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Fathiya El-Raey,1 Mohamed Alboraie,2 Naglaa Youssef,3,4 Ahmed Yousef,5 Ahmed A Abdelmoaty,6 Essam Hassan,7 Sahar M Hassany,8 Sherief Abd-Elsalam,9 Ramy Elsharkawy,10 Khaled Farrag,11 Mohamed Elbadry,12 Mohammed Tag-Adeen,13 Nermeen Abdeen,14 Omar Elshaarawy,15 Tamer Haydara,16 Adel Ahmed Hassan,17 Marwa El-Sayed,18 Yasser Fouad,19 Amin Abdel Baki,20 Samy Zaky21 1Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Damietta, Egypt; 2Department of Internal Medicine, Al-Azhar University, Cairo, Egypt; 3Medical-surgical Nursing department, Faculty of Nursing, Cairo University, Cairo, Egypt; 4Medical-surgical Nursing department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 5Department of Public Health and Community Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt; 6Tropical Medicine Department, Zagazig University, Zagazig, Egypt; 7Department of Tropical Medicine, Fayoum University, Fayoum, Egypt; 8Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt; 9Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt; 10Department of Tropical Medicine and Gastroenterology, Sohag University, Sohag, Egypt; 11Department of Tropical Medicine and Hygiene, National Medical Institute of Damanhour, Damanhour, Egypt; 12Endemic Medicine Department, Helwan University, Cairo, Egypt; 13Department of Internal Medicine, South Valley University, Qena Faculty of Medicine, Qena, Egypt; 14Department of Tropical Medicine, Alexandria University, Alexandria, Egypt; 15Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Menoufia, Egypt; 16Department of Internal medicine, Gastroenterology & Hepatology Unit, Kafrelsheikh University, Kafr el-Sheikh, Egypt; 17Infectious and Endemic Disease Department, Suez Canal University, Ismailia, Egypt; 18Department of Microbiology and Immunology, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 19Department of Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt; 20Department: Hepatology, Gastroenterology and Infectious Diseases Department, National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt; 21Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, EgyptCorrespondence: Marwa El-SayedDepartment of Microbiology and Immunology, Faculty of Medicine, South Valley University, Qena, 83523, EgyptTel +20 1003717916Fax +20 963216128Email marwa.elsayed@med.svu.edu.egMohamed AlboraieDepartment of internal medicine, faculty of medicine, Al-Azhar University, Nasr City, Cairo, 11884, EgyptTel +20 222602687Fax +20 224020184Email alboraie@azhar.edu.egBackground: Healthcare workers (HCWs) are still at higher risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections than the general population. Identifying risk factors associated with severe SARS-CoV-2 infections is of paramount importance to protect HCWs and the non-infected patients attending different healthcare facilities.Purpose: To recognize the predictors for severity of SARS-CoV2 infection among HCWs working in either COVID-19 or non-COVID-19 healthcare settings. Also, to assess compliance of HCW to standard precautions of infection control and explore the possible risk factors for SARS-CoV-2 infection among HCWs.Methods: A cross-sectional study was conducted among HCWs with suspected or confirmed SARS-CoV-2 infection, from different Egyptian governorates. They were asked to fill in a web-based self-reporting questionnaire. The questionnaire assessed the demographic and socio-economic characteristics of participants, compliance of HCWs to standard precautions of infection control and COVID-19 presentation.Results: Our study enrolled 204 HCWs (52.3% physicians). Infection of SARS-CoV-2 was confirmed in 61.3% by RT- PCR; 35.8% were admitted to hospital, and of these, 3.9% were admitted to the intensive care unit. While 30.4% had mild disease, 48.5% had moderate disease, 17.2% had severe disease and 3.9% had critical disease. Regression analysis for variables predicting COVID-19 severity among study healthcare workers showed that associated chronic diseases and management at home were the main independent variables predicting severity of their SARS-COV-2 infection, while the variables age, sex, residence, occupation or drug history of immunosuppressives had no role in severity prediction.Conclusion: Associated chronic diseases and management at home were the main independent variables predicting severity of SARS-COV-2 infection among HCWs. So, HCWs with chronic diseases should not work in COVID-19 designated hospitals, and there should be a screening strategy for their infection with SARS-COV-2. HCWs must not be negligent in adhering to strict precautions of infection control. HCWs infected with SARS-COV-2 must be managed in hospital not at home.Keywords: health care providers, SARS-CoV-2, COVID-19, delivery of health care, infection control introduction

