Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76138120180301Nutritional Status and Informational Needs for Patients with Liver Cirrhosis114867210.21608/aeji.2018.8672ENLamiaa ZakiAhmedNursing, Faculty of Nursing, Zagazig University,Egypt.Nadia MohamedTahaMedical Surgical Nursing, Faculty of Nursing, Zagazig University,Egypt.Mohamed El-khashabTropical medicine Department, Faculty of medicine, Zagazig University,Egypt.Eman ElsayedHusseinMedical Surgical Nursing, Faculty of Nursing, Zagazig University,Egypt.Journal Article20180704<strong>Background and study aim: </strong>Malnutrition is as an important complication of liver cirrhosis with prognostic implications; a marked knowledge gap exists concerning the information needs of liver cirrhosis patients. The aim of this study is to assess nutritional status and informational needs for patients with liver cirrhosis.
<strong>Subjects and Methods: </strong>A descriptive exploratory design was used in this study.<strong> </strong>The present study conducted in tropical medicine and gastroenterology units at Zagazig University Hospitals, A purposive sample of<strong> </strong>115<strong> </strong>patients, The study lasted from the beginning of October 2016 to the end of May 2017 .Three tools were used for collection of data, first tool was a structured interview questionnaire consisted of personal characteristics of patients, second tool was nutritional assessment form, third tool was informational needs questionnaire.
<strong>Results: </strong>The study findings revealed that more two third of studied patients were in the age group of less than Session [CurrentTestPartID] years with mean age 53.4±9.3 years, the majority of studied patients were in malnutrition (73.9%). By Subjective Global Assessment (SGA), there are strong correlation between SGA and Child Pugh score, the most important informational needs among the studied patients were medical domains 84.4%. In contrast, psychological domains achieved the least important 27.0%.
<strong>Conclusion: </strong>It can be concluded that patients with liver cirrhosis are suffering from malnutrition and nutritional deficiencies, and also patient with liver cirrhosis had different levels of informational needs. The most prioritized informational needs for patients with liver cirrhosis was Medical domain whereas the least priority was given to the Psychological domain. It also shows that information needs differ based on some socio-demographic and clinical characteristics and physical condition.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76138120180301Mean Platelet Volume and Mean Platelet Volume/Platelet Count Ratio as Diagnostic Markers for Hepatocellular Carcinoma in Chronic Hepatitis C Patients1523873110.21608/aeji.2018.8731ENMaha ZOmarDepartment of Hepatology ,Gastroenterology and Infectious Diseases, faculty of Medicine, Benha University , EgyptMohebat HGoudaDepartment of Pathology, faculty of Medicine, Benha University , EgyptMona MElbehisyDepartment of Clinical Pathology, faculty of Medicine, Benha University , EgyptJournal Article20180706<strong>Background and study aim: </strong>Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. AFP is the gold standard tumor marker for HCC, mean platelet volume (MPV) is a parameter obtained from complete blood count (CBC) by automated analyzers, shown to be increased in multiple malignancies and inflammatory conditions.This prospective study was designed to evaluate the diagnostic usefulness of MPV and MPV/ platelet count (PC) ratio in HCC patients due to chronic hepatitis C (CHC) infection.<br /> <strong>Materials and Methods: </strong>One hundred and twenty subjects enrolled in this study, they were divided into 4 equal groups: group I included 30 healthy subjects (control group), group II included 30 patients with chronic viral hepatitis without cirrhosis, group III included 30 cirrhotic patients without HCC and group IV included 30 cirrhotic patients with HCC.MPV, MPV/PC ratio & AFP were evaluated in all groups. Triphasic CT was done for patients of group IV to confirm the diagnosis of HCC. Liver biopsy was done for patients of group II to confirm the diagnosis of chronic hepatitis C<strong>.