Hypokalemia as a responsible factor related with the severity of hepatic encephalopathy: a wide multination cross-sectional study.

Several precipitating factors of hepatic encephalopathy have been recognized and studied. Hepatic encephalopathy which is a frequent and grave complication of liver failure, is associated with multiple biochemical changes like high serum ammonia, mercaptan and phenol levels, low albumin levels and derangements in electrolytes. It is characterized by a range of neuronal and psychological aberrations mainly due to the inability of liver to metabolize different neurotoxic chemicals produced in the body. Hypokalemia is one of the most important findings in hepatic encephalopathy and postulated as a precipitating factor of the condition. The authors aimed to know the frequency of hypokalemia and its relation to the severity of hepatic encephalopathy. Methods: After taking approval from the hospital ethical review committee, a total of 5000 patients with hepatic encephalopathy were recruited by consecutive sampling. They were interviewed, examined and investigated for serum potassium levels and other precipitating factors of hepatic encephalopathy. Results: Total of 5000 patients including 3070 (61.4%) males and 1930 (38.6%) females, aging 13 years and above were studied. The frequency of hypokalemia was 78% (3900 patients). Relating the serum potassium level with the severity of hepatic encephalopathy, 1200 (60%) out of 2000 patients with serum potassium below 2.5 mEq/l were in grade 4 (40%) and 800 out of 2000 were in grade 3 encephalopathy. On the other hand, only 700 patients (6.4%) out 1100 with serum potassium above 3.4 mEq/l were in grade 4 encephalopathy. Conclusion: Hypokalemia is a frequent finding in patients with hepatic encephalopathy and found to be directly related to its severity.

Therapeutic efficacy of dendritic cell injection in advanced hepatocellular carcinoma: the role of natural killer and T lymphocytes.

Aim of the study: Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related fatalities worldwide. The burden of HCC incidence in Egypt has doubled in the last 10 years. The primary aim of this research was to assess the safety and efficacy of autologous dendritic cells (DCs) generated from peripheral blood. Material and methods: This trial was carried out at the Sohag Center of Cardiac and Digestive System. Patients with HCC were grouped into two groups (control group and DC injection group). The study group received intradermal autologous DCs twice weekly for three weeks, with a total of six vaccinations of 0.7 IU, whereas the control group received conservative treatment. Results: The study group showed statistically significant clinical improvement in the Child-Pugh score and overall survival. Laboratory evaluation revealed a significant reduction of α-fetoprotein, from 232 ng/dl at baseline to 193 ng/dl after 3 months to 153 ng/dl after 6 months, in the injection group, as compared with the control group, which increased from 228 ng/dl at baseline to 269 ng/dl at 3 months to 305 ng/dl at 6 months. Also, liver function improved significantly at both 3 and 6 months in the injected group compared with the control group. Regarding lymphocyte subsets, T-cytotoxic lymphocytes (CD8+) and natural killer cells (CD56+ve) increased significantly in the injection group. Conclusions: DC injection may be effective treatment of patients with advanced HCC to improve quality of life.

Association of anti-neutrophil cytoplasmic antibody in ischemic stroke Egyptian patients with hepatitis C virus.

Some studies reported a high prevalence of ischemic stroke in hepatitis C virus patients, other several studies have suggested that hepatitis C virus (HCV) may act as a trigger for autoimmune diseases and autoantibodies including Anti-Neutrophil Cytoplasmic Antibody (ANCA) which predispose to vasculitis. Because vasculitis is a risk factor for ischemic stroke, we investigated the association of the hepatitis C virus with ANCA in first-ever ischemic stroke patients. This study included 67 Egyptian patients with first-ever ischemic stroke. These patients were clinically examined and investigated for HCV infection by chemiluminescence & Real Time-PCR, and ANCA antibodies by ELISA. Forty-two patients (62.7%) had HCV infection. Twenty-nine (43.2%) of them were cytoplasmic- Antineutrophil Cytoplasmic Antibodies (c-ANCA) positive, while none was perinuclear- Antineutrophil Cytoplasmic Antibodies (p-ANCA) positive. Comparison between c-ANCA positive and ANCA negative patients showed that 82.8% and 47.4% had anti-HCV antibody, respectively, with P-value 0.003. The c-ANCA level correlated significantly with age, and HCV antibody level. No statistically significant difference was found in both the consciousness and stroke severity between the negative and positive c- ANCA patients. However, patients with positive c-ANCA had smaller and multiple cerebral infarctions with P-value 0.002 and 0.01 respectively. Multiple regression analysis showed that the number and size of cerebral infarctions were independent predictors of c-ANCA positivity with P value 0.02, and 0.03 respectively. In conclusion, c-ANCA level correlates with HCV antibody and may predispose to ischemic stroke by a possible ANCA associated vasculitis.

Role of Lymphotoxin-α Gene Polymorphism in Hepatitis C Virus-Related Chronic Liver Disorders.

