Epidemiologic Profile and Predictors of Fatty Liver: A Hospital-Based Study

Background:Non-alcoholic fatty liver is the most common cause of chronic liver disease with increasing prevalence globally.Settings and Design:The current study is an analytical case control study; conducted in ultrasonography outpatient clinic of Cairo University Hospital.Materialsand Methods:150 consented fatty liver cases and 564 controls were screened for fatty liver infiltration using abdominal ultrasonography. Receiver Operating Characteristics (ROC) curve analysis was performed to explore the discriminant ability of the developed model.Results:Among cases, Age, sex and residence matching contributes 32.7%, 36% and 31.3% mild, moderateand severe degree of fatty liver respectively. Cases showed significantly higher body mass index(BMI), waist circumference (WC), total cholesterol, triglyceride, low density lipoprotein(LDL), and lower high density lipoprotein (HDL) than controls. Casesdemonstrated higher prevalence of hypertension(11.3%vs 8.3% respectively), and significantly higher prevalence of diabetes(22% vs. 9.2%)(p=0.03).Severe fatty liver cases were significantly older and had significantly higher WC, BMI, significantlyhigher association with diabetes mellitus, significantly higher levels of total cholesterol, triglycerides and LDL than non-severe degree cases. The significant predictors of sever fatty liver were BMI, total cholesterol and LDL (P = <0.001, R2= 0.543).Conclusion:The developed regression equation expressed good validation and calibration. It utilizes an algorithm that can quickly and easily address patients with fatty liver. It would useful as a fast, inexpensive primary screening tool for severe fatty liver.

Rates of Neonatal Morbidity and Mortality in the Neonatal Intensive Care Unit at Alexandria University Children's Hospital: one year study

Objectives: To determine the rates of neonatal morbidity and mortality in neonatal intensive care unit of Alexandria University Children's Hospital

Study Design: Hospital records of neonatal admissions at neonatal intensive care unit [NICU] of Alexandria University Children's Hospital [AUCH] from 1st January 2012-31[st] December 2012 were analyzed retrospectively. Percent neonatal mortality and morbidity were calculated from the record, along with the causes of neonatal morbidity. The data were collected and statistically analyzed

Results: Out of 2063 neonates, 1098 [53.2%] were males while 965 [46.8%] were females with a male to female ratio of 1.3: 1. Majority, 1633 out of 2063 [79.2%], of the neonates was admitted during the 1st day of their life, mean age 2 days. Of total neonates included in the study 635 neonates [30.8%] died during their hospital stay. Significant risk factors [P<0.05] associated with neonatal mortality were: Caesarean delivery, multiple births, maternal infection, neonatal respiratory distress, prematurity, and low birth weight [LBW]. The mortality rate decreased with the increase in birth weight, as well as gestational age. Prematurity, neonatal jaundice, Respiratory distress and sepsis were the most common causes of neonatal morbidities contributing 70.4%, 70%, 65.4% and 48.2% respectively. Overall mortality was 30.8%.Th e three most common causes of neonatal mortalities were Respiratory distress [29.2%], Prematurity [27.8%] and neonatal sepsis [23.1%]

Conclusion: Majority of patients were admitted in the first day of life which indicates that improvement in the prenatal, natal and nursery care as a whole can reduce the neonatal mortality and morbidity in preterm as well as full term neonates

