Medicine Research Institute Research Articles

ANGIOTENSINOGEN GENE POLYMORPHISM (M235T) IN SUDANESE HYPERTENSIVE PATIENTS.

23Nov 2016 ANGIOTENSINOGEN GENE POLYMORPHISM (M235T) IN SUDANESE HYPERTENSIVE PATIENTS. Rinan M Yosif , Ghada A Elfadil , Salah Eldin G Elzaki and Amar M . Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan. Department of Epidemiology, Tropical Medicine Research Institute, National Centre For Research ,Khartoum, Sudan. Department of Biochemistry and Molecular Biology, Faculty of Science and Technology, Al-Neelain University Sudan.

Ching-Yu Cheng: current status quo of population-based study on glaucoma

Dr. Ching-Yu Cheng ( Figure 1 ) is currently an Associate Professor of the Academic Medicine Research Institute and the Academic Clinical Program for Ophthalmology and Visual Sciences (Eye ACP) at Duke-NUS Graduate School of Medicine; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore. He directs the Singapore Epidemiology of Eye Diseases (SEED) Program, a large multi-disciplinary research program focusing on epidemiology, imaging and genetics on eye diseases in Singapore.

Ching-Yu Cheng: current status quo of population-based study on glaucoma

Dr. Ching-Yu Cheng ( Figure 1 ) is currently an Associate Professor of the Academic Medicine Research Institute and the Academic Clinical Program for Ophthalmology and Visual Sciences (Eye ACP) at Duke-NUS Graduate School of Medicine; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore. He directs the Singapore Epidemiology of Eye Diseases (SEED) Program, a large multi-disciplinary research program focusing on epidemiology, imaging and genetics on eye diseases in Singapore.

The Role of Vitamin D During Therapy in Chronic Hepatitis C Virus Infection and Its Relation to CYP 27 B1-1260 Promoter Polymorphism

Objective: vitamin D is a potent immunomodulator. A number of genetic polymorphisms in the vitamin D pathway have been shown to affect vitamin D signaling, and stratification according to such polymorphisms has already being implemented in randomized controlled clinical intervention studies. Aim of the work: the study was attempted to examine whether vitamin D improved viral response and predicted treatment outcome in patients with chronic hepatitis C virus (CHCV) infection. Patients and methods: ninety two patients with CHCV, whose age ranged between 20 and 56 years, were selected from the National Hepatology and Tropical Medicine Research Institute were included in this study, before and after the treatment with pegylated interferon (PEG-IFN), ribavirin (RBV) and vitamin D supplementation drops; 2000 IU/day, 10 drops/day, six patients whom received identical therapy without vitamin D were included to serve as controls. All the patients had body mass index (BMI) ≤ 30, were subjected to the following: history, clinical examination, abdominal ultrasonography and collection of blood samples for routine laboratory investigations. CBCs and analysis of the expression of CYP 27 B1-1260 gene, vitamin D receptor (VDR), and the levels of serum 25-hydroxyvitamin D before and after chronic hepatitis C virus treatment. Results: the treatment group with vitamin D had BMI ≤ 30 and high viral load 90900004.00 IU/ML, (P= 0.098). Sixty three percent of treated patients were HCV RNA negative at 48 weeks after treatment (SVR). Baseline serum vitamin D level was 8.5 minimum, mean level (32.9 ± 27 ng/mL). It increased after 48 wk vit D treatment, to a mean level of (54.9 ± 38 ng/mL). VDR show highly significant difference between patients and controls as regarding Ff=55.4% for patients (P=0.01), and 66.7% ff for the controls (P=0.006) alleles. CYP27B1 show non significant relation between patients and controls, with CYP27B1 genotype frequencies of the promoter polymorphism CC = 51.1% for patients, 66.7% for the control group, C allele frequency 69% for the patients, 83.3% for the controls, AC 35.9% for the patients, 33.3% for the controls. The majority of cases had A1F1 and A1F2 biopsy results. Conclusion: our study suggests a role of vitamin D in the response to treatment of chronic HCV patients. However, serum concentration is not a suitable predictor of treatment outcome. VDR had a predictive positive treatment outcome. CYP27B1-1260 was found to be an independent predictor of sustained virologic response (SVR). Recommendations: The level of recommended supplementation of vitamin D depends on the patient’s individual deficiency, although 2000 IU daily is a common dose. Patients taking vitamin D supplements should have serum measurements made after starting therapy to determine whether they are reaching target levels.

