Prevalence of occult hepatitis C virus in patients with HCV-antibody positivity and serum HCV RNA negativity

Introduction and aim: chronic hepatitis C infection [CHC] is a global health-care problem with an increasing burden year-by-year, particularly in Egypt. Even with the advent of high sensitive techniques, a subset of patients with positive HCV-Ab and negative HCV-viremia remain challenging. Therefore, we herein tried to determine the prevalence of occult HCV infection in peripherd blood mononuclear cells [PBMCs] of Patients presented with positive serologic test for anti-HCV-Ab and negative serum HCV-RNA-PCR [spontaneously cleared-patients] and also, we followed up those patients

Patients and Methods: between March 2010 to March 2015, a prospective study was designed to include all consecutive patients with HCV-Ab positivity and HCV-RNA negativity who attended to Assiut unit for treatment of viral hepatitis; sector of national committee for contrbl of viral hepatitis. A total of 25 patients were recruited. Spontaneous clearance of serum HCV infection was approved by [HCV-Ab positive using two 3rd generation ELISA tests and serum HCV RNA negative in three consecutive occasion each six months apart]. Follow up serum HCV RNA for patients with Occult 1 HCV Infection every 6 months. The RNA extraction step was performed by a protocol modified from, that of the QIAamp viral RNA kits [Qiagen, courtaboeuf, France]. Blood samples for separation of I PBMCs were collected from all patients. PBMCs were obtained using Ficoll-Hypaque density gradient of EDTA anticoagulated blood according to the manufacturer's instructions [Lymphoflot, Biotest,Dreleich, Germany]. Detection of HCV viral load was performed by kit supplied by applied Biosystem [HCV RT-PCR Kit lot No.]

Results: a total of 25 [21 males, mean age 36.2 +/- 9.1] patients who cleared HCV spontaneously [HCV- Ab positive and serum HCV RNA negative]. The genomic HCV RNA was detected in PBMCs from 3 [12%] of 25 patients. Follow up for those three patients with occult HCV infection were done for 18 months by measuring serum HCV RNA by using highly sensitive real-time Polymerase Chain Reaction [RT-PCR] every 6 months, only single patient became overt HCV with low level of viremia

Conclusion: occult HCV infection was detected in a considerable prevalence in patients in whom apparent clearance of HCV-viral load occurred that entails corporations of HCV-viral assay in PBMCs into the diagnostic algorithm

Impact of metformin on liver perfusion in women with polycystic ovary syndrome [PCOS] and non-alcoholic fatty liver disease [NAFLD]

To evaluate the impact of 6-month treatment with metformin on some liver functions and hepatic perfusion in obese women with PCOS and NAFLD. Twenty women with PCOS and NAFLD were given a total daily dose of 1.7 g of metformin for six consecutive months. BMI, fasting serum glucose, serum cholesterol, LDL, HDL, triglycerides, ALT, AST, alkaline phosphatase [ALP], gamma-glutamyltransferase [GOT], total and conjugated bilirubin and serum albumin were assayed. Total liver blood flow was assessed by Doppler ultrasound and was taken as the sum of flow volumes in the common hepatic artery and portal vein. All parameters were measured before and six months after metformin treatment. BMI, fasting serum glucose, total cholesterol, serum triglycerides and LDL decreased significantly, whereas HDL increased significantly, after metformin treatment. Basal serum ALT levels were higher than normal with a tendency towards reduction after metformin therapy, which did not reach statistical significance. Hepatic arterial blood flow, portal vein blood flow and consequently total hepatic blood flow increased significantly in PCOS women six months after metformin therapy. Six-month treatment with metformin had a favorable impact on some liver function tests and hepatic perfusion in PCOS women with NAFLD

