Detection of MET gene somatic mutations in hepatocellular carcinoma of Egyptian patients using next-generation sequencing.

INTRODUCTION: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer worldwide and fourth in Egypt. Liquid biopsy is important to get cell-tumour DNA (ctDNA), for subsequent utilisation as a biomarker for cancer diagnosis, prognosis, and treatment. In clinical oncology, ctDNA analysis is utilised in cancer screening. METHODS: The collected 48 blood samples from HCC patients were classified according to Barcelona Clinic Liver Cancer (BCLC) staging, in addition to Hepatitis C Virus (HCV) group and normal group. After the liquid biopsy, ctDNA and genomic DNA (gDNA) of the same individual were extracted. Next-generation sequencing (NGS) was conducted using a Hot spot panel, and data analysis via different cancer databases was performed. RESULTS: There were no significant differences in the detected mutation frequency between groups. The frequency of mutations was higher in ctDNA than in the gDNA samples from the same patients. Hence, it can be concluded that these mutations are somatic mutations, rather than germline mutations. CONCLUSION: Screening of the targeted genes such as c-MET for potential mutations is very important in the determination of the appropriate therapy. Therefore, it can be used as a biomarker in the prognosis of HCC. Such screenings are also of paramount importance in the development of personalised medicine.

Effect of Y3+ on the structural and photoluminescence properties of yttrium-doped sodium borate glass.

Glass of the composition 70%B2 O3 -(30-x)%Na2 O-x%Y2 O3 with x = 0, 0.5, 1, 1.5, 2, and 2.5 mol% was manufactured using the melt quenching method. X-ray diffraction tests indicated the amorphous structure of the glass, with the presence of some YBO3 clusters in the high yttrium content samples. Fourier transform infrared spectra analysis proved the presence of different borate groups and linkages, in addition to nonsystematic changes in the ratio BO3 /BO4 in the glass. The forming ability of the glass was found to be approximately stable for the low Y3+ content samples and increased for the heavily doped samples. The density of the samples was found to increase as the Y3+ concentration was increased, whereas the molar volume decreased. The bond strength of the examined glass suggested that a covalent nature was dominant between bonds. All the Y3+ -doped glass was found to emit greenish-cyan light when excited at λ ex = 365 nm . Photoluminescence intensity was shown to be enhanced by the generated YBO3 groups. The obtained correlated colour temperature values with 82.5% purity recommend the suitability of the glass for applications in outdoor illumination.

Business process improvement methods in healthcare: a comparative study.

PURPOSE: According to the literature concerned with this study, less than satisfactory outcomes have been achieved through implementing business process improvements methods (BPIMs) in industries, in general, and in healthcare, in particular. The existing methods used need to be enhanced in order to create more effective outcomes. There has also been a lack of studies documenting gaps or shortfalls in implementing BPIMs, to be presented to the BPI research community. Therefore, researchers of this paper have attempted to fill gaps between theory and practice. On the contrary, there is also a need to link practical outcomes in the healthcare domain with those of the BPI research community. The purpose of this paper is to review popular BPIMs, techniques and tools applied in the healthcare domain; it seeks to examine and highlight their significant roles, clarify their pros and cons, and find opportunities to enhance their impact on the achievement of more sustainable improvements in the healthcare domain. DESIGN/METHODOLOGY/APPROACH: This study has been carried out by using a methodology combining an in-depth literature review with a comparison framework, which is called as the "Framework for Comparing Business Process Improvement Methods." The framework is composed of seven dimensions and has been adapted from four recognized, related frameworks. In addition to the in-depth review of related literature and the adapted comparison framework, researchers have conducted several interviews with healthcare BPI practitioners in different hospitals, to attain their opinions of BPI methods and tools used in their practices. FINDINGS: The main results have indicated that significant improvements have been achieved by implementing BPIMs in the healthcare domain according to related literature. However, there were some shortfalls in the existing methods that need to be resolved. The most important of these has been the shortfall in representing and analyzing targeted domain knowledge during improvement phases. The tool currently used for representing the domain, specifically flowcharts, is very abstract and does not present the domain in a clear form. The flowchart tool also fails to clearly present the separation of concerns between business processes and the information systems processes that support a business in a given domain. PRACTICAL IMPLICATIONS: The findings of this study can be useful for BPI practitioners and researchers, mainly within the healthcare domain. The findings can help these groups to understand BPIMs shortfalls and encourage them to consider how BPIMs can be potentially improved. ORIGINALITY/VALUE: This researchers of this paper have proposed a comparison framework for highlighting popular BPIMs in the healthcare domain, along with their uses and shortfalls. In addition, they have conducted a deep literature review based on the practical results obtained from different healthcare institutions implementing unique BPIMs around the world. There has also been valuable interview feedback attained from BPI leaders of specific hospitals in Saudi Arabia. This combination is expected to contribute to knowledge of BPIMs from both theoretical and practical points of view.

