HCV/HIV coinfected Egyptian patients: a cross-sectional study of their main characteristics and barriers to HCV treatment initiation.

BACKGROUND: This study investigates different barriers preventing a cohort of Egyptian HIV/HCV coinfected patients from accessing HCV treatment, despite being available and free of charge, aiming to improve the long-term outcomes of coinfected patients and decreasing their liver-related morbidity and mortality. METHODS: This study included HIV patients who were referred to Kasr Alainy Viral Hepatitis Center to receive HCV treatment and who had to continue pretreatment assessment in order to receive direct acting antiviral agents free of charge. Patients who did not attend within 90 d were questioned via a telephone interview. Questions addressed sociodemographic status, HIV status and the main barriers to accessing healthcare. RESULTS: Overall, 474 HIV/HCV coinfected patients were eligible for HCV treatment and 223 (47.1%) patients did not complete work-up for HCV treatment. Fear of community stigma concerning HIV/HCV was the most important barrier to compliance with treatment (73.3%), followed by lack of a supportive work environment and employment opportunities (51.5%), whereas 39.3% stopped follow-up due to the lack of integrated services in the healthcare facility. CONCLUSIONS: Managing HCV in HCV/HIV coinfected patients still represents a major challenge, not only for healthcare providers, but also at a community level, to improve community awareness and manage the major obstacle facing those patients regarding community stigma.

The effect of ketogenic diet escalation in adolescents and adults with drug-resistant epilepsy: a prospective study.

BACKGROUND: Ketogenic diet (KD) is an accepted and effective treatment modality in patients with drug-resistant epilepsy (DRE). Different versions of ketogenic diets have been studied, however, the effect of ratio escalation in adolescence and adults has not been previously investigated. METHODS: The current open-labeled interventional study was conducted on 80 patients with drug-resistant epilepsy DRE, 40 patients (intervention group) were exposed to dietary intervention besides their regular antiseizure medication (ASM) and compared to 40 control patients. The intervention group received Ketogenic diet in 2:1 ratio for 1 month then were divided into 2 subgroups, group A1 continued the 2:1 ratio for another 2 months while group A2 escalated to 3:1 dietary regimen. Socio-demographic, anthropometric measurements, epilepsy clinical parameters, and laboratory tests were recorded in addition to safety and tolerability documentation. The response rate was recorded after 1month and 3month. RESULTS: Significant decrease in seizure frequency and severity were detected in Group A1 and A2 patients compared to controls after the 3 month period of intervention with significant improvement of quality of life scores in both subgroups. Both subgroups also showed comparable results regarding their response rate to KD. Better acceptance of diet taste were reported by subgroup A1 with a significantly higher lipid profile detected in subgroup A2. CONCLUSION: KD has a beneficial effect as adjunctive treatment in adolescents and adults with DRE. Escalation from 2:1 to 3:1 ratio is associated with less compliance rather than better response in patients with DRE.

Prevalence of SARS-CoV-2 infection and dynamics of antibodies response among previously undiagnosed healthcare workers in a university hospital: A prospective cohort study.

