BackgroundFascioliasis is a neglected zoonosis with major public health implications in humans. Although triclabendazole (TCBZ) is the drug of choice, there are records of TCBZ failure worldwide. TCBZ-resistant fascioliasis is treated with alternative approved drugs including nitazoxanide (NTZ), with varying levels of efficacy. Data on NTZ efficacy after TCBZ failure in Egypt is scarce. This study evaluated the efficacy of NTZ in cases of TCBZ failure during an outbreak of fascioliasis in Assiut governorate of Upper Egypt.Methodology/Principal findingsThis prospective study included 67 patients from the outpatient clinic in Manfalout locality of Assiut governorate with clinical manifestations of acute fascioliasis. These included high eosinophilia (> 6% eosinophils in peripheral blood), positive anti-Fasciola antibodies, and hepatic focal lesions (HFL) or ascites on abdominal ultrasound or computed tomography. All patients initially received TCBZ at recommended doses. Patients were followed up after 1 month to assess response. According to the responses, patients were categorized as non-responders and responders. The non-responders received a trial of NTZ and were re-assessed for response based on clinical manifestations, eosinophil count, and abdominal ultrasound. Patients not responding to NTZ received additional doses of TCBZ.One month after initial TCBZ treatment, 37 patients responded well to TCBZ, while 30 patients failed to respond with persistence of fever, abdominal pain, high eosinophilia, and HFL. Most non-responders were male (56.7%); females predominated among TCBZ responders (62.2%). The mean age of the non-responders was relatively lower, at 20.57 ± 14.47 years (p = 0.004). Following NTZ therapy, HFL disappeared in 9/30 (30%) patients and eosinophil counts normalized in only 2 (6.7%) patients, indicating an overall efficacy of 36.6%. The remaining cases received additional doses of TCBZ with complete clinical, pathological, and radiological resolution.Conclusions/SignificanceNitazoxanide was partially effective in TCBZ failure in acute human fascioliasis in Upper Egypt. Further studies with larger samples are highly encouraged and further research is urgently needed to find new therapeutic alternatives to TCBZ.

Background and aim: For a long time, the connection between liver cirrhosis (LC) and infections had been studied extensively. Because of their weakened immune system, cirrhotic patients are more likely to contract infectious diseases. Cirrhotic patients are more likely to undergo invasive diagnostic or surgical procedures that can change the host's protective barrier, putting them at a higher risk of contracting an infection. Patients and Methods:The study was conducted over one year duration between January and December 2019 at intensive care unit (ICU). It enrolled all patients with decompensated LC but patients with compensated LC or underlying chronic chest disease were excluded. Baseline evaluation with laboratory data was done in all patients. Blood and sputum cultures were achieved in patients with suspected NCI.Results: 845 patients with LC were admitted to ICU but 345 of them were excluded so, 500 patients were enrolled in the analysis. NCI occurred in 100 ( 20%) patients. The most frequent isolated organisms were Klebsiella species (32%), Candida albicans (19%), Strept.pneumoniae (12%) and Staph.aureus (10%). All of these infections were in form of pneumoniae. Up to 65% of patients with NCI were died. Based on the current study the predictors of NCI were; old age spontaneous bacterial peritonitis and low serum albumin. Conclusion: Patients with liver cirrhosis are liable to infections secondary to dysregulated immunity. NCI in cirrhotic patients has serious outcome. Hospitalized cirrhotic patients should be screened for NCI.

Background& aim: Autoimmune liver diseases (AILD) are relatively low diseases but their pattern and outcome are still unclear. It includes primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH). The current study was conducted to assess pattern of AILDs in our locality Methods: This retrospective study was conducted between 2016 and 2019 in Tropical Medicine and Gastroenterology Department, Assiut University Hospitals. In addition to characteristics of patients, types and outcome of AILDs were registered. Results: A total of 1750 patients with various chronic liver diseases were identified only 2.9% of those patients had different types of AILDs, as follows: 40 patients had AIH, 6 patients had PSC, and 4 patients had PBC, 80% of them were females. Conclusion: AILDs are still underappreciated in our community. Patients with unexplained abnormalities in liver functions should be suspected of having such diseases. Future multi-center studies on this topic are necessary.

Background and aim Biliary strictures are challenging clinical condition for gastroenterologists, radiologists, and surgical specialists. We aimed to find out the frequency of malignant biliary strictures in our institutions. Patients and methods This prospective study included 44 patients with biliary strictures who had undergone endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) in Aswan and Assiut University Hospitals. Results Thirty two patients (72.7%) had malignant strictures where distal stricture was the most frequent (68.8%) followed by hilar (25%) then mid and long segment strictures (3.1% each). Conclusion The vast majority of indeterminate biliary strictures are malignant (72.7%), so all indeterminate bile duct strictures in patients with obstructive jaundice should be considered malignant unless a benign etiology is definitively identifiable.

Background and study aims:The health care workers at endoscopy units are at a high risk of COVID-19 infection. Several guidelines for COVID-19 infection control measures at endoscopy units are available. However, the knowledge and practice of endoscopists toward these measures are not evaluated. We aimed to assess the level of knowledge and practice of Egyptian gastrointestinal (GI) endoscopists for these measures. Patientsand Method:An online questionnaire was filled by the GI endoscopists. It consisted of 4 sections; the demographic features of the participants, pre-endoscopic infection control measures, during endoscopy on COVID-19 patients measures and postendoscopic measures. Each of the last 3 sections contained questions assessing the knowledge and practices of the endoscopists. The answers to some questions were set up as 'yes' or 'no' and the other questions required selecting the appropriate answer.Results: A total of 120 participants completed the questionnaire. About half had endoscopic experience between 5 and 10 years. The overall correct answers regarding the knowledge were 45.6% while 62.2% for the practice. Low percent of correct answers was related to the personal protective equipment (PPE) use. About 56.7% and 58.3% found their level of knowledge and practices to be fair, respectively. Conclusion:The knowledge of the infection control against COVID-19 was insufficient among GI endoscopists particularly PPE use. Meanwhile, the practice was relatively adequate due to hospital policies of strict application of infection control measures.