Publications by authors named "Mohamed Eltabbakh"

15 Publications

  • Page 1 of 1

Long-Term Impact of Hepatitis C Virus Eradication on Liver Stiffness in Egyptian Patients.

Can J Gastroenterol Hepatol 2021 20;2021:4961919. Epub 2021 Sep 20.

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

Methods: Liver stiffness measurements (LSM) have been serially assessed 1, 3, and 5 years after HCV clearance in 655 patients who have been treated with DAAs.

Results: The mean age was 51.44 ± 10 years. 73% of patients were males. 48% were cirrhotics. In noncirrhotics, the mean LSM was significantly decreased from 8.29 ± 2.3 kPa to 4.03 ± 1.0 kPa ( < 0.0001) at the end of the follow-up. Likewise, LSM decreased in cirrhotics from 29.66 ± 14.25 kPa to 22.50 ± 11.16 kPa ( < 0.0001). The proportions of 1, 2, 3, and 4 patients at the baseline were 17.7%, 17.9%, 16.6%, and 47.8%, which became 56.5%, 4.1%, 4.9%, and 34.5%, respectively, with a substantial reversal of cirrhosis in 87 patients (27.7%) at the end of follow-up.

Conclusions: There was an overall significant regression of liver stiffness in all patients after sustained HCV eradication. Liver stiffness reflecting mild fibrosis (0-2) usually improves shortly after treatment, while measurements reflecting advanced fibrosis (3-4) take a longer time to regress to lower fibrosis stages.
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http://dx.doi.org/10.1155/2021/4961919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476245PMC
October 2021

Safety and efficacy of sofosbuvir/ledipasvir and sofosbuvir/daclatasvir in the treatment of hepatitis C in patients with decompensated cirrhosis.

Eur J Gastroenterol Hepatol 2021 Sep 21. Epub 2021 Sep 21.

Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo Tropical medicine, Faculty of Medicine, Alexandria University, Alexandria Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University Department of Internal Medicine, Al-Azhar University Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo Department of community medicine, Faculty of Medicine, Suez Canal University Hepatogastroenterology Department, National Hepatology & Tropical Medicine Research Institute, Cairo Gastroenterology Department, Damietta Cardiology and Gastroenterology Center, Damietta Hepatology and Gastroenterology Department, AGOZA Police Hospital, Cairo Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia, Egypt Hepatology and gastroenterology department, national liver institute.Menoufia University, Egypt.

Background: Hepatitis C virus (HCV)-related decompensated cirrhosis is a severe life-threatening illness. The safety of direct-acting antivirals (DAAs) has opened a gate of hope for that subgroup of patients who were previously contraindicated for interferon therapy.

Objective: We aimed at the investigation of the safety and efficacy of different DAAs regimens in the treatment of HCV-related decompensated cirrhosis patients, to determine sustained virological response (SVR)12 rates and to analyze the factors associated with response.

Methods: A retrospective, single-center study including HCV-related decompensated cirrhosis patients who received DAAs. Demographic, laboratory and clinical data were analyzed. The SVR12 rate was the primary outcome measure. Secondary outcomes included the predictors of response, changes in the baseline model for end-stage liver disease and child-turcotte-pugh (CTP) scores, and fibroindices (APRI and fibrosis-4 index) at 12 weeks after treatment.

Results: In total, 145 eligible patients (141 with CTP class B and 4 with class C) were enrolled in this study. SVR12 was achieved by 88.06% (118/134) of efficacy population on different DAAs regimens, Treatment was discontinued in 11 patients because of severe side effects without any deaths. Younger age showed a significant positive association with SVR12.

Conclusions: DAAs can be used for the treatment of HCV-related decompensated liver disease, with acceptable SVR12 rates and safety profiles.
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http://dx.doi.org/10.1097/MEG.0000000000002287DOI Listing
September 2021

Characterization of Crohn's disease patients in Egypt: Risk factors for postoperative recurrence (A cohort study).

Ann Med Surg (Lond) 2021 Sep 6;69:102781. Epub 2021 Sep 6.

Department of Tropical Medicine, Gastroenterology, and Hepatology, Ain Shams University, Abbasiya, Cairo, Egypt.

Background: The aim of study to identify the characterizations of Crohn's disease in Egyptian patients and to determine its predictors for postoperative recurrence.

Methods: We conducted a retrospective observational cohort study on 15 patients diagnosed as Crohn's disease with surgical interventions. Different characteristics of studied patients were analyzed to determine the risk factors for postoperative recurrence such as age at diagnosis, gender, smoking, main presenting symptom, Montreal classification, perianal disease, laboratory findings and protocol of management including surgical characteristics like age at operation, surgical indication, preoperative medication, surgical approach, and operative findings.

