Ahmed Abdel-Razik - Profile on Academia.edu (original) (raw)
Papers by Ahmed Abdel-Razik
Relation of insulin resistance and liver fibrosis progression in patients with chronic hepatitis C virus infection
PubMed, Jul 1, 2009
Background: Hepatitis C virus (HCV) infection can predispose to the development of insulin resist... more Background: Hepatitis C virus (HCV) infection can predispose to the development of insulin resistance before diabetes occurs. Such a potential link is particularly cogent in light of recent data indicate that diabetes may be associated with increased hepatic fibrosis progression in patients with chronic HCV infection. The aim of the study is to determine the prevalence of insulin resistance in non diabetic patients with chronic hepatitis C and its relation to liver fibrosis. Methods: Thirty eight patients with chronic liver diseases. They subdivided into 2 groups; chronic hepatitis C (CHC) with elevated liver enzymes and CHC with normal liver enzymes. Age and sex matched 12 healthy subjects as control group. All subjects were subjected to Careful history and copmlete examination with stress upon symptoms and signs of chronic liver diseases. Investigations include liver function tests; viral markers (Anti HCV antibodies & PCR for HCV). Serum fasting glucose; serum fasting insulin; homeostasis model assessment (HOMA), liver biopsy and abdominal ultrasound. Results: No correlation between viral load and hepatic fibrosis in HCV infected patients. Liver fibrosis is considerably higher among HCV patients with elevated serum transaminase levels. Insulin resistance is present in HCV infected cases compared with control group and it is positively correlated with liver fibrosis. Conclusion: The present data support the hypothesis that insulin resistance may increase the rate of fibrosis progression in non diabetic patients with chronic HCV. Follow up of hyperinsulinemia by serial measurement of HOMA test in non diabetic HCV infected patients may be a biochemical indicator for progression of liver fibrosis.
Medical Journal of Viral Hepatitis
Background: Staging of liver fibrosis is essential for managing patients with nonalcoholic fatty ... more Background: Staging of liver fibrosis is essential for managing patients with nonalcoholic fatty liver disease (NAFLD). Liver biopsy has well-known limitations and cannot be proposed to all patients. Previous studies have demonstrated that hepatic artery resistive index (HARI) is significantly altered in NAFLD patients. The aim of this study is to assess the value of (HARI) in evaluating the progression of liver fibrosis in NAFLD patients. Patients and methods: This study was carried out on 100 NAFLD patients. All patients had undergone Doppler ultrasound and transient elastography (TE) with controlled attenuation parameter (CAP) to quantify the degree of steatosis. Laboratory work and calculation of FIB-4, ASTplatelets ratio index (APRI), NAFLD fibrosis score (NFS) were done. Sensitivity and specificity of HARI values for predication of liver fibrosis were estimated by the receiver operating characteristic curve. Results: The study revealed a statistically significant positive correlation of HARI with liver stiffness measurement (LSM) measured by fibroscan, FIB4, NFS, age, Hba1c, fasting blood sugar (P <0.0001 for all) and LDL, HDL and albumin. However, a significant negative correlation of HARI with CAP was detected (P= 0.03). At a cutoff value of 0.76, HARI had 80% sensitivity and 76% specificity for prediction of advanced fibrosis (> 9.1 KPa) with area under ROC curve equal to 0.826. Moreover, HARI at a cutoff value 0.74 showed 83% sensitivity and 72% specificity for the prediction of liver cirrhosis (≥ 10.4 KPa) with the area under the ROC curve equal to 0.803. Conclusion: HARI is a good non-invasive tool to predict the risk of liver fibrosis progression in patients with NAFLD particularly advanced fibrosis and cirrhosis. HADRI correlates with other non-invasive methods of assessment of fibrosis including LSM, CAP, FIB4 and NFS, and may provide an easy, available tool for monitoring of patients with NAFLD. This study was carried out on 100 patients (28 males and 72 females) with NAFLD aged between (30-66) years old recruited from an out and inpatient clinic of Tropical medicine department, Mansoura University, Dakahlya, Egypt, between June 2018 and May 2021. All patients aged 18 years old and above with body mass index (BMI) more than 25 and evidence of any grade of fatty liver by ultrasonography. All subjects have signed a written
Shiha G1,2, *, Mousa N3, Abdel-Razik A3, Elhammady D3, Elshennawy H4, El-Farrash M5,6, Mousa E7, ... more Shiha G1,2, *, Mousa N3, Abdel-Razik A3, Elhammady D3, Elshennawy H4, El-Farrash M5,6, Mousa E7, Taha A8, El-bendary M3 and Eslam M9 1Departments of Internal Medicine, Mansoura University, Egypt 2Egyptian Liver Research Institute and Hospital (ELRIH), Sherbin, Mansoura University, Egypt 3Departments of Tropical Medicine, Mansoura University, Egypt 4Departments of Internal Medicine, National Liver Institute, Egypt 5Department of Microbiology, Mansoura University, Egypt 6Horus University, Egypt 7Faculty of Dentistry, Mansoura University, Egypt 8Faculty of Medicine, October 6 University, Egypt 9Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia
Medical Journal of Viral Hepatitis, 2020
Periodontal disease is a chronic infectious disease of the tissues surrounding the teeth that res... more Periodontal disease is a chronic infectious disease of the tissues surrounding the teeth that result in tooth loss. It affects up to 50% of the adult population worldwide. Serious periodontitis has been reported as the sixth most common infection around the world. Periodontal disease has been associated with liver disease. Moreover, dental infections may impact the clinical course of liver disease. Furthermore, untreated dental problems can lead to infections and sepsis and may cause many complications in liver transplanted patients. The results of studies documented high levels of dental management among patients with chronic liver diseases. Therefore, periodontitis in patients with chronic liver disease need to be detected early and treated under collaborative of hepatologist and dentist in order to prevent progression of chronic liver disease
European Journal of Medical Research
Background and aim There is lack of 30-day hospital readmission prediction score in patients with... more Background and aim There is lack of 30-day hospital readmission prediction score in patients with liver cirrhosis and SBP. The aim of this study is to recognize factors capable of predicting 30-day readmission and to develop a readmission risk score in patients with SBP. Methods This study prospectively examined the 30-day hospital readmission for patients previously discharged with a diagnosis of SBP. Based on index hospitalization variables, a multivariable logistic regression model was implemented to recognize predictors of patient hospital readmission within 30 days. Consequently, Mousa readmission risk score was established to predict 30-day hospital readmission. Results Of 475 patients hospitalized with SBP, 400 patients were included in this study. The 30-day readmission rate was 26.5%, with 16.03% of patients readmitted with SBP. Age ≥ 60, MELD > 15, serum bilirubin > 1.5 mg/dL, creatinine > 1.2 mg/dL, INR > 1.4, albumin < 2.5 g/dL, platelets count ≤ 74 (103/d...
