Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Time to Move Forward for Image Enhanced Endoscopy even in Resource Limited Areas10010217258410.21608/aeji.2021.172584ENMariam SZaghloulHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.Journal Article20210526Proper early detection of GI lesions is the key factor for improving patients’ prognosis and improving quality of care. It is our duty as a gastroenterologist offering endoscopic screening and diagnostic services to do the best for our patients care. In clinical studies, IEE outperformed conventional white-light endoscopy in diagnosing lesions and identifying their morphologies. Large-scale studies on various lesions for standardization of findings and training are needed. It is also hoped that every center could adopt the technology of IEE for better outcomes and quality.https://aeji.journals.ekb.eg/article_172584_e2ba23d2ef147f336a1b37cb3d22fad1.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Value of Macrophage Inflammatory Protein 1 Beta and Platelet Indices in Diagnosis of Spontaneous Bacterial Peritonitis10311215626210.21608/aeji.2021.59193.1131ENMaysaa ASaeedDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig,
Egypt.Naglaa AKhalifaDepartment of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig,
Egypt.Marwa MBadranDepartment of Internal Medicine, El Ahrar Teaching Hospital, Zagazig, Egypt.Kamal AAmerDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig,
Egypt.0000-0002-2147-0736Journal Article20210124<strong>Background and study aim:</strong> Spontaneous bacterial peritonitis (SBP) is a serious complication of decompensated liver cirrhosis. It may be presented with atypical symptoms or asymptomatic, so ascitic fluid examination is recommended beside the clinical evaluation for the diagnosis of SBP. This study aimed to evaluate the value of macrophage inflammatory protein Ib (MIP Ib) and platelet indices as diagnostic markers for spontaneous bacterial peritonitis.<br /> <strong>Patients and Method:</strong> This is a cross-sectional study comprised 75 cirrhotic patients. Patients were divided into two groups according to the presence of ascites: group I: Comprising 50 cirrhotic patients with ascites who were classified into: group Ia comprising 25 patients with SBP, group Ib comprising 25 without SBP, and group II: Comprising 25 cirrhotic patients without ascites with other bacterial infections. All patients were subjected to history taking, full clinical examination, ultrasonographic examination; laboratory investigation (complete blood count (CBC), liver, and kidney function tests and serum C reactive protein (CRP)), Diagnostic paracentesis and ascetic fluid examination were done for all ascitic patients. Measurement of MIP Ib in serum and ascitic fluid was done.<br /> <strong>Results: </strong>significant increases in CRP, white blood cell count, mean platelet volume (MPV) and platelet distribution width (PDW), were found in SBP group compared to other groups (P<0.001). Serum MIP-1b level at a cut-off value >85 pg/ml could predict presence of SBP, with a sensitivity 100% and a specificity 44%. Ascitic MIP-Ib at a cut-off value of > 120 pg/ml could predict the presence of SBP with sensitivity 68% and specificity 100%. Cut-off value for MPV was (> 8.5 fl) could predict SBP presence, with sensitivity 76% and specificity 52%. Cut-off value for PDW was (> 15 fl) could predict SBP presence, with sensitivity 84% and specificity 84%.<br /> <strong>Conclusion: </strong>Serum and ascitic MIP-1β and platelets indices are useful diagnostic biomarkers for spontaneous bacterial peritonitis .https://aeji.journals.ekb.eg/article_156262_f4f8539f3d80203438e3b5fb5ab20de1.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601How Valuable are Noninvasive Tests as Indicators of IBD Activity and Severity in the Primary Health Care 11311915637010.21608/aeji.2021.53849.1122ENMohamed HAhmedDepartment of Hepatology, Gastroenterology and Infectious Disease, Faculty of
Medicine, Kafrelsheikh University, KAFR ELSHIKH, Egypt.0000-0003-1761-3527Mohamed HEmaraDepartment of Hepatology, Gastroenterology and Infectious Disease, Faculty of
