Post-COVID-19 cryptosporidiosis: A serious risk or mere association?

@#Post-COVID-19 conditions encompass a wide range of health problems, including enteritis, but their association with parasitic infections has not yet been investigated. This study analyzed gastrointestinal symptoms, medical histories, fecal Cryptosporidium oocysts, and the history of COVID-19 infection in patients who attended the Faculty of Medicine, Cairo University, from January to July 2021. Fecal biomarkers, including H. pylori, occult blood, fecal calprotectin (FCAL), and TNF-a, were measured, and Cryptosporidium spp. genotypes were molecularly characterized among post-COVID-19 patients using RFLP. Preliminary results from 210 post-COVID-19 patients revealed that group 1 (Cryptosporidiumpositive) (n = 49) and group 2 (Cryptosporidium-negative) (n = 161) showed no significant difference in the prevalence rate of diabetes mellitus (DM). While group 2 was linked to diarrhea, only infections with Cryptosporidium post-COVID-19 were related to chronic diarrhea, vomiting, and weight loss. A total of 220 healthy subjects served as negative controls. Administering azithromycin, hydroxychloroquine, and ivermectin was significantly related to an increased risk of Cryptosporidium infection in group 1, whereas only azithromycin was more frequently recorded in group 2. Antioxidant supplementation insignificantly affected the incidence of cryptosporidiosis. Cryptosporidiosis with a history of COVID-19 was linked to H. pylori infections, increased inflammatory biomarkers (FCAL and TNF-a), and occult blood when compared with group 2. Cryptosporidium genotype 1 was the most commonly occurring subset in individuals with post-COVID-19. The findings demonstrated that aggravating gastrointestinal manifestations, increased fecal biomarkers and anti-COVID-19 therapeutic interventions are significantly related to the existence of Cryptosporidium oocysts in patients with post-COVID-19, indicating the predominance of.

The common histopathological findings of colon biopsies in Northern Saudi Arabia

Background: Colorectal cancer is considered as the most prevalent cancer among men and the third mostfrequent cancer among women in Saudi Arabia. Consequently, we aimed to assess the commonhistopathological findings of colon biopsies in Northern Saudi Arabia. Methodology: This study hasinvestigated the histopathological diagnosis of 88 patients subjected for colon and small intestine biopsies, theirages ranging from 18 to 99 years with a mean age of 48 years old at the Department of Pathology at KingKhalid Hospital, Hail, Northern Saudi Arabia. Results: Out of the 88 patients, 53(60.2%) were males and35(39.8%) were females. Diagnoses were reached in 77/88(87.5%) of the patients and could not be ascertainedin 11/88(12.5%). Adenocarcinoma was diagnosed in 10/77(13%) of the patients (9/10(90%) in colon-site and1/9(10%) in the small intestine. Conclusion: Colorectal precancerous and cancerous lesions are relativelyprevalent among patients referred to colorectal diagnostic biopsy. There is a substantial percentage ofinflammatory bowel cases among those referred to colorectal biopsies in Saudi Arabia.

value of Hetastarch in prophylaxis against renal impairment in cirrhotic patients with spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis [SBP] is an ominous complication of the late stage liver disease. Renal impairment in the course of SBP is a frequent event and constitutes the most important predictor of hospital mortality in these patients. Administration of intravenous albumin was applied for prevention of SBP related renal impairment and it reduced the incidence of renal impairment and mortality in comparison with treatment with antibiotic alone. Because albumin is expensive and not available in some settings, we worked to assess the possible use of Hetastarch and assess its beneficial effects in prevention of SBP related renal impairment. The present study was conducted on 60 patients with liver cirrhosis, ascites and SBP. The patients were divided into two groups: Group [1]: 30 subjects who received empirical antibiotic plus plasma expander for treatment of SBP and Group [2]: 30 subjects who received empirical antibiotic alone. The plasma expander chosen was Hetastarch [the colloidal solution hydroxyethyl starch [Haes-steril] in a dose of 500 cc every 8 hours/5 days [20 ml/kg B. wt/day] due to its relative less side effects on coagulation process. It was found that the administration of Hetastarch as a artificial plasma expander decreased renal impairment in patients with liver cirrhosis and spontaneous bacterial peritonitis. The incidence of renal impairment was significantly lower among patients treated with antibiotic therapy plus plasma expander [13.3%] than those treated with antibiotic alone [36.6%]. Patients received Hetastarch showed maintenance of renal function allover the follow up period, higher urine output, better renal profile than other group not treated by Hetastarch. We concluded that treatment with Hetastarch was safe and effective and it can be considered as an alternative to albumin in prophylaxis against renal impairment in cirrhotic patients with SBP

