Active and break spells of summer monsoon over Bangladesh.

This study examines the intraseasonal variability of the southwest summer monsoon over Bangladesh using rainfall data from rain gauge stations of the Bangladesh Meteorological Department (BMD) collected over 30 years (1988-2017). In this paper, active and break spells are defined as periods during the peak monsoon months of July and August, in which the daily precipitation lasts for three or more days at 0.5 above and below the daily climatological cycle. The active and break phases of the monsoon over a period of 10 years (2008-2017) were also analyzed by The Weather Research and Forecasting (WRF) model simulation for analysing synoptic conditions. The model simulations for each year were done for the period of 1 May to 30 September with 1 May as the initial condition with a single domain of 30 km resolution and 19 vertical levels. The final operational global analysis data from the Global Forecasting System of National Centers for Environment Prediction (NCEP-FNL) with resolution 1° × 1° is used for model simulation. The model-simulated daily rainfall, Sea Level Pressure (SLP), wind pattern at 850 hPa, 200 hPa, and Outgoing Longwave Radiation (OLR) are compared with the observations from Tropical Rainfall Measuring Mission (TRMM), ERA5 (ERA5 is the European Centre for Medium-Range Weather Forecasts fifth-gen global atmospheric reanalysis data), and Kalpana-1. This study also finds that the increase in rainfall is concurrent with a southwesterly wind and the decrease of rainfall simultaneously occurs with a southeasterly wind. Active days were found to have lower OLR values and lower SLP than break days.

Retraction Note: Combined effect of Schroth method and Gensingen brace on Cobb's angle and pulmonary functions in adolescent idiopathic scoliosis: a prospective, single blinded randomized controlled trial.

The article "Combined effect of Schroth method and Gensingen brace on Cobb's angle and pulmonary functions in adolescent idiopathic scoliosis: a prospective, single blinded randomized controlled trial", by S.A. Moawd, G. Nambi, A.E. El-Bagalaty, S.M. Hassan, S.E.B. Elsayed, F.M. Aboelmagd, N.A. Alhwoaimel, H.A. Abdeen, published in Eur Rev Med Pharmacol Sci 2023; 27 (2): 601-610-DOI: 10.26355/eurrev_202301_31061-PMID: 36734703 has been retracted by the Editor in Chief for the following reasons: After publication, concerns were raised about the use of copyright and trademark protected terms "Gensingen Brace" and "the Schroth Method" by the authors of the paper without permission for referring to results of a study with treatment of patients with a "Gensingen Brace". The owner of the copyright expressly denies the use of his trademark for scientific statements that are neither authorized by him nor correspond to the product's characteristics and qualities of his well-known products sold under the trademark. After being informed about the copyright and trademark issue, the corresponding author has been acknowledged and affirmed that the authors were not aware of the possible copyright and trademark infringement at the time of submission. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/31061.

Combined effect of Schroth method and Gensingen brace on Cobb's angle and pulmonary functions in adolescent idiopathic scoliosis: a prospective, single blinded randomized controlled trial.

OBJECTIVE: To detect the effect of the Schroth method added to the Gensingen brace for six months on Cobb's angle, axial rotation of the trunk, and pulmonary function in adolescent idiopathic scoliosis. PATIENTS AND METHODS: The study followed a prospective, single-blinded, randomized controlled trial design following the CONSORT guidelines. The study was conducted in Health and Rehabilitation Centre. 42 males aged 10-18 years old, diagnosed with adolescent idiopathic scoliosis (AIS) with curves of 35-40°, were recruited and then were allocated into three groups: Group A, Group B, and Group C. RESULTS: Significant improvement (p < 0.001) in Cobb's angle and the axial rotation of the trunk (ART) were noted after the treatment in the three groups, while pulmonary function showed better results in Group A (p < 0.001) when compared to the two other groups p ≥ 0.000). CONCLUSIONS: Six months of Schroth method added to Gensingen Brace demonstrate favorable results in Cobb's angle, thoracic trunk rotation angle, and pulmonary function in adolescent idiopathic scoliosis.

