BACKGROUND AND AIM: Chronic liver disease leads to reduction in health-related quality of life, particularly functional capacity. The data about the use of Six Minute Walk Test (6MWT) among cirrhotic patients are limited. The current study was done to evaluate the use of 6MWT in patients with HCV related chronic liver disease for assessing the functional capacity and to determine the correlation between the 6MWD and severity of chronic liver diseases. METHODS: This analytic cross-sectional study was carried out on 20 healthy volunteers (Group I), 40 HCV patients with early liver disease (Group II), and 40 HCV patients with liver cirrhosis (Group III). Six minute walk distance (6MWD) was calculated. RESULTS: The mean 6MWD was significantly lower in Groups II and III (325.8 ± 56.65 meter, and 131.79 ± 43.40 meter) compared to that of Group I (359.91 ± 38.63 meter) (p 0.01; p 0.001). The mean 6MWD was significantly lower in Group III compared to that of Group II (p 0.001). 6MWD was positively correlated with hemoglobin, platelets, and albumin (p 0.01). On the other hand, 6MWD was negatively correlated with bilirubin, AST, ALP, creatinine, and INR (p 0.05). There was a significant negative correlation between 6MWD and BMI in Groups II and III (p 0.05). There was no significant correlation between 6MWD and Child score or MELD score in Group III (p > 0.05). CONCLUSIONS: Six-minute walk test is a reliable indicator to measure the functional capacity for patients with HCV related chronic liver diseases.

AIM: This study aimed to evaluate the efficacy and safety of sofosbuvir (SOF)/ribavirin (RBV) and SOF/daclatasvir (DAC)/ RBV in Egyptian patients with hepatitis C virus (HCV)-related cirrhosis and to demonstrate the effects of these treatments on their haematological and biochemical profiles. PATIENTS AND METHODS: A prospective study was performed on 200 patients with HCV-related cirrhosis. Group 1 received SOF and RBV for 24 weeks, and Group 2 received SOF, DAC and RBV for 12 weeks. RESULTS: A sustained virological response (SVR) was achieved in 75 (75%) and 96 (96%) patients in Groups 1 and 2, respectively. The mean haemoglobin (Hb) level and platelet count decreased significantly at the end of treatment in both groups, and the percent decrease was significantly higher in Group 1 than in Group 2. The mean albumin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels decreased significantly at the end of treatment in both groups. There was a significant increase in the mean total bilirubin level in both groups at the end of treatment. The percent increase in the mean indirect bilirubin level was significantly higher in Group 2 than in Group 1. There was improvement in the Fibrosis-4 (FIB-4) score at the end of treatment in both groups. This improvement was maintained to SVR 12 in both groups. CONCLUSION: Patients with cirrhosis who received SOF, DAC and RBV for 12 weeks had a significantly higher SVR12 rate than those who received SOF and RBV for 24 weeks. In patients who achieved SVR, there was improvement in liver function parameters and the FIB4 score at the time of SVR12 in compared to baseline values.

AIM: This study aimed to evaluate the efficacy and safety of sofosbuvir (SOF)/ribavirin (RBV) and SOF/daclatasvir (DAC)/ RBV in Egyptian patients with hepatitis C virus (HCV)-related cirrhosis and to demonstrate the effects of these treatments on their haematological and biochemical profiles. PATIENTS AND METHODS: A prospective study was performed on 200 patients with HCV-related cirrhosis. Group 1 received SOF and RBV for 24 weeks, and Group 2 received SOF, DAC and RBV for 12 weeks. RESULTS: A sustained virological response (SVR) was achieved in 75 (75%) and 96 (96%) patients in Groups 1 and 2, respectively. The mean haemoglobin (Hb) level and platelet count decreased significantly at the end of treatment in both groups, and the percent decrease was significantly higher in Group 1 than in Group 2. The mean albumin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels decreased significantly at the end of treatment in both groups. There was a significant increase in the mean total bilirubin level in both groups at the end of treatment. The percent increase in the mean indirect bilirubin level was significantly higher in Group 2 than in Group 1. There was improvement in the Fibrosis-4 (FIB-4) score at the end of treatment in both groups. This improvement was maintained to SVR 12 in both groups. CONCLUSION: Patients with cirrhosis who received SOF, DAC and RBV for 12 weeks had a significantly higher SVR12 rate than those who received SOF and RBV for 24 weeks. In patients who achieved SVR, there was improvement in liver function parameters and the FIB4 score at the time of SVR12 in compared to baseline values.

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: 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%.