e13628 Background: Obesity is a major risk factor for breast cancer (BC). With 87.9% of Egyptian women overweight or obese, clarifying the interplay between adiposity, urbanicity, and disease presentation is critical. We evaluated the impact of urbanicity on BMI, comorbidities, and cancer stage at diagnosis in a large Egyptian BC cohort. Methods: We retrospectively analyzed patients at the Baheya Foundation cancer registry. Patients were stratified into High, Moderate, and Low Urban groups based on CAPMAS governorate classifications. Demographics, BMI, comorbidities (DM, HTN, CVD), and clinical stage were compared using ANOVA and Chi-square tests. Results: Among 10,361 patients, 74.0% had obesity (BMI ≥30 kg/m²), exceeding national (49.5%) and international rates, including the UK (17.9%) and North India (33.6%). High Urban patients trended toward the highest mean BMI (34.47 kg/m²; P = 0.092) and had significantly higher comorbidities vs. Moderate and Low Urban groups: DM (30.7% vs. 29.1% vs. 24.8%; P = 0.002), HTN (43.3% vs. 42.5% vs. 36.3%; P < 0.001), and CVD (11.0% vs. 10.8% vs. 8.2%; P = 0.041). Paradoxically, High Urban patients presented significantly earlier (Stage I-II: 53.6%) than Low Urban patients (46.8%; P < 0.001). Conclusions: Egyptian BC patients bear a disproportionate burden of obesity compared to global and national averages. A striking paradox exists: High Urban patients present with a worse metabolic profile yet are diagnosed at earlier stages, likely due to superior access to screening and healthcare facilities. Conversely, Low Urban patients present with more advanced disease despite fewer metabolic comorbidities. These findings highlight the critical role of geographic healthcare disparities in disease prognosis. Future interventions must tailor risk assessment strategies to ethnicity and culture, integrating weight management for urban populations while prioritizing early detection access in less urbanized regions. Baseline patient characteristics by urbanicity. Variable Category High Urban Moderate Urban Low Urban Total p-value Age at diagnosis (years) Mean ± SD 54.11 ± 12.22 53.37 ± 12.23 51.63 ± 12.33 53.35 ± 12.27 <0.001 BMI category (kg/m²) <25 254 (6.5%) 380 (7.0%) 76 (7.2%) 710 (6.9%) 0.86 25–29.9 747 (19.1%) 1,036 (19.2%) 199 (18.8%) 1,982 (19.1%) ≥30 2,900 (74.3%) 3,985 (73.8%) 784 (74.0%) 7,669 (74.0%) Diabetes mellitus 1,039 (30.7%) 1,383 (29.1%) 238 (24.8%) 2,660 (29.2%) 0.002 Hypertension 1,485 (43.3%) 2,040 (42.5%) 350 (36.3%) 3,875 (42.2%) <0.001 Cardiovascular disease 361 (11.0%) 501 (10.8%) 76 (8.2%) 938 (10.6%) 0.04 Clinical stage Early (I-II) 1,891 (53.6%) 2,515 (51.8%) 448 (46.8%) 4,854 (52.0%) <0.001 Late (III-IV) 1,638 (46.4%) 2,337 (48.2%) 510 (53.2%) 4,485 (48.0%)

