Expression of Vascular Endothelial Growth Factor in the Gastric Mucosa of Patients with Portal Hypertensive Gastropathy
Naglaa
El-Toukhy
Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Benha University, Benha, Egypt
author
Naglaa
Al-Husseini
Department of Biochemistry, Faculty of Medicine, Benha University, Benha, Egypt
author
text
article
2018
eng
Background and study aim: Portal hypertensive gastropathy (PHG) is a common finding in patients with cirrhosis and portal hypertension that occurs in between 7% and 98% of cases. High levels of vascular endothelial growth factor (VEGF) in mesentery suggested their contribution in portal hypertension secondary to liver cirrhosis. VEGF participates in regulation of angiogenesis in gastric wall in portal hypertension. The aim was to evaluate the serum concentration of VEGF and gastric mucosal expression of VEGF and its possible association with PHG.
Patients and Methods: Serum levels and gastric mucosal expression of VEGF were measured in fifty seven patients with liver cirrhosis and portal hypertensive gastropathy as well as eleven patients with liver cirrhosis without portal hypertensive gastropathy and another twenty one persons served as control group. They were clinically assessed and laboratory investigations were done including liver biochemical profile, and viral markers. Severity of liver disease was assessed by Child-Pugh, model for end stage liver disease (MELD) and updated (uMELD) scores. The presence of PHG was diagnosed by esophago-gastroduodenoscopy.
Results: Serum VEGF increased in patients with liver cirrhosis compared to healthy control. But there was no significant difference between patients with PHG and patients without PHG as regard to serum VEGF.VEGF expression in the gastric mucosa was highly significant in patients with PHG than patients without PHG and control group. Serum VEGF has no correlation with severity of liver disease or PHG grade.
Conclusion: VEGF was highly expressed in gastric mucosa rather than elevation of serum VEGF in patients with PHG.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
8
v.
4
no.
2018
156
163
https://aeji.journals.ekb.eg/article_21926_4df2253f2dc944e7b88e7c4359d7d902.pdf
dx.doi.org/10.21608/aeji.2018.21926
Prognostic Role of Serum Alpha-Fetoprotein in Hepatocellular Carcinoma Patients with Radiofrequency Ablation
Mohamed
Khalifa
Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
author
Ossama
Ahmed
Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
author
Eslam
Safwat
Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
author
text
article
2018
eng
Background and study aim: Prognostic value of serum alpha-fetoprotein (AFP) in hepatocellular carcinoma (HCC) is still debatable. We aimed to study this role in HCC patients who underwent radio-frequency ablation (RFA).
Materials and Methods: Records from HCC patients were retrospectively analyzed between January 2012 and December 2016. A minimum data set for each patient record of a follow-up period of at least 1 year was pre-defined before enrollment. In all, 153 patients were enrolled. AFP levels were recorded for all patients at the time of diagnosis, 1 month after RFA and at 3-month intervals afterward. Patients were divided according to pretreatment AFP level into 3 groups: group 1: AFP <20 ng/mL, group 2: AFP 20-200 ng/mL and group 3: AFP >200 ng/mL.
Results: Pretreatment AFP is not significantly correlated with age, baseline lesion number or size, baseline Child score or class, post RFA recurrence or death. The overall survival rates were 95%, 75.6%, 55.6%, 48.8%, and 48.8% at 1,2,3,4, and 5 years respectively. On comparing the 3 groups on disease-free survival, there was no statistically significant difference among the three classes. Child class A patients showed statistically significant better survival after RFA than those with Child class B. The ROC curve showed that AFP had inadequate accuracy to discriminate survivors and deceased patients and to discriminate patients with recurrence from those without recurrence.
Conclusion: AFP level could not be used as a good predictor of either death or recurrence of HCC after RFA
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
8
v.
4
no.
2018
164
173
https://aeji.journals.ekb.eg/article_21931_57e00cc11a375507efb143945f4eb17f.pdf
dx.doi.org/10.21608/aeji.2018.21931
Efficacy and Adverse Effects of Sofosbuvir plus Daclatasvir Therapy in Chronic HCV Patients in Sharkia Governorate, Egypt
Nahla
El-Gammal
Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
Noha
Shahin
Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
Abeer
abdelkader
Tropical Medicine Department, Faculty of medicine, Zagazig university, Zagazig, Egypt
author
text
article
2018
eng
Background and study aim: Hepatitis C is the most pressing public health challenge in Egypt with variable prevalence rates among different age groups. This study aimed to detect the efficacy and adverse effects of sofosbuvir plus daclatasvir therapy in treatment of chronic HCV patients in Sharkia governorate.