Endoscopic management of acute oesophageal variceal bleeding within 12 hours of admission is superior to 12–24 hours
British Journal of Biomedical Science, 2021
BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The Ame... more BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases (AASLD) recommended endoscopy management as soon as possible and not more than 12 hours after presentation. The United King guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. The aim of the study is to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission. METHODS We recruited 297 patients with AOVH. The patients were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected. RESULTS Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P= 0.001), significant reduction of ammonia levels (P< 0.0001) and significant improvement in associated hepatic encephalopathy grade (p=0.048). There were no major clinical vents in the <12 hour group, but 8 events in the 12-24 hour group (p<0.01). CONCLUSION Endoscopic management of acute esophageal variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding, reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reduce the cost of treatment, benefiting patient satisfaction and hospital bed availability.
Endoscopic management of acute oesophageal variceal bleeding within 12 hours of admission is superior to 12–24 hours
British Journal of Biomedical Science, 2021
BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The Ame... more BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases (AASLD) recommended endoscopy management as soon as possible and not more than 12 hours after presentation. The United King guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. The aim of the study is to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission. METHODS We recruited 297 patients with AOVH. The patients were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected. RESULTS Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P= 0.001), significant reduction of ammonia levels (P< 0.0001) and significant improvement in associated hepatic encephalopathy grade (p=0.048). There were no major clinical vents in the <12 hour group, but 8 events in the 12-24 hour group (p<0.01). CONCLUSION Endoscopic management of acute esophageal variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding, reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reduce the cost of treatment, benefiting patient satisfaction and hospital bed availability.
MEJ. Mansoura Engineering Journal
Many authors investigated fuzzy To and fuzzy Ro spaces depending IJpon the ordinary points of a s... more Many authors investigated fuzzy To and fuzzy Ro spaces depending IJpon the ordinary points of a set and not the fuzzy points. It is the pu£"pose of this note to SlJggest new definitions of fuzzy To and flJ zzy Ro-spaces u.s1ng Wong definition of fuzzy pOints. It will be also sho wn that these new definitions are equivalent to those introduced by Srivastava. Moreover the properties of To-ness and Ro-ness are sho wn to be both productive and hereditary and that a topologically generated fuzzy topological space .is To Or Ro if the original topologiCal. space is To or Ro, respectively.
Serum leptin and homeostasis model assessment-IR as novel predictors of early liver fibrosis in chronic hepatitis B virus infection
British Journal of Biomedical Science, 2018
The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains... more The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains unclear. We hypothesised links between serum leptin and insulin resistance in non-diabetic patients with chronic viral hepatitis B infection and their relation to liver fibrosis. We recruited 190 untreated patients with chronic HBV infection and 72 healthy controls. Serum leptin, fasting glucose, insulin, liver function tests (LFTs), C-peptide and Homeostasis model assessment-IR (HOMA-IR) were measured/calculated by ELISA and standard techniques. Serum leptin, C-peptide (both p<0.001), HOMA-IR (p=0.021) and several LFTs were increased in patients with chronic HBV-infection. In multivariate regression analysis, both HOMA-IR (p=0.003) and leptin (p=0.002) were significant independent predictors of HBV infection. There were significant positive correlations (p<0.01) between leptin and HOMA-IR (r=0.81), between serum leptin and METAVIR activity (r=0.95), and between HOMA-IR and BMI (r=0.75), fasting glucose (r=0.005), and fasting insulin (r=0.81). Several LFTs, glucose and insulin correlated modestly (r = 0.61 to 0.69, p<0.05) with leptin. . Serum leptin may be related to the rate of fibrosis progression in nondiabetic patients with chronic HBV infection. Follow-up by serial measurement of serum leptin and HOMA-IR in non diabetic HBV-infected patients may be used as a non-invasive marker of early liver fibrosis liver fibrosis.
