Correlation between serum levels of interleukins 10 and 12 and thrombocytopenia in hepatitis C cirrhotic (class A) patients

Hepatitis C virus (HCV) patients commonly have low platelet counts; however, the exact role of HCV infection in thrombocytopenia is unknown. This work aimed to study the serum levels of interleukins (IL) 10 and 12 in patients with mild and moderate thrombocytopenia associated with chronic hepatitis C infection. Our study included 15 patients with chronic HCV infection and newly diagnosed isolated autoimmune thrombocytopenia (Group I) and 15 patients with chronic HCV infection and normal platelet count as controls (Group II). All patients were examined for personal history and clinical aspects, complete blood count, bone marrow aspiration, liver function tests, HCV antibody assay by ELISA and polymerase chain reaction (PCR), abdominal ultrasound, Helicobacter pylori stool antigen test, evaluation of serum levels of IL-10, IL-12 and platelet specific antibodies. Our results revealed that eight patients from Group l had mild thrombocytopenia and seven patients had moderate thrombocytopenia. Serum IL-10 level was significantly elevated (t = 9.301, p < 0.001) while serum IL-12 showed a significant decrease (t = 6.502, p < 0.001) in Group I compared to the control group. No correlation was detected between platelet counts and the serum levels of either IL-10 [r = 0.454, p = 0.089 (Group I), r = 0.038, p = 0.89 (Group II)] or IL-12 [r = 0.497, p = 0.06 (Group I), r = 0.499, p = 0.058 (Group II)]. However, in Group I, a significant correlation was present only between moderate thrombocytopenia and serum levels of either IL-10 (r = 0.794, p = 0.033) or IL-12 (r = 0.967, p = 0.001), while no correlation was detected between these interleukin parameters and mild thrombocytopenia (r = 0.311 and p = 0.453 for IL-10 and r = -0.08 and p = 0.851 for IL-12). Based on our data, we may conclude that interleukins 10 and 12 are involved in low platelet levels.(AU)

Evaluation of prognostic value of cell adhesion molecules in chronic hepatitis C therapy

The most reliable determination of severity and prognosis in chronic viral hepatitis is the histological staging of the disease, which comprises an invasive procedure and is often not well accepted by patients. The search for alternative non-invasive methods is mandatory especially in follow-ups after initial assessment by biopsy. The aim of this study was to evaluate the role of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) in patients under interferon alpha therapy whether responsive or non-responsive to therapy. Thirty chronic hepatitis C patients (CHC) under combined therapy of interferon-α with ribavirin, whether responsive or non-responsive, were included in the study as well as ten healthy controls. Serum VCAM-1 and ICAM-1 levels were calculated using commercial enzyme linked immunosorbent assay (ELISA) kits. Before the therapy, sICAM-1 and sVCAM-1 levels were significantly higher among CHC patients (96.9 ± 39.74 and 679.4 ± 218.98 ng/mL, respectively) than in the control group (14.3 ± 4.32 and 108.9 ± 49.21 ng/mL, respectively), (p < 0.05 for both). They were higher among non-responsive than in responsive patients. Comparisons in soluble ICAM-1 (sICAM-1) levels of responsive persons during treatment revealed a statistically significant increase at baseline (81.27 ± 25.797) versus its value after one month (52.33 ± 12.76), p < 0.05 and after three months (49.67 ± 14.42), p < 0.05. However, no statistically significant difference was detected between one and three-month sICAM-1 levels post-therapy commencement (p = 0.055). Also, no statistically significant difference was detected between sVCAM-1 levels at baseline (521.47 ± 137.29) versus three months after therapy initiation (517.53 ± 130.6), p = 0.854. The occurrence of a significant decrease in sICAM-1 level as early as one month after therapy in responsive patients only allows us to conclude that sICAM-1 could be used as an early marker in CHC patients under interferon therapy to predict prognosis and guide the treatment, whereas sVCAM-1 does not present any difference between the studied groups.(AU)

Characterization and anti - microbial susceptibility of gram - negative bacteria isolated from bloodstream infections of cancer patients on chemotherapy in Pakistan.

