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Le Goallec A, Diai S, Collin S, Prost JB, Vincent T, Patel CJ. Using deep learning to predict abdominal age from liver and pancreas magnetic resonance images. Nat Commun 2022; 13:1979. [PMID: 35418184 PMCID: PMC9007982 DOI: 10.1038/s41467-022-29525-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/18/2022] [Indexed: 11/24/2022] Open
Abstract
With age, the prevalence of diseases such as fatty liver disease, cirrhosis, and type two diabetes increases. Approaches to both predict abdominal age and identify risk factors for accelerated abdominal age may ultimately lead to advances that will delay the onset of these diseases. We build an abdominal age predictor by training convolutional neural networks to predict abdominal age (or "AbdAge") from 45,552 liver magnetic resonance images [MRIs] and 36,784 pancreas MRIs (R-Squared = 73.3 ± 0.6; mean absolute error = 2.94 ± 0.03 years). Attention maps show that the prediction is driven by both liver and pancreas anatomical features, and surrounding organs and tissue. Abdominal aging is a complex trait, partially heritable (h_g2 = 26.3 ± 1.9%), and associated with 16 genetic loci (e.g. in PLEKHA1 and EFEMP1), biomarkers (e.g body impedance), clinical phenotypes (e.g, chest pain), diseases (e.g. hypertension), environmental (e.g smoking), and socioeconomic (e.g education, income) factors.
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Affiliation(s)
- Alan Le Goallec
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA.,Department of Systems, Synthetic and Quantitative Biology, Harvard University, Cambridge, MA, 02118, USA
| | - Samuel Diai
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA
| | - Sasha Collin
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA
| | - Jean-Baptiste Prost
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA
| | - Théo Vincent
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA.
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Warner ER, Aloor FZ, Satapathy SK. A narrative review of nutritional abnormalities, complications, and optimization in the cirrhotic patient. Transl Gastroenterol Hepatol 2022; 7:5. [PMID: 35243114 PMCID: PMC8826036 DOI: 10.21037/tgh-20-325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/08/2021] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE The purpose of this manuscript is to identify the pathophysiology of the metabolic abnormalities observed in cirrhosis and to uncover associations, if any, to its complications, such as sarcopenia and hepatic encephalopathy (HE). BACKGROUND Liver dysfunction in cirrhosis is known to be a precipitating factor in the disruption of many physiological pathways, specifically nutrient metabolism. As a result, affected patients are highly susceptible to derangements of processes affecting multiple classes of macro- and micronutrients, including proteins, carbohydrates, electrolytes, vitamins, and minerals. These disruptions are thought to be contributory to the pathogenesis of known complications of cirrhosis. METHODS Literature research of relevant topics was conducted for the above stated objective; sources were limited to articles from peer-reviewed journals published within the last 30 years. CONCLUSION This research established that there is positive correlation between nutrient derangements and the increased risk of complications of cirrhosis, which themselves carry significant morbidity and mortality risk. It also established that some nutrient and electrolyte abnormalities are independent indicators of prognosis and adverse outcomes, such as mortality. This also highlights the importance of comprehension of anomalous metabolism and its complications as it necessitates serious consideration in clinical care. In addition to medical management, cirrhotic patients also require ancillary assessment, such as comprehensive nutritional evaluation, to identify and treat reversible nutritional derangements. This consideration provides the best opportunity to achieve maximal health outcomes in the cirrhotic patient population.
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Affiliation(s)
- Edgewood R. Warner
- Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, Manhasset, NY, USA
| | | | - Sanjaya K. Satapathy
- Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases and Transplantation, Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, Manhasset, New York, USA
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Association of weight change in young adulthood with subsequent risk of hepatocellular carcinoma: a national cohort study. Eur J Cancer Prev 2021; 30:211-219. [PMID: 32925510 DOI: 10.1097/cej.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Risk of hepatocellular carcinoma (HCC) in young adults might be clinically overlooked for future HCC risk. Thus, we examined the association between weight change and future risk of developing HCC in young adults. We collected a nationwide and population-based cohort data of more than 2.2 million men and women aged between 20 and 39 who were without previous cancer diagnosis and underwent two consecutive biennial national health screening between 2002 and 2005 from the National Health Insurance Service database. The individuals were categorized as weight loss (≥5.0 kg and 2.0-4.9 kg), stable weight (weight gain or loss <2.0 kg), and weight gain (2.0-4.9 kg and ≥5.0 kg) and were followed-up for incident HCC from 1 January 2006 to 31 December 2018. During 12 years of follow-up, there were 2694 HCCs in men and 306 HCCs in women. In the multivariable Cox proportional hazards model adjusted for socioeconomic, health behavior, medical characteristics, and family history, weight gain of more than 5.0 kg and between 2.0 and 4.9 kg were associated with significantly increased risk in young men [hazard ratio (HR) 1.16, 95% confidence intervals (95% CI) 1.01-1.32] and young women (HR 1.34, 95% CI 1.01-1.77), respectively. Protective association of weight loss with HCC was not observed. The association of weight gain and HCC risk was stronger in young adults with underlying liver diseases compared to those without any liver disease (Pheterogeneity < 0.001). Weight gain during young adulthood should not be clinically overlooked for future HCC risk, especially among those with underlying liver diseases.