Medicine, Kafrelsheikh University, KAFR ELSHIKH, Egypt.0000-0002-1504-7851Eman MSaeedDepartment of Pathology, Faculty of Medicine, Kafrelsheikh University, KAFR
ELSHIKH, Egypt.Mohamed OAbouelfetouhAlsharkawya Primary Health Care center, Biala, KAFR ELSHIKH, Egypt.Aya MMahrosDepartment of Hepatology, Gastroenterology and Infectious Disease, Faculty of
Medicine, Kafrelsheikh University, KAFR ELSHIKH, Egypt.Journal Article20201220<strong>Background and study aims:</strong> Inflammatory bowel disease (IBD) is a chronic inflammatory and destructive disease of the bowel wall. Chronic inflammation is associated with ulcerations, strictures, perforations and is a risk factor for dysplasia and cancer. To reduce these long-standing complications, IBD patients are continuously in a need for treatment and monitoring. Primary health care centers lack specific IBD management facilities although they receive a reasonable number of IBD patients. Markers, such as ESR, CRP, fecal calprotectin (FC) have been widely used as noninvasive parameters for IBD monitoring. The aim of the current study was to evaluate readily available non-invasive tests (FC, ESR, Platelets, serum total proteins, serum albumin and hemoglobin level) in predicting IBD activity and severity in the primary health care.<br /> <strong>Patients and Methods:</strong> This prospective study included 96 newly diagnosed IBD patients. Patients from many primary health care centers covering the landscape of Kafr-Elshikh governorate in the North of Egyptian Nile delta after giving complete history, clinical examination, and laboratory investigation were referred to IBD clinic at Kafrelsheikh University Hospital for assessment and ileoclonoscopy with biopsies.<br /> <strong>Results: </strong>Seventy-eight (81.2%) patients were ulcerative colitis and 18(18.8%) were Crohn's disease, with mean age was 34.40 and 30.94 years respectively (P 0.380).FC, serum total proteins, ESR and HB level showed statistically significant difference between baseline levels and levels at time of remission. However, platelet count and serum albumin were not statistically different. The mean FC level at the time of diagnosis was 823.61±545.457μg/mg and after remission was 165.18±202.255μg/mg (P 0.000).<br /> <strong>Conclusion: </strong>Markers (FC, ESR, serum total proteins and HB level) can be used as non-invasive markers for monitoring IBD activity and severity in the primary health care centers. Fecal calprotectin correlate with endoscopic disease activity. Furthermore, the initial level of FC is a predictor of early dysplasia in ulcerative colitis patients .https://aeji.journals.ekb.eg/article_156370_3b7d48d87a4d550c8daccbc06502333a.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Primary Prophylaxis of Cardio-fundal Varices: A Comparative Study12012715648510.21608/aeji.2021.54879.1125ENMona MEl-KhwankyDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt. Ahmed FOmarDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt. Amira MSolimanDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt. Sahar AElnimrDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt. Mohamed MRefaeyDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt. Ahmed MEl-GebalyDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt. Journal Article20210105<strong>Background and study aims:</strong> Gastric varices (GV) are less frequent than esophageal varices (EV) and have a lower risk of bleeding. However, they are more prone to serious bleeding, often requiring more blood transfusions, and have a higher mortality rate. Our study assessed the comparative effectiveness of three modalities: endoscopic cyanoacrylate injection, non-selective beta-blockade and no primary prophylactic treatment.<br /> <strong>Patients and Method:</strong> Forty-eight cirrhotic patients with cardio-fundal varices were classified into three groups of16 patients each: group I: cyanoacrylate injected patients, group II: propranolol treated patients and group III: untreated patients. Upper gastrointestinal endoscopy was performed to establish the variceal status and repeated at 6-month intervals for 24 months to record of size of GV, appearance of EV, portal hypertensive Gastropathy (PHG) and occurrence of gastric variceal bleeding. Mortality rate was also recorded.