BackgroundMetabolically dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease worldwide and is increasing in parallel with metabolic syndrome and obesity. In this exploratory, cross-sectional study, we analysed metabolic changes in the blood and urine of patients with early-stage MASLD (fibrosis grades 0, 1, and 2) to identify metabolites associated with disease presence and the prevalent fibrosis stage and to develop machine learning models for case discrimination and fibrosis-stage stratification.MethodsFifty-one metabolites, including17 urinary organic acids, 14 blood amino acids, 19 blood acylcarnitines/free carnitine, and glucose, were quantified in 232 participants (100 controls and 132 patients with MASLD: 68 F0, 34 F1, and 30 F2) using gas chromatography–mass spectrometry (GC/MS) and tandem mass spectrometry (MS/MS). MASLD-associated metabolites were visualised using volcano plots, cluster heatmaps, and a metabolic network diagram. Three machine learning approaches, namely, orthogonal partial least squares discriminant analysis (OPLS-DA), random forest (RF), and support vector machines (SVM), were implemented within a strictly leakage-free pipeline (feature selection and preprocessing performed within training folds only), with performance evaluated on independent test sets and validated by permutation testing and repeated cross-validation.ResultsA case-discrimination panel comprised β-hydroxy butyrate, adipic acid, acylcarnitines (C0, C2, C3, C10:1, C14:1, and C18:1), formiminoglutamate, glucose, glycine, citric and lactic acids, Leu/Ile, pyroglutamate, sebacic and suberic acids, tiglylglycine, and valine. A stage-stratification panel comprising valine, ethylmalonate, glycine, acylcarnitines (C0, C8:1, C2, C5, C16, C10, C18, and C18:1), Leu/Ile, alanine, glutamine, pyroglutamate, 3-hydroxybutyrate, succinate, vanillylmandelate, and citrulline was associated with MASLD severity. Metabolite-based models discriminated disease status more effectively than FIB-4 (AUC 0.74) and APRI (AUC 0.70) in this cohort; permutation testing (OPLS-DA permutation p ≤ 0.001; random-forest empirical p ≈ 0.01) confirmed the models captured genuine biological structure rather than random patterns.ConclusionMachine learning applied to targeted blood and urinary metabolomics identified candidate metabolite signatures associated with early-stage MASLD and fibrosis stage. These findings are exploratory and hypothesis-generating; prospective, externally validated studies with metabolically matched comparators are required before clinical application.

Our study investigated the predictive efficacy of AI-based Machine Learning (ML) model for determining HER2 status in a population of 3424 breast cancer patients. Multivariate logistic regression analysis identified several independent variables that were predictive of HER2 positivity, namely age ≤ 40 years, tumor multicentricity, high tumor grade, high-grade DCIS, N3 stage disease, and negative ER status (p < 0.05). These findings suggest that patients presenting with these factors may benefit from more aggressive and targeted therapies. Furthermore, XGBoost ML model was trained using the dataset of 3324 patients, which was divided into an 80 % training set and a 20 % test set. The model achieved an impressive accuracy of 95 % on both training and test sets, as evidenced by the area under the curve (AUC) values of 0.95. The model ranked the presence of DCIS, DCIS component (major versus minor), DCIS grade, multiplicity of the tumor, and ER status as the top four variables for predicting HER2/neu status. To validate the performance of the proposed model, blind HER2 status data from an external validation cohort of 100 cases were utilized. Notably, the model demonstrated a sensitivity of 90.5 %, indicating its ability to accurately identify HER2-positive cases, and a specificity of 84.4 %, suggesting its capability to correctly classify HER2-negative cases. These results highlight the promising predictive efficacy of AI-based ML in determining HER2 status in breast cancer patients. The model's ability to accurately identify HER2-positive cases can assist in guiding treatment decisions, ensuring that patients receive appropriate and targeted therapies. However, further research with larger datasets is necessary to validate and generalize these findings.

BACKGROUND:IL2 is one of the key cytokines essential for regulating the immune system and the inflammation-related carcinogenesis process. Few studies have examined the relationship between lung cancer and the IL2-330 (rs2069762) gene polymorphism, despite several studies demonstrating that it is linked to numerous cancer types. OBJECTIVE:Our study aimed to investigate the association between IL2-330 (rs2069762) polymorphism and lung cancer risk and explore the role of IL2-330 polymorphism in survival outcomes (OS and PFS). PATIENTS AND METHODS:The study was conducted from October 2023 to November 2024, including 50 randomly selected patients diagnosed with lung cancer and 50 subjects matched for age and gender were used as controls in this case-control study. The IL2-330 (rs2069762) gene polymorphism was assessed using real-time PCR. RESULTS:We found that the AC genotype was associated with a notably lower risk of lung cancer in comparison to the AA genotype (95% CI: 0.06-0.61, p = 0.01). Conversely, the CC genotype showed no significant association with lung cancer risk when compared to the reference genotype. The comprehensive comparison of survival distributions among the AA, AC, and CC genotypes through the Log-Rank (Mantel-Cox) test indicated no statistically significant difference. CONCLUSIONS:According to our research, The AC genotype of IL2-330 (rs2069762) is associated with a significantly higher survival rate and lower risk of lung cancer. Further future studies are needed to confirm these findings.

