Development of Hepatocellular Carcinoma after Achieving Sustained HCVVirologic Response and Regression of Cirrhosis

Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer mortality. Interferon/ribavirin and direct acting antiviral (DAA) therapy have successfully treated HCV infection and may halt the progression of fibrosis. It is generally believed that HCC primarily occurs in the background of HCV- related cirrhosis; theoretically, achieving sustained viral response (SVR) could decrease the incidence of HCC by slowing down fibrosing process; hence preventing progression of cirrhosis. Here, we present a case of 64-year-old female who was successfully treated for HCV infection with interferon in 1994. Patient achieved sustained viral response (SVR) and has been in remission for 23 years. In June 2017, she presented with abdominal pain and CT scan revealed a liver mass which was subsequently biopsied and proved to be HCC. Patient was treated with partial hepatectomy and histologic examination of the resected liver mass revealed well-differentiated HCC; non-neoplastic liver demonstrated features of regression of cirrhosis/fibrosis with fibrous expansion of few portal tracts and scattered very fine curvilinear fibrous septa; no portal/lobular inflammation was present. The patient developed HCC 23 years after achieving SVR. Significant regression of cirrhosis/fibrosis in the non-neoplastic liver argues against the usual course of HCC development in cirrhotic/advanced fibrotic setting, and suggests the possibility of an alternative phenomenon, e.g., latency of HCV and/or oncologic potential of HCV at the genomic level. This rare event raises certain questions which have not been properly investigated in the course of HCC development, such as: 1) Relationship between regression of cirrhosis/fibrosis and developing HCC; 2) If absence and regression of cirrhosis/fibrosis carries the same value; 3) Necessity of updating the surveillance criteria in patient with SVR lacking cirrhosis; and 4) Oncologic potential of HCV acquired at the genomic level; these questions/issues are currently under investigation.https://scholarlycommons.henryford.com/merf2020caserpt/1084/thumbnail.jp

Lung Ultrasound Findings Compared to Chest CT Scan in Patients with COVID-19 Associated Pneumonia: A Pilot Study

Introduction: Lung US has been reported to be as useful as a chest CT scan and much better than a chest x-ray for the evaluation of pneumonia. Objective: This study aimed to compare the findings of lung ultrasound (US) and chest CT scan of patients with COVID-19-associated pneumonia in the Emergency Department (ED). Methods: This retrospective observational pilot study was carried out on confirmed COVID-19 patients in the isolation corona ward of the Imam Hussein Hospital ED from March 15 to March 22, 2020. After obtaining demographic data, the patients underwent a pulmonary bedside US examination, with the patients in the sitting position, turning their back to the examiner. A 10-point lung US was performed. Each lung was divided into two areas: posterior (three zones) and lateral (two zones). The patients’ lung ultrasound and chest CT scan as the standard imaging were blindly reviewed and recorded. The clinical value of ultrasound was evaluated with different severity of lung involvement according to CT severity score. Results: Nineteen patients (38 zones), including 13 males, were evaluated with a mean age of 62.5±16.8 years. B2 lines and consolidation observed in the US examinations were significantly correlated with ground-glass opacity and consolidation observed in CT scan examinations, respectively (p <0.0001). US sensitivity and specificity of finding B2 lines were 90% and 100%, respectively. Also, the sensitivity and specificity of US in identifying consolidation were 82% and 100%, respectively. In the lungs with moderate and severe lobar involvement, US findings were significantly correlated (p <0.05) with CT scan findings. Conclusions: Ultrasound evaluation is a safe, fast, and rapid technique for the evaluation of patients with moderate to severe COVID-19-associated pneumonia. It is a reproducible procedure and can be implemented by the operator after a short course of training

Descriptive Study of Liver Hydatid Cyst in the Post Graduated Hospital Khost

Liver hydatid cyst is a parasitic disease whose life cycle involves carnivores. And humans can also get infected by swallowing of parasite eggs. This disease can affect both men and women. This disease does not have a severe course; therefore, it is often diagnosed in the mixed stages or when the patient performs abdominal ultrasound examinations due to some other health problems. This is the reason why most of the serious hydatid disease conditions occur. Since Afghanistan is an agricultural country and livestock farming is common there, the possibility and incidence of this disease is very high in human. This study is a descriptive study in the form of a case series, from the 1400/07/01 to 1401/06/31 (one-year duration), on 40 patients which have been treated in Khost post graduate Hospital. In 40 patients who have a hydatid cyst of the liver, 29 patients representing 72.5% of the cases are from the districts and 11 from the center of Khost representing 27.5%. according to age, the most cases occurred in people under 30 years of age (28 people), which make up 59.5 %, 7 people were between 30 and 50 years old, 17.5 % and 5 people were over 50 years old. Which is 12.5 %. From the point of view of gender, the most cases are women (27), which make up 67.5 %. And 13 men, which constitute 32.5 % of the cases. From the point of view of cyst size, 25 patients whose cyst size was less than 7 cm and 70 % of patients and 15 patients whose cyst size was more than 9 cm showed 30 % cases. Open surgery was performed on all the above patients (100 %). According to complications, 2 patients had cyst rupture, which was 5 %, and one patient had a obstructive jaundice, which was 2.5 %. Most of the cases of this disease occurred in women and people under the age of thirty. From the point of view of the place of residence, the incidents occur more in the suburban areas. All patients with hydatid cyst of the liver, when diagnosed and operated on time, recover quickly, but follow-up treatment was necessary

