral medication, and reduces the rates of recurrence of symptoms.