Publications by authors named "Mohamed Alboraie"

52 Publications

Colorectal cancer in Arab world: A systematic review.

World J Gastrointest Oncol 2021 Nov;13(11):1791-1798

Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt.

Background: The incidence of colorectal cancer (CRC) is increasing among young individuals in the Arab world as well as in other regions of the world.

Aim: To explore the incidence and prevalence of CRC in the Arab world.

Methods: The PubMed, Scopus, Web of Science, EBSCO and Wiley databases were searched to retrieve relevant articles irrespective of the language or the publication year. The search terms were "("colon OR rectum OR sigmoid OR rectal OR colonic OR colorectal") AND ("cancer OR malignancy OR malignant OR neoplasm") AND ("Jordan" OR "United Arab Emirates" OR "Bahrain" OR "Tunisia" OR "Algeria" OR "Djibouti" OR "Saudi Arabia" OR "Sudan" OR "Syria" OR "Somalia" OR "Iraq" OR "Oman" OR "Palestine" OR "Qatar" OR "Comoros" OR "Kuwait" OR "Lebanon" OR "Libya" OR "Egypt" OR "Morocco" OR "Mauritania" OR "Yemen"). Reviews, meta-analyses, and articles containing nonoriginal data were excluded. Retrieved articles were screened, and relevant data were extracted. Descriptive statistics were used for data analysis.

Results: Nine studies were included. Five of the studies provided information regarding the prevalence of CRC. The prevalence of CRC was 0.72% in Saudi Arabia and 0.78% in the United Arab Emirate, while in Egypt, it ranged from 0.4% to 14%. Four studies showed information regarding the incidence. The annual incidence rate of CRC in Qatar was 7.5/100000/year. In Egypt, the crude incidence rate (CIR) in males was 3.1 for colon cancer and 1 for rectal cancer, while in females, it was 2.3 for colon cancer and 0.8 for rectal cancer. The age-standardized rate for CRC incidence in 2003 was 36.90 for males, 26.50 for females, and 30.49 for both sexes in Saudi Arabia. In 2016, the CIRs in Saudi Arabia were 3.6 and 2.1 in females for colon cancer and rectal cancer, respectively, while in males, it was 3.3 and 2.8 for colon cancer and rectal cancer, respectively. One study in Egypt revealed that 25% of CRC cases occurred among individuals younger than 40 years old.

Conclusion: There is a considerable prevalence of CRC in some Arab countries. More studies are needed to explore the incidence and prevalence of CRC in the rest of the Arab world.
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http://dx.doi.org/10.4251/wjgo.v13.i11.1791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8603455PMC
November 2021

Management of liver disease patients in different clinical situations during COVID-19 pandemic.

Egypt Liver J 2021 26;11(1):21. Epub 2021 Mar 26.

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Chronic liver diseases are common worldwide, especially in developing countries. The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/(COVID-19) leads to the infection of many patients with underlying chronic liver diseases. As a relatively new disease, management of COVID-19, in the context of chronic liver disease, is mainly based on the experience of the treating physician and the available data. In this review, we summarize the available evidence about the management of liver disease patients, in the context of COVID-19 infection, which can increase the severity of viral hepatitis B. Also, its clearance in HBV patients is delayed. A sixfold increased severity of COVID-19 was reported in obese patients with metabolic associated fatty liver disease (MAFDL). In patients with autoimmune liver disease (AILD), it is not recommended to change their immunosuppressive therapy (as long as they are not infected with COVID-19), in order to avoid a flare of liver disease. However, immunosuppressant drugs should be modified, in the case of infection with COVID-19. To date, no data suggest an increased risk or severity in metabolic liver diseases, such as hemochromatosis, Wilson's disease, or alpha-1 antitrypsin deficiency. Patients with liver cirrhosis should be carefully managed with minimum exposure to healthcare facilities. Basic investigations for follow-up can be scheduled at wider intervals; if patients need admission, this should be in COVID-19-clean areas. Patients with hepatocellular carcinomas may have a poor prognosis according to preliminary reports from China. The course of COVID-19 in liver transplant recipients on immunosuppression seems to have a benign course, based on few reports in children and adults. The hepatotoxicity of COVID-19 drugs ranges from mild liver enzyme elevation to a flare of underlying liver diseases. Therefore, the decision should be customized. Telemedicine can minimize the exposure of healthcare workers and patients to infection with COVID-19 and decrease the consumption of personal protective equipment.
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http://dx.doi.org/10.1186/s43066-021-00091-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994958PMC
March 2021

Predictors for Severity of SARS-CoV-2 Infection Among Healthcare Workers.

J Multidiscip Healthc 2021 25;14:2973-2981. Epub 2021 Oct 25.

Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, Egypt.

Background: Healthcare workers (HCWs) are still at higher risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections than the general population. Identifying risk factors associated with severe SARS-CoV-2 infections is of paramount importance to protect HCWs and the non-infected patients attending different healthcare facilities.

Purpose: To recognize the predictors for severity of SARS-CoV2 infection among HCWs working in either COVID-19 or non-COVID-19 healthcare settings. Also, to assess compliance of HCW to standard precautions of infection control and explore the possible risk factors for SARS-CoV-2 infection among HCWs.

Methods: A cross-sectional study was conducted among HCWs with suspected or confirmed SARS-CoV-2 infection, from different Egyptian governorates. They were asked to fill in a web-based self-reporting questionnaire. The questionnaire assessed the demographic and socio-economic characteristics of participants, compliance of HCWs to standard precautions of infection control and COVID-19 presentation.