Background Invasive micropapillary carcinoma (IMPC) was first proposed as an entity by Fisher et al. In the 2003 World Health Organization (WHO) guidelines for histologic classification of the breast tumors. IMPC was recognized as a distinct, rare histological subtype of breast cancer. IMPC is emerging as a surgical and oncological challenge due to its tendency to manifest as a palpable mass, larger in size and higher in grade than IDC with more rate of lymphovascular invasion (LVI) and lymph node (LN) involvement, which changes the surgical and adjuvant management plans to more aggressive, with comparative prognosis still being a point of ongoing debate. Aim of the study In this study, we compared the clinicopathological characteristics, survival and surgical management of breast cancer patients having invasive micropapillary carcinoma pathological subtype in comparison to those having invasive duct carcinoma. Method This is a comparative study on female patients presented to Baheya center for early detection and treatment of breast cancer, in the period from 2015 to 2022 diagnosed with breast cancer of IMPC subtype in one group compared with another group of invasive duct carcinoma. we analyzed 138 cases of IMPC and 500 cases of IDC. Results The incidence of LVI in the IMPC group was 88.3% in comparison to 47.0% in the IDC group (p < 0.001). IMPC had a higher incidence of lymph node involvement than the IDC group (68.8% and 56% respectively). IMPC had a lower rate of breast conserving surgery (26% vs.37.8%) compared with IDC.The survival analysis indicated that IMPC patients had no significant difference in overall survival compared with IDC patients and no differences were noted in locoregional recurrence rate and distant metastasis rate comparing IMPCs with IDCs. Conclusion The results from our PSM analysis suggested that there was no statistically significant difference in prognosis between IMPC and IDC patients after matching them with similar clinical characteristics. However, IMPC was found to be more aggressive, had larger tumor size, greater lymph node metastasis rate and an advanced tumor stage.

This study aims to investigate the diagnostic and prognostic relevance of MMP-2 and MMP-9 as biomarkers for breast cancer, as well as their association with clinicopathological factors. Breast cancer is a leading contributor to cancer-related deaths among women worldwide. The discovery of biomarkers is crucial for early diagnosis, outcome prediction, and effective treatment. Matrix metalloproteinases (MMPs) play a significant role in various physiological and pathological activities, including development, tissue repair, inflammation, cancer spread, and metastasis. While the prognostic significance of MMP-2 and MMP-9 levels in breast cancer has been studied, the findings remain inconclusive. Participants were divided into three groups, with each group consisting of 62 individuals: Group I comprised healthy controls, Group II consisted of newly diagnosed breast cancer patients (stage I-III), and Group III included patients with metastatic breast cancer. Levels of MMP-2 and MMP-9 were evaluated in these groups using the ELISA method. An evident increase in MMP-2 and MMP-9 levels was noted when comparing the control group with both the breast cancer and metastatic groups. Furthermore, a notable correlation was identified between serum MMP-9 levels and the pathological diagnosis of breast cancer ( P < 0.001) as well as tumor size ( P < 0.01). MMP-2 and MMP-9 have emerged as promising biomarkers for breast cancer, with MMP-9 specifically associated with disease prognosis. Continued investigation into the anti-tumor mechanisms of MMPs may yield significant advancements in the development of targeted therapeutic strategies for the management of breast cancer.

