Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76135220150620Percutaneous injection of Acetic Acid and Mitoxantrone Versus Radiofrequency Ablation in Treatment of Hepatocellular Carcinoma53611781310.21608/aeji.2015.17813ENEmad AMoustafaTropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.Ibrahim MHegazyTropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.Rashed MHassanTropical Medicine Department, Faculty of Medicine, Zagazig University, EgyptNashwa ENawarClinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Zagazig University, EgyptMostafa HEl-ShamyTropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.Soha AElhawariTropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.Journal Article20150603<strong>Background and study aim :</strong>Hepatocellular carcinoma (HCC) is currently the fifth most common solid tumor worldwide and the third leading cause of cancer-related death. New therapeutic choices have been developed for HCC, including percutaneous ablation therapy, transarterial chemoembolization and molecular target therapy. Percutaneous acetic acid injection (PAI) and radio-frequency ablation (RFA) techniques became well-known procedures for controlling small HCC.The aim of this study was to compare the outcomes of per-cutaneous combined PAI and mitoxantrone injection versus RFA in the treatment of HCC..
<strong>Patients and Methods:</strong>This prospective study was conducted on 120 patients with 120 focal nodular HCCs of 4 cm or less between 2012 and 2014. They were randomly divided into 2 groups, the first group included 60 patients treated with PAI plus percutaneous intratumoral injection of mitoxantrone, and the second group included 60 patients treated with radio-frequency ablation. Clinical assessment, laboratory evaluation and triphasic CT studies were performed to all patients pre-treatment and at 1,3,6 and 12 months post treatment and complications were recorded.
<strong>Results:</strong> The percentage of ablation in both groups at 1, 3, 6 and 12 months were 85%, 83.33%,78.34 and 73.33% in group I versus 88.33%, 88.3%, 85% and 81.66% in group II respectively with no statistical significant difference between the two groups. Percentage of ablation in small tumors was higher than large tumors in both groups. Side effects and complications are statistically higher in group II than group I.
<strong>Conclusion:</strong> Combination of PAI and Mitoxantrone is comparable to radiofrequency ablation in treatments of HCCs with less frequent complications.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76135220150621Study of TUBEX as a Rapid Diagnostic Test of Typhoid Fever62681781410.21608/aeji.2015.17814ENGamal SaadEl-DeebTropical Medicine Department , Faculty of Medicine , Menoufia University,EgyptHosam El-Din MostafaSeleemTropical Medicine Department , Faculty of Medicine ,Menoufia University,EgyptGehan Abd El-FatahTawfeekClinical Pathology Department ,Faculty of Medicine ,Menoufia University ,EgyptSameh SalahEmaraShebin El-Kom Fever Hospital ,Shebin El-Kom, EgyptJournal Article20150603<strong>Background and study aim :</strong> Several serologic tests for typhoid fever have been introduced which detect IgM or IgG antibodies to various purified antigens of S. Typhi as TUBEX test. This study aims to evaluate the performance of TUBEX test as a rapid diagnostic test of typhoid fever. .
<strong>Patients and Methods:</strong>The present study involved 44 patients admitted to Shebin El Kom Fever Hospital fulfilling the criteria of typhoid fever by WHO as (suffering from continuous fever at least 2 days, greater than 38.5°C in addition to headache, constipation or diarrhea) without identified cause of fever as pneumonia. Compared with 20 subjects; 10 with non specific fevers and 10 without fever using TUBEX test in correlation to the usual Widal test and blood culture as a gold standard.
<strong>Results:</strong> We revealed sensitivity, specificity, positive predictive value and negative predictive value respectively for Widal; 75%, 60%, 80.5%, 52.2% and for culture; 65.9%, 100%, 100%, 57.1%. In correlation with TUBEX test the results are at cutoff point 5 showing sensitivity, specificity, positive predictive value and negative predictive value respectively; 84.1%, 95%, 97.4% and 73.1%.
<strong>Conclusion:</strong> TUBEX results are superior to Widal test results in specificity and slightly in sensitivity as compared to the blood culture as a reference test.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76135220150625Antinuclear Antibody Positivity in Chronic Hepatitis C Patients: Effect on Histopathology and Impact on Early Response to Combined Antiviral Therapy69771781510.21608/aeji.2015.17815ENYehia SYounesHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Benha University,Egypt.Yasser ShaheenHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Benha University,Egypt.Hala El FekyHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Benha University,Egypt.Maha OmarHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Benha University,Egypt.Rasha SHEldesoukyCommunity Medicine Department, Faculty of Medicine, Benha University,Egypt.Rania ZAmerPathology Department, Faculty of Medicine, Benha University,Egypt.Rania IMabroukShebin El-Kom Teaching Hospital , Shebin El-Kom,EgyptJournal Article20150603<strong>Background and study aim :</strong> The prevalence of antinuclear antibody (ANA) has been documented in patients with hepatitis C virus (HCV) infection. Hepatitis C virus infection plays an important role in the pathogenesis of immunological derangement, but the mechanism remains unclear. The aim of this study is to detect the significance of ANA positivity and its impact on histopathology and early virological response (EVR) to combined antiviral therapy in chronic HCV patients. .