Results: Our study enrolled 204 HCWs (52.3% physicians). Infection of SARS-CoV-2 was confirmed in 61.3% by RT- PCR; 35.8% were admitted to hospital, and of these, 3.9% were admitted to the intensive care unit. While 30.4% had mild disease, 48.5% had moderate disease, 17.2% had severe disease and 3.9% had critical disease. Regression analysis for variables predicting COVID-19 severity among study healthcare workers showed that associated chronic diseases and management at home were the main independent variables predicting severity of their SARS-COV-2 infection, while the variables age, sex, residence, occupation or drug history of immunosuppressives had no role in severity prediction.

Conclusion: Associated chronic diseases and management at home were the main independent variables predicting severity of SARS-COV-2 infection among HCWs. So, HCWs with chronic diseases should not work in COVID-19 designated hospitals, and there should be a screening strategy for their infection with SARS-COV-2. HCWs must not be negligent in adhering to strict precautions of infection control. HCWs infected with SARS-COV-2 must be managed in hospital not at home.
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http://dx.doi.org/10.2147/JMDH.S335226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557804PMC
October 2021

A multi-centric study on validation of the Fear Scale for COVID-19 in five Arabic speaking countries.

Brain Behav 2021 11 17;11(11):e2375. Epub 2021 Oct 17.

Community Medicine Department, Alzaiem Alazhari University Faculty of Medicine.

Background: The Eight-item Fear Scale is a unidimensional scale evaluating the perceived feelings of fear associated with the thought of the coronavirus.

Aim: The Arabic version of this scale did not exist; hence, this study aimed to translate and evaluate the psychometric properties of the Fear Scale in participants aged 18 years and above in five Arabic countries: Egypt, Lebanon, Libya, Saudi Arabia, and Sudan by using a cross-sectional survey design.

Method: The English version of the COVID-19 Fear Scale was translated into Arabic following the guidelines and disseminated through social media. Factorial and convergent validity and internal reliability were evaluated.

Results: The total number of participants was 2783; the majority was young (41.9%) and female (60.5%). Fear scores were moderate in four countries and severe in Egypt. The scale showed good structural validity, with the items explaining up to 70% of the variance. The scale items correlated significantly with the total scores, and the Cronbach alpha was above 0.9.

Conclusion: The study concluded that the Arabic Fear Scale is a psychometrically robust scale that can be used to evaluate the perceived feelings of fear with the thought of the coronavirus or pandemic in general.
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http://dx.doi.org/10.1002/brb3.2375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613427PMC
November 2021

Evaluation of factors affecting patients' refusal of HCV treatment in a cohort of Egyptian patients.

J Public Health (Oxf) 2021 Oct 14. Epub 2021 Oct 14.

Endemic medicine department, Faculty of Medicine, Cairo University, Cairo 11652, Egypt.

Background: Treatment refusal, defined as active refusal of a patient to receive treatment despite physician recommendations, has not been extensively evaluated before in hepatitis C virus in the era of direct acting antivirals.

Objective: To investigate the reasons for refusal to receive hepatitis C virus treatment in Egypt.

Methods: an observational study conducted between July 2018 and November 2019 in Egypt. Enrollment was done to all patients who refused to get hepatitis C virus treatment during the national screening and treatment campaign. Reasons for their refusal were identified using a questionnaire as an instrument for data collection.

Results: Out of the 220 280 Egyptian hepatitis C virus patients who did not show up to start treatment and were contacted to get therapy, only 84 patients (0.038%) refused to receive treatment. The main reason for their refusal was having concerns about treatment (82.14%) and their main concern was the fear of adverse events (85.5%). Other causes of refusal were non-satisfactory experience at treatment centers (13.09%) and patients preferred to receive complementary and alternative medicines (4.7%). Most patients (65.4%) trusted the efficacy of directly acting antivirals for hepatitis C. None of the study participants was found to suffer from any psychiatric morbidity and the average score of the GHQ-12 was 10.7155.

Conclusion: Proper health education and awareness regarding hepatitis C virus treatment safety and efficacy is needed to increase treatment acceptance rates.
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http://dx.doi.org/10.1093/pubmed/fdab363DOI Listing
October 2021

Impact of COVID-19 on Endoscopy Training: Perspectives from a Global Survey of Program Directors and Endoscopy Trainers.

Clin Endosc 2021 09 30;54(5):678-687. Epub 2021 Sep 30.

Division of Gastroenterology, Scripps Clinic - Scripps Green Hospital, Scripps Green Hospital, San Diego, USA.

Background/aims: The coronavirus disease of 2019 (COVID-19) pandemic has impacted the training of medical trainees internationally. The aim of this study was to assess the global impact of COVID-19 on endoscopy training from the perspective of endoscopy trainers and to identify strategies implemented to mitigate the impact on trainee education.

Methods: Teaching faculty of gastroenterology (GI) training programs globally were invited to complete a 36-question web-based survey to report the characteristics of their training programs and the impact of COVID-19 on various aspects of endoscopy training, including what factors decisions were based on.