Management of nephrolithiasis in the Middle East over a recent decade: A systematic review.

Nephrolithiasis is a prevalent issue around the globe, particularly in hot climates such as Saudi Arabia. This analysis's objectives were to investigate the characteristics of kidney stones in Eastern Saudi Arabia and to provide the following findings: urinary stone composition, gender and age distribution, seasonal variations in stone formation, coexisting diseases linked to stone development, and urinary stone incidence. With comparisons to European and American populations, the primary risk factors for nephrolithiasis in Asian populations are to be determined through this systematic review and meta-analysis. We synthesized data from 13 geographically different studies using a thorough literature search through PubMed, ScienceDirect, and ResearchGate following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses criteria. Potential targets for specialized public health programs were highlighted by the elucidation of differences in health-care-seeking behavior and disparities in health-care access. The results of this systematic analysis give doctors, researchers, and policymakers a thorough understanding of the condition of nephrolithiasis care in Saudi Arabia today. In addition, to maximize the care of nephrolithiasis in this particular group, this review identifies information gaps and highlights the necessity of context-specific guidelines and future research initiatives. All things considered, this systematic review addresses the unique possibilities and problems that exist within the Saudi Arabian health-care sector while also adding to the worldwide conversation on nephrolithiasis.

Foodborne botulism outbreak with potential new management options.

OBJECTIVES: To shed some light on a potential therapeutic modality that may facilitate resolution of botulism symptoms, namely 3,4-diaminopyridine (3,4-DAP). METHODS: In Riyadh, Saudi Arabia, we recently encountered a foodborne botulism outbreak that, luckily, was discovered early. In Prince Sultan Military Medical city, we admitted, during a period of approximately 3 weeks, 15 probable cases, 2 of which were excluded due to more likely alternative diagnoses. We report in this case series 13 highly suspected cases of botulism that we encountered during the outbreak. RESULTS: A total of 12 out of 13 patients required intensive care unit (ICU) admission, one of which required intubation. Symptoms included cranial nerve palsies, gastrointestinal symptoms, limb and respiratory muscle weakness. Patients showed clinical improvement when received botulinum antitoxin and 3,4-DAP if given early in the course of the disease. CONCLUSION: Early admisntration of 3,4-DAP may facilitate recovery and prevent disease progression. Larger prospective trials should be carried out to confirm that.

Trend for hypospadias repair among surgeons in Saudi Arabia: Insights and recommendations.

Background: Currently, there are many techniques available for repairing hypospadias in urogenital reconstructive surgery. Aim: The purpose of this survey is to determine the preferred age of hypospadias repair patients, as well as the preferred surgical techniques among Saudi urologic and pediatric surgeons. Materials and Methods: An E-mail questionnaire was sent to urologic and pediatric surgeons throughout Saudi Arabia. Results: Forty-six participants from the Saudi regions returned completed questionnaires. Sixty-five percent of participants preferred age to do surgery on 6-18 months. While, 50% preferred meatal advancement and glanduloplasty techniques for coronal/glandular hypospadias, and 46% participate that tubularized incised plate (TIP). It was found that 86% of the participants admitted to using TIP procedure for subcoronal/distal penile hypospadias, whereas the majority of them (63%) used TIP for midpenile/proximal hypospadias with significant value P < 0.05. Ninety-eight percentage of surgeons stated that they prefer performing the chordee repair simultaneously. As a final note, 91% of participants have been omitted preoperative androgen in their protocols. Conclusions and Recommendation: We concluded from the surgeons' preferences regarding hypospadias repair in this study, that their preferences are highly successful rate and have few complications; however, we highly recommend using this study as a basis for future studies.

