Publications by authors named "Eman Abdelsameea"

38 Publications

Chemokine receptor CXCR6 gene polymorphism and treatment response of chronic hepatitis C virus in Egyptian patients.

Clin Exp Hepatol 2021 Dec 23;7(4):370-376. Epub 2021 Dec 23.

National Liver Institute, Egypt.

Aim Of The Study: Despite achieving a high cure rate of chronic hepatitis C nowadays, treatment failure remains a major concern and host genetic polymorphism could have a possible relation. The aim was to evaluate the role of chemokine receptor CXCR6 gene polymorphism in treatment response to direct acting antivirals (DAAs) in chronic hepatitis C virus (HCV) patients.

Material And Methods: We investigated the chemokine receptor CXCR6 gene single nucleotide polymorphism rs2234358 in three groups. Responder and non-responder groups (each comprising 50 naïve patients) and a control group of 50 apparently healthy individuals were studied.

Results: Genotype distribution revealed a significant difference ( = 0.037) between non-responders and the other 2 groups. Both control and responder groups showed allelic frequencies of 20% having the wild allele G and 80% having the variant allele T, while in the non-responder group 39% had G and 61% had the T alleles. Genotype GG was associated with significant increased risk of not responding to treatment by 4.25 times as compared with TT genotype ( = 0.019) and the G allele was associated with highly significant risk of not responding to treatment by 2.56 times compared with the T allele ( = 0.003).

Conclusions: CXCR6 gene (rs2234358) polymorphism could have a potential role in the virological treatment response with a protective effect of the T allele. This could explain the higher treatment success rate of Egyptian HCV patients.
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http://dx.doi.org/10.5114/ceh.2021.111490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977876PMC
December 2021

Role of liver biopsy in management of liver diseases without hepatic nodules following end of the interferon era: experience of a tertiary referral center.

Clin Exp Med 2022 Mar 9. Epub 2022 Mar 9.

Hepatology and Gasteroenterology, National Liver Institute, Menoufia University, Shebeen El-Koom, 32511, Egypt.

Liver biopsy (LB) is the cornerstone in the management of patients with liver diseases. However, a lot of queries had emerged about its role following the end of the interferon era. The aim of this study was to re-evaluate the current role of LB in the diagnosis of liver diseases. All patients who had underwent LB at the Department of Hepatology, National Liver Institute, from January 2015 through December 2018 were recruited. Indications for LB, pathology reports and medical records of all cases were retrieved, reviewed and statistically analyzed. A total of 275 liver biopsies were collected, 191 males and 84 females with mean age 41.22 ± 13.36 years. Etiological diagnosis made by histopathological evaluation was 48 drug-induced liver injury (DILI), 42 nonalcoholic fatty liver disease (NAFLD), 34 chronic hepatitis B, or C with cholestasis, 29 autoimmune hepatitis, 34 primary sclerosing cholangitis, 13 primary biliary cholangitis, 7 autoimmune overlap syndrome, 13 active bilharziasis and 10 Wilson's disease. Minor number of cases was diagnosed by different other etiologies. Initial diagnosis was made by liver biopsy and confirmed by clinical response and laboratory findings. Liver biopsy is still considered as the gold standard diagnostic measure of different liver diseases representing an integral component of management decisions in hepatology.
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http://dx.doi.org/10.1007/s10238-022-00797-1DOI Listing
March 2022

Hepatitis C Virus Infection in Eastern Libya: Efforts Needed to Improve HCV Testing and Linkage to Care in the Resource-Limited Setting.

Trop Med Infect Dis 2022 Jan 19;7(2). Epub 2022 Jan 19.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom 32511, Egypt.

Hepatitis C virus (HCV) is a significant public health problem, and the elimination of its infection by 2031 is a global goal. However, due to insufficient testing, lack of linkage to care (LTC) and treatment, Libya may be far from achieving this goal. This study aimed to explore HCV testing, the care and treatment of infected people, and to assess the burden of the infection among individuals who visited the main Medical Centre in Tobruk region, eastern Libya, for various medical and surgical conditions. A research team interviewed public health officials in Tobruk Medical Center, inspected available equipment, and obtained data available for people who were positive for antibodies to HCV (anti-HCV) as part of their routine pre-invasive procedures and pre-donation screening tests from January 2005 to April 2020. HCV antibody tests were positive for 612 cases out of 368,392 (0.17%). Of those who tested positive for anti-HCV antibodies, no one had followed up by RNA test for identifying individuals with chronic HCV infection, and there are no links to outpatient care and treatment. Our findings highlight the critical need for an up-to-date HCV diagnosis and linkage to care guidelines, which includes a follow-up RNA test for anti-HCV positive patients and early linkage to care for confirmed cases to accelerate the elimination of HCV infection from the community.
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http://dx.doi.org/10.3390/tropicalmed7020014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8878151PMC
January 2022

The association between micro-RNA gene polymorphisms and the development of hepatocellular carcinoma in Egyptian patients.

Arch Med Sci 2022 18;18(1):62-70. Epub 2021 Mar 18.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shibin el Kom, Egypt.

Introduction: The development and progression of hepatocellular carcinoma (HCC) is a multistage process involving the deregulation of genes that are crucial to cellular processes. Multiple risk factors are correlated with HCC. MicroRNA is differentially expressed in the development of different types of malignancies, including hepatic malignancy. Single nucleotide polymorphisms (SNPs) are the most common sequence variation in the human genome. SNPs in miRNAs may affect transcription, processing, or target recognition and result in malignant disease. The aim of the study was to determine the association between microRNA gene polymorphisms and the development of HCC in Egyptian patients.

Material And Methods: This study included 200 individuals who were matched in age and sex. Tumour staging was done using the BCLC staging system. Quantification and genotyping of microRNA were performed.

Results: Among the 200 patients, 2 groups were described: group I included 90 HCC patients with a male majority (72.2%), and group II comprised 110 controls. Three microRNA SNPs were assayed in both patients and controls. There was a significant association between rs10061133 miR-499b and the risk of HCC. The genotypes GG or G allele were significantly associated with an increased risk of HCC (GG: OR = 2.91, 95% CI: 1.23-4.22, = 0.013; G allele: OR = 1.79, 95% CI: 1.12-2.15, = 0.026) compared with the genotype of AA or AG or A allele.

