Purpose: To investigate the compositional and functional characteristics of T1DM-associated gut microbiota in two Egyptian cities
and to study the geographical locality effects.
Patients and Methods: This case-control study included 32 children with controlled T1DM and 16 controls, selected from two
different regions of Egypt. The gut microbiota of both diabetic and control children was analyzed through 16S rRNA gene sequencing;
this was done using the Illumina MiSeq platform.
Results: Consistent findings among the diabetic children included significantly lower alpha diversity than the control children, as well as
a lower mean Firmicutes/Bacteroidetes (F/B) ratio, and reduced proportions of Firmicutes and the genera Prevotella and Ruminococcus. In
the diabetic children, there were also significantly enriched representations of Actinobacteria, Bacteroidetes, and Proteobacteria and the
genera Lactobacilli, Bacteroides, and Faecalibacterium. When comparing the two diabetic groups, the Ismailia group (IsDM) was found to
have a significantly higher F/B ratio and diversity indices, with resultant differences at the functional level.
Conclusion: There are a number of consistent changes in the microbiota profile characterizing the diabetic groups irrespective of the
geographical location including significantly lower alpha diversity, mean Firmicutes/ Bacteroidetes (F/B) ratio, and reduced proportions of
Firmicutes and genera Prevotella and Ruminococcus. There are also significantly enriched representations of Actinobacteria, Bacteroidetes,
and Proteobacteria and genera Lactobacilli, Bacteroides, and Faecalibacterium pointing to the greater driving power of the disease.
Keywords: gut microbiota, dysbiosis, type 1 diabetes mellitus, children

Background: HBV infection is a significant health problem in Egypt which is categorized as an HB virus intermediate endemic area, with HB carrier rate ranging from 2%-7%. HBV infection is the 10th leading cause of death and HBV related hepatocellular carcinoma is the 5th most frequent cancer worldwide. Aims of the study: The present study aims to investigate the most important risk factors for transmission of HBV and HCV in urban and rural areas in Qena Governorate, Egypt. Patients and Methods: A matched case control study was conducted. The study included 600 patients, 100 HBV cases and 500 controls, aged above 20 years and below 70 years. Direct interview was done with each participant separately for filling the questionnaire during the period from January 2013 to January 2014. The collected data were reviewed, entered and statistically analyzed using SPSS version 19. Results: The mean age of cases and controls were 38.83 (± 12.62) and 44.26 (± 11.68) years respectively. Multivariate analysis shows that odds ratio of HBV infection is significantly higher among cases with some risk factors: injection by reused needle, sharing razors with others, dental procedures or oral surgery, blood transfusion and intravenous infusion and/or injection. Conclusion and Recommendations: The common risk factors exposures of hepatitis B infection included blood transfusion, dealing with patient blood, hospital admission, surgery, accidental stick with a blood contaminated needle, intravenous catheterization and dental procedures. There are statistically significant differences between HBV cases and their controls in the majority of these risk factors. The presence of these risk factors emphasizes the need for increasing the uptake of HB vaccine. Health care providers, health educators, and other community-based organizations must play an active role in counseling high-risk people
Key words: HBV- risk factors- Egypt- Rural –urban

Lupus nephritis (LN) is a common major organ manifestation and main cause of morbidity and mortality of the disease. We aimed to determine the level of serum and urinary monocyte chemoattractant protein-1(sMCP-1 and uMCP-1) in systemic lupus erythematosus (SLE) patients with and without LN and analyze their association with different clinical and serologic parameters of disease activity. We enrolled 60 female patients with SLE (32 with LN and 28 without LN) and 20 controls.MCP-1 and anti-dsDNA were measured by ELISA. There was statistically significant increase in serum and urinary MCP-1 in all SLE patients (mean=711.59, 676.68 pg/ml respectively) as compared to the control group (mean= 635.70, 632.40 pg/ml respectively), P=0.034, 0.020 respectively. Among patients with LN there was statistically significant increase in sMCP-1 (mean=723.58) compared to the control group (P=0.038, and in uMCP-1 (mean=699.08) compared to patients without LN (mean=651.07) and control group (mean=632.40), P=0.007, 0.002 respectively. Urinary, but not serum MCP-1, positively correlated with 24 hour proteinuria, anti-dsDNA, renal SLEDAI ,biopsy activity index (r=0.362, P=0.004; r=0.303, P=0.019; r= 0.267, P=0.039; r=0.353, P=0.047 respectively) and negatively correlated with serum albumin (r=-0.329, P=0.010).There was statistically significant increase in uMCP-1 and anti-dsDNA in patients with poor response compared to patients with good response to immunosuppressant therapy (P= 0.025; P=0.034 respectively). In conclusion, uMCP-1 is associated with LN and disease activity and may be used as a useful tool for diagnosis and follow up.

