The record of Vannella species (Vannellidae, Discosea, Amoebozoa) from freshwater sources in Dakahlyia Governorate, Egypt.

The River Nile is the main source of fresh water in Egypt, where its water is used for irrigation, drinking, fisheries, industrial uses, and recreation. For sustainable utilization of the River Nile and its branches in the Nile Delta region, it is necessary to monitor regular investigation for the biodiversity of protozoan fauna in the Damietta branch and other freshwater canals in Dakahlyia Governorate. Water samples were collected monthly from different water sources, for 1 year, and examined for protozoans, using phase-contrast microscopy and recorded video films, The genus Vannella Bovee 1965 is recorded for the first time in four freshwater localities: Demietta branch of the River Nile, Mansouria Canal, Bouhia Canal, and Bahr El-Saghir Canal. A detailed morphological description with a brief report of their locomotion has been given for four morphologically different Vannella species. The locomotive form of Vannella sp.1 has a long pointed posterior tail and 2 lateral posterior processes. Such a tail was absent in other Vannella species. Vannella sp.2 is unique among other recorded species, where its locomotive form possesses a long posterior rounded tail region and a frontal hyaloplasm provided with a wavy surface that forms several lobes and finger-like processes during locomotion. In addition, the hyaloplasm produces several transverse waves that vary in thickness and density. The floating form of Vannella sp.2 is of a radial type and has comparatively long hyaline pointed and spiral pseudopodia. The process of transformation of locomotive form to floating form in Vannella sp.2 has been followed up using several recorded video films. The locomotive form of Vannella sp.3 is bear-shaped, while that of Vannella sp.4 has variable shapes from semicircular to rectangular and sometimes fan-shaped. During movement in vivo, locomotive cells of all Vannella species, except Vannella sp.1, move in nearly a straight line, but there were variations in their rate of locomotion. Vannella sp.4 recorded the highest rate (6.8 µm/s), followed by Vannella sp.2 (4.5 µm/s), Vannella sp.3 (2.4 µm/s), and finally Vannella sp.1 (1.0 µm/s). Molecular studies and transmission electron microscope examinations are still needed to confirm the precise identity of each Vannella species.

Community structure, seasonal dynamics, and impact of some biological parameters of the African catfish Clarias gariepinus on the infection level of the helminth parasites.

Fish parasitic diseases impose a major economic concern on aquaculture. Identified parasites of Clarias gariepinus include one monogenean, Macrogyrodactylus clarii (gills), three digeneans Orientocreadium batrachoides, Eumasenia bangweulensis and Sanguinicola sp. (intestine), two cestodes Tetracampose ciliotheca and Monobothrioides chalmersius (intestine) and two nematodes Paracamallanus cyathopharynx and Procamallanus pseudolaeviconchus (intestine and stomach). Most nematodes, digeneans and cestodes occurred in all months of the study period. However, M. clarii and Sanguinicola sp. disappeared for 6 and 8 months of the year, respectively. The digenean group was the most dominant followed by the cestode and nematode groups, respectively. The nematodes attained the highest infection rate over the digeneans and cestodes while the monogenean M. clarii recorded the lowest infection rate. The infection level of examined parasites varied seasonally, but no overall significant pattern was detected. E. bangweulensis showed a highly significant difference for all parameters seasonally. A higher prevalence was obvious in males than females for most parasites, and the opposite for the mean intensity except for P. pseudolaeviconchus which was significantly different between females and males in the mean abundance. There were variations in the relationship between the host condition factor and helminth parasite infection levels. O. batrachoides, E. bangweulensis and P. cyathopharynx recorded the highest infection level in class II. The mean prevalence was highly significantly different between host classes for T. ciliotheca, M. chalmersius and P. pseudolaeviconchus.

Additional morphological characters of the nematode Capillostrongyloides fritschi (Travassos, 1914) Moravec, 1982 (Nematoda: Capillaridae) from Bagrus spp. (Bagridae) inhabiting Damietta Branch of the River Nile, Egypt with a special reference to evaginated cirrus.

