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Purpose The purpose of this study was to evaluate the efficiency of multiple abdominal fat indices as measured via ultrasonography for predicting the presence and severity of carotid artery atherosclerosis and to compare the predictive capacity of ultrasonographic measurements to that of anthropometric measurements. Methods A total of 92 patients were included in this study. All participants underwent clinical and laboratory assessments, and anthropometric measurements were obtained. Ultrasound examinations were performed to measure the values of all abdominal fat indices and the intima-media thickness, as well as to detect the presence of atherosclerotic plaques. Univariate and multivariate logistic regression analyses were performed. Results In the multivariate analysis, significant associations were detected between carotid artery atherosclerosis and posterior right perinephric fat thickness (PRPFT) (hazard ratio [HR], 15.23; P

Ramadan fasting is obligatory for Muslim healthy adults. However, there are many exemptions from fasting; including patients, whose diseases will be aggravated by fasting. Muslim patients with different liver diseases are frequently seen in the clinics discussing their intent to fast this month with their treating physicians. To answer our patients' inquiries about the expected benefits and/or risks of fasting and delivering them the best care, we carried out this review and we draw advices and recommendations based on the available evidence. A web-based search, combining multiple keywords representing different liver diseases with Ramadan fasting had been carried out. To answer the research question: Do adult Muslim patients with different liver diseases who fast the month of Ramadan have had a deleterious effect on their health in comparison to those who did not fast? Relevant publications were retrieved. No randomized controlled trials were focusing on Ramadan fasting and liver diseases in the filtered databases, eg Cochrane library. Consequently, non-filtered databases, eg PubMed, Google Scholar and Egyptian Knowledge Bank searched and full-text high-quality research articles were carefully analysed to draw recommendations. Other relevant publications with low quality of evidence like case studies and short communications were also reviewed to address practice advices. Although Ramadan fasting was found beneficial for patients with NAFLD, it was found deleterious to patients with Child B and C cirrhosis and patients with peptic ulcer. Patients with chronic hepatitis, Child A cirrhosis and those with non-complicated liver transplant can fast with prefasting assessment and strict follow up.

Debates are inevitable in science and could be a powerful tool for addressing controversial topics as it promotes critical thinking and inspires individuals to consider alternate viewpoints. However, debates can help only to identify the issues that need to be clarified to address this question, but it can never help resolve the controversy itself. In the era of evidence-based medicine, the need for an evidence-based debate is mandatory. Polarising opinions and major debate have recently arisen in hepatology on the nomenclature and diagnostic criteria for fatty liver disease associated with metabolic dysfunction (non alcoholic fatty liver disease [NAFLD]-metabolic (dysfunction) associated fatty liver disease [MAFLD] debate). The aim of this viewpoint is to suggest a way to settle the debate through evidence. Descriptive review using PubMed to identify literature on the evidence and eminence-based medicine and studies comparing MAFLD and NAFLD criteria. The emerging studies comparing the performance of diagnostic criteria of NAFLD and MAFLD represent the dawn of a new era for reframing the ongoing debate by acquisition of the mandatory evidence that will both resolve the debate and lead to novel avenues of research. In conclusion, the time has come to hold debate and focus on gathering and building the evidence to settle it. It does not matter who wins the debate and once there is robust evidence, we should all follow it wherever it leads.

Background: Identifying risk factors disease characteristics, severity and mortality of COVID-19 are poorly clear, particularly in Egypt brbrObjectives

Background: Treatment of Hepatitis C Virus (HCV) infection had significantly changed during the last few years. The combination of Sofosbuvir and Ledipasvir (SOF/LDV) has been shown to treat high proportions of patients with HCV. Aim of Study: The aim of the work was to assess the efficacy and risk factors for failure of SOF/LDV in Egyptian patients with HCV infection. Patients and Methods: In this prospective study, 138 patients who were HCV antibody positive and HCV RNA positive by Polymerase Chain Reaction (PCR), aged between 18 and 75 years, were enrolled. The patients assessed demo-graphically, and by laboratory and ultrasound. The patients received daily Sofosbuvir 400mg plus Ledipasvir 90mg for 12 weeks, the primary end point was a sustained virological response at 12 weeks (SVR12) after the end of treatment, determined by quantitative PCR for HCV RNA. The patients were classified into two groups according to SVR12: Respond-ers included 133 patients who had undetectable level of HCV RNA and non-responders included 5 patients who had detect-able level of HCV RNA. Results: The overall SVR12 was 96.4%. The response of cirrhotic vs. non-cirrhotic patients was (80% vs. 98.4) with statistically significant p-value (p

