Recent work demonstrated the presence of Helicobacter pylori (H. pylori) in the bile and gallbladder of more than 75 % of patients with gallbladder cancer and more than 50 % of patients with chronic cholecystitis. The aim of the work was to determine the prevalence of H. pylori in the gallbladder of patients operated on for chronic cholecystitis and relating their presence to the precancerous histological changes. In our study, fifty patients were operated on for chronic cholecystitis. The patients were subdivided into two groups (each includes 25 patients): H. pylori-positive group, who had H. pylori in their gallbladder mucosa detected by Giemsa stain, and H. pylori-negative group. The histological findings (mucosal erosions, atrophy, metaplasia, dysplasia, lymphoid infiltration, musculosa hypertrophy, and fibrosis) were compared between the two groups. Comparing the histological findings of the H. pylori-infected gallbladders with the non-infected ones, the gallbladders with mucosal hyperplasia, metaplasia/dysplasia, and lymphoid infiltration showed statistically significant differences, with a P value of 0.028, 0.049, and 0.022, respectively. On the other hand, no statistically significant differences were detected between the two groups in the degree of mucosal erosions (P = 0.299), atrophy, musculosa hypertrophy (P = 1.000), and fibrosis (P = 1.000). These results highlight the role of H. pylori infection in aggravating the mucosal lesions (mucosal hyperplasia, metaplasia, and lymphoid infiltration) of the gallbladder that is considered potentially precancerous.

Background/Aim:The frequency of sexual dysfunction (SD) is not well known in patients with chronic hepatitis C virus (HCV). In spite of the fact that histological benefits of peginterferon (Peg-IFN)/ribavirin therapy are well established, the effects on sexual health are less certain. To assess the prevalence of the SD and explore its relevance to histopathologic changes and Peg-IFN treatment.Materials and Methods:The study included 100 HCV males; all the patients completed questionnaires to assess their sexual function before and during the treatment.Results:Before treatment, SD was reported only by 12 (19.4%) and 10 (29.4%) patients of early and advanced liver fibrosis, respectively. SD during HCV treatment (with Peg-IFN and ribavirin) for liver fibrosis was significant, as 24 (70.6%) out of 34 (100%) of HCV patients had advanced fibrosis but only 20 (32.3%) out of 62 (100%) patients had early fibrosis and were sexually affected (P = 0.01). SD before treatment was found in 22 (22%) patients; 16 (16%) were >40 years old and 6 (6%) patients were ≤40 years old. SD showed highly significant (P = 0.001) difference prior to and during treatment. Pre treatment, 78 (78%) patients denied any SD and only 22 (22%) were sexually affected, while during treatment, the number of patients who were sexually affected rose to 44 (44%). The rest of the group [56 (56%)] did not report any sexual impairment.Conclusion:SD was noticed during Peg-IFN and ribavirin treatment in patients with advanced liver fibrosis. Age and advanced liver fibrosis were important factors in inducing SD. This is of key importance for clinical practice as it modifies the management of HCV patients.

ConClusions:Our study showed an association between advanced stage of liver fibrosis, the level of viremia and decreased BMD in chronic HCV patients. Replacement therapy for osteoporosis in advanced liver fibrosis caused by HCV is recommended.

The present study was carried out to assess the predictive value and expression of the proliferative activity of Ki-67 and the expression of p53 protein in Helicobacter pylori associated chronic gastritis. This study comprised archival blocks from 20 dyspeptic patients who at National Hepatology and Tropical Medicine Research Institute underwent a diagnostic oesophago-gastroduodenoscopy with multiple gastric antral endoscopic biopsies for histological examination. The blocks were cut at 5 nM thicknesses, stained by hematoxylin and eosin to score the inflammatory grade and subjected to Giemsa stain to assess H. pylori infection, and then immune-histochemical method was done to determine protein P53 and Ki-67. The obtained results indicated that there was no significant association between the expression of Ki67 and P53 in the studied cases. There was no significant association between Ki67 and P53 in the presence of intestinal atrophy, intestinal metaplasia, intestinal activity and intestinal inflammation. While, there was significant association between Ki67 and P53 in intestinal dysplasia, P = 0.015, 0.025, respectively. It could be concluded that the significant association of the proliferative marker Ki-67 and apoptotic marker p53 protein with intestinal dysplasia may be one of the main predictive values in the development of gastric carcinoma in patients with gastritis secondary to H. pylori infection.

