Pub Date : 2024-04-15DOI: 10.1186/s43066-024-00332-9
Héctor Raúl Ibarra-Sifuentes, Gustavo Abraham Canales-Azcona, Jaqueline Isabel Gómez-Arredondo, Carlos Javier Rodríguez-Álvarez
Hepatocellular carcinoma is a major public health problem, as is considered the fastest growing cause of cancer-related death. Cannonball metastases as an initial finding in hepatocellular carcinoma are considered a rare phenomenon. A 59-year-old man presented to the outpatient clinic for subacute cough, asthenia, and involuntary weight loss. Chest X-ray showed multiple, round, bilateral pulmonary solid lesions. Contrast-enhanced computed tomography of the chest and abdomen revealed multiple bilateral, contrast-enhanced pulmonary nodules known as "cannonball" lesions and a heterogeneous lesion located in the right lobe of the liver with retroperitoneal lymphadenopathy. A biopsy was performed, and the histopathological result was compatible with metastatic poorly differentiated hepatocellular carcinoma. Due to the advanced stage of the disease, the patient received palliative care and expired two months later. Cannonball metastases in hepatocellular carcinoma are considered a rare finding and represents a poor prognosis. It is important to awaken the interest of clinicians in a timely diagnosis, as well as a possible suspicion of hepatocellular carcinoma in patients with this radiographic pattern.
肝细胞癌是一个重大的公共卫生问题，被认为是增长最快的癌症相关死亡原因。作为肝细胞癌最初发现的炮弹转移被认为是一种罕见现象。一名 59 岁的男子因亚急性咳嗽、气喘和不自主体重减轻到门诊就诊。胸部 X 光片显示多发、圆形、双侧肺实变。胸部和腹部对比增强计算机断层扫描显示，双侧多发、对比增强的肺部结节被称为 "炮弹 "病变，一个位于肝脏右叶的异质性病变伴有腹膜后淋巴结病变。患者接受了活组织检查，组织病理学结果显示为转移性低分化肝细胞癌。由于病情已到晚期，患者接受了姑息治疗，两个月后去世。肝细胞癌的炮弹状转移被认为是一种罕见的发现，预后较差。唤醒临床医生对及时诊断的兴趣非常重要，同时也要对有这种影像学模式的患者进行肝细胞癌的可能怀疑。
{"title":"Cannonball Pulmonary Metastases as Initial Presentation of Hepatocellular Carcinoma: A Case Report and Literature Review","authors":"Héctor Raúl Ibarra-Sifuentes, Gustavo Abraham Canales-Azcona, Jaqueline Isabel Gómez-Arredondo, Carlos Javier Rodríguez-Álvarez","doi":"10.1186/s43066-024-00332-9","DOIUrl":"https://doi.org/10.1186/s43066-024-00332-9","url":null,"abstract":"Hepatocellular carcinoma is a major public health problem, as is considered the fastest growing cause of cancer-related death. Cannonball metastases as an initial finding in hepatocellular carcinoma are considered a rare phenomenon. A 59-year-old man presented to the outpatient clinic for subacute cough, asthenia, and involuntary weight loss. Chest X-ray showed multiple, round, bilateral pulmonary solid lesions. Contrast-enhanced computed tomography of the chest and abdomen revealed multiple bilateral, contrast-enhanced pulmonary nodules known as \"cannonball\" lesions and a heterogeneous lesion located in the right lobe of the liver with retroperitoneal lymphadenopathy. A biopsy was performed, and the histopathological result was compatible with metastatic poorly differentiated hepatocellular carcinoma. Due to the advanced stage of the disease, the patient received palliative care and expired two months later. Cannonball metastases in hepatocellular carcinoma are considered a rare finding and represents a poor prognosis. It is important to awaken the interest of clinicians in a timely diagnosis, as well as a possible suspicion of hepatocellular carcinoma in patients with this radiographic pattern.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-03DOI: 10.1186/s43066-024-00329-4
Mohammed Ahmed Medhat, Mohamed O. Abdelmalek, Mohamed A. Mekky, Sherief Abd-Elsalam, Mohamed Ahmed Yehya Abdel-Malek, Sayed Hassan Ahmed, Yusuf S. Amry, Waleed Attia Hassan