<strong>Patients and Methods:</strong>Two hundred Egyptian chronic HCV naïve patients were enrolled in this study. Antinuclear antibody (ANA) was detected by ELISA and it was considered positive with a titer > 1 : 14 by indirect immunofluorescence. Complete laboratory investigations and histological examination were done as a pretreatment work up for all patients. Patients were followed up during treatment and EVR was assessed in ANA positive and negative patients.
<strong>Results:</strong> There was a statistically significant difference between ANA positive and negative patients regarding viral load and histopathological criteria and no significant difference was detected regarding other demographic and laboratory criteria. EVR was close in ANA positive and ANA negative patients (77 for the former Vs. 80 for the later with P = 0.33). No autoimmune manifestations were detected during treatment among positive cases. Except for ALT & AST levels no statistically significant differences were detected between ANA positive and negative cases regarding haematological data, thyroid dysfunction. BMI, ALT levels, viral load and fibrosis stages were independent predictors of EVR.
<strong>Conclusion:</strong> ANA postivity in chronic HCV patients was associated with advanced fibrosis but didn't affect treatment response.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76135220150629Study of the Relationship between Blood Ammonia Level and Esophageal Varices in Patients with Liver Cirrhosis78851781610.21608/aeji.2015.17816ENAtef Abo-AlsoudAliTropical Medicine department, Faculty of Medicine, Menoufiya University ,EgyptAmira MaherBadawyTropical Medicine department, Faculty of Medicine, Menoufiya University ,EgyptAhmed Abdel-RahmanSonbolClinical Pathology department, Faculty of Medicine, Menoufiya University,EgyptMohammed ElsayedAyadShebin Elkom Teaching Hospital ,Shebin Elkom ,EgyptJournal Article20150607<strong>Background and study aim :</strong> Portal hypertension leads to formation of portosystemic collateral veins as oesophageal varices in patients with liver cirrhosis. Several studies have shown that blood ammonia is a vauable non invasive marker of oesophageal varices. This study is designed to evaluate the possible relation between blood ammonia level and oesophageal varices in patients with liver cirrhosis. .
<strong>Patients and Methods:</strong> This study was conducted on three groups of patients and control subjects. Group I included 20 cirrhotic patients without evidence of oesophageal varices. Group II included 40 cirrhotic patients with evidence of varices. Group III included 20 healthy control subjects. Serum level of ammonia were done for all patients and control subjects.
<strong>Results:</strong> There was a highly significant increase in the mean values of blood ammonia in cirrhotic patients with varices in comparison to other patients without varices, with highly significant positive correlation between serum ammonia and size of varices. There was a significant increase in the mean values of blood ammonia in cirrhotic patients with grade III and IV varices [large varices) in comparison to cirrhotic patients with grade I and II varices.