Results: The survey response rate was 52.6% (305 out of 580 individuals); 92.8% reported a negative impact on endoscopy training, with suspension of elective procedures (77.1%) being the most detrimental factor. Geographic variations were noted, with European programs reporting the lowest percentage of trainee participation in procedures. A higher proportion of trainees in the Americas were allowed to continue performing procedures, and trainers from the Americas reported receiving the greatest support for endoscopy teaching.

Conclusion: This study demonstrated that the COVID-19 pandemic has had a significant negative impact on GI endoscopy training internationally, as reported by endoscopy trainers. Focus-optimizing endoscopy training and assessment of competencies are necessary to ensure adequate endoscopy training.
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http://dx.doi.org/10.5946/ce.2021.140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8505182PMC
September 2021

Safety and efficacy of sofosbuvir/ledipasvir and sofosbuvir/daclatasvir in the treatment of hepatitis C in patients with decompensated cirrhosis.

Eur J Gastroenterol Hepatol 2021 Sep 21. Epub 2021 Sep 21.

Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo Tropical medicine, Faculty of Medicine, Alexandria University, Alexandria Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University Department of Internal Medicine, Al-Azhar University Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo Department of community medicine, Faculty of Medicine, Suez Canal University Hepatogastroenterology Department, National Hepatology & Tropical Medicine Research Institute, Cairo Gastroenterology Department, Damietta Cardiology and Gastroenterology Center, Damietta Hepatology and Gastroenterology Department, AGOZA Police Hospital, Cairo Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia, Egypt Hepatology and gastroenterology department, national liver institute.Menoufia University, Egypt.

Background: Hepatitis C virus (HCV)-related decompensated cirrhosis is a severe life-threatening illness. The safety of direct-acting antivirals (DAAs) has opened a gate of hope for that subgroup of patients who were previously contraindicated for interferon therapy.

Objective: We aimed at the investigation of the safety and efficacy of different DAAs regimens in the treatment of HCV-related decompensated cirrhosis patients, to determine sustained virological response (SVR)12 rates and to analyze the factors associated with response.

Methods: A retrospective, single-center study including HCV-related decompensated cirrhosis patients who received DAAs. Demographic, laboratory and clinical data were analyzed. The SVR12 rate was the primary outcome measure. Secondary outcomes included the predictors of response, changes in the baseline model for end-stage liver disease and child-turcotte-pugh (CTP) scores, and fibroindices (APRI and fibrosis-4 index) at 12 weeks after treatment.

Results: In total, 145 eligible patients (141 with CTP class B and 4 with class C) were enrolled in this study. SVR12 was achieved by 88.06% (118/134) of efficacy population on different DAAs regimens, Treatment was discontinued in 11 patients because of severe side effects without any deaths. Younger age showed a significant positive association with SVR12.

Conclusions: DAAs can be used for the treatment of HCV-related decompensated liver disease, with acceptable SVR12 rates and safety profiles.
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http://dx.doi.org/10.1097/MEG.0000000000002287DOI Listing
September 2021

How to identify, encourage, and support suitable candidates for leading roles in scientific societies: The UEG experience.

United European Gastroenterol J 2021 Aug 30. Epub 2021 Aug 30.

Department of Pathology, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.

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http://dx.doi.org/10.1002/ueg2.12148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435244PMC
August 2021

Knowledge, Applicability, and Barriers of Telemedicine in Egypt: A National Survey.

Int J Telemed Appl 2021 9;2021:5565652. Epub 2021 Jun 9.

Hepatogastroenterology and Infectious Diseases Department, Al-Azhar University, Cairo, Egypt.

Objectives: The study is aimed at evaluating knowledge, attitude, and barriers to telemedicine among the general population in Egypt.

Methods: A questionnaire-based cross-sectional design was carried out among the general Egyptian population. A convenience sampling method was used to approach the eligible participants from University Teaching Hospitals of eight governorates from May to July 2020.

Results: A total of 686 participants filled the questionnaire (49.4% were males, mean age 36.7 ± 11.2 years old). Half of the participants stated that they previously used a telemedicine tool, mainly to follow up laboratory results (67.3%). Video or phone calls (39.3%) and mobile applications (23.7%) were the most commonly recognized telemedicine tools by the participants. The included participants exhibited a high level of knowledge and attitude towards telemedicine. On the other hand, 21.9% stated that telemedicine services could jeopardize patient privacy. 32.8% reported that telemedicine service could lead to disclosing medical information to people who are not authorized to do so. Almost half of the participants agreed to strongly agreed that telemedicine service could increase medical errors. 60.80% of the participants said that they are more likely to prefer telemedicine than traditional ways. However, 13.70% stated that telemedicine is more likely to be challenging to use.

Conclusion: The Egyptian population has high knowledge about the applications of telemedicine. In addition, the vast majority of Egyptians appear to perceive the benefits of telemedicine positively and are willing to use it. However, some barriers that have been found must be taken into consideration to adopt telemedicine successfully, especially for people who are old, are low educated, and live in remote areas. Future studies should address the utility of telemedicine in improving the quality of healthcare and patient's health outcome and quality of life.
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http://dx.doi.org/10.1155/2021/5565652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192215PMC
June 2021

Effect of disease stage and treatment outcomes on the dynamics of liver functions during and after treatment of hepatitis C with directly acting antivirals.