Could Rifaximin Modify the Pathogenesis of Nafld? Multicentric Study
Journal of Hepatology, 2016
Journal of Public Health and Emergency, 2021
Hepatocellular carcinoma (HCC) is primarily caused by hepatitis C virus (HCV) infection, which is... more Hepatocellular carcinoma (HCC) is primarily caused by hepatitis C virus (HCV) infection, which is treated mainly by direct-acting antiviral agents (DAAs). Compared with interferon therapy, DAAs offer excellent results and tolerable side effects making them the preferred treatment for many groups of patients, especially old and cirrhotic patients. However, there is controversial data regarding HCC occurrence or recurrence following HCV eradication with DAAs, especially in patients with previously treated HCC. Most reports arise from studies restricted by various methodological limitations, thus hampering the interpretation of their results and preventing formulation of solid conclusions. These limitations include small sample size, exclusion of control arms, and inconsistent elimination of HCC or suspicious nodules before DAA treatment. Many of the studies were also not multi-centric, being mainly retrospective, observational studies consisting of a small number of patients and short follow-up time. As a result, the full picture on this issue remains unclear to date. This review evaluates literature data showing the effect of DAAs on HCC recurrence following successful treatment of the tumor. Despite initial negative reports demonstrating an increased risk of HCC recurrence after DAAs therapy, these data cannot be considered definitive and have not been confirmed by most subsequent studies which have shown no increase in HCC recurrence after DAA therapy.
Can combined blood neutrophil to lymphocyte ratio and C-reactive protein be used for diagnosis of spontaneous bacterial peritonitis?
British Journal of Biomedical Science, 2018
Abstract Background and objective: Spontaneous bacterial peritonitis (SBP) is diagnosed by the pr... more Abstract Background and objective: Spontaneous bacterial peritonitis (SBP) is diagnosed by the presence of ≥250 polymorphonuclear neutrophils (PMN)/mm3 in the ascites and the absence of surgically treatable cause of intra-abdominal infection. Blood neutrophil lymphocytic ratio (NLR) is an inexpensive and simple test for inflammation. C-reactive protein (CRP) is an inflammatory marker used for the diagnosis and follow-up of many diseases and morbidities. We aimed to evaluate the clinical utility of combined blood NLR and CRP as a non-invasive test for SBP diagnosis. Methods: Blood NLR was calculated, and CRP value determined in 180 cirrhotic patients with ascites (126 with and 54 without SBP). Sensitivity and specificity of combined blood NLR and CRP values for SBP diagnosis were estimated by receiver operator characteristic curve. Results: Both blood NLR and CRP values were significantly higher in SBP (p < 0.001). For SBP diagnosis, a blood NLR of >2.89 had a sensitivity 80.3% and specificity 88.9%. CRP >11.3 mg/dL had a sensitivity 88.9% and specificity 92.6%. In logistic regression analysis, combined blood NLR and CRP had a sensitivity 95.1% and specificity 96.3% at the same cut off values. Conclusions: Combined NLR and CRP could be used as a novel, simple, low-cost, non-invasive test for SBP diagnosis.
Therapeutic Advances in Gastroenterology, 2016
Background: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and functio... more Background: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose. Methods: Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs). Patients were randomized to receive 175 mg zinc gluconate, 50,000 IU vitamin A, 500 mg vitamin C and 100 mg vitamin E once daily plus lactulose, dose 30–60 ml/day for 3 months [group A ( n = 31)] or initiated and maintained on lactulose dose 30–60 ml/day for 3 months [group B ( n = 27)]. Neuropsychometric tests and laboratory inv...
Journal of Gastrointestinal Cancer, 2016
Background and Aims Ascites with unknown cause remains a diagnostic challenge, which needs novel ... more Background and Aims Ascites with unknown cause remains a diagnostic challenge, which needs novel noninvasive biomarkers for the precise diagnosis. We aimed to evaluate the ascitic fluid and serum C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) as diagnostic markers in the differential diagnosis of malignant and benign ascites. Methods In this prospective work, 315 consecutive patients with ascites were studied. Ascitic fluid and serum levels of CRP and VEGF were evaluated by using an enzyme-linked immunosorbent assay. Results Patients were divided into a benign ascites group (group 1) (n = 256) and a malignant ascites group (group 2) (n = 59). Ascitic and serum CRP were significantly elevated in malignant ascites than benign ascites group [5.
Medical Journal of Viral Hepatitis
Background: There are two variants of spontaneous bacterial peritonitis (SBP) include, culture ne... more Background: There are two variants of spontaneous bacterial peritonitis (SBP) include, culture negative neutrocytic ascites (CNNA) and culture positive SBP. Some suggested that, the clinical presentation of two variants is nearly similar, however, other reported that, patients with culture positive have a more severe course and higher mortality than CNNA. The aim of this study is to determine the clinical characteristics and predictors of CNNA in comparison to culture positive SBP. Materials and methods: This study included 300 consecutive patients with HCV related cirrhotic ascites. All patients underwent abdominal paracentesis and the ascitic fluid was processed for cell count and culture. Clinical and laboratory parameters of these patients were recorded at index admission.. Results: Out of 300 patients included in the study, 150 patients had SBP. Among the 150 patients with SBP, 100 patients were culture positive SBP (culture positive SBP with ascitic fluid PMNL ≥250 cells/m3) and 50 patients were CNNA (culture negative SBP with ascitic fluid PMNL ≥250 cells/m3). Compared to patients with culture positive SBP, patients with CNNA showed, a significant decrease as regards, fever, prevalence of DM, hepatic encephalopathy, platelets, blood PMNL and ascetic PMNL. Logistic regression analysis demonstrated that, decreased platelets count, blood PMNL and ascetic PMNL were independent predictor factors for CNNA. Conclusion: Patients with CNNA have a lower incidence of fever, prevalence of diabetes mellitus, hepatic encephalopathy, blood PMNL and ascetic PMNL versus culture positive SBP. Independent predictors of culture negative SBP are decreased platelets, blood PMNL and ascetic PMNL.
