Impact of chronic liver disease on COVID-19 infection at Zagazig University Hospitals

Background. Chronic liver disease (CLD) is linked to immune system failure, which increases the risk of infections and consequences brought on by COVID-19. Therefore, we aimed to compare hospitalized COVID -19 patients with and without CLD to assess the effect of CLD on the severity of COVID-19 infection. Methods. The study was conducted between April and October 2022 at Zagazig university hospitals. It enrolled 108 subjects admitted at the isolation hospital for COVID-19 illness. The cases were allocated equally into three groups, group (I): Patients without evidence of liver disease. Group (II): patients with chronic hepatitis, and group (III): patients with cirrhotic liver. Result. There were significant correlations between the severity of COVID -19 and the CTP classification of Group III (r=0.5 p=0.05 in child A, r=0.08 p=0.05 in child B, r=0.4 p=0.001in child C). In addition, there were significant correlations between laboratory parameters such as INR (r=0.6, p=0.05), bilirubin (r=0.4, p=0.001), ALT (r= 0.5, p=0.05), and AST (r=0.08, p=0.05) and severity of COVID -19 in studies groups. Conclusion: Those with CLD and cirrhosis had a higher death rate. COVID-19 severity related to the Child-Turcotte-Pugh score (CTP) score.

Variations of Arterial Supply of the Liver: C.T. Angiographic Study Among Sudanese Adults

Hepatobiliary surgery through laparoscopic approach is becoming a routine. Knowledge of extrahepatic arterial tree is essential for surgical and imaging procedures. Anatomical complexity is expected since the liver is developed by mergingof lobules with its separate blood supply. This makes a wide range of variations in the pattern of vascular arrangement and so reinforces the need for an accurate understanding of full spectrum of variations. This study aimed to investigate the variations in origin and distribution of extrahepatic arterial supply. Fifty volunteers (32 males and 18 females) aged 20­70 years were randomly recruited from the department of CT scan in Al Amal Hospital, Khartoum North, Sudan. The patients were already candidates for CT angiography with contrast for conditions other than hepatobiliary diseases. The reported data is related to those who accepted to participate in the study. Patients with history of hepatobiliary disease were excluded. 3D views of the scans were treated and the extrahepatic arterial tree was traced in a computer-based software. Key findings suggest that Michel's classification was considered the standard template for description ­ 76% of them showed Michel's type I classification. Types III and V constituted about 2%. About 4% of the cases were represented by types VI and IX. Other types of variations constituted about 12%. To conclude, although type I classification which describes the textbook pattern of hepatic artery distribution was significantly detected among the Sudanese population, other variants were to be considered since they are related to major arteries like aorta and superior mesenteric.

Sero-prevalence of Hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone, Southwest Ethiopia: Community based cross-sectional study

Background: Hepatitis B virus infection is one of the leading causes of liver diseases which occurs worldwide particularly in developing countries. It is often caused by prenatal transmission from mother to child or household transmission from a close contact during early childhood. It causes different complications like; jaundice, induces premature labor, and prematurity. Objective: The aim of this study was to estimate the Sero-prevalence of hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone, South West Ethiopia. Methods: A community-based cross-sectional study was conducted from December 15th, 2016, to February 15th, 2017. Multistage sampling technique was applied to select study participants. Logistic regression analysis was applied and p-values < 0.05 was used to see the significant association between dependent and independent variables. Results: A total of 330 participants were included in this study yielding 98.8% response rate. The Sero-prevalence of hbsag among women of reproductive age was 28(8.5%). Having multiple sexual partners (AOR = 18.73, 95% CI = [3.65, 96.21) history of unprotected sex (AOR = 9.39, 95% CI = [1.64, 53.77) were found to be significantly associated with Sero-prevalence of HBV. Conclusions: The Sero-prevalence of HBV infection among women of reproductive age was highly endemic. Hence, behavioral education and communication programs focusing on reduction of risky sexual behaviors should be designed to reduce HBV infection

