ABSTRACT
Bacterial meningitis is associated with disabling sequelae in a significant proportion of patients. It is associated with high mortality, risk of neuropsychological sequelae and risk of cognitive impairment the purpose of this study is to assess cognitive and neurological complications in adult patients with bacterial meningitis. A total of 45 patients with bacterial meningitis and 16 patients with tuberculous meningitis were enrolled. They were subjected to full medical history taking and clinical examination, full neurological examination on admission and discharge. Mini mental state examination [MMSE] and Wechsler memory scale [WMS] were used to assess cognitive function. The results showed that the ischemic brain insult [87.88%] followed by cranial nerves affection [32.42%] were the commonest neurological complication detected on discharge. Cognitive impairment was detected in 53.66% of patients using MMSE.WMS showed that orientation, information and logical memory were the most common affected. Cognitive and neurological complications were not statistically related to age or etiology [P>0.05]. Longer duration until diagnosis [Beta = -.18, p <0.001], presence of intracranial complications [Beta = -.12, p <0.005], need for mechanical ventilation [Beta = -.79, p <0.001] and drug abuse [Beta = -0.11, p < 0.05] were significant predictors of worse outcome assessed by Glasgow outcome score
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Aged , Cognition Disorders , Tuberculosis, Meningeal , NeurologyABSTRACT
Early diagnosis of hepatocellular carcinoma [HCC] is the only hope for cure. Although the role of alpha foetoprotein [AFP] in the diagnosis of advanced HCC is well recognised, at least one-third of cases will be missed unless another diagnostic tool is used. Increased levels of circulating interleukin-18 [IL-18] have been observed in patients with several cancer types and were described in patients with chronic hepatitis. The aim of this study is to assess the role of serum IL-18 level in the diagnosis of hepatitis C virus [HCV]-related HCC. A total of 75 subjects categorised into four groups, including 25 patients with HCV-related HCC and AFP above 200 ng/ml, 25 patients with HCV-related HCC and AFP below 200 ng/ml, 15 patients with HCV-related chronic liver disease and 10 healthy controls, were enrolled. HCC was diagnosed according to guidelines of the American Association for the Study of Liver Diseases. AFP and IL-18 were assessed in all subjects. AFP and IL-18 levels are significantly higher in patients with HCC than in disease control and healthy control subjects. IL-18 level is not correlating with the size or the number of hepatic focal lesions neither with the presence of lymphovascular invasion or abdominal lymphadenopathy. The best cut-off value of IL-18 for the diagnosis of HCC is 500 pg/ml with 84% sensitivity and 86.7% specificity and the area under receiver operating characteristic curve is 0.675. Serum IL-18 level is a suitable marker for the diagnosis of HCV-related HCC complementary to AFP, especially in cases with AFP level less than the diagnostic value
ABSTRACT
Carcinoma of the large bowel is the fourth commonest cancer worldwide. The most frequent site for metastasis is the liver. Overall 30% of patients develop liver metastasis during the course of their illness; of these, 23% to 47% are synchronous lesions. These data are based on western studies. No data are published on patients with colorectal cancer from Egypt. We aimed to assess the incidence of colorectal liver metastasis in Egyptian patients and to evaluate the differences in the clinico-pathological features and tumor behavior in patients with and without liver metastasis. One hundred forty eight patients were prospectively enrolled in the study. Patients were classified into metastatic group [n=78] and non metastatic group [n=70]. In the two groups macroscopic features compared including: tumor size [2 cm, 2-5 cm, and >5 cm], site of primary tumor, side of liver involved, clinical symptoms and liver profile. Carcinoembryonic antigen [CEA] and cancer antigen [CA19.9] levels were recorded. At microscopy, tumor differentiation, invasion and nodal status were evaluated. No difference was found in the distribution of the primary site and size of the tumor. Jaundice, hepatomegaly and ascites were significantly higher in patients with liver metastases. Patients with liver metastasis had higher levels of CEA, CA19.9, higher frequency of vascular invasion and nodal involvement