@article { author = {Ibrahim, Ibrahim}, title = {Fibrogenesis Markers and Hepatic Histopathology : What is the Role?}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {4}, number = {1}, pages = {1-3}, year = {2014}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2014.16285}, abstract = {The paper entitled " Can fibrogenesis markers reflect early hepatic histopathology in chronic hepatitis C?" published in this issue of the AfroEgyptian journal of infectious and Endemic Diseases by Abou El-Azm et al., aimed at evaluating individual and combined non invasive indicators of fibrogenesis (MMP-2, T1MP1 and APRI score) to assess early hepatic histopathology, and developing cirrhosis in chronic HCV patients with and without symptoms. The authors enrolled 344 patients (Group I:129 asymptomatic chronic-HCV, Group II: 135 with symptoms and Group III: 80 patients with compensated HCV-related cirrhosis). For each patient, APRI-Score was evaluated. Quantitative immunoassay measured serum MMP-2 and TIMP-1. Guided liver biopsy for histopathology staging and grading was done. The results imply that combination of markers raised the sensitivity, specificity and correlations. It could reflect early hepatic histopathology, developing cirrhosis and potentially could replace liver biopsies in pre-treatment and follow up of chronic HCV.}, keywords = {}, url = {https://aeji.journals.ekb.eg/article_16285.html}, eprint = {https://aeji.journals.ekb.eg/article_16285_448a773a69ea5a1fb48a6f3af5d96a10.pdf} } @article { author = {Abou El-Azm, Abdel-Raouf and Kobtan, Abdel Rahman and Elgendy., Zeinab and Mansour, Nagwa}, title = {Can Fibrogenesis Markers Reflect Early Hepatic Histopathology in Chronic Hepatitis C?}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {4}, number = {1}, pages = {4-12}, year = {2014}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2014.16286}, abstract = {Background and study aim: Chronic HCV can progress to cirrhosis, and HCC. Liver biopsy is the best to assess and monitor progression. But it has limitations.The aim of this study was to evaluate noninvasive indicators of fibrogenesis, matrix metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinase-1 (T1MP1) and AST/Platelet (APRI-score) for assessment of early hepatic histopathology in chronic-HCV, and cirrhosis. Patients and methods: A cross section study included 344 participants from Tanta University Hospitals, (GI): 129 asymptomatic chronic-HCV, (GII): 135 with symptoms. (GIII): 80 patients with compensated HCV-related cirrhosis and 30 healthy controls. Investigations proved diagnosis, and excluded associated diseases. APRI-Score was evaluated. Quantitative immunoassay measured serum MMP-2 and TIMP-1, guided liver biopsy for histopathology staging and grading. Results: Serum MMP-2& TIMP-1 showed significant difference between control& GI, GII, GIII, and GI, GII& GIII (P< 0.001) with significant correlation between GI& GIII, between GII & GIII, while insignificant between G1 & GII. There was significant positive correlation between APRI-score versus Metavir A, Metavir F, Ishak score of fibrosis, serum MMP-2 and serum TIMP-1 (P <0.001). Combined serum MMP-2, TIMP-1 and APRI-score showed high sensitivity, and specificity. Conclusion: This combination of markers raised the sensitivity, specificity and correlations. It could reflect early hepatic histopathology, developing cirrhosis and potentially could replace liver biopsies in pre-treatment, follow up of chronic-HCV, and screening of asymptomatic patients.}, keywords = {}, url = {https://aeji.journals.ekb.eg/article_16286.html}, eprint = {https://aeji.journals.ekb.eg/article_16286_5eb35ca81318c99d42e0284e448f3eaa.pdf} } @article { author = {Abdelaziz, Abdulla and Yousif, Monkez}, title = {Prevalence and Outcome of Bleeding Gastro-esophageal Varices in Medical Intensive Care Unit at Zagazig University Hospitals, Egypt}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {4}, number = {1}, pages = {13-22}, year = {2014}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2014.16444}, abstract = {Background and study aim:Ruptured gastro-esophageal varices (GEV) are the most severe and frequent cause of gastrointestinal bleeding in cirrhotic patients, leading to death in 5% to 8% of patients during the first 48 hours. Recently, the 6-week mortality rate has fallen from 34% to 20% due to the development of effective treatment strategies. This study was conducted to find out the prevalence of GEV as a cause of upper GI bleeding, a common medical emergency, and to find out the effect of other comorbidities and risk factors on the outcome. Patients and Methods: This was an observational longitudinal prospective study. It included patients admitted to hematemesis subunit of medical ICU at Zagazig University Hospitals with endoscopic diagnosis of bleeding GEV in the period from May to September 2013. 