Background: Staging of liver fibrosis is essential for managing patients with nonalcoholic fatty ... more Background: Staging of liver fibrosis is essential for managing patients with nonalcoholic fatty liver disease (NAFLD). Liver biopsy has well-known limitations and cannot be proposed to all patients. Previous studies have demonstrated that hepatic artery resistive index (HARI) is significantly altered in NAFLD patients. The aim of this study is to assess the value of (HARI) in evaluating the progression of liver fibrosis in NAFLD patients. Patients and methods: This study was carried out on 100 NAFLD patients. All patients had undergone Doppler ultrasound and transient elastography (TE) with controlled attenuation parameter (CAP) to quantify the degree of steatosis. Laboratory work and calculation of FIB-4, ASTplatelets ratio index (APRI), NAFLD fibrosis score (NFS) were done. Sensitivity and specificity of HARI values for predication of liver fibrosis were estimated by the receiver operating characteristic curve. Results: The study revealed a statistically significant positive correlation of HARI with liver stiffness measurement (LSM) measured by fibroscan, FIB4, NFS, age, Hba1c, fasting blood sugar (P <0.0001 for all) and LDL, HDL and albumin. However, a significant negative correlation of HARI with CAP was detected (P= 0.03). At a cutoff value of 0.76, HARI had 80% sensitivity and 76% specificity for prediction of advanced fibrosis (> 9.1 KPa) with area under ROC curve equal to 0.826. Moreover, HARI at a cutoff value 0.74 showed 83% sensitivity and 72% specificity for the prediction of liver cirrhosis (≥ 10.4 KPa) with the area under the ROC curve equal to 0.803. Conclusion: HARI is a good non-invasive tool to predict the risk of liver fibrosis progression in patients with NAFLD particularly advanced fibrosis and cirrhosis. HADRI correlates with other non-invasive methods of assessment of fibrosis including LSM, CAP, FIB4 and NFS, and may provide an easy, available tool for monitoring of patients with NAFLD. Patients and methods This study was carried out on 100 patients (28 males and 72 females) with NAFLD aged between (30-66) years old recruited from an out and inpatient clinic of Tropical medicine department, Mansoura University, Dakahlya, Egypt, between June 2018 and May 2021. All patients aged 18 years old and above with body mass index (BMI) more than 25 and evidence of any grade of fatty liver by ultrasonography. All subjects have signed a written
Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, ranging from 6% to 28% ... more Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, ranging from 6% to 28% with an average of approximately 13.8% in the general population. It has been reported that human leucocyte antigen (HLA) alleles are associated with the outcome of HCV infection, but this associations showed ethnic and geographical differences. The objective of this study is to investigate the association between the frequencies of HLA Class I and chronic HCV infection in Egyptian patients and to find out whether there is a relation between certain HLA Class I antigens and HCV viral load, degree of fibrosis, activity and alanine aminotransferase (ALT) level. A case control study was conducted on 100 patients with chronic HCV infection and 150 healthy controls. HLA-A and HLA-B typing by complement-dependent micro-lympho-cytotoxicity assay was performed for both groups. HLA-A11 antigen was significantly increased in patients with chronic HCV infection versus controls (OR 3.98; 95% CI = 1.85-8.89; P = 0.001; and Pc = 0.021). HLA-B12, HLA-B13, HLA-B17 and HLA-B40 were higher in patients, and HLA-A32 and HLA-B14 were higher in controls, although the significance was lost after correction for multiple testing. HLA-A9 was significantly associated with low viral load (P = 0.008, Pc = 0.048). The results of this work implicate that HLA-A11 antigen may influence chronic HCV infection and may play a role in viral persistence. Different HLA Class I antigens are not associated with degree of liver fibrosis, grades of activity or level of ALT. However, HLA-A9 is associated with low HCV viral load in chronic HCV Egyptian patients.
INTRODUCTION Previous studies examining the prevalence of serum autoantibodies in patients with N... more INTRODUCTION Previous studies examining the prevalence of serum autoantibodies in patients with NAFLD reported a wide range of prevalence rates depending on the threshold values used for an abnormal titer. We aimed to evaluate the association of anti-smooth muscle antibodies (ASMAbs) with pathological changes including liver fibrosis in NAFLD patients. PATIENTS AND METHODS 124 patients were enrolled and classifed on ASMAbs positive (>1/40) or negative (= or <1/40). AST, ALT, total bilirubin, albumin, triglycerides, prothrombin time were measured by standard routine methods. In addition to liver biopsy and ultrasonography, autoimmune markers (ANA, ASMAbs, and gammaglobulins were assessed. RESULTS Analysis of histological features showed significant difference between groups with tendency of patients with positive ASMAbs to have higher steatosis percent compared to those with negative ASMA (P < 0.001); also current study demonstrated that patients with fatty liver and positive ASMA have a significant difference as regard necro inflammation, liver fibrosis and NAS score when compared to patients with fatty liver and negative ASMAbs (P= 0.004, P <0.001 and P= 0.002) respectively. The result of Logistic regression for prediction of liver fibrosis (early versus significant fibrosis) showed that ASMA is a significant predictor for fibrosis with OR (95% CI): 6.29 (1.95-20.23). CONCLUSION ASMAbs are frequently present in NAFLD and have an impact on the histopathology of this liver disease.