Results: Nine of the studied patients (60%) suffered from clinical postoperative recurrence with mean duration of 23.5 ± 40.6 months. In comparison the demographic, clinical, operative, and medical treatment data between patients with postoperative recurrence of Crohn's disease and those without recurrence, age at diagnosis (mean age 42.9 years) and age at operation (mean 44.7 years) were found statistically significant in postoperative recurrence group (p-value = 0.001). According to Montreal classification of Crohn's disease, patients >40 years were significantly found in postoperative recurrence group, while patients between 17 and 40 years were significantly found in postoperative non-recurrence group (p-value=0.007) and ileal location of Crohn's disease was found significantly in postoperative recurrent group (p-value=0.044). Postoperative biological therapy significantly decreased the incidence of postoperative recurrence in the current study (p-value= 0.041).

Conclusions: Age at diagnosis, age at operation, ileal location of Crohn's disease can significantly predict postoperative recurrence. Also, postoperative biological therapy can significantly decrease the incidence of postoperative recurrence.
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http://dx.doi.org/10.1016/j.amsu.2021.102781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430268PMC
September 2021

Egypt's second wave of coronavirus disease of 2019 pandemic and its impact on patients with inflammatory bowel disease.

JGH Open 2021 Jun 6;5(6):664-668. Epub 2021 May 6.

Tropical Medicine Department, Faculty of Medicine Ain Shams University Cairo Egypt.

Background And Aim: After a decrease of COVID-19 cases in summer, Europe faced the appearance of a COVID-19 second wave. IBD patients are more vulnerable to various emotional and psychological stresses than normal individuals. The aim of this study explored the emotional state, perception, and coping strategies of patients with IBD during the COVID 19 pandemic period.

Methods: A cross-sectional study was conducted between 15 November and 15 December 2020. Patients presented to IBD Study Group Clinic, Department of Tropical Medicine, Ain Shams University Hospitals. The study included 105 IBD patients. A predesigned questionnaire was used that focused on patients' knowledge of the COVID-19 pandemic, and how it influenced patient care. Patient demographics, disease characteristics, and medication type were analyzed.

Results: We found 10.5% of patients stopped or delayed their medications owing to the COVID-19 pandemic second wave and 61% reported that their clinic visits were affected. Seven patients were tested, and two patients reported having been diagnosed with COVID-19, and 18 patients reported having relatives diagnosed with COVID-19.

Conclusion: A considerable number of patients with IBD had an interruption to their care because of the second wave COVID-19 pandemic. So, patients with IBD should take attention before, during, and after such pandemics to avoid undesirable disease-related outcomes.
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http://dx.doi.org/10.1002/jgh3.12551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171149PMC
June 2021

Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients.

World J Gastroenterol 2020 Oct;26(38):5884-5895

Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt.

Background: Bowel ultrasound and magnetic resonance enterography (MRE) are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications. They assess the degree of activity, help clinicians to identify patients in need of surgery, and can be used for patient follow-up.

Aim: To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease (IBD) patients in Egypt.

Methods: The study was conducted on 40 patients with IBD. All patients were subjected to clinical assessment, laboratory investigations, bowel ultrasound, MRE, and colonoscopy up to the terminal ileum with biopsies for histopathological examination.

Results: This study was conducted on 14 patients (35%) with ulcerative colitis and 26 patients (65%) with Crohn's disease; 34 (85%) of these patients had active disease. Bowel ultrasound detected different bowel lesions with the following accuracies: ileum (85%), large bowel (70%), fistula (95%), stricture and proximal dilatation (95%) and abscesses (100%). Also, it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.

Conclusion: In comparison to MRE, bowel ultrasound is a useful, non-invasive, and feasible bedside imaging tool for the detection of inflammation, detection of complications, and follow-up of IBD patients when performed by the attending physician.
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http://dx.doi.org/10.3748/wjg.v26.i38.5884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579751PMC
October 2020

Liver transplantation in the era of COVID-19.

Arab J Gastroenterol 2020 Jun 12;21(2):69-75. Epub 2020 May 12.

Internal Medicine Department, Hepatogastroenterology Unit, Kasr Al-Ainy School Of Medicine, Cairo University, Cairo, Egypt.

