Chronic Hepatitis C virus (HCV) infection and liver cirrhosis may be associated with atherosclerosis and coronary artery disease (CAD). There are two phases to atherosclerosis, Subclinical and Clinical. Assessment of atherosclerosis may be started at its Subclinical phase by the evaluation of Epicardial Fat Thickness (EpFT) and Carotid Intima Thickness (CIMT). The aim of the study was to evaluate Clinical and Subclinical atherosclerosis in chronic HCV patients with and without liver cirrhosis by evaluating CIMT and EpFT and correlating the results with Child-Pugh functional scoring of cirrhosis as well as with ultrasound and laboratory parameters that define the severity of liver disease. This study involved 64 chronic HCV patients that were divided into two groups: 24 patients without liver cirrhosis and 40 patients with liver cirrhosis in addition to 20 apparently healthy volunteers serving as control. All of the 84 subjects were subjected to the following: Clinical evaluation; Routine Laboratory Evaluation (CBC, Liver Function Tests, Renal Function Tests, Serum electrolytes, Cholesterol, Triglycerides, HBs antigen and HCV antibody); ECG; Abdominal ultrasound; Echocardiographic evaluation of segmental wall motion abnormalities and EpFT and B-Mode Carotid ultrasonography for evaluation of CIMT. In the cirrhotic HCV group, the CIMT and EpFT were both significantly increased [Compared to control group (p = 0.000), compared to the non-cirrhotic HCV group (p = 0.000)]. In the non-cirrhotic HCV group, the CIMT and EpFT were both significantly increased compared to the control group with a p-value of 0.003 for CIMT and 0.048 for EpFT. The CIMT and EpFT were also positively correlated with each other (r = 0.456, p = 0.001). There was a statistically significant increase in the EpFT and CIMT in Child class B patients compared to Child class A (p = 0.007 for CIMT and p = 0.028 for EpFT) and in Child class C patients compared to Child class B patients (p = 0.001 for CIMT and 0.005 for EpFT). CIMT and EpFT were correlated positively with AST (r = 0.385, p = 0.002 for CIMT, and r = 0.379, p = 0.003 for EpFT), Total Bilirubin (r = 0.378, p = 0.003 for CIMT, and r = 0.384, p = 0.002 for EpFT), INR% (r = 0.456, p = 0.001 for CIMT, and r = 0.384, p = 0.001 for EpFT), CRP (r = 0.378, p = 0.003 for CIMT, and r = 0.386, p = 0.002 for EpFT), spleen span (r = 0.417, p = 0.001 for CIMT, and r = 0.437, p = 0.001 for EpFT) and portal Vein Diameter (r = 0.372, p = 0.003 for CIMT, and r = 0.379, p = 0.003 for EpFT). CIMT and EpFT were correlated negatively with Albumin (r = -0.379, p = 0.003 for CIMT, and r = -0.370, p = 0.003 for EpFT), platelets count (r = -0.382, p = 0.002 for CIMT, and r = -0.378, p = 0.003 for EpFT) and Liver Span (r = -0.433, p = 0.001 for CIMT, and r = -0.424, p = 0.001 for EpFT). EpFT and CIMT significantly increased in chronic hepatitis C virus patients especially in those with cirrhosis and closely correlated with each other. Their thickness also correlated with the Child-Pugh functional scoring of cirrhosis as well as with ultrasound and laboratory parameters that define the severity of liver disease.The echocardiographic assessment of EpFT and the carotid Doppler assessment of CIMT may provide appropriate and simple screening markers for subclinical atherosclerosis and cardiovascular risk in chronic HCV patients with and without cirrhosis.

Hyponatremia is common in cirrhosis. The relationship between hyponatremia and severity of cirrhosis is evidenced by its close association with the occurrence of complications, the prevalence of hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, refectory ascites, and hepatic hydrothorax. The aim of this study was assess the impact of hyponatremia on the occurrence of both liver-related complications and the hemodynamic cardiovascular dysfunction.This prospective study was conducted in 2015 on 74 patients with liver cirrhosis. The patients were from the Gastroenterology and Hepatology Department of Theodor Bilharz Research Institute in Giza, Egypt. The patients were divided into three groups according to their serum level of sodium. Group 1 included 30 patients with serum sodium >135 meq/L, group 2 included 24 patients with serum sodium between135 and 125 meq/L, and group 3 included 20 patients with serum sodium <125 meq/L. For each of the patients, we conducted aclinical examination, laboratory investigations, chest X-ray, ECG, abdominal sonar, and echocardiography.Hyponatremia was found in 59.46% of our cirrhotic patients, and they showed significantly increased Model for End-Stage Liver Disease (MELD) score, MELD-Na score, QTc interval, Pulmonary vascular resistance (PVR) and inferior vena cava (IVC) collapsibility, and decreased SVR and IVC diameter. Also hepatic encephalopathy, ascites, renal failure, infectious complications, and pleural effusion were significantly more common in hyponatremic cirrhotic patients.In cirrhosis, hyponatremia is more common in severe cardiovascular dysfunction and associated with increased risk of hepatic encephalopathy, ascites, illness severity scores, renal failure, infectious complications, and pleural effusion. We recommend selective oral administration of vasopressin V2-receptor antagonist, tolvaptan, which acts to increase the excretion of free water, thereby resolving hypervolemic hyponatremia and may have the potential to improve outcomes in these patients.

