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Background Medical research has increased greatly in many developing countries during the recent decade, motivated by the need to improve health in these countries. Such research needs to be guided by fundamental ethical principles to ensure the protection of patient’s rights and welfare. Also, biobanks have become increasingly important for the study of health and disease. There is a significant public interest in the outcomes of genetic research, which include diagnostic, therapeutic, and preventive health methods. This study was conducted assess and raise the knowledge and attitude towards several aspects of research, related ethics, and biobank ethical issues for paramedical and administrative teams working at the National Liver Institute (NLI). Results The education intervention study was effective in increasing percentage of good knowledge in paramedical and administrative teams (p value p value Conclusion There were good knowledge and attitude about research and related ethics, but poor knowledge and attitude about biobanking. The educational intervention study significantly increased knowledge and attitude about research, related ethics, and biobanks.

Hussein M Ismail,1,2 Abeer S Algrafi,2 Osama Amoudi,3 Sameh Ahmed,4 Sultan S Al-Thagfan,5 Hassan Shora,6 Mohammed Aljohani,7 Mohammed Almutairi,7 Fahad Alharbi,7 Abdullah Alhejaili,7 Majed Alamri,7 Abdullah Muhawish,7 Ayat Abdallah8,9 1Department of cardiology, College of Medicine, Suez Canal University, Ismailia, Egypt; 2Department of medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 3Madinah Cardiac Center, Adult cardiology, Al-Madinah Al-Munawara, Saudi Arabia; 4Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 5Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 6Department of molecular biology/biochemistry, Port Said University, Port Said, Egypt; 7Medical intern, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 8Epidemiology and Preventive Medicine Department, National Liver Institute, Shebin El-Kom, Egypt; 9Department of Family and Community Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi ArabiaCorrespondence: Hussein M IsmailDepartment of Cardiology, College of Medicine, Suez Canal University, Ismailia, EgyptEmail husseinismail@med.suez.edu.eg; drhussein72@gmail.comBackground: Vitamin D deficiency is considered an emerging health problem that affects at least one billion patients worldwide. Calcitriol 1,25(OH)2D3 has several systemic effects, including anti-inflammatory, anti-thrombotic and anti-atherosclerotic impacts that explain its cardioprotective effects. The precise association between vitamin D and its metabolites and the value of supplements in acute coronary syndrome (ACS) is still controversial. This study aims to search the association between vitamin D2, D3, and metabolites and ACS in patients undergoing coronary angiography.Materials and Methods: This was a case–control study on 73 consecutive adult patients with ACS undergoing coronary angiography compared to 50 controls without coronary artery disease and matched for age and sex from June 2019 till July 2019. Echocardiography and coronary angiography were done for all cases. Plasma vitamin D and its metabolites were measured at admission for all participants along with chemistry profiles.Results: Vitamin D and its metabolites were statistically significantly lower in ACS patients than the controls. Multivariate regression analysis revealed that low levels of 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) significantly predicted ACS occurrence; the other significant predictors were high systolic blood pressure (BP), high total cholesterol, and low high-density lipoprotein-cholesterol. Interestingly, vitamin D2 and D3 did not significantly predict ACS (p> 0.05). We did not find a statistically significant association between the number of affected coronary vessels and vitamin D metabolites. Moreover, there was no statistically significant correlation between vitamin D and its metabolites and left ventricular ejection fraction measured by echocardiography.Conclusion: There was a strong association between vitamin D and all its metabolites with ACS. Significantly, low 25(OH)D and 1,25(OH)2D predicted ACS, but vitamin D2 and D3 did not. Large randomized controlled trials are needed to verify the beneficial values of vitamin D supplementation in ACS patients.Keywords: vitamin D3, vitamin D2, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D3, acute coronary syndrome, coronary artery disease

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries’ progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100000, reduce HBV prevalence among 1-year-olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.

Background Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-mortality globally. Hepatocarcinogenesis is a complex multifactorial process. Host genetic background appeared to play a crucial role in the progression of HCC among chronic hepatitis C patients, especially in the era of Genome Wide Association Studies (GWAS) which allowed us to study the association of millions of single nucleotide polymorphisms (SNPs) with different complex diseases. This article aimed to review the discovered SNPs associated with the risk of HCV-related HCC development which was reported in the published GWA studies and subsequent validation studies and also try to explain the possible functional pathways. Main text We reviewed the recent GWA studies which reported several new loci associated with the risk of HCV-related HCC, such as (SNPs) in MHC class I polypeptide-related sequence A (MICA), DEP domain-containing 5 (DEPDC5), Tolloid-like protein 1 (TLL1), and human leukocyte antigen (HLA) genes. We also explained the possible underlying biological mechanisms that affect the host immune response pathways. Additionally, we discussed the controversial results reported by the subsequent validation studies of different ethnicities. Conclusions Although GWA studies reported strong evidence of the association between the identified SNPs and the risk of HCV-related HCC development, more functional experiments are necessary to confirm the defined roles of these genetic mutations for the future clinical application in different populations.