Sociodemographic and medical characteristics of liver cirrhosis deaths in a Ghanaian tertiary hospita

Objective: Cirrhosis is common in Ghana because of its high risk factors prevalence. However, information on cirrhosis in Ghana is lacking. This study aimed to study the clinical, and laboratory characteristics of cirrhotic patients in a tertiary hospital in Ghana. Design: This was a retrospective study of sociodemographic characteristics, symptoms and signs, biochemical and fibrotic indices, treatments, and complications data of 247 patients with cirrhosis who died on admission. Setting: This study was carried out at the Gastroenterology Unit of the Korle-Bu Teaching Hospital, Ghana, Results: Two-thirds (68.0%) of the patients were within 30 to 60 years, with more than half (73.7%) being males. The most common aetiological factors among the patients were Hepatitis B virus infection (53.8%), alcohol use (31.6%) and Hepatitis C virus infection (4.9%). More than half (55.0%) of the patients reported late for admission, and 67.2% died within the first two weeks of admission. The most common clinical feature was abdominal distension (61.1% of patients), and the least was upper-abdominal mass (14.2%). The levels of most liver test parameters were elevated, fibrotic indices were high, and haemoglobin and albumin levels were reduced. More than half (53.8%) of the patients were in Child Pugh class B. The most common complication was hepatic encephalopathy; the least was hepato-renal syndrome. Definite treatment for complications of cirrhosis was lacking. Conclusion: Deaths from cirrhosis at the hospital were mostly of young males with chronic hepatitis B infection. Implementation of hepatitis B prevention and treatment guidelines can help reduce cirrhosis deaths.

Sociodemographic and medical characteristics of liver cirrhosis deaths in a Ghanaian tertiary hospital

Objective: Cirrhosis is common in Ghana because of its high risk factors prevalence. However, information on cirrhosis in Ghana is lacking. This study aimed to study the clinical, and laboratory characteristics of cirrhotic patients in a tertiary hospital in Ghana. Design: This was a retrospective study ofsociodemographic characteristics, symptoms and signs, biochemical and fibrotic indices, treatments, and complications data of 247 patients with cirrhosis who died on admission. Setting: This study was carried out at the Gastroenterology Unit of the Korle-Bu Teaching Hospital, Ghana, Results: Two-thirds (68.0%) of the patients were within 30 to 60 years, with more than half (73.7%) being males. The most common aetiological factors among the patients were Hepatitis B virus infection (53.8%), alcohol use (31.6%) and Hepatitis C virus infection (4.9%). More than half (55.0%) of the patients reported late for admission, and 67.2% died within the first two weeks of admission. The most common clinical feature was abdominal distension (61.1% of patients), and the least was upper-abdominal mass (14.2%). The levels of most liver test parameters were elevated, fibrotic indices were high, and haemoglobin and albumin levels were reduced. More than half (53.8%) of the patients were in Child Pugh class B. The most common complication was hepatic encephalopathy; the least was hepato-renal syndrome. Definite treatment for complications of cirrhosis was lacking. Conclusion: Deaths from cirrhosis at the hospital were mostly of young males with chronic hepatitis B infection. Implementation of hepatitis B prevention and treatment guidelines can help reduce cirrhosis deaths.

Study of Interleukin-18 in chronic Hepatitis C Virus related liver diseases

Background and study aim: ELISA can determine serum Interleukin (IL)-18 level. It is a sensitive; simple and rapid test; thus help to study changes of serum IL-18 levels in chronic HCV related liver diseases during different stages. The objective of this study was to study serum IL-18 levels in chronic HCV related liver diseases. Patients and methods: Sera from 60 patients with HCV related chronic liver diseases at various stages of HCV infection (chronic hepatitis; cirrhosis and complications) and sera of 10 normal controls were subjected to measurements of serum IL-18 level by ELISA assay.Results: There were highly significant increase in the mean values of serum IL-18 in chronic HCV related liver cirrhosis; non complicated and complicated patients in comparison to chronic active hepatitis C patients and healthy subjects and highly significant increase in the mean values of serum IL-18 in complicated patients in comparison to non complicated patients. There was highly significant increase in the mean values of serum IL-18 in decompensated liver cirrhosis patients when compared to compensated patients. Conclusion: Serum IL-18 level shows highly positive significant correlation with severity of liver dysfunction in HCV related liver cirrhosis

