Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761310120200301Ascitic non-HDL-C/HDL-C ratio:a novel prognostic marker in liver cirrhosis196548510.21608/aeji.2019.18845.1039ENMarwa MEsawyClinical Pathology Department, Faculty of Medicine, Zagazig University, EgyptMarwa AShabanaClinical Pathology Department, Faculty of Medicine, Zagazig University, EgyptElsayed SAbd ElbaserTropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt0000-0001-9492-9707Hany MElsadekInternal Medicine Department ,Faculty of Medicine , Zagazig University,EgyptJournal Article20191030<strong>Background and study aim: </strong>Laboratory tests were developed on ascitic fluid for assessing causes, mechanisms, and prognosis of the diseases. This study aimed to evaluate the prognostic value of ascitic lipids in cirrhosis with special consideration to the non-high-density lipoprotein cholesterol (HDL-C) and its related ratios.<br /> <strong>Methods: </strong>This cross-sectional study included 120 cirrhotic patients with ascites. Ascitic fluid analysis for lipid contents and calculations of ratios were done. Ascitic lipid contents and ratios are used to assess liver disease severity and predict the mortality in different Child-Pugh groups.<br /> <strong>Results: </strong>Regarding Child-Pugh score, ascitic cholesterol, and HDL-C showed significantly higher levels in group C when compared to groups A and B. Ascitic non-HDL-C and ascitic non-HDL-C/ HDL-C ratio had a statistically significant increasing trend among Child-Pugh groups. Serum-ascites cholesterol gradient showed no significant difference among Child-Pugh groups (p>0.05). Ascitic non-HDL-C/ HDL-C ratio had the highest positive linear correlation with cirrhosis severity scores (p<0.0001). High ascitic non-HDL-C/ HDL-C ratio patients had a higher mortality rate when compared to those with a lower ratio (38.5% versus 9.5%).<br /> <strong>Conclusion: </strong>Ascitic non-HDL-C/HDL-C ratio was more beneficial than non-HDL-C in cirrhosis severity prediction. Also, it could predict the cirrhotic patients' survival. So, Ascitic non-HDL-C/HDL-C ratio seems to be an excellent prognostic marker for cirrhosis.https://aeji.journals.ekb.eg/article_65485_48ff6129ca7133c655d2ec9343ef2953.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761310120200301Evaluation of HCV-associated Hepatocellular Carcinoma based on Alpha-fetoprotein levels10156548610.21608/aeji.2019.18899.1040ENElsayed SAbd ElbaserTropical Medicine Department, Faculty of Medicine, Zagazig university,Egypt0000-0001-9492-9707Marwa AShabanaClinical Pathology Department, Faculty of Medicine, Zagazig University, EgyptAbeer HusseinAbdelkaderTropical Medicine Department, Faculty of Medicine, Zagazig university,Egypt0000-0003-3588-0389Samir Abdel-AzimAfifiInternal Medicine Department, Faculty of Medicine, Zagazig University,Egypt0000-0003-4352-9687Journal Article20191109<strong>Background and study aim: </strong>Alpha-fetoprotein (AFP) cannot be relied on alone for diagnosis of hepatocellular carcinoma (HCC). However, it may have a prognostic value and can be used for monitoring response to different modalities of treatment for HCC. This study aimed to differentiate the clinical and pathological features of HCCs according to AFP levels.<br /> <strong>Subjects and Methods: </strong>This retrospective study included 60 patients with HCC secondary to chronic hepatitis C (HCV). They were divided based on serum AFP into two groups; group I; included 30 patients with AFP lower than 302.5ng/ml. and group II; included 30 patients with AFP higher than 302.5ng/ml. clinical, laboratory and pathological differences between both groups were compared.<br /> <br /> <strong>Results:</strong> Regarding the pathological features, patients with higher AFP secreting tumors have larger tumor size compared to lower AFP secreting tumors; (5.8 cm Vs. 4.5 cm, P value; 0.001). Number of lesions and tumor location were similar between the two groups.<br /> <strong>Conclusion: </strong>HCC-secreting high levels of AFP are larger and aggressive tumors when compared to low secreting AFP-HCC.https://aeji.journals.ekb.eg/article_65486_810f17827f44340b600bcf6402717925.