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Diagnostic non-invasive model of large risky esophageal varices in cirrhotic hepatitis C virus patients

World Journal of Hepatology 2016年第24期8卷 1028-1037页

作者： hatem elalfy Walid Elsherbiny Ashraf Abdel Rahman Dina Elhammady Shaker Wagih Shaltout Ayman Z Elsamanoudy Bassem El Deek Tropical Medicine Department Mansoura Faculty of Medicine Mansoura University Hospital Diagnostic Radiology Department Mansoura Faculty of Medicine Mansoura University Children Hospital Medical Biochemistry and Molecular Biology Faculty of Medicine Mansoura University Department of Community Medicine Faculty of Medicine Mansoura University

AIM To build a diagnostic non-invasive model for screening of large varices in cirrhotic hepatitis C virus(HCV) patients. METHODS This study was conducted on 124 post-HCV cirrhotic patients presenting to the clinics of the Endemic Medicine Department at Mansoura University Hospital for evaluation before HCV antiviral therapy: 78 were Child A and 46 were Child B(score ≤ 8). Inclusion criteria for patients enrolled in this study was presence of cirrhotic HCV(diagnosed by either biopsy or fulfillment of clinical basis). Exclusion criteria consisted of patients with other etiologies of liver cirrhosis, e.g., hepatitis B virus and patients with high MELD score on transplant list. All patients were subjected to full medical record, full basic investigations, endoscopy, and computed tomography(CT), and then divided into groups with no varices, small varices, or large risky varices. In addition, values of Fibrosis-4 score(FIB-4), aminotransferase-to-platelet ratio index(APRI), and platelet count/splenic diameter ratio(PC/SD) were also *** Detection of large varies is a multi-factorial process, affected by many variables. Choosing binary logistic regression, dependent factors were either large or small varices while independent factors included CT variables such coronary vein diameter, portal vein(PV) diameter, lieno-renal shunt and other laboratory noninvasive variables namely FIB-4, APRI, and platelet count/splenic diameter. Receiver operating characteristic(ROC) curve was plotted to determine the accuracy of non-invasive parameters for predicting the presence of large esophageal varices and the area under the ROC curve for each one of these parameters was obtained. A model was established and the best model for prediction of large risky esophageal varices used both PC/SD and PV diameter(75% accuracy), while the logistic model equation was shown to be(PV diameter ×-0.256) plus(PC/SD ×-0.006) plus(8.155). Values nearing 2 or more denote large ***

关键词： Diagnostic model Large varices Cirrhotic hepatitis C virus Computed tomography noninvasive variceal diagnosis

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Diffusion-weighted magnetic resonance imaging and micro-RNA in the diagnosis of hepatic fibrosis in chronic hepatitis C virus

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World Journal of Gastroenterology 2019年第11期25卷 1366-1377页

作者： Tarek Besheer hatem elalfy Mohamed Abd El-Maksoud Ahmed Abd El-Razek Saher Taman Khaled Zalata Wagdy Elkashef Hossam Zaghloul Heba Elshahawy Doaa Raafat Wafaa Elemshaty Eman Elsayed Abdel-Hady El-Gilany Mahmoud El-Bendary Department of Tropical Medicine and Hepatology Mansoura Faculty of Medicine-Mansoura University Department of Diagnostic Radiology Mansoura Faculty of Medicine-Mansoura University Department of Pathology Mansoura Faculty of Medicine-Mansoura University Department of Clinical Pathology Mansoura Faculty of Medicine-Mansoura University Department of Public Health and Preventive Medicine Mansoura Faculty of Medicine-Mansoura University

