Background: Non-alcoholic fatty liver disease (NAFLD) become a challenge as it`s prevalence, difficulty to diagnose and complex pathogenesis representing about 20% of common liver disorders Patients with NAFLD are at higher risk for adverse outcomes such as cirrhosis, HCC and liver-related mortality. Aim and objectives : We aim to assess the applicability and performance of real-time elastography for the diagnosis of liver fibrosis.Methods: One hundred and thirty subjects attended damanhour medical national institute hepatology and gastroenterology outpatient clinic were divided into two groups; Group (I): Hundred cases having NAFLD by ultrasound, Group (II): thirty healthy subjects as control. Results: Fibrosis stages in NAFLD patients significantly higher than in the control group diagnosed by real time elastrography (P = 0.001). There was an agreement between Realtime Elastrography and FIB-4 index and NAFLD fibrosis score 93% and 86% respectively and diagnostic performance of real time elastrography in advanced liver fibrosis ≥F3 was assessed in comparing with FIB-4 index show sensitivity 90%, specifity 93.3%, PPV 60%, NPV 98.8%, accuracy 93%, AUC0.917, 95%CI 0.81-1.0 and (p = 0.001). Conclusion : Real time elastography may be useful in diagnosis of fibrosis in non-alcoholic fatty liver disease.

Chronic Hepatitis C is endemic in many regions worldwide. Roughly 71 million people are infected with HCV all over the world .Egypt has been among the highest prevalence rates of HCV in the world. HCV is a major cause of chronic hepatitis, hepatic cirrhosis and hepatocellular carcinoma, moreover the most common cause of liver transplantation. Portal hypertension induced esophageal varices is one of life threatening complications results from liver cell failure leading to many mortalities and co-morbidities. The spread of HCV infection in Egypt is thought to be due to needle re-use during mass treatment programs for Schistosmiasis during late fifties till the early eighties. Unfortunately, transmission continues to occur, primarily through iatrogenic sources such as blood transfusion, injections and dental cares. Many lines of treatment were approved through years however the most promising ones the direct acting antivirals (DAAs) as those medications target specific steps within the HCV life cycle. A retrospective observational study, sample was based on provided data of 101 Egyptian Chronic HCV patients, how had been treated with sofosbuvir between the year 2015 and 2016 at one of the reference centers under the authority of MOHP compared with 101 egyptian patients infected with HCV who didn"t receive any type of antiviral treatment. Baseline laboratories, HCV RNA PCR, abdominal ultrasound, upper GI endoscopy was done for all patients in both groups, same investigations was done after 3 months, 6 months, 1 year for both groups The sample included 202 patients, divided over 2 arms treated and untreated with proportion 1:1, mean age for the whole sample were 51.1 ± 10.3 years old with high prevalence to males more than females n = 129 (63.8%), n = 73 (36.1%) respectively. Baseline characters showed significant differences in ALT, AST, AFP, INR, HB, PLT, albumin, Fscore, upper GI endoscope and proportion of patients with cirrhosis with p value < 0.05. After 3 months of treatment with DAAs patients had significant reduction of HB and PLT with p value 0.03 and 0.005 respectively. There was significant difference between treated and untreated arms in terms of progressive liver cirrhosis( p 0.0001) , ascites( p 0.0001) and HFL( p 0.005) favoring treatment group over untreated group. Majority of treated sample didn"t experience relapse) 96%( while only) 5%( relapsed post treatment, multivariate analysis revealed that relapse is correlated to liver cirrhosis with p value 0.013, PCR after 3 months of finishing treatment with p value 0.0001, relapse was correlated with increased fatigability in treated patients with (p 0.0001) HCV PCR load showed significant correlation to relpase after 3 months, moreover HCV PCR after 3 months is significantly correlated to relpas. DAAs have Higher safety and tolerability and the side effects of three groups were not sever enough to lead to treatment discontinuation.

Background: Spontaneous bacterial peritonitis (SBP) is a common severe complication in patients with liver cirrhosis. Endocan is a proteoglycan (PG) secreted by vascular endothelium, its serum level is elevated with an inflammatory or a malignant process. Aim: this study aimed to determine levels of serum endocan in cirrhotic patients with and without spontaneous bacterial peritonitis. Methodologies: A total of 83 patients with cirrhotic ascites were included in the study.41 of them had SBP . The severity of liver cirrhosis was assessed using the Child-Pugh score, the Model for End Stage Liver Disease (MELD), and its update (uMELD) scores . Ascitic fluid samples were collected for leucocytic count differentiation, albumin, glucose estimation, and the serum ascitic albumin gradient. . If the polymorph-nuclear leucocytic count in ascitic fluid was equal to or greater than 250/mm3, SBP diagnosed. Results: The serum endocan level was significantly higher in patients with SBP ROC analysis of serum endocan as a marker for SBP diagnosis revealed: sensitivity of 88.9%, specificity of 61.5% , and area under curve (AUC) of 0.792 at a cut-off value of 67.1(pg/ml). Conclusion: Although endocan level was higher in serum of SBP patients, it cannot be used as a diagnostic marker in SBP.