448 patients were enrolled in this study. 374 patients of them were observed until stabilization and discharge (survived group) and 74 patients were observed throughout their stay in the medical ICU and unfortunately passed away (deceased group). All subjects of our study were subjected to complete history, full physical examination, routine investigations and upper GIT endoscopy. Results: There was a significant positive correlation between hospital mortality and the age of the patients. The mean age of the deceased group was 59.44 ys ± 5.89 compared to 47.9 ys ± 9.93 of the survived group (p-value=0.036). Also the incidence of mortality in male sex was more than female sex (p-value= 0.005). The stage of liver disease according to Child-Pough class, MELD Score (model of end stage liver disease), the presence of complication of cirrhosis and abnormal liver functions (high serum bilirubin, elevated ALT, low serum albumin and prolonged INR) were the most important factors contributing to mortality in intensive care patients suffering from GEV bleeding (p-value= 0.002). The presence of co-morbid conditions (DM, COPD, renal failure), which were found in 20.3% of our patients, was associated with increased mortality (p-value=0.007). Severity of bleeding, delayed endoscopic intervension, hemodynamic instability (at the time of endoscopy), all were associated with increased risk of mortality. high APACHE II score (Acute Physiology and Chronic Health Evaluation) is associated with marked increase in mortality. Conclusion: Patients with variceal bleeding comprised a great burden to our medical ICU being about 13.7% of all admitted patients. The short term ICU mortality of these patients is 16.5%. The multivariate regression analysis identified the APACHE II score, MELD score, severity of the bleeding attacks, time to endoscopic intervention. ALT level, advancing age, presence of co-morbidities and spontaneous bacterial peritonitis (SBP) were found to be independent risk factors. So, primary and secondary prevention as well as better adherence to current guidelines for management of such cases to minimize the mortality as much as possible are recommended.}, keywords = {}, url = {https://aeji.journals.ekb.eg/article_16444.html}, eprint = {https://aeji.journals.ekb.eg/article_16444_afae1a9367ff3dc540fb77dd0823f54b.pdf} } @article { author = {Sherbini, Ahmad and Sherbiny, Hanan}, title = {Immunoprophylaxis of Compulsory Hepatitis B Vaccination in Sharkia, Egypt}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {4}, number = {1}, pages = {23-31}, year = {2014}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2014.16445}, abstract = {Background and study aim: Hepatitis B vaccination has been included in routine infant's immunization in Egypt since 1991. Although it could provide high levels of sero-protection, the duration of that protection remains largely unknown. The aim of this study was to evaluate the initial immunoprophylaxis response to compulsory hepatitis B vaccination and its long term protection in Egyptian children. Patients and methods: Antibodies to hepatitis B surface antigen (anti-HBs) was assessed in 200 apparently healthy Egyptian children.They were all vaccinated with hepatitis B vaccine in infancy through the compulsory vaccination program. They were classified into two groups, each contained 100 children. The 1st group included infants at least 2 months after completion of the 3 doses of the vaccine (≥8 months old). While the 2nd group included children aged 6-12 years old. Sera were obtained from all children and were tested for anti-HBs titer, HBsAg and antibodies to hepatitis B core antigen (anti-HBc) by ELISA. Children who were discovered to have non-protective titers (≤10 mIU/mL) received a booster dose of the vaccine and were re-evaluated within 2-4 weeks. Different factors associated with poor immune response were analyzed. Results: The initial responders rate of 83% was detected in group І which was significantly higher than that in group П of only 52%. Moreover, mean titer of Anti-Hbs was significantly decreased with age,( 48.9 ±15.8 mIU/ml in group І vs 12.6 ± 5.2 mIU/ml in group II). Also, within the 2nd group, a negative correlation between Anti-HBs mean level and age in years was displayed. No significant difference could be detected in the percentage of infected children between both groups (4% in group I vs.6% in group IІ). Sixty two percent of the boosted children showed a significant increase in their mean anti-HBs titer. Male gender and rural residence were associated with poor vaccine response in both groups. Conclusion: As maternal screening is not feasible in our country, Hep-B vaccine birth dose is a necessity to prevent perinatal infection. Most of infants vaccinated with compulsory Hep-B vaccine retained their immune protection years after vaccination either by high antiHBs titer or efficient memory T cells. However, large scale and long term follow up study is still needed before clearly answering the question about the need for booster dosing and its proper timing.