Adult intussusception. An overlooked diagnosis in the emergency department

To study the appropriate method of diagnosis and management in adult intussusception [AI] focusing on the clinical manifestations, diagnostic tools, and management of this rare disease. This retrospective study reviewed and analyzed the demographic data, clinical features, diagnosis, management, and pathology reports of all adult patients [18 years of age and older] with a diagnosis of intussusception admitted to Sohag University Hospital, Sohag, Egypt, and Najran Armed Forces Hospital, Najran, Kingdom of Saudi Arabia [KSA] from January 2004 to August 2012. From 2004-2012, 14 patients with AI were diagnosed and treated. Ages ranged from 22-63 years. Ten patients [71.4%] were males. Thirteen patients [92.9%] presented with abdominal pain. All patients were diagnosed after a CT scan, and confirmed at laparotomy. The lead point was found in all, except for 2 patients. Ileo-ileal and jejuno-jejunal intussusceptions represented most of our cases [64.3%], followed by ileocolic [28.5%], and colocolic [7.1%]. The most common causes were Peutz-Jeghers polyps [5 cases], submucosal lipoma [2], and malignancy [2]. Surgery was the treatment option in all except one patient. Postoperative complications occurred in 3 cases [21.4%]. One patient died 28 days postoperatively due to septic shock and multiorgan failure. Owing to its rarity, AI needs a high index of suspicion especially in patients attending ERs with recurrent abdominal pain. A CT scan is of prime importance in the diagnosis, and surgical treatment is the preferred method of management

Postoperative epidural analgesia: trials of bupivacaine combined with fentanyl or morphine after spinal fusion surgery

Background: major spinal fusion surgery causes severe postoperative pain, which persists for at least 3 days. Efficient and safe methods for postoperative analgesia after spinal fusion surgery are, therefore, mandatory. This study aimed to compare the analgesic effect of different epidural analgesia combinations and their effects on blood level of Beta-endorphin. We also studied the impact of these analgesic regimens on defined postoperative mobilization maneuvers and on patient satisfaction

Methods: This study was registered in clinical trials number NCT01838707. Sixty patients scheduled for elective posterior lumbar fusion surgery for correction of Spondylolisthesis were enrolled in this study. Patients were randomly allocated into three equal groups [20 each] according to analgesic drugs combinations administered through epidural catheter inserted intraoperatively. All patients received standard general anesthesia. Al the end of posterior instrumentation, the surgeon inserted the epidural catheter under direct vision in the midline. All patients in this study were nursed in a high dependency intensive care facility and received analgesics according to the following protocol. Continuous drug flow will be maintained with a syringe pump. The syringe pump was connected to the epidural catheter [with the reservoir contain either: 0.125% Bupivacaine HCI at flow rate of 4 5 ml/h [5-6.25mg/h bupivacaine]. 0.125% Bupivacaine HCI fentanyl 100 microg at flow rate of 3 5 ml/h [3.75-6.24 mg/h bupivacaine I 6-10 microg /h fentanyl] 0.125% Bupivacaine HCI morphine sulphate 3 mg at flow rate of 3 5 ml/h [3.75-6.24 mg/h bupivacaine 0.18-0.3 mg/h morphine]. Infusion was continued until the third postoperative day. The rate was increased if pain VAS >3 [visual analogue scale] at rest or VAS >6 with movement. The rate was decreased when patients have intolerable relevant motor block [Bromage score >0] or sensory disturbances [numbness], or hypotension [systolic blood pressure <90 mm Hg]. IV rescue analgesia will be Ketrolactromethamine 30 mg. Epidural catheters were removed on the third postoperative day. Pain was assessed using the VAS ranging from "0" [no pain] to "10" [worst imaginable pain]. Pain was evaluated at rest and during mobilization. Maneuvers of particular clinical importance for postoperative mobilization [alone and with help] were chosen: Turning in bed. Standing in front of the bed and walking, and using the toilet without help. The time needed until the patient can first successfully perform these maneuvers was documented. Three venous samples to measure serum B-endorphin level first one preoperative base line, second at first time VAS more three at rest and third sample when VAS less than three at rest. For assessment of patients satisfaction with postoperative pain management a verbal rating score was used. Motor block was quantified with the Bromage scale. Patients will be asked about sensory deficits. Verbal rating scores was used for sedation. Nausea and vomiting and the incidence of pruritus were recorded

