Role of right liver lobe diameter/serum albumin ratio in esophageal varices assessment in cirrhotic patients

Background: Liver cirrhosis is a pathologic condition characterized by fibrosis of the liver parenchyma and evidence of regenerative activity, resulting in portal hypertension. Portal hypertension plays a crucial role in the transition from the pre-clinical to the clinical phase of the disease. Bleeding from ruptured esophagogastric varices is the most severe complication of cirrhosis and is the cause of death in about one third of cirrhotic patients. Cirrhotic patients frequently undergo screening endoscopy for the presence of varices. These recommendations imply a considerable burden of endoscopies and related costs

Objective: the aim of the study was to determine the predictive value of noninvasive parameters [Rt. lobe diameter/ serum albumin ratio] in the prediction of esophageal varices

Subjects and Methods: This study was done on 120 patients divided into four groups: Group A: includes 30 cirrhotic patients with esophageal varices [OVs] grade I to II. Group B: includes 30 cirrhotic patients with OVs grade III to IV. Group C: includes 30 cirrhotic patients without OVs. Group D: includes 30 none cirrhotic patients presented for esophagogastroduodenoscopy [EGD] screening because of other etiologic factors that are not associated with liver cirrhosis. All participants were subjected to clinical examination; laboratory investigations [CBC, Liver function tests including serum albumin concentration, prothrombin time and concentration, modified Child-Pugh score and abdominal ultrasonography [studying the right lobe and left lobe diameter, the presence of periportal thickening, the splenic longest axis and the presence of ascites and Portal vein diameter, Right liver lobe diameter/albumin ratio were calculated for all patients]. Upper endoscopy was done for detection and grading of esophageal varices

Results: This study revealed that The predictors that showed statistically significantly associated with the presence of varices were increased right lobe diameter/Albumin ratio, shrunken Rt. hepatic lobe, splenomegaly, thrombocytopenia, and the more advanced liver disease [according to child class scoring of the patients], the more likely the presence of varices

Conclusion: Right lobe diameter/Albumin ratio is good predictor for the presence and grading of esophageal varices

Evaluation of ledipasvir plus sofosbuvir for treatment of compensated and decompensated HCV cirrhotic patients

Background: unlike human immunodeficiency virus [HIV] and hepatitis B virus [HBV], hepatitis C virus [HCV] infection is a curable disease. Current direct acting antiviral agent [DAA] targets are focused on HCV NS3/4A protein [protease], NS5B protein [polymerase] and NS5A protein. The first generation of DAAs includes boceprevir and telaprevir, which are protease inhibitors and were approved for clinical use in 2011. The cure rate for genotype 1 patients increased from 45% to 70% when boceprevir or telaprevir was added to standard PEG-IFN/ribavirin. More effective and less toxic second generation DAAs supplanted these drugs by 2013. The second generation of DAAs includes sofosbuvir, simeprevir and fixed combination medicines containing ledipasvir plus sofosbuvir and Viekira Pak. These drugs increase cure rates to over 90% without the need for interferon and effectively treat all HCV genotypes. With these drugs the "cure HCV" goal has become a reality. The aim of this study was to assess of ledipasvir plus sofosbuvir as treatment of HCV infection in patients with advanced liver disease including cirrhotic patients with child B and C

Patients and methods: in this prospective study, seventy five HCV PCR positive patients were classified into three groups according to child score. Each group included twenty five patients. All patients received ledipasvir plus sofosbuvir for six months. For all patients thorough medical history, clinical examination, kidney function tests, liver function tests, complete blood count, pelvi-abdominal ultrasound, HCVantibodies, hepatitis C viral RNA, quantitative, HbsAg, alpha fetoprotein as baseline screening. HCV PCR done for all patients at end of treatment and three months later to detect sustained virological response [SVR12]. Patients with combined HCV and HBV infection, hepatic or extrahepatic malignancies and late child C were excluded

Results: showed that no statistical significant difference were detected in patients of group A as regard liver function tests before and after treatment and SVR12 achieved by 96%. Patients of group B showed significant statistical difference as regard liver function tests before and after treatment with SVR12 achieved by 88%. In patients of group C there were significant statistical difference in liver function tests with SVR12 achieved by 80%. Also there were clinical improvement in patients of group B and C after end of treatment

