Abstract: PURPOSE: The presence of hepatitis B virus (HBV) DNA in liver tissue and/or in serum in the absence of detectable hepatitis B surface antigen (HBsAg) is called occult HBV infection. This pattern was identified in patients with chronic hepatitis C virus (HCV) infection. The aim of this study was to determine the role of antibodies to hepatitis B core antigen (anti-HBc) as a screening test for occult HBV infection in Egyptian chronic HCV patients. METHODS: One hundred chronic HCV patients negative for HBsAg were included and subdivided into two groups according to anti-HBc-IgG seroreactivity. Group A included 71 patients positive for anti-HBc (53 men and 18 women, mean age +/- SD 48.8 +/- 9.6 years), and group B included 29 patients negative for anti-HBc (18 men and 11 women, mean age +/- SD 46.6 +/- 11.7 years). All patients were subjected to full clinical assessment, routine laboratory investigations, abdominal ultrasonography and quantification of HBV-DNA by real-time PCR. RESULTS: Chronic HCV patients positive for anti-HBc have more severe liver disease compared with anti-HBc negative patients. Although HBV-DNA in the serum was detected in 22.5% of anti-HBc-positive chronic HCV patients, it was not detected in any of anti-HBc-negative chronic HCV patients. There was no significant difference in any of the clinical and laboratory data tested between anti-HBc-positive patients with and without HBV-DNA in the serum. CONCLUSION: A significant number of patients with anti-HBc had detectable levels of HBV-DNA in the serum. Egyptian chronic HCV patients have a high prevalence of occult HBV infection.

Abstract: Chronic neutrophilic leukaemia (CNL) is a rare myeloproliferative disorder of elderly patients characterised by sustained neutrophilia. The diagnosis of CNL requires the exclusion of BCR/ABL positive chronic myelogenous leukaemia and leukemoid reaction. We present here a case of a 61-year-old Egyptian man with CNL and 21 months of follow-up. The main symptom of our patient was purpura. Splenomegaly, hepatomegaly and lymph node enlargement were not detected at presentation or throughout the patient’s course. Thrombocytopenia was a considerable problem in our patient, causing recurrent bleeding and affecting the hydroxyurea dose adjustment. While hydroxyurea decreased the total leucocytic count, it could not affect the fatal course of the disease. The survival course of our patient extended to 21 months after presentation. The cause of death was attributed to disease progression.

Abstract: Introduction Patients with chronic liver disease ultimately progress to develop cirrhosis and portal hypertension. Recently it seems well established that nitric oxide disturbances play a key role in the pathogenesis of chronic liver disease and portal hypertension. The aim of this work was to clarify the correlation between chronic liver disease stages, liver function status, esophageal varices presence and nitric oxide disturbances. Subjects and methods All subjects (n = 120) in the present study were classified into; group I which included 15 age and sex matched healthy volunteers (taken as control), group II which included 20 patients with chronic active hepatitis, and group III which included 85 patients with hepatic cirrhosis. All subjects included were subjected to full clinical assessment, routine laboratory investigations, serum nitrate level determination using colorimetric method, abdominal ultrasonography and upper endoscopy. Results Increased serum nitrate level could not be detected in patients with chronic active hepatitis as well as those with early cirrhosis (Child’s class A). Progressive and significant increase of serum nitrate levels were detected in more advanced stages of cirrhosis (Child’s class B & C). The best non-invasive predictor for the presence of oesophageal varices was a combination of platelet count <150.000/mm3, splenomegaly >18 cm, Child’s class B or C and serum nitrate ≥38 μmol/l, with 93.3% sensitivity and 100% specificity. Conclusion Serum nitrate level can be used as a non-invasive predictor for progression of chronic liver disease as well as for the presence of oesophageal varices.

Abstract: Background/Aims: Patients with chronic liver disease ultimately progress to develop cirrhosis and portal hypertension. Recently it seems well established that nitric oxide disturbances play a key role in the pathogenesis of chronic liver disease and portal hypertension. The aim of this work was to clarify the correlation between liver disease stages, liver function status, oesophageal varices extent and the serum nitrate level. Methods: All subjects (n=120) in the present study were classified into ; group I which included 15 age and sex matched healthy volunteers (taken as control), group II which included 20 patients with chronic active hepatitis, and group III which included 85 patients with hepatic cirrhosis. All subjects included were subjected to full clinical assessment, routine laboratory investigations, serum nitrate level determination using colorimetric method, abdominal ultrasonography and upper endoscopy. Results: Increased serum nitrate levels could not be detected in patients with chronic active hepatitis as well as those with early cirrhosis (Child's class A). Progressive and significant increase of serum nitrate level was detected in more advanced stages of cirrhosis (Child's class B & C). The best non-invasive predictor for the presence of oesophageal varices was a combination of platelet count <150.000/ cmm, splenomegaly >18 cm, Child's class B or C and serum nitrate >38 ?mol/l, with 93.3% sensitivity and 100% specificity. Conclusions: Serum nitrate level can be used as a non-invasive predictor for progression of chronic liver disease as well as for the presence of oesophageal varices.