The catfish Bagrus bajad (Forsskål) and B. docmak (Forsskål) (Siluriformes: Bagridae) are well distributed in the River Nile and have an economic value with good marketing and use in aquaculture. Collected specimens of Capillostrongyloides fritschi (Travassos 1914) were redescribed using a phase-contrast microscope and scanning electron microscope. The most remarkable finding was the unique structure of the evaginated cirrus, being composed of a proximal long tube, a middle spherical bulb packed with mature spermatozoa, and a distal funnel-shaped structure. All regions of the cirrus are provided with longitudinal and transverse muscles and covered with transverse cuticular folds. The mechanism of cirrus emergence was discussed based on available musculature data. Other important findings are the short stylet of the mouth, the two lateral oral lobes, 6-10 buried cephalic papillae and the bacillary bands that lack elevations. Stichosome is formed of 35-44 stichocytes that were differentiated into black and white forms, each containing dense granules and translucent vacuoles. The intestine showed a convoluted part at its anterior region. The vulvar lips are slightly elevated, many mature eggs are cleaved, and their shells are 3-layered. The anus was found in a groove bounded by two unequal lobes.

Utility of Pre-Transplant Bladder Cycling for Patients With a Defunctionalized Bladder. A Randomized Controlled Trial.

OBJECTIVE: To study the necessity of pre-transplant programmed bladder cycling (PBC) in patients with defunctionalized bladder (DB). METHOD: This RCT included renal transplant (RT) candidates with DB. Eligible patients were assigned to 2 groups, group I underwent PBC before RT and group II underwent direct RT into the DB. The primary outcome was to assess the efficacy of PBC in improving post- RT bladder capacity. Secondly, to compare its impact on early urological complications and 3-month voiding function and 1-year graft function and survival. Graft function was evaluated using serum creatinine and eGFR using MDRD equation. RESULTS: Groups I included 23 patients and group II included 20 patients. The mean ±SD of bladder capacity was 88.7±11.7mL and 90.6 ±9.8mL in both groups, respectively (P = .5). In group I, PBC increased bladder capacity to 194.7 ±21.2 mL (P < .001). Targeted bladder capacity was achieved in 19 (82.6 %) patients and 2 patients developed UTI. At 3-months, bladder capacity, compliance and bladder contractility index improved significantly in both groups with a significant reduction in maximum detrusor pressure with no significant difference between both groups (P = .3,0.4, 0.2 and 0.8, respectively). Urinary leakage occurred in one (4.3%) and 3 patients (15%) in group 1 and 2, respectively (P = .2). At 1-year, no statistically significant differences in the median (IQR) serum creatinine (P = .05) and eGFR (P = .07) between both groups were noted. CONCLUSION: Pre-transplant PBC for DB-patients provided no clinical advantage concerning post-operative urological complication, urodynamic criteria and graft function and survival.

Soft Tissue Augmentation Using De-Epithelialized Free Gingival Graft Compared to Single-line Incision Subepithelial Connective Tissue Graft in the Management of Miller Class I and II Gingival Recession: A Randomized Controlled Clinical Trial.

Aims: The purpose of this randomized controlled clinical trial was to clinically assess soft tissue augmentation and compare patients' morbidity and root coverage outcomes of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) versus de-epithelialized free gingival graft (DFGG) in the management of Miller Class I and II gingival recession. Materials and Methods: Twenty-eight patients with Miller's Class I or II gingival recession (GR) defects were randomly assigned into two equal parallel groups treated with either CAF + SCTG, harvested using single-line incision technique (control), or CAF + DFGG (test). Gingival thickness (GT), recession depth, recession width, percentage of root coverage, keratinized tissue width, pocket depth, and clinical attachment level were measured at baseline and 3 and 6 months postoperatively. Patient-reported outcomes were assessed postoperatively, including pain, stress, bleeding, and inability to chew. Patients' overall satisfaction and root coverage esthetic scores were recorded at 6 months. Results: Both groups demonstrated a statistically significant improvement in all clinical outcomes after 3 and 6 months compared to baseline. DFGG showed a statistically significant increase in GT after 6 months. No statistically significant difference was detected in other clinical outcomes between both groups at different time intervals. Both treatments achieved 92.9% complete root coverage. Patients treated with CAF + DFGG reported significantly higher stress and inability to chew scores after 2 weeks than those treated with SCTG. There were no significant differences in patient satisfaction between both groups. Conclusions: CAF + SCTG and CAF + DFGG were both effective and can be applied safely in treating Miller Class I and II GRs.

