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Yousry Esam-Eldin Abo-Amer,1 Amal Ahmed Mohamed,2 Mohamed Mahmoud Elhoseeny,3 Samar M Rezk,4 Sherief Abdel-Salam,5 Abdulmohsen H Alrohaimi,6 Asmaa Sayed Abdelgeliel,7 Seham Saeed Alzahrani,8 Ibrahim Jafri,8 Leena S Alqahtani,9 Eman Fayad,8 Mohamed Fakhry,10 Moataz Yousry Soliman11 1Mahala Hepatology Teaching Hospital, Hepatology& Gastroenterology Department, Gharbia, Elgharbia, Egypt; 2National Hepatology & Tropical Medicine Research Institute, Department of Biochemistry, Cairo, Egypt; 3Department of Internal Medicine, Faculty of Medicine, Suez University, Suez, Egypt; 4Department of Clinical Nutrition, Mahalla Hepatology Teaching Hospital, El-Mahalla El-Kubra, Elgharbia, Egypt; 5Department of Tropical Medicine, Hepatology & Gastroenterology Unit, Faculty of Medicine, Tanta University, Tanta, Egypt; 6Department of Pharmacy Practice, College of Pharmacy, Shaqra University, Shaqra, 11961, Saudi Arabia; 7Department of Botany & Microbiology, Faculty of Science, South Valley University, Qena, 83523, Egypt; 8Department of Biotechnology, College of Science, Taif University, Taif, 21944, Saudi Arabia; 9Department of Biochemistry, College of Science, University of Jeddah, Jeddah, 23445, Saudi Arabia; 10Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Asyut, Egypt; 11Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptCorrespondence: Sherief Abdel-Salam, Department of Tropical Medicine, Hepatology & Gastroenterology Unit, Faculty of Medicine, Tanta University, El-Bahr Street, Tanta, Egypt, Tel +201147773440, Email sheriefabdelsalam@yahoo.comBackground & Aims: This research aimed to determine how variations in the vitamin D receptor gene affected the response of H. pylori infections to eradication therapy.Patients and Methods: On 105 adult H. Pylori-positive patients, a prospective cohort study was carried out. PCR was used to genotype all patients’ VDR gene polymorphisms. The patients in the study received standard triple eradication medication (clarithromycin 500 mg, amoxicillin 1000 mg, and omeprazole 20 mg) twice daily for 14 days. A stool test for H. pylori Ag was conducted 4 weeks following the end of treatment.Results: In our study, the usual triple therapy’s H. pylori eradication rate was 75.2%. The successful eradication of H. pylori and VDR rs 2228570 gene polymorphisms was more prevalent in CT gene polymorphism (64.6%) compared to non-responders (19.2%), while treatment failure was more prevalent in CC gene polymorphism (73.1% in non-responders compared to responders 24.1%), which is statistically significant. In regards to the eradication of H. pylori and VDR rs7975232 gene polymorphisms, the success of eradication was more prevalent in AC gene polymorphism (54.4%) vs non-responders (30.4%), while all patients (14) with gene AA (17.7%) are responders to standard treatment, while the failure of treatment was more prevalent in CC gene polymorphism (69.2% in non-responder vs 27.8% in responders) which is statistically significant. Our findings demonstrated a strong correlation between patients’ responses to H. pylori treatment and polymorphisms in the VDR gene (ApaI and TaqI) (P 0.05).Conclusion: As far as we are aware, this is the first study to identify a potential link between the FokI and Apal VDR polymorphism and treatment response in H pylori-positive patients. To evaluate the findings, more research with larger number of patients and different population is required.Keywords: Helicobacter, infection, gene, polymorphism, response, eradication

Yousry Esam-Eldin Abo-Amer, 1 Aisha Sabal, 2 Rehab Ahmed, 2 Nabil Fathy Esmael Hasan, 3 Rasha Refaie, 4 Sahar Mohamed Mostafa, 2 Ahmed Abdelhaleem Mohamed, 2 Mahmoud Khalil, 2 Waleed Elagawy, 5 Sherief Abd-Elsalam 6 1Hepatology, Gastroenterology and Infectious Diseases Department, Mahala Hepatology Teaching Hospital, Gharbia, Egypt; 2Hepatology, Tropical Medicine and Infectious Diseases Departments, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 3Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 4Internal Medicine Department, Helwan University, Helwan, Egypt; 5Department of Tropical Medicine, Portsaid University, Portsaid, Egypt; 6Tropical Medicine Department, Tanta University, Tanta, EgyptCorrespondence: Sherief Abd-ElsalamTropical Medicine Department, Tanta University, Tanta, EgyptTel +201063319696Email sherif.abdelbaky@med.tanta.edu.egBackground: Non-alcoholic fatty liver disease (NAFLD) is a very common disease that affects 25– 30% of the population in western countries. Many studies have observed the importance of H. pylori infection in the development of insulin resistance, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, and liver fibrosis and cirrhosis. However, the evidence from different studies was controversial. The present study aimed to investigate the relationship between H. pylori infection and NAFLD in a developing country.Patients and Methods: This cross-sectional study included all the attending outpatient clinics at four Major University hospitals and two research and clinical institutes in a developing country in the period between June and October 2019. Patients were assessed for the diagnosis of H. pylori infection as detected by H. pylori antigen in stool; they were also assessed for the diagnosis of NAFLD by ultrasound, fibroscan, and CAP.Results: The study was conducted on 646 patients; H. pylori infection was found to be present in 538 patients (83.3%). NAFLD (diagnosed by both U/S and Fibroscan with CAP), ALT, AST, hepatomegaly, hypertension, fasting blood sugar were significantly higher in H. pylori +ve group than H. pylori −ve group. After performing Linear regression of independent risk factors of NAFLD to prove or to refute the role of Helicobacter; H. pylori positivity, total cholesterol, degree of fatty liver by ultrasound, fasting blood sugar and diastolic blood pressure were independent risk factors for NAFLD.Conclusion: Helicobacter pylori infection was independent risk factors for NAFLD and correlated with increased degree of steatosis.Keywords: Helicobacter pylori, steatosis, fibrosis, NAFLD, prevalence, fibroscan

