Helicobacter pylori (H. pylori) plays a crucial role in the pathogenesis of gastritis, peptic ulcer, and gastric cancer. The presence of pathogenicity islands (PAI) genes contributes to the pathogenesis of many gastrointestinal disorders. Cytotoxin-associated gene A (cagA) and vacuolating cytotoxin gene (vacA) are the most known virulence genes in H. pylori. So, our aim was to study H. pylori virulence genes' role in gastric disorders pathogenesis. Our study included 150 adult patients who suffered dyspeptic symptoms and were referred to the GIT endoscopy unit. Gastric biopsies were attained for rapid urease test (RUT) and histopathological examination, and multiplex PCR technique for detection of virulence genes was performed. It was found that 100 specimens were (RUT) positive, of which sixty samples (60%) were PCR positive for H. pylori ureC gene. The vacA and cagA genes were identified in 61.6% and 53% of H. pylori strains, respectively. Only 5 cases were vacA-positive and cagA-negative. The most virulent vacA s1 allele existed in 56.6% of cases. Out of the 60 H. pylori strains, 66% had at least one virulence gene and 34% did not show any virulence gene. H. pylori infection showed significant increase with age. H. pylori are prevalent amid dyspeptic patients in our region. The main genotype combinations were vacA+/cagA+ of s1m1 genotype and they were frequently associated with peptic ulcer diseases, gastritis, and gastroesophageal reflux disease.

Background: Infection with hepatitis B virus (HBV) is a major worldwide health problem. The estimated prevalence of HBV is about 1.4% in Egypt. This infection is one of the main occupational hazards in the field of health care workers (HCW). Objectives: This study aimed to assess the prevalence of HBV infection among HCWs in Suez Canal University Hospital, East Egypt and their hepatitis B vaccination coverage. Methodology: A cross sectional descriptive study was conducted, including 450 Health Care Workers (HCWs) with more than 6 months of job experience, selected through stratified random sampling by HCW category. A structured questionnaire was used to collect demographic parameters, history of occupational exposures and HBV vaccination status. Blood samples were screened for HBsAg, hepatitis B core antibody, and hepatitis B surface antibody titer by ELISA. Results: Our study sample included 66.7% aged < 30 years. 73.5% of study sample were fully vaccinated, 10.7% were unvaccinated. Only 2.7% of those who have ever been vaccinated had HBsAb testing. There was a significant relation (p<0.001) between occupation and vaccination rate being the highest among nurses and doctors (80%, 78% respectively). Also a significant relationship (p<0.001) was found with education level and age, while no relation was found between gender and vaccination rate. The prevalence of chronic HBV infection and HBcAb were 0.4, and 15.6% respectively. HBV immunity achieved either by healed infection, or evidence of natural boosting was found among 13%. Immunity after vaccination was found in 75%, while 10% were still susceptible to infection. Only 21.1% report injury to infection control office and had viral markers testing. Conclusion: Although the use of hepatitis B vaccine decreased the incidence of HBV infection in new policies are needed for screening, vaccination, and serological response.

Several biomarkers of gemcitabine effectiveness have been studied in cancers, but less so in hepatocellular carcinoma (HCC), which is identified as the fifth most common cancer worldwide. Investigation of human equilibrative nucleoside transporter‐1 (HENT‐1) and deoxycytidine kinase (DCK), genes involved in gemcitabine uptake and metabolism, can be beneficial in the selection of potential cancer patients who could be responding to the treatment.

Background: It was found that there is a significant progressive decrease in the serum level of C24 ceramide with increasing severity of cirrhosis.Our aim was to evaluate the efficacy of C24 Ceramide (C24Cer) as a predictor of decompensation in cirrhotic patients at Suez Canal University hospital, Ismailia, Egypt.Subjects and Methods: Patients with viral related liver cirrhosis were consecutively confronted in the outpatient and inpatient sections.They were classified according to Child-Pugh into A, B, C groups.A control group (13 individuals) was compared with each group.Clinical assessment and Liver profile were performed.The serum level of C24Cer was measured using 20μL extracted serum with methanol: chloroform: HCl (15:83:2), using liquid chromatography coupled to tandem mass spectrometry.Results: Patients with Child-A cirrhosis showed a significantly higher mean C24Cer level compared to Child-C patients (p <0.001).Pairwise comparisons showed a statistically significant stepwise decrease in the mean C24Cer level from control group to Child-A, B then C cirrhotic patients respectively (p-value: 0.029, <0.001, and <0.001).There was a highly significant negative correlation between C24Cer and each of total bilirubin, PT, ascites grade, hepatic encephalopathy grade, and Child score (p<0.001 for each) as well as a highly significant positive correlation with albumin level (p<0.001).Conclusion: a low serum C24Cer is associated with hepatic decompensation and is good with a sensitivity of 100% and a specificity of 73%.Further studies are needed to elucidate the real-life significance of C24Cer as a non-invasive mortality predictor in cirrhosis.