Obesity and lifestyle behaviours among in-school children in Oman.

Background: Many countries are experiencing an increasing prevalence of childhood obesity and this needs to be carefully addressed. Aims: To determine the prevalence of overweight and obesity and the sociodemographic factors and lifestyle risk behaviours associated with obesity among in-school children in Al Buraimi Governorate, Oman. Methods: We conducted a cross-sectional study among 714 male and female in-school children aged 6-17 years in 14 government schools in Al Buraimi Governorate, Oman, from April to July 2019. Data were collected on the sociodemographic characteristics and lifestyle of the students using a self-administered questionnaire. The students' height, weight and waist circumference were also measured. The BMI-for-age growth charts cutoff reference standards of the WHO were used to determine weight category. Central obesity was assessed by calculating the waist-to-height ratio, and the waist-toheight ratio cutoff of 0.50 was used to identify central obesity in both boys and girls. Data analysis was conducted using SPSS version 21, involving both descriptive and inferential statistics. Results: A total of 714 students were included. The prevalence of overweight and obesity was 12.3% and 16.3% respectively, and 21.4% of the students had central obesity. Lifestyle risk behaviours were significantly associated with student's age, sex and mother's education (P < 0.05). Predictors of obesity were: unhealthy eating habits (adjusted odds ratio (AOR) = 5.20; 95% confidence interval (CI): 2.50-10.70), sedentary screen-based activities (AOR = 1.54; 95% CI: 1.05-2.26), inadequate night-time sleep duration (AOR = 0.60; 95% CI: 0.34-1.00), sibling obesity (AOR = 2.24; 95% CI: 1.55-3.25), paternal obesity (AOR = 1.66; 95% CI: 1.10-2.50) and maternal obesity (AOR = 1.64; 95% CI: 1.10-2.45). Conclusion: There is a need for effective health promotion programmes targeting in-school children in Oman, as well as regular monitoring of lifestyle behaviours associated with overweight and obesity among the younger populations. Larger studies are needed to understand the predictors of overweight and obesity among in-school children in Oman and to design relevant school-based interventions to prevent obesity among young Omanis.

Brucellar testicular abscess: The 17th case report and review of literature.

Brucellosis is an endemic zoonotic disease caused by intracellular gram-negative coccobacilli called Brucella. This infectious disease may implicate many farm animals and is transmissible to exposed humans. Brucellosis is potentially life-threatening and may lead to granulomatous multi-organ involvement with tendency to chronicity and recurrence. The treatment of brucellosis requires combined and protracted antimicrobial therapies to eliminate the disease and to avoid its relapse. Genitourinary brucellosis is common among infected humans in endemic areas and is considered the second-most affected focal site, which commonly manifests as epididymo-orchitis. Testicular abscess, however, is an extremely rare complication of brucellosis. To the best of our knowledge, in the literature, there are to date only 16 previously published case reports, including 22 patients of brucellar testicular abscesses, emphasizing the extreme rarity of this condition. Most of these cases harbored small abscesses, which were treated conservatively using antibiotics therapy only, or with added drainage of the abscesses. Larger abscesses were reported to necessitate orchiectomy. In some cases, the abscesses were mimicking tumors, and surgeries for orchiectomy were done accordingly. A summary of the previously reported cases in the literature is presented. Here, we present the 17th case report of a 34-year-old man with a right-side huge multilocular brucellar testicular abscess apparently replacing the entire testicle, who was successfully treated with organ-sparing management by incision-drainage of the large abscess with antibiotics, to eventually preserve his testis. In conclusion, brucellosis should be considered among the differential diagnoses of any testicular swelling, especially in endemic areas. Drainage of brucellar testicular abscess with appropriate medical treatment is feasible and may preserve the testicle, even with large abscess apparently replacing the entire testicle.

Medical Students' Syndrome among Medical Students in the University of Sharjah, UAE.