We used the MedCalc program to calculate the sample size. The con dence level of our study was 95... more We used the MedCalc program to calculate the sample size. The con dence level of our study was 95% with an alpha error of 0.05. The power of this study was decided at 90 with a beta error of 10. The maximum prediction of response by HLA was 60% with the minimal prediction from 50%. Our estimated sample was 112 patients, however we increased the sample by more than one third Abstract Background: Racial differences and broad spectrum response to anti-hepatitis C (anti-HCV) therapy suggest a possible role for host genetic diversity in treatment outcomes. We aim to determine the association and predictive value of certain human leukocyte antigen (HLA) class I alleles with either susceptibility to viral clearance or persistence following pegylated interferon (Peg-IFN) plus ribavirin therapy in chronic hepatitis C (HCV) genotype 4 patients in Egypt. Methods: This study included 200 unrelated chronic HCV patients who received Peg-IFN plus ribavirin therapy [112 patients with sustained virological response (SVR) and 88 non-responders (NR)]. Serological testing of HLA class I antigens (HLA-A and HLA-B alleles) were performed by standard complement-dependent microlymphocytotoxicity assay. Results: The frequency of HLA-A01 was signi cantly higher in SVR than in NR cases [OR: 0.51; 95% CI: 0.27-0.981; P = 0.042], while the frequency of alleles B38 (P = 0.011), B40 (P < 0.001) and B41 (P < 0.001) was signi cantly higher in NR cases (OR/95%
ABSTRACT Background/aim: The immunopathogenesis of occult hepatitis C virus (HCV) infection is a ... more ABSTRACT Background/aim: The immunopathogenesis of occult hepatitis C virus (HCV) infection is a matter of great controversy and has been suggested to involve a complex balance between cytokines with proinflammatory and anti-inflammatory activity. This work aimed at studying the production of serum Th1 and Th2 cytokines in patients with occult HCV infection. Methods: Serum levels of cytokines Th1 [interleukin-2 (IL-2) and interferon-γ (IFN-γ)] and Th2 (IL-4) were measured in 27 patients with occult HCV infection and in 28 patients with chronic hepatitis C infection. Results: The levels of IL-2 and IFN-γ were highly significantly increased in patients with chronic HCV infection (P&lt;0.001). In contrast, IL-4 showed a highly significant increase in occult HCV infection (P&lt;0.001). Significant increases were noted in chronic HCV infection with respect to bilirubin (P&lt;0.001), alanine transaminase (P=0.009), aspartate transaminase (P=0.013) and alfa-fetoprotein (P&lt;0.001) levels, whereas the level of serum albumin was significantly higher in occult HCV infection (P&lt;0.001). The degree of necroinflammation (P&lt;0.001), fibrosis (P&lt;0.001) and cirrhosis (P=0.03) was significantly increased during chronic HCV infection. Conclusion: Our data revealed a high prevalence of occult HCV infection (25%) in patients with unexplained persistently abnormal liver function test results. These patients exhibited a distinct immunoregulatory cytokine pattern, favouring viral persistence and explaining the less-aggressive course of this disease entity compared with chronic HCV infection.
Nonalcoholic Fatty Liver Disease (NAFLD) is a clinical syndrome characterized by predominant macr... more Nonalcoholic Fatty Liver Disease (NAFLD) is a clinical syndrome characterized by predominant macrovesicular steatosis of the liver. NAFLD comprises a range of liver conditions varying in severity of hepatocytes injury and resulting fibrosis-cirrhosis risk. Among these, hepatic steatosis (fatty liver) is referred to as NAFL, and nonalcoholic fatty liver (NAFL) is defined as a more grave process with both fat and inflammation in the liver that over time can cause liver cirrhosis (steatohepatitis). Liver biopsy is the gold standard method to differentiate, whether the patient with fatty liver has only steatosis, or NASH. Unfortunately, liver biopsy has well-known limitations (invasiveness and sampling variability) and cannot be proposed for all patients, especially given the high prevalence of NAFLD worldwide. This review discuss the radiologic evaluation of liver steatosis and fibrosis for patients with NAFLD.
To determine the prevalent pathogens responsible for spontaneous bacterial peritonitis (SBP) and ... more To determine the prevalent pathogens responsible for spontaneous bacterial peritonitis (SBP) and their sensitivity pattern, to test the efficiency of different culture techniques in microbial isolation, and to study the diagnostic predictors of such cases. Methods: One hundred eight SBP episodes from 92 adult patients were compared to 88 cirrhotic ascites patients cross-matched with age and sex without SBP. Ascitic fluid was subjected to cytological, biochemical examination and culture on both conventional and blood culture bottles at the bedside for bacterial identification and antimicrobial susceptibility testing. Results: The prevalence of SBP was 25.02%. Logistic regression analysis revealed that; previous SBP episode, low ascitic fluid protein levels, high serum creatinine and low serum albumin levels were the independent significant predictors of SBP. About forty-five per cent of SBP episodes were detected by conventional culture compared to 73.15% by modified technique with a...
