Prospective Comparison of Hepatocellular Carcinoma Behavior and Survival of Patients who Did or Did not Receive HCV Direct-Acting Antivirals.

BACKGROUND & AIMS: The safety and efficacy of hepatitis C (HCV) direct-acting antivirals (DAAs) have been established in several real-world trials; however, some reports have claimed an association between DAAs and hepatocellular carcinoma (HCC) occurrence or aggressive behavior. We aimed to prospectively examine differences in de-novo HCC tumor behavior and overall survival (OS) in DAAs-treated versus HCV-untreated patients as measured by BCLC progression during a two-year follow-up period. METHODS: This multicenter cohort study recruited 523 patients with de-novo HCV-related HCC. After exclusion criteria were applied, 353 patients were placed into; Group 1, including 236 patients without a history of DAAs therapy, and Group 2 including 117 patients with de-novo HCC developed after receiving DAAs. Patients were then stratified in each group according to BCLC staging (Liver, 2018). All patients received standard of care management and were followed until death or a maximum of 2 years. RESULTS: No statistically significant differences were observed between the two groups regarding tumor characteristics (number and size of lesions) and criteria for aggressiveness upon presentation. Among all BCLC stages, DAAs treated patients showed significantly lower baseline Fib4 values than DAA untreated patients in BCLC-0 stage (4.1 vs 7.7, p 0.019). No statistically significant differences were evident in HCC progression in the different BCLC stages at 12 and 24 months follow up periods (p 0.0718 and 0.279 respectively). Significantly better survival was recorded in Group 1 compared to Group 2 patients for BCLC stages C and D (p = 0.003 and 0.01, respectively). CONCLUSION: HCC may develop at an earlier stage of liver disease after DAAs therapy. No defensive role was found for DAAs treatment in delaying HCC progression that occurs after viral eradication.
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The COVEG score to predict severity and mortality among hospitalized patients with COVID-19.

INTRODUCTION: COVID-19 severity and mortality predictors could determine admission criteria and reduce mortality. We aimed to evaluate the clinical-laboratory features of hospitalized patients with COVID-19 to develop a novel score of severity and mortality. METHODOLOGY: This retrospective cohort study was conducted using data from patients with COVID-19 who were admitted to five Egyptian university hospitals. Demographics, comorbidities, clinical manifestations, laboratory parameters, the duration of hospitalization, and disease outcome were analyzed, and a score to predict severity and mortality was developed. RESULTS: A total of 1308 patients with COVID-19, with 996 (76.1%) being moderate and 312 (23.9%) being severe cases, were included. The mean age was 46.5 ± 17.1 years, and 61.6% were males. The overall mortality was 12.6%. Regression analysis determined significant predictors, and a ROC curve defined cut-off values. The COVEG severity score was defined by age ≥ 54, D-dimer ≥ 0.795, serum ferritin ≥ 406, C-reactive protein ≥ 30.1, and neutrophil: lymphocyte ratio ≥ 2.88. The COVEG mortality score was based on COVEG severity and the presence of cardiac diseases. Both COVEG scores had high predictive values (area under the curve 0.882 and 0.883, respectively). CONCLUSIONS: COVEG score predicts the severity and mortality of patients with COVID-19 accurately.

Sofosbuvir/ledipasvir in combination or nitazoxanide alone are safe and efficient treatments for COVID-19 infection: A randomized controlled trial for repurposing antivirals.

BACKGROUND AND STUDY AIMS: Currently, there is no therapy approved for COVID-19. We evaluated the efficacy and safety of sofosbuvir/ledipasvir and nitazoxanide for the treatment of patients with COVID-19 infection. PATIENTS AND METHODS: A multicenter, open-label randomized controlled trial included one hundred and ninety patients with non-severe COVID-19 infection. Patients were randomized into three groups. All groups received standard care treatment (SCT). In addition, group 1 received sofosbuvir/ledipasvir, and group 2 received nitazoxanide. Follow-up by reverse-transcriptase polymerase chain reaction (RT-PCR) was done at intervals of 5, 8, 11, and 14 days. The primary endpoint was viral clearance. RESULTS: Viral clearance was significantly higher in the sofosbuvir/ledipasvir and nitazoxanide groups compared to the SCT group in all follow-up intervals (p < 0.001). In the sofosbuvir/ledipasvir arm, 36.9% showed early viral clearance by day 5. By day 14, 83.1% of the sofosbuvir/ledipasvir group, 39.7% of the nitazoxanide group, and 19.4% of the SCT group tested negative for SARS-CoV-2. Sofosbuvir/ledipasvir and nitazoxanide treatment were the only significant factors in Cox regression of negative RT-PCR with the highest OR (17.88, 95% CI: 6.66-47.98 and 2.59, 95% CI: 1.11-6.07, respectively). No mortality or serious adverse events were recorded. CONCLUSION: The addition of sofosbuvir/ledipasvir or nitazoxanide to the SCT results in an early and high viral clearance rate in mild and moderate patients with COVID-19. These drugs represent a safe and affordable treatment for COVID-19.

Chloride-binders and their effect on the physico-mechanical properties of sulfate-resisting cement (SRC) hardened pastes upon exposure to sea water attack.

