Abstract Background Esophageal varices can lead to morbidity and mortality in patients with chronic liver diseases. There is a debate about the frequency of endoscopic variceal band ligation sessions needed for the eradication of esophageal varices. We aimed to explore the optimal interval for endoscopic variceal band ligation sessions needed to obliterate esophageal varices. Methods This study enrolled 374 patients with liver cirrhosis indicated for endoscopic variceal band ligation. After the first variceal band ligation, patients were randomly assigned to one of four groups regarding the interval of subsequent band ligation sessions: group 1 (subsequent band ligation every week), group 2 (subsequent band ligation every 2 weeks), group 3 (subsequent band ligation every 3 weeks), and group 4 (subsequent band ligation every 4 weeks). Patients were followed until esophageal varices were eradicated, with complications reported as bleeding or post-banding ulcers. Results The studied groups showed insignificant differences in the mean number of sessions required to eradicate varices completely and the mean number of subsequent band ligation sessions. Post-banding ulcers were highly incident in group 1 (52.9%), followed by group 2 (22.8%), group 3 (8.0%), and group 4 (2.7%), with a statistically significant difference between the studied groups (p < 0.001). Bleeding after the first band ligation session was reported in only group 2 (1.3%). Conclusion A 4-week interval of elective variceal band ligation sessions achieved complete eradication with a lower rate of complications, particularly post-banding ulcers.

Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD) is increasingly linked to a heightened risk of various infections, significantly impacting patient health outcomes. This review aims to explore the systemic implications of MASLD and its bidirectional relationship with infections to guide integrated management approaches. The rising prevalence of MASLD, driven by obesity and type 2 diabetes, has highlighted its association with compromise dysbiosis. These factors contribute to a higher risk of severe disease outcomes in patients with infections such as hepatitis B and C, HIV, COVID-19, and bacterial infections. Emerging evidence underscores a complex interplay between MASLD and infections that complicates clinical management. Addressing the dual burden of MASLD and associated infections necessitates a holistic approach to enhance patient care. Future research should focus on unraveling the mechanisms underpinning these interactions and developing tailored preventive and therapeutic strategies.

Abstract Acute bacterial meningitis (ABM) is an emerging disease with high morbidity and mortality. It is a globally serious disease and is considered endemic in Egypt, affecting all age groups and being common in low-standard and overcrowded areas. Early and appropriate antimicrobial therapy is crucial for suspected bacterial meningitis, even before the causative pathogen is identified. This is because definitive laboratory confirmation can take several days and may not always be successful. Those who do recover, especially if there was delayed appropriate intervention, can have permanent disabilities, such as brain damage, hearing loss, and learning disabilities. Rapid intervention in such cases is mandatory, which is not easy in countries with limited income due to weak capabilities and resources. Therefore, we are in dire need of making an Egyptian consensus that suits our country as a low-resource one, in order to facilitate and speed up the process of managing such cases. This consensus-based paper is under the supervision of the Egyptian Society of Fever comprising clinicians, microbiologists, epidemiologists, and public health representatives. They convened to assess the current situation and develop a new consensus on the management of ABM, taking into consideration the human and health potential of Egypt. All the experts who participated in writing and directing this conference belong to different Egyptian universities, and their main clinical interest was infectious diseases. Others work in fever hospitals that are affiliated with the Ministry of Health. They collaborated on the statements` writing, reviewing, and voting to reach the final version. Each statement was voted as strongly, moderately, or weekly recommended. Each statement should have a predefined score of 80% agreement to be accepted and reported in this consensus. Conclusion This Egyptian consensus model offers a feasible and context-specific approach to managing ABM, aiming to improve outcomes and reduce disparities in resource-limited settings.

Background Egypt faces a significant public health burden due to chronic liver diseases (CLD) and peptic ulcer disease. CLD, primarily caused by Hepatitis C virus (HCV) infection, affects over 2.9% of the population nationwide, with regional variations. Steatotic liver disease is rapidly emerging as a significant contributor to CLD, especially in urban areas. Acid-related disorders are another widespread condition that can significantly impact the quality of life. These factors and others significantly influence the indications and findings of gastrointestinal endoscopic procedures performed in Egypt.Aim We aimed to evaluate the clinico-demographic data, indications, and endoscopic findings in Egyptian patients undergoing gastrointestinal endoscopic procedures in various regions of Egypt.Methods This study employed a retrospective multicenter cross-sectional design. Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt.Results 5910 patients aged 38-63 were enrolled in the study; 75% underwent esophagogastroduodenoscopy (EGD), while 25% underwent a colonoscopy. In all studied patients, the most frequent indications for EGD were dyspepsia (19.5%), followed by hematemesis (19.06%), and melena (17.07%). The final EGD diagnoses for the recruited patients were portal hypertension-related sequelae (60.3%), followed by acid-related diseases (55%), while 10.44% of patients had a normally apparent endoscopy. Male gender, old age, and the presence of chronic liver diseases were more common in patients from upper than lower Egypt governorates. Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%). IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients, while normal colonoscopy findings were encountered in 18.21% of them.Conclusion This is the largest study describing the situation of endoscopic procedures in Egypt. our study highlights the significant impact of regional variations in disease burden on the utilization and outcomes of GI endoscopy in Egypt. The high prevalence of chronic liver disease is reflected in the EGD findings, while the colonoscopy results suggest a potential need for increased awareness of colorectal diseases.

