Several studies were performed to evaluate the degree of liver fibrosis by non-invasive markers. We aimed to assess the diagnostic value of both biglycan (BGN) and osteopontin (OPN) as non-invasive markers of hepatic fibrosis in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). This study was performed on 100 patients with CHB virus, 100 patients with CHC virus and 100 normal controls. All participants were subjected to the following laboratory tests: hemoglobin, platelet, alanine aminotransferase, aspartate aminotransferase, albumin, international normalized ratio, HBs Ag, hepatitis C virus (HCV) antibody, hepatitis B virus DNA, HCV RNA, liver biopsy, BGN and OPN. We found that BGN level was significantly increased in the CHB group compared with the controls (p<0.001), but the level was not different between the CHC group and the controls (p<0.96). OPN was increased in both the CHB and CHC groups compared with the controls (p<0.001). Positive correlation was found between fibrosis stages and BGN level of the CHB group (r=0.64; p<0.001) and between fibrosis stages and OPN level of the CHB (r=0.63; p<0.001) and CHC (r=0.59; p<0.03) groups. The area under the curve (AUC), sensitivity and specificity of BGN were 1.0, 100% and 100% in predicting fibrosis in patients with CHB, and 0.50, 26% and 78% in predicting fibrosis in patients with CHC. OPN had an AUC of 0.997, sensitivity of 96% and specificity of 100% in predicting fibrosis in patients with CHB, and 0.974, 96.5% and 100% in predicting fibrosis in patients with CHC. In conclusion, BGN and OPN could be considered non-invasive markers for liver fibrosis assessment.

The association between infection with Gram-negative bacteria and autoimmune diseases has been investigated with controversies about the role of the organisms especially, Helicobacter pylori (H. pylori). To evaluate the impact of the presence and activity of H. pylori on the disease activity in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS). This study was carried out on one hundred adult patients and 50 controls. Patients included 40 RA, 40 SLE, and 20 AS. Participants were subjected to clinical examination and laboratory investigations; ESR (spectrophotometric assay), CRP (turbidimetric method), serum H.pylori IgG antibody test (enzyme immunoassay), and H. pylori antigen test (lateral flow immunoassay, rapid one-step test) in stool. Positive test in stool indicated active current H. pylori infection. Mean age of patients was 36.95±10.34; 51.2±6.91, 35.5±3.71, and 48.82±5.81 in SLE, RA, AS, and control groups respectively. Serum H. pylori IgG antibodies was 0.803±0.497 U/mL in SLE group, 1.48±0.637 U/mL in RA group and 0.75±0.68 U/mL in AS group while it was 0.2±0.61U/mL in the control group with a significant difference (P=0.000). The H. pylori antigen in stool was found positive in 30%, 70% and 20% of patients of the three groups respectively while it was positive in 10% of the control group with P>0.001. Patients with active SLE (SLEDAI >3) and RA (DAS-28 >3.2) demonstrated higher frequency of positive test for H. pylori antigen in stool than patients at remission (66.7% P= 0.02 and 83.3% P= 0.01 respectively). In contrast, 22.2% of patients with active AS (BASDAI > 4) were positive for H. pylori in stool. In conclusion, H. pylori infection is associated with increased disease activity in patients with SLE and RA but not AS.

Background The World Health Organization (WHO) has named the virus as 2019 novel coronavirus on January 12, 2020, and has declared a public health emergency globally on January 30, 2020. The epidemic started in Wuhan, China, in December of 2019 and quickly spread to over 200 countries. COVID-19 can cause multiple organ injuries (e.g., kidney, heart, blood, and nervous system). Among them, acute kidney injury (AKI) is a critical complication due to its high incidence and mortality rate. So, it is essential to evaluate AKI in COVID-19 patients during this pandemic state. The aim of this work is to detect the occurrence of AKI in hospitalized COVID-19 patients. So, a retrospective study was conducted on hospitalized adult patients > 18 years old with confirmed SARS-CoV-2 infection admitted to the Abo Teeg Hospital at Assiut City, Egypt, from May 1, 2020, to July 1, 2020. All data were collected from medical records, patients’ follow-up, and charts. Data were verified, coded by the researcher, and analyzed using IBM-SPSS 21.0. Results Eighty-six COVID-19 patients were admitted to Abo Teeg Hospital in Assiut City, Egypt, between May and July 2020. Thirty-eight patients (33%) were of the male gender. Mean age was 58.07 ± 17.9, and 61 patients developed AKI. 32.8% of the AKI group were a stage I severity (increase in serum creatinine by 0.3 mg/dl within 48 h), 21.3% of them presented by stage II (2–2.9 times increase in serum creatinine), and 45.9% were in stage III (3 times or more increase in serum creatinine). The overall hospital mortality for the patients admitted to ICU with AKI was 6.7% (11/61), compared to 1% (4/25) in those without AKI. Conclusion Hospitalized patients with COVID-19 had a higher risk of AKI, and we recommended that those patients should be evaluated after discharge for the development of CKD.

