The Incidence of Bacteremia and Risk Factors of Post-Radiofrequency Ablation Fever for Patients with Hepato-Cellular Carcinoma

Post-radiofrequency ablation (RFA) fever is a self-limited complication of RFA. The correlation between post-RFA fever and bacteremia and the risk factors associated with post-RFA fever have not been evaluated. Patients with newly diagnosed or recurrent hepatocellular carcinoma who underwent ultrasonography-guided RFA between April 2014 and February 2019 were retrospectively enrolled. Post-RFA fever was defined as any episode of body temperature >38.0 °C after RFA during hospitalization. A total of 272 patients were enrolled, and there were 452 applications of RFA. The frequency of post-RFA fever was 18.4% (83/452), and 65.1% (54/83) of post-RFA fevers occurred on the first day after ablation. Patients with post-RFA fever had a longer hospital stay than those without (9.06 days vs. 5.50 days, p < 0.001). Only four (4.8%) patients with post-RFA fever had bacteremia. The independent factors associated with post-RFA fever were younger age (adjusted odds ratio (OR) = 0.96, 95% CI, 0.94–0.99, p = 0.019), low serum albumin level (adjusted OR = 0.49, 95% CI, 0.25–0.95, p = 0.036), general anesthesia (adjusted OR = 2.06, 95% CI, 1.15–3.69, p = 0.015), tumor size (adjusted OR = 1.52, 95% CI, 1.04–2.02, p = 0.032), and tumor number (adjusted OR = 1.71, 95% CI, 1.20–2.45, p = 0.003).

A Diagnostic Value of Serum Level Cyclase-Associated Plasma Protein 2 Versus Alpha Fetoproteins as a novel Biomarker for Detection of Hepato-Cellular Carcinoma in Egyptian Patients with Liver Cirrhosis

Background HCC is the third deadliest and fifth most common cancer worldwide, despite the widespread use of surveillance programs in at risk populations, more than half of HCC cases are diagnosed late, and curative therapies such as surgical resection, radiofrequency ablation or TACE are possible in less than 30% of patients. Objective To assess the value of plasma cyclase-associated protein 2 level in diagnosis of hepatocellular carcinoma among the Egyptian patients with chronic hepatitis c virus. Patients and Methods This study has been carried out in the department of Internal Medicine and Gastroenterology in Ain Shams University Hospitals and Manshiet El-Bakry general hospital, Department of Gastrohepatology. This study evaluate the significance of Plasma CAP2 level as a new diagnostic marker for HCC patients with post hepatitis C liver cirrhosis where (80) persons, divided into three groups; Group A included (30) patients with post hepatitis C liver cirrhosis without HCC, Group B included (40) patients with post hepatitis C liver cirrhosis and HCC, and Group C included (10) healthy subjects as a control group. Results In this study CAP2 was significantly higher in HCC group than in cirrhotic and control groups (p &lt; 0.001) with mean levels (30.7±12.4), (14.4±7.6), and (6.9±4.3) ng/ml respectively although in HCC patients with negative or low AFP levels. This finding could imply the role of CAP2 in diagnosing early and AFP negative HCC patients. Conclusion CAP2 is significantly elevated in HCC group than in cirrhotic and control groups with better sensitivity and specificity than AFP at cut off values ≥15.9 ng/ml and ≥53.2 ng/ml respectively. Such results support using of CAP2 as a better diagnostic marker for HCC. AFP and CAP-2 were higher in multiple lesions than in single lesions, but the differences were significant only in CAP-2 with ≥27.3 ng/ml in differentiating multiple from solitary lesions Considering the HCC if both of them were positive decreased sensitivity but had perfect specificity.

