AIM:To evaluate the accuracy of spot urinary Na/K and Na/creatinine (Cr) ratios as an alternative to 24-h urinary sodium in monitoring dietary compliance in patients with liver cirrhosis and ascites treated with diuretics. METHODS:The study was carried on 40 patients with liver cirrhosis and ascites treated with diuretic therapy. Patients were divided into two groups according to 24-h urinary sodium. We measured spot urine Na/K ratio, Na/ Cr ratio and 24-h urinary sodium. Student's t test was used to compare the interval variables and χ 2 test to compare the nominal variables between the two groups. Receiver operator characteristic curve was used to identify the best cutoff point for Na/K and Na/Cr ratio. RESULTS:The best cutoff point for Na/K ratio was 2.5 (P < 0.001) and area under the curve (AUC) was 0.9, and for Na/Cr ratio, the best cutoff point was 35 (P < 0.001) and AUC was 0.885. Na/K ratio showed higher sensitivity and accuracy compared to Na/Cr ratio (87.5% and 87% for Na/K ratio; 81% and 85% for Na/Cr ratio, respectively). CONCLUSION:Spot urine Na/K ratio has adequate accuracy for assessment of dietary sodium restriction compared with 24-h urinary sodium in patients with liver cirrhosis and ascites.

Background: Scarring or progressive fibrosis and cirrhosis develop over time as a result of chronic viral infection, which induces inflammation and tissue healing via deposition of extracellular matrix. There has been an increase in the sustained virological response (SVR) and the rate of eradication of HCV because of the effectiveness of directacting antiviral drugs (DAAs). Reduced hepatic fibrosis is associated with increased SVR rates. There are a variety of non-invasive fibrosis imaging, scoring, and marker methods: transient elastography, aminotransferase platelet ratio index (APRI), as well as fibrosis-4 (FIB-4) score. Objective: The purpose of this research was comparing the novel fibrosis index to APRI, (FIB-4) score and fibroscan in predicting the degree of hepatic fibrosis in Egyptian chronic HCV patients who were managed by DAAs. Patients and methods: 100 Egyptians with chronic HCV infection participated in a our 3-month long prospective Cohort research using the IFN-free DAA combination of Sofosbuvir and Daclatasvir ± Ribavirin. Results: There was significant regression of fibrosis with DAAs treatment in all patients achieving SVR by fibroscan, APRI and fib4. Novel fibrosis index is reliable and good tool in estimation of liver fibrosis in correlation to fibroscan, with the cutoff value in prediction of hepatic fibrosis stage 4 was >3.1 and has sensitivity of 81.5% while the specificity was 74.1%. Conclusion Novel fibrosis index has been found to be good reliable marker for assessment of liver fibrosis with high accuracy of predicting f4 fibrosis stage. There was significant marked reduction of fibrosis degree by fibroscan, APRI and FIB4 after DAAs treatment.

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Background Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, with more than 1 million new cases diagnosed every year. Liver transplantation (LT) has been used as a curative treatment for patients with HCC. In countries where the liver allograft allocation is based on the Model for End-Stage Liver Disease (MELD) system, patients with HCC within the Milan criteria (MC) receive exception points, preventing dropout from the list. Objective The aim of this study is to analyse the different risk factors leading to delisting in liver transplant patients with hepatocellular carcinoma. Methods This study was a retrospective cohort study which had been carried out during the period between January 2017 to June 2018. During it, 48 patients were listed for LDLT at Ain Shams Center for Organ Transplantation (ASCOT) at Ain Shams Specialized Hospital till liver transplantation. By the end of this period 29 patients were delisted due to several reasons while 12 got transplanted and 7 were still on the waiting list. The study protocol was approved by the medical ethics committee of Ain Shams University. Results Regarding this study’s results, 25% were transplanted, 60.42% were delisted and 14.58% remained on the waiting list. 51.72% of patients in this study were delisted due to unavailability of related donor. In this center only related donors were allowed to donate as it follows Egypt’s organ donation policies, there are no organ allocation systems and deceased donor liver transplantation is illegal limiting availability of donors. Conclusion At the end of this study we can conclude that, age and tumour classification were independent predictors of delisting HCC patients candidates for liver transplantation.