In Egypt, the national strategic plan for population redistribution supports the establishment of new towns and urban settlements across the coastal zones to relieve the pressure on the packed Nile Valley and Delta and encourages internal migration to new urban coastal communities. Since reinforced concrete has a poor service record in these areas, this situation urged us to design a research program in which a new route has been followed for confronting the concomitant effect of sulfate and chloride attack. Therefore, sulfate-resisting cement (type V) has been used for preparing concrete. The cement has been blended with a chloride-binder for fixing free chloride into an insoluble (or poorly soluble) reaction product. As to the steel reinforcement, the research program will investigate steel protection by an innovative inhibited cement slurry coating. The current-first part-of the research program has been concentrated for determining the influence of a chloride-binder [lead oxide (PbO)] as well as a novel proposed chemical compound [lead nitrate: Pb(NO3)2], as chloride-binders, on the physico-mechanical properties of hardened SRC pastes upon exposure to sea water. The investigation disclosed that these compounds marginally delay the setting time relative to the chloride-binder-free pastes, yet they improve workability, maintain alkalinity (hence carbonation resistance), and yield better compressive strength.

Management of life-threatening acute respiratory syndrome and severe pneumonia secondary to COVID-19 in pregnancy: A case report and literature review.

Evidence-based treatment involving multidisciplinary decision making is warranted to treat COVID-19 in pregnancy. This case presents the management of a critically ill pregnant women infected with SARS-CoV-2.

Clinical features and laboratory characteristics of patients hospitalized with COVID-19: single centre report from Egypt.

INTRODUCTION: The recently discovered novel coronavirus disease (COVID-19) has emerged in Wuhan, China, since January 2020. Egypt reported a low incidence of infection when compared with other countries. The aim of the study was to assess the characterization of COVID-19 infection among the Egyptian population. METHODOLOGY: Data were collected from a single COVID-19 quarantine hospital in Cairo. A total number of 195 cases were included with their clinical, laboratory, and radiological data. RESULTS: Three different age groups behaved differently for COVD-19 infection. The pediatric age group was asymptomatic entirely, the middle age group (18-50 years) were asymptomatic in 53.3% of cases, while 77.9% of those above 50 years were symptomatic (p ≤ 0.001). The latter group had a high incidence of COVID-pneumonia in (83.1%), and moderate to critical presentations were encountered in 66.3% of them. Neutrophil to lymphocyte (N/L) ratio correlated directly with the age and case severity. C-reactive protein (CRP) and computed tomography scan chest (CT-chest) had added value on COVID-19 diagnosis in suspected cases. CONCLUSIONS: In Egypt, patients above 50 years are at a higher risk for symptomatic COVID-19 infection and leaner for moderate to critical COVID-19 presentation. The triad of CT-chest, CRP, and N/L ratio could be an integrated panel for assessing disease severity.

Double-balloon valvuloplasty of calcified bioprosthetic pulmonary valve twenty-three years after implantation.

Balloon valvuloplasty to dilate stenotic bioprosthetic valves is rarely used, but has been applied successfully to dilate bioprosthetic mitral, aortic, tricuspid and, to a lesser extent, pulmonary valves. The case is reported of a 45-year-old male patient with right-sided heart failure who underwent a successful dilatation of a stenotic, calcific bioprosthetic pulmonary valve using double-balloon valvuloplasty.

Giant left atrium associated with massive thrombus formation.

Giant left atrium is a condition characterized by huge enlargement of the left atrium with a diameter exceeding 65mm. It is most commonly associated with long standing rheumatic mitral valve disease. We present a 45-year-old female patient with rheumatic mitral stenosis associated with giant left atrium occupied by an 11 × 10 × 5 cm thrombus weighing 500 gms. The patient underwent successful mitral valve replacement and thrombectomy through an inverted T-shaped biatrial incision.

Percutaneous mitral valvotomy versus closed surgical commissurotomy. Up to 15 years of follow-up of a prospective randomized study.

BACKGROUND: Immediate and intermediate term results of percutaneous mitral valvotomy (PMV) are comparable to closed surgical commissurotomy (CSC). We aimed at exploring this relation in the long term. METHODS: Previously, we randomized 40 consecutive patients with moderate to severe mitral stenosis [defined as mitral valve area (MVA) less than 1.5 cm²] to undergo either PMV (PMV group = 20 patients) or CSC (CSC group = 20 patients). For all patients, full echocardiographic assessment was performed before the procedure/operation. Patients assigned to PMV underwent the double balloon technique. Echocardiographic assessment was done following both procedures before discharge and repeated 1 and 6 months later. Echocardiographic follow-up was performed, thereafter, on a yearly basis for up to 15 years, with a mean follow-up period of 99 ± 12 months. RESULTS: Immediate echocardiographic results showed no statistically significant difference between the 2 groups regarding the final MVA or mean diastolic gradient across the mitral valve. Two patients dropped out from the CSC group and one from the PMV group. MVA was 1.8 ± 0.3 cm² versus 1.8 ± 0.4 cm² (p > 0.05) and mean diastolic pressure gradient across the mitral valve was 7 ± 4 mmHg versus 6.6 ± 4 mmHg (p > 0.05) in the PMV and CSC groups, respectively. Mitral restenosis occurred in 5 (26.3%) patients in the PMV group versus 5 (27.8%) patients in the CSC group (p > 0.05). Kaplan-Meier curves for restenosis-free survival showed no difference between the 2 groups. CONCLUSION: PMV achieves comparable results to CSC both in the short and long term.