Dermatologists' Knowledge and Attitude Toward Isotretinoin Ocular Side Effects in Egypt.

AIM: The FDA approved isotretinoin for moderate and severe nodulo-cystic acne, in which it proved effective. However, this misled the dermatologists into using isotretinoin for mild cases as well. This misuse increased the risk of developing adverse effects, especially on the ocular system. These adverse effects vary from mild reversible eye dryness to severe irreversible loss of night vision. Also, it causes contact lens intolerance and corneal ulcer on top. Both ophthalmologists and dermatologists have different perceptions of the drug. PURPOSE: To evaluate dermatologists' knowledge and attitude toward ocular adverse effects of isotretinoin in Egypt. METHODS: This cross-sectional study was conducted via an online questionnaire. The questionnaire had three parts: 1) demographic data, 2) knowledge about isotretinoin dry eye disorders, contact lens intolerance, and refractive surgery precautions and 3) dermatologists' management of a case on isotretinoin therapy. We contacted 111 participants from Facebook dermatologists' groups between March and April 2021. RESULTS: We surveyed 111 dermatologists. One hundred and five (94.6%) reported their knowledge about ocular side effects. One hundred of them (90.1%) informed their patients about the drug's adverse effects. Eighty-three (74.8%) reported their knowledge about contact lens intolerance. Forty-one dermatologists (36.9%) screened their patients for recent refractive surgery before isotretinoin therapy. Nearly, all dermatologists routinely prescribed lubricant eye drops for the patients, and 63 (56.8%) dermatologists sometimes referred their patients to an ophthalmologist. We found an association between knowledge about contact lens intolerance and years of experience (p=0.012). As well, we found that the academic degree of dermatologists is directly proportional with warning patients about ocular side effects (p=0.003) and refractive surgery (p=0.039). CONCLUSION: Egyptian dermatologists were knowledgeable about the effects of isotretinoin on eyes with inappropriate clinical practice.

Accumulation of nine heavy metals in water and gills, intestine and digenean parasites of the silver catfish, Bagrus bajad Forskål, 1775.

Bioindicator value of digenean parasites (Acanthostomum absconditum, Acanthostomum spiniceps and Haplorchoides cahirinus) of silver catfish, Bagrus bajad was assessed by analyzing the concentrations of nine heavy metals (Fe, Zn, Cu, Ni, Cd, Cr, Mn, Co, and Pb) using atomic absorption spectrometry. Additionally, the study compared heavy metals concentrations in four sinks (water, gills, intestine and digenean worms) from two aquatic habitats (the upstream and downstream) of the Damietta Branch of the River Nile from January to December, 2018. The results revealed that iron and manganese were the most abundant metals in water, gills, intestine and digenean worms at both the upstream and downstream aquatic habitats. In addition, the digenean worms of B. bajad inhabiting these two localities accumulated higher amounts of all analyzed heavy metals than water, gills and intestine (especially iron and manganese), except for chromium, the highest level of which was encountered in the gill tissues. The seasonal variations of heavy metals indicated their highest concentration in summer (for water, gills, intestine and digenean worms) and lowest concentration in autumn and winter (for water, gills and intestine), and in winter and spring (for digenean parasites). The results confirmed that the digenean intestinal parasites accumulate heavy metals pollutants in a significant manner and are important model for monitoring pollution.

The effect of anemia on the efficacy and safety of treating chronic hepatitis C infection with direct-acting antivirals in patients with chronic kidney disease.