</strong><br /> <strong>Results: </strong>MPV showed higher levels in HCC group compared to control, CHC, and cirrhotic groups with p value(<0.001) but there was no statistically significant difference between HCC group and cirrhotic group (p value=0.49), while MPV/platelet count ratio was higher in cirrhotic group (0.19±0.09 fL/ 10<sup>9</sup>/L) than HCC group (0.14±0.08 fL/10<sup>9</sup>/L) but also with no significant differences between both groups (p=0.06). There was insignificant positive correlation between MPV and AFP in HCC group ( Session [CurrentTestPartTermID];= 0.11 and p value =0.57). Also, there was insignificant negative correlation between MPV/PC and AFP in HCC group ( Session [CurrentTestPartTermID];= -0.17 and p value =0.37). In receiver operating characteristic (ROC) curve analysis, MPV had high sensitivity (73.33%), specificity (70 %), and area under curve (AUC) was 0.7, So it more better than MPV/platelet count ratio in diagnosis of HCC which had sensitivity (76.67%), low specificity (56.67%), and AUC was 0.63, while AFP had much higher sensitivity (90%), specificity (98.33%) than both studied parameters (MPV, MPV/PC ratio) with highly statistically difference when compared to MPV (p<0.001) and area under curve (AUC) was 0.9<strong>.</strong><br /> <strong>Conclusion: </strong>MPV and MPV/PC ratio are less sensitive and specific than AFP in diagnosis of HCC. So AFP is still the gold standard marker in diagnosis of HCC and MPV and MPV/PC ratio may be used only in association with other markers like AFP to improve sensitivity of tumor detection.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76138120180301An Overview Study of Malaria Infection in Almaza Military Fever Hospital; An Egyptian Pilot Study2433873210.21608/aeji.2018.8732ENRunia FouadEl-FollyDepartment of Tropical Medicine, Faculaty of Medicine, Ain Shams University, Cairo, Egypt.Amr MohamedEl-Sayedartment of Infection, Military Medical Academy, Cairo, EgyptMohamed Ezz ElarabDepartment of Hepatology and Gastroenterology, Internal Medicine Department, Ahmed Maher Educational Hospital, Cairo, Egypt.Journal Article20180706<strong>Background and study aim:</strong> Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female <em>Anopheles</em> mosquitoes.The aim of this study <strong> </strong>is to study the clinical presentations and outcomes of malarial infected cases attending Almaza Military Fever Hospital in Cairo.
<strong>Patients and Methods: </strong>Fifty patients with malarial infection were selected from those admitted to Almaza Military Fever Hospital. The following investigations were done for all cases; (CBC), liver and renal function tests, serological tests (rapid diagnostic test for serum malarial antigens & microscopic examination of peripheral blood film) and abdominal US.
<strong>Results: </strong>The majority of cases (76%) was already diagnosed and was coming from Peace Keeping Mission Forces in Africa. Congo was the most malaria-infected place (36%), then Ivory Coast (26%). Most of cases (80%) had intermittent fever. Six patients (12%) were admitted at ICU. The thick film method was the most sensitive diagnostic test (98%). <em>P. falciparum</em> was the commonest species among cases (80%) then <em>P. ovale</em> (20%). The best response in studied cases was poly-therapy (84%) while mono-therapy was effective in only 5 patients (10%), (82%) of cases were cured, one patient died and one patient had a relapse while 2 patient (4%) had recurred.
<strong>Conclusion: </strong>Thick film is the most sensitive and informative test among diagnostic test modalities. Combined therapy (polytherapy) is preferable than monotherapy.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76138120180301A study of the Role of 25 Hydroxy-Cholecalciferol Level on Non Alcoholic Fatty Liver Disease (NAFLD) in a Cohort of Egyptian Patients3440873310.21608/aeji.2018.8733ENElsayed SaadAbd ElbaserTropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.Journal Article20180706<strong>Background and study aim: </strong>Epidemiological and experimental data correlated hypovitaminosis D to the pathogenesis of NAFLD. So, the aim of this study was to evaluate the role of vitamin D in NAFLD patients with hypovitaminosis D.
