Fouad, A., D. Sabry, R. Ahmed, M. Kamal, S. A. Allah, S. Marzouk, M. Amin, R. Abd El Aziz, A. El Badri, H. Khattab, et al., "Comparative diagnostic study of biomarkers using FibroMax™ and pathology for prediction of liver steatosis in patients with chronic hepatitis C virus infection: an Egyptian study.", International journal of general medicine, vol. 6, pp. 127-34, 2013. Abstract

BACKGROUND: Steatosis is common in patients with hepatitis C virus (HCV) infection and may be a major determinant of progression of liver injury. This study evaluated FibroMax™ for noninvasive diagnosis of steatosis in patients with chronic HCV.

METHODS: This cross-sectional study included 44 patients naïve to treatment who were referred to our hepatology clinic for assessment of fitness for antiviral therapy. Chronic HCV infection was diagnosed by viral markers. Investigations included assessment of abdominal ultrasonography, liver biopsy, calculation of body mass index, and biomarker parameters in serum using FibroMax.

RESULTS: Histopathology of liver biopsies showed steatosis in 30 of 44 (68%) patients. FibroMax results were positively correlated with viral load by quantitative polymerase chain reaction and histopathological findings. Body mass index was significantly higher in steatotic patients (P = 0.003) and was significantly associated with the results on FibroMax (P = 0.005).

CONCLUSION: FibroMax was correlated with histopathology and body mass index in patients with HCV. Abdominal ultrasonography could not be used as a single tool to diagnose steatosis with HCV. Steatosis is correlated with viral load, which suggests a direct viral effect. We recommend FibroMax assessment in a larger number of patients to assess its applicability in patients with HCV and steatosis.

Salama, H., A. - R. N. Zekri, R. Ahmed, I. Medhat, E. S. Abdallah, T. Darwish, O. S. Ahmed, and A. Bahnassy, "Assessment of health-related quality of life in patients receiving stem cell therapy for end-stage liver disease: an Egyptian study.", Stem cell research & therapy, vol. 3, issue 6, pp. 49, 2012. Abstract

INTRODUCTION: This prospective cohort study aimed to assess the influence of stem cell therapy (SCT) on health-related quality of life (HRQOL) by using the SF-36 v2 and to elucidate the influence of objective clinical variables on subjective HRQOL.

METHODS: The study included 100 chronic liver disease patients (50 received SCT, and 50 received supportive medical treatment (SMT)). Both groups completed a modified SF-36 v2 form before therapy and at 1-, 3-, 6-, and 12-month intervals. Fifty healthy Egyptian volunteers were enrolled in the study and completed the SF-36 v2 form once.

RESULTS: Both SCT and SMT groups showed significantly lower pretherapy SF 36 v2 scores compared with healthy volunteers. In SCT-treated patients, limited complications were encountered (SF-36 v2 scores showed significant improvement in all domains throughout the follow-up period) compared with the deterioration shown by SMT patients after therapy. A significant association was detected between SF-36 v2 scores and laboratory data in SCT patients during the first month after therapy. The grade of ascites improved during the follow-up in SCT compared with SMT patients. The mean survival time was 277.56 days (95% CI, 246.217 to 308.903) for SMT and 359.300 days (95% CI, 353.022 to 365.578) for SCT patients (log rank, 0.00). Stem cell-treated patients showed no malignancies.

CONCLUSIONS: SCT positively affects health-related quality of life in cirrhosis patients. The survival rate was significantly improved after SCT.

El-Awady, A. A., M. M. Zaki, M. Kamal, A. Nabil, E. - S. A. El-Sayed, and W. El-Nabawy, "Plasma Concentration of Platelet Factor 4: As an Evidence of Platelet Activation in Parasitic Infections", Research Journal of Parasitology, vol. 7, issue 1, pp. 25-31, 2012. Abstract

