AIM:To assess whether schistosomiasis coinfection with chronic hepatitis C virus (HCV) influences hepatic fibrosis and pegylated-interferon/ribavirin (PEG-IFN/ RIB) therapy response. METHODS:This study was designed as...AIM:To assess whether schistosomiasis coinfection with chronic hepatitis C virus (HCV) influences hepatic fibrosis and pegylated-interferon/ribavirin (PEG-IFN/ RIB) therapy response. METHODS:This study was designed as a retrospective analysis of 3596 chronic HCV patients enrolled in the Egyptian National Program for HCV treatment with PEG-IFN/RIB. All patients underwent liver biopsy and anti-schistosomal antibodies testing prior to HCV treatment. The serology results were used to categorize the patients into group A (positive schistosomal serology) or group B (negative schistosomal serology). Patients in group A were given oral antischistosomal treatment(praziquantel, single dose) at four weeks prior to PEG-IFN/RIB. All patients received a 48-wk course of PEG-IFN (PEG-IFNα2a or PEG-IFNα2b)/RIB therapy. Clinical and laboratory follow-up examinations were carried out for 24 wk after cessation of therapy (to week 72). Correlations of positive schistosomal serology with fibrosis and treatment response were assessed by multiple regression analysis. RESULTS:Schistosomal antibody was positive in 27.3% of patients (15.9% females and 84.1% males). The patients in group A were older (P = 0.008) and had a higher proportion of males (P = 0.002) than the patients in group B. There was no significant association between fibrosis stage and positive schistosomal serology (P = 0.703). Early virological response was achieved in significantly more patients in group B than in group A (89.4% vs 86.5%, P = 0.015). However, significantly more patients in group A experienced breakthrough at week 24 than patients in group B (36.3% vs 32.3%, P = 0.024). End of treatment response was achieved in more patients in group B than in group A (62.0% vs 59.1%) but the difference did not reach statistical significance (P = 0.108). Sustained virological response occurred in significantly more patients in group B than in group A (37.6% vs 27.7%, P = 0.000). Multivariate logistic regression analysis of patient data at treatment weeks 48 and 72 showed that positive schistosomal serology was associated with failure of response to treatment at week 48 (OR = 1.3, P = 0.02) and at week 72 (OR = 1.7, P < 0.01). CONCLUSION:Positive schistosomal serology has no effect on fibrosis staging but is significantly associated with failure of response to HCV treatment despite antischistosomal therapy.展开更多
Background: Acute pancreatitis is one of the most serious complications of ERCP. Early diagnosis of post ERCP pancreatitis helps physicians to provide intensive care and possible medical treatment as early as possible...Background: Acute pancreatitis is one of the most serious complications of ERCP. Early diagnosis of post ERCP pancreatitis helps physicians to provide intensive care and possible medical treatment as early as possible. Trypsinogen-2 in urine is a good diagnostic and prognostic marker of acute pancreatitis. Objectives: To evaluate the diagnostic value of urinary trypsinogen-2 dipstick test for early diagnosis of post ERCP pancreatitis. Methods: A total of 37 patients with obstructive jaundice were tested with the urinary trypsinogen-2 dipstick test and serum levels of amylase and lipase before ERCP and 6 hours after ERCP. Results: Post ERCP pancreatitis was diagnosed in 6 (16%) of 37 patients. The sensitivity, specificity, positive predictive value and negative predictive value of urinary trypsinogen-2 dipstick test at 6 hours after ERCP were 100%, 97%, 86%, 100% respectively. At the cutoff level (130 U/L) for lipase, the positive predictive value and negative predictive value all were (100%), however, the positive predictive value and negative predictive value for amylase levels at cutoff (122 U/L) were 60%, 100% respectively. Serum lipase level was the best test for diagnosing post ERCP pancreatitis followed by the urinary trypsinogen-2 dipstick test. Conclusions: The urinary trypsinogen-2 dipstick test can be used as a rapid and easy test for early diagnosis of post ERCP pancreatitis with high sensitivity and specificity.展开更多
基金Supported by The Science and Technology Development Fund,No.1708
文摘AIM:To assess whether schistosomiasis coinfection with chronic hepatitis C virus (HCV) influences hepatic fibrosis and pegylated-interferon/ribavirin (PEG-IFN/ RIB) therapy response. METHODS:This study was designed as a retrospective analysis of 3596 chronic HCV patients enrolled in the Egyptian National Program for HCV treatment with PEG-IFN/RIB. All patients underwent liver biopsy and anti-schistosomal antibodies testing prior to HCV treatment. The serology results were used to categorize the patients into group A (positive schistosomal serology) or group B (negative schistosomal serology). Patients in group A were given oral antischistosomal treatment(praziquantel, single dose) at four weeks prior to PEG-IFN/RIB. All patients received a 48-wk course of PEG-IFN (PEG-IFNα2a or PEG-IFNα2b)/RIB therapy. Clinical and laboratory follow-up examinations were carried out for 24 wk after cessation of therapy (to week 72). Correlations of positive schistosomal serology with fibrosis and treatment response were assessed by multiple regression analysis. RESULTS:Schistosomal antibody was positive in 27.3% of patients (15.9% females and 84.1% males). The patients in group A were older (P = 0.008) and had a higher proportion of males (P = 0.002) than the patients in group B. There was no significant association between fibrosis stage and positive schistosomal serology (P = 0.703). Early virological response was achieved in significantly more patients in group B than in group A (89.4% vs 86.5%, P = 0.015). However, significantly more patients in group A experienced breakthrough at week 24 than patients in group B (36.3% vs 32.3%, P = 0.024). End of treatment response was achieved in more patients in group B than in group A (62.0% vs 59.1%) but the difference did not reach statistical significance (P = 0.108). Sustained virological response occurred in significantly more patients in group B than in group A (37.6% vs 27.7%, P = 0.000). Multivariate logistic regression analysis of patient data at treatment weeks 48 and 72 showed that positive schistosomal serology was associated with failure of response to treatment at week 48 (OR = 1.3, P = 0.02) and at week 72 (OR = 1.7, P < 0.01). CONCLUSION:Positive schistosomal serology has no effect on fibrosis staging but is significantly associated with failure of response to HCV treatment despite antischistosomal therapy.
文摘Background: Acute pancreatitis is one of the most serious complications of ERCP. Early diagnosis of post ERCP pancreatitis helps physicians to provide intensive care and possible medical treatment as early as possible. Trypsinogen-2 in urine is a good diagnostic and prognostic marker of acute pancreatitis. Objectives: To evaluate the diagnostic value of urinary trypsinogen-2 dipstick test for early diagnosis of post ERCP pancreatitis. Methods: A total of 37 patients with obstructive jaundice were tested with the urinary trypsinogen-2 dipstick test and serum levels of amylase and lipase before ERCP and 6 hours after ERCP. Results: Post ERCP pancreatitis was diagnosed in 6 (16%) of 37 patients. The sensitivity, specificity, positive predictive value and negative predictive value of urinary trypsinogen-2 dipstick test at 6 hours after ERCP were 100%, 97%, 86%, 100% respectively. At the cutoff level (130 U/L) for lipase, the positive predictive value and negative predictive value all were (100%), however, the positive predictive value and negative predictive value for amylase levels at cutoff (122 U/L) were 60%, 100% respectively. Serum lipase level was the best test for diagnosing post ERCP pancreatitis followed by the urinary trypsinogen-2 dipstick test. Conclusions: The urinary trypsinogen-2 dipstick test can be used as a rapid and easy test for early diagnosis of post ERCP pancreatitis with high sensitivity and specificity.