Conclusion: it could be concluded that there will be a dramatic improvement in HCV therapy followed the introduction of oral medicines that directly inhibiting the replication cycle of HCV. The combination pill contains a fixed-dose of ledipasvir 90 mg and sofosbuvir 400 mg, two direct-acting antiviral agents against HCV. Ledipasvir is an inhibitor of the NS5A protein, which is required for HCV replication. Sofosbuvir inhibits the HCV NS5B RNA-dependent RNA polymerase, which is also required for viral replication. Sofosbuvir is a nucleotide prodrug that undergoes intracellular metabolism to form a pharmacologically active triphosphate that can incorporate into the HCV RNA. Ledipasvir plus sofosbuvir can be used safely in treatment of compensated and decompensated post hepatitis C liver cirrhosis. SVR12 can be achieved by 96% in patients with early cirrhosis [child A], 88% in patients with child B cirrhosis and 80% in patients with child C with subsequent improvement in liver functions

Study factors affecting academic achievement among female students at Ibn Sina national college

Background: A good social environment is a key strategy to improve the level of education and achievement in medical college students. However, survey data from Jeddah, Saudi Arabia have indicated that a large number of medical students are affected negatively by their social status. This article comparatively explores the impact of four main factors: Social class/Background, Students' Personality, Health Status, and Psychological health on their achievement. Data were collected as part of a program of qualitative and quantitative research investigating the prevalence of bad environment effect on the psychological level of the students

Objectives: To study the four main factors Social class/Background, Students' Personality, Health Status, and Psychological health affecting academic achievement among Female Students at Ibn Sina National College

Methods: The study was conducted among 1315 female students attending colleges of Ibn Sina-Jeddah-Saudi Arabia between 1[st] of April - 31[th] of May 2016. An open-ended questionnaire was developed to cover the objectives

Conclusion: After assessment of the factors and variables across the targeted sites about the academic achievement were often conclude that overall achievement were very good regardless the factor

Free serotonin [5-HT] levels in Egyptian patients with esophageal and fundal varices

Background: Serotonin appears to be a central physiologic mediator of many gastrointestinal functions and a mediator of the brain-gut connection

Aim: The aim of this study was to determine concentrations of free serotonin in plasma in patients with and without esophageal and fundal varices

Participants and methods: Patients diagnosed with stigmata of chronic liver disease [history, clinical, laboratory, and radiological findings - e.g. jaundice, lower limb edema, hepatomegaly, and splenomegaly] and presenting with gastrointestinal symptoms were included in the study. After upper gastointestinal endoscopy, patients were divided into two groups: group I included 30 patients with liver cirrhosis complicated with varices and group II included 30 patients with liver cirrhosis who did not have varices. Thirty healthy participants served as the control group. All patients were subjected to history taking, clinical examination, laboratory tests, abdominal ultrasound, and upper gastrointestinal tract endoscopy [for group I and II]. Plasma free serotonin was measured by the ELISA test

Results: All groups were age-matched and sex-matched. Estimation of plasma free serotonin showed a highly statistically significant difference between groups [F=59.32, P<0.01]. A serotonin cutoff value of 24 ng/ml was chosen, with 100% sensitivity, 96.7% specificity, 98.3 to discriminate all chronic liver disease patients from healthy controls [area under the curve=0.981]. A cutoff value of 58.0 ng/ml to differentiate between patients with and without esophageal varices, with 80% sensitivity and 86.7% specificity [area under the curve=0.855]. A highly significant stepwise progressive increase in the marker level was recorded through grades of oesophageal varices 2-5 [stage 2, 20.7 +/- 7.7 ng/ml; stage 3, 44.3 +/- 8.9 ng/ml, P<0.01; stage 4, 100.1 +/- 12.4 ng/ml, P<0.01; stage 5, 114.6 +/- 14.7 ng/ml, P<0.05]. There was highly significant difference in plasma free serotonin levels in patients with esophageal and gastric varices compared with those with esophageal varices alone

Conclusion: Plasma free serotonin levels could possibly be used as a noninvasive predictive method for the presence of gastroesophageal varices

Antioxidant lipoxygenase inhibitors from the leaf extracts of Simmondsia chinensis

