Detecting cyberbullying using deep learning techniques: a pre-trained glove and focal loss technique

This study investigates the effectiveness of various deep learning and classical machine learning techniques in identifying instances of cyberbullying. The study compares the performance of five classical machine learning algorithms and three deep learning models. The data undergoes pre-processing, including text cleaning, tokenization, stemming, and stop word removal. The experiment uses accuracy, precision, recall, and F1 score metrics to evaluate the performance of the algorithms on the dataset. The results show that the proposed technique achieves high accuracy, precision, and F1 score values, with the Focal Loss algorithm achieving the highest accuracy of 99% and the highest precision of 86.72%. However, the recall values were relatively low for most algorithms, indicating that they struggled to identify all relevant data. Additionally, the study proposes a technique using a convolutional neural network with a bidirectional long short-term memory layer, trained on a pre-processed dataset of tweets using GloVe word embeddings and the focal loss function. The model achieved high accuracy, precision, and F1 score values, with the GRU algorithm achieving the highest accuracy of 97.0% and the NB algorithm achieving the highest precision of 96.6%.

Comparative performance of ensemble machine learning for Arabic cyberbullying and offensive language detection

Since cyberbullying impacts both individual victims and entire society, research on abusive language and its detection has attracted attention in recent years. Because social media sites like Facebook, Instagram, Twitter, and others are so widely accessible, hate speech, bullying, sexism, racism, aggressive material, harassment, poisonous comments, and other types of abuse have all substantially increased. Due to the critical requirement to detect, regulate, and limit the spread of harmful content on social networking sites, we conducted this study to automate the detection of offensive language or cyberbullying. We created a new Arabic balanced data set to be used in the offensive detection process because having a balanced data set for a model would result in improved accuracy models. Recently, the performance of single classifiers has been improved using ensemble machine learning. The purpose of this study is to examine the effectiveness of several single and ensemble machine learning algorithms in identifying Arabic text that contains foul language and cyberbullying. Applying them to three Arabic datasets, we have selected three machine learning classifiers and three ensemble models for this aim. Two of them are offensive datasets that are readily accessible in the public, while the third one was created. The results showed that the single learner machine learning strategy is inferior to the ensemble machine learning methodology. Voting performs is the best performing trained ensemble machine learning classifier, outperforming the best single learner classifier (65.1%, 76.2%, and 98%) for the same datasets with accuracy scores of (71.1%, 76.7%, and 98.5%) for each of the three datasets used. Finally, we improve the voting technique’s performance through hyperparameter tuning on the Arabic cyberbullying data set.

O-009 Controlled ovarian stimulation (COS) protocols for assisted reproduction: a Cochrane systematic review and network meta-analysis

Study question

What is the relative effectiveness and safety of existing COS protocols for women undergoing assisted reproductive technology (ART) treatment?

Summary answer

There was no difference in live birth between all protocols, but short antagonist protocols may reduce ovarian hyperstimulation syndrome in women with predicted normal/high response.

What is known already

Controlled ovarian stimulation is an essential step in most ART cycles. It involves the administration of exogenous gonadotrophins to induce multifollicular growth, usually in addition to drugs that prevent untimely ovulation by suppressing the pituitary gland. Different treatment combinations may be used in COS. These vary according to the type of drugs administered for pituitary suppression (e.g., gonadotrophin-releasing hormone [GnRH] agonists, antagonists) and ovarian stimulation (e.g., urinary or recombinant gonadotrophins). Drug dosages, timing and routes of administration also vary between different regimens. However, there is no consensus on how the existing COS protocols rank according to their effectiveness and safety.

Study design, size, duration

We searched the following databases to November 2021: MEDLINE, EMBASE, CINAHL, CENTRAL and ClinicalTrials.gov. We included randomised controlled trials (RCTs) comparing at least two COS protocols using GnRH agonists or antagonists for pituitary suppression; and human menopausal gonadotrophin (hMG), urinary or recombinant follicle-stimulating hormone (u/rFSH), with or without luteinising hormone (LH) for ovarian stimulation. The primary outcomes were the rates of live birth (LBR) and ovarian hyperstimulation syndrome (OHSS) per participant after one stimulation cycle.

Participants/materials, setting, methods

Two reviewers independently selected studies and extracted data. We conducted pairwise and network meta-analyses (NMA) according to participants’ predicted response to COS (normal, high and low). Using the Cochrane-RoB-1 tool, we restricted our primary analyses to RCTs at low risk of selection and other biases. We presented effect estimates as risk ratio (RR) with 95% confidence interval (CI) and considered I2>50% as representing substantial heterogeneity. For each outcome, we generated ranking plots comparing different interventions.

Main results and the role of chance

In total, our searches identified 9464 studies. The primary analysis included 68 RCTs assessing 17861 women and 34 different COS protocols. The evidence showed that in women with predicted normal or high response, the use of short GnRH antagonist protocols may result in little to no difference in LBR (RR 0.98, 95% CI 0.85 to 1.13; 6 studies; 2063 women; I2 = 0%; low-certainty evidence) and a reduction in OHSS (RR 0.88, 95% CI 0.78 to 0.99; 7 studies; 2246 women; I2 = 0%; low-certainty evidence) compared with long GnRH agonist protocols. The rankogram comparing different COS protocols showed a probability of 98% that short GnRH antagonist regimens are the best treatment to prevent OHSS. Sensitivity analyses including all studies showed that in women with predicted normal response undergoing long GnRH agonist cycles for pituitary suppression, the use of rFSH for ovarian stimulation may result in decreased fresh-cycle LBR compared to hMG (RR 0.80, 95% CI 0.68 to 0.95; 7 studies; 1575 women; I2 = 1%; low-certainty evidence). For the remaining interventions (e.g., agonist flare or progestogens for pituitary suppression, in combination with various gonadotrophin regimens) the evidence was uncertain of an effect or insufficient for quantitative synthesis.

