Living-Donor Liver Transplantation in Hepatitis C Virus Era: A Report of 500 Consecutive Cases in a Single Center.

BACKGROUND: Living donor liver transplantation (LDLT) is considered a safe alternative to deceased donor liver transplantation (DDLT). In Egypt, DDLT program is still awaited, making LDLT the only hope for patients with end-stage liver disease, mainly due to chronic hepatitis C virus (HCV) infection. The current study is conducted to evaluate our experience of LDLT and discuss the lessons learned from 500 consecutive cases in HCV area. METHODS: We reviewed the data of patients who underwent LDLT at Gastrointestinal Surgery Center, Mansoura University during the period between May 2004 and March 2017. RESULTS: During the study period, 500 cases underwent LDLT at our unit. The median age was 51 years, and most of our cases were males (446, 89.2%) and had HCV infection (453, 90.6%). The median MELD score was 15. Median ICU stay was 5 days, and hospital stay was 22 days. Postoperative morbidities occurred in 220 cases (44%). Early mortality occurred in 69 patients (13.8%), and late mortality occurred in 45 patients (9%). The 1-, 3-, 5-, and 7-year overall survival rates of all cases were 80.9%, 78.2%, 75.7%, and 75%, respectively. Preoperative creatinine, worm ischemia, blood transfusion, ICU stay, postoperative morbidities, and small for size syndrome were independent predictors for overall survival. CONCLUSIONS: In countries lacking DDLT, LDLT is the only effective alternative. LDLT requires a teamwork to achieve successful outcomes. LDLT should only be performed in centers with the adequate experience to avoid and decrease the hazards related to this procedure.

Incidence of influenza virus-associated severe acute respiratory infection in Damanhour district, Egypt, 2013.

The epidemiology, seasonality and risk factors for influenza virus infection remains poorly defined in countries such as Egypt. Between 1 January and 31 December 2013, we used surveillance data on patients hospitalized with severe acute respiratory infection in three Egyptian government hospitals in Damanhour district to estimate the incidence rate of laboratory-confirmed seasonal influenza. Samples were taken from 1727 of 1856 patients; of these, 19% were influenza virus positive. The overall incidence of influenza virus-associated SARI during the study period was estimated to be 44 cases per 100 000 person-years (95% CI: 39-48). The highest incidence of 166 cases per 100 000 person year (95% CI: 125-220) was observed in children aged 2 to 4 years. The incidence of influenza-virus associated SARI cases in pregnant women was estimated to be 17.3 cases per 100 000 person-years (95% CI: 6-54). Majority of influenza virus-associated SARI occurred in autumn and early winter, and influenza A(H3N2) virus predominated. This was the first ever description of the epidemiology of seasonal influenza in Egypt. However, additional works are needed for greater understanding of influenza burden in Egypt.

Influenza virus positivity and circulating subtypes among cases of influenza-like illness and severe acute respiratory infection, Egypt, 2012-2015.

Information on the prevalence of influenza, circulating virus subtypes and seasonality is essential for selecting strains for annual vaccines and for planning immunization programmes. Data were obtained from the 13 sentinel surveillance sites throughout Egypt during 2012-2015. Laboratory-confirmed influenza was found in 13% of cases of influenza-like illness (ILI) and 18% of cases of severe acute respiratory infection (SARI); positivity for influenza was similar in cases of ILI and SARI in patients up to 15 years of age but increased for SARI and decreased for ILI in people aged ≥ 15 years. The most commonly observed influenza virus subtypes were B followed by A/ H3 in ILI cases, and A/H1N1 followed by B in SARI cases. The seasonality of influenza in ILI cases was November- February, and that in SARI cases was November-March, peaking in January.

Control of malaria outbreak due to Plasmodium vivax in Aswan Governorate, Egypt.

In 2014, after several years of maintaining zero malaria indigenous cases, Egypt had an outbreak of Plasmodium vivax: 21 confirmed cases during May-June 2014. In response to the outbreak, the Ministry of Health and Population (MoHP) launched an emergency response through early detection and prompt treatment of cases, vector control, public education and intersectoral collaboration. Twenty cases (95.2%) were residents of El-Sheikh Mostafa village, Edfu district, Aswan governorate, southern Egypt. All cases, consequent to the index case were identified through house-to-house surveillance visits. One P. falciparum-infected case was also identified in the same village. Treatment of all infected cases was initiated following laboratory confirmation. The MoHP's rapid response to and containment of the outbreak demonstrates the institutional capacity for detection and control of outbreaks which can occur after elimination.

