Several outbreaks of acute hepatitis of unknown etiology (AHUE) in children were reported in 2022 in many countries, with adenovirus identified as the etiological agent in most of them. We aimed to evaluate the characteristics and outcomes of AHUE cases in Egypt.

Methodology

Hospitalized patients with acute hepatitis were included in the study. Drug-induced, alcoholic hepatitis, autoimmune hepatitis, and Wilson’s disease were identified either by medical history or by routine laboratory diagnosis. Molecular and serological approaches were used to investigate common viral causes of hepatitis, such as hepatitis A–E viruses, cytomegalovirus, Epstein–Barr virus, herpes simplex viruses (HSV1/2), adenovirus, parvovirus B19, and coxsackie virus.

Results

A total of 42 patients were recruited and divided into two groups: 24 cases of unknown hepatitis after excluding the common causes and 18 cases of known …

Renal disorders are associated with Hepatitis E virus (HEV) infection. Progression to end-stage renal disease and acute kidney injury are complications associated with HEV infection. The mechanisms by which HEV mediates the glomerular diseases remain unclear. CD10⁺/CD13⁺ primary proximal tubular (PT) epithelial cells, isolated from healthy donors, were infected with HEV. Inflammatory markers and kidney injury markers were assessed in the presence or absence of peripheral blood mononuclear cells (PBMCs) isolated from the same donors. HEV replicated efficiently in the PT cells as shown by the increase in HEV load over time and the expression of capsid Ag. In the absence of PBMCs, HEV was not nephrotoxic, with no direct effect on the transcription of chemokines (Cxcl-9, Cxcl-10, and Cxcl-11) nor the kidney injury markers (kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin 18 (lL-18)). While higher inflammatory responses, upregulation of chemokines and kidney injury markers expression, and signs of nephrotoxicity were recorded in HEV-infected PT cells cocultured with PBMCs. Interestingly, a significantly higher level of IFN-γ was released in the PBMCs-PT coculture compared to PT alone during HEV infection. In conclusion: The crosstalk between immune cells and renal epithelium and the signal axes IFN-γ/chemokines and IL-18 could be the immune-mediated mechanisms of HEV-induced renal disorder.

Background
Smoking influences the nature of airway inflammation in patients with bronchial
asthma though synthesis of certain cytokines. Patterns of bronchial asthma are
differentiated clinically, functionally, and regarding inflammatory biomarkers.
Aim
The research aimed to study the clinical, functional, sputum cytological differences,
and serum eotaxin-2 and periostin levels in asthmatic patients regarding smoking
status.
Patients and methods
The research was a cross-sectional study. The collection of cases began in August
2018 and ended in January 2020 at the Chest Department, Assiut University
Hospital. We studied 117 asthmatic patients who were classified regarding their
smoking status (45 nonsmokers, 42 smokers, and 30 former smokers) for serum
eotaxin-2 and periostin by enzyme-linked immunosorbent assay. The effects
of smoking were analyzed on inflammatory cells including eosinophilic and
neutrophilic percentages in sputum and serum eotaxin-2 and periostin levels.
Results
Smokers with asthma had worse clinical and functional outcomes. Asthmatic
smokers had mainly neutrophilic phenotype. Serum eotaxin-2 level was higher
in smokers compared with nonsmokers and former smokers. However, serum
periostin level was higher in nonsmokers compared with smokers and former
smokers. Serum eotaxin-2 had a positive correlation with smoking index and
eosinophilic and neutrophilic count in sputum, whereas serum periostin was
correlated negatively with smoking index and positively with eosinophilic count.
Conclusion
Asthmatic smokers had worse clinical and functional outcomes with increased
neutrophils in the sputum. The inflammatory biomarkers seen in smokers with
asthma showed low serum periostin and increased serum eotaxin-2 levels.

