Serum Islet Cell Autoantibodies During Interferon α Treatment in Patients With HCV-Genotype 4 Chronic Hepatitis

Chronic hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease worldwide and HCV genotype 4 (HCV4) is predominant in African and Middle Eastern countries. It is well established that interferon-α (IFNa) treatment for HCV may trigger serum autoantibodies against pancreatic islet cells (ICA) in a subgroup of patients. Available data on the incidence of ICA during IFNa therapy for chronic HCV4 infection are not conclusive. We investigated the appearance of ICA in 40 naïve Egyptian patients (38 males, 32 ± 6 years) with histologically defined chronic HCV4 infection undergoing IFNa treatment at a dose of 9-million U/week for 24 weeks. Serum samples were collected at baseline and following IFNa therapy and ICA were detected using indirect immunofluorescence. Baseline evaluation indicated that 2/40 (5%) patients had detectable serum ICA. After the completion of the treatment scheme, 12/38 (32%) previously ICA negative patients became ICA positive; however, no patient developed impaired glucose tolerance (IGT) or diabetes during follow-up. In conclusion, we submit that IFNa treatment for chronic hepatitis C (CHC) may induce serum ICA in one-third of Egyptian patients with HCV4. These autoantibodies, however, do not lead to alterations in glucose metabolism

Long-term effect of mass chemotherapy of Schistosoma mansoni on infection rate and diagnosis accuracy

Objectives: To assess the performance of microscopic stool examination, which is used widely for the diagnosis and assessment of infection rates of Schistosoma mansoni in Egypt, for the evaluation of chemotherapy efficacy after a decade of regular mass treatment. Methods: A total of 651 individuals from Lower Egypt (55 children and 596 adults) were examined for S. mansoni ova by microscopic stool examination (MSE) alone (n = 166; 111 adults and 55 children), rectal biopsy (RB) alone (n = 32 adults), or both MSE and RB (n = 453 adults). Results: Infection detection rates were significantly lower in the MSE alone group (9%; 15/166) compared to the RB alone group (40.6%; 13/32) and to the RB+MSE group (37.7%; 171/453). Out of all positive cases in the MSE+RB group, only 23/171 patients (13.5%) were positive by stool examination, of whom 21 were also positive by RB, in contrast to 169/171 patients (86.5%) positive by RB in the same group. It was noted that adding MSE to RB did not increase the prevalence compared to RB alone: 37.3% in the MSE+RB group vs. 40.6% in the RB only group. Using the summation of both MSE and RB tests as the gold standard, the sensitivity of MSE was significantly lower than that of RB: 13.5% vs. 98.8%. Conclusions: The implementation of mass treatment programmes has resulted in a new era of light infection, for which conventional parasitological methods for the diagnosis and monitoring of infection can miss many patients

<i>Helicobacter pylori </i> and Hepatitis C virus coinfection in Egyptian patients

<b>Introduction:</b> Chronic hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease worldwide. It has been shown that <i>Helicobacter pylori </i>(<i>H. pylori</i>) plays an important role in chronic gastritis, peptic ulcer disease and gastric malignancies, and its eradication has been advocated. The association between <i>H. pylori</i> infection and liver cirrhosis in patients with hepatitis C virus has been documented in different parts of the world; nevertheless, no conclusive data is available in Egypt. <b> Materials and Methods:</b> In the present study, the status of <i>H. pylori</i> infection was sought in 90 patients with chronic HCV infection and in 66 HCV-free healthy controls. <b> Results:</b> The study showed that the <i>H. pylori</i> positivity was increased significantly (<i>P </i>= 0.03) in the HCV-infected patients when compared to that in healthy controls, where <i>H. pylori</i> infection was found in 50 (55.6&#x0025;) out of 90 of the HCV-infected patients versus 26 (39.4&#x0025;) out of 66 of the healthy controls. In HCV-infected patients, the prevalence of <i>H. pylori</i> infection was increased significantly (<i>P </i>= 0.04) from chronic active hepatitis to cirrhosis.<i> H. pylori </i>infection was present in 6/18 (33.3&#x0025;), 10/21 (47.6&#x0025;), 16/27 (59.3&#x0025;), 18/24 (75.0&#x0025;) patients with chronic active hepatitis, Child-Pugh score A, Child-Pugh score B and Child-Pugh score C, respectively. More importantly, the prevalence of <i>H. pylori</i> infection in HCV-infected patients was increased very significantly (<i>P </i>= 0.003) with increasing Meld (model for end-stage liver disease) score. The prevalence of <i>H. pylori</i> was documented in 9/28 (32.1&#x0025;) patients with Meld score &#8804;10 and in 41/62 (66.1&#x0025;) patients with Meld score&#62; 10. <b> Conclusion:</b> It may be stated that our results collectively reflect a remarkable increase in <i>H. pylori</i> prevalence with advancing hepatic lesions, and the eradication treatment may prove beneficial in those patients with chronic hepatitis C

