Fibrosis assessment in chronic hepatitis B (CHB) is essential for prediction of long-term prognosis and proper treatment decision. This study was conducted to assess predictability of 5 simple noninvasive fibrosis indexes in comparison to liver biopsy in CHB patients.A total of 200 CHB adult Egyptian patients were consecutively included in this study, all were subjected to liver biopsy with staging of fibrosis using METAVIR scoring system. Fibrosis indexes including S-index, red cell distribution width to platelets ratio index (RPR), fibrosis-4 index (Fib-4), AST to platelets ratio index (APRI), and AST/ALT ratio index (AAR) were compared to biopsy result and their predictabilities for the different fibrosis stages were assessed using area under receiver operating characteristic curve (AUROC) analysis.S-index showed the highest AUROCs for predicting fibrosis among the studied indexes. AUROCs of S-index, RPR, Fib-4, APRI, and AAR were: 0.81, 0.67, 0.70, 0.68, and 0.60 for prediction of significant fibrosis (F2–F4), 0.90, 0.66, 0.68, 0.67, and 0.57 for advanced fibrosis (F3–F4), and 0.96, 0.62, 0.61, 0.57, and 0.53 for cirrhosis (F4), respectively. The optimal S-index cutoff for ruling in significant fibrosis was ≥0.3 with 94% specificity, 87% PPV, and 68% accuracy, while that for ruling out significant fibrosis was <0.1 with 96% sensitivity, 91% NPV, and 67% accuracy. Accuracy of S-index was higher for predicting cirrhosis (91%) than that for predicting advanced fibrosis (79%) and significant fibrosis (68%).S-index has the highest predictability for all fibrosis stages among the studied fibrosis indexes in HBeAg-negative CHB patients, with higher accuracy in cirrhosis than in the earlier fibrosis stages.

Objectives: The omega-3 (n-3) fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are known to play an important role in maintenance and modulation of neuronal functions. There is evidence that omega-3 fatty acids may have anticonvulsant effects. The effect of DHA and EPA on seizure rate in patients with DRE was investigated. Methods: A double-blind, randomized, placebo-controlled clinical trial included ninety-nine (n=99) DRE subjects, aged 5-16 (n=85) and 17-45 (n=14). After randomization, subjects were given two, four or six capsules per day of DHA (417.8 mg DHA and 50.8 mg EPA/capsule, n=33), EPA (385.6 mg EPA and 81.2 mg DHA/capsule, n=33) or placebo (high oleic acid sunflower oil, n=33) for one year. The primary endpoint was the effect of treatment on rate of seizure. Random-effects negative binomial regression models were fitted to model the patients' total count of seizures per month. The treatment effects on seizure incidence rate ratio was tested after controlling for the covariate effects of gender, age, rate of seizure per week at enrollment, type of seizure and number of AEDs combinations used at enrollment. Results: Fifty-nine subjects (n=59) completed the study (59.6%).The average number of seizures per month were 9.7 ± 1.2 in the EPA group, 11.7 ± 1.5 in the DHA group, and 16.6 ± 1.5 in the placebo group. Age, gender and seizure type adjusted seizure incidence rate ratios (IRRs) of the EPA and DHA groups compared with the placebo were 0.61 (CI= 0.42-0.88, p=0.008, 42% reduction) and 0.67 (CI = 0.46-1.0, p= 0.04, 39% reduction), respectively. There was no difference in IRR between the EPA and DHA groups (p=0.56). Both treatment groups had a significantly higher number of seizure-free days compared to placebo (p<0.05).

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Background: Accurate sub-classification of non-small cell lung carcinoma (NSCLC) is crucial for the targeted therapy. In lung cancer most of tumors are un-respectable at diagnosis and small biopsy or cytological specimen is commonly the only available material for histopathology diagnosis. Although most of NSCLC can be diagnosed by routine stains, however diagnosis of poorly differentiated or undifferentiated tumors in small biopsy is challenging. Objective: To evaluate the diagnostic value of Napsin A immunohistochemical (IHC) marker in NSCLC small biopsy. Materials and Methods: Forty-six cases of primary NSCLC diagnosed by biopsy with subsequent resection were enrolled in this study. Subtyping of tumors was done according to 2015 World Health Organization criteria. IHC expression of Napsin A was assessed for all the cases. For large cell carcinoma (LCC) cases, Thyroid Transcription Factor 1 (TTF-1) and P63 expression were also tested. Markers expression was correlated with the histological diagnosis of the tumor. Sensitivity, specificity, positive, negative predictive values, and total accuracy of the markers were calculated. Result: In NSCLC cases, the diagnostic sensitivity and specificity of Napsin A were 85.2% and 75% (respectively) with a PPV of 85.2%, NPV of 75.0% and 81.4% accuracy. In LCC cases TTF1 sensitivity was 57.1% and specificity 100%, PPV 100%, NPV 14.3%, accuracy 60.0%. In LCC P63 marker had a diagnostic sensitivity, specificity, PPV, NPV and accuracy of 100%, 85.7%, and 33.3%, 100.0% and 86.7% respectively. Expression of both Napsin A and TTF 1 in LCC cases raised the accuracy to 86.7%. Conclusions: In small biopsy specimens Napsin A can subtype NSCLC with high sensitivity and moderate specificity. Additions of TTF-1/p63 IHC markers can further enhance the accuracy.

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