Eosinophilic ascites is non-common and challenging disease. This study aimed to describe the clinical presentation and treatment of eosinophilic ascites. This was a prospective single-center study that included cases with eosinophilic ascites who were admitted to Tropical Medicine and Gastroenterology Department, Assiut University Hospital, Assiut, Egypt, during the period between May 2020 to May 2023. The clinical presentation, investigations, treatment, and follow-up data of the included patients were collected and analyzed. Seventeen cases of eosinophilic ascites were included in the study. The main presenting manifestations were abdominal pain (47.1%), and abdominal pain with distension (29.4%). Two patients presented with a picture of intestinal obstruction. Moderate ascites was found in 10 patients (58.8%) by ultrasound. Eosinophilia in the peripheral hemogram was detected in 76.5% of the study population. Endoscopic examination showed gastro-duodenitis in 9 patients (52.9%) and duodenitis in 4 patients (23.5%). All patients showed complete improvement and disappearance of ascites after starting steroids within two weeks. Eleven patients (64.7%) relapsed after discontinuation of steroids. Eosinophilic ascites is an uncommon cause of ascites that is often underdiagnosed. The relapse rate after stopping treatment is high but with excellent response to retreatment.
{"title":"Clinical and epidemiological characterization of eosinophilic ascites in Egypt: a single center experience","authors":"Mohammed Ahmed Medhat, Mohamed O. Abdelmalek, Mohamed A. Mekky, Sherief Abd-Elsalam, Mohamed Ahmed Yehya Abdel-Malek, Sayed Hassan Ahmed, Yusuf S. Amry, Waleed Attia Hassan","doi":"10.1186/s43066-024-00329-4","DOIUrl":"https://doi.org/10.1186/s43066-024-00329-4","url":null,"abstract":"Eosinophilic ascites is non-common and challenging disease. This study aimed to describe the clinical presentation and treatment of eosinophilic ascites. This was a prospective single-center study that included cases with eosinophilic ascites who were admitted to Tropical Medicine and Gastroenterology Department, Assiut University Hospital, Assiut, Egypt, during the period between May 2020 to May 2023. The clinical presentation, investigations, treatment, and follow-up data of the included patients were collected and analyzed. Seventeen cases of eosinophilic ascites were included in the study. The main presenting manifestations were abdominal pain (47.1%), and abdominal pain with distension (29.4%). Two patients presented with a picture of intestinal obstruction. Moderate ascites was found in 10 patients (58.8%) by ultrasound. Eosinophilia in the peripheral hemogram was detected in 76.5% of the study population. Endoscopic examination showed gastro-duodenitis in 9 patients (52.9%) and duodenitis in 4 patients (23.5%). All patients showed complete improvement and disappearance of ascites after starting steroids within two weeks. Eleven patients (64.7%) relapsed after discontinuation of steroids. Eosinophilic ascites is an uncommon cause of ascites that is often underdiagnosed. The relapse rate after stopping treatment is high but with excellent response to retreatment.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HBV infection is a significant concern in dialysis patients, influenced by various factors. This study aims to investigate the impact of serum uric acid levels on the immunogenicity of hepatitis Bvaccination in dialysis patients. A cross-sectional study was conducted, involving 125 hemodialysis patients. Prior to dialysis, assessments were made for uric acid, vitamin D, HBsAg, andHBsAb. Patients were divided into two groups based on uric acid levels: high level (≥ 6.5 mg/dl) and low level (< 6.5 mg/dl). Each group received three doses of a high-dose hepatitis B vaccine (40 mcg) at 0, 1, and 6 months. After 8 weeks of the 3rd dose of the vaccine, the anti-hepatitis B antibody titer (HBsAb) was measured and recorded. Data were analyzed using SPSS version 22. Among patients with high uric acid, 30 (26.8%) had low HBsAb and 82 (73.2%) had high HBsAb (> 10). In patients with low uric acid, 1 (7.7%) had low HBsAb and 12 (92.3%) had high HBsAb (> 10). There was no statistically significant difference inHBsAb between the two groups. The immune response of HBsAb and uric acid did not show significance based on demographic variables and laboratory results. This study found no correlation between uric acid levels and the immunogenicity of hepatitis B vaccination in hemodialysis patients. However, it is important to note that the group with low serum uric acid was very small compared to the other group and this may have influenced these results. Further studies with larger patient populations are needed to provide more conclusive evidence in this area.
