Hepatitis C virus in pregnancy has substantial risk for vertical HCV transmission: High viral load in HCV-positive women increases the risk of HCV transmission to neonates. Screening pregnant women during early stage of pregnancy and optimizing the HCV viral load in HCV-positive women might prevent vertical HCV transmission to neonates.

Patients with dyspeptic symptoms and a history of previous PUD should be considered for prophylactic treatment to prevent ulcer recurrence during prolonged daytime fasting in Ramadan, especially during the winter time.

Background/Aims. Renal impairment is a common complication of cirrhosis. Serum creatinine is less sensitive in these patients. Measurement of the glomerular filtration rate (GFR) is the gold standard but time consuming. The aim is to validate plasma NGAL (pNGAL) and urinary NGAL (uNGAL) as markers of renal function in patients with HCV related cirrhosis. Patient and Methods. One hundred HCV related end stage liver cirrhosis patients were randomized into two groups: Group I (n = 35), patients with GFR < 60 mL/m measured by isotope scanning of the kidney (Renogram), and Group II (n = 65), patients with GFR ≥ 60 mL/m. The pNGAL and uNGAL were measured within 2 days of the Renogram. Results. Both groups were matched with age, sex, and Child Pugh score. There was statistically significant difference between both groups regarding serum creatinine (1.98 ± 1.04 versus 1.38 ± 0.88 mg/dL; p = 0.003) and pNGAL level (5.79 ± 2.06 versus 7.25 ± 3.30 ng/dL; p = 0.019). Both groups were comparable (p > 0.05) for the uNGAL (6.00 ± 0.78 versus 6.03 ± 0.96 ng/mL). Unlike uNGAL, the pNGAL positively correlated with total GFR by Renogram (r = 0.3; p = 0.001). With a cutoff ≥4 ng/mL, pNGAL had 94.3% sensitivity and 1.5% specificity and PPV = 34, NPV = 33.3, LR+ = −175.1, and LR− = −60.6. Conclusion. The pNGAL is a promising marker of the renal function in patients with cirrhosis.

Ascites is a pathological accumulation of fluid in the peritoneal cavity. Cirrhosis is the most common cause of ascites, representing for 85% of cases. More than one cause may be responsible for the development of ascites (multifactorial). Development of ascites is a poor prognostic event in the natural history of cirrhosis, with approximately 15 and 44% of patients with ascites succumbing in 1 and 5 years, respectively. Patients with cirrhosis need referral for liver transplantation after development of ascites. Proper history and physical examination are important in diagnosing the cause of ascites. Diagnostic paracentesis and abdominal sonogram should be performed during initial evaluation. Low salt diet and diuretic are the initial treatment option, and large volume paracentesis is an option for non-responder to diuretics. Transjugular intrahepatic portosystemic stent-shunt (TIPS) is highly valuable in properly selected patients.

In countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities.The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients’ priority for UGE.Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB.Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S.Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority.

According to world psoriasis day consortium about 125 million people all over the world suffer from this disease, however, in some countries there is a higher prevalence rate of psoriasis, as in Kazakhstan,

Background: Liver fibrosis is one of the chronic hepatitis B (CHB) indications for treatment. Objectives: We aimed to assess the fibrosis index, FIB-4, King's fibrosis score, albumin-bilirubin (ALBI) score, gamma-glutamyl transferase-platelets (GPR), and gamma-glutamyl transferase-albumin (GAR) ratios as diagnostic models of liver fibrosis in CHB patients. Methods: The study enrolled 217 patients. Liver fibrosis was assessed by transient elastography, which showed 20.3% of the patients had F4 fibrosis. Treatment was given for 33.20 ± 20.94 months. Results: F4 fibrosis patients had higher values (P = 0.001) of Fibrosis index score, FIB-4 score, King's fibrosis score, ALBI score, GPR, and GAR than non-F4 fibrosis patients. All patients had improved values after treatment. The mean treatment-induced changes were comparable in patients with and without virological response. The Fibrosis index of >-32.66 showed 63.64% sensitivity and 91.33% specificity. The FIB-4 score of > 1.88 had 72.73% sensitivity and 91.33% specificity. The King's fibrosis score of > 7.93 demonstrated 90.91% sensitivity and 73.99% specificity. The ALBI score of >-2.7 had 70.45% sensitivity and 86.13% specificity. The GPR value of > 0.69 revealed 70.5% sensitivity and 94.2% specificity. The GAR value of > 1.28 showed 72.73% sensitivity and 46.4% specificity. The GAR was inferior to FIB-4 and GPR (P < 0.05). Conclusions: GPR, fibrosis index, King's fibrosis score, ALBI, and FIB-4 are useful diagnostic models of liver fibrosis in CHB patients.

Aim: Epidermal growth factor (EGF) is a mitogen for hepatocyte grown in vitro, and its expression is up-regulated during liver regeneration. EGF also plays an important role in tumor initiation and progression. The goal of this study is to assess whether EGF is associated with advanced hepatocellular carcinoma (HCC) and also whether it is a predictive factor of shortened survival. Methods: Serum EGF levels were evaluated in a total of 151 subjects: 51 patients with unresectable HCC, (21 of them were eligible for transarterial chemoembolization (TACE) and serum EGF levels were measured before and 1 week after TACE), 40 patients with chronic hepatitis without cirrhosis, 40 patients with cirrhosis, and 20 healthy controls. Patient demographic and laboratory variables were evaluated as predictive factors of survival in a Cox regression multivariate analysis using SPSS software. Results: The mean serum level of EGF in patients with HCC was 784.49 pg/mL, which was significantly higher (P < 0.05) than all other groups. Mean EGF level in cirrhotic patients was 144.69 pg/mL; in those with chronic hepatitis C without cirrhosis, it was 338.64 pg/mL; and in healthy controls, it was 297.15 pg/mL. In group Ia patients who underwent TACE, the mean serum level of EGF was 759.76 ± 287.88 pg/mL before TACE, and 801.14 ± 276.12 pg/mL 1 week after treatment (P = 0.34). On multivariate Cox regression analysis only age (P = 0.03) and higher serum EGF level (P = 0.005), were inversely correlated with overall survival. Conclusion: EGF levels were found to be significantly higher in HCC patients and together with age were the only predictors of poor survival in these patients. There was an increase in EGF levels 1 week after TACE in response to hypoxia; however, this increase was not statistically significant.