Aim We aimed to assess the safety and efficacy of propofol versus midazolam in cirrhotic patients undergoing upper GI endoscopy. Methods Ninety compensated cirrhotic patients (all met class I–III criteria according to the American Society of Anesthesia) were enrolled in this comparative study. They were classified into three groups according to scheduled pre‐endoscopy sedation drugs; the midazolam group, which included 30 patients who received IV weight‐dependent midazolam (0.05 mg/kg with additional doses of 1 mg every 2 min when necessary, up to a maximum dose of 0.1 mg/kg or 10 mg); the propofol group, which included 30 patients who received a propofol bolus dose according to age and weight (0.25 mg/kg with additional doses of 20–30 mg every 30–60 s when necessary, up to a maximum dose of 400 mg); and the combined group, which included 30 patients who received half a dose of midazolam and of propofol. Results Prolonged postendoscopy recovery times were reported in the midazolam group, while shorter recovery times were reported in the propofol and combined groups. All patients in the propofol and combined groups gained consciousness shortly postendoscopy; however, only half of the midazolam group's patients gained consciousness after the standard recovery time (10–30 min). Highly significant differences were found among the three groups regarding consciousness level according to the Glasgow coma scale, as well as regarding the occurrence of hypoxia during endoscopy. Conclusion Considering safety and efficacy issues, propofol is better than midazolam in gastrointestinal endoscopy, especially in patients with liver cirrhosis.

The possibility of delaying treatment of HCV due to severe thrombocytopenia is challenging. This study aimed to detect the prevalence of active helicobacter infection as a claimed cause of thrombocytopenia in a cohort of Egyptian patients with chronic active HCV awaiting combined anti-viral therapy. The study included 400 chronic HCV patients with thrombocytopenia. Laboratory investigations included liver function tests, real time quantitative PCR, reticulocytic count, ESR, ANA, bone marrow aspiration, measurement of anti-helicobacter antibodies, and helicobacter stool antigen. Positive cases for active H. pylori were given the standard triple therapy for 2 weeks. Helicobacter stool antigen was detected 4 weeks after termination of therapy and the change in platelet count was detected 1 month after eradication. A total of 248 out of 281 seropositive patients for H. pylori (88.3 %) showed positive stool antigen (p = 0.01). Eradication was achieved in 169 (68.1 %) patients with platelet mean count 114.9 ± 18.8 × 10(3)/μl with highly significant statistical difference from pretreatment value (49.7 ± 9.2 × 10(3)/μl, p = 0.000). Seventy-nine patients were resistant to conventional triple therapy and given a 7-day course of moxifloxacin-based therapy; 61 patients responded (77.1 %) with mean platelet improvement from 76.4 ± 17.4 × 10(3)/μl to 104.2 ± 15.2 × 10(3)/μl (p = 0.000). The non-responders showed no improvement in their platelet count (74.6 ± 20.5 vs. 73.6 ± 15.3 × 10(3)/ul, P = 0.5). Eradication of active H. pylori in HCV augments platelet count and enhances the early start of antiviral therapy.

No abstract

No abstract

Background and aim:Interferon-based therapy is associated with significant side effects, including the cardiac complications; these may affect the patients' adherence to therapy and consequently the response rate. The aim of this study was to detect the types and predictors of interferon induced cardiac complications in the Egyptian hepatitis C virus infected patients treated with pegylated interferon/ribavirin combination therapy. Patients and Methods: A total of 194, chronic HCV patients were followed up from the time of receiving treatment till 6 months after the end of treatment, to detect cardiac disorders and to determine the response status. Patients were assessed by through history taking, full clinical examination, full laboratory parameters and cardiac assessment using the standard 12 lead ECG and Transthoracic Doppler Echocardiography. Patients in the final analysis were divided into: Group A (who developed cardiac disorders) and group B (who did not develop cardiac disorders). Results:The baseline clinical features (cardiovascular risk factors and hemodynamics) were comparable in both groups. Patients who developed cardiac disorders had higher baseline ALT level, hepatic fibrosis and histologic activity in the liver biopsy than patients without cardiac disorders (P<0.05). The confirmed cardiac complications represented 18% (n=35) and included left ventricular systolic and diastolic dysfunction, pericardial effusion, arrhythmia and myocardial ischemia. Histological activity in the liver biopsy, ejection fraction (EF) and left ventricular end diastolic dimension (LVEDD) were independent predictors for cardiovascular complications. Conclusion: Pegylated interferon therapy of chronic HCV is associated with many types of cardiac complications, predictors of which were histological activity in the liver biopsy, EF and LVEDD.