<br /> <strong>Results: </strong>Gastric variceal bleeding and mortality rates in group I, II and III were 6.2% and 18.8%; 31.2% and 6.2%, 6.2% and 12.5% ( p= 0.194 and p= 0.761 respectively). All patients in group I had obliterated GV. The percentage of patients with large GV increased from 18.8 to 37.5% (p=0.055) in group II and from 25 to 56.2% (p=0.002) in group III. During follow up, EV appeared in 25% of patients in group I, 6%in group II and12% in group III (p=0.509).<br /> <strong>Conclusion: </strong>No significant difference in occurrence of gastric variceal bleeding or mortality rates among the three groups managed with cyanoacrylate injection, propranolol administration and observation without treatment .https://aeji.journals.ekb.eg/article_156485_c350ec04248872d2de9865fa20a2a026.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Potential Diagnostic and Prognostic Values of Hematological Biomarkers in COVID-19 12813315649810.21608/aeji.2021.52503.1120ENHamzullah KhanDepartment of Hematology, Nowshera Medical College, Nowshera/PGR HMC,
Peshawar 0000-0002-8184-5691Shahtaj KhanDepartment of Hematology, Hayatabad Medical Complex
Peshawar.Journal Article20201223<strong>Background and study aims:</strong> COVID-19 has spread around the globe in short span of time. We have been working as team to observe the pandemic since it hits our country and have been observing the different demographic, hematologic and inflammatory mediators that affect the outcome of the disease. To facilitate the clinicians working in isolation units and COVID-ICU, we tried to determine the clinical sensitivity of different hematological indices to predict the severity and mortality in COVID-19.<br /> <strong>Patients and Method:</strong> We did a cross sectional study covering 182 patients, 112(61.53%) males and 70(38.46%) females, who were tested COVID-19 positive in two tertiary care hospitals of Khyber Pukhtunkhwa (Qazi Hussain Ahmed Medical Complex Nowshera & Hayatabad Medical Complex Peshawar). Hematological markers were assessed for their diagnostic and prognostic values. Independent t-test was used in groups with different outcome (discharged satisfactorily vs expired) regarding hemoglobin concentration, neutrophil to lymphocyte ratio (NLR), absolute neutrophilic count (ANC) and platelet count.<br /> Receiver operating characteristics (ROC) curve was used as statistical tool to determine the relationship of clinical sensitivity and specificity of different hematological indicators to predict the worst outcome in COVID-19.<br /> <strong>Results: </strong>A statistically significant difference (p < 0.05) exists between the groups (discharged satisfactorily vs Expired) regarding NLR, ANC and platelet count. NLR is most reliable hematological prognostic indicator in COVID-19 to predict mortality/worst outcome with an area under curve (AUC) of 0.68 on ROC. The clinical sensitivity of hematological markers on ROC curve was: Hb%<11g/dl (59.1%), TLC>7.2k (75.9%), ANC >3.9% (86.2%), ALC1.8 (93.1%) and PLT <strong>Conclusion: </strong>The clinical sensitivity as measured by AUC for hematological markers i.e. NLR, ANC and platelet count is statistically significant and an abnormally elevated levels of hematological markers indicate the severity of the disease. Likewise leukocytosis, neutrophilia and lymphopenia, with high NLR and low platelet count are worst prognostic markers in COVID-19.https://aeji.journals.ekb.eg/article_156498_f03e6af80413c4d338e9808e01a917dd.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Prevalence of Parasitic Infections and Related Morbidity in Pediatric Patients on Regular Hemodialysis in Ain Shams University Pediatric Hospital, Cairo, Egypt 13414515679010.21608/aeji.2021.57107.1129ENMohammad ASharafDepartment of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine-
Ain Shams University, Cairo, Egypt.Ayman El-AshkarDepartment of Parasitology, Faculty of Medicine- Ain Shams University, Cairo,
Egypt.