Neutrophil to lymphocyte ratio as a reliable marker to predict insulin resistance and fibrosis stage in chronic hepatitis C virus infection
Acta Gastro-Enterologica Belgica, 2015
Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC)... more Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress. We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection. The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR>3 and CHC with HOMA-IR≤3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay. Patients with HOMA-IR>3 had a higher NLR compared with patients with HOMA-IR≤3 [2.61±0.95 and 1.92±0.86, respectively, P<0.001]. The NLR ratio was positively correlated with HOMA-I...
Frontiers in Medicine
Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) ... more Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis. Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up for 1 year. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), vascular endothelial growth factor (VEGF) levels and Fecal H. pylori antigen were evaluated by enzyme-linked immunosorbent assay (ELISA). All patients with positive H. pylori were treated and then followed up for 3 months. Participants with eradicated H. pylori were followed up for one further year. Results: H. pylori-positive patients (48.4%) were associated with increased levels of serum CRP, TNF-α, IL-6, NO, and VEGF, as well as increased incidence of varices, portal hypertensive gastropathy, gastric antral vascular ectasia, hepatocellular carcinoma (HCC), spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein thrombosis (PVT), and hepatorenal syndrome (all P < 0.05). Multivariate analysis models revealed that the presence of H. pylori was an independent risk variable for the development of portal vein thrombosis and hepatocellular carcinoma (P = 0.043, P = 0.037) respectively. After treatment of H. pylori infection, there was a significant reduction in all measured biochemical parameters and reported cirrhotic complications (all P < 0.05). Conclusion: Incidence of PVT and HCC development increased with H. pylori infection through increased inflammatory markers and vascular mediators. Moreover, its eradication may reduce the incidence of these complications.
Helicobacter, Jan 23, 2018
The relationship between Helicobacter pylori (H. pylori) and nonalcoholic fatty liver disease (NA... more The relationship between Helicobacter pylori (H. pylori) and nonalcoholic fatty liver disease (NAFLD) is a matter of debate. We achieved this prospective work to study whether H. pylori infection is a risk factor for NAFLD. A cohort multicenter pilot study of 369 adults without NAFLD at baseline was followed up for 2 years. Serum leptin, insulin, tumor necrosis factor-α, adiponectin, and interleukin-6 were measured using an enzyme-linked immunosorbent assay (ELISA). Homeostasis model assessment of insulin resistance (HOMA-IR) and leptin/adiponectin ratio (LAR) were calculated. Fecal H. pylori antigen was measured by ELISA. A total of 127 participants with H. pylori positive were treated and then followed up for 3 months. Helicobacter pylori-positive patients (46.3%) were associated with an increase in IR, proinflammatory cytokines, C-reactive protein (CRP), LAR, NAFLD-liver fat score (NAFLD-LFS), and hepatic steatosis index (HSI) (all P < 0.01). Multivariate analysis of NAFLD acc...
Neutrophil to lymphocyte ratio as a reliable marker to predict insulin resistance and fibrosis stage in chronic hepatitis C virus infection
Acta gastro-enterologica Belgica, 2015
BACKGROUND Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepati... more BACKGROUND Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress. AIM We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection. METHODS The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR>3 and CHC with HOMA-IR≤3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay. RESULTS Patients with HOMA-IR>3 had a higher NLR compared with patients with HOMA-IR≤3 [2.61±0.95 and 1.92±0.86, respectively, P<0.001]. The NLR ratio was po...
De novo Portal Vein Thrombosis in Non-Cirrhotic Non-Alcoholic Fatty Liver Disease: A 9-Year Prospective Cohort Study
Background and Aims: Approximately 30–40% of portal vein thrombosis (PVT) remains of unknown orig... more Background and Aims: Approximately 30–40% of portal vein thrombosis (PVT) remains of unknown origin. The association between non-alcoholic fatty liver disease (NAFLD) and PVT is a matter of debate. This study aimed to investigate the association between PVT and NAFLD. Methods: We included 94 out of 105 consecutive NAFLD patients in this prospective cohort study in addition to 94 from the healthy control group. We evaluated biochemical, clinical, immunological, and histopathological parameters; waist circumference (WC); leptin; adiponectin; and leptin/adiponectin ratio (LAR) for all participants at baseline and every 3 years thereafter. We described the characteristics of participants at baseline and showed individual WC, LAR, and PVT characteristics. Potential parameters to predict PVT development within 9 years were determined. Results: PVT developed in eight (8.5%) patients, mainly in the portal trunk. Univariate analysis showed three PVT-associated factors: diabetes mellitus (P =...
