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Background: Eradication of H. pylori is a challenging issue in many parts of the world including Egypt. Aim: To evaluate the safety and efficacy of adding nitazoxanide as an adjuvant drug to the standard clarithromycin-based regimen, a single-center phase 4 prospective superiority parallel open-label randomized controlled trial was conducted. Methodology: Two hundred naïve H. pylori-positive patients were randomly distributed into 4 groups in ratio 1:1:1:1; Group 1: 50 patients were treated by clarithromycin 500mg bid, amoxicillin1gm bid, omeprazole 20 mg, Group 2: 50 patients were treated by clarithromycin 500mg bid, metronidazole 500mg bid, omeprazole 20 mg bid, group 3: 50 patients were treated by clarithromycin 500mg bid, nitazoxanide 500mg bid, omeprazole 20 mg bid, and group 4: 50 patients were treated by clarithromycin 500mg bid, amoxicillin1gm bid, nitazoxanide 500mg bid, omeprazole 20 mg bid. All patients were treated for 14 days and assessed 4 weeks after treatment. Results: Adding nitazoxanide to standard clarithromycin based triple therapy achieved a high eradication rate of 84% in intention to treat analysis (ITT), and 89.36% in per protocol (PP) analysis with high significant p (0.01). Conclusions: adding nitazoxanide as an adjuvant drug to the standard clarithromycin-based regimen is effective and could be used as a first line regimen in the eradication of H. pylori.

Background There is ongoing debate regarding the impact of direct-acting antiviral drugs (DAAs) on the occurrence of de novo hepatocellular carcinoma (HCC). Vascular endothelial growth factor (VEGF) plays a crucial role in the development and angiogenesis of HCC. Aim This study aims to evaluate dynamic changes in vascular endothelial growth factor (VEGF) levels at different point times during and after treatment of HCV to evaluate the risk of de novo HCC in DAAs-treated HCV patients. Methods This prospective cohort study was conducted on 60 HCV-infected patients; 30 patients had early fibrosis (F1-F2) and 30 patients had advanced fibrosis (F3-F4). HCV-RNA, aspartate aminotransferase (AST) to platelet ratio index (APRI), and fibrosis-4 index scores, liver function tests, serum VEGF, alpha-fetoprotein (AFP), and abdominal ultrasound were done at baseline, 4 weeks after starting treatment, at the end of treatment, and 12 weeks after treatment. Results VEGF was significantly decreased after completion of treatment (78.94± 10.03) compared to its baseline level (103.17 ± 33.89 pg/ml). Conclusion No de-novo hepatic focal lesion was detected during and up to 12 weeks after completion of treatment. The treatment of HCV by DAAs was associated with a significant decrease in VEGF and AFP levels and an improvement in liver enzymes and fibrosis scores.

Introduction Computed tomography (CT) of the abdomen with contrast stands as the gold standard for assessing pancreatic cancer, encompassing both staging and vascular analysis. However, not all patients are suitable candidates for contrast-enhanced CT (CECT) scans due to factors such as contrast agent allergies, pregnancy, renal impairment, radiation risks, and limited tissue sampling capability in CECT scans of the abdomen. In light of these challenges, this study evaluated the diagnostic capabilities of endoscopic ultrasound (EUS) compared to CECT for staging and vascular assessment of pancreatic cancer. Methods Fifty patients diagnosed with pancreatic cancer underwent evaluations using both CECT scans and EUS, focusing on staging and vascular invasion assessment. Vascular evaluation was carried out using a categorization system based on EUS findings, classifying them into three types based on the tumor-vessel relationship: Type 1 indicating clear invasion or encasement of a vessel by a tumor or contact with a vessel wall exceeding 180 degrees, Type 2 representing abutment, wherein a tumor contacts a vessel wall but at an angle less than 180 degrees, and Type 3 implying clear non-invasion, where a discernible distance exists between a tumor and a vessel. In this categorization, Type 1 and Type 2 indicated signs of vascular invasion, while Type 3 indicated vascular non-invasion. These findings were subsequently compared to the results from CECT scans. The endoscopist performing EUS was blinded to the CT outcomes prior to the examination. Results Regarding pancreatic cancer staging, EUS exhibited remarkable sensitivity, specificity, and accuracy rates of 100% according to the T criterion.As for vascular invasion assessment, EUS demonstrated sensitivity, specificity, and accuracy of 100%, 95.93%, and 96%, respectively, for venous invasion. For arterial invasion, the figures were 95.65% sensitivity, 100% specificity, and an overall accuracy of 99.5%. Conclusion EUS is an effective modality for evaluating both staging and vascular invasion in pancreatic cancer, boasting exceptional sensitivity, specificity, and accuracy rates. The findings are robust enough to consider EUS a viable alternative to CT scans in evaluation, with the added advantage of EUS offering tissue sampling capability.

Objective A cohort study was conducted with the support of the WHO, where a standardized WHO protocol was followed to assess vaccine effectiveness (VE) against symptomatic RT‒PCR confirmed SARS‒CoV-2 infection among hospital health workers (HWs) eligible for vaccination at Al-Azhar University hospitals. Methods A WHO-supported cohort study was conducted from July 2022 through September 2023 and included 1249 HWs who were randomly selected and followed up biweekly for one year. At enrollment, nasopharyngeal (NP) and blood samples were collected from each participant and evaluated to detect SARS-CoV-2 RNA via a real-time PCR assay (QIAGEN) and for the quantitative detection of SARS-CoV-2 binding antibodies via the Roche Elecsys Anti-SARS-CoV-2 S immunoassay (Roche Diagnostics, GmbH, Germany). During follow-up, NP samples were collected from anyone who developed symptoms consistent with the WHO definition of suspected cases of SARS-CoV-2 infection. Results At enrollment, SARS-CoV-2 RNA was detected in 119/1235 (9.6%) HWs and 89% of the participants with positive RNA were asymptomatic. COVID-19-binding antibodies were detected among 1245/1248 (99.8%) HWs, and 53.2% of them had titers > 2500 U/mL, regardless of vaccination status. During follow-up, 232 participants had COVID-19 symptoms, but only 108 provided NP samples, and 18 (16.7%) of them were positive for SARS-CoV-2 RNA. No hospitalization or mortality was recordedat enrollment or during the follow-up period. The cumulative incidence of COVID-19 infection was higher among HWs with incomplete vaccination compared to unvaccinated, fully vaccinated, or those who received booster doses ( P  = 0.025). There was no significant difference in VE among HWs who were fully vaccinated or had booster doses compared with unvaccinated HWs, with adjusted VE values of 68% (95% CI -28–92%) and 64% (95% CI -170–95%), respectively ( P  = 0.106 and 0.318 respectively). The adjusted VE increased to 89% (95% CI -33–99%) among HWs with hybrid immunity compared with those who were unvaccinated with a previous COVID-19 infection ( P  = 0.082). Conclusion This study indicates that VE against symptomatic lab-confirmed SARS-CoV-2 infection was quite high with over 60% protection and was higher among HWs with hybrid immunity (immunity due to a combination of previous infection and vaccination) compared to unvaccinated HWs with previous COVID-19 infection. The findings also highlight the importance of completing the primary vaccination series against COVID-19. This study reveals a high rate of asymptomatic COVID-19, a lower rate of confirmed cases, who showed marked decrease in hospitalization and fatality rates. Real-world VE studies are essential to address several unresolved issues, such as the appropriate number of booster doses and the longevity of protection.