Conclusions: There is an association between the miRNA SNPs and the susceptibility to HCC, to explore some roles and mechanisms of SNPs within miRNAs in the occurrence and development of HCC.
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http://dx.doi.org/10.5114/aoms/100600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826692PMC
March 2021

Red cell distribution width as a predictor of outcome in hospitalized cirrhotic patients.

Eur J Gastroenterol Hepatol 2021 12;33(1S Suppl 1):e978-e985

Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom.

Background: A systemic inflammatory response syndrome (SIRS) is linked to red cell distribution width (RCDW), which produces pro-inflammatory signals that act directly on hematopoietic stem cells in the bone marrow. This stimulation may cause alterations in the membrane of red blood cells (RBCs), as assessed by RCDW, which have been linked to increased morbidity and death in a number of systemic disorders.

Aim: This study aims to evaluate RCDW as a predictor of outcome in hospitalized cirrhotic patients.

Methods: This prospective cross-sectional study was conducted on 1000 patients. The outcome was assessed by days of hospitalization; mortality in hospitalized patients or during short-term follow-up (3 months) and rehospitalization during follow-up of 6 months.

Results: Male represented 69.6%. Mean age was 57.67 ± 13.07 years old. Baseline co-morbidities were recorded as the presence of diabetes mellitus (200 patients) and hypertension (400 patients). Hepatitis C virus was the commonest etiology of the diseased liver (90%). Child-Pugh classes A, B and C of studied patients represented (21.2%, 38.8% and 40%). The survived patients during follow-up represented 63.3%. Area under the curve for RCDW was 0.923 (95% CI, 0.904-0.943), 0.910 for C-reactive protein (95% CI, 0.890-0.930), 0.904 for Hb (95% CI, 0.883-0.925) and 0.903 for platelets (95% CI, 0.882-0.924). RCDW cutoff point at 21.35 for predicting survival had sensitivity 93%, specificity 91%, accuracy 92%, positive predictive value 85 and negative predictive value 96. Regression analysis revealed a significant positive association between both RCDW and white blood cells with mortality.

Conclusion: RCDW could provide useful information for predicting the length of hospitalization and survival in hospitalized cirrhotic patients.
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http://dx.doi.org/10.1097/MEG.0000000000002337DOI Listing
December 2021

Helicobacter pylori versus platelet-to-spleen ratio as a risk factor for variceal bleeding in patients with liver-cirrhosis-related portal hypertension.

Am J Med Sci 2022 Jul 2;364(1):23-28. Epub 2022 Jan 2.

Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebein El-Kom, Menoufia Governorate, Egypt.

Background Acute upper gastrointestinal (GIT) bleeding is a common medical emergency clinically manifested by hematemesis and/or melena. This study aimed to elucidate the roles of Helicobacter pylori and the platelet-spleen ratio as risk factors for variceal bleeding in patients with portal hypertension secondary to liver cirrhosis. Methods The study was conducted on 200 patients with liver cirrhosis of various etiologies who were divided into two groups: group 1 included 100 patients with liver cirrhosis and portal hypertension with or without a history of upper GIT bleeding, and group 2 included 100 patients with liver cirrhosis without portal hypertension. Upper GIT endoscopy was performed, and biopsy samples were taken from the gastric antral mucosa for rapid urease testing. The platelet-spleen diameter ratio was calculated for all patients. Results In group 1, most patients who had a history of variceal bleeding were H. pylori-negative whereas most patients without a history of variceal bleeding were H. pylori-positive, implying that H. pylori may play a significant role as a protective factor against variceal bleeding. The calculated odds ratio for the rapid urease test was low (0.851), whereas the calculated odds ratio for the platelet-spleen diameter ratio was higher (9.766) than that for the rapid urease test. Thus, the rapid urease test plays a significantly higher role than the platelet-spleen ratio as a risk factor for bleeding (p-value = 0.001). Conclusions H. pylori has a more significant relationship with upper GIT bleeding than the platelet-spleen diameter ratio.
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http://dx.doi.org/10.1016/j.amjms.2021.10.018DOI Listing
July 2022

Lymphoepithelioma-like Hepatocellular Carcinoma: a Case Report and Review of Literature.

J Gastrointest Cancer 2021 Nov 23. Epub 2021 Nov 23.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt.

We report a case of hepatic lymphoepithelioma-like carcinoma-hepatocellular carcinoma subtype (LEL-HCC) in a 41-year-old man with chronic hepatitis C virus (HCV) infection. The patient presented with abdominal pain and further assessment revealed a hypoechoic mass on ultrasonography. Serum alpha-fetoprotein (AFP) was 13·6 ng/dl. The patient was diagnosed as hepatocellular carcinoma based on the established triphasic computed tomography (TCT) diagnostic criteria and he underwent a surgical resection of the mass. Microscopic examination showed sheets and cords of malignant epithelial cells intermixed with heavy lymphoid infiltrate, with more than 100 tumor-infiltrating lymphocytes (TILs) per 10 high-power-field (HPF). Based on immunohistochemical studies, the malignant cells were positive for Hep Par 1 and glypican 3, focally positive for cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20). TILs were diffusely positive for cluster of differentiation 3 CD3 with an approximately equal CD4/CD8 ratio. The patient was recurrence free at 25 months after surgery, as evident by CT and serum alpha-fetoprotein level. LEL-HCC is a rare variant of HCC with a relatively better prognosis. Exploring the potential for immune modulator-based therapy in this subset of tumors is highly recommended.
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http://dx.doi.org/10.1007/s12029-021-00757-0DOI Listing
November 2021

SARS-CoV-2-associated gastrointestinal and liver diseases: what is known and what is needed to explore.

Egypt Liver J 2021 31;11(1):64. Epub 2021 Jul 31.

Clinical Pharmacology Department, Faculty of Medicine, Menofia University, Shibin El Kom, Egypt.

Background: The pandemic of COVID19 which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described in China as an unexplained pneumonia transmitted by respiratory droplets. Gastrointestinal (GI) and liver injury associated with SARS-CoV-2 infection were reported as an early or sole disease manifestation, mainly outside China. The exact mechanism and incidence of GI and liver involvement are not well elucidated.

