Herpes Zoster reactivation in patients with chronic hepatitis C under treatment with directly acting antiviral agents: a case series

We report a series of cutaneous Herpes Zoster [HZ] reactivation cases in patients with hepatitis C virus [HCV] infection treated with directly acting antiviral [DAA] agents. Five cases were detected among 2133 treated patients with DAAs at one of the specialized viral hepatitis treatment centers in Egypt. A control group including 2300 age and sex matched HCV patients who were previously treated with pegylated interferon and ribavirin did not show any HZ reactivation reports while on treatment. None of cases had an evidence of immunosuppression or a risk factor for HZ reactivation. The DAAs used regimens were sofosbuvir/daclatasvir in 4 cases and sofosbuvir/simeprevir in one case. HCV clearance with antiviral therapy may bring immune changes causing reactivation of other latent viral infections like HZ. A high index of clinical suspicion may be needed to guarantee early and prompt management of such cases

Establishing ultrasound based transient elastography cutoffs for different stages of hepatic fibrosis and cirrhosis in Egyptian chronic hepatitis C patients

Background and study aim: transient elastography is widely used to assess fibrosis stage in chronic hepatitis C [CHC]. We aimed to establish and validate different transient elastography cut-off values for significant fibrosis and cirrhosis in CHC genotype 4 patients

Patients and Methods: the data of 100 treatment-naive CHC patients [training set] and 652 patients [validation set] were analysed. The patients were subjected to routine pretreatment laboratory investigations, liver biopsy and histopathological staging of hepatic fibrosis according to the METAVIR scoring system. Transient elastography was performed before and in the same week as liver biopsy using FibroScan [Echosens, Paris, France]. Transient elastography results were correlated to different stages of hepatic fibrosis in both the training and validation sets

Results: ROC curves were constructed. In the training set, the best transient elastography cut-off values for significant hepatic fibrosis [>/=F2 METAVIR], advanced hepatic fibrosis [>/=F3 METAVIR] and cirrhosis [F4 METAVIR] were 7.1, 9 and 12.2 kPa, with sensitivities of 87%, 87.5% and 90.9% and specificities of 100%, 99.9% and 99.9%, respectively. The application of these cut-offs in the validation set showed sensitivities of 85.5%, 82.8% and 92% and specificities of 86%, 89.4% and 99.01% for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, respectively

Conclusion: transient elastography performs well for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, with validated cut-offs of 7.1, 9 and 12.2 kPa, respectively, in genotype 4 CHC patients

FibroScan, APRI, FIB4, and GUCI: Role in prediction of fibrosis and response to therapy in Egyptian patients with HCV infection

Background and study aims: Multiple noninvasive methods have been used successfully in the prediction of fibrosis. However, their role in the prediction of response to hepatitis C virus [HCV] antiviral therapy is debatable. The aim of this study was to validate and compare the diagnostic performance of FibroScan, APRl [aspartate aminotransferase [AST]-to-platelet ratio index], FIB4, and GUCI [Goteborg University Cirrhosis Index] for the prediction of hepatic fibrosis and treatment outcome in HCV-infected patients receiving pegylated interferon and ribavirin [PEG-IFN/ribavirin]

Patients and methods: this study included 182 Egyptian patients with chronic HCV infection. They were classified into two groups based on the stages of fibrosis: mild to significant fibrosis [F1-F2] and advanved fibrosis [F3-F4]. The APRI, FIB4, and GUCI scores were calculated before the antiviral treatment. The FibroScan was performed for all patients before treatment

Results: stiffness and FIB4 have greater sensitivity and specificity in detecting advanced fibrosis of 80%, 77% and 88%, 84%, respectively. Based on multivariate regression analysis, FIB4, body mass index [BMI], and alpha-fetoprotein [AFP] level were found to be statistically significant predicators of advanced fibrosis [p-value: 0.000, 0.011, and 0.001, respectively] with odds ratio [OR: 3.184, 1.170, and 1.241, respectively]. With respect to virological response, the stiffness, APRI, FIB4, and GUCI were significantly lower in sustained virological responders. However, these are not good predictors of response to PEG-IFN/ribavirin therapy. AFP was the only statistically significant predictor of response [p = 0.002] with OR of 1.141 in multivariate regression analysis

Conclution: FibroScan and noninvasive scores such as APRI, FIB4, and GUCI can be used as good predictors of liver fibrosis in chronic hepatitis C. However, they are not good predictors of response to PEG-IFN/ribavirin therapy