Relation of insulin resistance and liver fibrosis progression in patients with chronic hepatitis C virus infection
PubMed, Jul 1, 2009
Background: Hepatitis C virus (HCV) infection can predispose to the development of insulin resist... more Background: Hepatitis C virus (HCV) infection can predispose to the development of insulin resistance before diabetes occurs. Such a potential link is particularly cogent in light of recent data indicate that diabetes may be associated with increased hepatic fibrosis progression in patients with chronic HCV infection. The aim of the study is to determine the prevalence of insulin resistance in non diabetic patients with chronic hepatitis C and its relation to liver fibrosis. Methods: Thirty eight patients with chronic liver diseases. They subdivided into 2 groups; chronic hepatitis C (CHC) with elevated liver enzymes and CHC with normal liver enzymes. Age and sex matched 12 healthy subjects as control group. All subjects were subjected to Careful history and copmlete examination with stress upon symptoms and signs of chronic liver diseases. Investigations include liver function tests; viral markers (Anti HCV antibodies & PCR for HCV). Serum fasting glucose; serum fasting insulin; homeostasis model assessment (HOMA), liver biopsy and abdominal ultrasound. Results: No correlation between viral load and hepatic fibrosis in HCV infected patients. Liver fibrosis is considerably higher among HCV patients with elevated serum transaminase levels. Insulin resistance is present in HCV infected cases compared with control group and it is positively correlated with liver fibrosis. Conclusion: The present data support the hypothesis that insulin resistance may increase the rate of fibrosis progression in non diabetic patients with chronic HCV. Follow up of hyperinsulinemia by serial measurement of HOMA test in non diabetic HCV infected patients may be a biochemical indicator for progression of liver fibrosis.
Medical Journal of Viral Hepatitis
Background: Staging of liver fibrosis is essential for managing patients with nonalcoholic fatty ... more Background: Staging of liver fibrosis is essential for managing patients with nonalcoholic fatty liver disease (NAFLD). Liver biopsy has well-known limitations and cannot be proposed to all patients. Previous studies have demonstrated that hepatic artery resistive index (HARI) is significantly altered in NAFLD patients. The aim of this study is to assess the value of (HARI) in evaluating the progression of liver fibrosis in NAFLD patients. Patients and methods: This study was carried out on 100 NAFLD patients. All patients had undergone Doppler ultrasound and transient elastography (TE) with controlled attenuation parameter (CAP) to quantify the degree of steatosis. Laboratory work and calculation of FIB-4, ASTplatelets ratio index (APRI), NAFLD fibrosis score (NFS) were done. Sensitivity and specificity of HARI values for predication of liver fibrosis were estimated by the receiver operating characteristic curve. Results: The study revealed a statistically significant positive correlation of HARI with liver stiffness measurement (LSM) measured by fibroscan, FIB4, NFS, age, Hba1c, fasting blood sugar (P <0.0001 for all) and LDL, HDL and albumin. However, a significant negative correlation of HARI with CAP was detected (P= 0.03). At a cutoff value of 0.76, HARI had 80% sensitivity and 76% specificity for prediction of advanced fibrosis (> 9.1 KPa) with area under ROC curve equal to 0.826. Moreover, HARI at a cutoff value 0.74 showed 83% sensitivity and 72% specificity for the prediction of liver cirrhosis (≥ 10.4 KPa) with the area under the ROC curve equal to 0.803. Conclusion: HARI is a good non-invasive tool to predict the risk of liver fibrosis progression in patients with NAFLD particularly advanced fibrosis and cirrhosis. HADRI correlates with other non-invasive methods of assessment of fibrosis including LSM, CAP, FIB4 and NFS, and may provide an easy, available tool for monitoring of patients with NAFLD. This study was carried out on 100 patients (28 males and 72 females) with NAFLD aged between (30-66) years old recruited from an out and inpatient clinic of Tropical medicine department, Mansoura University, Dakahlya, Egypt, between June 2018 and May 2021. All patients aged 18 years old and above with body mass index (BMI) more than 25 and evidence of any grade of fatty liver by ultrasonography. All subjects have signed a written
Shiha G1,2, *, Mousa N3, Abdel-Razik A3, Elhammady D3, Elshennawy H4, El-Farrash M5,6, Mousa E7, ... more Shiha G1,2, *, Mousa N3, Abdel-Razik A3, Elhammady D3, Elshennawy H4, El-Farrash M5,6, Mousa E7, Taha A8, El-bendary M3 and Eslam M9 1Departments of Internal Medicine, Mansoura University, Egypt 2Egyptian Liver Research Institute and Hospital (ELRIH), Sherbin, Mansoura University, Egypt 3Departments of Tropical Medicine, Mansoura University, Egypt 4Departments of Internal Medicine, National Liver Institute, Egypt 5Department of Microbiology, Mansoura University, Egypt 6Horus University, Egypt 7Faculty of Dentistry, Mansoura University, Egypt 8Faculty of Medicine, October 6 University, Egypt 9Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia
Medical Journal of Viral Hepatitis, 2020
Periodontal disease is a chronic infectious disease of the tissues surrounding the teeth that res... more Periodontal disease is a chronic infectious disease of the tissues surrounding the teeth that result in tooth loss. It affects up to 50% of the adult population worldwide. Serious periodontitis has been reported as the sixth most common infection around the world. Periodontal disease has been associated with liver disease. Moreover, dental infections may impact the clinical course of liver disease. Furthermore, untreated dental problems can lead to infections and sepsis and may cause many complications in liver transplanted patients. The results of studies documented high levels of dental management among patients with chronic liver diseases. Therefore, periodontitis in patients with chronic liver disease need to be detected early and treated under collaborative of hepatologist and dentist in order to prevent progression of chronic liver disease
European Journal of Medical Research
Background and aim There is lack of 30-day hospital readmission prediction score in patients with... more Background and aim There is lack of 30-day hospital readmission prediction score in patients with liver cirrhosis and SBP. The aim of this study is to recognize factors capable of predicting 30-day readmission and to develop a readmission risk score in patients with SBP. Methods This study prospectively examined the 30-day hospital readmission for patients previously discharged with a diagnosis of SBP. Based on index hospitalization variables, a multivariable logistic regression model was implemented to recognize predictors of patient hospital readmission within 30 days. Consequently, Mousa readmission risk score was established to predict 30-day hospital readmission. Results Of 475 patients hospitalized with SBP, 400 patients were included in this study. The 30-day readmission rate was 26.5%, with 16.03% of patients readmitted with SBP. Age ≥ 60, MELD > 15, serum bilirubin > 1.5 mg/dL, creatinine > 1.2 mg/dL, INR > 1.4, albumin < 2.5 g/dL, platelets count ≤ 74 (103/d...
