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Marwa Khalaf,1 Mohamed Alboraie,2 Muhammad Abdel-Gawad,3 Mohamed Abdelmalek,4 Ahmed Abu-Elfatth,4 Walaa Abdelhamed,5 Mariam Zaghloul,6 Rabab ElDeeb,7 Doaa Abdeltwab,4 Mohamed Abdelghani,4 Fathiya El-Raey,8 Hani Aboalam,1 Azza Badry,9 Mina Tharwat,10 Shima Afify,11 Doaa Elwazzan,7 Ahmed Shawkat Abdelmohsen,4 Hayam Fathy,12 Shaker Wagih Shaltout,13 Helal F Hetta,14 Shamardan E Bazeed15 1Assiut Liver Center, Ministry of Health, Assiut, 71515, Egypt; 2Department of Internal Medicine, Al-Azhar University, Cairo, Egypt; 3Hepatology, Gastroenterology and Infectious Diseases Department, Al-Azhar University, Assiut, Egypt; 4Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt; 5Tropical Medicine and Gastroenterology Department, Sohag University Hospital, Sohag, Egypt; 6Hepatology, Gastroenterology and Infectious Diseases Department, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt; 7Tropical Medicine Department, Alexandria University, Alexandria, Egypt; 8Hepatogastroenterology and Infectious Diseases Department, Al-Azhar University, Damietta, Egypt; 9Epidemiologist, Infectious Disease Control Department Preventive Medicine Assiut Health Affairs Directorate, Assiut, Egypt; 10Tropical Medicine and Gastroenterology Department, Aswan University, Aswan, Egypt; 11Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 12Internal Medicine, Hepatogastroenterology Unit, Assiut University, Assiut, Egypt; 13Tropical Medicine Department, Port Said University, Port Said, Egypt; 14Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt; 15Tropical Medicine and Gastroenterology Department, South Valley University, Qena, EgyptCorrespondence: Marwa Khalaf, Assiut liver center, Ministry of health, Assiut, 71515, Egypt, Email Marwa.Kh@med.aun.edu.eg Helal F Hetta, Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt, Email helalhetta@aun.edu.egBackground and Aim: Little is known about the persistence of symptoms after clearance of SARS-CoV-2 infection. Our study aimed to assess persistent symptoms in COVID-19 patients after clearance of SARS-CoV-2 infection.Methodology: A multi-center survey was conducted on first wave COVID-19 patients with confirmed SARS-CoV-2 infection. Sociodemographic and clinical characteristics, including presenting symptoms and persistent symptoms after viral clearance and possible factors contributing to persistence of such symptoms, were collected using an online multicomponent questionnaire. Descriptive and inferential statistical analysis was performed to detect the most persisting symptoms and factors contributing to their persistence.Results: Overall, 538 patients were enrolled. Mean age was 41.17 (±SD 14.84), 54.1% were males, and 18.6% were smokers. Hypertension and diabetes were the most reported co-morbidities. Mild symptoms were reported in 61.3% of patients, 51.3% were admitted to hospital and 6.5% were admitted to the intensive care unit. Our study identified 49 types of persisting symptoms. Fatigue (59.1%), sense of fever (46.5%), anorexia (24.3%) and diarrhea (24.3%) were the most commonly reported persisting symptoms followed by loss of taste and smell (22.3%), headache (21.4%), cough (20.8) and dyspnea (21%). The use of hydroxychloroquine, azithromycin and multivitamins were significantly associated with persistence of symptoms (OR = 8.03, 8.89 and 10.12, respectively).Conclusion: Our study revealed that in COVID-19 recovered patients, many patients reported persistence of at least one symptom, particularly fatigue and sense of fever. Follow-up of patients after discharge from hospital is recommended until complete resolution of symptoms.Keywords: coronavirus, COVID-19, SARS-CoV-2, fatigue, dyspnea

Background Liver cirrhosis is divided into two stages: compensated stage and another advanced stage which includes both decompensated cirrhosis and acute-on-chronic liver failure. The immune system is of major importance in cirrhosis pathophysiology. Sustained bacterial translocation from the intestine to systemic circulation causes a chronic systemic inflammatory syndrome. Inflammatory markers are emerging in the scope of cirrhosis and its complications due to their deleterious effects on disease progression and prognosis. The aim of the study was to assess the value of leukotriene B4 (LTB4) as a marker of decompensated cirrhosis and to evaluate its relation to disease progression and complications. Results The current study was conducted on 80 candidates in the Alexandria Main University Hospital, Tropical Medicine Department; they were categorized into three groups: group I (n = 30) compensated cirrhotic patients, group II (n = 30) decompensated cirrhotic patients, and group III (n = 20) apparently healthy individuals. Serum LTB4 was measured by ELISA. LTB4 showed statistically significant higher values in the decompensated group than the compensated group (p = 0.007) and the control group (p = 0.002). However, there was no statistically significant difference between the compensated group and the controls (p = 0.510). LTB4 correlated positively with the Child-Pugh score (p = 0.003). Moreover, it correlated positively with the MELD-Na score (p = 0.012). There was a significant correlation between the degree of ascites and serum LTB4 (p P > 0.204). Conclusion Serum LTB4 could be used as a sensitive biomarker of decompensation in cirrhotic patients.