Relation of ALT and AST levels to the histopathological changes in liver biopsies of patients with chronic hepatitis C genotype 4

Worldwide, Egypt has a high prevalence of adult hepatitis C virus [HCV] infection. Serum alanine aminotransferase [ALT] activity is most commonly measured to assess hepatic disease. The revision of the definition of the normal limits for the ALT level is advisable. The aim of this work was to compare the histopathological changes in the liver tissue biopsies of HCV-infected patients, clinically presenting with ALT levels below normal, based on the conventional, previously used upper limit of normal [ULN] of ALT [40 U/L for men and 30 U/L for women] with the proposed new ULN [30 U/L for men, and 19 U/L for women]. This is a retrospective cross-sectional study. A total of 668 cases of chronic hepatitis C genotype 4 were included. Patients were classified according to grades of histological activity and fibrosis stages [by the Metavir scoring system]. They were also classified into normal and high groups according to the old and new cutoffs of both aspartate transaminase [AST] and ALT levels.The results of our study showed that the serum AST level in our study showed a better correlation with the histopathological changes in liver biopsy rather than ALT, especially when using the old cutoff of the ULN for AST. The serum ALT level in our study [both the old and the new cutoffs] did not show a significant correlation with the histopathological status in the liver biopsies of our patients. This study concluded that the old cutoff of the ULN AST is a better predictor of fibrosis

Epstein-Barr virus and Interleukin-28B polymorphism in the prediction of response to interferon therapy in hepatitis C patients

Background and study aims: In chronic hepatitis C virus [HCV], viral and host factors are known to be predictors for anti-viral therapy. IL-28B genotype strongly influences treatment outcome, while Epstein-Barr virus [EBV] co-infection could accelerate the course of chronic HCV infection. This study was conducted to assess whether EBV co-infection adds to the predictive value of IL-28B

Patients and methods: A total of 105 patients with chronic HCV were classified according to their response to treatment into two groups: 38 sustained virological responders [SVRs] and 67 nonresponders [NRs]. Collected sera at baseline and follow-up [FUP] were used for assessing EBV antibodies by enzyme-linked immunosorbent assay [ELISA] and the expression of EBV genes [BNLF-1, BZLF-1, and EBER-2] by polymerase chain reaction [PCR]. Collected peripheral blood was used for detecting IL-28B rs.12979860 single-nucleotide polymorphism

Results: Regarding IL-28B genotype frequencies, a significant difference [p = 0.003] was observed between SVRs [C/C = 51.4%, C/T = 48.6%, T/T = 0%] and NRs [C/C = 25%, C/T = 55%, T/T = 20%]. On assessing EBV infection at baseline and FUP, it was found that 61% and 55% were positive, respectively, with no significant difference between SVRs and NRs. As for anti-viral capsid antigen [VCA] antibodies, the NRs had significantly higher baseline anti-VCA immunoglobulin M [IgM] levels than SVRs [p = 0.01]. While FUP anti-Epstein-Barr nuclear antigen-1 [EBNA-1] IgG reported a significant decline within SVR patients [p = 0.02], neither baseline nor FUP anti-VCA IgG levels showed a statistically significant viral response. Finally, on comparing EBV markers with CC versus CT and TT genotypes, it was found that FUP anti-VCA IgG levels were significantly increased in CC genotype [p = 0.003]

Conclusion: Interleukin-28B polymorphism could be a possible predictor of response to pegylated interferon/ribavirin therapy [PEG-IFN/RBV]. Furthermore, co-infection with EBV did not affect the response to IFN-based therapy in HCV-infected patients

A Polymorphism in the Microsomal Triglyceride Transfer Protein Can Predict the Response to Antiviral Therapy in Egyptian Patients with Chronic Hepatitis C Virus Genotype 4 Infection

