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Background: Ascites in cirrhosis has a poor prognosis, with mortality rates of around 40% at one year and 50% at two years. It is also associated with other complications, such as spontaneous bacterial peritonitis (SBP), which can lead to hepatorenal syndrome (HRS) in 30% of patients. Diagnostic paracentesis is the gold standard for diagnosing SBP. Serum biomarkers such as procalcitonin (PCT) have recently received a lot of attention for the early detection of SBP. Objective: To determine the usefulness of measuring serum procalcitonin levels in patients with liver cirrhosis and ascites for the diagnosis of spontaneous bacterial peritonitis. Patients and methods: A cross-sectional case-control study that was conducted on ninety (90) patients diagnosed with liver cirrhosis. They were divided into three groups: Group (A) included 30 cirrhotic patients with ascites diagnosed as spontaneous bacterial peritonitis, Group (B) included 30 cirrhotic patients with ascites but without spontaneous bacterial peritonitis, and Group (C) included 30 cirrhotic patients without ascites as a control group. Results: Serum procalcitonin levels in SBP patients were significantly higher than in sterile ascites and cirrhotic patients without ascites with a P value of 0.001. It had a better cutoff value of 0.315 ng/ml, sensitivity of 87% and specificity of 97% than serum CRP that had a cutoff value of 16 mg/L, sensitivity of 76% and specificity of 90% in cirrhotic patients for predicting ascitic fluid infection. Conclusion: In cirrhotic patients, serum procalcitonin levels appear to provide a satisfactory diagnostic accuracy in the diagnosis of spontaneous bacterial peritonitis, with a suggested cut-off value of 0.315 ng/ml. Further studies are needed to determine the widespread use of serum PCT as a predictor of SBP clinically. [ABSTRACT FROM AUTHOR]

Background: It is known that patients with high insulin resistance (IR) have a slower rate of decline in the viral load of HCV RNA compared to patients with low IR. Objective: to evaluate relation between insulin resistance on sustained treatment response with direct oral antiviral drugs on relapsed Egyptian chronic HCV patients. Patients and Methods: 50 patients with chronic hepatitis C met inclusion criteria divided into Group I were non responders to treatment and achieved sustained virological response (SVR) at week 12 on retreatment and Group II were non responders to treatment and failed to attain SVR after 12 weeks of retreatment. All participants received the direct antiviral therapy (DAA) sofosbuvir and daclatasvir for 12 weeks. HOMA-IR was calculated and PCR was done before treatment, at end of treatment, 12 weeks and 3 months after end of treatment. Results: there was a highly significant correlation between HOMA-IR and liver enzymes, lipid (P<0.01) and significant relation between HOMA-IR and BMI and waist circumference. After 6 months of treatment there was highly significant increase in insulin sensitivity and decrease in insulin resistance in patients after eradication of HCV (P<0.01). 12 cases of insulin resistance pretreatment and after 6 months: 3 cases HCV -ve became noninsulin resistant, 2 cases HCV -ve became insulin resistant, 2 cases of HCV -ve developed DM and 5 cases had no changes (still insulin resistant). Conclusion: prevalence of insulin resistance and diabetes mellitus in patients with chronic hepatitis C was due to multiple causes and clearance of HCV infection improves insulin resistance; not directly related to DAA. [ABSTRACT FROM AUTHOR]

Background: It is known that patients with high insulin resistance (IR) have a slower rate of decline in the viral load of HCV RNA compared to patients with low IR. Objective: to evaluate relation between insulin resistance on sustained treatment response with direct oral antiviral drugs on relapsed Egyptian chronic HCV patients. Patients and Methods: 50 patients with chronic hepatitis C met inclusion criteria divided into Group I were non responders to treatment and achieved sustained virological response (SVR) at week 12 on retreatment and Group II were non responders to treatment and failed to attain SVR after 12 weeks of retreatment. All participants received the direct antiviral therapy (DAA) sofosbuvir and daclatasvir for 12 weeks. HOMA-IR was calculated and PCR was done before treatment, at end of treatment, 12 weeks and 3 months after end of treatment. Results: there was a highly significant correlation between HOMA-IR and liver enzymes, lipid (P<0.01) and significant relation between HOMA-IR and BMI and waist circumference. After 6 months of treatment there was highly significant increase in insulin sensitivity and decrease in insulin resistance in patients after eradication of HCV (P<0.01). 12 cases of insulin resistance pretreatment and after 6 months: 3 cases HCV -ve became noninsulin resistant, 2 cases HCV -ve became insulin resistant, 2 cases of HCV -ve developed DM and 5 cases had no changes (still insulin resistant). Conclusion: prevalence of insulin resistance and diabetes mellitus in patients with chronic hepatitis C was due to multiple causes and clearance of HCV infection improves insulin resistance; not directly related to DAA. [ABSTRACT FROM AUTHOR]