Carvacrol mitigates vancomycin-induced nephrotoxicity via regulation of IkBα/p38MAPK and Keap1/Nrf2 signaling pathways: an experimental study with in silico evidence.

OBJECTIVE: Despite its evident renal toxicity, vancomycin is considered an effective glycopeptide antibiotic against life-threatening positive bacterial contagions. The current study aimed to investigate the potential protective effects of carvacrol as well as its underlying mechanism against vancomycin-induced nephrotoxicity. MATERIALS AND METHODS: The animals were randomly classified into four groups (8 rats per group). Group I, which served as a control group, received only vehicles. Group II received a single i.p. injection of 50 mg/kg of carvacrol for seven days. Group III received vancomycin (200 mg/kg, i.p.) as a singular daily dose for seven days. Carvacrol was administered to Group IV seven days prior to the daily vancomycin dose. RESULTS: The results revealed that carvacrol minimized vancomycin-induced renal injury as evidenced by lower serum cystatin C levels and kidney injury molecule-1 (KIM-1), in addition to a decline in renal damage caused by vancomycin as indicated in histopathological assessment. Furthermore, carvacrol significantly attenuated oxidative stress parameters and inflammatory mediators. Moreover, it downregulated Keap1, mitogen-activated protein kinase (p38MAPK), and nuclear factor kappa B (NF-κB) genes and proteins, along with controlling the NF-κB inhibitory protein (IkBα) and nuclear factor erythroid 2-related factor 2 (Nrf2) genes and proteins observed through streaming its genes. A molecular docking technique was also used to investigate the potential interactivity between carvacrol and proteins involved in regulating oxidative injury and inflammatory responses. CONCLUSIONS: The current study findings revealed that carvacrol administration before vancomycin could be a promising therapeutic approach for maceration of renal damage stimulated by vancomycin via controlling IkBα/MAPK and Keap1/Nrf2 signaling molecules.https://www.europeanreview.org/wp/wp-content/uploads/graphical-abstract-1.jpg.

Distinct effects of trampoline-based stretch-shortening cycle exercises on muscle strength and postural control in children with Down syndrome: a randomized controlled study.

OBJECTIVE: The aim of the study was to investigate the effect of a 3-month, trampoline-based stretch-shortening cycle (SSC) exercises on muscle strength and postural control in children with Down's syndrome (DS). PATIENTS AND METHODS: Thirty-two children with DS aged between 7-9 years were enrolled and randomly assigned into the control group (n = 16); received standard physical therapy (sPT) or SSC group (n = 16); received sPT in addition to a 15-minute, trampoline-based SSC training program twice per week for 12 successive weeks. Lower limb muscle strength and postural stability [anterior/posterior stability index (A/P-SI), medial/lateral stability index (M/L-SI)], and overall stability index (O-SI) were assessed pre- and post-treatment. RESULTS: Strength of hip extensor (p=0.034) and adductor (p=0.015), knee extensor (p=0.028) and flexor (p=0.01), and ankle dorsi (p=0.033) and plantar flexor (p=0.007) muscles increased significantly in the SSC group when compared with the control group. Also, the A/P-SI (p=0.019), M/L-SI (p=0.002), and O-SI (p=0.021) decreased significantly in the SSC group when compared with the control group, suggesting better postural control. CONCLUSIONS: Twelve weeks of trampoline-based SSC exercises are likely effective for enhancing muscle strength and postural control in children with DS and should consequently be included in the rehabilitation programs for these children.

Infrastructure alone cannot ensure resilience to weather events in drinking water supplies.

