@article { author = {Badawy, Ahmed and Hegazy, Ibrahim and Elshamy, Mustafa and Elnimr, Sahar and Abdelmoaty, Ahmed and Moustafa, Emad}, title = {Measurement of Splenic Stiffness as a Predictor of Oesophageal Varices in Patients with Liver Cirrhosis in Zagazig University Hospitals}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {80-91}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.16161}, abstract = {Background and study aim: Portal hypertension (PH) is a frequent complication of cirrhosis, contributing to the development of ascites, esophageal varices (EV) and hepatic encephalopathy. The best available methodology for the assessment of PH is measurement of the hepatic vein pressure gradient (HVPG). However, the performance of HVPG is limited to highly specialized centers and requires extensive experience Predicting the presence, grading and follow up of esophageal varices by non-invasive means might increase compliance and would permit to restrict the performance of endoscopy to those patients with a high probability of having varices. Patients and Methods: This study included 117 individuals divided into two groups. Group I: included 39 normal individuals as a control group for splenic stiffness measurement. Group II: included 78 cirrhotic patients. All patients of group II were subjected to upper GIT endoscopy and according to the results this group was subdivided into patients with no varices (IIa) and patients with esophageal varices (IIb). All patients underwent clinical assessment, routine laboratory evaluation, BMI, splenic and liver stiffness measurement, upper GIT endoscopy. Splenic stiffness measurement repeated for patients who had varices after 6 months of pharmaco medical treatment. Results: Splenic stiffness was found to be higher in cirrhotic group than control group, splenic stiffness measurement was found to be higher in patients who had varices than no varices in cirrhotic patients, cut off of SSM for the presence of varices ≥39.5 kpa had AUROC 0.999, sensitivity 97.7%, specificity 96.9%, PPV 97.8% and NPV while LSM showed cut off value for presence of varices >22.5 kpa had AUROC 0.641 sensitivity 84.44%, specificity 60.61%, PPV 74.5% and NPV 74.1%. PSR showed cut of ≤657.7 had AUROC 0.855 sensitivity 95.56%, specificity 78.79%, PPV 86% and NPV 92.9%. APRI showed cut off >2.7 had AUROC 0.657 sensitivity 57.78, specificity 93.94%, PPV 92.9% and NPV 62%. There was highly significant difference in median SS in patients with large varices versus small varices (49.6vs 71.58 kpa with p<.0001).SSM is not a useful tool for follow up of varices after pharmacological treatment with non selective beta-blockers (p=0.014). Conclusion: Fibroscan is a sensitive and reliable method for detection of esophageal varices. Splenic stiffness showed the best performance on detection of eosophageal varices, when compared to other non invasive predictors, PSR came in the 2nd place. Splenic stiffness measurement can differentiate small and large varices}, keywords = {Portal hypertension,Eosophage al varices,Hepatic vein pressure gradient,Splenic stiffness,measurement,Liver stiffness measurement}, url = {https://aeji.journals.ekb.eg/article_16161.html}, eprint = {https://aeji.journals.ekb.eg/article_16161_ab86272fe014aa0a07699c8269660da5.pdf} } @article { author = {Awwad, Adel and El Shewi, Mohammed and Tareif, Mohammed and Mostafa, Adham}, title = {Assessment of Fungal Infection of Peritoneal Fluid in Cirrhotic Ascites}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {92-101}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.16681}, abstract = {Background and study aim: Spontaneous peritonitis (SP) is the most important infectious complication of cirrhotic patients. The aim of this study is to evaluate the occurrence of fungal infection of peritoneal fluid in cirrhotic patients with ascites. Patients and Methods: Between September 2016 and April 2017, 50 Patients were classified into (SP group) and (non SP group) all patients were subjected to history taking, clinical examination, complete blood count, ESR,CRP, liver profile, kidney function tests, serological tests for viral hepatitis markers, abdominal ultrasonography and diagnostic abdominal paracentesis. The ascitic fluid was subjected to the following: microscobic examination, biochemical examination and microbiological cultures (bacterial and fungal). Results: MELD score was higher in SP group with Mean ± SD 23.08 ± 3.85. Analysis of the results showed that abdominal pain, hepatic encephalopathy and melena were the only significant clinical presentations (chief complaint) in patients with SP compared to non SP group (52%, 40% and 8% respectively). As regard risk factors of ascitic fluid infection, 40% had previous episodes of SP. In SP patients, mean PMN count in ascitic fluid was 675.20 ± 420.02 at the time of diagnosis. Ascitic fluid bacterial culture was positive in only 40% of SP patients. Ascitic fluid fungal culture was positive in only 2 patient (8%) of SP group and negative in all patients of non SP group. The isolated organism was Candida albicans. These 2 patient had proven spontaneous fungal peritonitis owing to the presence of Candida albicans as evidenced by clinical picture of spontaneous peritonitis, high ascitic fluid PMN count and. Conclusion: Spontaneous fungal peritonitis is less common than SBP but usually presented as a severe disease, so, clinical prediction and early detection helps in proper treatment and better prognosis.