Helicobacter pylori and Hepatitis C Virus Coinfection in Egyptian Patients

Introduction: Chronic hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease worldwide. It has been shown that Helicobacter pylori (H. pylori) plays an important role in chronic gastritis, peptic ulcer disease and gastric malignancies, and its eradication has been advocated. The association between H. pylori infection and liver cirrhosis in patients with hepatitis C virus has been documented in different parts of the world; nevertheless, no conclusive data is available in Egypt. Materials and Methods: In the present study, the status of H. pylori infection was sought in 90 patients with chronic HCV infection and in 66 HCV-free healthy controls. Results: The study showed that the H. pylori positivity was increased significantly (P = 0.03) in the HCV-infected patients when compared to that in healthy controls, where H. pylori infection was found in 50 (55.6%) out of 90 of the HCV-infected patients versus 26 (39.4%) out of 66 of the healthy controls. In HCV-infected patients, the prevalence of H. pylori infection was increased significantly (P = 0.04) from chronic active hepatitis to cirrhosis. H. pylori infection was present in 6/18 (33.3%), 10/21 (47.6%), 16/27 (59.3%), 18/24 (75.0%) patients with chronic active hepatitis, Child-Pugh score A, Child-Pugh score B and Child-Pugh score C, respectively. More importantly, the prevalence of H. pylori infection in HCV-infected patients was increased very significantly (P = 0.003) with increasing Meld (model for end-stage liver disease) score. The prevalence of H. pylori was documented in 9/28 (32.1%) patients with Meld score ≤10 and in 41/62 (66.1%) patients with Meld score> 10. Conclusion: It may be stated that our results collectively reflect a remarkable increase in H. pylori prevalence with advancing hepatic lesions, and the eradication treatment may prove beneficial in those patients with chronic hepatitis C

A simple scoring system to predict early prognosis of patients undergoing loco-regional therapy for hepatocellular carcinoma