Climate resilient water supplies are those that provide access to drinking water that is sustained through seasons and through extreme events, and where good water quality is also sustained. While surface and groundwater quality are widely understood to vary with rainfall, there is a gap in the evidence on the impact of weather and extremes in rainfall and temperature on drinking water quality, and the role of changes in water system management. A three-country (Bangladesh, Nepal and Tanzania) observational field study tracked 2353 households clustered around 685 water sources across seven different geographies over 14 months. Water quality (E. coli) data was modelled using GEE to account for clustering effects and repeated measures at households. All types of infrastructure were vulnerable to changes in weather, with differences varying between geographies; protected boreholes provided the greatest protection at the point of collection (PoC). Water quality at the point of use (PoU) was vulnerable to changes in weather, through changes in PoC water quality as well as changes in management behaviours, such as safe storage, treatment and cleaning. This is the first study to demonstrate the impact of rainfall and temperature extremes on water quality at the PoC, and the role that weather has on PoU water quality via management behaviours. Climate resilience for water supplies needs to consider the infrastructure as well as the management decisions that are taking place at a community and household level.

Lycopene nanoparticles promotes osteoblastogenesis and inhibits adipogenesis of rat bone marrow mesenchymal stem cells.

OBJECTIVE: Lycopene is a carotenoid and antioxidant with potent singlet oxygen quenching ability that reduces oxidative stress and promotes bone health. However, the cellular mechanisms by which lycopene influences bone metabolism are not known. MATERIALS AND METHODS: The present study investigated the effects of lycopene nanoparticles on the differentiation of rat bone marrow-derived mesenchymal stem cells into osteoblasts or adipocytes. RESULTS: In osteogenic medium, lycopene supplementation dose-dependently enhanced osteoblast differentiation, as evidenced by the transcription of Alpl, Runx2, Col1a1, Sp7, and Bglap, higher alkaline phosphatase activity, osteocalcin secretion and extracellular matrix mineralisation seen with Alizarin red S staining, and increased haem oxygenase levels. By contrast, lycopene in adipogenic medium inhibited adipocyte differentiation evidenced by decreases in the transcription of Tnfsf11, Tnfrsf11b, Pparg, Lpl, and Fabp4 and reduced fat accumulation observed by Oil Red O staining. CONCLUSIONS: Lycopene nanoparticles may promote bone health and are considered as a potential candidate for the prevention and/or treatment of bone loss conditions.

Atmospheric factors controlling stable isotope variations in modern precipitation of the tropical region of Bangladesh.

The study investigates the factors that control the isotopic composition of tropical precipitation in Bangladesh. Daily and monthly rainfall samples were collected from three stations from 2013 to 2015: (1) northern and moderately high altitude: Sylhet, (2) middle part of the country (close to Tropic of Cancer): Savar, and (3) southern coastal region: Barisal. To escape from the post-evaporation effect, proper care was adopted. This is supported by the fact that the local meteoric water lines (LMWLs) derived for the daily precipitations of all stations mostly follow the global meteoric water line (GMWL). The results exhibit a clear seasonal and spatial variation in both δ 18O and δ 2H of precipitation. 18O is more depleted in samples collected during rainy (monsoon) seasons, while 18O enrichment is associated to winter and summer (pre-monsoon) seasons. During rainy season, intra-seasonal variability of δ18O rainfall is clearly seen and remarkable depletion of 18O is observed during the period of intense convective activity over the Bay of Bengal. This feature indicates that isotope variability in Bangladesh is controlled by large-scale convective activity rather than local rainfall amount.

Prevalence of ticks (Acari: Ixodidae) and Theileria annulata infection of cattle in Gezira State, Sudan.