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Almeida LL, Pitombeira GSGN, Teixeira ÁAC, Teixeira VW, Silva Júnior VA, Vieira Filho LD, Evêncio Neto J. Protective effect of melatonin against herbicides-induced hepatotoxicity in rats. Toxicol Res (Camb) 2021; 10:1-10. [PMID: 33613967 DOI: 10.1093/toxres/tfaa087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 12/21/2022] Open
Abstract
Exposure to the herbicides Paraquat and Roundup® may cause cell lesions due to an increase in oxidative stress levels in different biological systems, even in the liver. The aim of this study was to analyze the effect of melatonin on liver of rats exposed to herbicides. A total of 35 rats were randomly divided into seven equal-sized groups: control, Paraquat, Roundup®, Paraquat + Roundup®, Paraquat + melatonin, Roundup® + melatonin, and Paraquat + Roundup® + melatonin. Samples of blood and hepatic tissue were collected at the end of the seventh day of exposure and treatment with melatonin. Body weight, hematological parameters, and histopathological, biochemical analyses and determination of oxidative stress levels in liver were evaluated. Body weight was compromised (P < 0.01). Alterations of hematologic parameters were significant when compared to control (P < 0.001). Biochemically, serum levels of albumin decreased (P < 0.001), but serum levels of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase increased (P < 0.001). Histopathology revealed necrotic hepatocytes, portal and central-lobular inflammatory infiltrate, congestion of capillaries. Serum levels of thiobarbituric acid reactive substances were found to be significantly elevated (P < 0.05; P < 0.001), and serum level of reduced glutathione was significantly lower (P < 0.05; P < 0.001). The groups treated concomitantly with melatonin revealed results similar to those of the control. However, melatonin acted as a protective agent for the liver against experimentally induced hepatic toxicity, promoting prevention of body weight, oxidative stress, and normalization of hematological and biochemical parameters.
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Affiliation(s)
- Lécio Leone Almeida
- Department of Biological Sciences, Regional University of Cariri, Rua Coronel Antônio Luís 1161, Pimenta, Crato, CE 63105-000, Brazil
| | - Giovanna Silva Girão Nobre Pitombeira
- Postgraduate Program in Biological Diversity and Natural Resources, Regional University of Cariri, Rua Coronel Antônio Luís 1161, Pimenta, Crato, CE 63105-000, Brazil
| | - Álvaro Aguiar Coelho Teixeira
- Department of Animal Physiology and Morfology, Federal Rural University of Pernambuco, Rua Manuel de Medeiros s/n° Dois Irmãos, Recife, PE 52171-900, Brazil
| | - Valéria Wanderley Teixeira
- Department of Animal Physiology and Morfology, Federal Rural University of Pernambuco, Rua Manuel de Medeiros s/n° Dois Irmãos, Recife, PE 52171-900, Brazil
| | - Valdemiro Amaro Silva Júnior
- Department of Veterinary Medicine, Federal Rural University of Pernambuco, Rua Manuel de Medeiros s/n° Dois Irmãos, Recife, PE 52171-900, Brazil
| | - Leucio Duarte Vieira Filho
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Av. da Engenharia Cidade Universitária, Recife, PE 50670-901, Brazil
| | - Joaquim Evêncio Neto
- Department of Animal Physiology and Morfology, Federal Rural University of Pernambuco, Rua Manuel de Medeiros s/n° Dois Irmãos, Recife, PE 52171-900, Brazil
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da Silva BS, Paulino AMB, Taffarel M, Borba IG, Telles LO, Lima VV, Aguiar DH, Dias MC, Nascimento AF, Sinhorin VDG, Luvizotto RDAM, Bomfim GF. High sucrose diet attenuates oxidative stress, inflammation and liver injury in thioacetamide-induced liver cirrhosis. Life Sci 2020; 267:118944. [PMID: 33359749 DOI: 10.1016/j.lfs.2020.118944] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 12/20/2022]
Abstract