Limitations, reasons for caution

The high number of interventions resulted in disconnected networks, limiting our ability to perform NMA for some comparisons. The certainty of the evidence was limited by serious risk of bias. Finally, the lack of data on cumulative LBR and differences in oocyte yield made comparisons between FSH preparations potentially unbalanced.

Wider implications of the findings

Our findings suggest that the use of short GnRH antagonist protocols may result in reduced OHSS rates in women with predicted normal or high ovarian response without compromising live birth rates. There is a paucity of high-quality RCTs comparing different gonadotrophin preparations (e.g., hMG versus rFSH) for COS.

Trial registration number

N/A

Comparative Performance of Ensemble Machine Learning for Arabic Cyberbullying and Offensive Language Detection.. [DOI: 10.21203/rs.3.rs-1730412/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

In recent years, research on abusive language and cyberbullying detection have gained a great deal of interest since it affects both individual victims and societies. Hateful communications, bullying, sexism, racism, aggressive content, harassment, toxic comments, and other forms of abuse have all increased dramatically due to the ease of access to social media platforms such as Facebook, Instagram, Twitter, and others. As a result, there is a significant need to identify, manage, and restrict the spread of offensive content on social networking sites, prompting us to perform this study to automate the detection of offensive language or cyberbullying. Having a balanced data set for a model would generate higher accuracy models, thus we build a new Arabic balanced data set to be used in the process of offensive detection. Lately, Ensemble Machine Learning has been used to enhance the performance of single classifiers. The aim of this study is to compare the performance of different single and ensemble machine learning algorithms in detecting Arabic text containing cyberbullying and offensive language. For this purpose, we have chosen three machine learning classifiers and three ensemble models and apply them to three Arabic datasets two of them are offensive datasets that are publicly available, and the third one which we constructed. The results showed that the ensemble machine learning methodology outperforms the single learner machine learning approach. Voting performs is the best among the trained ensemble machine learning classifiers, with accuracy scores of (71.1%, 76.7%, and 98.5%) for the three used datasets respectively, exceeding the score obtained by the best single learner classifier (65.1%, 76.2%, and 98%) for the same datasets. Finally we use hyperparameters tunning on the Arabic cyberbylluing data set to optize the performance of the voting technique.

The Effect of Rebalancing Techniques on the Classification Performance in Cyberbullying Datasets.. [DOI: 10.21203/rs.3.rs-1730456/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Machine learning plays an increasingly significant role in the building of Cyberbullying detection systems. In cyberbullying datasets, the percentage of normal labeled classes is higher than the percentage of abnormal labeled ones, which is called as class imbalance problem in data mining. Class imbalance is a challenging problem in classification, especially in the two-class dataset. Conventional machine learning methods also decrease classification performance for unseen samples of the minority class when class distributions are imbalanced. This is because the model appears to be extensively influenced by the majority class. Many researchers have proposed over-sampling and under-sampling techniques in the literature to solve this problem. In this paper, the effect of over-sampling and under-sampling techniques in cyberbullying datasets is examined. For the experimental study, first we perform a preprocessing step to improve the performance of machine learning algorithms. Then we examine the effect of the imbalanced data on the classification performance for four cyberbullying datasets. To study the classification performance on the balanced cyberbullying datasets, four resampling techniques (namely, Random under-sampling, Random Oversampling, SMOTE, SMOTE + TOMEK) are used to rebalance these datasets. The impact of each rebalancing technique on the classification performance using 8 well-known classification algorithms is examined. Our experiments showed that the performance of resampling technique depends on the dataset size, the imbalance ratio, and the classifier used. The conducted experiments proved that there are no techniques that will always perform better the others.

Chitosan-CdS Quantum Dots Biohybrid for Highly Selective Interaction with Copper(II) Ions

Cadmium sulfide (CdS) quantum dots (QDs) were homogeneously embedded into chitosan (CTS), denoted as CdS@CTS, via an in situ hydrothermal method. The intact structure of the synthesized materials was preserved using freeze-drying. The materials were characterized using X-ray diffraction (XRD), X-ray photoelectron spectroscopy, transmission electron microscopy, high-resolution TEM, scanning TEM, dispersive energy X-ray (EDX) for elemental analysis and mapping, Fourier transform infrared spectroscopy, nitrogen adsorption-desorption isotherms, thermogravimetric analysis, UV-vis spectroscopy, and diffuse reflectance spectroscopy (DRS). The synthesis procedure offered CdS QDs of 1-7 nm (average particle size of 3.2 nm). The functional groups of CTS modulate the in situ growth of CdS QDs and prevent the agglomeration of CdS QDs, offering homogenous distribution inside CTS. CdS@CTS QDs can also be used for naked-eye detection of heavy metals with high selectivity toward copper (Cu²⁺) ions. The mechanism of interactions between Cu²⁺ ions and CdS@CTS QDs were further studied.

Relation between the severity of liver cirrhosis and neurological symptoms, nerve conduction study results, and motor unit number estimation

Liver cirrhosis is a global health problem that can be associated with several neurological manifestations. We aimed to assessment of the relation between the severity of the liver cirrhosis and the neurological symptoms, nerve conduction studies (NCS), as well as detecting subclinical neuropathic affection using motor unit number estimation (MUNE) technique. This cross-sectional study was conducted on 56 cirrhotic patients and 61 age- and sex-matched healthy controls. Neurological manifestations, Child-Pugh classification, Model for End-Stage Liver Disease score, NCS and MUNE using a modified spike-triggered averaging technique were studied. Forty-five (80.3%) of the cirrhotic patients had neurological manifestations. Muscle cramps were the most frequently reported manifestation, followed by fatigue and then numbness. NCS abnormality was significantly related to the presence of neurological symptoms (p < 0.001) and not only to peripheral numbness. Only fatigue was significantly related to the lower MUNE values (p < 0.017). Child-Pugh classification progression was significantly related to the presence of fatigue and abnormal NCS results (p < 0.001); no similar relation was detected between the Child-Pugh classification and the MUNE value (p = 0.103). Higher MELD scores were significantly related to NCS abnormalities (p = 0.014) and negatively correlated, although not significantly, with the MUNE values (r = -0.246 and p = 0.067). The progression of liver cirrhosis was related to the presence of neurological manifestations and nerve conduction abnormalities. Nerve conduction abnormalities may be present even in the absence of clinical numbness. A decline in motor unit number could explain the pathophysiology of fatigue in cirrhotic patients.

