Kafr El Research Articles

Neogene–Quaternary paleoenvironments and kerogen assessment of the NDO B-1 well, offshore Nile Delta, Egypt, Eastern Mediterranean: palynological evidence

Palynofacies and palynological investigations conducted on the Neogene–Quaternary succession from the NDO B-1 well, located in the offshore Nile Delta, Egypt, in the Eastern Mediterranean, suggest generally shallow marine (neritic) conditions. These environments are manifested by the overall palynofacies composition and the occurrence of dinoflagellate cysts (e.g., Spiniferites spp., Lingulodinium spp., Hystrichokolpoma spp., Homotryblium spp. and Selenopemphix spp.). Neritic environments are suggested for the lower and middle Miocene Sidi Salim, and the Pliocene to Pleistocene upper Kafr El Sheikh, El Wastani and Mit Ghamr formations, while shallower, coastal to inner neritic settings were interpreted for the late Miocene (Qawasim and Rosetta formations) and early Pliocene (Abu Madi and lower Kafr El Sheikh formations). Anoxic conditions existed during the deposition of the studied well succession, which can be seen from the occurrence of imprints of pyrite crystals and some types of oxygen-sensitive dinoflagellate cysts. The palynofacies fluctuated repeatedly between Amorphous Organic Matter (AOM)-dominated and phytoclast-dominated intervals, of kerogen types II and III, respectively. The spore coloration index (SCI) of indigenous thin-walled palynomorphs confirms thermally mature sediments, generative of dry gas and wet gas/condensates. Reworking during the deposition of the upper Sidi Salim, Qawasim and Rosetta formations is inferred from the occurrence of Cretaceous dinoflagellate cysts and pollen.

An Economic Study of Recycling corn stover in Kafr El- Sheikh Governorate

An Economic Study of Recycling corn stover in Kafr El- Sheikh Governorate

An Economic Study of Recycling rice straw in Kafr El- Sheikh Governorate

An Economic Study of Recycling rice straw in Kafr El- Sheikh Governorate

Attitudes of Farmers towards Protecting the Rural Environment from pollution at Kafr El Sheikh Governorate

Attitudes of Farmers towards Protecting the Rural Environment from pollution at Kafr El Sheikh Governorate

Prevalence and Molecular Characterization of TEM and CTX-M Beta-Lactamase Genes of Escherichia coli Isolated From Cow Milk

Objective: The study objective was to investigate the presence and antibiotic resistance of toxigenic E. coli strains in the raw milk of dairycattle and to determine the prevalence of blaTEM and blaCTX-M genes in the selected isolates. Methods: Two hundred raw milk samples were collected from 20 dairy farms located in Kafr El Sheikh City. Results: Among the samples, 60 were positive for E. coli. The sensitivity of these isolates was detected against different antibiotics. Usingthe disk diffusion test, all the isolates were resistant to at least two beta-lactam antibiotics. The resistance to beta-lactam antibiotics bythe selected E. coli was varied to be highly significant. Five percent of the tested E. coli was highly resistant with a multi-antibiotic resistant (MAR) index, of 1.0, while 8% had the lowest MAR (0.14). Both blaTEM and blaCTX-M resistant genes were detected in isolate No. 52, while, blaCTX-M was detected in isolate No. 34 and blaTEM was detected in isolates No. 9, 21, 28, and 40. The PCR products of blaTEM and blaCTX-M genes were sequenced and deposited in the GenBank of the NCBI database with the accession numbers OR450046 and OR879117, respectively. Conclusion: The macrolides group of antibiotics especially erythromycin should not be a suitable treatment of dairy herds for mastitisby E. coli in Egypt. The majority of E. coli was multiple-antibiotic resistant and co-carried many virulence genes, and it may pose a greatpotential risk to public health.

