Tropical Medicine Department Research Articles

Role of colonoscopy in the diagnosis of lower gastrointestinal disorders in children

Introduction Adult colonoscopies are widely and routinely performed worldwide and provide a safe and effective diagnostic and therapeutic tool. Moreover, safety and effectiveness of pediatric colonoscopy in lower gastrointestinal diseases have been established. Aim To assess the role of colonoscopy in the diagnosis of lower gastrointestinal tract diseases in a group of Egyptian children. Patients and methods A total of 40 children were admitted to the Endoscopy Unit of Al-Zahraa University Hospital, Al-Azhar University, in both Pediatric and Tropical Medicine Departments in the period from October 2014 to December 2015. They presented with various lower gastrointestinal symptoms, indicated for colonoscopy evaluation. Thorough clinical history taking and clinical examination, complete blood count, bleeding profile, liver enzymes, and kidney function tests were done. Colonoscopy and histopathological examination of colonoscopic specimen were done. Results The most common indications of colonoscopy were bleeding per rectum in 42.5% of cases followed by bleeding per rectum associated with chronic abdominal pain in 25% of cases, bleeding per rectum associated with vomiting, hematemesis, and melena in 15% of cases, bloody chronic diarrhea in 7.5% of cases, chronic constipation associated with bleeding per rectum in 5% of cases, and nonbloody chronic diarrhea in 5% of cases. Regarding endoscopic results, colorectal polyps, inflammation with superficial ulceration, and normal mucosa were the main endoscopic findings, representing 42.5, 37.5, and 20% of cases, respectively. Based on histopathological results, juvenile polyps were the most common diagnoses in 42.5% of cases, whereas 37.5% of cases were chronic nonspecific colitis, 12.5% of cases were eosinophilic colitis, and 7.5% of cases were ulcerative colitis. Conclusion Colonoscopy is a valuable and safe tool for diagnosis of lower gastrointestinal diseases in children.

Peripheral neuropathy in patients with hepatitis C virus infection: a clinical and neurophysiological study

Background Hepatitis C virus (HCV)-positive patients may exhibit a wide range of extrahepatic manifestations, including peripheral neuropathy (PN). Aim The aim of this work was to study the incidence and patterns of PN among patients with HCV infection, with a special emphasis on the Egyptian HCV treatment protocol of direct-acting antiviral agents (DAAs). Patients and methods This was a case–control study carried out at the outpatient clinic of Neuropsychiatry and Tropical Medicine Departments in Tanta University Hospitals from August 2017 to April 2018. This study was applied on 60 patients with HCV infection targeting assessment of PN, clinically and neurophysiologically, before starting the Egyptian HCV treatment protocol of DAAs (visit 0) and 3 months later at the end of treatment with compliant drug therapy (visit 1), with follow-up of affected patients for 3 months after stoppage of treatment (visit 2). Results Clinical assessment of patients before treatment showed clinical diagnosis of neuropathy in 10% (6/60) of our patients, with sensory predominance, and by electrophysiology assessment, we found 15% (9/60) of our patients had PN, with sensory axonal type. After treatment, 30% (18/60) of our patients had a clinical evidence of PN with sensory predominance. By electrophysiology, 33.33% (20/60) of our patients were found with sensory axonal type. Follow-up showed partial regression of neuropathy at clinical and electrophysiological level. Conclusion DAAs induced PN in patients after receiving it at the end of treatment, with partial regression on follow-up.

Evaluation of serum dickkopf-1 as a novel biomarker for hepatocellular carcinoma

Background Hepatocellular carcinoma (HCC) is a common worldwide cancer. α-Fetoprotein (AFP) is a routinely used biomarker for HCC diagnosis, but with reduced clinical applicability due to low sensitivity and specificity. Dickkopf-1 (DKK-1) is vital in the differentiation, survival, apoptosis, and cell death. DKK-1 has a potential oncogenic role in carcinogenesis. Aim In this study, we evaluated the diagnostic and prognostic performance of serum DKK-1, AFP, and their combination in HCC. Patient and methods This study was done on 40 HCC patients, 24 liver cirrhosis patients, and 16 age-matched and sex-matched healthy controls. The patients were selected from the Tropical Medicine and Gastroenterology Department, Al-Rajhi Liver Hospital. Results The optimum cutoff for DKK-1 in HCC patients versus liver cirrhosis and control groups was more than 331 pg/ml with a sensitivity of 80.0% and specificity of 87.5%. The optimum cutoff for AFP was more than 8 IU/ml (sensitivity 77.5%, specificity 85.0%). The combination of the two markers had the best sensitivity (92.5%) in the diagnosis of HCC patients. Conclusion DKK-1 levels was significantly higher in newly diagnosed HCC patients than in the nonmalignant control group. The combination of the two markers (DKK-1 and AFP) enhanced the sensitivity.