Background: Recurrent unexplained miscarriage is still an unsolved reproductive health 15 problem. Inherited thrombophilias have been accused as one of the causes. Secondary to an 16 increased tendency for venous thromboembolism because of a mutation in a gene encoding a 17 protein involved in the coagulation cascade. These include prothrombin gene (PT G20210A) and 18 methylenetetrahydrofolate reductase (MTHFR) mutations. The study aims to evaluate the 19 association between polymorphisms in the prothrombin gene and the MTHFR gene with 20 recurrent miscarriage (RM). We also evaluated the association between Protein C (PC), Protein S 21 (PS), Antithrombin III (ATIII), and homocystiene with recurrent miscarriage (RM). 22
Methods: We conducted a comparative study on women with a history of two or more 23 miscarriages and healthy controls with no history of miscarriage and who had at least completed 24 one full-term normal pregnancy. Genetic analysis of the participants was done using the 5' 25 Nuclease Assay (TaqMan) PCR technique and various other blood tests were performed to check 26 general health indicators and thrombophilia markers. 27
Results: In this study of 195 RM group (Group I) participants and 90 healthy controls (Group 28 II), we noted significant discrepancies in health conditions. PC deficiency occurred in 7.2% of 29 Group I, but only 1.1% of Group II. PS deficiency was found in 65.6% of Group I versus 7.8% 30 of Group II. ATIII deficiency was observed in 9.2% of Group I and 2.2% of Group II. 31 Hyperhomocysteinemia was noted in 10.8% of Group I, and 2.2% of Group II. For the 32 prothrombin gene G20210A, two Group I participants were A/G, with no A/G in Group II, and 33 no AA carriers in either group. G allele was in 99.5% of Group I and 100% of Group II, while 34 the A allele was in 0.5% of Group I only. MTHFR C677T gene showed C/T mutation in 33.3% 35 of Group I and 32.2% of Group II, and T/T mutation in 12.8% of Group I and 8.9% of Group II. 36 The C allele was found in 70.5% of Group I and 75% of Group II, with the T allele in 29.5% of 37 Group I and 25% of Group II (p=0.269). 38
Conclusion: Prothrombin gene G20210A and MTHFR C677T gene polymorphisms are not 39 correlated with RM in the Egyptian population. About 70% of women in upper Egypt have at 40 least one type of MTHFRC677T gene polymorphism. However, Egyptian women with RM are 41 strongly associated with hyperhomocysteinemia, PC, PS, and AT deficiencies. 42

Background: Preoperative poor nutrition greatly raises the risk of complications and increases
length of stay (LOS). Glutamine deficiency may impair immune functions, reduce myocardial
adenosine triphosphate–adenosine diphosphate (ATP-ADP) substrate and decrease myocardial
glutathione level. We evaluated the effects of preoperative glutamine administration in
patients undergoing mitral valve replacement surgery upon cardiac and renal outcomes or
hospital/ICU LOS.
Methods: This prospective randomized double-blinded study included 60 patients above 18
up to 60 years undergoing mitral valve replacement. For 3 days preoperatively, Group
N patients received glutamine intravenously 0.4 g/kg/day while Group C patients received
intravenous normal saline as placebo. The primary outcome was to assess the effects of
glutamine on cardiac function as reflected on proBNP (brain natriuretic peptide) during 4
postoperative days. Secondary outcomes included renal function, vasoactive inotropic score,
duration of mechanical ventilation, and hospital/ICU stays.
Results: Postoperative proBNP was significantly lower in Group N during the entire period. It
was significantly decreased on the first postoperative day in both groups in comparison to the
preoperative values. No significant changes were recorded regarding renal functions, and
duration of mechanical ventilation between groups. Also, there was signifiacant difference
between the two studied groups regarding the vasoactive inotropic score at the 12th, 18th,
24th and 48th hours with lower scores in Group N. ICU and hospital stays were significantly
lower in Group N than Group C.
Conclusion: Short term of preoperative intravenous glutamine 0.4 g/kg/day decreased the
postoperative proBNP level and hospital/ICU stays in mitral valve replacement surgery. No
significant implication was reported upon postoperative human NGAL level or kidney
functions.

