APRI test and hyaluronic acid as non-invasive diagnostic tools for post HCV liver fibrosis: systematic review and meta-analysis

Background and study aims: Hepatitis C virus [HCV] accounts for a sizable proportion of chronic liver disease cases and represents the most common indication for liver transplantation. Precise diagnosis of hepatic fibrosis stage is considered a funnel-neck in proper management and follow-up of HCV-infected patients. Given the possible complications of liver biopsy, a non-invasive method for assessing hepatic fibrosis is needed. This study aimed to evaluate the diagnostic accuracy of APRI and hyaluronic acid as non-invasive diagnostic assessment tools for post HCV liver fibrosis

Patients and methods: Systematic literature searching identified studies performed on Egyptian territory to evaluate APRI and hyaluronic acid as non-invasive tests of fibrosis and using liver biopsy as the reference standard. Meta-analysis was performed for areas with an adequate number of publications. Validation of meta- analysis on APRI was done on a subset of 150 treatment-naive post-hepatitis C patients

Results: Both APRI and hyaluronic acid have superior predictive power for hepatic cirrhosis [F4] than for significant fibrosis [F2-F3]. The pooled estimate for sensitivities and specificities of APRI and hyaluronic acid to diagnose F4 were [84% and 82%] and [83% and 89%] respectively. In the subgroup of treatment naive post-hepatitis C patients, APRI had higher diagnostic performance to diagnose liver cirrhosis with 93.8% sensitivity and 72.4% specificity [AUC; 0.908, 95% CI; 0.851-0.965, p-value; <0.001] compared to its accuracy to diagnose significant hepatic fibrosis with 65.1% sensitivity and 77.8% [AUC; 0.685, 95% CI; 0.59-0.78, p-value; 0.001]

Conclusion: APRI score and hyaluronic acid levels are simple and reliable non-invasive markers to detect advanced fibrosis among post-hepatitis C patients

role of capsule endoscopy in obscure gastrointestinal bleeding

Obscure gastrointestinal bleeding is mostly recurrent and originates in the small bowel, which can be only partially examined by conventional endoscopy. Capsule endoscopy has revolutionized the evaluation of obscure gastrointestinal bleeding [OGIB]. The diagnostic yield of capsule endoscopy in OGIB was a main concern of many studies. The aim of this study is to assess the diagnostic yield of capsule endoscopy in cases of OGIB. Capsule-related complications and degree of inter-observer variation will be recorded as well. 54 consecutive patients suffering from OGIB, whether occult or overt, were subjected to capsule examination and data analysis. The majority [74.1%] presented with obscure overt bleeding. Examination was complete in 68.4%. The commonest lesions were angiodysplasias [17.5%]. Examinations were negative for lesions in 35.1% and hampered by limitations in 19.3%. The capsule diagnostic yield was 56.1%, while capsule retention occurred in 3.5%. The inter-observer agreement for the cause of bleeding was 91.2%. Capsule endoscopy proved helpful in solving the mystery of OGIB. It succeeded in diagnosing the cause of bleeding and directing further management with good compliance, high proportion of inter-observer agreement and low incidence of complications

Atypical osteomyelitis of the skull Base

The authors reporetd six cases of atypical osteomyelitis of the skull base in diabetic patients. They were studied clinically, radiologically and pathologically. This disease may arise without intial temporal bone affection or may complicate incompletely treated malignant otitis externa. Spread of the disease may occur through vascular involvement of the skull bones and fascial planes rather than through the air cells. The ethmoid the sphenoid and occipital bones are affected beside the temporal bones and the petrous apex. Multiple cranial nerves may be affected including the 2nd, 3rd, 4th, 5th, 9th and 10th nerves and the disease may present as the jugular foramen or the orbital apex syndromes. The morbidity and the mortality of the disease is higher in patients without previous temporal bone affection because it is usually not promptly recognized and treated