Nutritional assessment of cirrhotic patients with variable severity

Introduction Malnutrition presents in more than half of cirrhotic patients. It is varied from 20% in compensated liver disease to 80% in decompensated liver disease. This study aimed at assessing the frequency of malnutrition and relation between the malnutrition and degree of liver severity. Patients and methods This study was carried out in Tropical Medicine and Gastroenterology Department at El-Rajhy Hospital in Assiut University, Egypt, from December 2015 to December 2016 on 101 patients diagnosed with liver cirrhosis. Based on their medical profile, the liver disease severity was determined by Child–Pugh, model for end-stage liver disease, and model for end-stage liver disease sodium scores, then nutritional status of the patients was assessed by different methods including anthropometric diameters (BMI, triceps skinfold thickness, mid-arm circumference, and mid-arm muscle circumference), body composition analysis, subjective global assessment, creatinine–height index, prognostic nutritional index (PNI), and controlling nutritional status (CONUT), and finally, we assessed the relation between the nutritional status and the severity of liver disease. Results The frequency of malnutrition among the studied patients varied from 25.7% by BMI to 98% by PNI and CONUT. There was difference in degree of malnutrition between the different groups of liver disease; however, this variation was not significant when anthropometric measures and body composition analysis were used but was statistically significant when subjective global assessment, creatinine–height index, PNI, and CONUT were used. Conclusion The nutritional status of cirrhotic patients is an important tool, together with Child and model for end-stage liver disease scores, for the prediction of prognosis of such patients. All the nutritional assessment tools are needed together with no substitution of one method by another for precise assessment of malnutrition among cirrhotic patients.

Impact of designing nursing instructions on compliance to diuretic drugs among cirrhotic patients with ascites

Background and objectives: Compliance to medication is one of the critical determinants of successful management of ascites. The aim was to evaluate the impact of designing nursing instructions on compliance to diuretic drugs among cirrhotic patients with ascites. Methods: Research design: Quasi experimental (Pre / post-test). Setting: Tropical Medicine and Gastroenterology Department of Al-Rajhi Liver Hospital. Sample: A purposive sample of sixty male and female adult patients diagnosed with ascites due to liver cirrhosis. Tools: a)Patient assessment sheet. b) Drug compliance scale. Results: a statistically significant difference between pre, post 3 months and 6 months of implementing the designing nursing instruction regarding drug compliance and grade of ascites with p-value

Characterization of Respiratory Manifestations of Chronic Hepatitis C Virus Infected Patients

Background: chronic hepatitis C virus (HCV) infection has been reported in association with several extrahepatic manifestations. Chronic HCV infection is also associated with both direct and indirect effects on pulmonary tissue. Purpose: to evaluate phenotypes of respiratory manifestations of chronic hepatitis C virus. Patients and Methods: 1-this study was conducted on 150 Egyptian patients with chronic hepatitis C. Patients were selected from those attending the in patients and out patients clinic of the Tropical Medicine and Chest Departments, Al-Azhar University Hospital-Damietta from September 2016 to Septamber 2018. 2-also ,50 healthy subjects matched for age and sex were included as volunteer. 3-consent was informed by all patients and volunteer shared in this study. Results: C.O.P.D: documented in 32 patients (21.3%). Asthma: documented in 15 patients (10%) of all patients. Air way hyperreactivity: documented in 15patients (10%) of all patients. Idiopathic pulmonary fibrosis (IPF): is presented in 37 patients (24.6%). Pneumonia: documented in 10 patients (6%) of all patients. Transudative pleural effusion: documented in 10 patients (6%) of all patients. Adenocarcinoma: documented in 5 patients (3.3%) of all patients. Pseudolymphoma: documented in 1 patient (0.006%) of all patients. Lung abscess: documented in 10 patient (6%) of all patients. Pulmonary embolism: documented in 5 patients (3.3%) of all patients. Hepatopulmonary syndrom: documented in 10 patients (6%) of all patients. Conclusion: Chronic hepatitis C virus infection is related to the development of several pulmonary abnormalities. These pulmonary manifestations of HCV infection are frequently underdiagnosed. Recommendations: Any patient with chronic HCV infection should be evaluated with HRCT chest and pulmonary function tests for early diagnosis of pulmonary abnormalities to prevent further complications.