Background: Persistent undiagnosed effusion is present in approximately 15% of all causes of exudative effusion.
Pleural effusion caused by immunoglobulin G4 (IgG4) is a new type of pleural effusion. Tumor markers such as Carcinoembryonic
antigen (CEA) may play a role in the diagnosis of malignant pleural effusion. This study aimed to evaluate
the use of serum Immunoglobulin G4 and carcinoembryonic antigen in diagnosing pleural effusion.
Methods: This observational descriptive cross-sectional study comprised 89 individuals with exudative pleural
effusion who visited the Assiut university hospital’s chest department. All patients were examined and asked about
their medical history. Also, chest X-ray, MSCT chest, transthoracic ultrasonography, pleural fluid analysis and cytology,
serum level of carcinoembryonic antigen, and immunoglobulin G4 were performed. In addition, pleural biopsy, bronchoscopy,
and thoracoscopy were performed when required.
Results: In comparison to another diagnosis, the level of serum IgG 4 was observed to be substantially greater in
individuals with IgG4-associated effusion (725± 225.45). Patients with malignant mesothelioma (70± 16.24) and
metastatic adenocarcinoma (93.52± 19.34) had lower levels of IgG4. In contrast, the serum level of CEA was significantly
higher in individuals with malignant mesothelioma (79.50± 29.47) and metastatic adenocarcinoma (68.71±
28.98). Patients with para-pneumonic effusion had a minor serum level of CEA (0.36 ± 0.26). At cutoff point > 152
mg/dl serum IgG-4 had 100% sensitivity and 94% specificity in the diagnosis of IgG4 related pleural effusion with an
overall accuracy of 95.3% and area under the curve of 0.97. At the cutoff point > 5 ng/ml serum CEA had 77% sensitivity
and 100% specificity in diagnosing malignant pleural effusion with an overall accuracy of 91.1% and area under the
curve of 0.88.
Conclusion: Serum IgG4 higher than 152 mg/dl has good diagnostic accuracy in cases of undiagnosed pleural effusion.
Carcinoembryonic antigen aids in diagnosing malignant pleural effusion with a cutoff point higher than 5 ng/ml
in serum.

Breast cancer is one of the most malignant tumors in women across the globe. Diagnosis of breast cancer at early stages is essential to improve treatment outcomes and decrease mortality rates. There is a pressing need for new non-invasive biomarkers to improve early diagnosis of breast cancer. This study aims to assess plasma miR-27a for the early diagnosis of breast cancer. miR-27a was evaluated in a total of 95 blood samples, 40 newly diagnosed cancer patients, 20 patients with benign breast lesions, 20 females with positive family history for breast cancer and 15 apparently healthy controls, using quantitative real time polymerase chain reaction. Our results exhibited significantly higher expression level of plasma miR-27a in breast cancer patients (median= 8.3 and 19 fold change for early and late stages respectively) compared to controls, high risk group and benign group with (P <0.001) for each. Plasma miR-27a was significantly higher in late breast cancer (median=19 fold change) compared to early breast cancer (median= 8.3) with (P <0.001). There was no statistically significant difference of plasmamiR-27a levels in benign group (median=1.8 fold change) compared to both control group and high risk group. There was no statistically significant difference of plasma miR-27a levels in high risk group (median= 1.2 fold change) compared to control group (median= 1 fold change). We performed Receiver Operating Characteristic (ROC) analysis for discriminating malignant from non-malignant cases. Plasma miR-27a yielded an area under the curve (AUC) of 0.983 with sensitivity 97.5%, specificity 91% and accuracy 94%.We concluded that miR-27a expression level represents sensitive and specific non-invasive molecular biomarkers for diagnosis of breast cancer.

Background

Irritable bowel syndrome(IBS) ,Gastroesophageal reflux disease and functional ooesophageal disorders may overlap and share the same pathophysiologic mechanisms.

Objectives

The purpose of the study is to assess the incidence of variant esophageal disorders that can overlap IBS  using different diagnostic modalities.

Patients and methods

In this study, 100 IBS patients with esophageal symptoms were examined in the Department of Gastroenterology. All underwent esophagogastroduodenoscopy, ECG, barium swallow, abdominal ultrasound, esophageal motility studies, and 24-hour PH monitoring. Diagnosis of IBS and evaluation of esophageal symptoms was established according to Rome IV criteria.

