Salivary PCR detection of Helicobacter pylori DNA in Egyptian patients with dyspepsia

AbstractSeveral methods are available for detecting Helicobacter pylori infection: (1) invasive methods based on gastric biopsies, (2) non invasive methods like Urea Breath Test (UBT), serology and stool antigen tests. Importance of salivary PCR in detection of H. pylori is still questionable. To evaluate the role of salivary PCR technique in detecting H. pylori gastric affection in Egyptian patients with dyspepsia and in differentiating between functional dyspepsia and acid-ulcer syndrome. This study included 60 patients with dyspepsia classified into three groups: (Group 1) patients with gastric H. pylori and ulcers or erosions (n=20), (Group 2) patients with gastric H. pylori and no ulcers or erosions and had functional dyspepsia (n=20), (Group 3) patients without H. pylori and had functional dyspepsia (n=20). All underwent upper gastrointestinal endoscopy with biopsies, rapid urease test and salivary samples for H. pylori PCR. Significant difference between the three groups regarding salivary PCR values. No significant difference between Group 1 and Group 2 but both had significant difference with Group 3, significant difference between gastric H. pylori positive patients (n=40) and negative ones (n=20). Salivary PCR test had sensitivity of 85%, specificity of 70% in diagnosing H. pylori. PCR value of 534000Iu/ml had best sensitivity (75%) and specificity (100%) for diagnosing H. pylori, highly significant positive correlation between H. pylori gastric affection and salivary PCR values. No significant difference between patients with acid ulcer syndrome (n=20) and those with functional dyspepsia (n=40) as regard salivary PCR mean values. Salivary PCR test showed sensitivity of 100%, specificity of 50% in differentiating between patients with acid ulcer syndrome and those with functional dyspepsia. PCR value of 440000 Iu/ml had best sensitivity (100%) and specificity (55%) in differentiating acid ulcer syndrome from functional dyspepsia with non significant. H. pylori salivary PCR may be of value in diagnosing H. pylori gastric affection and is strongly correlated with it but it is of limited value in differentiating between acid ulcer syndrome and functional dyspepsia

Serum Calprotectin as a Non-invasive Diagnostic Marker for Spontaneous Bacterial Peritonitis in Egyptian Cirrhotic Patients

ABSTRACT BACKGROUND and AIM: Delayed diagnosis of spontaneous bacterial peritonitis (SBP) is associated wit

Factor V G1691A (Leiden) is a major etiological factor in Egyptian Budd-Chiari syndrome patients

Objective: Budd-Chiari syndrome is a multifactorial disease in which several prothrombotic disorders may predispose patients to the development of thrombosis at this uncommon location (hepatic veins). The aim of this study was to determine the prevalence and characteristics of inherited thrombophilia in Egyptian Budd-Chiari syndrome patients.Materials and Methods: The study included 47 Budd-Chiari syndrome patients (20 children and 27 adults). Genotyping of Factor V G1691A (Leiden), prothrombin G20210A (PT), and methylenetetrahydrofolate reductase C677T were performed using real-time PCR and fluorescence melting curve detection analysis.Results: Factor V Leiden was observed in 29 patients (61.7%). It is the only factor that caused Budd-Chiari syndrome in 18 of the patients and in 5 of the patients with inferior vena cava involvement. Myeloproliferative disease was noted in 12 (25.5%) patients, antiphospholipid syndrome in 5 (10.6%), and Behcet’s disease in 3 (6.4%). Interestingly, 3 of the children with Budd-Chiari syndrome had lipid storage disease.Conclusion: Factor V Leiden was a major etiological factor in Egyptian Budd-Chiari syndrome patients, which may have been related to the high frequency of this mutation in the study region. Factor V Leiden was also a strong thrombophilic factor and the leading cause of inferior vena cava thrombosis in these patients. Lipid storage disease should be included as a risk factor for Budd-Chiari syndrome

Outcome of Transjugular Intrahepatic Portosystemic Shunt in Budd-Chiari Syndrome: Long-Term Outcomes of 118 Patients; A Single-center Experience

