Worldwide, more than one million people die each year from hepatitis C virus (HCV) related diseases, and over 300 million people are chronically infected with hepatitis B or C. Egypt used to be on ...the top of the countries with heavy HCV burden. Some countries are making advances in elimination of HCV, yet multiple factors preventing progress; remain for the majority. These factors include lack of global funding sources for treatment, late diagnosis, poor data, and inadequate screening. Treatment of HCV in Egypt has become one of the top national priorities since 2007. Egypt started a national treatment program intending to provide cure for Egyptian HCV-infected patients. Mass HCV treatment program had started using Pegylated interferon and ribavirin between 2007 and 2014. Yet, with the development of highly-effective direct acting antivirals (DAAs) for HCV, elimination of viral hepatitis has become a real possibility. The Egyptian National Committee for the Control of Viral Hepatitis did its best to provide Egyptian HCV patients with DAAs. Egypt adopted a strategy that represents a model of care that could help other countries with high HCV prevalence rate in their battle against HCV. This review covers the effects of HCV management in Egyptian real life settings and the outcome of different treatment protocols. Also, it deals with the current and future strategies for HCV prevention and screening as well as the challenges facing HCV elimination and the prospect of future eradication of HCV.
The occurrence of hepatocellular carcinoma (HCC) is one of the most serious complications of hepatitis C virus (HCV) infection. Recently, effective antiviral medications have made sustained viral ...response (SVR) or cure a realistic therapeutic goal for most chronic HCV patients. Given HCV's tumorigenic propensity, it is not surprising that achieving SVR is helpful in preventing HCC. This review briefly summarizes and discusses the existing evidence on the relationship between hepatic carcinogenesis and viral eradication by antivirals, which is mainly divided into interferon‐based and direct‐acting antivirals (DAAs) based therapy. DAAs have changed the treatment landscape of chronic HCV, reaching high rates of SVR even in patients with advanced cirrhosis, with few contraindications and little side effects. Although some early reports suggested that DAA treatment increased the chance of HCC occurrence, more subsequent observational studies have refuted this theory. The probability of HCC recurrence after HCV eradication appears to be decreasing over time following SVR. Despite virological suppression/cure, individuals with liver cirrhosis are still at risk of HCC and should be monitored. There is a considerable need for markers/scores to predict the long‐term risk of HCC in patients with HCV‐related liver disease who attain SVR with direct‐acting antivirals.
According to this protocol, patients with COVID-19 infection are classified on clinical bases into mild, moderate, severe, and critical cases. ...critical patients are those who are meeting any of ...the following criteria; (a) occurrence of respiratory failure requiring mechanical ventilation, or (b) the presence of shock; other organ failures that require monitoring and treatment in the ICU. Additionally, some studies reported that meteorological factors could significantly affect COVID-19 rates of infection. ...the doubling time of COVID-19 positively was found to be correlated with temperature and inversely with humidity, implying that a decline in the infection progression rate will occur in spring and summer, as a 20°C increase in temperature is expected to lag the doubling time 1.8 days 6. According to this theory, the relatively low rates of COVID-19 infections and mortalities in Egypt may be partially attributed to the early intake of BCG vaccination in the country.
Variable models of care have been adopted in different countries in response to the COVID-19 pandemic. Egypt has assigned certain hospitals specifically for the quarantine of COVID-19 patients, where ...operational medical teams work continuously for 14 days, after which they are released for self-isolation at home for a similar period.
The study aimed to evaluate and compare perceived adverse psychological symptoms (stress, anxiety, depression), and insomnia by health-care professionals working in quarantine and non-quarantine hospitals during the COVID-19 pandemic in Egypt, and to explore associated factors with adverse psychological symptoms and insomnia.
An online cross-sectional survey was performed in April 2020, using a snowball sampling method. Sociodemographic information perceived general health, healthy lifestyle, insomnia (using Insomnia Severity Index), adverse psychological symptoms (using the Depression, Anxiety and Stress Scale-21), worries and concerns about COVID-19, future perspective about COVID-19, and coping strategies were collected.
Five hundred and forty health-care professionals participated; 10.2% (n=55) worked in quarantine hospitals. Younger age (ORa=0.96, 95% CI:0.93-0.99, ORa=0.95; 95% CI:0.92-0.97; ORa=0.96 CI:0.93-0.99), being not ready/sure of readiness to work in quarantine hospital (ORa=1.91, 95% CI:1.22-3.00; ORa=2.01, 95% CI:1.28-3.15; ORa=1.91, 95% CI:1.22-2.98), and insomnia (ORa=5.22, 95% CI:3.38-8.05; ORa=7.58, 95% CI:4.91-11.68; ORa=6.38 95% CI:4.19-9.73) significantly predicted stress, depression and anxiety, respectively. Being female (ORa=1.59, 95% CI:1.04-2.42; ORa=2.09, 95% CI:1.38-3.16) could also significantly predict stress and anxiety.
Female and younger age health care professionals were more prone to report adverse psychological symptoms. More and earlier screening for health-care professionals dealing with COVID-19, in addition to providing psychological support, is highly encouraged.