Abstract: Introduction: Hepatocellular carcinoma (HCC) is the sixth most common cancer and is the third leading cause of cancer-related deaths worldwide and its incidence is increasing. Aim of work: was to identify potential prognostic factors affecting survival in patients with unresectable HCC treated with local ablation. and proposing a new scoring system to predict early prognosis of those patients. Patients and methods: 150 consecutive patients with HCC who underwent RFA and/or TACE at National Liver Institute, Menoufiya University during 1 year were included in the study. Data of demographic, clinical, laboratory parameters and Triphasic spiral CT scan were collected. All patients were re-evaluated one month after intervention by laboratory testing and CT or MRI for detection of complications and detection of the effect of intervention Then all patients were followed up for 6 months for detection of mortality rate and prognostic factors related to survival. Results: 79.3% were males with mean age of 57.8 ± 9 year. Total bilirubin and serum creatinine significantly elevated one month after intervention (p&lt; 0.001). Serum albumin and AFP significantly decreased (p&lt; 0.001). Most of our patients were Child A and B. One month after intervention 49 (32.6%) remain Child (A) and 28 of them had no added points to their baseline child score, 76 (50.7%) patients had Child (B), Child (C) patients increased to 25 (16.7%). During 6 months follow up, upper GIT bleeding (due to bleeding esophageal varicies) occurred in 3 patients. Also, 3 patients developed infections and 12 patients developed hepatic decompensation. Development of complications was seen with (4.95 cm, tumor size with sensitivity of 78.9% and (p &lt; 0.01), AFP level of 184 ng/ml with sensitivity of 73.7% and (p &lt; 0.05), serum albumin level &lt; 2.35 g/dl with sensitivity of 73.7%, Child score &gt; 6.5 with sensitivity of 94.7%, MELD score &gt; 14.5 with a sensitivity of 78.9%. 14 patients died within 6 months of intervention (the mortality rate was 9.3%). The cause of death in most cases was progression of disease and/ or development of hepatic failure. The number of nodules significantly correlated with mortality (p &lt; 0.01). Tumor size above 5.9 cm, AFP &gt;330.5, serum albumin &lt;2.55 g/dl associated with increased mortality rate. Moreover, increased mortality was associated with Child score &gt;8.5 and MELD score &gt;13.5. Finally, we proposed a simple scoring system that could be used to predict outcome and stratify patients with unresectable HCC undergoing loco-regional therapy. Three factors; albumin &lt; 2.9 g/dl, AFP &gt; 330 and size of dominant tumor &gt; 5.3 cm were used in this score. A scoring system was derived by allocating one point for each factor that was elevated above the defined cut-off for AFP and tumor size or below the cut-off for the albumin; score 1=0 points, 2=1 point and score 3=&gt;1 point. The survival rate after six month from intervention for those with a score 1, 2 and 3 was 100%, 92.4% and 86.4% respectively. Conclusion: the new scoring system can be used easily to predict outcome in patients with HCC who are eligible to locoablative therapy. This scoring system needs to be validated on more patients. [Zaghla H, Gomaa AI, Elshimi E, Abdelaal EM, Elwaraki M, Gameel K and Badra G. A simple scoring system to predict early prognosis of patients undergoing loco-regional therapy for hepatocellular carcinoma. Life Sci

Significance of serum matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in chronic hepatitis C patients

Liver fibrosis (LF), where the chronic HCV infection is a major cause, is a characteristic of chronic liver diseases. LF results from chronic damage to the liver in conjunction with the accumulation of ECM proteins. Matrix metalloproteinases (MMPs) and their specific inhibitors (TIMPs) are thought to play an essential role in the hepatic lesions. The available data concerning the circulating levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in chronic hepatitis C are not conclusive. Therefore, the present study was designed to seek the relationship between serum MMP-9, and TIMP-1 to liver status in chronic liver disease in fifty patients divided into three groups (chronic hepatitis, liver cirrhosis and hepatocellular carcinoma). MMP-9 and TIMP-1 were analyzed by the enzyme linked immunosorbent assay (ELISA). The results showed that the lowest serum level of MMP-9 was found in chronic hepatitis patients compared to the control ( P < 0.05). Serum MMP-9 is decreasing during progression of chronic hepatitis to cirrhosis showing the least level in the cirrhotic group. Serum TIMP-1 was significantly higher in the cirrhotic group compared to chronic hepatitis ( P < 0.05) and controls ( P < 0.001). MMP-9 was negatively correlated to both TIMP-1 and the histological severity in chronic hepatitis. There was a positive correlation between TIMP-1 and the degree of fibrosis (r = 0.73, P < 0.001). Lastly, there was a statistically significant increase of MMP-9 ( P < 0.001) and TIMP-1 ( P < 0.05) in HCC patients compared with the other groups. In conclusion, these findings raise the possibility of using serum TIMP-1 as a non-invasive assay in liver fibrosis. Further, the altered balance between circulating MMP-9 and TIMP-1 during HCV infection may play an important role in aggravating liver injury progression in chronic liver diseases