Main Body: We conducted a PubMed search for all articles written in the English language about SARS-CoV-2 affecting the GI and liver. Following data extraction, 590 articles were selected. In addition to respiratory droplets, SARS-CoV-2 may reach the GI system through the fecal-oral route, saliva, and swallowing of nasopharyngeal fluids, while breastmilk and blood transmission were not implicated. Moreover, GI infection may act as a septic focus for viral persistence and transmission to the liver, appendix, and brain. In addition to the direct viral cytopathic effect, the mechanism of injury is multifactorial and is related to genetic and demographic variations. The most frequently reported GI symptoms are diarrhea, nausea, vomiting, abdominal pain, and bleeding. However, liver infection is generally discovered during laboratory testing or a post-mortem. Radiological imaging is the gold standard in diagnosing COVID-19 patients and contributes to understanding the mechanism of extra-thoracic involvement. Medications should be prescribed with caution, especially in chronic GI and liver patients.

Conclusion: GI manifestations are common in COVID-19 patients. Special care should be paid for high-risk patients, older males, and those with background liver disease.
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http://dx.doi.org/10.1186/s43066-021-00123-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325538PMC
July 2021

Hyaluronic acid as a potential marker for assessment of fibrosis regression after direct acting antiviral drugs in chronic hepatitis C patients.

Clin Exp Hepatol 2021 Sep 22;7(3):320-327. Epub 2021 Sep 22.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Egypt.

Introduction: Fibrosis is an inevitable complication of chronic hepatitis C virus (HCV) infection. Direct acting antivirals (DAAs) radically treated HCV and were suggested to ameliorate fibrosis. Silymarin (a natural herbal remedy) was proposed to further decrease hepatic inflammation and fibrosis. Consequently, serial monitoring of liver fibrosis status by different biomarkers is needed.

Aim Of The Study: To assess hyaluronic acid (HA) as a potential marker of fibrosis regression after DAAs in chronic HCV patients; in addition, to evaluate silymarin as an agent that, beside DAAs, could further improve fibrosis.

Material And Methods: Two groups were included (150 patients each). Group 1 received DAAs only, while group 2 received DAAs followed by silymarin. Hyaluronic acid and FIB4 score were assessed at baseline before treatment and 1 year after inclusion in the study.

Results: We found that DAA therapy alone or in combination with silymarin resulted in a significant reduction in serum HA level. However, the latter case showed a statistically significantly greater reduction ( = 0.034). Mean ±SD of serum HA level was 211.8 ±179.9 and 143.3 ±123.9 µg/l before and one year after inclusion respectively in group 1 ( = 0.001) and also, its level decreased significantly in group 2 from 188.3 ±211.8 µg/l before receiving DAAs to 126.4 ±136.9 µg/l at one year after inclusion ( = 0.001). There was no significant difference between the 2 studied groups as regards FIB-4 at 1 year after inclusion ( = 0.103).

Conclusions: Hyaluronic acid might be a sensitive marker for monitoring fibrosis regression in treated chronic HCV patients. Adding silymarin to treatment protocols could ameliorate the fibrosis status.
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http://dx.doi.org/10.5114/ceh.2021.109293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527342PMC
September 2021

Acute Hepatitis A Virus Infection in Tobruk, Eastern Libya: Increasing Trends After 2017.

Food Environ Virol 2022 03 11;14(1):89-93. Epub 2021 Oct 11.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt.

Acute hepatitis A is a self-limited liver inflammation caused by hepatitis A virus (HAV) infection. The infection is transmitted by direct contact from person to person via fecal-oral routes, or through consuming contaminated food and water. This study aims to estimate the frequency of HAV infection from medical records of Tobruk Medical Center, eastern Libya and its distribution during 6 years. The medical records department of Tobruk Medical Center follows guidelines of the international classification of diseases-10 for coding the diseases. The research estimates the frequency and distribution of HAV infection based on age and sex during the period from January 2015 to December 2020. HAV screening assay was performed using commercially available enzyme-linked immunosorbent assays HAV IgM microwell. 245 cases were recorded, 53.5% of cases were males. HAV infection was the most prevalent (92.6%) in age groups of < 5-20 years. A significant rise in the occurrence of HAV infection in the last three years was reported (p < 0.05). More than half of the cases (68%) were reported in 2019 and 2020. No case fatality rate was reported in the present study. There is an increase in the frequency of HAV infection in the last 3 years and the younger age groups (under 20 years old) are more vulnerable to HAV infection. More prevention and control efforts towards this age group should be a top public health priority to avoid the possibility of HAV outbreaks in the future.
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http://dx.doi.org/10.1007/s12560-021-09499-5DOI Listing
March 2022

The Putative Role of Natural Killer Cells in Patients with Hepatitis C Virus-Related Hepatocellular Carcinoma.

Asian Pac J Cancer Prev 2021 Aug 1;22(8):2559-2567. Epub 2021 Aug 1.

Department of Clinical and Chemical Pathology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.

Background: Natural Killer (NK) cells have crucial roles in immune responses against malignant transformation including hepatocellular carcinoma (HCC). The NKG2D receptor has a critical role in the NK recognition of target cells.

Aim: We assessed NKG2D receptor expression as a diagnostic biomarker for HCC detection and progression in Egyptian patients with hepatitis C virus (HCV)-related HCC.

Methods: We classified 81 patients into three groups: chronic hepatitis (21), cirrhotic (30) and HCC (30) patients, with 36 individuals enrolled to the control group. We analyzed NK levels in peripheral blood and NKG2D receptor expression in NK cells using flow cytometry.

Results: We observed a significant decrease in NKG2D (CD314) expression on circulating NK cells and frequency of NK cells expressing NKG2D (CD314) in HCC patients. Also, in patients, larger foci lesions significantly correlated with decreased NK cell numbers. Multiple foci numbers and patients with a Child score C significantly correlated with decreased circulating NK cells expressing NKG2D and decreased NKG2D expression.

Conclusion: The percentage of NK cells in peripheral blood and NKG2D receptor expression could function as potential biomarkers for HCC detection and progression.
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http://dx.doi.org/10.31557/APJCP.2021.22.8.2559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629465PMC
August 2021

Cancer incidence in the Tobruk area, eastern Libya: first results from Tobruk Medical Centre.

Epidemiol Health 2021 3;43:e2021050. Epub 2021 Aug 3.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt.

Objectives: Cancer is a major cause of morbidity and mortality worldwide, and it is an increasing problem in developing countries. Estimation of the incidence of cancer is important, especially in regions with limited epidemiological data on cancer. Therefore, the aim of this study was to provide an updated report on the incidence of cancers in the Tobruk region in eastern Libya.

Methods: Data on cancer patients from the records of the Department of Histopathology of Tobruk Medical Centre from January 2013 to June 2020 were included.