Abstract: Background/Aims: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections accounts for a substantial proportion of liver disease in Egypt. HBV and HCV are both transmitted through the blood and sexual contacts and infection with both viruses is common. Occult HBV is a new entity in which serum HBsAg is negative but HBV DNA is detectable in serum or liver tissues. The frequency of Occult HBV in chronic HCV patients is highly variable in the published studies. The aim of this study was to estimate the prevalence of occult HBV infection among chronic HCV Egyptian patients. Methods: One hundred chronic HCV patients, negative for HBsAg were included in the present study. All patients were subjected to anti-HBc IgG, anti-HBc IgM and HBeAg serologic tests. Quantitative assay of HBV DNA using Light Cycler real-time PCR in the serum was done for all patients. Results: HBV DNA was detected in 16 % of our patients. Anti-HBc IgG, anti-HBc IgM and HBeAg were detected in 69 %, 2 % and 4 % of our patients respectively. The frequency of anti-HBc IgG, anti-HBc IgM and HBeAg among patients with occult HBV infection was 100 %, 6.25 % and 6.25 % respectively. Conclusions: The prevalence of occult HBV infection among chronic HCV patients is 16 %.The main risk for occult HBV infection in chronic HCV patients is the presence of anti-HBc IgG anti

Abstract: Introduction: Erectile dysfunction is one of the most important complications of chronic liver disease the etiology of erectile dysfunction in patients with chronic liver diseases is multifactorial , the gonadal dysfunction and imbalance of sex hormones may be a possibility. The aim of the study was to determine the prevalence of erectile dysfunction in Egyptian cirrhotic patients and to assess the correlation between sex hormones and erectile dysfunction in male patients with cirrhosisPatients And Methods: Fifty five male patients with cirrhosis were included. The international index of erectile function-5 score was applied for all patients. They were classified according to Child's classification into classes A (n.15), B (n. 20), and C (n.20). Serum free and total testosterone hormone, prolactine hormone and serum estradiol were tested for all of them.Results: The overall prevalence of erectile dysfunction in patients with liver cirrhosis was 91.3%. According to Child's classification the percentage was 76.7%, 90%., and 100% in classes A, B and C respectively. There was a significant positive correlation between erectile score and testosterone level (free and total) and a high significant negative correlation between erectile score and prolactine as well as estradiol levels.Conclusion: Erectile dysfunction has a high prevalence rate in Egyptian cirrhotic patients . Low testosterone and high prolactine levels could be an etiological factor of erectile dysfunction in cirrhotic patients.?

Abstract: Introduction: Donor blood containing antibody to hepatitis B core antigen (anti-HBc) but lacking detectable hepatitis B surface antigen (HBsAg) and antibody ( anti-HBs) might transmit type B hepatitis. The aim of this study was to evaluate the role of HBcAb in blood screening for HBV infection in Egyptian blood donors. Subjects and methods: Serum samples were collected from 150 blood donors who tested negative for HBsAg, HBsAb, HCVAb, and HIV. All sera were subjected to HbcAb detection by using ELISA method and ALT level by using the calorimetric method. Samples which proved to be positive for HbcAb were further tested for the presence of HBV-DNA by PCR.Results: Antibodies to hepatitis B core antigen (HBcAb) were detected in 20 out of 150 (13.3% ) samples tested negative for HBsAg. HBV-DNA was detected in only two (10%) out of 20 HBcAb positive samples. Conclusion: Donor blood which is negative for HBsAg may be infectious for type B hepatitis if it possesses antibody to hepatitis B core antigen. It is recommended that the addition of this screening marker for routine use in blood banks may prevent the remaining cases of post-transfusion hepatitis B that might be transmitted from blood units screened only for HBsAg.?