Background and study aim  The term non-specific colitis refers to an inflammatory condition of the colon that microscopically lacks the characteristic features of any specific form of colitis and is commonly seen in pathology reports of colonoscopy biopsies. In fact, it has been questioned whether it is a separate pathological entity or it is merely an intermediate stage in the course of inflammatory bowel disease. This study was conducted to estimate the prevalence of non-specific colitis among patients with colitis and characterize its natural history over a 6 months year period. Patients and methods  Eighty adult patients presented for colonoscopy were enrolled. In the final analysis they were divided into Group A; the non-specific colitis Group and Group B; the inflammatory bowel disease Group. All patients were subjected to: full history taking, full clinical examination, laboratory investigations: which included stool analysis, CRP, ESR, complete colonoscopy and entire random colon biopsies for histopathological examination. Results  Group A included 67 patients (83.75%) while Group B included 13 (16.25%) patients. Patients with IBD had clinical and laboratory features of inflammation significantly higher than patients with non-specific colitis. Six patients (8.95%) of non-specific colitis group developed histologic features of florid inflammatory bowel disease after 6 months. There were no independent predictors of this conversion. Conclusion  Among our 80 patients with colonoscopy and biopsy 67 (83.75%) were diagnosed as non-specific colitis and out of them 6 patients (8.95%) were reexamined after 6 months and proved to have inflammtory bowel disese this change was not linked to predictive factors.

Background: Frailty recognized as a common clinical syndrome associated wih a high rate of morbidity and mortality. Aim of the Study: This study aimed at assessing the value of determination of some biomarkers in identification and recruitment of frail elderly. The association between these biomarkers and stages of frailty were also assessed Subjects and Methods : A total number of 100 elderly subjects (above 65 years old) were included in the work divided into three groups : Group 1 (non-frail) included 34 subjects (19 males and 15 females), their ages ranged from 66.3 to 72.9 with mean 67.6 + 3.3 year; Group 2 (pre-frail) included 26 subjects (1 males and 15 females), their ages ranged from 65.5 to 73.1 with mean age of 69.3 + 3.8 year and Group 3 (frail) included 40 subjects (25 males and 15 females), their ages ranged from 67.9+ to 78.3 with mean age of 73.1+5.2 year.All subjects of this study were subjected to : thorough clinical examination, Anthropometric measures (including mid upper arm circumference, mid calf circumference, body mass index), Timed get-up-and-go test, hand grip strengh test and laboratory investigations (including complete blood picture, serum albumin, serum alanine transferase, INR. Prothrombin time and partial thromboplastin time, Cholesterol and C-reactive protein.Results: In our study; frailty recorded higher prevalence than most of epidemiological studies. Regarding CRP, there was significant increase in CRP level in frail group (27.4 + 8.1 mg/l) compared to both pre-frail (14.3 + 4.5 pg/ml) and non-frail groups (7.5 + 5.5 pg/ml). Regarding cholesterol, there was significant decrease in cholesterol level in frail group (125.7 + 54.9) compared to both pre-frail (168.1 + 17.2) and non-frail (165.3 + 29.7) groups. Regarding TGUGT, it was prolonged in frail group compared to both pre-frail and non-frail groups. Conclusions: There is high prevalence of frailty among studied elderly population, the causes of which need further studies to unravel. The changes in biomarkers noticed in our frail elderly may suggest its use in diagnosis and follow up of frailty, a suggestion that still in its infancy and needs further more studies to verify.

Results: Minimal and grade-I hepatic encephalopathy were found in thirty out of the one hundred screened patients (30%). Minimal and grade-I hepatic encephalopathy were more common in Child class C, than in class B and A. Two weeks after Lactobacillus acidophilus intake, patients showed significant improvement in the performance of psychometric tests (P<0.001) while liver function tests and Child classes did not improve (P>0.05). Probiotics improved the clinical grades of hepatic encephalopathy; 96.7% (n=29) of patients showed improvement in clinical grade of hepatic encephalopathy and only one patient (3.3%) did not improve (P<0.05). Conclusion: Probiotics could be used to treat early grades of hepatic encephalopathy. Child classes and liver functions did not improve significantly after probiotic therapy.