Background: Hepatitis C virus (HCV) remains a major health problem worldwide with over 170 million persons chronically infected and a burden of 300000 deaths. HCV Genotype 4 is the predominant Genotype in Egypt. During the past decade, a dual combination of pegylated interferon (PegIFN) and ribavirin (RBV) has represented the standard of care. In the era of directly acting antiviral drugs (DAAs), optimal treatment of HCV Genotype 4 remains, more than ever before, to be defined. Simeprevir (SMV) is a second generation NS3/4A protease inhibitor (PI), active against Genotypes 1, 2, 4, 5 and 6. Objectives: To determine the efficacy of Simeprevir-Sofosbuvir for treatment of chronic HCV infection among patients attending Sohag Cardiac and Digestive center (Ministry of Health), Upper Egypt. Patients and Methods: A prospective, hospital based, descriptive study, included 100 patients with chronic HCV infection eligible to receive Simeprevir-Sofosbuvir combination according to the Guidelines of the Ministry of Health. Results: Early virological response (EVR) was achieved in 99%. At the end of treatment, 94% were negative for HCV (ETVR). Finally, 89% of cases were still negative (sustained virological response) (virological response 12 weeks after end of treatment). The total occurrence of side effects among our study population was 13%, and all of them were mild. Conclusion: The combination of SOF and SMV is efficacious and well tolerated and represents a good therapeutic option in patients with chronic HCV in Upper Egypt.

Background: Hepatitis C virus (HCV) remains a major health problem worldwide with over 170 million persons chronically infected and a burden of 300000 deaths. HCV Genotype 4 is the predominant Genotype in Egypt. During the past decade, a dual combination of pegylated interferon (PegIFN) and ribavirin (RBV) has represented the standard of care. In the era of directly acting antiviral drugs (DAAs), optimal treatment of HCV Genotype 4 remains, more than ever before, to be defined. Simeprevir (SMV) is a second generation NS3/4A protease inhibitor (PI), active against Genotypes 1, 2, 4, 5 and 6. Objectives: To determine the efficacy of Simeprevir-Sofosbuvir for treatment of chronic HCV infection among patients attending Sohag Cardiac and Digestive center (Ministry of Health), Upper Egypt. Patients and Methods: A prospective, hospital based, descriptive study, included 100 patients with chronic HCV infection eligible to receive Simeprevir-Sofosbuvir combination according to the Guidelines of the Ministry of Health. Results: Early virological response (EVR) was achieved in 99%. At the end of treatment, 94% were negative for HCV (ETVR). Finally, 89% of cases were still negative (sustained virological response) (virological response 12 weeks after end of treatment). The total occurrence of side effects among our study population was 13%, and all of them were mild. Conclusion: The combination of SOF and SMV is efficacious and well tolerated and represents a good therapeutic option in patients with chronic HCV in Upper Egypt.

Background/Purpose: About 248 million people are chronic HBV surface antigen carriers in the world. Hepatitis D virus (HDV)infection presentin more than 15 million people worldwide. HDV needs hepatitis B surface antigen (HBsAg) to help its replication. We aimed to estimate the prevalence of HDV infection among HBsAg positive individuals and to determine the clinical, laboratory and virological characters of HDV infected patients. Methods: This study was prospective cross-sectional analytic one including 186 HBsAg positive cases. Anti-HBc total, IgM and HBV PCR were done for all of these cases. Anti-HDV ELISA analysis was done for all cases. Positive samples for Anti-HDV by ELISA were then tested by HDV PCR. Results: Of the 186 HBsAg positive cases, 80 were reactive for anti-HDV antibodies, resulting in an overall anti-HDV seropositivity of 43%. Higher prevalence of liver cirrhosis (43.8%), HCC on top of cirrhosis (8.8%) were found in anti-HDV positive compared to anti-HDV negative cases (17.9%) and (3.8%) respectively (p value 0.001). Portal hypertension and Child-Pugh grade B, C were significantly higher in anti-HDVpositive cases as compared to the anti-HDV-negative ones (47.5% versus 18.9%) and (11.3% versus 6.6%); (16.3% versus 3.8%) respectively (p value 0.001 for each). HDV RNA was positive in 25 out of 80 antiHDV-positive cases (31.3%). Conclusion: Anti-HDV was seropositive in 43% among HBsAg positive cases in Upper Egypt. HDV RNA was positive by PCR in 25 out of 80 anti-HDV-positive cases (31.3%). HDV prevalence using PCR was 25/186 (13.4%) in Upper Egypt