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761310120200301Value of Serum- Ascites Albumin Gradient in Prediction of Presence and Severity of Gastric Varices in Cirrhotic Ascitic Patients16236566510.21608/aeji.2019.20016.1043ENTaghrid MMahmoudTropical Medicine Department, Faculty of Medicine,Zagazig University, Zagazig, Egypt.Sameh MAbdel MonemTropical Medicine Department, Faculty of Medicine,Zagazig University, Zagazig, Egypt.Essam Abdel WahabInternal Medicine Department, Faculty of Medicine,Zagazig University, Zagazig, Egypt.Hosam MDawodTropical Medicine Department, Faculty of Medicine,Zagazig University, Zagazig, Egypt.https://orcid.org/00Mokhtar AIbrahemClinical Pathology Department, Faculty of Medicine,Zagazig University, Zagazig, Egypt.Journal Article20191123<strong>Background and aim of the work: </strong>Gastric varices (GV) are an ominous complication of portal hypertension (PH). The prediction of GV is a mandatory request to avoid their risky bleeding. This work aimed at evaluating the value of Serum- Ascitic Albumin Gradient (SAAG) in prediction of the presence and severity of GV in cirrhotic ascitic patients.<br /> <strong>Patients and methods: </strong>A descriptive cross-sectional study was conducted on 75 cirrhotic ascitic patients. All participants were subjected to full history taking, thorough clinical examination and laboratory investigations including liver function tests, complete blood count, kidney function tests and hepatitis markers including anti hepatitis C virus antibody (HCV-Abs) and hepatitis B surface antigen (HBs-Ag). Abdominal ultrasonography and abdominal diagnostic paracentesis with calculation of SAAG were also done. Patients were also subjected to upper gastrointestinal (GI) endoscopy and they were divided into two main groups according to the presence or absence of GV. Patients with GV were further classified into three groups depending on the form and size of GV.<br /> <strong>Results: </strong>SAAG - at a cut off value ≥ 2.4 gm/dl - predicted the presence of gastric varices with 93.28 % specificity, 59.92 %positive predicting value, 66.67% sensitivity and 96.5% negative predicting value. SAAG value also showed a highly significant increase with the progression of grades of GV.<br /> <strong>Conclusion: </strong>Serum- ascites albumin gradient (SAAG) could be considered as an efficient non-invasive predictor for the presence of GV and could reflect the severity of G.V in cirrhotic ascitic patients.https://aeji.journals.ekb.eg/article_65665_11586cb1e6f2eb258bbd4a984e462f76.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761310120200301Efficacy of Radiofrequency ablation versus Percutaneous Ethanol Injection in Treating Small HCC Among Cirrhotic/bilharzial Patients24316590510.21608/aeji.2019.18974.1041ENAbeer HusseinAbdelkaderTropical Medicine Department, Faculty of Medicine, Zagazig university, Zagazig, Egypt0000-0003-3588-0389Ahmed AbdelmoatyTropical Medicine Department, Faculty of Medicine, Zagazig university, Zagazig, EgyptMohamed MagdyElkollyGastroentrology Department, Zifta General Hospital,Zefta, Gharpiah governorate, EgyptJournal Article20191114<strong>Background and study aim: </strong>The incidence of hepatocellular carcinoma (HCC) is rising worldwide being the fifth most common cancer and the third cause of cancer-related mortality. Early detection of HCC is associated with a better outcome. In Egypt and over the last decades, a remarkable rise of HCC was observed in the proportion of chronic liver disease patients. The aim of this study is to compare between Radiofrequency ablation (RF) & Percutaneous Ethanol Injection (PEI) in treating small HCC in cirrhotic /bilharzial patients.<br /> <strong>Patients and Methods: </strong>We divided patients into two groups; Group 1: (n=24) were HCC patients with small focal lesions treated by ethanol injection therapy using 99% sterile alcohol delivered in the lesion through a 21-gauge needle, amount of alcohol not exceeding 10ml every session. Group II: (n=24) were HCC patients with small focal lesions treated by radiofrequency ablation using Leveen Needle Electrode.patients were followed up at 1 and 3 months by abdominal ultrasoungraphy& triphasic CT to assess ablation status.<br /> <strong>Results: </strong>The 2 groups are comparable regarding their baseline. The incidence of HCC ablation by PEI is 87.5% while it was to 91.7% in the radiofrequency ablation group with no relapse after 3 months follow up. In both groups, this difference was not statistically significant.<br /> <strong>Conclusion: </strong>The Efficacy of PEI therapy is not inferior to percutaneous RF ablation in the treatment of small HCC lesions up to 2.5 cm in patients with mixed cirrhosis/bilharzial hepatic fibrosis.https://aeji.journals.ekb.eg/article_65905_a61c6b275d5c54d42abfd0d9a61ca031.