Egyptian Liver Journal
Latest articles in this journal
Egyptian Liver Journal, Volume 12, pp 1-4; https://doi.org/10.1186/s43066-022-00223-x
Background: Portal hypertension is considered as a major complication of liver cirrhosis. Endoscopy plays a main role in managing of gastrointestinal complications of portal hypertension. Endoscopists are at increased risk for COVID-19 infection because upper gastrointestinal (GI) endoscopy is a high-risk aerosol-generating procedure and may be a potential route for COVID-19. Objectives: To compare the outcome between cirrhotic patients who underwent classic regular endoscopic variceal ligation after primary bleeding episode every 2–4 weeks, and those presented during the era of COVID-19 and their follow-up were postponed 2 months later. Methods: This retrospective study included cross-matched 238 cirrhotic patients with portal hypertension presented with upper GI bleeding, 112 cirrhotic patients presented during the era of COVID19 (group A) underwent endoscopic variceal ligation, another session after 2 weeks and their subsequent follow-up was postponed 2 months later, and 126 cirrhotic patients as control (group B) underwent regular endoscopic variceal band ligation after primary bleeding episode every 2–4 weeks. Results: Eradication of varices was achieved in 32% of cases in group A, and 46% in group was not any statistically significant (p > 0.05); also, there was no any statistical significant difference between both groups regarding occurrence of rebleeding, post endoscopic symptoms, and mortality rate (p > 0.05). Conclusion: Band ligation and injection of esophageal and gastric vary every 2 months were as effective and safe as doing it every 2 to 4 weeks after primary bleeding episode for further studies and validation.
Egyptian Liver Journal, Volume 12, pp 1-8; https://doi.org/10.1186/s43066-022-00231-x
Background: Hepatitis C virus (HCV) may induce extrahepatic manifestations as acute or chronic renal dysfunction. The aim was to evaluate the diagnostic role of some biomarkers as cystatin C, cryoglobulins, rheumatoid factor (RF), and complement C3 for extrahepatic renal affection in newly diagnosed patients with HCV infection. Methods: Blood and urine were collected from randomized individuals screened for new HCV infection (n=400). The studied populations were divided into 3 groups: control group I: thirty healthy individuals not suffering from either liver or kidney diseases, group IIa: thirty HCV patients who have positive HCV antibody test but showed negative PCR test, and group IIb: thirty HCV patients who showed positive results for both HCV antibody and PCR tests. Results: In HCV group IIb, levels of serum total bilirubin, AST and ALT, and urine albumin/creatinine ratio were increased whereas serum albumin and creatinine clearance were decreased versus other groups. However, the levels of blood urea nitrogen and serum creatinine were still within the normal range in all groups. In HCV group IIb, cystatin C, cryoglobulins, and RF levels were increased; meanwhile, serum creatinine/cystatin C ratio and complement 3 levels were decreased compared to the other groups. HCV-infected patients significantly had higher serum cystatin C (>1.24 mg/L, P<0.001) and lower creatinine/cystatin C ratio (<70.1μMol/mg, P=0.002), and cystatin C was significantly correlated with liver and kidney parameters. Conclusion: High serum cystatin C and low creatinine/cystatin C ratio may be early indicators of mild renal dysfunction with normal serum levels of creatinine in HCV-infected individuals.
Egyptian Liver Journal, Volume 12, pp 1-8; https://doi.org/10.1186/s43066-022-00230-y
The ongoing COVID-19 pandemic is known to affect several body organs, including the liver. This results from several factors such as direct effect of SARS-CoV-2 on the liver, side effects of drug therapy and pre-existing liver diseases. Drug-induced liver injury can result from a range of drugs used in the treatment of COVID-19 such as antiviral drugs, anti-inflammatory drugs, antibiotics, herbal medications and vaccines. Metabolism of most drugs occurs in the liver, and this leaves the liver at risk of medication-induced liver damage. Being among pathologies from the disease, COVID-19 liver injury presents with abnormally high liver-related enzymes, such as aspartate aminotransferase, alanine aminotransferase, alkaline phosphate (ALP), and gamma-glutamyl transferase. It is reversible, generally not severe and occurs more mildly in children. However, COVID-19-associated liver injury is worsened by chronic liver diseases and vice versa. There is a high risk of abnormal ALT and AST, in-hospital liver injury and prolonged SARS-CoV-2 shedding in COVID-19 patients with previously existing metabolic-associated fatty liver disease. COVID-19-associated liver injury also appears to be severe and significantly associated with life-threatening COVID-19 and mortality in persons with a history of liver transplant. Where necessary, only supportive management is usually indicated. This paper evaluates the aetiology, clinical and laboratory features, occurrence and management of COVID-19-associated liver injury. It also elaborated on the role of drug therapy in the development of COVID-19 liver injury.