Results: There were no significant differences observed between the studied groups regarding patient characteristics [age, sex, ASA status, anesthesia time, surgery duration and number of segments fused]. There were no significant differences in all hemodynamic variables between the three groups, the results of this study showed less pain scores as recorded by VAS all over the study time for group 3 [bupivacaine+ morphine]. Pain scores were lowest for group Ill [bupivacaine + morphine] all over the study time when testing pain during movement. The mean times to turn in bed with and without assistance were lowest in group Ill [bupivacaine morphine]. B-endorphin level, there was no significant differences between means of B-endorphin samples between the groups or within each group. Patients were more satisfied in group 3 all over the study period. The incidence of nausea, vomiting or itching within the observation period was significantly different between the three groups. It was more common in the bupivacaine morphine group

In Conclusion: Epidural analgesia after spine surgery improve pain control and enhance functional recovery, but potential cost issues related to maintenance of the epidural infusion and ICU slay versus potential cost savings in hospital stay and effect on long term outcome must be considered. Also the cost of use B-endorphin as a biomarker of pain severity needs to be revised against the subjective assessment of pain

Rectus abdominis endometriosis. A descriptive analysis of 10 cases concerning this rare occurrence

To report 10 cases of rectus abdominis endometrioma, emphasizing the clinical presentations, imaging investigations, cytohistological findings, and surgical treatment employed. This is a descriptive analysis of 10 surgically-proven cases of rectus abdominis muscle endometriosis, seen over a 5-year period from 2007 to 2012 at Sohag University Hospital, Sohag, Egypt and Najran Armed Forces Hospital, Najran, Saudia Arabia. All patients had undergone ultrasonography. Computerized tomography [CT] and magnetic resonance imaging [MRI] were performed in some cases. Surgical excision was the way of treatment in all patients. This study was carried out in 10 women with a mean age of 33.9 years. Nine cases had previous history of cesarean section [CS] while one patient had laparoscopy converted to laparotomy for ovarian cyst. All patients were presented with abdominal pain but only 3 had a palpable mass. Ten lesions within the rectus abdominis muscle were detected with automated ultrasound and MRI depicted one lesion, which was missed by ultrasound in a patient who had 2 concomitant lesions. Preoperative fine needle aspiration [FNA] was carried out in 2 patients. Wide surgical excision was performed in all cases. Histopathology was confirmatory in each instance. No complications or recurrence were recorded on follow-up [6-24 months; mean 13.2 months]. This disease is not as rare as previously thought, and should be included in the differential diagnosis of abdominal wall masses in reproductive-age females

Magnitude and risk factors for burnout among primary health care physicians in Asir province, Saudi Arabia

Job-related burnout is an occupational hazard for health care professionals. This study aimed to determine the prevalence of burnout and its associated factors among physicians working at primary health care centres in Asir province, Saudi Arabia. In a cross-sectional survey applying the Maslach Burnout Inventory [MBI] with standard cutoffs, 29.5% of respondents reported high emotional exhaustion, 15.7% high depersonalization and 19.7% low personal accomplishment, with 6.3% scoring high in all 3 dimensions. High emotional exhaustion score was associated with younger age, Saudi nationality and salary 15 000-20 000 SR. Physicians who had more working days and those who had longer duration of annual vacation were less likely to report emotional exhaustion. High depersonalization score was associated with Saudi nationality, working for 5-15 years and salary > 20 000 SR. Low personal accomplishment score was associated with younger age, non-Saudi nationality, working for >/= 5 years and more annual vacation

Effect of aluminum on the histological structure of rats' cerebellar cortex and possible protection by melatonin

Aluminum [AL] is toxic to the central nervous system, and melatonin [MEL] reduces lipid peroxidation by its antioxidant activity. This study was carried out to investigate the histological changes in the cerebellar cortex of rats after AL treatment and to detect any possible protective role of MEL when given concomitantly with AL. This study used 50 adult male albino rats, randomly divided into five equal groups. Group I: control group; group II: received daily intraperitoneal [i.p.] injection of 1/2 ml 0.9% saline containing 2% ethanol; group III: received daily i.p. injection of MEL at 10 mg/kg bw dissolved in 1/2 ml 0.9% saline plus 2% ethanol; group IV: received daily i.p. injection of aluminum chloride at 10 mg/kg bw dissolved in 1/2 ml saline; group V: received both AL and MEL. After 2 months of treatment, the cerebellum was dissected out from each animal and was processed for light and electron microscopic studies. Morphometric and statistical analysis were conducted. After AL administration, the cerebellum exhibited significant reduction in the number of Purkinje cells and prominent peri neuronal spaces in the molecular layer around basket and stellate cells. Ultrastructurally, some of the few encountered Purkinje cells were shrunken with dense cytoplasm, ill-distinct nuclei, and swollen mitochondria with ruptured membranes and cristae. Granule cells revealed increased condensation of their nuclear chromatin. Concomitant administration of MEL with AL displayed an observable protection against these changes. MEL may have a protective role against AL-induced cerebellar toxicity

