Faecal calprotectin: correlation with endoscopic and histological gradings of disease activity in ulcerative colitis

Calprotectin is an abundant neutrophil protein which is extremely stable in feces. It is excreted in excess amount in feces during inflammatory bowel disease. This work aimed to study the relationship between faecal calprotectin concentrations and endscopic as well as histological gradings of disease activity in patients with ulcerative colitis [UC]. This study comprised 25 patients, who were confirmed to have UC by colonscopy and histological examination of colonic biopsies, in addition to 10 apparently healthy individuals as controls. Complete blood picture, C-reactive protein [CRP], erythrocytic sedimentation rate[ESR] and stool analysis were done for all studied individuals. In addition, faecal calprotectin was measured by using enzyme-linked immunosorbant assay [ELISA]. Colonoscopy was done for patients only and the severity of inflammation was assessed macroscopically and histologically by using the standard scoring systems. Patients were divided into patients with active UC and patients with no/low disease activity. Faecal calprotectin concentration was significantly higher in patients with UC [p<0.001] than in controls. Also, its levels were significantly higher in patients with active disease than in those with no/low activity [p<0.001]. Moreover faecal calprotectin concentrations increased significantly with the progression of both endoscopic and histological gradings of disease activity. Faecal calprotectin level was significantly higher in patients with active pancolitis than in those with left sided colitis or proctitis [p=0.003]. There was a significant positive correlation between both endoscopic as well as histological gradings of disease activity and faecal calprotectin. Also, faecal calprotectin significantly correlated with extent of the disease but there was no significant correlation with the clinical activity index, hemoglobin level, platelets count, leucocytic count, CRP and ESR. At cut-off value of 110mg/l faecal calprotectin detected active UC with a sensitivity of 93.3% and a specificity of 100% with a diagnostic accuracy of 96%. It was concluded that, faecal calprotectin level could be used as a non invasive marker of disease activity in patients with UC and it has the potential to reduce the number of invasive investigations performed in these patients

Rapid detection of C. albicans by using polymerase chain reaction in patients with acute leukaemia

Fungal infection is one of the most dangerous complications that affect leukemic patients under chemotherapy. For this reason it is extremely important to evaluate and treat febrile patients with acute leukemia properly. This study is carried out to highlight the usefulness of polymerase chain reaction [PCR] for the rapid and sensitive diagnosis of systemic Candidiasis compared to the conventional method of culture based identification of Candida albicans [C. albicans]. This study comprised 60 subjects: 40 acute leukemia patients [17 AML, 23 ALL] under chemotherapy suffering from fever episodes resistant to three days broad spectrum antibiotics, and 20 age-matched normal volunteers. All study members were subjected to complete blood count [CBC] and examination of biological [urine, oropharyngeal, vaginal] and blood samples for any microbial growth. The conventional cultures were clone for detection of C. albicans colonization on sabouraud dextrose agar media. Further identification was done by Germ tube test, chlamydospore production and characteristic sugar assimilation and fermentation tests. Detection of C. albicans DNA in blood samples was clone by PCR via single pair of primers designed in order to detect six out of seven secreted aspartic proteinase [SAP] genes. The patients group was further classified according to the exposure to risk factors and isolation of C. albicans from biological samples, and/.].- blood samples into two subgroups: low risk subgroup comprised 28 patients, 19 of them are free of C. albicans and 9 patients with C.albicans separated from one anatomical site, and high risk subgroup which comprised 12 patients hospitalized for 2 or more weeks, with fever for more than 3 days not responding to broad spectrum antibiotics. The results of the present study revealed that the patient group showed significant reduction in the total leucocytic count, red blood cell count, hemoglobin concentration, platelet count and absolute neutrophil count compared to the control group [P<0.001]. In low risk subgroup patients revealed negative results for isolation of C. albicans from blood samples by blood culture or by PCR for detection of C. albicans DNA in blood samples. Among the high risk subgroup C. albicans was; isolated by conventional culture method front only 2 out of 12 blood samples [16.7%] while 7 out of 12 [58.3%] blood samples were positive for C. albicans by PCR, this difference were of significant statistical difference [P<0.05]. There was significant statistical association between PCR positive results for C. albicans and severe neutropenia among leukemic patients P<0.05]. No significant statistical relation was found between PCR positive results for C.albicans and type of leukemia or duration of chemotherapy was detected. In conclusion These results indicate the potential value of PCR as rapid and sensitive technique for detecting C.albicans in blood sample, and for identifying patients at risk for invasive Candidiasis and starting treatment in the critical time

Effect of alfa-fetoprotein on monocytes expression of CD86 and secretion of tumour necrosis factor-alpha in patients with hepatocellular carcinoma

Hepatocellular carcinoma [HCC] constitutes a major health problem in Egypt due to the high prevalence of Hepatitis C virus [HCV]. Alfa-fetoprotein [AFP] is a tumour-associated antigen [Ag], and its serum level is elevated in patients with HCC. In vitro, AFP induces functional impairment of monocytes cells. This was demonstrated by the down-regulation of CD86 and tumour necrosis factor-a [TNF-alpha]. This study aimed to evaluate the effect of AFP level on monocytes function as a source of TNF-alpha and the expression of surface co-stimulatory molecule CD86 in patients with histopathologically proven HCC. This study comprised 23 patients. They were classified into group I [comprised 13 patients with AFP level >200 ng/ml] and group II [comprised 10 patients with API level<200ng/m1] in addition 10 cirrhotic patients with AFP level <200 ng/ml [group III] and 10 apparantely healthy individuals as a control group [group IV] were also included in this work. Serum AFP, CD86 and TNF-alpha were measured in all subjects using Enzyme Immunoassay [EIA], flow cytometery and Enzyme Linked Immunosorbent Assay [ELISA] respectively. CD86 and TNF-alpha were significantly reduced in patients of group I than those of groups II, III and IV [P<0.001]. Serum AFP level had a significant negative correlation with TNF-alpha level and CD86 expression in patients with HCC. On the other hand liver transaminases and total bilirubin level were significantly increased in groups I, II and III when compared to control group IV. The percent of patients infected with HCV was significantly higher in patients groups [I, II, III] when compared to control group while there was no significant difference between them as regard the percent of HBV infection. Serum albumin level in patients groups was significantly decreased when compared with control group. It can be concluded that AFP markedly impairs the function of monocytes, in addition, the ability of antigen presenting cells [APCS] of patients with HCC and high level of serum AFP to produce proinflammatory cytokines is reduced. Although the number of patients in this study was small, it provides a new insight into understanding the mechanisms underlying the suppression of immune recognition of tumour in patients with HCC. Further studies are needed to correlate these finding, with the clinical outcome of patients with HCC