Background Plasminogen activator inhibitor-1 (PAI-1), which is a part of urokinase plasminogen activation (uPA) system, had been reported to have a crucial role in the development of different types of cancers. The PAI-1 gene, located on chromosome 7, contains nine exons and eight introns. This gene is highly polymorphic, and its most common polymorphism (4G/5G) affects PAI-1 biosynthesis and consequently its circulating level. Aim The current study investigated the distribution of genotypes and the allelic frequency of the PAI-1 4G/5G polymorphism in hepatocellular carcinoma (HCC) compared to chronic HCV patients living in Egypt. Additionally, the effect of the PAI-1 4G/5G polymorphism on serum PAI-1 levels was assessed. Methods The study was carried on 50 HCC and 47 chronic HCV patients using real-time polymerase chain reaction. Results The genotypic distributions of the 4G/5G polymorphism (5G/5G, 4G/4G, 4G/5G, and 4G/4G + 4G/5G) and the frequency of alleles (5G and 4G) were not statistically significantly different between both study groups ( p > 0.05). In addition, serum levels of PAI-1did not show any significant difference between HCC patients and HCV patients regarding all different genotypes of the 5G/4G polymorphism at p > 0.05 neither between the different genotypes of the 5G/4G polymorphism in the same group at p > 0.05. Conclusion Our study suggests that the PAI-1 4G/5G polymorphism may not be considered as one of the underlying genetic causes of hepatocarcinogenesis in chronically HCV-infected patients living in Egypt.

Patients and Methods: A cross sectional study was carried out on 60 adult patients with advanced liver cirrhosis (Child’s C) who showed a low ejection fraction (EF) of <55 on ECHO. CCM related parameters including ejection fraction, left atrial and left end systolic/diastolic ventricular diameters (LAD, LVEDD) were measured using ECHO. All patients were assessed for AI by measuring fasting serum cortisol level using (Automated Chemoiluminescence Cobas e411 analyzer and EIA1887 kit). CCM related selected parameters were compared between those with and without AI. Results: The mean age was 63.83±7.64 with male sex predominance (87.4%). Their mean EF was 39.17±7.34, while 88.4% of them had a high LVEDD with a mean of 62.31±10.21 mm. The mean morning fasting free serum cortisol level was 7.95±5.23 mcg/dl with 48.4% of them having AI. Comparison of those with and without AI showed that the former group had a higher LAD (43.26±10.04 vs 42.76±7.64), LVESD (50.83±10.66 vs. 48.08±8 .17) and LVEDD (64.83±9.95vs. 59.94±9.97)) respectively. However, the difference was not statistically significant (P>0.05). There was no significant correlation between any of the CCM parameters or those of hepatic decompensation and the fasting serum cortisol level among the studied group (P>0.05).