Liver transplantation is considered the ultimate solution for patients with end-stage chronic liver disease or acute liver failure. Patients with liver transplant need special care starting from preoperative preparation, surgical intervention ending with postoperative care. Transplanted patients have to receive immunosuppressive therapy to prevent rejection. Such a state of immune suppression could predispose to different types of infections in liver transplant recipients. Currently, the world is suffering a pandemic caused by a new strain of the coronavirus family called COVID-19. Certain infection control precautions are needed to protect immunocompromised and vulnerable patients, including liver transplant candidates and recipients from acquiring COVID-19 infection. Restricting non-transplant elective surgical procedures, managing transplant patients in separate outpatient clinics, and in-patient wards can prevent transmission of infection both to patients and healthcare workers. Telemedicine can help in the triage of patients to screen for symptoms of COVID-19 before their regular appointment. Management of immunosuppressive therapy and drug-drug interactions in liver transplant recipients infected with COVID-19 should be cautiously practiced to prevent rejection and effectively treat the underlying infection. In this report, we are trying to summarize available evidence about different aspects of the management of liver transplant candidates and recipients in the era of COVID-19.
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http://dx.doi.org/10.1016/j.ajg.2020.04.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214343PMC
June 2020

Hepatitis C Antiviral Therapy In Patients With Successfully Treated Hepatocellular Carcinoma: Dancing With Wolves.

J Hepatocell Carcinoma 2019 19;6:183-191. Epub 2019 Nov 19.

Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.

Hepatitis C virus (HCV) infection is known to be one of the leading causes of hepatocellular carcinoma (HCC) all over the world. Previously, multiple studies have confirmed a decreased rate of HCC occurrence or recurrence in the cases of hepatitis C associated cirrhosis after treatment with interferon, in comparison to the untreated cases, even in the absence of clearance of HCV. Treatment programs with direct-acting antivirals (DAAs) as a new method for HCV treatment and cure in 2014, with higher safety and efficacy, were considered as an important step in the treatment of patients with history of HCC, improving their overall prognosis. Recently, reports coming from various European centers claimed that the risk of HCC increased following DAAs therapy, especially in cases with previous HCC. Moreover, other studies revealed that the recurrence of HCC after DAAs treatment was more aggressive. Even though others were not able to conclude the same results, the role of DAA therapy in recurrence of HCC in patients with previous HCC after sustained virological response (SVR) achievement remains questionable. This review explored the existing literature and discussed opinions on the possibility of increasing recurrence of HCC following DAA therapy, possible mechanisms, predictors of HCC recurrence post DAAs, and whether those patients should be treated or not.
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http://dx.doi.org/10.2147/JHC.S206668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879003PMC
November 2019

A significant upsurge of body mass index in patients with chronic hepatitis C successfully treated with direct-acting antiviral regimens.

Turk J Gastroenterol 2019 08;30(8):708-713

Endemic Medicine and Hepato-Gastroenterology Department, Cairo University School of Medicine, Cairo, Egypt.

Background/aims: There is less data regarding the changes in body mass index (BMI) after treating hepatitis C virus (HCV) patients with new direct-acting antiviral agents (DAAs). This study aimed to assess the changes in BMI in chronic HCV patients treated with DAAs in Egypt and to explore other factors influencing this change.

Materials And Methods: The data of chronic HCV patients who received antiviral therapy with new DAAs in one of Egypt's specialized viral hepatitis treatment centers were retrospectively analyzed. In addition to the routine clinical and laboratory workup, changes in body weight during and after treatment were monitored and BMI was calculated. Viral load was measured at 12 weeks post-treatment to assess a sustained virological response. Patients with documented thyroid abnormalities, bariatric surgery, or ensuing special diets were excluded. BMI of >30 was taken as the cutoff for pa¬tients with obesity.

Results: The study included 162 patients with a mean age of 48.56±11.49 years, of whom 61.1% were males, 16% were treatment-experienced, 12% were diabetic, and 29% were obese. Treatment duration was 12 weeks in 84% of patients and 24 weeks in 16% of patients. There was a significant increase in BMI post-treatment as compared to pretreatment measures (28.68±5.35 vs 28.18±4.55) (p=0.03). BMI changes were constant regardless of cirrhosis or previous treatment experience.

Conclusion: Treatment of chronic HCV with DAAs was associated with increased body mass index. Further studies are needed to explore if this effect is secondary to treatment with DAAs or is an improvement in the liver function and lifestyle of treated patients.
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http://dx.doi.org/10.5152/tjg.2019.18514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699564PMC
August 2019

Egyptian liver library: An indexed database for liver disease evidence in Egypt.

Arab J Gastroenterol 2019 Jun 4;20(2):109-113. Epub 2019 Jun 4.

Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.

Liver diseases are among the most challenging health care problems worldwide. In Egypt, we established different care programs to combat liver diseases including schistosomiasis and viral hepatitides. A lot of research work addressing liver diseases in Egypt have been published with special focus on these two major fields. Other liver disease seems to be neglected although present and contributing to the liver disease burden in Egypt. In this report we reviewed the available evidence published from Egypt and elucidate areas of weakness and future research needs. Our search for Egyptian liver disease evidence retrieved 4683 articles, 67% of them were relevant to the topic. Out of the relevant articles; 1646/3265 (50.4%) were discussing clinical science, 1131 (34.7%) were discussing basic science and 488 (14.9%) were discussing both basic and clinical sciences. Cairo university (16.8%, n = 513) and Mansoura university (9.3%, n = 285) had the largest number of publications related to liver disease in Egypt respectively. The most commonly reported diseases were hepatitis C in 719/3361 articles (21.4%), parasitic liver infestations in 663 articles (19.7%), hepatocellular carcinoma in 544 articles (16.2%), liver fibrosis or cirrhosis in 537 articles (16%), and drug induced liver injury in 516 articles (15.4%). Most of the reviewed articles (36%) were discussing treatment of chronic liver diseases (n = 1201) followed by diagnostics (28%, n = 940), pathogenesis and pathophysiology (21%, n = 706). This review will direct attention to areas with less research like hepatitis B related liver disease, HIV/HCV co-infections, and non-alcoholic fatty liver disease (NAFLD) to encourage future research in these topics. In conclusion; our results ring a bell inviting the development of a roadmap for liver research in Egypt targeting to put future policies to cover areas of weakness in liver research with an ultimate goal of tackling liver disease and its overwhelming socioeconomic burden in our developing country.
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http://dx.doi.org/10.1016/j.ajg.2019.05.004DOI Listing
June 2019

Towards hepatitis C virus elimination: Egyptian experience, achievements and limitations.

World J Gastroenterol 2018 Oct;24(38):4330-4340

Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11599, Egypt.

Worldwide, more than one million people die each year from hepatitis C virus (HCV) related diseases, and over 300 million people are chronically infected with hepatitis B or C. Egypt used to be on the top of the countries with heavy HCV burden. Some countries are making advances in elimination of HCV, yet multiple factors preventing progress; remain for the majority. These factors include lack of global funding sources for treatment, late diagnosis, poor data, and inadequate screening. Treatment of HCV in Egypt has become one of the top national priorities since 2007. Egypt started a national treatment program intending to provide cure for Egyptian HCV-infected patients. Mass HCV treatment program had started using Pegylated interferon and ribavirin between 2007 and 2014. Yet, with the development of highly-effective direct acting antivirals (DAAs) for HCV, elimination of viral hepatitis has become a real possibility. The Egyptian National Committee for the Control of Viral Hepatitis did its best to provide Egyptian HCV patients with DAAs. Egypt adopted a strategy that represents a model of care that could help other countries with high HCV prevalence rate in their battle against HCV. This review covers the effects of HCV management in Egyptian real life settings and the outcome of different treatment protocols. Also, it deals with the current and future strategies for HCV prevention and screening as well as the challenges facing HCV elimination and the prospect of future eradication of HCV.
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http://dx.doi.org/10.3748/wjg.v24.i38.4330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189850PMC
October 2018

Sofosbuvir Plus Daclatasvir in Treatment of Chronic Hepatitis C Genotype 4 Infection in a Cohort of Egyptian Patients: An Experiment the Size of Egyptian Village.

Int J Hepatol 2018 20;2018:9616234. Epub 2018 Mar 20.

Tropical Medicine & Infectious Diseases Department, Tanta University, Tanta, Egypt.

Background And Aims: As indicated by the World Health Organization (WHO), Egypt is positioned as the country with the world's highest prevalence of Hepatitis C virus (HCV). HCV is transmitted through unexamined blood transfusions, different employments of syringes, and poor cleansing, as per the WHO. Our study aimed at screening and management of chronic hepatitis C genotype 4 infected patients in Bardeen village, Sharkeya Governorate, Egypt, with Sofosbuvir plus Daclatasvir, as well as estimating the safety and efficacy of that regimen.

Methods: Screening of adult patients in Bardeen village was done from March 2016 till November 2016 using hepatitis C virus antibodies by third-generation ELISA testing. Positive results were confirmed by PCR. Patients eligible for treatment received Sofosbuvir 400 mg and Daclatasvir 60 mg daily for 12 weeks and were assessed for sustained virologic response at 12 weeks following the end of treatment (SVR 12).