OBJECTIVE@#To isolate and identify chemical constituents with antioxidant and lipoxygenase inhibitory effects of the ethanolic extract of Simmondsia chinensis (Jojoba) leaves.@*METHODS@#The alcoholic extract was subjected to successive solvent fractionation. The antioxidant active fractions (chloroform, ethyl acetate and aqueous fractions) were subjected to a combination of different chromatographic techniques guided by the antioxidant assay with DPPH. The structures of the isolated compounds were elucidated on the basis of spectroscopic evidences and correlated with known compounds. The antioxidant activity was assessed quantitively using DPPH and β-carotene methods. The inhibitory potential against enzyme lipoxygenase was assessed on soybean lipoxygenase enzyme.@*RESULTS@#Ten flavonoids and four lignans were isolated. Flavonoid aglycones showed stronger antioxidant and lipoxygenase inhibitory effects than their glycosides. Lignoid glycosides showed moderate to weak antioxidant and lipoxygenase inhibitory effects.@*CONCLUSIONS@#A total of 14 compounds were isolated and identified from Simmondsia chinensis; 12 of them were isolated for the first time. This is the first report that highlights deeply on the phenolic content of jojoba and their potential biological activities and shows the importance of this plant as a good source of phenolics in particular the flavonoid content.

Antioxidant lipoxygenase inhibitors from the leaf extracts of Simmondsia chinensis

Objective: To isolate and identify chemical constituents with antioxidant and lipoxygenase inhibitory effects of the ethanolic extract of Simmondsia chinensis (Jojoba) leaves. Methods: The alcoholic extract was subjected to successive solvent fractionation. The antioxidant active fractions (chloroform, ethyl acetate and aqueous fractions) were subjected to a combination of different chromatographic techniques guided by the antioxidant assay with DPPH. The structures of the isolated compounds were elucidated on the basis of spectroscopic evidences and correlated with known compounds. The antioxidant activity was assessed quantitively using DPPH and β-carotene methods. The inhibitory potential against enzyme lipoxygenase was assessed on soybean lipoxygenase enzyme. Results: Ten flavonoids and four lignans were isolated. Flavonoid aglycones showed stronger antioxidant and lipoxygenase inhibitory effects than their glycosides. Lignoid glycosides showed moderate to weak antioxidant and lipoxygenase inhibitory effects. Conclusions: A total of 14 compounds were isolated and identified from Simmondsia chinensis; 12 of them were isolated for the first time. This is the first report that highlights deeply on the phenolic content of jojoba and their potential biological activities and shows the importance of this plant as a good source of phenolics in particular the flavonoid content.

WHO/INRUD drug use indicators at primary healthcare centers in Alexandria, Egypt

Appropriate use of drugs is one essential element in achieving quality of health and medical care for patients and the community. The study aims to measure the performance of 10 primary health care centers [PHCCs] in Alexandria, Egypt regarding the use of drugs using the WHO/INRUD drug use indicators: prescribing, patient care and facility-specific indicators. One-thousand prescribing encounters were investigated for a period from January to December 2010. Three-hundred patients and 10 pharmacists were interviewed. Data entry and analysis were conducted using SPSS version 19. Mean, median and SD were measured. An ANOVA test was applied. Prescribing indicators were within optimal or slightly below the optimal value except encounters with antibiotics prescribed that were higher than the optimal value. The difference between PHCCs was statistically significant for all prescribing indicators [P = 0.000]. Concerning patient care indicators, average consultation and dispensing times were short, and there was no drug labeling at all. The difference between PHCCs was significant for all patient care indicators except the percentage of drugs labeled and patient's knowledge of correct dosage. Both facility-specific indicators were below the optimal value. Prescribing indicators were below optimum except average drugs/encounter and encounters with injection prescribed. Patient care indicators were below the optimal level especially for average consultation dispensing times and drug labeling. Facility-specific indicators were below optimum.

[Efficiency of endoscopic treatment with intra gastric balloon in severe to morbid obesity]

Obesity raises such a healthcare matter throughout the world. Its management is not only complex but also most often multidisciplinary. The medico-dietary treatment is of inconstant efficiency and the surgical treatment, though more efficient, presents a considerable morbidity-death rate. The endoscopic treatment through intra-gastric balloon avails a seducing alternative namely accounting for surgery preparation. To assess the efficiency of the endoscopic treatment through gastric balloon, both in the short and long term, and this is accounting for weight loss as well as tolerance. We have carried out a retrospective study including the patients suffering from severe to morbid obesity and who had a gastric balloon implemented in our Endoscopy Unit between November 2005 and December 2007. Twenty one patients were included. The average age was 32,19 +/- 12,65 years with extremes of 16 and 52 years. Fifteen patients suffered from morbid obesity. The patients' average weight was 134, 52 +/- 26,46 kg [extremes 88 and 194 kg]. Some co-morbidity was found out with 15 patients. Te balloon implementation [Héliosphère[registered sign]] was carried out with no incidents in all patients. Six months after the balloon implementation, the average weight loss was17,5% and the average loss of overweigh was 37%. In biological level, we noted a normalisation of fasting glycaemia in 28,6 % of cases, of the cholesterolemia in 100 %, of the triglyceridemia in 33,33%, of the uraemia in 42,8% and hepatic tests in 50 % of the cases. The metabolic syndrome disappeared in 28,57 % of cases. The assessment after a 5-year-period was marked by the need to surgical treatment in 4 patients and this is due to the loss of efficiency of endoscopic treatment. A bad tolerance of gastric balloon was observed in 34 % of the cases, dominated by sicknesses. Only one patient presented incoercible sicknesses with ionic troubles as well as deshydrating requiring the precocious extraction of the balloon after 48 hours of its implementation. The endoscopic treatment through intra gastric balloon is well tolerated but efficiently limited in time. It might be recommended in preparation for a surgical treatment or in case of contre- indication or surgery refusal

