ABSTRACT
We aimed to assess autoimmune pancreatic beta-cell dysfunction in Egyptian patients with chronic hepatitis C infection and to evaluate the impact of IFN-alpha therapy on the induction of pancreatic autoantibodies or insulin dependent diabetes mellitus [IDDM] in these patients. Diagnosis of chronic non cirrhotic hepatitis C in 108 patients was based on full clinical examination, liver function tests, hepatitis markers and liver biopsy. The HCV RNA was quantitatively assessed and the histopathological grading of the disease was based on the Ishak modified histological activity index [HAI]. Assessment of autoimmune pancreatic beta-cell dysfunction in patients with chronic hepatitis C before at the end of INF-alpha therapy and 6 months after its cessation was carried out by determination of serum levels of insulin autoantibodies [IAA] and islet cell autoantibodies [ICA]. Data demonstrate a statistically significant increase [p < 0.05] in positive serum IAA titers in patients with chronic hepatitis C both at the end of IFN-alpha therapy and 6 months after its cessation compared to titers before therapy [10% and 9%, respectively, vs. 4% of the cases]. IDDM and ICA, however, did not develop in these patients during IFN-alpha therapy. These findings suggest that IN-alpha therapy may be implicated in IAA induction in patients with chronic hepatitis C. and the phenomenon was not reversible 6 months after cessation of treatment. Whereas, the development of positive serum IAA titers in patients with chronic hepatitis C correlated significantly [p <0.001] with the presence of positive family history of DM in these patients, it did not correlate [p > 0.05] with sex, liver function test, viral load, HAI score or response to IFN-alpha therapy. We concluded that IFN-alpha therapy increase the susceptibility of patients with non cirrhotic chronic hepatitis C to develop positive IAA titers probably by provoking autoimmune disorders in these patients without induction of ICA or IDDM. Data also suggest that the increase in incidence of positive IAA titers may be used as a sensitive factor for the development of manifest IDDM in such patients
ABSTRACT
The present retrospective study aimed to determine the safety and efficacy of using butyl cyanoacrylate to control bleeding from gastric fundal varices. A total of 249 patients presented with bleeding from fundal varices underwent endoscopic injection of cyanoacrylate for hemostasis. Indications for treatment included chronic liver disease and portal hypertension, hematemesis and/or melena and gastric fundal varices at index endoscopy showing active bleeding or an overlying clot with no endoscopic evidences of bleeding from other sources. Injection therapy was administered as the first active measure. Cyanoacrylate was mixed with lipiodol [1:1] and injected strictly intravariceal through a Teflon injection device. The study concluded that cyanoacrylate injection to control gastric fundal variceal bleeding has been found to be remarkably safe and highly effective. An experienced team is always required