}, keywords = {Fungal infection,spontaneous fungal peritonitis}, url = {https://aeji.journals.ekb.eg/article_16681.html}, eprint = {https://aeji.journals.ekb.eg/article_16681_3e3931e952c9a984e93ce5b45f282e91.pdf} } @article { author = {Mohamed, Heba and El-Amin, Manal and Abdeen, Hoda and Fathy, Talaat}, title = {Cytomegalovirus Infection among Patients with Chronic Hepatitis C Virus and its relation to hepatitis C virus load}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {102-108}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.17774}, abstract = {Background and study aim: The clinical significance of Human Cytomegalovirus (HCMV) and its pathological effects have increased  in the past 20 years and it became one of the common causes of disability and may be mortality in immuno-compromisedhosts. This work aimed to assess the prevalence of HCMV infection in patients with chronic HCV and its correlation with HCV load in Clinical Pathology and Tropical Medicine departments, Faculty of Medicine, Zagazig University. Patients and Methods: This study included 120 individuals between May 2015 to May 2016..They were assigned into two groups: Group I (Control group) Included Session [CurrentTestPartID] apparently healthy persons (34 male & 26 female) with their age range from 21-Session [CurrentTestPartID] years (mean 37.3±12.4 years). Group II (Patient group) Included Session [CurrentTestPartID] chronic HCV patients (40 male & 20 female) with their age ranged from 20-62 years and mean age 37.5±11.9 years (all were Child A according to Child-Pugh classification) and were subdivided into 4 subgroups according to viral load by quantitative PCR (where lower detection limit assay less than 15 IU/mL) Resolved Group (viral load not detected), Mild viremia group (viral load: <200,000 IU/mL), Moderate viremia group (viral load: 200,000 - 2,000,000 IU/mL) and Severe viremia group (viral load: more than 2,000,000 IU/mL) as measured by the National Genetics Institute assay. Results: In this study; it was found that in HCV-positive group, serum ALT levels were higher in HCMV positive patients compared to HCMV negative patients. Also, there was a higher prevalence of CMV IgM among cases (28.3%) compared to controls (16.7%) while there was a higher percentage of CMV IgG among cases (91.7%) compared to controls (53.3%). Conclusion: CMV infection is common in chronic HCV patients and there was no correlation between hepatitis C virus load and CMV IgG but there was positive correlation between hepatitis C virus load and CMV IgM. There was no correlation between hepatitis C virus load and CMV IgG in all patients’ subgroups. Also there was no correlation between hepatitis C virus load and CMV IgM in mild and moderate cases but there was positive significant correlation between HCV viral load and CMV IgM in severe cases.}, keywords = {Cytomegalovirus,HCV,Viremia}, url = {https://aeji.journals.ekb.eg/article_17774.html}, eprint = {https://aeji.journals.ekb.eg/article_17774_834898b2c4cd3950ccaa5ec8b281a468.pdf} } @article { author = {Awaad, Adel and El Garem, No’omaan and ELeraky, Tamer and El Dahrouty, Hosam}, title = {Comparative Study between Triple Therapy (Peginterferon /Ribavirin/Sofosbuvir) and Dual Therapy (Simeprevir /Sofosbuvir) in Treatment of Chronic HCV Patients}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {109-117}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.17775}, abstract = {Background and study aim: Major changes have emerged during the last few years in the treatment of chronic HCV infection. Several direct acting antiviral agents (DAAs) have been developed showing potent activity with higher rates of sustained virological response. This study shows comparison between triple therapy regimen (Peginterferon/ Ribavirin/ Sofosbuvir) and dual therapy regimen (Simprevir/Sofosbuvir) concerning efficacy and safety for Egyptian patients with chronic HCV infection. Patients and Methods: This retrospective comparative study included 500 Egyptian patients with chronic HCV infection, randomly selected from Beni-Suef centre of treatment of viral hepatitis affiliated to the National committee for control of viral hepatitis (NCCVH). They were classified into two groups; triple therapy group included 250 patients had received pegylated interferon alpha, ribavirin and sofosbuvir for 12 weeks and dual therapy group included 250 patients had received sofosbuvir and simeprevir for 12 weeks. All patients were