Background: Transarterial Chemoembolization (TACE) is recommended as a treatment for unresectable Hepatocellular Carcinoma (HCC) in patients with normal compensated liver. The efficacy of TACE in cirrhotic patients with compromised liver function is unknown. Aim of Study: To evaluate the outcome following Tran-sarterial Chemoembolization (TACE) in patients with unap-plicable locoregional therapy in Hepatocellular Carcinoma (HCC). Patients and Methods: This Prospective Cohort study conducted on 50 patients with HCC at Tropical Medicine and Gastroenterology Department Qena University Hospital. Results: 56% of patients reached complete response within one month of treatment in mean duration of follow-up of 58.28 months, 66% of patients had recurrence 40% in

Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. Vitamin D deficiency may be one of the causes of its development. To assess the relation between recurrent attacks BPPV and Vitamin D deficiency. A case control study in which 40 patients were clinically diagnosed as posterior canal BPPV, Serum 25(OH) D was measured at 1st visit. Patients were divided into two groups; group A (20 patients) received Vitamin D supplementation in addition to canal repositioning maneuver and group B (20 patients) treated by canal repositioning maneuver only. Follow up of all patients for 6 months, neuro-otological assessment was repeated and recurrent attacks were recorded. Serum vitamin D was repeated after 6 month. This study included 14 males and 26 females age ranged from 35 to 61 years, Average serum of 25 (OH) D at the first visit was (12.4 ± 2 ng/ml) for group A, and (12.2 ± 1.7 ng/ml) for group B, all patients had low serum level of 25(OH) D (below 20 ng/ml). Recurrent BPPV episodes, were significantly lower in group A than that of group B. There is a relation between BPPV recurrence and low serum Vitamin D.

Zaki F Aref,1 Shamardan Ezz Eldin S Bazeed,2 Mohammed H Hassan,3 Abeer S Hassan,4 Alaa Rashad,5 Rehab G Hassan,6 Aida A Abdelmaksoud1 1ENT Department, Faculty of Medicine, South Valley University, Qena, Egypt; 2Tropical Medicine and Gastroenterology Department, Faculty of Medicine, South Valley University, Qena, Egypt; 3Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt; 4Department of Pharmaceutics, Faculty of Pharmacy, South Valley University, Qena, Egypt; 5Department of Chest Diseases and Tuberculosis, Faculty of Medicine, South Vally University, Qena, Egypt; 6Department of Public Health and Community Medicine, Faculty of Medicine, South Valley University, Qena, EgyptCorrespondence: Mohammed H HassanDepartment of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, EgyptTel +201098473605Email mohammedhosnyhassaan@med.svu.edu.egBackground: Ivermectin is an FDA-approved broad-spectrum anti-parasitic agent that has been shown to inhibit SARS-CoV-2 replication in vitro.Objective: We aimed to assess the therapeutic efficacy of ivermectin mucoadhesive nanosuspension intranasal spray in treatment of patients with mild COVID-19.Methods: This clinical trial included 114 patients diagnosed as mild COVID-19. Patients were divided randomly into two age and sex-matched groups; group A comprising 57 patients received ivermectin nanosuspension nasal spray twice daily plus the Egyptian protocol of treatment for mild COVID-19 and group B comprising 57 patients received the Egyptian protocol for mild COVID-19 only. Evaluation of the patients was performed depending on improvement of presenting manifestations, negativity of two consecutive pharyngeal swabs for the COVID-19 nucleic acid via rRT-PCR and assessments of hematological and biochemical parameters in the form of complete blood counts, C-reactive protein, serum ferritin and d-dimer which were performed at presentation and 7 days later.Results: Of the included patients confirmed with mild COVID-19, 82 were males (71.9%) and 32 females (28.1%) with mean age 45.1 ± 18.9. In group A, 54 patients (94.7%) achieved 2 consecutive negative PCR nasopharyngeal swabs in comparison to 43 patients (75.4%) in group B with P = 0.004. The durations of fever, cough, dyspnea and anosmia were significantly shorter in group A than group B, without significant difference regarding the duration of gastrointestinal symptoms. Duration taken for nasopharyngeal swab to be negative was significantly shorter in group A than in group B (8.3± 2.8 days versus 12.9 ± 4.3 days; P = 0.0001).Conclusion: Local use of ivermectin mucoadhesive nanosuspension nasal spray is safe and effective in treatment of patients with mild COVID-19 with rapid viral clearance and shortening the anosmia duration.Clinicaltrials.gov Identifier: NCT04716569; https://clinicaltrials.gov/ct2/show/NCT04716569.Keywords: ivermectin nanosuspension, nasal spray, COVID-19, biochemical and molecular

