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Background and study aim: Viral infections is the cause of liver inflammation, cirrhosis and even liver hepatocellular carcinoma (HCC). Despite the availability of HBV vaccine and antiviral treatment for HBV and HCV both remain a major health problem. The aim of this study To determine the seroprevalence of HBV and HCV infection among pregnant women in Sharkia governorate, Egypt. Subject and Methods: : is a cross-sectional study, It involved 563pregnant women attending the antenatal care clinic, all women are subjected to full history taking, clinical examination, laboratory investigations, detection of HBsAb, HCV antibodies by rapid one-step test then by ELISA if positive, PCR was done. Results: In this study, 10 cases had anti-HCV positive with ELISA, 8 cases were positive by PCR while one case was positive for HBs Ag by ELISA, no co-infected pregnant women were detected. the prevalence rate of HBV&HCV was 0.17%, 1.7 % respectively. Conclusion: All pregnant women should be routinely screened during an early antenatal visit for HCV Antibodies and HBsAg. Cases with HCV antibodies positivity should be subjected to PCR for HCV RNA.

Background and study aim: The incidence of hepatocellular carcinoma (HCC) is rising worldwide being the fifth most common cancer and the third cause of cancer-related mortality. Early detection of HCC is associated with a better outcome. In Egypt and over the last decades, a remarkable rise of HCC was observed in the proportion of chronic liver disease patients. The aim of this study is to compare between Radiofrequency ablation (RF) & Percutaneous Ethanol Injection (PEI) in treating small HCC in cirrhotic /bilharzial patients. Patients and Methods: We divided patients into two groups; Group 1: (n=24) were HCC patients with small focal lesions treated by ethanol injection therapy using 99% sterile alcohol delivered in the lesion through a 21-gauge needle, amount of alcohol not exceeding 10ml every session. Group II: (n=24) were HCC patients with small focal lesions treated by radiofrequency ablation using Leveen Needle Electrode.patients were followed up at 1 and 3 months by abdominal ultrasoungraphy& triphasic CT to assess ablation status. Results: The 2 groups are comparable regarding their baseline. The incidence of HCC ablation by PEI is 87.5% while it was to 91.7% in the radiofrequency ablation group with no relapse after 3 months follow up. In both groups, this difference was not statistically significant. Conclusion: The Efficacy of PEI therapy is not inferior to percutaneous RF ablation in the treatment of small HCC lesions up to 2.5 cm in patients with mixed cirrhosis/bilharzial hepatic fibrosis.

Background and study aim: Alpha-fetoprotein (AFP) cannot be relied on alone for diagnosis of hepatocellular carcinoma (HCC). However, it may have a prognostic value and can be used for monitoring response to different modalities of treatment for HCC. This study aimed to differentiate the clinical and pathological features of HCCs according to AFP levels. Subjects and Methods: This retrospective study included 60 patients with HCC secondary to chronic hepatitis C (HCV). They were divided based on serum AFP into two groups; group I; included 30 patients with AFP lower than 302.5ng/ml. and group II; included 30 patients with AFP higher than 302.5ng/ml. clinical, laboratory and pathological differences between both groups were compared. Results: Regarding the pathological features, patients with higher AFP secreting tumors have larger tumor size compared to lower AFP secreting tumors; (5.8 cm Vs. 4.5 cm, P value; 0.001). Number of lesions and tumor location were similar between the two groups. Conclusion: HCC-secreting high levels of AFP are larger and aggressive tumors when compared to low secreting AFP-HCC.

Background and study aim: Regarding the increased number of chronic liver diseases (CLD) patients suffering from ‎many manifestations e.g. diarrhea, this withdrew our attention to try to find a relation ‎between CLD and parasitic infections in those patients‎. Patients and Methods: A case-control study was performed on 190 participants suffering from gastrointestinal ‎complaints especially diarrhea attending Gastroenterology and Hepatology Outpatient ‎Clinics at Zagazig University Hospital, divided into 2 groups GI: 95 CLD patients. GII: 95 ‎non-CLD Control group patients. Cases underwent clinical, abdominal ultrasonographic, ‎and laboratory liver function assessments. Also, collected patients’ stool samples were ‎microscopically examined using iodine, Trichrome and Modified Ziehl-Neelsen stains. To ‎confirm accurate diagnosis to parasitic infections causing diarrhea, RIDA-ELISA for ‎Cryptosporidium spp. and Giardia lamblia copro-antigens detections was performed. Results: Parasitic infections among both studied groups were (47%), comprising (58%) in CLD and ‎‎(36%) in non-CLD as follow: Cryptosporidium (28%, 14%), Giardia (15%, 12%), mixed ‎‎(5%, 3%), E.histolytica spp. (5%, 4%), Blastocystis hominis (3%, 1%) and H. nana (1%, ‎‎2%) respectively. The sensitivity, specificity, PPV, NPP and accuracy of ELISA regarding ‎Giardia and Cryptosporidium infections were (100% and 89.6%, 97.5% and 100%, 87.9% ‎and 100%, 100% and 96.6%, 97.9% and 98.4%) respectively. In GI, most giardial cases ‎had normal ALT and AST levels (74%, 63%), but elevated in cryptosporidial infection ‎‎(59%, 66%) respectively, with statistically significant difference‎. Conclusion: Presence of intestinal parasitic infections; mainly Cryptosporidia and Giardia protozoa ‎among CLD patients was striking when compared to diarrheic non-CLD control group and ‎this may be attributed to impaired immune status.

