Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy

Background/Aims@#Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA. @*Methods@#We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed-upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology. @*Results@#We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications. @*Conclusions@#EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.

Assessment of fatigue in chronic hepatitis C Egyptian patients: relation to TNF-alpha, Leptin, IL-i and IL-6

Fatigue is a common symptom in chronic hepatitis C [CHC]; but it is not well understood and remains poorly investigated. One of the major obstacles to research is the highly non specific nature of fatigue. In 1994; the fatigue impact scale [FIS] was developed to improve our understanding of the effect of fatigue on quality of life. Recent attention has focused on the role of leptin and energy expenditure in chronic hepatitis C [CHC]. The importance of leptin in the regulation of energy balance, body composition and food intake has been demonstrated in both animal and human studies. 4herations in immune activation and cytokine release have been implicated in the occurrence of fatigue in CHC patients. The purpose of this study is to analyze fatigue in chronic hepatitis C Egyptian patients and to determine its relationship with the degree of underlying hepatitis, resting energy expenditure [PEE], circulating leptin and tumor necrosis factor-a [TNF-alpha], IL-1, and IL-6. Ninety patients were included in the study [61 males, 29 females], who were referred to the department of Tropical Medicine Al Hussein and Bab-Al-Sharyia University Hospitals during the period from March 2004 to March 2006. They were divided into two groups. Group I: 65 patients with chronic hepatitis C. Group II: 25 healthy persons, tested negative for hepatitis C [Control group]. All were submitted to history and clinical examination, liver function tests, HCV [Ab and PCR], the modified fatigue impact scale, resting energy expenditure, tumour necrosis factor [TNF-alpha], serum leptin. IL-alpha, and IL-6. FIS and REE, serum leptin, TNF-, IL-alpha and IL-6 were significantly elevated among HCV patients in comparison to controls. Fatigue didn't correlate with the degree of underlying hepatitis. Fatigue impact scale is a beneficial tool for subjective valuation of fatigue. Fatigue is present in CHC patients but it is not related to the degree of hepatitis. TNF-alpha, IL-1 and IL-6 may contribute partially to the occurrence of fatigue in these patients

Evaluation of the total hepatitis C virus core antigen assay in determining viraemia in Egyptian patients with chronic hepatitis C

Hepatitis C virus [HCV] is an important etiologic agent for chronic liver diseases in Egypt. Positivity of anti-HCV antibodies indicates past or current infection and in contrast to molecular detection of HCV-RNA does not give any indication about viral replication. Several problems still persist when RT-PCR is used for screening of patients. Recently, the availability of an anti-core antigen monoclonal antibody allowed development of an enzyme-linked immunosorbent assay [ELISA] detecting and quantifying total HCV core Ag [C-Ag] in peripheral blood of HCV-infected patients. The aim of this study is to evaluate the usefulness of the total HCV C-Ag in determining viremia compared to HCV-RNA detected by RT-PCR among anti-HCV positive Egyptian patients. In this study, 143 anti-HCV antibody positive patients were tested for HCV-RNA by PCR and HCV-Core antigen to evaluate the sensitivity and specificity of the latter. Among those 116 cases [81.11%] were HCV-RNA+ve and 111 [77.68] cases were HCV-Core Ag +ve, while 27 cases [18.84%] were HCV- RNA negative and 32[22.32%] were HCV-Core Ag -ve. Out of 116 patients who were HCV- RNA +ve, 111 [95.65%] were HCV-Core Ag +ve also, while 5 [4.35%] cases all with low viral load were negative. The sensitivity, specificity, PPV and NPV of HCV-Core Ag when referred to HCV-RNA were 95.7%, 100%, 100% and 84.4% respectively. Thus positive total HCV Core Ag could be a useful test in clinical practice to determine HCV viremia with a sensitivity and specificity close to that of PCR assays. However, a negative test is not reliable to exclude low viral load

Percutaneous ablation [radiofrequency and ethanol injection] versus hepatic resection in treatment of HCC in Egypt

