Accuracy of noninvasive methods for the diagnosis of liver fibrosis in children with chronic viral hepatitis.

BACKGROUND: Liver biopsy is the reference standard for assessing liver fibrosis. Moreover, it is an invasive procedure. Transient elastography (TE) is an accurate, noninvasive method for evaluating liver stiffness as a surrogate of liver fibrosis. The aspartate aminotransferase to platelet ratio index (APRI) and Hyaluronic acid (HA) are noninvasive alternatives to liver biopsy for detecting hepatic fibrosis. This study aimed to identify the accuracy of APRI, HA, and TE concerning liver biopsy in children with chronic viral hepatitis. METHODS: This cross-sectional study included 50 children, 5-18 years with chronic viral hepatitis B (HBV) or hepatitis C (HCV) who underwent liver biopsy within nine months of laboratory tests, determining APRI & performing TE. Twenty healthy children of age and sex-matching patients were included as a control group for the serum HA levels. RESULTS: The histopathological findings of the studied cases showed seven cases with (F0) fibrosis, 36 cases with mild (F1,2), two children with moderate (F3,4), and five children with severe (F5,6). The median (IQR) of steatosis was 4 (three had HCV). When correlating TE, APRI, and HA values in all cases with their laboratory data, there was a positive correlation between ALT and APRI values (P-value = 0.000), a positive correlation between AST and HA values (P-value = 0.02), and a negative correlation between stiffness and APRI. The sensitivity of HA, APRI, and TE compared to fibrosis detected by histopathology was 60.5, 65.1, and 60.5%, and their specificity was 71.4, 57.1, and 85.7%, respectively. TE was significantly higher in a group with (moderate to severe) fibrosis. CONCLUSION: APRI, HA, and TE are good indicators of the presence of fibrosis almost with the same accuracy. TE is the only method to differentiate mild cases from those with significant fibrosis.

Awareness of Hepatitis B Virus (HBV) Screening Before Marriage and Pregnancy Among Adults in the Al-Baha Region, Saudi Arabia.

Background Hepatitis B is a global public health concern. Understanding the awareness, testing practices, and vaccination status of individuals is crucial for effective prevention and control strategies. This study aims to assess these aspects among participants in the Al-Baha region, Saudi Arabia. Methodology A cross-sectional study was conducted among 440 participants. Demographic data, awareness of hepatitis B, knowledge of transmission modes, symptoms, and complications were collected through a structured questionnaire. Participants' testing and screening practices, sources of information, and vaccination status were also assessed. Data were analyzed using descriptive statistics and associations were explored using chi-square tests. Results The majority of participants were females (51.8%) and aged 18-25 years (55.2%). While most participants had heard of hepatitis B (85.7%), only a small percentage correctly identified sexual contact as a mode of transmission (38.6%). Knowledge regarding symptoms and complications was moderate, with 52.3% correctly identifying symptoms and 69.8% recognizing liver damage and cirrhosis as complications. Although awareness of screening was high (84.8%), the actual practice was low (35.0%). Education was the least reported source of information, while the internet (46.7%) and health care provider (27.6%) were commonly mentioned. Approximately half of the participants reported receiving the hepatitis B vaccine (48.9%), but a significant proportion had not completed all vaccine doses (55.0%). Conclusion The study revealed moderate awareness of hepatitis B among the participants, but knowledge gaps existed regarding transmission modes and complete symptom recognition. Testing and screening practices were suboptimal, with low rates of screening despite high awareness. Vaccination uptake was moderate, but incomplete vaccine schedules were prevalent. Targeted educational campaigns are needed to address knowledge gaps, promote testing and completion of vaccination schedules, and enhance the role of healthcare providers in disseminating accurate information. Improving knowledge and practices related to hepatitis B can strengthen public health efforts, enhance prevention, and control strategies.

Prevalence and Phylogenetic Analysis of Fusobacterium nucleatum and Virulent Factor FadA among Ulcerative Colitis Precancerous and Colorectal Carcinoma Patients in the Iraqi Kurdish Population.