Oxidative stress and dyslipidaemia among ghanaian HAART-Naive HIV Patients and those on HAART

"Background: Pharmacogenomics/pharmacogenetics has the potential to mitigate adverse drug reactions and optimize pharmacotherapy in individuals. Over the past several years; there has been increasing attention towards the characterization of pharmacogenomic biomarkers in African populations; both locally and internationally. However; the perceptions of the African health care community towards pharmacogenomic testing have not been studied. Objectives: To assess knowledge and perceptions of pharmacogenomics among health care professionals in Benin City; Nigeria. Methods: In this preliminary and pilot investigation; we used a semi-structured qualitative survey methodology to understand the perceptions of pharmacists and pharmacologists towards pharmacogenomics in an academic care centre in Benin City; Nigeria. Three themes were explored: Knowledge and experience with pharmacogenetics; Expectations about how a pharmacogenetic testing service could be used; and Capacity building for pharmacogenetic service delivery.Results: Though none of the participants had received training or undertaken research in pharmaco-genomics; all participants were familiar with the field and listed beneficial outcomes associated with pharmacogenetic testing. Participants identified factors such as lack of funding; infrastructure; and manpower for limitations of pharmacogenomic testing in Nigeria. Participants listed numerous ethical issues and concerns in recruiting participants for research and introducing pharmacogenetics in the clinic; including the need to ""win the confidence of the people."" Conclusion: Pharmacists and pharmacologists in an academic centre in Nigeria are aware of the benefits of pharmacogenomics; but cite many hurdles to overcome before this field can become a routine part of patient care in their communities."

Liver Biopsy: is it Safe in Children?

Introduction: The blind liver biopsy technique has been widely used in Sudan as the availability of the ultra sound machines and the committed Pediatrics Radiologist were not always at hands. Liver biopsy is an essential tool in the diagnosis of liver diseases and subsequently; initiating the appropriate treatment. Objective: The aim of the study was to observe the safety of blind liver biopsy in our children. retrospectively. Using a standard percussion technique biopsy sites were chosen and through intercostals space blind liver biopsies were performed by TruCut biopsy needle. The study was conducted at Gafaar Ibn Oaf Specialized Children Hospital; Khartoum Sudan; over the last five years; between January 2005-January 2010. Results: The first biopsy sample was considered macroscopically adequate in 94.8of cases. A years of age and of these 8 (11.4) complained of pain at the biopsy site; external hemorrhage from the biopsy site was seen in 1 (0.6) case but no sign of internal hemorrhage was detected during the 24 hours follow up period. No child died following the procedure. Conclusions: Blind liver biopsy in the studied hospitalized children was found to be a safe procedure

Pattern of Liver Diseases in Sudanese Children

We aimed at determining the pattern and the incidence of liver disease in the Sudanese children referred to the Gastroenterology unit as Gaafar Ibn Oaf Specialized Children Hospital; which has not been studied before. Materials and Methods: In a cross-sectional study conducted over 5 years; 450 liver needle biopsies were sent to the pathology laboratory of our center. Slides were prepared from paraffinembedded blocks; stained by routine H et E and special stains and were then reviewed. The frequency of each disorder; separately and in combination with the age group or gender of the patient were compared with other similar studies. Results: The male to female ratio was 1.5:1.The age range between 1 month and 15 years old and 42were less than 1 year old. The most common histological diagnosis was liver cirrhosis where no specific cause could be found (26) followed by neonatal hepatitis(20);fatty liver(12);Billary Atresia(10);chronic hepatitis(8); metabolic liver disease (6); Progressive Intrahepatic Cholestasis (5.5); non specific pathological changes (4.4) and Hepato Cellular Carcinoma in(4). Conclusion: A liver biopsy is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. We found that Idiopathic Liver Cirrhosis; Neonatal Hepatitis; Fatty Liver; Billary Atresia and Chronic Hepatitis in the stated order are the most prevalent histological diagnosis in Sudanese children. Hepatocellular Carcinoma is significantly high in our pediatrics population