<strong>Patients and Methods: </strong>We studied 78 consecutive patients with biopsy-proven NAFLD. Patients were divided into 2 groups according to serum level of 25 (OH) D; group I; have deficient 25 (OH) vitamin D (<50nmo/L) and group II; have sufficient 25 (OH) vitamin D (50-70 nmol/L). Liver injury profile (ALT, AST), lipid profile (LDL, HDL and triglycerides), inflammatory marker (CRP) as well as histopathological assessment according to NAS scoring were evaluated at baseline. Vitamin D supplementation for Session [UserIDID] weeks was given for both populations with follow up evaluation of laboratory parameters at the end of the study.
<strong>Results: </strong>Patients with deficient 25 (OH) vitamin D levels had significantly more severe NAFLD than those with sufficient<strong> </strong>25<strong> (</strong>OH) vitamin D levels at baseline. After Session [UserIDID] weeks of high dose vitamin D supplementation there was significant improvement in lipid profile (LDL, HDL, and triglycerides), hepatic transaminases (ALT, AST) and CRP in NAFLD patients with hypovitaminosis D, but no significant changes in NAFLD patients with sufficientvitamin D.
<strong>Conclusion: </strong>Correction of hypovitaminosis D may have beneficial effects on NAFLD in patients with moderate to severe activity but no effects in case of sufficient vitamin D.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76138120180301Risk of Ischemic Heart Disease in Patients with Non-alcoholic Fatty Liver Disease4147873410.21608/aeji.2018.8734ENMostafa SolimanElkadyDepartment of Hepatology, Gastroenterology, and Infectious Diseases,Faculty of Medicine, Benha University,EgyptHatem SamirEl-RaoufDepartment of Hepatology, Gastroenterology, and Infectious Diseases,Faculty of Medicine, Benha University,EgyptHany RaghebElkholyDepartment of Hepatology, Gastroenterology, and Infectious Diseases,Faculty of Medicine, Benha University,EgyptBadawy Abdul KhalekAbdul AzizDepartment of Hepatology, Gastroenterology, and Infectious Diseases,Faculty of Medicine, Benha University,EgyptWael AhmedMakladDepartment of Cardiology, Benha Teaching Hospital, Benha, EgyptAhmed Abd El-AllahTurkeyDepartment of Radiology, Faculty of Medicine Benha University, Benha, EgyptHayam Abd EL-HameedEl-sayedDepartment of Hepatology, Gastroenterology, and Infectious Diseases,Faculty of Medicine, Benha University,EgyptJournal Article20180706<strong>Background and study aim: </strong>Non-alcoholic fatty liver disease (NAFLD) has an increasing prevalence worldwide. It has also been closely associated with obesity and metabolic syndrome - two conditions known to be associated with ischemic heart disease (IHD). The aim of this study was to assess the association between NAFLD and ischemic heart disease.
<strong>Subjects and Methods: </strong>140 patients with NAFLD and 70 non-NAFLD subjects were selected. Full history taking, clinical examination and laboratory tests including blood sugar, lipid profile and liver profile were done. Ultrasonography was performed to prove NAFLD while ECG and echo-cardiography were used for detection of myocardial ischemia.
<strong>Results: </strong>Of the NAFLD group, the frequency of mild, moderate and severe NAFLD was 42.9%, 30% and 27.1% respectively. Subjects with NAFLD had a significantly higher BMI, waist circumference and weight compared to those of non NAFLD group (p=0.014, 0.0218 and <0.001 respectively). Independent risk factors for NAFLD were obesity, DM, high LDL, low HDL, waist circumference, glycated hemoglobin and IHD with odds ratios 1.09, 2.12, 1.01, 1.15, 1.13, 1.37 and 1.17 respectively. While independent risk factors for IHD included obesity, DM, high LDL, total cholesterol, triglycerides and the presence of NAFLD with odds ratios 1.31, 1.23, 1.19, 1.132, 1.68 respectively.