Fusobacterium nucleatum is considered one of the main risk factors that play a key role in the promotion and progression of colorectal carcinoma. The main goal of this study is to find out the association between the prevalence of various subtypes of Fusobacterium nucleatum with inflammation and colorectal cancer progression, in addition to screening the positive ratio of the possession of the FadA gene. One hundred tissue samples were collected from healthy individuals and patients from colonoscopy and surgical operation biopsies. The patients were categorized into (Ulcerative colitis, precancerous colitis and colorectal carcinoma) according to their colonoscopy and histopathology examination reports. Molecular detection of Fusobacterium nucleatum and FadA gene was performed via PCR and gel electrophoresis, and then phylogenetic analysis for Fusobacterium nucleatum was done using 16S rRNA partial sequencing based on specific primers. The results showed significant differences among the four groups regarding the prevalence of Fusobacterium nucleatum. The most prevalent subtype was Fusobacterium nucleatum subtype animalis, which constitutes 7 out of 17 samples. The ratio of the FadA-positive gene was 20% among the Fusobacterium nucleatum-positive cases. This finding suggested a strong correlation between Fusobacterium nucleatum and colon inflammation and cancer progression steps, and Fusobacterium nucleatum subtype animalis was the most prevalent subtype.

Post-COVID-19 Complications and their Laboratory Findings: A Cohort Study.

Type 2 severe acute respiratory syndrome caused by coronavirus infection has become the most well-known pandemic infectious viral disease in the present century. This study aims to find out the post-COVID-19 infection complications via a well-designed observational study. A total of 986 recovered cases (only the period ranged between 2 to 3 months after recovery) were obtained from public and private hospitals in Kirkuk and Erbil governorates\Iraq. The admitted patients were asked to answer a questionnaire through interviews; the laboratory findings were obtained from the patients. The results suggested that approximately half of post-COVID-19 patients (%45.606) were suffering from chest pain, while (%32.357) of the cases suffered headache and chest pain. Liver enzymes (ALT, AST, and ALP) showed abnormal percent values of 38.6,24.07, and 26.09, respectively. Renal function enzymes, mainly urea, were found to be abnormal in 45.37% of recovered individuals. Furthermore, abnormal LDH levels were found in (77.9%) of post-COVID-19 patients. This finding revealed that chest pain was an inflammatory condition and liver and renal enzyme disturbances, while elevation in LDH was the predominant long-term complication in post-COVID-19 patients.

Disseminated strongyloidiasis complicated by alveolar hemorrhage, meningitis, and septic shock treated with albendazole and subcutaneous ivermectin.

The case of a patient with disseminated strongyloidiasis following chemotherapy for lymphoplasmacytic lymphoma is presented.

Prevalence and 30-day all-cause mortality of carbapenem-and colistin-resistant bacteraemia caused by Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae: Description of a decade-long trend.

BACKGROUND: Bacteraemia due to carbapenem-resistant gram-negative bacteria is challenging. This study examined the burden of carbapenem and colistin resistance in Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii bacteraemia in Oman. METHODS: Adult patients admitted to Sultan Qaboos University Hospital between January 1, 2007 and December 31, 2016 with positive blood cultures for P. aeruginosa, A. baumannii, or K. pneumoniae were identified. Rates of carbapenem resistance, trends in prevalence, and 30-day all-cause mortality were examined. RESULTS: Two hundred and twenty-seven (29.8%) of 761 bacteraemia cases due to these three isolates were carbapenem-resistant, with 87.2% being healthcare-associated. A. baumannii caused 52% of all carbapenem-resistant bacteraemia, K. pneumoniae caused 30%, and P. aeruginosa caused 18%. Rates of carbapenem resistance in P. aeruginosa, A. baumannii, and K. pneumoniae bacteraemia increased from 20%, 67%, and 0%, respectively, in 2007 to 25%, 86%, and 35%, respectively, in 2016. Seventeen (7.9%) carbapenem-resistant bacteraemia cases were also colistin-resistant. Thirty-day all-cause mortality was 62% in patients with carbapenem-resistant bacteraemia and 22% in patients with carbapenem-sensitive bacteraemia. CONCLUSIONS: The prevalence of carbapenem-resistant K. pneumoniae, A. baumannii, and P. aeruginosa bacteraemia is increasing alarmingly in Oman, with a large proportion of K. pneumoniae and P. aeruginosa demonstrating additional resistance to colistin. Patients with carbapenem-resistant bacteraemia had higher 30-day all-cause mortality.

Depressive symptoms among Kuwaiti population attending primary healthcare setting: prevalence and influence of sociodemographic factors.