Prevalence and risk factor of renal dysfunction induced by bacterial infection other than spontaneous bacterial peritonitis in patients with cirrhosis

Deterioration of renal function in cirrhotic patients with spontaneous bacterial peritonitis [SBP] is a predictor for inhospital mortality. However, the clinical significance of renal dysfunction during bacterial infection other than SBP is unknown. To investigate the prevalence and clinical significance of renal dysfunction due to bacterial infections other than SBP in patients with liver cirrhosis. Retrospective data from in-patients with bacterial infections other than SBP were analyzed. Eighty-two patients were recruited for the analysis. Infection was located in urinary tract [41.5%], pneumonia [34.1%], biliary tract [3.7%], cellulitis [6.1%], gastrointestinal tract [4.9%] and bacteremia of unknown origin [9.7%]. Renal dysfunction developed in 40 patients [48.8%], of which 13 patients had irreversible renal dysfunction. In the univariate and multivariate analysis, the initial MELD score, neutrophil count, bilirubin, and blood pressure were significant risk factors for renal dysfunction. The prevalence of renal dysfunction during bacterial infection other than SBP in patients with liver cirrhosis was 48.8%, and its development was related to the severity of the liver disease. Occurrence of irreversible renal dysfunction seemed to affect the prognosis of these patients

Malignant epithelioid hemangioendothelioma: a case report

Malignant epithelioid hemangioendothelioma [EH] is a rare tumor of vascular origin. We report a case of a woman who was found to have multiple hepatic masses in the right lobe of the liver on radiologic investigations, initially misdiagnosed as a metastatic carcinoma. The diagnosis of EH was made on histopathological study and confirmed by immunohistochemistry, which showed diffuse response for CD34 marker and no response to tissue CEA, HMB-45 or S-100 protein. Partial hepatectomy was made with good results

[Factors predicting mortality in infected hospitalized cirrhotics patients: about 97 cases]

Infections are frequent in cirrhotic patients. They are potentially severe, modifying pejoratively the natural history of the cirrhosis and are suppliers of a heavy mortality. To determine the predictive factors of hospital mortality in cirrhotic infected patients. We conducted a retrospective study including 97 cirrhotic patients hospitalized in the department of gastroenterology of Charles Nicolle's hospital, for a first infectious episode and not having received antibiotics in the previous 15 days. Clinico-biological, bacteriological, therapeutic and evolutionary data were collected. Scores were adopted and calculated such as the score of Child-Pugh, the score MELD [The Model for End-Stage Liver Disease] and the score SOFA [Sequential Organ Failure Assessment]. These data allowed a descriptive study and an uni and multi-varied analysis. The median age of the studied population was of 59 +/- 12 years with a sex ratio of 0.83. The diabetes was the comorbidity most frequently associated with the cirrhosis [26.8% of the cases] Viral aetiology of the cirrhosis was dominant [3/4 of the cases] especially the virus C [62.5% of the cases]. The clinical presentation of the infection was polymorphic with presence of symptoms connected to the infection and the other connected to the progression of the liver disease. The fever was absent in 3/4 of the cases. The identified infections were, in order of frequency, urinary, infection of ascite, bronchopulmonary, cutaneous and gynecological. The responsible germs were especially bacilli gram negative of intestinal origin. The estimated scores of gravity were: a score of Child-Pugh C in 60% of the cases, an average score MELD in 18 +/- 8 points and a score average SOFA in 8 +/- 4 points. Multivariate study found that only encephalopathy, bilirubin level more than 40 micro mol/l and creatinin level more than 120 micro mol/l was independent factors predicting mortality. Infection in cirrhotic patients was a severe and mortal complication. The hepatic encephalopathy, the hyper bilirubinemia and the renal failure are predictive of the hospital mortality. The use of the scores of gravity: Child-Pugh, MELD and SOFA would an important help for the decision to admit in intensive care unit any infected cirrhotic patient