Endoscopic management of acute oesophageal variceal bleeding within 12 hours of admission is superior to 12–24 hours
British Journal of Biomedical Science, 2021
BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The Ame... more BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases (AASLD) recommended endoscopy management as soon as possible and not more than 12 hours after presentation. The United King guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. The aim of the study is to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission. METHODS We recruited 297 patients with AOVH. The patients were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected. RESULTS Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P= 0.001), significant reduction of ammonia levels (P< 0.0001) and significant improvement in associated hepatic encephalopathy grade (p=0.048). There were no major clinical vents in the <12 hour group, but 8 events in the 12-24 hour group (p<0.01). CONCLUSION Endoscopic management of acute esophageal variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding, reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reduce the cost of treatment, benefiting patient satisfaction and hospital bed availability.
Endoscopic management of acute oesophageal variceal bleeding within 12 hours of admission is superior to 12–24 hours
British Journal of Biomedical Science, 2021
BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The Ame... more BACKGROUND AND AIMS Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases (AASLD) recommended endoscopy management as soon as possible and not more than 12 hours after presentation. The United King guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. The aim of the study is to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission. METHODS We recruited 297 patients with AOVH. The patients were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected. RESULTS Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P= 0.001), significant reduction of ammonia levels (P< 0.0001) and significant improvement in associated hepatic encephalopathy grade (p=0.048). There were no major clinical vents in the <12 hour group, but 8 events in the 12-24 hour group (p<0.01). CONCLUSION Endoscopic management of acute esophageal variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding, reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reduce the cost of treatment, benefiting patient satisfaction and hospital bed availability.
MEJ. Mansoura Engineering Journal
Many authors investigated fuzzy To and fuzzy Ro spaces depending IJpon the ordinary points of a s... more Many authors investigated fuzzy To and fuzzy Ro spaces depending IJpon the ordinary points of a set and not the fuzzy points. It is the pu£"pose of this note to SlJggest new definitions of fuzzy To and flJ zzy Ro-spaces u.s1ng Wong definition of fuzzy pOints. It will be also sho wn that these new definitions are equivalent to those introduced by Srivastava. Moreover the properties of To-ness and Ro-ness are sho wn to be both productive and hereditary and that a topologically generated fuzzy topological space .is To Or Ro if the original topologiCal. space is To or Ro, respectively.
Serum leptin and homeostasis model assessment-IR as novel predictors of early liver fibrosis in chronic hepatitis B virus infection
British Journal of Biomedical Science, 2018
The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains... more The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains unclear. We hypothesised links between serum leptin and insulin resistance in non-diabetic patients with chronic viral hepatitis B infection and their relation to liver fibrosis. We recruited 190 untreated patients with chronic HBV infection and 72 healthy controls. Serum leptin, fasting glucose, insulin, liver function tests (LFTs), C-peptide and Homeostasis model assessment-IR (HOMA-IR) were measured/calculated by ELISA and standard techniques. Serum leptin, C-peptide (both p<0.001), HOMA-IR (p=0.021) and several LFTs were increased in patients with chronic HBV-infection. In multivariate regression analysis, both HOMA-IR (p=0.003) and leptin (p=0.002) were significant independent predictors of HBV infection. There were significant positive correlations (p<0.01) between leptin and HOMA-IR (r=0.81), between serum leptin and METAVIR activity (r=0.95), and between HOMA-IR and BMI (r=0.75), fasting glucose (r=0.005), and fasting insulin (r=0.81). Several LFTs, glucose and insulin correlated modestly (r = 0.61 to 0.69, p<0.05) with leptin. . Serum leptin may be related to the rate of fibrosis progression in nondiabetic patients with chronic HBV infection. Follow-up by serial measurement of serum leptin and HOMA-IR in non diabetic HBV-infected patients may be used as a non-invasive marker of early liver fibrosis liver fibrosis.
