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

Role of fibroscan and APRI in detection of liver fibrosis: a systematic review and meta-analysis

Fibroscan and APRI are promising noninvasive alternatives to liver biopsy for detecting hepatic fibrosis. However, their overall test performance in various settings remains questionable. The aim of our study was to perform a systematic review and meta-analysis of diagnostic accuracy studies comparing fibroscan and APRI with liver biopsy for hepatic fibrosis. Electronic and manual bibliographic searches to identify potential studies were performed. Selection of studies was based on reported accuracy of fibroscan and APRI compared with liver biopsy. Data extraction was performed independently by two reviewers. Meta-analysis combined the sensitivities, specificities, and likelihood ratios of individual studies. Extent and reasons for heterogeneity were assessed. 23 studies for fibroscan and 20 studies for APRI in full publication were identified. For patients with stage IV fibrosis [cirrhosis], the pooled estimates for sensitivity of fibroscan were 83.4% [95% confidence interval [CI], 71.7-95.0%] and specificity 92.4% [95% CI, 85.6-99.2%]. For patients with stage IV fibrosis [cirrhosis], the pooled estimates for sensitivity of APRI at cutoff point of 1.5 were 66.5% [95% CI, 25.0-100%] and specificity 71.7% [95% CI, 35.0-100%]. Diagnostic threshold bias was identified as an important cause of heterogeneity for pooled results in both patient groups. Fibroscan and APRI appear to be clinically useful tests for detecting cirrhosis however not useful tools in early stages of fibrosis

association of HLA class II DR B1 alleles with HCV infection in Egyptian children

Human leucocyte antigens [HLA] class II appear to play an important role in the individual's immune response to viral infection. The aim of this study is to assess the relationship between HLA class II antigens with the clinical, laboratory and histopathological state of the liver in Egyptian children and adolescents with chronic hepatitis C virus [HCV] infection. The study included 46 chronically infected HCV children and adolescents without - hepatitis B virus [HBV] nor human immunodeficiency virus - [HIV]. Their mean age was 10.4 +/- 4.23 years [3-17]. HLA-DRB typing was done by polymerase chain reaction [PCR] for the patients and 20 control subjects. Biochemical and haematological parameters were assessed as well as a liver biopsy was taken from the included patients. The most frequent alleles demonstrated among patients were DRB1*03, DRB1*04 and DRB1*13 [45.6%, 39.1% and 26.1%], respectively. Analysis of DRB1 frequencies between patients and control revealed that DRB1*15 is significantly reduced among patients when compared with the control group [p<0.01]. Patients possessing the allele DRB1*03 had significantly reduced platelet count [p=0.03], and this allele was presented to a greater extent in patients with minimal grade of inflammation. Patients with DRB1*04 had significantly low serum albumin [p=0.04] and patients with DRB1*13 had significantly high serum aspartate aminotransferase [AST] levels [p=0.05]. In Egyptian HCV-infected children, special HLA patterns were found; HLA DRB1*03 was present in nearly half of the patients, while the frequency of HLA DRB1*15 was significantly reduced among the cases in comparison to the control subjects

Non invasive prediction of varices in Egyptian cirrhotic patients

Cirrhotic patients frequently undergo screening endoscopy for the presence of varices. In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. In this study, our aim was to develop a predictive model using independent risk factors for the presence of varices in the enrolled patients. 200 patients with liver cirrhosis with no history of variceal haemorrhage were subjected to clinical examination; laboratory investigations [CBC, Liver biochemical profile, serum urea and creatinine], modified Child-Pugh score and MELD score were calculated. Abdominal ultrasonography and Doppler study of the portal and splenic veins studying the liver size, the presence of periportal thickening, hepatic veins flow pattern, the splenic longest axis and volume, the presence of ascites and collaterals. Portal vein and splenic vein diameter, patency, cross sectional area, mean flow velocity, blood flow volume congestion index and direction of flow of portal vein were calculated. Platelets count/Splenic diameter ratio and Right liver lobe diameter/ albumin ratio were calculated for all patients. Upper endoscopy was done where oesophageal varices were graded according to modified Thakeb classification. This study revealed that 83% of patients had oesophageal varices; 52% had small sized oesophageal varices and 31% had large sized oesophageal varices. In patients with varices; 12% had biphasic and 22.9% had monophasic hepatic veins flow pattern, with p value of 0.002. Portal vein direction of flow was bidirectional in 22.9% and Hepatofugal in 9.6% with a p value of 0.004. The portal vein velocity of 9.3 +/- 2.3cm/ sec with a p value of <0.001 and the ascites was present in 77% of patients with a p value of 0.005. In patients with large sized varices; shrunken liver was present in 83.1% of patients with a p value of 0.005 and serum albumin <2.5gm/dl with a p value of 0.008. Hepatic veins flow pattern [biphasic and monophasic], portal vein direction of flow [hepatofugal and bidirectional], decreased portal vein velocity and the presence of ascites [moderate and marked] were the significant variables for prediction of presence of varices. Shrunken liver and the low serum albumin were the significant variables for prediction of large varices