Treatment of hepatocellular carcinoma in cirrhotic patients: a prospective randomized study comparing radiofrequency and ethanol injection

Although surgery remains as a gold standard line for management of hepatocellular carcinoma [HCC], many cases are not candidates for surgery due to underlying chronic liver disease and limited functional reserve even with recent advances in the field of surgery. At the same time several local ablative techniques have emerged and proved to be minimally invasive and effective measures for in situ control of HCC, of these techniques, radiofrequency ablation [RFA], and percutaneous ethanol injection [PEI]. The aim of the current study was to evaluate the safety and efficacy of RFA and ethanol injection for the treatment of HCC, to reach a protocol for proper management of unresectable HCC and, also to assess the quality of life before and after each technique. In the current study we had two groups of patients with HCC on top of cirrhosis due to hepatitis C virus [HCV] infection, one of them was subjected to RFA [G 1] and the other [G2] was subjected to PEI as therapeutic modalities for their HCC. As regards GI, it included 30 patients with 36 HCC lesions with a mean size of 3.02 cm which were treated by percutaneous US guided RFA using cooled-tip electrodes with a mean of 1-2 sessions of RFA. Studied patients were followed over variable periods that ranged between 6-18 months with a mean of 11.6 months. The responses to therapy were as follows: Complete ablation in 32 out of 36 lesions [88.8%], partial response in 3 out of 36 lesions [8.3%], recurrence in 3 [8.3%] lesions, and newly developed lesions in 7 cases. G2 included 20 patients with 26 HCC lesions with a mean size of 3cm for which we used PEI modality, we found that 21 out of 26 lesions [80.7%] had complete response, 4 out of 26[15.3%] had partial response and one [3.8%] showed local recurrence, and newly developed lesions were seen in 5 cases. The period of follow up ranged from 4-12 months with a mean of 10 months. As regards survival, one year survival rate was 75% in GI and 80% in G2. We concluded that, both RFA and PEI are safe and effective procedures and result in significant improvement in quality of life in patients with unresectable HCC. RFA showed higher rate of complete necrosis and requires fewer sessions than PET in the management of HCC

Comparative study between endoscopic band ligation, alcohol injection and cyanoacrylate injection in management of gastric varices

Haemorrhage from gastric varices [GV] is a serious complication of portal hypertension. The role of endoscopy in the management of gastric varices is still controversial, but the efficacy in management of bleeding oesophageal varices has been greatly enhanced, so, rebleeding rate has been reduced by injection sclerotherapy or band ligation. On the other hand, the management of gastric varices is still a great challenge for endoscopists as traditional methods as vasoconstrictors and balloon tamponade don't effectively reduce the rebleeding rate. The aim of our work was to compare three different endoscopic methods in the management of type I and II gastric varices: [I] gastric variceal obturation using cyanoacrylate, [II] gastric variceal sclerotherapy using absolute alcohol and [III] gastric variceal ligation by rubber [O] bands. The comparison regards the technical ease, efficacy, complications and number of sessions needed to eradicate varices. To fulfill this aim we studied 60 patients with chronic liver disease and gastric varices presented to the central endoscopy unit Ain Shams University Hospital. The patients were categorized into [3] groups: Group I included 20 patients who underwent GV obturation using cyanoacrylate, group II included 20 patients who underwent GV sclerotherapy using alcohol injection, and group III included 20 patients who underwent GV band ligation. All patients were age and sex matched. We excluded patients with type III GV, hepatic encephalopathy, hepatocellular carcinoma and prior history of sclerotherapy, band ligation or shunt operation. Our results showed that, cyanoacrylate obturation of gastric varices was more effective in controlling gastric variceal bleeding than other methods with low number of sessions and low rebleeding rate than G.V. Ligation or alcohol injection. So we conclude that gastric variceal obturation by cyanoacrylate proved more effective and safer than gastric variceal ligation or injection sclerotherapy using absolute alcohol in the management of type I and II gastric varices

Cystopericystectomy for treatment of hydatid disease of the liver: a prospective randomized study

