Eff ect of preventive and curative interventions on hepatitis C virus transmission in Egypt (ANRS 1211): a modelling study

Most hepatitis C virus (HCV) transmission in Egypt is related to medical injections and procedures. To control the spread of HCV, the Egyptian Ministry of Health initiated awareness and education campaigns, strengthened infection control in health-care facilities, and subsidised anti-HCV treatment. We aimed to investigate the effect of these interventions on the spread of HCV by mathematical modelling. Methods We developed a mathematical model of HCV transmission in Zawyat Razin, a typical rural community. Our model assumes that each individual has two distinct types of medical procedures: injections and more invasive medical procedures. To quantify the severity of the spread of HCV, we used the notion of the basic reproduction number R0, a standard threshold parameter signalling whether transmission of an infectious disease is self-sustained and maintains an epidemic. If R0 is greater than 1, HCV is self-sustained; if R0 is 1 or less, HCV transmission is not self-sustained. We investigated whether heterogeneity in the rate of injection or invasive medical procedures is the determinant factor for HCV transmission and whether most iatrogenic transmission is caused by a small group of individuals who receive health-care interventions frequently. We then assessed whether interventions targeted at this group could reduce the spread of HCV. Findings The R0 of the spread of HCV without treatment was 3·54 (95% CI 1·28–6·18), suggesting a self-sustained spread. Furthermore, the present national treatment programme only decreased R0 from 3·54 to 3·03 (95% CI 1·10–5·25). Individuals with high rates of medical injections seem to be responsible for the spread of HCV in Egypt; the R0 of the spread of HCV without treatment would be 0·64 (95% CI 0·41–0·93) if everybody followed the average behaviour. The effect of treatment on HCV transmission is greatly enhanced if treatment is provided a mean of 2·5 years (95% CI 0·1–9·2) after chronic infection and with drug regimens with more than 80% efficacy. With these treatment parameters, preventive and curative interventions targeting individuals with high rates of medical injections might decrease R0 below 1 for treatment coverage lower than 5%. Interpretation Targeting preventive and curative interventions to individuals with high rates of medical injections in Egypt would result in a greater reduction the spread of HCV than would untargeted allocation. Such an approach might prove beneficial in other resource-limited countries with health-care-driven epidemics

Topical Oxybutynin 3% Gel versus Aluminum Chloride 15% Lotion in Treatment of Primary Focal Hyperhidrosis

Introduction: Hyperhidrosis is excessive sweating beyond thermoregulatory needs. It is a potentially disabling condition with challenging management. Aluminum chloride is the established topical treatment; however, response remains unsatisfactory. Oxybutynin is an anticholinergic drug that stands as a therapeutic chance for hyperhidrosis. Objectives: comparing the efficacy of topical oxybutynin 3% gel versus aluminum chloride 15% lotion in treatment of primary focal hyperhidrosis. Methods: Forty patients with hyperhidrosis were randomly distributed into 2 equal groups treated by either topical oxybutynin 3% gel or topical aluminum chloride 15% lotion once daily night application for 4 weeks (both groups). Evaluation was done at 2 and 4 weeks of treatment and after 1 month of the end of treatment for follow up by Minor iodine starch test, hyperhidrosis disease severity scale (HDSS) and dermatology life quality index (DLQI). Results: Both treatment modalities were effective with insignificant differences between patients of both groups regarding improvement in Minor iodine starch test and HDSS after 2 weeks of treatment (P = 0.561, 0.33 respectively). Oxybutynin 3% gel yielded significantly better improvement of Minor’s test, HDSS and patient’s quality of life at the end of 4 weeks of treatment with lower recurrence rate than aluminum chloride 15% lotion at 1 month follow up. Minimal adverse effects were noted in both studied groups. Conclusions: Oxybutynin 3% gel could be considered as a promising treatment modality for hyperhidrosis with higher efficacy than aluminum chloride 15% lotion and lower recurrence rate