BACKGROUND: Healthcare workers (HCWs) are a presumed high-risk population for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Identifying factors associated with seroprevalence can help establish better practices in healthcare settings. In this study, we evaluate prevalence of SARS-CoV-2 infection among previously undiagnosed HCWs and describe profiling of antibody responses against SARS-CoV-2, including neutralizing antibodies (NAbs). METHODS: We analyzed a cohort of 386 HCWs in a university hospital in Egypt and 725 volunteers not affiliated to any healthcare facility (non-healthcare workers - NHCWs). Participants provided a nasopharyngeal swab and serum samples for SARS-CoV-2 nucleic acid and SARS-CoV-2-specific antibodies, respectively. HCWs who tested positive by either test were sequentially monitored. RESULTS: At baseline, point prevalence of viral carriage was 11.4% in HCWs (n = 44/386) and 11.9% in NHCWs (86/725). The cumulative prevalence of SARS-CoV-2 infection among HCWs considering all studies was 25.6%, which was statistically lower than in NHCWs (41.0%). Prevalence was greatest among janitorial staff (45.9%) and the most affected departments were gastroenterology (31.1%), and emergency medicine (30.0%). Prior anosmia, fever or headache were associated with higher odds of positivity for SARS-CoV-2 infection. Regarding serial antibody measurements, RT-PCR-positive HCWs displayed IgG detection rates of 29.5%, 70% and 60% at visit 1, visit 2 and visit 3, respectively with slow decline of median IgG antibody titers, whereas, corresponding detection rates for total Ig antibodies were 50%, 90.3%, and 88.9%, respectively with increasing median titers. NAbs measured at each time point were positively correlated with total Ig levels, whereas IgG levels were positively correlated with NAbs at visit 1 and visit 3. CONCLUSION: Our results demonstrate lower cumulative prevalence of SARS-CoV-2 infection in HCWs than general population and suggest that asymptomatic HCWs exhibit considerable IgG and total Ig antibodies response as well as NAbs for up to 120 days, with positive correlation in between.

Is urinary ß2-microglobulin a reliable marker for assessment of renal tubular dysfunction in chronic hepatitis B patients receiving tenofovir therapy?

BACKGROUND AND AIM: Urinary ß2-microglobulin (ß2-M) is a marker for renal tubular dysfunction. The current study aimed to assess urinary ß2-M as a reliable marker for early prediction of tenofovir disoproxil fumarate (TDF)-related nephrotoxicity among hepatitis B virus (HBV) patients. METHODS: Forty-two HBV patients who were a candidate for TDF therapy or have recently started it (for less than 6 months) were enrolled and subjected to demographic, clinical, laboratory assessment, abdominal ultrasound and transient elastography. The glomerular filtration rate (GFR) was estimated using the Cockcroft-Gault equation. Also, urinary ß2-M was measured by the ELISA method within 6 months after the introduction of TDF treatment and 6 months later. RESULTS: Mean age was 41.8 (9.55) years, 27 were males and 59.5% of patients have elevated urinary ß2-M after 6 months follow-up of TDF therapy. Urinary ß2-M was 0.07 ± 0.07 µg/ml at baseline and insignificantly increased up to 0.09 ± 0.08 µg/ml after 6 months follow-up. Despite the insignificant increase in serum creatinine from 0.85 ± 0.23 mg/dl at baseline to 0.9 ± 0.21 mg/dl after 6 months and the insignificant decrease in eGFR from 126.2 ± 39.72 ml/min at baseline and 117.64 ± 42.23 ml/min at 6 months follow-up. No correlation was found between the changes in urinary ß2-M and the changes in other renal function indices at baseline and 6 months follow-up. CONCLUSIONS: Short-term TDF therapy is associated with nonsignificant changes either in eGFR or urinary ß2-M; these changes are not clinically relevant that indicates disease progression. Therefore, the suitability of urinary ß2-M as a screening tool for tenofovir induced tubular dysfunction should be further.

The awareness of neglected tropical diseases in a sample of medical and nursing students in Cairo University, Egypt: A cross-sectional study.

Neglected tropical diseases (NTDs) are a group of chronic diseases affecting 1.2 billion people worldwide, with more burden in the developing communities. Improving awareness about NTDs is a powerful affordable long-term intervention for infection control. In literature, there is a limited number of studies in the developing countries assessing the awareness of healthcare providers regarding these diseases. The present study aimed at assessing the awareness of a sample of Cairo University medical and nursing students regarding NTDs. A cross-sectional descriptive study was conducted on 184 medical and nursing students in Cairo University. An anonymous self-administered questionnaire in English language with an estimated completion time of 15 minutes was used for evaluation. It included question categories which cover the knowledge about NTDs and control measures as well as the willingness to participate in NTDs control activities. Content analysis was performed on the materials and specifications of the epidemiology course given to medical and nursing students. Out of the study participants, 26% knew the meaning of NTDs. The main source of their knowledge was social media followed by the epidemiology course. A percentage of 33% of the students agreed that NTDs are of public health importance in Egypt. Thirty four percent of the participants expressed their willingness to participate in control activities for NTDs. Comparing medical and nursing students, a higher percentage of the nursing students stated that NTDs are causing a public health problem in Egypt with a statistically significant difference (P value < 0.001), while a statistically significant higher percentage of medical students believed that the awareness level regarding NTDs in Egypt is low (P value = 0.002). Cairo University medical and nursing students in this study showed a gap in the level of knowledge regarding NTDs and their control activities which represents a great threat to the control of these diseases.