[Epidemiological, clinical and therapeutic features of hepatocellular carcinoma in cirrhotic patients]

Hepatocellular carcinoma [HCC] is the most frequent primitive hepatic tumor, the fifth most common cancer in the world, and the third highest cause of cancer-related mortality. The presence of cirrhosis is the main risk factor. To describe the epidemiological, clinical and therapeutic features of HCC. Retrospective study including all the patients with HCC occurring in cirrhotic liver followed in the gastroenterological department of Charles Nicolle hospital between 1997 and 2009. A hundred and one patient were enrolled; 64 men and 37 women with a median age of 65.4 years [31-88 years]. Cirrhosis was due to viral hepatitis B or C in 25.7% and 62.2% of cases respectively and was classified Child Pugh A, B and C in 30.7%, 50.5% and 18.8% of patients respectively. HCC was inaugural in most cases [68.3%] and it was revealed by a tumoral syndrome in 38.6% of cases, by decompensation in 22.7% and was discovered during systematic screening when cirrhosis was already known in 19.8% of cases. Diagnosis of HCC was non invasive, relying imaging and alphafetoprotein in most cases [95%].84 patients [83.2%] had and advanced HCC, with vascular or extra hepatic spread in 58 [57.5%] of them. Treatment was curative in 14 cases, based on surgical resection in one and percutaneous ablation in 13 cases. Six patients received transarterial chemoembolization as a palliative treatment. In 71 patients, only symptomatic treatment was given. The median survival time was 11 months. In the majority of the cases, HCC was diagnosed at an advanced stage and treatment was only symptomatic

Colonoscopy in elderly: feasibility, tolerance and indications: about 901 cases

Colonoscopy is the standard investigation for colonic disease, but clinicians often are reluctant to refer elderly patients for colonoscopy because of a perception of higher risk and a high rate of incomplete examinations. To evaluate feasibility and tolerance of this investigation in elderly and to review the most frequent indications of colonoscopy in these patients. A pilot retrospective study including 901 patients from January 2005 to December 2009; divided into two groups. Group [I] included patients 75 years old and more, group [II] included patients 45 years old or less. All those patients underwent colonoscopy at the gastroenterology department of Charles Nicole hospital. The 1st group included 231 patients, and the 2nd group included 670 one. A past history of colorectal cancer was more frequent in the group I [33.3% versus 9.90%; p<0.05] however history of chronic inflammatory bowel disease was more frequent in group II [0 versus 40.6%; p<0.05]. The main indication of colonoscopy was constipation in group II [6.1% versus 27%; p<0.05] and chronic diarrhoea in group I [42.9% versus 16.4%; p<0.05]. Bowel preparation was poor in 30.4% cases of the group I and 12.9% of group II [p<0.05]. The tolerance was similar in the two groups. The incomplete colonoscopy rate was higher in the group I [38.3% versus 23.4%; p<0.05]. The most frequent cause of colonoscopy interruption was the poor preparation in group I and the bad tolerance in group II. Diverticular disease, polyps and colorectal cancers prevailed in group I, whereas inflammatory bowel disease was current in group II. In elderly patients, colonoscopy is safe, well tolerated and offers a good diagnostic yield. Its non completion was essentially due to the poor preparation. Sedation did not seem essential. The optimisation of results of colonoscopy requires an improvement of quality preparation

[Intestinal intussusceptions in adults: a 20 cases study]

Intestinal intussusception occurs when a portion of the gastrointestinal tract invaginates into the part of the tract that precedes into the peristaltic direction. To determinate clinical presentation, diagnostic methods, and outcome of intestinal intussusception and to compare our results to previous data. A retrospective study of 20 patients with mean age of 40 years admitted between 1982 and 1999 and underwent surgery for intestinal intussusceptions. Our patients were 10 males and 10 females. The clinical findings were essentially abdominal pain[90%].Preoperative diagnosis of intestinal intussusceptions was established in 30% of cases. Intussusceptions were ileo-ileal [n=10], ileo-colic [n=7] and colo-colic [n=3]. 12 patients had tumors. For all intussusceptions involving the colon,all patients underwent resection while intussusceptions located on the small bowel were treated by reduction then resection or simple reduction then fixation. The mortality rate was 5%. Intestinal intussusception in adults is uncommon in comparison with children. Correct diagnosis is often established during surgery. Resection is recommended because of the frequent malignancy