Haidi Karam-Allah Ramadan,1 Manal A Mahmoud,2 Mohamed Zakaria Aburahma,1 Amal A Elkhawaga,3 Mohamed A El-Mokhtar,3 Ibrahim M Sayed,3,4 Amal Hosni,5 Sahar M Hassany,1 Mohammed A Medhat1 1Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt; 4Department of Pathology, School of Medicine, University of California, San Diego, CA, USA; 5Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, EgyptCorrespondence: Haidi Karam-Allah RamadanDepartment of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, EgyptEmail haidikaram@aun.edu.egBackground: The emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a worldwide devastating effect with a diagnostic challenge. Identifying risk factors of severity aids in assessment for the need of early hospitalization. We aimed to demonstrate, for the first time, the clinical, laboratory and radiological characteristics of coronavirus disease 2019 (COVID-19) patients, to identify the predictors of severity and to describe the antimicrobial resistance profile in patients from Upper Egypt.Materials and Methods: Demographic characters, clinical presentations, laboratory, and radiological data were recorded and analyzed. Presence of other respiratory microorganisms and their sensitivity patterns were identified using the VITEK2 system. Resistance-associated genes were tested by PCR.Results: The study included 260 COVID-19 patients. The majority were males (55.4%) aged between 51 and 70 years. Hypertension, diabetes, and ischemic heart disease were common comorbidities. Main clinical manifestations were fever (63.8%), cough (57.7%), dyspnea (40%) and fatigue (30%). According to severity, 51.5% were moderate, 25.4% mild and 23% severe/critical. Lymphopenia, elevated CRP, ferritin, and D-dimer occurred in all patients with significantly higher value in the severe group. Age > 53 years and elevated ferritin ≥ 484 ng/mL were significant risk factors for severity. About 10.7% of the COVID-19 patients showed bacterial and/or fungal infections. Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were the predominant isolated bacteria while Candida albicans and Candida glabrata were the predominant isolated fungi. All Staphylococci were methicillin-resistant and carried the mecA gene. Gram-negative isolates were multidrug-resistant and carried different resistance-associated genes, including NDM-1, KPC, TEM, CTX-M, and SHV.Conclusion: Older age and elevated serum ferritin were significant risk factors for severe COVID-19. Bacterial co-infection and multidrug resistance among patients with COVID-19 in Upper Egypt is common. Testing for presence of other co-infecting agents should be considered, and prompt treatment should be carried out according to the antimicrobial sensitivity reports.Keywords: COVID-19, clinical characteristics, ESBL, KPC, NDM-1, risk factors, disease severity, Upper Egypt