Eur J Gastroenterol Hepatol 2021 Jan 14. Epub 2021 Jan 14.

aEndemic Medicine Department, Faculty of Medicine, Helwan University bDepartment of Internal Medicine, Al-Azhar University cEndemic Medicine, Hepatology and Gastroenterology, Cairo University dInternal Medicine Department, Helwan University eTropical Medicine Department, Faculty of Medicine Ain Shams University, Cairo fEpidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia gNew Cairo Viral Hepatitis, Treatment Unit, New Cairo Hospital, Cairo hTropical Medicine, Faculty of Medicine, Alexandria University, Alexandria iTropical Medicine Department, National Hepatology and Tropical Medicine Research Institute jGastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Cairo, Egypt.

Background: Virus C infection is recently treated successfully with plenty of direct antiviral agents (DAAs). We aimed to evaluate the effect of disease stage and treatment outcome on the dynamics of liver functions during treatment of hepatitis C with DAAs.

Methods: We reported the liver function in 2354 subjects diagnosed as chronic hepatitis C before, during and after treatment with different DAAs regimens. Patients were classified into two groups according to treatment response with further subclassification according to the presence or absence of cirrhosis, and changes in liver functions were compared in each group and subgroup.

Results: Totally 2213 (94%) achieved sustained virological response (SVR) to DAAs therapy with significant improvement in all liver biochemistry. Also, there was an improvement in the non-SVR group's liver enzymes in relapsers during and after treatment; however, there was no improvement in serum albumin. We noticed a slight increase in serum bilirubin at weeks 4 and 8 for both groups.

Conclusion: DAAs therapy is associated with improvement of the liver biochemical profile and improved outcome in the majority of chronic hepatitis C virus patients due to suppression of viral replication. However, the long-term impact of DAAs therapy needs to be further evaluated.
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http://dx.doi.org/10.1097/MEG.0000000000002043DOI Listing
January 2021

Clinical study evaluating the efficacy of ivermectin in COVID-19 treatment: A randomized controlled study.

J Med Virol 2021 Oct 7;93(10):5833-5838. Epub 2021 Jun 7.

Department of Endemic Medicine, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.

Researchers around the world are working at record speed to find the best ways to treat and prevent coronavirus disease 2019 (COVID-19). This study aimed to evaluate the efficacy of ivermectin for the treatment of hospitalized mild to moderate COVID-19 infected patients. This was a randomized open-label controlled study that included 164 patients with COVID-19. Patients were randomized into two groups where Group 1 (Ivermectin group) included patients who received ivermectin 12 mg once daily for 3 days with standard care and Group 2 (control group) included patients who received standard protocol of treatment alone for 14 days. The main outcomes were mortality, the length of hospital stay, and the need for mechanical ventilation. All patients were followed up for 1 month. Overall, 82 individuals were randomized to receive ivermectin plus standard of care and 82 to receive standard of care alone. Patients in the ivermectin group had a shorter length of hospital stay (8.82 ± 4.94 days) than the control group (10.97 ± 5.28 days), but this was not statistically significant (p = 0.085). Three patients (3.7%) in each group required mechanical ventilation (p = 1.00). The death rate was three patients in the ivermectin group (3.7%) versus four patients (4.9%) in the control group without any significant difference between the two groups (p = 1.00). Although there was no statistically significant difference in any endpoints by ivermectin doses (12 mg/day for 3 days); there was an observed trend to reducing hospital stay in the ivermectin-treated group.
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http://dx.doi.org/10.1002/jmv.27122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242425PMC
October 2021

Current situation of viral hepatitis in Egypt.

Microbiol Immunol 2021 Sep 21;65(9):352-372. Epub 2021 Aug 21.

Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan.

An estimated 8-10 million people suffer from viral hepatitis in Egypt. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the major causes of viral hepatitis in Egypt as 50% or more of the Egyptian population are already exposed to HAV infection by the age of 15. In addition, over 60% of the Egyptian population test seropositive for anti-HEV in the first decade of life. HEV mainly causes self-limiting hepatitis; however, cases of fulminant hepatitis and liver failure were reported in Egypt. Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are the main causes of chronic hepatitis, liver cirrhosis, and liver cancer (hepatocellular carcinoma [HCC]) in Egypt. Globally, Egypt had the highest age-standardized death rate due to cirrhosis from 1990 to 2017. The prevalence rate of HBV (1.3%-1.5%) has declined after national infantile immunization. Coinfection of HBV patients with HDV is common in Egypt because HDV antibodies (IgG) vary in range from 8.3% to 43% among total HBV patients. After the conduction of multiple national programs to control HCV infection, a lower rate of HCV prevalence (4.6%) was recently reported. Data about the incidence of HCV after treatment with direct antiviral agents (DAAs) are lacking. An HCC incidence of 29/1000/year in cirrhotic patients after DAA treatment is reported. A higher rate of infiltrative pattern among HCC patients after DAA treatment is also recognized. Viral hepatitis is one of the major public health concerns in Egypt that needs more attention and funding from health policymakers.
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http://dx.doi.org/10.1111/1348-0421.12916DOI Listing
September 2021

Utility of Lung Ultrasound in Decision making to prioritize hospital admission for COVID-19 patients: A Developing Country Perspective.

Curr Med Imaging 2021 May 6. Epub 2021 May 6.

Professor of Pulmonology, Cairo University, Cairo, Egypt.

Background & Aims: In healthcare settings with limited resources, it is crucial to make a plan to prioritize hospital admission for patients affected by COVID-19. So, we tried to develop a novel approach for triaging COVID-19 patients and deciding the priority for hospital admission using Lung Ultrasound. In this study, we aimed to evaluate the efficacy of lung ultrasound in triaging suspected COVID-19 patients and assessment of the severity of COVID-19 pneumonia and its comparison with CT chest as the gold standard.