ABSTRACT
Background/Aims: Cirrhotic cardiomyopathy (CCM) is defined as an abnormal heart structure and function
in cirrhotic patients. CCM includes systolic and diastolic dysfunction, electrophysiological abnormalities, and
structural changes, both microscopic and macroscopic. Currently, there is no one diagnostic test that can identify
patients with CCM. Evaluation of the validity of galactin-3 and brain natriuretic peptide (BNP) as biomarkers
in the early detection of CCM in comparison to conventional echocardiography.
Materials and Methods: A case control study was carried out in the Departments of internal medicine and
tropical Medicine, Assuit University, Egypt. Seventy-one subjects were divided into the following three groups:
26 cirrhotic patients without ascites, 25 cirrhotic patients with ascites, and 20 healthy controls. All groups underwent
clinical examination, and laboratory investigation including BNP, galactin-3, and echocardiography.
Results: There was a significant difference between the three groups (p<0.001) with regard to corrected QT
(cQT), BNP and galactin-3. Left ventricular diastolic dysfunction with different grades was the most recorded
cardiac abnormality in the patient group I and II (88.5% and 96%; respectively) with significantly increased frequency
and severity in ascetic patients and with the advancement of liver cirrhosis. BNP and galactin-3 were
sensitive and specific biomarkers for the detection of diastolic dysfunction in cirrhotic patients (77.6%, 95.5%,
89.9% and 86.4%; respectively).
Conclusion: Diastolic dysfunction is a common cardiac abnormality in cirrhotic patients that worsens with the
advancement of cirrhosis. BNP and galactin-3 had higher sensitivity and specificity in the early detection of
CCM compared with those of conventional echocardiography.
Keywords: Liver cirrhosis, cardiomyopathy, ascites, cardiac function, BNP, galactin-3

Background
Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency
with significant morbidity and mortality. Intravenous (IV) route administration of
proton pump inhibitors is more commonly used for prevention of bleeding; however,
it is more expensive and invasive than the oral route. We, herein, compared
between oral and IV omeprazole in patients with high-risk UGIB regarding outcome.
Patients and methods
Patients with high risk for rebleeding peptic ulcers were included. All patients initially
received IV omeprazole, and then esophagogastroduodenoscopy with hemostatic
procedure was done. Thereafter, the patients were allocated to group A, who
received oral omeprazole, and group B, who received IV omeprazole. The patients
were followed up for 2 weeks for signs of rebleeding. Reendoscopy,
angioembolization, or surgery was provided when needed.
Results
The study included 189 patients (96 in group A and 93 in group B). Frequency of
rebleeding was higher among patients in group B (40%) compared with those in
group A (30%) (P: 0.1). Reendoscopy was more frequently required for patients in
group B (16.1%) than those in group A (3.1%) (P<0.001). Surgery was mandatory
for three (3.2%) patients in group B, whereas angioembolization was used nearly
equally in both groups (31.3% in group A vs. 29% in group B). Admission to ICU was
more frequently needed (P: 0.02) and the length of hospital stays was longer (P:
0.003) for patients of group B. Regarding UGIB-related deaths, three (3.1%)
patients from each group died.
Conclusion
Oral omeprazole is not inferior to IV omeprazole as adjuvant therapy to control
peptic ulcer bleeding and to reduce the frequency of rebleeding.

Abstract
Background The term “non-alcoholic fatty liver disease” (NAFLD) refers to a range of disorders caused by lipid
accumulation in the liver. High abdominal fat levels can cause adipocytes to become more lipolytic, releasing free
fatty acids into the portal venous system. In this study, we aimed to use the analysis of visceral fat, subcutaneous fat,
muscle mass, and liver volume to evaluate the severity of fatty liver in NAFLD.
Results This study enrolled 130 patients with non-alcoholic fatty liver disease. The mean age of studied patients was
51.38 ± 11.11 years, ranging between 25 and 65 years. Of the studied patients, 60 (46.2%) patients were males and 70
(53.8%) were females. The mean body mass index was 41.23 ± 7.83 (kg/m2). Based on the radiological assessment of
those patients, patients with grade III fatty liver had significantly higher total fat volume, visceral fat volume, subcutaneous
fat volume, fat rate in the body, visceral fat volume rate, psoas muscle volume, and psoas muscle ratio in
comparison with those with grade I and grade II fatty liver. Liver enzymes significantly correlated with total fat volume,
visceral fat volume rate, psoas muscle volume, psoas muscle ratio, and liver volume.
Conclusions The degree of fatty liver severity among patients with NAFLD was positively correlated with the amount
of subcutaneous, visceral fat, and muscle mass. Also, both liver transaminases had a significant positive correlation
with the amount of total and visceral fat, psoas muscle mass, and liver volume.
Keywords Non-alcoholic fatty liver, Visceral fat, Subcutaneous fat, Psoas muscle

