Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Global prevalence and genotype distribution of hepatitis C virus infection in 2015 : A modelling study

Publisher Copyright: © 2017 Elsevier LtdBackground The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of—and expansion on—the 2014 analysis, which reported 80 million (95% CI 64–103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8–1·1) in 2015, corresponding to 71·1 million (62·5–79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. Funding John C Martin Foundation.publishersversionPeer reviewe

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Efficacy of different treatment protocols for endometritis in Camelus dromedarius

Endometritis is considered a significant cause of infertility problems in dromedary camels. This study aimed to compare the efficacy of different treatment protocols for endometritis in dromedary camels under Abu Dhabi Emirates' conditions. A total of 112 dromedary she-camels with uterine infection were subjected to uterine swabbing for bacterial culture and received one of the following treatments: (i) uterine douching with lotagen every other day for three doses, (ii) single parenteral oxytetracycline injection, (iii) subcutaneous injection with ceftiofur for 5 days, or (vi) combined oxytetracycline-ceftiofur injection. The results showed that Escherichia coli was the most isolated bacteria, followed by Streptococcus species. Treatment efficacy was (P &lt; 0.05) higher in ceftiofur and oxytetracycline-ceftiofur protocols compared with lotagen and oxytetracycline protocols. The fertility indexes, services per conception and pregnancy rate, were improved in ceftiofur and mixed oxytetracycline plus ceftiofur protocols as the pregnancy rate was (P &lt; 0.05) higher in those protocols compared with lotagen and oxytetracycline protocols (71.4 and 67.9% vs. 39.3 and 42.9%, respectively). On the other hand, the number of services per conception was significantly lower in ceftiofur and oxytetracycline-ceftiofur protocols (1.2 for each protocol) than in lotagen and oxytetracycline protocols (1.8 and 1.7, respectively). In conclusion, subcutaneous injection of 1 ml ceftiofur per 50 kg body mass for 5 days can be used as an efficient treatment for uterine infection in female dromedary camels caused by E. coli and Streptococcus species for improving their fertility indexes

Tracking the Sources of Contamination and Evaluating the Effect of Cooking on Bacterial Load in Meat Meals Prepared and Served in Foodservice Establishments

In this study, we determined the aerobic plate count, Staphylococcus (Staph.) aureus count, and most probable numbers (MPN) of coliforms, fecal coliforms, and Escherichia (E.) coli, and the presence of Listeria monocytogenes in 120 samples of beef steak and beef burger at various stages of preparation in a randomly selected food serving establishment in Beni-Suef City, Egypt. Additionally, 60 swab samples from knives, cutting boards, and operator's hands were investigated for the same bacteriological criteria. Subsequently, bacterial isolates were subjected to molecular identification by investigating the presence of virulence and antibiotic resistance genes. The results showed that 100 % of meat product samples at various stages of preparation contained aerobic bacterial load and Staph. aureus. Conversely, E. coli and L. monocytogenes were undetectable in meat product samples. Interestingly, 13, 7, and 1 out of 20 swab samples from hands contained coliforms, fecal coliforms, and E. coli, respectively, while knives and cutting boards were free from fecal coliforms and E. coli. Furthermore, contamination with Staph. aureus was reported in 100 % of knives and hand swab samples and 50 % of cutting board swab samples. Furthermore, the only E. coli isolate from a worker's hand contained eaeA gene, but not Stx1 gene, which indicates that it is an enteropathogenic E. coli (EPEC) strain. Moreover, 6 and 5 Staph. aureus isolates from operator hands and beef steak after cooking had coa and mecA genes, respectively, which are responsible for plasma coagulation and methicillin resistance, respectively. To sum up, this food serving establishment does not apply proper food safety guidelines, practices inadequate cleaning and sanitizing and poor personal hygiene, accordingly, it should be faced with a high level of concern and consideration by the legal authorities

DAWWSEN: A DEFENSE MECHANISM AGAINST WORMHOLE ATTACKS IN WIRELESS SENSOR NETWORKS

Many obstacles impede the successful deployment of sensor networks. In addition to the limited resources issue, security is a major concern especially for applications such as home security monitoring, military, and battle field applications. In this paper we present a defense mechanism against wormhole attacks in wireless sensor networks. Specifically, a simple routing tree protocol is proposed and shown to be effective in defending against wormhole attacks through ns-2 simulations

Impacts of Moringa oleifera Foliage Substituted for Concentrate Feed on Growth, Nutrient Digestibility, Hematological Attributes, and Blood Minerals of Growing Goats under Abu Dhabi Conditions