Method: This was a multicenter cross-sectional study enrolled on 243 COVID-19 confirmed patients presented to the emergency department in three major University hospitals in Egypt. Lung ultrasound was done by an experienced emergency physician or chest physician according to the local protocol of each hospital. Demographic, clinical, and laboratory data were collected from each patient. Each patient was subjected to CT chest and lung ultrasound.

Results: A total of 243 confirmed COVID-19 patients were enrolled in this study, with a mean age of 46.7+10.4 years. Ground glass opacity (GGO), subpleural consolidation, trans-lobar consolidation, and crazy paving were reported in chest CT scans of 54.3%, 15.2%, 11.1%, and 8.6% of patients, respectively. B-line artifacts were found in 81.1% of COVID-19 patients, which was of confluent pattern in 18.9% of patients. The lung ultrasound findings of 197 patients (81.1%) were completely coincident with those of CT with a Kappa agreement value of 0.77, and this offered a diagnostic sensitivity of 74 %, a diagnostic specificity of 97.9 %, positive predictive value (PPV) of 90.2% and negative predictive value (NPV) of 93.6 % for lung ultrasound in triaging COVID-19 patients. Adding O2 saturation to the findings of lung imaging, the accuracy of evaluation of lung ultrasound to differentiate between severe and non-severe lung diseases showed that ultrasound had 100% sensitivity and specificity.

Conclusion: Lung Ultrasound with Oxygen saturation is a very efficient tool for decision-making to prioritize hospital admission for patients affected by COVID-19 in healthcare settings with limited resources.
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http://dx.doi.org/10.2174/1573405617666210506164243DOI Listing
May 2021

Pregnancy outcome of anti-HCV direct-acting antivirals: Real-life data from an Egyptian cohort.

Liver Int 2021 07 11;41(7):1494-1497. Epub 2021 May 11.

Department of Pediatrics and Clinical Research Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

We aimed to assess the pregnancy outcome in women with chronic HCV who had negative pregnancy test prior to the anti-HCV course and had unintended pregnancy while on HCV treatment. Hundred patients with a mean age of 30 ± 6.7 y were included and advised to withhold antivirals and continue follow-up in viral hepatitis and obstetrics centres till delivery. All patients received a 12-weeks regimen of anti-HCV [sofosbuvir plus daclatasvir (SOF/DCV): n = 95, SOF/DCV plus ribavirin: n = 3, and paritaprevir/ritonavir/ombitasvir plus ribavirin: n = 2]. Only nine patients completed the full antiviral course against medical advice, and 91 stopped between on-treatment weeks 4 and 8. Eighty-eight patients delivered full-term babies, eight had preterm babies and two had abortions. Of the nine patients who completed the full course of DAAs, seven (77.8%) delivered normal babies, attended their post-treatment week 12 visit, and all (100%) achieved sustained virological response. No major antiviral-related adverse events were reported.
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http://dx.doi.org/10.1111/liv.14913DOI Listing
July 2021

Circulating cell-free DNA, peripheral lymphocyte subsets alterations and neutrophil lymphocyte ratio in assessment of COVID-19 severity.

Innate Immun 2021 04 1;27(3):240-250. Epub 2021 Mar 1.

Clinical Pathology department Ain-Shams University, Egypt.

Cell destruction results in plasma accumulation of cell-free DNA (cfDNA). Dynamic changes in circulating lymphocytes are features of COVID-19. We aimed to investigate if cfDNA level can serve in stratification of COVID-19 patients, and if cfDNA level is associated with alterations in lymphocyte subsets and neutrophil-to-lymphocyte ratio (NLR). This cross-sectional comparative study enrolled 64 SARS-CoV-2-positive patients. Patients were subdivided to severe and non-severe groups. Plasma cfDNA concentration was determined by real-time quantitative PCR. Lymphocyte subsets were assessed by flow cytometry. There was significant increase in cfDNA among severe cases when compared with non-severe cases. cfDNA showed positive correlation with NLR and inverse correlation with T cell percentage. cfDNA positively correlated with ferritin and C-reactive protein. The output data of performed ROC curves to differentiate severe from non-severe cases revealed that cfDNA at cut-off ≥17.31 ng/µl and AUC of 0.96 yielded (93%) sensitivity and (73%) specificity. In summary, excessive release of cfDNA can serve as sensitive COVID-19 severity predictor. There is an association between cfDNA up-regulation and NLR up-regulation and T cell percentage down-regulation. cfDNA level can be used in stratification and personalized monitoring strategies in COVID-19 patients.
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http://dx.doi.org/10.1177/1753425921995577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054149PMC
April 2021

Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt.

World J Gastroenterol 2020 Nov;26(43):6880-6890

Department of Internal Medicine, Al-Azhar University, Cairo 11651, Egypt.

Background: The current coronavirus disease 2019 (COVID-19) pandemic has affected routine endoscopy service across the gastroenterology community. This led to the suspension of service provision for elective cases.

Aim: To assess the potential barriers for resuming the endoscopy service in Egypt.

Methods: A national online survey, four domains, was disseminated over a period of 4 wk in August 2020. The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s).