Patients and Methods: One hundred and ten patients were included in this study, divided into 4 groups; group I: 55 treatment naïve patients receiving (sofosbuvir + daclatasvir) for 12 weeks, group II: 36 treatment naïve patients receiving (sofosbuvir + daclatasvir +ribavirin) for 12 weeks, Group III: 9 treatment experienced patients receiving (sofosbuvir + daclatasvir + ribavirin) for Session [UserIDID] weeks and Group IV: 10 chronic HCV patients not receiving anti-viral therapy. Patients were followed by clinical and laboratory evaluation monthly during treatment and for 3 months after end of treatment. In addition, the virological response and adverse effects were reported.
Results: The rate of SVR response was equal in the three treated groups. There was statistically significant increase in nausea and headache in groups I and II while arthralgia, myalgia and fatigue were more frequent in group I. There was also statistically significant improvement in Child score among treated cirrhotic patients after treatment.
Conclusion: Daclatasvir plus sofosbuvir with or without ribavirin for 12 or Session [UserIDID] weeks is highly effective in treatment of naïve or experienced Egyptian HCV patients in Sharkia governorate. This combination is well tolerated in both cirrhotic and non-cirrhotic patients with mild adverse effects.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
8
v.
4
no.
2018
174
181
https://aeji.journals.ekb.eg/article_22073_ba7e3578bfbb7dc6b8dca1f16cfc20c2.pdf
dx.doi.org/10.21608/aeji.2018.22073
Current Evaluation of Sepsis among Patients with Liver Cirrhosis
Elsayed
Saad
Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
Olfat
Ibrahim
Anesthesia Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
text
article
2018
eng
Background and study aim: patients with liver cirrhosis have high incidence of sepsis. Spontaneous bacterial peritonitis and urinary tract infections are the most common infections among patients with livercirrhosis.New criteria including quick qSOFA and sepsis-3 criteria are used for diagnosing sepsis in patients with liver cirrhosis. These criteria appear to be more accurate than SIRS. The aim of this study is to evaluate the existing scoring systems in our patients with liver cirrhosis to identify patients with sepsis.
Patients and Methods: This prospective study included 288 consecutive patients previously diagnosed to have liver cirrhosis and suspected to have bacterial/fungal infections. Quick Sequential (sepsis-related) organ failure assessment (qSOFA) criteria and sepsis-3 criteria were used to identify patients with organ dysfunction due to sepsis.
Results: qSOFA and sepsis-3 criteria are more accurate than SIRS in detecting sepsis among patients with cirrhosis (The area under the receiver operating characteristic curve (AUROC) value for a model with qSOFA and sepsis-3 was AUROC: 0.77 and 0.76), while AUROC for SIRS was 0.66.
Conclusion: Sepsis-3 and qSOFA are more accurate than SIRS criteria in early detection of sepsis among patients with cirrhosis. Patients with positive criteria need intensive management due to high risk of in-hospital mortality.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
8
v.
4
no.
2018
182
188
https://aeji.journals.ekb.eg/article_22655_0296cabbdd27aada97a876af184b01e8.pdf
dx.doi.org/10.21608/aeji.2018.22655
Risk Factors of Hepatitis C in the Suez Canal Region, Egypt
Hesham
El-Sayed
Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismalia, Egypt
author
Sohair
Mehanna
Social Research Center, American University in Cairo, Cairo, Egypt
author
Adel
Hassan
Department of Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismalia, Egypt
author
Mahmoud
Sheded
Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez University, Suez, Egypt
author
Shaimaa
Sahmoud
Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismalia, Egypt
author
Samar
Elfiky
Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismalia, Egypt
author
Zeinab
Khadr
Social Research Center, American University in Cairo, Cairo, Egypt
author
text
article
2018
eng
Background and study aim: Egypt has very high prevalence of Hepatitis C virus (HCV) infection Aim: To identify possible risk factors of HCV in Suez Canal region of Egypt. Materials and Methods: HCV positive individuals in 5 different hospitals and control blood donors were subjected to anti HCV tests and interview questionnaire to identify risk factors. Results: A total of 1176 subjects were studied for HCV, of which 539 were HCV-positive and637 HCV-negative donors. Subjects who achieved less than university education, unemployed or gaining less than 600 Egyptian pounds monthly had an increased risk of HCV (OR= 4.18, CI3.28-5.34, p 0.000), (OR= 3.26, CI 2.55-4.16, p 0.000), and (OR= 3.32, CI 2.59-4.26, p 0.000). Informal male circumcision doubled the risk of HCV (OR= 2.08, CI 1.53-2.83, p 0.000). Shaving at a barber and sharing razors increased HCV risk 2 times, while sharing tooth brushes increased it 7 times (OR = 7.23, CI 2.74-18.79, p 0.000). HCV risk increased after endoscopy (OR =3.62, CI2.02-6.52, p 0.000), blood transfusion (OR 3.47, CI 2.18-5.54, p 0.000), and injection treatment(OR= 1.41, CI 1.02-1.95, p 0.040). Any delivery and dental care in governmental clinic were independent risk factors (OR 2.57, CI 1.25-5.30, 0.011), (OR 1.46, CI 1.08-1.97, p 0.014). Schistosomiasis parenteral treatment doubled the HCV risk (OR= 2.09, CI 1.35-3.23, p 0.001) and chronic kidney disease patients were more at risk (OR= 2.95, CI 1.40-6.24, p 0.005). Conclusion: Infection control in medical practice and behavioral modifications in this region is essential to prevent HCV transmission.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
8
v.
