[Assessment of liver fibrosis by magnetic resonance spectroscopy in asymptomatic children with Chronic Hepatitis C Viral Infection]

Background: Chronic hepatitis C is the most common cause of chronic liver disease and cirrhosis. Egypt is the highest affected country with a prevalence of 22%.In children, seroprevalence of HCV is 0.2% in children less than 11 years of age and 0.4% in children >/=11 years of age

Aim of the work: The purpose of this study was to assess the value of liver biopsy in diagnosis of activity grading and fibrosis staging in early asymptomatic children with chronic hepatitis C virus infection. We also aim to evaluate the use of 1H MRS and DW-MRI in assessment of some metabolic components [Glx/lipid, PME/lipid and Glyu/lipid ratios] and ADC of liver tissues and its correlation to the histopathological changes found in liver biopsy

Subjects and Methods: A cross-sectional study was conducted over a period of two years, included thirty children with asymptomatic chronic hepatitis C virus infection[mean age +/- SD 14.1 +/- 2.8years] and twenty healthy children as controls were included. Anti HCV antibodies, HCV RNA PCR, liver function tests, abdominal ultrasonography, MRS and DW-MRI were done for all cases and controls, Liver biopsy was done for all cases

Results: The results showed that HCV infection was more common in males [83.3%] and 16.7% of patients were obese. There were two significant risk factors for HCV infection in our patients: positive family history of HCV infection[56.7% ofpatients] and history of previous operation [26.7%].There were significant differences in the results of all liver enzymes [ALT, AST and ALP] in cases than controls. The results of METAVIR grades showed 29 cases [96.6%] had activity while 17 cases [56.7 %] had fibrosis and TGF-fbeta1 in liver tissues was positive in 19 cases [63.3%]. The results of MRS and DW-MRI showed significant differences between cases and controls and positive correlations between the results of 1H MRS with the results of liver biopsy [METAVIR Grades, METAVIR Stages and TGF-[beta1]

Conclusion: Early diagnosis of asymptomatic chronic hepatitis C is essential to prevent or delay end stage chronic parenchymal liver disease. TGF-1beta1 in liver tissue may be considered as a useful and better tool than METAVIR score in the assessment of hepatic fibrosis. 1H MRS may be a potential non-invasive helpful diagnostic tool in assessing the staging of asymptomatic chronic hepatitis C as the increase of its metabolites were correlated with histopathological changes. DW-MRI can be considered an effective method in evaluating liver disease activity in chronic hepatitis C

Recommendation: we recommend the use of larger sample size to assess different stages of liver fibrosis and the use of 1H MRS in monitoring treatments

Evaluation of heat shock protein70 expression in liver biopsies of chronic hepatitis C Egyptian patients

Background/Aim: Heat shock protein 70 [HSP70] is a member of heat shock protein family It has strong cytoprotective properties that prevent cell death triggered by stressful stimuli The aim of this work was to study the immunohistochemical expression of HSP70 in chronic HCV biopsies among Egyptian patients

Methods: Immunohistochemical stain using HSP70 was performed on 30 chronic hepatitis C needle biopsies, with different degrees of disease severity

Results: Positive HSP70 immunoreactivity was detected in 12/30 [40%] of the chronic hepatitis specimens with weak to moderate intensity. No statistically significant difference was detected between the mean of HSP70 expression and the following parameters; age, gender, necroinflammatory grade and stage of fibrosis [p=0.109, p=0.874, p=0.342 and p=0.182] respectively

Conclusion: Detection of HSP70 in chronic hepatitis specimens suggested that chronic inflammation and fibrosis act as stressful conditions which result in induction of HSP70 expression. HSP70 prevents stress induced apoptosis which may enhance viral replication by preserving the viral factory. Therefore, we can suggested that HSP70 may act as a therapeutic target to treat HCV infection by targeting host proteins as opposed to viral proteins to minimize the development of resistance to therapy

Diagnostic utility and complications of flexible fiberoptic bronchoscopy in Assiut University Hospital: a 7-year experience

Few studies with small number of patients reported their experience with flexible fiberoptic bronchoscopy [FFB]. We aimed to report our 7-year experience with the diagnostic yield and complications of FFB at Assiut University Hospital. A retrospective review of bronchoscopy reports and corresponding patients' charts over 7 years from January 2006 to December 2012 performed at the Department of Chest Diseases, Assiut University Hospital, was done. Indication for procedures, suspected diagnosis, final diagnosis, and complications were reported. Of 3980 bronchoscopies, 3660 [92%] were diagnostic. Mean age was 45 +/- 18 years and 68% were males. Malignancy and infection, including tuberculosis [TB], were the 2 main indica-tions for FFB [47% and 23.8%]. The overall diagnostic yield was 67%. A total of 1690 broncho-alveolar lavage [BAL], 1303 brushing, 188 transbronchial biopsies [TBB], and 645 bronchial biopsies [BB] were performed. Malignancy was confirmed in 70% of suspected cases. Tuberculosis was diagnosed in 58.5% of suspected cases, whereas bacterial pneumonia was diagnosed in 48.5%. Bronchoscopy diagnosed 38.4% of patients with interstitial lung disease. The diagnostic yield was 55% for sarcoidosis and 33% for usual interstitial pneumonia. The overall complication rate was 1.61%. Mortality rate was 0.05%. Our results confirm that flexible fiberoptic bronchoscopy is a valuable diagnostic tool, with a low rate of complications, particularly in patients with lung cancer. The diagnostic yield in our locality is almost similar to that reported in other series