Could Rifaximin Modify the Pathogenesis of Nafld? Multicentric Study
Journal of Hepatology, 2016
Journal of Public Health and Emergency, 2021
Hepatocellular carcinoma (HCC) is primarily caused by hepatitis C virus (HCV) infection, which is... more Hepatocellular carcinoma (HCC) is primarily caused by hepatitis C virus (HCV) infection, which is treated mainly by direct-acting antiviral agents (DAAs). Compared with interferon therapy, DAAs offer excellent results and tolerable side effects making them the preferred treatment for many groups of patients, especially old and cirrhotic patients. However, there is controversial data regarding HCC occurrence or recurrence following HCV eradication with DAAs, especially in patients with previously treated HCC. Most reports arise from studies restricted by various methodological limitations, thus hampering the interpretation of their results and preventing formulation of solid conclusions. These limitations include small sample size, exclusion of control arms, and inconsistent elimination of HCC or suspicious nodules before DAA treatment. Many of the studies were also not multi-centric, being mainly retrospective, observational studies consisting of a small number of patients and short follow-up time. As a result, the full picture on this issue remains unclear to date. This review evaluates literature data showing the effect of DAAs on HCC recurrence following successful treatment of the tumor. Despite initial negative reports demonstrating an increased risk of HCC recurrence after DAAs therapy, these data cannot be considered definitive and have not been confirmed by most subsequent studies which have shown no increase in HCC recurrence after DAA therapy.
Can combined blood neutrophil to lymphocyte ratio and C-reactive protein be used for diagnosis of spontaneous bacterial peritonitis?
British Journal of Biomedical Science, 2018
Abstract Background and objective: Spontaneous bacterial peritonitis (SBP) is diagnosed by the pr... more Abstract Background and objective: Spontaneous bacterial peritonitis (SBP) is diagnosed by the presence of ≥250 polymorphonuclear neutrophils (PMN)/mm3 in the ascites and the absence of surgically treatable cause of intra-abdominal infection. Blood neutrophil lymphocytic ratio (NLR) is an inexpensive and simple test for inflammation. C-reactive protein (CRP) is an inflammatory marker used for the diagnosis and follow-up of many diseases and morbidities. We aimed to evaluate the clinical utility of combined blood NLR and CRP as a non-invasive test for SBP diagnosis. Methods: Blood NLR was calculated, and CRP value determined in 180 cirrhotic patients with ascites (126 with and 54 without SBP). Sensitivity and specificity of combined blood NLR and CRP values for SBP diagnosis were estimated by receiver operator characteristic curve. Results: Both blood NLR and CRP values were significantly higher in SBP (p < 0.001). For SBP diagnosis, a blood NLR of >2.89 had a sensitivity 80.3% and specificity 88.9%. CRP >11.3 mg/dL had a sensitivity 88.9% and specificity 92.6%. In logistic regression analysis, combined blood NLR and CRP had a sensitivity 95.1% and specificity 96.3% at the same cut off values. Conclusions: Combined NLR and CRP could be used as a novel, simple, low-cost, non-invasive test for SBP diagnosis.
Therapeutic Advances in Gastroenterology, 2016
Background: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and functio... more Background: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose. Methods: Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs). Patients were randomized to receive 175 mg zinc gluconate, 50,000 IU vitamin A, 500 mg vitamin C and 100 mg vitamin E once daily plus lactulose, dose 30–60 ml/day for 3 months [group A ( n = 31)] or initiated and maintained on lactulose dose 30–60 ml/day for 3 months [group B ( n = 27)]. Neuropsychometric tests and laboratory inv...
Journal of Gastrointestinal Cancer, 2016
Background and Aims Ascites with unknown cause remains a diagnostic challenge, which needs novel ... more Background and Aims Ascites with unknown cause remains a diagnostic challenge, which needs novel noninvasive biomarkers for the precise diagnosis. We aimed to evaluate the ascitic fluid and serum C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) as diagnostic markers in the differential diagnosis of malignant and benign ascites. Methods In this prospective work, 315 consecutive patients with ascites were studied. Ascitic fluid and serum levels of CRP and VEGF were evaluated by using an enzyme-linked immunosorbent assay. Results Patients were divided into a benign ascites group (group 1) (n = 256) and a malignant ascites group (group 2) (n = 59). Ascitic and serum CRP were significantly elevated in malignant ascites than benign ascites group [5.
Medical Journal of Viral Hepatitis
Background: There are two variants of spontaneous bacterial peritonitis (SBP) include, culture ne... more Background: There are two variants of spontaneous bacterial peritonitis (SBP) include, culture negative neutrocytic ascites (CNNA) and culture positive SBP. Some suggested that, the clinical presentation of two variants is nearly similar, however, other reported that, patients with culture positive have a more severe course and higher mortality than CNNA. The aim of this study is to determine the clinical characteristics and predictors of CNNA in comparison to culture positive SBP. Materials and methods: This study included 300 consecutive patients with HCV related cirrhotic ascites. All patients underwent abdominal paracentesis and the ascitic fluid was processed for cell count and culture. Clinical and laboratory parameters of these patients were recorded at index admission.. Results: Out of 300 patients included in the study, 150 patients had SBP. Among the 150 patients with SBP, 100 patients were culture positive SBP (culture positive SBP with ascitic fluid PMNL ≥250 cells/m3) and 50 patients were CNNA (culture negative SBP with ascitic fluid PMNL ≥250 cells/m3). Compared to patients with culture positive SBP, patients with CNNA showed, a significant decrease as regards, fever, prevalence of DM, hepatic encephalopathy, platelets, blood PMNL and ascetic PMNL. Logistic regression analysis demonstrated that, decreased platelets count, blood PMNL and ascetic PMNL were independent predictor factors for CNNA. Conclusion: Patients with CNNA have a lower incidence of fever, prevalence of diabetes mellitus, hepatic encephalopathy, blood PMNL and ascetic PMNL versus culture positive SBP. Independent predictors of culture negative SBP are decreased platelets, blood PMNL and ascetic PMNL.