[Auto immune hepatitis type 1 triggered by cytomegalovirus infection]

Autoimmune hepatitis is chronic and uncommon disease. The pathogenesis is a complex process. Several triggers for autoimmunity in predisposed individuals. Report a new case. We report a case of 17-year-woman presented with autoimmune triggered by cytomegalovirus infection. Cytomegalovirus induced autoimmune hepatitis has not been reported previously. Evolution was favourable under antiviral treatment, corticosteroid and azathioprine

Hepatocellular carcinoma with sarcomatous change

Hepatocellular carcinoma [HCC] with sarcomatous change is an uncommon neoplasm with a poor prognosis. To report a new case. A 72-year-old man presented with abdominal right upper quadrant pain. The diagnosis of cirrhosis was suspected on clinical and biochemical data. On abdominal computed tomography, the mass was not enhanced in the arterial phase and exhibited peripheral enhancement during portal phase which persisted in the delayed phase. The serum alpha-fetoprotein was 500 ng/ml but since the imaging features were not typical of ordinary HCC, percutaneous liver biopsy was performed and confirmed the diagnosis of HCC with sarcomatous change. Except for liver biopsy, no diagnostic method could distinguish between sarcomatous and ordinary HCC

Evaluation of nutritional status in patients with liver cirrhosis

Malnutrition is a frequently reported complication in patients with liver cirrhosis. It has a high clinical and economic impact reflected by an increased morbidity and prolonged hospital stay. This preliminary prospective study aimed to determine the prevalence of malnutrition in hospitalized cirrhotic patients and to investigate whether biological and anthropometric parameters are a valuable tool for identifying malnutrition in these patients. The nutritional status of 44 consecutive cirrhotic patients [21 men, 23 women] was assessed according to the anthropometric measurements and biochemical analysis. The diagnosis of malnutrition was based on diminished values of Mid arm muscle circumference [MAMC] and/or Triceps skinfold thikness [TST] below the 5th percentile or less than 60%. The aetiology of cirrhosis was viral hepatitis in 29 patients [66%]. Cirrhosis was classified Child Pugh A, B or C in respectively 9, 26 and 9 patients; 37 patients [84%] have mild or tense ascite. In this study, malnutrition was found in 35 patients [79.5%], whereas 9 patients has a good nutritional status. TST and MAMC less than 60%was found in respectively 72%and 25%of patients. No significant statistical difference in epidemiological characteristics was found between malnourished and well-nourished patients. TST and MAMC decreased significantly according to the Child score [p=0.014 and 0.032 respectively; a positive correlation was found between these two paramelers and the severity of cirrhosis. In this study, the high prevalence of denutrition was associated with the severity of cirrhosis. Anthropometric parameters are valuable tools for malnutrition diagnosis

Transverse myelitis associated with chronic viral hepatitis C

HCV infection could cause several extra hepatic diseases including mixed cryoglobulinemia, Peripheral neuropathy is the most common complication of mixed cryoglobulinemia. In addition to cryoglobulinemia's neuropathy, transverse myelitis had been related to had infection. But causality of this association is not clearly established. A 55-year-old man presented with motor deficiency in lower extremities and urinary retention Neurological exams showed a spastic paraparesis and proprioceptive ataxia. Spinal MRI revealed a contrast enhancing signal abnormality within the spinal cord extending from Levels C3 to CS. Serology hepatitis C and viremia were positive. Clinical diagnosis of acute demyelinating sensorimotor polyneuropathy associated to chronic hepatitis C was etablished. Screening of HCV infection must be done in patients with transverse myelitis and no clear aetiology

[Nephrogenic ascites: an exceptional diagnosis. about one case]

Nephrogenic ascites is a clinical entity that manifests as refractory and exsudative ascites with unknown etiology in patients with end stage renal disease and often undergoing hemodialysis. This entity presents in practice many diagnostic and therapeutic difficulties. The aim of this study is to focus on these difficulties through a new observation. We report one case of nephrogenic ascites in chronic renal failure related to an idiopathic neurologic bladder. It's a 38 years old patient on hemodialysis for three years who consulted for exsudative ascites with a low rate of leucocytes. We conclude that nephrogenic ascites is rare. Its diagnosis is an exclusion diagnosis based on exclusion of other causes of ascites, particularly exsudative forms with low leucocytes rate. Its management is based essentially on renal transplantation and its prognosis is very poor