ABSTRACT
Background and study aims: Central nervous system [CNS] involvement in hepatitis C virus [HCV] infection has different facets such as anxiety, depression, cognitive impairment and vasculitis. We were interested in detecting subclinical CNS involvement in chronic HCV infected subjects with and without systemic vasculitis
Patients and methods: Nineteen patients [15 females and 4 males] with chronic HCV infection [mean age 46.5 +/- 7 and mean duration since diagnosis of HCV infection 4.7 +/- 4 years, including 6 [32%] Child-Pugh class A cirrhotic patients] and 30 age, sex and education matched healthy control subjects were studied. Thirteen patients had associated vasculitis. Patients and control subjects were assessed using the block design and comprehension subtests of Wechsler Bellevue Adult Intelligence Scale, Wechsler Memory scale [WMS], Beck Anxiety Inventory [BAI] and Beck Depression Inventory [BDI]. Brain HMPAO Single Photon Emission Computed Tomography [SPECT] was performed for HCV patients
Results: Patients with HCV had lower scores on the block design test compared to control subjects [8.37 +/- 1.89 versus 10.37 +/- 1.47, p < 0.001], lower total WMS scores [43.15 +/- 10.49 versus 60.27 +/- 8.08, p < 0.001] and higher anxiety and depression scores [16.94 +/- 10.46 and 37.17 +/- 10.38 versus 10.3 +/- 4.67 and 28.9 +/- 5.99, p = 0.004 and 0.001, respectively]. Total WMS were lower in HCV patients with vasculitis compared to those without vasculitis [39.14 +/- 9.3 versus 51.17 +/- 8.3, p = 0.019] while the block design and comprehension tests, BAI and BDI were not significantly different between both groups. The block design and comprehension tests, WMS, BAI and BDI were not significantly different between cirrhotic and non-cirrhotic patients. Seven patients had different patterns of cerebral hypoperfusion on SPECT, and all of them had associated vasculitis. Abnormal SPECT was associated with lower total WMS scores [35.87 +/- 10.8 versus 46.79 +/- 8.6 in those with normal SPECT, p = 0.049]
Conclusions: Vasculitis may contribute to the development of neuropsychiatric involvement in HCV patients
ABSTRACT
Prognosis of Systemic sclerosis largely depends on involvement of internal organs. Kidney affection has the worst prognosis and highest mortality rate. Aim was to evaluate renal impairment in patients with systemic sclerosis by measuring the Glomerular filtration rate and then calculating the GFR using the Cockcroft and Gault formula and the Modification of Diet in Renal Disease equation [MDRD] formula and test the accuracy of these formulae. The study included 31 scleroderma patients [27 females, 4 males] recruited from the Rheumatology and Rehabilitation Department, Cairo University hospitals, mean age 43.25 +/- 11.28 years, 16 had limited systemic sclerosis, 12 diffuse systemic sclerosis and 3 had overlap syndrome. Therty-one age and sex matched healthy controls were included. Estimation of disease severity was done using disease severity index. GFR was measured using TC99mDTPA. The modified Cockcroft and Gault formula and equation 7 from the Modification of Diet in Renal Disease [MDRD] were used. A measured GFR within normal [>89ml/min] was found in 14 patients [45.1%] with normal kidney function and serum creatinine. Reduced GFR was reported in 17 patients [54.9%], it ranged from 60-89ml/min with mild renal impairment in 10 patients [32.3%], and ranged from 30-59ml/min showing moderate functional impairment in 7 patients [22.6%], none of our patients had severe renal impairment according to the Gates method for measuring the GFR. The formulae used succeeded to detect reduction of GFR in 35.29% of those affected using the Cockcroft-Gault and in 41.17% of those affected using the MDRD. A positive correlation was found between MDRD and measured GFR, furthermore, the decline in the GFR didn't show any correlation with disease severity. A positive correlation was also reported between the presence of renal involvement and pulmonary vascular involvement in the group under study p=0.04. Measurement of the GFR using Gates method showed reduction of the GFR in 54.9% of the SSc patients under study. Serum creatinine was an insensitive tool for evaluating renal functional impairment. The formulae used weren't as precise as the measured GFR in diagnosing all cases with subclinical renal involvement in the studied population. Patients with systemic sclerosis should be screened for renal involvement irrespective of disease severity or duration