Background Medical students' syndrome (MSS) is a set of psychosomatic symptoms that affect students due to their medical background knowledge. Objectives This study aims to measure the prevalence and assess the knowledge about MSS among medical students at the University of Sharjah. It also aims to compare the attributed characteristics of MSS between different years of study. Methods A self-administered 24-item questionnaire was distributed to 503 students enrolled in the College of Medicine at University of Sharjah using nonprobability convenience sampling during June 2021. A total of 472 responses were completed and analyzed using descriptive studies and chi-squared test. Results The prevalence of MSS in this study was found to be 70.8% ( n = 334). Clinical year students were 1.75 times more likely to have felt they had a disease they studied about (95% confidence interval: 1.05-2.90, p = 0.03). Conclusion Medical students are more likely to experience MSS as their education progresses.

Role of MicroRNA-223 and MicroRNA-182 as Novel Biomarkers in Early Detection of Colorectal Cancer.

Background: Colorectal cancer is a common and lethal disease. It is estimated that approximately 145,600 new cases of large bowel cancer are diagnosed annually in the USA. MiRNA-223 and miRNA-182 have been reported in various cancers, such as lung, gastric, breast and colorectal cancer and proposed to be valid and reliable for diagnosis as well as prognosis. Aim: This study aimed to determine the role of miR-223 and miR-182 as novel biomarkers for early detection and prognosis of CRC. Patient and Methods: This case-control study was conducted at the department of Internal Medicine, Aswan University Hospital, in the period from the 1st of February 2020 to the 20th of April 2021. Thirty-five cases and thirty age- and sex-matched controls were included in the study. All patients were subject to complete clinical evaluation, routine investigations, occult blood in stool, serum levels of CEA and CA 19-9, serum levels of miR-223 and miR-182 by quantitative PCR. Results: Significant difference between the two studied groups regarding biomarker changes was found. ROC curve analysis showed that the new markers had excellent diagnostic as well as prognostic criteria. Micro-RNA-223 diagnostic accuracy, sensitivity, specificity, PPV, NPV, FDR and FOR were 97%, 97.1%, 96.7%, 97%, 97%, 3.3% and 2.9%, respectively. Also, micro-RNA-182 diagnostic accuracy, sensitivity, specificity, PPV, NPV, FDR and FOR were 97%, 98%, 96%, 96%, 98%, 3.9% and 2%, respectively. Conclusion: MiR-223 and miR-182 have been discovered to be relevant and reliable biomarkers for the early identification and prognosis of CRC. Increased levels of miR-223 and miR-182 were associated with increased risk of disease progression, and the more accurate the value of miR-223 and miR-182, the earlier the diagnosis of colorectal cancer.

Assessment of Brushing Techniques in School Children and Its Association with Dental Caries, Omdurman, 2019.

BACKGROUND: Dental caries are a common infectious disease of childhood. It is a highly prevalent disease among children. AIM: The goal of this study was to assess the different brushing techniques used by school children and to identify if there is an association between brushing techniques and dental caries. MATERIALS AND METHODS: A descriptive cross-sectional study was carried out among 396 school children (9-12 years old) chosen by convenience sampling technique from schools located in Omdurman locality, Sudan. After consent was taken, students were asked in an interview-based questionnaire about their brushing habits. Consequently, they were examined in an upright position using a sterile mouth mirror and a probe. The examination was carried out by a single examiner to investigate the presence of dental caries. The diagnosis was done based on the World Health Organization diagnostic criteria 2013. The data were analyzed through descriptive statistics and comparison between values using the chi-square test with a P value <0.05. RESULTS: The present study found that the prevalence of dental caries is 70.9%. The combined brushing technique was the most used technique (42.9%). There was no statistical significance between brushing techniques and dental caries (P value ≤0.330). There was a statistical significance between the periodic change of the toothbrush and dental caries (P value ≤0.001). There was statistical significance between the level of education of the mother (P value ≤0.001) and father (P value ≤0.012) to the brushing technique used by the child as well. CONCLUSION: Due to a lack of awareness consequent of lower socioeconomic status, only a few percentage of the Sudanese population knows how to implement the correct oral hygiene practices to combat dental caries. It is important to design a specific public health program that particularly targets families of low socioeconomic status, which represents the majority. Dental caries persist as a widespread condition in Sudan as a result of a deficit in these kinds of programs.

