Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, ranging from simple steatosis and non-alcoholic steatohepatitis (NASH) to cirrhosis, with its complications including hepatocellular carcinoma (HCC). The non-invasive diagnostic markers of NAFLD are gaining interest due to the invasive nature and potential side effects of liver biopsy, and are the current gold standard of diagnosis. Objective: This study aimed to evaluate hyaluronic acid (HA) as a potential non-invasive biomarker for diagnosis and prognosis of NAFLD and to compare it with the traditional non-invasive techniques. Patients and methods: This study included 63 subjects divided into 3 groups; including 21 patients with fatty liver, 21 patients with NASH, in addition to 21 healthy controls. Non-invasive assessment of liver fibrosis was done to all study subjects using aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 score (FIB4), in addition to measurement of HA serum levels. Results: As regard assessment of liver fibrosis, there was a highly significant statistical difference between groups as regard APRI and Fib4 scores. As for HA there was a highly significant statistical difference between study groups. HA receiver operating characteristics curves (ROC) achieved excellent diagnostic performance for fatty liver with 100% sensitivity and specificity at cutoff of 25 ng/ml for fatty liver, versus a sensitivity of 95.2% and specificity of 85.7% for NASH at cutoff of 110 ng/ml. Conclusion: HA can be used as an accurate and specific non-invasive biomarker for the diagnosis of NAFLD and staging of the severity of disease compared with the traditional known non-invasive scores.

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Background hepatic encephalopathy (HE) is a common complication in patient with liver cirrhosis. It comprises of a broad spectrum of neuropsychiatric abnormalities of varying severity, and affected patients usually suffer from psychomotor, cognitive, emotional, behavioural, and motor coordination dysfunctions. Patients with minimal HE (MHE), a subclinical form of HE, usually have a normal mental and neurological status upon routine clinical examination. The subtle deficits in patients with MHE can only be elicited by specialized neuropsychological tests. Aim of the Work the aim of this study was to evaluate the role of 3-Nitro-Tyrosine as a biomarker of Minimal Hepatic Encephalopathy in patients with liver cirrhosis. Patients and Methods our conducted study was a prospective case control study carried on 60 adult patients and 30 age matched controls. All were recruited from Internal Medicine and Hepatology and Gastroenterology Department at Ain Shams University Hospitals in the period between September 2016 and June 2018. All patients enrolled in the study were subjected to detailed history taking, full physical examination, laboratory investigations, psychometric tests for detection of MHE using specially digit symbol test (DST), Trail making test A (TMT A), Trail making test B (TMT B), serial dotting test (SDT) and 3-Nitro-Tyrosine level (3NT). Results our study found that the serum levels of 3-nitro-tyrosine are a good predictor of the presence of MHE in patients with liver cirrhosis, with good sensitivity (90%) and specificity (93.33%) and positive and negative predictive values were 93.1% and 90.3% respectively at a cutoff of 14.8 ng. Conclusion determination of 3-nitro-tyrosine in serum is easy and is not time consuming. It only requires taking a serum sample from the patient and determining 3-nitro-tyrosine concentration. This procedure can be therefore easily added to the routine clinical determinations in patients with liver cirrhosis. This would also allow extending the diagnosis of MHE to most clinical settings, helping to identify patients with MHE.

Background Idiopathic inflammatory bowel disease (IBD) includes those conditions characterized by a tendency for chronic or relapsing immune activation and inflammation within the gastrointestinal tract, Crohn’s disease (CD) and ulcerative colitis (UC) are the two major forms of idiopathic IBD. Aim of the Work The aim of this study is to evaluate the clinical usefulness of the soluble transferrin receptor-Ferritin index in the evaluation of anemia in patients with IBD and especially for differentiation between iron deficiency anemia and anemia of chronic disease. Patients and Methods This study included fifty patients with established diagnosis of IBD either Ulcerative Colitis or Crohn’s disease. They were collected at Internal Medicine and Gastroenterology outpatient clinics and inpatient wards at Ain Shams University hospitals as well at New Cairo hospital in the period from March 2017 to September 2017. They were classified into 2 groups: group I 25 patients with Crohn’s disease and anemia with active or inactive disease, group II 25 patients with ulcerative colitis and anemia with active or inactive disease, group III 25 healthy controls with no significant medical or family history of IBD. Results In the current study there was no significant difference between the different study groups regarding the demographic data except for the disease localization as there was significant difference between ulcerative and crohn’s disease. Conclusion The results of the current study stated that the sTfR and sTfR-F index seems to be very efficient in the detection and diagnosis of IDA, among patients with IBD. Its detection rate is higher using sTfR/F index than sTfR alone and of course higher than the other existing markers. It is essential to mention that the clinical use of this sTfR/F index rather adds to the value of other established markers, such as ferritin, transferrin and Tsat, than replaces them in the diagnosis of IDA. Therefore, sTfR-F index could be proposed as an additional parameter, which can improve the diagnosis of iron deficiency anemia in patients with IBD. This remains to be confirmed with other larger studies.