Over 70 million individuals are chronically infected with hepatitis C virus (HCV), and more than a million people die each year from illnesses associated with the HCV. For a long time, Egypt was at ...the top of the list of nations with the highest HCV prevalence. While several issues continue to hinder virus eradication, certain nations are making headway in the eradication of HCV. These constrains include a lack of international financing for medical care, delayed diagnosis, scanty data, and insufficient screening. Since 2007, the treatment of HCV has risen to the top of the national priority list in Egypt. Egypt launched a countrywide treatment program with the goal of eradicating HCV from the country. Pegylated interferon and ribavirin were first used in a mass HCV treatment program between 2007 and 2014. Yet, with the development of highly-effective direct acting antivirals (DAAs) for HCV, elimination of the disease has become a real possibility. In its fight against HCV, Egypt devised a strategy that serves as an example of care for other countries with high HCV prevalence rates. With this, Egypt was able to treat more than 4 million people with DAAs. Additionally, Egypt launched an extensive screening program for HCV infection that was able to screen more than 60 million citizens over 7 months. The model of HCV management in real-life Egyptian settings and the results of various treatment strategies are covered in this presentation. Obstacles associated with HCV eradication and the potential for future eradication will be also discussed. It also covers existing and future initiatives for HCV prevention and screening.
Introduction and Aims
Treatment of hepatitis C virus (HCV) genotype 4 patient with fixed dose combination of ombitasvir‐paritaprevir‐ritonavir plus ribavirin (OBV/rPTV/RBV) has been proven efficacy ...and safety in many clinical trials. The current study reports the efficacy and safety of OBV/rPTV/RBV (for treatment‐naïve), and OBV/rPTV/RBV/sofosbuvir (SOF) (for treatment‐experienced), in chronic HCV genotype 4 patients in real life settings.
Methods
Prospective cohort study including all adult chronic HCV genotype 4 patients who were scheduled to receive OBV/rPTV/RBV ± SOF for 12 or 24 weeks in New Cairo Viral Hepatitis Treatment Center. The primary efficacy endpoint was a virologic response at posttreatment week 12 (SVR12). Changes in hematological parameters, liver biochemical profile and fibrosis‐4 index (FIB‐4), as well as clinical and laboratory adverse events (AEs) across follow up visits (week 4, end of treatment EOT, and SVR12), were recorded.
Results
Our study included 325 patients (age; 47.63 ± 12.63 years, 55.38% n = 180 men). Most of the included patients (89.85%, n = 292) were treatment naïve and only 7% (n = 23) had liver cirrhosis. Overall, SVR12 was attained by 98.44% (316 of 321) of the patients; 97.15% (307 of 316) of patients who received 12 weeks of OBV/rPTV/RBV ± SOF and 100% (9 of 9) of patients who received 24 weeks of OBV/rPTV/RBV as assessed by modified intention to treat analysis. There was a significant improvement of baseline alanine aminotransferase, aspartate aminotransferase, hemoglobin, FIB‐4 at SVR12 (P < 0.05). The most common reported AEs were anemia (n = 106), fatigue (n = 41) and elevated indirect bilirubin (n = 37).
Conclusion
OBV/rPTV/RBV (±SOF) is a highly effective therapy for chronic HCV patients in real life settings.
Highlight
Treatment of chronic HCV patients with ombitasvir‐paritaprevir‐ritonavir was highly effective in real life settings (cure rate 98.44%).
We noticed significant improvement of baseline hepatic necroinflammatory markers, hemoglobin, FIB‐4 at SVR12 (p < 0.05).
The most common reported treatment related adverse events were anemia, fatigue and indirect hyperbilirubinemia.
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is common and closely associated with type 2 diabetes (T2D). We assessed ...the prevalence of NAFLD/MASLD in the general population and among patients with T2D in the Middle East and North Africa (MENA) region.
We searched PubMed and Embase for English-language articles published between 1990 and 2023 according to PRISMA. Each country's NAFLD/MASLD prevalence in the general population and in T2D patients was predicted by using a multivariable meta regression model. Input data were extracted from our systematic review, GBD and NCD Risk Factor Collaboration. Confidence intervals were constructed by using prediction intervals with the delta method.
Meta-analytic pooling estimated the prevalence of NAFLD/MASLD as 39.43% in the general population and 68.71% among T2D patients. NAFLD/MASLD prevalence has increased from 35.42% (2008-2016) to 46.20% (2017-2020). Using GBD-2019 dataset, it was predicted that there are 141.51 million cases of NAFLD/MASLD in the MENA region. The highest number of NAFLD/MASLD cases were expected in Egypt (25.71 million), followed by Türkiye (23.33 million) and Iran (19.85 million). Estimated NAFLD prevalence exceeded 40% in 10 of 21 countries with the top countries being Kuwait (45.37%), Egypt (45.0%), Qatar (44.4%), and Jordan (43.3%). Furthermore, it was predicted that there are 24.96 million cases of NAFLD/MASLD with T2D in the MENA region.
In the MENA region, prevalence of NAFLD/MASLD is very high and growing, necessitating an urgent need for regional public policy to deal with this growing burden.
PDF
