CXCLIO, CCL5 and CCL11 chemokines as predictors for interferon-induced thyroiditis in chronic hepatitis c patients submitted for

Background: Interferon alpha [IFN-q is widely used as a therapeutic agent for Hepatitis C [HCV] infections. Chemokines (including CXCLIO, CCL5 and CCLll] have been identified to play an important role in endocrine autoimmune diseases and particular attention has been raised by studies demonstrating CXC chemokines over expression in Hashimoto thyroiditis. Objective: Study serum levels of CXCLIO, CCL5, and CCLll chemokines as predictors for interfer on-induced thyroiditis in HCV patients submitted for antiviral therapy. Patients and Methods: Seventy two patients with HCV Infection selected from 100 patients submitted for INF-alpha and ribavirin therapy were recruited into; group 1 comprised 59 patients with negative anti-thyroid peroxidase antibodies [ATPO], group 2 comprised 13 patients with positive ATPO, Twenty healthy adults were included as control Thyroid function, auto-antibodies and serum chemokines [CXCLIO, CCL5, and CCLll, assayed by a quantitative sandwich immunoassay] were performed before therapy, after 12 and 24 weeks of treatment. Results: In comparison to group 1, group 2 patients had significantly higher ANA [P=0.03S], ATPO, CXCLIO and CCL5 [all P= 0.000] and significantly lower TSH [P=0.30] before therapy; higher ATPO, CCL5 [all P= 0.001] and lower TSH [P= 0.034] after 12 weeks; higher ATPO and lower TSH [all P= 0.001] after 24 weeks of therapy. Thyroiditis occurred in 10.2 % of group 1 and 38.5 % of group 2 patients after 12 weeks of therapy without significant difference between the two groups. After 24 weeks of therapy, group 2 patients had significantly higher number of thyroiditis [53.8 %] than group 1 [11.9 %] [P=0.001]. Significant increase of CXCLIO was found in patients with thyroiditis [P<0.05] at the end of therapy. Conclusion: As HCV infection might contributes to the initiation of thyroid autoimmunity and interferon induced thyroiditis is a frequent complication of IFN-a therapy, HCV infected patients could be subjected to thyroid screening by utilizing some chemokines as CXCLIO, CCL5 in addition to ATPO for identification of those who are prone to thyroiditis during IFN-a therapy?

Clinical relevance of serum vascular endothelial growth factor and interleukin-6 in patients with colorectal cancer

Some biological factors play a role in stimulation of malignant growth, metastasis and angiogenesis; however, their clinical relevance has not yet been well established for most of them. This work was aimed at studying the clinical relevance of serum vascular endothelial growth factor [VEGF] and interleukin-6 [IL-6], in patients with colorectal cancer [CRC]. Preoperative serum levels of VEGF and IL-6 were measured by enzyme-linked immuno-assay in 35 CRC patients and in 30 healthy controls. CRC patients with or without metastasis had significantly higher VEGF and IL-6 levels than healthy controls [all P <0.001]. Patients with advanced clinical stage had significantly higher levels of VEGF and IL-6 than those with early clinical stage [all P <0.001]. Also, patients with metastatic disease had significantly higher VEGF and IL-6levels than those with localized disease [all P<0.001]. The diagnostic accuracy for invasiveness was 83% for VEGF [cut off value = 240 pg/ml] and 66% for IL-6 [cut off value = 6.7 pg/ml], with sensitivity 79% and 74% and specificity 68% and 59%, respectively. In CRC patients, preoperative measurement of serum VEGF and IL-6 may prove useful non-invasive diagnostic indicators associated with advanced clinical stage and tumor metastasis that warrants further investigations

Anorectal dysfunctions in diabetic autonomic neuropathy and microangiopathy

Disturbed motility may explain gastrointestinal symptoms of patients with diabetic neuropathy. This study investigates the anorectal dysfunctions in diabetic autonomic neuropathy [DAN] and microangiopathy. The study includes 47 diabetic patients [group 1: 30 non-complicated; group 2: 17 complicated by DAN and microangiopathy] and 10 healthy non-diabetic volunteers as control subjects. Following medical history, clinical examination and laboratory investigations, the included patients were subjected to sigmoidoscopy with mucosal biopsy and anorectal manometry. The lower gastrointestinal symptoms [e.g., constipation, diarrhoea or faecal incontinence] were reported more in group 2 [complicated diabetic patients] than in group 1 [non-complicated diabetic patients] [p=0.003]. Group 2 patients had significantly higher fasting blood glucose, serum uric acid, serum creatinine and triglycerides than group 1 patients [p=0.001, 0.03, 0.04,<0.001, respectively]. Overall, diabetic patients had lower resting anal pressure [p=0.004], squeeze pressure [p=0.007], and higher thresholds of minimal rectal sensation and sense of desire for defaecation [all p<0.001] when compared to control subjects. Group 2 patients had lower resting anal pressure [p<0.001], squeeze pressure [p=0.02], and higher thresholds of minimal rectal sensation [p<0.001], sense of desire for defaecation [p=0.009] and maximum tolerable volume [p=0.002] than group 1 patients. Group 2b [patients with DAN and microaniopathy] had significantly lower resting anal pressure than group 2a [patients with DAN] [p=0.001]. Anorectal dysfunctions occur in diabetic patients particularly when complicated by autonomic neuropathy and microangiopathy

