Incidence and predictors of hematological side effects in chronic HCV Egyptian patients treated with PEGylated interferon and ribavirin.

AIM: The aim of this paper was to study the incidence and predictors of hematological abnormalities during treatment of chronic hepatitis C virus (HCV) patients with interferon and ribavirin. METHODS: One thousand and eighty-one chronic HCV patients who were treated with PEGylated interferon α-2a 180 µg (n = 536) or α-2b 1.5 µg/kg (n = 545) plus ribavirin for 48 weeks were included. Baseline demographic, laboratory, and histopathological data and, during treatment, hematological data were collected and analyzed using univariate and multivariate analyses to identify independent predictors of hematological side effects. RESULTS: During therapy, 168 of 1,018 (15.5 %) had moderate anemia (Hb <10 and ≥8.5 g/dL) and 88 (8.1 %) had severe anemia (Hb <8.5 g/dL). Two hundred and six patients (19.1 %) had moderate neutropenia (absolute neutrophil count (ANC) <750 and ≥500/mm(3)); only 55 (5.1 %) had severe neutropenia (ANC <500/mm(3)). Forty-three patients (4 %) had moderate (platelet <50,000 and ≥25,000/mm(3)) and 5 (1.4 %) had severe thrombocytopenia (platelet <25,000/mm(3)). Fibrosis stage, week 4 Hb level, and week 2 and 4 reduction level in Hb were independent predictors of moderate and severe anemia (p < 0.001). Fibrosis stage and ANC at weeks 2 and 4 were predictors of neutropenia (p < 0.001, 0.001, and 0.004, respectively). Fibrosis stage and platelet count at weeks 2 and 4 were predictors of thrombocytopenia (p < 0.001, <0.001, and 0.005, respectively). There was no association between interferon type and anemia (p = 0.57), neutropenia (p = 0.6), or thrombocytopenia (p = 0.79). CONCLUSIONS: Fibrosis stage and week 2 and 4 hematological parameter reduction levels were independent predictors of hematological side effects, which are not related to interferon type.

Hydrocele in filarial and non filarial patients. Histopathological, histochemical and ultrastructural studies.

Twenty biopsied material of the testicular tissue were obtained from patients with unilateral hydrocele (eight due to lymphatic filariasis and twelve of idiopathic causes). Twenty biopsies lymphatic were also obtained from the normal unaffected testes and were used as control. The data obtained from histopathological, histochemical and ultrastructural studies revealed alternation in the testicular tissue with hydrocele than in the normal control testis. In the filarial hydrocele 37.5% of the cases showed thickening of the basement membrane and fibrosis with arrest of the spermatogenesis at the level of secondary spermatocytes. In addition, 12.5% showed thickening with interstitial fibrosis. Microfilariae were seen in hydrocele fluid of 3/8 cases (37.5%). In the idiopathic hydrocele 50% of the testicular tissue showed marked collagen deposits and testicular atrophy with fibrosis and thickening of basement membrane. The second 50% of cases showed variable degree of maturation arrests. Explanation for these variations in the pathological and anatomical pictures in both types of hydrocele is suggested. In the filariasis hydrocele it is due to the inflammatory response that may subside and recurrent. In the idiopathic hydrocele, it is due to the irreversible hypoxia caused by the continuous mechanical pressure due to huge amount of hydrocele fluid resulting in irreversible degenerative process with marked fibrosis.

Histo- and immuno-pathological and electron microscopy studies of the splenic red pulps of schistosomiasis mansoni patients.

The histo- and immuno-pathological and electron microscopy (EM.) of the splenic red pulps studies were carried out for schistosomiasis mansoni patients and normal controls. The main pathological processes were interstitial haemorrhages, congestion, proliferation and hyperplasia of the red pulps of the schistosomiasis mansoni patients. The IgG showed marked reaction, moderate with IgA and mild with IgM. The E.M. showed an increase in the size of the different types of the reticular cells particularly those of the nuclear membrane with type II, nuclear degeneration, deposition of fibrin threads, marked fibrosis and phagocytosis and formation of pores at the sinusoidal basement membrane. It was concluded that these pathological processes and the alteration in the immunoregulatory system of the spleen of schistosomiasis mansoni patients reflect the role played and perpetrated in the development of splenomegaly.

Histopathological study of the bilharzial affection on the bladder and ureter.

This study was carried out on 68 cases (50 bilharzial stricture lower ureter, eight vesico-ureteral reflux cases and ten control). In cases of reflux associated with bilharziasis heavy ova-deposition was obvious all through the ureteral wall especially per-ureteral sheath. Also heavy deposition in the bladder wall involved the detrusor and trigonal muscle with fibrosis and obliteration of Waldeyer's space and atrophy and fasciculation of detrusor and trigonal muscle. This implies ureteral rigidity, impaired mobility and compression against a firm detrusor buttress.