Using Lamin B1 mRNA for the early diagnosis of hepatocellular carcinoma: a cross-sectional diagnostic accuracy study

Background : Hepatocellular carcinoma (HCC) is vital medical issue in Egypt. It accounts for 70.48% of all liver tumors among Egyptians. The aim of this study was to determine the diagnostic role of plasma levels of mRNA of lamin B1 by RT-qPCR as an early marker of HCC. Methods: This study was conducted at the Clinical Pathology Department in collaboration with the Department of Tropical Medicine and Infectious Diseases at Ain Shams University Hospitals. It included 30 patients with primary HCC and viral cirrhosis (all were hepatitis C virus-positive) (Group I), in addition to 10 patients with chronic liver diseases (Group II) and 10 healthy age- and sex-matched subjects (Group III). Group I was further classified according to the Barcelona-Clinic Liver Cancer Staging System. Serum α-fetoprotein (AFP) chemiluminescent-immunoassays and RT-qPCR analysis of plasma lamin B1 mRNA levels were performed for all participants. Results: AFP and lamin B1 significantly elevated in patients with HCC compared to those in the other studied groups. AFP and lamin B1 status could discriminate group I from group II and III. A significant increase was found among the three Barcelona stages with regards to AFP and lamin B1 levels. A significant decrease was found between group II and stage 0, A and B with regards to AFP and lamin B1. Lamin B1 and AFP could both differentiate HCC patients with one tumor nodule (T1) from those with two or more tumor nodules (T2&Tm), as well as between those with tumor sizes >3 cm and ≤3 cm. Conclusion: Measurement of lamin B1 mRNA is recommended in patients with chronic liver disease with normal serum AFP, especially in known cirrhotic patients that deteriorate rapidly without any apparent etiology.

Serum Resistin Level as a Diagnostic Marker in Non-Alcoholic Steatohepatitis

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.

Using Lamin B1 mRNA for the early diagnosis of hepatocellular carcinoma: a cross-sectional diagnostic accuracy study.

Background: Hepatocellular carcinoma (HCC) is vital medical issue in Egypt. It accounts for 70.48% of all liver tumors among Egyptians. The aim of this study was to determine the diagnostic role of plasma levels of mRNA of lamin B1 by RT-qPCR as an early marker of HCC. Methods: This study was conducted at the Clinical Pathology Department in collaboration with the Department of Tropical Medicine and Infectious Diseases at Ain Shams University Hospitals. It included 30 patients with primary HCC and viral cirrhosis (all were hepatitis C virus-positive) (Group I), in addition to 10 patients with chronic liver diseases (Group II) and 10 healthy age- and sex-matched subjects (Group III). Group I was further classified according to the Barcelona-Clinic Liver Cancer Staging System. Serum α-fetoprotein (AFP) chemiluminescent-immunoassays and RT-qPCR analysis of plasma lamin B1 mRNA levels were performed for all participants. Results: AFP and lamin B1 significantly elevated in patients with HCC compared to those in the other studied groups. AFP and lamin B1 status could discriminate group I from group II and III. A significant increase was found among the three Barcelona stages with regards to AFP and lamin B1 levels. A significant decrease was found between group II and stage 0, A and B with regards to AFP and lamin B1. Lamin B1 and AFP could both differentiate HCC patients with one tumor nodule (T1) from those with two or more tumor nodules (T2&Tm), as well as between those with tumor sizes >3 cm and ≤3 cm. Conclusion: Measurement of lamin B1 mRNA is recommended in patients with chronic liver disease with normal serum AFP, especially in known cirrhotic patients that deteriorate rapidly without any apparent etiology.

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.

Clinical Profile of patients with Ascitic Fluid Infection at Ain Shams University Hospitals