Background/Purpose: About 248 million people are chronic HBV surface antigen carriers in the world. Hepatitis D virus (HDV)infection presentin more than 15 million people worldwide. HDV needs hepatitis B surface antigen (HBsAg) to help its replication. We aimed to estimate the prevalence of HDV infection among HBsAg positive individuals and to determine the clinical, laboratory and virological characters of HDV infected patients. Methods: This study was prospective cross-sectional analytic one including 186 HBsAg positive cases. Anti-HBc total, IgM and HBV PCR were done for all of these cases. Anti-HDV ELISA analysis was done for all cases. Positive samples for Anti-HDV by ELISA were then tested by HDV PCR. Results: Of the 186 HBsAg positive cases, 80 were reactive for anti-HDV antibodies, resulting in an overall anti-HDV seropositivity of 43%. Higher prevalence of liver cirrhosis (43.8%), HCC on top of cirrhosis (8.8%) were found in anti-HDV positive compared to anti-HDV negative cases (17.9%) and (3.8%) respectively (p value 0.001). Portal hypertension and Child-Pugh grade B, C were significantly higher in anti-HDVpositive cases as compared to the anti-HDV-negative ones (47.5% versus 18.9%) and (11.3% versus 6.6%); (16.3% versus 3.8%) respectively (p value 0.001 for each). HDV RNA was positive in 25 out of 80 antiHDV-positive cases (31.3%). Conclusion: Anti-HDV was seropositive in 43% among HBsAg positive cases in Upper Egypt. HDV RNA was positive by PCR in 25 out of 80 anti-HDV-positive cases (31.3%). HDV prevalence using PCR was 25/186 (13.4%) in Upper Egypt

Background and study aims: Egypt has a high prevalence of hepatitis C virus (HCV) and high morbidity and mortality related to cirrhosis complications. Patients with cirrhosis have an increased risk of bacterial infections. Approximately 25–35% of cirrhotics had infections at admission or during hospitalisation. Data on infection among cirrhotics in Egypt are limited. This study aimed to determine the frequency and microbiological spectrum of infections in cirrhotics and possible risk factors. Patients and methods: This study was conducted at a tertiary care hospital. The frequency and microbiological spectrum of infections in cirrhotics were determined. The risk factors for infection were evaluated. Results: Of the 100 patients with liver cirrhosis, 61% had infection. Ascitic fluid infection (AFI) was the most common infection (44.3%), followed by urinary tract infection (UTI) (21.3%), respiratory tract infection (RTI) (19.7%), gastroenteritis (6.6%) and skin infection (4.9%). The only risk factor for infection among cirrhotics was diabetes mellitus (DM) (p = 0.047). The mean value of mid-arm muscle circumference was significantly lower in the infected group (p = 0.047). Among all the cirrhotics, 32.0% had mild to moderate malnutrition and 52.0% had severe malnutrition. The frequency of infection was higher in severe malnutrition (71.2%). Conclusions: The frequency of infections among cirrhotics was 61%. Many types of infections including AFI, RTI, UTI and skin infections were present in patients with liver cirrhosis, but AFI was the most common. DM was the only risk factor for infection, and independent predictors for infection were elevated WBC count and C-reactive protein levels. The frequency of infection was related to the degree of malnutrition.

Background/Aims: To evaluate the short-term outcome of the decision taken by the Hepatoma Board for the treatment of Hepatocellular carcinoma (HCC). Materials and Methods: This was a prospective descriptive study involving 74 patients with HCC diagnosed by the known criteria. The decisions taken by the Hepatoma Board for the 74 patients were as follows: 1- surgical resection (7 patients), 2- local ablative therapy (LAT) (22 patients), 3- conventional transarterial chemoembolization (TACE) (24 patients), and 4- palliative supportive care (21 patients). Results: The short-term mortality rate was 25.7% of the total patients. The success rate was nearly equal in LAT (68.2%) and surgery (71.4%), whereas the success rate was approximately 33.3% in TACE. There was no difference in the mean total bilirubin level before and after LAT, surgery, or TACE (p>0.05 for each). There was a significant decrease in the mean serum albumin level after TACE (p=0.000). There was a decrease in the mean alpha fetoprotein level after surgery and LAT (p=0.033) for surgery and (p=0.048) for LAT. Conclusion: The management of HCC is better performed through a multidisciplinary team decision. Surgery has comparable outcome to LAT but is more invasive. According to our local experience, conventional TACE has a success rate of 33.3%.