Serum Interleukin-5 Changes in Partly Controlled Atopic Asthmatic Children

BACKGROUND: Cytokines including Interleukin-5 play a key role in orchestrating the chronic inflammation of asthma. We aimed to determine the level of serum IL-5 in partly controlled atopic asthma in children and to assess the effect of different therapies on their levels.METHODS: The study included 40 children aged 6-12 years with partly controlled asthma. Cases were randomly divided into two groups; group ‘A’ receiving Leukotriene modifiers and group ‘B’ receiving inhaled corticosteroids; each for two months. They were compared to 20 healthy non-asthmatic, matched controls. Serum IL-5 was measured for cases on the first visit and two months after therapy. Absolute eosinophilic count and serum Ig-E were determined. Pulmonary function testing was performed using spirometer at the beginning and two months after regular therapy.RESULTS: Serum Interleukin-5 was significantly increased in asthmatic children during exacerbation and was significantly decreased after treatment. ROC curve analysis showed significant difference of IgE and PEFR after treatment with leukotriene modifier only.CONCLUSION: Serum IL-5 seems to have a role in asthma pathogenesis. Efficiency of the two therapies (ICs & LTA) was similar in this group of patients. Both treatments led to significant decline in serum IL-5, IgE levels and eosinophilic count

Characterization of greater middle eastern genetic variation for enhanced disease gene discovery

The Greater Middle East (GME) has been a central hub of human migration and population admixture. The tradition of consanguinity, variably practiced in the Persian Gulf region, North Africa, and Central Asia1-3, has resulted in an elevated burden of recessive disease4. Here we generated a whole-exome GME variome from 1,111 unrelated subjects. We detected substantial diversity and admixture in continental and subregional populations, corresponding to several ancient founder populations with little evidence of bottlenecks. Measured consanguinity rates were an order of magnitude above those in other sampled populations, and the GME population exhibited an increased burden of runs of homozygosity (ROHs) but showed no evidence for reduced burden of deleterious variation due to classically theorized ‘genetic purging’. Applying this database to unsolved recessive conditions in the GME population reduced the number of potential disease-causing variants by four- to sevenfold. These results show variegated genetic architecture in GME populations and support future human genetic discoveries in Mendelian and population genetics

A Case with Neurofibromatosis and Chronic Myeloid Leukemia in Blastic Crisis Treated with Imatinib

A 61-year-old female presented with complaints of fever, general weakness and hepatosplenomegaly. She had a history of nonfamilial peripheral neurofibromatosis diagnosed as von Recklinghausen's disease since 30 years previous. Physical examination was remarkable for skin colored cutaneous circumscribed nodules which appeared soft to the touch in both arms, the upper part of her abdomen, back, and posterior thigh. The liver was palpable 10 cm below the inferior border of the costal margin and she had evidence of significant splenomegaly. Laboratory results were as follows: hemoglobin 7.9 g/dl; ESR142 mm/hour; leukocytes 22400x109/L; neutrophils 35%; eosinophils 3%; basophils 4%; myelocytes40%; myeloblasts 14%; promyelocytes 2%; and band form 2%. The bone marrow picture was chronic myeloid leukemia in blastic form. Chest CT scan showed the presence of numerous cutaneous nodules (neurofibromatosis). A biopsy of the tissue fragment from the nodules confirmed the presence of diffuse neurofibromatosis. Bone marrow cytology that included cytogenetic and immunophenotyping confirmed the presence of chronic myeloid leukemia with a positive Philadelphia chromosome and diploidy female clone in a blastic form (acute myeloid leukemia). Addition of 600 mg oral imatinib mesylate daily for one month and reduced to 400 mg daily yields complete hematological remission and complete cytogenetic responses. This case illustrated an association between chronic myeloid leukemia, acute myeloid leukemia and neurofibromatosis in an adult

Detection of Virulence Determinants and Antimicrobial Susceptibility of Vibrio species Isolated from Raw Fish Markets