Department of Basic Medical Science, College of Medicine, University of Bisha,
Bisha, KSA.0000-0003-4815-8731Ezzat IOmranDepartment of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine-
Ain Shams University, Cairo, Egypt.Ihab ZFElhakimDepartment of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine-
Ain Shams University, Cairo, Egypt.0000-0001-7453-1582Journal Article20210109<strong>Background and study aim:</strong> Opportunistic parasitic infections have been documented to cause serious complications among immunocompromised patients, including those undergoing hemodialysis (HD). Therefore, this study aimed to determine the prevalence of common parasitic infections and associated morbidity among the HD pediatric patients at Ain Shams University Pediatric Hemodialysis Unit.<br /> <strong>Patients and Methods:</strong> A comparative cross-sectional study was conducted on 50 HD patients and 20 apparently healthy individuals from January 2018 to March 2019. Stool samples were examined for parasites using direct smear, formol ether concentration, and staining with modified Ziehl- Neelsen stain. The serological analysis for anti-<em>Toxoplasma</em> IgM and IgG and complete blood count was performed. The results were correlated with the history, physical, and demographic data of the study groups.<br /> <strong>Results: </strong>The overall prevalence rate of intestinal parasitoses among patients with HD was a little bit higher than the control group (70% versus 60%, respectively) but this was statistically insignificant. <em>Blastocystis hominis</em> (30%), <em>Entamoeba histolytica</em> (28%), and <em>Giardia lamblia </em>(20%) were the most frequent among children with HD, with a statistically significant difference in <em>Blastocystis hominis</em> infection rates between patients and their counterparts. Moreover, the overall <em>Toxoplasma gondii</em> seroprevalence rate among patients with HD was (22%) and the anti-<em>Toxoplasma</em> IgM was (2%).<br /> <strong>Conclusion: </strong>The overall rate of opportunistic parasitic infections and related clinical symptoms in children with HD was slightly more frequent than in the control group. So, stool examination for intestinal parasites and <em>Toxoplasma gondii</em> screening should be incorporated into routine clinical care for children with HD.https://aeji.journals.ekb.eg/article_156790_92ee9e08e87f19bc5fb732245cdab69d.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Role of I-scan in Diagnosis of Duodenal Mucosal Lesions during Gastroduodenoscopy14615415784910.21608/aeji.2021.57087.1128ENMarwa AIbrahimDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt.0000-0002-8299-8497Kamal AElkashishyDepartment of Pathology, Faculty of Medicine, Zagazig University, Egypt.Samy EAbdelwahabDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt.Nabila HAhmedDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt.0000-0002-9953-5034Mohamed IRadwanDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt.Journal Article20210201<strong>Background and study aim:</strong> Duodenal mucosal lesions are usually difficult to diagnose. White light endoscopy(WLE) generally does not visualize the duodenal villous patterns properly and miss small elevated lesions, which result in an inaccurate diagnosis. We aimed to assess the diagnostic accuracy of I-scan technology for evaluation and histological confirmation of mucosal lesions in the duodenum and its role in biopsy targeting.<br /> <strong>Patients and Method:</strong> This was a single center, cross-sectional study. Patients with any indication for duodenal mucosa histological examination on conventional white light endoscopy WLE and I Scan imaging were included. A definitive diagnosis was determined by histopathology examination of the biopsied specimen.<br /> <strong>Results: </strong>In our study 41 patients were included (25 males, 16 females, mean age 39.9 years). The criterion-related validity of I-scan as a diagnostic test was 91.9% sensitivity, 75% specificity, 97.1% PPV and 50% NPV compared to white light endoscopy , which achieved 67.6% sensitivity, 75% specificity, 96% PPV and 20% NPV. I-scan achieved 95.1% accuracy, 97% specificity, 75% sensitivity in the diagnosis of celiac disease and detection of duodenal villous atrophy compared to WLE, which achieved 92.7% accuracy, 100% specificity, 25% sensitivity. There was a significant association between disease diagnosis by I-scan and presenting by abdominal pain (p < 0.026).