Evaluation of factors affecting patients' refusal of HCV treatment in a cohort of Egyptian patients

BACKGROUND

Treatment refusal, defined as active refusal of a patient to receive treatment despite physician recommendations, has not been extensively evaluated before in hepatitis C virus in the era of direct acting antivirals.

OBJECTIVE

To investigate the reasons for refusal to receive hepatitis C virus treatment in Egypt.

METHODS

an observational study conducted between July 2018 and November 2019 in Egypt. Enrollment was done to all patients who refused to get hepatitis C virus treatment during the national screening and treatment campaign. Reasons for their refusal were identified using a questionnaire as an instrument for data collection.

RESULTS

Out of the 220 280 Egyptian hepatitis C virus patients who did not show up to start treatment and were contacted to get therapy, only 84 patients (0.038%) refused to receive treatment. The main reason for their refusal was having concerns about treatment (82.14%) and their main concern was the fear of adverse events (85.5%). Other causes of refusal were non-satisfactory experience at treatment centers (13.09%) and patients preferred to receive complementary and alternative medicines (4.7%). Most patients (65.4%) trusted the efficacy of directly acting antivirals for hepatitis C. None of the study participants was found to suffer from any psychiatric morbidity and the average score of the GHQ-12 was 10.7155.

CONCLUSION

Proper health education and awareness regarding hepatitis C virus treatment safety and efficacy is needed to increase treatment acceptance rates.

Evolution of liver fibrosis after interferon-based anti-hepatitis C virus therapy failure in 3,049 chronic hepatitis C patients without cirrhosis

BACKGROUND AND STUDY AIMS

Liver fibrosis is the underlying causeof hepatitis C virus (HCV)-related disease progression to endpoints such as cirrhosis, liver failure, and hepatocellular carcinoma. The aim of our study was to assess changes in hepatic fibrosis in patients with chronic HCV who had a fibrosis evaluation at two time points at least six months apart.

PATIENTS AND METHODS

This was a retrospective cohort study that included patients who had failed interferon therapy and received HCV retreatment with direct-acting antivirals (DAAs) at least six months later. Patients were evaluated previously for fibrosis according to liver biopsy and fibrosis biomarkers were evaluated before pegylated interferon and ribavirin (PEG/RBV) therapy. Fibrosis was re-evaluated with fibrosis-4 (FIB-4) scores before starting DAAs.

RESULTS

A total of 3,049 patients were included [age 43.47 ± 9.07 years, 55.20 % males] and baseline histopathology showed F1, F2, and F3 in 16.86 %, 46.21 %, and 36.93 %, respectively. The mean time interval between the last dose of previously failed IFN-therapy to the first dose of DAAs was 2.38 (±1.07) years. Overall, there was a significant increase in FIB-4 scores at retreatment times (from 11.71 ± 1.13 to 22.26 ± 1.68, p < 0.001). Patients with baseline FIB-4 < 1.45 (n = 1,569) and between 1.45 and 3.25 (n = 1,237) had significant increases in their FIB-4 at the retreatment time point [median difference; 0.41 (0.91) and 0.24 (1.5), p < 0.001, respectively], whereas patients with FIB-4 > 3.25 had significant reduction of their FIB-4 score at a retreatment timepoint [-0.98 (2.93), p ≤ 0.001].

CONCLUSION

Fibrosis progressed in most patients, even within six months for some patients, and this indicates retreatment of non-system vascular resistance patients even if they do not have significant fibrosis.

Nationwide hepatitis C virus screening and treatment of adolescents in Egyptian schools

Until 2018, Egypt had the highest prevalence of hepatitis C virus (HCV) infection globally, affecting approximately 7% of the population. Despite efforts in diagnosis and treatment since 2006, nearly 2 million individuals with chronic HCV infection had yet to be diagnosed as of early 2018. In December, 2018, a mass HCV screening campaign for adolescents aged 15-18 years was initiated. Among 3 024 325 adolescents screened, the HCV antibody seroprevalence was 11 477 (0·38%), of whom 8187 (78·7%) were HCV RNA-positive. Sustained virological response 12 weeks after completion of treatment (SVR12) was attained by 7327 (99·6%) adolescents with a fixed-dose combination of generic ledipasvir 90 mg plus sofosbuvir 400 mg. Although mass screening in this age group might not be regularly adopted by many health systems and its cost-effectiveness might be lower than the screening of adults and high-risk groups (eg, patients on haemodialysis, people who inject drugs), breaking the chain of transmission in younger populations should lead to a reduction in HCV incidence and complications, and hasten the elimination of the disease.

Effect of heating on the oxidative stability of corn oil and soybean oil

The effects of conventional and microwave heating on the oxidative properties of corn and soybean oil were evaluated. The results showed that acid value, peroxide value, oxidative indices, total oxidation value, and p-anisidine values changed significantly with the rise in temperature (p < 0.05). The peroxide and p-anisidine values for corn oil (PV: 50.670 meqO2/kg, p-AV: 8.248) were greater than soybean oil (PV: 41.694 meqO2/kg, p-AV: 7.566) for conventional heating. The peroxide and p-anisidine values for soybean oil (PV: 6.545 meqO2/kg, p-AV: 76.539) were greater compared to corn oil (PV: 5.074 meqO2/kg, p-AV: 65.360) for microwave heating. The results concluded that microwave heating had a greater impact on the chemical degradation of the fatty acids of the oil. The FT-IR spectra showed peak changes at 3743 cm-1 and 1739 cm-1 and confirmed the rancidity of the oils from microwave heating due to the formation of secondary oxidation products. It was concluded that corn oil showed more oxidative changes compared to soybean oil.