DETECTION OF IL-28 rs 12979860 GENE POLYMORPHISM BY REAL TIME PCR IN HEPATOCELLULAR CARCINOMA PATIENTS.

30Jun 2016 DETECTION OF IL-28 rs 12979860 GENE POLYMORPHISM BY REAL TIME PCR IN HEPATOCELLULAR CARCINOMA PATIENTS. Amal A. Mohamed , Ingy Badawy , Waleed A. Elagawy and AbeerA.Abdelmonem. Department of Biochemistry, National Hepatology and Tropical Medicine Institute, Cairo, Egypt. Faculty of Biotechnology, Misr university for Science and technology, Cairo, Egypt. Department of Tropical Medicine, National Hepatology and Tropical Medicine Research Institute Cairo, Egypt. Microbiology and Immunology, Beni-Suef Faculty of Medicine.

Mo1335 Magnifying Endoscopy With Narrow Band Imaging of Early Gastric Cancer: Correlation With Histopathology and Mucin Phenotype

Kyung-Sun Ok, Gwang Ha Kim, Do Youn Park, Hyun Jeong Lee, Hye Kyung Jeon, Dong Hoon Baek, Bong Eun Lee, and Geun Am Song Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Departments of Internal Medicine and Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Influence of Difficulty Variation of the Core Stabilization Exercise on Thickness Changes of Abdominal Muscles in Healthy Subjects: A Pilot Study

Jeong-Hyeon Kang, Hye-Rim Suh, Chang-Yong Kim, Hyeong-Dong Kim, Hyungkun Kim Department of Health Science, Graduate School, Korea University; Department of Physiology, College of Medicine and Neuroscience Research Institute, Korea University; The Biomechanics and Movement Rehabilitation Laboratory, Health and Sciences Institute, Korea University; Department of Physical Therapy, College of Health Science, Korea University; Department of Health Science, Graduate School, Korea University, Seoul, Korea

MONOCYTE CHEMOTACTIC PROTEIN AND RESPONSE TO PEGYLATED INTERFERON-ALPHA-2A TREATMENT IN PATIENTS WITH CHRONIC HEPATITIS C (CHC) GENOTYPE 4.

The prevalence of hepatitis C virus (HCV) infection varies across the world, with the highest number of infections reported in Egypt. Monocyte chemotactic protein-1 (MCP-1) is a potent chemokine, and its hepatic expression is up-regulated during chronic HCV infection. Fifty naive patients with chronic hepatitis C in National Hepatology & Tropical Medicine Research Institute and 20 healthy volunteers as controls were enrolled in a prospective study designed with strict inclusion criteria to nullify the effect of confounding variables and further minimize selection bias. Fifty naive patients were treated with PEG-IFN-a2b, at a dose of 1801 g/kg subcutaneously every week plus ribavirin at a dose of 1000- 1200 mg/day, according to the patient's body weight, for 48 weeks. Quantification of HCV-RNA by real-time PCR and MCP-1 by ELISA were performed for every patient and controls. There was a sta- tistically significant difference between patients and control group as regards the quantity of MCP-1 (P < 0.05) (Mann-Whitney test) (P = 0.004). There was a significant difference between responders and nonresponses regarding MCP-1 (P < 0.05), responders showed a higher percentage of cases with initial MCP-1 < 306 (P < 0.05). We conclude the importance of the detection of MCP-1 expression at the start of therapy as a factor for assessing the likelihood of HCV genotype 4 patients to achieving a sustained virological response to treatment with IFN-a2 in combination with ribavirin.

The Fundamental Role Played by Cell Cycle Proteins in Controlling Cell Proliferation in Chronic Hepatitis C Virus Infection.