Background: The highest prevalence of chronic Hepatitis C Virus (HCV) was reported in Egypt. DAAs has been avail-able, with a reported 12 weeks sustained virologic response (12w-SVR) above 95% after treatment for 12 weaks. Aim of Study: Aim of the current study was to evaluate evaluate efficacy of the 2-DAAs combination of ombitasvir, paritaprevir (co-dosed with ritonavir) with ribavirin in treatment of chronic HCV patients and evaluate correlation between virologic failure and risk factors. Patients and Methods: Chronic HCV patients (n=100) were enrolled in the current study. All patients received 25mg ombitasvir, 150mg paritaprevir, and 100mg ritonavir orally once daily plus Ribavirin 600-1000mg) for 12 weaks. Response was assessed 12 weeks after end of treatment by SRT-PCR. Results: The interferon-free regimen of ombitasvir/ pari-taprevir/ritonavir + ribavirin for 12 weeks achieved sustained virologic response in 91% of patients. Conclusion: In conclusion, the 12-week 2-DAA regimen of OBV/PTV/r and DSV achieved an SVR12 rate of 91% in previously untreated patients with HCV infection. Liver Cirrhosis has negative impact on 12 weeks-SVR. Conflict of Interest: The authors have no conflict of interest related to this publication.

Background: Egypt has the highest prevalence of chronic hepatitis C virus (HCV) infection. The direct acting anti-virus (DAAs) are available, with a reported 95% sustained virological response after treatment for 12 weeks (12w-SVR). Objectives: The current study aimed to assess the correlation between platelet count and the DAAs therapy outcome in chronic HCV (CHC) patients. Patients and methods: three hundred CHC patients, Child–Pugh grade A, both naïve and treatment experienced patients were enrolled in this study, from outpatient Clinic, Department of Gastroenterology, Hepatology and Tropical medicine, Qena university hospital, Qena, Egypt, treated with DAAs for 12 weeks, either dual or triple therapy, according to criteria recommended by the national committee for chronic viral hepatitis (NCCVH). Patients categorized into three groups: (1) Group I (non-thrombocytopenic group): included 100 CHC patients with platelet count ≥ 150 (109/L); (2) Group II (mild thrombocytopenic group): included 100 CHC patients with platelet count 100-149 (109/L); (3) Group III (moderate thrombocytopenia): included 100 CHC patients with platelet count 50–99 (109/L). Results: The Overall CHC patient's mean age were (48.2 ± 11), 226 (75.33%) were males and 74 (24.67%) were females. 97.6% (293/300)of CHC patients attainedSVR; 97 % in (Group I), and 98 % in both (Group II), and (Group III), after 12 weeks DAAs therapy with no significant difference between groups. Conclusion: both DAAs treatment modalities were efficient in the eradication of HCV; however, thrombocytopenia in CHC patients does not affect the DAAs therapy outcome.

Background: COVID-19 is a severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2). Deficiency of zinc has been supposed to contribute to loss of smell, and taste in COVID-19 patients. Our study aimed to assess the serum zinc levels among patients with COVID-19 of various severities, with and without olfaction dysfunction. Also, to evaluate the effect of zinc therapy in recovery of smell dysfunction among such patients.Methods: This study included 134 patients; real-time reverse transcription- polymerase chain reaction (rRT-PCR) proved SARS-CoV-2. Serum zinc levels were measured for all infected patients. One hundred and five patients were detected to have anosmia and/ or hyposmia and who were categorized randomly into 2 groups, the first group included 49 patients received zinc therapy and a second group included 56 patients who did not receive zinc. Follow up of all patients for recovery duration of olfactory and gustatory symptoms and duration of complete recovery of COVID-19. Results: Olfactory dysfunction was reported in 105 patients (78.4%). Serum zinc levels weren't significantly differs between the patients' subgroups regarding disease severity or the presence or absence of olfactory and/or gustatory dysfunction (p˃0.05). The median duration of recovery of gustatory and/or olfactory function was significantly shorter among patients received zinc therapy than those who did not received zinc (p< 0.001), while the median duration of complete recovery from COVID-19 wasn't significantly differ among the two groups (p˃0.05).Conclusion: Although zinc status of COVID19 patients didn't exhibited a significant role in development of anosmia and/or hyposmia or disease severity, but zinc therapy may have a significant role in shortening the duration of smell recovery in those patients without affecting the total recovery duration from COVID-19.