<strong>Conclusion:</strong>Blood ammonia level is a valuable, simple non invasive marker for prediction of oesophageal varices.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76135220150619Study of the Pattern of Brucellosis in Menoufyia Governorate86931781710.21608/aeji.2015.17817ENAtef Abo EL-SoudAliTropical Medicine Department, Faculty of Medicine, Menoufiya University ,EgyptAyman MohammedEl-LehlehTropical Medicine Department, Faculty of Medicine, Menoufiya University ,EgyptSomaia Abd El-MohsenShehab El-DeenTropical Medicine Department, Faculty of Medicine, Menoufiya University ,EgyptAmira Abd El-KaderEl-HendyClinical Pathology Department, Faculty of Medicine, Menoufiya University, EgyptEL Sayed MahmoudMohammed MousaTropical Medicine Department, Faculty of Medicine, Menoufiya University ,EgyptJournal Article20150602<strong>Background and study aim :</strong> ELISA can determine specific antibody classes against brucella, It is a sensitive, simple and rapid test, thus help to study the pattern of the brucellosis. The aim of this article is to study the pattern of the brucellosis in Menoufyia governorate. .<br /> <strong>Patients and Methods:</strong> Sera from 150 individuals from confirmed brucellosis cases and 25 healthy individuals were tested for presence of IgG and IgM antibodies by ELISA assay. Culture positivity for brucellosis was used as the reference standard for diagnosis.<br /> <strong>Results:</strong> Serum IgG and IgM for brucellosis by ELISA test had increased values in confirmed brucella cases, ELISA IgM was highly specific (100%) in all groups and sensitive (96%) in acute brucellosis, (100%) in subacute brucellosis and (64%) in chronic brucellosis. While, ELISA IgG specificity in all groups was (80%) and the sensitivity in acute brucellosis was (88%), in subacute and chronic brucellosis was (100%).<br /> <strong>Conclusion:</strong> ELISA IgG and IgM test for brucella is a simple and reliable test in the diagnosis of pattern of the brucellosis.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76135220150626Changes in CD4 and CD8 after Interventional Management of Hepatocellular Carcinoma941011781810.21608/aeji.2015.17818ENWalid El-SherbinyTropical Medicine Department, Faculty of Medicine, Mansoura University, Egypt.Nashwa KhairatAbousamraClinical Pathology Department, Faculty of Medicine , Mansoura University, Egypt.Muhammad DiastyTropical Medicine Department, Faculty of Medicine, Mansoura University, Egypt.Shaker WagihShaltoutTropical Medicine Department, Faculty of Medicine, Mansoura University, Egypt.Journal Article20150602<strong>Background and study aim :</strong> Hepato-cellular carcinoma (HCC) has many curative choices which in some circumstances are equal to or even better than surgery. These strategies for treatment of HCC may induce certain local effects which trigger distinct immunological responses that may have a systemic impact on the natural history of the tumour itself. These responses are validated through the measurement of specific immune cells in the systemic circulation. In this study, we tried to observe and analyze changes in the peripheral immune cells that accompany and follow HCC ablation by different procedures of radiological intervention and compare our results with literature. So, this study may be useful with other criteria in the guidelines for the selection of the optimal therapeutic strategy for each patient. .
<strong>Patients and Methods:</strong> This study was conducted on about 50patients diagnosed with HCC who were referred to Tropical Medicine Department at Mansoura University Hospital, Egypt and 20 healthy volunteers as a control. The therapeutic strategy was selected according to the tumor stage and general condition. RFA was performed for12 cases, PEI for 13, MWA for12 and TACE for 13 cases. All Patients were subjected to full history taking, clinical examination, liver function tests, anti HCV antibodies and HBS antigen by 3rd generation ELISA, serum alpha fetoprotein, abdominal ultrasonography, triphasic abdominal computerized tomo-graphy and lymphocyte subset assay by flow cytometry 1 day before, and 3 weeks after the treatment.
<strong>Results:</strong> Regarding the immunological status between control and HCC patients, there was a demonstrable difference in the number of cells in both groups, as the control group had higher levels of CD4+ and CD8+ values. In the RFA group, CD4+ cells and CD4/CD8 ratio remarkably increased after treatment (P <0.001), and the CD8+ cells significantly decreased (P <0.002) with concomitant increase in the CD4+/CD8+ ratio (P<0.001). In the PEI group, CD4+ cells markedly increased after treatment (P<0.001), but there were no significant differences in CD8+ cells and CD4/CD8 ratio. In the MWA group, CD4+ cells markedly increased after treatment (P<0.001), with increase in CD4/CD8 ratio (P<0.007) but there were no significant differences in CD8+ cells. In the TACE group, the CD4+ cells and CD4/CD8 ratio dramatically decreased after treatment (P<0.001), and the CD8+ cells increased significantly (P<0.001).
<strong>Conclusion:</strong> Our study has proved to find a relationship between immunity and different models of therapy in HCC patients and demonstrated a positive attitude towards increasing immune cells following ablation technique.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76135220150629Role of Insulin Resistance and Cytokeratin 18 on the Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation1021141781910.21608/aeji.2015.17819ENSoha EKhorshedTropical Medicine Department , Faculty of Medicine, Zagazig University, EgyptAlaa FayedClinical Oncology and Nuclear Medicine Department, Faculty of Medicine Zagazig University, EgyptLamiaa MahmoudKamelClinical pathology Department, Faculty of Medicine Zagazig University, EgyptShereen MAwadFamily Medicine Department , Faculty of Medicine Zagazig University, EgyptJournal Article20150604<strong>Background and study aim :</strong> Many studies have reported that insulin resistance raises the risk of primary hepatocellular carcinoma (HCC). Caspase-generated cytokeratin-18 (CK-18) fragments are produced during apoptosis of hepatic cells. The present study aims to evaluate the value of serum CK-18 and the impact of insulin resistance on recurrence of HCV related HCC in patients treated with radiofrequency ablation (RFA). .
