Background: Bacterial infection is related with poor outcome, but often full of diagnostic difficulties in cirrhotic patients. The role of clinical parameters such as systemic inflammatory response syndrome, leukocyte count, neutrophil count, and other markers remains unclear in liver cirrhosis patients. Aim: The aim of this study was to evaluate the usefulness of inflammatory markers and determined which markers were best for the diagnosis of infection in decompensated cirrhotic patients. Methods: This was a diagnostic study consisted of 80 cirrhotic patients admitted to Sanglah general hospital, Denpasar from August 2014 until July 2015. The presence of infection was evaluated. Markers of infection consist of leukocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP) and resistin were measured. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined. Results: Twenty patients (25%) had bacterial infections and spontaneous bacterial peritonitis (SBP) was the most common infections occurred. NLR, CRP, and resistin were higher in bacterial infections group (p < 0.05). Multiple logistic regression analyses showed that CRP and resistin were predictive factor for occurrence of bacterial infections (p < 0.05). For the diagnosis of infection, baseline CRP – using a 11.65 mg/L cut-off value - and resistin – using a 13 ng/mL cut-off value - generated area under the receiver operating characteristic (ROC) curve of 0.796 and 0.787, respectively. The sensitivity, specificity, PPV, and NPV for CRP were 90%, 73%, 52.9%, and 95.7%, respectively. For resistin, the sensitivity, specificity, PPV, and NPV were 90%, 59%, 41.9%, and 94.6% respectively. Conclusions: The present study suggests moderate to high accuracy for CRP and resistin as a diagnostic aid for bacterial infections in liver cirrhosis.

Background: Chronic Hepatitis B (CHB) affects 240 million people worldwide and is responsible for 686000 deaths annually due to its major complications. The World Health Organization (WHO) reported Syria as intermediate in the prevalence of CHB among the general population. However, no previous data was published about HBsAg-prevalence among pregnant women in this country. Objective: To determine the prevalence of Hepatitis B Surface Antigen (HBsAg) among the pregnant women admitted to one of the two main centers of obstetrics and gynecology in Damascus, Syria. Methods: A cross-section study included 794 participants who were evaluated using a pretested structured questionnaire and then were screened for HBsAg using the fourth generation of ELISA. Results: Six of all participants (0.75%) had a positive test for HBsAg. Hepatitis b vaccine has been introduced to the National Immunization Program for newborn and infants in Syria since 1994. We classified the recruited pregnant women into two age groups: (≤ 21) and (>21) years old. This classification correlates to the year of introducing the vaccine. All positive HBsAg tests were among the women older than 21 years (1.13%, p=0.186). The multivariate analysis using log-regression test showed that only the previous knowledge about Hepatitis B virus (HBV) was found to be a negative factor regarding the presence of HBsAg (P=0.003). Conclusion: The prevalence of HBsAg among the pregnant women admitted to an obstetrics and gynecology center in Damascus, Syria was 0.75%. The study emphasizes the importance of raising the level of awareness about HBV in the Syrian society with the need to conduct further studies in high-risk groups to determine precise risk factors of transmitting HBV infection.

Aim: There is an emerging problem of over-nutrition (ON) and associated complications in developing countries. However, data are limited on the size of the problem in primary school children, particularly those in non-urban areas, and on the trend in Nigeria. The study aimed at determining the prevalence of ON and elevated blood pressure (EBP), and the association between them among primary school children in non-urban areas. Materials and Methods: 1187 school children aged 6-11 years were recruited through multistage sampling. Their body mass index (BMI) and blood pressures were determined and classified using standard methods. The statistical significance of the difference between groups was determined using Yates' corrected χ² test or Fisher exact test as appropriate, with the level of significance set at p <0.05. Results: A total of 48 (4.0%) pupils had ON, and 69 (5.8%) EBP while 10 (0.8%) had both. The OR (95% CI) of hypertension in obese versus normal pupils was 28.59 (10.09, 80.99), p <<0.001). The OR (95% CI) of EBP in overweight or obese pupils (10/58, 17.2%) versus normal, thin or severely thin pupils (69/1129, 6.1%) was 3.2 (1.55, 6.60), p = 0.007. Conclusion: The prevalence of ON and EBP among primary school pupils in non-urban areas are low but EBP is associated with obesity. Therefore, early intervention and preventive measures for over-nutrition which include increase in physical activity and reduction of sedentary lifestyle among others should be in place as part of the School Health Programme and community-based program. This could greatly limit the further emergence and reduce the associated burden of over-nutrition.

Aims: Whilst it is well established that liquid enteral feeds can effectively bring Crohn's disease into remission, it is still not clear as to the role that foods play in inducing symptoms. We aimed to review food related symptoms in children once disease was in remission following treatment with liquid enteral feed (the first line treatment for children presenting to our unit with Crohn's) with or without immunosuppressive treatment. Methods: Children with Crohn's disease, presented between 2000-2005 and treated with liquid enteral feeds were reviewed. Paediatric Crohn's disease activity index (PCDAI), site of disease, and indicators of an allergic predisposition (atopy, non-food allergies) and results of blood tests for IgE and specific IgE to foods were recorded. Children were treated with liquid enteral feeds (E028 extra or Modulen) for 6-8 weeks then foods were individually introduced at 3-day intervals and foods that induced symptoms were avoided and reintroduced at later date. Results: 16 of the 49 children had food related symptoms. Abdominal pain was the most common problem (12 cases). 10 of the 49 were atopic and all 10 had food related symptoms. 13/49 had raised total IgE and 3 of 21 positive specific IgE. Foods most commonly causing symptoms were milk products, wheat, egg, Soya, potatoes. PCDAI ranged from 0-18 (mean 5.8). 24 male (49%), 25 female (51%), aged 5-16 years (mean 15) were included in this study. Conclusion: Food-associated symptoms occur in Crohn's children when re-starting a normal diet after a period of treatment with liquid enteral feeds. Atopic children are highly likely to develop food related symptoms and affected all atopic children in this study. Foods most commonly causing symptoms were milk, wheat, egg, Soya and potatoes. Individual reintroduction of food with dietician support is helpful if food-associated symptoms are to be detected.

Anti-TNFα has reported an enormous Progress in the management of chronic inflammatory bowel disease, but this therapy is not without side effects. Infectious risk is the main side effect, especially tuberculosis. Hence the need for a pre-therapeutic assessment before starting the treatment. Materials and methods: These are two cases of tuberculosis complicating the treatment with anti-TNFα in patients monitored for crohn's disease. RESULTS: Two men followed for Crohn's disease with indication of anti-TNFα biotherapy, who had a complete phthisiological assessment with negative quantiFERON. Both patients showed respiratory signs with fever after the attack treatment. Imaging showed an appearance of tuberculous miliary disease in both patients. The search for mycobacteria was negative. The anti-TNFα treatment was interrupted with the introduction of an anti-bacillary treatment. Conclusion: Treatment with anti-TNFα requires careful attention, so following the recommendations is fundamental, with rigorous monitoring throughout the treatment period, since a normal pre-therapeutic assessment including a negative quantiFERON does not eliminate a potential risk.