{"title":"Investigating the effect of serum level of uric acid on the immunogenicity of hepatitis B vaccination in dialysis patients","authors":"Nasibe Golestani, Najmeh Shamspour, Jalal Azmandian, Habibeh Ahmadipour, Mahdi Karamipour zarei","doi":"10.1186/s43066-024-00328-5","DOIUrl":"https://doi.org/10.1186/s43066-024-00328-5","url":null,"abstract":"HBV infection is a significant concern in dialysis patients, influenced by various factors. This study aims to investigate the impact of serum uric acid levels on the immunogenicity of hepatitis Bvaccination in dialysis patients. A cross-sectional study was conducted, involving 125 hemodialysis patients. Prior to dialysis, assessments were made for uric acid, vitamin D, HBsAg, andHBsAb. Patients were divided into two groups based on uric acid levels: high level (≥ 6.5 mg/dl) and low level (< 6.5 mg/dl). Each group received three doses of a high-dose hepatitis B vaccine (40 mcg) at 0, 1, and 6 months. After 8 weeks of the 3rd dose of the vaccine, the anti-hepatitis B antibody titer (HBsAb) was measured and recorded. Data were analyzed using SPSS version 22. Among patients with high uric acid, 30 (26.8%) had low HBsAb and 82 (73.2%) had high HBsAb (> 10). In patients with low uric acid, 1 (7.7%) had low HBsAb and 12 (92.3%) had high HBsAb (> 10). There was no statistically significant difference inHBsAb between the two groups. The immune response of HBsAb and uric acid did not show significance based on demographic variables and laboratory results. This study found no correlation between uric acid levels and the immunogenicity of hepatitis B vaccination in hemodialysis patients. However, it is important to note that the group with low serum uric acid was very small compared to the other group and this may have influenced these results. Further studies with larger patient populations are needed to provide more conclusive evidence in this area.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1186/s43066-024-00326-7
G. Esmat, H. Zaid, M. Hassany, W. Abdel-Razek, M. El-Serafy, Wafaa El Akel, Aysam Salah, Ehab Kamal, G. Elshishiney, I. Ammar, K. Kabil, Mohamed Abdallah, R. Saeed, T. Saad, Y. Omar, Hany Dabbous, Manal H. El-Sayed, Y. El Shazly, W. Doss, I. Waked
{"title":"Obesity prevalence in adults and patients with hepatitis C: results from screening a population of 50 million in Egypt","authors":"G. Esmat, H. Zaid, M. Hassany, W. Abdel-Razek, M. El-Serafy, Wafaa El Akel, Aysam Salah, Ehab Kamal, G. Elshishiney, I. Ammar, K. Kabil, Mohamed Abdallah, R. Saeed, T. Saad, Y. Omar, Hany Dabbous, Manal H. El-Sayed, Y. El Shazly, W. Doss, I. Waked","doi":"10.1186/s43066-024-00326-7","DOIUrl":"https://doi.org/10.1186/s43066-024-00326-7","url":null,"abstract":"","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140355949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1186/s43066-024-00327-6
Pranali A. Jadhav, Asha B. Thomas, R. Nanda, S. Chitlange
{"title":"Correlation of non-alcoholic fatty liver disease and gut microflora: clinical reports and treatment options","authors":"Pranali A. Jadhav, Asha B. Thomas, R. Nanda, S. Chitlange","doi":"10.1186/s43066-024-00327-6","DOIUrl":"https://doi.org/10.1186/s43066-024-00327-6","url":null,"abstract":"","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140356173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-19DOI: 10.1186/s43066-024-00325-8
Reham Ashour, Rahma Ibrahim, Ammar Muhammed
Hepatitis A is the most common cause of acute hepatitis around the globe, especially in developing countries. It often presents with signs and symptoms related to the gastrointestinal system. However, it rarely presents extrahepatic manifestations, which can be more common in adults than in children. We report a unique case of hepatitis A presenting with encephalitis that was resolved conservatively. Before attributing the neurological features to hepatitis A, we had to rule out other etiologies with similar presentations. Many viruses cause encephalitis, such as herpes simplex virus types 1 and 2, varicella zoster virus and enteroviruses. A few cases of hepatitis A complicated by encephalitis have