Results: In total, 402 cases were recorded. Men patients accounted for 30.3% (n=122) of cases, and women patients represented 69.6% (n=280). The overall mean age at the time of the first diagnosis was 49.0±17.1 years. The most common malignancies were breast and uterine cancer in women (18.4%, n=74; 15.9%, n=64, respectively), colorectal cancer (11.6%, n=47; 26 in women and 21 in men), bladder cancer (8.2%, n=33; 8 in women and 25 in men), and thyroid cancer (8.0%, n=32; 23 in women and 9 in men).

Conclusions: Breast and uterine cancers were the most common cancers in women, and bladder and colorectal cancer were the most common cancers in men, followed by colorectal cancer in both genders. These data will help health authorities launch preventive plans for cancer in the region. Further studies to identify aetiological factors and cancer-related risk factors need to be conducted in the region.
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http://dx.doi.org/10.4178/epih.e2021050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8602008PMC
November 2021

Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis.

World J Gastrointest Oncol 2021 May;13(5):424-439

Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt.

Background: Given the poor synthetic function of cirrhotic liver, successful resection for patients with hepatocellular carcinoma (HCC) necessitates the ability to achieve resections with tumor free margins.

Aim: To validate post hepatectomy liver failure score (PHLF), compare it to other established systems and to stratify risks in patients with cirrhosis who underwent curative liver resection for HCC.

Methods: Between December 2010 and January 2017, 120 patients underwent curative resection for HCC in patients with cirrhosis were included, the pre-operative, operative and post-operative factors were recorded to stratify patients' risks of decompensation, survival, and PHLF.

Results: The preoperative model for end-stage liver disease (MELD) score [odds ratio (OR) = 2.7, 95%CI: 1.2-5.7, = 0.013], tumor diameter (OR = 5.4, 95%CI: 2-14.8, = 0.001) and duration of hospital stay (OR = 2.5, 95%CI: 1.5-4.2, = 0.001) were significant independent predictors of hepatic decompensation after resection. While the preoperative MELD score [hazard ratio (HR) = 1.37, 95%CI: 1.16-1.62, < 0.001] and different grades of PHLF (grade A: HR = 2.33, 95%CI: 0.59-9.24; Grade B: HR = 3.15, 95%CI: 1.11-8.95; Grade C: HR = 373.41, 95%CI: 66.23-2105.43; < 0.001) and HCC recurrence (HR = 11.67, 95%CI: 4.19-32.52, < 0.001) were significant independent predictors for survival.

Conclusion: Preoperative MELD score and tumor diameter can independently predict hepatic decompensation. While, preoperative MELD score, different grades of PHLF and HCC recurrence can precisely predict survival.
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http://dx.doi.org/10.4251/wjgo.v13.i5.424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131904PMC
May 2021

Predictive Role of AURKA rs 1047972 Gene Polymorphism and the Risk of Development of Hepatocellular Carcinoma.

Immunol Invest 2021 May 21:1-11. Epub 2021 May 21.

Departement of Clinical Pathology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt.

Abbreviation: AFP: alpha-fetoprotein; ALP: alkaline phosphatase; ALT: alanine aminotransferase; AST: aspartate aminotransferase; AURKA: aurora kinase A; BCLC: Barcelona- Clinic Liver Cancer; CBC: complete blood count; CT: computed tomography; DM: diabetes mellitus; DNA: deoxyribonucleic acid; EDTA: ethylene diamine tetraacetic acid; GGT: gamma-glutamyl transferase; HB: hemoglobin; HBV: hepatitis B virus; HBsAg: hepatitis B surface antigen; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; INR: international normalized ratio; mRNA: messenger ribonucleic acid; OR: odds ratio; PVT: portal vein thrombosis; RT-PCR: real-time polymerase chain reaction; SNP: single nucleotide polymorphism; WBCs: white blood cells.
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http://dx.doi.org/10.1080/08820139.2021.1920609DOI Listing
May 2021

Portal vein thrombosis in hepatitis C virus-related cirrhotic patients: Prevalence and clinical characteristics in an Egyptian cohort.

Trop Doct 2021 Jul 4;51(3):314-318. Epub 2021 Mar 4.

Assistant professor, Department of Hepatology and Gastroenterology, 68873National Liver Institute, Menoufia University, Shebin El-Kom, Egypt.

Portal vein thrombosis is a catastrophe not uncommonly complicating hepatitis C virus-related liver cirrhosis. To estimate its prevalence and clinical characteristics, we investigated 1000 cirrhotic patients by abdominal ultrasound or Doppler study at least. Portal vein thrombosis was found in 21.6%, of whom 157 (72.7%) had malignancy. Complete portal vein thrombosis was found in 70.4%. Half of all these patients had at least one episode of portal hypertensive bleeding, a third had abdominal pain and a quarter presented with jaundice. Portal bilopathy was diagnosed in two cases (0.9%). There was significant association between severity of liver disease, ascites, male gender and site of segmental focal lesion and portal vein thrombosis.
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http://dx.doi.org/10.1177/0049475521998509DOI Listing
July 2021

FIB-5 versus FIB-4 index for assessment of hepatic fibrosis in chronic hepatitis B affected patients.

Clin Exp Hepatol 2020 Dec 30;6(4):335-338. Epub 2020 Dec 30.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Egypt.

Aim Of The Study: Chronic hepatitis B virus (HBV) infection is one of the major health problems worldwide. Use of non-invasive tests for assessment of hepatic fibrosis such as the FIB-4 index could be used to avoid liver biopsy. Another promising noninvasive test, FIB-5, could also be used to detect significant hepatic fibrosis. The aim of the study was to compare the use of FIB-5 and FIB-4 as noninvasive markers to assess chronic HBV-related hepatic fibrosis.

Material And Methods: This study was done on 176 chronic HBV patients who underwent liver biopsy. Grading and staging of liver fibrosis was done according to the METAVIR scoring system. FIB-5 and FIB-4 scores were calculated for all patients.

Results: As regards FIB-4 for differentiation between non-significant fibrosis (group I) and significant fibrosis (group II), at a cutoff level of 1.28 with positive predictive value (PPV) 41.4% and specificity 48% while at a cutoff level of 7.08 with PPV 98.8% and specificity 98% for FIB-5.

Conclusions: As regards both scores, the FIB-5 score was more specific than FIB-4 for diagnosing significant from nonsignificant hepatic fibrosis in patients with chronic HBV infection.
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http://dx.doi.org/10.5114/ceh.2020.102157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816634PMC
December 2020

Matrix Metalloproteinase-11 Gene Polymorphisms as a Risk for Hepatocellular Carcinoma Development in Egyptian Patients.

