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Background: Hepatic manifestations of hemophagocytic lymphohistiocytosis (HLH), an underrecognized primary presentation in pediatric age group, mandate high levels of suspicion for early diagnosis. Aim: This is to study the frequencies of clinical and laboratory hepatic involvement in patients with familial/primary or secondary/acquired HLH in relation to disease reactivation and outcome. Methods: A 6-month retrospective cohort study recruited 35 patients with HLH. Detailed clinical, laboratory, and genetic characteristics of HLH were collected. Hepatic transaminases and synthetic liver functions were collected at presentation, weeks 2 and 8 after starting treatment, and at time of reactivation. Biochemical liver involvement was considered when alanine aminotransferase (ALT) lived three-times more than the upper normal level. Overall (OS) and reactivation free survival were analyzed according to liver involvement. Results: Twenty patients (57%) had genetically confirmed HLH, 12 (34.3%) had MUNC13D mutations, 3 (8.5%) had STXBP2 mutations, and 5 (14.3%) had RAB27A mutations, while 9 (25.7%) had no genetic mutations with 4 of them had secondary HLH. Six patients (17.2%) patients had unknown genetics status. Median (IQR) age of the whole group was 18 months (6–36) with an age range of 2–108 months. Liver enlargement was detected at diagnosis in 29 (82.9%) and at reactivation in 18 (51.4%) patients. Eight (22.86%) patients had biochemical hepatic involvement at presentation with no significant difference in their demographic, initial clinical presentation, survival, or the type of mutant gene according to liver involvement. Conclusion: Variable hepatic biochemical involvement might be the presenting manifestation of HLH at diagnosis and upon reactivation, yet it did not impact disease outcome. [ABSTRACT FROM AUTHOR]

Obesity is a global health problem and has been increasing in Egypt over the last several decades. A national population screening program for hepatitis C included screening for obesity. Here we report the outcome of body mass index (BMI) calculation for the screened population and for patients with hepatitis C. Methods Adults 18 years and older (a target population of 62.5 million) were invited to participate in a screening program between October 2018 and April 2019. Persons had their BMI calculated. All data were entered in real-time to a central database via cellular networks. BMI data for patients with hepatitis C virus (HCV) infection before starting direct antiviral therapy were obtained from the National Committee for the Control of Viral Hepatitis (NCCVH) Findings 49.6 million persons (25.6 million females and 24.0 million males) voluntarily participated and had valid height and weight data. 12.7 million females (49.51%) and 7.09 million males (29.53%) were affected by obesity (BMI ≥ 30kg/m2). Obesity increased with age, was more prevalent in females, was more prevalent in the Nile Delta states and in urban areas. Detailed district-level prevalence for the whole country is identified. Prevalence of obesity among 335,504 patients with HCV was higher in females, increased with age, and was significantly lower overall and in males and females than in the screened general population. Conclusion This is the largest population screening program for obesity. We show that obesity prevalence in the general population is currently among the highest in the world, starting in young adults, and highlight the high prevalence areas. Prevalence is lower in patients with HCV. [ABSTRACT FROM AUTHOR]

Ochratoxin A (OTA) is a mycotoxin produced by Aspergillus spp. and Penicillium spp. that causes a threat to food safety and human health. Fungal biodegradation might be a promising strategy for reducing the OTA contamination in the future. In this study, the ability of Trichoderma koningii strains to degrade OTA produced by Aspergillus niger T2 (MW513392.1) isolated from tomato seeds was investigated. Among T. koningii strains tested, three strains; AUMC11519, AUMC11520 and AUMC11521 completely eliminated OTA from the culture medium, while AUMC11522 strain eliminated only 41.82% of OTA. OTα-amide, 3-phenylpropionic acid, OTα and phenylalanine were assayed as degradation products by FTIR analysis and LC–MS/MS spectra. Carboxypeptidase A (CPA) was found responsible for OTA degradation when a metal ion chelator, EDTA, was added to cell free supernatants of the three effective strains. OTA detoxification by T. koningii could present new prospective strategies for a possible application in food commodities intoxicated with ochratoxin. [ABSTRACT FROM AUTHOR]