This study was conducted in Gezira State, central Sudan during January, May and August 2014 to determine species of ticks infesting cattle and prevalence of Theileria annulata infection and antibodies. A total of 200 head of cattle were sampled for ticks, blood smears, lymph node biopsy smears and sera from five study areas. Zebu (Butana and Kenana) and cross-bred (Zebu X Friesian) cattle of both sexes were sampled. Cattle age groups were younger than one year, one year to younger than four years and four years and older. Coat colour of cattle was recorded. The results revealed that cattle were infested with Rhipicephalus evertsi evertsi (n = 562, 51.6%), Hyalomma anatolicum (n = 289, 26.5%), H. rufipes (n = 70, 6.4%), R. sanguineus sanguineus (n = 59, 5.4%), R. decoloratus (n = 39, 3.6%), Amblyomma lepidum (n = 35, 3.2%), H. impeltatum (n = 26, 2.4%) and H. dromedarii (n = 9, 0.8%). Out of 200 blood and biopsy smears, 33 (16.5%) showed piroplasms for Theileria spp., while 29 (14.5%) were positive for Theileria spp. schizonts. Seropositivity for T. annulata using indirect fluorescent antibody (IFA) test was 94 (47%). It is concluded that there are three genera of hard ticks and eight species in Gezira State and tropical theileriosis is endemic in the state. These findings are the first records in Gezira State, Central Sudan and it is highly recommended to consider the endemicity of tropical theileriosis particularly in cattle upgrading programmes.

Assessment of the prevalence of Theileria lestoquardi in sheep from the Sudan using serological and molecular methods.

Malignant theileriosis of sheep and goats caused by Theileria lestoquardi is considered to be among the most important tick borne diseases in the Sudan. Information on the prevalence of the disease in different parts of the Sudan is limited. The purpose of this study was to estimate the prevalence of the disease in five states of the Sudan using molecular and serological assays. A total of 393 blood and serum samples from clinically asymptomatic sheep were analysed using nested reverse line blot (nRLB) and loop mediated isothermal amplification (LAMP), as well as an enzyme-linked immunosorbent assay (ELISA). The results indicated a sero-prevalence of 33.8% while RLB and LAMP assays revealed molecular prevalences of 29.5 and 22.6% respectively. The prevalence of Theileria lestoquardi varied significantly according to the geographical origin of the infected animals, whereas age and gender did not have a significant effect. RLB data indicated that T. lestoquardi usually occurred as a co-infection with the non-pathogenic Theileria ovis. Using RLB as a gold standard, a sensitivity of 68.1% and a specificity of 96.4% were recorded for LAMP and a sensitivity of 75.9% and a specificity of 83.8% for ELISA. The Kappa coefficient between nRLB and LAMP indicated a significant level of agreement (0.692), but only moderate concordance (0.572) between nRLB and ELISA. The results of the present study confirm and extend earlier findings regarding the widespread of T. lestoquardi infections in sheep in the Sudan. The data provide evidence that should enable the veterinary authorities to deploy appropriate control measures.

Nano-sized mesoporous phosphated tin oxide as an efficient solid acid catalyst.

Herein, we prepared a mesoporous tin oxide catalyst (mSnO2) activated with phosphate species by the adsorption of phosphate ions from a phosphoric acid solution onto tin oxyhydroxide (Sn(OH)4) surface. The phosphate content ranged from 3 to 45 wt%. The nonaqueous titration of n-butylamine in acetonitrile was used to determine the total surface acidity level. FTIR of chemically adsorbed pyridine was used to differentiate between the Lewis and Brönsted acid sites. Thermal and X-ray diffraction analysis indicated that the addition of phosphate groups stabilized the mesostructure of mSnO2 and enabled it to keep its crystalline size at the nanoscale. FTIR analysis indicated the polymerization of the HPO4 2- groups into P2O7 4-, which in turn reacts with SnO2 to form a SnP2O7 layer, which stabilizes the mesoporous structure of SnO2. The acidity measurements showed that the phosphate species are distributed homogeneously over the mSnO2 surface until surface saturation coverage at 25 wt% PO4 3-, at which point the acid strength and surface acidity level are maximized. The catalytic activity was tested for the synthesis of hydroquinone diacetate, where it was found that the % yield of hydroquinone diacetate compound increased gradually with the increase in PO4 3- loading on mSnO2 until it reached a maximum value of 93.2% for the 25% PO4 3-/mSnO2 catalyst with 100% selectivity and excellent reusability for three consecutive runs with no loss in activity.

