Detection of Occult Hepatitis C Virus Infection in Egyptian Patients Who Achieved a Sustained Virologic Response to Direct-Acting Antiviral Agents.

BACKGROUND: Occult hepatitis C virus (HCV) infection (OCI) is diagnosed based on the detection of HCV-RNA in non-serum reservoirs, such as peripheral blood mononuclear cells (PBMCs) and/or hepatocytes with undetectable HCV-RNA in the serum. The current study was designed to shed more light on the presence of occult HCV in a population of cases who achieved an SVR after receiving treatments for HCV-infection and its significance. METHODS: This cross-sectional study evaluated 111 chronic HCV patients treated at Theodor Bilharz Research Institute, Egypt and achieved a sustained virological response (SVR) 12 -24 weeks after treatment with Direct acting antiviral drugs (DAAs). The treatment lasted 12 or 24 weeks using generic medications including Sofosbuvir (SOF) 400 mg/day and Daclatasvir (DCV) 60 mg/day ± weight-based Ribavirin (RBV) 600-1000 mg/day. After achieving the SVR 12 -24 weeks, all patients were subjected to clinical examination and full laboratory investigations. All the candidates were assessed for fibrosis pre/post-treatment by transient elastography (Fibroscan©). Eighty-seven patients (78.4%) received dual therapy (SOF/DCV) and 24 patients (21.6%) received triple therapy (SOF/DCV/RBV). One hundred and seven patients received the regimen for 12 weeks (96.4%) and only four patients received the regimen for 24 weeks (3.6%). All patients were examined in terms of HCV RNA in plasma and PBMCs. RESULTS: Nine patients (8.1%) were positive for PBMCs HCV RNA. The presence of Occult HCV infection (OCI) was significantly correlated with age, level of AFP, and the degree of liver stiffness. CONCLUSION: The OCI was present in 8.1% of the patients who achieved an SVR 12 - 24 weeks. These patients were mostly aged and with elevated AFP and advanced fibrosis. Monitoring and follow-up of those patients may help to assess the outcomes.

Modulatory effects of Chrysophyllum cainito L. extract on gamma radiation induced oxidative stress in rats.

This study aimed to evaluate the possibility of using the crude methanolic extract of Chrysophyllum cainito L. leaves (C. cainito L.); as a source of natural antioxidant compounds; to compensate the oxidative stress induced by ionizing radiation exposure in male rats. Phytochemical investigations of C. cainito L. leaves extract led to the isolation of phytocobstituents such as: Gallic acid (1), together with six flavonoids; 3//Galloyl myrecetrin (2), Rutin (3), Quercetrin (4), Myrecetrin (5), Myricetin (6), and Quercetin (7). In addition to two triterpenoids; ß -amyrin (8), and Lupeol (9). All metabolites were isolated for the first time from the genus Chrysophyllum. The structures were determined by spectroscopic methods (UV, ESI-MS, 1H and 13CNMR). These compounds reflected its beneficial effect to ameliorate the alterations induced by γ-irradiation via the adjustment of the antioxidant status, decreasing of MDA level, and an improvement in liver, kidney functions and lipid profile, as well as histological alterations of liver were reduced. We can conclude that C. cainito L. extract reduces the liver and kidney toxicity induced by exposure to gamma radiation.

Needling augmented with topical application of mitomycin C for management of bleb failure.