Background: The role of immune response to chronic hepatitis B virus (HBV) infection is complex; ... more Background: The role of immune response to chronic hepatitis B virus (HBV) infection is complex; and the specific T-cell response to this infection can determine the duration and the extent of liver disease. Objective: This study aimed at assessing the profile of Tlymphocyte subpopulations in chronic hepatitis B (CHB) patients and its association with HBV replication. Methodology: The case group included 50 CHB patients with normal liver function tests (LFTs); and the control group included 50 age and sexmatched healthy individuals. The HBV markers, LFTs and serum viral load were measured in cases. Blood CD4 and CD8 T-lymphocyte subpopulations and the CD4/CD8 ratio were assessed in both groups by flow cytometry. Results: Our results showed significantly higher CD8 T-cells; significantly lower CD3 and CD4 T-cells; markedly reduced CD4/CD8 ratio in the cases as compared to the controls (P<0.001, for all). This T-cell impairment was also significantly linked to HBeAg positivity and ...
Background: hepatitis is one of endemic diseases in Egypt represent in almost 15-18% of populatio... more Background: hepatitis is one of endemic diseases in Egypt represent in almost 15-18% of population, beside bilharzial preportal fibrosis with its sequelae of thrombocytopenia and bleeding disorders making a treating of chronic subdural haematoma challenging neurosurgeon for getting best results especially no guidelines to follow. Aim of the work: to evaluate the surgical results clinically, radiologically and efficacy of rapid correction of coagulopathy and platelets for evacuation of chronic subdural hematoma (CSDH) in prospective controlled manner. Material and method: it includes two groups: group A which had bleeding disorder due to liver disease (hepatitis & bilharsiasis) 75 cases and the other group B which is normal control group 150 cases) in the period from March 2008 till July 2014 with follow up range from 4 months to 4 years. The surgical procedure was done under general anesthesia by two burr holes’ evacuation. Clinical, neurological examination and Computed topography ...
Objective Evaluating the auditory function in patients with chronic hepatitis C treated with sofo... more Objective Evaluating the auditory function in patients with chronic hepatitis C treated with sofosbuvir and ribavirin. Methods This study involved 80 patients with chronic hepatitis C who agreed to receive sofosbuvir and ribavirin. All participants were subjected to baseline otological and audiological assessment just before treatment. The audiological assessment included standard pure tone audiometry, extended high-frequency audiometry, immitancemetry and otoacoustic emissions (OAEs) (transient and distortion product). According to baseline hearing threshold measurements, the study population was divided into 2 groups. Group 1 included 42 patients with normal hearing sensitivity (250–8000 Hz), and Group 2 included 38 patients with sensorineural hearing loss. After 24 weeks of therapy, otological and audiological assessments were repeated and compared between the two groups and before and after therapy. Results Post-treatment hearing threshold evaluation showed no significant differ...
Introduction: The hOGG1 gene encodes a DNA glycosylase enzyme responsible for DNA repair. The Ser... more Introduction: The hOGG1 gene encodes a DNA glycosylase enzyme responsible for DNA repair. The Ser326Cys polymorphism in this gene may influence its repair ability and thus plays a role in carcinogenesis. Several case-control studies have been conducted on this polymorphism and its relationship with the risk of hepatocellular carcinoma (HCC) but, the results were inconsistent. Also, yet the role of IR in the development of HCC associated with chronic HCV infection has not been establishedThe objective of this studyto evaluate the role of hOGG1 Ser326Cys gene polymorphism and insulin resistance (IR) in The Development of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C in Egyptian patients.Material and methods:This study was included 130subjects, they were divided into three groups: 40 as Control group, 61 as HCCgroup(HCV with HCC) and29 as HCV group (without HCC).Their age ranged from 4189 years. All subjects undergo the PCR analysis;the genotyping for hOGG1 was detected...
BMI1 is a polycomb group (PcG) proteins which maintain self-renewal of stem cells, and is overexp... more BMI1 is a polycomb group (PcG) proteins which maintain self-renewal of stem cells, and is overexpressed in leukemia. This study was aimed to investigate the expression of BMI1 chronic myeloid leukemia (CML) and its clinical significance. Expression levels of BMI1 in 45 CML patients and 10 healthy controls were measured by real time quantitative polymerase chain reaction (RQ-PCR). The results showed that the expression of BMI1 was significantly higher in advanced phase than in chronic phase (p <0.05) and healthy controls (p <0.05). The 3-year survival rate was significantly lower in advance patients than in chronic phase CML patients (95% vs. 50%, p = 0.005). Interstingly, overall survival was longer in low BMI1 expression patients than in high BMI1 expression patients (p = 0.012). We conclude that detecting BMI1 is helpful for the diagnosis and prognosis by predicting the overall survival and monitoring of patients with CML.
