Prediction of mortality in hospitalized Egyptian patients with Coronavirus disease-2019: A multicenter retrospective study.

We aimed to assess the epidemiological, clinical, and laboratory characteristics associated with mortality among hospitalized Egyptian patients with COVID-19. A multicenter, retrospective study was conducted on all polymerase chain reaction (PCR)-confirmed COVID-19 cases admitted through the period from April to July 2020. A generalized linear model was reconstructed with covariates based on predictor's statistical significance and clinically relevance. The odds ratio (OR) was calculated by using stepwise logistic regression modeling. A total of 3712 hospitalized patients were included; of them, 900 deaths were recorded (24.2%). Compared to survived patients, non-survived patients were more likely to be older than 60 years (65.7%), males (53.6%) diabetic (37.6%), hypertensive (37.2%), and had chronic renal insufficiency (9%). Non-survived patients were less likely to receive azithromycin (p <0.001), anticoagulants (p <0.001), and steroids (p <0.001). We found that age ≥ 60 years old (OR = 2.82, 95% CI 2.05-3.86; p <0.0001), diabetes mellitus (OR = 1.58, 95% CI 1.14-2.19; p = 0.006), hypertension (OR = 1.69, 95% CI 1.22-2.36; p = 0.002), chronic renal insufficiency (OR = 3.15, 95% CI 1.84-5.38; p <0.0001), tachycardia (OR = 1.65, 95% CI 1.22-2.23; p <0.001), hypoxemia (OR = 5.69, 95% CI 4.05-7.98; p <0.0001), GCS <13 (OR 515.2, 95% CI 148.5-1786.9; p <0.0001), the use of therapeutic dose of anticoagulation (OR = 0.4, 95% CI 0.22-0.74, p = 0.003) and azithromycin (OR = 0.16, 95% CI 0.09-0.26; p <0.0001) were independent negative predictors of mortality. In conclusion, age >60 years, comorbidities, tachycardia, hypoxemia, and altered consciousness level are independent predictors of mortality among Egyptian hospitalized patients with COVID-19. On the other hand, the use of anticoagulants and azithromycin is associated with reduced mortality.

Non-surgical management in 336 patients of hydatid disease: 23 years experience at Riyadh Military Hospital.

BACKGROUND/AIMS: Patients with hydatid cysts (336) were studied at Riyadh Military Hospital, Saudi Arabia, between February 1985-June 2008, out of which 254 patients underwent non-surgical management and 82 patients had surgery. METHODOLOGY: Drug therapy was administered to 194 of 254 patients: albendazole was administered in 65 patients; (albendazole+praziquantel) in 129 patients; 12 patients had endoscopic management; 48 patients had Percutaneous-Aspiration-Injection-Reaspiration (PAIR) and 82 patients had surgery. RESULTS: Out of 65 patients, 34 had completed albendazole of which 12 (35%), had cyst disappearance, 8 patients had partial cyst reduction, 12 had no response and were referred for combined therapy or PAIR; 66 patients with cysts in different organs completed the study using albendazole+praziquantel, in 50% of these cysts had disappeared and 16 (24%) observed reduction of cysts; 48 patients underwent PAIR, of which in 36 cysts (66.66%) disappeared; 82 patients had surgery and 20% had post-surgical complications. CONCLUSION: A great advance recently has happened in the non-surgical management of hydatid cysts including medical, PAIR and endoscopic management, which has led to a significant reduction in the need for surgical intervention.

Organ involvement in hepato-intestinal schistosomiasis.

The endoscopic, radiological and histological findings in several of our patients with Schistosoma mansoni infection are described. Seventy-two patients with hepatosplenic schistosomiasis. Endoscopic sclerotherapy was effective in 45 patients with bleeding varices. Ultrasound of the liver was suggestive of periportal fibrosis in 48 of these 72 patients, in 30 of whom liver biopsy demonstrated a Schistosoma granuloma or periportal fibrosis. Gastroscopy revealed congestion, erosions or ulcerations in the stomach in 40 of these patients and in the duodenum in 23 patients. Schistosoma ova and inflammatory changes were seen in endoscopic biopsies from the stomach in three out of twelve and five out of eight duodenal biopsies. The colonoscopic findings were suggestive of schistosomiasis in 98 out of 216 patients with colonic schistosomiasis. Eight patients had schistosomal polyps and one had colonic calcifications. Schistosoma ova were seen in surgical specimens from patients presenting with an acute abdomen due to appendicitis in six, cholecystitis in three and mesenteric vein thrombosis in three. In one of the latter the mesenteric angiogram showed an internal mesenteric vein blocked by ova.

Endoscopic sphincterotomy in acute gallstone pancreatitis and cholangitis: a Saudi hospital experience.