Improvement of Healthy Diet Related Knowledge among a Sample of Egyptian Women in Three Upper Egypt Governorates Using a Community Based Intervention.

BACKGROUND: Fostering a community-based approach is one of the United Nations Children's Fund (UNICEF) strategies to empower the public with the knowledge and tools required for improving the nutritional status. AIM: The current study was conducted to assess the knowledge of mothers/caregivers towards a healthy, safe, and affordable diet and to cover the detected knowledge gap using a community-based approach. METHODS: A pre-posttest experimental design was carried out at a community level at three Upper Egypt governorates: Assiut, Qena, and Sohag over six months from September 2017 till February 2018. In the preparatory phase, 22 non-governmental organisations (NGOs) were selected per governorate, and 15 trainers were prepared at the central level to train 40 trainees from each governorate. In the implementation phase, 11,000 women were approached, 6548 of them agreed to participate in the baseline knowledge assessment: 1774 women from Assiut, 2337 from Qena, and 2437 from Sohag. RESULTS: A significant improvement in the participants' subtotal and total knowledge scores in all dimensions of nutrition education which are: food economics, food safety, and a healthy diet. The highest percent change was in Assiut 77.1 (69.3: 109.9), followed by Qena 54.9 (27.2: 93.3), and then Sohag 43.7 (31.6: 61.4) which was noticed among the participants from the 3 governorates. CONCLUSION: This community-based approach was a successful intervention to deliver effective health education messages; thus, improving participants' knowledge regarding food safety, healthy diet, and food economics. It represented the success of NGOs to enhance health and nutrition literacy among the participating women living in underprivileged areas. It is recommended to encourage collaboration with NGOs to move the community towards healthy behaviours.

Community-based interventions to support maternal and child health practices in Upper Egypt.

BACKGROUND: Actions to improve mother and child health should address the needs and demands of the local population. Community-based interventions contribute to understanding the current situation, mobilization of local resources, commitment to achievements and better chance for sustainability. AIMS: This was a community-based intervention implemented in two Upper Egypt governorates to improve coverage of selected maternal and child health interventions in Egyptian villages. METHODS: The study was conducted between May 2016 and December 2017. The National Population Council started communication with Governorate leaders, Directors of Local Unit, Health District and Health Unit to facilitate implementation. A three-day training of trainers workshop was held for eight public health universities' staff from two selected governorates. More than 30 National Population Council coordinators were trained for using an observation checklist. University trainers implemented a four-day workshop attended by 37 Mother and Child Friends participants from Fayoum and 38 from Beni-Sweif. The Mother and Child Friends team selected 1200 women to attend the Health education sessions, and a total of 143 and 121 women participated in the focus group discussions before the first and after the last Health education session for evaluation. RESULTS: An 18 items pre-test questionnaire completed by the trainees was useful to identify major gaps in knowledge and to evaluate the effect of training. There was significant improvement in the post-test in Fayoum (15.6 ± 1.3 SD) and in Beni-Sweif (14.1± 1.5 SD). Likert scale evaluation revealed Mother and Child Friends satisfaction with the training and Mother and Child Friends team provided Health education to the participants. Most of the sessions had no negative comments by the observers. Focus group discussions held after the Health education classes revealed positive changes in the participants' knowledge and attitude. CONCLUSIONS: Implementation revealed that more needs were expressed by women and the Mother and Child Friends team. Future activities should consider customization to address community needs and expectations.