been reported in the literature. In our case, developing a tonic-clonic seizure with no past seizure history demanded more investigations to exclude other etiologies. Ultimately, clinical signs and laboratory investigations led us to consider hepatitis A as the main cause of the patient’s symptoms of encephalitis. Hepatitis A virus may present with extrahepatic manifestations more than expected, so more studies and research should be done to increase physicians’ knowledge of these manifestations, make early diagnosis, and administer the effective treatment. • Encephalitis is a rare extrahepatic manifestation of HAV. • Encephalitis presenting with a tonic-clonic seizure and loss of consciousness in an icteric patient. • Differential diagnosis is important to exclude other etiologies of encephalopathy.
{"title":"Acute hepatitis A complicated by encephalitis: a case report and literature review","authors":"Reham Ashour, Rahma Ibrahim, Ammar Muhammed","doi":"10.1186/s43066-024-00325-8","DOIUrl":"https://doi.org/10.1186/s43066-024-00325-8","url":null,"abstract":"Hepatitis A is the most common cause of acute hepatitis around the globe, especially in developing countries. It often presents with signs and symptoms related to the gastrointestinal system. However, it rarely presents extrahepatic manifestations, which can be more common in adults than in children. We report a unique case of hepatitis A presenting with encephalitis that was resolved conservatively. Before attributing the neurological features to hepatitis A, we had to rule out other etiologies with similar presentations. Many viruses cause encephalitis, such as herpes simplex virus types 1 and 2, varicella zoster virus and enteroviruses. A few cases of hepatitis A complicated by encephalitis have been reported in the literature. In our case, developing a tonic-clonic seizure with no past seizure history demanded more investigations to exclude other etiologies. Ultimately, clinical signs and laboratory investigations led us to consider hepatitis A as the main cause of the patient’s symptoms of encephalitis. Hepatitis A virus may present with extrahepatic manifestations more than expected, so more studies and research should be done to increase physicians’ knowledge of these manifestations, make early diagnosis, and administer the effective treatment. • Encephalitis is a rare extrahepatic manifestation of HAV. • Encephalitis presenting with a tonic-clonic seizure and loss of consciousness in an icteric patient. • Differential diagnosis is important to exclude other etiologies of encephalopathy.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140169408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.1186/s43066-024-00322-x
Ashraf Abbass, Azza El Sheashaey, Ashraf El Fert, Manar Obada, Eman Abdelsameea, Mohammed Abdel-Samiee, Asmaa Ibrahim, Ashraf Khalil
Hepatic energy metabolism is intricately linked with the metabolic changes associated with HCV infection and hepatocellular carcinoma (HCC). This study investigated the potential of carnitine and acylcarnitines as markers for monitoring the development and progression of HCC in the context of HCV-induced liver cirrhosis. Blood samples from patients with chronic liver cirrhosis due to HCV (n = 55) and from those with HCC (n = 90) were analyzed, alongside samples from healthy control subjects (n = 25), utilizing liquid chromatography coupled with mass spectrometry. Principal component analysis revealed distinct metabolic clustering patterns, segregating HCC and HCV patients into separate groups. Pairwise comparisons showed significantly elevated acylcarnitine levels in both HCV and HCC patients when compared to the control group (p = 0.001). Importantly, there was no significant difference between HCV and HCC groups, although linear trend analysis indicated an increasing linear trend that reached its peak in the HCC group, signifying a notable relationship with disease severity (p = 0.001). The observed carnitine and acylcarnitine levels in HCV and HCC patients offer crucial clinical insights, suggesting their potential as valuable diagnostic and prognostic markers.