Abstract Background Immediate breast reconstruction (IBR) with direct to implant (DTI) is the preferred method of reconstruction by many surgeons and patients, however, acellular dermal matrix (ADM) and other synthetic meshes are expensive especially in low- and middle-income countries. Aim of the work To evaluate the technique, indications, aesthetic outcomes, and short and long-term complications of DTI breast reconstruction performed with Ultrapro®, a low-cost alternative mesh to ADM and other synthetic meshes. Methods Our study is a prospective cohort study that was conducted on 133 patients who experienced IBR following nipple-sparing mastectomy (NSM) or skin sparing mastectomy (SSM) using silicone implants and Ultrapro® mesh between December 2020 and December 2023. Techniques used were either sub-pectoral or pre-pectoral, evaluating aesthetic outcome, complication rate and patient satisfaction using breast Q questionnaire. Results We included 133 patients (141 breasts) with a median age of 39 years. Mean duration of follow up: 20.364 ± 5.39 months. The sub-pectoral and the pre pectoral techniques were used for 80 breasts and 61 breasts respectively. We used the Ultrapro® mesh in all our patients. Smooth round silicone implants were used. The overall Major complications rate was 16.3%. 8 implants (5.7%) were lost within 6 months post-operatively while 2 implants were removed in the late post-operative period (after 6 months) one due to rupture and the other due to local recurrence. Capsular contracture Baker 3 and 4 was observed in 36 breasts (25%), 31 of them had post mastectomy radiotherapy treatment. 11 (7.8%) were managed by capsulotomies and re-insertion of the same implant. Radiotherapy was a significant risk factors for major complications and capsular contracture with p value of (0.01) and (0.0001) respectively. Conclusion DTI in properly selected patients offers excellent outcomes and patient satisfaction. The complication rate is low and improves with the experience of the surgeon. The Ultrapro® mesh is a safe, low-cost alternative to ADM or other synthetic meshes especially in low socioeconomic countries. Radiotherapy is a significant risk factor for major complications and capsular contractures.

Breast cancer is a highly common form of cancer that impacts a considerable proportion of women on a global scale. Interleukin 17A (IL-17A) is a cytokine that has both anti-tumor and pro-tumor effects, which can vary depending on the specific tumor microenvironment. The aim of this study was to determine whether IL-17A can be used as a biomarker for diagnosis of breast cancer. Therefore, we compared concentrations of serum IL-17A in patients suffering from breast carcinoma and normal control women by an enzyme-linked immunosorbent assay (ELISA). This study included 86 women, 44 patients that were diagnosed with breast carcinoma, and 42 normal control women. Serum IL-17A levels in both case and control groups were measured by sandwich ELISA kits. The IL-17A serum level was significantly higher among patients with breast carcinoma than in the control group (p <0.001). The serum IL-17A concentration was significantly higher in estrogen receptor-positive cases than in estrogen receptor-negative cases (p=0.033). The highest levels of IL-17A were detected in patients with stage 2 breast carcinoma rather than stage 3 with no significant correlation. There was no correlation between IL-17A level and tumor size, lymph node invasion, or metastasis in patients with breast cancer. In conclusion, a high level of IL-17A in breast carcinoma patients compared to the control group was detected in our study. It indicates that IL-17A could be a promising biomarker for diagnosis of breast cancer and may play a role in tumor development. High levels of IL-17A were not a predictor of poor prognosis in breast cancer patients as it was not related to tumor size, lymph node invasion, or metastasis.

BACKGROUND:Toll-like receptors (TLRs) play an important role in regulation of immune cells and are vital in tumorigenesis due to its crucial role in inflammatory microenvironment regulation, as they promote the synthesis and release of inflammatory cytokines and chemokines. Toll-like receptors 4 and TLRs 9 were found to be highly expressed in breast cancer. The aim of this study is to investigate the soluble toll-like receptors 4 and 9 (sTLR4 and sTLR9) as potential biomarkers for diagnosis and prognosis of breast cancer and their association with the clinicopathological parameters of breast cancer.PATIENTS AND METHOD:In this retrospective case-control study, 186 female subjects were recruited and divided into three groups, Group I: 62 healthy control, Group II: 62 subjects diagnosed with non-metastatic breast cancer, and Group III: 62 subjects diagnosed with metastatic breast cancer. Enzyme-linked immunosorbent assay (ELISA) technique was used to quantify the levels of sTLR4 and sTLR9 in serum.RESULTS:Both non-metastatic and metastatic groups showed significant higher levels of both serum sTLR4 and sTLR9 expression compared to healthy controls. Only sTLR9 was significantly increased among metastatic patients compared to non-metastatic group. Serum levels of sTLR9 and sTLR4 were still significantly associated with breast cancer in a multiple logistic regression model (P = <.001). ROC curves showed that both sTLR4 and sTLR9 can be a significant parameter to discriminate between normal females and breast cancer patients.CONCLUSION:Soluble toll-like receptors 4 and sTLR9 are over-expressed in patients with metastatic and non-metastatic BC than in benign cases. The expression levels of sTLR4 and TLR9 have clinical interest as indicators of tumor aggressiveness suggested to be prognostic biomarkers. Toll-like receptors may represent therapeutic targets in breast cancer.

