[Association of insulin resistance with alanine aminotransferase activity in patients with nonalcoholic fatty liver disease]

Background: Nonalcoholic fatty liver disease [NAFLD] is a term with a wide spectrum of disorders ranging from simple steatosis to progressive nonalcoholic steatohepatitis [NASH], cirrhosis and hepatocellular carcinoma. Serum alanine aminotransferase [ALT] level is a well-recognized clinical marker of liver injury and may represent a consequence of the proinflammatory process accused in the pathogenesis of NAFLD. Insulin resistance seems to predispose lipid accumulation within the liver and progress to fibrosis in NAFLD

Aim of the study: to investigate the association of insulin resistance with ALT activity in NAFLD patients

Patients and Methods: 50 patients with NAFLD, diagnosed by abdominal ultrasonography, were included in this study. Full history, clinical evaluation, body mass index [BMI], waist circumference and laboratory tests including liver function tests, lipid profile, random blood glucose [RBG] and glycated Hemoglobin [HBA1c] were done. Also, fasting blood glucose and fasting insulin levels were determined for calculation of Homeostasis Model Assessment-Insulin Resistance [HOMA-IR]

Results: Patients were divided into two groups; group I included 28 patients with elevated serum ALT level and group II included 22 patients with normal serum ALT level. There was significant difference between the two groups as regard to prevalence of type 2 diabetes mellitus, elevated RBG level, HbAlc, HOMA-IR and waist circumference but no significant difference between the two groups regarding age, sex, BMI, lipid profile and incidence of hypertension and ischemic heart disease

Conclusion: Our findings suggested that increased ALT activity was associated with insulin resistance in patients with NAFLD

[Prescription of psychotropic drugs in pregnant women]

Taking psychotropic drugs during pregnancy is now a common situation. It confronts the prescriber to the problem of risk-benefit balance. In pregnant women, there is a significant increase in the distribution and excretion of drugs; most of psychotropic medications pass easily the placenta, while the capacity of liver metabolism and renal excretion in the fetus are low. The use of those substances [antidepressants, anxiolytics, mood stabilizers and antipsychotics] is however possible during pregnancy, taking into account the precautions for each class. In the first trimester, the prescription is usually not recommended, especially for mood stabilizers belonging to the family of anticonvulsants. Using the lowest effective dose, of molecules having the more perspective, and reducing dosage, late in pregnancy, is recommended. Finally, parental involvement in decision-making is mandatory

Phytosomal encapsulation of a panax ginseng root extract for increasing its efficacy and safety

Phytosomes are complexes created when an herbal substance is combined with phosphatidylcholine. The new molecule is both water-soluble and fat-soluble, for greater bioavailability and absorption. Panax ginseng root extract is used as a tonic agent or an adaptogen that helps to improve overall health. Several pharmacological effects of P. ginseng has been investigated e.g. improvement of physical and mental performance, immune stimulation, liver protection and regulating glycaemia level. The main active components of P.ginseng are ginsenosides saponins. Ginsenosides Phytosomes were prepared using an aprotic solvent which is methylene chloride. Two types of ginsenosides phytosomes were prepared from L-alpha- phosphatidylcholine obtained from either egg yolk or soybean. Amount of complexed ginsenosides was estimated directly in the complex [phytosomes] using UV-visible recording spectrophotometer. The ratio of complexation between ginsenosides and lipids was 1:3 w/w. Dissolution rate profiles of the two types of phytosomes are nearly the same and they showed more sustained release of ginsenosides compared to the root extract; that can be explained by increased lipophilicity of ginsenosides by lipid complexation; denoting that the biological effect of ginsenosides phytosomes is expected to be maintained for longer time than that for the root extract. Characterization of phytosomes was carried out using Proton Nuclear Magnetic Resonance [[1]HNMR], Carbon Thirteen Nuclear Magnetic Resonance [[13]CNMR], Fourier Transform Infrared spectroscopy [FT-IR] and Differential Scanning Calorimetry [DSC]. All these characterization techniques have provided an evidence of complex formation. Ginsenosides phytosomes prepared using soybean L-alpha- phosphatidylcholine were biologically evaluated for enhancing the immunity against S.mansoni cercariae. Infected mice were divided at random into three groups; one as a control, the other two groups were administered the free drug [P.ginseng root extract] and the complexed drug [ginsenosides phytosomes] orally. Immunological response for the three groups was assessed by Enzyme Linked Immunosorbent Assay [ELISA] and worm and ova count in both liver and intestine. The results proved the promoted biological efficacy for the group administered phytosomes; due to increased lipophilicity of ginsenosides attained by complexation with phospholipids