Background Esophageal adenocarcinoma has the fastest growing incidence of any solid tumor in the Western world. Prognosis remains poor with overall five-year survival rates under 25 %. Only a limited number of patients benefit from chemotherapy and there are no biomarkers that can predict outcome. Previous studies have indicated that induction of autophagy can influence various aspects of tumor cell biology, including chemosensitivity. The objective of this study was to assess whether expression of the autophagy marker (LC3B) correlated with patient outcome. Methods Esophageal adenocarcinoma tumor tissue from two independent sites, was examined retrospectively. Tumors from 104 neoadjuvant naïve patients and 48 patients post neoadjuvant therapy were assembled into tissue microarrays prior to immunohistochemical analysis. Kaplan-Meier survival curves and log-rank tests were used to assess impact of LC3B expression on survival. Cox regression was used to examine association with clinical risk factors. Results A distinct globular pattern of LC3B expression was found to be predictive of outcome in both patient groups, irrespective of treatment (p

Drug-induced liver injury (DILI) is a frequent cause of liver injury and acute liver failure. We aimed to review all hospitalized DILI cases in a tertiary Egyptian center from January 2015 through January 2016. Cases with elevated alanine aminotransferase more than 3-fold and/or alkaline phosphatase more than 2-fold the upper limit of normal value were prospectively recruited and followed for one year. Drug history, liver biopsy whenever feasible and application of Roussel Uclaf Causality Assessment Method (RUCAM) were the diagnostic prerequisites after exclusion of other etiologies of acute liver injury. In order of frequency, the incriminated drugs were: Diclofenac (31 cases, 41.3%), amoxicillin-clavulanate (14 cases, 18.7%), halothane toxicity (8 cases, 10.7%), ibuprofen (4 cases, 5.3%), Khat (3 cases, 4%), tramadol (3 cases, 4%), Sofosbuvir with ribavirin (2 cases, 2.7%), and acetylsalicylic acid (2 cases, 2.7%) with one offending drug in 93.3% of cases. Forty-four cases (58.7%) were males; while 56 cases (74.7%) had HCV related chronic liver disease. Thirty-two cases (42.7%) presented with pattern of hepatocellular injury, while 23 cases (30.7%) were with cholestasis, and 20 cases (20.7%) with a mixed hepatocellular/cholestatic injury. One case received a transplant (0.75%), 7 cases died (9.3%), 23 cases (30.6%) developed liver decompensation (hepatic encephalopathy and ascites), and 44 cases completely resolved (58.7%). In conclusion, Diclofenac is the commonest offender in DILI occurrence in an Egyptian cohort. Age and prothrombin concentration were the only predictors of unfavorable outcomes of DILI.

Background and objectives. Second-hand smoke (SHS) is an important public health problem worldwide. The study aimed to estimate the prevalence of SHS exposure and its associated risk factors among intermediate and secondary school students.Methods. A cross-sectional study was conducted in 2013 among 3400 students from 34 intermediate and secondary schools in Madinah City, Saudi Arabia. Data about sociodemographic and smoking-related factors and SHS exposure were collected using a self-administered questionnaire.Results. Of the 3210 students analyzed, the prevalence of SHS exposure was 32.7% 49.3%, and 25% inside, outside, and both inside and outside the home, respectively. The highest risk of SHS exposure was associated with the adolescent’s smoking status, parental smoking, close friends smoking, and family structure. The risk was markedly increased in association with parental smoking for exposure inside the home (OR = 6.49; 95% CI = 5.44–7.73) and with close friends smoking for exposure outside the home (OR = 4.16; 95% CI = 3.54–4.77). The risk of SHS, however, was lower among adolescents having knowledge about smoking and highly educated parents.Conclusion. The study revealed a considerably high prevalence of SHS both inside and outside the home among adolescents. Knowledge and beliefs about SHS exposure are the main preventable approach.