Molecular, serological and parasitological survey of Theileria annulata in North Kordofan State, Sudan.

This survey was conducted to detect Theileria annulata infection in indigenous (Zebu) and cross (indigenous × Friesian) cattle (n 604) of different sex & age groups, and to investigate prevalence of ticks infesting cattle in North Kordofan State, Sudan. Ticks, blood smears, serum samples and blood spots on filter paper were collected from four municipalities at four monthly intervals during the period from August 2008 to July 2009. Out of 604 blood smears, 69 (11.4%, 95% CI: 16.9-5.9) were positive for Theileria piroplasms; whereas, out of 240 serum samples, 164 (68.3%, 95% CI: 89.3-47.3) were positive for antibodies against T. annulata using IFA test. Using PCR, out of 100 blood spots on filter paper, 8 (8%, 95% CI: 9.6-6.4) revealed T. annulata DNA. The highest prevalence of Theileria spp. piroplasms and T. annulata antibodies was recorded in August (15.9 ±â€¯4.6) followed by February (13.3 ±â€¯3.8) and the lowest was in May (3.9 ±â€¯1.0). Among cattle breeds, the highest prevalence of piroplasms (11.9 ±â€¯5.0) and T. annulata antibodies (68.9 ±â€¯10) was among zebu cattle. PCR assays revealed the highest prevalence rate of T. annulata DNA in February (12.5 ±â€¯1.4) followed by August (6.1 ±â€¯0.7) and the lowest was in May (5.7 ±â€¯0.7). According to cattle breeds, T. annulata DNA was detected in cross-bred cattle (3.3 ±â€¯0.4) more than zebu cattle (10 ±â€¯1.6). Seven tick species belonging to four genera and were identified, Amblyomma lepidum, Hyalomma dromedarii, H. impeltatum, H. rufipes, Rhipicephalus evertsi evertsi, Rhipicephalus decoloratus, R. annulatus. The most abundant tick species was H. rufipes followed by H. impeltatum, R. e. evertsi, H. dromedarii, R. decoloratus, A. lepidum and R. annulatus. Theileria annulata has been detected for the first time in North Kordofan State, though at a low prevalence rate. This finding is an alarming situation since tropical theileriosis is an emerging disease and it is widely believed that this economically important tick-borne parasite does not exist in this state. The possible alternative vector(s) of T. annulata in the absence of the known vector H. anatolicum is discussed.

Aflatoxin, proximate composition and mineral profile of stored broiler feed treated with medicinal plant leaves.

OBJECTIVES: In the present investigation, the Morus alba (M. alba), Vitis vinifera (V. vinifera), Ficus religiosa (F. religiosa) and Citrus paradisi (C. paradisi) leaves anti-aflatoxigenic activities were evaluated in Aspergillus flavus (A. flavus) inoculated feed. METHODS: The broiler feed inoculated with A. flavus was treated with selected medicinal plant leaf powder (5%, 10% and 15% w/w) and stored for the period of six months at 28°C and 16% moisture. The aflatoxins (AFTs) were estimated at the end of each month by Reversed Phase High Performance Liquid Chromatography (RP-HPLC) method along with proximate composition and mineral contents. RESULTS: Plant leaves controlled AFTs efficiently without affecting the feed proximate composition and mineral contents. The M. alba leaves completely inhibition (100%) the AFTs (B1 and B2) in feed at very low concentration (5%). Other plants also showed significant (P<0.05) inhibition of AFTs production without affecting the feed quality over the storage period of six months. CONCLUSION: Based on promising efficiency of selected medicinal plant leaves, A. flavus produced AFTs could possibly be controlled in stored poultry feed.

Aflatoxin biosynthesis control produced by Aspergillus flavus in layer hens feed during storage period of six months.

