Background: Helicobacter pylori infection is one of the most prevalent chronic bacterial human infections worldwide. Helicobacter pylori colonizes the gastric mucosa and causes persistent gastritis that may progress to gastric cancer. Increased resistance of H. pylori presents a major problem in most countries. Statins, including simvastatin, which are currently used to treat hypercholesterolemia, appear to have potential synergistic role to antibiotics. This study aimed to assess the value of adding simvastatin as adjuvant to standard triple therapy in patients infected with H. pylori . Methods: This study was conducted on 100 patients diagnosed with H. pylori by the presence of antigen in stools. All patients were randomly subjected either to the standard triple regimen (clarithromycin 500 mg bid + amoxicillin 1 g bid + omeprazole 20 mg bid) (group 1, N=50) or to the standard triple regimen plus simvastatin (clarithromycin 500 mg bid + amoxicillin 1 g bid + omeprazole 20 mg bid + simvastatin 20 mg bid) (group 2, N=50). Both groups were treated for 14 days and eradication of H. pylori was assessed by a stool antigen test 4 weeks after therapy. Results: Eradication of H. pylori infection was significantly higher in patients treated with the standard triple therapy plus simvastatin (n=41, 82%) than in patients treated with the standard triple therapy (n=31, 62%) ( P <0.022). Conclusion: Simvastatin significantly improves the H. pylori eradication rate.

Background: computed tomography (CT) of the abdomen with contrast is the gold standard method for the evaluation of pancreatic cancer concerning staging and vascular assessment. however, not all patients can be evaluated by contrast-enhanced CT abdomen as those with an allergy to the contrast agent, pregnancy, and renal impairment, in addition to hazards of radiation and non-availability of tissue sampling in CECT abdomen .so this study was designed to evaluate the diagnostic ability of Endoscopic Ultrasound for staging and vascular assessment of pancreatic cancer in comparison to CT abdomen with contrast. Method: fifty patients with cancer pancreas were evaluated by CECT and EUS as regard staging and vascular invasion. The vascular assessment was done by dividing the EUS findings into three types by the relationship between tumors and major vessels, type 1, clear invasion, encasement of the vessel by a tumor or tumor that contacts a vessel wall more than 180o; type2, Abutment, a tumor that contacts a vessel wall but less than 180o and type 3, clear non-invasion, the existence of distance between a tumor and a vessel. We regarded type 1 and type 2 as signs of vascular invasion and type 3 as a sign of vascular non-invasion, these findings were compared with the findings of the CECT abdomen. The endoscopist was blind to the CT result before the EUS examination. Result: as regards staging of pancreatic cancer EUS showed sensitivity, specificity, and accuracy of 100% for all. and as regard vascular invasion EUS showed sensitivity, specificity, and accuracy of 100%,95.93%, and 96% respectively for venous invasion and 95.65%,100%, and 99.5% for arterial invasion. Conclusion: EUS can evaluate staging and vascular invasion of pancreatic cancer with very high sensitivity, specificity, and accuracy to the extent it can replace CT in evaluation, with the superiority of EUS due to tissue sampling.

Introduction: Nonalcoholic fatty liver disease (NAFLD) has been linked with a number of extra hepatic diseases and could be a potential risk factor of decreasing bone mineral density (BMD). Aim: To assess bone mineral density, serum calcium and serum vitamin D in Upper Egyptian patients with NAFLD to determine if patients who have NAFLD are at risk of developing osteoporosis or not. Methods: cross-section study was done on a total 100 individuals; 50 patients diagnosed with NAFLD crossed-matched with 50 individuals without NAFLD regarding to age, sex and body mass index (BMI). Bone mineral density, serum calcium and phosphorus levels, serum parathyroid hormone, serum vitamin D and fasting insulin level were assessed. Results: In this study, there is significant difference in bone mineral density between patients with NAFLD (-2.29 ± 0.4) and controlled individuals (-1.53 ± 0.1) with p value < 0.001 and osteoporosis was more prevalent in patients with NAFLD than control group with p value < 0.001. Serum vitamin D level was statistical significant predicts osteoporosis (P<0.001). Conclusion: The study showed a significant decreased in bone density, vitamin D and serum calcium in patients with NAFLD than controls.

Nonalcoholic fatty liver disease (NAFLD) has been linked with a number of extra hepatic diseases and could be a potential risk factor of decreasing bone mineral density. To determine whether Upper Egyptian patients with NAFLD are at risk of developing osteoporosis. Cross sectional study was done on a total 100 individuals; 50 patients diagnosed with NAFLD (based on ultrasound imaging) crossed-matched with 50 individuals without NAFLD based on age, sex and body mass index. Bone mineral density, serum calcium and phosphorus levels, serum parathyroid hormone, serum vitamin D and fasting insulin level were assessed. Osteoporosis was prevalent in NAFLD patients versus to controls (19/50 vs. 0/50; P < 0.001). There was significant decrease in bone mineral density in NAFLD patients than controls (− 2.29 ± 0.4 vs. − 1.53 ± 0.1; P < 0.001). There was a statistical significance decrease in serum vitamin D and calcium levels in NAFLD patients than controls. Furthermore, vitamin D levels in the NAFLD group was a predictor for osteoporosis (OR 0.614; 95% CI 0.348–0.825). Patients with NAFLD tend to have a significant decrease in bone density, vitamin D, and serum calcium levels than controls.

Background normal sexual activity is an important issue in the quality of life for both males and females. Several diseases were associated with erectile dysfunction, unfortunately, data about erectile dysfunction in cirrhotic patients was scanty. This study was conducted to determine the prevalence and risk factors of erectile dysfunction in patients with liver cirrhosis. Method: a cross-sectional study was conducted on 200 patients with liver cirrhosis they were divided into three groups according to Child score and erectile dysfunction was studied by (IIEF-5) Questionnaire and penile Doppler. Results the prevalence of erectile dysfunction in the cirrhotic patient was 80%. the erectile dysfunction worsens with the worsening of the liver condition (Child C), also 20% of the cirrhotic patients had penile venous leakage which became 28.6% in advance liver cirrhosis (Child C). Multivariate logistic regression showed that advancing in age, Albumin less than 2.8 g/dl, INR 1.7-2.2, Hb>16 g/dl and Child C were predictors of erectile dysfunction in cirrhotic patients. Conclusion Erectile dysfunction was found in 80% of cirrhotic patients. It was more frequently observed in cirrhotic patients having an advanced disease (child C). Patients reporting ED had elevated INR, serum bilirubin, suppressed serum albumin, and elevated level of hemoglobin.