Background The mechanism of lymphomagenesis of hepatitis C virus (HCV)-related B-cell lymphoma is... more Background The mechanism of lymphomagenesis of hepatitis C virus (HCV)-related B-cell lymphoma is unknown. Recently, it has been suggested that HCV may induce B-cell clonal proliferation and t(14;18) translocation in patients chronically infected with the virus. Aim The aim of this study was to assess the occurrence of immunoglobulin heavy chain ( IgH ) gene rearrangement and t(14;18) translocation in Egyptian chronic HCV patients and to examine the effect of antiviral treatment on IgH rearrangement and t(14;18) in HCV-infected patients. Patients and methods Forty-five Egyptian patients with chronic HCV infection were selected. The level of HCV-RNA in the serum was quantified using the Stratagene Mx3000P Real-Time PCR System at diagnosis and 3, 6, and 12 months from the beginning of the therapy. IgH clonality was detected using multiplex VH-JH (FR2) PCR, whereas t(14;18) was detected using nested PCR before and after antiviral therapy. Results After 3 months of antiviral therapy, 24/45 patients (53.3%) showed an early virological response and completed their 12 months of antiviral therapy, after which they showed complete clearance of serum HCV-RNA (responder group). However, 21/45 patients (46.7%) did not show early virological response and hence stopped their therapy (nonresponder group). Clonal IgH rearrangement and t(14;18) were detected in 33.3 and 40% of patients, respectively. The percentage of patients who lose their clonal IgH or t(14;18) varies according to the completion of antiviral therapy. On comparing responder (12 months therapy) versus nonresponder (3 months therapy) groups, the loss of clonal IgH was nonsignificant (100 vs. 66.7%, P =0.134) whereas it was highly significant in terms of regression in t(14;18) (75 vs. 0%, P =0.0006). Conclusion In Egyptian patients with chronic HCV infection, the presence of clonal B cell and t(14;18) is a frequent finding. Twelve months of antiviral therapy are efficiently effective for regression of clonal IgH gene rearrangement and t(14;18) .
This study was planned to evaluate the in vitro production of IL-1 beta and IL-4 by peripheral bl... more This study was planned to evaluate the in vitro production of IL-1 beta and IL-4 by peripheral blood mononuclear cells (PBMCs) and total IgE in patients with fascioliasis before and 3 months after treatment with purified extract of myrrh from Commiphora molmol tree (Mirazid), to determine the role of these variables in immunopathogenesis of the disease in relation to this new drug. The study was carried out in Departments of Tropical Medicine, Al-Azhar University Hospitals in the period from March 2002 to November 2003. A total of 35 patients with chronic fascioliasis with age range from 9-45 years in addition to 10 healthy subjects with matched age and sex serving as controls were studied. Serum IgE and in vitro IL-1 and IL-4 were estimated by enzyme immuno-assay (ELISA) before and 3 months after therapy. Results revealed significant increase in IL-1 beta in patients before treatment than control (p<0.001) but it decreased significantly after therapy (p<0.001) to reach the co...
The role of Notch pathway in hepatocarcinogenesis is unclear with conflicting results reported fr... more The role of Notch pathway in hepatocarcinogenesis is unclear with conflicting results reported from different researchers. This study aimed to investigate the exact role of Notch1 in hepatocarcinogenesis and its influence on survival and to determine the possibility of it being a target therapy. Differential immunohistochemical expression of Notch1 in 100 cases of hepatocellular carcinoma (HCC) and adjacent non-neoplastic liver tissue was performed. The results showed that expression of Notch1 was significantly higher in the non-neoplastic hepatic tissues than in HCC tissues (p &lt; 0.001), but there was no significant difference in Notch1 expression between cirrhotic and non-cirrhotic liver tissue (p = 0.197). Notch1 expression was higher in low grade than in high grade HCC (p = 0.036). Notch1 expression showed reverse correlation with mitotic count (p = 0.008), and necrosis (p = 0.005). The disease free survival was shorter in patients displaying low levels of Notch1 expression (p = 0.045). The overall survival showed no significant difference between high and low levels of Notch1 expression; however, it was somewhat longer in patients with high Notch1 expression (p = 0.220). In conclusion, the tumour suppressor role of Notch1 was supported and the use of Notch1 agonists may have a role in improving the prognosis of HCC.
There are millions of chronic hepatitis C (CHC) virus-infected patients who have been treated wit... more There are millions of chronic hepatitis C (CHC) virus-infected patients who have been treated with a combination therapy (interferon and ribavirin) and have achieved a virological response (SVR) worldwide. The aim of this study is to evaluate the risk factors for de-novo diabetes mellitus in CHC patients treated with combination therapy (interferon and ribavirin) and have achieved an SVR. A total of 214 nondiabetic CHC patients with SVR and baseline homeostasis model assessment (HOMA) less than or equal to 2 were divided into group A, which included 108 patients with a BMI less than 25, and group B, which included 106 patients with a BMI of at least 25 and less than 30. HOMA insulin resistance (IR) and BMI were measured at the baseline, at achievement of an SVR, and 1 year after achievement of an SVR. Leptin levels were assessed at baseline and 1 year after achievement of an SVR in patients with increased BMI. One year after SVR, 36 (33.33%) patients from group A developed increasing BMI with no significant changes in HOMA versus that at SVR (P=0.53), but showed a significant reduction versus baseline HOMA (P=0.02). In group B, 68 (64.1%) patients showed increased BMI of at least 25, with a significant increase in HOMA versus that at SVR (P=0.02), and with no significant reduction versus baseline HOMA (P=0.44). In group B, serum leptin showed a significant reduction 12 months after achievement of an SVR versus baseline in patients with increased BMI. Six patients from group B with increased BMI after 1 year developed de-novo IR and type two diabetes mellitus. In nondiabetic CHC patients with SVR and baseline BMI of at least 25, the post-SVR increase in BMI predisposed to an increase in HOMA-IR and could be considered a predisposing factor for diabetes mellitus.