Surgical intervention remains the principal form of definitive treatment of liver echinococcosis. The aim of this report is to evaluate the technique of cystopericystectomy for treatment of liver hydatid disease, comparing the results of this technique with the traditional surgical technique of cyst evacuation. Method: Twenty three patients with hydatid disease of the liver were randomized into two groups. Twelve cases were managed by cystopericystectomy and compared with 11 cases managed by the more conservative technique of cyst evacuation. Thoracic x-ray, abdominal ultrasound and computed tomography had been performed previously. The following aspects were considered as selection criteria: Cyst located in segments III, IV, V, VI and VIII; and no evidence of infection or calcification. Cystopericystecomy was total closed cystopericystectomy [n=6], total open cystopericystectomy[n=4], and subtotal cystopericystectomy[n=2]. All patients were treated with oral albemdazole for two months after surgery. The mean operation time, blood transfusion, hospital stay and any evidence of hydatid recurrence we measured and statistical analysis was done. Result: Surgery was performed on 23 patients with liver hydatid disease [12 women and 11 men] with a mean age of 44.9 years [range, 22-83 years], the mean diameter of liver cyst was 7.6 cm [range, 5-12 cm]. The mean [s.d] operration time was 186.3 +/- 35.2 minutes in the group of cystopericystectomy, and it was 145.4 +/- 24.6 minutes in the traditional surgical technique of cyst evacuation, and the difference was statistically significant [P<0.05]. Blood transfusion was required in 5 patients [41.6%] in the group of cystopericystectomy, and in 2 patients [18.2%] in the traditional technique of cyst evacuation, and the difference was not statistically significant [P>0.05]. Hospital stay was 11.3 +/- 4.1 days in cystopericystectomy group and 12.1 +/- 4.6 days in the traditional techique of cyst evacuation, with no difference between the two groups. During a mean follow - up period of 18 months [range, 12-30 months], no mortality was verified. The incidence of postoperative complications was 8.3% in the group randomized to cystopericystectomy and it was 18.2% in the group randomized to cyst evacuatin. Recurrence of hydatid disease was observed in one patient [9.1%] in the group treated by cyst evacuation, but no recurrence was observed in cystopericystectomy. The technique of cystopericystectomy is a valuable alternative to the more conservative technique of cyst evacuation in selective cases. The results of cystopericystectomy are comparable with the results of conservative surgical technique, with a lower incidence of morbidity and recurrence of hydatid disease in cystopericystectomy when compared with the traditional more conservative surgical technique of cyst evacuation

Resistive index as a predictor of kidney dysfunction and hepatorenal syndrome in different stages of liver cirrhosis

Renal hemodynamic changes begin early in the course of liver disease-related functional kidney failure The hallmark - change is intense intra-renal vasoconstnction associated with reduced renal blood flow and elevated renal arterial vascular resistance. Nitric oxide has been proposed to constitute a mediator of both the hyperdynamic circulation and renal failure in patients with advanced hepatic disease. The aim of this study was to evaluate the renal hemodynamic changes by renal duplex Doppler ultrasound and nitric oxide as predictors of kidney dysfunction and hepatorenal syndrome [HRS] in patients with liver cirrhosis. Twenty five patients with liver cirrhosis without ascites, 25 patients had liver cirrhosis with ascites, 25 patients with HRS and, 25 patients with end stage renal disease [ESRD] without liver disease, and 25 normal subjects as control group were enrolled in this study, they were age and sex matched. All the participants were subjected to lull medical history clinical examination, routine investigations, in addition to duplex Doppler ultrasound on the intra-renal arteries to detect the resistive index [RI] and measurement of the stable end product of nitric oxide [serum nitrate]. The highest values of RI of intra renal arteries and serum nitric oxide were found in patients with ESRD. RI of intra-renal arteries and serum nitric oxide levels were significantly higher in patients with HRS than in cirrhotic patients [ascitic and non ascitic] and control group. Also our study revealed that RI and serum nitric oxide were significantly higher in the non ascitic phase of liver cirrhosis than normal control group but increased more with the development of ascites, and reached higher value in patients with HRS. The study revealed a highly significant direct correlation between serum nitric oxide and RI of intra-renal arteries among the studied cirrhotic patients. An increased renal RI can predict development of HRS independent of liver disease severity and is better predictor than the individual parameters of the child-Pugh classifications