Development and evaluation of a novel score for prediction of large oesophageal varices in patients with hepatitis c virus-induced liver cirrhosis.

OBJECTIVE: Variceal bleeding is one of the most common life-threatening complications of liver cirrhosis. This study aimed to develop and evaluate a predictive score, named Platelet count, Alpha fetoprotein (AFP) and Prothrombin-INR (PAP) for the prediction of large oesophageal varices and to compare PAP score with eight common liver fibrosis scores (AAR, APRI, GUCI, BRC score, Fibro-Alfa, FIB4, Lok and Fibro-Q) in patients with hepatitis C virus (HCV) induced liver cirrhosis. METHODS: A total of 277 patients with HCV-induced liver cirrhosis were evaluated by upper gastrointestinal endoscopy for presence of varices. Liver biochemical profile, complete blood count, prothrombin time and AFP were estimated. Stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs) were used to create a predictive score (PAP score) comprising platelet count, AFP and prothrombin-INR. RESULTS: PAP score predicts large oesophageal varices in patients with HCV-induced liver cirrhosis with AUC of 0.85. The optimum cut-off for predicting large oesophageal varices using ROC curve analysis was 0.27. At this point the PAP score had 77% sensitivity, 86% specificity, 94% negative predictive value and 84% efficiency. The diagnostic performances (AUC) of eight common liver fibrosis scores were 0.58 for the AAR score, 0.63 for APRI, 0.66 for GUCI, 0.68 for BRC, 0.72 for Fibro-Alfa, 0.70 for FIB4, 0.72 for Lok and 0.77 for Fibro-Q. CONCLUSION: PAP scores a non-invasive, inexpensive and simple score that could predict the presence of large oesophageal varices reducing the need of endoscopy. The PAP score has a superior AUC score than other scores, suggesting improved clinical value.

Outcome of microsurgical testicular sperm extraction in familial idiopathic nonobstructive azoospermia.

The aim of the study was to evaluate the sperm retrieval rate by microsurgical testicular sperm extraction (TESE) in familial idiopathic nonobstructive azoospermia (NOA). One hundred and nineteen patients with idiopathic NOA who underwent microsurgical TESE over the past 5 years were included. Patients were then divided into two groups; Group 'A' with familial idiopathic NOA (11 families with two brothers in each family, 22 patients) and Group 'B' with nonfamilial idiopathic NOA (97 patients). Clinical data as well as data of microsurgical TESE were recorded. In Group 'A', the sperm retrieval rate was 9.1% (2/22 patients) compared to 45.4% in Group 'B' (44/97 patients) (P ≤ 0.05). The two patients in Group 'A' with successful sperm retrieval belonged to one family. The histopathological diagnosis was the same in the brothers in each family. It can be concluded that the testicular sperm retrieval rate in familial idiopathic NOA is significantly lower than in nonfamilial idiopathic NOA.

Association of human leucocyte antigen Class I (HLA-A and HLA-B) with chronic hepatitis C virus infection in Egyptian patients.

Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, ranging from 6% to 28% with an average of approximately 13.8% in the general population. It has been reported that human leucocyte antigen (HLA) alleles are associated with the outcome of HCV infection, but this associations showed ethnic and geographical differences. The objective of this study is to investigate the association between the frequencies of HLA Class I and chronic HCV infection in Egyptian patients and to find out whether there is a relation between certain HLA Class I antigens and HCV viral load, degree of fibrosis, activity and alanine aminotransferase (ALT) level. A case control study was conducted on 100 patients with chronic HCV infection and 150 healthy controls. HLA-A and HLA-B typing by complement-dependent micro-lympho-cytotoxicity assay was performed for both groups. HLA-A11 antigen was significantly increased in patients with chronic HCV infection versus controls (OR 3.98; 95% CI = 1.85-8.89; P = 0.001; and Pc = 0.021). HLA-B12, HLA-B13, HLA-B17 and HLA-B40 were higher in patients, and HLA-A32 and HLA-B14 were higher in controls, although the significance was lost after correction for multiple testing. HLA-A9 was significantly associated with low viral load (P = 0.008, Pc = 0.048). The results of this work implicate that HLA-A11 antigen may influence chronic HCV infection and may play a role in viral persistence. Different HLA Class I antigens are not associated with degree of liver fibrosis, grades of activity or level of ALT. However, HLA-A9 is associated with low HCV viral load in chronic HCV Egyptian patients.