Background: examining the alteration of cell cycle genes in early hepatitis C virus (HCV) found that altered expression of mitotic checkpoint genes, MAD2L1, KNTC1, CDC16 and CDC34, KNTC1 known as “rough deal protein” (ROD) is part of a complex involved in elaborating an inhibitory signal due to improper chromosomal aligment during cell division. Aim of the work: attempt for the identification of proteins (genes), which act as predictive factors to identify patients with high risk of cell transformation and HCC development. Patients and methods: fifty three patients with chronic HCV infection, age ranged between 18 and 58 years, time of assessment was before starting therapy of hepatitis C at the National Hepatology and Tropical Medicine Research Institute. Ten healthy individuals were included to serve as controls. All the patients and controls were subjected to the following: history, clinical examination, abdominal ultrasonography, and collection of blood samples for routine laboratory investigation; CBCs. Liver biopsy was done to all patients and controls, patients revealed mild fibrosis (Metavir fibrosis scores from F1 to F3). Also, we used freshly frozen liver biopsies mRNA levels with perspective protein levels of four genes: P27, P15, KNTC1, MAD2L1. Results: significant association of P27, P15, KNTC1 and MAD2L-1 with the progression of liver fibrosis in chronic HCV liver biopsy was found. Conclusion: there is altered gene expression in HCV-associated liver disease. Recommendations: the emerging interest of hepatologists in the influence of genetic factors in HCV. Evaluation of the expression of key proteins related to the cell cycle and apoptosis in chronically infected patients with HCV would be of significance to understand disease pathogenesis, and will help in identifying novel prognostic indicators.

DETECTION OF HELICOBACTER ANTIGEN IN STOOL SAMPLES AND ITS RELATION TO H. PYLORI POSITIVE CHOLECYSTITIS IN EGYPTIAN PATIENTS WITH CHRONIC CALCULAR CHOLECYSTITIS.

Evidences supporting the association between H. pylori infection and chronic cholecystitis could be found by using direct culture or staining of H. pylori in gallbladder tissues as well as indirect techniques. Stool antigen test has been widely used due to its noninvasive nature. Various stool antigen tests were developed to detect H. pylori using an enzyme immunoassay (EIA) based on monoclonal or polyclonal antibodies This study evaluated the frequency of H. pylori antigen in stool samples of patients with chronic calcular cholecystitis as regard gall bladder histopathological changes. Fifty patients were included presented with symptomatic qholecystolithiasis recruited from the outpatient clinic of National Hepatology and Tropical Medicine Research Institute during 2014-2015. Full history and clinical examination and abdominal ultrasonography were performed. Stool samples were collected, prepared and examined for detection of H. pylori antigen. Cholecystectomy was done for all patients; 45 patients (90%) by laparoscopic Cholecystectomy and 5 patients (10%) by open surgery and removed gallbladders were submitted to pathology department for detection of H. pylori in tissue under microscope using Giemsa stain. The results showed that (82%) were females with mean age (42.6 +/- 1 years). The mean BMI was (29 + 7.2) H. pylori-specific antigen in stool samples was detected in 40% of patients and 38% were detected in patients; tissue, with significant correlation between H. pylori-specific antigen in stool and in tissue. Histopathological pictures infection in tissue were 68.4% mucosal erosions, 63.2% mucosal atrophy, 57.9% mucosal hyperplasia, 26.3% metaplasia, 42.1% musculosa hypertrophy, 26.3% fibrosis, but lymphoid aggregates were in 42.1% of cases.

IFN-Stimulated Genes Upregulation Pattern in Chronic Hepatitis C

Background: The development of effective tools for the large-scale analysis of gene expression has provided new insights into the involvement of gene networks and regular pathways in various disease processes. The chemokine receptor CXCR3 is a G protein-coupled receptor found predominantly on T cells that is activated by three ligands as follow: CXCL9 (Mig), CXCL10 (IP-10) and CXCL11 (I-TAC), and play a key role in immune and inflammatory responses by promoting recruitment and activation of different subpopulations of leukocytes. Aim of the work: The study is a logical functional approach for the development of serum markers chemokines that bind to CXC chemokine receptor 3 to determine whether they play a role in the future of immune system to clear HCV, these chemokines: CXCL9, CXCL10 and CXCL11. Patients and methods: 131 male and female patients with chronic hepatitis C virus (CHCV) infection, their age ranges between 22 and 55 years, selected from the National Hepatology and Tropical Medicine Research Institute. The included patients were divided to two groups, the first group: 80 patients were investigated for the predictive values of CXCL9,10,11 and CXCR3 chemokines in peripheral blood mononuclear cells (PBMCs), the second group were fifty one patients analyzed for the expression of surface markers on CD8+T cells. Twenty healthy individuals were included to serve as controls for each group. All the patients and controls were subjected to the following: history, clinical examination, abdominal ultrasonography and collection of blood samples for routine laboratory investigation and serological assay. Results: Chemokine CXCL9, CXCL10, CXCL11 and their receptor CXCR3 expression levels are induced in PBMCs during CHCV infection, associated with increased the expression levels of CD8+T cells in CHCV patients. Conclusion: The interaction between chemokines and their receptors is essential in recruiting HCV-specific T cells to control the infection. Recommendations: The regulationof chemokines and their receptors could be a future potential therapeutic target to decrease liver inflammation and to increase specific T cell migration to the infected liver, the blocking of chemokines and chemokine receptor engagement is a therapeutic strategy that should be explored in the near future for non-responders to current anti-HCV therapy.