Context: Budd–Chiari syndrome (BCS) is a heterogeneous group of clinical conditions ranging from acute liver failure to completely asymptomatic patient. Patients with BCS nonresponsive to medical treatment or who are not candidates for angioplasty/stenting are routinely treated with transjugular intrahepatic portosystemic shunt (TIPS) to improve portal venous outflow. Aims: This retrospective study aims at determining the short and long-term outcomes of TIPS in BCS patients. Subjects and Methods: This retrospective study included 118 patients with primary BCS who underwent TIPS from 2005 to 2011. They were classified according to Child-Pugh, model for end-stage liver disease (MELD), Rotterdam and BCS-TIPS scores. Short-term outcome of TIPS (<1 year) was determined and included immediate postprocedure complications, effect on clinical status, liver profile, and stent patency. Long-term outcome (1–5 years) was determined and included stent patency rate, time, and pattern of management of stent occlusion and survival rates at 1, 3, and 5 years. Statistical Analysis Used: SPSS statistical package version 16. Paired t-test was used to compare pre and post-TIPS MELD and Child-Pugh scores. Chi-square test and Kaplan–Meier survival curve were used to examine the association between short- and long-term occlusion, liver function and survival outcomes. P < 0.05 was considered statistically significant. Results: By the 1st year, there was a significant decline in the percentage of patients having ascites and abdominal pain, increase in mean serum albumin from 3.42–4.02 g/dl and reduction in bilirubin levels from 2.57–1.35 mg/dl (P < 0.001). The rate of stent occlusion by the 1st year was 27.4%. During long-term follow-up, there was a marked improvement in clinical status, liver profile, Child–Pugh, and MELD scores (P < 0.001). The 1- and 5-year shunt patency rates were 72.6% and 78.7%, respectively. The main management of post-TIPS occlusion was angioplasty without stenting. The 1-, 3-, and 5-year survival rates were 95.8%, 93.2%, and 91.5%, respectively. There was a significant relation between survival and post-TIPS MELD score (P = 0.009). Conclusions: TIPS is an effective treatment modality for BCS and has a long-term survival benefit with satisfactory shunt patency and patient survival

Serum Golgi protein-73 in combination with α-fetoprotein for diagnosing hepatocellular carcinoma in Egyptian patients

Background and aim Hepatocellular carcinoma (HCC) is the third cause of cancer-related mortality. α-fetoprotein (AFP) is not a highly sensitive marker for predicting HCC despite its high specificity. Serum Golgi protein-73 (sGP73) seems to be promising new marker. This study aimed at evaluating the role of sGP73 alone and in combination with AFP for diagnosing HCC. Patients and methods This study was conducted on 90 Egyptian patients who were equally divided into two groups. Group 1 included 45 patients with hepatitis C virus-related liver cirrhosis without clinical or radiological evidence of HCC, and group 2 included 45 patients diagnosed as having HCC by triphasic abdominal computed tomography. Serum AFP and GP73 were measured using enzyme-linked immunosorbent assay. Results A cutoff value greater than or equal to 40 ng/ml for AFP had a sensitivity of 51.1%, specificity of 97.8%, and area under the curve (AUC) of 0.802. sGP73 with a cutoff value greater than or equal to 1.4 ng/ml yielded a sensitivity of 75.6%, specificity of 97.8%, diagnostic accuracy of 86.7%, and AUC of 0.908. The combined use of AFP and sGp73 led to an increase in sensitivity to 84.4%, specificity to 95.6%, diagnostic accuracy to 90%, and AUC to 0.947. Conclusion The combined use of AFP and sGp73 could increase the sensitivity and specificity for HCC diagnosis

Pattern of Vascular Involvement in Egyptian Patients with Budd-Chiari Syndrome: Relation to Etiology and Impact on Clinical Presentation

Introduction and aim. Budd-Chiari syndrome (BCS) is caused by hepatic venous outflow obstruction. This work aims to analyze the pattern of vascular involvement in Egyptian patients with BCS, demonstrates its relation to etiology and shows its impact on clinical presentation.Material and methods. The current retrospective study was conducted at The Tropical Medicine Department, Ain Shams University on one hundred Egyptian patients with confirmed diagnosis of primary BCS who were presented to the Budd-Chiari Study Group (BCSG) from April 2014 to May 2016 by collecting clinical, laboratory and radiological data from their medical records.Results. Isolated hepatic vein occlusion (HVO) was the most common pattern of vascular involvement (43%), followed by combined HVO and inferior vena cava (IVC) compression by enlarged caudate lobe (32%), then combined HVO and IVC stenosis/webs (21%), and lastly isolated IVC occlusion (4%). Ascites was more significantly encountered in BCS patients with HVO than in those with isolated inferior vena cava (IVC) occlusion and patent HVs (P = 0.005). Abdominal pain was significantly encountered in patients with occluded three major HVs (P = 0.044). Behcet’s disease was significantly detected in isolated IVC occlusion. Protein C deficiency was significantly detected in patients with combined HVO and IVC compression.Conclusion. Isolated HVs occlusion was the most common pattern of vascular involvement in Egyptian patients with primary BCS. Vascular pattern of involvement affected the clinical presentation and was related to the underlying thrombophilia in those patients