BACKGROUND/AIM: Chronic hepatitis-C infection is a great health burden in Egypt. The effect of anemia on the efficacy and safety of direct-acting anti-viral (DAA) therapies for those with chronic-kidney disease (CKD) has not been evaluated. PATIENTS/METHODS: This single-center retrospective study included 235 renal patients: i.e., 70-CKD patients not on hemodialysis (42 with anemia, 28 without); 40 hemodialysis patients (16 anemic; 24 non-anemic), and 125 kidney-transplant (KTx) recipients (40 anemic; 85 non-anemic). Anemia was defined by a hemoglobin level < 10.5 g/dL. Hemodialysis patients received ritonavir-boosted paritaprevir/ombitasvir. KTx patients received sofosbuvir/daclatasvir. CKD patients with eGFR > 30 mL/min/1.73 m2 received sofosbuvir/daclatasvir. Those with eGFR < 30 mL/min/1.73 m2 received ritonavir-boosted paritaprevir/ombitasvir; 64 non-anemic patients also received ribavirin therapy. RESULTS: Mean age of CKDs was 49.1 years, 43.2 years for HDs, and 45.2 years for KTx patients. Most were male; body-mass index was ~ 23.8. Anemia did not affect the efficacy of DAAs in hemodialysis, CKD, or KTx patients. Most patients achieved a rapid virologic response (RVR), and a 12- and 24-week sustained viral response. Worsening of anemia among the non-anemic group was mostly related to ribavirin therapy in hemodialysis patients (11/16 patients). Acute kidney injury in CKDs occurred more frequently within the anemic group (59.5%) compared to the non-anemic group (32.1%). For KTx, graft impairment was more common among the anemic group (7/40) compared to the non-anemic group (2/85). CONCLUSION: Hemoglobin levels of < 10.5 g/dL prior to DAA treatment did not affect the virological response in renal patients but was associated with increased serum creatinine among KTx and those with CKD.

5-Year Long-Term Outcome of Live-Donor Renal Transplant Recipients With Enterocystoplasty and Ureterocystoplasty: An Age- and Sex-Matched Pair Analysis.

OBJECTIVE: To assess surgical complications, febrile UTI, graft function and 5-year graft survival after renal transplantation (RT) in patients with augmentation cytsoplasty (AC) and to compare them to RT patients with normal lower urinary tract. MATERIALS AND METHODS: A case-control study of 34 RT patients with AC including 23 patients with enterocystoplasty (EC) and 11 patients with ureterocystoplasty (UC) was performed. The primary outcome was to determine the difference between both groups regarding postoperative surgical complications and febrile UTI episodes. Graft function was compared at 1, 3, and 5 years and 5-year graft survival was determined. The secondary outcome was to compare them to an age- and gender-matched control group (122 patients) with normal lower urinary tract. RESULTS: There was no significant difference regarding surgical complications or rates of hospital readmission between AC groups. Seventeen (73.9%) and 5 (45.5%) patients developed 33 and 14 episodes of febrile UTI in EC and UC groups, respectively (P= .5). Control group had shown lower incidence surgical complications (P = .001) and febrile UTIs (P = .02) compared to AC groups. At 3 and 5 years, UC had higher median eGFR than EC (P = .08, 0.008, respectively). The 5-year graft survival was 32 (94.1%) with no statistically significant difference between EC (95.7%) and UC (90.9%) (P = .5) or between AC and control (85.2%, P = .3). CONCLUSION: Although RT after AC was associated with higher surgical complications and UTI episodes, they had comparable 5-year graft survival to their control. When indicated, UC should be the preferred choice of AC whenever possible.

CYP3A5 Gene-Guided Tacrolimus Treatment of Living-Donor Egyptian Kidney Transplanted Patients.

BACKGROUND: Tacrolimus is an approved first-line immunosuppressive agent for kidney transplantations. Part of interindividual and interethnic differences in the response of patients to tacrolimus is attributed to polymorphisms at CYP3A5 metabolic enzyme. CYP3A5 gene expression status is associated with tacrolimus dose requirement in renal transplant recipients. MATERIALS AND METHODS: In this study, we determined the allelic frequency of CYP3A5*3 in 76 renal transplanted patients of Egyptian descent. Secondly, we evaluated the influence of the CYP3A5 gene variant on tacrolimus doses required for these patients as well on dose-adjusted tacrolimus trough-concentrations. RESULTS: The CYP3A5*3 variant was the most frequent allele detected at 85.53%. Additionally, our results showed that, mean tacrolimus daily requirements for heterozygous patients (CYP3A5*1/*3) were significantly higher compared to homozygous patients (CYP3A5*3/*3) during the first year after kidney transplantation. CONCLUSION: This is the first study in Egypt contributing to the individualization of tacrolimus dosing in Egyptian patients, informed by the CYP3A5 genotype.