Objectives Since being declared a global pandemic, the SARS-CoV-2 virus had a significant impact on the entire globe. The pandemic has placed a heavy burden on healthcare systems worldwide, and cancer patients are particularly prone. Despite the fact that initial international reports suggest delays in breast cancer (BC) diagnosis and screening programs, the Egyptian context requires additional research on this topic. To examine whether COVID-19 has changed the pattern of disease presentation before and after the pandemic, focusing on the tumor, node, and metastasis (TNM) staging of the disease at the initial presentation Methods This single-center, retrospective study of female BC patients initially diagnosed at Baheya Foundation was conducted during the following time frames: from Jan 2019 to Jan 2020 (Pre COVID-19 cohort) and from Mar 2020 to Mar 2021 (post–COVID-19 cohort). We compared the two cohorts in terms of clinical characteristics, tumor characteristics, and the number of days from presentation to treatment. Our primary endpoint was the difference in the TNM stage of BC at the initial presentation. Results This analysis included 710 BC patients, 350 from the pre-COVID cohort and 360 from the post-COVID group. We detected a 27.9% increase in late-stage BC (stages III-IV) in the post-pandemic cohort compared to the pre-pandemic (60.1% vs. 47%, p < 0.001). The time from diagnosis to commencement of treatment was significantly longer (28.34 ± 18.845 vs 36.04 ± 23.641 days, p < 0.001) in the post-COVID cohort (mean difference = 7.702, 95% CI 4.54–10.85, p < 0.001). A higher percentage of patients in the post-pandemic cohort received systemic neoadjuvant therapy (p-value for Exact’s test for all treatment options = 0.001). Conclusions The number of patients requiring systemic neoadjuvant chemotherapy increased dramatically in the post-pandemic group with advanced stages of BC at presentation. This study highlights the need for proper management of cancer patients during any future pandemic.

In Egypt, hepatocellular carcinoma (HCC) is the most prevalent cancer in men and the second most prevalent cancer in women. In addition, Egypt has one of the highest prevalences of hepatitis C infection in the world. The aim of the present work was to study the potential role of the 16 KIR genes in the outcome of individuals with chronic hepatitis C virus (HCV) infection in Egypt. The study was carried out under an IRB-approved protocol. Sequence-Specific-Primer-PCR (SSP-PCR) was used for KIR genotyping of germline DNA extracted from peripheral blood leukocytes or from the non-tumor liver of 83 HCC patients, 100 patients with chronic HCV infection without HCC, and 120 matched healthy controls. Out of the 83 HCC patients, only 7 (8.4%) were treated by interferon and/or interferon Ribavirin combination, while for the remaining patients 50 (60.2%) received no prior HCV therapy and 26 (31.3%) were treated with direct-acting antiviral (DAA). Our results showed that KIR haplotype AA that contains more inhibitory KIR genes and fewer activating genes was observed with a significantly lower frequency in HCC patients (6/83, 7.2%) compared to chronic HCV (27/100, 27.0%) (p = 0.0005, OR = 0.21 [0.08–0.53]) and healthy controls (29/119, 24.4%) (p = 0.001, OR = 0.24 [0.09–0.61]). In addition, the frequency of genotype 6 (G6) which contains all the KIR genes was significantly high in the HCC patients (16/83, 19.3%) compared to chronic HCV (8/100, 8.0%) (p = 0.02, OR = 2.7 [1.11–6.79]) and healthy controls (8/119, 6.7%) (p = 0.006, OR = 3.31 [1.35–8.16]). Activating KIR genes 2DS1 and 3DS1 were significantly higher in HCC patients (48/83, 57.83% and 45/83, 54.22%) compared to the chronic HCV patients (36/100, 36% and 34/100, 34%), p = 0.028, 0.027, respectively. Our results are contrary to a prior work on HCC from patients with HCV who were mostly treated by interferon-based therapies. In conclusion, KIR haplotype AA has an important role in host defense against HCC progression especially in patients treated by DAA, suggesting an important role of the KIR genotype status on the outcome of chronic HCV infection.