Evaluation of ketamine as a co-sedation with midazolam and propofol in severe head trauma patients: a non-invasive assessment of cerebral hemodynamics using transcranial doppler ultra sonography

The current study investigates the effect of ketamine bolus injection 3 mg/kg every 6 hours for 48 hours in patients with severe head injury [GCS

Value of duplex ultrasound to investigate whether large volume paracentesis without infusions is safe, easy and economic in selected cirrhotic patients

In tense or refractory asciites, large volume paracentesis [LVP] combined with intravenous infusions has been suggested as the preferable treatment. Flow volume rate [FVR] of portal vein [PV] and Hepatic artery [HA] were measured before and one day after large volume paracentesis [L VP]. 58 cirrhotic patients with ascites were allocated into 2 groups; group [1]: 28 patients were not infused by isotonic fluids, group [2] 30 patients [divided into 3 equal subgroups 2a, 2b and 2c] were infused by different isotonic solutions as follow saline, hemaccel and human albumin respectively. FVR of PV in group 1, 2a, 2b and 2c before LVP were 1894.4+3.3, 1235.5+7.8, 1253.9+19 and 2172+4,2 ml/mm respectively and one day after LVP they were 2207+11,2, 1666+7.4, 1396+29.3 and 1835+8.7 ml/min respectively. FVR of HA in group 1, 2a, 2b and 2c before LVP were 222,7+3.2, 182.3+4.4, 286.4+5.9 and 238,8+4.1 ml/min respectively. FVR of HA in group If 2a, 2b and 2c after LVP were 541.7+4.2, 329.1+2.9, 289,7+1.7 and 284 4+4.2 ml/min respectively, We conclude that FVR was significantly increased after LVP in the majority of the patients; more in patients non infused as compared to infused patients provided we select probably our patients. LVP less than 5 liters without infusions in selected patients are effective, safe, easy and economic. This research was funded by Theodor Bilharz Research Institute [TBRI] and Egyptian Academy of Research and Technology

Diagnostic and clinical significance of Argyrophilic proteins in patients with acute leukemia

The number [amount] of Argyrophilic proteins [AgNORs] were estimated in bone marrow smears of thirty-six patients with acute leukemia at initial diagnosis: 24 children [10 males 14 females] and 12 adults [6 males and 6 females] as well as 12 matched controls. The purpose of the present work was to study the possible relation of AgNORS to immunophenotypic markers and clinical outcome. Silver staining of AgNORS was applied to bone marrow smears, and immunophenotyping was done by FACS flow cytometry. Statistically significant difference in mean AgNORS count/nucleus was observed in patients versus control [p<0.05], and a different staining pattern was observed in acute lymphoblastic leukemia [ALL] [fine dots] versus acute myeloid leukemia [AML] patients [coarse dots]. Positive correlation was found between AgNORS and bone marrow blast percent, while negative correlation was found with age, hemoglobin concentration and platelet count. Strong AgNORS staining was associated with immaturity markers and poor response to treatment. Eighty percent [80%] of AML and 70% of ALL patients with mean AgNORS<2.5 achieved complete remission. Determination of AgNORS has a major predictive value and adds an additional tool to differentiate ALL from AML smear Hence, it should be included in the diagnostic and prognostic workup of patients with acute leukemia

In situ hybrdization of epstein-barr virus encoded RNA [EBER] in aspiration samples in lymphoma

This study aimed at applying a non-isotopic in situ hybridization technique for EBV detection on fine needle aspiration [FNA] samples using the cell print instrument-blue supplied with 15 micro filter. A total of 35 selected FNA from lymph nodes, confirmed on biopsy basis, included 18 Hodgkin's disease, 12 cases of Non-Hodgkin's lymphoma and 5 cases of metastasis from nasopharyngeal carcinoma, used as control. All cases of Hodgkin's disease showed a condensed EBV positivity picked up by all mononucleated and binucleated Reed Sternberg cells, in all the subtypes; sparing other polymorphic reactive cellularity. In Non-Hodgkin's lymphoma cases, 10/12 cases were EBV negative except for insignificant occasional scattered weak positivity picked up by the resulting lymphocytes. The remaining 2 cases gave condensed EBV positivity in few scattered reticulum cells. Retrospective immunohistochemical staining by [CD [15, 20, 43]] for these 2 cases, proved to belong to Hodgkin's disease, lymphocytic predominance of B-cell type. All cases of metastatic nasopharyngeal carcinoma showed a condensed positivity in all the metastatic epithelial cells. The usefulness of applying ISH for EBV on aspirate samples on wider scale is recommended and the possible carcinogenic role of EBV in the evolution of various subtypes of Egyptian Hodgkin's disease is discussed