Background: Staging of liver fibrosis is essential for managing patients with nonalcoholic fatty ... more Background: Staging of liver fibrosis is essential for managing patients with nonalcoholic fatty liver disease (NAFLD). Liver biopsy has well-known limitations and cannot be proposed to all patients. Previous studies have demonstrated that hepatic artery resistive index (HARI) is significantly altered in NAFLD patients. The aim of this study is to assess the value of (HARI) in evaluating the progression of liver fibrosis in NAFLD patients. Patients and methods: This study was carried out on 100 NAFLD patients. All patients had undergone Doppler ultrasound and transient elastography (TE) with controlled attenuation parameter (CAP) to quantify the degree of steatosis. Laboratory work and calculation of FIB-4, ASTplatelets ratio index (APRI), NAFLD fibrosis score (NFS) were done. Sensitivity and specificity of HARI values for predication of liver fibrosis were estimated by the receiver operating characteristic curve. Results: The study revealed a statistically significant positive correlation of HARI with liver stiffness measurement (LSM) measured by fibroscan, FIB4, NFS, age, Hba1c, fasting blood sugar (P <0.0001 for all) and LDL, HDL and albumin. However, a significant negative correlation of HARI with CAP was detected (P= 0.03). At a cutoff value of 0.76, HARI had 80% sensitivity and 76% specificity for prediction of advanced fibrosis (> 9.1 KPa) with area under ROC curve equal to 0.826. Moreover, HARI at a cutoff value 0.74 showed 83% sensitivity and 72% specificity for the prediction of liver cirrhosis (≥ 10.4 KPa) with the area under the ROC curve equal to 0.803. Conclusion: HARI is a good non-invasive tool to predict the risk of liver fibrosis progression in patients with NAFLD particularly advanced fibrosis and cirrhosis. HADRI correlates with other non-invasive methods of assessment of fibrosis including LSM, CAP, FIB4 and NFS, and may provide an easy, available tool for monitoring of patients with NAFLD. Patients and methods This study was carried out on 100 patients (28 males and 72 females) with NAFLD aged between (30-66) years old recruited from an out and inpatient clinic of Tropical medicine department, Mansoura University, Dakahlya, Egypt, between June 2018 and May 2021. All patients aged 18 years old and above with body mass index (BMI) more than 25 and evidence of any grade of fatty liver by ultrasonography. All subjects have signed a written
Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, ranging from 6% to 28% ... more Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, ranging from 6% to 28% with an average of approximately 13.8% in the general population. It has been reported that human leucocyte antigen (HLA) alleles are associated with the outcome of HCV infection, but this associations showed ethnic and geographical differences. The objective of this study is to investigate the association between the frequencies of HLA Class I and chronic HCV infection in Egyptian patients and to find out whether there is a relation between certain HLA Class I antigens and HCV viral load, degree of fibrosis, activity and alanine aminotransferase (ALT) level. A case control study was conducted on 100 patients with chronic HCV infection and 150 healthy controls. HLA-A and HLA-B typing by complement-dependent micro-lympho-cytotoxicity assay was performed for both groups. HLA-A11 antigen was significantly increased in patients with chronic HCV infection versus controls (OR 3.98; 95% CI = 1.85-8.89; P = 0.001; and Pc = 0.021). HLA-B12, HLA-B13, HLA-B17 and HLA-B40 were higher in patients, and HLA-A32 and HLA-B14 were higher in controls, although the significance was lost after correction for multiple testing. HLA-A9 was significantly associated with low viral load (P = 0.008, Pc = 0.048). The results of this work implicate that HLA-A11 antigen may influence chronic HCV infection and may play a role in viral persistence. Different HLA Class I antigens are not associated with degree of liver fibrosis, grades of activity or level of ALT. However, HLA-A9 is associated with low HCV viral load in chronic HCV Egyptian patients.
INTRODUCTION Previous studies examining the prevalence of serum autoantibodies in patients with N... more INTRODUCTION Previous studies examining the prevalence of serum autoantibodies in patients with NAFLD reported a wide range of prevalence rates depending on the threshold values used for an abnormal titer. We aimed to evaluate the association of anti-smooth muscle antibodies (ASMAbs) with pathological changes including liver fibrosis in NAFLD patients. PATIENTS AND METHODS 124 patients were enrolled and classifed on ASMAbs positive (>1/40) or negative (= or <1/40). AST, ALT, total bilirubin, albumin, triglycerides, prothrombin time were measured by standard routine methods. In addition to liver biopsy and ultrasonography, autoimmune markers (ANA, ASMAbs, and gammaglobulins were assessed. RESULTS Analysis of histological features showed significant difference between groups with tendency of patients with positive ASMAbs to have higher steatosis percent compared to those with negative ASMA (P < 0.001); also current study demonstrated that patients with fatty liver and positive ASMA have a significant difference as regard necro inflammation, liver fibrosis and NAS score when compared to patients with fatty liver and negative ASMAbs (P= 0.004, P <0.001 and P= 0.002) respectively. The result of Logistic regression for prediction of liver fibrosis (early versus significant fibrosis) showed that ASMA is a significant predictor for fibrosis with OR (95% CI): 6.29 (1.95-20.23). CONCLUSION ASMAbs are frequently present in NAFLD and have an impact on the histopathology of this liver disease.
