Background: The introduction of biosimilar medicines has paved the way for the NHS to make substantial savings. Etanercept biosimilar was launched in February 2016 and provided an opportunity for huge savings to be made for the overall health economy. The drug cost was 30% cheaper than etanercept originator. Methods: Croydon Health Services had 193 rheumatoid arthritis patients eligible for the switch. To date, 25 patients (13%) have not switched for various reasons and 168 patients were switched to the biosimilar. The total saving was over£ 200,000 for Croydon CCG. A monitoring database was set up to follow these patients to ensure safety and efficacy of the new treatment. Results: Of the 168 patients switched, 18 (11%) have switched back to the originator product. The reasons for switchback were lack of efficacy in 11 patients (7%) and intolerance in 7 (4%). The most common intolerances were

The aim of this prospective study was to compare scrotal ultrasonographic findings in obese and normal weight infertile men and correlate these findings with semen parameters and hormonal profile

Asymmetric breast density is a potentially perplexing finding; it may be due to normal hormonal variation of the parenchymal pattern and summation artifact or it may indicate an underlying true pathology. The current study aimed to identify the role of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) values in the assessment of breast asymmetries. Fifty breast lesions were detected corresponding to the mammographic asymmetry. There were 35 (70%) benign lesions and 15 (30%) malignant lesions. The mean ADC value was 1.59 ± 0.4 × 10–3 mm2/s for benign lesions and 0.82 ± 0.3 × 10–3 mm2/s for malignant lesions. The ADC cutoff value to differentiate between benign and malignant lesions was 1.10 × 10–3 mm2/s with sensitivity 80%, specificity 88.6%, positive predictive value 75%, negative predictive value 91%, and accuracy 86%. Best results were achieved by implementation of the combined DCE-MRI and DWI protocol, with sensitivity 93.3%, specificity 94.3%, positive predictive value 87.5%, negative predictive value 97.1%, and accuracy 94%. Dynamic contrast-enhanced MRI (DCE-MRI) was the most sensitive method for the detection of the underlying malignant pathology of breast asymmetries. However, it provided a limited specificity that may cause improper final BIRADS classification and may increase the unnecessary invasive procedures. DWI was used as an adjunctive method to DCE-MRI that maintained high sensitivity and increased specificity and the overall diagnostic accuracy of breast MRI examination. Best results can be achieved by the combined protocol of DCE-MRI and DWI

Systemic sclerosis (SSc) is an autoimmune disease associated with immune abnormalities and widespread vascular lesions, including increased intimal and medial thickness. These changes may be reflected in early atherosclerosis and cardiovascular risks. We aimed in this study to examine the carotid artery intima-media thickness and MRI brain findings in SSc patients and compared them to a group of normal controls. A relationship between these parameters and clinical measures in SSc was also sought. Seventy-two SSc patients with no central nervous system (CNS) symptoms and 42 healthy controls were included. Clinical and laboratory measures, Medsger’s severity scale, and Doppler ultrasound common carotid artery intima-media thickness (CCA-IMT) were measured. Brain fluid-attenuated inversion recovery (FLAIR)-MRI and diffusion-weighted MRI (DWI) were also done. SSc patients had more CCA-IMT, higher CRP, and more brain MRI hyperintense lesions than controls (P < 0.05). Significant positive correlations existed between CCA-IMT and Medsger vascular (r = 0.7, P = 0.02). The FLAIR-MRI showed multiple hyperintense lesions in 24 patients (33%), ranging 0–36 lesions. SSc patients with more lesions (positive MRI) had longer disease duration (P = 0.001) and left and right carotid artery atheromata (P = 0.001, and 0.013, respectively) than SSc patients with negative MRIs; Medsger vascular score did not separate the SSc groups (P = 0.08). In systemic sclerosis patients without central nervous system symptoms, MRI lesion numbers correlated with CCA-IMT. MRI abnormalities were found more frequently if CRP