Background: Giant cell hepatitis is rarely described in adults; referred to as post infantile giant cell hepatitis (PIGCH). Most reports have mentioned PIGCH's association with systemic lupus erythromatosis, autoimmune hepatitis, lymphoma, and leukemia. However, links with other medical disorders are still evolving. Reports of primary sclerosing cholangitis (PSC) presenting as IgG4-SC has been typically described in association with other IgG4-related disorders, most frequently autoimmune pancreatitis. However, some cases of isolated IgG4-SC have been reported. Herein; we report a case of IgG4-SC presented by PIGCH. Case description: A 29-year-old gentleman presented with two month jaundice and biochemical evidence of acute hepatitis. He reported no history of drug exposure, had no gall bladder or pancreatic disease, nor prior similar attacks. The work up revealed negative serology for viral hepatitis. Markers of autoimmune liver disease were negative except for pANCA, and serum levels of pancreatic enzymes, copper and ceruplasmin were normal, and urinary copper was normal. Results: Abdominal sonography and MRCP showed normal pancreas and biliary tract. ERCP showed that the common bile duct had a single short narrowed segment with thickened walls. Histological examination of colonoscopic biopsies taken from the terminal ileum and colon demonstrated no pathological alterations. Liver histology showed evidence of parenchymal extinction with extensive giant cell transformation, ductular proliferation, cholestasis, and positive IgG4 staining, a picture suggestive of PSC and PIGCH. Discussion: In this case, we did not test for serum levels of IgG4, and resorted to immune-staining of liver tissue, as this is the hallmark for diagnosing IgG4-SC. Histopathological features and, more definitely, the positive IgG4 immunostaining were present in the liver tissue, which were crucial in diagnosing this case as IgG4-SC (IAC). Conclusion: This case presented with both IgG4-SC and biopsy proven PIGCH, and had a favourable outcome with biliary drainage and immuno-suppression therapy

Background: Hepatic progenitor cells (HPC) as a hepatic regeneration reservoir, are now signified as one of the promising therapeutics. However, connection to cells resistant to apoptosis in pathogenesis of chronic hepatitis C virus (HCV) is still evolving. Aim: title relationship between HPC and cells resistant to apoptosis in HCV along with liver disease severity and fibrosis progression. Methods: liver biopsies of 91 chronic HCV patients were immunohistochemically examined. Both demographic and clinical characteristics were sourced from the data registries. METAVIR scoring was unified for both Grading and staging. Immunostaining with CK7, Ki67, and bcl2 antibodies was done. Results: Transaminases, platelets and prothrombin time exhibited significant relation with Ki67, CK7 both isolated and ductular and bcl2 both LPT and LAH. CK7 ductular showed association with fibrosis and necroinflammatory activity (P 0.05). Moreover, bcl2 both (LPT) and (LAH) demonstrated association with fibrosis and necroinflammatory activity (P< 0.05). Positive correlation between immunoexpression of HPCs both isolated (r=0.547

Background : Liver cancer is the fifth most common cancer in men and the seventh in women. Hepatocellular carcinoma (HCC) is responsible for significant morbidity and mortality in patients with liver cirrhosis and accounts for 90% of primary liver cancer. Synovial sarcoma X chromosome (SSX) genes belong to cancer testis antigens (CTA) family; expressed only in germ cell tumors. There have been some studies about the SSX genes expression in the HCC. To the best of our knowledge no reports included these genes expression in the Egyptian patients with HCC. Aim: This study aims to evaluate the SSX-1 and SSX-5 mRNA expression in tumor cells circulating in the peripheral blood (PB) of a cohort of Egyptian patients with HCC and to find out any possible associations between these genes expression and different clinical/laboratory parameters. Subjects and methods: This study included 100 subjects; 52 HCC cases, 25 with post viral hepatitis liver cirrhosis and 23 apparently healthy controls. Expression of SSX-1 and SSX-5 mRNA in PB was tested by reverse transcription polymerase chain reaction (RT-PCR). Results: SSX-1 and SSX-5 mRNA were expressed in 40.4% and 36.5% of the HCC patients, respectively. SSX-1 and/or SSX-5 were not detected in healthy controls or cirrhotic patients. Neither SSX-1 nor SSX-5 expression showed an association with Alfa-Fetoprotein (AFP) levels, tumor size, tumor differentiation, hepatitis B infection and Bilharziasis (P >0.05). Conclusion: SSX-1 and SSX-5 mRNA are specifically expressed in tumor cells circulating in PB of HCC patients and thus could be used as easy access, simple method molecular markers for early diagnosis of HCC patients in Egypt. Keywords: SSX-1; SSX-5; Gene expression; Peripheral blood; Hepatocellular carcinoma