OBJECTIVES: The aim of this study was to estimate the prevalence of depressive disorders and the influence of sociodemographic characteristics on primary healthcare (PHC) setting in Kuwait. SUBJECTS AND METHODS: A cross-sectional survey was conducted in PHC setting in Kuwait using the Beck Depression Inventory second edition questionnaire (BDI II) as a screening instrument, together with a sociodemographic questionnaire. A representative sample drawn from the target population consisted of 2,320 subjects of Kuwaiti nationality randomly selected from 18 PHC centers covering all Kuwait governorates during the period from April 2003 to January 2004. The target age group was 21-64 years. Participants were asked to complete the BDI II questionnaire consisting of 21 items reflecting the depressive disorder independently. Sociodemographic data such as sex, age, marital status, children, occupation, educational status, chronic diseases and social problems were included in the questionnaire. The optimum cutoff score for BDI II was estimated. RESULTS: A total of 2,320 participants completed the questionnaire, 1,082 (46.8%) male and 1,237 (53.2%) female; 860 (37.1%) screened positive for depressive symptoms, among whom 352 (15.3%) were male and 508 (21.7%) female. Of all participants, 163 (7.0%) were severely depressed, 314 (13.5%) moderately depressed and 383 (16.5%) mildly depressed. Depressive disorder was more prevalent among women than men, young than old, more among highly educated individuals, working participants, married individuals, and parents with 3 or more children. CONCLUSION: Depressive disorder is a highly prevalent condition among Kuwaiti patients attending PHC setting. Chronic diseases and social problems are risk factors for depressive disorder.

[Utility of gas chromatography for the identification of mycobacterial species]. / Utilidad de la cromatografia gaseosa para la identificación de micobacterias.

The human immunodeficiency virus (HIV) epidemic has altered the epidemiological profile of tuberculosis in both industrialized and developing countries. Serious diseases caused by mycobacteria other than Mycobacterium tuberculosis, mostly belonging to the M. avium-intracellulare complex (MAC), have become very common in association with severe immunosuppression. The increase in mycobacterial disease complexity has stimulated the development of more rapid and efficient methods for diagnosis. In the present study, we investigated and assessed the suitability of a gas-liquid chromatography technique for diagnosis of clinically important mycobacteria in Argentina. An identification scheme was developed from the results obtained in a previous study where we characterized the cellular fatty acids and the mycolic acid cleavage products from most frequent species in Argentina. Of 183 isolates tested, 69% were correctly identified to species level and 5% were incorrectly classified. If we only take into account the isolates that could be identified, 93% were correctly identified. Although all of the isolates of M. tuberculosis were correctly identified, four isolates of MAC incorrectly matched by M. tuberculosis. Gas chromatography provides a rapid technique of highly predictive value for mycobacteria identification; it could be used in reference laboratories as a rapid presumptive identification until the biochemical tests are completed.

[Characterization of fatty acids and mycolic acid degradation products in mycobacterial species of major incidence in Argentina]. / Caracterización de ácidos grasos y productos de degradación de ácidos micólicos en especies micobacterianas de mayor incidenica en Argentina.

The human immunodeficiency virus (HIV) epidemic has altered the epidemiological profile of tuberculosis in both industrialized and developing countries. Serious diseases caused by mycobacteria other that M. tuberculosis, mostly belonging to the M. avium-intracellulare complex (MAC), have become very common in association with severe immunosuppression. The increase in mycobacterial disease complexity has stimulated the development of more rapid and efficient methods of diagnosis. In the present study we characterized the cellular fatty acids and the mycolic acid cleavage product from most frequent mycobacteria species in Argentina using gas chromatography in order to develop a rapid technique for their identification. Fatty acids and mycolic acids extracted from saponified mycobacterial cells were examined as methyl esters by capillary has chromatography. The major constituent fatty acids in all species, with the exception of M. smegmatis, were octadecenoic (18:1) and hexadecanoic (16:1) acids. The fatty acids and mycolic acid cleavage product profiles from the studied species were quantitatively but not qualitatively different. Tuberculostearic acid was found in all species. Significantly different amounts of some fatty acids (p < 0.01) were observed among clinical isolates of M. tuberculosis, M. bovis and MAC. Traces of 2-eicosanol were detected in the M. tuberculosis H37Rv strain. Although a limited number of strains and species were tested, preliminary results indicate that this method could be used to characterize mycobacterial cultures.

Maternal height and labour outcome.