Background and study aim: Hepatitis C is the most pressing public health challenge in Egypt with variable prevalence rates among different age groups. This study aimed to detect the efficacy and adverse effects of sofosbuvir plus daclatasvir therapy in treatment of chronic HCV patients in Sharkia governorate. Patients and Methods: One hundred and ten patients were included in this study, divided into 4 groups; group I: 55 treatment naive patients receiving (sofosbuvir + daclatasvir) for 12 weeks, group II: 36 treatment naive patients receiving (sofosbuvir + daclatasvir +ribavirin) for 12 weeks, Group III: 9 treatment experienced patients receiving (sofosbuvir + daclatasvir + ribavirin) for Session [UserIDID] weeks and Group IV: 10 chronic HCV patients not receiving anti-viral therapy. Patients were followed by clinical and laboratory evaluation monthly during treatment and for 3 months after end of treatment. In addition, the virological response and adverse effects were reported. Results: The rate of SVR response was equal in the three treated groups. There was statistically significant increase in nausea and headache in groups I and II while arthralgia, myalgia and fatigue were more frequent in group I. There was also statistically significant improvement in Child score among treated cirrhotic patients after treatment. Conclusion: Daclatasvir plus sofosbuvir with or without ribavirin for 12 or Session [UserIDID] weeks is highly effective in treatment of naive or experienced Egyptian HCV patients in Sharkia governorate. This combination is well tolerated in both cirrhotic and non-cirrhotic patients with mild adverse effects.

Background and study aim: Proper assessment of liver fibrosis and cirrhosis by non- invasive procedures are needed before appropriate management. This study aimed at detecting the role of IL-1α and TGF-β1as non-invasive liver fibrosis markers in chronic liver diseases. Patients and methods: The subjects included in this study were divided into 4 groups. Group1: 15 chronic HCV patients, group 2: 15 HCC patients, group 3: 15 patients with NAFLD, group 4: 15 healthy control subjects. Serum IL-1α and TGF-β1 measured by ELISA to patients and control groups with calculation of FIB-4 and APRI score. Results: IL-1α and TGF-β1 were significantly high in all hepatic patients compared to control group. The highest level of serum TGF-β1 was in HCC patients. There was a positive correlation between serum IL-1α and ALT, AST, ALP and HCV RNA by PCR. There was a negative correlation between IL-1α and TGF-β1. There was a highly significant positive correlation between TGF-β1 and FIB4, APRI score, ALP and AFP. Conclusion: Chronic liver diseases including HCV, HCC and NAFLD were associated with higher levels of IL-1α and TGF-β1 than healthy subjects.

Background and study aim: Spontaneous bacterial peritonitis is a serious condition that needs rapid diagnosis and rapid management due to its serious sequelae. SBP is diagnosed when the polymorpho-nuclear cells count in the ascetic fluid exceeds 250 cell/µL. Mean platelet volume (MPV) was found to be significantly larger in the cirrhotic patients with ascetic fluid infection than cirrhotic patients without ascetic fluid infection. In our study we aimed to assess the role and clinical performance of MPV as a diagnostic marker of SBP. Patients and Methods: This cross sectional study was performed on 124 cirrhotic patients with ascites. They were classified into two groups according to ascetic fluid PMN count into two groups. Group I: 38 patients with ascetic fluid infection, PMN >250 cell/µL and group II: 86 patients without ascetic fluid infection, PMN count Results: The MPV was significantly higher among patients with ascetic fluid infection (11.1±1.2 vs 9.4±1.1 p

Background and study aim: Hepatitis C virus infection is a multisystemic disease with many extrahepatic manifestations. Affection of bone matrix density is a common complication of chronic hepatitis and cirrhosis. The pathogenesis of osteoporosis in chronic liver disease is still unknown and is expected to be multifactorial. The aim of this work is to assess the frequency of osteoporosis/osteopenia in patients with chronic hepatitis C virus infection with or without cirrhosis. Patients and methods:This study was carried out on 30 patients with chronic HCV infection without cirrhosis (Group II), 30 patients with chronic HCV infection with compensated cirrhosis (Group III) and 20 age and gender matched healthy controls (Group I). All subjects of the study performed liver function tests, viral markers, liver biopsy, hormonal assay and Bone Mineral density measurement (BMD) by Dual energy X-ray absorptiometry (DEXA). Results : In patients with chronic hepatitis C (group II) the frequency of osteopenia was 11 (36.7%), osteoporosis 2 (6.7 %), total patients with low BMD was 13 (43.3%). In cirrhotic patients (group III), the frequency of osteopenia was 13 (43.3%), osteoporosis was 3 (10.0%), and total patients with low BMD was 16(53.3%) vs 1(5.0%) in the control group (group I). there was also no significant difference between patients with low BMD and patients with normal BMD as regards age, gender, common risk factors, liver function tests or hormonal levels. Conclusion : Reduced BMD is common chronic HCV-infected patients with and without cirrhosis. HCV infection is a risk factor of osteoporosis.