Purpose: Bloodstream infection remains a major cause of morbidity and mortality in patients undergoing treatment for cancer. Severe infections due to Gram-negative bacilli & staphylococci are common in cancer patients. Altered gut flora because of frequent antibiotic administration and damage of epithelial surfaces contribute to the development of infection. To access the use of new potent antibiotics against bloodstream infection in cancer patients and to determine the cross resistance of Gram-negative bacterial strains. Materials and Methods: We studied the bacterial spectrum & antimicrobial susceptibility pattern of cephalosporins, fluoroquinolones, carbapenems and aminoglycosides against Gram-negative bacterial strains in cancer patients. The susceptibility was determined by broth dilution method according to National Committee for Clinical Laboratory Standards (NCCLS) now called Clinical Laboratory Standards Institute (CLSI) during study period (July 2006 to Jan 2007). Results: A total of 60 Gram-negative bacterial blood cultures were examined. Among these, Pseudomonas aeruginosa was the most common (38%). The Minimum Inhibitory Concentration at which 50% (MIC 50 ) and 90% (MIC 90 ) of Enterobacteriaceae and P. aeruginosa inhibited were found. Resistance in P.aeruginosa against cefepime, meropenem, ciprofloxacin, ceftriaxone, tobramycin, cefoperazone and imipenem was 60%, 13%, 80%, 67%, 40%, 90% and 10% respectively while for Enterobacteriaceae 80%, 20%, 88%, 72%, 20%, 90% and four per cent resistance was observed. Meropenem was found to be the most effective antimicrobial against Gram-negative bacteria. Conclusion: High resistance observed in this study warrants the needs of surveillance of resistant pattern of antimicrobial agents. Due to increased level of drug resistance, carbapenem would be a prudent choice in high- risk cases.

Superiority of laparoscopic guided needle biopsy over percutaneous blind needle biopsy in diagnosing hepatocellular carcinoma associated with cirrhosis

This is a retrospective study of 40 patients clinically suspected of having hepatocellular carcinoma. Group I[20] patients underwent laparoscopic Tru-cut needle liver biopsy and Group II [20 patients] underwent percutaneous blind needle liver biopsy. In the first group, in 17[85%] of the patients, the diagnosis of hepatocellular carcinoma was confirmed by histopathology, direct observation of cirrhosis was seen in 8 [40%] patients, histopathology confirmation of cirrhosis was documented in 6[35%] patients. In the second group, 14[70%] of the patients were confirmed to have hepatocellular carcinoma histopathologically and no patients confirmed to have cirrhosis. Both procedures were safe. While ascitic leak from the infraumbilical incision was the only complication encountered in the 1st group, no complications were encountered in the 2nd group. The results support the premise that laparoscopy directed cutting needle biopsy is superior over other techniques in fulfilling all the diagnostic requirements for hepatocellular carcinoma and associated liver cirrhosis which is important for surgical liver resection

Long-term results of gill Vernet procedure for vesica-ureteric reflux

The authors reviewed nine children with 15 refluxing urters who had Gil Vernet procedure at Salmaniya Medical Complex between 1984 and 1987. The follow-up period ranged between 7.5 to 11 years with a mean of 9.3 years. All the ureters stopped refluxing. Three patients presented with dysuria and lower abdominal pain. These three patients had urinary bladder claculi over protruding non-absorbable sutures. Gil Vernet procedure stops vesico-ureteric reflux, but the non-absorbable sutures have the risk of urinary bladder claculus formation. It is recommended to replace the non-absorbable sutures by long lasting inverted buried absorbable sutures

