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Meningitis is a public health concern. It is caused by several etiologic agents that vary by age group and geographical area. This study aims to highlight the etiological and predictive factors of acute meningitis in hospitalized febrile patients in Mansoura Fever Hospital, Egypt. This study includes cases admitted with suspected meningitis. The study is conducted in the period between April 2019 and March 2020. Lumbar puncture, CSF examination and blood culture and sensitivity were done. Brain Magnetic Resonance Imaging (MRI) was performed before lumbar puncture in some patients. Detailed analysis of epidemiologic characteristics, clinical data, laboratory findings, the causative organisms and predictors of patients with Bacterial Meningitis (BM) were studied. This study included 110 patients had BM with CSF leukocytosis > 100 cells/mm3. Out of 110 CSF samples, 95 cases (86.4%) pathogens were detected by direct Gram-stained smear. Gram positive cocci were the commonest microorganism isolated. 66.4% of patients had blood culture growth of the same organism as the CSF culture. Reagent strip CSF examinations showed a positive correlation compared with laboratory tests. BM had 22.7% mortality rate. Predictive factors of poor outcomes include CSF/serum glucose ratio >0.6, CSF protein >80 mg/dl and Tonsillitis. Prognostic factors that are associated with poor outcome include old age, late presentation, delayed antibiotics treatment, neurologic complications and Glasgo Coma Scale (GCS). BM remains a leading cause of morbidity and mortality,so early diagnosis and treatment decrease both. Predictors of poor outcome of BM are CSF/serum glucose ratio >0.6, CSF protein >80 mg/dl and Tonsillitis. Key words: Bacterial meningitis, lumbar puncture, cerebrospinal fluid (CSF) analysis.

Background: Meningitis is a serious health problem that results in grave morbidity and mortality. It is caused by several organisms and present with various presenting pictures imparting some challenge. Aim: Highlighting the etiology and prognosis of acute meningitis in Mansoura Fever Hospital. Subjects and Methods: A prospective cross sectional observational study. The study included 350 cases admitted with suspected meningitis. Lumbar puncture: for collection of cerebrospinal fluid (CSF) samples. CSF analysis, microbiological examination of CSF, and blood culture and antibiotic sensitivity test were done. Brain magnetic resonant imaging (MRI) was performed before lumbar puncture in some patients. Detailed analysis of epidemiologic characteristics, clinical data and laboratory findings, the causative organisms, prognosis of all the patients with acute bacterial meningitis (ABM) were studied. Results: Meningitis occurred at all age groups. A significant proportion of meningitis patients (60%) reported a positive history of antibiotic intake in the few days (3-5) before admission to the hospital. 79.1% of ABM patients had a CSF leukocyte count in the range of > 100 up to 1,000 cell/mm3 and 80% had CSF neutrophil percentage > 50%. The pathogens were detected by direct Gram-stained smear in 86.4% of patients. Gram +ve bacteria was detected in 55/110 (50%) of cases. Gram -ve bacteria detected in 40/110 (36.4%) of cases. ABM carried a high mortality rate (22.7%). ABM had 22.7% mortality rate. Conclusions: Meningitis is endemic in Egypt with a significant mortality rate. Strept pneumonia was the most common offending organism.

Background and study aim: Cardiac dysfunction in cirrhotic patients presented by imperfect cardiac contractility in response to stress and/or change in the diastolic relaxation of the heart with electrophysiological changes in lack of other recognized cardiac disease. The study aimed to assess the cardiac changes in cirrhotic patients. Patients and Methods: our study was conducted on 100 adult cirrhotic patients who were divided according to the Child Pugh score into 3 groups: G1: comprised 30 Child A patients. G2: comprised 30 Child B patients. G3: comprised 40 Child C patients. Full history, clinical examination, laboratory (CBC, liver and kidney function tests, viral markers and FBS), ECG and cardiac echo-doppler were done for all patients. Results: Out of 100 cirrhotic patients, QTC interval was found to be prolonged in 70 cirrhotic patients. Echo-cardiographic abnormalities were found in Child B and C group patients more than in Child A patients. There was significant increase in Echo parameters as (IVRT and PAP) with liver disease deterioration from Child A to Child C. There was no significant difference regarding left and right ventricular end diastolic diameter among the studied groups. Conclusion: 70% of cirrhotic patients had cardiac changes and there is positive correlation between severity of liver cirrhosis and cardiac changes.