<strong>Patients and Methods:</strong> The present study was conducted on 60 HCV patients. Group I: 30 patients with HCC treated by RFA and group II: 30 non HCC cirrhotic patients. Insulin resistance was estimated by the homeostatic model assessment of insulin resistance (HOMA-IR) and CK-18 level was measured for all patients using ELISA.
<strong>Results:</strong> HOMA-IR and CK-18 levels were significantly elevated in HCC patients when compared to non HCC cirrhotic patients. There was a significant increase in CK-18 and HOMA-IR levels in patients with local recurrence versus those with no recurrence (p<0.001). Univariate analysis revealed that HOMA-IR (p=<0.001) and CK-18 (p=<0.001) were significant predictors of recurrence of HCC.
<strong>Conclusion:</strong> CK-18 and HOMA-IR are potential prognostic markers as they can predict the recurrence of HCC.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76135220150626Nurses Knowledge and Practice Regarding Gastrointestinal Endoscopy and Suggested Nursing Guidelines1151301782010.21608/aeji.2015.17820ENWafaa MohamedAmerMedical Surgical Nursing Department, Faculty of Nursing, Zagazig University,EgyptNadia MohamedTahaMedical Surgical Nursing Department, Faculty of Nursing, Zagazig University,EgyptHowida KameelZatonMedical Surgical Nursing Department, Faculty of Nursing, Zagazig University,EgyptJournal Article20150603<strong>Background and study aim :</strong> The increased of demand for GIT endoscopies necessitates the assistance of highly trained endoscopy nurses to perform her role to take care of patients undergoing different GIT endoscopies through the whole phases of endoscopy.The aim of this study is to assess knowledge and practice of nurses regarding to Gastrointestinal Endoscopy procedure and suggested nursing guideline. .
<strong>Patients and Methods:</strong> The present study conducted in Gastrointestinal Endoscopy Unit at Zagazig University Hospitals. The study subject includes all available endoscopy 35 nurses. Three tools were used for collection of data, first questionnaire sheet to collect knowledge about socio demographic characteristics of study nurses and questions to assess nurses' knowledge regarding endoscopy as definition, structure, complications, nursing role, guidelines and types of endoscopy and her role in the pre-procedure, during procedure and post- procedure. Second tool was nursing attitude. Third tool was an observational checklist to assess nurses' practice in the pre procedure, during procedure and post procedure in endoscopy and Suggested nursing guideline.
<strong>Results:</strong> The study revealed that more than half of the nurses had their age equal 25 years or less and most of them had diploma degree and that more than half of nurses had their working experience range from 8 years to less than 28 years. Most of studied nurses had satisfactory level of nurses' knowledge regarding Gastrointestinal Endoscopy. The majority of nurses had positive attitude. The majority of nurses had unsatisfactory nurses' level of practice before, during and after GI endoscope, discharge instructions and manual disinfection of endoscopy. Also, there were statistical significant relationship between total nurses' knowledge regarding GI endoscopy and their age, training and work duration and not significant with nurse qualification.
<strong>Conclusion:</strong> We can conclude that the nurse age, training and working duration are affecting the level of nurses' knowledge regarding gastrointestinal endoscopy including; general precautions, basic steps to clean and disinfection in endoscopy unit. The majority of nurses had positive attitude. While training and qualification can affect dealing with patients in addition to nurses' level of practice before, during and after GI endoscope, discharge instructions and manual disinfection of endoscopy. So, we recommend adequate education and training of all nurses working with gastrointestinal endoscopy unit, with continuous evaluation of nurses' work practice. Periodic evaluation may help to take decision regarding training programs to increase theoretical and practical experience. Further studies are necessary to identify effects of educational programs on nurses' performance in gastrointestinal endoscopy unit.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76135220150621Spontaneous Cryptococcal Peritonitis Successfully Treated with Fluconazole1311331782110.21608/aeji.2015.17821ENMaysaa AbdallahSaeedTropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.Tarig S.A.Al KhuwaitirMedicine Department, King Saud Medical City, Kingdom of Saudi ArabiaJournal Article20150602<span>Spontaneous cryptococcal peritonitis is an uncommon infection that predominantly encountered in immunocompromised. Its clinical presentation is indistinguishable from spontaneous bacterial peritonitis and often results in fatal outcome. Liver disease is an under recognized predisposition for cryptococcal disease. We report a case of spontaneous cryptococcal peritonitis in HIV-negative, non-diabetic female patient with chronic hepatitis C related cirrhosis. Cryptococcus infection was diagnosed by India ink and culture of ascetic fluid. The patient was successfully treated with fluconazole and she was well at the follow up of 9 months. Early clinical suspicion and initiation of antifungal are of paramount to save the patient’s life.</span>