Long-term efficacy data for the recombinant zoster vaccine: impact on public health and cost effectiveness in Germany.

The aim of the study was to update previously published public health impact and cost-effectiveness analyses of the recombinant zoster vaccine (RZV), in the German population aged ≥50 years of age (YOA), with the latest vaccine efficacy (VE) estimates against herpes zoster (HZ). The updated estimates are derived from a long-term follow-up study. A previously published multi-cohort Markov model following age cohorts over their lifetime was used. Demographic, epidemiological, cost, and utility data were based on German specific sources. Vaccine coverage was assumed to be 40%, with a second dose compliance of 70%. The estimated VE at time 0 was 98.9% (95% C.I.: 94.0-100%) with an annual waning of 1.5% (95% CI: 0.0-3.4%) for the age group 50-69 YOA. Corresponding values were 95.4% (95% C.I.: 89.7-100%) and 2.3% (95% CI: 0.3-4.4%) for the age group ≥70 YOA. It was estimated that, over the remaining lifetime since vaccination, RZV would prevent approximately 884 thousand (K), 603 K, and 538 K HZ cases in three age cohorts 50-59, 60-69, and ≥70 YOA, respectively. The number needed to vaccinate to prevent one HZ and one postherpetic neuralgia case was 6 and 36 (50-59 YOA cohort), 6 and 34 (60-69 YOA cohort), 10 and 48 (≥70 YOA cohort). The incremental cost-effectiveness ratio of vaccination ranged from €26 K/quality-adjusted life year (QALY) in 60 YOA to €35 K/QALY in 70 YOA. Due to the higher, sustained, RZV VE, improved public health and cost-effectiveness results were observed compared to previous analyses.

PLAIN LANGUAGE SUMMARYWhat is the context?Shingles is a viral infection caused by the reactivation of the chickenpox virus. It causes a painful rash that lasts for several weeks.The incidence and severity of shingles increase with age. In Germany alone there are approximately 400,000 new cases annually.Vaccination can help prevent shingles.Previous studies, based on data collected up to four years post-vaccination, estimated the number of shingles cases prevented. What is new?Here, we use data from the same studies followed over a longer-term to update previous analyses in the German population.We found, based on data up to 8 years following vaccination, that:○ In adults 50-69 years: the vaccine initially prevents 98.9% of cases, with a reduction of 1.5% each year(for example, after one year, it would prevent 97.4% of cases).○ In adults over 70 years of age: the vaccine initially prevents 95.4% of cases, with a reduction of 2.3% each year (for example, after one year, it would prevent 93.1% of cases).○ Vaccination would reduce the number of shingles cases by 0.9 million in a cohort of adults aged 50-59 years, 0.6 million in adults 60-69 years, and 0.5 million in adults older than 70 years, over the remainder of their lifetime.What is the impact?The study provides more certainty regarding results as it is based on the most complete/up to date data. The results showed the potential of Shingrix to prevent shingles while at the same time providing good value for money.

Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment.

BACKGROUND: Egypt was one of the first countries to implement a national programme to eliminate lymphatic filariasis based on WHO's strategy of repeated rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole (target population, 2.5 million in 181 localities). We assessed the effect of five yearly rounds of MDA on filariasis in four sentinel villages in Egypt. METHODS: We studied two areas with different infection rates before MDA: the Qalubyia study area had a low infection rate because of previous treatment with diethylcarbamazine; this was typical of most filariasis-endemic villages in Egypt before MDA. The Giza study area had a high baseline infection rate. We undertook repeated surveys in villages for treatment compliance and tests for microfilaraemia and circulating filarial antigenaemia, antibodies to filarial antigen Bm14 in schoolchildren, and infections in indoor-resting mosquitoes (assessed by PCR). FINDINGS: MDA compliance rates were excellent (>80%). In Giza after MDA, prevalence rates of microfilaraemia and circulating filarial antigenaemia fell from 11.5% to 1.2%, and from 19.0% to 4.8%, respectively (p<0.0001). Corresponding rates in Qalubyia fell from 3.1% to 0% and 13.6% to 3.1%, respectively (p<0.0001). Rates of antifilarial antibody and circulating filarial antigenaemia in schoolchildren (aged about 7-8 years), fell from 18.3% to 0.2% (p<0.0001) and from 10.0% to 0.4% (p<0.0001) in Giza, respectively, and from 1.7% to 0% and 1.7% to 0% (both p=0.13) in Qalubyia, respectively. Mosquito infection rates fell from 3.07% (95% CI 2.38-3.88) to 0.19% (0.08-0.38) in Giza and from 4.37% (3.07-5.99) to 0% (0-0.05) in Qalubyia. INTERPRETATION: MDA greatly affects variables related to infection (microfilaraemia and circulating filarial antigenaemia prevalence rates) and transmission (antifilarial antibodies in young children and mosquito infection rates). Our results suggest that after five rounds of MDA filariasis is likely to have been eliminated in most endemic localities in Egypt.