<strong>Conclusion: </strong>NAFLD was independently associated with increased risk of myocardial ischemia<strong>.</strong>Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76138120180301Role of Hepatitis C Virus Core Antigen Assay in Blood Donors Screening at Zagazig University Hospitals4854873510.21608/aeji.2018.8735ENRashed MHassanTropical Medicine Department ,Faculty of Medicine ,Zagazig University ,Zagazig ,EgyptAbdelmonem MElshamyTropical Medicine Department, Faculty of Medicine,Zagazig University, Zagazig, Egypt.Sameh MAbdel MonemTropical Medicine Department, Faculty of Medicine,Zagazig University, Zagazig, EgyptEmad AMoustafaTropical Medicine Department, Faculty of Medicine,Zagazig University, Zagazig, EgyptEssam AWahabInternal Medicine Department, Faculty of Medicine,Zagazig University, Zagazig, Egypt.Journal Article20180706<strong>Background and study aim: </strong>Hepatitis C virus (HCV) infection is a major public health problem worldwide. Blood donations screening achieved mainly by serological identification of HCV-Antibody (Ab), has largely reduced HCV transmission. HCV Core Antigen (CAg) tests have been introduced to supplement anti-HCV tests and HCV PCR analyses. CAg may be a useful screening test for identifying window phase of HCV infected patients whom are candidate for blood donations. The study aimed to evaluate diagnostic performance of HCV core antigen in comparison to HCV-RNA quantification and anti-HCV-Ab analyses in attendances of blood bank of Zagazig University hospitals.
<strong>Patients and Methods: </strong>The study was performed on 92 participants attending the blood banks of Zagazig University Hospitals for blood donation between May 2015 to November 2017. The participants were classified into two groups; group A, which included 46 donors (32 males and 14 females) with negative HCV antibody and group B, which Included 46 patients (30 males and 16 females) with positive HCV antibody. Clinical assessment, HCV AB detection by ELISA, Prototype ELISA for HCV core antigen for presence of HCV core antigen and HCV RNA Quantitative were done for all participants.
<strong>Results: </strong>No significant differences between both studied regarding sex and age. A high significant relation between HCV AB positivity and negativity as regard HCV PCR was found in both groups. A high significant relation between HCV core antigen positivity and negativity as regard HCV PCR. There was high significant relation between HCV core antigen positivity and HCV PCR in group A patients. There was a high significant relation between HCV core antigen positivity and HCV PCR in positive HCV antibody patients and statistically a high significant relation between HCV core antigen negativity and HCV PCR in group B patients.
<strong>Conclusion: </strong>HCV core Ag can be identified by serological ELISA. This assay is cheap, easily performed, and compatible with HCV PCR. Its application may prevent the vast majority of HCV transmissions caused by the transfusion of window phase donations.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76138120180301Assessment of Alpha-1-Acid Glycoprotein as a new Biomarker for Hepatocellular Carcinoma5561873610.21608/aeji.2018.8736ENBadawy AAbdul AzizDepartment of Hepatology, Gastroenterology and Infectious diseases, Faculty of Medicine,Benha University, Egypt.Maha Zein-ElabedinOmarDepartment of Hepatology, Gastroenterology and Infectious diseases, Faculty of Medicine,Benha University, Egypt.Abdelmoneam AhmedDepartment of Internal Medicine, Faculty of Medicine, Benha University, Egypt.Medhat AKhalilDepartment of Internal Medicine, Faculty of Medicine, Benha University, Egypt.Amira MNAbdelrahmanDepartment of Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Egypt.Journal Article20180706<strong>Background and study aim: </strong>The outcome of patients with hepatocellular carcinoma (HCC) remains poor because of late diagnosis. We aimed to evaluate the performances of serum alpha -1-acid glycoprotein (AAG) for the diagnosis of HCC, especially for HCC with low alpha-fetoprotein (AFP).