New trends in the management of HIV infection

Undoubtedly there has been good progress in finding some drugs that fight HIV infection. The list of some of these drugs includes: AZT, ddC, ddl, 3TC and Protease inhibitors [e.g. Indinavir, ritanovir, Saquinavir] during the last few years; however the age of antiviral monotherapy for HIV infection is over. Several clinical trials have shown clinical endpoint benefit both in terms of progression and survival using a combination of antiviral agents i.e. there is growing evidence that combination therapy is the way forward in HIV treatment. Triple combination is considered a new therapeutic approach and by applying some advanced Laboratory Investigations e.g. CD 4 count, viral load measurement etc, these techniques can guide the treating doctor to a proper evaluation of the progress of the condition of his patient. Prophylaxis and treatment of the most common opportunistic infections have also added to the benefit for AIDS patients

Analysis of laparoscopic cholecystecomies in 606 patient: Experience at King Fahad hospital, Medina

This is a retrospective study of 606 patients who underwent laparoscopic cholecystectomy at King Fahad Hospital, Medina, Saudi Arabia. The majority of them, 488 [80.5%], were females. Fifty [8.3%] patients presented with acute cholecystitis and 556 [91.7%] were chronic cases. Common bile duct stones were detected in 22 [3.6%] patients. Laparoscopic cholecystectomy was successful in 539 [89%] patients and converted to open cholecystectomy in 67 [11%] patients due to a variety of reasons. The mean operative time was 65.9 minutes. Most of the patients [64.7%] were discharged within 72 hours. There were no deaths in this series. The overall complication rate was 5.6% and the incidence of major ductal injury was 0.8%

Pattern of cancer in Madina Al-Munawara region

This is a retrospective study of 2237 histologically proven cases of cancer over a 12 year period from 1981 to 1993. There were 1687 [75.4%] Saudi and 550 [24.6%] non-Saudi patients. Among both sexes, the most common malignancies were from the gastrointestinal tract [29.3%], lymphoma/leukemia [18.4%], head and neck [8.8%] and breast [8.5%]. The most common malignancies among males were lymphoma / leukemia, hepatoma, skin and stomach. Among females, the order of frequency of malignancy was breast, lymphoma/leukemia, esophagus, colon and thyroid. Comparison with other leading studies of the Kingdom has been made. The most common malignancies were discussed with the possible etiological factors

effect of thiola, piroxicam and diltiazem on the uterine contratility of gamma-irraidated rats

Accidental radfiation exposure raises concern for functional modifications in the uterine physiology. In the current work, total body gamma-irradiation [0.7, 1.4 and 2.1 Gy] of non-pregnant adult female albino rats increased significantly the frequency and amplitude of uterine contractions in-vivo. Administration of Thiola [a sulghydryl containing agent] in doses of 100 or 250 mg/kg, pre-irradiation, or Piroxicam [a potent prostaglandin inhibitor] in a dose of 2 mg/kg, pre- or post-irradiation failed to normalize the changes induced by gamma-irradiation. However, administration of Diltiazem [a Ca+2 channel blocker, 8 mg/kg] pre- or post-irradiation caused significant decrease in the frequency of uterine contractions [21% and 24% respectively] as well as the amplitude of contractions [62% and 39 respectively] in comparison to the uterotonic pattern of gamma-irradiation alone. The results indicate a promising tocolytic activity of Diltiazem against the uterotonic effect of gamma-radiation

Acute appendicitis: a pathological study of 2504 cases at Asir central hospital

Acute appendicitis is one of the most common surgical conditions but very little has been published on appendectomies in Saudi Arabia. In order to determine the pattern of appendiceal diseases and critical evaluation of diagnostic accuracy, we obtained pathological data from 2504 appendectomies performed in Asir region during a period of 20 months [January. 1989 - August, 1990]. The data revealed evidence of inflammation in 2100 [83.9%] specimens. In 338 [13.5%] cases, the inflammatory changes were limited to the lumen or mucosal layer of the appendix. No inflammatory changes were seen in 395 [15.8%] cases. Granulomatous inflammation was present in 9 [0.4%]. Schistosomal infestation was observed in 24 [1%] cases. Enterobius vermicularis [pinworm] was also present in 45 [1.8%] specimens. No significant seasonal variation in the incidence of acute appendicitis was observed

Effect of varying time of lignocaine injection on cardiovascular and sympathoadrenal response to tracheal intubation