The Impact of Type 2 Diabetes Mellitus on the Markers of Osteoporosis (Sclerostin and CTRP3) in Postmenopausal Women: A Comparative, Observational, Study.. [DOI: 10.21203/rs.3.rs-67681/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background In the present study, our goal was to assess the impact of type 2 diabetes mellites (T2DM) on osteoporosis markers (sclerostin and CTRP3) among postmenopausal women, and whether sclerostin and CTRP3 can be used as early biomarkers of osteoporosis/osteopenia in T2DM patients. Methods In a comparative, observation, study, a total of 30 postmenopausal women with osteoporosis/osteopenia and T2DM were included, as well as 30 non-diabetic women with osteoporosis/osteopenia. Thirty age and sex-matched healthy women were included as control groups. The enzyme-linked immunosorbent assay (ELISA) was used to assess the serum levels of sclerostin and CTRP3. Results A total of 90 women were included in the present study (30 patients per group). The serum CTRP3 was significantly lower in the DM-OST (3.45 ± 3.5 ng/dL) and OST (9.15 ± 3.65 ng/dL) groups than the control group (16.80 ± 0.55 ng/dL; p < 0.001); likewise, the serum sclerostin was higher in the DM-OST (109.95 ± 28.96 pmol/L) and OST (51.52 ± 23.18 pmol/L) than the control group (11.22 ± 1.21 pmol/L; p < 0.001). Notably, the serum CTRP3 was significantly lower and sclerostin was significantly higher in the DM-OST group than the OST group (p < 0.001)). In the DM + OST and OST groups, the serum CTRP3 correlated positively with BMD of lumbar spines, left femur, and left forearm. Serum CTRP3 was associated with lower risk of osteoporosis (OR) and diabetes (OR) in postmenopausal women. In addition, the serum sclerostin was associated with higher risk of osteoporosis (OR) and diabetes (OR) in postmenopausal women. Conclusion The present study provides a novel evidence about the impact of T2DM on osteoporosis biomarkers, serum CTRP3 and sclerostin. The results indicated that women with combined T2DM and osteoporosis/osteopenia exhibited more dysregulation in both biomarkers than women with osteoporosis/osteopenia. alone. Thus, serum CTRP3 and sclerostin can be used as biomarkers for early detection of osteoporosis in diabetic patients.

Clinical utility of transient elastography as an imaging tool to assess the short-term impact of laparoscopic sleeve gastrectomy, together with clinical and biochemical parameters and clinico-biochemical indices, on obese patients with nonalcoholic fatty liver disease: An Egyptian pilot study

INTRODUCTION

Nonalcoholic fatty liver disease (NAFLD) is a metabolic liver disorder commonly attributed to fatty acid deposition that can induce hepatic necroinflammation, defined as nonalcoholic steatohepatitis (NASH). It is strongly associated with obesity. Laparoscopic sleeve gastrectomy (LSG) is a favorable surgical modality for the treatment of morbid obesity.

AIM

Our study evaluated the impact of LSG on patients with NAFLD and morbid obesity, 3 months after the operation, through clinical and biochemical characteristics, clinico-biochemical indices, and imaging parameters.

PATIENTS AND METHODS

Morbidly obese patients with NAFLD±NASH underwent LSG. They were thoroughly evaluated clinically (body weight, body mass index, waist circumference) and biochemically (transaminases and triglycerides), as well as through the fatty liver index (FLI), the hepatic steatosis index (HSI), and ultrasound elastography imaging studies (liver stiffness measurement [LSM] and the controlled attenuation parameter [CAP]), before and 3 months after the LSG.

RESULTS

Twenty-six obese patients with NAFLD underwent LSG that resulted in a significantly high reduction in all the parameters analyzed, except for liver transaminases.

CONCLUSION

LSG is considered an efficient surgical modality for the treatment of morbidly obese patients with NAFLD.

Serum microRNA let-7a-1/let-7d/let-7f and miRNA 143/145 Gene Expression Profiles as Potential Biomarkers in HCV Induced Hepatocellular Carcinoma

Background:

Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide. Which make liver cirrhosis and hepatocellular carcinoma (HCC) major health concerns in Egypt. Circulating microRNAs (miRNAs) have been investigated as biomarkers for malignancies. We investigated miRNA gene expression of Lethal-7 (let-7) cluster: let7-a-1, let-7d-1, let-7f-1 and miRNA (miR)143/145 cluster in sera of HCC patients and chronic HCV patients.

Methods:

The study included 40 post HCV-Hepatocellular carcinoma patients, 40 chronic HCV patients divided into 2 subgroups, 20 cirrhotic patients and 20 non-cirrhotic patients, and 40 apparently healthy subjects as a control group. Gene expression analysis for studied miRNAs was done using quantitative SYBR Green reverse-transcription Real-Time polymerase chain reaction (PCR).

Results:

We found that Let-7a-1 gene expression was significantly downregulated in the serum of HCV-HCC patients than in HCV non HCC cirrhotic group and was significantly upregulated in the serum of liver cirrhosis patients than HCV non-cirrhotic group. miR-143 and miR-145 expressions were significantly downregulated in the serum of HCC patients than in control group and miR-143 was significantly downregulated in the serum of non-cirrhotic HCV patients than in control group.

Conclusion:

The downregulation of serum let-7-a1, miR-143, and miR-145 gene expression may exhibit significant influence on the development of HCC in chronic HCV Egyptian patients and can be used as biomarkers for HCC diagnosis.