Tumor Necrosis Factor-Alpha ( TNF-α ) Gene Expression in Chronic Hepatitis B Virus Infection

Background: Tumor necrosis-alpha (TNF-α) is produced by macrophages, neutrophils, T-cells and NK-cells after stimulation. In turn, TNF-α can stimulate secretion, increase the expression of adhesion molecules as well as active neutrophils. Hence, it fulfills the role as a principal mediator of cellular immune response and inflammation, and may play an important role in non-cytopathic and cytolytic clearance of hepatitis B virus (HBV). The clearance of HBV is a complex process which may be influenced by many factors including polymorphisms in the tumor necrosis (TNF- ) gene promoter. Aim of the work: The study aimed to determine the TNF-α as a gene expressed in chronic hepatitis B virus infection and its role in outcome of the virus. Patients and methods: Ninety four patients with chronic HBV infection, their age between 19 and 59 years, selected from the National Hepatology and Tropical Medicine Research Institute were included in this study, during treatment and twenty healthy individuals were included to serve as controls. All the patients and controls were subjected to the following; history, clinical examination, abdominal ultrasonography and collection of blood samples for routine laboratory investigation, and serological assay for HBsAg, HBsAb, HBeAg, HBeAb, HBV DNA (quantitative), and TNF-α promoter polymorphisms in two sites 238 and 308. Results: The prevalence of the variant at position -308 GA was similar in all investigated groups (patients and controls).An association was found between the TNF-α promoter polymorphism at position -238 and the development of chronic HBV infection with sensitivity of 93% and specificity of 75%. Conclusion: TNF-α-308 GA was significantly associated with clearance, showing protective antibody and persistent HBV infection. The promoter variant of TNF-α at position 238 GA, GG appears to be linked to defective viral clearance, controls had higher TNF-α-238 GG,GA, AA as compared to cases with significant difference. Recommendations: The variation in the genes governing the levels of constitutive and inducible TNF-α might be an important factor, which might explain the variable outcome of HBV infection.

Sodium tanshinone IIA sulfonate for reduction of periprocedural myocardial injury during percutaneous coronary intervention (STAMP trial): Rationale and design

a Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China b Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China c Chinese Medicine Research Institute, Tianjin University of Chinese Medicine, Tianjin 300193, China d Physiology & Experimental Medicine, Hospital for Sick Children, Toronto M5G 0A4, Canada

Role of Interleukin-10, Interleukin-12 in the Response Prediction during Combined PEG Interferon-alpha 2a and Ribavirin Therapy in Patients with Chronic Hepatitis C

Background: Egypt has the highest prevalence of adult HCV infection in the world, averaging 15%-25% in rural communities. Sustained virological response in genotype 4 Egyptian patients treated with PEG-IFN alfa-2a and ribavirin was estimated around 60%. It is of major interest for both patient care and economic approach to predict failure of response. Several factors have been shown to influence response to antiviral treatment. Cytokines play an important role in the pathogenesis, progression and treatment outcome of HCV infection. Aim: The current study was designated to assess serum interleukin-10 and interleukin-12 levels in CHC genotype 4 patients and investigate their benefit as predictors of antiviral response. Methods: This study was conducted on a total number of 70 participants admitted to Hepatology and Gastroenterology Department in NHTMRI (National Hepatology & Tropical Medicine Research Institute). The participants of this study were divided into two groups as following; Group I: 20 healthy subjects (as controls), while the cases in Group II: 50 patients with chronic hepatitis C (CHC) genotype 4. Results: Our results showed that IL-12 and IL-10 levels were higher in patients with HCV infection than in control participants and were significantly higher in the group of the sustained responders, compared with non-responders. Serum IL-10 level showed a sensitivity and specificity of 76.7% and 73.3% respectively while serum IL-12 level showed sensitivity and specificity of 90% and 75% respectively. Conclusion: These results demonstrate the beneficial role ofIL-10, IL-12 in achieving an SVR during IFN-alpha and ribavirin therapy

Difficulty of Delayed Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiography Management of Choledocholithiasis