Aflatoxins (AFTs) are a group of closely related toxins that are produced by different fungus species. Food and feed contamination with AFT is a worldwide health-related problem. As a result of fungal attack, the food and feed resulted in a principal socioeconomic loss and toxins produced in feed and food items harm the humans and animals in different ways. The anti-aflatoxigenic effect Psidium guajava, Ficus benghalensis, Gardenia radicans, Punica granatum and Ziziphus jujuba leaves were evaluated against aflatoxins (AFTs), produced by Aspergillus flavus in layer feed during storage. Among the investigated medicinal plant leaves, P. granatum showed highly promising anti-aflatoxigenic activity and completely inhibited the AFTs (B1 and B2) production over storage period without compromising the nutritive quality of feed (ash, protein, fat, fiber, Fe, Ca, P and K contents). Leaves of F. benghalensis and Z. jujuba were also effective however, higher concentration (15%) inhibited the AFTs production up to 99% and also maintained nutritive quality of feed. G. radicans was found least effective in controlling the AFTs production. Results revealed that all plant leaves were effective in controlling AFTs production in layer feed over the storage period of six months and these plants are potential candidate to replace the fungicides used to protect feed and other agricultural commodities from AFTs production during storage.

Note: A novel trigger generator for a pseudospark switch.

A novel trigger generator for operating a pseudospark switch has been developed based on a series connection of several insulated gate bipolar transistors. The trigger generator can be operated in single shot mode up to a repetition rate of 1 kHz. It is characterized by a fast rise time and low jitter between the output trigger pulses of less than 1 ns. It produces 3 kV, 1 µs pulses into a 50 Ω load that can trigger a pseudospark switch. By eliminating bulkier, slower high voltage components, the overall volume of the trigger generator is reduced. This allows for faster, high voltage switching to take place and thereby increasing the power density of the unit. Using this pseudospark trigger generator, it is possible to trigger single or multiple pseudospark gaps without the requirement to use a pulse shaping circuit.

Sickle cell anemia and α-thalassemia: a modulating factor in homozygous HbS/S patients in Oman.

We report the general phenotype severity and the hematological presentation in a cohort of 125 sickle cell anemia (SCA) patients with identical homozygous HbS/S genotype and categorized by identical ß(S) haplotype, both with and without alpha thalassemia. No clear general phenotype correlation was found when patients were compared regardless of the haplotype but overall, patients with homozygous alpha thalassemia (α-/α-) had the highest Hb, HCT, RBC and the lowest MCV, MCH and MCHC levels. When patients with identical haplotype were compared, the mildest hematological and clinical conditions were observed in patients of the Asian/Asian haplotype, also known as Arab-Indian haplotype, and carriers of α-thalassemia, suggesting an additional ameliorating effect of alpha thalassemia. In conclusion, our results show that alpha thalassemia improves the hematological conditions but amelioration of the general disease severity is only noticed when compared in cohorts of the same haplotype.

Molecular diagnostics of the HBB gene in an Omani cohort using bench-top DNA Ion Torrent PGM technology.

Hemoglobinopathies, such as sickle cell disease (SCD) and beta-thalassemia major (TM), are severe diseases and the most common autosomal recessive condition worldwide and in particular in Oman. Early screening and diagnosis of carriers are the key for primary prevention. Once a country-wide population screening program is mandated by law, a sequencing technology that can rapidly confirm or identify disease-causing mutations for a large number of patients in a short period of time will be necessary. While Sanger sequencing is the standard protocol for molecular diagnosis, next generation sequencing starts to become available to reference laboratories. Using the Ion Torrent PGM sequencer, we have analyzed a cohort of 297 unrelated Omani cases and reliably identified mutations in the beta-globin (HBB) gene. Our model study has shown that Ion Torrent PGM can rapidly sequence such a small gene in a large number of samples using a barcoded uni-directional or bi-directional sequence methodology, reducing cost, workload and providing accurate diagnosis. Based on our results we believe that the Ion Torrent PGM sequencing platform, able to analyze hundreds of patients simultaneously for a single disease gene can be a valid molecular screening alternative to ABI sequencing in the diagnosis of hemoglobinopathies and other genetic disorders in the near future.