Dispersed Ag2O/Ag on CNT-Graphene Composite: An Implication for Magnificent Photoreduction and Energy Storage Applications

A simple hydrothermal route assisted by a triblock copolymer was used to synthesize Ag2O/Ag nanoparticles on a robotic support consists of functionalized MWCNTs and graphene composite (Ag2O/Ag/CNT-graphene). The composites together with the individual analog of Ag/CNT and Ag/graphene were characterized by means of XRD, TEM-SAED, N2 sorptiometry, Raman, FTIR, UV-Vis, and photoluminescence spectroscopy. These nanomaterials were then tested for the catalytic reduction of 4-nitrophenol (4-NP) to the technologically beneficial 4-aminophenol (4-AP). The Ag2O@Ag@CNT-graphene composite calcined at 400°C has shown fascinating reduction performances for 4-NP either in the dark (k = 0.014 s-1) or under visible light illumination (k = 0.039 s-1) in the presence of 5 mM NaBH4 compared to Ag/CNT (0.0112 s-1) and Ag/graphene (0.010 s-1) catalysts. This was chiefly because Ag2O@Ag@CNT-graphene comprises the highest pore volume (0.49 cm3/g) and involves three types of pores in the margin from 1.8 to 4.0 nm in front of only one modal type of pores for the rest of the catalysts and thus maximizes the adsorptive capacity of the reactants (4-NP and NaBH4). Moreover, the former composite exhibits the highest concentration of the Ag2O component as established by numerous techniques in addition to the cyclic voltammetry, proposing it's facile reaction with 4-NP along with the simultaneous transfer of surface hydrogen and electrons from NaBH4 ions to produce 4-AP. The promotion of the p-n junction evaluated using the Mott-schottky equation on Ag2O@Ag@CNT-graphene assisted by charges separation and surface plasmon resonance bands of Ag and Ag2O are found to be advantageous for 4-NP reduction. The latter composite delivers a specific capacitance of 355 F g-1 at 1.0 A g-1 exceeding those of Ag/CNT (230 F g-1) and Ag/graphene (185 F g-1). The EIS study establishes the high electronic conductivity of the metallic Ag and Ag2O moieties, low internal resistance of CNT-graphene as well as the marked ionic transfer facilitated by the composite porous nature.

Effect of treatment with direct acting antivirals on body mass index and hepatic steatosis in chronic hepatitis C

Direct Acting Agents (DAAs) have high cure rate but still lack the knowledge of their effect on hepatic steatosis in chronic hepatitis C (CHC). Controlled Attenuation Parameter (CAP), evaluated with transient elastography, could help in assessment of steatosis grades. We aim to evaluate the effect of DAAs on BMI and steatosis in CHC using CAP. This cohort study included 155 CHC Egyptian patients divided into three groups according to the DAAs regimens. All patients were subjected to pre-treatment and 3-months post-treatment evaluation including BMI, laboratory workup and liver stiffness measurement with simultaneous CAP determination using the (FibroScan®) M probe. Patients mean age was 45.78 ± 11.6 years, 60.6% were females, mean BMI 26.63 ± 2.75 and 18.1% were cirrhotic. Baseline assessment revealed no steatosis in 43.9%, 32.9% had mild-moderate steatosis and 23.2% had severe steatosis. The overall sustained virological response 12 was 93.6%. Follow-up revealed stationary steatosis in 56.7% of patients and regression in 21.3%. Mean pre-treatment CAP were significantly lower in responders 244.9 ± 62.4 dB/m versus non-responders; 300 ±28.4 dB/m (P = 0.04). ROC curve delineated 273 dB/m as best cutoff for detection of responders with an AUC of 0.801, sensitivity 68.2%, and specificity 100%. BMI significantly increased after treatment (P = 0.004) particularly in patients with worsened steatosis (P = 0.001). Steatosis significantly correlated with BMI (r = 0.3, P value = < 0.001). DAAs causes a significant change in steatosis grade in a subset of treated patients. Pretreatment CAP was significantly lower in responders. BMI significantly increases following treatment particularly in patients with worsened steatosis.

Comparing the efficiency of Fib-4, Egy-score, APRI, and GUCI in liver fibrosis staging in Egyptians with chronic hepatitis C

Assessment of hepatic fibrosis in chronic hepatitis C virus patients by liver biopsy is not widely accepted despite its accuracy, being invasive, carrying complications, and adding cost. This paved the way to development and use of non-invasive markers of fibrosis in diagnosis of hepatic fibrosis. We aimed at evaluating the efficiency of Fib-4, Egy-score, Aspartate-to-platelet ratio index (APRI), and Göteborg University Cirrhosis Index (GUCI) in comparison to liver biopsy, in the assessment of hepatic fibrosis in chronic hepatitis C patients. This was a cross sectional study including 200 chronic HCV patients were divided into two groups according to stage of fibrosis (Metavir score) into non-significant fibrosis (<F2) and significant fibrosis (≥F2). Reference needle liver biopsy was compared to Fib-4, Egyscore, APRI, and GUCI. Older age (P < 0.001) and higher BMI (P = 0.005) were significantly related to significant fibrosis and positively correlated with fibrosis progression (r = 0.361, P = 0.000, and r = 0.165, P = 0.019 respectively). Fib-4 >1.27, APRI >0.48, Egy-score >0.73, and GUCI >0.57 significantly predict significant fibrosis (P < 0.01). Fib-4 carries the best performance and significant reliability with AUROC 0.783, sensitivity 74%, specificity 69%, PPV 0.55, and NPV 0.86. The addition of BMI to Fib-4 improved the significant fibrosis AUROC curve performance but did not reach statistical significant improvement. We concluded that age and BMI are good predictors of hepatic fibrosis. Fib-4 (>1.27) is the best method of prediction of significant fibrosis compared to Egy-score, APRI, and GUCI. Addition of BMI to Fib-4 did not improve diagnostic value of Fib-4.