Results: A hundred and thirteen Egyptian endoscopy centers participated in the survey. The waiting list was increased by ≥ 50% in 44.9% of areas with clusters of COVID-19 cases ( = 49) and in 35.5% of areas with sporadic cases ( = 62). Thirty nine (34.8%) centers suffered from staff shortage, which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis. In multivariate analysis, the burden of cases in the unit locality, staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice ( = 0.029, < 0.001 and 0.02, respectively) and Odd's ratio (0.15, 1.8 and 0.16, respectively).

Conclusion: The COVID-19 pandemic has led to restrictions in endoscopic volumes. The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery. Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.
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http://dx.doi.org/10.3748/wjg.v26.i43.6880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684458PMC
November 2020

Do Zinc Supplements Enhance the Clinical Efficacy of Hydroxychloroquine?: a Randomized, Multicenter Trial.

Biol Trace Elem Res 2021 Oct 27;199(10):3642-3646. Epub 2020 Nov 27.

Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.

No specific treatment for COVID-19 infection is available up till now, and there is a great urge for effective treatment to reduce morbidity and mortality during this pandemic. We aimed to evaluate the effect of combining chloroquine/hydroxychloroquine (CQ/HCQ) and zinc in the treatment of COVID-19 patients. This was a randomized clinical trial conducted at three major University hospitals in Egypt. One hundred ninety-one patients with a confirmed diagnosis of COVID-19 infection were randomized into two groups: group I (96) patients received both HCQ and zinc, and group II (95) received HCQ only. The primary endpoints were the recovery within 28 days, the need for mechanical ventilation, and death. The two groups were matched for age and gender. They had no significant difference regarding any of the baseline laboratory parameters or clinical severity grading. Clinical recovery after 28 days was achieved by 79.2% in the zinc group and 77.9% in zinc-free treatment group, without any significant difference (p = 0.969). The need for mechanical ventilation and the overall mortality rates did not show any significant difference between the 2 groups either (p = 0.537 and 0.986, respectively). The age of the patient and the need for mechanical ventilation were the only risk factors associated with the patients' mortality by the univariate regression analysis (p = 0.001 and < 0.001, respectively). Zinc supplements did not enhance the clinical efficacy of HCQ. More randomized studies are needed to evaluate the value of adding zinc to other therapies for COVID 19. ClinicalTrials.gov Identifier: NCT04447534.
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http://dx.doi.org/10.1007/s12011-020-02512-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695238PMC
October 2021

Revised Nomenclature for Fatty Liver Disease: Cutting through the Confusion.

J Clin Transl Hepatol 2020 Sep 21;8(3):354-355. Epub 2020 Sep 21.

Department of Gastroenterology and Endemic Medicine, Minia University, Minia, Egypt.

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http://dx.doi.org/10.14218/JCTH.2020.00049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7562809PMC
September 2020

The global impact of COVID-19 on gastrointestinal endoscopy units: An international survey of endoscopists.

Arab J Gastroenterol 2020 Sep 26;21(3):156-161. Epub 2020 Aug 26.

Division of Gastroenterology and Hepatology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA.

Background & Study Aims: Corona virus disease-19 (COVID-19) pandemic has markedly impacted routine medical services including gastrointestinal (GI) endoscopy. We aim to report the real-life performance in high volume GI endoscopy units during the pandemic.

Patients And Methods: A web-based survey covering all aspects of daily performance in GI endoscopy units was sent to endoscopy units worldwide. Responses were collected and data were analyzed to reveal the effect of COVID-19 pandemic on endoscopy practice.

Results: Participants from 48 countries (n = 163) responded to the survey with response rate of 67.35%. The majority (85%) decreased procedure volume by over 50%, and four endoscopy units (2.45%) completely stopped. The top three indications for procedures included upper GI bleeding (89.6%), lower GI bleeding (65.6%) and cholangitis (62.6%). The majority (93.9%) triaged patients for COVID-19 prior to procedure. N95 masks were used in (57.1%), isolation gowns in (74.2%) and head covers in (78.5%). Most centers (65%) did not extend use of N95 masks, however 50.9% of centers reused N95 masks. Almost all (91.4%) centers used standard endoscopic decontamination and most (69%) had no negative pressure rooms. Forty-two centers (25.8%) reported positive cases of SARS-CoV-2 infection among patients and 50 (30.7%) centers reported positive cases of SARS-CoV-2 infection among their healthcare workers.

Conclusions: Most GI endoscopy centers had a significant reduction in their volume and most procedures performed were urgent. Most centers used the recommended personal protective equipment (PPE) by GI societies however there is still a possibility of transmission of SARS-CoV-2 infection in GI endoscopy units.
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http://dx.doi.org/10.1016/j.ajg.2020.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448955PMC
September 2020

Hydroxychloroquine in the Treatment of COVID-19: A Multicenter Randomized Controlled Study.

Am J Trop Med Hyg 2020 10;103(4):1635-1639

Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.