Background: Mental stress plagued type II diabetes (T2DM) patients. The psychological and emotional issues related to diabetes and its effects include depression, anxiety, poor diet, and hypoglycemia fear. Aim: Compare the impact of diabetes on depression and anxiety in Egyptian and Saudi diabetics. Methods: The diabetes, gastroenterology, and hepatology sections of University of Ha’il Clinic, KSA, and the Theodor Bilharz Research Institute, Egypt, conducted this retrospective study. Everyone gave informed consent before participating. Interviews with male and female outpatients and inpatients were conducted from June 2021 to December 2022. The self-administered validated Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) scale measured sociodemographic characteristics and symptoms of depression and anxiety. Results: In patients with diabetes, the prevalence of depression was higher in KSA [34.8%] than in Egypt [18%], while anxiety was higher in Egypt [40%] than in KSA [29.1%]. Most depressed patients were 31–55 years old (61.2%) from KSA and 97.8% (41–55 years old) from Egypt. Female anxiety was 70.7% in KSA and 51.0% in Egypt, with no significant difference. The duration of diabetes in depressed patients was 5–10 years ([46.9%, Saudis] vs. [57.8%, Egyptians]), while anxious patients (5–10 years [39.0%, Saudis] vs. >20 years [65.0%, Egyptians]) were mainly type-2. Most depressive patients had an HbA1c (59.2%) from 7–10% (Saudis) and 77.8% [>10% Egyptians] compared to anxiety patients (46.3%) and 48.0% [>10% Egyptians]. Depressed and anxious patients from both nations had higher glucose, triglycerides, and cholesterol levels. Saudis and Egyptians with obesity had higher rates of sadness (75.5% vs. 68.9%) and anxiety (82.9% vs. 69.0%). Treatment adherence and serum glucose monitoring were not significantly different from depression in diabetes individuals in both ethnicities. Conclusions: Anxiety was more common among Egyptian patients because of overcrowding, working whole days to fulfill life requirements, and the unavailability of health insurance to all citizens. Meanwhile, in KSA, obesity, unhealthy food, and less exercise reflect the high percentage of depression among patients with diabetes. The detection of depression and anxiety in the context of DM should be critical for the physical health and quality of life of Saudi and Egyptian diabetics. Further investigation is warranted to encompass anxiety and depression within the scope of future research.

Background: The risk of dying from chronic liver diseases (CLDs) is two to three times higher for patients with diabetes (DM). Nonalcoholic fatty liver disease (NAFLD) is the primary cause of this increased risk, which has an etiology unrelated to alcohol or viruses. Previous research reported that diabetes and CLD are related, since they influence each other. Aim: Estimation of the impact of diabetes (DM) on liver diseases (LD), and of the impact of liver diseases on DM among Egyptian and Saudi patients. It is a descriptive and prospective analytical study design. The investigation was carried out in Saudi Arabia and Egypt at gastroenterology outpatient clinics. Methods: Prospective data were collected through face-to-face patient interviews during clinic visits between June 2021 and June 2023. The interviews covered the patients’ basic characteristics and information on DM and LD. Certain laboratory tests were conducted on these patients, such as liver function, glucose level, lipid profile, INR, and prothrombin time. Results: The total of 2748 participants in this study included 1242 diabetic patients of both genders from Saudi Arabia and 1506 from Egypt. Most Saudis had between 10 and 20 years’ duration of DM (35.5%), with HbA1c (7–10%) values of 47.8%, while the Egyptian patients had >20 years’ duration of DM (39.8%), with HbA1c (7–10%) values of 49.8%. Regarding the impact of DM on the development of liver diseases, about 35.5% (Saudis) vs. 23.5% (Egyptians) had liver diseases due to DM, a significant difference (p-value = 0.011). Liver enzymes were increased in many of the Egyptian and Saudi patients (41.4% vs. 33%), while the presence of fatty liver (28.2% vs. 35.7%) and hepatocellular carcinoma (13.7% vs. 6.1%) were also significantly different (p-value = 0.047). While the impact of liver diseases on DM was observed more among Egyptian (59%) than among Saudi (46.4%) patients because of liver cirrhosis (HCV or HBV), known to be a reason for diabetes in Egyptians (27.9%) vs. Saudis (8.0%), a higher incidence of fatty liver leading to DM was observed in Saudis than in Egyptians (15.9% vs. 11.6%) (p-value = 0.000. Obesity was more prevalent among Saudi patients (63.8%) than among Egyptian patients (48.6%) (p-value = 0.019). Fewer Egyptians (about 65%) suffered from dyslipidemia than Saudis (about 80%). Higher INR and longer prothrombin times were observed in Egyptians (29.9% and 29.1%, respectively) than in Saudis (20.3% and 18.8%, respectively), with a significant difference between the two nations (p-value < 0.050). Conclusions: We may conclude that diabetes in most patients has a negative impact on the development of liver diseases (particularly fatty liver in Saudi patients). In addition, most liver diseases (liver cirrhosis) have a negative influence on the development of DM (more so in Egyptian patients). There is a link between DM and liver disease. In particular, liver cirrhosis and diabetes were found to influence each other. Therefore, correct medication, adherence to treatment, lifestyle modifications, successful cirrhosis control (in patients with liver diseases), and diabetic control (in diabetic patients) could lead to effective management of both diseases. The negative fallouts in the two cases were prompted by obesity, morbid eating, and poor quality of life.

