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Background: Polymorphisms in the cytokine gene involving IFN gamma (IFN-α) have been implicated in many infections including HCV. The aim of this study is to evaluate the association between IFN-α polymorphism in three regions, (+2109A/G, +874A/T, -183G/T) and either chronicity or spontaneous viral clearance (SCV) in HCV infected patients. Materials and Methods: The study included 200 HCV-infected patients divided into Group I of 100 patients with spontaneous virus clearance (SVC) and Group II of 100 patients with persistent chronic hepatitis C infection (PI) who did not receive any therapy. These patients were subjected to history taking, full clinical examination and laboratory investigations included analysis of IFN-α gene polymorphisms. Results: At locus +2109 of the IFN-α gene, patients with A/A genotype had a significantly higher rate of spontaneous hepatitis C clearance while the G/G genotype was more prone to persistent infection. No statistically significant difference was found between both groups regarding loci +874 and - 183 of the IFN-α gene, but column proportion comparison using Bonferroni method at locus +874 revealed a higher proportion for T/A genotype in SVC group. Both haplotypes AAT and TGT were more susceptible to chronic HCV infection, as were heterozygote T/A at locus +874 and G/G genotype at locus +2109s. A/G and A/A genotypes at locus +2109, TLC at cut off value =7.15, and AST at cut off value =27.5 were considered independent predictors for development of SVC. Conclusions: Polymorphisms in the IFN-α gene may play role in sequelae following HCV infection, possibly determining whether the virus will be cleared spontaneously or not. [ABSTRACT FROM AUTHOR]

Background: Gastric varices (GV) bleed less frequently than esophageal varices however, gastric variceal bleeding is more severe with higher mortality and rebleeding rates. Treatment of gastric variceal bleeding (GVB) by tissue adhesive mainly cyanoacrylate glues has been used for gastric variceal obturation. We aimed to determine predictors of early rebleeding and mortality in patients with the first attack of GVB. Materials and methods: The study included 120 patients with a first attack of GVB.The patients subjected to thorough history, full examination, laboratory, and radiological investigations. Child Turcott Pugh score (CTP), and model of end stage liver disease (MELD) score were calculated. Upper gastrointestinal (GI) endoscopy with gastric variceal obturation (GVO) by cyanoacrylate glues were done for all included patients. Follow up during hospitalization and 6 weeks after discharge to determine early rebleeding (within 14 days) and early mortality (within 6 weeks). Results: Among 120 included patients in the study, 24 patients (20%) were presented with early rebleeding and 19 patients (15.83%) were presented with early mortality. Multi-variable logestic regression analysis showed that, Child Pugh Score was an independent prognostic factor associated with early rebleeding and early mortality. It was found that, current smoking, increased bilirubin, INR, creatinine, decreased albumin, presence of ascites, higher CTP and MELD scores are significantly more in early rebleeding and early mortality groups, while lower platelet count in early rebleeding only. Moreover, hepatic encephalopathy, and higher transaminases are more in early mortality group. There was no significant difference in gastric variceal signs between the study groups except that increase mortality in patients with more than one varix. Conclusion: Child Turcott Pugh score was an independent prognostic factor associated with early rebleeding and early mortality in patients with GVB. [ABSTRACT FROM AUTHOR]

Background: Direct-acting antivirals (DAAs) are welltolerated drugs for the treatment of chronic hepatitis C infection (CHC). We aimed to assess the patient compliance during DAAs treatment of CHC. Materials and Methods: The study included 371 CHC patients commencing DAAs therapy. The socioeconomic status of patients was assessed at index time. Three questions were asked to all patients to determine their attitude towards DAAs. All patients were asked at each visit about drug adherence and side effects using a questionnaire. Adherence was measured using two equations; the first was Continuous, Single Interval Measure of Medication Gaps (CSG) = Number of days without any medication/total days in the interval and the second was, Pill count = (Number of dosage units dispensed-number of dosage units remained)/(prescribed number of dosage unit per day× number of days between 2 visits). Results: Out of 371 patients included in the study only, 368 patients continued the study divided into two groups; group (A) included 184 patients received (Sofosbuvir plus Daclatasvir) and group (B) included 184 received (Sofosbuvir plus Daclatasvir and Ribavirin). The adherence to DAAs was 99% in group A versus 100% in group B with no significant difference in CSG, pill count, and several days with improper timing of dosage between the two groups. The common side effects noticed in both groups were fatigue and headache. Conclusions: Treatment of chronic hepatitis C infection, using Sofosbuvir plus Daclatasvir with or without Ribavirin, is well tolerated with very high adherence and few side effects. [ABSTRACT FROM AUTHOR]

Background: Spontaneous bacterial peritonitis (SBP) is a severe complication of cirrhotic ascites. SBP diagnosis is based on the count of ascitic fluid neutrophils (>250/mm3). This procedure is an invasive maneuver with many complications. This study aimed to find a sensitive diagnostic tool for SBP by examining ascitic fluid Macrophage Inflammatory Protein type 1 beta (MIP-1ß) as a rapid bedside test for diagnosis of SBP. Materials and methods: The study included 53 cirrhotic ascitic patients (33 with and 20 without SBP). Patients were subjected to thorough medical history taking, clinical examination, and laboratory investigation. Two ascitic fluid samples were taken, the first at admission time for cell count and culture, and the second sample was taken 48 hours after treatment in patients with SBP. Ascitic MIP-1ß was measured using ELISA technique at admission in both groups and 48 hours after treatment in the SBP group. Results: Ascitic MIP-1ß and CRP levels were significantly higher in the SBP group versus non-SBP patients. There was a significant positive correlation between ascitic fluid MIP-1ß and WBCs and serum CRP. Ascitic fluid MIP-1ß at a cut-off value = of 31.95 pg/ml had 79% sensitivity and 75% specificity for the diagnosis of SBP. Combined ascetic fluid MIP-1ß at the cut-off value =31.95 pg/ml and CRP in serum at a cut-off value =of 36 mg/L had 61% sensitivity and 100% specificity. There was a significant decrease of both, ascitic MIP-1ß and ascetic fluid PMN after treatment of SBP. Conclusions: Ascitic fluid MIP-1ß is highly sensitive and specific in the diagnosis of SBP-especially when combined with CRP. [ABSTRACT FROM AUTHOR]