<br /> <strong>Conclusion: </strong>I-scan represents a simple technique that helps in the diagnosis of duodenal mucosal lesions with high sensitivity, specificity and reduces false negative diagnosis; especially in patients who had abdominal pain.https://aeji.journals.ekb.eg/article_157849_4480c74305d428604ddc338c0ec0c23f.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Impact of Hepatitis C Viral Load in Chronic Kidney Disease Patients15516016455710.21608/aeji.2021.53057.1121ENWalid Ahmed RagabAbdelhamidDepartment of Internal Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, EgyptAlsayed AlnahalDepartment of Internal Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, EgyptAyman ZakiDepartment of Gasteroenterology, Alahrar Teaching Hospital, Zagazig, EgyptAyman FathyElsayedDepartment of Internal Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, EgyptJournal Article20201211<strong>Background and study aim:</strong> Chronic hepatitis C virus (HCV) infection is linked to chronic kidney disease (CKD) and hastens its progress to end-stage renal disease (ESRD). Previous studies have examined the association between chronic HCV and CKD and reported that HCV is correlated with proteinuria but not with low estimated glomerular filtration rate (eGFR) depending mainly on anti-HCV antibodies to diagnose chronic HCV infection. However, it is the HCV viral load to diagnose active HCV infection. Therefore, our study aimed to elucidate the relationship between HCV viral load and CKD.<br /> <strong>Patients/Material and Method:</strong> It’s a cross-sectional observational study that included 204 subjects that were classified into group 1 (90 chronic HCV patients without a history of chronic kidney disease) and group 2 (114 chronic HCV patients with a history of chronic kidney disease). All subjects underwent full history taking, medical examination, and laboratory investigation from May 2017 to May 2019.<br /> <strong>Results: </strong>In CKD patients, HCV viral load was correlated with age, platelet count, serum creatinine, eGFR, and serum bilirubin. Higher HCV viral load was one of the significant predictors of low eGFR in patients with chronic HCV infection in addition to the female sex, older age, lower hemoglobin, higher international normalized ratio, and higher alanine transaminase.<br /> <strong>Conclusion: </strong>There is a strong positive association between HCV viral load and serum creatinine in CKD patients. Higher HCV viral load carries a greater risk for lower eGFR in patients with chronic HCV infection .https://aeji.journals.ekb.eg/article_164557_296f9d19c1f6b4f563d40a919ad6d87e.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Comparison of B Type Natriuretic Peptide and Echocardiographic Findings among Patients with Various Stages of Liver Diseases16116915936210.21608/aeji.2021.55352.1126ENFawzi AttiaKhalilDepartment of Internal Medicine, Suez Canal University-Faculty Of Medicine, Egypt.Khalil AliKhalilDepartment of Internal Medicine, Suez Canal University-Faculty Of Medicine, Egypt.Ahmed Tag El-dinAbdallahDepartment of Cardiology, Suez Canal University-Faculty Of Medicine, Egypt. Wanees ShawkiGabraDepartment of Internal Medicine, Suez Canal University-Faculty Of Medicine, Egypt.Mohamed MahmoudAbdoDepartment of Internal Medicine, Suez Canal University-Faculty Of Medicine, Egypt.Journal Article20210119<strong>Background and study aim:</strong> Cirrhotic cardiomyopathy of cirrhotic patients without heart diseases is a chronic cardiac disorder with impaired cardiac contractility, responding to stress as well as altered diastolic relaxation. More studies are required to address unanswered questions, including consensus definition, particular diagnostic tests, exact prevalence of such syndrome in addition to proper management approaches. Herein, we aimed at determining prevalence regarding cirrhotic cardiomyopathy in our patients and improving early diagnosis of this syndrome.