Background: Egypt is the country of highest prevalence of chronic HCV infection. Elderly infected individuals are more liable than younger infected individuals to have increased course of infection, increased risk of disease progression, and consequently increased incidence of occurrence of advanced liver disease. Aims: The current study aimed to assess the safety and the efficacy of the treatment with direct acting antivirals based regimens in hepatitis C virus infected individuals aged ≥60 years. Setting: Unit of Hepatic Viruses Treatment, Qena university hospital, South Valley University, Qena, Egypt Patients and methods: three hundred elderly individuals with chronic hepatitis C virus infection, Child–Pugh grade A, were involved in this study, treated with DAAs for twelve weeks, either dual therapy or triple therapy(with addition of ribavirin), according to criteria of the national committee for chronic viral hepatitis. Results: The Overall CHC infected individuals mean age were 69.9 ± 5.3 years, 71.7% were male and 18.3% were females. The sustained virological response (SVR) rate at 12 weeks post-treatment was 96% (288/300). We discovered a statistically important association between virological failure and degree of fibrosis, rates of sustained virological response were 98.8% in patients with no liver cirrhosis and 84.5 % in patients with established liver cirrhosis, there were high important difference between cirrhotic and non-cirrhotic patients (P < 0.001). Conclusion: DAAs treatment reached 12weeks-sustained virological response in 96% of chronic hepatitis C virus-patient with high safety profile. Liver Cirrhosis has negative effect on 12weeks-SVR. Key Words: Direct-acting anti-virus, SVR, HCV.

OBJECTIVES This study aimed to determine the causative bacterial agents of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and to define antibiotic-resistance patterns in addition to identifying the genetic mutations in the quinolone resistance determining regions (QRDRs). PATIENTS AND METHODS Twenty milliliters of ascetic fluid was obtained from 51 patients with SBP. The antibiotic-sensitivity patterns of different strains were determined by the Kirby-Bauer method. Extracted bacterial DNA was used to determine the mutations in four different genes in QRDRs (gyrA, gyrB, parC, and parE) by sequencing after gene amplification by PCR. RESULTS Gram-negative bacilli were detected in 60.7% of the patients. Escherichia coli was detected in 33.3% of the patients, and Staphylococcus aureus was detected in 21.6%. Gram-negative bacilli showed the best sensitivity to meropenem (90.3%), followed by amikacin (83.9%). Gram-positive cocci were sensitive to vancomycin and oxacillin at 90 and 80%, respectively. Fluoroquinolone resistance was detected in 27% of the bacterial strains. Mutations in the gyrA and parC genes were detected in quinolone-resistant strains (64.3 and 35.7%, respectively). Several mutations were found in the gyrA gene (Ser83Leu, Ser81Phe, and Ser-84Leu). Ser80Ile and Ser79Tyr mutations were detected in the parC gene. No mutation was detected in the parE gene. CONCLUSION Frequent use of antibiotics as prophylaxis against SBP leads to an increase in antibiotic resistance and changes the microbial pattern of causative agents. The gyrA gene mutation was the most common mutation detected in fluoroquinolone-resistant strains.

This study was performed to determine the prevalence of HBV and HCV infection among blood donors and the occurrence of HEV in hepatitis viruses seropositive blood donors. Also, to investigate the correlation between the occurrence of hepatitis viruses and other risk factors (gender, age, occupation, educational level, residency and donors’ types). A total of 11,604 blood samples from apparently healthy blood donors of age range 18–60 years old were collected. The blood donors were categorized as voluntary and replacement donors. Blood samples from donors were tested for the presence of HBsAg, HCV and HEV antibodies by using Enzyme-linked immunosorbent assay. The overall results indicated that 671 out of 11,604 blood donors; 370 persons (3.188%) HCV, 295 persons (2.542%) HBV and 6 persons (0.052%) HCV and HBV; were hepatitis viruses seropositive donors. The prevalence of HEV were 193 (28.76%) among these seropositive blood donors. There is a highly significant correlation among HCV, HBV and other risk factors. Also, the HEV showed high significant with age and educational level and significant with donor types and locations. All investigated virus combinations (HEV/HCV, HEV/HBV and HEV/HCV/HBV) were highly significant with the risk factors except for occupation. In conclusion, the HEV is significantly correlated to HCV and HBV seropositive donors and should be screened among blood donors.