Egyptian Liver Journal, Volume 12, pp 1-11; https://doi.org/10.1186/s43066-022-00225-9
Background: Liver is a complex, highly vascular organ, where anatomical variations are the norm. This study aimed to analyze all the three hepatic vascular anatomical variations in a single study which would help us understand the prevalence of hepatic vascular (arterial, portal, venous) anomalies in the population catered to by our institution. Methods: A retrospective analysis of 545 contrast-enhanced CT scans was done from November 2019 from the institute PACS after satisfying the inclusion and exclusion criteria. The raw imaging data were processed in PACS software — Centricity™ Universal Viewer and Syngo.via Vb20 platform, for axial, coronal, and axial-oblique multiplanar reformation, maximum intensity projection (MIP), and volume rendering (VR) images. Data were analyzed in the three vascular phases to determine the anatomical variations. Analysis was done by two surgical residents in the division of HPB surgery, which was verified by a certified radiologist. Results: There were no major differences in the prevalence rates of the vascular anomalies across gender and domicile distributions. The prevalence of normal hepatic artery and variant hepatic artery in our study was 69% and 31%, respectively. Accessory left hepatic artery (10%) was the most common hepatic artery variant in our study. Single RHV was seen in 77.4%, and other RHV variants like two RHV with common trunk, two RHV with independent drainage, and three RHV with common trunk contribute 22.6% of our study population. Accessory inferior RHV was seen in 19.8% of the study population. Normal portal vein anatomy was found in 81.1% in our study, and the most common variant in our study population was trifurcation of portal vein (16.1%). Conclusion: This was the largest study until date from South India, studying all three hepatic vascular anatomical variations in a single study. Variations in the anatomy of hepatic arteries, portal veins, and hepatic veins are common. A good knowledge of the same is necessary especially for a hepatobiliary surgeon or for an interventional radiologist, to plan and avoid complications during a procedure. Preoperative contrast-enhanced CT scan and whenever necessary a VR or a MIP reconstruction will precisely help in identifying these variations.
Egyptian Liver Journal, Volume 12, pp 1-12; https://doi.org/10.1186/s43066-022-00228-6
Background: Wilson disease (WD) is an inherited disorder of copper metabolism commonly involving the liver, cornea, and brain. Its incidence is increasing day by day worldwide. Early diagnosis and prompt treatment are the key for best outcome. Material and methods: A cross-sectional descriptive study was done from January 2014 to December 2019. Sixty children of both genders between 3 and 18 years were diagnosed by clinical and laboratory profile meeting selected criteria. Results: Mean age was 8.42 ± 2.6 years and male female ratio was 1.5:1. Consanguinity of marriage was found in 38.3% cases. Seventy percent of cases were hepatic, 16.7% were neuropsychiatric, 5.0% were hepatic with neuropsychiatric, and 8.3% cases were manifested asymptomatically. Asymptomatic and hepatic WD were reported between 3 and 10 years and most of the neuropsychiatric and hepatic with neuropsychiatric manifested after 10 years of age. More than 50% cases improved, a little more than 20% children died, 18.4% were unchanged and 6.6% were hepatic added neuropsychiatric manifestations. Most of the asymptomatic (100%) and hepatic (61.9%) cases improved. High mortality was found with 76.9% cases of acute liver failure (ALF), 7.7% case of chronic liver disease (CLD) and 25% cases of CLD with portal hypertension (CLD and PH). Most of the neuropsychiatric cases (90.0%), and approximately two-third (66.6%) of hepatic with neuropsychiatric cases remained unchanged. Neuropsychiatric manifestations were added in 15.4% cases of CLD and 25% cases of CLD with PH patient. The treatment was well tolerated in 66% children without any side effects. Low WBC (6.3%) and platelet count (4.3%), vomiting (6.3%), anorexia (4.3%), loss of taste (4.3%), rash (4.3%), and proteinuria (2.1%) were found in few cases. Conclusion: Majority of the children were presented with hepatic manifestations. More than half of patients with WD treated by D-penicillamine (DP) were improved. Significant mortality was found in acute liver failure whereas neuropsychiatric presentations had persistent abnormalities. No major side effects of DP was observed in most of the cases. Early diagnosis and prompt treatment were crucial for better outcome.