AIMS Liver cirrhosis is the main chronic liver disease and is considered a catabolic disease. Cirrhotic patients have a low energy intake and high energy expenditure at rest, leading to metabolic disorders. Malnutrition is associated with complications of cirrhosis and has been shown that a nutritional intervention with increase of energy intake improves the survival of cirrhotic patients. Therefore, our aim was to evaluate the effect of a high sucrose diet in the liver of animals with cirrhosis induced by thioacetamide and investigate the mechanism involved. MAIN METHODS Male Wistar rats were divided into three groups: Control; Thioacetamide; and Thioacetamide + high sucrose diet. The thioacetamide was administrated (100 mg kg-1) intraperitoneally and the sucrose was offered in drinking water (300 g L-1). KEY FINDINGS The administration of thioacetamide was associated with fibrosis and inflammatory infiltrate in the liver and increased levels of transaminases enzymes. The high sucrose diet promoted a reduction of theses parameters in cirrhotic rats. The malnutrition observed in cirrhotic rats was attenuated by the high sucrose diet shown by the improvements in weight loss, subcutaneous fat, and caloric intake. The high sucrose diet also attenuated the oxidative stress present in the liver of animals with thioacetamide-induced cirrhosis. SIGNIFICANCE The high sucrose diet had anti-inflammatory and anti-oxidant effects in the liver of animals with thioacetamide-induced cirrhosis. In addition, the high sucrose diet also improved malnutrition and catabolism present in cirrhosis. Thus, a high sucrose diet may be a therapeutic option for cirrhotic patients in a catabolic state.
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Affiliation(s)
- Bianca Sulzbacher da Silva
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil
| | - Angélica Macedo Borgês Paulino
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil
| | - Maiara Taffarel
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil
| | - Ian Gabriel Borba
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil
| | - Luciana Ortega Telles
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil
| | - Victor Vitorino Lima
- Institute of Biological and Health Sciences, Federal University of Mato Grosso, Barra do Garças, MT, Brazil
| | - Danilo Henrique Aguiar
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil
| | - Marcos Correa Dias
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil
| | - André Ferreira Nascimento
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil
| | | | - Renata de Azevedo Melo Luvizotto
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil
| | - Gisele Facholi Bomfim
- NUPADS - Health Education and Research Center, Institute of Health Science - Federal University of Mato Grosso, Sinop, MT, Brazil.
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Comparing the effects of whey and casein supplementation on nutritional status and immune parameters in patients with chronic liver disease: a randomised double-blind controlled trial. Br J Nutr 2020; 125:768-779. [PMID: 32807252 DOI: 10.1017/s0007114520003219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Protein supplementation may be beneficial for patients with chronic liver disease (CLD). This study compared the effects of whey protein isolate (WP) and casein (CA) supplementation on nutritional status and immune parameters of CLD patients who were randomly assigned to take 20 g of WP or CA twice per d as a supplement for 15 d. Body composition, muscle functionality and plasmatic immunomarkers were assessed before and after supplementation. Patients were also classified according to the model for end-stage liver disease (MELD) into less (MELD < 15) and more (MELD ≥ 15) severe disease groups. Malnutrition, determined by the Subjective Global Assessment at baseline, was observed in 57·4 % and 54·2 % of patients in the WP and CA groups, respectively (P = 0·649). Protein intake was lower at baseline in the WP group than in the CA group (P = 0·035), with no difference after supplementation (P = 0·410). Both the WP and CA MELD < 15 groups increased protein intake after supplementation according to the intragroup analysis. No differences were observed in body composition, muscle functionality, most plasma cytokines (TNF, IL-6, IL-1β and interferon-γ), immunomodulatory proteins (sTNFR1, sTNFR2, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor) or immunomodulatory hormones (adiponectin, insulin and leptin) after supplementation in the WP groups at the two assessed moments. WP supplementation increased the levels of interferon-γ-induced protein-10/CXCL10 (P = 0·022), eotaxin-1/CCL11 (P = 0·031) and monocyte chemoattractant protein-1/CCL2 (P = 0·018) and decreased IL-5 (P = 0·027), including among those in the MELD ≥ 15 group, for whom IL-10 was also increased (P = 0·008). Thus, WP consumption by patients with CLD impacted the immunomodulatory responses when compared with CA with no impact on nutritional status.