4
no.
2018
189
195
https://aeji.journals.ekb.eg/article_22656_e9bbe71a74c4df77b13e9d828dcbf179.pdf
dx.doi.org/10.21608/aeji.2018.22656
The Association between Helicobacter pylori and Graves' Disease
Taghrid
Abdalla
Tropical Medicine Department,Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
Fayrouz
Selim
Internal Medicine Department,Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
Thoraya
Hosny
Clinical Pathology Department,Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
text
article
2018
eng
Background and study aim: Helicobacter pylori (H. pylori) infection is a very common health problem associated with both gastric and extra gastric manifestations. Its association with autoimmune thyroid diseases (ATD) including Graves’ Disease (GD) was suspected and needed to be furtherly investigated.
Patients and Methods: This case - control study included 43 patients with GD and a control group of 47 healthy volunteers. Hormonal diagnosis of GD was achieved by decreased level of thyroid stimulating hormone (TSH) and elevated levels of tri-iodothyronine (FT3) and free thyroxine (FT4) and serological diagnosis was achieved by positive titers of auto-antibodies against thyroglobulin (TG Abs), thyroid peroxidase (TPO Abs) and thyrotropin receptor (TR Abs). H. pylori infection was diagnosed by detecting H. pylori antigens in stool using an amplified enzyme immunoassay (amplified EIA). The antibodies against Cytotoxin-associated gene A (Cag-A) were assessed in serum samples using the enzyme-linked immunosorbent assay method (ELISA). The results were statistically analyzed using Fisher's test and the respective Odd's ratio (OR).
Results: No significant difference in prevalence of H. pylori infection was found between GD patients and the control group.
Conclusion: No association between H. pylori infection and Graves' disease could be detected.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
8
v.
4
no.
2018
196
201
https://aeji.journals.ekb.eg/article_23076_33bf70cc2e0d6f04edda2621ca9fbc39.pdf
dx.doi.org/10.21608/aeji.2018.23076
Significance of screening antibodies to hepatitis B core antigen among chronic hepatitis C patients before antiviral therapy
Mohamed
Fathallah
Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
author
Amany
Moustafa
Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
author
Mohamed
Aboelmagd
Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
author
Shyma
Elkhodary
Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
author
Mohammed
Elhamouly
Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
author
text
article
2018
eng
Background and study aim: Anti-hepatitis B core (anti-HBc) sero-positivity in general population in Egypt is reported to be 10-13%. This study was performed to determine the prevalence of anti-HBc among chronic hepatitis C patients before antiviral therapy.
Patients and Methods: A total of 178 consenting patients with chronic HCV infection eligible for treatment with DAAs according to program of National Committee for Control of Hepatitis Infection in Portsaid, Egypt from April to October 2017. All of the patients were screened for anti-HBs and anti-HBc. Anti-HBc–positive patients were assayed for HBV DNA.
Results: Out of 178 chronic hepatitis C patients, Eighty four patients (47.2%) were treated with triple therapy (Sofosbuvir/ Daclatasvir/Ribavirin) and ninety four patients (52.8%) with dual therapy (Sofosbuvir/Daclatasvir). A65 patients (36.5%) werereactive for anti-HBc. Of 84 patients, 34 (40.5%) who treated with triple therapy were reactive for anti-HBc. Of 94 patients, 31 (33%) who treated with dual therapy were reactive for it. All patients were negative for anti-HBs and anti-HBc–positive patients were no detected HBV DNA at baseline and 12 weeks after DAAs.