BACKGROUND Diffusion-weighted magnetic resonance imaging has shown promise in the detection and quantification of hepatic fibrosis. In addition, the liver has numerous endogenous micro-RNAs(miRs) that play important roles in the regulation of biological processes such as cell proliferation and hepatic *** To assess diffusion-weighted magnetic resonance imaging and miRs in diagnosing and staging hepatic fibrosis in patients with chronic hepatitis *** This prospective study included 208 patients and 82 age-and sex-matched controls who underwent diffusion-weighted magnetic resonance imaging of the abdomen, miR profiling, and liver biopsy. Pathological scoring was classified according to the METAVIR scoring system. The apparent diffusion coefficient (ADC) and miR were calculated and correlated with pathological *** The ADC value decreased significantly with the progression of fibrosis, from controls(F0) to patients with early fibrosis(F1 and F2) to those with late fibrosis(F3 and F4)(median 1.92, 1.53, and 1.25 × 10^(-3) mm^2/s, respectively)(P = 0.001).The cut-off ADC value used to differentiate patients from controls was 1.83 × 10^(-3) mm^2/s with an area under the curve(AUC) of 0.992. Combining ADC and miR-200 b revealed the highest AUC(0.995) for differentiating patients from controls with an accuracy of 96.9%. The cut-off ADC used to differentiate early fibrosis from late fibrosis was 1.54 × 10^(-3) mm^2/s with an AUC of 0.866. The combination of ADC and miR-200 b revealed the best AUC(0.925) for differentiating early fibrosis from late fibrosis with an accuracy of 80.2%. The ADC correlated with miR-200 b(r =-0.61, P = 0.001), miR-21(r =-0.62, P = 0.001), and miR-29(r = 0.52,P = 0.001).CONCLUSION Combining ADC and miRs offers an alternative surrogate non-invasive diagnostic tool for diagnosing and staging hepatic fibrosis in patients with chronic hepatitis C.

关键词： Diffusion Magnetic resonance imaging Fibrosis Liver Hepatitis C virus Micro-RNA

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Epidemiological Aspects of Intrafamilial Spread of HCV Infection in Egyptian Population: A Pilot Study

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Open Journal of Gastroenterology 2014年第5期4卷 228-236页

作者： Mahmoud El-Bendary Gamal Esmat Mustafa Neamatallah Emily Kamel Tarek Besheer hatem elalfy Maged El-Setouhy Dalia Omran Department of Community Environmental and Occupational Medicine Ain-Shams Faculty of Medicine Ain-Shams University Cairo Egypt Medical Biochemistry Department Mansoura Faculty of Medicine Mansoura University Mansoura Egypt Public Health & Preventive Medicine Department Mansoura Faculty of Medicine Mansoura University Mansoura Egypt Tropical Medicine & Hepatology Department Cairo Faculty of Medicine Cairo University Giza Egypt Tropical Medicine & Hepatology Department Mansoura Faculty of Medicine Mansoura University Mansoura Egypt

Aim: Liver disease is a leading cause of morbidity and mortality among Egyptians. The major cause is infection with HCV, with 70 000 up to 140 000 newly reported cases annually. The objectives of this study were to determine the prevalence of anti-HCV antibodies among household contacts of HCV index cases and to identify the possible risk factors of transmission of HCV among Egyptian families. Material and Methods: The present external pilot study (double centre study) was performed on a convenient sample of 125 index cases and their 321 household family contacts recruited from Mansoura & Cairo University where 2 questionnaires were used to collect data from the index & their related contacts. The all were exposed to clinical examinations, routine laboratory testing & screening for the prevalence of Anti-HCV antibodies. Results: The prevalence of anti-HCV seropositivity among household contacts of index cases was found to be 13.7% which husbands of female index cases ranked first followed by wives of male index cases (36.36% versus 17.86% respectively,

关键词： HCV Intrafamilial Transmission Epidemiology

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Pathological characterization of occult hepatitis B virus infection in hepatitis C virus-associated or non-alcoholic steatohepatitis-related hepatocellular carcinoma

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World Journal of Meta-Analysis 2020年第2期8卷 67-77页