Total phenolic content and versatile biological activity of some selected widely consumed Egyptian vegetables'extract

Ethanolic extract as well as essential oils of parsley [Petroselinum crispum], Coriander [Coriander sativum] and dill [Anethum graveolens L.] were subjected for biological evaluation. Thus, these extracts and vegetables oils were evaluated for their inhibitory effects against different types of microorganisms using the agar diffusion technique. The ethanolic extracts as well as the essential oils were tested against two Gram-positive bacterial strains [Bacillus subtilis and Staphylococcus aureus], two Gram-negative bacterial strains [Pseudomonas aeruginosa and Escherichia coli], one yeast strain [Candida albicans] and three fungal strains [Aspergillus fumigatus, Penicillium italicum and Syncephalastrum racemosum]. Furthermore, the previous extracts and essential oils were evaluated for their antioxidant activity using 1, 1-diphenyl- 2-picrylhydrazyl [DPPH] scavenging techaque

Antibody response to hepatitis B immunization in Egyptian children with sickle cell disease

Despite improvement in the safety of blood products, sickle cell disease [SCD] and thalassemic patients are at greater risk than the general population for hepatitis B infection and chronic liver disease, making hepatitis B immunization especially important for this population. This study was conducted to evaluate and follow up the antibody response to hepatitis B vaccination, in patients with SCD, after 1-15 years of vaccination. participants were 30 SCD and 30 thalassemic patients attending the Hematology Department, Children's Hospital, Cairo University as well as 30 ages and sex matched normal controls. They were subjected to clinical evaluation, complete blood count, and measurement of liver transaminases, serum bilirubin, and serum ferritin levels as well as estimation of anti-HBs titer by enzymatic immunoassay. Anti-HBs titers in SCD patients ranged between 5.6 and 381 IU/L [54.83 +/- 15.30], while the levels of thalassemic patients ranged between 16 and 343 IU/L [93.4 +/- 30] and those of the control group ranged from 10 to 523 IU/L [83.4 +/- 28.1] which revealed statistically significant decrease in SCD patients compared to thalassemic and healthy controls [p =0.0317]. Out of the 30 SCD patients, 40% showed anti-HBs titer below 10 IU/L [non-protective titer], while none of the thalassemic patients or the control group revealed the same. Achievement of a protective titer had no correlation with sex, consanguinity, or any of the clinical or laboratory data tested. Immune dysfunction in thalassemia is not playing a major role in response to hepatitis B vaccination. However, SCD children should have their anti- HBs titer measured after routine hepatitis B immunization to ensure that they achieved protective titer, then after 1 year of vaccination and repeated every 5 years and those who do not seroconvert should receive additional doses. Booster HBV vaccination of unprotected SCD patients seems mandatory

Effect of designing and implementing a teaching program for patients undergoing coronary artery bypass graft surgery on their quality of life