Serum Resistin Levels in Nonalcoholic Fatty Liver Disease and their Relationship to Severity of Liver Disease

Background: Resistin is a hormone that is linked to the development of insulin resistance (IR); but information on the direct relationship of resistin levels in humans with nonalcoholic fatty liver disease (NAFLD); and their effect on the histological severity of NAFLD; is lacking. Objective: The aim of the current study is to determine the circulating resistin levels obtained from patients with NAFLD and to correlate them with insulin resistance and hepatic histological features. Methods: Blood samples were collected from 30 consecutive patients with liver-biopsy-proven NAFLD and 30 subjects as controls. Serum resistin levels were measured. Body mass index (BMI) was calculated for all subjects; and serum insulin; C-peptide; and lipoprotein levels were also measured. Results: Mean serum resistin level and BMI in the NAFLD group were significantly higher than in the controls (both P 0.001). Both men and women in the NAFLD group had higher mean serum resistin levels than did the men and women in the control group (all P 0.001). Multivariate analysis showed that the percentage of hepatic steatosis; sex; BMI; and homeostasis model assessment of insulin resistance [HOMA(IR)] were related to serum resistin levels. Conclusion: These data suggest increased resistin levels in NAFLD patients which are related to histological severity of the disease. These findings support the link between resistin; insulin resistance and BMI in these patients

The modulatory effect of cochlospermum tinctorium a rich aqueous root extract on liver damage induced by carbon tetrachloride in rats

The aqueous root extract of Cochlospermum tinctorium (CTR) was investigated for its phytochemical composition; acute oral toxicity and hepatoprotective effect on carbon tetrachloride (CCl4) induced liver damage in rats. Phytochemical screening indicates the presence of alkaloids; tannins; cardiac glycosides; saponins; flavonoids; triterpenes; cyanogenic glycosides and volatile oils while steroids and anthraquinones were absent. Administration of 5000 mg/kg (body weight) of the extract orally did not produce any death in the rats within the observable period. The extract at 100 - 300 mg/kg (body weight) significantly and dose dependently reduced the levels of Alanine aminotransferase (ALT); Aspartate aminotransferase (AST) and Alkaline phosphatase (ALP) enzymes levels in the CCl4 -treated rats. The values of serum albumin; serum total protein and reduced glutathione in the extract treated groups of rats remained comparatively higher than its values in the CCl4 - treated group. The pretreatment of the rats with the extract produced a significant (P 0.05) reduction in blood clotting time. The histopathological findings were in support of the biochemical changes recorded during the study. These results suggest that aqueous root extract of CTR possess hepatoprotective effect against CCl4- induced liver damage in rats and the extract at 5000 mg/kg body weight appeared to be safe when administered orally

The Spectrum of Liver Diseases in HIV Infected Individuals at an HIV Treatment Clinic in Kampala; Uganda

Background: Liver diseases are common in patients with HIV due to viral hepatitis B and C co-infections; opportunistic infections or malignancies; antiretroviral drugs and drugs for opportunistic infections. Objective: To describe the spectrum of liver diseases in HIV-infected patients attending an HIV clinic in Kampala; Uganda. Method: Consecutive patients presenting with jaundice; right upper quadrant pain with fever or malaise; ascites and/or tender hepatomegaly were recruited and underwent investigations to evaluate the cause of their liver disease. Results: Seventy-seven consecutive patients were recruited over an eleven month period. Of these; 23 (30) had increased transaminases because of nevirapine (NVP) and/or isoniazid (INH) hepatotoxicity. Although 14 (61) patients with drug-induced liver disease presented with jaundice; all recovered with drug discontinuation. Hepatitis B surface antigen was positive in 11 (15) patients while anti-hepatitis C antibody was reactive in only 2 (3). Probable granulomatous hepatitis due to tuberculosis was diagnosed in 7 (9) patients and all responded to anti-TB therapy. Other diagnoses included alcoholic liver disease; AIDS cholangiopathy; hepatocellular carcinoma; schistosomiasis; haemangioma and hepatic adenoma. Twelve (16) patients died during follow-up of which 7 (9) died because of liver disease. Conclusion: Drug history; liver enzyme studies; ultrasound; and hepatitis B and C investigations identified the probable etiology in 60 (78) of 77 patients with HIV infection presenting with symptoms and/or signs of liver disease

