Effectiveness of hepatitis B vaccination in chronic HCV patients after successful generic direct acting antiviral therapy: significance of isolated hepatitis B core antibodies.

OBJECTIVE: Previous reports show conflicting results regarding hepatitis B virus (HBV) vaccine efficacy in Hepatitis C virus (HCV) infected individuals and in those with isolated hepatitis B core antibodies (HBcAb). We aimed to evaluate the effectiveness of HBV vaccine and identify possible factors that may contribute to hyporesponsivness in HCV-treated patients, including those with isolated HBcAb. METHODS: We conducted a prospective study with 118 enrolled chronic HCV patients who followed a 12-week regimen of direct acting antivirals (DAAs) and were evaluated for HBV serological markers. Eventually, 98 received appropriate HBV vaccination and were assessed for response. RESULTS: A total of 57.1% were vaccine responders although only 5.1% achieved a seroprotective level of HBsAb titre. The response rate was significantly lower among treated HCV patients with isolated HBcAb [2 (5.6%) vs. 40 (64.5%) respectively]. On multivariate analysis, advanced age [OR (95% CI) = 1.09 (1.02-1.17)] and presence of isolated HbcAb [OR (95% CI) = 39.59 (7.98-196.63)] were predictors of vaccine non-response. In our cost-effectiveness models, the cost of HBV serological screening was less than the nationally adopted non-screening approach. A model ratifying reinforced vaccination in non-responder HBcAb seropositive HCV patients would incur extra cost. CONCLUSION: Hyporesponsiveness to the HBV vaccination is frequent in chronic HCV patients even after achieving SVR following DAAs. Although there is no consensus on the clinical management of patients with isolated HBcAb, our cost-effectiveness options may support decision-making for better clinical benefit and proper health investments.

Accessibility of registration offices for births and deaths: Red Sea Governorate, Egypt.

Background: Frontier governorates in Egypt have widely dispersed residential areas, which may make birth/death registration difficult for people because of the distance to registration offices. Aims: This study aimed to assess the accessibility of birth/death registration offices in the Red Sea Governorate, one of Egypt's frontier governorates. Methods: OpenStreetMap was used to locate residential areas and road networks of the Red Sea Governorate. Buffer analysis, with a radius of 20 km around registration offices, was done to assess the coverage. Network analysis was also conducted to calculate the distance between residential areas and registration offices. All spatial analysis work was done using ArcGIS 10.1 software. Results: On delineating the areas of the Red Sea Governorate, 73 residential areas were identified (eight cities, 12 main villages and 53 residential areas outside of the cities and villages). Buffer analysis showed that even a 20 km buffer was not enough to cover all the residential areas. All cities had a good accessibility to registration offices compared with main villages (e.g. 1.5 km compared with 104.5 km), although two main villages had a good accessibility (0.2 km and 0.4 km) as the registration offices were in the villages. For all 73 residential areas, the median distance was 37.6 km with 60.65 km interquartile range. Conclusions: Residential areas in the Red Sea Governorate have varying levels of accessibility to birth/death registration offices. New registration techniques are suggested to improve accessibility to birth/death registration.

Glycemic control among patients with type 2 diabetes in a low resource setting in Rwanda: a prospective cohort study.

Introduction: diabetes is a leading cause of death, disability, and high healthcare costs, especially among patients with poor glycemic control. Providing decentralized diabetes care to patients in low-income countries remains a major challenge. We aimed to assess hemoglobin A1C (HbA1c) level of patients enrolled in primary-level non-communicable disease clinics of Rwamagana, Rwanda, and identify predictors associated with a) change in HbA1c level over a 6-month period or b) achieving HbA1c <7%. We also explored whether living in a community with a home-based care practitioner was associated with HbA1c-related outcomes. Methods: we conducted structured interviews and HbA1c testing among patients with type 2 diabetes at baseline and after six months. Multivariable linear regression and multivariable logistic regression were used. Results: hundred and thirty (130) participants enrolled at baseline, and 123 patients remained in the study after six months. At baseline, 26% of patients had HbA1c <7%. After 6-months, 37% of patients had HbA1c <7%. Factors correlated with the greatest improvements in HbA1c were having HbA1c >9% at baseline, while factors associated with having HbA1c <7% after six months included older age and having HbA1c <7% at baseline. We did not find significant associations between home-based care practitioners and improvement in HbA1c level or achieving HbA1c <7. Conclusion: the number of patients with well-controlled glycemia improved over time during this study but was still low overall. Care provided by home-based care practitioners was not associated with six-month HbA1c outcomes. Enhanced care is needed to achieve glycemia control in primary healthcare settings.

Regression tree modelling to predict total average extra costs in household spending during COVID-19 pandemic.

BACKGROUND: Prevention of coronavirus (COVID-19) regarding households has many aspects, such as buying mask, hand sanitizer, face shield, and many others. As a result of buying the previous items, the household spending per month will increase during the COVID-19 pandemic period. This study aimed to calculate the average costs of each extra item involved in households spending during COVID-19 pandemic and to predict the total average extra costs spending by households. RESULTS: Most of the respondents were females (81%) and aged between 30 and 40 (56.3%). About 63.1% of families had the same monthly income while 35.4% had a decrease in monthly income. A significant reduction in days of leaving home before and after COVID-19 pandemic was observed (before; median = 6, after; median = 5, P = < 0.001). The extra spending in grocery was the dominated item compared to other items (mean = 707.2 L.E./month, SD = 530.7). Regarding regression tree, the maximum average extra costs due to COVID-19 pandemic were 1386 L.E./month (around 88.56$/month (1$-> 15.65L.E.)) while the minimum average extra costs were 217 L.E./month (around 13.86$/month). CONCLUSIONS: The effect of COVID-19 pandemic in households spending varies largely between households, it depends on what they do to prevent COVID-19.