Asian Pac J Cancer Prev 2020 Dec 1;21(12):3725-3734. Epub 2020 Dec 1.

Departement of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebein El-Kom, Egypt.

Background: Chronic hepatitis C (CHC) virus infection is one of major risk factors of hepatocellular carcinoma (HCC) in Egypt, which is a major cause of cancer mortalityin the world. Matrix metalloproteinase-11 (MMP-11) has an important role in tumor migration and metastasis. Therefore, this study aimed to determine relation between MMP-11 gene polymorphisms and risk of HCC development among Egyptian cirrhotic patients.

Subjects And Methods: Two hundred and sixty patients were included, 140 of them with HCC on top of CHC and 120 patients with post CHC liver cirrhosis (LC) as well as 140 subjects were enrolled in the study as healthy controls. Two single nucleotide polymorphisms (SNPs) rs738791 and rs738792 for MMP-11 gene were done using real-time PCR.

Results: Combination of CT and TT allele of rs738791 genotypes was more significantly frequent in HCC compared to LC patients and controls, however, a higher frequency of T allele was found in HCC patients compared to LC and controls. In spite of lake of significant difference between patient groups regarding the rs738792 genotypes, the CC genotype was considered a risk of developing portal vein thrombosis, and was associated with advanced tumor stage, increased tumor size, higher Cancer of the Liver Italian Program [CLIP] score, more advanced Barcelona stage [D] and with child Pugh class [C].

Conclusion: Genetic variations in MMP-11 may be implicated in post HCV-HCC development and might be dependable biomarkers for HCC progression.
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http://dx.doi.org/10.31557/APJCP.2020.21.12.3725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046319PMC
December 2020

Direct acting antivirals are associated with more liver stiffness regression than pegylated interferon therapy in chronic hepatitis C patients.

Expert Rev Anti Infect Ther 2021 08 29;19(8):1053-1059. Epub 2020 Dec 29.

Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El-Koom, Egypt.

Objectives: Extent of post-treatment fibrosis change in patients with different stages of fibrosis not fully known. We aimed to study changes in liver fibrosis in chronic hepatitis C patients who were treated with pegylated interferon/ribavirin (PEG/RBV) or direct acting antivirals (DAAs).

Methods: Retrospective evaluation of results of transient elastography (TE) was done before and 1 year after end of treatment for patients treated with PEG/RBV ( = 268) and DAAs ( = 245).

Results: The average age was 45.54 ± 10.64 years; mainly males. All patients in the DAAs group achieved sustained virological response (SVR), unlike 56.3% of the patients in the PEG/RBV group. F3-F4 fibrosis was predominant in the PEG/RBV nonresponder patients (51.3%) and DAAs responders (57.1%). TE decreased 1 year after end of treatment ( = 0.001) in the viral responders of the PEG/RBV group (7.44 ± 4.02 vs. 10.24 ± 7.29 kPa) and DAAs group (12.12 ± 9.21 vs. 16.81 ± 12.84 kPa) respectively. The delta TE change in the DAAs responders was higher than the PEG/RBV responders ( = 0.001) and PEG/RBV nonresponders ( = 0.001). The percentage of patients with liver fibrosis regression was higher in DAAs responders (52.5%) than in PEG/RBV responders (23.3%).

Conclusion: Treatment with DAAs is associated with fibrosis improvement more than treatment with PEG/RBV in chronic hepatitis C patients.
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http://dx.doi.org/10.1080/14787210.2021.1864326DOI Listing
August 2021

Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt.

World J Gastroenterol 2020 Nov;26(43):6880-6890

Department of Internal Medicine, Al-Azhar University, Cairo 11651, Egypt.

Background: The current coronavirus disease 2019 (COVID-19) pandemic has affected routine endoscopy service across the gastroenterology community. This led to the suspension of service provision for elective cases.

Aim: To assess the potential barriers for resuming the endoscopy service in Egypt.

Methods: A national online survey, four domains, was disseminated over a period of 4 wk in August 2020. The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s).

Results: A hundred and thirteen Egyptian endoscopy centers participated in the survey. The waiting list was increased by ≥ 50% in 44.9% of areas with clusters of COVID-19 cases ( = 49) and in 35.5% of areas with sporadic cases ( = 62). Thirty nine (34.8%) centers suffered from staff shortage, which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis. In multivariate analysis, the burden of cases in the unit locality, staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice ( = 0.029, < 0.001 and 0.02, respectively) and Odd's ratio (0.15, 1.8 and 0.16, respectively).

Conclusion: The COVID-19 pandemic has led to restrictions in endoscopic volumes. The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery. Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.
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http://dx.doi.org/10.3748/wjg.v26.i43.6880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684458PMC
November 2020

DNA Methyltransferases as Potential Biomarkers for HCV Related Hepatocellular Carcinoma.

Asian Pac J Cancer Prev 2020 Nov 1;21(11):3357-3363. Epub 2020 Nov 1.

Hepatology and Gastroenterology, National Liver Institute, Clinical Pathology, Menoufia University, Shebeen El-Kom, Egypt.

Background: Hepatocellular carcinoma (HCC) is a major health concern in many countries including Egypt. The alteration in DNA methylation that was observed in HCC patients suggests a possible role of DNA methyltransferases (DNMTs) in the disease pathogenesis in addition to potential role as a disease biomarker.

Aim: To study the change in DNMTs expression in chronic HCV infected patients as potential non- invasive biomarker for diagnosis of hepatocellular carcinoma.

Methods: 26 patients with HCC, 45 patients with liver cirrhosis, 20 chronic HCV patients and 20 apparently healthy individuals as a control group were enrolled in this study. Real-Time Quantitative Reverse Transcription PCR (qRT-PCR) was performed for all study participants.

Results: A significant difference in DNMTs expression was observed among the studied groups. Receiver operating characteristics (ROC) curve analysis revealed that with a cutoff value of 3.16 for DNMT 3A expression, sensitivity and specificity were 80.8 and 95.6% respectively and area under curve (AUC) was 0.958, p < 0.001 for discriminating hepatocellular carcinoma among post hepatitis C cirrhotic patients. Besides DNMT 3B relative expression cutoff value of 3.10 showed 84.6% sensitivity and 77.8% specificity and AUC was 0.888, p < 0.001. On the other hand, cutoff value 0.65 for DNMT1 relative expression showed 92.3% sensitivity and 44.4% specificity and AUC was 0.72, p= 0.002. DNMT1, DNMT 3A and DNMT 3B have significant positive correlation with the level of AFP (p-value = 0.003, 0.004 and 0.008 respectively). The relative expression of DNMT3B was significantly correlated to focal lesion size (p-value = 0.015). High DNMTs expression was significantly associated with the presence of multiple focal lesions but not with the Child Pugh grade (p> 0.05).