Impacts of physicochemical and heavy metal parameters on infestation level of the monogeneans, Quadriacanthus spp. infesting Nile catfish, Clarias gariepinus of different water localities in Nile Delta, Egypt.

Fish parasites can be used as bio-indicators to evaluate pollution degree in aquatic ecosystems. Limited research has, however, investigated the potentiality of these parasitic worms to tolerate various environmental factors. This study, therefore, investigated whether the gill, Quadriacanthus monogenean parasites of Bagrus bajad Forskål, 1775 are potential bio-indicators of aquatic ecosystem health. The seasonal differences in prevalence, mean intensity and abundance of Quadriacanthus species of Clarias gariepinus varied between each other and between the three localities. Most Quadriacanthus species exhibited their highest prevalence, mean intensity and abundance in Spring and/or Summer and their lowest values in Autumn and/or Winter. The seasonal differences in prevalence were significant for Q. kearni and Q. clariadis while a significant difference in the mean intensity between different seasons was recorded only for Q. aegypticus. Also, seasonal differences in the abundance were highly significant for Q. aegypticus and significant for Q. kearni. The total dissolved solids, Chlorides, Sulphate, Sodium, Cadmium and Lead were higher at Manzala Lake than standard permissible limits. The pH has significant correlations with the infestation levels of all Quadriacanthus spp. Dissolved oxygen showed a highly significant positive correlation with the mean intensity of Q. clariadis and a significant positive correlation with the abundance of Q. clariadis. Iron was the only heavy metal to record a significant positive relationship with the mean intensity of Q. kearni. It is noteworthy that Quadriacanthus species were found to have a noticeable ability to resist the effect of hazardous concentrations of many physicochemical and heavy metals parameters. Therefore, it is highly recommended that these monogeneans could be regarded as bio-indicators for water quality.

High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents.

BACKGROUND: Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min. AIM: The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD. METHODS: Eighteen CKD stage 2-3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them. RESULTS: The patients'age was 49.2 ± 12 years. Baseline serum creatinine was 3.76 ± 1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33-12.97); p = 0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84-29.35); p = 0.001]. CONCLUSION: Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation.

Outcome of Live-Donor Renal Transplants With Incidentally Diagnosed Renal Angiomyolipoma in the Donor.

INTRODUCTION: Accepting donors with renal lesion amenable for pre-transplant management with no suspected long-term harm seems to expand the live-donor pool. We aimed to assess the long-term outcome of live-donor renal transplantation with incidentally discovered renal angiomyolipoma (AML) during routine evaluation of donors. PATIENTS AND METHODS: A retrospective evaluation of incidentally discovered AML, during live-related-donor evaluation, was performed. The tumor criteria were retrieved. In cases with exophytic tumor, a back-table, partial nephrectomy was done with frozen section to exclude malignancy. Endophytic lesions were kept in situ and transplanted. Both donor and recipient were followed up by periodic imaging. RESULTS: Among 2925 cases, 6 AML with a median volume of 0.96 (range, 0.5-2) cm2 were identified. The median recipients' age was 21 (range, 10-38) years and the median donors' age was 48 (range, 45-50). Two AML were exophytic and back-table partial nephrectomy was performed, while 4 were endophytic and kept in situ, and the kidney was transplanted. After a median follow-up of 82 (range, 25-150) months, 4 patients were alive with functioning grafts and 2 resumed hemodialysis 5 and 7 years after transplantation. There was no evidence of increase in the AML size or newly developed AML in the grafts. All donors were alive with normal renal function (mean ± standard deviation, serum creatinine was 0.9 ± 0.2 mg/dL) and none developed new AML in the remaining kidney. CONCLUSION: Incidentally discovered AML during live-donor evaluation is not a contraindication of donation after proper counseling of the couples and regular, periodic follow-up.

Comparative analysis for optimizing the modified release tacrolimus (Advagraf) after kidney transplantation: A prospective randomized trial.