Morbidity and mortality in icu patients with end stage liver disease

Acute or chronic liver failure is associated with numerous complications which may occur in combination and patients may require intensive care unit [ICU] treatment; many do not survive. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. To estimate the frequency of different morbidity changes and to evaluate risk factors responsible for mortality among patients with end stage liver disease [ESLD] admitted to the ICU. A total of 120 patients with ESLD were enrolled [102 males [85%] and 18 females [15%]. All were consecutively admitted to the ICU at the Tropical Medicine and Gastroenterology Department, Assiut University Hospital from May 1[st] to August 31[st], 2013. Full history taking, thorough clinical examination, full investigations and assessment of patients accordinglo C-hild-Turcotte-Pugh [CTP] class and Model for End-stage Liver Disease [MELD] score were done with close monitoring and follow up. The mean age of patients was [56.23 +/- 11.21] years. Regarding clinical presentation, hepatic cncephalopathy [HE] was found in 87.5%, jaundice in 60%, hematemesis in 41.7%. hepatorenal syndrome [MRS] in 35.8% and spontaneous bacterial peritonitis [SBP] in 20.8%. The majority of patients [86.7%] were CTP class C. Mortality rate was 57.5%; the main causes of death were HRS [10.8%], HE[21.7], aspiration pneumonia [10%], septic shock [2.5%] and irreversible shock in only.7%. There was a significant correlation between mortality and old age, CTP and MELD scores and a longer stay at the ICU. We found six risk factors independently affecting the outcome of ESLD patients in the ICU. Those were HE, jaundice, HRS, increased white blood cell count, increased hemoglobin and decreased prothrombin concentrations. Among ESLD patients having more risk factors, mortality rates were higher, 86.2% with 5-6 risk factors and 21.7% with 1-2 risk factors. Rates of improvement were highest with 1-2 risk factors [78.3%] and worst with 5-6 risk factors [13.8%]. The mortality rate in of ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP and MELD scores as well as HE, HRS and jaundice were significant predictors of mortality in ESLD patients in the ICU. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin and prothrombin concentrations were indepejident risk factors affecting the outcome of ESLD patients in the ICU

Study of the impact of viral load of hepatitis C on patients with concomitant psoriasis vulgaris

Concomitant hepatitis C virus [HCV] infection and psoriasis vulgaris [PV] are not uncommon coexisting diseases, especially in areas with high viral hepatitis endemicity. To date, data about the interaction between both diseases are scarce. Therefore, we aimed to describe the possible interplay between the HCV viral load and psoriatic activity in concomitant Egyptian diseased patients. Between December 2011 and August 2013, all psoriatic patients attending Assiut University Hospital outpatient clinics were tested for HCV serologic assay. Patients with positively coexisting diseases were further reevaluated for psoriasis area severity index [PASI] score assessment, liver function tests, HCV-RNA-polymerase chain reaction [PCR] assays, and sonographic examination of the liver. For comparative purposes, another matched group [n = 26] with psoriasis only [HCV-negative group] was enrolled as a control. During the period of the study, 20 patients with concomitant PV and HCV infection [HCV-positive group; 50% males, mean age of 44.15 +/- 10.66 years] were recruited. The mean PASI score was 44.75 +/- 10.38 and clinical signs of liver dysfunction were observed in 40% [n = 8], 100% had abnormal liver function tests [n = 20], and 75% had sonographic findings of cirrhosis [n = 15]. The PASI score was significantly higher in the HCV-positive psoriatic group compared to the HCV-negative control [p < 0.001]. Significant correlations were detected between the PASI score and the viral loads, and also with alanine aminotransferase [ALT]. When HCV was found concomitantly with PV, a high possibility of severe disease pattern will be expected that entails special precautions in the treatment process