Sahar M Hassany,1 Wesam Hassan,2 Hany Abo-alam,2 Marwa Khalaf,2 Amany M Nafeh,3 Eman Nasr-eldin,4 Ehab F Mostafa1 1Tropical Medicine and Gastroenterology Department, Alrajhi University Hospital, Assiut University, Assiut, Egypt; 2Hepatology Centre, Ministry of Heath, Assiut, Egypt; 3Microbiology and Immunity Department, Assiut University, Assiut, Egypt; 4Clinical Pathology Department, Assiut University, Assiut, EgyptCorrespondence: Sahar M HassanyAlrajhi University Hospital, Assiut University, Assiut, EgyptTel +201007314122Fax +20882375308Email saharhassany@yahoo.comPurpose: In interferon-free era, direct-acting antiviral agents (DAAs) have achieved high eradication rates with an excellent safety profile since revolutionized the management of hepatitis c virus (HCV) patients. Published papers have suggested a possible increased incidence of hepatocellular carcinoma (HCC) after successful DAAs treatment. Other papers have been published about the problem but without conclusive results. Because of this debate, we aim to evaluate the effects of antiviral therapy (Sofosbuvir plus Daclatasvir with or without Ribavirin) on the de novo occurrence of HCC in patients with liver cirrhosis (LC).Patients and Methods: A prospective cohort study has included 350 patients who have visited our center for HCV treatment. Pretreatment history, examination, complete blood picture, liver function tests, kidney function tests, HA1C for diabetic patients, HCV PCR, HBsAg, alpha-fetoprotein (AFP), and abdominal ultrasound have been done, also Child-Pogh (CP) and Model for End-Stage Liver Disease (MELD) score before treatment. These investigations have been repeated for 3 months after the end of treatment. Abdominal ultrasound (US) has been done for 3 months after treatment and every 4 months for 2 years after the end of treatment to detect HCC occurrence.Results: Patients age (58.11 ± 7.48), 55.4% of patients were males, 30.3% of patients were diabetic, 84.3% of them were treatment naïve and sustained virological response (SVR) occured in 94% of them. HCC occurrence after treatment was 6.7% in patients with SVR and 23.8% in patients with non-SVR (P value=0.016) during follow-up period. There is significant improvement of CP score. No significant changes in MELD score.Conclusion: Treatment of HCV-related LC patients with sofosbuvir and daclatasvir with or without ribavirin for 3 or 6 months showed high SVR and significant improvement in CP score, but still at risk of HCC even if treated and should be followed up regularly according to screening programs with special meticulous attention to those with non-SVR.Keywords: de-novo HCC occurrence, HCV treatment

Background: The sickle cell trait (SCT) disorder possesses a clinical heterogeneity ranging from a symptomless condition to sudden death. This study aimed to develop a diagnostic approach that helps the characterization and identification of SCT from normal subjects and sickle cell disease (SCD) patients, and to assess its severity., Methods: Sixty controls, 24 SCD patients and 31 SCT subjects were assessed clinically, radiologically and by laboratory investigations., Results: Of the SCT subjects, 12.8% were symptomatic (3.2% anemic, 6.4% hemolytic crisis, and 3.2% painful crises). Anemia was normocytic in 66.6%, and normochromic and polychromatic in 33.4%. Significantly lower red blood cells (RBCs), hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), hematocrit (Hct), Shine and Lal index (SL), and hemoglobin A (Hb A), and higher mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), Ricerca index (RI), and Huber-Herklotz index (HH) were found in SCT subjects compared with the controls. Hb A and hemoglobin S (Hb S) were excellent in discriminating SCT from SCD (cut-off for SCT > 50% and < 40%) followed by Hct, MCHC, Hb, Green and King index (GK), and England and Fraser index (EF) (cut-off for SCT > 33%, > 32, > 11, < 71, and < 10, respectively). Radiologically normal findings were detected in 87% of SCT subjects; they had nearly normal liver and renal function tests (except one case each). A schematic diagnostic paradigm for SCT was proposed., Conclusion: This study allowed understanding of SCT in various aspects, i.e., clinical, hematological, biochemical and radiological. Thus, it could help prevention of the Hb S variant disorder and proper management of carriers. This might be applied in pre-marital screening, particularly in those with family history of Hb S disorder., Competing Interests: The authors declare no conflict of interest., (Copyright 2022, Khaled et al.)

