Objectives: Sarcopenia is a common entity in cirrhosis with significant morbidity and mortality. However, the effects of sarcopenia on the risk of complications and survival after liver transplant remain controversial. We aimed to evaluate the effect of sarcopenia on survival and complications after liver transplant. Materials and Methods: Our study cohort included 61 adult patients with hepatitis C-related cirrhosis who underwent living donor liver transplant. Pretransplant clinical and anthropometric assessments included body mass index, hand grip, mid-arm circumference, triceps skin fold thickness, and gait speed. Sarcopenia was determined by computed tomography using the skeletal muscle index at the third lumbar vertebra cut- off value of < 38.5 cm(2)/m(2) for women and <52.4 cm(2)/m(2) for men; these patients were then followed up for 6 months after transplant to determine survival and complications. Results: At time of liver transplant, sarcopenia was present in 27/ 61 patients (44.3%). At follow-up after transplant, sarcopenia was found in 14 patients (30.4%) among 46 survivors; all patients who survived were male patients. Among patients with sarcopenia posttransplant, 12 had sarcopenia before transplant and 2 developed sarcopenia after transplant. Liver dysfunction, lower triceps skin fold thickness, recent infections, and sarcopenia pretransplant were associated with posttransplant complications, especially infection (42.8%) and prolonged intensive care unit stay. Age and pretransplant sarcopenia were found to be independent predictors of posttransplant mortality. Conclusions: Sarcopenia is a common entity in patients with cirrhosis who are on liver transplant wait lists and may continue after liver transplant. De novo sarcopenia after liver transplant is also a common finding. Sarcopenia can affect patient outcomes, including prolonged intensive care unit stay and poor shortterm survival.

Direct-acting antivirals (DAAs) are used for hepatitis C virus (HCV) treatment. However, treatment failure and hepatocellular carcinoma (HCC) development following treatment was reported. In this study, we assessed the role of serum vitamin D, interleukin 13 (IL-13), and microRNA-135a in the prediction of treatment failure with DAA and HCC development among Egyptian HCV-infected patients. A total of 950 patients with HCV-related chronic liver disease underwent DAA treatment. Before DAAs, serum vitamin D and IL-13 were determined by ELISA, and gene expression of miRNA-135a was assessed in serum by real-time PCR. The predictive abilities of these markers were determined using the receiver operating characteristic (ROC) curve. Sustained virological response (SVR) was achieved in 92.6% of HCV-infected patients (responders). High viral load, IL-13, miRNA-135a, and low vitamin D levels were associated with treatment failure and HCC development. HCC development was recorded in non-responders, but not in the responders (35.7% vs. 0% p < 0.001). In conclusion: serum IL-13, Vitamin D, and miRNA-135a could be potential biomarkers in monitoring DAA treatment and HCC prediction. DAAs-induced SVR may decrease the incidence of HCC.

Background: In recent years, there has been growing awareness of metabolic dysfunction-associated steatotic liver disease (MASLD) linked to hypothyroidism. However, insufficient data exists on how levothyroxine (LT4) replacement therapy impacts MASLD. We aimed to assess the effects of LT4 treatment on dyslipidemia and MASLD in patients with subclinical hypothyroidism (SCH). Methods: In a randomized, controlled study, 230 patients with MASLD were screened for SCH, and 182 were diagnosed with SCH. Of these, 30 had significant SCH and 152 had mild SCH. All patients with significant SCH received LT4 therapy (significant SCH-LT4), while those with mild SCH were divided into two groups: 50 received LT4 treatment (mild SCH-LT4) and 102 did not (mild SCH-control). Results: Significant improvements in hepatic steatosis severity were observed in the treated groups compared with the control. After LT4 treatment, MASLD prevalence decreased to 50% (p = 0.001) in the significant SCH-LT4 group and to 60% (p = 0.025) in the mild SCH-LT4 group. In the mild SCH-control group, MASLD prevalence improved slightly but non-significantly from 100 to 75% (p = 0.164). Compared to other groups, the significant SCH-LT4 group showed greater improvements in metabolic parameters, including weight, body mass index, total cholesterol, high-density lipoprotein cholesterol, and C-reactive protein, emphasizing the notable impact of levothyroxine. Conclusion: This study highlights that LT4 treatment can significantly improve MASLD, dyslipidemia, and systemic inflammation in MASLD patients with SCH, particularly in those with significant SCH. These findings support the clinical use of thyroxine for managing MASLD and dyslipidemia in SCH patients.

Background: Cirrhotic patients are highly susceptible to bacterial infections due to immune dysfunction, frequent hospitalizations, and invasive procedures. The rise of multidrug-resistant (MDR) organisms complicates treatment and worsens outcomes. This study aimed to evaluate the epidemiology, risk factors, and outcomes of MDR infections in cirrhotic patients admitted to the intensive care unit (ICU). Methods: This prospective cohort study included cirrhotic ICU patients with suspected infection at a tertiary care center from January 2022 to December 2023. Clinical specimens were collected from the suspected site of infection, and antimicrobial susceptibility testing was performed. Intra-hospital outcomes were analyzed. Results: MDR organisms were identified in 83.3% of isolates, with 78.3% among Gram-positive and 87.7% among Gram-negative bacteria. Methicillin resistance was detected in 66% of Staphylococcus species, while 39% of Enterococci were vancomycin-resistant. The most common MDR Gram-negative pathogens were ESBL-producing Enterobacterales; approximately 60% of Acinetobacter and Pseudomonas isolates were carbapenem-resistant. Advanced cirrhosis, comorbidities, invasive procedures, previous episodes of spontaneous bacterial peritonitis (SBP), and prolonged hospital stays were more common in patients with MDR infections, although none of them was statistically significant. Patients with MDR infections had higher rates of complications, including hepatic encephalopathy (35.5% vs. 21.6%, p = 206) and hepatorenal syndrome (37.3% vs. 15.7%, p = 0.063), as well as higher mortality (17.4% vs. 9.8%, p = 0.440) compared to those without. Conclusion: MDR infections are frequent in cirrhotic ICU patients, with a trend toward more complications (e.g., hepatic encephalopathy and hepatorenal syndrome) and higher mortality, underscoring the need for early detection and stronger antimicrobial stewardship.

Background: Low back pain is a common and disabling condition with diverse etiologies, including infectious causes like brucellosis, particularly in endemic regions. We aimed to assess the seroprevalence of Brucella antibodies among high-risk patients presenting with low back pain. Methods: A case-control study was conducted involving 66 patients with nonspecific low back pain and 30 age- and sex-matched controls without low back pain, all at high risk for brucellosis. Clinical data were collected, and Brucella antibodies were measured using the SERION ELISA Classic Brucella IgG/IgM/IgA kit. Results: Brucella seropositivity was significantly higher in those with low back pain (54.5%) compared to controls (23.3%) ( p = 0.004). No significant differences were observed between seropositive and seronegative patients in demographic or clinical characteristics. Most patients with low back pain had rural backgrounds and occupational exposure to livestock. Conclusion: Brucellosis could be an overlooked cause of low back pain in endemic areas. Early serological screening, especially using ELISA, is crucial for prompt diagnosis and to prevent complications.