Platelet transfusion (PTx) has been identified as an important risk factor for morbidity and mortality after liver transplantation (LTx). Our aim was to evaluate the safety of therapeutic rather than prophylactic PTx policy in severe thrombocytopenic patients undergoing LTx. Recipients of LTx were divided into two groups: group I (GI) (n = 76) platelet count (PC) ≥ 50 × 10(9)/l and group II (GII) PC 50 × 109/l (n = 76). Platelets were transfused following a thromboelastometry protocol and clinical signs of diffuse bleeding. Both groups were compared regarding hemoglobin (Hb), international normalized ratio (INR), fibrinogen level, blood loss (BL), blood products required, percentage of bloodless surgery, duration of mechanical ventilation, ICU stay, and vascular complications. Each group was further subdivided according to PTx into (GI NPTx and GII NPTx) with no platelet transfusion (NPTx) and (GI PTx and GII PTx) received PTx. These subgroups were further compared for some variables. Base line Hb was significantly higher while INR was significantly lower in GI.75% avoided PTx in GII. Comparisons of BL, packed red blood cells (PRBCs), and cryoprecipitate transfusion were insignificant. Fresh frozen plasma (FFP) transfusion was higher and the percentage of bloodless surgery was lower in GII. In GII, PC increased after start of surgery. Two cases of hepatic artery thrombosis in GI and one in GII were recorded. Recovery of platelets was quicker, and duration of mechanical ventilation and ICU stay was shorter in NPTx patients regardless the base line PC. Cut-off values of PC 30 × 10(9)/l (with sensitivity 73.7% and specificity 78.8%, p 0.01), BL of 3750 ml in GI (sensitivity of 75% and specificity of 69%, p 0.01) and of 3250 ml in GII (sensitivity of 84.2% and specificity of 87.7% (p 0.01)) could indicate the need of PTx. With therapeutic approach, 75% of patients in GII could avoid unnecessary PTx with its hazards without excessive bleeding. PC in GII increased intraoperatively, PTx may lead to delayed recovery of platelets, increased duration of mechanical ventilation and ICU stay. The given cut-off values may help to guide PTx.

Background there are several reports on the outcomes of cardiac surgery in relation to body mass index. Some concluded that obesity did not increase morbidity or mortality after cardiac surgery, whereas others demonstrated that obesity was a predictor of both morbidity and mortality. Methods this was a retrospective study of 3370 adult patients undergoing cardiac surgery. The patients were divided into 4 groups according to body mass index. The 4 groups were compared in terms of preoperative, operative, and postoperative characteristics. Results obese patients had a significantly younger mean age. Diabetes, hypertension, and hyperlipidemia were significantly more common in obese patients. The crossclamp time was significantly longer in the underweight group. Reoperation for bleeding, and pulmonary, gastrointestinal, and renal complications were significantly more common in the underweight group. Wound complications were significantly more frequent in the obese group. Mortality was inversely proportional to body mass index. The adjusted odds ratios of the early clinical outcomes demonstrated a higher risk of wound complications in overweight and obese patients Conclusion body mass index has no effect on early clinical outcomes after cardiac surgery, except for a higher risk of wound complications in overweight and obese patients.

Background: Esophageal adenocarcinoma has the fastest growing incidence of any solid tumor in the Western world. Prognosis remains poor with overall five-year survival rates under 25 %. Only a limited number of patients benefit from chemotherapy and there are no biomarkers that can predict outcome. Previous studies have indicated that induction of autophagy can influence various aspects of tumor cell biology, including chemosensitivity. The objective of this study was to assess whether expression of the autophagy marker (LC3B) correlated with patient outcome. Methods: Esophageal adenocarcinoma tumor tissue from two independent sites, was examined retrospectively. Tumors from 104 neoadjuvant naïve patients and 48 patients post neoadjuvant therapy were assembled into tissue microarrays prior to immunohistochemical analysis. Kaplan-Meier survival curves and log-rank tests were used to assess impact of LC3B expression on survival. Cox regression was used to examine association with clinical risk factors. Results: A distinct globular pattern of LC3B expression was found to be predictive of outcome in both patient groups, irrespective of treatment (p