Description: The circadian system has a role in regulating gastrointestinal physiology. Perturbation of this system is associated with gastrointestinal tract dysfunction. Shiftwork and poor sleep quality are associated with functional gastrointestinal disorders among many professional groups. This study compared bowel habits between trainee nurses with regular and irregular patterns of shiftwork. Male and female nursing students, enrolled on the first year (regular shifts; n=49) and the fourth year (irregular shifts, n=48) of a nursing degree course were surveyed. Questionnaires were used to assess functional diarrhea and constipation over a three month period. The prevalence of functional constipation among regular shift workers was lower than that found among irregular shift workers; 31.3% and 61.2%, respectively. There was no difference between the two groups in relation to the prevalence of diarrhea. This suggests an association between shiftwork and functional constipation, but not with functional diarrhea.

Description: Not available

Description: Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide. Most of data came from lower Egypt regions (Cairo and northern to it). So, we decided to study risk factors and prevalence of HCV transmission in our governorate. In this cross sectional study, we recruited 631 blood donors from April, 2011 to March 2012 who were tested for anti-HCV, HBs Ag, anti- HBc and anti-HIV. Fifty seven donors were excluded as they are HBs Ag and anti-HBc positive. We found 138 (24%) HCV seropositive participants. Logistic regression final model demonstrated that endoscopy, hospital admission, socioeconomic status, IV drug use and age made a significant contribution to prediction (P=0.0001). The level of education also made significant contribution to prediction (P=0.014). In conclusion, it is wise to determine high HCV prevalence areas and risk factors for its seropositivity then build up a governorate suitable infection control program concentrating upon prevention more than treatment of HCV patients. Also, the introduction of pre-test and post-test counseling in blood banks will help in better donor selection and early detection of patients.

Description: Serum cholinesterase levels are closely correlated with the severity of liver disease. The aim of the paper was to assess the value of serum cholinesterase in evaluating liver reserve function in cirrhotic patients. 90 patients with liver cirrhosis and thirty healthy control group were included. Liver cirrhosis patients were classified according to child score into three equal groups: Child A liver cirrhosis, Child B liver cirrhosis and Child C liver cirrhosis. Patients were subjected to clinical evaluation, laboratory analysis, abdominal U/S. Measuring serum cholinesterase, and Calculation of both Child and model of end stage liver disease (MELD) scores. The level of serum cholinesterase was higher in control group than the three groups of liver cirrhosis with median (IQR) 17,410 (12,111-21,774), 7528 (5200-9856), 6021 (4500-7542), 3828.5 (1541-6060), respectively P〈0.001). And the level of serum cholinesterase was higher in Child A more than Child B and Child C and the level of serum cholinesterase was higher in Child B more than Child C with very strong negative correlation between serum Cholinesterase level and Child score (r=-0.9, P〈0.001). Also strong negative correlation between serum Cholinesterase level and MELD score (r=- 0.85, P=0.001), and positive correlation with prothrombin concentration (r=0.554, P=0.009), and serum albumin levels (r=0.582, P=0.0002). Serum cholinesterase is a good biomarker of cirrhosis. Since it distinguishes decompensated from compensated cirrhosis well, low levels in cirrhosis may serve as a useful prognostic marker of advanced liver disease.

Description: Small-for-size liver syndrome and posthepatectomy liver failure remain a major challenge for surgeons. Recently, updates in literature points to describe this two syndrome as two face of the same coin. These syndromes are characterized by hyperbilirubinemia, coagulopathy, hyper-GGT, high portal pressure and flow in liver remnant, occurring within the first postoperative week. It can lead to post-operative sepsis and bleeding, increasing mortality and morbidity. Despite the large experience in the field of transplantation, few studies are focused on small-for-size syndrome after major hepatectomy. For years, scientists were focused on the size of liver remnant, supposing a small liver remnant, in relation with the primary liver size, was the cause of the syndrome. The strategies used to prevent it after transplantation, have however shown a predominant role of high portal pressure and flow, leading to an alteration in functional regeneration of liver parenchyma, as the prevalent mechanism. According to these evidences, we suggest adopting another nomenclature for the two syndromes: small-for-flow-liver failure. In this article, we analyze and summarize different experiences, proposing our inward algorithm, including the role of portal flow and pressure measurements. This review seeks to be an operative instrument for surgeons and hepatologists in an effort to find a common point of view regarding small for flow liver failure and its management strategies.

Description: Bouveret's syndrome is a rare cause of gallstone ileus that occurs more often in the elderly and has a female predominance. In this case report we describe a patient with classic risk factors and typical presentation who underwent one-stage surgical repair without complications. Bouveret's syndrome is a diagnosis that requires a high index of suspicion; diagnosis is often delayed. Advances in imaging have improved diagnostic accuracy, but surgical exploration is required in some cases. Although non-invasive methods of treatment have been utilized with some success, surgery remains the treatment of choice for most patients. However, there is still controversy regarding best surgical approach. Choice of treatment may depend on a patient's underlying co-morbidities and surgical risk factor, age, and likelihood of recurrent symptoms. 

