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Mohamed A El-Mokhtar, 1,* Helal F Hetta, 1,* Mohamed A Mekky, 2 Doaa M Abd El-Kareem, 3 Mohammed Ramadan, 4 Mohammed Salah, 5 Nahed A Mohamed, 6 Eman A El-Masry, 7, 8 Sara Adel, 9 Ibrahim M Sayed 1, 10 1Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt; 2Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, Egypt; 3Department of Clinical Pathology, Faculty of Medicine Assiut University, Assiut, Egypt; 4Microbiology and Immunology Department, Faculty of Pharmacy Al-Azhar University-Assiut branch, Assiut, 71526, Egypt; 5Microbiology and Immunology Department, Faculty of Pharmacy Port Said University, Port Said, 42526, Egypt; 6Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt; 7Microbiology and Immunology Unit, Department of Pathology, College of Medicine, Jouf University, Al-Jouf, Saudi Arabia; 8Department of Medical Microbiology and Immunology, College of Medicine, Menoufia University, Menoufia, Egypt; 9Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Assiut, 71515, Egypt; 10Department of Pathology, School of Medicine, University of California, San Diego, CA, 92093, USA*These authors contributed equally to this work.Correspondence: Ibrahim M SayedDepartment of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, EgyptEmail Ibrahim.ibrahim@aun.edu.egBackground: Mutations within the “a” determinant region (position 124– 147) that is present in the major hydrophilic region (MHR, position 99– 160) of the hepatitis B surface antigen (HBsAg) are associated with vaccine-escape, lack of diagnosis, and failure to hepatitis B immunoglobulin (HBIG) therapy. Data regarding the amino acid changes of “a” determinant region of HBsAg are limited in Egypt. The prevalence and mutations in this region among chronic HBV (CHB)-i

Wael Abd Elgwad Elsewify,1 Elham Ahmed Hassan,2 Mohamed A Mekky,2 Abeer Sharaf El-Din Abd El-Rehim,2 Zain El-Abdeen Ahmed Sayed,3 Mohamed Omar Abdel Malek,2 Tarek TH ElMelegy,4 Abeer Sabry5 1Department of Internal Medicine, Faculty of Medicine, Aswan University, Aswan, Egypt; 2Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 4Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt; 5Department of Internal Medicine, Faculty of Medicine, Helwan University, Cairo, EgyptCorrespondence: Wael Abd Elgwad ElsewifyDepartment of Internal Medicine, Faculty of Medicine, Aswan University, Aswan 81528, EgyptTel +20 1001657295Fax +20 973480449Email waelelsewify@yahoo.comBackground: Screening of hepatocellular carcinoma (HCC) is challenged especially in patients with normal alpha-fetoprotein (AFP) levels. Aberrant p16 methylation has been implicated in HCC.Objectives and Aims: This study aimed to assess serum methylated p16 (MP16) expression levels and to evaluate MP16 diagnostic performance in HCC detection among HCV-infected Egyptian patients with normal AFP levels.Methods: MP16 levels were quantified using real-time PCR in 230 serum samples (30 healthy controls, 95 with HCV-HCC, 40 with chronic hepatitis C “CHC” and 65 with HCV cirrhosis). Diagnostic performance of MP16 for diagnosis of HCC was done using receiver operator characteristic curve analysis.Results: Serum MP16 levels were significantly higher in HCC than CHC, cirrhosis, and healthy subjects and significantly higher in HCC with normal AFP levels than those with higher AFP. ROC curves revealed promising diagnostic performance for MP16 in discriminating HCC with normal AFP levels from non-HCC cases. This predictive ability improved by combining MP16 and AFP (AUC of 0.872 with 100% sensitivity, 76.5% specificity, 7

Mohamed A Mekky,1 Hani I Sayed,2 Mohamed O Abdelmalek,1 Medhat A Saleh,3 Osman A Osman,1 Heba A Osman,4 Khairy H Morsy,5 Helal F Hetta6,7 1Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, Egypt; 2Center for Management of Viral Hepatitis, Ministry of Health, Assiut, Egypt; 3Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt; 4Department of Tropical Medicine and Gastroenterology, South Valley University Hospital, Qena, Egypt; 5Department of Tropical Medicine and Gastroenterology, Sohag University Hospital, Sohag, Egypt; 6Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt; 7Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA Background: Occult hepatitis C virus (HCV) infection (OCI) is characterized by the detection of HCV-RNA in non-serum reservoirs, such as peripheral blood mononuclear cells (PBMCs) and/or hepatocytes with undetectable HCV-RNA or antibodies in the serum. In this study, we tried to evaluate the prevalence and possible predictors of OCI in patients who achieved sustained virologic response (SVR) post sofosbuvir/daclatasvir (SOF/DCV) therapy.Patients and methods: A cross-sectional multicenter study was designed to enroll 1,280 HCV-infected patients who received SOF (400 mg) plus DCV (60 mg) once daily ± ribavirin regimen for 12 weeks and achieved SVR 12 weeks post treatment. They were randomly recruited from three dedicated Egyptian centers for management of HCV. Real-time PCR was performed to detect HCV-RNA in serum and PBMCs and to evaluate the different risk factors pertaining to the existence of OCI.Results: HCV-RNA was detected in PBMCs of 50 (3.9%) of them. All OCI cases exhibited significant fibrosis score and raised pre-treatment alanine aminotransferase (ALT) levels. Logistic regression analysis comparing OCI with non-OCI revealed that high pre-treatment viral load