Immunoelectron microscopic study of Fc gamma receptors on the macrophages and fibronectin in murine hepatic schistosomiasis

This study dealt with the in vivo determination and distribution of Fc gamma receptors on macrophage, and the fibronectin expression by macrophage, in liver granuloma, in the acute [8 weeks] and chronic [20 weeks] stages of Schistosoma mansoni infection in mice. The application of electron microscopic immunoperoxidase technique delineated the location and distribution of Fc gamma receptors on macrophage surface membrane in both acute and chronic immunomodulated granuloma. In the acute granuloma, it revealed an increased density of Fc gamma receptors on macrophage surface denoting its activation. Whereas in chronic granuloma the Fc gamma receptors on macrophage were demonstrated to be less dense. This diminished expression can be taken as a monitor of immunomodulation and is attributed to diminished expression of the receptors on the macrophage surface itself and not only to decrease in number of cells. Immunoelectron labelling of tissue fibronectin displayed intracellular deposition in macrophage, endothelial cells and fibroblast cells in the 8 weeks granuloma. It decreased in the immunomodulated granuloma in correlation with Fc gamma receptors. Thus understanding of the complex interactions between Fc gamma receptors, fibronectin and macrophage may be helpful in attempts to manipulate fibrous tissue deposition in granulomatous lesions

place of laparoscopy in acute abdomen

Laparoscopy offers a simple safe and rapid mean of evaluation and diagnosis of intrabdominal diseases when the indications for laparotomy are equivocal. In this study laparoscopy was employed in 60 patients with acute abdomen. Three categories of patients were included, those with queery acute appendicitis [40 patients], those with blunt abdominal trauma [10 patients] and those with a provisional diagnosis of acute cholecystitis [10 patients]. Laparoscopy was done for every case for diagnosis and proceed accordingly.It was concluded that, laparoscopy is a very useful procedure in managing the patient who complained of acute abdominal pain and indication for laparotomy is equivocal. So the main value of laparoscopy in such cases were either avoiding unnecessary laparotomy or proceeding laparoscopically or ending into laparotomy

Laparoscopic cholecystectomy in elderly patients

Laparoscopic cholecystectomy was done for twenty patients. The results showed that it was a safe technique as the success rate was 95% with no mortality and a complication rate of 15.7%. The complications were: operative bleeding in two cases and bile leakage in one case, all of them were controlled during the procedure. The mean operative time was 82 minutes and the mean length of hospital stay was 2.2 days. Only one patient required conversion of the laparoscopic procedure to laparotomy because he was found to have a carcinoma of the gallbladder during the procedure. The above results are encouraging, however, laparoscopic cholecystectomy should be applied in elderly patients on a wide scale, for better evaluation. Age alone should not be a contraindication to this procedure, as elderly patients should share its benefits of less postoperative pain, hence shorter postoperative bedridden time and lower incidence of respiratory complications, also, less incidence of wound infection and shorter hospital stay

Release profile of niclosamide from mixed elastomers

A new blend of elastomers containing niclosamide, the most potent molluscicide against snail vectors of schistosomiasis, has been prepared and subjected to in vitro release measurements. The blend consists of 70% natural rubber [NR], and 30% styrene butadiene rubber [SBR] with and without certain additives such as a porosigen [ammonium sulfate] and surfactant [sodium lauryl sulfate SLS] in different concentrations. The results revealed that the biocide release obeys a diffusion controlled mechanism with a complex release pattern, in all samples tested. The presence of SBR in NR matrix has markedly increased the NES release rate, while ammonium sulfate or SLS did not increase the release rate in general. This study indicated that mixing selected elastomers is more useful than the use of additives for developing of compositions possessing a required release rate

Duodenogastric reflux before and after simple cholecystectomy in patients with gallstone disease

20 gallstone patients were investigated for the occurrence of duodenogastric reflux [DGR] before and after cholecystectomy and compared their results with 20 control subjects. DGR was found in 35% of the control group compared to 70% of the gallstone patients, and the mean bile acid [BA] concentration in the gastric juice of the control group was 1.86 mu mol/hour compared to 7.93 mu mol/hour for gallstone patients before operation and 26.49 mu mol/hour after cholecystectomy. None of the gallstone patients without DGR developed reflux after cholecystectomy. However, in those with DGR, the reflux increased significantly after cholecystectomy. This may be due to the presence of great amount of BA in the duodenum after cholecystectomy which leads to greater reflux through the previously incompetent pyloric sphincter