Platelets number in the circulation largely exceeds that needed for haemostasis. There is increasing evidences that platelets have an immunological role against parasites. Assessment of platelet factor 4 concentrations in patients with parasitic infections can be used as an indicator for platelet activation. This study aims to evaluate the in vivo platelet activation in parasitic infections through measuring the plasma level of platelet factor 4 in a protozoal and a helminthic infection both before and after treatment. Thus 30 patients, 22 diagnosed to have giardiasis and 8 diagnosed to have hydrated disease, were subjected to serum samples collection before (Ag1 and Ah1) and after treatment (Ag2 and Ah2), respectively. The study also included 20 healthy adult as a control group. Both platelet counts and plasma levels of PF4 were measured. Platelet counts in both giardiasis and hydatid patients were significantly elevated after treatment compared to their counts before treatment. Plasma level of PF4 was reduced with a statistically significant difference in both diseases after treatment. Also there was a statistically significant difference between the mean values of PF4 of the control group (C-PF4) and in the tested groups of both diseases before and after treatment (p<0.5). Thus parasitic infections lead to platelets activation with increase in platelet count although within normal range for platelets. Plasma level of platelet factor 4 is significantly increased in both infections and decreased after treatment, thus can be used as an indicator for parasitic infection and for prediction of succession of recovery after treatment.

Sabry, D., R. Ahmed, N. Abosaif, H. Talkhan, and S. A. Allah, "Hepatitis B virus DNA in serum of hepatitis B surface antigen negative hemodialysis patients", nephrology research & reviews, vol. 2, issue 1, pp. 17-20, 2010. Abstract

Hepatitis B virus (HBV) infection remains a serious issue in the dialysis population. Transmission of HBV through dialysis machines or other sources as well as seroconversion from HBV negative patients to positive ones is still not well understood. Seventy patients were selected from our chronic hemodialysis (HD) center. They were divided into two groups: Group (I) included 35 patients with negative hepatitis B surface antigen (HBsAg), while another 35 already known to have HBsAg positive were chosen as a control group (Group II). The aim of the study was to detect the presence of HBV DNA by analyzing the serum PCR of the negative (HBsAg) patients (Group I) then analyzing the viral sequencing of 5 of them in comparison to 5 of the known HBsAg positive. All patients received blood transfusions, were positive for HCV but negative for HDV and HIV. In group I, HBV DNA by PCR was detected in serum of 17/35 (48.5%) patients. Only 3 of them were positive for HBcAb. In group II, HBV DNA by PCR was detected in serum of 35/35 (100%) patients. The alanine transaminase enzyme (ALT) level was significantly higher than negative patients. Sequencing of the virus showed some mutated segments in 5 of the positive DNA by PCR compared to already positive HBsAg positive patients in Group II.
In conclusion, a high proportion of HBsAgnegative hemodialysis patients were found to have positive HBV DNA by PCR. Sequencing of the virus revealed some mutated segments of the DNA. These findings are of major importance for the planning of future screening of patients on hemodialysis. We recommend measuring HBV DNA of all negative HBsAg patients on HD as this can change the management and prognosis of this particular group on chronic HD.

Ahmed, R., H. Salama, E. S. Abdallah, S. M. el-din Ahmed, D. Sabry, D. I. N. A. OMAR, and T. Darwish, "Correlation between HCV viraemia and splenic volume in chronic HCV infected patients: an Egyptian study.", Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology, vol. 13, issue 2, pp. 58-64, 2012 Jun. Abstract

BACKGROUND AND STUDY AIMS: As HCV lymphotropism was ascertained, this study was carried out to verify the possible involvement of the spleen in HCV-related chronic hepatitis.

PATIENTS AND METHODS: A cross-sectional study was conducted on 97 HCV infected patients attending for treatment with interferon, categorised as follows; before treatment (group I, n=49), non-responders (group II, n=18), responders (group III, n=18) and group IV (n=12) including patients with HCV RNA below detection limit after 24 weeks of treatment. A control group of healthy blood donors (n=19) was enrolled in our study. Conventional ultrasonography was carried out on all participants. Splenic volume was measured and compared between the groups, and its relationship to HCV RNA concentration was investigated.

RESULTS: It was found that the splenic volume of patients of both groups I and II is significantly greater than that of the control group (p-values : 0.004 and 0.009, respectively) and, of patients of both groups III and IV. The latter are not significantly greater than that of the control group (p-value: 0.8 and 0.6, respectively). A significant positive relationship was detected between the splenic volume and the HCV RNA concentration in group I (r=0.56, p-value=0.00) but this is insignificant in group II. There is no significant relationship between the splenic longitudinal diameter and the HCV RNA concentration in any of the studied groups.