The COVID-19 pandemic is showing an exponential growth, mandating an urgent need to develop an effective treatment. Indeed, to date, a well-established therapy is still lacking. We aimed to evaluate the safety and efficacy of hydroxychloroquine (HCQ) added to standard care in patients with COVID-19. This was a multicenter, randomized controlled trial conducted at three major university hospitals in Egypt. One hundred ninety-four patients with confirmed diagnosis of COVID-19 were included in the study after signing informed consent. They were equally randomized into two arms: 97 patients administrated HCQ plus standard care (HCQ group) and 97 patients administered only standard care as a control arm (control group). The primary endpoints were recovery within 28 days, need for mechanical ventilation, or death. The two groups were matched for age and gender. There was no significant difference between them regarding any of the baseline characteristics or laboratory parameters. Four patients (4.1%) in the HCQ group and 5 (5.2%) patients in the control group needed mechanical ventilation ( = 0.75). The overall mortality did not differ between the two groups, as six patients (6.2%) died in the HCQ group and 5 (5.2%) died in the control group ( = 0.77). Univariate logistic regression analysis showed that HCQ treatment was not significantly associated with decreased mortality in COVID-19 patients. So, adding HCQ to standard care did not add significant benefit, did not decrease the need for ventilation, and did not reduce mortality rates in COVID-19 patients.
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http://dx.doi.org/10.4269/ajtmh.20-0873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543820PMC
October 2020

Liver transplantation in the era of COVID-19.

Arab J Gastroenterol 2020 Jun 12;21(2):69-75. Epub 2020 May 12.

Internal Medicine Department, Hepatogastroenterology Unit, Kasr Al-Ainy School Of Medicine, Cairo University, Cairo, Egypt.

Liver transplantation is considered the ultimate solution for patients with end-stage chronic liver disease or acute liver failure. Patients with liver transplant need special care starting from preoperative preparation, surgical intervention ending with postoperative care. Transplanted patients have to receive immunosuppressive therapy to prevent rejection. Such a state of immune suppression could predispose to different types of infections in liver transplant recipients. Currently, the world is suffering a pandemic caused by a new strain of the coronavirus family called COVID-19. Certain infection control precautions are needed to protect immunocompromised and vulnerable patients, including liver transplant candidates and recipients from acquiring COVID-19 infection. Restricting non-transplant elective surgical procedures, managing transplant patients in separate outpatient clinics, and in-patient wards can prevent transmission of infection both to patients and healthcare workers. Telemedicine can help in the triage of patients to screen for symptoms of COVID-19 before their regular appointment. Management of immunosuppressive therapy and drug-drug interactions in liver transplant recipients infected with COVID-19 should be cautiously practiced to prevent rejection and effectively treat the underlying infection. In this report, we are trying to summarize available evidence about different aspects of the management of liver transplant candidates and recipients in the era of COVID-19.
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http://dx.doi.org/10.1016/j.ajg.2020.04.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214343PMC
June 2020

Retreatment of chronic hepatitis C patients who failed previous therapy with directly acting antivirals: A multicenter study.

Int J Infect Dis 2020 Jul 20;96:367-370. Epub 2020 Apr 20.

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Egypt.

Aim Of The Study: The current study aimed to evaluate the efficacy of different DAAs regimens in the treatment of chronic hepatitis C (CHC) Egyptian patients who failed to achieve SVR after their treatment with SOF-based regimens.

Methods: This was a retrospective observational multicenter study that included CHC patients that failed to achieve cure on SOF-based regimens who were re-treated using different DAAs regimen and were allocated according to national guidelines for the treatment of hepatitis C. Primary outcome was to assess the SVR12 rate among prior non-responders after retreatment with a second course of DAAs.

Results: Our study included 172 patients who failed to achieve SVR after treatment with SOF-based treatment regimen [age: 51.2 ± 11.3, 58.7% men]. Included patients were retreated using SOF/DCV/RBV, SOF/ r/PAR /OMB /RBV, SOF/DCV/SIM, SOF/LDV ± RBV or SIM/SOF. SVR12 was successfully attained in 95.35% (164/172) of the included non-responders.

Conclusion: The current multicenter study proved the efficacy of various DAAs regimens issued by the National Committee for Control of Viral Hepatitis for retreatment of relapsed CHC Egyptian patients.
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http://dx.doi.org/10.1016/j.ijid.2020.04.022DOI Listing
July 2020

Correction to: Prevalence of prolonged QT interval in patients with HCV-related chronic liver disease.

Egypt Heart J 2019 Oct 29;71(1):21. Epub 2019 Oct 29.

Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt.

Following publication of the original article [1], the authors reported that the family name of Mohamed El Kassas was incorrectly published as Mohamed ElKassas.
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http://dx.doi.org/10.1186/s43044-019-0020-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821435PMC
October 2019

Prevalence of prolonged QT interval in patients with HCV-related chronic liver disease.

Egypt Heart J 2019 Sep 7;71(1):15. Epub 2019 Sep 7.

Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt.

Background: Hepatitis C virus (HCV) is a common disease in Egypt with a high socioeconomic burden and extra-hepatic manifestations as QT prolongation, but previous studies included mainly patients with advanced liver disease, so in this study, we aimed to delineate the prevalence of QT prolongation in early-stage HCV patients.

Results: The study included 874 HCV patients with early cirrhosis; in Child's class A, 57 (6.5%) patients had prolonged QT interval corrected (QTc). There was significant higher proportion of cirrhotic patients in the prolonged QTc group (31.6%) vs. in the normal QTc group (11.5%). QTc was 424.39 ± 36.6 vs. 411.51 ± 32.89 ms in cirrhotic and non-cirrhotic patients, respectively (P, 0.001). There was significant higher proportion of Fibrosis 4 (FIB-4) ≥ 1.45 score in the prolonged QTc (77.2%) vs. in the normal QTc group (56.8%) (P, 0.003). QTc interval was 417.76 ± 34.12 ms in patients with FIB-4 score ≥ 1.45 vs. 406.78 ± 31.95 ms in those with FIB-4 < 1.45 (P, < 0.001). FIB-4 score value of 2.108 predicted prolonged QTc with a sensitivity of 63.2% and a specificity of 64.5% (P, < 0.001). Twenty-four patients of long QTc group sent ECGs after HCV eradication, and 19 patients (79%) showed QTc normalization.