Coronary Artery Bypass Graft surgery has become established as a powerful therapy for prolonging survival and improving the quality of life of certain subsets of patients with coronary artery disease. Patient education is a vital component of cardiac rehabilitation. It aims to improve quality of life, ensure continuity of care and promote adherence to health care treatment plans. Aim of the study was of there folds, designing, implementing a teaching program and evaluating its effects on the quality of life of patients with coronary artery bypass graft surgery. A quasi-experimental research design. The research was conducted at the Department of Thoracic and Cardiovascular Surgery, Ain Shams University Specialized Hospital. Sixty patients undergoing coronary artery bypass graft surgery. Patients were divided into two equal groups [the study and control group]. The study group was exposed to the designed patient teaching program and quality of life index scale was measured for both group, pre, immediate postoperative and three months after operation. The study group patients demonstrated total improvement in their quality of life index score [183.5 +/- 68.5] preoperatively to [243.5 +/- 68.3] three months after operative. A highly significant difference was documented between study group quality of life index score [243.5 +/- 68.3] versus [201.4 +/- 54.1] for the control group subjects three months after operative. The patients who participated in the teaching program demonstrated an improvement in their cognition, and practices of self-care and quality of life index score compared with the control group. A further research is recommended to study the effect of patient education program on the cost effectiveness, decreasing hospital readmissions and hospital stays, improving the personal quality of life and minimizes complications of illness and therapies

effect of some avian pox vaccines on the immune response of Turkey vaccinated with fowl cholera

Live attenuated fowl cholera; fowl pox turkeys to fowl cholera vaccine. and pigeon pox vaccines were used to vaccinate turkey in a mutual manner. Six groups of turkeys [20 birds/group] were used. The first group was vaccinated with live attenuated fowl cholera and fowl pox vaccines via the wing web and feather follicle respectively. The second group was vaccinated with fowl cholera and pigeon pox vaccine, while the third group was vaccinated with fowl pox alone. The fourth group was vaccinated with pigeon pox vaccine alone and the fifth group was vaccinated with live attenuated fowl cholera vaccine alone. The sixth group was kept as unvaccinated control. The results of indirect haemagglutination test [IHA] and ELISA revealed a significant increase in Pasteurella multocida antibody titers between group [1], group [2] and group [5]. It could be concluded that the use of the pox vaccines enhance the immune response of vaccinate turkey in a mutual manner

Enhancing nurses' knowledge and awareness about risk management: system design

Risk management is a process that identifies, analyses and treats potential hazards in a hospital. This study in Egypt aimed to enhance nurses, knowledge and awareness about risk management. Baseline knowledge and awareness of 33 nurse managers and 65 staff nurses showed that 35.7% of nurses had adequate knowledge and 50.0% were aware of the current risk management processes at the hospital. A nursing risk management system was designed and a jury group of 30 nursing leaders and 30 physicians validated the system. Implementation of the system through training sessions to raise awareness led to statistically significant improvements in nurses' knowledge, which persisted at follow-up

Vascular endothelial growth factor [Vegf] localization in the mammary gland at various stages of its physiological cycle; a histological and immunohistochemical study

Vascular Endothelial Growth Factor [VEGF] is a potent angiogenic and vascular permeability enhancing factor under both physiological and pathological conditions including tumor angiogenesis. To study the localization and intensity of VEGF in the mammary gland at various stages of its physiological cycle. Mammary glands from sixty female albino rats were divided intosix groups [10 rats each]: Group I nulliparous, group II early pregnancy, group III late pregnancy, group IV lactating, group V early involution and group VI late involution. Human specimens from five females of variable age [childbearing and post-menopausal] were examined. Animal specimens were subjected to histological study while all specimens were subjected to immunohistochemical detection of VEGF. Morphometric analysis was performed for area% and optical density of positive VEGF reaction. VEGF was detected in epithelial lining of ducts and acini, endothelium of blood vessels as well as some stroma cells and macrophages. It was detected in resting nulliparous rat mammary gland with an increase during early pregnancy that became remarkable in late pregnancy and reached its maximum during lactation. Furthermore, VEGF was also detected in milk within lactating mammary acini. During involution, VEGF decreased progressively and reached a minimum in late involution. Human specimens showed stronger VEGF reaction during childbearing period than in post-menopause. The localization of VEGF in the endothelial cells of blood vessels, epithelium of mammary gland ducts and acini as well as some stroma cells and macrophages denoted that it is secreted by those cells. The increased VEGF in pregnancy and lactation indicates that it plays an important role in the development and function of the manunary gland