Matrixyl Patch vs Matrixyl Cream: A Comparative In Vivo Investigation of Matrixyl (MTI) Effect on Wound Healing

[Image: see text] Wound healing is one of the most complex biological processes. Studies show that Matrixyl (MTI), known as a cosmetic peptide, can lead to a faster healing process. The contribution of MTI to collagen formation during wound healing also depends on its mode of delivery and its release over time. Here, we investigate two modes of MTI-delivery system, the influence of MTI patch for wound healing application in comparison with MTI cream. In this study, animals were randomly divided into seven groups and studied for 21 days: patches containing two different concentrations of MTI (P-MTI-0.1 mg and P-MTI-1 mg), a cream containing MTI (C-MTI-1 mg), a patch (P-MTI-0), a cream with no MTI (C-MTI-0), a positive control (Comfeel), and a negative control (sham) group. To study the wound healing process, the change in collagen density, angiogenesis, epitheliogenesis, histopathology, immunohistochemical analysis, and wound area through imaging was monitored and measured. The macroscopic results showed that wound healing was improved from 63.5 up to 81.81% in treatment groups compared to that in the negative control group (P < 0.05 and P < 0.001). In addition, C-MTI-1 and P-MTI-1 had a larger impact on wound healing compared to that in the positive control group (Comfeel, P < 0.05). In hematoxylin and eosin (H&E) staining analysis, the rejuvenation of skin appendage was visible in both groups of cream and patches with MTI. According to the obtained results, the re-epithelialization had a higher range for the patch with MTI in comparison with cream containing MTI and positive control

Descriptive Study of Inguinal Hernia in the Post Graduated Hospital Khost

Hernia is derived from the Latin word for rupture1. A hernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Although a hernia can occur at various sites of the body, these defects most commonly involve the abdominal wall, particularly the inguinal region. Hernia surgery is one of the earliest forms of surgery and various techniques of hernia repair have been described. The ideal treatment of inguinal hernia should be well defined and should be the least traumatic as regards to both the requested type of anesthesia and the operative technique, least expensive, least per-and postoperative morbidity, the chosen technique should also be the easiest to learn and perform and the positive results should be the most reproducible. This research was conducted on 214 patients, out of which only 2 patients were female, which are 1.6%, and all other patients were male, which are 98.4%. The average age of all patients are 18-50 years old, of which 42 patients are 18-28 years old, 49 patients are 29-39 years old, and 123 patients are 40-50 years old. Out of 214 patients, 126 patients had Right inguinal hernia which are 59%, 77 patients had left inguinal hernia which are 36% and 11 patients had hernia on both sides which are 5%. 67 patients had direct inguinal hernia which are 31.1% and 147 patients had indirect inguinal hernia which are 68.9%. The diagnosis of these patients was mostly based on history and clinical signs and symptoms of the patient. Among those patients, 70 were underwent shouldice repair, which are 23.7%, 114 patients underwent bassini repair, which are 53.0 %, and 30 patients underwent meshplasty, which are 14.3%. Fortunately, all of the patients who have been operated have been cured and the death rate are zero, and only 12 patients, which are 5.6% of the total, were previously operated. 5 patients had hematocele which are 2.3%, 3 patients developed neuralgia after surgery which are 1.4% and 3 patients had infection which are 1.4%. So, we said that only 5.14% of our patients had post-operative complications, fortunately 94.86% of patients were cured without complications

Docking-Based Screening of Cell-Penetrating Peptides with Antiviral Features and Ebola Virus Proteins as a Drug Discovery Approach to Develop a Treatment for Ebola Virus Disease

Ebola drug discovery continues to be challenging as yet. Proteins of the virus should be targeted at the relevant biologically active site for drug or inhibitor binding to be effective. In this regard, by considering the important role of Ebola virus proteins in the viral mechanisms of this viral disease, the Ebola proteins are selected as our drug targets in this study. The discovery of novel therapeutic molecules or peptides will be highly expensive; therefore, we attempted to identify possible antigens of EBOV proteins by conducting docking-based screening of cell penetrating peptides (CPPs) that have antiviral potential features utilizing Hex software version 8.0.0. The E-value scores obtained in this research were very much higher than the previously reported docking studies. CPPs that possess suitable interaction with the targets would be specified as promising candidates for further in vitro and in vivo examination aimed at developing new drugs for Ebola infection treatment