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Background Hepatitis B virus (HBV) may reactivate when treating chronic hepatitis C (CHC) with direct-acting antivirals (DAA). We aimed to investigate the risk of HBV infection and reactivation during DAA therapy by performing a prospective observational study carried on 200 patients positive for chronic HCV who were candidates for treatment by DAA therapy according to the Egyptian guidelines from February 2019 to December 2019; the patients identified to carry HBsAg at baseline or with positive HBc Abs were further assessed for other HBV markers: hepatitis B e antigen at baseline, and serum HBV DNA quantitative measurement at baseline, week 4 of treatment, end of treatment. On the other hand, recent infection by HBV among those patients was observed. Results Of all participants, 49% were males and 51% were females, aged above 18 years. There is a highly statistically significant difference (p-value < 0.05) between HCV RNA PCR (at the beginning, at the end of 4 weeks, and at the end of 12 weeks) in studied patients. There was a highly statistically significant difference found between the liver function tests at the beginning, at the end of 4 weeks, and at the end of 12 weeks of treatment where it shows improvement except for serum albumin. At beginning of the study, there were 34 patients who are co-infected with HCV and HBV with quantitative PCR test for HBV DNA ≥ 20 IU/ml. After 1 month of DAA therapy, reactivation was detected in 6 cases (4 occult cases show reverse seroconversion (became HBs Ag positive), and 2 co-infected cases show increased HBV DNA > 1000 IU/L above the baseline level). In addition, 3 new cases acquired recent infection with the positivity of HBc IgM and detectable levels of HBV DNA. After 3 months of study, reactivation was detected in one patient with co-infection (where increased HBV DNA > 1000 IU/L above the baseline level), and 5 new cases acquired recent infection late in the study. Conclusion Screening for HBV infection prior to DAA therapy is required to detect recent infection of reactivation of previous infection during or after DAA therapy.

Introduction Vitamin D is suggested to influence glucose homeostasis. An inverse relationship between serum 25-hydroxyvitamin D (25(OH)D) and glycemic control in non-chronic kidney disease (CKD) patients with type 2 diabetes was reported. We aimed to examine this association among type 2 diabetes patients with CKD. Objectives To examine the relation between plasma 25-hydroxyvitamin D3 (25(OH)D3) levels and glycemic state in diabetic patients at various stages of CKD. Patients and methods A total of 70 participants (40 men and 30 women) with a mean age of 65.3±11.5 years suffering from type 2 diabetes mellitus with various stages of CKD were recruited. Blood for glycated hemoglobin (HbA1c), serum 25(OH)D3, renal profile, and estimated glomerular filtration rate was drawn at enrollment. Correlation and regression analyses were carried out to assess the relationship of serum 25(OH)D, HbA1c, and other metabolic traits. Results Our study shows the following results: Most of the participants are urban with age range from 50 to 70 years. Forty percent of the participants are with good glycemic control, 30% with moderate control, and 30% with bad control. Fifty percent of the patients were at CKD stage 3. Stage 5 patients differed significantly from stages 1 to 4 patients where they were younger, with lowest mean HbA1C value and a much higher mean 25(OH)D level (around twice of stage 1 patients). Half of the cases are vitamin D deficient, nearly a third of them are insufficient, and about 20% are sufficient. The level of 25(OH)D3 correlates inversely with the level of HbA1C irrespective of estimated glomerular filtration rate or the age of the patients. Conclusion The present study reported a significant inverse relationship between serum 25 (OH)D3 and HbA1c levels in type 2 diabetics with suboptimal glycemic control and concomitant different stages of CKD.

Background: Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycaemia as a result of insulin deficiency, insulin resistance or both. Objective: To assess the impact of vitamin D replacement therapy on glycemic state in type 2 diabetic chronic kidney disease (CKD) patients. Patients and Methods: 70 patients previously diagnosed as type 2 DM (according to guidelines used by National Institute of Health USA) attending Al-Azhar Assuit University Hospital, internal medicine department and outpatient clinics was included in our study where vit. D was replaced in our groups and its impact on glycemic state was analyzed by bivariate and multivariate analyses. Results: Our study is a prospective study revealed a significant negative correlation between 25(OH)D levels and HbA1c values before and after vit. D replacement therapy. Conclusion: Vitamin D replacement therapy had a beneficial effect on glucose hemostasis via a significant reduction in HbA1c, this emphasizes the potential therapeutic implications of vitamin D supplementation as a promising preventative and therapeutic agent for improved glycemic control among type 2 DM patients with CKD.

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