{"title":"Exploring the prognostic significance of blood carnitine and acylcarnitines in hepatitis C virus-induced hepatocellular carcinoma","authors":"Ashraf Abbass, Azza El Sheashaey, Ashraf El Fert, Manar Obada, Eman Abdelsameea, Mohammed Abdel-Samiee, Asmaa Ibrahim, Ashraf Khalil","doi":"10.1186/s43066-024-00322-x","DOIUrl":"https://doi.org/10.1186/s43066-024-00322-x","url":null,"abstract":"Hepatic energy metabolism is intricately linked with the metabolic changes associated with HCV infection and hepatocellular carcinoma (HCC). This study investigated the potential of carnitine and acylcarnitines as markers for monitoring the development and progression of HCC in the context of HCV-induced liver cirrhosis. Blood samples from patients with chronic liver cirrhosis due to HCV (n = 55) and from those with HCC (n = 90) were analyzed, alongside samples from healthy control subjects (n = 25), utilizing liquid chromatography coupled with mass spectrometry. Principal component analysis revealed distinct metabolic clustering patterns, segregating HCC and HCV patients into separate groups. Pairwise comparisons showed significantly elevated acylcarnitine levels in both HCV and HCC patients when compared to the control group (p = 0.001). Importantly, there was no significant difference between HCV and HCC groups, although linear trend analysis indicated an increasing linear trend that reached its peak in the HCC group, signifying a notable relationship with disease severity (p = 0.001). The observed carnitine and acylcarnitine levels in HCV and HCC patients offer crucial clinical insights, suggesting their potential as valuable diagnostic and prognostic markers.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140169089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1186/s43066-024-00321-y
Heba Omar, Mohammed Hamdy Abdel Maksoud, Ahmed A. Goma, Essam A. Hassan, Nancy Abdalla Atta, Mahmoud Khalil, Mohamed Soliman Hegazy, Samy Zaky, Gamal Esmat
NS5A inhibitors are an important option for treating chronic HCV-GT4 patients. Retreatments after NS5A-based DAAs failure are limited. We aimed to determine the effectiveness and safety of SOF/VEL-containing regimens for HCV retreatment after NS5A-regimen failure. Prospective cohort study assessing the efficacy and safety of retreatment with SOF/VEL in addition to either voxilaprevir or ribavirin in patients who had failed previous NS5A-based DAA treatment. The primary outcome was SVR12. Safety and tolerability data were collected. One hundred fifty patients were included. The mean age was 53 years, 64% were male, and 50% of included patients had liver cirrhosis, with a mean FIB-4 score of 3.12 (± 2.30) and Child-Turcotte-Pugh (CTP) score of 7.27 (± 0.48), and failed previous SOF/DCV + RBV, they were assigned to 24 weeks of SOF/VEL + RBV. The remaining 50% of participants had no liver cirrhosis and failed previous SOF/DCV, they were assigned to 12 weeks of treatment with SOF/VEL/VOX. Overall, SVR12 was achieved by 96% (n = 144/150) of included patients; 97.33% for SOF/VEL/VOX and 94.67% for SOF/VEL/RBV. Thirty-one patients experienced mild AEs; the most commonly reported mild AE in the SOF/VEL + RBV group was hyperbilirubinemia (n = 9) whereas in the SOF/VEL/VOX group were headache (n = 4) and vertigo (n = 4). Only one patient in SOF/VEL + RBV reported moderate treatment-related AE in the form of anemia and no reported severe AE. Retreatment of non-cirrhotic patients with 12 weeks SOF/VEL/VOX and treatment of cirrhotic patients with 24 weeks with SOF/VEL + RBV after the failure of first-line NS5A-based therapy was an effective and well-tolerated treatment option.
