Characteristics of sudanese camel-hair fibres under subtropical desert condition.

The study assessed the quality and variability of camel hair fibres in arid regions of Egypt. Raw camel-hair samples were collected from fifteen Sudanese camels divided into seven males (414.60 ± 38.19 kg, BW) and eight females (401.67 ± 26.76 kg BW), and the study investigated the influences of animal sex on both the physical and chemical traits of camel-hair fibers. The relationships among physical properties and both mineral and amino acid content were studied. Camel's sex had no significant effect on any of the studied traits including fibre diameter (FD), prickle factor (PF), medullated fibre (MF), staple length (SL) and staple strength (SS). In the meantime, no significant differences were found between males and females in fibers' minerals contents except potassium, where fibres of females had significantly higher potassium content than those of males. For amino acids contents in camel fibres, camel sex had a significant effect only on glutamic acid, since fibres of males showed higher (P < 0.05) content than females. Fibre diameter had positive (P < 0.01) correlations with prickle factor (r = 0.83) and medullated fibres (r = 0.73). Zinc content in camel fibres was positively correlated with fibre diameter (r = 0.57; P < 0.05) and medullated fibres (r = 0.73; P < 0.01). Moreover, a significant (negative correlation coefficient P < 0.05) was found between fibre diameter and both sulfur and proline contents (r=-0.39 and - 0.56). Ammonia content in fibres was correlated negatively (P < 0.05) with prickle factor and elongation (r=-0.62 and - 0.58, respectively). The variability in the physical properties and chemical composition of Sudanese camel-hair fibers under subtropical desert conditions may shed light on the possibility of improving fiber quality.

Is methotrexate hepatotoxicity associated with cumulative dose? A systematic review and meta-analysis.

BACKGROUND/OBJECTIVE: Methotrexate (MTX) is widely used in various medical specialties. However, hepatotoxicity is an ongoing concern and this is thought to be directly associated with cumulative dose. We sought to synthesise the published literature to evaluate the association between methotrexate hepatotoxicity and cumulative dose. METHODS: A systematic review of Medline (PubMed) EMBASE, CINAHL and The Cochrane Library was performed. Full texts of articles were examined, and excluded articles were recorded with reasons for exclusion. A meta-analysis of correlation coefficients was performed using Fisher's z-transformation and a random effects model. Cochran's Q-test and the I2 statistic were calculated to assess heterogeneity. RESULTS: A total of 35 studies met inclusion criteria. Measures of hepatotoxicity were highly varied and included liver biopsy, elastography, FibroTest, biochemical tests and scoring systems (Fib-4, APRI, AST:ALT). Some studies analysed for the association with MTX cumulative dose using more than one modality. Overall, 38 analyses found no significant association between MTX cumulative dose and hepatoxicity vs eight that identified a significant association. The pooled correlation coefficient from five studies which utilised elastography was 0.18 (95% CI, -0.09 to 0.42), with significant heterogeneity between studies (P < 0.0001), I2  = 92%). CONCLUSIONS: Our synthesis of a large volume of studies in this review found no significant association between MTX cumulative dose and hepatotoxicity, both in terms of vote counting and with regard to the meta-analysis of correlation coefficients from studies that utilised elastography. This challenges the long-held belief that liver injury is a direct result of drug accumulation.

Facilitating treatment of HCV in primary care in regional Australia: closing the access gap.

BACKGROUND: Australia has unrestricted access to direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. In order to increase access to treatment, primary care providers are able to prescribe DAA after fibrosis assessment and specialist consultation. Transient elastography (TE) is recommended prior to commencement of HCV treatment; however, TE is rarely available outside secondary care centres in Australia and therefore a requirement for TE could represent a barrier to access to HCV treatment in primary care. OBJECTIVES: In order to bridge this access gap, we developed a community-based TE service across the Sunshine Coast and Wide Bay areas of Queensland. DESIGN: Retrospective analysis of a prospectively recorded HCV treatment database. INTERVENTIONS: A nurse-led service equipped with two mobile Fibroscan units assesses patients in eight locations across regional Queensland. Patients are referred into the service via primary care and undergo nurse-led TE at a location convenient to the patient. Patients are discussed at a weekly multidisciplinary team meeting and a treatment recommendation made to the referring GP. Treatment is initiated and monitored in primary care. Patients with cirrhosis are offered follow-up in secondary care. RESULTS: 327 patients have undergone assessment and commenced treatment in primary care. Median age 48 years (IQR 38-56), 66% male. 57% genotype 1, 40% genotype 3; 82% treatment naïve; 10% had cirrhosis (liver stiffness >12.5 kPa). The majority were treated with sofosbuvir-based regimens. 26% treated with 8-week regimens. All patients had treatment prescribed and monitored in primary care. Telephone follow-up to confirm sustained virological response (SVR) was performed by clinic nurses. 147 patients remain on treatment. 180 patients have completed treatment. SVR data were not available for 19 patients (lost to follow-up). Intention-to-treat SVR rate was 85.5%. In patients with complete data SVR rate was 95.6%. CONCLUSION: Community-based TE assessment facilitates access to HCV treatment in primary care with excellent SVR rates.

Malabsorption Secondary to Gout-Induced Amyloidosis.

Many chronic inflammatory conditions can lead to systemic amyloidosis. However, secondary amyloidosis has rarely been associated with gout, and the literature reports only a handful of cases, all presenting with renal disease. We report a patient with a history of poorly controlled gout who presented with malabsorption. Endoscopic biopsies confirmed a diagnosis of small intestinal amyloidosis. This was believed to be a consequence of gout. Interestingly, renal involvement was subclinical. Our case raises awareness of this rare association and highlights the importance of considering a diagnosis of amyloidosis in patients who present with the combination of gout and gastrointestinal symptoms.