Introduction Rheumatoid arthritis (RA) is a systemic autoimmune disease presented by inflammatory polyarthritis, affecting predominantly smaller joints such as hands and feet but can also affect large joints. Heat shock protein 70 (HSP70) is released from damaged cells after stress and has been found in the bloodstream of patients with RA. Aim To study the applicability of HSP70 serum levels as a diagnostic factor and a severity indicator in patients with RA Patients and methods The study included 59 patients with RA and 14 controls. Patients were classified according to disease activity score 28 into four groups: 10 patients in remission, 12 patients with low disease activity, 18 patients with moderate disease activity, and 19 patients with high disease activity. HSP70 and anti‑cyclic citrullinated peptide assessments were done by ELISA technique. Results Patients with RA had a higher HSP70 level than the control group (P < 0.001), irrespective of presence or absence of rheumatoid factor or anti‑citrullinated cyclic peptide. Next, diagnostic accuracy of the HSP70 in diagnosis of RA was evaluated (area under curve = 0.91). HSP70 had 89.8% sensitivity and 92.8% specificity in diagnosis of RA. In addition to diagnostic value, HSP70 can distinguish between high disease activity (76.67 ± 16.06 ng/ml) and mild (25.57 ± 7.39 ng/ml), moderate (35.17 ± 8.34 ng/ml), or remission phase (16.90 ± 4.06 ng/ml). Conclusion The study demonstrates an increase in the serum level of HSP70 in patients with RA in comparison with controls.

Background and aims
Hepatocellular carcinoma (HCC) is one of the commonest tumors and considered
the fifth most common malignant neoplasm and a major cause of death. Egypt has
increased incidence of HCC cases, as Egypt has the highest prevalence of hepatitis
C virus (HCV) infection. The aim was to study the epidemiological characteristics of
HCC in Assiut, Egypt.
Patients and methods
A descriptive observational study design was applied for the present study. The
studied population was 400 patients with HCC (288 of them were male and 112
were female) who fulfilled the diagnostic criteria for HCC. Data were analyzed for
exploring the clinical, etiological, radiological, and tumor characteristics of the
studied patients.
Results
The mean age of the patients was 59.85±9.1 years. Most cases (68%) were from
rural areas, 38% of the patients were in agricultural occupation, and 32% of the
patients were accidentally discovered to have HCC .The most frequent symptom
was abdominal pain (15%). HCV antibody was present in 63% of the patients, HBV
infection was recorded in 28%, coinfection was seen in 3%, and no viral infection
was present in 6%. Diabetes mellitus was present in 37% and obesity in 24% of the
patients. Right lobe of the liver was the most frequent affected lobe (61%), and 69%
of the cases had a single lesion.
Conclusion
HCC incidence had been increasing in the past years in Egypt. The high prevalence
of HCV infection in Egypt makes the surveillance strategies important for early
detection of HCC in these patients to provide better curative treatment modalities in
the early stages.
Keywords:
chronic liver disease, hepatitis B virus infection, hepatitis C virus infection, hepatocellular
carcinoma

ABSTRACT
Background and aim: accurate diagnosis of inflammatory bowel disease (IBD) are mandatory steps for a good outcome. Its standard method for assessment is still ileo-colonoscopy; however, many recent reports described the utility of intestinal ultrasound (IUS) and duplex US in evaluating patients with IBD. We aimed to explore the efficacy of IUS and duplex US for the accurate diagnosis and follow-up of patients with IBD.
Methods: The current study was performed for >2 years between September 2018 and September 2020. A total of 60 patients diagnosed with IBD and 51 control subjects who underwent colonoscopy for reasons other than IBD were included. The two groups underwent colonoscopy and IUS with Doppler for the diagnosis and follow-up of patients after 1 year of treatment. Results: The mean age of patients with IBD was 29.23 ± 5.62 years, and 56.7% of them were females. The majority of them presented with abdominal pain, diarrhea, and bleeding per rectum. Patients with IBD had significantly lower hemoglobin, iron, and ferritin levels with higher C-reactive protein and erythrocyte sedimentation rates. The IBD group had significantly higher wall thickness (WT), peak systolic velocity (PSV), and end-diastolic velocity (EDV). After 1 year, the IBD group showed a significant reduction of WT and PSV. The PSV had the best diagnostic performance for the prediction of histological and clinical responses. Conclusion: IUS and duplex US are considered rapid noninvasive tools for the assessment of patients with IBD. Moreover, they can be used to predict histological and clinical responses.
Keywords: Colonoscopy, End-diastolic velocity, Inflammatory bowel disease, Intestinal ultrasound, Peak systolic velocity

Background and aim: Inflammatory Bowel Disease (IBD) and Diabetes mellitus (DM) etiology are still unclear, but
both have genetic basis and share several complications. So we aimed to search for whether the two diseases are
associated with each other and whether there are risk factors that increase the incidence of diabetes mellitus in
inflammatory bowel disease patients.
Methods: This study was conducted on 130 inflammatory bowel disease patients who were diagnosed by
colonoscopy and biopsy from EL-Raghy Assiut University Hospital and were not known to have DM before the study
in the period from October 2019 to June 2021.
These patients underwent a full history, a thorough clinical examination, and routine lab investigation, especially
fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1c).
Results: Out of 130 patients; 26 (20%) were found to be diabetics and the other 104 (80%) were non-diabetics. The
mean age of the studied patients was 32.45 ± 9.05 years, majority (78.5%) of them were males. And we found that
patients with DM were significantly younger than those without DM. The family history of DM was higher among
those patients with DM. The susceptibility of DM is increasing with the lengthening of IBD duration. No significant
difference was present between both groups of patients as regards the type of treatment for IBD.
Conclusion: Diabetes mellitus risk increases in patients with IBD who are younger than 30 years old, have a positive
family history of diabetes mellitus, and have had IBD for more than 3 years.
Key words: Association, Diabetes mellitus, Inflammatory Bowel Disease.

Abstract: Autoimmune hepatitis (AIH) is a chronic inflammatory disorder with complex
immunopathogenesis. Dysbiosis has been linked to many autoimmune diseases, but its detailed role
in autoimmune hepatitis (AIH) still needs rigorous evaluation, especially in Egypt. We aimed to
identify the shift in the gut microbiota profile and resultant metabolic pathways in AIH Egyptian
patients compared to healthy individuals. Stool samples were collected from 15 AIH-naive patients
and from 10 healthy individuals. The V3-V4 hyper-variable regions in16S rRNA gene was amplified
and sequenced using Illumina MiSeq platform. Significantly lower bacterial diversity in AIH patients
was found compared to the controls. A phylum-level analysis showed the overrepresentation of
Firmicutes, Bacteroides, and Proteobacteria. At the genus level, AIH-associated enrichment of
Faecalibacterium, Blautia, Streptococcus, Haemophilus, Bacteroides, Veillonella, Eubacterium, Lachnospiraceae
and Butyricicoccus was reported in contrast to Prevotella, Parabacteroides and Dilaster, which were
significantly retracted in such patients. Overall, the predicted metabolic pathways associated with
dysbiosis in AIH patients could orchestrate the potential pathogenic roles of gut microbiota in
autoimmune disease, though not in a disease-specific manner, calling for future large-scale studies.
Keywords: bioinformatics; microbiome; autoimmune hepatitis

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.