Background: Bleeding esophageal varices (OVs) due to portal hypertension are one of the major complications with high mortality in liver cirrhosis. So, early detection and management are mandatory. Aim: To evaluate the role of Von Willebrand factor (VWF) in predicting the presence of OVs. Patients and Methods: 62 patients with liver cirrhosis representing different Child-Pugh classes were included. The diagnosis of liver cirrhosis was based on the combination of clinical, laboratory and US examinations. All included patients underwent the following investigations: complete blood count, liver function tests (ALT, AST, serum bilirubin, albumin and total protein, prothrombin time (PT) and concentration (PC), INR and serum alkaline phosphatase), serum creatinine, Von Willebrand factor antigen (VWF-Ag) measurement and abdominal US. Upper endoscopic evaluation was done to detect presence or absence of varices (esophageal or gastric) and/or PHG. Results: 38 males and 24 females with their mean age (46 ± 12 years old) were included. Plasma Von Willebrand factor-Ag level was significantly higher in patients with OVs than those without varices (P value = 0.000). Also, its level was significantly higher in patients with higher grade of OVs, G3 than those with G1 or G2 (P value = 0.000). Patients with large OVs including those with G2 and G3 showed significantly higher values of VWF than those with small OVs (NO and G1) (P value = 0.000). VWF was independent predictor for detecting the presence of OVs with good sensitivity (90), specificity (77.3) and accuracy (85.5) at a cutoff value of 1.74 U/ml. Also it was an independent predictor for detecting the presence of large OVs with good sensitivity (91.2), specificity (85.7) and accuracy (88.7) at a cutoff value of 2.16 U/ml. Conclusion: VWF-Ag could be used as a non invasive laboratory independent predictor for the detection of OVs.

Background: Bacterial infection in cirrhotic patients is a fatal complication. The high incidence of bacterial infections in those patients may be related to several alterations in the defensive mechanisms against infections and increased intestinal permeability with bacterial translocation. Aim: To evaluate the role of portal hypertension (PH) in predicting the occurrence of bacterial infections in decompensated cirrhosis. Patients and Methods: In this retrospective cohort study, 99 patients—56 males and 43 females, with decompensated liver cirrhosis were included. Diagnosis of liver cirrhosis was based on clinical, laboratory and ultrasonographic examinations. Patients were classified according to the presence of bacterial infection into patients with infection—Group 1, and those without infection—Group 2. Laboratory, abdominal US and upper endoscopic data for all patients were collected. Logistic regression analysis was done to detect the independent factors for prediction of bacterial infection. Results: The mean age of patients was 50.5 ± 14.2 years. Bacterial infection was found in 41 patients (41.4%) and no infection in 58 patients (58.6%). Infected patients showed statistically significant higher values in the level of bilirubin, PT and Child-Pugh score (P value = 0.000) and lower values in the level of albumin, total serum protein and PC than those without infection (P value = 0.006, 0.000 and 0.000 respectively). Portal vein diameter (PVD) and splenic diameter (SD) showed statistically significant higher values in infected patients than in those without infection (P value = 0.028 and 0.000 respectively), also infection was more significantly prevalent in patients with varices than those without varices (P value = 0.000). The independent predictors for bacterial infection were: the age, total serum bilirubin, serum albumin, PT, PC, child score, PVD, SD and the presence of varices. Conclusion: Presence of varices (as a complication of PH) is an independent risk factor for the development of bacterial infection in decompensated cirrhotic patients and reduction of PH by any way could decrease this fatal complication.

Background Hyaluronic acid (HA) is an attractive potential marker for noninvasive diagnosis of liver fibrosis instead of liver biopsy for both patients and physicians. Aim To assess the role of HA for diagnosing the progression of steatosis to steato-hepatitis (SH) and fibrosis in patients with Chronic Hepatitis C virus (HCV) infection. Methods 90 patients with chronic HCV infection, 77 (85.6%) males and 13 (14.4%) females, were included. Blood samples were collected for routine laboratory investigations, liver function tests and serum HA measurements. A liver biopsy was taken for histopathological examination. Results Steatosis was found in 37 patients (41.1%), fibrosis in 29 patients (32.2%) and SH in 51 patients (56.7%). The mean serum HA for all patients was 86.4±48.2 ng/L. HA levels were significantly higher in patients with fibrosis (95.6±53 vs 54.5±3.5) and SH (88.7±52 vs 49.9±12) than those without (P value = 0.001and 0.001 respectively). HA levels were also significantly higher in patients with an advanced degree of fibrosis, SH and steatosis as compared to those with mild degrees (P value = 0.000, 0.001 and 0.01 respectively). Positive correlations were found between serum HA and the degree of fibrosis, SH and steatosis (P value =0.000 and r = + 0.758, 0.701and 0.727 respectively). The mean HA cut off value for the diagnosis of fibrosis and SH was taken to be 70 and 60 ng/L providing a diagnostic accuracy of 94.1% and 91.6% respectively. Conclusion Serum HA level is a good noninvasive marker for the diagnosis of fibrosis and steato-hepatitis in patients with chronic HCV infection.