Erectile dysfunction in spinal cord-injured men: different treatment options.

To evaluate the efficacy, safety and patients' preference of different treatment modalities of ED in men with SCI. Sixty SCI men with ED were included in the study. They were divided into three groups. Group A received sildenafil, group B received intracorporal injection (ICI) and were then shifted to sildenafil and group C used vacuum constriction devices (VCD) and were then shifted to sildenafil. Erection was evaluated before and after each treatment. Ninety percent of patients reported improvement of erection after sildenafil and ICI treatment according to IIEF-EF and only 70% of patients reported improvement in erection with VCD. However, 14 patients reported that they preferred sildenafil due to the easier route of administration. In men with SCI, sildenafil is the most effective treatment and is widely accepted. ICI, VCD therapy in SCI patients should be used according to patient's preference and choice.

Cytophotometric estimation of hepatocytes DNA in chronic liver diseases including schistosomiasis for detection of early preneoplastic changes.

No doubt chronic liver diseases due to schistosomiasis and other causes as virus hepatitis are not uncommon among Egyptian patients. Besides, neoplastic changes in such patients are always seen. So, the aim of this work was to evaluate the estimation of hepatocytes DNA in chronic liver diseases as a diagnostic feature for early preneoplastic changes in different groups of patients. These groups included (a) chronic persistent hepatitis, (b) chronic active hepatitis, (c) liver cirrhosis due to schistosomiasis and other causes & (d) hepatocellular carcinoma. The results were evaluated histochemically and histopathologically. It was concluded that the cytophotometic evidence of hepatocytes DNA in chronic liver diseases is a promising mean in detecting early preneoplastic changes.

Some clinical features of pediculosis among school children.

Pediculosis is one of the most conspicuous and important type of contagious disease among school children. Lice infestation is always accompanied with different clinical manifestations. Thirty lousy school children were clinically examined. The common manifestation was pruritus with or without lymphadenopathy. The least common manifestation was erythema. Other manifestations as excoriation, bite reaction, impetigo contagiosa, crusts behind ears. Conjunctivitis and psoriasis were also seen. It was concluded that school children are the group at high risk for lice infestation.

A case of human fascioliasis in Qualyobia Governorate.

Human fascioliasis has been recently become a health problem in Alexandria and Dakahlia governorates. This paper report a new focus of human fascioliasis.

On the specificity of the indirect haemagglutination in diagnosis of visceral leishmaniasis.

Human sera were collected from parasitologically proven cases of filariasis, strongyloidiasis, hymenolepiasis and ascariasis. Antibodies against these parasites cross react in the indirect haemagglutination for the antileishmanial antibodies at dilution up to 1:128. The diagnostic titer should be raised to 256 in order to increase the specificity of the test in areas where such parasites occur.

Some aspects of sandflies of the genus Phlebotomus in El Agamy, Alexandria.

Leishmaniasis presents a health problem in several countries of the old world. Cutaneous and now visceral leishmaniasis have been reported in Egypt. Visceral leishmaniasis has been reported in El Agamy, Alexandria. In this paper, the seasonal and daily hours of activities of both P. papatasi and P. langeroni as well as the blood preference were studied over two successive years. The results showed a bi-model or two peaks a year. The sandflies started to appear in the last of March or beginning of April and ended in last of November or beginning of December. The indoor hours of activity standard earlier and ended later than the outdoors one. The blood of the females of P. papatasi was mainly human blood, while that of P. langeroni was mainly non-human blood.