Pretreatment and on-treatment indicators of virologic breakthrough of lamivudine therapy in chronic hepatitis B patients: an Egyptian study.

The primary objectives of hepatitis B treatment include improved clinical and histological progression as well as virus eradication. For many years, lamivudine was a first-line therapy for treating hepatitis B virus (HBV) infection. However, its long-term use is associated with high resistance rates (up to 70% after 5 years) due to mutations in the viral YMDD motif. The purpose of this study was to outline factors responsible for the development of viral resistance during long-term lamivudine therapy. Initially, 230 patients receiving lamivudine therapy for chronic hepatitis B (CHB) infection were enrolled in the study. All subjects received follow-ups in the first year to assess viral and biochemical responses. Only 136 and 104 patients received follow-up assessments during the second and third years of treatment, respectively. Viral breakthrough (VBT) occurred in 49 of 230 patients (21.3%). Hepatitis B "e" antigen (HBeAg) status before treatment was significantly associated with VBT in the first 2 years of treatment; however, this effect was not significant in the third year. Pre-treatment HBV DNA levels were predictive of VBT in the HBeAg-positive subgroup after all years of treatment (P = 0.001, P = 0.002, and P = 0.002, respectively). These levels were also predictive in the HBeAg-negative subgroup after 1 year of treatment (P = 0.001). In resource-poor communities, financial concerns drive the selection of antiviral therapy to treat CHB. Lamivudine monotherapy is a relatively cheap and effective treatment to manage CHB. However, consistent follow-ups and treatment modifications appear essential to prevent long-term treatment failure.

Bioecology and breeding performance of cattle egret (Bubulcus ibis) in selected sites at Sharkia Governorate, Egypt.

Cattle egret Bubulcus ibis, feeds on insect pests in many agro-ecosystems. Thus, there is an urgent need to study the breeding chronology of cattle egret, in order to develop suitable protection programs for this beneficial bird to perform its role as abiological control agent in Egyptian agro-ecosystems. The study was conducted at Sharkia Governorate, Egypt, from December 2018 to December 2020; in different habitats (irrigation canals, drainage canals, garbage collection areas and Abbasa ponds). The mean clutch size ranged from 2-5 eggs/nest with an incubation period ranging between 21-25 days. The mean percentage of hatching success was 90.21%, while the total number of mortality eggs was 47 and the total egg hatching was 433. Also the total number of nests located nearby tree trunks were 73, while nests located in the core of the tree were 47 nests, and nests located at the peripherals were 15 nests.

Survey and population dynamics of land snails at Sharkia Governorate, Egypt.

Land snails are a destructive agricultural pest in economic crops, but the populations for that pest are highly influenced by temperature and humidity, therefore climatic changes affected their behavior, distribution and population dynamics, for these reasons researchers should follow up on the changes in their behavior, distribution, and population dynamics. In this study, a survey study was conducted to define land snail species existing at Sharkia Governorate, Egypt, from January 2019 to March 2022 in horticultural, vegetable, and field crops and study the population dynamics for the dominant land snail species. Results showed that there are six species of land snails, these species were, Monacha cartusiana, Succinea putris, Eobania vermiculata, Theba pisana, Helicella vestalis, and Cochlicella acuta. The population dynamics of two prevalent land snail species (M. cartusiana and S. putris), were conducted during two successive growing seasons, the Egyptian clover harbored the highest number of M. cartusiana followed by wheat, while the onion was the lowest one during the study period. In the same trends, the land snail S. putris recorded the highest numbers during the growing season of the Egyptian clover crop. Finally, it is concluded that the land snail M. cartusiana considered the first grade of infestation existed everywhere at Sharkia Governorate, and the population density of the land snail is increase gradually after winter till reach the maximum density in spring.

Does long-distance pollen dispersal preclude inbreeding in tropical trees? Fragmentation genetics of Dysoxylum malabaricum in an agro-forest landscape.

Tropical trees often display long-distance pollen dispersal, even in highly fragmented landscapes. Understanding how patterns of spatial isolation influence pollen dispersal and interact with background patterns of fine-scale spatial genetic structure (FSGS) is critical for evaluating the genetic consequences of habitat fragmentation. In the endangered tropical timber tree Dysoxylum malabaricum (Meliaceae), we apply eleven microsatellite markers with paternity and parentage analysis to directly estimate historic gene flow and contemporary pollen dispersal across a large area (216 km(2)) in a highly fragmented agro-forest landscape. A comparison of genetic diversity and genetic structure in adult and juvenile life stages indicates an increase in differentiation and FSGS over time. Paternity analysis and parentage analysis demonstrate high genetic connectivity across the landscape by pollen dispersal. A comparison between mother trees in forest patches with low and high densities of adult trees shows that the frequency of short-distance mating increases, as does average kinship among mates in low-density stands. This indicates that there are potentially negative genetic consequences of low population density associated with forest fragmentation. Single isolated trees, in contrast, frequently receive heterogeneous pollen from distances exceeding 5 km. We discuss the processes leading to the observed patterns of pollen dispersal and the implications of this for conservation management of D. malabaricum and tropical trees more generally.

