The therapeutic effect of pegylated interferon (peg-IFN) alfa-2a combined with ribavirin (RBV) on chronic hepatitis C Egyptian patients is low and further efforts are required to optimize this therapy for achievement of higher rates of virological response. This study aimed to evaluate the safety and efficacy of hydroxychloroquine (HCQ) in combination with pegylated interferon plus ribavirin on early virological response (EVR) in chronic hepatitis C Egyptian patients. Naïve 120 Egyptian patients with chronic hepatitis C virus infection were divided into two groups. Group 1 have administered the standard of care therapy (pegylated interferon alfa-2a plus ribavirin) for 12 weeks, (n = 60). Group 2 have administered hydroxychloroquine plus standard of care therapy for 12 weeks, (n = 60). Therapeutics included hydroxychloroquine (200 mg) oral twice daily, peginterferon alfa-2a (160 μg) subcutaneous once weekly and oral weight-based ribavirin (1000-1200 mg/day). Baseline characteristics were similar in the two groups. The percentage of early virological response was significantly more in patients given the triple therapy than in patients given the standard of care [54/60 (90%) vs. 43/60 (71.7%); P = 0.011; respectively]. Biochemical response at week 12 was also significantly higher in patients given the triple therapy compared with the standard of care [58/60 (96.7%) vs. 42/60 (70%); P < 0.001; respectively]. Along the study, the observed adverse events were mild and similar across treatment groups. Addition of hydroxychloroquine to pegylated interferon plus ribavirin improves the rate of early virological and biochemical responses in chronic hepatitis C Egyptian patients without an increase in adverse events. J. Med. Virol. 88:2170-2178, 2016. © 2016 Wiley Periodicals, Inc.

Background and aimsSeveral angiogenic factors are involved in the development and progression of hepatocellular carcinoma (HCC), a hypervascular tumor. Vascular endothelial growth factor (VEGF) is a primary driving force for angiogenesis, and its overexpression has been reported in HCC. However, the significance of plasma and tissue VEGF levels in HCC in Egyptian patients with chronic hepatitis C (CHC) infection is understudied. The aim of this study was to evaluate the role of VEGF (measured in plasma and liver tissue) in patients with hepatitis C virus-related HCC and to assess its significance in the diagnosis and prognosis of HCC.Materials and methodsA total of 90 subjects were studied. Among 90 subjects, 60 with CHC were examined and were subdivided into two groups: 30 patients with CHC-related HCC (HCC group) and 30 patients with CHC without HCC (non-HCC group). Thirty apparently healthy subjects served as the control group. VEGF was estimated in plasma by enzyme-linked immunosorbent assay and its expression in liver tissue was evaluated by real-time polymerase chain reaction. VEGF expression level and its relationship to tumor parameters, patients’ liver function profile, and patients’ clinical parameters were also investigated.ResultsPlasma VEGF levels in the HCC group were significantly higher than those of the non-HCC group, and both groups had significantly higher plasma VEGF levels than did the control group. Liver tissue VEGF expression was significantly higher in the HCC group than in the non-HCC group and positively correlated with plasma VEGF in the HCC group. The plasma VEGF levels were positively correlated with patients’ age, aspartate aminotransferase levels, serum alpha-fetoprotein levels, the presence of portal vein thrombosis, and the number of hepatic focal lesions in the HCC group. However, plasma VEGF levels were not significantly correlated with the Child-Pugh score, alanine aminotransferase levels, the size of focal lesions, and Okuda stage. Using both the VEGF and alpha-fetoprotein levels to detect HCC maximizes the sensitivity and specificity.ConclusionPlasma levels of VEGF may be a useful diagnostic and prognostic marker for HCC in patients who have been diagnosed with CHC.

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Background: Hepatocellular carcinoma (HCC) has an increasing incidence worldwide, and is considered the second cause of cancer-related death. Aim: The aim of the study is to assess the usefulness of real-time shear-wave elastography in differentiating HCC from other hepatic focal lesions. Patients and methods: The current study was conducted on 110 patients in addition to 10 healthy subjects, divided into four groups as follows: liver cirrhosis, HCC, hepatic focal lesions other than HCC, and control. Demographic, laboratory and imaging data were collected and then elastographic assessment of the hepatic focal lesions and the surrounding liver parenchyma using elastograph point quantification (ElastPQ) (iU22x MATRIX, Philips) was done. Results: ElastPQ (iU22x MATRIX, Philips) has shown its ability to differentiate between HCC and cystic focal lesions, HCC and cholangiocarcinoma, and HCC and focal nodular hyperplasia (FNH). Cystic lesions demonstrated lower stiffness in comparison to HCC; however, cholangiocarcinoma and FNH demonstrated higher stiffness in comparison to HCC. ElastPQ was unable to differentiate between stiffness in both ‘HCC and hemangioma’ and ‘HCC and metastatic focal lesions’. ElastPQ showed that HCC, cystic focal lesions, and cholangiocarcinoma had lower stiffness in comparison to their surrounding liver parenchyma, whereas FNH had higher stiffness in comparison to the surrounding liver parenchyma. ElastPQ showed that the surrounding liver parenchyma of the HCC group has the highest stiffness amongst all studied hepatic focal lesions surrounding liver parenchyma. Conclusion: ‘Point’ shear-waves elastography (ElastPQ; Philips iU22x MATRIX, Philips) is a noninvasive, quantitative and nonradiating method for evaluation of tissue elasticity, and is helpful in differentiating HCC from other hepatic focal lesions.

Background: In spite of being invasive and expensive, endoscopic and histologic evaluation measures remain the gold standard for diagnosis of ulcerative colitis. There is a need for widely available, reasonably priced biomarkers for testing outside of endoscopic evaluation. Objective: To evaluate fecal calgranulin C, Neutrophil / Lymphocyte ratio and Lymphocyte / Monocyte ratio in ulcerative colitis patients as noninvasive biomarkers of disease activity and severity compared with colonoscopy. Patients and Methods: A cross -sectional study was conducted on 50 patients with ulcerative colitis and were classified into two groups: Group I: (50) patients in active state and Group II: the same (50) patients in remission state. Patients were subjected to thorough clinical examination, laboratory investigations including fecal calgranulin C and colonoscopic assessment. Results: Fecal calgranulin C, neutrophils, monocytes and N/LR were reliable indicators of activity and severity of active UC compared to inactive UC (p < 0.001). The mean fecal calgranulin C level for UC in exacerbation and remission was (709.30 ± 172.31 and 84.86 ± 19.42) pg/ml respectively. The optimal cutoff was estimated at 185pg/ml with sensitivity and a specificity of 94% and 92%, respectively. Significant elevation of NLR was observed in active UC group compared to inactive UC (2.44 ± 0.56 and 1.56 ± 0.36) respectively. Conclusion Fecal calgranulin C and NLR could be used as noninvasive markers to predict activity and severity of UC and to reduce the need for invasive endoscopies.

Introduction:Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, with an estimated 500,000 deaths per year. 1 Advances in diagnostic imaging and widespread application of screening programs in highrisk populations have allowed detection of small HCC, which can be curable by partial hepatic resection (HR), liver transplantation, or local ablation therapies. Out of these, liver transplantation, which offers the potential to both resect the entire potentially tumourbearing liver and to eliminate the cirrhosis, achieves the best results but can be offered only to a minority of patients because of the shortage of donors and high cost. 2 Therefore, HR has generally been accepted as the first treatment of choice for HCC in many centres. Nevertheless, the associated cirrhosis carries a high risk of intraoperative

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