Coagulopathy, cytokine release, platelet hyperactivity and endothelial activation are regarded as potential major contributors to COVID-19 morbidity. Complement activation might provide a bridge linking these factors in severe COVID-19 illness. In this study, we investigated the prognostic significance of selected complement factors in hospitalized patients with severe COVID-19 infection. The study included 300 hospitalized adults with severe COVID-19 infection. Complement factors (C3, C3a, C4, sC5b-9) were assessed by commercial ELISA kits. Outcome parameters included mortality, intensive care unit admission and duration of hospital stay. It was found that survivors had significantly higher serum C3 (median (IQR): 128.5 (116.3–141.0) mg/dL vs 98.0 (70.0–112.8) mg/dL, p<0.001) and C4 (median (IQR): 36.0 (30.0–42.0) mg/dL vs 31.0 (26.0–35.0) mg/dL, p<0.001) levels when compared with non-survivors. On the other hand, it was shown that survivors had significantly lower C3a (median (IQR): 203.0 (170.3–244.0) ng/mL vs 385.0 (293.0–424.8) ng/mL, p<0.001) and sC5b-9 (median (IQR): 294.0 (242.0–318.8) ng/mL vs 393.0 (342.0–436.5) ng/mL, p<0.001) levels when compared with non-survivors. Multivariate logistic regression analysis identified C3a (OR: 0.97 (95% CI 0.96 to 0.99), p<0.001) and C4 (OR: 0.92 (95% CI 0.86 to 0.98), p=0.011) levels as significant predictors of mortality. In conclusion, serum levels of complement factors are related to mortality in severely ill patients with COVID-19.

Objective: To compare balloon extraction versus Dormia basket in the retrieval of proximally migrated stent. Methods: The prospective study was conducted at Tanta University Hospital and Kafrelsheikh University Hospital, Egypt, from December 2019 to December 2020, and comprised adult patients of either gender who presented with proximally migrated biliary plastic stent who were evaluated with respect to risk factor for migration. The difference in efficacy of and Dormia basket group A and balloon extraction group B was evaluated. Data was analysed using SPSS 21. Results: Of the 80 patients, 43(53.8%) were males and 37(46.3%) were females. The overall mean age was 55.7±14.2 years. Group A had 40(50%) patients; 21(52.2%) males and 19(47.5%) females with mean age 56.9±14.1 years. Group B had 40(50%) patients; 22(55%) males and 18(45%) females with mean age 54.6±14.5 years. (p>0.05). Change-over to the other method was done in 15(37.5%) patients of group A and in 8(20%) of group B (p=0.084).Mean time of the procedure was 57.4±21.7min in group A and 37.5±21.6min in group B (p &le;0.001). Complications occurred in 3(7.5%) group A patients and 2(5.0%) group B patients (p=1.0). Conclusion: Balloon extraction was found to be more successful than Dormia basket in the extraction of proximally migrated stent. Keywords: Cholangiopancreatography, Endoscopic retrograde, Cholestasis, Stents, Cholangitis.

Objective: To evaluate the diagnostic and prognostic role of ascitic fluid calprotectin and its ratio to total protein in spontaneous bacterial peritonitis cases.Method: The prospective study was conducted at Kafrelsheikh University Hospital, Egypt, from November 2019 to December 2020, and comprised cirrhotic patients of either gender with ascites. Diagnostic abdominal paracentesis was performed for all patients and ascetic fluid calprotectin was measured. Patients were followed for development of spontaneous bacterial peritonitis or mortality. Data was analysed using SPSS 20.Results: Of the 90 patients, 61(67.7%) were males and 29(32.2%) were females. There were 67(74.4%) patients with spontaneous bacterial peritonitis; 48(71.6%) males and 19(28.3%) females with mean age 60.42±8.3 years. The remaining 23(25.5%) did not have spontaneous bacterial peritonitis; 13(56.5%) males and 10(43.4%) females with mean age 59.7±7.4 years. The patients had significantly higher calprotectin, and calprotectin/total protein ratio (p<0.05). Logistic regression identified ascitic fluid calprotectin as a significant predictor of mortality (p=0.05). Thenon-survivors had significantly higher ascitic fluid calprotectin and calprotectin/total protein ratio compared to thesurvivors (p<0.05).Conclusion: Ascites calprotectin level and its ratio to total protein was found to be accurate diagnostic and predictivebiomarkers for spontaneous bacterial peritonitis.Keywords: Ascitic fluid, Ascites, Gastroenterology, Prognosis, Paracentesis, Peritonitis, Liver cirrhosis, Communicablediseases, Morbidity.