BACKGROUND/AIMS: A polymorphism in the microsomal triglyceride transfer protein (MTP) is associated with hepatic fibrosis, and carriers showed higher levels of steatosis, higher levels of hepatitis C virus (HCV) RNA and advanced fibrosis. The aim of this study was to study MTP expression pattern in HCV patients and impact of the MTP polymorphism on the response to antiviral therapy. METHODS: One hundred consecutive naive HCV genotype 4 patients were recruited to receive antiviral therapy, and 40 control subjects were also recruited. Demographic, laboratory, and histopathology data were collected. DNA was isolated, and the samples were subjected to polymerase chain reaction analysis and genotyping for MTP by restriction fragment length polymorphism analysis. RESULTS: Patients and controls were age- and sex-matched (male/female, 56/44, age, 39.2+/-7.8 years for patients with HCV; male/female, 18/22, age, 38.1+/-8.1 years for controls). MTP single nucleotide polymorphisms (SNPs) (GG, GT, TT) and alleles (G, T) in the patients versus the controls were 70%, 21%, 9% & 80.5%, 19.5% versus 10%, 87.5%, 2.5% & 53.8%, 46.3%, respectively (p=0.0001). The sustained viral response (SVR) of the patients was 60%. SNPs in MTP genotypes (GG, GT, and TT) and alleles (G and T) in the responders and nonresponders were 71.7%, 25%, 3.3% & 84.2%, 15.8% versus 67.5%, 15%, 17.5% & 75%, 25% (p=0.038 and p=0.109, respectively). A multivariate analysis showed that the GT genotype was an independent predictor of SVR (area under the curve 90% and p=0.0001). CONCLUSIONS: MTP could be a new predictor for SVR to antiviral therapy in patients with HCV genotype 4 infection.

Response and seroconversion rates among HBeAg-positive chronic HBV Egyptian patients treated with peginterferon alpha 2a [Pegasys], a single-centre experience

We aimed to evaluate the therapeutic efficacy of pegylated interferon alpha- 2a 180 micro g as a treatment for hepatitis B 'e' antigen [HBeAg]-positive genotype D chronic hepatitis B patients. Thirty patients attending the outpatient clinic at the National Hepatology and Tropical Medicine Research Institute were treated with peg.interferon alpha-2a [180 micro g] weekly for a period of 48 weeks. Pre-enrolment assessment was performed through biochemical, serological and quantitative HBV DNA testing. Liver biopsy was performed in all patients. Evaluation was done at weeks 12, 24 and 48 of treatment by liver enzymes, complete blood count [CBC], HBeAg /HBeAb and quantitative HBV DNA testing. At the end of 48 weeks of treatment only three cases [10%] of the study population showed HBeAg seroconversion and an undetectable HBV DNA level. None of responders exhibited hepatitis B surface antigen [HbsAg] loss. There were five [16.7%] primary non-responders, four [13.3%] relapses, four [13.3%] cases flared at week 12, and 14 [46.6%] cases who were non-responders. No specific predictors of response could be identified among patients. One year of peg. interferon alpha-2a 180 microgm weekly led to HBeAg seroconversion and an undetectable HBV DNA level in 10% of cases. Considering the privilege of a finite duration of treatment, tailoring of treatment and proper patient selection is of great importance in considering this therapy as a first line of treatment among HBeAg-positive chronic HBV Egyptian patients

Human schistosomiasis: clinical perspective: review

The clinical manifestations of schistosomiasis pass by acute, sub acute and chronic stages that mirror the immune response to infection. The later includes in succession innate, TH1 and TH2 adaptive stages, with an ultimate establishment of concomitant immunity. Some patients may also develop late complications, or suffer the sequelae of co-infection with other parasites, bacteria or viruses. Acute manifestations are species-independent; occur during the early stages of invasion and migration, where infection-naivety and the host's racial and genetic setting play a major role. Sub acute manifestations occur after maturity of the parasite and settlement in target organs. They are related to the formation of granulomata around eggs or dead worms, primarily in the lower urinary tract with Schistosoma haematobium, and the colon and rectum with Schistosoma mansoni, Schistosoma japonicum, Schistosoma intercalatum and Schistosoma mekongi infection. Secondary manifestations during this stage may occur in the kidneys, liver, lungs or other ectopic sites. Chronic morbidity is attributed to the healing of granulomata by fibrosis and calcification at the sites of oval entrapment, deposition of schistosomal antigen-antibody complexes in the renal glomeruli or the development of secondary amyloidosis. Malignancy may complicate the chronic lesions in the urinary bladder or colon. Co-infection with salmonella or hepatitis viruses B or C may confound the clinical picture of schistosomiasis, while the latter may have a negative impact on the course of other co-infections as malaria, leishmaniasis and HIV. Prevention of schistosomiasis is basically geared around education and periodic mass treatment, an effective vaccine being still experimental. Praziquantel is the drug of choice in the treatment of active infection by any species, with a cure rate of 80%. Other antischistosomal drugs include metrifonate for S. haematobium, oxamniquine for S. mansoni and Artemether and, possibly, Mirazid for both. Surgical treatment may be needed for fibrotic lesions