To avoid the depletion and degradation of natural resources and to maintain long-term environmental quality and sustainability, the present study investigated the impacts of Moringa oleifera foliage (MF) as a replacement for concentrate feed on growth performance, blood hematology, serum metabolites, and serum mineral profile in growing goats. A total of 30 growing local goats (4 months old ± 7 days, with an average weight of 15.80 kg ± 147 g), were randomly allotted to five treatment groups comprising 0%, 25%, 50%, 75%, or 100% of MF replacing the concentrate feed as daily feed. The MF75 and MF100 percent diets decreased (p &lt; 0.05) final body weight (FBW), average daily gain (ADG), and crude protein (CP) of the diet. Moreover, MF up to 75% improved acid detergent fiber (ADF) digestibility. Feeding MF at different levels did not have any deleterious effects on blood chemistry parameters. Urea, low-density lipoprotein (LDL), and alkaline phosphatase (ALP) values were depressed (p &lt; 0.05), due to increasing the MF (MF50, MF75, and MF100) level in the diet of growing goats kept in an arid region, when compared to the control group. Both of MF75 and MF100 led to a decrease (p &lt; 0.05) in phosphorous (P) level, compared with the other groups. The results were interpreted that feeding MF to replace 25% DM of the concentrate feed had no adverse effects on growth performance, feed utilization, serum metabolites, and serum minerals in growing goats reared under arid conditions. The increasing of MF level up to 50% or more significantly altered ADG and blood levels of creatinine, urea and ALP

Data_Sheet_1_Efficacy of different treatment protocols for endometritis in Camelus dromedarius.docx

Endometritis is considered a significant cause of infertility problems in dromedary camels. This study aimed to compare the efficacy of different treatment protocols for endometritis in dromedary camels under Abu Dhabi Emirates' conditions. A total of 112 dromedary she-camels with uterine infection were subjected to uterine swabbing for bacterial culture and received one of the following treatments: (i) uterine douching with lotagen every other day for three doses, (ii) single parenteral oxytetracycline injection, (iii) subcutaneous injection with ceftiofur for 5 days, or (vi) combined oxytetracycline-ceftiofur injection. The results showed that Escherichia coli was the most isolated bacteria, followed by Streptococcus species. Treatment efficacy was (P < 0.05) higher in ceftiofur and oxytetracycline-ceftiofur protocols compared with lotagen and oxytetracycline protocols. The fertility indexes, services per conception and pregnancy rate, were improved in ceftiofur and mixed oxytetracycline plus ceftiofur protocols as the pregnancy rate was (P < 0.05) higher in those protocols compared with lotagen and oxytetracycline protocols (71.4 and 67.9% vs. 39.3 and 42.9%, respectively). On the other hand, the number of services per conception was significantly lower in ceftiofur and oxytetracycline-ceftiofur protocols (1.2 for each protocol) than in lotagen and oxytetracycline protocols (1.8 and 1.7, respectively). In conclusion, subcutaneous injection of 1 ml ceftiofur per 50 kg body mass for 5 days can be used as an efficient treatment for uterine infection in female dromedary camels caused by E. coli and Streptococcus species for improving their fertility indexes.</p

Diagnostic utility of sonar guided biopsy in tuberculous effusion

Background/aim: Tuberculous pleural effusion remains the commonest cause of exudative effusions in areas with a high prevalence of tuberculosis and histological examination of pleural tissue is the gold standard for its diagnosis. This study was to assess the diagnostic utility of sonar guided biopsy in tuberculous pleural effusion. Patients and methods: 50 patients (34 men) of mean ± SD age 38.7 ± 16.7 years with pleural effusions and a clinical suspicion of tuberculosis were enrolled in the study. Transthoracic ultrasound was performed on all patients, who were then randomly assigned to undergo ⩾4 Abrams needle biopsies followed by ⩾4 Tru-Cut needle biopsies or vice versa. Results: Pleural tuberculosis was diagnosed in 31 patients, alternative diagnoses were established in 16 patients and 3 remained undiagnosed. Pleural biopsy specimens obtained with Abrams needles contained pleural tissue in 29 patients (92.0%) and were diagnostic for tuberculosis in 26 patients (sensitivity 82%), whereas Tru-Cut needle biopsy specimens only contained pleural tissue in 21 patients (78%) and were diagnostic in 21 patients (sensitivity 64%). Conclusions: Ultrasound-assisted pleural biopsies performed with an Abrams needle are more likely to contain pleural tissue and have a significantly higher diagnostic sensitivity for pleural tuberculosis

Impact of cytotoxin-associated gene A of <i>Helicobacter pylori </i>strains on microalbuminuria in type 2 diabetes

Cytotoxin-associated gene A (CagA) positive strains of H. pylori have a significant correlation with gastritis and peptic ulcer, and may induce persistent systemic inflammatory response, increase vascular damage, and compromise glycemic control in diabetic patients. To evaluate correlation between infection by cagA positive strains of H. pylori and occurrence of microalbuminuria and glycemic control in type 2 diabetic patients, we prospectively studied 98 dyspeptic type 2 diabetic patients as a study group and 102 dyspeptic non-diabetic subjects as a control group. Gastric biopsy specimens obtained with endoscopy were cultured to isolate H. pylori. All the isolated H. pylori strains from cultures were used for detection of cagA gene by polymerase chain reaction. There was no significant difference between study and control groups regarding infection with cagA positive strains of H. pylori ( P= 0.145). Furthermore, there was no significant differences between both groups concerning the incidence of microalbuminuria ( P= 0.145). On the other hand, there was an extremely statistically significant difference in the inci-dence of microalbuminuria and glycemic control in the diabetic patients between those infected with cagA positive strains of H. pylori and cag A negative starins (P= 0.000). We conclude that infection with cagA positive strains of H. pylori are strongly associated with the increased inci-dence of microalbuminuria and poor glycemic control in type 2 diabetic patients