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

Band ligation versus beta-blockers in the prevention of primary bleeding of oesophageal varices: clinical, biochemical, ultrasongraphic and endoscopic evaluation

Most of the published data comparing endoscopic variceal band ligation [EVL] to propranolol for primary prevention of variceal bleeding have reached a conclusion that EVL is the option for patients with contraindications or intolerance to beta-blockers. Whether it is an alternative to beta-blockers that could be used for all cirrhotic patients with varices in case propranolol fails, or it is the prophylactic treatment of choice has not been answered. This study was designed to compare the effectiveness of prophylactic EVL to propranolol in the primary prevention of variceal bleeding from medium and large sized varices among Egyptian patients. The study included 60 patients with chronic liver disease, grade III or IV varices and negative history of variceal bleeding. Patients were randomized to receive either EVL or propranolol and were followed up every 3 months for one year. In the EVL group, successful initial variceal obliteration was achieved in 22 patients [88%]. In 5 of these patients [22.7%], variceal recurrence to grade II occurred. Failure to reduce the size of varices was reported in one patient [4%]. Patients in the propranolol group showed high incidence of hypotension [52.1%]. The mean dose of propranolol was low [43 +/- 7.3mg]. A resting heart rate of 69 beats/mm was 100% sensitive and 100% specific for the development of hypotension. Both groups were comparable as regards bleeding and overall mortality but compliance to therapy was significantly less in the propranolol group. Adverse effects to therapy were significantly higher in the propranolol group as hypotension occurred in 52.1% of patients. Although EVL is an invasive therapy as compared to propranolol, yet patients are more compliant to this short term therapy. Given this fact in addition to the high incidence of drug intolerability seen with propranolol makes EVL the preferred therapeutic option despite the comparable effectiveness of the two modalities in the primary prevention of variceal bleeding

Eyolution of living doner liver transplantation in Egypt

To date, cadaveric organ donation is illegal in Egypt. Therefore, Egypt recently introduced living donor liver transplantation [LDLT], aiming to save those who are suffering from end stage liver disease. Herein, we study the evolution of LDLT in Egypt. In Egypt, between August 2001 and February 2004, we approached all centers performing LDLT through personal communication and sent a questionnaire to each center asking for limited information regarding their LDLT experience. We identified and approached 7 LDLT centers, which collectively performed a total of 130 LDLT procedures, however, 3 major centers performed most of the cases [91%]. Overseas surgical teams, mainly from Japan, France, Korea, and Germany, either performed or supervised almost all procedures. Out of those 7 LDLT centers, 5 centers agreed to provide complete data on their patients including a total of 73 LDLT procedures. Out of those 73 recipients, 50 [68.5%] survived after a median follow-up period of 305 days [range 15-826 days]. They reported single donor mortality. Hepatitis C virus cirrhosis, whether alone or mixed with schistosomiasis, was the main indication for LDLT. Egypt recently introduced LDLT with reasonable outcomes; yet, it carries considerable risks to healthy donors, it lacks cadaveric back up, and is not feasible for all patients. We hope that the initial success in LDLT will not deter the efforts to legalize cadaveric organ donation in Egypt

changing pattern of meningococcal carriage among new army recruits

This study was designed to evaluate the prevalence of meningococcal carrier state among new army recruits and to identify the prevailing serogroups as well as their antibiotic sensitivity. Two hundred and forty eight healthy recruits from a military training centre were studied. Their ages ranged between 20 and 23 years. Nasopharyngeal swabs showed that 38.3 percent were carriers for Neisseria meningitides. Typing of the isolated strains revealed that 14.7 percent were serogroup A, 62.1 percent serogroup B, 5.2 percent serogroup X, 1.1 percent serogroup Y and 1.1 percent serogroup Z. Polyagglutinable strains were found in 8.4 percent and autoagglutinable strains in 7.4 percent of recruits. All isolated strains were found to be highly sensitive in vitro to chloramphenicol, penicillin G, ciprofloxacin, rifampin and cefixime. Only 12.6 percent were sensitive to trimetheprim sulfamethoxazole