Empirical treatment with cefotaxime is effective in 81% of cases; meropenem is effective in cefotaxime-resistant cases.

Background and study aim: Hepatitis C virus infection represents a potential public health problem worldwide. Many studies have shown markedly higher prevalence of insulin resistance (IR) and type 2 diabetes mellitus (T2DM) among patients with hepatitis C virus (HCV) infection compared to healthy subjects. Fetuin-A is one of the principal hepatokines regulating the human metabolism. This study aimed to estimate the level of Fetuin-A in HCV patients with concomitant T2DM, and its relation to insulin resistance. Patients and Methods: The study was conducted on 115 subjects, 87 patients had chronic HCV infection with and without T2DM, diabetic patients without HCV infection and 28 healthy control, they were subjected to full history taking thorough clinical examination, abdominal ultrasonography, routine laboratory investigation including fasting and post prandial blood glucose level and assessment of HOMA-IR, viral markers and serum Fetuin-A level by ELISA. Results: There was high statistically significant increase of serum Fetuin-A level among HCV with DM patient group followed by HCV group when compared to DM and control groups. Serum Fetuin-A level was higher in HCV patients than non HCV subjects with statistically significant difference.Also,it was higher among diabetic patients than non diabetic subjects with statistically significant difference.Serum Fetuin-A level was positively correlated with glucose homeostasis parameters in both HCV and HCV&D.M patients with high statistically significant difference. At Cutoff value of serum Fetuin-A >5.2 mg/mL, Sensitivity was 54.84, Specificity was 96.30, positive PV 94.4 and negative PV was 65.0 for prediction of IR in HCV patients. While, at Cutoff value of serum Fetuin-A >4.9 mg/mL, sensitivity was 72.41, specificity was 79.31, positive PV was 77.8 and negative PV was 74.2 for prediction of DM in HCV patients. Conclusion : Fetuin-A may have role as a mediator in IR of either HCV or diabetes. However, Fetuin-A is more specific for evaluation of IR than DM in HCV patients as other factors may be incriminated in the pathogenesis of DM in HCV patients other than serum Fetuin-A level alone.

The goal of the present study was to examine the immunohistochemical expression of Glypican-3 (GPC3) and Enhancer of zeste homologue 2 (EZH2) in various histological types of hepatic nodules in order to clarify their discriminatory diagnostic value. We correlated biomarkers' expressions with the clinicopathological variables of primary liver malignancy. Biomarkers' expression was investigated in 64 liver needle biopsies. The specimens included primary liver malignancy (57.81%), metastatic carcinomas (15.62%) and non-malignant nodules 26.56%. The expression of GPC3 was detected in 83.33% and 15.38% of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) respectively, but not expressed in any of metastatic nodules. In HCC, GPC3 was more expressed in cases with cirrhosis, large masses of tumor and high HCCs grades with statistically significant differences with P value of 0.01, 0.035 and 0.03 respectively. The EZH2 expression was detected in 91.66% of HCC, in all cases of CC and metastatic nodules and in 5.88% of non-malignant nodules. The sensitivity, specificity and diagnostic accuracy of differentiating HCCs from non-malignant nodules were 80.95%, 100% and 90.24% respectively for GPC3; and 85.71%, 95.65% and 91.89% respectively for EZH2. The sensitivity, specificity and diagnostic accuracy for differentiating HCCs from CCs were 73.33%, 90.91% and 83.78% respectively for GPC3; and 0.0%, 62.86% and 59.46% respectively for EZH2. The sensitivity, specificity and diagnostic accuracy for differentiating HCCs from metastatic nodules were 71.43%, 100% and 88.24% respectively for GPC3; and 0.0%, 68.75% and 64.71% respectively for EZH2. In conclusion, GPC3 might be used as a good biomarker for differential diagnosis of HCC from non-malignant nodules, CC and metastasis. Its overexpression might be an indication of poor HCC prognosis. On the other hand, EZH2 is not specific for HCC, but could be a reliable biomarker for discrimination of hepatic cancers compared to non-malignant nodules.

Background and study aim: Many recent studies showed that chronic infection with hepatitis C virus (HCV) is associated with increased risk for B-cell non-Hodgkin's lymphoma (NHL). The aim of this study is to evaluate the frequency of HCV infection in a series of de novo B cell non Hodgkin's lymphoma (NHL) patients and to correlate virological findings with clinicohistological features. Patients and methods: 50 patients with B cell NHL diagnosed by histopathology and immunophenotyping were recruited from Tropical medicine department and Oncology unit affiliated to Internal medicine department, Zagazig University hospitals. Gender and age matched controls (N = 50) were volunteers selected from relatives of patients. Study participants were subjected to history taking, clinical examination, routine and specific laboratory tests. Anti-HCV antibody was determined by ELISA for all study participants. HCV RNA PCR was done for all cases and HCV antibody positive controls. Appropriate radiologic examinations were performed. Results: Frequency of HCV infections were statistically significantly higher in B cell NHL patients than in controls (p = 0.004). ALT levels were statistically significantly higher in HCV positive patients than in HCV positive controls (p < 0.001) and HCV negative patients but without statistically significant difference (p = 0.067). There was no statistically significant difference in histologic types, grades and stages of NHL between HCV positive patients and HCV negative patients. Cryoglobulinemia showed no significant difference between studied groups. Conclusion: HCV has a strong association with de novo B cell NHL, not complicating essential mixed cryoglobulinemia (EMC).