Risk factors and outcome in ICU patients with end-stage liver disease

Acute or chronic liver failure is associated with numerous complications that may occur in combination, and patients may require ICU treatment. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. The present study aims to estimate the frequency of mortality and evaluate morbidity from cirrhosis in patients with end-stage liver disease [ESLD] admitted to the ICU and evaluate the relationship between the demographic, clinical, and laboratory data [potential risk factors] of those patients and mortality. A total of 120 patients with ESLD were enrolled [102 [85%] male and 18 [15%] female patients]. History taking, clinical examination, and other laboratory investigations were carried out, and patients were classifi ed according to the Child-Turcotte-Pugh [CTP] and the model for endstage liver disease [MELD] scores. Regarding the clinical presentation, hepatic encephalopathy [HE] was found in 87.5% of patients, jaundice in 60%, hematemesis in 41.7%, hepatorenal syndrome [HRS] in 35.8%, and spontaneous bacterial peritonitis in 20.8% of patients. The mortality rate was 57.5%; the main causes of death were HRS [40.8%], HE [21.7%], aspiration pneumonia [10%], septic shock [2.5%], and irreversible shock [1.7%]. There was a significant relationship between mortality and old age, CTP and MELD scores, and a longer stay at the ICU. Increased white blood cell count, increased hemoglobin and decreased prothrombin concentration, and elevated creatinine were independent risk factors of mortality in ESLD patients in the ICU. Mortality rates were higher in patients with 5-6 risk factors [86.2%] than in those with 1-2 risk factors [21.7%]. Mortality rate in ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP, MELD score, HE, HRS, and jaundice were significant predictors of mortality in ESLD patients. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin, and prothrombin concentration were independent risk factors of mortality in ESLD patients

Results of endoscopic sclerotherapy with n-butyl-2-cyanoacrylate versus ethanolamine oleate in treatment of bleeding gastric varices

Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension. Gastric variceal injection of N-butyl-2-cyanoacrylate has been shown to be effective however: rare serious side effects have been reported as pulmonary embolism and portal vein thrombosis. Also, the optimal treatment of bleeding gastroesophageal varices is not yet fully determined and whether to use ethanolamine oleale or N-butyI-2-cyanoaCrYlate for sclerotherapy is not yet clear. Aim of the work: To compare between N-butyl-2-cyanoacrylate [NBC] and ethanolamine oleate [EAO] injection in patients with bleeding gastric varices. This study included 157 patients with bleeding gastric varices underwent sclerotherapy in 4ssuit University Hospital Endoscopy Unit. Fifty two patients with bleeding isolated gastric varices [IGV] underwent sclerotherapy with a mean of 2 mL NBC. One hundred and five patients with bleeding gastro-oesophageal varices [GOV] were randomally divided into 2 groups. The first group included 36 patients were subjected to endoscopic variceal obturation using NBC. The second group included 69 patients were subjected to endoscopic sclerotherapy using EAO. Outcome parameters were primary haemostasis [bleeding control within the first 48 hs.], and recurrent bleeding [after 48 hs. of oesophago-gastro-duOdefl0Sc0PY]. All those patients were followed up for one week after sclerotherapy to detect rebleeding or any intervention related complications. Primary haemostasis was significantly higher in patients treated with NBC than those treated with EAO [96.6% vs. 82.6%; p< 0.005]. Re-bleeding within one week after initial sclerotherapy was significantly lower in patients treated with NBC than those treated with EAO [5.9% vs. 19.3%; p< 0.05]. In patients with gastroesophageal varices type 1, there was no statistically significant d4fference between NBC and EAO sclerotherapy regarding primary haemostasis [100% vs. 91.5%, p>0.05] and rebleeding [no cases vs. 9.3% p>0.05]. in patients with gastroesophageal varices type 2, there was high statistically significant difference between NBC and EAO sclerotherapy regarding primary haemostasis [100% vs. 63.3%; p<0.005] and rebleeding [no cases vs. 50% p<0.005]. No significant difference was present between NBC and EAO sclerotherapy regarding the occurrence of intervention related complications. Secondary haemostasis was achieved with NBC sclerotherapy in 100% of cases presented with failure of primary haemostasis or rebleeding. No mortality cases reported during the first week of follow up in both groups. N-butyl2-cyanoaCrYlate is safe and statistically significantly more effective than ethanolamine oleate in controlling GV bleeding. Ethanolamine oleate sclerotherapy still have a role in treatment of bleeding gastroesophageal varices type one only