Immunosuppression management in clinical transplantation aims to balance delivery of efficacy against adverse reactions using therapeutic drug monitoring. Adherence to posttransplant immunosuppressive medications and minimizing variability in drug exposure are important considerations in preventing rejection and maximizing overall transplant outcomes. The availability of once-daily tacrolimus may add a potential benefit by simplifying immunosuppressive regimens, though improving compliance among transplant recipients. The aim of our study is to investigate the safety and efficacy of the once-daily formulation of tacrolimus (Advagraf) against the usually used twice daily tablets (Prograf). A prospective randomized trial 1:2 was designed for 99 consecutive live-related renal transplant recipients who received their grafts at a single center (study group, Advagraf, 33 recipients and control group, Prograf, 66 recipients). The demographic data were homogeneous among both groups regarding donors and patients' characteristics. Posttransplant hypertension, infection, malignancy, and diabetes mellitus were comparable among both groups. Renal function and rejection episodes showed no statistical significance among recipients of both groups. Despite slight higher Advagraf unit doses, there was no statistical difference regarding the tacrolimus trough levels, between the two groups. Our singlecenter experience revealed that the availability of once-daily tacrolimus formulation could give potential benefit of improved medication compliance and better allograft outcomes by decreasing pill burden and thereby simplifying dosing schedule, Advagraf was non-inferior to twice-daily tacrolimus regarding safety and efficacy. Although being nonsignificant, a trend for better kidney function was noted in this short-term study in the Advagraf group, so long-term follow-up is needed to verify this.

Posttransplant Erythrocytosis Among Egyptian Living-Donor Kidney Transplant Recipients.

OBJECTIVES: The goal when treating patients with end-stage renal disease is to increase patient survival and to provide a better quality of life, both of which can be achieved by kidney transplant. Identifying problems associated with kidney transplant is an essential step toward improved graft function. Here, we evaluated posttransplant erythrocytosis, a frequent complication among kidney transplant recipients. MATERIALS AND METHODS: In this single-center retro-spective study, we identified 1850 kidney transplant recipients who were transplanted at the Mansoura Urology and Nephrology Center (Mansoura University, Mansoura, Egypt) from 1990 and 2013. From these patients, we identified 174 transplant recipients with posttransplant erythrocytosis and another 174 recipients without posttransplant erythrocytosis (control group). All recipients were evaluated retrospectively regarding incidence and risk factors for posttransplant erythrocytosis occurrence, graft function and survival, and patient survival. RESULTS: Both patient groups were comparable regarding age and sex (mean age of 32 years and higher percentage of male recipients in both groups). Degree of HLA class I and class II matching was not significantly different between groups. There were also no significant differences in immunosuppression protocols, although most patients were on steroid and cyclosporine therapy. Prevalence of acute and chronic rejection episodes was comparable between groups. Graft function was better in the posttransplant erythrocytosis group than in the control group, and higher patient survival was noted in patients with posttransplant erythrocytosis (P < .001). CONCLUSIONS: Posttransplant erythrocytosis was correlated with good graft function. In our study patients, those with posttransplant erythrocytosis had better graft and patient survival.

Postrenal transplant malignancy: Incidence, risk factors, and prognosis.

The newer and potent immunosuppressive agents have successfully reduced the risk of rejection after kidney transplantation, but the development of cardiovascular diseases, infections, and malignancy is major factors limiting their success. Posttransplantation malignancy is the second most common cause of death in renal transplant recipients after cardiovascular disease; it is expected that mortality due to malignancy may become the most common cause of death within the next two decades. This study is designed to evaluate the incidence, risk factors, and types of malignancies occurring after renal transplantation and their impact on patient and graft survival. A total of 2288 patients underwent living donor renal allotransplantation in the Urology and Nephrology Center, Mansoura University, during the period between 1975 and 2011. Among these patients, 100 patients developed posttransplantation malignancy. Patients were categorized into five major groups according to their type of malignancy; Kaposi's sarcoma (KS), non-Kaposi's skin tumors (non-KS), posttransplant lymphoproliferative disorders (PTLD), solid tumors, and genitourinary and reproductive system (GU and RS). Overall, the incidence of cancer in renal transplant recipients was 4%. There were 83 male (83%) and 17 female patients (17%). The most frequent cancer was KS seen in 33 patients (33%). The lowest median time to development of cancer was observed in KS (35 months). The highest median time to development of cancer was observed in PTLD (133 months). The best graft survival was observed in PTLD and the worst in non-KS tumors. The best patient survival was observed in KS and the worst in GU and RS tumors. Azathioprine-based regimen was associated with a higher rate of cancer. The number of patients who died was 65 (65%). Our results indicate that the occurrence of malignancy has an important impact on short- and long-term graft and patient survival.