Depression, anxiety, and stress among dental students, Kafr El Sheik University, Egypt: a cross-sectional study

Abstract Background Dentistry students face many pressures associated with treatment methods, training, and Faculty-level administration. Although several research have assessed the anxiety, stress, and depression of undergraduate students studying dentistry globally, data is limited in Egypt. This work aimed to determine the levels of depression, anxiety, and stress in dental students at the Faculty of Dentistry, Kafr El Sheik University, Egypt. Methods This questionnaire-based, cross-sectional study included 400 students at the Faculty of Dentistry, Kafr El Sheik University, Egypt. Participants were recruited using snowball sampling using a physical copy of the Depression, Anxiety, and Stress Scale (DASS 21) questionnaire. Results Depression level was low in 90 (22.5%), moderate in 215 (53.8%), and high in 95 (23.8%) participants. Anxiety level was low in 134 (33.5%), moderate in 193 (48.3%), and high in 73 (18.3%) participants. Stress level was low in 43 (10.8%), moderate in 206 (51.5%), and high in 151 (37.8%) participants. There was a significant relation between overall DASS 21 and age greater than 20, higher year, female sex, below average financial status, and last year’s regrade of students (P value < 0.001, 0.008, and 0.041, respectively) and an insignificant relation between overall DASS 21 and residence of students. A significant relation between year and (depression, anxiety, stress, and overall DASS 21) was observed. Conclusions The significant depression, anxiety, and stress prevalence among Egyptian dentistry students is concerning.

Large-Scale Molecular Epidemiological Survey of Blastocystis sp. among Herbivores in Egypt and Assessment of Potential Zoonotic Risk.

Given the proven zoonotic potential of the intestinal protozoan Blastocystis sp., a fast-growing number of surveys are being conducted to identify potential animal reservoirs for transmission of the parasite. Nevertheless, few epidemiological studies have been conducted on farmed animals in Egypt. Therefore, a total of 1089 fecal samples were collected from herbivores (sheep, goats, camels, horses, and rabbits) in six Egyptian governorates (Dakahlia, Gharbia, Kafr El Sheikh, Giza, Aswan, and Sharqia). Samples were screened for the presence of Blastocystis sp. by real-time PCR followed by sequencing of positive PCR products and phylogenetic analysis for subtyping of the isolates. Overall, Blastocystis sp. was identified in 37.6% of the samples, with significant differences in frequency between animal groups (sheep, 65.5%; camels, 62.2%; goats, 36.0%; rabbits, 10.1%; horses, 3.3%). Mixed infections were reported in 35.7% of the Blastocystis sp.-positive samples. A wide range of subtypes (STs) with varying frequency were identified from single infections in ruminants including sheep (ST1-ST3, ST5, ST10, ST14, ST21, ST24, ST26, and ST40), goats (ST1, ST3, ST5, ST10, ST26, ST40, ST43, and ST44), and camels (ST3, ST10, ST21, ST24-ST26, ST30, and ST44). Most of them overlapped across these animal groups, highlighting their adaptation to ruminant hosts. In other herbivores, only three and two STs were evidenced in rabbits (ST1-ST3) and horses (ST3 and ST44), respectively. The greater occurrence and wider genetic diversity of parasite isolates among ruminants, in contrast to other herbivores, strongly suggested that dietary habits likely played a significant role in influencing both the colonization rates of Blastocystis sp. and ST preference. Of all the isolates subtyped herein, 66.3% were reported as potentially zoonotic, emphasizing the significant role these animal groups may play in transmitting the parasite to humans. These findings also expand our knowledge on the prevalence, genetic diversity, host specificity, and zoonotic potential of Blastocystis sp. in herbivores.

