[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to assess the effect of hepatitis C virus (HCV) infection on graft and patient survival in a cohort of Libyan renal transplant recipients. Medical records of 241 renal transplant (RT) patients who have been followed-up at the Benghazi Nephrology Center up to February 2010 were reviewed. Based on the presence or absence of anti-HCV antibodies and HCV-RNA in the serum, patients were divided into two groups: HCV-positives and HCV-negatives. Anti-HCV antibodies were detected by the enzyme-linked immunosorbent assay technique and HCV-RNA by the polymerase chain reaction. Of the 241 RT patients, 162 were male and 79 were female. One hundred and ten patients (45.6%) were HCV-positives and 131 (54.4%) were HCV-negatives. Acute graft rejection was significantly higher among HCV-negative than HCV-positive patients (42 patients versus 28 patients, respectively; P < 0.001). Conversely, chronic graft rejection was higher among HCV-positives than that among HCV-negative patients (35 patients versus 24 patients, respectively; P <0.05), and this difference became more significant after a 12-month period of transplantation (P <0.01). Seventeen patients died during the follow-up: Seven HCV-positives (6.3%) and 10 HCV-negatives (7.6%), and there was no significant difference in the death rate following RT between the two groups (P = 0.08). Among the seven deaths of HCV-positives, liver disease-related complications were the main cause of death in three (42.8%) HCV-positive patients compared with none in the HCV-negative patients. The presence of HCV infection influenced chronic graft survival in RT patients and a higher proportion of HCV-infected patients had hepatic dysfunctions after RT. An increase in fatal liver complications was noted in HCV-positive patients with RT. In addition to pre-RT-specific therapy of HCV infection, all measures should be taken to prevent HCV infection pre- and post-RT. HCV-infected RT recipients need close monitoring for graft and liver function to prolong allograft and patient survival.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 11/2014; 25(6):1315-20. DOI:10.4103/1319-2442.144303
[Show abstract][Hide abstract] ABSTRACT: Background
Thrombocytopenia is defined as a platelet count of less than 150 × 103 μl. It is commonly diagnosed and has attracted more interest from the researchers in pregnant women during the last 20 years, especially in hypertensive pregnant women.
To assess the incidence of thrombocytopenia in hypertensive pregnant women during the third trimester of pregnancy.
Five hundred forty-four pregnant women were included in this study from a total of 10,272 admitted at the Obstetrics and Gynecology Department at Tripoli Medical Center during January–August 2007. Frequent blood pressure monitorings and full blood counts were performed in several medical follow ups. They were not known to be HBV, HCV, or HIV positive women before pregnancy, and none was reported to have evidence of HBV, HCV, or HIV upon performing HBs-Ag, anti-HCV antibody, or HIV-antigen positive tests. Data were arranged in Excel Microsoft program version 2010, and statistically analyzed by SPSS windows program version 17.
Five hundred and forty-four women were hypertensive according to WHO hypertension definition criteria. Sixty-seven women had only one reading of high blood pressure, while 39 women fulfilled HELP syndrome criteria (hemolysis elevated liver enzymes low platelet). These 39 women were excluded from the study. Therefore, only 438 pregnant women remained eligible for the study. The mean age was (32.56 ± 1.5), with their ages ranging between 18 and 49 years. Most of the included women were primigravida 179 (39 %), gravid 2, para one were 72 (16.4 %), and the rest were gravid 3 or more (42.6 %). The blood pressure was 140-160/90-110 mmHg in 365 women (83.4 %), and 73 women (16.7 %) had blood pressure readings more than 160/110 mmHg. Mean platelets count was (206.49 × 103/μl ± 3.35), and ranged between (41.0 - 449.0 × 103/μl). Thrombocytopenia (less than 150 × 103/μl) was recorded in 103 women (23.5 %). All pregnancy cases were delivered safely with no fetal complications.
Gestational thrombocytopenia (GT) is recognized as a major cause of thrombocytopenia particularly in hypertensive pregnant women during the third trimester. Careful follow up during and after pregnancy for those women is recommended.
Journal of Obstetrics and Gynecology of India 04/2013; 63(2). DOI:10.1007/s13224-012-0257-2
[Show abstract][Hide abstract] ABSTRACT: Children with Down syndrome (DS) have about a 40 to 50% incidence of congenital heart disease (CHD). The objectives of this study were to evaluate the distribution and frequency of CHD patterns in Libyan children with DS.
All patients with DS who were referred to the cardiology clinic between January 1995 and December 2008 were reviewed.