monitored for treatment safety and efficacy. Results: In the triple therapy group, mostly observed clinical side effects were; flu like illness (40% of patients), GI manifestations (20.8% of patients) and psychological manifestations (10.4% of patients) while photosensitivity (22% of patients), flu like illness (18.8% of patients) and GI manifestations (4.8% of patients) were the most frequently occurring clinical adverse effects in dual therapy group. Anemia (62.4% of patients) and leucopenia (49.6% of patients) were the mostly observed hematological abnormalities in triple therapy group while hyperbilirubinemia (38% of patients) was the mainly observed biochemical abnormality in dual therapy group. In the triple therapy group, the end of treatment response (ETR) rate was 95.6% while sustained virological response (SVR) rate was 91.2%. In dual therapy group, ETR rate was 95.6 % while SVR rate was 93.6 %. Conclusion: The dual therapy (Simeprevir and Sofosbuvir) regimen is more tolerated than triple therapy (Peginterferon, Ribavirin and Sofosbuvir) regimen for Egyptian patients with chronic HCV infection. There was no statistically significant difference as regard sustained virological response between both triple therapy and dual therapy regimens.}, keywords = {HCV,Triple therapy,dual therapy,side effects,virological response}, url = {https://aeji.journals.ekb.eg/article_17775.html}, eprint = {https://aeji.journals.ekb.eg/article_17775_061b729955367cb1f410f753bbe86de2.pdf} } @article { author = {Nafee, Abeer and Shaheen, Noha and Pasha, Heba and Saad, Mai}, title = {Serum Fetuin-A Evaluation in Chronic Hepatitis C-Virus Patients with Concomitant Type 2 Diabetes Mellitus}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {118-128}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.17786}, abstract = {Background and study aim: Hepatitis C virus infection represents a potential public health problem worldwide. Many studies have shown markedly higher prevalence of insulin resistance (IR) and type 2 diabetes mellitus (T2DM) among patients with hepatitis C virus (HCV) infection compared to healthy subjects. Fetuin-A is one of the principal hepatokines regulating the human metabolism. This study aimed to estimate the level of Fetuin-A in HCV patients with concomitant T2DM, and its relation to insulin resistance. Patients and Methods: The study was conducted on 115 subjects, 87 patients had chronic HCV infection with and without T2DM, diabetic patients without HCV infection and 28 healthy control, they were subjected to full history taking thorough clinical examination, abdominal ultrasonography, routine laboratory investigation including fasting and post prandial blood glucose level and assessment of HOMA- IR, viral markers and serum Fetuin-A level by ELISA. Results Conclusion : There was high statistically significant increase of serum Fetuin-A level among HCV with DM patient group followed by HCV group when compared to DM and control groups. Serum Fetuin-A level was higher in HCV patients than non HCV subjects with statistically significant difference.Also,it was higher among diabetic patients than non diabetic subjects with statistically significant difference.Serum Fetuin-A level was positively correlated with glucose homeostasis parameters in both HCV and HCV&D.M patients with high statistically significant difference. At Cut-off value of serum Fetuin-A >5.2 mg/mL, Sensitivity was 54.84, Specificity was 96.30, positive PV 94.4 and negative PV was 65.0 for prediction of IR in HCV patients. While, at Cut-off value of serum Fetuin-A >4.9 mg/mL, sensitivity was 72.41, specificity was 79.31, positive PV was 77.8 and negative PV was 74.2 for prediction of DM in HCV patients. Conclusion: Fetuin-A may have role as a mediator in IR of either HCV or diabetes. However, Fetuin-A is more specific for evaluation of IR than DM in HCV patients as other factors may be incriminated in the pathogenesis of DM in HCV patients other than serum Fetuin-A level alone.}, keywords = {HCV Fetuin-A diabetes}, url = {https://aeji.journals.ekb.eg/article_17786.html}, eprint = {https://aeji.journals.ekb.eg/article_17786_f356ee20ad81ba3bc6152f070e85e8d4.pdf} } @article { author = {Elgammal, Nahla and Dawod, Hosam and Jouda, Amal}, title = {Efficacy and Adverse Effects of Sofosbuvir-Based Therapies (Double and Triple Regimens) in Chronic HCV Patients}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {129-135}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.17796}, abstract = {Background and study aim: Egypt has the highest prevalence of hepatitis C virus in the world and it is about14.7 %. Until 2012, the combination of pegylated interferon-α and ribavirin was the standard of care in CHC. Sofosbuvir has an excellent tolerability and safety. Most severe adverse effects were observed when sofosbuvir was combined with ribavirin and/or pegylated interferon. The aim of this study is to compare double therapy (sofosbuvir + ribavirin) and