A study of the effect of varying the time of a prior dose of IV lignocaine 1.5 mg/Kg on the cardiovascular and catecholamine response to laryngoscopey and endotracheal intubation was carried out on forty ASA patients undergoing abdominal surgery. They were randomly allocated into four equal groups according to the time of administration of lignocine before intubation. Group I: received lignocaine 2 minutes before intubation. Group II: lignocaine was given 3 minutes before intubation. Group III: received lignocaine 5 minutes before intubation. Group IV: no lignocaine was given [control]. For all patients heart rate, systolic blood pressure, diatolic blood pressure, mean arterial pressure and plasma catecholamines were measured before induction and 1, 3 and 5 minutes after intubation. We have found that lignocaine at a dose of 1.5 mg/Kg given intravenously 3 minutes before intubation offered statistically significant attenuation of the increase in all hemodynamic variables and plasma catecholamines compared to other groups

Effect of isoflurane and halothane anesthesia on glucose homeostasis in children

This study included forty children who underwent elective surgical procedures of the lower abdominal, genitourinary, upper and lower exteremities. Their ages ranged from 4-8 years. According to the type of anesthetic and the time of IV glucose loading, they were classified into two equal groups [halothane and isoflurane] who were further included into four equal subgroups. Subgroup A: glucose loading was given immediately after maintenance of anesthesia by isoflurane. Subgroup B: glucose leading was administered just after commencement of surgery under isoflurane anesthesia. Subgroup C: glucose loading was administered just after beginning of surgery under halothane anesthesia. Venous blood samples were taken during fasting and following glucose leading for measurement of plasma glucose, insulin, cortisol and catecholamines. Our results revealed that surgery in children under isoflurane anesthesia produced a significant increase in plasma glucose, catecholamines, cortisol and a significant decrease in plasma insulin than under halothane anesthesia. We concluded that surgery in children under isoflurane anesthesia produced more glucose intolerance than under halothane anesthesia and further attention to the hormonal and metabolic changes in pediatric patients is still needed

interaction of vecuronium with fentanyl and midazolam in rat hemidiaphragm preparation: invitro study

The interaction of vecuronium with fentanyl and midazolam-was studdied to rat phremnerve hemidiaphragm preparation in vitro where the muscle was indirectly stimulated through its nerve with supramaximal impulses at 0.1 H[z] in organ bath solution. The results denote that both fentanyl and midazolam inhibit the twitch tension height that increase with time and dosage, and not antagonized with neostigmine. Also, subeffective inhibitory concentrations of fentanyl or midazolam interact with vecuronium increasing its myoneural blockade in synergistic-not additive-manner. The combinations of vecuronium, fentanyl and midazolam were partially antagonized with neostigmine. Pretreatment of midazolam-vecuronium combination with flumazenil 1.8 ugm1[-1]1 increased the ED50 of vecuronium by 35% [asort of midozolam antagonistic action] compared with the ED50 of vecuronium in presence of midazolam alone

Effect of feeding of artemisia Hebra alba on glucokinase and ATPase activity in normal and diabetic rabbits

Since acute or chronic feeding on extract of the plant herb Artemisia herbal alba [AHA] was shown to reduce fasting blood sugar level in alloxan-diabetic [ALX-D] rabbits without altering plasma insulin or intestinal glucose absorption, the following work was done to show its effect on hepatic glucokinase [GK] and dinitrophenal [DNP]-stimulated mitochondrial ATPase [DSM-A TPase] activities. Diabetes mellitus resulted in a significant decrease in the activity of hepatic glucokinase [GK] [P < 0.05 after 4 weeks] and DSM-ATPase [60% after 12. weeks]. Daily oral treatment with AHA [0.5 p/kg/day] for 16 weeks reduced fasting blood glucose in normal [from 113.8 +/- 11.0 to 80.8 +/- 8.4 mg/Dl] and ALX-D animals [from 385.3 +/- 35.6 to 231.8 +/- 12.5 mg/Dl], and impeded the reduction in activities of [GK] [P < 0.05 after 4 weeks] and ATPase [P < 0.05 after 4 weeks] in ALX-D rabbits when compared with untreated animals. These effects were less than that of insulin, but persisted for I week after AHA withdrawal. Fasting for 72h reduced GK activity in normal animals [from 0.73 +/- 008 to 0.37 +/- 0.04 micro mol/g tissue/min] and diabetic animals [from 0.46 +/- 0.03 to 0.30 +/- 0.03 micro mol/g tissue/min], and this was partially impeded by AHA pretreatment. It is concluded that AHA constituents might have an insulin-like orpotentiating. action which protects KG and ATPase activities in liver and possibly other tissues and help to control the hyperglycaemia of diabetes, but can potentiate the hypoglycaemia of starvation