<strong>Patients and Methods: </strong>Ninety patients included in this study, Session [CurrentTestPartID] had HCC, and 30 (50%) of these were AFP low HCC (AFP ≤20 ng/mL). The remaining 30 patients were chronic hepatitis C and cirrhosis without HCC as control group. Plasma AAG was analyzed using quantitative enzyme immunoassay technique.
<strong>Results: </strong>Serum level of AAG was significantly elevated in low AFP HCC group compared with high AFP HCC and cirrhotic without HCC group, 1307.20 ± 9627 vs (850.82 ± 795.14 and 309.77± 220.17 respectively). Receiver operating characteristic (ROC) curve showed that the best cut off for AAG and AFP was 740 μg/ml and 20 ng/mL respectively. The area under the curve of AAG was significantly higher than that for AFP (0.95 vs 0.92) respectively. AAG at a cut-off value of 740 μg/ml provides higher sensitivity (73.3% vs 62%, respectively) and specificity (74.0%, and 71%, respectively) in low AFP HCC than high AFP HCC
<strong>Conclusion: </strong>The role of AFP in the diagnosis of HCC is limited; AAG had better performance in diagnosing HCC patients with low AFP. So Serum level of AAG might be used as a potential diagnostic marker for hepatocellular carcinoma.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76138120180301Fecal Calprotectin in Patients with Hepatic Encephalopathy6267873710.21608/aeji.2018.8737ENAmany LashinHepatology, Gastroenterology and Infectious Diseases Department, Benha University, EgyptTamer EEl-ErakyHepatology, Gastroenterology and Infectious Diseases Department, Benha University, EgyptWaleed Al AzabNeuropsychiatry Department, Benha University, EgyptAmira Nour EldinClinical Pathology Department, Benha University, EgyptAhmed Abd AlmaksoudAmerHepatology and Gastroenterology Unit, El Helal Hospital, Ministry of Health, EgyptJournal Article20180706<strong>Background and study aim: </strong>Cal-protectin is a cytoplasmatic protein of neutrophilic granulocytes and it is an established marker for the assessment of localized intestinal inflammation .Bacterial translocation is known to play an important role in the pathogenesis of certain complications of cirrhosis such as hepatic encephalopathy (HE). This study amid to assess: the value of fecal calprotectin in the diagnosis of hepatic encephalopathy, relationship between level of fecal calprotectin and the degree of hepatic encephalopathy.
<strong>Patients and Methods: </strong>This cross sectional study was conducted on 90 patients attended to the Hepatology, Gastroenterology and Infectious Diseases Department of Benha University Hospital between March and July 2016. All medical diseases which are known to influence the level of fecal calprotectin were excluded (as: gastro-intestinal bleeding or inflmmatory bowel disease). The degree of liver insufficiency was assessed according to the Child Pugh classifiation and Model of End Stage Liver Disease (MELD); and degree of hepatic encephalopathy by West-Haven criteria, and the number connection test.
<strong>Results: </strong>The mean value of fecal calprotectin in patients with overt HE was 304.4 ± 41.05 μg/g, and in patients with MHE was 74.4 ± 23.9 μg/g and in the group of liver cirrhosis without encephalopathy was 57.55± 8.92 and in healthy group was 25.22 ± 8.63, respectively with high significant difference (p<0.001). There was no significant correlation between fecal calprotectin and (age, psychometric test, Child-Pugh classification, MELD score and West-Haven criteria).
<strong>Conclusion: </strong>This study confirmed significantly higher values of fecal calprotectin in patients with hepatic encephalopathy. Among patints with OHE and patients of MHE, no significant correlation between fecal calprotectin and age, psychometric test, Child classification, MELD score and West-Haven criteria were detected.