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Background Spontaneous bacterial peritonitis (SBP) is an ascitic fluid infection in patients with liver cirrhosis in the absence of surgical causes. The drop of the ascitic fluid polymorphonuclear leukocyte count (AFPC) ≥25% of baseline 48h post-start of antibiotics is a predictor of antibiotic response. This study was designed to compare the diagnostic accuracy of AFPC 24h of antibiotic to the standard 48h. Three hundred ninety-nine SBP patients were classified into 2 groups. Group I (31.1%) are patients that lacked ≥25% drop and group II (68.9%) the opposite. Results The average age was 51.99 ±11.21 years. Most patients were males (70.9%), normotensive (75.8%), non-diabetics (50.8%), and without recent intake history of proton pump inhibitors (75.8%) and B-blockers (77%). Group II patients had statistically significant (p p>0.05). Group II patients compared to group I had statistically (p =0.001) lower AFPC 24h [800 (970) vs. 1100 (1700) cell/mm3], higher percent drop of the AFPC 24h [28.09 (24) vs. −10.17 (35)], and ≥25% drop [154 (90.6%) vs. 16 (9.4%)]. The 24h AFPC >980 cell/mm3 was associated with AFPC 48h non-response (AUROC =0.634, p =0.001, 58.87% sensitivity, 64.36% specificity). The 24-h AFPC percent drop >8% was associated with AFPC 48h response (AUROC =0.849, p=0.001, 85.82% sensitivity, 80.49% specificity). Conclusion Concordance of 24- and 48-h diagnostic follow-up ascitic fluid polymorphonuclear leukocyte count in the guidance of the antibiotic therapy.

Chronic hepatitis C Virus (HCV) causes significant decline in the Health Related Quality of Life (HRQL). Recently, direct Acting Anti-viral Drugs (DAA) have been endorsed as standard of care for treatment for HCV. To study the HRQL in patients with HCV and cirrhosis before and after DAA. Study design: Prospective cohort hospital based study. We included 500 patients with HCV and cirrhosis fulfilled all eligibility criteria for treatment and completed the survey of HRQL using (SF-36 and CLDQ questioners) before and after treatment. Patients were treated by combination of one of the following regimens: (a) Sofosbuvir (SOF) plus Daclatasvir (DAC) ± Ribavirin (RBV) in 2 divided doses or (b) SOF plus Simeprevir (SIM) ± RBV or c) SOF plus RBV. On treatment, 35.2% of the patients had a poor physical function and half of them had poor role-emotional, while 45.7% patients’ had excellent role-emotional, 49% noticed change in their mode, evaluation of HRQL before and after treatment through SF-36 and CLDQ showed an improvement in different domains. (p

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 Salmonella 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.

Objective This study aimed to assess the correlation between the genotyping of interleukin-10 (IL-10 polymorphism rs 1800871) and the incidence hepatocellular carcinoma (HCC) among patients with hepatitis C virus (HCV) treated with direct acting antivirals (DAAs). Method For 200 patients with HCV infection who completed DAA treatment and followed up for 1 year, IL-10 polymorphism SNP(-819) rs 1800871 analysis was conducted via real time polymerase chain reaction. During the follow-up period, 100 patients who developed HCC were selected and compared with 100 patients who did not develop any complications. Results The studied patients were divided into two groups according to the incidence of complications after completion of DAA treatments. During the follow-up, 100 patients with HCV infection who developed HCC were selected and compared with 100 patients with HCV infection who did not develop any complications (positive control group). For the HCC group (n = 100), the mean age was 58.1 ± 6.4 years, with 92.7% being male and 7.3% being female; 91% had cirrhosis, 10% had lymphadenitis, 75% had splenomegaly, and 17% had ascites. In the positive control group (n = 100), mean age was 46.3 ± 9.4 years, with 68% being male and 32% being female; 20% had cirrhosis, 12% had splenomegaly, and 4.2% had ascites. The results demonstrated that sofosbuvir (SOF) + daclatasvir + ribavirin regimen was the most prevalent drug treatment for patients with HCC (72%), while SOF + Simeprevir was the most safe treatment for HCV infection among patients with HCC (2%). CT genotype was the most common genotype in the HCC group (56%), among different drug regimen (67.8%). T allele was the most prevalent in HCC group (61%), while the C allele was the least prevalent (39%). Conclusion IL-10 genotyping may help in selecting the safest and most accurate drug regimen according to the safest genotype response relationship and follow-up of genotype resistance.