Neutrophil to lymphocyte ratio as a reliable marker to predict insulin resistance and fibrosis stage in chronic hepatitis C virus infection
Acta Gastro-Enterologica Belgica, 2015
Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC)... more Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress. We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection. The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR>3 and CHC with HOMA-IR≤3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay. Patients with HOMA-IR>3 had a higher NLR compared with patients with HOMA-IR≤3 [2.61±0.95 and 1.92±0.86, respectively, P<0.001]. The NLR ratio was positively correlated with HOMA-I...
Frontiers in Medicine
Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) ... more Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis. Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up for 1 year. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), vascular endothelial growth factor (VEGF) levels and Fecal H. pylori antigen were evaluated by enzyme-linked immunosorbent assay (ELISA). All patients with positive H. pylori were treated and then followed up for 3 months. Participants with eradicated H. pylori were followed up for one further year. Results: H. pylori-positive patients (48.4%) were associated with increased levels of serum CRP, TNF-α, IL-6, NO, and VEGF, as well as increased incidence of varices, portal hypertensive gastropathy, gastric antral vascular ectasia, hepatocellular carcinoma (HCC), spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein thrombosis (PVT), and hepatorenal syndrome (all P < 0.05). Multivariate analysis models revealed that the presence of H. pylori was an independent risk variable for the development of portal vein thrombosis and hepatocellular carcinoma (P = 0.043, P = 0.037) respectively. After treatment of H. pylori infection, there was a significant reduction in all measured biochemical parameters and reported cirrhotic complications (all P < 0.05). Conclusion: Incidence of PVT and HCC development increased with H. pylori infection through increased inflammatory markers and vascular mediators. Moreover, its eradication may reduce the incidence of these complications.
Helicobacter, Jan 23, 2018
The relationship between Helicobacter pylori (H. pylori) and nonalcoholic fatty liver disease (NA... more The relationship between Helicobacter pylori (H. pylori) and nonalcoholic fatty liver disease (NAFLD) is a matter of debate. We achieved this prospective work to study whether H. pylori infection is a risk factor for NAFLD. A cohort multicenter pilot study of 369 adults without NAFLD at baseline was followed up for 2 years. Serum leptin, insulin, tumor necrosis factor-α, adiponectin, and interleukin-6 were measured using an enzyme-linked immunosorbent assay (ELISA). Homeostasis model assessment of insulin resistance (HOMA-IR) and leptin/adiponectin ratio (LAR) were calculated. Fecal H. pylori antigen was measured by ELISA. A total of 127 participants with H. pylori positive were treated and then followed up for 3 months. Helicobacter pylori-positive patients (46.3%) were associated with an increase in IR, proinflammatory cytokines, C-reactive protein (CRP), LAR, NAFLD-liver fat score (NAFLD-LFS), and hepatic steatosis index (HSI) (all P < 0.01). Multivariate analysis of NAFLD acc...
Neutrophil to lymphocyte ratio as a reliable marker to predict insulin resistance and fibrosis stage in chronic hepatitis C virus infection
Acta gastro-enterologica Belgica, 2015
BACKGROUND Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepati... more BACKGROUND Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress. AIM We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection. METHODS The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR>3 and CHC with HOMA-IR≤3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay. RESULTS Patients with HOMA-IR>3 had a higher NLR compared with patients with HOMA-IR≤3 [2.61±0.95 and 1.92±0.86, respectively, P<0.001]. The NLR ratio was po...
De novo Portal Vein Thrombosis in Non-Cirrhotic Non-Alcoholic Fatty Liver Disease: A 9-Year Prospective Cohort Study
Background and Aims: Approximately 30–40% of portal vein thrombosis (PVT) remains of unknown orig... more Background and Aims: Approximately 30–40% of portal vein thrombosis (PVT) remains of unknown origin. The association between non-alcoholic fatty liver disease (NAFLD) and PVT is a matter of debate. This study aimed to investigate the association between PVT and NAFLD. Methods: We included 94 out of 105 consecutive NAFLD patients in this prospective cohort study in addition to 94 from the healthy control group. We evaluated biochemical, clinical, immunological, and histopathological parameters; waist circumference (WC); leptin; adiponectin; and leptin/adiponectin ratio (LAR) for all participants at baseline and every 3 years thereafter. We described the characteristics of participants at baseline and showed individual WC, LAR, and PVT characteristics. Potential parameters to predict PVT development within 9 years were determined. Results: PVT developed in eight (8.5%) patients, mainly in the portal trunk. Univariate analysis showed three PVT-associated factors: diabetes mellitus (P =...