Oxidative stress and X-ray metal assessment in ovarian tissues of the beetle, Calosoma olivieri (Coleoptera, Carabidae) collected from Kafr El Zayat, Egypt

Oxidative stress and X-ray metal assessment in ovarian tissues of the beetle, Calosoma olivieri (Coleoptera, Carabidae) collected from Kafr El Zayat, Egypt

Molecular and ultrastructure abnormalities in ovaries of Calosoma olivieri collected from Kafr El Zayat, Egypt triggered by heavy metal exposure

Molecular and ultrastructure abnormalities in ovaries of Calosoma olivieri collected from Kafr El Zayat, Egypt triggered by heavy metal exposure

#1810 The association between circulating fibroblast growth factor 23 (FGF23) and serum aldosterone level in chronic kidney disease patients

Abstract Background and Aims Chronic kidney disease (CKD) remains a major health problem, till now, diagnosis of CKD depends on radiology and estimated glomerular filtration rate (eGFR). Therefore, there is an ultimate need for new sensitive prognostic and diagnostic biomarkers for diagnosis and progression of CKD. CKD is accompanied by increased levels of circulating fibroblast growth factor 23 (FGF23) and aldosterone levels. In the current study, we aim to evaluate the association between circulating FGF23 and serum aldosterone levels in CKD patients and to test the hypothesis that aldosterone may be a direct driving factor of increased FGF23 secretion in CKD patients. Method This cross section observational study was carried out at Kafr El Sheikh University Hospital's internal medicine department which enrolled 140 subjects that were divided into two groups: group I: 70 patients with various stages of newly diagnosed chronic kidney disease who did not receive renin-angiotensin-aldosterone system (RAAS) blocker yet (CKD stage 1 –5) & group II: 70 apparently healthy subjects (of corresponding age and sex as a control group). We detected serum FGF-23 and Serum aldosterone using enzyme-linked immunosorbent assay (ELISA). Results A strong correlation was identified between FGF-23 and serum aldosterone in group I (p = < 0.001), there was remarkably stage dependent strong associations in CKD patients. High FGF-23 and serum aldosterone significantly independently increase risk of CKD by 1.15 and 1.043 folds respectively. The best cutoff of FGF-23 in prediction of kidney injury is ≥59.735 with area under curve 0.977, sensitivity 91.4%, specificity 90%, positive predictive value 90.1%, negative predictive value 91.3% and overall accuracy 90.7% (p < 0.001). The best cutoff of aldosterone in prediction of kidney injury is ≥117.59 with area under curve 0.978, sensitivity 92.9%, specificity 88.6%, positive predictive value 89%, negative predictive value 92.5% and overall accuracy 90.7% (p < 0.001). Conclusion FGF23 and aldosterone may be used as markers in CKD progression. aldosterone may be a direct driving factor of increased FGF23 secretion in CKD patients.

Role of virtual reality in examining the effect of fear of falling (FOF) on postural stability in individuals without and with Parkinson’s disease in Egypt: a mixed-methods feasibility study protocol

BackgroundFalls are common in older people and individuals with neurological conditions. Parkinson’s disease (PD) is known for postural instability causing mobility disabilities, falls and reduced quality of life. The fear...

Assessment of Bacterial Isolates from Diabetic Foot Ulcers and Their Antimicrobial Susceptibility Patterns among Diabetic Patients Attending Kafr El Sheikh University Hospital

Assessment of Bacterial Isolates from Diabetic Foot Ulcers and Their Antimicrobial Susceptibility Patterns among Diabetic Patients Attending Kafr El Sheikh University Hospital

Alterations in histopathology and stress-associated gene expression induced by infection with Prohemistomum vivax encysted metacercariae in Nile tilapia