Description: Intramural duodenal hematomas (IDA) have rarely been associated with pancreatic diseases. Conservative treatment is recommended but course of disease can be life threatening, serious complications may occur (i.e. duodenal perforation) with imperative surgery. The management of diagnostic and treatment in IDH was improving over the years. Computed tomography (CT) and endoscopic ultrasound (EUS) are excellent tools for diagnosis and follow up of IDH. We report a case of a 31-year-old alcoholic who presented with vomiting, exsiccosis, hypochondriac pain and positive shock index. Esophagogastroduodenoscopy showed gastric outlet obstruction caused by obliterating tumor of bulbus duodeni. Initial suspicion was malign tumor of the duodenum confirmed by native CT and histology. Further diagnostic using EUS-guided aspirate resulted in IDH. By conservative management with nasogastric decompression and digestive rest the patient recovered. In course of disease the hematoma got smaller, but parts were still seen in CT 6 month later.

Description: Desmoid tumours are unique mesenchymal neoplasm. They are able to spread to proximal tissues but tend not to metastasize. Our case presents a 66-year-old female referred for evaluation of the prominent, palpable mass located into the left abdomen. Imaging studies revealed a tumour up to 22 cm, extending below the diaphragm to the retroperitoneal and intra-abdominal cavity. Contrast enhanced ultrasound showed strong inhomogeneous arterial hyper-enhancement followed by persistent enhancement in a venous phase. Histology obtained with tru-cut needle biopsy established desmoid tumour, with overall proliferating activity (Ki-67 expression) of 20%. The lesion had been identified as sporadic and ‘unresectable’. During the patient’s follow-up a slow but continuous elevation of serum creatinine was registered eventually led to anuria, requiring emergent haemodialysis. The non-obstructing nephropathy is an unusual complication of the disease course, therefore we briefly reviewed the published data on abdominal desmoid tumours and critically analysed the relation with kidney injury.

Description: Salmonella Typhi chronically infects the gallbladder and is considered as a predisposing factor for gallbladder cancers. We screen for any Salmonella Typhi isolates present in the gallbladder of 155 patients undergoing cholecystectomy for chronic cholelithiasis in two different regions within the country. Along with microbiological identification, we develop a multiplex PCR assay to speciate the Salmonella spp. Characterisation studies involve determining tolerance to bile, quantifying biofilm forming ability and antibiotic susceptibility testing using disc diffusion assay. Eight (10.66%) of 75 patients (100%) from region in North India (New Delhi) were positive for S .Typhi on culture compared to two (2.5%) of 80 patients from other region in South (Goa). All the isolates had a minimum inhibitory concentration to bile of 4% with minimum bactericidal concentration varying between 4%-6%. Crystal violet assays revealed that the gallbladder isolates showed a quicker and better biofilm masses. Multi-drug resistance (MDR) is common among Salmonella strains but a few gallbladder isolates from the typhoid endemic region possessed a concern with its resistance to fluroquinolones. All the isolates were susceptible to ceftriaxone indicating its possible use in treatment of chronically infected individuals. It was seen that supplementing the media with sub-lethal bile concentrations did enhance the biofilm forming ability of the organism without any significant alterations in the drug resistant patterns. Furthermore, growth in sub-lethal bile concentration also induced similar changes in total protein profiles in all the gallbladder isolates.

Description: Background-Objectives: Due to the lack of effective medical treatment for non-alcoholic steatohepatitis (NASH), we aimed to evaluate new treatment options. In particular, our goal was to investigate and compare the effects of N-acetylcysteine (NAC) and Adalimumab treatment on tumor necrosis factor alpha (TNF-α) and oxidative stress during the development of NASH in a rat model of the disease. Materials and Methods : Our study included a total of 35 female Wistar albino rats that were divided into 5 groups of 7 each, and evaluated over a 6 week period. One group received a normal diet, while the other four groups received a methionine and choline deficient (MCD) diet. One of the groups receiving the MCD diet did not take any medicine, while the other three were administered NAC, adalimumab, or a NAC/adalimumab combination therapy. Results : NASH was successfully established in the MCD diet group. Levels of TNF-α were effectively suppressed in the three groups that received therapy. Even though adalimumab significantly enhanced suppression of TNF-α, the NASH score was suppressed to a more statistically significant extent in the groups receiving NAC. Conclusions : Our study showed that TNF-α and oxidative stress play an important role in NASH pathogenesis. The antioxidant agent, NAC, was found to be superior to the anti-TNF agent, Adalimumab, in the improvement of total NASH score. Although these drugs did not prevent the development of NASH, it was shown that they mildly reverse the NASH histopathology score, suggesting improvement of and overall liver function.