Hepatic and Intestinal Schistosomiasis: review

Schistosomiasis is an endemic disease in Egypt caused by the trematode Schistosoma which has different species. Hepatic schistosomiasis represents the best known form of chronic disease with a wide range of clinical manifestations. The pathogenesis of schistosomiasis is related to the host cellular immune response. This leads to granuloma formation and neo angiogenesis with subsequent periportal fibrosis manifested as portal hypertension, splenomegaly and esophageal varices. Intestinal schistosomiasis is another well identified form of chronic schistosomal affection. Egg deposition and granuloma formation eventually leads to acute then chronic schistosomal colitis and is commonly associated with polyp formation. It frequently presents as abdominal pain, diarrhea, tenesmus and anal pain. Definite diagnosis of schistosomiasis disease depends on microscopy and egg identification. Marked progress regarding serologic diagnosis occurred with development of recent PCR techniques that can confirm schistosomal affection at any stage. Many antischistosomal drugs have been described for treatment, praziquantel being the most safe and efficient drug. Still ongoing studies try to develop effective vaccines with identification of many target antigens. Preventive programs are highly needed to control the disease morbidity and to break the cycle of transmission

Hepatic fibrosis and serum alpha-fetoprotein [AFP] as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment

Elevated levels of alpha-fetoprotein [AFP] can be seen in patients with chronic hepatitis C [CHC] and liver cirrhosis without hepatocellular carcinoma and were negatively associated with treatment response. However, factors associated with its changes are not identified. We aimed in this study to verify a cut-off value for AFP as a predictor of response to standard of care [SOC] antiviral therapy in Egyptian chronic hepatitis C virus [HCV]-infected patients and identify factors associated with its changes post treatment. A total of 175 chronic non-cirrhotic HCV-infected patients were evaluated for baseline serum AFP and liver biopsy were classified according to Ishak scoring system of hepatic fibrosis. All patients were scheduled to receive SOC antiviral therapy for 48 weeks and had been followed up to week 72. Reassessment of AFP and repeated liver biopsy at week 72 were feasible only in 79 patients. High baseline AFP levels were observed in non-respondents [non-sustained virological respondents [non-SVRs]] [P< 0.01]; the AFP level decreased in all patients post treatment [P= 0.01], especially in the SVRs [P < 0.01]. In multivariate analysis, hepatic fibrosis was a predictor of response to treatment [P=0.02], while body mass index [BMI] [25-30 kg mr[2]], hepatic activity [A2], hepatic fibrosis stage [F2-F4] and fibrosis improvement were predictors of AFP difference [P = 0.007, 0.01, 0.012, <0.001, 0.030, and 0.018], respectively. The diagnostic performance to predict the HCV treatment response was best by adding both AFP and hepatic fibrosis stage factors; the best cut-off value for AFP was 3.57 ng dr1 with 50% sensitivity and 68% specificity with area under the curve [AUC] of 0.55 and for hepatic fibrosis stage was 3, with a sensitivity of 88%, a specificity of 30% with an AUC of 0.58. In chronic HCV-infected patients, serum AFP below 3.57 ng dl[-1] and hepatic fibrosis stage 3 are expected to have good response to treatment; BMI [25-30 kg m[-1]], A2, fibrosis >2 and fibrosis improvement predict AFP change post treatment

Fibroscan of chronic HCV patients coinfected with schistosomiasis

Both hepatitis C virus [HCV] and schistosomiasis are highly endemic in Egypt and coinfection is frequently encountered. Such coinfection is responsible for leading to a more severe liver disease. Hence, the aim of the study was to assess the fibroscan in chronic HCV patients coinfected with Schistosoma. This study included 231 chronic HCV patients. Routine pre-treatment work-up was done including anti-schistosomal antibodies. Liver stiffness measurements using fibroscan and reference needle-liver biopsy were done. Patients were categorised into two groups: HCV patients with positive schistosomal serology and HCV patients with negative schistosomal serology. Anti-schistosomal antibody was positive in 29% of the studied population. Positive schistosomal serology status was significantly associated with the disagreement between the results of liver biopsy [Metavir] and the fibroscan results [p value = 0.02], which was more obvious in F2 and F3 fibrosis stages. The sensitivity of fibroscan for the detection of the F2 stage decreased from 64% among negative schistosomal serology patients to 30.8% among positive schistosomal serology patients, and for the F3 stage it decreased from 43.8% to 21.4%, respectively. Multivariate logistic regression showed that fibrosis stages [FO-F1 and F4] were the most independent factors that were associated with the agreement between fibroscan and liver biopsy [odds ratio [OR] 3.4, 7.12 and p value <0.001, <0.001, respectively]. Although the sensitivity of fibroscan for the detection of fibrosis stages [F2 and F3] was impaired in patients with positive schistosomal serology, fibrosis stages [FO-F1 and F4] were the most independent factors associated with the agreement between fibroscan and liver biopsy

