Critical flickering frequency test: a diagnostic tool for minimal hepatic encephalopathy.

BACKGROUND: Minimal hepatic encephalopathy (MHE) is underestimated. It affects 30-55% of patients with liver cirrhosis and can change their daily functions. Psychometric tests are sensitive in diagnosing MHE, but interpretation is difficult. Availability of a simpler diagnostic tool for MHE is mandatory. Critical flicker frequency (CFF) is a simple diagnostic test. AIM: The aim of this study was to assess the diagnostic accuracy of CFF test for MHE. PATIENTS AND METHODS: A total of 86 patients with cirrhosis with negative history of overt hepatic encephalopathy were included. History, clinical examination, laboratory investigations, and abdominal ultrasonography data were collected. Arabic version of number connection test, serial dotting test, and line tracing test were done. Total psychometric hepatic encephalopathy score (PHES) was used to diagnose MHE. CFF was done for all patients with MHE diagnosis at 39 Hz. RESULTS: Of the 86 patients, 45 (52.3%) had MHE with PHES. Patients with MHE had significantly older age, presentation with jaundice, ascites, lower hemoglobin level, lower serum albumin, prolonged INR, higher Child class and score (P≤0.001), and higher model of end stage liver disease score (P=0.001) than patients without MHE. In comparison with PHES, CFF has a sensitivity of 91.1±8.32%, specificity of 92.7±7.96%, positive predictive value of 93.2±7.44%, and negative predictive value of 90.4±8.91%. In receiver operating characteristic curve, CFF is excellent in diagnosis of MHE, with area under the curve 0.937 (P<0.001). CONCLUSION: MHE is common among patients with liver cirrhosis. CFF is a simple, rapid, noninvasive test for diagnosis of MHE, with a very good accuracy at 39 Hz.

Serum human endothelial cell-specific molecule-1 (endocan) and vascular endothelial growth factor in cirrhotic HCV patients with hepatocellular carcinoma as predictors of mortality.

OBJECTIVES: The aim of this study was to assess serum levels of endocan & VEGF in patients with hepatitis C virus-related HCC and their diagnostic and predictive value of mortality. METHODS: A total of 195 patients with CHC were subdivided into the following two groups: 105 HCV cirrhotic patients with HCC and 90 HCV cirrhotic patients without HCC. Sixty apparently healthy subjects served as the control group. The serum VEGF and endocan were assessed by ELISA. RESULTS: The mean serum endocan level was 4257.6± 847.6 pg/mL in HCC patients, compared to 2099.2± 459.6 pg/mL in liver cirrhosis patients without HCC. VEGF levels in the HCC group were non-significantly higher than those of the non-HCC group, and control group. Endocan at cut-off value 2967 pg/ml had higher sensitivity and higher specificity in diagnosis of HCC than AFP and VEGF. The median follow up period was 9 months, survival curve analysis was done in HCC group and showed that probability of survival among HCC group with higher levels of VEGF and endocan were significantly lower than that patients with low levels. In HCC patients, elevated serum endocan levels were significantly associated with poor hepatic functions and a greater number and size of tumours. Multivariate analysis showed that serum endocan levels (≥4000 pg/ml), as well as elevated serum fetoprotein (>100 ng/dl), were independent prognostic biomarkers for mortality. CONCLUSION: Endocan may be a useful diagnostic marker for HCC and a good predictor of mortality, especially when combined with AFP and VEGF.

Role of intrafamilial transmission in high prevalence of hepatitis C virus in Egypt.

BACKGROUND: Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide. Although an effective HCV treatment program has been adopted, it is estimated that the number of newly reported cases in Egypt is still high. Intrafamilial transmission may play a role in the high prevalence of HCV in Egypt. Identification of risk factors for the transmission of HCV may help in decreasing its prevalence and eliminating its infection. AIM: The aim of this study was to estimate the prevalence of HCV infection among the household contacts of HCV patients and identify the possible risk factors associated with intrafamilial transmission. METHODS: This study was designed as a cohort study of 90 families of patients with confirmed chronic HCV and 38 families of non-HCV-infected persons. Diagnosis of HCV infection was performed by detection of HCV antibodies by fourth-generation enzyme-linked immunosorbent assay and confirmed by HCV RNA polymerase chain reaction. A pre-prepared questionnaire on risk factors was filled out by the participants. The prevalence of HCV was calculated, and univariate and multivariate analyses were carried out to identify the independent risk factors. RESULTS: Among 90 positive-index families, 32 (35.6%) had contact persons with HCV infection compared to two of 38 (5.3%) negative-index families (P < 0.001, odds ratio [OR] = 9.9). Out of 257 index-positive contacts, 38 (14.8%) were infected compared to three of 75 (4%) of index-negative contacts (P = 0.01, OR = 4.3). Infection was associated with older age (6.9% of those aged <20 years, 10.4% of those aged 20-39 years, and 22% of those aged ≥40 years were infected) (P = 0.007). Husbands of infected wives were at a higher risk (33% infected) than wives (13.5%) and sons (16.9%) (P < 0.001). A history of hepatic encephalopathy was the independent predictor of intrafamilial transmission (P < 0.001, OR = 5.4). CONCLUSION: Intrafamilial transmission was found to possibly play a major role in the high prevalence of HCV in Egypt. Transmission was associated with older age and contact with patients with hepatic encephalopathy and was high among husbands of infected wives.