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761310120200301Is Glypican-3 useful Diagnostic Marker that Distinguishes Hepatocellular Carcinoma from Liver Cirrhosis?32386906910.21608/aeji.2020.19307.1042ENSeham AOmarInternal Medicine Department, Faculty of Medicine, Suez Canal University, Egypt.0002-0854-362xBasma BadreldinHasanClinical Pathology Department, Faculty of Medicine, Port Said University, Egypt.Wael GamalBiochemistry Department ,Faculty of Medicine, Suez Canal University, Egypt.Adel AhmedHasanEndemic and infectious Diseases Department, Faculty of Medicine, Suez Canal University, EgypJournal Article20191109<strong>Background and study aim: </strong>Glypican-3 (GPC3) is common kind and new type of the Glypicans group. These groups were connected to the epithelial cell membrane by a glycosyl-phosphatidylinositol bond. These proteins control the signaling action of various growth factors, especially Wnts. This reaction is predicated on the power of glypican to initiate, promote or suppress the reaction of these growth agents with their interactive signaling receptors. It is obviously proven and documented that GPC3 is secreted and released by most malignant liver cells, this glypican is not isolated from healthy hepatocyte, cirrhotic liver cells , or in even in benign liver masses. GPC3 accelerates the development of malignant liver lesions especially HCC by stimulating canonical Wnt impulses. The study aimed to characterize and assess the diagnostic accuracy of serum glypican-3 (GPC3) in early detection of HCC in cirrhotic patients and could be used as good screening marker for HCC in cirrhotic patients instead of AFP.<br /> <strong>Patients and Methods: </strong>We enrolled 60 patients which divided into 2 groups, group1 which included 30 patients diagnosed to have HCC and group 2 which included 30 patients diagnosed to have liver cirrhosis.<br /> <strong>Results: </strong>Our results revealed increased levels of Glypican-3 in hepatoma group and liver cirrhosis group with no significant difference (<em>p</em>=0.3).<br /> <strong>Conclusion: </strong>Serum GPC3 is not an efficient immune-marker for HCC that can be used alone to differentiate HCC from benign hepatic focal lesions, particularly hepatocellular adenoma.https://aeji.journals.ekb.eg/article_69069_5c742ce5dfd5d7a13e2838c768807336.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761310120200301Study of the Relation between Endothelial Nitric Oxide Synthase G894T Gene Variants and Occurrence of Type II Hepatorenal Syndrome39496929310.21608/aeji.2020.21140.1045ENHossam IMohammedTropical Medicine Department , Faculty of Medicine, Menoufia University,Egypt.Safaa ITayelMedical Biochemistry and Molecular Biology Department , Faculty of Medicine ,Menoufia University,Egypt.Mostafa MEl NimerGastroenterology resident, Kafr Elshigh Hospital, Kafr Elshigh ,Egypt.Naglaa SElabdTropical Medicine Department , Faculty of Medicine, Menoufia University,Egypt.0000-0001-8786-0190Journal Article20191219<strong>Background and study aim: </strong>The progress of hepatorenal syndrome (HRS) in hepatic patients is not yet understood. Nitric oxide level, through its impact on haemodynamic circulation, may be engaged in the progress of the disease. Our study expected to clarify the possible role of eNOS G894T in decompensated liver cirrhosis and HRS and its relationship with nitrite level.<br /> <strong>Methods: </strong>Study included 80 cirrhotic patients (40 decompensated cirrhotic and 40 HRS) and 40 healthy participants as controls. Renal and liver function tests, CBC, serum electrolytes, plasma nitrite and eNOS G894T by real-time PCR were surveyed.<br /> <strong>Results: </strong>There were higher frequencies of TT and GT genotypes of eNOS G894T versus GG in both cirrhotic (22.5% and 50% respectively) and HRS (30% and 45% respectively) than in controls (10% and 30%) (P=0.007). T allele was more prevalent than G allele in cirrhotic (47.5%) and HRS (52.5%) patients compared to controls (25.0%) (P=0.001). TT and GT genotypes increase risk of cirrhosis by OR 4.909 [95% CI: 1.24 – 19.46] and OR 3.636 [95% CI: 1.32 – 9.99] and HRS OR7.200 [95% CI: 1.86 – 27.77] and 3.600[95% CI: 1.27 – 10.7] respectively. T allele can increase risk of cirrhosis by OR 2.714 [95% CI: 1.39 – 5.30] and HRS OR 3.316 [95% CI: 1.70 – 6.48]. Clear connections were observed between TT genotype and lower plasma nitrite level (P<0.001).<br /> <strong>Conclusion: </strong>Mutant variants of eNOS G894T gene in cirrhotic and HRS patients from controls could partially explain the progress to decompensation and HRS in liver cirrhosis.https://aeji.journals.ekb.eg/article_69293_e3ef9451c4bb5b003a88f63cd8849cac.