Influenza virus positivity and circulating subtypes among cases of influenza-like illness and severe acute respiratory infection, Egypt, 2012-2015

Information on the prevalence of influenza, circulating virus subtypes and seasonality is essential for selecting strains for annual vaccines and for planning immunization programmes. Data were obtained from the 13 sentinel surveillance sites throughout Egypt during 2012-2015. Laboratory-confirmed influenza was found in 13% of cases of influenza-like illness [ILI] and 18% of cases of severe acute respiratory infection [SARI]; positivity for influenza was similar in cases of ILI and SARI in patients up to 15 years of age but increased for SARI and decreased for ILI in people aged >/- 15 years . The most commonly observed influenza virus subtypes were B followed by A/H3 in ILI cases, and A/H1N1 followed by B in SARI cases. The seasonality of influenza in ILI cases was November-February, and that in SARI cases was November-March, peaking in January

Les informations sur la prévalence de la grippe, les sous-types circulants du virus et la saisonnalité sont essentielles pour la sélection des souches destinées aux vaccins annuels, ainsi que pour la planification des programmes de vaccination. Les données sont issues des 13 sites sentinelles de surveillance à travers l'Egypte pour la période 2012-2015. La présence de la grippe a été confirmée en laboratoire pour 13% des cas de syndrome de type grippal [STG] et 18% des cas d'infection respiratoire aigue sévère [IRAS] ; chez les personnes dont l'âge est inférieur ou égal à 15 ans, le taux de positivité pour la grippe était semblable pour les cas de STG et d'IRAS. Cependant, il augmentait pour les IRAS et diminuait pour le STG chez les personnes de 15 ans et plus. Les sous-types du virus de la grippe les plus fréquemment identifiés étaient le virus B suivi du A/H3 pour les cas de STG, et le virus A/H1N1 suivi du B pour les cas d'IRAS. La saisonnalité de la grippe s'étendait de novembre à février pour les cas de STG, et de novembre à mars, avec un pic en janvier, pour les cas d'IRAS

Incidence of influenza virus-associated severe acute respiratory infection in Damanhour district, Egypt, 2013

The epidemiology, seasonality and risk factors for influenza virus infection remains poorly defined in countries such as Egypt. Between 1 January and 31 December 2013, we used surveillance data on patients hospitalized with severe acute respiratory infection in three Egyptian government hospitals in Damanhour district to estimate the incidence rate of laboratory-confirmed seasonal influenza. Samples were taken from 1727 of 1856 patients; of these, 19% were influenza virus positive. The overall incidence of influenza virus-associated SARI during the study period was estimated to be 44 cases per 100 000 person-years [95% CI: 39-48]. The highest incidence of 166 cases per 100 000 person year [95% CI: 125-220] was observed in children aged 2 to 4 years. The incidence of influenza-virus associated SARI cases in pregnant women was estimated to be 17.3 cases per 100 000 person-years [95% CI: 6-54]. Majority of influenza virus-associated SARI occurred in autumn and early winter, and influenza A[H3N2] virus predominated. This was the first ever description of the epidemiology of seasonal influenza in Egypt. However, additional works are needed for greater understanding of influenza burden in Egypt