Introduction: Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide with a high morbidity and mortality. Alpha-fetoprotein (AFP) is considered the main tumor marker for HCC diagnosis, but the variation in its diagnostic validity among studies justifies further investigation of the underlying contributing factors. Ethnic difference could be one of the factors that has not been well studied. We aimed at investigating the ethnic difference in AFP validity between Egyptian (representing Arabic North African) and Japanese (representing Asian) for HCC diagnosis. Methods: Four cohorts with chronic liver diseases (CLD) were studied: 171 Egyptian (65 HCC/106 non-HCC), and 173 Japanese (45 HCC/128 non-HCC). Laboratory tests including serum AFP, protein-induced vitamin K deficiency or absence (PIVKA-II), alanine aminotransferase (ALT), total bilirubin, platelet count, HBsAg, anti-HCV, and HCV core antigen were conducted using standard commercially available assays. Results: A significantly higher sensitivity of AFP in Egyptian in comparison with Japanese for HCC diagnosis (99 vs 67%, P < 0.001) was observed using an AFP cut-off point of 10 ng/mL, with a comparable specificity (75 vs 82%) While a sensitivity of 98 versus 56%, P < 0.001 and a specificity of 83 versus 89% was found for AFP cut-off point of 20 ng/mL, respectively. The area under the receiver operating characteristic curve (ROC) was found to be 0.98 (95%CI = 0.969–0.997) for Egyptian and 0.77 (95%CI = 0.686–0.864) for Japanese. The highest sensitivity for the former group occurred at AFP = 20.5 ng/mL and at AFP = 10.2 ng/mL for the latter. Univariate analysis showed no effect for age, sex, underlying liver disease, cirrhosis, Child's class or tumor characteristics (size, pathological grade) on AFP sensitivity, while race significantly contributed to the higher sensitivity among Egyptians in comparison with the Japanese. Using ROC analysis, the AFP cut-off point for HCC detection in each subgroup of patients with and without each of the risk factors of interest was determined and the subgroups were again subclassified according to AFP positivity (< or ≥ the decided cut-off point for each group). Logistic regression analysis of those factors combined showed that Egyptian ethnicity with an AFP level >20.5 ng/mL ( P = 0.007), older age (>50 years) with an AFP level >26 ng/mL ( P = 0.010), and cirrhosis with an AFP level >10.5 ng/mL ( P = 0.014) were the independent risk factors for HCC. Conclusion: There is an ethnic variation in AFP validity between Egyptian and Japanese patients with a significantly lower sensitivity in the latter. Alpha-fetoprotein should not be the only marker used for screening HCC among Asian Japanese and younger age groups (<50 years) with CLD. In addition, an AFP cut-off point of 20 ng/mL is recommended when screening patients of Asian origin for HCC.

AIM:To investigate the clinical significance of KL-6 as a tumor marker of HCC in two different ethnic groups with chronic liver disease consecutively encountered at outpatient clinics.METHODS:Serum KL-6 was measured by the sandwich enzyme immunoassay method using the KL-6 antibody (Ab) as both the capture and tracer Ab according to the manufacturer's instructions (Eisai, Tokyo, Japan). Assessment of alpha fetoprotein (AFP) and protein induced vitamin K deficiency or absence (PIVKA-II) was performed in both groups using commercially available kits.RESULTS:A significantly higher mean serum KL-6 (556+/-467 U/L) was found in HCC in comparison with non-HCC groups either with (391+/-176 U/L; P<0.001) or without (361+/-161 U/L; P<0.001) liver cirrhosis (LC). Serum KL-6 level did not correlate with either AFP or PIVKA-II serU/Levels. Using receiver operating curve analysis for KL-6 as a predictor for HCC showed that the area under the curve was 0.574 (95%CI = 0.50-0.64) and the KL-6 level that gave the best sensitivity (61%) was found to be 334 U/L but according to the manufacturer's instructions; a cut-off point of 500 U/L was used that showed the highest specificity (80%) in comparison with AFP and PIVKA-II (78% vs 72% respectively). Combining the values of the three markers improved specificity of AFP for HCC diagnosis from 78% for AFP alone; 93% for AFP plus PIVKA-II to 99% for both plus KL-6 value (P<0.001). Mean serum alkaline phosphatase level was significantly higher in KL-6 positive (564+/-475) in comparison with KL-6 negative (505+/-469) HCC patients (P = 0.021), but such a difference was not found among non-HCC corresponding groups.CONCLUSION:KL-6 is suggested as a tumor for HCC. Its positivity may reflect HCC-associated cholestasis and/or local tumor invasion.

Hepatitis B and C viruses (HBV and HCV) have been associated with hepatocellular carcinoma (HCC). Recently, a novel DNA virus was isolated from a patient with posttransfusion hepatitis of unknown etiology and designated TT virus (TTV). To examine whether this virus is associated with HCC, we investigated sera from 82 Egyptian patients with histopathologically-diagnosed HCC. All subjects underwent serological investigations for detection of hepatitis B surface antigen (HbsAg), hepatitis B core antibody (HbcAb) and anti-HCV. Detection of TTV-DNA was performed by semi-nested polymerase chain reaction (PCR) using TTV-specific primers. TTV-DNA was detected in 28% of the patients. Age, gender, risk factors and biochemical liver functions did not significantly differ between TTV-DNA positive and negative patients. TTV was detected in 27.1% of patients with HCV-HCC, 25% of HBV-HCC, 66.7% of dual HCV and HBV infection and 40% of those with non-B, non-C-HCC (NBNC-HCC). It is concluded that, in this the cohort of Egyptian patients with HCC, TTV infection is common and is not associated with HCV, HBV, NBNC-HCC, history of schistosomiasis or blood transfusion.