Objectives. The study is aimed at evaluating knowledge, attitude, and barriers to telemedicine among the general population in Egypt. Methods. A questionnaire-based cross-sectional design was carried out among the general Egyptian population. A convenience sampling method was used to approach the eligible participants from University Teaching Hospitals of eight governorates from May to July 2020. Results. A total of 686 participants filled the questionnaire (49.4% were males, mean age 36.7 ± 11.2 years old). Half of the participants stated that they previously used a telemedicine tool, mainly to follow up laboratory results (67.3%). Video or phone calls (39.3%) and mobile applications (23.7%) were the most commonly recognized telemedicine tools by the participants. The included participants exhibited a high level of knowledge and attitude towards telemedicine. On the other hand, 21.9% stated that telemedicine services could jeopardize patient privacy. 32.8% reported that telemedicine service could lead to disclosing medical information to people who are not authorized to do so. Almost half of the participants agreed to strongly agreed that telemedicine service could increase medical errors. 60.80% of the participants said that they are more likely to prefer telemedicine than traditional ways. However, 13.70% stated that telemedicine is more likely to be challenging to use. Conclusion. The Egyptian population has high knowledge about the applications of telemedicine. In addition, the vast majority of Egyptians appear to perceive the benefits of telemedicine positively and are willing to use it. However, some barriers that have been found must be taken into consideration to adopt telemedicine successfully, especially for people who are old, are low educated, and live in remote areas. Future studies should address the utility of telemedicine in improving the quality of healthcare and patient’s health outcome and quality of life.

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Aims: To investigate changes in liver function tests in calcular cholecystitis (acute and chronic) and to relate that changes to cholecystitis. Methods: A retrospective study including 389 patients with clinical and sonographic evidence of cholecystitis with exclusion of other causes of elevated liver function tests, which are done preoperatively and four weeks postoperatively. Results: Increased liver function tests observed in both acute and chronic cholecystitis. The only significant differences between both groups were a higher bilirubin level (P= 0.001) and WBC (P= 0.018). Pre and post-cholecystectomy levels of AST, ALK-P and GGT were significantly changed (P= 0.001). Conclusion: Our study showed that the abnormal biochemical liver function tests resolved rapidly and spontaneously after cholecystectomy indicating transient hepatocellular injury with cholecystitis.

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Hepatitis C virus (HCV) infection can affect the neurological system, and neuropathy is one of these manifestations. Hepatitis C virus infection is associated with diabetes mellitus (DM) type II, and diabetic patients are at higher risk of acquiring HCV infection. Sweat function has been proposed to assess early autonomic neuropathy. This study aimed to evaluate small fiber neuropathy in asymptomatic HCV-related cirrhotic patients with or without DM through sweat function assessment by Sudoscan test. Three groups were involved: 47 healthy controls, 48 HCV-related cirrhotic patients without DM (group 1), and 49 HCV-related cirrhotic patients with DM type II (group 2). All participants were subjected to liver panel tests, renal function tests, cell blood counts, HbA1c, and abdominal ultrasound. Sweat function was assessed in all patients and controls by measuring hand and feet electrochemical skin conductance (ESC, microSiemens [µS]) using Sudoscan. Peripheral neuropathy was detected in none of the controls, 39% of group 1 patients, and 62% of group 2 patients (P < 0.0001). The mean feet ESC (FESC) was 88.3 ± 6.8 µS in controls, 67.2 ± 19.2 µS in group 1, and 57.9 ± 19.4 µS in group 2 (P < 0.0001). A significant correlation was observed between FESC and bilirubin, albumin, creatinine, international normalized ratio, transaminases, and splenic size. Electrochemical skin conductance measurement is a valuable, noninvasive method for early detection of small fiber neuropathy in asymptomatic HCV-related cirrhosis, with or without DM.