Background: Ascites is a common problem in patients with chronic liver disease. About 60% of patients with cirrhosis will develop ascites. Patients with chronic liver disease and cirrhosis frequently develop infections of the ascitic fluid. Aim: The aim of this study is to assess the clinical profile of patients with ascetic fluid infection admitted to Tropical Medicine department at Ain Shams University hospitals. Patients and Methods: The current Cross-sectional study was conducted at The Tropical Medicine Department, Ain Shams University on 87 Egyptian patients with chronic liver disease and ascites during the 12-months period from June 2017 to May 2018 by collecting their clinical, laboratory and radiological data. Results: The frequency of infected ascites among the studied patients with chronic liver disease and ascites was 31%. The main presenting symptom of infected ascites was abdominal pain (37%) and the most common clinical sign was lower limb edema (81%). The most frequently isolated micro-organism was E.coli that was detected in 7% of patients with infected ascites. Among the 27 patients with infected ascites, 12 patients responded to the third generation cephalosporins, nine patients responded to Meropenem. Conclusion: Infection of the ascitic fluid is frequent among patients with chronic liver disease and cirrhosis admitted to Ain Shams University Hospitals. Almost one third of the ascitic patients developed at least one attack of spontaneous bacterial peritonitis or bacterascites. Monomicrobialbacterascites is more frequent than polymicrobialbacterascites and E coli is the most common isolated organism. Third-generation, broad-spectrum cephalosporins remain a good initial therapy for patients who do not have allergy to cephalosporins. Alternative antibiotics such as Meropenem and pipercillin-tazobactam should be considered for patients for patients who fail to improve on traditional antibiotic regimens.

Clinical Profile of patients with Ascitic Fluid Infection at Ain Shams University Hospitals

Background: Ascites is a common problem in patients with chronic liver disease. About 60% of patients with cirrhosis will develop ascites. Patients with chronic liver disease and cirrhosis frequently develop infections of the ascitic fluid. Aim: The aim of this study is to assess the clinical profile of patients with ascetic fluid infection admitted to Tropical Medicine department at Ain Shams University hospitals. Patients and Methods: The current Cross-sectional study was conducted at The Tropical Medicine Department, Ain Shams University on 87 Egyptian patients with chronic liver disease and ascites during the 12-months period from June 2017 to May 2018 by collecting their clinical, laboratory and radiological data. Results: The frequency of infected ascites among the studied patients with chronic liver disease and ascites was 31%. The main presenting symptom of infected ascites was abdominal pain (37%) and the most common clinical sign was lower limb edema (81%). The most frequently isolated micro-organism was E.coli that was detected in 7% of patients with infected ascites. Among the 27 patients with infected ascites, 12 patients responded to the third generation cephalosporins, nine patients responded to Meropenem. Conclusion: Infection of the ascitic fluid is frequent among patients with chronic liver disease and cirrhosis admitted to Ain Shams University Hospitals. Almost one third of the ascitic patients developed at least one attack of spontaneous bacterial peritonitis or bacterascites. Monomicrobialbacterascites is more frequent than polymicrobialbacterascites and E coli is the most common isolated organism. Third-generation, broad-spectrum cephalosporins remain a good initial therapy for patients who do not have allergy to cephalosporins. Alternative antibiotics such as Meropenem and pipercillin-tazobactam should be considered for patients for patients who fail to improve on traditional antibiotic regimens.

Validation of AFP Model as a Predictor of Response, Recurrence and Survival in HCC Patients Underwent Locoregional Treatment

Background: incidence of hepatocellular carcinoma (HCC) has rapidly increased worldwide. HCC is the sixth most common malignancy and the third most common cause of cancer related death. Since HCC usually develops in a damaged liver, the prognosis of HCC depends not only on tumor progression but also on the degree of liver dysfunction. In Egypt, HCC constitutes 70.48% of all liver tumors among Egyptians. Aim of the Work: to validate the use of AFP model as a predictor of response, recurrence and survival in hepatocellular carcinoma patients after locoregional treatment. Patients and Methods: this study was conducted at Tropical Medicine department and HCC clinic, Ain Shams University Hospitals. The study was approved by the Research and Ethics Committee of Ain Shams University, Cairo, Egypt in accordance with local research governance requirements. Results: according to this classification 130 patients are for RFA and 70 patients are for TACE but actually 132 patients underwent TACE and 68 patients underwent RFA this could be explained by the facts that some lesions are large in size (>4cm) and others are located near main bile duct, intestinal loop or blood vessel so RFA couldn’t be done. Conclusion: AFP model may be a predictor of response, recurrence and survival in HCC patients undergoing locoregional treatment (TACE or RFA) but more studies with larger sample size are needed to validate its use.