Spatial analysis of completeness of death registration in Egypt.

PURPOSE: Civil registration and vital statistics (CRVS) systems should be the primary source of routine mortality data. However, there is lack of information about the completeness of death registration at the sub-national level of Egypt. The current study was conducted to estimate the completeness of death registration at the national and sub-national levels of Egypt, to investigate the spatial patterns of the completeness, and to examine the factors that influence it. METHODS: Data from the Central Agency for Public Mobilization and Statistics (CAPMAS, 2018) and Egypt Demographic and Health Survey (EDHS 2008, 2014) were used to estimate the completeness of death registration using an empirical method (random-effects models); hot spot analysis was conducted using Moran's I and Getis-Ord Gi*; and the geographically weighted regression (GWR) model has been also carried out. RESULTS: The study estimates show that Egypt has 96% completeness of death registration, and all governorates have completeness of more than 90% except for Beni-Suef, Menia, Aswan, Suhag, Luxor, ELWadi ELGidid, and South Sinai. According to sex, the death registration of females is slightly better than that of males (96.8% compared to 95.4%). Concerning residence, urban area has almost complete death registration compared to rural area (99.5% and 85.4%, respectively). Hot spot analysis shows that all hot spots are centered on the north of Egypt, while all cold spots are focused on the south. However, according to the geographically weighted regression (GWR) model, poverty, illiteracy, and health office density are considered major factors for the completeness of death registration. CONCLUSION: Although the completeness in Egypt is almost 100%, this analysis suggests that it may not be, and that it could be somewhat lower in some rural areas. However, there is uncertainty in the sub-national estimates because deaths are only reported by place of occurrence and not place of usual residence. Thus, efforts should focus on improving the quality of data of the vital registration system in some rural areas and in lower Egyptian governorates.

Validity and reliability of the Arabic version of the "Personal Wellbeing Index-Adults" on adults with hearing impairment.

Background: The Personal Wellbeing Index-Adults (PWI-A) is the most widely used instrumentfor measuring subjective-quality of life (QoL). The current study seeks to investigate the constructvalidity and reliability of the Arabic version of the PWI-A on adults with bilateral hearingimpairment by comparing the single-factor solution with the two-factor solution. Methods: A cross-sectional study was conducted at the Audio-Vestibular Medicine Unit of Alexandria University from July-2017 to January-2018. A total of 205 adults were interviewed tomeasure the subjective-QoL using the PWI-A instrument. Internal consistency was determinedusing both Cronbach's alpha and composite reliability (CR). Validity was assessed by constructvalidity, including ordinal regression, ordinal exploratory factor analysis (OEFA), and ordinalconfirmatory factor analysis (OCFA). Results: The first four items of the PWI-A which are: satisfaction with living standard, health,achievements, and relationships were the most important indicators of subjective-wellbeing(Part r2 0.0547, 0.0324, 0.0361, and 0.0225, respectively). OEFA suggested that the two-factormodel contributes better than the single-factor model. OCFA validated this suggested solution;(two-factor: RMSEA=0.084 (90% CI=0.01-0.14); CFI=0.964; AIC=52.64; single-factor: RMSEA=0.119 (90% CI=0.07-0.17); CFI=0.922; AIC=62.77). Good internal consistency wasalso presented (two-factor: Cronbach's alpha=0.719, 0.693; single-factor: Cronbach's alpha =0.750). Conclusion: The Arabic version of the PWI-A is a multidimensional scale that consists of twodimensions: the first is related to subjective-QoL, and the second is related to satisfaction withthe community. Thus, it is recommended to use the short version of the PWI-A with only fouritems to measure subjective-QoL, as it achieved sufficient reliability and construct validity.

Topiramate for smoking cessation: Systematic review and meta-analysis.

INTRODUCTION: Topiramate is an antiepileptic drug that has been used for many labeled and off-labeled indications. It may be useful in reducing withdrawal symptoms of various addictive agents such as alcohol, cocaine, cannabis and smoking. To date, some studies have examined the effectiveness of topiramate for smoking cessation. The present review aims to synthesize the results from those studies and determine topiramate effectiveness in smoking cessation. METHODS: A comprehensive search was conducted in the databases: PubMed/Medline, Cochrane, Egyptian Knowledge Bank, and Google Scholar. All clinical trials that examined the effect of topiramate, compared with the placebo, on smoking cessation rate were included. Statistical analysis using fixed effect models, heterogeneity and sensitivity analysis were conducted using RevMan 5.3. RESULTS: Five trials met the inclusion criteria and were included in the meta-analysis. Topiramate non-significantly increased prolonged smoking abstinence rate (OR=1.19, 95% CI: 0.57-2.5) compared with the placebo. On the other hand, topiramate significantly increased the abstinence rate at weeks 4, 6, 8 and 12 (OR=3.07, 95% CI: 1.19-7.93; OR=4.03, 95% CI: 1.98-8.2; OR=2.29, 95% CI: 1.23-4.28; and OR=2.45, 95% CI: 1.37-4.39; respectively) compared with the placebo. CONCLUSIONS: Based on the five trials, where publication bias cannot be excluded, the current evidence is not sufficient to show a significant difference to favor topiramate in prolonged smoking cessation over the placebo, although the 12th week point prevalence favored topiramate.