We used the MedCalc program to calculate the sample size. The con dence level of our study was 95... more We used the MedCalc program to calculate the sample size. The con dence level of our study was 95% with an alpha error of 0.05. The power of this study was decided at 90 with a beta error of 10. The maximum prediction of response by HLA was 60% with the minimal prediction from 50%. Our estimated sample was 112 patients, however we increased the sample by more than one third Abstract Background: Racial differences and broad spectrum response to anti-hepatitis C (anti-HCV) therapy suggest a possible role for host genetic diversity in treatment outcomes. We aim to determine the association and predictive value of certain human leukocyte antigen (HLA) class I alleles with either susceptibility to viral clearance or persistence following pegylated interferon (Peg-IFN) plus ribavirin therapy in chronic hepatitis C (HCV) genotype 4 patients in Egypt. Methods: This study included 200 unrelated chronic HCV patients who received Peg-IFN plus ribavirin therapy [112 patients with sustained virological response (SVR) and 88 non-responders (NR)]. Serological testing of HLA class I antigens (HLA-A and HLA-B alleles) were performed by standard complement-dependent microlymphocytotoxicity assay. Results: The frequency of HLA-A01 was signi cantly higher in SVR than in NR cases [OR: 0.51; 95% CI: 0.27-0.981; P = 0.042], while the frequency of alleles B38 (P = 0.011), B40 (P < 0.001) and B41 (P < 0.001) was signi cantly higher in NR cases (OR/95%
ABSTRACT Background/aim: The immunopathogenesis of occult hepatitis C virus (HCV) infection is a ... more ABSTRACT Background/aim: The immunopathogenesis of occult hepatitis C virus (HCV) infection is a matter of great controversy and has been suggested to involve a complex balance between cytokines with proinflammatory and anti-inflammatory activity. This work aimed at studying the production of serum Th1 and Th2 cytokines in patients with occult HCV infection. Methods: Serum levels of cytokines Th1 [interleukin-2 (IL-2) and interferon-γ (IFN-γ)] and Th2 (IL-4) were measured in 27 patients with occult HCV infection and in 28 patients with chronic hepatitis C infection. Results: The levels of IL-2 and IFN-γ were highly significantly increased in patients with chronic HCV infection (P&lt;0.001). In contrast, IL-4 showed a highly significant increase in occult HCV infection (P&lt;0.001). Significant increases were noted in chronic HCV infection with respect to bilirubin (P&lt;0.001), alanine transaminase (P=0.009), aspartate transaminase (P=0.013) and alfa-fetoprotein (P&lt;0.001) levels, whereas the level of serum albumin was significantly higher in occult HCV infection (P&lt;0.001). The degree of necroinflammation (P&lt;0.001), fibrosis (P&lt;0.001) and cirrhosis (P=0.03) was significantly increased during chronic HCV infection. Conclusion: Our data revealed a high prevalence of occult HCV infection (25%) in patients with unexplained persistently abnormal liver function test results. These patients exhibited a distinct immunoregulatory cytokine pattern, favouring viral persistence and explaining the less-aggressive course of this disease entity compared with chronic HCV infection.
Nonalcoholic Fatty Liver Disease (NAFLD) is a clinical syndrome characterized by predominant macr... more Nonalcoholic Fatty Liver Disease (NAFLD) is a clinical syndrome characterized by predominant macrovesicular steatosis of the liver. NAFLD comprises a range of liver conditions varying in severity of hepatocytes injury and resulting fibrosis-cirrhosis risk. Among these, hepatic steatosis (fatty liver) is referred to as NAFL, and nonalcoholic fatty liver (NAFL) is defined as a more grave process with both fat and inflammation in the liver that over time can cause liver cirrhosis (steatohepatitis). Liver biopsy is the gold standard method to differentiate, whether the patient with fatty liver has only steatosis, or NASH. Unfortunately, liver biopsy has well-known limitations (invasiveness and sampling variability) and cannot be proposed for all patients, especially given the high prevalence of NAFLD worldwide. This review discuss the radiologic evaluation of liver steatosis and fibrosis for patients with NAFLD.
To determine the prevalent pathogens responsible for spontaneous bacterial peritonitis (SBP) and ... more To determine the prevalent pathogens responsible for spontaneous bacterial peritonitis (SBP) and their sensitivity pattern, to test the efficiency of different culture techniques in microbial isolation, and to study the diagnostic predictors of such cases. Methods: One hundred eight SBP episodes from 92 adult patients were compared to 88 cirrhotic ascites patients cross-matched with age and sex without SBP. Ascitic fluid was subjected to cytological, biochemical examination and culture on both conventional and blood culture bottles at the bedside for bacterial identification and antimicrobial susceptibility testing. Results: The prevalence of SBP was 25.02%. Logistic regression analysis revealed that; previous SBP episode, low ascitic fluid protein levels, high serum creatinine and low serum albumin levels were the independent significant predictors of SBP. About forty-five per cent of SBP episodes were detected by conventional culture compared to 73.15% by modified technique with a...