Diabetes Co-existing with Chronic Liver Disease : Clinical Features and Reponse to Therapy

Background and objectives : Diabetes mellitus (DM) and chronic liver disease (cirrhosis) may co-exist in the same individual. Diabetes may cause non-alcoholic steatohepatitis with necroinflammatory changes and granuloma formation leading to hepatic fibrosis. Cirrhosis of the liver from alcohol and hepatitis C infection; on the other hand; may give rise to insulin resistance or may result in progressive impairment of insulin secretion leading to DM. We studied the clinical features and response to therapy of diabetic patients with the two conditions to determine if there are differences in the clinical features and effects of the chronic liver disease (CLD) on the management of DM. Methods: This was a prospective study conducted at the Diabetes Clinic at the Jos University Teaching Hospital (JUTH) over a period of two years. Newly diagnosed diabetics with features of CLD (cirrhosis) were enrolled into the study after obtaining a consent. Age; sex; body mass index (BMI); family history of diabetes were recorded; as well as symptoms and signs of DM or CLD. Serum fasting blood glucose (FBS); prothrombin time ratio (PTR); and serum fasting lipids (serum lipoproteins and serum triglycerides) were measured. Urinalysis was done. The responses to therapy were classified as very rapid; rapid and gradual based on our previous unpublished observations that diabetic patients with CLD responded briskly to antidiabetes therapy. Result : 26 patients (19 men; and 7 women) were seen with both diseases agreed to participate in the study. This accounted for 8.6of the diabetic population attending the diabetes clinic. The mean age of the patients was 54.6 (9.2 ) years spanning a range of 34-75 years. Mean BMI was 21.6 (6) kg/m2. The mean serum albumin concentration was 25.5 (8.5) g/l; mean FBS was 15.5 (3.4) mmol/l and PTR was 1.6 (0.43). Urinalysis showed glycosuriain all patients with only one patient showing trace of ketonuria. Clinical features of DM and CLD were few each. There was a brisk response to insulin therapy so that one needs to be cautious with insulin administration.Conclusion : Diabetes in patients with CLD has similar but fewer features compared to patients with type 2 DM. CLD affects the response to therapy; particularly insulintherapy and calls for caution; as these patients may be sensitive to therapy

Profil de la pathologie hepatique observee en echographie a l'Hopital Saint Joseph de Kinshasa

Ce travail presente la part respective des pathologies hepatiques observees en echographie a l'Hopital Saint Joseph de Limete/Kinshasa de janvier 1995 a octobre 1996. La cirrhose et les hepatomegalies non-specifiques sont les anomalies les plus frequemment rencontrees; suivies du cancer primitif. Les abces hepatiques; essentiellement amibiens; viennent en 4e position apres la steatose. Les autres lesions (metastases; kystes; angiomes;...) sont faiblement represente. Compte tenu de la frequence elevee de cirrhose et du cancer primitif; l'auteur formule le souhait d'une vaccination quasi-systematique contre le virus de l'hepatite B

Nutritional status and levels of liver enzymes in Ghanaian alcoholics

The well nourished alcoholics appeared to have some protection from alcoholic liver damage; although their fat levels were higher which may predispose to cardiac disease. Alcoholics therefore; show some degree of impaired liver function which is more severe among those who are malnourished