Non-invasive fibrosis seromarkers as a predictor of liver fibrosis in chronic hepatitis C and/or non-alcoholic steatohepatitis

In patients with chronic hepatitis C, the precise stage of hepatic fibrosis is the most important predictor of disease progression and it determines the need for antiviral therapy. Although liver biopsy is acknowledged as the gold standard for evaluating fibrosis, it is occasionally prone to sampling error and complications. We aimed to correlate an index of biochemical markers with histological features of fibrosis to predict hepatic fibrosis in patients with chronic hepatitis C virus, patients with combined hepatitis C virus and non-alcoholic steatohepatitis and those with non-alcoholic steatohepatitis, aiming to reduce the use of the liver biopsy. Out of those attending our out patient clinic for clinical, haematological, biochemical, virological, histological and ultrasonographic assessment prior to interferon therapy for hepatitis C virus, we enrolled 41 patients and grouped them according to histopathological examination of their liver biopsies into: Group I: 21 chronic hepatitis C virus patients as defined by positive 3rd generation ELISA; Group II: 20 patients with combined hepatitis C virus and NASH. We added a third group [Group III] of 15 patients having non alcoholic steatohepatitis as defined clinically, biochemically and through diagnostic percutanous liver biopsy. There were 33 male 23 female patients; 35 [62.5%] of them were from rural areas and 21 [37.5%] were from urban areas; the mean ages were 40.5 +/- 9, 46.6 +/- 7.7 and 42.13 +/- 11.06 in Group I, II and III respectively. Twenty apparently healthy individuals served as the control group. All the patients and the control group were submitted to full clinical history and examination, abdominal ultrasonography, CBC, liver biochemical profile and fibrosis biomarkers [apolipoprotein A1, haptoglobin, alpha2 marcoglobulin, GGT]. Liver biopsy was done for suitable patients after taking a consent and the results of fibrosis seromarkers were compared with the results of liver biopsy using the Metavir scoring system, We also estimated patients' body mass index, fasting and post prandial blood glucose. We excluded patients with other causes of chronic liver disease and co-morbidities that could confound the results of the non-invasive markers adopted, including schistosomiasis which was excluded by serological test. 43% of Group I and 40% of Group II had advanced fibrosis. None of Group III had advanced fibrosis; mild fibrosis was detected in 80% of them. gamma-GT was found positively correlated to the degree of hepatic fibrosis in Groups I, II and III [r = 0.667, 0.656 and 0.121, respectively] with P values of 0.001, 0.002, 0.668, respectively. alpha2 macroglobulin was found to be a reliable predictor of fibrosis [r = 0.30, P = 0.02] with ROC curve [area under the curve = 0.70] best cutoff value 2.55 g/L with sensitivity of 0.80 and specificity of 0.50. The results of haptoglobin were negatively related to the degree of hepatic fibrosis in Group I and II with ROC curve area under the curve of 0.33 and P value of 0.04. Significant direct correlation was seen in Group III [r = 0.55, P = 0.03], so by regression analysis, haptoglobin can be used as a good predictor for fibrosis in Group III [r = 0.54, P=0.04]. Apolipoprotein A1 has negative correlation to the stage of fibrosis in Groups I and II although the results were statistically insignificant. APRI index was found significantly directly correlated to the fibrosis stage and the grade of inflammation of all studied groups [r= 0.57, P< 0.01 and r = 0.36, P< 0.01, respectively] with a best cutoff value of 0.62, with sensitivity of 0.86 and specificity of 0.57. In patients with advanced fibrosis the best cutoff value was found to be 0.72 with sensitivity of 0.94 and specificity of 0.67. Mordified APRI test showed AUC of 0.79 [P<0.01] with a best cutoff value of 0.067 at which sensitivity and specificity were 0.82 and 0.61, respectively. Alpha macroglobulin, haptoglobin, apolipoprotein A1, APRI index and a modified APRI index, were found be significant predictors of hepatic fibrosis and were reprocessed by stepwise logistic regression

Evaluation of fibrosis sero-markers versus liver biopsy in Egyptian patients with hepatitis C and/or NASH and/or schistosomiasis

