Percutaneous transhepatic stenting in management of post living donor liver transplantation hepatic venous stenosis

Aim: To evaluate the effectiveness and safety of percutaneous transhepatic stent placement in management of hepatic venous outflow obstruction after living-donor liver transplantation (LDLT). Materials and methods: From September 2010 to May 2015 percutaneous transhepatic venography was performed in 30 patients of 489 patients who underwent LDLT with suspected hepatic venous outflow obstruction with stent placement performed in 25 patients. Patient follow-up included clinical and laboratory data collection, Doppler ultrasonography (US), hepatic venography, and computed tomography. Technical success, complications, clinical improvement, and recurrence were evaluated. Results: Technical success was achieved in all patients. The mean pressure gradients across the stenosis before and after the procedure were 17.8 mmHg ± 6.4 (range, 3–39 mmHg) and 2.4 mmHg ± 2.6 (range, 0–8 mmHg), respectively. Four patients developed recurrent stenosis, and these patients underwent balloon angioplasty and remained with no events until the end of the observation period. During the mean follow-up period of 21 months (range 10–40 months) clinical success was achieved in 24 of 25 patients (96%). Conclusion: In conclusion, percutaneous transhepatic stenting is safe and effective for venous outflow obstruction after LDLT

Effectiveness of Direct-Acting Antivirals in Treatment of Elderly Egyptian Chronic Hepatitis C Patients

Background: Hepatitis C virus treatment has dramatically improved by direct-acting antiviral (DAA) therapy. The aim of this study was to assess the efficacy and safety of DAA in elderly Egyptian chronic hepatitis C (CHC) patients. Methods: The study was carried out on 327 CHC elderly patients >60 years; patients were divided into 3 age subgroups (<65, 65–75 and >75 years) on DAA therapy for 12 weeks. Ninety-one patients (27.8%) were treated with dual therapy, 234 patients (71.6%) with triple therapy and 2 patients (0.6%) with quadrable therapy. Results: All patients achieved end-of-treatment virological response (100%). ALT levels normalized during therapy. The follow-up rate of sustained virological response at 12 weeks after the end of treatment (SVR12) was 100%. One hundred and two patients had missed SVR12 data due to being lost tofollow-up. Two hundred twenty-two adverse events were reported (67.8%), including anemia in 30 patients (9.1%), leucopenia in 129 patients (39.4%) and thrombocytopenia in 63 patients (19.2%). No serious side effects led to discontinuation of therapy. No hepatic decompensation was observed, and no patients died. Conclusion: Age does not influence the success of DAA treatment and all DAA regimens are well tolerated, safe and highly efficacious, even in those aged 75 years or older

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

Evaluation of large cupping in children with anemia

Introduction In adults, large optic disc cups are often a sign of glaucoma. Children, however, show a lower prevalence of glaucoma than adults, but may present with optic disc cupping of nonglaucomatous origin. Aim of the work The purpose of this study is to evaluate with large cupping in children having anemia. Patients and methods This is a prospective analysis of patients attending the ophthalmology outpatient clinic in Beni Suef, Fayoum, and Misr universities. All patients were subjected to standard ophthalmological examination, optical coherence tomography (OCT), fundus photography, complete blood count (CBC), and stool analysis to diagnose the cause of anemia. Results In this study examination cupping of greater than 0.4 was detected in 236 patients out of 3361 patients examined within the same age. The mean age of the selected patients (236 patients) was 11.48 ± 3.2 ranging from 6 to 18 years of which 137 (58.05%) were girls and 99 (41.95%) boys. The mean best corrected visual acuity converted to logMAR is 0.093 ± 0.109 ranging from 0.301 (6/12) in 53 eyes to 0 (6/6) in 260, whereas the rest best-corrected visual acuity 0.176 (6/9). The mean intraocular pressure was 11.75 ± 1.539.The mean cup disc ratio was 0.498 ± 0.0934 (0.497 ± 0.095 for females and 0.501 ± 0.090 for males). The majority of patients (females more than males) had C/D ratio similarity between both eyes, whereas very few had 0.2 differences (males more than females). The mean Hb concentration was 10.79 ± 0.89 g/dl in females and 11.04 ± 1.09 g/dl in males. It was as low as 7.2 in males and 7.8 in females. The stool analysis for the patients showed that 126 patients (74 females, 52 males) were infected with Entamoeba histolytica, whereas 31 patients (22 females, nine males) were infected with Giardia lamblia and 79 patients did not have parasitic manifestations. Conclusion In conclusion to our work we found that functional optic nerve damage is a possibility in children with anemia and cupping and with normal intraocular pressure and that there is very high incidence of parasitic infestation in those children and young adolescents that warns for state intervention to deal with this problem. A larger scanning by the ministry of health may be needed to verify these results

Microelimination of hepatitis C in patients with chronic hemolytic anemias: a single-center experience

Abstract Background Patients with chronic hemolytic anemias (CHA) are at a high risk for transfusion-transmitted infections. Various studies in Egypt have shown a prevalence of hepatitis C virus (HCV) infection in 24–37% of those patients. Elimination of hepatitis C virus (HCV) in patients with CHA would prevent early progression of liver disease. In this study, we aimed to assess the efficacy, safety, and tolerability of sofosbuvir (SOF) and daclatasvir (DAC) in the special population of HCV-infected patients with CHA. In this prospective study, 21 consenting hepatitis C patients were recruited and treated using ribavirin-free SOF/DAC regimen for either 12 or 24 weeks according to categorization of patients into easy or hard-to-treat in accordance with the national protocols. Sustained virological response was assessed by RT-PCR for HCV-RNA at 12 weeks post-treatment (SVR12). Any treatment-related adverse events were noted. Results All patients were adherent to treatment with no discontinuation of therapy. SVR12 was achieved in 19 out of 21 patients (90.5%). There was a significant improvement in levels of ALT (p<0.009) after completion of therapy. On the other hand, the hemoglobin, total bilirubin, and ferritin levels showed a non-significant difference (p<0.501, p<0.542, and p<0.339, respectively). Moderate adverse events were observed in 2 out of 21 patients (9.5%), including sickling crisis and hepatic decompensation. Conclusion The results of this study substantiate the favorable efficacy, safety, and tolerability of ribavirin-free direct-acting antivirals (DAAs) in the special population of HCV-infected patients with CHA. Micro-elimination of HCV in special patient populations allows for pragmatic delivery of care to patients with co-morbid conditions who are in most need for treatment and allows for achievement of global elimination of HCV worldwide

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