Mantle Cell Lymphoma Presenting as Diarrhea in a Liver Transplant Recipient

We present a 63-year-old man with a medical history of hepatocellular carcinoma who underwent orthotopic liver transplant 10 years prior on long-term immunosuppressive therapy. The patient presented to the clinic with diarrhea, and the workup revealed mantle cell lymphoma. Mantle cell lymphoma is an extremely rare finding in transplanted livers. It is essential to include mantle cell lymphoma, along with a broad differential, during the workup of diarrhea in post-transplant patients

The relationship between Intima-Media Thickness and Carotid Plaque Characteristics with Incidence and Severity of Premature Coronary Artery Disease

Background: Carotid intima media thickness (CIMT) and carotid plaque can predict premature coronary heart disease (PCAD) in patients hospitalized due to coronary artery disease or undergoing therapeutic interventions. This study aimed to determine the relationship between intima media thickness and carotid plaque characteristics with the incidence and severity of premature coronary artery disease. Materials and Methods: The current study was an analytical cross-sectional study conducted on patients referred to Imam Hossein Hospital in 2021-2022 who underwent coronary angiography. Patients were classified into two groups with coronary artery involvement and the group without evidence of significant coronary involvement. Then the data of patients, such as sex, age, risk factors of cardiovascular diseases, and clinical history of individuals, were collected through interviews and aspects related to carotid intima media thickness and plaque formation through a specialized review of reports. Results: A total of 59 women (%59) and 41 men (%41) participated in this study. The mean age was 51.50±9.54. The results of this study showed that there was a direct (positive) and significant correlation between carotid intima media thickness factors, including right and left carotid intima-media thickness, right and left carotid intima media thickness scores, and the number of carotid plaques with increasing severity of coronary artery involvement (P-values<0.05). There was a statistically significant correlation between carotid plaque number and severity of coronary artery disease (P-value<0.05). Conclusion: CIMT has a significant correlation with PCAD, and in patients at risk of PCAD, measurement of CIMT was a suitable method

Targeted superparamagnetic iron oxide nanoparticles for early detection of cancer: Possibilities and challenges

Nanomedicine, the integration of nanotechnological tools in medicine demonstrated promising potential to revolutionize the diagnosis and treatment of various human health conditions. Nanoparticles (NPs) have shown much promise in diagnostics of cancer, especially since they can accommodate targeting molecules on their surface, which search for specific tumor cell receptors upon injection into the blood stream. This concentrates the NPs in the desired tumor location. Furthermore, such receptor-specific targeting may be exploited for detection of potential metastases in an early stage. Some NPs, such as superparamagnetic iron oxide NPs (SPIONs), are also compatible with magnetic resonance imaging (MRI), which makes their clinical translation and application rather easy and accessible for tumor imaging purposes. Furthermore, multifunctional and/or theranostic NPs can be used for simultaneous imaging of cancer and drug delivery. In this review article, we will specifically focus on the application of SPIONs in early detection and imaging of major cancer types. From the Clinical Editor: Super-paramagnetic iron oxide nanoparticles (SPIONs) have been reported by many to be useful as an MRI contrast agent in the detection of tumors. To further enhance the tumor imaging, SPIONs can be coupled with tumor targeting motifs. In this article, the authors performed a comprehensive review on the current status of using targeted SPIONS in tumor detection and also the potential hurdles to overcome. © 2015 Elsevier Inc. All rights reserved

Late clinical events of drug eluting versus bare metal stenting; OPCES' ancillary study

Objective: To compare one year clinical outcomes of patients with chronic stable angina who underwent implantation of bare metal stent (BMS) or drug eluting stent (DES). Methodology: Four hundred forty two (442) participants of OPCES study (Osvix versus Plavix in Cardiovascular Events after Stenting) were included in this sub-study. After evaluation of exclusion criteria (combined DES and BMS stenting (n=31) and incomplete data (n=48) patients were divided in two groups according to selected stent(DES or BMS). Follow-up was conducted by a structured telephone interview after 6 and 12 months. The patients' documents were reviewed by the Study Event Committee in the Isfahan Cardiovascular Research Center to evaluate the occurrence of study endpoints which consisted of clinical success rate and major adverse cardiac events (Major Adverse Cardiac Events (MACE), cardiac death, non-fatal MI, target vessel revascularization and stroke) in hospital, after 6 and 12 months. Results: One hundred sixty six (45.7%) patients were in the DES and 197(54.3%) were in the BMS group. Procedural complications were seen more frequently in the DES group (1.0% vs. 4.8%, P=0.027), the prevalence of the in-hospital MACE, angiographic and clinical success rate were the same between both the groups. There was no significant difference regarding 6 and 12 months MACE rate in patients treated by BMS or DES (6 months: 1.1% vs. 0.6%, p>0.999 12 month: 3.4% vs 2.6%, P = 0.755). Conclusion: Considering the same clinical outcome and the economical parameters, use of the BMS after proper patient selection are recommended