Conclusion: The mRNA levels of DNMTs could be a potential biomarker for early detection of HCC development.
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http://dx.doi.org/10.31557/APJCP.2020.21.11.3357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033121PMC
November 2020

Variceal recurrence 4 years post endoscopic band ligation in hepatitis C patients who achieved sustained virological response with oral direct-acting antiviral therapy.

J Viral Hepat 2021 02 9;28(2):279-287. Epub 2020 Nov 9.

Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia, Egypt.

Oral Direct-acting antivirals (DAAs) are safe, highly effective altering disease burden and prognosis in hepatitis C patients. Sustained virologic response (SVR) is achieved nowadays in more than 90% of the treated patients and related to the improvements in functions of the liver, fibrosis plus survival. Furthermore, portal hypertension is thought to be improved with achievement of virological response, parallel to the improvements in hepatic inflammation and fibrosis. We aimed to assess the recurrence rate of oesophageal varices by long-term follow-up in patients treated with different DAAs regimens who had achieved SVR. We studied 176 Child A cirrhotic HCV patients who achieved SVR after DAAs treatment and had a history of endoscopic oesophageal varices obliteration and were on maximum tolerated propranolol dose. They were subjected to follow-up upper gastrointestinal endoscopy repeated every 6 months for 4 years. Fifty-two patients (29.5%) had recurrence of oesophageal varices observed during the 4-years follow-up upper GIT endoscopy. On multivariate analysis, platelet count was the only significant variable, P-value = .007*. HbA1C, HOMA IR, BMI 1 and BMI 2 showed non-significant differences between the studied groups. By ROC analysis, we identified baseline platelet count of 96 000/µL with 100% sensitivity (95% confidence interval [CI] [91%-100%]) and 74% specificity (95% CI [65%-81%]). Spearman correlation showed a positive correlation between AFP, age, AST, Bilirubin, creatinine, INR. Patients who achieved SVR post DAAs showed a significant decrease in oesophageal varices recurrence post endoscopic obliteration. Baseline platelet count was found to be a strong independent predictor for oesophageal varices recurrence.
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http://dx.doi.org/10.1111/jvh.13426DOI Listing
February 2021

Anti-HBc and hepatitis B virus DNA among HBsAg-negative blood donors from the main central blood bank units in Eastern Libya.

Transfus Med 2020 Oct 7;30(5):401-405. Epub 2020 Sep 7.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shibin Al Kawm, Egypt.

Background: Post-transfusion hepatitis B virus (PTHB) infection is still a public health problem in the world. In many developed countries, nucleic acid testing (NAT) for detection of Hepatitis B Virus (HBV)-DNA has been implemented to enhance blood donation safety. In Libya, however, the testing for HBV infection is limited to the detection of HBV surface antigen (HBsAg) only.

Objectives: To determine the frequency of anti-Hepatitis B core antibody (HBc) and HBV-DNA in HBsAg-negative, anti-HBc-positive blood donors in the main Central Blood Bank Units (CBBUs) in eastern Libya.

Methods: One thousand blood samples were obtained from healthy blood donors at the five main CBBUs in eastern Libya. The samples were screened for HBsAg and anti-HBc. Real-time polymerase chain reaction (PCR) was carried out to detect HBV-DNA in all anti-HBc-positive samples.

Results: A total of 94 (9.4%) donors were positive for anti-HBc. Of the 94 anti-HBc-positive samples, 9 samples (9.5%) tested positive for HBV-DNA by real-time PCR.

Conclusion: The rate of anti-HBc among blood donors in this study (9.4%) was similar to that reported from other regions in the country. In the absence of advanced tests for the detection of HBV infection in blood donors, such as NAT, anti-HBc should be routinely tested for, at least for first-time donors.
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http://dx.doi.org/10.1111/tme.12711DOI Listing
October 2020

Urine Neutrophil Gelatinase-Associated Lipocalin a Possible Diagnostic Marker for Egyptian Hepatocellular Carcinoma Patients.

Asian Pac J Cancer Prev 2020 Aug 1;21(8):2259-2264. Epub 2020 Aug 1.

Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt.

Background: Most effective method for reducing mortality from hepatocellular carcinoma (HCC) is early diagnosis. Despite its lack of adequate sensitivity, ultrasound is considered fundamental for HCC screening.

Aim: to evaluate urinary neutrophil gelatinase-associated lipocalin (NGAL) as non-invasive marker for HCC diagnosis in Egyptian patients.

Methods: One hundred and twenty patients were divided into three groups (40 patients each): patients with chronic viral hepatitis (HCV or HBV), cirrhotic patients and HCC patients and 40 healthy age and gender matched subjects were enrolled as control group. After clinical assessments, urinary NGAL was measured by enzyme-linked immunosorbent assay.

Results: Our results revealed that median level of urinary NGAL was 290, 834, 1090 and 1925 pg/ml in control, chronic hepatitis, cirrhotic and HCC groups respectively among studied groups (p<0.001). Receiver operating characteristics (ROC) analysis showed that urinary NGAL cutoff value of 1255 ng/ml could discriminate between HCC and cirrhosis. The area under curve (AUC) was 0.95 with 90% sensitivity, 87.5% specificity (p-value <0.001). In HCC group, urine NGAL level didn`t show significant correlation with Child Pugh score, MELD score or Barcelona Clinic Liver Cancer (BCLC) stage.

Conclusion: Urinary NGAL could be a simple, non-invasive test for diagnosis of HCC in chronic liver disease patients.
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http://dx.doi.org/10.31557/APJCP.2020.21.8.2259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771944PMC
August 2020

Value of IFNL3 genetic polymorphism in the prediction of HCV treatment response to direct-acting antiviral drugs versus interferon therapy.

Expert Rev Anti Infect Ther 2020 09 22;18(9):947-954. Epub 2020 Jun 22.

Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University , Shebin El‑Kom, Egypt.