Abstract: Background: Hormones of the thyroid gland play an important role in the regulation of various metabolic processes. Disturbances in thyroid hormone concentrations may lead to hyperlipidemia and obesity, thus contributing to NAFLD. Aim: To evaluate thyroid dysfunction and determine its possible relationship to nonalcoholic fatty liver disease (NAFLD) in obese adults. Methods: our cross-sectional study recruited 100 obese patients, patients were subjected to a full medical history, physical examination, abdominal ultrasonography as well as routine laboratory tests in addition to liver function and thyroid function testing. NAFLD was recognized on the basis of ultrasonographic findings, and in the absence of other causes of liver disease. Results: Patients was divided in two groups, Group 1 (65 patients) with NAFLD and Group 2 (35 patients) without NAFLD. Out of 100 patients recruited in the study; the most common thyroid dysfunction was overt hypothyroidism (22%) followed by (9%) had subclinical hypothyroidism. 26 patients with NAFLD (40%) were found to have thyroid dysfunction, of them 8 NAFLD patients (12.3%) had subclinical hypothyroidism and 18 NAFLD patients (27.7%) had overt hypothyroidism. Although Prevalence of thyroid dysfunction (whether overt hypothyroidism or subclinical hypothyroidism) was 22 % and 9 % respectively among patients with obesity, there was non-significant positive correlation between BMI and TSH (r= 0.051 and P=0.612). Multivariate regression analysis revealed that; fatty liver , obesity index and dyslipedemia were predictors of thyroid dysfunction in obese patients. Conclusion:Thyroid hypofunction is common in obese patients with NAFLD, which has implications for screening for hypothyroidism in patients with NAFLD and for the administration of appropriate therapy for hypothyroidism.
Keywords: Non-alcoholic fatty liver disease, Hypothyroidism, Obesity.

Key Words
Chronic hepatitis C • Hepatocellular carcinoma • Vimentin • LaminB1 • Antiku 86
Abstract
Background/Aims: Hepatocellular carcinoma (HCC) is the fifth most common malignancy and
most frequently develops in patients with cirrhosis. Surveillance strategies are recommended
in high-risk groups because early detection of small lesions improves the likelihood of
curative treatment. This study investigated the prospective clinical significance of serum levels
of anti-Ku86 and plasma levels of lamin B1and vimentin as early markers of HCC. Methods:
We recruited 74 patients at Assiut University Hospital—37 with HCC and 37 with chronic
liver disease (liver cirrhosis patients)—and 36 age- and sex-matched healthy controls. Lamin
B1 and vimentin mRNA expression levels were evaluated by reverse transcription-PCR and
serum levels of anti-Ku86 were measured by enzyme-linked immunosorbent assay. Results:
Compared with liver disease patients and controls, HCC patients showed higher levels of lamin
B1 mRNA (sensitivity, 96%; specificity, 65%), vimentin mRNA (sensitivity, 94%; specificity, 92%),
and anti-Ku86 (sensitivity, 94%; specificity, 80%). LaminB1 levels were significantly higher in
patients with a tumor size < 2 cm than in patients with tumors 2–5 cm and >5cm in size. Lamin
B1 had significant positive correlations with alpha-fetoprotein (AFP) (P=0.034) and anti-Ku86
(P=0.002). Receiver operating characteristic curves for differentiating HCCfrom liver cirrhosis
revealed a higher area under the curve(AUC).for vimentin than for AFP, lamin B1, and anti-Ku86
for the diagnosis of HCC (P<0.001). Conclusion: Circulating levels of anti-Ku86, lamin B1,and
vimentin might be potential surrogate markers of HCC, either alone or in combination with
AFP. However, independent and discriminative serological biomarkers with higher sensitivity
and specificity are still needed for the early detection of HCC.