A novel mutation in exon 1 of GATA4 in Egyptian patients with congenital heart disease.

BACKGROUND/AIM: Congenital heart disease (CHD) is a common birth defect. Many studies have reported GATA4 mutations in patients with CHD, mainly septal defects. This study aimed to investigate the GATA4 exon 1 mutation in Egyptian patients with isolated congenital heart defects as a possible causative mutation. MATERIALS AND METHODS: Screening for mutations or any sequence variations in exon 1 of the GATA4 gene was carried out by PCR amplification followed by direct sequencings in 165 Egyptian patients with different nonsyndromic congenital heart diseases and 93 controls who were matched in terms of age and sex. Thorough clinical assessments were done for all subjects, along with X-ray, 2D echocardiography, and Doppler examinations. RESULTS: The most common CHD among our cases was isolated ventricular septal defect (VSD) in 47.3% (78/165), followed by isolated atrial septal defect. A novel nonsynonymous sequence variation in fragment 2 (P193H) of exon 1 of GATA4 was detected in 15 (9.1%) of the subjects with septal defects. This mutation was not seen in any of the control group subjects. CONCLUSION: There is a high prevalence of exon 1 GATA4 mutation (9.1%) in our study compared to other studies in different populations, which may correlate with different ethnic populations.

Frequency of the Original Kidney Disease and Its Effect on the Outcome of Kidney Transplant in the Urology-Nephrology Center Mansoura University.

OBJECTIVES: Renal allograft function and graft survival depends on many factors, including the source of the graft, immunologic matching between donor and recipient, incidence of acute rejection, and recurrence of the original kidney disease. This work aimed to evaluate the effects of the original kidney disease on patient and graft survival. MATERIALS AND METHODS: This was a retrospective, single-center study that included 2189 kidney transplant recipients who were transplanted at The Urology and Nephrology Centre, Mansoura University, between 1976 and 2010. Of 2189 recipients, 1350 patients with unknown original kidney disease were excluded, with the remaining 839 patients divided into 4 groups according to their original kidney disease. RESULTS: We found pretransplant dialysis and blood transfusion to be statistically significant among the 4 groups. Regarding induction immunosuppressive therapy, a statistical significance was found between the 4 groups regarding the presence and type of induction therapy, with no statistical significance regarding the type of maintenance immunosuppression. There was no statistical significance between the 4 groups regarding the incidence of acute and chronic rejection. We also found recurrence of original kidney disease to be statistically significant in the 4 groups, particularly in the group that included patients with glomerular disease, where the highest rate of recurrence was reported in patients with focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis, and patient and graft survival was also statistically significant. CONCLUSIONS: The original kidney disease has an effect on renal allograft function and graft and patient survival.

Antiviral activity of virocidal peptide derived from NS5A against two different HCV genotypes: an in vitro study.

This study aimed at assessment of the antiviral activity of an amphipathic α-helical peptide derived from the hepatitis C virus NS5A known as C5A virocidal peptide against different HCV genotypes. Two sources of HCV virus for in vitro study: HCV genotype 4 sera samples and JFH-1 infectious culture system genotype 2a were used. Several virocidal peptide concentrations were tested to determine the concentration that inhibits HCV propagation in Huh 7.5 cells according to three different prortocols (pre-infection, coinfection, and post infection). The capacity of the virocidal peptide to block HCV in Huh7.5 cells infected with different 10 individual serum samples was evaluated. In the pre-infection protocol, virocidal concentration (20, 50, and 75 µM) showed no viral RNA. In the co-infection protocol, virocidal concentrations (10, 20, 50, 75 µM) showed no viral RNA while in post-infection protocol, 75 µM was the only concentration that blocked the HCV activity. Results of Huh7.5 cell line transfected with HCV cc J6/JFH and treated with virocidal peptide revealed that only the higher virocidal concentration (75 µM) showed no amplification. The percentage of virocidal blocking in the 10 HCV individual serum samples was 60%. In conclusion, the C5A virocidal peptide has potent antiviral activity against HCV.