<br /> <strong>Patients and methods:</strong> 72 chronic liver disease (CLD) patients were recruited from gastroenterology department of Suez Canal University Hospital, Ismailia, Egypt. The patients were then divided into three main groups according to Child-Pugh criteria, and each group included 24 patients. All patients underwent a medical history assessment and clinical examination, laboratory investigations involving BNP levels, ECG in addition to echocardiography .<br /> <strong>Results: </strong>QTc interval prolongation was present in 56% of our decompensated cirrhotic patients. Diastolic dysfunction exhibiting different grades (grade I- II) was found in most cirrhotic patients (82%) in this study, while LT atrial dilatation with different grades (mild to severe) was found in 69% of patients. Increased Child-Pugh class was significantly associated (p-value <0.05) with cirrhotic patients holding ECG abnormalities, diastolic dysfunction, in addition to increased BNP levels and left atrial diameter.<br /> <strong>Conclusion: </strong>Herein, we demonstrated a statistically significant correlation in patients with cirrhosis between cardiac dysfunction and cirrhosis severity. BNP may be an early marker to identify cirrhotic cardiomyopathy's latent entity.https://aeji.journals.ekb.eg/article_159362_917fa8917d82aadf084e53eb9947dbd4.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Is Insulin-Like Growth Factor-I (IGF-I) efficient as a Diagnostic Biomarker in Differentiating Cholangiocarcinoma from Benign Biliary Obstruction?17017716607610.21608/aeji.2021.54056.1123ENSamar DarweeshHepato-gastroenterology and Endemic Medicine Department, Faculty of medicine, Cairo University, Cairo, Egypt.Fawzy AttiaDepartment of Internal Medicine, Faculty of Medicine, Suez Canal University,
Ismailia governorate, Egypt.Journal Article20210109<strong>Background and study aim:</strong> Cholangiocarcinoma (CCA) is a rarely curable cancer and is infrequently diagnosed early. There is a growing interest in evaluating CCA biomarkers in serum and bile. CCA cells express insulin-like growth factor-I (IGF-I) which modulates cell growth and reduces apoptosis. The aim of this study is to evaluate biliary and serum IGF-I as diagnostic biomarkers in patients with extrahepatic cholangio-carcinoma vs. benign biliary obstruction.<br /> <strong>Patients and Method:</strong> We conducted a prospective cross-sectional study on 60 patients with extrahepatic biliary obstruction divided into: CCA group (n=30) and benign obstruction (n=30). All patients had diagnostic and therapeutic ERCP with IGF-I assessment in serum and bile.<br /> <strong>Results: </strong>The CCA group mean age was significantly higher than the benign obstruction group (69.0±4.68 vs. 56.0±6.47years, p˂0.001). The etiologies of benign biliary obstruction were bile duct stones (n=18), benign stricture (n=11) and cholangitis (n=2). The mean biliary IGF-I in CCA patients was significantly higher (19-20 folds) than the benign biliary obstruction group (639.14±86.77 vs. 33.60±8.75, p˂0.001). The mean serum IGF-I in the CAA group was higher than the benign group, however, this was non-significant (223.06±76.53 vs. 198.34±38.74, p=0.192). Biliary IGF-I cutoff of 292.24ng/ml in CCA vs. benign group showed 100% sensitivity and specificity (AUC=1, p=<0.001). While a serum IGF-I cutoff of 236.32ng/mL in CCA vs. benign group showed a sensitivity/ specificity of 50%/80% respectively (AUC=0.614, p=0.081).<br /> <strong>Conclusion: </strong>Biliary but not serum IGF-I was an excellent marker in differentiating extrahepatic CCA from extrahepatic benign biliary obstruction with a 100% sensitivity and specificity. The diagnostic utility of serum IGF-I in biliary malignancies needs further study .https://aeji.journals.ekb.eg/article_166076_9e3316aabd0a1bd940eb18fbea217c75.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Evaluation of Liver Stiffness-Spleen Size-to-Platelet Count Ratio Score as a Risk Score for the Prediction of Oesophageal Varices in Compensated Cirrhotic Patients17818516625010.21608/aeji.2021.61381.1134ENHoda MohamedSalehDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig,
Egypt.Ahmed Lotfy SharafDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig,
Egypt.0000-0003-0318-0783Elsayed SaadAbd ElbaserDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig,
