Study of vitamin d level in cirrhotic hcv patients before and after transplantation

Background: chronic hepatitis C is a common condition. Transfusion of blood or blood-related products was one of the main routes of HCV transmission. Furthermore, nosocomial infections represent a key source of infection, particularly in some of the high-prevalence countries [such as Egypt, Pakistan and Eastern Europe]. In general, prevalence increases with increasing age until peak prevalence at 55-64 years in most regions. At least six HCV genotypes are known, Genotype 4 frequency is the highest from Central Africa to the Middle East. Worldwide people infected with HCV are at an increased risk of developing serious hepatic complications including cirrhosis and hepatocellular carcinoma

Aim of the Work: the aim of this work is to study vitamin D level in post HCV liver cirrhosis patients before and six months after liver transplantation in addition to chronic HCV patients without cirrhosis

Patients and Methods: this prospective case control study was conducted on 25 patients. 15 of them with liver cirrhosis due to chronic hepatitis C virus evaluated before and six months after liver transplantation in addition to 10 chronic HCV patients without cirrhosis as control group. Liver cirrhosis or transplantation patients were recruited from Ain Shams specialized hospital liver transplantation unit and chronic HCV patients without cirrhosis were recruited from hepatology outpatient clinic of Ain Shams university hospital in the period from February 2017 to November 2017. Symptoms suggestive of liver disease [e.g. jaundice, bleeding tendency, increased abdominal girth]

Results: this study was conducted on 25 patients. 15 of them with liver cirrhosis due to chronic hepatitis C virus evaluated before and six months after liver transplantation in addition to 10 chronic HCV patients without cirrhosis as control group. Group I: Consists of 15 [60%] patients with post HCV liver cirrhosis before liver transplantation. They were 13 males [86.6%] and 2 females [13.3%]. Their mean age was 50.53 +/- 4.52. Group II: Consists of the same patients of group I evaluated six months post liver transplantation. Group III: Consists of 10 [40%] patients with chronic HCV without cirrhosis. They were 6 males [60%] and 4 females [40%]. Their mean age was 53.0 +/- 8.46

Conclusion: this study concluded that vitamin D deficiency is prevalent among patients with liver cirrhosis. Liver transplantation improves vitamin D level but not to the recommended normal level i.e. vitamin D deficiency or insufficiency can persist after transplantation

Comparative study between endoscopic band ligation, alcohol injection and cyanoacrylate injection in management of gastric varices

Haemorrhage from gastric varices [GV] is a serious complication of portal hypertension. The role of endoscopy in the management of gastric varices is still controversial, but the efficacy in management of bleeding oesophageal varices has been greatly enhanced, so, rebleeding rate has been reduced by injection sclerotherapy or band ligation. On the other hand, the management of gastric varices is still a great challenge for endoscopists as traditional methods as vasoconstrictors and balloon tamponade don't effectively reduce the rebleeding rate. The aim of our work was to compare three different endoscopic methods in the management of type I and II gastric varices: [I] gastric variceal obturation using cyanoacrylate, [II] gastric variceal sclerotherapy using absolute alcohol and [III] gastric variceal ligation by rubber [O] bands. The comparison regards the technical ease, efficacy, complications and number of sessions needed to eradicate varices. To fulfill this aim we studied 60 patients with chronic liver disease and gastric varices presented to the central endoscopy unit Ain Shams University Hospital. The patients were categorized into [3] groups: Group I included 20 patients who underwent GV obturation using cyanoacrylate, group II included 20 patients who underwent GV sclerotherapy using alcohol injection, and group III included 20 patients who underwent GV band ligation. All patients were age and sex matched. We excluded patients with type III GV, hepatic encephalopathy, hepatocellular carcinoma and prior history of sclerotherapy, band ligation or shunt operation. Our results showed that, cyanoacrylate obturation of gastric varices was more effective in controlling gastric variceal bleeding than other methods with low number of sessions and low rebleeding rate than G.V. Ligation or alcohol injection. So we conclude that gastric variceal obturation by cyanoacrylate proved more effective and safer than gastric variceal ligation or injection sclerotherapy using absolute alcohol in the management of type I and II gastric varices

Herpes group viruses diagnosis by polymerase chain reaction in Guillain bare syndrome and transverse myelitis

This study included 35 patients, their ages ranged from 11 months to 7 years. 20 cases presented with clinical manifestation of Guillain Barre syndrome [GBS] and 15 cases with clinical manifestations of transverse myelitis [TM]. All cases were subjected to general and neurological examinations and CSF analysis, computed tomography of dorsolumbar region for 15 cases with transverse myelitis. Polymerase chain reaction [PCR] was done for both CSF and blood of all cases for detection of cytomegalovirus-DNA, herpes simplex DNA and Epstein-Barr- DNA. Preceding illness in the form of upper respiratory infection, gastroenteritis and exanthem were detected in 65% and 39.99% among cases of GBS and TM, respectively. Total outcome among all 35 patients [8 weeks after onset of neurological manifestations] showed complete recovery in 45.71%, recovery with residual squelae in 40% and death in 14.29%. Cytomegalo-virus DNA PCR positive signal was the most commonly detected marker of viral infection in this study