Background: Hepatitis C virus treatment has dramatically improved by direct-acting antiviral (DAA) therapy. The aim of this study was to assess the efficacy and safety of DAA in elderly Egyptian chronic hepatitis C (CHC) patients. Methods: The study was carried out on 327 CHC elderly patients >60 years; patients were divided into 3 age subgroups (<65, 65–75 and >75 years) on DAA therapy for 12 weeks. Ninety-one patients (27.8%) were treated with dual therapy, 234 patients (71.6%) with triple therapy and 2 patients (0.6%) with quadrable therapy. Results: All patients achieved end-of-treatment virological response (100%). ALT levels normalized during therapy. The follow-up rate of sustained virological response at 12 weeks after the end of treatment (SVR12) was 100%. One hundred and two patients had missed SVR12 data due to being lost tofollow-up. Two hundred twenty-two adverse events were reported (67.8%), including anemia in 30 patients (9.1%), leucopenia in 129 patients (39.4%) and thrombocytopenia in 63 patients (19.2%). No serious side effects led to discontinuation of therapy. No hepatic decompensation was observed, and no patients died. Conclusion: Age does not influence the success of DAA treatment and all DAA regimens are well tolerated, safe and highly efficacious, even in those aged 75 years or older.

Background/aims We prospectively evaluated the role of endoscopic ultrasound (EUS) in detecting the cause of common bile duct (CBD) dilatation in patients in whom trans-abdominal ultrasound (TUS) could not demonstrate the cause of dilation as a proper second step in the diagnostic workup of patients with obstructive jaundice compared to magnetic resonance cholangiopancreatography (MRCP). Methods This study was conducted on patients with obstructive jaundice admitted to the inpatient ward or the outpatient endoscopy unit of Theodor Bilharz Research Institute (TBRI) during the period between January 2019 and August 2019. A patient with obstructive jaundice and TUS showed CBD dilatation with internal diameter ≥ 7 mm and biliary stricture. Results During the period between January 2019 and August 2019, 136 were recruited; 8 patients who were pregnant and 3 patients who had gastric bypass surgery were excluded. Sixty-five patients were diagnosed confidently by TUS as biliary stones and were excluded from the analysis. Sixty patients with obstructive jaundice and indefinite etiology on TUS were included in the final analysis. The final diagnosis of patients was 38 patients (63.33%) of malignant etiology [26 pancreatic cancer (43.33%), 4 cholangiocarcinoma (6.66%), and 8 with ampullary cancer (13.33%)] and 22 patients (36.67%) of benign etiology [10 calcular obstruction (16.66%), 8 benign stricture (13.33%), and 4 pancreatitis (6.66%)]. The sensitivity and specificity values for malignant stricture detected by EUS were 100% and 86.36%, respectively, with positive predictive value of 92.68%, negative predictive value of 100%, and accuracy of 95%, while MRI showed 82.14% sensitivity and 25% specificity with positive predictive value of 79.31 and accuracy of 69.4%. EUS supported correct diagnosis in 57 patients (95%: CI 86.08 to 98.96%) while MRI did it in 36 patients (69.44%: CI 51.89% to 83.65%).Only 43 (71.7%) patients needed endoscopic retrograde cholangiopancreatography (ERCP) for management of obstructive jaundice, sparing 17 patients (28.3%) unnecessary invasive procedures. Conclusions EUS is a minimally invasive method with low incidence of complications with high diagnostic accuracy in patients with dilated CBD and normal MRCP.

Background: Hepatocellular carcinoma (HCC) is one of the commonest malignancies worldwide that carries a bad prognosis particularly in Egypt due to the high prevalence of HCV burden. Late diagnosis of HCC especially in cirrhosis suffering-liver is one of the causes that worsen HCC outcome. Identification of molecular pathways of HCC will open the gate for early diagnosis and effective management. Oscillation of calcium controlled by the α2δ1 subunit has been proposed as one of the mechanisms in tumor-initiating cell properties of HCC. In this study, we aim to evaluate the serum α2δ1 subunit level as a biological marker for HCC. A total of 90 participants were enrolled, 40 patients with HCC, 40 patients with cirrhosis, and 10 healthy volunteers; serum level of α2δ1 was assessed in all participants with ELISA Results: The mean serum levels of α2δ1 were significantly higher in HCC group (19.53 ± 6.87 ng/dL) than cirrhotic (6.24 ± 2.64 ng/dL) and control groups (0.67 ± 0.48 ng/dL) (P = 0.001). There was no significance between α2δ1 and etiology of liver disease as viral (HCV, HBV) or non-viral (P = 0.14). Conclusion: α2δ1 subunit may serve as a potential non-invasive marker with excellent sensitivity for diagnosis of HCC regardless of the etiology of liver disease.

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Background There are different types of pancreatic cysts.They can be classified by different ways. Each of them has different plan of management. that is why their differentiation became mandatory before setting their treatment plans. Aim of the study To Evaluate PGE2 as a marker of differentiation of mucin containing pancreatic cysts and prediction of dysplasia in these cyst. A Secondary aim is differentiation of mucin from non mucin containing pancreatic cystic lesions Patients and Methods 40 patients were recruited from the Department of Internal Medicine and the Outpatient Clinic of Cairo University hospital in the period between December 2018 and August 2019. A case control study design was adopted where the patients were grouped as follow : Group 1 - composed of 20 patients with pancreatic mucinous cystic lesions defined by EUS guided samples, Histopathology and Radiological findings. Group 2: - composed of 20 patients with pancreatic non mucinous cystic lesions defined by EUS guided samples, Histopathology and Radiological findings. Results In our study, there was a significant differences in PGE2 level between true and inflammatory pancreatic cysts (p = 0.001) .However, there is insignificant differences between mucinous, non mucinous (p = 0.406). There was insignificant differences between different grades of IPMN dysplasia (p = 0.615) Conclusion Prostaglandin E2 is pancreatic cystic fluid marker which can be used for differentiation between true pancreatic cysts from inflammatory pancreatic cysts which have different plans of management. Prostaglandin E2 is not good marker to be used for differentiation between different grades of IPMN dysplasia.