Background: The role of immune response to chronic hepatitis B virus (HBV) infection is complex; ... more Background: The role of immune response to chronic hepatitis B virus (HBV) infection is complex; and the specific T-cell response to this infection can determine the duration and the extent of liver disease. Objective: This study aimed at assessing the profile of Tlymphocyte subpopulations in chronic hepatitis B (CHB) patients and its association with HBV replication. Methodology: The case group included 50 CHB patients with normal liver function tests (LFTs); and the control group included 50 age and sexmatched healthy individuals. The HBV markers, LFTs and serum viral load were measured in cases. Blood CD4 and CD8 T-lymphocyte subpopulations and the CD4/CD8 ratio were assessed in both groups by flow cytometry. Results: Our results showed significantly higher CD8 T-cells; significantly lower CD3 and CD4 T-cells; markedly reduced CD4/CD8 ratio in the cases as compared to the controls (P<0.001, for all). This T-cell impairment was also significantly linked to HBeAg positivity and ...
Background: hepatitis is one of endemic diseases in Egypt represent in almost 15-18% of populatio... more Background: hepatitis is one of endemic diseases in Egypt represent in almost 15-18% of population, beside bilharzial preportal fibrosis with its sequelae of thrombocytopenia and bleeding disorders making a treating of chronic subdural haematoma challenging neurosurgeon for getting best results especially no guidelines to follow. Aim of the work: to evaluate the surgical results clinically, radiologically and efficacy of rapid correction of coagulopathy and platelets for evacuation of chronic subdural hematoma (CSDH) in prospective controlled manner. Material and method: it includes two groups: group A which had bleeding disorder due to liver disease (hepatitis & bilharsiasis) 75 cases and the other group B which is normal control group 150 cases) in the period from March 2008 till July 2014 with follow up range from 4 months to 4 years. The surgical procedure was done under general anesthesia by two burr holes’ evacuation. Clinical, neurological examination and Computed topography ...
Objective Evaluating the auditory function in patients with chronic hepatitis C treated with sofo... more Objective Evaluating the auditory function in patients with chronic hepatitis C treated with sofosbuvir and ribavirin. Methods This study involved 80 patients with chronic hepatitis C who agreed to receive sofosbuvir and ribavirin. All participants were subjected to baseline otological and audiological assessment just before treatment. The audiological assessment included standard pure tone audiometry, extended high-frequency audiometry, immitancemetry and otoacoustic emissions (OAEs) (transient and distortion product). According to baseline hearing threshold measurements, the study population was divided into 2 groups. Group 1 included 42 patients with normal hearing sensitivity (250–8000 Hz), and Group 2 included 38 patients with sensorineural hearing loss. After 24 weeks of therapy, otological and audiological assessments were repeated and compared between the two groups and before and after therapy. Results Post-treatment hearing threshold evaluation showed no significant differ...
Introduction: The hOGG1 gene encodes a DNA glycosylase enzyme responsible for DNA repair. The Ser... more Introduction: The hOGG1 gene encodes a DNA glycosylase enzyme responsible for DNA repair. The Ser326Cys polymorphism in this gene may influence its repair ability and thus plays a role in carcinogenesis. Several case-control studies have been conducted on this polymorphism and its relationship with the risk of hepatocellular carcinoma (HCC) but, the results were inconsistent. Also, yet the role of IR in the development of HCC associated with chronic HCV infection has not been establishedThe objective of this studyto evaluate the role of hOGG1 Ser326Cys gene polymorphism and insulin resistance (IR) in The Development of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C in Egyptian patients.Material and methods:This study was included 130subjects, they were divided into three groups: 40 as Control group, 61 as HCCgroup(HCV with HCC) and29 as HCV group (without HCC).Their age ranged from 4189 years. All subjects undergo the PCR analysis;the genotyping for hOGG1 was detected...
BMI1 is a polycomb group (PcG) proteins which maintain self-renewal of stem cells, and is overexp... more BMI1 is a polycomb group (PcG) proteins which maintain self-renewal of stem cells, and is overexpressed in leukemia. This study was aimed to investigate the expression of BMI1 chronic myeloid leukemia (CML) and its clinical significance. Expression levels of BMI1 in 45 CML patients and 10 healthy controls were measured by real time quantitative polymerase chain reaction (RQ-PCR). The results showed that the expression of BMI1 was significantly higher in advanced phase than in chronic phase (p <0.05) and healthy controls (p <0.05). The 3-year survival rate was significantly lower in advance patients than in chronic phase CML patients (95% vs. 50%, p = 0.005). Interstingly, overall survival was longer in low BMI1 expression patients than in high BMI1 expression patients (p = 0.012). We conclude that detecting BMI1 is helpful for the diagnosis and prognosis by predicting the overall survival and monitoring of patients with CML.