Long-pulsed Nd:YAG laser vs. intense pulsed light for hair removal in dark skin: a randomized controlled trial.

BACKGROUND: Although several lasers meet the wavelength criteria for selective follicular destruction, the treatment of darker skin phototypes is particularly challenging because absorption of laser energy by the targeted hairs is compromised by an increased concentration of epidermal melanin. OBJECTIVES: To compare satisfaction level, safety and effectiveness of a long-pulsed Nd:YAG laser and intense pulsed light (IPL) in axillary hair reduction in subjects with dark skin. METHODS: The study design was a within-patient, right-left, assessor-blinded, comparison of long-pulsed Nd:YAG laser and IPL. Fifty women (skin phototypes IV-VI) volunteered for removal of axillary hair. Five sessions at 4- to 6-week intervals were performed. Hair counts at both sides were compared at baseline and 6months after the last session. Final overall evaluations were performed by subjects and clinician at the end of the study. Satisfaction was scored for both devices. RESULTS: Thirty-nine women completed the study. At 6months, the decrease in hair counts on the laser side (79·4%, P<0·001 vs. pretreatment) was significantly (P<0·01) greater than that on the IPL side (54·4%, P<0·01 vs. pretreatment). Only temporary adverse effects were reported at both sides. Higher pain scores and more inflammation were reported with Nd:YAG laser; however, it was preferred by 29 volunteers (74%). Volunteers reported higher satisfaction score with Nd:YAG laser (P<0·01). CONCLUSIONS: Dark skin can be treated by both systems safely and effectively; however, long-pulsed (1064 nm) Nd:YAG laser is more effective as reported by both subjects and clinician.

Serum levels of visfatin and omentin-1 in patients with psoriasis and their relation to disease severity.

BACKGROUND: The association of the novel adipokines visfatin and omentin-1 with psoriasis is still obscure. Data concerning other inflammatory diseases suggest a possible role of these adipokines in the pathophysiology of psoriasis. OBJECTIVES: To investigate serum levels of visfatin and omentin-1 in patients with psoriasis compared with healthy controls, and to consider their relation to disease duration, disease severity and obesity markers. METHODS: Visfatin and omentin-1 concentrations were measured in 46 patients with plaque-type psoriasis and 42 healthy controls by using specific enzyme-linked immunosorbent assays. RESULTS: Patients with psoriasis showed considerably higher serum levels of visfatin than healthy controls with significant positive correlation with disease severity and duration. They also showed lower levels of ominten-1 compared with healthy controls with significant inverse correlation with body mass index and waist circumference. CONCLUSIONS: Coordinated roles for visfatin and omentin-1 are suggested in the modulation of the inflammatory environment in patients with psoriasis. Given the significant relations of omentin-1 with obesity markers, the health consequences of excessive weight should be better communicated to patients with psoriasis.

Effect of dexmedetomidine premedication on the intraocular pressure changes after succinylcholine and intubation.

BACKGROUND: Succinylcholine is still recommended for some situations in open globe injuries. However, the use of succinylcholine is associated with an increase in intraocular pressure (IOP). This may be deleterious in open globe injuries. No method has previously been shown to abolish completely this rise in the IOP. We investigated whether dexmedetomidine, an alpha-2 agonist, could attenuate this increase in the IOP after succinylcholine and intubation. METHODS: Forty patients with no pre-existing eye disease undergoing general anaesthesia were randomly premedicated by i.v. dexmedetomidine 0.6 microg kg(-1), or saline. Heart rate (HR), mean arterial pressure (MAP), and IOP (using Schioetz tonometer) were measured before, after the premedication, after thiopental, after succinylcholine, immediately after intubation, and then every 2 min for 6 min. RESULTS: Succinylcholine and intubation increased IOP in both groups. However, in the dexmedetomidine group, the IOP rise was not different from the baseline value (P=0.65) and was significantly lower than in the saline group (P=0.003). After intubation, the MAP in the control group was higher than that in the dexmedetomidine group (P=0.041) and exceeded the baseline value (P<0.001). The HR also showed less fluctuation in the dexmedetomidine group than in the saline group. CONCLUSIONS: We conclude that dexmedetomidine could be a beneficial premedication in open globe injuries.