Backgroundand study aim:The differential diagnosis between bacterial meningitis and aseptic meningitis is a critical clinical issue and ‎searching for reliable and valid markers is required. This work aimed to assess the role of the combined ‎measuring of CSF lactate and serum procalcitonin in the diagnosis of acute bacterial meningitis‎‎‎. Patients and Method:‎A cross-sectional study including 42 meningitis patients was conducted at Zagazig Fever Hospital and Zagazig ‎University Hospitals in the period from November 2018 to June 2019, Patients were divided according to their ‎final diagnosis into two groups; group I included 13 patients with bacterial meningitis ( positive CSF bacterial ‎culture and/or Gram stain ), group II included 29 patients with aseptic meningitis (negative CSF bacterial ‎culture and Gram stain), The data collection sheet included clinical assessments, lumbar puncture with CSF ‎analysis, CSF lactate level testing, and Serum procalcitonin level testing‎‎.‎ Results: One hundred five of house officer participated Serum procalcitonin and CSF lactate levels were significantly higher in the bacterial meningitis group (1.16 ‎‎±1.24, 7.5 ± 6.6, respectively) than patients with aseptic meningitis (0.059 ± 0.04, 3.98 ± 2.1, respectively). ‎The measuring of both serum procalcitonin and CSF lactate levels had got a higher sensitivity, specificity, and ‎accuracy (96.6%, 76.9%, 90.9% respectively) for the diagnosis of bacterial meningitis more than measuring ‎either of them only‎‎‎. Conclusion: The combined measuring of both serum procalcitonin and CSF lactate levels is highly accurate in the diagnosis ‎of bacterial meningitis cases and helps to differentiate bacterial meningitis from aseptic meningitis‎‎‎‎.

Background: Acinetobacter baumannii (A. baumannii) has emerged as a nosocomial pathogen especially in the intensive care units (ICUS). It’s enlisted at the top of urgent threat level organisms in CDC’s antibiotic resistance threats report. Objectives: To assess prevalence, risk factors of health care associated infection by A. baumannii, and to compare the in-vitro efficacy of colistin sulfate- tigecycline combinations versus their individual combination with levofloxacin and meropenem against carbapenem resistant A. baumannii clinical isolates from an Egyptian tertiary care hospital ICUs. Methodology: The study included 250 ICU patients, samples were collected according to the site of infection. A. baumannii was isolated, identified and tested for antibiotic susceptibility by disc diffusion. Broth microdilution method was used for assessment of colistin, Tigecycline, levofloxacin, and meropenem. Thirty isolates resistant to all carbapenems were tested by the checkerboard method to assess effect of antibiotic combinations. Results: forty-six A. baumannii were isolated, with highest prevalence in respiratory secretions. Prior antibiotic administration and failure of empirical antibiotic therapy were found to be a major risk factors of infections by A. baumannii. Colistin combination with meropenem showed the highest synergy (50%). Tigecycline-meropenem combination had the highest antagonistic effect (66.7%). Conclusion: No antagonistic effect of colistin combination with meropenem was confirmed in this study. Only colistin-based combinations, particularly those with meropenem may confer therapeutic benefits against carbapenem-resistant A. baumannii.

Background No chemotherapeutic agents have been standardised for transarterial chemoembolisation (TACE). In particular, doxorubicin has no defined optimal dosage in TACE procedures. We compared low versus currently used dose of doxorubicin for TACE in patients with hepatocellular carcinoma (HCC) in terms of severity of post-embolisation syndrome (PES) and overall survival (OS). Methods From October 2014 to March 2018, we enrolled patients with primary HCC scheduled for TACE. Patients were randomised to receive 50 mg (group A) or 100 mg (group B) of doxorubicin. Outcomes were the rate of patients with PES; free-time-to-PES; changes in laboratory results; tumour response at 1, 3, and 6 months after TACE; and overall survival. Results Twenty-eight patients (24 males, 4 females) were enrolled, aged 58.9 ± 6.8 years (mean ± standard deviation). Fifteen of them palliated with 50 mg (group A) and 13 with 100 mg (group B) of doxorubicin for a total of 68 TACE procedures (of 28 patients who had repeated TACE procedures). Visual analogue scale (VAS) and duration of pain were significantly differently lower in group A than in group B (p p = 0.003). No significant differences between both groups were observed for tumour response to TACE and OS. The doxorubicin dose was significantly correlated with duration of pain, fever, and VAS score. Conclusion A lower dose of doxorubicin (50 mg) was associated with fewer PES symptoms compared with 100 mg, without effects on tumour response nor OS.