Background The mechanism of lymphomagenesis of hepatitis C virus (HCV)-related B-cell lymphoma is... more Background The mechanism of lymphomagenesis of hepatitis C virus (HCV)-related B-cell lymphoma is unknown. Recently, it has been suggested that HCV may induce B-cell clonal proliferation and t(14;18) translocation in patients chronically infected with the virus. Aim The aim of this study was to assess the occurrence of immunoglobulin heavy chain ( IgH ) gene rearrangement and t(14;18) translocation in Egyptian chronic HCV patients and to examine the effect of antiviral treatment on IgH rearrangement and t(14;18) in HCV-infected patients. Patients and methods Forty-five Egyptian patients with chronic HCV infection were selected. The level of HCV-RNA in the serum was quantified using the Stratagene Mx3000P Real-Time PCR System at diagnosis and 3, 6, and 12 months from the beginning of the therapy. IgH clonality was detected using multiplex VH-JH (FR2) PCR, whereas t(14;18) was detected using nested PCR before and after antiviral therapy. Results After 3 months of antiviral therapy, 24/45 patients (53.3%) showed an early virological response and completed their 12 months of antiviral therapy, after which they showed complete clearance of serum HCV-RNA (responder group). However, 21/45 patients (46.7%) did not show early virological response and hence stopped their therapy (nonresponder group). Clonal IgH rearrangement and t(14;18) were detected in 33.3 and 40% of patients, respectively. The percentage of patients who lose their clonal IgH or t(14;18) varies according to the completion of antiviral therapy. On comparing responder (12 months therapy) versus nonresponder (3 months therapy) groups, the loss of clonal IgH was nonsignificant (100 vs. 66.7%, P =0.134) whereas it was highly significant in terms of regression in t(14;18) (75 vs. 0%, P =0.0006). Conclusion In Egyptian patients with chronic HCV infection, the presence of clonal B cell and t(14;18) is a frequent finding. Twelve months of antiviral therapy are efficiently effective for regression of clonal IgH gene rearrangement and t(14;18) .
This study was planned to evaluate the in vitro production of IL-1 beta and IL-4 by peripheral bl... more This study was planned to evaluate the in vitro production of IL-1 beta and IL-4 by peripheral blood mononuclear cells (PBMCs) and total IgE in patients with fascioliasis before and 3 months after treatment with purified extract of myrrh from Commiphora molmol tree (Mirazid), to determine the role of these variables in immunopathogenesis of the disease in relation to this new drug. The study was carried out in Departments of Tropical Medicine, Al-Azhar University Hospitals in the period from March 2002 to November 2003. A total of 35 patients with chronic fascioliasis with age range from 9-45 years in addition to 10 healthy subjects with matched age and sex serving as controls were studied. Serum IgE and in vitro IL-1 and IL-4 were estimated by enzyme immuno-assay (ELISA) before and 3 months after therapy. Results revealed significant increase in IL-1 beta in patients before treatment than control (p<0.001) but it decreased significantly after therapy (p<0.001) to reach the co...
The role of Notch pathway in hepatocarcinogenesis is unclear with conflicting results reported fr... more The role of Notch pathway in hepatocarcinogenesis is unclear with conflicting results reported from different researchers. This study aimed to investigate the exact role of Notch1 in hepatocarcinogenesis and its influence on survival and to determine the possibility of it being a target therapy. Differential immunohistochemical expression of Notch1 in 100 cases of hepatocellular carcinoma (HCC) and adjacent non-neoplastic liver tissue was performed. The results showed that expression of Notch1 was significantly higher in the non-neoplastic hepatic tissues than in HCC tissues (p &lt; 0.001), but there was no significant difference in Notch1 expression between cirrhotic and non-cirrhotic liver tissue (p = 0.197). Notch1 expression was higher in low grade than in high grade HCC (p = 0.036). Notch1 expression showed reverse correlation with mitotic count (p = 0.008), and necrosis (p = 0.005). The disease free survival was shorter in patients displaying low levels of Notch1 expression (p = 0.045). The overall survival showed no significant difference between high and low levels of Notch1 expression; however, it was somewhat longer in patients with high Notch1 expression (p = 0.220). In conclusion, the tumour suppressor role of Notch1 was supported and the use of Notch1 agonists may have a role in improving the prognosis of HCC.
There are millions of chronic hepatitis C (CHC) virus-infected patients who have been treated wit... more There are millions of chronic hepatitis C (CHC) virus-infected patients who have been treated with a combination therapy (interferon and ribavirin) and have achieved a virological response (SVR) worldwide. The aim of this study is to evaluate the risk factors for de-novo diabetes mellitus in CHC patients treated with combination therapy (interferon and ribavirin) and have achieved an SVR. A total of 214 nondiabetic CHC patients with SVR and baseline homeostasis model assessment (HOMA) less than or equal to 2 were divided into group A, which included 108 patients with a BMI less than 25, and group B, which included 106 patients with a BMI of at least 25 and less than 30. HOMA insulin resistance (IR) and BMI were measured at the baseline, at achievement of an SVR, and 1 year after achievement of an SVR. Leptin levels were assessed at baseline and 1 year after achievement of an SVR in patients with increased BMI. One year after SVR, 36 (33.33%) patients from group A developed increasing BMI with no significant changes in HOMA versus that at SVR (P=0.53), but showed a significant reduction versus baseline HOMA (P=0.02). In group B, 68 (64.1%) patients showed increased BMI of at least 25, with a significant increase in HOMA versus that at SVR (P=0.02), and with no significant reduction versus baseline HOMA (P=0.44). In group B, serum leptin showed a significant reduction 12 months after achievement of an SVR versus baseline in patients with increased BMI. Six patients from group B with increased BMI after 1 year developed de-novo IR and type two diabetes mellitus. In nondiabetic CHC patients with SVR and baseline BMI of at least 25, the post-SVR increase in BMI predisposed to an increase in HOMA-IR and could be considered a predisposing factor for diabetes mellitus.
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Papers by Raghda Farag