Comparison between modified rives procedure and bilayer mesh repair in management of large inguinoscrotal hernia and their effect on testicular volume and perfusion

To compare two different techniques in management of inguinoscrotal hernia with destroyed transversalis fascia of myopectineal orifice [Nyhus type III B and IV B and D], modified Rives procedure [MRP] and hilayer mesh repair [BMR] as regard: surgical problems, operative time, postoperative complications, hospital stay, effect on testicular volume [TV] and pcrfusion [TP] and recurrence rate. Patients -were divided into 2 comparable groups as regard age, BMI and type of hernia: I: 29 patients underwent MRP. II: 30 patients underwent BMR, preperitoneal mesh inserted through internal ring and onlay patch. US and CDUS were done to measure TV and peak systolic and end diastolic velocities and accordingly resistive index [RI] measured as indicator of TP. TP on hernial side was compared with healthy side preoperatively and with same side after one year. TV was measured postoperatively after one year. MRP was demanding and difficult especially in patients with BMI >30 and time consuming than BMR [111.24 +/- 16.42/87.8 +/- 15.96 min, P < 0.001]. BMR had less hospital stay [1.5 +/- 0.68/1.96 +/- 0.74 days, P = 0.016] but insignificant low postoperative morbidity than MRP. No recurrence in both groups after 2.42 +/- 1.007 and 2.48 +/- 0.95 y respectively. TP was impaired on hernial side preoperatively in both groups compared with healthy side [RI: 0.68 +/- 0.05 / 0.62 +/- 0.08, P - 0.0025 and 0.69 +/- 0.04 / 0.62 +/- 0.05, P< 0.001 respectively] and improved postoperatively [0.61 +/- 0.007, P < 0.001 and 0.62 +/- 0.07, P < 0.007 respectively]. TV was insignificantly affected [18.62 +/- 2.93 / 17.56 +/- 2.39 cm3, P= 0.762 and 18.38 +/- 2.641 / 16.57 +/- 2.51 cm3, P = 0.158 respectively]. On conclusion, BMR of Nyhus type III B and IV B and D is easier, and less time consuming than MRP. Both techniques are safe on testicles with improvement of TP postoperatively and economic

Prevalence of depression, anxiety and stress as measured by the depression, anxiety, and stress scale [DASS-42] among secondary school girls in Abha, Saudi Arabia

To determine the prevalence of symptoms of depression, anxiety and stress among secondary school girls. A cross- sectional study was carried out on secondary school girls in Abha city, Aseer Region, Saudi Arabia, using the Arabic version of the Depression, Anxiety, and Stress Scale [DASS-42]. Of 545 female students recruited in this study, 73.4% had the symptoms of at least one of the three studied disorders; 50.1% had at least two disorders. The prevalence of symptoms of depression, anxiety and stress was 41.5%, 66.2% and 52.5% respectively. The majority of symptoms were mild to moderate in severity. The scores for depression, anxiety, and stress were positively and significantly correlated. No significant association was found between the girls' sociodemographic characteristics and the scores of the three studied disorders. One of the most important aspects of a primary care physician's care of females is to screen for and treat common mental disorders

randomized comparative study between needle aspirations versus surgical drainage in liver abscess

To compare the therapeutic effectiveness of ultrasound guided needle aspiration versus open surgical drainage in treatment of liver abscess. Between March 2003 and May 2006, 60 consecutive patients with liver abscesses were treated with intravenous antibiotics and randomized in two groups: ultrasound guided intermittent needle aspiration [18G disposable trocar needle]; and open surgical drainage. There was no statistically significant difference between the two groups regarding patient demographics, abscess size and number, the presenting clinical symptoms and laboratory findings. The success rate was 80% in needle aspiration group versus 100% of open surgical group, the number of aspirations required varied from one aspiration [10 patients] up to 3 aspirations in 8 patients. The average time needed for clinical relief and the mean hospital stay for the successful treated patients were similar in both groups. Although both needle aspiration and open surgical drainage are safe methods for treatment of liver abscesses, open surgical drainage is more effective

