Background: Hepatocellular carcinoma (HCC) is one of the commonest malignancies worldwide that carries a bad prognosis particularly in Egypt due to the high prevalence of HCV burden. Late diagnosis of HCC especially in cirrhosis suffering-liver is one of the causes that worsen HCC outcome. Identification of molecular pathways of HCC will open the gate for early diagnosis and effective management. Oscillation of calcium controlled by the α2δ1 subunit has been proposed as one of the mechanisms in tumor-initiating cell properties of HCC. In this study, we aim to evaluate the serum α2δ1 subunit level as a biological marker for HCC. A total of 90 participants were enrolled, 40 patients with HCC, 40 patients with cirrhosis, and 10 healthy volunteers; serum level of α2δ1 was assessed in all participants with ELISA Results: The mean serum levels of α2δ1 were significantly higher in HCC group (19.53 ± 6.87 ng/dL) than cirrhotic (6.24 ± 2.64 ng/dL) and control groups (0.67 ± 0.48 ng/dL) (P = 0.001). There was no significance between α2δ1 and etiology of liver disease as viral (HCV, HBV) or non-viral (P = 0.14). Conclusion: α2δ1 subunit may serve as a potential non-invasive marker with excellent sensitivity for diagnosis of HCC regardless of the etiology of liver disease.

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BackgroundPortal hypertension commonly accompanies liver cirrhosis. Bleeding because of oesophageal varices (OV) is one of the most dreaded complications of cirrhosis because of its high mortality rate. Endoscopy is recommended for the screening of OV. Aim of the work We aimed to assess the value of a model for end-stage liver disease (MELD) and MELD-Na scores, platelet count, alanine aminotransferase, aspartate aminotransferase and spleen size as predictors of OV. Patients and methods A total of 100 patients with established liver cirrhosis (80 men, 20 women) were enrolled in the study. All patients were subjected to a full clinical assessment and routine laboratory investigations. Child-Turcotte-Pugh, MELD and MELD-Na scores were calculated for each patient. Upper gastrointestinal endoscopy was performed for all patients. ResultsThe means of both MELD and MELD-Na were significantly higher among patients with OV. MELD at least 11.5 and MELD-Na at least 14.5 were both sensitive and specific for the presence of OV. Also, the MELD score showed increasing values with increasing grades of OV (Po0.01). Multivariate regression analysis identified the following two predictors of the presence of OV: MELD score at least 11.5 and platelet count up to 142.5 ( Â 1000/mm 3 ). Conclusion MELD, MELD-Na, spleen size and low platelet count can be used independently as predictors of OV; also, MELD can predict high-risk varices. However, it cannot completely replace the need for endoscopy because of its low specificity and sensitivity.

BackgroundCombined treatment with vasoactive drugs, prophylactic antibiotics and endoscopic techniques is the recommended standard of care for patients with acute variceal bleeding. However, treatment failure occurs in about 10-15% of patients. With the development and validation of the Model for End-stage Liver Disease (MELD) scoring system as an index of the severity of liver disease, it is now possible to use it as predictor of survival and variceal rebleeding. ObjectivesThe aim of this study was to investigate the value of the MELD score in predicting early variceal rebleeding after endoscopic intervention in cirrhotic patients. Materials and methodsThis study included 100 randomly selected patients admitted with acute variceal hemorrhage. All patients were subjected to mult-operator endoscopic intervention (band ligation or sclerotherapy) to control bleeding. Patients were followed for 1 week to detect variceal rebleeding. The MELD score and the Child Pugh score were calculated for all patients. ResultsRebleeding occurred in 22% of the patients and the mean time for rebleeding was 2.591 ± 1.552 days. Patients with rebleeding had a younger age, used the Sengestaken tube more frequently, required packed RBCs transfusion and had a larger size of varices, higher serum creatinine, higher INR, higher serum total bilirubin and a higher MELD score than nonrebleeders. Patients with rebleeding also had a higher Child class and their varices were mainly esophageal. At a cutoff value of more than 20, the MELD score had a sensitivity of 90.91%, a specificity of 75.64%, a positive predictive value of 51.3% and a negative predictive value of 96.7% in predicting early rebleeding with the area under the ROC curve being 0.892. ConclusionAddition of the MELD score as a predictor of early variceal rebleeding will improve the ability to identify patients who are at a substantially increased risk of rebleeding over a short term. Patients with MELD more than 20 have a high risk of rebleeding.

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