Background and aim: The direct-acting antivirals (DAAs) treatment has greatly improved sustained virologic response (SVR) in chronic non-cirrhotic hepatitis C virus (HCV) patients and to less extent in those with cirrhosis. There is a stressing need for predicting the outcome of DAAs treatment especially in “difficult to treat” patients. This work aimed to study the value of the Child-Turcotte-Pugh (CTP) score in the prediction of treatment outcome with DAAs in “difficult to treat” chronic HCV patients. Materials and methods: A retrospective cohort study was conducted where files of 120 “difficult to treat” patients were randomly selected from the follow-up clinic. Patients’ data were collected before and after treatment including history taking, clinical examination, laboratory investigations, and abdominal ultrasonography. Child-Turcotte-Pugh (CTP) scores were calculated. Results: There was no significant difference in mean Child score between patients with and without SVR before treatment, while this difference became significant after treatment. The patients without complications showed a highly significant decrease in their mean Child score after treatment, while patients with complications did not show any significant differences. Conclusion: The baseline Child-Turcotte-Pugh score cannot predict the treatment response of DAAs in “difficult to treat” chronic HCV patients, but it is significantly associated with the occurrence of complications.

Aim We aimed to assess the safety and efficacy of propofol versus midazolam in cirrhotic patients undergoing upper GI endoscopy. Methods Ninety compensated cirrhotic patients (all met class I-III criteria according to the American Society of Anesthesia) were enrolled in this comparative study. They were classified into three groups according to scheduled pre-endoscopy sedation drugs; the midazolam group, which included 30 patients who received IV weight-dependent midazolam (0.05 mg/kg with additional doses of 1 mg every 2 min when necessary, up to a maximum dose of 0.1 mg/kg or 10 mg); the propofol group, which included 30 patients who received a propofol bolus dose according to age and weight (0.25 mg/kg with additional doses of 20-30 mg every 30-60 s when necessary, up to a maximum dose of 400 mg); and the combined group, which included 30 patients who received half a dose of midazolam and of propofol. Results Prolonged postendoscopy recovery times were reported in the midazolam group, while shorter recovery times were reported in the propofol and combined groups. All patients in the propofol and combined groups gained consciousness shortly postendoscopy; however, only half of the midazolam group's patients gained consciousness after the standard recovery time (10-30 min). Highly significant differences were found among the three groups regarding consciousness level according to the Glasgow coma scale, as well as regarding the occurrence of hypoxia during endoscopy. Conclusion Considering safety and efficacy issues, propofol is better than midazolam in gastrointestinal endoscopy, especially in patients with liver cirrhosis.

Aim We aimed to assess the safety and efficacy of propofol versus midazolam in cirrhotic patients undergoing upper GI endoscopy. Methods Ninety compensated cirrhotic patients (all met class I–III criteria according to the American Society of Anesthesia) were enrolled in this comparative study. They were classified into three groups according to scheduled pre‐endoscopy sedation drugs; the midazolam group, which included 30 patients who received IV weight‐dependent midazolam (0.05 mg/kg with additional doses of 1 mg every 2 min when necessary, up to a maximum dose of 0.1 mg/kg or 10 mg); the propofol group, which included 30 patients who received a propofol bolus dose according to age and weight (0.25 mg/kg with additional doses of 20–30 mg every 30–60 s when necessary, up to a maximum dose of 400 mg); and the combined group, which included 30 patients who received half a dose of midazolam and of propofol. Results Prolonged postendoscopy recovery times were reported in the midazolam group, while shorter recovery times were reported in the propofol and combined groups. All patients in the propofol and combined groups gained consciousness shortly postendoscopy; however, only half of the midazolam group's patients gained consciousness after the standard recovery time (10–30 min). Highly significant differences were found among the three groups regarding consciousness level according to the Glasgow coma scale, as well as regarding the occurrence of hypoxia during endoscopy. Conclusion Considering safety and efficacy issues, propofol is better than midazolam in gastrointestinal endoscopy, especially in patients with liver cirrhosis.