L'épidémiologie, la saisonnalité et les facteurs de risque liés à l'infection par le virus de la grippe demeurent mal définis dans des pays tels que l'Egypte. Entre le 1[er] janvier et le 31 décembre 2013, nous avons utilisé les données de la surveillance des patients hospitalisés pour une infection respiratoire aiguë sévère [IRAS] dans trois hôpitaux publics égyptiens dans le district de Damanhour afin d'estimer le taux d'incidence de la grippe saisonnière confirmée en laboratoire. Des prélèvements ont été réalisés sur 1727 des 1856 patients ; 19% étaient positifs au virus de la grippe. L'incidence globale des IRAS associées au virus de la grippe durant la période étudiée s'élevait, selon les estimations, à 44 cas pour 100 000 personnes-années [IC 95% : 39-48]. L'incidence la plus élevée, en l'occurrence 166 cas pour 100 000 personnes-années [IC 95% : 125-220], a été observée chez les enfants âgés de 2 à 4 ans. L'incidence des cas d'IRAS associées au virus de la grippe chez les femmes enceintes s'élevait, selon les estimations, à 17 cas pour 100 000 personnes-années [IC 95% : 6-54]. La majorité des cas d'IRAS associées au virus de la grippe sont survenus en automne et au début de l'hiver, et le virus de la grippe A[H3N2] était prédominant. Toutefois, des études complémentaires sont nécessaires pour mieux comprendre la charge de la grippe en Egypte

Control of malaria outbreak due to Plasmodium vivax in Aswan governorate, Egypt

In 2014, after several years of maintaining zero malaria indigenous cases, Egypt had an outbreak of Plasmodium vivax: 21 confirmed cases during May-June 2014. In response to the outbreak, the Ministry of Health and Population [MoHP] launched an emergency response through early detection and prompt treatment of cases, vector control, public education and intersectoral collaboration. Twenty cases [95.2%] were residents of El-Sheikh Mostafa village, Edfu district, Aswan governorate, southern Egypt. All cases, consequent to the index case were identified through house-to-house surveillance visits. One P. falciparum-infected case was also identified in the same village. Treatment of all infected cases was initiated following laboratory confirmation. The MoHP's rapid response to and containment of the outbreak demonstrates the institutional capacity for detection and control of outbreaks which can occur after elimination

En 2014, après s'être maintenue plusieurs années sans aucun cas autochtone de paludisme, legypte a connu une flambée de Plasmodium vivax : 21 cas confirmés entre mai et juin 2014. En réponse à la flambée, le ministère égyptien de la Santé publique et de la Population a mis en place un plan d'urgence comprenant le dépistage précoce et le traitement rapide des cas, la lutte antivectorielle, la sensibilisation du public et la collaboration intersectorielle. Vingt de ces cas [95,2 %] se sont déclarés chez des résidents du village d'El-Sheikh Mostafa, dans la circonscription d'Edfou [Gouvernorat d'Assouan, au sud de legypte]. Suite au cas indicateur, la totalité des cas a été identifiée grâce aux visites de surveillance effectuées au porte-à-porte. Un cas d'infection à P. falciparum a également été identifié dans le même village. Après confirmation en laboratoire, le traitement de l'ensemble des cas infectés a été entrepris. La réponse rapide du ministère de la Santé publique et de la Population et l'endiguement de la flambée attestent de ses moyens institutionnels pour la détection, la confirmation et le traitement du paludisme, ainsi que la maîtrise des flambées susceptibles de survenir après l'élimination de la maladie

Association of host tropism of Middle East syndrome coronavirus with the amino acid structure of host cell receptor dipeptidyl peptidase 4.

The Middle East syndrome coronavirus (MERS-CoV) is a recently emerging betacoronavirus with high fatality. Recently, dipeptidyle peptidase (CD26, DPP4) was identified as the host cell receptor for MERS-CoV. Interestingly, despite of common presence of DPP4 receptors the binding and infection of various cells shows imminent variability. In this report, we provide a tool for prediction of the host tropism of the virus based on the host receptor binding interface. We found out that, in the binding of MERS-CoV to cells the amino acid residues in lancets 4 and 5 of DPP4 receptor, namely K267, Q286, T288, R317, R336, Q344 A291, L294, and I295 are involved. Changes in these residues correspond to profound decrease in virus binding to cells. The nine residues at the interface between the virus spikes and the lancets 4 and 5 of host DPP4 can be used as a predictive tool for the host tropism and virus affinity to host cell receptors.

Highlights and conclusions from the Eastern Mediterranean Public Health Network (EMPHNET) conference 2011.

As a follow up of a short communication that the Eastern Mediterranean Health journal published in December 2011, this article reports on highlights and conclusions from scientific abstracts, methodology workshops and plenary sessions that were presented as part of the Eastern Mediterranean Public Health Network (EMPHNET) conference held from 6 to 9 December 2011 in Sharm Al Sheikh, Egypt.