Background: Patients with hematological disorders especially those who underwent bone marrow transplantation are known for having some degree of immune system derangement and cytokine signaling instability as well as patients who were diagnosed with active malignancy and needed chemotherapy. Objective: The study aimed to compare the outcome between patients infected with COVID 19 who use immune suppression (either acute or chronic immune suppression) to fight COVID infection and how our different bodies and immune systems can handle it versus the normal population. Patients and Methods: This study was a cross-sectional study in December 2020 conducted on 96 subjects who caught COVID-19 infection, the subjects were categorized into three groups: Group 1: consists of 32 patients who underwent BMT (patients on chronic immunosuppressive drugs), Group 2: consists of 32 patients with hematological diseases (patients on chemotherapy or acute immunosuppressive drugs), and Group 3: control group (non-immunosuppressed patients) consists of 32 patients with patients had symptomatic COVID-19 infections requiring hospital admission. Results: We found improved overall survival in group 1 with 4 out of the total 32 patients succumbed to their deaths, 2 of the 4 patients were in the peri-engraftment period with the statistically significant improved OS when compared to patients in group 2 with a P-value of 0.038. Conclusion: Acute immune suppression is done by chemotherapy worsen the outcome of COVID-19 infection, while chronic immunosuppression had the best outcome in COVID-19 patients even better than the normal population due to loss of immune cell signaling and absent cytokines storm that might occur. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma is a highly prevalent tumor globally and the world's second leading cause of cancerrelated deaths. Glypican-3, a heparan sulfate proteoglycan expressed on the surface of HCC cells, has emerged as a new molecule with a strong link to occurrence and progression of HCC. Objective: This study was done to determine the role of Glypican-3 in diagnosis of HCC and its prognostic value following different treatment modalities. Patients and methods: The study included thirty patients with liver cirrhosis and HCC on top, and thirty patients with liver cirrhosis without HCC. Standard laboratory investigations, abdominal ultrasound and triphasic computed tomography were done for all patients. Serum alpha fetoprotein and Glypican-3 were measured in all patients before and one month after different treatment modalities. Results: Glypican-3 was significantly higher in HCC group (2.28 ± 0.97) in comparison to cirrhosis group (0.56 ± 0.31) with P-value <0.001. Glypican-3 level was higher in larger sized lesions with p value 0.023, one month after treatment with different modalities, Glypican-3 declined significantly (from 2.28 ± 0.97 to 1.44 ± 0.93) with p value <0.001. At a cutoff point of > 1.1 ng/ml Glypican-3 has 93.3% sensitivity, 96.67% specificity, 96.6% PPV and 93.5% NPV for detection of HCC. Conclusion: Glypican-3 can be a valuable diagnostic marker for HCC diagnosis and prognosis after various treatment modalities and may be complementary to alpha fetoprotein increasing overall sensitivity of HCC detection. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is a risk factor for increased morbidity and mortality plus cardiovascular disease and malignancy. Despite all of these, most patients have good prognosis if diagnosed at early stages. Objective: The study was designed to evaluate different non-invasive methods as a diagnostic tool of nonalcoholic fatty liver disease among diabetic and non-diabetic patients. Patients and Methods: The study was done on 100 patients were divided into two groups of 50 diabetics and 50 non-diabetics with fatty liver disease on abdominal ultrasonography finding. These patients were assessed with transient elastography (TE) after lab tests and then scoring systems (Fib-4 and NAFLD fibrosis score) and liver stiffness scores were compared between the two groups. Results: There was statistically significant difference between the two groups as regard Fib-4 and NAFLD fibrosis score (p< 0.001), where Fib-4 and NAFLD fibrosis score were higher in group I (diabetic) than in group II (nondiabetic). A statistically significant difference between the two groups as regard liver stiffness (p<0.001), where liver stiffness was higher in group I than in group II. Liver stiffness score and NAFLD fibrosis score were statistically significantly higher in those with (>F2) than those with (F2 or less) (p<0.001). Conclusion: A combination of Fibroscan, Fib-4 and NAFLD fibrosis score provides a valuable non-invasive method in diagnosis of NAFLD patients, and this can eliminate the need for liver biopsy in patients without clear indication, especially diabetic patients that can help in early diagnosis of NAFLD before development of fibrosis. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is a risk factor for increased morbidity and mortality plus cardiovascular disease and malignancy. Despite all of these, most patients have good prognosis if diagnosed at early stages. Objective: The study was designed to evaluate different non-invasive methods as a diagnostic tool of nonalcoholic fatty liver disease among diabetic and non-diabetic patients. Patients and Methods: The study was done on 100 patients were divided into two groups of 50 diabetics and 50 non-diabetics with fatty liver disease on abdominal ultrasonography finding. These patients were assessed with transient elastography (TE) after lab tests and then scoring systems (Fib-4 and NAFLD fibrosis score) and liver stiffness scores were compared between the two groups. Results: There was statistically significant difference between the two groups as regard Fib-4 and NAFLD fibrosis score (p< 0.001), where Fib-4 and NAFLD fibrosis score were higher in group I (diabetic) than in group II (nondiabetic). A statistically significant difference between the two groups as regard liver stiffness (p<0.001), where liver stiffness was higher in group I than in group II. Liver stiffness score and NAFLD fibrosis score were statistically significantly higher in those with (>F2) than those with (F2 or less) (p<0.001). Conclusion: A combination of Fibroscan, Fib-4 and NAFLD fibrosis score provides a valuable non-invasive method in diagnosis of NAFLD patients, and this can eliminate the need for liver biopsy in patients without clear indication, especially diabetic patients that can help in early diagnosis of NAFLD before development of fibrosis. [ABSTRACT FROM AUTHOR]