ABSTRACT
Purpose@#The outcome predictors of Kasai portoenterostomy (KPE) for biliary atresia (BA) are controversial. This study aimed to identify possible short-term outcome predictors of KPE for BA in infants. @*Methods@#This retrospective study included infants with BA who underwent KPE between January 2015 and December 2017 and were followed up for at least 6 months after surgery at the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Egypt. The short-term outcome was jaundice clearance within 6 months following surgery. All data were compared between the jaundice free group and those with persistent jaundice to identify the predictors of jaundice clearance. @*Results@#The study included 75 infants. The mean age at the time of surgery was 82.43±22.77 days (range, 37–150 days), and 28 (37.3%) infants cleared their jaundice within 6 months postoperative. Age at surgery did not significantly affect the outcome (p=0.518). Infants with persistent jaundice had significantly higher pre-operative levels of aspartate aminotransferase (AST) than those who were jaundice free (p=0.041). Receiver operating characteristic curve analysis showed that preoperative AST ≤180 IU/L was predictive of a successful KPE, with sensitivity 74.5% and specificity 60.7%. Infants with bile plugs in liver biopsy had a 6-fold higher risk of persistent jaundice than those without bile plugs (95% confidence interval: 1.59–20.75, p=0.008). @*Conclusion@#Jaundice clearance after KPE for BA can be predicted using preoperative AST and presence of bile plugs in liver biopsy.
ABSTRACT
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
ABSTRACT
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
ABSTRACT
Background and study aims: Chronic infection caused by Helicobacter pylori [H. pylori] is associated with chronic gastritis, peptic ulcer disease, and gastric cancer. Eradication of H. pylori reduces morbidity of chronic gastritis and incidence of gastric cancer in high-risk population. We aimed at testing the efficacy of clarithromycin-based triple therapy and bismuth-based quadruple therapy for eradicating H. pylori in patients with chronic gastritis in Kuwait
Patients and methods: A total of 218 dyspeptic patients from different countries who were proved to have chronic gastritis by endoscopy and gastric biopsy were enroled. All of them were naïve to H. pylori eradication therapy. They were randomised into two groups: group A, received triple therapy [omeprazole, amoxicillin, and clarithromycin] for 10 days, and group B, received quadruple therapy [omeprazole, bismuth subcitrate potassium, tetracycline, and metronidazole] for 10 days. All patients were tested for eradication of H. pylori by carbon-13 urea breath test 4 weeks after treatment
Results: Total response rate of eradication therapy in both groups was 77.5% [n = 169]. However, group B [n = 100] had a higher eradication rate [88%] than group A [n = 118] [68.6%]. H. pylori eradication rate was significantly higher in males [84.2%] than females [70.2%] in both groups [p < 0.01]. There were no differences in eradication rates with regard to median age or nationality
Conclusion: Bismuth-based quadruple therapy is more effective as a first-line therapy than clarithromycin-based triple therapy for eradicating H. pylori in patients with H. pylori-related chronic gastritis in Kuwait