CONCLUSION: The splenic volume positively correlated with HCV RNA concentration in HCV positive patients, but this become insignificant in non-responders to interferon therapy. The successful response to interferon therapy matches with near normal splenic volume whilst non-responders to Interferon therapy matches with increased splenic volume. The change in the viral load leads to a corresponding change in the splenic volume and does not affect the splenic longitudinal diameter.

Ahmed, R., H. Salama, A. Fouad, D. Sabry, E. - S. AbdAlah, and M. Kamal, "Detection of aberrant p16INK4A methylation in sera of patients with HCV-related liver diseases: An Egyptian study.", Medical science monitor : international medical journal of experimental and clinical research, vol. 16, issue 9, pp. CR410-5, 2010 Sep. Abstract

BACKGROUND: The present study was performed to estimate the frequency of methylated p16INK4A in the sera of patients with hepatitis C virus (HCV)-related chronic active hepatitis (CAH), liver cirrhosis (LC), and hepatocellular carcinoma (HCC) and to evaluate the role of p16INK4A as a tumor marker of HCC.

MATERIAL/METHODS: The sera of 17 CAH, 20 LC, and 25 HCC patients were examined in this study. The methylation status of p16INK4A was evaluated by methylation-specific PCR of the serum samples.

RESULTS: Methylated p16INK4A was detected in 47.1% (8/17) of the CAH patients, 5% (4/20) of the LC patients, and in 92% (23/25) of the HCC patients. HBV markers were detected in (4/25) of HCC patients; all had methylated p16INK4A. No association was demonstrated between p16INK4A methylation and serum AFP level in the HCC group.

CONCLUSIONS: The results of this study indicate that aberrant DNA methylation contributes to hepatocarcinogenesis and it may be an early event during hepatocarcinogenesis. As the status of p16INK4A methylation was not associated with serum AFP level, it may have a complementary role with AFP as a tumor marker of HCC.

Salama, M. K., D. Sabry, M. A. S. Al-Ghussein, R. Ahmed, S. A. Allah, F. M. Taha, W. Fathy, M. S. Wadie, M. Nabih, A. Abul-Fotouh, et al., "Molecular detection of monocyte chemotactic protein-1 polymorphism in spontaneous bacterial peritonitis patients.", World journal of gastroenterology : WJG, vol. 20, issue 33, pp. 11793-9, 2014 Sep 7. Abstract

AIM: To investigate the association of the functional monocyte chemotactic protein-1 (MCP-1) promoter polymorphism (A-2518G) with spontaneous bacterial peritonitis (SBP).

METHODS: Fifty patients with post-hepatitis C liver cirrhosis and ascites were categorized into two groups; group I included 25 patients with SBP and group II included 25 patients free from SBP. In addition, a group of 20 healthy volunteers were included. We assessed the MCP-1 gene polymorphism and gene expression as well as interleukin (IL)-10 levels in both blood and ascitic fluid.

RESULTS: A significant MCP-1 gene polymorphism was detected in groups I and II (P = 0.001 and 0.02 respectively). Group I was associated with a significantly higher frequency of AG genotype [control 8 (40%) vs SBP 19 (76.0%), P < 0.001], and group II was associated with a significantly higher frequency of GG genotype when compared to healthy volunteers [control 1 (5%) vs cirrhotic 16 (64%), P < 0.001]. Accordingly, the frequency of G allele was significantly higher in both groups (I and II) [control 10 (25%) vs SBP 27 (54%), P < 0.001 and vs cirrhotic 37 (74.0%), P < 0.001, respectively]. The total blood and ascetic fluid levels of IL-10 and MCP-1 gene expression were significantly higher in group I than in group II. Group I showed significant reductions in the levels of MCP-1 gene expression and IL-10 in the whole blood and ascetic fluid after therapy.

CONCLUSION: MCP-1 GG genotype and G allele may predispose HCV infected patients to a more progressive disease course, while AG genotype may increase the susceptibility to SBP. Patients carrying these genotypes should be under supervision to prevent or restrict further complications.