Although liver biopsy is acknowledged as the gold standard for evaluating fibrosis, it is occasionally prone to sampling error and complications. Is to correlate an index of biochemical markers with histological features of fibrosis in patients with chronic hepatitis C virus [HCV] and/or non alcoholic steatohepatitis [NASH] with or without schistosomiasis in order to reduce the use of liver biopsy. Fifty-six patients [n-56] attending tropical medicine clinics in Kasr El-Aini and Beni Suef Faculty of Medicine were enrolled and classified into 3 groups according to the histopathological findings of their liver biopsy. Stool and urine analysis were done to exclude passage of Schistosoma ova, in addition to liver biopsy, abdominal ultrasonography, and testing of their sera for fibrosis biomarkers [Apolipoprotein Al, Haptoglobin, Alpha-2-Macroglobulin, and Ganima-glutamyl transpeptidase [GGT]]. Patients with history of contact with canal water [35 patients] were screened for Schistosoma mansoni infection by detecting anti-Schistosoma IgG antibodies and circulating Schistosoma soluble egg antigen using indirect ELISA and sandwich ELISA techniques, respectively. Forty-three [43%] of group I [HCV] and 40% of group II [HCV and NASH] had advanced fibrosis [F3 and F4]. Out of the 35 patients with positive history of canal water contact 25 [71.4%] were antibody positive; Schistosoma antigen was detected in only 5 patients [14.3%], with no statistically significant differences in the level of fibrosis seromarkers from other patients. Alpha-2-macroglobulin was found to be a reliable predictor of fibrosis. Haptoglobin was negatively related to the degree of hepatic fibrosis in groups I and II and significantly directly correlated in group III [NASH]. By regression analysis, haptoglobin can be a good predictor for fibrosis in group Ill. Apolipoprotein Al had insignificant negative correlation to the stage of fibrosis in groups I and II. GGT was positively correlated to the degree of hepatic fibrosis in groups I, II and III. AST/platelet ratio index [APRI] proved significantly directly correlated with fibrosis stage and grade of inflammation of the studied patients. Co-infection with schistosomiasis in patients with HCV and/or NASH gave no statistically significant differenceinfibrosis staging in all groups.Alpha-2-macroglobulin, haptoglobin and apolipoprotein Al, besides APRI index and modified APRI index proved to be significant predictors of hepatic fibrosis

Cranioplasty: successful use of rib grafts

Background: numerous materials are available for use in Cranioplasty including bone, ceramics and metals. Rib graft as a construct for cranial reconstruction offers several advantages including autologous bone source, a formable platform, low infection rate, regeneration at the donor site and high fusion rates

Aim of the work: the present series aims to clinical evaluation of the use of rib grafts in Cranioplasty

Patients and methods: rib autograft Cranioplasty was performed in 15 patients. 12of them were males and 3 were females. The mean age was 18 years. When single rib needed, it has been harvested from the 5th rib and when two ribs needed, they were f harvested from the 4th and 6th ribs. 20 ribs were totally harvested

Results: the reasons for cranial reconstruction were: post traumatic calvarial defects [73.6%]. Previous craniotomy [13.2%], congenital defect [6.6%] and fibrous dysplasia resection [6.6%]. The size of the defects ranged between 15 and 84cm2. The mean follow up period was 16 months post-operatively. Normal cranial contour was achieved in all patients. One patient developed CSF leak that resolved spontaneously No donor site complications were noted [Pneumothorax, haemothorax post-operative pain no post-operative infections were encountered and graft resorption was not noticed in all patients

Conclusion: the use of autologous rib graft for cranioplasty,particularly in young age group was found to have low cost effectiveness, easily harvested, easily moulded to the skull shape, osteointegrated adequately with the surrounding bone thus offers good brain protection and is associated with low complication rate