Highlights and conclusions from the Eastern Mediterranean Public Health Network [EMPHNET] Conference 2011

As a follow up of a short communication that the Eastern Mediterranean Health Journal published in December 2011, this article reports on highlights and conclusions from scientific abstracts, methodology workshops and plenary sessions that were presented as part of the Eastern Mediterranean Public Health Network [EMPHNET] conference held from 6 to 9 December 2011 in Sharm Al Sheikh, Egypt

Sentinel surveillance for patients with acute hepatitis in Egypt, 2001-04.

Viral hepatitis is a major problem in Egypt. To define the epidemiology of the disease, sentinel surveillance was established in 5 hospitals in diverse areas of the country in 2001. Data were completed for patients meeting the case definition for viral hepatitis. Of a total of 5909 patients evaluated, 4189 (70.9%) showed positive antibody markers for hepatitis. Out of those, 40.2% had evidence of hepatitis A virus (HAV) infection, 30.0% hepatitis B virus (HBV) and 29.8% hepatitis C virus (HCV) infection. This surveillance system was useful in identifying the variable endemicity of acute HAV infection in different regions and for better understanding the epidemiology of HBV and HCV infection.

Sentinel surveillance for patients with acute hepatitis in Egypt, 2001-04

Viral hepatitis is a major problem in Egypt. To define the epidemiology of the disease, sentinel surveillance was established in 5 hospitals in diverse areas of the country in 2001. Data were completed for patients meeting the case definition for viral hepatitis. Of a total of 5909 patients evaluated, 4189 [70.9%] showed positive antibody markers for hepatitis. Out of those, 40.2% had evidence of hepatitis A virus [HAV] infection, 30.0% hepatitis B virus [HBV] and 29.8% hepatitis C virus [HCV] infection. This surveillance system was useful in identifying the variable endemicity of acute HAV infection in different regions and for better understanding the epidemiology of HBV and HCV infection

Injection prescribing patterns in public health care facilities in Egypt.

This study assessed the frequency of and rationale for use of injections at health care facilities in Egypt based on WHO core drug use indicators. We reviewed 1406 prescriptions in 43 randomly selected hospitals and primary health care clinics in 2 governorates in Upper and Lower Egypt in 2001. Patients received an injection at 18.1% of encounters. The most frequently prescribed parenteral drugs were anti-infectives (56.9% of injections) and analgesics (13.7%). Injections were more often prescribed in hospitals than in primary health care clinics and in rural than in urban settings. Most injections (94.7%) could have been replaced by a suitable oral preparation. Further efforts are needed to enforce the essential medicines programme in Egypt to improve rational drug prescribing.

Injection prescribing patterns in public health care facilities in Egypt

This study assessed the frequency of and rationale for use of injections at health care facilities in Egypt based on WHO core drug use indicators. We reviewed 1406 prescriptions in 43 randomly selected hospitals and primary health care clinics in 2 governorates in Upper and Lower Egypt in 2001. Patients received an injection at 18.1% of encounters. The most frequently prescribed parenteral drugs were anti-infectives [56.9% of injections] and analgesics [13.7%]. Injections were more often prescribed in hospitals than in primary health care clinics and in rural than in urban settings. Most injections [94.7%] could have been replaced by a suitable oral preparation. Further efforts are needed to enforce the essential medicines programme in Egypt to improve rational drug prescribing

Role of diffusion-weighted echo-planar MR imaging in differentiation of residual or recurrent head and neck tumors and posttreatment changes.