Aim: Common bile duct stones (CBDS) management consists of CBD clearance. Since, in most cases, CBDS are due to gallstone migration, there is also a formal indication for cholecystectomy. Timing for endoscopic retrograde cholangiography (ERC) is a matter of debate, as it may be performed before, after, or even during cholecystectomy, according to the so-called “rendez-vous technique”. This retrospective study is aimed to evaluate the difficulty of laparoscopic cholecystectomy (LC) done after more than 2 weeks period for patients underwent ERC to manage CBDS. Methods: The present study enrolled 99 (69 males and 30 females) patients, whom suffered from CBD stones. The patients were revised and the clinical records were presented at the National Hepatology and Tropical Medicine Research Institute (NHTMRI) - at surgery department, from May 2012 to November 2014. Results: Preoperative jaundice was positive in 33 patients (total serum bilirubin > 2 mg/dL), ERC was done to all patients and stent was placed in 24 patients. Surgery (LC) was delayed more than 2 weeks due to unfitness for surgery 24, patient reluctance 27, and long waiting list 48 patients. During LC different grades of adhesions at Callot’s triangle were reported as; grade I in 27, grade II in 42, grade III in18, and grade IV in 12. Conversion to open surgery occurred in 33 patients. Mortality occurred in 3 patients and morbidity in 30 patients. Conclusion: Concomitant or early LC (within 1 week) after ERC for CBDS is strongly recommended, otherwise, a high surgical expertise is advised to perform the procedure after that period.

A Survey of the Pain Management of Acute Painful Crisis among Patients with Sickle Cell Disease at Two Centres in Jamaica.

The aim of this survey was to establish the pain management approaches to acute painful crisis (APC) in sickle cell patients at two healthcare facilities and to compare with available guidelines. A multi-centre observational survey of the management of APC in sickle cell patients was conducted. Data were collected at the Sickle Cell Unit (SCU), Tropical Medicine Research Institute (TMRI) and Accident and Emergency Department (A&E), University Hospital of the West Indies. One hundred episodes of uncomplicated APC involving 81 patients managed at the SCU clinic and 64 episodes at the A&E in a total of 28 patients were included in the data set. Drugs used at the SCU included oral morphine, codeine and paracetamol and intramuscular diclofenac. At the A&E, parenteral morphine and pethidine were most commonly used. At the SCU, the mean time to initiation of analgesics was 38 minutes (IQR 25 to 50 minutes); at the A&E, this was 111 minutes (IQR 50 to 150 minutes). At the SCU, the mean duration of stay (DOS) was 2.9 hours (IQR 1.9 to 3.8 hours) with 94% of the patients being discharged home. At the A&E, the mean DOS was 13.0 hours (IQR 8.3 to 16.9 hours) with 93% of the patients being discharged home. The A&E patient group contained multiple high frequency presenters. Documentation of pain severity scores was inconsistent. The findings of the survey indicate that the management of APC at the two centres is substantially different. Further study is required to investigate patient satisfaction, centre preference and analgesic therapy efficacy.

Hepatitis C-Virus Infection and Risk of Coronary Heart Diseases

Background: The world Health Organization has declared hepatitis C a global health problem, with approximately 3 % of the worldﹶs population. HCV infection was associated with a high risk of CHD. Hs-CRP and fibrinogen was considered as markers of coronary artery disease, their elevation correlated with incidence of CAD, However Apo A deficiency predict future risk of CAD. Aim: To study correlation between HCV infections and marker risk factors of coronary heart disease in different stages of liver disease. Patients & Method: Forty three chronic HCV patients were recruited at specialized hepatology clinic in National Hepatology and Tropical Medicine Research Institute (NHTMRI),Cairo; they were classified into 3 groups according to Child – Pugh score (A, B, C), 42 % were Child class A, 28 % Child B and 30 % Child C, age from 20 to 80 years. 15 healthy subjects served as control group. Detection of the following tests occurred for both groups: Liver function tests: ALT, AST, ALP, total protein, albumin, bilirubin, GGT and AFP. Ultra sensitive CRP, fibrinogen, apoprotein A and Lipid profile: Total Cholesterol, triglyceride, HDL-C, LDL-C, and Total Lipid. Results: the data obtained from results show that :liver enzymes AST, ALT, total bilirubin, albumin, total protein and INR levels were significantly different between groups and control (p 0.05). Cardiac enzymes; CK and LDH levels were not significantly different between groups and control (p> 0.05). The APO A levels were not differs significantly in study groups and controls (p> 0.05). The fibrinogen andhs-CRP levels in the patients appeared to be significantly higher than those in the healthy controls (p< 0.05). Conclusion: hs-CRP and fibrinogen may be considered as a CHC progression prognostic factor, Evidence indicates that hepatitis C virus (HCV) have a key role in coronary heart disease.