Effect of Direct-Acting Agents on Fibrosis Regression in Chronic Hepatitis C Virus Patients' Treatment Compared with Interferon-Containing Regimens

Hepatitis C virus (HCV) treatment is aiming to cure and prevent the development, progression of fibrosis, and related complications. Interferon-based therapy was claimed to reduce or even reverse fibrosis. Although direct-acting agents have a better cure rate, we still lack the knowledge of their effect on fibrosis regression. We aim to assess fibrosis regression in direct-acting agents compared with interferon-based treatment regimens in the treatment of chronic HCV patients. The 204 chronic HCV patients were divided into 3 groups; group 1(N = 68) received Peg-IFN and ribavirin, group 2 (N = 69) received sofosbuvir and ribavirin, and group 3 (N = 67) received Peg-IFN, ribavirin, and sofosbuvir. Fibrosis assessment was performed by transient elastography (TE), APRI and FIB 4, in the pretreatment and at least 3 months after end of treatment. Of these, 66.2% of the patients did not show significant fibrosis changes, 6.4% fibrosis progressed, and 27.5% of fibrosis regressed (P < 0.0001) by TE. Similar results were detected in the different treatment regimens with no statistically significant difference between the regimens. Fibrosis regression was detected in 43.3% of cirrhotic patients who achieved sustained virological response (SVR) and only in 27.4% with significant fibrosis. Significant improvement of posttreatment aspartate transaminase, alanine transaminase, and alpha fetoprotein as well as APRI and FIB 4 scores were detected. Fibrosis regression (TE, APRI and FIB 4) was detected with direct-acting agents and interferon-based therapy. Treated patients with significant fibrosis will benefit of fibrosis regression irrespective to their treatment response, whereas fibrosis regression was associated with SVR in cirrhotic patients.

Single Nucleotide rs760370 Polymorphism at the Main Ribavirin Transporter Gene Detection by PCR-RFLP Assay Compared with the TaqMan Assay and Its Relation to Sustained Virological Response in Chronic HCV Patients Treated with Pegylated Interferon-Ribavirin Therapy

Ribavirin clearly plays a role in chronic hepatitis C treatment response. The equilibrative nucleoside transporter-1 codified by SLC29A1 gene has been associated with ribavirin uptake into hepatocytes and erythrocytes. rs760370A>G single nucleotide polymorphism (SNP) at the SLC29A1 gene may have a role in ribavirin-based regimen treatment response. Accuracy of the polymerase-chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay compared with the TaqMan assay for the detection of the SNP rs760370 at the main ribavirin transporter gene and its relation to sustained virological response in chronic hepatitis C virus (HCV) patients treated with pegylated interferon-ribavirin therapy. The study included 100 chronic HCV patients who were treated with pegylated interferon-ribavirin therapy. The patients were categorized according to the treatment response into responders (50 patients) and null responders (50 patients). rs760370 SNP was measured using TaqMan 5-nuclease assay and by the newly developed PCR-based RFLP assay. The overall accuracy of the newly developed PCR-RFLP assay compared with the TaqMan assay for rs760370 polymorphism detection was 100%. Allelic frequencies at rs760370 were as follows: A/A genotype (28%), A/G genotype (58%), and G/G genotype (14%). Treatment response was not significantly related with rs760370 polymorphism (P = 0.5). Ribavirin-induced anemia was good predictor of sustained virological response (P = 0.001), but was not related to rs760370 polymorphism (P = 0.92). PCR-RFLP assay is an accurate, cost-effective method in the detection of rs760370 compared with TaqMan assay. rs760370 SNP cannot serve as predictor of response in chronic HCV patients treated with interferon ribavirin therapy.

Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding

BACKGROUND AND AIMS

Band ligation and propranolol are the current therapies for primary prevention of variceal bleeding. Carvedilol is a rising nonselective beta-blocker used for reducing portal pressure with favorable outcome. The aim of this study to assess the efficacy of carvedilol, propranolol, and band ligation for primary prevention of variceal bleeding based on the effect of each regimen on progression of Child score and portal hypertensive gastropathy after 1 year.

METHODS

The study included 264 cirrhotic patients with medium/large-sized varices who were candidates for primary prophylaxis of variceal bleeding. Patients were randomly divided into three groups: group I: band ligation; group II: propranolol; group III: carvedilol.

RESULTS

Group I showed higher success rate of 75 %, followed by group III with 70.2 % and group II with 65.2 %. Risk of bleeding was comparable between the three groups, with group II carrying the highest rate of complications (34.7 %) followed by group III (14.2 %) and finally group I (5.7 %). After 1 year of follow-up, Child score did not improve in any of the studied groups, while portal hypertensive gastropathy significantly increased in group I but decreased in groups II and III.

CONCLUSIONS

Band ligation is the best treatment option for primary prevention of variceal bleeding with minimal complications. Carvedilol is a good pharmaceutical alternative medicine to propranolol with lesser side-effects. Progress of liver disease as represented by Child score is not affected by any of the primary variceal prophylactic regimens, although medical treatment reduces portal hypertensive gastropathy. Choice of treatment depends on patient will, compliance with treatment, and endoscopist competence.

Validation of Hepa-index as a non-invasive biomarkers panel for assessment of hepatic fibrosis in Egyptians with chronic hepatitis C

OBJECTIVES

To validate the diagnostic performance of Hepa-Index in predicting different stages of hepatic fibrosis in Egyptian patients with chronic hepatitis C (CHC). Methods: Hundred treatment naïve chronic hepatitis C Egyptian patients were prospectively enrolled between June 2014 and January 2015. They were subjected to: platelet count, alpha-2-macroglobulin (α2-MG), total bilirubin, gamma glutamyl transpeptidase (GGT), total cholesterol, liver biopsy and histopathological staging of hepatic fibrosis according to METAVIR scoring system. Hepa-Index was calculated according to the formula: Hepa-Index=exp (-0.021 x platelet +1.65 x α2-MG+0.2 x total bilirubin + 0.026 x GGT -1.215 x total cholesterol) / (1+exp (-0.021 x platelet + 1.65 x α2-MG + 0.2 x total bilirubin +0.026 x GGT -1.215 x total cholesterol).  Results: Hepa-Index correlates positively with the stage of hepatic fibrosis. Cut off values of Hepa-Index were: 0.2 for predicting significant hepatic fibrosis (≥F2 METAVIR), 0.3 for severe hepatic fibrosis (≥F3 METAVIR) and 0.4 for cirrhosis (F4 METAVIR). Hepa-Index was able to detect significant fibrosis with sensitivity of 69.4%, specificity of 76.3% and AUROC of 0.803. Hepa-Index was also able to detect severe hepatic fibrosis with sensitivity of 79.2%, specificity of 64.5% and AUROC of 0.783 and cirrhosis with sensitivity of 81.8%, specificity of 68.5% and AUROC of 0.744. Conclusion: Hepa-Index is a good non-invasive biomarkers panel that can be used for non-invasive assessment of hepatic fibrosis in chronic hepatitis C patients.