Effect of intra-articular dexmedetomidine on postoperative analgesia after arthroscopic knee surgery.

BACKGROUND: Alpha-2-adrenergic agonists have peripheral analgesic effects. We have assessed the potential analgesic effect of dexmedetomidine after intra-articular administration in arthroscopic knee surgery. METHODS: Sixty patients undergoing arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The control group received i.v. and intra-articular saline, the intra-articular group received i.v. saline and intra-articular dexmedetomidine, and the i.v. group received i.v. dexmedetomidine and intra-articular saline. Haemodynamic changes, pain visual analogue scale (VAS), sedation score, the time to first postoperative analgesic request, and the total postoperative analgesic use during the first 24 h were evaluated. RESULTS: Dexmedetomidine administration resulted in a significant reduction in pain scores for 6 h after operation in the intra-articular group but only for 1 h in the i.v. group. The time to first postoperative analgesic request was longer in the intra-articular group [312.0 (SD 120.7) min] compared with the control group [71.0 (50.1) min] and the i.v. group [102.1 (54.4) min] (P<0.001). Total diclofenac requirement was significantly lower in the intra-articular group [90.0 (46.2) mg] than in the control group [165.0 (52.2) mg] and in the i.v. group [129.3 (54.3) mg] (P<0.05). CONCLUSIONS: Intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery, with an increased time to first analgesic request and a decreased need for postoperative analgesia.

Generic daclatasvir plus sofosbuvir, with or without ribavirin, in treatment of chronic hepatitis C: real-world results from 18 378 patients in Egypt.

BACKGROUND: Treatment of chronic hepatitis C using combination of sofosbuvir (SOF) and daclatasvir (DCV) was used in several clinical trials and multicentre studies, which were somewhat limited to genotypes 1-3. The national program in Egypt is using SOF-DCV combination for large scale treatment. AIM: To assess the efficacy and safety of combined SOF-DCV in treating patients with HCV-G4 in a real-world setting. METHODS: Data and outcome of chronic HCV patients who were treated for 12 weeks with generic medications: DCV 60 mg plus SOF 400 mg ± ribavirin (RBV) within the national hepatitis C treatment program in Egypt are presented. Treatment-naïve patients without cirrhosis were treated without RBV, and those who had cirrhosis or were treatment-experienced (interferon experienced or SOF experienced) received RBV. Efficacy and safety were assessed, and baseline factors associated with sustained virological response at post-treatment week 12 (SVR12) were explored. RESULTS: During the first 2 months of the programme, 18 378 patients with HCV-G4 started treatment with SOF-DCV with or without RBV. Overall, 95.1% achieved SVR12 (95.4% among patients treated without RBV and 94.7% for patients treated with RBV, P = .32). Treatment was prematurely discontinued in only 1.5% of patients. The most common events leading to discontinuation were patient withdrawal (n = 76) and pregnancy (n = 5). Five deaths occurred within this group. CONCLUSIONS: Real-world experience of generic SOF-DCV in patients with chronic HCV-G4 proved to be safe and associated with a high SVR12 rate, in patients with different stages of fibrosis.

Differentiation of pityriasis rubra pilaris from plaque psoriasis by dermoscopy.

Pityriasis rubra pilaris (PRP) and plaque psoriasis (PP) are two distinctive erythemato-squamous skin diseases that often have to be differentiated from each other and from other similar dermatoses. Dermoscopy has been proven to aid the clinical diagnosis of several inflammatory disorders, minimizing the need for skin biopsy. Our aim was to determine the dermoscopic patterns of PRP compared to PP and to assess the significance of certain dermoscopic criteria in the diagnosis of PRP. This case-control study included 11 patients with biopsy proven PRP and 25 patients with biopsy proven plaque psoriasis. The most recently developed lesion of each patient was examined by non-contact dermoscopy. Whitish keratotic plugs and linear vessels in yellowish background are significant dermoscopic features of PRP compared to white diffuse scales and dotted vessels in a light red background in PP. In conclusion, PRP and PP reveal specific distinguishing dermoscopic patterns that may assist in their clinical diagnosis and may also be useful for the differential diagnosis from other resembling dermatoses.

Factor VIII inhibitor and bronchogenic carcinoma.