Vibriosis is a major cause of death in farmed aquaculture systems around the world caused by an infection with Vibrio spp. This study was performed to detect the prevalence of pathogenic Vibrio species from various fish species (n=200) collected from Port-Said fish markets as well as to assess the antimicrobial resistance profile and virulence determinants of the isolated Vibrio. Fish samples were inoculated onto Vibrio-selective medium (TCBS), and phenotypically identified using biochemical tests and the suspected isolates were then confirmed by PCR targeting collagenase gene followed by sequencing of the amplified gene. Disc diffusion method was used to investigate the antimicrobial susceptibility of the isolated strains as well as the virulence determinants were detected by PCR assay. Out of 200 fish samples, 80 Vibrio isolates including V. parahaemolyticus (22 /80) and V. alginolyticus (58 /80) were recovered. While V. vulnificus couldn’t be identified. Vibrio isolates displayed high resistance to beta-lactams antimicrobials and a lower resistance were displayed against tetracycline, quinolones and carbapenems. Additionally, tlh gene was present in all V. parahaemolyticus isolates, while the tdh gene was present in 27.1% (6/22). In conclusion, the results of this study provide information on the hazards that certain fish and shellfish could bring by transferring virulent and genetic resistance of V. parahaemolyticus and V. alginolyticus to people through food., therefore, consumers should be more alert, prepare food properly, and avoid undercooked or cross-contaminated fish

Detection of Virulence Determinants and Antimicrobial Susceptibility of Vibrio species Isolated from Raw Fish Markets

Vibriosis is a major cause of death in farmed aquaculture systems around the world caused by an infection with Vibrio spp. This study was performed to detect the prevalence of pathogenic Vibrio species from various fish species (n=200) collected from Port-Said fish markets as well as to assess the antimicrobial resistance profile and virulence determinants of the isolated Vibrio. Fish samples were inoculated onto Vibrio-selective medium (TCBS), and phenotypically identified using biochemical tests and the suspected isolates were then confirmed by PCR targeting collagenase gene followed by sequencing of the amplified gene. Disc diffusion method was used to investigate the antimicrobial susceptibility of the isolated strains as well as the virulence determinants were detected by PCR assay. Out of 200 fish samples, 80 Vibrio isolates including V. parahaemolyticus (22 /80) and V. alginolyticus (58 /80) were recovered. While V. vulnificus couldn’t be identified. Vibrio isolates displayed high resistance to beta-lactams antimicrobials and a lower resistance were displayed against tetracycline, quinolones and carbapenems. Additionally, tlh gene was present in all V. parahaemolyticus isolates, while the tdh gene was present in 27.1% (6/22). In conclusion, the results of this study provide information on the hazards that certain fish and shellfish could bring by transferring virulent and genetic resistance of V. parahaemolyticus and V. alginolyticus to people through food., therefore, consumers should be more alert, prepare food properly, and avoid undercooked or cross-contaminated fish

NRF2 and P73 polymorphisms in Egyptian women with breast cancer

The aim of the study was to assess the role of Nrf2 promoter and P73 G4C14 to A4T14 polymorphisms in  breast cancer and the potential relation to the onset of the disease. Eighty six female patients with breast tumor were included in this study. Nrf2 (rs6721961) and p73 (G4A) genetic polymorphisms in promoter  and exon2 region respectively were investigated using PCR-CTPP assay. The genotype frequencies of the three genotypes of Nrf2 promoter SNP (CC, CA, AA) showed no significant difference between benign and malignant  groups. Genotype frequencies for P73 G4A SNP (GG, GA) showed no significant difference between benign and malignant groups, no patient have the AA genotype. Regarding the onset of disease, the three Nrf2 genotypes in pre - and post-menopausal patients, showed that the distribution differ significantly in the 2 patients groups and that the AA genotype is significantly higher in the pre-menopausal patients compared to post-menopausal patients. Nrf2 (rs6721961) AA genotype might be related to early breast cancer onset. P73 G4A polymorphism shows no relation to both disease risk and disease onset. Therefore Nrf2 (rs6721961) promoter genotyping  might be related to the risk of pre-menopausal breast cancer.Key words: Breast cancer, Polymorphisms, Nrf2, P7