Metarhizium anisopliae as a biological control agent against Hyalomma anatolicum (Acari: Ixodidae).

In the Sudan, ticks and Tick-borne Diseases (TBDs) with subsequent costs of control and treatment are causing substantial economic loss. Control of ticks is mainly by chemical insecticides. The rising environmental hazards and problem of resistance has motivated research on biological agents as alternative methods of control. The present study aims at controlling livestock ticks using fungi for their unique mode of action besides their ability to adhere to the cuticle, to germinate and penetrate enzymatically. The study was conducted to evaluate the fungus Metarhizium anisopliae for tick control as an alternative mean to chemical acaricides. Pathogenicity of the fungus was tested on different developmental stages of the tick Hyalomma anatolicum. The fungus induced high mortality to flat immature stages. It, also, affected reproductive potential of the females. Egg laid, hatching percent, fertility and moulting percent of immature stages were significantly (p < or = 0.05) reduced. It was, also, shown that the fungus had ability to adhere to the cuticle and penetrate the integument of the tick. Conidia of the fungus were isolated from their internal tissues. This phenomenon is important in considering fungi as bioinsecticides. Infection of eggs laid by treated engorged female ticks, with the fungus might demonstrate suggesting transovarian transmission. The use of M. anisopliae to control ticks is discussed.

Rayleigh-Taylor instability of an ultrathin foil accelerated by the radiation pressure of an intense laser.

We report experimental evidence for a Rayleigh-Taylor-like instability driven by radiation pressure of an ultraintense (10(21) W/cm(2)) laser pulse. The instability is witnessed by the highly modulated profile of the accelerated proton beam produced when the laser irradiates a 5 nm diamondlike carbon (90% C, 10% H) target. Clear anticorrelation between bubblelike modulations of the proton beam and transmitted laser profile further demonstrate the role of the radiation pressure in modulating the foil. Measurements of the modulation wavelength, and of the acceleration from Doppler-broadening of back-reflected light, agree quantitatively with particle-in-cell simulations performed for our experimental parameters and which confirm the existence of this instability.

Experience of fibrosing cholestatic hepatitis with hepatitis C virus in kidney transplant recipients.

BACKGROUND: Fibrosing cholestatic hepatitis C (FCH-C) is a rare entity that occurs among immune-compromised patients resulting from the direct hepatotoxicity of a high intracellular viral load along with an ineffective immune system ultimately leading to a fatal outcome. We have describes herein 4 renal transplant recipients who were diagnosed with FCH-C at our institution in the last 8 months. METHODS: Four renal transplant recipients presented with jaundice and deteriorating liver function tests. They were diagnosed to display FCH-C based on the presence of hepatitis C virus (HCV) RNA and characteristic liver biopsy findings; there was no evidence of any other cause of cholestasis or biliary obstruction. RESULTS: The patients were men of ages 40, 25, 20, and 27 years. The durations after transplantation were 1.5, 10, 1.5 and 2.0 years, respectively. In all cases pretransplantation screening was negative for HCV antibody, HCV RNA, and hepatitis B surface antigen (HBsAg). All 4 patients were infected with genotype 1, whereas case 2 had coinfection with type 3. Cases 1 and 2 who were treated with interferon and ribavirin, showed improvement in cholestasis but did not achieve a rapid virological response. Case 1 developed graft dysfunction secondary to acute cellular rejection at 4 months after initiation of interferon treatment, which was treated with pulse steroids. Interferon-based therapy was stopped prematurely in both cases due to pancytopenia. Case 3 developed florid pyelonephritis and died without receiving therapy for hepatitis C. Case 4 was managed conservatively by decreasing the immunosuppression with regular monitoring. CONCLUSION: FCH-C is difficult to treat and shows high morbidity and mortality rates. Treatment is associated with a risk of graft rejection.