Striking decrease in blood loss with a urologist-assisted standardized multidisciplinary approach in the management of abnormally invasive placenta.

OBJECTIVE: The aim of this study was to investigate the outcome of a standardized multidisciplinary approach using a modified surgical technique in the management of abnormally invasive placenta (AIP), with special reference to blood loss and the need for transfusion. MATERIALS AND METHODS: Data were collected retrospectively in women managed with a recently adopted multidisciplinary strategy using a modified surgical approach, involving a urologist (study group: 10 patients). Women managed before the introduction of this standardized management served as a control group (nine patients). Comparisons were made between the study group and the control group. The main outcome measures were blood loss and the need for transfusion in the two groups. RESULTS: Standardized multidisciplinary management, involving a modified surgical technique performed by a urologist, decreased blood loss in the study group compared with the control group [median 1400 ml (range 400-3000 ml) vs median 8000 ml (2300-40000 ml); p < .001]. It also decreased postoperative complications and the need for transfusion of blood products. CONCLUSIONS: Standardized multidisciplinary management of patients with AIP, using a modified surgical technique, reduces the risks of massive obstetric hemorrhage, the need for massive transfusion and the risk of postoperative complications. Involving an experienced urologist appears to be of paramount importance in the management of AIP.

Comparison between normal saline and Ringer's acetate in bipolar transurethral resection of the prostate.

OBJECTIVE: The standard surgical treatment for benign prostatic hypertrophy (BPH) is transurethral resection of the prostate (TURP). The aim of this study was to compare normal saline (NS) (0.9% sodium chloride) and Ringer's acetate (RA) as irrigation fluid with regard to visibility, resection feasibility, coagulation and bleeding in bipolar TURP. MATERIALS AND METHODS: Twenty patients (mean age 70 years) who were diagnosed with BPH were recruited to the study. The first three 3 liter bags of irrigation fluid contained either NS or RA and were administered in a randomized fashion. The surgeon assessed visibility, bleeding, coagulation, resection efficacy and overall outcome after each 3 liter bag on a scale of 1-10. RESULTS: The results disclosed only marginal differences between the two fluids with regard to the recorded parameters. All of the differences lacked statistical significance (p > .05). CONCLUSION: RA can be used as an irrigation fluid in bipolar TURP with no obvious difference in comparison with NS.

Bancroftian filariasis: effect of repeated treatment with diethylcarbamazine and albendazole on microfilaraemia, antigenaemia and antifilarial antibodies.

Diethylcarbamazine/albendazole (DEC/ALB) therapy is widely used in mass drug administration (MDA) programmes aimed at eliminating lymphatic filariasis. We studied the effects of repeated annual treatments with DEC/ALB on Wuchereria bancrofti microfilaraemia, filarial antigenaemia and IgG4 antibodies to Bm14 antigen. Fifty-seven subjects with asymptomatic microfilaraemia were treated with one or seven daily doses of DEC/ALB at time zero. All subjects were re-treated with single-dose DEC/ALB 12, 24 and 36 months later. The two treatment groups had comparable pre-treatment microfilaria counts. Multidose treatment cleared microfilaraemia more effectively than single-dose treatment. Filarial antigen levels decreased equally in both treatment groups. Total antigen clearance was observed in 29.6%, 52.0%, 63.6% and 79.5% of subjects at 12, 24, 36 and 48 months. These clearance rates are much higher than those observed in prior treatment trials with DEC or ivermectin. Antibody levels increased 4 weeks after treatment and then slowly decreased in most subjects. Antibody tests turned negative in 20%, 35%, 39.4% and 52.5% of treated subjects at 12, 24, 36 and 48 months post treatment. These results show that the studied parameters decline at different rates and to differing degrees following DEC/ALB treatment. These findings have important implications regarding strategies for monitoring the effects of MDA in populations.