Comparison of Behavioral and Psychological Symptoms between Early and Late Onset Alzheimer's Disease According to the Progression of Dementia

인제대학교 해운대백병원 정신건강의학과*, 부산대학교 의과대학 신경과학교실†, 부산대학교 심리학과‡ Comparison of Behavioral and Psychological Symptoms between Early and Late Onset Alzheimer’s Disease According to the Progression of Dementia Yeo-Ju Yoon, M.A.*, Eun-Joo Kim, M.D.†, Chang Hee Hong, Ph.D.‡ Department of Psychiatry*, Inje university paik-hospital, Busan; Department of Neurology†, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan; Department of Psychology‡, Pusan National University, Busan, Korea

Surface-modified solid lipid nanoparticles for oral delivery of docetaxel: enhanced intestinal absorption and lymphatic uptake

Docetaxel is a potent anticancer drug, but development of an oral formulation has been hindered mainly due to its poor oral bioavailability. In this study, solid lipid nanoparticles (SLNs) surface-modified by Tween 80 or D-alpha-tocopheryl poly(ethylene glycol 1000) succinate (TPGS 1000) were prepared and evaluated in terms of their feasibility as oral delivery systems for docetaxel. Tween 80-emulsified and TPGS 1000-emulsified tristearin-based lipidic nanoparticles were prepared by a solvent-diffusion method, and their particle size distribution, zeta potential, drug loading, and particle morphology were characterized. An in vitro release study showed a sustained-release profile of docetaxel from the SLNs compared with an intravenous docetaxel formulation (Taxotere®). Tween 80-emulsified SLNs showed enhanced intestinal absorption, lymphatic uptake, and relative oral bioavailability of docetaxel compared with Taxotere in rats. These results may be attributable to the absorption-enhancing effects of the tristearin nanoparticle. Moreover, compared with Tween 80-emulsified SLNs, the intestinal absorption and relative oral bioavailability of docetaxel in rats were further improved in TPGS 1000-emulsified SLNs, probably due to better inhibition of drug efflux by TPGS 1000, along with intestinal lymphatic uptake. Taken together, it is worth noting that these surface-modified SLNs may serve as efficient oral delivery systems for docetaxel.

Liver Biopsy and FibroScan to Detect Early Histopathological Changes in Chronic HBV Patients Not Candidate for Treatment.

BackgroundWe aimed at evaluating liver biopsy and FibroScan (FS) to assess early histopathological changes among chronic hepatitis B virus (HBV) patients not candidates for treatment.MethodsOne hundred thirty-five chronic hepatitis B naive patients were followed up twice weekly at National Hepatology and Tropical Medicine Research Institute. All patients were not candidates for treatment according to both Egyptian and international guidelines. Pre-enrollment assessment was performed through biochemical, serological and quantitative HBV DNA testing. Liver biopsy was performed to 59 patients based on the guidelines while FS was performed to patients who were not candidates for liver biopsy (102 patients). Twenty-six patients performed both liver biopsy and FS (isolated liver biopsy 33 patients and isolated FS 76 patients).ResultsAt the end of study period, liver biopsy group showed that majority of subjects had grade F1 fibrosis (61.0%). Only 13.6% were F3. FS showed that almost half (47.1%) of subjects had a grade of F0 and 21.6% with grade F1. Only 4.9% of subjects had fibrosis grades of F3 or F4. In each test, nearly two-thirds of patients had evidence of F0/F1 fibrosis and the remaining one-third had more marked fibrosis. The degree of fibrosis as detected by both liver biopsy and FS was directly related to alanine aminotransferase (ALT), aspartate aminotransferase (AST), S. albumin and prothrombin. Patients with advanced fibrosis had significantly higher ALT and AST, while their S. albumin and prothrombin were significantly lower than those with minimal fibrosis.ConclusionFS study requires further validation in HBV but could be confidently used at the present time as a predictor for the degree of hepatic fibrosis in chronic HBV patients. Liver biopsy could be spared for cases that present with elevated liver functions and/or marked impairment of synthetic liver functions.