Egypt.0000-0001-9492-9707Journal Article20210306<strong>Background and study aims:</strong> The prevalence of gastro-esophageal varices (GOVs) in cirrhotic patients ranges from 40-80%.The most serious complication of cirrhosis is variceal hemorrhage since it has a mortality rate of 17-57%. Endoscopy is the standard test to detect GOVs. This study aimed at the evaluation of liver stiffness (LS)-spleen size-to-platelet count ratio score (LSPS) as a risk score for the prediction of esophageal varices (OVs) in patients with compensated liver cirrhosis.<br /> <strong>Patients and Method:</strong> This study included 51 patients with compensated cirrhosis. Screening upper endoscopy was done for the detection of OVs. They were also evaluated by transient elastography and laboratory tests, then divided according to the presence or absence of OVs. We compared both groups based on LSPS and platelet count splenic diameter ratio (PSR).<br /> <strong>Results: </strong>the LSPS ratio has sensitivity 87.88% and specificity 88.89% for prediction of OVs. Regarding Platelet count /Splenic diameter ratio the cut off value for the prediction of OV was 909.09 with sensitivity 87.9% and specificity 88.9%.<br /> <strong>Conclusion: </strong>PSR and LSPS provided good diagnostic tool for the prediction of esophageal varices in compensated cirrhotic patients.https://aeji.journals.ekb.eg/article_166250_148cab515f350a17ee0465f75abcbee7.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Doppler Ultrasound and Fibroscan Parameters Versus Liver Biopsy in Evaluation of Hepatic Fibrosis in Egyptian Patients with Chronic Hepatitis C18619817232810.21608/aeji.2021.55780.1127ENNadia ElwanDepartment of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta,
Egypt.Manal HemisaDepartment of Diagnostic Radiology, Tanta University, Tanta, Egypt.Hanan SolimanDepartment of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta,
Egypt.0000 0001 5099 6158Mohammed ElhendawyDepartment of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta,
Egypt.Shimaa SolimanDepartment of Public Health and Community Medicine, Menoufia University Faculty
of Medicine, Menoufia, Egypt .Nehad HawashDepartment of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta,
Egypt.Rehab BadawiDepartment of Public Health and Community Medicine, Menoufia University Faculty
of Medicine, Menoufia, Egypt .Journal Article20210312<strong>Background and study aim:</strong> Liver biopsy is the gold standard method to assess hepatic inflammation and fibrosis in chronic hepatitis C infection (HCV). The non-invasive assessment of liver fibrosis is the key target that has inspired many new methods because of the limitations of liver biopsy. The aim of the work was to improve the efficiency of non-invasive liver fibrosis assessment in Egyptian patients with chronic hepatitis C by comparing Doppler ultrasound (US) of hepatic blood flow and fibroscan with liver biopsy.<br /> <strong>Patients and Method:</strong> In this retrospective analysis, 78 patients with HCV had already undergone liver biopsies as part of work panel prior to HCV treatment. Fibroscan examination, abdominal ultrasonography and Doppler ultrasound were done to the patients by experienced operators.<br /> <strong>Results: </strong>There was a strong positive correlation between the degree of liver fibrosis by fibroscan and the degree of inflammation in the histopathological analysis. Receiver Operator Characteristic (ROC) curve analysis revealed that fibroscan failed to detect FII fibrosis. However, fibroscan was more accurate in detecting FIII fibrosis.The Doppler ultrasound parameter ROC curve analysis, the portal vein blood flow volume (PVBFV) was shown to be more accurate in detecting lower grades of fibrosis than higher.<br /> <strong>Conclusion: </strong>For detection higher degrees of fibrosis, Fibroscan has a strong match with liver biopsy; however, Doppler US is more sensitive in detecting lower grades of fibrosis in patients infected with HCV .https://aeji.journals.ekb.eg/article_172328_7f60c61fe6d0eb8d502744681d5fe2cf.