Comparison of liver biopsy and noninvasive techniques for liver fibrosis assessment in patients infected with HCV-genotype 4 in Egypt.

In Egypt, as elsewhere, liver biopsy (LB) remains the gold standard to assess liver fibrosis in chronic hepatitis C (CHC) and is required to decide whether a treatment should be proposed. Many of its disadvantages have led to develop noninvasive methods to replace LB. These new methods should be evaluated in Egypt, where circulating virus genotype 4 (G4), increased body mass index and co-infection with schistosomiasis may interfere with liver fibrosis assessment. Egyptian CHC-infected patients with G4 underwent a LB, an elastometry measurement (Fibroscan(©)), and serum markers (APRI, Fib4 and Fibrotest(©)). Patients had to have a LB ≥15 mm length or ≥10 portal tracts with two pathologists blinded readings to be included in the analysis. Patients with hepatitis B virus co-infection were excluded. Three hundred and twelve patients are reported. The performance of each technique for distinguishing F0F1 vs F2F3F4 was compared. The area under receiver operating characteristic curves was 0.70, 0.76, 0.71 and 0.75 for APRI, Fib-4, Fibrotest© and Fibroscan©, respectively (no influence of schistosomiasis was noticed). An algorithm using the Fib4 for identifying patients with F2 stage or more reduced by nearly 90% the number of liver biopsies. Our results demonstrated that noninvasive techniques were feasible in Egypt, for CHC G4-infected patients. Because of its validity and its easiness to perform, we believe that Fib4 may be used to assess the F2 threshold, which decides whether treatment should be proposed or delayed.

Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis.

BACKGROUND: Microbial infection of the pancreatic tissue in patients with severe acute pancreatitis increases the morbidity and mortality rates. Colonization of the lower gastrointestinal tract and oropharynx with Gram-negative, but sometimes also Gram-positive, bacteria precedes contamination of the pancreas. The aim of this study was to determine whether lactic acid bacteria such as Lactobacillus plantarum 299 could prevent colonization of the gut by potential pathogens and thus reduce the endotoxaemia associated with acute pancreatitis. METHODS: Patients with acute pancreatitis were randomized into two double-blind groups. The treatment group received a freeze-dried preparation containing live L. plantarum 299 in a dose of 109 organisms, together with a substrate of oat fibre, for 1 week by nasojejunal tube. The control group received a similar preparation but the Lactobacillus was inactivated by heat. RESULTS: A total of 45 patients completed the study. Twenty-two patients received treatment with live and 23 with heat-killed L. plantarum 299. Infected pancreatic necrosis and abscesses occurred in one of 22 patients in the treatment group, compared with seven of 23 in the control group (P = 0.023). The mean length of stay was 13.7 days in the treatment group versus 21.4 days in the control group (P not significant). CONCLUSION: Supplementary L. plantarum 299 was effective in reducing pancreatic sepsis and the number of surgical interventions.

Relief of sever left ventricular outflow obstruction in a case of hypertrophic obstructive cardiomyopathy treated with practolol.

The clinical and haemodynamic findings in a patient with hypertrophic obstructive cardiomyopathy and severe left ventricular outflow obstruction are presented. Treatment with an increasing dose of orally administered practolol up to a maximum of 1200 mg a day, resulted in symptomatic improvement, and abolition of the resting gradient when the patient was recatheterized six months later.