BACKGROUND:Hepatitis C virus is one of the most common etiologic agents of chronic liver diseases, including liver cirrhosis and hepatocellular carcinoma in which there is continuous inflammation and regeneration of hepatocytes. Cytokeratin-18 (CK18) has been suggested to play an important role in tumorigenesis of epithelial cancers.AIM:Estimation of CK18 serum levels in patients with chronic viral hepatitis C (CHCV) and hepatocellular carcinoma (HCC) and find the relationship between their levels, the severity of the disease and the development of HCC.METHODS:We measured serum levels of CK18 in 60 Egyptian patients (30 with CHCV & 30 with HCC) and 30 healthy controls.RESULTS:Patients with HCC had highly significant increased CK18 levels compared with CHCV patients, healthy controls. Cytokeratin-18 among the three classes of Child-Pugh classification show highly significant gradual increase from child A to C. Furthermore, In HCC there were positive correlations between CK18 and with RBCs, ESR, and AFP.CONCLUSION:CK18 is a sensitive indicator of the severity of liver disease. Patients with CHCV infection can be followed up by measurement of its serum level which can predict the development of HCC. The combination of AFP and CK18 increased the sensitivity of detection for HCC.

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Background: Hepatic encephalopathy has a negative effect on patient health-related quality of life. Apart from increased blood ammonia, alterations in various other substances (Tumor necrosis Factor-Alpha (TNF-α), Ghrelin)have been implicated in the pathogenesis of hepatic encephalopathy (HE). Ghrelin and TNF-alpha have numerous metabolic actions. Aim of the work: was to estimate the role of TNF-α, Ghrelin and Evoked Potentials changes in patients with hepatic encephalopathy, and their relation to grades of hepatic encephalopathy Methods: We measured serum levels of TNF-α, Ghrelin in 40 patients with liver cirrhosis (20 with hepatic encephalopathy & 20 without encephalopathy) and 10 healthy controls. All subjects underwent to neurophysiological test: p300,visual and auditory evoked potentials. Results: The results of this study showed highly significant increase in TNF-α, Ghrelin & levels in both groups when compared to the control group with a significant increase in the cirrhotic encephalopathic group. Also significant correlation between TNF-α, Ghrelin & grading of encephalopathy was found. Delay in latency and decrease amplitude of VEP, p 300 and ABR were significant in cirrhotic patients with hepatic encephalopathy. Conclusion: TNF-α, Ghrelin levels are sensitive indicators of the severity of liver disease. Patients with liver cirrhosis can be followed up by measurement of these serum markers which might predict the development of encephalopathy. The increasing levels of Ghrelin & TNF-α is more prominent in cirrhosis with encephalopathy. The presence of nutritional and metabolic abnormalities, including malnutrition in cirrhosis, at least partly, elucidates high Ghrelin level. The applied neurophysiological tests are a simple, suitable and objective method for differentiating the degrees of encephalopathy and for identifying the preclinical stage of encephalopathy because abnormalities in these tests may prompt the clinician to initiate treatment.

Hepatitis delta virus (HDV) is a defective RNA virus that does not encode its own envelope proteins and depends on the expression of the hepatitis B virus (HBV) surface antigen (HBsAg) in the same cell to complete its life cycle. Although the interest in HDV was limited thereafter as HDV coinfections seemed to decline with the introduction of vaccines against HBV, several studies reported more severe courses of acute infections and higher prevalence of advanced cirrhosis and hepatocellular carcinoma (HCC) in patients coinfected with HBV and HDV than those infected by HBV alone.The epidemiology of HDV infection worldwide was obscure, the prevalence of infection remained uncertain and geographic information is incomplete because many countries do not report the