IntroductionThe worldwide shortage of donor livers has prompted the search for alternative cell therapies. Previous data from our laboratory proved a supportive role for stem cell therapy in the treatment of end-stage liver disease patients. Therefore; this study was conducted to assess the clinical and biochemical effects of repeated stem cell infusion.MethodsNinety patients with liver cirrhosis were randomized to receive either one session treatment (G-I) or two sessions 4 months apart (G-II) of autologous haematopoietic stem cells (HSCs) transplantation and a control group (G-III) who received regular liver treatment. G-CSF was administered to transplanted patients before infusion; HSCs were isolated from 400 cc bone marrow (BM) aspirate. CD34+/CD133+ cells were purified: 50 % of the cells were infused locally in the portal vein on the same day and the other 50 % were differentiated to MSC and infused systemically in a peripheral vein (one session treatment G-I). In G-II, the same process was repeated after 4 months from the first treatment (two session’s treatment G-II). Liver function was monitored for 12 months after stem cell therapy (SCT).ResultsStatistically significant improvement was reported in the transplanted patients (G-1) as regards the mean serum albumin, bilirubin and INR levels which started to improve after 2 weeks of treatment and continued to improve till the 6th month in the single infusion group. The two sessions infused group (G-II) showed sustained response which continued throughout the all follow-up period (12 month). By the end of the study, 36.7 % of the patients in G-I and 66.7 % in G-II showed improvement in the degree of ascites compared to the control group (G-III). We also reported an improvement in the hepatic functional reserve as assessed by the Child-Pugh and MELD score. Safety of the procedure was evidenced by the low incidence of complications encountered.ConclusionIn patients with end-stage liver disease, the repeated infusion with combined routes portal and peripheral veins has a beneficial effect on liver functions with minimal adverse events and more lasting clinical efficacy after repeated HSCs infusion.

ARFI can be used as a reliable method in assessment of significant fibrosis post-LDLT.

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Introduction After hepatocellular carcinoma (HCC) interventional therapies, noninvasive vascular diagnostic imaging [duplex, Color/power Doppler ultrasonography, and triphasic computed tomography (CT)] determines the lesion complete/incomplete ablation. The aim was to analyze the usefulness of duplex, color/power Doppler ultrasonography in HCC ablation after percutaneous ablative therapies (PATs). Methods We included 30 patients with 33 HCCs subjected to duplex/Doppler ultrasonography, ultrasound-guided fine-needle aspiration cytology (FNAC), and triphasic CT, all these before and after PATs. Results One week after treatment ended, out of 21 lesions with pretreatment positive color-Doppler, signals disappeared in 19 (90.5%) lesions. Out of 29 lesions with pretreatment positive power-Doppler, signals disappeared in 24 (82.8%). Out of 13 lesions with pretreatment intralesional power/duplex arterial signals, signals disappeared in eight (61.5%). There was a significant correlation (P < 0.05) between power-Doppler arterial signals and FNAC. Before HCC ablation, power-Doppler demonstrated a sensitivity 40% and specificity 96% in HCC detection in relation to FNAC, it had a sensitivity 60% and specificity 85% in HCC detection compared to triphasic CT. After HCC ablation, power-Doppler had a sensitivity and specificity of 100% in viable malignancy detection in relation to FNAC. Power-Doppler had a sensitivity 89% and specificity 93% in residual malignancy detection in relation to triphasic CT. Conclusion Power-Doppler is a good positive test as intralesional arterial signals in a cirrhotic liver lesion is highly suggestive of HCC. Power-Doppler was sensitive in HCC ablation assessment in pretreatment positive cases only. Both triphasic CT and duplex/Doppler are complementary and the use of different diagnostic modalities after ablation is mandatory.

Background and rationale: Coronavirus disease 2019 (COVID-19) infection is a respiratory tract infection because of a novel coronavirus. The clinical picture ranges from asymptomatic to severe manifestations mandating intensive care and respiratory support. We aimed to assess the serum level of iron, total iron binding capacity (TIBC), and transferrin saturation in COVID-19 patients and their relation to disease severity and outcome. Methodology: This observational cross-sectional analytical study was conducted on 100 confirmed cases of COVID-19 who were admitted to Kasr Al-Ainy hospitals between June and December 2020.Serum levels of iron, total iron binding capacity (TIBC), and transferrin saturation were measured for all study populations. Result: One hundred patients were involved in this research, 51males and 49 females, with a mean age of 51±14.9years. Regarding the disease severity,53% were moderate cases, 34% were mild, and 13% were severe cases. Fifty-two (54.2%) patients showed normal serum levels of iron, 38 patients (39.6%) showed high serum levels of iron, and 6 patients (6.3%) showed low serum levels of iron. The mean ±SD values of iron, TIBC, and transferrin saturation were 163.1±105 mcg/dL, 366 ± 162.6 mcg/dL, 44.4 ± 20.2 %, respectively. Iron, total iron binding capacity (TIBC) levels and transferrin saturation did not show a significant association as regards either COVID-19 severity or mortality. Mortality and deterioration were detected in 31.7% out of 60 patients with COVID-19. The results showed that obese patients showed a higher percentage of severe COVID-19,which was statistically significant (p=0.037).There was a statistically significant higher mortality rate in patients with severe COVID-19 (p=0.000).High mortality was observed significantly in patients with diabetes mellitus (p=0.041).Iron levels, total iron binding capacity (TIBC) levels and transferrin saturation did not show a significant association regarding either COVID-19 severity or mortality. Conclusion: In our study, COVID-19 severity was not related to iron metabolism but was affected by obesity and diabetes mellitus. COVID-19 mortality was significantly associated with diabetes.

