Background In Egypt, the prevalence of chronic hepatitis C (CHC) infection is 13.8% of whole population and about 80% of the patients with hepatocellular carcinoma have underling hepatitis C. Aim This study was designed to assess the diagnostic value of plasma miR-122 and miR-21 in patients with CHC, genotype-4, to detect fibrosis progression versus noninvasive indices and their diagnostic value in detection of early stages of hepatocellular carcinoma (HCC). Methodology A prospective study that included 180 patients, divided into 3 groups: healthy controls (group I), CHC patients (group II), and hepatitis C patients with HCC (group III); all cases were subjected to thorough clinical, radiological, and laboratory investigations. Selected biomarkers were evaluated and correlated with degree of liver damage. Results revealed that miR-122 followed by miR-21 had the highest efficiency in prediction of liver cell damage. Also, miR-21 was strongly correlated with vascular endothelial growth factor (VEGF) and alpha fetoprotein (α-FP) in HCC patients. Conclusions Plasma miR-122 and miR-21 had strong correlation with degree fibrosis in HCV genotype-4 patients; consequently they can be considered as potential biomarker for early detection of hepatic fibrosis. Moreover, miR-21 can be used as a potential biomarker, for early detection of HCC combined with VEGF and α-FP.

PACTR201602001476292.

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as bariatric surgery, a small percentage of subjects regain weight after surgery. This study was designed to evaluate body weight changes over a period of two years after LSG and investigate the role of serotonin in regulating energy balance. This is a prospective cohort study. A total of 92 patients with morbid obesity (64 women and 28 men) underwent LSG. All the participants were subjected to physical examination and detailed medical history. Anthropometric measurements were accomplished pre-operative and post-operatively at a frequency of four times per year for two years follow-up. Laboratory investigations were performed pre-operatively, and one and two years post-operatively. Blood samples were collected in the fasting state; for glucose, lipid profile and hormonal assays. Hormones measured were plasma insulin, leptin, serotonin and ghrelin. Results revealed that 35.7% weight loss occurred after one year. However, there was variability in the individual weight loss curve during the period between the first and second post-operative years. Thus, patients were divided into two groups: group I included 78 patients (84%) who maintained the lost weight, and group II included 14 patients (16.0%) who regained weight within 24 months post-operatively. Correlation with BMI revealed positive correlation with leptin and serotonin, whilst negative correlation with ghrelin in group II patients. Mechanisms of weight loss after LSG are not only attributable to gastric restriction but also to the neurohormonal changes. In addition, serotonin may possibly contribute to the interplay of regulatory systems of energy homeostasis.

Background: Modified radical mastectomy (MRM) with axillary clearance of lymph nodes was routinely performed under general anaesthesia with intra-and postoperative opioid analgesia. Recently, there has been a move toward opioid-free anesthesia (OFA) to appreciate the goals of hypnosis with amnesia and sympathetic stability without the adverse effects of opioids.The aim of this study was to evaluate the effect of OFA versus opioid-based anaesthesia (OBA) in patients with breast cancer, who had undergone unilateral MRM. The primary aims:• Pain intensity using the visual analogue scale in the first 24 h post-operatively.• Screening for post mastectomy neuropathic pain. The secondary aims:• Effect of opioid and surgical stress on the immune system.• Patient outcome including haemodynamic stability, patient satisfaction and occurrence of post-operative complications. Methods: Forty adult female patients scheduled for elective unilateral MRM were randomly divided into two groups (20 patients in each group): OFA and OBA. Results: There was statistically significant decrease in pain score at rest and on movement in the OFA group. Postoperative nausea and vomiting was significantly decreased in the OFA group (P = 0.04). Patients in the OFA group were more satisfied than those in the OBA group using verbal rating scale for satisfaction (P < 0.001). There was significant low incidence of neuropathic pain in the OFA group; also, we found significant changes in interleukin 10, tumour necrosis factor alpha and caspase 3 between the two groups. Conclusion: OFA is safe and effective in mastectomy as it decreases the pain score and the incidence of post mastectomy neuropathic pain; moreover, it also shows better immune response postoperatively.

Background:The COVID-19 pandemic created a remarkable impact on healthcare providers (HCP) both physically and psychologically. Perceived psychological stress (PSS) influences the homeostatic equilibrium, involving activation of the sympathetic nervous system and hypothalamus pituitary adrenal (HPA) axis. Copeptin, C-terminal portion of Vasopressin (AVP) precursor is stable; however, evidence about impact of PSS on copeptin levels is limited. Aim: The aim of this study was to estimate the influence of psychological stress on copeptin levels among HCP working in intensive care unit (ICU). Methods: A total of 70 HCP served in quarantine ICU participated in this prospective study; 35 physicians (28 males and 7 females) and 35 nurses (10 males and 25 females). A control group of 40 HCP matched age, BMI and specialty in non-quarantine hospitals. Fasting morning blood samples were withdrawn for determination of copeptin, cortisol, insulin at three points; prequarantine at ICU. Second point at end of first week and third point was two weeks' post quarantine. A questionnaire was conducted to all participants to assess stress (PSS). Cortisol was determined by a chemiluminescence immunoassay while insulin and Copeptin were measured by ELISA. Results: Baseline plasma copeptin level pre-quarantine was significantly increased 15.76 ± 8.6 pmol/l (P = 0.001*) and was positively correlated with high stress PSS score mean 66.9 ± 18.3. Post-quarantine copeptin was markedly reduced 3.98 ± 1.28 pmol/l and mean PSS was 23.0 ± 7.95 (P = 0.001*). Also, there was positive correlation between plasma copeptin and PSS, systolic blood pressure and serum insulin. On the other hand, there was no correlation between copeptin and serum cortisol. Conclusion:Our finding suggested that copeptin may be used a potential biomarker for physiological strain during work in a stressful environment.