Hepatitis C virus:A global view

Hepatitis C virus(HCV) is a global challenge; 130-175 million are chronically infected. Over 350000 die each year from HCV. Chronic HCV is the primary cause of cirrhosis, hepatocellular carcinoma(HCC), and end-stage liver disease. Management of chronic HCV is aimed at preventing cirrhosis, reducing the risk of HCC, and treating extra hepatic complications. New treatments for chronic HCV has been devoted based on direct-acting antivirals, as pegylated interferon(peginterferon) is responsible for many side effects and limits treatment access. Sofosbuvir is the first compound to enter the market with Peginterferon-free combination regimens.

Micro RNAs and clinical implications in hepatocellular carcinoma

AIM To assess the role of some circulating miRNAs(miR-23a, miR-203, miR338, miR-34, and miR-16) as tumor markers for diagnosis of hepatocellular carcinoma(HCC).METHODS One hundred and seventy-one subjects were enrolled, 57 patients with HCC, 57 patients with liver cirrhosis(LC) and 57 healthy subjects as control group. Severity of liver disease was assessed by Child Pugh score. Tumor staging was done using Okuda staging system. Quantification of Micro RNA(miR-23a, miR-203, miR338, miR-34, and miR-16) was performed.RESULTS All studied miRNA showed significant difference between HCC and cirrhotic patients in comparison tohealthy control. miR-23a showed statistically significant difference between HCC and cirrhotic patients being higher in HCC group than cirrhotic. miR-23a is significantly higher in HCC patients with focal lesion size equal or more than 5cm, patients with multiple focal lesions and Okuda stage Ⅲ. At cutoff value ≥ 210, miR-23a showed accuracy 79.3% to diagnose HCC patients with sensitivity 89.47% and specificity about 64.91%. At cut off level ≥ 200 ng/mL, serum alpha fetoprotein had 73.68% sensitivity, 52.63% specificity, 43.75% PPV, 80% NPV for diagnosis of HCC.CONCLUSION MicroR NA 23a can be used as a screening test for early detection of HCC. Also, it is related to larger size of tumour, late Okuda staging and multiple hepatic focal lesions, so it might be a prognostic biomarker.

Evaluation of liver tissue by polymerase chain reaction for hepatitis B virus in patients with negative viremia

AIM: To assess the clinical significance of Hepatitis B virus (HBV) DNA localization in the liver tissue of patients with positive HBsAg and negative viremia.METHODS: HBV virological parameters of 33 HBsAg positive chronic hepatitis patients, including seromarkers and HBV DNA amplification in both sera and liver biopsies, were evaluated.RESULTS: Ten patients had negative viremia and positive HBV DNA in their liver biopsies. Most of them had HBeAg-negative/HBeAb-positive chronic hepatitis.Their liver biochemical and histopathological profiles were different from the viremic patients. Their disease pattern was designated as 'hepatitis B in situ'.CONCLUSION: Hepatitis B in situ is a consequential entity which can be missed in clinical practice. It is a new clinical pattern of chronic HBV infection that considers HBV in liver biopsy and adds a new indication for antiviral therapy.

The combination of endoglin and FIB-4 increases the accuracy of detection of hepatic fibrosis in chronic hepatitis C patients

Background and aim: In patients infected with chronic hepatitis C virus, liver biopsy is the gold standard method of staging fibrosis. Different combinations of serum markers attempted to correlate with hepatic fibrosis in place of liver biopsy and have shown encouraging results. The aim of our study is to evaluate the diagnostic value of endoglin and FIB-4 as non-invasive markers of hepatic fibrosis in HCV patients. Methods: We estimated serum endoglin & FIB-4 index in 40 infected chronic hepatitis C patients. Histological staging of hepatic fibrosis was done according to the METAVIR scoring system. Results: Both endoglin and FIB-4 index showed positive correlation with age and aspartate transaminase and inverse correlation with albumin. The diagnostic performance determined by AUROCs for early fibrosis (≤F2), was 0.868 for endoglin and 0.887 for FIB-4, at cut off va- lues of 5.5 & 0.98 with sensitivity of 64.3% & 82.1%, and specificity of 100% & 85% respectively. For ad-vanced fibrosis (>F2), the AUROC was 0.98 for endoglin and 0.967 for FIB-4, obtained at cut off values of 6.29 & 1.6, with sensitivity of 100% & 91.7%, and specificity of 89.3% & 92.9%, respectively. Conclusion: Both serum endoglin and FIB-4 index are fairly accurate in differentiating stages of hepatic fibrosis;their combination in a single equation enhanced the accuracy of fibrosis detection in chronic HCV patients.

Value of transabdominal bowel ultrasonography and splanchic vascular parameters in the evaluation of inflammatory bowel disease

Background: Although non-specific, transabdominal bowel ultrasonography, in real time or in color Doppler;has been beneficial in evaluating the location, extent and activity of inflammatory bowel disease (IBD). Aim: To assess the potential role of bowel transabdominal bowel ultrasonography in the diagnosis and follow-up of IBD. Patients and Methods: A cohort of 30 adults histologically-proven active IBD patients;ulcerative colitis (UC) (n = 20), Crohn’s disease (CD) (n = 10) were prospectively assessed in addition to 20 non-IBD participants representing the control group. All participants underwent the full colonoscopy in addition to real time and color Doppler ultrasonography. Bowel wall thickness, peri-enteric changes, and hemodynamic changes in the portal vein and mesenteric arteries were recorded at initial enrollment and after complete remission in 10 IBD patients. Results: Bowel wall was significantly thickened in all active IBD patients with a significant decrease after disease quiescence in CD patients;p value p value