Results

27% of cases were diagnosed as ERD (Erosive Reflux Disease) depending on the presence of reflux esophagitis in upper endoscopy, 24% of cases were diagnosed as NERD (Non-Erosive Reflux Disease) depending on the absence of esophagitis in upper endoscopy and presence of acid reflux in 24-hour pH monitoring. While in 49% of cases, upper endoscopy and 24-hour pH-monitoring were normal, they were diagnosed as Functional Esophageal Disorders (FED).In our study, FED was the most prevalent among different IBS subtypes. Female gender was most predominant in different IBS subtypes except IBS-C (Irritable Bowel Syndrome - Constipation). FED was prevalent at a younger age than NERD and ERD. However, NERD and ERD were prevalent at higher BMI (Body Mass Index) than FED.

Conclusion

There is a high frequency of overlap between IBS and variant esophageal disorders i.e. ERD, NERD, and …

Abstract
Trichinella spiralis infection is a food-borne zoonotic disease caused by nematodes
that dwell in the tissues, presenting a significant public health concern. This study
aimed to evaluate the effectiveness of different treatments including silver nanoparticles
(AgNPs), myrrh biosynthesized AgNPs “AgNPs synthesized using plant-based
green technologies”, myrrh extract, and myrrh essential oil, as alternative treatments
against T. spiralis infection. Parasitological, histopathological, and cytotoxicity assessments
were conducted to investigate the effects of various concentrations of these
treatments in reducing the populations of adult worms and larvae during both the
intestinal and muscular phases of T. spiralis-infected mice. The results showed that
the highest antihelminthic efficacy against the intestinal phase of T. spiralis was
achieved by myrrh extract (86.66%), followed closely by AgNPs (84.96%) and myrrh
AgNPs (82.51%) at higher concentrations (800 mg/kg for myrrh extract, 40 μg/mL
for AgNPs, and 40 μg/mL for myrrh AgNPs). While the group treated with myrrh
essential oil showed the lowest percentage of adult reduction (78.14%). However, all
treatments demonstrated comparable effects in reducing the larvae population in the
muscle phase. Histopathological examination of the tissues revealed compelling evidence
of the effectiveness of AgNPs, particularly when prepared with myrrh. Additionally,
a comprehensive assessment of the cytotoxicity of AgNPs indicated low
toxicity levels. This study supports that AgNPs synthesized using plant-based green
technologies hold therapeutic potential for the treatment of T. spiralis infectionThese findings present a promising avenue for the development of novel antiparasitic
drugs that are both effective and safe

Introduction: Haemonchus spp. are considered the most important strongylid
nematodes with a worldwide distribution. The parasite’s blood-sucking nature
can lead to severe anemia in infected animals. Despite its widespread impact,
there is a dearth of comprehensive data on morphological and molecular
identification methods for Haemonchus spp. in sheep from Upper Egypt.
To address this gap, our current study aimed to assess the prevalence of
Haemonchus spp. in 400 sheep fecal samples.
Methods: We employed microscopic examination and molecular techniques,
using polymerase chain reaction (PCR) targeting the 18S gene for precise
identification. Additionally, the potential risk factors associated with the infection
by the parasite in sheep were explored.
Results: The study pointed out that 33.00% (132 of 400) of the examined sheep
were infected with Haemonchus spp. Sheep age and seasonal variability were
found to be significant factors (p < 0.05) associated with the infection. Notably,
sheep under 2 years old exhibited a higher risk, with an infection rate of 43.75%
(84 out of 192), than their older counterparts. Furthermore, all reported infections
were exclusively observed during the cold season, constituting 58.93% (132 out
of 224) of cases. By contrast, no statistically significant association (p > 0.05)
was found between the sex of the examined sheep and the occurrence of
haemonchosis. Employing molecular methods, we isolated and identified the
parasite through PCR analysis of cultured larvae, which were then subsequently
confirmed as Haemonchus contortus via phylogenetic analysis.
Discussion: The study concluded that there was a relatively high occurrence of
H. contortus among sheep from Upper Egypt. We recommend the implementation
of stringent and effective control measures to combat the infection and safeguard
livestock health.