Hepatitis C virus (HCV) infection can affect the neurological system, and neuropathy is one of these manifestations. Hepatitis C virus infection is associated with diabetes mellitus (DM) type II, and diabetic patients are at higher risk of acquiring HCV infection. Sweat function has been proposed to assess early autonomic neuropathy. This study aimed to evaluate small fiber neuropathy in asymptomatic HCV-related cirrhotic patients with or without DM through sweat function assessment by Sudoscan test. Three groups were involved: 47 healthy controls, 48 HCV-related cirrhotic patients without DM (group 1), and 49 HCV-related cirrhotic patients with DM type II (group 2). All participants were subjected to liver panel tests, renal function tests, cell blood counts, HbA1c, and abdominal ultrasound. Sweat function was assessed in all patients and controls by measuring hand and feet electrochemical skin conductance (ESC, microSiemens [µS]) using Sudoscan. Peripheral neuropathy was detected in none of the controls, 39% of group 1 patients, and 62% of group 2 patients (P < 0.0001). The mean feet ESC (FESC) was 88.3 ± 6.8 µS in controls, 67.2 ± 19.2 µS in group 1, and 57.9 ± 19.4 µS in group 2 (P < 0.0001). A significant correlation was observed between FESC and bilirubin, albumin, creatinine, international normalized ratio, transaminases, and splenic size. Electrochemical skin conductance measurement is a valuable, noninvasive method for early detection of small fiber neuropathy in asymptomatic HCV-related cirrhosis, with or without DM.

Oral Direct-acting antivirals (DAAs) are safe, highly effective altering disease burden and prognosis in hepatitis C patients. Sustained virologic response (SVR) is achieved nowadays in more than 90% of the treated patients and related to the improvements in functions of the liver, fibrosis plus survival. Furthermore, portal hypertension is thought to be improved with achievement of virological response, parallel to the improvements in hepatic inflammation and fibrosis. We aimed to assess the recurrence rate of oesophageal varices by long-term follow-up in patients treated with different DAAs regimens who had achieved SVR. We studied 176 Child A cirrhotic HCV patients who achieved SVR after DAAs treatment and had a history of endoscopic oesophageal varices obliteration and were on maximum tolerated propranolol dose. They were subjected to follow-up upper gastrointestinal endoscopy repeated every 6 months for 4 years. Fifty-two patients (29.5%) had recurrence of oesophageal varices observed during the 4-years follow-up upper GIT endoscopy. On multivariate analysis, platelet count was the only significant variable, P-value = .007*. HbA1C, HOMA IR, BMI 1 and BMI 2 showed non-significant differences between the studied groups. By ROC analysis, we identified baseline platelet count of 96 000/µL with 100% sensitivity (95% confidence interval [CI] [91%-100%]) and 74% specificity (95% CI [65%-81%]). Spearman correlation showed a positive correlation between AFP, age, AST, Bilirubin, creatinine, INR. Patients who achieved SVR post DAAs showed a significant decrease in oesophageal varices recurrence post endoscopic obliteration. Baseline platelet count was found to be a strong independent predictor for oesophageal varices recurrence.

Background and Aim: Little is known about persistence of symptoms after clearance of SARS-CoV-2 infection. This study aimed to assess persistent symptoms in COVID-19 patients after clearance of SARS-CoV-2 infection. Methodology: A multi-central survey was conducted onCOVID-19 patients with documented SARS-CoV-2 infection. Baseline demographic and clinical characteristics including presenting symptoms and persist symptoms after viral clearance and possible factors contributing to persistence of such symptoms were collected using an online multicomponent questionnaire. Descriptive and inferential statistical analysis was performed to detect the most persisting symptoms and factors contributing to its persistence. Results: Overall, 538 patients were enrolled.Mean age was 41.17 (±SD 14.84), 54.1% were males, and 18.6% were smokers. Hypertension and diabetes were the most reported comorbidities. Mild symptoms were reported in 61.3% of patients, 51.3% were admitted to hospital and 6.5% were admitted to ICU.Our study identified 49 types of persisting symptom. Fatigue (59.1%),sense of fever (46.5%), anorexia (24.3%) and diarrhea (24.3%) were the most commonly reported persisting symptoms followed by loss of taste and smell (22.3%), headache (21.4%), cough (20.8), and dyspnea (21%). The use of hydroxychloroquine, azithromycin and multivitamins were significantly associated with persistence of symptoms (OR= 8.03, 8.89 and 10.12 respectively). Conclusion: Our study revealed thatin patients recovered from COVID-19, many patients reported persistence of at least 1 symptom,particularly fatigue and sense of fever. Follow up of cured patient after discharge from hospital is recommended till complete resolution of symptoms. Funding Statement: None to declare. Declaration of Interests: All authors have no conflicts of interest to declare. Ethics Approval Statement: This study was approved by the Damietta Faculty of Medicine- Al Azhar University Ethical committee- IRB 00012367.