Background and study aim: Non-alcoholic fatty liver disease (NAFLD) is a state defined by extreme fat accumulation in the form of triglycerides (steatosis) in the liver. A subgroup of NAFLD patients characterized by injury to the hepatocytes and inflammation in addition to excessive fat, the latter condition, nominated non-alcoholic steatohepatitis (NASH). The work aimed to evaluate the role of serum resistin level as a diagnostic marker in patients with non-alcoholic steatohepatitis who were admitted to the Tropical Medicine and Internal Medicine departments, Faculty of Medicine, Zagazig University (inpatient and outpatient). Patients and Methods: This study was performed on 38 patients between April 2017 to May 2018.They were classified into two groups; control group included 19 non-obese apparently healthy individuals, 11 males and 8 females with average age of 43.2 year and average body mass index of 23.46 Kg/m2 and patients group included 19 patients with NASH, 13 males and 6 females with average age of 44 year and average body mass index of 32.71 Kg/m2. They had bright fatty liver on ultrasono-graphic examination and raised ALT and AST and liver biopsy confirmed the diagnosis of NASH. Clinical assessment, laboratory evaluation, pelvi-abdominal ultrasound, and serum resistin were done for all participants. Results: In this study: Cut off level of serum resistin was >3.7 ng/ml and there was a significant difference as regard serum resistin in NASH group in comparison with control group. Conclusion: Serum resistin level was significantly higher among NASH group in comparison to the control group. Serum resistin level may be a good diagnostic marker for patients with NASH.

Background and study aim: Hepatitis B virus (HBV) is a major risk factor of hepatocellular carcinoma (HCC) in all age groups. There is a need to differentiate between them in the adolescence age by laboratory and physical examination for assessment of different outcomes of both diseases. Subjects and Methods: Cross sectional study that included Session [UserIDID] adolescents with HBV, another Session [UserIDID] with HCC with age ranging from 12 and up to 17 years. They were selected from those admitted to Tropical Medicine Department, Menofia University and Tropical Medicine Department, Zagazig University. All patient underwent laboratory assessment of interleukin6 (IL6) and were further examined at the Cardiology Unit in Pediatric department of Ain Shams University hospitals for complete echo-cardiographic and anthropometric evaluation. Results: Twenty four patients have HCC were examined with mean age (14.15± 3.01) years and another Session [UserIDID] are having HBV (14.64±3.13) years. Differences were found between both groups as regards IL6 as mean values were (13.29 pg/ml) in HBV and (77.63 pg/ml) in HCC group while no differences were detected as regards cardiac and anthropometric evaluations. Conclusion: IL6 seems to be a useful marker to compare between HBV and HCC in adolescent patients instead of depending on clinical cardiac evaluation or growth parameters that showed no differences.

Background and study aim: Hepatitis C virus (HCV) infection is a major public health problem worldwide. Blood donations screening achieved mainly by serological identification of HCV-Antibody (Ab), has largely reduced HCV transmission. HCV Core Antigen (CAg) tests have been introduced to supplement anti-HCV tests and HCV PCR analyses. CAg may be a useful screening test for identifying window phase of HCV infected patients whom are candidate for blood donations. The study aimed to evaluate diagnostic performance of HCV core antigen in comparison to HCV-RNA quantification and anti-HCV-Ab analyses in attendances of blood bank of Zagazig University hospitals. Patients and Methods: The study was performed on 92 participants attending the blood banks of Zagazig University Hospitals for blood donation between May 2015 to November 2017. The participants were classified into two groups; group A, which included 46 donors (32 males and 14 females) with negative HCV antibody and group B, which Included 46 patients (30 males and 16 females) with positive HCV antibody. Clinical assessment, HCV AB detection by ELISA, Prototype ELISA for HCV core antigen for presence of HCV core antigen and HCV RNA Quantitative were done for all participants. Results: No significant differences between both studied regarding sex and age. A high significant relation between HCV AB positivity and negativity as regard HCV PCR was found in both groups. A high significant relation between HCV core antigen positivity and negativity as regard HCV PCR. There was high significant relation between HCV core antigen positivity and HCV PCR in group A patients. There was a high significant relation between HCV core antigen positivity and HCV PCR in positive HCV antibody patients and statistically a high significant relation between HCV core antigen negativity and HCV PCR in group B patients. Conclusion: HCV core Ag can be identified by serological ELISA. This assay is cheap, easily performed, and compatible with HCV PCR. Its application may prevent the vast majority of HCV transmissions caused by the transfusion of window phase donations.