}, keywords = {vaccine,hepatitis B,Immunoprophylaxis,Anamnestic reaction}, url = {https://aeji.journals.ekb.eg/article_16445.html}, eprint = {https://aeji.journals.ekb.eg/article_16445_0419e0739a8497c8aa349fca737a8666.pdf} } @article { author = {Abdalla, Taghrid and El Shelfa, Wael and El-Sayed, Saeed and Dawoud, Haitham}, title = {Hemodynamic Changes of Hepatic Veins as Predictors of Large Oesophageal Varices in Liver Cirrhotic Patients}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {4}, number = {1}, pages = {32-40}, year = {2014}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2014.16446}, abstract = {  Background and study aim: Oesophageal varices (OV) are morbid and mortal complications of portal hypertension. Oesophago-gastroduodenoscopy (OGD) is the main diagnostic yet semi- invasive tool; different non-invasive methods were developed for early prediction and assessment of OV yet not fully evaluated. This work aims at assessment of changes of hepatic venous wave patterns as early predictors of large OV in cirrhotic patients without history of variceal bleeding. Patients and methods: A number of 50 previously diagnosed liver cirrhotic patients were subjected to detailed history taking. After exclusion criteria only 46 patients were included in the study. They were subjected to routine investigations, OGD, abdominal ultrasound (US) and Color Doppler studying of the hepatic veins (HV). Results : Out of the total number (46 liver cirrhotic patients included in the study), the triphasic waves were detected in (26.1%), biphasic waves in (43.5%) and monophasic waves in (30.4 %). Small varices were detected in (65.2 %), while large varices were detected in (34.8 %).The sensitivity of loss of the triphasic waveform in detecting large varices was high (93.8 %), specificity was (36.7 %), the positive predictive value was (44.1 %) and the negative predictive value was high (91.7 %). Conclusion : The loss of hepatic venous triphasic waveform - detected by Color Doppler Abdominal Ultrasound Study- is a weak predictor of large OV in liver cirrhotic patients without history of variceal bleeding}, keywords = {Liver,cirrhosis- esophageal,varices-,Oesophagogastroduod,enoscopy- Color,Doppler Abdominal,Ultrasound- hepatic,vein}, url = {https://aeji.journals.ekb.eg/article_16446.html}, eprint = {https://aeji.journals.ekb.eg/article_16446_a7ef5a88580464b33d36352b8d73feb8.pdf} } @article { author = {Salem, Ghada and Sherbini, Ahmad}, title = {Frequency of Cholestatic Liver Diseases in Zagazig University Hospitals, with Special Emphasize on Extrahepatic Causes}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {4}, number = {1}, pages = {41-51}, year = {2014}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2014.16447}, abstract = {Background and study aim : Extrahepatic cholestasis results from the mechanical obstruction of large bile ducts outside the liver or within the porta hepatis. The common etiologies of cholestasis have been reported to vary from one center to another. Our aim was to assess the frequency of cholestatic disorders in patients admitted to our department and try to identify the underlying extrahepatic causes aiming at improving the quality of management offered to this patients group. Patients and methods: In the present study, 506 cases admitted to our department were included. Sixty one of them met our inclusion criteria, of high serum alkaline phosphatase (ALP≥1.5 times the upper limit of normal), high gamma glutamyl transferase (GGT≥3 times the upper limit of normal) and ultrasonogrpahic (US) features of extrahepatic cholestasis (dilated intra and/or extra-hepatic ducts) of whatever etiology. The selected patients underwent the following: Full history taking and thorough physical examination, complete blood picture, liver and kidney function tests and abdominal CT. Also, ERCP was performed whenever needed and the tumor markers, alpha feto-protein & (CA 19-9) were assessed in selected cases "when mass lesions were detected". Results : The frequency of cholestatic liver diseases presented with elevated both ALP & GGT as described above, was %19.7 (100 of 506 patients).While the frequency of extrahepatic cholestasis was 12.1% with females accounting for 54.1% and males were 