Yehia Sadek Younis,1 Hatem Samir Alegaily,1 Waleed Elagawy,2 Atteyat Aboelmaged Semeya,3 Yousry Esam-Eldin Abo-Amer,3 Mohamed El-Abgeegy,4 Sahar Mohamed Mostafa,4 Heba Fadl Elsergany,4 Sherief Abd-Elsalam5 1Hepatology, Gastroenterology and Infectious Diseases, Benha Faculty of Medicine, Qalybia, Egypt; 2Department of Tropical Medicine, Faculty of Medicine, Port Said University, Port Fouad, Egypt; 3Hepatology, Gastroenterology and Infectious Diseases, Mahala Hepatology Teaching Hospital, Gharbia, Egypt; 4National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 5Department of Tropical Medicine, Faculty of Medicine, Tanta University, Gharbia, EgyptCorrespondence: Sherief Abd-ElsalamDepartment of Tropical Medicine, Faculty of Medicine, Tanta University, El-Geish Street, Tanta, EgyptTel +201095159522Email Sherif_tropical@yahoo.comBackground: This study aimed to evaluate the role of Dickopff 1 (DKK1) serum levels as a marker for early detection of hepatocellular carcinoma (HCC) and to compare it with alphafetoprotein (AFP) after non-surgical intervention (microwave ablation, radiofrequency ablation) in HCC.Patients and methods: This prospective study was conducted in Al-Mahalla hepatology teaching hospital from June 2015 to June 2017. One hundred and twenty patients were included. They were classified into four groups: Group A: 40 patients with chronic liver disease; Group B: 40 patients with HCC which were divided into 2 main sub groups, group Ba which included HCC patients who were not eligible for ablative therapy and group Bb which included HCC patients who were eligible for ablative therapy; Group C: 20 healthy control subjects matched for age and sex; Group D: 20 HCC patients with negative AFP, DKK1 was done for them.Results: There was a highly significant difference (p < 0.001) between groups regarding serum level of Dickpoff 1 with mean of 1 ng/mL in group A (cirrhotic), 2.38 ng/mL in group B (HCC), and 1.83 ng/mL in group D (AFP negative HCC) in comparison to control group C with mean of 0.54 ng/mL. There was a highly statistically significant difference (p value less =0.01) in the studied groups regarding serum Dickpoff 1 before and after intervention with a mean of 2.38 ng/mL before intervention and mean of 1.37 ng/mL after 1 month of intervention.Conclusion: Serum Dkk-1 has higher sensitivity, specificity, and accuracy in early diagnosis of HCC than AFP.Keywords: serum Dickopff 1, aphafeto protein, hepatocellular carcinoma, radiofrequency ablation, microwave ablation, TACE

Ahmed Mohamed Saleh,1 Essam Ali Hassan,1 Ahmed Ali Gomaa,1 Tamer Mahmoud El Baz,2 Mohamed El-Abgeegy,3 Mohamed Ismail Seleem,3 Yousry Esam-Eldin Abo-amer,4 Heba Fadl Elsergany,3 Eman Ibrahim El-Desoki Mahmoud,3 Sherief Abd-Elsalam51Tropical Medicine Department, Fayoum University, Al Fayyum, Egypt; 2Endemic Medicine Department, Cairo University, Giza, Egypt; 3Liver Transplantation Team, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 4Hepatology, Gastroenterology, and Infectious Diseases Department, Mahala Hepatology Teaching Hospital, Gharbia, Egypt; 5Tropical Medicine Department, Tanta University, Tanta, EgyptBackground and aim: Liver transplantation (LT) has emerged as an established therapeutic option for patients with chronic liver disease. Patients with end-stage liver disease are at high risk of infection with multidrug-resistant organisms, which may affect the outcome of LT. The aim of this study was to evaluate the impact of pre-transplant infection on the outcome of living-donor LT.Methods: Prospective follow-up was done for 50 patients with chronic liver disease who had had LT performed from September 2013 to December 2017. We divided patients into group 1 (patients who had had infection within 3 months before transplantation with adequate treatment [n=20]), and group 2 (patients without infection [n=30]). Both groups were followed for 4 months post-operatively.Results: Patients with high Modelfor End-Stage Liver Disease scores were more susceptible to infection pre- and post-operatively, and chest infection was the most common infection pre-transplant. There were no significant statistical differences regarding hospital and ICU stay and post-operative course between the groups, but the mortality rate was higher in group 1 (40%) than in group 2 (23.3%), and the causes of mortality in the group 1 were mainly due to medical causes (infections and sepsis, 75%) versus 28.6% in group 2.Conclusion: Liver-cell failure and concomitant infection 3 months before LT with adequate treatment had no significant statistical differences regarding hospital, ICU stay, or medical complications, but post-operative infection and mortality rate were more frequent in group 1 and the causes of mortality were mainly medical.Keywords: hepatitis C virus, cirrhosis, steatosis, chronic liver disease, liver transplantation, outcome