Abstract: Introduction: Patients with hepatic cirrhosis frequently require surgical procedures. Many investigators have documented a high risk of morbidity and mortality associated with surgical procedures in this group of patients. The aim of this study was to clarify the risk factors and document the operative morbidity and mortality in cirrhotic patients undergoing surgery.Subjects and Methods: One hundred seventy six patients with hepatic cirrhosis undergoing surgery were included in this study. Preoperative, intraoperative and postoperative variables associated with 30 days morbidity and mortality were assessed by univariate and multivariate analysis. The sensitivity of both Child's classification and MELD score to predict postoperative prognosis were also assessed. Results: The perioperative mortality rate -30 days- was 9.7 % and the perioperative morbidity rate was 36.9 %. New onset or worsening of ascites was the most frequent postoperative complication. Factors that were identified as high independent risk factors for morbidity and mortality included upper GI bleeding, bleeding tendency, ascites, serum bilirubin 4mg/dl or more, presence of hepatosplenic schistosomiasis, ASA ( American Society of Anesthesiologists, Physical Status Scale ) class 4-5 and emergent surgical procedures. Conclusion: Preoperative assessment can predict survival with high accuracy in cirrhotic patients requiring surgical procedures.

Abstract: INTRODUCTION: Erectile dysfunction is one of the most important complications of chronic liver disease. The etiology of erectile dysfunction in patients with chronic liver diseases is multifactorial, the gonadal dysfunction and imbalance of sex hormones may be a possibility. AIMS & METHODS: Aim: The aim of the study was to determine the prevalence of erectile dysfunction in Egyptian cirrhotic patients and to assess the correlation between sex hormones and erectile dysfunction in patients with cirrhosis. Patients And Methods: Fifty five male patients with cirrhosis were included. The international index of erectile function-5 score was applied for all patients. They were classified according to Child's classification into classes A (n.15), B (n. 20), and C (n.20). Serum free and total testosterone hormone, prolactine hormone and serum estradiol were tested for all of them. RESULTS: The overall prevalence of erectile dysfunction in patients with liver cirrhosis was 91.3%. According to Child's classification the percentage was 76.7%, 90%., and 100% in classes A, B and C respectively. There was a significant positive correlation between erectile score and testosterone level and a high significant negative correlation between erectile score and prolactine as well as estradiol levels. CONCLUSION: Erectile dysfunction has a high prevalence rate in Egyptian cirrhotic patients. Low testosterone, high prolactine and high estradiol levels could be an etiological factors of erectile dysfunction in cirrhotic patients.

Abstract:

Abstract: Introduction: Donor blood containing antibody to hepatitis B core antigen (anti-HBc) but lacking detectable hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) might transmit type B hepatitis. The aim of this study was to evaluate the role of HBcAb in blood screening for HBV infection in Egyptian blood donors. Subjects and methods: Serum samples were collected from 150 blood donors who tested negative for HBsAg, HBsAb, HCV-Ab and HIV. All sera were subjected to HBcAb detection by using ELISA method and ALT level by using the calorimetric method. Samples which proved to be positive for HBcAb were further tested for the presence of HBV-DNA by PCR. Results: Antibodies to hepatitis B core antigen (HBcAb) were detected in 20 out of 150 (13.3%) samples tested negative for HBsAg. HBV-DNA was detected in only two (10%) out of 20 HBcAb positive samples. Conclusion: Donor blood which is negative for HBsAg may be infectious for type B hepatitis if it possesses antibody to hepatitis B core antigen. It is recommended that the addition of this screening marker for routine use in blood banks may prevent the remaining cases of post-transfusion hepatitis B that might be transmitted from blood units screened only for HBsAg.

Abstract: Introduction: Patients with hepatic cirrhosis frequently require surgical procedures. Many investigators have documented a high risk of morbidity and mortality associated with surgical procedures in this group of patients. The aim of this study was to clarify the risk factors and document the operative morbidity and mortality in cirrhotic patients undergoing surgery. Subjects and methods: One hundred seventy-six patients with hepatic cirrhosis undergoing surgery were included in this study. Pre-operative, intraoperative and post-operative variables associated with 30 days morbidity and mortality was assessed by univariate and multivariate analysis. The sensitivity of both Child’s classification and MELD score to predict post-operative prognosis were also assessed. Results: The perioperative mortality rate at 30 days was 9.7% and the perioperative morbidity rate was 36.9%. New onset or worsening of ascites was the most frequent post-operative complication. Factors that were identified as high independent risk factors for morbidity and mortality included upper GI bleeding, bleeding tendency, ascites, serum bilirubin 4 mg/dl or more, presence of hepatosplenic schistosomiasis, ASA (American Society of Anesthesiologists, Physical Status Scale) class 4–5 and emergent surgical procedures. Conclusion: Pre-operative assessment can predict survival with high accuracy in cirrhotic patients requiring surgical procedures.