Of the 1 193 patients reviewed, 537 (45%) had an associated CHD. Overall there were 349 (65%) patients who had a single cardiac lesion, and 188 (35%) had multiple cardiac lesions. The most common isolated cardiac lesion was atrial septal defect (ASD), found in 125 (23%) patients, followed by atrioventricular septal defect (AVSD) in 103 (19%), and ventricular septal defect (VSD) in 76 (14%).
Atrial septal defect was the most common cardiac lesion. The distribution of CHDs in Libyan children with DS was similar to what has been reported internationally, but the frequency was not compared with international rates.
[Show abstract][Hide abstract] ABSTRACT: Immunosuppressive therapy post-kidney transplantation is usually used continuously and should be regularly monitored. Inadequate dosages of immunosuppressive drugs and lack of regular monitoring can lead to either severe side effects or allograft rejection.
To study the hematologic adverse effects and differences between azathioprine and mycophenolate used as maintenance immunosuppressive therapy.
Fifty-nine (32 male and 27 female) renal transplant patients were enrolled in the study. Patients were transplanted and followed at the University Clinic Cologne, Germany. The mean patient age was 48±2.03 years (standard error of the mean) during the study period, and the mean age at transplantation was 46.8±2.04 years. All patients received mycophenolate for 270 days, and then shifted to an azathioprine-based regimen for 720 days. Both regimens contained prednisolone and cyclosporine. The mean dose of mycophenolate and azathioprine was 20.03 mg/kg/d and 1.3 mg/kg/d, respectively. Data were collected and arranged in Excel Microsoft program, and the statistical analysis was carried out by SPSS V16 package. Analysis of variance and paired t test were used to compare the means of changes that occurred before and after the day 0. P value of ≤.5 were considered statistically significant.
White blood cells increased significantly after the transplantation during mycophenolate period (9.2×10(3), P=.001, .017), while after the shift it tended to decrease, although the change was not statistically significant. On the contrary, absolute leukocyte count decreased after starting azathioprine, and the decrease was statistically significant 12 months after (P=.006). MCV was stable during mycophenolate (89.1±0.31 fl), but increased significantly following the switch to azathioprine (91.8±0.02 fl, P<.000). Hemoglobin increased after transplantation and continued to increase steadily, although at -270 day, hemoglobin level was significantly lower than day 0 level (P=.001), and the hematocrit showed the same trend. Serum iron increased significantly (P=.000-.005), and serum transferrin saturation increased also significantly during azathioprine (P=.000-.001), respectively. Thrombocyte count did not change significantly under the two regimes. There was no evidence of hemolysis, and reticulocyte percentage ranged between 1.3% and 2%. Bilirubin and the liver enzymes were almost normal in all the patients.
Mycophenolate and azathioprine hematologic adverse effect are not significantly different as long as close observation and follow-up are performed. Therefore, mycophenolate- and azathioprine-based maintenance regimens can be used interchangeably without significant hematologic adverse effects.
[Show abstract][Hide abstract] ABSTRACT: To conduct a systematic investigation of the clinical relevance of rotavirus infection in the setting of paediatric cancer patients receiving intensive chemotherapy.
Twenty-eight paediatric cancer patients with positive rotavirus antigen tests were eligible for a retrospective case-control study (January 1995-December 2004). Rota-positive patients were compared with 28 rota-negative patients matched for age, underlying disease and chemotherapy. The National Cancer Institute Common Toxicity Criteria were used to determine clinical severity.
Median duration of rota-related symptoms (diarrhoea, fever and vomiting) was 7 days (range 4-34 days; 75th percentile 9 days). Median duration of viral shedding was 17 days (4-73 days; 75th percentile 39.5 days). The rota infection was nosocomially acquired in 19 patients (68%). The proportions of patients with diarrhoea > or =NCI II, fever >39 degrees C, clinically relevant dehydration, metabolic acidosis, mucositis and neutropenia were significantly higher in rota-positive patients. Rota-positive patients tended to have a prolonged period of hospitalization (median 8 versus 4 days; p=0.008). A higher proportion of rota-positive patients had to receive parenteral nutrition and tube feeding (p<0.001).
Rotavirus is a clinically relevant but preventable pathogen in paediatric cancer patients, since many cases seem to be nosocomial in origin. Rapid microbiological testing and contact precautions should be strictly applied to any symptomatic patient and to their immediate contacts. Prolonged viral shedding in immunocompromised paediatric patients necessitates repeated testing in order to determine the duration of isolation.