Doppler changes in chronic hepatitis C virus Egyptian patients with sustained virological response [SVR]

Duplex-doppler ultrasound is a non-invasive method for the assessment of hepatic haemodynamics beyond conventional gray-scale imaging. The clinical values of the methods used for the grading and staging of chronic hepatitis C virus [HCY] infection and the prediction of hepatic steatosis still have to be determined. Was to study the predictive value of pulse wave Doppler ultrasonography in Egyptian patients treated with interferon and Ribavirin through comparing the heamodynamics before and after treatment as well as the detection of the differences in Doppler parameters in IFN-SYR and IFN-NR patients. This study included 50 Hey patients treated with PEG-IFN and Ribavirin. Thirty six patients showed SYR while the remaining 14 patients were non responders. Real time abdominal ultrasonography was done with special concern on abdominal Doppler. Doppler was done by a single ultrasonographer pre and post treatment with special emphasis on liver heamodynamics [Portal vein diameter, Portal vein flow and mean velocities [PVPV] and [PVMV], portal vein circumference and area, hepatic artery resistance and pulsatility indices [HARI] and [HAPI], as well as splenic vein diameter, splenic artery resistance and pulsatility indices [SARI] and [SAPI]]. Hepatic veins phasicity: [triphasic, biphasic, or monophasic], congestion index [in cm/s], modified hepatic vascular index [in cm/s] [MHI], hepatic vascular index and portal hypetiension index were also measured. All the patients were treated by Pegylated interferon 180 microg/week and Ribavirin 13-15 mg/kg/day for 48 weeks [IfPCR still was positive after 24 weeks of treatment, treatment was discontinued, but the patient remained on follow up]. All patients in the study gave an informed consent. Liver biopsies were done for all patients prior to interferon therapy and at 72 weeks [6 months after the end of treatment] with histopathological grading according to METAYIR score. The chronic Hey infected patients in whom IFN and Ribavirin treatment resulted in complete response [SYR] showed that the mean PVPV was [17.59 +/- 5.79 cm/s] while post treatment was [16.39 +/- 3.76 cm/ s]. HAPI pre treatment was [1.77 +/- 0.7 cm/s], and post treatment was [1.62 +/- 0.46 cm/s], and the HARI pre treatment was [0.61 +/- 0.16 cm/s], while post treatment was [0.61 +/- 0.18 cm/s], with no statistical significant difference in the responder group, while the SVMV showed statistical significant difference pre [18.8 +/- 7.37 cm/s], and post treatment [15.2 +/- 4 cm/s]. Also the SVMV pre treatment was [14.7 +/- 5.71 cm/s], while post treatment was[12 +/- 3.74 cm/s], and this was statistically significant [p<0.05]. Pulse wave Doppler ultrasonography is an easy and non-invasive procedure for evaluating the chronic HCY liver disease, but not effective nor valid to estimate the effect and response to anti-viral therapy

Relationship between HCV infection and Insulin resistance in non-obese non-diabetic patients

Hepatitis C is a major cause of liver-related morbidity and mortality and represents a major public health problem in Egypt and worldwide. There is growing evidence as regard to the association between hepatitis C virus [HCV] infection and type 2 diabetes mellitus. However, the mutual link and related virological implication have not been fully clarified. Insulin resistance [IR] plays a primary role in the development of type 2 DM. This is supported by the results of prospective longitudinal studies showing that IR is the best predictor of the development of type 2 DM, preceding its onset by 10-20 years. To assess the correlation between HCV morbidity and Insulin resistance [IR] detected by HOMA test in none diabetic none obese HCV patients. The study participants were subcategorized into two groups,Group [I]: included 867 healthy subjects [negative HCV RNA] as a control group. Group [II]: included 277 patients with chronic HCV as a study group. The 2 groups were subjected to thorough history taking, full clinical examination, Anthropometric study,ultrasonographic examination and laboratory investigations including liver functions, viral markers, and qualitative PCR for HCV RNA ,lipid profile, glucose profile and HOMA test. This study revealed higher insulin resistance in the HCV study group than the control group

Detection of visceral adiposity by ultrasonography and its relation to insulin resistance in HCV patients