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Safety and Efficacy of Sofosbuvir Based Regimens in Treating Chronic Hepatitis C Virus in Egyptian Patients: Real World Study: Single Center Experience19920717409410.21608/aeji.2021.76041.1148ENMohamed AbbasyDepartment of Hepatology, National Liver Institute, Menoufia University, EgyptTamer Abou ElelaDepartment of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, EgyptOlfat HendyDepartment of Clinical Pathology, National Liver Institute, Menoufia University, Egypt.Omkolsoum Al-HaddadDepartment of Hepatology, National Liver Institute, Menoufia University, EgyptEhab DarwieshDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, EgyptTary SalmanDepartment of Hepatology, National Liver Institute, Menoufia University, EgyptTalaat ZakareyaDepartment of Hepatology, National Liver Institute, Menoufia University, EgyptJournal Article20210511<strong>Backgroundand study aims:</strong>Hepatitis C virus (HCV) is the main leading cause of liver disease in Egypt. A new era of HCV treatment has been started with the evolution of direct acting antiviral agents. Sofosbuvir (SOF)-based therapy was introduced by the Egyptian ministry of health in 2014 in an attempt to decrease disease burden. We aimed to evaluate efficacy and safety of Sofosbuvir-based regimens in HCV Egyptian patients with compensated liver disease.<br /> <strong>Patients and Method:</strong>This study was conducted in National Liver Institute, MenoufiaUniversity, Egypt. Seven hundred patients out of seven hundred fifty-eight chronic HCV patients with compensated liver disease who met the inclusion criteria were included. According to treatment regimen patients were divided to 4 groups; group 1 received Sofosbuvir (SOF), Pegylated interferon (PEG-IFN) plus ribavirin (RBV), group 2 received SOF plus RBV, group 3 received SOF and Simeprevir± RBV, group 4 received SOF and Daclatasvir ±RBV.<br /> <strong>Results:</strong>The overall SVR was 90.9%, 81.5%, 95% and 98% in groups 1, 2, 3, and 4 respectively. SVR in patients with liver cirrhosis was 90.56, 79.16, 95 and 96% in the 4 groups respectively. In treatment experienced patients, SVR was 86.8% in group 1, 78.3% in group 2, 100% in group 3 and 86.7% in group 4.<br /> <strong>Conclusion: </strong>Sofosbuvir plus daclatasvir with or without ribavirin is the safest andmost effective SOF-based regimen in treatment of HCV Egyptian patients with compensated liver disease.https://aeji.journals.ekb.eg/article_174094_b142ce97b734e39d4f2f4de4b3d13c40.pdfZagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-761311220210601Association between Insulin-Like Growth Factor- 1 and Severity of Liver Disease in Patients with Liver Cirrhosis 20821517409510.21608/aeji.2021.61888.1136ENNaglaa El-ToukhyDepartment of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Benha University, EgyptMohamed Abd El-HamedKhidrDepartment of Clinical and Chemical Pathology, Faculty of Medicine, EL Azhar University, EgyptMona YoussefDepartment of Hepatology, Gastroenterology and Infectious Diseases, Benha
Teaching Hospital, Egypt.Journal Article20210306<strong>Background and study aim:</strong> Liver cirrhosis is the end result of chronic liver disease and it is a dynamic process that needs close monitoring to prevent its progression and complications. Insulin-like growth factor-1 (IGF-1) is an anabolic hormone secreted mainly by the liver. The aim of this study was to evaluate the serum IGF-1 level and its association with the severity of liver disease in patients with liver cirrhosis.<br /> <strong>Method:</strong> This study was conducted on 85 patients with liver cirrhosis. Child's classification, MELD, uMELD and IGF-1 were assessed in all patients.<br /> <strong>Results: </strong>The studied patients were 45 males and 40 females. Their mean age was 45.25±5.88 ranging from 34-60 years. As regard the severity of liver disease 70.59% of patients were Child C, 16.47% were Child B and 12.94% were Child A. The mean value of IGF-1 was significantly lower in Child C (35.09± 7.74 ng/ml) cirrhotic patients than Child B (123.5±41.35 ng/ml) and Child A (249.82±49.11 ng/ml) patients. Also, IGF-1 was significantly lower in patients with MELD score > 17 and uMELD > 4.18. Applying the ROC curves to assess IGF-1 as a marker of liver disease severity according to Child's, MELD and uMELD scores at IGF-1 cutoff value of 69.5 µg/ml, 196 µg/ml,196 µg/ml and AUCs were 0.9840, 0.7046, 0.8991 respectively. IGF-1 is negatively correlated with the severity of liver disease.<br /> <strong>Conclusion: </strong>IGF-1 could be used to assess the severity of liver disease in patients with liver cirrhosis.https://aeji.journals.ekb.eg/article_174095_cd57467525d20b2cd2f714182faa70b8.pdf