The pathogenesis of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) differs according to whether prior treatment with interferon (IFN) vs. direct-acting antiviral agents (DAAs) was administered. Cyclo- oxygenase-2 (COX-2), yes-associated protein 1 (YAP), and transcriptional co-activator with PDZ-binding motif (TAZ) play a crucial role in hepatocarcinogenesis. However, their roles in untreated or treated HCV-related HCC development have not been clarified. Therefore, we performed an immunohistochemical study and stained tissue from 83 HCV-related HCC cases using antibodies against COX-2, YAP, and TAZ and correlated their expression with the clinicopathological characteri stics and survival data. The cases were subdivided into 3 groups based on prior HCV treatment. In the 3 groups, COX-2 was significantly higher in HCC tissue compared with adjacent non-tumour liver tissue. However, the expression of YAP/TAZ was not significantly different between HCC and adjacent non-tumour tissue. We further grouped HCC cases into YAP+/TAZ+ and YAP-/TAZ- cases. In the YAP+/TAZ+ cases, COX-2 was significantly associated with tumour size, tumour multifocality, and late pathologic stage. No significant difference was observed in COX-2 and TAZ expression as a result of IFN or DAA treatment; however, YAP was significantly higher in IFN-treated HCC. Cyclo-oxygenase-2 overexpression may play a role in late HCC development, while YAP/TAZ could play an early role in HCC progression. Sustained expression of combined YAP/TAZ could mediate the poor prognostic role of COX-2.

Background and study aims: Currently, there is no therapy approved for COVID-19. We evaluated the effi-cacy and safety of sofosbuvir/ledipasvir and nitazoxanide for the treatment of patients with COVID-19 infection.Patients and methods: A multicenter, open-label randomized controlled trial included one hundred and ninety patients with non-severe COVID-19 infection. Patients were randomized into three groups. All groups received standard care treatment (SCT). In addition, group 1 received sofosbuvir/ledipasvir, and group 2 received nitazoxanide. Follow-up by reverse-transcriptase polymerase chain reaction (RT-PCR) was done at intervals of 5, 8, 11, and 14 days. The primary endpoint was viral clearance.Results: Viral clearance was significantly higher in the sofosbuvir/ledipasvir and nitazoxanide groups compared to the SCT group in all follow-up intervals (p < 0.001). In the sofosbuvir/ledipasvir arm, 36.9% showed early viral clearance by day 5. By day 14, 83.1% of the sofosbuvir/ledipasvir group, 39.7% of the nitazoxanide group, and 19.4% of the SCT group tested negative for SARS-CoV-2. Sofosbuvir/ledi-pasvir and nitazoxanide treatment were the only significant factors in Cox regression of negative RT-PCR with the highest OR (17.88, 95% CI: 6.66-47.98 and 2.59, 95% CI: 1.11-6.07, respectively). No mor-tality or serious adverse events were recorded. Conclusion: The addition of sofosbuvir/ledipasvir or nitazoxanide to the SCT results in an early and high viral clearance rate in mild and moderate patients with COVID-19. These drugs represent a safe and affordable treatment for COVID-19.(c) 2022 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