National treatment programme of hepatitis C in Egypt: Hepatitis C virus model of care

Hepatitis C virus (HCV) infection is a major health problem in Egypt as the nation bears the highest prevalence rate worldwide. This necessitated establishing a novel model of care (MOC) to contain the epidemic, deliver patient care and ensure global treatment access. In this review, we describe the process of development of the Egyptian model and future strategies for sustainability. Although the magnitude of the HCV problem was known for many years, the HCV MOC only came into being in 2006 with the establishment of the National Committee for Control of Viral Hepatitis (NCCVH) to set up and implement a national control strategy for the disease and other causes of viral hepatitis. The strategy outlines best practices for patient care delivery by applying a set of service principles through identified clinical streams and patient flow continuums. The Egyptian national viral hepatitis treatment programme is considered one of the most successful and effective public health programmes. To date, more than one million patients were evaluated and more than 850 000 received treatment under the umbrella of the programme since 2006. The NCCVH has been successful in establishing a strong infrastructure for controlling viral hepatitis in Egypt. It established a nationwide network of digitally connected viral hepatitis-specialized treatment centres covering the country map to enhance treatment access. Practice guidelines suiting local circumstances were issued and regularly updated and are applied in all affiliated centres. This review illustrates the model and the successful Egyptian experience. It sets an exemplar for states, organizations and policy-makers setting up programmes for care and management of people with hepatitis C.

SnO₂(β-Bi₂O₃)/Bi₂Sn₂O₇ nanohybrids doped with Pt and Pd nanoparticles: applications in visible light photocatalysis, electrical conductivity and dye-sensitized solar cells

Bi2O3-SnO2 nanocomposites formed at a nominal molar ratio of 3 : 1 and loaded with Pd/Pt nanoparticles synthesized by a sol gel-hydrothermal method with the aid of a template were thoroughly characterized by X-ray diffraction, TEM-EDX, N2 sorptiometry, diffuse reflectance UV-Vis, FTIR, photoluminescence and electrical conductivity. It has been shown that Pd and Pt stimulate the existence of β-Bi2O3 and SnO2, respectively together with the key component Bi2Sn2O7. The photocatalytic results indicate that Pd/β-Bi2O3-Bi2Sn2O7 revealed a remarkable performance for the degradation of methylene blue (MB) dye as compared to the Pt/SnO2-Bi2Sn2O7 and Bi2O3-SnO2 samples in both the UV and visible regions. The enhanced photocatalytic activity of the Pd/β-Bi2O3-Bi2Sn2O7 nanocomposite is primarily attributed to the broad contact between the β-Bi2O3 and Bi2Sn2O7 phases, which indicates high mesoporosity and heterojunction structures resulting in separation efficacy between photo-induced electron-hole pairs. Specifically, the photosensitive β-Bi2O3 is easily excited and released electrons to be accepted by Bi2Sn2O7 and Pd that might be deposited in the interlayer between β-Bi2O3 and Bi2Sn2O7. The degradation mechanism of MB over Pd/β-Bi2O3-Bi2Sn2O7 in the visible region showed that the dye degradation proceeds through evolution of ˙O2(-) and ˙OH radicals as evaluated using photoluminescence and free radical trapping experiments. An insight into the electrical properties including the dielectric constant and impedance of the materials indicates that Pd/β-Bi2O3-Bi2Sn2O7 has the highest conductivity based on increasing the ionic transport and defects at the β-Bi2O3/Bi2Sn2O7 heterojunction. This material displayed an improved photocurrent response of a higher power conversion efficiency, exceeding that of Pt/SnO2-Bi2Sn2O7 and SnBi3 by 50% and 250%, respectively, in dye-sensitized solar cells. Picosecond-resolved photoluminescence (PL) and polarization gated PL anisotropy measurements were combined to clarify the process of FRET from the excited Pd/β-Bi2O3-Bi2Sn2O7 to SD N719. This indicates that the latter structure can be proposed as a multifunctional candidate for use in dye-sensitized solar cells, as an electrical material and as an efficient photocatalyst based on its versatile structure.

Sofosbuvir plus ribavirin for treating Egyptian patients with hepatitis C genotype 4

BACKGROUND & AIMS

Egypt has the highest prevalence of chronic hepatitis C virus (HCV) infection in the world, and more than 90% of patients are infected with genotype 4 virus. We evaluated the efficacy and safety of the HCV polymerase inhibitor sofosbuvir in combination with ribavirin in HCV genotype 4 patients in Egypt.

METHODS

Treatment-naïve or treatment-experienced patients with genotype 4 HCV infection (n=103) were randomly assigned to receive either 12 or 24 weeks of sofosbuvir 400 mg and ribavirin 1000-1200 mg daily. Randomization was stratified by prior treatment experience and by presence or absence of cirrhosis. The primary endpoint was the percentage of patients with HCV RNA <25 IU/ml 12 weeks after therapy (SVR12).

RESULTS

Among all patients, 52% had received prior HCV treatment and 17% had cirrhosis at baseline. SVR12 rates were 90% (46/51) with 24 weeks and 77% (40/52) with 12 weeks of sofosbuvir and ribavirin therapy. Patients with cirrhosis at baseline had lower rates of SVR12 (63% 12 weeks, 78% 24 weeks) than those without cirrhosis (80% 12 weeks, 93% 24 weeks). The most common adverse events were fatigue, headache, insomnia, and anemia. Two patients experienced serious adverse events (cerebral ischemia, dyspnea). No adverse events resulted in treatment discontinuation.