comparative study of different methods of insulin administration on blood glucose, serum phosphate and potassium in diabetic rabbits

A study employing different methods of insulin administration was done to compare their effects on blood glucose, serum phosphate and potassium levels in altoxan-diabetic rabbits [ALX-D]. Maximum reduction in blood glucose level occurred in 1,2,3, and 4h after intravenous [lV] intraperitoneal [IP], subcutaneous [SC], or eye drops methods, respectively. The maximum reduction in serum phosphate and potassium levels occurred at 1,2h after IV, IP, respectively, and 3h after SC and eye drops methods. The recovery to original normal values was also quicker with IV or IP methods than SC or eye drops methods of administration. It was interesting to note that the magnitude of insulin action did not significantly differ between SC and eye drops method and was comparable to IP or IV methods of administration

Somatostatina en el tratamiento de emergencia de la hemorragia digestiva alta en hipertensos portales / Somatostatin in the emergency treatment of upper digestive hemorrhage in patients with portal hypertension

Durante un período de 2 años se evaluó utilidad de la somatostatina (250 mcg en bolo seguido de 250 mcg/h IV) en 17 episodios de hemorragia por várices esofágicas (VES) y 7 por lesiones agudas de la mucosa gastroduodenal (LAMG) en hipertensos portales diagnosticados por endoscopía de urgencia. Se obtuvo la hemostásia inicial (dentro de las 2 hs.) en el 76% de las VES y el 100% de las LAMG. Tres de los 4 pacientes con VES y los 2 con LAMG que recidivaron la hemorragia durante el tratamiento respondieron al duplicar la dosis de somatostatina. La hemostasia a las 24 hs., fue del 71% para las VES, iniciándose en ese momento la esclerosis endoscópica, y del 100% ára las LAMG. Con las combinación de distintas terapéuticas se controló la hemorragia en 16 de los 17 pacientes com VES (94%). En ningún caso se observaron efectos colaterales adjudicables a la somatostatina. De acuerdo a nuestros hallazgos la somatostatina es una opción terapéutica valiosa en el tratamiento de emergencia de la hemorragia digestiva alta en pacientes con hipertensión portal

Diabetes and adenosine triphosphatase: the effects of insulin, thyroxin and inhibitors on atpase

The enzyme ATPase was obtained from liver mitochondria of normal [N] and alloxan diabetic [D] rabbits. Results of the present study show that diabetes inhibited DNP-stimulated ATPase activity [40%].Insulin had no effect on the enzyme activity in N rabbits, but restored it to normal level in D animals. Thyroxine administered in vivo increased ATPase activity in both N [55%]and D [50%] rabbits. However, thiouracill given orally decreased enzyme activity in N [45%] and in D [32%] rabbits, but the enzyme activity is restored to normal level after treatment with thyroxine. The effect of some inhibitors of adenine nucleotide translocase on ATPase were carried out, it was found that, the enzyme activity is inhibited in N and D rabbits by sulfobromophthalein [I [50]; N = 12,D = 6 n mol/mg protein]; agaric acid [I[50]; N > 40,D = 25 n mol/mg protein]; hexachlorophene, 12 n mol/mg protein inhibited the enzyme activity [47% in N and 28% in D]. However, 2-p-chlorophenyl-4 [3,4-dihydroxy-phenyl]- thiazole is a weak inhibitor