Do You Have To Evaluate The Heart Of The Cirrhotic Patients?

Objectives: To identify patients with occult cardiac dysfunction and itsrelationship with the severity of liver impairment. Method: This is a Judgment (Purposive) Sampling, cross-sectionalstudy that was conducted at Kafrelsheikh University Hospital, Egypt, from November 2019 to December 2020, and comprised adult patients of either gender with liver cirrhosis. After detailed history, a clinical examination, pathological assessment and cardiac evaluation based on electrocardiogram and echocardiography, the patients were divided into three groups. Patients who had dyspnoea or cyanosis were in group A, those who did not have dyspnoea or cyanosis but had electrocardiogram and echocardiography abnormalities were in group B, and patients who did not have dyspnoea, cyanosis or electrocardiogram and echocardiography abnormalities were in group C. The severity of the liver disease was evaluated using Child-Pugh and Model of End Liver Disease scores. Data was analysed using SPSS 20. RESULTS: Of the 300 patients, 153(51%) were males and 147(49%) were females. The overall mean age was 55.1±5.1 years(range: 20-60 years). There were 58(19.33%) patientsin group A, 108(36%) in group B and 134(44.66%) in group C. Group A patientsshowed higher Child-Pugh and Model of End Liver Disease scoresthan the other groups(p<0.05). Child-Pugh score >6 and Model of End Liver Disease score >37 yielded the best accuracy for detecting cardiac abnormalities in group B (p<0.05). CONCLUSIONS: There were significant cardiac changes in cirrhotic patients.

The Predictors of Hepatorenal Syndrome Development in HCV Cirrhotic Ascitic Egyptian Patients with Spontaneous Bacterial Peritonitis.

BACKGROUND & AIM: Spontaneous bacterial peritonitis is considered a precipitating factor for renal impairment in patients with liver cirrhosis. No specific study addressing this problem has been reported. This study aimed to detect the incidence and predictive factors of hepatorenal syndrome in these patients. MATERIALS AND METHODS: This study enrolled 121 hepatic cirrhotic patients with spontaneous bacterial peritonitis. History taking, clinical examination, and laboratory investigations including ascitic fluid analysis were carried out. Kidney function tests were repeated 3 days after the initiation of treatment. Patients were divided into 2 groups after one week of treatment during the follow-up period: Group I: patients without hepatorenal syndrome, and Group II: patients with hepatorenal syndrome. Multivariate analysis was performed to determine independent predictors of hepatorenal syndrome development. RESULTS: A total of 30 patients (24.8%) developed hepatorenal syndrome. Patients with hepatorenal syndrome had significantly lower sodium and albumin levels as well as higher creatinine, bilirubin, Child-Turcotte-Pugh score, portal vein diameter, Model for End-Stage Liver Disease score. Higher percentage of them had a history of recurrent spontaneous bacterial peritonitis and multiple therapeutic paracentesis of ascites. Multivariate analysis detected that serum bilirubin, Model for End-Stage Liver Disease-Sodium, and portal vein diameter were significant predictors of hepatorenal syndrome. Cutoff values were determined as 3.3 mg/dl for bilirubin, 15.9 mm for portal vein diameter, and 26 for Model for End-Stage Liver Disease-Sodium. CONCLUSION: Hepatorenal syndrome is a common complication of spontaneous bacterial peritonitis. In our study, high serum bilirubin, Model for End-Stage Liver Disease-Sodium, and portal vein diameter are predictors of the development of hepatorenal syndrome in patients with spontaneous bacterial peritonitis.

Irritable bowel syndrome in Egyptian medical students, prevalence and associated factors: a cross-sectional study.

Introduction: irritable bowel syndrome is a recurrent chronic gastrointestinal functional disorder. Despite it is not dangerous; it carries a significant feedback on self-confidence and quality of life. Medical students are expected to develop irritable bowel syndrome because they are subjected to stress due to over academic pressure. The objectives were to investigate irritable bowel syndrome prevalence, and to detect the related risk factors in this specific group of Egyptian people. Methods: this cross-sectional study performed in two faculties of medicine in Nile Delta, Egypt. It had been built on self-administered questionnaires including Rome III criteria for diagnosis of irritable bowel syndrome, as well as several questions for gathering socio-demographic information and manifestations suggesting irritable bowel syndrome. Results: fifty (27.5%) of 182 evaluated medical students achieved criteria of irritable bowel syndrome, 64% of them were mixed type. Irritable bowel syndrome had a significant relationship with coffee, milk products, fewer vegetables, and fruits intake (P=0.034, P=0.044, P<0.001 respectively). Depression, anxiety, and food intolerance were detected to be significantly related to irritable bowel syndrome (p<0.001, p=0.005, p=0.04) respectively. Conclusion: it was demonstrated that many Egyptian medical students were suffering from irritable bowel syndrome. Some dietary habits, anxiety, and depression of the students could be risk factors related to development of irritable bowel syndrome.

Study of Serum Soluble Programmed Death Ligand 1 as a Prognostic Factor in Hepatocellular Carcinoma in Egyptian Patients.

BACKGROUND: The expression of programmed cell death ligands on tumor cells has a role in the suppression of antitumor immunity, resulting in tumor immune evasion. OBJECTIVE: In this study, we evaluated the prognostic value of the soluble form of programmed death-ligand1 (sPD-L1) in Egyptian hepatocellular carcinoma (HCC) patients. METHODS: This prospective cohort study was performed between November 2016 to November 2018 on 85 individuals (25 HCC patients, 25 HCC with vascular invasion and/or extrahepatic metastasis, 25 patients with liver cirrhosis, 10 healthy controls). The levels of sPD-L1 were determined in all subjects and compared in different groups and stages of cirrhosis and HCC. The association between sPD-L1 levels and overall survival (OS) was assessed. RESULTS: Significant statistical difference in sPD-L1 was detected between different study groups. The cut-off value for normal sPD-L1 was defined by high sPD-L1 levels determined in a healthy control cohort. It was 2.522 ng/ml. In HCC patients, cut-off value was 7.42 ng/ml (sensitivity 88%, specificity 100%). In HCC with vascular invasion or metastasis, cut-off value was 9.62 ng/ml (sensitivity 88%, specificity 88%). Patients with high serum sPD-L1 or serum bilirubin concentrations had an increased risk of mortality. CONCLUSION: High sPD-L1 level could be a possible prognostic indicator for a poor outcome in liver cirrhosis and HCC patients. The predictive value of sPD-L1 levels for a successful anti- PD1/PD-L1 therapy should be investigated in the future.