Background and study aim: The gold standard investigation to stage hepatic cirrhosis is liver biopsy. Being invasive with several major and minor procedure-related complications, liver biopsy is not universally-applied in all the indicated population. In addition to observer-related variations and sampling errors, the need for alternatives to liver biopsy has emerged including several lab-based indices of those; red cell volume distribution width-to-platelet ratio (RPR) have been postulated in some studies. The aim of this article is to study the diagnostic performance of RPR in staging liver cirrhosis in HCV-infected patients. Patients and Methods: 236 patients who had underwent liver biopsy for IFN-based therapy were included in the present study according to pre-defined inclusion and exclusion criteria. They were classified into 4 groups according to the stage of cirrhosis reported by the liver biopsy. Laboratory data, including CBC and biochemical studies, RPR, APRI score and FIB-4 were tabulated for statistical analysis. Results: The AUROCs values for RPR were 0.795, 0.811 and 0.886 for F2, F3 and F4 stage of cirrhosis respectively which were consistently higher than those of APRI (0.680, 0.754 and 0.746 for F2, F3 and F4 stages respectively) and FIB-4 (0.653, 0.765 and 0.810 for F2, F3 and F4 stages respectively). RPR was significantly-correlated with APRI (P

Background: Portal vein thrombosis (PVT) might be a catastrophic event complicating liver cirrhosis and hepatocellular carcinoma (HCC). Aim: role of JAK2 RS V617F mutation as a risk factor for PVT development in liver cirrhosis and HCC. Methods: A case control study conducted on 100 PVT patients (76 HCC and 24 liver cirrhosis) additionally, 100 healthy individuals used as a control group. PVT was diagnosed incidentally by Doppler ultrasound during routine follow-up HCC screening. Prothrombin G20210A mutation, MTHFR mutation, Factor V Leiden mutation (VFL), antithrombin III (ATIII), protein C, S, and antiphospholipid antibodies, along with JAK2 RS V617F mutation by real-time polymerase chain reaction all were analyzed. Results: Patients with PVT were significantly older (p

Background: Despite the outstanding results of direct-acting antiviral therapies (DAAs) of Hepatitis C infection (HCV), non-responders had to be more defined. Aim: assess the outcome of DAAs in lin...

Background: Direct acting antivirals (DAAs) are highly effective for treatment of hepatitis C (HCV) but brand products are priced beyond the means of most low and middle income countries (LMICs). Although a few DAAs are offered at reduced prices in access programs, they are still beyond affordability in limited resource settings with a large HCV infected population. Cheap generics might fill this economic need, but studies comparing their clinical efficacy to that of original products are limited. Aim: To compare efficacy of brand and generic DAAs used in the national treatment program in Egypt. Methods: HCV treatment eligible patients (n = 971) were enrolled. They were treated with 12 weeks of either sofosbuvir-daclatasvir (SOF-DCV) or SOF-ledipasvir (SOF-LDV). Ribavirin (RBV) was added to patients with cirrhosis and to SOF experienced patients. Patients with cirrhosis who were RBV intolerant were treated for 24 weeks without RBV. Results: Most patients were males (61.4%), treatment naïve (88.6%), without cirrhosis (61.7%), and the mean age was 51.3 ± 11.31 years. Baseline characteristics were not different in patients treated with brand or generic medications regarding age, liver tests, creatinine, platelets, MELD score, baseline HCV-RNA and transient elastography. Overall sustained virologic response (SVR) rate was 98.1%, which was similar for generic and brand drugs (98.2% vs. 98.1%; p = 1), and similar with both regimens used (SOF-DCV ± RBV: brand: 98.1%, generic 97.8%; p = 0.729, SOF-LDV ± RBV: brand 98.2%, generic 100%; p = 0.729). AST and ALT decreased significantly with initiation of therapy with both generic and original drugs. Conclusion: Generic and brand DAAs are equally effective for achieving SVR and improving aminotransferases. Keywords: HCV, Direct acting antivirals, Generic, Brand, Sofosbuvir, Ledipasvir, Daclatasvir, Sustained virological response