An inhibitor to procoagulant factor VIII (FVIIIC) developed in a patient three years after palliative resection of a bronchogenic carcinoma. The inhibitor was not active against ristocetin cofactor but possibly had some activity against factor XI. It responded to immunosuppressive therapy. This is apparently the first reported association of carcinoma and factor VIII inhibitor.

Hereditary prolongation of the Q-T interval. Genetic observations and management in three families with twelve affected members.

Three families with the prolongation Q-T interval are described. Two demonstrated the nonsex-linked dominant mode of inheritance of the condition without neural deafness (the Romano-Ward syndrome). Family A had four affected members in three generations. Family B had three affected members in two generations, but the parents of the affected children were distant relatives. Family C had five affected members in three generations. Of the nine living affected members, seven were asymptomatic and never experienced syncope. The remaining two, aged 7 and 9 years, respectively, had multiple syncopal attacks. Of three affected members who died, two had electrocardiograms before death. The thirds, an apparently healthy boy of 14 years, had a single syncopal attack 13 months before he died in his sleep. The nature of the dysrhythmia causing syncope was documented in two cases. One of the affected children was treated successfully with a permanent demand pacemaker and propranolol, the other with propranolol alone. The electrophysiologic findings and the management of both symptomatic and asymptomatic patients are discussed.

Circumoval precipitin (COP) test in schistosomiasis with frozen Schistosoma mansoni eggs.

Frozen Schistosoma mansoni eggs were successfully employed in the circumoval precipitin (COP) test for schistosomiasis yielding results comparable with fresh eggs. This development may permit both standardization and kit production of the COP test.

Use of co-immobilized beta-amylase and pullulanase in reduction of saccharification time of starch and increase in maltose yield.

Beta-amylase and pullulanase were co-immobilized to poly(acrylamide-acrylic acid) resin [P(AAm-AAc)] using 1-ethyl-3-(3-dimethylaminopropyl) carbodimide hydrochloride (EDC). The combined beta-amylase and pullulanase activity was 32% relative to the nonimmobilized beta-amylase. Co-immobilization of beta-amylase and pullulanase increased the maltose yield compared to thart of the immobilized beta-amylase alone and reduced the saccharification time to about 50 h. The results showed that there is a significant increase in the thermal stability, pH stability, and stability toward gamma irradiation. The results also suggest that the co-immobilization of beta-amylase and pullulanase is a potentially useful approach for commercial starch hydrolysis.

Effectiveness of immersion treatments with acids, trisodium phosphate, and herb decoctions in reducing populations of Yarrowia lipolytica and naturally occurring aerobic microorganisms on raw chicken.

Yarrowia lipolytica, one of the predominant yeasts in raw poultry, is believed to play a role in spoilage. This study was undertaken to investigate treatments to control the growth of Y. lipolytica on raw chicken stored at refrigeration temperature. Raw chicken wings inoculated with a mixture of five strains of Y. lipolytica isolated from raw poultry were dipped in solutions containing 2, 5, or 8% lactic acid, 2% lactic acid containing 0.2, 0.4, or 0.8% potassium sorbate or sodium benzoate, and 4, 8, or 12% trisodium phosphate solution. Populations of the yeast and total aerobic microorganisms were determined before and after treatment. Immersion of wings in 2% lactic acid (with or without 0.2% potassium sorbate or sodium benzoate) or 4% trisodium phosphate caused a significant (alpha = 0.05) reduction in numbers of Y. lipolytica and aerobic microorganisms. Treatment with 2% lactic acid containing 0.4 or 0.8% preservative did not result in additional significant reductions. Treatment of chicken wings with 2% lactic acid or 8% trisodium phosphate significantly reduced numbers of Y. lipolytica by 1.47 and 0.65 log10 cfu/g, respectively, and aerobic microorganisms by 2.60 and 1.21 log10 cfu/g, respectively, compared to controls. Growth of Y. lipolytica on wings stored at 5 degrees C for up to 9 days, however, was not affected by these treatments. Significant reductions in the population of Y. lipolytica occurred when the yeast was inoculated into 100% basil, marjoram, sage, and thyme decoctions, but not in 100% oregano or rosemary decoctions, held at 5 degrees C for 24 h. Treatment of chicken wings with 100% sage or thyme decoctions significantly reduced populations of Y. lipolytica but did not control its growth during storage at 5 degrees C for up to 9 days. The small, temporary decreases in numbers of Y. lipolytica and aerobic microorganisms resulting from immersion treatment of chicken wings with sage and thyme decoctions render these treatments of questionable value as preservation interventions.

Presence and changes in populations of yeasts on raw and processed poultry products stored at refrigeration temperature.