Background and aim of the work: Portal hypertension (PHT) and the eventual Oesophageal varices (OV) is one of the awful complications of liver cirrhosis. Bleeding from OV is a real leading cause of death. This study aims at evaluating serum ascites albumin gradient (SAAG) as a predictor of OV. Patients and methods: A descriptive cross-sectional study was conducted on 105 males and 26 females where they were divided into two main groups and sub groups according to the presence and size of OV. All participants were subjected to full history taking, thorough clinical examination, laboratory investigations, liver function tests, complete blood count, kidney function tests, hepatitis markers: HCV-Ab (anti hepatitis c virus antibody) hepatitis B surface antigen (HBs-Ag), abdominal ultrasonography and abdominal diagnostic paracentesis with calculation of SAAG. Results: there is highly significant increased SAAG in cirrhotic patients with OV than those without. Moreover, SAAG increases significantly with the grade of O.V. Conclusion: Serum ascites albumin gradient (SAAG) could be used as a non-invasive predictor for the presence of O.V in cirrhotic patients with ascites. Moreover, SAAG value increased significantly with the progression of O.V.

Background: SEN virus (SENV) and Torque teno virus (TTV) are blood born viruses. Their effect on the development and progress of liver diseases is still unclear. The aim of this study was to determine the prevalence and effect of SENV and TTV among chronic hepatitis C (CHC) patients. Patients and Methods: two hundred patients with CHC were the subjects of this work. A single blood sample was collected from each patient. Thorough clinical examination and relevant laboratory and radiological investigations were done. SENV and TTV were tested for by polymerase chain reaction (PCR). Results: SENV was identified in 3 and TTV was found in 21 (10.5%) of patients. No statistically significant difference was detected as regards clinical status, laboratory findings or radiological examination between SENV or TTV positive and negative patients. Conclusion: SENV and TTV exist among CHC patients. They had insignificant implications on the course or progression of liver diseases.

Purpose To evaluate the role of multi-detector computed tomography (MDCT) in detection and characterization of chemotherapy induced hepatic changes. Materials and methods This retrospective study included 400 patients with confirmed 14 malignancies and treated by standard chemotherapy regimens. The most common malignancy was non-Hodgkin lymphoma and mostly chemotherapy regimen was Cyclophosphamide, Hydroxydaunomycin, Oncovin and Prednisolone (CHOP). All patients underwent CT scan using 64 MDCT scanner (Brilliance 64, Philips) before chemotherapy and follow-up after 6 months from last session of chemotherapy. Precontrast series and post-contrast triphasic study were done for all patients. All the patients underwent radiological evaluation for hepatic changes after chemotherapy treatment. All CT scans were evaluated for fatty liver, capsular retraction, venoocclusive disease and biliary sclerosis. Four patients with capsular retraction underwent liver biopsy. Results Forty patients (32 females and 8 males) had hepatic changes due to effect of chemotherapy. The most common CT finding was fatty liver. Hepatic fatty changes were detected in 36/40 patients. These fatty changes were diffuse, focal fatty and diffuse with fatty spare area. Four patients had capsular retraction: 1 patient with HD and 3 patients with metastatic cancer breast. Veno-occlusive disease and biliary sclerosis were not detected.

Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70 - 80% of all liver cancers and the 5-year survival is only 3 - 5%. This bad prognosis is due to the lack of an effective method for early diagnosis. So, only 30 - 40% of patients with HCC are suitable for curative treatments at the time of diagnosis. Thus, there is a great need for tools to diagnose HCC early especially in cirrhotic patients. The aim of this work is to assess the validity of serum DKK1 as a diagnostic marker for HCC and to assess prognostic value of serum DKK1 in predicting treatment response, complication and survival in HCC patients. Patients and Methods: This study included Session [CurrentTestPartID] Patients divided into two groups. Group A: consisted of 30 patients with post hepatitic C and/or B liver cirrhosis. Group B: consisted of 30 patients with HCC on top of post hepatitic C and/or B liver cirrhosis. Group B patients underwent either radiofrequency ablation or ethanol injection. Clinical assessment, routine laboratory evaluation, CT studies and measurement of serum alpha-fetoprotein (AFP) and DKK1 were performed to all patients and repeated to group B patients 1 and 3 months after treatment. Results: The optimum cut off value of DKK1 for diagnosis of HCC was 4.3 ng/mL (AUC 0.89, sensitivity 66.7% and specificity 96.6%) (P 101 ng/mL with 90% sensitivity and 75.9% specificity (p

Background and study aim : Endoscopic treatment has become the principal first-line intervention in patients with bleeding oesophegeal varices, both during the acute event and for long-term therapy to prevent recurrent bleeding. Several clinical considerations affect the prognosis in individual patients including the severity portal hypertension, the location of the bleeding varices, residual hepatic function, the presence of associated systemic disease, and others. Early rebleeding has been shown to be a strong predictor of mortality and recurrent variceal bleeding substantially increases the risk of complications which further contribute to mortality. This study aimed to evaluate early rebleeding after different methods of endoscopic intervention and investigate the different parameters of the patient that can be correlated to it. Patients and methods: Hundred and four cirrhotic patients with first attack of variceal bleeding were included in this study. They were randomly allocated to two groups, group I: 52 patients who were managed by endoscopic variceal sclerotherapy and group II: 52 patients who were managed by endoscopic variceal band ligation to control their attack. The patients were followed up for six weeks and all their clinical, laboratory, endoscopic parameters were monitored. The rate of mortality and early rebleeding was measured and correlated to these different patients' parameters Results: There was no significant difference between the two groups as regards rate of early rebleeding (15.4% in group I vs 9.6% in group II P= 0.374). The rate of early rebleeding was significantly correlated to Child's score (r=+0.136 P=0.014), PT (r=+0.35 P

Aim Nonalcoholic fatty liver disease (NAFLD) is probably the most common liver disorder in the world. A subgroup of NAFLD patients is characterized by injury to the hepatocytes and inflammation in addition to excessive fat (steatohepatitis), the latter condition is nominated nonalcoholic steatohepatitis (NASH). This work aimed to evaluate the role of probiotics on the outcome of NASH in patients admitted to the Tropical Medicine Department, Faculty of Medicine, Zagazig University (inpatients and outpatients). Materials and methods This study was performed on 30 patients (17 males and 13 females), with body mass index from 30 to 35 and average age of 44 years with bright fatty liver in ultrasonography and raised alanine transaminase (ALT) and aspartate transaminase (AST) and positive liver biopsy findings. The patients were divided into group I (case group) that included 15 patients who received probiotics and group II of 15 patients as control group who did not receive probiotics; the study was conducted between November 2014 and April 2016. Clinical assessment, laboratory evaluation, pelvic-abdominal ultrasound, and liver biopsy of all cases were carried out. Results In this study, there was significant decrease in liver enzymes (ALT and AST) and no statistically significant other laboratory findings. Also there was relief for dyspepsia in some patients. Conclusion Probiotics treatment is effective, safe, well-tolerated, inexpensive, appropriate for long-term use, and optimally, works at multiple levels to downregulate inflammatory mediators, and therefore, probiotics could be an option in the treatment of NASH. How to cite this article Monem SMA. Probiotic Therapy in Patients with Nonalcoholic Steatohepatitis in Zagazig University Hospitals. Euroasian J Hepato-Gastroenterol 2017;7(1):101-106.