Cardiac arrhythmias and syncope are rare consequence of therapy with pegylated interferon. We report a 55-year-old Egyptian woman who developed palpitation and syncopal attacks twice within 3 months after starting therapy with pegylated interferon α2b and ribavirin for the treatment of chronic hepatitis C virus. Hepatitis C virus-RNA was undetectable after 12 week. The electrocardiogram holter revealed ventricular extra-systoles on top of sinus tachycardia. pegylated interferon α2b therapy was continued but with a reduced dose. Close follow up revealed neither palpitation nor syncope and hepatitis C virus-RNA was undetectable at 24 and 48 weeks of treatment. In conclusion, our study suggests readjustment of the dose of pegylated interferon α2b therapy to avoid these serious side effects.

Aim:To evaluate the significance of rheumatic hand manifestations in chronic HCV patients. methods: Two hundred and ninety seven HCV patients were subjected to history taking, clinical examination, laboratory investigations including erythrocytic sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA) and anti-cyclic citrullinated peptide (Anti-CCP) and plain X-ray for hands and wrists. Results: The range of patients' age was 18-82 years (43.97±13.56). Their disease duration ranged from 6 months to 25 years (7.3+5.6).Hand affection was present in 137 patients (46.1%). The most frequent hand manifestations were arthralgia (28.6%), tenosynovitis (10.1%), Raynaud's phenomenon (9.1%), and arthritis (5.1%), while laboratory abnormalities were RF in (38.4%), ANA in (6.4%), cryoglobulins in (9.4%) and Anti-CCP in (1.3%). Female gender was the most important risk factors for hand manifestations. The patterns of arthritis in chronic HCV patients were non deforming polyarticular arthritis that affected the small joints of the hands and oligoarthritis. ConClusion: Our study strongly supports a direct role of HCV in inducing rheumatic hand manifestations and autoantibodies in chronic HCV patients, but it is mostly non-deforming and nonsignificant. Surveillance is needed for the detection of rheumatic manifestations and autoantibodies with occasional multidisciplinary team (hepatologist and rheumatologist) approach to HCV patients for early diagnosis and treatment. A long term follow up study for rheumatological manifestations in HCV patients is recommended to reduce health disparities.

Aim:  Cirrhosis represents a common histological pathway for a wide variety of chronic liver diseases. Hepatitis C virus (HCV) is the most important cause of liver cirrhosis in Egypt. Although cirrhosis has been regarded as a relative contraindication for laparoscopic cholecystectomy (LC) as a result of bleeding complications and subsequent liver failure, several reports support the safety of LC in selected patients. This was a prospective study to evaluate the efficacy and safety of LC in cirrhotic patients. Methods:  A total of 177 hepatitis C positive patients with chronic calculus cholecystitis who here scheduled for LC between January 2010 and March 2011 were included in the present study. LC was carried out on patients who fulfilled the inclusion criteria. Two risk stratification‐schemes were used to estimate the perioperative risk of patients with cirrhosis; the Child–Turcotte–Pugh (CTP) score and the Model for End‐stage Liver Disease (MELD) score. Results:  All patients were HCV‐positive patients with Child class A cirrhosis and MELD score ≤ 9. Mean surgical time was 55 min. Surgical difficulty varied between average in 64%, moderate in 28% and extensive in 8%, where 3.4% required conversion to open cholecystectomy. Postoperative follow up of all patients was a multidisciplinary approach by both surgeons and hepatologists. All patients showed sound recovery confirmed by abdominal sonar to exclude intra‐abdominal collections, and application of both CTP and MELD scores, where all patients kept a Child class A score and MELD score ≤ 9. Conclusion:  LC is a safe procedure for hepatitis C‐positive cirrhotic patients when established risk stratifications systems, such as CTP and MELD scores, are used for evaluation.

AIM: Cost effectively diagnosis of common bile duct stones (CBDS) and timing of management remains a topic of argument for the proper management of such condition. CBD clearance can be done by surgery (open or laparoscopic), endoscopy and lithotripsy. Moreover, the gallbladder which is mostly the source of the stones is indicated for cholecystectomy. This retrospective study is aimed to evaluate the difficulty of laparoscopic cholecystectomy (LC) done after more than 2 weeks period for patients underwent ERC to manage CBDS. METHODS: The present study enrolled 99 (69 males and 30 females) patients, whom suffered from CBD stones. The patients were revised and the clinical records were presented at the National Hepatology and Tropical Medicine Research Institute (NHTMRI)-at surgery department, from May 2012 to November 2014. RESULTS: Preoperative jaundice was positive in 33 patients (total serum bilirubin > 2 mg/dL), ERC was done to all patients and stent was placed in 24 patients. Surgery (LC) was delayed more than 2 weeks due to unfitness for surgery 24, patient reluctance 27, and long waiting list 48 patients. During LC different grades of adhesions at Callot's triangle were reported as; grade I in 27, grade II in 42, grade III in18, and grade IV in 12. Conversion to open surgery occurred in 33 patients. Mortality occurred in 3 patients and morbidity in 30 patients.