Potential Diagnostic and Prognostic Value of Lymphocytic Mitochondrial DNA Deletion in Relation to Folic Acid Status in HCV-Related Hepatocellular Carcinoma

Objective:

We assessed the possibility of using mitochondrial (mt) DNA deletion as a molecular biomarker for disease progression in HCV-related hepatocellular carcinoma (HCC) and to identify its association with folic acid status.

Methods:

Serum folic acid and lymphocytic mtDNA deletions were assessed in 90 patients; 50 with HCC, 20 with liver cirrhosis (LC), and 20 with chronic hepatitis C (CHC) compared to 10 healthy control subjects. The diagnostic accuracy of mtDNA deletions frequency was evaluated using receiver-operating characteristic (ROC) curve analysis Survival analysis was performed using the Kaplan-Meier method. Differences in the survival rates were compared using log-rank test.

Result:

Our data revealed a significant elevation of mtDNA deletions frequency in the HCC group compared to the other groups (P-value <0.01). Also, our data showed a significant correlation between folate deficiency and high frequency of mtDNA deletions in patients with HCV-related HCC when compared to the other groups (r= -0.094 and P-value <0.05). Moreover, the size of the hepatic focal lesion in the HCC patients was positively correlated with mtDNA deletions (r= 0.09 and P-value <0.01). The median survival time for the HCC patients with high frequency of mtDNA deletions (∆Ct ≥3.9; 5.7+ 0.6 months) was significantly shorter than those with low mtDNA deletions frequency (∆Ct < 3.9; 11.9+ 0.04 months, P-value <0.01).

Conclusion:

Our data provided an evidence that lymphocytic mtDNA deletion could be used as non-invasive biomarker for disease progression and patients’ survival in HCV-related HCC. Also, our findings implied a causal relationship between the folate deficiency and the high mtDNA deletions frequency among Egyptian patients with HCV related HCC.

Varietal Preferences and Within-Orchard and Tree Distribution of Newly Recorded Gall Midges, Dasineura amaramanjarae and Procontarinia mangiferae (Diptera: Cecidomyiidae), From Commercial Mango Cultivars in Pakistan

Gall midges (Diptera: Cecidomyiidae) damage mango by feeding on flowers and fruit tissues, inducing galls on leaves, and providing inoculums of anthracnose. Dasineura amaramanjarae Grover and Procontarinia mangiferae (Felt), two gall midges that damage flowers in all mango-growing areas of the world, have recently been recorded in Pakistan, and studies were conducted in 2011 and 2012 on the within-tree and orchard distribution patterns and cultivar preference of both species in Pakistan at one location (Rahim Yar Khan). Both gall midge species were found on all mango cultivars examined (Chaunsa, Fajri, Dusehri, Surkha, Sindhri, and Anwar Ratul), with the most damage occurring to Surkha and Dusehri. Research on midge distribution patterns in different parts of mango orchards (central, southern, northern, eastern, and western sides) showed these species to be found in all areas, with the greatest numbers in the central and southern regions. In addition, both species were most abundant on the lower parts of the mango tree canopy.

Value of kidney-ureter-bladder radiography in the erect position in addition to standard intravenous urography examination

OBJECTIVES

To determine if additional kidney-ureter-bladder radiography in the erect position can improve the diagnostic yield of standard intravenous urography (IVU) examination.

SUBJECTS AND METHODS

This prospective study was conducted from March to July 2007 on 108 consecutive patients (65 males and 43 females, age ranging from 20 to 50 years) who were referred to the Department of Radiology, Al-Amiri Hospital, Kuwait, for IVU examinations. After 15 min, a film was done in the erect position in addition to the routine IVU protocol.

RESULTS

Additional information was demonstrated in the erect radiograph as follows: detecting nephroptosis in 18 (17%) patients, improved visualization of the ureters in 58 (54%) patients, and differentiation between phleboliths and ureteric stone was possible in 12 (11%) patients.

CONCLUSIONS

Our study demonstrated significant additional findings in the erect position (at 15 min) compared to the supine position.

Kinetics of bromination of safranine by peroxydisulphate ion in presence of bromide ion

Kinetics of bromination safranine by peroxydisulphate ion in presence of bromide ion has been investigated at various temperatures and ionic strengths. The rate followed first order kinetics in peroxy disulphate and bromide ion each, and zero order kinetics in safranine. A linear relation was obtained for the variation of logarithm of rate constant (log k) with the square root of ionic strength of the media (mu). The rate constants for the rate controlling step were evaluated and interpreted as a function of ionic strengths and temperatures. The values of activation parameters were also computed.

Renal transplant experience at king fahad national guard hospital

Between September 1988 and end of 1995, 170 renal transplantations were performed at the King Fahad National Guard Hospital, Riyadh. There were 102 cadaver donor (CAD) and 68 living related donor (LRD) transplants. All patients received triple drug immunosuppression. Patients with delayed graft function received anti-thymocyte globulin instead of cyclosporin until recovery of graft function. The 1,3 and 5 year graft survival was as follows: all transplants 83.5%, 77.6%, 74.7% respectively; LRD transplants, 89.7%, 85.2%, 80.9% respectively; CAD transplants, 81.0%, 72.5%, 70.5% respectively. The commonest cause of graft loss was chronic rejection. The 1,3 and 5 year patient survival was as follows: all transplants, 97.0%, 94.7%, 93.5% respectively; LRD transplants, 98.5%, 97.0%, 95.5% respectively; CAD transplants, 96.0%, 93.0%, 92.0% respectively. The overall results in our center are comparable to those published from other centers in Saudi Arabia and abroad.