Background Patient presented with jaundice, initial evaluation should be ultrasonography for evaluation of liver parenchymal changes, cirrhosis and assessment of hepatic vascularity and evaluation of intrahepatic, extrahepatic biliary system. Aim of the Work to compare between the Conventional US and Endoscopic Ultrasound in diagnosis of obstructive jaundice and other diagnostic modality including CT/MRI, ERCP for diagnosis and evaluation of the cause of OJ. Patients and Methods This study was conducted on 60 patients with obstructed jaundice as evident by ultrasonography in the form of dilated CBD with IHBRDs, with visualization of Gall bladder content and pancreas if can be well visualized, all patients had clinically apparent jaundice with disturbance of liver biochemical profile, all patient underwent EUS and compare finding with US including CBD diameter and IHBRDs degree. Results EUS provide better visualization of CBD and IHBRDs with diagnosis of pathological lesion including stones, malignancy. EUS also has better visualization of pancreatic pathology including inflammation and malignancy and extent of the tumor including local extent, lymphatic spread with vascular invasion. Conclusion EUS is better than US and other modality CT&MRI and ERCP in diagnosis of distal CBD stricture including malignant obstruction especially in cases of early malignancy and small tumors, and calculary distal obstruction. CT is insensitive in diagnosis of periampullary cancer, EUS provide early diagnosis of Pancreaticobiliary malignancy and give better advandage for early resectability .

Objectives This study was carried out to assess myostatin levels in obese males and females with and without fatty liver. Methodology This is a comparative case control study was conducted in Ain Shams University hospital. Patients were divided into two groups. Group1: 40 obese patients of both sexes (20 of them with fatty liver and 20 without fatty liver) Group 2: 40 normal weight patients of both sexes (20 with fatty liver and 20 without) In this study we considered the serum concentration of myostatin seems to range from 7 to 32 ng/ml in the general population as in the literature All participating patients have to sign informed oral or written consent after through explanation of the purpose and procedure of the study. The current protocol is to be approved by the Ethical Committee of Internal Medicine Department and the Ethical Committee of Faculty of medicine Ain shams University. The collected data was be tabulated and statistically analyzed using SPSS program (Statistical Package for Social Sciences) software version 20.0 Descriptive statistics was done for numerical parametric data as mean+-SD (standard deviation) and minimum and maximum of the range and for numerical non parametric data The level of significance is taken at p value &lt;0.050 is significant otherwise is non-significant. Results The body mass index (BMI) among the groups of patients is significantly associated with gender and the present or absent of fatty liver. Statistically significant with value (0.000) BMI is significantly associated with gender in the present or absent of fatty liver. Statistically significant with value 0.005 Very few report myostatin level less than the normal value 2/80 (2.5%), normal range was only 12/80 (15%) and those reported high range of myostatin were 66/80 (82.5%). The myostatin level is significantly associated the BMI. 95% CI of difference were between 103.25 to 233.9. Std. error of mean is 32.84. Statistically significant with value (0.000) where it is considered to be significant with value &lt;0.05. Conclusion This study revealed the association between BMI, gender and elevated myostatin at level of statistically significant value. The majority of the study population reported high range of myostatin were in about 82.5% the range was above the normal values. A large scale, multicentre study to provide strong evidence was recommended.

Article informationBackground: These days, inflammatory bowel disease [IBD] is growing more common.Its diagnosis relies on invasive techniques like colonoscopy and biopsy, and its activity is monitored by fecal calprotectin levels that have a low compliance rate, so there is a pressing need for a serum biomarker that is non-invasive, accepted, and accurate for diagnosing and monitoring IBD activity. The aim of the work: The goal of our research is to study serum calprotectin as a candidate biomarker in IBD. Methods: The study included 50 patients with IBD who were recruited from Ain Shams University Hospitals' Gastroenterology clinic. Sixty percent were diagnosed with ulcerative colitis, with half in activity and the other half in remission, and 40% were diagnosed with Chron's disease, with half in activity and the other half in remission.A control group of 20 apparently healthy individuals comparable in age and sex were also included in the study. All subjects had their serum calprotectin tested by ELISA in addition to their ESR and CRP measurements. Results: Serum calprotectin levels were significantly higher in patients with IBD than in controls and in clinically active patients than those in remission in both UC and CD groups. Although there was a positive association between serum calprotectin levels and CRP and ESR, serum calprotectin had a higher diagnostic value than CRP and ESR due to its higher sensitivity and specificity. Our findings demonstrated that serum calprotectin and platelet count had a direct relationship, while serum calprotectin and serum albumin and hemoglobin levels had an inverse relationship. Conclusion: Serum calprotectin levels are raised and linked to clinical activity in IBD patients, implying that it could be utilised as a clinically useful indicator of disease activity.