OBJECTIVES:The objective of this study was to screen for significant hepatic fibrosis or steatosis in asymptomatic, apparently healthy subjects by using Vibration-controlled transient elastography and controlled attenuation parameter (CAP).METHODS:Prospectively, 433 asymptomatic apparently healthy adults were included. Fibroscan/CAP examination was performed for all of them. Subjects with liver stiffness measurement > 6 kPa or CAP >248 dB/m were further evaluated to assess underlying chronic liver disease.RESULTS:According to fibroscan/CAP examination, subjects were classified into four subgroups: normal (119) with CAP score of 215.85 ± 24.81 dB/m and fibrosis score of 4.47 ± 0.81 kPa, subjects with steatosis only 133 with CAP score of 309.41 ± 42.6 dB/m and fibrosis score of 4.74 ± 0.82 kPa, subjects with both steatosis and fibrosis 95 with CAP score of 318.20 ± 39.89 dB/m and fibrosis score of 7.92 ± 2.58 kPaand subjects with fibrosis only 86 with CAP score of 213.48 ± 22.62 dB/m and fibrosis score of 6.96 ± 1.11 kPa. S0 was present in 205 (47.3%), S1 in 48 (10.2%), S2 in 16 (3.7%) and S3 in 168 (38.8%) of studied subjects, whereas F0-1 was present in 371 (85.7%), F2 in 44 (10.16%), F3 in 16 (3.7%) subjects and F4 in only one (0.23%) subject. Subjects with both steatosis and fibrosis showed significantly higher transaminases, triglycerides and total cholesterol levels than other subgroups.CONCLUSIONS:Most asymptomatic, apparently healthy subjects (72%) have significant steatosis and fibrosis. Liver stiffness measurement and CAP might represent promising first-line noninvasive procedures to screen for silent liver diseases in the general population.

BACKGROUND AND STUDY AIMSDespite its wide availability, we do not have sufficient data aboutthe quality of colonoscopy in Egypt. In this study, we proposed 13 indicators to assess the quality of colonoscopy procedures in the included study centers aiming to attain a representative image of the quality of CS in Egypt.PATIENTS AND METHODSA multicenter prospective study was conducted between July and December 2020, which included all patients who underwent colonoscopy in the participating centers. The following were the proposed quality indicators: indications for colonoscopy, preprocedure clinical assessment, obtaining written informed consent, adequate colon preparation, sedation, cecal intubation rate (CIR), withdrawal time, adenoma detection rate (ADR), complication rate, photographic documentation, automated sterilization, regular infection control check, and well-equipped postprocedure recovery room.RESULTA total of 1,006 colonoscopy procedures were performed during the study duration in the included centers. Our analysis showed the following four indicators that were fulfilled in all centers: appropriate indications for colonoscopy, preprocedure assessment, written informed consent, and automated sterilization. However, photographic documentation and postprocedure follow-up room were fulfilled only in 57 %. Furthermore, 71 % of the centers performed regular infection control checks. Adequate colon preparation was achieved in 61 % of the procedures, 81 % of the procedures were performed under sedation, 95.4 % CIR, 11-min mean withdrawal time, 15 % ADR, and 0.1 % overall complication rate. Statistically significant factors affecting CIR were age > 40 years, high-definition endoscope, previous colon intervention, and rectal bleeding, whereas those affecting ADR were age > 40 years, the use of image enhancement, previous colon intervention, rectal bleeding, the use of water pump, and a withdrawal time of > 9 min.CONCLUSIONOur study revealed the bright aspects of colonoscopy practice in Egypt, including high CIRs and low complication rates; conversely, ADR, bowel cleansing quality, and infection control measures should be improved.

Colonoscopy is an endoscopic procedure that examines the mucosa of the large intestine and distal terminal ileum for histopathological sampling and therapeutic procedures.Aim of the work: Comparing propofol & dexmedetomidine effects as conscious sedation in colonoscopy.Methods: Forty patients of both sexes candidates for colonoscopy were randomized to (D group & P group) each one included 20 patients: D Group: Dexmedetomidine was given as an initial loading dosage of 1 µg/kg i.v over ten minutes then received propofol 0.5mg/kg, then a continuous I.V. dexmedetomidine infusion (0.2-0.8) µg/kg/h was started until the procedure completed.P Group: The intravenous loading dose of propofol 2 mg/kg was given, then a continuous infusion of propofol 25-100 µg/kg/min was started until the procedure was completed.Results: The level of sedation was assessed using the Ramsay Sedation Score (RSS) showed a significant increase in the P group (2-2) compared to the D group activity (1-2) throughout 1-hour post-operatively.After 5 min of the procedure heart rate significantly decreased in group D then it became non-significant during the remaining time.The oxygen saturation % values showed a significant reduction in the P group (mean 95.45 ± 2.70) at 5 min of the procedure then it became non-significant during all remaining time.Although Bradycardia was more significantly higher in the D group, hypotension and respiratory complications were more significant higher in the P group.Also, the endoscopist was satisfied in the D group.Conclusion: In patients undergoing colonoscopy, dexmedetomidine combined with a low dose of propofol resulted in greater conscious sedation and adequate endoscopist satisfaction than propofol alone.