The aim of this study was to assess if maternal height has an effect on duration of labour, mode of delivery and birth weight. This was a retrospective analysis of casenotes of 1000 white primigravidae in a district general hospital. Spearman's rank correlation coefficient, logistic regression analysis, and Pearson's correlation coefficient was used to determine the relation between height and duration of labour, height and mode of delivery and birth weight, respectively. Odds ratio was used to quantify the association. There was no significant association between height and duration of labour. There was a statistically significant positive correlation between height and birth weight and a negative association between height and incidence of caesarean sections. A cut-off height of 160 cm is proposed as a screening tool to predict a need for caesarean section.

Management of uterine fibroids.

Until recently the management of uterine fibroids has been exclusively surgical in the form of either hysterectomy or myomectomy. The development of minimally invasive techniques and the introduction of LHRH agonists has allowed more conservative management to maintain or restore fertility.

Obstetric outcome in women over the age of 40 years.

This is a retrospective review of 109 deliveries during a 5-year period in women aged 40 years or over and the results were compared with other studies in literature. The incidence was 1%. There was no increase in complications of pregnancy though there was an increased caesarean section rate and perinatal mortality rate. It is imperative that all mature pregnant women are managed as a high risk group but we should be mindful of the need to justify intervention in the same way as in the younger age group.

The effect of hysterectomy on urinary symptoms and residual bladder volume.

This was a prospective, clinical study to evaluate the effect of abdominal and vaginal hysterectomy for benign indications on urinary symptoms and residual bladder volume. One hundred and seven women undergoing hysterectomy for benign conditions were included in the study that took place in a district general hospital between April 1998 and January 2000. Urinary symptoms such as stress incontinence of urine, urgency, frequency, nocturia, sensation of incomplete voiding and voiding difficulties were considered. A questionnaire was filled out and the residual bladder volume measured with a 'Bard' bladder scanner on three occasions-before the operation, postoperative days 3 or 4 and at the 6-week postoperative visit. Statistical analysis involved using a generalised estimating equation and significance assessed at the 5% level. Each woman acted as her own control. There was no evidence of changes in nocturia and voiding difficulties after surgery. All other symptoms and residual bladder volumes decreased significantly postoperatively. The type of hysterectomy did not have an effect.

The influence of religious beliefs on general practitioners' attitudes towards termination of pregnancy--a pilot study.

We set out to examine the attitudes of general practitioners in the West Norfolk area towards requests for abortion for various reasons and explore the factors that may influence their views, particularly their religious beliefs. This cross-sectional survey was conducted using a questionnaire, targeting 140 general practitioners. A response rate of 51.4% was achieved. All respondents were older than 30, and were mostly males (84.6%), married (93.8%) with children (90.9%). Most were either Church of England Christians (C of E) (48.5%) or had no stated religion (35.3%). The former were significantly less likely to agree with abortion than the latter for social reasons (P = 0.02) or in the case of teenage pregnancy (P = 0.006). A total of 73.8% of respondents followed-up patients after termination. Other associations were indicated, but were not statistically significant. Larger studies are needed to verify these associations for general practitioners in general.

Assessment of women's satisfaction with medical termination of pregnancy.

This was a prospective study involving 205 women seeking medical abortion with gestational age

Vaginal sacrospinous fixation: experience in a district general hospital.

This is an observational retrospective study, which included 77 patients who underwent sacrospinous fixation (SSF) over a period of 3 years in a district general hospital. Casenotes were reviewed and all patients were invited to attend a further review appointment (14-49 months). The object was to determine short- and long-term success of SSF,particularly in elderly (28% were > or = 70 years), obese (24.7%) and medically compromised (64.9%) patients. Fifty-two patients (67.5%) had previous gynaecological procedures, while the remaining 25 (32.5%) had no previous surgery. Intra- and postoperative complications were 3.9% and 32.5%, respectively. There was considerable relief of patients' symptoms at both short- and long-term followup, while the rate of recurrence of vault prolapse was 10.3%. Our experience suggests that SSF appears to be a safe and effective procedure, especially for those who may constitute surgical or anaesthetic risks. It has a reasonable success rate, good postoperative recovery and acceptable long-term results.

Vaginal pressure as an index of intra-abdominal pressure during urodynamic evaluation.

Vaginal pressure was measured using balloon catheters in 20 patients and open-ended fluid-filled catheters in another 21. The results showed excellent correlation between vaginal, vesical and rectal pressures in response to changes in abdominal pressure.