CONCLUSION

Sofosbuvir plus ribavirin for 12 or 24 weeks is effective in treating both treatment-naïve and treatment-experienced Egyptian patients with genotype 4 HCV.

Value of Egy-Score in diagnosis of significant, advanced hepatic fibrosis and cirrhosis compared to aspartate aminotransferase-to-platelet ratio index, FIB-4 and Forns' index in chronic hepatitis C virus

AIM

Serum markers and developed scores are of rising importance in non-invasive diagnosis of hepatic fibrosis. Aspartate aminotransferase-to-platelet ratio index (APRI), FIB-4 and Forns' index are validated scores used for diagnosis of liver fibrosis. The Egy-Score is a newly developed score for detection of hepatic fibrosis with promising results. We aimed to assess the accuracy of the Egy-Score in the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis compared to APRI, FIB-4 and Forns' in chronic hepatitis C virus (HCV) patients.

METHODS

A retrospective study including 100 chronic hepatitis C naïve Egyptian patients was performed. Patients were classified according to stages of fibrosis into three groups: significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4). Egy-Score, APRI, FIB-4 and Forns' index were calculated. Regression analysis and receiver-operator curves were plotted to assess the sensitivity, specificity and predictive values for the significant scores with the best cut-off for diagnosis.

RESULTS

An Egy-Score of 3.28 or more was superior to APRI, FIB-4 and Forns' index for detecting advanced fibrosis with a sensitivity of 91% and specificity of 78%. An Egy-Score of 3.67 or more was superior to APRI, FIB-4 and Forns' index for detecting cirrhosis with a sensitivity of 82% and specificity of 87%. Forns' index was superior to Egy-Score, FIB-4 and APRI for detecting significant fibrosis.

CONCLUSION

The Egy-Score is a promising, accurate, easily calculated, cost-effective score in the prediction of hepatic fibrosis in chronic HCV patients with superiority over APRI, FIB-4 and Forns' index in advanced hepatic fibrosis and cirrhosis.

Electrical and optical properties of nickel ferrite/polyaniline nanocomposite

Polyaniline-NiFe2O4 nanocomposites (PANI-NiFe2O4) with different contents of NiFe2O4 (2.5, 5 and 50 wt%) were prepared via in situ chemical oxidation polymerization, while the nanoparticles nickel ferrite were synthesized by sol-gel method. The prepared samples were characterized using some techniques such as Fourier transforms infrared (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM) and thermogravimetric analysis (TGA). Moreover, the electrical conductivity and optical properties of the nanocomposites were investigated. Pure (PANI) and the composites containing 2.5 and 5 wt% NiFe2O4 showed amorphous structures, while the one with 50 wt% NiFe2O4 showed a spinel crystalline structure. The SEM images of the composites showed different aggregations for the different nickel ferrite contents. FTIR spectra revealed to the formation of some interactions between the PANI macromolecule and the NiFe2O4 nanoparticles, while the thermal analyses indicated an increase in the composites stability for samples with higher NiFe2O4 nanoparticles contents. The electrical conductivity of PANI-NiFe2O4 nanocomposite was found to increase with the rise in NiFe2O4 nanoparticle content, probably due to the polaron/bipolaron formation. The optical absorption experiments illustrate direct transition with an energy band gap of Eg  = 1.0 for PANI-NiFe2O4 nanocomposite.

Egy-score as a noninvasive score for the assessment of hepatic fibrosis in chronic hepatitis C: a preliminary approach

BACKGROUND AND AIMS

Egy-Score is a new noninvasive score for prediction of severe hepatic fibrosis in patients with chronic liver diseases. The aim of this study was to validate Egy-Score as a noninvasive score for predicting stage of hepatic fibrosis in a group of Egyptian chronic hepatitis C patients.

PATIENTS AND METHODS

One hundred Egyptian patients with chronic hepatitis C were enrolled. Mean age was 40.25 ± 9.39 years. They were subjected to CA19-9, alpha-2-macroglobulin, total bilirubin, platelet count and albumin, liver biopsy, and histopathological staging of hepatic fibrosis according to METAVIR scoring system as part of their assessment for treatment. Egy-Score was calculated according to the following formula: Egy-Score = 3.52 + 0.0063 × CA19-9 + 0.0203 × age + 0.4485 × alpha-2-macroglobulin + 0.0303 × bilirubin - 0.0048 × platelet - 0.0462 × albumin. Egy-Score results were correlated to the stage of hepatic fibrosis.

RESULTS

Egy-Score correlates positively with the stage of hepatic fibrosis (F0-F4). Egy-Score was able to differentiate significant hepatic fibrosis, severe hepatic fibrosis, and cirrhosis accurately. Cutoff values of Egy-Score were 2.91850 (for significant fibrosis), 3.28624 (for severe fibrosis), and 3.67570 (for cirrhosis). Sensitivity, specificity, and areas-under-ROC curve (AUROCs) were 75.8%, 68.42%, and 0.776 (for significant fibrosis "≥F2"), 91.67%, 77.63%, and 0.875 (for severe fibrosis "≥F3"), and 81.82%, 86.52%, and 0.874 (for cirrhosis "F4"), respectively.

CONCLUSION

Egy-Score is a useful noninvasive panel of surrogate biomarkers that could accurately predict different stages of hepatic fibrosis in patients with chronic hepatitis C.

Serum autoantibodies positivity prevalence in patients with chronic HCV and impact on pegylated interferon and ribavirin treatment response

BACKGROUND & AIMS

Prevalence of serum autoantibodies in chronic hepatitis C (HCV) patients is higher than that in the general population. Interferon may induce autoimmune manifestations in patients treated with peg-interferon and ribavirin. Effect of autoantibody seropositivity and treatment response are limited and controversial. To detect the prevalence of serum autoantibodies in patients with chronic HCV and impact on histopathology and treatment response.