Background: Hepatocellular carcinoma (HCC) is the most dangerous complication of chronic liver disease. It is a multifactorial complicated disease. Hepatitis C and hepatitis B viruses (HCV and HBV, respectively) represent the main causes of HCC in Egypt. Early diagnosis is very important to aid in early intervention. Objectives: The goal of this research is to evaluate the metabolic role of different amino acids as non-invasive biomarkers over the course of HCC. Methods: This study included 302 participants with 97 diagnosed, untreated HCC patients, 81 chronic HCV patients, 56 chronic HBV patients, 18 co-infected patients, and a control group of 50 normal age and gender-matched individuals. All participants provided complete medical histories and underwent complete clinical examinations, abdominal ultrasonography and/or computed tomography, routine laboratory investigations, estimation of serum α-fetoprotein, and determination of amino acid levels using ultra-performance liquid chromatography (UPLC MS/MS). Results: This work revealed a decline in branched chain amino acids (BCAA) and increase in aromatic amino acids (AAA) among infected groups (HCC, HBV, HCV, and co-infected patients) compared to control subjects and a marked change in Fisher’s and the BCAAs/tyrosine molar concentration ratios (BTR) between controls and infected groups. Conclusion: Different amino acids could be used as non-invasive markers to discriminate and follow chronic hepatitis patients to predict the course of HCC.

Incorporation of telemedicine in general clinical practice is becoming a compelling need nowadays in the context of COVID-19 pandemic and its consequent burdens on the healthcare systems. Though telemedicine appears to be appealing and carries a lot of advantages, yet it is still faced by many challenges and barriers especially in developing countries. Our aim was to explore the impression of healthcare providers about telemedicine and its applicability in clinical practice in Egypt. A cross-sectional study was conducted among healthcare providers from different Egyptian governorates through a web-based survey. The survey gathered information about demographic, socioeconomic features of the enrolled healthcare participants; their knowledge, previous experience, impression about telemedicine, advantages of telemedicine over traditional medical services, barriers that may face telemedicine, and additional services that can be provided by telemedicine were also explored. Our study enrolled 642 healthcare providers from all over Egypt, 43.77% were females, of which 55.5% were physicians, 27.3% were nurses, 6.1% were technicians, 7.6% were administrative clerks, and 3.6% were medical directors. Sixty-four percent of participants reported that they have never used telemedicine. Smartphones were the most commonly used mean in the group who used telemedicine (65%), and smartphone applications were the favorable telemedicine service for about 50% of participants. Participants assumed that the use of telemedicine might not have a negative effect on the doctor-patient relationship but raised some concerns regarding the privacy and security of patients' data. Despite the fact that telemedicine appears to be appealing and widely accepted by healthcare providers, yet still, its implementation is confronted by some obstacles. Precise organizational guidelines need to be developed to clearly figure out the exact role of each healthcare provider to minimize their doubtfulness about telemedicine and to facilitate its adoption.

•Treatment of chronic hepatitis C virus (HCV) with new direct-acting antiviral agents (DAAs) has been proven efficacious and safe in many clinical trials.•Several factors influence patient compliance with DAAs, and cause treatment discontinuation, resulting in waste of money and effort that could exhaust the health care system.•Treatment regimen, longer treatment duration, and unfavorable liver functions were associated with treatment discontinuation.

Abstract Background Hepatocellular carcinoma (HCC) remains a major health problem despite the emergence of several preventive and therapeutic modalities. HCC has heterogeneous and wide morpho-molecular patterns, resulting in unique clinical and prognostic criteria. Therefore, we aimed to study the clinical and pathological criteria of HCC to update the morpho-molecular classifications and provide a guide to the diagnosis of this disease. Methods Five hundred thirty pathologically analyzed HCC cases were included in this study. The clinical and survival data of these cases were collected. Results Hepatitis C virus is still the dominant cause of HCC in Egypt. Post-direct-acting antiviral agent HCC showed an aggressive course compared to interferon-related HCC. Old age, male gender, elevated alpha-fetoprotein level, tumor size, and background liver were important prognostic parameters. Special HCC variants have characteristic clinical, laboratory, radiological, prognostic, and survival data. Tumor-infiltrating lymphocytes rather than neutrophil-rich HCC have an excellent prognosis. Conclusions HCC is a heterogenous tumor with diverse clinical, pathological, and prognostic parameters. Incorporating the clinicopathological profile per specific subtype is essential in the treatment decision of patients with HCC. Trial registration This was a retrospective study that included 530 HCC cases eligible for analysis. The cases were obtained from the archives of the Pathology Department, during the period between January 2010 and December 2019. Clinical and survival data were collected from the patients’ medical records after approval by the institutional review board (IRB No. 246/2021) of Liver National Institute, Menoufia University. The research followed the guidelines outlined in the Declaration of Helsinki and registered on ClinicalTrials.gov (NCT05047146).