Hepatitis C is a major cause of liver-related morbidity and mortality and represents a major public health problem in Egypt and worldwide, Ultrasonography is a simple non-invasive method for detection of visceral fat, which is directly, correlated with insulin resistance [IR] as well as development of type 2 diabetes mellitus. To assess the validity of detection of visceral adipose tissue area with Ultrasonography and its correlation with IR in HCV patients. The study participants were subcategorized into two groups, Group [I]: included 867 healthy subjects with negative [HCV] RNA as a control group. Group [II]: included 277 patients with chronic HCV as a study group. The 2 groups were subjected to thorough history taking, full clinical examination, Anthropometric study,ultrasonographic examination and laboratory investigations including liver functions, viral markers, and qualitative PCR for HCV RNA ,lipid profile and glucose profile. This study revealed that Ultrasonography is a simple, non-invasive, safe method in detection of visceral adiposity, which is correlated significantly with IR in chronic HCV patients

Study of the enhancing effect of sodium chloride injection on radiofrequency ablation of hepatocellular carcinoma

One of the potential strategies to increase the efficacy of RFA is to modulate the biologic environment of the treated tissues. Several investigators have studied increasing RFA heating by combining intra-tumoral injections of different concentrations of sodium chloride with RFA. The aim of this study is to assess the enhancing effect of normal saline [NS] on radiofrequency ablation [RFA] of hepatocellular carcinoma [HCC] using a cool-tip needle. This study included 40 patients with HCC [proved by histopathology or combined spiral CT and elevated alpha-fetoprotein]. They were randomly divided into two groups [20 patients in each group]. The first group was treated with RFA preceded by intra-tumoral normal saline injection [RFA + S]; the second group was treated with RFA only [RFA]. The procedure was successful in all patients [100%] of the RFA + S group and in 11 [55%] of the RFA group [as proved by spiral CT or pathology]. This difference between the two procedures was statistically highly significant [P = <0.01]. No major complications occurred in either group. Combined RFA and normal saline is more effective than RFA alone. Considering the reduced cost and wide availability of isotonic saline together with the easy performance of the intra-tumoral injection, the dramatic improvement in therapeutic effect of RFA to 100% could be a breakthrough in future strategies to modernize the RFA technique

Quality of life of Egyptian donors after living-related liver transplantation

Quality of life after liver donation must remain a primary outcome measure when we consider the utility of living donor liver transplants. In making clinical decisions on the use of transplantation for chronic liver diseases, consideration should be given to the key factors likely to affect subsequent health related quality of life. It would be beneficial for donors, if factors predicting good quality of life are identified. The aim of this study was to assess the health related quality of life changes experienced by donors following living related liver transplantation using the Short Form 36 [SF-36] questionnaire. Between August 2001 and December 2006, 125 adults received liver grafts from living donors at Dar Al-Fouad Hospital, Cairo, Egypt. The SF-36v2 questionnaire was applied to 30 donors after at least 6 months following donation and maximally 4 years after donation [mean +/- SD:3.28 +/- 1.56 years]. Furthermore, 30 healthy volunteers were taken as a control group. None of the donors required re-surgery and no deaths were reported. Only 4 [13.3%] donors experienced minor complications, which did not affect their quality of life and had no long term effects. No significant difference was found between donors and control group when means of the Physical and Mental Component Summary were compared. The physical functioning domain was the only domain of health which showed a statistically significant difference between both groups. Health related quality of life of donors was not compromised after full recovery. All donors had good recovery and returned to regular activities within 2-4 months post donation

Towards an Egyptian guideline from screening to treatment of hepatocellular carcinoma [part I]

These recommendations provide a data-supported and based-evidenced approach to the screening, diagnosis, staging and treatment of Egyptian patients with hepatocellular carcinoma [HCC] in which we tried to construct an Egyptian algorithm for our Egyptian HCC patients in terms of type and timing of surveillance, readily available diagnostic tools that suit our means and the proper and efficient timely treatment that suits our resources. They are based on the experience of the authors in the specified topic and the AASLD Policy on the Development and Use of Practice Guidelines. These recommendations suggest preferred approaches to screening [for early detection of cases with hepatic nodule and/or elevated AFP], diagnosis [for accurate diagnosis of HCC cases], staging [for detection of specific category of treatment according the patient's general condition] and treatment [selection of the most suitable treatment option for the patient after his proper evaluation]. In an attempt to characterize the quality of evidence supported recommendations, the Egyptian Guidelines requires a category to be assigned and reported with each recommendation [Table I]