Conclusions: HCV is associated with QTc prolongation even in patients with early chronic liver disease stages without significant fibrosis. Also, it is related to the degree of fibrosis and cirrhosis. At a cutoff value of 2.108, FIB-4 score can predict prolonged QTc. HCV eradication is associated with a high incidence of QTc normalization.
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http://dx.doi.org/10.1186/s43044-019-0016-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821436PMC
September 2019

Egyptian recommendations for management of Helicobacter pylori infection: 2018 report.

Arab J Gastroenterol 2019 Sep 26;20(3):175-179. Epub 2019 Sep 26.

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

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http://dx.doi.org/10.1016/j.ajg.2019.09.001DOI Listing
September 2019

A significant upsurge of body mass index in patients with chronic hepatitis C successfully treated with direct-acting antiviral regimens.

Turk J Gastroenterol 2019 08;30(8):708-713

Endemic Medicine and Hepato-Gastroenterology Department, Cairo University School of Medicine, Cairo, Egypt.

Background/aims: There is less data regarding the changes in body mass index (BMI) after treating hepatitis C virus (HCV) patients with new direct-acting antiviral agents (DAAs). This study aimed to assess the changes in BMI in chronic HCV patients treated with DAAs in Egypt and to explore other factors influencing this change.

Materials And Methods: The data of chronic HCV patients who received antiviral therapy with new DAAs in one of Egypt's specialized viral hepatitis treatment centers were retrospectively analyzed. In addition to the routine clinical and laboratory workup, changes in body weight during and after treatment were monitored and BMI was calculated. Viral load was measured at 12 weeks post-treatment to assess a sustained virological response. Patients with documented thyroid abnormalities, bariatric surgery, or ensuing special diets were excluded. BMI of >30 was taken as the cutoff for pa¬tients with obesity.

Results: The study included 162 patients with a mean age of 48.56±11.49 years, of whom 61.1% were males, 16% were treatment-experienced, 12% were diabetic, and 29% were obese. Treatment duration was 12 weeks in 84% of patients and 24 weeks in 16% of patients. There was a significant increase in BMI post-treatment as compared to pretreatment measures (28.68±5.35 vs 28.18±4.55) (p=0.03). BMI changes were constant regardless of cirrhosis or previous treatment experience.

Conclusion: Treatment of chronic HCV with DAAs was associated with increased body mass index. Further studies are needed to explore if this effect is secondary to treatment with DAAs or is an improvement in the liver function and lifestyle of treated patients.
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http://dx.doi.org/10.5152/tjg.2019.18514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699564PMC
August 2019

Egyptian liver library: An indexed database for liver disease evidence in Egypt.

Arab J Gastroenterol 2019 Jun 4;20(2):109-113. Epub 2019 Jun 4.

Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.

Liver diseases are among the most challenging health care problems worldwide. In Egypt, we established different care programs to combat liver diseases including schistosomiasis and viral hepatitides. A lot of research work addressing liver diseases in Egypt have been published with special focus on these two major fields. Other liver disease seems to be neglected although present and contributing to the liver disease burden in Egypt. In this report we reviewed the available evidence published from Egypt and elucidate areas of weakness and future research needs. Our search for Egyptian liver disease evidence retrieved 4683 articles, 67% of them were relevant to the topic. Out of the relevant articles; 1646/3265 (50.4%) were discussing clinical science, 1131 (34.7%) were discussing basic science and 488 (14.9%) were discussing both basic and clinical sciences. Cairo university (16.8%, n = 513) and Mansoura university (9.3%, n = 285) had the largest number of publications related to liver disease in Egypt respectively. The most commonly reported diseases were hepatitis C in 719/3361 articles (21.4%), parasitic liver infestations in 663 articles (19.7%), hepatocellular carcinoma in 544 articles (16.2%), liver fibrosis or cirrhosis in 537 articles (16%), and drug induced liver injury in 516 articles (15.4%). Most of the reviewed articles (36%) were discussing treatment of chronic liver diseases (n = 1201) followed by diagnostics (28%, n = 940), pathogenesis and pathophysiology (21%, n = 706). This review will direct attention to areas with less research like hepatitis B related liver disease, HIV/HCV co-infections, and non-alcoholic fatty liver disease (NAFLD) to encourage future research in these topics. In conclusion; our results ring a bell inviting the development of a roadmap for liver research in Egypt targeting to put future policies to cover areas of weakness in liver research with an ultimate goal of tackling liver disease and its overwhelming socioeconomic burden in our developing country.
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http://dx.doi.org/10.1016/j.ajg.2019.05.004DOI Listing
June 2019

High success rates for the use of ombitasvir/paritaprevir/ritonavir containing regimens in treatment of naïve and experienced chronic hepatitis C genotype 4: Real world results.

J Med Virol 2019 Apr 5. Epub 2019 Apr 5.

Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt.

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.
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http://dx.doi.org/10.1002/jmv.25478DOI Listing
April 2019
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