Egyptian Liver Journal, Volume 12, pp 1-9; https://doi.org/10.1186/s43066-022-00229-5
Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases. It is shown that moderate to high physical activities can play a crucial role in improving this disease. Aim: The purpose of this study was to explore the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on the levels of the myonectin in serum and tissue levels and fatty acid transport protein 4 (FATP4) in male rats with NAFLD. Materials and methods: Thirty-three male rats were randomly divided into five groups: high-fat diet to confirm NAFLD induction (n = 5), normal diet sedentary (n = 7), high-fat diet sedentary (n = 7), high-fat diet with HIIT (n = 7), and high-fat diet with MCIT (n = 7). Induction of NAFLD was performed by feeding rats for 12 weeks with a high-fat diet containing 60% fat. The training protocols were performed in five sessions per week for 8 weeks. The HIIT group has performed 4 × 4 min interval running on a treadmill up to 80–95% maximal oxygen uptake (VO2max) and then recovered at 50–60% VO2max. The MICT protocol has performed up to 50–60% VO2max for 50 min. myonectin and FATP4 were also measured by the animal Elisa kit (Zellbio, Germany) with a sensitivity of 0.02 ng/L. Insulin resistance was evaluated by the insulin resistance homeostasis assessment index using the following formula (HOMA-IR): “fasting glucose (mg/dl) × fasting in insulin (mg/L) ÷ 405”. One-way ANOVA analysis of variance was utilized for statistical analyses and Tukey’s post hoc test at a significant level of p < 0.05. Results: The 8-week intervention showed that both HIIT and MICT positively influenced the serum myonectin and FATP4 levels (p < 0.05). Moreover, there was a significant difference between the trained groups in tissue levels of the myonectin and serum levels of FATP4 (p < 0.05). Conclusions: Altogether, both HIIT and MICT can lead to valuable adaptations and recovery of NAFLD in male rats.
Egyptian Liver Journal, Volume 12, pp 1-8; https://doi.org/10.1186/s43066-022-00227-7
Background/objective: Hepatic encephalopathy (HE) is a main manifestation of acute decompensation in liver cirrhosis. Recently, systemic inflammation was proposed as a key mechanism in the development of acute kidney injury (AKI) in cirrhotic patients. The urine albumin creatinine ratio (UACR) is considered a marker of systemic inflammation in a variety of clinical settings. Here, we aimed to evaluate the role of the urine albumin creatinine ratio in the early prediction of AKI in HE. Patients and methods: Sixty-seven consecutive patients presented with cirrhotic HE, and 59 age- and sex-matched cirrhotic patients with no history of HE served as controls. HE was defined and graded by the West Haven criteria. The severity of liver cirrhosis was evaluated by the Child-Turcotte-Pugh (CTP) score, and model for end-stage liver disease (MELD) score. The incidence of AKI that developed during hospital admission and the in-hospital mortality rate was estimated among HE patients. In addition, predictors of AKI were analyzed. Results: The mean age of HE patients was 58.09±12.26 years; 36 (53.7%) were males, and 31 (46.3%) were females. Among HE patients, 16 (23.9%) developed AKI during hospital admission. The in-hospital mortality rate among HE patients was 22 (32.8%), the in-hospital mortality among HE-AKI patients was 81.3% (n=13/16), and UACR levels > 91.5 mg/g identified HE-AKI with 81.25% sensitivity (AUC = 0.85, P ≤ 0.001). Conclusions: Patients with cirrhotic HE are at high risk of AKI. HE-AKI patients had a high rate of in-hospital mortality. Estimation of UACR at hospital admission is suggested for the early detection of patients with HE-AKI.