{"title":"Effectiveness and safety of SOF/VEL containing rescue therapy in treating chronic HCV-GT4 patients previously failed NS5A inhibitors-based DAAs","authors":"Heba Omar, Mohammed Hamdy Abdel Maksoud, Ahmed A. Goma, Essam A. Hassan, Nancy Abdalla Atta, Mahmoud Khalil, Mohamed Soliman Hegazy, Samy Zaky, Gamal Esmat","doi":"10.1186/s43066-024-00321-y","DOIUrl":"https://doi.org/10.1186/s43066-024-00321-y","url":null,"abstract":"NS5A inhibitors are an important option for treating chronic HCV-GT4 patients. Retreatments after NS5A-based DAAs failure are limited. We aimed to determine the effectiveness and safety of SOF/VEL-containing regimens for HCV retreatment after NS5A-regimen failure. Prospective cohort study assessing the efficacy and safety of retreatment with SOF/VEL in addition to either voxilaprevir or ribavirin in patients who had failed previous NS5A-based DAA treatment. The primary outcome was SVR12. Safety and tolerability data were collected. One hundred fifty patients were included. The mean age was 53 years, 64% were male, and 50% of included patients had liver cirrhosis, with a mean FIB-4 score of 3.12 (± 2.30) and Child-Turcotte-Pugh (CTP) score of 7.27 (± 0.48), and failed previous SOF/DCV + RBV, they were assigned to 24 weeks of SOF/VEL + RBV. The remaining 50% of participants had no liver cirrhosis and failed previous SOF/DCV, they were assigned to 12 weeks of treatment with SOF/VEL/VOX. Overall, SVR12 was achieved by 96% (n = 144/150) of included patients; 97.33% for SOF/VEL/VOX and 94.67% for SOF/VEL/RBV. Thirty-one patients experienced mild AEs; the most commonly reported mild AE in the SOF/VEL + RBV group was hyperbilirubinemia (n = 9) whereas in the SOF/VEL/VOX group were headache (n = 4) and vertigo (n = 4). Only one patient in SOF/VEL + RBV reported moderate treatment-related AE in the form of anemia and no reported severe AE. Retreatment of non-cirrhotic patients with 12 weeks SOF/VEL/VOX and treatment of cirrhotic patients with 24 weeks with SOF/VEL + RBV after the failure of first-line NS5A-based therapy was an effective and well-tolerated treatment option.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140099777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-09DOI: 10.1186/s43066-024-00320-z
A. Allam, M. Khedr, Shimaa Saad Elkholy, Takwa Abd El Rahman Yassin, Ola Ahmed Fouad
{"title":"Bile duct matrix metalloproteinase-7 expression: a new modality for diagnosis of biliary atresia","authors":"A. Allam, M. Khedr, Shimaa Saad Elkholy, Takwa Abd El Rahman Yassin, Ola Ahmed Fouad","doi":"10.1186/s43066-024-00320-z","DOIUrl":"https://doi.org/10.1186/s43066-024-00320-z","url":null,"abstract":"","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140077067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-08DOI: 10.1186/s43066-024-00323-w
Mona A. Abu El-Makarem, Aml A. Mohammad, Ola A. Afifi, Nehal I. Abbas, Tarek A. Abd El-Zaher, Safaa M. Abdel Halim, Aliaa S. Abd El-Fattah