INTRODUCTION: Precise identification of HCV induced liver fibrosis is needed for tailoring therapy, monitoring fibrosis regression after sustained virologic response and management of complications. Few studies investigated the role of MicroRNAs in predicting liver fibrosis. The current study evaluated the diagnostic accuracy of circulating miRNAs; miR-122, miR-192, miR-855, miR-375, miR-224, and miR-221 in prediction of hepatic fibrosis and to validate their usefulness against other commonly used noninvasive fibrosis scores using liver biopsy as the gold standard. METHODS: Seventy patients with chronic HCV, enrolled from Theodor Bilhariz research institute were included in this study. They were subjected to routine laboratory investigations, HCV-RNA, serum miR-122, 192, 885, 375, 224 and 221 by PCR, ultrasound guided liver biopsy and calculation of the following scores: Fibrosis Index (Fi), Fibro-Alfa , Hui index , aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), Biotechnology Research Center (BRC) score, aspartate to platelet ratio index (APRI), Fibro-Q , Gotebörg University Cirrhosis Index) (GUCI) and FIB-4 score. RESULTS: There was no statistically significant difference in laboratory parameters except for miR-122 which was significantly lower in patients with significant and advanced fibrosis (P < 0.0001 and P = 0.007, respectively). Univariate analysis identified miR-122, bilirubin and miR-855 as independent predictors of significant fibrosis. The AUC were 0.78, 0.67and 0.63, respectively (Figure 1a,c). Multivariate analysis selected the best overall formula combining miR-122, bilirubin and miR-855 as a novel noninvasive score for predicting significant liver fibrosis. KAFI Score = 4.558 – (miR-122 × 0.089 + miR-855 × 0.051 + bilirubin × 0.366), where 4.558 is a numeric constant. The area under the ROC curve (AUC) of this score for identifying significant fibrosis was 0.83 (Figure 1d). A cut-off of 0.41 had 77% sensitivity, 75% specificity, 65% positive predictive value, 85 % negative predictive value and 76% efficiency for predicting significant liver fibrosis. The AUCs of FI, Fibro- Alfa, Hui, AAR, BRC, APRI, Fibro-Q, GUCI and FIB 4 were 0.46, 0.53, 0.54, 0.60, 0.61, 0.62, 0.62, 0.62 and 0.67; respectively for predicting significant fibrosis. KAFI score yielded AUC 0.83 for predicting significant fibrosis and 0.80 for predicting advanced fibrosis. CONCLUSION: KAFI score is better than the current scores in discriminating hepatic-fibrosis in chronic hepatitis C patients

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Introduction: Identification of HCV- induced liver fibrosis is mandatory for tailoring therapy, and management of complications. The current study evaluated the accuracy of circulating miRNAs; in diagnosis of hepatic fibrosis. Patients  and methods: Seventy HCV patients were subjected to routine laboratory investigations, HCV-RNA, serum miRNA-122, 221, 192, 224 , 375, and 885  by PCR, liver biopsy and calculation of the following scores:  aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), aspartate to platelet ratio index (APRI), FIB-4 score,  Hui index,  Fibrosis Index (FI), Fibro-Q ,  Fibro-Alfa Biotechnology Research Center (BRC) score and  Gotebörg University Cirrhosis Index (GUCI). Results: Patients with significant and advanced fibrosis have significantly lower miR-122 (P < 0.0001 and P= 0.007, respectively).  miR-122, bilirubin and miR-855 were found to be  independent predictors of significant fibrosis in univariate analysis. A novel score; Cairo University Fibrosis Index (CUFI) based on microRNA 122, bilirubin and microRNA 855 were formulated for predicting significant liver fibrosis. The AUC of this score, for predicting significant and advanced hepatic fibrosis was 0.83 and 0.80 respectively.  This AUC was higher than those of other fibrosis scores. Conclusion: Cairo University Fibrosis Index is better than the existing scores in assessing fibrosis in chronic HCV patients.