Background and aims: Micro-elimination of hepatitis C in renal patients is crucial. This study aims to assess the efficacy and safety of directly acting antivirals in chronic kidney disease patients and the effect of treatment on kidney functions. Results: This prospective cohort study included 77 chronic HCV-infected patients with chronic kidney disease. Patients were consented and treated for 12 weeks with either sofosbuvir and daclatasvir ± ribavirin if glomerular filtration rate was > 30 mL/min per 1.73m2 or ritonavir-boosted paritaprevir-ombitasvir-ribavirin if it was < 30 mL/min per 1.73m2. Patients were divided into two categories (responders versus non-responders). Predictors of response to treatment were statistically analyzed through logistic regression analysis. Sixty-two patients received ritonavir-boosted paritaprevir-ombitasvir-ribavirin, 3 received sofosbuvir and daclatasvir, and 12 received sofosbuvir and daclatasvir plus ribavirin. Most patients were on hemodialysis (n = 36) while 31 were stage 3 kidney disease. All patients completed their treatment course; ribavirin doses were adjusted or stopped in patients who developed anemia (40%). Seventy-two patients (93.5%) achieved sustained virological response 12 weeks following end-of-treatment. Five patients (6.5%) were non-responders, 4 of whom were on hemodialysis (p = 0.179). All non-responders were on ritonavir-boosted paritaprevir-ombitasvir-ribavirin. The mean serum creatinine level at weeks 4 and 8 of treatment demonstrated significant improvement compared to pretreatment values (p < 0.001) in patients on conservative therapy. Conclusion: Treatment of chronic kidney disease patients for chronic hepatitis C with directly acting antivirals is safe, efficacious with high response rates and likely to improve renal functions if started early in the course of kidney disease. [ABSTRACT FROM AUTHOR]

Low-density polyethylene (LDPE) possesses various applications in several industries owing to its durability, low-cost, and many mechano-thermal properties. Unfortunately, LDPE waste creates an environmental threat. The level of biodegradation of black LDPE sheets with fungi isolated from different landfills sites in Sharqiyah Governorate, Egypt, was evaluated. LDPE sheets, the only source of carbon, along with minimal salt medium were incubated on a rotary shaker at 30 °C and 120 rpm for 16 weeks. Aspergillus carbonarius MH 856457.1 and A. fumigatus MF 276893 confirmed to be good candidates for LDPE biodegradation. A mixed culture of two strains showed the excellent weight loss% of sheets as compared to single isolate. Further efforts to improve the degrading capacity through physical and chemical treatments were performed. The biodegradation was significantly stimulated by 39.1% (thermal treatment), 17.76% (HNO3 treatment), and 5.79% (Gamma-irradiation treatment). Laccases and manganese peroxidases activities were assayed. LDPE biodegradation was analyzed by scanning electronic microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and gas chromatography–mass spectrometry (GC–MS). FTIR spectra showed the appearance of new functional groups assigned to hydrocarbon biodegradation and confirmed the role of manganese peroxidase in process. The changes in the FTIR spectra of the mixed culture biomass before and after the biodegradation (Δ73 cm−1) and the surface changes in the biodegraded LDPE (as indicated from SEM) confirmed the depolymerization of LDPE. From GC–MS analysis, the plasticizers bis(2-ethylhexyl) phthalate, Diisssctyl phthalate, 1,2-benzenedicarboxylic acid diisooctyl ester, and tributyl acetylcitrate completely biodegraded. Moreover, several antioxidants, antimicrobial, and anticancer compounds, and methyl esters of fatty acids were produced. [ABSTRACT FROM AUTHOR]