Hepatocellular carcinoma [HCC] is common in Egypt due to the high prevalence of HCV infection and the intermediate prevalence of HBV infection. There is no unequivocal evidence to establish the first line treatment in patients with HCC and compensated cirrhosis and thus studies comparing the different options are needed. Is to compare the effectiveness of percutaneous ablation [PEI, RFA] versus hepatic resection in treatment of HCC patients. This study included 45 HCC patients subjected to medical history, clinical assessment and complete investigations. They were distributed randomly between 3 lines of therapy; Group [1]: 14 patients who underwent RFA, Group [2]: 15 patients who underwent PEI and Group [3]: 16 patients who underwent surgery. Follow up was done for 12 months. The mean age of the patients was 53.19 +/- 4.08 years, 34 [75.6%] were males and 11 [24.4%] were females. All patients came from slum or rural areas in Egypt with low socioeconomic status and 85.1% were smokers. Thirty six [80%] were HCV Ab positive, 5 [11.11%] HBs Ag positive and 4 [8.89%] negative for both markers. Rectal biopsy for Bilharzial ova was positive in 20 [44.44%] patients; 57.6% had cirrhosis, 29.2% had chronic hepatitis and 13.2% had normal liver parenchyma. The tumor was a solitary nodule in 41 [091.11%] patients, two or three nodules in 2 [4.45%] patients. A tumor with a diameter <3cms was found in 28 [62.2%] patients and between 3 and 5cm in 17 [37.8%] patients. The tumor was located in the right lobe in 33 [73.3%] patients and in the left lobe in 12 [26.7%] patients. Child's class A was found in 41 [90.9%] patients and 4 [9.1%] were Child's class B. The response rate between the three modalities of therapy [resection, RF or PEI] showed no statistical significance. There were minimal changes of liver function tests with no statistically significant difference between pre and post percutaneous ablation therapy [PEI, RFA]. The deterioration of liver function [increase in liver transaminases and decrease of serum albumin] and complications were statistically significantly higher in the surgically managed group compared to PEI and RFA groups. PEI showed lower complications than RFA or surgery. Both percutaneous ablation and surgical resection did not significantly differ in terms of efficacy, however, percutaneous ablation therapy showed no mortality and low rate of complications. The choice between either forms of percutaneous ablation should be individualized to every case according to the cost, tumor site and the availability of the therapeutic modality. Surgical resection should not he chosen as a therapy for HCC unless functional hepatic reserve allows it. More studies on large number of cases and follow up for at least five years are needed

Multidrug resistant typhoid fever in Egypt

Typhoid fever is a global health problem, with an estimated 20 million cases and 700.000 deaths annually. In Egypt, since the beginning of the 1980s, there has been an increase prevalence of multidrug resistance to the first line antimirobials, such as chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole [TMP-SMX], shifting the drug of choice for the treatment of typhoid fever to fl uoroquinolones and third generation cephalosporins. Was to detect if multidrug resistant [MDR] typhoid fever is still a problem in Egypt after two decades of its widespread. Also, we studied if resistance had appeared to quinolones and third generation cephalosporins which were widely used for treatment of typhoid fever in the last fi fteen years. In the period between March 2006 and March 2007, thirty seven patients with positive blood culture for Salmonella typhi were included in this study. They were 23 [62%] males and 14 [38%] females with age range from 3 to 45 years [mean 19 +/- 8.2 years]. Drug sensitivity tests showed that 34 [92%] of Salmonella typhi isolates were sensitive to chloramphenicol and 24 [65%] and 23 [62%] isolates were sensitive to ampicillin and TMPSMX, respectively. Only one [3%] isolate was MDR to chloramphenicol, ampicillin and TMP-SMX. All isolates were sensitive to ciprofl oxacin and ceftriaxone. Forteen [38%] patients were treated with chloramphenicol and twenty three [62%] patients were treated with ceftriaxone. All patients were cured. The mean time of defervescence for ceftriaxone and chloramphenicol was 3.7 +/- 1.2 and 5.8 +/- 1.2, respectively. Ceftriaxone was signifi cantly associated with a shorter time of defervescence compared with chloramphenicol. There is marked reduction of prevalence of MDR Salmonella typhi isolates and marked increase of susceptibility of these isolates to chloramphenicol, returning it to be one of the drugs of choice for treatment of acute typhoid fever. No drug resistance to ceftriaxone and ciprofloxacin was reported after many years of using for treatment of acute typhoid fever. Ceftriaxone was significantly associated with short time of defervescence making it the drug of choice for treatment of severe and complicated cases of typhoid fever. Due to high degree of resistance to ampicillin and TMP-SMX they should not be used as first line drugs for treatment of acute typhoid fever

protective role of anti-oxidant beta-carotene on schistosoma mansoni infected murine mice