Role Of Platelets-Derived Growth Factor Receptor ß and Tumor Necrosis Factor α In The Pathology Of Chronic Hepatitis C

Background: Chronic liver diseases are characterized by two fundamental aspects,persistent injury and fibrosis, which are cardinal features for the continuous progression towards cirrhosis and end stage liver failure. Objective: To study the expression of platelets derived growth factor receptor s(PDGFR- β) and tumor necrosis factor (TNF α) in the liver and their relation to the stage and grade of chronic HCV. Patients and Methods: Analytical cross-sectional study was conducted on fiftypatients with proven chronic hepatitis C. All patients were referred to Tropical Medicine and Gastroenterology Department, Sohag University Hospital. Patients were categorized into two groups according to the histological stages of chronic hepatitis C as follows, group 1 includes 40 patients in stages 0,1 and 2; whereas group 2 includes 10 patients in stage 3. All patients were then recategorized according to the grades of inflammatory activity into patients with minimal and mild inflammation (G1+G2=32 patients) and those with moderate and severe inflammation (G3 +G4=18 patients). All patients were subjected to full history taking, complete clinical examination, complete blood count, liver function tests. Liver biopsy was evaluated for immunohistochemical expression of PDGFR- β and TNFα. Results: The included patients were 80 % males and 20 % females. Their mean agewas 44.42±11.17 years. The mean average weighted scores (AWS) of Imunohisto-chemical expression of PDGFR- β, and TNFα were significantly higher in moderate and severe inflammation versus minimal and mild inflammation (P=0.05; 0.0001respectively). Similarly, the mean AWS of PDGFR- β, and TNFα were significantly higher in patients with stage 3 versus stages 0,1 and 2 (P=0.04; 0.0001 respectively). Conclusion: Expression of PDGFR- β, and TNFα markers were associated with progression of disease activity and fibrosis.

Platelets Accumulation In The Liver : A novel Mechanism Of Thrombocytopenia In Chronic Hepatic C Patients

Background and aim: Thrombocytopenia is a common complication of chronicliver diseases and is due to various causes.The effect of thrombocytopenia on liver damage and the exact mechanisms that lead to thrombocytopenia in chronic liver disease and cirrhosis are still unclear. As Platelets Derived Growth Factor s (PDGF-s) is released from platelets (PLTs) upon activation. We tried to identify PLTs and PDGFR- s in the liver to shed some light on the pathophysiology of thrombocytopenia and liver fibrosis in chronic hepatic C patients. Patients and Methods: Analytical cross-sectional study was conducted on fiftypatients with proven chronic hepatitis C. All patients were referred to Tropical Medicine and Gastroenterology Department, Sohag University Hospital. Patients were categorized into two groups. Group 1 includes patients with PLT count less than 150000/µL (thrombocytopenia). Group 2 includes patients with normal PLT count (150000-450000/µL). All patients were subjected to full history taking, complete clinical examination, complete blood count, liver function tests. Liver biopsy was obtained for histological staging and grading. Immunohistochemical study of PLTs and PDGFR- s were done using monoclonal antibodies against PLT's surface marker CD41 and PDGFR- s. Results: The included patients were 80 % males and 20 % females. Their mean agewas 44.42± 11.17 years. The mean average weighted score (AWS) of Imunohisto-chemical expression of CD41was significantly higher in thrombocytopenic group compared to normal PLTs group (5.8±2.86 vs 3.43±3.03; P<0.001). There was a significant negative correlation between CD41 expression and peripheral PLT count (r=-0.4; P=0.007). PDGFR- s expression was significantly stronger in thrombocytopenic patients than patients with normal PLT count (6.9±3.6 vs 5.27±3.92; P=0.001). It showed also a significant negative correlation with peripheral PLT count (r=-0.34, P=0.045). Both CD41 and PDGFR- s expression were significantly elevated in patients with advanced stage of fibrosis than in those with earlier stages (7.26±5.23 vs 5.88±3.24; P=0.04 &9.2±2.7 vs 6.7±3.6; P Conclusion: The accumulation of PLTs in the liver in patients with chronic hepatitisC may be involved in thrombocytopenia and liver fibrosis.

Assessment of IL-10 Polymorphism and TGF beta 1 Polymorphism in Egyptian Patients with Chronic Liver Disease

Aim of the work: to determine the role of Interleukin-10 (IL-10) polymorphism (rs 1800896) and Transforming Growth Factor-Beta-1(TGF-β1) polymorphism (509 CT) as markers for cirrhosis in Egyptian patients with chronic liver disease. Subjects and Methods: This case-control study was carried out on selected patients admitted to Tropical medicine department, Al Zahraa University Hospital during the period from March 2016 to April 2017. Genotyping of IL-10 (rs 1800896) and TGF-β1 (509 CT) polymorphisms were performed using real-time polymerase chain reaction (PCR) technique. Results: There was significant increase in IL10 and TGF β1 509 gene polymorphisms in compensated and de-compensated groups as compared to control group. Conclusion: Interleukin 10 rs 1800896 gene polymorphism and TGF β1 509 gene polymorphism are associated with risk of liver cirrhosis in patients with chronic hepatitis C virus infection. These findings could be useful for future screening for early detection of liver cirrhosis.