Oesophageal dysmotility in diabetic patients with varices

Complications involving the gastrointestinal tract are important causes of morbidity in cirrhotic patients with diabetes mellitus. Our aim was to study the possible influences of varices on oesophageal motility in diabetic patients. A total of 40 diabetic patients were recruited into two groups: group 1:19 patients without varices; group 2: 21 patients with varices. Twenty healthy volunteers were selected as control. Oesophageal manometry was performed for patients and control subjects. In comparison to control subjects, group 1 had lower residual pressure with incomplete relaxation of the lower oesophageal sphincter [LES] [p

Protective immunity after hepatitis B vaccination

The purpose of this study was to evaluate the long term maintenance of antibody levels in adult healthcare workers and in children [with or without diabetes] after a three-dose regimen of HB vaccine and the ability to boost antibody levels with re-immunization. This study was conducted on 131 individuals including: an Adult group [67] comprising 52 HB vaccinated adult health care workers and 15 unvaccinated adult heath care workers as a control group; and a Children group [64] of 44 non-diabetic and 20 diabetic children. Following proper history and clinical examination, all serum specimens were tested for HBsAg, anti-HBs, anti-HBc and HCV antibodies. The longer the time lapse since the last dose of HB vaccine in both adult health care workers and non-diabetic children, the lower the seroprotection rate [lower mean Anti-HBs levels] [P = 0.006, 0.004 respectively]. Significantly increased Anti-HBs levels were found after booster dose vaccination of either children or adult health care workers [all P < 0.001 for both] and 97.22% of serongative children; 100% of the seronegative adults turned seropositive. HB vaccine could be highly protective against HBV infection as evidenced by the absence of hepatitis B infection in the vaccinated groups. The longer the time lapse after vaccination, the lower is the seroprotection rate and the lower the mean Anti-HBs, but with persistence of an effective immunological memory in vaccinees. HB vaccine boosting could be advised for high risk subjects including adult health care workers and diabetic children at five year intervals

Ulcerative colitis patients requiring liver biopsy for detection of hepatobiliary abnormalities

There has been conflicting evidence to both support and refute the rationale of liver biopsy as a gold standard for diagnosis of existing disease of the liver in patients with ulcerative colitis [UC]. A trial to Identify UC patients in whom liver biopsy could be justified for detection of hepatobiliary abnormalities. The study included 60 patients with established diagnosis of UC based on clinical, laboratory, radiological, colonoscopic and histopathological characteristics. Following medical history, clinical examination and laboratory investigations, assessment of the liver was done using abdominal ultrasound scan. Liver biopsy and histopathological examination was performed for patients having sonographic hepatic affection with raised transaminases. Group 1 included 26 patients with sonographic hepatobiliary abnormalities [group 1a; 11 patients with elevated transaminases and group 1b; 15 patients with normal transaminases]. Group 2 included 34 patients without sonographic hepatobiliary changes. 75% of the studied UC patients had moderate-to-severe disease activity. Group 1 patients had more severe UC disease activity than group 2 [P= 0.018]. Duration of ulcerative colitis disease was longer and abdominal tenderness and hepatomegaly were significantly more in group 1 than group 2 patients [P= P=0.0001, 0.006 and 0.000 respectively]. ALP, ALT and AST levels were significantly higher in group 1 than group 2 patients [P = 0.007, 0.004 and 0.0001 respectively]. Serum bilirubin, ALP, AST and ALT were significantly higher in group la than group 1b patients [P = 0.026, 0.021, 0.001, and 0.001, respectively]. The pathology results of liver biopsies in group la patients proved small duct "PSC" in one patient, nonspecific reactive hepatitis in 4 patients and liver steatosis in 6 patients. Minor abnormalities in liver tissue are common in UC patients particularly in presence of sonographic and biochemical evidence of liver disease and liver biopsy could be justified in this subset of patients

Anorectal functions in schistosomal colitis

Schistosomiasis is a common disorder in Egypt and is associated with significant disability and health care costs. Over many decades, epidemiological, physiological, and socio-economic data have emerged to improve our understanding of this disorder and its prophylaxis and treatment. The objectives of this work were to study the sensory and motor functions of the rectum and anal canal in patients with schistosomal colitis, and its possible impacts on the clinical presentation of those patients. The study was conducted on 60 male patients with intestinal schistosomiasis diagnosed by stool analysis, Sigmoidoscopy and mucosal biopsy. Twenty healthy male volunteers were also studied as control. All patients and control were subjected to thorough history taking, clinical examination, and a series of investigations [laboratory, radiological, sigmoidoscopy with mucosal biopsy, and anorectal manometry. In comparison to control subjects, patients with schistosomal colitis as a whole had lower thresholds of all rectal sensations [P<0.01], asymptomatic patients with schistosomal colitis had lower thresholds of first rectal sensation [P<0.05] and maximum tolerable volume [P=0.02]. On the other hand, symptomatic patients with schistosomal colitis had lower thresholds of all rectal sensations [P<0.001] than control, and had lower thresholds of first rectal sensation [P<0.05], sense of desire for defecation [P<0.01], and maximum tolerable volume [P<0.02] when compared to asymptomatic patients

Conclusion: because altered rectal perception is present in almost all patients with schistosomal colitis, and perception thresholds vary according to the patient's symptomatology, the identified abnormalities in rectal response may prove useful in furthering our understanding of the pathophysiology of symptoms in those patients. Thus, it is a matter of altered sensation of the gut, which, may be a predictor for symptomatization rather than the magnitude of pathological impact