Favipiravir is considered a potential treatment for COVID-19 due its efficacy against different viral infections. We aimed to explore the safety and efficacy of favipiravir in treatment of COVID-19 mild and moderate cases. It was randomized-controlled open-label interventional phase 3 clinical trial [NCT04349241]. 100 patients were recruited from 18th April till 18th May. 50 patients received favipiravir 3200 mg at day 1 followed by 600 mg twice (day 2–day 10). 50 patients received hydroxychloroquine 800 mg at day 1 followed by 200 mg twice (day 2–10) and oral oseltamivir 75 mg/12 h/day for 10 days. Patients were enrolled from Ain Shams University Hospital and Assiut University Hospital. Both arms were comparable as regards demographic characteristics and comorbidities. The average onset of SARS-CoV-2 PCR negativity was 8.1 and 8.3 days in HCQ-arm and favipiravir-arm respectively. 55.1% of those on HCQ-arm turned PCR negative at/or before 7th day from diagnosis compared to 48% in favipiravir-arm (p = 0.7). 4 patients in FVP arm developed transient transaminitis on the other hand heartburn and nausea were reported in about 20 patients in HCQ-arm. Only one patient in HCQ-arm died after developing acute myocarditis resulted in acute heart failure. Favipiravir is a safe effective alternative for hydroxychloroquine in mild or moderate COVID-19 infected patients. [ABSTRACT FROM AUTHOR]

No specific antiviral drugs have been approved for the treatment of COVID-19. This study aimed to evaluate the efficacy of favipiravir in treatment of COVID-19. This was a multicenter randomized controlled study including 96 patients with COVID- 19 who were randomly assigned into a chloroquine (CQ) group and a favipiravir group. None of the patients in the favipiravir group needed mechanical ventilation (p = 0.129). One patient (2.3%) in the favipiravir group and two patients (4.2%) in the CQ group died (p = 1.00). Favipiravir is a promising drug for COVID-19 that decreases the hospital stay and the need for mechanical ventilation. ClinicalTrials.gov Identifier NCT04351295. [ABSTRACT FROM AUTHOR]

Background: The judicious prescription of antibiotics has become a central focus of professional and public health measures to combat the spread of resistant organisms.Materials and Methods: A one-year multi-center prospective follow-up study of 1,320 healthy infants was conducted. The study aim was to determine the prevalence and identify the predictors of antibiotics misuse in viral respiratory illnesses among healthy infants in the first year of life. Infants born between August 2001 and February 2002 were recruited through the clinics and dispensaries of 117 pediatricians located in the Greater Beirut area of Lebanon. On each routine visit from birth until one year of life, pediatricians reported any episodes of upper respiratory tract infection (URTI; common cold) and bronchiolitis, as well as the treatment type, duration, and dose. Predictors that were considered included infant, maternal, and pediatrician characteristics.Results: Of the 1,320 recruited infants, 770 (58.3%) had common cold or acute bronchiolitis on at least one occasion during the study period. Pediatricians prescribed antibiotics at least once in 21.4% of cases diagnosed as the common cold and 45.5% of cases of acute bronchiolitis. Logistic regression analysis revealed that antibiotics misuse was more common among infants born to mothers with lower educational levels (odds ratio [OR] = 1.6; 95% confidence interval [CI]: 1.1-2.3). Furthermore, pediatricians tend to prescribe antibiotics in dispensaries more often than in private clinics (OR = 1.4; 95% CI: 1.0-2.3).Conclusion: This study shows a substantial quantity of antibiotics prescriptions for common cold and acute bronchiolitis in our population. Our findings suggest that lower maternal education and pediatricians working in dispensaries (versus private clinics) are associated with increased antibiotics misuse. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVE:: Fulminant, potentially life-threatening infection represents a major long-term risk after splenectomy. This study examines the impact of patient's knowledge and compliance on the prevention of overwhelming postsplenectomy infection (OPSI). METHODS:: A Total of 318 splenectomized patients (median age: 18 years (10-26years); M?:?F, 187?:?131) were enrolled in this study. A questionnaire was administered to assess the degree of knowledge and patient compliance and their role in the prevention of postsplenectomy risks; while identifying the group of health-care providers most successful in conveying information. RESULTS:: The 318 patients had been splenectomized and followed up through a 17-year period. OPSI occurred among 5.7% (n=18) of patients. Of these, 56% occurred within the first 6 months and 44% in the following 10 years post splenectomy. Three patients died of OPSI, two during the first 6 months and one 2 years later. Of the followed up patients, 44.8% (n=142) had good knowledge of the risks of splenectomy and their prevention, 30.4% (n=96) had fair knowledge and 24.8% (n=79) had poor knowledge. Patients displaying greatest knowledge had a prevalence of OPSI of 1.4% compared to 16.5% among those with poor knowledge (P<0.001). In all, 60% of patients with good knowledge got their information principally from their tending hematologist. Among patients on regular and irregular prophylactic oral penicillin, OPSI occurred in 2.7 and 10% respectively (P<0.01). The incidence of OPSI also decreased from 7.3 to 3.2% after routine administration of pneumococcal vaccine (P<0.05). CONCLUSION:: Although good knowledge, prophylactic penicillin and peumococcal vaccination have remarkably reduced OPSI, it was not enough for complete prevention. The use of lifelong antibiotic prophylaxis remains of disputed value since no OPSI was recorded more than 10 years post splenectomy.The Hematology Journal (2004) 5, 77-80. doi:10.1038/sj.thj.6200328 [ABSTRACT FROM AUTHOR]