Cardiac Parameters and Interleukin-6 Differences between Adolescents with Hepatitis B Infection versus those Complicated with Hepatocelluar Carcinoma

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.

Association of IL-12 B Gene Polymorphism with Staging of Liver Disease in Chronic HCV Patients.

Cell-mediated immunity plays a critical role in viral clearance and disease progression during Hepatitis C virus (HCV) infection. Interleukin (IL)-12 is a cytokine that has been shown to be a potent antiviral cytokine. The aim of this work is to investigate the association of IL-12 B gene polymorphism with staging of liver disease in chronic HCV patients. This cross sectional study was carried out in tropical medicine department, Tanta university hospital, Egypt, on 120 chronic HCV patients with various stages of liver disease and 30 healthy subjects served as control. All the participants were tested for IL- 12 B (p40) gene polymorphism. the frequency of AA genotype was higher in HCV patients with decompensated cirrhosis and in HCV patients with Hepatocellular carcinoma (HCC). However, the CC genotype was less detected in all groups, with the lowest percentage (6.6%) detected in decompensated cirrhosis and HCC patients. AA genotype presented more frequently in late stages of HCV chronically ill patients, while, CC genotype had no significant association with staging of liver disease and had low frequency especially in late stages of liver disease.

Point-of-care lung ultrasound for diagnosis of Pneumocystis jirovecii pneumonia: notes from the field

BackgroundThoracic ultrasound is helpful to evaluate lung pathology in patients with acute dyspnea. Several studies have demonstrated the efficacy of point-of-care ultrasound in patients with extrapulmonary TB and HIV co-infection. This retrospective, open-label case–control study explores the role of lung ultrasound in the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in HIV-positive patients. In particular, it highlights the potential role of specific sonographic features that may be unique to this population.MethodsThe record of all HIV-positive patients admitted from 1.1.2013 to 31.6.2017 to the Department of Infectious Diseases and Tropical Medicine of san Bortolo Hospital, Vicenza, Italy, with a discharge diagnosis of acute lung injury (ALI) and who received point-of-care ultrasound of the chest for clinical purposes was included in the analysis. The patients were scanned according with the evidence-based recommendation.ResultsOf 273 HIV-positive patients whose records were reviewed, 81 (29.6%) were diagnosed with ALI. Complete documentation was available for 24 patients, of which 14 (58.3%) had microbiologically confirmed PJP (PJP+) and 10 (41.7%) had other conditions (PJP−). B-lines, subpleural consolidations, and cystic changes were significantly more frequent in patients with PJP (14/14 vs. 6/10, p = 0.0198; 14/14 vs. 4/10, p = 0.0016; 8/14 vs. 0/10, p = 0.0019, respectively). In particular, B-lines and subpleural consolidations were present in all PJP+ patients in our cohort giving a sensitivity of 100%, but their specificity was low (45 and 60%, respectively). On the contrary, the presence of consolidations with cystic changes had a very high specificity for PJP (100%), but low sensitivity (57%). Pleural effusions and consolidations with linear air bronchograms were not observed in PJP+ patients.ConclusionsB-lines, subpleural consolidations, and cystic changes are suggestive of PJP. Lung consolidation with air bronchograms and pleural effusion should prompt suspicion of other etiologies. These findings have the potential to be useful in the daily management of HIV-positive patients in resource-limited settings where other diagnostic tools are rarely available.

THE POLYMORPHISM OF TUMOR NECROSIS FACTOR ALPHA AND HEPATITIS C VIRUS RELATED HCC.

28Mar 2018 THE POLYMORPHISM OF TUMOR NECROSIS FACTOR ALPHA AND HEPATITIS C VIRUS RELATED HCC. Mona Salah , Bothina Madkou , Rabab Fouad , Faiza El-Essawy , khaled Tawfeek , Tamer Mahmoud El-baz and Ayman Mohamed Abdel Aziz. Department of Clinical and Chemical Pathology, Kasr Al Aini,-Cairo University, Cairo-Egypt. Department of Hematology, Theodor Bilharz Research Institute, Cairo-Egypt. Department of Tropical Medicine, Kasr Al Aini-Cairo University, Cairo-Egypt. Department of Tropical Medicine, Theodor Bilharz Research Institute, Cairo-Egypt.