PURPOSE: To study the effect of topical application of mitomycin C on enhancing the efficacy of needling in the management of bleb failure. PATIENTS AND METHODS: Thirty-six eyes of 32 consecutive patients with an intraocular pressure over 21 mmHg, without bleb or with a thick, flat bleb after the second postoperative month after trabeculectomy, were included in the study. Needling with mitomycin C was performed in the other 18 eyes with bleb failure (group A) and needling without antimetabolite was performed in 18 eyes (group B). Topical application of mitomycin C (0.4 mg/mL) with a microsponge over the conjunctiva at the failed bleb for 5 minutes (group A) was performed; after irrigation, the needling procedure was the same in both groups. A 30-gauge needle was used to perforate the area of subconjunctival and subscleral fibrosis and to reestablish flow; conjunctival puncture was at least 7 mm away from the bleb and no sutures were taken after needling. Follow-up was performed for 1 year after needling. RESULTS: Overall, 55 needling procedures were performed; needling was done twice in 17 eyes in group B, whereas only 2 eyes needed more than 1 needling procedure in group A. The difference was statistically highly significant, and the mean follow-up was 8.9 ± 3.7 months. Mean intraocular pressure was 28.9 ± 4.2 mm Hg and 27.8 ± 4.7 mm Hg in group A and group B respectively before any intervention; this decreased to a mean of 19.8 ± 2.7 mm Hg and 20.5 ± 4.8 mm Hg respectively without medication after 6 months of last needling. Complications included diffuse corneal punctate epitheliopathy lasting for 2 to 3 weeks (2 eyes in group A), subconjunctival hemorrhage (3 eyes in each group), and hyphema (2 eyes in each group). CONCLUSIONS: Topical application of mitomycin C with needle revision seems to be an extremely effective way to revive failed filtration surgery. The incidence of complications related to mitomycin C was minimal.

Validation of Epstein criteria of insignificant prostate cancer in Middle East patients.

BACKGROUND: Since introduction of Contemporary Epstein criteria, it has been studied and validated in many countries and nations. However, they were not validated in Middle East patients up till now. AIM OF THE WORK: To validate the Contemporary Epstein criteria in Middle East patients. MATERIALS AND METHODS: On past 8 years, 70 cases underwent radical prostatectomy for T1c prostate cancer. Contemporary Epstein criteria were applied retrospectively on prostatic biopsies. Among our patients, 35 cases met the criteria for clinically insignificant prostate cancer. Pathological revision of the prostatic biopsies, definitive prostatectomy specimens and re-staging were done by single pathologist. Assessment of recurrence rate was done. Up and down grading of the Gleason scoring was studied. RESULTS: The preoperative data and biopsy results using the Contemporary Epstein criteria were fulfilled on 35 cases. On definitive pathology; 16 cases (45.7%) had Gleason score >6, while 8.6% of cases are non-organ confined (2 cases and 1 case with extra- capsular and Seminal vesicles infiltrations, respectively). Both lobes were involved in 20 cases. Moreover, 40% (14 cases) showed upgrading of the score. Lymphatic permeation could be recognized in four cases. Mean follow-up time 88.1 months, 8.6% cases develop metastasis. CONCLUSION: Whenever Epstein criteria are applied in Middle East patients, the decision of active surveillance based for clinically insignificant prostate cancer (who met the Epstein criteria) will miss nearly 46% of unfavorable prostate cancer. As well as a risk of later metastasis could be in 8.6% of them.

Lymph node involvement in patients with bladder cancer treated with radical cystectomy: a patho-anatomical study--a single center experience.

PURPOSE: To our knowledge the extent of lymphadenectomy with cystectomy, the number of lymph nodes to be retrieved and the anatomical groups to be dissected are still undetermined. This study was done to clarify these issues. MATERIALS AND METHODS: A total of 200 patients underwent radical cystectomy and extended lymphadenectomy up to the level of origin of the inferior mesenteric artery. Removed tissues were labeled according to anatomical location and sent separately for pathological evaluation. In each group the number and status of lymph nodes were determined. The number of positive nodes was correlated with the number of retrieved nodes. Cases with a single positive node were identified and the anatomical location was defined. RESULTS: The mean number of retrieved nodes per patient +/- SE was 50.6 +/- 14.4 and 48 (24%) patients had nodal disease. The mean number of positive nodes per involved case was 8.08 +/- 13.2. There was a weak correlation between the number of positive nodes and the number of harvested nodes. Bilateral disease was noted in 39.6% of cases. Single node involvement was observed in 22 cases, of which all except 1 were in the endopelvic region. CONCLUSIONS: There is a sentinel region, which is the endopelvic region (that is the internal iliac and obturator groups of lymph nodes). There are no skipped lesions. Negative nodes in the endopelvic region indicate that more proximal dissection is not necessary. Bilateral endopelvic dissection is mandatory.