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Welch N, Dasarathy J, Runkana A, Penumatsa R, Bellar A, Reen J, Rotroff D, McCullough AJ, Dasarathy S. Continued muscle loss increases mortality in cirrhosis: Impact of aetiology of liver disease. Liver Int 2020; 40:1178-1188. [PMID: 31889396 PMCID: PMC7195232 DOI: 10.1111/liv.14358] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/19/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Sarcopenia or skeletal muscle loss adversely affects outcomes in cirrhosis. The impact of aetiology of liver disease on the severity or the rate of muscle loss is not known. METHODS Consecutive, well-characterized adult patients with cirrhosis due to viral hepatitis (VH), alcoholic liver disease (ALD) or non-alcoholic fatty liver disease (NAFLD) and non-diseased controls with at least two temporally distinct abdominal CT (computed tomography) scans were evaluated. Psoas, paraspinal and abdominal wall muscle areas at the L3 vertebra level were quantified on the CT scans. Standardized rate of change in muscle area was expressed as change in area/100 days. Univariate and multivariable analyses were performed to identify contributors to rate of muscle loss and survival. RESULTS Among 83 cirrhotics (NAFLD n = 26, ALD n = 39, VH n = 18), there were 20 (24.1%) deaths over 62.7 ± 41.3 months. The mean percentage change in psoas area was -0.03 ± 0.05/100d in controls and -3.52 ± 0.45/100d in cirrhosis (P < .001). The mean percentage change in psoas area was -1.72 ± 0.27/100d in NAFLD, -5.28 ± 0.86/100d in ALD and -2.29 ± 0.28/100d in VH. Among cirrhotics, patients with ALD had the lowest initial muscle area and most rapid rate of reduction in muscle area. Aetiology of liver disease, model for end-stage liver disease (MELD) and the rate of loss of muscle area were independent risk factors for survival. CONCLUSIONS Aetiology of liver disease is an independent risk factor for sarcopenia with the greatest rate of muscle loss noted in ALD. Survival in cirrhosis was dependent on initial muscle mass, rate of muscle loss and MELD score.
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Affiliation(s)
- Nicole Welch
- Departments of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio,Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
| | | | - Ashok Runkana
- Department of Cardiology, West Virginia University Hospitals, Morgantown, West Virginia
| | - Revathi Penumatsa
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
| | - Annette Bellar
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
| | - Jaspreet Reen
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Rotroff
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Arthur J. McCullough
- Departments of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Srinivasan Dasarathy
- Departments of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio,Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
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Shousha HI, Abdelaziz RA, Azab SM, Khairy M, Afifi SA, Mehrez MI, Eshra MA, Abdelrahim AY. Effect of treatment with direct acting antivirals on body mass index and hepatic steatosis in chronic hepatitis C. J Med Virol 2018; 90:1099-1105. [PMID: 29469217 DOI: 10.1002/jmv.25062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 02/03/2018] [Indexed: 12/21/2022]
Abstract
Direct Acting Agents (DAAs) have high cure rate but still lack the knowledge of their effect on hepatic steatosis in chronic hepatitis C (CHC). Controlled Attenuation Parameter (CAP), evaluated with transient elastography, could help in assessment of steatosis grades. We aim to evaluate the effect of DAAs on BMI and steatosis in CHC using CAP. This cohort study included 155 CHC Egyptian patients divided into three groups according to the DAAs regimens. All patients were subjected to pre-treatment and 3-months post-treatment evaluation including BMI, laboratory workup and liver stiffness measurement with simultaneous CAP determination using the (FibroScan®) M probe. Patients mean age was 45.78 ± 11.6 years, 60.6% were females, mean BMI 26.63 ± 2.75 and 18.1% were cirrhotic. Baseline assessment revealed no steatosis in 43.9%, 32.9% had mild-moderate steatosis and 23.2% had severe steatosis. The overall sustained virological response 12 was 93.6%. Follow-up revealed stationary steatosis in 56.7% of patients and regression in 21.3%. Mean pre-treatment CAP were significantly lower in responders 244.9 ± 62.4 dB/m versus non-responders; 300 ±28.4 dB/m (P = 0.04). ROC curve delineated 273 dB/m as best cutoff for detection of responders with an AUC of 0.801, sensitivity 68.2%, and specificity 100%. BMI significantly increased after treatment (P = 0.004) particularly in patients with worsened steatosis (P = 0.001). Steatosis significantly correlated with BMI (r = 0.3, P value = < 0.001). DAAs causes a significant change in steatosis grade in a subset of treated patients. Pretreatment CAP was significantly lower in responders. BMI significantly increases following treatment particularly in patients with worsened steatosis.
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Affiliation(s)
- Hend I Shousha
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rasha A Abdelaziz
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherief M Azab
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Khairy
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shahira A Afifi
- Heliopolis Hospital for Armed Forces Officers' Families, Cairo, Egypt
| | - Mai I Mehrez
- National Hepatology and Tropical Medicine Institute, Cairo, Egypt
| | - Mohamed A Eshra
- Physiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Y Abdelrahim
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
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