45.9% with mean ages SD of 51.1 11.7 years. Benign causes of surgical obstructive jaundice were more frequent than malignant ones (57.4% VS 42.6%). The most common cause was choledocholithiasis in 25/61 (40.9%), followed by cancer head of pancreas 9/61 (14.8%), peri-ampullary carcinoma 8/61 (13.11%), cholangiocarcinoma 5/61 (8.2%) and pancreatitis 4/61 (6.6%). Dark urine, clay stool and itching were more common in patients with malignant obstructive jaundice. There was a highly positive agreement between ALP and GGT with P Conclusion : We concluded that, the frequency of cholestatic liver diseases in our department was %19.7. Among them, extrahepatic causes had a frequency of 12.1% with choledocholithiasis as the commonest benign etiology, while cancer head of pancreas was the most frequently met with malignancy. ERCP is considered the gold standard modality in diagnosis and management of extrahepatic cholestasis}, keywords = {}, url = {https://aeji.journals.ekb.eg/article_16447.html}, eprint = {https://aeji.journals.ekb.eg/article_16447_058846dbe1c11660a282d166488c6f2a.pdf} } @article { author = {Zaher, Tarik}, title = {Juvenile Polyposis Syndrome in 11- Years Old Girl}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {4}, number = {1}, pages = {52-52}, year = {2014}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2014.16522}, abstract = {A 11-years old Egyptian girl presented by bleeding per rectum. On endoscopic examination, multiple sigmoid colon polyps(>5) with mucosal prolapse were seen. Polypectomy was done in multiple sessions ( this video shows the first session) . Microscopic examination confirmed the diagnosis of Juvenile Polyposis . Juvenile polyposis (JP) is an autosomal dominant hamartomatous polyposis syndrome where affected individuals are predisposed to colorectal and upper gastrointestinal cancer. Forty-five percent of JP patients have mutations or deletions involving the coding regions of SMAD4 and BMPR1A[1]. Juvenile polyps have a distinctive histology characterized by an abundance of edematous lamina propria with inflammatory cells and cystically dilated glands lined by cuboidal to columnar epithelium with reactive changes. Clinically, juvenile polyposis syndrome is defined by the presence of 5 or more juvenile polyps in the colorectum, juvenile polyps throughout the gastrointestinal tract or any number of juvenile polyps and a positive family history of juvenile polyposis.}, keywords = {}, url = {https://aeji.journals.ekb.eg/article_16522.html}, eprint = {https://aeji.journals.ekb.eg/article_16522_27d9dd8c7298310e004d9990a5a9602e.pdf} } @article { author = {Abdelrahim, Ahmed and Elzaki, A. and Osman, H.}, title = {Hydatid Disease of the Liver}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {4}, number = {1}, pages = {53-55}, year = {2014}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2014.16526}, abstract = {We reported a 40 years old male with a chronic RUQ pain, an enlarged liver and a palpable mass. The patient was referred to the x-ray department for a longitudinal abdominal ultrasound. A cystic mass with floating membrane and posterior enhancement was reported indicating a Liver hydatid cyst. The Hydatid cyst was in the range of Gharbi’s type II.}, keywords = {Liver,Hydatid cyst,Ultrasonography,Echinococcosis}, url = {https://aeji.journals.ekb.eg/article_16526.html}, eprint = {https://aeji.journals.ekb.eg/article_16526_3ec864cc9aa3a18bca08a2f72d91315b.pdf} } @article { author = {Mohamed, Salem and Hamed, Emad}, title = {ERCP : Is it Really Safe in Cirrhosis?}, journal = {Afro-Egyptian Journal of Infectious and Endemic Diseases}, volume = {4}, number = {1}, pages = {56-56}, year = {2014}, publisher = {Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department}, issn = {2090-7613}, eissn = {2090-7184}, doi = {10.21608/aeji.2014.16533}, abstract = {Endoscopic-retrogradecholangiopancreatography (ERCP) currently has a pivotal importance in management of a wide variety of hepato-pancreatico-biliary disorders. It is a major endoscopic technique that requires not only high volume centres but also highly qualified endoscopic teams. Patients with liver cirrhosis are at increased risk for complications after surgery and probably also after the major endoscopic techniques including the ERCP. That is why the paper published by El-Naggar et al., 2013 in the Afro-Egyptian Journal of Infectious and Endemic Diseases seems interesting; the authors performed several invasive procedures in patients with Child A and B liver cirrhosis and the outcomes were unexpectedly excellent.}, keywords = {}, url = {https://aeji.journals.ekb.eg/article_16533.html}, eprint = {https://aeji.journals.ekb.eg/article_16533_b1fe9be08e40b882b7544aa0e7558780.pdf} }