Background: The coronavirus disease 19 (COVID-19) pandemic has spread rapidly around the globe with considerable morbidity and mortality. Coexistence of comorbidities with COVID-19 had consistently been reported as risk factors for unfavorable outcome. We aimed to evaluate the impact of comorbidities in COVID-19 patients on the outcome and determine predictors of prolonged hospital stay, requisite for intensive care unit (ICU) admission. Four hundred and thirty-nine adult patients who are admitted through (June and July 2020) in our University Hospitals were included in the study. All participants were diagnosed with COVID-19 according to Egyptian Ministry of Health guidance as definite case or probable case., Results: Patients with comorbidities represented 61.7% of all cases. Constitutional symptoms especially myalgia and lower respiratory tract (LRT) symptoms such as dyspnea were significantly higher in patients with comorbidities ( P  < 0.05). Patients with comorbidities had significantly worse laboratory parameters. ICU admission was higher in patients with comorbidities (35.8%). Among different comorbidities 45.4% of cardiovascular diseases (CVD) cases were admitted in ICU followed by diabetes mellitus (DM) cases (40.8%). Also, patients with comorbidities needed invasive mechanical ventilation more than those without comorbidity (31 versus 10.7%, P  < 0.001). Significant lower frequency of recovery was found in COVID-19 patients with comorbidities (59% versus 81%, P  < 0.001) and death rate was significantly higher in cases with comorbidities ( P  < 0.001) . The survival rates in cases with pre-existing CVD and neurological diseases were lower than those without disease ( P  < 0.002 and 0.001, respectively)., Conclusions: Association of cardiovascular comorbid conditions including hypertension or neurological diseases including old cerebrovascular strokes together with COVID-19 infections carries higher risks of mortality. However, other comorbidities such as diabetes mellitus, chronic pulmonary or kidney diseases may also contribute to increased COVID-19 severity., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2022.)

Background: Healthcare workers (HCWs) are at a high risk for disease exposure. Given the limited availability of nucleic acid testing by PCR in low resource settings, serological assays can provide useful data on the proportion of HCWs who have recently or previously been infected. Therefore, in this study, we conducted an immunologic study to determine the seroprevalence of anti-SARS-CoV-2 antibodies in two university hospitals in Egypt., Methods: in this cross sectional study, HCWs who were working in SARS-CoV-2 Isolation Hospitals were interviewed. Estimating specific antibodies (IgM and IgG) against SARS-CoV-2 was carried out using an enzyme-linked immunosorbent assay targeting the Spike antigen of SARS-CoV-2 virus., Results: Out of 111, 82 (74%) HCWs accepted to participate with a mean age of 31.5 ± 8.5 years. Anti-SARS-COV2 antibodies were detected in 38/82 (46.3%) of cases with a mean age of 31 years and female HCWs constituted 57.6% of cases. The highest rate of seropositivity was from the nurses (60.5%), and physicians (31.6%) with only (7.9%) technicians. Only 28/82 (34.1%) HCWs reported previous history of COVID19. We reported a statistically significant difference in the timing of exposure (p = 0.010) and the frequency of contact with COVID-19 cases (p = 0.040) between previously infected and on-infected HCWs. Longer time of recovery was reported from IgG positive HCWs (p = 0.036)., Conclusion: The high frequency of seropositive HCWs in investigated hospitals is alarming, especially among asymptomatic personnel. Confirmation of diseased HCWs (among seropositive ones) are warranted., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

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.

Hepatitis B virus (HBV) vaccination patterns and the understanding of its risks among healthcare workers (HCWs) is a critical step to decrease transmission. However, the depth of this understanding is understudied. We distributed surveys to HCWs in 12 countries in Africa. Surveys had nine multiple-choice questions that assessed HCWs' awareness and understanding of HBV. Participants included consultants, medical trainees, nurses, students, laboratory personnel, and other hospital workers. Surveys were completed anonymously. Fisher's exact test was used for analysis, with a P -value of < 0.05 considered significant; 1,044 surveys were collected from Kenya, Egypt, Sudan, Tanzania, Ethiopia, Uganda, Malawi, Madagascar, Nigeria, Cameroon, Ghana, and Sierra Leone. Hepatitis B virus serostatus awareness, vaccination rate, and vaccination of HCWs' children were 65%, 61%, and 48%, respectively. Medical trainees had higher serostatus awareness, vaccination rate, and vaccination of their children than HCWs in other occupations (79% versus 62%, P < 0.001; 74% versus 58%, P < 0.001; and 62% versus 45%, P = 0.006, respectively). Cost was cited as the most frequent reason for non-vaccination. West African countries were more aware of their serostatus but less often vaccinated than East African countries (79% versus 59%, P < 0.0001 and 52% versus 60%, P = 0.03, respectively). West African countries cited cost as the reason for non-vaccination more than East African countries (59% versus 40%, P = 0.0003). Our study shows low HBV serostatus awareness and vaccination rate among HCWs in Africa, and reveals gaps in the perception and understanding of HBV prevention that should be addressed to protect HCWs and improve their capacity to control HBV infection.