作者： hatem elalfy Tarek Besheer Dina Elhammady Ahmed El Mesery Shaker Wagih Shaltout Mohamed Abd El-Maksoud Ahmed I Amin Ahmed Nasr Bekhit Mahmoud Abd El Aziz Mahmoud El-Bendary Endemic Medicine Department Faculty of MedicineMansoura UniversityMansoura 35516Egypt Tropical Medicine Department Faculty of MedicinePort Said UniversityPort Said 42511Egypt Internal Medicine Department Faculty of MedicinePort Said UniversityPort Said 42511Egypt Tropical Medicine Department Zagazig General HospitalZagazig 44511Egypt

Occult hepatitis B virus(HBV)infection,by definition,is a state in which infection with this virus does not manifest with the conventional diagnostic laboratory criteria reserved for the obvious form of HBV *** a result,occult HBV infection is commonly a surprise finding discovered accidently during the evaluation of other apparent liver diseases,such as hepatitis C virus(HCV)infection or non-alcoholic fatty liver disease and,more importantly,their evolution into life-threatening hepatocellular *** infection with HCV and occult HBV is rarely considered when assessing these more obvious conditions,and in an attempt to offer a better understanding of this phenomenon,this study attempted to shed some light onto the uniqueness of occult HBV infection by addressing the natural history of HBV and HCV infections,as well as non-alcoholic fatty liver *** was carried out by taking into account the exclusive integration process undertaken by the HBV genome into infected host hepatocytes,with consideration given to conditions which afford reactivation of the occult infection and stress on the molecular mechanisms that underlie occult HBV ***,the clinical outcome of occult HBV infection and its relation to hepatocellular carcinoma is analyzed.

关键词： Occult hepatitis B virus Hepatitis C virus Non-alcoholic fatty liver disease Hepatocellular carcinoma Clinical outcome Pathophysiology of occult hepatitis B virus

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Medical treatment of inflammatory punctual stenosis monitored by anterior segment optical coherence tomography

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International Journal of Ophthalmology(English edition) 2020年第7期13卷 1074-1078页

作者： Hanan Youssef elalfy Mahmoud A Elsamkary Ahmed M Shafek Elridy Tarek M Saad Saad Mohamed Rashad Samah M Fawzy Al Dorra Subspecialty Ophthalmology Centre Cairo 11751Egypt Department of Ophthalmology Ain Shams UniversityCairo 11471Egypt

AIM:To evaluate the role of medical treatment in the management of inflammatory punctum stenosis guided by spectral domain anterior segment optical coherence tomography(OCT).METHODS:This prospective study included 60 patients complaining of epiphora due to inflammatory punctual *** were divided into two groups:Group A(30 patients)treated with a combination of preservative free hydrocortisone sodium phosphate 3.35 mg/m L eye drops,and preservative free artificial tears based on sodium hyaluronate,polyethylene and propylene Glycol;Group B(30 patients)treated with the same preservative free artificial tears *** normal subjects were included for comparison of pre-treatment anatomical *** starting treatment,all patients underwent anterior segment assessment including slit lamp examination,measurement of intraocular pressure(IOP),fluorescein dye disappearance test,and measurement of the outer punctum diameter(OPD)by Spectral domain anterior segment *** assessments were repeated at each follow up done at 1 and 3 mo later,together with subjective evaluation of patient’s satisfaction of the treatment outcome by simple rating ***:Punctual diameter increased significantly with treatment in both groups(P<0.0001);although the widening was more in Group A as compared to group B(16.2%vs 8%of the original punctual size,mean difference of 28.933μm,P=0.0076).Subjective satisfaction with treatment outcome was also better in group A(70%vs 40%,Chi-square P=0.0397).CONCLUSION:A combination of preservative free steroid eye drops and artificial tears causes significant widening of inflammed stenotic punctae and improvement of the associated epiphora.

关键词： artificial tears hydrocortisone inflammatory punctual stenosis optical coherence tomography preservatives

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