Results: Out of 2047 subjects screened for hepatitis C virus, 249 (12.2%) showed positive results. 221 out of those 249 subjects (88.7%) had detectable RNA by PCR. Treatment of eligible patients (183 patients) with Sofosbuvir plus Daclatasvir for 12 weeks resulted in 96% achievement of sustained virologic response at week 12. Adverse events were tolerable.

Conclusion: Sofosbuvir plus Daclatasvir regimen is safe and effective for treatment of chronic hepatitis C Genotype 4 infected patients with minimal adverse events. HCV eradication program implemented in Egypt can be a model for other countries with HCV and limited resources. The availability of generic drugs in Egypt will help much in eradication of the virus.
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http://dx.doi.org/10.1155/2018/9616234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884208PMC
March 2018

Complications and mortality after adult to adult living donor liver transplantation: A retrospective cohort study.

Ann Med Surg (Lond) 2015 Jun 25;4(2):162-71. Epub 2015 Apr 25.

Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Kom, Menoufiya, Egypt.

Background And Aims: Living donor liver transplantation (LDLT) is widely performed for patients to resolve the critical shortage of organs from cadavers. Despite rapid implementation of the procedure, both complications and mortality of LDLT are annoying problems. The aim of this study was to analyze complications and mortality of patients after adult to adult LDLT (A-ALDLT) in a single center.

Methods: Between April 2003 and November 2013, 167 (A-ALDLT) recipients in National Liver Institute, Egypt were included. We retrospectively analyzed complications and mortality in them.

Results: The overall incidence of complications was 86.2% (n = 144) and classified as biliary 43.7% (n = 73), vascular 21.6% (n = 36), Small for size syndrome (SFSS) 12.6% (n = 21), Gastrointestinal tract (GIT) 19.8% (n = 33), wound 12.6% (n = 21), chest 19.8% (n = 33), neurological 26.3% (n = 44), renal 21% (n = 35), intra abdominal collection 21.6% (n = 36), recurrent hepatitis C virus (HCV) 16.8% (n = 28), recurrent hepatocellular carcinoma (HCC) 2.4% (n = 4), acute rejection 19.2% (n = 32). 65 (45.1%) of 144 complicated patients died, while 10 (43.5%) of 23 non complicated died. The incidence of whole, in hospital and late mortalities were 44.9%, 28.7% and 16.2% respectively.

Conclusions: Mortality was higher among complicated cases where vascular complications and SFSS had significant effect on it so prevention and treatment of them is required for improving outcome.
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http://dx.doi.org/10.1016/j.amsu.2015.04.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434206PMC
June 2015

Utility and cost-effectiveness of screening for hepatocellular carcinoma in a resource-limited setting.

Med Oncol 2015 Jan 13;32(1):432. Epub 2014 Dec 13.

Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El-Kom, Menoufiya, 32511, Egypt,

The utility, efficacy and cost-effectiveness of establishing a prospective screening program for hepatocellular carcinoma (HCC) in a low-cost setting as Egypt has not been previously studied. Eligible patients in this observational study were screened by ultrasound and alpha-fetoprotein (AFP) every 6 months. A focal lesion on ultrasound or AFP >200 ng/ml or significant increase in 6 months indicated a recall. Characteristics of cases detected on screening were compared to patients diagnosed outside the screening program. Of 1,920 eligible patients, 1,286 patients participated and 102 patients (7.9 %) developed HCC, with an annual incidence of 5.3 %. Ninety-one (89.2 %) were BCLC stage 0 or A and 11 (10.8 %) stage D. Ultrasound detected a hepatic focal lesion in 99 patients, of which 74 were confirmed to be HCC, and AFP added another 28 HCC cases. The annual cost of detecting a treatable HCC case by ultrasound was 3,980 EGP ( 400) and by both ultrasound and AFP 4,645 EGP ( 500). Adding the cost of treatment, the cost/quality-adjusted life year (QALY) gained was 7,907 EGP ( 800)/QALY for screening with ultrasound only, and 8,430 EGP ( 850)/QALY for using both ultrasound and AFP, which in both cases is <50 % of the per capita GDP and <20 % of the accepted cost/QALY for Egypt. Screening for HCC is feasible and is highly cost-effective in a resource-limited setting. Adding AFP to ultrasound increased detection with a trivial addition to cost/QALY.
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http://dx.doi.org/10.1007/s12032-014-0432-7DOI Listing
January 2015
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