Background: Cardiovascular diseases are common in hemodialysis (HD) patients and cardiovascular mortality is responsible for 50% of overall deaths in these patients. Epicardial fat thickness (EpFT) may be an effective marker for the prediction of cardiovascular diseases in hemodialysis patients. The thickness of EpF can be measured by echocardiography that can accurately estimate the actual amount of EpF. The aim of the current study is to assess the association between EpFT and carotid intima-media thickness (CIMT), left ventricular systolic and diastolic function and left ventricular mass index in patients with chronic kidney disease (CKD) undergoing hemodialysis to clarify the relationships between EpF and cardiovascular disease risk in these patients. Materials and Methods: Forty adult uremic patients from dialysis unit and twenty (age and sex matched) healthy control subjects were included in this study. Clinical evaluation, routine laboratory investigations, echocardiographic study including measurement of EpFT and carotid Duplex to estimate CIMT were done to all subjects. Results: we found highly significant increase in serum C-reactive protein and significant increase in serum phosphorus and triglyceride with significant decrease in serum calcium and high-density lipoprotein cholesterol in hemodialysis patients compared to the controls. Also, there were significant increases in left ventricular mass index, left atrium diameter, carotid intima-media thickness, epicardial fat thickness, peak velocity of the late filling wave due to atrial contraction (A wave) and deceleration time of E wave in hemodialysis patients compared to the controls. There were also highly significant decrease in E/A ratio in hemodialysis patients compared to healthy control subjects. EpFT measured by echocardiography in hemodialysis patients was positively correlated with body mass index, CRP, left atrium diameter, left ventricular mass index, deceleration time and CIMT and negatively correlated with high-density lipoprotein cholesterol and E/A ratio. Conclusion: Hemodialysis patients can be evaluated routinely by echocardiography for early detection of cardiovascular structural and functional changes which are common in these patients and epicardial fat thickness is an effective marker for the prediction of cardiovascular risk in hemodialysis patients.

Sepsis is widely diagnosed In ICU patients. The sepsis markers are numerous with variable sensitivity and specificity. Adiponectin is a protein hormone that is secreted from adipose tissue into the bloodstream. It is a key substance in metabolic syndrome and has an anti-inflammatory property. The relationship between adiponectin and sepsis is unclear. In the current study, we aim to demonstrate that low plasma adiponectin level could be an early predictor for morbidity and mortality of sepsis by its comparison with c-reactive protein, serum lactate and procalcitonine. Thirty patients admitted to the intensive care unit with picture clinically suggesting sepsis were enrolled in the study. Predisposition, insult/infection, response, and organ dysfunction (PIRO) score was used to follow the course of the septic process. Plasma adiponectin level, serum lactate level, procalcitonin level(PCT), c-reactive protein(CRP) were checked on day1 then day 4 then day 7 and so on until ICU discharge or demise for a total of 28 days . PIRO score was able to expect sepsis prognosis with high statistical significance. Procalcitonin, serum lactate and adiponectin were valuable in follow up the sepsis prognosis with P value (0, 0.01 & 0 respectively) on the contrary CRP had poor prognostic value in sepsis follow up (P value 0.16).We conclude that PIRO score is an effective model for staging of sepsis and predict mortality. Measuring serial procalcitonin levels may be the most useful in order to understand the trend, identify the peak, and be able to identify resolution of sepsis. Early high lactate level is a predictor for poor prognosis of sepsis. Adiponectin is similar to procalcitinin in early detection of sepsis & can be used as a prognostic indicator with considering that adiponectin level could be affected by other metabolic disorders.