BACKGROUND: Tumor necrosis factor (TNF) family includes lymphotoxin-alpha (LTA) which is a pro-inflammatory cytokine which plays a role in hepatic fibrogenesis. LTA gene polymorphism plays a role in different inflammatory and immunomodulatory diseases. This polymorphism is also suggested to affect chronic hepatitis C (CHC) infection course. AIM: To study the contribution of LTA gene polymorphism in different chronic hepatitis C stages and hepatocellular carcinoma risk. PATIENTS AND METHODS: Our study included 108 chronic HCV patients grouped according to the disease stage. Group (A): CHC, group (B): liver cirrhosis (LC), group (C): LC with HCC, and group (D): healthy controls. Routine laboratory investigations, polymerase chain reaction (PCR) for quantification of HCV, abdominal ultrasonography, and Liver stiffness measurement (LSM) were done. Child-Turcotte-Pugh, Model for end-stage liver disease (MELD), and Fibrosis index based on 4 (FIB-4) scores were calculated. We used the PCR-restriction fragment length polymorphism technique for lymphotoxin-α genotyping. RESULTS: The A/G genotype was predominant in all groups. In HCC patients, G/G genotype was more frequent (31.8%) than in the LC group (19.4%), CHC group (17.8%), and controls (4.17%). A significant association was found between LTA genotypes and the child classes in HCC (P<0.01) but not in LC patients (P>0.05). HCC patients carrying A/G genotype had higher MELD scores than other genotypes. Multivariate binary logistic regression analysis confirmed that LTA G/G genotype and low platelet count were independent predictors for HCC development in patients with HCV-related LC. CONCLUSION: Detection of LTA G/G genotype in chronic HCV patients could help to recognize high-risk patients for disease progression and HCC development.

Impact of COVID-19 infection on liver and alimentary tract: clinical insight.

Aim of the study: Our aim was to evaluate the impact of COVID-19 infection on the liver and alimentary tract. Material and methods: This is a retrospective multicenter study that was performed in non-intensive care units (ICU) at Minia, Assiut, and Sohag University Hospitals from March 1st, 2020 to August 1st, 2020. The clinical characteristics of 1238 consecutively confirmed COVID-19 discharged cases were enrolled. Patients with respiratory distress were recorded as severe cases, while others were recorded as mild-moderate cases. Patients with ≥ 2× upper limit of normal of alanine aminotransferase (ALT), aspartate aminotransferase (AST), or bilirubin were defined as patients with liver injury, while others were recorded as patients without liver injury. Results: The severe group included 460 patients (37.2%) while the mild-moderate group included 778 patients (62.8%). Fever, white blood cell (WBC) and C-reactive protein (CRP) levels were significantly higher in the severe group (p < 0.05). The hepatic injury group included 296 patients (23.9%) while the group without hepatic injury included 942 patients (76.1%). Males were more likely to have liver injury (p < 0.05). Fever and abdominal pain were significantly higher in the hepatic injury group. Patients with liver injury had increased levels of WBCs, CRP and chest computed tomography (CT) score and had a longer hospital stay (p < 0.05). Chest CT score was a predictor of liver injury (p < 0.05). Conclusions: Liver injury in non-ICU hospitalized COVID-19 patients is common but it is mild and has a good prognosis. Liver injury may be related to the degree of chest CT lesions.

Efficacy and safety of sofosbuvir and daclatasvir with or without ribavirin in elderly patients with chronic hepatitis C virus infection.

Hepatitis C virus (HCV) infection is considered as a major public health problem that, worldwide, chronically affects 170 million people. Elderly patients are more likely than younger patients to have increased duration of infection, increased rate of disease progression, and subsequently increased incidence of advanced liver disease. Natural history models predicted that the prevalence of HCV infection and its chronic sequelae as well as extrahepatic manifestations will eventually increase through the next decade and will mostly affect those who are greater than 60 years of age. Moreover, polytherapy and polypharmacy are frequent in elderly patients due to associated comorbidities. As advanced age is associated with increasing risk of development of cirrhosis and hepatocellular carcinoma, elderly patients are in special need of safe and effective antiviral therapies. Achievement of sustained viral responses (SVR) is associated with reduced liver-related complications and overall mortality in such patients with the advanced liver disease. With the recent introduction of interferon-free direct-acting antivirals, successful treatment for chronic HCV infection had dramatically improved, with overall cure rates that exceed 90% SVR. In our study, we aimed to study the efficacy and safety of combined sofosbuvir and daclatasvir, with or without ribavirin, in management of chronically infected HCV elderly patients who are more than 60 years old.

Can eicosapentaenoic acid maintain the original ribavirin dose or affect the response during the treatment course of chronic hepatitis C virus (HCV) patients?

BACKGROUND/AIMS: Combination therapy with peginterferon (PEG-IFN) and ribavirin (RBV) has been recommended as a standard therapy for patients with chronic hepatitis C virus (HCV). Our aim was to evaluate the efficacy of eicosapentaenoic acid (EPA) against RBV-associated hemolytic anemia. MATERIALS AND METHODS: Two hundred and forty HCV patients included in the study were randomized to either the EPA group (n=120) or non-EPA group (n=120), and they received combination therapy with or without EPA. We compare changes in hemoglobin levels with RBV dose reduction rate in each group as well as treatment response. RESULTS: Of 120 patients randomized to receive combination therapy with EPA, 15/86 (17.5%) patients required RBV dose reduction, whereas 71/86 (82.5%) patients did not require RBV dose reduction; in the non-EPA group, 22/80 (27.5%) patients required RBV dose reduction and 58/80 (72.5%) patients did not require RBV dose reduction. There was no significant difference between the two groups in the rates of virologic response. CONCLUSION: EPA can decrease the rate of RBV dose reduction and RBV-induced hemolysis during the course of combination treatment. Further trials are required to investigate the role of EPA in the current regimens of HCV treatment that include ribavirin.