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761310120200301Coexistence of Spontaneous Bacterial Peritonitis and Spontaneous Bacterial Empyema Carries Poor Prognosis in Cirrhotic Patients with Ascites and Hydrothorax50597175010.21608/aeji.2020.21321.1046ENWagdy Abd El-FattahMohamedChest Diseases and Tuberculosis Department, Faculty of Medicine, Suez Canal University, Egypt.Nashaat MSolimanEndemic and Infectious Disease Department, Faculty of Medicine, Suez Canal University, Egypt.Abdulrahman AlduraywishInternal Medicine Department, Jouf University, Saudi ArabiaMahmoud KamelMansourMicrobiology and Immunology Department, Faculty of Medicine, Suez Canal University, Egypt.Mohamed MosaadChest Diseases and Tuberculosis Department, Faculty of Medicine, Suez Canal University, Egypt.Mostafa MRaghebChest Diseases and Tuberculosis Department, Faculty of Medicine, Suez Canal University, Egypt.Journal Article20191222<strong>Background and study aim:</strong>Patients with decompensated cirrhosis suffer from serious sequelae including infections that may endanger life. The study aimed at determination of the incidence, outcomes and risk factors of spontaneous bacterial empyema (SBEM) among patients with cirrhotic ascites and hydrothorax.<br /> <strong>Patients and Methods: </strong>This study included 50 patients subjected to clinical, imaging and biochemical workup including diagnostic tapping of ascitic and pleural fluid to diagnose spontaneous bacterial peritonitis (SBP) by cellular count and SBEM by cellular count and culture.<br /> <strong>Results: </strong>There The mean age was 57.14 years and 52% were males. SBP was found in 25 cases (50%); alone in 15 and with concomitant SBEM in 10. Only 7 (14%) had positive culture of the pleural fluid including five gram positive bacteria. Patients SBP and SBP/SBEM had significantly higher mean age, higher median TLC, and corrected PMN in pleural fluid compared to patients with no infection. The infection group stayed a significantly more duration in hospital. All the four deaths occurred in the infection group, three with SBP/SBEM and one with SBP. By multivariate logistic regression analysis, pleural fluid TLC and corrected PMN and duration of hospital stay were significant independent predictors of SBEM.<br /> <strong>Conclusion: </strong>SBEM is a common sequel of hydrothorax in patients with cirrhotic ascites and its coexistence with SBP leads to higher morbidity and mortality.https://aeji.journals.ekb.eg/article_71750_b686ebbd763753019e952153132c6377.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761310120200301Image Case:Blood Malaria Parasites in a 20 Years Old Male Student Traveled to Sudan.60607097010.21608/aeji.2020.70970ENTarik IZaherTropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.0000-0002-3846-0032Nahla ElgammalTropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.Samia EEtewaParasitology Department, Faculty of Medicine, Zagazig University ,Egypt.Taghrid MMahmoudTropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.Shereen MIbrahemParasitology Department, Faculty of Medicine, Zagazig University ,Egypt.Ahmed MansourHaematology Unit ,Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.Journal Article20200213A 20 years old male student presented with fever (reaching 40 C), rigors, nausea, vomiting, abdominal pain and severe weakness for three weeks. He gave a history of staying in Sudan for 14 months from where he arrived to Egypt about three months before admission to Haematology Unit, Internal Medicine and Tropical Medicine Departments ,Zagazig University Hospitals.<br /> He suffered from a similar attack about one year ago when he was in Sudan. The condition was diagnosed that time as malaria but the species was not defined . According to the patient, he was treated with lumifantrine -artemether and improved.<br /> By examination of the patient, he looked very ill with severe pallor, and marked splenomegaly. His investigations showed Pancytopenia with (RBC 2.400,000/ul and hemoglobin 8.6 gm/dl), thrombocytopenia (platelets 100,000/ul) and leukopenia (3700/ul). ESR was high up to 110/ 1st hour and so CRP and LDH were also high. By ultrasound examination, the longitudinal diameter of his spleen was 18 cm. Multiple blood films were done and ring forms and gametocytes of <em>Plasmodium falciparum</em> were visualized. Diagnosis of Malaria infection was established and the species was defined as <em>Plasmodium falciparum</em> .<br /> The patient received full course of artemether- lumefantrine (20/ 120 mg/ tablet) where he was given 6 doses, 4 tablets each. This course was followed by a course of doxycycline 100 mg capsule(twice per day)completed for one month(to avoid recrudescence). The patient showed marked progressive clinical and laboratory improvement. His splenomegaly improved almost to the normal longitudinal diameter (13cm). Complete recovery was obtained after follow up for 3 monthes.<br /> https://aeji.journals.ekb.eg/article_70970_3be1280a92de2e6b401e0d44d1c76bb2.pdf