Aim: To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma (HCC)., Methods: The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study was based on a questionnaire with 20 items. Each questionnaire consisted of two parts: (1) personal information regarding the physician (name, age, specialty and type of health care setting); and (2) professional experience in the care of patients at risk for HCC development (screening, knowledge about the cause and natural course of liver diseases and HCC risk)., Results: Sixty-eight percent of doctors with an MD degree, 48% of doctors with a master degree or a diploma and 40% of doctors with a Bachelor of Medicine, Bachelor of Surgery certificate considered the hepatitis C virus (HCV) genotype as risk factor for HCC development (P < 0.05). Ninety percent of physicians specialized in tropical medicine, internal medicine or gastroenterology and 67% of physicians in other specialties advise patients to undergo screening for HCV and hepatitis B virus infection as well as liver cirrhosis (P < 0.05). Eighty-six percent of doctors in University Hospitals and 69% of Ministry of Health (MOH) doctors consider HCV infection as the leading cause of HCC in Egypt (P < 0.05). Seventy-two percent of doctors with an MD degree, 55% of doctors with a master degree or a diploma, 56% of doctors with an MBBCH certificate, 74% of doctors in University Hospitals and 46% of MOH hospital doctors consider abdominal ultrasonography as the most important investigation in HCC screening (P < 0.05). Sixty-five percent of physicians in tropical medicine, internal medicine or gastroenterology and 37% of physicians in other specialties recommend as HCC screening interval of 3 mo (P < 0.05). Seventy-one percent of doctors with an MD degree, 50% of doctors with a master degree or diploma and 60% of doctors with an MBBCH certificate follow the same recommendation., Conclusion: In Egypt, physicians specialized in tropical medicine, internal medicine or gastroenterology with an MD degree and working in a University Hospital are best informed about HCC.

Background: End-stage liver disease (ESLD) is associated with dysregulation of the immune system and increased susceptibility to infections. Although invasive fungal infection (IFI) is a growing public health problem, studies of IFI in ESLD are lacking. The aims of this study were to screen for IFI in ESLD and to assess risk factors and serum interleukin 17 (IL-17) as a marker of the cellular immune response., Methods: Both blood and ascitic fluid samples were collected from 46 patients with ESLD for fungal culture and PCR. Serum IL-17 levels were determined., Results: Seven patients had isolated IFI (four had spontaneous fungal peritonitis, two had fungemia, and one had a disseminated fungal infection) and five cases had combined fungal and bacterial infections. Spontaneous fungal peritonitis was attributed to Candida species, while fungemia was caused by Aspergillus species. Patients with IFI had higher serum IL-17 levels and increased mortality compared to patients without IFI. A history of antibiotic use (p = 0.002), higher model for end-stage liver disease (MELD) scores (p = 0.04), and hepatorenal syndrome (p = 0.006) were risk factors for IFI., Conclusions: Patients with ESLD had a low frequency of IFI; however, in patients with these infections, delayed diagnosis and treatment may contribute to a high fatality rate. Thus, clinicians should have a high index of suspicion for this unusual but lethal entity, as prompt detection and appropriate treatment can improve the outcome., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)