Background/Aims: To evaluate the short-term outcome of the decision taken by the Hepatoma Board for the treatment of Hepatocellular carcinoma (HCC). Materials and Methods: This was a prospective descriptive study involving 74 patients with HCC diagnosed by the known criteria. The decisions taken by the Hepatoma Board for the 74 patients were as follows: 1- surgical resection (7 patients), 2- local ablative therapy (LAT) (22 patients), 3- conventional transarterial chemoembolization (TACE) (24 patients), and 4- palliative supportive care (21 patients). Results: The short-term mortality rate was 25.7% of the total patients. The success rate was nearly equal in LAT (68.2%) and surgery (71.4%), whereas the success rate was approximately 33.3% in TACE. There was no difference in the mean total bilirubin level before and after LAT, surgery, or TACE (p>0.05 for each). There was a significant decrease in the mean serum albumin level after TACE (p=0.000). There was a decrease in the mean alpha fetoprotein level after surgery and LAT (p=0.033) for surgery and (p=0.048) for LAT. Conclusion: The management of HCC is better performed through a multidisciplinary team decision. Surgery has comparable outcome to LAT but is more invasive. According to our local experience, conventional TACE has a success rate of 33.3%.

Background/Aims: To evaluate the short-term outcome of the decision taken by the Hepatoma Board for the treatment of Hepatocellular carcinoma (HCC). Materials and Methods: This was a prospective descriptive study involving 74 patients with HCC diagnosed by the known criteria. The decisions taken by the Hepatoma Board for the 74 patients were as follows: 1- surgical resection (7 patients), 2- local ablative therapy (LAT) (22 patients), 3- conventional transarterial chemoembolization (TACE) (24 patients), and 4- palliative supportive care (21 patients). Results: The short-term mortality rate was 25.7% of the total patients. The success rate was nearly equal in LAT (68.2%) and surgery (71.4%), whereas the success rate was approximately 33.3% in TACE. There was no difference in the mean total bilirubin level before and after LAT, surgery, or TACE (p>0.05 for each). There was a significant decrease in the mean serum albumin level after TACE (p=0.000). There was a decrease in the mean alpha fetoprotein level after surgery and LAT (p=0.033) for surgery and (p=0.048) for LAT. Conclusion: The management of HCC is better performed through a multidisciplinary team decision. Surgery has comparable outcome to LAT but is more invasive. According to our local experience, conventional TACE has a success rate of 33.3%.

Background: The aim of this study was the evaluation of safety and outcome of temporal clamping of coronary artery in comparison to intraluminal coronary shunting, during distal anastomosis in off-pump coronary artery bypass grafting (CABG). Methods: To evaluate the early outcome of coronary clamping, we randomly compared the results of 25 patients submitted to coronary clamping using microvascular clamps during off-pump CABG (group A), with the results of another 25 patients had traditional intraluminal coronary shunting during same procedure (group B). All patients proved to have coronary artery disease with no difference between the groups in preoperative clinical variables. Results: Clamp group (A) had significant shorter operative time than shunt group (B); it was 224.2 ± 44.1 min in group (A) versus 250.4 ± 33.7 in group (B). Our new coronary clamp was applied in (93%) of target vessels but coronary shunt was implanted in (96%) of target vessels during distal coronary anastomosis. Clamp group (A) had low number of patients who required inotropic support (adrenaline > 0.15 mg/kg/min) > 24 Hours during perioperative period. The study showed two cases of mortality in both groups. At 6 months follow up; no difference between both groups was found, but late postoperative ejection fraction in group (A) was better, when compared to group (B). Conclusions: Temporal coronary clamping technique may be used as an applicable option to create a bloodless field during off-pump CABG surgery. It seems to be faster and cheaper than intraluminal shunting. Also, it has the same complications, mortality and ICU stay.

Background: The CHADS2 and CHA2DS2VASc and scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation (AF). All the components of CHA2DS2VASc are important risk and prognostic factors for cardiovascular disease. This study evaluates the effectiveness and accuracy of CHA2DS2VASc score as a risk-stratification tool for in hospital and short-term clinical outcome in ST-elevation myocardial infarction (STEMI) patients. Materials and methods: Our study involved 171 patients admitted with STEMI regardless of presence or absence of AF.GRACE, TIMI and CHA2DS2VASc scores were calculated to all patients at hospital admission. Patients were divided into three groups (score0-2, 3-4 and ≥5) according to CHA2DS2VASc RS .The primary end point was major adverse cardiovascular events (MACE) including cardiovascular death, non- fatal myocardial infarction (MI), and stroke during hospital admission at 3 months and 6 months. The area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive ability of each score at different time points. Results: Our six months follow up was completed in all patients. Cumulative incidence of MACE was 29 cases. In chi-square analysis, incidence of MACE was significantly higher in patients with CHA2DS2VASc score ≥5compared to3–4and 0–2 (38.89% vs19.57% vs12.15%, P = 0.01).Death is the most significant complication (p0.001). Both TIMI score and GRACE RS didn't demonstrate better discrimination than CHA2DS2VASc risk score in predicting in-hospital, 3-month and 6-month MACE. Conclusion: Our study demonstrates that CHA2DS2VASc score is an independent predictor for short-term prognosis in STEMI patients and can be used as a risk-stratification system in STEMI patients irrespective of method of treatment.