Due to limited data on the pathogenicity of Prohemistomum vivax (P. vivax) and its impacts on fish health, this study aimed to determine the morphological, molecular characteristics, pathogenicity, and histopathological alterations in fish infected with P. vivax. Eight hundred (800) Nile tilapia (Oreochromis niloticus) were collected from various farms in Kafr El Sheikh Governorate. The fish were examined for encysted metacercariae (EMC) in different organs. Tissue specimens were collected and underwent histopathological analysis, expression of stress-related genes, and genetic characterization by sequencing of the internal transcribed spacer 2 (ITS2). P. vivax metacercariae were oval to round in shape and were collected from various organs including the muscle, skin, eyes, intestine, liver, kidney, and gills of infected O. niloticus. Sequencing and phylogenetic analysis of the ITS2 region revealed a 507-bp fragment, confirming parasite identity and matching within the same clade as other P. vivax isolates. Infected fish displayed abdominal hydropsy, skin darkening, and emaciation. P. vivax encysted metacercariae were detected during the study period in 620/800 fish, with an overall prevalence of 77.5%. The seasonal prevalence was 95% in summer, 85% in spring, 55% in autumn, and 75% in winter. The intensity of infection was 1–40 cysts per microscopic field. Histopathological examination of muscles revealed parasitic cysts embedded within muscle fibers, causing severe degeneration and necrosis. Upregulation of cytochrome P450 (cpy1a1), heat shock protein 70 (hsp-70), and tumor suppressor p53 (p53) was recorded in both liver and muscle samples of infected tilapia compared to controls. This indicates activation of detoxification, cellular stress, and apoptotic pathways in response to P. vivax infection. There is limited data available on the pathogenicity of P. vivax and its impacts on fish health; thus, this study provides key insights into the morphology, pathogenicity, and histopathological impacts of P. vivax in Nile tilapia.

Optimal site selection for construction and demolition waste disposal using GIS-FAHP: a case study from Kafr El Sheikh City, Egypt.

The increasing number of building and demolition projects results in huge amounts of construction and demolition wastes (CDWs) that are illegally dumped. However, these wastes must be disposed of in appropriate legal sites to protect the environment and human health. After reviewing the literature, no prior research examined optimal site selection for dumping or recycling CDW in an Egyptian city. Furthermore, the absence of field surveys did not offer a holistic understanding of the specific criteria used in the model for this region, nor did it permit an assessment of the suitability of existing dumpsites, thereby revealing certain limitations in the final results. In this regard, this research aims to apply a multi-criteria geographic information system (GIS)-based framework to identify an optimal site for CDW disposal in Kafr El Sheikh City. The criteria affecting the site selection are identified and categorized from prior literature, which are further refined using field surveys and focus group to evaluate their applicability in the context of an Egyptian city. After conducting questionnaire surveys, the trapezoidal interval type II fuzzy analytic hierarchy process is applied to compute the weights of the identified criteria from the perspective of each group of experts. The entropy-based aggregation approach is employed to identify the compromise weights taking into account the preferences of different groups. GIS is a powerful tool for geoprocessing and analyzing spatial big data. The result is a scenario map for the optimal site locations with varying suitability scales (i.e., excellent, very good, good, average, poor, and very poor). The proposed methodology provides what-if scenarios based on a selected set of criteria. According to the results of the multi-criteria decision analysis models, the suitability varies based on the weights of the criteria. For the equal-weighted criteria model, the excellent category covers 5.96% of the study area, increasing to 6.48% for the weighted criteria model. These areas primarily lie in the northeast direction. Conversely, the majority of the study area, 41.80% under equal-weighted criteria and 32.39% under weighted criteria, falls within the average and poor suitability categories, respectively. In general, the most suitable areas are located on the outskirts of the city, and the suitability decreases near the central business district. To bridge the gap between research findings and practical applications, a land use analysis employing satellite imagery is conducted to pinpoint suitable locations for CDW disposal. Existing CDW dumpsites predominantly fall within the range of poor to very good for the equal-weighted criteria model, while the weighted criteria model categorizes them into the poor (16.66%) and average (83.33%) categories. The findings demonstrated the applicability of the proposed framework for CDW disposal management and planning.

