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

BACKGROUND

Treatment of chronic hepatitis C using combination of sofosbuvir (SOF) and daclatasvir (DCV) was used in several clinical trials and multicentre studies, which were somewhat limited to genotypes 1-3. The national program in Egypt is using SOF-DCV combination for large scale treatment.

AIM

To assess the efficacy and safety of combined SOF-DCV in treating patients with HCV-G4 in a real-world setting.

METHODS

Data and outcome of chronic HCV patients who were treated for 12 weeks with generic medications: DCV 60 mg plus SOF 400 mg ± ribavirin (RBV) within the national hepatitis C treatment program in Egypt are presented. Treatment-naïve patients without cirrhosis were treated without RBV, and those who had cirrhosis or were treatment-experienced (interferon experienced or SOF experienced) received RBV. Efficacy and safety were assessed, and baseline factors associated with sustained virological response at post-treatment week 12 (SVR12) were explored.

RESULTS

During the first 2 months of the programme, 18 378 patients with HCV-G4 started treatment with SOF-DCV with or without RBV. Overall, 95.1% achieved SVR12 (95.4% among patients treated without RBV and 94.7% for patients treated with RBV, P = .32). Treatment was prematurely discontinued in only 1.5% of patients. The most common events leading to discontinuation were patient withdrawal (n = 76) and pregnancy (n = 5). Five deaths occurred within this group.

CONCLUSIONS

Real-world experience of generic SOF-DCV in patients with chronic HCV-G4 proved to be safe and associated with a high SVR12 rate, in patients with different stages of fibrosis.

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

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

Derivatives of Khellinonequinone and their Aflatoxigenic Activity

Nitration of khellinone leads to the formation of a small amount of 3-nitrokhellinone and 5-acetyl-6-hydroxybenzofuran-4.7-dione (khellinonequinone) as a main product. The latter compound reacts with primary amines to give the corresponding imino compounds. Reaction of khellinone with o-phenylenediamine involves condensation followed by cyclisation. While on the other hand treating with phenyl hydrazines gives the phenyl hydrazone. The pyrazolobenzofuran derivative was obtained by the action of hydrazine hydrate on khellinonequinone. Finally the reaction with malononitrile leads to the formation of the ylidene derivative. Two quinone derivatives showed a weak effect on mycelial growth and aflatoxin formation.

Assessing the state of health research in the Eastern Mediterranean Region

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

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

BACKGROUND

The association of the novel adipokines visfatin and omentin-1 with psoriasis is still obscure. Data concerning other inflammatory diseases suggest a possible role of these adipokines in the pathophysiology of psoriasis.

OBJECTIVES

To investigate serum levels of visfatin and omentin-1 in patients with psoriasis compared with healthy controls, and to consider their relation to disease duration, disease severity and obesity markers.

METHODS

Visfatin and omentin-1 concentrations were measured in 46 patients with plaque-type psoriasis and 42 healthy controls by using specific enzyme-linked immunosorbent assays.

RESULTS

Patients with psoriasis showed considerably higher serum levels of visfatin than healthy controls with significant positive correlation with disease severity and duration. They also showed lower levels of ominten-1 compared with healthy controls with significant inverse correlation with body mass index and waist circumference.

CONCLUSIONS

Coordinated roles for visfatin and omentin-1 are suggested in the modulation of the inflammatory environment in patients with psoriasis. Given the significant relations of omentin-1 with obesity markers, the health consequences of excessive weight should be better communicated to patients with psoriasis.

Structural analysis of human liver glyceraldehyde-3-phosphate dehydrogenase

The crystal structure of human liver glyceraldehyde-3-phosphate dehydrogenase (GAPDH) has been determined. This structure represents the first moderate-resolution (2.5 A) and crystallographically refined (Rfree = 22.9%) human GAPDH structure. The liver GAPDH structure consists of a homotetramer, each subunit of which is bound to a nicotinamide adenine dinucleotide (NAD+) molecule. The GAPDH enzyme has glycolytic and non-glycolytic functions, both of which are of chemotherapeutic interest. The availability of a high-quality human GAPDH structure is a necessity for structure-based drug design. In this study, structural differences between human liver and skeletal muscle GAPDHs are reported in order to understand how these two enzymes might respond to anti-trypanosomatid GAPDH inhibitors.

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

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

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

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

Laparoscopic Supracervical Hysterectomy (L-SH)

Laparoscopic supracervical hysterectomy is a viable alternative with putative advantages over the same procedure performed via laparotomy for those individuals requiring uterine extirpation without indication for cervical removal. The laparoscopic approach to this procedure provides even lower morbidity and therefore can enhance clinical outcomes. The risk of subsequent cervical cancer, an uncommon and largely preventable occurrence, may not outweigh the benefits of supracervical hysterectomy, which should be offered as an option for selected patients. Therefore it seems likely that, in a woman with a history of regular screening with negative cytology, there will be a minimal risk of future malignant change in a cervical remnant, even this risk would be reduced to near zero if the transition zone and part or all of the endocervical cana were to be removed.

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

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

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

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

The single gallbladder stone - is it innocent?

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

Laparoscopic cholecystectomy: The first year experience

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

A randomized trial of 13-cis retinoic acid with or without cytosine arabinoside in patients with the myelodysplastic syndrome

Ninety-eight consecutive patients with myelodysplastic syndrome were randomized to a treated or a control group, both receiving conventional supportive therapy. The treated group were given 13-cis-retinoic acid 20 mg/d if marrow blasts were less than or equal to 5% or cytosine arabinoside 10 mg/d subcutaneously on 6 d/week if marrow blasts were 6-30%, to which retinoic acid was added after 12 weeks. Serum levels of the drugs in the treated group were similar to those that would produce inhibition of CFU-GM growth in vitro. In patients in the low blast group receiving retinoic acid, myeloid surface antigens reverted from an abnormal to a normal pattern. Log rank analysis carried out after 25 months showed no significant difference in survival between the treated and control group, either in the total patient population or in the high and low blast groups considered separately. However, analysis of 39 non-sideroblastic patients with less than or equal to 5% blasts showed an increase in survival in the treated group.

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

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

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

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

Cervical lymphadenopathy caused by Aspergillus terreus

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