Acetazolamide suppresses the progression of hepatocellular carcinoma induced by diethylnitrosamine in Wistar albino rats.

Hepatocellular carcinoma (HCC) continues to be the most prevalent type of liver cancer worldwide. Diethylnitrosamine (DEN)-induced HCC is an extensively used hepatic cancer model in experimental animals. Acetazolamide (AZA) is a carbonic anhydrase enzyme inhibitor. This study aimed to assess the therapeutic mechanism of AZA against DEN-induced HCC. Thirty male Wistar albino rats were divided equally into three groups. Group I (C): control group, Group II (HCC): DEN-induced HCC, and Group III (HCC/AZA): AZA-treated HCC. Verification of the HCC induced by DEN was confirmed by elevated liver enzymes' activities, and increased α-fetoprotein (AFP) levels, as well as distinct liver architecture changes. On the other hand, the AZA-treated HCC group experienced decreases in the activities of serum liver enzymes and AFP levels, as well as, regulated liver architecture. Additionally, it downregulated p-p38 MAPK/p-JNK1/JNK2/p-C-Jun/p-NF-κB p65 protein expressions. Moreover, it ameliorated autophagy by controlling the expression of the p-AMPK/p-mTOR1/LC3 I/II proteins. Furthermore, it downregulated the relative gene expressions of carbonic anhydrase-IX (CAIX) and hexokinase-II (HKII). Histopathological examination of AZA-treated HCC liver tissues supported these findings. Conclusion: AZA provides a new dimension in ameliorating experimentally induced HCC through regulation of hepatic biomarkers, antioxidant status, inflammatory markers, and autophagy, mediated by amelioration of CAIX and HKII gene expressions.

Association between Severity of Liver Disease, Frequency of Helicobacter pylori Infection, and Degree of Gastric Lesion in Egyptian Patients with Hepatitis B Virus Infection.

The relationship between hepatitis B virus (HBV) infection, severity of liver disease, frequency of Helicobacter pylori infection, and degree of gastric lesions was not yet fully investigated in Egyptian patients. The present work was performed on 100 Egyptian patients with HBV from the National Hepatology and Tropical Medicine Institute and 70 healthy volunteers as control group. The participants were subjected to full medical history taking, clinical examination, and laboratory investigations. All patients were positive for HBV surface antigen (HBV sAg), HBV DNA, and negative for hepatitis C virus antibodies. The severity of the liver disease was assessed using Child-Pugh scoring system. Screening of all participants for H. pylori Ag in stool was performed. Biopsy specimens were taken from the gastric lesions of H. pylori-infected patients for histopathological examination. The mean age of the patients and control group were 34.9 and 33.4 years, respectively. The levels of the liver enzymes were statistically higher in HBV patients than the control group. Helicobacter pylori Ag in stool was detected in 45.7% of the control group, and a higher percentage (60%) was detected in the patients group. Chronic gastritis with glandular atrophy and metaplasia was found in 15.6% of patients of Child-Pugh A, 70% of Child-Pugh B, and 100% of Child-Pugh C. It could be concluded that the prognosis of the liver disease significantly influences the severity of the gastric pathology in H. pylori infection.

The prevalence of coeliac disease in patients fulfilling Rome III criteria for irritable bowel syndrome.

BACKGROUND AND STUDY AIM: The clinical presentation of coeliac disease can vary from a classical malabsorption syndrome to more subtle atypical gastrointestinal manifestations similar to irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of coeliac disease in Egyptian patients with clinically diagnosed diarrhoea-predominant IBS (according to Rome III criteria). PATIENTS AND METHODS: This study was conducted on 100 patients with clinically diagnosed diarrhoea-predominant IBS (fulfilling Rome III criteria). They were subjected to complete clinical evaluation, routine laboratory investigations, abdominal ultrasonography and serum anti-tissue transglutaminase antibody (anti-tTG) test as a predictor marker for coeliac disease. All patients who tested positive for serum anti-tTG underwent upper gastrointestinal endoscopy with four to eight biopsy samples collected from the second part of the duodenum. RESULTS: All of the studied 100 patients presented with abdominal pain or discomfort, flatulence and diarrhoea. Eight patients (8%) exhibited high levels of serum anti-tTG, and their duodenal biopsy samples satisfied the histopathological criteria of coeliac disease. The studied patients were divided into two groups: Group I comprising 92 patients with IBS and negative anti-tTG results and Group II comprising eight patients with IBS and positive anti-tTG results. A non-significant difference was noted between the two groups in age, gender and duration of abdominal pain (p>0.05). The haemoglobin level was found to be significantly reduced in anti-tTG-positive patients (p<0.01), as was the Na level in anti-tTG-negative patients (p<0.05). A highly statistically significant inverse correlation was noted between anti-tTG and both serum total protein and serum albumin. CONCLUSION: Some symptoms overlap between coeliac disease and IBS. A lack of awareness may lead to a diagnostic delay in these patients.

Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients.

AIM: To evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients. METHODS: This prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty age- and sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A (TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score (PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group. RESULTS: Before LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls (P < 0.001). There was a statistically significant improvement in test values in the patient group after LT; however, their values were still significantly worse than those of the controls (P < 0.001). The PHES detected MHE in 16 patients (80%) before LT with a median value of -7 ± 3.5. The median PHES value was significantly improved following LT, reaching -4.5 ± 5 (P < 0.001), and the number of patients with MHE decreased to 11 (55%). The pre-transplant model for end-stage liver disease (MELD) score ≥ 15 was significantly related to the presence of post-transplant MHE (P = 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score < 15. CONCLUSION: Reversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score < 15.