Physicians as viral hepatitis advocates: empowerment through education

Background: Viral hepatitis is the most serious infections due to its asymptomatic nature for a long period and complications like liver cirrhosis and hepato cellular carcinoma. Also, available literatures suggest low vaccination status, poor to moderate knowledge about prevention and management of viral hepatitis. Moving forward, physicians can act as advocates in disseminating the correct knowledge about prevention and transmission of viral hepatitis. With this background one-day training program for physicians was conceptualised under project PRAKASH to educate and empower them about prevention and management of viral hepatitis.Methods: A pre-post study design was undertaken among the physicians who registered themselves for hepatitis induction program. An online link to the knowledge, attitude and practice (KAP) questionnaire consisted of 59 questions of knowledge (35 questions), attitude (12 questions) and practice (12 questions) along with demographic variables was shared with the registered participants. Same knowledge questions were asked during post-test. Paired-t-test and Independent samples t-test were used in analysis using statistical package for the social sciences (SPSS) v-21. Level of significance was taken at p<0.05.Results: A total of 204 clinicians were trained over five training and pre-post was available for 170 participants. The mean knowledge, attitude and practice scores were found to be 25.11±4.85, 50.17±6.86, 20.18±3.90 out of total score of 35, 60 and 24 respectively. Post knowledge score had increased significantly when compared with pre-score. Pre-knowledge score was found significant with experience level.Conclusions: Overall, study observed significant improvement of knowledge among physicians which can be attributable to training program and this program can be up scaled and help in empowering the physicians on various health-related topics across the country.

HAND FOOT SYNDROME ASSOCIATED WITH DRUG SORAFENIB – UNUSUAL HISTOLOGICAL PRESENTATION

A 60-year-old male presented with skin lesions on the limbs of both the extremities, nature of which is hyperchromatic, scaly in nature which was considered as Chronic Lichenoid Dermatoses. The patient was on treatment with Sorafenib for Hepato-Cellular Carcinoma.

Cyclic Peptide Mimotopes for the Detection of Serum Anti–ATIC Autoantibody Biomarker in Hepato-Cellular Carcinoma

Tumor-associated (TA) autoantibodies have been identified at the early tumor stage before developing clinical symptoms, which holds hope for early cancer diagnosis. We identified a TA autoantibody from HBx-transgenic (HBx-tg) hepatocellular carcinoma (HCC) model mouse, characterized its target antigen, and examined its relationship to human HCC. The mimotopes corresponding to the antigenic epitope of TA autoantibody were screened from a random cyclic peptide library and used for the detection of serum TA autoantibody. The target antigen of the TA autoantibody was identified as an oncogenic bi-functional purine biosynthesis protein, ATIC. It was upregulated in liver cancer tissues of HBx-tg mouse as well as human HCC tissues. Over-expressed ATIC was also secreted extracellularly via the cancer-derived exosomes, which might cause auto-immune responses. The cyclic peptide mimotope with a high affinity to anti-ATIC autoantibody, CLPSWFHRC, distinguishes between serum samples from HCC patients and healthy subjects with 70.83% sensitivity, 90.68% specificity (AUC = 0.87). However, the recombinant human ATIC protein showed a low affinity to anti-ATIC autoantibody, which may be incompatible as a capture antigen for serum TA autoantibody. This study indicates that anti-ATIC autoantibody can be a potential HCC-associated serum biomarker and suggests that autoantibody biomarker’s efficiency can be improved by using antigenic mimicry to native antigens present in vivo.

Ensembled liver cancer detection and classification using CT images

Computed tomography (CT) images are commonly used to diagnose liver disease. It is sometimes very difficult to comment on the type, category and level of the tumor, even for experienced radiologists, directly from the CT image, due to the varying intensities. In recent years, it has been important to design and develop computer-assisted imaging techniques to help doctors/physicians improve their diagnosis. The proposed work is to detect the presence of a tumor region in the liver and classify the different stages of the tumor from CT images. CT images of the liver have been classified between normal and tumor classes. In addition, CT images of the tumor have been classified between Hepato Cellular Carcinoma (HCC) and Metastases (MET). The performance of six different classifiers was evaluated on different parameters. The accuracy achieved for different classifiers varies between 98.39% and 100% for tumor identification and between 76.38% and 87.01% for tumor classification. To further, improve performance, a multi-level ensemble model is developed to detect a tumor (liver cancer) and to classify between HCC and MET using features extracted from CT images. The k-fold cross-validation (CV) is also used to justify the robustness of the classifiers. Compared to the individual classifier, the multi-level ensemble model achieved high accuracy in both the detection and classification of different tumors. This study demonstrates automated tumor characterization based on liver CT images and will assist the radiologist in detecting and classifying different types of tumors at a very early stage.