Conclusion: Our results suggest including anti-HBc as an additional screening test for chronic hepatitis C patient in Egypt who are eligible for DAAs to reduce the risk of HBV reactivation and fulminant hepatitis after DAAs.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
8
v.
4
no.
2018
202
208
https://aeji.journals.ekb.eg/article_23077_98efa6933d6c622cca0ceb919dc83392.pdf
dx.doi.org/10.21608/aeji.2018.23077
Efficacy and Safety of Peg-Interferon/Sofosbuvir/Ribavirin VS Sofosbuvir/Simeprevir in Egyptian chronic hepatitis C patients
Mohamed
Fathallah
Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
author
Mohammed
Elhamouly
Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
author
Amany
Moustafa
Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
author
Ahmed
Gaber
Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
author
text
article
2018
eng
Background and study aim: Recently, multiple regimens of different direct-acting antiviral agents (DAAs) have been emerged. We aimed to assess the efficacy, safety and improvement of liver profile for patients treated with regimens of direct acting-antivirals in Egypt.
Patients and Methods: A retrospective observational study was conducted at Suez governorate, including a simple random sample of 76 patients treated with directly-acting antiviral therapy and came to our center to enroll our follow up program after antiviral therapy from November 2015 to May 2016. Sustained viral response (SVR) was established at week 12 after end of treatment.
Results: A total of 76 chronic hepatitis C patients initiated treatment with DAAs. Forty patients (52.6%) were treated with triple therapy and thirty-six patients (47.3%) with dual therapy. All patients were treated for 12 weeks. According to Intention to treat analysis, 35 of 40 patients (87%) who treated with triple therapy achieved SVR while 32 of 36 patients (88.9%) treated with dual therapy achieved SVR. However, the difference between responders after both regimens wasn’t statistically significant (p= 1). In the group treated with triple therapy, significantly more patients had anemia, leukopenia and thrombocytopenia with no serious side effects leading to discontinuation of therapy.
Conclusion: Both regimens had similar efficacy, but the dual therapy was more tolerated with less side effect profile.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
8
v.
4
no.
2018
209
217
https://aeji.journals.ekb.eg/article_23078_ed3bb880f6b0d1d66e8b6d285a134d34.pdf
dx.doi.org/10.21608/aeji.2018.23078
Hepatic Fascioliasis, Unexpected Diagnosis and Atypical Presentation
Tarik
Zaher
Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
Elsayed
Saad
Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
Ahmad
Elsamak
Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
author
text
article
2018
eng
A 35 years old female living in a village belongs to Zagazig, a city in the Nile delta, Egypt, presented to another health institute with upper abdominal pain, anorexia for one month. Her blood results were as follow; normal complete blood count (CBC), increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) more than twice the upper limit of normal, alkaline phosphatase (ALP): 185 U/L, gamma-glutamyl transpeptidase (GGT): 115 U/L and bilirubin: 1.5 mg/dl. Abdominal ultrasonography showed hypo-echoic focal lesions with ill-defined borders which were confirmed by abdominal CT. Her physician gave a probable diagnosis of HCC (based on high incidence of HCC in our community) and referred to our hospital. On admission the patient complained of upper abdominal pain. On examination there was no fever, no jaundice, and no organomegaly. Repeated laboratory tests showed normal CBC, ALT; 55 U/L, AST; 43U/L, ALP; 143 U/L, GGT; 96 U/L, bilirubin; 2 mg/dl and Alfa fetoprotein (AFP); 6 ng/ml. Abdominal CT imaging confirmed the presence of multiple branching hypo-dense focal lesions in segments 7 and 8 of the liver but no cirrhosis (Fig. 1). Serology for viral hepatitis (B,C) was negative. However, repeated stool analysis revealed Fasciola eggs. Nitazoxanide was given for one month. Her symptoms resolved and liver biochemistry improved. However, CT abdomen showed regression of the lesions but didn’t disappear completely, so, Triclabendazole 10mg/kg was given once. Two months later, there was resolution of the focal lesions completely.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
8
v.
4
no.
2018
218
220
https://aeji.journals.ekb.eg/article_23825_62d34123bb91df54f6c8ea914c936d7b.pdf
dx.doi.org/10.21608/aeji.2018.23825