Evaluation of the results of acute acromioclavicular joint reconstruction using Double Endobutton technique

Abstract Background Acromioclavicular joint (ACJ) dislocation is a common injury, which accounts for ~9% of all shoulder injuries. Surgical techniques for reconstructing or repairing ACJ dislocation have evolved over the last decades. Recent surgical techniques focus on reconstruction of the coracoclavicular ligament to recover the stability of ACJ. Patients and methods This was a prospective case series study that included 23 patients with acute ACJ dislocation, admitted to the Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Kafr El Sheikh and Benha University. All cases were treated by coracoclavicular repair using Double Endobutton technique and Ethibond suture. The follow-up period ranged from 18 to 24 months postoperatively. Outcomes were assessed using Constant score and DASH score at of 6 weeks, 3, 6, 12 months, and final follow up. Radiological assessment was done using Zanca view and stress anteroposterior radiographs of both shoulders to compare acromiohumeral interval at the end of follow up. Results This study included 23 patients that were admitted to our department. Their mean age were 34.2 ± 2.3 years. The average time between injury and surgery was 5.2 ± 1.4 days. There were 20 men and three females. Regarding DASH score it improved from preoperative value of 88.3 ± 11.2 points to 14.3 ± 2.4 points. Regarding Constant score, it improved significantly from preoperative value of 45.3 ± 2.2 points to a postoperative value of 92.3 ± 3.6 points. Regarding acromiohumeral interval, the mean distance was 9.3 mm immediate postoperative period, and it was 10.1 at the end of follow up (P>0.05). Conclusion ACJ reconstruction using Double Endobutton technique is safe, easy, and effective technique in cases with acute ACJ dislocation with little postoperative complications and excellent clinical and radiological outcomes.

Microsatellite markers application in the genetic survey of native rabbits in the Egyptian delta

The human interest in exotic animal breeds in the agricultural sector led to the deterioration of local breeds. The interest in national farm animal genetic studies is important for the agriculture ecosystems under climate change challenges. Microsatellite markers are important tools to determine the genetic status of breeds, populations, and subpopulations. In this study, 28 microsatellite loci were used to investigate the genetic situation among 274 biological samples collected from the native Delta Egypt rabbits (NDER) population in the north of Egypt. They belonged to eight subpopulations (Damietta, Dakahlia, Kafr El sheikh, Beheira, Gharbia, Menoufia, Sharqia, and Qalyubia). It was found that expected heterozygosity (He) values were greater than observed heterozygosity (Ho). A total of 184 alleles were identified, with a mean of 6.571 and 4.122 as effective alleles. About 89% of microsatellite markers expressed high informative values in the polymorphism information content (PIC). The comparison among 8 NDER subpopulations showed low genetic variability parameters with high inbreeding coefficient (FIS) values in the north (Damietta, Dakahlia, Kafr El sheikh, Beheira, and Gharbia). However, values of genetic variables increased with decreasing FIS in the middle (Menoufia), east (Sharqia), and south (Qalyubia) Delta. Furthermore, the discriminant analysis principal components (DAPC) showed overlaying in the north. In the same context, the neighbor-joining tree (NJ) and heatmap showed the genetic convergence among the northern subpopulations. The analysis of STRUCTURE found 4 clusters (K= 8). The north subpopulations were in one cluster, while others in the middle, east, and south were a separate cluster for each subpopulation. Our findings show that the NDER suffers from genetic drift in the northern Delta subpopulations. On the contrary, the south, east, and middle subpopulations showed more genetic variability. A strategy of correct mating should be fostered to improve the genetic traits of rabbits.

Antibacterial activity of two actinomycetes species isolated from black sand in North Egypt