triple therapy (sofosbuvir + ribavirin +peg- INF) for chronic HCV infection in Egyptian patients as regards efficacy and adverse effects. Patients and Methods: The study included 72 patients allocated in two groups according to the criteria of eligibility to interferon therapy in the National Committee for Control of Viral Hepatitis protocol. Group I received the double therapy for Session [UserIDID] weeks (ribavirin and sofosbuvir) and group II received the triple therapy for 12 weeks (INF, ribavirin and sofosbuvir). The two groups were followed up all through the period of treatment and for three months after treatment and the all the changes in the laboratory parameters were monitored along with the adverse effects and response to treatment. Results: The rate of sustained virological response was 88.9% in group I vs 94.4% in group II there was no significant differences between the two groups as regards the side effects encountered during treatment except for fatigue and flu like symptoms which were significantly higher in group II. Conclusion: Double therapy (sofosbuvir and ribavirin) for Session [UserIDID] weeks is effective as triple therapy (INF, sofosbuvir and ribavirin) for 12 weeks in treating Egyptian patients with hepatitis C with less side effects.  }, keywords = {Chronic hepatitis C,Sofosbuvir,interferon,nucleotide analogue,polymerase inhibitor}, url = {https://aeji.journals.ekb.eg/article_17796.html}, eprint = {https://aeji.journals.ekb.eg/article_17796_52d621ae16aab19611e49b8db37aa53b.pdf} } @article { author = {Ibrahim, Ibrahim and Murad, Mohammed}, title = {Value of HCV Core Antigen Testing in Detection of HCV Antibody Negative HCV Infection in Patients with Asymptomatic Elevation of Liver Transaminases of Unknown Etiology}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {136-145}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.17788}, abstract = {Background and aim of the work: Elevation of liver transaminases is the marker of hepatocyte affection by an inflammatory process. HCV infection is a common infection in Egypt. HCV antibodies are detected at least 6 weeks from the onset of infection; a period of time which is called window or preseroconversion phase. Moreover, the immune system is so weak as to mount for a detectable level of HCV antibodies as in cases of HIV, lymphomas and patients on chemotherapy. The aim of the present work is to study HCV core antigen as a marker of HCV infection in HCV antibody negative patients with asymptomatic elevation of liver transaminases of unknown etiology. Patients and Methods: 110 asymptomatic patients with elevated liver transaminases of unknown etiology were included in the study; 55 of them were HCV antibody negative and 55 were HCV antibody positive. HCV core antigen and HCV RNA PCR were determined in all patients. HCV antibody testing was repeated in all HCV antibody negative patients after 6 weeks. Results: Out of 55 HCV antibody negative patients with elevated liver transaminases of unknown etiology, 5 turned out to have HCV infection as proved by HCV RNA PCR. 4 of these 5 were positive for HCV core antigen. 3 of these 5 converted to HCV antibody positive after 6 weeks of follow up. Conclusion: HCV core antigen is a good marker for detection of HCV infection in HCV antibody negative patients with asymptomatic elevation of liver transaminases of unknown etiology.}, keywords = {HCV antibody negative,HCV core antigen,HCV RNA PCR and elevation of liver enzymes of unknown etiology}, url = {https://aeji.journals.ekb.eg/article_17788.html}, eprint = {https://aeji.journals.ekb.eg/article_17788_d9acef559149fad108cb095f1a1763ff.pdf} } @article { author = {Abdelmoaty, Ahmed and Hassan, Nagla}, title = {Evaluation of INR Elevation in Cirrhotic Patients as a Risk Factor for Esophageal Variceal Bleeding}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {146-154}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.17789}, abstract = {Background and study aim: Bleeding esophageal varices is a life threatening complication in cirrhotic patients. So, studying risk factors for bleeding esophageal varices is a must. Because of complexity and dynamic nature of coagulation process in cirrhotic patients, INR is considered a false method to measure bleeding risk in such patients. This study aims at evaluating INR elevation in cirrhotic patients as a risk factor for esophageal variceal bleeding. Patients and Methods: This case control study was conducted at the Intensive Care Unit and inpatient wards of Tropical Medicine Department affiliated to Zagazig University Hospitals in the period from April 2016 to January 2017. According to inclusion and exclusion criteria, 202 patients with liver cirrhosis and esophageal varices were included in this study. Cases were cirrhotic patients admitted to the hospital due to first attack of actively bleeding esophageal varices. Controls were cirrhoticpatients without bleeding esophageal varices admitted with ascites, SBP or hepatic encephalopathy. Results: Median admission INR was 1.3 in bleeders compared to 1.9 in non-bleeders with a highly significant statistical difference between both groups. Conclusion: Study concluded that INR elevation reflects the degree of liver dysfunction not the risk of bleeding from esophageal varices.