Egyptian Liver Journal, Volume 12, pp 1-11; https://doi.org/10.1186/s43066-022-00226-8
The first direct-acting antiviral (DAA) medications were approved for the treatment of chronic hepatitis C virus (HCV) in 2011. Later, the appearance of novel DAAs had revolutionized the landscape of HCV treatment whose early treatment options were limited to interferon (IFN) either alone or in combinations. This review discusses the paradigm shift in legibility for treating different groups of patients with HCV after the introduction of DAAs, along with the consequent changes in treatment guidelines. IFN-based therapy was the firstly used for treating chronic HCV. Unfortunately, it exhibited many pitfalls, such as low efficacy in some patients and unsuitability for usage in lots of patients with some specific conditions, which could be comorbidities such as autoimmune thyroiditis, or liver related as in decompensated cirrhosis. Furthermore, IFN failed to treat all the extrahepatic manifestations of HCV. Nowadays, the breakthroughs brought by DAAs have benefited the patients and enabled the treatment of those who could not be treated or did not usually respond well to IFN. DAAs achieve a high success rate of HCV eradication in addition to avoiding unfavorable harms and, sometimes, adverse effects related to the previously used PEGylated IFN regimens.
Egyptian Liver Journal, Volume 12, pp 1-6; https://doi.org/10.1186/s43066-022-00222-y
Background: Iron deficiency anemia is common among patients with chronic liver disease. Reticulocyte hemoglobin is a marker for iron availability in the bone marrow that is not affected by inflammation. Objective: The aim of this study is to detect the diagnostic value of reticulocyte hemoglobin (Ret-Hb) in diagnosis of iron deficiency anemia among children with chronic liver disease. Methods: This is a cross-sectional study that included thirty-three children with chronic liver disease (CLD) and Hb < 11 g/dL, MCV < 77 fl, regularly attending the Pediatric Hepatology Clinic, Cairo University Children Hospitals. Patients underwent full history taking, and full iron profile and reticulocyte Hb were done. Results: The median age of our patients was 5.9 years with a median age of onset of CLD was 1.6 years. The mean reticulocytic Hb was 25.52 ± 4.53 pg (N: 28–36 pg). Mean serum ferritin was 89 ± 16.55 ng/ml (N: 7–140 ng/ml). There was a statistically positive significant linear correlation between S-ferritin and Ret. Hb, r = +0.433, p = 0.012. ROC curve analysis of reticulocytic Hb, at cutoff ≤ 29.3 pg for diagnosis of iron deficiency anemia in children with CLD, had an AUC of 0.824 with a sensitivity of 92.59% and a specificity of 83.33%, with p = 0.012. Conclusion: Reticulocyte Hb is a sensitive and specific marker for detection of iron deficiency anemia in CLD patients. Anemia in CLD was mostly iron deficiency anemia.
Egyptian Liver Journal, Volume 12, pp 1-5; https://doi.org/10.1186/s43066-022-00220-0
Backgrounds and aim: Neutrophil extracellular traps (NETs) have been shown to play an important role in inflammatory and thrombotic processes. Investigating the presence of NETs in liver cirrhosis to detect any contribution to occurrence of complications may help predict or prevent those complications. Methods: Among 78 cirrhotic patients, the serum NETs level was measured using ELISA and compared to different etiologies of liver cirrhosis (Viral, HCC, Bilharzial, NASH, cardiac cirrhosis and undetermined etiology) as well as markers of inflammation and complications in those patients. Results: We found that NETs are substantially found in LCF and have a significant relation to malignant portal vein thrombosis but not other studied complications or etiology of liver cirrhosis. Conclusion: NETs however found in liver cirrhosis patients may not play as a significant role in occurrence of complications as thought. So, NETs cannot be reliably used as a biomarker or predictor for occurrence of thrombosis in liver cirrhosis patients. Lay summary: Liver cirrhosis patients have many factors at play that lead to development of thrombosis. NETS may play a role with the development of malignant thrombosis in those patients. Further evaluation for their level and action should be studied before considering NETs as a key player in development of complications.