Wound complications and pro-inflammatory cytokine levels in wound fluid as a result of scalpel versus diathermy dissection

Diathermy [electrocautery] has been postulated as a risk factor for wound complications. This study was conducted to evaluate the effects of diathermy and scalpel dissections on wound complications and local cytokine levels. From Jan. 2007 to Dec. 2007, we recruited 36 patients with operable breast cancer for this study. Those patients undergoing modified radical mastectomy were assigned to flap dissection with either diathermy [n = 18] or scalpel [n = 18]. Blood loss, drain volume and duration, seroma formation and wound complications were recorded. Tumor necrosis factor-alpha [TNF-alpha] and interleukin [IL]- 6 levels were measured in drain fluids at postoperative 24 hours. The diathermy group had significantly reduced blood loss and total drain volume, but increased seroma formation rate. Significantly elevated levels of TNF-alpha were measured in drain fluids of patients with diathermy dissection. The use of diathermy causes less bleeding and total drain output with an increased rate of seroma formation. Diathermy dissection increases pro-inflammatory cytokine response in wound fluid, which may reflect an aggravated inflammation and increased potential for tissue damage

Role of systemic inflammatory response in prognosis and survival after curative resection of colorectal cancer

Some studies have shown that the presence of a systemic inflammatory response, as evidenced by raised circulating concentrations of C. reactive protein [CRP] predicted recurrence and overall survival in patients with colorectal cancer. The aim of this study was to examine the relationship between the inflammatory response and prognosis and survival in patients undergoing potentially curative resection for colorectal cancer. 90 patients considered to have undergone curative resection were studied. Circulating CRP concentration was measured before and after operation. The majority of patients were aged 65 years or more, had colonic tumours and Dukes stage B lesions. 23 patients had raised preoperative value, 11 [47.8%] of them, had raised concentration after operation. 67 patients with a normal preoperative value, 60 [89.5%] of them had normal postoperative value. During follow up, 17 [18.8%] patients developed recurrence and 25 [27. 7%] died. In patients who have undergone potentially curative resection for colorectal cancer the presence of a systemic inflammatory response predicts a poor outcome

Influence of human leucocyte antigen HAL-DRB1 and anti-cyclic citrullinated peptide antibodies on rheumatoid arthritis patients

To determine whether the presence of certain Human Leukocyte Antigen [HLA]-DRB1 locus is associated with production of anti-cyclic citrullinated peptide antibodies [anti-CCPAbs] and to analyze to what extent they are associated with increased susceptibility to and severity of rheumatoid arthritis [RA] in Egyptian population. Twenty nine RA patients were included in a case control study, all gave informed consents and the study was approved by the Ain Shams university ethical committee. Assessment of RA disease activity and severity was done by simplified disease activity index [SDAI] and Larsen scores respectively. Another fifteen age and sex matched subjects were also included as a control group, concentrations of anti-ccPAbs were determined in the sera of all subjects and in the synovial fluid of RA patients. The presence of HLA-DRB1 shared epitope [SE+] alleles were also determined. The alleles most strongly associated with RA susceptibility were HLA-DRB1 [01 and 04] [41.4%]. RA patients with serum anti-ccPAb titres above 60 U/ml had a higher frequency distribution of HLA-DRB1 01 [58.3%] and DRB1 04 alleles [83.3%]. There was significant positive correlation between serum and synovial anti-CCPAb titres, also between serum anti-CCPAb titres and RA disease activity and severity. HLA-DRB 1 SE+alleles [01 and 04] were strongly expressed among Egyptian RA patients. They were associated with the production of anti-CCPAb in high titres which could be involved in the disease process of RA. The presence of anti-CCPAb in high titres was associated with more active and aggressive disease. So, early determination of HLA-DRB 1 SE+alleles and serum anti-CCPAb titre in RA patients could facilitate the prediction of disease course and prognosis at the time of initial presentation