Schistosomiasis is the second most prevalent tropical disease in the world after malaria and is caused by the Schistosoma, genus of fluke. The pathophysiology of schistosomiasis is due to the immune response against the schistosome eggs. The clinical manifestations depend on the species of parasite, intensity of worm burden, and immunity of the person to the parasite. Many trials were done for production of vaccine against infection of shistosomiasis and many efforts were spent to prevent infection, but the rate of new cases is still high. On the other hand, we need a methed to prevent or at least decrease the inflammatory reaction caused by schistosomiasis. This study aimed to the evaluation of possible protective effect of anti-oxidant beta-carotene on S.mansoni infected mice or decrease the inflammatory reaction caused by schistosomiasis. Sixty mice were included in this study and they were divided into 4 groups, every group is 15 mice: Group [1]: [treated infected group]; Group [2]: [treated noninfected group]; Group [3]: [infected group] and Group [4]: [normal control]. The results: b-carotene reduced worm burden to about 20%. Beta-carotene significantly reduced hepatic and intestinal tissue egg load with a reduction percentage of 26% and 18% respectively. Beta-carotene normalized the serum enzyme AST that were elevated by schistosomal infection. Beta-carotene did not significantly change serum proteins both in infected and non infected animals. Beta-carotene exerted immunomodulatory effects on inflammatory reaction of hepatic schistosoma reflected as significant reduction in mean cellular infiltration diameter, more circumscription and less inflammatory cellular content, as well as more inflammatory reaction changes in schistosomal ova. We recommended further studies to judge the protective efficacy of beta-carotene through histological study of animal skin and to judge its therapeutic efficacy if administered adjuvant with antibilharzial therapy

Role of bone mineral densimetry in chronic viral hepatits patients

A total of 40 patients [29 males and 11 females] aged between 12 and 80 years presented with chronic liver diseases was submitted to bone densitometry examinations. The patients were divided into three groups: Group 1 was composed of 15 cases with positive HCV chronic liver diseases, group 2 was composed of 15 cases with positive HBV chronic liver diseases and group 3 was composed of 10 cases of normal control subjects. Bone densitometry and dual- energy X-ray absorptiometry [DEXA] scan proved to be the most valuable technique for the assessment of osteoporosis in patients with chronic liver diseases

Study of some biochemical assays in serum and ascitic fluid for differentiation between cirrhotic and malignant ascites

The clinical diagnosis of ascites is an easy task but the etiological diagnosis of the type of ascites is occasionally a different problem. Many studies have investigated the possibility of using a single marker to detect cancer in ascitic patients; but no analysis of ascitic fluid including cytology has been shown to be specific and sufficiently sensitive for either hepatic or extrahepatic cancer. To evaluate the role of various biochemical parameters including cholesterol, LDH, total protein, albumin and glucose for the differentiation of cirrhotic ascites from malignancy related ascites, fifty ascitic patients were classified into three main groups: Group I: included 20 patients with cirrhotic ascites. Group II: included 15 ascitic patients with hepatocellular carcinoma on top of liver cirrhosis. Group III: included 15 ascitic patients with extrahepatic malignancy without liver cirrhosis. All patients were subjected to: clinical history and examination, various imaging, routine laboratory investigations, histopathological examination, cytological examination of ascitic fluid, and biochemical analysis of both serum and ascitic fluid. We found that, although cytological examination of ascitic fluid is specific, it is less sensitive than ascitic fluid biochemical analysis in determining the cause of ascites. The accuracy of ascitic fluid cholesterol LDH, SAAG, A/S LDH ratio, A/S cholesterol ratio, A/S protein ratio, AFTp and ascitic/blood glucose ratio in discrimination of exudative malignant ascites from transudative cirrhotic ascites are [91%, 91%, 91%, 86%, 83%, 83%, 80% and 71%] respectively. Ascitic fluid biochemical analysis may be useful than cytological examination in follow-up of cirrhotic ascitic patients aiming to early detection of complication