: Despite the outstanding results of direct-acting antiviral therapies (DAAs) of Hepatitis C infection (HCV), non-responders had to be more defined. : assess the outcome of DAAs in linkage with Interferon lambda 3 (IFNL3) in HCV patients. : This case-control-study was conducted on 495 chronic-HCV (genotype-4a), previously treated Egyptians by either DAAs (responders 195, 120 relapsers) or interferon/ribavirin (IFN/RBV) (140 responders, 60 relapsers), and 98 healthy controls. IFNL3 distribution, clinical and laboratory data were assessed. : CT was the most predominant genotype in Egyptians (51%). All genotypes were sensitive to DAAs mainly CT genotype (60%), even TT genotype (resistant to IFN/RBV 40%) had 29.2% sensitivity. CT genotype was predominant in sofosbuvir/Daclatasvir responders (67.6%) (OR = 0.66), while non-CT prevailed in relapsers (56.7%). TT genotype may respond to SOF/Ledi better than other regimens (66.7%). In IFN/RBV relapsers; CT genotype was commoner (50%) than others, while CC genotype predominated in responders (54.3%). The c allele was the commonest in responders to IFN/RBV (71.4%), while the T allele was resistant to treatment (65% in relapsers). Addition of RBV to SOF/DCV reported higher resistance with CT genotype (42.2%-50%) and TT genotype (17.8%-27.8%). : This study recommended IFNL3 genotyping to be a prerequisite before stratifying treatment for HCV-4a Egyptians.
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http://dx.doi.org/10.1080/14787210.2020.1771180DOI Listing
September 2020

XRCC1 Gene Polymorphism Increases the Risk of Hepatocellular Carcinoma in Egyptian Population.

Asian Pac J Cancer Prev 2020 Apr 1;21(4):1031-1037. Epub 2020 Apr 1.

Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia, Egypt.

Several major risk factors for hepatocellular carcinoma (HCC) have been identified, including chronic infection of hepatitis B virus (HBV) and hepatitis C virus (HCV). Nevertheless, only a fraction of infected patients develops HCC during their lifetime suggesting that genetic factors might modulate HCC development. X-ray repair cross complementing group1 (XRCC1) participates in the repair pathways of DNA.

Aim: to investigate the association between XRCC1 gene polymorphism and HCC in Egyptian chronic hepatitis C patients.

Methods: This study was assessed on 40 patients with HCC secondary to chronic HCV infection who were compared to 20 cirrhotic HCV patients and 40- age and gender- matched healthy control group. After collection of relevant clinical data and basic laboratory tests, c.1517G>C SNP of XRCC1 gene polymorphism was performed by (PCR-RFLP) technique.

Results: A statistically higher frequency of XRCC1 (CC, GC) genotypes and increased (C) allele frequency in patients with HCC was found in comparison to cirrhotic HCV patients as well as control group. In addition, patients with the XRCC1 (CC, GC) genotypes had significantly higher number and larger size of tumor foci and significantly higher Child Pugh grades. Multivariate analysis showed that the presence of c.1517G>C SNP of XRCC1 gene is an independent risk for the development of HCC in chronic HCV patients with 3.7 fold increased risk of HCC development.

In Conclusion: XRCC1 gene polymorphism could be associated with increased risk of HCC development in chronic HCV Egyptian patients.
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http://dx.doi.org/10.31557/APJCP.2020.21.4.1031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445958PMC
April 2020

Platelet-albumin-bilirubin score - a predictor of outcome of acute variceal bleeding in patients with cirrhosis.

World J Hepatol 2020 Mar;12(3):99-107

Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin Elkom 32511, Egypt.

Background: The albumin-bilirubin (ALBI) score was validated as a prognostic indicator in patients with liver disease and hepatocellular carcinoma. Incorporating platelet count in the platelet-albumin-bilirubin (PALBI) score improved validity in predicting outcome of patients undergoing resection and ablation.

Aim: To evaluate the PALBI score in predicting outcome of acute variceal bleeding in patients with cirrhosis.

Methods: The data of 1517 patients with cirrhosis presenting with variceal bleeding were analyzed. Child Turcotte Pugh (CTP) class, Model of End-stage Liver Disease (MELD), ALBI and PALBI scores were calculated on admission, and were correlated to the outcome of variceal bleeding. Areas under the receiving-operator characteristic curve (AUROC) were calculated for survival and rebleeding.

Results: Mean age was 52.6 years; 1176 were male (77.5%), 69 CTP-A (4.5%), 434 CTP-B (29.2%), 1014 CTP-C (66.8%); 306 PALBI-1 (20.2%), 285 PALBI-2 (18.8%), and 926 PALBI-3 (61.1%). Three hundred and thirty-two patients died during hospitalization (21.9%). Bleeding-related mortality occurred in 11% of CTP-B, 28% of CTP-C, in 21.8% of PALBI-2 and 34.4% of PALBI-3 patients. The AUROC for predicting survival of acute variceal bleeding was 0.668, 0.689, 0.803 and 0.871 for CTP, MELD, ALBI and PALBI scores, respectively. For predicting rebleeding the AUROC was 0.681, 0.74, 0.766 and 0.794 for CTP, MELD, ALBI and PALBI scores, respectively.

Conclusion: PALBI score on admission is a good prognostic indicator for patients with acute variceal bleeding and predicts early mortality and rebleeding.
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http://dx.doi.org/10.4254/wjh.v12.i3.99DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7097503PMC
March 2020

Presentations, Causes and Outcomes of Drug-Induced Liver Injury in Egypt.

Sci Rep 2020 03 20;10(1):5124. Epub 2020 Mar 20.

Hepatology and gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt.