Alterations of hemostasis in patients with decompensated cirrhosis are complex. Accordingly, standard coagulation tests are not feasible to evaluate bleeding risk in these patients. The aim of this study was to assess the coagulation kinetics in cirrhotic patients with variceal bleeding using rotational thromboelastometry (ROTEM). ROTEM including EXTEM, INTEM, and FIBTEM which represent extrinsic, intrinsic pathways, and fibrinogen activity, respectively, was measured in 60 cirrhotic patients with variceal bleeding who were compared to 60 patients with stable cirrhosis. APTEM was optionally performed to evaluate fibrinolysis. Overall, cirrhosis patients displayed features of hypofibrinolysis, whereas the state of hypocoagulability was significantly higher in cirrhotic patients with variceal bleeding (61.7% versus 30%, p = 0.001). Values of clot formation time (CFT) by EXTEM and INTEM correlated positively with those of model for end-stage liver disease score (r = 0.529, p = 0.001, and r = 0.595, p < 0.001, respectively). Furthermore, in a multivariate analysis, values of CFT in both assays were significantly associated with increased risk of 1.9 (95% CI = 1.04–2.45, p = 0.02) and of 1.78 (95% CI = 1.02–2.14, p = 0.01), respectively, for occurrence of variceal bleeding. Cirrhotic patients with variceal bleeding frequently showed a hypocoagulable state that is triggered by thrombocytopenia and/or hypofibrinogenemia. CFT by EXTEM and INTEM seemed to be an extra marker for disease severity and prognosis in cirrhosis patients, in addition to its valuable role in prediction of variceal bleeding in these patients. However, large multicenter studies have yet been required.
{"title":"The coagulation changes associated with acute variceal bleeding in patients with HCV-induced cirrhosis as assessed by rotational thromboelastometry","authors":"Mona A. Abu El-Makarem, Aml A. Mohammad, Ola A. Afifi, Nehal I. Abbas, Tarek A. Abd El-Zaher, Safaa M. Abdel Halim, Aliaa S. Abd El-Fattah","doi":"10.1186/s43066-024-00323-w","DOIUrl":"https://doi.org/10.1186/s43066-024-00323-w","url":null,"abstract":"Alterations of hemostasis in patients with decompensated cirrhosis are complex. Accordingly, standard coagulation tests are not feasible to evaluate bleeding risk in these patients. The aim of this study was to assess the coagulation kinetics in cirrhotic patients with variceal bleeding using rotational thromboelastometry (ROTEM). ROTEM including EXTEM, INTEM, and FIBTEM which represent extrinsic, intrinsic pathways, and fibrinogen activity, respectively, was measured in 60 cirrhotic patients with variceal bleeding who were compared to 60 patients with stable cirrhosis. APTEM was optionally performed to evaluate fibrinolysis. Overall, cirrhosis patients displayed features of hypofibrinolysis, whereas the state of hypocoagulability was significantly higher in cirrhotic patients with variceal bleeding (61.7% versus 30%, p = 0.001). Values of clot formation time (CFT) by EXTEM and INTEM correlated positively with those of model for end-stage liver disease score (r = 0.529, p = 0.001, and r = 0.595, p < 0.001, respectively). Furthermore, in a multivariate analysis, values of CFT in both assays were significantly associated with increased risk of 1.9 (95% CI = 1.04–2.45, p = 0.02) and of 1.78 (95% CI = 1.02–2.14, p = 0.01), respectively, for occurrence of variceal bleeding. Cirrhotic patients with variceal bleeding frequently showed a hypocoagulable state that is triggered by thrombocytopenia and/or hypofibrinogenemia. CFT by EXTEM and INTEM seemed to be an extra marker for disease severity and prognosis in cirrhosis patients, in addition to its valuable role in prediction of variceal bleeding in these patients. However, large multicenter studies have yet been required.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140070746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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