Increasingly high levels of multidrug-resistant (MDR) pathogens have necessitated the discovery of novel bioactive compounds. For this reason, two actinomycetes strains, Streptomyces griseorubens and Streptomyces rochei, were isolated for the first time from the black sand shores of Kafr El Sheikh in Egypt, which is home to several large fish farms. Isolates were identified via phenotypic, biochemical and 16S rRNA sequence protocols. Both strains exhibited powerful antimicrobial activity against three serious MDR pathogens: Bacillus subtilis, Salmonella enteritidis and Pseudomonas aeruginosa. The bioactive compounds of isolates’ filtrates were identified using gas chromatography–mass spectroscopy (GC-MS). For S. griseorubens, the detectable antibacterial compounds were hexanoic acid, 2-ethyl-, 2-ethylhexyl ester, n-Decane, hexadecanoic acid methyl ester, benzene acetic acid, ricinolic acid, and ethylparaben, while S. rochei secretes heptadecane, 2,6-dimethyl-, benzene acetic acid, dibutyl phthalate, octacosane, hexacosane, and vitamin A aldehyde. These results strongly encourage the use of these eco-friendly isolates as a biocontrol against MDR pathogens that attack fish farms. Significance: Streptomyces spp. act as strong weapons for fighting multidrug resistance in pathogenic bacteria – one of the most important current threats to public health. They are additionally regarded as eco-friendly organisms that can be used as a biocontrol agent against infections that endanger fish farms.

Organic facies and hydrocarbon source rock potentiality of the Neogene succession in the Central South Mediterranean, offshore Nile Delta Basin, Egypt

Neogene succession in the offshore Nile Delta region is essential to the hydrocarbon petroleum system. Up to date, little is known about the nature and distribution of organic matter and its potential to generate hydrocarbon. This potential is tested through extensive palynofacies and organic geochemical analyses in a new approach in this region. Based on the palynofacies analysis, the samples from NDOB-1 and Baltim-1wells are discriminated into four types using the statistical application of cluster and principal component analyses. These four types are distal-High Oxic type A, proximal-suboxic type B, proximal-dysoxic type C, and distal-oxic type D. In addition, the analysis leads to identifying the proximal-distal and oxygen depletion trends based on the values of the principal component analysis (axis 1). This palynofacies analysis is used as an environmental framework for hydrocarbon source rock evaluation. This evaluation is integrated with the organic geochemical parameters by pyrolysis (Rock-Eval and gas chromatography) and spectroscopic (Fourier Transform Infrared) methods. This study reveals that the dominant kerogen types are IV (inert) and III (gas-prone) which are remarked by the opaque and brown translucent phytoclasts palynofacies types A and D, respectively. Kerogen type II is presented in a minor abundance in palynofacies types B and C that are distinguished with AOM. However, kerogen type II organic matter is much diluted with kerogen type IV and III, leading to poor to fair organic geochemical quality (S2 and hydrogen index). Both wells' maturity levels are detected within the Kafr El Shiekh Formation. Nevertheless, the poor hydrocarbon source rock quality becomes important if considered with the volume and thickness of the Neogene sediment, as indicated by the source potential index that has a cumulative value of 2.5 t HC/m2 in NDOB-1 well and 2.8 t HC/m2in Baltim-1 well. These values are comparable to some of the prolific hydrocarbon fields in other places.

Amyloid A in Serum and Ascetic Fluid as a Marker of Spontaneous Bacterial Peritonitis