Myiasis is the infestation of human tissues by dipterous fly larvae of the class Insecta. Clogmia albipunctatus, family Psychodidae, is one of the most medically important insects that cause human myiasis. The aim of the present study is the morphological identification and the molecular characterization of moth flies causing many cases of urinary myiasis in Egypt, based on sequencing of the mitochondrial DNA of the larvae. Seven urinary samples of patients complaining of urinary symptoms and giving a history of low socioeconomic level were examined. Recovered larvae were identified using light microscopy and SEM. For molecular identification, the mitochondrial genes Cytochrome B (cytB), NADH1, NADH1, and 16S were sequenced and phylogenetically analyzed. The morphological and molecular characterization could accurately diagnose our patients to have C. albipunctatus infestation. Such results provided the initial set of data on the molecular identification and phylogenetic analysis of moth flies based on DNA barcoding in Egypt.

This study aimed to determine the incidence of E. coli in raw milk and
cheese, in addition to isolate and identify Enterotoxigenic E. coli. The
existence of heat stable toxin (STh) and heat labile toxin (LT) genes were
determined in the isolated strains. This study included 350 samples of raw
milk and cheese samples. Different media were used to isolate E. coli and
different biochemical tests were used for identification. E. coli was detected
in 61.4% of samples. They were tested for the presence of STh and LT
genes by PCR. ETEC was detected in 3.7% of E. coli isolates. Only one
strain from milk of street samples that found to harbor STh gene. Seven
strains were detected in Kareish cheese including two strains harbor LT
gene and five strains harbor STh gene.

Chronic granulomatous disease (CGD) is a rare inherited primary
immunodeficiency disorder that affects phagocytes and is characterized
by a marked increased susceptibility to severe bacterial and
fungal infections. We aimed to describe the clinical presentations of
pediatric patients with CGD in Upper Egypt and to identify the
defective component of NADPH oxidase. Pediatric patients diagnosed
with CGD within one year from January 2018 to
January 2019 were enrolled in the study. Patient history, clinical
and laboratory investigations were carried out, including nitroblue
tetrazolium test and flow cytometry DHR analysis. Infectious microorganisms
were isolated from infected sites to identify the causative
agents and their resistance profile. A total of 15 patients were
diagnosed with CGD. Failure to thrive and lymphadenopathy were
the most common presentations. The median age of clinical onset
was 1.17 years of age. The most common gene mutations were
observed in the CYBA gene. All cases showed pulmonary infections
followed by abscesses. Staphylococcus aureus and Klebsiella pneumoniae
were the most frequently isolated bacterial pathogens,
Aspergillus spp and Candida spp were isolated from fungal infections.
4/15 (26.7%) children died due to severe serious infections.
We concluded that CGD is common in Upper Egypt, and we recommend
raising the awareness and testing for CGD in pediatric
patients with recurrent or persistent infections, especially those
with a familiar history of similar manifestations to avoid delays in
proper diagnosis and deterioration of cases.

The monocyte/macrophage lineage cells were found involved in the pathogenesis of systemic sclerosis
(SSc) disease. The naïve macrophages are activated either to M1 cells with proinflammatory roles or to
M2 cells that function to resolve inflammation with tissue repair. Recently, cells with dual phenotypes
were detected in SSc disease. So, we aimed in this study to demonstrate different monocyte/macrophage
phenotypes in peripheral cells from a group of Egyptian SSc patients, correlating percentages of these
cells with the clinical findings in patients.
The study participants comprised 41 patients with diffuse cutaneous SSc disease and 25 healthy individuals
as controls. Clinical, radiological, and laboratory tests were conducted for SSc patients. Different
phenotypes of the monocyte/macrophage subsets were identified in peripheral blood of patients and controls
by flow cytometry for characteristic M1 (CD80, CD86, and TLR4) and M2 (CD204, CD163 and CD206)
markers.
SSc patients showed higher percentages of peripheral cells of the M1, M2, and mixed M1/M2 phenotypes
within the monocyte/macrophage lineage compared to controls. Different cell phenotypes were
associated significantly with the disease duration, modified Rodnan’s score, the Medsger skin score,
and the Medsger lung in SSc patients. Some cells with the M1/M2 phenotypes were higher in SSc patients
with pitting scars, arthritis, and myalgia.