Patients receiving chemotherapy experience exacerbations of chronic hepatitis B (HBV) or hepatitis C (HCV) viral infections. We examined the pattern of liver disease induced by these infections in 92 children and adolescents with elevated transaminases (median age: 9 years). This included 76 with hematological malignancies (55 ALL, 15 NHL and six Hodgkin's disease) and 16 with thalassemia major. Liver disease was graded: A - occasional hypertransaminemia, B - persistent hypertransaminemia, C - severe hepatitis without encephalopathy, D - fulminant hepatic failure (FHF) and death. Screening included HBsAg, anti-HCV antibody, HBV-DNA and HCV-RNA: 26 had liver biopsies. A total of 60 (79%) patients with malignancies were HBsAg and/or HBV-DNA(+)(genotype D-E) and 47 (62%) were anti-HCV and/or HCV-RNA(+); 33 were coinfected with HBV and HCV. Grade A (n=24) included 16 with HCV and 12 with HBV (six coinfected); 18 with HBV and 11 with HCV (10 coinfected) were graded B (n=22). All grade C (n=25) had HBV with 16 HCV coinfected. FHF and death occurred in five HBV-DNA(+) patients, in four within a month of i.v. methotrexate. Patterns C and D were associated with HBsAg and HBV-DNA (P=0.001 and P<0.001, respectively). In all, 70% of HBV-infected children suffered chemotherapy-associated flares. None of the thalassemics had severe hepatitis exacerbations; 94% had HCV markers with none HBV-DNA(+). One died of progressive cirrhosis.CONCLUSIONS:: Children with hematological malignancies have worse liver disease when associated with chronic HBV. FHF occurred in HBsAg/HBV-DNA(+) children following i.v. methotrexate. Early recognition of hepatic dysfunction in HBV carriers is essential in order to reduce incidence of life-threatening complications.The Hematology Journal (2003) 4, 321-327. doi:10.1038/sj.thj.6200300 [ABSTRACT FROM AUTHOR]

Retraction Note to: Efficacy of favipiravir in COVID-19 treatment: a multi-center randomized study First, the reported baseline variables showed that the distribution of one variable was highly statistically different in the two study groups. These doubts are reinforced by the equal gender distribution even though gender was not stated to be an inclusion parameter by the authors. [Extracted from the article]