METHODS

Retrospective study including 3673 Egyptian chronic HCV naïve patients enrolled in the Egyptian national programme for HCV treatment with pegylated interferon and ribavirin in the years 2007-2010. Antinuclear antibody (ANA) was determined by ELISA considered positive with a titre ≥ 1:40 by indirect immunofluorescence. ANA-positive patients pre treatment workup including serum aminotransferases, thyroid profile and liver biopsy, follow-up during treatment and sustained virological response (SVR) were assessed compared to ANA-negative patients.

RESULTS

Serum ANA was positive in 1.6% of the studied patients. There were no statistically significant differences concerning the demographic, biochemical and histopathological data in ANA positive and negative patients. SVR was comparable between ANA-positive and ANA-negative patients (67.8% and 61.3% respectively). Follow-up treatment; ANA-positive patients' did not experience statistically significant haematological complications, flare-up of serum transaminases, thyroid dysfunction. No systemic autoimmune disorders developed during follow-up.

CONCLUSIONS

ANA positivity is not a factor in chronic HCV disease progression and does not affect the treatment response. Pegylated interferon and ribavirin therapy is safe and effective in autoantibodies-positive chronic HCV patients with no need for further follow-up or worry during the treatment in absence of systemic autoimmune disorders.

The impact of interleukin 28b gene polymorphism on the virological response to combined pegylated interferon and ribavirin therapy in chronic HCV genotype 4 infected egyptian patients using data mining analysis

BACKGROUND

Chronic HCV represents one of the common causes of chronic liver disease worldwide with Egypt having the highest prevalence, namely genotype 4. Interleukin IL-28B gene polymorphism has been shown to relate to HCV treatment response, mainly in genotype1.

OBJECTIVES

We aim to evaluate the predictive power of the rs12979860 IL28B SNP and its protein for treatment response in genotype 4 Egyptian patients by regression analysis and decision tree analysis.

PATIENTS AND METHODS

The study included 263 chronic HCV Egyptian patients receiving peg-interferon and ribavirin therapy. Patients were classified into 3 groups; non responders (83patients), relapsers (76patients) and sustained virological responders (104 patients). Serum IL 28 B was performed, DNA was extracted and analyzed by direct sequencing of the SNP rs 12979860 of IL28B gene.

RESULTS

CT, CC and TT represented 56 %, 25 % and 19% of the patients, respectively. Absence of C allele (TT genotype) was significantly correlated with the early failure of response while CC was associated with sustained virological response. The decision tree showed that baseline alpha fetoprotein (AFP ≤ 2.68 ng/ml) was the variable of initial split (the strongest predictor of response) confirmed by regression analysis. Patients with TT genotype had the highest probability of failure of response.

CONCLUSIONS

Absence of the C allele was significantly associated with failure of response. The presence of C allele was associated with a favorable outcome. AFP is a strong baseline predictor of HCV treatment response. A decision tree model is useful for predicting the probability of response to therapy.

Non-invasive prediction of hepatic fibrosis in patients with chronic HCV based on the routine pre-treatment workup

BACKGROUND

Hepatic fibrosis is an inclusion indicator for treatment and a major independent predictor of treatment response in patients with chronic hepatitis C. Liver biopsy, considered as the "gold standard" for evaluating liver fibrosis, has carried some drawbacks. Currently used noninvasive predictors of fibrosis are considered less accurate than liver biopsy.

OBJECTIVES

Our aim was to assess noninvasive predictors of fibrosis in patients with chronic hepatitis C using the routine laboratory pre-treatment workup.

PATIENTS AND METHODS

Cross sectional study including 4289 Egyptian patients with chronic hepatitis C were assessed for the need to interferon and ribavirin therapy. Routine pre-treatment workup and reference needle liver biopsy were performed. FIB-4 index, APRI and modified APRI scores were validated. Patients were divided into two groups, first with no or minimal fibrosis, and second with moderate and marked fibrosis using the Metavir score.

RESULTS

Multivariate logistic regression analysis showed that age, body mass index, aspartate aminotransferase, alpha fetoprotein, platelets count, FIB-4 index, APRI and modified APRI score were significant independent predictors of fibrosis. Age > 43 years, aspartate aminotransferase > 47U/L, platelets < 205×103/mm(3), and alpha fetoprotein > 2.6 ng/ml had the highest cutoff points in receiver operator characteristic curves. Taking into account the four variables together; the presence of ≥ 2 variables is associated with moderate and advanced fibrosis with a sensitivity of 0.81, specificity of 0.5, positive predictive value of 0.53 and negative predictive value of 0.79. FIB-4 index represented the best performing receiver operator characteristic curve for diagnosing moderate and marked fibrosis among other independent factors with a sensitivity of 0.74, specificity of 0.6, positive predictive value of 0.56 and negative predictive value of 0.76.

CONCLUSIONS

Chronic HCV pre-treatment routine work up and composite fibrosis scores are good noninvasive predictor of liver fibrosis and can be used as an alternative method to invasive liver biopsy without adding more financial expenses to the treatment.

Validity of the in vitro fertilisation league tables: influence of patients' characteristics

We tested the hypothesis that restricting comparison of the live birth rate following in vitro fertilisation (IVF) treatment in those couples having their first IVF cycle in whom the female is under 35 years of age and has a normal follicle-stimulating hormone level would improve the validity of comparing IVF clinics' success rates. We analysed all cycles performed over a 2-year period in patients who fulfilled these criteria and divided the study population according to the referring primary care trusts: group A (n = 90) were referred from Lambeth, Southwark and Lewisham and group B (n = 134) were referred from Brent and Harrow. There was no significant difference between the two groups with regard to their IVF cycle characteristics. The two groups differed in their ethnicity, cause of infertility, prevalence of uterine fibroids and smoking and alcohol consumption habits. Group A had a significantly lower live birth rate (OR = 0.45, 95% CI 0.21-0.95, P = 0.02) compared with group B. This study confirms the impact of the non-IVF-related patient characteristics on treatment outcome and the poor validity of comparing IVF clinics' success rates based on the sparse data published by national IVF registries.