Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancer related deaths. Radiofrequency ablation (RFA) and microwave ablation (MWA) are effective measures for HCC management. Although MWA is usually considered to be superior to RFA in the medical community, clinical studies showed contradictory results. We aimed to compare the efficacy of both techniques using a randomized controlled trial. Methods: We had assessed all patients with definite HCC who were referred to our unit during the period from mid-June 2017 to mid-December 2017 for inclusion in the study. After fulfilling the criteria, patients were randomized to either RFA or MWA. Achieving complete ablation was ensured. Patients were followed up every 3 months after the procedure to detect any tumor recurrence. Results: There were no statistically significant differences between both techniques regarding complications, local tumor recurrence, development of de novo HCC lesions and changes in the modified Child-Pugh score. Time of ablation using MWA was significantly shorter than RFA (P<0.001). Conclusions: RFA and MWA are comparable techniques for HCC treatment. Our group couldn't prove any superiority of MWA over RFA except for the shorter time needed for ablation.

Background We investigated tolerability and effectiveness of generic, less expensive direct antiviral drugs in the treatment of hepatitis C virus genotype 4 (HCV GT‐4) in an Egyptian cohort. Patients and Methods Retrospectively, we analysed data from 648 patients with HCV GT4 attending Alexandria Main University Hospital from January 2016 to May 2017 [488 treatment naïve/160 treatment‐experienced/288 with chronic hepatitis/360 with cirrhosis]. Patients received generic sofosbuvir/ledipasvir (n = 168, treatment naïve = 136, treatment‐experienced = 32) or sofosbuvir/daclatasvir (n = 480, treatment naïve = 352, treatment‐experienced = 128) ± ribavirin. We assessed sustained virologic response 12 weeks after treatment, non‐response, relapse, treatment discontinuation and drug adverse reactions. Results An overall sustained virologic response 12 weeks after treatment was achieved in 97.8%, non‐response in 0.6%, relapse in 0.3% and discontinuation of treatment in 1.3% of patients. Sofosbuvir/ledipasvir ± ribavirin regimen attained an overall sustained virologic response 12 weeks after treatment in 96.4% of patients (100% of treatment‐experienced vs 95.6% of treatment naïve, P = 0.28), vs 98.3% for sofosbuvir/daclatasvir ± ribavirin regimen (100% of treatment‐experienced vs 97.7% of treatment naïve, P = 0.08). No severe drug adverse events or deaths were reported except anaemia due to ribavirin. Conclusion Generic direct antiviral drugs used in treating Egyptian patients with HCV GT‐4 demonstrated equal potency, safety and tolerability compared to original brands, with low cost which would help to provide treatment to a larger scale of patients.

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Background: Coronavirus disease-2019 (COVID-19) is a global pandemic health problem which causes a wide spectrum of clinical manifestations and considerable mortality rates. Unfortunately, recovered patients who survive COVID-19 may continue to report wide varieties of clinical manifestations of multisystem affection such as fatigue, dyspnea, myalgia, anxiety, depression, acute myocardial infarction, peripheral and pulmonary embolisms. Objective: We aimed to assess the prevalence of post-COVID-19 manifestations. Methods: We conducted a systematic review on post COVID-19 manifestations by searching Pubmed, Scopus, Web of Science (WOS), EBSCO, Wily, and World health organization (WHO) databases. Screening, selection, data extraction, data synthesis and quality assessment were done by two independent reviewers. Results: Of 1,371 references, 817 references remained after duplicates, reviews; case reports, commentaries, and any article containing non-original information were removed. According to eligibility criteria for this systematic review, 12 studies were included for qualitative synthesis. The overall prevalence of post-COVID-19 manifestations ranged from 35% to 90.5%. Fatigue, dyspnea, neuropsychological disorders, and pain were the most frequent post COVID-19 symptoms. Conclusion: This systematic review showed that 35% to 90.5% of recovered patients who survive COVID-19 continue to have wide varieties of clinical manifestations and fatigue, dyspnea, neuropsychological disorders, and pain were the most frequent post COVID-19 symptoms.

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Background. Albuminuria is an early clinical indicator of diabetic kidney disease (DKD). however, it has several limitations. The aim of this study was to evaluate the plasma microrNA-192 (mirNA-192) expression and its diagnostic performance in patients with type 2 diabetes mellitus (T2DM) and DKD. Methods. In this case-control study, 75 subjects were included into 3 groups: group (1): 20 patients with T2DM and UACr (urinary albumin creatinine ratio) < 30 mg/gm, group (2): 30 patients with T2DM and ACr ≥ 30 mg/gm, and group (3): 25 healthy controls. Patients were recruited from the outpatient clinic of the Diabetes unit at our institution. real-Time Quantitative reverse Transcription PCr was used to assess plasma mirNA-192 expression. Results. Plasma miRNA-192 was significantly higher in T2DM patients with DKD compared to those with normal UAE. Additionally, in patients with T2DM, plasma mirNA-192 was positively correlated with UACr. The rOC curve analysis for mirNA-192 plasma expression in patients with T2DM, revealed that mirNA-192 had a good diagnostic performance (AUC = 0.778) to define T2DM patients with DKD. Conclusion. Plasma expression of mirNA-192 was able to discriminate increased UAE among patients with T2DM; suggesting a promising role for mirNA-192 as a potential biomarker for DKD.

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Background: Conflicting data have been published about the risk of hepatocellular carcinoma (HCC) following direct-acting antivirals (DAAs). We investigated the incidence of HCC occurrence/recurrence after DAAs therapy. Patients and Methods: Retrospectively, we analyzed data of 392 patients with F3–4 fibrosis and cirrhosis treated by DAAs during the period from August 2015 to May 2018. In HCC-experienced patients, HCC treatment modality, and the duration between HCC management and DAAs initiation were recorded. In all patients, pretreatment clinicolaboratory evaluation, and imaging before, during and after DAAs were done. Results: De novo HCC occurred in 7.6% of naïve patients, while recurrence appeared in 28% of patients with previous HCC. Pretreatment alpha-fetoprotein was an independent predictor of HCC occurrence, while the time between HCC ablation and the beginning of DAAs was the only predictor of HCC recurrence (p < 0.001). Half of the patients who started DAAs before 6 months had HCC recurrence, while patients who started DAAs at ≥6 months had no recurrence (p< 0.0001). Conclusions: Although HCC occurrence after DAAs was not high, recurrence was apparently high. Pretreatment alpha-fetoprotein is a predictor for de novo HCC. The time between HCC ablation and DAAs was the strongest predictor of recurrence.