Background: Spontaneous bacterial peritonitis (SBP) is a serious, recurrent, and life-threatening condition developing in cirrhotic patients with a high mortality rate. Its diagnosis is based on ascitic fluid polymorphonuclear leukocytes (PMNs) to be more than 250/? L.Objectives: polymorphonuclear leukocytes (PMNs) to be more than 250/? L. Objective: The aim of the study was to evaluate the ascitic fluid and serum levels of calprotectin, procalcitonin (PCT) and endocan as appropriate markers for predicting and diagnosing SBP.Patients and Methods: This study was conducted on 90 patients with liver cirrhosis: 35 with decompensated cirrhosis and spontaneous bacterial peritonitis, 35 with decompensated cirrhosis without spontaneous bacterial peritonitis and 20 with compensated cirrhosis with no ascites. We evaluate the correlations of calprotectin, procalcitonin and endocan with indicators of infection and inflammation associated with spontaneous bacterial peritonitis in liver cirrhotic patients. Ascitic fluid and serum levels of Calprotectin, procalcitonin, endocan, and polymorphonuclear leukocytes, serum CRP, and blood leukocytes were analyzed. The control group (n = 30) composed of healthy blood donors with normal aminotransferase levels, normal complete blood counts and negative markers for viral hepatitis and HIV.Results: Ascitic fluid and serum levels of Calprotectin, procalcitonin, endocan, and PMNs, serum CRP and blood leukocytes were statistically elevated in cirrhotic patients with SBP than the control group and cirrhotic patients without SBP. There were statistically significant correlations between the existence of SBP with serum calprotectin (r = 0.512), serum procalcitonin (r= 0.370), serum endocan (r = 0.501), ascitic calprotectin (r = 508), ascitic procalcitonin (r = 0.501), ascitic endocan (r = 0.496), ascitic PMNs (r = 0.562), and CRP (r = 0.492), for all P < 0.001. The diagnostic accuracies of calprotectin, endocan, procalcitonin, and PMNs were elevated in progressive disease stage. Ascitic PMNs ≥ 250/mm³ had a sensitivity of 97% and specificity of 94.7%, Serum calprotectin levels ≥ 45 µg/ml had a sensitivity of 96% and specificity of 94%, ascitic calprotectin levels ≥ 0.95 µg/ml had a sensitivity of 95% and specificity of 89.2%, serum endocan levels ≥ 2.03 ng/ml had a sensitivity of 90% and specificity of 83.7%, ascitic procalcitonin levels ≥0.33ng/ml had a ARAFAT KASSEM et al. 258sensitivity of 89.9% and specificity of 83.3%, ascitic endocan levels ≥ 0.65 ng/ml had a sensitivity of 88.9% and specificity of 78.5%, and lastly serum procalcitonin levels ≥2.50 ng/ml had a sensitivity of 87.9% and specificity of 76.8% for the diagnosis of SBP in decompensated cirrhotic patients. Conclusion:Ascitic fluid PMNs, serum calprotectin, ascitic calprotectin,serum endocan, ascitic procalcitonin, and serum procalcitonin, could be useful as powerful diagnostic markers to assess the progression of liver disease and early prediction of spontaneous bacterial peritonitis in cirrhotic patients.

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Background: Several precipitating factors of hepatic encephalopathy have been recognized and studied. Hepatic encephalopathy which is a frequent and grave complication of liver failure, is associated with multiple biochemical changes like high serum ammonia, mercaptan and phenol levels, low albumin levels and derangements in electrolytes. It is characterized by a range of neuronal and psychological aberrations mainly due to the inability of liver to metabolize different neurotoxic chemicals produced in the body. Hypokalemia is one of the most important findings in hepatic encephalopathy and postulated as a precipitating factor of the condition. The authors aimed to know the frequency of hypokalemia and its relation to the severity of hepatic encephalopathy. Methods: After taking approval from the hospital ethical review committee, a total of 5000 patients with hepatic encephalopathy were recruited by consecutive sampling. They were interviewed, examined and investigated for serum potassium levels and other precipitating factors of hepatic encephalopathy. Results: Total of 5000 patients including 3070 (61.4%) males and 1930 (38.6%) females, aging 13 years and above were studied. The frequency of hypokalemia was 78% (3900 patients). Relating the serum potassium level with the severity of hepatic encephalopathy, 1200 (60%) out of 2000 patients with serum potassium below 2.5 mEq/l were in grade 4 (40%) and 800 out of 2000 were in grade 3 encephalopathy. On the other hand, only 700 patients (6.4%) out 1100 with serum potassium above 3.4 mEq/l were in grade 4 encephalopathy. Conclusion: Hypokalemia is a frequent finding in patients with hepatic encephalopathy and found to be directly related to its severity.