A study was undertaken to determine populations and profiles of yeast species on fresh and processed poultry products upon purchase from retail supermarkets and after storage at 5 degrees C until shelf life expiration, and to assess the potential role of these yeasts in product spoilage. Fifty samples representing 15 commercial raw, marinated, smoked, or roasted chicken and turkey products were analyzed. Yeast populations were determined by plating on dichloran rose bengal chloramphenicol (DRBC) agar and tryptone glucose yeast extract (TGY) agar. Proteolytic activity was determined using caseinate and gelatin agars and lipolytic activity was determined on plate count agar supplemented with tributyrin. Populations of aerobic microorganisms were also determined. Initial populations of yeasts (log10 cfu/g) ranged from less than 1 (detection limit) to 2.89, and increased by the expiration date to 0.37-5.06, indicating the presence of psychrotrophic species. Highest initial populations were detected in raw chicken breast, wings, and ground chicken, as well as in turkey necks and legs, whereas roasted chicken and turkey products contained less than 1 log10 cfu/g. During storage, yeast populations increased significantly (P < or = 0.05) in whole chicken, ground chicken, liver, heart and gizzard, and in ground turkey and turkey sausage. Isolates (152 strains) of yeasts from poultry products consisted of 12 species. Yarrowia lipolytica and Candida zeylanoides were predominant, making up 39 and 26% of the isolates, respectively. Six different species of basidiomycetous yeasts representing 24% of the isolates were identified. Most Y. lipolytica strains showed strong proteolytic and lipolytic activities, whereas C. zeylanoides was weakly lipolytic. Results suggest that yeasts, particularly Y. lipolytica, may play a more prominent role than previously recognized in the spoilage of fresh and processed poultry stored at 5 degrees C.

The single gallbladder stone - is it innocent?

At Security Forces Hospital, 692 consecutive patients underwent surgery for gallstone disease over a period of two years. Eighty of these patients had a solitary gallbladder stone. They are compared, by their presentation, operative findings, mortality and morbidity rates, with the remaining patients harboring multiple gallstones. The demographic data were similar in both groups; however, the frequency of developing mucocele, empyema, gallbladder perforation and postoperative complications were significantly higher in the group with solitary stones than those with multiple gallstones. Furthermore, the need for emergency surgical intervention and technically difficult surgeries were also more frequent in the single stone group. It appears that a solitary gallbladder stone is associated with increased risks more than multiple stones; hence, it may be justified to offer the patient with a solitary stone more attention and surgical priority.

Laparoscopic cholecystectomy: The first year experience.

A total of 307 consecutive patients with symptomatic gallstones were admitted for cholecystectomy. Two hundred seventy patients (88%) were considered suitable for laparoscopic cholecystectomy. Forty-two of these (17%) were admitted on an emergency basis. The procedure was accomplished successfully in 246 patients (91%), while in the remaining 24 patients (9%), the attempt had to be abandoned and converted to open cholecystectomy. Postoperative complications, mostly minor, occurred in 22 patients (9%). Suspected common bile duct stones were treated with endoscopic retrograde cholangiopancreatography (ERCP) prior to surgery. The mean operative time was 82 minutes and 70% of the patients were discharged home within 489 hours after surgery and more than 90% were sent home by the third postoperative day. The results suggest that laparoscopic cholecystectomy is feasible for the majority of patients with symptomatic gallstones.

Assessing the state of health research in the Eastern Mediterranean Region.

Member states across the Eastern Mediterranean region face unprecedented health challenges, buffeted by demographic change, a dual disease burden, rising health costs, and the effects of ongoing conflict and population movements - exacerbated in the near-term by instability arising from recent political upheaval in the Middle East. However, health actors in the region are not well positioned to respond to these challenges because of a dearth of good quality health research. This review presents an assessment of the current state of health research systems across the Eastern Mediterranean based on publicly available literature and data sources. The review finds that - while there have been important improvements in productivity in the Region since the early 1990s - overall research performance is poor with critical deficits in system stewardship, research training and human resource development, and basic data surveillance. Translation of research into policy and practice is hampered by weak institutional and financial incentives, and concerns over the political sensitivity of findings. These problems are attributable primarily to chronic under-investment - both financial and political - in Research and Development systems. This review identifies key areas for a regional strategy and how to address challenges, including increased funding, research capacity-building, reform of governance arrangements and sustained political investment in research support. A central finding is that the poverty of publicly available data on research systems makes meaningful cross-comparisons of performance within the EMR difficult. We therefore conclude by calling for work to improve understanding of health research systems across the region as a matter of urgency.