The pandemic of COVID19 which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described in China as an unexplained pneumonia transmitted by respiratory droplets. Gastrointestinal (GI) and liver injury associated with SARS-CoV-2 infection were reported as an early or sole disease manifestation, mainly outside China. The exact mechanism and incidence of GI and liver involvement are not well elucidated. We conducted a PubMed search for all articles written in the English language about SARS-CoV-2 affecting the GI and liver. Following data extraction, 590 articles were selected. In addition to respiratory droplets, SARS-CoV-2 may reach the GI system through the fecal-oral route, saliva, and swallowing of nasopharyngeal fluids, while breastmilk and blood transmission were not implicated. Moreover, GI infection may act as a septic focus for viral persistence and transmission to the liver, appendix, and brain. In addition to the direct viral cytopathic effect, the mechanism of injury is multifactorial and is related to genetic and demographic variations. The most frequently reported GI symptoms are diarrhea, nausea, vomiting, abdominal pain, and bleeding. However, liver infection is generally discovered during laboratory testing or a post-mortem. Radiological imaging is the gold standard in diagnosing COVID-19 patients and contributes to understanding the mechanism of extra-thoracic involvement. Medications should be prescribed with caution, especially in chronic GI and liver patients. GI manifestations are common in COVID-19 patients. Special care should be paid for high-risk patients, older males, and those with background liver disease.

Trichinella spiralis can cause systemic inflammatory manifestations all over the body beforehabituating their destination in the striated muscles. Its new borne larvae (NBL) most dangerousphase go via bloodstream of different organs during migration.This study explored the anti-inflammatory, antioxidant and anti-apoptotic effects of Curcumin(Cur) and Curcumin nanoparticles (Cur-Nano) on inflammatory and pathological changes occurredin different organs in murine trichinellosis during larval migratory phase.Forty (40) male Swiss albino mice were divided into four groups of ten mice each. GI: miceinfected and treated with Cur, GII: mice infected and treated with Cur-Nano, GIII: infected nontreatedmice (positive control) and GIV: non-infected non-treated (negative control). Mice wereinfected orally with 200 T. spiralis larvae per mouse. GI & GII received treatment on 13th daypost infection (dpi) for 5 successive days. All mice were sacrificed on the 30th dpi. Effects of Cur& Cur-Nano were evaluated by counting T. spiralis encysted larvae in muscle by light microscope.Frozen sera (-20°C) were used for quantitative estimation of ALT, AST, TNFα, transforminggrowth factor-β (TGF-β) and Troponin (Trop). Specimens of lung, liver, brain and heartwere fixed in neutral buffered formalin for H&E and immunohistochemical staining.The results showed that number of encysted T. spiralis larvae in GI & GII was significantlyreduced compared to GIII. In both treated groups (GI & GII), there was a significant reduction inmean levels of AST, ALT, TNFα, TGF-β, & Trop. There was significant improvement of bileduct injury and proliferation, alveolar and pleural inflammation, and bronchial epithelial proliferation,as well as improvement of degenerative changes in brain and heart. The infected nontreatedgroup (GIII) showed significant overexpression of Cyclooxygenase-2 (COX2), caspase 3,glial fibrillary acidic protein (GFAP), arginase and granzyme b, with a significant low expressionof peroxisome proliferator-activated receptors (PPARs) as compared to treated groups.

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.