Correlation between carbohydrate antigen 19-9 and alpha-fetoprotein in diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is a common malignancy over the world and Egypt, specially related to viral [B, C] hepatitis and cirrhosis. In many patients, imaging radiology is not conclusive in diagnosis of HCC, so tumor markers may help to solve the problem. Alpha fetoprotein [AFP] and Carbohydrate antigen 19-9 [CA 19-9] are used in this situation. This study was done on 60 patients divided into 2 groups: group I; 30 patients with HCC and group II: 30 patients with chronic liver diseases with or without cirrhosis. The results were: demographic case distribution; HCC is still of old age group [>52 years], more in males [70%] than in females [30%], farmers [40%] more than other jobs, rural population [60%] than urban [40%], related to HCV infection [96%] and HBV infection [23%]. AFP and CA 19-9 were highly significant in serum of HCC group than group II. There was no correlation between the level of both AFP and CA19-9 and biochemical liver tests, number or size of the tumor. But there is high correlation with histopathology of the tumor. By using ROC curve, the best cut-off of AFP is 25 ng/ml with a sensitivity and specificity of 86.7%, and for CA19-9, it was 97 u/ml with a sensitivity of 53.3% and specificity of 86.7%. CA19-9 enhance AFP in diagnosis of HCC in 30% of cases. So, using CA19-9 in combination with APP can increase diagnosis of HCC in hepatic focal lesion by 30%. But, we still need other sensitive and specific non invasive technique for diagnosis of HCC

frequency of Anti-HCV among Egyptian rural school children: Its relation to schistosomiasis

This study was conduced on 190 male students, aged 8-12 years from Shobrabas village, Menufeyia governorate, Cairo. They were subjected to full clinical assessment, urine and stool examination, abdominal ultrasonography, together with HBV and HCV seromarkers, using ETA technique. HCV seropositivity was 12.7% and there were a significant increase in anti-HCV seropositivity among students with schistosomal hepatomegaly + splenomegaly. Anti-HCV seropositivity was not related to activity of schstosomiasis nor to hepatitis B seromarkers status

Brucellosis in Egyptian patients with prolonged fever

This study was conducted on 43 patients [19 males and 24 females, with a mean age of 27.6 +/- 14.18 years], presenting with fever of more than 3 weeks duration, in addition to 20 healthy subjects serving as a control group. Blood cultures for brucella using biphasic medium were done and proved to be negative for all of them. Brucellosis was diagnosed serologically in 7/43 cases [16.3 percent] using the microagglutination technique. Enteric fever was diagnosed in 9/43 cases [20 percent] using Widal lest. Brucellosis was diagnosed more in the risk groups [Farmers and workers in animal farms]. The possible modes of infection were ingestion of raw milk, fresh cheese or contact with animals. The favorable clinical features of brucella cases were fever, drenching sweats, rigors, arthralgia and backache. All brucella cases responded well treatment with tetracycline and streptomycin

Ultrasonically guided percutaneous fine-needle aspiration biopsy of hepatic focal lesions

Ultrasonically guided percutaneous fine-needle aspiration biopsies of the liver were performed on 215 patients with a clinical and sonographic suggestion of hepatic malignancy. Several aspirations at the suspected areas were made in each case. The aspirate cytology was positive for malignancy in 161 cases [hepatocellular carcinoma 98 cases, anaplastic carcinoma 12, angiosarcoma 9 and metastatic carcinoma 42]. There were no false positive results. 145 cases with malignancy were diagnosed on the initial aspirate and among the negative cases, 16 showed evidence of malignancy on repeated aspiration [false negative in 9.9 percent, dropped to zero level on re-aspiration]. Aspirate cytology in the non-malignant focal areas revealed: haemangioma in 9 cases, echogenic liver abscesses, focal fatty degeneration 15, regenerative nodules in 22 cases. The puncture and aspirate of these 215 cases did not reveal any immediate compactions. Multiple fine-needle aspirate cytology of hepatic focal areas under ultrasonic guidance are of great diagnostic value with high accuracy in detecting hepatic malignancy

effect of therapeutic abdominal paracentesis on serum albumin, Na+, K+, creatinine and blood urea

Follow up of 12 patients with liver cirrhosis and ascites after therapeutic abdominal paracentesis revealed two groups with different outcome. All cases in the first group [after massive paracentesis of about 9 liters] developed hepatic encephalopathy after 2-3 weeks - the second group [after moderate paracentesis of about 4-liters did not develop any complications till discharge from 3 weeks to 3 months. Biochemical changes showed that serum albumin levels were markedly lowered in both groups after paracentesis. Serum Na[+] and K[+] were not much affected after paracentesis renal functions tests [blood urea and serum creatinine] became worse in the first group, while in the second group it showed moderate improvement. Blood and ascitic cultures before and after paracentesis were negative