Thirty-five patients with acute gallstone pancreatitis and/or cholangitis underwent endoscopic sphincterotomy. In 15 out of 18 patients with acute gallstone pancreatitis, common bile duct (CBD) stones, 5 of which were impacted, were removed. This resulted in prompt improvement in 12 of these patients. Eleven patients had acute gallstone cholangitis in ten of whom--including one patient who had cholangiocarcinoma associated with Clonorchis sinensis--CBD stones were extracted. Six other patients had both acute pancreatitis and cholangitis, one of whom had a choledochal cyst and had surgery; another patient with a post-surgical CBD fistula and retained stone, improved following stone extraction and nasobiliary tube insertion. The duration of hospitalization ranged between 5 and 19 days in the 26 patients treated endoscopically, and between 25 and 90 days in the 9 surgically treated patients.

Hepatitis C virus infection in chronic liver disease and hepatocellular carcinoma in Saudi Arabia.

The prevalence of antibody to hepatitis C virus (HCV) was determined in 139 patients with chronic liver disease (CLD) and 42 patients with hepatocellular carcinoma (HCC) during one year at the Riyadh Military Hospital, Saudi Arabia. The anti-HCV was detected in 36 of 96 (37.5%) HBsAg-negative patients with chronic liver disease and six of 43 (13.9%) HBsAg-positive patients with chronic liver disease. In addition, 11 (42.3%) HBsAg-negative hepatocellular carcinoma patients and two of 16 (12.5%) HBsAg-positive hepatocellular patients had antibody to HCV. The anti-HCV prevalence was 1.5% in 4818 healthy blood donors and 1% in 385 antenatal patients. The overall HCV seropositivity of 30.4% in 181 liver disease patients (CLD and HCC) in Saudi Arabia is lower than that reported from European countries.

Endoscopic management of biliary hydatid disease: report on six cases.

Six patients with a ruptured Echinococcus liver cyst were treated by means of endoscopy. The treatment consisted of endoscopic sphincterotomy, cyst material extraction and hypotonic saline lavage via a nasobiliary catheter. In five patients successful complete endoscopic treatment was achieved, including removal of daughter cysts. In the sixth patient only partial treatment could be performed with clearance of daughter cysts since there was no communication with the main liver cyst. Follow-up ultrasonography, CT and ERCP in all patients showed complete cure and no evidence of disease recurrence in five of them. The sixth patient required surgery one month after endoscopic treatment of the acute biliary obstruction.

Advances in diagnosis and management of hydatid disease.

Over the last decade substantial improvements have been made in the diagnosis and management of hydatid disease. New diagnostic tests, imaging procedures including ultrasonography, computerized tomography, magnetic resonance and ERCP. Until recently the only definitive treatment for hydatid disease has been surgery, which carries high morbidity, mortality and recurrence. Advances in drug therapy has been influenced by the introduction of Albendazole. In our own study, Albendazole was administered to 22 patients with hydatid disease of the liver, and encouraging results were achieved in most of the patients. Another recent improvement has been the introduction of a non-surgical endoscopic method for the management of biliary and liver echinococcus. In 1985 we published the first report on the use of this procedure. The fourth recent aspect of treatment is the percutaneous aspiration and drainage of hydatid cyst of the liver. These recent developments, used either alone or in combination, are, we believe, good potential alternatives to operative surgery that carry a smaller incidence of complications, morbidity and mortality.

Human dicrocoeliasis. Report on 208 cases from Saudi Arabia.

In 3 years, Dicrocoelium dendriticum ova were detected in 208 patients at the Armed Forces Hospital, Riyadh, Saudi Arabia during 1984-1986. At least 7 of these patients had a true infection and at least 34 patients had spurious infection as they gave a history of eating raw liver. 23% of the 208 patients were under 14 years of age. The peak incidence was between October and November in each of the 3 years. 134 of these patients were symptomatic. 16 patients had disturbed liver functions and 13 had eosinophilia. 10 patients had gall bladder or biliary tree disease and in at least 2 of which it was due to D. dendriticum. Malabsorption occurred in one patient. Praziquantel was used in 9 patients and was successful in treating 4 of these patients.

Comparison between stool examination, serology and large bowel biopsy in diagnosing Schistosoma mansoni.

This report evaluates the diagnostic method in 167 patients with colonic schistosomiasis. These patients formed a part of a large number of patients who had sigmoidoscopy or colonoscopy for various gastrointestinal problems. During sigmoidoscopy or colonoscopy examination, typical intestinal Schistosomia lesions could be seen and at the same time several biopsies could be taken. Stool examination showed Schistosoma mansoni ova in only 19 patients (11.37%) of the 167 patients whose colonic biopsies were positive for Schistosoma mansoni. Serological tests were carried out in 115 of these patients and 88 patients (52.69%) had a titre of 64 or more. This study shows that endoscopic colonic biopsy is a better method than stool examination and serological tests in the diagnosis of intestinal or hepatosplenic schistosomiasis.