Background and AimThe role of the metabolic syndrome in hepatocellular carcinoma (HCC) has been previously reported. This study aims to investigate the possible role of vitamin D3, Zinc, Parathyroid hormone (PTH), calcium and phosphorus serum levels as non-traditional metabolic risk factors in HCV-related HCC.MethodThis cross-sectional observational study recruited HCV infected patients with and without HCC. All patients were subjected to demographic, biochemical, and hematological assessment. Serum levels of vitamin D3, Zinc, PTH, calcium, and phosphorus were determined in all the study participants.ResultsThis study includes 50 patients with HCV-related HCC compared to 40 patients with HCV-related liver cirrhosis and 30 patients with HCV chronic hepatitis C (CHC) without HCC. Our results show significantly higher age, male sex, aspartate transaminase (AST), PTH and corrected serum calcium levels in the HCC patients compared to values in the other two groups, (p < 0.001); while significant lower vitamin D3 and zinc levels were detected among the HCC patients compared to patients with non-HCC liver cirrhosis and CHC, (p < 0.001).Vitamin D3 deficiency was detected in 96% of the HCC patients, while it was detected in only 22.5% of the cirrhotic patients and in none of the CHC patients, (p < 0.001). However, on multiple stepwise regression analysis, only the age, AST, PTH, and corrected calcium levels were the independent predictors for HCC when studied in relation to chronic liver disease.ConclusionThis study indicates the prevalent deficient levels of vitamin D3 and zinc in HCC patients; however, a causal relationship is not established in this study.
Background: Central nervous system (CNS) malformations are the most common congenital abnormalities. The detection of fetal anomalies was one of the earliest uses and remains a pivotal application of prenatal ultrasound. Objective: This prospective study aims to clear out the value of 3/4D examination with advanced techniques (TUI, MIP & surface mode) over 2D in the evolution of fetal neural anomalies. Patients and methods: 120 pregnant women with suspected CNS fetal anomalies by 2D US were examined over a period starting from January 2015 until October 2017. Fetal gestation ranged from 8-39 weeks with a 24-week mean age. In all patients, 2D and 3/4D ultrasound as well as fetal Doppler were performed. Results: 3/4D ultrasound shows higher sensitivity in the detection of neural anomalies such as anencephaly, Chiari malformation, Hydranencephaly, holoprosencephaly, encephalocele, meningocele (spina bifida with no brain changes), Iniencephaly and Dandy-Walker variants, 3/4D ultrasound of 100% deletion rate over 85% for the 2D ultrasound. 3/4d & 2D ultrasound had the same detection rate of anomalies like hydrocephalus (communicating & non-communicating), microcephaly, and Dandy-Walker malformation. Conclusion: 3/4D ultrasound had a higher sensitivity in the detection of fetal neural anomalies over 2D which allows early interference or decision-making to save fetal or material life.
It is unclear whether direct-acting antiviral drugs (DAAs) result in the complete eradication of HCV infection or whether some quantities of the virus may persist after achieving a sustained virologic response (SVR). Aim The aim of this work was to study the possibility of the persistence of HCV RNA in peripheral blood mononuclear cells (PBMCs) after achieving SVR following DAA treatment. This study included 100 patients infected with HCV genotype 4, who were candidates for receiving DAAs and who achieved SVR during follow-up, as determined at 12 and/or 24 weeks following the end of treatment. All patients were subjected to demographic, biochemical and hematological assessments. Detection of HCV RNA in the serum and PBMCs and determination of the HCV genotype were performed with real-time PCR. We detected HCV RNA in the PBMCs of 20 out of 100 (20%) patients infected with HCV genotype 4, who achieved SVR. However, the persistent viral load in the PBMCs was very low (range: 400–900 U/mL; mean ± SD: 645.45 ± 153 U/mL). Multiple logistic regression analysis showed that only the higher posttreatment levels of aspartate transaminase (AST) were significantly predictive of HCV RNA persistence in the PBMCs (OR: 1.29; 95% CI: 1.08–1.55). Additionally, according to the Cox proportional hazard model, liver cirrhosis was the only significant risk factor for the persistence of HCV infection in PBMCs (HR: 5.8; 95% CI: 1.3–26.1; P < 0.02). Our results indicated the persistence of HCV RNA in some HCV patients who achieved SVR after treatment with DAAs.
Objectives:To study the detection rate of congenital fetal heart anomalies in first trimester scanning compared with second trimester scanning and to postnatal exam and neonatal echocardiography. Methods: This is a prospective observational study performed at a tertiary Fetal Medicine Unit. Patients had a first trimester scan from 11-14 weeks which included screening for Down's syndrome by measurement of the NT thickness, detection of Nasal bone, measurement of DV flow and tricuspid valve flow. Full anatomy exam was performed with special interest in the heart. Examination of the heart included; the four chamber view, intact inter-venticular septum, correct outflow tract and the three vessel view in the mediastinum. Pulsed Doppler was done at level of tricuspid valve to exclude regurgitation.A similar examination of the heart was performed at 20-24 weeks with full anatomy survey for other congenital malformations.Comparison of the two fetal heart examinations was done compared to final neonatal examination and neonatal echocardiography when indicated. Results: A total of 300 pregnant females were examined. The mean age of the patients were; 29.9 ± 6.3. Mean BMI was 32.5.The mean GA at the first trimester was 12.9 ± 0.9 and the mean GA at the second trimester was 20.4 ± 1.4.A total of 11 congenital heart anomalies were confirmed postnatally (3.7%).Seven were diagnosed and 4 were missed at the first trimester and one was falsely diagnosed as having an anomaly giving a detection rate of 63.6%, specificity 99.7%, PPV 87.5%, NPV 98.6% and agreement reached 98.3% (kappa 0.728)In the second trimester scan 9 cases were diagnosed, 2 cases were missed giving a detection rate of 81.8%, specificity 99%, PPV 75%, NPV 99.3% agreement 98.3% (kappa 0.774). Conclusions: First trimester heart examination has a good detection rate for congenital heart anomalies and should be done as a routine during first trimester screening for Down's syndrome. We describe here a remarkable case that had never been reported before. It's an antenatal diagnosis of a fistula between the rectum and the subcutaneous layer creating a meconial layer under the skin of the fetal bottom. Ultrasound and IRM showed this infiltration creating a mass extending to the caudal pole of the lumbosacral region at the root of both thighs. The surgical pediatric team confirmed the nature of the lesion after birth. Despite the important size of the mass, the pediatric and surgical cares have permitted an anatomic restitution. To our knowledge, such lesion has never been reported in the literature whether for an antenatal or a postnatal diagnosis. This case widens the range of perineal masses diagnosis. Teratoma of an undescended testicle is a rare cause of fetal abdominal cystic mass. The criteria for its prenatal diagnosis are unclear. We hereby present a prenatal diagnosis of isolated fetal testicular teratoma confirmed on early neonatal surgical excision, and describe two-and three-dimensional ultrasound, and Doppler criteria for its diagnosis. OP26.10A 31 year old ...
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