Background: The hepatitis C pandemic has been systematically studied and characterized in North America and Europe, but this important public health problem has not received equivalent attention in other regions. Aim: The objective of this systematic review was to characterize hepatitis C virus (HCV) epidemiology in selected countries of Asia, Australia and Egypt, i.e. in a geographical area inhabited by over 40% of the global population. Methodology: Data references were identified through indexed journals and non‐indexed sources. In this work, 7770 articles were reviewed and 690 were selected based on their relevance. Results: We estimated that 49.3–64.0 million adults in Asia, Australia and Egypt are anti‐HCV positive. China alone has more HCV infections than all of Europe or the Americas. While most countries had prevalence rates from 1 to 2% we documented several with relatively high prevalence rates, including Egypt (15%), Pakistan (4.7%) and Taiwan (4.4%). Nosocomial infection, blood transfusion (before screening) and injection drug use were identified as common risk factors in the region. Genotype 1 was common in Australia, China, Taiwan and other countries in North Asia, while genotype 6 was found in Vietnam and other Southeast Asian countries. In India and Pakistan genotype 3 was predominant, while genotype 4 was found in Middle Eastern countries such as Egypt, Saudi Arabia and Syria. Conclusion: We recommend implementation of surveillance systems to guide effective public health policy that may lead to the eventual curtailment of the spread of this pandemic infection.

Bone marrow MSCs transplantation either undifferentiated or differentiated can be used as a potential treatment for liver cirrhosis.

Liver fibrosis is a common pathway leading to cirrhosis, which is the final result of injury to the liver.

Background Dendritic cells (DCs) could be used as potential cellular adjuvant for the production of specific tumor vaccines. Objectives Our study was aimed to evaluate the safety and efficacy of autologous pulsed DC vaccine in advanced hepatocellular carcinoma (HCC) patients in comparison with supportive treatment. Methods Thirty patients with advanced HCC not suitable for radical or loco-regional therapies were enrolled. Patients were divided into 2 groups, group I consisted of 15 patients received I.D vaccination with mature autologous DCs pulsed ex vivo with a liver tumor cell line lysate. Group II (control group, no. 15) received supportive treatment. One hundred and 4 ml of venous blood were obtained from each patient to generate DCs. DCs were identified by CD80, CD83, CD86 and HLA-DR expressions using flow cytometry. Follow up at 3, and 6 months post injection by clinical, radiological and laboratory assessment was done. Results Improvement in overall survival was observed. Partial radiological response was obtained in 2 patients (13.3 %), stable course in 9 patients (60 %) and 4 patients (26.7 %) showed progressive disease (died at 4 months post-injection). Both CD8+ T cells and serum interferon gamma were elevated after DCs injection. Conclusion Autologous DC vaccination in advanced HCC patients is safe and well tolerate.

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Background/Aims. Unplanned hospitalisation is a marker of poor prognosis and a major financial burden in patients with cirrhosis. Frailty-screening tools could determine the risk for unplanned hospital admissions and death. The study aims to evaluate the bedside frailty-screening tool (Short Physical Performance Battery (SPPB)) in prediction of mortality in patients with liver cirrhosis. Methods. One hundred forty-five patients with liver cirrhosis were recruited from Cairo University Hospital. Clinical assessment and routine laboratory tests were performed, and the SPPB frailty index, Child score, and model for end-stage liver disease (MELD) score were calculated on admission. These metrics were compared to assess mortality outcomes over the course of 90 days. Results. The mean age of the patients was 60 ± 7 years, and frailty index score (SD) was 6 ± 3. The overall 90-day readmission rate was 43.4%, while the overall 90-day mortality rate was 18.6%. SPPB scores differed significantly between survivors (4.1 ± 1.4) and nonsurvivors (6.47 ± 2.8) (P value ≤ 0.001) as well as between readmitted patients (7.5 ± 2.9) and patients who were not readmitted (4.5 ± 1.9) (P value ≤ 0.001), while the Child and MELD scores showed no associations with patient outcomes. SPPB performed better with a specificity of 72.3% and a sensitivity of 72.2% for predicting mortality. Conclusions. SPPB could be a screening tool used to detect frailty and excelled over traditional scores as a predictor of death. A low SPPB frailty score among hospitalised patients with cirrhosis is associated with poor outcomes.

Progression of recurrent hepatitis C is accelerated in liver transplant (LT) recipients. Direct-acting antivirals (DAAs) have recently emerged as a promising therapeutic regimen for the treatment of hepatitis C virus infection. Rates of sustained virological response (SVR) have drastically improved since the introduction of DAAs. The aim is to elucidate the changes in liver stiffness measurement (LSM) by transient elastography (TE) as well as acoustic radiation force impulse (ARFI) elastography and fibrosis scores after DAA treatment in LT recipients with hepatitis C virus recurrence. A single-center, prospective study including 58 LT recipients with hepatitis C recurrence who received different sofosbuvir-based treatment regimens. Transient elastography and ARFI elastography values were recorded as well as fibrosis 4 score (FIB-4) and aspartate aminotransferase-to-platelet ratio index were calculated at baseline and SVR at week 24 (SVR24). The outcome was improvement in LSM and at least a 20% decrease in LSM at SVR24 compared with baseline. The sustained virological response was 98.1%. There was improvement of platelet counts, alanine aminotransferase, and aspartate aminotransferase, which in turn caused improvement in fibrosis scores at SVR24. LSM by TE and ARFI elastography decreased from the baseline median value of 6.3 kPa (interquartile range [IQR]; 4.6 to 8.8 kPa) and 1.28 m/s (IQR; 1.07 to 1.53 m/s) to an SVR24 median value of 6.2 kPa (IQR; 4.85 to 8.9 kPa) and 1.12 (IQR; 0.97 to 1.30 m/s), respectively. Logistic regression analysis showed that baseline viral load was the only significant predictor of improvement in LS after DAA therapy at SVR24. Sofosbuvir-based treatment resulted in an early improvement in parameters of liver fibrosis in post-LT patients with hepatitis C recurrence.