Drug-induced liver injury (DILI) is a frequent cause of liver injury and acute liver failure. We aimed to review all hospitalized DILI cases in a tertiary Egyptian center from January 2015 through January 2016. Cases with elevated alanine aminotransferase more than 3-fold and/or alkaline phosphatase more than 2-fold the upper limit of normal value were prospectively recruited and followed for one year. Drug history, liver biopsy whenever feasible and application of Roussel Uclaf Causality Assessment Method (RUCAM) were the diagnostic prerequisites after exclusion of other etiologies of acute liver injury. In order of frequency, the incriminated drugs were: Diclofenac (31 cases, 41.3%), amoxicillin-clavulanate (14 cases, 18.7%), halothane toxicity (8 cases, 10.7%), ibuprofen (4 cases, 5.3%), Khat (3 cases, 4%), tramadol (3 cases, 4%), Sofosbuvir with ribavirin (2 cases, 2.7%), and acetylsalicylic acid (2 cases, 2.7%) with one offending drug in 93.3% of cases. Forty-four cases (58.7%) were males; while 56 cases (74.7%) had HCV related chronic liver disease. Thirty-two cases (42.7%) presented with pattern of hepatocellular injury, while 23 cases (30.7%) were with cholestasis, and 20 cases (20.7%) with a mixed hepatocellular/cholestatic injury. One case received a transplant (0.75%), 7 cases died (9.3%), 23 cases (30.6%) developed liver decompensation (hepatic encephalopathy and ascites), and 44 cases completely resolved (58.7%). In conclusion, Diclofenac is the commonest offender in DILI occurrence in an Egyptian cohort. Age and prothrombin concentration were the only predictors of unfavorable outcomes of DILI.
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http://dx.doi.org/10.1038/s41598-020-61872-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083870PMC
March 2020

Association between IFN-λ 3 Gene Polymorphisms and Outcome of Treatment with Direct Acting Antivirals in Chronic HCV-Infected Egyptian Patients.

Immunol Invest 2021 Jan 5;50(1):12-22. Epub 2020 Feb 5.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University , Shibin Al Kawm, Egypt.

: Single nucleotide polymorphisms (SNPs) of the interferon lambda 3 (IFN-λ 3) gene are associated with viral clearance and treatment response in chronic hepatitis C virus (HCV) infection. : to assess whether specific IFN-λ 3 gene SNP, known as rs12979860 (C > T), could predict the outcome of treatment with direct acting antivirals (DAAs) among Egyptian patients with chronic HCV genotype 4 infection. : Tetra-primer (ARMS-PCR) and PCR-RFLP methods were used for SNP genotyping in 100 chronic HCV-infected patients and 50 healthy subjects as control group. : The CC (wild type) genotype of rs12979860 was identified in 20 patients, 50% of them achieved sustained virological response (SVR). SNP genotype TT was found in 17 patients and only 2 of them (11.76%) were responders. The frequency of CT genotypes was significantly higher in responders than in non-responders (= .021). In contrast, the frequency of TT genotypes was significantly higher in non-responders (42.85%, < .001). On univariate and multivariate logistic regression analyses of the significant predictors of SVR, there were six predictive factors (Age, diabetes mellitus, AST, albumin, type of therapy and IFN-λ 3 genotype). : The TT genotype and T allele were significantly associated with failure to achieve SVR. However, CT genotype of IFN-λ 3 (rs12979860) may be considered as a predictor for SVR in patients who received DAAs.
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http://dx.doi.org/10.1080/08820139.2020.1722158DOI Listing
January 2021

Elastography and serum markers of fibrosis versus liver biopsy in 1270 Egyptian patients with hepatitis C.

Eur J Gastroenterol Hepatol 2020 12;32(12):1553-1558

Departments of Hepatology and Gastroenterology.

Background: Chronic hepatitis C (CHC) is a leading cause of liver fibrosis.

Objective: To compare utility of liver transient elastography, AST-to-platelet ratio index (APRI), fibrosis-4 index (FIB4), Forns Index and Goteborg University cirrhosis index (GUCI) in predicting fibrosis stage assessed by liver biopsy in Egyptian CHC patients.

Methods: One thousand two-hundred and seventy CHC patients undergoing liver biopsy in preparation for therapy and 40 healthy potential living liver donors had transient elastography and calculation of APRI, FIB4, Forns and GUCI scores on the same day or day preceding the biopsy.

Results: Mean age was 39.89 (17-60 years) and most were males (70.7%). All donors had F0 fibrosis, most patients had F1-F2 fibrosis (n = 1011, 79.6%) and 259 (20.4%) had F3-F4 fibrosis. Patients with F3-F4 fibrosis had higher median values of APRI (0.99 vs. 0.46), FIB4 (2.15 vs. 0.95) and Forns (7.34 vs. 4.79) indices, GUCI score (1.16 vs. 0.49) and transient elastography (19.2 vs. 6.2 kPa) (all P = 0.001). For F1 discrimination, AUROC of transient elastography was higher than both Forns and GUCI scores (P = 0.001). APRI, FIB4 and GUCI had lower AUROC than transient elastography for predicting fibrosis stage in F2 and F3 patients (P = 0.001). Transient elastography had the best area under receiver operating characteristic curve for predicting fibrosis stage in F4 patients (P = 0.001). The transient elastography cutoff values (kPa) were F1 (>4.8), F2 (>8.3), F3 (>10.1) and F4 (>13.4). Age, APRI, FIB4, Forns, GUCI and transient elastography were independent predictors of F3-F4 fibrosis.

Conclusion: Liver elastography is superior to APRI, FIB4, Forns and GUCI scores in predicting fibrosis in CHC patients.
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http://dx.doi.org/10.1097/MEG.0000000000001672DOI Listing
December 2020

On-treatment improvement of an emerging psychosomatic depressive disorder among salmonella carriers: a multicenter experience from Egypt.

Infect Drug Resist 2019 22;12:2573-2582. Epub 2019 Aug 22.

Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt.

Background: As physicians in a referral hospital, we observed the association between history of enteric fever and somatic disorders associated with low mood. At the Al-Hussein University Hospital, Cairo and the National Liver Institute Hospital, Menoufia, we receive patients from all over Egypt, including rural areas where enteric fever is endemic.

Aim: Here in, 60 Egyptian patients referred to us for evaluation of different somatic disorders are reported.

Methods: After extensive evaluations, the patients' symptoms were function-related. Also, their typhoid carrier states were documented, and the severity of depression using Hamilton-D (HAM-D) questionnaire was evaluated and recorded. All patients were treated with ceftriaxone, 2 gm, IV, daily for 15 days. The clinical evaluation and Hamilton score were reassessed at the end of the treatment and 6 weeks thereafter. The patients did not receive any anti-depressant nor anti-anxiety treatment during their course. Typhoid carrier was defined by documenting the history of typhoid fever that was diagnosed by culturing the species, and not by serology, isolated from stool culture along with febrile condition, plus the absence of fever in the past 3 weeks. The Widal test was not accepted as a criterion for enrollment.

Results: Patients showed clinically significant improvement in the somatic complaints, and their HAM-D score immediately post-treatment that was consolidated for 6 weeks post-treatment completion.

Conclusion: In this study, the typhoid carrier was associated with the psychosomatic depression that improved by antibiotic therapy.
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http://dx.doi.org/10.2147/IDR.S206642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709802PMC
August 2019
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