Background & Aims Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic. Methods A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists’ discussion held in Cairo July 2021 followed by electric voting for each statement. Results The statements were electronically voted to be either “agree,” “not agree,” or “neutral.” For a statement to be accepted to the consensus, it should have 80% agreement. Conclusion Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.

BACKGROUND AND AIMS:In the midst of this pandemic, planning the prioritization of hospital admissions for patients affected with COVID-19 should be of prime concern, particularly in healthcare settings with limited resources. Thus, in this study, we aimed to develop a novel approach to triage COVID-19 patients and attempt to prioritize their hospital admission using Lung Ultrasonography (LUS). The efficacy of LUS in triaging suspected COVID-19 patients and assessing the severity of COVID-19 pneumonia was evaluated; the findings were then compared with those obtained by chest computed tomography (CT). METHODS:This multicenter, cross-sectional study comprised 243 COVID-19 patients who presented to the emergency department in 3 major university hospitals in Egypt. LUS was performed by an experienced emergency or chest physician, according to the local protocol of each hospital. Demographic, clinical, and laboratory data were then collected from each patient. Each patient was subjected to chest CT scans and LUS. RESULTS:The mean age of the 243 patients was 46.7 ± 10.4 years. Ground-glass opacity, subpleural consolidation, translobar consolidation, and crazy paving were reported in the chest CT scans of 54.3%, 15.2%, 11.1%, and 8.6% of the patients, respectively. B-line artifacts were observed in 81.1% of the patients (confluent pattern, 18.9%). The LUS findings completely coincided with the CT findings (Kappa agreement value, 0.77) in 197 patients (81.1%) and offered a diagnostic sensitivity of 74%, diagnostic specificity of 97.9%, positive predictive value of 90.2%, and negative predictive value of 93.6% for the COVID-19 patients. Following the addition of O2 saturation to the lung imaging findings, the ultrasound method was able to demonstrate 100% sensitivity and specificity in accurately differentiating between severe and non-severe lung diseases. CONCLUSION:LUS with oxygen saturation might prove to be effective in prioritizing the hospital admission of COVID-19 patients, particularly in healthcare settings with limited resources.

Objective To assess the role of endoscopic duodenal biopsies in diagnosing lactose intolerance of adult Egyptian patients with dyspeptic symptoms. Patients and methods A validated self-administered questionnaire was applied on 200 patients for symptom assessment after ingestion of lactose or lactose products. They are referred to the Hepatogastro-enterology and Infectious Diseases Department of Al-Zahraa University Hospital during the period from December 2018 to December 2019. Forty adult patients out of 200 were selected and subjected to history taking, clinical, laboratory evaluation, stool analysis, and abdominal ultrasound. They underwent upper gastrointestinal (GI) endoscopy and two postbulbar duodenal biopsies were taken for histopathology and biochemical assay of the lactase enzyme. Results The symptom questionnaire of 200 patients after ingestion of lactose-containing products showed that the mean and SD score of flatulence was the highest score (5.69±0.24); abdominal cramping was 3.29±0.16 while diarrhea was 0.84±0.09 and vomiting was the lowest score (0.30±0.05). Forty patients were selected for upper GI endoscopy with a mean age of 35.15±12.14 years; of the patients, 70.0% were women and 30.0% were men There was no statistically significant results as regards laboratory data or abdominal ultrasound. According to the values of lactase enzyme level in duodenal biopsies; 65% of patients had mild hypolactasia compared with 35% who were constant with normo lactasia and no patients with severe hypolactasia. Conclusion Adult patients with lactose intolerance mainly complain of abdominal cramps and flatulence more than other GI tract symptoms. Biochemical assay of lactase enzyme 35% who were constant with normolactasia and no patients with severe hypolactasia.

BACKGROUND The current coronavirus disease 2019 (COVID-19) pandemic has affected routine endoscopy service across the gastroenterology community. This led to the suspension of service provision for elective cases. AIM To assess the potential barriers for resuming the endoscopy service in Egypt. METHODS A national online survey, four domains, was disseminated over a period of 4 wk in August 2020. The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s). RESULTS A hundred and thirteen Egyptian endoscopy centers participated in the survey. The waiting list was increased by ≥ 50% in 44.9% of areas with clusters of COVID-19 cases (n = 49) and in 35.5% of areas with sporadic cases (n = 62). Thirty nine (34.8%) centers suffered from staff shortage, which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis. In multivariate analysis, the burden of cases in the unit locality, staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice (P = 0.029, < 0.001 and 0.02, respectively) and Odd’s ratio (0.15, 1.8 and 0.16, respectively). CONCLUSION The COVID-19 pandemic has led to restrictions in endoscopic volumes. The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery. Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.