BACKGROUND AND PURPOSE: The purpose of this work was to evaluate whether diffusion-weighted MR imaging can be used in differentiating residual or recurrent head and neck tumors from postoperative or postradiation changes. MATERIALS AND METHODS: This study included 32 patients clinically suspected for recurrent head and neck tumor after surgery (n=3), radiation therapy (n=13), or both (n=16). Diffusion-weighted MR imaging was done by using a single-shot spin-echo echo-planar sequence. The apparent diffusion coefficient (ADC) value of the suspected lesion was calculated and correlated with pathologic results. RESULTS: Adequate diffusion-weighted MR images and ADC maps were obtained in 30 patients (93.8%). The mean ADC value of residual or recurrent lesions (1.17 +/- 0.33 x 10(-3) mm(2)/s) was less than that of posttherapeutic changes (2.07 +/- 0.25 x 10(-3) mm(2)/s), and the difference was statistically significant (P<.001). When an ADC value of 1.30 x 10(-3) mm(2)/s was used as a threshold value for differentiation, the best results were obtained with an accuracy of 87%, sensitivity of 84%, specificity of 90%, positive predictive value of 94%, and negative predictive value of 76%. CONCLUSIONS: Diffusion-weighted MR imaging with ADC measurement has promising results for differentiating residual or recurrent head and neck tumors from postoperative or postradiation changes.

A retrospective hospital study of human cystic echinococcosis in Egypt.

We performed a retrospective study to determine annual clinical incidence of human cystic echinococcosis (CE) in 14 Egyptian hospitals between January 1997 and December 1999. From 492 353 records examined, 133 (0.027%) new human CE cases were recorded. Of these, 50 (37.6%) were from Alexandria and Matrouh hospitals, 33 (24.8%) from Giza Chest Hospital and 50 from other regions. Matrouh governorate had the highest annual clinical incidence (1.34-2.60 per 100 000) followed by Giza governorate (0.80-1.16 per 100 000). About a third of those affected were aged < or = 20 years. Liver and lungs were the organs most affected. Although human CE is of low endemicity in Egypt, it may-represent a public health concern in Matrouh and Giza governorates.

Evaluation of chronic urticaria in patients with Hashimoto thyroiditis.

The coincidence of Hashimoto thyroiditis (HT) and chronic idiopathic urticaria (CIU) is a commonly observed phenomenon in western New York. Previous literature suggested that there may be a direct relationship between them. We undertook these studies to determine whether humoral or cell-mediated mechanisms might link HT and CIU. Skin biopsies from patients with CIU, with or without HT, were indistinguishable by light microscopy. No immune complex deposition was observed, although only the skin from patients with CIU and HT contained perivascular fibrin deposits. Similarly, immunohistochemical studies evaluating cellular expression of CD3, CD4, CD8, CD20, and CD68 failed to differentiate between CIU with or without HT. Analysis of Vbeta restriction in thyroid tissue of patients with HT and the skin of patients with CIU and HT by in situ polymerase chain reaction failed to reveal any oligoclonal T-lymphocyte subpopulations. In contrast, only patients with CIU and HT had anti-FcepsilonRI antibodies in their sera that could induce degranulation of normal basophils. Some sera from patients with CIU and HT caused degranulation of normal basophils in the absence of anti-FceRI. The factor causing basophil degranulation in these sera was not determined. Patients with CIU and HT failed to improve clinically with thyroid replacement therapy. All CIU patients were equally well managed with symptomatic therapies. In conclusion, HT likely represents a marker of other autoimmunity, rather than being a direct causative agent in CIU. Management of CIU, with or without HT and with or without anti-FceRI antibodies, should be the same. Future studies will have to examine whether cell-mediated responses participate in CIU, especially in association with HT.

Microscopic polyangiitis in a pediatric patient.

Microscopic polyangiitis (MPA), previously called hypersensitivity angiitis, is a systemic necrotizing vasculitis that involves many organ systems including the skin, joints, kidneys, and lungs. Microscopic polyangiitis most commonly affects adults in the fourth and fifth decades of life, with only a few cases reported in children. We describe a pediatric patient with microscopic polyangiitis. Arch Fam Med. 2000;9:1189-1192

Comparison of magnetic resonance angiography and conventional angiography in sickle cell disease: clinical significance and reliability.

We retrospectively reviewed the medical records and conventional angiograms of 21 patients with known sickle cell disease, who underwent a total of 50 magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) studies. MRA and conventional angiography were assessed separately for evidence of stenosis or occlusion. Follow up MRI/MRA studies were also assessed for evidence of progression, regression or stability of the disease in these patients. In the carotid circulation, MRA made the correct diagnosis in 85% of the vessels evaluated with a sensitivity of 80.5% and a specificity of 94%. MRA was also found to show evidence of disease progression, more often than did MRI or the clinical condition of the patients.