}, keywords = {INR elevation,bleeders and non-bleeders}, url = {https://aeji.journals.ekb.eg/article_17789.html}, eprint = {https://aeji.journals.ekb.eg/article_17789_939951432c3ca8f0d621613ce6745949.pdf} } @article { author = {Al Dahshan, Magdy and Zaky, Samy and Seif El-Din, Sameh and Ali, Mohammed and Nouh, Alaa and Hammad, Radi}, title = {Efficacy of Sofosbuvir Plus Ribavirin with and without Pegylated Interferon in Management of Egyptian Chronic Hepatitis C Patients}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {155-158}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.17790}, abstract = {Background and study aim: Egypt is one of the highest prevalence of antibodies to hepatitis C virus (HCV) in the world, estimated nationally at 6.3%. Applying best treatment protocol has a great impact on the national disease burden. DAAs open the door to decrease HCV prevalence as well as to treat infected subjects. Patients and Methods: In this study 1000 patients treated by Pegylated interferon, Sofosbuvir and weight adjusted Ribavirin. Another group of 1000 patients treated by Sofosbuvir and weight adjusted Ribavirin. Results: Two groups showed sustained virological response : 90.1% and 72.3% respectively. Both groups approved that previous treatment status and viral load has no impact on response prediction. Both showed that males are more likely to respond than females. Conclusion: Addition of Direct Acting Antivirals (DAAs), like sofosbovir, to the standard treatment with interferon and ribavirin improved the duration of the treatment and the sustained virological response (SVR). Treating of cirrhotics byPEGINF+SOF+RBV and SOF+RBV leads to decrease success rates. Validation of SVR once will be a golden rule.  }, keywords = {HCV,DAAs,Sofosbuvir}, url = {https://aeji.journals.ekb.eg/article_17790.html}, eprint = {https://aeji.journals.ekb.eg/article_17790_9d9e1a93fa1470e02e8d0b3879518b27.pdf} } @article { author = {Badran, Abdel Ghani and El-Tokhy, Naglaa and Seif, Seham and Baioumy, Hossam}, title = {Role of Transient Elastography in Early Detection of HCC in Cirrhotic Patients}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {7}, number = {3}, pages = {159-168}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2017.17792}, abstract = {Background and study aim: Hepatocellular carcinoma (HCC) is common primary malignancy of the liver and one of the most frequent causes of death in patients with liver cirrhosis. Nowadays, liver stiffness measured non-invasively by transient elastography has been reported to be well correlated with histologically assessed liver fibrosis stage. The degree of liver fibrosis is the strongest indicator of risk for HCC development, that’s why liver stiffness measured by transient elastography is helpful in demarcating patients at a high risk for HCC, who need frequent check-up by imaging examinations.The aim of this study was to study the role of ultrasound elastography (FibroScan) in early detection of hepatocellular carcinoma in cirrhotic patients as well as verifying whether ultrasound elastography (Fibro-Scan), could be used as a tool for identifying cirrhotic patients who are at high risk of developing HCC. Patients and Methods: This study included 100 patients; 50 with HCC and 50 cirrhotics without evidence of HCC . For all groups, clinical data and image findings were studied. Tumour characteristics were assessed including size, number and site. Tumor staging was done using Okuda, CLIP, VISUM and Tokyo staging systems. Transient elastography was done for all patients and the results were expressed in kilopascal. Results: Liver stiffness was significantly higher in HCC patients compared to cirrhotic patients. The sensitivity and specificity in diagnosis of HCC were 72% and 84% respectively at cut-off of 30.4 kpa with 91.1% accuracy. Fibroscan has a positive significant correlation with tumour size (P<0.001), Child–Pugh (P<0.001), Okuda classification (P<0.001), CLIP staging (P<0.001) and Tokyo classification (P<0.001) among HCC patients. It was found that likelihood of HCC risk was correlated with increase of liver stiffness. At liver stiffness of 25-30 kpa the probability of HCC is 91% so, these patients should undergo close follow up. Patients with stiffness ≥30 kpa had HCC. Conclusion: Fibroscan could be used for early detection of HCC in cirrhotic patients and determining the patients who are at high risk for developing HCC.  }, keywords = {Hepatocellular carcinoma,Transient elastography,Liver Stiffness}, url = {https://aeji.journals.ekb.eg/article_17792.html}, eprint = {https://aeji.journals.ekb.eg/article_17792_1adaa526541667643ef612fb2af81a3f.pdf} }