Duplex Doppler sonographic assessment of the effects of diethylcarbamazine and albendazole therapy on adult filarial worms and adjacent host tissues in Bancroftian filariasis.

We used duplex Doppler sonography to assess effects of diethylcarbamazine and albendazole therapy (DEC/ALB) on adult Wuchereria bancrofti in vivo. The study was performed in clinically normal Egyptian adults with blood microfilaria counts > 80/mL. Motile adult worms were observed before treatment in dilated scrotal lymphatic vessels in 28 of 36 men (78%) and over the proximal extremities in 5 of 22 women (23%). Most worm nests were inactivated in the months following treatment (90% at 12 months). Circulating filarial antigen levels (a marker for living adult worms) also fell dramatically following treatment. Some men had intrascrotal calcifications and/or non-palpable hydroceles detectable by ultrasound before they were treated. New hydroceles and intrascrotal calcifications appeared after treatment in many cases. However, most of these were transient and of no clinical significance. Prevelance rates for hydrocele and intrascrotal calcifications 24 months after treatment were essentially the same as those prior to treatment. These results show that DEC/ALB is highly active against adult W. bancrofti. They also suggest that host responses to dying adult worms are important in the pathogenesis of filarial hydroceles.

A randomized clinical trial comparing single- and multi-dose combination therapy with diethylcarbamazine and albendazole for treatment of bancroftian filariasis.

The Global Program for Elimination of Lymphatic Filariasis calls for mass drug administration for endemic populations outside of sub-Saharan Africa with a single dose of diethylcarbamazine (DEC) and albendazole (Alb) annually for 4-6 years. Single-dose DEC/Alb dramatically reduces blood microfilaria (MF) counts, but most treated subjects fail to completely clear MF after a single dose. A more effective regimen might reduce the number of years required for elimination programs. We performed a randomized clinical trial in Egyptian adults with asymptomatic microfilaremia to compare treatment with seven daily doses of oral DEC (6 mg/kg) and Alb (400 mg) with a single dose of the same combination. We also studied the effect of re-treatment with single-dose DEC/Alb 12 months after the first treatment course. Multi-dose DEC/Alb was significantly more effective than single-dose therapy for reducing and clearing microfilaremia (mean reduction in MF/ml relative to pretreatment counts at 12 months, 99.6% versus 85.7%, with complete clearance in 75% versus 23.1%). The two regimens had similar activity against adult filarial worms, as indicated by serial ultrasound assessments. Neither regimen resulted in complete clearance of filarial antigenemia. There was no difference in adverse events, which were mild to moderate. Blood microfilaria and parasite antigen clearance rates increased following re-treatment. Multi-dose DEC/Alb may be a useful option for filariasis elimination programs, especially in the first year (when enthusiasm for mass drug administration and coverage rates are high), to quickly reduce community MF loads and transmission rates.

The impact of single-dose diethylcarbamazine treatment of bancroftian filariasis in a low-endemicity setting in Egypt.

This study was designed to evaluate the effect of a single dose of diethylcarbamazine (DEC, 6 mg/kg) on Wuchereria bancrofti infections in a low-endemicity setting in Egypt (microfilaremia, or MF, 3.7%, median MF 34/mL). Subjects with MF or filarial antigenemia were treated and restudied 1 year later. Treatment with DEC dramatically reduced blood MF counts, with clearance in 69% of subjects. Treatment also reduced filarial antigen levels, but low clearance rates suggest that some adult worms survived treatment in most patients. Mass treatment was administered in one village; 27 months later, MF prevalence had decreased 84% (from 4.9% to 0.8%). These results show that single-dose DEC treatment can have a major effect on MF prevalence rates and levels in low-endemicity settings. Although the World Health Organization advocates repeated multidrug regimens for filariasis elimination, mass treatment with DEC alone may be sufficient to interrupt transmission in areas with low infection intensities and prevalence rates.