Abstract Background Esophageal varices (EV) are a major complication of cirrhosis secondary to the development of clinically significant portal hypertension EV can lead to life-threatening bleeding, further decompensation and death among patients with cirrhosis. Aim of the Work The aim of this study is to assess the role of the clinical usefulness of the Amyloid A (serum and ascetic fluid) in patients with ascites (liver cirrhosis) and as a diagnostic marker for Spontaneous Bacterial Peritonitis. Patients and Methods This prospective study was conducted on 240 cirrhotic patients selected randomly presented for screening for esophageal varices at Hepatology, Gastroenterology and Infectious Diseases Department, Benha University Hospital Hospitals and at Kafr El- Shiekh Liver Research center Results The cause of cirrhosis was HCV in 205 patients (85.42%), HBV in 14 patients (5.83%), BHF in 47 patients (19.58%) with, AIH in 6 patients (2.5%) and other diseases in 21 patients (8.75%). the prevalence of oesophageal varices and its staging were 55 patients (22.9%) had no oesophageal varices, 44 patients (18.3%) had esophageal varices grade I-II (Small EVs) and 141 patients (58.8%) had oesophageal varices grade III-IV (Large EVs). According to Child-Pugh (CP) Score, 129 (53.75%) patients were Child A, 72 (30%) patients were Child B and 39 (22.9%) patients were Child C. ALBI ranged from -3.2 - (-0.42) with mean value −1.94 ± - 0.74. 67 (27.9%) patients were ALBI 1, 100 (41.7%) patients were ALBI 2 and 73 (30.4%) patients were ALBI 3. 50 (20.83%) patients were ALBI-PLT 2, 30 (12.5%) patients were ALBI-PLT 3, 88 (36.67%) patients were ALBI-PLT 4, 72 (30.0%) patients were ALBI-PLT 5. There was a significant difference among cirrhotic patients regarding EVs as regard to hemoglobin, platelets, APRI, albumin, total bilirubin, ALBI, ALBI-PLT, INR, Child-Pugh (CP) score, platelet count/spleen diameter ratio, spleen size and ascites (P < 0.001). Regarding the presence of EV, ALBI, ALBI-PLT, Child-Pugh (CP) Score and platelet count/spleen diameter ratio, are good predictors for the presence of oesophageal varices. ALBI at cut-off >-2.6 can predict oesophageal varices with sensitivity 83.77, specificity 53.06, PPV 87.4, NPV 45.6, AUC 0.711 and P-value <0.001, ALBI- PLT at cut-off >2 can predict oesophageal varices with sensitivity 96.48, specificity 87.76, PPV 96.9, NPV 97.7, AUC 0.982 and P-value <0.001. Regarding differentiation between Small EVs and large EVs, This study showed that ALBI, ALBI-PLT, Child-Pugh (CP) Scores, platelet count/spleen diameter ratio, spleen size and APRI could be used in prediction of the size of EVs, ALBI at cut-off >-2.03 can predict the size with sensitivity 95.28, specificity 93.75, PPV 96.8, NPV 90.9, AUC 0.971 and Pvalue <0.001. Conclusion Combined ALBI grade and platelet count (ALBI-PLT score), albumin-bilirubin ratio (ALBI), could be used as a serum non-invasive marker of the presence of oesophageal varices which may help in reducing unnecessary endoscopies and a good selection of patients who need an endoscopy to decrease intervention and burden on endoscopy units.

The Use of Nuetrophil Gelatinase Associated Lipocalin (NGAL) as a Novel Marker in Early Diagnosis of Hepato Renal Syndrome in Advanced Cirrhotic Patients

Abstract Background Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality. Objective To predict value of serum and urinary NGAL as an early predictor of hepatorenal syndrome in cirrhotic patients. Patients and Methods The study was conducted on 60 participants with cirrhosis child C on Child-Pugh score, each one was investigated for both Urinary and Plasma NGAL level. Randomized controlled clinical trial. This study is a prospective, random, clinical trial conducted at Kafr El Sheikh Liver Institution Results Group I had Urinary NGAL ranged from 12 - 120, with a mean value of 61.45 ± 36.17. While group II A, ranged from 211-493 with a mean value of 379 ± 72.825. And in group II B, ranged from 306- 732 with a mean value of 438.05 ± 111.26. There was statistical difference between studied groups, p value <0.001. It was found that Urinary NGAL not only good predictor for early renal affection, but also it can differentiate between HRS and non HRS AKI due to the marked difference readings of its level in groups with renal impairment. Conclusion Both Plasma and urinary NGAL levels are markedly elevated in renal affection whatever the cause, so they are highly sensitive in detecting early renal impairment. However, the rate of elevation of plasma NGAL is so close in different types of AKI so it’s not advisable to use it alone to diagnose HRS. On the other hand, Urinary NGAL show noticeable differences between degree of elevation with different causes of AKI, so it’s somehow could be a trusted diagnostic tool to diagnose HRS.